Patent Description:
Furthermore, from <CIT>, which constitutes prior art under Art. <NUM>(<NUM>) EPC, there is known an adhesion promotion device configured for use with a surgical stapler in an anastomosis procedure, the device comprising:.

In a medical field, a medical procedure (for example, anastomosis for a digestive tract) of joining biological organs to each other by performing a surgical operation is known. In a case where the medical procedure as described above is performed, as a prognosis determinant after surgery, a fact is important that there is no delay in adhesion in a joint portion joined between the biological organs.

In the medical procedure of joining the biological organs, various methods and various medical instruments are used. For example, a method of suturing the biological organs by using a biodegradable suture, or a method of using a mechanical joining device (refer to PTL <NUM>) for suturing the biological organs by using a stapler has been proposed. In particular, in a case where anastomosis is performed by using the mechanical joining device, compared to a method of using the suture, a joining force between the biological organs can be improved in the joint portion. Accordingly, risk factors of an anastomotic leakage can be reduced.

However, a progress degree of the adhesion in the joint portion depends on a state of biological tissues in a joint object site (joint target site) of a patient. Therefore, for example, even in a case where the joining device as disclosed in PTL <NUM> is used, depending on the state of the biological tissues of the patient, there is a possibility that the risk factors of the anastomotic leakage cannot be sufficiently reduced.

Therefore, the present invention aims to provide an adhesion promotion device capable of reducing risk factors of an anastomotic leakage after a surgical operation is performed. Solution to Problem.

According to an embodiment of the present invention, there is provided an adhesion promotion device according to independent claim <NUM>. The dependent claims relate to advantageous embodiments.

According to the adhesion promotion device of the present invention, the main body portion is pinched between the biological organs serving as the joint object. In this manner, it is possible to promote adhesion of the biological tissue of the biological organ. In addition, the second region is configured to be separated from the first region in the direction intersecting with the surface direction of the first region. Accordingly, the adhesion promotion device is disposed to cover a suture portion formed by performing purse-string suture on the biological organ. Therefore, the main body portion can be suppressed from falling out of the biological organ. According to the above-described configurations, the operator can effectively reduce risk factors of an anastomotic leakage of the biological organs. Brief Description of Drawings.

In describing the drawings, the same reference numerals will be assigned to the same elements, and repeated description will be omitted. In addition, dimensional ratios in the drawings may be exaggerated for convenience of description, and may be different from actual ratios in some cases.

<FIG> are views for describing a configuration of an adhesion promotion device <NUM> according to an embodiment of the present invention.

As illustrated in <FIG>, the adhesion promotion device <NUM> is applicable to a medical procedure (for example, anastomosis for a digestive tract) in which predetermined biological organs are joined to each other. As will be described later, in describing the present specification, the large intestine anastomosis will be described as an example of the medical procedure of using the adhesion promotion device <NUM>.

As illustrated in <FIG>, the adhesion promotion device <NUM> has a main body portion <NUM> disposed between the biological organs serving as a joint object.

The main body portion <NUM> is formed in a sheet shape that promotes adhesion of a biological tissue. For example, the main body portion <NUM> can be formed of a biodegradable sheet member (thin film-shaped member). The main body portion <NUM> has a substantially circular shape. However, a shape of the main body portion <NUM> is not particularly limited, and may be an elliptical shape or a polygonal shape (rectangular shape or triangular shape), for example.

As illustrated in <FIG>, the main body portion <NUM> has a first region <NUM> provided outward in a radial direction of the main body portion <NUM>, a second region <NUM> provided inward of the first region <NUM>, and an connect portion <NUM> that connects the first region <NUM> and the second region <NUM> with each other. The first region <NUM>, the second region <NUM>, and the connect portion <NUM> are configured to be integral and continuous with each other.

The first region <NUM> is formed in a substantially circular shape when viewed from above. A plurality of through-holes 11A are formed in the first region <NUM>.

