Patent Description:
In general, diseases such as cancer of the digestive tract such as the esophagus, stomach, and large intestine develop and progress mainly from the mucous membrane of the digestive tract. Likewise, lung cancer develops mainly from the tracheal mucosa and bladder cancer develops and progresses mainly from the bladder mucosa. Accordingly, in order to confirm the diagnosis of a disease of a hollow organ such as the digestive tract, trachea, and bladder, it is essential to insert an endoscope into the hollow organ, observe the mucous membrane, and perform biopsy on the affected tissue. Then, the affected tissue is surgically excised as necessary based on the confirmed diagnosis.

However, a surgeon approaches the hollow organ from the outside during the surgical resection, and thus it is impossible to directly and visually recognize the affected area. In other words, in a case where the digestive tract, lungs, or bladder is observed with the naked eye or a laparoscope during thoracotomy, laparotomy, or laparoscopic surgery, the mucous membrane is invisible whereas the gastrointestinal serosa, tracheal serosa, and bladder peritoneal surfaces are visible. Accordingly, it is necessary to attach a marker into the hollow organ such that excision area determination is possible even in the case of observation from the outside of the hollow organ.

Surgical markers have been proposed as such a marker. The surgical markers are placed near a clip that is locked to a mucous membrane in the body and include an LED emitting near infrared light or an illuminant formed of a fluorescent luminescent substance (Patent Document <NUM>).

However, the surgical marker that uses the LED as an illuminant requires electric power supply, and thus an increase in complexity arises in terms of device configuration and it is difficult to form the marker with compactness such that the marker can be passed through the treatment instrument guide tube of an endoscope. In addition, although the surgical marker that uses the illuminant formed of the fluorescent luminescent substance emits fluorescence by irradiation with excitation light from the outside of a hollow organ and it is not necessary to supply electric power for fluorescence emission, the intensity of the fluorescence emitted to the outside (serosal side) of the hollow organ is weak and it is practically difficult to visually recognize the luminous part from the outside of the hollow organ.

Patent Document <NUM> proposes a biological compression clip to address the above-described drawbacks of the surgical markers. The clip includes a clip main body having an arm portion and a tubular member fastened to the clip main body such that the arm portion can be closed. The clip is provided with a pressing portion that presses a mucous membrane (hollow organ inner wall) against the tubular member and contains a fluorescent pigment emitting red or near infrared light. In this clip, the pressing portion containing the fluorescent pigment is attached to the hollow organ inner wall with the wall of the hollow organ pressed, and thus fluorescence attenuation during transmission through the hollow organ wall (hemoglobin in blood in particular) is kept to a minimum. As a result, the luminous part can be visually and satisfactorily recognized even in the case of fluorescence observation from the outside of the hollow organ. However, in the clip illustrated in Patent Document <NUM>, a resin material containing a fluorescent pigment constitutes the tubular member (fastening ring) for arm portion closing, and thus fastening to the hollow organ inner wall by the arm portion is likely to loosen and the attachment stability of the clip main body needs to be improved.

<CIT> describes a fluorescent indication clip for surgery.

<CIT> describes a fluorescent clip having arms.

<CIT> describes a medical clip device, a method for producing a medical clip device and a method of operating such a device.

The invention has been made in view of such a point, and an object of the invention is to provide an indwelling clip that allows easy visual recognition of light emission of a fluorescent body from the outside of a hollow organ and that enables excellent attachment stability to the inner wall of the hollow organ.

The preferred invention relates to an indwelling clip and is defined by the features of the independent claim <NUM>.

The indwelling clip of the invention is transported into a hollow organ and attached to the inner wall of the hollow organ by means of, for example, an endoscope and a clip device. When the clip is attached, the fluorescent body provided on the outer surface of the claw portion of the clip main body is pressed against the hollow organ inner wall.

As a result, according to the indwelling clip of the invention, fluorescence attenuation during transmission through a hollow organ wall is kept to a minimum and it is easy to visually recognize the light emission of the fluorescent body from the outside of the hollow organ. In addition, it is not necessary to configure the fastening ring closing the arm plate portion with a fluorescent body, and thus the design of the fastening ring is unrestricted and the clip is capable of being excellent in terms of the stability of attachment to the hollow organ inner wall. It should be noted that the visual recognition of the light emission of the fluorescent body from the outside of the hollow organ may be performed visually or by image recognition by means of an imaging device such as a laparoscope in accordance with the wavelength of the light or the like.

The fluorescent body may protrude from the claw portions to an outside of the arm plate portion. In addition, the fluorescent body may protrude outward from a tip of the claw portions. Further, the fluorescent body may be continuously provided from the outer surface of the claw portions to an outer surface of the arm plate portions.

Further, the fastening ring may be made of metal.

Hereinafter, embodiments of the invention will be specifically described with reference to the drawings.

First, a first embodiment of the invention will be described with reference to <FIG>. As illustrated in <FIG>, an indwelling clip <NUM> of the present embodiment is used as, for example, a marker that can be attached to the inner wall of a hollow organ in a living body and whose position can be visually recognized from the outside of the lumen. The indwelling clip <NUM> has a clip main body <NUM> and a fluorescent body <NUM>.

The clip main body <NUM> includes a connecting plate portion <NUM>, a pair of arm plate portions <NUM>, and a fastening ring <NUM>. The connecting plate portion <NUM> is folded in a substantially U shape. The arm plate portions <NUM> and <NUM> are integrally formed so as to be respectively continuous with the end portions of the U shape and open in a substantially V shape toward the tip side thereof.

The fastening ring <NUM> is a ring-shaped member that is slidably and externally fitted onto the connecting plate portion <NUM> on the base end side of the arm plate portion <NUM>. The fastening ring <NUM> is a member that is slid by means of a clip device <NUM> illustrated in <FIG> (described later). The clip device <NUM> has an inner sheath <NUM> and a connecting hook <NUM> disposed so as to be capable of moving forward and backward with respect to the inner sheath <NUM> and detachably connected to (disengageably engaged with) the connecting plate portion <NUM>. The fastening ring <NUM> illustrated in <FIG> and <FIG> is pressed by the distal end of the inner sheath <NUM>, slides, and closes the arm plate portion <NUM> by the connecting hook <NUM> being pulled inward from the tip portion of the inner sheath <NUM> as illustrated in <FIG> with the connecting hook <NUM> illustrated in <FIG> connected to the connecting plate portion <NUM>.

