JP2001187060A - Clip driving device for operation - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a clip driving device for operation capable of driving a clip for operation into the vicinity of an affected part of a subject to be operated on while grasping the affected part. SOLUTION: A base part 1 is provided with a main pipe 11 having a clip holding part 16 for holding a clip 5. An arm device 4 is provided with clip discharging parts 41f and 42f comprising at least two arms 41 and 42 which are mounted on an end side of the main pipe 11 and for discharging the clip 5, and clip guiding parts 41d and 42d for guiding the clip 5 to the clip discharging parts 41f and 42f along the arms 41 and 42. After an affected part W is grasped by the arms 41 and 42, the clip 5 in the clip holding part 16 is discharged toward the arm device 4, and the clip 5 is guided to the clip discharging parts 41f and 42f along the clip guiding parts 41d and 42d. then, upon discharging from the clip discharging parts 41f and 42f, the clip 5 is driven into the vicinity of the affected part W of the subject to be operated on.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical clip driving device for driving a surgical clip (hereinafter, also simply referred to as a "clip") near an affected part of a surgical object such as a living body.

[0002]

2. Description of the Related Art The prior art will be described by taking an example of endoscopic surgery on an affected part of a living body as an operation target.
In recent years, surgery using an endoscope has been performed. For example, in surgery for removing an affected part of the stomach wall, literature (a new treatment method for early gastric cancer, laparoscopic local gastrectomy by the lesion lifting method, stomach and intestine 28: 1461-1468, 1993)
Year). In this operation, a cylindrical trocar having a hollow portion penetrates the skin into the abdomen of a living body and is inserted from the outside of the abdomen into the inside of the stomach, and a single rod (also called a T-bar) having a thread connected near the center. Is placed inside the stomach from outside the abdomen through the hollow part of the trocar. Next, the thread passing through the hollow portion of the trocar is pulled from the outside of the abdomen of the living body, and the rod is hooked on the stomach wall so that the rod is positioned at approximately 90 ° with respect to the thread. Thereby, the wall near the affected part of the stomach wall is lifted.
In other words, this operation requires one trocar to use one T-bar. Further, in order to pull the thread, the strength of the engaging portion between the rod and the thread and the strength of the thread itself are required. Gas is supplied into the abdomen to form a surgical space between the stomach and the skin.

[0003] With the wall near the affected part of the stomach wall raised as described above, the affected part of the stomach wall is excised and removed with an excision tool such as a scalpel while observing the vicinity of the affected part with an endoscope. After resection, sutures are performed as appropriate.

[0004]

However, the operation using a rod called a T-bar is not always easy, and improvement has been desired.

The present invention has been made in view of the above circumstances, and a surgical clip can be driven into the vicinity of an affected part of a surgical object such as a living body while grasping the vicinity of the affected part of a surgical object such as a living body. It is an object to provide a surgical clip driving device.

[0006]

A surgical clip driving apparatus according to the present invention includes a base having a main pipe having a clip holding portion capable of holding a surgical clip driven near an affected part of a surgical object; A clip detaching portion for detaching a clip from the arm, which is formed of at least two arms openably and closably provided at a distal end side of the main pipe, and a clip held by the clip holding portion to the arm to the clip detaching portion. An arm device that has a clip guide portion for guiding along the arm, and grips the vicinity of the affected part of the operation target with the closing of the arm, an arm opening / closing operation that is provided on the base and opens and closes the arm of the arm device, and a clip holding The clip in the section is discharged toward the arm device and the discharged clip is guided to the clip release section along the clip guide section, One and is characterized in that it comprises a closing-hammering operation unit that performs a clip hammering operation to implant a clip with the withdrawal to the affected area around the surgical object from the clip detachment unit.

According to the surgical clip driving device of the present invention, an arm opening / closing operation for opening / closing the arm of the arm device with the opening / closing / driving operation section is executed. Thus, the vicinity of the affected part of the operation target such as a living body can be gripped by the arm of the arm device.

A clip held in the clip holding portion is discharged toward the arm device by the opening / closing / punching operation portion, and the discharged clip is clipped along the clip guide portion of the arm device. Guide to the detachment part. Further, the clip is detached from the arm device through the clip detaching unit by the opening / closing / punching operation unit, and the clip is driven into the vicinity of the affected part of the operation target with the detachment, thereby executing the clip driving operation.

Since the clip is detached from the arm of the arm device, the clip driving position is near the affected part of the operation target grasped and lifted by the arm device.

The above-described arm opening / closing operation and clip driving operation can be generally performed by manually operating the opening / closing / driving operation section.

[0011] At the time of surgery, the clip driven into the vicinity of the affected part of the operation target is appropriately lifted as needed, thereby lifting the vicinity of the affected part of the operation target together with the clip. If the vicinity of the affected part is lifted in this way, the work of removing the vicinity of the affected part with a cutting tool such as a scalpel becomes favorable. The affected part after resection is sutured as necessary.

[0012] As described above, a typical form of lifting the clip driven into the vicinity of the affected part of the surgical object is as follows.
There is a form in which the vicinity of an affected part of an operation target is lifted by pulling a thread passed through a clip. Further, the clip itself driven into the vicinity of the affected part of the operation target may be held and lifted by the arm of the arm device of the surgical clip driving device according to the present invention.

[0013]

BEST MODE FOR CARRYING OUT THE INVENTION The following embodiments a to s can be adopted as necessary as a surgical clip driving device according to the present invention. However, the surgical clip driving device according to the present invention is not limited to these embodiments.

A: The clips are opposed to each other and can be opened and closed, and the object to be operated (generally a living body) upon closing.
Has a first claw portion and a second claw portion which are inserted in the vicinity of the affected part, and elastic biasing force is accumulated in a direction in which the first claw portion and the second claw portion are closed with opening. In this case, the clip guide portion of the arm device forcibly opens the clip and releases the clip of the arm device so that the elastic biasing force is accumulated in the direction in which the first claw portion and the second claw portion of the clip close. To the department. In this case, if the clip is detached from the arm device via the clip detaching portion, the first and second claw portions of the clip are automatically closed by the elastic urging force accumulated in the clip itself. It is easy to drive a clip near an affected part such as a living body.

B: The clip includes a first plate portion having a first claw portion inserted near an affected part of an operation target (generally, a living body) and a first protrusion projecting in a width direction of the clip. , The second to be inserted near the affected part of the surgical object (living body)
It has a claw portion and a second projecting portion projecting in the width direction of the clip, and also has a second plate portion facing the first plate portion.

C: In the above b, the clip is urged in a direction in which the first plate portion and the second plate portion approach each other.
In this case, if the first plate portion and the second plate portion of the clip are forcibly opened using the arm of the arm device, the clip is elastically moved in the direction in which the first claw portion and the second claw portion close. The biasing force can be accumulated.

