Adjustable endoscope traction device

Abstract

The invention aims to provide a traction device for fully exposing the submucosa so as to provide proper conditions for free movement of a dissecting device in the whole dissecting process of the tumor mucosa. The traction device (1) of the invention is characterized in that it comprises a proximal anchor (3) mounted so as to be movable relative to the elastic member (2) between a minimum proximal distance and a maximum proximal distance, and in that the traction device comprises an adjustment member (6) mounted so as to be movable relative to the elastic member (2) between a minimum proximal distance and a maximum proximal distance. The adjustment member is configured to adjust the maximum proximal distance between an initial maximum proximal distance and a final maximum proximal distance less than the initial maximum proximal distance.

Description

Technical Field

[0001] The present invention relates to the technical field of endoscopic devices, and more particularly to a traction device for biological tissues, for example, for removing superficial tumors of the digestive tract. Background Art

[0002] A known traction device is used for removing superficial tumors of the digestive tract. Such a traction device generally comprises a proximal anchor and an elastic member configured to apply a proximal traction force to the proximal anchor.

[0003] In fact, the technique used to remove superficial tumors of the digestive tract is submucosal dissection. This is a complex technique that allows the removal of superficial tumors in a minimally invasive way. Submucosal dissection consists in separating the tumor mucosa from the rest of the digestive tract wall, especially from the muscles, by using the submucosal layer as a dissection plane. This surgery is called minimally invasive surgery because it does not damage the organs and the healing time is quite short compared to traditional minimally invasive surgeries.

[0004] The traction device makes it easier to peel off the submucosa by pulling the mucosa away from the muscle to expose the submucosa. To this end, a proximal anchor is fixed to the proximal portion of the tumor mucosa by means of an endoscopic hemostatic clip, and an elastic member is fixed to the opposite wall of the digestive tract to apply traction on the proximal portion of the tumor mucosa, which enables separation of the tumor mucosa from the rest of the digestive tract wall.

[0005] However, current traction devices are not completely satisfactory. In fact, after the first part of the submucosal layer under the proximal part of the tumor mucosa is removed, the proximal part relaxes and the traction force applied by the elastic member on the proximal anchor becomes insufficient to fully expose the submucosal layer. Then, it becomes difficult to insert the dissection device and continue the dissection operation under good conditions.

[0006] In this case, an object of the present invention is to provide a traction device for fully exposing the submucosal layer, thereby providing suitable conditions for the free movement of the dissecting device during the entire resection process of the tumor mucosa. Summary of the invention

[0007] The solution of the invention is a traction device for biological tissue as defined in the attached claim 1. The invention also relates to the variants of the dependent claims. A person skilled in the art will appreciate that each feature of the dependent claims and the variants of the description can be combined independently with the above features without constituting an intermediate summary. BRIEF DESCRIPTION OF THE DRAWINGS

[0008] Other characteristics and advantages of the invention will emerge from the following description of specific embodiments of the invention, which is given as a guide and not as a limitation, with reference to the accompanying drawings, in which:

[0009]

Figure 1

[0010]

Figure 2

[0011]

Figure 3

[0012]

Figure 4

Figure 1

[0013]

Figure 5

Figure 1

[0014]

Figure 6

Figure 1

[0015]

Figure 7

[0016]

Figure 8

[0017]

Fig. 9

Figure 1

[0018]

Fig.10

Figure 1

[0019] Refer to the attached figure Figure 1 】to

Figure 8

Figure 8

[0020] The traction device (1) comprises a proximal anchor (3). It can be Figure 1 The embodiment of the proximal anchor (3) is a circular ring, a triangle, a rectangle or any shape suitable for a person skilled in the art. The ring can be rigid, flexible or elastic. For example, the ring can be made of metal, plastic, latex or any other material suitable for a person skilled in the art. The ring can also be made of a thread made of cotton, silk, polyester, nylon or any other material suitable for a person skilled in the art. Preferably, the proximal anchor (3) is made of at least one hypoallergenic material, such as polyglycolic acid, polybutylene glycol, sugar isomers, polylactide, polyglycolide, polydioxanone, polypropylene. Cleverly, the proximal anchor (3) has a surface coating made of at least one of the above-mentioned types of hypoallergenic materials. Preferably, the ring constituting the proximal anchor (3) has an opening (31) configured to allow the jaws of the endoscopic hemostatic clip (203) to move freely. In particular, the ring can have an opening (31) extending over a semicircle of 8 mm diameter. Typically, an endoscopic hemostatic clip is a clamp with jaws having two gripping surfaces. An endoscopic hemostatic clip is configured to be secured to biological tissue by clamping the biological tissue between its jaws.

