CA1139628A - Hemostatic clip applying instrument - Google Patents
Hemostatic clip applying instrumentInfo
- Publication number
- CA1139628A CA1139628A CA000396120A CA396120A CA1139628A CA 1139628 A CA1139628 A CA 1139628A CA 000396120 A CA000396120 A CA 000396120A CA 396120 A CA396120 A CA 396120A CA 1139628 A CA1139628 A CA 1139628A
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- Canada
- Prior art keywords
- clip
- deforming
- clips
- pusher
- jaws
- Prior art date
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Abstract
ABSTRACT OF THE DISCLOSURE
A repeating hemostatic clip applying instrument is disclosed. Shaped like a pair of dog-nosed pliers, the other ends of the jaws are adapted to hold a clip which may be applied to a blood vessel with the instrument. The rear-ward portion of the jaws overlap and a rectangular channel is formed in one of them through which clips may be pushed by a pusher extending down the center line of the instru-ment. One of the jaws is adapted to receive a cartridge containing a stack of U-shaped clips which may be pushed one at a time to the distal end of the jaws by the pusher.
The instrument basically comprises only three pivoted members, the pusher and its operating linkage, and one or two springs. Several forms of pusher-actuating means are disclosed, two of these include a bell crank and cam so that the pusher will be operated before the jaws can be closed. The third comprises a free bell crank and a pair of unbalanced springs to achieve the same object. The cart-ridge is provided with a spring for urging the U-shaped stack of clips down to the pusher channel, and a clip follower for preventing misalignment of the clips in the cartridge. These above and various other features operate together in a synergistic manner to apply a plurality of hemostatic clips in a surprisingly simple, light instrument providing an almost conventional "feel"
A repeating hemostatic clip applying instrument is disclosed. Shaped like a pair of dog-nosed pliers, the other ends of the jaws are adapted to hold a clip which may be applied to a blood vessel with the instrument. The rear-ward portion of the jaws overlap and a rectangular channel is formed in one of them through which clips may be pushed by a pusher extending down the center line of the instru-ment. One of the jaws is adapted to receive a cartridge containing a stack of U-shaped clips which may be pushed one at a time to the distal end of the jaws by the pusher.
The instrument basically comprises only three pivoted members, the pusher and its operating linkage, and one or two springs. Several forms of pusher-actuating means are disclosed, two of these include a bell crank and cam so that the pusher will be operated before the jaws can be closed. The third comprises a free bell crank and a pair of unbalanced springs to achieve the same object. The cart-ridge is provided with a spring for urging the U-shaped stack of clips down to the pusher channel, and a clip follower for preventing misalignment of the clips in the cartridge. These above and various other features operate together in a synergistic manner to apply a plurality of hemostatic clips in a surprisingly simple, light instrument providing an almost conventional "feel"
Description
1:~3~.Z~3 HEMOSTATIC CLIP APPLYING INSTRU~ENT
-This invention relates to repeating hemostatic clip applying instruments. More particularly, it re-lates to the rapid and repeated ligation of so called bleeders in surgical procedures.
This application is a division of copending Canadian Patent Application Serial no. 288,310 filed October 7, 1977. The parent application claims a clip cartridge for use with the repeating hemostatic clip applying instrument of this application.
After a surgeon has made his incision, it is necessary to clamp the tissue wherever blood is being lost due to the cutting of blood vessels. The usual technique is to clamp each so-called bleeder with a hemo-stat (lockinq dog-nosed pliers) as soon after the vessel is severed as possible. This controls the loss of blood until a ligature can be tied around the vessel. As many a~ 20 or more bleeders may be clamped by as many hemo-stats in common surgical procedures before they are tied.
Thus, a single operation often requires the use o~ a large number of hemostats. These are handed to the sur-geon and his assistants, one at a time, by the scrub nurse.
The surgical field often becomes cluttered with hemostats, which interfere with the surgeon's view and hinder the convenient application of additional hemostats.
However, a good surgical practice requires the appli-cation of hemostats to all bleeders before any are tied.
The tying process requires one hand to hold the hemostat and two hands to pass the suture material a-round the hemostat and to form the ligature by tying a knot. This procedure thus requires two people. In addition, the ligatures must be cut and the excess suture material removed from the incision. The used hemostats must be handed to the scrub nurse and be readied for reuse.
Thus, this entire technique for the achievement of hemo-stasis requires the coordination and teamwork of at least thre~ people. The speed with which the bleeders may be tied off is often the determining factor in the time --`` 1139~8 required for the opening stages of many surgical oper-ations.
Many instruments have been disclosed in the prior art for ligating bleeders. However, none of these have come into general use, due to inherent deficiencies.
Instruments such as disclosed in United States Patent Nos. 3,033,204, 3,040,747, and 3,169,526, issued to E.C. Wood; United States Patent No. 2,268,755, issued to S.F. Li; and United States Patent No. 1,635,602, issued to H.G. Gould et al, have been designed for aiding the surgeon in applying a single pretied length of suture material to a bleeder. Other instruments, such as that disclosed in United States Patent No. 2,371,082 issued to F. Vistreich are designed to apply a single collar of resilient material to a deep bleeder. However, these in-struments, since they apply only one ligature at a time after which another preformed ligature must be affixed to the instrument before it can then be applied to the next bleeder, do not materially reduce the amount of time or effort required in a surgical procedure. Other more com-plex instruments, such as disclosed in United States Patent Nos. 2,898,915 and 2,898,916, issued to K. Kammer, have been devised for automatically tying a successive plurality of ligatures from a spool of suture material. I disclosed a repeating ligature gun for applying a plurality of pre-tied or preformed ligatures (United States Patent No.
3,687,138). However, these prior art instruments are com-plex, are difficult to load with the suture material, and, being complicated, are hard to disassemble and sterilize.
None of the above prior art instruments has come into general use.
In order to obviate some of the above problems in the prior art, hemostatic clips have come into wide-- spread use in surgery in recent years. In current surgical practice, these clips are used not only for occluding blood vessels but also for application to other structures such as nerves; for example, in vagotomy. A number of efforts have been made to facilitate loading of the clips into the instrument. This generally is done one at a time l~ Z8 by a scrub nurse who then hands the instrument to the surgeon for application and receives the empty instrument back for reloading with another single clip. As the clips are small and difficult to handle, cartridges which hold the clips and then aid in loading the clips one at a time into the instrument have been developed. Since the clips are not firmly held in the instruments, they sometimes fall out during handling of the instrument by the scrub nurse and the surgeon priox to application.
What is needed is an instrument which will rapidly and repeatedly clamp and ligate bleeders; an instrument that can be operated with one hand; an in-strument which does not leave any excess material, such as cut ends in the incision; an instrument whiah may be reloaded by means of a cartridge with a plurality of pre-formed ligatures repeatedly during an operation; and an instrument which is easy to disassemble and sterilize.
It is also desirable that the instrument handle as much as possible in the same manner as prior art surgical instruments such as towel clamps, hemostats, and clip appliers. Furthermore, it would be a highly desirable feature of such an instrument if it were adapt-ed to apply a hemostatic clip which has already been accepted in surgical practice and in particular approved by the Food and Drug Administration (FDA) for retention in the human body as the provision of any other material or even shape of clip or preformed ligature may be occas-ioned with years o tests and delay before FDA approval may be secured.
In accordance with the present invention, there is provided a apparatus for applying hemostatic clips to body tissue comprising; means for storing a plurality of undeformed hemostatic clips having elongated, spaced-apart arms; clip deforming means for receiving, holding and deforming a clip, the deformation occurring by flattening the clip through movement of the spaced-apart arms towards one another; means ~.,2~
for feeding one clip at a time from the means for skoring to the clip deforming means; and actuating means, including two relatively moveable handles engageable by one hand, for sequentially actuating the clip feeding means and the clip 5 deforming means to first cause the clip feeding means to move a clip from the means for storing to the clip deforming means and to then cause the clip deforming means to deform the clip.
Such an apparatus or instrument enables the 10 problems o~ the prior art to be overcome and a plural-ity of clips to be applied one at a time from a single instrument in simple, efficient manner using the action of a single hand.
The means for storing a plurality of unde-formed hemostatic clips, may take the form of a cart-ridge as defined in the parent application. In general, the cartridge of the present application comprises means for holding a stack of generally U-shaped clips aligned perpendicular to the plane of the pusher channel, a spring to push the clips toward the pusher channel, a bottom stop for preventing the clips from ~alling out of the c~idge, interlocking mechanism for interlocking the cartridge with the instrument, a clip fol-lower between the stack of clips and the spring mechanism, and finger grips for ease of application and removal of the 25 cartridge to or from the instrument. As used therein and also herein, U-shaped indicates a clip having two substan-tially parallel arms connected by a bight of constant radius, by a V-shaped section, or by any variation of these.
