WO2021210364A1

WO2021210364A1 - Clip removal device

Info

Publication number: WO2021210364A1
Application number: PCT/JP2021/012240
Authority: WO
Inventors: 宜央池田; 邦弘藤本
Original assignee: 国立大学法人愛媛大学
Priority date: 2020-04-17
Filing date: 2021-03-24
Publication date: 2021-10-21
Also published as: JPWO2021210364A1

Abstract

The present invention reliably releases the grip of a clip main body on a biological tissue regardless of the orientation of the clip main body. A removal loop part 4 is pulled into a sheath 2, from a state in which a clip 10 is disposed within the opening of the removal loop part 4 so as to be further toward the sheath side than is a narrow part 41. Thus the narrow part 41 is used to move a tightening ring 12 to the rear side of the clip main body 11 so that the grip of the clip main body 11 on the biological tissue is released.

Description

Clip removal device

The present invention relates to a clip removing device that removes a clip placed in the body while holding a body tissue by an operation from outside the body.

As a mechanical hemostatic device (hereinafter referred to as a clip), as shown in Patent Document 1, by moving a tightening ring with respect to a clip body having a pair of arm portions, the pair of arm portions are brought close to each other. Some grip the body tissue.

As a device for removing such a clip, as shown in Patent Document 2, a device in which a removal device main body having a pair of longitudinal pieces is provided at the tip of a drive wire inserted through a sheath is considered. In this removal device, a pair of longitudinal pieces sandwich a pair of arm portions by pulling a drive wire into the sheath, and an engaging taper portion provided on the longitudinal pieces moves the tightening ring toward the base end portion of the clip. It is a configuration.

In order to reliably move the tightening ring in the above-mentioned removing device, the orientation of the longitudinal pieces with respect to the pair of arm portions of the clip is adjusted so that the force is applied in the direction in which the arm portions are closed to each other, and the tightening ring is used. It is necessary to loosen the tightening of the arm part.

However, in order to adjust the orientation of the pair of longitudinal pieces of the removal device inserted inside the body according to the clip by operation from outside the body, it is necessary to operate the removal device by trial and error, which requires high skill and luck. It is necessary and it is extremely difficult to remove the clip efficiently.

Japanese Unexamined Patent Publication No. 2009-189705 International Publication No. 2018/062414

The present invention has been made in view of the above-mentioned problems, and its main subject is to reliably release the grip of the internal tissue by the clip body regardless of the orientation of the clip body.

That is, the clip removing device according to the present invention has a clip body that expands forward in a natural state and a state in which the clip body is elastically deformed and closed by moving the clip body from the rear side to the front side. A clip removing device having a tightening ring for removing a clip placed inside the body while the clip body grips the internal tissue by the tightening ring, and a tubular sheath. The removal loop portion has an operation wire that is inserted into the sheath so as to be able to advance and retreat, and an annular removal loop portion that is connected to the tip portion of the operation wire and is made of a linear elastic body, and the removal loop portion has an opening width. The clip has a constricted portion in which the size of the clip is reduced, and the clip is elastically deformed by being recessed with respect to the sheath due to the advancement and retreat of the operating wire. By pulling the removal loop portion into the sheath from the state in which the clip body is arranged, the tightening ring is moved to the rear side of the clip body by using the constriction portion, and the gripping of the internal tissue by the clip body is released. It is characterized by doing.

With such a clip removal device, the clip is placed on the sheath side of the constriction in the opening of the annular removal loop portion, and the removal loop portion is pulled into the sheath to release the grip of the internal tissue by the clip body. can do. Here, by pulling the removal loop portion into the sheath, the clip body is tightened by surrounding the entire circumference with the tip portion of the sheath and the removal loop portion (particularly the constricted portion), so that the tightening ring is tightened regardless of the orientation of the clip body. It is possible to release the tightening by and move it to the rear side of the clip body.

In order to remove the clip removed from the body tissue to the outside of the body without leaving the clip inside the body, the removal loop portion is continuously pulled into the sheath after the clip body is released from gripping the body tissue. It is desirable to hold the clip body by sandwiching it between the removal loop portion and the tip portion of the sheath.

