Clip device

Abstract

This clip device comprises: a clip unit having an arm that includes a first arm and a second arm, and a holder for supporting the arm so that the arm can be opened and closed; a sheath separably connected to the clip unit; and a regulating member capable of regulating an opening operation in which the first arm transitions from a closed state to an open state. The arm can transition to: a first form in which the first arm and the second arm can be opened and closed; and a second form in which the second arm can be opened and closed and the opening operation of the first arm is restricted by the regulating member.

Description

Clip Device

[0001] This application claims the benefit of U.S. Provisional Application No. 63 / 508,588, filed June 16, 2023, and U.S. Provisional Application No. 63 / 590,939, filed October 17, 2023, the entire 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 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 having a first arm and a second arm and a holder that supports the arm so that it can be opened and closed; a sheath that is detachably connected to the clip unit; and a regulating member that can regulate the opening operation of the first arm as it transitions from a closed state to an open state, and the arms can be transitioned between a first state in which the first arm and the second arm can be opened and closed, and a second state in which the second arm can be opened and closed and the opening operation of the first arm is regulated by the regulating member.

[0008] The clip device of the present invention is capable of suitably gripping tissue in a narrow space such as a lumen.

[0009] 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 in the clip device; 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 clip locked in a closed configuration; FIG. 4 is a diagram showing the clip device with the sheath and holder separated; FIG. 5 is a diagram showing the clip device with the sheath and holder separated; FIG. 6 is a cross-sectional view of an operating section including a restraining member; FIG. 7 is a diagram showing the pair of arms in a normal configuration (first configuration); FIG. 8 is a diagram showing a transition to a swing configuration (second configuration); FIG. 9 is a diagram showing the pair of arms in a second configuration; FIG. 10 is a diagram showing the clip unit with the pair of arms swung; FIG. 11 is a diagram showing a locking step by the clip unit; FIG. 12 is a diagram showing a separation step by the clip unit; FIG. 13 is a diagram showing a clip device according to a second embodiment; FIG. 14 is a cross-sectional view of an operating section in the clip device; FIG. 15 is a diagram showing a modified example of a restraining member in the clip device; FIG. 16 is a clip device according to a third embodiment; FIG. 17 is a diagram showing the restraining member in the clip device; FIG. 18 is a diagram showing the operation of the restraining member; FIG. 19 is a diagram showing a pair of arms in a second configuration; FIG. 19 is a diagram showing a rotation member which is a modified example of a slide member; FIG. 19 is a diagram showing the rotation member. FIG. 19 is a diagram showing a clip device according to a fourth embodiment; Fig. 10 is a view showing a restraining member in the clip device. Fig. 11 is a view showing the restraining member. Fig. 12 is a view showing a pressing member which is a modified example of the inner sheath in the clip device. Fig. 13 is a view showing the operation of the pressing member. Fig. 14 is a view showing the operation of the pressing member. Fig. 15 is a view showing a clip device according to a fifth embodiment. Fig. 16 is a view showing a clip unit in the clip device.

[0010] First Embodiment A first embodiment of the present invention will be described with reference to Fig. 1 to Fig. 15. 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.

[0011] 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.

[0012] 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.

[0013] [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, an operating section 240, and a restricting member 250. 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.

[0014] 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.

[0015] 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.

[0016] 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.

[0017] 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.

[0018] 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. The slit portion 241a supports the slider 242 so that the slider 242 can move forward and backward.

[0019] The slider 242 is attached to the operation unit main body 241 so as to be movable forward and backward in the longitudinal direction A, 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 forward and backward along the operation unit main body 241, the operation wires 230 (the first operation wire 231 and the second operation wire 232) move forward and backward relative to the sheath 220.

[0020] 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 .

[0021] The restricting member 250 restricts the opening operation of the clip 2 of the clip unit 100, which transitions from a closed configuration (closed state) to an open configuration (open state). The restricting member 250 is provided on the operation unit main body 241. The restricting member 250 has a first restricting member 251 that restricts movement of the first operation wire 231 toward the distal end side A1, and a second restricting member 252 that restricts movement of the second operation wire 232 toward the distal end side A1.

[0022] [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.

[0023] 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.

[0024] 4 is a diagram showing the clip unit 100 with the pair of arms 21 in the open configuration. The pair of arms 21 can be opened and closed in the front direction F, and can transition between an open configuration (open state) and a closed configuration (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. 12 ).

[0025] 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.

[0026] 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." The operation in which the pair of arms 21 transition from an open configuration (open state) to a closed configuration (closed state) is referred to as the "closing operation." The operation in which the pair of arms 21 transition from a closed configuration (closed state) to an open configuration (open state) is referred to as the "opening operation."

[0027] 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.

[0028] The claws 22 are formed by bending the tips of the first arm 211 and the second arm 212 inward.

[0029] 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.

