U.S. patent application number 11/179215 was filed with the patent office on 2006-01-19 for tissue stapling method and tissue stapler.
This patent application is currently assigned to Olympus Corporation. Invention is credited to Yuta Okada, Ryuta Sekine.
Application Number | 20060011698 11/179215 |
Document ID | / |
Family ID | 34937855 |
Filed Date | 2006-01-19 |
United States Patent
Application |
20060011698 |
Kind Code |
A1 |
Okada; Yuta ; et
al. |
January 19, 2006 |
Tissue stapling method and tissue stapler
Abstract
A position information transmitting member for transmitting
position information to a staple receiving portion is provided in a
tissue stapler having a staple receiving portion which comprises
the anvil of the stapler. Thereby, an operator can easily locate
the position of and grasp the staple receiving portion located
within a tissue to swiftly execute stapling. The tissue stapler
includes a stapling portion provided with an endoscope inserting
tube path, a stapling portion provided with a staple injecting
portion arranged on a distal end side of the inserting portion, and
a staple receiving member (anvil) arranged separately from the
inserting portion, to be grasped by a treatment tool introduced via
the inserting portion in a state when it is opposed to the stapling
portion via a tissue, to bend a distal end portion of a staple
pressed out from the staple injecting portion of the stapling
portion which has penetrated through the tissue.
Inventors: |
Okada; Yuta; (Hachioji-Shi,
JP) ; Sekine; Ryuta; (Koganei-shi, JP) |
Correspondence
Address: |
OSTROLENK FABER GERB & SOFFEN
1180 AVENUE OF THE AMERICAS
NEW YORK
NY
100368403
US
|
Assignee: |
Olympus Corporation
|
Family ID: |
34937855 |
Appl. No.: |
11/179215 |
Filed: |
July 12, 2005 |
Current U.S.
Class: |
227/175.1 |
Current CPC
Class: |
A61B 17/1114 20130101;
A61B 2017/320052 20130101; A61B 17/07207 20130101; A61B 2017/2905
20130101; A61B 17/115 20130101; A61B 2017/2926 20130101; A61B
2017/00398 20130101; A61B 2017/306 20130101 |
Class at
Publication: |
227/175.1 |
International
Class: |
A61B 17/04 20060101
A61B017/04 |
Foreign Application Data
Date |
Code |
Application Number |
Jul 14, 2004 |
JP |
2004-207740 |
Claims
1. A tissue stapler comprising: an inserting portion provided with
an endoscope inserting tube path; a stapling portion provided with
a staple injecting portion arranged at a distal end of the
inserting portion; a staple receiving member arranged separately
from the inserting portion and structured for being grasped by and
fixed to a treatment tool introduced through the inserting portion
in a state of being opposed to the stapling portion via a body
tissue, the staple receiving member being formed to bend a distal
end portion of a stapling staple member pressed out from the staple
injecting portion of the stapling portion and penetrating through
the tissue; and a position information transmitting member provided
at the staple receiving member for transmitting position
information.
2. The tissue stapler according to claim 1, further comprising: a
position detecting member for detecting a position of the staple
receiving member by receiving the position information from the
position information transmitting member; and a guiding member for
guiding the staple receiving member based on detected information
of the position detecting member.
3. The tissue stapler according to claim 2, wherein the position
detecting member is arranged to be detected by at least one of an
endoscope introduced via the inserting portion and the treatment
tool, and wherein the guiding member comprises the treatment tool
introduced via the inserting portion or the endoscope.
4. The tissue stapler according to claim 2, wherein at least one of
the position detecting member and the guiding member includes an
endoscope and the treatment tool introduced transabdominally.
5. The tissue stapler according to claim 1, wherein the staple
receiving member is structured to be grasped by and fixed to the
treatment portion using a magnetic force.
6. The tissue stapler according to claim 1, wherein the stapling
portion includes a cutting member for cutting an inner peripheral
portion of the staple injecting portion.
7. The tissue stapler according to claim 1, wherein the staple
receiving member includes a main body thereof provided with a
grasped portion having a diameter smaller than that of the stapling
portion, a plurality of arm portions coupled with the main body and
structured to be able to be folded in an inactivated state, and to
expand when grasped at the grasped portion, to positions juxtaposed
to the stapling portion.
8. The tissue stapler according to claim 1, wherein the stapling
portion is provided with a plurality of the staple injecting
portions arranged in a substantially ring shape.
9. A staple receiving member of a tissue stapler comprising: a
position information transmitting member for outputting
electromagnetic waves for informing its position to another
device.
10. The staple receiving member according to a tissue stapler
according to claim 9, wherein the position information transmitting
member outputs light as the electromagnetic waves.
11. The staple receiving member of a tissue stapler according to
claim 9, further comprising: a shaft member structured to be
grasped by a treatment tool and including the position information
transmitting member thereat.
12. The tissue stapler according to claim 1, wherein the stapling
portion comprises a grasping piece made of first and second
pivotably arranged arms which are openable and closeable to grasp
the staple receiving member.
13. The tissue stapler according to claim 1, further comprising a
rotating member for rotating a portion of the stapling portion
relative to the staple receiving member.
14. The tissue stapler according to claim 1, further comprising a
suction arrangement for creating suction in an area between the
stapling portion and the staple receiving member to draw the body
tissue therebetween for being thereafter clamped and stapled.
15. The tissue stapler according to claim 1, wherein the stapling
portion comprises staples that are peripherally and spacedly
arranged relative to one another and the staple members being
oriented at an angle relative to the axial direction of the
stapling portion.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This application is based upon and claims the benefit of
priority from prior Japanese Patent Application No. 2004-207740,
filed Jul. 14, 2004, the entire contents of which is incorporated
herein by reference.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to a tissue stapling method
and a tissue stapler. A tissue stapler is used when, for example,
the intraluminal organ of the esophagus, the stomach or the like is
subjected to an anastomosis or a fixing treatment during surgery or
the like.
[0004] 2. Description of the Related Art
[0005] Tissue staplers have been known in the related art. A tissue
stapler is used in anastomosing end portions of the normal
intraluminal organ after or before cutting off a morbid or diseased
portion of the intraluminal organ of, for example, the large
intestine, or the small intestine, or in anastomosing side portions
of the stomach and the small intestines. Such a tissue stapler can
considerably shorten an operation time period by stapling the
tissue with a plurality of staples, arranged in a ring-like shape
and simultaneously cutting off a substantially central portion of
the tissue stapled along the ring-like shape.
[0006] Such a tissue stapler is provided with a stapling portion
arranged with a plurality of staples at a distal end of an
inserting portion that is inserted into the intraluminal organ, and
a distal end portion of the stapling portion is attachably and
detachably integrated with an anvil which provides a tissue fixing
portion. The anvil is able to staple the tissue by pressing a foot
portion of the staple into contact with the staple projected from a
stapling portion. Further, a control section is provided on a
proximal side of the inserting portion of the tissue stapler.
[0007] Recently, there has been proposed an inserting portion to be
inserted into the intraluminal organ formed to provide flexibility
in consideration of insertability into a deep portion of the
intraluminal organ, or promoting insertability by arranging an
observing optical system at a distal end thereof (refer to, for
example, JP-A-2003-111763, U.S. Pat. No. 5,411,508).
