U.S. patent application number 10/341762 was filed with the patent office on 2003-07-31 for medical ligating apparatus.
This patent application is currently assigned to OLYMPUS OPTICAL CO., LTD.. Invention is credited to Kawashima, Koichi, Miyamoto, Satoshi, Onuki, Yoshio.
Application Number | 20030144673 10/341762 |
Document ID | / |
Family ID | 27605951 |
Filed Date | 2003-07-31 |
United States Patent
Application |
20030144673 |
Kind Code |
A1 |
Onuki, Yoshio ; et
al. |
July 31, 2003 |
Medical ligating apparatus
Abstract
A medical ligating apparatus comprises a medical ligating device
consisting of a ligating member which consists of a flexible wire
rod and ligates living tissues, and a fixing member which is
movably provided at the ligating member and fixes the living
tissues in a ligated state, a manipulating device having a flexible
sheath and a proximal manipulating section, and cutting means for
cutting the ligating member, the cutting means being provided on
the manipulating device and being movably provided on the ligating
member.
Inventors: |
Onuki, Yoshio; (Hino-shi,
JP) ; Miyamoto, Satoshi; (Nishitama-gun, JP) ;
Kawashima, Koichi; (Hachioji-shi, JP) |
Correspondence
Address: |
SCULLY SCOTT MURPHY & PRESSER, PC
400 GARDEN CITY PLAZA
GARDEN CITY
NY
11530
|
Assignee: |
OLYMPUS OPTICAL CO., LTD.
TOKYO
JP
|
Family ID: |
27605951 |
Appl. No.: |
10/341762 |
Filed: |
January 14, 2003 |
Current U.S.
Class: |
606/139 |
Current CPC
Class: |
A61B 17/12013 20130101;
A61B 17/32056 20130101; A61B 2017/0488 20130101; A61B 2017/12018
20130101 |
Class at
Publication: |
606/139 |
International
Class: |
A61B 017/10 |
Foreign Application Data
Date |
Code |
Application Number |
Jan 16, 2002 |
JP |
2002-007687 |
Claims
What is claimed is:
1. A medical ligating apparatus comprising: a medical ligating
device including a ligating member which has a flexible wire rod
and ligates living tissues, and a fixing member which is movably
provided at the ligating member and fixes the living tissues in a
ligated state; a manipulating device having a flexible sheath and a
proximal manipulating section; and wherein the manipulating device
comprises cutting means for cutting the ligating member, the
cutting means being provided on the manipulating device and being
movably provided on the ligating member.
2. A medical ligating apparatus comprising: a medical ligating
device including a ligating member which has a flexible wire rod
and ligates living tissues, and a fixing member which is movably
provided at the ligating member and fixes the living tissues in a
ligated state; and a manipulating device having a flexible sheath
and a proximal manipulating section, wherein the manipulating
device comprises cutting means for cutting the ligating member, the
cutting means being movably provided on the ligating member, and
the cutting means is advanced and retracted or is rotated to cut
the ligating member at a proximal end side of the fixing
member.
3. A medical ligating apparatus comprising: a medical ligating
device including a ligating member which has a flexible wire rod
and ligates living tissues, and a fixing member which is movably
provided at the ligating member and fixes the living tissues in a
ligated state; and a manipulating device having a flexible sheath
and a proximal manipulating section, wherein the manipulating
device comprises cutting means for cutting the ligating member, the
cutting means being movably provided on the ligating member, and
the medical ligating device comprises a receiving member which is
movably provided on the ligating member and receives the cutting
means.
4. A medical ligating device comprising: a ligating member which
includes a flexible wire rod and ligates living tissues; a fixing
member which is movably provided on the ligating member and fixes
the living tissues in a ligated state; and cutting means for
cutting the ligating member, the cutting means being movably
provided on the ligating member.
5. A medical ligating apparatus comprising: a medical ligating
device according to claim 4; and a manipulating device having a
flexible sheath and a proximal manipulating section.
6. A medical ligating device comprising: a ligating member which
includes a flexible wire rod and ligates living tissues; a fixing
member which is movably provided on the ligating member that fixes
the living tissues in a ligated state; and cutting means for
cutting the ligating member, the cutting means being provided on
the fixing member.
7. A medical ligating apparatus comprising: a medical ligating
device according to claim 6; and a manipulating device having a
flexible sheath and a proximal manipulating section.
8. A ligating apparatus for ligating living tissues by a ligating
device using a predetermined elongated material, comprising:
tracting and ligating means for tracting a proximal end of the
ligating device and ligating the living tissues by a distal end of
the ligating device; and cutting means for cutting the proximal end
of the ligating device, while the tracting and ligating means is
ligating the living tissues in the distal end of the ligating
device, the cutting means having a blade section which is movably
operated in parallel to a tracting direction of the tracting and
ligating means and which is oriented to a distal end side of the
tracting direction.
9. A ligating apparatus according to claim 8, further comprising a
receiving member which has an abutment section against which the
blade section abuts and disposes the ligating device between the
abutment section and the blade section.
10. A ligating apparatus according to claim 9, further comprising a
sheath which has an external diameter capable of being inserted
into the cutting means and is inserted into the cutting means, and
a receiving member to be mounted on a distal end of the sheath.
11. A ligating apparatus according to claim 9, further comprising:
a sheath which has an internal diameter large enough to allow the
cutting means to be inserted; and a receiving member to be mounted
on a distal end of the sheath.
12. A ligating apparatus for ligating living tissues by a ligating
device using a predetermined elongated material, comprising:
tracting and ligating means for tracting a proximal end of the
ligating device and ligating the living tissues by a distal end of
the ligating device; and cutting means being movable back and forth
and rotable in a tracking direction of the tracking and ligating
means, having a blade section oriented to the proximal end of the
ligating device, and configured to cut the proximal end portion
from of the ligating device which has ligated the living tissues by
assistance of the tracking and ligating means, leaving the distal
end portion of the ligating device;
13. A ligating apparatus according to claim 12, wherein the cutting
means further comprises a blade section which has a ring-shaped
cross section in a plane perpendicular to a tracking direction of
the tracking means.
