JP7548810B2 - Clip cartridge, and method for connecting clip to linear object - Google Patents

Description

The present invention relates to a clip cartridge for connecting a medical clip to a linear object having a connecting portion at the tip side.

In endoscopic procedures, medical clips are used to clamp the tissue to be treated, such as an affected area. Medical clips are attached to the tip of a linear object such as a wire and carried inside the patient's body. A clipping device, which includes a linear object and a clip attached to the tip of the linear object, is inserted into the forceps channel from the forceps port of the endoscope and carried to the tissue to be treated, enabling the clip to be used inside the patient's body. Multiple clips are often used in one procedure, and a new clip must be attached to the clipping device each time a clipping operation is performed. Therefore, clip cartridges have been proposed as connecting aids to efficiently attach clips (e.g., Patent Documents 1 to 6).

International Publication No. 2020/121401 JP 2017-217206 A JP 2017-148182 A JP 2009-11769 A WO 2017/94455 International Publication No. 2018/123137

To reduce the burden on the surgeon and patient by shortening the procedure time, it is beneficial to provide a clip cartridge that can be attached more efficiently. Therefore, the present invention aims to provide a clip cartridge that contributes to the efficiency of clip attachment, and a method of connecting a clip to a linear object.

One embodiment of the clip cartridge of the present invention that has achieved the above object is a clip cartridge for connecting a medical clip to a linear object having a connecting portion at its tip, comprising: a clip case; a ring disposed within the clip case and having an inner cavity into which the clip is inserted; a clip disposed within the clip case and opened and closed by the ring, the clip having a first arm and a second arm opposed to each other, a tip for clamping an object, and a base end for connecting to the connecting portion of the linear object; the clip case has an insertion opening on its outer surface through which the connecting portion of the linear object is inserted; and the clip case has a The gist of the present invention is that the clip case has a first mounting surface on which the ring is placed, a second mounting surface on which the clip is placed, and an insertion passage that is connected to the insertion opening and through which the linear object is inserted, the first mounting surface is a surface on which the ring is placed so that the direction of the central axis of the ring is parallel to the extending direction of the insertion passage, and the second mounting surface is a surface different from the first mounting surface, the first mounting surface is located farther from the insertion opening than the insertion passage in the clip case, and the second mounting surface is located farther from the insertion opening than the first mounting surface in the clip case, and in a mounted state in which the ring is placed on the first mounting surface and the clip is placed on the second mounting surface, the lowest end of the clip is located lower than the lowest end of the ring. By setting the height of the clip and the ring in this way, when the linear object is inserted into the clip case, the connecting portion of the linear object passing through the inner cavity of the ring is located above the clip. In this state, if the linear object is pushed into the clip, the linear object can be fitted between the first and second arms of the clip from one side in the width direction. Therefore, the clip cartridge allows efficient connection of the clip and the linear object.

In the above placement state, it is preferable that the bottom end of the second placement surface is lower than the bottom end of the first placement surface. In the above placement state, it is preferable that the central axis of the ring is higher than the top end of the base end of the clip. In the above placement state, it is preferable that the top end of the clip is lower than the bottom end of the first placement surface. In the above placement state, it is also possible that the top end of the clip is higher than the bottom end of the first placement surface, and the top end of the second placement surface is lower than the bottom end of the first placement surface.

In the above-mentioned placement state, it is preferable that the second placement surface is parallel to the horizontal plane. In the above-mentioned placement state, the second placement surface may be inclined so as to be lower toward the tip side of the clip. In the above-mentioned placement state, it is preferable that the extension direction of the insertion passage is parallel to the horizontal plane. In the above-mentioned placement state, the insertion passage may be inclined so as to be lower toward the tip side of the clip.

The clip case has a first case body having a first mounting surface and a second mounting surface, and a second case body covering the first case body, and a protrusion protruding toward the second case body is provided at a position on the second mounting surface corresponding to the base end side of the clip, and it is preferable that the uppermost end of the protrusion is higher than the lowermost end of the first mounting surface in the mounted state. It is preferable that the protrusion is on an extension line of the insertion passage. The clip case has a first case body having a first mounting surface and a second mounting surface, and a second case body covering the first case body, and an insertion opening may be provided in the second case body.

In the above-described placement state, when the connecting portion of the linear object is inserted into the clip case, it is preferable that the uppermost end of the connecting portion of the linear object is located higher than the uppermost end of the clip. The clip has a width direction perpendicular to the direction from the tip to the base end and the opening/closing direction, the clip has a first end and a second end in the width direction, and has a connecting portion where the first arm and the second arm are connected to each other at the first end side in the width direction, and the clip and the linear object are connected by fitting the connecting portion of the linear object from the second end side in the width direction between the first arm and the second arm of the clip on the second placement surface. The clip case has a first case body having a first placement surface and a second placement surface, and a second case body covering the first case body, and it is preferable that the clip is placed on the second placement surface so that the first end side of the clip in the width direction faces the second placement surface side and the second end side faces the second case body side. In the above-described clip cartridge, it is preferable that the clip and the linear object, which are connected to each other, can be pulled out of the clip case through the insertion opening.

The present invention also provides a method for connecting a medical clip to a linear object having a connecting portion at its tip. One embodiment of the above method includes a clip case, a ring disposed in the clip case and having an inner cavity into which the clip is inserted, a clip disposed in the clip case and having first and second arms opposed to each other, a tip for clamping an object, and a base end connected to the connecting portion of the linear object, the first and second arms being opened and closed by the ring, the clip having a width direction perpendicular to the direction from the tip to the base end and the direction in which the clip is opened and closed, the clip having a first end and a second end in the width direction, and a connecting portion at the first end where the first and second arms are connected to each other, the clip case has a first mounting surface on which the ring is mounted, a second mounting surface on which the clip is mounted, and an insertion passage communicating with the insertion opening and through which the linear object is inserted, the first mounting surface being a ring. The second mounting surface is a surface on which the ring is placed so that the direction of the central axis of the ring is parallel to the extension direction of the insertion passage, and the second mounting surface is a surface different from the first mounting surface, and in the clip case, the second mounting surface is located farther from the insertion opening than the first mounting surface, and the first mounting surface is located farther from the insertion opening than the insertion passage, and the ring is placed on the first mounting surface, and in a mounted state in which the clip is placed on the second mounting surface, a clip cartridge is prepared in which the bottom end of the clip is lower than the bottom end of the ring; a step of inserting a connecting portion of a linear object into the clip case from the insertion opening; a step of passing the connecting portion through the ring on the first mounting surface; and a step of fitting the connecting portion between the first arm and the second arm of the clip on the second mounting surface from the second end side in the width direction. According to the above method, it is easy to fit the connecting portion of the linear object between the first arm and the second arm of the clip, so that the clip and the linear object can be efficiently connected.

The above clip cartridge and the above method for connecting a clip to a linear object allow for efficient connection of the clip to the linear object.