As will be described later, the first region <NUM> is joined to the biological tissue by a joining device <NUM> including a first engagement instrument <NUM> disposed in one joint target site of the biological organ, and a second engagement instrument <NUM> disposed in the other joint target site of the biological organs and facing the first engagement instrument <NUM> (refer to <FIG>).

The second region <NUM> is formed in a substantially circular shape when viewed from above. A plurality of through-holes 12A are formed in the second region <NUM>.

As illustrated in <FIG>, a hole portion <NUM> is formed in the vicinity of the center of the second region <NUM>. The hole portion <NUM> may be formed in advance in the main body portion <NUM>, or may be prepared by an operator while a medical procedure is performed.

As illustrated in <FIG>, the second region <NUM> is configured to be separated from the first region <NUM> in a direction intersecting with a surface direction of the first region <NUM> (upward direction in <FIG>).

The connect portion <NUM> is formed in a substantially circular shape when viewed from above. A plurality of through-holes 13A are formed in the connect portion <NUM>.

As illustrated in <FIG>, the connect portion <NUM> has a cross-sectional shape which is narrowed from the first region <NUM> side to the second region <NUM> side. The connect portion <NUM> is formed in a tapered shape in this way. Accordingly, in a step illustrated in <FIG> (to be described later), the first region <NUM>, the second region <NUM>, and the connect portion <NUM> can be preferably brought into contact with the biological organ (mouth side A1 of a large intestine).

The main body portion <NUM> is configured in this way. Accordingly, an accommodation portion <NUM> is formed below the second region <NUM> and the connect portion <NUM>. The accommodation portion <NUM> accommodates a suture portion A11 formed by performing purse-string suture on the biological organ (to be described later).

It is preferable that a size E3 of the accommodation portion <NUM> (corresponding to a length along the surface direction of the second region <NUM> and the connect portion <NUM>, refer to <FIG>) is located inward of a region E1 where the first engagement instrument <NUM> and the second engagement instrument <NUM> of the joining device <NUM> illustrated in <FIG> face and overlap each other across the main body portion <NUM>.

The accommodation portion <NUM> is configured in this way. Accordingly, when the adhesion promotion device <NUM> is punched, the second region <NUM> and the connect portion <NUM> can be punched by the joining device <NUM>, and only the first regions <NUM> of the main body portion <NUM> is disposed between the pair of biological organs. Therefore, the pair of biological organs can be preferably joined to each other.

As illustrated in <FIG>, the plurality of through-holes 11A, 12A, and 13A are regularly and periodically provided in the surface direction. However, the plurality of through-holes 11A, 12A, and 13A may be randomly provided in the surface direction.

The plurality of through-holes 11A, 12A, and 13A have substantially the same shape as each other. Therefore, a configuration of the through-hole 11A will be described herein as a representative with reference to <FIG>.

As illustrated in <FIG>, the through-hole 11A extends substantially perpendicularly between the front surface <NUM> and the rear surface <NUM> along the thickness direction (upward-downward direction in <FIG>) of the main body portion <NUM>. The through-hole 11A may be bent or curved in a zigzag manner between the front surface <NUM> and the rear surface <NUM>, in a cross section taken along the thickness direction of the main body portion <NUM>.

The through-hole 11A has a substantially circular planar shape (shape when the first region <NUM> of the main body portion <NUM> is viewed in a plan view). However, a shape of the through-hole 11A is not particularly limited, and may be an elliptical shape or a polygonal shape (rectangular shape or triangular shape), for example. In addition, each of the through-holes 11A, 12A, and 13A may have a different planar shape or cross-sectional shape.

