Clamp, system and clamp deployment method

Abstract

A clamp (1), such as a three-arm clamp, can include a central arm (2), a pair of outer arms (3) rotatably connected to the central arm, a slide pin (511, 521) advancing and retracting along a longitudinal direction of the central arm, and a retention feature on either the pair of outer arms or the central arm (2) for retaining a clamping force between the central arm (2) and the pair of outer arms (3). A release feature can be included to provide a detachable connection between the slide pin and a force transfer for advancing and retracting the slide pin in the longitudinal direction. The pair of outer arms (3) can define an outer arm slot (310, 320) in which the slide pin (511, 521) is slidable for advancing and retracting the slide pin along the outer arm slot to actuate the pair of outer arms.

Description

Technical Field

[0001] This disclosure relates to a clamp. More specifically, this disclosure relates to a multi-arm clamp and a method for tissue closure using the multi-arm clamp. Background Technology

[0002] Endoscopic surgery may involve ligating the removed tissue portions using clamps, for example, to facilitate hemostasis. Typically, the clamps are locked in place with the removed or cut tissue positioned between them, and the clamps are deployed within the body cavity.

[0003] In the method of Chinese patent application No. 111481304, the clamp includes a central arm and two outer arms, and the operator can ligate the excised tissue portion by independently operating the two outer arms. Summary of the Invention

[0004] In the method of Patent Document 1, when manipulating treated excised tissue or other tissue held in a clamp, the tissue may detach from the arm of the clamp. The operator can increase the clamping force of the arm to hold the tissue securely within the clamp. However, the tissue may be torn or damaged, and this clamping force cannot be adjusted without continuous operator input.

[0005] This disclosure addresses such challenges. For example, this disclosure may include or use clamps and tissue closure methods employing clamps capable of holding tissue with appropriate clamping force, including maintaining the tissue in a clamped state without requiring an operator to maintain external control. Related methods described herein include using clamps to close tissue.

[0006] According to one aspect of this disclosure, as an illustration, a three-arm clamp includes: a central arm; a pair of outer arms configured to be rotatably connected to the central arm; a sliding pin configured to advance and retract along the longitudinal direction of the central arm; a retaining feature disposed on either the pair of outer arms or the central arm and configured to retain (e.g., in an adjustable manner) a clamping force established between the central arm and the pair of outer arms; a release feature detachably connected to the sliding pin; and a force transmission member configured to advance and retract the sliding pin connected to the release feature, wherein the pair of outer arms includes outer arm grooves in which the sliding pin can slide, and the pair of outer arms are actuated when the sliding pin advances and retracts along the longitudinal direction to slide in the outer arm grooves.

[0007] According to another aspect of this disclosure, a clamp includes: a central arm including a first pin, a first groove, and a second pin movable in the first groove; a pair of outer arms including a second groove, the second pin being slidable in the second groove, the pair of outer arms being rotatably connected to the central arm via the first pin; a wire detachably connected to the central arm or the pair of outer arms and configured to drive opening and closing operations of the pair of outer arms; and a retaining feature including an end portion disposed on the central arm or the pair of outer arms and configured, for example, to retain a clamping force for holding tissue in an adjustable manner.

[0008] According to another aspect of this disclosure, a clamp deployment method includes: clamping a first portion of tissue by a first arm and a central arm; adjusting the clamping force for clamping the first portion to maintain the first portion in a clamped state without requiring further force input by an operator; moving the first portion in a direction toward a second portion of tissue while the first portion is clamped by maintaining the clamping force; and clamping the second portion by the central arm and the second arm after the first portion has moved to the vicinity of the second portion.

[0009] [Effects or potential advantages]

[0010] According to the clamps and tissue closure methods described above in this disclosure, tissues can be clamped with appropriate clamping force while maintaining the tissues in a clamped state without requiring further force input from the operator. Attached Figure Description

[0011] Figure 1 This is a diagram illustrating an example of the overall configuration of an endoscopic treatment appliance (e.g., a system) that includes a clamp according to a first embodiment of this disclosure.

[0012] Figure 2 This is a diagram showing an example of the fixture's handling section in a closed state.

[0013] Figure 3 This is a diagram showing an example of the first outer arm of the fixture's handling section in an open state.

[0014] Figure 4 This is a diagram showing an example of the second outer arm of the fixture's handling section in an open state.

[0015] Figure 5 It is a perspective sectional view showing an example of the first outer arm of the disposal section of the fixture described in this disclosure.

[0016] Figure 6 It is a three-dimensional sectional view, which shows an example of another way of the first outer arm of the fixture's handling section.

[0017] Figure 7 This is a diagram showing an example of the central arm of the fixture's handling section.

[0018] Figure 8 Another example of the central arm of the fixture's handling section is shown.

[0019] Figure 9 This is a diagram showing an example of the tensioning member and operating line of the clamp.

[0020] Figure 10 This is a schematic diagram illustrating an example of using a clamp to perform a tissue manipulation procedure.

[0021] Figure 11 This is a schematic diagram illustrating an example of using a clamp to perform a tissue manipulation procedure.

[0022] Figure 12 This is a schematic diagram illustrating an example of using a clamp to perform a tissue manipulation procedure.

[0023] Figure 13 This is a schematic diagram illustrating an example of using a clamp to perform a tissue manipulation procedure.

[0024] Figure 14 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in the first variation of this disclosure.

[0025] Figure 15 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in this variation.

[0026] Figure 16 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in this variation.

[0027] Figure 17 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in the second variation of this disclosure.

[0028] Figure 18 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in this variation.

[0029] Figure 19 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in this variation.

[0030] Figure 20 This is a partial sectional view, which shows an example of the configuration structure of the central arm of the clamp according to the second embodiment of this disclosure.

[0031] Figure 21This is a partial sectional view showing an example of the configuration structure of the central arm of the fixture described in a variation of this disclosure.

[0032] Figure 22 This is a schematic diagram illustrating an example of the configuration structure of the handling section of the fixture described in this disclosure.

[0033] Figure 23 This is a schematic diagram illustrating an example of using a clamp to perform a tissue manipulation procedure.

[0034] Figure 24 This is a schematic diagram illustrating an example of using a clamp to perform a tissue manipulation procedure.

[0035] Figure 25 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in the first variation of this disclosure.

[0036] Figure 26 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in this variation.

[0037] Figure 27 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in this variation.

[0038] Figure 28 This is a schematic diagram illustrating an example of using a clamp to perform a tissue manipulation procedure.

[0039] Figure 29 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture in the second variation of this disclosure.

[0040] Figure 30 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture according to the third embodiment of this disclosure.

[0041] Figure 31 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in this disclosure.

[0042] Figure 32 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in this disclosure.

[0043] Figure 33 This is a side view, which shows an example of the configuration structure of the disposal section of the fixture described in a variation of this disclosure. Detailed Implementation

[0044] Reference Figures 1 to 9 A clamping device according to a first embodiment of this disclosure will be described. (Refer to...) Figures 10 to 13The treatment of biological tissue (defects) as the object of treatment using the clamping device of this disclosure is described. (Refer to...) Figures 14 to 16 The clamping device of the first modification of this disclosure will be described. (Refer to...) Figures 17 to 19 The clamping device of the second modification of this disclosure will be described.

[0045] In the embodiments described herein, the same reference numerals are used to denote similar components. Furthermore, in the following description, expressions indicating relative or absolute arrangements, such as “parallel,” “orthogonal,” “central,” and “coaxial,” are used not only to literally describe such arrangements, but also to describe relative arrangements or separated states, such that the same function can be achieved even if, for example, the structures are not strictly parallel, orthogonal, central, or coaxial. The term “patient” as used in this specification includes any living organism, and also includes the term “subject.” A patient can be a human or an animal.

[0046] Figure 1 This is a diagram showing the overall configuration of the clamping device 100. The clamping device 100 includes a handling unit (clamp) 1 and a pulling member 5 (see...). Figure 9 ), Operation line 6 (see) Figure 9 The clamping device 100 includes a handling section 1, a sheath 7, and an operating section (handle) 8. In the following description, the side of the handling section 1 in the longitudinal direction A of the clamping device 100 is defined as the distal side (far side) A1 of the clamping device 100, and the side of the operating section 8 of the clamping device 100 is defined as the proximal side (proximal side) A2 of the clamping device 100. In the clamping device 100, the handling section 1, the pulling member 5, the operating line 6, the sheath 7, and the operating section 8 are arranged sequentially from the distal side A1 to the proximal side A2 of the clamping device 100.

[0047] The clamping device 100 is used, for example, with an endoscope not shown in the figure. More specifically, the clamping device 100 can be used by an operator operating the operating unit 8 to treat biological tissue by inserting the sheath 7 and the treatment part 1 located at the distal side A1 of the sheath 7 into the treatment device channel formed in the endoscope, and guiding the treatment part 1 into the vicinity of the biological tissue within the lumen to be treated. In this embodiment, the endoscope used with the clamping device 100 may be a flexible endoscope.

[0048] Figure 2 This is a diagram showing the closed state of the handling section 1 of the clamping device 100 described in this embodiment.

[0049] Treatment unit (clamp) 1 is a clamp useful for the therapeutic treatment of patients, such as preventing tissue bleeding, closing perforations and stopping bleeding, shrinking sutures in internal wounds, marking injuries and traction (mucosal masses), and other surgical procedures. Figure 2As shown, the handling unit 1 includes a central arm 2, a pair of outer arms 3, and a clamping retainer 4. The pair of outer arms 3 includes a first outer arm 31 and a second outer arm 32 configured to open and close relative to the central arm 2. The first outer arm (first arm) 31 and the second outer arm (second arm) 32 are disposed on both sides of the central arm 2 to clamp the central arm 2 therebetween, and open independently in opposite directions. That is, the handling unit 1 of the clamping device 100 in this embodiment is a three-arm clamp, which includes a first outer arm 31, a second outer arm 32, and a central arm 2.

[0050] The direction in which one of the outer arms 3 of the processing unit 1 opens and closes relative to the central arm 2 is defined as the opening / closing direction B. The direction in which the first outer arm 31 opens to separate from the central arm 2 is called the first side B1. Furthermore, the direction in which the second outer arm 32 opens to separate from the central arm 2 is defined as the second side B2. The direction orthogonal to the longitudinal direction A and the opening / closing direction B is called the thickness direction C.

[0051] [Outer Arm 3]

[0052] In this embodiment, a pair of outer arms 3 are movable relative to a sliding pin, and the retaining feature includes a plurality of teeth formed on the base end side of the pair of outer arms 3, the plurality of teeth engaging with the sliding pin.

[0053] like Figures 2 to 5 As shown, one pair of outer arms 3 includes a first outer arm 31 and a second outer arm 32. Figure 3 This is a diagram showing the first outer arm 31 of the handling section 1 of the clamping device 100 in the open state. Figure 4 This diagram shows the second outer arm 32 of the handling section 1 of the clamping device 100 in the open state. Figure 5 This is a diagram showing the first outer arm 31 of the handling section 1 of the clamping device 100 described in this embodiment. Figure 6 This diagram illustrates another configuration of the first outer arm 31 of the handling section 1 of the clamping device 100 described in this embodiment. The first outer arm 31 is disposed on a first side B1 of the central arm 2 in the opening / closing direction B. The second outer arm 32 is disposed on a second side B2 of the central arm 2 in the opening / closing direction B. The first outer arm 31 and the second outer arm 32 can be opened and closed independently.