As illustrated in <FIG>, a claw portion <NUM> is integrally formed in the tip portion of each arm plate portion <NUM>. The claw portion <NUM> is folded toward the inner side (that is, in the closing direction) at the tip of the arm plate portion <NUM>. Each claw portion <NUM> has a recessed notch portion 23a at the intermediate part of the tip thereof.

The connecting plate portion <NUM>, the pair of arm plate portions <NUM>, and the pair of claw portions <NUM> are formed by one thin and slender plate material being folded and molded. Although not particularly limited, the plate thickness of the plate material constituting the connecting plate portion <NUM>, the pair of arm plate portions <NUM>, and the pair of claw portions <NUM> is preferably <NUM> to <NUM>. An elastic metal plate is preferable as the plate material. For example, a stainless steel plate is used as the plate material. In addition, the fastening ring <NUM> is also made of metal in the present embodiment. The material of the fastening ring <NUM> is not particularly limited. The fastening ring <NUM> may be made of a metal (such as stainless steel) similar to the metal of the plate material constituting the arm plate portion <NUM> and so on. Alternatively, the fastening ring <NUM> may be made of a metal different from the metal of the plate material constituting the arm plate portion <NUM> and so on, examples of which include a titanium alloy, gold, and aluminum.

Each of the arm plate portions <NUM> has a base end portion 22a and a grip portion 22b. A through hole 22c is formed in the grip portion 22b of each arm plate portion <NUM>. The through holes 22c are formed without impairing the desired strength of the arm plate portion <NUM> (grip portion 22b). The through holes 22c are formed from the viewpoint of elasticity (repulsive force) adjustment at a time when the arm plate portion <NUM> is closed by the fastening ring <NUM>.

A substantially cylindrical ring member constitutes the fastening ring <NUM> slidably fitted on the connecting plate portion <NUM>. Alternatively, the fastening ring <NUM> may be constituted by a spring obtained by a wire rod being wound into a coil shape. The connecting plate portion <NUM> is inserted through the guide hole inside the fastening ring <NUM>, and the fastening ring <NUM> is mounted (externally fitted) so as to be axially movable (slideable) between the outer periphery of the connecting plate portion <NUM> and the outer periphery of the base end portion 22a of the arm plate portion <NUM>. It should be noted that a stopper protrusion 21a is formed on the connecting plate portion <NUM> as illustrated in <FIG> such that the fastening ring <NUM> does not come off to the outside of the connecting plate portion <NUM>.

In a state where the fastening ring <NUM> is disposed on the rear side of the arm plate portion <NUM> (connecting plate portion <NUM>) as illustrated in <FIG>, the arm plate portion <NUM> is open owing to the elasticity of the arm plate portion <NUM> itself. It should be noted that it is possible to close the arm plate portion <NUM>, if necessary, by moving (sliding) the fastening ring <NUM> to a position near the tip of the base end portion 22a (close to the grip portion 22b) as illustrated in <FIG>.

As illustrated in <FIG>, the outer surface of at least one of the claw portions <NUM> is provided with the fluorescent body <NUM> containing a fluorescent pigment emitting red or near infrared light as a result of irradiation with excitation light. The pair of claw portions <NUM> are capable of meshing with each other. It is preferable that at least the fluorescent body <NUM> is mounted on the outer surface of the claw portion <NUM> that is positioned outside in a state where the claw portions <NUM> mesh with each other. The fluorescent body <NUM> is mounted onto the outer surface of the claw portion <NUM> by adhesion, insert molding, or the like.

Although the shape of the fluorescent body <NUM> in the present embodiment is the same as the outer surface shape of the claw portion <NUM>, the shapes may be different from each other. The fluorescent body <NUM> is formed of a polymer material composition containing a fluorescent pigment. The fluorescent pigment emits fluorescence in a red or near infrared wavelength range of <NUM> to <NUM>,<NUM>. Light in such a wavelength range is highly transmissive with respect to human tissue such as skin, fat, and muscle and is capable of satisfactorily reaching approximately <NUM> to <NUM> below a biological tissue surface.

Examples of the fluorescent pigment that emits the fluorescence in the wavelength range described above include a water-soluble pigment such as riboflavin, thiamine, nicotinamide adenine dinucleotide (NADH), and indocyanine green (ICG) and an oil-soluble pigment such as the azo-boron complex compound described in <CIT>. A pigment highly compatible with a polymer material is particularly preferable in that the pigment is stably retained in the polymer material without elution in a living body. Especially, the azo-boron complex compound described in <CIT> or the like is preferable in that the compound or the like is excellent in fluorescence emission intensity and in light resistance, heat resistance, and compatibility with respect to a polymer material such as polyurethane.

The preferred concentration of the fluorescent pigment in the polymer material composition containing the fluorescent pigment is usually and preferably <NUM> to <NUM>% by mass although the concentration depends on the type of the polymer material used as a fluorescent pigment or a binder.

Usable as the polymer material containing the fluorescent pigment is polyurethane, polypropylene, polyethylene, polyvinyl chloride, polyamide, polyamide elastomer, or the like proportionally mixed with a curing agent as necessary.

The polymer material contains the fluorescent pigment by, for example, the fluorescent pigment being kneaded into the polymer material by means of a twin-screw kneader. Subsequently, the fluorescent body <NUM> can be obtained by extrusion or injection molding into a predetermined shape, during which post-processing is performed if necessary. The fluorescent body <NUM> is fixed to the outer surface of the claw portion <NUM> by means such as adhesion and insert molding.

It should be noted that a contrast agent such as barium sulfate may be added, if necessary, to the polymer material composition containing the fluorescent pigment. As a result, it is also possible to track the fluorescent body <NUM> in the hollow organ by imaging the fluorescent body <NUM> with an X-ray even if the indwelling clip <NUM> comes off the inner wall of the hollow organ after pinching of the inner wall of the hollow organ in the living body or the fluorescent body <NUM> falls from the clip main body <NUM>.

