Clamp indwelling device and clamp

Abstract

In order to continuously and smoothly leave a plurality of clamps, a clamp leaving device (100) includes: an insertion portion (4); a power transmission member (5); a hollow member formed with a through passage; an arm member including a first arm (21) and a second arm (22) inserted into the through passage in a manner of protruding from a distal end of the hollow member, the arm member being connected with the power transmission member and configured to be able to switch between an open state and a closed state according to the advance and retreat of the power transmission member; and an adjustment mechanism (251, 252, 361, 362) that, in the open state, configures the first arm and the second arm to have equal protruding lengths in an axis direction in which the first arm and the second arm protrude from the hollow member, and, in the closed state, configures the first arm and the second arm to have different protruding lengths in the axis direction in which the first arm and the second arm protrude from the hollow member.

Description

TECHNICAL FIELD

[0001] The present application relates to a clip indwelling device and a clip used for ligation of tissue. BACKGROUND

[0002] In the past, a clip indwelling device has been used to perform a hemostatic treatment or to close an opening generated in a biological tissue. The clip indwelling device is inserted into a body using an endoscope device or a laparoscope, and is configured to be capable of performing ligation by clamping a treatment target site with a clip. For example, Patent Literature 1 discloses a ligation device including a pair of arms and a tube member that closes the pair of arms, and retains a state in which a biological tissue is clamped with distal end portions of the arms of each other to ligate the biological tissue. In the ligation device of Patent Literature 1, after the pair of arms are closed to ligate the tissue, the connection of an operation wire to the arms and the connection of the tube member to a coil sheath are released. As a result, the clip composed of the arms and the tube member is separated from the ligation device and is indwelled on the tissue (mucosa).

[0003] Prior art documents

[0004] Patent documents

[0005] Patent Literature 1: Japanese Patent Application Publication No. 2004-73646 SUMMARY

[0006] PROBLEMS TO BE SOLVED BY THE INVENTION

[0007] For example, there is a case where a plurality of clips are indwelled in a manner of surrounding a treatment target site. Since the tissue in which the clips are indwelled is soft, the tube member of the clip indwelled later collapses toward the tissue side after the clip is indwelled. In a case where a plurality of clips are indwelled in a close position, if the tube member of the clip indwelled first collapses, the operation of indwelling the next clip with the ligation device is hindered. Therefore, a process of changing the direction in which the tube member collapses to deviate the tube member of the clip indwelled first from the indwelling position of the next clip is required, and the surgery takes time.

[0008] SOLUTION TO PROBLEM

[0009] The clip indwelling device of the present application includes: an insertion portion that is inserted into a body; a power transmission member that is provided in the insertion portion in a manner that is capable of advancing and retreating; a hollow member that is attached to a distal end of the insertion portion, and that has a through passage formed in a central axis direction; an arm member that includes a first arm and a second arm that are inserted into the through passage in a manner that protrudes from a distal end of the hollow member, and that is connected to the power transmission member, and that is configured to be capable of switching between an open state in which the first arm and the second arm are open to each other, and a closed state in which the first arm and the second arm are closed to each other, in accordance with the advancing and retreating of the power transmission member; and an adjustment mechanism that configures the first arm and the second arm in the open state so that protrusion lengths of the first arm and the second arm in the axis direction from the hollow member are equal, and configures the first arm and the second arm in the closed state so that the protrusion lengths of the first arm and the second arm in the axis direction from the hollow member are different.

[0010] The clip 1 of the present embodiment includes: a hollow member that has a through passage formed in a central axis direction; an arm member that includes a first arm and a second arm that are inserted into the through passage in a manner that protrudes from a distal end of the hollow member, and that is connected to a power transmission member provided in a clip indwelling device, and that is configured to be capable of switching between an open state and a closed state, in which the first arm and the second arm are open to each other when a relative position of the first arm and the second arm with respect to the central axis direction of the hollow member is located at a position that is distal side from a first position, and in which the first arm and the second arm are closed to each other when the first arm and the second arm retreat within the through passage from the first position; and an adjustment mechanism that configures the first arm and the second arm in the open state so that protrusion lengths of the first arm and the second arm in the central axis direction from the hollow member are equal, and configures the first arm and the second arm in the closed state so that the protrusion lengths of the first arm and the second arm in the central axis direction from the hollow member are different.

[0011] Effects of the Invention

[0012] The clip indwelling device and the clip of the present application can continuously and smoothly indwell a plurality of clips. BRIEF DESCRIPTION OF DRAWINGS

[0013] Figure 1 is an overall view of the clip indwelling device of the first embodiment.

[0014] Figure 2 is a partial cross-sectional view that shows a distal end portion of the clip indwelling device of the first embodiment.

[0015] Figure 3is a partial cross-sectional view showing the distal end portion of the clip indwelling device of the first embodiment.

[0016] Figure 4 is a cross-sectional view showing the distal end portion of the clip indwelling device of the first embodiment.

[0017] Figure 5 is a cross-sectional view of the clip of the first embodiment.

[0018] Figure 6 is a cross-sectional view showing the distal end portion of the clip indwelling device of the first embodiment.

[0019] Figure 7 is a side view of the clip of the first embodiment.

[0020] Figure 8 is a cross-sectional view showing the use form of the clip of the first embodiment.

[0021] Figure 9 is a schematic view showing the use form of the clip of the first embodiment.

[0022] Figure 10 is a cross-sectional view showing the distal end portion of the clip indwelling device of the second embodiment.

[0023] Figure 11 is a cross-sectional view of the clip of the second embodiment.

[0024] Figure 12 is a cross-sectional view showing the distal end portion of the clip indwelling device of the third embodiment.

[0025] Figure 13 is a front view showing the advance and retreat guide member.

[0026] Figure 14 is a cross-sectional view showing the distal end portion of the clip indwelling device of the third embodiment.

[0027] Figure 15 is a cross-sectional view showing the distal end portion of the clip indwelling device of the third embodiment.

[0028] Figure 16 is a cross-sectional view showing the distal end portion of the clip indwelling device of the fourth embodiment.

[0029] Figure 17 is a cross-sectional view showing the distal end portion of the clip indwelling device of the fourth embodiment.

[0030] Figure 18 is a cross-sectional view showing the distal end portion of the clip indwelling device of the modification of the fourth embodiment.

[0031] Figure 19is Figure 18 XIX-XIX sectional views of the present embodiment. DETAILED DESCRIPTION

[0032] (First Embodiment)

[0033] Hereinafter, referring to Figures 1 to 9 the clamp indwelling device 100 and the clamp 1 of the first embodiment will be described. Figure 1 is a general view showing the clamp indwelling device 100 of the present embodiment. Figure 2 and Figure 3 is a partial sectional view showing the distal end portion of the clamp indwelling device 100. Figure 4 is a sectional view of the clamp indwelling device 100 along the length direction. Figure 5 is a sectional view of the clamp 1 along the length direction. Figure 4 shows the open state of the clamp 1 described later. Figure 5 shows the closed state of the clamp 1 described later.

