Clip for endoscope

Abstract

A clip for grasping tissue may have a first arm with a first jaw at a distal end of the first arm and a second arm with a second jaw at a distal end of the second arm, where the first arm and the second arm are configured to move in a direction toward each other to close the clip. The clip includes one or more anchors on the arms of the clip, the anchors protruding in a direction other than a direction in which the first and second arms are configured to move toward each other to close the clip. Such an anchor may be more easily attached to the tissue of the patient when contacted than a clip without the anchor.

Description

[0001] This application is a divisional application of an application filed on October 12, 2021, with application number 202111186087.2, and invention name “Clip for endoscope”.

[0002] Citation of Related Applications

[0003] This application claims priority to U.S. Provisional Application No. 63 / 092,981, filed on October 16, 2020, the entire disclosure of which is incorporated herein by reference. Technical Field

[0004] The present invention relates to a clip that is configured to grasp tissue of a patient during surgery and that can be used with a surgical tool such as an endoscope. Background Art

[0005] In the following description, reference is made to specific structures and / or methods. However, the following references should not be construed as admitting that these structures and / or methods constitute prior art. Applicants expressly reserve the right to prove that such structures and / or methods do not conform to the prior art of the present invention.

[0006] Endoscopic clips (i.e., endoscope clips) are surgical tools used with an endoscope to grasp tissue within the human body. Endoscopic clips have found use in therapeutic procedures such as preventing tissue bleeding, closing perforations, and other surgical procedures. There are many types of endoscopic clips in different shapes and / or sizes, which can be managed using disposable and reloadable systems, and can be openable or non-openable to facilitate placement of the clip within the body.

[0007] For example, JP 2015008858 discloses an endoscopic clamp for grasping body tissue, which includes protrusions on the inner surface of the arm plate of the clamp. The protrusions point inwardly to face each other and are designed to facilitate holding tissue between the arms of the clamp when the clamp is closed.

[0008] However, there remains a need for a clip that is configured to grasp tissue of a patient during a surgical procedure and that can be used with a surgical tool, such as an endoscope. Summary of the invention

[0009] An advantage of the present invention is a clip including an anchor that can be more easily attached to a patient's tissue when in contact with the patient's tissue than a clip without an anchor. For example, the clip of the present disclosure can more easily facilitate grasping of tissue when the clip approaches such tissue at an angle less than perpendicular to the tissue.

[0010] These and other advantages are met, at least in part, by a clamp for grasping tissue, the clamp having: a first arm having a first claw at a distal end of the first arm; and a second arm having a second claw at a distal end of the second arm. The first arm and the second arm are configured to move in a direction toward each other to close the clamp. In some embodiments, the first claw and the second claw face each other. In another embodiment, the first arm and the second arm can move in a repeated direction toward each other and away from each other to close and open the clamp. In other embodiments, the first arm and the second arm are configured to move in a direction toward each other to close the clamp, and once the arms are closed, the clamp can be locked from opening.

[0011] Advantageously, the clip includes one or more anchors, such as a first anchor located on the first arm. Optionally, the clip may also include a second anchor, such as located on the second arm. The first anchor may protrude from the first arm in a direction different from the direction in which the first arm and the second arm are configured to move toward each other to close the clip. And, when present, the second anchor may protrude from the second arm in a direction different from the direction in which the first arm and the second arm are configured to move toward each other to close the clip. In various embodiments, the clip includes a first anchor and a second anchor.

[0012] Additional embodiments of the present disclosure include one or more of the following features, alone or in combination. For example, the clip of the present disclosure can be assembled with a compression tube that can be connected to a sheath. The clip can also be connected to a wire directly or through a connecting member. In some embodiments, the assembly can include a cover to shield the first anchor and the optional second anchor when the clip is retracted into the compression tube. In other embodiments, the first anchor and the optional second anchor can protrude through the slit in the arm. In yet another embodiment, the first anchor and the optional second anchor can protrude from the arm in a direction orthogonal to the plane defined by the first arm and the second arm. In other embodiments, the anchor can be configured to rotate toward the plane defined by the first arm and the second arm. In some embodiments, the first arm and the second arm are configured to bend.