14. A ligating apparatus for ligating living tissues by a ligating
device using a predetermined elongated material, comprising:
tracting and ligating means for tracting a proximal end of the
ligating device and ligating the living tissues by using a distal
end of the ligating device; and cutting means being rotable in a
tracking direction of the tracking and ligating means, having a
blade section oriented to the proximal end of the ligating device,
and configured to cut to cut the proximal end portion from of the
ligating device which has ligated the living tissues by assistance
of the tracking and ligating means, leaving the distal end portion
of the ligating device;
15. A ligating apparatus for ligating living tissues, comprising: a
ligating device which includes a predetermined elongated material
and ligates living tissues; tracting and ligating means for
tracting a proximal end of the ligating device and ligating the
living tissues by a distal end of the ligating device; and cutting
means for cutting the proximal end of the ligating device, while
the tracting and ligating means is ligating the living tissues in
the distal end of the ligating device, the cutting means having a
blade section that is movably operated in parallel to a tracting
direction of the tracting and ligating means and that is oriented
to a distal end side of the tracting direction.
16. A ligating apparatus for ligating living tissues by a ligating
device using a predetermined elongated material, comprising:
tracting and ligating means for tracting a proximal end of the
ligating device and ligate the living tissues; a first stopper and
a second stopper which oppose each other, with the ligating device
sandwiched therebetween, and which are engaged with each other by
virtue of a traction force when the traction and ligating means
pulls the ligating device, and which lock the ligating device in a
frictional manner, thereby maintaining a ligation state by the
ligating device; and cutting means for cutting the proximal end of
the ligating device, while the tracting and ligating means is
ligating the living tissues in the distal end of the ligating
device, the cutting means being provided at least one of the first
and second stoppers.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is based upon and claims the benefit of
priority from the prior Japanese Patent Application No. 2002-7687,
filed Jan. 16, 2002, the entire contents of which are incorporated
herein by reference.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to a medical ligating
apparatus for ligating living tissues by inserting the apparatus
into a body in a trans-endoscopic manner.
[0004] 2. Description of the Related Art
[0005] Conventionally, medical ligating apparatuses for ligating a
lesion of a living tissue, such as polyp, by inserting the
apparatuses through endoscope channels, and inserting them into
cavities in a trans-endoscopic manner are known from Jpn. Pat.
Appln. KOKAI Publication Nos. 10-194, 10-277046, 11-244294,
48-71090, 8-98840, and 54-30692 and the like. These medical
ligating apparatuses are composed of: a sheath that can be inserted
through an endoscope channel; a manipulating wire movably inserted
through this sheath; a loop shaped ligating wire removably
connected to a distal end of this manipulating wire; and a stopper
provided at a proximal end of this ligating wire.
[0006] In this medical ligating apparatus, when a ligating wire is
hooked on a lesion of a living tissue, such as polyp and a
manipulating wire is pulled toward a proximal manipulating section
side, a stopper moves relatively to the distal end side of the
ligating wire. As a result, the loop of the ligating wire is
reduced in diameter. Then, the lesion is tightly bound. A blood
flow at the lesion is stopped by this ligation, and thus, the
lesion tissue necroses and slips off several days later in a
ligated state. Then, a ligating device consisting of the ligating
wire and the stopper slips off at the same time, and is naturally
discharged from the anus.
[0007] The ligating wire is formed of, for example, a synthetic
resin such as nylon or polyolefin, or alternatively, stainless
steel. The stopper is formed of a thin tube consisting of an
elastic element such as silicon rubber. In addition, the stopper is
a knot formed at a part of the ligating wire as disclosed in Jpn.
Pat. Appln. KOKAI Publication No. 48-71090.
[0008] After the ligating wire has been tightly bound on the
lesion, it is required to isolate the ligating wire and
manipulating wire connected to each other. Therefore, as disclosed
in Jpn. Pat. Appln. KOKAI Publication No. 48-71090, a scissors is
inserted through the endoscope channel, and a proximal end of the
ligating wire is cut by the scissors. As disclosed in Jpn. Pat.
Appln. KOKAI Publication No. 54-30692, a cutter member is provided
at the distal end of a sheath, and a ligating wire is cut by the
cutter member.
[0009] However, as described previously, after the ligating wire
has been tightly bound on the lesion, the scissors is inserted
through the endoscope channel in order to isolate the ligating wire
and manipulating wire connected with each other. In a manipulation
for cutting the proximal end of the ligating wire by the scissors,
it is required to replace the medical ligating device with the
scissors, and insert it into a body cavity in a trans-endoscopic
manner. Thus, there is a problem that an operation time is
extended.
[0010] In addition, with a structure in which an openable cutter
member is provided in the distal end of the sheath as shown in FIG.
7 of Jpn. Pat. Appln. KOKAI Publication No. 54-30692, a large
number of parts are required, resulting in higher manufacturing
cost. In addition to wires of the ligating device, the manipulating
wire for actuating the cutter member is inserted into the sheath.
Thus, the sheath is increased in diameter, making it difficult to
insert the sheath into an endoscope having a channel with its small
internal diameter.
[0011] In the case of the cutter member in which a blade oriented
in the transverse direction at a proximal end side as shown in FIG.
8 of Jpn. Pat. Appln. KOKAI Publication No. 54-30692 is provided in
a cylindrically shaped member, there is a problem that its
manufacture is very difficult, and the sheath is increased in
diameter.
[0012] Further, in the conventional medical ligating apparatuses,
the proximal end of the ligating wire is cut, thereby isolating the
ligating wire and manipulating wire connected with each other.
Thus, the ligating wire remains in the body cavity while this wire
is extended from a ligating section. Therefore, for example,
interference with another treatment device or endoscope may
occur.
