Tissue clip compatible installation or retrofit set

Abstract

The present disclosure relates to a tissue clip adaptive attachment or retrofit set (1) with a cap attachment (2). The tissue clip adaptive attachment or retrofit set (1) is designed to be attached, particularly to be mounted, to the distal end of a shaft-type medical endoscope (3), and for this purpose has a preferably proximal attachment or mounting portion (4) and a preferably distal tissue clip holding portion (5). In the region of the proximal attachment or mounting portion (4) and the distal tissue clip holding portion (5), a cavity (6) is formed therein that is open at least in the distal direction, and a tissue clip (9) is radially supported on its radially outwardly facing outer circumferential surface (8) and can be displaced distally by a distancing device in the form of a cable-pull operable distancing ring (10) that is axially slidably mounted on the radially outer circumferential surface (8) of the tissue clip holding portion (5) to move the tissue clip (9). The cable pull is in direct contact with the distancing ring (10) at at least two connection or engagement points (18) for transmitting a sliding force.

Description

[Technical Field]

[0001] The present disclosure relates to a tissue clip adapting / attaching set with a cap attachment, which is designed to be mounted or fitted / attached to the distal end of a shaft-type medical endoscope and, for this purpose, has a proximal mounting / mounting portion and a distal tissue clip holding portion. In the region of the proximal mounting / mounting portion and the distal tissue clip holding portion, a distally opening cavity is formed therein, and a tissue clip is radially supported on one of the radially outwardly facing circumferential surfaces of the distal tissue clip holding portion and can be radially displaced by a pull-off device, preferably operable / actuable from the proximal end of the endoscope or from outside the body. The pull-off device is in the form of a pull-off ring slidably mounted on the radially outer circumferential surface of the tissue clip holding portion and adapted to guide / displace / move the tissue clip. [Background technology]

[0002] An endoscope is a medical working tool generally used for visual exploration and, in some cases, manipulation of a patient's body cavity. For exploration, an endoscope generally has an optical device at its distal end (also known as the endoscope head) (facing the patient, not the user). For manipulation, an endoscope optionally has one or more internal working channels extending from a proximal endoscope portion (facing the user, not the patient) that protrudes outward from the patient's cavity, or an extracorporeal endoscope handle via a flexible or rigid endoscope shaft adjacent to the endoscope head, allowing for the extracorporeal insertion or delivery of one or more medical instruments, such as forceps, anchors, scissors, needles, slings, scalpels, etc.

[0003] Such endoscopes may optionally be provided with additional capabilities by attaching a cap or sleeve over the endoscope head that houses / contains at least the optics, e.g., radially external to the distal endoscope head. As used herein, a cap or sleeve has a certain function or comprises a certain functional component. This allows the endoscope to be used as a (minimally invasive) instrument to perform interventional or surgical procedures in addition to its original function, i.e., exploration, and / or as access for minimally invasive (medical) instruments.

[0004] Endoscopes with additional functions implemented by caps (cap attachments) are already known from the prior art, for example DE 102017112896 A1 shows a tissue clip application set or retrofit set, which can be attached to the distal end of an endoscope in order to detach the tissue clips from the cap attachment by means of a tear-off ring.

[0005] Another example of an endoscopic cap is disclosed in German Utility Model No. 202008007774. The endoscopic cap has a holding and separating device for tissue clips that can be pressed against the expanding sleeve of the endoscopic cap. An open forward groove is arranged at the front edge of the expanding sleeve, cutting open the jacket wall of the cap on both sides. Furthermore, the endoscopic cap has, in the axial front cap part, a separating thread or fiber that radially crosses the forward groove and is slidably inserted or insertable into an endoscope channel operating radially inside the endoscopic cap.

[0006] Also, U.S. Patent Application No. 2013 / 0325039 shows an endoscopic cap capable of extracting tissue clips by a proximal actuation extraction device in the form of an actuator cable connected to a carrier / distraction ring disposed within the cap, which displaces the tissue clips.