[0013] Other advantages of the present invention will become apparent to those skilled in the art from the following detailed description, which is intended to illustrate the best mode of carrying out the present invention, and only preferred embodiments of the present invention are shown and described in the following detailed description. As will be appreciated, the present invention is capable of other and different embodiments, and its many details are capable of modification in various obvious aspects, all of which do not depart from the present invention. Therefore, the drawings and description are to be regarded as illustrative in nature, and not restrictive. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Referring to the drawings, wherein elements with the same reference numerals represent similar elements throughout, wherein:

[0015] Figure 1A , Figure 1B , Figure 1C and Figure 1D A schematic diagram illustrates a clamp having an anchor protruding from an outer surface of a first arm and an outer surface of a second arm. The anchor is shown in this example as protruding from the respective arms in a direction different from the reciprocating direction of opening and closing the clamp of the first and second arms, with Figure 1A The structure shown is different. Figure 1E A clip with a coupling mechanism is schematically shown, Figure 1F A clamp having multiple arms is schematically shown.

[0016] Figure 2A , Figure 2B , Figure 2C , Figure 2D and Figure 2E A clip with an anchor is schematically illustrated, wherein the anchor may be concealed by a cover connected to a component of a clip device according to aspects of the present disclosure.

[0017] Figure 3A and Figure 3B A flexible anchor that may protrude through a slot in an arm of a clip after the clip is opened is schematically illustrated according to aspects of the present disclosure.

[0018] Figure 3C yes Figure 3B An enlarged view of the arm of the clamp.

[0019] Figure 4A and Figure 4B A flexible anchor that may protrude through a slot in an arm of a clip after the clip is opened is schematically illustrated according to aspects of the present disclosure.

[0020] Figure 4C yes Figure 4B An enlarged view of the arm of the clamp.

[0021] Figure 4D , Figure 4E , Figure 4F , Figure 4G and Figure 4H Another flexible anchor that may protrude through a slot in an arm of a clip after the clip is opened is schematically illustrated according to aspects of the present disclosure.

[0022] Figure 5A and Figure 5B A clip having an anchor protruding from the first arm and the second arm in a direction different from when the first arm and the second arm are closed is schematically illustrated. In this example, when the clip is in a closed state, the clip forms a width (W) defined by opposite ends of the anchor, the width (W) being less than the width of the compression tube or less than the width of the channel in the treatment tool.

[0023] Fig. 6A and 6B A clamp comprising an anchor located on an arm protruding in a direction normal to a plane formed by the arms and a compression tube having an opening large enough to allow the anchor to enter the tube when the clamp is retracted into the compression tube is schematically illustrated.

[0024] Fig. 7A , Figure 7B , Figure 7C A clip for grasping biological tissue of a patient having one or more bioabsorbable anchors according to aspects of the present disclosure is schematically illustrated.

[0025] Fig. 8A , Figure 8B , Figure 8C A clamp for clamping biological tissue of a patient according to aspects of the present disclosure is schematically illustrated, the clamp having an anchor.

[0026] Fig.9A , Fig. 9B , Fig. 9C Schematically illustrated are clips having more than one anchor per arm and / or wherein the anchors project in different directions from each other according to aspects of the present disclosure.

[0027] Fig. 10A , Fig. 10B , Fig. 10C A clamp for clamping biological tissue of a patient according to aspects of the present disclosure is schematically illustrated, the clamp having two anchors.

[0028] Fig.11A , Fig. 11B and Fig. 11C A clip having an anchor configured to rotate into the plane of the clip's arms is schematically illustrated according to aspects of the present disclosure.

[0029] Fig. 12A and Fig. 12B A clamp having arms with indicia identifying the location of an anchor located on the respective arm is schematically illustrated according to aspects of the present disclosure.

[0030] Fig.13A and Fig. 13B A clip having a jaw with a notch, or where the width of the jaw is greater or less than the width of the anchor so that the anchor can be more easily viewed when the clip is in use is schematically illustrated according to aspects of the present disclosure.

[0031] Fig.14A and Fig. 14B Schematically illustrates a side view of a clamp arm, wherein an anchor protrudes from the first arm in a perpendicular direction to the longitudinal direction of the arm. In this example, the anchor is in the shape of a hook that allows the clamp to be attached perpendicularly to the tissue.

[0032] Fig.15A and Fig. 15B Schematically illustrated is a side view of a clip configured to be released from a surgical tool after the clip is attached to tissue of a patient and including a flexure member on an arm of the clip according to aspects of the present disclosure.

[0033] Fig.16A and Fig. 16B A side view of a clip configured to include a curved member on an arm of the clip is schematically illustrated according to aspects of the present disclosure.

[0034] Fig. 16C yes Fig.16A An enlarged view of the clamp arm.

[0035] Fig.17A A side view of a clip configured to include a curved member and a notch on an arm of the clip is schematically illustrated according to aspects of the present disclosure.