BRIEF SUMMARY OF THE INVENTION
[0013] It is an object of the present invention to provide a
medical ligating apparatus in which a fixing member for fixing
living tissues while they are ligated by a ligating member is
provided, ligation is carried out by the ligating member, and then,
the ligating member can be cut at a proximal end of the fixing
member by a series of manipulations.
[0014] According to the present invention, there is provided a
medical ligating apparatus comprising: a medical ligating device
consisting of a ligating member which consists of a flexible wire
rod and ligates living tissues, and a fixing member which is
movably provided at the ligating member and fixes the living
tissues in a ligated state; and a manipulating device having a
flexible sheath and a proximal manipulating section, wherein the
manipulating device comprises cutting means for cutting the
ligating member, the cutting means movably provided on the ligating
member and can move back and forth.
[0015] According to the present invention, in the medical ligating
apparatus, the manipulating device comprises cutting means for
cutting the ligating member, the cutting means being movably
provided on the ligating member, and the cutting means is advanced
and retracted or rotated so that the ligating member can be cut at
a proximal end of the fixing member.
[0016] Further, according to the present invention, in the medical
ligating apparatus, the manipulating device comprises cutting means
for cutting the ligating member, the cutting means being movably
provided on the ligating member, and the medical ligating device
comprises a receiving member for receiving the cutting means, the
receiving member being movably provided on the ligating member.
[0017] According to the invention, there is provided a medical
ligating device, a ligating member which includes a flexible wire
rod and ligates living tissues; a fixing member which is movably
provided on the ligating member that fixes the living tissues in a
ligated state; and cutting means for cutting the ligating member,
the cutting means being provided on the fixing member.
[0018] Additional objects and advantages of the invention will be
set forth in the description which follows, and in part will be
obvious from the description, or may be learned by practice of the
invention. The objects and advantages of the invention may be
realized and obtained by means of the instrumentalities and
combinations particularly pointed out hereinafter.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING
[0019] The accompanying drawings, which are incorporated in and
constitute a part of the specification, illustrate presently
preferred embodiment of the invention, and together with the
general description given above and the detailed description of the
preferred embodiment given below, serve to explain the principles
of the invention.
[0020] FIG. 1 is a structural view showing an entire medical
ligating apparatus according to a first embodiment of the present
invention, in which its distal end is cross-sectioned;
[0021] FIG. 2 is a longitudinal side cross section showing a distal
end of the medical ligating apparatus according to the first
embodiment;
[0022] FIG. 3 is a longitudinal side cross section showing a distal
end of the medical ligating apparatus according to the same
embodiment;
[0023] FIG. 4 is a longitudinal side cross section showing a distal
end of the medical ligating apparatus according to the first
embodiment;
[0024] FIG. 5 is a perspective view showing a state in which a
lesion is ligated by a ligating wire according to the first
embodiment;
[0025] FIG. 6 is a longitudinal side cross section showing a distal
end of a medical ligating apparatus according to a second
embodiment of the present invention;
[0026] FIG. 7 shows the second embodiment and is a longitudinal,
side cross-sectional view of the distal end of the medical ligating
apparatus;
[0027] FIG. 8 shows a third embodiment and is a longitudinal, side
cross-sectional view of the distal end of the medical ligating
apparatus;
[0028] FIG. 9 is a longitudinal side cross section showing a distal
end of a medical ligating apparatus according to a fourth
embodiment of the present invention;
[0029] FIG. 10 is a plan view showing a distal end of the medical
ligating apparatus according to the fourth embodiment;
[0030] FIG. 11 is a sectional view taken along the line XI-XI of
FIG. 9;
[0031] FIG. 12 is a sectional view taken along the line XII-XII of
FIG. 9;
[0032] FIG. 13 is a sectional view taken along the line XIII-XIII
of FIG. 9;
[0033] FIG. 14 is a longitudinal side cross section showing a
distal end of the medical ligating apparatus in a state in which
the ligating wire of the fourth embodiment is cut.
[0034] FIG. 15 is a longitudinal side cross section showing a
distal end of a medical ligating apparatus showing a modified
example of the first embodiment of the present invention;
[0035] FIG. 16 is a longitudinal side cross section showing a
distal end of a medical ligating apparatus according to a fifth
embodiment of the present invention;
[0036] FIG. 17 is an external view showing a distal end of a
cutting sheath according to the fifth embodiment;
[0037] FIG. 18A and FIG. 18B are perspective views showing a state
during ligation according to the fifth embodiment;
[0038] FIG. 19 is a longitudinal side cross section showing a
distal end of a medical ligating apparatus according to a sixth
embodiment of the present invention; and
[0039] FIG. 20 is an external view showing the apparatus in a
direction indicated by the arrow XX in FIG. 19 according to the
sixth embodiment.
DETAILED DESCRIPTION OF THE INVENTION
[0040] Hereinafter, embodiments of the present invention will be
described with reference to the accompanying drawings.
[0041] FIG. 1 to FIG. 5 show a first embodiment of the present
invention. FIG. 1 is a structural view showing an entire medical
ligating apparatus, in which its distal end is cross-sectioned.
FIG. 2 to FIG. 4 are longitudinal side cross sections of the distal
end. FIG. 5 is a perspective view showing a state in which a lesion
is ligated by a ligating wire.
[0042] As shown in FIG. 1, a medical ligating apparatus 1 is
composed of: a medical ligating device 2 retained in a living body;
and a manipulating device 3 for guiding the medical ligating device
2 into the living body, thereby carrying out ligating manipulation.
The manipulating device 3 is composed of: an insert section 4
having flexibility, the insert section being inserted into an
endoscope channel; and a proximal manipulating section 5.