[0054] like Figure 2 and Figure 3 As shown, the first outer arm 31 is configured to open and close relative to the central arm 2 in the opening and closing direction B. Specifically, the first outer arm 31 is rotatably attached to the central arm 2 via a first rotating pin 211 disposed in the first through hole 313. The first outer arm 31 includes a first sliding groove 310, a first engaging portion 311, a first through hole 313, and a first arm portion 312.

[0055] like Figure 3As shown, a first sliding groove 310 is disposed on the proximal side A2 of the first outer arm 31. The first sliding groove 310 engages with a first sliding pin 511, which will be described below. Figure 2 and Figure 3 As shown, in this embodiment, a retaining feature including a ratchet feature is formed on the inner wall of the first sliding groove 310 by arranging a plurality of teeth 315 in the longitudinal direction. The plurality of teeth 315 are arranged to control the first sliding pin 511 of the first pulling member 51, described below, to advance and retract along the first sliding groove 310. More specifically, the advance and retraction of the first sliding pin 511 is limited by the engagement of the first sliding pin 511 with the plurality of teeth 315, and can be used to maintain the clamping force.

[0056] like Figure 5 and Figure 6 As shown, the arrangement of the plurality of teeth 315 formed on the inner wall of the first sliding groove 310 relative to the first outer arm 31 of this embodiment is illustrated. Figure 5 As shown, for example, multiple teeth 315 are distributed along the entire longitudinal length of the first sliding groove 310 of the first outer arm 31. The multiple teeth 315 may be formed continuously in the longitudinal direction of the first sliding groove 310, or they may be formed at predetermined intervals. The multiple teeth 315 may be formed in the same shape and of the same size. The multiple teeth 315 may have a size such that, for example, when an operator operates the first pulling member 51 to move the first sliding pin 511 forward or backward, the first sliding pin 511 can extend beyond the size of the teeth 315. However, when no external force, such as that exerted by the operator, is present, the first sliding pin 511 can be fixed by the teeth 315.

[0057] More specifically, in this embodiment, for example, when the first sliding pin 511 passes any one of the plurality of teeth 315, the sliding pin 511 is positioned between two adjacent teeth 315. In this state, the first sliding pin 511 will be prohibited from passing the teeth 315 unless an operator applies external force. As a result, the first sliding pin 511 is in a state where the forward and backward movement of the first sliding pin 511 is restricted by the teeth 315. In this state, the relative positional relationship between the first sliding pin 511 and the teeth 315 is restricted, thereby maintaining the first outer arm 31 in an open or closed state relative to the central arm 2. In other words, since the distance between the first outer arm 31 and the central arm 2 is restricted, if tissue is located between the first outer arm 31 and the central arm 2, the clamping force of the first outer arm 31 and the central arm 2 on the tissue is maintained without the need for operator input force.

[0058] like Figure 6As shown, for example, multiple teeth 315 can be distributed within the first sliding groove 310 of the first outer arm 31, and distributed over approximately half the longitudinal length. Specifically, the multiple teeth 315 can be distributed only along the longitudinal direction on the proximal side. According to this configuration, the first sliding pin 511 can freely move forward and backward in the first sliding groove 310 until it contacts the multiple teeth 315. When the first sliding pin 511 moves forward and backward in the first sliding groove 310, the opening and closing states of the first outer arm 31 and the central arm 2 can be adjusted. Therefore, the state in which the tissue to be disposed of is held by the first outer arm 31 and the central arm 2 can be adjusted. In this way, the gripping or holding of the tissue to be disposed of can be achieved by using the disposal unit 1 of the clamping device 100.

[0059] The first engagement portion 311 is an elastic member located on the proximal side A2 of the first outer arm 31 and elastic in the opening and closing direction B. The first engagement portion 311 is, for example, a leaf spring. When the first outer arm 31 is closed relative to the central arm 2, the first engagement portion 311 is accommodated within the clamp retainer 4. More specifically, as... Figure 3 As shown, with the first outer arm 31 open relative to the central arm 2, the first engagement portion 311 is located outside the clamp holder 4, which will be described later. On the other hand, as... Figure 2 As shown, with the first outer arm 31 closed relative to the central arm 2, the first engagement portion 311 is accommodated within the clamp holder 4. With the first outer arm 31 closed relative to the central arm 2, the length L1 of the first engagement portion 311 in the opening / closing direction B is substantially equal to or substantially greater than the inner diameter of the clamp holder 4.

[0060] When the first outer arm 31 changes from a closed state to an open state relative to the central arm 2 along the opening / closing direction B, the first engagement portion 311 rotates together with the first outer arm 31 and enters the interior of the clamp holder 4 from the nearest end of the first engagement portion 311. During the process of the first engagement portion 311 entering the interior of the clamp holder 4, preferably each portion of the first engagement portion 311 that contacts the clamp holder 4 is formed as a circle or has a chamfered profile so as not to damage the inner circumferential surface of the clamp holder 4.

[0061] The first through hole 313 is a hole that engages with the first rotating pin 211. The first rotating pin 211 connects the first through hole 313 and the through hole 21 provided in the central arm 2. According to this configuration, the first outer arm 31 can rotate relative to the central arm 2 about the first through hole 313.

[0062] By rotating the first arm 312 relative to the central arm 2 in the opening / closing direction B, its distal end approaches the distal end 2a of the central arm 2 to grasp tissue. The first arm 312 is positioned further distally A1 than the first through-hole 313, and includes a contact surface 31c formed to contact tissue. The contact surface 31c includes a first clamping surface (inner surface) 312a and a first outer surface 312b.

[0063] The first clamping surface (inner surface) 312a is an inner surface that contacts the tissue and faces the central arm 2 in the opening / closing direction B. The first arm portion 312 is formed by the first clamping surface (inner surface) 312a recessed towards the first side B1. The first outer surface 312b is a surface provided in the opening / closing direction B on the side opposite to the first clamping surface (inner surface) 312a. That is, the first arm portion 312 has a recess on the first clamping surface 312a side and a rounded protrusion on the first outer surface 312b side. Therefore, when the tissue is clamped by the first outer arm 31 and the central arm 2, the tissue is contained in the recess of the first outer arm 31.

[0064] like Figure 2 and Figure 4 As shown, the second outer arm 32 is configured to open and close relative to the central arm 2 in the opening / closing direction B. Specifically, the second outer arm 32 is configured to open and close relative to the central arm 2 on the opposite side of the first outer arm 31 via a second rotating pin 221 disposed in the second through hole 323. The second outer arm 32 includes a second sliding groove 320, a second engaging portion 321, a second through hole 323, and a second arm portion 322.

[0065] In this embodiment, the second outer arm 32 may have the same configuration as the first outer arm 31. That is, a ratchet structure is formed on the inner wall of the second sliding groove 320 of the second outer arm 32 by arranging a plurality of teeth 325 in the longitudinal direction. The plurality of teeth 325 are arranged to control the second sliding pin 521 of the second pulling member 52 to advance and retract along the second sliding groove 320, which will be described later. More specifically, the advance and retraction of the second sliding pin 521 is limited by the engagement of the second sliding pin 521 with the plurality of teeth 325. In this embodiment, the second outer arm 32 has the same configuration as the first outer arm 31, and repeated descriptions are omitted.

[0066] Figure 7 This is a perspective view showing the central arm 2 of the handling section 1 of the clamping device 100. Figure 8 This is a side view showing the configuration structure of the central arm 2 in this embodiment. Figures 9 to 12 This is a diagram showing different configurations of the central arm 2 in this embodiment.

[0067] like Figure 2As shown, the central arm 2 is a rod-shaped member disposed between a pair of outer arms 3 along the longitudinal direction A. The central arm 2 includes a rod portion 20A formed on the distal side A1 and a connecting portion 20B formed on the proximal side A2.

[0068] For example, such as Figure 7 As shown, the rod portion 20A includes a generally circular rod-shaped member formed of a biocompatible material. The entire outer surface of the rod portion 20A is exposed, and the rod portion 20A has a contact surface 2c capable of contacting tissue. The rod portion 20A includes a distal end portion 2a and a rod-shaped portion 2b.

[0069] The distal end portion 2a is located at the distal end of the rod-shaped portion 2b. The distal end portion 2a is formed into a generally disc-shaped portion with a diameter larger than that of the rod-shaped portion 2b. Therefore, the central arm 2 can be locked to the tissue by hooking the distal end portion 2a onto the tissue.

[0070] The rod-shaped portion 2b is a generally circular rod-shaped member with a distal end 2a disposed at its distal end. The rod-shaped portion 2b includes a first opposing surface (opposing surface) 25 and a second opposing surface (opposing surface) 26, as well as a plurality of protrusions 27 formed on the first opposing surface 25 and the second opposing surface 26.

[0071] A first opposing surface (opposing surface) 25 is formed on the rod-shaped portion 2b of the contact surface 2c, and the first opposing surface 25 is a surface opposite to the first outer arm 31 provided on the first side B1 in the opening and closing direction B.

[0072] The second opposing surface (opposing surface) 26 is formed on the rod-shaped portion 2b of the contact surface 2c. The second opposing surface 26 is the surface opposite to the first outer arm 31 of the first side B1 provided in the opening and closing direction B.

[0073] A connecting portion 20B is provided on the proximal end side A2 of the rod portion 20A. The connecting portion 20B is plate-shaped, and its thickness direction is substantially aligned with the thickness direction C. The connecting portion 20B is configured to connect the central arm 2 and a pair of outer arms 3, a clamp retainer 4 (described later), and a tensioning member 5. Figure 7 As shown, the connecting part 20B includes a through hole 21, a through hole 22, a connecting groove (central arm groove) 23, and a tail part 24.

[0074] The through hole 21 is a hole that penetrates the connecting portion 20B along the thickness direction C. The through hole 21 is formed on the distal end side A1 of the connecting portion 20B. The through hole 21 engages with the first rotating pin 211.

[0075] The through hole 22 is a hole that penetrates the connecting portion 20B along the thickness direction C. The through hole 22 is formed on the distal end side A1 of the connecting portion 20B. The through hole 22 is located at substantially the same position as the through hole 21 in the longitudinal direction A. The through hole 21 engages with the first rotating pin 211. The through hole 22 engages with the second rotating pin 221.

[0076] The engagement groove 23 is a groove formed on the connecting portion 20B that extends in the longitudinal direction A. The engagement groove 23 is configured to engage with the first sliding pin 511, such that the first sliding pin 511 can move forward and backward along the engagement groove 23.

[0077] Tail portion 24 is formed at the proximal end A2 of the connecting portion 20B of the central arm 2. Tail portion 24 is connected to the clamp retainer 4, which will be described below.

[0078] like Figure 8 As shown, in the central arm 2 of this embodiment, a plurality of protrusions 27 are formed on the first opposing surface 25 and the second opposing surface 26.

[0079] like Figure 2 and Figure 7 As shown, the plurality of protrusions 27 are protrusions provided on the central arm 2. The plurality of protrusions 27 include a first protrusion 27a provided on the first opposing surface 25 and a second protrusion 27b provided on the second opposing surface 26. The first protrusion 27a protrudes from the first opposing surface 25 toward the first outer arm 31 provided on the first side B1 in the opening and closing direction B. The second protrusion 27b protrudes from the second opposing surface 26 toward the second outer arm 32 provided on the second side B2 in the opening and closing direction B.