[0036] Fig.18A and Fig.18B Schematically illustrated is a side view of a clamp having an arm with two parts hinged together by a joint according to aspects of the present disclosure.

[0037] Fig.19A and Fig.19B A clamp having an arm having two parts hinged together by a joint, wherein the arm can be locked in a bent state, is schematically illustrated according to aspects of the present disclosure.

[0038] Fig.19C yes Fig.19B An enlarged view of the arm of the clamp.

[0039] Fig. 20A , Fig. 20B , Fig. 20C , Fig.20D Schematically illustrated is a side view of another embodiment of a clamp having an arm having two parts hinged together by a joint according to aspects of the present disclosure.

[0040] In all the drawings, the sizes of the various components are appropriately adjusted for clarity. For ease of viewing, in some cases, only some named features in the drawings are marked with reference numerals. DETAILED DESCRIPTION

[0041] The clips disclosed herein can be used in the treatment of patients, such as preventing tissue bleeding, closing perforations and stopping bleeding and internal wound suture contraction, marking lesions and traction (mucosal elevation) and other surgical procedures. As used herein, the term "patient" includes any and all organisms and includes the term "subject". The patient can be a human or an animal.

[0042] A clamp commonly used to grasp patient tissue is actuated by a clamp operating tool. Such a tool actuates the clamp by an operating wire, which is typically housed in a flexible tube, in which the operating wire can be advanced and retracted longitudinally by a handle of the operating tool. References herein to the term "distal" refer to a direction away from the operating handle, while references to the term "proximal" refer to a direction toward the operating handle. Clamp operating tools such as those described in U.S. Pat. Nos. 8,480,685 and 9,949,740 may be used with the clamp of the present disclosure, and each disclosure is incorporated herein by reference in its entirety.

[0043] Will refer to FIG. 1A to FIG. 20D Various embodiments and aspects of clips according to the present disclosure are described.

[0044] like Figure 1A-Figure 1D As shown, a clamp 10 for clamping biological tissue of a patient has a first arm 12 and a second arm 13, the first arm 12 having a first claw 12a at the distal end of the first arm 12, and the second arm 13 having a second claw 13a at the distal end of the second arm 13. As further illustrated, the first claw 12a and the second claw 13a face each other, and the first arm 12 and the second arm 13 are configured to move in a repeated direction (R) toward and away from each other to close and open the clamp. The first claw and the second claw can be located on the same or substantially the same plane so that when the arms are closed, the claws contact each other.

[0045] The clamp of the present disclosure advantageously includes one or more anchors protruding from the first arm and / or the second arm. Anchors as used herein include structures that can be attached to the patient's tissue when in contact with minimal force, and can include, for example, protrusions, hooks, barbs, nails, etc. One or more anchors protrude from their respective arms in a direction other than the direction in which the first arm and the second arm are configured to move toward each other to close the clamp. For example, the anchors can protrude in a direction other than the claw or in a direction orthogonal to the plane defined by the first and second arms (in a perpendicular direction relative to the arms), or in any other direction other than the direction in which the first arm and the second arm are configured to move toward each other to close the clamp.

[0046] In the present invention, the shape of the clamp 10 for clamping the biological tissue of the patient is not limited to Figure 1A The shape shown in the figure may also be a clip with a connecting mechanism (such as Figure 1E as shown) or a multi-arm clamp (as shown Figure 1F Other types of clips such as those shown).

[0047] Specifically, Figure 1EA clamp with a coupling mechanism is schematically illustrated. The clamp 10 has a first arm 12 and a second arm 13. The first arm 12 and the second arm 13 can rotate about a common pivot formed by a pin 9 so as to open and close them. The first arm 12 and the second arm 13 are provided with guide slots 8, respectively, and the guide slots 8 on the first arm 12 and the second arm 13 partially overlap each other. The clamp 10 also includes a guide pin 5, which extends through the guide slots 8 in the overlapping portion thereof.

[0048] Figure 1F Schematically illustrates a clamp having multiple arms ( Figure 1F A three-arm clamp is shown as a reference in the figure. Depending on the actual application, the clamp 10 may also have more than three arms. The clamp 10 for clamping the biological tissue of the patient comprises a fixed arm 11 and two movable arms (i.e., a first arm 12 and a second arm 13) rotatably connected to the fixed arm 11 through a pin 9. The first arm 12 comprises a first claw 12a at the distal end of the first arm 12, and the second arm 13 comprises a second claw 13a at the distal end of the second arm 13.

