Clamp system

Abstract

Provided is a jig system which is most suitable for the treatment of suturing and tightening a biological tissue. The jig system includes: a jig unit having a first arm and a second arm that can be opened and closed; a wire capable of operating the opening and closing of the jig; and a sheath through which the wire can pass, and the jig unit has a support part that swingably supports the first arm and the second arm.

Description

[0001] This application is a divisional application of application No. 202310059762.8, filed on January 17, 2023, with the title of "JIG SYSTEM". TECHNICAL FIELD

[0002] This application claims the benefit of U.S. Provisional Application No. 63 / 301,121, filed on January 20, 2022, the disclosure of which is incorporated by reference herein in its entirety.

[0003] The present invention relates to a jig system. BACKGROUND

[0004] Medical instruments such as a jig unit that treats biological tissue are used in a treatment process using an endoscope. These medical instruments are introduced to a treatment site using an introduction device that can pass through a channel of an endoscope.

[0005] A treatment instrument that punctures biological tissue is described in Patent Literature 1. The treatment instrument described in Patent Literature 1 can be left in the body in a state of puncturing biological tissue.

[0006] Prior art documents

[0007] Patent documents

[0008] Patent Literature 1: Japanese Patent Application Publication No. 9-38093 SUMMARY

[0009] PROBLEMS TO BE SOLVED BY THE INVENTION

[0010] However, the treatment instrument described in Patent Literature 1 can not be the most suitable treatment instrument for performing a treatment such as suturing and tightening a resected portion or a defect portion of tissue.

[0011] In view of the above circumstances, an object of the present invention is to provide a jig system that is most suitable for a treatment of suturing and tightening biological tissue.

[0012] MEANS FOR SOLVING THE PROBLEMS

[0013] To solve the above problems, the present invention proposes the following means.

[0014] The jig system according to the first aspect of the present invention includes: a jig unit having a first arm and a second arm that can be opened and closed; a wire that can operate the opening and closing of the jig; and a sheath that can be passed through by the wire, the jig unit having a support portion that supports the first arm and the second arm in a swingable manner.

[0015] EFFECTS OF THE INVENTION

[0016] The jig system of the present application can appropriately perform, for example, a treatment of suturing and tightening a resected portion, a defect portion. BRIEF DESCRIPTION OF DRAWINGS

[0017] Figure 1 is a perspective view of a supply device.

[0018] Figure 2 is a perspective view of a jig unit of a first embodiment.

[0019] Figure 3 is a perspective view of the jig unit with a pair of arms swung.

[0020] Figure 4 is a perspective view of the jig unit loaded in the supply device.

[0021] Figure 5 is a diagram showing a defect portion formed in a living tissue in a body.

[0022] Figure 6 is a sectional view of a suturing and tightening direction of the defect portion.

[0023] Figure 7 is a diagram showing the jig unit performing a treatment of the defect portion by a front approach.

[0024] Figure 8 is a diagram showing the jig unit performing a treatment of the defect portion by a tangential approach.

[0025] Figure 9 is a diagram showing the jig unit with a pair of arms swung.

[0026] Figure 10 is a diagram showing a traction step performed with the jig unit.

[0027] Figure 11 is a diagram showing a separation step performed with the jig unit.

[0028] Figure 12 is a diagram showing a modification example of a sheath of the supply device.

[0029] Figure 13 is a diagram showing an action of the modification example of the sheath.

[0030] Figure 14 is a diagram showing an action of the modification example of the sheath.

[0031] Figure 15 is a diagram showing an approach step performed using the modification example of the sheath.

[0032] Figure 16 is a perspective view of a jig unit of a second embodiment.

[0033] Figure 17 is a side view of the tissue gripping portion of the clip unit.

[0034] Figure 18 is a perspective view of a pair of arms gripping the first and second mucosa.

[0035] Figure 19 is a side view of a pair of arms gripping the first and second mucosa.

[0036] Figure 20 is a diagram showing the pulling step performed by the clip unit.

[0037] Figure 21 is a perspective view of the clip unit of the third embodiment.

[0038] Figure 22 is a side view of the tissue gripping portion of the clip unit.

[0039] Figure 23 is a perspective view of a pair of arms gripping the first and second mucosa.

[0040] Figure 24 is a perspective view of the clip unit of the fourth embodiment.

[0041] Figure 25 is a diagram showing the supply loaded with the clip unit.

[0042] Figure 26 is a diagram showing the first gripping step performed by the clip unit.

[0043] Figure 27 is a diagram showing the first gripping step performed by the clip unit.

[0044] Figure 28 is a diagram showing the second gripping step performed by the clip unit.

[0045] Figure 29 is a diagram showing the separation step performed by the clip unit.

[0046] Figure 30 is a perspective view of the clip unit of the fifth embodiment.

[0047] Figure 31 is a diagram showing the first gripping step performed by the clip unit.

[0048] Figure 32 is a diagram showing the second gripping step performed by the clip unit.

[0049] Figure 33 is a diagram showing the separation step performed by the clip unit.

[0050] Figure 34 is a diagram showing another aspect of the first gripping step and the second gripping step using the jig unit.

[0051] Figure 35 is a perspective view of the jig unit of the sixth embodiment.

[0052] Figure 36 is a diagram showing the first gripping step using the jig unit.

[0053] Figure 37 is a diagram showing the second gripping step using the jig unit.

[0054] Figure 38 is a diagram showing the pulling step using the jig unit.

[0055] Figure 39 is a diagram showing the separating step using the jig unit.

[0056] Figure 40 is a perspective view of the jig unit of the seventh embodiment.

[0057] Figure 41 is a diagram showing the first gripping step using the jig unit.

[0058] Figure 42 is a diagram showing the first separating step using the jig unit.

[0059] Figure 43 is a diagram showing the joining step using the jig unit.

[0060] Figure 44 is a diagram showing the second gripping step using the jig unit.

[0061] Figure 45 is a diagram showing the second separating step using the jig unit.

[0062] Figure 46 is a diagram showing the jig unit and the feeder of the eighth embodiment.

[0063] Figure 47 is a diagram showing the movement of the first arm and the second arm of the jig unit.

[0064] Figure 48 is a diagram showing the approaching step using the jig unit.

