Clip device and clip unit

Abstract

This clip device comprises: a clip unit having arms that open and close in terms of the front direction, and a holder that supports the arms in a manner pivotable in the opening direction and the closing direction; a sheath that is releasably connected to the clip unit; and a wire that passes through the sheath and is releasably connected to the arms. The arms include a first arm and a second arm. The arms can transition between a first mode in which the first arm and the second arm pivot independently, and a second mode in which the first arm pivoting in the opening direction among the opening direction and the closing direction causes the second arm to pivot in the closing direction among the opening direction and the closing direction.

Description

Clip Devices and Clip Units

[0001] This application claims priority to U.S. Provisional Application No. 63 / 508,620, filed June 16, 2023, the contents of which are incorporated herein by reference.

[0002] In endoscopic treatment, medical instruments such as clip devices for treating biological tissue are used. These medical instruments are introduced to the treatment site by an applicator (introduction device) that can be inserted through a channel of an endoscope.

[0003] Patent Document 1 describes a clipping device for treating biological tissue. In the clipping device described in Patent Document 1, a control wire that controls the clip has a bent portion. When the bent portion of the control wire bends, the clip connected to the control wire moves significantly and comes into contact with the tissue.

[0004] US Patent Application Publication No. 2021 / 030425

[0005] However, since medical instruments such as clip devices are used in narrow lumens, it is desirable that they not only contact tissue but also adequately grasp the tissue in a narrow space.

[0006] In view of the above circumstances, an object of the present invention is to provide a clip device and a clip unit that can suitably grasp tissue in a narrow space such as a lumen.

[0007] A clip device according to a first aspect of the present invention comprises a clip unit having an arm that opens and closes toward the front and a holder that supports the arm so that it can rotate in the opening and closing direction, a sheath that is detachably connected to the clip unit, and a wire that is inserted through the sheath and detachably connected to the arm, wherein the arm has a first arm and a second arm, and the arm is capable of transitioning between a first form in which the first arm and the second arm rotate independently, and a second form in which the first arm that rotates in the opening direction of the opening and closing direction rotates the second arm in the closing direction of the opening and closing direction.

[0008] A clip device according to a second aspect of the present invention comprises a clip unit having an arm that opens and closes toward the front and a holder that supports the arm so that it can rotate in the opening and closing direction, a sheath that is detachably connected to the clip unit and extends in the longitudinal axis direction, and a wire that is inserted through the sheath and detachably connected to the arm, wherein the arm is transitionable between a first form in which the front direction is along the longitudinal axis direction and a second form in which the front direction intersects the longitudinal axis direction.

[0009] A clip unit according to a third aspect of the present invention is a clip unit that is loaded into the sheath of an applicator, and comprises an arm that opens and closes toward the front, and a holder that supports the arm so that it can rotate in the opening and closing direction, wherein the arm has a first arm and a second arm, and the arm is capable of transitioning between a first form in which the first arm and the second arm rotate independently, and a second form in which the first arm that rotates in the opening direction of the opening and closing direction rotates the second arm in the closing direction of the opening and closing direction.

[0010] The clip device and clip unit of the present invention can suitably grasp tissue in a narrow space such as a lumen.

[0011] 1 is a diagram showing a clip device according to a first embodiment; FIG. 1 is a cross-sectional view of a clip unit loaded in an applicator; FIG. 1 is a cross-sectional view of the clip unit loaded in the applicator; FIG. 2 is a diagram showing the clip unit with a pair of arms in an open configuration; FIG. 3 is a diagram showing the transition of the configuration of the pair of arms; FIG. 4 is a diagram showing the clip locked in a closed configuration; FIG. 5 is a diagram showing the clip device with the sheath and holder of the applicator separated; FIG. 6 is a diagram showing the clip device with the sheath and holder of the applicator separated; FIG. 7 is a diagram showing the clip unit treating tissue by a tangential approach; FIG. 8 is a diagram showing the clip unit with the pair of arms swung; FIG. 9 is a diagram showing a locking step by the clip unit; FIG. 10 is a diagram showing a separation step by the clip unit; FIG. 11 is a diagram showing a modified example of the clip of the clip unit; FIG. 12 is a diagram showing the modified example of the clip; FIG. 13 is a diagram showing the modified example of the clip.

