Surgical tissue clip application set and endoscope with tissue clip application set

Abstract

The present invention relates to a surgical tissue clip application set (2) for an endoscope or an endoscope comprising a tissue clip (4) for stapling tissue together, a cap (6) mountable on a distal end portion of the endoscope, in particular attachable thereto or formed by a distal end portion of the endoscope and on the radial outer circumferential surface (10) of which the tissue clip (4) is supported radially, and a pull-off ring (8) which is arranged axially displaceably on the cap (6) and by the axial displacement of which the tissue clip (4) can be displaced in the distal direction, wherein the cap (6) and the pull-off ring (8) can be or are connected to each other in a rotationally secured manner. The present invention also relates to an endoscope with the surgical tissue clip application set (2).

Description

[0001] Surgical tissue clip application set and endoscope with tissue clip application set

[0002] Description

[0003] Technical area

[0004] The present disclosure relates to a surgical tissue clip application set for an endoscope or an endoscope and to an endoscope having such a surgical tissue clip application set.

[0005] Background of the Revelation

[0006] When inserting medical devices into a body orifice, particularly into a patient's hollow organ, endoscopic implantation procedures can be performed in a known manner, which pose little risk to the patient. For example, it is known to attach medical devices to the hollow organ starting from the interior of the hollow organ. In this case, tissue clips / tissue staples are inserted into the hollow organ, preferably with the aid of an endoscope or a similar advancement device, and positioned at predetermined points / positions on the inside of the organ. For this purpose, the respective tissue clip is brought towards the organ tissue, and elastic hinges of the tissue clip are used to snap the clip into place and thus attach it to the organ tissue.This tissue clip then holds or clamps a fold of tissue between its gripping sections ( / (gripping) teeth / spikes), causing the gripping sections to cut ( / pierce) and / or penetrate the tissue.

[0007] The prior art includes approaches for surgical tissue clips that are attached to a patient's organ tissue wall via an endoscopic procedure. For example, EP 2 449 983 B1 describes a clip that is placed on an endoscope head in a spread-open position and inserted into the patient. Once correctly positioned, the endoscope head then pushes the clip forward / distalward, causing the tissue clip to snap shut and clamp the organ tissue between its gripping sections.

[0008] Furthermore, there are approaches in the prior art to implement or simplify the application of the tissue clip, in particular the removal of the tissue clip. For example, EP 3 638 092 B1 shows a tissue clip application set comprising a tissue clip, a cap (or cap attachment) that can be placed or attached to the distal end of an endoscope, and a removal ring mounted on the cap for axial sliding. The removal ring can be pulled forward by means of a removal device to push the tissue clip forward beyond the cap, so that it is removed from the cap.

[0009] The pull-off ring is usually operated via a pull-off device, in particular in the form of a cable pull, which has a thread coupled to the pull-off ring. To apply the pulling force, the thread can be or is coupled to an actuating device, in particular in the form of a manually rotatable handwheel, at a proximal end of the endoscope, i.e. at the operator-side end. The thread can be firmly connected to the handwheel, for example clamped to the handwheel, so that it is wound up when the handwheel is turned and thus pulled in a proximal direction. From the actuating device, the thread is preferably guided within an endoscope working channel to the distal end of the endoscope, i.e. the patient-side end.When the cap is placed on the endoscope, the thread is guided outward distally of the pull-off ring (out of the endoscope's working channel or an extension thereof), where it is coupled to the pull-off ring, specifically through the pull-off ring (twice), guided inward again distally of the pull-off ring (e.g., into the endoscope's working channel), and there firmly tied to the cap or endoscope. This enables the pull-off ring (and thus also the tissue clip) to be displaced (axially) far enough by pulling on the thread in a distal direction that the tissue clip is pushed off the cap distally for application.Particularly during the preparatory handling of the tissue clip application set, especially when placing the cap on the distal end of the endoscope, the problem arises that the tissue clip application set is held in place in the area of ​​the pull-off ring and is often placed / attached / slid onto the endoscope with a screwing motion. This can cause the pull-off ring to twist on the cap, which in turn can lead to problems when moving the pull-off ring, as the thread guidance can be compromised by the changed rotational position and the pull-off ring can become jammed. This, in turn, can lead to the tissue clip not being able to be removed or not being able to be removed in the intended position.

[0010] Summary of the present disclosure

[0011] Therefore, the object of the present disclosure is to avoid or at least mitigate the disadvantages described above and, in particular, to provide a surgical tissue clip application set which ensures simple, precise and problem-free application of the tissue clip.

[0012] The object of the present disclosure is achieved by a surgical tissue clip application set having the features of patent claim 1. Advantageous further developments are the subject of the subclaims.

[0013] Accordingly, the present disclosure relates to a surgical tissue clip application set for an endoscope or an endoscope, comprising a tissue clip for stapling tissue, a cap, and a removal ring. The cap can be mounted on a distal end portion of the endoscope, in particular can be plugged onto it. Alternatively, the cap is formed by a distal end portion of the endoscope, i.e., it is not a separate component but is formed integrally by the endoscope. The cap has a preferably substantially cylindrical outer peripheral surface, radially outer peripheral surface, on which the tissue clip is radially supported. This means that the tissue clip is placed / plugged onto the cap (externally). The removal ring is arranged so as to be axially displaceable (relative to the cap), in particular on the radial outer peripheral surface of the cap, wherein the removal ring can be actuated for its axial displacement preferably by means of a removal device in the form of a cable pull.By axially displacing the pull-off ring, the tissue clip can be displaced distally, preferably to such an extent that the tissue clip is pushed off the cap. In other words, the pull-off ring is coupled to the tissue clip, in particular arranged axially adjacent to the tissue clip (on its proximal side), in such a way that the axial displacement of the pull-off ring moves the tissue clip distally / forwardly / axially / beyond the distal end of the endoscope and / or cap, in particular the pull-off ring pushes / pushes the tissue clip distally.