[0030] 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, thereby supporting the main body 24 so as to be rotatable relative to the holder 3. The main body 24 is provided so that the plate thickness direction substantially coincides with the up-down direction B.

[0031] 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.

[0032] 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.

[0033] 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.

[0034] The operation wire 230 moves toward the distal end side A1 to open the pair of arms 21. The operation wire 230 moves toward the proximal end side A2 to close the pair of arms 21. The advancing / retracting direction of the operation wire 230 that opens the pair of arms 21 is referred to as the "opening direction." The advancing / retracting direction of the operation wire 230 that closes the pair of arms 21 is referred to as the "closing direction." In this embodiment, the opening direction is the direction in which the operation wire 230 moves toward the distal end side A1, and the closing direction is the direction in which the operation wire 230 moves toward the proximal end side A2. Note that the opening direction may be the direction in which the operation wire 230 moves toward the proximal end side A2, and the closing direction may be the direction in which the operation wire 230 moves toward the distal end side A1.

[0035] 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.

[0036] 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 .

[0037] 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.

[0038] 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.

[0039] 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.

[0040] Fig. 5 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.

[0041] 6 is a diagram showing the clip 2 locked in the closed configuration. As the clip 2 moves toward the proximal end A2 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 further toward the proximal end A2 than 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 further toward the proximal end A2 than the engaging portion 34, and the pair of clips 2 are locked in the closed configuration.

[0042] 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.

[0043] 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.

[0044] 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.

[0045] 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.

[0046] 7 and 8 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.

[0047] [Operation and Function of Restriction Member 250] Next, the operation and function of the restriction member 250 will be described with reference to FIGS.

[0048] 9 is a cross-sectional view of the operating unit 240 including the restricting member 250. The restricting member 250 transitions the pair of arms 21 between a normal configuration (first configuration, FIG. 10) and a swing configuration (second configuration, FIG. 12).

[0049] The regulating member 250 has a first regulating member 251 that regulates the movement of the first operating wire 231 toward the tip side A1 (opening direction), and a second regulating member 252 that regulates the movement of the second operating wire 232 toward the tip side A1 (opening direction).

[0050] The first stop member 251 has a first stop knob 251a, a first knob engagement portion 251b, a first spring 251c, and a first slider engagement portion 251d.

[0051] The first control knob 251a is a knob attached so as to be able to advance and retreat in a slit 241s formed in the operation portion main body 241 along the longitudinal direction A. The surgeon can move the first control knob 251a between a position on the distal end side A1 and a position on the proximal end side A2.

[0052] The first knob engagement portion 251b is fixed to a predetermined position on the first operation wire 231. The first knob engagement portion 251b is fixed to a position where it can engage with the first restriction knob 251a that is disposed at the position on the base end side A2.

[0053] The first spring 251c is a compression spring. The first operation wire 231 is inserted through the first spring 251c. The tip of the first spring 251c is attached to the first knob engagement portion 251b. The base end of the first spring 251c is attached to the operation unit main body 241. The first spring 251c pushes the first knob engagement portion 251b and the first operation wire 231 toward the tip side A1. Note that the first stop member 251 does not necessarily have to have the first spring 251c.

[0054] The first slider engagement portion 251d is provided at the base end of the first operation wire 231 and is connected to the slider 242. The first slider engagement portion 251d is attached to a slit 242s formed in the slider 242 along the longitudinal direction A so as to be able to advance and retreat. The first slider engagement portion 251d advances and retreats in conjunction with the slider 242 until a predetermined force is applied in the longitudinal direction A. The first slider engagement portion 251d advances and retreats relative to the slider 242 when a force equal to or greater than the predetermined force is applied in the longitudinal direction A. The first slider engagement portion 251d engages with the end of the slit 242s in the longitudinal direction A and therefore cannot move outside the slit 242s.

[0055] The second restricting member 252 has a second restricting knob 252 a, a second knob engaging portion 252 b, a second spring 252 c, and a second slider engaging portion 252 d. The second restricting member 252 is the same as the first restricting member 251 except that the second restricting member 252 restricts the movement of the second operating wire 232.

[0056] The restricting member 250 may have at least one of the first restricting member 251 and the second restricting member 252. For example, if the restricting member 250 has the first restricting member 251 but does not have the second restricting member 252, the restricting member 250 restricts the movement of only the first operating wire 231.

[0057] As shown in FIG. 9, by moving the first restricting knob 251a and the second knob engaging portion 252b to the tip of the slit 241s, the pair of arms 21 transitions to the normal configuration (first configuration).

[0058] FIG. 10 is a diagram showing the pair of arms 21 in the normal configuration (first configuration). The normal configuration (first configuration) is an operating configuration in which the first arm 211 and the second arm 212 can open and close. In this embodiment, the first arm 211 and the second arm 212 can open and close in coordination. As shown in FIG. 10 , when the surgeon moves the slider 242 toward the distal end side A1, the restricting member 250 does not restrict the movement of the operation wire 230, and the slider 242 advances the first operation wire 231 and the second operation wire 232 in coordination. The front direction F of the pair of arms 21 is aligned with the longitudinal axis direction L of the sheath 220. Note that when the pair of arms 21 are in the normal configuration, the front 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.