[0007] However, the endoscopic caps disclosed in the prior art always suffer from the drawback that the distancing ring guided inside the cap reduces the available cross-sectional area of ​​the working channel, whereas a distancing ring guided on the periphery and actuatable by a distancing string is prone to clogging and may even be damaged. [Prior art documents] [Patent documents]

[0008] [Patent Document 1] German Patent Publication No. 102017112896 [Patent Document 2] German Utility Model No. 202008007774 [Patent Document 3] U.S. Patent Application No. 2013 / 0325039 Summary of the Invention [Problem to be solved by the invention]

[0009] It is an object and goal of the present disclosure to eliminate or at least reduce the disadvantages of the prior art, and in particular to provide a tissue clip adaptive attachment or retrofit set that eliminates or reduces the risk of distraction ring clogging without (undue) limiting the available area of ​​the working channel.

[0010] Said objects and aims are solved by the present disclosure, which relates to a comprehensive tissue clip adaptive attachment or retrofit set, by the subject matter of claim 1. The present disclosure is therefore based on the understanding of introducing forces into the distancing ring as uniform or symmetrical as possible. [Means for solving the problem]

[0011] In accordance with the present disclosure, the tissue clip adaptive attachment or retrofit set is configured / made so that actuation of the distraction device applies an axial force to the distraction ring that is distributed around the circumference of the distraction ring or applied as symmetrically as possible.

[0012] For this purpose, possibly according to a first embodiment of the present disclosure, which may be claimed independently, the simple pulley principle is constructively applied, according to the following: the (first) cable pull end is held stationary (distal); a central portion of the cable pull is longitudinally slidably coupled to a (proximal) load, specifically a distancing ring; The other (second) cable pull end is directed posteriorly around the distal deflection in the direction of the (proximal) load and possibly beyond the distal deflection (proximally).

[0013] The central portion operatively coupled to the load, i.e., the distancing ring, can be dimensioned and / or positioned in such a way as to apply a force substantially symmetrically to the load (distancing ring), thereby avoiding jamming. Specifically, the central portion of the cable pull may be in sliding contact with the load (distancing ring) at at least two hinge points (coupling loops, attachment points) circumferentially spaced (preferably at opposite poles) on the endoscope / (separating) endoscopic cap. As a result, when the cable pull is pulled, the central portion slides longitudinally at the hinge points, thereby displacing the distancing ring distally according to the pulley principle. Preferably, the cable pull portion between at least two hinge points on the distancing ring is directed longitudinally in the circumferential direction (preferably proximally forward), thereby allowing the distancing ring force to be more uniformly introduced into the distancing ring over the corresponding circumferential portion.

[0014] Advantageous embodiments are claimed in the dependent claims and are described below.

[0015] In a preferred embodiment, as already indicated, the axial force can act on the distraction ring at at least two hinge locations / engagement points, preferably evenly / uniformly distributed around its periphery, during operation / activation of the distraction device. Here, it can be advantageous if a distraction thread / pulling fiber / pulling cable is connected (looped) to the distraction ring, with one end leading from the cavity to the proximal end of the endoscope and the other end fixed to the tissue clip holding portion. Particularly preferably, a single distraction thread can be guided on the cap attachment so that actuation of the distraction thread pulls the distraction ring distally at two engagement points. This allows the distraction ring to be pulled distally at at least two engagement points with only a single (unbranched) distraction thread, while at the same time ensuring a more uniform application of force and thus a lower tilting moment.

[0016] According to a particularly advantageous further development, the tear-away thread is Preferably, from the proximal end of the endoscope, through the internal (or external) working channel of the endoscope, to the cavity; radially outward from the cavity (of the separating endoscope cap) through a first distal radial through-opening formed in the tissue clip retaining portion; Thereafter, through a first axial through opening formed in the distancing ring, Then, along the outer circumferential surface of the (separating) endoscope cap and through a second axial through-opening formed in the distancing ring, preferably offset by 180 degrees from the first axial through-opening, The detachment thread may be guided into the cavity through a second distal radial through-opening formed in the tissue clip holding portion, preferably offset by 180 degrees from the first radial through-opening, where the detachment thread may be secured to the tissue clip holding portion (securing point).

[0017] Preferably, at least two separation threads assigned to an engagement point may be arranged on the separation ring, which ensures that substantially the same axial force is applied to each engagement point and that no tilting moment occurs.

[0018] It is also contemplated that the separation thread may be guided along the cap attachment so that more than one engagement point is configured. Here, the separation thread may be guided through further radial and axial through-openings to obtain additional engagement points. In particular, deflection points may be located or configured distally between the engagement points, like pulleys. In a particularly advantageous configuration, the separation thread may be configured to enter the cavity beyond the leading edge and then exit again via a further distal radial through-opening, from which it proceeds to the next proximal engagement point on the separation ring.

