Clip for endoscope

Abstract

To provide a clip device capable of easily grasping the tissue of a patient in surgical treatment.SOLUTION: The clip includes an arm member that is openable and closable and has a first arm and a second arm, and a holder that supports the arm member, the first arm includes a first claw extending at a first angle with respect to the first arm, and a first anchor extending at a second angle larger than the first angle with respect to the first arm, the second arm includes a second claw extending at a third angle with respect to the second arm, and a second anchor extending at a fourth angle larger than the third angle with respect to the second arm, when the arm member is in a closed state, a distance between a tip of the first anchor and a tip of the second anchor is smaller than a width of the holder in an opening / closing direction of the arm member.SELECTED DRAWING: Figure 5B

Description

[Technical Field]

[0001] [CROSS-REFERENCE TO RELATED APPLICATIONS] This application claims the benefit of U.S. Provisional Application No. 63 / 092,981, filed October 16, 2020, the entire contents of which are incorporated herein by reference.

[0002] [Technical field] The present invention relates to a clip for grasping tissue of a patient during a surgical procedure, which can be used with a surgical instrument such as an endoscope. [Background technology]

[0003] In the following description, reference is made to certain structures and / or methods. However, the following description should not be construed as an admission that these structures and / or methods are prior art. Applicant expressly reserves the right to demonstrate that such structures and / or methods do not qualify as prior art to the present invention.

[0004] Endoscopic clips, or endoclips, are used with endoscopes to grasp tissue within the human body. Endoclips find use in therapeutic procedures such as preventing tissue bleeding, closing perforations, and other surgical procedures. Many endoclips come in different shapes and / or sizes, can be handled using disposable and reloadable systems, and are available with or without a retractable closure to facilitate placement of the clip in the body.

[0005] For example, Patent Document 1 discloses an endoscopic clip having protrusions on the inner surface of the clip's arm plates. The protrusions are directed inward and face each other, and are configured to facilitate holding tissue between the clip's arms when the clip is closed. [Prior art documents] [Patent documents]

[0006] [Patent Document 1] JP 2015-008858 A Summary of the Invention [Problem to be solved by the invention]

[0007] However, there continues to be a further need for clips that can grasp patient tissue during surgical procedures and that can be used with surgical instruments such as endoscopes. [Means for solving the problem]

[0008] An advantage of the present invention is that the clip includes an anchor and can contact and adhere to a patient's tissue more easily than a clip without an anchor. The clip of the present disclosure can more easily grasp tissue, for example, when the clip approaches the tissue at an angle less than perpendicular to the tissue.

[0009] These and other advantages are provided, at least in part, by the following clip: The clip is configured to grasp tissue and includes a first arm having a first claw at a distal end and a second arm having a second claw at a distal end, the first arm and the second arm being movable toward each other in a direction to close the clip. In some embodiments, the first claw and the second claw face each other. In other embodiments, the first arm and the second arm are movable in a reciprocating direction to move the clip toward and away from each other, opening and closing the clip. In other embodiments, the first arm and the second arm are configured to move toward each other in a direction to close the clip, and once the arms are closed, the clip can be locked to prevent opening.

[0010] Advantageously, the clip comprises one or more anchors, such as a first anchor on the first arm. The clip may optionally comprise a second anchor on the second arm. The first anchor protrudes from the first arm in a direction other than the direction in which the first and second arms move toward each other to close the clip. If the clip comprises a second anchor, the second anchor protrudes from the second arm in a direction other than the direction in which the first and second arms move toward each other to close the clip. In some embodiments, the clip comprises a first anchor and a second anchor.

[0011] Embodiments of the present disclosure may include one or more of the following features, individually or in combination. For example, the clip of the present disclosure may be configured with a pressure tube connectable to a sheath. The clip may be connected to a wire directly or via a connector. In some embodiments, the clip may be combined with a cover that protects the first anchor and the second anchor when the clip is retracted into the pressure tube. In other embodiments, the first anchor and the second anchor may protrude through slits in the arms. In other embodiments, the first anchor and the second anchor may protrude in a direction perpendicular to a plane defined by the first arm and the second arm. In other embodiments, the first arm and the second arm may be rotatable toward a plane defined by the first arm and the second arm. In other embodiments, each of the first arm and the second arm may be bendable.

[0012] Additional advantages of the present invention will become readily apparent to those skilled in the art from the following detailed description, wherein only preferred embodiments of the invention are shown and described, merely as illustrations of the best mode contemplated for carrying out the invention. As will be realized, the invention is capable of other and different embodiments, and its several details can be modified in various obvious respects, all without departing from the invention. Accordingly, the drawings and description are to be regarded as illustrative in nature, and not as restrictive. [Brief explanation of the drawings]