[0080] In this embodiment, as Figure 7 As shown, multiple teeth 231 are formed in the engagement groove 23 along the longitudinal direction of the central arm 2. Figure 7 As shown, a plurality of teeth 231 are distributed along the entire length of the engagement groove 23 in the longitudinal direction. The plurality of teeth 231 can be formed continuously along the longitudinal direction of the engagement groove 23 and can be formed at predetermined intervals. The plurality of teeth 231 can be formed to have the same shape and the same size. Each of the plurality of teeth 231 can have dimensions such that, for example, when an operator operates the first pulling member 51 to move the first sliding pin 511 forward and backward, the first sliding pin 511 can pass over the plurality of teeth 221. However, when the operator does not apply external force, the first sliding pin 511 is prohibited from passing over the teeth 231.

[0081] More specifically, in this embodiment, for example, when the first sliding pin 511 crosses any one of the plurality of teeth 231, the first sliding pin 511 enters a state located between two adjacent teeth 231. In this state, the first sliding pin 511 is prohibited from crossing the teeth 231 without external force applied by the operator. Therefore, the forward and backward movement of the first sliding pin 511 is restricted by the teeth 231. In this state, since the relative positional relationship between the first sliding pin 511 and the plurality of teeth 231 is restricted, the first outer arm 31 is maintained in an open and closed state relative to the central arm 2. In other words, since the distance between the first outer arm 31 and the central arm 2 is constant, when the tissue is located between the first outer arm 31 and the central arm 2, the force with which the first outer arm 31 and the central arm 4 clamp the tissue is kept within the clamping range of the first outer arm 31 and the central arm 2.

[0082] For example, such as Figure 8 As shown, the plurality of teeth 231 can be distributed on approximately half the longitudinal length of the engagement groove 23 of the central arm 2. For example, the plurality of teeth 231 can be distributed only on the proximal side of the engagement groove 23 of the central arm 2 in the longitudinal direction. According to this configuration, the first sliding pin 511 can move freely forward and backward in the engagement groove 23 until the first sliding pin 511 contacts the plurality of teeth 231. Therefore, when the first sliding pin 511 moves forward and backward in the engagement groove 23, the opening and closing state of the first outer arm 31 and the central arm 2 can be adjusted. Thus, the state in which the tissue to be disposed of is clamped by the first outer arm 31 and the central arm 2 can be adjusted. That is, according to this configuration, the release or clamping of the tissue to be disposed of can be achieved by using the disposal section 1 of the clamping device 100 of this embodiment.

[0083] As described above, configurations in which multiple teeth 315 and 325 are formed in the first sliding groove 310 of the first outer arm 31 and the second sliding groove 320 of the second outer arm 32, respectively, and configurations in which multiple teeth 231 are formed in the engagement groove 23 of the central arm 2 have been described. However, the clamping device 100 of this embodiment may include either of the above two configurations. For example, a configuration may be adopted in which multiple teeth 315 and 325 are formed in the first sliding groove 310 of the first outer arm 31 and the second sliding groove 320 of the second outer arm 32, while no teeth 231 are formed in the engagement groove 23 of the central arm 2. Other configurations may also be adopted in which multiple teeth 231 are formed in the engagement groove 23 of the central arm 2, instead of forming multiple teeth 315 and 325 in each of the first sliding groove 310 of the first outer arm 31 and the second sliding groove 320 of the second outer arm 32.

[0084] [Clamp Retainer 4]

[0085] like Figure 2As shown, the clamp holder 4 has a longitudinal axis and is a tubular structure, for example, formed as a cylinder. In this embodiment, the clamp holder 4 is arranged along the longitudinal direction A. The clamp holder 4 is configured to allow at least the proximal ends of the outer arm 3 and the central arm 2, which are in the closed state, to enter.

[0086] The clamp holder 4 has a groove 41 formed on the distal end side A1 and the first side B1 and the second side B2 in the opening and closing direction B. The groove 41 is, for example, a slit formed from the distal end toward the proximal end side A2, and the groove 41 has dimensions suitable for the first engagement portion 311 of the first outer arm 31 and the second engagement portion 321 of the second outer arm 32 to enter.

[0087] In the clamp holder 4, for example, an engagement hole may be formed at the proximal end, into which a pair of tail portions 24 of the central arm 2 engage. Thus, the central arm 2 is attached to the clamp holder 4. The central arm 2 and the clamp holder 4 may be integrally formed.

[0088] The inner diameter of the clamp holder 4 is the same as or slightly shorter than the length L1 of the first engagement portion 311 and the length L2 of the second engagement portion 321. The clamp holder 4 can accommodate the first engagement portion 311 and the second engagement portion 321. When the first outer arm 31 rotates in the opening / closing direction B towards the second side B2, the first engagement portion 311 enters the interior of the clamp holder 4 from the groove 41. Similarly, when the second outer arm 32 rotates in the opening / closing direction B towards the first side B1, the second engagement portion 321 enters the interior of the clamp holder 4 from the groove 41. Before the first engagement portion 311 engages and locks with the clamp holder 4, the first outer arm 31 can be reopened relative to the central arm 2. Likewise, before the second engagement portion 321 engages and locks with the clamp holder 4, the second outer arm 32 can be reopened relative to the central arm 2.

[0089] With the first engagement portion 311 housed inside the clamp holder 4, when the first engagement portion 311 retracts further to the proximal side A2, it contacts the inner circumferential surface of the clamp holder 4 and elastically deforms to engage and lock with the interior of the clamp holder 4. Similarly, with the second engagement portion 321 housed inside the clamp holder 4, when the second engagement portion 321 retracts further to the proximal side A2, it contacts the inner circumferential surface of the clamp holder 4 and elastically deforms to engage and lock with the interior of the clamp holder 4. This maintains the closed state of the first outer arm 31 and the second outer arm 32 relative to the central arm 2. The clamp holder 4 can be configured to initially lock only one of the first engagement portion 311 and the second engagement portion 321.

[0090] Figure 9 This is a diagram showing the pulling member 5 of the clamping device 100. (See diagram below.) Figure 9As shown, the tension member 5 includes a first tension member 51 and a second tension member 52. The first tension member 51 and the second tension member 52 have substantially the same configuration structure.

[0091] The distal end 51a of the first traction member 51 is connected to the proximal side A2 of the first outer arm 31. Furthermore, the proximal side A2 of the first traction member 51 is connected to the distal end of the first operating line 61. The first traction member 51 includes a first sliding pin hole 510 and a first sliding pin 511 located at its distal end.

[0092] The first sliding pin hole 510 is a hole provided at the distal end 51a of the first traction member 51. The first sliding pin hole 510 can engage with the first sliding pin 511. The first sliding pin hole 510 includes a cutout 512 located on the distal end side A1.

[0093] The first sliding pin 511 is configured to connect the first sliding pin hole 510, the first sliding groove 310 of the first outer arm 31, and the engagement groove 23. Through the sliding operation of the first slider 812 of the operating part 8 along the longitudinal direction A, the first sliding pin 511 can advance and retract along the first sliding groove 320 and the engagement groove 23. When the first sliding pin 511 advances towards the distal end A1 along the first sliding groove 310 and the engagement groove 23, the first outer arm 31 rotates about the first rotating pin 211 to open in the opening / closing direction B, thus being in an open state relative to the central arm 2. When the first sliding pin 511 retracts towards the proximal end A2 along the first sliding groove 310 and the engagement groove 23, the first outer arm 31 rotates about the first rotating pin 211 to close in the opening / closing direction B, thus being in a closed state relative to the central arm 2. Here, the closed state of the first outer arm 31 relative to the central arm 2 includes a state where the distance between the distal end of the first outer arm 31 and the distal end of the central arm 2 is essentially zero. In this state, the first outer arm 31 and the central arm 2 are configured to hold the biological tissue, which is the object of disposal, between the first outer arm 31 and the central arm 2.

[0094] In this embodiment, when the first sliding pin 511 moves forward and backward along the first sliding groove 310, the first sliding pin 311 may abut against a plurality of teeth 315 formed on the inner wall of the first sliding groove 310, and then pass over the plurality of teeth 315. When the first sliding pin 511 abuts against and passes over any one of the plurality of teeth 315, the force applied by the operator operating the first pulling member 51 becomes greater than when the first sliding pin 511 moves forward and backward in the first sliding groove 310 without the plurality of teeth 315. Therefore, the operator can identify the engagement of the first sliding pin 511 with the teeth 315 and the passing over the teeth 315 by the tactile feedback of the operator's hand. At this time, even if the operator does not continue to grasp the operating part 8 described later on the hand side, the tissue remains in a state of being held by the first outer arm 31 and the central arm 2.

[0095] The distal end 52a of the second traction member 52 is connected to the proximal side A2 of the second outer arm 32, and the proximal side A2 of the second traction member 52 is connected to the distal end of the second operating line 62. The second traction member 52 has a second sliding pin hole 520 and a second sliding pin 521 at the distal end 52a.

[0096] The second sliding pin hole 520 is a hole provided at the distal end 52a of the second traction member 52 and capable of engaging with the second sliding pin 521. The second sliding pin hole 520 includes a cutout 522 on the distal end side A1.

[0097] The second sliding pin 521 is configured to connect the second sliding pin hole 520, the second sliding groove 320 of the second outer arm 32, and the engagement groove 23. By sliding the second sliding member 822 of the operating part 8 along the longitudinal direction A, the second sliding pin 521 can advance and retract along the second sliding groove 320 and the engagement groove 23. When the second sliding pin 521 advances along the second sliding groove 320 and the engagement groove 23 toward the distal end A1, the second outer arm 32 rotates about the second rotating pin 221 to open in the opening / closing direction B, thus being in an open state relative to the central arm 2. When the second sliding pin 521 retracts along the second sliding groove 320 and the engagement groove 23 toward the proximal end A2, the second outer arm 32 rotates about the second rotating pin 221 to close in the opening / closing direction B, thus being in a closed state relative to the central arm 2. Therefore, the second outer arm 32 can open and close relative to the central arm 2 in the opening / closing direction. Here, the closed state of the second outer arm 32 relative to the central arm 2 includes a state where the distance between the distal end of the second outer arm 32 and the distal end of the central arm 2 is essentially zero. In this state, the target biological tissue is trapped between the second outer arm 32 and the central arm 2.

[0098] In this embodiment, when the second sliding pin 521 moves forward and backward along the second sliding groove 320, the second sliding pin 521 may abut against a plurality of teeth 325 formed on the inner wall of the second sliding groove 320, and then pass over the plurality of teeth 325. When the second sliding pin 521 abuts against and passes over any one of the plurality of teeth 325, the force required by the operator to operate the second pulling member 52 is greater than when the second sliding pin 521 moves forward and backward in the second sliding groove 320 without the plurality of teeth 325. Therefore, the operator can identify the engagement of the second sliding pin 521 with the teeth 325 and the passing over the teeth 325 by the tactile feedback of the operator's hand. At this time, even if the operator does not continue to grasp the operating part 8 described later on the hand side, the tissue remains held by the second outer arm 32 and the central arm 2.