[0019] According to a second alternative embodiment of the present disclosure, which may optionally be claimed independently, the distancing ring has support / bearing members fastened / fixed to the cap attachment, preferably to its tissue clip holding portion, for example in the form of a support ring with an axial or radial outer surface having a slope / pitch in the distal direction (e.g., a wedge-shaped distal front or spindle), and a sliding ring axially slidably and rotatably mounted along the outer circumferential surface of the tissue clip holding portion and disposed (at least partially) distal to the support member / support ring, the sliding ring having a profiling that operatively engages with the slope of the support ring.

[0020] Furthermore, the separation string is disposed on the sliding ring such that (manual) actuation of the separation string causes the separation string to rotate the sliding ring about the axis of rotation and displace the sliding ring in a distal direction as a result of functional engagement of the cross section of the sliding ring with the slope of the support ring.

[0021] For this purpose, it is advantageous if at least one respective ramp / cam / support wedge is arranged on the front face of the support ring facing the sliding ring and on the front face of the sliding ring facing the support ring, the orientation of said wedges being opposite, so that upon actuation of the separating string and corresponding rotation of the sliding ring relative to the support ring, the spacing between the support ring and the sliding ring increases in the axial direction.

[0022] According to another further development, an internal thread may be arranged on the sliding ring and an external thread with a corresponding pitch may be arranged on the support ring, which engages with said internal thread, so that when the separating string is activated, the distance between the support ring and the sliding ring increases in the axial direction. Of course, an internal thread may be arranged on the support ring and an external thread arranged on the sliding ring, which engages with said internal thread, so that when the separating string is activated, the distance between the support ring and the sliding ring increases in the axial direction.

[0023] Furthermore, it may be advantageous for at least one tear-away string to be guided in an axial groove formed in the tissue clip holding portion in the distal and / or proximal direction, so that the tissue clip passes through the tear-away string guided in the axial groove during removal.

[0024] In accordance with the present disclosure, the at least one distraction string may be routed to the proximal end of the endoscope via a separate longitudinal passageway, preferably located laterally along the endoscope shaft, although it is also contemplated that the at least one distraction string may be routed within the internal working channel of the endoscope toward the proximal end of the endoscope.

[0025] For adaptive attachment of tissue clips or optimized use of retrofit sets, the cap attachment may be comprised of a cap sleeve that is firmly connected to the cap attachment, preferably of one piece with the cap attachment, and that radially, at least partially, surrounds the tissue clip attached to the tissue clip holding portion. [Brief explanation of the drawings]

[0026] The present disclosure will be described in detail below with reference to drawings based on preferred configuration examples. [Figure 1] FIG. 1 shows a schematic diagram of a tissue clip adaptive attachment or retrofit set secured to an endoscope, according to a preferred embodiment. [Figure 2] FIG. 2 shows a side view of a tissue clip adaptive attachment or retrofit set according to a preferred embodiment. [Figure 3] FIG. 3 shows a longitudinal cross-sectional view of a tissue clip adaptive attachment or retrofit set according to a variation of the preferred embodiment. [Figure 4] FIG. 4 shows a partial schematic view of a separating device according to a further example configuration, which may possibly be claimed independently. [Figure 5] FIG. 5 shows a partial schematic view of a separating device according to a further example configuration, which may possibly be claimed independently. [Figure 6] 6 shows a partial schematic view of a separating device according to a further embodiment, which may possibly be claimed independently. The drawings are essentially schematic and are intended merely to facilitate understanding of the present disclosure. Identical elements are provided with identical reference symbols. The features of the various embodiments may be interchangeable. DETAILED DESCRIPTION OF THE INVENTION

[0027] FIG. 1 shows a schematic diagram of a tissue clip adaptor or retrofit set 1 configured as or including a cap attachment 2. The cap attachment 2 may be placed on, and in particular attached or fitted to, the distal end (endoscope head) of an endoscope 3. The endoscope 3, only partially shown in FIG. 1 , typically has a (flexible or rigid) endoscope shaft at its distal end, on which at least one optical system and an illumination device are located, as is known from the prior art discussed above and the description that forms the subject of this application. Furthermore, such endoscopes 3 often have an internal working channel, through which, for example, (minimally invasive) medical instruments (e.g., forceps, scissors, etc.) can be inserted into a patient's cavity (shown and represented by dashed lines in FIG. 1 ). Finally, a rinsing device may be provided at the distal end (endoscope head) of the endoscope 3, allowing the optics to be cleaned.