The clips used in this invention are preferably 30 rectangular in cross section and provided with a knurled pattern on the inside surface to help retain tissue. A
rectangular cross section having a height/width ratio of
-This invention relates to repeating hemostatic clip applying instruments. More particularly, it re-lates to the rapid and repeated ligation of so called bleeders in surgical procedures.
This application is a division of copending Canadian Patent Application Serial no. 288,310 filed October 7, 1977. The parent application claims a clip cartridge for use with the repeating hemostatic clip applying instrument of this application.
After a surgeon has made his incision, it is necessary to clamp the tissue wherever blood is being lost due to the cutting of blood vessels. The usual technique is to clamp each so-called bleeder with a hemo-stat (lockinq dog-nosed pliers) as soon after the vessel is severed as possible. This controls the loss of blood until a ligature can be tied around the vessel. As many a~ 20 or more bleeders may be clamped by as many hemo-stats in common surgical procedures before they are tied.
Thus, a single operation often requires the use o~ a large number of hemostats. These are handed to the sur-geon and his assistants, one at a time, by the scrub nurse.
The surgical field often becomes cluttered with hemostats, which interfere with the surgeon's view and hinder the convenient application of additional hemostats.
However, a good surgical practice requires the appli-cation of hemostats to all bleeders before any are tied.
The tying process requires one hand to hold the hemostat and two hands to pass the suture material a-round the hemostat and to form the ligature by tying a knot. This procedure thus requires two people. In addition, the ligatures must be cut and the excess suture material removed from the incision. The used hemostats must be handed to the scrub nurse and be readied for reuse.
Thus, this entire technique for the achievement of hemo-stasis requires the coordination and teamwork of at least thre~ people. The speed with which the bleeders may be tied off is often the determining factor in the time --`` 1139~8 required for the opening stages of many surgical oper-ations.
Many instruments have been disclosed in the prior art for ligating bleeders. However, none of these have come into general use, due to inherent deficiencies.
Instruments such as disclosed in United States Patent Nos. 3,033,204, 3,040,747, and 3,169,526, issued to E.C. Wood; United States Patent No. 2,268,755, issued to S.F. Li; and United States Patent No. 1,635,602, issued to H.G. Gould et al, have been designed for aiding the surgeon in applying a single pretied length of suture material to a bleeder. Other instruments, such as that disclosed in United States Patent No. 2,371,082 issued to F. Vistreich are designed to apply a single collar of resilient material to a deep bleeder. However, these in-struments, since they apply only one ligature at a time after which another preformed ligature must be affixed to the instrument before it can then be applied to the next bleeder, do not materially reduce the amount of time or effort required in a surgical procedure. Other more com-plex instruments, such as disclosed in United States Patent Nos. 2,898,915 and 2,898,916, issued to K. Kammer, have been devised for automatically tying a successive plurality of ligatures from a spool of suture material. I disclosed a repeating ligature gun for applying a plurality of pre-tied or preformed ligatures (United States Patent No.
3,687,138). However, these prior art instruments are com-plex, are difficult to load with the suture material, and, being complicated, are hard to disassemble and sterilize.
None of the above prior art instruments has come into general use.
In order to obviate some of the above problems in the prior art, hemostatic clips have come into wide-- spread use in surgery in recent years. In current surgical practice, these clips are used not only for occluding blood vessels but also for application to other structures such as nerves; for example, in vagotomy. A number of efforts have been made to facilitate loading of the clips into the instrument. This generally is done one at a time l~ Z8 by a scrub nurse who then hands the instrument to the surgeon for application and receives the empty instrument back for reloading with another single clip. As the clips are small and difficult to handle, cartridges which hold the clips and then aid in loading the clips one at a time into the instrument have been developed. Since the clips are not firmly held in the instruments, they sometimes fall out during handling of the instrument by the scrub nurse and the surgeon priox to application.
What is needed is an instrument which will rapidly and repeatedly clamp and ligate bleeders; an instrument that can be operated with one hand; an in-strument which does not leave any excess material, such as cut ends in the incision; an instrument whiah may be reloaded by means of a cartridge with a plurality of pre-formed ligatures repeatedly during an operation; and an instrument which is easy to disassemble and sterilize.
It is also desirable that the instrument handle as much as possible in the same manner as prior art surgical instruments such as towel clamps, hemostats, and clip appliers. Furthermore, it would be a highly desirable feature of such an instrument if it were adapt-ed to apply a hemostatic clip which has already been accepted in surgical practice and in particular approved by the Food and Drug Administration (FDA) for retention in the human body as the provision of any other material or even shape of clip or preformed ligature may be occas-ioned with years o tests and delay before FDA approval may be secured.
In accordance with the present invention, there is provided a apparatus for applying hemostatic clips to body tissue comprising; means for storing a plurality of undeformed hemostatic clips having elongated, spaced-apart arms; clip deforming means for receiving, holding and deforming a clip, the deformation occurring by flattening the clip through movement of the spaced-apart arms towards one another; means ~.,2~
for feeding one clip at a time from the means for skoring to the clip deforming means; and actuating means, including two relatively moveable handles engageable by one hand, for sequentially actuating the clip feeding means and the clip 5 deforming means to first cause the clip feeding means to move a clip from the means for storing to the clip deforming means and to then cause the clip deforming means to deform the clip.
Such an apparatus or instrument enables the 10 problems o~ the prior art to be overcome and a plural-ity of clips to be applied one at a time from a single instrument in simple, efficient manner using the action of a single hand.
The means for storing a plurality of unde-formed hemostatic clips, may take the form of a cart-ridge as defined in the parent application. In general, the cartridge of the present application comprises means for holding a stack of generally U-shaped clips aligned perpendicular to the plane of the pusher channel, a spring to push the clips toward the pusher channel, a bottom stop for preventing the clips from ~alling out of the c~idge, interlocking mechanism for interlocking the cartridge with the instrument, a clip fol-lower between the stack of clips and the spring mechanism, and finger grips for ease of application and removal of the 25 cartridge to or from the instrument. As used therein and also herein, U-shaped indicates a clip having two substan-tially parallel arms connected by a bight of constant radius, by a V-shaped section, or by any variation of these.
The clips used in this invention are preferably 30 rectangular in cross section and provided with a knurled pattern on the inside surface to help retain tissue. A
rectangular cross section having a height/width ratio of
2/1 is particularly preferred to prevent the clips from twisting as they are closed and to provide the closed clip 35 with a square cross section. The clip may be of any conven-ient size and constructed of any biomedically acceptable material. A particularly preferred clip is one formed of tantalum and having a uniform rectangular cross section of 0.015 in. wide by 0.030 in. high. The inside surface of the ~3~
clip is preferably coined in a diamond knurl pattern to in-crease the gripping power of the clip on the tissue.
In general, the instrument to which the present invention is directed is similar in function to existing single clip applying instruments such as disclosed in United States Patent No. 3,713,533, in that with one actu-ation of the instrument, one clip is applied to tissue by being crushed thereabout by a pair of jaws. The clips are preferably also of substantially the same material size and shape when closed about the tissue as the formed clips disclosed in that patent. The instrument is so designed that in its preferred embodiment it is substantially similar in shape to present single clip applying instruments which are, in fact, designed much like numerous types of hemo-stats and other surgical clamps, having t~o ring handlesand a generally elongated form which permits controlled handling and good visibility at the tip.
The present invention differs from single clip applying instruments in that a disposable cartridga is pro-vided which holds a plurality of clips and feeds them tothe instrument one at a time. Other instruments have been patented for repeatedly applying surgical clips or ligatures such as disclosed in United States Patent Nos. 2,277,139, 2,968,041, 3,082,426, 3,844,289, 3,638,847 and my Patent ~o. 3,841,521. However, although the need for a repeating hemostatic clip applying instrument has been recongnized for decades, none is presently in the market or in clinical use.
Deficiencies in prior art repeating instruments which have led to their nonuse in clinical practice may be categorized as: overly complex instruments with a very large number of parts; instruments which obscure the physicians' field of view; gun type instruments which meet great resistance on the part of surgeons used to ring-handled plier type instruments; instruments with a greatmany small moving interfaces between parts which make them subject to frictional failure, extremely difficult to sterilize without disassembly, and extremely difficult to disassemble and re-assemble for good sterilization practice;
`-~ 113~ 8 lack of simple replaceable cartridges; operation which requires pulling of tissue into the instrument; and com-plex cartridge mechanisms which lead to prohibitive cart-ridge costs.
The inventor has recognized that optimal vis-ibility to the tip, incorporation of an inexpensive multiple clip containing cartridge which can be rapidly changed, and completely automatic one hand operation, preferably with a ring handle configuration, are crucial if the instrument is to be clinically useful.
A new principle unique to all clip applying instruments is employed. The disposable cartridge, re-movably mounted on the instrument, holds a plurality of clips in alignment with a channel on the instrument. The instrument then removes the clips, one at a time, from the cartridge and feeds them through the channel to the jaws for application to the tissue. This principle of having the cartridge feed the clips to a position on the instrument remote from the jaws and then having the instrument feed each clip to the jaws permits the cartridge to be placed remote from the jaws, out of the line of visibility. It also permit~ the simplest possible construction of the jaws, that is, of only two pieces, which further aids visibility.