[0014] According to one aspect of the present disclosure, the cap and the pull-off ring are connectable or connected to each other in a rotationally secured manner. This means that in the connected state, the cap and the pull-off ring are not rotatable relative to each other (about a longitudinal axis / center axis of the application set (or the cap or the pull-off ring).

[0015] The core of the disclosure is therefore that the pull-off ring arranged on the outside of the cap, on which an actuating force for displacing the pull-off ring (and thus the tissue clip) in a distal direction is introduced, preferably by pulling on a thread of a pull-off device guided by a thread guide, cannot be rotated on the cap, in particular when the cap is placed on the endoscope, i.e. in a starting position (a position not yet displaced in the distal direction) of the pull-off ring.

[0016] This has the advantage that the thread guide acting on the puller ring cannot be negatively influenced by twisting and the functionality of the fabric clip application set can be guaranteed in a particularly robust manner.

[0017] In other words, the disclosure relates to a surgical tissue clip application equipment or retrofit kit ( / tissue clip application kit), with a cap attachment ( / a cap) which is designed to be mounted on the distal end section of a medical endoscope of the shaft type, in particular to be slipped over said end section, and which for this purpose has a preferably proximal mounting or slipping section and a preferably distal tissue clip holding section, in the area of ​​which a cavity which is open at least in the distal direction is formed on the inside and on whose one, radially outwardly facing circumferential surface a tissue clip is radially supported, which by means of a pulling device in the form of a cable-operated, axially sliding-mounted on the radial outer circumferential surface of the tissue clip holding section,the removal ring, which moves the tissue clip and is connected or connected to the cap attachment in a rotationally fixed manner, can be displaced distally.

[0018] According to a preferred embodiment, the puller ring can have a cap anti-rotation device, in particular in the form of one (longitudinal / axial) projection or preferably several, in particular in the form of two (longitudinal / axial) projections, which can be brought or is brought into positive engagement with the cap, in particular with one (or more) corresponding (longitudinal / axial) groove(s) formed in the cap, to prevent rotation. This means that the puller ring has, for example, projections / positive-locking elements / feet extending in / along / preferably parallel to the longitudinal / axial direction of the puller ring (or cap), which can be brought or are brought into contact with corresponding grooves / counter-positive-locking elements in the circumferential direction in order to prevent rotation of the puller ring relative to the cap. In other words, the puller ring can be or is connected to the cap in a positive, rotationally fixed manner.In this way, the anti-twist protection can be reliably ensured even when a large force is applied in the circumferential direction.

[0019] According to a preferred development, the cap rotation lock, in particular the projection or one or more projections or each of them, can have two contact surfaces perpendicular to the circumferential direction for form-fitting engagement with the cap, for example can be designed to be substantially rectangular in cross-section. In particular, the two contact surfaces can each serve as circumferential stops in different directions of rotation. This has the advantage that rotation is neither possible clockwise nor counterclockwise. According to one embodiment, the pull-off ring can have a base body that is preferably closed on the circumference and in particular has a ring-shaped cross-section. Alternatively, the base body can have an opening on the circumference, i.e. can be designed to be only almost closed, for example enclosing a ring sector greater than 330°, preferably greater than 340° or 350°, in particular greater than 355°.

[0020] According to a preferred embodiment, the cap anti-rotation device can extend proximally from the base body. This means that the cap anti-rotation device is formed on the side of the pull-off ring that is opposite the axial displacement direction of the pull-off ring (or facing away from the tissue clip). This has the advantage that when designing the cap, in particular the grooves / counter-form-locking elements, it is not necessary to consider that the axial displacement of the pull-off ring is not restricted or prevented by the cap.

[0021] According to a preferred embodiment, the pull-off ring can be axially displaceable in the distal direction from a starting position / assembly position for the distal displacement of the tissue clip, and the pull-off ring can be connected to the cap in a rotationally secured manner, preferably exclusively, in the starting position (and during an initial path from the starting position corresponding in particular to the length of the rotation lock). This means that the pull-off ring does not have to be rotationally fixed to the cap in every axial position, but at least in the starting position. This ensures that rotation between the pull-off ring and cap is excluded, particularly in the position of the pull-off ring in which the pull-off ring is located before application of the tissue clip, i.e. that rotation is not possible, especially when mounting the application set on the endoscope.

[0022] According to a preferred embodiment, the fabric clip can have two diametrically opposed gripping sections and two preferably arcuate hinge sections connecting the gripping sections, wherein the cap anti-twist device can be arranged in the circumferential direction in the region of one (or alternatively both) of the hinge sections. This means that a region of the puller ring abutting the gripping sections is arranged offset in the circumferential direction from the cap anti-twist device. Since the puller ring can have a greater mass in the region abutting the gripping sections than in a region adjacent to the hinge sections, a uniform mass distribution is achieved.

[0023] According to one embodiment, the gripping sections can be pivotable relative to each other about a hinge axis defined by the two hinge sections. This allows the gripping sections to spread / open against the elasticity of the tissue clip and to close the gripping sections due to the elasticity of the tissue clip.