[0028] Endoscopes 3 of known design also have an endoscope handle at the proximal end by which the endoscope 3 can be held and manipulated. It should be noted that the endoscope 3 may have an interface to a robot instead of a handle.

[0029] According to a preferred embodiment, the tissue clip adapting attachment or retrofit set 1 or cap attachment 2 has a proximal attachment / mounting portion 4 and a distal tissue clip holding portion 5, which may at least partially or completely overlap in the axial direction. As described above, the tissue clip adapting attachment or retrofit set 1 with the attachment / mounting portion 4 may be temporarily attached to or fitted, respectively, to the distal end of the endoscope 3. For this purpose, the attachment / mounting portion 4 is preferably formed in the shape of a sleeve or cuff made of a flexible, preferably elastic, material. Alternatively, the attachment / mounting portion 4 can be manufactured from a radially expandable plastic sleeve, for example, by providing at least one longitudinal slot or as a result of a predetermined inherent flexibility. Furthermore, the attachment / mounting portion 4 is fitted to the distal end so as to form a quasi-axial extension of the distal end of the endoscope shaft, i.e., is not inserted into the internal working channel of the endoscope 3. The internal working channel of the endoscope 3 thus remains open and available for insertion of a medical instrument.

[0030] It should be mentioned here that the cap attachment 2 can also be connected to the endoscope head of the (commercially available) endoscope 3 in other ways, for example using a separate cap sleeve, heat shrink tubing, and similar connecting members.

[0031] The tissue clip holding portion 5 is preferably more rigid (hollow) than the attachment / mounting portion 4 and is preferably joined to the attachment / mounting portion 4 as an extension of one piece, in particular of one piece of material, or consists of a plastic sleeve connected to the attachment / mounting portion 4 by, for example, bonding or welding. At least the tissue clip holding portion 5 defines a hollow or cavity 6 therein. The hollow or cavity 6 is provided, for example, to temporarily receive the patient's tissue, and at the distal end of the tissue clip holding portion 5 forming a distal leading or trailing edge 7, merges with a radially outward facing side / periphery 8 on which the tissue clip 9 (in its expanded state) is supported so as to be axially movable.

[0032] It should be noted here that this outer peripheral surface 8 may be the largest radially outer surface (as shown in FIG. 1) or may be further covered / surrounded by an outer peripheral surface disposed further radially outward to form an axially extending annular gap (not shown in FIG. 1) for receiving a tissue clip 9.

[0033] 1 , the tissue clip 9 is coupled / attached at its proximal front surface / edge to a distancing ring 10, which is also supported / mounted on the outer circumferential surface 8 of the tissue clip holding portion 5. This connects the distancing ring 10 to the distancing string 11 as follows: as will be explained in more detail below and in FIG. 2 , manually actuating the distancing string 11 (pulling the distancing string 11 in the proximal direction) causes the distancing ring 10 to slide distally along the tissue clip holding portion 5, thereby shifting / displacing the tissue clip 9 distally. In other words, pulling the distancing string 11 displaces the distancing ring 10, and thus the tissue clip 9, in the axial direction of the tissue clip holding portion 5.

[0034] 1, the cap sleeve 12 may be disposed / fixed to the cap attachment 2, or the cap sleeve 12 may be rigidly connected to the cap attachment 2, in particular may be a single piece of material with the cap attachment 2. This cap sleeve 12 at least partially surrounds the tissue clip 9 that is pulled by the tissue clip holding portion 5, and thus can at least partially protect the distancing device consisting of the distancing ring 10 and the distancing string 11.

[0035] FIG. 3 shows a longitudinal cross section of a tissue clip adaptive attachment or retrofit set 1 according to a preferred embodiment.