[0013] [Figure 1A] 1 is a diagram illustrating a clip of an anchor protruding from the outer peripheral surface of a first arm and the outer peripheral surface of a second arm, in this example, the anchor protruding from each arm in a direction that diverges from the reciprocating direction of the first and second arms that open and close the clip. [Figure 1B] 1 is a diagram illustrating a clip of an anchor protruding from the outer peripheral surface of a first arm and the outer peripheral surface of a second arm, in this example, the anchor protruding from each arm in a direction that diverges from the reciprocating direction of the first and second arms that open and close the clip. [Figure 1C] 1 is a diagram illustrating a clip of an anchor protruding from the outer peripheral surface of a first arm and the outer peripheral surface of a second arm, in this example, the anchor protruding from each arm in a direction that diverges from the reciprocating direction of the first and second arms that open and close the clip. [Figure 1D] 1 is a diagram illustrating a clip of an anchor protruding from the outer peripheral surface of a first arm and the outer peripheral surface of a second arm, in this example, the anchor protruding from each arm in a direction that diverges from the reciprocating direction of the first and second arms that open and close the clip. [Figure 2A] 1A-1C are schematic diagrams illustrating a clip with anchors that can be protected by a cover connected to a component of a clip device according to aspects of the present disclosure. [Figure 2B] 1A-1C are schematic diagrams illustrating a clip with anchors that can be protected by a cover connected to a component of a clip device according to aspects of the present disclosure. [Figure 2C] 1A-1C are schematic diagrams illustrating a clip with anchors that can be protected by a cover connected to a component of a clip device according to aspects of the present disclosure. [Figure 2D] 1A-1C are schematic diagrams illustrating a clip with anchors that can be protected by a cover connected to a component of a clip device according to aspects of the present disclosure. [Figure 2E]1A-1C are schematic diagrams illustrating a clip with anchors that can be protected by a cover connected to a component of a clip device according to aspects of the present disclosure. [Figure 3A] 10A-10C illustrate soft anchors protruding through slits in the arms of a clip after the clip has opened, according to aspects of the present disclosure. [Figure 3B] 10A-10C illustrate soft anchors protruding through slits in the arms of a clip after the clip has opened, according to aspects of the present disclosure. [Figure 3C] FIG. 3C is an enlarged view of the arms of the clip shown in FIG. 3B. [Figure 4A] 10A-10C are schematic diagrams illustrating soft anchors protruding through slits in the arms of a clip after the clip has opened, according to aspects of the present disclosure. [Figure 4B] 10A-10C are schematic diagrams illustrating soft anchors protruding through slits in the arms of a clip after the clip has opened, according to aspects of the present disclosure. [Figure 4C] FIG. 4B is an enlarged view of the arms of the clip shown in FIG. 4A. [Figure 4D] 10A-10C are schematic diagrams illustrating other soft anchors protruding through slits in the arms of a clip after the clip has been opened, according to aspects of the present disclosure. [Figure 4E] 10A-10C are schematic diagrams illustrating other soft anchors protruding through slits in the arms of a clip after the clip has been opened, according to aspects of the present disclosure. [Figure 4F] 10A-10C are schematic diagrams illustrating other soft anchors protruding through slits in the arms of a clip after the clip has been opened, according to aspects of the present disclosure. [Figure 4G] 10A-10C are schematic diagrams illustrating other soft anchors protruding through slits in the arms of a clip after the clip has been opened, according to aspects of the present disclosure. [Figure 4H] 10A-10C are schematic diagrams illustrating other soft anchors protruding through slits in the arms of a clip after the clip has been opened, according to aspects of the present disclosure. [Figure 5A]10 is a diagram illustrating a clip having anchors protruding from the first and second arms in a direction from which the first and second arms diverge to a direction from which the arms close. In this example, the width W defined by both ends of the anchor in the closed state is smaller than the width of the pressure tube and smaller than the width of a treatment tool channel such as an endoscope channel. [Figure 5B] 10 is a diagram illustrating a clip having anchors protruding from the first and second arms in a direction from which the first and second arms diverge to a direction from which the arms close. In this example, the width W defined by both ends of the anchor in the closed state is smaller than the width of the pressure tube and smaller than the width of a treatment tool channel such as an endoscope channel. [Figure 6A] FIG. 10 is a schematic diagram of a clip having an anchor protruding in a direction perpendicular to the plane formed by the arms and a pressure tube having an opening large enough for the anchor to enter when the clip is pulled into the pressure tube. [Figure 6B] FIG. 10 is a schematic diagram of a clip having an anchor protruding in a direction perpendicular to the plane formed by the arms and a pressure tube having an opening large enough for the anchor to enter when the clip is pulled into the pressure tube. [Figure 7A] 1A-1C are schematic diagrams illustrating a clip having one or more bioabsorbable anchors for grasping biological tissue of a patient, according to aspects of the present disclosure. [Figure 7B] 1A-1C are schematic diagrams illustrating a clip having one or more bioabsorbable anchors for grasping biological tissue of a patient, according to aspects of the present disclosure. [Figure 7C] 1A-1C are schematic diagrams illustrating a clip having one or more bioabsorbable anchors for grasping biological tissue of a patient, according to aspects of the present disclosure. [Figure 8] 1A and 1B are schematic diagrams illustrating a clip having one anchor and gripping a patient's biological tissue, according to aspects of the present disclosure. [Figure 9A]1A-1C are schematic diagrams illustrating clips having multiple anchors per arm and / or multiple anchors protruding in different directions according to embodiments of the present disclosure. [Figure 9B] 1A-1C are schematic diagrams illustrating clips having multiple anchors per arm and / or multiple anchors protruding in different directions according to embodiments of the present disclosure. [Figure 9C] 1A-1C are schematic diagrams illustrating clips having multiple anchors per arm and / or multiple anchors protruding in different directions according to embodiments of the present disclosure. [Figure 10] 1A and 1B are schematic diagrams illustrating a clip having two anchors and gripping a patient's biological tissue, according to aspects of the present disclosure. [Figure 11A] 10A-10C are schematic diagrams illustrating a clip with an anchor configured to rotate relative to a plane defined by the arms when the clip is retracted into the pressure tube according to aspects of the present disclosure. [Figure 11B] 10A-10C are schematic diagrams illustrating a clip with an anchor configured to rotate relative to a plane defined by the arms when the clip is retracted into the pressure tube according to aspects of the present disclosure. [Figure 11C] 10A-10C are schematic diagrams illustrating a clip with an anchor configured to rotate relative to a plane defined by the arms when the clip is retracted into the pressure tube according to aspects of the present disclosure. [Figure 12A] 1A and 1B are schematic diagrams illustrating a clip according to aspects of the present disclosure, the clip having arms with markers identifying the location of anchors on each arm. [Figure 12B] 1A and 1B are schematic diagrams illustrating a clip according to aspects of the present disclosure, the clip having arms with markers identifying the location of anchors on each arm. [Figure 13A] 1A and 1B are schematic diagrams illustrating a clip according to an embodiment of the present disclosure, the clip having gapped claws or claws that are wider or narrower than the anchor width, to allow for easier observation of the anchor when the clip is in use. [Figure 13B] 1A and 1B are schematic diagrams illustrating a clip according to an embodiment of the present disclosure, the clip having gapped claws or claws that are wider or narrower than the anchor width, to allow for easier observation of the anchor when the clip is in use. [Figure 14A] 1 is a schematic side view of a clip arm with an anchor protruding from the arm in a direction perpendicular to the longitudinal axis of the first arm, in this example the anchor is hook-shaped to allow for perpendicular placement of the clip in tissue. [Figure 14B] 1 is a schematic side view of a clip arm with an anchor protruding from the arm in a direction perpendicular to the longitudinal axis of the first arm, in this example the anchor is hook-shaped to allow for perpendicular placement of the clip in tissue. [Figure 15A] FIG. 10 is a schematic side view of a clip according to an aspect of the present disclosure, the clip having a curved portion in the arm of the clip, configured to be detached from the surgical instrument after the clip is attached to the patient's tissue. [Figure 15B] FIG. 10 is a schematic side view of a clip according to an aspect of the present disclosure, the clip having a curved portion in the arm of the clip, configured to be detached from the surgical instrument after the clip is attached to the patient's tissue. [Figure 16] 1C is a schematic side view of a clip having a curved portion on the arm according to an embodiment of the present disclosure, and FIG. [Figure 17A] 1 is a schematic side view of a clip according to an aspect of the present disclosure, the clip having a curved portion and a notch on the arm. FIG. [Figure 18] 1 is a schematic side view of a clip having two articulated arms connected via a joint according to an embodiment of the present disclosure. FIG. [Figure 19] 1A and 1B are schematic diagrams illustrating a clip having an arm with two articulated portions connected via a joint that can lock the arm in a bent state according to an embodiment of the present disclosure, and (C) is an enlarged view of the arm of the clip shown in (B). [Figure 20] 10 is a schematic side view of another embodiment of a clip having two articulated arms connected via a joint. FIG. DETAILED DESCRIPTION OF THE INVENTION

