Medical device

Abstract

This medical device comprises: a sheath extending in the longitudinal direction; a treatment part disposed on a tip side of the sheath; a wire which is inserted into the sheath and to which the treatment part is fixed; a handle which is disposed on a base end side of the sheath and to which the wire is fixed; and a transmission member which is disposed on the outer peripheral side of the sheath and extends from the handle to the tip side. The treatment part, the wire, the handle, and the transmission member can rotate with respect to the sheath in the circumferential direction with respect to the longitudinal direction.

Description

medical devices

[0001] The present invention relates to a medical device equipped with an endoscopic treatment section. This application claims priority to U.S. Provisional Patent Application No. 63 / 649,465, filed May 20, 2024, the contents of which are incorporated herein by reference.

[0002] In endoscopic treatment, treatment units such as clip units and forceps are used. The treatment unit is introduced to the treatment site by an applicator (introduction device) that can be inserted through a channel of an endoscope. The applicator includes, for example, a wire connected to the treatment unit, a handle for operating the treatment unit via the wire, and a sheath through which the wire is inserted.

[0003] When performing treatment using a treatment portion, it is necessary to rotate the treatment portion appropriately. For example, Patent Document 1 describes a medical device configured to rotate a treatment tool by rotating a sheath. When performing treatment using the treatment portion, the sheath is inserted into a channel of an endoscope, so the treatment tool can be rotated by rotating the portion of the sheath exposed from the channel of the endoscope.

[0004] US Patent Application Publication No. 2017 / 0224341

[0005] However, in the medical device described in Patent Document 1, when the treatment portion is rotated by rotating the sheath, the sheath comes into contact with the inner wall of the endoscope channel, generating friction, which makes it difficult for the rotation of the sheath to be transmitted to the treatment portion, making it difficult for the treatment portion to rotate.

[0006] In view of the above circumstances, an object of the present invention is to provide a medical instrument in which the treatment portion can be easily rotated when the sheath is inserted into the channel of the endoscope.

[0007] In order to solve the above problems, the present invention proposes the following means: A medical device according to a first aspect of the present invention includes a sheath extending in a longitudinal direction, a treatment section disposed at a distal end of the sheath, a wire inserted through the sheath and to which the treatment section is fixed, a handle disposed at a proximal end of the sheath and to which the wire is fixed, and a transmission member disposed on the outer periphery of the sheath and extending from the handle to the distal end, wherein the treatment section, the wire, the handle, and the transmission member are rotatable in a circumferential direction with respect to the longitudinal direction with respect to the sheath.

[0008] In the medical device of the present invention, when the sheath is inserted into the channel of the endoscope, the treatment portion can be easily rotated, and treatment using the treatment portion can be smoothly carried out.

[0009] 16. FIG. 17 is a side view showing a clip device according to the first embodiment. FIG. 18 is a perspective view showing a clip introduction device. FIG. 19 is a side view showing an operation unit, partially in cross section. FIG. 19 is a perspective view showing an outer sheath, showing the configuration of the outer sheath. FIG. 20 is a perspective view showing a clip unit. FIG. 21 is a plan view showing a cartridge. FIG. 22 is a view showing the clip unit connected to the clip introduction device. FIG. 23 is a view showing the clip unit connected to the clip introduction device. FIG. 24 is a view showing the clip unit being pulled out from the cartridge. FIG. 25 is a view showing a state in which the sheath of the clip device is inserted into a treatment instrument channel of an endoscope. FIG. 26 is a perspective view showing a state in which the endoscopic system is in use. FIG. 27 is a view showing a state in which the sheath of the clip device is inserted into a treatment instrument channel of an endoscope. FIG. 28 is a perspective view showing a state in which the endoscopic system is in use. FIG. 29 is a cross-sectional view of the operation unit according to Modification 1, showing a cross-section along the longitudinal direction. FIG. 29 is an enlarged view of the area indicated by dashed line D13 of the operation unit shown in FIG. 14. FIG. 29 is a side view showing an operation unit according to Modification 2, partially in cross section. FIG. 29 is a cross-sectional view of the operation unit, partially in cross section, showing a cross-section along the longitudinal direction. FIG. 29 is a cross-sectional view of the operation unit shown in FIG. 16. 21. FIG. 22 is an enlarged view of the range indicated by dashed line D17 of the operating unit shown in FIG. 18. FIG. 23 is a side view of the operating unit main body, showing a cross section of the slider. FIG. 24 is a cross-sectional view taken along line F19-F19 of the operating unit shown in FIG. 16. FIG. 25 is an enlarged view of the range indicated by dashed line D20 of the operating unit shown in FIG. 21. FIG. 26 is a cross-sectional view of the operating unit according to Modification 3, showing a cross section along the longitudinal direction. FIG. 27 is a side view of an outer sheath according to Modification 4. FIG. 28 is a side view of an outer sheath configured to be extendable and retractable. FIG. 29 is a side view of a transmission member configured to be extendable and retractable in the longitudinal direction. FIG. 29 is a side view of a clip device according to a second embodiment. FIG. 29 shows a state in which the sheath of the clip device is inserted into a treatment instrument channel of an endoscope. FIG. 29 is a side view of a clip device according to Modification 5.

[0010] Hereinafter, an embodiment of a medical device according to the present invention will be described with reference to the drawings. In the following description, components having the same or similar functions will be assigned the same reference numerals. Duplicate descriptions of those components may be omitted. In this embodiment, a clip device will be described as an example of a medical device.

[0011] First Embodiment [Clip Device 300] A clip device 300 according to a first embodiment of the present invention will be described with reference to FIGS. 1 to 26. FIG.

[0012] 1 is a side view showing a clip device 300 according to a first embodiment. The clip device 300 includes a clip introduction device (applicator) 200 and a clip unit 1. The clip unit 1 is loaded into the clip introduction device 200.

[0013] [Clip Introducing Device 200] Fig. 2 is a perspective view showing clip introducing device 200. As shown in Fig. 2, clip introducing device 200 includes a sheath 220, an operating wire 230, an operating portion (handle) 240, and an outer sheath (transmitting member) 250.

[0014] In the clip introduction device 200, the direction in which the sheath 220 extends is defined as a longitudinal direction K. In addition, the distal end side of the longitudinal direction K is defined as K1, and the proximal end side thereof is defined as K2. Furthermore, the circumferential direction relative to the longitudinal direction K is defined as a circumferential direction S.

[0015] 2, the sheath 220 includes a distal tip 221, a distal coil 222, and a proximal coil 224, and is formed in an elongated tubular shape as a whole. The sheath 220 is a member extending in the longitudinal direction K. The distal coil 222 is disposed on the distal end side of the sheath 220. The distal tip 221 is disposed at the distal end of the distal coil 222.

[0016] The sheath 220 is inserted into a treatment instrument channel (endoscope channel) 430 of the endoscope 400, which will be described later, and is used in combination with the endoscope. Therefore, the sheath 220 is formed to be sufficiently longer than the length M6 of the treatment instrument channel 430. The sheath 220 is flexible and bends to fit the treatment instrument channel 430.