[0059] 11 is a diagram showing a transition to the swing form (second form). By moving one of the first restricting knob 251a and the second knob engaging portion 252b to the base end of the slit 241s, the pair of arms 21 transition to the swing form (second form).

[0060] FIG. 12 is a diagram illustrating the pair of arms 21 in the second configuration. The swing configuration (second configuration) is an operating configuration in which one of the first arm 211 and the second arm 212 can be opened and closed, and the opening movement of the other arm is restricted by the restricting member 250. The first restricting knob 251a, which has moved to the proximal end, restricts the movement of the first operating wire 231 toward the distal side A1 (opening direction), thereby restricting the opening movement of the first arm 211. Alternatively, the second restricting knob 252a, which has moved to the proximal end, restricts the movement of the second operating wire 232 toward the distal side A1 (opening direction), thereby restricting the opening movement of the second arm 212. As illustrated in FIG. 12 , when the surgeon moves the slider 242 toward the distal side A1 (opening direction), the restricting member 250 restricts the movement of the second operating wire 232 toward the distal side A1 (opening direction), and the slider 242 moves only the first operating wire 231 toward the distal side A1 (opening direction). As a result, only the first arm 211 is in the open configuration. The front direction F of the pair of arms 21 is aligned in a direction intersecting with the longitudinal axis direction L of the sheath 220 .

[0061] 12 , movement of the second operating wire 232 toward the distal end side A1 (opening direction) is restricted. Therefore, a force equal to or greater than a predetermined value is applied to the second slider engaging portion 252d in the longitudinal direction A, and the second slider engaging portion 252d moves toward the proximal end side A2 relative to the slider 242.

[0062] [Operation and Function of Clip Device 300] Next, the operation and function of the clip device 300 will be described with reference to FIGS. 13 to 15. FIG.

[0063] <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.

[0064] 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.

[0065] <Tangential Approach> FIG. 13 is a diagram showing the clip unit 100 with the pair of arms 21 swung. The surgeon approaches the clip 2 to the tissue T, which is the treatment area, using a tangential approach. The surgeon operates the second stop member 252 to restrict the opening of the second arm 212, which hooks the distal (rear, far) mucosa (second mucosa M2 in FIG. 13 ) of the first mucosa M1 and the second mucosa M2, which are located on either side of the center of the tissue T. Specifically, the surgeon restricts the opening of the second arm 212 by moving the second knob engagement portion 252b to the proximal end of the slit 241s. The surgeon moves the slider 242 to the distal side A1 to place only the first arm 211 in the open configuration. The pair of arms 21 transition to the swing configuration (second configuration). The pair of arms 21 are positioned such that the forward direction F faces the front of the tissue T, which is the treatment area. The surgeon grasps the first mucosa M1 and the second mucosa M2 with the pair of arms 21.

[0066] <Traction Step> The user retracts the slider 242 along the operation unit 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 (first arm 211 in FIG. 13 ) gradually close.

[0067] 14 is a diagram showing the lock step performed by the clip unit 100. The surgeon further retracts the operation wire 230 by retracting the slider 242 along the operation unit main body 241. When the clip 2 is pulled to a predetermined position in the holder 3, the engagement portion 25 of the clip 2 engages with the engagement 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.

[0068] <Separation Step> Figure 15 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.

[0069] The clip device 300 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 to position the pair of arms 21 facing the front of the tissue T, which is the treatment area. The clip device 300 swings the clip 2 by restricting the opening movement of one of the arms 21, making it easy to position the pair of arms 21 facing the front of the tissue T, even in a narrow lumen.

[0070] 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.

[0071] Second Embodiment A clip device 300B according to a second embodiment of the present invention will be described with reference to Figures 16 and 17. In the following description, components that are common to those already described will be assigned the same reference numerals, and duplicate descriptions will be omitted.

[0072] 16 is a diagram showing a clip device 300B according to this embodiment. The clip device (clip system, endoscopic treatment tool) 300B includes a clip unit 100 and an applicator 200B. The clip unit 100 is loaded into the applicator 200B, which can be inserted into a channel of an endoscope, and introduced to a treatment position.

[0073] The applicator (clip unit introduction device) 200B includes a sheath 220, an operating wire 230, an operating portion 240B, and a restricting member 250B.

[0074] The operating unit 240B includes an operating unit main body 241, a first slider 243, a second slider 244, and a thumb ring 248.

[0075] The first slider 243 is attached to the operation portion main body 241 so as to be movable forward and backward in the longitudinal direction A, and is attached to a base end of the first operation wire 231. When the first slider 243 moves forward and backward along the operation portion main body 241, the first operation wire 231 moves forward and backward relative to the sheath 220.