[0008] Further, when the intraluminal organs are anastomosed by
using the tissue stapler with the promoted insertability of the
inserting portion, the inserting portion and the anvil are inserted
into the intraluminal organ orally or via the anum. Further, the
intraluminal organs are anastomosed at an aimed position in the
coelom of the intraluminal organ by confirming a distal end
position of the inserting portion and a position of the anvil used
in combination with the inserting portion and controlling the
movement of at least one of them.
[0009] Hence, in addition to anastomosis being assisted by a rigid
scope and forceps, recently there has also been proposed a tissue
stapler constituted to facilitate operability by opposedly
arranging magnets at the anastomosing portion and the anvil to
enable their positioning proximate to each other by a magnetic
force (refer to, for example, U.S. Pat. No. 5,411,507).
[0010] However, although observing optical systems are disclosed in
the tissue staplers of JP-A-2003-111763 and U.S. Pat. No.
5,411,508, the apparatus parts, per se are disposed in the
intraluminal organ and therefore, in order to execute anastomosis
while attracting the organs disposed at positions remote from each
other in the coelom, there is need for assistance by a rigid scope
and forceps which are transabdominally inserted (introduced).
Further, even on the premise of the transabdominal approach, the
position of the distal end of the tissue stapler and the position
of the anvil disposed in the intraluminal organ need to be
confirmed by the rigid scope and grasped to be guided by the
grasping forceps and therefore, there is a drawback that handling
is awkward.
[0011] Further, the tissue stapling system of U.S. Pat. No.
5,411,507 is not useful when the tissues to be anastomosed are not
disposed proximate each other, necessitating assistance of a rigid
scope and a grasping forceps which are transabodomnally inserted.
This constitutes a substantial drawback.
[0012] The invention has been made in view of the above-described
observations and it is an object of the invention to provide a
tissue stapler of improved handling operability.
BRIEF SUMMARY OF THE INVENTION
[0013] In a staple receiving portion (anvil) of a tissue stapler,
the invention features providing a position information
transmitting member for transmitting position information.
[0014] An embodiment of the tissue stapler includes an inserting
portion provided with an endoscope inserting tube path, a stapling
portion provided with a staple injecting portion arranged on a
distal end side of the inserting portion, and a staple receiving
member (anvil) arranged separately from the inserting portion. The
staple receiving member is grasped by a treatment tool introduced
via the inserting portion in a state where it is juxtaposed to the
stapling portion. The staple receiving member is capable of folding
(bending) a distal end portion of a staple member penetrating
through the tissue, which staple member protrudes from the staple
injecting portion of the stapling portion.
[0015] According to the above-described constitution, by detecting
the position information transmitted from the position information
transmitting member at the staple receiving portion, an operator
can obtain the position of the staple receiving member in the
tissue. Therefore, the operator can grasp the staple receiving
portion by operating a treatment tool inserted into the inserting
portion based on the position information. Therefore, stapling can
be finished conveniently and easily without depending on hunch, and
in a swift manner.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] These and other features, aspects and advantages of the
apparatus and methods of the present invention will become better
understood with regard to the following description, appended
claims, and accompanying drawings, where:
[0017] FIG. 1 is a perspective view showing a tissue stapler
according to a first embodiment of the invention;
[0018] FIG. 2 is a perspective view showing an anvil and a stapling
portion of FIG. 1;
[0019] FIG. 3 is a perspective view showing a shaft member of the
anvil of FIG. 1;
[0020] FIG. 4 is a perspective view showing a portion of an anvil
grasping piece of FIG. 1;
[0021] FIG. 5 is a view showing a state of inserting the anvil and
the stapling portion of FIG. 1 into the tissue;
[0022] FIG. 6 is a view showing a state of grasping the anvil by
the anvil grasping piece via the tissue follows the state of FIG.
5;
[0023] FIG. 7 is a view showing a state of grasping the anvil by
the anvil grasping piece via the tissue follows the state of FIG.
6;
[0024] FIG. 8 is a view showing a state of subjecting the tissue to
the stapling and anastomosing treatment follows the state of FIG.
7;
[0025] FIG. 9 is a view showing a state of separating the stapled
portion from a state of finishing to staple and the tissue
anastomose of FIG. 8;
[0026] FIG. 10 is a view showing another example of an anvil
grasping portion applied to the first embodiment;
[0027] FIG. 11 is a view showing another example of the anvil
grasping portion applied to the first embodiment;
[0028] FIG. 12 is a view showing a state of grasping to fix the
tissue of FIG. 11;
[0029] FIG. 13 is a view showing another example of the anvil
grasping portion applied to the first embodiment;
[0030] FIG. 14 is a view showing a grasping and fixing state of
FIG. 13;
[0031] FIG. 15 is a perspective view showing a portion of a tissue
stapler according to a second embodiment of the invention;
[0032] FIG. 16 is a view showing a state of stapling the tissue
according to FIG. 15;
[0033] FIG. 17 is a view showing a state before stapling tissue by
a stapling portion of FIG. 15;
[0034] FIG. 18 is a view showing a state of stapling the tissue of
FIG. 17;
[0035] FIG. 19 is a view sectioning to show a portion of an anvil
of a tissue stapler according to a third embodiment of the
invention;
[0036] FIG. 20 is a view showing a state of expanding an anvil arm
of the anvil of FIG. 19;
[0037] FIG. 21 is a view showing an initial state of grasping to
fix the tissue by an anvil grasping piece on a side of a stapling
portion of the anvil of FIG. 19;
[0038] FIG. 22 is a view showing a state of grasping the anvil of
FIG. 21 by the anvil grasping piece;
[0039] FIG. 23 is a view showing a state of grasping to fix the
anvil of FIG. 21 by the anvil grasping piece;
[0040] FIG. 24 is a view showing a state of subjecting the tissue
to the stapling and anastomosing treatment from the state of FIG.
23;
[0041] FIG. 25 is a view showing other example of an anvil used in
a tissue stapler according to a third embodiment of the
invention;
[0042] FIG. 26 is a view showing a reference example of a tissue
stapler according to the invention;
[0043] FIG. 27 is a view showing a state of the tissue stapler of
FIG. 26 before stapling the tissue;
[0044] FIG. 28 is a view showing a state of finishing to staple the
tissue of FIG. 27;
[0045] FIG. 29 is a view showing another reference example of a
tissue stapler according to the invention;
[0046] FIG. 30 is a view showing a state of restraining a staple
member of FIG. 29; and
[0047] FIG. 31 is a view that explains a procedure of stapling the
tissue of FIG. 29.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0048] An embodiment of the invention will be described below with
reference to the accompanying drawings.
[0049] FIG. 1 shows a tissue stapler according to the first
embodiment of the invention. The tissue stapler includes an anvil
12 which is a staple receiving member arranged separately from a
stapler main body 2.
[0050] The stapler main body 2 is provided with a stapling portion
4 on a distal end side of an inserting portion 3 and provided with
a proximal side control section 5 on a proximal side of the
inserting portion 3. The inserting portion 3 is formed with an
endoscope inserting tube path 6 from the stapling portion 4 to the
hand-held control section 5 substantially on an axial portion
thereof (refer to FIG. 2) and the endoscope inserting tube path 6
is inserted with an endoscope 7. A treatment tool inserting tube
path 8 of the endoscope 7 accommodating a treatment tool, for
example, an anvil grasping piece 11, and the anvil 12 is detachably
grasped by an anvil grasping portion 9 at a distal end of the anvil
grasping piece 11. The anvil grasping piece 11 is arranged with a
proximal side control section 10 on a proximal side and the
proximal side control section 10 is operably located on a proximal
side of the inserting portion 3.