[0065] Figure 49 is a diagram showing the gripping step using the jig unit.

[0066] Figure 50is a view showing a gripping step using the jig unit.

[0067] Figure 51 is a view showing a pulling step using the jig unit.

[0068] Figure 52 is a view showing a front surface approach using the jig unit.

[0069] Figure 53 is a view showing a tangential approach using the jig unit.

[0070] BRIEF DESCRIPTION OF DRAWINGS

[0071] 300, 300B, 300C, 300D, 300E, 300F, 300G, 300H, jig system (jig device, endoscope suture tightening device); 100, 100B, 100C, 100D, 100E, 100F, 100G, 100H, jig unit; 2, 2B, 2C, 2D, 2E, 2F, 2G, jig (jig arm); 21, 21B, 21C, 21D, 21E, 21F, 21G, pair of arms; 211, 211B, 211C, 211D, 211E, 211F, 211G, 211H, first arm; 212, 212B, 212C, 212D, 212E, 212F, 212H, second arm; 22, 22B, 22C, 22F, tissue gripping portion; 23, 23D, 23F, gripping portion; 24, 24B, claw; 25, connecting portion; 26a, front end portion (anchor); 26b, first anchor; 26c, second anchor; 27, connecting ring; 28, support portion; 3, pressing tube (tubular member); 4, connecting member; 41, insertion portion; 42, connecting portion; 43, connecting portion main body; 44, elastic arm portion; 200, 200D, 200H, feeder (jig unit introduction device); 220, 220A, sheath; 221, tip head; 222, tip side coil; 224, hand side coil; 225, restriction portion; 230, operation wire (power transmission member); 231, arrow hook portion (connection portion); 232, wire; 240, 240D, operation portion; 241, operation portion main body; 242, 242D, slider; 242H, first slider; 243H, second slider; 247, connector. DETAILED DESCRIPTION

[0072] (First Embodiment)

[0073] REFERENCE Figures 1-12 The first embodiment of the present application will be described.

[0074] The clip system (clip device, endoscope suture tightening device) 300 of the present embodiment includes the clip unit 100 and the feeder 200. The clip unit 100 is introduced to a treatment position while being loaded to the feeder 200 that can pass through a channel of an endoscope.

[0075] [Feeder 200]

[0076] Figure 1 is a perspective view of the feeder 200.

[0077] The feeder (clip unit introduction device) 200 includes a sheath 220, an operation wire 230, and an operation portion 240. The feeder 200 is used in combination with an endoscope, for example, by passing through a treatment instrument passage of the endoscope. Therefore, the sheath 220 is formed to be long enough compared to the length of the treatment instrument passage of the endoscope. The sheath 220 has flexibility and is bent in cooperation with the bending of the insertion portion of the endoscope.

[0078] The sheath 220 includes a tip 221, a tip-side coil 222, and a hand-side coil 224 and is formed as a whole in an elongated tubular shape. The tip-side coil 222 is disposed on the tip portion side of the sheath 220. The tip 221 is disposed on the tip portion of the tip-side coil 222.

[0079] As shown in Figure 1 , the operation wire (power transmission member) 230 includes an arrow hook portion (connection portion) 231 connected to the clip unit 100 and a wire 232 that operates the arrow hook portion 231.

[0080] The arrow hook portion 231 includes a substantially conical engagement portion 231a that engages with the clip unit 100 and a wire connection portion 231b provided on the base end of the engagement portion 231a. The arrow hook portion 231 is formed of a metal material such as stainless steel material, for example.

[0081] The wire 232 is passed through in a manner that is able to advance and retreat with respect to the sheath 220. The tip portion of the wire 232 is fixed to the base end of the wire connection portion 231b by welding, for example.

[0082] As shown in Figure 1 , the operation portion 240 includes an operation portion main body 241, a slider 242, and a thumb ring 248. The operation portion main body 241, the slider 242, and the thumb ring 248 are injection molded from a resin material, for example. The operation portion main body 241 includes a slit portion 241a and a rotation knob 241b on the tip side. The slit portion 241a supports the slider 242 so as to be able to advance and retreat.

[0083] The slider 242 is installed so as to be able to advance and retreat along the length axis direction of the operation section body 241, and the base end of the wire 232 is installed. By advancing and retreating the slider 242 along the operation section body 241, the wire 232 advances and retreats with respect to the sheath 220, and the arrow hook portion 231 advances and retreats.

[0084] The thumb ring 248 is installed to the base end of the operation section body 241 so as to be able to rotate around the length axis of the operation section body 241.

[0085] [Clamp unit 100]

[0086] Figure 2 is a perspective view of the clamp unit 100 of the present embodiment.

[0087] The clamp unit 100 includes a clamp 2, a pressing tube 3, and a link member 4. In the following description, the clamp 2 side in the length direction A of the clamp unit 100 is set as the front end side (distal side) Al of the clamp unit 100, and the link member 4 side is set as the base end side (proximal side) A2 of the clamp unit 100.

[0088] The clamp (clamp arm) 2 has a pair of arms 21 that can be opened and closed toward the front end side Al, and a support portion 28 that supports the pair of arms 21 so as to be able to rotate. The support portion 28 is installed to the front end of the link member 4.

[0089] The pair of arms 21 has a first arm 211 and a second arm 212. The first arm 211 and the second arm 212 are disposed on both sides across the center axis O1 of the length direction A of the clamp unit 100. The following position of the pair of arms 21 is set as the "initial position" of the pair of arms 21, that is, the first arm 211 and the second arm 212 are disposed at positions symmetrical with respect to the center axis O1. In addition, the clamp 2 can have three or more arms.

[0090] The first arm 211 and the second arm 212 are formed in a plate shape, and the plate thickness direction of the first arm 211 and the second arm 212 is substantially coincident with the opening and closing direction P of the first arm 211 and the second arm 212.

[0091] The first arm 211 and the second arm 212 have a tissue holding portion 22, a flat plate-shaped holding portion 23, and a link portion 25 linked to the support portion 28, from the front end side Al toward the base end side A2. The tissue holding portion 22 is formed by bending the front end of the first arm 211 and the second arm 212 toward the inside. A claw 24 toward the inside is formed at the front end of the first arm 211 and the second arm 212.

[0092] Figure 3 is a perspective view of the clamp unit 100 in which the pair of arms 21 is swung.