D: In the above item b, the arm device has a first arm having a first through hole through which the first plate portion of the clip can penetrate, and a second through hole through which the second plate portion of the clip can penetrate. A second arm. Even when the first plate portion of the clip moves along the first arm, the first plate portion of the clip can penetrate through the first through hole in the thickness direction of the first arm. The same applies to the second plate portion of the clip. Even when the second plate portion moves along the second arm, the second plate portion of the clip is connected to the second arm portion through the second through-hole. Direction.

E: In the above item b, the clip guide of the arm device has a first sliding surface formed on the first arm for sliding the first projection of the clip, and a second sliding surface of the clip formed on the second arm. A second sliding surface for sliding the protrusion.

In this case, the first projection of the clip can easily slide on the first sliding surface of the first arm, and the second projection of the clip can easily slide on the second sliding surface of the second arm. Can slide. Therefore, if the first arm and the second arm of the arm device are open, the first plate portion and the second plate portion of the clip can be forcibly opened. In this case, an elastic biasing force is accumulated in the clip in the direction in which the first and second claws of the clip close. Therefore, when the clip is detached from the arm device, the first and second claws of the clip are closed by the elastic biasing force accumulated in the clip itself, and are automatically inserted near the affected part.

F: The arm device has a function of forcibly opening the clip. In this case, elastic biasing force is accumulated in the clip in the direction in which the claw portion of the clip closes. Therefore, if the clip is detached from the arm device after forcibly opening the clip, the claw portion of the clip can be closed and the clip can be effectively driven near the affected part.

G: The clip release portion of the arm device is the first
A first notch provided in front of the first sliding surface of the arm and penetrating the first projection of the clip, and a first notch provided in front of the second sliding surface of the second arm and penetrating the second projection of the clip. It has two notches.

In this case, if the first projecting portion of the clip passes through the first notch, the first plate portion of the clip passes through the first through hole of the second arm. The second protrusion of the clip is the second
When the clip passes through the notch, the second plate portion of the clip passes through the second through hole of the second arm. As a result, the clip is detached from the arm device.

H: In the above item d, at least one of the first through hole of the first arm and the second through hole of the second arm is openable and closable. A protective lid is provided that closes at least one of the openings and allows the clip to penetrate with the opening.

As long as no external force acts on the protective lid, the protective lid is in a closed state and closes at least one of the first through hole and the second through hole. For this reason, when the clip is guided along the clip guide portion of the arm device, it is possible to prevent the nail portion of the clip from hitting the vicinity of the affected part of the operation target such as a living body. When necessary, the protective lid is opened and the clip can be released from the arm device.

I: The clip holding portion of the main pipe can hold a plurality of clips in series. This makes it possible to continuously drive a plurality of clips into the vicinity of the affected part in a short time, which contributes to shortening of the operation. The number of clips to be held in series can be appropriately selected, and 2 to 10 or 3 to 5 or the like can be adopted, but is not limited thereto. It is preferable to also hold a preliminary clip.

J: The opening / closing / punching operation section includes an arm opening / closing mechanism for opening / closing the arm of the arm apparatus, and discharges the clip in the clip holding section toward the arm apparatus and places the discharged clip along the clip guide section. A clip driving mechanism for performing a clip driving operation of guiding the clip to a clip detaching portion of the arm device and driving the clip near an affected part of an operation target (generally, a living body) with the detachment from the clip detaching portion. ing.

K: In the above j, the arm opening / closing mechanism is
An arm operating mechanism for opening and closing the arm of the arm device, and a manual operating unit for the arm for manually operating the arm operating mechanism are provided.

L: In the above j, the clip driving mechanism discharges the clip in the clip holding portion of the main pipe toward the arm device and clips the discharged clip along the clip guide portion of the arm device. An operating mechanism for a clip that guides to the detaching portion and performs a clip driving operation of driving the clip into the vicinity of an affected part of an operation target (generally, a living body) with the detachment of the arm device from the clip detaching portion; It has a manual operating section for the clip for manually operating the operating mechanism for the clip.

M: The manual operation unit for the arm and the manual operation unit for the clip are independent of each other. In this case,
The operation of grasping the affected part of the surgical object such as a living body near the affected part and the operation of driving the clip into the vicinity of the affected part can be performed independently and separately, which is advantageous in preventing malfunction of clip driving.

N: In the above-mentioned m, after operating the manual operation unit for the arm, the manual operation unit for the clip is configured to be operable. In this case, an operation of driving a clip near the affected part gripped by the arm device can be performed after performing a gripping operation near the affected part of an operation target such as a living body with the arm device, and therefore, a clip driving location This is advantageous in preventing mistakes.

O: An operating mechanism for the arm for opening and closing the arm of the arm device is provided in the main pipe, and is a long body provided so as to be movable along a direction in which the main pipe extends. And a link for opening and closing the arm of the arm device. Even if the main pipe of the surgical clip driving device according to the present invention is long, it can be dealt with.

P: The clip operating mechanism is provided in the main pipe, is provided so as to be able to advance toward the clip holding portion along the direction in which the main pipe extends, and has a plurality of engaging members along the length direction of the main pipe. A ratchet that has a set of teeth in series and pushes out the clip of the clip holding portion toward the arm device as it advances, a ratchet stopper that locks the ratchet locking teeth to prevent the ratchet from retreating, and a ratchet that connects the ratchet to the main pipe. A ratchet pressing body for advancing toward the clip holding section along the length direction.The ratchet pressing body moves the ratchet toward the clip holding section with operation of the manual operating section for the clip, and eventually to the arm device. Press and move forward. When the ratchet is employed in this manner, it is advantageous to prevent the ratchet from retreating due to the latching action of the ratchet, and cannot be reused as described later, and the surgical clip driving device according to the present invention has a disposable structure ( Disposable), prevention of infectious diseases, etc., which is advantageous in terms of hygiene.

Q: The outside of the base is provided with an idling grip that can idle with respect to the base. This makes it possible to adjust the position by appropriately rotating the surgical clip driving device.

R: The arm device, when closed, is substantially straight with the main pipe at the base. The arm device of the surgical clip driving device according to the present invention can be easily inserted into a hollow pipe-shaped trocar.

S: The surgical clip driving device can be used for endoscopic surgery.

The present invention is not limited to the above embodiments as described above.

[0037]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, a first embodiment of the present invention will be described with reference to the drawings.

(Main Structure of the Embodiment) The surgical clip driving apparatus of the present embodiment is for operating on an affected part (for example, a stomach) of a living body which is an operation target in an endoscopic operation. It is also called a gastro clipper that forms a shape. The surgical clip driving device is mounted on the base 1 that constitutes the main body of the surgical clip driving device as shown in FIGS. 1 and 2, and on the distal end side of the base 1 as shown in FIGS. An openable and closable arm device 4 and, as shown in FIGS. 1 and 2, an opening and closing and hammering operation unit 3 for performing an opening / closing operation of the arm device 4 and a hammering operation of hammering the clip 5 into an affected part of a living body
With

First, the base 1 will be described. As shown in FIG. 1, the base 1 has a gun-shaped body 10 and a long main pipe 11 formed of a straight cylindrical pipe solidified at a tip 10 c of the body 10. The tip 10c of the body 10 and the other end 11a of the main pipe 11 are provided with an idling grip 19 which is provided so as to be able to spin along the circumferential direction of the main pipe 11 with respect to these. The idling grip 19 is composed of a plurality of rotating rings 19a arranged side by side along the axial length direction of the main pipe 11, and a connecting portion 19c connecting the rotating rings 19a.