[0034] As shown in Figure 1 , the clamp indwelling device 100 includes a sheath 4, an operation wire 5, an operation portion 6, and a clamp 1. The clamp indwelling device 100 clamps the clamp 1 at the distal end of the operation wire 5 and mounts it at the distal end of the sheath 4, and is configured to be able to indwell the clamp 1 at the treatment target site of a living body by the operation of the operation portion 6. The clamp indwelling device 100 is a device that the sheath 4 is inserted into the body, and is indwelled by the clamp 1 gripping the tissue T of the treatment target site. The clamp indwelling device 100 of the present embodiment is used, for example, by being inserted into the body through the treatment instrument channel of an endoscope.

[0035] In the following description, in the length direction of the clamp indwelling device 100 in the state of extending in a straight line, the side of the operation portion 6 is called the proximal side, and the side opposite to the proximal side and the side provided with the clamp 1 is called the distal side. The length axis of the sheath 4 is provided along the center axis C of the tubular pressure tube 3 of the clamp 1 described later. In the following description, there is a case where the axis of the clamp indwelling device 100 extending in the length direction on the center axis C of the pressure tube 3 is described as the center axis C.

[0036] The sheath 4 is a longitudinal tubular member having flexibility. The sheath 4 is formed with a tube 41 along the center axis C in the entire length range. The sheath 4 is, for example, a coil sheath formed by tightly winding a wire made of stainless steel such as SUS301 around the length axis. The proximal end of the sheath 4 is connected to the operation main body 62 of the operation portion 6. The tube 41 is opened at the distal end 42 of the sheath 4. The sheath 4 is an example of an insertion portion.

[0037] As shown in Figure 1As shown, the operation section 6 includes an operation body 62 and a slider 61. The slider 61 is configured to be slidable with respect to the operation body 62 in the direction of the central axis C. The slider 61 is connected to the operation wire 5.

[0038] A proximal end of the operation wire 5 is fixed to the slider 61 of the operation section 6, and a clamping member 8 is fixed to a distal end of the operation wire 5. The operation wire 5 is a wire-like member formed of a single wire or a twisted wire made of metal. The operation wire 5 is inserted through the sheath 4. The operation wire 5 is configured to be able to advance and retreat in the sheath 4 by advancing and retreating the slider 61 with respect to the operation body 62. The operation wire 5 is an example of a power transmission member.

[0039] Figure 6 is a cross-sectional view of the clamp indwelling device 100 along the length direction, and is a cross-sectional view observed from a direction orthogonal to the Figure 4 As shown in Figure 4 and Figure 6 As shown, the clamping member 8 has a fixed portion 84, a base portion 83, a proximal clamping portion 82, and a distal clamping portion 81. The fixed portion 84 is located at a proximal end of the clamping member 8 and is fixed to the distal end of the operation wire 5. The base portion 83 is a flat plate-like portion extending from the distal end of the fixed portion 84 to the distal side. The proximal clamping portion 82 and the distal clamping portion 81 protrude from the base portion 83 in a direction orthogonal to the central axis C. As shown in Figure 4 The proximal portion of the distal clamping portion 81 has a curved wall surface that imitates the curved shape of the connection end portion 26 of the arm member 2. The proximal clamping portion 82 is separated from the distal clamping portion 81 to the proximal side and is provided at a position opposite the curved wall surface. The arm member 2 described later is clamped between the proximal clamping portion 82 and the distal clamping portion 81. The clamping member 8 advances and retreats in the insertion passage 31 in conjunction with the advance and retreat of the operation wire 5.

[0040] The clamp 1 is configured to include the arm member 2 and the pressing tube 3. The clamp 1 is provided so that the proximal end of the pressing tube 3 abuts against the distal end of the sheath 4.

[0041] The arm member 2 has a first arm 21 and a second arm 22. The arm member 2 is made of, for example, a thin and long plate made of metal such as stainless steel, cobalt-chromium alloy, titanium, or the like. The arm member 2 has a connection end portion 26 formed of a letter U shape by bending processing in the thickness direction at a middle portion of the thin and long plate, and both end portions of the plate constitute the first arm 21 and the second arm 22. In the following description, the surfaces of the pair of arms 21 and 22 that face each other are referred to as inner surfaces 201, and the surfaces on the side opposite the inner surfaces 201 and opposite the insertion passage 31 are referred to as outer surfaces 202.

[0042] The pair of arms 21, 22 includes base portions 231, 232, curved portions 251, 252, and claw portions 241, 242. The base portions 231, 232 extend in parallel at a position farther than the connection end portion 26. A stopper 27 is formed in each of the base portions 231, 232. The stopper 27 is provided to fix the arm member 2 to the press pipe 3 when the indwelling clip 1 is left. As shown in Figure 6 The stopper 27 is protrusively formed so as to extend from both sides of the base portions 231, 232 in a direction intersecting the central axis C. The stopper 27 is protrusively formed so as to be linearly symmetrical with respect to the central axis C when viewed from the outer surface 202 side of the arm member 2. The length of the portion provided with the stopper 27 in a direction orthogonal to the central axis C is slightly larger than the opening diameter of the flange 34 of the press pipe 3.

[0043] In a natural state in which no external force is applied to the arm member 2, the arm member 2 is given a curved shape that maintains the first arm 21 and the second arm 22 in an open state. The portion given the curved shape is referred to as the curved portion 251, 252.

[0044] The curved portions 251, 252 are located at a position farther than the base portions 231, 232. The curved portions 251, 252 are given a curved tendency so as to be separated from each other as they go toward the distal side in the natural state. In the natural state, the curved portions 251, 252 have different curvatures from each other. The curvature of the curved portion 252 of the second arm 22 is larger than the curvature of the curved portion 251 of the first arm 21. The curved portions 251, 252 having different curvatures are an example of the adjustment mechanism.

[0045] The claw portions 241, 242 are provided at a position farther than the curved portions 251, 252. The claw portions 241, 242 are formed so as to be bent toward each other and the inner surface 201 side at the distal end portion of each of the arms 21, 22.

