JP2008514244A - Endoscopic device having independently operated legs - Google Patents

Abstract

The present invention relates to an endoscope clip having a plurality of independently controlled legs. The present invention also relates to a method for using a clip having a plurality of legs that operate independently. The clips and methods of the present invention may be used, for example and without limitation, to repair lacerations and other defects with an endoscope.
[Selection] Figure 4

Description

The present invention relates to an endoscopic clip having legs that may be advanced and controlled independently of each other, as well as the method of using the clip. The clip and method of the present invention may be used, for example, to repair or suture a laceration or another defect with an endoscope, or in another environment where contact is limited to a small incision or opening. is there. Devices and methods may also be used for access and fixation to tissue or another material.

More non-invasive surgical procedures can reduce patient trauma and, as a result, can reduce the length of hospital stay, as well as hospital and medical costs. Endoscopic surgery has recently provided significant opportunities to reduce the invasiveness of many surgical procedures. This type of surgery involves the use of an endoscope, an instrument that allows visual inspection and enlargement of a body cavity. The endoscope can be flexible, semi-flexible or rigid. Endoscopes are small surgeries for examining organs including gastrointestinal, respiratory and reproductive and ureteral lumens, for example to see organ structures through body cavities such as mouth, anus, bladder and vagina, or natural openings May be inserted through a mechanical incision. The endoscope has a meridian for cleaning, inhalation and insertion of equipment instruments when a surgical procedure is performed.
During a surgical procedure, the surgeon frequently needs to repair or restore lacerations or defects, or otherwise requires tissue or another material to be approached or fixed by suturing. However, the technical suturing ability of the endoscope is limited. In response to this problem, surgeons have sought alternatives to conventional suturing techniques that are more appropriate for use in endoscopes. These alternatives include the use of endoscopic clips.
While the use of endoscopic clips has alleviated some of the problems associated with suturing at the end of the endoscope, there is still room for improvement in their design and use. For example, as currently used, the “legs” of clips are joined at their proximal ends. This structure requires that the distal ends of the legs have a fixed distance and relationship between them. These fixed relationships limit the surgeon's ability to properly place the clip relative to a particular laceration or defect or another area that requires treatment. For example, these clips cannot target a laceration or defect with a particular curve or angle and cannot span a larger width of the laceration or defect. In addition, because the proximal ends of the legs are coupled, the surgeon cannot adjust the positioning of one leg of the clip without affecting the positioning of the second leg. Positioning is also a limitation because if the clip is placed within the working jaw plate, the clip may not be properly oriented or the clip may be misaligned during application. There is a possibility that. Finally, the legs of the clips currently in use must operate as soon as they are fixed. If unbalanced pressure is applied to the leg during fixation, leg shearing can occur and further tissue damage can occur.

