DE1516408B1 - Surgical clamp - Google Patents

Description

1 2

The invention relates to a surgical clamp which is indistinguishable. The usage of with two jaws that can be pressed against one another, very small of such clamps on blood vessels at least one of which has an elastic clamping surface of diameter, d. H. has a diameter of less than 1 cm, knife, becomes very critical because of the low clearness

There are already different clamping or Ab- 5 width of these vessels no essential intervention binding devices known for surgical purposes. allows without a noticeable cross-sectional So has z. B. a binding device (German reduction to lead. Atraumatic instruments, patent specification 393 351) the shape of an inflatable bandage which does not damage these areas, the inner radius of which is by means of air or liquid, would therefore be advantageous
pressure can be reduced. This device covered with rubber clamping jaws of the already device is only very limited by its structure and the type explained do not represent a solution to this difficulty, in particular for pressing the artery, since with them the greatest pressure can still be turned, but not for clamping off Vascular systems or arteries created at the point of greatest thickness of the vessel. The Austrian and the clamping pressure not evenly over a patent specification 113 451 teaches a Kompressorium, which is distributed i ₅ blood vessel of variable thickness,
two object of the invention, which can be increased in volume by means of compressed air, is therefore a surgical one

Has pads, which provide a counter pressure to clamp, in addition to their handiness preferably two wound sites are created and and independence from supply devices two in this way the outflowing blood stream when compressing pressure-absorbing resp. suppress. Has 20 pressure-reducing jaws.

In order to use the compressor, the task is performed with a surgical clamp

possible, the wound sites of the type described at the outset to be pressed must be easily accessible according to the invention, but this is solved in the case of surgical interventions by the combination of the features that intervention is only rarely the case. The two above - the clamping surface, the outer surface of the thin, elastic-mentioned devices have, in addition to their un- see shell of a liquid-filled chamber, the handiness also all those disadvantages of the liquid-filled chamber raised on the cheek, which is normally arranged with supply devices and Adhere to the chamber untied auxiliary devices, since the interchangeable is arranged on the jaw.
Clamping devices from their supply devices when applying clamping pressure to an between

Compressed air or pressurized liquid in the vessel located in the jaws will be in the keep. Coat located fluid displaced so that

These disadvantages do occur with a scissor-shaped surgical clamp, which is still known to be adapted to the irregular shape of the vessel and does not occur vertically in several directions (US Pat. 35 able to exert clamping pressure. In this way, there is material that is open at the ends, the required clamping force can be applied to the vessel, for example an artery or the like, with a dampening of the minimum amount of injuries when compressed. The clamp thus enables a full pressure only through the slight constant closure of the vessel, without the hose material becoming so elastic. A continued or later developing "hard" clamping of the vascular system has the effect of causing permanent damage, but is also extremely disadvantageous, since the inner surface for closing a blood vessel via intravon blood vessels from a very smooth, luminal endothelium Objects without trauma effects,
designated layer consists, which is through from the outside Preferably the liquid-filled chamber

acting forces can be damaged. One 45 is formed in a soft jaw insert, the relatively normal or healthy artery is detachably attached to one jaw. According to such damage, although without serious, if necessary, a consequence can also be tolerated on the other jaw, but the hard jaw insert, for example, the arteries diseased with its atherosclerosis and the vein clamping surface two rows of teeth with a lateral system are not capable of considerable external forces 50 has outward facing feet. In this way, without significant residual effects, the advantage is achieved that the clamped-off vessels are affected. Among other things, tensile forces can be exerted in every direction when closing and the position of the arteries affected by atherosclerosis can be changed immediately without the risk of severing or breaking off the atherosclerosis substance being pulled out of the clamp. In the venous system, in 55 v / earth. Such jaw inserts are often of great necessity to ensure that the blood flow is slow.
previous endothelial trauma, and when closing the technical progress and the inventive

the vein can cause immediate thrombosis and possible- contents of the subject invention are in the funny manner Pulmonary embolism occur. 60 combination of the application of the subject matter of the invention

The reasoned from clamping arteries with the help of the finding features.