[0076] The second slider 244 is attached to the operation portion main body 241 so as to be able to advance and retreat in the longitudinal direction A, and is attached to the base end of the second operation wire 232. When the second slider 244 advances and retreats along the operation portion main body 241, the second operation wire 232 advances and retreats relative to the sheath 220.

[0077] 17 is a cross-sectional view of the operation portion 240B. The restriction member 250B transitions the pair of arms 21 between a normal configuration (first configuration) and a swing configuration (second configuration).

[0078] The restricting member 250B has a first restricting member 251B that restricts movement of the first operating wire 231 toward the distal end side A1 (opening direction), and a second restricting member 252B that restricts movement of the second operating wire 232 toward the distal end side A1 (opening direction). Note that the restricting member 250B may have only one of the first restricting member 251B and the second restricting member 252B, and may not have the other.

[0079] The first stop member 251B is a ratchet that stops the operation of the first slider 243 that moves the first operation wire 231 in the opening direction. Specifically, the first stop member 251B includes a main body first convex portion 251p provided on the operation unit main body 241 and a first slider convex portion 251q provided on the first slider 243. The first slider convex portion 251q easily climbs over the main body first convex portion 251p toward the base end side A2 (closing direction) but has difficulty climbing over the main body first convex portion 251p toward the tip end side A1 (opening direction).

[0080] The second restricting member 252B is a ratchet that restricts the operation of the second slider 244 that moves the second operation wire 232 in the opening direction. Specifically, the second restricting member 252B includes a main body second convex portion 252p provided on the operation unit main body 241 and a second slider convex portion 252q provided on the second slider 244. The second slider convex portion 252q easily climbs over the main body second convex portion 252p toward the base end side A2 (closing direction) but has difficulty climbing over the main body second convex portion 252p toward the tip end side A1 (opening direction).

[0081] By moving the first slider convex portion 251q toward the tip side A1 (opening direction) of the main body first convex portion 251p and moving the second slider convex portion 252q toward the tip side A1 (opening direction) of the main body second convex portion 252p, the pair of arms 21 transition to the normal form (first form).

[0082] The normal configuration (first configuration) is an operating configuration in which the first arm 211 and the second arm 212 can be opened and closed. In this embodiment, the first arm 211 and the second arm 212 can be opened and closed independently. In this configuration, the first restricting member 251B does not restrict the advancement and retreat of the first operating wire 231. The second restricting member 252B does not restrict the advancement and retreat of the second operating wire 232.

[0083] By moving one of the first slider convex portion 251q and the second slider convex portion 252q toward the base end side A2 (closing direction) from the corresponding main body convex portion (main body first convex portion 251p, main body second convex portion 252p), the pair of arms 21 transition to a swing form (second form).

[0084] The swing configuration (second configuration) is an operating configuration in which one of the first arm 211 and the second arm 212 can be opened and closed, and the opening operation of the other arm is restricted by the restricting member 250B. The first slider protrusion 251q, which has moved to the base end, restricts the movement of the first operation wire 231 toward the distal end side A1 (opening direction), thereby restricting the opening operation of the first arm 211. Alternatively, the second slider protrusion 252q, which has moved to the base end, restricts the movement of the second operation wire 232 toward the distal end side A1 (opening direction), thereby restricting the opening operation of the second arm 212. As illustrated in FIG. 17 , the surgeon restricts the movement of the second operation wire 232 toward the distal end side A1 (opening direction) using the second restricting member 252B. The surgeon moves the first slider 243 toward the distal end side A1 to move only the first operation wire 231 toward the distal end side A1 (opening direction). As a result, only the first arm 211 is in the open configuration.

[0085] The clip device 300B 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 to position the pair of arms 21 facing each other in front of the tissue T, which is the treatment area. The clip device 300B can easily restrict the opening movement of one of the pair of arms 21 (the first arm 211 and the second arm 212) that operate independently.

[0086] Although the second 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.

[0087] 18 is a diagram showing a modified example of the restricting member 250B. The operation unit main body 241 may be provided with a plurality of main body first protrusions 251p. The plurality of main body first protrusions 251p are arranged along the longitudinal direction A. The degree of closure of the pair of arms 21 in the swing form (second form) can be changed in stages.

[0088] Third Embodiment A clip device 300C according to a third embodiment of the present invention will be described with reference to Figures 19 to 22. In the following description, components that are common to those already described will be assigned the same reference numerals, and duplicate descriptions will be omitted.

[0089] 19 is a diagram showing a clip device 300C according to this embodiment. The clip device (clip system, endoscopic treatment tool) 300C includes a clip unit 100 and an applicator 200C. The clip unit 100 is loaded into the applicator 200C, which can be inserted into a channel of an endoscope, and introduced to a treatment position.

[0090] The applicator (clip unit introduction device) 200C includes a sheath 220, an operating wire 230, an operating portion 240C, and a restricting member 250C.

