Gripper system

Abstract

The present invention provides a clamp system most suitable for treatment of suturing and tightening of biological tissue. The clamp system includes a clamp unit having a first arm and a second arm capable of being opened and closed, a wire capable of operating the opening and closing of the clamp, and a sheath capable of being penetrated by the wire, the clamp unit having a support portion supporting the first arm and the second arm in a swingable manner.

Description

Technical Field

[0001] This application claims the benefit of U.S. Provisional Application No. 63 / 301121, filed January 20, 2022, the entire contents of which are incorporated herein by reference.

[0002] This invention relates to a clamping system. Background Technology

[0003] During endoscopic treatments, medical devices such as clamp units are used to manipulate biological tissues. These devices are introduced to the treatment site via a guide that passes through the endoscope.

[0004] Patent Document 1 describes a treatment device that punctures biological tissue. The treatment device described in Patent Document 1 can be left in the body in a punctured state.

[0005] Existing technical documents

[0006] Patent documents

[0007] Patent Document 1: Japanese Patent Application Publication No. 9-38093 Summary of the Invention

[0008] The problem the invention aims to solve

[0009] However, the treatment device described in Patent Document 1 may not be the most suitable treatment device for performing treatments such as suturing and tightening the excised or defective parts of tissue.

[0010] Based on the above, the object of the present invention is to provide a clamping system most suitable for the treatment of suturing and tightening biological tissues.

[0011] Solution for solving the problem

[0012] To address the above problems, the present invention proposes the following solution.

[0013] The clamping system of the first technical solution of the present invention includes: a clamping unit having a first arm and a second arm that can be opened and closed; a wire that can operate the opening and closing of the clamp; and a sheath through which the wire can pass, wherein the clamping unit has a support portion that supports the first arm and the second arm in a swingable manner.

[0014] The effects of the invention

[0015] The clamping system of the present invention, for example, can properly perform the procedure of suturing and tightening the cut portion or defect portion. Attached Figure Description

[0016] Figure 1This is a 3D diagram of the feeder.

[0017] Figure 2 This is a perspective view of the clamping unit according to the first embodiment.

[0018] Figure 3 This is a three-dimensional view of the clamping unit with a pair of arms swinging.

[0019] Figure 4 This is a perspective view of the clamp unit loaded into the feeder.

[0020] Figure 5 It is a diagram showing the defects formed in the tissues of organisms within the body.

[0021] Figure 6 This is a cross-sectional view showing the direction of suture tightening for the defect.

[0022] Figure 7 This is a diagram showing the fixture unit that treats the defect by approaching it from the front.

[0023] Figure 8 This is a diagram showing the fixture unit that treats the defect by approaching it tangentially.

[0024] Figure 9 This is a diagram showing the clamp unit where a pair of arms have swung.

[0025] Figure 10 This is a diagram illustrating the traction steps performed using this clamping unit.

[0026] Figure 11 This is a diagram illustrating the separation steps performed using this fixture unit.

[0027] Figure 12 This is a diagram showing a modified example of the sheath of the feeder.

[0028] Figure 13 This is a diagram illustrating the action of a modified example of the sheath.

[0029] Figure 14 This is a diagram illustrating the action of a modified example of the sheath.

[0030] Figure 15 This is a diagram illustrating the approach steps performed in a modified example using this sheath.

[0031] Figure 16 This is a perspective view of the clamping unit according to the second embodiment.

[0032] Figure 17 This is a side view of the organization and holding part of the clamping unit.

[0033] Figure 18It is a three-dimensional diagram of a pair of arms that hold the first and second mucosa.

[0034] Figure 19 It is a side view of a pair of arms that hold the first and second mucosa.

[0035] Figure 20 This is a diagram illustrating the traction steps performed by the clamping unit.

[0036] Figure 21 This is a perspective view of the clamping unit according to the third embodiment.

[0037] Figure 22 This is a side view of the organization and holding part of the clamping unit.

[0038] Figure 23 It is a three-dimensional diagram of a pair of arms that hold the first and second mucosa.

[0039] Figure 24 This is a perspective view of the clamping unit according to the fourth embodiment.

[0040] Figure 25 This is a diagram showing a feeder containing the fixture unit.

[0041] Figure 26 This diagram illustrates the first gripping step performed using this clamping unit.

[0042] Figure 27 This diagram illustrates the first gripping step performed using this clamping unit.

[0043] Figure 28 This diagram illustrates the second gripping step performed using the clamping unit.

[0044] Figure 29 This is a diagram illustrating the separation steps performed using this fixture unit.

[0045] Figure 30 This is a perspective view of the clamping unit according to the fifth embodiment.

[0046] Figure 31 This diagram illustrates the first gripping step performed using this clamping unit.

[0047] Figure 32 This diagram illustrates the second gripping step performed using the clamping unit.

[0048] Figure 33 This is a diagram illustrating the separation steps performed using this fixture unit.

[0049] Figure 34 This diagram illustrates another variation of the first and second gripping steps performed using this clamping unit.

[0050] Figure 35 This is a perspective view of the clamping unit according to the sixth embodiment.

[0051] Figure 36 This diagram illustrates the first gripping step performed using this clamping unit.

[0052] Figure 37 This diagram illustrates the second gripping step performed using the clamping unit.

[0053] Figure 38 This is a diagram illustrating the traction steps performed using this clamping unit.

[0054] Figure 39 This is a diagram illustrating the separation steps performed using this fixture unit.

[0055] Figure 40 This is a perspective view of the clamping unit according to the seventh embodiment.

[0056] Figure 41 This diagram illustrates the first gripping step performed using this clamping unit.

[0057] Figure 42 This is a diagram illustrating the first separation step performed using this fixture unit.

[0058] Figure 43 This diagram illustrates the connection steps performed using this fixture unit.

[0059] Figure 44 This diagram illustrates the second gripping step performed using the clamping unit.

[0060] Figure 45 This diagram illustrates the second separation step performed using this fixture unit.

[0061] Figure 46 This is a diagram showing the clamping unit and feeder of the eighth embodiment.

[0062] Figure 47 This is a diagram showing the movement of the first and second arms of the clamping unit.

[0063] Figure 48 This is a diagram illustrating the approach steps performed using this fixture unit.