[0012] First Embodiment A first embodiment of the present invention will be described with reference to Fig. 1 to Fig. 13. Fig. 1 is a diagram showing a clip device 300 according to this embodiment. The clip device (clip system, endoscopic treatment tool) 300 includes a clip unit 100 and an applicator 200. The clip unit 100 is loaded into the applicator 200, which can be inserted into a channel of an endoscope, and introduced to a treatment position.

[0013] The clip device 300 may be capable of reloading the clip unit 100 into the applicator 200. In this case, a user can remove a used clip unit 100 from the applicator 200 and reload an unused clip unit 100 into the applicator 200.

[0014] In the following description, the clip unit 100 side in the longitudinal direction A of the clip device 300 will be referred to as the tip side (distal side) A1 of the clip device 300, and the operating portion 240 side of the applicator 200 will be referred to as the base side (proximal side) A2 of the clip device 300.

[0015] [Applicator 200] Figure 2 is a cross-sectional view of the clip unit 100 loaded into the applicator 200. The applicator (clip unit introduction device) 200 includes a sheath 220, an operating wire 230, and an operating section 240. The applicator 200 is inserted, for example, into a treatment tool insertion channel of an endoscope and used in combination with the endoscope. For this reason, the sheath 220 is formed to be sufficiently longer than the length of the treatment tool insertion channel of the endoscope. The sheath 220 is flexible and bends in accordance with the curvature of the insertion section of the endoscope.

[0016] 3 is a cross-sectional view of the clip unit 100 loaded into the applicator 200. The sheath 220 is a coil sheath. An engagement hole 222 with which the connecting member 4 of the clip unit 100 engages is provided at a distal end 221 of the sheath 220. The engagement holes 222 are provided on both sides of a central axis along the longitudinal axis direction L of the sheath 220.

[0017] The operation wire (power transmission member) 230 is inserted through the sheath 220 and attached to the clip unit 100 and the operation section 240. As shown in Fig. 3 , the operation wire 230 can protrude from the distal end portion 221 of the sheath 220 to the distal side A1. The operation wire 230 advances and retreats through the distal end portion 221 along the longitudinal axis direction L of the sheath 220 to transmit power to the clip 2 of the clip unit 100.

[0018] A connecting portion 233 is provided at the tip of the operation wire 230, which is detachably connected to a connecting portion 26 of the clip 2, which will be described later. The outer diameter of the connecting portion 233 is larger than the outer diameter of the operation wire 230. A slit 234 is provided at the tip of the connecting portion 233, into which the connecting portion 26 of the clip 2, which will be described later, is fitted so as to be relatively movable.

[0019] The operation wire 230 includes a first operation wire 231 and a second operation wire 232. The first operation wire 231 and the second operation wire 232 run parallel to each other in the internal space of the sheath 220.

[0020] The operation unit 240 includes an operation unit main body 241, a slider 242, and a thumb ring 248. The operation unit main body 241, the slider 242, and the thumb ring 248 are injection molded from, for example, a resin material. The operation unit main body 241 includes a slit portion 241a and a rotating grip 241b on the tip side. The slit portion 241a supports the slider 242 so that it can move forward and backward.

[0021] The slider 242 is attached to be movable back and forth in the longitudinal axis direction of the operation unit main body 241, and has the base ends of the operation wires 230 (the first operation wire 231 and the second operation wire 232) attached thereto. When the slider 242 moves back and forth along the operation unit main body 241, the operation wires 230 (the first operation wire 231 and the second operation wire 232) move back and forth relative to the sheath 220.

[0022] The thumb ring 248 is attached to the base end of the operation portion body 241 so as to be rotatable around the longitudinal axis of the operation portion body 241 .

[0023] [Clip Unit 100] The clip unit 100 is loaded onto the distal end 221 of the sheath 220 of the applicator 200. The clip unit 100 includes a clip 2, a holder 3, and a connecting member 4.