[0091] The operating unit 240C includes an operating unit main body 241, a first slider 243, a second slider 244, and a thumb ring 248.

[0092] 20 is a diagram showing a restricting member 250C. The restricting member 250C transitions the pair of arms 21 between a normal configuration (first configuration) and a swing configuration (second configuration).

[0093] 21 is a diagram showing the operation of the restricting member 250C. The restricting member 250C is a wire stopper that restricts the movement of one of the first operation wire 231 and the second operation wire 232. The restricting member 250C is attached to the operation unit main body 241 and has a slide member 250s that is slidable in the opposing direction in which the first operation wire 231 and the second operation wire 232 face each other. The slide member 250s in contact with the first operation wire 231 restricts the forward and backward movement of the first operation wire 231 in the longitudinal direction A. The slide member 250s in contact with the second operation wire 232 restricts the forward and backward movement of the second operation wire 232 in the longitudinal direction A.

[0094] By moving the slide member 250s to a position where it does not come into contact with either the first operating wire 231 or the second operating wire 232, the pair of arms 21 transitions to the normal form (first form).

[0095] The normal configuration (first configuration) is an operating configuration in which the first arm 211 and the second arm 212 can be opened and closed. In this embodiment, the first arm 211 and the second arm 212 can be opened and closed independently. In this configuration, the slide member 250s does not restrict the forward and backward movement of the first operating wire 231 and the second operating wire 232.

[0096] By moving the slide member 250s to a position where it contacts one of the first operating wire 231 and the second operating wire 232, the pair of arms 21 transition to the swing form (second form).

[0097] FIG. 22 is a diagram illustrating a pair of arms 21 in the second configuration. The swing configuration (second configuration) is an operating configuration in which one of the first arm 211 and the second arm 212 can open and close, and the opening movement of the other arm is restricted by the restricting member 250C. The slide member 250s in contact with the first operating wire 231 restricts the movement of the first operating wire 231, thereby restricting the opening movement of the first arm 211. Alternatively, the slide member 250s in contact with the second operating wire 232 restricts the movement of the second operating wire 232, thereby restricting the opening movement of the second arm 212. As illustrated in FIG. 22 , the surgeon restricts the movement of the second operating wire 232 toward the distal end side A1 (opening direction) using the restricting member 250C. The surgeon moves the first slider 243 toward the distal end side A1 to move only the first operating wire 231 toward the distal end side A1 (opening direction). As a result, only the first arm 211 is in the open configuration.

[0098] The clip device 300C 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 to position the pair of arms 21 facing each other in front of the tissue T, which is the treatment area. The clip device 300C can easily restrict the opening movement of one of the pair of arms 21 (the first arm 211 and the second arm 212) that operate independently.

[0099] Although the third 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.

[0100] 23 and 24 are views showing a rotating member 250r, which is a modified example of the sliding member 250s. The rotating member 250r is rotatably attached to the operation unit main body 241. By rotating, the rotating member 250r can move to a position where it does not contact either the first operation wire 231 or the second operation wire 232, and can move to a position where it contacts either the first operation wire 231 or the second operation wire 232.

[0101] (Modification) In the above embodiment, the restricting member 250 etc. can restrict the opening operation of the first arm 211 and the second arm 212. However, the restricting member 250 etc. may be configured to restrict the opening operation of only one of the first arm 211 and the second arm 212.

[0102] A clip device 300D according to a fourth embodiment of the present invention will be described with reference to Fig. 25 to Fig. 27. In the following description, components common to those already described will be assigned the same reference numerals and redundant description will be omitted.

[0103] 25 is a diagram showing a clip device 300D according to this embodiment. The clip device (clip system, endoscopic treatment tool) 300D includes a clip unit 100 and an applicator 200D. The clip unit 100 is loaded into the applicator 200D, which can be inserted into a channel of an endoscope, and introduced to a treatment position.

[0104] The applicator (clip unit introduction device) 200D includes a sheath 220, an inner sheath 224, an operating wire 230, an operating portion 240D, and a restricting member 250D.

[0105] The inner sheath 224 is a cylindrical member that is movably inserted through the internal space of the sheath 220. The first operating wire 231 and the second operating wire 232 run parallel to each other in an internal space 224s of the inner sheath 224.

[0106] The operating section 240D includes an operating section main body 241, a first slider 243, a second slider 244, an inner sheath slider 245, and a thumb ring 248.

[0107] The inner sheath slider 245 is attached to the operation portion main body 241 so as to be movable forward and backward in the longitudinal direction A, and the proximal end of the inner sheath 224 is attached thereto.

[0108] 26 and 27 are diagrams showing a restricting member 250C. The restricting member 250D transitions the pair of arms 21 between an independent configuration (third configuration) and a cooperative configuration (fourth configuration).