Rigid Instruments Presently Known Long Term The following is an embodiment of the remainings Effects lead to a continuation on the basis of the drawings explained in more detail, ongoing narrowing of the clear width of the artery. It shows

There is an initial deposition of micro- 65 F i g. 1 is a perspective view of a chirurthrombie based on the development of a gic clamp with the features of the invention, Endothelial pad is followed, whereupon a point F i g. FIG. 2 shows a side view of the clamp in FIG is affected by atherosclerosis on a smaller scale,

F i g. 3 is a view from the direction of the line 3-3 in Fig.l,

F i g. 4 shows a section along the line 4-4 in FIG. 5 through both jaws of the clamp in the event that the upper jaw a soft jaw insert and the lower jaw a three-sided hard jaw insert has, on a larger scale,

F i g. 5 shows a partial section approximately along the line 5-5 in FIG. 4,

F i g. 5A is a partial perspective view of the hard jaw insert according to FIGS. 4 and 5,

F i g. 6 is a partial side view of a two-sided hard jaw insert;

F i g. 7 is a perspective view of the jaw insert according to FIG. 6, F i g. 8 a section through a diseased artery,

F i g. Figure 9 is a partial view showing the action of the hydraulic jacket in closing the clamp illustrated on a diseased artery,

Fig. 10 is a view similar to Fig. 9 showing the complete closure of the clamp via an intramural

»Luminal object shows
11 is a partially broken away side view of a modified embodiment of the soft jaw insert and FIG

Figure 12 is a partial perspective view of the insert according to FIG. 11.

Although the invention is shown in connection with the occlusion of a diseased artery and is described, the clamp can of course also at other locations on the body tissue Advantage can be applied.

The clamp according to the invention has two straight, elongated jaws 10 and 11 which can be pivoted at 12 are interconnected and backwards outgoing handles 14 and 15 in general Have arrangement of scissors. Preferably the jaws at 13 are below a noticeable Angle bent towards the joint and handle sections. The very end of each The handle carries a finger loop 16 and each handle section is provided with conventional locking lugs 17 provided, the interengageable locking

• have teeth. The finger loops are under at 18 bent at a small angle with respect to the handle sections; they are compliant to some extent or resilient and slotted at 20 for a reason to be explained.

The two jaws 10 and 11 are identical and each have a longitudinal one keyhole-shaped slot with an enlarged section 25 and a narrower section 26, which merges into a surface section 27 facing the opposite jaw. The to Surface sections 27 located on both sides of the slot are preferably under a small one Angle to each other and form a cross-sectionally V-shaped seat for a soft resp. a hard jaw insert to be described below.

According to FIG. 4, this soft jaw insert 30 consists of a flexible rubber hose, which encloses a closed chamber 31 filled with a liquid such as glycerine. This hose forms a hydraulic jacket of substantially rectangular cross-section, which is preferably has the specially illustrated configuration. The outer surface 32 of the insert 30 is curved outward, while its two side walls 33 are curved inward. The rear wall 34 has the angle the jaw surface sections 27 adapted V-shape.

On the rear wall 34 of the insert 30 is a tongue consisting of the same piece of material with a extended band section 35 which is inserted into the extended slot section 25 of the jaw slot can be formed, and a thinner neck portion 36 which in the narrower slot portion 26 is fitted. To facilitate insertion and removal of the soft jaw insert 30 as well as to reinforce and stiffen the soft tongue-shaped rubber section is on the expanded Edge portion 35 preferably a relatively stiff metallic or non-metallic sleeve 40 attached, which can be inserted into the slot section 25 with a sliding fit.

The one that can be inserted into the other jaw and, in the embodiment shown, is inserted into the jaw 10 hard jaw member has a toothed bar made of metal or a hard, non-metallic material on, which can take various forms. In the F i g. 4, 5 and 5 A is such a three-sided or Jaw insert 50 having three rows of teeth is shown, along the back of which one of the same Piece of material formed tongue 51 extends from keyhole-shaped cross-section, which can be pushed into the further and the narrower slot section 25 of the jaw 10. The surface of insert 50 has a central row of teeth for teeth 52 and two side rows of teeth provided for the teeth 53.