[0017] The sheath 220 is provided to be rotatable in the circumferential direction S relative to the operating wire 230. The sheath 220 is provided to be rotatable in the circumferential direction S relative to the operating portion 240. The sheath 220 is provided to be rotatable in the circumferential direction S relative to the outer sheath 250. The sheath 220 is provided to be rotatable in the circumferential direction S relative to the clip unit 1.

[0018] 2, the operating wire (power transmission unit) 230 is inserted into the sheath 220. The operating wire 230 includes an arrowhead hook (connection unit) 231 connected to the clip unit 1, and a wire 232 that operates the arrowhead hook 231.

[0019] 2, the arrowhead hook 231 includes a substantially conical engaging portion 231a that engages with the clip unit 1, and a wire connecting portion 231b provided at the base end of the engaging portion 231a. The arrowhead hook 231 is formed of a metal material such as stainless steel.

[0020] The wire 232 is inserted so as to be able to move forward and backward relative to the sheath 220. The distal end of the wire 232 is fixed to the proximal end of the wire connecting portion 231b by, for example, welding.

[0021] The operation wire 230 is provided so as to be rotatable relative to the sheath 220 in the circumferential direction S. The operation wire 230 is fixed to the operation section 240, and rotates in the circumferential direction S in conjunction with the operation section 240. The operation wire 230 is provided so as not to be rotatable relative to the outer sheath 250 in the circumferential direction S. The operation wire 230 is connected to the clip unit 1, and rotates in the circumferential direction S in conjunction with the clip unit 1.

[0022] Fig. 3 is a side view, partially in cross section, showing the operation unit 240. As shown in Fig. 2, the operation unit 240 is disposed on the proximal end side K2 of the sheath 220. As shown in Fig. 3, the operation unit 240 includes an operation unit main body (handle main body) 241, a slider 242, and a thumb ring 248. The operation unit main body 241, the slider 242, and the thumb ring 248 are injection molded from, for example, a resin material. The operation unit main body 241 includes a slit portion 241a and a rotating grip 241b on the distal end side. The slit portion 241a supports the slider 242 so that it can advance and retreat.

[0023] The slider 242 is attached to the operation unit body 241 so as to be movable forward and backward in the longitudinal direction K, and is provided with a base end of the wire 232. The slider 242 is supported by the operation unit body 241. When the slider 242 moves forward and backward along the operation unit body 241, the wire 232 moves forward and backward relative to the sheath 220, and the arrowhead hook 231 moves forward and backward.

[0024] The thumb ring 248 is attached to the base end of the operation portion body 241 so as to be rotatable in the circumferential direction S relative to the operation portion body 241. The thumb ring 248 rotates in the circumferential direction S relative to the operation portion body 241 with the longitudinal direction K as the rotation axis.

[0025] As shown in FIG. 3 , a retainer 241c is provided inside the operation unit main body 241. The retainer 241c is formed in a cylindrical shape extending in the longitudinal direction K. The retainer 241c is provided rotatably in the circumferential direction S relative to the operation unit main body 241. The retainer 241c rotates in the circumferential direction S relative to the operation unit main body 241, with the longitudinal direction K as its rotation axis. The range in which the retainer 241c can move in the longitudinal direction K is limited. The range in which the retainer 241c can move in the longitudinal direction K is shorter than the length of the retainer 241c in the longitudinal direction K. Note that the retainer 241c does not have to be movable in the longitudinal direction K. The sheath 220 is fixed to the tip of the retainer 241c. The sheath 220 and the retainer 241c move together.

[0026] The operating portion 240 has a first portion 240a connected to the outer sheath 250 and a second portion 240b connected to the first portion 240a so as to be rotatable relative to the first portion 240a in the circumferential direction S. The first portion 240a has an operating portion main body 241 and a slider 242. The second portion 240b has a thumb ring 248.

[0027] The operation unit 240 is provided so as to be rotatable relative to the sheath 220 in the circumferential direction S. The operation unit 240 is fixed to the operation wire 230, and rotates in the circumferential direction S in conjunction with the operation wire 230. The operation unit 240 is fixed to the outer sheath 250, and rotates in the circumferential direction S in conjunction with the outer sheath 250.

[0028] FIG. 4 is a perspective view showing the outer sheath 250, illustrating the configuration of the outer sheath 250. As shown in FIG. 1, the outer sheath 250 is disposed on the outer peripheral side of the sheath 220. Specifically, the sheath 220 is inserted into the outer sheath 250. As shown in FIG. 4, the outer sheath 250 is formed in a cylindrical shape into which the sheath 220 is inserted. As shown in FIG. 3, the outer sheath 250 extends from the distal end of the operation unit main body 241 to the distal end side K1 in the longitudinal direction K. The outer sheath 250 is fixed to the operation unit main body 241. The outer sheath 250 has higher flexibility than the operation unit 240 and can bend along the sheath 220. A length M5 of the outer sheath 250 in the longitudinal direction K is longer than a length M4 of the operation unit 240 in the longitudinal direction K. The length M5 of the outer sheath 250 in the longitudinal direction K is shorter than the length M9 of the sheath 220 in the longitudinal direction K.

[0029] As shown in Fig. 4, the outer sheath 250 has an inner layer portion 251, an outer layer portion 252, and a middle layer portion 253 disposed radially between the inner layer portion 251 and the outer layer portion 252. The outer sheath 250 is, for example, a braid-in-tube. The inner layer portion 251 is formed from a material containing resin. The outer layer portion 252 is formed from a material containing resin. The middle layer portion 253 is a material having a higher hardness than the inner layer portion 251. The middle layer portion 253 is a material having a higher hardness than the outer layer portion 252. Note that the outer layer portion 252 may be a material having a higher hardness than the inner layer portion 251 and the middle layer portion 253. The middle layer portion 253 is formed from a metal wire.

[0030] The outer sheath 250 is provided so as to be rotatable relative to the sheath 220 in the circumferential direction S. The outer sheath 250 is provided so as not to be rotatable relative to the operating wire 230 in the circumferential direction S. The outer sheath 250 is fixed to the operating section 240, and rotates in the circumferential direction S in conjunction with the operating section 240. The clip unit 1, the operating wire 230, the operating section 240, and the outer sheath 250 are rotatable relative to the sheath 220 in the circumferential direction S.

[0031] [Clip unit 1] Fig. 5 is a perspective view showing the clip unit 1. As shown in Fig. 1, the clip unit 1 is disposed on the distal side K1 of the sheath 220. As shown in Fig. 5, the clip unit 1 includes a clip 2, a pressing member 3, and a connecting member 4.

[0032] The clip unit 1 is a "treatment portion" that is inserted into a treatment instrument channel 430 of an endoscope 400 and used to treat an affected area.

[0033] The clip unit 1 and the sheath 220 are not fixed to each other. Furthermore, the clip unit 1 is rotatable in the circumferential direction S relative to the sheath 220.

[0034] In the following description, the clip 2 side in the longitudinal direction A of the clip unit 1 is referred to as the tip side (distal side) A1 of the clip unit 1, and the connecting member 4 side is referred to as the base side (proximal side) A2 of the clip unit 1. Furthermore, the direction perpendicular to the longitudinal direction A is referred to as the "second direction B" or "left-right direction B." Furthermore, the direction perpendicular to the longitudinal direction A and the second direction B is referred to as the "first direction C" or "up-down direction C."