[0046] The press pipe 3 is a tubular hollow member formed with a through passage 31 in the central axis C direction. The through passage 31 communicates from the distal end to the proximal end of the press pipe 3. A flange 34 is formed at the proximal end portion of the through passage 31. The flange 34 protrudes in a circular ring shape toward the radial inner side from the inner wall surface of the through passage 31. The press pipe 3 is made of, for example, a metal material such as stainless steel, titanium alloy (Ti-6AL-4V or the like), cobalt-chromium alloy, or a resin material such as polyphthalamide (PPA) or polyamide (PA) that has a moderate elasticity and high rigidity. The distal end portion of the through passage 31 can also be formed with a tapered surface 311 in which the opening diameter is slightly widened toward the distal end surface of the press pipe 3.

[0047] As shown in Figure 7As shown, a mark 35 is provided on the outer surface of the clamping tube 3. The mark 35 is provided to indicate the position of the first arm 21 or the second arm 22. The mark 35 is formed on the outer surface of the clamping tube 3, for example, by printing. The mark 35 is an elongated mark 35 extending along the central axis C of the clamping tube 3. A mark 35 is formed on a portion of the circumference of the clamping tube 3. The arm member 2 is positioned relative to the clamping tube 3 in such a way that the first arm 21 or the second arm 22 is located on the extension line of the mark 35. By providing the mark 35, the surgical operator can identify the image of the endoscope and the position of the first arm 21 or the second arm 22 about the central axis C when the clamp is in place.

[0048] Markings 35 can also be formed at two intervals, spaced 180 degrees apart, in the circumferential direction of the pressure tube 3. In this case, the arm member 2 is positioned relative to the pressure tube 3 in such a way that the positions of each marking 35 are aligned with the positions of the first arm 21 and the second arm 22 in the circumferential direction.

[0049] like Figure 4 As shown, the connecting end 26 is inserted into the through passage 31, and within the through passage 31, the connecting end 26 is inserted between the proximal locking part 82 and the distal locking part 81, thereby locking it against the locking member 8. With the connecting end 26 locked against the locking member 8, the arm member 2 passes through the through passage 31 of the pressure tube 3. Figure 4 As shown, by means of the locking member 8, the arm member 2 is connected to the operating line 5 by means of the locking member 8, a connecting end 26 is disposed between the proximal locking part 82 and the distal locking part 81. Figure 4 and Figure 6 As shown, the arm member 2, which is locked to the locking member 8, is kept so that it can move forward and backward along the central axis C within the through passage 31.

[0050] The first arm 21 and the second arm 22 are inserted into the through passage 31 with the distal end of the self-pressurizing tube 3 protruding. That is, the proximal portions of the bases 231 and 232 of the first arm 21 and the second arm 22 are inserted into the through passage 31, and the distal portions of the first arm 21 and the second arm 22 protrude from the distal end of the self-pressurizing tube 3.

[0051] The opening of flange 34 is slightly larger than the external dimensions of locking member 8 and connecting end 26 in the locked state. As a result, locking member 8 and connecting end 26 are locked in place by flange 34 while maintaining the locked state. Arm member 2 is configured to move from a position where connecting end 26 is disposed within through passage 31 to a position where connecting end 26 is exposed near the proximal end of pressure tube 3.

[0052] The arm member 2 is capable of advancing and retreating in the direction of the central axis C within the through passage 31 of the pressure tube 3. The arm member 2 is configured to be switchable between the open state and the closed state in accordance with its relative position with respect to the direction of the central axis C of the pressure tube 3. When the stopper 27 is positioned at a position further distal side than the flange 34, the arm member 2 is capable of advancing and retreating with respect to the pressure tube 3. Thus, the clamp 1 is configured to be capable of performing a so-called regrasping operation. That is, if the arm member 2 is relatively advanced with respect to the pressure tube 3 after temporarily clamping the tissue with the pair of claw portions 241, 242 of the arm member 2, the pair of arms 21, 22 can be opened again, and the state in which the pair of claw portions 241, 242 clamps the tissue can be released. Also, if the arm member 2 is relatively retreated with respect to the pressure tube 3 while the pair of arms 21, 22 is in the open state, the tissue can be clamped again with the pair of claw portions 241, 242.

[0053] When the stopper 27 is positioned at a position proximal side than the flange 34, the arm member 2 is incapable of advancing and retreating with respect to the pressure tube 3. Specifically, if the stopper 27 moves to the proximal side beyond the flange 34, the stopper 27 is caught at the wall surface of the pressure tube 3 on the proximal side of the flange 34, and is restricted from advancing. In the closed state, since the arm member 2 clamps the tissue T, the distal end portions of the arms 21, 22 are kept in a state of protruding to the distal side of the pressure tube 3. As a result, the arm member 2 is kept in the closed state.

[0054] As shown in FIG. 6, when the arm member 2 is in the open state, the distal end portions of the arms 21, 22 protrude to the distal side of the pressure tube 3. In the open state, the pair of arms 21, 22 is spaced apart from each other in a direction orthogonal to the central axis C. Figure 4 As shown in FIG. 6, when the arm member 2 is in the open state, the distal end portions of the arms 21, 22 protrude to the distal side of the pressure tube 3. In the open state, the pair of arms 21, 22 is spaced apart from each other in a direction orthogonal to the central axis C.

[0055] As shown in FIG. 6, when the arm member 2 is in the open state, the distal end portions of the arms 21, 22 protrude to the distal side of the pressure tube 3. In the open state, the pair of arms 21, 22 is spaced apart from each other in a direction orthogonal to the central axis C. Figure 4 As shown in FIG. 6, when the arm member 2 is in the open state, the distal end portions of the arms 21, 22 protrude to the distal side of the pressure tube 3. In the open state, the pair of arms 21, 22 is spaced apart from each other in a direction orthogonal to the central axis C.

[0056] The total length of the second arm 22 is longer than that of the first arm 21. Specifically, the length of the second arm 22 from the connecting end 26 of the arm member 2 to the second claw 242 is longer than the length from the connecting end 26 to the first claw 241. However, since the curvature of the bent portion 252 of the second arm 22 is greater than that of the bent portion 251 of the first arm 21, in the open state, the protruding length LC1 of the self-pressing tube 3 of the first arm 21 and the protruding length LC2 of the self-pressing tube 3 of the second arm 22 are equal in the direction of the central axis C. That is, the bent portions 251 and 252 with different curvatures function as an adjustment mechanism.

[0057] The curved portion 252 is given a curved shape such that the distal end of the second arm 22 in the direction of the central axis C is positioned approximately equal to the distal end of the first arm 21 in the direction of the central axis C when the arm member 2 is in the open state. The protruding lengths LC1 and LC2 of the first arm 21 and the second arm 22 protruding from the pressure tube 3 are equal, resulting in the arm member 2 in the open state being easily pressed against the tissue at the treatment site when the clamp 1 is in place, making it easier to clamp the tissue.