[0021] The traction device (1) also includes a distal anchor (4). It can be Figure 1 The embodiment of the invention can be a circular ring, a triangle, a rectangle or any shape suitable for a person skilled in the art. The ring can be rigid, flexible or elastic. For example, the ring can be made of metal, plastic, latex or any other material suitable for a person skilled in the art. The ring can also be made of a thread made of cotton, polyester, nylon or any other material suitable for a person skilled in the art. Preferably, the distal anchor (4) is made of at least one hypoallergenic material, such as the above-mentioned materials. Ingeniously, the distal anchor (4) includes a surface coating made of at least one hypoallergenic material as described above. Preferably, the ring constituting the distal anchor (4) has an opening (41) configured to allow the jaws of the endoscopic hemostatic clip (204) to move freely. In particular, the ring can have an opening (41) extending over a semicircle of 5 mm diameter.

[0022] The traction device (1) further comprises an elastic member (2). It comprises at least one elastic portion having a length (L) and a Young's modulus (E). "At least one elastic portion" should be understood to mean that the elastic member (2) can be completely elastic or can comprise at least one elastic portion. Figure 1 】to

Figure 8

Figure 1

Figure 3

[0023] The Young's modulus (E) is less than 0.1 GPa. Advantageously, the Young's modulus (E) is between 0.001 GPa and 0.05 GPa. Preferably, the Young's modulus (E) is between 0.008 GPa and 0.03 GPa.

[0024] The elastic member (2) may have an opening configured to allow the jaws of the endoscopic hemostatic clip (202) to move freely. The passage may be an opening through the elastic member (2). In some embodiments, the passage may have the shape of a cylindrical or toric insert, or any other shape suitable to those skilled in the art. In particular, the passage may extend over a semicircle of 5 mm diameter. When the elastic portion of the elastic member (2) is annular, the opening of the ring may act as a passage.

[0025] The elastic portion is configured to exert traction on the distal anchor (4) and the proximal anchor (3) when the length (L) is extended beyond the contracted length (Lc).

[0026] The proximal anchor (3) is mounted to move relative to the elastic member (2) between a minimum proximal distance and a maximum proximal distance. The minimum proximal distance is preferably between 0 mm and 10 mm. The maximum proximal distance is preferably between 10 mm and 50 mm. Figure 1In the embodiment shown, the proximal anchor (3) can be mounted to move relative to the elastic member (2) by means of a proximal wire (32). It can be made of cotton, polyester, nylon or any other material suitable for a person skilled in the art. The length of the proximal wire can be between 10 mm and 50 mm. In some embodiments, the proximal anchor (3) can be mounted to move relative to the elastic member (2) by means of a flexible belt or a flexible rod.

[0027] The traction device (1) comprises an adjustment member (6) which is configured to adjust the maximum proximal distance between an initial maximum proximal distance and a final maximum proximal distance which is smaller than the initial maximum proximal distance.

[0028] In the attached figure [ Figure 1 In a first embodiment of the adjustment member shown in FIG. 1 , the adjustment member (6) may include a clamp (61). The latter includes a body (62) and a holder (63). The body (62) may have a cylindrical or parallelepiped-shaped profile or any other shape suitable for a person skilled in the art. The body (62) preferably has a diameter or thickness between 0.2 mm and 5 mm. The body (62) may have a length between 5 cm and 20 cm. The holder (63) is configured so that the body (62) can move freely so as to produce a closed curve with a variable length perimeter. The body (62) may include one or more visual markings, wherein each of the visual markings makes it possible to specify a length with a given perimeter when the visual markings are located at the height of the holder (63). In particular, the visual marking may be a colored line along the body (62). In one embodiment, the visual marking may be a colored area along the body (62). Preferably, the clamp (61) includes 2 to 6 visual markings. The end of the body (62) opposite to the holder (63) may include a pull ring (64). The pull ring (64) is preferably configured to allow grasping by the endoscopic surgical clamp (210). In particular, the pull ring (64) may have a diameter between 5 mm and 20 mm. The clamp (61) may be made of a plastic material, a composite material or any other material suitable for a person skilled in the art. Preferably, the clamp (61) is made of a hypoallergenic material, such as the above-mentioned materials. The clamp (61) may be cleverly made of a shape memory material, such as Nitinol.

[0029] The clamp (61) may include a non-return mechanism configured to prevent the body (62) from sliding in a direction that increases its circumference. The non-return mechanism may be of any type suitable to a person skilled in the art.