[0014] Reference is made to the accompanying drawings, in which elements having the same numeral designation represent like elements throughout. Throughout all drawings, dimensions of each component have been appropriately adjusted for clarity. In some instances, only some of the named features are labeled in the figures for clarity.

[0015] The clips of the present disclosure are directed to clip devices useful in therapeutic patient procedures such as preventing tissue bleeding, closing perforations and hemostasis, suturing internal wounds, marking lesions and traction (mucosal elevations), and other surgical procedures. As used herein, the term "patient" includes any living organism and includes the term "subject." A patient may be a human or an animal.

[0016] Clips that clamp tissue are typically actuated using a clip operating tool. Such tools typically actuate the clip via a control wire housed in a flexible tube. The control wire can be advanced and retracted longitudinally within the flexible tube by manipulating the tool's handle. As used herein, the term "distal" refers to a direction away from the control handle, while the term "proximal" refers to a direction toward the control handle. Clip operating tools are disclosed in U.S. Pat. Nos. 8,480,685 and 9,949,740, the entire disclosures of which are incorporated herein by reference.

[0017] Various embodiments of clips according to the present disclosure will be described with reference to FIGS.

[0018] 1A to 1D, a clip 10 for grasping a patient's biological tissue includes a first arm 12 having a first claw 12a at its tip and a second arm 13 having a second claw 13a at its tip. As further shown, the first claw 12a and the second claw 13a face each other, and the first arm 12 and the second arm 13 are configured to move in a reciprocating direction (R) to open and close the clip, moving it toward and away from each other. When the arms are closed, the first claw and the second claw are flush or nearly flush and contact each other.