[0043] The insert section 4 is composed of: an outer sheath 6 that
consists of a flexible sheath; an inner sheath 7 that consists of a
flexible sheath and is movably inserted into the outer sheath 6 in
an axial direction; a cutting sheath 8 engaged with the outer of
the inner sheath 7, the cutting sheath being movably inserted in an
axial direction; and a manipulating wire 9 that is retractable in
an axial direction, the manipulating wire being inserted through
the inner sheath 7.
[0044] The outer sheath 6 is made of, for example, a plastic having
flexibility such as polyethylene or PTFE, and is 2 mm to 5 mm in
diameter. In addition, the inner sheath 7 is made of, for example,
a plastic having flexibility such as polyethylene or PTFE. A
metallic-meshed sheath may be inserted in a plastic sheath. The
manipulating wire 9 is formed of a metal twist wire such as
stainless steel.
[0045] The proximal manipulating section 5 is composed of: a grip
10 fixed to a proximal end of the outer sheath 6; a slider 12 fixed
to a proximal end of the manipulating wire 9, the slider being
retractable relative to a manipulating section main body 11; a
cutting manipulating section 13 fixed to a proximal end of the
cutting sheath 8; and a finger hook ring 14. The outer sheath 6,
manipulating wire 9, and cutting sheath 8 can be moved relatively
in the forward and backward direction by means of the grip 10,
slider 12, and cutting manipulating section 13.
[0046] At a distal end of the cutting sheath 8, there is provided
an annular cutting member 15 made of a metal such as stainless
steel, the cutting member serving as cutting means. A sharp cutting
blade 16 is provided all around the distal end of the cutting
member 15. In addition, a hook shaped engagement member 17 is
securely fixed to the distal end of the manipulating wire 9.
[0047] Next, a description of the medical ligating device 2 will be
given. In the medical ligating device 2, there is provided a loop
shaped ligating wire 18 serving as a ligating member for ligating
living tissues at the distal end portion of the device. The
ligating wire 18 is formed of a synthetic resin such as nylon or
polyolefin, a metal thin wire such as stainless, a silk yarn, or
biologically absorptive yarn, and is 0.2 mm to 1 mm in wire
diameter. The ligating wire 18 may be in any form of a single wire,
twist wire, or knitted wire. In addition, the proximal end side of
the ligating wire 18 is folded, and a fold section 19 is formed.
Both ends of the ligating wire 18 and the parallel two wires are
fixed to an internal cavity of a connecting pipe 20 serving as a
fixing parts by means of adhesive bonding or the like.
[0048] At the intermediate portion of the ligating wire 18, a
tubular stopper 21 serving as a fixing member that is retractable
on the wire is movably engaged. The stopper 21 is made of, for
example, a rubber such as silicon rubber or fluorine rubber or a
variety of thermoplastic elastomers, or a knot of the ligating wire
18. The stopper 21 is advanced, whereby a loop section is reduced
in diameter. The stopper 21 is retracted, whereby the loop section
is increased in diameter.
[0049] A receiving member 22 for receiving the cutting member 15 is
provided at the ligating wire 18 at the proximal end of the stopper
21. The receiving member 22 is formed in a cylindrical shape, and
is formed of a metal such as stainless or a plastic such as
polypropylene, ABS, polyacetal, polycarbonate or the like. An
annular protrusion 23 is integrally provided at a substantially
intermediate portion in an axial direction. A converging section 24
is provided at the proximal end of the receiving member 22. The
converging section 24 is designed so as to be supported after being
inserted into the distal end of the inner sheath 7. Therefore,
there is no step between an outer periphery face of the inner
sheath 7 and an outer periphery face of the receiving member 22 so
that the cutting sheath 8 can be advanced and retracted
smoothly.
[0050] A pair of distal end holes 25a, 25b through which the
ligating wire 18 can be inserted are punched at the distal end side
more than the annular protrusion 23 of the receiving member 22. A
pair of proximal end holes 26a, 26b through which the ligating wire
18 can be inserted are punched at the proximal end side more than
the annular protrusion 23. The inner face at the distal end side of
the distal end holes 25a, 25b and the inner face at the proximal
end side of the proximal end holes 26a, 26b are formed on an
incline face so that the ligating wire 18 can be easily inserted
and withdrawn. Further, a side face at the proximal end side of the
annular protrusion 23 is formed as an abutment face 27 of the
cutting member 15.
[0051] Each of the folded portions of the ligating wire 18 is led
from a proximal opening of the receiving member 22 to the inner of
the receiving member 22. Next, these portions each are led from the
proximal end holes 26a, 26b to the outer of the receiving member
22. Then, these portions each are led from the distal end holes
25a, 25b to the inner of the receiving member 22 via the outer of
the annular protrusion 23. Finally, these portions each are led
from the distal opening to the outer. At the distal end side of the
receiving member 22, the ligating wire 18 is pressed into an
internal cavity of the stopper 21 in a bound state. Further, the
full length of the receiving member 22 is about 5 mm to 10 mm. The
length of the remaining wire after cut is determined depending on a
dimension L between its distal face of receiving member 22 and
proximal end holes 26a, 26b each. Thus, the shorter L is desirable,
and is set to about 2 mm to 5 mm.
[0052] Now, dimensions of the receiving member 22, annular
protrusion 23, and cutting member 15 will be described here. Assume
that an external diameter of the receiving member 22 is A, an
external diameter of the annular protrusion 23 is B, and an
internal diameter of the cutting member 15 is C. These diameters
are about 1 mm to 3 mm, and a relationship of A<C, B>C, and
B-A=about 0.2 mm to 1 mm is established. In addition, the proximal
end holes 26a, 26b, as shown in FIG. 15, may be spaced forwardly or
backwardly, respectively.
[0053] Now, an operation of the first embodiment will be described
here.