1 is an exploded perspective view of a clip cartridge according to an embodiment of the present invention; 2 is a cross-sectional view (partially a side view) taken along an extension direction of an insertion passage of the clip cartridge shown in FIG. 1 ; 3 is a cross-sectional view of the clip cartridge shown in FIG. 2 taken along line III-III. FIG. 2 is a side view of a clip according to one embodiment of the present invention. 1 is a schematic diagram showing an example of a method for connecting a clip and a linear object according to an embodiment of the present invention. 1 is a schematic diagram showing an example of a method for connecting a clip and a linear object according to an embodiment of the present invention. 1 is a schematic diagram showing an example of a method for connecting a clip and a linear object according to an embodiment of the present invention. 1 is a schematic diagram showing an example of a method for connecting a clip and a linear object according to an embodiment of the present invention. 1 is a schematic diagram showing an example of a method for connecting a clip and a linear object according to an embodiment of the present invention. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2. 1. FIG. 4 is a perspective view showing a modified example of the first case body of the clip cartridge shown in FIG. 3 is a schematic diagram showing a modified example of the clip cartridge shown in FIG. 2.

One embodiment of the clip cartridge of the present invention relates to a clip cartridge for connecting a medical clip to a linear object having a connecting portion at the tip side. The clip cartridge is used when performing treatment using a clip device under an endoscope. In detail, by transporting the clip device with the clip attached to it through the forceps channel of the endoscope to the tissue to be treated, treatment using the clip can be performed inside the patient's body.

The clip cartridge has a clip case, a ring disposed in the clip case and having an inner cavity into which the clip is inserted, and a clip disposed in the clip case and opened and closed by the ring, the clip having a first arm and a second arm opposed to each other, a tip for clamping an object, and a base end connected to the connecting part of a linear object. The clip case has an insertion opening into which the connecting part of the linear object is inserted on its outer surface, and the clip case has inside thereof a first mounting surface on which the ring is placed, a second mounting surface on which the clip is placed, and an insertion passage communicating with the insertion opening and through which the linear object is inserted. The first mounting surface is a surface on which the ring is placed so that the direction of the central axis of the ring is parallel to the extension direction of the insertion passage, and the second mounting surface is a surface different from the first mounting surface. Within the clip case, the first mounting surface is located farther from the insertion opening than the insertion passage, and the second mounting surface is located farther from the insertion opening than the first mounting surface. The gist of the invention is that in a mounted state in which the ring is placed on the first mounting surface and the clip is placed on the second mounting surface, the bottom end of the clip is located lower than the bottom end of the ring. By setting the height of the clip and ring in this way, when a linear object is inserted into the clip case, the connecting portion of the linear object passing through the inner cavity of the ring is located above the clip. In this state, when the linear object is pushed toward the clip, the linear object can be fitted between the first and second arms of the clip from one side in the width direction. Therefore, the clip cartridge allows efficient connection of the clip and the linear object.

The present invention will be described in more detail below based on the following embodiment, but the present invention is not limited to the following embodiment, and can of course be modified appropriately within the scope of the above and below, all of which are included in the technical scope of the present invention. In addition, hatching and component symbols may be omitted in each drawing for convenience, but in such cases, reference should be made to the specification or other drawings. Furthermore, the dimensions of various components in the drawings may differ from the actual dimensions, as priority is given to contributing to an understanding of the features of the present invention.

The configurations of the clip cartridge, clip device, and clip system will be described with reference to Figures 1 to 21. Figure 1 is an exploded perspective view of a clip cartridge according to one embodiment of the present invention. Figure 2 is a cross-sectional view (partial side view) along the extension direction of the insertion passage of the clip cartridge shown in Figure 1. Figure 3 is a cross-sectional view of the clip cartridge shown in Figure 2 along III-III. Figure 4 is a side view of a clip according to one embodiment of the present invention. Figures 5 to 9 are schematic diagrams showing an example of a method of connecting a clip and a linear object according to one embodiment of the present invention. Figures 10 to 19 and Figure 21 are schematic diagrams showing modified examples of the clip cartridge shown in Figure 2, and Figure 20 is a perspective view showing a modified example of the first case body of the clip cartridge shown in Figure 1. Note that Figure 1 shows that a plurality of connection pins 26J are provided in the second case body 26, and a plurality of holes 25K into which the connection pins 26J are inserted are provided in the first case body 25. In the drawings other than Figure 1, the connection pins 26J and the holes 25K are omitted.

The clip cartridge 1 has a ring 2, a clip 5, and a clip case 10. Hereinafter, the clip cartridge may be referred to as a cartridge, and the clip case may be referred to as a case. Before describing the cartridge 1 in detail, the clip device and the clip system will be described. The clip device includes at least a clip 5, a ring 2, and a linear object 30. As shown in FIG. 5, the linear object 30 is formed linearly and has a tip 30A and a base end (not shown) in the longitudinal axis direction. The linear object 30 has a connecting portion 32 on the tip 30A side that is connected to the clip 5. The tip 30A side of the linear object 30 is inserted into the cartridge 1. The clip system includes at least a case 10; a clip device having a clip 5, a ring 2, and a linear object 30; and the clip device includes a clip 5, a ring 2, and a linear object 30. The details will be described later, but the clip 5 and the ring 2 are housed inside the case 10. For example, as shown in FIG. 5, the tip 30A of the linear object 30 of the clip device is inserted into the case 10, and as shown in FIG. 6, the linear object 30 is passed through the inner cavity 4 of the ring 2, after which the clip 5 can be attached to the connecting portion 32 of the linear object 30 as shown in FIG. 7 and FIG. 8. This operation makes the clip device ready for use.

The linear object 30 can be composed of one or more members. The connecting portion 32 may be formed integrally with the linear object 30. As shown in FIG. 5, the linear object 30 may have a long linear object body 31 and a connecting portion 32 attached to the tip side of the linear object body 31.

The linear body 31 may be solid or hollow. The linear body 31 may be a single wire or a twisted wire made by twisting together single wires. For the linear body 31, for example, a metal wire such as stainless steel or carbon steel, or a thread made of a synthetic resin such as polyamide resin, polyolefin resin, polyester resin, polyimide resin, or fluororesin can be used. The surface of the linear body 31 may be coated with a resin such as fluororesin.

The shape of the connecting part 32 is not particularly limited as long as it can be connected to the base end 5B side of the clip 5. The connecting part 32 can be a sphere, an oval sphere, a semispherical sphere, a semi-oval sphere, a teardrop shape, a polygonal shape, a pyramid shape, a frustum shape, a column shape, or a combination of these shapes. The connecting part 32 may have a larger outer diameter than the linear object body 31. The connecting part 32 can be fixed to the clip 5 and the linear object 30 by connecting the connecting part 32 to the connected part 9 preferably provided on the base end 5B side of the clip 5. The connecting form between the clip 5 and the linear object 30 is not particularly limited, and examples thereof include a form in which the connected part 9 of the clip 5 shown in FIG. 4 is sandwiched and connected by two connecting members arranged on the tip side of the linear object 30, and a form in which the connecting part 32 on the tip side of the linear object 30 is sandwiched and connected at the part where the first arm 6 and the second arm 7 on the base end 5B side of the clip 5 shown in FIG. 4 are parallel. In the clip cartridge 1, the clip 5 and the linear object 30 can be preferably connected in a manner in which the linear object 30 approaches the clip 5 from the width direction z.