The present invention solves many of the problems described in connection with currently used endoscope clips. The present invention may solve these problems by providing an endoscopic clip having independently controlled legs that are not joined at their proximal ends.
One embodiment of the present invention may be a device having the following configuration: an outer tube having a proximal end and a distal end; an inner tube having a proximal end and a distal end; and An extruded tube device comprising an end cap secured to the distal end of the inner tube; a retaining collar inside the distal end of the inner tube; a leg having a respective proximal and distal end; A retainer positioned proximal to the retaining collar with a slot allowing passage of the section; and an actuating member coupled to the proximal end of the leg. Each leg may have an outwardly directed tab. Prior to deployment, the distal end of the leg may be located closest to the retaining collar at the distal end of the inner tube. The legs, actuating members and retainers may be within the inner tube. The outer tube and the inner tube are connected to a proximal handle that may actuate each leg independently through a separate control cable that is coupled to the proximal end of each leg actuating member. there is a possibility. The distal end of the leg may consist of a hook having a rear end. The leg or hook may have a trichome protrusion. The legs or hooks can have sharp edges. This pointed end is protected when the leg is extended from the device and may be in a sealed and locked position. The rear end of the hook may be angled outwardly within the inner tube.
In an embodiment of the present invention, the actuating member may be a guide block. In addition, the proximal handle may rotate the inner tube independently of the outer tube. The handle may also control the inner tube and leg actuation members. The retaining collar may have a slot that allows passage of the legs. The device may consist of 2, 3, 4 or more legs.
The device is used to connect the legs of the present invention and the connected legs may be released. If the legs are extended from the endoscopic device and are in a sealed and locked position, the legs can be folded and have a weak portion that can separate the legs from the device. .
The inner tube may be a wound stainless steel tube. The legs may be made from a spring material. The outer and / or inner tubes may have a coil towards their distal end. The control cable, in certain embodiments, is approximately. May have a diameter of 50 mm. The outer tube may have an outer diameter of about 2.5 mm in certain embodiments. The outer tube may have an inner diameter of about 2.0 mm in certain embodiments. The inner tube may have an inner diameter of about 1.5 mm in certain embodiments. The legs may be formed with a wire having a diameter of about 0.25 mm before curing in certain embodiments.
The invention further comprises a method of using the above apparatus for joining a target material with an endoscope. The method includes extending a first leg from the inner tube; engaging the distal end of the first leg with a target material; extending a second leg from the inner tube; Engagement of the distal end of the second leg with a target material; simultaneous pulling of the leg to a connected position; and release of the leg in the connected position from the device It consists of; The method further comprises repeating the extension and engagement of additional legs as required. Extension and engagement of the legs can be completed by sliding an actuating member connected to the proximal end of the legs. The engagement step may be further completed by hooking and / or securing. The pulling step may be completed by sliding the inner tube over the extended and engaged legs. While the extension and engagement of the legs are described as occurring sequentially, the extension and engagement of the legs can occur simultaneously. The release step may consist of applying a force on the leg through the actuating member that can break the leg at a weak part of the leg.
The target material that is bound by the method may include, for example, without limitation, tissue, tissue surrounding a laceration, tissue on an alternative side of a laceration and / or tissue defect. The method may be used, for example, without limitation, to repair a tissue defect, repair a tissue laceration, fix a tissue or adjacent tissue, or fix a tissue or another material. There is a possibility that.

Detailed description of specific examples

It is understood that the present invention is not limited to the particular methodologies, compounds, materials, manufacturing methods, uses and applications described herein as they may vary. It is also understood that the terminology used herein is used to describe only specific examples and is not intended to limit the scope of the present invention. It should be noted that the singular forms “a”, “an”, and “the” as used herein and in the appended claims also include the plural unless the context clearly dictates otherwise. Thus, for example, a reference to “a leg” or “clip” is a reference to one or more legs or clips, and includes equivalents thereof known to those skilled in the art.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although specific methods, devices and materials are described, any methods and materials equivalent or similar to those described herein can be used in the practice or testing of the present invention.
As used herein, the term “patient” is composed of any and all living organisms, and a “patient” can be associated with a human being or any other animal.
In the following description, directional terms such as “distal end” and “proximal” are used in conjunction with each other and do not relate to positioning or orientation in relation to an external coordinate system. In addition, “locking” and “connection” spread in the same space in meaning.
The terms "endoscope" or "by endoscopy" are not only related to traditional endoscopes and endoscopic procedures, but are also used for visual inspection where contact is limited to small incisions or openings Also related to semi-rigid or flexible optical instruments. In general, such tests are performed on the human body, but the use of terms is not so limited. It should also be understood that references to endoscopes and endoscopic procedures include procedures for all life forms, whether life or death, as well as inanimate inspections through small openings. It should also be understood that endoscopes and endoscopic procedures include laparoscopic devices and laparoscopic procedures. The term “endoscope” also includes echo endoscopes that may include, for example, an ultrasound transducer at the tip of the device.
The term “material” relates to the substrate engaged by the legs of the present invention. In many cases, the material engaged is tissue in the body, but the use of the term is not so limited.
The term “coupled or coupled” includes repair of a laceration or any material defect that may be engaged, hooked, or penetrated by the legs of the present invention, and includes the repair of healthy tissue or another material. Endoscopic procedures, closure of lacerations or other defects similar to those produced by conventional suturing or stapling, and tissue or other materials, as well as implantation into areas of incomplete tissue or other materials In particular. The term also includes one or more of the tissues accessible by the endoscope, such as, but not limited to, walls of hollow or solid organs, vessels, blood vessels or soft tissue structures. Crossing and / or fixing of layers.