[0064] Figure 49 This diagram illustrates the gripping steps performed using this clamping unit.

[0065] Figure 50 This diagram illustrates the gripping steps performed using this clamping unit.

[0066] Figure 51 This is a diagram illustrating the traction steps performed using this clamping unit.

[0067] Figure 52 This is a diagram showing a frontal approach using this fixture unit.

[0068] Figure 53 This is a diagram showing the tangential approach achieved using this fixture unit.

[0069] Explanation of reference numerals in the attached figures

[0070] 300, 300B, 300C, 300D, 300E, 300F, 300G, 300H, clamping systems (clamping devices, endoscopic suture tightening devices); 100, 100B, 100C, 100D, 100E, 100F, 100G, 100H, clamping units; 2, 2B, 2C, 2D, 2E, 2F, 2G, clamps (clamping arms); 21, 21B, 21 C, 21D, 21E, 21F, 21G, a pair of arms; 211, 211B, 211C, 211D, 211E, 211F, 211G, 211H, the first arm; 212, 212B, 212C, 212D, 212E, 212F, 212H, the second arm; 22, 22B, 22C, 22F, tissue holding parts; 23, 23D, 23F, holding parts; 24, 2 4B. Claw; 25. Connecting part; 26a. Front end (anchor); 26b. First anchor; 26c. Second anchor; 27. Connecting ring; 28. Support part; 3. Pressure tube (tubular component); 4. Connecting component; 41. Insertion part; 42. Connecting part; 43. Connecting part body; 44. Elastic arm; 200, 200D, 200H. Feeder (clamp unit guide device); 220, 220 A. Sheath; 221. Front end head; 222. Front end side coil; 224. Hand side coil; 225. Restriction part; 230. Operating line (power transmission component); 231. Arrow hook part (connecting part); 232. Line; 240, 240D. Operating part; 241. Operating part body; 242, 242D. Sliding member; 242H. First sliding member; 243H. Second sliding member; 247. Connector. Detailed Implementation

[0071] (First Implementation)

[0072] Reference Figures 1-12 The first embodiment of the present invention will be described.

[0073] The clamping system (clamping device, endoscopic suture tightening device) 300 of this embodiment includes a clamping unit 100 and a feeder 200. The clamping unit 100 is loaded into the feeder 200, which is capable of penetrating the endoscope, and is guided to the treatment position.

[0074] [Supply Unit 200]

[0075] Figure 1 This is a 3D view of the feeder 200.

[0076] The feeder (clamp unit introduction device) 200 includes a sheath 220, an operating line 230, and an operating section 240. The feeder 200 is used in combination with the endoscope, for example, by passing through the instrument passage of the endoscope. Therefore, the sheath 220 is formed to be sufficiently long compared to the length of the instrument passage of the endoscope. The sheath 220 is flexible and bends to accommodate the curvature of the endoscope insertion portion.

[0077] The sheath 220 includes a front end head 221, a front side coil 222, and a side coil 224, and is formed into a slender tubular shape. The front side coil 222 is disposed on the front end side of the sheath 220. The front end head 221 is disposed on the front end of the front side coil 222.

[0078] like Figure 1 As shown, the operating line (power transmission component) 230 includes a line 232 that connects the arrow hook portion (connecting portion) 231 to the clamp unit 100 and the operating arrow hook portion 231.

[0079] The arrow hook portion 231 includes a generally conical engaging portion 231a that engages with the clamp unit 100, and a wire connecting portion 231b located at the base end of the engaging portion 231a. The arrow hook portion 231 is formed of a metal material such as stainless steel.

[0080] The wire 232 passes through the sheath 220 in a manner that allows it to move freely in and out of the sheath. The front end of the wire 232 is fixed to the base end of the wire connector 231b, for example, by welding.

[0081] like Figure 1 As shown, the operating unit 240 includes an operating unit body 241, a slider 242, and a thumb ring 248. The operating unit body 241, slider 242, and thumb ring 248 are, for example, injection molded from resin material. The operating unit body 241 includes a slit portion 241a and a rotating handle 241b located at the front end. The slit portion 241a supports the slider 242, enabling it to move forward and backward.

[0082] The slider 242 is installed in a manner that allows it to move forward and backward along the longitudinal axis of the operating part body 241, and the base end of the wire 232 is mounted thereon. By moving the slider 242 forward and backward along the operating part body 241, the wire 232 moves forward and backward relative to the sheath 220, and the arrow hook portion 231 moves forward and backward.

[0083] The thumb ring 248 is mounted on the base of the operating part body 241 in such a way that it can rotate about the length axis of the operating part body 241.

[0084] [Clamping Unit 100]

[0085] Figure 2 This is a perspective view of the clamping unit 100 of this embodiment.

[0086] The clamping unit 100 includes a clamp 2, a pressure tube 3, and a connecting member 4. In the following description, the clamp 2 side in the length direction A of the clamping unit 100 is designated as the front end side (far side) A1 of the clamping unit 100, and the connecting member 4 side is designated as the base end side (proximal side) A2 of the clamping unit 100.

[0087] The clamp (clamp arm) 2 has a pair of arms 21 that can be opened and closed toward the front end side A1 and a support portion 28 that supports the pair of arms 21 in a rotatable manner. The support portion 28 is mounted on the front end of the connecting member 4.

[0088] A pair of arms 21 has a first arm 211 and a second arm 212. The first arm 211 and the second arm 212 are arranged on both sides of the central axis O1 in the longitudinal direction A of the clamp unit 100. The "initial position" of the pair of arms 21 is defined as follows: the first arm 211 and the second arm 212 are arranged symmetrically with respect to the central axis O1. Alternatively, the clamp 2 may have more than three arms.

[0089] The first arm 211 and the second arm 212 are formed in the shape of plates, and the thickness direction of the first arm 211 and the second arm 212 is approximately consistent with the opening and closing direction P of the first arm 211 and the second arm 212.

[0090] The first arm 211 and the second arm 212 have a tissue holding portion 22, a flat holding portion 23, and a connecting portion 25 connected to the support portion 28, extending from the front end side A1 toward the base end side A2. The tissue holding portion 22 is formed by bending the front ends of the first arm 211 and the second arm 212 inward. Claws 24 facing inward are formed at the front ends of the first arm 211 and the second arm 212.