In addition, the fluorescent body <NUM> may be a body in which the outer surface of the claw portion <NUM> of the clip main body <NUM> is coated with a paint containing a fluorescent pigment. In addition, the fluorescent body <NUM> may be a body in which the outer surface of a plate material formed of a polymer material composition containing a fluorescent pigment is turned into two layers or coated with a transparent material containing no fluorescent pigment. In addition, a fluorescent pigment may be fixed by means of gelatin or the like on the surface of a plate material formed of a material containing no fluorescent pigment. The thickness of the fluorescent body <NUM> is determined such that sufficient fluorescence characteristics can be obtained. Although not particularly limited, the thickness is preferably <NUM> to <NUM>,<NUM>.

In the present embodiment, the indwelling clip <NUM> is transported into a hollow organ <NUM> illustrated in <FIG> and the clip <NUM> is attached to a specific position on the inner wall of the hollow organ <NUM> by means of, for example, the endoscope that is illustrated in <FIG> and the clip device <NUM> illustrated in <FIG>. For example, the clip <NUM> is attached around a tumor 4b at a part of a mucous membrane (hollow organ inner wall) 4a on the inner wall of the hollow organ <NUM> so that the tumor is located. It is preferable that a plurality of the clips <NUM> are attached to the inner wall of the hollow organ <NUM> although both the single clip <NUM> and the plurality of clips <NUM> may be attached to the inner wall of the hollow organ <NUM>.

Here, the clip device <NUM> illustrated in <FIG> will be described. The clip device <NUM> is to transport the indwelling clip <NUM> into the body via the treatment instrument guide tube of an endoscope <NUM> illustrated in <FIG> and perform internal tissue gripping and placement (clipping).

The clip device <NUM> has the connecting hook <NUM>, the inner sheath <NUM>, a drive wire <NUM>, an outer sheath <NUM>, a reinforcing coil <NUM>, a first slider portion <NUM>, a base portion <NUM>, and a second slider portion <NUM>.

As illustrated in <FIG>, the tubular inner sheath <NUM> is inserted through the tubular outer sheath <NUM> and the drive wire <NUM> is inserted through the inner sheath <NUM>. The inner sheath <NUM> is slidable in the outer sheath <NUM>, and the drive wire <NUM> is slidable in the inner sheath <NUM>.

The outer sheath <NUM> is made of a flexible hollow tube, and a coil tube is used in the present embodiment. Usable as the coil tube is a flat wire coil tube obtained by spiral winding of a long flat plate made of metal (stainless steel) or the like. Alternatively, a round wire coil tube or an inner flat coil tube may be used. The inner diameter of the tip portion of the outer sheath <NUM> is approximately <NUM> to <NUM>.

The inner sheath <NUM> is made of a flexible hollow tube, and a wire tube is used in the present embodiment. The wire tube is a tube made of a hollow stranded wire obtained by a plurality of wires (cables) made of metal (stainless steel) or the like being spirally twisted so as to become hollow. It should be noted that the inner sheath <NUM> may be a sheath in which a wire tube is mainly used and only a part of the tip side thereof is a coil tube. The inner diameter of the tip portion of the inner sheath <NUM> is approximately <NUM> to <NUM>.

The drive wire <NUM> is made of a flexible wire, and a wire rope is used in the present embodiment. The wire rope is a rope made of a stranded wire obtained by spiral twisting of a plurality of wires (cables) made of metal (stainless steel) or the like. Alternatively, a wire tube similar to the inner sheath <NUM> may be used as the drive wire <NUM>.

The connecting hook <NUM> disposed at the distal end of the clip device <NUM> illustrated in <FIG> has a pair of arm portions 51a and 51a made of an elastic body disposed in a substantially V shape toward the tip thereof. By cooperation with the inner sheath <NUM>, the connecting hook <NUM> is capable of taking two, open and closed, states. Claw portions are formed by folding to the inner side (side of mutual facing) in the tip portions of the arm portions 51a and 51a of the connecting hook <NUM>, and thus the connecting plate portion <NUM> of the clip main body <NUM> can be gripped and connected.

The base end portion of the connecting hook <NUM> is a U-shaped portion that is formed in a substantially U shape and continuous with the base end portions of the pair of arm portions 51a and 51a. The connecting hook <NUM> can be formed by one slender plate material made of an elastic body being appropriately folded (plastically deformed). Although not particularly limited, the plate material constituting the connecting hook <NUM> has a plate thickness of approximately <NUM> to <NUM> and a width of approximately <NUM>. Stainless steel or the like is used as the plate material.

The base end portion of the connecting hook <NUM> is fixed by laser welding or the like to the tip (distal end) of the drive wire <NUM> slidably inserted in the inner sheath <NUM>. The connecting hook <NUM> may be swingable with respect to the drive wire <NUM> by a substantially annular ring member being fixed by laser welding or the like to the distal end of the drive wire <NUM> and the U-shaped portion of the connecting hook <NUM> being passed through the ring member.

The vicinity of the base end (proximal end) side of the outer sheath <NUM> is inserted in the reinforcing coil <NUM> and integrally fixed in the reinforcing coil <NUM>. The reinforcing coil <NUM> is integrally fixed in the first slider portion <NUM>, and the distal end side part of the base portion <NUM> is inserted and disposed inside the first slider portion <NUM>. The first slider portion <NUM> is slidable with respect to the base portion <NUM> such that the first slider portion <NUM> can be positioned between a position at which the first slider portion <NUM> has moved to the tip (distal end) side and two positions at which the first slider portion <NUM> has moved to the base end portion (proximal end) side.

The second slider portion <NUM> is slidably held by the base portion <NUM>. The inner sheath <NUM> is fixed to the base portion <NUM>. The proximal end of the drive wire <NUM> is fixed to the second slider portion <NUM>.