The connecting portion 32 may be made of any material that is biocompatible, such as metals such as stainless steel or carbon steel, or synthetic resins such as polyamide resin, polyolefin resin, polyester resin, polyimide resin, or fluororesin.

It is preferable that at least a portion of the linear object 30 is disposed within the inner tube 35. That is, it is preferable that the clip device further has an inner tube 35, and that the linear object 30 is disposed within the inner cavity of the inner tube 35. When the clip 5 is connected to the linear object 30 for use, the opening degree of the clip 5 can be adjusted by moving the linear object 30 proximally or distally relative to the longitudinal axis of the inner tube 35. For example, when the linear object 30 is moved proximally relative to the inner tube 35, the ring 2 comes into contact with the inner tube 35, and the clip 5 can be closed by moving the ring 2 toward the tip 5A of the clip 5.

It is desirable for the inner tube 35 to have both flexibility to bend along the shape of the inside of the body cavity and rigidity to reliably reach the tissue to be treated. The inner tube 35 can be composed of a coil body made of metal or synthetic resin, a tube made of multiple short cylindrical joint pieces connected in the axial direction to enable rotation, a tube made of synthetic resin, or a combination of these.

The clip device may further have an outer tube 36. In this case, the inner tube 35 is disposed in the inner cavity of the outer tube 36. It is preferable that the clip 5 is configured to be freely inserted and removed from the outer tube 36 when the clip 5 is connected to the linear object 30. By storing the clip 5 inside the outer tube 36, the clip 5 does not need to be exposed to the outside. In addition, storing the clip 5 inside the outer tube 36 while the clip 5 is being transported close to the target tissue prevents the clip 5 from damaging the forceps channel or internal tissue other than the lesion. Note that, during treatment, the clip 5 and ring 2 are exposed from the outer tube 36 and used.

It is desirable that the outer cylinder 36 has flexibility and rigidity similar to the inner cylinder 35. The outer cylinder 36 can be composed of a cylinder made of synthetic resin, a coil body made of metal or synthetic resin, a cylinder made of multiple short cylindrical joint pieces connected in the axial direction to enable rotation, or a combination of these. Among these, a cylinder made of synthetic resin is preferably used for the outer cylinder 36. The outer cylinder 36 may be composed of a transparent or semi-transparent material to make it easier to check the positional relationship between the outer cylinder 36 and the inner cylinder 35.

The clip 5 is for medical use and is used, for example, in endoscopic procedures for sealing, countertraction, hemostasis, suturing, and marking of objects such as lesions. The clip 5 is placed inside the case 10 and is opened and closed by the ring 2. The clip 5 has a tip 5A that clamps the object and a base end 5B that is connected to the connecting portion 32 of the linear object 30. The clip 5 is configured so that the tip 5A side can be opened and closed by the ring 2, with the base end 5B side as a fulcrum.

As shown in FIG. 4, the clip 5 has a first arm 6 and a second arm 7 that face each other. The first arm 6 and the second arm 7 each extend from the base end 5B to the tip 5A. The first arm 6 and the second arm 7 have portions that extend away from each other toward the tip 5A. The first arm 6 and the second arm 7 are connected to each other at the base end 5B. FIG. 3 shows a connection portion 8 that connects the first arm 6 and the second arm 7 to each other. The first side of a single elongated plate bent into a U-shape or Y-shape may be the first arm 6, and the second side of the same may be the second arm 7. Also, one of two elongated plates arranged opposite each other may be the first arm 6, and the other may be the second arm 7.

The clip 5 preferably has a width direction z perpendicular to the direction x from the tip 5A to the base 5B and the opening/closing direction y. The clip 5 preferably has a first end 5C and a second end 5D in the width direction z. The opening/closing direction y is perpendicular to the direction x, and is the direction of the arrow y shown in FIG. 4. The trajectory of the opening and closing of the first arm 6 and the second arm 7 may include a directional component other than the direction y, such as a circular arc. The connection portion 8 is preferably provided on the first end 5C side of the clip 5 in the width direction z.

It is preferable that the connected portion 9 is provided on the base end 5B side of the clip 5. The connected portion 9 is connected to the connecting portion 32 of the linear object 30. The structure of the connected portion 9 is not particularly limited, but for example, as shown in FIG. 4, the first arm 6 has a first claw 9A protruding toward the second arm 7 on its base end 5B side, and the second arm 7 has a second claw 9B protruding toward the first arm 6 on its base end 5B side. The first claw 9A and the second claw 9B are caught on the connecting portion 32, so that the linear object 30 is less likely to come off the clip 5 after the clip 5 and the linear object 30 are connected. Another embodiment of the connected portion 9 includes a connection by pinching the connecting portion 32 on the tip side of the linear object 30 at the part where the first arm 6 and the second arm 7 are parallel on the base end 5B side of the clip 5 shown in FIG. 4.

As shown in FIG. 2, the ring 2 is disposed within the case 10 and has an inner cavity 4 into which the clip 5 is inserted. The ring 2 and clip 5 are disposed apart within the case 10. When the linear object 30 is pulled out toward the hand after the clip 5 and linear object 30 are connected, the ring 2 is disposed so as to surround the clip 5. The outer diameter of the ring 2 is smaller than the inner diameter of the outer tube 36. This allows the clip 5 and ring 2 to be housed within the outer tube 36.

The shape of the cross section perpendicular to the central axis 3 of the ring 2 is not particularly limited, but may be, for example, a circle, an oval, or a polygon. The ring 2 may have a C-shaped cross section with a notch, or may have a coil shape formed by winding a wire in a spiral shape.

The clip 5 and the ring 2 are preferably made of a material that is highly elastic and biocompatible. The clip 5 and the ring 2 can be made of, for example, stainless steel such as SUS301, SUS303, SUS304, and SUS631, Ni-Ti alloy, etc.

