JPH0975359A - Ligating and suturing device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a ligating and suturing device capable of surely holding large vascular tissues, such as blood vessels, and has excellent operability. SOLUTION: This ligating and suturing device for ligating the vascular tissues in the celom has an extension part 2 to be inserted into the celom, a clip 10 having a pair of leg parts and a bent part in the central part, a clip holding groove 6 for holding this clip at the front end of this extension part and an operating handle part which exits on the operator side of the extension part and operates to bind the clip. The device includes a cartridge 9 housing the plural clips, a clip extruding member 7 for supplying the clips from the front end of this cartridge 9 to the front end of the clip holding groove 6, a slope 6a for converting the force to extrude the clip at the front end in a front end direction to the force to close the leg parts of the clip and a clip welding and fixing means consisting of a recessed part and projecting part for fixing the mating faces of the closed clip.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a ligating and suturing device for ligating tubular tissues such as blood vessels in the field of surgery.

[0002]

2. Description of the Related Art A device for ligating an annular tissue such as a blood vessel in a body cavity is disclosed in Japanese Patent Publication No. 671818.
In this device, a plurality of resin clips are stored in the extension part, and the clip legs are pushed out by the pusher means that pushes them toward the jaw part to continuously close the clips.

Further, an instrument for simultaneously ligating and cutting a blood vessel is disclosed in USP 3,735,762.
This device is one in which a wire suture is pushed toward the anvil and wrapped around a blood vessel on the anvil to ligate the blood vessel.

In recent years, endoscopic surgery in which an operation is performed by inserting an endoscope, forceps or the like into a body cavity from a small incision in the abdominal wall through a trocar cannula has become widespread. A continuous ligation instrument that can be used for this endoscopic surgery is USP 5,192,2.
88. In this device, a plurality of U-shaped metal clips are housed in an insertion portion, the clips are rotated sideways with a hammer, and then pressed against an anvil to deform the clips to ligate blood vessels.

[0005]

However, since the device of Japanese Patent Publication No. 61-7818 has hooks inside both ends of the legs, the hooks were an obstacle when the blood vessel was placed between the legs. . Furthermore, since the jaw width is small,
There is a problem that the diameter of the blood vessel that can be sandwiched is small for the size of the clip.

The device of USP 3,735,762 can deform the clip with a simple structure, but the space surrounded by the wire suture after the deformation is large and the blood vessel cannot be surely ligated.

In USP 5,192,288, the clip is U
Since the mold is housed as it is and it is necessary to rotate it at the tip of the insertion part, the diameter of the insertion part becomes large, and the blood vessel to be ligated becomes a shadow of the insertion part, resulting in poor operability.

Further, since the clip is closed by plastic deformation or mechanical connection in any of the instruments, a reliable and strong ligation force cannot be obtained.

The present invention has been made in view of the above circumstances, and its purpose is to improve the operability when sandwiching a tubular tissue such as a large blood vessel and arranging a clip around the tubular tissue. An object of the present invention is to provide a ligature and suture device which is excellent and has a simple structure.

[0010]

In order to achieve the above object, the present invention provides an extension part to be inserted into a body cavity, a clip having a pair of legs and a bent part in the central part, and the clip to be extended. A clip holding part to hold at the tip of the part,
In the ligation and suturing device for ligating the tubular tissue in the body cavity, the accommodating means for accommodating the plurality of clips is provided on the proximal side of the extension part, and has an operation handle part for performing an operation of closing the clip, Clip supplying means for supplying the clip from the tip part of the clip accommodating means to the tip of the clip holding part, and force converting means for converting the force for pushing the clip at the tip part in the tip direction to the force for closing the clip leg part, Clip fixing means for fixing the mating surface of the closed clip.

From the clip storing means which is stored with the clip opened, the clip is fed to the tip side by the clip supplying means. The clip moved to the tip side is closed by the force converting means for converting the pushing force in the tip direction into the closing force, and the closed mating surface is fixed by the clip welding fixing means.

[0012]

Embodiments of the present invention will be described below with reference to the drawings.

1 to 10 show a first embodiment. FIG. 1 shows the overall configuration of a ligation instrument, which is composed of a handle portion 1 as an operating portion and an extension portion 2 connected to the handle portion 1 and inserted into a body cavity. The diameter of the extension 2 is preferably φ12 or less, and the cross section is circular.