Figures 1 through 11 represent an exemplary apparatus and method of the present invention. These devices and methods are represented and described herein to better explain the invention. It will be understood that the devices and methods shown are exemplary only, and that other configurations, sizes and styles are within the scope of the present invention.
Referring to the drawings, FIG. 1 represents an isometric view of the distal end of a device of the present invention having two legs 70 that advance. Leg 70 is shown protruding from the distal end of outer tube 40. In the illustrated embodiment of FIG. 1, the legs 70 have hooks on their distal ends. In other embodiments of the present invention, legs 70 may include hooks on their distal ends, as well as barbed fixation members on distal end portions or leg tips. In other embodiments of the invention, legs 70 may include hooks on portions or ends of their distal ends, as well as a plurality of barbed fixation members. In other embodiments of the present invention, the legs 70 lack a hook on their distal ends and instead have one or more barbed fixation members on the distal ends of the legs. there is a possibility. The legs 70 in the provided device may have any combination of the hook and barbed fixation member structures described above. For example, in one embodiment, all legs 70 may have the same structure. In another example, the legs 70 in the device may have different structures.
In addition to the device legs 70, FIG. 1 represents two control cables 50 extending from the proximal end of the outer tube 40. The outer tube 40 can extend the overall length of the device. Control cable 50 is coupled or connectable at a proximal end to a control device in a handpiece (not shown). The outer tube 40 is also coupled to or connectable to a handpiece on its proximal end.
FIG. 2 is a longitudinal cross-sectional view of a particular embodiment of the present invention. This view shows a control cable 50 connected to an actuating member (guide block 60 in this view) attached to the proximal end of the leg 70 of the present invention in the inner tube 20, all located in the outer tube 40. Indicates. The inner tube 20 also has an end attachment 30 that is coupled to its distal end that contacts the proximal end of the retaining collar 100. Inner tube 20 and end fitting 30 are formed together with an extruded tube device (denoted 10 in FIG. 5) that advances retaining collar 100 during clip placement. In this configuration, the device may be supplied with the working meridian of the endoscope. The control cable 50 can deliver some axial tension or compression to the guide block 60 due to the support provided by the inner tube 20.
FIG. 3 is a longitudinal cross-sectional view of a particular embodiment of the device of the present invention. One leg 70 is represented as fully advanced while the second leg 70 is represented as partially advanced. FIG. 3 also shows the outer tube 40. While the embodiment represented in this figure represents two legs 70, the device of the present invention is not limited to this embodiment. In other embodiments of the invention, the device may have two or more legs 70. In another embodiment, the device of the present invention may have more than two legs 70. In another embodiment, the device of the present invention may have four or more legs 70. In an embodiment of the invention, all legs 70 may be located at the distal end of the device. In this embodiment, the guide block 60 is a half cylinder when there are two legs 70, a third cylinder when there are three legs 70, and when there are four legs 70, It could be a quarter cylinder or others. It is contemplated that each portion of guide block 60 may have a control cable 50 attached to its proximal end. In other embodiments of the present invention, the legs 70 may be classified into two pairs, with the first pair being disposed distally and the second pair being the first pair of guide blocks 60. The third pair is disposed proximally and elsewhere of the second pair of guide blocks 60. In this embodiment, each pair of legs 70 has a half cylinder guide block, and the control cable 50 is connected to the outer periphery of the inner tube 20 to allow a continuous pair of legs 70. May be configured to move along.
If two legs 70 are included in an embodiment of the invention, or if the legs 70 are included in pairs, the guide block 60 may slide axially relative to the longitudinal axis of the device. There may be a half cylinder. The guide block 60 may have planar side surfaces that face each other within the inner tube 20. Since the length of the guide block 60 is set, the maximum relative movement of the guide block 60 is less than the length of the guide block 60. In this configuration, the guide blocks 60 may remain combined along their surfaces.