A thickness T (refer to <FIG>) of the main body portion <NUM> (first region <NUM>, second region <NUM>, and connect portion <NUM>) is not particularly limited. However, the thickness is preferably <NUM> to <NUM>, and is more preferably <NUM> to <NUM>. In a case where the thickness of the main body portion <NUM> is <NUM> or larger (particularly in a case where the thickness is <NUM> or larger), the main body portion <NUM> can be provided with strength to such an extent that the main body portion <NUM> is not damaged when the adhesion promotion device <NUM> is handled. On the other hand, in a case where the thickness of the main body portion <NUM> is <NUM> or smaller (particularly when the thickness is <NUM> or smaller), the main body portion <NUM> can be provided with sufficient flexibility to follow the biological tissue after the main body portion <NUM> closely adheres to the biological tissue to which the main body portion <NUM> is applied.

It is preferable that the main body portion <NUM> has a ratio value of hole diameter D (distance D illustrated in <FIG>) of the through-hole 11A with respect to a pitch P (distance P illustrated in <FIG> and a distance between the through-holes 11A adjacent to each other) of the through-holes 11A is <NUM> or greater and smaller than <NUM>. In a case where the planar shape of the through-hole 11A is a perfect circle, the hole diameter D of the through-hole 11A is equal to a diameter of the perfect circle. On the other hand, in a case where the planar shape of the through-hole 11A is not the perfect circle, the diameter of the perfect circle (diameter corresponding to a circle) having an area the same as an area of an opening portion (portion facing the front surface <NUM> or the rear surface <NUM> in the through-hole 11A) of the through-hole 11A can be defined as the hole diameter D of the through-hole 11A.

The main body portion <NUM> has the plurality of through-holes 11A, 12A, and 13A. Accordingly, a plurality of values exist in the hole diameter D corresponding to each of the through-holes 11A, 12A, and 13A. Therefore, in calculating the above-described ratio value, an arithmetic mean value of two or more values of the hole diameter D corresponding to each of the plurality of the through-hole 11A, 12A, and 13A is used as a representative value of the hole diameter D. On the other hand, the pitch P of the plurality of through-holes 11A, 12A, and 13A is defined by a shortest distance between the opening portions of the two through-holes 11A, 12A, and 13A. However, with regard to the value of the pitch P, a plurality of values exist in the pitch P corresponding to a combination of the through-holes 11A, 12A, and 13A adjacent to each other. Therefore, in calculating the above-described ratio value, the arithmetic mean value of two or more values of the pitch P corresponding to each combination of the through-holes 11A, 12A, and 13A adjacent to each other is used as the representative value of the pitch P.

The pitch P, the hole diameter D, and the ratio of the hole diameter D with respect to the pitch P of the through-holes 11A, 12A, and 13A are examples, and the configuration is not limited thereto.

The main body portion <NUM> can be formed of a biodegradable material. A material of forming the main body portion <NUM> is not particularly limited, and includes a biodegradable resin, for example. For example, as the biodegradable resin, it is possible to use known degradable (co)polymers disclosed in <CIT>, <CIT>, Pamphlet of International Publication No. <CIT>, or <CIT>. Specifically, the biodegradable resin includes (<NUM>) a polymer selected from a group consisting of aliphatic polyester, polyester, polyacid anhydride, polyorthoester, polycarbonate, polyphosphazene, polyphosphate ester, polyvinyl alcohol, polypeptide, polysaccharide, protein, and cellulose, and (<NUM>) a copolymer formed of one or more monomers forming (<NUM>) described above. That is, it is preferable that the biodegradable sheet includes at least one type of the biodegradable resin selected from the group consisting of the polymer selected from the group consisting of aliphatic polyester, polyester, polyacid anhydride, polyorthoester, polycarbonate, polyphosphazene, polyphosphate ester, polyvinyl alcohol, polypeptide, polysaccharide, protein, and cellulose, and the copolymer formed of one or more monomers forming the polymer.

