Stapler for mucosectomy

The present invention relates to a stapler used in mucosal resection of a tubular organ, and more particularly to a stapler in which a groove is provided in a central rod so that more mucosal tissue can be accurately resected.

Mucosal resection is the best surgery for the treatment of hemorrhoids, rectal hernias, and leaked rectal mucosa. Ring-shaped staplers are already known, and some, such as a decomposable ring, have both a function of binding a mucous membrane by a staple and a function of compressing the mucous membrane. A rod is provided at the center of such a stapler. In mucosal resection, it is necessary to pull the mucosa of the tubular organ into the stapler and remove as much mucosa as possible.

In order to achieve such an object, the annular stapler disclosed in Patent Document 1 (US6102271) has its head portion fitted with two goblet-shaped outer shells and an interpolator (sliding in the axial direction). It is composed of a goblet-shaped outer shell body and an interpolated body, and hereinafter referred to as a goblet-shaped fitting body when both are represented). Two through holes are provided on the outer surface near the tube shaft (stem: part near the handle) of this goblet-shaped outer shell, and the thread that is purse-sewn on the mucous membrane is passed through these through holes to the outside of the goblet-shaped body. Is issued. By pulling this thread toward the outside of the goblet-shaped outer shell, the mucous membrane as far as it enters the body is pulled in. The mucous membrane inside the body is cut by an annular blade provided at the tip of the goblet-shaped interpolator. When the central shaft with an anvil (cylindrical pedestal of staple) attached to the tip is moved, the anvil approaches the tip of the goblet-shaped outer shell, and the mucous membrane can be cut and bound with a suture staple at the same time. However, the stapler disclosed in Patent Document 1 has a drawback that the mucous membrane cannot be accurately excised by a uniform control method because the suture is pulled manually.

<p><patcit num="1"><text>US6102271</text></patcit></p>

An object of the present invention is to provide a stapler for mucosal resection that does not have such drawbacks. The main feature of this purpose is the first claim (a goblet-shaped outer shell having a central shaft hole (5) in which a rod (6) is slidably inserted into the head portion and a slidable outer shell. In a stapler for mucosal resection including at least a goblet-shaped fitting body (1, 2) composed of an interpolated body to be fitted, one or more ring-shaped grooves (11) are axially formed on the outer peripheral surface of the rod (6). The groove (11) is configured to accommodate the mucous membrane (9a) of the part where the stapler is sutured around the rod (6)). Achieved by the stapler described in detail. Other features will be described in the second and subsequent claims.

In order to achieve the above object, the stapler of the present invention is provided with a central rod, and one or more ring-shaped grooves are formed on the outer peripheral surface thereof in the outer peripheral direction orthogonal to the rod axis. When the thread is sewn around the groove so that the mucosal tissue is stored in this groove, the sewn part of the squeeze does not slide on the rod even if the central rod is pulled into the goblet-shaped interpolated tube shaft. .. The shape of the grooves should be properly designed and their spacing should be tightly defined so that the amount of tubular mucosal tissue that is drawn into the goblet-like interpolator when the rod is pulled can be controlled uniformly.

Another advantage of the stapler according to the present invention is that the amount of mucous membrane to be excised can be accurately adjusted by simply selecting a specific ring-shaped groove from a plurality of ring-shaped grooves formed by adjusting the position on the rod.

Further features and advantages of the stapler according to the invention will be understood by those skilled in the art from two embodiments described in detail below with reference to the drawings. The following examples are not described for the purpose of limiting.