[0030] In particular, the non-return mechanism may be flexible non-return bristles or non-return strips located on the body (62) of the clamp (61) so as to:

[0031] - when the portion of the body to which the non-return bristles or the non-return strips are fixed moves in the retaining frame (63) in a direction of decreasing circumferential length, it moves closer to the body (62),

[0032] - When the portion of the body to which the non-return bristles or the non-return strips are fixed tends to move in the retaining frame in a direction of increasing circumferential length, it moves away from the body (62) and abuts against the retaining frame (63).

[0033] In one embodiment, the backstop mechanism may be a stopper positioned along the body (62) and at least one flexible band located in the holder (63), wherein the at least one band is configured to:

[0034] - when the body moves in the retaining frame (63) in a direction of decreasing circumferential length, moves away from the body (62) to allow the stopper to pass,

[0035] - when the body tends to move in the retaining frame (63) in a direction of increasing circumferential length,

[0036] Moves adjacent the body (62) to obstruct the stopper.

[0037] In other embodiments, the non-return mechanism comprises a toothed element moving in a cone formed by the retaining frame (63) such that the toothed element:

[0038] - move away from each other so that the body (62) is free to move when it moves in the holder (63) in a direction of decreasing circumferential length,

[0039] - moved closer to each other so as to exert pressure on the body (62) so that when the body tends to move in the cage in a direction of increasing circumferential length, the body cannot move freely in the cage (63).

[0040] Refer to the attached figure Figures 1 to 3 】In the embodiment picture shown in FIG. 1 , the adjusting member (6) may further include a central guide (65) located on the elastic member (2). The central guide (65) is configured to enable the main body (62) of the clamp (61) to move freely. Although some embodiments do not include the central guide, the presence of the central guide (65) improves the adjusting function of the adjusting member (6).

[0041] As shown in the attached picture Figures 1 to 3】, the center guide (65) can be a ring mounted on the elastic member (2). The center guide (65) can also be an opening passing through the elastic member (2). In some embodiments, the center guide (65) can have the shape of a cylindrical or complex curved insert or any other shape suitable for those skilled in the art. The center guide (65) can have a channel, the size of which is at least greater than 0.2 mm, preferably greater than 0.5 mm, at the diameter or thickness of the body (62) of the clamp (61).

[0042] The adjustment member (6) may further include a proximal guide (66) configured to allow the body (62) of the clamp (61) to move freely. The proximal guide (66) may be located on the proximal anchor (3). The proximal guide (66) may be of any type suitable for a person skilled in the art.

[0043] In particular, when the proximal anchor (3) is made of wire, the proximal guide (66) may have the shape of a cylindrical or toric insert, or any other shape suitable for a person skilled in the art.

[0044] Likewise, when the proximal anchor (3) is made of a rigid material, the proximal guide (66) may be made integrally with the body of the proximal anchor. Then, the proximal guide (66) may have the shape of an opening located on the body of the proximal anchor (3), or a cylindrical, annular, or any other shape protruding from the body of the proximal anchor (3) to the inside or outside of the proximal anchor.

[0045] In one particular embodiment, the opening (31) of the proximal anchor (3) serves as a proximal guide (66).

[0046] The proximal guide (66) may alternatively be located on the proximal line (32). In particular, the proximal guide (66) may be located at the end of the proximal line (32). Figure 1 】To Figure

【 Figure 8 In the embodiment shown in FIG. 1 , the proximal guide (66) can also be located between the two parts of the proximal line (32). The proximal guide (66) is advantageously located near the proximal anchor (3). The proximal guide (66) can have the shape of a cylindrical or toric insert or any other shape suitable to a person skilled in the art. When the proximal anchor (3) is a strip, the proximal guide (66) can have the shape of an eyelet.

[0047] The proximal guide (66) may have a channel having a dimension at least greater than 0.2 mm, preferably greater than 0.5 mm, in diameter or thickness of the body (62) of the clamp (61).

[0048] In this first embodiment of the adjustment member ( 6 ), the clamp ( 61 ) is then configured to reduce the maximum proximal distance as its circumference decreases.

[0049] In a second, not shown, embodiment of the adjustment member (6), it may include a proximal coil configured to wind up the proximal wire (32) when the traction force on the proximal wire is less than the restoring force. The restoring force is preferably between 0.2N and 1.8N. In one embodiment, the proximal coil includes a roller configured to receive the winding of the proximal wire (32). The proximal coil also includes a housing on which the roller is mounted so that it can rotate freely. The proximal coil ultimately includes a return spring configured to start winding the proximal wire (32) around the roller when the traction force on the proximal wire is less than the restoring force. The housing may be fixed to the elastic member (2). Ingeniously, in one embodiment, the return spring is used as the elastic member (2).

