# Patent

## Title
Clip unit, ligation device using the same, and method for fabricating the clip unit

## Abstract

A clip unit includes: a clip body having a pair of arm parts; and a fastening ring arranged in the outside of the clip body and configured to maintain the arm parts in the closed state, in which the clip body includes a connection base section connecting the base end side of the pair of arm parts, and a connection tail section provided on the connection base section to extend opposite to the arm parts and connected to the front end of a transmission member, and the connection base section has a flat part perpendicular to the axial direction of the fastening ring, and the arm parts and the connection tail section are connected on a side of the flat part.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is based on and claims priority under 35 USC 119 from Japanese Patent Application No. 2011-202023 filed on Sep. 15, 2011; the entire content of which is incorporated herein by reference.
BACKGROUND OF THE INVENTION
1. Technical Field
The invention relates to a clip unit, a ligation device using the same, and a method for fabricating the clip unit.
2. Related Art
In general, a ligation device for an endoscope includes a clip unit configured to ligate a biological tissue and located at a front end of an elongated flexible sheath extending from a handle manipulation unit. The clip unit ligates a biological tissue from a desired direction by manipulating a manipulation wire inserted through the sheath to be reciprocated in the axial direction of the sheath and to be rotated around the axial direction of the sheath from the handle manipulation unit. Finally, by strongly pulling the manipulation wire to the handle manipulation side, the clip unit is detained in a body cavity in the state where the clip unit grips the biological tissue.
An example of this type of ligation device is configured to fracture a part of the clip unit when releasing the connection between the clip unit and the hook of the manipulation wire. However, since fine fragments produced due to the fracture may be scattered into the body cavity, various clip units have been proposed which are configured to release the connection by plastic deformation of the clip body or elastic deformation of the hook side (see, for example, Patent Document 1 (JP-A-2009-66226) and Patent Document 2 (JP-A-2002-360591)).
The clip disclosed in Patent Document 1 has a construction in which a hook is engaged with a claw part protruding from the base end side of the clip body which is formed by bending a plate material, and when the engagement is released, the claw part is plastically deformed. In addition, the clip disclosed in Patent Document 2 has a construction in which a hook of a slitting structure is engaged with a connection hole opened in the base end side of the clip body, and when the engagement is released, the hook is deformed by the connection hole to be disengaged from the connection hole.
SUMMARY OF THE INVENTION
However, in the clip of Patent Document 1, since the axial cross-section in the base end side of the clip body has a rectangular shape with one side of which is opened, a torsional component is applied to the deformation of an arm part by a tensile force at the time of releasing the engagement. Due to this, the ligation condition at the front end side of the arm part may be changed. In addition, in the clip of Patent Document 2, since a large force may be loaded to the clip body when releasing the engagement, there is a concern that the front end side of the arm part of the clip may be deformed. As such, when releasing the connection between the clip unit and the hook of the manipulation wire, an unexpected force may be applied to the clip unit such that the ligation condition may be changed or the clip may be damaged.
Accordingly, an object of the present invention is to provide a clip unit configured such that even if a large force is applied when releasing the connection between a clip unit and a hook of a manipulation wire, the connection tail section side and the arm part side of the clip unit do not affect each other, and ligation can always be stably performed. Also provided is a ligation device using the same, and a method of fabricating the clip unit.
(1) According to an aspect of the invention, a clip unit that ligates a biological tissue and is configured to be attached to a front end of a transmission member for transmitting a driving force, the clip unit includes:
a clip body having a pair of arm parts; and
a fastening ring arranged in an outside of the clip body and configured to maintain the arm parts in a closed state,
in which: the clip body includes a connection base section connecting a base end side of the pair of arm parts, and a connection tail section provided on the connection base section to extend opposite to the arm parts and connected to a front end of the transmission member; and
the connection base section has a flat part perpendicular to the axial direction of the fastening ring, and the arm parts and the connection tail section are connected on a side of the flat part.
(2) According to another aspect of the invention, a ligation device includes:
the clip unit of (1);
a flexible sheath member of an elongated shape; and
a manipulation unit configured to transmit the driving force to the transmission member, the manipulation unit being arranged on a base end side of the sheath member opposite to a front end side thereof where the clip unit is supported.
(3) According to another aspect of the invention, a method of fabricating the clip unit includes:
punching a contour of the clip body from a band-shaped plate material in a state where a fixing runner is connected to the connection base section;
bending the clip body while supporting the connection base section with the fixing runner; and
separating the fixing runner from the connection base section.
With the clip unit and a ligation device using the same, even if a large force is applied when releasing the connection between the clip unit and the hook of the manipulation wire, the arm part side and the connection tail side of the clip unit do not affect each other and ligation can always be performed stably. In addition, with this method of fabricating the clip unit, since the clip body is continuously processed by a plurality of processing steps, it is possible to efficiently fabricate the clip body.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 illustrates an entire configuration of a ligation device for describing an exemplary embodiment of the present invention.
FIG. 2 illustrates the configuration of a clip unit partially in cut-away.
FIG. 3 is an exploded perspective view of the clip unit illustrated in FIG. 2.
FIGS. 4A and 4B are a side view and a front view of the clip body, respectively.
FIG. 5 is a bottom view of the clip body seen from the direction indicated by arrow V1 in FIG. 4B.
FIGS. 6A and 6B are a side view and a front view of the front end side of an inner fastening ring, respectively, and FIG. 6C is the side view of the rear end side of the inner fastening ring.
FIG. 7 is a cross-sectional view taken along line A-A in FIG. 6B.
FIG. 8A is a perspective view illustrating a state where the clip body and the inner fastening ring are engaged with each other without showing an outer fastening ring, and FIG. 8B is a cross-sectional view taken along line B-B in FIG. 8A.
FIGS. 9A and 9B are a side view of the front end side of the outer fastening ring, and a front view thereof, respectively.
FIG. 10 is a cross-sectional view taken along line C-C in FIG. 9A.
FIG. 11 is a cross-sectional view illustrating the outer fastening ring and the inner fastening ring in the state where they are engaged with each other.
FIG. 12 is a cross-sectional view of the handle manipulation unit of the ligation device.
FIG. 13 is an enlarged cross-sectional view of the front end part of the manipulation unit body and an area in the vicinity of the front end part of the slitting section illustrated in FIG. 12.
FIG. 14 is an exploded perspective view of a manipulation wire anchor for anchoring the manipulation wire to a slider.
FIG. 15 is a sectioned perspective view of the slider body.
FIG. 16 is a cross-sectional view of a front end sheath.
FIG. 17 is a front view illustrating the hook and the guide bead which are fixed to the front end of the manipulation wire.
FIG. 18 is a cross-sectional view taken along line D-D in FIG. 17.
FIG. 19 is a perspective view illustrating, partially in cut-away, a state where the clip body and the hook are engaged with each other.
FIG. 20 is a perspective view of a clip case.
FIG. 21 is an exploded perspective view of the clip case.
FIG. 22 is a side view of the clip case.
FIGS. 23A to 23D are explanatory views illustrating a sequence of mounting the clip unit in the clip case to the hook.
FIG. 24 is an enlarged view of the part indicated by arrow A3 in the bottom case of FIG. 23A.
FIG. 25 is a perspective view of the part indicated by arrow A3 in the bottom case of FIG. 23A.
FIGS. 26A to 26C are explanatory views illustrating the hook from the state where the hook is inserted into the connection tail section of the clip body to the state where the hook is connected to the connection tail section in a step-by-step manner.
FIG. 27 is an enlarged explanatory view illustrating a state where the flap parts are being closed;
FIG. 28A is an explanatory view illustrating a state where the clip body and the outer fastening ring are connected with each other, and FIG. 28B is an explanatory view illustrating the front end sheath curved in the connected state of FIG. 28A.
FIG. 29 is an explanatory view illustrating a configuration example in which the guide bead is replaced by a guide spring.
FIG. 30 is an explanatory view illustrating a configuration example in which a guide bead is arranged at the rear end of the guide spring.
FIGS. 31A to 31F are explanatory views illustrating states where the arm parts of the clip unit are expanded from the front end sheath.
FIGS. 32A to 32E are explanatory views illustrating the actions of the arm parts of the clip unit from expanding after having protruded to the outside from the front end sheath to ligating a biological tissue, in a step-by-step manner.
FIG. 33A is an explanatory view illustrating the appearance of an expansion retaining protrusion of the inner fastening ring entering into the slit part in the base end section, and FIG. 33B is an explanatory view illustrating the appearance of the expansion retaining protrusion abutting against the front end of the slit part.
FIG. 34 is an explanatory view illustrating a rotation operation of the manipulation unit body in relation to the finger pull ring.
FIG. 35 is an explanatory view illustrating a disengagement prevention protrusion of an arm part locked by a stepped part formed by a constricted spot of the outer fastening ring.
FIG. 36 is a view shown in the direction indicated by arrow V2 in FIG. 35.
FIG. 37 is an explanatory view illustrating, partially in cut-away, a state where the clip unit has completed the ligation.
FIGS. 38A and 38B are explanatory views illustrating the hook and the connection tail section in the state where the hook and the connection tail section are engaged with each other, and in the state where the hook and the connection tail section is started to be disconnected, respectively.
FIGS. 39A to 39C are explanatory views illustrating a process of releasing the J-shaped claw parts from the engagement in a step-by-step manner.
FIG. 40A is a partial configuration view of a connection tail section formed with a pair of engagement claw parts, and FIG. 40B is a bottom view of FIG. 40A.
FIG. 41A is a partial configuration view of a connection tail section with an engagement claw part arranged in an opening formed in an arm part, and FIG. 41B is a bottom view of FIG. 41A.
FIG. 42 is an explanatory view illustrating a construction in which a reinforcement rib is provided to extend in the longitudinal direction of each of the arm parts with a bending point of the arm part as the center.
FIG. 43 is a cross-sectional view taken along line E-E of FIG. 42.
FIG. 44 is a plan view in the step of punching the contour of the clip body while leaving fixing runners.
FIG. 45 is an explanatory view schematically illustrating a construction of a press apparatus for sequentially performing a punching process, various bending processes, etc. for a band-shaped plate material to fabricate the clip body.
FIGS. 46A to 46F are explanatory views illustrating processing sequentially performed in individual processing stages.



DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION
Now, exemplary embodiments of the present invention will be described with reference to drawings.
FIG. 1 is an entire configuration view illustrating a ligation device as a medical treatment instrument for describing an exemplary embodiment of the present invention.
A ligation device 100 includes a clip manipulation device 11 which is loaded with a clip unit 13. The clip manipulation device 11 includes a front end sheath 15 configured as an insertion part to be inserted into a channel of an endoscope (not shown) to be inserted into a body cavity, and a handle manipulation unit 17 located at the base end side of the front end sheath 15. The front end sheath 15 and the handle manipulation unit 17 are interconnected by abuse end sheath 19, and a manipulation wire 21 is inserted through the inside of the front end sheath 15 and the inside of the base end sheath 19 to be capable of being reciprocated in the axial direction.
The front end sheath 15 and the base end sheath 19 are configured as a guide tube formed by, for example, a densely wound stainless steel coil. The manipulation wire 21 is formed by a stranded metal wire with a proper elasticity, such as, for example, a stainless steel and a NiTi alloy. In addition, to the front end of the manipulation wire 21 which is opposite to the handle manipulation unit 17, a hook 23 and a guide bead 25 are fixed in this order from the front end.
The clip unit 13 includes a fastening ring 26 formed as a cylindrical body, and a clip body 27 supported in the fastening ring 26, and the fastening ring 26 is mounted on the hook 23 provided at the front end of the manipulation wire 21.
The handle manipulation unit 17 includes: a manipulation unit body 33 to which the base end side of the base end sheath 19 is fixed to be rotatable about the axis thereof; a slider 35 connected to be restrained from being rotated in relation to the manipulation wire 21; and a finger pull ring 37 provided at the rear end of the manipulation unit body 33 to be rotatable. The slider 35 is arranged to be restrained from being rotated in relation to the manipulation unit body 33 but to be capable of reciprocating in the axial direction of the sheath.
The handle manipulation unit 17 is capable of reciprocating the clip unit 13 connected to the manipulation wire 21 at the front end of the front end sheath 15 in the axial direction of the sheath by relatively moving the manipulation unit body 33 and the slider 35 in a longitudinal direction. In addition, by rotating the manipulation unit body 33 and the slider 35 around the axis thereof, the clip unit 13 connected to the manipulation wire 21 is allowed to be rotated about the sheath axis.
That is, the clip manipulation device 11 is configured such that, when the slider 35 is moved away from the finger pull ring 37, the manipulation wire 21 is moved in the direction for making the manipulation wire 21 protrude forward from the front end sheath 15, and to the contrary, when the slider 35 is moved toward the finger pull ring 37, the manipulation wire 21 is moved in the direction for making the manipulation wire 21 be pulled into the front end sheath 15. In addition, when the manipulation unit body 33 and the slider 35 are rotated around the axis, the manipulation wire 21 is rotated together with the slider 35. The clip unit 13 loaded in the front end side of the manipulation wire 21 is maintained in the state in which it is restrained from being rotated by the hook 23, which will be described later. Accordingly, the clip unit 13 is released by the extension of the manipulation wire 21, and rotationally driven by the rotation of the manipulation wire 21.
The manipulation wire 21 is capable of using an appropriate wire which may readily transmit the rotation of one end thereof to the other end. For example, even a torque wire may be used which is difficult to produce rollover. In addition, a cable obtained by wire-drawing a stainless steel may be also used.
In the following description, a direction directed toward the finger pull ring 37 of the handle manipulation unit 17 of the ligation device 100 is referred to as a base end direction or rear side, and a direction directed toward the front end of the clip body 27 is referred to as a distal end direction or front side. In addition, the axial direction of the fastening ring 26 of the clip unit 13, as well as the axial direction of the front end sheath 15, the base end sheath 19, and the manipulation wire 21 will be referred to as a longitudinal axis direction.
<Clip Unit>
Next, the configuration of the clip unit 13 will be described in detail.
FIG. 2 is a configuration view illustrating, partially in cut-way, the clip unit, and FIG. 3 is an exploded perspective view of the clip unit. The clip unit 13 includes a fastening ring 26 and a clip body 27. The fastening ring 26 is constituted with an outer fastening ring 29 formed as a cylindrical body, and an inner fastening ring 31 inserted into the inside of the cylindrical body of the outer fastening ring 29.
The clip body 27 includes: a pair of arm parts 39, 39 which are expanded and biased in relation to each other; a base end section 41 formed in a loop shape for interconnecting the base ends of the arm parts 39, 39; a connection tail section 43 formed on the base end section 41 at the side opposite to the pair of arm parts 39, 39 (at the rear side). The arm parts 39, 39 may be closed to each other when inserted into the fastening ring 26, so that a biological tissue can be grasped by the arm parts 39, 39.
All the clip body 27, the outer fastening ring 29, and the inner fastening ring 31 may be formed from a metallic material, such as a stainless steel. The clip body 27 is formed by bending a band-shaped resilient metallic plate material in a U-shape. The outer fastening ring 29 is a cylindrical member and accommodates the inner fastening ring 31 within the inside thereof. The inner fastening ring 31 includes a pair of flap parts 45, 45 which are configured to be expanded and biased diametrically outward by elastic resilience.
The outer fastening ring 29 is formed with a pair of flap protruding holes 93, 93 at positions corresponding to the flap parts 45, 45 of the inner fastening ring 31, so that when the inner fastening ring 31 is accommodated in the outer fastening ring 29, the flap parts 45, 45 partially protrude radially outward from the flap protruding holes 93, 93.
The clip unit 13 is formed by inserting the base end section 41 and the connection tail section 43 of the clip body 27 into the outer fastening ring 29, which accommodates the inner fastening ring 31, from the front side of the outer fastening ring 29. A hook 23 is engaged with the clip unit 13, in which the hook 23 is provided at the front end of the manipulation wire 21 and inserted into the clip unit 13 from the rear side of the clip unit 13.
<Clip Body>
FIGS. 4A and 4B urea side view and a front view of the clip body, respectively, and FIG. 5 is a bottom view of the clip body viewed in the direction indicated by arrow V1 in FIG. 4B.
The clip body 27 is formed by bending a band-shaped metallic plate material in such a manner that a pair of the arm parts 39, 39, the base end section 41 and the connection tail section 43 are integrally formed. The base end section 41 and the connection tail section 43 extend from the connection base section 40 which has a flat surface (a flat part) which is perpendicular to the longitudinal central axis of the clip body 27. A pair of loop parts 47, 47 extend from the connection base section 40 and abut against each other at the arm part 39 side of the loop parts 47, 47 (loop ends), whereby the base end section 41 is formed in a loop shape in the entirety. The loop parts 47, 47 are arranged symmetrically, and connected to the arm parts 39, 39, respectively, in the side opposite to the connection base section 40.
In addition, “perpendicular” includes “perpendicular” and “substantially perpendicular”.
At the abutting loop ends, one of the loop parts 47, 47 is formed with an engagement hole 49, and the other of the loop parts 47, 47 is formed with a deviation prevention claw 51 for engaging with the engagement hole 49. As the engagement hole 49 and the deviation prevention claw 51 are engaged with each other, the pair of arm parts 39, 39 are prevented from being deviated in the longitudinal axis direction and in the direction perpendicular to the longitudinal axis direction. In addition, each of the loop parts 47, 47 is formed with a slit part 53 along the loop.
The arm parts 39, 39, which are provided to extend further beyond the loop end of the loop parts 47, 47, are formed by band-shaped resilient metallic plate material members which are symmetrically arranged to be opposed to each other. The arm parts 39, 39 include: linear plate parts 57 with a predetermined width in the direction perpendicular to the expanding direction of the arm parts 39, 39; disengagement prevention protrusions 59 which are wider than the linear plate parts 57; middle parts 63, each of which is formed with a pull-in prevention protrusion 61 via a taper part 65; and front end parts 67 configured to be capable of grasping a biological tissue therebetween, in this order from the base end section 41. The arm parts 39, 39 are biased to be expanded from each other with reference to the engagement hole 49 and the deviation prevention claw 51 by the elastic resilience of the clip body 27.
A pair of the arm parts 39, 39 are formed in circular arc shapes with a curvature in such a manner that the linear plate parts 57 are bulging inwardly each other. At the front end sides of the linear plate parts 57, first bending points 64a are provided where the arm parts 39, 39 are bent outward, and in the vicinity of the pull-in prevention protrusions 61 of the middle parts 63, second bending points 64b are provided where the arm parts 39, 39 are bent inwardly. In addition, the arm parts 39, 39 are inwardly bent at third bending points 64c positioned closer to the front end side than the middle parts 63, thereby forming the front end parts 67.
When a pair of the arm parts 39 are opened by the elastic resilience of the clip body 27, the pair of front end parts 67, 67 are largely spaced from each other, thereby forming a grasping gap 69 between the front end parts 67, 67. When the arm parts 39 are closed, the front end parts 67, 67 approach each other to be capable of grasping a biological tissue. In addition, as illustrated in FIG. 4, each of the front ends of the front end parts 67, 67 may be formed to have an obtuse-angled convex part and an obtuse-angled concave part to be engaged with each other, or may have a linear shape.
The connection tail section 43 includes: a pair of plate-shaped arms 71 extending from the connection base section 40 of the base end section 41 in the direction opposite to the pair of arm parts 39; and J-shaped claw parts 73 as engagement claw parts, which are U-turned at the rear ends 71a of the arms 71, respectively, and extend toward the front side (in the direction to the arm parts 39). The pair of arms 71 define a space for accommodating the hook. Each of the J-shaped claw parts 73 is inclined inwardly at the front end 73a in advance, in which the J-shaped claw parts 73 are inclined more inwardly than the arms 71. In addition, each of the arms 71 extending from the connection base section 40 with a predetermined width has a wider part at the central area thereof, and engagement step parts 75 are formed by the wider parts.
As illustrated in FIG. 5, the connection tail section 43 is formed in such a manner that an arm part center line ACL and a connection tail section center line JCL are different in phase by an angle θ (for example, 40 degrees to 70 degrees, preferably 55 degrees to 60 degrees), wherein the arm part center line ACL extends through the center of the pair of arm parts 39 which are provided to extend from the base end section 41, and the connection tail section center line JCL extends through the center of a pair of arms 71 of the connection tail section 43 which are provided to extend from the connection base section 40 of the base end section 41. That is, the expansion direction of the arm parts 39 are determined to intersect the expansion direction of the connection tail section 43 with the angle θ.