As shown in FIG. 1, a cylindrical storage having a rectangular cross section functioning as a clip holding portion for storing a plurality of (five in the embodiment) clips 5 in series is provided at the distal end side of the main pipe 11. A pipe 16 is held. The rear end 16a of the storage pipe 16 is fixed in the main pipe 11 with a stopper 16p. The stopper 16p also fixes in the main pipe 11 a ratchet stopper 13 having a resiliently deformable claw shape projecting inward of the main pipe 11 in a radial direction. As shown in FIG. 4, the distal end 16c of the storage pipe 16 is fixed by a shaft 41c for pivotally supporting a first arm 41 described later. As shown in FIG. 4, a cap 18 for mounting the arm device 4 is held on the tip 11 c side of the main pipe 11. The cap 18 is for mounting the arm device 4 described later.

As shown in FIGS. 9A and 9B, a clip 5 is attached to the distal end side of the storage pipe 16, that is, the arm device 4 side.
A clip guide 16x functioning as a second clip guide portion for guiding the opening in the opening direction is fixed. The clip guide 16x has a triangular cross section, and has a pair of inclined guide surfaces 16s that become wider toward the tip of the arm device 4.

Next, the opening / closing and driving operation section 3 will be described. As shown in FIG. 1, the opening / closing / driving operation unit 3 has a manual operation unit 2 provided on the base unit 1 for the surgeon to manually operate the surgical clip driving device according to the present embodiment. As can be understood from FIG.
An arm lever 22, which functions as a manual operation unit for arm opening / closing operation, that is, an arm, and a clip lever 24, which functions as a manual operation unit for clip driving operation, that is, for a clip.

The arm lever 22 has a shaft 22
In FIG. 1, the return spring 26, which is a torsion coil spring that is rotatably supported in the directions of the arrows A1 and A2 and functions as biasing means, is always biased in the clockwise direction in FIG. Have been. The arm lever 22 is provided with a rotation stopper 27 provided on the body 10.
Can be brought into contact with each other, and the rotation is limited by the contact. The arm lever 22 is placed on the body 1 against the return spring 26 by the operator placing his / her finger on the grip surface 22b.
It can be gripped in the direction of the zero grip 10e, that is, in the direction of arrow A1. The other end 22c of the arm lever 22
Is a pin 23x on one end 23b of the arm link lever 23.
Are connected by The arm link lever 23 is pivotally supported on the body 10 by a shaft 23a so as to be rotatable in the direction of arrow B1 and in the opposite direction. The other end 2 of the arm link lever 23
3c is a spherical rear end 32a of the arm rod 32 described later.
Are rotatably connected to the The spherical rear end 32a can function as a spherical axis. By being gripped by the operator, the arm lever 22 is rotated counterclockwise, that is,
When the arm link lever 23 rotates about the center 2a,
Rotates clockwise around the shaft 23a, that is, in the direction of arrow B1, and operates to pull the spherical rear end 32a of the arm rod 32 toward the body 10, that is, in the direction of arrow D1.

A space P around the connecting portion between the arm link lever 23 and the rear end 32a of the arm rod 32 is provided for allowing vertical movement with the rotation of the arm link lever 23.
1 is provided. Therefore, although the other end 23c of the arm link lever 23 moves up and down, the rear end 32a of the arm rod 32 operates horizontally without moving up and down.

As shown in FIG. 1, the hook 22d of the arm lever 22 can be engaged with the hook stopper 21b of the body 10. The hook 22d and the hook stopper 21b function as stoppers that restrain the arm lever 22 in the closed state. Eventually, it functions as an arm stopper that restrains the arm device 4 in the closed state. The hook stopper 21b and the hook 22d can be engaged and disengaged.

As shown in FIG. 1, the clip lever 24
Are arranged in front of the arm lever 22, that is, on the side of the arm device 4.
It is pivotably supported in two directions. Arm lever 22
The hook surface 22d of the clip lever 24 is locked with the hook 22d of the clip lever 24 on the hook stopper 21b of the body 10.
The operator puts his / her finger on b, and grasps in the direction of the grip 10 e of the body 10.

The clip lever 24 is rotated in the direction of arrow F1 on condition that the hook stopper 21b and the hook 22d are locked in order to prevent the clip 5 from being accidentally driven against the intention of the operator. It has a possible structure. That is, by rotating the arm lever 22 in the direction of the arrow A1, the clip 5 can be driven into the vicinity of the affected part while the arm apparatus 4 is closed and the vicinity of the affected part of the living body is gripped by the arm apparatus 4.

As shown in FIG. 1, a U-shaped groove 24x is formed at the other end 24c of the clip lever 24. A pin-shaped groove provided at one end of the clip link lever 25 is formed in the groove 24x. The protrusion 25b is fitted and connected.

As shown in FIG. 1, the clip link lever 25 is connected to the body 10 by arrows G1 and G2 with a shaft 25a.
It is pivotally supported so as to be rotatable in the direction. The other end 25c of the clip link lever 25 is connected to a spring 37 as described later.
And abuts against a flange-shaped rear end 33a functioning as a pressed portion of the pressing pipe 33 urged in the direction of arrow D1.

As shown in FIG. 1, the seat 10s of the body 10
A coil-shaped spring 37 is interposed between the main pipe 11 and the pressing pipe 33 and is arranged coaxially with the main pipe 11 and the pressing pipe 33. Since the spring 37 presses the rear end 33a of the pressing pipe 33, the pressing pipe 33 is constantly urged in the direction away from the arm device 4, that is, in the direction of arrow D1. Therefore, as described above, the rear end 33 a of the flange shape of the pressing pipe 33 always contacts the other end 25 c of the clip link lever 25.

When the clip lever 24 is rotated counterclockwise about the shaft 24a in the direction of arrow F1 by being gripped by the operator, the clip link lever 25 is rotated counterclockwise in the direction of arrow G1 and the pressing pipe 3
3 to push the rear end 33a, push pipe 33 with arrow D2.
It is pushed out of the body 10 in the direction, and is operated toward the arm device 4, that is, in the direction of arrow H1. Note that the clip link lever 25 is set based on the positional relationship between the clip lever 24 and the pressing pipe 33, and may be eliminated depending on the positional relationship. Similarly, the arm link lever 23 is set based on the arrangement relationship between the arm lever 22 and an arm rod 32 described later, and may be eliminated depending on the arrangement relationship.