[0054] First, the slider 12 is manipulated, whereby the
manipulating wire 9 is advanced, and the engagement member 17 is
protruded from distal openings of the outer sheath 6 and inner
sheath 7. In this state, the fold section 19 at the proximal end of
the ligating wire 18 is hooked on a hook section of the engagement
member 17. When the slider 12 is manipulated, thereby retracting
the manipulating wire 9 and introducing the engagement member 17
into the inner of the inner sheath 7, the converging section 24 of
the receiving member 22 is supported after being inserted into the
distal opening of the inner sheath 7. In this state, when the grip
10 is manipulated, thereby advancing the outer sheath 6, the
ligating wire 18 is housed into the inner of the outer sheath 6,
and a loop section is reduced in diameter, as shown in FIG. 2.
[0055] In this state, the insert section 4 is inserted through the
endoscope channel, and is inserted into a body cavity. Then, a
distal end of the insert section 4 is guided to a target site in
the body cavity. While a lesion 28 such as polyp is observed by
means of an endoscope, when the grip 10 is manipulated, thereby
retracting the outer sheath 6, the ligating wire 18 is protruded
from the distal opening of the outer sheath 6. Then, the loop
section of the ligating wire 18 is elastically restored, and is
increased in diameter, as shown in FIG. 1.
[0056] Next, while the lesion 28 is observed by means of the
endoscope, after the loop section of the ligating wire 18 has been
hooked on a root of the lesion 28, the slider 12 is manipulated,
thereby retracting the manipulating wire 9. Then, the proximal end
of the ligating wire 18 is introduced into the inner of the inner
sheath 7 via the engagement member 17, and the stopper 21 and
receiving member 22 move in a distal end direction of the ligating
wire 18. Therefore, the loop section of the ligating wire 18 is
reduced in diameter, as shown in FIG. 3, and the lesion 28 is
tightly bound. The blood flow to the lesion 28 is stopped by this
ligation.
[0057] Next, while the slider 12 is held, when the cutting
manipulating section 13 is manipulated, thereby advancing the
cutting sheath 8, the cutting sheath 8 is advanced while it is
guided to the inner sheath 7. Then, the cutting member 15 is
engaged with the proximal end of the receiving member 22, and the
cutting blade 16 abuts against the abutment face 27. Therefore, the
proximal end side of the ligating wire 18 inserted into the
receiving member 22 is cut in the vicinity of the proximal end
holes 26a, 26b, as shown in FIG. 4.
[0058] At this time, the proximal end side of the ligating wire 18
is pulled by the manipulating wire 9, and a tensile stress is
applied. Thus, the cutting blade 16 cuts well. In FIG. 4, a time
difference may occur without the two top and bottom ligating wires
18 being cut at the same time. However, the two top and bottom
ligating wires 18 are connected to each other by means of the
connecting pipe 20. Even if these wires are cut one by one, a
tensile stress is maintained, and thus, the cutting performance is
not degraded.
[0059] In the case where the proximal end holes 26a, 26b are
displaced forwardly and backwardly, after one of the ligating wires
18 has been cut by the cutting blade 16, the other ligating wire 18
is cut. As a result, both of the ligating wires 18 and the cutting
blade 16 do not come into contact with each other at the same time.
Thus, the cutting force applied to the ligating wire 18 is not
dispersed, and the cutting is made easy.
[0060] When the proximal end side of the ligating wire 18 is cut,
the inner sheath 7 and receiving member 22 are separated from each
other. Then, the ligating device 2 and manipulating device 3 are
completely separated from each other. When the insert section 4 is
drawn from the endoscope channel, the receiving member 22 slips off
from the cut proximal end of the ligating wire 18. Therefore, as
shown in FIG. 5, only the ligating wire 18 held in a tightly bound
state by means of the stopper 21 is retained in the body, and a
surgical operation for tightly binding the lesion 28 completes. The
receiving member 22 having slipped off from the ligating wire 18 is
naturally discharged to the outer of the body via the digestive
tract.
[0061] In this way, according to the medical ligating apparatus 1,
a manipulation for tightly binding the lesion 28 by the ligating
wires 18 and a manipulation of cutting and separating the ligating
wires 18 can be carried out in series. Therefore, unlike the prior
art, there is no need to replace the ligating apparatus with the
scissors in the endoscope channel, and a surgical operation time
can be reduced. Moreover, the ligating wire 18 can be cut at a
portion close to the stopper 21. Thus, the ligating wire 18 does
not remain in the body cavity while being in an expanded state, and
interference with another treatment device or an endoscope can be
prevented.
[0062] Such a simple structure is provided that the cutting means
15 having the cutting blade 16 oriented in the longitudinal
direction of the manipulating device 3 is mounted at the distal end
of the cutting sheath 8, thus making it possible to reduce the
manufacturing cost of the manipulating device and reduce the
manipulating device in diameter. Further, even when the cutting
performance of the cutting blade 16 is degraded due to repeated use
of the manipulating device 3, the cutting sheath 8 and cutting
means 15 can be easily replaced by removing them from the
manipulating device 3.
[0063] FIG. 6 and FIG. 7 show a second embodiment of the present
invention. Like elements in the first embodiment are designated by
like reference numerals. A duplicate description is omitted here.
FIG. 6 and FIG. 7 are longitudinal side cross sections showing a
distal end side of a medical ligating apparatus. An annular groove
30 into which the cutting blade 16 of the cutting member 15 is to
be inserted is provided on the proximal side face of the annular
protrusion 23 of the receiving member 22 according to the present
embodiment.
[0064] Therefore, while the slider 12 is maintained, when the
cutting manipulating section 13 is manipulated, thereby advancing
the cutting sheath 8, the cutting sheath 8 is advanced while it is
guided to the inner sheath 7. Then, the cutting blade 16 of the
cutting member 15 is inserted into the annular groove 30 of the
receiving member 22. Therefore, the proximal end side of the
ligating wire 18 inserted into the receiving member 22 is cut in
the vicinity of the proximal end holes 26a, 26b, as shown in FIG.
7. At this time, the cutting blade 16 is guided to the annular
groove 30, whereby the blade does not slip on the wire, and can cut
the wire reliably. In addition, the cutting performance is improved
more significantly.
