Applicator

Abstract

An applicator comprising: a linear power transmission member having a distal end part to which a clip can be connected; a sheath into which the power transmission member is inserted; a handle connected to a base end part of the sheath; and a slider connected to a base end part of the power transmission member, supported by the handle, and movable relative to the handle in the longitudinal direction of the handle, wherein the slider has a first engagement part, the handle has a third engagement part that can engage with the first engagement part, and, by engaging with the first engagement part, the third engagement part restricts the slider from moving toward the distal end side in the longitudinal direction.

Description

Applicator

[0001] The present invention relates to an applicator for use in an endoscopic treatment section. This application claims priority to U.S. Provisional Patent Application No. 63 / 680,614, filed August 8, 2024, U.S. Provisional Patent Application No. 63 / 759,540, filed February 17, 2025, and U.S. Provisional Patent Application No. 63 / 820,026, filed June 9, 2025, the contents of which are incorporated herein by reference.

[0002] In endoscopic treatment, clip units are used. The clip unit is introduced to the treatment site by an applicator (introduction device) that can be inserted into the channel of an endoscope. The applicator includes, for example, a wire (power transmission member) connected to the clip unit, a handle equipped with a slider that operates the clip unit via the wire, and a sheath through which the wire is inserted.

[0003] When the sheath is inserted into the channel of the endoscope, by maintaining the clip of the clip unit in a closed state, it is possible to prevent the gripping portion of the clip from getting caught on the inner surface of the channel of the endoscope.

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

[0005] However, with the applicator described in Patent Document 1, it is not easy to maintain the slider position so that the clip is in a closed state when the sheath is inserted into the channel of the endoscope. In particular, in treatments using clip units, the sheath is often inserted into the channel of the endoscope multiple times, which poses a problem of difficulty in maintaining the slider position so that the clip is in a closed state.

[0006] In view of the above circumstances, an object of the present invention is to provide an applicator that makes it easy to maintain the position of a slider.

[0007] In order to solve the above problems, the present invention proposes the following means: An applicator according to a first aspect of the present invention comprises a linear power transmission member having a distal end to which a clip can be connected, a sheath through which the power transmission member is inserted, a handle connected to a proximal end of the sheath, and a slider connected to the proximal end of the power transmission member and supported by the handle, the slider being movable relative to the handle in a longitudinal direction of the handle, the slider having a first engagement portion, the handle having a third engagement portion engageable with the first engagement portion, and the third engagement portion engaging with the first engagement portion to restrict movement of the slider toward the distal end in the longitudinal direction.

[0008] The applicator of the present invention makes it easy to maintain the position of the slider and to insert the sheath into the channel of the endoscope, so that treatment using a clip can be carried out smoothly.

[0009] 1 is a side view showing a clip device according to a first embodiment; FIG. 2 is a side view showing a tip portion of the operation wire; FIG. 3 is a cross-sectional view of the tip portion of the operation wire; FIG. 4 is a side view showing a clip unit; FIG. 5 is a cross-sectional view of the clip unit, showing a cross-section perpendicular to the up-down direction; FIG. 6 is a cross-sectional view of the clip unit, showing a cross-section perpendicular to the left-right direction; FIG. 7 is a cross-sectional view of the operation unit, showing a cross-section taken along the longitudinal direction; FIG. 8 is a plan view showing a cartridge; FIG. 9 is a side view showing a clip introducing device; FIG. 10 is a cross-sectional view of the operation unit, showing a cross-section taken along the longitudinal direction; FIG. 11 is a view showing a state in which the clip introducing device is inserted into the cartridge; FIG. 12 is a view showing a state in which the clip unit is connected to the clip introducing device; FIG. 13 is a view showing a state in which the clip unit is pulled out from the cartridge; FIG. 14 is a side view showing the clip device; FIG. 15 is a cross-sectional view of the operation unit, showing a cross-section taken along the longitudinal direction; FIG. 16 is a cross-sectional view of the operation unit, showing a cross-section taken along the longitudinal direction; FIG. 17 is a cross-sectional view of the operation unit according to a first modified example, showing a cross-section taken along the longitudinal direction; FIG. 18 is a side view showing the clip introducing device; 29 is a cross-sectional view showing a sheath, showing a cross section cut along a plane along the axial direction. FIG. 29 is a cross-sectional view showing the sheath, showing a cross section cut along a plane along the axial direction. FIG. 29 is a cross-sectional view showing the sheath, showing a cross section cut along a plane along the axial direction. FIG. 29 is a cross-sectional view showing the operation unit, showing a cross section cut along the longitudinal direction. FIG. 29 is a cross-sectional view showing the operation unit, showing a cross section cut along the longitudinal direction. FIG. 29 is a cross-sectional view showing an operation unit according to Modification 2, showing a cross section cut along the longitudinal direction. FIG. 29 is a cross-sectional view showing the operation unit, showing a cross section cut along the longitudinal direction. FIG. 29 is a cross-sectional view showing an operation unit according to Modification 3, showing a cross section cut along the longitudinal direction. FIG. 29 is a detailed view showing a region surrounded by a dashed line D29 of the operation unit shown in FIG. 28. FIG. 30 is a side view showing an engagement portion and a release protrusion. FIG. 31 is a diagram showing a change in the amount of operating force of the slider. FIG. 32 is a diagram showing a state in which the first engagement portion engages with the third engagement portion. FIG. 33 is a diagram showing a state in which the first engagement portion engages with the third engagement portion. FIG. 34 is a diagram showing a state in which the first engagement portion engages with the third engagement portion.10 is a diagram showing a state in which the first engagement portion gets over the fourth abutment surface. FIG. 10 is a diagram showing a state in which the first engagement portion gets over the fourth abutment surface. FIG. 10 is a cross-sectional view showing an operation unit according to Modification 4, showing a cross-section taken along the longitudinal direction. FIG. 10 is a cross-sectional view showing the operation unit, showing a cross-section taken along the longitudinal direction. FIG. 10 is a cross-sectional view showing the operation unit, showing a cross-section taken along the longitudinal direction. FIG. 10 is a cross-sectional view showing the operation unit according to Modification 5, showing a cross-section taken along the longitudinal direction. FIG. 10 is a cross-sectional view showing the operation unit, showing a cross-section taken along the longitudinal direction. FIG. 10 is a side view showing the clip introduction device. FIG. 10 is a side view showing the clip introduction device. FIG. 10 is a cross-sectional view showing an operation unit according to Modification 6, showing a cross-section taken along the longitudinal direction. FIG. 10 is a cross-sectional view showing an operation unit according to Modification 7, showing a cross-section taken along the longitudinal direction. FIG. 10 is a cross-sectional view showing an operation unit according to Modification 8, showing a cross-section taken along the longitudinal direction. FIG. 10 is a side view showing an operation unit according to a second embodiment.

[0010] Hereinafter, an applicator according to an embodiment will be described with reference to the drawings. Note that in each drawing, the scale of each component may be appropriately changed as necessary to make each component large enough to be visible.

[0011] (First embodiment) [Clip device 300] A clip device 300 according to this embodiment will be described with reference to Fig. 1 to Fig. 46. First, the overall configuration of the clip device 300 will be described. However, the clip device 300 does not need to have all of the components described below, and some components may be omitted as appropriate.

[0012] Fig. 1 is a side view showing a clip device 300 according to the first embodiment. The clip device 300 is a device that is inserted into a treatment tool insertion channel (not shown) of an endoscope and used to treat an affected area. As shown in Fig. 1, the clip device 300 includes a clip introducer (applicator) 200 and a clip unit 1. The clip unit 1 is loaded into the clip introducer 200.

[0013] The clip introducing device 200 is inserted into a treatment tool insertion channel of an endoscope and is used in combination with the endoscope. The clip introducing device 200 includes a sheath 220, an operating wire (power transmission member) 230, and an operating section 240.

[0014] The sheath 220 is a tubular member that is inserted into the treatment tool insertion channel of the endoscope. The sheath 220 is formed to be sufficiently longer than the length of the treatment tool insertion channel of the endoscope. The sheath 220 is flexible and formed to be stretchable in the axial direction, and curves in accordance with the curvature of the insertion portion of the endoscope. The sheath 220 is formed, for example, from a metal coil. The sheath 220 has a tubular hood 221 (see FIG. 2) at its tip.

[0015] 2 is a side view showing the distal end of the operating wire 230. The operating wire 230 is formed in a linear shape, is inserted into the sheath 220, and is arranged so as to be movable forward and backward in the axial direction relative to the sheath 220. The operating wire 230 has a connecting portion (distal end) 231 connected to the clip unit 1, and a wire 232 that operates the connecting portion 231.

[0016] The connecting portion 231 is a member capable of gripping the clip unit 1. The connecting portion 231 is, for example, a pair of forceps. The connecting portion 231 is formed of a metal material such as stainless steel.

[0017] Fig. 3 is a cross-sectional view of the distal end of the operating wire 230. The wire 232 is inserted into the sheath 220 so as to be able to move back and forth freely. As shown in Fig. 3, a connecting portion 231 is fixed to the distal end of the wire 232 via a connecting member 233. The wire 232 is, for example, a stranded wire made of metal wires.

[0018] A stopper 235 is provided at the distal end of the wire 232. The stopper 235 is a member that restricts the range of movement of the wire 232 toward the distal end relative to the sheath 220. For example, the stopper 235 is a member that restricts the movement of the wire 232 toward the distal end when the connection portion 231 protrudes from the distal end of the sheath 220. The stopper 235 is, for example, a protrusion that protrudes radially outward from the outer circumferential surface of the wire 232 and is configured to abut against a step (protrusion) provided at the base end of the hood 221. The configuration of the stopper 235 is not limited. For example, the stopper 235 may be provided at the connection portion, or may be configured to abut against a step (protrusion) provided on the sheath 220.

[0019] The operating unit 240 is a member that operates the clip unit 1 via the operating wire 230. As shown in FIG. 1 , the operating unit 240 is disposed on the proximal end side of the sheath 220. The operating unit 240 has an operating unit main body (handle) 241, a slider 242, and a thumb ring 243. The operating unit main body 241, the slider 242, and the thumb ring 243 are injection molded from, for example, a resin material. The operating unit main body 241 has a slit portion 241a and a rotating grip 241b attached to the distal end side. The slit portion 241a supports the slider 242 so that it can move forward and backward. Here, with respect to the operating unit 240, the direction in which the slider 242 moves forward and backward is defined as the longitudinal direction K, with the distal end side being defined as K1 and the proximal end side being defined as K2.

[0020] The slider 242 is attached to the operation unit main body 241 so as to be movable forward and backward in the longitudinal direction K. A base end of the wire 232 is attached to the slider 242. The slider 242 is supported by the operation unit main body 241. When the slider 242 moves forward and backward along the longitudinal direction K of the operation unit main body 241, the wire 232 moves forward and backward relative to the sheath 220, and the connection portion 231 moves forward and backward.

[0021] The thumb ring 243 is attached to the base end of the operation portion body 241 so as to be rotatable in the circumferential direction relative to the operation portion body 241. The thumb ring 243 rotates in the circumferential direction relative to the operation portion body 241 with the longitudinal direction K as the rotation axis.

[0022] [Clip unit 1] Fig. 4 is a side view showing the clip unit 1. The clip unit 1 is a treatment section that is inserted into a treatment tool insertion channel of an endoscope and used to treat an affected area. The clip unit 1 is disposed on the distal end side of the sheath 220 (see Fig. 1). As shown in Fig. 4, the clip unit 1 includes a clip 2 and a presser member 3.

[0023] In the following description, the clip 2 side in the longitudinal direction A of the clip unit 1 is referred to as the distal side A1 of the clip unit 1, and the connecting member 4 side is referred to as the proximal side A2 of the clip unit 1. The direction perpendicular to the longitudinal direction A is referred to as the left-right direction B. The direction perpendicular to the longitudinal direction A and the left-right direction B is referred to as the up-down direction C.

[0024] Fig. 5 is a cross-sectional view of the clip unit 1, showing a cross section cut along a plane perpendicular to the up-down direction C. As shown in Figs. 4 and 5, the clip 2 is formed by bending a metal plate at its center. The clip 2 has a pair of arms 21 that can be opened and closed, and a base end portion 23 that connects the pair of arms 21. The clip 2 can transition between an open state P1 and a closed state P2.