[0024] The clip (clip arm) 2 has a pair of arms 21. The clip (clip arm) 2 may have an auxiliary arm other than the pair of arms 21.

[0025] 4 is a diagram showing the clip unit 100 with the pair of arms 21 in the open position. The pair of arms 21 can be opened and closed in the front direction F, and can transition between an open position (open state) and a closed position (closed state). The pair of arms 21 can swing in a swing direction Q. The front direction F of the pair of arms 21 changes as they swing (see FIG. 5).

[0026] The pair of arms 21 includes a first arm 211 and a second arm 212. The first arm 211 and the second arm 212 are supported by the holder 3 so as to be rotatable in the opening / closing direction P around a rotation axis RO along the up-down direction B that is approximately perpendicular to the longitudinal direction A. The first arm 211 and the second arm 212 are separately supported by the holder 3.

[0027] Of the opening / closing directions P, the direction in which one arm approaches the other arm is referred to as the "closing direction P1." Of the opening / closing directions P, the direction in which one arm moves away from the other arm is referred to as the "opening direction P2." The direction in which the pair of arms 21 face each other is referred to as the "inside," and the side opposite the inside is referred to as the "outside."

[0028] The first arm 211 and the second arm 212 have, from the distal end side A1 to the proximal end side A2, a claw 22, a gripping portion 23, a main body portion 24, and an engaging portion 25. The main body portion 24 has a connecting portion 26 and a link portion 27.

[0029] The claws 22 are formed by bending the tips of the first arm 211 and the second arm 212 inward.

[0030] 2, the gripping portion 23 is formed in a flat plate shape and is a portion that grips tissue. The gripping portion 23 of the first arm 211 and the gripping portion 23 of the second arm 212 are provided so that their flat plate surfaces face each other.

[0031] 3, the main body 24 is formed in a flat plate shape and is supported by pins 33 of the holder 3 so as to be rotatable in the opening / closing direction P. Specifically, through holes 28 formed in the inner surface 24a of the main body 24 are fitted onto the pins 33 of the holder 3, so that the main body 24 is rotatably supported relative to the holder 3. The main body 24 is provided such that the plate thickness direction substantially coincides with the up-down direction B.

[0032] The engaging portion 25 is a portion that can engage with the engaging portion 34 of the holder 3. The engaging portion 25 is a convex portion that protrudes outward from the outer surface 24b of the main body portion 24.

[0033] 2, the through hole 28 has a first through hole 28a that is circular when viewed from the vertical direction B, and a second through hole 28b that is oval when viewed from the vertical direction B. The second through hole 28b is continuous with the first through hole 28a and extends from the first through hole 28a to the tip side A1.

[0034] The connecting portion 26 is a portion that is separably connected to the slit 234 of the connecting portion 233 of the operation wire 230. The connecting portion 26 is a convex portion that protrudes inward from the inner surface 24a of the main body 24. When the operation wire 230 is pulled with a force equal to or greater than a predetermined value, the connecting portion 26 comes out of the slit 234, and the operation wire 230 and the connecting portion 26 are separated.

[0035] The link portion 27 engages with the other arm 21 when the pair of arms 21 are in a swing state, which will be described later. As shown in Fig. 3, the link portion 27 is provided at an end of the main body portion 24 in a width direction C that is substantially perpendicular to the longitudinal direction A and the up-down direction B. The link portion 27 extends inward from the main body portion 24. The claw 22 and the link portion 27 are provided on opposite sides of the rotation axis RO.

[0036] Fig. 5 is a diagram showing the transition of the configuration of the pair of arms 21. The pair of arms 21 can transition between a normal configuration (first configuration) shown in Fig. 4 and a swing configuration (second configuration) shown in Fig. 5.

