JP2008543354A - Ligation clip with reduced closing force - Google Patents

Abstract

  The polymer surgical clip 12 has first and second bent legs 22, 24 having a proximal end coupled by a flexible hinge portion 26 and having a pair of opposing side surfaces 52, 54, respectively. The first and second legs 22, 24 can be moved from the open position to the closed position to clamp the tube. The distal end of the first leg is a female locking member 40. The distal end of the second leg is a male locking member 50 that is complementary to the female locking member. The clip has a detent D on the outer surface between the hinge portion and the female locking member. Detent D serves to straighten the first leg when closing the clip and reduce the force required to close the surgical clip.

Description

Field of Invention

  The present invention relates to a surgical clip, and more particularly to a ligation clip that requires a small closing force when an automatic clip applier is used. In addition, this disclosure relates to an improvement in a surgical clip that is provided with a detente on the outer surface of the hook-side leg, which includes a hook-side leg on the lower jaw of the automatic clip attachment during closure. When in contact, it helps straighten the legs, thereby reducing the force required to close the ligating clip.

Background of the Invention

  Surgical procedures often require ligation of human tubes and other tissues. For example, in many surgical procedures it is necessary to cut blood vessels (eg, veins or arteries). Cutting these blood vessels requires ligation to reduce the amount of bleeding. In many cases, surgeons attempt to temporarily ligate blood vessels during surgery to reduce blood flow to the surgical site. In other cases, the surgeon attempts to permanently ligate the tube. Ligation of a tube or other tissue is accomplished by closing the tube with a ligation clip or suturing the tube with a surgical suture. The use of surgical threads for ligation requires complex manipulation of needles and suture materials to make a knot, and these are also necessary to protect the tube. Such complex operations are not only time consuming, but also difficult to implement, especially in endoscopic surgery, due to limited space and visibility. In contrast, ligation clips can be installed relatively easily and quickly. Generally, the clip is attached to a tube or other tissue using a specialized instrument, i.e., what is commonly referred to as a surgical clip applier, a ligation clip applier, or a hemostatic clip applier. Therefore, the use of ligation clips used under an endoscope has evolved dramatically, as do surgical operations performed in an open environment.

  The ligating clips can be classified according to their geometric shape (symmetrical clip, asymmetrical clip) and the material to be manufactured (metal clip, polymer clip). Symmetric clips are generally “U” or “V” shaped and are therefore substantially symmetric with respect to a central or longitudinal axis extending between the legs of the clip. Symmetric clips are usually formed of metals such as stainless steel, titanium, tantalum, or alloys thereof. The metal clip is permanently deformed to cover the tube by using a dedicated clip applier. An example of such a clip is disclosed in US Pat. No. 5,509,920 by Phillips et al. US Pat. No. 3,326,216 to Wood et al., An example of a metal clip applier, ie, having a forceps shape and having an equiangular jaw that grips and maintains alignment when the clip is deformed Is disclosed. A further mounting of such a clip on the mounter with multiple clips for continuous mounting is disclosed in US Pat. No. 4,509,518 by McGarry et al.

  With the advent of advanced diagnostic methods using X-ray tomography (CATSCAN) and magnetic resonance imaging (MRI), metal clips have been found to interfere with such image processing techniques. . To overcome such interference limitations, biocompatible polymers are increasingly being used. Unlike metal clips, which are usually symmetrical, polymer clips are usually designed asymmetrically and therefore have no axis of symmetry reference. Plastic clips do not permanently deform because they securely close around tubes and other tissues. For this reason, the plastic clip incorporates a latch mechanism for stabilizing the closed state and making the tube safe against reopening. Well known polymer clips are disclosed, for example, in US Pat. No. 4,834,096 and US Pat. No. 5,062,846 by Oh et al. These are all assigned to the assignee of the subject matter disclosed herein. These plastic clips are generally composed of a pair of curved legs, which are joined at the base side by a hinge or rear part. The end of the curved leg includes a connecting latch member. In order to lock the clip properly, for example, the end of one leg has a lip-like or hook-like structure in which the end of the other leg can be fitted safely.