[0058] like Figure 2 As shown, when arm member 2 is in the open state, the second distance D2 from the central axis C to the claw portion 242 of the second arm 22 in the direction orthogonal to the central axis C is longer than the first distance D1 from the central axis C to the first claw portion 241 of the first arm 21 in the direction orthogonal to the central axis C. As a result, in the closed state, the protrusion of the second arm 22 is longer than that of the first arm 21, and in the open state, the protrusion lengths LC1 and LC2 of the first arm 21 and the second arm 22 protruding from the self-pressurizing tube 3 can be equal. Consequently, when the clamp 1 is in place, it is easy to press the open arm member 2 against the tissue at the treatment site, and it is easy to clamp the tissue.

[0059] like Figure 5As shown, if the arm member 2 is retracted from the open state relative to the pressure tube 3, the pair of arms 21, 22 come into contact with the distal end of the pressure tube 3 and are retracted, moving closer to each other. If the arm member 2 is retracted, the stopper 27 moves to a position closer to the flange 34 than the flange 34, and the arm member 2 becomes the closed state. In the closed state, the connecting end 26 of the arm member 2 protrudes to a position closer to the proximal end of the pressure tube 3 than the pressure tube 3, and the curved portions 251, 252 of the first arm 21 and the second arm 22 are retracted into the through passage 31, and the claw portions 241, 242 are close to the center axis C. As described above, the total lengths of the first arm 21 and the second arm 22 are different, and therefore, in the closed state of the arm member 2, the protrusion lengths LC1, LC2 of the distal ends of the first arm 21 and the second arm 22 from the pressure tube 3 in the direction of the center axis C are different. Specifically, the protrusion length LC2 of the second arm 22 from the pressure tube 3 in the direction of the center axis C is longer than the protrusion length LC1 of the first arm 21 from the pressure tube 3 in the direction of the center axis C. In the closed state, the first claw portion 241 is positioned closer to the proximal end than the second claw portion 242.

[0060] Figure 8 is a schematic view showing a state in which the clip 1 is left in a treatment target site. The tissue T in which the clip 1 is left is generally soft. On the other hand, the length of the clip 1 in the direction of the center axis C is longer than the length of the pressure tube 3 in the radial direction, and the center of gravity of the clip 1 when left is on the proximal side of the pressure tube 3. Therefore, the clip 1 left in the tissue T is inclined with respect to the tissue T, not standing upright. At this time, if the pair of arms is symmetrically arranged and left as in the conventional clip, the direction in which the pressure tube is inclined is not determined. In contrast to this, as shown in Figure 8 the present embodiment, the clip 1 in the closed state has the second arm 22 protruding longer than the first arm 21 and gripping the tissue T. As a result, the clip 1 is inclined to the side of the first arm 21, which has a smaller amount of protrusion to the distal side. That is, the direction in which the pressure tube 3 of the clip 1 is inclined after being left is determined to be the side of the first arm 21.

[0061] Figure 9 is a schematic view showing a configuration in which a plurality of clips 1 are left around a treatment target site. As Figure 9As shown, when the ligature is performed, the clips 1 are left in positions close to each other, and there is a case where the distance between the clips 1 is shorter than the length in the direction of the central axis C of the clip 1. Therefore, if the pressing tube of the clip left first is inclined toward the left of the clip left later, the left operation is hindered. However, in the clip 1 of the present embodiment, the direction in which the pressing tube 3 is inclined in the closed state in which the tissue T is gripped is determined to be the side of the first arm 21. Thus, the operator can easily adjust so that the pressing tube 3 of the clip 1 left first is not inclined toward the left of the clip 1 left later. Thus, it is not necessary to change the direction of the inclined pressing tube as in the conventional clip, and the plurality of clips 1 can be left smoothly. As a result, the operation time can be shortened.

[0062] With the clip leaving device 100 and the clip 1 of the present embodiment, it is possible to control the direction in which the proximal end of the pressing tube 3 of the clip 1 left later is inclined. Thus, it is possible to incline the proximal end of the clip 1 left first toward a position that does not hinder the leaving of the clip next. As a result, in the case where a plurality of clips 1 are left continuously in positions close to each other, the clip 1 left first does not hinder the leaving of the clip next, and the plurality of clips can be left smoothly.

[0063] With the clip leaving device 100 and the clip 1 of the present embodiment, in the open state, the curvature of the first bent portion 251 of the first arm 21 is different from the curvature of the second bent portion 252 of the second arm 22. As a result, it is possible to configure the pair of arms 21, 22 so that the amount of protrusion of the pair of arms 21, 22 from the pressing tube 3 is different in the closed state, but the amount of protrusion of the pair of arms 21, 22 from the pressing tube 3 is equal in the open state. As a result, in the open state, the pair of arms 21, 22 is opened like the conventional clip, and the operation of gripping the tissue T pressed against the treatment target site is easy.

[0064] With the clip leaving device 100 and the clip 1 of the present embodiment, the marker 35 is provided on the outer surface of the pressing tube 3, and the position of the marker 35 corresponds to the position of the arm member 2. As a result, it is possible to identify the position of the arm member 2 around the central axis C and the opening / closing direction of the arm member 2 using the marker 35.

[0065] In the case where the pressure tube 3 is provided with the marker 35, the positions of the pair of arms 21, 22 around the central axis C in the state where the jig 1 is installed to the jig housing device 100 are not particularly limited as long as the positions are aligned with the position of the marker 35. For example, the jig 1 can be installed to the jig housing device 100 in such a manner that the second arm 22 is disposed at the position of the distal end of the pressure tube 3 closest to the tissue T when the sheath 4 and the jig 1 are advanced with respect to the tissue T. That is, the jig 1 can be installed to the jig housing device 100 in such a manner that the second arm 22 is disposed at the lower side of the pressure tube 3 when the sheath 4 is pushed into the tissue T. In this case, the jig 1 collapses to the distal side in the advancing and retreating direction of the sheath 4 after the jig 1 is housed. As a result, as long as a plurality of jigs 1 are sequentially housed from the distal side to the proximal side, the next jig 1 can be smoothly housed.

[0066] (Second Embodiment)

[0067] Reference Figure 10 and Figure 11 The jig 1A of the second embodiment will be described. In the following description, the same reference numerals are assigned to the constituent elements common to those already described, and the repeated description will be omitted. Figure 10 The jig 1A in the open state is shown, Figure 11 The jig 1A in the closed state is shown.

[0068] The jig 1A of the present embodiment is an example in which the structure of the adjustment mechanism is different from that of the arm member 2 of the first embodiment. The jig 1A is provided with the extension and retraction portion 28 at the base 232 of the second arm 22. As shown in Figure 10 , the extension and retraction portion 28 is bent in the thickness direction of the second arm 22. The curvatures of the bent portions 251, 252 of the respective arms 21, 22 of the jig 1A are substantially equal.