[0109] The restricting member 250D restricts the relative movement of the first operation wire 231 and the second operation wire 232 in the longitudinal direction A, thereby causing the first operation wire 231 and the second operation wire 232 to operate cooperatively. The restricting member 250D has a first engaging portion 253 attached to the first operation wire 231 and a second engaging portion 254 attached to the second operation wire 232. As shown in Fig. 27 , when the first engaging portion 253 and the second engaging portion 254, which are close to each other in the radial direction R, engage with each other, the relative movement of the first operation wire 231 and the second operation wire 232 in the longitudinal direction A is restricted.

[0110] When the first engaging portion 253 and the second engaging portion 254 are engaged with each other, it is desirable that the angle of the first arm 211 and the angle of the second arm 212 with respect to the longitudinal axis direction L of the sheath 220 be approximately the same.

[0111] As shown in FIG. 26 , by moving the inner sheath slider 245 to the base end side A2 and moving the inner sheath 224 to a position where the first engaging portion 253 and the second engaging portion 254 are not included in the internal space 224s, the pair of arms 21 transition to the independent form (third form).

[0112] The independent configuration (third configuration) is an operating configuration in which the first arm 211 and the second arm 212 can be opened and closed independently. At this time, the restricting member 250D does not restrict the relative movement of the first operating wire 231 and the second operating wire 232. In the independent configuration (third configuration), for example, by moving the first slider 243 (first operating wire 231) toward the distal end side A1 of the second slider 244 (second operating wire 232), the pair of arms 21 can transition to a quasi-swing configuration (quasi-second configuration) like the swing configuration (second configuration). Note that the quasi-swing configuration (quasi-second configuration) is an operating configuration in which one of the first arm 211 and the second arm 212 can be opened and closed, and the opening operation of the other is restricted by the user.

[0113] As shown in FIG. 27 , by moving the inner sheath slider 245 toward the distal end side A1 and moving the inner sheath 224 to a position that includes the first engagement portion 253 and the second engagement portion 254 in the internal space 224s, the pair of arms 21 transition to the cooperative form (fourth form).

[0114] The cooperative configuration (fourth configuration) is an operating configuration in which the first arm 211 and the second arm 212 can open and close in cooperation with each other. The first engaging portion 253 and the second engaging portion 254, which have moved into the internal space 224s of the inner sheath 224, engage with each other in the radial direction R. The engagement between the first engaging portion 253 and the second engaging portion 254 restricts the relative movement of the first operating wire 231 and the second operating wire 232.

[0115] The clip device 300D according to this embodiment can suitably grasp tissue T in a lumen. The clip device 300D can suitably grasp tissue T by easily switching between an independent configuration (third configuration) in which the first arm 211 and the second arm 212 can open and close independently, and a cooperative configuration (fourth configuration) in which the first arm 211 and the second arm 212 can open and close in cooperation.

[0116] Although the fourth 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.

[0117] 28 is a diagram showing a pressing member 225 which is a modified example of the inner sheath 224. The pressing member 225 is an elastic member provided at the proximal end of the sheath 220. The pressing member 225 is capable of protruding into the internal space of the sheath 220 by elastically deforming.

[0118] 29 and 30 are diagrams illustrating the operation of the pressing member 225. The first engaging portion 253 and the second engaging portion 254 are pressed from both sides in the radial direction R by the pressing member 225, and thereby engage with each other, thereby restricting the relative movement of the first operating wire 231 and the second operating wire 232.

[0119] (Modification) The pressing member 225 may be a hard member instead of the elastically deformable elastic member shown in FIG. 30 . For example, the pressing member 225, which is a hard member, is movable relative to the operation unit main body 241 in the radial direction R like a push switch. The pressing member 225, which is a hard member, is movable between a first position where it is separated from the first engaging portion 253 and the second engaging portion 254, and a second position where it is in contact with the first engaging portion 253 and the second engaging portion 254. By further including a structure that maintains the pressing member 225, which is a hard member, in the second position, the pressing member 225, which is a hard member, can maintain engagement between the first engaging portion 253 and the second engaging portion 254 even when the user releases the pressing member 225.

[0120] Fifth Embodiment A clip device 300E according to a fifth embodiment of the present invention will be described with reference to Figures 31 and 32. In the following description, components that are common to those already described will be assigned the same reference numerals, and duplicate descriptions will be omitted.

[0121] 31 is a diagram showing a clip device 300E according to this embodiment. The clip device (clip system, endoscopic treatment tool) 300E includes a clip unit 100E and an applicator 200D. The clip unit 100E is loaded into the applicator 200D, which can be inserted into a channel of an endoscope, and introduced to a treatment position.

[0122] 32 is a diagram showing a clip unit 100E. The clip unit 100E is loaded onto a distal end portion 221 of a sheath 220 of an applicator 200D. The clip unit 100E includes a clip 2E, a holder 3, and a connecting member 4.

[0123] The clip (clip arm) 2E has a pair of arms 21E. The clip (clip arm) 2E may have an auxiliary arm or the like other than the pair of arms 21E.

