Surgical tissue clip application assembly and endoscope having tissue clip application assembly

Abstract

The present disclosure relates to a surgical tissue clip application assembly (2) for an endoscope or for an endoscope, comprising a tissue clip (4) for suturing tissue, a cap (6) mountable on a distal end section of the endoscope, in particular insertable onto the end section, and a pull-out ring (8), the invention relates to an endoscope (1) having a cover (6), on which the tissue clip (4) is radially supported, or formed by a distal end section of the endoscope, and on a radially outer peripheral surface (10) of which the tissue clip (4) is radially supported, and a pull-out ring (7), which is arranged axially displaceably on the cover (6) and by means of an axial displacement of which the tissue clip (4) is displaceable in a distal direction, the cover (6) and the pull-out ring (8) can be or are connected to each other in a rotationally fixed manner. Furthermore, the present disclosure relates to an endoscope having a surgical tissue clip application assembly (2).

Description

Technical Field

[0001] This disclosure relates to a surgical tissue clip application component for an endoscope or an endoscope, and an endoscope having such a surgical tissue clip application component. Background Technology

[0002] When introducing medical products into body openings, particularly into a patient's hollow organs, the endoscopic implantation process can be performed in a known manner that is low-risk for the patient. For example, it is known to secure the medical product to the hollow organ from within. Here, the tissue clip / tissue clamp is preferably introduced into the hollow organ by means of an endoscope or similar propulsion device and positioned at a predetermined point / location inside the organ. The corresponding tissue clip is then guided to the organ tissue and its elastic hinge is used to snap the clip in place, thereby securing it to the organ tissue. The tissue clip then holds or clamps tissue folds between its grasping segments ( / (grasping) teeth / tips), whereby the grasping segments cut into ( / penetrate) and / or penetrate the tissue.

[0003] In the prior art, there are solutions for surgical tissue clips that are fastened to the patient's organ tissue wall via endoscopic insertion. Thus, for example, EP 2 449 983 B1 describes a clip that is introduced into the patient in an open form over an endoscope and then pushed forward / distally from the endoscope at the appropriate position, whereby the tissue clips snap together and clamp the organ tissue between their grasping sections.

[0004] Furthermore, there are existing methods in the art for implementing or simplifying the application of tissue clips, particularly for the removal of tissue clips. For example, EP 3 638 092 B1 shows a tissue clip application assembly that includes a tissue clip, a cap ( / cap attachment) that can be placed / inserted onto the distal end of an endoscope, and a pull-out ring axially slidably supported on the cap, the pull-out ring being able to be pulled forward by means of a pull-out device, thereby pushing the tissue clip forward beyond the cap, so that the tissue clip is removed from the cap.

[0005] Typically, the pull-out ring is operated here by a pull-out device, particularly in the form of a rope-pulling mechanism, having a yarn coupled to the pull-out ring. To apply tension, the yarn is coupled or coupled at the proximal end of the endoscope, i.e., the operator-side end, to an operating device, particularly in the form of a manually rotatable handwheel. The yarn can be fixedly connected to the handwheel, for example, clamped to it, so that the yarn is wound around as the handwheel rotates and thus pulled proximally. The yarn is preferably guided from the operating device, preferably inside the endoscope's working channel, to the distal end of the endoscope, i.e., the patient-side end. At the tip of the endoscope or at the cap on the endoscope, the yarn is guided outward distal to the pull-out ring (out of the endoscope's working channel or its extension), there coupled to the pull-out ring, particularly (double-)guided through the pull-out ring, then guided inward again distal to the pull-out ring (e.g., in the endoscope's working channel) and there, for example, fixedly connected to the cap or endoscope. This achieves the function that, by pulling the yarn in the distal direction, the loop (and thus the tissue clip) can be moved (axially) until the tissue clip is pushed off the cap distally for its application.

[0006] A problem arises particularly when preparing to operate the tissue clip application assembly, especially when placing the cap on the distal end of the endoscope. This is because the tissue clip application assembly is secured in the area of ​​the pull-out ring and is frequently placed / inserted / pushed onto the endoscope using a twisting motion. The pull-out ring can be twisted on the cap, which in turn causes problems when the pull-out ring moves, as the yarn guide may be affected by the changed rotational position and the pull-out ring may become misaligned. This, in turn, can cause the tissue clip to fail to detach or not detach at the intended position. Summary of the Invention

[0007] Therefore, the object of this disclosure is to avoid or at least mitigate the aforementioned disadvantages and, in particular, to provide a surgical tissue clip application component that ensures easy, accurate, and effortless application of tissue clips.

[0008] The objective of this disclosure is achieved by a surgical tissue clip application component having the features of claim 1. Advantageous improvements are the subject of the dependent claims.

[0009] Therefore, this disclosure relates to surgical tissue clip application components for endoscopes or endoscopes, including tissue clips for suturing tissue, a cap, and a pull-out ring. The cap can be mounted on, and in particular, inserted into, a distal end section of the endoscope. Alternatively, the cap is formed from the distal end section of the endoscope, i.e., without a separate component, but constructed integrally with the endoscope. The cap has a radially outer peripheral surface, preferably substantially cylindrical, on which the tissue clip is radially supported. This means that the tissue clip is placed / inserted onto the cap (externally). The pull-out ring (relative to the cap) is axially movable on the cap, particularly on the radially outer peripheral surface of the cap, wherein, for axial movement of the pull-out ring, it is preferably actuated by means of a pull-out device in the form of a rope pulling device. By the axial movement of the pull-out ring, the tissue clip is movable in the distal direction, preferably to the extent that the tissue clip is pushed off the cap. In other words, the pull-out ring is coupled to the tissue clip in such a way that, in particular, it is arranged axially against the tissue clip (on the proximal side of the tissue clip), i.e., the axial movement of the pull-out ring causes the tissue clip to move distally / forward / axially / beyond the distal endoscope and / or cap end, in particular the pull-out ring pushes / presses the tissue clip distally.