[0091] Figure 3 It is a perspective view of a clamping unit 100 with a pair of arms 21 swinging.

[0092] The support 28 supports a pair of arms 21 so that they can rotate and swing about a rotation axis RO that is approximately perpendicular to the length direction A. The swing direction (rotation direction) Q of the pair of arms 21 about the rotation axis RO is approximately the same as the opening and closing direction P of the pair of arms 21. That is, the swing direction of the pair of arms 21 and the opening and closing direction of the pair of arms 21 are along the same plane. In addition, the rotation axis RO is not limited to an axis that is approximately perpendicular to the length direction A, but can also be an axis that intersects the length direction A.

[0093] When at least one of the first arm 211 and the second arm 212 comes into contact with biological tissue, or when a predetermined or greater external force is applied to at least one of the first arm 211 and the second arm 212, the support portion 28 causes the pair of arms 21 to swing. Otherwise, the support portion 28 does not cause the pair of arms 21 to swing.

[0094] The clamping tube (tubular member) 3 is a cylindrical tube capable of accommodating at least a portion of the clamp 2. The clamping tube 3 has an internal space 38 for the clamp 2 to move in and out along the length direction A. The clamping tube 3 can fix the clamp 2, which is pulled into the internal space 38, into a closed state.

[0095] Figure 4 This is a perspective view of the clamp unit 100 loaded into the feeder 200.

[0096] The connecting component 4 includes an insertion part 41 that is inserted into the internal space 38 of the pressure tube 3 and a connecting part 42 provided at the base end of the insertion part 41. The insertion part 41 is mounted on the support part 28 of the clamp 2. The connecting part 42 is detachably connected to the arrow hook part 231 that passes through the sheath 220.

[0097] The insertion portion 41 is formed in a generally cylindrical rod shape. The insertion portion 41 has a fracture portion that breaks or deforms when a predetermined breaking force is applied. By breaking or deforming through the fracture portion, the pair of arms 21 and the connecting portion 42 are separated.

[0098] The connecting part 42 is an engaging part that engages (connects) with the arrow hook part 231 of the feeder 200. The connecting part 42 has a connecting part body 43 and an elastic arm part 44.

[0099] An elastic arm 44 is provided at the base end of the connecting body 43 and branches into a forked shape. The elastic arm 44 can elastically deform relative to the connecting body 43 and can open and close relative to the connecting body 43. A notch 44m is formed in the elastic arm 44 for holding and accommodating the engaging portion 231a of the arrow hook portion 231. The notch 44m is shaped to fit tightly against the outer peripheral surface of the engaging portion 231a of the arrow hook portion 231.

[0100] [Sewing tightening treatment using clamp unit 100]

[0101] Next, the suture tightening procedure using the clamp unit 100 will be described. Specifically, the suture tightening procedure performed using an endoscope will be described. Figure 5 The procedure of suturing and tightening the defect D formed by biological tissue in the body is explained.

[0102] Figure 6 This is a cross-sectional view of the suture tightening direction S of the defect D.

[0103] The surgeon approaches the defect D with an endoscope. The surgeon observes the defect D and determines the suturing tightening direction S based on its size and shape. In the following description, the mucosa surrounding the edge of the defect D and positioned opposite each other in the suturing tightening direction S, separated from the defect D, will be referred to as "first mucosa M1" and "second mucosa M2".

[0104] <Approach Steps>

[0105] The surgeon inserts the clamp unit 100, loaded in the feeder 200, into the body through the endoscope channel. The surgeon moves the endoscope and sheath 220 to bring the clamps 2 of the clamp unit 100 close to the defect D, which is the treatment area.

[0106] At least two methods exist for bringing the clamp unit 100 close to the treatment area: frontal approach AP1 and tangential approach AP2. In frontal approach AP1, the surgeon manipulates the endoscope and sheath 220 to position the clamp unit 100 so that its longitudinal direction A is substantially perpendicular to the surface of the treatment area. In tangential approach AP2, the surgeon manipulates the endoscope and sheath 220 to position the clamp unit 100 along its longitudinal direction A along the surface of the treatment area.

[0107] <Approaching AP1 from the front>

[0108] Figure 7 This diagram illustrates a clamp unit 100 used to treat the defect D by approaching AP1 from the front. The surgeon brings the clamp unit 100 close to the defect D, which is the treatment area, by approaching AP1 from the front. A pair of arms 21 are positioned in the initial position. The pair of arms 21 are positioned facing the front of the defect D, which is the treatment area. The first mucosa M1 and the second mucosa M2 are held by the pair of arms 21.

[0109] <Tangent close to AP2>

[0110] Figure 8 This diagram illustrates a clamp unit 100 used to treat defect D by approaching AP2 tangentially. The surgeon brings the clamp unit 100 close to the defect D, which is the treatment area, by approaching AP2 tangentially. A pair of arms 21 are positioned in the initial position. The surgeon attaches the tissue holding portion 22 of the first arm 211 to the mucosa on the endoscopic side (proximal side) of the first mucosa M1 and the second mucosa M2. Figure 8 The middle part is the first mucosa M1).

[0111] Figure 9This diagram shows a clamp unit 100 with a pair of arms 21 swinging. The surgeon moves the tissue holding part 22, which is engaged with the clamp unit 100 on the first mucosa M1, closer to the defect D, which is the treatment area. Specifically, the surgeon advances the feeder 200 relative to the treatment instrument channel of the endoscope. Alternatively, the surgeon moves the clamp unit 100 closer to the defect D by advancing the endoscope. As a result, Figure 9 As shown, a pair of arms 21 swing (SW) around the rotation axis RO, with the second arm 212 contacting the second mucosa M2. Specifically, the support portion 28 causes the first arm 211 to swing towards the sheath 220. Furthermore, the support portion 28 causes the second arm 212 to swing away from the sheath 220. As a result, the pair of arms 21 are positioned facing the front of the defect D, which is the treatment area. The first mucosa M1 and the second mucosa M2 are held by the pair of arms 21.

[0112] <Traction Steps>

[0113] Figure 10 This diagram illustrates the traction steps performed using the clamp unit 100.