[0049] like Figure 1A-1F As further shown, the first arm 12 includes a first anchor 14a located on an outer surface of the first arm 12 and protruding in a direction different from the first claw 12a, and the second arm 13 includes a second anchor 14b located on an outer surface thereof and protruding in a direction different from the second claw 13a. The clip 10 can be deployed from a tube (also referred to herein as a press tube) 16 that can be coupled to a flexible tube 18. During operation, the clip 10 is directed toward the flexible tube 18. Figure 1C and Figure 1D The arms 12 and 13 of the open tissue receiving configuration shown can be closed by actuating an operating wire (not shown) coupled to the clip to enable the clip to slide proximally and distally in the tube. The operating wire can be advanced and retracted longitudinally in the flexible tube (not shown) by a handle of an operating tool (not shown). The clip is opened and closed by moving the arms and claws toward and away from each other, sliding proximally and distally. In some embodiments, once the clip is retracted into the compression tube, the clip can be locked and cannot be opened.

[0050] like Figure 1C-Figure 1D As shown, the advantage of the clip of the present disclosure is that even when the approach (A) of the clip is not perpendicular to the tissue, e.g. Figure 1C The diagram shows a vertical approach, while Figure 1DA tangential approach is illustrated, and the clip can still be attached to tissue. During a non-perpendicular approach, anchors (14b) located on arms 13 can capture tissue (T) near a lesion (D). When the clip is closed after the anchors capture the tissue, the claws and arms can lift the tissue so that the claws of the arms can more easily grasp the tissue. In addition, after the anchors capture the tissue, the clip can be rotated to further grasp the tissue in the claws of the arms with the anchors attached to the tissue. Advantageously, one or more anchors located on the outer surface of the arms of the clip of the present disclosure can prevent the distal ends of the arms of the clip from being dislodged during a tangential approach to tissue ( Figure 1D )slide.

[0051] FIG. 2A to FIG. 6B Different aspects of the clips of the present disclosure and different ways to mitigate contact of the anchor with other parts of the clip tool or endoscope are illustrated. For example, Figure 2A-2E A cover is shown that can conceal the anchor of the clip. Figure 2A-2B In the embodiment, the cover 21 is attached to the compression tube (tube) 16 and extends distally from the compression tube 16. The clip 10 can be closed by slidably retracting into the compression tube 16 ( Figure 2B ). When the clamp is retracted into the compression tube, the cover can be sufficiently extended distally to shield one or more anchors located on the outer surface of the arm. Figure 2B As shown, when the clip 10 is retracted into the compression tube 16, the cover 21 is extended distally sufficiently to conceal the anchors 14a and 14b.

[0052] Figure 2C-Figure 2E Different attachment locations of the cover that can conceal the anchor of the clip are shown. For example, Figure 2C A cover 21 is shown attached to the sheath 18 . Figure 2D-Figure 2E It is shown how the cover 21 is attached to the connecting member 29 or wire 27 . Figure 2D The clip is shown in an open state with the anchor 14 exposed. Figure 2E The clip is shown in a closed state with the anchor concealed by the cover 21. Regardless of the location of attachment, when the clip is retracted into the compression tube, the cover is sufficiently extended distally to conceal the anchor. The cover 21 may be made of plastic or other elastic material or metal and may be attached by adhesive or welding.

[0053] Figure 3A-3C and Figure 4A-4C A flexible anchor is shown that can protrude through the slots in the arms of the clip after the clip is opened. Figure 3A As shown, when the clamp is in the closed state ( Figure 3A ), the anchors 34a and 34b may be shielded by the inner surfaces of the first arm 32 and the second arm 33 of the clip 30. The anchors 34a and 34b are connected to the clip 30 by the flexible members 31a and 31b, respectively. Figure 3B and Figure 3C In the open state shown, anchor 34a protrudes through slot 35 in first arm 32 of clip 30. Anchor 34b similarly protrudes through slot (not shown for convenience) in second arm 33 when clip 30 is in the open state. In this way, the anchors can be concealed prior to deploying the clip (such as deploying clip 30 from crimp tube 16).

[0054] In a separate embodiment, Figure 4A-4H A flexible anchor is shown that can protrude through the slots in the arms of the clip after the clip is opened. In particular, when the clip 40 is moved toward the closed state ( Figure 4B-4C ), the anchors 44a and 44b can be retracted toward the first arm 42 and the second arm 43, respectively. The anchors 44a and 44b are connected to the clip 40 by the flexible members 41a and 41b, respectively. Figure 4A In the illustrated open position, anchor 44a protrudes through flexible member 41a through slot 45 in first arm 42 of clip 40. Anchor 44b similarly protrudes through slot (not shown for convenience) in second arm 43 when clip 40 is in the open position. In this way, the anchor can be brought toward the arms of the clip when the clip is retracted into compression tube 16.

