EP0000756B1 - Agrafeuse chirurgicale - Google Patents

Agrafeuse chirurgicale Download PDF

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Publication number
EP0000756B1
EP0000756B1 EP19780100549 EP78100549A EP0000756B1 EP 0000756 B1 EP0000756 B1 EP 0000756B1 EP 19780100549 EP19780100549 EP 19780100549 EP 78100549 A EP78100549 A EP 78100549A EP 0000756 B1 EP0000756 B1 EP 0000756B1
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EP
European Patent Office
Prior art keywords
clip
main body
clips
coupled
magazine
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Expired
Application number
EP19780100549
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German (de)
English (en)
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EP0000756A1 (fr
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Charles H. Klieman
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Individual
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Individual
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips

Definitions

  • the invention relates to the field of devices useful in the application of hemostatic clips, and more specifically, to devices for the application of hemostatic clips used in the strangulation of blood vessels and other fluid ducts.
  • Wood U.S. Patent No. 3,326,216.
  • the Wood device consists of a hemostat-like instrument which has finger loop portions coupled to jaw portions. The jaw portions are adapted to hold a hemostatic clip therebetween so that the clip may be closed about a vessel by bringing the finger loops together.
  • Wood also discloses a separate cartridge which holds a plurality of clips. When the Wood device is to be used, the jaw portions are placed about one clip contained in the cartridge, and the clip is removed from the cartridge by the engagement of the clip by the jaw portions. Then when the clip has been used, a new clip may be placed in the device by returning to the clip cartridge and inserting a new clip.
  • the Wood device Two problems are apparent with the Wood device. First, the hemostatic clips are not automatically fed into the jaws of the device, but must be individually placed there. This procedure is time consuming and cumbersome. In addition, the Wood device is capable of expanding its jaw wider than the width of a clip contained therein. Thus, a clip may be accidentally dropped from the device causing a great deal of inconvenience and delay.
  • Miles discloses a surgical stapling device which consists of finger loops coupled to a pair of arms which terminate in jaw portions, the jaw portions being adapted to grasp and hold a tubular member.
  • the device also has a magazine for holding a plurality of clips along the length of one arm, and manually operable clip ejector means for placing a clip about the tubular member which is to be closed.
  • the tubular member is first grasped and held by the jaw portions of the Miles device. The surgeon then places his index finger on a button attached to the clip ejector.
  • the clip ejector By urging the button forward, the clip ejector places a clip about the tubular member. Then, the clip may be deformed about the blood vessel by bringing the pair of finger loops together, an obvious disadvantage of the Miles device is that it is cumbersome, in that the surgeon must manually move a clip between the jaws of the device while holding the device steady so as not to loose the grasp of the tubular member. Also, as the clips are used from the cartridge, the button moves farther forward so that it becomes more and more difficult to reach. Also, this procedure is time consuming in that each individual clip must be manually fed between the jaws of the stapling device. Furthermore, the construction of the Miles device, particularly in the jaw portions, provides poor visibility to the surgeon since the thickness of the device obscures the vessels which are to be closed.
  • DeCarlo U. S. Patent No. 3,740,944.
  • DeCarlo disclosed a gun-like device for suturing and severing blood vessels in a three stage procedure. First, jaws of the device are closed about the blood vessel by the actuation of the gun-like trigger mechanism. Second, a pair of pushers extend through the device and come forward to crimp a pair of clips, brought from an internal magazine, about the vessel in two spaced locations. Third, a blade comes forward from the device upon further actuation of the gun-like handles and severs the blood vessels between the two clip locations.
  • the internal clip magazine of the DeCarlo device uses a pair of leaf spring assemblies to index a plurality of pairs of hemostatic clips.
  • the clips are stored in a pair of index guide rails where they are moved forward in unison by opposing leaf spring assemblies.
  • One leaf spring assembly is attached to the moveable main body portion while the opposing leaf spring assembly is affixed to one guide rail.