[0025] The pair of arms 21 includes a first arm 211 and a second arm 212. The first arm 211 and the second arm 212 are arranged 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.

[0026] A tissue gripping portion 22 is formed at the end of the tip side A1 of the first arm 211 and the second arm 212. The tissue gripping portion 22 is formed by bending the tip of the first arm 211 and the second arm 212 inward.

[0027] The base end portion 23 is bent into a U-shape. The base end portion 23 connects the first arm 211 and the second arm 212. The first arm 211 and the second arm 212 connected by the base end portion 23 are provided so as to be able to open and close toward the tip side A1. The base end portion 23 biases the first arm 211 and the second arm 212 so that the clip 2 is in the open state P1. Therefore, the pair of arms 21 have a self-expanding force. The pair of arms 21 are retracted into the pressing member 3 and elastically deform to be in the closed state P2.

[0028] The base end portion 23 has a predetermined orientation in which it can be connected to the connecting portion 231. For example, the base end portion 23 is configured to be connectable to the connecting portion 231 in a state in which the opening / closing direction of the connecting portion 231 coincides with the up-down direction C. In this case, the connecting portion 231 connects to the base end portion 23 by grasping the U-shaped portion of the base end portion 23 from the up-down direction C.

[0029] The holding 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 base end 23 of the clip 2 is housed inside the holding member 3. The distal ends of the pair of arms 21 protrude from a distal opening 3a of the holding member 3. The diameter of the base opening 3b of the holding member 3 is smaller than the diameter of the distal opening 3a.

[0030] The retaining member 3 is formed by injection molding a thermoplastic resin having appropriate elasticity, such as a material softer than the clip 2, such as PPA (polyphthalamide), PA (polyamide), PEEK (polyether ether ketone), or LCP (liquid crystal polymer). The retaining member 3 may be formed from a metal instead of a thermoplastic resin.

[0031] FIG. 6 is a cross-sectional view of the clip unit 1, showing a cross section cut along a plane perpendicular to the left-right direction B. As shown in FIG. 6, a locking portion 24 is formed on the base end portion 23. The locking portion 24 is a protrusion that protrudes in the width direction of the base end portion 23. The portion of the base end portion 23 where the locking portion 24 is formed has a larger dimension in the width direction. The tip side A1 of the locking portion 24 is formed with a contact surface 24a that is perpendicular to the longitudinal direction A. The base end side A2 of the locking portion 24 is formed with an inclined surface 24b that forms an acute angle with respect to the longitudinal direction. The locking portion 24 is formed on each of the first arm 211 side and the second arm 212 side of the base end portion 23.

[0032] Each locking portion 24 can pass through the base-end opening 3b as the first arm 211 and the second arm 212 approach each other. When each locking portion 24 moves from the distal side A1 of the base-end opening 3b toward the proximal side A2, the inclined surface 24b abuts against the edge of the base-end opening 3b, causing the first arm 211 and the second arm 212 to approach each other, allowing each locking portion 24 to pass through the base-end opening 3b. On the other hand, when each locking portion 24 attempts to move from the proximal side A2 of the base-end opening 3b toward the distal side A1, the abutment surface 24a abuts against the edge of the base-end opening 3b, preventing each locking portion 24 from passing through the base-end opening 3b. Therefore, the clip 2 is locked in the closed state P2. The pressing member 3 can fix the clip 2, which has been retracted into the internal space, in the closed state P2.

[0033] [Engagement Portions 244, 245, 246] Figure 7 is a cross-sectional view of the operating unit 240, showing a cross-section taken along the longitudinal direction K. As shown in Figure 7, the slider 242 has a first engagement portion 244. The first engagement portion 244 is provided on the guided portion 242a of the slider 242 that is inserted into the slit portion 241a. Here, the radial direction R is defined with the longitudinal direction K as the main axis, and the side of the radial direction R that is away from the center of the operating unit 240 is the outer side R1, and the side of the radial direction R that is toward the center of the operating unit 240 is the inner side R2. The first engagement portion 244 is a protrusion that protrudes toward the outer side R1. The first engagement portion 244 is an elastically deformable member.

[0034] The operation unit main body 241 has a second engagement portion 245 and a third engagement portion 246. The second engagement portion 245 is a member that can engage with the first engagement portion 244 and restricts the slider 242 from moving toward the base end side K2 in the longitudinal direction K. The third engagement portion 246 is a member that can engage with the first engagement portion 244 and restricts the slider 242 from moving toward the tip end side K1 in the longitudinal direction K.

[0035] The second engaging portion 245 is a member that engages with the first engaging portion 244 of the slider 242 at a position where the connection portion 231 of the operation wire 230 protrudes from the tip of the sheath 220. The second engaging portion 245 is provided in the slit portion 241a of the operation portion main body 241. The second engaging portion 245 is a protruding portion that protrudes toward the inner side R2. The second engaging portion 245 is formed with a second inclined surface 245a on the side portion of the base end side K2 that inclines toward the inner side R2 as it progresses toward the tip side K1. The second inclined surface 245a is a member that abuts against the first engaging portion 244 of the slider 242 at a position where the clip 2 is in the open state P1. When the first engagement portion 244 and the second engagement portion 245 are engaged with each other, and the slider 242 receives a predetermined amount of force on the base end side K2 in the longitudinal direction K, the first engagement portion 244 moves toward the base end side K2 of the second engagement portion 245 while elastically deforming, and the engagement between the first engagement portion 244 and the second engagement portion 245 is released.

[0036] The third engagement portion 246 is a member that engages with the first engagement portion 244 of the slider 242 at a position where the clip 2 is in the closed state P2. The third engagement portion 246 is provided in the slit portion 241a of the operation portion main body 241. The third engagement portion 246 is a protrusion that protrudes toward the inner side R2. The third engagement portion 246 is formed, on a side portion of the distal end side A1, with a third inclined surface 246a that inclines toward the inner side R2 as it progresses toward the proximal end side A2. The third inclined surface 246a is a member that abuts against the first engagement portion 244 of the slider 242 at a position where the clip 2 is in the closed state P2. When the first engagement portion 244 and the third engagement portion 246 are engaged with each other, and the slider 242 receives a predetermined amount of force on the tip side K1 in the longitudinal direction K, the first engagement portion 244 moves toward the tip side K1 of the third engagement portion 246 while elastically deforming, and the engagement between the first engagement portion 244 and the third engagement portion 246 is released.

[0037] Two of each of the first engaging portion 244, the second engaging portion 245, and the third engaging portion 246 are provided, spaced apart in the circumferential direction. There is no limitation on the number of first engaging portions 244, second engaging portions 245, and third engaging portions 246. One of each of the first engaging portion 244, second engaging portion 245, and third engaging portion 246 may be provided, or three or more of each may be provided.

[0038] 8 is a plan view showing the cartridge 5. The cartridge 5 is a case for storing the clip unit 1 and for loading the clip unit 1 into the clip introducer device 200. A support system that includes the clip unit 1 and the cartridge 5 and that facilitates loading of the clip unit 1 into the clip introducer device 200 is referred to as a cartridge system 100.

[0039] 8, the cartridge 5 has a cartridge body 70 formed in the shape of a rectangular box. Here, of two directions that are perpendicular to the longitudinal direction Z of the cartridge 5 and perpendicular to each other, one is referred to as the "left-right direction X" and the other is referred to as the "height direction Y." In addition, in the cartridge 5 storing the clip unit 1, the pair of arms 21 side is referred to as the tip side Z1 of the cartridge 5, and the connecting member 4 side is referred to as the base side Z2 of the cartridge 5.

[0040] A storage area 7S is formed inside the cartridge body 70, in which the clip unit 1 is stored so as to be movable in the longitudinal direction Z. The storage area 7S has 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 Z1 to the proximal end side Z2 in the longitudinal direction L of the cartridge 5.

[0041] 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 Z. The sheath insertion region 74 is a region into which the distal end of the sheath 220 is inserted after passing through the insertion port 67. The first region 71 and the sheath insertion region 74 are in communication with each other.

[0042] The cartridge body 70 is formed with an insertion opening 67 through which the sheath 220 can be inserted. The insertion opening 67 has an opening surface that is formed substantially perpendicular to the longitudinal direction Z. The insertion opening 67 is formed on the side surface of the cartridge body 70 on the base end side Z2. The insertion opening 67 communicates with the sheath insertion region 74.

[0043] The insertion opening 67 is provided with a direction adjustment unit (not shown) that adjusts the orientation of the connection unit 231 inserted into the insertion opening 67 to a direction that allows connection to the base end portion 23. For example, the direction adjustment unit is a member that rotates the connection unit 231 so that the opening / closing direction of the connection unit 231 coincides with the up-down direction C. The direction adjustment unit is, for example, an inclined surface that rotates the connection unit 231.

[0044] The cartridge 5 is approximately 40 mm wide, 70 to 80 mm long, and 5 mm thick, making it easy to hold. The cartridge 5 is injection molded from a transparent resin material with appropriate hardness, such as ABS, PC, PP, PS, acrylic, or cycloolefin polymer. Because the cartridge 5 is made from a transparent resin material, the user can easily determine whether the clip unit 1 is present inside.

[0045] [Method of Loading Clip Unit 1] Next, a method of loading the clip unit 1 will be described with reference to FIGS. 9 to 13. FIG.

[0046] Fig. 9 is a side view showing the clip introducer device 200. Fig. 9 is a diagram showing the clip introducer device 200 in the loadable state Q1. The user moves the slider 242 toward the distal end side K1 relative to the operation unit body 241 to place the clip introducer device 200 in the loadable state Q1, as shown in Fig. 9. The loadable state Q1 is a state in which the connecting portion 231 of the clip introducer device 200 protrudes from the distal end of the sheath 220. At this time, the stopper 235 provided on the operation wire 230 or the connecting portion 231 may hit a step (protrusion) provided on the sheath 220 or the hood 221.

[0047] FIG. 10 is a cross-sectional view of the operating unit 240, taken along the longitudinal direction K. FIG. 10 illustrates the operating unit 240 in a state in which the first engaging portion 244 and the second engaging portion 245 are engaged. As shown in FIG. 10 , the user can place the clip introducing device 200 in the loadable state Q1 by moving the slider 242 to a position where the first engaging portion 244 and the second engaging portion 245 are engaged. The engagement between the first engaging portion 244 and the second engaging portion 245 restricts the slider 242 from moving toward the proximal end side A2. Therefore, even if the user releases the slider 242, the clip introducing device 200 can be maintained in the loadable state Q1. Note that the first engaging portion 244 elastically deforms when the first engaging portion 244 and the second engaging portion 245 transition from a disengaged state (see FIG. 7 ) to a state in which the first engaging portion 244 and the second engaging portion 245 are engaged (see FIG. 10 ).

[0048] 11 is a diagram showing the state in which the clip introduction device 200 is being inserted into the cartridge 5. As shown in FIG. 11 , the user inserts the sheath 220 through the insertion port 67 of the cartridge 5 and advances the sheath 220 to the distal end side Z1 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 to bring the connecting portion 231 into contact with the proximal end 23 of the clip 2.

[0049] 12 is a diagram showing the clip unit 1 connected to the clip introducer device 200. The user connects the connecting portion 231 to the proximal end 23 of the clip 2 by further advancing the sheath 220. At this time, the connecting portion 231 receives a force from the clip 2 toward the proximal end side A2. However, because the first engaging portion 244 and the second engaging portion 245 are engaged, the clip introducer device 200 is maintained in the loadable state Q1, and therefore, movement of the connecting portion 231 to the proximal end side A2 is suppressed. This makes it easy for the user to connect the connecting portion 231 to the proximal end 23.

[0050] 13 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 A2 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 A2. By retracting the sheath 220 toward the proximal end side A2 of the cartridge 5, the user can pull out the clip unit 1 loaded in the clip introduction device 200 from the cartridge 5.

[0051] [Operation of Clip Device 300] Next, the operation of the clip device 300 will be described with reference to Figs.