[0055] like Figure 4D-Figure 4H As further illustrated in FIG. 1 , the clip and the flexible member may be in a closed state when inserted into a tool such as an endoscope. Figure 4E and Figure 4F As the clamp arms and flexible member are forced toward the open state, the clamp arms and flexible member open in operation to exit the channel of the tool ( Figure 4D and Figure 4G In operation, a handle (not shown) connected to the proximal end of the wire (not shown) operates the wire (47) to retract the clamp (40) within the compression tube (16) to close the clamp arms. Certain clamp devices may include a connecting member (49) to engage and release the compression tube (16) from the sheath (18). Figure 4H ). Such a device includes a connecting member to engage and disengage the distal end of the engagement clip from the wire. In addition, the connecting member may include an internal engagement and disengagement element. The flexible member may be connected to the wire or the connecting member and retracted into the compression tube ( Figure 4H ).

[0056] In a separate embodiment, Figure 5A and Figure 5BA clamp 50 for clamping biological tissue of a patient is shown, and the clamp 50 has a first arm 12 and a second arm 13, the first arm 12 having a first claw 12a at the distal end of the first arm 12, and the second arm 13 having a second claw 13a at the distal end of the second arm 13. As further illustrated, the first claw 12a and the second claw 13a face each other, and the first arm 12 and the second arm 13 are configured to move in a repeated direction (R) toward and away from each other to close and open the clamp. As further illustrated in the figure, the first arm 12 includes an anchor 14a protruding from the first arm 12 in a direction different from the first claw 12a, and the second arm 13 includes a second anchor 14b protruding from the second arm 13 in a direction different from the second claw 13a. The clamp 50 can be deployed from within the compression tube 16 to an open state ( Figure 5A ). When in the closed state ( Figure 5B ), the clamp forms a width (W) defined by the distance between the distal ends of the anchors, the width (W) being smaller than the width of the compression tube 16 or smaller than the width of a channel in a treatment tool (51) such as a channel in an endoscope, so that the anchors protruding from the arms (14a, 14b) do not contact or minimally contact the channel.

[0057] In another embodiment, Fig. 6A and Figure 6B A clamp is shown having a first arm 12 having a first claw 12a at a distal end of the first arm 12 and a second arm 13 having a second claw 13a at a distal end of the second arm 13. As further illustrated, the first claw 12a and the second claw 13a face each other, and the first arm 12 and the second arm 13 are configured to move in a direction toward each other to close the clamp. In this embodiment, when the arms are closed, the claws 12a and 13a are in contact. As further illustrated in the figure, the clamp includes an anchor 64a located at the first arm 12 and includes an anchor 64b located at the second arm 13, wherein the two anchors protrude in a direction orthogonal to a plane formed by the first arm 12 and the second arm 13. The compression tube 66 has an opening, for example, of a diameter (D), which is large enough to allow the anchors to enter the tube when the clamp is retracted into the compression tube. Figure 6B Anchor 64 is shown in compression tube 66 when the clamp is retracted into the compression tube and the clamp is in a closed state.

[0058] It should be noted that the arms, claws and anchors may have any suitable form, such as a wire (as in e.g. Figures 1A to 1D ) or in the form of a belt (as in, for example, Fig. 6A and Figure 6B ) or may have a mixed form, such as one of the arms and claws being in the form of a belt and the anchor being in the form of a line.

[0059] 7A to 8COther aspects of anchors that may be included on the arms of the clip are illustrated. In particular, Figure 7A-7C A clamp 70 for grasping a biological tissue (T) of a patient is shown, the clamp 70 having a first arm 12 and a second arm 13, the first arm 12 having a first claw 12a at the distal end of the first arm 12, and the second arm 13 having a second claw 13a at the distal end of the second arm 13. The first claw 12a and the second claw 13a face each other. As further illustrated, the first arm 12 includes a first anchor 74a located on the outer surface of the first arm 12, the first anchor 74a protruding in a direction different from the first claw 12a, and the second arm 13 includes a second anchor 74b located on the outer surface of the second arm 13, the second anchor 74b protruding in a direction different from the second claw 13a. In this example, the first anchor 74a and the second anchor 74b are made of bioabsorbable material. In this way, after the anchors are attached to the tissue (T), they can eventually dissolve in the tissue and be removed from the clamp ( Figure 7C ). Such an anchor made of a bioabsorbable material may be initially attached to the clamp arm by an adhesive such as a bioabsorbable adhesive.