[0010] According to one aspect of this disclosure, the cap and pull-out ring are mutually connectable or interlocking with each other in a rotationally resistant manner. This means that the cap and pull-out ring cannot be twisted relative to each other about the longitudinal / central axis of the application component (or the cap or pull-out ring) in the connected state.

[0011] Therefore, the core of the present invention is that the pull-out ring arranged outside the cap cannot be twisted on the cap, especially when the cap is inserted into the endoscope, that is, in the initial position of the pull-out ring (the position before it has moved in the distal direction), preferably by means of the yarn of the pull-out device which is guided by the yarn to introduce a manipulative force on the pull-out ring to orient the pull-out ring (and thus the tissue clip) distally.

[0012] The advantage of this is that the yarn guidance acting on the pull-out loop is not adversely affected by twisting and the functionality of the tissue clip application components can be ensured in a particularly robust manner.

[0013] In other words, this disclosure relates to a surgical tissue clip application accessory or modification assembly ( / tissue clip application assembly) having a cap attachment ( / cap) configured to be mounted on, in particular fitted onto, a distal end section of a rod-structure type medical endoscope, and the cap attachment having a preferably proximal mounting or fitting section and a preferably distal tissue clip holding section, wherein a cavity is formed internally in the region of the tissue clip holding section and is open at least in the distal direction, and a tissue clip is radially supported on the radially outwardly pointing circumferential surface of the tissue clip holding section, the tissue clip being movable distally by means of a pull-out device, which takes the form of a pull-out ring that is axially slidably supported on the radially outer circumferential surface of the tissue clip holding section, and is movable to and anti-rotationally connected to the cap attachment.

[0014] According to a preferred embodiment, the pull-out ring has a cover anti-rotation portion, particularly in the form of a (longitudinal / axial) protrusion or preferably multiple protrusions, especially two (longitudinal / axial) protrusions, which can be engaged or drawn into a form-locking engagement with the cover, particularly with one (or more) corresponding (longitudinal / axial) grooves constructed in the cover, to prevent relative rotation. That is, the pull-out ring, for example, has protrusions / form-locking elements / legs extending in / along / preferably parallel to the longitudinal / axial direction of the pull-out ring (or cover), which can be engaged or drawn into abutment with corresponding grooves / fitting form-locking elements in the circumferential direction to prevent the pull-out ring from twisting relative to the cover. In other words, the pull-out ring can be connected or connected to the cover in a form-locking manner to prevent relative rotation. Therefore, anti-relative rotation can be reliably ensured even when large forces are introduced in the circumferential direction.

[0015] According to a preferred improvement, the anti-rotation portion of the cover, particularly one or more protrusions or each of the protrusions, can have two abutting surfaces perpendicular to the circumferential direction to fit against the cover in a form-locking manner, for example, constructed substantially rectangular in cross-section. In particular, the two abutting surfaces can function as stops on the circumferential side in different rotational directions. This has the advantage that it prevents rotation in both clockwise and counterclockwise directions.

[0016] According to an embodiment, the pull-out ring may have a base that is preferably closed on the circumferential side, particularly annular in cross-section. Alternatively, the base may have an opening on the circumferential side, that is, it may be constructed only in a nearly closed manner, for example, surrounding an annular sector greater than 330°, preferably greater than 340° or 350°, especially greater than 355°.

[0017] According to a preferred embodiment, the cap anti-rotation portion can extend proximally away from the base. That is, the cap anti-rotation portion is constructed on the side of the pull-out ring opposite to the axial movement direction of the pull-out ring (or away from the tissue clip). This has the advantage that when constructing the cap, especially the groove / fitting shape locking element, it is not necessary to consider that the axial movement of the pull-out ring is not restricted or prevented by the cap.

[0018] According to a preferred embodiment, in order to move the tissue clamp distally, the pull-out ring can be axially moved distally from the starting position / installation position, and the pull-out ring is preferably anti-rotationally connected to the cap only in the initial position (and during the initial stroke, particularly corresponding to the length of the anti-rotation portion). This means that the pull-out ring does not necessarily need to be anti-rotationally fixed to the cap in each axial position, but is fixed at least in the initial position. This achieves, particularly in the position of the pull-out ring (where the pull-out ring is located before the tissue clamp is applied), the elimination of torsion between the pull-out ring and the cap, i.e., torsion that is primarily impossible when mounting the application components onto the endoscope.

[0019] According to a preferred embodiment, the tissue clip may have two diametrically opposed gripping sections and two preferably arc-shaped hinged sections connecting the gripping sections, wherein the cap anti-rotation portion may be arranged circumferentially in a region of one (or alternatively both) of the hinged sections. That is, the region of the pull-out ring abutting the gripping section is circumferentially offset relative to the cap anti-rotation portion. Since the pull-out ring in the region abutting the gripping section can have a greater mass than in the region adjacent to the hinged section, a uniform mass distribution can be obtained.

[0020] According to the embodiment, the gripping sections are pivotable relative to each other about a hinge axis defined by the two hinged sections. This allows the gripping sections to open / close against the elasticity of the tissue clip, and also allows the gripping sections to close due to the elasticity of the tissue clip.

[0021] According to a preferred embodiment, the cap anti-rotation portion can be constructed symmetrically with respect to a longitudinal plane axis preferably containing the hinge axis, which is the plane containing the longitudinal / central axis of the application component (or cap or pull-out ring) and the hinge axis. Therefore, tilt-free axial movement of the pull-out ring can be supported. Since the tissue clip is also constructed approximately symmetrically with respect to its hinge axis, a uniform weight / mass distribution is achieved.