When the second slider portion <NUM> is slid to the tip side (distal end side) with respect to the base portion <NUM>, the inner sheath <NUM> is pulled in with respect to the drive wire <NUM> and the connecting hook <NUM> at the tip of the drive wire <NUM> protrudes from the tip of the inner sheath <NUM> and opens owing to its own elasticity. When the second slider portion <NUM> is slid to the base end side (proximal end side) with respect to the base portion <NUM>, the drive wire <NUM> is pulled in with respect to the inner sheath <NUM> and the connecting hook <NUM> at the tip of the drive wire <NUM> gradually closes while moving into the inner sheath <NUM> and is embedded into the inner sheath <NUM>. As a result, the connecting hook <NUM> is completely closed.

When the first slider portion <NUM> is slid to the base end side position with respect to the base portion <NUM>, the inner sheath <NUM> is capable of protruding from the tip of the outer sheath <NUM>. Conversely, when the first slider portion <NUM> is slid to the tip side position with respect to the base portion <NUM>, the tip of the inner sheath <NUM> can be stored (embedded) into the outer sheath <NUM>.

Next, an example of how the indwelling clip <NUM> is used will be described with reference to <FIG>, <FIG>, and <FIG>. The connecting hook <NUM> of the clip device <NUM> is engaged with a connecting hole <NUM> formed inside the connecting plate portion <NUM> of the clip main body <NUM>, and the connecting hook <NUM> is pulled into the inner sheath <NUM>. As a result, the connecting hook <NUM> is closed and the clip main body <NUM> of the indwelling clip <NUM> is attached to the tip of the inner sheath <NUM> (see <FIG>).

In this state, the distal end portion of the inner sheath <NUM> to which the indwelling clip <NUM> (clip main body <NUM> and fluorescent body <NUM>) is connected is pulled into the outer sheath <NUM> and the entire indwelling clip <NUM> is accommodated inside the distal end portion of the outer sheath <NUM> (see <FIG>). In this state, the fastening ring <NUM> of the clip main body <NUM> is positioned on the connecting plate portion <NUM> and the arm plate portion <NUM> is closed by the action of the inner wall of the outer sheath <NUM>.

The distal end portion of the outer sheath <NUM> of the clip device <NUM> where the indwelling clip <NUM> is mounted is inserted into the hollow organ <NUM> by means of the endoscope <NUM> illustrated in <FIG>. Next, the indwelling clip <NUM> is caused to protrude from the distal end of the outer sheath <NUM> by the outer sheath <NUM> illustrated in <FIG> being slid to the proximal end side. As a result, the arm plate portion <NUM> is opened owing to its own elasticity as illustrated in <FIG>.

Positioning around a lesion part such as the tumor 4b illustrated in <FIG> is performed with the arm plate portion <NUM> open. Next, the inner sheath <NUM> illustrated in <FIG> is slid to the distal end side with respect to the drive wire <NUM>. Then, the fastening ring <NUM> slides to the tip side of the arm plate portion <NUM>. As a result, the arm plate portions <NUM> are gradually closed (approach each other) and a part of the mucous membrane 4a is sandwiched.

The inner sheath <NUM> is further slid to the distal end side with respect to the drive wire <NUM>, the fastening ring <NUM> is moved to the tip side of the arm plate portion <NUM>, and the clip main body <NUM> of the indwelling clip <NUM> is completely closed. In this state, the inner sheath <NUM> is slid to the proximal end side with respect to the drive wire <NUM>, the connecting hook <NUM> is pushed out of the distal end of the inner sheath <NUM> and opened, and the gripping (engagement) by the connecting hook <NUM> of the clip main body <NUM> is released. As a result, the clipping of a part of the mucous membrane 4a by the indwelling clip <NUM> is completed as illustrated in <FIG>.

Next, once the clip device <NUM> is removed from the endoscope, another and separately prepared indwelling clip <NUM> is mounted onto the distal end portion of the clip device <NUM> (or a separately prepared clip device similar in configuration to the clip device <NUM>). Next, the distal end portion of the clip device <NUM> where the separately prepared indwelling clip <NUM> is mounted is transported to the vicinity of a site positioned on the opposite side across the tumor 4b. Then, the clip <NUM> is capable of clipping a part of the mucous membrane 4a in a manner similar to what has been described above. In this manner, the plurality of clips <NUM> are capable of clipping the mucous membrane 4a positioned around the tumor 4b.

As described above, in the present embodiment, the indwelling clip <NUM> is transported into the hollow organ <NUM> and the clip <NUM> is attached to a specific position by means of, for example, the endoscope <NUM> illustrated in <FIG> and the clip device <NUM> illustrated in <FIG>. When the clip <NUM> is attached, the fluorescent body <NUM> provided on the outer surface of the claw portion <NUM> of the clip main body <NUM> bites into and is pressed against the mucous membrane 4a of the inner wall of the hollow organ <NUM>. At the part where the fluorescent body <NUM> is pressed, it is possible to eliminate blood from a blood vessel by compressing the underlying vascular network of the mucous membrane 4a. As a result, when irradiation with excitation light is performed inward (toward the mucous membrane side) from the outer side (serosal side) of the hollow organ <NUM> during thoracotomy, laparotomy, or laparoscopic surgery, the excitation light is unlikely to be absorbed by the hemoglobin contained in the blood of the underlying vascular network of the mucous membrane and the excitation light easily reaches the fluorescent body <NUM> provided on the outer surface of the claw portion <NUM>.

The fluorescent body <NUM> provided on the outer surface of the claw portion <NUM> contains the fluorescent pigment that emits red or near infrared light as a result of irradiation with excitation light. Accordingly, excitation light emitted from the outside of the hollow organ <NUM> is hardly absorbed by the hemoglobin and is efficiently absorbed by the fluorescent pigment of the fluorescent body <NUM>. As a result, the fluorescence emitted from the fluorescent pigment of the fluorescent body <NUM> is also emitted to the outside of the hollow organ <NUM> while being hardly absorbed by the hemoglobin. Accordingly, the light emission of the fluorescent body <NUM> attached on the mucous membrane 4a of the hollow organ <NUM> can be visually and satisfactorily recognized from the outside of the hollow organ <NUM>. In addition, since the fastening ring <NUM> is metallic, the fastening of the indwelling clip <NUM> is unlikely to loosen and the attachment stability of the clip <NUM> is also improved. It should be noted that the visual recognition of the light emission of the fluorescent body <NUM> from the outside of the hollow organ <NUM> may be performed by means for facilitating visual fluorescence recognition without being affected by the excitation light being selected in accordance with the wavelengths of the excitation light and the fluorescence. For example, the visual recognition may be performed visually or by image recognition by means of an imaging device such as a medical near infrared camera system and a laparoscope provided with a near infrared camera.