A method for manufacturing the main body portion <NUM> is not particularly limited. For example, the following method may be adopted. A fiber formed of the above-described biodegradable resin is prepared, and a mesh-shaped sheet is manufactured by using the fiber. The sheet is shaped to form the first region <NUM>, the second region <NUM>, and the connect portion <NUM>. The method for preparing the fiber formed of the biodegradable resin is not particularly limited. For example, the method includes an electrospinning method (electrospinning method and electrostatic spinning method) and a melt blow method. For the main body portion <NUM>, only one of the above-described methods may be selected and used, or two or more of the above-described methods may be selected and appropriately combined with each other. As another example of the method for manufacturing the main body portion <NUM>, the biodegradable sheet according to the present invention may be manufactured by spinning the fiber formed of the above-described biodegradable resin in accordance with a usual method in the related art and knitting the obtained fiber into a mesh shape.

The main body portion <NUM> induces a biological reaction by a forming material such as the biodegradable resin forming the main body portion <NUM>. The main body portion <NUM> induces expression of a biological component such as fibrin by the action. The biological component induced in this way can promote the adhesion by being accumulated to penetrate the through-holes 11A, 12A, and 13A of the main body portion <NUM>. Therefore, the main body portion <NUM> is disposed between the biological organs serving as the joint object. In this manner, the adhesion is promoted by the above-described mechanism.

A material of the main body portion <NUM> may not be biodegradable as long as the adhesion of the biological organ can be promoted. In addition, the main body portion <NUM> may not have the through-holes 11A, 12A, and 13A regardless of the material, as long as the adhesion of the biological organ can be promoted.

As described above, the adhesion promotion device <NUM> according to the present embodiment has the main body portion <NUM> disposed between the biological organs serving as the joint object. The main body portion <NUM> has the sheet-shaped first region <NUM> disposed between one joint target site and the other joint target site of the biological organs to promote the adhesion of the biological tissue, the second region <NUM> disposed inward of the first region <NUM> and separated from the first region <NUM> in the direction intersecting with the surface direction of the first region <NUM>, and the connect portion <NUM> that connects the first region <NUM> and the second region <NUM> with each other. According to the adhesion promotion device <NUM> configured in this way, the adhesion of the biological tissue of the biological organ can be promoted by pinching the main body portion <NUM> between the biological organs serving as the joint object. In addition, the second region <NUM> is configured to be separated from the first region <NUM> in the direction intersecting with the surface direction of the first region <NUM>. Accordingly, the adhesion promotion device <NUM> is disposed to cover the suture portion A11 formed by performing purse-string suture on the biological organ. Therefore, the main body portion <NUM> can be suppressed from falling out of the biological organ. According to the above-described configurations, the operator can effectively reduce risk factors of an anastomotic leakage of the biological organ. Furthermore, the adhesion promotion device <NUM> can be prevented from unintentionally interfering with the mouth side A1 of the large intestine. Accordingly, the adhesion promotion device <NUM> can be preferably disposed on the mouth side A1 of the large intestine.

In addition, the connect portion <NUM> has the cross-sectional shape which is narrowed from the first region <NUM> side toward the second region <NUM> side. According to the adhesion promotion device <NUM> configured in this way, as described above, the first region <NUM>, the second region <NUM>, and the connect portion <NUM> can be preferably brought into contact with the biological organ.

In addition, the first region <NUM> is joined to the biological tissue by the joining device <NUM> including the first engagement instrument <NUM> disposed in one joint target site of the biological organ, and the second engagement instrument <NUM> disposed in the other joint target site of the biological organs and facing the first engagement instrument <NUM>. The connect portion <NUM> and the second region <NUM> are located inward of the region where the first engagement instrument <NUM> and the second engagement instrument <NUM> face and overlap each other across the main body portion <NUM> when the main body portion <NUM> is joined to the biological tissue by the first engagement instrument <NUM> and the second engagement instrument <NUM>. According to the adhesion promotion device <NUM> configured in this way, the joining device <NUM> can reliably punch the second region <NUM> and the connect portion <NUM> when the adhesion promotion device <NUM> is punched. Only the first region <NUM> of the main body portion <NUM> is disposed between the pair of biological organs. Therefore, the pair of biological organs can be preferably joined to each other.