A substantially V-shaped tip opening portion 3 is provided at the tip of the extension portion 2 so as to face sideways. A channel 4 is provided in the longitudinal direction in the extension portion 2, and the channel 4 communicates with the tip opening portion 3. A probe 5 as a vibration transmitting member connected to an ultrasonic transducer described later in the handle portion 1 is provided in the channel 4 slidably on a long axis. The probe 5 is made of stainless steel,
It is made of duralumin and is a metal such as Ti6A14V. It has a substantially cylindrical shape with a conical tip.

Further, as shown in FIGS.
A clip 10 to be described later is accommodated on the side of the clip holding groove 6 as a passage communicating with the tip opening portion 3 and a pair of pushing members as clip feeding means for pushing the clip 10 to the tip opening portion 3. 7 are provided so as to sandwich the clip holding groove 6.

The clip holding groove 6 has an inclined portion 6a as a force converting means near the tip opening portion 3, and the width of the clip holding groove 6 widens at the inclined portion 6a so that the clip 10 can be easily removed. ing. Here, the angle of the inclined portion 6a with respect to the long axis of the extending portion is preferably 30 ° to 60 °. A cartridge 9 as a clip storing means is provided at the rear part. In the cartridge 9, clips 10 made of a bioabsorbable resin prepared by blending linear polylactic acid or polyglycolic acid or a biocompatible resin such as nylon are arranged in a plurality of rows, and springs are provided from the rear end. It is urged toward the tip side by elastic means such as 9a and pressing means.
At the tip of the cartridge 9, the clip 10 is restrained from moving toward the tip by two locking springs 11a and 11b which are leaf springs.

In the normal state, the locking springs 11a and 11b are fixed so as to partially project into the clip holding groove 6, and are arranged above and below the clip holding groove 6 at intervals of one clip 10. It is fixed one by one.

A cylindrical probe cover 12 is provided in the portion of the probe 5 excluding the tip portion, and an O-ring 13 made of a thermosetting resin made of silicon or Teflon is provided between the probe 5 and the probe 5. . Furthermore, the probe cover 1
A guide member 14 is slidably provided between the channel 2 and the channel 4 of the extension 2.

Here, the shape of the clip 10 will be described with reference to FIG. 8. The clip 10 has a hinge portion 10a composed of a thin portion in the central portion, and the notches on the upper surface and the lower surface of the hinge portion 10a are on the upper surface. It is smaller, and the clip 10 is easily bent to the upper surface side, that is, the probe 5 side. Further, the notch on the upper surface of the clip 10 is preferably U-shaped, and the notch on the lower surface has a gentle, substantially M-shape, and continues to the lower surfaces of both leg portions. One side surface of the notch on the lower surface is 45 ° or less, for example, 30 ° with respect to the upper surface of the clip 10, and the other side surface is 80 ° relative to the upper surface.
The angle is more than °. Further, protrusions 15 are provided on both sides near the hinge portion 10a so as to engage with the tip of the pushing member 7.

Further, a concave portion 10x as a clip fixing means is provided on one of the upper surfaces of both ends of the clip 10 and a convex portion 10y is provided on the other. Further, it is desirable that the side surfaces of the projection 15 and the hinge portion 10a of 80 ° or more be on the tip side. The clip 10 of the present embodiment uses a resin that is stretched and oriented in the longitudinal direction in order to improve the bending resistance of the hinge portion 10a.

As shown in FIG. 3, the push-out member 7 is made of a metal plate material such as stainless steel, has a notch 7a at its tip which engages with a protrusion on the side surface of the clip 10, and has a locking spring at its middle portion. A flange portion 7b is provided for coming into contact with 11b and pushing it up.

As shown in FIGS. 5 and 6, the handle portion 1 has a grip portion 1a, a lever 16 that can be opened and closed, an ultrasonic transducer 17 that can slide, and an extension portion 2 for rotating the extension portion 2. A rotary knob 18 and a cylindrical driving member 19 for sliding the pushing member 7 and the probe 5 are provided. The ultrasonic transducer 17 is connected to an ultrasonic drive circuit 25 and a drive power supply 26, as shown in FIG.