When the fluorescent body <NUM> emits light by the excitation light emitted from the outside of the hollow organ <NUM> during thoracotomy, laparotomy, or laparoscopic surgery, the light emitted by the fluorescent body <NUM> may be imaged visually, by means of an imaging device, or the like, the fluorescent body <NUM> can be located from the outside of the hollow organ <NUM>, and the lesion part such as the tumor 4b can be located therefrom. Accordingly, it is possible to excise the hollow organ <NUM> corresponding to the tumor 4b from the outside by means of an ordinary scalpel, a high-frequency knife, or the like and the excision can be limited to the minimum required range. It should be noted that the clip <NUM> can be taken out of the body together with the excision of the tumor 4b.

Next, a second embodiment of the invention will be described with reference to <FIG>. It should be noted that the description will focus on changes from the first embodiment described with reference to <FIG>.

As illustrated in <FIG>, an indwelling clip 1a of the present embodiment is similar to the indwelling clip <NUM> of the first embodiment except that a fluorescent body 3a is changed in shape and configuration. In other words, in the present embodiment, the clip main body <NUM> is similar to the clip main body <NUM> of the first embodiment and only the fluorescent body 3a is different from the fluorescent body <NUM> of the first embodiment. The fluorescent body 3a is formed integrally with a protruding portion <NUM> protruding from the claw portion <NUM> to the outside of the arm plate portion <NUM>.

The protruding portion <NUM> is provided on each fluorescent body 3a and protrudes in a direction away from the clip main body <NUM> from the boundary between the claw portion <NUM> of the clip main body <NUM> and the arm plate portion <NUM> toward the outside of the arm plate portion <NUM> so as to extend the outer surface of the claw portion <NUM>. The protruding portion <NUM> is formed integrally with the fluorescent body 3a and is made of, for example, a polymer material composition containing a fluorescent pigment.

Also in the present embodiment, the indwelling clip 1a is transported into the hollow organ <NUM> and the clip 1a is attached to a specific position by means of, for example, the endoscope <NUM> illustrated in <FIG> and the clip device <NUM> illustrated in <FIG>. When the clip 1a is attached, the tip portion of the claw portion <NUM> of the clip main body <NUM> bites into the mucous membrane 4a of the inner wall of the hollow organ <NUM> and the fluorescent body 3a provided on the outer surface of the claw portion <NUM> is pressed against the mucous membrane 4a. At the part where the fluorescent body 3a is pressed, it is possible to eliminate blood from a blood vessel by compressing the underlying vascular network of the mucous membrane 4a. As a result, when irradiation with excitation light is performed inward (toward the mucous membrane side) from the outer side (serosal side) of the hollow organ <NUM> during thoracotomy, laparotomy, or laparoscopic surgery, the excitation light is unlikely to be absorbed by the hemoglobin contained in the blood of the underlying vascular network of the mucous membrane and the excitation light easily reaches the fluorescent body 3a provided on the outer surface of the claw portion <NUM>. In the present embodiment in particular, the area of the fluorescent body 3a is large and the fluorescent area is large owing to the presence of the protruding portion <NUM>, and thus it is particularly easy to visually recognize the fluorescent light. Others are similar to those of the first embodiment described above.

Next, a third embodiment of the invention will be described with reference to <FIG>. It should be noted that the description will focus on changes from the first embodiment described with reference to <FIG>.

As illustrated in <FIG>, an indwelling clip 1b of the present embodiment is similar to the indwelling clip <NUM> of the first embodiment except that a fluorescent body 3b is changed in shape and configuration. In other words, in the present embodiment, the clip main body <NUM> is similar to the clip main body <NUM> of the first embodiment and only the fluorescent body 3b is different from the fluorescent body <NUM> of the first embodiment. The fluorescent body 3b is formed integrally with a claw-shaped protruding portion <NUM> protruding from the claw portion <NUM> toward the tip of the claw portion <NUM>.

The claw-shaped protruding portion <NUM> is provided on each fluorescent body 3b. The claw-shaped protruding portion <NUM> protrudes in a direction away from the claw portion <NUM> along the outer surface of the claw portion <NUM> from the tip of the claw portion <NUM> of the clip main body <NUM>. The claw-shaped protruding portion <NUM> has a sharp tip. The claw-shaped protruding portion <NUM> is formed integrally with the fluorescent body 3b and is made of, for example, a polymer material composition containing a fluorescent pigment.

Also in the present embodiment, the indwelling clip 1b is transported into the hollow organ <NUM> and the clip 1b is attached to a specific position by means of, for example, the endoscope <NUM> illustrated in <FIG> and the clip device <NUM> illustrated in <FIG>. When the clip 1b is attached, the tip portion of the claw portion <NUM> of the clip main body <NUM> bites into the mucous membrane 4a of the inner wall of the hollow organ <NUM> together with the claw-shaped protruding portion <NUM> and the fluorescent body 3b provided on the outer surface of the claw portion <NUM> is pressed against the mucous membrane 4a. At the part where the fluorescent body 3b is pressed, it is possible to eliminate blood from a blood vessel by compressing the underlying vascular network of the mucous membrane 4a. As a result, when irradiation with excitation light is performed inward (toward the mucous membrane side) from the outer side (serosal side) of the hollow organ <NUM> during thoracotomy, laparotomy, or laparoscopic surgery, the excitation light is unlikely to be absorbed by the hemoglobin contained in the blood of the underlying vascular network of the mucous membrane and the excitation light easily reaches the fluorescent body 3b provided on the outer surface of the claw portion <NUM>. In the present embodiment in particular, the area of the fluorescent body 3b is large and the fluorescent area is large owing to the presence of the claw-shaped protruding portion <NUM>, and thus it is particularly easy to visually recognize the fluorescent light. Others are similar to those of the first embodiment described above.

