JP7672158B2 - Clip removal device - Google Patents

Description

The present invention relates to a clip removal device that removes a clip placed inside the body while gripping internal tissue by operating from outside the body.

As shown in Patent Document 1, mechanical hemostatic devices (hereafter referred to as clips) include a clip body having a pair of arms, which has a fastening ring moved relative to the clip body to bring the pair of arms closer to each other and grasp internal tissue.

One such clip removal device is one that has a removal device body with a pair of longitudinal pieces at the tip of a drive wire inserted into a sheath, as shown in Patent Document 2. In this removal device, the pair of longitudinal pieces clamp a pair of arms by retracting the drive wire into the sheath, and the engaging tapered portions on the longitudinal pieces move the tightening ring toward the base end of the clip.

In order to reliably move the tightening ring in the above-mentioned removal device, it is necessary to adjust the orientation of the long piece relative to the pair of arms of the clip so that a force is applied in the direction in which the arms close together, thereby loosening the tightening of the arms by the tightening ring.

However, in order to adjust the orientation of the pair of long pieces of the removal device inserted inside the body to match the clip by operating from outside the body, it is necessary to operate the removal device by trial and error, which requires a high level of skill and luck, making it extremely difficult to remove the clip efficiently.

JP 2009-189705 A International Publication No. 2018/062414

The present invention was made in consideration of the problems described above, and its main objective is to reliably release the grip of internal tissue by the clip body regardless of the orientation of the clip body.

That is, the clip removal device according to the present invention has a clip body that opens forward in its natural state, and a clamping ring that moves from the rear side of the clip body to the front side, thereby elastically deforming the clip body to a closed state, and is a clip removal device that removes a clip that has been placed inside the body with the clip body gripping internal tissue by the clamping ring, by operating from outside the body, and is characterized in that it has a cylindrical sheath, an operating wire that is inserted into the sheath so as to be able to advance and retreat, and an annular detachment loop portion made of a linear elastic body that is connected to the tip of the operating wire, and the detachment loop portion has a constricted portion that reduces the opening width, and elastically deforms by protruding and sinking into the sheath as the operating wire advances and retreats, and by drawing the detachment loop portion into the sheath from a state in which the clip is positioned closer to the sheath than the constricted portion within the opening of the detachment loop portion, the clamping ring is moved toward the rear side of the clip body, thereby releasing the grip of the internal tissue by the clip body.

With such a clip removal device, the clip is placed inside the opening of the annular detachment loop on the sheath side of the constricted portion, and the clip body can be released from its grip on the internal tissue simply by retracting the detachment loop into the sheath. By retracting the detachment loop into the sheath, the clip body is completely surrounded and fastened by the tip of the sheath and the detachment loop (particularly the constricted portion), so that the clamping by the clamping ring can be released and the clip body can be moved to the rear side regardless of the orientation of the clip body.

In order to remove the clip from the internal tissue without leaving it behind inside the body, it is desirable to hold the clip body by clamping it between the detachment loop portion and the tip of the sheath by continuing to pull the detachment loop portion into the sheath after the clip body has released its grip on the internal tissue.

It is desirable that the pair of linear portions forming the constricted portion cross each other when the detachment loop portion is retracted into the sheath.
With this configuration, the pair of linear portions that form the constricted portion intersect with each other, making it easier to move the tightening ring rearward.

It is desirable that the pair of linear portions forming the waist portion be adjacent to or in contact with each other over a predetermined length in a deployed state in which the detachment loop portion projects from the sheath.
With this configuration, as the detachment loop portion is pulled into the sheath, the clip body moves between the pair of linear portions that form the constricted portion, making it even easier to move the fastening ring rearward.

In order to avoid damaging body tissue when removing the clip, it is desirable that the tip of the removal loop portion has an arc-shaped curved shape when the removal loop portion is in the deployed state where it protrudes from the sheath.

In order to make it easier to apply force toward the rear side of the tightening ring when clamping the clip body, it is desirable for the removal loop portion to have a curved shape in side view when in the deployed state protruding from the sheath.