[0069] As shown in Figure 10 , the protruding length LC1 of the first arm 21 of the jig 1A in the open state in the direction of the central axis C from the distal end 32 of the pressure tube 3 is equal to the protruding length LC2 of the second arm 22 in the direction of the central axis C from the distal end 32 of the pressure tube 3. In the open state, the first distance D1 from the central axis C to the first claw portion 241 of the first arm 21 in the direction orthogonal to the central axis C is equal to the second distance D2 from the central axis C to the claw portion 242 of the second arm 22 in the direction orthogonal to the central axis C.

[0070] As shown in Figure 11As shown, if the arm member 2A is retracted and the clamp 1A becomes the closed state, the stretchable portion 28 is released from the bent state by elastic deformation. Specifically, if the arm member 2A is retracted with respect to the pressure tube 3 from a state in which the claw portions 241, 242 of the pair of arms 21, 22 press the tissue T in the open state, the pair of arms 21, 22 are brought close to each other. Since the tissue T is sandwiched between the claw portions 241, 242, the distal end portions of the arms 21, 22 are kept in a state in which they are separated from each other more than the opening of the through passage 31, and even if the arm member 2A is retracted, the distal end portions of the arms 21, 22 do not enter the through passage 31. In this state, if the arm member 2A is continuously retracted, the arm member 2A is applied with a pulling force to both sides in the central axis C direction, the stretchable portion 28 is stretched from the bent shape, and the length of the central axis C direction of the second arm 22 is increased. If the stopper 27 passes the flange 34 to the proximal side, the stopper 27 is caught by the proximal wall of the flange 34, and the arm member 2A is restricted from advancing. The distal end portion of the arm member 2A sandwiches the tissue T, and as a result, the arm member 2A is kept in a state in which it is sandwiched by the tissue T and the distal end portion of the pressure tube 3, and becomes the closed state. As shown in FIG. 6, in the closed state, the protruding amount LC2 of the second arm 22 in the central axis C direction from the pressure tube 3 is longer than the protruding amount LC1 of the first arm 21 in the central axis C direction from the pressure tube 3. In the closed state, the first claw portion 241 is positioned at a position closer to the proximal side than the second claw portion 242. Figure 11 As shown, in the closed state, the protruding amount LC2 of the second arm 22 in the central axis C direction from the pressure tube 3 is longer than the protruding amount LC1 of the first arm 21 in the central axis C direction from the pressure tube 3. In the closed state, the first claw portion 241 is positioned at a position closer to the proximal side than the second claw portion 242.

[0071] With the clamp 1A of the present embodiment, as with the first embodiment, it is possible to control the direction in which the proximal end portion of the pressure tube 3 of the clamp 1 is laid down after the placement. Thus, it is possible to incline the proximal end portion of the clamp 1 that is placed first toward a position that does not interfere with the placement of the next clamp. As a result, in the case in which a plurality of clamps 1 are placed consecutively at a close position, the clamp 1 that is placed first does not interfere with the placement of the next clamp 1, and it is possible to place the plurality of clamps smoothly.

[0072] (Third Embodiment)

[0073] Reference Figures 12 to 15 A clamp placement device 100B and a clamp 1B of the third embodiment will be described. The structure of the arm member 2B and the pressure tube 3B of the clamp 1B of the present embodiment is different from that of the first embodiment. The clamp placement device 100B is provided with a retracting and advancing guide member 7 instead of the catching member 8 of the first embodiment.

[0074] Figure 13 is a front view of the retracting and advancing guide member 7 as viewed from the central axis C direction. The retracting and advancing guide member 7 has a flat plate shape, and its proximal surface is fixed to the operation wire 5. As shown in Figure 13As shown, the advance-retract guide member 7 has a circular arc portion 73 and two recessed portions 71, 72. The circular arc portion 73 is a shape similar to the inner peripheral surface of the through passage 31, and has a size that enables sliding contact with the inner peripheral surface of the through passage 31. The two recessed portions 71, 72 are each a rectangular notch portion. The advance-retract guide member 7 is linked to the advance-retraction of the operation wire 5 relative to the sheath 4, and is configured to be able to advance and retract within the through passage 31. The advance-retract guide member 7 has a size that enables advancement and retraction in such a manner that the axis of the operation wire 5 and the central axis C of the pressure tube 3B are coaxial when advancing and retracting within the through passage 31.

[0075] The pressure tube 3B does not have the flange 34 of the pressure tube 3 of the first embodiment, and has a cylindrical shape. Two locking portions 361, 362 are formed in the pressure tube 3B. The locking portions 361, 362 are holes that pass through from the through passage 31 of the pressure tube 3 toward the outer surface. The two locking portions 361, 362 are opened 180 degrees apart in the circumferential direction of the pressure tube 3. In the central axis C direction, the positions of the two locking portions 361, 362 are different. The first locking portion 361 is formed at a position closer to the proximal side than the second locking portion 362.

[0076] The form of the locking portions 361, 362 is not limited to a through hole. For example, the locking portion can also be a recess into which the locking protrusions 291, 292 described later can enter and be locked.

[0077] The first arm 21B and the second arm 22B are each independently configured. The first arm 21B and the second arm 22B are different members having substantially equal overall lengths. The first arm 21B and the second arm 22B have substantially equal shapes. The base portions 231B, 232B of the respective arms 21B, 22B have curved shapes.

[0078] As shown in Figs. 1, 2, and 3, the two locking pieces 293, 294 are formed in the inner surface 201 of the base portion 231B, 232B of each arm 21B, 22B. The two locking pieces 293, 294 are configured to be able to be locked to the advance-retract guide member 7. The two locking pieces 293, 294 are separated in the length direction and project in a zigzag shape in the thickness direction of the arm 21B, 22B from the inner surface 201 of the base portion 231B, 232B. The distal locking piece 293 has a proximal side edge that is orthogonal to the inner surface 201 of the base portion 231B, 232B. The proximal locking piece 294 has a substantially triangular shape. Figure 14 Figure 15 As shown in Figs. 1, 2, and 3, the two locking pieces 293, 294 are formed in the inner surface 201 of the base portion 231B, 232B of each arm 21B, 22B. The two locking pieces 293, 294 are configured to be able to be locked to the advance-retract guide member 7. The two locking pieces 293, 294 are separated in the length direction and project in a zigzag shape in the thickness direction of the arm 21B, 22B from the inner surface 201 of the base portion 231B, 232B. The distal locking piece 293 has a proximal side edge that is orthogonal to the inner surface 201 of the base portion 231B, 232B. The proximal locking piece 294 has a substantially triangular shape.