  • the leaf spring assembly attached to the main body moves forward and contacts portions of the clips contained within the magazine. Further movement of the main body portion moves individual clips along the index guide rail and ultimately ejects a pair of clips.
  • the main body portion begins to return to its original static position.
  • DeCarlo device due to the three-stage operation, the device is necessarily bulky. This is a major disadvantage in that many surgical procedures require severence and closure of blood vessels in very limited areas so that a bulky instrument may not be able to reach the required vessel. The bulkiness of the device also creates a further disadvantage in that it produces a lack of visibility for the surgeon. Thus, the very vessel that is to be severed and closed may be obscured since the surgeon may not be able to see around the device. A further disadvantage stems from the fact that the DeCarlo device does not adapt to the application of a single clip, but only applies a pair of clips to the vessel to be closed. In a great many surgical procedures, only the application of one clip is desired while the application of two clips would only complicate the severance procedure.
  • a hemospatic clip applicator device useful for rapidly and automatically applying clips for the strangulation of blood vessels and the like has a clip magazine means coupled to the exerior of a main body, the clip magazine means being adapted to hold a plurality of hemostatic clips. Attached to one end of the main body is a clip deforming means adapted to hold and crimp a hemostatic clip about a blood vessel. Slideably disposed within the main body is a clip feed means which is adapted to move clips from the clip magazine means to the clip deforming means. Coupled to the clip feed means and the clip deforming means are actuating means.
  • a hemostatic clip is fed from the clip magazine means into the main body, where it is moved forward to the clip deforming means and there crimped about a blood vessel or the like.
  • This sequence of feeding clips to the clip deforming means and crimping them therein, may be repeated until the plurality of clips located in the clip magazine means is depleted.
  • a hemostatic clip applicator device which is useful in rapidly applying a hemostatic clip about blood vessels and other fluid ducts.
  • the hemostatic clip applicator of the present invention may be used with any other suitably adapted hemostatic clip.
  • the hemostatic clip applying device 2 of the present invention is shown in its static configuration.
  • Clip applying device 2 has an actuating means comprised of an upper handle portion and a lower handle portion.
  • the upper handle portion is comprised of upper finger loop 4, and upper finger loop member 5, while the lower handle portion is comprised of lower finger loop 6 and lower finger loop member 7.
  • upper finger loop 4 may be brought to its forward position 8, while lower finger loop 6 may be moved to an inward position 10.
  • Upper finger loop 4 and upper finger loop member 5 pivot about upper finger loop pivot 12 while being biased toward rear stop pin 16 by first spring means 14.
  • Upper finger loop member 5 is coupled to clip feed blade 18 by feed blade pivot 17.
  • Clip feed blade 18 is a clip feed means which in the presently preferred embodiment is a blade member adapted to slide through main body 20 by the forward movement of upper finger loop 4. Upper finger loop 4 will continue to move clip feed blade 18 through main body 20 until upper finger loop member 5 abuts forward stop means 21.
  • the leading edge 24 of clip feed blade 18 is adapted to correspond to the bail portion or trailing edge of a hemostatic clip which may be placed in recess 26 by any suitably adapted means. In the presently preferred embodiment, leading edge 24 is "V"-shaped.
  • FIGURE 1 when a hemostatic clip is placed in the clip receiving means formed by recess 26, the forward movement of the upper finger loop 4 will cause clip feed blade 18 to abut the bail portion of the hemostatic clip and move the clip toward the forward end of main body 20.
  • a clip deforming means adapted to deform a hemostatic clip about a blood vessel or the like.
  • the clip deforming means is comprised of upper jaw portion 32 and lower jaw portion 34.
  • Upper jaw portion 32 is fixedly coupled to the lower finger loop member 7 and pivotally coupled to main. body 20, while lower jaw portion 34 is fixedly coupled to main body 20.