According to the present invention described above, the grip of internal tissue by the clip body can be reliably released regardless of the orientation of the clip body.

1 is an overall schematic diagram of a clip removal device according to an embodiment of the present invention; 1A and 1B are diagrams showing an example of a clip in an open state and a closed state, respectively. 4A and 4B are a plan view and a side view of the detachment loop portion of the embodiment in an expanded state. 13 is a perspective view showing a state in which a clip is placed at a sheath side opening of the detachment loop portion of the embodiment. FIG. 13A and 13B are a plan view and a side view showing a state in which a clip is placed at a sheath side opening of the detachment loop portion of the embodiment. 13A and 13B are a plan view and a side view showing the state in which the clip body is surrounded by the narrowed portion of the detachment loop portion, the sheath side opening, and the tip end of the sheath in this embodiment. 11A and 11B are a plan view and a side view showing a state in which the grip of the clip by the detachment loop portion of the embodiment is released. 11A and 11B are a plan view and a side view showing a state in which a clip is held by the tip opening of the detachment loop portion of the embodiment.

REFERENCE SIGNS LIST 100: Clip removal device 10: Clip 11: Clip body 12: Clamping ring 2: Sheath 2a: Distal end of sheath 3: Operating wire 4: Removal loop 41: Necked portion 41a: Pair of linear portions 42 forming the necked portion Sheath side opening 43: Distal end opening

A clip removal device according to one embodiment of the present invention will be described with reference to the drawings. Note that in all of the drawings shown below, some details have been omitted or exaggerated for ease of understanding.

1. Device configuration
First, an example of the clip 10 to be removed by the clip removal device 100 of this embodiment will be described.

As shown in Fig. 1, the clip 10 has a clip body 11 that opens forward in its natural state, and a fastening ring 12 that elastically deforms the clip body 11 to a closed state by moving the clip body 11 from the rear side to the front side. The clip body 11 has a pair of arms 11a, and when the clip body 11 is closed by the fastening ring 12, the pair of arms 11a approach each other and grasp the internal tissue BT (see Fig. 1(b)). Note that by moving the fastening ring 12 from the front side to the rear side, the pair of arms 11a move away from each other and the grip on the internal tissue BT is released (see Fig. 1(a)).

The clip removal device 100 of this embodiment is an endoscopic treatment tool used together with an endoscope, as shown in Figure 2, and removes the clip 10 that has been placed inside the body while grasping the internal tissue BT by operating it from outside the body.

Specifically, as shown in FIG. 1, the clip removal device 100 has a cylindrical sheath 2, an operating wire 3 inserted into the sheath 2 so as to be movable forward and backward, and an annular removal loop portion 4 made of a linear elastic body and connected to the tip of the operating wire 3.

The sheath 2 is inserted into the endoscope from a treatment tool insertion port provided in the operation section of the endoscope, and is, for example, cylindrical and flexible. The sheath 2 passes through the insertion section of the endoscope and extends from a treatment tool outlet provided at the tip of the insertion section. In addition, an operation handle section 5 for operating the operation wire 3 is provided at the base end section 2b of the sheath 2.

The operating wire 3 is moved back and forth within the sheath 2 by the operating handle 5, and has a detachable loop portion 4 at its tip.

The detachable loop portion 4 is formed by deforming a linear elastic body into a ring shape, as shown in Figure 3. Specifically, the detachable loop portion 4 is configured to be in a ring shape by connecting both ends of a single linear elastic body to the operating wire 3.

Here, the filamentary elastic body has a strength sufficient to maintain its shape when deployed and protruding from the tip 2a of the sheath 2, and may be, for example, a metal wire made of stainless steel, Ni-Ti or titanium, or a resin wire made of polyvinyl chloride, nylon, polyurethane, polypropylene, fluororesin, or a combination of the above-mentioned metal wire and resin wire.

This detachable loop portion 4 is roughly gourd-shaped when in an expanded state protruding from the tip portion 2a of the sheath 2, has a narrowed portion 41 which reduces the opening width, and elastically deforms by protruding and sinking into the tip portion 2a of the sheath 2 as the operating wire 3 advances and retreats.