[0052] FIG. 14 is a side view showing the clip device 300. Note that FIG. 14 shows the clip device 300 in the open state P1. In the clip device 300, as shown in FIG. 14 , the clip 2 can be placed in the open state P1 by moving the slider 242 toward the distal end side K1 relative to the operation unit main body 241 in the longitudinal direction K. Specifically, the clip 2 can be placed in the open state P1 by moving the slider 242 to a position where the first engagement portion 244 abuts against the second inclined surface 245a of the second engagement portion 245. When the first engagement portion 244 abuts against the second inclined surface 245a, the slider 242 is less likely to move toward the distal end side K1, making it easier for the user to notice that the first engagement portion 244 abuts against the second inclined surface 245a. Therefore, the user can intuitively operate the slider 242.

[0053] FIG. 15 is a side view showing the clip device 300. Note that FIG. 15 shows the clip device 300 in the closed state P2. FIG. 16 is a cross-sectional view of the operating unit 240, taken along the longitudinal direction K. Note that FIG. 16 shows the operating unit 240 in a state in which the first engagement portion 244 abuts against the third inclined surface 246a. In the clip device 300, as shown in FIG. 15, the clip 2 can be placed in the closed state P2 by moving the slider 242 toward the proximal end K2 relative to the operating unit main body 241 in the longitudinal direction K. As shown in FIG. 16, when the first engagement portion 244 abuts against the third inclined surface 246a of the third engagement portion 246, the clip 2 is in the closed state P2. The clip 2 can be placed in the closed state P2 by moving the slider 242 to a position where the first engagement portion 244 abuts against the third inclined surface 246a of the third engagement portion 246. When the first engagement portion 244 abuts against the third inclined surface 246 a, the slider 242 is less likely to move toward the base end side K2, so the user can easily notice that the first engagement portion 244 has abutted against the third inclined surface 246 a. Therefore, the user can intuitively operate the slider 242.

[0054] FIG. 17 is a cross-sectional view of the operating unit 240, taken along the longitudinal direction K. FIG. 17 shows the operating unit 240 in a state in which the first engagement portion 244 and the third engagement portion 246 are engaged with each other. In the clip device 300, the clip 2 can be maintained in the closed state P2 by further moving the slider 242 toward the proximal end side K2 relative to the operating unit body 241 in the longitudinal direction K. Specifically, as shown in FIG. 17 , by moving the slider 242 to a position where the first engagement portion 244 engages with the third engagement portion 246, the clip 2 is prevented from transitioning from the closed state P2 to the open state P1, and the clip 2 can be maintained in the closed state P2.

[0055] The clip introduction device 200 according to this embodiment includes an operating wire (power transmission member) 230 having a connection portion (tip portion) 231 to which a clip 2 can be connected, a sheath 220 through which the operating wire (power transmission member) 230 is inserted, an operating unit main body (handle) 241 connected to the base end of the sheath 220, and a slider 242 connected to the base end of the operating wire (power transmission member) 230 and supported by the operating unit main body (handle) 241, and movable relative to the operating unit main body (handle) 241 in the longitudinal direction K of the operating unit main body (handle) 241, the slider 242 having a first engagement portion 244, the operating unit main body (handle) 241 having a second engagement portion 245 engageable with the first engagement portion 244, and the second engagement portion 245 is configured to engage with the first engagement portion 244, thereby restricting movement of the slider 242 toward the base end side K2 in the longitudinal direction K, thereby making it easy to maintain the position of the slider 242. For example, when connecting the clip 2 to the connecting portion 231, the movement of the connecting portion 231 toward the base end side A2 is suppressed, making it easier for the user to connect the connecting portion 231 to the clip 2.

[0056] The clip introduction device 200 according to this embodiment includes an operating wire (power transmission member) 230 having a connection portion (tip portion) 231 to which a clip 2 can be connected, a sheath 220 through which the operating wire (power transmission member) 230 is inserted, an operating unit main body (handle) 241 connected to the base end of the sheath 220, and a slider 242 connected to the base end of the operating wire (power transmission member) 230 and supported by the operating unit main body (handle) 241, and movable relative to the operating unit main body (handle) 241 in the longitudinal direction K of the operating unit main body (handle) 241, the slider 242 having a first engagement portion 244, the operating unit main body (handle) 241 having a third engagement portion 246 engageable with the first engagement portion 244, and the third engagement portion 246 is configured to engage with the first engagement portion 244, thereby restricting movement of the slider 242 toward the tip side K1 in the longitudinal direction K, thereby making it easy to maintain the position of the slider 242. For example, when inserting the sheath 220 into the treatment instrument insertion channel of an endoscope, the transition of the clip 2 from the closed state P2 to the open state P1 is suppressed, making it easier for the user to insert the sheath 220 into the treatment instrument insertion channel.

[0057] According to the clip introduction device 200 of this embodiment, the second engagement portion 245 is configured to have a second inclined surface 245a formed on the side of the base end side K2 that inclines inward R2 as it progresses toward the tip end side K1 in the longitudinal direction K. Therefore, when the first engagement portion 244 engages with the second engagement portion 245, the first engagement portion 244 abuts against the second inclined surface 245a, making it easy for the first engagement portion 244 and the second engagement portion 245 to elastically deform in the radial direction R, and making it easy for the first engagement portion 244 to engage with the second engagement portion 245.

[0058] According to the clip introduction device 200 of this embodiment, the third engagement portion 246 is configured to have a third inclined surface 246a formed on the side of the tip side K1 that inclines inward R2 as it progresses toward the base side K2 in the longitudinal direction K. Therefore, when the first engagement portion 244 engages with the third engagement portion 246, the first engagement portion 244 abuts against the third inclined surface 246a, making it easy for the first engagement portion 244 and the third engagement portion 246 to be elastically deformed in the radial direction R, and making it easy for the first engagement portion 244 to engage with the third engagement portion 246.

[0059] In the following description, components having the same or similar functions are denoted by the same reference numerals, and redundant descriptions of those components may be omitted.

[0060] 18 to 25, a clip introducer (applicator) 200B according to Modification 1 will be described. The clip introducer 200B is a modification of the clip introducer 200.

[0061] Like the clip introducer device 200, the clip introducer device 200B is a device that is inserted into a treatment tool insertion channel of an endoscope and used in combination with the endoscope. The clip introducer device 200B has a sheath 220, an operation wire (power transmission member) 230B, and an operation unit 240B. The configuration of the sheath 220 has been explained in connection with the clip introducer device 200, and therefore will not be explained here.

[0062] Like the manipulation wire 230, the manipulation wire 230B is inserted through the sheath 220 and is arranged so as to be movable axially back and forth relative to the sheath 220. The manipulation wire 230B has a connecting portion 231 and a wire 232B that manipulates the connecting portion 231. The configuration of the connecting portion 231 has been described in the clip introduction device 200, and therefore will not be described here.

[0063] 18 is a cross-sectional view of an operating section 240B according to Modification 1, taken along the longitudinal direction K. Like the wire 232, the wire 232B is inserted into the sheath 220 so as to be able to move forward and backward. A connecting section 231 is fixed to the tip of the wire 232B via a connecting member 233. As shown in FIG. 18, the wire 232B has an expandable section 232Ba.

[0064] The expandable portion 232Ba is a member that can expand and contract in the longitudinal direction K. The expandable portion 232Ba is provided at the base end of the wire 232B. The expandable portion 232Ba is an elastic member, such as a coil spring. The expandable portion 232Ba is disposed inside the operating portion 240. For example, the expandable portion 232Ba can abut against the wire 232B, but is not connected to it.

[0065] The expandable portion 232Ba expands and contracts in accordance with the length of the sheath 220 (path length of the wire 232B). That is, the operating wire 230B expands and contracts in accordance with the length of the sheath 220 (path length of the wire 232B).

[0066] The operating section 240B is a member that operates the clip unit 1 via the operating wire 230B, similar to the operating section 240. The operating section 240B is disposed on the proximal end side of the sheath 220. The operating section 240B has an operating section main body 241B, a slider 242B, and a thumb ring 243. The operating section main body 241B has a slit section 241Ba and a rotating grip 241b. The slit section 241Ba supports the slider 242B so that it can move forward and backward. The configurations of the thumb ring 243 and the rotating grip 241b have been described in the clip introduction device 200, so description thereof will be omitted here.

[0067] Like the slider 242, the slider 242B is attached to the operation unit main body 241B so as to be movable back and forth in the longitudinal direction K. The base end of the wire 232 is attached to the slider 242B. When the slider 242B moves back and forth along the longitudinal direction K of the operation unit main body 241, the wire 232B moves back and forth relative to the sheath 220, and the connection portion 231 moves back and forth. A space capable of accommodating the expansion / contraction portion 232Ba is formed inside the guided portion 242Ba of the slider 242B that is inserted into the slit portion 241Ba. The expansion / contraction portion 232Ba is disposed inside the guided portion 242Ba.

[0068] [Engagement Portions 244B, 245B, 246B] The slider 242B has a first engagement portion 244B. The first engagement portion 244B is a modified example of the first engagement portion 244. The first engagement portion 244B is formed in a cylindrical shape and is provided on the inner periphery of the slider 242B. The first engagement portion 244B is a protrusion that protrudes toward the inner side R2. The first engagement portion 244B is a member that is elastically deformable in the radial direction R, such as a leaf spring. The shape of the first engagement portion 244B is not limited. For example, the first engagement portion 244B may be formed in a rectangular cylindrical shape.

[0069] The operation unit main body 241B has a second engagement portion 245B and a third engagement portion 246B. The second engagement portion 245B is a modified example of the second engagement portion 245, and the third engagement portion 246B is a modified example of the third engagement portion 246. The second engagement portion 245B is a member that can engage with the first engagement portion 244B and is a member that restricts movement of the slider 242B toward the base end side K2 in the longitudinal direction K. The third engagement portion 246B is a member that can engage with the first engagement portion 244B and is a member that restricts movement of the slider 242B toward the tip side K1 in the longitudinal direction K.

[0070] The second engagement portion 245B is a member that engages with the first engagement portion 244B of the slider 242B at a position where the connection portion 231 of the operation wire 230B protrudes from the distal end of the sheath 220. The second engagement portion 245B is provided on the outer periphery of the rod-shaped operation portion main body 241B. The second engagement portion 245B is a protrusion that protrudes outward R1. The second engagement portion 245B is formed with a second inclined surface 245a, which inclines outward R1 as it progresses toward the distal end side K1, on a side portion of the base end side K2. The second engagement portion 245B is formed with a second abutting surface 245b, which is perpendicular to the longitudinal direction K, on ​​a side portion of the distal end side K1. When the first engagement portion 244B and the second engagement portion 245B are engaged with each other, and the slider 242B receives a predetermined amount of force on the base end side K2 in the longitudinal direction K, the first engagement portion 244B moves toward the base end side K2 of the second engagement portion 245B while elastically deforming, and the engagement between the first engagement portion 244B and the second engagement portion 245B is released.

[0071] The operation unit main body 241B has a second engagement surface (first surface) 245s formed on its outer periphery, extending in the longitudinal direction K toward the distal end side K1 from the second engagement portion 245B. The second engagement surface 245s is formed at a position spaced apart from the first engagement portion 244B in the radial direction R. When the first engagement portion 244B is positioned on the outer side R1 of the second engagement surface 245s, the first engagement portion 244B and the second engagement portion 245B are engaged with each other. When the first engagement portion 244B is positioned so as to overlap with the second engagement surface 245s as viewed in the radial direction R, the connection portion 231 protrudes from the distal end of the sheath 220.

[0072] The third engagement portion 246B is a member that engages with the first engagement portion 244B of the slider 242B when the clip 2 is in the closed state P2. The third engagement portion 246B is provided on the outer periphery of the rod-shaped operating unit main body 241B. The third engagement portion 246B is a protrusion that protrudes outward R1. The third engagement portion 246B has a third inclined surface 246a formed on a side portion of the distal end side A1 that inclines inward R2 as it progresses toward the proximal end side A2. The third inclined surface 246a is a member that abuts against the first engagement portion 244B of the slider 242B when the clip 2 is in the closed state P2. The third engagement portion 246B has a third abutment surface 246b formed on a side portion of the proximal end side K2 that is perpendicular to the longitudinal direction K. When the first engagement portion 244B and the third engagement portion 246B are engaged with each other, and the slider 242B receives a predetermined amount of force on the tip side K1 in the longitudinal direction K, the first engagement portion 244B moves toward the tip side K1 of the third engagement portion 246B while elastically deforming, and the engagement between the first engagement portion 244B and the third engagement portion 246B is released.