The instrument thus has a pair of clip applying jaws with a channel leading thereto from a remote position where the cartridge containing a plurality of clips may be removably affixed. It, in addition, has a clip feed mechanism and appropriate sequencing and spring return means so that, in operation, when a pair of ring handles are squeezed together, the forwardmost clip is removed from the cartridge, fed to the jaws and clamped about tissue positioned therebetween, and, upon release, the instrument returns to a position ready to repeat.
The instrument is basically comprised of four main portions: (1) a first pivoted member comprising a ring handle with a wide distal portion terminating in one jaw member; (2) a second pivotal member having a wide distal portion terminating in the other jaw member; (3) a clip 1~3~
pushing mechanism; and (4) an elongated ring handle. One of the distal portions is provided with a channel for a pusher to push the hemostatic clips to the jaws. This distal portion also has a cartridge receiving portion.
The other distal portion acts as a cover for the channel.
A linkage is provided between the ring handles and the clip pushing mechanism for pushing the clip out of the cart-ridge, forward to the jaws and then allowing the jaws to close. This is accomplished in two embodiments of the in-ven*ion by providing a rotating bell crank on a proximal ` extension of the pusher channel member.
The bell cranks each have a cam which is engagedby an extension on one of the ring handles and is operated by an extension on the other ring handle to rotate when the handles are first closed to operate the push member. The cam has a cut away portion into which the extension on the opposite r~ng handle then falls to allow the handle to close and close the jaws.
In another embodiment, the bell crank is free float ing and is connected by its center pivot to one ring handle and at one of its outer pivots to the other ring handle, and at the other outer pivot to a link connected to the pusher. This free floating bell crank linkage, by its geometry, causes the pusher to be operated against the force of a weak spring. Thereafter the ring handle to which no jaw is connected, biased by another spring, is able to come down against a surface of the jaw mechanism to which no ring handle is connected to close the jaws.
The invention accordingly comprises articles of manufacture possessing the features, properties and the relations of elements which will be exemplified in the articles hereinafter described, and apparatus comprising the features of construction, combinations of elements and arrangements of parts which will be exemplified in the con-structions hereinafter set forth. The scope of the in-vention is indicated in the claims.
For a fuller understanding of the nature of the invention, reference should be had to the following detail-ed description taken in connection with the accompanying ri ~3~
drawings, in which:
FIGURE 1 is a top perspective view of a repeat-ing hemostatic clip applying instrument and multi-clip cartridge therefor assembled in accordance with one embodiment of the invention and ready for operation;
FIGURE 2 is a top view of the instrument shown in FIGURE 1 in partial cross section along the plane 2-2 of FIGURE l;
FIGURE 3 is an enlarged top view, partially cut away, of the instrument shown in FIGURE 1 with the cross section of FIGURE 2 extended and the instrument partially actuated to move a clip from the cartridge to the clip applying jaws;
FIGURE 4 is an enlarged top view, partially in cross sectio.n, similar to FIGURE 3 showing the instrument fully actuate~ to close the clip between the jaws;
FIGURE 5 is an enlarged cut away view showing a detail of the jaws of the instrument of FIGURE l;
FIGURE 6 is a cross-sectional view, partially cut away, taken along the line 6-6 of FIGURE 2;
FIGURE 7 is an enlarged exploded perspective cut away view of the clip applying jaws and a portion of the cartridge mount of the instrument of FIGURE l;
FIGURE 8 is an exploded diagrammatic view showing the small number of basic parts of the instrument of FIGURE l;
FIGURE 9 is an enlarged cross-sectional cut away view taken along the plane 9-9 of FIGURE 2;
FIGURE 10 is a top cross-sectional cut away view taken along the line 10-10 of FIGURE 9;
FIGURE 11 is a cross-sectional view taken along the line 11-11 of FIGURE 9;
FIGURE 12 is an enlarged top perspective view of the cartridge used in the instrument of FIGURE 1 and con-structed in accordance with the invention of parent applica-tion Serial No. 288,310;
FIGURE 12A is an end plan view of the cartridge shown in FIGURE 12;
FIGURE 13 is an enlarged perspective bottom view 1~L3~Z~3 similar to FIGURE 12;
FIGURE 14 is an enlarged perspective diagram-matic top view of the clips and clip follower used in the cartridge of FIGURE 12;
FIGURE 15 is a partial cross-sectional top view, partially cut away, similar to FIGURE 2, of an alternative embodiment of the invention having a different clip ad-vancing mechanism;
FIGURE 16 is a top view partially in cross-section and partially cut away similar to FIGURE 15 showing the alternative embodiment with the clip advance mechanism fully advanced;
FIGURE 17 is a partial cross-sectional view partially cut away taken along the line 17-17 of FIGURE 15;
FIGURE 18 is a top perspective view similar to FIGURE 1, partially cut away, of a urther alternative embodiment of the invention having curved jaws for im-proved handling and visibility, FIGURES 15 to 18 being located on the same sheet of drawings as FIGURE l;
FIGURE 19 is a top plan view of another alter-nati~e embodiment of the invention having a single pivot and a floating bell crank pusher actuating mechanism;
FIGURE 20 is a top plan diagrammatic view of an alternative form of clip cartridge constructed in accord-ance with the invention of parent application Serial No.
288,310; and FIGURE 21 is a top plan view of a U-shaped clip having a V-shaped connecting section.
In the following description of the drawings, the 30. same reference characters refer to the same elements throughout the several views of the drawings.
More particularly, referring to FIGURE 1, a re-peating hemostatic clip applying instrument according to the invention is generally indicated at 42. It comprises a left and a right jaw 44 and 46 at the end of left and right distal end portions 4 8 and 50.
Referring to FIGURES 1 and 8, left jaw 44 is mounted to the distal end 48 of a left jaw actuating member generally indicated at 52 comprising the aforesaid distal ~40 end 48, pivot hole 54, handle shaft 56, handle ring 58, and _ g _ ~39~8 sequencing stop extension 60.
Distal end 48 is provided with a cartridge clearance cut out 62 (see also FIGURES 7 and 9). A jaws return spring 64 is attached to the handle shaft 56 by means of appropriate rivets, screws, or the like 66.
Still referring to ~IGURES 1 and 8, particularly FIGURE 8, the right jaw 46 and right distal extension 50 are part of a single main }~ody generally indicated at 68.
Main body 68 has a pivot hole 70, commonly pivoted to pivot hole 54 on left jaws actuating member 52 around a pivot 72 shown in FIGURE 1. The main body 68 has a chan-nel formed therein by alternating slots 74 in the bottom thereof and 76 in the top thereof which overlap to form a continuous channel which terminates at an elongated cut out 78 for receiving the cartridge senerally indicated at 80.
The pusher channel is extended as clip channel 82 on the bottom side of the distal end 50 of the main body 68 to the right jaw 46.
The main body 68 is also provided with stabiliz-ing flangea 84, béll crank pivot hole 86, a pusher actuat-ing member stop 88, a pusher actuating ~ber pi~t 90 to w~ich a push-er actuating m~rber, generally indicated at 92, is pivoted by-m3ans of a pi~t hole 94 therein, and a pivot 96 (FIGt~æ 1) .
Still referring to FIGURES 1 and 8, particularly FIGURE 8, the pusher actuating member 92 comprises a handle shaft 96, a ring handle 98, and a bell crank actuator ex-tension 100 having a ~ell crank pivot slot 102 therein. The pusher actuating member 92 is provided with a pusher return spring 104 which is preferably less strong than the jaws return spring 64.
Still referring to FIGURES 1 and 8, particularly FIGURE 8, a clip pusher, generally indicated at 106, is preferably provided with a thin forward portion 108 and thic3~ rearward portion 110. It is connected by means of pivot 112 to a pusher link 114, which in turn is connected by means of a pivot 116 to a bell crank, generally indicated at 118. As best seen in FIGURE 1, bell crank 118 is pro-vided at one end with a bifurcated arm 122 straddling a ~ 3~621~3 narrow portion of pusher link 114 and at its opposite end with a bifurcated arm 124 straddling bell crank actuator extension 100. Pivot pin 126 is fi~ed in arm 124 and rides in bell crank pivot slot 102 (FIGURE 8).
Still referring to FIGURES 1 and 8, the bell crank 118 is provided with a sequencing stop surface 128 on which sequencing stop extension 60 rides, a sequencing drop-off cut out 130 and a main pivot 132 pivoted to the bell crank pivot hole 86 by means of pivot 134 (FIGURE 1) -sequencing stop surface 128 and cut out 130 forming a cam.
The main body 68 is relieved at 95 for rotation of bell crank 118 and at 95' for rotation of the link 114 and rotation of bell crank 118 (FIGURES 1 and 2).