[0079] The separation distance of the distal locking piece 293 and the proximal locking piece 294 is slightly longer than the thickness of the advance-retract guide member 7. As shown in Figs. 1, 2, and 3, the distal locking piece 293 and the proximal locking piece 294 are configured to be able to be locked to the advance-retract guide member 7. Figure 12 ​As shown, the first arm 21B is positioned in the first recess 71, and the distal locking piece 293 and the proximal locking piece 294 are disposed on both sides in the central axis C direction of the first recess 71. The second arm 22B is positioned in the second recess 72, and the distal locking piece 293 and the proximal locking piece 294 are disposed on both sides in the central axis C direction of the recesses 71, 72 of the advance / retreat guide member 7. In this state, by disposing the pair of arms 21B, 22B in the through passage 31, the arm member 2B is able to advance / retreat with respect to the pressing pipe 3B, and the arms 21B, 22B are able to open / close in a manner installed to the operation wire 5.

[0080] The distal portion of the first arm 21B and the second arm 22B are provided with locking protrusions 291, 292, respectively. The locking protrusions 291, 292 are sawtoothed protrusions in the thickness direction of the arms 21B, 22B from the outer surface 202 of the arms 21B, 22B. The locking protrusions 291, 292 are provided at positions closer to the proximal side than the locking pieces 293, 294. The first locking protrusion 291 of the first arm 21B is provided at a position closer to the proximal side than the second locking protrusion 292 of the second arm 22B. The second locking protrusion 292 is provided in the vicinity of the proximal locking piece 294.

[0081] Since the locking pieces 293, 294 are locked to the recesses 71, 72 of the advance / retreat guide member 7 on both sides in the central axis C direction, the arm member 2B is installed in a manner able to advance / retreat in accordance with the advance / retreat of the operation wire 5. Details are described later, but the arm member 2B is able to advance / retreat with respect to the pressing pipe 3B before the locking state of the second arm 22B and the advance / retreat guide member 7 is released. Thus, the jig 1B is configured to be able to perform so-called regrasping.

[0082] The open state of the jig 1B is described. In the open state, as shown in FIG. 6, the first arm 21B is positioned in the first recess 71, and the second arm 22B is positioned in the second recess 72. The distal locking piece 293 and the proximal locking piece 294 are disposed on both sides in the central axis C direction of the recesses 71, 72 of the advance / retreat guide member 7. Figure 12 As shown, in the central axis C direction, the protruding amount LC1 of the first arm 21B from the pressing pipe 3B is equal to the protruding amount LC2 of the second arm 22B from the pressing pipe 3B. The locking protrusions 291, 292 abut the inner peripheral surface of the through passage 31.

[0083] If the operation wire 5 is retracted from the open state shown in FIG. 6, as shown in FIG. 7, the first arm 21B is positioned in the first recess 71, and the second arm 22B is positioned in the second recess 72. The distal locking piece 293 and the proximal locking piece 294 are disposed on both sides in the central axis C direction of the recesses 71, 72 of the advance / retreat guide member 7. Figure 12 Figure 14 ​As shown, when the retraction guide member 7 retracts relative to the pressure tube 3B, the locking protrusion 292 of the second arm 22B first enters the second locking portion 362. As a result, the second arm 22 moves in the direction separating from the second recess 72 of the retraction guide member 7, releasing the locking plates 293 and 294 from the second recess 72. Afterwards, even if the operating line 5 retracts, the retraction of the second arm 22B is restricted. If the operating line 5 retracts further, the first locking protrusion 291 of the first arm 21B enters the first locking portion 361. Similar to the second arm 22B, the first arm 21B moves in the direction separating from the first recess 71 of the retraction guide member 7, releasing the locking plates 293 and 294 from the first recess 71. As a result, as... Figure 15 As shown, arm component 2B is in a closed state.

[0084] Arm 21B and arm 22B are respectively given a curved shape in the thickness direction. When clamp 1B is in place, with the tissue T clamped by arms 21B and 22B, the locking protrusions 291 and 292 are locked into the locking portions 361 and 362. As a result, each arm 21B and 22B applies a force radially outward toward the pressure tube 3B, and the distal ends of each arm 21 and 22 remain protruding to the distal side of the pressure tube 3. As a result, arm member 2 remains in the closed state.

[0085] When arm member 2B is in the closed state, the protrusion amounts LC1 and LC2 of the distal ends of the first arm 21B and the second arm 22B protruding from the pressure tube 3B along the central axis C are different. Specifically, the protrusion amount LC2 of the pressure tube 3B of the second arm 22B along the central axis C is longer than the protrusion amount LC1 of the pressure tube 3B of the first arm 21B along the central axis C. In the closed state, the first claw portion 241 is located closer to the positioning side than the second claw portion 242. That is, the locking protrusions 291 and 292 and the locking portions 361 and 362 function as adjustment mechanisms.

[0086] like Figure 15 As shown, the clamp 1B after placement is similar to the embodiment described above, except that the distal ends of the first arm 21B and the second arm 22B have different protrusion amounts LC1 and LC2 in the direction of the central axis C of the pressure tube 3B. In the closed state, the protrusion amount LC2 of the second arm 22 in the direction of the central axis C of the pressure tube 3B is longer than the protrusion amount LC1 of the first arm 21 in the direction of the central axis C of the pressure tube 3B. In the closed state, the first claw 241 is located closer to the positioning side than the second claw 242. As a result, similar to the embodiment described above, the direction of inclination of the pressure tube 3B after placement is determined to be the first arm 21B side.

[0087] The clip indwelling device 100B and the clip 1B according to the present embodiment, like the above-described embodiments, can control the direction in which the proximal end portion of the pressing tube 3 of the clip 1 is laid down after indwelling. Thus, the proximal end portion of the clip 1 that is indwelled first can be inclined toward a position that does not interfere with the indwelling of the next clip. As a result, in a case where a plurality of clips 1 are continuously indwelled in a relatively close position, the clip 1 that is indwelled first does not interfere with the indwelling of the next clip 1, and the plurality of clips can be indwelled smoothly.

[0088] (4th Embodiment)

[0089] Reference Figures 16 to 19 The clip indwelling device 100C and the clip 1C according to the 4th embodiment will be described. The clip indwelling device 100C according to the present embodiment is a clip indwelling device 100C that can perform the regrasping operation by the clip 1C, like the above-described embodiments.