[0050] The distal anchor (4) can be mounted to move relative to the elastic member (2) between a minimum distal distance and a maximum distal distance. The minimum distal distance is preferably between 0 mm and 10 mm. The maximum distal distance is preferably between 10 mm and 50 mm. In a preferred embodiment of the distal anchor (4), the maximum distal distance does not exceed 1 / 3 of the maximum proximal distance. As shown in the accompanying drawings [ Figure 1 】to

【 Figure 8 In the embodiment shown, the distal anchor (4) can be mounted to move relative to the elastic member (2) by means of a distal wire (42). It can be made of cotton, polyester, nylon or any other material suitable for a person skilled in the art. The distal wire (42) can have a length between 10 mm and 50 mm. In some embodiments, the distal anchor (4) can be mounted to move relative to the elastic member (2) by means of a flexible belt or a flexible rod.

[0051] Then, the adjustment member (6) is capable of adjusting the maximum distal end distance between an initial maximum distal end distance and a final maximum distal end distance that is smaller than the initial maximum distal end distance.

[0052] According to a first embodiment of the adjustment member (6), it may include a distal guide (67) configured to allow the body (62) of the clamp (61) to move freely. The distal guide (67) may be located on the distal anchor (4).

[0053] The distal guide (67) may be of any type suitable to one skilled in the art.

[0054] In particular, when the distal anchor (4) is made of wire, the distal guide (67) may have the shape of a cylindrical or toric insert, or any other shape suitable to a person skilled in the art.

[0055] Likewise, when the distal anchor (4) is made of a rigid material, the distal guide (67) may be made integrally with the body of the distal anchor. Then, the distal guide (67) may have the shape of an opening located on the body of the distal anchor (4), or a cylindrical, annular, or any other shape protruding from the body of the distal anchor (4) toward the inside or outside of the distal anchor.

[0056] In one embodiment, the opening (41) of the distal anchor (4) serves as a distal guide (67).

[0057] The distal guide (67) may alternatively be located on the distal wire (42). In particular, the distal guide (67) may be located at the end of the distal wire (42). The distal guide (67) may also be located between two portions of the distal wire (42), as shown in FIG. Figure 1 】to

Figure 8

[0058] The distal guide (67) may have a channel having a dimension at least greater than 0.2 mm, preferably greater than 0.5 mm, in diameter or thickness of the body (62) of the clamp (61).

[0059] In this first embodiment of the adjustment member (6), the clamp (61) may be configured to decrease the maximum distal distance as its circumference decreases.

[0060] In a second, not shown, embodiment of the adjustment member (6), it may comprise a distal coil configured to wind up the distal wire (42) when the traction on the distal wire is less than the restoring force. The restoring force is preferably between 0.2 N and 1.8 N. In one embodiment, the distal coil comprises a drum configured to receive the winding of the distal wire (42). The distal coil further comprises a housing on which the drum is mounted so that it can rotate freely. The distal coil finally comprises a return spring configured to start winding the distal wire (42) on the drum when the traction on the distal wire is less than the restoring force. The housing may be fixed to the elastic member (2). Ingeniously, in one embodiment, the return spring is used as the elastic member (2). The elastic member (2) comprises several elastic members, namely a return spring for the proximal coil and a return spring for the distal coil. Ingeniously, the housing of the proximal coil and the housing of the distal coil constitute a single housing.

[0061] The proximal anchor (3) can be mounted to move relative to the elastic member (4) between a minimum spacing distance and a maximum spacing distance. The minimum spacing distance is preferably between 0 mm and 10 mm. The maximum spacing distance is preferably between 10 mm and 50 mm. In fact, all the embodiments described above for the distal anchor (4) and the proximal anchor (3) allow the proximal anchor (3) to move relative to the distal anchor (4).

[0062] The adjustment member (6) may then be configured to reduce the maximum separation distance between the initial maximum separation distance and a final maximum separation distance that is smaller than the initial maximum separation distance. In fact, all of the above-described embodiments for the adjustment member (6) may reduce the maximum separation distance.

[0063] As shown in the attached picture Figure 1 】to

Fig.10

[0064] In a variation of the embodiment at the cable tie, the adjustment member (6) may further include a fastening guide configured such that the body (62) of the clamp (61) can move freely so that the retaining frame (63) of the clamp is clamped between the distal guide (67) and the fastening guide.

[0065] The fastening guide may be located on the distal anchor (4). The fastening guide may be of any type suitable for a person skilled in the art.

[0066] In particular, when the distal anchor (4) is made of wire, the fastening guide may have the shape of a cylindrical or toric insert or any other shape suitable for a person skilled in the art.

[0067] Likewise, when the distal anchor (4) is made of a rigid material, the fastening guide may be made integrally with the body of the distal anchor. Then, the fastening guide may have the shape of an opening located on the body of the distal anchor (4), or a cylindrical, annular or any other shape protruding from the body of the distal anchor (4) toward the inside or outside of the distal anchor.