[0051] The stapling portion 4 is inserted with a staple container
41 that is substantially hollow, and a distal end face of the
staple container 41 is provided with a plurality of staple
containing holes 20 in double rows, in a ring-like shape (refer to
FIG. 2). The staple containing holes 20 are equipped with staples
21, each of which has a substantially horseshoe shape. As shown,
the plurality of staple containing holes 20 are arranged
alternately on an inner peripheral side and on an outer peripheral
side in the ring-like shape aligned in double rows.
[0052] Further, the staple container 41 is provided with a cutter
member inserting hole 22 in a ring-like shape in parallel with the
staple containing hole 20 on an inner peripheral side of the staple
containing hole 20. Further, a moving member 23 substantially in a
cylindrical shape is movably inserted into the staple container 41
along the axis of the endoscope inserting tube path 6. On end of
the proximal side of the moving member 23 is provided with a female
screw portion 24, and the screw portion 24 is screwed with a screw
member 27. The screw member 27 is connected to a motor unit 15
(refer to FIG. 1), described later, via a cable 28. When the motor
unit 15 is driven, a rotational force thereof is transmitted via
the cable 28 to adjust the position of the moving member 23 to move
the moving member 23 in an axial direction.
[0053] The other end of the moving member 23 is provided with a
plurality of staple extruding members 25 each substantially in a
plate-like shape having a width and a thickness insertable into the
staple containing hole 20 at positions corresponding to the
respective staple containing holes 20. When the moving member 23 is
maximally moved rearward to the proximal side, a distal end of the
staple extruding member 25 is disposed at a proximal side end of
the staple containing hole 20. Further, in a state of maximally
moving forward the moving member 23 to a distal end side, the
moving member 23 is urged to move the staple extruding member 25 in
the same direction to contact the staple 21 to extrude the staple
21 from a distal end face of the staple containing hole 20.
[0054] Further, in an inner side of the staple extruding member 25,
there is provided a cutter member 26 having a cylindrical shape
entirely surrounding the endoscope inserting tube path 6. A blade
tip of the cutter member 26 is contained in the staple containing
member 41 of the stapling portion 4 when the moving member 23 is
positioned in the most proximal position, and is projected from an
distal end face of the stapling portion 4 when the moving member 23
is in the most distal position.
[0055] The anvil 12 includes an anvil main body 42 and a shaft
member 16, and the shaft member 16 is formed to have an outer
diameter insertable into the endoscope inserting tube path 6. The
shaft member 16 is provided with a shaft 30 (refer to FIG. 3)
extending from the anvil main body 42, and a distal end side of the
shaft 30 is formed with a distal end grasped portion 32
substantially in a spherical shape. Further, a proximal end side
(rear end side) of the distal end grasped portion 32 is formed with
a fitting groove 33 over an entire periphery of the shaft 16, and
the anvil grasping portion 9 detachably grasps at the fitting
groove 33.
[0056] Further, the shaft 30 is covered with a shaft cover member
31 from a rear portion of the fitting groove 33 to the anvil main
body 42. The shaft cover member 31 is provided with a transparent
portion 35 at a vicinity of a fitting groove 33, and the shaft 30
inside of the transparent portion 35 is provided with a light
emitting member 34 of, for example, an LED or the like constituting
a position information transmitting member. The light emitting
member 34 is electrically connected to a power source member (not
shown) provided in the anvil main body 42 via a cable 36 and emits
light by being energized with a power source member (not
shown).
[0057] The anvil main body 42 is provided with a plurality of
recess portions 17 for underfolding (bending) staple feet arranged
substantially in a ring-like shape in double rows at positions
opposed to the staple containing holes 20 of the stapling portion
4. Further, a cutter member receiving slit 18 substantially in a
ring-like shape is provided at a position opposed to the cutter
member 26 of the stapling portion 4. Further, the anvil main body
42 is provided with a tissue receiving portion 19 for receiving a
tissue to be cut off, surrounding a proximal end of the shaft
member 16. The anvil main body 42 is provided with a guide wire
inserting hole 39a (through hole) connecting a distal end side
thereof and the tissue receiving portion 19 (refer to FIG. 2).
[0058] Further, the proximal side control section 5 is extended
with a cable tube 14 via an anti-folding member 13, an end portion
of the cable tube 14 is electrically connected to the motor unit
15. A motor (not shown) is accommodated in the motor unit 15 and a
rotational force of the motor is transmitted to the cable 28. The
cable 28 is provided inside of a cable tube path 29 connecting the
cable tube 14 and the stapling portion 4, and connected to the
screw member 27 for transmitting the rotational force.
[0059] The anvil grasping piece 11 is provided with the anvil
grasping portion 9 to grasp and release the anvil 12 at the distal
end thereof. As shown FIG. 4, the anvil grasping portion 9 is
provided with a pair of grasping arms 38 substantially in a hollow
shape openably and closably pivoted on a shaft 37 provided at a
distal end of the inserting portion 3, and distal end portions of
the grasping arms 38 are provided with a grasping groove 39 which
forms an opening in a closed state of the grasping arms 38. When
the grasping arms 38 are closed, the grasping groove 39 is fitted
with the fitting groove 33 of the anvil 12. The pair of grasping
arms 38 of the anvil grasping portion 9 are connected to the
proximal side control section 10 arranged on the proximal side of
the inserting portion 3 by a link mechanism (not shown) and an
operating wire (not shown). The grasping arms 38 are operated to
open and close via the operating wire and the link mechanism by an
open-close operation of the proximal side control section 10.
[0060] In the above-described configuration, when a tissue, for
example a large intestine, is partially cut off to be stapled, an
operator initially inserts a guide wire 45 to a deep portion of the
large intestine 46 per anum as shown in FIG. 5. Further, the
operator inserts the anvil 12 passed through the guide wire
inserting hole 39a from the anus side end of the guide wire 45 to a
position beyond a morbid portion 73 following the guide of the
guide wire 45. Next, the operator inserts the inserting portion of
the stapler main body 2 with the endoscope 7 inserted in the
endoscope inserting tube path, into the large intestine 46 per
anum. The endoscope, as a position detecting device, reaches near
the morbid portion 73 and stops at the anum side thereof in the
intestine 46.
[0061] At this point, the operator confirms the positions of the
anvil 12 and the inserting portion 3 of the stapler main body 2 by
a rigid scope 47 inserted transabdominally. At this time, since the
light emitting member 34 in the shaft 30 and the endoscope 7
inserted into the inserting portion 3 are emitting light, the
position of the anvil 12 is determined by observing the light
through enteron wall of the large intestine 46. Thus the light of
the anvil provides position information.
[0062] Further, while the operator is grasping a vicinity of the
morbid portion 73 of the large intestine 46 with a grasping forceps
74 which is a guiding member inserted into the coelom
transabodominally and moving the grasping portion to one side, the
operator drags the anvil 12 to a vicinity of the stapling portion 4
of the inserting portion 3 by the other grasping forceps 48.