[0090] The clip indwelling device 100C is provided with a connection tube 101 at the distal end of the sheath 4. The connection tube 101 is engaged by being inserted into the distal end of the sheath 4 through the proximal cylindrical portion. The proximal opening of the connection tube 101 is provided in communication with the inside of the sheath 4, and the locking member and the operation wire 5 are threaded therethrough in a slidable manner. The inside of the connection tube 101 is provided with a stepped portion in the order of the first tube 104, the second tube 105, and the third tube 106 from the proximal side, in a manner that the opening size of the tube increases in order. The first tube 104 has an opening size that allows the locking member and the fixed portion 84C of the operation wire 5 to be inserted and withdrawn. The third tube 106 has an opening size that allows the pressing tube 3C of the clip 1C described later to be inserted. The opening size of the second tube 105 is larger than the opening size of the first tube 104 and smaller than the opening size of the third tube 106. A stepped portion 107 is formed between the third tube 106 and the second tube 105. The opening of the second tube 105 is smaller than the diameter of the pressing tube 3C. The auxiliary tube 102 is provided inside the third tube 106. The auxiliary tube 102 is locked to the pressing tube 3C in a manner that it can rotate around the central axis.

[0091] The locking member has a fixed portion 84C, a base portion 83C, and a distal locking portion 81C. The fixed portion 84C is fixed to the operation wire 5. The base portion 83C and the distal locking portion 81C have a pair of arm shapes that can be opened and closed by elastic deformation. The base portion 83C and the distal locking portion 81C are given a curved shape in advance, so as to be spread apart from each other in a natural state where no external force is applied. The base portion 83C and the distal locking portion 81C approach each other when in contact with the inner circumferential surface of the auxiliary tube 102, and are closed at a position along the central axis C of the pressing tube 3.

[0092] The inner side of the distal clamping portion 81C is provided with a clamp holding portion 85C. If the distal clamping portion 81C and the base portion 83C are closed, the connecting end portion 26 of the arm member 2C is clamped inside and held by the clamp holding portion 85C.

[0093] The clamp 1C is provided inside the pressure tube 3C with a retracting guide member 7C. The retracting guide member 7C is configured to include a coil spring 75 and a washer 74.

[0094] The pair of arms 21, 22 has the same structure as the first embodiment or the second embodiment. Further, the pair of arms 21, 22 is respectively formed with a spring stopper 271. Each spring stopper 271 is formed at a position distal from the stopper 27C. The spring stopper 271 protrudes from the side surface of the arm 21, 22 in a direction orthogonal to the central axis C.

[0095] The coil spring 75 is arranged inside the pressure tube 3C so that the proximal end of the coil spring 75 abuts against the distal face of the flange 34C of the pressure tube 3C. The washer 74 is arranged proximal to the distal end of the coil spring 75. The base portions 231, 232 of the pair of arms 21, 22 are inserted in the opening of the coil spring 75 and the washer 74, and the spring stopper 271 is arranged distal to the retracting guide member 7C. The retracting guide member 7C is arranged between the spring stopper 271 and the flange 34C of the pressure tube 3C.

[0096] The proximal end of the pressure tube 3C is arranged in the third pipe 106 of the connecting pipe 101 so as to abut against the auxiliary pipe 102. As shown in Figure 16 In a state where the coil spring 75 is not compressed, the arm member 2C is arranged at a distal advanced position relative to the pressure tube 3C. Upon pulling of the operation wire 5, the spring stopper 271 retreats to the proximal side, the coil spring 75 is compressed, and the arms 21, 22 move in the direction of closing. Since the washer 74 is arranged between the spring stopper 271 and the coil spring 75, the coil spring 75 can be prevented from flexing when the spring stopper 271 retreats and the coil spring 75 is compressed, and the winding diameter of the coil spring 75 can be maintained in a good state. As a result, the operation of the coil spring 75 is stabilized, and the clamp 1C can be stably held on the extension line of the operation wire 5.

[0097] If the arms 21, 22 retreat and the stopper 27C comes into contact with the proximal end face of the pressure tube 3C and is clamped, the arms 21, 22 are closed. When the arms 21, 22 are closed and the stopper 27 is clamped, the clamping member 8C retreats to a position proximal to the auxiliary pipe 102, and the distal clamping portions 81C open in the direction of separating from each other. As shown in Figure 17As shown, if the distal locking portion 81C of the locking member 8C is opened, the state in which the connection end portion 26 is held by the distal locking portion 81C is released. As a result, the clamp 1C is detached from the connection tube 101. If the distal locking portion 81C is opened in the natural state, the locking member 8C comes into contact with the first tube line 104 of the connection tube 101, and a resistance to the retraction of the operation wire 5 is exerted. If the holding of the connection end portion 26 by the distal locking portion 81C is released and the distal locking portion 81C comes into contact with the first tube line 104, a load change when the operation portion 6 is operated is generated, and the operator can recognize the state in which the clamp 1C is left.

[0098] As shown in the modification example of the clamp 1D as well, the arms 21D, 22D have chamfered surfaces 233 formed by chamfering. Figure 18 and Figure 19 As shown in the modification example of the clamp 1D as well, the arms 21D, 22D have chamfered surfaces 233 formed by chamfering. Figure 19 is Figure 18 As shown in the modification example of the clamp 1D as well, the arms 21D, 22D have chamfered surfaces 233 formed by chamfering. Figure 19 As shown in the modification example of the clamp 1D as well, the arms 21D, 22D have chamfered surfaces 233 formed by chamfering.

[0099] The chamfered surfaces 233 are not limited to the clamp of the fourth embodiment, and can be provided to the clamps of the other embodiments.

[0100] The pressure tube is not limited to the examples shown in the above-described embodiments, and can be configured so that the arm member penetrates therethrough and the arm member becomes from the open state to the closed state depending on the relative position of the pressure tube and the arm member.

[0101] The clamp leaving device of the above-described embodiments shows an example in which the clamp is left in the tissue in the body by inserting the device through the treatment instrument channel of the endoscope into the body, but the form of the clamp leaving device is not limited thereto. For example, the device can be one in which the insertion portion is configured by a hard tube and the clamp is left using a laparoscope.

[0102] The above-described embodiments of the present application have been described, but the scope of the protection of the present application is not limited to the above-described embodiments, and the combination of the constituent elements of the embodiments or various modifications or deletions of the constituent elements can be made within the scope of the gist of the present application. The present application is not limited by the foregoing description, but only by the appended claims.

[0103] Industrial Applicability

[0104] A clip indwelling device and a clip capable of continuously and smoothly indwelling a plurality of clips and capable of shortening a surgery time.

[0105] Explanation of Reference Numerals

[0106] 1, 1A, 1B, 1C, clip; 2, 2A, 2B, 2C, arm member; 4, sheath (insertion portion); 5, operation wire (power transmission member); 7, advance / retreat guide member; 21, 21B, first arm; 22, 22B, second arm; 31, through passage; 32, distal end; 35, mark; 100, 100B, 100C, clip indwelling device; 251, first bent portion; 252, second bent portion.