[0114] The surgical operator retracts the arrow hook 231 by moving the slider 242 back along the operating part body 241. The connecting member 4, attached to the arrow hook 231, pulls the clamp 2. The clamp 2, pulled by the connecting member 4, is pulled into the pressure tube 3. When the clamp 2 is pulled into the predetermined position of the pressure tube 3, the clamp 2 is restricted from moving relative to the pressure tube 3 towards the front end A1, and the pair of arms 21 are locked in a closed state. When the pair of arms 21 are locked in the closed state, the pair of arms 21 will not return to the open state.

[0115] in addition, Figure 10 The feeder 200 shown is positioned approximately perpendicular to the surface of the treatment area by approaching AP1 from the front. When the feeder 200 is positioned tangentially to AP2, it is positioned along the surface of the treatment area.

[0116] <Separation Steps>

[0117] Figure 11 This is a diagram illustrating the separation steps performed using the clamp unit 100.

[0118] The surgeon further pulls on clamp 2. A fracturing force is applied to the fractured portion of the insertion part 41 of the connecting member 4 due to the pull, causing the fractured portion to break. As a result, the pair of arms 21 and the connecting part 42 separate. The surgeon retracts the sheath 220, leaving clamp 2 and pressure tube 3, which have been ligated to the first mucosa M1 and the second mucosa M2, inside the body.

[0119] Using the clamp unit 100 of this embodiment, the procedure of suturing and tightening the defect D can be properly performed. Even when the defect D is treated by approaching AP2 tangentially, the pair of arms 21 can be swung about the rotation axis RO and positioned so that the front of the pair of arms 21 faces the defect D, which is the treatment area.

[0120] The first embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the structure may be configured by appropriately combining the constituent elements shown in the above embodiment and the variations shown below.

[0121] (Variation 1-1)

[0122] Figure 12 This diagram shows a modified example of the sheath 220A, which is the sheath 220 of the feeder 200. The sheath 220A includes a front end head 221, a front end side coil 222, a hand-side side coil 224, and a limiting portion 225. The limiting portion 225 is provided along the length direction A on the outer peripheral surface of the front end side coil 222. The limiting portion 225 is only provided in a portion of the circumferential direction C relative to the length direction A. The limiting portion 225 is the part that fixes the outer peripheral surface of the front end side coil 222. The limiting portion 225 is, for example, formed by welding the outer peripheral surface of the front end side coil 222. The limiting portion 225 may also be formed by joining a plate member to the outer peripheral surface of the front end side coil 222 by welding or the like.

[0123] Figure 13 and Figure 14 This is a diagram showing the operation of the sheath 220A.

[0124] When the front-end coil 222 is bent toward the side where the limiting portion 225 is provided relative to the central axis of the length direction A of the sheath 220A, the front-end coil 222 of the sheath 220A is as follows: Figure 13 The front-side coil 222 of the sheath 220 is bent in the same manner as the front-side coil 222 of the sheath 220. On the other hand, when it is desired to bend the front-side coil 222 towards the side opposite to the side where the limiting portion 225 is provided, with respect to the central axis of the length direction A of the sheath 220A, the limiting portion 225 fixes the outer peripheral surface of the front-side coil 222, thus the front-side coil 222 of the sheath 220A... Figure 14 As shown, it does not bend.

[0125] Figure 15 This is a diagram showing the approach steps performed using the sheath 220A.

[0126] When the surgeon approaches AP2 tangentially and grasps the first mucosa M1 and the second mucosa M2 using a pair of arms 21, it is necessary to press the pair of arms 21 against the biological tissue. At this time, if the limiting portion 225 of the sheath 220A is positioned in the direction in which the pair of arms 21 swing relative to the central axis of the sheath 220A's longitudinal direction A (biological tissue side), the front coil 222 will not bend when the pair of arms 21 are pressed against the biological tissue, making it easy to press. The sheath 220A may also have markings that facilitate endoscopic visual confirmation of the location of the limiting portion 225.

[0127] (Second Implementation)

[0128] Reference Figures 16-20 The clamping system 300B according to the second embodiment of the present invention will be described. In the following description, the same reference numerals are used for the parts that have been described previously, and repeated descriptions will be omitted.

[0129] The clamping system 300B includes a clamping unit 100B and a feeder 200. The clamping unit 100B is loaded into the feeder 200, which is capable of passing through the endoscope, and is guided to the treatment position.

[0130] Figure 16 This is a perspective view of the clamping unit 100B of this embodiment.

[0131] The clamp unit 100B includes a clamp 2B, a pressure tube 3, and a connecting component 4.

[0132] The clamp (clamp arm) 2B has a pair of arms 21B that can be opened and closed toward the front end side A1 and a support portion 28 that supports the pair of arms 21B in a swingable manner. Alternatively, the support portion 28 can also support the pair of arms 21B in a non-swinging manner.

[0133] A pair of arms 21B has a first arm 211B and a second arm 212B. The first arm 211B and the second arm 212B are arranged on both sides of the central axis O1 in the length direction A.

[0134] The first arm 211B and the second arm 212B have a tissue holding portion 22B, a flat holding portion 23, and a connecting portion 25 extending from the front end side A1 toward the base end side A2. The tissue holding portion 22B is formed by bending the front ends of the first arm 211B and the second arm 212B inward.

[0135] The tissue holding portion 22B has a front end portion (anchor) 26a disposed at the front end of the tissue holding portion 22B. The front end portion (anchor) 26a is formed in a generally circular plate shape, and its thickness direction is approximately aligned with the opening and closing direction P of the pair of arms 21B. In the vertical direction B, which is approximately perpendicular to the length direction A and the opening and closing direction P, the length of the front end portion (anchor) 26a is longer than the length of the other parts of the tissue holding portion 22B.

[0136] Figure 17 This is a side view of the organization control section 22B.

[0137] The front end portion (anchor) 26a of the organization holding part 22B has a claw 24B on the inside side of the opening and closing direction P. The claw 24B extends toward the inside side of the opening and closing direction P.

[0138] Figure 18 It is a three-dimensional view of a pair of arms 21B that hold the first mucosa M1 and the second mucosa M2. Figure 19 This is a side view of a pair of arms 21B that hold the first mucosa M1 and the second mucosa M2. The surgeon approaches the AP2 tangentially to bring the clamp unit 100B close to the defect D, which is the treatment area. The surgeon can reliably hold the first mucosa M1 and the second mucosa M2 using the front end (anchor) 26a with claws 24B.