[0037] The normal configuration (first configuration) is an operating configuration in which the first arm 211 and the second arm 212 rotate independently. When the pair of arms 21 are in the normal configuration, as shown in FIG. 4 , the forward direction F of the pair of arms 21 is aligned with the longitudinal axis direction L of the sheath 220. That is, the normal configuration is a configuration in which an imaginary line segment V is perpendicular to the central axis O2 of the longitudinal axis direction L of the sheath 220. Here, the imaginary line segment V is a line segment connecting the tips of the pair of arms 21 in the open configuration. Furthermore, the normal configuration is a configuration in which, in the pair of arms 21 in the open configuration, the distance between the tip of the first arm 211 and the central axis O2 of the sheath 220 is approximately equal to the distance between the tip of the second arm 212 and the central axis O2 of the sheath 220. Note that, when the pair of arms 21 are in the normal configuration, the forward direction F of the pair of arms 21 does not necessarily have to be aligned with the longitudinal axis direction L of the sheath 220. The first arm 211 and the second arm 212 may rotate independently so that the front direction F of the pair of arms 21 does not align with the longitudinal axis direction L of the sheath 220 .

[0038] The swing configuration (second configuration) is an operating configuration in which one arm (one of the first arm 211 and the second arm 212) rotating in the opening direction P2 of the opening / closing direction P rotates the other arm (the other of the first arm 211 and the second arm 212) in the closing direction P1 of the opening / closing direction P. When the pair of arms 21 are in the swing configuration, as shown in FIG. 5 , the front direction F of the pair of arms 21 is aligned along a direction intersecting with the longitudinal axis direction L of the sheath 220. That is, the swing configuration of the clip unit 100 is a configuration in which the imaginary line V intersects with the central axis O2 of the sheath 220. Furthermore, the swing configuration is a configuration in which, in the pair of arms 21 in the open configuration, the distance between the tip of the first arm 211 and the central axis O2 of the sheath 220 is smaller or larger than the distance between the tip of the second arm 212 and the central axis O2 of the sheath 220.

[0039] The angle at which the first arm 211 and the second arm 212 open toward the front direction F is defined as the opening / closing angle θ. When the opening / closing angle θ is less than a predetermined angle, the pair of arms 21 is in the normal configuration (first configuration). When the opening / closing angle θ is a predetermined angle, the pair of arms 21 is in the swing configuration (second configuration).

[0040] When the opening / closing angle θ reaches a predetermined angle, the link portion 27 of the first arm 211, which is rotating in the opening direction P2, engages with the second arm 212. Furthermore, the first arm 211 engages with the link portion 27 of the second arm 212. When the first arm 211 further rotates in the opening direction P2, the link portion 27 of the first arm 211 rotates the second arm 212 in the closing direction P1 of the opening / closing direction P. Furthermore, the first arm 211 rotates the link portion 27 of the second arm 212 in the closing direction P1 of the opening / closing direction P. As a result, the pair of arms 21 swing in the swing direction Q. The swing direction (rotation direction) Q substantially coincides with the opening / closing direction P of the pair of arms 21. In other words, the plane in which the pair of arms 21 swing (the plane through which the swinging pair of arms 21 pass) and the plane in which the pair of arms 21 open and close (the plane through which the opening and closing pair of arms 21 pass) substantially coincide with each other.

[0041] When the opening / closing angle θ is a predetermined angle, the second arm 212, which rotates in the opening direction P2 of the opening / closing direction P, similarly rotates the first arm 211 in the closing direction P1 of the opening / closing direction P. As a result, the pair of arms 21 swing in the swing direction Q.

[0042] For example, when the first arm 211 rotates in the opening direction P2 and then rotates in the closing direction P1, the opening / closing angle θ becomes less than the predetermined angle. When the opening / closing angle θ becomes less than the predetermined angle, the pair of arms 21 returns to the normal configuration (first configuration).

[0043] The holder 3 supports the clip 2 so as to be rotatable in the opening / closing direction P around a rotation axis RO along the up-down direction B that is substantially perpendicular to the longitudinal direction A. The holder 3 has an internal space 38 in which the main body 24 of the clip 2 is stored.

[0044] As shown in FIG. 3 , the holder 3 has a proximal pipe portion 30 , a first support portion 31 , a second support portion 32 , a pin 33 , and an engagement portion 34 .