The case 10 accommodates the ring 2 and the clip 5 inside. The case 10 has an insertion opening 11 on its outer surface into which the connecting portion 32 of the linear object 30 is inserted. Inside the case 10, there are a first mounting surface 14 on which the ring 2 is placed, a second mounting surface 16 on which the clip 5 is placed, and an insertion passage 12 that communicates with the insertion opening 11 and through which the linear object 30 is inserted. The first mounting surface 14 is a surface on which the ring 2 is placed so that the direction of the central axis 3 of the ring 2 is parallel to the extension direction u of the insertion passage 12. The second mounting surface 16 is a surface different from the first mounting surface 14. In the case 10, the first mounting surface 14 is located farther from the insertion opening 11 than the insertion passage 12, and the second mounting surface 16 is located farther from the insertion opening 11 than the first mounting surface 14. In the mounted state in which the ring 2 is mounted on the first mounting surface 14 and the clip 5 is mounted on the second mounting surface 16, the lowest end 5L of the clip 5 is located lower than the lowest end 2L of the ring 2, as shown in Figs. 2 and 3. By setting the height of the clip 5 and the ring 2 in this manner, when the linear object 30 is inserted into the case 10, the connecting portion 32 of the linear object 30 passing through the inner cavity 4 of the ring 2 is located above the clip 5. In this state, when the linear object 30 is pushed toward the clip 5, the linear object 30 can be fitted between the first arm 6 and the second arm 7 on the base end 5B side of the clip 5 from one side of the first arm 6 and the second arm 7 of the clip 5 in the width direction z. Therefore, the cartridge 1 allows efficient connection between the clip 5 and the linear object 30.

A method of connecting the clip 5 and the linear object 30 using the cartridge 1 will be described. As shown in Figs. 2 and 3, the ring 2 is placed on the first mounting surface 14, and the clip 5 is placed on the second mounting surface 16. In this mounted state, the tip 30A of the linear object 30 is inserted into the insertion passage 12 from the insertion port 11 as shown in Fig. 5. When the linear object 30 is inserted toward the back side (the side indicated by the arrow A in Fig. 5), the linear object 30 passes through the inner cavity 4 of the ring 2 placed on the first mounting surface 14. When the linear object 30 is further inserted toward the back, the tip 30A of the linear object 30 reaches the position of the second mounting surface 16. In the above mounted state, the bottom end 5L of the clip 5 is lower than the bottom end 2L of the ring 2, so that at least a part of the linear object 30 is positioned higher than the clip 5 when the tip 30A of the linear object 30 reaches the position of the second mounting surface 16. By pushing the linear object 30 toward the clip 5 (the side indicated by the arrow B in FIG. 6), the linear object 30 can be fitted between the first arm 6 and the second arm 7 of the clip 5 from one side in the width direction z of the first arm 6 and the second arm 7 as shown in FIG. 6 to FIG. 8. In FIG. 5 to FIG. 7, the case 10 has a first case body 25 having a second mounting surface 16 and a second case body 26 covering the first case body 25, and the second case body 26 has a pressing part 40 that moves toward the first case body 25 and presses the linear object 30. The clip 5 can be attached to the linear object 30 by moving the pressing part 40 toward the first case body 25 while the pressing part 40 is in contact with the linear object 30. Note that the pressing part 40 is not shown in FIG. 5 to FIG. 7 and FIG. 9, but the pressing part 40 can be provided on the second case body 26 in other embodiments as well. According to the cartridge 1, when connecting the clip 5 and the linear object 30, it is not necessary to move the linear object 30 in the direction from the base end 5B of the clip 5 toward the tip end 5A to insert the connecting portion 32 into the connected portion 9 of the clip 5. This contributes to suppressing the occurrence of connection failures between the clip 5 and the linear object 30 and suppressing deformation of the base end 5B side of the clip 5. Note that in Figure 2, one side of the clip 5 in the width direction z is the side opposite the side in contact with the second mounting surface 16, and in the drawing, it is the second end 5D side.

After connecting the clip 5 and the linear object 30 inside the case 10, pulling the linear object 30 toward the hand as shown in FIG. 9 positions the ring 2 so that it surrounds the clip 5. Pulling the linear object 30 further toward the hand can store the clip 5 and ring 2 inside the outer tube 36. By pulling the outer tube 36 and the linear object 30 toward the hand, the clip device can be removed from the case 10 with the clip 5 and ring 2 stored inside the outer tube 36. When performing a treatment, the clip 5 and ring 2 are exposed from the outer tube 36 and used.

As shown in FIG. 6, when the second case body 26 is pressed from the outside, the pressing portion 40 may come into contact with the linear object 30. A button 45 may be provided on the outside of the second case body 26 as an operation portion for an operator to press. The button 45 may be located in a position overlapping with the pressing portion 40, and the pressing portion 40 may move in conjunction with the movement operation of the button 45. FIG. 7 shows a state in which the pressure on the second case body 26 is released and the pressing portion 40 moves to the side of the arrow C (the direction opposite to the pressing direction).

A protruding portion 50 protruding toward the first case body 25 may be provided on the inside of the second case body 26, and a pressing portion 40 may be provided at a tip portion 51 of the protruding portion 50. An elastic piece 27 may be provided on the second case body 26, a first end of the elastic piece 27 may be fixed to the second case body 26, and a second end of the elastic piece 27 may be elastically deformed with the first end side as a fulcrum, and the pressing portion 40 may be provided on the second end side of the elastic piece 27.

As shown in FIG. 9, it is preferable that the clip 5 and the linear object 30, which are connected to each other, can be pulled out of the case 10 through the insertion opening 11. Since there is no need to disassemble the case 10 when removing the clip 5 from the case 10, the procedure can be performed immediately after connecting the clip 5 to the linear object 30.

The case 10 may have a container shape capable of housing the ring 2 and clip 5 therein. The outer shape of the case 10 may be, for example, a polyhedron. An example of a polyhedron is a rectangular parallelepiped shape. Figure 1 shows an example in which the outer shape of the case 10 is a flat rectangular parallelepiped shape. The case 10 may be composed of one or more members.

The case 10 preferably has a first case body 25 having a first mounting surface 14 and a second mounting surface 16, and a second case body 26 covering the first case body 25. In order to prevent the clip 5 from falling off the second mounting surface 16, the case 10 preferably has a wall 25A extending in a direction from the first case body 25 toward the second case body 26. As can be seen from FIGS. 1 to 3, the first case body 25 and the second case body 26 each have a concave portion, and the concave portions of these case bodies may be arranged to face each other to form a clip storage section 17 that stores the clip 5. In addition, the first case body 25 may be formed in a plate shape, and the second case body 26 may be formed in an inverted concave shape so as to cover the plate-shaped first case body 25. The first case body 25 may be formed in a concave shape, and the second case body 26 may be formed in a plate shape.

The insertion opening 11 may be provided in any part of the outer surface of the case 10 as long as it is connected to the insertion passage 12. If the case 10 is a rectangular parallelepiped having a top surface 10A, a bottom surface 10B, and four side surfaces 10C to 10F, the insertion opening 11 may be provided in the top surface 10A or any of the four side surfaces 10C to 10F. The insertion opening 11 may correspond to the entrance of the insertion passage 12.

When the case 10 has a first case body 25 and a second case body 26 covering the first case body 25, the insertion opening 11 may be provided across the first case body 25 and the second case body 26 as shown in FIG. 2.