[0036] In the distal end region (facing away from the user) of the tissue clip holding portion 5, a first radial through-opening 13 connects the inner cavity 6 with the outer peripheral surface 8, and is configured so that the tearing thread 11, introduced into the cavity 6, is introduced via the first radial through-opening 13. In a preferred configuration, the tearing thread 11 extends with its proximal end through the cavity 6 towards the endoscope 3 and is introduced via a separate longitudinal passage 14 that is temporarily arranged on the endoscope 3, for example by a clip and / or strap, to the proximal end of the endoscope 3, i.e., preferably outside the patient's hollow organ, so that the tearing thread 11 can be manipulated / actuated, preferably manually, from outside the patient's hollow organ. Alternatively, the tearing thread 11 may be introduced via the cavity 6 into the working channel of the endoscope 3 and from there to the proximal end of the endoscope 3. As a further alternative, the tear string can be routed into a tube / channel that is held separately from the endoscope / endoscope shaft, so that the cap attachment, together with the attached clips, tube and tear string routed longitudinally therein, forms a uniform tissue clip adaptive attachment or retrofit set 1 that can be added to a (commercially available) endoscope as an optional smart feature without compromising its internal function.

[0037] In a preferred configuration, such a tear-away string 11 is led radially through a first radial through-opening 13 originating from the cavity 6 to the outer / circumferential surface of the tissue clip adaptive mounting or retrofit set 1, and from there is led proximally through a first axial through-opening 15 formed in the tear-away ring 10. The tear-away string 11 then travels (i.e., circumferentially) around the tissue clip holding portion 5 along the outer circumferential surface 8 of the (sleeve-shaped) cap attachment 2, as shown in FIG. 2, and is then led distal to the distal end region of the tissue clip holding portion 5 through a second axial through-opening 16 formed in the tear-away ring 10, which is preferably offset by 180 degrees from the first axial through-opening 15, where it is returned into the cavity 6 through a second radial through-opening 17, which is preferably offset by 180 degrees from the first radial through-opening 13, and is anchored to the tissue clip holding portion 5.

[0038] 3, one end of the tearing thread 11 is attached to the proximal end of the endoscope 3, and the other end of the tearing thread 11 is attached to the tissue clip holding part 5. The tearing thread 11 starts from the proximal end of the endoscope 3 and is led via a separate channel or working channel (tube) or via a channel of the endoscope 3 towards its distal end and from there into the cavity 6 of the tissue clip adaptive mounting or retrofit set 1. In the distal end region of the tissue clip holding part 5, the tearing thread 11 passes through the first radial through-opening 13 and exits, where it is led proximally along the outer peripheral surface 8 of the tearing ring, through the first axial through-opening 15 of the tearing ring 10, and then distally again along the outer peripheral surface 8 through the second axial through-opening 16 of the tearing ring 10. Via a second radial through opening 17 formed in the distal end region of the tissue clip holding portion 5 , the tear-away string 11 re-enters the cavity 6 and is attached to the tissue clip holding portion 5 .

[0039] This thread guidance basically corresponds to a simple pulley with a rigidly fixed upper thread end, a (working) end that is first guided around the upper flexure and then extends downwards, and a central part of the thread that is located between the fixed part and the flexure and is suspended over the load.

[0040] When the user thereby activates the distraction string 11 at the proximal end of the endoscope 3, i.e., pulls the distraction string 11 in the proximal direction as shown by arrow A in Figure 2, an axial force acts on the distraction ring 10 in the distal direction at the at least two engagement points 18 in the region of the two axial through-openings 15, 16, ultimately shifting / displacing the distraction ring 10 towards the distal end of the tissue clip holding portion 5 in order to detach the tissue clip 9 beyond its leading edge 7 from the tissue clip holding portion 5. Since the axial force acts on the distraction ring 10 at each of the at least two engagement points 18, any tilting moment that would occur at only one engagement point when an axial force is applied, tilting / twisting the distraction ring 10 about its central axis / axis of rotation, can be eliminated or at least minimized, thereby reducing the risk of jamming of the distraction ring 10 on the tissue clip holding portion 5.

[0041] In other words, the function of the tissue clip adapting attachment or retrofit set 1 according to the preferred embodiment or a variant of the preferred embodiment can generally be described as follows: First, the tissue clip adapting attachment or retrofit set 1 according to the present disclosure is attached / fitted to the distal end of a (commonly known) endoscope 3. The distal end of the endoscope 3, together with the fitted tissue clip adapting attachment or retrofit set 1, can be directed toward the wall of the hollow organ by a known orientation mechanism, for example in the form of a Bowden cable. As soon as the distal front side, i.e., the distal leading edge 7 (which may be rounded), of the tissue clip adapting attachment or retrofit set 1 is pressed against the tissue of the wall of the patient's hollow organ, the patient's tissue can be drawn into the cavity 6 of the tissue clip adapting attachment or retrofit set 1. This is achieved by the negative pressure created in the cavity 6 and / or by an inserted instrument (forceps, hook, tissue anchor, etc.). Additionally, other medical instruments can be introduced into cavity 6 through the internal working channel of endoscope 3 in order to grasp the patient's tissue to be treated at two separate locations and draw it into cavity 6. In this way, the patient's tissue can be grasped even more easily. Once sufficient tissue has been drawn into cavity 6, tissue clip 9 is removed distally by tear string 11 beyond leading edge 7, with leading end 7 together with tissue clip 9 clamping the patient's tissue.