[0024] According to a preferred embodiment, the cap anti-twist device can be axially symmetrical to a longitudinal plane, preferably containing the hinge axis, i.e., a plane containing the longitudinal axis / center axis of the application set (or the cap or the pull-off ring) and the hinge axis. This can support tilt-free axial displacement of the pull-off ring. Since the tissue clip is also approximately (axially) symmetrical to its hinge axis, a uniform weight / mass distribution is achieved.

[0025] According to one embodiment, the tissue clip application set can comprise a pull-off device, in particular in the form of a cable, which is coupled to the pull-off ring for axial displacement of the pull-off ring in such a way that, upon actuation of the pull-off device, a tensile force acts on a peripheral side of the pull-off ring. In particular, the pull-off device can comprise a thread coupled to the pull-off ring, which thread can be coupled or is coupled, in particular firmly connected thereto, for example, clamped therein, to an actuating device, in particular in the form of a manually rotatable handwheel, for applying the tensile force at a proximal (operator-side) end of the endoscope.Preferably, the thread may not be rigidly attached to the pull-off ring, but rather may be movable relative to the pull-off ring, in particular longitudinally displaceable, but in particular guided through the pull-off ring in such a way that pulling on the thread pulls the pull-off ring in a distal direction (by a distance less than the thread pulling path). Such a thread guide is known, for example, from EP 3638 092 B1, the content of which concerning the thread guide is incorporated into this application.

[0026] According to a preferred embodiment, the cap anti-twist device can be arranged, preferably exclusively, on the circumferential side of the pull-off ring that absorbs the tensile force. In other words, the thread can be guided axially through the pull-off ring, for example (starting from its tensile end / end at which the tensile force is introduced), from distal to proximal, in particular on a first circumferential side, and can be guided axially through the pull-off ring, for example from proximal to distal, on a second circumferential side diametrically opposite the first circumferential side, so that the tensile force is introduced into the pull-off ring on the first circumferential side. The cap anti-twist device can preferably only be arranged on the first circumferential side. This has the advantage that jamming of the cap anti-twist device with the cap is avoided.

[0027] According to a preferred embodiment, the cap anti-twist device can be designed axially symmetrically to a longitudinal plane containing a tensile force introduction point (on the pull-off ring). This has the advantage that the tensile force can be introduced evenly and supports tilt-free movement. The longitudinal plane containing the tensile force introduction point preferably corresponds to the longitudinal plane containing the hinge axis.

[0028] According to a preferred embodiment, the pull-off ring and the tissue clip can be connected to each other in a rotationally secured manner. This means that the tissue clip and the pull-off ring cannot be rotated relative to each other (around the longitudinal axis / center axis of the application set (or the cap or the pull-off ring) in the connected state. This also prevents (unintentional) rotation of the tissue clip toward the pull-off ring and thus toward / toward the cap.

[0029] According to a preferred embodiment, the puller ring can have a clip anti-twist device, in particular in the form of one (longitudinal-axial) projection or preferably several, in particular in the form of two (longitudinal-axial) projections, which can be or are brought into positive engagement with the tissue clip, in particular with one (or more) corresponding contact surfaces formed on the tissue clip, to prevent rotation. This means that the puller ring, for example, has projections / positive locking elements / bumps / crescents / Dracula teeth extending at least partially in / along the longitudinal direction / axial direction of the puller ring (i.e. also preferably partially inclined to the longitudinal direction / axial direction of the puller ring), which can be or are brought into contact with corresponding contact surfaces / counter-positive locking elements in the circumferential direction in order to prevent rotation between the puller ring and the tissue clip or between the puller ring and the tissue clip.In other words, the puller ring is connected to the fabric clip (connectable or) in a form-fitting, rotationally fixed manner.

[0030] According to a preferred development, the clip anti-rotation device, in particular the projection or one or more projections, can have two contact surfaces inclined to the circumferential direction, in particular curved (outwardly convex), for positive engagement with the fabric clip, for example, with a substantially semi-oval / crescent-shaped cross-section. In particular, the two contact surfaces can each serve as circumferential stops in different directions of rotation. This has the advantage that neither clockwise nor counterclockwise rotation is possible.

[0031] According to a preferred embodiment, the clip anti-twist device can extend distally from the base body. This means that the clip anti-twist device is formed on the side of the puller ring facing the tissue clip. This allows for a simple design of the clip anti-twist device.

[0032] According to a preferred embodiment, the clip anti-twist device can be arranged circumferentially in the region of (at least one or preferably) both of the gripping sections. Thus, a simple design of the clip anti-twist device can be achieved by positive engagement with the gripping sections (which are more stable than the hinge sections). This also means that a region of the pull-off ring adjacent to the hinge sections is arranged offset in the circumferential direction from the clip anti-twist device. In other words, the clip anti-twist device and the cap anti-twist device are arranged offset in the circumferential direction.

[0033] According to a preferred embodiment, the clip anti-twist device can be axially symmetrical to a first longitudinal plane, wherein the first longitudinal plane preferably corresponds to the longitudinal plane to which the cap anti-twist device is axially symmetrical. This means that the clip anti-twist device and the cap anti-twist device can be axially symmetrical to the same plane of symmetry. This achieves a uniform weight / mass distribution.

[0034] According to a preferred embodiment, the clip anti-twist device can be axially symmetrical to a second longitudinal plane, wherein the second longitudinal plane is perpendicular to the first longitudinal plane. This means that the clip anti-twist device has two axes of symmetry.