In addition, the loop parts 47, 47 of the base end section 41 are connected to the side surfaces of the flat part of the connection base section 40 via constricted spots 50 illustrated in FIG. 5 (see FIG. 8B), respectively. As a pair of the loop parts 47, 47 are connected to the connection base section 40 via the constricted spots 50, external forces applied to the arm parts 39, 39 are retrieved at the constricted spots 50, and deformation is prevented from reaching the connection base section 40 and the connection tail section 43. The constricted spots 50 also prevent external forces from reaching the arm parts 39, 39 from the connection tail section 43.
<Inner Fastening Ring>
FIGS. 6A and 6B are a side view and a front view of the front end side of the inner fastening ring, respectively, and FIG. 6C is a side view of the rear end side of the inner fastening ring. FIG. 7 illustrates a cross-sectional view taken along line A-A in FIG. 6B.
The inner fastening ring 31 includes a ring part 77, and a pair of flap parts 45, 45 extending from a one side end face 77a. The pair of flap parts 45, 45 are formed by slightly expanding free ends 45a from the axial direction at two diametrically outer edge positions on the one side end face 77a of the ring part 77.
On the one side end face 77a to which the flap parts 45, 45 are connected, a pair of recesses 81, 81 are formed, and the engagement step parts 75 of the clip body 27 (see FIG. 4) are engaged in the recesses 81, 81, respectively. In addition, on the front end face 77b of the ring part 77 opposite to the one side end face 77a, an expansion retaining protrusion 55 is formed to protrude from the ring part 77 to an inclined front side facing diametrically inward. The expansion retaining protrusion 55 will be described later.
Each of the flap parts 45, 45 is formed to have a circular arc shape in a diametrical cross-section perpendicular to the axial direction, and is formed with a bulge part 83 opposite to the other flap part 45 at the axially central area thereof, in which the length of the circular arc in the diametrical cross-section is increased at the bulge part 83. The bulge parts 83 are formed with flap locking holes 85, 85, respectively. The inner fastening ring 31 is formed in such a manner that when the flap parts 45 are closed, the outer diameter of the inner fastening ring 31 is substantially equal to or slightly smaller than the inner diameter of the outer fastening ring 29.
The inner fastening ring 31 and the clip body 27 are engaged with each other as follows. FIG. 8A is a perspective view illustrating the assembled state of the clip body and the inner fastening ring without illustrating the outer fastening ring, and FIG. 8B is a cross-sectional view taken along line A-A in FIG. 8A. As shown in FIG. 8A, the connection tail section 43 of the clip body 27 is inserted into the ring part 77 of the inner fastening ring 31 in the P1 direction in FIG. 8A. At this time, as illustrated in FIG. 8B, the engagement step parts 75 of the connection tail section 43 are snugly fitted in the recesses 81 provided in the one side end face 77a of the ring part 77, such that the engagement step parts 75 and the recesses 81 are engaged with each other. Accordingly, even when an attempt is made to pull out the clip body 27 from the inner fastening ring 31 in the P2 direction in FIG. 8A, the engagement step parts 75 and the recesses 81 abut against each other such that they cannot be separated from each other.
<Outer Fastening Ring>
FIGS. 9A and 9B are a side view at the front end side and a front view of the outer fastening ring, respectively, and FIG. 10 is a cross-sectional view taken along line C-C in FIG. 9A.
The outer fastening ring 29 includes a cylindrical section 87, a constricted spot 89 formed by reducing the diameter of the cylindrical section 87 in the vicinity of the front end of the cylindrical section 87, and a taper section 91 extending from the constricted spot 89 in such a manner that the diameter of the taper section 91 is gradually increased as approaching the front end side. The inner diameter of the cylindrical section 87 is slightly larger than the outer diameter of the ring part 77 of the inner fastening ring 31 (see FIG. 6), such that the inner fastening ring 31 is capable of being fitted in the inside of the outer fastening ring 29. In addition, in the cylindrical section 87, a pair of flap protruding holes 93 are formed to be elongated along the axis, wherein the flap protruding holes 93 are arranged opposite to each other. Each longer side 39a forming the periphery of each of the flap protruding holes 93 is formed with flap opening prevention taps 95, 95 substantially at the central areas thereof in such a manner that the flap opening prevention taps 95, 95 protrude toward one another in the circumferential direction of the cylindrical section 87.
As illustrated in FIG. 9A, the inner face of the constricted spot 89 of the outer fastening ring 29 is formed in a substantially oval shape, so that the diameter of the major axis DL and the diameter of minor axis DS are formed in different sizes. Line C-C in FIG. 9A is a line that interconnects the centers of the widths of the flap protruding holes 93, 93 in the circumferential direction, wherein line C-C indicates a central position in the circumferential direction where the flap protruding holes 93, 93 are formed. The line C-C has a slope of a predetermined angle (for example, about 45°), and the flap protruding holes 93, 93 are formed to correspond the phase angle of the connection tail section 43 of the clip body 27.
As illustrated in FIG. 10, an inner diameter step part 97 is formed over the entire circumference of the boundary of the inner peripheries of the cylindrical section 87 and the constricted spot 89. Between the cylindrical section 87 and the constricted spot 89, a pair of planar parts 79 are formed at circumferential positions substantially the same with the flap protruding holes 93, wherein the planar parts 79 gradually reduce the diameter from the outer diameter of the cylindrical section 87 to an outer diameter in the vicinity of the outer diameter of the constricted spot 89 along the axis.
For this reason, the diametrical cross-sectional shape of the area of the planar part 79 between the cylindrical section 87 and the constricted spot 89 has parallel parts formed by the planar parts 79 and circular arc parts formed by the cylindrical section 87. This diametrical cross-sectional shape is similar to the diametrical cross-sectional shape of the ring part 77 (see FIG. 6) of the inner fastening ring 31, and the inner diameter of the outer fastening ring 29 is slightly larger than the outer diameter of the ring part 77 of the inner fastening ring 31.
FIG. 11 is a cross-sectional view illustrating the outer fastening ring 29 and the inner fastening ring 31 in a state where they are engaged with each other.
The outer fastening ring 29 and the inner fastening ring 31 are engaged with each other by inserting the inner fastening ring 31 into the cylindrical section 87 of the outer fastening ring 29 in such a manner that the ring part 77 side is positioned at the forefront. The inner fastening ring 31 is positioned in the axial direction as the front end face 77b of the ring part 77 abuts against the inner diameter step part 97 of the constricted spot 89. In addition, the position of the inner fastening ring 31 in the rotating direction is determined by fitting the planar parts 77c of the ring part 77 of the inner fastening ring 31 in the inner periphery of the parts formed with the planar parts 79 in the outer fastening ring 29, and fitting the ring part 77 of the inner fastening ring 31 in the outer fastening ring 29.
In addition, the flap opening prevention taps 95 of the outer fastening ring 29 are respectively inserted into the flap locking holes 85 provided in the pair of flap parts 45 of the inner fastening ring 31, and the flap opening prevention taps 95 respectively abut against one side 85a of the flap locking holes 85. As a result, the flap parts 45 configured to be expanded by elastic resilience are prevented from being excessively opened by abutting against the flap opening prevention taps 95, and the expansion angle of the flap parts 45 can be securely maintained at a predetermined angle established at the time of design.
In addition, since the maximum outer diameter of the loop parts 47 of the clip body 27 is determined in a size that makes the loop parts 47 abut against the taper section 91 of the outer fastening ring 29, the inner fastening ring 31 and the clip body 27, which are formed integrally with each other, are prevented from being deviated to the rear side in relation to the outer fastening ring 29. Furthermore, the clip body 27 is inseparably engaged with the inner fastening ring 31. For this reason, the clip body 27 and the outer fastening ring 29 will not be deviated from each other by vibration at the time of transportation or the like.
<Handle Manipulation Unit>
FIG. 12 is a cross-sectional view of the handle manipulation unit of the ligation device.
As described above, the handle manipulation unit 17 includes a manipulation unit body 33 to which the base end side of the base end sheath 19 is fixed to be rotatable around the axis, a slider 35, and a finger pull ring 37. The manipulation unit body 33 is provided with a slitting section 99 formed with a slit along the axial direction, and the slider 35 is configured to be movable in the axial direction within the slit forming extension. The slider 35 consists of a slider body 115 and a manipulation wire anchor 113.
FIG. 13 is an enlarged cross-sectional view of the front end part A1 of the manipulation unit body 33 and a part A2 in the vicinity of the front end part of the slitting section 99 illustrated in FIG. 12.
A fixing clasp 107 is provided at the front end of the manipulation unit body 33, wherein a base end sheath 19 with the manipulation wire 21 inserted therein, and an bending prevention spring 111 configured to cover and protect the base end sheath 19 are inserted into the front end part 107a of the fixing clasp 107 along the axis. On the front end of the manipulation unit body 33, a cap 109 is press-fitted.
The manipulation wire 21 fed from the base end sheath 19 is installed to extend from the base end of the fixing clasp 107 toward the slider 35, and the manipulation wire 21 covered by a buckling prevention pipe 117 is inserted through a guide pipe 105 which is arranged in the base end side of the fixing clasp 107. In addition, the buckling prevention pipe 117 is installed to extend to the slider 35, and retains the manipulation wire 21 in a linear shape.
The front end of the buckling prevention pipe 117 is slidably fitted in the guide pipe 105, and when the slider 35 is slid, specifically, when the slider 35 is moved in the direction opposite to the finger pull ring 37, the buckling prevention pipe 117 prevents the occurrence of buckling of the manipulation wire 21, thereby enabling the stable manipulation of the manipulation wire 21.
In the base end side of the guide pipe 105, there are provided an O-ring 103 and a washer 101. The washer 101 is locked by a stepped part 33a of the manipulation unit body 33 to restrain the axial movement of the O-ring 103. The inner diameter of the washer 101 is smaller than the outer diameter of the O-ring 103 to prevent the O-ring 103 from escaping to the rear side. In addition, a gap is provided between the washer 101 and the guide pipe 105, and a gap is also provided between the O-ring 103 and the guide pipe 105.