The lever 16 and the drive member 19 are rotatably connected by a link 20. The link 20 is composed of a first link 20a which is a plate-shaped member and a second link 20b having a semicircular cross section, and the second link 20b.
By fitting the inner periphery of the drive member 19 with the small-diameter portion 24, which is a circumferential groove of the drive member 19, the drive member 1 is attached to the handle portion 1.
It is rotatable about the major axis of 9.

A plurality of latches 21 which are elastically movable to the side in the front of the driving member 19 and have a sloped surface at the tip are fixed. The latches 21 are connected to the pushing member 7 and have a ring shape having a flange inside. Can be engaged with the transmission member 22.

A push-out spring 23, which is an elastic member, is provided between the transmission member 22 and the handle portion 1 and biases the transmission member 22 and the push-out member 7 toward the tip side. A coil spring 23a is also indirectly interposed between the drive member 19 and the probe 5.

A probe cover 1 is provided at the rear end of the extension 2.
An elastic resin, which is a sealing means having a hole for the pushing member 7 of 2 to slide, is provided, and the O-ring 13 around the probe 5 prevents the gas flow from the extension 2 into the handle 1. Extension part 2 into the body cavity that is restrained and pneumoperitoneum
The pneumoperitoneum pressure does not decrease even when the is inserted.

Next, the operation of the ligature and suture instrument constructed as described above will be described.

As shown in FIGS. 9 and 10, the extension portion 2 is inserted into the abdominal cavity 33 insufflated by carbon dioxide or the like through the trocar 32. Then, the tubular tissue 34 such as a blood vessel to be ligated is put in the distal end opening 3 of the extension 2.

When the lever 16 of the handle portion 1 is started to be closed, the transmission member 22 and the latch 21 are disengaged from each other by the cam means or the like in the handle portion 1, and the transmission member 22 and the pushing member 7 are moved toward the front end side by the pushing spring 23. Slide it (see Figure 6 (a)).

At this time, in the extension part 2, the cartridge 9
The clip 10 located in front of the engaging member engages with the notch 7a at the tip of the pushing member 7, moves over the locking spring 11a, and moves along the clip holding groove 6 to the inclined portion 6a at the tip (see FIG. 7 (a)). ).

When the front end of the clip 10 contacts the inclined portion 6a, a force for rotating the clip 10 around the projection 15 as a rotation axis is applied, and the hinge portion is bent by the reaction force from the clip holding groove 6. At this time, the notch of 80 on the lower surface
° Lateral legs push up further on the sides. In this way, when the tip of the clip 10 reaches the abutting surface, the clip 10 surrounds the tip opening portion 3 and becomes V-shaped.
It becomes a letter shape (see Fig. 7 (b), (c), (d)).

Then, the lever 16 of the handle portion 1 is further added.
When the probe is closed, the probe 5 further moves to the tip side and hits the end of the V-shaped clip 10 at the tip of the extension portion 2 and presses the clip 10 until the clip 10 is completely closed. At this time, since the coil spring 23a is provided between the driving member 19 and the probe 5, the clip 10
Will be pushed with a constant force (see Fig. 7 (e)).

With the clip 10 completely closed,
The ultrasonic transducer 17 in the handle portion 1 is driven to transmit the ultrasonic vibration to the clip 10 via the probe 5. The clip 10 is ultrasonically welded at both ends in contact with each other, fixed in a closed shape, and ligation of the tubular tissue sandwiched therebetween is completed.

When the lever 16 is completely closed, the latch 21 and the transmission member 22 are re-engaged in the handle portion 1, and when the closing force on the lever 16 is released, the lever 16 is released.
Is returned to the open state because it is biased toward the open side, the transmission member 22 and the drive member 19 move rearward, and return to the initial state shown in FIG. 6A.

At the same time, the pushing member 7 and the probe 5 also move rearward in the extension portion 2 and return to the initial state shown in FIG. 2 (a).

Next, the mechanism for repeating the clip 10 will be described. When the clip 10 held by the locking spring 11a on the front side of the cartridge 9 is moved to the front end side by the pushing member 7, the front end of the cartridge 9 is engaged. The stop spring 11b is flipped up by the flange portion 7b on the upper surface of the pushing member 7, and the leading clip 10 in the cartridge 9 is moved by the rear spring 9a.
It moves until it comes into contact with the locking spring 11a advanced to the front (see FIG. 2 (b)).