[0139] Figure 20 This diagram illustrates the traction steps performed using the clamp unit 100B.

[0140] The surgeon pulls the clamp 2 into the predetermined position of the pressure tube 3, locking the pair of arms 21B in a closed state. Because the front end (anchor) 26a with claw 24B reliably holds the first mucosa M1 and the second mucosa M2, the front end (anchor) 26a is not easily displaced from the first mucosa M1 and the second mucosa M2.

[0141] Using the clamp unit 100B of this embodiment, the procedure of suturing and tightening the defective portion D can be properly performed. A pair of arms 21B can reliably hold the first mucosa M1 and the second mucosa M2.

[0142] The second embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the structure may be configured by appropriately combining the constituent elements shown in the above-described embodiment and the variations shown below.

[0143] (Third Implementation)

[0144] Reference Figures 21-23The clamping system 300C according to the third embodiment of the present invention will be described. In the following description, the same reference numerals are used for the parts that have been described previously, and repeated descriptions will be omitted.

[0145] The clamping system 300C includes a clamping unit 100C and a feeder 200. The clamping unit 100C is loaded into the feeder 200, which is capable of passing through the endoscope, and is guided to the treatment position.

[0146] Figure 21 This is a perspective view of the clamping unit 100C of this embodiment.

[0147] The clamping unit 100C includes a clamp 2C, a pressure tube 3, and a connecting component 4.

[0148] The clamp (clamp arm) 2C has a pair of arms 21C that can be opened and closed toward the front end side A1 and a support portion 28 that supports the pair of arms 21C in a swingable manner. Alternatively, the support portion 28 can also support the pair of arms 21C in a non-swinging manner.

[0149] A pair of arms 21C has a first arm 211C and a second arm 212C. The first arm 211C and the second arm 212C are arranged on both sides of the central axis O1 in the length direction A.

[0150] The first arm 211C and the second arm 212C have a tissue holding portion 22C, a flat holding portion 23, and a connecting portion 25 extending from the front end side A1 toward the base end side A2. The tissue holding portion 22C is formed by bending the front ends of the first arm 211B and the second arm 212B inward.

[0151] Figure 22 This is a side view of the organization and control section 22C.

[0152] The tissue holding portion 22C has a first anchor 26b and a second anchor 26c. The first anchor 26b and the second anchor 26c are located on both sides of the tissue holding portion 22C in the vertical direction B. The first anchor 26b and the second anchor 26c are formed into sharp shapes that protrude along the vertical direction B. In the vertical direction B, the length D1 from the front end of the first anchor 26b to the front end of the second anchor 26c is longer than the length D2 of the other parts of the tissue holding portion 22B.

[0153] Figure 23 This is a three-dimensional view of a pair of arms 21C holding the first mucosa M1 and the second mucosa M2. The surgical operator approaches AP2 tangentially to bring the clamp unit 100C close to the defect D, which is the treatment area. The biological tissue side of the first anchor 26b and the second anchor 26c (in...) Figure 23The second anchor 26c is inserted into the biological tissue. The surgeon can reliably hold the first mucosa M1 and the second mucosa M2 using the tissue holding portion 22C with the first anchor 26b and the second anchor 26c.

[0154] Using the clamp unit 100C of this embodiment, the procedure of suturing and tightening the defective portion D can be properly performed. A pair of arms 21C can reliably hold the first mucosa M1 and the second mucosa M2.

[0155] The third embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the structure may be configured by appropriately combining the constituent elements shown in the above-described embodiment and the variations shown below.

[0156] (Fourth Implementation)

[0157] Reference Figures 24-29 The clamping system 300D according to the fourth embodiment of the present invention will be described. In the following description, the same reference numerals are used for the parts that have been described previously, and repeated descriptions will be omitted.

[0158] The clamping system 300D includes a clamping unit 100D and a feeder 200D. The clamping unit 100D is loaded into the feeder 200D, which is able to pass through the endoscope, and is guided to the treatment position.

[0159] Figure 24 This is a perspective view of the fixture unit 100D of this embodiment.

[0160] The clamp unit 100D includes a clamp 2D, a pressure tube 3, and a connecting member 4. The clamp unit 100D is used in conjunction with the feeder 200D and can supply high-frequency current from the arrow hook portion 231 connected to the connecting member 4 to the clamp 2D.

[0161] The clamp 2D has a pair of arms 21D that can be opened and closed toward the front end side A1 and a support portion 28 that supports the pair of arms 21D in a swingable manner. Alternatively, the support portion 28 can also support the pair of arms 21D in a non-swinging manner.

[0162] A pair of arms 21D has a first arm 211D and a second arm 212D. The first arm 211D and the second arm 212D are arranged on both sides of a central axis O1 in the length direction A. At least one of the first arm 211D and the second arm 212D is energized.

[0163] The first arm 211D and the second arm 212D have a tissue holding portion 22, a holding portion 23D, and a connecting portion 25 extending from the front end side A1 toward the base end side A2. The holding portion 23D has a curved portion 23a that bends inward from the front end side A1.

[0164] Figure 25 This is a diagram showing a feeder 200D containing a clamp unit 100D. The feeder 200D includes a sheath 220, an operating line 230, and an operating section 240D.

[0165] The operating unit 240D includes an operating unit body 241, a slider 242D, a connector 247, and a thumb ring 248.

[0166] The slider 242D is mounted in a manner that allows it to move forward and backward along the longitudinal axis of the operating part body 241, and the base end of the wire 232 is mounted thereon. As the slider 242D moves forward and backward along the operating part body 241, the wire 232 moves forward and backward relative to the sheath 220, and the arrow hook portion 231 moves forward and backward.

[0167] Connector 247 can be connected to a high-frequency power supply device (not shown), and is electrically and physically connected to the base end of line 232. Connector 247 can supply high-frequency current from the high-frequency power supply device to the connector member 4 and the clamp 2D via line 232. Connector 247 is supported by a slider 242D and is formed into a generally cylindrical shape.