For convenience of explanation, the clip 5 driven near the affected part of the living body will be described. The clip 2 (made of metal, for example, stainless steel) is driven into the affected part of the living body, has a U-shaped cross section, and has a sharp first claw inserted near the affected part of the living body as shown in FIG. Part 51
And a sharp second claw 5 facing the first claw 51 and being inserted near the affected part of the living body.
3 and a second plate portion 54 facing the first plate portion 52. As shown in FIG. 6, the first plate portion 52 of the clip 5
An ear-shaped first protruding portion 55 protruding outward in the width direction is protruded from the tip of. Similarly, at the tip of the second plate portion 54, an ear-shaped second projecting outward in the width direction is provided.
The protrusion 56 is protruded. Also, as shown in FIG. 6, in a state where the clip 5 is stored in the storage pipe 16, the clip 5 can be advanced along the length direction of the storage pipe 16 along the storage pipe 16 having a rectangular cross section. Have been. First plate portion 52 and second plate portion 5 of clip 5
4 is an arrow M1 due to the elastic biasing force of the clip 5 itself.
The first claws 51 and the second claws 53 are always closed in the directions (directions approaching each other). In FIG. 6, the protrusion width of the first protrusion 55 and the second protrusion 56 of the clip 5 in the width direction is illustrated as a dimension SA. The clip guides 16x are provided on the inner wall surface of the storage pipe 16 so as to face each other, and serve to transfer the clip 5 from the storage pipe 16 to the guide rails 41m and 42m of the arm device 4 as described later. . When the claws 51 and 53 of the clip 5 are closed, as shown in FIG.
The distance between the protrusion 55 and the second protrusion 56 is the dimension MA
It is illustrated as In FIG. 9A, the distance between the widened inclined ends of the inclined guide surface 16s of the clip guide 16x is shown as a dimension MB. Here, since the dimension MB is set to be larger than the dimension MA, when the clip 5 of the storage pipe 16 moves in the direction of the arrow H1 and advances to the clip guide 16x, the first projecting portion 55 of the clip 5 and the 2 The projecting portion 56 contacts the inclined guide surface 16s of the clip guide 16x and the inclined guide surface 1s.
It can slide along a 6 s slope. As a result,
The first plate portion 51 and the second plate portion 52 of the clip 5 are indicated by an arrow M2.
Can be forced to open in the direction. In this case, the elastic biasing force for biasing the clip 5 in the closing direction is applied to the clip 5.
Stored in itself.

Next, the arm device 4 will be described with reference to FIG. The arm device 4 uses a shaft 41c to attach caps 18 provided at the tip of the main pipe 11 to the arrows K2, K2.
A first arm 41 pivotally supported to be openable and closable in one direction;
A second arm 42 is fixed to the cap 18 via a shaft 42c so as not to rotate. As shown in FIG. 4, the second arm 42 extends along the length direction of the main pipe 11 and is arranged in an extended line of the main pipe 11. FIG.
As shown in the figure, the first arm 41 has a first claw portion 41a provided at the distal end in the length direction and protruding inward to grip the vicinity of the affected part of the living body. It is a slit-shaped first through hole 41k extending along the first plate portion 52 of the clip 5 and a back surface formed on the outer side of the first arm 41 in the direction of the arrow K2 which is the opening and closing direction. The groove width SB is set to be larger than the protrusion width SA of the first slide surface 41d and the first protrusion 55 of the clip 5 provided in front of the first slide surface 41d.
Notch 41f for penetrating the first sliding surface 4 and the first sliding surface 4
A first guide rail 41m is formed behind the first sliding surface 41d so as to be inclined with respect to the first sliding surface 41d and guides the clip 5 to the first sliding surface 41d. The first notch 41f functions as a clip detaching portion for detaching the clip 5 from the arm device 4. As shown in FIG. 4, the first sliding surface 41d and the first guide rail 41m are respectively provided on both sides in the width direction of the first arm 41 so as to sandwich the first through hole 41k. The first sliding surface 41d and the first guide rail 41m are provided with a first notch 41f which is a clip detaching portion of the arm device 4.
It can function as a clip guiding unit for guiding the clip 5 up to.

As shown in FIG. 4, the second arm 42 is substantially the same as the first arm 41. The second arm 42 is provided at the distal end in the longitudinal direction and protrudes inward to grasp the affected part of the living body. A claw portion 42a, a second through hole 42k extending along the length direction of the second arm 42 and capable of penetrating the second plate portion 54 of the clip 5, and an outer side of the second arm 42 in the opening and closing direction. The second sliding surface 42d which is the formed rear surface, and the second projecting portion 56 of the clip 5 provided in front of the second sliding surface 42d.
A second notch 42f for penetrating the clip 5 having the groove width SB set to be larger than the protrusion width SA of the second sliding surface 42d, and the clip 5 formed to be inclined with respect to the second sliding surface 42d. Second guide rail 42m for guiding to sliding surface 42d
With The second notch 42f functions as a clip detaching portion for detaching the clip 5 from the arm device 4. As shown in FIG. 4, the second sliding surface 42d and the second guide rail 42m are respectively provided on both sides in the width direction of the second arm 42 so as to sandwich the second through hole 42k. Second
The sliding surface 42d and the second guide rail 42m are connected to the arm device 4
Can function as a clip guiding portion for guiding the clip 5 to the second notch 42f which is a clip detaching portion in.

As shown in FIGS. 7 and 8, on the opposite side of the first sliding surface 41d of the first arm 41 and the second sliding surface 42d of the second arm 42, a protective cover 41g which can be opened and closed, 42
g is arranged by the stopper 41r. Protective lid 41
g and 42g can be opened by rotating inward, that is, in the direction of arrow S1. However, the protective lids 41g and 42g are moved by the spring forces of the protective lids 41g and 42g themselves.
To contact the parts 41t and 42t of the protective cover 41g,
42g is prevented from rotating further outward, that is, in the direction of arrow S2. Thus, the protective lids 41g, 42
Although g has an inward opening property, it has a structure in which it does not open outward, and has a non-return property.

The ear-shaped first protrusion 55 of the clip 5 is
When the notch 41f is penetrated, as shown in FIG.
Is the protective lid 41g due to the elastic biasing force accumulated in itself.
Is opened in the direction of arrow S1, the first penetrating hole 41k is penetrated in the direction of arrow K4, and the first claw 51 of the clip 5 is
It is designed to be inserted nearby. Similarly, when the ear-shaped second protrusion 56 of the clip 5 passes through the second notch 42f, the clip 5 opens the protective cover 42g in the direction of arrow S1 by its own elastic urging force as shown in FIG. 2 penetrates the through hole 42k in the direction of arrow K5, and
The claw 53 is inserted into the diseased part W of the living body.

In this embodiment, as shown in FIG. 7, the claw portions 51 and 53 of the clip 5 are faced and the through holes 41k and 4k are provided.
Since the protective lids 41g and 42g for closing the 2k are provided on the arm device 4, when the clip 5 advances toward the distal ends of the first arm 41 and the second arm 42, the protective lid 41g is closed.
g and 42g protect the vicinity of the diseased part W, and the vicinity of the diseased part W is prevented from being damaged by the sharp claws 41a and 42a of the clip 5. Therefore, the protective lids 41g, 42g
Functions as protection means for protecting the vicinity of the affected part W of the living body when the clip 5 moves.