[0099] With the first outer arm 31 closed relative to the central arm 2 and the first engagement portion 311 locked inside the clamp holder 4, the first slider 812 of the operating part 8 is further operated to slide towards the proximal side A2. Then, the cut portion 512 deforms or breaks and separates from the first sliding pin 511. The first pulling member 51 separates from the connected central arm 2 and the first outer arm 31. With the second outer arm 32 closed relative to the central arm 2 and the second engagement portion 321 locked inside the clamp holder 4, the second slider 622 of the operating part 8 is operated towards the proximal side A2, causing the second sliding pin 521 to slide towards the proximal side A2. Then, the cut portion 522 deforms or breaks and separates from the second sliding pin 521. The second pulling member 52 separates from the connected central arm 2 and the second outer arm 32. When the first traction member 51 and the second traction member 52 are separated from the central arm 2, the first outer arm 31 and the second outer arm 32 respectively, the disposal part 1 of the clamping device 100, which includes the central arm 2, the outer arm 3 and the clamp holding member 4, can be placed in the cavity while clamping the tissue.

[0100] like Figure 9 As shown, the operating line 6 has a first operating line 61 and a second operating line 62. The first operating line 61 and the second operating line 62 have substantially the same configuration structure.

[0101] The distal end of the first operating line 61 is connected to the proximal end of the first traction member 51. The proximal end of the first operating line 61 is fixed to the first slider 812 of the operating part 8. The first operating line 61 is inserted into the sheath 7 to be able to move forward and backward. The first operating line 61 may be formed, for example, from a single wire or stranded wire made of metal. The outer peripheral surface of the first operating line 61 may be covered by a non-conductive component or the like. The first operating line 61 may be fixed to the first traction member 51 by various methods, such as bonding or welding. The first operating line 61 is configured to cause the first traction member 51 to move forward and backward by operating the first slider 812 of the operating part 8 attached to its proximal end.

[0102] In the second operating line 62, its distal end is connected to the proximal end of the second traction member 52. The proximal end of the second operating line 62 is fixed to the second slider 822 of the operating part 8. The second operating line 61 is inserted into the sheath 7 to be able to move forward and backward. The second operating line 62 can be formed of, for example, a single wire or stranded wire made of metal. The outer peripheral surface of the second operating line 62 can be covered by a non-conductive component or the like. The second operating line 62 can be fixed to the second traction member 52 by various methods, such as bonding or welding. The second operating line 62 is configured to move the second traction member 52 forward and backward by operating the second slider 812 of the operating part 8 attached to its proximal end, causing the second slider 812 to slide.

[0103] The sheath 7 is configured to extend along the longitudinal direction A, and for example, as Figure 1 As shown, the sheath 7 is an elongated member capable of being inserted into a lumen. The sheath 7 is formed of an insulating material, such as a fluoropolymer like PTFE (polytetrafluoroethylene) or a resin material like HDPE (high-density polyethylene). The sheath 7 can be flexible, and its shape can be easily changed to accommodate the curvature of the lumen within the lumen. The sheath 7 is configured to be inserted into or withdrawable from a channel (not shown) of the clamping device 100. The proximal end 7b of the sheath 7 is connected to the operating part 8, while the distal end 7a is connected to the proximal end 4b of the clamp holder 4. Furthermore, the sheath 7 can accommodate a first operating line 61 and a second operating line 62.

[0104] like Figure 1 As shown, the operating part (handle) 8 includes a distal end 80a, a first operating part 81, and a second operating part 82. Figure 1 As shown, the distal end 80a is connected to the proximal end 7b of the sheath 7. The first operating part 81 and the second operating part 82 are connected to the distal end 80a and extend from the distal end 80a toward the proximal side A2 in two directions.

[0105] The first operating part 81 includes a first operating part body 811, a first slider 812, and a finger holding part 813.

[0106] The first operating part body 811 is configured to operate the first traction member 51 and the first outer arm 31 via the first operating line 61. The first operating part body 811 of the first operating part 81 is formed as a rod extending in the longitudinal direction A.

[0107] The first slider 812 is configured to slide along the longitudinal direction A of the first operating part body 811. The proximal end of the first operating line 61 is fixed to the first slider 812. The first slider 812 is configured to pass through the first operating part body 811. When the first slider 812 moves forward and backward along the first operating part body 811 in the longitudinal direction A, the first pulling member 51 fixed to the distal end of the first operating line 61 moves forward and backward together with the first operating line 61 in the longitudinal direction A.

[0108] The finger holding portion 813 is a generally annular portion for holding the finger and is formed on the proximal side A2 of the first operating portion body 811.

[0109] The second operation unit 82 includes a second operation unit body 821, a second slider 822, and a finger holding part 823.

[0110] The second operating unit body 821 is configured to operate the second traction member 52 and the second outer arm 32 via the second operating line 62. The second operating unit body 821 of the second operating unit 82 is formed as a rod extending in the longitudinal direction A.

[0111] The second slider 822 is configured to slide along the longitudinal direction A of the second operating part body 821. The proximal end of the second operating line 62 is fixed to the second slider 822. The second slider 822 is configured to pass through the second operating part body 821, and when the second slider 822 moves forward and backward along the second operating part body 821 in the longitudinal direction A, the second pulling member 52 fixed to the distal end of the second operating line 62 moves forward and backward together with the second operating line 62 in the longitudinal direction A.

[0112] The finger holding portion 823 is a generally annular portion for holding the finger and is formed on the proximal side A2 of the second operating portion body 821.

[0113] Next, refer to Figures 10 to 13 The operation and effects of the clamping device 100 are described. In this embodiment, as an example of how to use the clamping device 100, the treatment of wounds (defects) in body tissue, i.e., a tissue closure method, will be described. In this embodiment, for the sake of simplicity, the operation of the clamping device 100 will be described as an example of a configuration in which multiple teeth 315, 325 are respectively formed in the first sliding groove 310 of the first outer arm 31 and the second sliding groove 320 of the second outer arm 32 of the treatment section 1. However, this embodiment is not limited to this. A configuration in which multiple teeth 231 are provided in the engagement groove 23 of the central arm 2 of the treatment section 1 can also be operated in the same manner.

[0114] Figure 10 The diagram schematically shows the first outer arm 31 of the handling section 1 of the clamping device 100 open and the handling section 1 approaching the tissue to be clamped. Figure 11 This diagram schematically shows the state in which the first outer arm 31 of the handling section 1 of the clamping device 100 is closed and the tissue is clamped. Figure 12 This diagram schematically shows the first outer arm 31 of the handling section 1 of the clamping device 100 clamping the tissue, while the second outer arm 32 is open and the handling section 1 is close to the tissue to be clamped. Figure 13 This diagram schematically shows the second outer arm 32 of the handling section 1 of the clamping device 100 closed, and the handling section 1 deployed from the clamping device 1 while the handling section 1 is holding the tissue.

[0115] (Prepare)

[0116] As preparation, the operator identifies wounds in the body tissue. More specifically, the operator inserts the endoscope through a natural opening in the lumen (e.g., the patient's mouth) into the digestive tract, such as the esophagus, stomach, duodenum, or large intestine, and while observing the images obtained by the imaging section of the endoscope, identifies defects T that form holes in the tissue D of the lumen as objects to be treated.

[0117] (Insert operation)

[0118] The operator inserts the clamping device 100 into the endoscope channel and extends the clamping device 100 from the distal opening of the endoscope's working channel. The operator moves the treatment section 1, located on the distal side A1 of the clamping device 100, to the vicinity of the defect T.

[0119] (Arrangement Operation)

[0120] like Figure 10 As shown, the operator moves the first traction member 51 toward the distal side A1 by pushing and advancing the first slider 812 of the first operating part body 811 in the longitudinal direction A. Therefore, as the first sliding pin 511 connected to the first traction member 51 advances, the first outer arm 31 rotates about the first rotating pin 211. More specifically, the first outer arm 31 rotates toward the first side B1 in the opening / closing direction B, causing the first arm portion 312 of the distal side A1 to separate from the central arm 2. As a result, the first outer arm 31 opens relative to the central arm 2, enabling it to clamp the first portion Ta of the defect T, which is the object of treatment. In this arrangement step, the operator moves the first traction member 51 toward the distal side A1, causing the first sliding pin 511 to pass over the plurality of teeth 315 formed in the first sliding groove 310, while moving distally along the first sliding groove 310 of the first outer arm 31. In this state, the operator moves the first outer arm 31 and the central arm 2, which are in the open state, toward the first part Ta of the defect T to be clamped, and places the first part Ta between the first outer arm 31 and the central arm 2.

[0121] (Clamping operation)

[0122] exist Figure 11 In this process, when the operator has confirmed that the first portion Ta of the defect T is located between the first outer arm 31 and the central arm 2, the operator moves the first pulling member 51 to the proximal side A2 by pulling the first sliding member 812 of the first operating part 81. Therefore, when the first sliding pin 511 connected to the first pulling member 51 retracts, the first arm portion 312 of the first outer arm 31 rotates towards the second side B2 of the central arm 2 in the opening / closing direction B. As a result, the first outer arm 31 enters a closed state relative to the central arm 2 to clamp the first portion (first position) Ta of the defect T, which is the object of disposal.

[0123] As the operator pulls the first slider 812 toward the proximal side A2, the first engagement portion 311 formed on the proximal side A1 of the first outer arm 31 also rotates in the opening / closing direction B around the first rotating pin 211. Therefore, the first engagement portion 311 enters the groove 41 formed in the clamp holder 4 and is accommodated within the clamp holder 4. As a result, the first portion Ta of the defect T is clamped by the first outer arm 31 and the central arm 2. During this process, when the operator moves the first pulling member 51 to the proximal side A2, the first sliding pin 511 moves toward the proximal side along the first sliding groove 310 of the first outer arm 31, while simultaneously engaging with any one of the plurality of teeth 315 formed in the first sliding groove 310. In this state, the forward and backward movement of the first sliding pin 511 along the first sliding groove 310 is restricted by the plurality of teeth 315 formed in the first sliding groove 310. Therefore, even if the operator does not maintain the state of pulling the first sliding member 812 towards the proximal side A2, the first part Ta of the defect T can be kept clamped by the first outer arm 31 and the central arm 2. During this process, the operator can adjust the relative positional relationship between the first sliding pin 511 and the plurality of teeth 315 to appropriately adjust the clamping force used to clamp the first part Ta of the defect T as the object of disposal. More specifically, the clamping force is adjusted to such an extent that the first part Ta of the defect T as the object of disposal will not slip out of the gap between the first outer arm 31 and the central arm 2, and to prevent the clamping force from being too large and damaging the first part Ta of the defect T. However, the operator can release and grasp the first part Ta of the defect T by operating the operating part 8 again to advance the first outer arm 31 and turn the first outer arm 31 into an open state relative to the central arm 2.

[0124] (Traction Operation)

[0125] exist Figure 12 In this process, while the first portion Ta of defect T is held between the first outer arm 31 and the central arm 2, the operator moves the entire treatment unit 1 to the vicinity of the second portion Tb of defect T, which is a ligation defect, and the first portion Ta of defect T is ligated to the ligation object. During this process, even if the operator does not perform any operation, the closed state between the first outer arm 31 and the central arm 2 can be maintained by the engagement of the first sliding pin 511 with the plurality of teeth 315.

[0126] (Arrangement Operation)

[0127] When the operator has confirmed that the treatment unit 1 has reached the vicinity of the second part Tb of the defect T, the operator moves the second pulling member 52 toward the distal side A1 by pushing and advancing the second sliding member 822 of the second operating unit 82 in the longitudinal direction A. Therefore, as Figure 12As shown, when the second sliding pin 521 connected to the second pulling member 52 advances, the second outer arm 32 rotates about the second rotating pin 221 as the rotation center. More specifically, the second outer arm 32 rotates toward the second side B2 in the opening / closing direction B, causing the distal second arm portion 322 to separate from the central arm 2. Therefore, the second outer arm 32 is in an open state relative to the central arm 2 and can clamp the second part Tb of the defect T to be disposed of. In this state, the operator moves the second outer arm 32 and the central arm 2 toward the second part Tb of the defect T to be clamped in the open state, and places the second part Tb of the defect T between the second outer arm 32 and the central arm 2.