  • FIGURE 2 is a top view of the forward portion of clip applying device 2. Illustrated here is the relationship between main body 20, lower finger loop member 7 and upper jaw portion 32. It can be seen that lower finger loop member 7 is fixedly coupled to upper jaw portion 32, while the combination of member 7 and jaw portion 32 is pivotally coupled to main body 20 by upper jaw pivot 36. Thus, rotation of member 7 about pivot 36 by movement of lower finger loop 6 results in rotation of upper jaw 32 about pivot 36. Therefore, inward and outward movement of lower finger loop 6 will result in movement of upper jaw 32 toward and away from lower jaw portion 34. Also shown in FIGURE 2 is the curved configuration of upper jaw portion 32 and lower jaw portion 34.
  • This curved forward portion of clip applying device 2 provides the distinct advantage of improved visibility during usage since the vessel which is to be closed will be located to one side or the other of the main body 20.
  • the presently preferred embodiment of the upper and lower jaw portions utilizes a curved configuration, other configurations, such as straight jaw portions, may also be used.
  • FIGURE 3 illustrates the jaw portions 32 and 34 as they are closed about a deformed clip 38.
  • This configuration would have resulted from feeding of a clip into the jaw portions 32 and 34 by the forward movement of upper finger loop 4, followed by the rearward movement of upper finger loop 4 and then the inward movement of lower finger loop 6. It may be noted that rearward movement of upper finger loop 4 has caused feed blade 18 to return to its unactuated position, thus exiting jaw portions 32 and 34 and recess 26, so that the jaw portions are free to close about a clip.
  • FIGURE 4 shows in greater detail the forward portion of clip applying device 2, including clip feed blade 18 and its leading edge 24 as it is disposed in groove 35 in main body 20. It can be seen that a clip 37 disposed in recess 26 will be moved forward by the leading edge 24 of clip feed blade 18 so that the clip 37 and clip feed blade 18 slide within the groove 40 in upper jaw portion 32 and groove 42 in lower jaw portion 34. As noted in FIGURE 2, jaw portions 32 and 34 are curved away from main body 20. Thus, feed blade 18 must be configured so as to be capable of being moved forward through grooves 35, 40 and 42 while simultaneously bending away from main body 20 in grooves 40 and 42. In the presently preferred embodiment, this capability has been provided by constructing feed blade 18 of four layers of thin blades of metal in a laminated configuration.
  • the four layers are only coupled at discrete points so that feed blade 18 is able to move longitudinally through main body 20 while curving around grooves 40 and 42 in jaw portions 32 and 34. Also shown in FIGURE 4 are rivets 30 and mounting holes 28 for coupling a clip magazine to the clip applicator device 2.
  • FIGURE 5 is a top view of the forward portion of clip applying device 2 showing lateral clip magazine 41 replaceably coupled to main body 20 by clip magazine pin 46 disposed in mounting hole 20 and clip leaf spring 48 disposed under rivet 30.
  • Hemostatic clips are disposed in clip magazine housing 44 in a lateral relationship to main body 20 and urged toward recess 26 of clip applying device 2 by the spring contact 50 of central clip leaf spring 49.
  • recess 26 is clear so that a clip may be fed from clip magazine housing 44 into recess 26.
  • the clip disposed in recess 26 is then available for movement to the jaw portions 32 and 34 when clip feed blade 18 is moved forward by the actuation of upper finger loop 4.
  • Both the clip and clip feed blade 18 then move through groove 35 in main body 20 and grooves 40 and 42 in upper jaw portions 32 and 34 respectively until upper finger loop member 5 has reached its farthest forward position. Also. shown in FIGURE 5 is lower finger loop member 7 as it is coupled to upper jaw portion 32, so that they both may rotate about upper jaw pivot 36.
  • FIGURE 6 is a side view of the forward portion of the clip applying device 2, showing the lateral clip magazine housing 44 and its associated clip leaf spring 48. It can be seen from this illustration that clip magazine housing 44 is coupled to main body 20 by a portion of clip leaf spring 48 which lies under rivet 30, and by clip magazine pins 46 being disposed in mounting holes 28 in main body 20. Thus, to mount lateral clip magazine housing 44 on main body 20, recesses 52 in clip leaf spring 48 are urged around the shaft portion of rivet 30 until pins 46 can be located in mounting holes 28. When lateral clip magazine housing 44 is so positioned, central leaf spring 48 is positioned over clips 37 contained in housing 44 so that leaf spring 49 contacts the clips 37 at point 50 and thereby urges them into the main body 20.