The buckling prevention pipe 117 is inserted through the guide pipe 105, the O-ring 103 and the washer 101 with a proper gap for enabling the rotation of the buckling prevention pipe 117. The inner diameter of the guide pipe 105 is determined as a size that enables the insertion of the buckling prevention pipe 117, and provides a little clearance for the manipulation wire 21. The guide pipe 105 and the fixing clasp 107 are configured to be rotatable in relation to each other. The inner diameter of the O-ring 103 and the outer diameter of the buckling prevention pipe 117 have a relationship in size such that they are rotatable around the axis, and frictional resistance is produced in the axial direction. The parts depicted by dotted lines in FIG. 13 indicate welded parts.
FIG. 14 is an exploded perspective view of a manipulation wire anchor for anchoring the manipulation wire 21 to the slider 35, and FIG. 15 is a sectioned perspective view of the slider body.
The slider 35 is comprised of a slider body 115 and a manipulation wire anchor 113 configured in a halved structure. The slider 35 is fabricated by combining the manipulation wire anchor 113 with the slider body 115 fitted in the manipulation unit body 33 across the slitting section 99 (see FIG. 12) and press-fitting and fixing the manipulation wire anchor 113 to the slider body 115. The slider body 115 and the manipulation wire anchor 113 combined thereby become slidable along the slitting section 99.
As illustrated in FIG. 14, the manipulation wire anchor 113 consists of a top wire anchor 113a and a bottom wire anchor 113b, each of which is substantially semi-circular. The top wire anchor 113a and the bottom wire anchor 113b have the same shape obtained by halving the manipulation wire anchor 113. Both the anchors 113a and 113b have a recess 121 for accommodating a caulking clasp 119 (illustrated in the drawing as a flat shape after mashed) fixedly attached to the rear end of the buckling prevention pipe 117. The top wire anchor 113a and the bottom wire anchor 113b are combined with each other with depressions 123 and protrusions 125. In addition, the bottom wire anchor 113b has a pair of recesses 127, 127 which are engaged with a pair of latching claws 129, 129 of the slider body 115 illustrated in FIG. 15 to prevent relative rotation thereof as well as to conduct positional alignment thereof.
The buckling prevention pipe, the wire and the caulking clasp are integrated with each other by fitting the buckling prevention pipe 117 over the wire, fitting the caulking clasp 119 over the buckling prevention pipe 117, and then caulking the caulking clasp with a pressing tool or the like. The caulking clasp 119 is turned to a non-circular shape through the caulking process, and its relative rotation in relation to the manipulation wire anchor 113 is blocked. As a result, the buckling prevention pipe 117 is fixed to the manipulation wire anchor 113 together with the manipulation wire 21 inserted through the buckling prevention pipe 117.
When performing manipulation by the handle manipulation unit 17 configured as described above, a thumb is inserted into the finger pull ring 37, and the index finger and the middle finger of the same hand are positioned to grasp the slider 35 therebetween. In addition, in order to rotate the clip unit around the axis, the manipulation unit body 33 is rotated.
The rotation of the manipulation unit body 33 is transmitted to the slider 35 and the manipulation wire 21 from the manipulation unit body 33, as illustrated in FIG. 13. In addition, since the manipulation unit body 33 and the fixing clasp 107 are rotatably fixed, the rotation of the manipulation unit body 33 is not transmitted to the sheaths 19, 15 including the fixing clasp 107. That is, by rotating the manipulation unit body 33, the manipulation wire 21 is rotated but the base end sheath 19 and the front end sheath 15 are not rotated.
<Front End Sheath>
FIG. 16 is a cross-sectional view of the front end sheath. At the base end of the front end sheath 15, the front end part of the base end sheath 19 is welded via a connection ring 131. The inner diameter of the front end sheath 15 is slightly larger than the outer diameter of the outer fastening ring 29 (see FIG. 9), so that the outer fastening ring 29 can be accommodated in the front end sheath 15. The manipulation wire 21 extending from the base end sheath 19 is inserted through the front end sheath 15, and protrudes to the outside toward the front side from the front end sheath 15. At the front end part which is the distal end of the manipulation wire 21, a hook 23 and a guide bead 25 are fixed through soldering or laser welding. As a result, when the slider 35 (see FIG. 12) is slid in the axial direction in relation to the manipulation unit body 33, reciprocating actions are performed following the slide action so as to push the manipulation wire 21 out of the front end sheath 15 to the front side and to return the manipulation wire 21 to the front end sheath 15.
In addition, in the inside of the front end sheath 15 or the base end sheath 19, a retainer coil (a retainer member) 201 is arranged between the front end sheath 15 or the base end sheath 19 and the manipulation wire 21. The retainer coil is formed of a highly wear-resistant hard metal, such as a stainless steel, and is formed in a circular cross-section. By interposing the retainer coil 201 between the inner periphery of the front end sheath 15 or the base end sheath 19 and the manipulation wire 21, the front end sheath 15 or the base end sheath 19 and the manipulation wire 21 do not directly contact with each other and contact with the retainer coil 201 with a small contact area.
For this reason, resistance against the reciprocation of the manipulation wire 21 in the front end sheath 15 or the base end sheath 19 and resistance against the rotation of the manipulation wire 21 may be reduced, and the manipulation wire 21 may be manipulated more smoothly with excellent responsiveness. By determining the hardness of the retainer coil 201 to be substantially equal to that of the manipulation wire 21, the abrasion caused by the sliding movement between the retainer coil 201 and the manipulation wire 21 may be suppressed.
The front end part of the retainer coil 201 is fixedly attached to the guide bead 25, and the retainer coil 201 extends to the handle manipulation unit side. As the retainer coil 201 is arranged in the front end side of the front end sheath where the clip unit is mounted, it is possible to reduce contact resistance in relation to the front end part of the front end sheath which has a lot of opportunities to be curved. For this reason, even if the front end sheath 15 is complicatedly curved, the reciprocation in the axial direction and rotation of the manipulation wire 21 can be smoothly performed. In addition, by fixedly attaching the retainer coil 201 to the guide bead 25, the arranging place of the retainer coil 201 will not be deviated from the front end of the manipulation wire 21.
In addition, the rear end part of the retainer coil 201 is formed as a free end that is not fixed to the front end sheath 15 and the manipulation wire 21. Due to this, the retainer coil 201 becomes extensible within the front end sheath 15, and the rotation of the free end is not restrained. Accordingly, a following performance, such as a curving behavior, can be enhanced.
It is more desirable for the retainer coil 201 to be in a loosely wound condition in which adjacent coil parts are spaced from each other rather than in a closely wound condition in which adjacent coils contact with each other. By forming the retainer coil 201 in the loosely wounded condition, it is possible to further reduce the contact area, thereby further reducing contact resistance. In addition, when cleaning the inside of a sheath, the circulation of cleaning liquid may be facilitated, and the cleaning performance may be improved.
The winding direction of the retainer coil 201 is preferably in a reverse direction to the winding direction for the densely wound coils of the front end sheath 15 and the base end sheath 19. In addition, the winding direction of the retainer coil 201 is preferably in a reverse direction to the winding direction of the stranded wire of the manipulation wire 21. In such a case, it is possible to prevent the retainer coil 201 from penetrating into gaps between strands in the inner surface of a sheath member or gaps between strands of the manipulation wire 21 to increase manipulation resistance. As a result, the twisting characteristics of the retainer coil 201 and the manipulation wire 21 may be averaged to remove unevenness in curving characteristic.
<Hook>
FIG. 17 is a front view of the hook 23 and the guide bead 25 fixed to the front end of the manipulation wire 21, and FIG. 18 is a cross-sectional view taken along line D-D of FIG. 17.
The hook 23 fixed to the front end of the manipulation wire 21 through soldering or laser welding is configured to have the maximum outer diameter smaller than the inner diameter of the outer fastening ring 29 (see FIG. 9) to be capable of being inserted into the outer fastening ring 29. The hook 23 has, from the front end, a hook part 135, an under-head expanded-diameter part (expanded-diameter part) 137, and a rear end expanded-diameter part 139, which are integrally formed. The hook part 135 includes in order from the front end: a front end taper part (front side inclined surface) 141 of which the diameter reduces as approaching to the front side and an under-head taper part (rear side inclined surface) 143 which is formed on the rear side in the axial directions. The sectional area of the front end taper part 141 in the cross-section perpendicular to the axis gradually increases as approaching to the rear side in the axial direction. The sectional area of the under-head taper part 143 in the cross-section perpendicular to the axis gradually reduces as approaching to the rear side in the axial direction. The inclined angle of the under-head taper part 143 is designed as an angle of, for example, 90 degrees to 135 degrees in relation to the axial direction, and deforms the J-shaped claw parts 73 of the connection tail section 43, which is engaged with the under-head taper part 143, to control the magnitude of force when releasing the engagement. The cross-section of the hook 23 is not limited to the circular shape and may have a different shape, such as a pyramid shape or the like.
The under-head expanded-diameter part 137 has front and rear sides, each of which is formed in a taper shape, and a key recess 145 engaged with the J-shaped claw parts 73 provided in the connection tail section 43 of the clip body 27 (see FIG. 4) is formed at a portion of the outer periphery of the under-head expanded-diameter part 137. When the hook 23 and the connection tail section 43 of the clip body 27 are connected, the under-head expanded-diameter part 137 maintains the coaxiality between the hook 23 and the connection tail section 43, and secures the stability of engagement. In addition, the rear end expanded-diameter part 139 includes a small diameter part 147, and a large diameter part 149 formed at the rear end of the small diameter part 147.
<Guide Bead>
The guide bead 25 is spaced from the hook in the rear side of the hook 23 and fixed to the manipulation wire 21 by soldering or laser welding. Since the hook 23 and the guide bead 25 are spaced from each other and fixed to the manipulation wire 21, the manipulation wire 21 may be curved therebetween and the degree of freedom in mutual movement may be improved. At the front end of the guide bead 25, a front end taper part 151 is formed, and at the rear end, a rear end taper part 153 is formed. The front end taper part 151 has an effect of guiding the guide bead 25 into the outer fastening ring 29 to be smoothly inserted into the outer fastening ring 29. The rear end taper part 153 has an effect of guiding the guide bead 25 to the front end sheath 15 to be smoothly accommodated in the front end sheath 15 when the clip unit 13 is pulled into the front end sheath 15.