The insertion opening 11 may be provided in either the first case body 25 or the second case body 26. In FIG. 10, the case 10 has a first case body 25 having a first mounting surface 14 and a second mounting surface 16, and a second case body 26 covering the first case body 25, and the insertion opening 11 is provided in the second case body 26. This makes it easier to bring the linear object 30 closer to one side of the clip 5 in the width direction z when the linear object 30 is inserted into the case 1. In FIG. 10, the insertion opening 11 is provided in the upper surface of the second case body 26 (upper surface portion 10A of the case 10).

The insertion passage 12 is a passage for inserting the linear object 30, and is formed to connect the insertion opening 11 and the ring accommodating section 15 having the first mounting surface 14. The insertion passage 12 is usually formed to extend straight from the insertion opening 11 to the ring accommodating section 15. As described below, the insertion passage 12 may be inclined. The extension direction u of the insertion passage 12 corresponds to the direction from the insertion opening 11 to the ring accommodating section 15 having the first mounting surface 14. The insertion opening 11 and the insertion passage 12 are preferably large enough to allow the outer tube 36 to be inserted therethrough.

The first mounting surface 14 is a surface having a portion that contacts at least a portion of the ring 2. On the first mounting surface 14, the ring 2 is arranged so that the direction of the central axis 3 is parallel to the extension direction u of the insertion passage 12. The extension direction u of the insertion passage 12 can be determined, for example, by the extension direction of the center of the longitudinal axis of the insertion passage 12. The direction of the central axis 3 of the ring 2 being parallel to the extension direction u of the insertion passage 12 also includes the direction of the central axis 3 of the ring 2 being substantially parallel to the extension direction u of the insertion passage 12. For example, the direction of the central axis 3 of the ring 2 being inclined within ±5 degrees with respect to the extension direction u of the insertion passage 12 is also included. Note that when the cartridge 1 is viewed from the direction of the central axis 3 of the ring 2, the direction of the central axis 3 of the ring 2 and the extension direction of the center of the longitudinal axis of the insertion passage 12 do not have to overlap.

The first mounting surface 14 may be composed of a single surface, or may be composed of multiple surfaces. The first mounting surface 14 may be composed of only flat surfaces, may be composed of only curved surfaces, or may be composed of a combination of flat surfaces and curved surfaces. The first mounting surface 14 may have a shape that follows the outer circumferential surface of the ring 2.

When the case 10 has a first case body 25 and a second case body 26 covering the first case body 25, it is preferable that the first case body 25 has a first mounting surface 14. The first mounting surface 14 may be a part of the inner surface of the first case body 25. For example, it may be a part of the surface of the protrusion 25B provided on the inner surface of the first case body 25 as shown in FIG. 1. As another aspect, the first case body 25 may have a retaining member (not shown) on its inside that holds the ring 2, and a part of the surface of the retaining member may be the first mounting surface 14.

A clip storage section 17 for storing a clip is provided on the rear side of the first mounting surface 14. The clip storage section 17 has a second mounting surface 16. The second mounting surface 16 is a surface having a portion that contacts at least a portion of the clip 5. On the second mounting surface 16, the clip 5 is placed in a state in which the first arm portion 6 and the second arm portion 7 of the clip 5 are open. The clip 5 is arranged so that the base end 5B side of the clip 5 faces the insertion passage 12 side. The second mounting surface 16 may contact the base end 5B of the clip 5, may contact the tip 5A of the clip 5, or may contact both the tip 5A and the base end 5B.

The second mounting surface 16 may be composed of a single surface or may be composed of multiple surfaces. The second mounting surface 16 may be composed of only flat surfaces, may be composed of only curved surfaces, or may be composed of a combination of flat surfaces and curved surfaces. The second mounting surface 16 may have a shape that follows the edge of the first arm 6 and the second arm 7 of the clip 5 in the width direction z.

The second placement surface 16 is a surface different from the first placement surface 14. This indicates that in a placed state, the heights of the first placement surface 14 and the second placement surface 16 are different in at least a portion. The first placement surface 14 and the second placement surface 16 may be different surfaces separated by a step or the like as shown in FIG. 2, or the first placement surface 14 and the second placement surface 16, which are at least partially different in height, may be connected to form a continuous shape as shown in FIG. 11.

In the placement state shown in Figures 2 and 3, the ring 2 is placed on the first placement surface 14 with at least a portion of the ring 2 in contact with the first placement surface 14, and the clip 5 is placed on the second placement surface 16 with at least a portion of the clip 5 in contact with the second placement surface 16. Note that the placement state does not include a state in which either the ring 2 or the clip 5 is not in contact with the placement surface. To achieve the placement state described above, the first case body 25 should be positioned vertically lower than the second case body 26.

When the case 10 has a first case body 25 and a second case body 26 covering the first case body 25, the second mounting surface 16 may be a part of the inner surface of the first case body 25. In another embodiment, the first case body 25 may have a support member (not shown) on its inside that supports the clip 5, and a part of the surface of the support member may be the second mounting surface 16.

In Figures 2 and 10 to 13, an example is described in which the first arm 6 and the second arm 7 of the clip 5 have a constant width from the tip 5A to the base end 5B, but the shape of the clip 5 is not limited to this form.

As shown in FIG. 2, in the above-described placement state, the second placement surface 16 may be parallel to a horizontal plane. This makes it easier to stably place the clip 5. The horizontal plane is a plane that includes a horizontal direction m perpendicular to the direction of gravity n.

As shown in Figures 11 and 12, in the above-described placement state, the second placement surface 16 may be inclined so as to be lower toward the tip 5A side of the clip 5. This allows the clip 5 to be placed so that the base end 5B side that is connected to the linear object 30 is higher. As a result, it becomes easier to bring the connecting portion 32 of the linear object 30 closer to the clip 5, making it easier to connect.

As shown in FIG. 13, in the above-described mounting state, the second mounting surface 16 may be inclined so as to be lower toward the base end 5B side of the clip 5. Compared to a case in which the second mounting surface 16 is inclined so as to be lower toward the tip end 5A side of the clip 5, the linear object 30 can be accessed from a higher position relative to the base end 5B side of the clip 5. Note that, although the direction of the central axis 3 of the ring 2 is parallel to the second mounting surface 16 in FIG. 10, the second mounting surface 16 may be inclined relative to the direction of the central axis 3 of the ring 2 as shown in FIGS. 11 to 13.

As shown in Figures 2, 10, 12 and 13, the entire clip 5 may be located lower than the lowest end 2L of the ring 2, or at least a portion of the clip 5 may be located higher than the lowest end 2L of the ring 2, as shown in Figure 11.