  • magazine 41 When the clips 37 in clip magazine housing 44 have been depleted, magazine 41 may be removed and a new magazine installed by lifting housing 44 from main body 20 until pins 46 have cleared holes 28 so that clip leaf spring 44 may be moved longitudinally out from under rivets 30. When the depleted magazine 44 has been removed, a new magazine containing a supply of clips 37 may be installed.
  • FIGURE 7 is a top cutaway view showing in greater detail lateral clip magazine 41.
  • Clip leaf spring 48 is disposed under rivet 30 so that central clip leaf spring 49 is positioned over clips 37 contained in magazine housing 44. It can be seen from this FIGURE that central leaf spring 49 exerts a pressure on clips 37 at contact point 50 so as to urge the clips individually into recess 26 of main body 20.
  • recess 26 is empty so that a clip 37 may move into recess 26 and be held there by the urging of adjacent clips 37.
  • clip feed blade 18 slides laterally through body portion 20 and carries clip 37 from recess 26 toward the jaw portions 32 and 34.
  • clip applicating device 2 of the present invention provides an automatic feeding and crimping of hemostatic clips.
  • a clip is moved from an external magazine 41, into a receiving means 26, and disposed in jaw portions 32 and 34 where it is deformed around a blood vessel or the like.
  • This process of inward and outward movement of finger loops 4 and 6 may be repeated rapidly, so that one vessel after another is closed by the hemostatic clips 37, until the supply of clips in magazine 41 is depleted.
  • a new magazine 41 may be substituted for the depleted magazine so that vessel closures may be continued.
  • the clip applicating device 2 of the present invention provides the further advantage of high visibility to the user. Because the device 2 is of an extremely thin design, essentially the width of currently used hemostats and because jaw portions 32 and 34 are curved away from the main body 20, a surgeon using clip applying device 2 will have a clear view of the vessel he is closing and, in addition, will be able to reach remote and obscure regions for further vessel closure. In addition, clip applying device 2 is constructed so as to prevent a clip 37 from accidentally dropping from the device, thereby obviating a great deal of inconvenience and lost time.
  • FIGURE 8 illustrates clip applying device 2 which utilizes another alternate embodiment of a clip magazine, in this case a parallel clip magazine 70.
  • a parallel clip magazine 70 Disposed in parallel clip magazine 70 is a plurality of hemostatic clips which lay parallel to main body 20 and are sequentially fed toward recess 26.
  • Parallel clip magazine 70 is replaceably coupled to main body 20 by magazine couplings 72, which in the'presently preferred embodiment are spring clips which snap over corresponding portions of main body 20.
  • the magazine 70 is so adapted that forward movement of upper finger loop 4 and the corresponding movement of upper finger loop member 5 and clip feed blade 18 results in the sequential placement of hemostatic clips in recess 26. Further actuation of upper finger loop 4 results in movement of a clip between upper jaw portion 32 and lower jaw portion 34.
  • upper finger loop 4 When a clip has been so placed, upper finger loop 4 is returned until it abuts rear stop pin 16 at which time lower finger loop 6 may be moved inward so as to cause upper jaw portion 32 to move toward lower jaw portion 34 and thereby close the hemostatic clip about the blood vessel.
  • Upper finger loop 4 is biased toward stop pin 16 by first spring 14, while lower finger loop 6 is biased toward lower finger loop member stop pin 19 by second spring means 22.
  • FIGURE 9 is a top view of a clip applying device 2 showing parallel clip magazine 70 and its coupling 72 to main body 20. Also shown in FIGURE 9 is the relationship between upper finger loop 4, lower finger loop 6, and lower finger loop member 7 as it is coupled to upper jaw portion 32. Lower finger loop member 7 is fixedly coupled to upper jaw portion 32, while lower finger loop member 7 is pivotally coupled to main body 20 by upper jaw pivot 36. Thus, movement of lower finger loop 6 results in movement of upper jaw portion 32 about upper jaw pivot 36. It can be seen from FIGURES 8 and 9 that parallel clip magazine 70 provides even greater visibility to the surgeon since the magazine 70 only slightly increases the width of the clip applying device 2.