Specifically, before the constricted portion 41 is pulled into the sheath 2, the opening size of the detachable loop portion 4 changes primarily at the opening on the sheath side of the constricted portion 41 (hereinafter, the sheath side opening 42), and after the constricted portion 41 is pulled into the sheath 2, the opening size of the opening on the tip side of the constricted portion 41 (hereinafter, the tip side opening 43) changes.

The pair of linear portions 41a forming the constricted portion 41 in the detachable loop portion 4 are adjacent to or in contact with each other over a predetermined range when the detachable loop portion 4 is in an expanded state in which it protrudes from the distal end 2a of the sheath 2. In FIG. 3, the pair of linear portions 41a forming the constricted portion 41 are configured to be close to each other, but they may be configured to be in contact with each other, or may be in contact or in close contact so as to overlap in a plan view.

In addition, the pair of linear portions 42a that form the sheath side opening 42 in the detachable loop portion 4 are each curved outward, for example in an arc shape, thereby forming the sheath side opening 42.

In addition, the tip 4x of the detachment loop portion 4 is curved in an arc shape when the detachment loop portion 4 is in an expanded state where it protrudes from the tip 2a of the sheath 2. In other words, the linear portion 43a forming the tip opening 43 is curved in an arc shape. This prevents damage to the body tissue BT during the removal operation of the clip 10.

Furthermore, the detachment loop portion 4 has a curved shape in side view when in the deployed state protruding from the distal end portion 2a of the sheath 2. Here, the curved shape may be a continuously curved arc shape in side view, or may be an intermittent (partial) curved shape overall. In this configuration, when the clip 10 is removed, the detachment loop portion 4 is curved in a direction away from the body tissue BT.

2. Operation of the Clip Removal Device 100
Next, the operation and manipulation of the clip removing device 100 of this embodiment will be described with reference to FIGS.

First, as shown in Figures 4 and 5, the clip 10 is placed in the sheath-side opening 42 of the detachment loop portion 4. At this time, the detachment loop portion 4 is positioned on the lower side (the inner tissue side) of the fastening ring 12 in the clip body 11.

In this state, the operating wire 3 is moved toward the base end 2b of the sheath 2 to retract the detachment loop portion 4 into the sheath 2. Then, as shown in Figure 6, the opening size of the sheath side opening 42 becomes smaller and the pair of linear portions 41a forming the constricted portion 41 cross each other. As a result, the clip body 11 is surrounded and tightened all around by the pair of linear portions 41a forming the constricted portion 41, the pair of linear portions 42a forming the sheath side opening 42, and the distal end 2a of the sheath 2, and the tightening by the tightening ring 12 is loosened.

Here, the tightening ring 12 comes into contact with the linear portions 41a, 42a or the tip portion 2a of the sheath 2, causing the tightening ring 12 to move rearward from the clip body 11. Note that the movement of the tightening ring 12 rearward can be promoted by repeatedly slightly moving the detachment loop portion 4 in and out of the sheath 2. At this time, the pair of linear portions 41a forming the constricted portion 41 cross each other and overlap one on top of the other, making it easier for the tightening ring 12 to move rearward.

In addition, by further retracting the removal loop portion 4 into the sheath 2 and moving the clip body 11 between the pair of linear portions 41a that form the constricted portion 41, the fastening ring 12 moves to the rear side of the clip body 11.

Here, since the removal loop portion 4 is curved, the removal loop portion 4 comes into contact with the fastening ring 12 in such a way as to lift the fastening ring 12 rearward, and the fastening ring 12 is pushed rearward, making it easier for the fastening ring 12 to move rearward of the clip body 11.

As the clamping ring 12 moves rearward from the clip body 11, the clip body 11 spreads forward while being held by the detachment loop 4, and the grip of the internal tissue BT by the clip body 11 is released, as shown in Figure 7. Note that even in this state, the clip 10 is still clamped by the detachment loop 4.