[0060] Figures 8A-11C An anchor member is shown protruding in a direction orthogonal to the plane defined by the first arm and the second arm. In particular, Fig. 8A and Fig. 10C A clamp 10 for grasping a biological tissue (T) of a patient is shown, the clamp 10 having a first arm 12 having a first claw 12a at a distal end of the first arm 12 and a second arm 13 having a second claw 13a at a distal end of the second arm 13, wherein the first claw 12a and the second claw 13a face each other, and the first arm 12 and the second arm 13 are configured to move toward each other to close the clamp. Fig. 8A In FIG. 1 , the first arm 12 includes a first anchor 84a, wherein the anchor 84a protrudes from the first arm in a direction orthogonal to a plane (P) defined by the first arm and the second arm. As shown, the arms may form a plane having an x-coordinate and a y-coordinate, and the anchor may protrude along a z-coordinate. Fig. 10A In the embodiment, the first arm 12 includes a first anchor 104a, wherein the anchor 104a protrudes from the first arm in a direction orthogonal to the plane defined by the first arm and the second arm, and the second arm 13 includes a second anchor 104b, wherein the anchor 104b protrudes from the second arm in a direction orthogonal to the plane defined by the first arm and the second arm. The anchors 104a and 104b protrude from the plane defined by the arms in opposite directions. The configuration in which one or more anchors protrude in a direction orthogonal to the plane defined by the first arm and the second arm can advantageously allow the anchors in orthogonal directions ( Figure 8B , Fig. 10B ) captures the tissue enhancement (respectively Figure 8C 81 of 81 Fig. 10C 101 in), which helps to grasp the tissue in the arm.

[0061] Figure 9A-9C The illustrations show clips having more than one anchor per arm and / or wherein the anchors project in different directions from each other. In particular, Fig.9A A first arm 12 is shown having two anchors. A first anchor 94a protrudes from the first arm in a direction orthogonal to the plane defined by the first arm 12 and the second arm, and a second anchor 94c protrudes from the first arm in a direction orthogonal to the plane defined by the first arm 12 and the second arm but opposite to the first anchor 94a. The second arm 13 also has two anchors. A third anchor 94b protrudes from the second arm in a direction orthogonal to the plane defined by the first arm and the second arm 13, and a fourth anchor 94d protrudes from the second arm in a direction orthogonal to the plane defined by the first arm and the second arm 13 but opposite to the third anchor 94b. Fig. 9B A first arm 12 having two anchors (94a, 94b) and a second arm 13 having a third anchor (94d) are shown. Fig. 9C Each arm of the clip is shown having one anchor (94a, 94d), but the anchors project in opposite directions from the plane defined by the arms.

[0062] Figure 11A-11B as well as Fig. 11C The illustration shows an anchor member configured to rotate into the plane of the arm when the clamp is retracted into the compression tube. Figure 11A-11B , first and second anchors (114a, 114b) are attached to respective first and second arms (12, 13) by structures such as pins (111a, 111b), which allow the anchors to rotate toward a plane defined by the arms when the clamp is retracted into the compression tube 116 and the edge of the compression tube contacts the anchors (119).

[0063] Fig. 11C Another structure is shown that is configured to rotate the anchor into the plane of the arm of the clamp when the arm is slidably retracted into or extended from the compression tube. As shown, the anchor 114 is formed integrally with the clamp arm 13 and is forced into an open state, but is forced into a closed state when retracted in the compression tube 116. With this structure, no pin is required to allow the arm of the clamp to include an anchor that can rotate toward the plane defined by the arm when the clamp is retracted into the compression tube 116. Instead, the anchor has a spring-open force and pops out of the compression tube when extended distally from the tube.

[0064] Figure 12A-Figure 13B The clip is shown with an anchor that can be more easily identified when the clip is in use. For example, Fig. 12A and Fig. 12BA first arm 12 and a second arm 13 are shown with a marking 121 on each arm, the marking 121 identifying the location of the first anchor 124a or 124b located on each arm. In this way, when the anchor is not easily visible to the user (such as when the anchor is stuck in the tissue (T)), the user can identify the location of the anchor by the marking (121a, 121b) located on the corresponding first arm or second arm. The marking 121 located on the arm of the clip can be caused by a fluorescent mark on the arm, a color, a symbol, a texture (such as roughness, etc.), or an equivalent on the arm at the anchor location.