[0124] The pair of arms 21E can be opened and closed in a forward direction F, and can transition between an open configuration (open state) and a closed configuration (closed state). The pair of arms 21E can swing in a swing direction Q. The forward direction F of the pair of arms 21E changes as they swing.

[0125] The pair of arms 21E includes a first arm 211E and a second arm 212E. The first arm 211E and the second arm 212E 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 substantially perpendicular to the longitudinal direction A. The first arm 211E and the second arm 212E are separately supported by the holder 3.

[0126] 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 21E face each other is referred to as the "inside," and the side opposite the inside is referred to as the "outside." The operation in which the pair of arms 21E transition from an open configuration (open state) to a closed configuration (closed state) is referred to as the "closing operation." The operation in which the pair of arms 21E transition from a closed configuration (closed state) to an open configuration (open state) is referred to as the "opening operation."

[0127] The first arm 211E and the second arm 212E have, from the distal end side A1 to the proximal end side A2, a claw 22, a gripping portion 23, a main body portion 24E, and an engaging portion 25. The main body portion 24E has a connecting portion 26 and a link portion 27.

[0128] The link portion 27 engages with the other arm of the pair of arms 21E when the pair of arms 21E are in a swing form, which will be described later. As shown in Figure 32, the link portion 27 is provided at an end of the main body portion 24 in the width direction C, which is approximately 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.

[0129] The pair of arms 21E can transition between a normal form (third form) shown in FIG. 31 and a swing form (fifth form) shown in FIG.

[0130] In the normal configuration (third configuration), the first arm 211E and the second arm 212E rotate independently. In this configuration, the restricting member 250D does not restrict the relative movement of the first operating wire 231 and the second operating wire 232.

[0131] The swing configuration (fifth configuration) is an operating configuration in which one arm (one of the first arm 211E and the second arm 212E) rotating in the opening direction P2 of the opening and closing direction P rotates the other arm (the other of the first arm 211E and the second arm 212E) in the closing direction P1 of the opening and closing direction P. When the pair of arms 21E are in the swing configuration, the front direction F of the pair of arms 21E is aligned in a direction intersecting with the longitudinal axis direction L of the sheath 220, as shown in FIG.

[0132] The angle at which the first arm 211E and the second arm 212E 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 21E is in the normal configuration (third configuration). When the opening / closing angle θ is a predetermined angle, the pair of arms 21E is in the swing configuration (fifth configuration).

[0133] When the opening / closing angle θ reaches a predetermined angle, the link portion 27 of the first arm 211E, which is rotating in the opening direction P2, engages with the second arm 212E. Furthermore, the first arm 211E engages with the link portion 27 of the second arm 212E. When the first arm 211E further rotates in the opening direction P2, the link portion 27 of the first arm 211E rotates the second arm 212E in the closing direction P1 of the opening / closing direction P. Furthermore, the first arm 211E rotates the link portion 27 of the second arm 212E in the closing direction P1 of the opening / closing direction P. As a result, the pair of arms 21E 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 21E. In other words, the plane on which the pair of arms 21E swing (the plane through which the pair of swinging arms 21E pass) and the plane on which the pair of arms 21E open and close (the plane through which the pair of opening and closing arms 21E pass) are approximately the same.

[0134] When the opening / closing angle θ is a predetermined angle, the second arm 212E rotating in the opening direction P2 of the opening / closing direction P similarly rotates the first arm 211E in the closing direction P1 of the opening / closing direction P. As a result, the pair of arms 21E swing in the swing direction Q.

[0135] For example, when the first arm 211E that has been rotating in the opening direction P2 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 21E returns to the normal configuration (third configuration).

[0136] As in the fourth embodiment, by operating the inner sheath slider 245, the restricting member 250D transitions the pair of arms 21E between the independent form (third form) and the cooperative form (fourth form).

[0137] The clip device 300E according to this embodiment can suitably grasp tissue T in a lumen. The clip device 300E can suitably grasp tissue T by easily switching between an independent configuration (third configuration) in which the first arm 211E and the second arm 212E can open and close independently, a cooperative configuration (fourth configuration) in which the first arm 211E and the second arm 212E can open and close in cooperation, and a swing configuration (fifth configuration).

[0138] Although the fifth 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 gist of the present invention. Furthermore, the components shown in the embodiment and modifications can be configured in any suitable combination.