[0035] The clip (clip arm) 2 is formed by bending a metal plate at the center. As shown in Figure 5, the clip 2 has a pair of openable and closable arms 21. The base end A2 of the clip 2 is inserted into the internal space of the pressing member 3.

[0036] 5, 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 disposed on either side of a central axis O1 in the longitudinal direction A of the clip unit 1. Note that the clip 2 may have three or more arms.

[0037] 5, the first arm 211 and the second arm 212 have tissue gripping portions 22 formed at the ends on the tip side A1. The tissue gripping portions 22 are formed by bending the tips of the first arm 211 and the second arm 212 inward.

[0038] The holding member (tubular member) 3 is a cylindrical member capable of storing at least a portion of the clip 2. The holding member 3 has an internal space through which the clip 2 advances and retreats in the longitudinal direction A. The holding member 3 can fix the clip 2 in a closed state after it has been retracted into the internal space. As shown in Figure 5, the holding member 3 has a holding tube 3A provided on the base end side A2 and a holding pipe 3B provided on the tip end side A1.

[0039] The pressure tube (second tubular member) 3A is formed in a cylindrical shape by injection molding a thermoplastic resin having a suitable elasticity, such as PPA (polyphthalamide), PA (polyamide), PEEK (polyether ether ketone), or LCP (liquid crystal polymer), which is softer than the clip 2. Note that the pressure tube 3A may be formed from a metal instead of a thermoplastic resin.

[0040] The pressure pipe (first tubular member) 3B is a cylindrical member made of metal. The pressure pipe 3B is press-fitted into the tip of the pressure pipe 3A. The pressure pipe 3A and the pressure pipe 3B may be connected by heat welding, adhesive bonding, or screw fastening.

[0041] The connecting member 4 is detachably connected to the base end of the clip 2. The connecting member 4 is also detachably connected to the arrowhead hook 231 that passes through the sheath 220. In other words, the connecting member 4 connects the clip 2 and the arrowhead hook 231 together.

[0042] [Cartridge 5] FIG. 6 is a plan view showing the cartridge 5. As shown in FIG.

[0043] A system including the clip unit 1 and the cartridge 5 capable of accommodating the clip unit 1 is referred to as a cartridge system 100. The cartridge system 100 is a support system for easily loading the clip unit 1 into a clip introduction device 200.

[0044] 6, the cartridge 5 is a case that stores the clip unit 1. The cartridge 5 is about 40 mm wide, about 70 to 80 mm long, and about 5 mm thick, making it easy to hold in your hand.

[0045] The cartridge 5 is manufactured by injection molding from a transparent resin material with appropriate hardness, such as ABS, PC, PP, PS, acrylic, cycloolefin polymer, etc. The cartridge 5 is formed using a transparent resin material, making it easy for the user to determine whether the clip unit 1 is present inside.

[0046] As shown in Figure 6, of the two directions perpendicular to the longitudinal direction (insertion direction) L of the cartridge 5 and perpendicular to each other, one is referred to as the "width direction W" and the other as the "height direction H." Furthermore, a plane parallel to the longitudinal direction L and the width direction W is referred to as the "horizontal plane HP." A plane parallel to the longitudinal direction L and the height direction H is referred to as the "vertical plane VP." Furthermore, in the cartridge 5 storing the clip unit 1, the side of the pair of arms 21 is referred to as the tip side L1 of the cartridge 5, and the side of the connecting member 4 is referred to as the base side L2 of the cartridge 5.

[0047] 6, the cartridge 5 has a cartridge body (case body portion) 70 formed in a substantially rectangular box shape. An insertion port (opening) 67 is formed in the cartridge body 70. A treatment tool storage area 7S is formed inside the cartridge body 70.

[0048] The cartridge body 70 is formed with a treatment tool storage area 7S in which the clip unit 1 is stored so as to be movable in the longitudinal direction (advance / retract direction) L. As shown in Fig. 6 , the treatment tool storage area 7S includes a first area 71 and a sheath insertion area 74. The first area 71 and the sheath insertion area 74 are arranged from the distal end side L1 to the proximal end side L2 in the longitudinal direction L of the cartridge 5.

[0049] The cartridge body 70 is formed with an insertion port (opening) 67 through which the sheath 220 can be inserted. The insertion port 67 has an opening surface that is formed substantially perpendicular to the longitudinal direction L. The insertion port 67 is formed on the side surface of the base end side L2 of the cartridge body 70. The insertion port 67 communicates with the sheath insertion region 74.

[0050] The first region 71 is an internal space in which the clip unit 1 is stored so as to be movable in the longitudinal direction L. The first region 71 communicates with the sheath insertion region 74.

[0051] The sheath insertion region 74 is a region into which the distal end portion of the sheath 220 is inserted after passing through the insertion port 67. The sheath insertion region 74 is located on the proximal end side L2 of the first region 71 and communicates with the first region 71.

[0052] 7 to 9, a method for loading the clip unit 1 will be described. Figures 7 to 9 are diagrams for explaining a method for loading the clip unit 1 into the clip introducer 200 using the cartridge 5.

[0053] 7 is a diagram showing the clip unit 1 connected to the clip introduction device 200. The user advances the sheath 220 toward the distal end of the cartridge 5. At this time, the user, for example, holds the cartridge 5 with one hand while moving the sheath 220 with the other hand. The user further advances the sheath 220, bringing the arrowhead hook 231 into contact with the connecting member 4.

[0054] 8 is a diagram showing the clip unit 1 connected to the clip introduction device 200. The user further advances the sheath 220 to connect the engaging portion 231a of the arrowhead hook 231 with the connecting member 4.

[0055] 9 is a diagram showing how the clip unit 1 is being pulled out of the cartridge 5. The user retracts the sheath 220 toward the proximal end side L2 of the cartridge 5. At this time, the user, for example, holds the cartridge 5 with one hand while moving the sheath 220 with the other hand. The sheath 220 pulls the clip unit 1 toward the proximal end side L2. By retracting the sheath 220 toward the proximal end side L2 of the cartridge 5, the user can pull out the clip unit 1 loaded in the clip introduction device 200 from the cartridge 5.

[0056] The clip unit 1 pulled out from the cartridge 5 can be used by being inserted into a treatment instrument channel 430 of an endoscope 400, which will be described later.

[0057] [Endoscope System 500] Here, the endoscope system 500 will be described with reference to FIGS. 10 and 11. FIG.

[0058] Fig. 10 shows a state in which the sheath 220 of the clip device 300 is inserted into the treatment instrument channel 430 of the endoscope 400. Fig. 11 is a perspective view showing the endoscope system 500 in use.

[0059] A system including the clip device 300 and the endoscope 400 is referred to as an endoscope system 500. The endoscope system 500 is a system used during endoscopic treatment.