[0065] Fig.13A and Fig. 13B Clips are shown with jaws having notches, or where the width of the jaws is greater or less than the width of the anchor, so that the anchor can be more easily viewed when the clip is in use. Figure 13A-13B A clip 10 is shown having first and second arms (12, 13) with first and second claws (12a, 13a) wherein the width of the first and second anchors is less than the width of the claws (134a, 134b) or greater than the width of the claws (134c, 134d) to facilitate viewing of the anchors during use. Additionally or alternatively, the claws may include notches to facilitate viewing of the anchors. Fig.13A A first prong 132a having a notch to facilitate viewing of the anchor 134a and a second prong 133a having a notch to facilitate viewing of the anchor 134b are shown.

[0066] Figures 14A-20D The clamp arms according to the present disclosure are schematically illustrated, and can further advantageously apply perpendicular forces to the tissue when the clamps are tangential to the tissue, and can be bent to facilitate placing multiple clamps in close proximity to each other. For example, Fig.14A and Fig. 14B A side view of the clip 10 is shown showing the first arm 12 with an anchor 144 protruding from the first arm 12 in a perpendicular direction to the longitudinal direction of the first arm. In this example, the anchor 144 is hook-shaped and in a direction orthogonal to the plane defined by the first and second arms of the clip, which allows the clip to be placed vertically on the tissue. After the anchor 144 is attached to the tissue (T), the clip can be rotated 141, which generates a vertical force on the tissue. Another advantage of the anchor on the clip set forth in the present disclosure is that such a clip can be firmly pressed against the mucosa, allowing more tissue to be inserted between the jaws and more tissue to be grasped by the clip.

[0067] In certain embodiments, the clips of the present disclosure can be disconnected from a surgical tool and clamped onto a patient's tissue. To facilitate placement of the clips adjacent to each other, the clip arms can be configured to be curved. Fig.15A and Fig. 15BAs shown in the side view of , the clip can be configured to be released from the surgical tool after the clip is attached to the patient's tissue (150a). However, due to the proximal end of the clip and any member attached to the proximal end of the clip (such as compression tube 156), the placement of the second clip (150b) is somewhat limited. In this example, the clip 150c has a first arm 152 and a second arm (not shown) and a compression tube 156, wherein the first anchor 154 is located in the first arm 152. As shown, the clip 150c includes a curved portion or member 151 along the clip. In this way, when attached to the patient's tissue, the clips having anchors and arms (150c and 150d) configured to bend can be more easily placed adjacent to each other.

[0068] Figures 16A-20D The various structural features of the clamp arm are schematically illustrated to be configured to bend. For example, Fig.16A and Fig. 16C A clip 160 is shown having a first arm 162, the first arm 162 including a highly elastic member 161. The second arm of the clip 160 also has a highly elastic member, but is not FIG. 16A to FIG. 16C 166, the clamp arm is in a straight position (L) when the clamp is loaded in the pressure tube 166, but when deployed from the pressure tube 166, the clamp arm 162 is bent as shown in the unloaded state (U). As an alternative or in addition to the elastic member, the clamp arm may have one or more springs to force the clamp arm in a bent state. When such a clamp is placed in the channel of the endoscope (165), the arm will be in a straight position, but when deployed from the channel, the arm will be bent ( Fig. 16B ).exist Fig.17A In the embodiment of the present invention, the clamp arm 172 includes a notch 171 that relieves stress when the arm is bent.

[0069] Other structures that can be used to configure the arms of the clip of the present disclosure to be curved are shown in Figures 18A-20D .exist Fig.18A and Fig.18B In the embodiment, the clamp arm 182 includes two parts (182a, 182b) hinged together by a joint 181. Figure 19A-Figure 19C The locked configuration of the arms of the clip configured to be bent is illustrated. Fig.19A A clamp arm 192 is shown, which includes two hinged parts (192a, 192b) connected by a joint 191. Part 192b can have a pin 195a that moves along a slot 195b as the arm moves toward the flexed position. The pin can pass over a protrusion 195c in the slot 195b to lock the arm in the flexed state. Figure 19B-Figure 19CA clamp arm 195 is shown comprising two hinged portions (195a, 195b) connected by a joint 191, wherein an inner portion 195a of the arm 195 has a concave surface 197a and an outer portion 195b of the arm 195 has a convex surface 197b, such that when the outer portion 195b of the arm 195 is rotated to position the arm in a bent state, the concave surface 197a fits into the convex surface 197b, as shown in a cross-sectional view of the arm 195.