It is desirable that the pair of streaks forming the constricted portion intersect each other when the removal loop portion is pulled into the sheath.
With this configuration, the pair of streaks forming the constricted portion intersect with each other, so that the tightening ring can be easily moved to the rear side.

It is desirable that the pair of streaks forming the constricted portion are adjacent to or in contact with each other over a predetermined length in a deployed state in which the removal loop portion protrudes from the sheath.
With this configuration, the clip body moves between the pair of streaks forming the constricted portion as the removal loop portion is pulled into the sheath, and the tightening ring can be moved more easily on the rear side. ..

In order to prevent damage to internal tissues during the clip removal operation, the tip of the removal loop portion must have an arcuate curved shape when the removal loop portion protrudes from the sheath. Is desirable.

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

According to the present invention described above, it is possible to reliably release the grip of the internal tissue by the clip body regardless of the orientation of the clip body.

It is an overall schematic diagram of the clip removal device which concerns on one Embodiment of this invention. It is a figure which shows (a) open state, (b) closed state in an example of a clip. It is a top view and the side view of the unfolded state in the removal loop part of the same embodiment. It is a perspective view which shows the state which arranged the clip in the sheath side opening of the removal loop part of the same embodiment. It is a top view and the side view which shows the state which the clip is arranged in the sheath side opening of the removal loop part of the same embodiment. It is a top view and the side view which shows the state which surrounded the clip body by the constriction part of the removal loop part of the same embodiment, the opening on the sheath side, and the tip part of a sheath. It is a top view and the side view which shows the state which the grip of a clip is released by the removal loop part of the same embodiment. It is a top view and the side view which shows the state which held the clip by the tip side opening of the removal loop part of the same embodiment.

100 ・・・ Clip removal device 10 ・・・ Clip 11 ・・・ Clip body 12 ・・・ Tightening ring 2 ・・・ Sheath 2a ・・・ Sheath tip 3 ・・・ Operation wire 4 ・・・ Removal loop 41 ・・・ Constriction 41a ・・・ A pair of streaks forming a constriction 42 ・・・ Sheath side opening 43 ・・・ Tip side opening

The clip removing device according to the embodiment of the present invention will be described with reference to the drawings. In addition, all of the figures shown below are schematically drawn by omitting or exaggerating them as appropriate for the sake of clarity.

<1. Device configuration>
First, an example of the clip 10 removed by the clip removing device 100 of the present embodiment will be described.

As shown in FIG. 1, the clip 10 elastically deforms the clip body 11 that expands forward in a natural state and moves the clip body 11 from the rear side to the front side. It has a tightening ring 12 that keeps it closed. The clip body 11 has a pair of arm portions 11a, and when the clip main body 11 is closed by the tightening ring 12, the pair of arm portions 11a are close to each other to grip the internal tissue BT (FIG. 1 (b). )reference). By moving the tightening ring 12 from the front side to the rear side, the pair of arm portions 11a are separated from each other to release the gripping of the internal tissue BT (see FIG. 1A).

Then, as shown in FIG. 2, the clip removing device 100 of the present embodiment is a treatment tool for an endoscope used together with an endoscope, and a clip 10 is placed in the body while holding the internal tissue BT. It is removed by operation from outside the body.

Specifically, as shown in FIG. 1, the clip removing device 100 is connected to a cylindrical sheath 2, an operation wire 3 inserted into the sheath 2 so as to be able to advance and retreat, and a tip portion of the operation wire 3. It has an annular removal loop portion 4 made of a wire elastic body.

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

The operation wire 3 moves back and forth in the sheath 2 by the operation handle 5, and a removal loop portion 4 is provided at the tip thereof.

As shown in FIG. 3, the removal loop portion 4 is formed by deforming a linear elastic body in an annular shape. Specifically, the removal loop portion 4 is configured to be annular by connecting both ends of one linear elastic body to the operation wire 3.

Here, the linear elastic body has enough strength to maintain its own shape in a deployed state protruding from the tip portion 2a of the sheath 2, and is, for example, stainless steel, Ni—Ti, titanium, or the like. A metal wire made of, a resin wire made of polyvinyl chloride, nylon, polyurethane, polypropylene, a fluororesin, or the like, or a wire obtained by combining the metal wire and a resin wire can be used.