[0022] According to embodiments, the tissue clip application assembly may have a pull-out device, particularly in the form of a rope traction device, coupled to a pull-out ring for axial movement, such that a pulling force is applied to the circumferential side of the pull-out ring when the pull-out device is manipulated. In particular, the pull-out device may have a yarn coupled to the pull-out ring, which can be coupled to or is coupled to an actuating device, particularly in the form of a manually rotatable handwheel, and is fixedly connected to, for example, clamped within, the actuating device to apply a pulling force to the proximal (operator-side) end of the endoscope. Preferably, the yarn is not fixedly fastened to the pull-out ring but is movable relative to the pull-out ring, particularly longitudinally, but particularly through the pull-out ring in such a way that the traction of the yarn pulls the pull-out ring in a distal direction (through a path smaller than the yarn traction path). Such yarn guidance is known, for example, from EP 3 638 092 B1, and its contents are included in this application.

[0023] According to a preferred embodiment, the cap anti-rotation portion is preferably arranged only on the tensile-bearing circumferential side of the pull-out ring. In other words, the yarn can pass axially from the distal to the proximal side of the pull-out ring, for example (from the tension-introducing end / end of the pull-out ring), and axially from the proximal to the distal side of the pull-out ring, for example, on a second circumferential side opposite the first circumferential side along the diameter, thereby introducing tension into the pull-out ring on the first circumferential side. Here, the cap anti-rotation portion is preferably arranged only on the first circumferential side. This has the advantage of avoiding misalignment between the cap anti-rotation portion and the cap.

[0024] According to a preferred embodiment, the anti-rotation portion of the cover can be constructed symmetrically with respect to the longitudinal plane axis containing the tension introduction position (on the pull-out ring). This has the advantage that the tension can be uniformly introduced and supports tilt-free movement. The longitudinal plane containing the tension introduction position preferably corresponds to the longitudinal plane containing the hinge axis.

[0025] According to a preferred embodiment, the pull-out ring and the tissue clip are (possibly connected or) connected to each other in a way that resists relative rotation. This means that the tissue clip and the pull-out ring cannot be twisted relative to each other about the longitudinal / central axis of the application component (or cap or pull-out ring) in the connected state. This also prevents (unintentional) twisting of the tissue clip relative to the pull-out ring and thus prevents twisting on / relative to the cap.

[0026] According to a preferred embodiment, the pull-out ring has a clamping anti-rotation portion, particularly in the form of a (longitudinal / axial) protrusion or preferably multiple protrusions, especially in the form of two (longitudinal / axial) protrusions, which can be brought into or be brought into a form-locking engagement with the tissue clip, particularly with one (or more) corresponding abutment surfaces constructed at the tissue clip, to resist relative rotation. That is, the pull-out ring, for example, has protrusions / form-locking elements / bumps / crescents / extrusion teeth extending at least partially in / along the longitudinal / axial direction of the pull-out ring (i.e., preferably also partially inclined relative to the longitudinal / axial direction of the pull-out ring), which can be abutted or positioned against the corresponding abutment surfaces / matching form-locking elements in the circumferential direction to prevent torsion between the pull-out ring and the tissue clip. In other words, the pull-out ring is (can be connected to or) connected to the tissue clip in a form-locking manner to resist relative rotation.

[0027] According to a preferred improvement, the clamping anti-rotation portion, particularly one or more protrusions, or each protrusion, may have two particularly (outwardly convex) curved abutment surfaces inclined relative to the circumferential direction for form-locking abutment against the tissue clip, for example, being substantially constructed in a semi-elliptical / crescent shape in cross-section. In particular, the two abutment surfaces can serve as stops on the circumferential side, respectively, in different rotational directions. This has the advantage that it prevents twisting in either a clockwise or counterclockwise direction.

[0028] According to a preferred embodiment, the clamp-resistance rotation portion extends distally from the base. That is, the clamp-resistance rotation portion is constructed on the side of the pull-out ring facing the tissue clip. Therefore, a simple construction of the clamp-resistance rotation portion can be achieved.

[0029] According to a preferred embodiment, the clamping anti-rotation portion can be arranged circumferentially in the regions of at least one or preferably two gripping sections. Therefore, a simple construction of the clamping anti-rotation portion can be achieved by form-fitting it against the gripping section (which is constructed to be more stable than the hinge section). That is, the region of the pull-out ring adjacent to the hinge section is arranged circumferentially offset relative to the clamping anti-rotation portion. In other words, the clamping anti-rotation portion and the cover anti-rotation portion are arranged circumferentially offset.

[0030] According to a preferred embodiment, the clamping and anti-rotating portions can be constructed symmetrically with respect to the first longitudinal plane axis, wherein the first longitudinal plane preferably corresponds to the longitudinal plane, and the cover anti-rotating portion is symmetrical with respect to the longitudinal plane axis. That is, the clamping and anti-rotating portions can be symmetrical about the same symmetry plane axis. This achieves a uniform weight / mass distribution.

[0031] According to a preferred embodiment, the clamping and anti-rotation portion can be constructed symmetrically with respect to the second longitudinal plane axis, wherein the second longitudinal plane is perpendicular to the first longitudinal plane. That is, the clamping and anti-rotation portion has two axes of symmetry.