[0035] According to a further aspect, which can be present in combination with or independently of the above-described aspect concerning the anti-twist device between the cap and the pull-off ring, the pull-off ring can have two diametrically opposed (longitudinally / axially extending) through-holes through which a thread of the pull-off device can be or is passed, wherein a distal exit opening of the through-holes can be arranged proximal to the clip anti-twist device. This means that the through-holes are arranged such that their distal exit opening is not located on a distally outermost end face of the pull-off ring, but is offset in the proximal direction.This has the advantage that, despite the (distal) enlargement of the removal ring due to the clip anti-twist device, the distal exit opening is not shifted forward by the length of the clip anti-twist device, as this would otherwise result in the removal ring being unable to be pulled forward as far.

[0036] The present disclosure therefore also relates to a surgical tissue clip application set for an endoscope or an endoscope, comprising a tissue clip for tacking tissue together, a cap which can be mounted on a distal end section of the endoscope, in particular can be plugged onto it or is formed by a distal end section of the endoscope and on whose radial outer circumferential surface the tissue clip is radially supported, and a pull-off ring which is arranged axially displaceably on the cap and by whose axial displacement the tissue clip can be displaced in the distal direction, wherein the pull-off ring and the tissue clip are connected to one another in a rotationally secured manner via a clip anti-twist device, the pull-off ring has two diametrically opposed through-holes through which a thread of a pull-off device can be or is passed, and wherein a distal outlet opening of the through-holes is arranged proximal to the clip anti-twist device.

[0037] According to a preferred embodiment, the through-holes can be arranged circumferentially in the region of the hinge sections. This means that the through-holes can be arranged / configured offset circumferentially from the clip anti-twist device and / or the gripping sections, preferably centrally between the gripping sections, i.e., offset by 80° to 100°, preferably by approximately 90°, from the gripping sections. This makes it easy to prevent the design of the clip anti-twist device from influencing / conditioning the position of the distal exit opening.

[0038] According to an alternative preferred embodiment, the clip anti-rotation device for each gripping section can be formed by two circumferentially offset partial projections, each serving as a circumferential stop in one direction of rotation. The through holes are arranged circumferentially, preferably centrally, between the two partial projections (for one gripping section). This means that the distal outlet opening is arranged circumferentially in the region of the gripping sections or partial projections and (in the longitudinal / axial direction) in the region of the base body of the pull-off ring. This has the advantage that a thread guide does not need to be modified compared to known thread guides.

[0039] According to a further aspect, which can be present in combination with or independently of the above-described aspect concerning the anti-twist protection between the cap and the pull-off ring, the pull-off ring can, at least in sections, in particular at least on the inner circumference, preferably completely, have a color that corresponds to a wavelength range of 380 to 500 nm, in particular 420 to 490 nm. This means that the pull-off ring can be designed such that the pull-off ring reflects light with a wavelength of 380 to 500 nm, in particular 420 to 490 nm. Simply put, the pull-off ring can have a blue color.

[0040] The present disclosure therefore also relates to a surgical tissue clip application set for an endoscope or an endoscope, comprising a tissue clip for tacking tissue together, a cap which can be mounted on a distal end section of the endoscope, in particular can be plugged onto it or is formed by a distal end section of the endoscope and on whose radial outer circumferential surface the tissue clip is radially supported, and a pull-off ring which is arranged axially displaceably on the cap and by whose axial displacement the tissue clip can be displaced in the distal direction, wherein the pull-off ring at least in sections, in particular at least on the inner circumferential side, preferably completely has a color which corresponds to a wavelength range of 380 to 500 nm, in particular 420 to 490 nm.

[0041] This color choice has the advantage that the pull-off ring is particularly easy to recognize, and in particular to distinguish from tissue, since the color blue does not occur naturally in the human body. This means that the position of the pull-off ring can be easily determined, which in turn makes it possible to draw conclusions about the position of the tissue clip. In particular, the pull-off ring is particularly visible through the endoscope's optics when it is in its advanced position / tissue clip ejection position, i.e. when the tissue clip has already been removed from the endoscope or cap. This means that as soon as the distinctive, almost unmistakable blue color of the pull-off ring is visible, it can be assumed that the tissue clip has been applied. In other words, the color of the pull-off ring makes it easier to check andDetermining whether the tissue clip has already been applied or whether the puller ring needs to be pushed further forward by actuating the puller device. According to a preferred embodiment, the cap can be transparent / clear / translucent at least in a distal end region of the cap or in a region in which the puller ring sits / is arranged (at the tissue clip ejection position) or within which the puller ring is axially displaceable. This means that the puller ring can be optically detected through the cap wall. This has the advantage that the puller ring is not only optically detectable when the puller ring (or part of the puller ring) has been pushed beyond the distal end of the cap, but the position of the puller ring can preferably already be detected in the mounting position of the puller ring (from inside the endoscope).

[0042] The present disclosure also relates to an endoscope, preferably of the shaft type, with a tissue clip application set, wherein the endoscope has a distal end section onto which the cap can be mounted, in particular plugged onto, or which forms the cap. The endoscope has an optical device at the distal, i.e. patient-facing, endoscope end / endoscope head and optionally one or more working channels which extend from a proximal (patient-facing) endoscope section (which usually protrudes outwards from the patient cavity) or extracorporeal endoscope handle through a (connected) flexible or rigid endoscope shaft to the endoscope head and enables the extracorporeal introduction and feeding of one or more medical instruments.