[0060] The endoscope 400 is a well-known direct-view flexible endoscope and includes a long insertion section 410, an endoscope operation section 420, and a treatment instrument channel 430. The endoscope operation section 420 is provided at the proximal end of the insertion section 410. In the following description, the side of the endoscope 400 facing the endoscope operation section 420 is referred to as the proximal side. The side of the insertion section 410 opposite the endoscope operation section 420 in the longitudinal axis direction is referred to as the distal side of the endoscope 400. Treatment instruments such as the clip device 300 are inserted through the treatment instrument channel 430. The treatment instrument channel 430 is a member through which a treatment section such as the clip unit 1 can be inserted. The endoscope 400 may be a side-view flexible endoscope.

[0061] A forceps port 440 that communicates with the treatment tool channel 430 is provided distal to the endoscope operation section 420. A user can insert an endoscopic treatment tool such as the clip device 300 through the forceps port 440. A forceps plug 450 is attached to the forceps port 440 to prevent leakage of bodily fluids.

[0062] Here, the configuration of the clip device 300 will be described in comparison with the endoscope 400. The operation section 240 is formed so as not to be able to be inserted into the treatment instrument channel 430. Specifically, the outer diameter M1 of the operation section 240 is larger than the inner diameter M3 of the treatment instrument channel 430. The outer sheath 250 is formed so as to be able to be inserted into the treatment instrument channel 430. Specifically, the outer diameter M2 of the outer sheath 250 is smaller than the inner diameter M3 of the treatment instrument channel 430.

[0063] A length M7 from the tip of the clip unit 1 to the tip of the outer sheath 250 in the longitudinal direction K of the clip device 300 is shorter than a length M6 of the treatment instrument channel 430. Specifically, when the sheath 220 is inserted into the treatment instrument channel 430 and the clip unit 1 protrudes from the tip of the treatment instrument channel 430, the tip of the outer sheath 250 is housed in the treatment instrument channel 430.

[0064] 12 and 13 , when the clip unit 1 protrudes from the distal end of the treatment instrument channel 430, the distal end of the outer sheath 250 does not have to be housed in the treatment instrument channel 430. Specifically, when the clip unit 1 protrudes from the distal end of the treatment instrument channel 430, the length M8 between the distal end of the outer sheath 250 and the forceps opening 440 may be 30 cm or less. In this case, the user can simultaneously rotate and advance / retract the outer sheath 250 near the forceps opening 440 while grasping one point of the outer sheath 250, allowing the user to perform intuitive operation.

[0065] [Operation of Clip Device 300] Next, the operation of the clip device 300 will be described with reference to FIGS. 10 and 11. FIG.

[0066] 10 , the clip device 300 is used with the sheath 220 inserted into the treatment instrument channel 430. The user inserts the sheath 220 until the clip unit 1 protrudes from the treatment instrument channel 430. At this time, the distal end of the outer sheath 250 is housed in the treatment instrument channel 430.

[0067] 11 , the user operates the endoscope operation unit 420 with one hand and operates the outer sheath 250 with the other hand. When using the endoscope system 500, a caregiver who operates the operation unit 240 of the clip device 300 is required in addition to the user who operates the endoscope 400.

[0068] The user needs to rotate the clip unit 1 appropriately. The user can rotate the clip unit 1 in the circumferential direction S by rotating the outer sheath 250 in the circumferential direction S. When the outer sheath 250 rotates in the circumferential direction S, the rotation is transmitted in this order to the operation unit main body 241 and the operation wire 230, causing the clip unit 1 to rotate in the circumferential direction S. In other words, the force that rotates the outer sheath 250 can be transmitted to the treatment unit via the operation unit 240 and the operation wire 230, and the outer sheath 250 itself has enough rigidity to transmit the force of rotation of the outer sheath 250 to the operation unit 240. By rotating the clip unit 1 in the circumferential direction S, the user can operate the clip unit 1 in an appropriate orientation.

[0069] According to the clip device 300 of this embodiment, the clip unit 1 can be rotated by rotating the outer sheath 250, and therefore the user can rotate the clip unit 1 in the circumferential direction S while operating the endoscope 400. Specifically, the user can rotate the clip unit 1 in the circumferential direction S by operating the outer sheath 250 with one hand while operating the endoscope operating section 420 with the other hand. Therefore, the clip device 300 is easy to use.

[0070] According to the clip device 300 of this embodiment, the operation wire 230, which is a member that transmits the rotation of the outer sheath 250 to the clip unit 1, is not subjected to friction from the treatment instrument channel 430, and therefore the rotation is easily transmitted. Specifically, because the operation wire 230 is inserted through the sheath 220, it can rotate without being subjected to friction from the treatment instrument channel 430. Therefore, when the sheath 220 is inserted through the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be performed smoothly.

[0071] According to the clip device 300 of this embodiment, the outer sheath 250 is rotatable relative to the sheath 220, and therefore when the outer sheath 250 is rotated in the circumferential direction S, the sheath 220 does not rotate in the circumferential direction S and is not affected by friction between the sheath 220 and the treatment instrument channel 430. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be performed smoothly.

[0072] According to the clip device 300 of this embodiment, the outer sheath 250 is formed in a cylindrical shape through which the sheath 220 is inserted, and therefore the user can easily rotate the outer sheath 250 in the circumferential direction S. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be smoothly performed.

[0073] According to the clip device 300 of this embodiment, the outer sheath 250 has higher flexibility than the operating section 240 and can be bent along the sheath 220, so that the shape of the sheath 220 can be deformed while the clip unit 1 can be rotated at a position away from the operating section 240. Therefore, the clip device 300 is easy to use.

[0074] According to the clip device 300 of this embodiment, the outer diameter M2 of the outer sheath 250 is smaller than the inner diameter M3 of the treatment instrument channel 430, and therefore the outer sheath 250 can be used while inserted into the treatment instrument channel 430. Therefore, it is possible to prevent causes that would hinder operation, such as the tip of the outer sheath 250 coming into contact with the forceps port 440 while operating the clip device 300, and the clip device 300 is easy to use.

[0075] According to the clip device 300 of this embodiment, the length M5 of the outer sheath 250 in the longitudinal direction K is longer than the length M4 of the operating portion 240, so the user can operate the clip unit 1 at a position away from the operating portion 240. Therefore, the clip device 300 is easy to use.

[0076] According to the clip device 300 of this embodiment, the length M5 of the outer sheath 250 in the longitudinal direction K is shorter than the length M9 of the sheath 220, and therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the length by which the outer sheath 250 is inserted into the treatment instrument channel 430 is short. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be performed smoothly.

[0077] According to the clip device 300 of this embodiment, the length M7 from the tip of the clip unit 1 to the tip of the outer sheath 250 in the longitudinal direction K is shorter than the length M6 of the treatment instrument channel 430, and therefore the outer sheath 250 can be used in a state where it is inserted into the treatment instrument channel 430. Even when the tip of the treatment instrument channel 430 and the tip of the clip unit 1 are aligned, the tip of the outer sheath 250 is inserted into the treatment instrument channel 430. Therefore, it is possible to prevent causes that would hinder operation, such as the tip of the outer sheath 250 coming into contact with the forceps port 440 during operation of the clip device 300, and the clip device 300 is easy to use.