Now referring to FIGURES 9 through 13, a plural-ity of U-shaped hemostatic clips, generally indicated at 136, are stacked vertically in clip chamber 170 of cart-ridge 80 formed by guide means 158, 160 and 166. Clip stack 136 is perpendicular to the plane of pusher 106 with lowermost clip 142 resting in the plane of pusher 106 on clip stop platform 162. Platform 162 cooperates with clip chamber guide means to form a rearward aperture for re-ceiving pusher 106 and a forward rectangular slot 169 for passing clip 142 from the cartridge. Clip guide means 152 which also functions as an interlocking mechanism for inter-locking the cartridge with the instrument, has a channelcorresponding in width to the width of clips 136 and slot 169 for guiding and aligning clip 142 as it is pushed from the clip stack into clip channel 82 by pusher 106. Lower-most clip 142 resting on platform stop 162, forward slot 169 and the channel in clip guide 152, are all aligned with clip channel 82 extending to jaws 44 and 46 when cartridge 80 is mounted on instrument 42 as best seen in FIGURE 9.
In operation, with the cartridge 80 mounted to the instrument 42 as illustrated in FIGURES 1 through 4, the pusher 106 extends to just behind the clips 136. The surgeon places the jaws 44-46 about tissues to be clipped.
He then closes the two ring handles 58-98. First the push~r actuating member 92 moves about pivot 97 against pusher return spring 104, this rotates the bell crank counter-clockwise pushing the pusher 106 by means of pusher link114 to cause the lowermost clip 142 (FIGURE 9) in the clip stack 136 to be advanced through slot 169 and the channel of clip guide means 152 into channel 82 to between the jaws 44 and 46 as shown in FIGURE 3. Since the jaws 44-46 surround tissue, the clip 142 is pushed around the tissue and remains in the jaws. As shown in FIGURES 5 and 7, the jaws 44-46 are preferably provided with clip slots 138 ex-tending from the clip channel 82 and opening at a two de-gree angle therefrom. This angle assures that the jaws willbe parallel when closed. Small detents (not shown) may be disposed at the forwardmost end of the clip slots 138 (FIGURE 7) to stop distal motion of the clip.
During the above action, and referring to FIGURE
clip is preferably coined in a diamond knurl pattern to in-crease the gripping power of the clip on the tissue.
In general, the instrument to which the present invention is directed is similar in function to existing single clip applying instruments such as disclosed in United States Patent No. 3,713,533, in that with one actu-ation of the instrument, one clip is applied to tissue by being crushed thereabout by a pair of jaws. The clips are preferably also of substantially the same material size and shape when closed about the tissue as the formed clips disclosed in that patent. The instrument is so designed that in its preferred embodiment it is substantially similar in shape to present single clip applying instruments which are, in fact, designed much like numerous types of hemo-stats and other surgical clamps, having t~o ring handlesand a generally elongated form which permits controlled handling and good visibility at the tip.
The present invention differs from single clip applying instruments in that a disposable cartridga is pro-vided which holds a plurality of clips and feeds them tothe instrument one at a time. Other instruments have been patented for repeatedly applying surgical clips or ligatures such as disclosed in United States Patent Nos. 2,277,139, 2,968,041, 3,082,426, 3,844,289, 3,638,847 and my Patent ~o. 3,841,521. However, although the need for a repeating hemostatic clip applying instrument has been recongnized for decades, none is presently in the market or in clinical use.
Deficiencies in prior art repeating instruments which have led to their nonuse in clinical practice may be categorized as: overly complex instruments with a very large number of parts; instruments which obscure the physicians' field of view; gun type instruments which meet great resistance on the part of surgeons used to ring-handled plier type instruments; instruments with a greatmany small moving interfaces between parts which make them subject to frictional failure, extremely difficult to sterilize without disassembly, and extremely difficult to disassemble and re-assemble for good sterilization practice;
`-~ 113~ 8 lack of simple replaceable cartridges; operation which requires pulling of tissue into the instrument; and com-plex cartridge mechanisms which lead to prohibitive cart-ridge costs.
The inventor has recognized that optimal vis-ibility to the tip, incorporation of an inexpensive multiple clip containing cartridge which can be rapidly changed, and completely automatic one hand operation, preferably with a ring handle configuration, are crucial if the instrument is to be clinically useful.
A new principle unique to all clip applying instruments is employed. The disposable cartridge, re-movably mounted on the instrument, holds a plurality of clips in alignment with a channel on the instrument. The instrument then removes the clips, one at a time, from the cartridge and feeds them through the channel to the jaws for application to the tissue. This principle of having the cartridge feed the clips to a position on the instrument remote from the jaws and then having the instrument feed each clip to the jaws permits the cartridge to be placed remote from the jaws, out of the line of visibility. It also permit~ the simplest possible construction of the jaws, that is, of only two pieces, which further aids visibility.
The instrument thus has a pair of clip applying jaws with a channel leading thereto from a remote position where the cartridge containing a plurality of clips may be removably affixed. It, in addition, has a clip feed mechanism and appropriate sequencing and spring return means so that, in operation, when a pair of ring handles are squeezed together, the forwardmost clip is removed from the cartridge, fed to the jaws and clamped about tissue positioned therebetween, and, upon release, the instrument returns to a position ready to repeat.
The instrument is basically comprised of four main portions: (1) a first pivoted member comprising a ring handle with a wide distal portion terminating in one jaw member; (2) a second pivotal member having a wide distal portion terminating in the other jaw member; (3) a clip 1~3~
pushing mechanism; and (4) an elongated ring handle. One of the distal portions is provided with a channel for a pusher to push the hemostatic clips to the jaws. This distal portion also has a cartridge receiving portion.
The other distal portion acts as a cover for the channel.
A linkage is provided between the ring handles and the clip pushing mechanism for pushing the clip out of the cart-ridge, forward to the jaws and then allowing the jaws to close. This is accomplished in two embodiments of the in-ven*ion by providing a rotating bell crank on a proximal ` extension of the pusher channel member.
The bell cranks each have a cam which is engagedby an extension on one of the ring handles and is operated by an extension on the other ring handle to rotate when the handles are first closed to operate the push member. The cam has a cut away portion into which the extension on the opposite r~ng handle then falls to allow the handle to close and close the jaws.
In another embodiment, the bell crank is free float ing and is connected by its center pivot to one ring handle and at one of its outer pivots to the other ring handle, and at the other outer pivot to a link connected to the pusher. This free floating bell crank linkage, by its geometry, causes the pusher to be operated against the force of a weak spring. Thereafter the ring handle to which no jaw is connected, biased by another spring, is able to come down against a surface of the jaw mechanism to which no ring handle is connected to close the jaws.
The invention accordingly comprises articles of manufacture possessing the features, properties and the relations of elements which will be exemplified in the articles hereinafter described, and apparatus comprising the features of construction, combinations of elements and arrangements of parts which will be exemplified in the con-structions hereinafter set forth. The scope of the in-vention is indicated in the claims.
For a fuller understanding of the nature of the invention, reference should be had to the following detail-ed description taken in connection with the accompanying ri ~3~
drawings, in which:
FIGURE 1 is a top perspective view of a repeat-ing hemostatic clip applying instrument and multi-clip cartridge therefor assembled in accordance with one embodiment of the invention and ready for operation;
FIGURE 2 is a top view of the instrument shown in FIGURE 1 in partial cross section along the plane 2-2 of FIGURE l;
FIGURE 3 is an enlarged top view, partially cut away, of the instrument shown in FIGURE 1 with the cross section of FIGURE 2 extended and the instrument partially actuated to move a clip from the cartridge to the clip applying jaws;
FIGURE 4 is an enlarged top view, partially in cross sectio.n, similar to FIGURE 3 showing the instrument fully actuate~ to close the clip between the jaws;
FIGURE 5 is an enlarged cut away view showing a detail of the jaws of the instrument of FIGURE l;
FIGURE 6 is a cross-sectional view, partially cut away, taken along the line 6-6 of FIGURE 2;
FIGURE 7 is an enlarged exploded perspective cut away view of the clip applying jaws and a portion of the cartridge mount of the instrument of FIGURE l;
FIGURE 8 is an exploded diagrammatic view showing the small number of basic parts of the instrument of FIGURE l;
FIGURE 9 is an enlarged cross-sectional cut away view taken along the plane 9-9 of FIGURE 2;
FIGURE 10 is a top cross-sectional cut away view taken along the line 10-10 of FIGURE 9;
FIGURE 11 is a cross-sectional view taken along the line 11-11 of FIGURE 9;
FIGURE 12 is an enlarged top perspective view of the cartridge used in the instrument of FIGURE 1 and con-structed in accordance with the invention of parent applica-tion Serial No. 288,310;
FIGURE 12A is an end plan view of the cartridge shown in FIGURE 12;
FIGURE 13 is an enlarged perspective bottom view 1~L3~Z~3 similar to FIGURE 12;
FIGURE 14 is an enlarged perspective diagram-matic top view of the clips and clip follower used in the cartridge of FIGURE 12;
FIGURE 15 is a partial cross-sectional top view, partially cut away, similar to FIGURE 2, of an alternative embodiment of the invention having a different clip ad-vancing mechanism;
FIGURE 16 is a top view partially in cross-section and partially cut away similar to FIGURE 15 showing the alternative embodiment with the clip advance mechanism fully advanced;
FIGURE 17 is a partial cross-sectional view partially cut away taken along the line 17-17 of FIGURE 15;
FIGURE 18 is a top perspective view similar to FIGURE 1, partially cut away, of a urther alternative embodiment of the invention having curved jaws for im-proved handling and visibility, FIGURES 15 to 18 being located on the same sheet of drawings as FIGURE l;
FIGURE 19 is a top plan view of another alter-nati~e embodiment of the invention having a single pivot and a floating bell crank pusher actuating mechanism;
FIGURE 20 is a top plan diagrammatic view of an alternative form of clip cartridge constructed in accord-ance with the invention of parent application Serial No.