[0063] Thus, a side face and another side face of the large
intestine 46 near each other as the intestine forms a loop, and the
anvil 12 and the stapling portion 4 of the inserting portion 3 come
closer to each other. The operator detects light emitted from the
light emitting member 34 of the anvil 12 with the endoscope 7 by
reducing an emitted light amount of the rigid scope 47 in a state
of making the anvil 12 and the stapling portion 4 proximate to each
other. When the shaft 30 is grasped by the anvil grasping piece 11
with the enteron wall using the light as a guide, the distal end
grasped portion 32 of the anvil 12 is contained in the hollow
portion of the grasping arms 38 and the grasping groove 39 of the
grasping arms 38 are fitted together with the fitting groove 33.
Thereby, the distal end grasped portion 32 is firmly grasped are
held by the anvil grasping piece 11 (refer to FIG. 6 and FIG.
7).
[0064] Next, the operator drags the endoscope 7 and the anvil
grasping piece 11 into the endoscope inserting tube path 6, while
grasping the anvil 12 along with the large intestine 46. This
interposes the large intestine wall of two layers between the anvil
12 and the stapling portion 4 of the inserting portion 3. At this
point, the cable 28 is rotated by driving the motor unit 15. Then,
the rotational force of the cable 28 is transmitted to the screw
member 27, the screw member 27 is driven to rotate and the moving
member 23 is moved linearly in the direction of the distal end.
[0065] As a result, the moving member 23 pushes the staple
extruding member 25 in the distal direction, which extrudes the
staple 21 from the staple containing hole 20.
[0066] Then, the distal end portion of the staple 21 pierces
through the intestine wall of two layers and press contacts with
the recess portion 17 of the anvil main body 42. Thereby, the foot
of the staple is underfolded to an inner side along the shape of
the recess portion 17 to staple the large intestine wall. Further,
the cutter member 26 projects from the stapling portion 4
responsive to the moving member 23 to cut the large intestine wall
to form the anastomosed opening portion 49. At this point, the
blade tip is received in the cutter member receiving slit 18. The
tissue cut off by the cutter member 26 is captured in the tissue
receiving portion 19.
[0067] At a stage of finishing to staple and cut off the large
intestine wall in this way, the anvil grasping piece 11 is
temporarily moved forward to form a gap between the anvil 12 and
the stapling portion 4, then the large intestine 46 stapled by the
staple 21 is released, thereafter, the inserting portion is drawn
out (refer to FIG. 8).
[0068] Thus, the large intestine 46 substantially formed in the
loop shape has, the side faces of the enteron anastomosed,
incorporating the morbid portion 73 in the loop portion. The
operator cuts off and staples each root portion of the loop by a
tissue staple remover 43 inserted into the enteron transabdominally
(refer to FIG. 9).
[0069] Although an explanation has been given of a procedure of
cutting off a large intestine portion, the operation is not limited
thereto but can similarly be carried out to staple other tissue
types. That is, the operator inserts the anvil 12 constituting the
staple receiving member provided with the light emitting member 34
constituting a position information transmitting member into the
first tissue and inserts the inserting portion 3 into the second
tissue. According to the described embodiment, the inserting
portion 3 includes the stapling portion 4, integrated with the
anvil 12, provided with the plurality of staple injecting portions
substantially in the ring-like shape and the endoscope 7 with the
anvil grasping piece 11 is inserted into the inserting portion
3.
[0070] Next, the operator determines the position of the anvil 12,
by detecting the position information from the light emitting
member 34 of the anvil 12, using at least one of, for example, the
endoscope 7 inserted into the inserting portion 3 or the anvil
grasping piece 11 mounted to the endoscope 7, or the rigid scope 47
inserted transabdominally. Further, the anvil 12 is grasped by the
anvil grasping piece 11 via the first and the second tissue, being
guided by the anvil grasping piece 11 or the grasping piece
inserted transabdominally, for example, by the grasping forceps 48
serving as a guiding member. Thereafter, the operator performs the
stapling treatment by the stapling portion 4 of the inserting
portion 3 and the anvil 12.
[0071] Further, although in the above-described stapling treatment
procedure, an explanation has been given of a case in which the
transabdominally inserted rigid scope 47 and the grasping forceps
48 are used as the position information detecting member for
detecting the position information from the anvil 12 and as the
guiding member for guiding the anvil 12 based on the detected
position information, the procedure is not limited thereto. For
example, the guiding members may be constituted by using the
endoscope 7 mounted to the inserting portion 3 and the anvil
grasping piece 11.
[0072] As described above, the tissue stapler is constituted such
that the anvil 12 is arranged with the light emitting member 34 and
the anvil 12 is grasped to be attached to the stapling portion 4 by
the anvil grasping piece 11 of the endoscope 7 inserted through the
inserting portion 3 by specifying the position of the anvil 12
based on the position information from the light emitting member
34.
[0073] Thus, high accuracy guiding can be obtained by detecting the
position information of the anvil 12 by the rigid scope 47 inserted
transabdominally and using the grasping forceps 48, similarly
inserted, and the anvil can firmly be grasped to be fixed swiftly
and easily.
[0074] For example, under the assistance of the grasping forceps
48, by having the anvil 12 located in the tissue such as a large
intestine lumen approach to the stapling portion 4 of the inserting
portion 3, the operator can identify the anvil 12 transabdominally
with the endoscope and easily execute an anastomosis operation.
[0075] Further, the lumen of the large intestine or the like can be
cut off and anastomosed without cutting the enteron wall and highly
reliable and highly accurate cutting and anastomosing treatment can
be carried out.
[0076] Further, the structure of an anvil grasping portion of the
anvil grasping piece 11 mounted to the endoscope 7 is not limited
to a constitution described above. Rather, the structure is
similarly effective even when constituted as shown by FIGS. 10, 11,
12, 13 and 14. In FIG. 10 through FIG. 14, the same portions as
those of FIG. 1 through FIG. 9 are annotated with the same
reference characters and the explanation thereof is omitted.
[0077] According to the structure of the anvil grasping portion of
FIG. 10, an anvil grasping portion 50 comprises an operating wire
51 connected to the proximal side control section 10 and inserted
into a distal end portion of a sheath 52, and a pair of grasping
arms 54 are arranged openably and closably at a distal end portion
of the operating wire 51. The pair of grasping arms 54 are arranged
expandably in a state of being projected from the distal end
portion of the sheath 52, and distal end sides thereof are provided
with grasping grooves 53 having an opening diameter portion capable
of being fitted to the fitting groove 33 of the shaft 30 of the
anvil 12 and hollow portions 55 for accommodating the distal end
grasped portion 32 of the anvil 12.
[0078] Further, according to the structure of the anvil grasping
portion of FIG. 11 and FIG. 12, a distal end side of a shaft member
57 of an anvil 56 is provided with a fitting groove 58 and a distal
grasping portion 59 in this order, and a distal end side of the
distal end grasping portion 59 is provided with a magnet member 60
serving also as a position information transmitting member.
Further, a distal end portion of an anvil grasping portion 61 used
in combination with the anvil 56 is provided with a recess portion
62 in correspondence with the fitting groove 58 of the shaft member
57. Further, a magnet member 63 also serving as a position
information transmitting member in cooperation with the magnet
member 60 is accommodated in the recess portion 62 in an axially
movable direction. The magnet member 63 is connected with an
operating wire 64 that can be moved forwardly and backwardly with
the operation of the proximal side control section 10.