When the pushing member 7 starts moving backward,
The locking spring 11b is again attached to the clip 10 in the cartridge 9.
It is possible to prevent the movement of each clip 10 by entering between the row and the clip 10 in front of the cartridge 9.

When the push-out member 7 moves completely to the rear side and engages with the clip 10 on the front side of the cartridge 9, the initial state is set. By repeating the above operation, a plurality of clips 10 can be continuously used.

According to the ligating and suturing device of this embodiment, the member 7 for pushing out the clip 10 and the member for closing the clip 10 can be made common and a simple structure can be obtained. Further, since the structure inside the distal end portion of the extension portion 2 becomes simple, the distal end can be made small, and when the blood vessel 34 is inserted into the opening portion 3 and the clip 10 is arranged around the blood vessel 34, the clip 10 is Since the blood vessel 34 of the target portion is easily seen because it moves around the back, the treatment can be performed safely and the operability is improved.

Further, since it is not necessary to latch the tip ends of the legs of the clip 10, the clip 10 is inserted when the blood vessel 34 is sandwiched.
The large blood vessel 34
Will be pinched.

Also, since ultrasonic welding is used to fix the legs of the clip 10 in the closed state, strong and reliable ligation can be performed.

Since the clips 10 are arranged in a linear shape when the cartridge 9 is stored, the diameter of the extension portion 2 can be reduced.

As a modified example of this embodiment, as shown in FIG. 11, an engaging hole 10b is provided in place of the projection 15 on the side surface of the hinge portion 10a of the clip 10, and the pushing member 7 is provided.
You may provide the protrusion 7c which engages with the engagement hole 10b at the front-end | tip of b.

In this case, there is no extra convex portion of the shape of the clip 10, and it becomes easy to slide in the cartridge 9.

Further, the shape of the clip 10 is not limited to a straight line in a natural state, and a clip bent by 90 ° may be used. In this case, it becomes easy to close at the tip of the extension part 2.

FIG. 12 shows a second embodiment, in which a hook 10c is provided on one upper surface of the leg end of the clip 10 and a receiving portion 10d that meshes with the hook 10c is provided on one upper surface. The receiving portion 10d has a step so that the hook 10c does not come off after being engaged with the hook 10c, and the heights of the both end portions from the lower surfaces are substantially equal.

The other structure is almost the same as that of the first embodiment, and the probe 5 does not have to be a column and may be a plate, for example, in which the ultrasonic transducer 17 is removed from the handle 1. Also, the material does not have to be titanium.

In this way, the clip 10 pushes the pushing member 7 out.
Is moved to the inclined portion 6a at the tip of the clip holding groove 6 to be V-shaped, and then both ends of the leg portion are pressed by the probe 5. At this time, the hook 10c and the receiving portion 10d at both ends of the clip 10 are engaged and fixed in the closed state. Others are the same as the first embodiment.

According to this embodiment, the ultrasonic transducer 17 is not necessary from the handle portion 1 and the structure is simple. Further, the probe 10 can be a plate member, and the probe cover 1
Since 2 is eliminated, the diameter of the extension portion 2 can be further reduced. Since both ends of the clip 10 have substantially the same height from the lower surface, they can be arranged in a row in the cartridge 9. Others are the same as the first embodiment.

13 to 15 show a third embodiment,
It extends from the rear lower surface of the hinge portion 10a of the clip 10,
An arm 10e smaller than the width of the leg portion of the clip 10 is provided, and a guide 6b into which the arm 10d is slidably fitted is provided at the center of the clip holding groove 6 up to the front of the clip holding groove 6. Others are the same as those in the second embodiment.

When the tip of the leg of the clip 10 slides along the inclined surface and the arm 10d on the lower surface of the leg reaches the end of the guide, the arm 10d is pushed out from the end of the guide by the force of sliding the clip 10. At that time, the rear side of the leg portion of the clip 10 rotates around the hinge portion 10a, and the shape of the clip 10 becomes V-shaped at the opening. After that, the probe 5 pushes the leg portion from the rear and fixes both ends of the leg portion to the closed shape by the hooks 10c.

According to this embodiment, since the arm portion 10e is provided, the rear portion of the leg portion of the clip 10 can be reliably raised. Others are the same as those in the second embodiment.