Next, a fourth embodiment of the invention will be described with reference to <FIG>. It should be noted that the description will focus on changes from the first embodiment described with reference to <FIG>.

As illustrated in <FIG>, an indwelling clip 1c of the present embodiment is similar to the indwelling clip <NUM> of the first embodiment except that a fluorescent body 3c is changed in shape and configuration. In other words, in the present embodiment, the clip main body <NUM> is similar to the clip main body <NUM> of the first embodiment and only the fluorescent body 3c is different from the fluorescent body <NUM> of the first embodiment. The fluorescent body 3c is formed integrally with an extending portion <NUM> continuously formed from the outer surface of the claw portion <NUM> to the outer surface of the arm plate portion <NUM>.

The extending portion <NUM> is formed on each fluorescent body 3a. The extending portion <NUM> is continuously formed from the outer surface of the claw portion <NUM> to the outer surface of the grip portion 22b in the arm plate portion <NUM>. A part of the inner surface of the extending portion <NUM> may enter the through hole 22c formed in the arm plate portion <NUM>. The part of the extending portion <NUM> entering the through hole 22c is preferable in that the fluorescent body 3c is unlikely to fall from the clip main body <NUM>. The extending portion <NUM> is formed integrally with the fluorescent body 3c and is made of, for example, a polymer material composition containing a fluorescent pigment. It should be noted that the extending portion <NUM> may also be formed inside the arm plate portion <NUM>.

Also in the present embodiment, the indwelling clip 1c is transported into the hollow organ <NUM> and the clip 1c is attached to a specific position by means of, for example, the endoscope <NUM> illustrated in <FIG> and the clip device <NUM> illustrated in <FIG>. When the clip 1c is attached, the tip portion of the claw portion <NUM> of the clip main body <NUM> bites into the mucous membrane 4a of the inner wall of the hollow organ <NUM> together with the extending portion <NUM> and the fluorescent body 3c provided on the outer surface of the claw portion <NUM> is pressed against the mucous membrane 4a. At the part where the fluorescent body 3c is pressed, it is possible to eliminate blood from a blood vessel by compressing the underlying vascular network of the mucous membrane 4a. As a result, when irradiation with excitation light is performed inward (toward the mucous membrane side) from the outer side (serosal side) of the hollow organ <NUM> during thoracotomy, laparotomy, or laparoscopic surgery, the excitation light is unlikely to be absorbed by the hemoglobin contained in the blood of the underlying vascular network of the mucous membrane and the excitation light easily reaches the fluorescent body 3c provided on the outer surface of the claw portion <NUM>. In the present embodiment in particular, the area of the fluorescent body 3c is large and the fluorescent area is large owing to the presence of the extending portion <NUM>, and thus it is particularly easy to visually recognize the fluorescent light. Others are similar to those of the first embodiment described above.

Next, a fifth embodiment of the invention will be described with reference to <FIG>. It should be noted that the description will focus on changes from the fourth embodiment described with reference to <FIG>.

As illustrated in <FIG>, an indwelling clip 1d of the present embodiment has a fluorescent body 3d_1. The fluorescent body 3d_1 is different from the fluorescent body 3c in the fourth embodiment in that the fluorescent body 3d_1 has a tip protruding portion 35_1. The fluorescent body 3d_1 is provided on the claw portion <NUM> formed in the tip portion of one arm plate portion <NUM> of the pair of arm plate portions <NUM> and <NUM>. It should be noted that the indwelling clip 1d of the present embodiment is provided with fluorescent bodies 3d_2 and 3d_3 in addition to the fluorescent body 3d_1.

The fluorescent body 3d_3 is made of a flat plate-shaped fluorescent body. The fluorescent body 3d_3 is attached on the inner surface of each of the pair of arm plate portions <NUM> (grip portions 22b), and the grip portion 22b is sandwiched between the fluorescent body 3d_3 and the fluorescent body 3d_1 (3d_2).

The fluorescent body 3d_2 is provided on the other arm plate portion <NUM> of the pair of arm plate portions <NUM> and <NUM>. The fluorescent body 3d_2 provided on the other arm plate portion <NUM> is formed integrally with a tip protruding portion 35_2. The tip protruding portion 35_2 has a protrusion shape and protrudes from the tip portion of the arm plate portion <NUM> (grip portion 22b) to the outside of the tip of the arm plate portion <NUM>.

The tip protruding portion 35_2 is made of a flat plate-shaped fluorescent body and is tapered in the width direction and the thickness direction toward the tip thereof. Accordingly, the tip protruding portion 35_2 has excellent piercing properties and the tip protruding portion 35_2 is capable of easily biting into the mucous membrane 4a of the inner wall of the hollow organ <NUM> with the clip 1d attached on the inner wall of the hollow organ <NUM>.

The wall thickness of the tip protruding portion 35_2 is approximately equal to or larger than the wall thickness of the fluorescent body 3c illustrated in the fourth embodiment. Accordingly, the tip protruding portion 35_2 is given sufficient strength and the tip protruding portion 35_2 is capable of biting into the mucous membrane 4a of the inner wall of the hollow organ <NUM> without bending with the clip 1d attached on the inner wall of the hollow organ <NUM>.

The tip protruding portion 35_2 protrudes along the longitudinal direction of the arm plate portion <NUM>. The ratio L1 / L of a protrusion length L1 from the tip portion of the arm plate portion <NUM> to a total length L of the fluorescent body 3d_2 is preferably <NUM> to <NUM>. The same applies to the tip protruding portion 35_1 and the respective protrusion lengths of the tip protruding portion 35_1 and the tip protruding portion 35_2 are substantially equal to each other.

As illustrated in <FIG>, the fluorescent body 3d_1 is provided on the claw portion <NUM> that is disposed outside when the pair of arm plate portions <NUM> and <NUM> are closed. The fluorescent body 3d_1 provided on the claw portion <NUM> is formed integrally with the tip protruding portion 35_1. The tip protruding portion 35_1 has a protrusion shape and protrudes to the outside of the tip of the arm plate portion <NUM> from the outer surface of the claw portion <NUM> (or from the tip portion of the arm plate portion <NUM> (grip portion 22b)).