[0032] According to another aspect (which may exist in combination with or independently of the aforementioned aspect concerning the anti-relative rotation between the cover and the pull-out ring), the pull-out ring may have two diameter-opposed (extending in the longitudinal / axial direction) through-holes through which the yarn of the pull-out device can be guided, wherein the distal outlet of the through-hole can be arranged proximal to the anti-relative rotation portion. That is, the through-hole is arranged such that its distal outlet is not located on the outermost distal end of the pull-out ring, but is offset from it in a proximal direction. This has the advantage that although the pull-out ring (on the distal side) is enlarged by the anti-relative rotation portion, the distal outlet does not move the length of the anti-relative rotation portion forward, because otherwise this would prevent the pull-out ring from being pulled forward any further.

[0033] Therefore, this disclosure also relates to an endoscope or a surgical tissue clip application assembly for an endoscope, comprising a tissue clip for suturing tissue, a cap, and a pull-out ring, the cap being mountable on, particularly insertable into, or formed from, a distal end section of the endoscope, and the tissue clip being radially supported on the radially outer circumferential surface of the cap, the pull-out ring being axially movably disposed on the cap and the tissue clip being movable in a distal direction by axial displacement of the pull-out ring, wherein the pull-out ring and the tissue clip are mutually connected in a non-rotational manner via a clamping anti-rotational rotational portion, the pull-out ring having two diametrically opposed through-holes through which a yarn of a pull-out device can be guided or is guided through, and wherein the distal outlet of the through-holes is disposed proximal to the clamping anti-rotational rotational portion.

[0034] According to a preferred embodiment, the through-hole can be arranged circumferentially in the region of the hinge section. That is, the through-hole can be arranged / constructed circumferentially offset from the clamping relative rotation portion and / or the gripping section, preferably centrally located between the gripping sections, i.e., offset by 80° to 100°, preferably about 90°, relative to the gripping sections. Therefore, the construction of the clamping relative rotation portion can be easily avoided from affecting / determining the position of the distal outlet.

[0035] According to an alternative preferred embodiment, for each gripping section, the clamping anti-rotation portion can be formed by two circumferentially offset partial protrusions that serve as circumferential stops in the rotational direction, wherein the through hole is preferably centrally arranged between the two partial protrusions (for the gripping section) in the circumferential direction. This means that the distal outlet is arranged circumferentially in the region of the gripping section or partial protrusion and (in the longitudinal / axial direction) in the region of the pull-out ring's base. This has the advantage that the yarn guide does not need to be changed relative to known yarn guides.

[0036] According to another aspect (which may exist in combination with or independently of the aspect concerning resistance to relative rotation between the cap and the pull-out ring described above), the pull-out ring may be at least segmentally, especially at least on the inner circumference side, and preferably entirely colored, the color corresponding to a wavelength range of 380 nm to 500 nm, especially 420 nm to 490 nm. That is, the pull-out ring may have the characteristic that it reflects light with wavelengths of 380 nm to 500 nm, especially 420 nm to 490 nm. Simply put, the pull-out ring may be blue.

[0037] Therefore, this disclosure also relates to an endoscope or a surgical tissue clip application assembly for an endoscope, comprising a tissue clip for suturing tissue, a cap, and a pull-out ring, the cap being mountable on, particularly insertable into, or formed from, a distal end section of the endoscope, and the tissue clip being radially supported on the radially outer circumferential surface of the cap, the pull-out ring being axially movably disposed on the cap and the tissue clip being movable in a distal direction by axial displacement of the pull-out ring, wherein the pull-out ring is at least segmentally, particularly at least circumferentially, preferably entirely colored, the color corresponding to a wavelength range of 380 nm to 500 nm, particularly 420 nm to 490 nm.

[0038] The advantage of this color selection is that the pull-out ring is particularly well identifiable and easily distinguishable from tissue, as blue is not naturally present in the human body. That is, the position of the pull-out ring can be easily determined, which in turn allows for the deduction of the tissue clip's position. This is especially true when the pull-out ring is in its forward-advanced / tissue clip ejection position, i.e., when the tissue clip has been detached from the endoscope or cap; the pull-out ring becomes particularly visible through the endoscope's optics. In other words, the simple, almost unmistakably blue color of the pull-out ring indicates that a tissue clip has been applied. Conversely, the coloring of the pull-out ring facilitates checking or determining whether tissue clip application has been performed or whether the pull-out ring must be pushed further forward by manipulating the pull-out device.

[0039] According to a preferred embodiment, the cap may be constructed to be transparent / transparent / light-transmitting, at least in the region of the distal end of the cap or in the region where a pull-out ring is mounted / arranged (at the tissue clip ejection position) or where the pull-out ring is axially movable. That is, the pull-out ring can be optically detected through the cap wall. This has the advantage that the pull-out ring is not only optically detected when the pull-out ring (or a portion of the pull-out ring) is pushed onto the distal end of the cap, but rather its position is preferably already detected in the pull-out ring's mounting position (from inside the endoscope).

[0040] This disclosure also relates to an endoscope of a preferred rod structure type with a tissue clip application assembly, wherein the endoscope has a distal end section to which a cap is mountable, particularly insertable, or wherein the distal end section forms the cap. The endoscope has optics at a distal (i.e., patient-facing endoscope tip / lens) and optionally one or more working channels extending from a proximal (patient-facing) endoscope section (which typically extends outward from the patient cavity) or an external endoscope handle through a flexible or rigid endoscope rod (attached thereto) to the endoscope lens, enabling the external introduction and supply of one or more medical devices. Attached Figure Description

[0041] Figure 1 and Figure 2 An tissue clip application component according to the present disclosure is shown, wherein only the cap and pull-out ring according to the first embodiment are shown; Figure 3 The pull-out ring according to the first embodiment is shown. Figure 4 The pull-out ring according to the second embodiment is shown. Figures 5 to 7 The tissue clip application component according to the first embodiment is shown. Figure 8 and Figure 9 This illustrates how the pull-out device of the tissue clip application component works. Figure 10 and Figure 11 The diagram illustrates yarn guidance on a pull-out loop according to the first and second embodiments, and... Figure 12 A schematic diagram of an endoscope according to this disclosure is shown. Detailed Implementation

[0042] The embodiments of this disclosure will now be described with reference to the accompanying drawings.