[0078] According to the clip device 300 of this embodiment, when the sheath 220 is inserted into the treatment instrument channel 430 and the clip unit 1 protrudes from the distal end of the treatment instrument channel 430, the distal end of the outer sheath 250 is housed in the treatment instrument channel 430, and therefore the outer sheath 250 can be used while inserted into the treatment instrument channel 430. Therefore, it is possible to prevent causes that would hinder operation, such as the distal end of the outer sheath 250 coming into contact with the forceps port 440 while operating the clip device 300, and the clip device 300 is easy to use.

[0079] According to the clip device 300 of this embodiment, the operating unit 240 has a first portion 240a that can rotate in conjunction with the outer sheath 250 and a second portion 240b that is connected to the first portion 240a so as to be rotatable relative to the first portion 240a, so that when a user rotates the outer sheath 250 in the circumferential direction S and the first portion 240a rotates in the circumferential direction S, the caregiver operating the operating unit 240 supports the second portion 240b and does not interfere with the rotation of the first portion 240a. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be performed smoothly.

[0080] According to the clip device 300 of this embodiment, the slider 242 is arranged in the first part 240a, so that the caregiver operating the operating portion 240 can easily move the slider 242 back and forth in the longitudinal direction K, making the clip device 300 easy to use.

[0081] According to the clip device 300 of this embodiment, the outer sheath 250 has an inner layer portion 251, an outer layer portion 252, and a middle layer portion 253 that is disposed radially between the inner layer portion 251 and the outer layer portion 252 and has a higher hardness than the inner layer portion 251 and the outer layer portion 252. Therefore, the outer sheath 250 can transmit rotation applied to the distal end portion to the operating portion 240. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be performed smoothly.

[0082] According to the clip device 300 of this embodiment, the inner layer 251 is formed containing resin, the outer layer 252 is formed containing resin, and the middle layer 253 is formed containing metal wire, so that the outer sheath 250 has appropriate hardness and can transmit rotation applied to the distal end portion to the operation section 240. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be carried out smoothly.

[0083] (Modification 1) [Operation Unit 240B] Next, an operation unit 240B according to Modification 1 will be described with reference to FIGS. 14 and 15. FIG.

[0084] 14 is a cross-sectional view of an operating unit 240B according to Modification 1, showing a cross section along the longitudinal direction K. The operating unit 240B is a modification of the operating unit 240. The operating unit 240B differs from the operating unit 240 in that it has a stopper 249.

[0085] The stopper 249 is a member that restricts relative rotation between the first portion 240a and the second portion 240b. In the operating portion 240B, the stopper 249 is a member that restricts relative rotation between the operating portion main body 241 and the thumb ring 248. The stopper 249 is, for example, an O-ring. As shown in FIG. 14 , the stopper 249 is provided at the connection portion between the operating portion main body 241 and the thumb ring 248.

[0086] 15 is an enlarged view of the area indicated by the dashed line D13 of the operation unit 240B shown in FIG. 14. As shown in FIG. 15, a radially recessed groove 241d is formed in the base end 241t of the operation unit main body 241. The groove 241d is formed on the outer periphery of the base end 241t of the operation unit main body 241. The stopper 249 is formed in a ring shape and is fitted into the groove 241d. The tip end 248s of the thumb ring 248 is formed in a cylindrical shape and is attached so as to cover the outer periphery of the stopper 249. The stopper 249 is compressed radially by the outer periphery of the base end 241t of the operation unit main body 241 and the inner periphery of the tip end 248s of the thumb ring 248.

[0087] The stopper 249 is a friction member that generates friction between itself and the first portion 240a. In the operating portion 240B, the stopper 249 is a friction member that generates friction between itself and the operating portion main body 241. The stopper 249 is a friction member that generates friction between itself and the second portion 240b. In the operating portion 240B, the stopper 249 is a friction member that generates friction between itself and the thumb ring 248. The stopper 249 is formed to include rubber.

[0088] The friction between the stopper 249 and the operation unit main body 241 is determined according to the rotational transmissibility of the outer sheath 250. Specifically, the frictional force between the stopper 249 and the operation unit main body 241 > {rotational angle of the outer sheath 250 × (1 - rotational transmissibility of the outer sheath 250)} × torque required to rotate the outer sheath 250 by 1 degree (N mm / deg). For example, when the rotational operation angle of the outer sheath 250 is 90°, the rotational transmissibility of the outer sheath 250 is 33%, and the torque required to rotate the outer sheath 250 is 10 N mm / deg, a 60° twist accumulates in the outer sheath 250, and the frictional force of the stopper 249 is, for example, greater than 600 N mm. The friction between the stopper 249 and the operation unit main body 241 and between the stopper 249 and the thumb ring 248 is preferably greater than 10 mN m. The friction between the stopper 249 and the operation portion main body 241 and between the stopper 249 and the thumb ring 248 may be 5 mN·m or more, or 10 mN·m or less.

[0089] When the outer sheath 250 rotates in the circumferential direction S while inserted into the treatment instrument channel 430, friction occurs between the outer sheath 250 and the forceps stopper 450. Therefore, if the user rotates the outer sheath 250 in the circumferential direction S with a force smaller than the frictional force between the outer sheath 250 and the forceps stopper 450, the outer sheath 250 and the forceps stopper 450 do not rotate relative to each other in the circumferential direction S. Even when the outer sheath 250 and the forceps stopper 450 do not rotate relative to each other in the circumferential direction S, the clip unit 1 rotates via the operation section 240 and the operation wire 230 due to the twisting of the outer sheath 250. However, when the outer sheath 250 is untwisted, the clip unit 1 returns to its original state. Therefore, the user needs to rotate the outer sheath 250 in the circumferential direction S with a force larger than the frictional force between the outer sheath 250 and the forceps stopper 450.

[0090] Since the operation portion 240B has the stopper 249, the user can rotate the outer sheath 250 in the circumferential direction S with a force equal to or greater than the force restricted by the stopper 249, thereby preventing the clip unit 1 from rotating due to twisting of the outer sheath 250. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be performed smoothly.

[0091] Friction occurs between the operation portion main body 241 and the stopper 249, and friction occurs between the thumb ring 248 and the stopper 249, allowing the user to rotate the outer sheath 250 in the circumferential direction S with a force greater than or equal to the frictional force between the operation portion main body 241 and the stopper 249 and the frictional force between the thumb ring 248 and the stopper 249, thereby preventing the clip unit 1 from rotating due to twisting of the outer sheath 250. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be performed smoothly.

[0092] When a force greater than a predetermined amount is applied to the operation portion main body 241 and the treatment instrument channel 430 in the circumferential direction S, the operation portion main body 241 and the treatment instrument channel 430 rotate relatively in the circumferential direction S, and therefore the user rotates the outer sheath 250 in the circumferential direction S with a force greater than or equal to the frictional force between the operation portion main body 241 and the stopper 249 and the frictional force between the thumb ring 248 and the stopper 249. Therefore, rotation of the clip unit 1 due to twisting of the outer sheath 250 can be suppressed, and when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, allowing treatment using the clip unit 1 to proceed smoothly.

[0093] Although the stopper 249 shown in the first modified example is formed in a ring shape, there is no limitation on the shape of the stopper 249. The stopper 249 may be configured to restrict the relative rotation between the operation unit main body 241 and the thumb ring 248.