Next, an arm opening and closing mechanism for opening and closing the arm device 4 will be described. As shown in FIG. 4, the arm opening / closing mechanism includes two parallel rods 3 which are long members internally provided in the main pipe 11 along the length direction of the main pipe 11.
It has an arm rod 32 having 2r, and an arm transmission lever 34 pivotally supported at the tip of a rod 32r of the arm rod 32 via a shaft 32b. The arm transmission lever 34 is pivotally supported by the base end 41x of the first arm 41 by a shaft 34e.

As described above, the spherical rear end 32a of the arm rod 32 is connected to the arm link lever 23 as shown in FIG. 1, and is pulled in the direction of arrow D1 with the operation of the arm link lever 23. As a result, the entire arm rod 32 is pulled in the direction of arrow D1, and the arm transmission lever 34 is pulled in the same direction.
The arm 41 moves in the direction of arrow K1 about the axis 41c (FIG. 1).
(See Reference). That is, the arm device 4 is closed. As described above, the second arm 42 does not rotate. When the arm device 4 is closed in this way, the arm device 4
Since the affected part W of the living body can be grasped by the claw portions 41a and 42a, the affected part W of the living body can be lifted by a desired amount by operating the surgical clip driving device according to the present embodiment.

The operation mechanism for the clip will be described. As shown in FIG. 1, the clip operating mechanism is provided in the main pipe 11 and is provided so as to be able to advance toward the storage pipe 16 which is a clip holding portion along a direction in which the main pipe 11 extends. A ratchet 39 functioning as locking tooth means, and an arrow D1 of the ratchet 39 fixed to the main pipe 11 and locked to the locking teeth 38 of the ratchet 39.
A ratchet stopper 13 that suppresses retreat in the direction, and a pressing pipe 33 that functions as a ratchet pressing body that presses the ratchet 39 and advances in the direction of the arrow H1 toward the storage pipe 16 along the length direction of the main pipe 11. Have. As shown in FIG. 1, the pressing pipe 33 is an elastically deformable locking claw 33 that meshes with the locking tooth 38 of the ratchet 39.
c. The locking teeth 38 of the ratchet 39 are
A plurality of pressure pipes 33 are formed in series along the length direction. The locking teeth 38 have a substantially right-angled triangular shape, and include a locking surface 38a that locks with the locking claw 33c and an inclined surface 3 that allows the ratchet 39 to advance in the arrow H1 direction.
8c.

When the operator grips the clip lever 24 in the direction of arrow F1, the operating force is applied to the clip lever 2.
4, transmitted to the clip link lever 25 and the pressing pipe 33, and the pressing pipe 33 advances in the direction of arrow H1. As a result, the locking claw 33c of the pressing pipe 33 is
The ratchet 39 is advanced in the direction of the arrow H1 to press the locking surface 38a of the locking tooth 38 in the direction of the arrow H1. As a result, the rearmost clip 5 in the storage pipe 16 is pressurized by the piston 39a at the tip of the ratchet 39 so that the arrow H1
Push in the direction. The main pipe 1 in the storage pipe 16
A plurality of clips 5 arranged in series along one length direction are in contact with each other. Therefore, the entirety of the clip 5 in the storage pipe 16 advances in the storage pipe 16 in the direction of arrow H1, that is, toward the arm device 4.

In this state, the ratchet 39 is pushed out in the direction of the arrow H1 by the locking claw 33c of the pressing pipe 33, but the locking surface 38a of the locking tooth 38 of the ratchet 39.
Meshes with the ratchet stopper 13 so that the ratchet 3
9 cannot retreat in the direction of arrow D1. That is, the ratchet 39 is of a one-way movement type that can move forward in the direction in which the clip 5 is pushed out but cannot retreat in the reverse direction.

However, after the clip 5 is pushed out, the pressing pipe 33 is returned in the direction of arrow D1, that is, backward by the urging force of the spring 37, and can be automatically returned to the original position. For this reason, as can be understood from FIG.
3, the clip link lever 25 is pressed by the shaft portion 25a.
, And can be automatically returned to the original position.

As a result, the clip lever 24 moves to the arrow F2.
The clip lever 24 is pushed back in the direction and automatically returned to the original position, so that the operator can operate (grip) the clip lever 24 again. Therefore, when the operator rotates the clip lever 24 in the direction of arrow F1 in the same manner as described above, the clip 5 is gradually pushed out in the direction of arrow H1.

(Usage Pattern and Effect) The usage pattern of the surgical clip driving apparatus according to this embodiment will be described.
First, in FIG. 1, the operator grasps and releases the arm lever 22 in the direction of arrow A1, and
The arm 41 is opened and closed appropriately. As a result, FIG.
As shown in (A), the vicinity of an affected part W such as a stomach of a living body is firstly moved.
The vicinity of the affected area W is gripped a plurality of times by being sandwiched between the first claw 41a of the arm 41 and the second claw 42a of the second arm 42 from outside. At this time, as shown in FIG. 9A, the wall W1 near the diseased part W is bent and overlaps, and has a U-shaped or V-shaped cross section. The first arm 41 and the second arm 42
Since the wall W1 near the affected area W is gripped, as shown in FIG. 9A, the wall W1 is opened in a V-shape corresponding to the thickness of the overlapping wall W1. As described above, gripping the vicinity of the affected area W a plurality of times is performed by holding the clip 5 at an appropriate position near the affected area W.
This is a positioning operation performed to drive the.

In the case of endoscopic surgery, a hollow pipe-shaped trocar is inserted into the abdomen of the living body from outside, though not shown. When inserting the arm device 4 into the trocar, the first arm 41 is closed by the arm lever 22 and the arm device 4 is closed. When the arm device 4 is closed as described above, the main pipe 11 of the surgical clip driving device is substantially aligned with the first arm 41 and the second arm 42. In this state, the surgical clip driving device is inserted from the arm device 4 into the hollow portion of the trocar, and the arm device 4 is inserted into the abdomen of the living body.

As described above, an appropriate position near the affected part W such as the stomach of a living body is held between the first arm 41 and the second arm 42 from outside. In this state, the arm lever 22
The arm lever 22 is held at a gripped position by engaging the hook 22d with the hook stopper 21b.
That is, the arm device 4 is closed to close the wall W1 near the affected part W of the living body.
While holding it.

Thereafter, when the surgeon grasps and releases the clip lever 24, the clip 5 stored in the storage pipe 16 gradually moves toward the arm device 4 with the arrow H1.
The outlet 1 at the end of the storage pipe 16.
It is discharged from 6w. As shown in FIG. 9A, the dimension MB of the clip guide 16x is set larger than the dimension MA of the clip 5. Therefore, when the clip 5 advances to the clip guide 16x, the first protrusion 55 and the second protrusion 56 of the clip 5 come into contact with the inclined guide surface 16s of the clip guide 16x, and the inclination of the inclined guide surface 16s is reduced. As a result, the first plate portion 51 and the second plate portion 52 of the clip 5 can be forcibly opened in the arrow M2 direction. As a result, the first clip 5
The projecting portion 55 moves to the first guide rail 41m of the first arm 41 of the arm device 4, and further advances in the direction of arrow H3 along the first sliding surface 41d. Similarly, the other second projecting portion 56 of the clip 5 moves to the second guide rail 42m of the second arm 42 of the arm device 4, and advances in the direction of the arrow H3 along the second sliding surface 42d.