[0128] (Clamping operation)

[0129] like Figure 13 As shown, when the operator has confirmed that the second portion Tb of defect T is located between the second outer arm 32 and the central arm 2, the operator moves the second pulling member 52 to the proximal side A2 by pulling the second sliding member 822 of the second operating part 82. Therefore, when the second sliding pin 521 connected to the second pulling member 52 retracts, the second arm portion 322 of the second outer arm 32 rotates toward the central arm 2 in the opening / closing direction B toward the first side B1. As a result, the second outer arm 32 enters a closed state relative to the central arm 2 to clamp the second portion Tb of defect T, which is the object of disposal.

[0130] As the operator pulls the second slider 822 toward the proximal side A2, the second engagement portion 321 formed on the proximal side A2 of the second outer arm 32 also rotates in the opening / closing direction B with the second rotating pin 221 as the rotation center. Therefore, the second engagement portion 321 enters the groove 41 formed in the clamp holder 4 to be accommodated within the clamp holder 4. Thus, the second portion Tb of the defect T is clamped by the second outer arm 32 and the central arm 2. During this process, when the operator moves the second pulling member 52 to the proximal side A2, the second sliding pin 521 engages with any one of the plurality of teeth 325 formed in the second sliding groove 320, while simultaneously moving along the second sliding groove 320 of the second outer arm 32 to the proximal side. In this state, the forward and backward movement of the second sliding pin 521 along the second sliding groove 320 is restricted by the plurality of teeth 325 formed in the second sliding groove 320. Therefore, even if the operator does not keep the second sliding member 822 pulled towards the proximal side A2, the second part Tb of the defect T remains held between the second outer arm 32 and the central arm 2. During this process, the clamping force used to hold the second part Tb of the defect T, the object of treatment, can be appropriately adjusted by the operator adjusting the relative positional relationship between the second sliding pin 521 and the plurality of teeth 325. More specifically, it is preferable to adjust the clamping force to such an extent that the second part Tb of the defect T, the object of treatment, will not slip out of the gap between the second outer arm 32 and the central arm 2, and to prevent excessive clamping force from damaging the second part Tb of the defect T. However, the operator can advance the second outer arm 32 and turn it into an open state relative to the central arm 2, so as to release and then hold the second part Tb of the defect T by operating the operating part 8 again.

[0131] Subsequently, when the operator further retracts the first slider 812 of the operating unit 8 along the longitudinal direction A to the proximal side A2, the clamp holding member 4 is configured such that the first engagement portion 311 of the first outer arm 31 engages within the clamp holding member 4, and the first outer arm 31 is locked in place. When the second slider 822 of the operating unit 8 further retracts along the longitudinal direction A to the proximal side A2, the clamp holding member 4 is configured such that the second engagement portion 321 of the second outer arm 32 engages within the clamp holding member 4, and the second outer arm 32 is locked in place.

[0132] As described above, during the operation of the clamping device 100, the base ends of one pair of outer arms 3 (first outer arm 31, second outer arm 32) extend freely relative to the clamping retainer 4, corresponding to the sliding of the sliding pins (first sliding pin 511, second sliding pin 521) in the engagement groove (i.e., the central arm groove) 23.

[0133] (Deployment Operation)

[0134] Through the above-mentioned measures, such as Figure 13As shown, the first part Ta and the second part Tb of the defect T, which is to be disposed of, are held by the disposal unit 1. In this state, the operator moves the first pulling member 51 and the second pulling member 52 to the proximal side A2 by further pulling the first sliding member 812 of the first operating unit 81 and the second sliding member 822 of the second operating unit 82 towards the proximal side A2.

[0135] In this embodiment, the first pulling member 51 and the second pulling member 52 are detachably engaged with the first sliding pin 511 and the second sliding pin 521, respectively. For example, when the operator pulls the first pulling member 51 towards the proximal side A2, the cut portion 512 of the first pulling member 51 deforms or breaks, and the first sliding pin 511 can be pulled out from the first sliding pin hole 510 and disengage from it. Furthermore, when the operator pulls the second pulling member 52 towards the proximal side A2, the cut portion 522 of the second pulling member 52 deforms or breaks, and the second sliding pin 521 can be pulled out from the second sliding pin hole 520 to disengage. The specific configuration of the engagement between the first pulling member 51 or the second pulling member 52 and the first sliding pin 511 or the second sliding pin 521 is not limited to this embodiment.

[0136] As described above, when the operator moves the first pulling member 51 and the second pulling member 52 to the proximal side A2 with a force exceeding a predetermined value, the engagement between the first pulling member 51 or the second pulling member 52 and the first sliding pin 511 or the second sliding pin 521 is released. Therefore, with the first part Ta of the defect T clamped by the first outer arm 31 and the central arm 2, and the second part Tb of the defect T clamped by the second outer arm 32 and the central arm 2, the disposal part 1 of the clamping device 100 is deployed in the cavity.

[0137] Subsequently, the operator operates the operating part 8 of the clamping device 100 to remove the sheath 7 from the patient's body, thereby completing the treatment of the object.

[0138] In this embodiment, according to the above configuration structure, the treatment unit 1 of the clamping device 100 can close the defect T of the tissue D that is the object of treatment.

[0139] [Effect of clamping device 100]

[0140] According to the clamping device 100 of this embodiment, during the clamping and traction operations of clamping the defect T to be treated, even if the operator does not maintain the state of pulling the first sliding member 812 or the second sliding member 822 towards the proximal side A2, the defect T to be treated can still be held in a state by the first outer arm 31 or the second outer arm 32 and the central arm 2. In other words, according to the clamping device 100 of this embodiment, even if the operator does not operate the operating part 8, that is, even if the operator does not operate the handle, the force of one pair of outer arms 3 and the central arm 2 of the treatment part 1 in clamping the defect T can be appropriately maintained, which can prevent the tissue from slipping off the arms, thereby reliably clamping the tissue.

[0141] In this embodiment, the ratchet structure is formed by a plurality of teeth 315 or a plurality of teeth 325 formed in the first sliding groove 310 of the first outer arm 31 or the second sliding groove 320 of the second outer arm 32, and a plurality of teeth 231 formed in the engagement groove 23 of the central arm 2. According to this configuration, a pair of outer arms 3 and the central arm 2 can be moved step by step by the operator. The force that causes the first sliding pin 511 or the second sliding pin 521 to pass over the plurality of teeth 315 or the plurality of teeth 325 is set to be less than the force used to release the engagement between the first pulling member 51 or the second pulling member 52 and the first sliding pin 511 or the second sliding pin 521, that is, the force used to deploy the handling part 1 of the clamping device 100 in the cavity.

[0142] In this embodiment, a plurality of teeth 231 or a plurality of teeth 315, 325 disposed on the central arm 2, together with a first sliding pin 511 and a second sliding pin 521 disposed on a pair of outer arms 3, provide a clamping force adjustment structure. This clamping force adjustment structure is configured to adjust the clamping force used to clamp the defect T of the biological tissue being disposed of. In this embodiment, the central arm 2, a pair of outer arms 3, and the clamping force adjustment structure provide a clamping structure for clamping biological tissue.

[0143] In this embodiment, the release structure for opening and closing the clamping structure is configured to consist of a pair of pulling members 5 and a pair of operating lines 6. The pair of pulling members 5 and the pair of operating lines 6 serve as a force transmission device for transmitting the operator's force to the clamping structure. As described above, the pair of pulling members 5 are detachably connected to an outer arm 3 and a central arm 2.

[0144] The first embodiment of this disclosure has been described in detail above with reference to the accompanying drawings. However, the specific configuration structure is not limited to this embodiment, and also includes design changes made without departing from the spirit of this embodiment. Furthermore, the configuration structure elements shown in the above embodiment, the following embodiments, and variations can be appropriately combined and configured.

[0145] (First variation)

[0146] In this variation, the outer arm is movable relative to the clamp retainer, and the retaining feature includes a plurality of teeth formed on the base end side of the outer arm, the plurality of teeth engaging with the clamp retainer.

[0147] The following will refer to Figures 14 to 16 The configuration structure of the handling section 1A of the clamping device 100 in the first modified example of this embodiment is described. Figures 14-16 The diagram shows the configuration structure of the processing unit 1A in this modified example, taking the opening and closing operation of the first outer arm 31 of the processing unit 1A as an example. Figure 14 This is a diagram showing the open state of the first outer arm 31 and the central arm 2 of the processing unit 1A. Figure 15 This diagram illustrates the operation of the first outer arm 31 rotating inward along direction R to approach the central arm 2. Figure 16 This is a diagram showing the closed state of the first outer arm 31 and the central arm 2.

[0148] like Figures 14 to 16 As shown, compared with the first embodiment described above, in the processing unit 1A of this modified example, instead of the plurality of teeth 315, 325 formed in the sliding grooves (first sliding groove 310 and second sliding groove 320) of the outer arms 3 and the plurality of teeth 231 formed in the engagement groove 23 of the central arm 2, a plurality of teeth 316 are formed at the proximal end 311A ​​of the first outer arm 31 and the proximal end of the second outer arm 32.

[0149] like Figure 14 As shown, instead of the elastic member of the first embodiment described above, such as the first engagement portion 311, the proximal end 311A ​​of the first outer arm 31 is formed with a generally arcuate proximal surface. The proximal end 311A ​​is not elastic, and a plurality of teeth 316 are formed to protrude from the proximal surface toward the clamp holder 4. A protrusion (stop, mating member) 4c configured to engage with each of the plurality of teeth 316 is formed on the distal surface of the clamp holder 4 to correspond to the plurality of teeth 316 formed on the proximal end of the proximal end 311A. In this modified example, the plurality of teeth 316 formed on the proximal surface of the proximal end 311A ​​of the first outer arm 31 and the protrusion 4c formed on the distal surface of the clamp holder 4 can engage with each other. The protrusion 4c formed on the distal surface of the clamp holder 4 can restrict the movement of the plurality of teeth 316 when engaged with them. In this modified example, the protrusion 4c is provided as a matching feature on the front end side of the clamp holder 4 and protrudes toward the base end of the first outer arm 31. Furthermore, the other configuration structures of the handling section 1A of the clamping device 100 are the same as those in the first embodiment described above, and therefore their description is omitted.

[0150] like Figures 14 to 16As shown, when the operator operates to retract the first pulling member 51 to the proximal side, the first sliding pin 511 moves proximally along the first sliding groove 310 of the first outer arm 31. When the first sliding pin 511 moves towards the proximal end, the proximal end portion 311A ​​formed on the proximal end side A2 of the first outer arm 31 rotates about the first rotating pin 211 as the rotation center along the opening and closing direction B, that is, the proximal end portion 311A ​​rotates inward along the radial direction R.