[0139] DESCRIPTION OF SYMBOLS 300, 300A, 300B, 300C, 300D, 300E Clip device (clip system, endoscopic treatment tool) 200, 200B, 200C, 200D Applicator (clip unit introduction device) 220 Sheath 221 Tip portion 230 Operation wire (power transmission member) 231 First operation wire 232 Second operation wire 233 Connecting portion 234 Slit 250, 250B, 250C, 250D Restraining member 240 Operation portion 100, 100E Clip unit 2, 2E Clip (clip arm) 21, 21E Pair of arms 211, 211E First arm 212, 212E Second arm 22 Claw 23, 23A Grip portion 24 Main body 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 pipe portion 31 First support portion 32 Second support portion 33 Pin 34 Engagement portion 35 Engagement hole 38 Internal space 4 Connecting member 41 Annular portion 42 Support arm 43 Tip portion

Claims

1. A clip device comprising: a clip unit having an arm having a first arm and a second arm, and a holder supporting the arm so that it can be opened and closed; a sheath detachably connected to the clip unit; and a regulating member capable of regulating the opening operation of the first arm from a closed state to an open state, wherein the arms are transitionable between a first state in which the first arm and the second arm can be opened and closed, and a second state in which the second arm can be opened and closed and the opening operation of the first arm is regulated by the regulating member.

2. The clip device according to claim 1, further comprising a second restricting member capable of restricting an opening operation in which the second arm transitions from the closed configuration to the open configuration.

3. The clip device according to claim 1, wherein when said arms are in said first configuration, said first arm and said second arm are capable of opening and closing in coordination with each other.

4. The clip device according to claim 1, wherein when said arms are in said first configuration, said first arm and said second arm are capable of being opened and closed independently.

5. A clip device as described in claim 1, further comprising: a first wire that is inserted through the sheath and detachably connected to the first arm; and a second wire that is inserted through the sheath and detachably connected to the second arm, wherein the first wire moves in an opening direction to cause the first arm to perform the opening operation, and the regulating member regulates the movement of the first wire in the opening direction, thereby regulating the opening operation of the first arm.

6. The clip device of claim 5, further comprising a slider connected to the first wire and the second wire, wherein the restricting member includes a mechanism for restricting movement of the first wire in the opening direction regardless of the operation of the slider to move the first wire in the opening direction.

7. The clip device of claim 5, further comprising: a first slider connected to the first wire; and a second slider connected to the second wire, wherein the regulating member includes a ratchet that regulates the operation of the first slider to move the first wire in the opening direction.

8. The clip device of claim 5, further comprising: a first slider connected to the first wire; and a second slider connected to the second wire, wherein the restricting member includes a wire stopper that restricts movement of the first wire.

9. A clip device as claimed in any one of claims 6 to 8, further comprising an operating section to which the sheath is attached, and the restricting member is provided on the operating section.

10. A clip device comprising: a clip unit having an arm having a first arm and a second arm, and a holder supporting the arm so that it can be opened and closed in an opening and closing direction; a sheath detachably connected to the clip unit; and a regulating member that causes the first arm and the second arm to operate in coordination, wherein the arms are transitionable between a third state in which the first arm and the second arm can be opened and closed independently, and a fourth state in which the first arm and the second arm can be opened and closed in coordination by the regulating member.

11. A clip device as described in claim 10, further comprising: a first wire that passes through the sheath and is separably connected to the first arm; and a second wire that passes through the sheath and is separably connected to the second arm, wherein the regulating member regulates the relative movement between the first wire and the second wire, thereby causing the first arm and the second arm to move in a coordinated manner.

12. A clip device as described in claim 11, further comprising: a first slider connected to the first wire; and a second slider connected to the second wire, wherein the regulating member comprises: a first engagement portion attached to the first wire; and a second engagement portion attached to the second wire, and when the first engagement portion and the second engagement portion engage, the relative movement of the first wire and the second wire is regulated.

13. A clip device as described in claim 12, further comprising an inner sheath through which the sheath is inserted so as to be capable of being advanced and retreated, the first wire and the second wire are inserted through the inner sheath, and when the inner sheath is positioned at a position where the first engagement portion and the second engagement portion are inserted, the first engagement portion and the second engagement portion engage with each other.

14. The clip device according to claim 10, wherein the arms are further capable of transitioning to a fifth configuration in which the first arm rotating in the opening direction causes the second arm to rotate in the closing direction in the opening and closing direction.

15. The clip device according to claim 14, wherein an opening / closing angle is an angle at which the first arm and the second arm open, and when the arms are in the third configuration and the opening / closing angle reaches a predetermined angle, the arms transition to the fifth configuration.

16. The clip device of claim 15, wherein said first arm has a link portion that engages said second arm when said arm is in said fifth configuration.

17. A clip device as described in claim 16, 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.

18. A clip device as described in claim 5 or claim 11, further comprising a connecting member that separably connects the sheath and the holder, the connecting member separating the sheath and the holder when the first wire and the second wire are pulled.

19. The clip device according to claim 18, wherein the clip unit includes a locking mechanism for locking the arms in a closed configuration.

20. A clip device as described in claim 19, wherein the locking mechanism comprises an engageable portion provided on the holder and an engaging portion provided on the arm, and the arm is pulled by the first wire and the second wire, and the engaging portion engages with the engageable portion, thereby locking the arm in the closed configuration.

Images