288,310; and FIGURE 21 is a top plan view of a U-shaped clip having a V-shaped connecting section.
In the following description of the drawings, the 30. same reference characters refer to the same elements throughout the several views of the drawings.
More particularly, referring to FIGURE 1, a re-peating hemostatic clip applying instrument according to the invention is generally indicated at 42. It comprises a left and a right jaw 44 and 46 at the end of left and right distal end portions 4 8 and 50.
Referring to FIGURES 1 and 8, left jaw 44 is mounted to the distal end 48 of a left jaw actuating member generally indicated at 52 comprising the aforesaid distal ~40 end 48, pivot hole 54, handle shaft 56, handle ring 58, and _ g _ ~39~8 sequencing stop extension 60.
Distal end 48 is provided with a cartridge clearance cut out 62 (see also FIGURES 7 and 9). A jaws return spring 64 is attached to the handle shaft 56 by means of appropriate rivets, screws, or the like 66.
Still referring to ~IGURES 1 and 8, particularly FIGURE 8, the right jaw 46 and right distal extension 50 are part of a single main }~ody generally indicated at 68.
Main body 68 has a pivot hole 70, commonly pivoted to pivot hole 54 on left jaws actuating member 52 around a pivot 72 shown in FIGURE 1. The main body 68 has a chan-nel formed therein by alternating slots 74 in the bottom thereof and 76 in the top thereof which overlap to form a continuous channel which terminates at an elongated cut out 78 for receiving the cartridge senerally indicated at 80.
The pusher channel is extended as clip channel 82 on the bottom side of the distal end 50 of the main body 68 to the right jaw 46.
The main body 68 is also provided with stabiliz-ing flangea 84, béll crank pivot hole 86, a pusher actuat-ing member stop 88, a pusher actuating ~ber pi~t 90 to w~ich a push-er actuating m~rber, generally indicated at 92, is pivoted by-m3ans of a pi~t hole 94 therein, and a pivot 96 (FIGt~æ 1) .
Still referring to FIGURES 1 and 8, particularly FIGURE 8, the pusher actuating member 92 comprises a handle shaft 96, a ring handle 98, and a bell crank actuator ex-tension 100 having a ~ell crank pivot slot 102 therein. The pusher actuating member 92 is provided with a pusher return spring 104 which is preferably less strong than the jaws return spring 64.
Still referring to FIGURES 1 and 8, particularly FIGURE 8, a clip pusher, generally indicated at 106, is preferably provided with a thin forward portion 108 and thic3~ rearward portion 110. It is connected by means of pivot 112 to a pusher link 114, which in turn is connected by means of a pivot 116 to a bell crank, generally indicated at 118. As best seen in FIGURE 1, bell crank 118 is pro-vided at one end with a bifurcated arm 122 straddling a ~ 3~621~3 narrow portion of pusher link 114 and at its opposite end with a bifurcated arm 124 straddling bell crank actuator extension 100. Pivot pin 126 is fi~ed in arm 124 and rides in bell crank pivot slot 102 (FIGURE 8).
Still referring to FIGURES 1 and 8, the bell crank 118 is provided with a sequencing stop surface 128 on which sequencing stop extension 60 rides, a sequencing drop-off cut out 130 and a main pivot 132 pivoted to the bell crank pivot hole 86 by means of pivot 134 (FIGURE 1) -sequencing stop surface 128 and cut out 130 forming a cam.
The main body 68 is relieved at 95 for rotation of bell crank 118 and at 95' for rotation of the link 114 and rotation of bell crank 118 (FIGURES 1 and 2).
Now referring to FIGURES 9 through 13, a plural-ity of U-shaped hemostatic clips, generally indicated at 136, are stacked vertically in clip chamber 170 of cart-ridge 80 formed by guide means 158, 160 and 166. Clip stack 136 is perpendicular to the plane of pusher 106 with lowermost clip 142 resting in the plane of pusher 106 on clip stop platform 162. Platform 162 cooperates with clip chamber guide means to form a rearward aperture for re-ceiving pusher 106 and a forward rectangular slot 169 for passing clip 142 from the cartridge. Clip guide means 152 which also functions as an interlocking mechanism for inter-locking the cartridge with the instrument, has a channelcorresponding in width to the width of clips 136 and slot 169 for guiding and aligning clip 142 as it is pushed from the clip stack into clip channel 82 by pusher 106. Lower-most clip 142 resting on platform stop 162, forward slot 169 and the channel in clip guide 152, are all aligned with clip channel 82 extending to jaws 44 and 46 when cartridge 80 is mounted on instrument 42 as best seen in FIGURE 9.
In operation, with the cartridge 80 mounted to the instrument 42 as illustrated in FIGURES 1 through 4, the pusher 106 extends to just behind the clips 136. The surgeon places the jaws 44-46 about tissues to be clipped.
He then closes the two ring handles 58-98. First the push~r actuating member 92 moves about pivot 97 against pusher return spring 104, this rotates the bell crank counter-clockwise pushing the pusher 106 by means of pusher link114 to cause the lowermost clip 142 (FIGURE 9) in the clip stack 136 to be advanced through slot 169 and the channel of clip guide means 152 into channel 82 to between the jaws 44 and 46 as shown in FIGURE 3. Since the jaws 44-46 surround tissue, the clip 142 is pushed around the tissue and remains in the jaws. As shown in FIGURES 5 and 7, the jaws 44-46 are preferably provided with clip slots 138 ex-tending from the clip channel 82 and opening at a two de-gree angle therefrom. This angle assures that the jaws willbe parallel when closed. Small detents (not shown) may be disposed at the forwardmost end of the clip slots 138 (FIGURE 7) to stop distal motion of the clip.
During the above action, and referring to FIGURE
3, the sequencing stop extension 60 has been riding on the sequencing stop surface 128 of the bell crank 118. How-ever, oncethe pusher 106 has advanced to its farthest position (at this position pusher actuating member handle shaft 96 contorts stop 88), the sequencing stop extension 60 drops into the sequencing drop cutoff 130 on the bell crank 118.
This allows the left jaw actuating member 52 to rotate about pivot pin 72 thereby bringing the left jaw 44 against the right jaw 46, to close the clip 142 all as shown in FIGURE
This allows the left jaw actuating member 52 to rotate about pivot pin 72 thereby bringing the left jaw 44 against the right jaw 46, to close the clip 142 all as shown in FIGURE
4. The sequencing drop cutoff 130 positively prevents re-turn of the pusher 106 so that the clip is positively lock-ed between tissue, jaws 44-46, and the ~istal end of the pusher 106 until the jaws are closed.
When the surgeon now releases the pressure on the handle shafts 56 and 96 of the left jaw actuating member 52 and pusher actuating member 92, the jaw return spring 64 first rotates left jaw actuating member 52 about pivot pin 72 under action of the jaws return spring 64 until it comes against the head of adjustment screw 144 mounted to the main body 68. Cam surface 130, being released by stop extension 60, rotates about pivot 134 and pusher actuating member 92, under the action of pusher return spring 104, rotates about pivot 97 returning the instrument to its rest position shown in FIGURE 2.
The clips may also be mounted in the cartridge 80 ~3~`2~3 with their open ends slightly resiliently pressed together so that they tend to widen when released. This allows them to widen when they reach the jaws 44-46 and to be resil-iently retained therein. Alternatively, the clearance be-tween the jaws may be made smaller than the channel throughwhich the clips are pushed, so that they are resiliently squeezed down when they reach the jaws to be retained there-in. The clip slots may also be provided with transversely oriented serrations for retaining the clips therein, in the manner disclosed in U.S. Patent No. 3,713,533.
Again, referring to FIGURES 9 through 13, the cartridge 80 comprises a main body portion 146, preferably of transparent plastic material for low cost manufacture and to allow the user to see the number of clips 136 re-maining in the stack or magazine and a leaf spring 148mounted thereto, by suitable attachment means, for example, a screw 150. Those skilled in the art will understand that spring 148 may be attached by means of a heat sealed plastic rivet or might even be integrally molded with the body 146 if a suitable plastic were employed. The cartridge 80 fits snugly into cartridge cut out 78 in right jaw extension 50.