  • FIGURES 10, 11, 12 and 13 generally illustrate that parallel clip magazine 70 is comprised of a parallel clip magazine housing 94, which has a plurality of inwardly biased leaf springs 76, a lost motion link 82 and a clip loading blade 78 which also has a plurality of inwardly biased leaf springs 88. More specifically, FIGURE 10 illustrates leaf springs 76 in clip housing 94 and the configuration of hemostatic clip 37 within housing 94. It can be seen that each leaf spring 76 has a "V"-shaped leading edge 77 which is adapted to correspond to the "V"-shaped bail portion of clips 37. As will be described more fully hereinbelow, the function of each leaf spring 76 is to prevent rearward movement of clips 37.
  • FIGURE 11 is a cross-sectional view of magazine 70 as it is coupled to main body 20 by magazine couplings 72. Magazine coupling 72 is adapted to spring outward around main body 20 until it can be positioned in notch 96 in main body 20. Disposed within parallel clip magazine 70 are inwardly biased leaf springs 76 in housing 94, clip loading blade 78, with inwardly biased leaf springs 88, along with lost motion link 82. Adjacent lost motion link 82 is clip feed blade 18 of clip applying device 2.' FIGURES 12a and 12b show in greater detail lost motion link 82. FIGURE 12a, a top view of lost motion link 82, illustrates lost motion link pin 86 and slot 84. FIGURE 12b is a side view of lost motion link 82 also illustrating pin 86 and slot 84. Pin 86 is fixedly coupled to one end of lost motion link 82, while slot 84 is an elongated aperture disposed entirely through link 82.
  • parallel clip magazine 70 can be best understood from the sequence illustrated in FIGURES 13a, 13b and 13c.
  • FIGURE 13a parallel clip magazine 70 is shown coupled to main body 20.
  • leaf springs 76 extending inwardly from housing 94
  • clip loading blade 78 with inwardly extending leaf springs 88
  • lost motion link 82 is the clip feed blade 18, of applying device 2 which has a feed blade pin 90 attached thereto.
  • FIGURE 15a clip feed blade 18 is in its fully retracted position so that a hemostatic clip 37 is located in recess 26 of main body 20. Hemostatic clip 37 is held in recess 26 by clip guide spring 92.
  • a plurality of hemostatic clips 37 Disposed within parallel clip magazine 70 are a plurality of hemostatic clips 37 which will be sequentially moved into recess 26 by the urging of leaf springs 88 coupled to clip loading blade 78. It can be seen in FIGURE 13a that feed blade pin 90 is located in the extreme right hand portion of slot 84 in lost motion link 82 and that clip loading blade 78 is coupled to lost motion link 82 by lost moiion link pin 86.
  • FIGURE 13b it can be seen that clip feed blade 18, which is coupled to upper finger loop 4, has been moved forward so that the clip 37 which was in recess 26 has been moved along its path toward the jaw portions.
  • feed blade pin 90 has freely moved the length of slot 84 in lost motion link 82, the distance A, so that neither lost link 82 nor clip loading blade 78 has had a forward movement.
  • hemostatic clips 37 disposed within the magazine 70 have not moved, while the clip 37 which was located in the recess 26 has been moved toward the device jaws.
  • clip loading blade 78 will also undergo a rearward movement.
  • leaf springs 88 will abut a clip 37 and bend outward sufficiently so that the blade 78 is not impeded.
  • the blade leaf springs 88 have cleared the clips 37, they will return to their inward biased position.
  • Clips 37 are prevented from undergoing a rearward movement by the protrusion of leaf springs 76 in housing 94. That is, the bail portions of clips 37 abut the leading edge of leaf springs 76 and are prevented from moving rearward.