[0043] Short description of the characters

[0044] Figures 1 and 2 show a tissue clip application kit according to the present disclosure, showing only a cap and a pull ring according to a first embodiment;

[0045] Fig. 3 shows the puller ring according to the first embodiment,

[0046] Fig. 4 shows a puller ring according to a second embodiment, Figs. 5 to 7 show the tissue clip application set according to the first embodiment,

[0047] Figs. 8 and 9 show the operation of a puller device of the tissue clip application set,

[0048] Figs. 10 and 11 show a thread guide on the puller ring according to the first and second embodiments, and

[0049] Fig. 12 shows a schematic representation of an endoscope according to the present disclosure.

[0050] Description of the embodiments

[0051] Hereinafter, embodiments of the present disclosure will be described based on the accompanying drawings.

[0052] Figs. 1 and 2 show a surgical tissue clip application set 2 for an endoscope 38 or an endoscope 38 according to the present disclosure. The tissue clip application set 2 includes a tissue clip 4, a cap 6, and a pull-off ring 8. The tissue clip 4 is not shown in Figs. 1 and 2 and is described below with reference to Figs. 5 to 7.

[0053] The cap 6 can be mounted on a distal end section of the endoscope, in particular can be plugged onto it. Alternatively, the cap 6 is formed by a distal end section of the endoscope, i.e., not a separate component, but rather is formed integrally by the endoscope. The cap 6 is tubular and encloses a hollow interior. The cap 6 has an annular cross-section, preferably over its entire longitudinal extent. The cap 6 has a radial outer peripheral surface 10, preferably in the shape of a cylinder jacket. The tissue clip 4 is placed / plugged onto the cap 6 (externally), preferably in the spread / expanded state, and is supported radially (internally) on the radial outer peripheral surface 10 (cf. Figs. 5 to 7). The pull-off ring 8 is placed / plugged onto the cap 6 (externally). The pull-off ring 8 is arranged proximal to the tissue clip 4 and preferably lies axially against the tissue clip 4 (see Figs. 5 to 7).The pull-off ring 8 is arranged, preferably in a sliding / sliding-bearing manner, axially / longitudinally displaceable on the radial outer circumferential surface 10 of the cap 6. In particular, the pull-off ring 8 is displaceable from a starting position / assembly position (cf. Fig. 1) into an ejection position (cf. Fig. 2) on the cap 6. The ejection position is located distal to the starting position, i.e. closer to a distal end of the cap 6. The pull-off ring 8 can be actuated for its axial displacement, preferably by means of a pull-off device 30 in the form of a cable pull. The pull-off device 30 is not shown in Figs. 1 and 2 and is described below with reference to Figs. 8 and 9.

[0054] By axially displacing the pull-off ring 8 (and the axial abutment of the pull-off ring 8 on the tissue clip 4), the tissue clip 4 can be displaced, in particular pressed / slidable, in a distal / forward / towards the distal end of the cap 6. The tissue clip 4 can preferably be displaced by the pull-off ring 8 so far that the tissue clip 4 is pushed / stripped off the cap 5. This means that the pull-off ring 8 is coupled to the tissue clip 4, in particular is arranged axially abutting the tissue clip 4 (on its proximal side), in such a way that the axial displacement of the pull-off ring 8 moves the tissue clip 4 in a distal / forward / axial / beyond the distal end of the endoscope and / or cap, in particular the pull-off ring 8 pushes / pushes the tissue clip 4 in a distal direction.

[0055] According to one aspect of the present disclosure, the cap 6 and the pull-off ring 8 are connected or secured against rotation, i.e., in the connected state (about a longitudinal axis / central axis of the application set 2 (or the cap 6 or the pull-off ring 8)) they cannot be rotated relative to one another.

[0056] For this purpose, the puller ring 8 preferably has a cap anti-twist device 12, which can be or is brought into positive engagement with the cap 6 to prevent rotation. In the illustrated embodiments, the cap anti-twist device 12 of the puller ring 8 is designed in the form of two positive-locking elements / longitudinal / axial projections 14, which engage in corresponding counter-positive-locking elements / longitudinal / axial grooves 16 formed in the cap. Alternatively, the cap anti-twist device 12 can also be formed by just one projection or by more than two projections, even if this is not illustrated. The projections 14 can be or are brought into positive engagement with the grooves 16. For this purpose, the projections 14 preferably have two contact surfaces perpendicular to the circumferential direction. In the illustrated embodiments, the projections 14 are each substantially rectangular in cross-section.

[0057] The pull-off ring 8 preferably has a base body 18 (see Figs. 3 and 4). The base body 18 can preferably be circumferentially closed and, in particular, annular in cross-section. Alternatively, the base body 18 can have an opening on its circumference, i.e., be only nearly closed, for example, enclosing a ring sector greater than 330°, preferably greater than 340° or 350°, in particular greater than 355°.

[0058] Preferably, the cap anti-rotation device 12, i.e., the projections 14, can extend proximally from the base body 18. This means that the projections 14 are designed as feet protruding from the base body 18. In particular, the cap anti-rotation device 12 can be formed on the side of the pull-off ring 8 that is opposite the axial displacement direction of the pull-off ring 8 or that faces away from the tissue clip 4.

[0059] Preferably, the pull-off ring 8 can be connected to the cap 6 in a rotationally secured manner, preferably exclusively, in the starting position (as well as during an initial path from the starting position, in particular corresponding to the length of the anti-rotation device). This means that the anti-rotation device does not need to be implemented in the ejection position of the pull-off ring 8.

[0060] In particular, the tissue clip 4 can have two diametrically opposed gripping sections 20 with gripping teeth and two preferably curved hinge sections 22 connecting the gripping sections 20 (see Figs. 5 to 7). For spreading / expanding and to be able to be placed on the cap 6 and snapped shut again when removed from the cap 6, the gripping sections 20 can be pivoted relative to one another about a hinge axis defined by the two hinge sections 22.