[0045] The proximal tubular portion 30 is a hard member formed of metal or the like, and is formed in a circular shape. The proximal tubular portion 30 is provided with an engagement hole 35 with which the connecting member 4 engages. The engagement holes 35 are provided on both sides of a central axis along the longitudinal axis direction L of the sheath 220.

[0046] The first support portion 31 and the second support portion 32 are formed in a plate shape and extend from the proximal pipe portion 30 to the distal side A1. The first support portion 31 and the second support portion 32 are provided opposite each other in the vertical direction B. The pair of arms 21 are disposed between the first support portion 31 and the second support portion 32.

[0047] The pin 33 is fixed to the first support portion 31 and the second support portion 32. The pin 33 passes through the through-hole 28 of the main body portion 24 of the pair of arms 21. The pin 33 is formed in a cylindrical shape. The central axis of the pin 33 is the rotation axis RO of the pair of arms 21.

[0048] Fig. 6 is a diagram showing the clip 2 locked in the closed state. The engaging portions 34 are portions that can engage with the engaging portions 25 of the pair of arms 21. The engaging portions 34 are convex portions that protrude from the inner peripheral surface of the proximal tubular portion 30 toward the pair of arms 21. As shown in Fig. 6, when the pair of arms 21 move to the proximal side A2 and the engaging portions 25 move further to the proximal side A2 than the engaging portions 34, the engaging portions 25 cannot move further to the distal side A1 than the engaging portions 34.

[0049] 7 is a diagram showing the clip 2 locked in the closed configuration. As the clip 2 moves toward the proximal end A1 so that the position of the pin 33 moves from the first through-hole 28a to the second through-hole 28b, the engaging portion 25 moves toward the proximal end A2 relative to the engaging portion 34. By pulling the pair of clips 2 toward the proximal end A2, the pair of clips 2 transition to the closed configuration, and the position of the pin 33 moves from the first through-hole 28a to the second through-hole 28b. As a result, the engaging portion 25 moves toward the proximal end A2 relative to the engaging portion 34, and the pair of clips 2 are locked in the closed configuration.

[0050] The engaging portion 25 and the engaging portion 34 of the holder 3 constitute a locking mechanism that locks the clip 2 in the closed state. Once the pair of arms 21 are locked in the closed state by the locking mechanism, the pair of arms 21 cannot return to the open state. Note that the locking mechanism is not limited to the combination of the engaging portion 25 of the clip 2 and the engaging portion 34 of the holder 3, and other configurations may be used.

[0051] The connecting member 4 detachably connects the sheath 220 and the holder 3. The connecting member 4 has a circular ring portion 41 and a pair of support arms 42.

[0052] The annular portion 41 is formed in a ring shape. The operation wires 230 (the first operation wire 231 and the second operation wire 232) are inserted through the annular portion 41.

[0053] The pair of support arms 42 have elasticity and are provided on both sides of a central axis along the longitudinal axis direction L of the sheath 220. Tip portions 43 of the pair of support arms 42 are inserted through the engagement holes 222 of the sheath 220 and the engagement holes 35 of the holder 3. The tip portions 43 are inserted through the engagement holes 222 of the sheath 220 and the engagement holes 35 of the holder 3, thereby connecting the sheath 220 and the holder 3.

[0054] 8 and 9 are views showing the clip device 300 in which the sheath 220 and the holder 3 are separated. After the clip 2 is locked in the closed state, when the operating wire 230 is further pulled toward the proximal side A2, the slit 234 of the connecting portion 233 is disengaged from the connecting portion 26 of the clip 2. When the operating wire 230 is further pulled toward the proximal side A2, the connecting portion 233 engages with the annular portion 41, moving the connecting member 4 toward the proximal side A2. The tip portion 43 of the connecting member 4 disengages from the engagement hole 222 of the sheath 220 and the engagement hole 35 of the holder 3. As a result, the sheath 220 and the holder 3 are separated.

[0055] [Operation and Function of Clip Unit 100] Next, the operation and function of the clip unit 100 will be described with reference to Figs. 10 to 13 .