The removal loop portion 4 has a substantially gourd shape in a deployed state protruding from the tip portion 2a of the sheath 2, has a constricted portion 41 having a small opening width, and the tip of the sheath 2 is moved back and forth by the operation wire 3. It is elastically deformed by being recessed with respect to the portion 2a.

Specifically, in the removal loop portion 4, before the constricted portion 41 is pulled into the sheath 2, the opening size of the opening on the sheath side of the constricted portion 41 (hereinafter referred to as the sheath-side opening 42) mainly changes, and the constricted portion 4 is constricted. After the portion 41 is pulled into the sheath 2, the opening size of the opening on the distal end side (hereinafter, the distal end side opening 43) of the constricted portion 41 changes.

The pair of streak portions 41a forming the constricted portion 41 in the removal loop portion 4 are adjacent to or in contact with each other over a predetermined range in a deployed state in which the removal loop portion 4 protrudes from the tip portion 2a of the sheath 2. In FIG. 3, the pair of streak portions 41a forming the constricted portion 41 are close to each other, but they may be in contact with each other, or they may be in contact with each other or close to each other so as to overlap each other in a plan view. Is also good.

The pair of streaks 42a forming the sheath-side opening 42 in the removal loop portion 4 are curved outward, for example, in an arc shape to form the sheath-side opening 42.

Further, the tip portion 4x of the removal loop portion 4 has a shape curved in an arc shape in a deployed state in which the removal loop portion 4 protrudes from the tip portion 2a of the sheath 2. That is, the streak portion 43a forming the tip end side opening 43 is curved in an arc shape. This prevents the internal tissue BT from being damaged during the removal operation of the clip 10.

Further, the removal loop portion 4 has a curved shape in a side view in a deployed state protruding from the tip portion 2a of the sheath 2. Here, the warped shape may be an arc shape that is continuously bent in the side view, or may be a shape that is intermittently (partially) bent and warped as a whole. In this configuration, when the clip 10 is removed, the removal loop portion 4 is warped in the direction away from the body tissue BT.

<2. Operation / operation of clip removal device 100>
Next, the operation and operation contents of the clip removing device 100 of the present embodiment will be described with reference to FIGS. 4 to 8.

First, as shown in FIGS. 4 and 5, the clip 10 is arranged in the sheath-side opening 42 of the removal loop portion 4. At this time, the removal loop portion 4 is located on the lower side (internal tissue side) of the tightening ring 12 in the clip main body 11.

In this state, the removal loop portion 4 is pulled into the sheath 2 by moving the operation wire 3 to the base end portion 2b side of the sheath 2. Then, as shown in FIG. 6, the opening size of the sheath-side opening 42 becomes smaller, and the pair of streaks 41a forming the constricted portion 41 intersect with each other. As a result, the entire circumference of the clip body 11 is surrounded by a pair of streaks 41a forming the constriction 41, a pair of streaks 42a forming the sheath-side opening 42, and a tip 2a of the sheath 2. It is tightened and the tightening by the tightening ring 12 is loosened.

Here, when the tightening ring 12 comes into contact with the

streaks

41a, 42a or the tip 2a of the sheath 2, the tightening ring 12 moves to the rear side of the clip body 11. It is possible to promote the movement of the tightening ring 12 to the rear side by repeatedly inserting and removing the removal loop portion 4 from and out of the sheath 2. At this time, since the pair of streak portions 41a forming the constricted portion 41 are in a state of intersecting each other and overlapping vertically, the tightening ring 12 can easily move to the rear side.

Further, the removal loop portion 4 is further pulled into the sheath 2, and the clip main body 11 moves between the pair of linear portions 41a forming the constricted portion 41, whereby the tightening ring 12 moves to the rear side of the clip main body 11. ..

Here, since the removal loop portion 4 is curved, the removal loop portion 4 comes into contact with the tightening ring 12 so as to lift it to the rear side, the tightening ring 12 is pushed up to the rear side, and the tightening ring 12 is attached to the clip body 11. It becomes easier to move to the rear side.

As the tightening ring 12 moves to the rear side of the clip body 11, as shown in FIG. 7, the clip body 11 expands forward while being held by the removal loop portion 4, and the inside of the body formed by the clip body 11 The grip of the tissue BT is released. Even in this state, the clip 10 is sandwiched between the removal loop portions 4.