The rear end taper part 153 is set to have a length that is exposed to the rear side from the rear end of the outer fastening ring 29 when the hook 23 and the clip unit 13 are connected. Due to this, the rear end taper part 153 can be smoothly introduced into the front end sheath 15 without causing the front end part of the front end sheath and the rear end part of the clip unit 13 to be interfered with each other even if the entirety of the clip unit 13 has completely protruded to the outside from the front end sheath.
FIG. 19 is a perspective view illustrating, partially in cut-away, the clip body and the hook in the state where they are engaged with each other.
When the hook 23 and the clip unit 13 are connected, the clip body 27 is restrained in rotating position around the axial direction since the J-shaped claw parts 73 of the connection tail section 43 are engaged in the key recess 145. In addition, the front ends 73a of the J-shaped claw parts 73 are engaged with the under-head taper part 143, thereby determining the axial position of the clip body 27. In this state, since the key recess 145 is engaged with the connection tail section 43 (J-shaped claw parts 73) of the clip body 27, the torque of the manipulation wire 21 can be transmitted to the clip body 27.
<Clip Case>
In the clip manipulation device 11 configured as described above, the clip unit 13 is mounted on the hook 23 provided at the front end of the manipulation wire 21, and a biological tissue is ligated by a pair of the arm parts of the clip unit 13. The clip unit 13 is accommodated in a clip case 161 in advance, which is illustrated in FIG. 20 as a perspective view, and the clip unit 13 is mounted on the hook 23 by inserting the hook 23 at the front end of the manipulation wire 21 into the case from the accommodated state.
An exploded perspective view of the clip case is illustrated in FIG. 21. The clip case 161 is comprised of a top case 163 and a bottom case 165, and is configured by combining the top case 163 and the bottom case 165. The clip unit 13 is located in a clip receiving chamber 167 formed between the top case 163 and the bottom case 165. The top case 163 and the bottom case 165 are integrated by engaging a plurality of engagement claws 171 formed in the top case 163 with claw engagement parts 173 formed in the bottom case 165.
A side view of the clip case is illustrated in FIG. 22. The top case 163 has a sheath press part 169 narrowly formed in the thickness direction. In addition, an anti-slipping uneven pattern 175 is formed on the bottom case 165 at a position corresponding to the sheath press part 169, thereby enhancing a grip performance when the clip case 161 is grasped.
<Mounting of Clip Unit>
A sequence of mounting the clip unit of the clip case to the hook is illustrated in FIGS. 23A to 23D. As illustrated in FIG. 23A, the clip unit 13 is arranged in the clip receiving chamber 167 in advance.
In order to mount the clip unit 13 to the clip mounting device, the front end sheath 15 is firstly inserted into a sheath insertion part 179 from a sheath guide part 177 of the clip case 161, which are illustrated in FIG. 20. In addition, the front end sheath 15 is pushed into the sheath insertion part 179 until the front end of the front end sheath 15 is abutted against the end of the inside of the sheath insertion part 179. In this state, the clip case 161 is gripped in the thickness direction while pressing the front end sheath 15 against the clip case 161 as illustrated in FIG. 22.
The part indicated by arrow A3 of the bottom case 165 in FIG. 23A is illustrated in FIG. 24 as an enlarged view and is illustrated in FIG. 25 as a perspective view, respectively.
As illustrated in FIGS. 24 and 25, the front end of the front end sheath 15 is pushed into the sheath insertion part 179 to a position where the front end abuts against the sheath abutting part 180. Then, the outer fastening ring 29 is positioned such that the taper section 91 of the front end abuts against a fastening ring abutting part 183 in a state where the outer fastening ring 29 is laid in a fastening ring retaining part 181 of a concavely curved shape. As a result, the clip unit 13 is prevented from getting out in the direction indicated by arrow Q in FIG. 24. That is, even if a forward pushing force is applied to the clip unit 13 by inserting the hook, the relative position of the clip unit 13 and the clip case 161 is not changed. For this reason, the clip unit 13 is prevented from coming into contact with and being damaged by the clip case 161.
Since the outer periphery of the outer fastening ring 29 is retained in the fastening ring retaining part 181 corresponding to the outer periphery, the outer fastening ring 29 is precisely retained within the clip case 161, and the outer fastening ring 29 may be arranged without axial deviation. Therefore, the front end part of the front end sheath 15 and the rear end part of the outer fastening ring 29 will not interfere with each other when the front end sheath 15 is inserted into the clip case 161.
In addition, the flap parts 45 of the inner fastening ring 31 come into contact with the flap guide taper part 185 such that the clip unit 13 laid in the clip case 161 is biased to the base end side not to be disengaged. As a result, the clip unit 13 will not escape from the clip case 161 by the self-weight of the clip unit 13, vibration at the time of transportation, and handling of the clip case.
Then, the slider 35 of the handle manipulation unit 17 is moved forward, and the manipulation wire 21 is extended, so that the hook protrudes to the outside from the front end of the front end sheath 15. FIGS. 26A to 26C are explanatory views illustrating the hook from the state where it is inserted into the connection tail section 43 of the clip body 27 to the state where it is connected to the connection tail section 43 in a step-by-step manner. The hook 23 starts to be engaged with the connection tail section 43 as illustrated in FIG. 26A, then the J-shaped claw parts 73 are moved to pass the under-head expanded-diameter part 137 of the hook 23 as illustrated in FIG. 26B, and then the front ends 73a of the J-shaped claw parts 73 are engaged with the under-head taper part 143 of the hook 23 as illustrated in FIG. 26C, thereby completing the connection between the hook 23 and the clip body 27.
Next, the slider 35 of the handle manipulation unit 17 is moved backward to pull the manipulation wire 21 backward. As such, as illustrated in FIG. 23B, the flap parts 45 extending radially outward from the outer fastening ring 29 are closed. FIG. 27 is an enlarged explanatory view illustrating the flap parts while they are being closed. When the manipulation wire 21 is pulled backward, the front ends 73a of the J-shaped claw parts 73 are abutted against the under-head taper part 143 of the hook part 135, whereby the pulling force is transmitted to the clip unit 13. When the clip unit 13 is pulled out to the base end side in relation to the clip case 161, the free ends 45a of the flap parts 45 abut against the flap guide taper part 185 of the clip case 161, thereby gradually reducing the opening extent, and finally closing the opening to the extent of the outer diameter of the outer fastening ring 29.
When the free ends 45a of the flap parts 45 are closed to the outer diameter of the outer fastening ring 29, the clip unit 13 is inserted into the front end sheath 15 as illustrated in FIG. 23C. The force at the time of closing the flap parts 45 is set to be sufficiently smaller than that for deforming and introducing the loop parts 47 of the base end section 41 (see FIG. 4) of the clip body 27 into the outer fastening ring 29. For this reason, the flap parts 45 are securely closed.
In addition, when the flap parts 45 are closed, hook abutments 187 of the flap parts 45 abut against a flap abutting taper part 189 of the hook 23. Due to this abutting of the hook abutments 187, the relative movement between the hook 23 and the inner fastening ring 31 is restrained, and the reciprocating movement by the manipulation wire 21 in the axial direction may be directly transmitted to the inner fastening ring 31. That is, the position for transmitting force from the hook 23 to the clip unit 13 after the flap parts 45 are closed is changed from the engagement position of the J-shaped claw parts 73 and the under-head taper part 143 of the hook 23 to the engagement position of the hook abutments 187 and the flap abutting taper part 189 of the hook 23.
When the manipulation wire 21 is pulled backward, the clip unit 13 is stored in the front end sheath 15 as illustrated in FIG. 23D. When the clip unit 13 is stored, the arm parts 39 of the clip body 27 are guided to the ring part 77 of the inner fastening ring 31 (see FIG. 6) and inserted into the front end sheath 15 while being closed.
As such, the clip unit 13 is mounted to the clip manipulation device 11 illustrated in FIG. 1.
<Manipulation for Ligation>
Next, manipulation for ligating a biological tissue by the ligation device 100 illustrated in FIG. 1 will be described.
(Insertion of Sheath into Forceps Channel)
An operator of an endoscope inserts the front end sheath 15 into a forceps channel which is a treatment instrument insertion passage of the endoscope in a state where the clip unit 13 is stored in the front end sheath 15 of the ligation device 100. In such a case, the connected form of the clip body 27 and the outer fastening ring 29 is changed to a curved state illustrated in FIG. 28B by following the curve of the front end sheath 15 from the linear state illustrated in FIG. 28A. Since the hook 23 and the guide bead 25 are spaced from each other and fixed to the manipulation wire 21, the manipulation wire 21 can be curved between the hook 23 and the guide bead 25, and the degree of freedom in mutual movement can be enhanced.
The outer fastening ring 29 is formed from a hard metal material. For this reason, the longitudinal length of the outer fastening ring 29 determines the facilitation of insertion in relation to the endoscope, and it is desirable that the entire length of the outer fastening ring 29 is short.
As illustrated in FIG. 29, the guide bead 25 may be replaced by a guide spring 191 arranged to the outside of the manipulation wire 21 in the rear side of the outer fastening ring 29. By setting the guide spring 191 is a length that makes the rear end of the guide spring 191 be always inserted into the front end sheath 15 in the entire stroke area of the reciprocating movement of the manipulation wire 21 in the axial direction, it is possible to secure the following performance for curving and a guidance performance to the front end sheath 15.
As illustrated in FIG. 30, a guide bead 25A having a rear end taper part 25a may be provided at the rear end of the guide spring 191A. The guide bead 25A is fixed to the manipulation wire 21 by soldering or welding. The guide spring 191A is arranged to be free between the hook 23 and the guide bead 25A without being biased. With this arrangement, even if the guide spring 191A is set in a length that makes the rear end thereof project from the front end sheath 15, the rear end of the guide spring 191A can be introduced into the front end sheath 15 without interference between the front end 15a of the front end sheath 15 and the guide spring 191A. Accordingly, the following performance for curving and the guidance performance to the front end sheath 15 can be secured and the entire length of the guide spring 191A can be set shortly. Therefore, the flexibility can be further enhanced.
(Clip Protrusion from Front End Sheath)
FIGS. 31A to 31F illustrate the arm parts of the clip unit until they are expanded from the front end sheath.
As illustrated in FIG. 31A, the clip unit 13 protrudes to the outside from the front end of the front end sheath 15 by continuously feeding the manipulation wire toward the front side by manipulation from the handle manipulation unit in the state where the clip unit is accommodated in the front end sheath 15. FIG. 31B illustrates the clip unit 13 when the arm parts 39 start to protrude from the front end sheath 15.