[0151] When the proximal end portion 311A ​​formed on the proximal side A2 of the first outer arm 31 rotates radially inward, the protrusion 4c and the plurality of teeth 316 move relative to each other radially, causing the protrusion 4c to pass over the plurality of teeth 316. Each of the protrusion 4c and the plurality of teeth 316 moves (rotates) relative to each other, causing the relative positional relationship to change gradually. Therefore, the relative opening and closing relationship between the first outer arm 31 and the central arm 2 also changes gradually. Furthermore, when the protrusion 4c passes over any one of the plurality of teeth 316 and engages with any one of the plurality of teeth 316, the relative positional relationship between the protrusion 4c and the teeth 316 does not change unless an external force is applied by the operator. That is, in this state, even if the operator does not operate the operating part 8, the opening and closing relationship between the first outer arm 31 and the central arm 2 remains unchanged.

[0152] like Figure 16 As shown, the protrusion 4c moves relative to the plurality of teeth 316, causing the first outer arm 31 to rotate to approach the central arm 2, and to clamp the defect T of the biological tissue to be disposed of. For example, the first portion Ta of the defect T can be clamped by the disposal section 1A of the clamping device 100 of this variant by the first outer arm 31 and the central arm 2 approaching each other to enter a substantially closed state (see Figure 16 In this state, even if the operator does not maintain the state of pulling the first slider 812 towards the proximal side A2, the open and closed state of the first outer arm 31 and the central arm 2 can still be maintained. That is, according to the disposal unit 1A of the clamping device 100 of this modified example, the clamping force for clamping the defect T of biological tissue by the first outer arm 31 and the central arm 2 can be gradually changed by the gradual relative movement between the protrusion 4c provided in the clamp holding member 4 and the plurality of teeth 316 provided in the proximal end 311A ​​of the first outer arm 31. Furthermore, even if the operator does not operate the operation unit 8 to maintain the state of pulling the first slider 812 towards the proximal side A2, the relative positional relationship between the protrusion 4c and the plurality of teeth 316 will not change, thereby maintaining the open and closed relationship between the first outer arm 31 and the central arm 2.

[0153] In the treatment section 1A of the clamping device 100 of this modified example, the second outer arm 32 has the same configuration structure as the first outer arm 31. Therefore, a repeated description of the configuration structure of the second outer arm 32 is omitted. In the treatment section 1A of the clamping device 100 of this modified example, a plurality of teeth 316 formed on the proximal end 311A ​​of the first outer arm 31 and a protrusion 4c provided on the distal surface of the clamping retainer 4 provide a clamping force adjustment structure, which is configured to adjust the clamping force for clamping the defect T of the biological tissue to be treated.

[0154] like Figures 14 to 16 As shown, an example of the configuration structure of the treatment section 1A of the clamping device 100 described in this modified example has been described. However, this disclosure is not limited to this. For example, a configuration structure in which a protrusion is formed in the first outer arm 31 and a plurality of corresponding teeth are formed on the distal surface of the clamping retainer 4 can be adopted. In addition, for example, in the treatment section 1A of the clamping device 100, the plurality of teeth 316 may be formed only on a portion of the proximal surface of the proximal end 311A ​​of the first outer arm 31. More specifically, even if not shown in the figure, the plurality of teeth 316 may be formed only on the portion of the proximal surface of the proximal end 311A ​​of the first outer arm 31 located radially outward. According to this configuration structure, the first outer arm 31 and the central arm 2 can be freely opened and closed before the protrusion 4c formed on the distal surface of the clamping retainer 4 passes over any one of the plurality of teeth 316 to engage with it. That is, according to this configuration structure, the operator can easily clamp the first part Ta of the defect T of the tissue to be treated.

[0155] When using the treatment section 1A of the clamping device 100 in this modified example, the operator can perform the treatment of ligation of the defect T in the biological tissue to be treated by the same steps as in the first embodiment described above. More specifically, for example, when the operator has confirmed during the clamping step that the first portion Ta of the defect T is located between the first outer arm 31 and the central arm 2, the operator moves the first traction member 51 to the proximal side A2 by pulling the first slider 812 of the first operating section 81. Therefore, as Figure 15 and Figure 16 As shown, when the first sliding pin 511 connected to the first pulling member 51 retracts, the first arm portion 312 located on the distal side of the first outer arm 31 rotates toward the central arm 2 on the second side B2 of the opening / closing direction B, while the proximal end 311A ​​rotates relative to the protrusion 4c located on the distal surface of the clamp holder 4 on the first side B1 of the opening / closing direction B. As a result, the first outer arm 31 enters a closed state relative to the central arm 2 to clamp the first part Ta of the defect T to be disposed of. During this process, the relative positional relationship between the protrusion 4c and the plurality of teeth 316 gradually changes, causing the clamping force of the first outer arm 31 and the central arm 2 to gradually change as well.

[0156] (Second variation)

[0157] The following will refer to Figures 17 to 19 The configuration structure of the handling section 1B of the clamping device 100 in the second modification of this embodiment is described. The difference between the handling section 1B of the clamping device 100 in this modification and that in the first embodiment described above is the engagement between the pulling member and the outer arm.

[0158] like Figure 17 As shown, in this modified example, the first outer arm 31B, instead of the first sliding groove 310 formed in the first embodiment described above, adopts a configuration structure in which a plurality of teeth 317 are formed in the circumferential direction of the proximal end 311B, and the proximal surface of the proximal end 311B is formed as a circle. Protrusions (stops, matching members) 4c corresponding to the plurality of teeth 317 are formed on the distal surface of the clamp holding member 4 in this modified example. In addition, a gear 53 is formed on the distal side of the first pulling member 51B in this modified example, and the gear 53 meshes with the plurality of teeth 317 formed on the proximal end 311B of the first outer arm 31B. In the disposal section 1B of the clamping device 100 in this modified example, the gear 53 provided on the distal side of the pulling member 51B and the plurality of teeth 317 formed on the proximal end 311B of the first outer arm 31B constitute a rack and pinion transmission structure.

[0159] According to the handling section 1B of the clamping device 100 in this modified example, such as Figures 17 to 19 As shown, the gear 53 located on the distal end of the pulling member 5B and the plurality of teeth 317 formed on the proximal end 311B of the first outer arm 31B engage with each other, thereby achieving mutual meshing. According to the handling section 1B of the clamping device 100 of this modified example, when the operator moves the pulling member 5B forward and backward along the longitudinal direction A, the gear 53 and the plurality of teeth 317 engage with each other, converting the linear movement of the pulling member 5B along the longitudinal direction A into a rotational operation of the proximal end 311B of the first outer arm 31B. More specifically, when the operator moves the pulling member 5B forward along the longitudinal direction A to the distal end A1, the first outer arm 31B rotates along the opening / closing direction B to the first side B1, so that the first outer arm 31B and the central arm 2 are in the open state. On the other hand, when the operator moves the pulling member 5B backward along the longitudinal direction A to the proximal side, the first outer arm 31B rotates along the opening / closing direction B on the second side B2, so that the first outer arm 31B and the central arm 2 enter the closed state.

[0160] In this process, through the relative movement between the protrusion 4c provided on the distal surface of the clamp holder 4 and the plurality of teeth 317 formed on the proximal end 311B of the first outer arm 31B, the protrusion 4c passes over any one of the plurality of teeth 317 and enters a state of engagement with any one of the plurality of teeth 317. According to the above configuration structure, the relative positional relationship between the gear 53 and the plurality of teeth 317 can be gradually changed as the pulling member 5B moves forward and backward in the longitudinal direction A. Whenever the protrusion 4c provided on the distal surface of the clamp holder 4 passes over any one of the plurality of teeth 317, the first outer arm 31B rotates gradually relative to the central arm 2. In other words, in this process, the clamping force of the first outer arm 31B and the central arm 2 on the defect T of the biological tissue to be disposed of gradually changes with the change in the relative positional relationship between the first outer arm 31B and the central arm 2. In this modified example, the gear 53 and the plurality of teeth 317 can move relative to each other in a linked manner. On the other hand, the protrusion 4c provided on the distal surface of the clamp holder 4 can restrict the movement of the multiple teeth 317 when engaged with the multiple teeth 317.

[0161] When using the treatment section 1B of the clamping device 100 in this modified example, the operator can perform ligation treatment on the defect T of the biological tissue to be treated according to the same steps as in the first embodiment described above. That is, for example, when the operator has confirmed in the clamping step that the first part Ta of the defect T is located between the first outer arm 31B and the central arm 2, the operator moves the first pulling member 51B to the proximal side A2 by pulling the first sliding member 812 of the first operating section 81. Therefore, as Figure 17 , Figure 18 and Figure 19 As shown, when the operator retracts the first pulling member 51B to the proximal side A2, the first outer arm 31B rotates towards the central arm 2 on the second side B2 of the opening / closing direction B, while the proximal end 311B located on the distal surface of the clamp holder 4 rotates relative to the protrusion 4c on the first side B1 of the opening / closing direction B. As a result, the first outer arm 31B enters a closed state relative to the central arm 2 to clamp the first portion Ta of the defect T, which is the object of treatment. During this process, the relative positional relationship between the protrusion 4c and the plurality of teeth 317 gradually changes, causing the clamping force between the first outer arm 31B and the central arm 2 to also gradually change.

[0162] (Second Embodiment)

[0163] The following will refer to Figures 20 to 24 The configuration structure of the handling unit 1C of the clamping device 100 according to the second embodiment of this disclosure will be described. Figure 20 The configuration structure of the central arm 2C of the handling section 1C of the clamping device 100 described in this embodiment is shown. Figure 21 This is a diagram showing a modified example of the configuration structure of the central arm 2C. Figure 22 This is a diagram showing the configuration structure of the handling section 1C of the clamping device 100 described in this embodiment. Figure 23 and Figure 24 This diagram illustrates the treatment of defects T in biological tissue as the object of treatment using the treatment unit 1C of the clamping device 100 of this embodiment.

[0164] The handling section 1C of the clamping device 100 in this embodiment differs from the handling section 1 of the clamping device 100 in the following way: the handling section 1C includes an elastic member 29, which is configured to push the central arm 2C out toward the distal end A1 in the longitudinal direction A. The elastic member 29 in this embodiment can be, for example, made of various conventional springs. Figure 20 As shown, the central arm 2C of this embodiment includes a rod portion 20A formed on the distal side A1 and a connecting portion 20B formed on the proximal side A2. A space 28 for accommodating an elastic member 29 is formed in the connecting portion 20B of the central arm 2C. In the space 28, the distal end of the elastic member 29 is connected to the proximal end of the rod portion 20A of the central arm 2C, and the proximal end of the elastic member 29 is fixed to the inner wall of the space 28. In this embodiment, the proximal end of the elastic member 29 and the rod portion 20A are accommodated in the space 28, thereby limiting radial movement caused by bending of the elastic member 29. In this embodiment, preferably, the elastic member 29 is disposed on the proximal side of the central arm 2C, i.e., at the position where it is accommodated in the clamp holder 4.

[0165] exist Figure 20 An example of the configuration structure of the central arm 2C in this embodiment is shown, but the configuration structure of the central arm in this embodiment is not limited to this. For example, as Figure 21 As shown, as a variation of the configuration structure of the central arm 2C, the rod portion 20A of the central arm 2C can be configured to be elastic, replacing the elastic member 29. For example... Figure 21 As shown, the rod portion 20A of the central arm 2C may have a pair of proximal ends 2e biased to be separated from each other. The pair of proximal ends 2e are biased to be separated from each other, thereby applying a biasing force to push the rod portion 20A of the central arm 2C toward the distal end side A1 in the longitudinal direction A, and the pair of proximal ends 2e engage in the space 28 formed in the central arm 2C. Figure 20 The configuration structures shown are similar. Figure 21 The central arm 2C shown is configured to bias the rod 20A toward the distal side A1 in the longitudinal direction A in order to push the rod 20A.