[0043] Figure 1 and Figure 2This illustration shows a surgical tissue clip application assembly 2 for an endoscope 38 or an endoscope 38 according to the present disclosure. The tissue clip application assembly 2 has a tissue clip 4, a cap 6, and a pull-out ring 8. The tissue clip 4 is not in... Figure 1 and Figure 2 The above is shown and will be referenced below. Figures 5 to 7 Describe it.

[0044] The cover 6 can be mounted on the distal end section of the endoscope, particularly inserted into that end section. Alternatively, the cover 6 is formed from the distal end section of the endoscope, i.e., without a separate component, but constructed integrally with the endoscope. The cover 6 is tubularly constructed and encloses a hollow internal space. The cover 6 preferably has an annular cross-section over its entire longitudinal extension. The cover 6 has a preferably cylindrical radial outer peripheral surface 10. The tissue clip 4 is preferably placed / inserted onto the cover 6 in the open / expanded state (externally) and radially (internally) supported on the radial outer peripheral surface 10 (see [link]). Figures 5 to 7 ).

[0045] The pull-out ring 8 (external) is placed / inserted onto the cap 6. The pull-out ring 8 is positioned proximal to the tissue clip 4 and preferably axially abuts against the tissue clip 4 (see [link]). Figures 5 to 7 The pull-out ring 8 is preferably arranged on the radial outer circumferential surface 10 of the cover 6 in a sliding / sliding support manner, and is axially / longitudinally movable. In particular, the pull-out ring 8 can be moved from the initial / installed position on the cover 6 (see...). Figure 1 Move to the throw position (see Figure 2 The ejection position is located far from the initial position, i.e., closer to the far end of cover 6. For axial movement of the pull-out ring, the pull-out ring 8 is preferably operable by means of a pull-out device 30 in the form of a rope pulling mechanism. The pull-out device 30 is not in... Figure 1 and Figure 2 The above is shown and will be referenced below. Figure 8 and Figure 9 Describe it.

[0046] By axial movement of the pull-out ring 8 (and by the pull-out ring 8 axially abutting against the tissue clip 4), the tissue clip 4 is movable, particularly compressible / pushable, in a direction distal / forward / towards the distal end of the cover 6. Here, the tissue clip 4 is preferably movable by the pull-out ring 8 to such an extent that the tissue clip 4 is pushed off / detached from the cover 5. That is, the pull-out ring 8 is coupled to the tissue clip 4 in such a way, particularly axially abutting against the tissue clip 4 (on the proximal side of the tissue clip), that is, the axial movement of the pull-out ring 8 causes the tissue clip 4 to move distally / forward / axially / beyond the distal end of the endoscope and / or the cover, particularly by the pull-out ring 8 pushing / pressing the tissue clip 4 distally.

[0047] According to one aspect of this disclosure, the cover 6 and the pull-out ring 8 are connectable or interlocked with each other in a way that resists relative rotation, i.e., in the connected state, the longitudinal axis / central axis around the application component 2 (or the cover 6 or the pull-out ring 8) cannot be twisted relative to each other.

[0048] Therefore, the pull-out ring 8 preferably has a cover anti-rotation portion 12, which can be placed or placed in a form-locking engagement with the cover 6 to resist relative rotation. In the illustrated embodiment, the cover anti-rotation portion 12 of the pull-out ring 8 is constructed in the form of two form-locking elements / longitudinal / axial protrusions 14 that are fitted into corresponding mating form-locking elements / longitudinal / axial grooves 16 constructed in the cover. Alternatively, the cover anti-rotation portion 12 can also be formed by only one protrusion or by more than two protrusions, although this is not shown. The protrusions 14 and the grooves 16 can be placed or placed in a form-locking abutment. Preferably, the protrusions 14 have two abutment surfaces perpendicular to the circumferential direction. In the illustrated embodiment, the protrusions 14 are each constructed substantially rectangular in cross-section.

[0049] Preferably, the pull-out ring 8 has a base 18 (see...) Figure 3 and Figure 4 The substrate 18 is preferably constructed in a closed manner on the circumferential side and is particularly annular in cross-section. Alternatively, the substrate 18 may have openings on the circumferential side, that is, be constructed only in a nearly closed manner, for example, enclosing an annular sector greater than 330°, preferably greater than 340° or 350°, and particularly greater than 355°.

[0050] Preferably, the cap anti-rotation portion 12, i.e., the protrusion 14, can extend from the base 18 in a proximal direction. That is, the protrusion 14 is configured as a support protruding from the base 18. In particular, the cap anti-rotation portion 12 can be configured on a side of the pull-out ring 8 that is opposite to or away from the axial movement direction of the pull-out ring 8 and the tissue clip 4.

[0051] Preferably, the pull-out ring 8 is preferably connected to the cover 6 in an anti-relative-rotational manner only in the initial position (and during the initial stroke from the initial position, particularly corresponding to the anti-relative-rotational length). This means that anti-relative-rotational measures are not necessary in the ejected position of the pull-out ring 8.

[0052] In particular, the tissue clip 4 may have two diametrically opposed gripping sections 20, each gripping section having gripping teeth and two preferably arcuate hinged sections 22 connecting the gripping sections 20 respectively (see...). Figures 5 to 7 In order to open / expand and to be able to be placed on the cover 6 and to be able to be re-fastened when detached from the cover 6, the gripping section 20 is able to pivot relative to each other about a hinge axis defined by the two hinge sections 22.