[0056] <Approach Step> The surgeon introduces the clip unit 100 loaded in the applicator 200 into the body via the channel of the endoscope. The surgeon moves the endoscope and the sheath 220 to bring the clip 2 of the clip unit 100 closer to the tissue T, which is the treatment area.

[0057] Methods for approaching the clip unit 100 to the treatment area include at least a frontal approach and a tangential approach. In the frontal approach, the surgeon operates the endoscope and sheath 220 to position the clip unit 100 so that the longitudinal direction A of the clip unit 100 is approximately perpendicular to the surface of the treatment area. In the tangential approach, the surgeon operates the endoscope and sheath 220 to position the clip unit 100 so that the longitudinal direction A of the clip unit 100 is along the surface of the treatment area.

[0058] <Tangential Approach> Figure 10 is a diagram showing the clip unit 100 for treating tissue T by a tangential approach. The surgeon approaches the clip 2, which is in the normal and open configuration, to the tissue T, which is the treatment area, by a tangential approach. The surgeon hooks the claw 22 of the first arm 211 onto the mucosa (first mucosa M1 in Figure 10) that is on the endoscope side (near side) of the first mucosa M1 and second mucosa M2, which are located on either side of the center of the tissue T.

[0059] FIG. 11 is a diagram showing the clip unit 100 with the pair of arms 21 swinging. The surgeon moves the clip unit 100, with the claws 22 hooked on the first mucosa M1, closer to the tissue T, which is the treatment area. Specifically, the surgeon advances the applicator 200 relative to the endoscope channel. Alternatively, the surgeon advances the endoscope to further press the clip unit 100 against the tissue T. The link portion 27 of the first arm 211, which rotates in the opening direction P2 of the opening / closing direction P, rotates the second arm 212 in the closing direction P1 of the opening / closing direction P. Furthermore, the first arm 211 rotates the link portion 27 of the second arm 212 in the closing direction P1 of the opening / closing direction P. As a result, as shown in FIG. 11 , the pair of arms 21 swing in the swing direction Q around the rotation axis RO. The clip 2 transitions to the swing form. When the second arm 212 comes into contact with the second mucosa M2, the pair of arms 21 are positioned so that the front direction F faces the front of the tissue T, which is the treatment area. The first mucosa M1 and the second mucosa M2 are grasped by the pair of arms 21.

[0060] The surgeon may move the first operating wire 231 forward to rotate the first arm 211 in the opening direction P2, thereby transitioning the clip 2 from the normal configuration to the swing configuration.

[0061] <Traction Step> The user retracts the slider 242 along the operation portion main body 241, thereby retracting the operation wire 230. The connecting member 4 connected to the operation wire 230 retracts the clip 2. As the clip 2 is pulled toward the base end side A2, the pair of arms 21 gradually close.

[0062] 12 is a diagram showing the lock step performed by the clip unit 100. The surgeon further retracts the operating wire 230 by retracting the slider 242 along the operating unit main body 241. When the clip 2 is pulled to a predetermined position in the holder 3, the engaging portion 25 of the clip 2 engages with the engaging portion 34 of the holder 3, and the pair of arms 21 is locked in the closed state. Once the pair of arms 21 is locked in the closed state, the pair of arms 21 cannot return to the open state.

[0063] <Separation Step> Figure 13 is a diagram showing the separation step performed by the clip unit 100. The surgeon further pulls the clip 2. The tip portion 43 of the connecting member 4 disengages from the engagement hole 222 of the sheath 220 and the engagement hole 35 of the holder 3. As a result, the sheath 220 and the holder 3 are separated. The surgeon retracts the sheath 220, and leaves the clip 2 and the holder 3 in the body with the first mucosa M1 and the second mucosa M2 ligated together.

[0064] The clip unit 100 according to this embodiment can suitably grasp tissue T in a lumen. Even when treating tissue T using a tangential approach, the clip 2 can be swung so that the pair of arms 21 are positioned facing the front of the tissue T, which is the treatment area. Because one arm of the clip unit 100 swings in conjunction with the other arm, it is easy to position the clip unit 100 facing the front of the tissue T, even in a narrow lumen.

[0065] Although the first embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the embodiment and modifications can be configured in any suitable combination.