[0019] The clips of the present disclosure advantageously have one or more anchors (protrusions) protruding from the first arm and / or the second arm. Anchors, as used herein, include structures that can attach to a patient's tissue by contact with minimal force, and may include, for example, protrusions, hooks, barbs, spikes, etc. The one or more anchors protrude from each arm in a direction other than the direction in which the first and second arms move toward each other to close the clip. For example, the anchors may protrude in a direction diverging from the prongs, in a direction perpendicular to the plane defined by the first and second arms (perpendicular to the arms), or in a direction other than the direction in which the first and second arms move toward each other to close the clip.

[0020] As further shown in FIGS. 1A to 1D , the first arm 12 has a first anchor (first protrusion) 14a that protrudes from the outer periphery of the first arm 12 in a direction branching from the first claw 12a. The second arm 13 has a second anchor (second protrusion) 14b that protrudes from the outer periphery of the second arm 13 in a direction branching from the second claw 13a. The clip 10 can be deployed from a pipe (hereinafter also referred to as a “holding tube”) 16 that can be connected to a flexible tube 18. During surgery, the arms 12 and 13 are biased to an open state configured to receive tissue, as shown in FIGS. 1C and 1D , and are closed by being driven by a control wire (not shown). The control wire is coupled to the clip and can slide the clip proximally and distally within the pipe. The control wire can be advanced and retracted within the flexible tube by operating the control handle of a clip manipulation tool (not shown). Sliding the clip proximally and distally moves the arms and claws toward and away from each other, thereby opening and closing the clip. In some embodiments, once the clip is retracted into the hold-down tube, the clip can be locked to prevent opening.

[0021] As shown in FIGS. 1C and 1D, the clip of the present disclosure has the advantage of being able to attach to tissue even when the clip's approach is not perpendicular to the tissue, such as a tangential approach. Here, FIG. 1C illustrates a perpendicular approach, and FIG. 1D illustrates a tangential approach. In a non-perpendicular approach, the second anchor 14b of the second arm 13 can capture tissue T near the defect D. When the clip is closed after the anchor captures the tissue, the claws and arms can lift the tissue, allowing the claws of the arms to more easily grip the tissue. Furthermore, after the anchor captures the tissue, the clip can rotate so that the claws of the arms further grip the tissue with the anchor attached to the tissue. Advantageously, one or more anchors with arms provided on the periphery of the clip of the present disclosure can prevent the tips of the clip's arms from slipping when the clip is tangentially approached to the tissue (FIG. 1D).

[0022] Specifically, as shown in FIG. 1D , the surgeon presses second arm 13 against tissue T in the direction of the tangential approach (the direction of the arrow indicated by A in the figure), thereby hooking and drawing the mucosa with second anchor 14b, and thereby allowing the mucosa to be tucked into second arm 13. By further pressing second arm 13, the surgeon can rotate clip 10 around second anchor 14, thereby orienting the clip directly toward tissue T. Note that, to optimally exert the above-described effect, it is desirable that at least one of first anchor 14a and second anchor 14b contact tissue T perpendicularly in the tangential approach.

[0023] Figures 2A through 6B illustrate another embodiment of a clip of the present disclosure, illustrating another method for reducing contact with a clip tool or endoscope. For example, Figures 2A through 2E show a cover for protecting the anchors of the clip. In Figures 2A and 2B, cover 21 is attached to and extends distally from pressure tube 16. Clip 10 is closed by retracting it into pressure tube 16 (Figure 2B). When the clip is retracted into the pressure tube, cover 21 can extend distally enough to protect one or more anchors located on the periphery of the arms. As shown in Figure 2B, when clip 10 is retracted into pressure tube 16, cover 21 extends distally enough to protect anchors 14a and 14b.

[0024] Figures 2C-2E show different attachment locations for the cover that can protect the anchor of the clip. For example, Figure 2C shows cover 21 attached to sheath 18. Figures 2D-2E show how cover 21 can be attached to link 29 or wire 27. Figure 2D shows the clip in an open position, exposing the anchor. Figure 2E shows the clip in a closed position, protecting the anchor with cover 21. When the clip is retracted into the pressure tube, the cover extends distally enough to protect the anchor, regardless of where it is attached. Cover 21 can be made of plastic or other resilient material or metal and can be attached with adhesive or welding.

[0025] 3A-3C and 4A-4C show flexible anchors protruding through slits in the arms of the clip after the clip is opened. As shown in FIG. 3A, when the clip is closed, the first anchor 34a and the second anchor 34b are protected by the inner surfaces of the first arm 32 and the second arm 33 of the clip 30. The first anchor 34a and the second anchor 34b are connected to the clip 30 by flexible members 31a and 31b, respectively. As shown in FIGS. 3B and 3C, when the clip 30 is in the open state, the first anchor 34a protrudes through a slit 35 in the first arm 32 of the clip 30. When the clip 30 is in the open state, the second anchor 34b also protrudes through a slit in the second arm 33 of the clip 30, although this is not shown for convenience. In this way, the anchors can be protected before the clip is deployed, such as when the clip is deployed from a pressure tube.