The forward end of the cartridge body 146 is provided with a forward clip guide means and retention tongue 152. Since the cartridge closely fits into the cut out 78, no other retention means is required. However, a detent and recess may be provided at the rear extension 154 of the cartridge body 146 and the rear end 156 of the cut out 78, or on other suitable parts of the cartridge and adjacent parts of the instrument.
The cartridge body is provided with guide surfaces 158 and 160 for guiding the clip magazine or stack 136 and at the bottom thereof with a clip platform stop 162, which fits into the cartridge clearance cut out 62 in the distal left jaw entension 48. The end of the spring 164 preferably extends through a cut out 166 to provide a visual indication of the number of clips remaining in the stack 136.
Spring pressures and friction prevents bottom clip 142 from moving either forward or rearward when the cartridge is out of the instrument. A clip follower 172 is ~l3~6;~13 provided for applying the force of the spring 148 against the clip stack 136 in an even manner. To this end, the clip follower 172 is provided with a clip follower fulcrum ridge 174 within a clip follower spring guide slot gen-erally indicated at 176. Since the clip follower fulcrumridge 174 is at the middle of the clip follower 172, the force is applied evenly to the clip stack 136 and the clip stack cannot rock out of alignment with the clip channel extension 82.
: 10 An alternative form sequencing mechanism is em-ployed in the alternative embodiment illustrated in FIGURES
15, 16, and 17. Here, the bell crank, generally indicated at 180, is provided with a sequencing stop extension accept-ing slot 182 for receiving an elongated sequencing stop extension 184 mounted to the handle shaft 56 of the left jaw actuating member generally indicated at 52. The push-er slide channel 186 is formed in two pieces, I88 and 190, joined together by a plurality of fasteners 192. A single spring 194 is employed which is mounted to handle 56 by rivets or screws 196 and acts between handle 56 and bell crank actuator extension 100 by means of ears 198 acting on extended pivot pin 200.
Referr-ng to FIGURE 17 in this embodiment of the invention, the bell crank 180 is provided with a narrow arm 202 which fits into a slot 204 formed in the bell crank actuator extension 100.
In another alternative form of the invention, il-lustrated in FIGURE 18, the thin forward portion 108 of the clip pusher 106 (not shown) is made flexible and the dis.tal extensions 50 and 48 are curved for better visibility of the tip for use by surgeons who are used to curved or offset hemostatic instruments. The cartridge 80 may be, but need not be, conformed to this c~rvature which may be restricted to the portion of the instrument between the jaws 44 and 46 and the rearward end of the cartridge 80.
Now referring to FIGURE 8, those skilled in the art will understand, upon reflection, that the two pivot points of pivot holes 54 and 70 and pivot holes 90 and 94 respec-tively, could be combined into common axis. That is, pivot ~3~21 3 hole 70 could be eliminated and pivot hole 54 moved down until it was in line with pivot holes 90 and 94 when the instrument was assembled. Furthermore, the cartridge cut out 50 and main body 68 could be formed as part of the left jaws actuating member in which case the right jaws actu-ating member would comprise only the right jaw 46, the distal extension 50, the pivot hole 90, and the pusher actuating member stop 88, which also acts as the right jaws actuating member when contacted by the handle shaft 96 of the pusher actuating member 92.
Now referring to FIGURE 19, a single pivot instru-ment is generally indicated at 220. It comprises a main body 222 having a jaws extension 224 terminating in lower jaw 226. The upper finger loop extension 228 is integral with the main body 222 and terminates in upper finger loop 230. Lower finger loop extension 232 is pivoted to the main body at pivot 234 and terminates in lower finger loop 236. Upper jaw 238 is mounted to an arm also pivoted at pivot 234 and terminating at an asymmetrical T-shaped extension generally indicated at 240. The lowermost ex-tension 242 is contacted with lower finger loop extension 232 when the two finger loops 230 and 236 are brought to-gether and this causes the T-shape extension 240 and the upper jaw 238 to pivot about pivot 234 against the action of a spring 244 mounted at one end to finger loop extension 228 and engaging the uppermost portion 246 of the T-shaped extension 240.
The pusher mechanism is mounted in the main body 222 and a portion of the pusher channel 248 may be seen.
The distal end of the pusher 250 is pivoted at pivot 252 to link 254. Link 254 is pivoted at pivot 256 to floating bell crank 258 which is pivoted at pivot 260 and connected at its other end at pivot 262 to lowermost finger loop extension 232. Pivot 260 is connected to link 264 which in turn is connected at its other end at pivot 266 to spring 265 which may be integral with spring 244 both being mounted to upper-most finger loop extension 228. Travel of spring 265 is preferably limited by stop 268 integrally formed with upper-most finger loop extension 228.
When the two finger loops 230 and 236 are broughttogether pivot 260 moves to position 260' and the linkages and other pivots mo~e to the positions shown by the dotted lines and circles connected to point 260'. This causes the pusher to move fully forward pushing the clip from the cartridge 269 forward in between the jaws 226 and 238. As the front end of finger loops 230 and 236 are brought closer together, pivot 266 moves to point 266' and lowermost finger loop extension 232 ves to position 232' shown by dotted lines thus engaging the T-extension 240 and closing the uppermost jaw 238 against the lower jaw 226.
Now referring to FIGURE 20, an alternative form of clip cartridge 270 having clipstack 272 therein may be pro-vided with an internal clip leg or with support~g flanges 274 to prevent the clips 272 from bending inward within the cartridge 270. It will be understood that the walls of the cartridge 276 and 278 which engage the back bight 280 of the clipstack 272 need not continue all the way araund the clips but merely need to engage the back of the clip9 to prevent them from moving backward in the stack.
In FIGURE 21 there is shown a preferred form of U-8haped clip 300 having straight legs 302 and a V-shaped bight 304. The apex 306 of the bight 304 provides a crease which insures that the clip will close at the apex. This provides smoother operation of the instrument and insures that the legs 302, when closed on a bleeder, are of the same length. Otherwise, clip 300 is the same as those previously described.
Referring again to FIGURES 1 through 4, those skilled in the art will also understand that the pusher re-turn spring 104 acting between the main body 68 and the pusher actuating member 92, could be located anywhere in the operating chain between the bell crank actuator extension, the bell crank 118, the pusher link 114 or the clip pusher 106, and the main body 68. All that is required is that a force cause the pusher member 106 to return to its normal position. This will also cause the entire mechanism in-cluding the pusher actuating member 92 to return to its normal rest position. Thus a compression spring may be ~3~ 8 located within the main body operating directly on the pusher 106 or the link pin 112 or a coil-spring may operate between the main body 68 and the beIl crank 118, or be-tween the bell crank and the pusher link, or between the bell crank and the bell actuator extension. Similarly, the jaws return spring 64 may be replaced by any spring providing ultimately a rotational force between the left jaw actuating member 52 and the right jaw 46. Thus, com-pression springs may be mounted between the main body 68 and the handle shaft 56 or between the distal extension 48 and 50, or a coil spring may act at the pivot hole or at the pivot 72 (FIGURE 1). Similarly, a coil spring acting at the pivot 97, between the main body 68 and the pusher actuating member 92 could replace the pusher return spring 104.
Those skilled in the art will also understand that many different sequencing mechanisms could be employ-ed, which upon bringing the two ring handles 58 and 98 to-gether, would cause the pusher la6 to advance the lower-most clip 142, and then the jaws 44 and 46 to close, clos-ing the clip. One such instrument employing a free floating bell crank is illustrated in Figure 19. This instrument also employ a ~ingle pivot. Now referring to Figure 19, many other sequencing mechanisms will come to mind, for example, a rack and gear mechanism for advancing the pusher.
However, it will be noted by those skilled in the art that I have provided simple mechanisms employing only rotary contacts for low friction and smooth operation, which also provide very long pusher travel for relatively small closure travel between the ring handles.
I have thus provided repeating clip applying instruments and cartridges therefor, which may be employed during an operation to apply any number of hemostatic clips by merely changing pre-sterilized cartridges containing a plurality of the clips.
It will thus be seen that, since certain changes may be made in the above articles and constructions without departing from the scope of the invention, it is intended that all matter contained in the above description or shown ~13~628 in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
For example, all of the clips in the aartridge need not be stacked as I have shown in FIGURE 9. All that is necessary is that the bottom most clip 142 be presented at the end of the pusher and the beginning of the clip channel leading to the jaws. Thus, the clips might be mounted horizontally in a plane above the pusher, all biased by a spring forward, and another spring would be provided for biasing the forwardmost clip downward against the clip platform stop so that it would be in position at the for-ward end of the pusher for being pushed into the clip channel. Many other variations will readily come to mind upon reflection.