[0168] [Sewing tightening treatment using clamp unit 100D]

[0169] Next, the suture tightening procedure using the clamp unit 100D will be described. Specifically, the suture tightening procedure performed using an endoscope will be explained. Figure 5 The procedure of suturing and tightening the defect D formed by biological tissue in the body is explained.

[0170] <Approach Steps>

[0171] The surgeon inserts the clamp unit 100D, loaded into the feeder 200D, into the body through the endoscope channel. The surgeon moves the endoscope and sheath 220 to bring the clamp 2D of the clamp unit 100D close to the defect D, which is the treatment area. The surgeon moves the suture 232 forward and backward to unfold the clamp 2D into the appropriate position.

[0172] <First Step of Control>

[0173] Figure 26 and Figure 27This diagram illustrates the first gripping step performed using the clamp unit 100D. The surgeon creates a small hole at the edge of the defect D by applying a high-frequency current to the clamp 2D. Alternatively, the surgeon may damage the biological tissue to create a bulge (clamp). For example, the surgeon may... Figure 26 A high-frequency current is applied to the first arm 211D to create an opening in the first mucosa M1. Alternatively, the surgical operator can also... Figure 27 As shown, a high-frequency current is applied while the first mucosa M1 is held by the first arm 211D and the second arm 212D. The surgeon holds the first mucosa M1 by inserting the tip of the first arm 211D into the formed small hole or bulge (clamp). Because the tip of the first arm 211D is inserted into the formed small hole or bulge (clamp), it is not easy to slip.

[0174] <Second Step of Control>

[0175] Figure 28 This diagram illustrates the second gripping step performed using the clamping unit 100D.

[0176] The surgeon moves the clamp unit 100D in the direction along the suture tightening direction S, moving the tip of the second arm 212D to the vicinity of the second mucosa M2. The surgeon then uses the second arm 212D to hold the second mucosa M2 in the same manner as using the first arm 211D to hold the first mucosa M1.

[0177] <Steps to stop bleeding>

[0178] In cases of bleeding in the body's own tissues, the surgeon can also perform hemostasis by applying a high-frequency current to the clamp 2D to cauterize the bleeding site.

[0179] <Traction Steps>

[0180] The surgical operator retracts the arrow hook 231 by moving the slider 242D backward along the operating part body 241. The connecting member 4, connected to the arrow hook 231, pulls the clamp 2D. The clamp 2D, pulled by the connecting member 4, is pulled into the pressure tube 3. When the clamp 2D is pulled into the predetermined position of the pressure tube 3, the clamp 2D is restricted from moving towards the front end relative to the pressure tube 3, and the pair of arms 21D is locked in a closed state. When the pair of arms 21D is locked in the closed state, the pair of arms 21D cannot return to the open state.

[0181] <Separation Steps>

[0182] Figure 29 This diagram illustrates the separation steps performed using the fixture unit 100D.

[0183] The surgeon further pulls on clamp 2D. A fracturing force is applied to the fractured portion of the insertion part 41 of the connecting member 4 due to the pull, causing the fractured portion to break. As a result, the pair of arms 21D and the connecting part 42 separate. The surgeon retracts the sheath 220, leaving clamp 2D and pressure tube 3, which have been ligated to the first mucosa M1 and the second mucosa M2, in place inside the body.

[0184] Using the clamp unit 100D of this embodiment, the procedure of suturing and tightening the defect D can be properly performed. By inserting the front end of the clamp 2D into a small hole or protrusion (clamping protrusion) formed by high-frequency current, the clamp 2D is less likely to slip relative to the tissue.

[0185] The fourth embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the structure may be configured by appropriately combining the constituent elements shown in the above-described embodiment and the variations shown below.

[0186] (Fifth Implementation)

[0187] Reference Figures 30-34 The clamping system 300E according to the fifth embodiment of the present invention will be described. In the following description, the same reference numerals are used for the parts that have been described previously, and repeated descriptions will be omitted.

[0188] The clamping system 300E includes a clamping unit 100E and a feeder 200D. The clamping unit 100E is loaded into the feeder 200D, which is able to pass through the endoscope, and is guided to the treatment position.

[0189] Figure 30 This is a perspective view of the fixture unit 100E of this embodiment.

[0190] The clamp unit 100E includes a clamp 2E, a pressure tube 3, and a connecting member 4. The clamp unit 100E is used in conjunction with the feeder 200D and can supply high-frequency current from the arrow hook portion 231 connected to the connecting member 4 to the clamp 2E.

[0191] The clamp 2E has a pair of arms 21E that can be opened and closed toward the front end side A1 and a support portion 28 that supports the pair of arms 21E in a swingable manner. Alternatively, the support portion 28 can also support the pair of arms 21E in a non-swinging manner.

[0192] A pair of arms 21E has a first arm 211E and a second arm 212E. The first arm 211E and the second arm 212E are arranged on both sides of a central axis O1 in the longitudinal direction A. At least one of the first arm 211E and the second arm 212E is energized.

[0193] The first arm 211E and the second arm 212E have tissue holding portion 22, holding portion 23 and connecting portion 25 extending from the front end side A1 toward the base end side A2.

[0194] Figure 31 This diagram illustrates the first gripping step performed using the clamping unit 100E.

[0195] The surgeon applies a high-frequency current to the first arm 211E to create an opening in the first mucosa M1. The surgeon holds the first mucosa M1 by inserting the tip of the first arm 211E into the smaller opening. Because the tip of the first arm 211E is inserted into the smaller opening, it is less likely to slip.

[0196] Figure 32 This diagram illustrates the second gripping step performed using the clamping unit 100E.

[0197] The surgeon moves the clamp unit 100E in the direction along the suture tightening direction S, moving the tip of the second arm 212D to the vicinity of the second mucosa M2. The surgeon then uses the second arm 212D to hold the second mucosa M2 in the same manner as using the first arm 211E to hold the first mucosa M1.

[0198] <Steps to stop bleeding>

[0199] In cases of bleeding from biological tissue, the surgeon can also apply a high-frequency current to the clamp 2E to cauterize the bleeding site and thus achieve hemostasis.