[0026] In another embodiment, Figures 4A through 4H show flexible anchors protruding through slits in the arms of the clip after the clip is opened. Specifically, as the clip 30 moves toward the closed position, the first anchor 44a and the second anchor 44b are retracted toward the first arm 42 and the second arm 43, respectively (Figures 4B-4C). When the clip 40 is in the open position, as shown in Figure 4A, the first anchor 44a protrudes through a slit 45 provided in the first arm 42 of the clip 40 by the flexible member 41a. When the clip 40 is in the open position, the second anchor 44b also protrudes through a slit provided in the second arm 43 of the clip 40, although this is not shown for convenience. In this manner, the anchors can be moved closer to the arms of the clip as the clip is retracted into the pressure tube 16.

[0027] As further shown in FIGS. 4D through 4H, when inserted into a tool such as an endoscope (FIGS. 4E and 4F), the clip and flexible member can be in a closed state. Because the clip arms and flexible member are biased to an open state, they open when the clip is removed from the tool channel (FIGS. 4D and 4G). During surgery, an operating handle (not shown) connected to the proximal end of a wire (not shown) manipulates the wire 47 to retract the clip 40 into the pressure tube 16 to close the clip. Certain clip devices may include a detachable connector 49 that connects the pressure tube to the sheath 18 (FIG. 4H). Such clip devices include a connector that engages or disengages the distal end of the clip from the wire. Furthermore, the connector may include an internal engaging or disengaging element (FIG. 4H).

[0028] In another embodiment, Figures 5A and 5B show a clip 50 for grasping a patient's biological tissue. The clip includes a first arm 12 having a first claw 12a at its distal end and a second arm 13 having a second claw 13a at its distal end. As further shown, the first claw 12a and the second claw 13a face each other, and the first arm 12 and the second arm 13 are configured to move in a reciprocating direction (R) to move toward and away from each other to open and close the clip. As further shown in the figures, the first arm 12 has a first anchor 14a protruding in a direction branching from the first claw 12a, and the second arm 13 has a second anchor 14b protruding in a direction branching from the second claw 13a. The clip 50 can be deployed toward an open state from within a pressure tube 16 (Figure 5A). The width W, defined as the distance between the anchors in the closed state (Figure 5B), is smaller than the width of the pressure tube 16 and the width of a treatment tool channel, such as an endoscope channel, so that the anchors 14a and 14b protruding from the arms do not or only minimally contact the channel.

[0029] In another embodiment, FIGS. 6A and 6B show a clip including a first arm 12 having a first claw 12a at its distal end and a second arm 13 having a second claw 13a at its distal end. As further shown, the first claw 12a and the second claw 13a face each other, and the first arm 12 and the second arm 13 are configured to move toward each other to close the clip. In this embodiment, the first claw 12a and the second claw 13a come into contact when the arms are closed. As further shown, the clip includes a first anchor 64a on the first arm 12 and a second anchor 64b on the second arm 13. Both anchors protrude in a direction perpendicular to the plane formed by the first arm 12 and the second arm 13. The pressure tube 66 has an opening, e.g., a diameter D large enough to allow the anchor to enter the pressure tube when the clip is retracted into the pressure tube. FIG. 6B shows the anchor 64 in the pressure tube 66 when the clip is retracted into the pressure tube and in a closed position.

[0030] The arms, claws and anchors may be in any suitable form, for example in the form of a wire (as in the embodiment shown in Figures 1A to 1D), in the form of a ribbon (as in the embodiment shown in Figures 6A to 6B), or in a combination form, for example, such that the arms and claws are in the form of a ribbon and the anchor is in the form of a wire.

[0031] Figures 7 to 8 show another embodiment of anchors provided on the arms of a clip. In particular, Figures 7A to 7C show a clip for grasping a patient's biological tissue T. The clip includes a first arm 12 having a first claw 12a at its distal end and a second arm 13 having a second claw 13a at its distal end. The first claw 12a and the second claw 13a face each other. As further shown, the first arm 12 has a first anchor 74a protruding from the outer periphery of the first arm 12 in a direction branching off from the first claw 12a. The second arm 13 has a second anchor 74b protruding from the outer periphery of the second arm 13 in a direction branching off from the second claw 13a. In this example, the first anchor 74a and the second anchor 74b are formed of a bioabsorbable material. Thus, after the anchors adhere to the tissue T, they eventually dissolve in the tissue and can be removed from the clip (Figure 7C). Anchors made of such bioabsorbable materials can be attached to the clip arms with an adhesive, such as a bioabsorbable adhesive.