[0061] Preferably, the cap anti-twist device 12 can be arranged circumferentially in the region of one of the hinge sections 22. This means that a region of the pull-off ring 8 abutting the gripping sections 20 is offset circumferentially from the cap anti-twist device 12, in particular centrally therebetween.

[0062] Preferably, the cap anti-twist device 12 can be axially symmetrical to a longitudinal plane, ie, a plane containing the longitudinal axis / center axis of the tissue clip application set 2. Preferably, the longitudinal plane, ie, the plane of symmetry of the cap anti-twist device 12, can contain the hinge axis.

[0063] In addition, the fabric clip application set 2 can have the removal device 30 (see Figs. 8 and 9), particularly in the form of a cable pull. The removal device 30 can be coupled or is coupled to the removal ring 8 for axial displacement of the removal ring 8 in such a way that, upon actuation of the removal device, a tensile force acts on a peripheral side of the removal ring 8. In particular, the cap anti-rotation device 12 can be arranged, preferably exclusively, on the peripheral side of the removal ring 8 that absorbs the tensile force.

[0064] Preferably, the longitudinal plane, ie, the plane of symmetry of the cap anti-rotation device 12, can contain a tensile force introduction point (on the pull-off ring 8). The longitudinal plane containing the tensile force introduction point can preferably correspond to the longitudinal plane containing the hinge axis.

[0065] According to a further aspect of the present disclosure, which may be independently claimable, the pull-off ring 8 and the fabric clip 4 can be connected to one another in a rotationally secured / rotationally fixed manner (around the longitudinal axis / central axis of the application set 2), i.e., they cannot be rotated relative to one another. For this purpose, the pull-off ring 8 preferably has a clip anti-rotation lock 24, which can be brought or is brought into positive engagement with the fabric clip 4 to prevent rotation. In the illustrated embodiments, the clip anti-rotation lock 24 of the pull-off ring 8 is designed in the form of two positive-locking elements / protrusions 26, which bear against corresponding counter-positive-locking elements / contact surfaces formed on the fabric clip 4. For this purpose, the projections 26 preferably have two contact surfaces inclined to the circumferential direction, in particular curved (outwardly convex), for positive contact with the fabric clip 4.A shape of the projections 26 preferably corresponds to a proximal end face section of the tissue clip 4 in the region of the gripping sections 20. The proximal end face section preferably forms the contact surfaces.

[0066] Preferably, the clip anti-rotation device 24 can extend distally from the base body 18 of the removal ring 8. This means that the clip anti-rotation device is formed on the side of the removal ring 8 facing the tissue clip 4.

[0067] The clip anti-rotation device 24 can preferably be arranged circumferentially in the region of the gripping sections 20. This also means that a region of the pull-off ring 8 adjacent to the hinge sections 22 is offset in the circumferential direction from the clip anti-rotation device 24, in particular centrally therebetween. In other words, the clip anti-rotation device 24 and the cap anti-rotation device 12 can preferably be arranged / configured offset in the circumferential direction.

[0068] Preferably, the clip anti-rotation device 24 can be axially symmetrical to a first longitudinal plane. In particular, the first longitudinal plane can correspond to the longitudinal plane to which the cap anti-rotation device 12 is axially symmetrical. This means that the clip anti-rotation device 24 and the cap anti-rotation device 12 can be axially symmetrical to the same plane of symmetry. Preferably, the clip anti-rotation device 24 can be axially symmetrical to a second longitudinal plane. In particular, the second longitudinal plane can be perpendicular to the first longitudinal plane. This means that the clip anti-rotation device has two axes of symmetry.

[0069] In the embodiment shown in Fig. 3, the clip anti-rotation device 24 is formed in the form of two projections 26 (one projection 26 per gripping section 20), each of which has a substantially semi-oval / crescent-shaped cross-section. In the embodiment shown in Fig. 4, the clip anti-rotation device 24 is formed by two projections 26 (one projection 26 per gripping section 20), each of which is in turn formed by two partial projections / bumps / Dracula teeth 28 offset in the circumferential direction, each serving as a circumferential stop in one direction of rotation.

[0070] Figs. 5 and 7 show the tissue clip application set 2. The tissue clip 4 has, as described above, the gripping sections 20 arranged alternately in the circumferential direction and each connected to one another, each with a plurality of (gripping) teeth and hinge sections 22, so that the gripping sections 20 can be spread open and the tissue clip 4 can be placed externally on the cap 6. The tissue clip 4 sits distal to the pull-off ring 8 on the cap 6, so that when the pull-off ring 8 is advanced axially, the tissue clip 4 is pushed forward and thereby stripped from the cap 6.

[0071] The operation of the above-mentioned removal device 30 is described with reference to Figs. 8 and 9. The removal device 30 has a thread 32 coupled to the removal ring 8. Preferably, the thread 32 cannot be rigidly attached to the removal ring 8, but can be moved relative to the removal ring 8, in particular longitudinally displaceable. In particular, the thread 32 is guided or can be guided through the removal ring 8 in such a way that pulling on the thread 32 pulls the removal ring 8 (in particular by a distance less than the thread pulling path) in the distal direction.