[0093] The support portion 28 supports the pair of arms 21 so as to be able to pivot and be able to swing (be able to pivot) about a rotation axis RO in a direction that is substantially perpendicular to the length direction A. The swinging direction (rotation direction) Q of the pair of arms 21 about the rotation axis RO is substantially in line with the opening / closing direction P of the pair of arms 21. That is, the direction in which the pair of arms 21 swings and the direction in which the pair of arms 21 opens / closes are in the same plane. Note that the rotation axis RO is not limited to an axis in a direction that is substantially perpendicular to the length direction A, and can be an axis in a direction that intersects the length direction A.

[0094] The support portion 28 causes the pair of arms 21 to swing when at least one of the first arm 211 and the second arm 212 comes into contact with the biological tissue, when a force of a predetermined level or greater is applied to at least one of the first arm 211 and the second arm 212, and so on. In other cases, the support portion 28 does not cause the pair of arms 21 to swing.

[0095] The pressing tube (tubular member) 3 is a circular tubular member that is able to accommodate at least a portion of the clip 2. The pressing tube 3 has an internal space 38 in which the clip 2 is able to advance and retreat in the length direction A. The pressing tube 3 is able to fix the clip 2 that has been pulled into the internal space 38 in a closed state.

[0096] Figure 4 is a perspective view of the clip unit 100 that is loaded into the feeder 200.

[0097] The connecting member 4 includes an insertion portion 41 that is inserted into the internal space 38 of the pressing tube 3, and a connecting portion 42 that is provided at the base end of the insertion portion 41. The insertion portion 41 is attached to the support portion 28 of the clip 2. The connecting portion 42 is connected to the arrow hook portion 231 that is inserted through the sheath 220 in a detachable manner.

[0098] The insertion portion 41 is formed in a substantially cylindrical rod shape. The insertion portion 41 has a breaking portion that breaks or deforms when a predetermined breaking force is applied. By breaking or deforming the breaking portion, the pair of arms 21 and the connecting portion 42 are separated.

[0099] The connecting portion 42 is an engagement portion that is engaged (connected) by the arrow hook portion 231 of the feeder 200. The connecting portion 42 has a connecting portion main body 43 and an elastic arm portion 44.

[0100] The elastic arm portion 44 is provided at the base end of the connecting portion main body 43, and is bifurcated. The elastic arm portion 44 is able to elastically deform with respect to the connecting portion main body 43, and is able to open and close with respect to the connecting portion main body 43. The elastic arm portion 44 has a notch portion 44m that holds and accommodates the engagement portion 231a of the arrow hook portion 231. The notch portion 44m is formed in a shape that fits the outer circumferential surface of the engagement portion 231a of the arrow hook portion 231.

[0101] [Stapling treatment using the clip unit 100]

[0102] Next, a stapling treatment using the clip unit 100 is described. Specifically, a treatment of stapling and tightening the defect D formed by a living body tissue in a body is described. Figure 5

[0103] Figure 6 is a cross-sectional view of the stapling and tightening direction S of the defect D.

[0104] The surgical operator brings the endoscope close to the defect D. The surgical operator observes the defect D and determines the stapling and tightening direction S of the defect D in accordance with the size and shape of the defect D. In the following description, the mucosa surrounding the edge of the defect D and the mucosa oppositely arranged in the stapling and tightening direction S across the defect D are referred to as "first mucosa Ml" and "second mucosa M2".

[0105] <Approach Step>

[0106] The surgical operator introduces the clip unit 100 loaded in the feeder 200 into the body via the channel of the endoscope. The surgical operator moves the endoscope, the sheath 220, and brings the clip 2 of the clip unit 100 close to the defect D as a treatment area.

[0107] There are at least a frontal approach API and a tangential approach AP2 in the method of bringing the clip unit 100 close to the treatment area. In the frontal approach API, the surgical operator operates the endoscope, the sheath 220, and thereby arranges the clip unit 100 in a manner that the length direction A of the clip unit 100 is substantially perpendicular to the surface of the treatment area. In the tangential approach AP2, the surgical operator operates the endoscope, the sheath 220, and thereby arranges the clip unit 100 in a manner that the length direction A of the clip unit 100 is along the surface of the treatment area.

[0108] <Frontal Approach API>

[0109] Figure 7 is a view of the clip unit 100 that indicates a treatment of the defect D by the frontal approach API. The surgical operator brings the clip unit 100 close to the defect D as a treatment area by the frontal approach API. The pair of arms 21 is arranged at the initial position. The pair of arms 21 is arranged opposite to the front of the defect D as a treatment area. The first mucosa Ml and the second mucosa M2 are held by the pair of arms 21.

[0110] <Tangential Approach AP2>

[0111] Figure 8 ​is a view showing the clip unit 100 approaching the defect D by tangential approach AP2. The operator approaches the clip unit 100 by tangential approach AP2 to the defect D as a treatment area. The pair of arms 21 is disposed at the initial position. The operator hooks the tissue holding portion 22 of the first arm 211 to the mucosa (in this case, the first mucosa Ml) on the endoscope side (proximal side) among the first and second mucosae Ml, M2. Figure 8

[0112] Figure 9 is a view showing the clip unit 100 in which the pair of arms 21 has been swung. The operator brings the clip unit 100 in which the tissue holding portion 22 is hooked to the first mucosa Ml closer to the defect D as a treatment area. Specifically, the operator advances the feeder 200 with respect to the treatment instrument channel of the endoscope. Alternatively, the operator brings the clip unit 100 closer to the defect D by advancing the endoscope. As a result, as shown in Figure 9 , the pair of arms 21 swings (SW) about the rotation axis RO, and the second arm 212 comes into contact with the second mucosa M2. Specifically, the support portion 28 swings the first arm 211 toward the sheath 220. In addition, the support portion 28 swings the second arm 212 away from the sheath 220. As a result, the pair of arms 21 is disposed opposite the front surface of the defect D as a treatment area. The first and second mucosae Ml, M2 are held by the pair of arms 21.

[0113] <Tract Step>

[0114] Figure 10 is a view showing the tract step by the clip unit 100.