The shape of the tip protruding portion 35_1 corresponds to the shape of the outer surface of the claw portion <NUM>, and a part (side portion <NUM>) of the tip protruding portion 35_1 protrudes in the extension direction of the claw portion <NUM>. Most of the claw portion <NUM> is covered with one end of the side portion <NUM> of the tip protruding portion 35_2.

A length L2 of the side portion <NUM> along the extension direction of the claw portion <NUM> is approximately equal to or shorter than the length of the claw portion <NUM> in the extension direction. Accordingly, the tip protruding portion 35_1 does not come into contact with the tip protruding portion 35_2 and the tip protruding portions 35_1 and 35_2 do not hinder the clipping by the clip 1d when the pair of arm plate portions <NUM> and <NUM> are closed.

In addition, the length L2 decreases toward the tip of the fluorescent body 3d_1 and the tip protruding portion 35_1 is tapered as a whole toward the tip thereof. Accordingly, the tip protruding portion 35_1 has excellent piercing properties and the tip protruding portion 35_1 is capable of easily biting into the mucous membrane 4a of the inner wall of the hollow organ <NUM> with the clip 1d attached on the inner wall of the hollow organ <NUM>.

A recessed notch portion 35a is formed at the intermediate part of the tip of the tip protruding portion 35_1. Alternatively, the notch portion 35a may be omitted in a case where the notch portion 23a (see <FIG>) is not formed in the claw portion <NUM>.

The tip protruding portion 35_1 is curved (bent) along the width direction such that the shape (cross-sectional shape) of the tip protruding portion 35_1 is a substantially C shaped. In addition, a fluorescent body larger in volume (or area) than the tip protruding portion 35_2 constitutes the tip protruding portion 35_1. Accordingly, the fluorescence intensity of the tip protruding portion 35_1 exceeds the fluorescence intensity of the tip protruding portion 35_2.

The outer surfaces of the fluorescent bodies 3d_1 and 3d_2 are curved along the width direction of the fluorescent bodies 3d_1 and 3d_2 (similar to the width direction of the arm plate portion <NUM>) from the viewpoint of easily accommodating the entire clip 1d inside the distal end portion of the outer sheath <NUM> of the clip device <NUM> (see <FIG>).

Also in the present embodiment, the indwelling clip 1d is transported into the hollow organ <NUM> and the clip 1d is attached to a specific position by means of, for example, the endoscope <NUM> illustrated in <FIG> and the clip device <NUM> illustrated in <FIG>. When the clip 1d is attached, the tip protruding portions 35_1 and 35_2 bite into the mucous membrane 4a of the inner wall of the hollow organ <NUM> together with the tip portion of the claw portion <NUM> of the clip main body <NUM> and the tip protruding portions 35_1 and 35_2 (tip-most portions of the tip protruding portions 35_1 and 35_2 in particular) are pressed against the mucous membrane 4a. At the parts where the tip protruding portions 35_1 and 35_2 are pressed, it is possible to eliminate blood from a blood vessel by compressing the underlying vascular network of the mucous membrane 4a. As a result, when irradiation with excitation light is performed inward (toward the mucous membrane side) from the outer side (serosal side) of the hollow organ <NUM> during thoracotomy, laparotomy, or laparoscopic surgery, the excitation light is unlikely to be absorbed by the hemoglobin contained in the blood of the underlying vascular network of the mucous membrane and the excitation light easily reaches the tip protruding portions 35_1 and 35_2 of the fluorescent bodies 3d_1 and 3d_2 and the fluorescent bodies 3d_1 and 3d_2 provided on the outer surface of the arm plate portions <NUM>. In the present embodiment in particular, the area of the fluorescent body 3d_1 is large and the fluorescent area is large owing to the presence of the tip protruding portion 35_1, and thus it is particularly easy to visually recognize the fluorescent light. Others are similar to those of the fourth embodiment described above.

In addition, in the present embodiment, the pair of arm plate portions <NUM> and <NUM> are provided with the fluorescent bodies 3d_1 and 3d_2, respectively. Accordingly, when the mucous membrane 4a of the inner wall of the hollow organ <NUM> is bitten by the fluorescent body 3d_1 and the fluorescent body 3d_2 as illustrated in <FIG>, it is possible to prevent the clip 1d from falling to one side of the pair of arm plate portions <NUM> and <NUM> and maintain a state where the clip 1d is erect substantially perpendicularly to the mucous membrane 4a.

Next, a sixth embodiment of the invention will be described with reference to <FIG>. It should be noted that the description will focus on changes from the fourth embodiment described with reference to <FIG>.

As illustrated in <FIG>, an indwelling clip 1e of the present embodiment has a clip main body <NUM>' and a fluorescent body 3e. The fluorescent body 3e is different from the fluorescent body 3c in the fourth embodiment in that the fluorescent body 3e has a tip protruding portion 35e. As illustrated in <FIG>, the clip main body <NUM>' has an arm plate portion <NUM>' in addition to the arm plate portion <NUM>.

The arm plate portion <NUM>' differs from the arm plate portion 22b in that the arm plate portion <NUM>' has a grip portion 22b'. A recessed notch portion <NUM> is formed at the intermediate part of the tip of the grip portion 22b', and the tip portion of the grip portion 22b' is not provided with the claw portion <NUM>.

When the fluorescent body 3e is formed by injection molding or the like in the present embodiment, the grip portion 22b' of the arm plate portion <NUM>' is integrated with the fluorescent body 3e by insert molding or the like. As illustrated in <FIG>, the fluorescent body 3e has the tip protruding portion 35e. The tip protruding portion 35e differs from the tip protruding portion 35_2 illustrated in <FIG> in that the tip protruding portion 35e has a claw-shaped portion <NUM>.

The tip protruding portion 35e protrudes from the tip portion of the arm plate portion <NUM>' along the longitudinal direction of the arm plate portion <NUM>'. The ratio L3 / L of a protrusion length L3 of the tip protruding portion 35e to the total length L of the fluorescent body 3e is preferably <NUM> to <NUM>.