[0094] (Modification 2) [Operation Unit 240C] Next, an operation unit 240C according to Modification 2 will be described with reference to FIGS. 16 to 22. FIG.

[0095] 16 is a side view, partially in cross section, showing an operation unit 240C according to Modification 2. The operation unit 240C is a modification of the operation unit 240. The operation unit 240C differs from the operation unit 240 in that it includes a rotation operation unit 243.

[0096] The rotary operation unit 243 is a member that is provided so as to be rotatable in the circumferential direction S relative to the operation unit main body 241. As shown in Fig. 16 , the rotary operation unit 243 is provided on the tip side of the operation unit main body 241. The rotary operation unit 243 rotates in the circumferential direction S relative to the operation unit main body 241.

[0097] 16, the sheath 220 is connected to the rotation operation unit 243 via a retaining member 241c. The sheath 220 is connected to the rotation operation unit 243 so as to be unable to advance or retreat in the longitudinal direction K. The sheath 220 is connected to the rotation operation unit 243 so as to be rotatable in the circumferential direction S.

[0098] 17 is a cross-sectional view of the operating portion 240C, showing a cross section along the longitudinal direction K. As shown in FIGS. 16 and 17 , the wire 232 passes through an insertion passage 243a formed inside the rotation operating portion 243 toward the base end side, and is then connected to the slider 242.

[0099] Figure 18 is a cross-sectional view of the operation unit 240C taken along line F14-F14 in Figure 16. Figure 19 is an enlarged view of the area indicated by dashed line D17 in the operation unit 240C in Figure 18. The wire 232 is provided so as to be movable forward and backward in the longitudinal direction K relative to the rotary operation unit 243. The wire 232 is provided so as to be rotatable in the circumferential direction S relative to the operation unit main body 241 in conjunction with the rotary operation unit 243.

[0100] The wire 232 is provided with a rotation transmission member 232a that transmits rotation of the rotation operation unit 243 in the circumferential direction S to the wire 232. As shown in Figures 17 to 19, the rotation transmission member 232a is provided on the outer periphery of the wire 232. The rotation transmission member 232a is provided in a region of the outer periphery of the wire 232 that passes through the insertion path 243a in the longitudinal direction K. The rotation transmission member 232a is fixed to the wire 232.

[0101] The rotation transmission member 232a is a member that extends in the longitudinal direction K. The rotation transmission member 232a is formed in a rotationally asymmetric shape when viewed in the longitudinal direction K. For example, the rotation transmission member 232a is formed in a U-shape when viewed in the longitudinal direction K.

[0102] The insertion passage 243a through which the rotation transmission member 232a is inserted is formed in a shape that restricts rotation of the rotation transmission member 232a in the circumferential direction S when viewed from the longitudinal direction K. The insertion passage 243a is formed in a rotationally asymmetric shape when viewed from the longitudinal direction K. The insertion passage 243a is formed, for example, in a substantially rectangular shape. Therefore, the rotation transmission member 232a can transmit rotation of the rotation operation unit 243 in the circumferential direction S to the wire while being able to advance and retreat through the insertion passage 243a in the longitudinal direction K.

[0103] Figure 20 is a side view showing the operation unit main body 241, showing a cross section of the slider 242. Figure 21 is a cross section taken along line F19-F19 of the operation unit 240C shown in Figure 16. Figure 22 is an enlarged view of the area indicated by dashed line D20 of the operation unit 240C shown in Figure 21. The wire 232 is provided so as to be movable forward and backward in the longitudinal direction K in conjunction with the slider 242. The wire 232 is provided so as to be rotatable in the circumferential direction S relative to the slider 242.

[0104] The wire 232 is provided with a retainer 232b that transmits the advancement and retreat of the slider 242 in the longitudinal direction K to the wire 232. As shown in Figures 20 to 22 , the retainer 232b is provided on the outer periphery of the wire 232. The retainer 232b is provided in a region of the outer periphery of the wire 232 that overlaps with the slider 242 in the longitudinal direction K. The retainer 232b is provided at the base end of the wire 232. The retainer 232b is fixed to the wire 232.

[0105] The retaining member 232b is a member extending in the longitudinal direction K. When viewed from the longitudinal direction K, the retaining member 232b is formed in a circular shape.

[0106] The retainer 232b is accommodated in a storage space 242a formed inside the slider 242. As shown in FIG. 20 , the length of the storage space 242a in the longitudinal direction K is slightly longer than the length of the retainer 232b in the longitudinal direction K. This restricts movement of the retainer 232b relative to the storage space 242a in the longitudinal direction K, and the forward and backward movement of the slider 242 in the longitudinal direction K is transmitted to the wire 232. As shown in FIGS. 21 and 22 , the storage space 242a is sized to allow the retainer 232b to rotate in the circumferential direction S when viewed from the longitudinal direction K. Specifically, it is sufficient that the length of the longest portion of the width of the retainer 232b when viewed from the longitudinal direction K is shorter than the length of the shortest portion of the width of the storage space 242a. For example, the storage space 242a is shaped like a rectangle with sides larger than the diameter of the retainer 232b when viewed from the longitudinal direction K. Therefore, the retainer 232 b can transmit the advancement and retreat of the slider 242 in the longitudinal direction K to the wire 232 while being rotatable in the circumferential direction S.

[0107] In the operation unit 240C, the thumb ring 248 is fixed to the operation unit body 241.

[0108] Similar to the operation unit 240, the operation unit 240C has a first portion 240a connected to the outer sheath 250 and a second portion 240b connected to the first portion 240a so as to be rotatable relative to the first portion 240a in the circumferential direction S. In the operation unit 240C, the first portion 240a has a rotation operation unit 243. In the operation unit 240C, the second portion 240b has an operation unit main body 241, a slider 242, and a thumb ring 248.

[0109] According to the operation unit 240C, when the outer sheath 250 rotates in the circumferential direction S, the rotation operation unit 243 rotates in the circumferential direction S in conjunction with the rotation, but the operation unit main body 241 and the slider 242 do not rotate in conjunction with the rotation. Therefore, the caregiver operating the operation unit 240C can easily maintain the position of the slider 242. The clip device 300 equipped with the operation unit 240C is easy to use.

[0110] The operating unit 240C has a rotation transmission member 232a and a retaining member 232b, but the configuration of the operating unit 240C is not limited thereto. The operating unit 240C may have a configuration in which the first part 240a has a rotation operating unit 243 and the second part 240b has an operating unit main body 241, a slider 242, and a thumb ring 248.

[0111] (Modification 3) [Operation Unit 240D] Next, an operation unit 240D according to Modification 3 will be described with reference to FIG.

[0112] 23 is a cross-sectional view of an operating unit 240D according to Modification 3, taken along the longitudinal direction K. The operating unit 240D is a modification of the operating unit 240C. The operating unit 240D differs from the operating unit 240 in that it has a stopper 249.

[0113] In the operation unit 240D, the stopper 249 is a member that restricts relative rotation in the circumferential direction S between the rotation operation unit 243 and the operation unit main body 241. As shown in FIG. 23 , the stopper 249 is provided at the connection portion between the rotation operation unit 243 and the operation unit main body 241.