[0068] The fastening guide may alternatively be located on the distal wire (42). In this case, the fastening guide is advantageously located near the distal anchor (4). The fastening guide may have the shape of a cylindrical or toric insert, or any other shape suitable to a person skilled in the art. When the distal anchor (4) is a strip, the fastening guide may have the shape of an eyelet.

[0069] The fastening guide can also be located on the tensioning wire. It is fixed to the distal anchor (4). The tensioning wire can be made of cotton, polyester, nylon or any other material suitable for a person skilled in the art. The tensioning wire can have a length between 5 mm and 20 mm. In some variations of the embodiment, the tensioning wire is replaced by a flexible belt or a flexible rod. The fastening guide is advantageously located near the distal anchor (4). The fastening guide can have the shape of a cylindrical or complex curved insert, or any other shape suitable for a person skilled in the art.

[0070] The fastening guide may have a channel having a dimension at least greater than 0.2 mm, preferably greater than 0.5 mm, at the diameter or thickness of the body (62) of the clamp (61).

[0071] As shown in the attached picture Figure 2 】In the embodiment shown, the traction device (1) may include a second proximal anchor (3') of the same type as the above-mentioned proximal anchor (3). This means that the second proximal anchor (3') has the same characteristics as the above-mentioned proximal anchor (3), especially in terms of shape, material, mobility, distance to other objects, etc. In particular, the second proximal anchor (3') may include an opening (31') and be installed so that it can move freely relative to the elastic member with the help of a second proximal line (32'). As mentioned above, the elastic part of the elastic member (2) is configured to exert a traction force on the second proximal anchor (3') when its length (L) extends beyond the contraction length (Lc). In addition, the second proximal anchor (3') can be installed to move between a minimum frontal distance and a maximum frontal distance relative to the aforementioned proximal anchor (3).

[0072] Likewise, the adjustment member (6) can be configured to adjust the second maximum proximal distance between a second initial maximum proximal distance and a second final maximum proximal distance that is less than the second initial maximum proximal distance. To this end, the adjustment member (6) can include a second proximal guide (66') or a second proximal coil, depending on the selected embodiment. The adjustment member (6) can also be configured to adjust the maximum frontal distance between the initial maximum frontal distance and a final maximum frontal distance that is less than the initial maximum frontal distance.

[0073] Refer to the attached figure Figure 2 】In the embodiment shown in the figure, the adjusting member (6) may further include a second central guide (65') located on the elastic member (2). The second central guide (65') is of the same type as the central guide (65). This means that the second central guide (65') has the same features as the central guide (65), particularly in terms of shape, material, position relative to the elastic member (2), etc. To this end, the second central guide (65') is configured so that the body (62) of the clamp (61) can move freely. Advantageously, the body (62) of the clamp (61) moves through the distal guide (67), then through the central guide (65), then through the proximal guide (66), then through the second proximal guide (66'), and then through the second central guide (65'). Alternatively, as shown in the accompanying drawing [ Figure 2 】As shown, the body (62) of the clamp (61) moves through the distal guide (67), then through the second central guide (65'), then through the second proximal guide (66'), then through the proximal guide (66), and then through the central guide (65).

[0074] As shown in the attached picture Figure 3 In the embodiment shown in FIG. 1 , the traction device (1) may further include one or more lateral anchors (5, 5'). Preferably, the traction device (1) includes an even number of lateral anchors (5, 5'). For each pair of lateral anchors (5, 5'), one lateral anchor (5, 5') is located on one side of the traction device (1), and the other lateral anchor is located on the other side of the traction device.

[0075] The lateral anchor (5, 5') can be a circular ring, a triangle, a rectangle or any shape suitable for a person skilled in the art. The ring can be rigid, flexible or elastic. For example, the ring can be made of metal, plastic, latex or any other material suitable for a person skilled in the art. The ring can also be made of a thread made of cotton, polyester, nylon or any other material suitable for a person skilled in the art. Preferably, the lateral anchor (5, 5') is made of at least one hypoallergenic material as described above. Ingeniously, the lateral anchor (5, 5') includes a hypoallergenic coating made of at least one hypoallergenic material as described above. Preferably, the ring has an opening (51, 51') configured to allow the jaws of the endoscopic hemostatic clip to move freely. In particular, the ring can have an opening (51, 51') extending over a semicircle of 8 mm diameter.

[0076] The resilient portion of the resilient member (2) may then be configured to exert a traction force on the lateral anchors (5, 5') when its length (L) is extended beyond the retracted length (Lc).