FIG. 4 represents two legs 70 that are fully advanced and unlocked. FIG. 4 also shows a guide block 60 attached to the proximal end of the leg 70, a retainer 110 in a cylindrically shaped elastomeric section having a groove over its entire length, and nested at the distal end of the device. A retaining collar 100 is shown, which may be a tubular ring with a slot. A slot in the retaining collar 100 allows passage of the leg 70 during clip placement. FIG. 4 also shows a tab 120 that may be provided on the leg 70 of the present invention. If the leg 70 is advanced and engaged, the retaining collar 100 of the present invention may be advanced by the end cap 30 until the retaining collar 100 contacts these tabs 120. FIG. 4 also represents the outer tube 40 and the control cable 50.
FIG. 5 is a longitudinal cross-sectional view of a particular embodiment of the device of the present invention. In this view, the two legs 70 have advanced and the retaining collar 100 has also been advanced to guide the legs to the locked position. The extruded tube device 10 (consisting of the inner tube 20 and the end cap 30) pushes the retaining collar 100 toward the distal end of the leg 70. The advancement of the retaining collar 100 may lead the legs 70 together to the connected position as shown in FIG. If the legs 70 are properly positioned, they will generally pull together, for example, the sides of a laceration or defect, if pulled into the locked position by the retaining collar 100. FIG. 5 also represents the outer tube 40, control cable 50, guide block 60 and retainer 110.
FIG. 6 is a vertical cross-sectional view from the closest distance of the clip at the locking position. This figure represents the leg 70 of the clip after they have been pulled together to the tab 120 on the leg 70 by advancement of the retaining collar 100. This figure also represents the slot 105 of the retaining collar 100 that receives the curved region 90 of the leg 70 as well as the retainer 110.
FIG. 7 is a detailed plan view of an exemplary leg 70 of the present invention. In this example, leg 70 includes a hook on its distal end, tab 120 and a curved region of leg 90. In one example, the curved region 90 of the leg 70 may include a weak region 80. Stress within the curved region 90 of the weak region 80 may be intensified by the bending moment caused by the eccentric load of the curved region 90 of the leg 70. FIG. 8 represents further details of the weak region 80.
FIG. 9 is a detailed isometric view of an exemplary retaining collar 100 having a slot 105 that allows passage of the leg 70 of the present invention.
FIG. 10 is a detailed isometric view of an exemplary retainer 110 showing a groove 115 over the length of the retainer.
FIG. 11 is an exemplary leg 70 having a hook and barbed fixation member 135. A barbed fixation member 135 is placed at the end of the hook at the distal end of the leg 70 as shown in this embodiment. A barbed fixation member 135 may be included to improve protection of tissue or other material engagement. For example, if engaged with material, the leg 70 can be separated if such release is not guided or intended. With respect to the barbed fixation member 135, however, separation of the leg 70 is unlikely to occur because the barbed fixation member 135 may help to further preserve tissue or other material.
The device of the present invention is used in a particularly wide variety of applications where it is appropriate to endoscopically join human tissue or another material such as, for example, suturing, stapling, or apposition of tissue or another material. There is a possibility that. When used in the body, the device of the present invention may be used to combine unwanted separations of soft tissue caused by, for example, but not limited to, injury, disease or surgical incision. The devices and methods of the present invention may be used in bonding or implanting, for example, healthy tissue or another material onto an area of incomplete tissue or another material. The devices and methods of the present invention may also be used to approximate and / or fix tissue or other materials within the body. In addition, the device can be accessed with, for example, an endoscope, such as, but not limited to, one of the tissues such as a hollow or solid organ, vessel, blood vessel or soft tissue wall or It may be used to bond to cross and / or secure further layers. The device of the present invention may provide various advantages over known devices. For example, the independent nature of the legs 70 allows them to be placed and engaged without interfering with each other, and allows the legs to reach the entire greater width of tissue or another material. Thus, closing larger lacerations or defects than previously possible. The independent nature of the legs 70 can also allow better positioning during the endoscopic procedure. Finally, the various leg 70 configurations may allow the surgeon to select a structure to deal with and hold lacerations or defects provided more safely.
In use, the device of the present invention may be supplied on the working meridian of the endoscope. If the device is placed with an endoscope, it can be placed near a laceration or another defect. Positioning around the laceration or defect may be improved by rotating the inner tube 20 to align the legs 70, with the orientation of the laceration or defect under control of the handpiece. Once positioning is complete, leg 70 may be advanced and manipulated by manipulation of its control cable 50 and guide block 60 to engage tissue or another material on one side of the laceration or defect. There is. For example, if a hook structure is used, tissue or another material can be caught by the first leg. The second leg 70 can then be advanced and manipulated with its control cable 50 and guide block 60 to engage different pieces of tissue or other material surrounding the laceration or defect. The amount of the second leg extension associated with the first leg extension may be adjustable. This feature of the device of the present invention allows the device to handle lacerations or defects of various sizes, shapes and orientations. The additional legs 70 can continue to advance as needed to deal with lacerations or defects. While the general use of the present invention will be described in terms of extending and engaging the legs 70 of the device in turn, the legs 70 (i) proceed simultaneously and sequentially engage tissue or another material, It is also conceivable to (ii) proceed in order and engage simultaneously, or (iii) proceed simultaneously and engage.