[0066] 14 to 17 are diagrams showing a clip 2A, which is a modified example of the clip 2. The clip 2A has a pair of arms 21A. The pair of arms 21A can be opened and closed in a front direction F, and can transition between an open configuration (open state) and a closed configuration (closed state). The pair of arms 21A can swing in a swing direction Q. The front direction F of the pair of arms 21A changes as they swing (see FIG. 17 ).

[0067] The pair of arms 21A includes a first arm 211A and a second arm 212A. The first arm 211A and the second arm 212A are supported by the holder 3 so as to be rotatable in the opening / closing direction P around a rotation axis RO along the up-down direction B. The first arm 211A and the second arm 212A are separately supported by the holder 3.

[0068] The first arm 211A and the second arm 212A have, from the distal end side A1 to the proximal end side A2, a claw 22, a gripping portion 23A, a main body portion 24A, and an engaging portion 25. The main body portion 24A has a connecting portion 26. The main body portion 24A does not have a link portion 27.

[0069] The gripping portion 23A is formed in a flat plate shape and is a portion for gripping tissue. The gripping portion 23A of the first arm 211A and the gripping portion 23A of the second arm 212A are provided so that their flat plate surfaces face each other.

[0070] The gripping portion 23A has a distal gripping portion 23a provided on the distal side A1 and a proximal gripping portion 23b provided on the proximal side A2. The width of the proximal gripping portion 23b in the vertical direction B is wider than the width of the distal gripping portion 23a in the vertical direction B. The width of the proximal gripping portion 23b in the vertical direction B is wider than the width of the main body portion 24A in the vertical direction B.

[0071] The main body 24A is supported by the pin 33 of the holder 3 so as to be rotatable in the opening / closing direction P, similarly to the main body 24 of the above embodiment.

[0072] When the opening / closing angle θ reaches a predetermined angle, the main body portion (link portion) 24A of the first arm 211A, which is rotating in the opening direction P2, engages with the base-end grip portion 23b of the second arm 212A. The base-end grip portion 23b of the first arm 211A also engages with the main body portion (link portion) 24A of the second arm 212A. When the first arm 211A further rotates in the opening direction P2, the main body portion (link portion) 24A of the first arm 211A rotates the base-end grip portion 23b of the second arm 212A in the closing direction P1 of the opening / closing direction P. The base-end grip portion 23b of the first arm 211A also rotates the main body portion (link portion) 24A of the second arm 212A in the closing direction P1 of the opening / closing direction P. As a result, the pair of arms 21A swing in the swing direction Q.

[0073] 300 Clip device (clip system, endoscopic treatment tool) 200 Applicator (clip unit introduction device) 220 Sheath 221 Distal end portion 230 Operation wire (power transmission member) 231 First operation wire 232 Second operation wire 233 Connecting portion 234 Slit 240 Operation portion 100 Clip unit 2, 2A Clip (clip arm) 21, 21A Pair of arms 211, 211A First arm 212, 212A Second arm 22 Claw 23, 23A Grip portion 24 Main body portion 24A Main body portion (link portion) 25 Engagement portion 26 Connecting portion 27 Link portion 28 Through hole 28a First through hole 28b Second through hole 3 Holder 30 Base end tube portion 31 First support portion 32 Second support portion 33 Pin 34 Engagement portion 35 Engagement hole 38 Internal space 4 Connection member 41 Annular portion 42 Support arm 43 Tip portion

Claims

1. A clip device comprising: a clip unit having an arm that opens and closes toward the front and a holder that supports the arm so that it can rotate in the opening and closing direction; a sheath that is detachably connected to the clip unit; and a wire that is inserted through the sheath and detachably connected to the arm, wherein the arm has a first arm and a second arm, and the arm is capable of transitioning between a first state in which the first arm and the second arm rotate independently, and a second state in which the first arm that rotates in the opening direction of the opening and closing direction rotates the second arm in the closing direction of the opening and closing direction.

2. The clip device according to claim 1, wherein an opening / closing angle is an angle at which the first arm and the second arm open toward the front direction, and when the opening / closing angle is less than a predetermined angle, the arms are in the first form, and when the opening / closing angle is the predetermined angle, the arms are in the second form.