[0114] With the operation unit 240D, the user can rotate the outer sheath 250 in the circumferential direction S with a force equal to or greater than the force restricted by the stopper 249, thereby preventing the clip unit 1 from rotating due to twisting of the outer sheath 250. Therefore, when the sheath 220 is inserted into the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be carried out smoothly.

[0115] (Modification 4) [Outer Sheath 250E] Next, an outer sheath 250E according to Modification 4 will be described with reference to Figs. 24 to 26 .

[0116] 24 is a side view showing an outer sheath 250E according to Modification 4. The outer sheath 250E is a modification of the outer sheath 250. The outer sheath 250E is configured to be extendable and contractible in the longitudinal direction K.

[0117] The outer sheath 250E is a member that can transition between a contracted state and an extended state. The contracted state is a state in which the outer sheath 250E has a first length in the longitudinal direction K. The extended state is a state in which the outer sheath 250E has a second length in the longitudinal direction K that is longer than the first length. The outer sheath 250E is configured in a bellows shape, for example, as shown in FIG. 24 . The outer sheath 250E is rotatable in the circumferential direction S relative to the sheath 220 regardless of whether it is in the contracted state or the extended state.

[0118] The outer sheath 250E is configured to be extendable and contractible, so that the length of the outer sheath 250E can be adjusted in the longitudinal direction K. Therefore, the clip device 300 including the outer sheath 250E is easy to use.

[0119] 25 is a side view showing an outer sheath 250E configured to be extendable and retractable. The configuration of the outer sheath 250E is not limited. As shown in FIG. 25, the outer sheath 250E may be configured such that a plurality of tubular members having different radial sizes are connected in the longitudinal direction K.

[0120] Fig. 26 is a side view showing a transmission member 250Ea configured to be expandable and contractible in the longitudinal direction K. As shown in Fig. 26, the clip device 300 may be provided with a transmission member 250Ea configured to be expandable and contractible in the longitudinal direction K, instead of the outer sheath 250E. The transmission member 250Ea shown in Fig. 26 is a plate-like member that is elastically deformable and has slits formed therein.

[0121] In the clip device 300 according to this embodiment, an outer sheath 250 is provided, but it is sufficient that a transmission member that is fixed to the operating portion 240 and can transmit rotation in the circumferential direction S to the operating portion 240 is provided.

[0122] In the clip device 300 according to this embodiment, the outer sheath 250 has an inner layer portion 251, an outer layer portion 252, and a middle layer portion 253, but the configuration of the outer sheath 250 is not limited thereto. The outer sheath 250 may be, for example, a single-layer tube. The outer sheath 250 may be, for example, a tubing coil. The outer sheath 250 may have any configuration as long as it can transmit rotation in the circumferential direction S to the operating portion 240.

[0123] In the clip device 300 according to this embodiment, the clip unit 1 is configured to be loaded into the clip unit 1 using the cartridge 5, but the configuration of the clip unit 1 is not limited thereto. The clip unit 1 may be attached to the clip introducer 200 in advance. Also, the clip introducer 200 may be reloaded with a new clip unit 1 using the cartridge 5.

[0124] In this embodiment, the treatment part is the clip unit 1, but the treatment part is not limited to this. The treatment part may be any member that is attached to the clip introduction device 200 and used in endoscopic treatment, such as forceps or a knife.

[0125] In this embodiment, the clip device 300 is used as an example of a medical instrument, but the clip introduction device 200 can be used as an applicator in a medical instrument in which a treatment part such as forceps or a knife is connected to an applicator.

[0126] 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 above embodiment and modifications can be configured in any suitable combination.

[0127] Second Embodiment [Clip Device 300F] A clip device 300F according to a second embodiment of the present invention will be described with reference to Figures 27 and 29. The clip device 300F according to the second embodiment differs from the clip device 300 according to the first embodiment in the configuration of the clip introduction device. In the following description, components that are common to those already described will be assigned the same reference numerals, and redundant description will be omitted.

[0128] 27 is a side view showing a clip device 300F according to the second embodiment. The clip device 300F includes a clip introducer 200F and a clip unit 1. The clip unit 1 is loaded into the clip introducer 200F.

[0129] The clip unit 1 and the sheath 220 are not fixed to each other. Furthermore, the clip unit 1 is rotatable in the circumferential direction S relative to the sheath 220.

[0130] [Clip Introducing Device 200F] Clip introducing device 200F includes a sheath 220, an operating wire 230, and an operating portion 240. Unlike clip introducing device 200, clip introducing device 200F does not need to include outer sheath 250.

[0131] In the clip introduction device 200F, the sheath 220 and the operation section 240 are fixed to each other. A connection section 200f between the sheath 220 and the operation section 240 is fixed by, for example, adhesive.

[0132] When the sheath 220 rotates in the circumferential direction S, the operating unit 240 also rotates in the circumferential direction S in conjunction with the sheath 220. The clip unit 1, the operating wire 230, the operating unit 240, and the sheath 220 can rotate in conjunction with each other in the circumferential direction S. Therefore, by rotating the sheath 220 in the circumferential direction S, the user can rotate the clip unit 1 via the operating unit 240 and the operating wire 230.

[0133] FIG. 28 shows a state in which the sheath 220 of the clip device 300F is inserted into the treatment instrument channel 430 of the endoscope 400.

[0134] 28, the clip device 300F is used in a state in which the sheath 220 is inserted into the treatment instrument channel 430. The user inserts the sheath 220 until the clip unit 1 protrudes from the treatment instrument channel 430.

[0135] The user operates the endoscope operation unit 420 with one hand and operates the sheath 220 with the other hand. In addition to the user who operates the endoscope 400, an assistant is required to operate the operation unit 240 of the clip device 300F.

[0136] The user needs to rotate the clip unit 1 appropriately. The user can rotate the clip unit 1 by rotating the sheath 220 in the circumferential direction S. When the sheath 220 rotates in the circumferential direction S, the rotation is transmitted in this order to the operation portion main body 241 and the operation wire 230, causing the clip unit 1 to rotate. By rotating the clip unit 1, the user can operate the clip unit 1 in an appropriate orientation.

[0137] According to the clip device 300F of this embodiment, the clip unit 1 can be rotated by rotating the sheath 220 in the circumferential direction S, and therefore the user can rotate the clip unit 1 while operating the endoscope 400. Specifically, the user can rotate the clip unit 1 by operating the outer sheath 250 with the other hand while operating the endoscope operating section 420 with one hand. Therefore, the clip device 300F is easy to use.

[0138] According to the clip device 300F of this embodiment, the operation wire 230, which is a member that transmits the rotation of the sheath 220 in the circumferential direction S to the clip unit 1, is not subjected to friction from the treatment instrument channel 430, and therefore the rotation is easily transmitted. Specifically, because the operation wire 230 is inserted through the sheath 220, it can rotate in the circumferential direction S without being subjected to friction from the treatment instrument channel 430. Although the sheath 220 is inserted through the treatment instrument channel 430, as shown in FIG. 28 , the portion that transmits the rotation in the circumferential direction S to the operation unit 240 is exposed from the treatment instrument channel 430. Therefore, when the rotation of the sheath 220 in the circumferential direction S is transmitted to the operation unit 240, it is less affected by friction between the sheath 220 and the treatment instrument channel 430. Therefore, when the sheath 220 is inserted through the treatment instrument channel 430, the clip unit 1 can be easily rotated, and treatment using the clip unit 1 can be performed smoothly.