[0053] Preferably, the cover-resistant rotating portion 12 can be arranged circumferentially in a region of one of the hinge sections 22. That is, the region of the pull-out ring 8 that abuts against the gripping section 20 is arranged circumferentially offset relative to the cover-resistant rotating portion 12, especially in the middle of the region therebetween.

[0054] Preferably, the cap-mount relative rotation portion 12 can be constructed symmetrically with respect to the longitudinal plane, i.e., the plane axis containing the longitudinal / central axis of the tissue clip application component 2. The longitudinal plane, i.e., the plane of symmetry of the cap-mount relative rotation portion 12, preferably includes the hinge axis.

[0055] Furthermore, the tissue clip application component 2 may have a pull-out device 30, particularly in the form of a rope traction device (see...). Figure 8 and Figure 9 To allow axial movement of the pull-out ring 8, the pull-out device 30 is coupled or is coupled to the pull-out ring 8 such that a pulling force is applied to the circumferential side of the pull-out ring 8 when the pull-out device is manipulated. The anti-rotation portion 12 is particularly preferably arranged only on the circumferential side of the pull-out ring 8 that bears the pulling force.

[0056] Preferably, the longitudinal plane, i.e. the plane of symmetry of the cover anti-rotation portion 12, may include the tension-introducing position (at the pull-out ring 8). Here, the longitudinal plane including the tension-introducing position may preferably correspond to the longitudinal plane including the hinge axis.

[0057] According to other aspects of this disclosure that are claimed independently when necessary, the pull-out ring 8 and the tissue clip 4 can be connected to each other (or connected to each other) against relative rotation (around the longitudinal / central axis of the application component 2), i.e., they cannot be twisted relative to each other.

[0058] Therefore, the pull-out ring 8 preferably has a clamping anti-rotation portion 24, which can be placed or placed in a form-locking engagement with the tissue clip 4 to resist relative rotation. In the illustrated embodiment, the clamping anti-rotation portion 24 of the pull-out ring 8 is constructed in the form of two form-locking elements / protrusions 26 abutting against corresponding mating form-locking elements / abutting surfaces constructed on the tissue clip 4. Preferably, for this purpose, the protrusion 26 has two particularly (outwardly convex) curved abutting surfaces that are inclined relative to the circumferential direction for form-locking abutment against the tissue clip 4. The shape of the protrusion 26 preferably corresponds to the proximal end face section of the tissue clip 4 in the region of the gripping section 20. The proximal end face section preferably forms the abutting surface.

[0059] Preferably, the clamp-resistance rotation portion 24 can extend distally from the base 18 of the pull-out ring 8. That is, the clamp-resistance rotation portion is constructed on the side of the pull-out ring 8 facing the tissue clip 4.

[0060] Preferably, the clamping anti-rotation portion 24 can be arranged circumferentially in the region of the gripping section 20. That is, the region of the pull-out ring 8 adjacent to the hinge section 22 is arranged circumferentially offset relative to the clamping anti-rotation portion 24, especially in the middle between them. In other words, the clamping anti-rotation portion 24 and the cover anti-rotation portion 12 can preferably be arranged / constructed circumferentially offset.

[0061] Preferably, the clamping and rotating portion 24 can be constructed symmetrically with respect to the first longitudinal plane axis. Specifically, the first longitudinal plane can correspond to the longitudinal plane, with the cover and rotating portion 12 symmetrical about this longitudinal plane axis. That is, the clamping and rotating portion 24 and the cover and rotating portion 12 can be symmetrical about the same symmetry plane axis. Preferably, the clamping and rotating portion 24 can be constructed symmetrically with respect to the second longitudinal plane axis. Specifically, the second longitudinal plane can be perpendicular to the first longitudinal plane. That is, the clamping and rotating portion has two axes of symmetry.

[0062] exist Figure 3 In the embodiment shown, the clamping and anti-rotation portion 24 is formed in the form of two protrusions 26 (each gripping segment 20 has one protrusion 26), which are respectively configured as semi-elliptical / crescent-shaped in cross-section. Figure 4 In the embodiment shown, the clamping and anti-rotation portion 24 is composed of two protrusions 26 (each gripping section 20 has one protrusion 26), wherein each protrusion 26 is formed by two circumferentially offset partial protrusions / bumps / extrusion teeth 28 that serve as circumferential stops in the rotation direction.

[0063] Figure 5 and Figure 7 The tissue clip application component 2 is shown. As described above, the tissue clip 4 has gripping sections 20 arranged alternately in the circumferential direction and connected to each other. Each gripping section has a plurality of (gripping) teeth and a hinged section 22, such that the gripping sections 20 can open and the tissue clip 4 can be placed on the outside of the cover 6. The tissue clip 4 is located on the cover 6 distal to the pull-out ring 8, such that as the pull-out ring 8 moves axially forward, the tissue clip 4 is pushed forward together and thereby detached from the cover 6.

[0064] Reference Figure 8 and Figure 9 The operation of the pull-out device 30 described above is described. The pull-out device 30 has a yarn 32 coupled to a pull-out ring 8. Preferably, the yarn 32 is not fixedly fastened to the pull-out ring 8, but is movable relative to the pull-out ring 8, particularly longitudinally. Specifically, the yarn 32 is guided or can be guided through the pull-out ring 8 such that the pull of the yarn 32 pulls the pull-out ring 8 in a distal direction (particularly a path smaller than the yarn traction path).