If a sufficient number of legs are advanced and engaged by the tissue or other material surrounding the laceration or defect, the quality of engagement between each leg and the tissue or another material is By applying a light force to each leg by pulling the control cable 50, it may be inspected. If filled with the fixation of the leg in tissue or another material, the extruded tube device 10 (inner tube 20 and end cap 30) may be moved until the retaining collar 100 contacts the tab 120 on the leg 70. There is a possibility that the retaining collar 100 is pushed forward. The advancement of the retaining collar 100 may pull the rear of the deployed leg 70 together in a sealed and locked position, and thus a variety of tissue or other material surrounding the laceration or another defect. Pull the areas side by side. If necessary, the retaining collar 100 may also be released. For example, if one or more of the deployed legs are not fully deployed or removed or separated from tissue or another material, the collar 100 is released and the leg or legs are separated from each other. Transferred to location and / or reengaged with tissue or another material.
If advancement of the retaining collar 100 pulls the leg 70 into a closed, locked position, thus causing the laceration or defect closure or tissue or another material to be juxtaposed, the leg 70 will cause the working clip to move inwardly. May be disassembled to release from the endoscopic device. The leg 70 may break in the weakened area 80 of the curved area 90 by applying an increasing load to the control cable 50 until an unexpected loss of tension is detected. In the operative position, the hook tab 120 abuts the extrusion tube device 10, so that during disassembly, all forces placed on the legs 70 must be absorbed by the device, and significant force is applied to the tissue surrounding the clip. Or sent to another material. After separation from the endoscopic device, the endoscope may be removed while the clip remains in place. Thus, the device of the present invention can effectively lead to the closure of lacerations or other defects and the juxtaposition of tissue or other materials similar to those produced by conventional suturing or stapling.
Embodiments of the present invention consist of a proximal handle that controls the expansion and contraction of the independent leg 70 as well as rotating, extending and contracting the inner tube 20 independently of the outer tube 40. And may be controlled. In an embodiment of the present invention, the proximal handle of the device can be coupled or connected to the intake port of an endoscope or echo endoscope. For example, an example of such an endoscope is described in US Pat. 6,638,213; 6,614,595; and 6,520,908. In another embodiment, the proximal handle of the device of the present invention is screwed in, which may be securely secured to the instrumentation meridian intake port of the endoscope using a luer lock mechanism. is there.
The control cable 50 of the present invention may be housed in the inner tube 20 of the present invention. These control cables 50 may independently control the expansion and contraction of the legs 70 of the present invention. In an embodiment of the present invention, the control cable 50 may be flexible when bent. In other embodiments, the control cable 50 may be a metal cable. In other embodiments, the control cable 50 of the present invention may be a solid stainless steel wire. In other embodiments, the control cable 50 may have a diameter of about 0.50 mm. Further, in embodiments of the present invention, the control cable 50 may move through the proximal center of the inner tube 20 to the proximal handle. In other embodiments, the control cable 50 may move to the proximal handle toward the outer periphery of the inner tube 20. The control cable 50 can be coupled or connected to a proximal handle.