<figref num="1">In the first embodiment of the stapler according to the present invention, it is a partially cutaway side view in a state where the head portion is in an open position.</figref><figref num="2">FIG. 5 is a vertical cross-sectional view showing a state in which the head portion of the stapler shown in FIG. 1 is partially cut by a hollow tubular introduction member and inserted into the illustrated tubular organ.</figref><figref num="3">It is a vertical cross-sectional view which shows the state which the head part of the stapler inserted into the inside of a tubular organ through a hollow tubular introduction member is in a closed position.</figref><figref num="4">It is a partial cutout side view of the head part in the state which the 2nd Embodiment of the stapler by this invention is in an open position.</figref><figref num="5">It is an unequal angle projection (bird's-eye view) showing a state in which the head portion of the stapler shown in FIG. 4 inserted into a tubular organ through a hollow tubular introduction member is in a closed position, with a part of the tubular organ cut out. ..</figref><figref num="6">It is sectional drawing in the longitudinal direction of the head part of the stapler shown in FIG.</figref>

FIGS. 1 and 2 show the head portion of the stapler, which has a goblet-shaped outer shell body 1 having a first hollow tube shaft portion 1a and a goblet-shaped outer shell body 1 coaxially and slidably inserted inside the goblet-shaped outer shell body 1. It has an interpolation body 2. The goblet-shaped interpolator 2 is smaller (height) than the goblet-shaped outer shell 1. An annular blade 3 is attached to the tip of the goblet-shaped interpolation body 2, and at a position where the goblet-shaped interpolation body 2 is retracted to the inner part of the outer shell body 1, the annular blade 3 is the tip portion of the goblet-shaped outer shell body 1. It is stored in the outer shell 1 without protruding from 4. A second hollow tube shaft portion 2a provided with a central shaft hole 5 into which the rod 6 is slidably inserted is provided at the end of the goblet-shaped interpolation body 2 opposite to the annular blade 3. The rod 6 is configured so that the anvil 8 is attached to the end portion 7 on the side opposite to the sliding portion of the central shaft hole 5. In the head portion of the stapler shown, the hollow tube shaft portion 1a of the goblet-shaped outer shell 1 is connected to a handle (not shown) by a known method. A known rod pulling means (not shown) is provided on the handle of the stapler, and when the rod 6 is gradually pulled into the central shaft hole 5 of the second pipe shaft portion 2a by the means, the anvil 8 and the annular blade 3 gradually move. Approach. In this way, the head portion of the stapler is closed and the mucosa is excised. The annular blade 3 is advanced to excise the mucosa by a blade moving means (not shown) known to those skilled in the art provided on the handle of the stapler. The end 4 of the goblet-shaped outer shell 2 may be provided with a storage portion 4a for accommodating a sewing means such as a metal staple. In FIG. 2, the stapler head portion is inserted into the tubular organ 9 in the open position through a hollow tubular introduction member 10 provided with flanges 10a and 10b.

In the present invention, one or more ring-shaped grooves 11 are provided on the outer peripheral surface of the rod 6 at intervals in the axial direction. The ring-shaped groove 11 is provided so that the mucous membrane 9a of the tubular organ 9 that has been purse-sewn with a thread (not shown) is housed in the groove. By adjusting the number of ring-shaped grooves 11 and their intervals, fixing portions for purse-string stitching can be provided at various positions on the outer peripheral surface of the rod. Therefore, even if the amount to be excised is different, the maximum amount of mucous membrane can be excised accordingly.

The depth of the ring-shaped groove 11 of the rod 6 is 0.5 mm to 3 mm, preferably about 1 mm. The cross section of the rod 6 is preferably circular in cross section, but may be polygonal.

Each of the ring-shaped grooves 11 has a cylindrical groove portion 12 having a diameter smaller than that of the outer peripheral surface of the rod 6, and an inclined surface (fillet surface) 13 connecting the cylindrical groove portion 12 and the outer peripheral surface of the rod. It is composed of. The outer diameter difference between the circumferential groove portion 12 and the outer peripheral surface of the rod 6 (height difference of the inclined surface 13) is preferably about 1 mm (1 ± 0.1 mm).