Claims

1. A clip indwelling device, wherein the clip indwelling device comprises: an insertion portion to be inserted into a body; a power transmission member provided in the insertion portion in a manner capable of advancing and retreating; a hollow member mounted to a distal end of the insertion portion, formed with a through passage in a central axis direction; an arm member including a first arm and a second arm inserted into the through passage in a manner protruding from a distal end of the hollow member, the arm member being connected to the power transmission member and configured to be switched between an open state in which the first arm and the second arm are spread apart from each other and a closed state in which the first arm and the second arm are closed to each other, in accordance with the advancing and retreating of the power transmission member; and an adjustment mechanism configured to, in the open state, arrange the first arm and the second arm so that protruding lengths of the first arm and the second arm in the axis direction from the hollow member are equal, and, in the closed state, arrange the first arm and the second arm so that the protruding lengths of the first arm and the second arm in the axis direction from the hollow member are different.

2. The clip indwelling device according to claim 1, wherein in the open state, a first distance between a distal end of the first arm and a central axis of the hollow member is different from a second distance between a distal end of the second arm and the central axis of the hollow member.

3. The clip indwelling device according to claim 1, wherein the first arm has a first curved portion curved in the open state, the second arm has a second curved portion curved in the open state, a curvature of the first curved portion is different from a curvature of the second curved portion, the adjustment mechanism is for the first curved portion and the second curved portion.

4. The clip indwelling device according to claim 1, wherein the power transmission member is one linear member connected to the arm member, the first arm and the second arm advance and retreat in the hollow member in conjunction with the advancing and retreating of the power transmission member in the insertion portion.

5. The clip indwelling device according to claim 1, wherein a telescopic portion is provided in the first arm or the second arm, the telescopic portion is released from being curved when the arm member is in the closed state, the adjustment mechanism is for the telescopic portion.

6. The clip indwelling device according to claim 1, wherein the first arm and the second arm are independently provided in the arm member, an advancing and retreating guide member is provided at a distal end of the power transmission member to be engaged with a proximal end portion of the first arm and a proximal end portion of the second arm, the hollow member is provided with a first engagement portion to engage the proximal end portion of the first arm and a second engagement portion to engage the proximal end portion of the second arm, positions of the first engagement portion and the second engagement portion in the central axis direction are different, the adjustment mechanism is for the first engagement portion and the second engagement portion.

7. The clip indwelling device according to claim 1, wherein a position marker indicating a position of the arm member around the central axis is provided in the hollow member.

8. A clip, wherein the clip comprises: A hollow member formed with a through passage in a central axis direction; An arm member including a first arm and a second arm inserted into the through passage in a manner protruding from a distal end of the hollow member, the arm member connected to a power transmission member provided in a clamp indwelling device, configured to be able to switch between an open state and a closed state, in which the relative positions of the first arm and the second arm with respect to the central axis direction of the hollow member are located at a position further distal than a first position, the first arm and the second arm are in the open state in which the first arm and the second arm are open, the first arm and the second arm are retracted within the through passage from the first position, and the first arm and the second arm are in the closed state in which the first arm and the second arm are closed by being close to each other; and An adjustment mechanism that configures the first arm and the second arm such that the protruding lengths of the first arm and the second arm in the central axis direction from the hollow member are equal in the open state, and configures the first arm and the second arm such that the protruding lengths of the first arm and the second arm in the central axis direction from the hollow member are different in the closed state.

9. The clamp according to claim 8, wherein In the open state, a first distance between the distal end of the first arm and the central axis of the hollow member is different from a second distance between the distal end of the second arm and the central axis of the hollow member.

10. The clamp according to claim 8, wherein The first arm has a first curved portion that is curved in the open state, The second arm has a second curved portion that is curved in the open state, The curvature of the first curved portion is different from the curvature of the second curved portion, The adjustment mechanism is the first curved portion and the second curved portion.

11. The clamp according to claim 8, wherein A telescopic portion is provided in the first arm or the second arm, The telescopic portion is uncurled when the arm member is in the closed state, The adjustment mechanism is the telescopic portion.

12. The clamp according to claim 8, wherein The first arm and the second arm are independently provided in the arm member, The first arm includes a first clamping member that clamps a proximal end portion of the first arm to the hollow member, The second arm includes a second clamping member that clamps a proximal end portion of the second arm to the hollow member, The positions of the first clamping member and the second clamping member in the central axis direction are different, The adjustment mechanism is the first clamping member and the second clamping member.

13. The clamp according to claim 8, wherein A positioning marker that indicates the position of the arm member around the central axis is provided in the hollow member.

14. A clamp, wherein The clamp includes: An arm member having a first arm extending in a length direction and a second arm extending in the length direction; A hollow member formed with a through passage in the length direction for the arm member to pass through; and An adjustment mechanism, the arm member is inserted into the through passage in a manner protruding from a distal end of the hollow member, and is configured to be switchable between an open state in which the first arm and the second arm are open to each other and a closed state in which the first arm and the second arm are closed to each other by advancing and retreating in the length direction within the hollow member, the adjustment mechanism configures the first arm and the second arm so that protruding lengths of the first arm and the second arm in the length direction from the hollow member are equal when the arm member is in the open state, the adjustment mechanism configures the first arm and the second arm so that protruding lengths of the first arm and the second arm in the length direction from the hollow member are different when the arm member is in the closed state.

15. The clamp according to claim 14, wherein a first distance between a distal end of the first arm and a central axis of the hollow member is different from a second distance between a distal end of the second arm and the central axis of the hollow member in the open state.

16. The clamp according to claim 14, wherein the first arm has a first curved portion that is curved in the open state, the second arm has a second curved portion that is curved in the open state, a curvature of the first curved portion is different from a curvature of the second curved portion, the adjustment mechanism is for the first curved portion and the second curved portion.

17. The clamp according to claim 14, wherein the second arm has a telescopic portion that is curved in a thickness direction of the second arm, the telescopic portion is uncurved when the arm member is in the closed state, the adjustment mechanism is for the telescopic portion.

18. The clamp according to claim 14, wherein the first arm and the second arm are independently provided in the arm member, the first arm includes a first clamping member that clamps a proximal end portion of the first arm to the hollow member, the second arm includes a second clamping member that clamps a proximal end portion of the second arm to the hollow member, positions of the first clamping member and the second clamping member in the length direction are different, the adjustment mechanism is for the first clamping member and the second clamping member.

19. The clamp according to claim 14, wherein the hollow member has a positioning mark that indicates a position of the arm member around the length direction.

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