[0077] The lateral anchor (5, 5') can be mounted to move between a minimum lateral distance and a maximum lateral distance relative to the elastic member (2). The minimum lateral distance is preferably between 0mm and 10mm. The maximum lateral distance is preferably between 10mm and 50mm. The lateral anchor (5, 5') can be mounted to move relative to the elastic member (2) by means of a lateral line (52, 52'). It can be made of cotton, polyester, nylon or any other material suitable for those skilled in the art. The lateral line (52, 52') can have a length between 10mm and 50mm. In some variations of the embodiment, the lateral anchor (5, 5') can be mounted to move relative to the elastic member (2) by means of a flexible belt or a flexible rod.

[0078] The adjustment member (6) may be configured to adjust the maximum lateral distance between an initial maximum lateral distance and a final maximum lateral distance that is smaller than the initial maximum lateral distance.

[0079] In its first embodiment, the adjustment member (6) may then comprise, for each lateral anchor (5, 5'), a lateral guide (68, 68') configured so that the body (62) of the clamp (61) can move freely. The lateral guide (68, 68') may be located on the lateral anchor (5, 5'). The lateral guide may be of any type suitable for a person skilled in the art.

[0080] In particular, when the lateral anchors (5, 5') are made of wire, the lateral guides (68, 68') may have the shape of a cylindrical or toric insert or any other shape suitable to a person skilled in the art.

[0081] Likewise, when the lateral anchor (5, 5') is made of a rigid material, the lateral guide (68, 68') can be made integrally with the body of the lateral anchor. Then, the lateral guide (68, 68') can have the shape of an opening located on the body of the lateral anchor (5, 5'), or a cylindrical, annular or any other shape protruding from the body of the lateral anchor (5, 5') toward the inside or outside of the lateral anchor.

[0082] In a particular embodiment, the openings (51, 51') of the lateral anchors (5, 5') serve as lateral guides (68, 68').

[0083] The lateral guide (68, 68') may alternatively be located on the lateral line (52, 52'). In particular, the lateral guide (68, 68') may be located at the end of the lateral line (52, 52'). The lateral guide (68, 68') may also be located between two portions of the lateral line (52, 52'), as shown in FIG. Figure 3 】The embodiment shown. In this case, the lateral guides (68, 68') are advantageously located near the lateral anchors (5, 5'). The lateral guides (68, 68') can have the shape of a cylindrical or toric insert or any other shape suitable for a person skilled in the art. When the lateral anchors (5, 5') are strips, the lateral guides (68, 68') can have the shape of an eyelet.

[0084] The lateral guides (68, 68') may have a channel whose dimensions are at least greater than 0.2 mm, preferably greater than 0.5 mm, at the diameter or thickness of the body (62) of the clamp (61).

[0085] Refer to the attached figure Figure 3 】, the adjusting member (6) may further include a second central guide (65') located on the elastic member (2). The second central guide (65') is of the same type as the central guide (65). This means that the second central guide (65') has the same features as the above-mentioned central guide (65), especially in terms of shape, material, position relative to the elastic member (2), etc. To this end, the second central guide (65') is configured so that the main body (62) of the clamp (61) can move freely. Advantageously, as shown in the accompanying drawings [ Figure 3】, the main body (62) of the clamp (61) moves through the distal guide (67), then through the central guide (65), then through the first lateral guide (68), through the proximal guide (66), then through the second lateral guide (68'), and then through the second central guide (65'). Alternatively, the main body (62) of the clamp (61) moves through the distal guide (67), then through the second central guide (65'), then through the second lateral guide (66'), then through the proximal guide (66), then through the first lateral guide (66), and then through the central guide (65).

[0086] In this first embodiment of the adjustment member ( 6 ), the clamp ( 61 ) is then configured to reduce the maximum lateral distance when its circumference decreases.

[0087] In a second embodiment of the adjustment member (6), it may include a lateral coil configured to roll up the lateral wire (52, 52') when the traction force on the lateral wire is less than the restoring force. The restoring force is preferably between 0.2N and 1.8N. In one embodiment, the lateral coil includes a roller configured to receive the winding of the lateral wire (52, 52'). The lateral coil also includes a housing on which the roller is mounted so as to be freely rotatable. The lateral coil finally includes a return spring configured to start winding the lateral wire (52, 52') on the roller when the traction force on the lateral wire is less than the restoring force. The housing can be fixed to the elastic member (2). Ingeniously, in one embodiment, the return spring is used as the elastic member (2). The elastic member includes several elastic members, namely a return spring for the proximal coil, a return spring for the distal coil and a return spring for the lateral coil. Ingeniously, the housing of the proximal coil, the housing of the distal coil and the housing of the lateral coil constitute a single housing.