[0079] In the above-described constitution, the anvil 56 is
inserted into the lumen of, for example, the small intestine or the
like, the anvil grasping piece 61 is placed proximate to the anvil
56, the operating wire 64 is extruded by operating the proximal
side control section 10, and the magnet member 63 is projected from
the anvil grasping portion 61. Then, the magnet member 63 and the
magnet member 60 of the anvil 56 attract each other magnetically,
to become positioned proximate to each other. At this point, by
drawing the operating wire 64 by operating the proximal side
control section 10 again, the shaft member 57 is drawn into an
inner portion of the anvil grasping portion 61, and the projected
portion 62 is fitted to the fitting groove 58 to become fixedly
grasped thereby (refer to FIG. 12). The magnetic force between the
magnet member 60 and the magnet member 63 increases the grasping
strength and fixing of the anvil.
[0080] According to a structure of an anvil grasping portion of
FIG. 13 and FIG. 14, the anvil grasping portion 65 comprises an
operating wire 68 connected to the proximal side operating portion
10, inserted into an operating tube 67. The operating tube 67 is
movably inserted into an inserting sheath 66, to move axially
therein. Further, a distal end of the operating tube 67 is provided
with a pair of grasping arms 71 that are capable of being opened
and closed, when the arms project from the inserting sheath 66.
Distal ends of the grasping arms 71 are provided with grasping
grooves 69 having a diameter of an opening fitted to the fitting
groove 58 of the shaft member 57 (refer to FIG. 11), and hollow
portions 70 for accommodating the distal end grasping portion
59.
[0081] Further, a magnet 72 is provided at a distal end of the
operating wire 68, in correspondence with the magnet 60 of the
shaft member 57 of the anvil 56, in a manner that enables it to be
extracted and retracted from and to the distal end of the inserting
sheath 66 by being moved in the axial direction inside of the
inserting sheath 66 along with the operating tube 67.
[0082] In the above-described embodiment, the operator first places
the anvil holding portion 65 proximate to the anvil 56 inserted
into the lumen, for example, the small intestine or the like
extruding the operating tube 67 and the operating wire 68 by
operating the proximal side control section 10. Then, the magnet 60
of the anvil 56 and the magnet 72 of the operating wire attract and
approach each other is magnetically.
[0083] The operating wire 68 is then drawn into the operating tube
67, and the operating tube 67 is drawn into the inserting sheath
66. Then, the grasping arms 71 are closed through the above drawing
operations, and the grasping grooves 69 become fitted to the
fitting groove 58 of the shaft member 57 of the anvil 56 and the
anvil 56 is fixedly grasped by the anvil grasping portion 65.
[0084] Further, although the embodiment has been explained for the
case where the position information transmitting member utilizes
the light emitting member 34 and the magnetic force of the magnet
members 60, 63, the utility of the position information
transmitting member is not limited to this precise embodiment. For
example, the position information transmitting member may be formed
to transmit an electromagnetic wave such as visible light or the
like as position information. The position information transmitting
member and a position detecting member for detecting the position
information may be a device that converts electric energy into
visible light or the like, for example, a semiconductor LED or
organic EL, a semiconductor laser, a device that emits light by a
chemical reaction using luminol, or a fluorescent substance
emitting fluorescence light induced by light emitted from the
endoscope.
[0085] Luminescence of green color or blue color is particularly
effective, since the luminescence of these colors is easy to detect
in the coelom.
[0086] Further, the emitted light energy is not limited to visible
light, but may be, for example, radio wave, X-ray, gamma ray or the
like having extremely shorter wavelengths, or infrared radiation
having a longer wavelength. Further, the transmitted energy may be
radiated as wave energy or as supersonic, acoustic energy, or the
like. Detecting the position information can be effected, other
than through detection of light by CCD or the like provided at a
distal end of the endoscope. Thus, the method of detecting radio
wave by an antenna, detecting a magnetic field by a Hall element or
the like, detecting radioactive ray by a scintillator, detecting
supersonic wave by a transducer or the like can be utilized.
[0087] Although the first embodiment has been explained for the
case in which the anvil grasping piece 11 as a treatment tool is
inserted into the inserting portion 3 via the endoscope 7, the
first embodiment is not limited thereto. For example, the anvil
grasping piece 11 can be directly inserted into the endoscope
inserting tube path 6 of the inserting portion 3.
[0088] FIG. 15 and FIG. 16 show a main portion of a tissue stapler
according to a second embodiment of the invention. FIG. 15 shows a
grasping state and FIG. 16 shows a stapling state. FIG. 15 and FIG.
16 also show previously described portions identified by the same
reference numerals.
[0089] That is, a stapling portion 76 is provided at the distal end
portion of the inserting portion 3 and is inserted with a staple
container 77 substantially in a ring-like shape. A distal end face
of the staple container 77 is provided with a plurality of staple
containing holes 78 arranged in double rows in a ring-like shape.
The staple containing holes 78 are provided such that positions of
the holes are alternate to each other on an outer side and an inner
side. A proximal side end of the staple container 78 is provided
with a staple slide slit 79 in a ring-like shape in the form of
following the staple containing holes 78 as shown by FIG. 17 and
FIG. 18.
[0090] The staple containing holes 78 contain the staples 80 bend
in a horseshoe-like shape. The proximal sides of the staples 80 are
opposedly arranged with staple extruding members 84. The staple
extruding member 84 is provided with a projected portion 82 brought
into contact with the staple 80 and brought into contact with a
projected portion 81 provided on a proximal side of the staple
containing hole 78. The staple extruding member 84 is also provided
with a projected portion 83 projecting into the staple side slit 79
on a proximal side of the projected portion 81. The projected
portion 83 of the staple extruding member 84 is provided with an
inclined face.
[0091] Further, the staple containing member 77 is provided with a
cutter member inserting hole 85 substantially in a ring-like shape
on an inner peripheral side of the staple containing hole 78.
Further, a proximal side of the staple container 77 is arranged
with a rotating member 86 substantially cylindrically shaped and
having a plane at a distal end side thereof, the rotating member
can rotate around the axis of the endoscope inserting tube path 6.
A distal end face of the rotating member 86 is provided with a
staple slider 87 substantially in a plate-like shape. A distal end
portion of the staple slider 87 is provided with an inclined face,
and the inclined face is designed to contact with the inclined face
of the projected portion 83 (refer to FIG. 17). Further, an inner
peripheral side of the staple slider 87 is provided with a cutter
member 88 substantially in a shape of a thin plate. A blade tip of
the cutter member 88 is projected from the staple containing member
77 to a distal end side, being inserted through the cutter member
inserting hole 85.
[0092] A proximal side of the rotating member 86 is substantially
cylindrical in shape, and an inner wall side thereof is provided
with a gear (not shown). A gear member 89 is meshed with the gear
(not shown). A drive gear 90 is brought in mesh with the gear
member 89. The drive gear is connected to the motor unit 15 via a
cable 91, and is driven to rotate by the driving force transmitted
via the cable 91 from the motor unit 15.
[0093] A distal end side of the staple container 77 is covered with
a cover member 92. The cover member 92 is provided with a plurality
of staple inserting holes 93 in double rows substantially in a
ring-like shape at positions opposed to the staple containing holes
78. An inner peripheral portion of the staple inserting holes 93 is
provided with a center hole 94, corresponding to the cutter
inserting hole 85. Further, in an interval between the cover member
92 and the staple container 77, a spring member 95 is engagingly
provided to push the cover member 92 to the distal direction
relative to the staple container 77. The cover member 92 is not
detached from the staple container 77 because a projection provided
on an inner wall of the proximal side of the cover member 92 abuts
a projected member 96 of the staple container 77.