[0042] 4 to 6 show diagrammatically a separating device according to another embodiment of the above configuration, which can be claimed independently, and in the following essentially only the features which differ from the first embodiment will be considered.

[0043] The distancing ring 10 is consequently made in two parts, comprising a stationary support ring / connecting piece 19 connected to the cap attachment 2 and a sliding rotatable ring 20 (hereinafter simply referred to as the sliding ring) displaceable relative to the support ring 19. The distancing thread 11 is attached to the outer circumferential surface of the sliding ring 20 in such a way that the distancing thread 11 extends at least partially in the circumferential direction, so that the sliding ring 20 rotates about an axis of rotation when the distancing thread 11 is actuated, i.e. when the distancing thread 11 is pulled in the proximal direction.

[0044] As shown in FIG. 4 , the front surface of the support ring 19 facing the sliding ring 20 is configured with two ramps / cams / wedge profiles 21. In addition, the front surface of the sliding ring 20 facing the support ring 19 also has two ramps 22 that proceed in opposite directions relative to the wedge profiles 21. That is, as shown in FIGS. 5 and 6 , each end surface of the support ring 19 or the sliding ring 20 is configured with a ramp surface / profile, and when the sliding ring 20 rotates relative to the support ring 19, the ramp surfaces / profiles, preferably the ramps 21 and 22, slide against each other, thereby causing the sliding ring 20 and the support ring 19 to increasingly move apart from each other in the axial direction. The sliding ring 20 pushes the tissue clip 9 distally to remove the tissue clip 9 from the tissue clip holding portion 5.

[0045] In the above preferred configuration, the tearing string 11 is guided between the outer peripheral surface 8 and the tissue clip 9. That is, the tearing string 11 passes through the tissue clip 9 radially inward between the first radial through-opening 13 and the first axial through-opening 15, and between the second axial through-opening 16 and the second radial through-opening 17. It is also conceivable to form respective axial grooves on the outer peripheral surface 8 of the tissue clip holding portion 5 in which the tearing string 11 is guided, so that the tissue clip 9 lightly touches the tearing string 11 guided in the axial groove during removal.

[0046] Furthermore, in a preferred embodiment, the tear-off thread 11 is guided along the cap attachment 2 so that, when activated, two engagement points 18 are set.

[0047] Alternatively, however, the distancing thread 11 may be guided along the cap attachment 2 so that more than one engagement point is formed. This means that the distancing thread 11 is guided through further radial and axial through-openings to obtain additional engagement points. However, similar to a pulley, a deflection point must be located or formed distally between the engagement points. To form a deflection point, the distancing thread 11 may, for example, be guided inwardly beyond the leading edge 7 into the cavity 6, and then outward again through a further distal radial through-opening, from which it may be guided to the next proximal engagement point on the distancing ring 10.

[0048] Also, in a preferred configuration, the tear-away thread 11 is fixed to the cap attachment 2 inside the region of the cavity 6. However, other fixing points are also conceivable, as long as the tear-away thread 11 is held stationary distally. Thus, the tear-away thread 11 may be fixed distally to the outer circumferential surface 8 or may have at its distal end a body or node with a cross-sectional area larger than the cross-sectional area of ​​the second radial through-opening 17, the body or node being configured or attached in such a way that, after passing through the second radial through-opening 17, the distal end of the tear-away thread 11 cannot pass through the second radial through-opening 17 or is held stationary.

[0049] Furthermore, in a preferred configuration, the distancing thread 11 is led at the engagement point via an axial through-opening. However, it is also conceivable that small holes are configured or arranged on the distancing ring 10 to allow deflection of the distancing thread 11.

[0050] As mentioned above, in a preferred embodiment, two engagement points 18 are formed on the separating ring 10 for guiding the separating thread 11. However, instead of forming two engagement points, a second separating thread may be provided, or multiple separating threads may be provided for multiple engagement points, respectively. In other words, a separate separating thread may be associated with each engagement point.