The middle teeth 52 are inclined away from the cheek ends, while the side teeth 53 are below at an angle of about 45 ° from the general plane of the clamping surface of the hard Jaw insert 50 are inclined outward. The middle teeth 52 undercut in the upward direction Immediate clamping pressure relatively blunt surfaces, but have tips that are so arranged are that they penetrate a jammed object if it is along the jaws moves away from the joint 12. The side teeth 53 offer in the upward direction below the immediate Clamping pressure relatively blunt surfaces, but are provided with sharp points, which are so arranged are that they are able to penetrate the jammed object if this one crosses shifting force directed towards the jaws is exerted.

In order to hold the hard jaw insert 50 releasably in the relevant slot 20, locking devices are provided intended. According to FIGS. 4 and 5, a spring finger 54 is provided at the outer end of the tongue 51, which has a projection 55 which engages in a bore 56 in the jaw 10. The one on the soft Jaw insert 30 provided sleeve 40 can be provided with a similar locking projection. These projections are tapered so that the inserts can be easily withdrawn if desired can. When pressure is applied to the inner end of the jaw insert located next to the hinge 12 is exerted to remove the insert, the protrusion 55 rolls itself out of the bore 56 out off. A compression 57 provided at the outer end of the tongue 51 forms an expansion which prevents this insert end from entering the slot section 26. This prevents

5 6

that the hard jaw insert 50 with the wrong conventional rubber jaw members are not essential is pushed into the slot first. borrowed better than the hard cheeks, since they too

6 and 7 is a two-sided or two the greatest pressure on the place of the largest wall-tooth rows having hard jaw insert 50 a strength and thereby a break off or illustrates that only the teeth 53 and longitudinal 5 splinters of the outgrowth material cause ,
its central portion an open, trough-shaped. In this way, this jaw insert avoids a clamp according to the invention. The soft 50 α mainly in both directions transverse to the jaw insert 30 is able to yield a tensile force without further ado. The configuration of the and to adapt to the shape of the outgrowth and both rows of teeth can be identical or different to lent a complete closure of the lumen, so that they effect both parallel to the jaws without breaking the outgrowth or transversely to it Apply traction. To pull the trigger. The hydrostatic jacket of the soft concave space between the two tooth jaw insert 30 exerts stabilized at all rows of contact and supports the convex clamping pressure perpendicular to the surface of the soft jaw insert 30 when the 15 surface of the artery and exerts on the thickest two Jaws 10, 11 jammed against each other section of the outgrowth no greater pressure will be. out than on any other part of the artery. At the

Since the finger loops 16 loosen the clamp at a small angle, the outgrowth is not disrupted the handles 14 and 15 are bent or detached so that they are with the bloodstream, the clamp is normally grasped so that 20 could be picked up.

one jaw 10 or 11, the lower one and the other when applying clamping pressure according to FIG. 10

Jaw 11 or 10 forms the upper jaw. This displaces the hydraulic fluid to the opposing removal and interchangeability of the ends of the chamber 31 and allows the soft and hard jaw inserts to allow end portions of the shell to expand. This means that each jaw insert leads to a slight deformation of the jacket at will or can be inserted into the lower jaw. Bubble-shaped deformed outer end section, if desired, can also be closed in both jaws 10, 61, in which part of the hydraulic fluid a-11 soft jaw inserts 30 or hard jaws, if the chamber 31 uninserts 50 or 50 α are used. The inserts are closed indirectly over the artery. These can be manufactured cheaply from hard plastic, the bubble-shaped end section of the hydraulic jacket, which, if re-use is desired, prevents the clamp from slipping off the blood vessel, and can be sterilized in an autoclave. The purpose of the concave side walls 33, or can be used as disposable parts, is to avoid bulging when applying clamping pressure which is not reused after a single use. With increased fluidity. The side walls then expand in

F i g. Figure 8 shows a typical cross-section through the flat configuration of Figure 8.