  U.S. Pat. No. 5,062,846 by Oh et al. Teaches the end of a clip, which includes a side boss that mates with the jaws of the clip applier. A clip applier specifically designed for asymmetric plastic clips is used to close the clip in the vicinity of the tissue to be ligated and to latch or lock the clip in the closed state. In surgery, the clip mount jaws operate to contact and compress the leg of the clip. This causes the legs to pivot inward with respect to the hinge. This warps the hook of one leg and accepts the end of the other leg. US Pat. No. 5,100,416 to Oh et al. Discloses a clip applier for use in an asymmetric plastic clip for use in an open surgical environment rather than an endoscope. This US Pat. No. 5,100,416 was also assigned to the assignee of the subject matter disclosed herein.

  In addition to adapting to complex diagnostic methods, asymmetric clips have other advantages over symmetrical clips. For example, since the asymmetric clip is formed of a polymer material, the opening of the asymmetric clip is generally larger than the opening of the symmetric clip. This allows the surgeon to place the clip more accurately with respect to the desired tube. In addition, the type of clip described in the aforementioned US Pat. No. 4,834,096 and US Pat. No. 5,062,846 is positioned prior to securing the clip onto the tube in a process called clip approach. Or change the position before removing the clip from the tube.

  Various types of hemostatic or aneurysm asymmetric clips are used in surgery, which ligates blood vessels and other tissues to stop blood flow. In certain surgical procedures, such as the sterilization process, such clips are used to break or occlude conduits and blood vessels.

  A special technique that requires considerable force to close an asymmetrical ligation clip applied to close a tube or other tissue using an automatic clip applier such as EMDO5 available from Pilling Weck Incorporated Known as. The clip is advanced from the magazine and inserted into the jaws of the automatic clip applier. The considerable force required to close the ligation clip occurs due to the bending of the ligation clip legs caused by the spring-driven clip feeder. Axial loading by a spring-driven feeder causes further bending due to the curvature of the two legs of the ligating clip. Since this bending increases the collision between the female locking member and the male locking member, more force is required when closing the ligation clip or when straightening the two legs of the ligation clip. .

  Polymer ligation clips are well known in the surgical world, and the ligation clips have many improvements, but for ligation clips using an automatic clip applier such as ENDO5 available from Pilling Weck Incorporated. No improvements have been made to reduce the force required to close or lock the door. Thus, it appears that there has long been a need for improved polymer clips to reduce the closing force when mounting with an automatic clip mounter. This disclosure is believed to contribute to such an improvement of the surgical ligation clip.

Summary of the Invention

  Consistent with the disclosure herein, a surgical polymer clip is provided of the type having first and second legs that are joined together by a flexible hinge at the proximal end. Each leg has a tube clamp inner surface, an opposite outer surface, and a pair of opposing side surfaces. The inner surface of the tube clamp is opposed to the inner surface of the tube clamp of the other leg. Further, the female locking member is located at the end of the first leg, and the male locking member is located at the end of the second leg. When the first and second leg members move from the open position to the closed position with respect to the hinge portion, the male lock member engages with the female lock member to lock the female lock member and the female lock member. As a result, the clip is removably formed to lock in the closed position.

  The surgical clip further includes a pair of bosses coupled to opposing sides of the first leg at a location between the hinge portion and the distal end of the first leg. In a more preferred embodiment, it has a pair of second bosses that are coupled to opposing sides of the second leg at the end of the second leg. The pointed tissue penetrating tooth extends outward from each of the pair of second bosses toward the distal end of the first leg.

  In a more preferred embodiment, the clip has a detent on the outer surface of the first leg that protrudes outward from a position between the flexible hinge and the female locking member. The detents straighten the lower or first leg while closing the surgical clip by the jaws of the automatic clip applier, thereby reducing the closing force applied to the clip by the automatic clip applier, Facilitates closing and locking of surgical clips. The detent has an arcuate shape so that the radius of the detent is not greater than the radius of the pair of bosses at the distal end of the first leg adjacent to the female locking member.

  In a further preferred embodiment, at a position between the hinge and the distal end, the tube clamp inner surface of the first leg has a concave radius of curvature and the outer surface has a convex radius of curvature. In the same embodiment, at a position between the hinge and the distal end, the tube clamp inner surface of the second leg has a convex radius of curvature and the outer surface has a concave radius of curvature. At least one of the inner surfaces of the clip has a number of protrusions protruding from the inner surface, the protrusions being provided to improve the retention of the tube when attempting to close the clip and during closing. It has been. Even more preferably, both inner surfaces have a number of protrusions.