[0200] <Traction Steps>

[0201] The surgical operator retracts the arrow hook 231 by moving the slider 242 back along the operating part body 241. The connecting member 4, connected to the arrow hook 231, pulls the clamp 2E. The clamp 2E, pulled by the connecting member 4, is pulled into the pressure tube 3. When the clamp 2E is pulled into the predetermined position of the pressure tube 3, the clamp 2E is restricted from moving towards the front end relative to the pressure tube 3, and the pair of arms 21E are locked in a closed state. When the pair of arms 21E is locked in the closed state, the pair of arms 21E cannot return to the open state.

[0202] Figure 33 This is a diagram illustrating the separation steps performed using the clamp unit 100E.

[0203] The surgeon further pulls on clamp 2E. A fracturing force is applied to the fractured portion of the insertion part 41 of the connecting member 4, causing the fractured portion to break. As a result, the pair of arms 21E and the connecting part 42 separate. The surgeon retracts the sheath 220, leaving clamp 2E and compression tube 3, which have been ligated to the first mucosa M1 and the second mucosa M2, in place inside the body.

[0204] Figure 34 This diagram illustrates another configuration of the first and second gripping steps performed using the clamp unit 100E. The surgeon can also supply high-frequency current to the clamp 2E while both the first arm 211E and the second arm 212E are in contact with the biological tissue.

[0205] Using the clamp unit 100E of this embodiment, the procedure of suturing and tightening the defect D can be performed appropriately. By inserting the front end of the clamp 2E into a small hole formed using a high-frequency current, the clamp 2E is less likely to slip relative to the tissue.

[0206] The fifth embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the components shown in the above-described embodiments and the variations shown below can be appropriately combined to form the embodiment.

[0207] (Sixth Implementation Method)

[0208] Reference Figures 35-39 The clamping system 300F according to the sixth embodiment of the present invention will be described. In the following description, the same reference numerals are used for the parts that have been described previously, and repeated descriptions will be omitted.

[0209] The clamping system 300F includes a clamping unit 100F and a feeder 200. The clamping unit 100F is loaded into the feeder 200, which is able to pass through the endoscope, and is guided to the treatment position.

[0210] Figure 35 This is a perspective view of the clamping unit 100F of this embodiment.

[0211] The clamp unit 100F includes clamp 2F, pressure tube 3, and connecting component 4.

[0212] The clamp 2F has a pair of arms 21F that can be opened and closed toward the front end side A1 and a support portion 28 that supports the pair of arms 21F in a swingable manner. Alternatively, the support portion 28 can also support the pair of arms 21F in a non-swinging manner.

[0213] A pair of arms 21F has a first arm 211F and a second arm 212F. The first arm 211F and the second arm 212F are arranged on both sides of the central axis O1 in the length direction A.

[0214] The first arm 211F and the second arm 212F have a tissue holding portion 22F, a holding portion 23F, and a connecting portion 25 extending from the front end side A1 toward the base end side A2. The tissue holding portion 22F is formed into a sharp arrowhead shape at the front end. The tissue holding portion 22F may also have barbs. The front end of the holding portion 23F is bent to a greater extent in a direction away from the central axis O1 (outward direction), forming a hook shape.

[0215] Figure 36 This diagram illustrates the first gripping step performed using the clamping unit 100F.

[0216] The surgeon inserts the anterior end of the first arm 211F into the first mucosa M1. Specifically, the surgeon inserts the anterior end of the first arm 211F from the inside to the outside at the edge of the defect D.

[0217] Figure 37 This diagram illustrates the second gripping step performed using the clamping unit 100F.

[0218] The surgeon moves the clamp unit 100F in the direction of suture tightening S, bringing the tip of the second arm 212F to the vicinity of the second mucosa M2. The surgeon then inserts the tip of the second arm 212F into the second mucosa M2. Specifically, the surgeon inserts the tip of the second arm 212F from the inside to the outside at the edge of the defect D.

[0219] Figure 38 This is a diagram showing the traction steps performed using the clamp unit 100F.

[0220] The surgeon retracts the arrow hook 231 by moving the slider 242 back along the operating body 241. A connecting member 4, a traction clamp 2F, is attached to the arrow hook 231. A pair of arms 21F pull each other closer, bringing the first mucosa M1 and the second mucosa M2 closer together.

[0221] Figure 39 This is a diagram illustrating the separation steps performed using the clamp unit 100F.

[0222] The surgeon retracts the sheath 220, leaving the clamp 2F and the compression tube 3 in place inside the body, which have ligated the first mucosa M1 and the second mucosa M2.

[0223] Using the clamp unit 100F of this embodiment, the procedure of suturing and tightening the defect D can be properly performed. A pair of arms 21F can reliably hold the first mucosa M1 and the second mucosa M2.

[0224] The sixth embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the embodiment shown above and the variations shown below can be appropriately combined to form the invention.

[0225] (Seventh Implementation)

[0226] Reference Figures 40-45 The clamping system 300G according to the seventh embodiment of the present invention will be described. In the following description, the same reference numerals are used for structures that are common to the parts already described, and repeated descriptions are omitted.

[0227] The clamping system 300G includes a clamping unit 100G and a feeder 200. The clamping unit 100G is loaded into the feeder 200, which is able to pass through the endoscope, and is guided to the treatment position.

[0228] Figure 40 This is a perspective view of the clamping unit 100G of this embodiment.

[0229] The clamp unit 100G includes a clamp 2G, a pressure tube 3, and a connecting component 4.

[0230] The clamp (clamp arm) 2G has a pair of arms 21G that can be opened and closed toward the front end side A1 and a support portion 28 that supports the pair of arms 21G in a swingable manner. Alternatively, the support portion 28 can also support the pair of arms 21G in a non-swinging manner.

[0231] A pair of arms 21G has a first arm 211G and a second arm 212. The first arm 211G and the second arm 212 are arranged on both sides of the central axis O1 in the length direction A.

[0232] The first arm 211G has a tissue holding portion 22, a flat holding portion 23, a connecting portion 25, and a connecting ring 27. The connecting ring 27 is formed in a ring shape and is located on the outside of the opening / closing direction P at the front end of the holding portion 23. The connecting ring 27 allows the second arm 212 of another clamping unit 100G to pass through. The connecting ring 27 may also be provided at a bent portion of the first arm 211G. In addition, the second arm 212 may also have a connecting ring 27.

[0233] Figure 41 This diagram illustrates the first gripping step performed using the clamping unit 100G.