[0072] In particular, the thread 32 for applying the tensile force at a proximal (operator-side) end of the endoscope can be coupled or coupled to an actuating device, in particular in the form of a manually rotatable handwheel, in particular can be firmly connected thereto, for example clamped therein. From the actuating device, the thread 32 can preferably be guided within an endoscope working channel to the distal, i.e., the patient-side, end of the endoscope. At the tip of the endoscope or the cap 6 placed on the endoscope, the thread can be guided outwards distally of the pull-off ring 8, there coupled to the pull-off ring 8, in particular guided (twice) through the pull-off ring 8, guided inwards again distally of the pull-off ring 8, and there firmly tied, for example, to the cap 6 or to the endoscope.

[0073] Preferably, the thread 32 can be guided axially through the pull-off ring 8 on a first circumferential side, for example (starting from its pulling end / end at which the pulling force is introduced) from distal to proximal. The thread 32 can then be guided externally on the cap 6 and proximal to the pull-off ring 8 along its circumference to a second circumferential side diametrically opposite the first circumferential side (cf. Fig. 8). On the second circumferential side, the thread 32 can be guided axially through the pull-off ring 8, for example from proximal to distal. This has the effect that the pulling force of the thread 32 is introduced into the pull-off ring 8 on the first circumferential side, and the pull-off ring 8 is pulled forward by pulling on the thread 32. In particular, the cap anti-twist device 12 is preferably arranged on the first circumferential side.

[0074] Preferably, the pull-off ring can have two diametrically opposite (longitudinally / axially extending) through holes 34 through which the thread 32 of the pull-off device 30 can be or is passed.

[0075] According to a further aspect, which may be independently claimable, a distal exit opening 36 of the through-holes 34 can be arranged proximal to the clip anti-rotation device 24. This means that the through-holes 34 are arranged such that their distal exit opening 36 is not located on a distally outermost end face of the pull-off ring 8, but is offset in the proximal direction thereto.

[0076] Preferably, the through holes 34 can be arranged in the circumferential direction in the region of the

[0077] Hinge sections 22 can be arranged (see Fig. 3). This means that the through holes can be arranged / configured offset in the circumferential direction relative to the clip anti-twist device 24 and / or the gripping sections 20, preferably centrally between the gripping sections, i.e. offset by 80° to 100°, preferably by approximately 90°, relative to the gripping sections. Thus, the distal outlet opening 36 can be arranged (in the longitudinal direction / in the axial direction) in the region of the base body 18 of the pull-off ring 8.

[0078] Alternatively, the through holes 34 can be arranged in the circumferential direction, preferably centrally, between the two partial projections 28 (see Fig. 4). This means that the distal outlet opening 36 is arranged in the circumferential direction in the region of the gripping sections 20 or the partial projections 28 and (in the longitudinal / axial direction) in the region of the base body 18 of the pull-off ring 8.

[0079] According to a further aspect, which may be independently claimable, the pull-off ring 8 can, at least in sections, in particular at least along its inner circumference, preferably completely, have a color corresponding to a wavelength range of 380 to 500 nm, in particular 420 to 490 nm. This means that the pull-off ring 8 can be designed such that it reflects light with a wavelength of 380 to 500 nm, in particular 420 to 490 nm. This means that the pull-off ring 8 can preferably have a blue color.

[0080] Preferably, the cap 6 can be designed to be transparent / transparent / light-permeable, at least in a distal end region of the cap 6 or in a region in which the pull-off ring 8 (at the tissue clip ejection position) sits / is arranged or within which the pull-off ring 8 is axially displaceable.

[0081] Fig. 12 shows the endoscope 38 according to the present disclosure. The endoscope 38 has a distal end portion 40. The cap 6 can be mounted on the distal end portion 40. In particular, the cap 6 can be plugged or slipped onto the distal end portion 40. Alternatively, the distal end portion 40 can form the cap 6 itself. The endoscope 38 has an optical device arranged in the distal end portion 40. In addition, the endoscope 38 has a proximal endoscope handle 42 and a rigid or flexible endoscope shaft 44 that extends distally from the endoscope handle 42 and is connected to the endoscope handle 42. The distal end portion 40 can be formed by a distal end region of the endoscope shaft 44. Alternatively, the distal end portion 40 can extend distally from the endoscope shaft 44 and be connected to the endoscope shaft 44.

[0082] 2 fabric clip application set

[0083] 4 fabric clips

[0084] 6 cap

[0085] 8 Puller ring

[0086] 10 radial outer peripheral surface

[0087] 12 Cap anti-twist device

[0088] 14 lead

[0089] 16 grooves

[0090] 18 basic bodies

[0091] 20 gripping section

[0092] 22 Hinge section

[0093] 24 Clip anti-twist device

[0094] 26 lead

[0095] 28 partial projection

[0096] 30 Pulling device

[0097] 32 threads

[0098] 34 through hole

[0099] 36 distal exit opening

[0100] 38 Endoscope

[0101] 40 distal end section

[0102] 42 Endoscope handle

[0103] 44 Endoscope shaft

Claims

Claims 1. Surgical tissue clip application set (2) for an endoscope (38) or an endoscope (38), with a tissue clip (4) for tacking tissue together, a cap (6) which can be mounted on a distal end section (40) of the endoscope (38), in particular can be plugged onto it or is formed by a distal end section (40) of the endoscope (38) and on whose radial outer circumferential surface (10) the tissue clip (4) is radially supported, and a pull-off ring (8) which is arranged axially displaceably on the cap (6) and by whose axial displacement the tissue clip (4) can be displaced in the distal direction, characterized in that the cap (6) and the pull-off ring (8) can be connected or are connected to one another in a rotationally secured manner.

2. Tissue clip application set (2) according to claim 1, characterized in that the pull-off ring (8) has a cap anti-twist device (12), in particular in the form of a projection (14) or preferably a plurality of projections (14), which can be or is brought into positive engagement with the cap (6), in particular with one or preferably a plurality of corresponding grooves (16) formed in the cap (6), for the purpose of preventing rotation.