[0115] The operator retracts the arrow hook portion 231 by retracting the slide 242 along the operation portion main body 241. The link member 4 linked to the arrow hook portion 231 tracts the clip 2. The clip 2 tracted by the link member 4 is drawn into the press pipe 3. When the clip 2 is drawn into the press pipe 3 to a predetermined position, the clip 2 is restricted from moving toward the distal end side Al with respect to the press pipe 3, and the pair of arms 21 is locked in the closed state. When the pair of arms 21 is locked in the closed state, the pair of arms 21 does not return to the open state.

[0116] In addition, Figure 10 the feeder 200 is disposed so that the feeder 200 is substantially perpendicular to the surface of the treatment area by frontal approach API. In the case where the feeder 200 is disposed by tangential approach AP2, the feeder 200 is disposed so as to follow the surface of the treatment area.

[0117] <Separation Step>

[0118] ​Figure 11 is a view showing a separation step by the clip unit 100.

[0119] The surgical operator further pulls the clip 2. A breaking force due to the pulling is applied to the broken portion of the insertion portion 41 of the link member 4, and the broken portion breaks. As a result, the pair of arms 21 and the link portion 42 are separated. The surgical operator retracts the sheath 220, and leaves the clip 2 and the pressure tube 3 in the state in which the first mucosa Ml and the second mucosa M2 are ligated in the body.

[0120] The clip unit 100 according to the present embodiment can appropriately perform the treatment of suturing and tightening the defect D. Even in the case where the defect D is treated by approaching the AP2 by the tangent line, the pair of arms 21 can be disposed so as to face the front surface of the defect D as the treatment region by oscillating the pair of arms 21 about the rotation axis RO.

[0121] The first embodiment of the present application has been described in detail above with reference to the drawings, but the specific structure is not limited to this embodiment, and design changes and the like within a range not departing from the gist of the present application are included. Further, it can be that the constituent elements shown in the above-described embodiments and the following modification examples are appropriately combined.

[0122] (Modification Example 1-1)

[0123] Figure 12 is a view showing a sheath 220A which is a modification example of the sheath 220 of the supply 200. The sheath 220A includes the tip 221, the front end side coil 222, the hand side coil 224, and the restriction portion 225. The restriction portion 225 is provided on the outer peripheral surface of the front end side coil 222 along the length direction A. The restriction portion 225 is provided only on a part of the circumferential direction C with respect to the length direction A. The restriction portion 225 is a portion which fixes the outer peripheral surface of the front end side coil 222. The restriction portion 225 is, for example, a portion in which the outer peripheral surface of the front end side coil 222 is welded. The restriction portion 225 can also be a portion in which a plate member is joined to the outer peripheral surface of the front end side coil 222 by welding or the like.

[0124] Figure 13 and Figure 14 is a view showing the operation of the sheath 220A.

[0125] When the front end side coil 222 is to be bent to the side on which the restriction portion 225 is provided with respect to the central axis of the length direction A of the sheath 220A, the front end side coil 222 of the sheath 220A is bent as shown in Figure 13The front end side coil 222 is shown to be bent in the same way as the front end side coil 222 of the sheath 220. On the other hand, when the front end side coil 222 is to be bent to the side opposite to the side on which the restriction portion 225 is provided with respect to the center axis of the length direction A of the sheath 220A, the front end side coil 222 of the sheath 220A is not bent as shown because the restriction portion 225 fixes the outer peripheral surface of the front end side coil 222. Figure 14

[0126] Figure 15 is a view showing the approaching step using the sheath 220A.

[0127] When the operator approaches AP2 by the incision line and holds the first mucosa Ml and the second mucosa M2 using the pair of arms 21, the pair of arms 21 needs to be pressed against the biological tissue. At this time, if the restriction portion 225 of the sheath 220A is arranged in the direction in which the pair of arms 21 swings with respect to the center axis of the length direction A of the sheath 220A (the biological tissue side), the front end side coil 222 is not bent when the pair of arms 21 is pressed against the biological tissue, and is easy to press. The sheath 220A can also have a mark that makes it easy to visually confirm the position of the restriction portion 225 using an endoscope.

[0128] (Second Embodiment)

[0129] Reference Figures 16-20 A jig system 300B of a second embodiment of the present application will be described. In the following description, the same reference numerals are attached to structures common to those already described, and repeated description is omitted.

[0130] The jig system 300B includes a jig unit 100B and a feeder 200. The jig unit 100B is introduced to a treatment position by being loaded to the feeder 200 that can pass through the channel of an endoscope.

[0131] Figure 16 is a perspective view of the jig unit 100B of the present embodiment.

[0132] The jig unit 100B includes a jig 2B, a pressing tube 3, and a connecting member 4.

[0133] The jig (jig arm) 2B has a pair of arms 21B that can be opened and closed toward the front end side Al and a support portion 28 that supports the pair of arms 21B in a swingable manner. In addition, the support portion 28 can support the pair of arms 21B in a non-swingable manner.

[0134] The pair of arms 21B has a first arm 211B and a second arm 212B. The first arm 211B and the second arm 212B are arranged on both sides across the center axis Ol of the length direction A.

[0135] ​The first arm 211B and the second arm 212B have the tissue holding portion 22B, a flat plate-shaped holding portion 23, and a connecting portion 25 from the front end side Al toward the base end side A2. The tissue holding portion 22B is formed by bending the front ends of the first arm 211B and the second arm 212B toward the inner side.

[0136] The tissue holding portion 22B has a front end portion (anchor) 26a provided at the front end of the tissue holding portion 22B. The front end portion (anchor) 26a is formed in a substantially circular plate shape, and the plate thickness direction thereof is substantially in line with the opening / closing direction P of the pair of arms 21B. In the up / down direction B that is substantially perpendicular to the length direction A and the opening / closing direction P, the length of the front end portion (anchor) 26a is longer than the length of the other portions of the tissue holding portion 22B.

[0137] Figure 17 is a side view of the tissue holding portion 22B.

[0138] The front end portion (anchor) 26a of the tissue holding portion 22B has a claw 24B on the inner side of the opening / closing direction P. The claw 24B extends toward the inner side of the opening / closing direction P.