When performing mucosal resection with the stapler according to the present invention, first, the leaked portion of the mucosa 9a to be excised in the tubular organ 9 is sutured with a drawstring purse. Then, the head portion of the stapler in the open position is inserted into the tubular organ 9. That is, the anvil 8 is passed through the drawstring suture portion with the anvil 8 and the end portion 4 of the goblet-shaped outer shell 1 separated from each other. In this way, the mucous membrane is sewn with a purse around the rod 6 of the portion sandwiched between the end 4 of the goblet-shaped outer shell 1 and the anvil 8. When the purse-string suture portion of the mucous membrane 9a is positioned at the portion of the ring-shaped groove 11 of the rod 6, the purse-string suture portion does not slide on the rod 6 and shift, so that the purse-string suture portion can be fixed in a fixed position. In order to accurately excise a large amount of mucosa with a uniform control method, one of a plurality of ring-shaped grooves 11 provided in the rod 6 is selected by adjusting the mutual spacing.

As shown in FIG. 3, when the rod 6 is pulled into the central shaft hole 5 provided in the tube shaft portion 2a of the goblet-shaped interpolation body 2, the stapler head portion closes and the mucous membrane of the excised portion becomes a goblet-shaped outer shell body. Upon entering 1, the mucosa to be excised is pressed by the anvil 8 against the end 4 of the goblet-like outer shell 1.

After closing the head portion of the stapler by the rod pulling means, the mucous membrane of the end 4 of the goblet-shaped outer shell 1 is joined by the joining means 14. As such a joining means 14, for example, a metal staple or the like is preferable. By moving the goblet-shaped interpolation 2 and the annular blade 3 provided at the end thereof in the direction of the anvil 8 using an appropriate moving means, the mucous membrane and the joining means 14 that have entered the goblet-shaped interpolation 2 are used. Separate from the mucosa of the tubular organ 9 joined by. And finally, the head part of the stapler is pulled out from the tubular organ 9.

FIGS. 4, 5 and 6 illustrate the second embodiment of the present invention in which the disassembly type compression device is applied to the head portion of the stapler. In this embodiment, the anvil 8'supports the main component 14' of the compression means. This component 14'has a configuration in which when the head portion of the stapler is closed, it is complementaryly connected to the mutual complementary portions 14'' and 14'''provided at the end portion 4 of the goblet-shaped outer shell body 1.

During mucosal resection, the tubular organ 9 is preferably kept open by the hollow tubular introduction member 10 as shown in FIGS. 2, 3, 5, and 6.

Hereinafter, an embodiment of the stapler according to the present invention will be described, but the convenience of providing the rod 6 with a plurality of ring-shaped grooves 11 will be described, and the distance and excision between the anvils 8 and 8'and the groove 11 will be described. It is only explained to emphasize that the relationship between the amount of mucosa to be treated is constant, and is not intended to be limited.

In a stapler equipped with an annular blade 3 having a diameter of 24 mm and a rod 6 having a diameter of 5 mm, the rod 6 is formed with a ring-shaped groove 11 having a depth of 1 mm, and the diameter of the rod 6 at the portion of the groove 11 is 3 mm. ..

For example, when the ring-shaped groove 11 is placed at the connecting portion between the rod 6 and the anvils 8 and 8', a 21 mm mucous membrane can be excised by suturing with a purse in this groove 11. This is twice the length from the annular blade 3 to the ring groove 11, that is, the radius of the annular blade 3 of 12 mm minus the radius of the rod 6 in the groove 11.

In order to excise a larger amount of mucosa, it is preferable to provide ring-shaped grooves 11 at three locations of 10 mm, 20 mm, and 30 mm from the anvils 8 and 8', respectively. The resectable mucosal lengths in these grooves are approximately 29 mm, 45 mm and 63.5 mm, respectively. As shown in FIGS. 3 and 6, if the grooves 11 are provided at intervals from the anvils 8 and 8', the goblet-shaped interpolation body is formed when the rod 6 is pulled toward the tube shaft portion 2a of the goblet-shaped interpolation body 2. A large amount of mucous membrane can be drawn into 2. The longer the length from the annular blade 3 to the ring-shaped groove 11 to which the mucous membrane 9a is sewn with a purse, the larger the amount of mucous membrane drawn. Thus, it is clear that the stapler of the present invention can be used for faster, more accurate and safer surgery.