[0032] 8 to 11 show anchors protruding in a direction perpendicular to the plane defined by the first and second arms. In particular, FIGS. 8 and 10 show a clip for grasping a patient's biological tissue T, which includes a first arm 12 having a first claw 12a at its distal end and a second arm 13 having a second claw 13a at its distal end. The first claw 12a and the second claw 13a face each other, and the first arm 12 and the second arm 13 are configured to move toward each other to close the clip. As shown in FIG. 8(A), the second arm 13 has a first anchor 84a protruding from it in a direction perpendicular to the plane P defined by the first and second arms. As shown in the figures, the arms form a plane having X and Y coordinates, and the anchor protrudes in the Z-axis direction. In FIG. 10(A), the first arm 12 has a first anchor 104a protruding in a direction perpendicular to the plane defined by the first and second arms 12 and 13. The second arm 13 has a second anchor 104b that protrudes in a direction perpendicular to the plane defined by the first arm and the second arm. The first anchor 104a and the second anchor 104b protrude in opposite directions from the plane defined by the arms. The configuration in which at least one anchor protrudes in a direction perpendicular to the plane defined by the first arm and the second arm lifts tissue when the arms approach each other (81 in FIG. 8(C) and 101 in FIG. 10(C)), allowing the tissue to be advantageously captured by the perpendicular anchor (FIGS. 8(B) and 10(B)), facilitating grasping of tissue by the arms.

[0033] As shown in Figure 10(B), the claws of the arms that do not have a protrusion on the tissue T side come into direct contact with the tissue T. As shown in Figure 10(C), when the arms approach each other, the tissue is lifted, and finally the tissue T is grasped by the two claws.

[0034] 9A through 9C illustrate clips having multiple anchors per arm and / or multiple anchors protruding in different directions. In particular, FIG. 9A shows a first arm 12 having two anchors. A first anchor 94a protrudes from the first arm 12 in a direction perpendicular to the plane defined by the first and second arms. A second anchor 94c protrudes from the first arm 12 in a direction perpendicular to the plane defined by the first and second arms, opposite the direction of the first anchor 94a. The second arm 13 also has two anchors. A third anchor 94b protrudes from the second arm 13 in a direction perpendicular to the plane defined by the first and second arms. A fourth anchor 94d protrudes from the second arm 13 in a direction perpendicular to the plane defined by the first and second arms, opposite the direction of the third anchor 94b. FIG. 9B shows a first arm 12 having two anchors (first anchor 94a and third anchor 94b) and a second arm 13 having a fourth anchor 94d. FIG. 9C shows arms each having one anchor (first anchor 94a, fourth anchor 94d), which project in different directions relative to the plane defined by the first and second arms.

[0035] 11A, 11B, and 11C illustrate anchors configured to rotate relative to the plane defined by the arms when the clip is retracted into the pressure tube. For example, referring to FIGS. 11A and 11B, first anchor 114a and second anchor 114b are attached to first arm 12 and second arm 13, respectively, by structures, such as pins (111a, 111b), that allow the anchors to rotate relative to the plane defined by the arms when the clip is retracted into pressure tube 116 and the end of the pressure tube contacts the anchors.

[0036] The surgeon hooks the mucosa with the first anchor 114a and the second anchor 114b. As shown in FIG. 11B, the surgeon retracts the first arm 12 and the second arm 13 into the pressure tube 116, causing the first anchor 114a and the second anchor 114b that have come into contact with the pressure tube 116 to rotate toward the plane defined by the first arm 12 and the second arm 13 (119 shown in FIG. 11B). As a result, the mucosa hooked on the first anchor 114a and the second anchor 114b is lifted up to the first claw 12a and the second claw 13a. The surgeon can easily transfer the mucosa hooked on the first anchor 114a and the second anchor 114b to the first claw 12a and the second claw 13a.

[0037] 11C illustrates an anchor structure configured to rotate the anchor relative to the plane defined by the arms of the clip when the arms extend and retract from the pressure tube. As shown, anchor 114 is integrally formed with arms 13 and biased to an open position. However, anchor 114 closes when retracted into pressure tube 116. This structure eliminates the need for a pin to configure the anchor to rotate relative to the plane defined by the arms when the clip is retracted into pressure tube 116. Instead, the anchor has a spring biased to an open position and pops out of the pressure tube when retracted distally from the pressure tube.

[0038] 12-13 show clips with anchors that can be easily identified during use. For example, FIGS. 12A and 12B show a first arm 12 and a second arm 13 with markers 121 identifying the location of a first anchor 124a or a second anchor 124b on each arm. In this manner, even when the anchors are not visible to the user, such as when they are caught in tissue T, the user can identify the location of the anchors using the markers (121a, 121b) on the first and second arms, respectively. The markers 121 on the clip arms may be formed by fluorescent markers, colors, symbols, textures created on the arms such as bumps, or the like, or the like at the anchor locations.

[0039] Figures 13A and 13B show clips with claws that have gaps or that are wider or narrower than the anchors, allowing for easier viewing of the anchors during use. For example, Figures 13A and 13B show clip 10 in which first and second arms (12, 13) have first and second claws (12a, 13a), each of which has a width that is narrower than the claw width (134a, 134b) or wider than the claw width (134c, 134d), allowing for easier viewing of the anchors during use. Figure 13A shows first claw 132a with a gap that allows for easy viewing of first anchor 134a, and second claw 133a with a gap that allows for easy viewing of second anchor 134b.