[0139] Figure 18 is a perspective view of the pair of arms 21B that hold the first mucosa Ml and the second mucosa M2. Figure 19 is a side view of the pair of arms 21B that hold the first mucosa Ml and the second mucosa M2. The surgical operator brings the clip unit 100B close to the defect D that is the treatment region by approaching the tangent AP2. The surgical operator can reliably hold the first mucosa Ml and the second mucosa M2 with the front end portion (anchor) 26a having the claw 24B.

[0140] Figure 20 is a view that shows the traction step performed by the clip unit 100B.

[0141] The surgical operator pulls the clip 2 into a predetermined position of the pressure tube 3, and locks the pair of arms 21B in the closed state. Since the front end portion (anchor) 26a having the claw 24B reliably holds the first mucosa Ml and the second mucosa M2, the front end portion (anchor) 26a is not easily deviated from the first mucosa Ml and the second mucosa M2.

[0142] With the clip unit 100B of the present embodiment, the treatment of suturing and tightening the defect D can be appropriately performed. The pair of arms 21B can reliably hold the first mucosa Ml and the second mucosa M2.

[0143] The above describes the second embodiment of the present application in detail with reference to the drawings, but the specific structure is not limited to this embodiment, and design changes and the like within the scope of the gist of the present application are included. Furthermore, it can be that the constituent elements shown in the above-described embodiments and the modification examples shown below are appropriately combined.

[0144] (Third Embodiment)

[0145] Reference Figures 21-23 A clip system 300C of a third embodiment of the present application will be described. In the following description, the same reference numerals are assigned to structures common to those already described, and repeated description is omitted.

[0146] The clip system 300C includes a clip unit 100C and a feeder 200. The clip unit 100C is introduced to a treatment site while being loaded to the feeder 200 which can be inserted through a channel of an endoscope.

[0147] Figure 21 is a perspective view of the clip unit 100C of the present embodiment.

[0148] The clip unit 100C includes a clip 2C, a pressing tube 3, and a connecting member 4.

[0149] The clip (clip arm) 2C has a pair of arms 21C which can be opened and closed toward the front end side Al, and a support portion 28 which supports the pair of arms 21C in a swingable manner. In addition, the support portion 28 can also support the pair of arms 21C in a non-swingable manner.

[0150] The pair of arms 21C has a first arm 211C and a second arm 212C. The first arm 211C and the second arm 212C are disposed on both sides across a center axis O1 of the length direction A.

[0151] The first arm 211C and the second arm 212C have a tissue holding portion 22C, a flat plate-shaped holding portion 23, and a connecting portion 25 from the front end side Al toward the base end side A2. The tissue holding portion 22C is formed by bending the front end of the first arm 211B and the second arm 212B toward the inside.

[0152] Figure 22 is a side view of the tissue holding portion 22C.

[0153] The tissue holding portion 22C has a first anchor 26b and a second anchor 26c. The first anchor 26b and the second anchor 26c are provided on both sides in the up-down direction B of the tissue holding portion 22C. The first anchor 26b and the second anchor 26c are formed in a sharp shape which protrudes in the up-down direction B. In the up-down direction B, the length D1 from the front end of the first anchor 26b to the front end of the second anchor 26c is longer than the length D2 of the other portion of the tissue holding portion 22B.

[0154] Figure 23is a perspective view of a pair of arms 21C that hold the first mucosa Ml and the second mucosa M2. The surgical operator brings the clip unit 100C close to the defect D as a treatment region by approaching the AP2 through the incision line. The living tissue side of the anchor (in this case, the second anchor 26c) among the first anchor 26b and the second anchor 26c penetrates the living tissue. The surgical operator can reliably hold the first mucosa Ml and the second mucosa M2 with the tissue holding portion 22C having the first anchor 26b and the second anchor 26c. Figure 23

[0155] With the clip unit 100C of the present embodiment, treatment of suturing and tightening the defect D can be appropriately performed. The pair of arms 21C can reliably hold the first mucosa Ml and the second mucosa M2.

[0156] The third embodiment of the present application has been described in detail above with reference to the drawings, but the specific structure is not limited to this embodiment, and design changes and the like within a range not departing from the gist of the present application are included. Furthermore, it can be that the constituent elements shown in the above-described embodiments and the modification examples shown below are appropriately combined.

[0157] (Fourth Embodiment)

[0158] Reference Figures 24-29 The clip system 300D of the fourth embodiment of the present application will be described. In the following description, the same reference numerals are assigned to structures common to those already described, and repeated description is omitted.

[0159] The clip system 300D includes a clip unit 100D and a feeder 200D. The clip unit 100D is introduced to a treatment position by being loaded in the feeder 200D that can pass through the channel of an endoscope.

[0160] Figure 24 is a perspective view of the clip unit 100D of the present embodiment.

[0161] The clip unit 100D includes a clip 2D, a pressing tube 3, and a link member 4. The clip unit 100D is used by being loaded in the feeder 200D, and can supply high-frequency current supplied from the arrow hook portion 231 linked to the link member 4 to the clip 2D.

[0162] The clip 2D has a pair of arms 21D that can be opened and closed toward the front end side Al and a support portion 28 that supports the pair of arms 21D in a swingable manner. Alternatively, the support portion 28 can support the pair of arms 21D in a non-swingable manner.

[0163] ​A pair of arms 21D has a first arm 211D and a second arm 212D. The first arm 211D and the second arm 212D are arranged on both sides of a central axis O1 in the length direction A. At least one of the first arm 211D and the second arm 212D is energized.

[0164] The first arm 211D and the second arm 212D have a tissue holding portion 22, a holding portion 23D, and a connecting portion 25 extending from the front end side A1 toward the base end side A2. The holding portion 23D has a curved portion 23a that bends inward from the front end side A1.

[0165] Figure 25 This is a diagram showing a feeder 200D containing a clamp unit 100D. The feeder 200D includes a sheath 220, an operating line 230, and an operating section 240D.

[0166] The operating unit 240D includes an operating unit body 241, a slider 242D, a connector 247, and a thumb ring 248.

[0167] The slider 242D is mounted in a manner that allows it to move forward and backward along the longitudinal axis of the operating part body 241, and the base end of the wire 232 is mounted thereon. As the slider 242D moves forward and backward along the operating part body 241, the wire 232 moves forward and backward relative to the sheath 220, and the arrow hook portion 231 moves forward and backward.