  The surgical clip disclosed herein is preferably formed of a polymeric material, thereby minimizing interference with advanced technology diagnostic methods such as CAT SCAN, MRI and MRS. At the same time, despite having sufficient strength and high safety of the clip latching mechanism, the clip is almost as small as a similar metal clip. The surgical clip of the present disclosure is further configured to have a reduced closing force when mounted on an automatic clip applier, as compared to a conventional surgical polymer clip.

  It is therefore an object of the surgical clip disclosed herein to provide a surgical polymer clip with reduced closing force.

  Some purposes of the subject matter disclosed herein have been described above. Other objects will become apparent over time as the description proceeds, incorporating the drawings with the description most appropriately described below.

Detailed Description of the Preferred Embodiment

  First, an example of the asymmetric surgical clip 12 will be described with reference to FIGS. 1 to 8 together with a detente D. FIG. The detent D is provided on the bottom leg to reduce the closing force, and reducing the closing force is consistent with the subject matter disclosed herein. The clip 12 or similar design is particularly useful as a hemostatic clip that latches around a tube or other type of tissue to ligate the tube, thereby stopping or reducing fluid flow in the tube. is there. Clip 12 can be constructed of any suitable biocompatible material, i.e., any metal or polymer. However, the subject matter disclosed herein is particularly useful for practices using polymer clips. Accordingly, the clip 12 is preferably of the type commonly used for surgical implants, and is a body formed of a suitable tough biocompatible plastic that is generally made of an integral polymer. Consists of the body. Examples include, but are not limited to, acetyl polyoxymethylene (POM), polyethylene terephthalate (PET), polybutylene terephthalate (PBT), polyoxymethylene, injection molding with similar properties. , Thermoplastic materials other than those described above, which are formed by extrusion or other methods.

  Referring to FIG. 1, the body of clip 12 is comprised of a first or outer leg indicated at 22 and a second or inner leg indicated at 24. The first and second legs 22, 24 are joined by a hinge portion indicated at 26 on their base side. The first and second legs 22, 24 each have a pair of opposed side surfaces 52, 54. The first and second legs 22, 24 have complementary arcuate side shapes. Accordingly, the first leg 22 has a concave inner surface 28 and a convex outer surface 30, and the second leg 24 has a convex inner surface 32 and a concave outer surface 34. The convex inner surface 32 of the second leg 24 and the concave inner surface 28 of the first leg 22 have substantially the same radius of curvature. The detent D is provided on the convex outer surface 30 of the first leg 22.

  The hinge portion 26 has a continuous concave inner surface 36 and a continuous convex outer surface 38. The concave inner surface 36 of the hinge portion 26 connects the concave inner surface 28 of the first leg 22 and the convex inner surface 32 of the second leg 24. The convex outer surface 38 of the hinge portion 26 connects the convex outer surface 30 of the first leg 22 and the concave outer surface 34 of the second leg 24.

  The first leg 22 has a female locking member 40 at its end. The female lock member 40 includes a resilient hook 41 that is bent inward. The second leg 24 ends as a male locking member 50. The male locking member 50 includes a pointed tip 42 at its distal end. The hook 41 is bent inward toward the hinge portion 26 at the end, and has a lateral slope 44. Slope 44 and concave inner surface 28 define a latching recess 46 that latches clip 12 into a latched or locked position around a tube or other tissue when compressed. It is adapted to fit and engage the tip 42 of the male locking member 50.

  As best shown in FIGS. 1 and 2, the upper surface of the hook 41 is most preferably the two convex surfaces 47 forming a sharpened cutting edge 49. Cutting edge 49 facilitates cutting connective tissue adjacent to tubes and other tissues when the clip is latched in place.

  As best shown in FIGS. 1 and 2, the clip 12 has opposing sides 52 and 54. Characteristically, the body of clip 12 has a constant thickness between sides 52 and 54. A pair of cylindrical bosses 56, 58 are formed coaxially on each of the side surfaces 52, 54 of the first leg 22, adjacent to the end of the first leg 22, on the inside immediately adjacent to the hook 41. ing. As illustrated in the example of the clip 12, a bridge portion 66 connects the bosses 56 and 58. As is apparent from FIG. 1, the bosses 56 and 58 protrude outward beyond the convex outer surface 30 of the first leg 22.