[0073] The operation portion main body 241B has a third engagement surface (third surface) 246s formed on its outer periphery, extending in the longitudinal direction K toward the base end side K2 from the third engagement portion 246B. The third engagement surface 246s is formed at a position spaced apart from the first engagement portion 244B in the radial direction R. When the first engagement portion 244B is positioned on the outer side R1 of the third engagement surface 246s, the first engagement portion 244B and the third engagement portion 246B are engaged with each other. When the first engagement portion 244B is positioned so as to overlap with the third engagement surface 246s as viewed from the radial direction R, the clip 2 is in the closed state P2.

[0074] [Compression Amount of the Expandable Section 232Ba] The expandable section 232Ba is configured to be in a contracted state when the sheath 220 and the wire 232B are bent in a U-shape. The expandable section 232Ba is configured to be in an uncompressed state when the sheath and the wire 232B are wound three times (see FIG. 20). The maximum compression amount of the expandable section 232Ba is greater than the possible difference in path length between the sheath 220 and the wire 232B (the amount of expansion of the sheath 220). The force applied to the slider 242B is calculated by multiplying the difference in path length between the sheath 220 and the wire 232B by the spring constant of the expandable section 232Ba. Therefore, the first engaging portion 244B and the second engaging portion 245B are configured so that the engagement between the first engaging portion 244B and the second engaging portion 245B is not released even if a force equal to the path difference between the sheath 220 and the wire 232B multiplied by the spring constant of the extension / contraction portion 232Ba is applied.

[0075] [Operation of Clip Introducing Device 200B] Next, the operation of the clip introducing device 200B will be described. Note that explanations of operations that overlap with those of the clip introducing device 200 will be omitted.

[0076] 19 and 20 are side views of clip introducer device 200B. Note that the clip introducer device 200B shown in FIG. 19 has the sheath 220 bent into a U-shape, while the clip introducer device 200B shown in FIG. 20 has the sheath 220 wound three times. Because the axial lengths of the sheath 220 and wire 232B in the clip introducer device 200B are sufficiently long relative to the length of the user's arm, it is difficult to use the clip introducer device 200B with the sheath 220 and wire 232B straight. Therefore, the clip introducer device 200B is sometimes used with the sheath 220 and wire 232B bent into a U-shape (see FIG. 19 ) or with the sheath 220 and wire 232B wound three or four times. When the sheath 220 and wire 232B change from the U-shape bent state to the state wound three or four times, the sheath 220 and wire 232B change into a more curved state. Furthermore, when the sheath 220 and the wire 232B change from a state in which they are wound 3-4 times to a state in which they are bent into a U-shape, the sheath 220 and the wire 232B change from a curved state to a state in which they are nearly straight.

[0077] 21-23 are cross-sectional views of the sheath 220, showing a cross section cut along a plane along the axial direction. FIG. 21 shows the sheath 220 in a state close to being straight. FIG. 22 shows the sheath 220 in a more curved state than FIG. 21, showing a state in which the wire 232B is arranged along the inside of the curved sheath 220. FIG. 23 shows the sheath 220 in a more curved state than FIG. 21, showing a state in which the wire 232B is arranged along the outside of the curved sheath 220. As shown in FIG. 21, the closer the sheath 220 and the wire 232B are to being straight, the more the lengths of the sheath 220 and the wire 232B become approximately equal. On the other hand, as shown in FIGS. 22 and 23, the more the sheath 220 and the wire 232B are curved, the longer the length of the sheath 220 becomes compared to the length of the wire 232B. Note that the "length of sheath 220 is increased" refers to the path length of wire 232B being increased due to gaps being generated between the wire strands of the coil that forms sheath 220. Because sheath 220 is formed to be stretchable in the axial direction, the outside of sheath 220 stretches when bent. Therefore, particularly when wire 232B is arranged along the outside of bent sheath 220 (see FIG. 23 ), the difference in length between sheath 220 and wire 232B becomes large.

[0078] FIG. 24 is a cross-sectional view showing the operation unit 240B, taken along the longitudinal direction K. FIG. 24 shows a state in which the extension / contraction portion 232Ba is extended. At this time, the connection portion 231 protrudes from the distal end of the sheath 220. When the sheath 220 and the wire 232B are bent and the sheath 220 is extended in the axial direction (i.e., when the path length of the wire 232B is lengthened), as shown in FIG. 24 , the wire 232B is pulled toward the distal end K1 relative to the operation unit 240B, and the extension / contraction portion 232Ba is extended. Therefore, even when the sheath 220 is extended in the axial direction due to the sheath 220 and the wire 232B being bent, the slider 242B is prevented from being pulled toward the distal end K1, and the position of the slider 242B is maintained, thereby maintaining the state of the clip 2. More specifically, if the lengths of the sheath 220 and the wire 232B are set so that when the sheath 220 is contracted in the axial direction, the connection portion 231 protrudes from the tip of the sheath 220 and the first engagement portion 244B and the second engagement portion 245B are engaged, even if the sheath 220 expands in the axial direction, the slider 242B is prevented from being pulled toward the tip side K1, the position of the slider 242B is maintained, and the state of the clip 2 is also maintained.

[0079] FIG. 25 is a cross-sectional view showing the operation unit 240B, taken along the longitudinal direction K. FIG. 25 shows a state in which the expandable portion 232Ba is contracted. At this time, the connection portion 231 protrudes from the distal end of the sheath 220. When the sheath 220 and the wire 232B are deformed from a curved state to a linear state, thereby contracting the sheath 220 in the axial direction (i.e., when the path length of the wire 232B is shortened), as shown in FIG. 25, the wire 232B is pushed toward the proximal end side K2 relative to the operation unit 240B, and the expandable portion 232Ba is contracted. Therefore, even when the sheath 220 is contracted in the axial direction due to the sheath 220 and the wire 232B changing from a curved state to a state close to a linear state, the slider 242B is prevented from being pushed toward the proximal end side K2, and the position of the slider 242B is maintained, thereby maintaining the state of the clip 2. More specifically, if the lengths of the sheath 220 and the wire 232B are set so that when the sheath 220 is extended in the axial direction, the connection portion 231 protrudes from the tip of the sheath 220 and the first engagement portion 244B and the second engagement portion 245B are engaged, even if the sheath 220 contracts in the axial direction, the slider 242B is prevented from being pushed out toward the base end side K2, the position of the slider 242B is maintained, and the state of the clip 2 is also maintained.

[0080] According to the clip introduction device 200B of the first modification, the operation wire (power transmission member) 230B has an expandable portion 232Ba that is expandable in the longitudinal direction K, and the expandable portion 232Ba is configured to expand and contract in response to the bending of the operation wire (power transmission member) 230B and the sheath 220 when the first engagement portion 244B and the second engagement portion 245B are engaged with each other. This prevents a path difference from occurring between the operation wire (power transmission member) 230B and the sheath 220 even if the sheath 220 expands and contracts due to the bending of the operation wire (power transmission member) 230B and the sheath 220. More specifically, although a path difference occurs between the operation wire 230B and the sheath 220, the path difference that occurs is canceled out by the expandable portion 232Ba.

[0081] In the clip introduction device 200B according to the first modification, the first engagement portion 244B is configured as a leaf spring elastically deformable in the radial direction R. This allows the first engagement portion 244B to rapidly return from its elastically deformed state to its initial state, making it easier for the user to recognize that the first engagement portion 244B has returned to its original state. In particular, the sound generated when the first engagement portion 244B overcomes a step makes it easier for the user to recognize the return. For example, when the first engagement portion 244B overcomes the first inclined surface 244a and engages with the second engagement portion 245B, the first engagement portion 244B rapidly returns to its original state, generating a sound, making it easier for the user to recognize that the first engagement portion 244B has engaged with the second engagement portion 245B. Similarly, the user can easily recognize that the first engagement portion 244B has engaged with the third engagement portion 246B.

[0082] According to the clip introduction device 200B of the first modification, the second engaging portion 245B is configured to have a second abutment surface 245b formed on a side portion of the distal end side K1 that is perpendicular to the longitudinal direction K. Therefore, when the first engaging portion 244B engages with the second engaging portion 245B, the first engaging portion 244B abuts against the second abutment surface 245b, thereby preventing the first engaging portion 244B from moving toward the proximal end side K2, making it difficult for the first engaging portion 244B to disengage from the second engaging portion 245B. Furthermore, because the second abutment surface 245b is formed, the elastic deformation of the first engaging portion 244B returns swiftly when the first engaging portion 244B engages with the second engaging portion 245B from the proximal end side K2 to the distal end side K1, making it easy for the user to notice that the first engaging portion 244B has engaged with the second engaging portion 245B.

[0083] According to the clip introduction device 200B of the first modification, the third engagement portion 246 is configured to have a third abutment surface 246b formed on a side portion of the proximal end side K2 that is perpendicular to the longitudinal direction K. Therefore, when the first engagement portion 244 engages with the third engagement portion 246, the first engagement portion 244 abuts against the third abutment surface 246b, thereby preventing the first engagement portion 244 from moving toward the distal end side K1, and therefore making it difficult for the first engagement portion 244 to disengage from the third engagement portion 246. Furthermore, because the third abutment surface 246b is formed, when the first engagement portion 244B engages with the third engagement portion 246B from the distal end side K1 to the proximal end side K2, the elastic deformation of the first engagement portion 244B returns swiftly, making it easy for the user to notice that the first engagement portion 244B has engaged with the third engagement portion 246B.

[0084] (Modification 2) [Clip introducer device 200C] Next, a clip introducer device (applicator) 200C according to Modification 2 will be described with reference to Figures 26 and 27. Clip introducer device 200C is a modification of clip introducer device 200B.

[0085] 26 and 27 are cross-sectional views showing an operating unit 240B according to Modification 2, taken along the longitudinal direction K. FIG. 26 shows a cross-section of the operating unit 240B in a state in which the sheath 220 and the wire 232B are bent into a U-shape. FIG. 27 shows a cross-section of the operating unit 240B in a state in which the sheath 220 and the wire 232B are wound three times. As shown in FIGS. 26 and 27, the clip introducing device 200C has an expandable portion 232Ca instead of the expandable portion 232Ba. Because the clip introducing device 200C has the same or similar configuration as the clip introducing device 200B except for the expandable portion 232Ca, a redundant description of the configuration will be omitted.

[0086] 26, the expandable portion 232Ca is arranged in a contracted state when the sheath 220 and the wire 232B are bent into a U-shape, and is arranged in a state in which it can be further contracted. Therefore, when the sheath 220 and the wire 232B are bent into a U-shape when the first engaging portion 244B and the second engaging portion 245B are engaged with each other, the amount of pushing back force when the connecting portion 231 is pushed toward the base end side A2 is prevented from becoming too large.

[0087] 27, the expandable portion 232Ca is arranged in a contracted state when the sheath 220 and the wire 232B are wound three times. Therefore, when the sheath 220 and the wire 232B are wound three times with the first engaging portion 244B and the second engaging portion 245B engaged, the pushing force when the connecting portion 231 is pushed toward the base end side A2 is prevented from becoming too small. Furthermore, when the sheath 220 and the wire 232B are bent in a U-shape, the expandable portion 232Ca is contracted more than when wound three times.

[0088] The expandable portion 232Ca is formed by a spring, and the amount of force with which the expandable portion 232Ca attempts to return from a contracted state to its initial state can be calculated by multiplying the spring constant by the amount of compression of the spring. The amount of force with which the expandable portion 232Ca attempts to return from a contracted state to its initial state varies depending on the amount of compression of the spring, and the amount of force with which the connecting portion 231 pushes back when it is pushed toward the base end side A2 varies depending on the amount of force with which the expandable portion 232Ca attempts to return from a contracted state to its initial state, and the amount of compression of the spring varies depending on the states of the sheath 220 and the wire 232B. Therefore, the amount of force with which the connecting portion 231 pushes back when it is pushed toward the base end side A2 varies depending on the states of the sheath 220 and the wire 232B.