[0088] The lateral anchors (5, 5') may be mounted to move relative to the distal anchor (4) and / or the proximal anchor (3) between a minimum lateral separation distance and a maximum lateral separation distance. The minimum lateral separation distance is preferably between 0 mm and 10 mm. The maximum lateral separation distance is preferably between 10 mm and 50 mm. In fact, all the embodiments described above for the distal anchor (4), the proximal anchor (3) and the lateral anchors (5, 5') allow the anchors to move relative to each other.

[0089] The adjustment member (6) may then be configured to reduce the maximum separation distance between the initial maximum lateral separation distance and a final maximum lateral separation distance that is less than the initial maximum lateral separation distance. In fact, all of the above embodiments for the adjustment member (6) may reduce the maximum lateral separation distance.

[0090] Another aspect of the invention relates to a process for pulling biological tissue (101) in a cavity by means of a pulling device (1) according to the invention. The process is usually involved in the resection of biological tissue (101) of the mucosal type and is characterized by a tumor (102). The biological tissue (101) is usually located in the wall of the digestive tract (100). In the process, with the help of an endoscopic dissection device, the edge of the biological tissue (101) to be removed is removed. Figure 4 】 shows biological tissue (101) after its edge (103) has been cut off. The biological tissue (101) must then be separated from the rest of the wall of the digestive tract (100). To this end, it is necessary to exert traction on the biological tissue (101) in order to remove it from the rest of the wall of the digestive tract (100). The submucosal layer (104) made of fibers will be stretched and exposed so that it can be dissected with an endoscopic dissection device (220). The traction process makes it possible to exert traction on the biological tissue (101). The traction process comprises the following steps:

[0091] a) fixing the proximal anchor (3) to the proximal portion of the biological tissue (101) by means of a first endoscopic hemostatic clip (203),

[0092] b) fixing the distal anchor (4) to the distal portion of the biological tissue (101) by means of a second endoscopic hemostatic clip (204),

[0093] c) fixing the elastic member (2) to the cavity wall (105) in front of the biological tissue (101) by means of a third endoscopic hemostatic clip (202), so that the elastic part of the elastic member (2) extends beyond the contraction length (Lc), and exerts traction on the distal anchor (4) and the proximal anchor (3).

[0094] When the biological tissue (101) has a proximal region greater than 3 cm wide, the traction process may further include the following steps:

[0095] d) fixing a second proximal anchor (3') remote from the proximal anchor (3) fixed in step a) to the proximal portion of the biological tissue (101) by means of another endoscopic hemostatic clip.

[0096] When the biological tissue (101) extends beyond a length of 8 cm and a width of 5 cm, the traction process may still include at least one of the following steps, depending on the number of lateral anchors in the traction device:

[0097] e) Fixing the lateral anchor (5, 5') to the side of the biological tissue (101) by means of another endoscopic hemostatic clip.

[0098] Once the first step of the traction process is implemented, as shown in the attached figure [ Figure 5】, the submucosal layer (104) of the biological tissue (101) is sufficiently exposed. Then, the proximal portion of the submucosal layer (104) is dissected with the aid of the dissecting device (220). However, as shown in the accompanying drawing [ Figure 6 】As shown in FIG. 1 , once the proximal portion of the submucosal layer (104) is dissected, the proximal portion of the biological tissue (101) is no longer constrained by the submucosal layer (104) and relaxes, so that the traction force applied to the biological tissue is no longer sufficient to expose the submucosal layer and allow the dissecting device (220) to pass through.

[0099] To solve this problem, the traction process also includes the following steps:

[0100] d) When the traction force applied to the proximal anchor (3) is below a threshold value (Ts), the maximum proximal distance is reduced by means of the adjustment member (6).

[0101] Depending on the embodiment selected for the traction device (1), the process may also include the following steps independently or in combination:

[0102] e) when the traction force applied to the distal anchor (4) is below a threshold value (Ts), reducing the maximum distal distance by means of the adjustment member (6),

[0103] f) reducing the second maximum proximal distance by means of the adjustment member (6) when the traction force exerted on the second proximal anchor (3') is below a threshold value (Ts).

[0104] g) reducing the maximum lateral distance by means of the adjustment member (6) when the traction force applied to the lateral anchors (5, 5') is below a threshold value (Ts),

[0105] e) when the traction force applied to the proximal anchor (3) and / or the distal anchor (4) is below a threshold value (Ts), reducing the maximum separation distance by means of the adjustment member (6),

[0106] f) reducing the maximum separation distance by means of the adjustment member (6) when the traction force applied to the proximal anchor (3) and / or the distal anchor (4) and / or one of the lateral anchors (5, 5') is below a threshold value (Ts),

[0107] In practice, the threshold value (Ts) is the position at which it is no longer possible to move the dissecting device (220) without contacting the biological tissue (101). The threshold value (Ts) is typically between 0.2N and 1.8N.