[0168] Connector 247 can be connected to a high-frequency power supply device (not shown), and is electrically and physically connected to the base end of line 232. Connector 247 can supply high-frequency current from the high-frequency power supply device to the connector member 4 and the clamp 2D via line 232. Connector 247 is supported by a slider 242D and is formed into a generally cylindrical shape.

[0169] [Sewing tightening treatment using clamp unit 100D]

[0170] Next, the suture tightening procedure using the clamp unit 100D will be described. Specifically, the suture tightening procedure performed using an endoscope will be explained. Figure 5 The procedure of suturing and tightening the defect D formed by biological tissue in the body is explained.

[0171] <Approach Steps>

[0172] The surgeon inserts the clamp unit 100D, loaded into the feeder 200D, into the body through the endoscope channel. The surgeon moves the endoscope and sheath 220 to bring the clamp 2D of the clamp unit 100D close to the defect D, which is the treatment area. The surgeon moves the suture 232 forward and backward to unfold the clamp 2D into the appropriate position.

[0173] <First Step of Control>

[0174] Figure 26 and Figure 27 is a view showing a first grasping step by the clip unit 100D. The operator opens a small hole at the edge of the defect D by passing high-frequency current to the clip 2D. Alternatively, the operator forms a protuberance (catch) by damaging the biological tissue. For example, the operator passes high-frequency current to the first arm 211D as shown in Figure 26 , and opens a hole at the first mucosa Ml. Alternatively, the operator can pass high-frequency current as shown in Figure 27 while grasping the first mucosa Ml with the first arm 211D and the second arm 212D. The operator grasps the first mucosa Ml by inserting the tip of the first arm 211D into the small hole or the protuberance (catch) formed. The tip of the first arm 211D is less likely to slip because it is inserted into the small hole or the protuberance (catch) formed.

[0175] <Second grasping step>

[0176] Figure 28 is a view showing a second grasping step by the clip unit 100D.

[0177] The operator moves the clip unit 100D in the direction along the suture tightening direction S, and moves the tip of the second arm 212D to the vicinity of the second mucosa M2. The operator grasps the second mucosa M2 with the second arm 212D in the same manner as the method of grasping the first mucosa Ml with the first arm 211D.

[0178] <Hemostasis step>

[0179] In the case where bleeding occurs from the biological tissue, the operator can perform a hemostasis treatment by passing high-frequency current to the clip 2D to cauterize the bleeding site.

[0180] <Pulling step>

[0181] The operator retracts the arrow hook 231 by moving the slide 242D backward along the operation portion main body 241. The link member 4 linked to the arrow hook 231 pulls the clip 2D. The clip 2D pulled by the link member 4 is drawn into the pressure tube 3. When the clip 2D is drawn to a predetermined position of the pressure tube 3, the clip 2D is restricted from moving toward the tip end side with respect to the pressure tube 3, and the pair of arms 21D is locked in the closed state. When the pair of arms 21D is locked in the closed state, the pair of arms 21D cannot be restored to the open state.

[0182] <Separation step>

[0183] Figure 29 is a view showing a separation step by the clip unit 100D.

[0184] The operator further pulls the clip 2D. A breaking force due to the pulling is applied to the breaking portion of the insertion portion 41 of the link member 4, and the breaking portion breaks. As a result, the pair of arms 21D and the link portion 42 are separated. The operator retracts the sheath 220, and leaves the clip 2D in the state in which the first mucosa Ml and the second mucosa M2 are ligated and the pressure tube 3 in the body.

[0185] With the clip unit 100D of the present embodiment, the treatment of suturing and tightening the defective portion D can be appropriately performed. By inserting the tip of the clip 2D into the smaller hole or the bump (nub) formed with the high-frequency current, the clip 2D is less likely to slip with respect to the tissue.

[0186] The fourth embodiment of the present application has been described in detail above with reference to the drawings, but the specific structure is not limited to this embodiment, and design changes and the like within a range not departing from the gist of the present application are included. Furthermore, it can be that the constituent elements shown in the above-described embodiments and the following modification examples are appropriately combined.

[0187] (Fifth Embodiment)

[0188] Reference Figures 30-34 A clip system 300E of a fifth embodiment of the present application will be described. In the following description, the same reference numerals are attached to the structures common to those already described, and the repeated description is omitted.

[0189] The clip system 300E includes a clip unit 100E and a feeder 200D. The clip unit 100E is introduced to a treatment site while being loaded in the feeder 200D capable of passing through a channel of an endoscope.

[0190] Figure 30 is a perspective view of the clip unit 100E of the present embodiment.

[0191] The clip unit 100E includes a clip 2E, a pressure tube 3, and a link member 4. The clip unit 100E is used while being loaded in the feeder 200D, and can supply the high-frequency current supplied from the arrow hook portion 231 linked to the link member 4 to the clip 2E.

[0192] The clip 2E has a pair of arms 21E capable of opening and closing toward the tip side Al and a support portion 28 that supports the pair of arms 21E in a swingable manner. Alternatively, the support portion 28 can support the pair of arms 21E in a non-swingable manner.

[0193] The pair of arms 21E has a first arm 211E and a second arm 212E. The first arm 211E and the second arm 212E are disposed on both sides across a center axis O1 of the length direction A. At least one of the first arm 211E and the second arm 212E has electrical conductivity.

[0194] The first arm 211E and the second arm 212E have the tissue holding portion 22, the holding portion 23, and the connecting portion 25 from the front end side Al toward the base end side A2.

[0195] Figure 31 is a view showing a first holding step by the clip unit 100E.

[0196] The surgical operator applies high-frequency current to the first arm 211E to open a hole in the first mucosa Ml. The surgical operator holds the first mucosa Ml by inserting the front end of the first arm 211E into the small hole formed. The front end of the first arm 211E is less likely to slip because it is inserted into the small hole formed.

[0197] Figure 32 is a view showing a second holding step by the clip unit 100E.

[0198] The surgical operator moves the clip unit 100E in a direction along the suture tightening direction S to move the front end of the second arm 212D to the vicinity of the second mucosa M2. The surgical operator holds the second mucosa M2 by the second arm 212D in the same way as the way of holding the first mucosa Ml by the first arm 211E.