Moreover, it will be seen that I have provided a repeating hemostatic clip applying instrument involving very few parts, which is simple to operate and use, convenient to sterilize and surprisingly provides this in an instrument which handle~ in the manner in which surgeons have desired for many years. I have achieved this surprising result by a cunning choice of elements that synergistically work to-gether.
It is to be understood that the following claims are intended to cover all of the generic and speGific features of the invention herein described, and all state-ments of the scope of the invention which, as a matter of language, m~ght be said to fall therebetween.
When the surgeon now releases the pressure on the handle shafts 56 and 96 of the left jaw actuating member 52 and pusher actuating member 92, the jaw return spring 64 first rotates left jaw actuating member 52 about pivot pin 72 under action of the jaws return spring 64 until it comes against the head of adjustment screw 144 mounted to the main body 68. Cam surface 130, being released by stop extension 60, rotates about pivot 134 and pusher actuating member 92, under the action of pusher return spring 104, rotates about pivot 97 returning the instrument to its rest position shown in FIGURE 2.
The clips may also be mounted in the cartridge 80 ~3~`2~3 with their open ends slightly resiliently pressed together so that they tend to widen when released. This allows them to widen when they reach the jaws 44-46 and to be resil-iently retained therein. Alternatively, the clearance be-tween the jaws may be made smaller than the channel throughwhich the clips are pushed, so that they are resiliently squeezed down when they reach the jaws to be retained there-in. The clip slots may also be provided with transversely oriented serrations for retaining the clips therein, in the manner disclosed in U.S. Patent No. 3,713,533.
Again, referring to FIGURES 9 through 13, the cartridge 80 comprises a main body portion 146, preferably of transparent plastic material for low cost manufacture and to allow the user to see the number of clips 136 re-maining in the stack or magazine and a leaf spring 148mounted thereto, by suitable attachment means, for example, a screw 150. Those skilled in the art will understand that spring 148 may be attached by means of a heat sealed plastic rivet or might even be integrally molded with the body 146 if a suitable plastic were employed. The cartridge 80 fits snugly into cartridge cut out 78 in right jaw extension 50.
The forward end of the cartridge body 146 is provided with a forward clip guide means and retention tongue 152. Since the cartridge closely fits into the cut out 78, no other retention means is required. However, a detent and recess may be provided at the rear extension 154 of the cartridge body 146 and the rear end 156 of the cut out 78, or on other suitable parts of the cartridge and adjacent parts of the instrument.
The cartridge body is provided with guide surfaces 158 and 160 for guiding the clip magazine or stack 136 and at the bottom thereof with a clip platform stop 162, which fits into the cartridge clearance cut out 62 in the distal left jaw entension 48. The end of the spring 164 preferably extends through a cut out 166 to provide a visual indication of the number of clips remaining in the stack 136.
Spring pressures and friction prevents bottom clip 142 from moving either forward or rearward when the cartridge is out of the instrument. A clip follower 172 is ~l3~6;~13 provided for applying the force of the spring 148 against the clip stack 136 in an even manner. To this end, the clip follower 172 is provided with a clip follower fulcrum ridge 174 within a clip follower spring guide slot gen-erally indicated at 176. Since the clip follower fulcrumridge 174 is at the middle of the clip follower 172, the force is applied evenly to the clip stack 136 and the clip stack cannot rock out of alignment with the clip channel extension 82.
: 10 An alternative form sequencing mechanism is em-ployed in the alternative embodiment illustrated in FIGURES
15, 16, and 17. Here, the bell crank, generally indicated at 180, is provided with a sequencing stop extension accept-ing slot 182 for receiving an elongated sequencing stop extension 184 mounted to the handle shaft 56 of the left jaw actuating member generally indicated at 52. The push-er slide channel 186 is formed in two pieces, I88 and 190, joined together by a plurality of fasteners 192. A single spring 194 is employed which is mounted to handle 56 by rivets or screws 196 and acts between handle 56 and bell crank actuator extension 100 by means of ears 198 acting on extended pivot pin 200.
Referr-ng to FIGURE 17 in this embodiment of the invention, the bell crank 180 is provided with a narrow arm 202 which fits into a slot 204 formed in the bell crank actuator extension 100.
In another alternative form of the invention, il-lustrated in FIGURE 18, the thin forward portion 108 of the clip pusher 106 (not shown) is made flexible and the dis.tal extensions 50 and 48 are curved for better visibility of the tip for use by surgeons who are used to curved or offset hemostatic instruments. The cartridge 80 may be, but need not be, conformed to this c~rvature which may be restricted to the portion of the instrument between the jaws 44 and 46 and the rearward end of the cartridge 80.
Now referring to FIGURE 8, those skilled in the art will understand, upon reflection, that the two pivot points of pivot holes 54 and 70 and pivot holes 90 and 94 respec-tively, could be combined into common axis. That is, pivot ~3~21 3 hole 70 could be eliminated and pivot hole 54 moved down until it was in line with pivot holes 90 and 94 when the instrument was assembled. Furthermore, the cartridge cut out 50 and main body 68 could be formed as part of the left jaws actuating member in which case the right jaws actu-ating member would comprise only the right jaw 46, the distal extension 50, the pivot hole 90, and the pusher actuating member stop 88, which also acts as the right jaws actuating member when contacted by the handle shaft 96 of the pusher actuating member 92.
Now referring to FIGURE 19, a single pivot instru-ment is generally indicated at 220. It comprises a main body 222 having a jaws extension 224 terminating in lower jaw 226. The upper finger loop extension 228 is integral with the main body 222 and terminates in upper finger loop 230. Lower finger loop extension 232 is pivoted to the main body at pivot 234 and terminates in lower finger loop 236. Upper jaw 238 is mounted to an arm also pivoted at pivot 234 and terminating at an asymmetrical T-shaped extension generally indicated at 240. The lowermost ex-tension 242 is contacted with lower finger loop extension 232 when the two finger loops 230 and 236 are brought to-gether and this causes the T-shape extension 240 and the upper jaw 238 to pivot about pivot 234 against the action of a spring 244 mounted at one end to finger loop extension 228 and engaging the uppermost portion 246 of the T-shaped extension 240.
The pusher mechanism is mounted in the main body 222 and a portion of the pusher channel 248 may be seen.
The distal end of the pusher 250 is pivoted at pivot 252 to link 254. Link 254 is pivoted at pivot 256 to floating bell crank 258 which is pivoted at pivot 260 and connected at its other end at pivot 262 to lowermost finger loop extension 232. Pivot 260 is connected to link 264 which in turn is connected at its other end at pivot 266 to spring 265 which may be integral with spring 244 both being mounted to upper-most finger loop extension 228. Travel of spring 265 is preferably limited by stop 268 integrally formed with upper-most finger loop extension 228.
When the two finger loops 230 and 236 are broughttogether pivot 260 moves to position 260' and the linkages and other pivots mo~e to the positions shown by the dotted lines and circles connected to point 260'. This causes the pusher to move fully forward pushing the clip from the cartridge 269 forward in between the jaws 226 and 238. As the front end of finger loops 230 and 236 are brought closer together, pivot 266 moves to point 266' and lowermost finger loop extension 232 ves to position 232' shown by dotted lines thus engaging the T-extension 240 and closing the uppermost jaw 238 against the lower jaw 226.
Now referring to FIGURE 20, an alternative form of clip cartridge 270 having clipstack 272 therein may be pro-vided with an internal clip leg or with support~g flanges 274 to prevent the clips 272 from bending inward within the cartridge 270. It will be understood that the walls of the cartridge 276 and 278 which engage the back bight 280 of the clipstack 272 need not continue all the way araund the clips but merely need to engage the back of the clip9 to prevent them from moving backward in the stack.
In FIGURE 21 there is shown a preferred form of U-8haped clip 300 having straight legs 302 and a V-shaped bight 304. The apex 306 of the bight 304 provides a crease which insures that the clip will close at the apex. This provides smoother operation of the instrument and insures that the legs 302, when closed on a bleeder, are of the same length. Otherwise, clip 300 is the same as those previously described.
Referring again to FIGURES 1 through 4, those skilled in the art will also understand that the pusher re-turn spring 104 acting between the main body 68 and the pusher actuating member 92, could be located anywhere in the operating chain between the bell crank actuator extension, the bell crank 118, the pusher link 114 or the clip pusher 106, and the main body 68. All that is required is that a force cause the pusher member 106 to return to its normal position. This will also cause the entire mechanism in-cluding the pusher actuating member 92 to return to its normal rest position. Thus a compression spring may be ~3~ 8 located within the main body operating directly on the pusher 106 or the link pin 112 or a coil-spring may operate between the main body 68 and the beIl crank 118, or be-tween the bell crank and the pusher link, or between the bell crank and the bell actuator extension. Similarly, the jaws return spring 64 may be replaced by any spring providing ultimately a rotational force between the left jaw actuating member 52 and the right jaw 46. Thus, com-pression springs may be mounted between the main body 68 and the handle shaft 56 or between the distal extension 48 and 50, or a coil spring may act at the pivot hole or at the pivot 72 (FIGURE 1). Similarly, a coil spring acting at the pivot 97, between the main body 68 and the pusher actuating member 92 could replace the pusher return spring 104.