When the clip unit 13 protrudes to the outside from the front end sheath 15, the arm parts 39 are gradually expanded as illustrated in FIG. 31C. Then, when the flap protruding holes 93 of the outer fastening ring 29 completely get out of the front end sheath 15 as illustrated in FIG. 31D, the flap parts 45 are elastically returned from the flap protruding holes 93 and hence individually opened diametrically outward. The flap parts 45 are maintained at a predetermined opening angle where each of the flap opening prevention taps 95 is engaged with one side 85a of each one of the flap locking holes 85 (see FIG. 11).
Then, as illustrated in FIG. 31E, the clip unit 13 further protrudes from the front end sheath until the flap parts 45 are certainly opened, and as illustrated in FIG. 31F, the clip unit 13 is returned to the rear side by pulling the manipulation wire to the base end side. At this time, the free ends 45a of the flap parts 45 are stopped at a position where they abut against the front end 15a of the front end sheath 15.
That is, the flap parts 45 function as a stopper for determining the axial positions of the clip unit 13 and the front end sheath 15. The diametrically outward opening angle of the flap parts 45 is determined by the designed sizes of the outer fastening ring 29 and the inner fastening ring 31 rather than the front end sheath 15, and hence the opening angle is fixed. For this reason, even if an axial deviation or inclination of the clip unit 13 and the front end sheath occurs, the free ends 45a of the flap parts 45 certainly abut against the front end 15a of the front end sheath 15, thereby functioning as a stopper at a correct position.
(Opening/Closing Action of Arm Parts)
Next, the opening/closing action of the arm parts for gripping a biological tissue will be described.
FIGS. 32A to 32E illustrate the actions of the arm parts of the clip unit, from expanding after having protruded to the outside from the front end sheath to ligating a biological tissue, in a step-by-step manner.
Since the arm parts 39 of the clip body 27 are closed when the clip unit 13 stored in the front end sheath 15, the clip unit 13 tends to be closed, thereby reducing the opening angle. The plastic deformation of the base end section 41 may compensate for the reduction of the opening angle.
When the base end section 41 of the clip body 27 illustrated in FIG. 32A is inserted into the constricted spot 89 of the outer fastening ring 29 by being pulled by the manipulation wire, the loop parts 47, 47 are gradually narrowed as illustrated in FIG. 32B, and hence the base end section 41 is plastically deformed. That is, the outer diameter of the base end section 41 of the clip body 27 is larger than the inner diameter DS (see FIG. 9) in the major axis side in the constricted spot 89 of the outer fastening ring 29. For this reason, when the base end section 41 of the clip body 27 is pulled into the outer fastening ring 29, the loop parts 47, 47 of the base end section 41 are pressed and deformed from the opposite sides thereof.
As the loop parts 47, 47 of the base end section 41 are deformed, the arm parts 39, 39 of the clip body 27 perform expansion movement using a deviation prevention claw 51 as a fulcrum point. Accordingly, as illustrated in FIG. 32B, the arm parts 39, 39 are widely expanded as illustrated to have an opening size that is capable of gripping a sufficient amount of tissue.
The timing of expanding the arm parts 39, 39 is transmitted to an operator as timing when a resistance against the pulling of the manipulation wire has occurred. That is, an expansion retaining protrusion 55 of the inner fastening ring 31 illustrated in FIG. 33A is introduced into the slit part 53 formed in the base end section 41 of the clip body 27 as the base end section 41 is moved to the base end side (downward in the drawing) by pulling the manipulation wire. When the manipulation wire is pulled again, the expansion retaining protrusion 55 abuts against the front end part 55a of the slit part 53, thereby producing a resistance against the pulling of the manipulation wire as illustrated in FIG. 33B.
With the resistance, the operator may readily recognize that the arm parts 39, 39 are opened at their maximum, and may temporarily stop the pulling operation of the manipulation wire in the state where the arm parts 39, 39 are opened at their maximum.
(Rotation of Clip)
As illustrated in FIG. 32C, the operator moves the clip unit 13 mounted in the front end sheath to a treatment position within a body cavity in the state where the arm parts 39, 39 are kept expanded. Then, the clip unit 13 is rotated according to a treatment direction. As described above, the rotation of the clip unit is performed by rotating the manipulation unit body 33 illustrated in FIG. 34 around the axis
(Starting of Ligation)
Next, as illustrated in FIG. 32C, the operator sets the arm parts 39, 39 to a target treatment position (an affected area 195), and pulls the slider 35 of the handle manipulation unit 17 (see FIG. 34) to the rear side, i.e., to the finger pull ring 37 side. Accordingly, as illustrated in FIG. 32D, the arm parts 39, 39 are closed, and the affected area 195 is gripped. At this time, the bent linear plate parts 57 of the arm parts 39, 39 (see FIG. 4) slidably contact with the inner diameter areas of the major axis (DL) side in the constricted spot 89 of the outer fastening ring 29 (see FIG. 9), and hence the ligation action of the clip is performed.
At this time, in the base end section 41 of the clip body 27 illustrated in FIG. 33, the expansion retaining protrusion 55 formed in the slit part 53 is plastically deformed, so that the engagement between the clip body 27 and the inner fastening ring 31 is released. The expansion retaining protrusion 55 is set to be plastically deformed by a force in the extent of 10 N to 20 N, and the engagement with the inner fastening ring 31 may be readily released with the force applied when gripping the affected area 195 with the arm parts 39, 39.
As a result, the clip body 27 is made to be movable backward again, and by retracting the slider 35 to the finger pull ring 37, the clip body 27 is inserted into the outer fastening ring 29 as illustrated in FIG. 32E.
(Ligation State)
When the arm parts 39, 39 are completely closed, a disengagement prevention protrusion 59 formed widely on a portion of each of the arm parts 39 is locked at the stepped part 89a formed by the constricted spot 89 of the outer fastening ring 29 as illustrated in FIG. 35. As a result, it is possible to prevent the clip body 27 from coming out to the front side of the outer fastening ring 29, and the ligation state by the arm parts 39, 39 will be retained.
In addition, when the clip body 27 is moved backward (downward in the drawing), the taper part 65 of the arm parts 39 and the pull-in prevention protrusions 61 abut against the inner diameter areas of the minor axis DS side of the constricted spot 89 (see FIG. 9), so that the clip body 27 cannot be further pulled into the outer fastening ring 29.
FIG. 36 illustrates a view shown in the direction indicated by arrow V2 in FIG. 35.
As described above, the shape the inside of the constricted spot 89 is formed in an oval shape, in which the diameter of the major axis DL and the diameter of the minor axis DS are different from each other. The major axis of the constricted spot 89 is set to coincide with the expansion direction of the arm parts 39, 39 of the clip body 27. Due to this, the constricted spot 89 abuts against the loop parts 47, 47 of the base end section 41 (see FIG. 4) to control the expansion extent of the pair of arm parts 39. In addition, the minor axis of the constricted spot 89 is set to be parallel to the widthwise direction of the each of the pull-in prevention protrusions 61 on the arm parts 39, 39. Due to this, when the clip body 27 is accommodated in the outer fastening ring 29, the constricted spot 89 engaged with the pull-in prevention protrusions 61 to control the pull-in extent of the clip body 27.
(Release of Clip Unit)
FIG. 37 illustrates, partially in cut-away, the clip unit in the state where the clip unit has completed ligation.
If the pulling force of the hook 23 is further increased in the state where the pull-in prevention protrusions 61 formed on the arm parts 39 of the clip body 27 and the constricted spot 89 of the outer fastening ring 29 are engaged with each other, a tensile force is also applied to the engagement part between the hook 23 and the connection tail section 43 of the clip body 27.
FIG. 38A illustrates the hook and the connection tail section in the engaged state, and FIG. 38B illustrates the hook and the connection tail section in the state of starting to release the engagement. As illustrated in FIG. 38A, the hook part 135 of the hook 23 is positioned such that the front ends 73a of the J-shaped claw parts 73 of the connection tail section 43 abut against the under-head taper part 143 formed on the rear side from the largest outer diameter area of the front end taper part 141. When the hook 23 is returned backward in relation to the connection tail section 43, the J-shaped claw parts 73 are forcibly spread diametrically outward, thereby releasing the engagement with the under-head taper part 143 as illustrated in the FIG. 38B.
FIGS. 39A to 39C illustrate a process of releasing the J-shaped claw parts from the engagement in a step-by-step manner.
As illustrated in FIG. 39A, when the hook 23 is returned backward from the state in which the front ends 73a of the J-shaped claw parts 73 of the connection tail section 43 abut on the under-head taper part 143, the front ends 73a of the J-shaped claw parts 73 are expanded diametrically outward while being slid on the under-head taper part 143. In addition, when the front ends 73a of the J-shaped claw parts 73 are spread diametrically outward over the maximum outer diameter of the hook part 135 as illustrated in FIG. 39B, the hook 23 is disengaged from the connection tail section 43 and the engagement of the hook 23 and the connection tail section 43 is released as illustrated in FIG. 39C.
Due to this, it is possible to retract the clip manipulation device within a body cavity in the state where the clip unit that has ligated a biological tissue such as an affected area is detained in the body cavity.
In addition, since the load from the engagement claw parts 73A, 73A is evenly applied, and the bending moment applied to the arm part 71A is reduced, it is possible to enhance the connection strength.
<Examples of Other Configurations of Clip Body>
FIGS. 40A and 40B and FIGS. 41A and 41B illustrate different examples of configuration of the connection tail section 43, respectively.
FIG. 40A is a partial configuration view of a connection tail section formed with a pair of engagement claw parts 73A, 73A, and FIG. 40B is a bottom view of FIG. 40A. In this example of configuration, the pair of the engagement claw parts 73A, 73A are provided respectively to extend toward the front side with reference to the rear end 71a of the arm 71A. The engagement claw parts 73A, 73A are inwardly inclined toward the central axis of the hook accommodated by the connection tail section 43A as illustrated in FIG. 40B.
With this arrangement, the engagement claw parts 73A, 73A abut against the rear inclined surface of the hook, whereby the connection strength between the clip unit and the hook can be increased. In addition, the number of the engagement claw parts is not limited two, and three or more engagement claw parts may be provided.
FIG. 41A illustrates a partial configuration view in which an engagement claw part is arranged in an opening formed in an arm 71B, and FIG. 41B is a bottom view of FIG. 41A. In this example of configuration, an opening 199 is formed in the vicinity of the rear end 71a of the arm 71B, and an engagement claw part 73B is provided in the opening 199 to extend from the rear end 71a side of the opening 199 to the front side. The engagement claw part 73B is inclined inwardly toward the central axis of the hook to the same with the above-described claw parts.