[0089] The amount of force required to push back when connecting portion 231 is pushed toward base end side A2 must also be determined taking into consideration the force transmission of wire 232B. For example, if the sheath 220 and wire 232B are designed so that when they are bent in a U-shape, the compression amount of expandable portion 232Ca is 17 mm and the force transmission is 80%, then when expandable portion 232Ca is provided with a spring constant of 0.1 N / mm, the amount of force required to push connecting portion 231 in by 1 mm is 2.6 N, and when expandable portion 232Ca is provided with a spring constant of 0.05 N / mm, the amount of force required to push connecting portion 231 in by 1 mm is 1.55 N.

[0090] Furthermore, for example, if the sheath 220 and the wire 232B are designed so that when they are wound around one turn, the compression amount of the expansion / contraction portion 232Ca is 15 mm and the force transmission is 75%, when the expansion / contraction portion 232Ca has a spring constant of 0.1 N / mm, the force required to push the connection portion 231 in by 1 mm is 2.5 N, and when the expansion / contraction portion 232Ca has a spring constant of 0.05 N / mm, the force required to push the connection portion 231 in by 1 mm is 1.5 N.

[0091] Furthermore, for example, if the sheath 220 and the wire 232B are designed so that when they are wound two times, the compression amount of the expansion section 232Ca is 10 mm and the force transmission is 65%, when the expansion section 232Ca has a spring constant of 0.1 N / mm, the force required to push the connection section 231 in by 1 mm is 2 N, and when the expansion section 232Ca has a spring constant of 0.05 N / mm, the force required to push the connection section 231 in by 1 mm is 1.25 N.

[0092] Furthermore, for example, if the sheath 220 and the wire 232B are designed so that when they are wound three times, the compression amount of the expansion section 232Ca is 5 mm and the force transmission is 60%, when the expansion section 232Ca has a spring constant of 0.1 N / mm, the force required to push the connection section 231 in by 1 mm is 1.3 N, and when the expansion section 232Ca has a spring constant of 0.05 N / mm, the force required to push the connection section 231 in by 1 mm is 0.9 N.

[0093] The spring constant of the expandable portion 232Ca is preferably 0.05 N / mm. When connecting the clip 2 to the connecting portion 231 using the cartridge 5, if the force required to push the connecting portion 231 is too great when adjusting the orientation of the connecting portion 231 through the insertion opening 67 of the cartridge 5, the connecting portion 231 may be deformed without rotating. On the other hand, if the force required to push the connecting portion 231 is too small, the connecting portion 231 may be pushed in without rotating. Therefore, the force required to push the connecting portion 231 is preferably configured to be 0.75-1.5 N. Even if the sheath 220 and the wire 232B are deformed, the force required to push the connecting portion 231 will be close to 0.75-1.5 N, so the spring constant of the expandable portion 232Ca is preferably 0.05 N / mm.

[0094] The expandable portion 232Ca contracts when the first engaging portion 244B moves from the base end side K2 of the second engaging portion 245B to a position where it engages with the second engaging portion 245B in the longitudinal direction K. Furthermore, the expandable portion 232Ca expands when the first engaging portion 244B moves from the position where it engages with the second engaging portion 245B to the base end side K2 of the second engaging portion 245B in the longitudinal direction K.

[0095] According to clip introduction device 200C of Modification 2, expandable portion 232Ca is configured to be disposed in a compressed state inside operation portion 240B, and therefore, even if clip 2 is connected to connection portion 231 using cartridge 5 with sheath 220 and operation wire (power transmission member) 230B wound around it, connection portion 231 is prevented from being pushed in without rotating when the orientation of connection portion 231 is adjusted at insertion opening 67 of cartridge 5. In other words, connection portion 231 is prevented from moving toward the base end without rotating when the orientation of connection portion 231 is adjusted at insertion opening 67 of cartridge 5.

[0096] According to clip introduction device 200C of Modification 2, expandable portion 232Ca is configured to be compressed when first engaging portion 244B and second engaging portion 245B are engaged and when operation wire (power transmission member) 230B and sheath 220 are bent into a U-shape, and is further configured to be disposed inside operation portion 240B in a compressible state. This prevents deformation of connection portion 231 or cartridge 5 without rotation when adjusting the orientation of connection portion 231 at insertion opening 67 of cartridge 5, even if clip 2 is connected to connection portion 231 using cartridge 5 when sheath 220 and operation wire (power transmission member) 230B are bent into a U-shape. In other words, connection portion 231 can be smoothly rotated when adjusting the orientation of connection portion 231 at insertion opening 67 of cartridge 5.

[0097] (Modification 3) [Clip introducer device 200D] Next, a clip introducer device (applicator) 200D according to Modification 3 will be described with reference to Figures 28 to 36. Clip introducer device 200D is a modification of clip introducer device 200C.

[0098] Fig. 28 is a cross-sectional view showing an operating unit 240D according to Modification 3, taken along the longitudinal direction K. As shown in Fig. 28, clip introducer device 200D has operating unit 240 instead of operating unit 240B. Clip introducer device 200D has the same or similar configuration as clip introducer device 200C except for operating unit 240B, and therefore a redundant description of those configurations will be omitted.

[0099] Operating unit 240D is a member that operates clip unit 1 via operating wire 230B, similar to operating unit 240B. Operating unit 240D is disposed on the proximal end side of sheath 220. Operating unit 240D has operating unit main body 241D, slider 242B, and thumb ring 243. Operating unit main body 241D has slit portion 241Ba and rotating grip 241b. The configurations of slider 242B, thumb ring 243, slit portion 241Ba, and rotating grip have been described in clip introducer device 200 or clip introducer device 200B, so description thereof will be omitted here.

[0100] [Engagement Portions 245D, 246D and Release Protrusion 247D] Figure 29 is a detailed view showing the area surrounded by the dashed line D29 of the operation unit 240D shown in Figure 28. As shown in Figure 28, the operation unit main body 241D has a second engagement portion 245D, a third engagement portion 246D, and a release protrusion 247D. The second engagement portion 245D is a modified version of the second engagement portion 245B, and the third engagement portion 246D is a modified version of the third engagement portion 246B. The second engagement portion 245D is a member engageable with the first engagement portion 244B and restricts movement of the slider 242B toward the base end side K2 in the longitudinal direction K. The third engagement portion 246D is a member engageable with the first engagement portion 244B and restricts movement of the slider 242B toward the tip end side K1 in the longitudinal direction K.

[0101] The second engagement portion 245D is a member that engages with the first engagement portion 244B at a position where the connection portion 231 of the operation wire 230B protrudes from the distal end of the sheath 220. The second engagement portion 245D is a member that protrudes toward the outer side R1 from the outer circumferential portion 241s of the rod-shaped operation unit main body 241D. The second engagement portion 245D has a second inclined surface 245a formed on a side portion of the base end side K2 that inclines toward the outer side R1 as it progresses toward the distal end side K1. The second inclined surface 245a is formed from the outer circumferential portion 241s to a second vertex 245c of the second engagement portion 245D. The second engagement portion 245D has a second abutting surface 245b formed on a side portion of the distal end side K1 that is perpendicular to the longitudinal direction K. The second abutting surface 245b extends from the outer circumferential portion 241s to the outer side R1 and is formed to the second vertex 245c.

[0102] The operation unit main body 241D has a second engagement surface (first surface) 245s formed on its outer periphery, extending in the longitudinal direction K toward the distal end side K1 from the second engagement portion 245D. The second engagement surface 245s is formed at a position spaced apart from the first engagement portion 244B in the radial direction R. When the first engagement portion 244B is positioned on the outer side R1 of the second engagement surface 245s, the first engagement portion 244B and the second engagement portion 245D are engaged with each other. When the first engagement portion 244B is positioned so as to overlap with the second engagement surface 245s as viewed in the radial direction R, the connection portion 231 protrudes from the distal end of the sheath 220.

[0103] The third engagement portion 246D is a member that engages with the first engagement portion 244B when the clip 2 is in the closed state P2. The third engagement portion 246D is a member that protrudes outward R1 from the outer periphery 241s of the rod-shaped operating unit main body 241D. The third engagement portion 246D is a member that protrudes outward R1 from the outer periphery 241s of the rod-shaped operating unit main body 241D. The third engagement portion 246D has a third inclined surface 246a formed on a side portion of the distal end side K1 that inclines outward R1 as it progresses toward the proximal end side K2. The third inclined surface 246a is formed from the outer periphery 241s to a third vertex 246c of the third engagement portion 246D. The third engagement portion 246D has a third abutment surface 246b formed on a side portion of the proximal end side K2 that is perpendicular to the longitudinal direction K. The third abutment surface 246b is formed to extend from the outer circumferential portion 241s to the outer side R1 up to a third vertex 246c.

[0104] The operation portion main body 241B has a third engagement surface (third surface) 246s formed on its outer periphery, extending in the longitudinal direction K toward the base end side K2 from the third engagement portion 246D. The third engagement surface 246s is formed at a position spaced apart from the first engagement portion 244B in the radial direction R. When the first engagement portion 244B is positioned on the outer side R1 of the third engagement surface 246s, the first engagement portion 244B and the third engagement portion 246B are engaged with each other. When the first engagement portion 244B is positioned so as to overlap with the third engagement surface 246s as viewed in the radial direction R, the clip 2 is in the closed state P2.

[0105] The second engaging portion 245D and the third engaging portion 246D are spaced apart in the longitudinal direction K. The third engaging portion 246D is located closer to the base end K2 than the second engaging portion 245D. A non-contact surface (second surface) 248 is formed along the longitudinal direction K between the second engaging portion 245D and the third engaging portion 246D. The non-contact surface 248 is formed at a position spaced apart from the first engaging portion 244B in the radial direction R. The non-contact surface 248 is formed at a position not in contact with the first engaging portion 244B. Note that due to design errors, etc., the first engaging portion 244B may slightly contact the non-contact surface 248. When the first engaging portion 244B is positioned so as to overlap the non-contact surface 248 as viewed from the radial direction R, the clip 2 is in the open state P1.

[0106] The release protrusion 247D is a member that abuts against the first engagement portion 244B in the radial direction R while biasing the first engagement portion 244B toward the outer side R1. The release protrusion 247D is located closer to the base end side K2 than the third engagement portion 246D. The release protrusion 247D is a member that protrudes toward the outer side R1 from the outer circumferential portion 241s of the rod-shaped operation portion main body 241D. The release protrusion 247D is formed along the longitudinal direction K. In the radial direction R, the release protrusion 247D is formed at least up to a position where it contacts the first engagement portion 244B when the clip 2 is locked in the closed state P2. A sliding surface (fourth surface) 247a is formed along the longitudinal direction K on the side portion of the outer side R1. The sliding surface 247a is formed at a position where it can abut against the first engagement portion 244B in the radial direction R. A fourth abutment surface 247b perpendicular to the longitudinal direction K is formed on the side of the tip side K1 of the release protrusion 247D. The fourth abutment surface 247b extends from the outer circumferential portion 241s to the outer side R1 and is formed to the sliding surface 247a. When the first engagement portion 244B is positioned so as to overlap with the sliding surface 247a as viewed from the radial direction R, the clip 2 is locked in the closed state P2 (locked state).

[0107] 30 is a side view showing the engagement portions 245D, 246D and the release protrusion 247D. The height T3 from the outer periphery 241s to the third vertex 246c is greater than the height T2 from the outer periphery 241s to the second vertex 245c. The height T4 from the outer periphery 241s to the sliding surface 247a is substantially equal to the height T3 from the outer periphery 241s to the third vertex 246c. The height of the third abutting surface 246b in the radial direction R is greater than the height of the second abutting surface 245b in the radial direction R, and the height of the fourth abutting surface 247b in the radial direction R is substantially equal to the height of the third abutting surface 246b in the radial direction R.

[0108] [Functions of Engagement Portions 245D, 246D and Release Protrusion 247D] Next, the functions of the engagement portions 245D, 246D and the release protrusion 247D will be described with reference to FIGS. 31 to 36. FIG.

[0109] FIG. 31 illustrates changes in the amount of operating force applied to the slider 242B. When engaging the first engagement portion 244B with the second engagement portion 245D or the third engagement portion 246D, a predetermined amount of operating force must be applied to the slider 242B. Similarly, when disengaging the first engagement portion 244B from the second engagement portion 245D or the third engagement portion 246D, a predetermined amount of operating force must be applied to the slider 242B. When engaging the first engagement portion 244B with the second engagement portion 245D, the first engagement portion 244B must be moved from the base end K2 to the tip end K1 relative to the second engagement portion 245D. At this time, the first engagement portion 244B moves over the second inclined surface 245a from the base end K2 to the tip end K1. Therefore, the user must gradually apply an amount of operating force to the slider 242B. For example, the first engagement portion 244B and the second engagement portion 245D are configured to engage with each other when an operating force of 2.5 N is applied to the slider 242B. In this case, an operating force of 2.5 N must also be applied to the slider 242B when disengaging the first engagement portion 244B from the second engagement portion 245D.