[0199] < Hemostasis Step >

[0200] In a case where bleeding occurs from the biological tissue, the surgical operator can also perform a hemostasis treatment by applying high-frequency current to the clip 2E to cauterize the bleeding site.

[0201] < Traction Step >

[0202] The surgical operator retracts the arrow hook portion 231 by retracting the slide member 242 along the operation portion main body 241. The link member 4 linked to the arrow hook portion 231 pulls the clip 2E. The clip 2E pulled by the link member 4 is drawn into the compression tube 3. When the clip 2E is drawn to a predetermined position of the compression tube 3, the clip 2E is restricted from moving toward the front end side with respect to the compression tube 3, and the pair of arms 21E is locked in the closed state. When the pair of arms 21E is locked in the closed state, the pair of arms 21E cannot be restored to the open state.

[0203] Figure 33 is a view showing a separation step by the clip unit 100E.

[0204] The operator further pulls the clip 2E. A breaking force due to the pulling is applied to the breaking portion of the insertion portion 41 of the link member 4, and the breaking portion breaks. As a result, the pair of arms 21E and the link portion 42 are separated. The operator retracts the sheath 220, and leaves the clip 2E and the pressure tube 3 in the state in which the first mucosa Ml and the second mucosa M2 are ligated in the body.

[0205] Figure 34 is a view that shows another mode of the first grasping step and the second grasping step by the clip unit 100E. The operator can also supply the clip 2E with high-frequency current in a state in which both the first arm 211E and the second arm 212E are in contact with the biological tissue.

[0206] With the clip unit 100E of the present embodiment, the treatment of suturing the defect D can be appropriately performed. By inserting the tip of the clip 2E into the smaller hole formed by the high-frequency current, the clip 2E is less likely to slip with respect to the tissue.

[0207] The fifth embodiment of the present application has been described in detail above with reference to the drawings, but the specific structure is not limited to this embodiment, and design changes and the like within a range not departing from the gist of the present application are also included. Furthermore, it can be that the constituent elements shown in the above-described embodiments and the modification examples shown below are appropriately combined.

[0208] (Sixth Embodiment)

[0209] Reference Figures 35-39 A clip system 300F of a sixth embodiment of the present application will be described. In the following description, the same reference numerals are attached to structures common to those already described, and repeated description is omitted.

[0210] The clip system 300F includes a clip unit 100F and a feeder 200. The clip unit 100F is introduced to a treatment position by being guided into the feeder 200 that can pass through a channel of an endoscope.

[0211] Figure 35 is a perspective view of the clip unit 100F of the present embodiment.

[0212] The clip unit 100F includes a clip 2F, a pressure tube 3, and a link member 4.

[0213] The clip 2F has a pair of arms 21F that can be opened and closed toward the tip side Al, and a support portion 28 that supports the pair of arms 21F in a swingable manner. Alternatively, the support portion 28 can support the pair of arms 21F in a non-swingable manner.

[0214] The pair of arms 21F has a first arm 211F and a second arm 212F. The first arm 211F and the second arm 212F are disposed on both sides across the center axis O1 of the length direction A.

[0215] The first arm 211F and the second arm 212F have the tissue holding portion 22F, the holding portion 23F, and the connecting portion 25 from the front end side Al toward the base end side A2. The tissue holding portion 22F is formed in an arrowhead shape with a sharp front end. The tissue holding portion 22F can also have a barb. The holding portion 23F has its front end side bent to a large extent in a direction away from the center axis O1 (outward direction), and is formed in a hook shape.

[0216] Figure 36 is a view showing a first holding step performed by the clip unit 100F.

[0217] The surgical operator penetrates the front end of the first arm 211F into the first mucosa M1. Specifically, the surgical operator penetrates the front end of the first arm 211F from the inside toward the outside at the edge of the defect D.

[0218] Figure 37 is a view showing a second holding step performed by the clip unit 100F.

[0219] The surgical operator moves the clip unit 100F in a direction along the suture tightening direction S, and moves the front end of the second arm 212F to the vicinity of the second mucosa M2. The surgical operator penetrates the front end of the second arm 212F into the second mucosa M2. Specifically, the surgical operator penetrates the front end of the second arm 212F from the inside toward the outside at the edge of the defect D.

[0220] Figure 38 is a view showing a pulling step performed by the clip unit 100F.

[0221] The surgical operator retracts the arrowhead hook portion 231 by retracting the slide 242 along the operation portion main body 241. The connecting member 4 connected to the arrowhead hook portion 231 pulls the clip 2F. The pair of arms 21F are drawn closer to each other, and the first mucosa M1 and the second mucosa M2 are drawn closer to each other.

[0222] Figure 39 is a view showing a separation step performed by the clip unit 100F.

[0223] The surgical operator retracts the sheath 220, and leaves the clip 2F and the pressure tube 3 in the state of ligating the first mucosa M1 and the second mucosa M2 inside the body.

[0224] The clip unit 100F according to the present embodiment can appropriately perform the treatment of suture tightening of the defect D. The pair of arms 21F can reliably hold the first mucosa M1 and the second mucosa M2.

[0225] The above describes the sixth embodiment of the present application in detail with reference to the drawings, but the specific structure is not limited to this embodiment, and design changes and the like within a range not departing from the gist of the present application are included. Furthermore, it can be that the constituent elements shown in the above-described embodiments and the following modification examples are appropriately combined to constitute.

[0226] (SEVENTH EMBODIMENT)

[0227] Reference Figures 40-45 A clamp system 300G of a seventh embodiment of the present application will be described. In the following description, the same reference numerals are attached to the structures common to the already described portions, and the repeated description is omitted.

[0228] The clamp system 300G includes a clamp unit 100G and a feeder 200. The clamp unit 100G is introduced to a treatment position by being loaded to the feeder 200 which can penetrate a channel of an endoscope.

[0229] Figure 40 is a perspective view of the clamp unit 100G of the present embodiment.

[0230] The clamp unit 100G includes a clamp 2G, a pressing tube 3, and a connecting member 4.

[0231] The clamp (clamp arm) 2G has a pair of arms 21G which can be opened and closed toward the front end side Al, and a support portion 28 which supports the pair of arms 21G in a swingable manner. In addition, the support portion 28 can also support the pair of arms 21G in a non-swingable manner.