[0139] (Modification 5) [Clip Device 300G] Next, a clip device 300G according to Modification 5 will be described with reference to FIG.

[0140] 29 is a side view showing a clip device 300G according to Modification 5. Clip device 300G is a modification of clip device 300F. Clip device 300G differs from clip device 300F in that it has a grip 200g.

[0141] The grip 200g is a member that is grasped by the user when the user rotates the sheath 220 in the circumferential direction S. The grip 200g is provided on the sheath 220. The grip 200g is connected to the outer periphery of the sheath 220. The grip 200g is a member that can slide on the sheath 220 in the longitudinal direction K. The outer diameter of the grip 200g is larger than the outer diameter of the sheath 220. The grip 200g has a shape that is easy to grip. The grip 200g has an outer diameter that is easy to grip.

[0142] The grip 200g is a member that has, for example, a slit formed on the inner diameter side and is crushed when grasped by the user, allowing the user to grasp the sheath 220 via the grip 200g. The grip 200g is, for example, a cylindrical rubber member. The user can move the grip 200g to a position that is easy to grasp and grasp it.

[0143] The provision of the grip 200g makes it easy for the user to rotate the sheath 220 in the circumferential direction S. Therefore, the clip device 300F is easy to use.

[0144] 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 above embodiment and modifications can be configured in any suitable combination.

[0145] 300 Clip device 300F Clip device 300G Clip device 200 Clip introduction device (applicator) 200F Clip introduction device (applicator) 200f Connection part 200g Grip 220 Sheath 221 Distal tip 222 Distal coil 224 Proximal coil 230 Operation wire 231 Arrowhead hook 231a Engagement part 231b Wire connection part 232 Wire 232a Rotation transmission member 232b Stopper 240 Operation part 240B Operation part 240C Operation part 240D Operation part 240a First part 240b Second part 241 Operation part body 241a Slit part 241b Rotation grip 241c Stopper 241d Groove part 241t Base end part 242 Slider 242a Storage space 243 Rotation operation section 243a Insertion passage 248 Thumb ring 248s Tip section 249 Stopper 250 Outer sheath (transmission member) 250E Outer sheath (transmission member) 251 Inner layer section 252 Outer layer section 253 Middle layer section 1 Clip unit 2 Clip 21 Arm 211 First arm 212 Second arm 22 Tissue grasping section 3 Pressing member (holder) 3A Pressing tube 3B Pipe 4 Connecting member 100 Cartridge system 5 Cartridge 70 Cartridge body (case) 67 Insertion port (opening) 7S Treatment tool storage area 71 First area 74 Sheath insertion area 500 Endoscope system 400 Endoscope 410 Insertion section 420 Endoscope operation section 430 Treatment tool channel 440 Forceps port 450 Forceps plug K Longitudinal direction K1 Distal end side K2 Base end side S Circumferential direction

Claims

1. A medical device comprising: a sheath extending in the longitudinal direction; a treatment section arranged at the distal end side of the sheath; a wire inserted into the sheath and to which the treatment section is fixed; a handle arranged at the proximal end side of the sheath and to which the wire is fixed; and a transmission member arranged on the outer periphery of the sheath and extending from the handle to the distal end side, wherein the treatment section, the wire, the handle, and the transmission member are rotatable in the circumferential direction with respect to the longitudinal direction relative to the sheath.

2. The medical device according to claim 1, wherein the transmission member is formed in a cylindrical shape through which the sheath is inserted.

3. The medical device according to claim 1, wherein the handle comprises: a handle body; and a slider supported by the handle body and movable back and forth in the longitudinal direction; the wire is connected to the slider and movable back and forth in the longitudinal direction in conjunction with the slider; and the transmission member has higher flexibility than the handle and is bendable along the sheath.

4. The medical device according to claim 1, wherein the outer diameter of the handle is larger than the inner diameter of an endoscope channel through which the treatment section can be inserted, and the outer diameter of the transmission member is smaller than the inner diameter of the endoscope channel.

5. The medical device according to claim 1, wherein the length of the transmission member is longer than the length of the handle in the longitudinal direction.

6. The medical device according to claim 1, wherein the length of the transmission member is shorter than the length of the sheath in the longitudinal direction.

7. The medical device according to claim 1, wherein the length from the tip of the treatment section to the tip of the transmission member in the longitudinal direction is shorter than the length of an endoscope channel through which the treatment section can be inserted.

8. The medical device according to claim 7, wherein, when the treatment section is inserted into the endoscope channel and protrudes from the tip of the endoscope channel, the tip of the transmission member is housed in the endoscope channel.

9. The medical device according to claim 1, wherein, when the treatment section is inserted into the endoscope channel and protrudes from the tip of the endoscope channel, the length between the tip of the transmission member and the forceps port of the endoscope channel is 30 cm or less.

10. The medical device according to claim 1, wherein the handle has: a first portion connected to the transmission member and rotatable in conjunction with the transmission member; and a second portion connected to the first portion so as to be rotatable relative to the first portion.

11. The medical device according to claim 10, wherein the handle comprises: a handle body; and a slider supported by the handle body and movable back and forth in the longitudinal direction, the slider being disposed in the first portion.

12. The medical device according to claim 10, wherein the handle comprises: a handle body; and a slider supported by the handle body and movable back and forth in the longitudinal direction, the slider being disposed in the second portion.

13. The medical device according to claim 10, wherein the handle has a stopper between the first part and the second part that restricts relative rotation between the first part and the second part.

14. The medical device according to claim 13, wherein the stopper is a friction member that generates friction between itself and the first portion and generates friction between itself and the second portion.

15. The medical device according to claim 14, wherein, when the treatment section is inserted into an endoscope channel through which the treatment section can be inserted, the friction between the stopper and the first section and between the stopper and the second section is determined by the rotational transmission capability of the transmission member.

16. The medical device of claim 13, wherein the friction between the stopper and the first portion and between the stopper and the second portion is greater than 10 mN·m.

17. The medical device of claim 1, wherein the transmission member has a higher flexibility than the handle, and the transmission member has an inner layer portion, an outer layer portion, and a middle layer portion that is disposed radially between the inner layer portion and the outer layer portion and has a higher hardness than the inner layer portion and the outer layer portion.

18. The medical device according to claim 1, wherein the transmission member is capable of transitioning between a contracted state having a first length in the longitudinal direction and an extended state having a second length in the longitudinal direction that is longer than the first length.

19. A medical device comprising: a sheath extending in the longitudinal direction; a treatment section arranged on the distal side of the sheath; a wire inserted through the sheath and to which the treatment section is fixed; and a handle arranged on the proximal side of the sheath and to which the wire is fixed, wherein the sheath and the handle are fixed, and the treatment section, the wire, the handle, and the sheath are rotatable in a circumferential direction relative to the longitudinal direction in conjunction with each other.

20. The medical device of claim 19, further comprising a grip connected to the sheath, the grip being slidable on the sheath and having an outer diameter greater than an outer diameter of the sheath.

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