  • forward movement of clips 37 is accomplished by the abutment of the leading edge of leaf springs 88 with the bail portion of clips 37.
  • both leaf springs 76 and 88 in their relationship to clips 37 is accomplished by the location of rear stop pin 16 and forward stop means 21.
  • the rear stop pin 16 is positioned so that abutment of upper finger loop member 5 with pin 16 results in sufficient movement of clip loading blade 78 so that loading blade leaf springs 88 stop slightly behind each adjacent clip 37. This positioning of pin 16 ensures that each leaf spring 88 will be able to move the adjacent clip 37 forward.
  • the forward stop means 21, on the other hand, is positioned so that abutment of upper finger loop member 5 results in sufficient forward movement of leaf springs 88 so that each clip 37 is placed just beyond the rearward adjacent leaf spring 76. Thus, the prevention of rearward movement of clips 37 is ensured since each leaf spring 76 is always behind the forward adjacent clip 37.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Reproductive Health (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Claims (29)

1. Appareil chirurgical de pose d'agrafes, du type comprenant un corps principal (20), des moyens (32, 34) pour déformer les agrafes, montés sur le corps principal, des moyens (18) d'entraînement des agrafes, pour déplacer les agrafes vers les moyens de déformation des agrafes, et des moyens d'actionnement (5, 7), associés aux moyens d'entraînement et aux moyens de déformation, caractérisé par le fait qu'il comprend en outre un magasin à agrafes (41), monté à l'extérieur du corps principal, et agencé pour contenir une pluralité d'agrafes (37), ledit corps principal (20) comportant des moyens (26) pour recevoir les agrafes (37) provenant du magasin à agrafes (41), lesdits moyens d'entraînement des agrafes (18) étant montés coulissants dans le corps principal (20), et agencés pour déplacer les agrafes (37) desdits moyens (26) de réception des agrafes vers lesdits moyens de déformation (32, 34) des agrafes, lesdits moyens d'actionnement (5, 7) comprenant une partie supérieure de manoeuvre (4), montée pivotante sur le corps principal (20) et les moyens d'entraînement des agrafes, et une partie inférieure de manoeuvre (6), montée pivotante sur-le corps principal, et solidaire des moyens de déformation des agrafes, de sorte qu'un mouvement vers l'avant de ladite partie supérieure de manoeuvre provoque le coulissement desdit moyens d'entraînement (18) dans ledit corps principal (20), et ainsi, l'amenée d'une agrafe (37) dans lesdits moyens (32, 34) de déformation des agrafes, et qu'un mouvement vers l'arrière de ladite partie supérieure de manoeuvre (4), associé à un mouvement vers l'intérieur de ladite partie inférieure de manoeuvre (6) provoque la déformation d'une agrafe (37) située dans les moyens (32, 34) de déformation des agrafes, par ces dits moyens.
2. Appareil selon la revendication 1, dans lequel les moyens (18) d'entraînement des agrafes consistent en un élément allongé disposé longitudinalement dans le corps principal (20).
3. Appareil selon la revendication 2, dans lequel les moyens (18) d'entraînement consistent en un élément en forme de lame, constitué d'une pluralité de bandes superposées, agencées pour se déplacer longitudinalement par rapport au corps principal (20), tout en s'incurvant latéralement.
4. Appareil selon la revendication 3, dans lequel le magasin à agrafes (41) comprend un logement (44) monté sur ledit corps principal (120) de façon amovible, ledit logement (44) étant agence pour contenir une pluralité d'agrafes (37) et pousser lesdites agrafes dans les moyens (26) de réception des agrafes du corps. principal.
5. Appareil selon la revendication 4, dans lequel les moyens (32, 34) de déformation des agrafes comprennent une mâchoire supérieure (32) et une mâchoire inférieure (34), les deux mâchoires étant agencées pour recevoir, main-. tenir et déformer entre elles une agrafe (37).
6. Appareil selon la revendication 1, dans lequel le magasin à agrafes (41) comprend un logement (44) dans lequel on peut déposer une pluralité d'agrafes, pour les amener une à une dans les moyens (26) de réception des agrafes du corps principal.