The claw-shaped portion <NUM> is configured as a part of the tip protruding portion 35e and is formed integrally with the tip portion of the tip protruding portion 35e. As illustrated in <FIG>, the claw-shaped portion <NUM> is disposed outside the claw portion <NUM> formed on one arm plate portion <NUM> when the pair of arm plate portions <NUM> and <NUM>' are closed. It should be noted that the claw-shaped portion <NUM> may be configured as the entire tip protruding portion 35e.

The claw-shaped portion <NUM> is bent at a predetermined angle with respect to the extension direction of the tip protruding portion 35e and extends toward the inner side (that is, in the closing direction of the pair of arm plate portions <NUM> and <NUM>'). The wall thickness of the claw-shaped portion <NUM> is approximately equal to or larger than the wall thickness of the fluorescent body 3c illustrated in the fourth embodiment. The claw-shaped portion <NUM> has a recessed notch portion 37a at the intermediate part of the tip thereof.

The claw-shaped portion <NUM> has a shape corresponding to the claw portion <NUM> formed in the tip portion of the arm plate portion <NUM> and is similar in role to the claw portion <NUM>. In other words, in the present embodiment, the claw-shaped portion <NUM> replaces the claw portion <NUM> in one arm plate portion <NUM>'. Accordingly, when the pair of arm plate portions <NUM> and <NUM>' are closed, the claw portion <NUM> formed in the tip portion of the arm plate portion <NUM> and the claw-shaped portion <NUM> of the fluorescent body 3e provided on the arm plate portion <NUM>' engage with each other and the mucous membrane 4a of the inner wall of the hollow organ <NUM> can be grabbed by means of the claw portion <NUM> and the claw-shaped portion <NUM>.

As illustrated in <FIG>, in the present embodiment, a part of the fluorescent body 3e is also provided on the inner surface of the arm plate portion <NUM>' (grip portion 22b') and the outer surface and the inner surface of the grip portion 22b' are covered with the fluorescent body 3e. The part of the fluorescent body 3e that is formed on the inner surface of the grip portion 22b' is connected to the lower surface of the tip protruding portion 35e.

The fluorescent body 3e illustrated in <FIG> enters the notch portion <NUM> of the grip portion 22b' illustrated in <FIG>. Accordingly, the fluorescent body 3e is firmly fixed to the grip portion 22b' and it is possible to prevent the fluorescent body 3e from falling (slipping) from the grip portion 22b'.

Also in the present embodiment, the indwelling clip 1e is transported into the hollow organ <NUM> and the clip 1e is attached to a specific position by means of, for example, the endoscope <NUM> illustrated in <FIG> and the clip device <NUM> illustrated in <FIG>. When the clip 1e is attached, the tip portion of the claw portion <NUM> of the clip main body <NUM>' and the claw-shaped portion <NUM> of the fluorescent body 3e bite into the mucous membrane 4a of the inner wall of the hollow organ <NUM> and the tip protruding portion 35e (claw-shaped portion <NUM> of the tip protruding portion 35e in particular) is pressed against the mucous membrane 4a. At the part where the tip protruding portion 35e is pressed, it is possible to eliminate blood from a blood vessel by compressing the underlying vascular network of the mucous membrane 4a. As a result, when irradiation with excitation light is performed inward (toward the mucous membrane side) from the outer side (serosal side) of the hollow organ <NUM> during thoracotomy, laparotomy, or laparoscopic surgery, the excitation light is unlikely to be absorbed by the hemoglobin contained in the blood of the underlying vascular network of the mucous membrane and the excitation light easily reaches the tip protruding portion 35e of the fluorescent body 3e. In the present embodiment in particular, the area of the fluorescent body 3e is large and the fluorescent area is large owing to the presence of the claw-shaped portion <NUM>, and thus it is particularly easy to visually recognize the fluorescent light. Others are similar to those of the fourth embodiment described above.

In addition, in the present embodiment, it is possible to increase the degree of freedom in designing the fluorescent body 3e and the clip main body <NUM>' (grip portion 22b' in particular) by forming the fluorescent body 3e by injection molding or the like, examples of which include a part of the tip protruding portion 35e constituting the claw-shaped portion <NUM> and introducing a shape (notch portion <NUM>) that has an anti-slip effect into the grip portion 22b'.

The biological tissue in which the indwelling clips of the above-described embodiments are used is not particularly limited. Examples of the biological tissue include hollow organs such as the digestive tract, trachea, bladder, bile duct, pancreatic duct, ureter, renal tract, liver, kidney, and lung. In addition, the indwelling clip of the invention can also be used for applications other than partial hollow organ excision.

In the sixth embodiment, the fluorescent body 3e is integrated with the grip portion 22b' of the arm plate portion <NUM>' by insert molding. Alternatively, the fluorescent body 3e may be fixed to the grip portion 22b' by means such as adhesion.

In the sixth embodiment, the fluorescent body may be engaged with the through hole 22c formed in the arm plate portion <NUM>. In this case, the through hole 22c may be partially covered with the fluorescent body. For example, only the vicinity of the peripheral edge of the through hole 22c may be covered with the fluorescent body.

Claim 1:
An indwelling clip (<NUM>) comprising a clip main body (<NUM>) including:
a pair of arm plate portions (<NUM>,<NUM>) capable of opening in a substantially V shape with an elastic force;
claw portions (<NUM>,<NUM>) formed on respective tip portions of the arm plate portions (<NUM>,<NUM>); and
a fastening ring (<NUM>) attached to the arm plate portions (<NUM>,<NUM>) so as to be movable along a longitudinal direction of the pair of arm plate portions (<NUM>,<NUM>) and be able to close the pair of arm plate portions (<NUM>,<NUM>) by moving in a direction of the claw portions (<NUM>,<NUM>),
wherein an outer surface of at least one of the claw portions (<NUM>,<NUM>) is provided with a fluorescent body (<NUM>) containing a fluorescent pigment emitting red or near infrared light by being irradiated with excitation light, and
characterised in that the fluorescent body (<NUM>) is an extrusion molded body or an injection molded body of a polymer material composition containing the fluorescent pigment.