In addition, when the main body portion <NUM> is joined to the biological tissue by the first engagement instrument <NUM> and the second engagement instrument <NUM>, the outer edge of the first region <NUM> is located outward of the region where the first engagement instrument <NUM> and the second engagement instrument <NUM> face and overlap each other across the main body portion <NUM>. According to the adhesion promotion device <NUM> configured in this way, when the adhesion promotion device <NUM> is punched, the joining device <NUM> can reliably dispose the first region <NUM> between the pair of biological organs.

Hitherto, the adhesion promotion device <NUM> has been described with reference to the embodiment. However, the present invention is not limited to the description of the above-described embodiment, and various modifications can be made within the scope not departing from the concept. Hereinafter, modification examples of the adhesion promotion device will be described. In describing the modification examples, configurations and contents which are described above in the adhesion promotion device <NUM> according to the above-described embodiment will be appropriately omitted in the description.

A configuration of an adhesion promotion device <NUM> according to Modification Example <NUM> will be described with reference to <FIG> is a view corresponding to <FIG> of the adhesion promotion device <NUM> according to Modification Example <NUM>.

As illustrated in <FIG>, the adhesion promotion device <NUM> according to Modification Example <NUM> has a main body portion <NUM> disposed between the biological organs serving as the joint object.

As illustrated in <FIG>, the main body portion <NUM> has the first region <NUM> provided outward in the radial direction of the main body portion <NUM>, the second region <NUM> provided inward of the first region <NUM>, and an connect portion <NUM> that connects the first region <NUM> and the second region <NUM> with each other. The first region <NUM> and the second region <NUM> have configurations the same as those of the first region <NUM> and the second region <NUM> of the adhesion promotion device <NUM> according to the above-described embodiment, and thus, description thereof will be omitted.

As illustrated in <FIG>, the connect portion <NUM> has a cross-sectional shape which is widened from the first region <NUM> side toward the second region <NUM> side. The connect portion <NUM> is formed in a tapered shape in this way. Accordingly, in a step illustrated in <FIG> (to be described later), the first region <NUM>, the second region <NUM>, and the connect portion <NUM> can be preferably brought into contact with the biological organ.

Next, a configuration of an adhesion promotion device <NUM> according to Modification Example <NUM> will be described with reference to <FIG> is a view corresponding to <FIG> of the adhesion promotion device <NUM> according to Modification Example <NUM>.

As illustrated in <FIG>, the connect portion <NUM> has a cross-sectional shape orthogonal to the surface direction of the first region <NUM>. According to the adhesion promotion device <NUM> configured in this way, the second region <NUM> is configured to be separated from the first region <NUM> in the direction intersecting with the surface direction of the first region <NUM>. Accordingly, the adhesion promotion device <NUM> is configured to cover the suture portion A11 formed by performing purse-string suture on the biological organ. Therefore, the main body portion <NUM> can be suppressed from falling out of the biological organ.

Next, a treatment method of using the adhesion promotion device will be described.

<FIG> is a flowchart illustrating each procedure of the treatment method of using the adhesion promotion device.

The treatment method includes disposing the adhesion promotion device including the sheet-shaped main body portion that promotes the adhesion of the biological tissue between one joint target site and the other joint target site of the joint object of the biological organ (S11), and joining one joint target site and the other joint target site to each other in a state where at least a portion of the main body portion of the adhesion promotion device is disposed between one joint target site and the other joint target site (S12).

The biological organs joined by using the treatment method and the joint target site in the biological organs are not particularly limited, and can be selected in any desired manner. However, in the following description, large intestine anastomosis will be described as an example. In addition, as the adhesion promotion device used in each medical procedure described below, for example, any desired device can be selected from the above-described adhesion promotion devices. However, in the following description, as a representative example that can be suitably used for each medical procedure, an application example of the adhesion promotion device <NUM> according to the embodiment illustrated in <FIG> will be described. In addition, in each medical procedure described below, detailed description of a known medical procedure or a known joining device will be appropriately omitted.