The width of the first arm 6 and the second arm 7 of the clip 5 may be constant, or may vary depending on the position in the direction from the tip 5A to the base end 5B. For example, as shown in FIG. 14, the width on the tip 5A side may be wider than the width on the base end 5B side. In FIG. 15, the width of the first arm 6 and the second arm 7 gradually increases from the base end 5B to the tip 5A. In FIG. 16, the first arm 6 has a narrow portion 6A and a wide portion 6B. Although not shown, the second arm 7 also has a narrow portion and a wide portion. The wide portion 6B is located closer to the tip 5A than the narrow portion 6A, is wider than the narrow portion 6A, and is longer in the direction from the tip 5A to the base end 5B than the narrow portion 6A. The second arm 7 has a similar configuration. By changing the width of the clip 5 in this way, the gripping force of the clip 5 can be adjusted, and the positional relationship between the ring 2 and the clip 5 can be adjusted.

As shown in Figures 2 and 3, in the above-described placement state, it is preferable that the bottom end 5L of the second placement surface 16 is located at a lower position than the bottom end 14L of the first placement surface 14. When the linear object 30 is inserted into the case 10, at least a portion of the linear object 30 is likely to be located at a higher position than the clip 5.

As shown in FIG. 2, in the above-described placement state, the central axis 3 of the ring 2 is preferably located higher than the uppermost end 5N of the base end 5B of the clip 5. Since the linear object 30 passes through the inner cavity 4 of the ring 2, at least a portion of the linear object 30 is likely to be located higher than the clip 5 when the linear object 30 is inserted into the case 10.

As shown in FIG. 3, in the above-described placement state, it is preferable that the uppermost end 5M of the clip 5 is located lower than the lowermost end 14L of the first placement surface 14. This makes it easier for at least a portion of the linear object 30 to be positioned higher than the clip 5 when the linear object 30 is inserted into the case 10.

2 and 12 to 16 show an example in which the second mounting surface 16 is composed of a single surface portion. On the other hand, as shown in FIG. 17, the second mounting surface 16 may be composed of multiple surfaces. FIG. 17 shows an example in which the second mounting surface 16 has a first planar portion 16A and a second planar portion 16B located higher than the first planar portion 16A. The first planar portion 16A is located farther from the insertion opening 11 than the second planar portion 16B. The first planar portion A is in contact with the wide portion 6B on the tip end 5A side of the clip 5, and the second planar portion 16B is in contact with the narrow portion 6A on the base end 5B side of the clip 5. In this way, the second mounting surface 16 may be shaped to match the first arm portion 6 and the second arm portion 7 of the clip 5. Since the second mounting surface 16 makes it easier to support the clip 5, it is possible to suppress the clip 5 from being displaced.

As shown in Figures 14 and 16, a portion of the clip 5 may not be in contact with the second mounting surface 16. In Figure 14, a portion of the section between the tip 5A and base 5B of the clip 5 is not in contact with the second mounting surface 16. This is because the width of the arm is different between the tip 5A side and the base 5B side of the clip 5, and the second mounting surface 16 is composed of a single surface. In Figure 16, a portion of the base 5B side of the clip 5 is floating above the second mounting surface 16. This is because the wide portion of the arm of the clip 5 is formed longer than the narrow portion, and the second mounting surface 16 is composed of a single surface.

As shown in FIG. 18, in the above-described placement state, the uppermost end 5M of the clip 5 may be higher than the lowermost end 14L of the first placement surface 14, and the uppermost end 16M of the second placement surface 16 may be lower than the lowermost end 14L of the first placement surface 14. Even if the clip 5 is placed in this manner, at least a part of the linear object 30 can be placed at a higher position than the clip 5. Even in this embodiment, it is preferable that the uppermost end 5N of the base end 5B of the clip 5 is lower than the lowermost end 14L of the first placement surface 14 in order to make it easier to connect the clip 5 and the linear object 30.

As shown in FIG. 2, in the above-described placement state, it is preferable that the extension direction u of the insertion passage 12 is parallel to the horizontal plane. By extending the insertion passage 12 in this manner, it becomes easier to insert the linear object 30.

As shown in FIG. 19, in the above-described placement state, the insertion passage 12 may be inclined so as to be lower toward the tip 5A of the clip 5. By extending the insertion passage 12 in this manner, it becomes easier to bring the linear object 30 closer to the clip 5 when the tip 30A of the linear object 30 reaches the second placement surface 16.

As shown in FIG. 20, a first abutment portion 18 for stopping the movement of the ring 2 may be provided on the side farther from the insertion opening 11 than the first mounting surface 14. The first abutment portion 18 can contact the ring 2 to stop the movement of the ring 2, making it easier to connect the clip 5 and the linear object 30. In detail, it is possible to prevent the ring 2 from moving toward the clip 5 during connection, and the base end 5B of the clip 5 from entering the inner cavity 4 of the ring 2.

As shown in FIG. 20, a second abutment portion 19 for stopping the movement of the ring 2 may be provided on the side closer to the insertion opening 11 than the first mounting surface 14. Since the second abutment portion 19 can come into contact with the ring 2 and stop the movement of the ring 2, the ring 2 is less likely to move toward the insertion opening 11, and therefore the ring 2 is less likely to fall off the first mounting surface 14 or the case 10.

The first contact portion 18 and the second contact portion 19 may be fixed to the first case body 25, or may be provided on a member different from the first case body 25 and the second case body 26.

As shown in Figs. 20 and 21, the second mounting surface 16 may be provided with a protrusion 20 for preventing the movement of the linear object 30. When the case 10 has a first case body 25 having the first mounting surface 14 and the second mounting surface 16, and a second case body 26 covering the first case body 25, it is preferable that a protrusion 20 protruding toward the second case body 26 is provided at a position on the second mounting surface 16 corresponding to the base end 5B side of the clip 5. By abutting the linear object 30 against the protrusion 20, excessive insertion of the linear object 30 can be prevented, making it easier to connect the clip 5 and the linear object 30.

It is preferable that the tip 30A of the connecting portion 32 of the linear object 30 comes into contact with the protruding portion 20 to stop the linear object 30 from entering the case 10. When the clip 5 and the linear object 30 are connected by fitting the connecting portion 32 of the linear object 30 to the base end 5B side of the clip 5, it is important that the position of the base end 5B side of the clip 5 and the position of the tip 30A side of the linear object 30 inside the case 10 are appropriate. It is preferable that these positions are adjusted by the case 10. By providing the protruding portion 20 at an appropriate position inside the case 10, the clip 5 and the linear object 30 can be appropriately positioned for connection simply by inserting the linear object 30 through the insertion opening 11 of the case 10.

The shape of the protrusion 20 can be, for example, a cylinder, a cone, a frustum, a sphere, an ellipsoid, or a combination of these.

As shown in FIG. 21, it is preferable that the protrusion 20 is on an extension of the insertion passage 12. The extension of the insertion passage 12 refers to the line extending from the part where the linear object 30 comes into contact when the linear object 30 is inserted into the insertion passage 12 in the above-described placement state. The protrusion 20 may be on an extension of the central axis 3 of the ring 2. When the linear object 30 is inserted into the case 10, the tip 30A of the linear object 30 abuts against the protrusion 20, so excessive insertion of the linear object 30 can be prevented.