[0065] FIG. 8 shows a third embodiment of the present invention.
Like elements in the first embodiment are designated by like
reference numerals. A duplicate description is omitted here. FIG. 8
is a longitudinal side cross section showing a distal end side of a
medical ligating apparatus. The cutting member 31 of the present
embodiment is provided at the inner of a sheath 7a so as to be
advanced and retracted by means of the cutting sheath 8. The
cutting member 31 may be removable from the cutting sheath 8 so as
to facilitate replacement.
[0066] In addition, a receiving member 32 is formed in a
cylindrical shape that does not have an annular protrusion, and the
distal end holes 25a, 25b and the proximal end holes 26a, 26b are
provided. An abutment face 34 of a cutting blade 33 of a cutting
member 31 is provided on an internal wall of the receiving member
32.
[0067] Therefore, when the cutting manipulating section 13 is
manipulated, thereby advancing the cutting sheath 8, the cutting
sheath 8 is advanced while it is guided to the sheath 7a. Then, the
cutting blade 33 of the cutting member 31 abuts against the
abutment face 34 of the receiving member 32. Therefore, the
proximal end side of the ligating wire 18 inserted into the
receiving member 32 is cut in the vicinity of the proximal end
holes 26a, 26b.
[0068] As in the present embodiment, the cutting member 31 is
provided at the inner of the sheath 7a, whereby any protrusion is
eliminated at the outer of the sheath 7a, and the cutting blade is
not exposed. In this way, the outer sheath is eliminated, and thus,
wiring can be directly provided to the endoscope channel. The outer
sheath is eliminated, whereby the insert section 4 of the medical
ligating apparatus 1 is reduced in diameter, and wiring can be
provided to a channel with its small internal diameter.
[0069] FIG. 9 to FIG. 14 show a fourth embodiment of the present
invention. Like elements in the first embodiment are designated by
like reference numerals. A duplicate description is omitted here.
FIG. 9 is a longitudinal side cross section showing a distal end
side of a medical ligating apparatus. FIG. 10 is a plan view
showing the same. FIG. 11 is a cross section taken along the line
XI-XI. FIG. 12 is a sectional view taken along the line XII-XII.
FIG. 13 is a sectional view taken along the like XIII-XIII. FIG. 14
is a longitudinal side cross section showing a distal end side of a
medical ligating apparatus in a state in which a ligating wire is
cut.
[0070] A fixing member 40 is provided at the proximal end side of
the ligating wire 18. This fixing member 40 is preferably made of a
plastic such as polypropylene, ABS, polyacetal, polycarbonate, or
alternatively, a comparatively rigid material with excellent
fluidity such as a liquid crystal polymer or polyphthal amide. This
member may be made of a metal such as stainless or aluminum, is
about 1 mm to 3 mm in external diameter, and is about 5 mm to 10 mm
in length.
[0071] The fixing member 40 is composed of a first member 41 and a
second member 42. The first member 41 is formed in a cylindrical
shape. A large diameter section 43 is provided at a proximal end of
the first member, and a press-in section 44 consisting of a short
diameter section is provided at a distal end thereof. An annular
cutting member 45 is engagingly fitted to the outer periphery at
the distal end side of the large diameter section 43 while its
cutting blade 46 is oriented to the distal end side. Wire guides
47a, 47b are provided at the top and bottom portions of the outer
periphery of the proximal end side of the large diameter section
43. Further, at the outer periphery of the distal end side of the
large diameter section 43, engagement claws 48a, 48b are provided
at the right and left parts which are biased by 90 degrees in a
peripheral direction relative to the wire guides 47a, 47b. In
addition, at a coaxial section of the first member 41, an internal
cavity 49 is provided in an axial direction. A protrusion 50 is
provided at the substantially intermediate section in the axial
direction of this internal cavity 49. The height of this protrusion
50 is between 0.1 mm to 0.3 mm.
[0072] In the second member 42, a columnar section 51 is provided
at its distal end, and a cylindrical section 52 is provided
integrally with the columnar section 51 at its proximal end. At the
center of the columnar section 51, an insert shaft 53 to be
inserted into the internal cavity 49 of the first member 41 is
protruded through the inner of the cylindrical section 52. Further,
a fixing internal cavity 54 into which a press-in section 44 of the
first member 41 is to be pressed is provided at the columnar
section 51 so as to surround the insert shaft 53. The length of the
fixing internal cavity 54 is between 1 mm to 3 mm.
[0073] In addition, distal end holes 55a, 55b into the ligating
wires 18 are inserted one by one are provided at the distal face of
the second member 42. Side holes 56a, 56b are provided at the top
and bottom parts at the outer periphery of the cylindrical section
52 of the second member 42. Slits 57a, 57b are provided in the
neighborhood of these holes. Further, at the cylindrical section
52, engagement holes 58a, 58b to be engaged with the engagement
claws 48a, 48b of the first member 41 are provided at the right and
left parts which are biased by 90 degrees in a peripheral direction
relative to the slits 57a, 57b. In addition, an abutment face 59 of
the cutting blade 46 is provided on an end face at the proximal end
side of the columnar section 51 of the second member 42, and an
abutment section 60, on which the press-in section 44 abuts, is
provided in the vicinity of the distal end of the fixing internal
cavity 54. A single-side clearance between an internal diameter of
the fixing internal cavity 54 and an external diameter of the
press-in section 44 is defined so as to be smaller than an external
diameter of the ligating wire 18.
[0074] The insert shaft 53 of the second member 42 is inserted into
the internal cavity 49 of the first member 41, and a distal face of
the insert shaft 53 abuts against the protrusion 50, whereby the
insertion depth is restricted. Therefore, the cylindrical section
52 of the second member 42 is engaged with the outer of the cutting
member 45 so as to cover the cutting blade 46.