Hereinafter, in the description in the present specification, "disposing the adhesion promotion device between the biological organs" means at least any one of disposing the adhesion promotion device in a state of being in direct or indirect contact with the biological organs, disposing the adhesion promotion device in a state where a spatial gap is formed between the adhesion promotion device and the biological organs, and disposing the adhesion promotion device in both the states (for example, disposing the adhesion promotion device in a state where the adhesion promotion device is in contact with one biological organ and the adhesion promotion device is not in contact with the other biological organ). In addition, in the description in the present specification, a "periphery" does not define a strict range (region), and means a predetermined range (region) as long as a treatment purpose (joining the biological organs to each other) can be achieved. In addition, as long as the treatment purpose can be achieved, in the medical procedure described in each treatment method, orders can be appropriately switched thereamong. In addition, in the description in the present specification, "moving the portions to be relatively closer to each other" means both moving two or more objects to be closer to each other, and moving only one to be closer to the other one.

<FIG> is a flowchart illustrating a procedure of a treatment method (large intestine anastomosis), and <FIG> are views for describing the large intestine anastomosis.

In the treatment method, the biological organ serving as the joint object is a large intestine cut due to excision of a cancer tumor. Specifically, the biological organs serving as the joint object are a mouth side A1 of the cut large intestine and an anal side A2 of the cut large intestine. In the following description, a procedure will be described in which a mouth portion periphery (one joint target site) on the mouth side A1 of the cut large intestine and a portion (other joint target site) of an intestinal wall on the anal side A2 of the cut large intestine are joined to each other.

As illustrated in <FIG>, the treatment method includes disposing the adhesion promotion device <NUM> between the mouth portion periphery of the large intestine and the intestinal wall of the large intestine (S101), moving the mouth portion periphery of the large intestine and the intestinal wall of the large intestine to be relatively closer to each other (S102), pinching the main body portion <NUM> of the adhesion promotion device <NUM> between the mouth portion periphery of the large intestine and the intestinal wall of the large intestine (S103), joining the mouth portion periphery of the large intestine and the intestinal wall of the large intestine to each other in a state where the main body portion <NUM> of the adhesion promotion device <NUM> is pinched therebetween (S104), and causing the main body portion <NUM> of the adhesion promotion device <NUM> to indwell between the mouth portion periphery of the large intestine and the intestinal wall of the large intestine (S105).

Next, the treatment method will be described in detail with reference to <FIG>.

As illustrated in <FIG>, the operator inserts the first engagement instrument <NUM> of the joining device <NUM> into the mouth side A1 of the large intestine. In addition, the operator disposes the second engagement instrument <NUM> of the joining device <NUM> on the anal side A2 of the large intestine. Before the second engagement instrument <NUM> is disposed on the anal side A2 of the large intestine, the operator forms a through-hole A21 for inserting the second engagement instrument <NUM> of the joining device <NUM> into the anal side A2 of the large intestine. A timing at which the through-hole A21 is formed is not particularly limited as long as the timing is before the second engagement instrument <NUM> is disposed.

For example, as the joining device <NUM>, a known device used for the large intestine anastomosis can be used. For example, the first engagement instrument <NUM> and the second engagement instrument <NUM> which configure the joining device <NUM> include anvils and trocars. As the first engagement instrument <NUM> and the second engagement instrument <NUM> engage with each other, the joining device <NUM> excises the biological tissue disposed between the first engagement instrument <NUM> and the second engagement instrument <NUM>, and sutures a periphery of the excised biological tissue into a circumferential shape by using a stapler. For example, the first engagement instrument <NUM> is an instrument including a cylindrical engagement target portion <NUM>. For example, the second engagement instrument <NUM> is an instrument including an engagement pin <NUM> to engage with and to be inserted into the engagement target portion <NUM> of the first engagement instrument <NUM>.