[0094] Further, an anvil 98 projects with a shaft member 100
substantially at a central portion thereof, which shaft member is
to be fixedly grasped by an anvil grasping piece 99 inserted
through the endoscope inserting tube path 6. Further, a surrounding
portion of the shaft member 100 is provided with a plurality of
recess portions 101 in double rows substantially in a ring-like
shape at positions opposed to the staple containing holes 78 and
the staple inserting holes 93. Further, a cutter receiving slit 102
is provided at a position opposed to the cutter inserting hole
85.
[0095] Further, although not illustrated in FIG. 15 and FIG. 16,
the anvil 98 is provided with, for example, the light emitting
member 34 as the position information transmitting member, similar
to the shaft member 100, position information being emitted via the
light emitting member 34.
[0096] In the above-described embodiment, when a lumen wall such as
the stomach wall 103 and the small intestine wall 104 are to be
stapled, the operator first positions the stomach wall 103 and the
small intestine wall 104 between the stapling portion 76 and the
anvil 98. This is done by grasping the shaft member 100 of the
anvil 98 by operating the anvil grasping piece 99 integrated to the
endoscope 7 inserted through the inserting portion 3 based on
position information from the anvil 98. In this state, when the
operator drags the anvil grasping piece 99 into the endoscope
inserting tube path 6, the cover member 92 is pressed to the
proximal side against the biasing force of the spring member 95.
Thereby, the blade tip of the cutter member 88 projects from a
distal end face of the cover member 92 through the cutter member
inserting hole 85 and the center hole 94 and is received in the
cutter receiving slit 102 while piercing through the stomach wall
103 and the small intestine wall 104. In this way, the stapling
portion 76, the stomach wall 103, the small intestine wall 104 and
the anvil 98 come into close contact with each other (refer to FIG.
16, FIG. 18).
[0097] At this stage, the operator drives the motor unit 15 of the
inserting portion 3, whereby the drive force of the motor unit 15
rotates the cable 91, to rotate member 86 via the drive gear 90 and
the gear 89. The rotating member 86 moves the staple slider 87 in
sliding contact with the inclined face of the projected portion 83
in the staple slide slit 79 and causes the staple extruding member
84 and the staple 80 to extrude to the distal end side. Then, the
foot portion of the staple 80 pierces the stomach wall 103 and the
small intestine wall 104 by being inserted through the staple
inserting hole 93, and contacts the recess portion 101 of the anvil
98 disposed at a position opposed thereto. The foot portion is bend
to an inner side along the recess portion 101 to staple the stomach
wall 103 and the small intestine wall 104 together.
[0098] At the same time, the staple slider 87 rotates the cutter
member 88 along the cutter inserting hole 85 in accordance with
rotation of the rotating member 86 to cut off the stomach wall 103
and the small intestine wall 104 with the blade tip portion
piercing through the stomach wall 103 and the small intestine wall
104.
[0099] According to the second embodiment, by enabling cutting the
tissue in the ring-like shape by using the cutter member 88
substantially in a plate-like shape, the force exerted on
constituent parts of the staple extruding member 84, the cutter
member 88 and the like and the tissue can be reduced. Therefore,
injury to tissue such as debridement or the like can be prevented.
Further, slender diameter formation of the driving cable 91 and
simplification of the constitution can be achieved with a reduction
in the drive force.
[0100] FIG. 19 shows a main portion of a tissue stapler according
to a third embodiment of the invention, portions previously
described bearing the same reference notations and providing
equivalent function.
[0101] Thus, an anvil 150 has an anvil distal end portion 151 with
a spherical face at one end face of an anvil main body 152 (refer
to FIG. 19 and FIG. 20), a proximal side of the anvil main body 152
constituting the other face which projects to face a shaft member
158 having a distal end grasped portion 159 substantially at a
center portion thereof. Further, a surrounding portion of the anvil
main body 152 is provided with anvil arm accommodating portions 153
in a recess shape at a plurality of portions thereof, for example,
at four portions thereof substantially in a cross-like shape. The
anvil arm accommodating portions 153 are provided with anvil arms
155 constituting staple receivers able to be folded and expanded
via pivoting shafts 154 thereof.
[0102] The anvil arms 155 are respectively attachedly engaged with
wound spring members 157 between the pivoting shafts 154 and
projected portions 156 to exert biasing forces in the expanding
directions, and when the anvil arms 155 expand around the pivoting
shafts by the biasing forces of the wound spring members 157, the
anvil arms 155 project from the anvil main body 152 in the
peripheral directions. Further, the anvil arms 155 can be rotated
reversely against biasing forces of the wound spring members 157 to
be folded and accommodated in the anvil arm accommodating portions
153. Thereby, the outer shape of the anvil 150 becomes
substantially similar to an outer shape dimension of the anvil main
body 152 to be brought into a so-called small diameter
formation.
[0103] The anvil arms 155 are respectively provided with locking
portions 163 in a recess shape on proximal sides thereof, and
projected portions 164 formed radially at one end of an operating
wire 165 are selectively locked by the respective locking portions
163. A middle portion of the operating wire 165 is loosely inserted
into a wire inserting tube path 161 provided at the shaft member
158 movably in the axial direction. A base end portion of the
operating wire 165 is provided with an operating portion 162 and
the operating portion 162 is projected to a slit 160 provided at a
shaft member 158 to be able to be operated to move axially. The
operating wire 165 is subjected to a biasing force in a direction
of the anvil main body via a spring member 166. When the operating
portion 162 is grasped by an anvil grasping piece 170, the
operating portion 162 is moved in the direction of the proximal
side against a biasing force of the spring member 166 and the
plurality of projected portions 164 are respectively detached from
the locking portions 163 of the anvil arms 155.
[0104] Further, although not illustrated in the drawing, the anvil
150 is provided with, for example, the aforementioned light
emitting member 34 as the position information transmitting means
similar to the first embodiment, in correspondence with, for
example, the shaft member 158 so that position information is
transmitted via the light emitting member 34.
[0105] A distal end side of an inserting portion 169 constituting
the tissue stapler is provided with a stapling portion 172. The
stapling portion 172 is provided with, for example, wide portions
172a at four portions thereof substantially in a cross-like shape
in correspondence with the anvil arms 155 of the anvil 150. The
wide portion 172a has a shape corresponding to the state of the
expanding the anvil arm 155, and is provided with, for example, the
staple containing hole 20 and the cutter member inserting hole 22
similar to the first embodiment. Further, the stapling portion 172
is provided with an endoscope inserting tube path 178 similarly
inserted with the endoscope 7 inserted with the anvil grasping
piece 170.
[0106] In the above-described embodiment, the operator inserts the
anvil 150, for example, orally into the small intestine 168 with
the anvil arms 155 folded around the pivoting shafts to be
contained in the anvil arm accommodating portions 153. On the other
hand, the operator inserts the inserting portion 169 into the
stomach 167 constituting the other lumen, for example, orally, by
cutting a portion of the stomach 167 to approach the coelom from an
opening portion 171 thereof (refer to FIG. 21). At this point, the
operator confirms the position of the anvil 150 based on the
position information from the anvil 150 in the small intestine 168,
and cuts a corresponding portion of the small intestine 168. The
operator grasps the anvil shaft member 158 by the anvil grasping
piece 170 along with the distal end grasping portion 159 and an
operating portion 162 of the operating wire 165 (refer to FIG.