a diseased artery .4 whose clear width is determined by the shape and configuration of the hardest

a hard outgrowth 60 atherosclerotic material jaw insert 50 provided teeth 52, 53 is under-reduced. This material forms a protrusion to support preventing the clamp from loosening or lumps on one side of the inner wall of the 40 from the blood vessel and ensure other anterior artery. Such an outgrowth is often in one part. Conventional clamps of this type have Area of the artery present to be pinched off, at an angle of 90 ° from the allden got to. The surgeon can easily find teeth protruding through the common plane of the jaw, Feel with your fingers the presence of this, which is the outer and sometimes the middle Determine the outgrowth and determine at which 45 vascular skin penetrate in order to create a pulling effect from the side the artery it is located. He then brings them to practice. The ability to exercise a traction The side of the artery showing the outgrowth against action is necessary because in the event of one the artery slips off hard jaw 10 and jammed the soft jaw the clamp heavy bleeding can occur. A 11 according to FIG. 9 against the opposite side. Moving or slipping can be longitudinal and This will compress the artery flat, 50 across, and at an angle between until the sound upper side is facing downwards against these directions, with the clamp The outgrowth closes, but the artery has not yet been closed off by the end of a severed blood vessel is so that the blood continues to slip through the or the latter between the ends of the constricted arterial cross-section is able to flow. The clamping jaws can slip out. In the latter If both jaws 10, 11 of the clamp are conventional, the tips of the clamping jaws slip last If there are hard jaws, the surgeon has no other detachment from the surface of the vessel. According to the invention Choice than to apply greater pressure than slipping in that direction through the bladder complete closure of the lumen or shaped enlarged chamber 31 of the jacket of the Cross-section and to interrupt the blood flow soft jaw insert 30 and through the middle is required. If the outgrowth material is hard and 60 teeth row of the three-sided hard jaw insert 50 is brittle, it will be broken and prevented.

broken particles of it either immediately or during normal clamping without pulling

later, after the clamp has been released from the blood stream, teeth 52, 53 of the invention taken. This often has serious injury clamp a relatively flat, not a Patients result when there is such a protruding surface opposite the blood vessel. if broken particles finally deposit and one, however, through an external force, for example thinner Artery blocked, which is a vital way of inadvertent movement or be-part of the body, like the brain. Deliberate shifting of the position of the clamp,

When a pulling force is applied, the outwardly directed sharp ends of the side teeth 53 penetrate into the vessel and prevent the vessel from sliding lengthways through the jaws. The soft one Jaw insert 30 and certain teeth of the other jaw insert 50 thus prevent displacement in one direction, while other, usually not penetrating into the vessel If necessary, penetrate teeth into the vessel and prevent displacement in the other direction capital.

In the above description it was assumed that the jaws 10, 11 according to FIGS. 9 and 10 are attached to the blood vessel across the blood vessel. However, the bending of the jaws provided at 13 enables another clamping position, in which the blood vessel lies parallel to the cheeks. This orientation of the clamp can used to partially pinch off a large blood vessel wider than the jaws as is sometimes desired. For this purpose, two metal jaw inserts, such as the Jaw insert 50, or two inserts with different tooth configuration or if desired a soft and a hard one can be used.

The slotted finger loops 16 are used to hold the clamp so that after attachment does not hang down from the blood vessel. The ring sections located on both sides of the slot 20 are flexible and can be bent out of the plane of the eyelet to form a fold of the cover sheet lying on the patient can be pushed into the slot. One of those eyelets can thus serve as a spring clip to fix the clamp and put it in the desired position to keep what continues to lessen the tendency of the clamp to get disconnected from one Blood vessel being withdrawn contributes.

11 and 12, a soft jaw insert 30 A is shown with a different reinforcement device for the retaining tongue. In this modified embodiment of the invention, the tongue 51 is embedded in a stiffening bead strip 70 made of metal or hard plastic. The bulge strip 70 has a longitudinal slot 71 for receiving the neck portion 36 of the tongue, as well as transverse bores 72 separating the sole of the slot. The bead strip 70 is inserted into the mold for the rubber hose, so that the rubber flows into the slot 71 and the bores 72 during casting and forms locking plugs 73 in the latter. The bead strip is dimensioned so that it can be inserted with a sliding fit into the enlarged slot section 25 of the jaw slot in question. Similar to the hard jaw insert 50 according to FIG. 5, a locking means may be provided. The sleeve 40 according to FIG. 4 can be equipped similarly.