[0110] When the first engagement portion 244B moves in the longitudinal direction K between the second engagement portion 245D and the third engagement portion 246D, the first engagement portion 244B moves in the longitudinal direction K at a position spaced apart from the non-contact surface 248 in the radial direction R. Therefore, when the first engagement portion 244B moves in the longitudinal direction K between the second engagement portion 245D and the third engagement portion 246D, it does not receive sliding resistance from the non-contact surface 248.

[0111] 32-34 are diagrams showing the manner in which the first engagement portion 244B engages with the third engagement portion 246D. Note that FIGS. 32-34 show cross sections along the longitudinal direction K of the operating portion 240D. When engaging the first engagement portion 244B with the third engagement portion 246D, as shown in FIGS. 32 to 34, the first engagement portion 244B must be moved from the distal end K1 to the proximal end K2 relative to the third engagement portion 246D. At this time, the first engagement portion 244B moves over the third inclined surface 246a from the distal end K1 toward the proximal end K2. Therefore, the user must gradually apply an operating force to the slider 242B. For example, the first engagement portion 244B and the third engagement portion 246D are configured to engage with each other when an operating force of 8 N is applied to the slider 242B. In this case, when releasing the engagement between the first engagement portion 244B and the third engagement portion 246D, an operating force of 8 N must also be applied to the slider 242B.

[0112] 35-36 are diagrams illustrating the first engagement portion 244B climbing over the fourth abutment surface 247b. Note that FIGS. 35-36 show cross sections along the longitudinal direction K of the operating unit 240D. When the first engagement portion 244B and the third engagement portion 246D are engaged and the first engagement portion 244B is brought into contact with the sliding surface 247a of the release protrusion 247D, the first engagement portion 244B must climb over the fourth abutment surface 247b. Therefore, the user must apply a predetermined amount of force to the slider 242B. For example, the first engagement portion 244B is configured to climb over the fourth abutment surface 247b when an operating force of 8 N is applied to the slider 242B.

[0113] When the first engagement portion 244B slides on the sliding surface 247a of the release protrusion 247D, the first engagement portion 244B receives a sliding resistance. For example, the first engagement portion 244B is configured to slide on the sliding surface 247a when an operating force of 3 N is applied to the slider 242B.

[0114] According to the clip introduction device 200D of this embodiment, the height T3 from the outer periphery 241s to the third apex 246c is configured to be higher than the height T2 from the outer periphery 241s to the second apex 245c, so that the operating force required to engage the first engagement portion 244B with the second engagement portion 245D is smaller than the operating force required to engage the first engagement portion 244B with the third engagement portion 246D. When engaging the first engagement portion 244B with the third engagement portion 246D, the slider 242B is operated by pulling it toward the proximal end side K2, whereas when engaging the first engagement portion 244B with the second engagement portion 245D, the slider 242B is operated by pushing it toward the distal end side K1. For example, because the slider 242B is operated while being held with two fingers, pushing it toward the distal end side K1 is more difficult than pulling it toward the proximal end side K2. Therefore, the amount of operating force required to engage the first engagement portion 244B, which requires pushing the slider 242B, with the second engagement portion 245D is reduced, thereby improving the operability of the clip introduction device 200D.

[0115] According to the clip introduction device 200D of this embodiment, the operating unit main body 241D is configured to have the release protrusion 247D that contacts the first engagement portion 244B at the position where the clip 2 is locked in the closed state P2, so that the user can recognize that the clip 2 is approaching the closed state P2 by noticing that the first engagement portion 244B has contacted the release protrusion 247D while operating the slider 242B. Furthermore, because the slider 242B is less likely to move toward the base end side K2, the clip 2 is prevented from being unintentionally locked in the closed state P2.

[0116] According to the clip introduction device 200D of this embodiment, the release protrusion 247D is configured so that a sliding surface 247a is formed along the longitudinal direction K on the side of the outer side R1, making it difficult for the slider 242B to move toward the base end side K2, thereby preventing the clip 2 from being unintentionally locked in the closed state P2.

[0117] (Modification 4) [Clip introducer device 200E] Next, with reference to Figures 37 to 39, a clip introducer device (applicator) 200E according to Modification 4 will be described. Clip introducer device 200E is a modification of clip introducer device 200D.

[0118] Fig. 37 is a cross-sectional view showing an operating portion 240B according to Modification 4, taken along the longitudinal direction K. As shown in Fig. 37, clip introducer device 200E has a first engaging portion 244E instead of first engaging portion 244B. Clip introducer device 200E has the same or similar configuration as clip introducer device 200D except for first engaging portion 244E, and therefore a redundant description of those configurations will be omitted.

[0119] The first engagement portion 244E is provided so as to be movable relative to the slider 242B in the longitudinal direction K. The first engagement portion 244E is an elastically deformable protrusion that protrudes toward the inner side R2, similar to the first engagement portion 244B, and is, for example, a leaf spring. Movement of the first engagement portion 244E toward the distal end side K1 is restricted by a front abutment surface 242Bp formed on the distal end side K1 of the first engagement portion 244E of the slider 242B. Furthermore, movement of the first engagement portion 244E toward the proximal end side K2 is restricted by a rear abutment surface 242Bq formed on the proximal end side K2 of the first engagement portion 244E of the slider 242B.

[0120] [Function of First Engagement Portion 244E] Next, the function of the first engagement portion 244E will be described with reference to FIGS. 38 and 39. FIG.

[0121] FIG. 38 is a cross-sectional view showing the operating unit 240D, taken along the longitudinal direction K. FIG. 38 also shows a state in which the slider 242B is operated toward the base end side K2 and the first engagement portion 244E is engaged with the third engagement portion 246D. As shown in FIG. 38 , when the slider 242B is operated toward the base end side K2, the first engagement portion 244E moves toward the tip end side K1 relative to the slider 242B and abuts against the front abutment surface 242Bp. Therefore, when the first engagement portion 244E engages with the third engagement portion 246D, the first engagement portion 244E abuts against the front abutment surface 242Bp.

[0122] FIG. 39z is a cross-sectional view showing the operating unit 240D, taken along the longitudinal direction K. Note that FIG. 39 shows a state in which the slider 242B is not operated or is operated toward the distal end side K1. When the user releases the slider 242B after the first engagement portion 244E engages with the third engagement portion 246D, the slider 242B is pulled toward the distal end side K1 by the wire 232B, and the slider 242B moves toward the distal end side K1 relative to the first engagement portion 244E and stops at a position where the rear abutment surface 242Bq abuts against the first engagement portion 244E. Therefore, when the first engagement portion 244E is engaged with the third engagement portion 246D, the first engagement portion 244E abuts against the rear abutment surface 242Bq.

[0123] When the first engagement portion 244E is in contact with the rear contact surface 242Bq, the wire 232B (or the expandable portion 232Ca) contracts by the amount that the slider 242B has moved toward the distal end K1 relative to the first engagement portion 244E, compared to when the first engagement portion 244E is in contact with the front contact surface 242Bp. Here, the force required to secure the first engagement portion 244E to the third engagement portion 246D must exceed the tension of the wire 232B. Therefore, the force required to secure the first engagement portion 244E to the third engagement portion 246D is reduced by the amount that the wire 232B has contracted. In other words, the operating force required to release the first engagement portion 244E from the third engagement portion 246D is reduced. For example, in a configuration in which the spring constant of wire 232B is 4 N / mm, if wire 232B is compressed by 1.5 mm when first engagement portion 244E is in contact with rear contact surface 242Bq compared to when it is in contact with front contact surface 242Bp, the amount of force required to engage first engagement portion 244E with third engagement portion 246D is reduced by approximately 6 N. Therefore, it is easy for the user to release first engagement portion 244E from engagement with third engagement portion 246D.

[0124] According to the clip introduction device 200E of this embodiment, the first engagement portion 244E is configured to be movable relative to the slider 242B in the longitudinal direction K, which makes it easy to disengage the first engagement portion 244E from the third engagement portion 246D. In other words, the force required to secure the first engagement portion 244E and the third engagement portion 246D can be reduced. For example, increasing the opening width of the clip 2 requires a greater force to engage the first engagement portion 244E with the third engagement portion 246D. However, the above structure reduces the force required to disengage the first engagement portion 244E from the third engagement portion 246D. This makes it easy for the user to open and close the clip 2.

[0125] (Modification 5) [Clip introducer device 200F] Next, with reference to Figures 40 to 43, a clip introducer device (applicator) 200F according to Modification 5 will be described. Clip introducer device 200F is a modification of clip introducer device 200E.

[0126] Fig. 40 is a cross-sectional view showing an operating section 240D according to Modification 5, taken along the longitudinal direction K. As shown in Fig. 40, clip introducer device 200F has a sheath 220F instead of sheath 220. Clip introducer device 200F has the same or similar configuration as clip introducer device 200E except for sheath 220F, and therefore a redundant description of those configurations will be omitted.

[0127] The sheath 220F is a tubular member that is inserted into the treatment tool insertion channel of the endoscope, similar to the sheath 220. The sheath 220F differs from the sheath 220 in the configuration of the base end side K2. The sheath 220F has a retainer 222 and a sheath extendable portion 223F at the base end.

[0128] The retaining member 222 is a member that restricts movement of the sheath 220 in the longitudinal direction K relative to the operation unit main body 241D. The retaining member 222 is provided at the base end of the sheath 220F. The retaining member 222 rotates circumferentially relative to the operation unit main body 241D, with the longitudinal direction K as the rotation axis. The movable range of the retaining member 222 in the longitudinal direction K is limited by a housing portion for the retaining member 222 formed in the operation unit main body 241D. The movable range of the retaining member 222 in the longitudinal direction K is shorter than the length of the retaining member 222 in the longitudinal direction K. Note that the retaining member 222 does not have to be movable in the longitudinal direction K.

[0129] The sheath telescopic section 223F is a member that can expand and contract in the longitudinal direction K. The sheath telescopic section 223F is provided at the proximal end of the sheath 220F. The sheath telescopic section 223F is an elastic member, such as a coil spring. The sheath telescopic section 223F is disposed inside the operation section main body 241D. A washer 224F is provided between the sheath telescopic section 223F and the inner wall of the operation section main body 241D. The sheath telescopic section 223F expands and contracts as the sheath 220F advances and retreats in the longitudinal direction K. The sheath telescopic section 223F is a member that is more easily elastically deformed than the sheath 220F.

[0130] The sheath telescopic section 223F telescopically extends and retracts in accordance with the length of the sheath 220F (path length of the wire 232B). That is, the sheath 220F telescopically extends and retracts in accordance with the length of the sheath 220F (path length of the wire 232B).

[0131] When the sheath 220F and the wire 232B are bent into a U-shape with the first engaging portion 244E and the third engaging portion 246D engaged (see FIG. 42 ), the sheath extendable / retractable portion 223F is configured to be in a compressed state. At this time, the amount of compression of the sheath extendable / retractable portion 223F is preferably approximately equal to the amount of compression that occurs when a force required to elastically deform the clip 2 into the closed state P2 is applied. For example, if the force required to elastically deform the clip 2 into the closed state P2 is 3 N and the spring constant of the sheath extendable / retractable portion 223F is 1 N / mm, the sheath extendable / retractable portion 223F is preferably configured to be in a contracted state by 3 mm.

[0132] Figure 41 is a cross-sectional view showing the operation unit 240D, taken along the longitudinal direction K. The sheath telescopic unit 223F shown in Figure 41 is in a compressed state. When the first engaging unit 244E and the third engaging unit 246D are engaged and the sheath 220F and the wire 232B are wound three times (see Figure 43), the sheath telescopic unit 223F is configured to be in a compressed state. When the sheath 220F and the wire 232B are wound three times, the sheath telescopic unit 223F is more compressed than when the sheath 220F and the wire 232B are bent in a U-shape.