After the clip body 11 has released its grip on the internal tissue BT, the detachable loop portion 4 continues to be pulled into the sheath 2, and as shown in FIG. 8, the clip body 11 moves to the tip opening 43 of the detachable loop portion 4 and is held by being clamped between the linear portion 43a that forms the tip opening 43 of the detachable loop portion 4 and the tip portion 2a of the sheath 2.

The detached clip 10 can be removed from the body by pulling the sheath 2 together with the detachment loop portion 4 holding the clip 10 from the insertion portion of the endoscope. When the detachment loop portion 4 is removed from the body and pulled out of the sheath 2, the distal end opening 43 is expanded by the elastic restoring force of the linear portion 43a that forms the distal end opening 43, and the clip 10 is separated from the detachment loop portion 4.

3. Effects of this embodiment
According to the clip removal device 100 of this embodiment configured in this manner, the clip 10 is placed inside the opening of the annular detachment loop portion 4 on the sheath side of the constricted portion 41, and the grip of the internal tissue by the clip body 11 can be released simply by retracting the detachment loop portion 4 into the sheath 2. Here, by retracting the detachment loop portion 4 into the sheath 2, the clip body 11 is entirely surrounded and fastened by the tip portion 2a of the sheath 2 and the detachment loop portion 4 (particularly the constricted portion 41), so that the fastening by the fastening ring 12 can be released and the clip body 11 can be moved to the rear side regardless of the orientation of the clip body 11 (without adjusting the direction of the detachment loop portion 4).

In addition, after the clip body 11 releases its grip on the internal tissue BT, the clip body 11 is held by being clamped between the detachable loop portion 4 and the tip portion 2a of the sheath 2, so that the clip 10 that has been detached from the internal tissue BT can be removed outside the body without being left behind inside the body.

4. Other embodiments
For example, in the above embodiment, the detachable loop portion 4 has a symmetrical shape in a plan view, but may have an asymmetrical shape in a plan view. In this case, the detachable loop portion 4 may have a shape in which a constricted portion 41 is formed on only one side.

In addition, while the removal loop portion 4 in the above embodiment has a curved shape when viewed from the side, it may also have a straight shape when viewed from the side.

In addition, various modifications and combinations of the embodiments may be made as long as they do not contradict the spirit of the present invention.

According to the present invention, the grip of internal tissue by the clip body can be reliably released regardless of the orientation of the clip body.

Claims (4)

A clip removal device includes a clip body that naturally expands toward the front, and a fastening ring that moves the clip body from the rear side to the front side to elastically deform the clip body and close it, and the clip is placed inside the body with the clip body gripping internal tissue by the fastening ring, and the clip removal device is operable from outside the body to remove the clip,
A cylindrical sheath;
An operating wire inserted into the sheath so as to be capable of advancing and retreating;
a ring-shaped detachable loop portion connected to the distal end of the operating wire and made of a linear elastic body;
the detachment loop portion has a constricted portion that reduces an opening width, and is elastically deformed by protruding and retracting with respect to the sheath as the operation wire advances and retreats,
the pair of linear portions forming the waisted portion are adjacent to or in contact with each other over a predetermined length in a deployed state in which the detachment loop portion protrudes from the sheath, and cross each other forward of the tip end of the sheath when the detachment loop portion is retracted into the sheath,
A clip removal device in which the clip is positioned within the opening of the detachment loop portion on the sheath side of the constricted portion, and the detachment loop portion is pulled into the sheath, causing a pair of linear portions forming the constricted portion to cross each other, and the clip body is tightened by the pair of crossed linear portions forming the constricted portion and the tip portion of the sheath, thereby moving the tightening ring to the rear side of the clip body and releasing the grip of the internal tissue by the clip body. The clip removal device according to claim 1, in which the clip body is held by being sandwiched between the detachment loop portion and the distal end of the sheath by retracting the detachment loop portion into the sheath after the grip of the internal tissue by the clip body is released. The clip removal device according to claim 1, wherein the tip of the detachment loop portion is curved in an arc shape when the detachment loop portion is in an expanded state in which the detachment loop portion protrudes from the sheath. The clip removal device according to claim 1, wherein the removal loop portion has a curved shape in a side view when in a deployed state protruding from the sheath.

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