3. The clip device according to claim 2, wherein said first arm has a link portion that engages with said second arm when said arm is in said second configuration.

4. A clip device as described in claim 3, wherein the first arm is supported by the holder so as to be rotatable around a rotation axis, and the tip of the first arm and the link portion of the first arm are provided on opposite sides of the rotation axis.

5. The clip device according to claim 1, further comprising a connecting member that separably connects said sheath and said holder, said connecting member separating said sheath and said holder when said wire is pulled.

6. The clip device according to claim 1, wherein the clip unit has a locking mechanism for locking the arms in a closed configuration.

7. A clip device as described in claim 6, wherein the locking mechanism comprises an engaged portion provided on the holder and an engaging portion provided on the arm, and when the arm is pulled by the wire, the engaging portion engages with the engaged portion, thereby locking the arm in the closed configuration.

8. A clip device comprising: a clip unit having an arm that opens and closes toward the front and a holder that supports the arm so that it can rotate in the opening and closing direction; a sheath that is detachably connected to the clip unit and extends in a longitudinal direction; and a wire that is inserted through the sheath and detachably connected to the arm, wherein the arm is transitionable between a first form in which the front direction is aligned with the longitudinal direction and a second form in which the front direction intersects with the longitudinal direction.

9. The clip device according to claim 8, wherein the arm has a first arm and a second arm, an opening / closing angle is an angle at which the first arm and the second arm open toward the front direction, and when the opening / closing angle is less than a predetermined angle, the arm is in the first form, and when the opening / closing angle is the predetermined angle, the arm is in the second form.

10. The clip device of claim 9, wherein said first arm has a link portion that engages said second arm when said arm is in said second configuration.

11. A clip device as described in claim 10, wherein the first arm is supported by the holder so as to be rotatable around a rotation axis, and the tip of the first arm and the link portion of the first arm are provided on opposite sides of the rotation axis.

12. The clip device according to claim 8, further comprising a connecting member that separably connects the sheath and the holder, the connecting member separating the sheath and the holder when the wire is pulled.

13. The clip device according to claim 8, wherein the clip unit has a locking mechanism for locking the arms in a closed configuration.

14. A clip device as described in claim 13, wherein the locking mechanism comprises an engaged portion provided on the holder and an engaging portion provided on the arm, and when the arm is pulled by the wire, the engaging portion engages with the engaged portion, thereby locking the arm in the closed configuration.

15. A clip unit to be loaded into a sheath of an applicator, comprising: an arm that opens and closes toward the front; and a holder that supports the arm so that it can rotate in the opening and closing direction, wherein the arm has a first arm and a second arm, and the arm is capable of transitioning between a first state in which the first arm and the second arm rotate independently, and a second state in which the first arm rotating in the opening direction of the opening and closing direction rotates the second arm in the closing direction of the opening and closing direction.

16. A clip unit as described in claim 15, wherein an opening / closing angle is an angle at which the first arm and the second arm open toward the front direction, and when the opening / closing angle is less than a predetermined angle, the arms are in the first form, and when the opening / closing angle is the predetermined angle, the arms are in the second form.

17. The clip unit according to claim 16, wherein the first arm has a link portion that engages with the second arm when the arm is in the second configuration.

18. A clip unit as described in claim 17, wherein the first arm is supported by the holder so as to be rotatable around a rotation axis, and the tip of the first arm and the link portion of the first arm are provided on opposite sides of the rotation axis.

19. The clip unit according to claim 15, further comprising a connecting member that separably connects the sheath and the holder, the connecting member separating the sheath and the holder when a wire connected to the arm is pulled.

20. The clip unit according to claim 15, further comprising a locking mechanism for locking the arms in a closed configuration.

21. A clip unit as described in claim 20, wherein the locking mechanism comprises an engaged portion provided on the holder and an engaging portion provided on the arm, and when the arm is pulled by a wire connected to the arm, the engaging portion engages with the engaged portion, thereby locking the arm in the closed configuration.

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