7. Appareil selon la revendication 6, dans lequel le magasin à agrafes (41) est monté sur le corps principal (20) de façon amovible.
8. Appareil selon la revendication 7, dans lequel le corps principal (20) est un élément allongé, et le magasin à agrafes (41) est agencé pour que les agrafes (37) soient disposées latéralement par rapport au corps principal (20), le magasin à agrafes (41) comprenant en outre des moyens élastiques (48) montés sur le corps principal (20), et agencés pour pousser lesdites agrafes (37) dudit magasin (41) dans les moyens (26) de réception des agrafes du corps principal.
9. Appareil selon la revendication 8, dans lequel les moyens élastiques (48) consistent en un ressort en lame monté à une extrémité dudit magasin (41).
10. Appareil selon la revendication 6, dans lequel le corps principal (20) est un élément allongé, et le magasin à agrafes (41) comprend un logement (94) agencé pour recevoir lesdites agrafes (37) dans une position parallèle au corps principal (20).
11. Appareil selon la revendication 10, dans lequel le magasin à agrafes (41) comprend un chargeur d'agrafes en forme de lame (78), et le logement (94) comprend en outre une pluralité de ressorts en lame (76) incurvés vers l'intérieur, et agencés de façon à ce que le chargeur en forme de lame (78) fasse avancer les agrafes (37) une à une à travers le logement (94), tandis que lesdits ressorts en lame (76) empêchent le mouvement desdites agrafes (37) vers l'arrière.
12. Appareil selon la revendication 11, dans lequel le chargeur en forme de lame (78) comprend une pluralité de ressorts en lame (88) disposés sur le dit chargeur en forme de lame (78), de façon à être sensiblement face aux ressorts à lame (76) du logement (94).
13. Appareil selon la revendication 12, lequel comprend en outre des moyens de liaison à course morte (82) agencés pour coopérer avec lesdits moyens (18) d'entraînement des agrafes, lesdits moyens de liaison (82) étant montés coulissants dans ledit logement (94), et montés sur ledit chargeur (78), de sorte qu'un premier mouvement desdits moyens (18) d'entraînement vers l'avant n'implique aucun mouvement du chargeur (78) vers l'avant tandis qu'un mouvement supplémentaire desdits moyens (18) d'entraînement implique un mouvement du chargeur (78) vers l'avant.
14. Appareil selon la revendication 13, dans lequel sont en outre montés sur le logement (94) des moyens élastiques de guidage (92), agencés pour pousser lesdites agrafes dudit logement (94) dans lesdits moyens (26) de réception des agrafes du corps principal.
15. Appareil selon la revendication 14, lequel comprend en outre des moyens de fixation permettant le montage et le démontage du magasin (41) sur le corps principal (20).
16. Appareil selon la revendication 15, dans lequel les moyens de déformation des agrafes comprennent une mâchoire supérieure (32) et une mâchoire inférieure (34), les deux mâchoires étant agencées pour recevoir, maintenir et déformer entre elles une agrafes (37).
17. Appareil selon la revendication 16, dans lequel lesdites mâchoires (32, 34) comportent des gorges (40, 42) disposées longitudinalement dans ces mâchoires pour y recevoir et maintenir une agrafe (37).
18. Appareil selon la revendication 17, dans lequel lesdites mâchoires (32, 34) présentent respectivement deux surfaces sensiblement planes, se faisant face, agencées pour s'accoller sensiblement et pour déformer une agrafe (37) lorsque les moyens d'actionnement (5, 7) son manoeuvrés.
19. Appareil selon la revendication 18, dans lequel lesdites mâchoires (32, 34) sont incurvées en s'écartant du corps principal (20).
20. Appareil selon la revendication 19, dans lequel lesdits moyens (18) d'entraînement des agrafes sont agencés pour coulisser hors du corps principal (20) et sensiblement à travers les gorges (40, 42) desdites mâchoires (32, 34).