FIG. 16 shows a modification of the third embodiment.
This modification is an example in which a joint portion having a rotating shaft 10f is formed in the hinge portion of the clip 10. Others are the same as those in the third embodiment.

According to this modification, since the rotary shaft 10f is provided, there is an effect that the force for bending the grip 10 becomes small.

According to the above embodiment, the following structure can be obtained.

(Supplementary Note 1) An extension portion to be inserted into a body cavity, a clip having a pair of legs and a bent portion in the central portion, a clip holding portion for holding the clip at the tip of the extension portion, and A storing means for storing a plurality of the clips in a ligating and suturing device for ligating a tubular tissue in a body cavity, the operating means having an operation handle part for closing the clip on the proximal side of the extension part, and the clip. Clip supplying means for supplying the clip from the tip portion of the accommodating means to the tip of the clip holding portion; force converting means for converting force for pushing the clip at the tip portion in the tip direction into force for closing the clip leg portion; A ligature and suture instrument, comprising: a clip fixing means for fixing a mating surface of a closed clip.

(Supplementary Note 2) The ligature and suture instrument according to Supplementary Note 1, wherein the storage means holds the clip in an open state.

(Supplementary Note 3) The ligature and suture instrument according to Supplementary Note 1 or 2, wherein the storage means holds the clip in an obtuse angled opened state.

(Supplementary Note 4) The ligature and suture instrument according to Supplementary Note 1 or 2, wherein the storing means holds the clip in a linearly opened state.

(Supplementary Note 5) The above-mentioned clip is in a state in which it is opened at an obtuse angle in the storing means or is straight, and the pair of clip leg portions form approximately 90 ° with each other at the tip of the clip holding portion, and then are completely fixed by the clip fixing means. The ligature and suture instrument according to any one of appendices 1 to 4, wherein the ligature and suture is closed by welding and fixed by welding.

(Supplementary Note 6) The supplementary note 1 is characterized in that the force converting means is formed by an inclined surface provided at the tip of the extension portion.
The ligating and suturing device described.

(Supplementary Note 7) The ligating and suturing device according to Supplementary Note 1, wherein the force converting means includes an inclined surface continuing from the lower surface of the clip bending portion.

(Supplementary Note 8) The ligating and suturing device according to Supplementary Note 7, wherein the slope is at least 50 ° with respect to the upper surface of the leg.

(Supplementary note 9) The ligating and suturing device according to supplementary note 8, wherein the inclined surface of 50 ° or more is on one side of the clip bending portion at the center of the leg.

(Supplementary Note 10) The ligature and suture instrument according to Supplementary Note 1, wherein the clip has an engaging portion for engaging with a clip supplying means on a side surface near a central portion.

(Supplementary Note 11) The ligating and suturing device according to Supplementary Note 10, wherein the engaging portion is a convex portion.

(Supplementary Note 12) The ligature and suture instrument according to Supplementary Note 10, wherein the engaging portion is a recess.

(Supplementary Note 13) The ligature and suture instrument according to Supplementary Note 1, wherein the clip fixing means is an ultrasonic vibration transmitting means.

(Supplementary Note 14) The ligature and suture instrument according to Supplementary Note 1, wherein the clip has irregularities on the upper surfaces of both ends of each leg.

(Supplementary Note 15) The ligature and suture instrument according to Supplementary Note 1, wherein the clip fixing means is a mechanical engaging means provided at both ends of the clip leg portion.

(Supplementary Note 16) The ligature and suture instrument according to Supplementary Note 15, wherein the mechanical engaging means is a latch and a hook.

(Supplementary Note 17) The ligature and suture instrument according to Supplementary Note 1, wherein the clip is a biocompatible resin.

(Supplementary Note 18) The ligature and suture instrument according to Supplementary Note 1, wherein the clip is a bioabsorbable resin.

(Supplementary Note 19) The ligature and suture instrument according to Supplementary Note 1, wherein the bent portion is a thin portion or a joint portion.

According to Supplementary Note 1, a large ligature tissue such as a blood vessel can be reliably sandwiched, and a ligating and suturing device excellent in operability can be provided.

According to Supplementary Notes 2 to 5, the clip can be accommodated in an open shape, the diameter of the device can be reduced, and it becomes easy to confirm how the distal end portion closes the tubular tissue.

According to Supplementary Notes 6 and 7, it is possible to easily rotate the clip leg portion by providing the inclined surface near the bent portion.