[0075] The ligating wire 18 is inserted from the distal end holes
55a, 55b into the inner of the second member 42, and is led out to
the outer through the side holes 56a, 56b. Further, the ligating
wire 18 is guided by the slits 57a, 57b and wire guides 47a, 47b,
and is led to the proximal end side of the fixing member 40.
Connection between the fold section 19 of the ligating wire 18 and
both of the ends via the connecting pipe 20 is similar to that in
the first embodiment.
[0076] Next, an operation of a fourth embodiment will be
described.
[0077] First, the manipulating wire 9 is advanced, whereby the
engagement member 17 is protruded from a distal opening of the
sheath 7a. In this state, the fold section 19 at the proximal end
of the ligating wire 18 is hooked on a hook section of the
engagement member 17. When the manipulating wire 9 is retracted,
thereby introducing the engagement member 17 into the inner of the
sheath 7a, the converging section 24 of the fixing member 40 is
supported after being inserted into the distal opening of the
sheath 7a. In this state, the sheath 7a including the ligating wire
18 is inserted through the endoscope channel, and is inserted into
the body cavity. Then, the distal end of the sheath 7a is guided to
a target site in the body cavity. While the lesion 28 such as polyp
is observed by means of the endoscope, when the sheath 7a is
advanced, the ligating wire 18 is protruded from the distal opening
of the channel. Then, the loop section of the ligating wire 18 is
elastically restored, and is increased in diameter, as shown in
FIG. 9.
[0078] Next, while the lesion 28 is observed by means of the
endoscope, after the loop section of the ligating wire 18 is hooked
on the root of the lesion 28, when the manipulating wire 9 is
retracted, the proximal end of the ligating wire 18 is introduced
into the inner of the sheath 7a via the engagement member 17. Then,
the ligating wire 18 is reduced in diameter, and the lesion 28 is
tightly bound.
[0079] When the manipulating wire 9 is further retracted, the
distal face of the second member 42 of the fixing member 40 abuts
against the lesion 28, and the lesion 28 serves as a stopper. Thus,
the first member 41 is relatively advanced, and the second member
42 is retracted. Therefore, the insert shaft 53 of the second
member 42 breaks the protrusion 50, and is inserted into the
internal cavity 49 of the first member 41.
[0080] In addition, the press-in section 44 of the first member 41
is advanced in the direction of the fixing internal cavity 54 of
the second member 42. Thus, the intermediate section of the
ligating wire 18 is fixed to be pinched between an internal face of
the fixing internal cavity 54 and an external face of the press-in
section 44. Further, when the press-in section 44 of the first
member 41 is advanced in the direction of the fixing internal
cavity 54 of the second member 42, the cutting blade 46 of the
cutting member 45 provided at the first member 41 abuts against an
abutment face 59 of the second member 42. Therefore, when the
intermediate section of the ligating wire 18 is cut, and a cut end
is pinched and fixed between the internal face of the fixing
internal cavity 54 and the external face of the press-in section
44.
[0081] In addition, when the distal end of the press-in section 44
abuts against an abutment section 60, the engagement claws 48a, 48b
of the first member 41 are engaged with the engagement holes 58a,
58b, and the first member 41 is engaged with the second member
42.
[0082] The sheath 7a and the fixing member 40 are separated from
each other by disconnection of the ligating wire 18, and the
ligating device 2 and manipulating device 3 are completely
separated from each other. When the sheath 7a is drawn from the
endoscope channel, only the ligating wire 18 held in a tightly
bound state by means of the fixing member 40 is retained in the
body, and a surgical operation for tightly binding the lesion 28
completes.
[0083] In this way, according to the medical ligating apparatus 1,
a manipulation for cutting and separating the ligating wires 18 at
the same time when the lesion 28 is tightly bound by the ligating
wire 18 can be carried out in series. Therefore, unlike the prior
art, there is no need to replace the ligating apparatus with the
scissors in the endoscope channel, and a surgical operation time
can be reduced. Moreover, the cut end of the ligating wire 18 is
housed at the inner of the fixing member 40, and thus, interference
with another treatment device or an endoscope can be prevented more
effectively. In addition, the cutting member 45 is provided at the
medical ligating device 2 itself. Thus, a new cutting blade is
always used without repeated use of the cutting blade 46. As a
result, the ligating wire 18 can be cut reliably.
[0084] The cutting member 45 is provided at the inner of the fixing
member 40, whereby a protrusion is eliminated. Thus, the outer
sheath becomes unnecessary, and the wire can be directly inserted
through the endoscope channel. The outer sheath becomes
unnecessary, whereby the insert section 4 of the medical ligating
apparatus 1 can be reduced in diameter, and the wire can be
inserted through a channel with its small internal diameter.
[0085] FIG. 16 to FIG. 18 show a fifth embodiment of the present
invention. FIG. 16 is a longitudinal side cross section showing a
distal end of the apparatus. FIG. 17 is an external view showing a
distal end of a cutting sheath. FIG. 18 is a perspective view
showing a state during ligation. Only differences from the first to
third embodiments will be described here.
[0086] As shown in FIG. 16, an external diameter of the stopper 21
is substantially equal to that of the inner sheath 7, and a distal
face of the inner sheath 7 can abut against a proximal face of the
stopper 21. A cutting sheath 8 is formed of a metallic meshed
plastic (for example, polyethylene, PTFE, nylon or the like), or
alternatively, a metallic multi-striped coil, and is excellent in
rotation tracking properties.
[0087] As shown in FIG. 17, a cutting member 65 is connected at a
distal end of the cutting sheath 8. The cutting member 65 has a
cutout 61. A cutting blade 66 is provided at the distal edge and
side face edge of the cutout 61. A claw section 62 is provided at
the distal end side of the cutout 61.
[0088] Next, an operation of a fifth embodiment of the invention
will be described.
[0089] After the loop section of the ligating wire 18 has been
hooked on the lesion 28, the slider 12 is pulled toward the
proximal side, and the lesion 28 is ligated. Then, the slider 12 is
slightly pushed and advanced to the distal end side, and a portion
of the ligating wire 18 at the proximal end side of the stopper 21
is exposed to the distal end side of the inner sheath 7, as shown
in FIG. 18A.