The outer tube 40 of the present invention may provide several functions. As well as protecting the device itself, it may protect the instrumentation meridian of the endoscope from the device of the present invention. The outer tube 40 reinforces the device and helps to properly guide and position the device even after the device has moved beyond the path provided in the endoscope. The outer tube 40 may also help to expand or expand the tissue penetrating tube. In embodiments of the present invention, the outer tube 40 may be separate from the rest of the device of the present invention. Thus, in this embodiment, the outer tube 40 may move independently of the rest of the device. In another embodiment of the invention, the outer tube 40 is made of a material that cannot penetrate. In other embodiments of the present invention, the outer tube may be a flexible plastic tube. In other embodiments of the present invention, the outer diameter of the outer tube 40 may be of an appropriate size that allows it to be easily inserted into the majority of the working meridian of the endoscope. In other embodiments of the invention, the outer diameter of the outer tube 40 may be about 2.5 mm. In other examples, the inner diameter of the outer tube 40 may be about 2.0 mm. The outer tube 40 can be coupled or connected to a proximal handle.
The extruded tube apparatus 10 of the present invention may be comprised of an inner tube 20 that resides within an outer tube 40, as well as an end cap 30 that is fitted and secured to the distal end of the inner tube 20. . The push tube device 10 may be similar to that used in many endoscope accessories. In an embodiment of the present invention, the extruded tube device 10 is flexible, but can support axial compressive loads when constrained in the outer tube 40. In other embodiments of the invention, the inner tube 20 may be comprised of a wound stainless steel tube. In other embodiments of the present invention, the extruded tube device 10 may have an outer diameter of about 1.65 mm. In other embodiments of the present invention, the extruded tube device 10 may have an inner diameter of about 1.52 mm. The tube 20 inside the extruded tube device 10 can be coupled or connected to a proximal handle.
Ligating clips are generally classified according to their geometry as symmetric or asymmetric clips. Symmetric clips are generally “U” or “V” shaped clips that are essentially symmetric around a central longitudinal axis that extends between the legs of the clip. In contrast, asymmetric clips do not have an axis of symmetry. The clips of the present invention can be symmetric or asymmetric during use because the legs 70 of the clip of the present invention are not joined at their proximal ends. This feature of the leg 70 of the present invention allows the clip to cope with lacerations or other defects of various shapes, sizes and orientations.
In one embodiment, if the leg 70 of the present invention includes a barbed fixation member 135, the barbed fixation member 135 may include a tapered conical tip. In other examples, the barbed fixation member 135 may penetrate one or more layers of tissue or other material in the pre-expanded configuration before expanding to the fixed configuration.
The clip of the present invention can be made of any material using conventional manufacturing methods. For example, the materials used in the present invention are conventional biological materials such as various metals, plastics, elastomers and bioabsorbable polymeric materials, as well as stainless steel and other surgical alloys of steel. May contain compatible materials. In general, unless such results are desired, it is important to avoid the use of materials that possibly cause an allergic reaction or inflammation. Examples of bioabsorbable polymeric materials that may be used in the present invention include, but are not limited to, glycolide homopolymers and copolymers, lactides, and paradioxanone, trimethylene carbonate and epsilon・ Contains caprolactone. When made of a bioabsorbable polymer material, the clip of the present invention injects the appropriate polymer melted into a suitably designed mold in the process state conventionally used for such polymer systems. May be created by doing. After the polymer melt cools, the polymer molded in the mold to meet the clip design criteria may be released from the mold. The shaped clip can then be sterilized using conventional methods to provide a suitable clip for surgical application. In embodiments of the present invention, the clip may be made of stainless steel with a hardened spring, such as 17-7 PH in the CH900 state (hardened), for example. In other embodiments of the invention, the clip may be formed of a wire having a diameter of about 0.25 mm before curing.
In various embodiments of the present invention, the clip leg 70 may have a weak area 80 that allows the clip to be disconnected from the endoscopic device if pulled into the locked position. There is sex. In an embodiment of the present invention, the weak region 80 may be created by reducing the diameter of the leg wire. In another embodiment, the weak region may be designed to break when a tension load of about 1 pound is applied to the leg 70 through the control cable 50 and the actuation member 60.
Other embodiments and advantages of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. The specification and examples are intended to be illustrative.