[0040] 14-20 schematically illustrate clip arms according to the present disclosure that can advantageously apply a force perpendicular to the tissue when the clip is tangential to the tissue and can be curved to allow multiple clips to be positioned close to one another. For example, FIGS. 14A and 14B are side views of clip 10, showing first arm 12 with anchor 144 extending from first arm 12 in a direction perpendicular to the longitudinal axis of the first arm. In this example, anchor 144 is hook-shaped and extends perpendicular to the plane defined by the first and second arms of the clip, allowing the clip to be positioned perpendicular to tissue T. After anchor 144 attaches to tissue T, the clip rotates (141 shown in FIG. 14B), exerting a force V perpendicular to the tissue. Another advantage of anchors on clips as described herein is that they can firmly press the clip against the mucosa, allowing more tissue to be inserted between the prongs and grasped by the clip.

[0041] Specifically, the surgeon hooks sharp portion 144a provided at the tip of anchor 144 onto the mucous membrane and presses sheath 18 toward tissue T in the longitudinal direction of sheath 18. As a result, sharp portion 144a rotates around the hooked portion (141 shown in FIG. 14B), and sheath 18 bends. This generates an additional force pressing anchor 144 against tissue T. Conventional clips can only be pressed in the longitudinal direction of sheath 18, but clip 10 of the present embodiment can also be pressed in a direction V perpendicular to the longitudinal direction of sheath 18.

[0042] In certain embodiments, clips of the present disclosure can be detached from a surgical instrument and used to clip patient tissue. To facilitate adjacent placement of the clips, the clip arms are configured to be curved. As shown in the side views of FIGS. 15A and 15B, the clip can be configured to be detached from the surgical instrument after it is attached to the patient's tissue (150a). However, placement of a second clip (150b) is somewhat limited by the proximal end of the clip and a member attached to the proximal end of the clip, such as a pressure tube. In this example, clip 150c includes a first arm 152 having a first anchor 154, a second arm (not shown), and a pressure tube 156. As shown, clip 150c includes a curved portion or member 151 along the clip. In this manner, clips with bendable arms and anchors can be easily positioned adjacent to each other when attached to the patient's tissue.

[0043] Figures 16 through 20 schematically illustrate various structural features of bendable clip arms. For example, Figures 16(A) and 16(C) show a clip 160 having a first arm 162 with a resilient member 161. The second arm of the clip 160 also has a resilient member, but this is not shown in the side view of Figure 16. The clip arms are biased to a bent state, and when the clip is loaded onto the pressure tube 166, the clip arms assume a straight state L. When the clip arms 162 are deployed from the pressure tube 166, they are curved, as shown in the unloaded state U. As an alternative to or in addition to a resilient member, the clip arms may have one or more springs that bias the arms into a bent state. When such a clip is placed in a channel of an endoscope 165, the arms are straight. When the clip is deployed from the channel, the arms are curved (Figure 16(B)). In FIG. 17A, clip arms 172 include notches 171 that allow stress relief when the arms are bent.

[0044] Other structures that can be used to configure the arms of a representative disclosed clip to be bendable are shown in FIGS. 18 to 20. In FIGS. 18(A) and 18(B), a clip arm 182 has two joints (a distal joint 182a and a proximal joint 182b) connected via a joint 181. FIGS. 19(A) to 19(C) show configurations for locking the arms of a bendable clip. FIG. 19(A) shows a clip arm 192 having two joints (a distal joint 192a and a proximal joint 192b) connected to a joint 191. The proximal joint 192b has a pin 191a that moves along a groove 191b when the arm moves to a bent position. The pin passes through a protrusion 191c provided in the groove 191b, locking the arm in the bent state. 19(B) and 19(C) show a clip arm 195 having two joints (an inner joint 195a and an outer joint 195b) connected via a joint 191, with the inner joint 195a of the arm having a recess 197a and the outer joint 195b having a protrusion 197b. When the outer joint 195b of the arm 195 rotates to a position where the arm is bent, the recess 197a engages with the protrusion 197b, as shown in the cross-sectional view of the arm 195 (FIG. 19(C)).

[0045] Figures 20(A) to 20(D) show an articulated clip arm with a spring. In Figure 20(A), the arm 202 has two articulation sections (a distal articulation section 202a and a proximal articulation section 202b) connected by a spring 201. The clip arm is biased to a curved state, and when a clip is loaded onto the pressure tube 206, the clip arm assumes a straight state L. On the other hand, when the clip arm 202 is deployed from the pressure tube 166, it bends as shown in Figure 20(B) as an unloaded state U. When such a clip is placed in a channel of an endoscope 205, the arm is straight. On the other hand, when the clip is deployed from the channel, the arm bends (Figures 20(C) and 20(D)).

[0046] In other examples, the clip arms can be formed from a shape memory alloy, such as nickel titanium, that transitions between straight or bent configurations based on stress state or temperature.