[0090] Next the cutting manipulating section 13 is manipulated,
whereby the cutting sheath 8 is advanced to be protruded to the
distal end side more than the inner sheath 7. In this state, by
using a bending manipulation of the endoscope or the like, the
ligating wire 18 exposed as shown in FIG. 18B is hooked on a claw
section 62.
[0091] Then, the cutting manipulating section 13 is pulled to the
proximal side or is rotated in the direction shown in FIG. 18B,
whereby a cutting blade 66 provided at a cutting member 65 cuts the
ligating wire 18 at the proximal end side of the stopper 21.
[0092] According to the present embodiment, unlike the first to
third embodiments, there is no need to provide a receiving member
at the medical ligating device 2, and the number of parts is
reduced. Thus the manufacturing cost can be reduced. In addition,
the ligating wire 18 does not pass through the distal end holes
25a, 25b and proximal end holes 26a, 26b of the receiving member in
a bent state, and extends straight between a proximal end of the
stopper 21 and the engagement member 17. This makes it possible to
push and advance the stopper 21 to the distal end side with a
gentle force when the lesion 28 is ligated.
[0093] FIG. 19 and FIG. 20 show a sixth embodiment of the present
invention. FIG. 19 is a longitudinal side cross section showing a
distal end of the apparatus. FIG. 20 is an external view of the
apparatus in the direction indicated by the arrow XX in FIG. 19.
Only differences from the first to third embodiments will be
described here.
[0094] An annular cutting member 75 is provided at the proximal end
side of the stopper 21. The cutting member 75 is formed of a metal
member such as stainless. A converging section 24 is provided at
the proximal end side of the cutting member 75, and is designed to
enable engagement with a distal internal cavity of the sheath 7a.
An external diameter of the converging section 24 is slightly
larger than the distal internal diameter of the sheath 7a. This
external diameter is defined in a dimension such that the cutting
member 75, when engaged with the distal internal cavity of the
sheath 7a, does not slip off easily nor rotate relative to the
sheath 7a.
[0095] In addition, the sheath 7a is formed of a metallic meshed
plastic (for example, polyethylene, PTFE, or nylon and the like),
or alternatively, a metallic multi-stripe coil, and is excellent in
rotation tracking properties.
[0096] A distal end hole 71 and proximal end hole 72 through which
two ligating wires 18 can be inserted are provided on a side face
of the cutting member 75. These holes communicate with an internal
cavity of the cutting member 75. After the ligating wire 18 has
passed through the inner of the stopper 21, the ligating wire
enters a distal opening of the cutting member 75. Then, the
ligating wire 18 is exposed to the outer through the distal end
hole 71. Further, the ligating wire 18 extends to the engagement
member 17 through the proximal end hole 72, an internal cavity of
the cutting member 75, and an internal cavity of the sheath 7a.
[0097] It is desirable that a distance L between the distal end of
the cutting member 75 and the distal end hole 71 be short. The
distance L is set to about 2 mm to 5 mm. In addition, a cutting
blade 76 is provided at both edges of the distal end hole 71.
[0098] Next, an operation of a sixth embodiment will be
described.
[0099] After the lesion 28 has been ligated at the loop section of
the legating wire 18, the proximal end side of the sheath 7a is
rotated. The cutting member 75 and the distal end of the sheath 7a
are engaged with each other so as not to easily rotate
therebetween. Thus, the cutting member 75 rotates in unison with
the sheath 7a.
[0100] The distal end side of the ligating wire 18 is fixed to be
ligated around the lesion 28. Thus, when the cutting member 75
rotates, the cutting blade 76 abuts against a portion of the
ligating wire 18 which is passing through the distal end hole 71,
and cuts the portion of the wire. When the manipulating device 3 is
removed from the endoscope, the cutting member 75 is taken out of
the body while it is fixed to the distal end of the sheath 7a.
[0101] The cutting blade 76 may be provided at a distal edge of the
distal end hole 71. In this case, the sheath 7a is pulled to the
proximal side, whereby the ligating wire 18 is cut by the cutting
blade 76. In this case, the sheath 7a and converging section 24
must be set so as not to be disengaged from each other in the range
of a force required to cut the ligating wire 18.
[0102] According to the present embodiment, the cutting member 75
is provided in place of the receiving members according to the
first to third embodiments. As a result, the cutting sheath 8
becomes unnecessary, the number of parts is reduced, and the
manufacturing cost can be reduced. In addition, unlike the first to
third embodiments, the medical ligating device is not retained in
the body in such a state that another member remains at the
proximal end side of the fixing member. Thus, interference with
another treatment device or an endoscope can be prevented more
efficiently immediately after the ligating device has been
retained.
[0103] As has been described above, a manipulation for tightly
binding a lesion by a ligating member and a manipulation for
cutting the ligating member can be carried out in series. In
addition, there is no need to replace the ligating apparatus with
the scissors in the endoscope channel, and a surgical operation
time can be reduced. Moreover, the ligating member can be cut at a
portion close to the fixing member. Thus, the cut end of the
ligating member does not remain in the body cavity while it is
extended, and interference with another treatment device or an
endoscope can be prevented. In addition, the cutting blade extends
in the longitudinal direction of the manipulating device. Thus, the
manipulating device can be reduced in diameter. Further, means for
cutting the ligating member is formed with a simple structure.
Thus, the manufacturing cost can be reduced. Note that the ligating
device is not limited to a loop-shaped one.
[0104] Additional advantages and modifications will readily occur
to those skilled in the art. Therefore, the invention in its
broader aspects is not limited to the specific details and
representative embodiments shown and described herein. Accordingly,
various modifications may be made without departing from the spirit
or scope of the general inventive concept as defined by the
appended claims and their equivalents.
* * * * *