[0166] Figure 22 This is a diagram showing the configuration structure of the handling section 1C of the clamping device 100 in this embodiment. Figure 22As shown, in this embodiment, the elastic member 29 in the handling section 1C of the clamping device 100 is housed in the space 28 formed in the central arm 2C. On the other hand, the distal ends of the first outer arm 31 and the second outer arm 32 of the handling section 1C in this embodiment are located at a position on the distal side A1, which is further distal than the central arm 2C. In other words, as... Figure 22 As shown, when the first outer arm 31 or the second outer arm 32 and the central arm 2C are in a closed state, due to the biasing force of the elastic member 29, the distal surface 2a1 of the central arm 2C abuts against the inner surface 31a of the distal end of the first outer arm 31 and the inner surface 32a of the distal end of the second outer arm 32. The other configurations of the handling section 1C of the clamping device 100 in this embodiment are generally similar to the handling section 1 of the clamping device 100 described in the first embodiment.

[0167] Figure 23 and Figure 24 This diagram illustrates the use of the treatment section 1C of the clamping device 100 of this embodiment to ligate a defect T in a biological tissue that is to be treated. Figure 23 As shown, during the clamping operation, the first portion Ta of defect T is clamped by the first outer arm 31 and the central arm 2C. More specifically, the first portion Ta of defect T is clamped between the inner surface 31a of the distal end of the first outer arm 31 and the distal surface 2a1 of the central arm 2C. Because the elastic member 29 of this embodiment biases the central arm 2C to push it toward the distal side A1 in the longitudinal direction A, in this state, even if the operator unintentionally moves the first slider 812 of the operating part 8 toward the distal side A1 in the longitudinal direction A, the first portion Ta of defect T can remain clamped by the first outer arm 31 and the central arm 2C. Furthermore, because the first portion Ta of defect T is clamped between the inner surface 31a of the first outer arm 31 and the distal surface 2a1 of the central arm 2C, damage to the tissue by the sharp edges of the first outer arm 31a and the central arm 2C can be prevented. The elastic member 29 is configured to allow the central arm 2C to move toward the proximal side A2 in the longitudinal direction A. Therefore, it is possible to prevent the first part Ta of defect T from being clamped by the inner surface 31a of the distal end of the first outer arm 31 and the distal surface 2a1 of the central arm 2C with excessive force.

[0168] like Figure 24As shown, similar to the processing performed using the handling unit 1 of the clamping device 100 of the first embodiment described above, when the operator moves the second slider 822 of the operating unit 8 backward along the longitudinal direction A toward the proximal side A2, the second outer arm 32 rotates relative to the central arm 2C toward the first side B1 in the opening and closing direction B. Therefore, the second portion Tb of the defect T is clamped between the inner surface 32a of the distal end of the second outer arm 32 and the distal surface 2a1 of the central arm 2C. Thereafter, even if the operator unintentionally moves the second slider 822 of the operating unit 8 toward the distal side A1 in the longitudinal direction A, the second portion Tb of the defect T remains clamped by the second outer arm 32 and the central arm 2C.

[0169] In the treatment section 1C of the clamping device 100 of this embodiment, the material and configuration structure of the elastic member 29 can be appropriately determined to properly clamp the defect T of the biological tissue to be treated.

[0170] (First variation)

[0171] The following will refer to Figures 25 to 28 The disposal unit 1D of the clamping device 100 described in the first modified example of this embodiment is described. Figures 25 to 27 This is a diagram showing the operation of the handling unit 1D of the clamping device 100 described in this modified example. Figure 28 This diagram shows the treatment section 1D of the clamping device 100 of this modified example performing ligation treatment on the defect T of the biological tissue to be treated.

[0172] like Figures 25 to 27 As shown, the configuration structure of the central arm 2D of the handling section 1D of the clamping device 100 in this modified example differs from the configuration structure of the central arm 2 in the first embodiment described above. More specifically, in the central arm 2D of the clamping device 100 in this modified example, the rod-shaped portion 2b is configured to branch into a first rod-shaped portion 2b1 and a second rod-shaped portion 2b2 along the longitudinal direction A. An elastic member is provided between the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2. Due to the elastic member provided between the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2, the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2 are biased to separate from each other along the opening and closing direction B. Furthermore, as... Figure 25As shown, the central arm 2D includes a first distal end portion 2a3 and a second distal end portion 2a4 corresponding to the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2. When the first outer arm 31, the second outer arm 32, and the central arm 2D are in a closed state, the first distal end portion 2a3 and the second distal end portion 2a4 can be located at a position further along the longitudinal direction A than the distal ends of the first outer arm 31 and the second outer arm 32, towards the distal end side A1. However, the configuration structure of this modified example is not limited to this. For example, when the first outer arm 31, the second outer arm 32, and the central arm 2D are in a closed state, the first distal end portion 2a3 and the second distal end portion 2a4 can be located at a position further along the longitudinal direction A than the distal ends of the first outer arm 31 and the second outer arm 32, towards the proximal end side A2. The first distal end portion 2a3 and the second distal end portion 2a4 can each be formed with an inclined surface 2f that slopes from their respective distal ends toward the proximal end side. A mating surface 31b is formed on the first outer arm 31, connecting its distal surface and inner surface 31a and being substantially parallel to the corresponding inclined surface 2f. Similarly, a mating surface 32b is formed on the second outer arm 32, connecting its distal surface and inner surface 32a and being substantially parallel to the corresponding inclined surface 2f.

[0173] like Figure 26 As shown, the handling section 1D of the clamping device 100 in this modified example has the above-described configuration structure, such that when the operator retracts the first pulling member 51 or the second pulling member 52 to the proximal side A2 in the longitudinal direction A, the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2 are opened by means of the biasing force of the elastic member to separate from each other in the opening and closing direction B. During this process, the inclined surface 2f of the first distal end portion 2a3 located on the distal side A1 of the first rod-shaped portion 2b1 engages with the engagement surface 31b of the first outer arm 31, and the inclined surface 2f of the first distal end portion 2a4 located on the distal side A1 of the second rod-shaped portion 2b2 engages with the engagement surface 32b of the second outer arm 32.

[0174] like Figure 27 As shown, when the operator continues to retract the first pulling member 51 or the second pulling member 52 towards the proximal side A2 along the longitudinal direction A, the distance between the first distal end 2a3 and the second distal end 2a4 further increases. In the treatment section 1D of the clamping device 100 of this modified example, the first distal end 2a3 and the second distal end 2a4 are configured to be pre-opened at a predetermined interval. Therefore, when the first outer arm 31 is opened by the operator, a gap for placing biological tissue as the treatment object is formed between the first outer arm 31 and the first distal end 2a3 of the central arm 2D. Similarly, when the second outer arm 32 is opened by the operator, a gap for placing biological tissue as the treatment object is formed between the second outer arm 32 and the second distal end 2a4 of the central arm 2D.

[0175] Figure 28This diagram illustrates the ligation of biological tissue T, the object of treatment, using the treatment section 1D of the clamping device 100 of this modified example. Figure 28 As shown, the first portion Ta of the defect T in the biological tissue to be treated is held between the first outer arm 31 and the first rod-shaped portion 2b1 of the central arm 2D. More specifically, the first portion Ta of the defect T is held between the mating surface 31b of the first outer arm 31 and the inclined surface 2f of the first rod-shaped portion 2b1 of the central arm 2D. According to the treatment unit 1D of this embodiment, since the first rod-shaped portion 2b1 of the central arm 2D is biased to the first side B1 in the opening and closing direction B, even if the operator unintentionally moves the first slider 812 of the operation unit 8 toward the distal side A1 in the longitudinal direction A, the state in which the first portion Ta of the defect T is held between the first rod-shaped portion 2b1 of the central arm 2D and the first outer arm 31 can be maintained.

[0176] Similar to the traction steps of the first embodiment described above, with the first portion Ta of the defect T held in place, the operator pulls the entire treatment unit 1D to the vicinity of the second portion Tb of the defect T. Thereafter, the operator moves the second slider 822 of the operating unit 8 forward along the longitudinal direction A toward the distal end A1, thereby positioning the second portion Tb of the defect T between the second rod-shaped portion 2b2 of the second outer arm 32 and the central arm 2D. Figure 28 As shown, the second distal end portion 2a2 corresponding to the second rod-shaped portion 2b2 has an inclined surface 2f formed to be inclined from its distal end surface to the proximal end side, and the second rod-shaped portion 2b2 is biased to open on the second side B2 in the opening and closing direction B, so that the second rod-shaped portion 2b2 can be placed more easily below the second part Tb of the defect T.

[0177] In this state, when the operator moves the second slider 822 of the operating part 8 backward toward the proximal side A2 in the longitudinal direction A, the second outer arm 32 rotates toward the first side B1 in the opening and closing direction B toward the second rod-shaped part 2b2, so that the second part Tb of the defect T can be clamped by the second outer arm 32 and the second rod-shaped part 2b2.

[0178] Similar to the example above, according to the handling section 1D of the clamping device 100 in this modified example, the object to be handled can be held with an appropriate clamping force even if the operator does not operate the operating section 8 of the clamping device 100. Furthermore, by clamping the object to be handled through the engagement surface 31b of the first outer arm 31 and the inclined surface 2f of the first rod-shaped portion 2b1 of the central arm 2D, or through the engagement surface 32b of the second outer arm 32 and the inclined surface 2f of the second rod-shaped portion 2b2 of the central arm 2D, damage to the object to be handled by sharp parts can be prevented.

[0179] (Second variation)

[0180] The following will refer to Figure 29The configuration structure of the handling section 1E of the clamping device 100 in this embodiment is described. In the first modified example described above, the central arm 2D of the clamping device 100 branches from its root into a first rod-shaped portion 2b1 and a second rod-shaped portion 2b2. On the other hand, as... Figure 29 As shown, in this modified example, the central arm 2E of the handling section 1E of the clamping device 100 branches into a first rod-shaped portion 2b1 and a second rod-shaped portion 2b2 from a position near its distal end. That is, the central arm 2E of the clamping device 100 in this modified example has a first rod-shaped portion 2b1, a second rod-shaped portion 2b2, and a proximal rod-shaped portion 2b3 formed thereon. An elastic member (not shown) is provided between the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2 in the central arm 2E of this modified example. Due to the elastic member provided between the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2, the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2 are biased to separate from each other along the opening / closing direction B.

[0181] In the treatment section 1E of the clamping device 100 according to this modification, since the central arm 2E branches near its distal end, the biasing force is applied more reliably to the root of the defect T in the biological tissue to be treated by means of the elastic member provided between the first rod-shaped portion 2b1 and the second rod-shaped portion 2b2. Generally, in biological tissues such as mucous membranes, since the root is harder than the distal end, the root of the biological tissue can be clamped with a greater clamping force by the treatment section 1E of the clamping device 100 of this modification, and the biological tissue can be prevented from slipping off the treatment section 1E. According to the treatment section 1E of the clamping device 100 of this modification, the defect T in the biological tissue to be treated can be ligated by an operation similar to that described in the first modification.

[0182] (Third Embodiment)

[0183] The following will be referenced Figures 30 to 32 The configuration structure of the handling unit 1F of the clamping device 100 according to the third embodiment of this disclosure is described. Figure 30 As shown, in the processing section 1F of the clamping device 100 in this embodiment, the elastic member 18 is configured to connect the proximal end 311C of the first outer arm 31 and the inner peripheral surface 42 of the clamping retainer 4.