In the above described placement state, it is preferable that the uppermost end 20M of the protrusion 20 is located higher than the central axis 3 of the ring 2. This ensures that the tip 30A of the linear object 30 abuts against the protrusion 20 when the linear object 30 is inserted into the case 10, thereby preventing excessive insertion of the linear object 30.

The protruding portion 20 is columnar and protrudes toward the second case body 26, and preferably has a notch 21 on the insertion opening 11 side of the protruding portion 20. The notch 21 is preferably cut in a V-shape that narrows toward the tip 5A of the clip 5. This makes it easier for the tip 30A of the linear object 30 to butt into the V-shaped portion.

Next, a preferred positional relationship between the cartridge 1 and the linear object 30 will be described. As shown in FIG. 5, when the connecting portion 32 of the linear object 30 is inserted into the case 10 in the above-described placement state, it is preferred that the uppermost end 32M of the connecting portion 32 of the linear object 30 is located higher than the uppermost end 5M of the clip 5. When the tip 30A of the linear object 30 reaches the second placement surface 16, at least a portion of the linear object 30 can be positioned above the clip 5.

The clip 5 has a direction x from the tip 5A to the base 5B and a width direction z perpendicular to the opening/closing direction y, and the clip 5 has a first end 5C and a second end 5D in the width direction z, and preferably has a connection portion 8 at the first end 5C side in the width direction z where the first arm 6 and the second arm 7 are connected to each other. In that case, as shown in Figures 6 to 7, it is preferable that the clip 5 and the linear object 30 are connected by fitting the connection portion 32 of the linear object 30 from the second end 5D side in the width direction z between the first arm 6 and the second arm 7 of the clip 5 on the second mounting surface 16. When connecting the clip 5 and the linear object 30, it is not necessary to move the linear object 30 in the direction from the base end 5B to the tip 5A of the clip 5 to insert the connection portion 32 into the connected portion 9 of the clip 5, so that connection failure can be prevented. The first arm 6 and the second arm 7 are connected to each other at the base end 5B side of the clip 5. Here, the base end 5B side of the clip 5 refers to the portion of the clip 5 closer to the base end 5B than the center in the direction x from the tip 5A toward the base end 5B. In order to facilitate the closing operation of the clip 5 with the ring 2, it is preferable that the first arm 6 and the second arm 7 are connected at a portion where the arms of the clip 5 are not spread out. Also, as shown in FIG. 4, it is preferable that the first arm 6 and the second arm 7 of the clip 5 are connected by a connection portion 8. It is preferable that the portion where the first arm 6 and the second arm 7 are connected, such as the connection portion 8, is shaped to form a bridge between the arms of the clip 5.

When the case 10 has a first case body 25 having a first mounting surface 14 and a second mounting surface 16, and a second case body 26 covering the first case body 25, it is preferable that the clip 5 is mounted on the second mounting surface 16 so that the first end 5C side of the clip 5 in the width direction z faces the second mounting surface 16 and the second end 5D side faces the second case body 26. This makes it easier to fit the connecting portion 32 of the linear object 30 from the second end 5D side in the width direction z between the first arm portion 6 and the second arm portion 7 of the clip 5 on the second mounting surface 16.

By pressing a part of the case 10 from the outside, the linear object 30 is pressed by the case 10, and the connecting part 32 of the linear object 30 can be fitted from the second end 5D side in the width direction z between the first arm 6 and the second arm 7 of the clip 5 on the second mounting surface 16. A part of the case 10 may be elastically deformable to make it easier for the case 10 to come into contact with the linear object 30. In addition, the connecting part 32 may be connected to the clip 5 by moving the linear object 30 to one side in the width direction z at the hand side.

The material of the case 10 is not particularly limited, but it is preferably made of synthetic resin, as this facilitates precision machining, keeps the clip 5 and ring 2 housed therein hygienic, and prevents damage to the clip 5. When the case 10 has a first case body 25 having a first mounting surface 14 and a second mounting surface 16, and a second case body 26 covering the first case body 25, it is preferable that at least one of the first case body 25 and the second case body 26 is made of a transparent or semi-transparent material. This makes it easier for the operator to connect the clip 5 and the linear object 30 while visually checking.

By using the cartridge 1 as described above, it is possible to connect a medical clip 5 to a linear object 30 having a connecting portion 32 on the tip side. One embodiment of a method for connecting a clip 5 to a linear object 30 is a clip 5 that is arranged in a case 10, a ring 2 having an inner cavity into which the clip 5 is inserted, and a clip 5 that is arranged in the case 10 and has a first arm 6 and a second arm 7 that face each other, a tip that holds an object, and a base end that is connected to the connecting portion 32 of the linear object 30, and the first arm 6 and the second arm 7 are opened and closed by the ring 2, and the clip 5 is moved in a direction from the tip 5A toward the base end 5B. and a clip 5 having a width direction z perpendicular to the direction x and the opening/closing direction y of the clip 5, a first end 5C and a second end 5D in the width direction z, the clip 5 having a connection portion 8 at the first end 5C side where a first arm portion 6 and a second arm portion 7 are connected to each other. The case 10 has therein a first mounting surface 14 on which the ring 2 is mounted, a second mounting surface 16 on which the clip 5 is mounted, and an insertion passage 12 communicating with the insertion opening 11 and through which a linear object 30 is inserted. The first mounting surface 14 is disposed between the ring 2 and the second mounting surface 16. The second mounting surface 16 is a surface on which the ring 2 is placed so that the direction of the central axis 3 of the second mounting surface 16 is parallel to the extending direction u of the insertion passage 12, the second mounting surface 16 is a surface different from the first mounting surface 14, and within the case 10, the second mounting surface 16 is located farther from the insertion opening 11 than the first mounting surface 14, and the first mounting surface 14 is located farther from the insertion opening 11 than the insertion passage 12, and in a mounted state in which the ring 2 is placed on the first mounting surface 14 and the clip 5 is placed on the second mounting surface 16, The method includes the steps of: preparing a cartridge 1 in which the bottom end 5L of the clip 5 is lower than the bottom end 2L of the ring 2; inserting a connecting portion 32 of a linear object 30 into the case 10 from the insertion opening 11; passing the connecting portion 32 through the ring 2 on the first mounting surface 14; and fitting the connecting portion 32 from the second end 5D side in the width direction z between the first arm 6 and the second arm 7 of the clip 5 on the second mounting surface 16. Step S1 is shown in FIGS. 1 to 3, step S2 is shown in FIG. 5, step S3 is shown in FIG. 6, and step S4 is shown in FIGS. 7 to 8. This method makes it easier to fit the connecting portion 32 of the linear object 30 between the first arm 6 and the second arm 7 of the clip 5, so that the clip 5 and the linear object 30 can be connected efficiently.