According to Appendix 8, the inclination angle of the slope on one side is 5
When the angle is 0 ° or more, only one side of the leg can be rotated and raised, and the clip can be easily placed around the tubular tissue such as a blood vessel.

According to Supplementary Notes 9 and 10, by having the engaging portion on the side surface of the central portion, it becomes easy to close around the bent portion.

According to Supplementary Notes 11 and 12, by making the engaging portion convex or concave, it is possible to reliably engage the pushing member.

According to appendix 13, strong and reliable ligation can be achieved by welding and fixing both ends of the clip leg portion using ultrasonic vibration. Further, the hooks at both ends of the clip leg are not required, the clip shape can be simplified, and the hooks do not interfere with the blood vessel when the clip is placed around the blood vessel.

According to Supplementary Note 14, by forming the concavities and convexities on both ends of the leg, it becomes easy to weld by ultrasonic vibration.

According to Supplementary Notes 15 and 16, a member for transmitting an ultrasonic wave from the clip is not required, which has a simple structure and can be miniaturized.

According to Supplementary Note 17, the clip shape can be made to meet the above specifications by using resin.

According to Supplementary Note 18, the use of a bioabsorbable resin can reduce the influence on the human body.

According to Supplementary Note 19, by providing the bent portion with a thin portion or a joint portion, both legs can be easily closed at the center of the clip.

[0087]

As described above, according to the present invention, it is possible to reliably sandwich a large tubular tissue such as a blood vessel,
Further, it is possible to provide a ligature and suture device that is structurally simple and has excellent operability.

[Brief description of drawings]

1A and 1B show a ligating and suturing device according to a first embodiment of the present invention, in which FIG. 1A is an overall side view, and FIG.
(C) is a plan view of the tip.

FIG. 2 shows the extension part of the same embodiment, (a) is a vertical side view in an initial state, and (b) is a vertical side view in a ligated state.

FIG. 3 is a perspective view of the internal structure of the distal end portion of the extension portion of the same embodiment.

FIG. 4 shows a distal end portion of an extension portion of the same embodiment, (a) is a vertical plan view, and (b) is a sectional view taken along line AA.

FIG. 5 is a vertical sectional side view of the handle portion of the same embodiment.

FIG. 6 shows a handle portion of the same embodiment, (a) is a vertical sectional side view in an initial state, and (b) is a vertical sectional side view in a ligated state.

FIG. 7 is an operation explanatory view of the embodiment.

FIG. 8 shows a modified example of the clip of the same embodiment, (a)
Is a perspective view and (b) is a side view.

FIG. 9 is an operation explanatory view of the embodiment.

FIG. 10 is an operation explanatory view of the embodiment.

FIG. 11 is a perspective view showing a modified example of the clip of the same embodiment.

FIG. 12 is a side view showing a clip according to a second embodiment of the present invention.

13A and 13B show a clip according to a third embodiment of the present invention, wherein FIG. 13A is a side view and FIG. 13B is a left side view.

FIG. 14 is a perspective view of a distal end portion of the extension portion according to the same embodiment.

FIG. 15 is a vertical cross-sectional side view of the distal end portion of the extension portion for explaining the operation of the same embodiment.

FIG. 16 shows a modified example of the clip of the embodiment,
(A) is a side view, a left side view, (b) is a perspective view.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Handle part 2 ... Extension part 3 ... Tip opening part 5 ... Probe 6 ... Clip holding groove 7 ... Extrusion member 9 ... Cartridge 10 ... Clip 10x ... Recessed part 10y ... Convex part

Claims (1)

[Claims] 1. An extension part to be inserted into a body cavity, a clip having a pair of legs and a bent part in a central part, and a clip holding part for holding the clip at a tip part of the extension part.
A storing means for storing a plurality of the clips in a ligating and suturing device, which is on the proximal side of the extending portion, has an operation handle portion for performing an operation of closing the clip, and ligates a tubular tissue in a body cavity. Clip supplying means for supplying the clip from the tip part of the clip accommodating means to the tip of the clip holding part, and force converting means for converting the force for pushing the clip at the tip part in the tip direction to the force for closing the clip leg part, A ligature and suture instrument, comprising clip welding fixing means for welding and fixing the mating surfaces of the closed clips.