[0108] Refer to the attached figure Figure 7 】, the maximum proximal distance is reduced by traction on the body (62) of the clamp (61), so that the circumferential length of the clamp is reduced. The traction is achieved with the aid of / through the clamp (210) for endoscopic surgery.

[0109] Therefore, as shown in the attached figure [ Figure 7 】, once the maximum proximal distance is reduced, the traction force applied to the biological tissue (101) is sufficient to expose the submucosal layer (104) again and allow the dissection device (220) to pass through. The exposed portion of the submucosal layer (104) is then dissected. As previously described, after the dissection, the biological tissue (101) relaxes and the traction force is no longer sufficient for dissection. Then, according to the accompanying drawing [ Figure 8 】, repeat step d) as many times as needed.

[0110] Another aspect of the invention relates to a release device (300) for the traction device (1) of the invention. The release device (300) cleverly makes it possible to place the traction device (1) on biological tissue (101) for traction while avoiding the risk of disturbing the wall of the digestive tract (100) and thus avoiding the risk of entanglement of the various movable anchors.

[0111] Refer to the attached figure Fig. 9 】and

Fig.10

[0112] As shown in the attached picture Fig.10 】, the release device (300) further comprises a piston (303) which is configured to slide through the interior of the tube (301) to push the traction device (1) out of the tube. The piston (303) can be operated mechanically or by pressure differential. The piston (303) can be made of plastic, metal or any other material suitable for a person skilled in the art.

Claims

1. A traction device (1) for biological tissue, comprising: - a proximal anchor (3), - a distal anchor (4), - an elastic member (2) comprising at least one elastic portion having a length (L) and a Young's modulus (E) less than 0.1 GPa, the elastic member being configured to exert a traction force on the distal anchor (4) and the proximal anchor (3) when the length (L) is extended beyond a contracted length (Lc), It is characterized in that The proximal length (3) is mounted to move relative to the elastic member (2) between a minimum proximal distance and a maximum proximal distance, and the traction device includes an adjustment member (6) configured to adjust the maximum proximal distance between an initial maximum proximal distance and a final maximum proximal distance that is less than the initial maximum proximal distance.

2. The traction device according to claim 1, characterized in that: The distal anchor (4) is mounted to move relative to the elastic member (2) between a minimum distal distance and a maximum distal distance, and the adjustment member (6) is configured to adjust the maximum distal distance between an initial maximum distal distance and a final maximum distal distance that is less than the initial maximum distal distance.

3. A traction device according to any one of the preceding claims, characterized in that The proximal anchor (3) is mounted to move relative to the distal anchor (4) between a minimum separation distance and a maximum separation distance, and the adjustment member (6) is configured to reduce the maximum separation distance between an initial maximum separation distance and a final maximum separation distance that is less than the initial maximum separation distance.

4. Traction device according to one of the preceding claims, characterized in that The elastic portion of the elastic member (2) has a Young's modulus between 0.001 GPa and 0.05 GPa.

5. A traction device according to any one of the preceding claims, characterised in that The proximal anchor (3) is mounted to move relative to the elastic member (2) by means of a proximal wire (32).

6. The traction device according to claim 5, characterized in that: The regulating member (6) comprises: - a fixture (61) comprising a body (62) and a holder (63), the holder (63) being configured to enable the body to move freely in order to produce a closed curve with a variable length perimeter, - a central guide (65) placed together on the elastic member (2) and configured to enable the body (62) of the clamp (61) to move freely, a proximal guide (66) placed together on the proximal anchor (3) or the proximal wire (32) and configured to enable the body (62) of the clamp (61) to move freely, - the clamp (61) is configured to reduce the maximum proximal distance as its circumferential length decreases.

7. Traction device according to one of the preceding claims, characterized in that The distal anchor (4) is mounted to move relative to the elastic member (2) by means of a distal wire (42).

8. The traction device according to claim 7, in combination with claim 6, characterized in that: The adjustment member (6) includes a distal guide (67) which is placed together with the distal anchor (4) or the distal wire (42) and is configured to enable the body (62) of the clamp (61) to move freely, and the clamp is configured to reduce the maximum distal distance when its circumferential length decreases.

9. The traction device according to claim 8, characterized in that: The adjustment member (6) comprises a cable tie (70) configured to hold the retaining frame (63) at a given tightening distance from the distal anchor (4).

10. The traction device according to any one of claims 6 to 9, characterized in that The clamp (61) includes a non-return mechanism configured to prevent the main body (62) from sliding in a direction that increases its circumferential length.

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