[0184] Similar to the embodiments described above, the clamp holder 4 in this embodiment is a tubular structure with a longitudinal axis, for example, formed in a cylindrical shape. Figure 30As shown, an elastic member 18 is provided between the proximal surface of the base end portion 311C of the first outer arm 31 and the inner circumferential surface 42 of the clamp holder 4. This elastic member 18 is used to bias the first outer arm 31 to rotate in the opening / closing direction B. The elastic member 18 is positioned to contact the inner circumferential surface 42 of the clamp holder 4, and it is not necessary to fix the elastic member 18 to the inner circumferential surface 42 of the clamp holder 4. The elastic member 18 can be formed, for example, by using various leaf spring structures. More specifically, such as... Figure 31 As shown, due to the biasing force of the elastic member 18 in this embodiment, the first outer arm 31 is biased when no external force is applied, causing its distal end to rotate toward the distal end 2a of the central arm 2F on the second side B2 in the opening / closing direction B. The material and configuration structure of the elastic member 18 can be appropriately selected according to the characteristics of the biological tissue to be treated, the treatment location, etc.

[0185] In addition, such as Figure 32 As shown, when the first outer arm 31, the second outer arm 32, and the central arm 2F of this embodiment are in a closed state, the distal ends of the first outer arm 31 and the second outer arm 32 are located at a position A1 further along the longitudinal direction A than the distal end of the central arm 2F. That is, as Figure 32 As shown, when the first outer arm 31, the second outer arm 32, and the central arm 2F are in a closed state, the inner surface 31a of the first outer arm 31 and the inner surface 32a of the second outer arm 32 abut against the distal surface 2a1 of the distal end 2a of the central arm 2F.

[0186] According to the clamping device 100 of this embodiment, the disposal unit 1F, due to the elastic member 18 provided between the proximal surface of the proximal end 311C of the first outer arm 31 and the inner peripheral surface 42 of the clamping retainer 4, can clamp the object to be disposed between the first outer arm 31 and the central arm 2F with an appropriate clamping force. Similar to the embodiment described above, the disposal unit 1F of the clamping device 100 of this embodiment can maintain the defect T of the biological tissue to be disposed of, even if the operator does not continue to grasp the first sliding member 812 of the operating unit 8, in a state where it is clamped by the first outer arm 31 and the central arm 2F.

[0187] In this embodiment, a configuration is described where the elastic member 18 is disposed between the proximal surface of the proximal end 311C of the first outer arm 31 and the inner peripheral surface 42 of the clamp retainer 4, but this embodiment is not limited thereto. The elastic member 18 is configured to connect the first outer arm 31 and the clamp retainer 4, and this configuration can be adjusted appropriately.

[0188] In this embodiment, the elastic member 18 can be disposed on either the first outer arm 31 or the second outer arm 32. More specifically, in this disclosure, when ligating a defect T in the biological tissue to be treated, the elastic member 18 can be disposed only on the outer arm 3, which is configured to first grasp the first portion Ta of the defect T. However, depending on the configuration of the elastic member 18 disposed on both the first outer arm 31 and the second outer arm 32, the operator does not need to be aware of the first outer arm 31 and the second outer arm 32 to be used, thereby simplifying the procedure.

[0189] (Modified Example)

[0190] The following will refer to Figure 33 The configuration structure of the handling portion 1G of the clamping device 100 described in a modified embodiment of this invention is described. For example... Figure 33 As shown, in the handling section 1G of the clamping device 100 of this modified example, an elastic member 19 is provided for connecting the first outer arm 31 and the central arm 2G. Similarly, the elastic member 19 is provided between the second outer arm 32 and the central arm 2G for connecting the second outer arm 32 and the central arm 2G. More specifically, for example, according to the elastic member 19 provided between the proximal end of the first outer arm 31 and the central arm 2G, in a state where no external force is applied, the first outer arm 31 is biased to rotate toward the central arm 2G on the second side B2 in the opening / closing direction B. On the other hand, according to the elastic member 19 provided between the proximal end of the second outer arm 32 and the central arm 2G, in a state where no external force is applied, the second outer arm 32 is biased to rotate toward the central arm 2G on the first side B1 in the opening / closing direction B. The elastic member 19 of this modified example can be configured, for example, to use various spring hinge structures.

[0191] In this embodiment, the elastic member 19 may be disposed on only one of the first outer arm 31 and the second outer arm 32. More specifically, in this disclosure, when ligating a defect T in the biological tissue to be treated, the elastic member 19 may be disposed on only the outer arm 3 configured to first grasp the first portion Ta of the defect T. However, according to the configuration of the elastic member 19 disposed on both the first outer arm 31 and the second outer arm 32, the operator does not need to be aware of the first outer arm 31 and the second outer arm 32 to be used, thereby simplifying the procedure.

[0192] [Industrial Applicability]

[0193] According to each of the above embodiments of the present disclosure, a clamp and tissue closure method can be provided for clamping tissue with appropriate clamping force and maintaining the tissue in a clamped state even without operator intervention.

[0194] [List of Labels in the Attached Images]

[0195] 100 clamping device

[0196] 1, 1A, 1B, 1C, 1D, 1E, 1F, 1G Processing Unit (Clamp)

[0197] 18, 19 Elastic members

[0198] 2, 2C, 2D, 2E, 2F, 2G central arms

[0199] 2c, 31c, 32c contact surfaces

[0200] 4c, 27, 37 protrusions

[0201] 25, 25A First Opposite Plane (Opposite Plane)

[0202] 26, 26A Second Opposite Plane (Opposite Plane)

[0203] 3. Outer arm

[0204] 31, 31B First outer arm

[0205] 31b, 32b mating surfaces

[0206] 31c contact surface

[0207] Teeth 315, 325, 316, 317

[0208] 32 Second outer arm

[0209] 312a, 312Ba First clamping surface (inner surface)

[0210] 322a, 322Aa Second clamping surface (inner surface)

[0211] 4. Fixture retainer

[0212] 5, 5B, 51B tension members

[0213] 6. Operating Line

[0214] 61 First Operating Line

[0215] 62 Second Operating Line

[0216] 7. Sheath

[0217] 8. Operations Department

[0218] 81 First Operations Department

[0219] 82 Second Operations Section

[0220] 812 First Slider

[0221] 822 Second Slider

[0222] A. Vertical direction

[0223] A1 distal side

[0224] A2 proximal side

[0225] B Opening / Closing Direction

[0226] B 1 First side

[0227] B2 Second Side

[0228] Organization D

[0229] T-detection

[0230] Ta Part 1

[0231] Tb Part Two.

Claims

1. A multi-arm gripper, comprising: Central arm; An outer arm is configured to be rotatably connected to the central arm; Two sliding pins are configured to move along the longitudinal axis of the central arm to open or close the pair of arms using the arm slots defined by the pair of arms. A retaining feature is provided on each of the central arm or the pair of outer arms, the retaining feature being configured to adjustably retain the clamping force between the central arm and the pair of outer arms for clamping tissue; as well as A force transmission element configured to move the two sliding pins along the longitudinal axis. One of the outer arms includes an outer arm groove, the outer arm groove being configured to allow movement of the two sliding pins. The retaining feature includes a plurality of teeth formed in the outer arm groove, the outer arm groove including a first region that restricts the translational movement of the sliding pin by the plurality of teeth and a second region that allows the translational movement of the sliding pin.

2. The multi-arm clamp of claim 1, wherein the multi-arm clamp further comprises a clamp retainer configured to receive the proximal end of at least one of the pair of arms, the pair of arms being movable relative to the two sliding pins and the clamp retainer, the retaining feature comprising a plurality of teeth formed on the base end side of the pair of arms, the plurality of teeth engaging the two sliding pins or the clamp retainer.

3. The multi-arm clamp of claim 1, wherein the retaining feature includes corresponding teeth configured to restrict the sliding of the two sliding pins along the outer arm groove.

4. The multi-arm clamp according to claim 1, wherein the central arm defines a central arm slot; and The two sliding pins are configured to slide along the central arm groove in the direction of the longitudinal axis of the central arm.

5. The multi-arm clamp of claim 4, wherein the retaining feature includes corresponding teeth formed on the outer arm groove, the teeth being configured to restrict the sliding of the two sliding pins along the outer arm groove.

6. The multi-arm clamp according to claim 1, comprising: A clamp retainer configured to receive the proximal end of at least one of the outer arms. The retaining feature includes: The corresponding teeth are provided at the proximal end of the outer arms; and A matching feature is disposed inside the clamp retainer, the matching feature being configured to engage with at least one of the corresponding teeth.

7. The multi-arm clamp according to claim 6, wherein the matching feature is a protrusion provided on the front end side of the clamp holder, the protrusion protruding toward the base end of one pair of outer arms.

8. The multi-arm clamp according to claim 6, wherein the central arm has a central arm groove, and the base ends of one pair of outer arms extend freely and retract freely relative to the clamp retainer in response to the sliding of the two sliding pins within the central arm groove.

9. The multi-arm clamp according to claim 6, wherein the matching feature comprises a pawl or a rack.

10. The multi-arm clamp of claim 1, wherein the central arm defines a central arm slot; and The retaining feature includes a spring disposed at the end of the central arm groove.

11. The multi-arm clamp of claim 10, wherein the central arm includes a branch located at a proximal end of the central arm, the branch defining a distal end; and The branch is biased by the spring, causing the distal end of the branch to move radially outward.

12. The multi-arm clamp of claim 10, wherein the central arm includes a branch located at the distal end of the central arm, the branch being biased by the spring such that the branch moves laterally relative to the central arm.

13. The multi-arm clamp according to claim 1, comprising: A clamp retainer located at the proximal end of one of the outer arms; The retaining feature includes a spring between the proximal end of the first outer arm and the clamp retainer in one pair of outer arms; The spring is configured to bias the first outer arm to close the pair of outer arms.

14. The multi-arm clamp of claim 1, wherein the retaining feature includes a spring between the pair of arms, the spring being configured to bias the pair of arms to close the pair of arms.

15. The multi-arm clamp according to any one of claims 1 to 14, wherein the force transmission element includes a line configured to control the movement of the outer arm.

16. A clamp, comprising: The central arm defines the slender first slot; A pair of outer arms, including a first outer arm defining an elongated second groove; A first pin rotatably engages the central arm and the first outer arm; The second pin is configured to translate along the first slot and the second slot; A force transmitter detachably attached to the central arm or one of the outer arms, the force transmitter being configured to actuate the outer arms to open or close the outer arms; as well as The ratchet is located in the first groove and the second groove. The first groove or the second groove includes a first region that restricts the translational movement of the second pin by means of the ratchet and a second region that allows the translational movement of the second pin.

17. The clamp of claim 16, wherein the ratchet comprises a plurality of teeth.

18. The clamp of claim 16, wherein one pair of outer arms is configured to extend such that the distal ends of the pair of outer arms are positioned away from the central arm; The clamp further includes a biasing member configured to bias the central arm toward the distal ends of one pair of outer arms.

19. The clamp of claim 16, wherein one pair of outer arms further comprises a second outer arm, the first outer arm and the second outer arm being configured to at least partially surround the central arm; The central arm includes a first central arm and a second central arm; The first central arm is offset toward the first outer arm; and The second central arm is offset toward the second outer arm.

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