[0232] The pair of arms 21G has a first arm 211G and a second arm 212. The first arm 211G and the second arm 212 are disposed on both sides across a center axis O1 of the length direction A.

[0233] The first arm 211G has a tissue holding portion 22, a flat plate-shaped holding portion 23, a connecting portion 25, and a connecting ring 27. The connecting ring 27 is formed in a ring shape, and is provided at the front end portion of the holding portion 23 on the outside in the opening and closing direction P. The connecting ring 27 can be penetrated by the second arm 212 of another clamp unit 100G. The connecting ring 27 can also be provided at a portion where the first arm 211G is bent. In addition, the second arm 212 can also have a connecting ring 27.

[0234] Figure 41 is a view showing a first holding step performed by the clamp unit 100G.

[0235] The surgical operator holds the first mucosa Ml with the pair of arms 21G of the clamp 2G of the first clamp unit 100G (hereinafter also referred to as "clamp unit 100Gl").

[0236] Figure 42 is a view showing a first separation step by the clip unit 100G.

[0237] The operator of the surgery retracts the sheath 220, leaving the clip 2G and the pressure tube 3 in the state of having ligated only the first mucosa Ml in the body.

[0238] Figure 43 is a view showing a connection step by the clip unit 100G.

[0239] The operator of the surgery loads a second clip unit 100G (hereinafter also referred to as "clip unit 100G2") to the feeder 200. The operator of the surgery passes the second arm 212 of the clip 2G of the clip unit 100G2 through the connection ring 27 of the first arm 211G of the clip unit 100G1.

[0240] Figure 44 is a view showing a second grasping step by the clip unit 100G.

[0241] The operator of the surgery moves the clip unit 100G in the direction along the suture tightening direction S, moving the tip of the second arm 212 to the vicinity of the second mucosa M2. The operator of the surgery grasps the second mucosa M2 by the pair of arms 21G of the clip 2G.

[0242] Figure 45 is a view showing a second separation step by the clip unit 100G.

[0243] The operator of the surgery retracts the sheath 220, leaving the clip 2G and the pressure tube 3 in the state of having ligated only the second mucosa M2 in the body.

[0244] The clip unit 100G of the present embodiment enables appropriate implementation of the treatment of suture tightening of the defect D. The clip unit 100G enables reliable grasping of the first mucosa Ml and the second mucosa M2 by connecting the clips 2G of the two clip units 100G.

[0245] The seventh embodiment of the present application has been described in detail above with reference to the drawings, but the specific structure is not limited to this embodiment, and design changes and the like within the scope of the gist of the present application are included. Furthermore, it can be that the constituent elements shown in the above-described embodiments and the modification examples shown below are appropriately combined.

[0246] (Eighth Embodiment)

[0247] Reference Figures 46-53 The clip system 300H of the eighth embodiment of the present application will be described. In the following description, the same reference numerals are attached to the structures common to the already described portions, and the repeated description is omitted.

[0248] The clip system 300H includes the clip unit 100H and the feeder 200H. The clip unit 100H is introduced to the treatment site with the feeder 200H which can be inserted through the channel of the endoscope.

[0249] Figure 46 is a view that shows the clip unit 100H and the feeder 200H of the present embodiment. The feeder 200H has a first slider 242H and a second slider 243H. The clip unit 100H has a first arm 211H and a second arm 212H.

[0250] Figure 47 is a view that shows the actions of the first arm 211H and the second arm 212H.

[0251] The first arm 211H and the second arm 212H are independently driven. The first arm 211H is driven with the first slider 242H. The second arm 212H is driven with the second slider 243H.

[0252] Figure 48 is a view that shows the approaching step with the clip unit 100H.

[0253] The surgical operator approaches AP2 by the tangent line to bring the clip unit 100H close to the defect D which is the treatment area.

[0254] Figure 49 is a view that shows the grasping step with the clip unit 100H.

[0255] The surgical operator adjusts the length (the amount of protrusion from the pressure tube 3) of the first arm 211H and the second arm 212H. Specifically, the surgical operator adjusts so that both of the front ends of the two arms are in contact with the mucosa. More preferably, the surgical operator brings the first arm 211H in contact with the first mucosa Ml and brings the second arm 212H in contact with the second mucosa M2.

[0256] Figure 50 is a view that shows the grasping step with the clip unit 100H.

[0257] The surgical operator can also bring the second arm 212H in contact with the second mucosa M2 by moving the clip unit 100H in the direction along the suture tightening direction S in the state where the first arm 211H is in contact with the first mucosa Ml.

[0258] Figure 51 is a view that shows the pulling step with the clip unit 100H.

[0259] The surgeon pulls the first arm 211H and the second arm 212H by retracting the first slider 242H and the second slider 243H. The first arm 211H and the second arm 212H are pulled closer to each other, bringing the first mucosa M1 and the second mucosa M2 closer together.

[0260] The clamp unit 100H of this embodiment can properly perform the procedure of suturing and tightening the defective portion D. The clamp unit 100H, when approaching AP1 from the front, passes through... Figure 52 As shown, the lengths of the first arm 211H and the second arm 212H are set to be the same, thereby reliably holding the first mucosa M1 and the second mucosa M2. The clamping unit 100H, in tangential approach to AP2, passes through... Figure 53 As shown, the lengths of the first arm 211H and the second arm 212H are set to different lengths depending on the situation, so that the first mucosa M1 and the second mucosa M2 can be reliably held.

[0261] The eighth embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the constituent elements shown in the above-described embodiment and the variations shown below can be appropriately combined to form the embodiment.

Claims

1. A clamping system, wherein, The clamping system includes: A clamping unit having a first arm and a second arm that can be opened and closed; A line that can operate the opening and closing of the first arm and the second arm; and A sheath that allows the wire to pass through. The clamping unit has a support portion that supports the first arm and the second arm in a swingable manner. The swinging direction of the first arm and the second arm is consistent with the opening and closing direction of the first arm and the second arm. The opening and closing rotations of the first and second arms have the same axis of rotation as the swinging motion of the first and second arms.

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

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

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

5. The clamping system according to claim 1, wherein, The axis of rotation is perpendicular to the length direction of the clamping unit.

6. The clamping system according to claim 1, wherein, The axis of rotation intersects the length direction of the clamping unit.

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

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

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