[0133] [Function of Clip Introducing Device 200F] Next, the function of the clip introducing device 200F will be described. Note that a description of the function that overlaps with the clip introducing device 200E will be omitted.

[0134] 42 and 43 are side views showing clip introducer device 200F. The clip introducer device 200F shown in FIG. 42 has sheath 220F bent into a U-shape, while the clip introducer device 200F shown in FIG. 20 has sheath 220F wound three times. Clip introducer device 200F may be used with sheath 220F and wire 232B bent into a U-shape (see FIG. 42 ) or with sheath 220F and wire 232B wound three or four times (see FIG. 43 ). When sheath 220F and wire 232B transition from a U-shape bent state to a state wound three times, sheath 220F and wire 232B become more curved, and thus sheath 220F (path length of wire 232B) elongates. At this time, the sheath telescopic section 223F compresses (see FIG. 41 ), thereby suppressing the occurrence of a path difference in the axial direction between the sheath 220F and the wire 232B. On the other hand, when the sheath 220F and the wire 232B transition from a state in which they are wound three times to a state in which they are bent into a U-shape, the sheath 220F and the wire 232B become nearly linear, and the sheath 220F (path length of the wire 232B) shortens. At this time, the sheath telescopic section 223F expands (see FIG. 40 ), thereby suppressing the occurrence of a path difference in the axial direction between the sheath 220F and the wire 232B. In particular, the above-described effect occurs when the clip is in the closed state P2, i.e., when the movement of the tip (connection section 231) of the wire 232B toward the proximal end is restricted and the position of the slider 242B relative to the operation section main body 241D is fixed.

[0135] According to the clip introduction device 200F of this embodiment, the sheath extension / retraction portion 223F is a member that is more elastically deformable than the sheath 220F, so that when the sheath 220F extends, the sheath extension / retraction portion 223F tends to contract, and when the sheath 220F contracts, the sheath extension / retraction portion 223F tends to expand. Therefore, even if the axial length of the sheath 220F changes relative to the axial length of the wire 232B, the slider 242B is prevented from being pulled by the wire 232B, thereby preventing the clip from being unintentionally locked or released.

[0136] According to the clip introduction device 200F of this embodiment, the sheath extendable / retractable portion 223F is configured to be constantly compressed, so that the amount of operating force applied to the slider 242B when elastically deforming the clip 2 to the closed state P2 is less likely to be affected by the sheath extendable / retractable portion 223F. When elastically deforming the clip 2 to the closed state P2, the sheath extendable / retractable portion 223F may contract as the sheath 220F is pushed toward the proximal end side K2. However, because the sheath extendable / retractable portion 223F is pre-compressed (shrunk), it is less likely to be affected by this, and an increase in the operating force applied by the user to operate the slider 242B is suppressed. In particular, because the compression amount of the sheath extendable / retractable portion 223F is configured to be approximately equal to the compression amount caused by the application of the force required to elastically deform the clip 2 to the closed state P2, the sheath extendable / retractable portion 223F hardly contracts when elastically deforming the clip 2 to the closed state P2, further suppressing an increase in the operating force applied by the user to operate the slider 242B. Therefore, the clip introduction device 200F is easy to use.

[0137] (Modification 6) [Clip introducer device 200G] Next, a clip introducer device (applicator) 200G according to Modification 6 will be described with reference to Fig. 44. Clip introducer device 200G is a modification of clip introducer device 200F.

[0138] Fig. 44 is a cross-sectional view showing an operating unit 240D according to Modification 6, taken along the longitudinal direction K. As shown in Fig. 44, clip introducer device 200G has a third engaging portion 246G instead of third engaging portion 246D. Clip introducer device 200G has the same or similar configuration as clip introducer device 200F except for third engaging portion 246G, and therefore a redundant description of those configurations will be omitted.

[0139] The third engagement portion 246G is a modified example of the third engagement portion 246D. The third engagement portion 246G is provided at a different position on the operation unit main body 241D in the longitudinal direction K than the third engagement portion 246D. The third engagement portion 246G is provided so that the third inclined surface 246a is formed on the proximal end side K2 from the position of the first engagement portion 244E when the clip 2 is in the closed state P2. In other words, the first engagement portion 244E and the third inclined surface 246a are not in contact with each other the instant the clip 2 is in the closed state P2. However, the first engagement portion 244E and the third engagement portion 246G are configured to engage with each other when the first engagement portion 244E moves further toward the proximal end side K2 from the position where the clip 2 is in the closed state P2. In other words, the clip 2 is in the closed state P2 when the first engagement portion 244E and the third inclined surface 246a come into contact with each other. Therefore, when the clip 2 is transitioned from the open state P1 to the closed state P2, the first engagement portion 244E is prevented from coming into contact with the third engagement portion 246G, making it easier to open and close the clip 2.

[0140] The sheath extension and contraction section 223F is configured to remain in its initial state and not be compressed when the clip 2 is transitioning from the open state P1 to the closed state P2. The sheath extension and contraction section 223F is configured to be compressed as the slider 242B moves further toward the proximal end side K2 from the position where the clip 2 is in the closed state P2. Therefore, it is possible to prevent the wire 232B from being excessively pulled toward the proximal end side K2 after the clip 2 is in the closed state P2.

[0141] The sheath telescopic portion 223F is formed of a material that is more elastic than the telescopic portion 232Ca. The spring constant of the sheath telescopic portion 223F is smaller than that of the telescopic portion 232Ca. For example, the spring constant of the telescopic portion 232Ca is designed to be approximately 4 N / mm, and the spring constant of the sheath telescopic portion 223F is designed to be 0.29 N / mm. Therefore, as the slider 242B moves toward the proximal end K2 from the position where the clip 2 is in the closed state P2 to the position where the first engagement portion 244E and the third engagement portion 246G engage, the sheath telescopic portion 223F contracts, but the telescopic portion 232Ca contracts very little. In this case, the engagement between the first engagement portion 244E and the third engagement portion 246G is not affected by the telescopic portion 232Ca, making it easier to engage the first engagement portion 244E and the third engagement portion 246G.

[0142] (Modification 7) [Clip introducer device 200H] Next, a clip introducer device (applicator) 200H according to Modification 7 will be described with reference to Fig. 45. The clip introducer device 200H is a modification of the clip introducer device 200G.

[0143] FIG. 45 is a cross-sectional view showing an operating unit 240H according to Modification 7, taken along the longitudinal direction K. As shown in FIG. 45, the clip introduction device 200H has an operating unit 240H instead of the operating unit 240D. The operating unit 240H is formed with a stopper 249Ha that generates sliding resistance between the operating unit main body 241D and the slider 242B. The stopper 249Ha is, for example, a rubber-like member provided on the inner circumferential surface of the slider 242B. The slider 242B may be pressure-bonded to the operating unit main body 241D. Furthermore, the contact surface between the slider 242B and the operating unit main body 241D may be rough, increasing the coefficient of friction.

[0144] The operation unit 240H has a stopper 249Hb that generates a sliding resistance between the operation unit main body 241D and the wire 232B. The stopper 249Hb is, for example, a rubber-like member wound around the wire 232B.

[0145] In clip introduction device 200H, stoppers 249Ha and 249Hb limit the movement of slider 242B in the longitudinal direction K, making it easier to maintain slider 242B at a position where connecting portion 231 protrudes from the tip of sheath 220F and where clip 2 is in the closed state P2. Therefore, clip introduction device 200H does not need to have first engagement portion 244E, second engagement portion 245D, third engagement portion 246G, or release protrusion 247D. Alternatively, only one of stoppers 249Ha and 249Hb may be provided.

[0146] When clip introduction device 200H has first engagement portion 244E, second engagement portion 245D, third engagement portion 246G, and release protrusion 247D, stopper 249Ha generates sliding resistance between first engagement portion 244E and second engagement surface 245s, between first engagement portion 244E and non-contact surface 248, between first engagement portion 244E and third engagement surface 246s, and between first engagement portion 244E and sliding surface 247a. In this case, the sliding resistance between second engagement surface 245s or non-contact surface 248 and first engagement portion 244E is smaller than the sliding resistance between third engagement surface 246s or sliding surface 247a and first engagement portion 244E.

[0147] (Modification 8) [Clip introducer device 200I] Next, with reference to Fig. 46, a clip introducer device (applicator) 200I according to Modification 8 will be described. Clip introducer device 200I is a modification of clip introducer device 200F.

[0148] 46 is a cross-sectional view showing an operating portion 240D according to Modification 8, taken along the longitudinal direction K. As shown in FIG. 46, the clip introduction device 200I does not need to have the third engagement portion 246G. In this case, the user can easily open and close the clip 2.

[0149] Although the embodiments of the present invention have been described in detail above with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like are also included within the scope of the present invention. Furthermore, the components shown in the above-described embodiments and modifications can be configured by appropriately combining them.

[0150] In the clip introduction device 200, the first engaging portion 244 and the second engaging portion 245 are protrusions, but the configuration of the first engaging portion 244 and the second engaging portion 245 is not limited. For example, the first engaging portion 244 and the second engaging portion 245 may be recesses and projections that can fit together. For example, the first engaging portion 244 and the second engaging portion 245 may be members that can engage with each other, and the second engaging portion 245 may be a member that restricts movement of the proximal end side K2 of the first engaging portion 244.

[0151] In the clip introduction device 200, the first engaging portion 244 and the third engaging portion 246 are protrusions, but the configuration of the first engaging portion 244 and the third engaging portion 246 is not limited. For example, the first engaging portion 244 and the third engaging portion 246 may be recesses and projections that can fit together. For example, the first engaging portion 244 and the third engaging portion 246 may be members that can fit together, and the third engaging portion 246 may be a member that restricts movement of the distal end side K1 of the first engaging portion 244.

[0152] The direction in which the first engaging portion 244 protrudes is not limited in the clip introduction device 200. For example, the first engaging portion 244 may be a protruding portion that protrudes to one side in the radial direction R with the longitudinal direction K as the main axis.

[0153] The direction in which the second engaging portion 245 protrudes is not limited in the clip introduction device 200. For example, the second engaging portion 245 may be a protruding portion that protrudes in the radial direction R, which has the longitudinal direction K as its main axis, on the other side opposite to the side on which the first engaging portion 244 protrudes.

[0154] The direction in which the third engaging portion 246 protrudes is not limited in the clip introduction device 200. For example, the third engaging portion 246 may be a protruding portion that protrudes in the radial direction R, which has the longitudinal direction K as its main axis, on the other side opposite to the side on which the first engaging portion 244 protrudes.

[0155] In the clip introduction device 200, the first engaging portion 244 and the second engaging portion 245 are elastically deformable members, but the configuration of the first engaging portion 244 and the second engaging portion 245 is not limited. For example, it is sufficient that either the first engaging portion 244 or the second engaging portion 245 is elastically deformable. Also, for example, if the operation portion main body 241 or the slider 242 is elastically deformable, the first engaging portion 244 and the second engaging portion 245 do not have to be elastically deformable.

[0156] In the clip introduction device 200, the first engagement portion 244 and the third engagement portion 246 are elastically deformable members, but the configuration of the first engagement portion 244 and the third engagement portion 246 is not limited. For example, it is sufficient that either the first engagement portion 244 or the third engagement portion 246 is elastically deformable. Also, for example, if the operation portion main body 241 or the slider 242 is elastically deformable, the first engagement portion 244 and the third engagement portion 246 do not have to be elastically deformable.

[0157] Although it is preferable that the clip introducing device 200 be provided with the second engaging portion 245, there are no limitations on the configuration of the clip introducing device 200. For example, if the third engaging portion 246 is provided, the second engaging portion 245 may not be provided.

[0158] Although it is preferable that the clip introducer device 200 be provided with the third engagement portion 246, there are no limitations on the configuration of the clip introducer device 200. For example, if the second engagement portion 245 is provided, the third engagement portion 246 does not have to be provided.

[0159] In the clip device 300, the clip unit 1 is configured to be loadable into the clip introducer 200 by the cartridge system 100, but the configuration of the clip unit 1 is not limited thereto. For example, the clip unit 1 may be fixed to the clip introducer 200, and a new clip unit 1 may not be reloaded into the clip introducer 200. In this case, the second engagement portion 245 may not be formed.