21. Appareil chirurgical de pose d'agrafes, du type comprenant un corps principal (20), des moyens (32, 34) pour déformer les agrafes, montés sur le corps principal, des moyens (18) d'entraînement des agrafes, pour déplacer les agrafes vers les moyens (32, 34) de déformation des agrafes, et des moyens d'actionnement (5, 7), associés aux moyens d'entraînement et aux moyens de déformation, caractérisé par le fait que le corps principal (20) comporte des moyens (26) de réception des agrafes (37), lesdits moyens (18) d'entraînement des agrafes étant montés coulissant à l'intérieur dudit corps principal (20), et agencés pour déplacer les agrafes (37) desdits moyens (26) de réception des agrafes vers les moyens (32, 34) de déformation des agrafes, et lesdits moyens d'actionnement (5, 7) comprenant une partie supérieure de manoeuvre (4) montée pivotante sur le corps principal et les moyens d'entraînement des agrafes, et une partie inférieure de manoeuvre (6) montée pivotante sur le corps principal, et solidaire des moyens de déformation des agrafes, de sorte qu'un mouvement vers l'avant de ladite partie supérieure de manoeuvre provoque le coulissement desdits moyens (18) d'entraînement dans ledit corps principal (20), et ainsi, l'amenée d'une agrafe (37) des moyens (26) de réception des agrafes vers les moyens (32, 34) de déformation des agrafes, et qu'un mouvement vers l'arrière de la partie supérieure de manoeuvre (4), associé à un mouvement vers l'intérieur de la partie inférieure de manoeuvre (6) provoque la déformation d'une agrafe (37), située dans les moyens (32, 34) de déformation des agrafes, par ces dits moyens.
22. Appareil selon la revendication 21, dans lequel les moyens (18) d'entraînement des agrafes consistent en un élément allongé disposé longitudinalement dans le corps principal (20).
23. Appareil selon la revendication 22, dans lequel les moyens (18) d'entraînement consistent en un élément en forme de lame, constitué d'une pluralité de bandes superposées, agencées pour se déplacer longitudinalement par rapport au corps principal (20), tout en s'incurvant latéralement.
24. Appareil selon la revendication 23, dans lequel les moyens (32, 34) de déformation des agrafes comprennent une mâchoire supérieure (32) et une mâchoire inférieure (34), les deux mâchoires étant agencées pour recevoir, maintenir et déformer entre elles une agrafe (37).
25. Appareil selon la revendication 21, dans lequel les moyens (32, 34) de déformation des agrafes comprennent une mâchoire supérieure (32) et une mâchoire inférieure (34), les deux mâchoires étant agencées pour recevoir, maintenir et déformer entre elles une agrafe (37).
26. Appareil selon la revendication 25, dans lequel chaque mâchoire (32, 34) comporte une gorge (40, 42), disposée longitundinalement dans cette mâchoire, pour y recevoir et maintenir une agrafe (37).
27. Appareil selon la revendication 26, dans lequel lesdites mâchoires (32, 34) présentent respectivement deux surfaces sensiblement planes, se faisant face, agencées pour s'accoller sensiblement et pour déformer une agrafe (37) lorsque les moyens d'actionnement (5, 7) sont manoeuvrés.
28. Appareil selon la revendication 27, dans lequel lesdites mâchoires (32, 34) sont incurvées en s'écartant du corps principal (20).
29. Appareil selon la revendication 28, dans lequel lesdits moyens (18) d'entraînement des agrafes sont agencés pour coulisser hors du corps principal (20), et sensiblement à travers les gorges (40, 42) desdites mâchoires (32, 34).
EP19780100549 1977-08-05 1978-07-29 Agrafeuse chirurgicale Expired EP0000756B1 (fr)

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US822096 1977-08-05

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EP0000756B1 true EP0000756B1 (fr) 1981-10-21

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DE2861194D1 (en) 1981-12-24
JPS5740775B2 (fr) 1982-08-30
CA1124605A (fr) 1982-06-01
JPS5441588A (en) 1979-04-02
EP0000756A1 (fr) 1979-02-21

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