Therefore, the clip guide 16x connects the clip 5 in the storage pipe 16 to the first arm 4 of the arm device 4.
1. It functions as a second clip guide for guiding to the second arm 42. The clip guide 16x also functions as a clip initial opening unit that initially opens the clip 5 to guide the clip 5 to the first arm 41 and the second arm 42 of the arm device 4.

As shown in FIG. 9B, the first protrusion 55 of the clip 5 is connected to the first guide rail 41m of the first arm 41.
Similarly, by sliding along the first sliding surface 41d, the second projecting portion 56 of the clip 5 is similarly moved along the second guide rail 42m of the second arm 42 and the second sliding surface 42d. By sliding, the first plate portion 5 of the clip 5
2. The second plate portion 54 can be forcibly and gradually opened in the direction of arrow M2. Thus, the first plate portion 52 of the clip 5,
When the opening angle of the second plate portion 54 increases, the elastic biasing force for moving the claws 51 and 53 of the clip 5 in the closing direction gradually accumulates in the clip 5.

At this time, as can be understood from FIG. 9B, the first elastic biasing force accumulated in the clip 5 causes the first
The direction in which the plate portion 52 and the second plate portion 54 approach each other (arrow M
1), the first protrusion 55 of the clip 5 is in close contact with the sliding surface 41 d of the first arm 41, and the other second protrusion 56 of the clip 5 is
The second sliding surface 42d is in close contact with the second sliding surface 42d. Therefore, unnecessary sliding of the clip 5 during sliding is suppressed.

As described above, the first protrusion 5 of the clip 5
9 (B) and 10 (A) when the slide 5 moves along the first arm 41 and the second protrusion 56 of the clip 5 slides along the second arm 42. The first and second through holes 41g and 42g are
k, since the second through-hole 42k is closed, the nails 51 and 53 of the clip 5 are prevented from damaging the vicinity of the affected part W as described above.

When the first projection 55 of the clip 5 reaches the first notch 41f and the second projection 56 of the clip 5 reaches the second notch 41f, the clip 5 has its own elasticity. 10B, the first plate portion 52 of the clip 5 automatically penetrates the first through-hole 41k, and the clip 51 is urged in the closing direction, that is, the direction of the arrow M1. Second of 5
The plate portion 54 also automatically penetrates the second through hole 42k. As a result, as shown in FIG. 10B, the first claw portion 51 of the clip 5 and the first claw portion 51 of the clip 5 are placed outside the wall W <b> 1 near the affected part W of the living body held by the first arm 41 and second arm 42. The two claws 53 are inserted.

As described above, in this embodiment, the clip 5 is forcibly opened to some extent by utilizing the opening of the arms 41 and 42 of the arm device 4 accompanying the grasping of the affected part W and the affected part of the living body in this state. Since the clip 5 is driven into the W, the insertion force of the first claw 51 and the second claw 53 of the clip 5 into the affected area W is ensured. Therefore, it is possible to prevent the clip 5 from dropping from the affected part W during the operation.

When the clip 5 is driven into the vicinity of the affected part W of the living body, as shown in FIG.
g and 42g are pressed by the clip 5 and automatically opened. Therefore, the clip 5 can pass through the first arm 41 and the second arm 42.

As described above, the first clip 5 is driven. When the surgeon confirms that the first clip 5 has been driven by an endoscope or the like (clip lever 2
The operation force of the hook stopper 21b and the hook 22d are released. Thereby, as can be understood from FIG.
Rotate in two directions to return to the original position.

Thereafter, the position is changed in the vicinity of the diseased part W of the living body, and another position is similarly gripped by the first arm 41 and the second arm 42, and the next clip 5 is gripped near the diseased part W in the gripped state. Into the position.

By repeating these arm operation operation and clip driving operation sequentially, a desired number of clips 5 are driven into a predetermined position near the affected part W of the living body. In normal surgery, three or four clips 5 are used,
The number of clips 5 is five in total for spare use.

After the clip 5 is driven into the vicinity of the affected area W as described above, the rear end 5w formed on the opposite side to the claw portions 51 and 53 of the clip 5 is illustrated, although not particularly shown. The clip 5 is lifted together with the vicinity of the diseased part W using a substantially clip holder (a clip holder). With the vicinity of the diseased part W of the living body lifted in this way, the surgeon resects a predetermined position near the diseased part W with a cutting tool such as a scalpel.

The other clips 5 are sequentially lifted by the clip holder (not shown), and the operator cuts off a predetermined position near the affected part W. Thereby, the affected part W of the living body is removed. The clip 5 driven into the affected area W can be lifted by the surgical clip driving device according to the present embodiment. In this case, there is no need to prepare a separate clip holder, which can reduce costs and improve operability. When the operation is completed, the arm device 4 can be closed and the arm device 4 can be pulled out through the hollow portion of the trocar.

As described above, in the present embodiment, the clip 5 can be sent out and driven into the vicinity of the grasped affected part W after the affected part W of the living body is grasped by the arm device 4. Can be facilitated. That is, the surgical clip driving device according to the present embodiment is
Both the near gripping function and the clip 5 driving function can be achieved.

In the present embodiment, since the storage pipe 16 accommodates a plurality of clips 5 in series, the surgical clip driving device according to the present embodiment does not need to be pulled out of the trocar, and the storage pipe 16 according to the present embodiment can be used. A plurality of clips 5 can be continuously driven while the surgical clip driving device is inserted into the hollow portion of the trocar, which is advantageous for shortening the operation time.

In this embodiment, the clip lever 24 is
Unless it is rotated in one direction, the clip 5 remains stored in the storage pipe 16, and the clip 5 is not exposed to the outside. For this reason, even if the position is adjusted so that the vicinity of the affected part W of the living body is gripped a plurality of times by the opening and closing operation of the arm device 4, the clip 5 is not exposed from the storage pipe 16 at this stage, and the vicinity of the affected part W of the living body is Can be prevented from being damaged by the claw portions 51 and 53 that are the tips of the clip 5.

Generally, surgical instruments are required to be disposable (disposable) from the viewpoint of hygiene in order to prevent infectious diseases and the like. In this regard, in the surgical clip driving device according to the present embodiment, the ratchet 39 is engaged with the ratchet stopper 13 as shown in FIG. 39 can be moved. In other words, the ratchet 39 can push out the clip 5 by the locking action of the ratchet stopper 13, but cannot retreat in the opposite direction (the direction of the arrow H2).
For this reason, after the driving of the clip 5 is completed, the dimension of the storage chamber of the storage pipe 16 in the axial direction remains small, and a new clip 5 cannot be packed again in the storage pipe 16. Therefore, the surgical clip driving device according to the present embodiment is disposable (disposable), which is advantageous in terms of hygiene.