[0160] Second Embodiment [Clip Device 300J] Next, a clip device 300J according to a second embodiment will be described with reference to Fig. 47. However, the clip device 300J does not need to have all of the components described below, and some components may be omitted as appropriate.

[0161] 47 is a side view showing an operation section 240J according to the second embodiment. The clip device 300J is a device that is inserted into a treatment tool insertion channel (not shown) of an endoscope and used to treat an affected area. The clip device 300J includes a clip introducer (applicator) 200J and a clip unit 1. The clip unit 1 is loaded into the clip introducer 200J. The configuration of the clip unit 1 has been explained in connection with the clip device 300, and therefore will not be explained here.

[0162] The clip introducer 200J is a device that is inserted into a treatment tool insertion channel of an endoscope and used in combination with the endoscope. The clip introducer 200J includes a sheath 220, a manipulation wire 230, and a manipulation section 240J. The configurations of the sheath 220 and the manipulation wire 230 have been described in connection with the clip device 300, and therefore will not be described here.

[0163] The operating portion 240J is a member that operates the clip unit 1 via the operating wire 230. As shown in FIG. 47 , the operating portion 240J is disposed on the proximal end side of the sheath 220. The operating portion 240J has an operating portion main body (handle) 241J, a slider 242, a thumb ring 243, a first engaging portion 244, a second engaging portion 245, and a third engaging portion 246. The configurations of the slider 242, the thumb ring 243, the first engaging portion 244, the second engaging portion 245, and the third engaging portion 246 have been described in the clip device 300, and therefore will not be described here.

[0164] The operation unit body 241J is injection-molded from, for example, a resin material. The operation unit body 241J has a slit portion 241a, a rotating grip 241b, and a slider biasing member 241Jc. The configurations of the slit portion 241a and the rotating grip 241b have been described in the clip device 300, so a description thereof will be omitted here.

[0165] The slider biasing member 241Jc is a member that biases the slider 242 toward the tip side K1. The slider biasing member 241Jc is arranged in the slit portion 241a. The slider biasing member 241Jc connects the end of the slider 242 on the tip side K1 to the side surface of the slit portion 241a on the tip side K1. The slider biasing member 241Jc is, for example, a coil spring, and is arranged to cover the wire 232. In this case, the wire 232 inserted inside the slider biasing member 241Jc suppresses deflection of the spring.

[0166] The slider biasing member 241Jc biases the slider 242 to a position where the connecting portion 231 protrudes from the distal end of the sheath 220. That is, when the user releases the slider 242, the slider 242 is pulled by the slider biasing member 241Jc and moved to a position where the connecting portion 231 protrudes from the distal end of the sheath 220. This makes it easier for the user to connect the clip unit 1 to the connecting portion 231. Furthermore, by reducing the spring constant of the slider biasing member 241Jc, the force with which the slider 242 is biased toward the distal end side K1 by the slider biasing member 241Jc is reduced, making it easier to move the slider 242 toward the proximal end side K2.

[0167] Although the embodiments of the present invention have 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-described embodiments can be configured by appropriately combining them.

[0168] In the clip introducer device 200J according to the second embodiment, the configuration of the sheath 220 is not limited, and for example, sheath 220F may be provided instead of sheath 220. In the clip introducer device 200J according to the second embodiment, the configuration of the operation wire 230 is not limited, and for example, operation wire 230B may be provided instead of operation wire 230. In the clip introducer device 200J according to the second embodiment, the configuration of the slider 242 is not limited, and for example, slider 242B may be provided instead of slider 242. In the clip introducer device 200J according to the second embodiment, the configuration of the first engagement portion 244 is not limited, and for example, first engagement portion 244B or first engagement portion 244E may be provided instead of first engagement portion 244. In the clip introducer device 200J according to the second embodiment, the configuration of the second engagement portion 245 is not limited, and for example, second engagement portion 245B or second engagement portion 245D may be provided instead of second engagement portion 245. In the clip introducing device 200J according to the second embodiment, the configuration of the third engaging portion 246 is not limited, and for example, third engaging portion 246B, third engaging portion 246D, or third engaging portion 246G may be provided instead of third engaging portion 246. The clip introducing device 200J according to the second embodiment may further include a release protrusion 247D in the operation portion 240J. The clip introducing device 200J according to the second embodiment may further include a stopper 249Ha or a stopper 249Hb in the operation portion 240J.

[0169] 300, 300J... Clip device, 200, 200B, 200C, 200D, 200E, 200F, 200G, 200H, 200I, 200J... Clip introduction device (applicator), 220, 220F... Sheath, 221... Hood, 222... Stopper, 223F... Sheath extension / contraction portion, 224F... Washer, 230, 230B... Operation wire (power transmission member), 231... Connection portion (tip portion), 232, 232B... Wire, 232Ba, 232Ca... Extension portion, 233... Jointer member, 240, 240B, 240D, 240J... Operation portion , 241, 241B, 241D... operation unit main body (handle), 241a, 241Ba... slit portion, 241b... rotating grip, 241Jc... slider biasing member, 241s... outer periphery, 242, 242B... slider, 242a, 242Ba... guided portion, 242Bp... front contact surface, 242Bq... rear contact surface, 243... thumb ring, 244, 244B, 244E... first engagement portion, 245, 245B, 245D... second engagement portion, 245a... second inclined surface, 245b... second abutment surface, 245c... second vertex, 245s... second engagement surface (first surface), 2 46, 246B, 246D, 246G...third engagement portion, 246a...third inclined surface, 246b...third abutting surface, 246c...third vertex, 246s...third engagement surface (third surface), 247D...release protrusion, 247a...sliding surface (fourth surface), 247b...fourth abutting surface, 248...non-contact surface (second surface), 249Ha...stopper, 249Hb...stopper, 1...clip unit, 2...clip, 21...arm, 211...first arm, 212...second arm, 22...tissue gripping portion, 23...base end portion, 24...engaging portion, 24a...abutting surface, 24b...inclined Surface, 3...pressing member, 3a...tip opening, 3b...proximal opening, 100...cartridge system, 5...cartridge, 70...cartridge body, 67...insertion port, 7S...storage area, 71...first area, 74...sheath insertion area, Q1...loadable state, P1...open state, P2...closed state, K...longitudinal direction, K1...tip side, K2...proximal side, R...radial direction, R1...outside, R2...inside, A...longitudinal direction, A1...tip side, A2...proximal side, B...left-right direction, C...up-down direction, Z...longitudinal direction, Z1...tip side, Z2...proximal side, X...left-right direction, Y...height direction, O1...central axis

Claims

1. An applicator comprising: a linear power transmission member having a tip end to which a clip can be connected; a sheath through which the power transmission member is inserted; a handle connected to the base end of the sheath; and a slider connected to the base end of the power transmission member and supported by the handle, the slider being movable relative to the handle in the longitudinal direction of the handle, wherein the slider has a first engagement portion, and the handle has a third engagement portion engageable with the first engagement portion, and the third engagement portion engages with the first engagement portion to restrict movement of the slider toward the tip end in the longitudinal direction.

2. An applicator as described in claim 1, wherein the first engagement portion is a protruding portion that protrudes to one side in a radial direction with the longitudinal direction as the main axis, the third engagement portion is a protruding portion that protrudes to the other side in the radial direction, and the third engagement portion is formed with a third inclined surface that inclines to the other side in the radial direction as it progresses toward the base end in the longitudinal direction at its side on the tip end side, and a third abutment surface that intersects with the longitudinal direction at its side on the base end side.

3. An applicator as described in claim 1, wherein the handle has a second engagement portion that can engage with the first engagement portion, and the second engagement portion engages with the first engagement portion to restrict movement of the slider toward the base end in the longitudinal direction.

4. An applicator as described in claim 3, wherein the first engagement portion is a protrusion that protrudes to one side in a radial direction with the longitudinal direction as the main axis, the second engagement portion is a protrusion that protrudes to the other side in the radial direction, the third engagement portion is a protrusion that protrudes to the other side in the radial direction, and the second engagement portion is formed with a second inclined surface that inclines to the other side in the radial direction as it progresses toward the tip end at its side on the base end side in the longitudinal direction, and a second abutment surface that intersects with the longitudinal direction at its side on the tip end side.

5. An applicator as described in claim 2, wherein the clip can transition between an open state and a closed state by the slider moving relative to the handle in the longitudinal direction, and the clip is in the closed state when the first engagement portion abuts against the third inclined surface.

6. An applicator as described in claim 4, wherein the clip can transition between an open state and a closed state by relative movement of the slider in the longitudinal direction with respect to the handle, and the clip is in the open state when the first engagement portion abuts against the second inclined surface.

7. An applicator as described in claim 3, wherein the first engagement portion is a protruding portion that protrudes to one side in a radial direction with the longitudinal direction as the main axis, the second engagement portion is a protruding portion that protrudes to the other side in the radial direction, and the third engagement portion is a protruding portion that protrudes to the other side in the radial direction, and the amount of protrusion of the second engagement portion in the radial direction is smaller than the amount of protrusion of the third engagement portion in the radial direction.

8. An applicator as described in claim 1, wherein the first engagement portion is a protrusion that protrudes to one side in a radial direction with the longitudinal direction as the main axis, the third engagement portion is a protrusion that protrudes to the other side in the radial direction, and the first engagement portion is an elastic member that is elastically deformable in the radial direction.

9. An applicator as described in claim 1, wherein the first engagement portion is a protrusion that protrudes to one side in a radial direction with the longitudinal direction as the main axis, the third engagement portion is a protrusion that protrudes to the other side in the radial direction, and the first engagement portion is movable relative to the slider in the longitudinal direction.

10. An applicator as described in claim 3, wherein the handle is formed with: a first surface extending in the longitudinal direction on the distal side of the second engagement portion; a second surface extending in the longitudinal direction on the proximal side of the second engagement portion and on the distal side of the third engagement portion; a third surface extending in the longitudinal direction on the proximal side of the third engagement portion; and a fourth surface extending in the longitudinal direction on the proximal side of the third surface.

11. An applicator as described in claim 10, wherein the first engagement portion is a protruding portion that protrudes to one side in a radial direction with the longitudinal direction as the main axis, the second engagement portion is a protruding portion that protrudes to the other side in the radial direction, the third engagement portion is a protruding portion that protrudes to the other side in the radial direction, the first surface, the second surface, and the third surface are formed at positions spaced apart from the first engagement portion in the radial direction, and the fourth surface is formed at a position that can abut against the first engagement portion in the radial direction.

12. An applicator as described in claim 10, wherein the power transmission member has a connecting portion at its tip that can be connected to the clip, and the connecting portion protrudes from the tip of the sheath when positioned so that the first engagement portion overlaps with the first surface when viewed from a radial direction with the longitudinal direction as the main axis.

13. An applicator as described in claim 10, wherein the clip can transition between an open state and a closed state by the slider moving relative to the handle in the longitudinal direction, and the clip is in the open state when the first engagement portion is positioned so as to overlap the second surface when viewed from a radial direction with the longitudinal direction as the main axis.

14. An applicator as described in claim 10, wherein the clip can transition between an open state and a closed state by the slider moving relative to the handle in the longitudinal direction, and the clip is in the closed state when the first engagement portion is positioned so as to overlap the third surface when viewed from a radial direction with the longitudinal direction as the main axis.

15. The applicator described in claim 10, wherein the clip can transition to a locked state in which it is locked in a closed state by the slider moving relatively toward the base end with respect to the handle by a predetermined distance or more, and the clip is in a locked state when it is positioned so that the first engagement portion overlaps with the third surface when viewed from a radial direction with the longitudinal direction as the main axis.

16. The applicator according to claim 1, wherein the sheath has an expandable portion that is expandable in the longitudinal direction, and the expandable portion expands and contracts in response to the curvature of the power transmission member and the sheath when the first engaging portion and the third engaging portion are engaged.

17. The applicator according to claim 16, wherein the stretchable portion is an elastic member provided at the proximal end of the sheath.

18. The applicator of claim 17, wherein the elastic member is disposed within the handle in a compressed state.

19. The applicator according to claim 1, further comprising a stopper that generates sliding resistance between the power transmission member or the slider and the handle.

20. The applicator according to claim 10, further comprising stoppers that generate sliding resistance between the first engagement portion and the first surface, between the first engagement portion and the second surface, between the first engagement portion and the third surface, and between the first engagement portion and the fourth surface.

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