[0234] The surgeon holds the first mucosa M1 using the pair of arms 21G of the clamp 2G of the first clamp unit 100G (hereinafter also referred to as "clamp unit 100G1").

[0235] Figure 42This is a diagram showing the first separation step performed using the fixture unit 100G.

[0236] The surgeon retracts the sheath 220, leaving the clamp 2G and the compression tube 3 in place inside the body, with only the first mucosa M1 ligated.

[0237] Figure 43 This is a diagram showing the connection steps performed using the fixture unit 100G.

[0238] The surgeon loads the second clamp unit 100G (hereinafter also referred to as "clamp unit 100G2") into the feeder 200. The surgeon passes the second arm 212 of the clamp 2G of clamp unit 100G2 through the connecting ring 27 of the first arm 211G of clamp unit 100G1.

[0239] Figure 44 This diagram illustrates the second gripping step performed using the clamping unit 100G.

[0240] The surgeon moves the clamp unit 100G in the direction along the suture tightening direction S, moving the tip of the second arm 212 to the vicinity of the second mucosa M2. The surgeon then uses the pair of arms 21G of the clamp 2G to hold the second mucosa M2.

[0241] Figure 45 This is a diagram showing the second separation step performed using the fixture unit 100G.

[0242] The surgeon retracts the sheath 220, leaving the clamp 2G and the compression tube 3 in place inside the body, with only the second mucosa M2 ligated.

[0243] Using the clamp unit 100G of this embodiment, the procedure of suturing and tightening the defective portion D can be properly performed. The clamp unit 100G can connect the clamps 2G of two clamp units 100G to reliably hold the first mucosa M1 and the second mucosa M2.

[0244] The seventh embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the structure may be configured by appropriately combining the constituent elements shown in the above-described embodiments and the variations shown below.

[0245] (Eighth Implementation Method)

[0246] Reference Figures 46-53 The clamping system 300H according to the eighth embodiment of the present invention will be described. In the following description, the same reference numerals are used for the parts that have been described previously, and repeated descriptions will be omitted.

[0247] The clamping system 300H includes a clamping unit 100H and a feeder 200H. The clamping unit 100H is loaded into the feeder 200H, which is able to pass through the endoscope, and is guided to the treatment position.

[0248] Figure 46 This diagram illustrates the clamping unit 100H and the feeder 200H of this embodiment. The feeder 200H has a first slider 242H and a second slider 243H. The clamping unit 100H has a first arm 211H and a second arm 212H.

[0249] Figure 47 This is a diagram showing the movements of the first arm 211H and the second arm 212H.

[0250] The first arm 211H and the second arm 212H are driven independently. The first arm 211H is driven by the first slider 242H. The second arm 212H is driven by the second slider 243H.

[0251] Figure 48 This is a diagram showing the approach steps performed using the fixture unit 100H.

[0252] The surgeon approaches AP2 through a tangential line, bringing the clamp unit 100H close to the defect D, which is the treatment area.

[0253] Figure 49 This diagram illustrates the holding steps performed using the clamping unit 100H.

[0254] The surgeon adjusts the lengths (protrusion amount of the self-compression tube 3) of the first arm 211H and the second arm 212H. Specifically, the surgeon adjusts the lengths so that the tips of both arms are in contact with the mucosa. More preferably, the surgeon positions the first arm 211H in contact with the first mucosa M1 and the second arm 212H in contact with the second mucosa M2.

[0255] Figure 50 This diagram illustrates the gripping steps performed using the clamping unit 100H.

[0256] The surgeon can also bring the second arm 212H into contact with the second mucosa M2 by moving the clamp unit 100H in the direction along the suture tightening direction S while the first arm 211H is in contact with the first mucosa M1.

[0257] Figure 51 This is a diagram showing the traction steps performed using the clamp unit 100H.

[0258] The surgeon pulls the first arm 211H and the second arm 212H by retracting the first slider 242H and the second slider 243H. The first arm 211H and the second arm 212H are pulled closer to each other, bringing the first mucosa M1 and the second mucosa M2 closer together.

[0259] The clamp unit 100H of this embodiment can properly perform the procedure of suturing and tightening the defective portion D. The clamp unit 100H, when approaching AP1 from the front, passes through... Figure 52 As shown, the lengths of the first arm 211H and the second arm 212H are set to be the same, thereby reliably holding the first mucosa M1 and the second mucosa M2. The clamping unit 100H, in tangential approach to AP2, passes through... Figure 53 As shown, the lengths of the first arm 211H and the second arm 212H are set to different lengths depending on the situation, so that the first mucosa M1 and the second mucosa M2 can be reliably held.

[0260] The eighth embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the constituent elements shown in the above-described embodiment and the variations shown below can be appropriately combined to form the embodiment.

Claims

1. A clamping system, wherein, The clamping system includes: A clamping unit having a first arm and a second arm that can be opened and closed; A line that can operate the opening and closing of the first arm and the second arm; and A sheath that allows the wire to pass through. The clamping unit has a support portion that supports the first arm and the second arm in a swingable manner. The sheath has a limiting portion that restricts the deflection of the sheath in the direction of swing of the first arm and the second arm.

2. The clamping system according to claim 1, wherein, The swinging direction of the first arm and the second arm is consistent with the opening and closing direction of the first arm and the second arm.

3. The clamping system according to claim 1, wherein, The support portion allows the first arm to swing towards the sheath. The support portion allows the second arm to swing away from the sheath.

4. The clamping system according to claim 1, wherein, The first arm and the second arm are formed in a plate shape. The thickness direction of the first arm and the second arm is consistent with the swing direction of the first arm and the second arm.

5. The clamping system according to claim 1, wherein, The first arm and the second arm are formed in a plate shape. The thickness direction of the first arm and the second arm is consistent with the opening and closing direction of the first arm and the second arm.

6. The clamping system according to claim 1, wherein, The sheath is a coil sheath. The limiting part is formed by welding the outer peripheral surface of the coil sheath.

7. The clamping system according to claim 1, wherein, The support portion causes the first arm and the second arm to swing by contacting the biological tissue with at least one of the first arm and the second arm.

8. The clamping system according to claim 1, wherein, The support portion causes the first arm and the second arm to swing by applying an external force to at least one of the first arm and the second arm.

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