With this arrangement, the engagement claw part 73B may be simply configured. As a result, it is easy to fabricate and assemble.
The above-described clip body 27 may be formed by bending a flat metallic plate, and a large force is applied to the arm parts 39, 39 at the time of ligation. Therefore, as illustrated in FIG. 42, a clip body 27A is formed with reinforcement ribs 197, 197 extending in the longitudinal direction with the second bending points 64b as the centers, respectively. The reinforcement ribs 197, 197 are formed to bulge on the inner sides which the pair of the arm parts 39, 39 are opposite to each other.
FIG. 43 is a cross-sectional view taken along line E-E of FIG. 42. Each of the reinforcement ribs 197 is formed by pressing an arm part 39 in the thickness direction of the plate. Since the strength of the clip body 27 is increased by providing the reinforcement ribs 197, 197, a stronger ligation may be performed for a biological tissue, and the arm parts may be formed more narrowly to miniaturize the clip body.
<Method of Fabricating Clip Body>
Next, a method of fabricating a clip body will be described.
The clip body is formed by punching a contour of a clip body from a band-shaped plate material by leaving fixing runners, and bending the plate material in a step-by-step manner in the state where the plate material is supported by the fixing runner.
FIG. 44 illustrates a plan view in the step of punching the contour of the clip body by leaving fixing runners. The clip body 27 is supported by fixing runners 215 in a hole 213 formed by punching the plate material 211. A pair of fixing runners 215, 215 are connected to a connection base section 40 at the center of the clip body 27 developed on a plane.
Specifically, the longitudinal direction of the connection tail section 43 extending from the connection base section 40 when the connection tail section 43 is developed on a plane intersects at an acute angle θ1 with respect to the longitudinal direction of the arm parts 39, 39 extending from the connection base section 40 when the arm parts 39, 39 are developed on the plane. More specifically, a connection tail section center line JCL which extends in the longitudinal direction of the connection tail section 43 extending from the connection base section 40 when the connection tail section 43 is developed on the plane intersects at the acute angle θ1 with respect to the arm part center line ACL which extends in the longitudinal direction of the arm parts 39, 39 extending from the connection base section 40 when the arm parts 39, 39 are developed on the plane.
In an obtuse angle area of the connection tail section 43 where the longitudinal direction of the parts 39, 39 and the longitudinal direction of the connection tail section 43 intersect, a connection part is provided to be connected with a fixing runner 215. The connection direction of the fixing runner 215 and the connection base section 40 intersects the longitudinal direction of the connection tail section 43 at an angle θ2 and intersects the longitudinal direction of the arm parts 39, 39 at an angle θ3. More specifically, a center line RCL which extends in the connection direction of the fixing runner 215 and the connection base section 40 intersects the center line JCL at the angle θ2 and intersects the center line ACL at the angle θ3.
In summary, the center line ACL of the arm parts 39, 39, the center line JCL of the connection tail section 43, and the center line RCL of the fixing runner 215 intersect at the connection base section 40, respectively.
Further, the intersection angles θ1, θ2, θ3 are equal with each other. It is possible to suppress the interference of the connection tail section 43 and the fixing runners 215, and to arrange the connection tail section 43 and the fixing runners 215 with an increased space efficiency.
In addition, “equal” includes “equal” and “substantially equal”.
FIG. 45 is an illustration schematically showing a construction of a press apparatus that sequentially performs a punching process and various bending processes to fabricate a clip body from a band-shaped plate material. The press apparatus 217 includes a plurality of processing stages and a transport unit 219 for sequentially transporting the band-shaped plate material 211 to the individual processing stages. In the leading processing stage, a punching press machine 221 for performing a punching process is arranged to punch a plate material 211 to a condition as illustrated in FIG. 44. In the next stage, a plurality of bending press machines 223, 225, 227, . . . for bending processes are arranged.
The plate material 211 processed by the punching press machine 221 is moved to the next processing stage by the transport unit 219, and a bending process by the bending press machine 223 is performed. At this time, the punching press machine 221 newly performs a punching process. Consequently, the processing stages simultaneously perform individual processes, respectively.
FIGS. 46A to 46F are explanatory views illustrating individual processes sequentially performed in individual processing stages.
FIG. 46A illustrates the clip body 27 after the punching process, in which the clip body 27 is supported by fixing runners 215 in a hole 213 of the plate material 211. FIG. 46B illustrates the clip body 27 in the state where the third bending points 64c (see FIGS. 4 and 5) of the front end parts 67 of the arm parts 39, 39 are bent. In addition, FIG. 46C illustrates the clip body 27 in the state where the second bending pints 64b are bent, and FIG. 46D illustrates the clip body 27 in the state where the first bending points 64a are bent.
In addition, FIGS. 46E and 46F illustrate the clip body 27 in the state where the bending parts between the linear plate parts 57 and the base end section 41 are bent. By performing the individual processes in the processing stages, respectively, as described above, and separating the fixing runners 215 from the connection base section 40 in the final processing stage, which is not illustrated, the shape of the clip body 27 illustrated in FIG. 4 is obtained.
As described above, the inventive ligation device 100 is not limited to using it as a ligation device but may be converted into another treatment instrument for an endoscope that has a hook and an engagement claw part. In addition, it is possible to configure an endoscope system which enables a smooth endoscopic treatment by inserting the ligation device 100 through a treatment instrument inserting channel, through which a sheath member of an endoscope is inserted, and then introducing the ligation device 100 to the inside of a body cavity.
Like this, the present invention is not limited to the above-described exemplary embodiments. It is expected by the present invention that modifications and applications will be made by a person skilled in the art on based on the disclosure of the specification and a well-known technology, and the modifications and applications are included in the scope to be protected.
As described above, the following items are disclosed in the present specification.
(1) A clip unit that ligates a biological tissue and is configured to be attached to a front end of a transmission member for transmitting a driving force, the clip unit includes:
a clip body having a pair of arm parts; and
a fastening ring arranged in an outside of the clip body and configured to maintain the arm parts in a closed state,
in which: the clip body includes a connection base section connecting a base end side of the pair of arm parts, and a connection tail section provided on the connection base section to extend opposite to the arm parts and connected to a front end of the transmission member; and
the connection base section has a flat part perpendicular to the axial direction of the fastening ring, and the arm parts and the connection tail section are connected on a side of the flat part.
With this clip unit, it is possible to make external forces applied to the arm parts and the connection base section not affect each other since the arm parts and the connection base section via the flat part of the connection base section. For this reason, even if a large force is applied when releasing the connection between the clip unit and a hook of a manipulation wire, the arm part side and the connection tail side of the clip unit may always perform ligation stably without affecting each other.
(2) In the clip unit of (1):
the clip body is formed by bending a single plate-shaped piece; and
a longitudinal direction of the connection tail section extending from the connection base section when the connection tail section is developed on a plane intersects at an acute angle with respect to a longitudinal direction of the arm parts extending from the connection base section when the arm parts are developed on a plane.
With this clip unit, since the longitudinal direction of the arm parts and the longitudinal direction of the connection tail section intersect at an acute angle, it is possible to narrow the width of the arm parts perpendicular to the longitudinal direction of the arm parts, and to form the connection tail section with an excellent efficiency.
(3) In the clip unit of (2):
the clip unit includes, in an obtuse area of the connection base section where the longitudinal direction of the arm parts and the longitudinal direction of the connection tail section intersect, a connection part to which a fixing runner has been connected, the fixing runner being configured to support the clip body when performing the bending; and
a connection direction of the fixing runner and the connection base section intersects the longitudinal direction of the arm parts at an acute angle.
With this clip unit, since the fixing runner is connected to the connection base section in the obtuse intersection area, the connection is completed with a little interference with the connection tail section, and the connection tail section can be formed with an excellent efficiency.
(4) In the clip unit of (3):
a center line of the arm parts extending along the longitudinal direction of the arm parts, a center line of the connection tail section extending along the longitudinal direction of the connection tail section, and a center line of the fixing runner extending along the connection direction of the fixing runner intersect at the connection base section, respectively.
With this clip unit, since the respective center lines intersect at the connection base section, so that external forces applied to the arm parts and/or the connection tail section are applied to the connection base part, it is possible to prevent the external forces from propagating to other parts.
(5) In the clip unit of (3) or (4):
the longitudinal direction of the arm parts, the longitudinal direction of the connection tail section, and the connection direction of the fixing runner respectively intersect at an equal angle.
With this clip unit, since the respective directions intersect at an equal angle, it is possible to arrange the arm parts, the connection tail section and the fixing runner efficiently with space-saving.
(6) A ligation device includes:
the clip unit of any one of (1) to (5);
a flexible sheath member of an elongated shape; and
a manipulation unit configured to transmit the driving force to the transmission member, the manipulation unit being arranged on a base end side of the sheath member opposite to a front end side thereof where the clip unit is supported.
With this ligation device, a stable ligation action may be always obtained.
(7) A method of fabricating the clip unit of any one of (2) to (5) includes:
punching a contour of the clip body from a band-shaped plate material in a state where a fixing runner is connected to the connection base section;
bending the clip body while supporting the connection base section with the fixing runner; and
separating the fixing runner from the connection base section.
With this method of fabricating the clip unit, since the clip body is continuously processed by a plurality of processing steps, it is possible to efficiently fabricate the clip body.