3. Tissue clip application set (2) according to claim 2, characterized in that the cap anti-twist device (12), in particular the projection (14) or each of the plurality of projections (14), has two contact surfaces perpendicular to the circumferential direction for positive contact with the cap (6), for example is substantially rectangular in cross section.

4. Tissue clip application set (2) according to one of claims 1 to 3, characterized in that the pull-off ring (8) has a base body (18) which is preferably closed on the circumference and in particular has an annular cross-section, and the cap anti-twist device (12) extends away from the base body (18) in the proximal direction.

5. Tissue clip application set (2) according to one of claims 1 to 4, characterized in that the pull-off ring (8) for the distally directed displacement of the tissue clip (4) is axially displaceable from a starting position in the distal direction and the pull-off ring (8) is connected to the cap (6) in a rotationally secured manner, preferably exclusively, in the starting position.

6. Tissue clip application set (2) according to one of claims 1 to 5, characterized in that the tissue clip (4) has two diametrically opposed gripping sections (20) and two preferably arcuate hinge sections (22) connecting the gripping sections (20), wherein the cap anti-twist device (12) is arranged in the circumferential direction in the region of one of the hinge sections (22).

7. Tissue clip application set (2) according to claim 6, characterized in that the gripping sections (20) are pivotable relative to one another about a hinge axis defined by the two hinge sections, wherein the cap anti-twist device (12) is formed axially symmetrically to a longitudinal plane, preferably containing the hinge axis.

8. Tissue clip application set (2) according to one of claims 1 to 7, characterized by a pulling device (30), in particular in the form of a cable pull, which is coupled to the pulling ring (8) for the axial displacement of the pulling ring (8) in such a way that when the pulling device (30) is actuated, a tensile force acts on a circumferential side of the pulling ring (8), wherein the cap anti-twist device (12) is arranged, preferably exclusively, on the circumferential side of the pulling ring (8) which absorbs the tensile force.

9. Tissue clip application set (2) according to claim 8, characterized in that the cap anti-twist device (12) is formed axially symmetrically to a longitudinal plane containing an introduction point of the tensile force.

10. Tissue clip application set (2) according to one of claims 1 to 9, characterized in that the pull-off ring (8) and the tissue clip (4) are connected to one another in a rotationally secured manner.

11. Tissue clip application set (2) according to claim 10, characterized in that the pull-off ring (8) has a clip anti-twist device (24), in particular in the form of one projection (26) or preferably several, in particular in the form of two projections (26), which can be brought or is brought into positive engagement with the tissue clip (4), in particular with one or preferably several corresponding contact surfaces formed on the tissue clip (4), for the purpose of preventing rotation.

12. Tissue clip application set (2) according to claim 11, characterized in that the clip anti-twist device (24), in particular the projection (26) or each of the plurality of projections (26), has two contact surfaces inclined to the circumferential direction, in particular curved, for form-fitting contact with the tissue clip (4), for example is designed to be substantially semi-oval in cross section.

13. Tissue clip application set (2) according to one of claims 10 to 12 and claim 4, characterized in that the clip anti-twist device (24) extends distally from the base body (18).

14. Tissue clip application set (2) according to one of claims 10 to 13 and claim 6, characterized in that the clip anti-twist device (24) is arranged in the circumferential direction in the region of the gripping sections (20).

15. Tissue clip application set (2) according to one of claims 10 to 14 and claim 7, characterized in that the clip anti-twist device (24) is designed to be axially symmetrical to a first longitudinal plane, wherein the first longitudinal plane preferably corresponds to the longitudinal plane to which the cap anti-twist device (12) is axially symmetrical.

16. Tissue clip application set (2) according to claim 15, characterized in that the clip anti-twist device (24) is formed axially symmetrically to a second longitudinal plane, wherein the second longitudinal plane is perpendicular to the first longitudinal plane.

17. Tissue clip application set (2) according to one of claims 1 to 16 and claim 8, characterized in that the pull-off ring (8) has two diametrically opposed through-holes (34) through which a thread (32) of the pull-off device (30) can be or is passed through, wherein a distal outlet opening (36) of the through-holes (34) is arranged proximal to the clip anti-twist device (24).

18. Tissue clip application set (2) according to claim 17 and claim 6, characterized in that the through holes (34) are arranged in the circumferential direction in the region of the hinge sections (22).

19. Tissue clip application set (2) according to claim 17 and claims 6 and 11, characterized in that the clip anti-twist device (24) is formed by two partial projections (28) offset in the circumferential direction, each serving as circumferential stops in one direction of rotation, wherein the through holes (34) are arranged in the circumferential direction, preferably centrally, between the two partial projections (28).

20. Tissue clip application set (2) according to one of claims 1 to 19, characterized in that the pull-off ring (8) has at least in sections, in particular at least on the inner circumference, preferably completely, a color corresponding to a wavelength range of 380 nm to 500 nm, in particular 420 nm to 490 nm 21. Tissue clip application set (2) according to claim 20, characterized in that the cap (6), in particular at least in a distal end region of the cap (6) or in a region in which the pull-off ring (8) is arranged or within which the pull-off ring (8) is axially displaceable, is transparent.

22. Endoscope (38) with a tissue clip application set (2) according to one of claims 1 to 21, wherein the endoscope (38) has a distal end portion (40) onto which the cap (6) can be mounted, in particular plugged onto, or which forms the cap (6).

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