[0070] Figures 20A-20D The figure shows the clamp arms hinged together by springs. Fig. 20A In the embodiment, the arm 202 includes two parts (202a, 202b) connected together by a spring 201. The clamp arm is forced to be in a bent state, so that when the clamp is loaded in the pressure tube 206, the clamp arm is in a straight position (L), but when it is deployed from the pressure tube 206, the clamp arm 202 is bent, as shown in FIG. Fig. 20B When such a clip is placed in the channel of an endoscope (205), the arms of the clip will be in a straight position, but when deployed from the channel, the arms will be bent ( Fig. 20C and Fig.20D ).

[0071] In other examples, the clamp arms may be made of a shape memory alloy, such as Nitinol, and be in a straightened or bent configuration based on stress state or temperature.

[0072] Although the claimed invention has been described in detail with reference to specific embodiments of the present invention, it will be apparent to those of ordinary skill in the art that various changes and modifications may be made to the claimed invention without departing from the spirit and scope of the present invention. Thus, for example, using only routine experiments, those skilled in the art will recognize or be able to determine many equivalents of the specific substances and processes described herein. Such equivalents are considered to be within the scope of the present invention and are covered by the attached schemes.

Claims

1. A clip, comprising: A first arm (132), the first arm comprising: a first body having a distal end; a first claw (132a) located at the distal end of the first body; and a first anchor (134a) located at the distal end of the first body; and a second arm (133), The width of the first anchor in a direction intersecting the longitudinal direction of the clip is smaller than the width of the first claw in the direction. 2 . The clip according to claim 1 , wherein a width of the first body in the direction is the same as a width of the first claw in the direction. 3 . The clip according to claim 1 , wherein a width of a distal end of the first anchor in the direction is smaller than a width of a proximal end of the first anchor in the direction.

4. The clip of claim 1, wherein a proximal end of the first jaw and a proximal end of the first anchor are aligned on a line in the direction.

5. The clip of claim 1, wherein the first distance is the same as the second distance, wherein the first distance is the distance between the proximal end of the first body and the proximal end of the first claw in the longitudinal direction, and the second distance is the distance between the proximal end of the first body and the proximal end of the first anchor in the longitudinal direction. The clamp of claim 1 , wherein the first jaw comprises a first-first jaw and a second-first jaw. 7 . The clip according to claim 6 , wherein the width of the first jaw is the sum of a width of the first-first jaw in the direction and a width of the second-first jaw in the direction.

8. The clip according to claim 6, wherein the first-first jaw is spaced apart from the second-first jaw in the direction.

9. The clip of claim 8, wherein the first anchor is located between the first-first jaw and the second-first jaw.

10. The clip of claim 9, wherein the first-first jaw is spaced apart from the first anchor in the direction.

11. The clip of claim 9, wherein a proximal end of the first-first jaw, a proximal end of the second-first jaw, and a proximal end of the first anchor are aligned on a line in the direction.

12. The clip of claim 9, wherein the first distance is the same as the second distance, wherein the first distance is the distance between the proximal end of the first body and the proximal end of the first-first claw in the longitudinal direction, and the second distance is the distance between the proximal end of the first body and the proximal end of the first anchor in the longitudinal direction.

13. The clip according to claim 9, wherein a sum of widths of the first-first claw, the second-first claw, and the first anchor in the direction is smaller than a width of the first body in the direction.

14. The clip of claim 1, wherein the first jaw is bent relative to the first body, the first anchor is bent relative to the first body, and A first angle is smaller than a second angle, wherein the first angle is defined between the first claw and the first body and the second angle is defined between the first anchor and the first body.

15. The clip of claim 14, wherein the first angle and the second angle are located on a side facing the second arm.

16. The clip of claim 14, wherein the first angle and the second angle are less than 180 degrees.

17. The clip of claim 1, wherein a gap exists between the first anchor and the first claw in a longitudinal direction of the first arm.

18. The clip of claim 1, wherein the second arm comprises: a second body having a distal end; a second claw (133a) located at the distal end of the second body; and A second anchor (134b) is located at the distal end of the second body.

19. The clip of claim 18, wherein a width of the second anchor in the direction is smaller than a width of the second jaw in the direction.

20. The clip of claim 18, further comprising a tube (166) configured to receive the first arm and the second arm, in, When the first arm and the second arm are in a closed position, a distance between a distal end of the first anchor and a distal end of the second anchor is less than a diameter (W) of the tube.

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