FIG. 6 is an isometric view of the distal end of a particular embodiment of the present invention having two legs of an advancing clip. FIG. 4 is a longitudinal cross-sectional view of the distal end of a particular embodiment of the present invention. FIG. 4 is a longitudinal cross-sectional view of the distal end of a particular embodiment of the present invention with one leg fully advanced and the second leg partially advanced. FIG. 6 is a longitudinal cross-sectional view of a particular embodiment of the present invention having two legs that are fully advanced. FIG. 6 is a longitudinal cross-sectional view of the distal end of a particular embodiment of the present invention having a retaining collar that is advanced. It is a longitudinal cross-sectional view of the action | operation clip after isolation | separation from an endoscope apparatus. FIG. 2 is a detailed plan view of a typical leg. This is a detail of a weak part of a typical leg. FIG. 2 is a detailed isometric view of a typical retaining collar. FIG. 2 is a detailed isometric view of an exemplary retainer. FIG. 3 is a detailed view of an exemplary hook having a stylus projection.

Claims (32)

An extruded tube device comprising: an outer tube having a proximal end and a distal end; an inner tube having a proximal end and a distal end; and an end cap secured to the distal end of the inner tube; A retaining collar in the distal end of the inner tube; legs each having a proximal end and a distal end; located proximal to the retaining collar having a slot allowing passage of the legs And a device comprising an actuating member coupled to the proximal end of the leg,
Wherein the legs each have an outward tab; the distal end of the leg prior to placement is the distal end of the inner tube but proximal to the retaining collar The leg, the actuating member and the retainer are in the inner tube; and the outer tube and the inner tube are proximal to the actuating member of each of the legs. A device connected to a proximal handle that operates each leg independently through a separate control cable connected to the end. The apparatus of claim 1, wherein the distal end of the leg comprises a hook having a rear end. The apparatus of claim 1, wherein the rear end of the hook is bent outwardly within the inner tube. 2. The device of claim 1 wherein the leg comprises a barbed fixation member. The apparatus according to claim 1, wherein the operating member is a guide block. The apparatus of claim 1, wherein the proximal handle rotates the inner tube independently of the outer tube. 2. The apparatus of claim 1, wherein the inner tube comprises a coiled stainless steel tube. The apparatus of claim 1, wherein the retaining collar further comprises a slot that allows the leg to pass therethrough. The apparatus of claim 1, wherein the inner tube, the leg and the actuating member are controlled by the proximal handle to interlock the leg. 2. The device of claim 1 comprising two or more legs. 2. A device according to claim 1, comprising three or more legs. 2. A device according to claim 1, comprising four or more legs. 10. Apparatus according to claim 9, wherein the connected legs are released. 10. The device of claim 9, wherein the leg can be folded once the leg is in an extended, sealed and locked position from the device. A device consisting of weak parts that can be separated. 2. The device of claim 1, wherein the leg comprises a pointed end. The device of claim 1, wherein the pointed end is protected when the leg extends from the device and is in a sealed and locked position. 2. A device according to claim 1, wherein the legs are made of spring material. The apparatus of claim 1, wherein the outer tube comprises a coil toward its distal end. 2. A device according to claim 1, wherein the inner tube comprises a coil towards its distal end. A method of endoscopically coupling material using the apparatus of claim 1, wherein the coupling is an extension of a first leg from the inner tube; Engagement of the distal end with the target material; extension of the second leg from the inner tube; engagement of the distal end of the second leg with the target material; to a connected position Traction of the legs; and release of the legs in the coupled position from the device. 21. The method of claim 20, further comprising repeating the extension of the additional leg and the engagement as necessary. 21. The method of claim 20, wherein the extension is achieved by sliding the actuating member connected to the proximal end of the leg. 21. The method of claim 20, wherein the engagement is achieved by hooking the target material. 21. The method of claim 20, wherein the engagement is achieved by securing the target material. 21. The method of claim 20, wherein the traction is achieved by sliding the inner tube over the extended and engaged legs. 21. The method of claim 20, wherein the legs are extended and engaged in sequence. 21. The method of claim 20, wherein the legs are simultaneously extended and engaged. 21. The method according to claim 20, wherein the target material comprises a structure. 21. The method of claim 20, wherein the target material surrounds a laceration. 21. The method of claim 20, wherein the target material comprises tissue on an alternative side of a laceration. 21. The method of claim 20, wherein the method is used to repair a tissue defect. 21. The method of claim 20, wherein the releasing step comprises applying a force to the leg through the actuating member that may fold the leg at the weak portion of the leg.

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