1: Clip cartridge 2: Ring, 2L: Bottom end of ring, 3: Central axis, 4: Inner cavity 5: Clip, 5A: Tip, 5B: Base end, 5C: First end in width direction, 5D: Second end in width direction, 5L: Bottom end of clip, 5M: Top end of clip. 5N: top end of base end of clip, 6: first arm, 7: second arm, 8: connection portion, 9: connected portion, 10: clip case, 11: insertion port, 12: insertion passage, 14: first mounting surface, 14L: bottom end of first mounting surface, 16: second mounting surface, 16L: bottom end of second mounting surface, 20: protrusion, 25: first case body, 26: second case body, 30: linear object, 31: linear object main body, 32: connecting portion, 35: inner tube, 36: outer tube, m: horizontal direction, n: direction of gravity, u: extension direction of insertion passage, x: direction from tip to base end, y: opening/closing direction, z: width direction

Claims (17)

A clip cartridge for connecting a medical clip to a linear object having a connecting portion at a tip end thereof,
Clip case and
a ring disposed within the clip case and having an inner cavity into which the clip is inserted;
a clip that is disposed in the clip case and opens and closes by the ring, the clip having a first arm portion and a second arm portion that face each other, the clip having a tip end that holds an object and a base end that is connected to the connecting portion of the linear object;
the clip case has an insertion opening on an outer surface thereof into which the connecting portion of the linear object is inserted,
the clip case has, inside thereof, a first mounting surface on which the ring is mounted, a second mounting surface on which the clip is mounted, and an insertion passage communicating with the insertion opening and through which the linear object is inserted;
the first mounting surface is a surface on which the ring is mounted so that a direction of a central axis of the ring is parallel to an extension direction of the insertion passage,
The second placement surface is a surface different from the first placement surface,
In the clip case, the first mounting surface is located farther from the insertion opening than the insertion passage, and the second mounting surface is located farther from the insertion opening than the first mounting surface,
A clip cartridge in which, in a mounted state in which the ring is mounted on the first mounting surface and the clip is mounted on the second mounting surface, the bottom end of the clip is located lower than the bottom end of the ring. The clip cartridge according to claim 1, wherein in the mounted state, the bottom end of the second mounting surface is located lower than the bottom end of the first mounting surface. The clip cartridge according to claim 1 or 2, wherein in the mounted state, the central axis of the ring is located higher than the uppermost end of the base end of the clip. A clip cartridge according to any one of claims 1 to 3, wherein in the mounted state, the uppermost end of the clip is located lower than the lowermost end of the first mounting surface. A clip cartridge according to any one of claims 1 to 3, wherein in the mounted state, the uppermost end of the clip is higher than the lowermost end of the first mounting surface, and the uppermost end of the second mounting surface is lower than the lowermost end of the first mounting surface. The clip cartridge according to any one of claims 1 to 5, wherein in the mounted state, the second mounting surface is parallel to a horizontal plane. The clip cartridge according to any one of claims 1 to 6, wherein in the mounted state, the second mounting surface is inclined so as to be lower toward the tip side of the clip. The clip cartridge according to any one of claims 1 to 7, wherein in the mounted state, the extension direction of the insertion passage is parallel to a horizontal plane. A clip cartridge according to any one of claims 1 to 8, in which, in the loaded state, the insertion passage is inclined so as to be lower toward the tip side of the clip. A clip cartridge as described in any one of claims 1 to 9, wherein in the placed state, when the connecting portion of the linear object is inserted into the clip case, the uppermost end of the connecting portion of the linear object is at a higher position than the uppermost end of the clip. the clip has a width direction perpendicular to a direction from the tip end toward the base end and to a direction in which the clip is opened and closed, the clip has a first end and a second end in the width direction, and a connection portion at which the first arm portion and the second arm portion are connected to each other on the first end side in the width direction,
A clip cartridge as described in any one of claims 1 to 10, wherein the clip and the linear object are connected by fitting the connecting portion of the linear object between the first arm portion and the second arm portion of the clip located on the second mounting surface from the second end side in the width direction. the clip case includes a first case body having the first mounting surface and the second mounting surface, and a second case body covering the first case body,
The clip cartridge according to claim 11, wherein the clip is placed on the second mounting surface so that the first end side of the clip in the width direction faces the second mounting surface and the second end side faces the second case body. the clip case includes a first case body having the first mounting surface and the second mounting surface, and a second case body covering the first case body,
a protruding portion protruding toward the second case body is provided at a position on the second mounting surface corresponding to the base end side of the clip,
12. The clip cartridge according to claim 1 , wherein in the mounted state, an uppermost end of the protruding portion is located higher than a lowermost end of the first mounting surface. The clip cartridge according to claim 13 , wherein the protruding portion is on an extension of the insertion passage. the clip case includes a first case body having the first mounting surface and the second mounting surface, and a second case body covering the first case body,
The clip cartridge according to any one of claims 1 to 11, wherein the second case body is provided with the insertion opening. The clip cartridge according to any one of claims 1 to 15, in which the clip and the linear object, which are connected to each other, can be pulled out of the clip case through the insertion opening. A method for connecting a medical clip to a linear object having a connecting portion on a tip side, comprising the steps of:
Clip case and
a ring disposed within the clip case and having an inner cavity into which the clip is inserted;
a clip disposed within the clip case, the clip having first and second arms opposed to each other, a tip for clamping an object, and a base end connected to the connecting portion of a linear object, the first and second arms being opened and closed by the ring, the clip having a width direction perpendicular to a direction from the tip to the base end and to a direction in which the clip is opened and closed, the clip having a first end and a second end in the width direction, and a connecting portion at the first end side where the first and second arms are connected to each other; the clip case having an insertion opening on an outer surface thereof through which the connecting portion of the linear object is inserted, and a first mounting surface on which the ring is mounted and a connecting portion at which the clip is connected to the first end side on which the clip case is inserted, a step of preparing a clip cartridge having a second mounting surface on which a clip is placed and an insertion passage communicating with the insertion opening and through which the linear object is inserted, the first mounting surface being a surface on which the ring is placed so that a direction of a central axis of the ring is parallel to an extending direction of the insertion passage, the second mounting surface being a surface different from the first mounting surface, the second mounting surface being located farther from the insertion opening than the first mounting surface within the clip case, and the first mounting surface being located farther from the insertion opening than the insertion passage, the ring being placed on the first mounting surface, and the clip being placed on the second mounting surface, in a mounted state in which the clip is placed on the second mounting surface, a bottom end of the clip is located lower than a bottom end of the ring;
inserting the connecting portion of the linear object into the clip case through the insertion opening;
threading the coupling portion through the ring on the first mounting surface;
A method for connecting a clip to a linear object, comprising: a step of fitting the connecting portion between the first arm portion and the second arm portion of the clip located on the second mounting surface from the second end side in the width direction.

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