[0065] In particular, to apply tension at the proximal (operator-side) end of the endoscope, the yarn 32 can be coupled or coupled to, and particularly fixedly connected to, an operating device, especially in the form of a manually rotatable handwheel, for example, clamped within the operating device. The yarn 32 can be guided from the operating device, preferably within the working channel of the endoscope, to the distal end of the endoscope, i.e., the patient-side end. At the tip of the endoscope or on the cap 6 placed on the endoscope, the yarn can be guided outward distal to the pull-out ring 8, where it couples with the pull-out ring 8, particularly (doublely) guided through the pull-out ring 8, then guided inward again distal to the pull-out ring 8 and substantially fixedly connected thereto to the cap 6 or the endoscope.

[0066] Preferably, the yarn 32 may pass axially through the pull-out ring 8 on the first circumferential side, for example from the distal to the proximal side (starting from the pulling end / end that introduces the tension). The yarn 32 may then be guided circumferentially on the outside of the cover 6 and proximal to the second circumferential side opposite the first circumferential side in diameter (see...). Figure 8 On the second circumferential side, the yarn 32 can be axially guided, for example, from the proximal side to the distal side, through the pull-out ring 8. This has the effect that the tension of the yarn 32 on the first circumferential side is introduced into the pull-out ring 8, and the pull-out ring 8 is pulled forward by pulling the yarn 32. In particular, the anti-rotation portion 12 is preferably arranged on the first circumferential side.

[0067] Preferably, the pull-out ring may have two diameter-opposite (extending in the longitudinal / axial direction) through holes 34 through which the yarn 32 of the pull-out device 30 may be guided or guided through.

[0068] Depending on other aspects that may be independently protected if necessary, the distal outlet 36 of the through hole 34 may be arranged near the clamping relative rotation portion 24. That is, the through hole 34 is arranged such that its distal outlet 36 is not located on the outermost distal end of the pull-out ring 8, but is offset from it in a proximal direction.

[0069] Preferably, the through hole 34 can be arranged in the circumferential direction in the region of the hinge section 22 (see...). Figure 3 In other words, the through-hole can be arranged / constructed in a staggered manner relative to the clamping rotation portion 24 and / or the gripping section 20 in the circumferential direction, preferably centrally arranged between the gripping sections, that is, staggered by 80° to 100°, preferably about 90°, relative to the gripping sections. Therefore, the distal outlet 36 (in the longitudinal direction / in the axial direction) can be arranged in the region of the base 18 of the pull-out ring 8.

[0070] Alternatively, the through hole 34 can be arranged circumferentially between the two partial protrusions 28, preferably in the middle (see...). Figure 4 This means that the distal outlet 36 is arranged circumferentially in the region of the gripping section 20 or the partial protrusion 28 and (in the longitudinal / axial direction) in the region of the base 18 of the pull-out ring 8.

[0071] According to other aspects that may be independently claimed if necessary, the pull-out ring 8 may preferably have a color corresponding to a wavelength range of 380 nm to 500 nm, especially 420 nm to 490 nm, at least in sections, particularly at least on the inner circumference side. That is, the pull-out ring 8 may have the characteristic that it reflects light with wavelengths of 380 nm to 500 nm, especially 420 nm to 490 nm. That is, the pull-out ring 8 is preferably blue.

[0072] Preferably, the cap 6 is made transparent / transparent / light-transmitting at least in the region of its distal end or in the region where the pull-out ring 8 is mounted / arranged (at the tissue clip ejection position) or where the pull-out ring 8 is axially movable.

[0073] Figure 12 An endoscope 38 according to the present disclosure is shown. The endoscope 38 has a distal end section 40. A cover 6 can be mounted on the distal end section 40. In particular, the cover 6 can be inserted into or fitted onto the distal end section 40. Alternatively, the distal end section 40 can form the cover 6 itself.

[0074] The endoscope 38 has optics disposed in a distal end section 40. Furthermore, the endoscope 38 has a proximal endoscope handle 42 and a rigid or flexible endoscope stem 44, the endoscope stem extending distally from and connected to the endoscope handle 42. The distal end section 40 may be formed from the distal end region of the endoscope stem 44. Alternatively, the distal end section 40 may extend distally from and be connected to the endoscope stem 44.

[0075] List of reference numerals

[0076] 2 Tissue Folder Application Components

[0077] 4 tissue clips

[0078] 6 lids

[0079] 8 Pull out the ring

[0080] 10 Radial outer circumferential surface

[0081] 12. Cover anti-relative rotation part

[0082] 14. Protrusion

[0083] 16 Grooves

[0084] 18 Matrix

[0085] 20. Capture Section

[0086] 22 Articulated Section

[0087] 24 Clamping Relative Rotation Part

[0088] 26 protrusions

[0089] 28 Partial protrusions

[0090] 30 Pull-out device

[0091] 32 yarn

[0092] 34 through holes

[0093] 36. Distant Exit

[0094] 38. Endoscope

[0095] 40 Distal end section

[0096] 42 Endoscope Handle

[0097] 44 Endoscope rod

Claims

1. A surgical tissue clip application component (2) for an endoscope (38) or an endoscope (38), having Tissue clips (4) used for suturing tissue. A cover (6) is mountable on, in particular insertable into, the distal end section (40) of the endoscope (38), or formed by, the distal end section (40) of the endoscope (38), and the tissue clip (4) is radially supported on the radially outer peripheral surface (10) of the cover. A pull-out ring (8) is axially movably arranged on the cover (6), and the axial displacement of the pull-out ring allows the tissue clip (4) to move in the distal direction. Its features are, The cover (6) and the pull-out ring (8) can be connected to each other or be connected to each other in a way that resists relative rotation.

2. The tissue clip application component (2) according to claim 1, characterized in that, The pull-out ring (8) has a cover anti-rotation portion (12) in the form of a protrusion (14) or preferably a plurality of protrusions (14), which can be engaged or be engaged with the cover (6) in order to resist relative rotation, particularly with a corresponding groove (16) formed in the cover (6).