22).
[0107] Next, the operator draws the anvil grasping piece 170 into
the inserting portion. Then, the operating portion 162 of the
operating wire 165 is moved to the proximal side by the anvil
grasping piece 170 against the biasing force of the spring member
166 and the projected portions 164 are detached from the locking
portions 163 of the anvil arms 155. Thereby, the anvil arms 155
pivot and expand outwardly around the pivoting shafts due to the
biasing forces of the wound spring members 157, becoming detached
from the anvil arm accommodating portions 153. At the same time,
when the anvil grasping piece 170 is drawn into the inserting
portion 169, the anvil arms 155 of the anvil 150 contact the wide
portions 172a of the stapling portion 172, the stomach wall and the
small intestine wall being interposed therebetween.
[0108] The operator then presses a staple (not illustrated in FIG.
23) from a staple inserting hole 172c of the stapling portion 172
by operating the control section 10 (refer to FIG. 1) of the
inserting portion 169. As a result, a distal end portion of the
extruded staple 21 is pressed into a recess portion (not shown) of
the anvil arm 155, piercing and stapling the stomach wall and the
small intestine wall (refer to FIG. 23). Thereafter, a cutter
member 172e is displayed from a cutter member inserting hole 172d
of the stapling portion 172, and a stapled inner peripheral side
thereof is cut in a ring-like shape and an anastomosed hole 173 is
formed as shown in FIG. 24.
[0109] The third embodiment enables easy insertion of the anvil 150
into the lumen and enables realizing a large diameter stapling,
which enhances the handling operability.
[0110] Further according to the third embodiment, positional
relationship between the stapling portion 172 and the anvil 150 can
be precisely set during stapling. Further, by enabling adjusting
the positional relationship between the stapling portion 172 and
the anvil 150 by twisting the endoscope 7 and the anvil grasping
piece 170, the stapling portion 172 and the anvil 150 can be
grasped more conveniently, easily and accurately.
[0111] Further, the structure of the anvil is not limited as
described above, at it can also take the form shown by Fi.25. In
FIG. 25, portions previously described with reference to FIG. 19
through FIG. 24 bear the same reference numerals and a detailed
explanation thereof will be omitted.
[0112] In FIG. 25, a root end of the shaft member 158 of the anvil
main body 151 includes a projecting fitting portion 158a
substantially hexagonally shaped. Further, the anvil structure
includes a complementary recess fitting portion 172b also
hexagonally shaped and formed on a distal end side of the endoscope
inserting tube path 178 in the stapling portion 172 of the
inserting portion 169. The anvil 150 is fixedly grasped to fit the
recess fitting portion 158a of the anvil main body 151 to the
recess fitting portion 172b. Thereby, the positional relationship
between the anvil 150 and the stapling portion 172 is accurately
set to fix and obtain further improved, excellent effects.
[0113] Next, a fourth embodiment of a tissue stapler is now
described by reference to FIG. 26, which shows a tissue stapler
which includes an inserting portion 112 to be inserted into
substantially flexible tissue, a stapling portion 111 provided on a
distal end side of the inserting portion, an operating portion 113
provided on a proximal side of the inserting portion, and an anvil
portion 114 arranged on a distal end of the stapling portion
111.
[0114] An operating shaft 115 extends on a proximal side of the
anvil portion 114. The operating shaft 115 is arranged to move
forward and rearward in an operating shaft inserting tube path 116
to communicate the stapling portion 111, the inserting portion 112,
and the operating portion 113 from a distal end to a proximal side
thereof. The proximal side projects from the operating portion 13,
and a grasping portion 119 is provided at an end portion on the
proximal side.
[0115] Further, the anvil portion 114 is provided with an endoscope
inserting tube path 121 opened to a distal end side thereof, and
communicating to the proximal side and to the operating shaft 115.
An endoscope 131 is operably insertable through the endoscope
inserting tube path 121. The endoscope inserting tube path 121 is
provided with airtight valves 117, 118 on the distal end side and
the proximal side to provide a predetermined interval therebetween.
Further, the operating shaft 115 is provided with a plurality of
suction holes 120 at a side wall portion, between the anvil portion
114 and the stapling portion 111, in a manner extending to a distal
end side and an end portion on the proximal side, with a suction
mouthpiece 122 communicating with the endoscope inserting tube 121.
The suction mouthpiece 122 is connected with a suction source (not
shown) to provide suction inside the operating shaft via the
suction source.
[0116] The stapling portion 111 is substantially cylindrical at a
distal end side thereof and includes the operating shaft inserting
tube path 116 on a proximal side thereof. Further, the operating
shaft inserting tube path 116 is inserted with the operating shaft
115.
[0117] Further, the stapling portion 111 includes a staple
container 123 with a tube member extending to the proximal
operating portion 113. A distal end of the staple container 123 is
provided with a plurality of staple containing holes 124 in double
rows substantially in a ring-like shape to penetrate the staple
container 123. Staples 125 are respectively contained in the staple
containing holes 124.
[0118] A proximal side of the staple container 123 has a
cylindrical, moving member 126 that is movable forward and
rearward, axially within the operating shaft inserting tube path
116. A distal face of the moving member 126 is arranged with staple
extruding members 127, each substantially in a shape of a thin
plate, at positions opposed to the staple containing holes 124.
Further, at a wall face of a proximal side of the moving member
126, an extruding member 129, communicating from a distal end to a
proximal side of the inserting portion 112, extends to the proximal
side operating portion 113. The extruding member 129 is arranged
movably in an inserting tube path 128, outwardly mounted to the
operating shaft 115.
[0119] Further, an end face on a proximal side of the anvil portion
114 has recess portions 130 at positions opposed to the staple
containing holes 124.
[0120] The operating portion 113 projects to provide a grip member
132 for grasping, a portion of a root of the grip member 132 being
provided with a handle member 134 able to be operated to pivot
centering on a shaft 133. The handle member 134 is coupled with an
operating ring 144 via a link 135. The operating ring 144 is
arranged to move forward and rearward coaxially within the
operating shaft inserting tube path 116 and is attached to the
extruding member 129.
[0121] Further, inside the operating portion 113 there is a
projecting portion 137 of a rod-like shape, projecting from the
proximal side to an inner side. The projecting portion 137 is
opposed to an elastically deformable cantilever spring member 136
provided at a side portion of the operating shaft 115 and is
selectively elastically lockable by the cantilever spring member
136. Further, a spring member 138 is engagingly attached between
the projected portion 137 of the operating shaft 115 and the staple
container 123.
[0122] Further, the operating portion 113 is provided with a switch
hole 139 which is juxtaposed to the cantilever spring member 136,
and the switch hole 139 is provided with a pressable switch 140.
The switch 140 which is juxtaposed to the cantilever spring member
136 of the operating shaft 115, presses the cantilever spring
member 136 by pressing the switch 40 and releases the operating
portion 113 from being locked by the projecting portion 137.
Thereby, the operating shaft 115 is biased to move to a proximal
side by a biasing force of the spring member 138.
[0123] The above-described embodiment describes a tissue stapler
suitable for the so-to-called regurgitant esophagitis used for
forming a valve structure at, for example, a stomach-esophagus
bonding portion 143 which staples the tissue at the cardia.