Further, depending on the position where the clip 5 is driven in the vicinity of the affected part W, it is necessary to change the angle of the surgical clip driving device. In this case,
The main pipe 31 is made using the rotation of the idle grip 19.
Is rotated about its central axis P3, the surgical clip driving device can be turned around the central axis P3 of the main pipe 31, and the angle of the surgical clip driving device can be adjusted during the operation. This can facilitate the operation.

As shown in FIG. 1, the pressing pipe 33 and the coil spring 37 are coaxially arranged, and the ratchet 39 for advancing the clip 5 is arranged in the pressing pipe 33. Can be downsized in the radial direction. Therefore, it is advantageous to insert the surgical clip driving device according to the present embodiment into the hollow portion of the pipe-shaped trocar inserted into the abdomen of the living body.

In the present embodiment, the arm rod 32 for opening and closing the arm device 4 is divided into two as shown in FIG. 5, and has two parallel rods 32r. 2
The rods 32r are located in the main pipe 11 and run in parallel on both sides of the storage pipe 16 along the length direction of the main pipe 11. The rod 32r is connected to the arm transmission lever 34 by a shaft 32b, and swings the arm transmission lever 34, and thus opens and closes the first arm 41. Therefore, the driving force for opening and closing the first arm 41 of the arm device 4 is transmitted by the two rods 32r from both sides in the width direction of the first arm 41, so that the bias of the driving force transmission is suppressed, and This is advantageous for smooth opening and closing of one arm 41.

(Embodiment 2) Embodiment 2 is shown in FIG. The second embodiment has basically the same configuration as the first embodiment, and has the same operation and effect. Parts common to the first embodiment are denoted by common reference numerals. In this embodiment, the illustration of the arm device 4 side is omitted. In this embodiment, a method in which the clip lever 24M is pushed out in the direction of the arrow H1, that is, toward the arm device 4 by a direct-acting method, instead of rotating the clip lever 24M, is employed.

Hereinafter, description will be added. Body 1 of base 1
A lever stopper 10v extends in a radially outward direction at a rear portion of the lever. Also in this embodiment, the opening / closing and driving operation unit 3
Has a manual operation unit 2 for an operator to manually operate the surgical clip driving device according to the present embodiment. As can be understood from FIG. 11, the manual operation unit 2 includes a pivotable arm lever 22 that functions as a manual operation unit for opening and closing an arm, that is, an arm that is pivotally supported by the body 10, and a clip operating unit for clip driving. And a direct-acting clip lever 24M that functions as a manual operation unit for clips.

The arm lever 22 is pivotally supported on the body 10 by a shaft 22a in the directions of arrows A1 and A2, and is returned by a return spring 26 which is a torsion coil spring functioning as an urging means. 11
In the clockwise direction, that is, in the direction of arrow A2. The arm lever 22 is designed so that the operator can put his / her finger on the grip surface 22b thereof and grip the arm lever 22 in the direction of the grip 10e of the body 10, that is, in the direction of arrow A1, against the return spring 26. One end 23b of an arm link lever 23 is connected to the other end 22c of the arm lever 22 by a pin 23x. The arm link lever 23 is pivotally supported on the body 10 by a shaft 23a so as to be rotatable in the direction of arrow B1 and in the opposite direction. Arm link lever 2
The other end 23c of 3 is rotatably connected to a spherical rear end 32a of the arm rod 32 described later. When the arm lever 22 is rotated counterclockwise around the shaft 22a in the direction of arrow A1 by being gripped by the operator, the arm link lever 23 is rotated clockwise around the shaft 23a, ie, in the direction of arrow B1. The spherical rear end 32a of the rod 32 is operated to be pulled toward the body 10, that is, in the direction of arrow D1.

As shown in FIG. 11, the hook 22d of the arm lever 22 can be engaged with the stopper 21b of the body 10.

As shown in FIG. 11, the clip lever 24
M is a direct-acting type, is arranged behind the body 10, and can be pushed in the direction of the arrow H1. The clip lever 24M includes a shaft portion 24p extending linearly inserted slidably into a slide hole 10u of the body 10, and a shaft portion 2P.
Handle portion 24r extended in the outer diameter direction at the shaft end of 4p
With When the operator pushes the clip lever 24M in the direction of the arrow H1 so that the handle portion 24r comes into contact with the lever stopper 10v of the body 10, the pressing pipe 33 moves together with the rear end 33a of the arrow H against the spring 37 against the spring 37.
The clip 5 advances in one direction, and the entirety of the plurality of clips 5 (omitted in FIG. 11) advances similarly to the above-described embodiment.

When the pressing operation of the clip lever 24M is released, the pressing pipe 33 is automatically moved in the direction opposite to the arrow H1 direction by the spring 37 until the projection 24m of the shaft portion 24p contacts the stopper portion 10x of the body 10. Retreats to
The clip lever 24M is automatically returned to the original position. Thereby, the return amount of the clip lever 24M is defined. The pushing amount L of the clip lever 24M, which is the distance until the handle portion 24r comes into contact with the lever stopper 10v.
Reference numeral 1 is substantially the same as the length of the clip 5 (omitted in FIG. 11). Therefore, if the clip lever 24M is pushed once until the handle portion 24r of the clip lever 24M contacts the lever stopper 10v of the base 1,
One clip 5 can be driven.

In this embodiment, similarly to the first embodiment, the affected part W of the living body is controlled by the arm device 4 (omitted in FIG. 11).
After grasping the vicinity, the clip 5 can be sent out and driven in the direction of arrow H1 near the grasped affected part W, so that the clip 5 driving operation can be facilitated. That is, the surgical clip driving device according to the present embodiment can achieve both the gripping function near the affected part W and the clip 5 driving function.

(Other Embodiments) In the first embodiment described above, the clips 5 are arranged in series along the length direction of the main pipe 11, but the present invention is not limited to this. Alternatively, the clip 5 may be arranged in the storage pipe 16 in a form having both series and parallel.

In the first embodiment, when a single clip 5 is pushed out, the rotary clip lever 24 is rotated.
Operation was required several times, but the clip lever 2
By changing the ratio of the movement distance of the ratchet 39 to the rotation angle of 4, the clip 5 may be pushed out only by the operation of once gripping the clip lever 24.

Further, the projections 55, 56 of the clip 5
Is to reduce the sliding resistance of the clip 5 by, for example, curving the surface in contact with the clip guide 16x, or by rounding the corners of the projecting portions 55 and 56 of the clip 5, Protruding part 5 of clip 5 at the time of resection and extraction
5 and 56 may be shaped to prevent the body from being caught on other parts of the living body.

The above embodiment is applied to the operation of the stomach wall of a living body, but is not limited to this, and can be applied to the operation of other organs.

The present invention is not limited to the embodiment described above and shown in the drawings, but can be implemented with appropriate modifications as needed without departing from the scope of the invention.

(Supplementary Note) The following technical idea can be understood from the above description.