Those skilled in the art will also understand that many different sequencing mechanisms could be employ-ed, which upon bringing the two ring handles 58 and 98 to-gether, would cause the pusher la6 to advance the lower-most clip 142, and then the jaws 44 and 46 to close, clos-ing the clip. One such instrument employing a free floating bell crank is illustrated in Figure 19. This instrument also employ a ~ingle pivot. Now referring to Figure 19, many other sequencing mechanisms will come to mind, for example, a rack and gear mechanism for advancing the pusher.
However, it will be noted by those skilled in the art that I have provided simple mechanisms employing only rotary contacts for low friction and smooth operation, which also provide very long pusher travel for relatively small closure travel between the ring handles.
I have thus provided repeating clip applying instruments and cartridges therefor, which may be employed during an operation to apply any number of hemostatic clips by merely changing pre-sterilized cartridges containing a plurality of the clips.
It will thus be seen that, since certain changes may be made in the above articles and constructions without departing from the scope of the invention, it is intended that all matter contained in the above description or shown ~13~628 in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
For example, all of the clips in the aartridge need not be stacked as I have shown in FIGURE 9. All that is necessary is that the bottom most clip 142 be presented at the end of the pusher and the beginning of the clip channel leading to the jaws. Thus, the clips might be mounted horizontally in a plane above the pusher, all biased by a spring forward, and another spring would be provided for biasing the forwardmost clip downward against the clip platform stop so that it would be in position at the for-ward end of the pusher for being pushed into the clip channel. Many other variations will readily come to mind upon reflection.
Moreover, it will be seen that I have provided a repeating hemostatic clip applying instrument involving very few parts, which is simple to operate and use, convenient to sterilize and surprisingly provides this in an instrument which handle~ in the manner in which surgeons have desired for many years. I have achieved this surprising result by a cunning choice of elements that synergistically work to-gether.
It is to be understood that the following claims are intended to cover all of the generic and speGific features of the invention herein described, and all state-ments of the scope of the invention which, as a matter of language, m~ght be said to fall therebetween.
Claims (18)
1. Apparatus for applying hemostatic clips to body tissue comprising:
means for storing a plurality of undeformed hemostatic clips having elongated, spaced-apart arms;
clip deforming means for receiving, holding and deforming a clip, the deformation occurring by flattening the clip through movement of the spaced-apart arms towards one another;
means for feeding one clip at a time from the means for storing to the clip deforming means; and actuating means, including two relatively moveable handles engageable by one hand, for sequentially actuating the clip feeding means and the clip deforming means to first cause the clip feeding means to move a clip from the means for storing to the clip deforming means and to then cause the clip deforming means to deform the clip.
means for storing a plurality of undeformed hemostatic clips having elongated, spaced-apart arms;
clip deforming means for receiving, holding and deforming a clip, the deformation occurring by flattening the clip through movement of the spaced-apart arms towards one another;
means for feeding one clip at a time from the means for storing to the clip deforming means; and actuating means, including two relatively moveable handles engageable by one hand, for sequentially actuating the clip feeding means and the clip deforming means to first cause the clip feeding means to move a clip from the means for storing to the clip deforming means and to then cause the clip deforming means to deform the clip.
2. The apparatus of claim 1 wherein the handles are relatively moveable from an initial position, through an intermediate position to a final position and the clip is fed to the clip deforming means as the handles move from the initial to the intermediate position and the clip is deformed as the handles move from the intermediate position to the final position.
3. The apparatus of claim 2 wherein the distance between the handles is greater in the initial position than in the intermediate position and the distance between the handles is greater in the intermediate position than in the final position so that by progressively decreasing the distance between the handles a clip is fed from the means for storing to the clip deforming means and then deformed.
4. The apparatus of claim 3 further comprising spring means for resiliently biasing the handles toward the initial position.
5. The apparatus of claim 1 wherein the clip deforming means comprises a pair of opposing relatively pivotable jaws, each jaw having a longitudinal channel for receiving a respective one of the arms of a clip.
6. The apparatus of claim 5 wherein the means for feeding comprises a pusher mounted for reciprocation between the means for storing and the clip deforming means for pushing a clip from the means for storing into the channels in the jaws.
7. The apparatus of claim 6 wherein the actuating means further includes:
first means for reciprocating the pusher from the means for storing to the clip deforming means;
second means for pivoting the jaws toward one another; and sequencing means responsive to relative motion of the handles for preventing operation of the second means until operation of the first means has been completed.
first means for reciprocating the pusher from the means for storing to the clip deforming means;
second means for pivoting the jaws toward one another; and sequencing means responsive to relative motion of the handles for preventing operation of the second means until operation of the first means has been completed.
8. The apparatus of claim 7 wherein the first means comprises bell crank means operable by a first of the handles, the second means is operable by a second of the handles, and the sequencing means comprises cam means connected to the bell crank means for preventing motion of the second handle until the bell crank means has been operated by the first handle.
9. The apparatus of any one of claims 1, 2 or 3 wherein the clip deforming means is disposed at an angle relative to at least a portion of the means for storing.
10. The apparatus of any one of claims 1, 2 or 3 wherein the means for storing is removably mounted relative to the remainder of the apparatus.
11. The apparatus of claim 1 wherein the handles are respectively engageable by the thumb and at least one finger of one hand.
12. The apparatus of claim 11 wherein the portions of the handles respectively engageable by the thumb and a finger are rings into which the thumb or a finger can be inserted.
13. A surgical clip applying device comprising:
(i) a main body;
(ii) clip magazine means coupled to the exterior of said main body for holding a plurality of clips;
(iii) clip deforming means coupled to said main body for receiving and deforming said clips;
(iv) clip feed means slideably disposed within said clip magazine means and adapted to slide into said clip deforming means for moving said clips from said clip magazine means to said clip deforming means; and (v) actuating means coupled to said clip feed means and said clip deforming means for sequentially actuating said clip feed means and said clip deforming means, whereby actuation of said actuating means first causes said clip feed means to move one said clip from said clip magazine means to said clip deforming means and then causes said clip to be deformed by said clip deforming means.
(i) a main body;
(ii) clip magazine means coupled to the exterior of said main body for holding a plurality of clips;
(iii) clip deforming means coupled to said main body for receiving and deforming said clips;
(iv) clip feed means slideably disposed within said clip magazine means and adapted to slide into said clip deforming means for moving said clips from said clip magazine means to said clip deforming means; and (v) actuating means coupled to said clip feed means and said clip deforming means for sequentially actuating said clip feed means and said clip deforming means, whereby actuation of said actuating means first causes said clip feed means to move one said clip from said clip magazine means to said clip deforming means and then causes said clip to be deformed by said clip deforming means.
14. The device of Claim 13 wherein said clip feed means is an elongated member longitudinally disposed within said clip magazine means.
15. The device of claim 13 wherein said clip magazine means includes a housing wherein a plurality of clips are stored and sequentially fed into said clip deforming means.
16. The device of claim 13 wherein said clip deforming means includes an upper jaw portion and a lower jaw portion, both said jaw portions being adapted to receive, maintain and deform a clip therebetween.
17. The device of Claim 16 wherein said jaw portions include grooves longitudinally disposed in said jaw portions so as to receive and maintain a clip therein.
18. The device of Claim 17 wherein said jaw portions have opposing substantially flat surfaces such that said flat surfaces come substantially together by operation of said actuating means, thereby deforming a clip disposed therein.
Applications Claiming Priority (5)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US05/730,933 US4166466A (en) | 1976-10-08 | 1976-10-08 | Repeating hemostatic clip applying instruments and multi-clip cartridges therefor |
| US730,933 | 1976-10-08 | ||
| US05/832,772 US4157196A (en) | 1976-09-13 | 1977-09-13 | Hydraulic coupling device |
| US05/832,972 US4226242A (en) | 1977-09-13 | 1977-09-13 | Repeating hemostatic clip applying instruments and multi-clip cartridges therefor |
| US832,772 | 1977-09-13 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1139628A true CA1139628A (en) | 1983-01-18 |
Family
ID=27419148
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000396120A Expired CA1139628A (en) | 1976-10-08 | 1982-02-11 | Hemostatic clip applying instrument |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA1139628A (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN107879096A (en) * | 2017-12-01 | 2018-04-06 | 北京电子科技职业学院 | Electrode distraction forcep and feed device |
-
1982
- 1982-02-11 CA CA000396120A patent/CA1139628A/en not_active Expired
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN107879096A (en) * | 2017-12-01 | 2018-04-06 | 北京电子科技职业学院 | Electrode distraction forcep and feed device |
| CN107879096B (en) * | 2017-12-01 | 2023-12-19 | 北京电子科技职业学院 | Electrode opening clamp and feeding device |
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| MKEX | Expiry |