As illustrated in <FIG>, the operator inserts the engagement target portion <NUM> of the first engagement instrument <NUM> into the mouth side A1 of the large intestine, and performs purse-string suture in a projecting state of the engagement target portion <NUM>, thereby forming the suture portion A11. An outer surface of the suture portion A11 has a shape partially projecting to a projection side due to the suture.

Next, as illustrated in <FIG>, the operator disposes the adhesion promotion device <NUM> between the mouth side A1 of the large intestine and the anal side A2 of the large intestine. In this case, the adhesion promotion device <NUM> is configured to include the first region <NUM>, the second region <NUM>, and the connect portion <NUM>. Accordingly, the adhesion promotion device <NUM> is disposed to cover the suture portion A11 partially projecting due to the suture. Then, the operator causes the engagement target portion <NUM> included in the first engagement instrument <NUM> to pass through the hole portion <NUM> of the main body portion <NUM>. Therefore, while the operator performs the medical procedure, the operator can prevent the adhesion promotion device <NUM> from falling out of the mouth side A1 of the large intestine. Furthermore, the adhesion promotion device <NUM> can be prevented from unintentionally interfering with the mouth side A1 of the large intestine. Accordingly, the adhesion promotion device <NUM> can be preferably disposed on the mouth side A1 of the large intestine.

Next, as illustrated in <FIG>, the operator engages the first engagement instrument <NUM> and the second engagement instrument <NUM> with each other by moving both of these to be relatively closer to each other. The operator pinches the mouth portion periphery on the mouth side A1 of the large intestine, the main body portion <NUM> of the adhesion promotion device <NUM>, and the periphery of the through-hole A21 formed on the intestinal wall on the anal side A2 of the large intestine, between the first engagement instrument <NUM> and the second engagement instrument <NUM>. The operator causes the joining device <NUM> to excise a portion on the mouth side A1 of the large intestine, a portion of the main body portion <NUM> of the adhesion promotion device <NUM>, and a portion on the anal side A2 of the large intestine pinched between the first engagement instrument <NUM> and the second engagement instrument <NUM>. In addition, at the same time, the operator operates the joining device <NUM> to join the peripheries of the excised site by using a stapler (not illustrated).

Next, as illustrated in <FIG>, the operator removes the joining device <NUM> outward of the living body from the anal side A2 of the large intestine via an anus, for example. Here, in the medical procedure, the joining device <NUM> punches each configuration member pinched by the joining device <NUM> by using a punching blade (not illustrated) incorporated in the first engagement instrument <NUM> or the second engagement instrument <NUM>. Therefore, the region E2 where the biological organ joined by the joining device <NUM> is punched is located inward of the region E1 where the first engagement instrument <NUM> and the second engagement instrument <NUM> face and overlap each other across the main body portion <NUM>.

Claim 1:
An adhesion promotion device (<NUM>, <NUM>, <NUM>) configured for use with a surgical stapler in an anastomosis procedure, the device comprising:
a main body portion (<NUM>, <NUM>, <NUM>) configured to be disposed between biological organs and configured to serve as a joint object,
wherein the main body portion (<NUM>, <NUM>, <NUM>) has a sheet-shaped first region (<NUM>) which is formed in a substantially circular shape configured to be disposed between one joint target site and another joint target site of the biological organs to promote adhesion of a biological tissue,
a second region (<NUM>) which is formed in a substantially circular shape provided inward of the first region (<NUM>) and separated from the first region (<NUM>) in a direction intersecting with a surface direction of the first region (<NUM>), and
a connecting portion (<NUM>, <NUM>, <NUM>) that connects the first region (<NUM>) and the second region (<NUM>) with each other, wherein the second region (<NUM>) and the connecting portion (<NUM>, <NUM>, <NUM>) form an accommodation portion (<NUM>), the accommodation portion (<NUM>) being configured to accommodate a suture portion of the biological organs,
a plurality of through-holes (11A) are formed in the first region (<NUM>), wherein the second region is substantially parallel to the first region, and
wherein a plurality of through holes (11A) are formed in the second region.