After the body tissue BT is released from being gripped by the clip body 11, the removal loop portion 4 is continuously pulled into the sheath 2, so that the clip body 11 has an opening 43 on the tip side of the removal loop portion 4, as shown in FIG. It is sandwiched and held by the streak portion 43a forming the tip end side opening 43 of the removal loop portion 4 and the tip end portion 2a of the sheath 2.

The removed clip 10 can be taken out of the body by pulling out the sheath 2 from the insertion part of the endoscope together with the removal loop part 4 holding the clip 10. When the removal loop portion 4 is taken out of the body and taken out from the sheath 2, the tip side opening 43 expands due to the elastic recovery force of the streak portion 43a forming the tip side opening 43, and the clip 10 is removed from the removal loop portion 4. Stay away from.

<3. Effect of this embodiment>
According to the clip removing device 100 of the present embodiment configured in this way, the clip 10 is arranged on the sheath side of the constricted portion 41 in the opening of the annular removing loop portion 4, and the removing loop portion 4 is pulled into the sheath 2. Only by itself, the gripping of the internal tissue by the clip body 11 can be released. Here, by pulling the removal loop portion 4 into the sheath 2, the clip main body 11 is tightened by surrounding the entire circumference with the tip portion 2a of the sheath 2 and the removal loop portion 4 (particularly the constricted portion 41). Regardless of the direction of (without adjusting the direction of the removal loop portion 4), the tightening by the tightening ring 12 can be released and the clip body 11 can be moved to the rear side.

Further, after the clip body 11 is released from gripping the internal tissue BT, the clip body 11 is removed and held by being sandwiched between the loop portion 4 and the tip portion 2a of the sheath 2, so that the clip 10 removed from the internal tissue BT is held. Can be taken out of the body without leaving it inside the body.

<4. Other embodiments>
For example, in the above-described embodiment, the removal loop portion 4 has a symmetrical shape in a plan view, but may have an asymmetric shape in a plan view. At this time, the shape may be such that the constriction portion 41 is formed only on one side of the removal loop portion 4.

Further, although the removal loop portion 4 of the above embodiment has a curved shape in a side view, it may have a linear shape in a side view.

Other than that, various embodiments may be modified or combined as long as it does not contradict the gist of the present invention.

According to the present invention, it is possible to reliably release the grip of the internal tissue by the clip body regardless of the orientation of the clip body.

Claims

It has a clip body that expands forward in a natural state, and a tightening ring that elastically deforms the clip body to close it by moving it from the rear side to the front side of the clip body. A clip removal device that removes a clip placed inside the body with the clip body gripping the body tissue by a tightening ring by operating from outside the body.
With a tubular sheath,
An operation wire that is inserted into the sheath so that it can move forward and backward,
It is connected to the tip of the operation wire and has an annular removal loop portion made of a linear elastic body.
The removal loop portion has a constricted portion in which the opening width is reduced, and is elastically deformed by being recessed with respect to the sheath due to the advancement and retreat of the operation wire.
By pulling the removal loop portion into the sheath from the state where the clip is arranged on the sheath side of the constriction portion in the opening of the removal loop portion, the tightening ring is attached to the clip body by using the constriction portion. A clip removing device that is moved to the rear side to release the grip of the internal tissue by the clip body.
A claim that the clip body is sandwiched and held by the removal loop portion and the tip end portion of the sheath by continuously pulling the removal loop portion into the sheath after the clip body is released from gripping the internal tissue. The clip removing device according to 1.
The clip removing device according to claim 1, wherein the pair of streaks forming the constricted portion intersect with each other when the removing loop portion is pulled into the sheath.
The clip removing device according to claim 1, wherein the pair of streaks forming the constricted portion are adjacent to or in contact with each other over a predetermined length in a deployed state in which the removing loop portion protrudes from the sheath. ..
The clip removing device according to claim 1, wherein the tip portion of the removal loop portion has a shape curved in an arc shape in a deployed state in which the removal loop portion protrudes from the sheath.
The clip removing device according to claim 1, wherein the removal loop portion has a curved shape in a side view in a deployed state protruding from the sheath.