[0124] Thus, the operator inserts the stapling portion 111 of the
inserting portion 112 including the anvil portion 114 orally to the
stomach-esophagus bonding portion 143 under a field of view of the
endoscope 131 inserted into the operating shaft 115. Next, the
operator extrudes the operating shaft 115 projecting from the
operating portion 113 against the spring member 138. Then, the
anvil portion 114 is projected from the stapling portion 111 to the
distal end side and forms a space as shown by a section of FIG. 26
between the anvil portion 114 and the distal end face of the
stapling portion 111. At this point, the cantilever spring member
136 is brought into contact with the projected portion 137 of the
operating shaft 115 and presses the switch 140 outside of the
operating portion 113 by a distal end portion thereof. At this
point, the operator adjusts the space at a pertinent position of
the stomach-esophagus bonding portion 143 by adjusting the position
of the anvil portion 114 by reversely rotating the endoscope 131
inserted into the stomach 141.
[0125] Subsequently, the operator actuates the suction source (not
shown) connected to the suction mouthpiece 122 provided at the
grasping portion 119 of the operating shaft 115, to provide suction
inside of the operating shaft 115, and the esophagus 142 is drawn
into the space between the anvil portion 114 and the stapling
portion 111 (refer to FIG. 27). The switch 140 of the operating
portion is then pressed, and the operating shaft 115 is moved and
pressed back in the direction of the proximal side by the biasing
force of the spring member 138. The esophagus 142 is pinched
between the anvil portion 114 and the stapling portion 111.
[0126] Next, the handle 134 is gripped and the operating ring 144
is moved in the direction of the distal end side. The extruding
member 129, the moving member 126 and the staple extruding member
127 then move in the direction of the distal end side. At this
stage, the staple extruding member 127 projects the staple 125 from
the staple containing hole 127, whereby the distal end portion of
the staple 125 pierces through the esophagus 142, and contacts the
recess portion 130 of the anvil portion 114. The distal end is
folded to bend to the inner side to staple the esophagus over an
entire periphery thereof (refer to FIG. 28).
[0127] The fourth embodiment enables stapling the esophagus-stomach
bonding portion over the entire periphery, orally and in one
motion. A desired valve can thereby be easily formed at the
stomach-esophagus bonding portion and, therefore, a highly
effective treatment against regurgitant esophagitis is obtained.
Further, by executing stapling with position confirmation using the
field of view of the endoscope, convenient, easy and positive
treatment can be realized.
[0128] FIG. 29 shows a tissue stapler according to a fifth
embodiment, in which an anvil member 176 provided at a distal end
side projects within an operating shaft member 177 on a proximal
side thereof. The anvil member 176 and the operating shaft member
177 are formed with an endoscope inserting tube path 178 from a
distal end side to reach a proximal side. A stapler main body 179
is outwardly mounted to the operating shaft 177 to move axially
forward and rearward, and a staple pressing member 180 is inserted
to an outer peripheral portion of the stapler main body 179 to move
forward and rearward. The endoscope inserting tube path 178 is
inserted with an endoscope 181 and a proximal side thereof is
provided with a proximal side operating portion, not
illustrated.
[0129] An outer peripheral wall of the anvil member 176 is provided
with a plurality of slit portions 182 in a long axis direction
(distal and rear direction) with predetermined intervals
therebetween (refer to FIG. 30). Further, a distal end side of the
stapler main body 179 is provided with a plurality of locking
staple containing slit portions 183 opposed to the slit portions
182 at predetermined intervals therebetween. The locking staple
containing slit portions 183 are fixed to contain end portions of
proximal sides of locking staple members 184 at fixing positions
185 at distal end portions on the proximal sides.
[0130] The locking staple members 184, on the proximal distal ends
thereof are formed with an angle of inclination to open to an outer
side directions of the stapler main body 179. The staple distal end
portions thereof are arranged to be opened to the outer sides of a
distal end portion of the stapler main body 179 and a peripheral
wall of the stapler main body 179. Further, a distal end side of
the staple pressing member 180 is provided with a plurality of
restraining projections 186 contained in the slit portions 182 and
the locking staple containing slit portion 183 are able to move
forward and rearward and are placed at predetermined intervals.
[0131] Further, a distal end portion of the stapler main body 179
is provided with a plurality of staple containing holes 187 between
the locking staple containing slits 183 in correspondence with
recess portions designed to bend staples, not illustrated, formed
at a side face of the anvil member 176 on the proximal side.
[0132] In the above-described embodiment, the operator first brings
the anvil member 176 substantially into contact with the stapler
main body 179 by acting to draw the operating shaft member 177 and
moves the staple pressing member 180 in the direction of the distal
end side. Then, the restraining projections 186 of the staple
pressing member 180 press the locking staple members 184 to be
contained in the slit portions 182 of the anvil member 176.
[0133] In this state, the endoscope 181 is inserted through the
endoscope inserting tube path 178, the whole device being orally
inserted to the esophagus-stomach stapling portion 189 along the
endoscope 181. Successively, the operator forms a space between the
anvil member 176 and the distal end portion of the stapler main
body 179 as shown by a section in FIG. 29 by projecting the
operating shaft member 177 while viewing the endoscope 181 in the
stomach. At this stage, when the operator draws back the staple
pressing member 180 to the proximal side, the locking staple
members 184 are projected to the outer peripheral side of the
staple pressing member 180.
[0134] In this state, as the whole device is pressed to move
forward orally, the locking staple members 184 pierce the muscle
layer of the esophagus 188 (refer to FIG. 31), and subsequently,
the staple pressing member 180 is pressed forward to the stapler
main body 179. Then, by bringing the restraining projection 186 of
the staple pressing member 180 into contact with the locking staple
members 184 to move to the distal end side, the locking staple
members 184 are contained in the locking staple containing slit
portions 183 again. Thereby, the esophagus 188 is drawn into the
space formed between the anvil member 176 and the distal end of the
stapler main body 179. By drawing the operating shaft member 177 in
this state, the esophagus 188 is pinched between the anvil member
176 and the distal end of the stapler main body 179 and by the
subsequent operation of a control section, not illustrated, the
esophagus tissue is stapled substantially over an entire periphery
thereof by staples (not shown) arranged in the stapler main body
179.
[0135] According to the fifth embodiment, the esophagus tissue is
mechanically drawn by the locking staple member 184 in a manner
that enables forming the valve structure at the esophagus-stomach
bonding portion by stapling the esophagus tissue over an entire
periphery through all the layers including the muscle layer. Thus,
a sturdier and longer lasting valve can be provided.
[0136] The above-described embodiments describe the case where the
tissue is stapled over the entire periphery. The embodiments are,
however, not so limited. For example, the position to be stapled
can also be the portion of the esophagus-stomach bonding portion,
such as a third periphery of or a half periphery thereof. Thereby,
for a patient with a comparatively insignificant condition, the
valve structure can be formed over less than the entire periphery.
This is done by reducing a number and the outer diameter of the
locking staple members used for drawing down the stapled portion,
the anvil and the esophagus tissue by correspondingly limiting the
stapled portion. Thus, an outer diameter of the inserting portion
of the tissue stapler can be reduced and the burden on the patient
whose tissue is being stapled can be alleviated.
[0137] While there has been shown and described what are considered
to be preferred embodiments of the invention, it will, of course,
be understood that various modifications and changes in form or
detail could readily be made without departing from the spirit of
the invention. It is therefore intended that the invention be not
limited to the exact forms described and illustrated, but should be
constructed to cover all modifications that may fall within the
scope of the appended claims.
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