[0047] While the claimed invention has been described in detail with reference to specific embodiments, it will be apparent to those skilled in the art that various changes and modifications can be made to the claimed invention without departing from the spirit and scope of the invention. Thus, for example, those skilled in the art will recognize or be able to ascertain, using no more than routine experimentation, equivalents to the specific substances and procedures described herein. Such equivalents are considered to be within the scope of this invention and are covered by the following claims. [Explanation of symbols]

[0048] 10, 30, 40, 50, 160 clips 12,32,42 First Arm 12a,132a First claw 13,33,43 Second Arm 13a,133a Second claw 14a, 34a, 44a, 64a, 74a, 104a, 114a, 124a, 134a, 134c First anchor (first protrusion) 14b, 34b, 44b, 64b, 74b, 104b, 114b, 124b, 134b, 134d Second anchor (second protrusion) 84a First anchor (first protrusion) 94a First anchor (first protrusion) 94b Third anchor (third protrusion) 94c Second anchor (second protrusion) 94d Fourth anchor (fourth protrusion) 144 Anchor 16,66,116,156,166,206 Pipe, pressure pipe 18 Flexible tube (sheath) 18 Sheath 21 Cover 27,47 wire 29,49 Connecting part 35,45 slit 111a, 111b pins 121, 121a, 121b markers 151 Curved parts, curved members 152,162 First Arm 154 First Anchor 161 Elastic member 162,172,182,192,195,202 Clip Arm (Arm) 171 Notch 181 Joint 182a, 192a, 195a, 202a Tip joint 182b, 192b, 195b, 202b Proximal joint 191 Joint 191a pin 191b Groove 191c protrusion 197a Recess 197b Convex part 201 Spring

Claims

1. an arm member having a first arm and a second arm and capable of being opened and closed; a holder for supporting the arm member; Equipped with The first arm a first claw extending at a first angle relative to the first arm; a first anchor extending at a second angle relative to the first arm that is greater than the first angle; and The second arm is a second claw extending at a third angle relative to the second arm; a second anchor extending at a fourth angle relative to the second arm that is greater than the third angle; and When the arm members are in a closed state, a distance between a tip of the first anchor and a tip of the second anchor in an opening / closing direction of the arm members is smaller than a width of the holder. clip.

2. When the first arm and the second arm are in a closed state, at least a portion of the first arm and at least a portion of the second arm are housed in the holder, and the first anchor and the second anchor are disposed at positions protruding from the holder. The clip of claim 1 .

3. the first arm has a first arm body that grasps tissue and a first deformation portion that deforms when the arm member transitions from an open state to a closed state, the second arm has a second arm body that grasps tissue and a second deformation portion that deforms when the arm member transitions from an open state to a closed state, the first claw and the first anchor are provided at a tip of the first arm body, the second claw and the second anchor are provided at a tip of the second arm body; The clip of claim 2.

4. a wire capable of operating the arm member; a sheath through which the wire can be inserted; Furthermore, When the arm members are in a closed state, the distance between the tip of the first anchor and the tip of the second anchor is smaller than the inner diameter of the sheath. The clip of claim 1 .

5. The first claw and the second claw are configured to be able to grasp tissue, the first anchor and the second anchor are barbs capable of piercing tissue; The clip of claim 1 .

6. the first claw and the first anchor extend from a tip of the first arm in a bifurcated manner, The second claw and the second anchor extend from a tip of the second arm in a bifurcated manner. The clip of claim 1 .

7. a base end of the first claw and a base end of the first anchor are connected to each other; The base end of the second claw and the base end of the second anchor are connected to each other. The clip of claim 6.

8. a width of the first anchor is smaller than a width of the first claw in a width direction intersecting both a direction in which the first arm extends and a direction in which the arm member opens and closes; a width of the second anchor is smaller than a width of the second claw in a width direction intersecting both a direction in which the second arm extends and a direction in which the arm member opens and closes; The clip of claim 1 .

9. an arm member having a first arm and a second arm and capable of being opened and closed; a holder for supporting the arm member; Equipped with The first arm a first claw extending from the first arm; a first anchor extending from the first arm and branching off from the first claw; and The second arm is a second claw extending from the second arm; a second anchor extending from the second arm and branching off from the second claw; and When the arm members are in a closed state, a distance between a tip of the first anchor and a tip of the second anchor in an opening / closing direction of the arm members is smaller than a width of the holder. clip.

10. When the first arm and the second arm are in a closed state, at least a portion of the first arm and at least a portion of the second arm are housed in the holder, and the first anchor and the second anchor are disposed at positions protruding from the holder. The clip of claim 9.

11. the first arm has a first arm body that grasps tissue and a first deformation portion that deforms when the arm member transitions from an open state to a closed state, the second arm has a second arm body that grasps tissue and a second deformation portion that deforms when the arm member transitions from an open state to a closed state, the first claw and the first anchor are provided at a tip of the first arm body, the second claw and the second anchor are provided at a tip of the second arm body; The clip of claim 10.

12. a wire capable of operating the arm member; a sheath through which the wire can be inserted; Furthermore, When the arm members are in a closed state, the distance between the tip of the first anchor and the tip of the second anchor is smaller than the inner diameter of the sheath. The clip of claim 9.

13. The first claw and the second claw are configured to be able to grasp tissue, the first anchor and the second anchor are barbs capable of piercing tissue; The clip of claim 9.

14. a base end of the first claw and a base end of the first anchor are connected to each other; The base end of the second claw and the base end of the second anchor are connected to each other. The clip of claim 9.

15. a width of the first anchor is smaller than a width of the first claw in a width direction intersecting both a direction in which the first arm extends and a direction in which the arm member opens and closes; a width of the second anchor is smaller than a width of the second claw in a width direction intersecting both a direction in which the second arm extends and a direction in which the arm member opens and closes; The clip of claim 9.

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