[0051] Furthermore, in a further configuration, the support ring 19 and the sliding ring 20 have ramps 21, 22. Alternatively, an internal thread may be configured on the support ring 19, which engages with an external thread configured on the sliding ring 20, so that rotation of the sliding ring 20 by actuation of the separation string 11 displaces the sliding ring 20 distally relative to the support ring 19. It is also conceivable that an internal thread is configured on the sliding ring 20 and an external thread is configured on the support ring 19. [Explanation of symbols]

[0052] 1 Tissue Clip Adaptation or Retrofit Set 2 Cap Attachments 3 Endoscopy 4 Mounting / Placement Part 5 Tissue clip holding part 6 cavities 7 leading edge 8 Side / outer surface 9 Tissue Clips 10 Pull-Apart Ring 11 Pull-off thread 12 Cap Sleeves 13 First radial through opening 14 Longitudinal aisle 15 first axial through opening 16 Second axial through opening 17 Second radial through opening 18 Engagement point 19 Support ring 20 Sliding ring 21 Support ring side ramp / cam 22 Sliding ring side ramp / cam

Claims

1. A tissue clip adaptive installation or retrofit set (1), comprising: a cap attachment (2) designed to be attached to the distal end of a shaft-type medical endoscope (3); a mounting or placing portion (4) for mounting the tissue clip adaptive attachment or retrofit set (1) to the distal end of the medical endoscope (3); a tissue clip holding portion (5) having a cavity (6) formed therein that is open at least in a distal direction; a tissue clip (9) supported radially on one of the distally and radially outwardly facing peripheral surfaces (8) of said tissue clip holding portion (5) and supported so as to be displaceable in said distal direction; a distancing device in the form of a distancing ring (10) actuatable by a cable pull to move said tissue clip (9); and the cap attachment (2) having the mounting or placing portion (4) proximally and the tissue clip holding portion (5) distally; said cable pull being or comprising a tear-off thread (11); the central part of the separating thread (11) is in direct contact with the separating ring (10) at two engagement points (18) so that it can slide by applying a force to the separating thread (11); The tissue clip adaptive attachment or retrofit set (1) is characterized in that one end of the separation string (11) is fixed or held stationary at or near the one end distal to the tissue clip (9) of the cap attachment, passes from there through a first of the two engagement points (18), and finally passes through a second of the two engagement points (18), returns to the folded portion of the cap attachment in the distal direction, then bends back in the proximal direction, and the other end reaches the proximal end of the endoscope, thereby causing the tissue clip (9) to move in the distal direction by operating the other end of the separation string (11) in the proximal direction, thereby reducing the distance between the first of the two engagement points (18) of the separation ring (10) and the one end of the separation string (11), and the longitudinal distance between the second of the two engagement points (18) and the folded portion of the cap attachment.

2. 2. The tissue clip adaptive attachment or retrofit set (1) according to claim 1, characterized in that the two engagement points (18) are evenly distributed around the circumference of the distancing ring (10).

3. 2. The tissue clip adaptive attachment or retrofit set (1) according to claim 1, characterized in that the detachment thread (11) is slidably guided longitudinally through the first and second of the two engagement points (18) by folding back the detachment thread (11) on the circumferential surface (8) of the cap attachment (2) facing radially outward, so that when the detachment thread (11) is activated, it pulls the detachment ring (10) in the distal direction at the two engagement points (18).

4. 4. The tissue clip adaptive attachment or retrofit set (1) according to claim 3, characterized in that the detachment thread (11) is in sliding contact with the proximal front surface of the detachment ring (10) at its periphery between the two engagement points (18).

5. The separation thread (11) is drawn from the cavity (6) by radially outwardly through a first distal radial through-opening (13) formed in said tissue clip holding portion (5); through a first axial through-opening (15) formed in the distancing ring (10) along the circumferential surface (8); and and through a second axial through-opening (16) formed in said distancing ring (10), 2. The tissue clip adaptive attachment or retrofit set (1) according to claim 1, characterized in that the tissue clip is guided through a second distal radial through-opening (17) formed in the tissue clip holding portion (5).

6. 3. The tissue clip adaptive attachment or retrofit set (1) according to claim 2, characterized in that at least two detachment threads (11) separately associated with each of the two engagement points (18) are arranged on the detachment ring (10).

Images