Although only a single way of attaching the hard and soft jaw members above is shown and described on the clamp, other types of attachment are evident possible. For example, the jaw insert can be inserted into the slot provided in the clamp in place of the one engaging tongue 51 be provided on its back with two buttons or snaps, while each jaw 10, 11 is provided with two pans or receptacles for releasably snapping in the buttons can be.

Claims (23)

Patent claims: 1. Surgical clamp with two jaws which can be pressed against one another, of which at least one having an elastic clamping surface, characterized by the combination following features: a) the clamping surface is the outer surface (32) of the thin, elastic jacket of a liquid-filled Chamber (31); b) the liquid-filled chamber is arranged in a raised manner on the associated jaw (11), and c) the chamber (31) is interchangeably arranged on the jaw (11). 2. Clamp according to claim 1, characterized in that the jaws (10, 11) are elongated are. 3. Clamp according to claim 2, characterized in that the outer surface (32) of the elastic Clamping surface has a convex cross-section. 4. Terminal according to claim 2 or 3, characterized in that the elastic jacket of the Chamber (31) has two concave side walls. 5. Clamp according to claim 2, 3 or 4, characterized in that the liquid-filled Chamber (31) is formed in a soft jaw insert (30) which is detachable on the jaw (11) is attached. 6. Clamp according to claim 5, characterized in that the soft jaw insert (30) with Is removably secured in place on the jaw (11) by means of a resilient device. 7. A clamp according to claim 5 or 6, characterized in that the soft jaw insert (30) is attached to the jaw with the aid of a tongue (51) which is attached to the jacket and slidably in a longitudinal slot (A 1) formed in the jaw (11) is. 8. A clamp according to claim 7, characterized in that the edge of the tongue (51) through an attached reinforcing flap (70) is stiffened. 9. A clamp according to claim 7 or 8, characterized in that the longitudinal slot (A 1) in cross section has an inner portion of enlarged cross section and its outer portion forms a neck portion (36) and that the tongue (51) is shaped accordingly. 10. Clamp according to claim 7, 8 or 9, characterized in that the jaw (11) and the jaw insert (30) are provided with complementary V-shaped seat surfaces. 11. Clamp according to one of claims 6 to 10, characterized in that the resilient Device a spring finger (54) attached to the tongue (51) with an in the jaw (11) formed bore (56) engaging projection (55). 12. Terminal according to claim 11, characterized in that the spring finger (54) on one end of the tongue (51) is located and that the 009 550/38 The tongue is provided with a compression (57) that allows the tongue to be inserted into the slot with the wrong ending prevented. 13. Clamp according to claim 6, characterized in that the soft jaw insert (30) is attached to the jaw (11) by means of a releasable snap connection. 14. Terminal according to one of claims 2 to 13, characterized in that on the the other jaw (10) of the clamp has a hard jaw insert (50) attached to it Clamping surface has two rows of teeth (53) with laterally outwardly directed tips. 15. Clamp according to claim 14, characterized in that that the hard jaw insert (50) between the two rows of teeth (53) a third Has row of teeth (52), the tooth tips of which point in the longitudinal direction. 16. Clamp according to claim 14 or 15, characterized in that the teeth (52, 53) are curved Have surfaces. 17. Clamp according to claim 14, 15 or 16, characterized in that the hard jaw insert (50) is detachably attached to the jaw (10) of the clamp. 18. Terminal according to claim 5 and 17, characterized characterized in that the hard and soft jaw inserts (50) by means of similar means attached to the jaws (10, 11) and thus interchangeable with one another. 19. Clamp according to one of claims 1 to 18, characterized in that the jaws (10,11) are articulated together. 20. Terminal according to one of claims 1 to 19, characterized in that at each Jaw (10,11) a handle (14,15) is attached to actuate the clamp. 21. A clamp according to claim 20, characterized in that on each handle (14, 15) the end remote from the jaws (10, 11) each a finger loop (16) is provided. 22. Clamp according to claim 21, characterized in that the finger loops (16) are slotted are. 23. Clamp according to claim 21 or 22, characterized in that the finger eyelet (16) having end portion of each handle (14, 15) at an angle in one direction is bent out of the plane of movement of the handles and that the jaws (10,11) below bent out of this plane at an angle in the other direction. For this purpose 2 sheets of drawings