## Claims

1. A clip unit that ligates a biological tissue and is configured to be attached to a front end of a transmission member for transmitting a driving force, the clip unit comprising:
a clip body having a pair of arm parts; and
a fastening ring arranged in an outside of the clip body and configured to maintain the arm parts in a closed state,
wherein:
the clip body includes:
a connection base section connecting a base end side of the pair of arm parts; and
a connection tail section provided on the connection base section to extend opposite to the arm parts and connected to a front end of the transmission member,

the connection base section has a flat part perpendicular to an axial direction of the fastening ring, and the arm parts are connected on a first side of the flat part and the connection tail section is connected on a second side of the flat part, said second side being different from said first side, and
wherein: the clip body is formed by bending a single plate-shaped piece; and a longitudinal direction of the connection tail section extending from the connection base section when the connection tail section is developed on a plane intersects at an acute angle with respect to a longitudinal direction of the arm parts extending from the connection base section when the arm parts are developed on the plane.

2. The clip unit according to claim 1, wherein:
the clip unit includes, in an obtuse area of the connection base section where the longitudinal direction of the arm parts and the longitudinal direction of the connection tail section intersect:
a connection part to which a fixing runner has been connected, the fixing runner being configured to support the clip body when performing the bending; and
a direction in which the fixing runner is connected to the connection base section intersects the longitudinal direction of the arm parts at an acute angle.

3. The clip unit according to claim 2, wherein:
a center line of the arm parts extending along the longitudinal direction of the arm parts, a center line of the connection tail section extending along the longitudinal direction of the connection tail section, and
a center line of the fixing runner extending along the connection direction of the fixing runner intersect at the connection base section, respectively.

4. The clip unit according to claim 2, wherein: the longitudinal direction of the arm parts, the longitudinal direction of the connection tail section, and the connection direction of the fixing runner respectively intersect at an equal angle.

5. A ligation device comprising:
the clip unit according to claim 1;
a flexible sheath member of an elongated shape; and
a manipulation unit configured to transmit the driving force to the transmission member, the manipulation unit being arranged on a base end side of the sheath member opposite to a front end side thereof where the clip unit is supported.

6. A method of fabricating the clip unit according to claim 1, comprising:
punching a contour of the clip body from a band-shaped plate material in a state where a fixing runner is connected to the connection base section;
bending the clip body while supporting the connection base section with the fixing runner; and
separating the fixing runner from the connection base section.

7. The clip unit according to claim 1, wherein the pair of arm parts, the connection base section, and the connection tail of the clip body are each structurally separate parts connected together.

8. The clip unit according to claim 1, wherein the connection base section comprises:
a first part angled away from the flat part and connected to the flat part;
a second part angled away from the flat part and the first part and connected to the flat part;
a third part connected to the first part and angled in a same direction as the second part; and
a fourth part connected to the second part and angled in a same direction as the first part.

9. The clip unit according to claim 1, wherein the connection base section includes a structural member disposed between the flat part and the pairs of arms.

10. The clip unit according to claim 1, wherein the arm parts and the connection based section are separated from each other in the axial direction.

11. The clip unit according to claim 1, wherein the connection base section includes a pair of loop parts disposed between the flat part and the pair of arm parts.

12. The clip unit according to claim 1, wherein the connection base section includes a pair of loop parts extending from the flat part to the pair of arm parts and abut against each other at the pair of arm parts at the base end side.

13. The clip unit according to claim 12, wherein the pair of arm parts are separated from the flat part by the pair of loop parts.

14. The clip unit according to claim 1, wherein the connection tail section includes:
a pair of plate-shaped arms extending from the connection base section in a direction opposite to the pair of arm parts; and
J-shaped claw parts as engagement claw parts,
wherein the J-shaped claw parts are U-turned at rear ends of the pair of plate-shaped arms, respectively, and
wherein the J-shaped claw parts extend in a direction towards the pair of the arm.

15. The clip unit according to claim 14, wherein the transmission member is connected to the J-shaped claw parts.

16. A clip unit that ligates a biological tissue and is configured to be attached to a front end of a transmission member for transmitting a driving force, the clip unit comprising:
a clip body having a pair of arm parts; and
a fastening ring arranged in an outside of the clip body and configured to maintain the arm parts in a closed state,
wherein:
the clip body includes:
a connection base section connecting a base end side of the pair of arm parts; and
a connection tail section provided on the connection base section to extend opposite to the arm parts and connected to a front end of the transmission member,

the connection base section has a flat part perpendicular to an axial direction of the fastening ring, and the arm parts are connected on a first side of the flat part and the connection tail section is connected on a second side of the flat part;
the clip body is formed by bending a single plate-shaped piece;
a longitudinal direction of the connection tail section extending from the connection base section when the connection tail section is developed on a plane intersects at an acute angle with respect to a longitudinal direction of the arm parts extending from the connection base section when the arm parts are developed on the plane; and
the clip unit includes, in an obtuse area of the connection base section where the longitudinal direction of the arm parts and the longitudinal direction of the connection tail section intersect:
a connection part to which a fixing runner has been connected, the fixing runner being configured to support the clip body when performing the bending; and
a direction in which the fixing runner is connected to the connection base section intersects the longitudinal direction of the arm parts at an acute angle.