3. The tissue clip application component (2) according to claim 2, characterized in that, The anti-rotation portion (12) of the cover, especially the protrusion (14) or each of the plurality of protrusions (14), has two abutment surfaces perpendicular to the circumferential direction for form-fitting against the cover (6), for example, constructed substantially rectangular in cross-section.

4. The tissue clip application component (2) according to any one of claims 1 to 3, characterized in that, The pull-out ring (8) has a base (18) that is preferably closed on the circumferential side, especially in the cross-section, and the cover anti-rotation part (12) extends away from the base (18) in a proximal direction.

5. The tissue clip application component (2) according to any one of claims 1 to 4, characterized in that, In order for the tissue clip (4) to move distally from its initial position, the pull-out ring (8) is axially movable distally, and the pull-out ring (8) is preferably specifically connected to the cap (6) in the initial position in a way that resists relative rotation.

6. The tissue clip application component (2) according to any one of claims 1 to 5, characterized in that, The tissue clip (4) has two gripping sections (20) that are opposite each other along the diameter and two preferably arc-shaped hinged sections (22) that connect the gripping sections (20) respectively, wherein the cover anti-rotation part (12) is arranged in the circumferential direction in the region of one of the hinged sections (22).

7. The tissue clip application component (2) according to claim 6, characterized in that, The gripping section (20) is pivotable relative to each other about a hinge axis defined by the two hinge sections, wherein the cover anti-rotation portion (12) is constructed symmetrically with respect to a longitudinal plane axis that preferably includes the hinge axis.

8. The tissue clip application component (2) according to any one of claims 1 to 7, characterized in that, The tissue clip application component includes a pull-out device (30), particularly in the form of a rope pulling device, which is coupled to the pull-out ring (8) for axial movement such that when the pull-out device (30) is manipulated, a pulling force is applied to the circumferential side of the pull-out ring (8), wherein the cap anti-rotation part (12) is preferably arranged only on the circumferential side of the pull-out ring (8) that bears the pulling force.

9. The tissue clip application component (2) according to claim 8, characterized in that, The cover anti-rotation part (12) is constructed symmetrically with respect to the longitudinal plane axis of the position where the tension is introduced.

10. The tissue clip application component (2) according to any one of claims 1 to 9, characterized in that, The pull-out ring (8) and the tissue clip (4) are connected to each other in a way that resists relative rotation.

11. The tissue clip application component (2) according to claim 10, characterized in that, The pull-out ring (8) has a clamping anti-rotation portion (24) in the form of a single protrusion (26) or preferably multiple protrusions, especially two protrusions (26), which can be engaged or be engaged with the tissue clip (4) in order to resist relative rotation, especially with one or more corresponding surfaces constructed in the tissue clip (4).

12. The tissue clip application component (2) according to claim 11, characterized in that, The clamping anti-rotation portion (24), especially the protrusion (26) or each of the plurality of protrusions (26) has two particularly curved abutment surfaces inclined in the circumferential direction for shape-locking abutment against the tissue clip (4), for example, constructed substantially semi-elliptical in cross-section.

13. The tissue clip application component (2) according to any one of claims 10 to 12 and claim 4, characterized in that, The clamping and anti-rotation part (24) extends distally from the base (18).

14. The tissue clip application component (2) according to any one of claims 10 to 13 and claim 6, characterized in that, The clamping and anti-rotation part (24) is arranged in the circumferential direction in the region of one of the gripping sections (20).

15. The tissue clip application component (2) according to any one of claims 10 to 14 and claim 7, characterized in that, The clamping anti-rotation part (24) is constructed symmetrically with respect to the first longitudinal plane axis, wherein the first longitudinal plane preferably corresponds to the longitudinal plane, and the cover anti-rotation part (12) is symmetrical with respect to the longitudinal plane axis.

16. The tissue clip application component (2) according to claim 15, characterized in that, The clamping anti-rotation part (24) is constructed symmetrically with respect to the axis of the second longitudinal plane, wherein the second longitudinal plane is perpendicular to the first longitudinal plane.

17. The tissue clip application component (2) according to any one of claims 1 to 16 and claim 8, characterized in that, The pull-out ring (8) has two diameter-opposite through holes (34), through which the yarn (32) of the pull-out device (30) can be guided or guided through the through holes, wherein the distal outlet (36) of the through holes (34) is arranged near the clamping relative rotation part (24).

18. The tissue clip application component (2) according to claims 17 and 6, characterized in that, The through hole (34) is arranged in the region of the hinge section (22) along the circumferential direction.

19. The tissue clip application component (2) according to claims 17, 6, and 11, characterized in that, The clamping anti-rotation part (24) is formed by two circumferentially offset partial protrusions (28) that serve as circumferential stops in the direction of rotation, wherein the through hole (34) is preferably centrally arranged between the two partial protrusions (28) in the circumferential direction.

20. The tissue clip application component (2) according to any one of claims 1 to 19, characterized in that, The pull-out ring (8) is at least segmentally, especially at least on the inner circumferential side, and preferably entirely colored, the color corresponding to a wavelength range of 380 nm to 500 nm, especially 420 nm to 490 nm.

21. The tissue clip application component (2) according to claim 20, characterized in that, The cover (6) is made transparent, particularly at least in the distal end region of the cover (6) or in the region where the pull-out ring (8) is arranged or in the region where the pull-out ring (8) is axially movable.

22. An endoscope (38) having a tissue clip application component (2) according to any one of claims 1 to 21, wherein, The endoscope (38) has a distal end section (40), and the cover (6) can be mounted on the distal end section, in particular can be inserted into the distal end section, or the distal end section forms the cover (6).

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