A first plate having a first claw inserted into the vicinity of the affected part of the living body, and a second claw facing the first claw and inserted into the vicinity of the affected part of the living body;
A surgical clip having a second plate portion facing the plate portion, wherein an ear-shaped first protrusion projecting outward in the width direction is projected from a tip of the first plate portion; An ear-shaped second protruding outward in the width direction is provided at the tip of the second plate portion.
A surgical clip, wherein a projection is projected. The first projecting portion and the second projecting portion are guided to the clip detaching portion along the clip guiding portion of the arm of the arm device.

[0102]

According to the surgical clip driving apparatus of the present invention, the arm opening / closing operation for opening / closing the arm of the arm apparatus by the opening / closing / driving operation section is executed. Thereby, the vicinity of the affected part of the operation target such as a living body can be gripped and lifted by the arm. The clip in the clip holding section is discharged toward the arm device by the opening / closing / punching operation section, and the discharged clip is guided to the clip releasing section along the clip guide section. Further, the clip can be detached from the clip detaching section of the arm device by the opening / closing / punching operation section, and the clip can be driven into the vicinity of the affected part of the operation target such as a living body with the detachment.

[Brief description of the drawings]

FIG. 1 is a side internal configuration diagram of the vicinity of a base of a surgical clip driving device according to a first embodiment.

FIG. 2 is a plan internal configuration diagram illustrating the vicinity of a base of the surgical clip driving device according to the first embodiment and viewed from a direction II in FIG. 1;

FIG. 3 is a side internal configuration diagram near the arm device of the surgical clip driving device according to the first embodiment.

FIG. 4 is a side internal configuration diagram showing an enlarged view of the vicinity of an arm device of the surgical clip driving device according to the first embodiment.

FIG. 5 is an enlarged plan internal configuration diagram showing the vicinity of an arm device of the surgical clip driving device according to the first embodiment.

FIG. 6 is a sectional view taken along the line VI-VI of FIG. 4;

FIG. 7 is a diagram showing a state where the vicinity of an affected part of a living body is grasped by a first arm and a second arm of the arm device.

FIG. 8 is a diagram showing a state where a clip is driven from an arm device near an affected part of a living body gripped by a first arm and a second arm.

FIG. 9 is a view showing each state in which a clip discharged from a storage pipe is driven into the vicinity of an affected part of a living body using a first arm and a second arm of an arm device.

FIG. 10 is a diagram showing each state in which a clip discharged from a storage pipe is driven into the vicinity of an affected part of a living body using a first arm and a second arm of an arm device.

FIG. 11 is a side internal configuration diagram of the vicinity of a base of the surgical clip driving device according to the second embodiment (parts of an arm device and the like are not shown).

[Explanation of symbols]

In the figure, 1 is a base, 11 is a main pipe, 16 is a storage pipe (clip holding section), 16x is a clip guide (second clip guide section), 3 is an opening / closing / punching operation section, and 22 is an arm lever (for an arm). , 24 and 24M are clip levers (manual operation parts for clips), 32 is an arm rod, 33 is a pressing pipe (ratchet pressing body), 3
9 is a ratchet, 4 is an arm device, 41 is a first arm,
41d is the first sliding surface (clip guide portion), 41m is the first sliding surface.
A guide rail (clip guide portion), 41f a first notch (clip detaching portion), 42 a second arm, 42d a second sliding surface (clip guide portion), 42m a second guide rail (clip guide portion), 42f is a second notch (clip detaching portion),
41g and 42g are protective lids, 5 is a clip, 51 is a first
A claw portion, 52 indicates a first plate portion, 53 indicates a second claw portion, 54 indicates a second plate portion, 55 indicates a first protrusion, and 56 indicates a second protrusion.

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Naoyuki Higashi 70, Ikegami, Iragami, Hata-gun, Aichi Prefecture, Japan 70 Aikan Kiko Co., Ltd. Address 6 Aisin Kiko Co., Ltd. F term (reference) 4C060 DD31 DD50 EE30 GG21 GG40

Claims (7)

[Claims] 1. A base having a main pipe having a clip holding portion capable of holding a surgical clip driven into the vicinity of an affected part of an operation target, and at least two parts provided at the tip side of the main pipe so as to be openable and closable.
An arm having a clip releasing portion for releasing the clip from the arm and a clip guiding portion for guiding the clip held by the clip holding portion along the arm to the clip releasing portion; An arm device that grips the affected part of the surgical object near the affected part with the closing of the arm, an arm opening / closing operation that is provided on the base and opens and closes the arm of the arm device, and discharges and discharges the clip in the clip holding unit to the arm device An opening / closing / driving operation unit for guiding the clip along the clip guiding unit to the clip detaching unit, and performing a clip driving operation of driving the clip into the vicinity of the affected part of the operation target with the detachment from the clip releasing unit. A surgical clip driving device, comprising: 2. The surgical operation according to claim 1, wherein the base has a second clip guide for transferring the clip held by the clip holder to the clip guide of the arm device. Clip driving device. 3. The clip according to claim 1, wherein the clips are opposed to each other and openable and closable.
The clip device has a claw portion, and elastic biasing force is accumulated in a direction in which the first claw portion and the second claw portion are closed with opening, and the clip guide portion of the arm device includes a first claw portion and a second claw of the clip. A surgical clip driving device characterized in that a clip is opened and guided to a clip detaching portion of an arm device so that an elastic biasing force is accumulated in a direction in which the portion is closed. 4. The clip according to at least one of claims 1 to 3, wherein the clip has a first claw inserted into the vicinity of the affected part of the operation target and a first projection protruding in the width direction of the clip.
A first plate portion having a projecting portion, a second claw portion to be inserted in the vicinity of the affected part of the operation target, and a second projecting portion projecting in the width direction of the clip, and facing the first plate portion. A first arm having a first through hole through which the first plate portion of the clip can penetrate, and a second through hole through which the second plate portion of the clip can penetrate. A clip guide portion of the arm device, a first sliding surface formed on the first arm for sliding the first protrusion of the clip, and a clip guide portion formed on the second arm. A second sliding surface for sliding the second projecting portion of the clip. The clip detaching portion of the arm device is provided in front of the first sliding surface of the first arm, and the first projecting portion of the clip is provided. A first notch for penetrating the second arm, and a cutout provided in front of the second sliding surface of the second arm. Surgical clip hammering device, characterized in that the second and a notch for passing the second protrusion-up. 5. The first through hole according to claim 4, wherein at least one of the first through hole of the first arm and the second through hole of the second arm is openable and closable, and is closed and closed. And a protective lid for allowing at least one of the two to be closed and allowing the clip to penetrate with the opening. 6. The surgical clip driving device according to claim 1, wherein the clip holding portion of the main pipe can hold a plurality of clips in series. 7. The at least one of claims 1 to 6, wherein the opening / closing / punching operation section comprises: an arm opening / closing mechanism for opening / closing an arm of the arm device; and discharging the clip in the clip holding portion toward the arm device. Guide the ejected clip along the clip guide to the clip release portion of the arm device, and
A clip driving mechanism for performing a clip driving operation of driving a clip into the vicinity of an affected part of an operation target in accordance with detachment from a clip detaching portion.