  Referring again to the ends of the second or inner leg 24, another pair of cylindrical bosses 62 and 64 are coaxially formed on the opposing side surfaces of the tip portion 42 of the inner leg 24. As is clear from FIGS. 1 and 2, the bosses 62 and 64 of the second leg 24 extend longitudinally forward beyond the distal end portion 42.

  Similarly, as best shown in FIGS. 1 and 2, the hook 41 of the first leg 22 ends with a sharp tip 68 with a cutting edge 49 extending along at least the longitudinal direction of the upper surface of the hook 41. It is preferable. The male locking member 50 of the second leg 24 includes a pair of pointed tissue penetrating teeth 72, 74. The tissue penetrating teeth 72 and 74 cooperate with the cutting edge 49 and the sharp tip 68 of the hook 41 to assist in grasping, stretching and puncturing nearby connective tissue.

  The first and second legs 22, 24 have a plurality of protrusions or teeth 76. A plurality of protrusions or teeth 76 extend from the inner surfaces 28, 32 of the first and second legs 22, 24. These features are designed to engage the tissue of the tube to be pinched and to help prevent the tube from sliding laterally or longitudinally. It should be noted that other clips related to the subject matter disclosed herein are equally suitable for use, as they do not have such a feature.

Clip disclosure

  In the practice of ligation and cutting of tubes and other tissues as understood by a person skilled in the art, the clip 12 is used with a suitable clip mounter, such as the EMDO5 automatic clip mounter available from Pilling Weck Incorporated. Designed to undergo compression to latch or lock in a closed position around the tube. The clip mounting device engages with the bosses 56, 58, 62, 64 of the clip 12 and pivots the bosses 56, 58, 62, 64 inward with respect to the hinge part 26. This closes the first and second legs 22, 24 around the tube. In so doing, the convex inner surface 32 of the second leg 24 and the concave inner surface 28 of the first leg 22 complementary thereto contact the outer wall of the tube.

  However, before contact is made between the first leg 22 and the second leg 24, pointed tissue penetrating teeth 72, 74 over the bosses 62, 64 of the second leg 24 surround the tube. The connective tissue is pierced and penetrated between them, and the connective tissue is disassembled. While the teeth 72 and 74 slide, at the same time, the sharp tip 68 and hook 41 of the first leg 22 begin to penetrate the connective tissue and push up the connective tissue. The sharp tip 68 and the cutting edge 49 on the hook 41 enter the inside of the groove 43 of the pointed tip 42 of the second leg 24. Thereby, the connective tissue begins to be pierced or cut.

  As the cutting edge 49 of the hook 41 and the sharp tip 68 continue to move in the groove 43 between the teeth 72 and 74, the shear force contributes to further drilling and cutting of the connective tissue surrounding the tube. To do. If all the connective tissue has not yet been cut between the distal end of the second leg 24 and the hook 41, the connective tissue is easily pierced by the sharp tip 68 and the second leg 24 It extends and thins until it is cut by the cutting edge 49 of the hook 41 passing through the groove 43. Once the connective tissue is cut, the female locking member 40 and the male locking member 50 engage to lock without interference.

  Cutting edge 49 is understood to be a desirable feature of the preferred embodiment of clip 12. Other embodiments of the clip 12 that do not include the cutting edge 49 are within the scope of the disclosure herein. Therefore, the clip 12 may or may not include the cutting edge 49 as described above.

  The distal end portion 42 of the second leg 24 starts to contact the female lock member 40 of the hook 41. Further pivoting movement of the clip mounter jaws causes the first leg 22 to extend longitudinally and deflect the hook 41. This causes the male locking member 50 at the tip 42 to adjust the position in the latch recess 46 of the female locking member 40. When the mounting device is opened, when the clip 12 is in the closed position in the latched state, the distal end portion 42 snaps into the latch recess 46 of the female lock member 40 and is set in conformity. In the latched state, the tip 42 engages between the concave inner surface 28 and the bevel 44, thereby securely clamping a specified tube or other tissue between the concave inner surface 28 and the convex inner surface 32. To do. Once the closed position of the clip 12 and the ligation of the tube are ensured, the two clips 12 on either side of the cut are most appropriate and the physician can safely cut the tube.

Embodiment to reduce closing force

  As will now be described and shown, to focus now on the new features of the clip 12, the applicant clips the detent D on the outer surface 30 of the first leg 22 and projects outwardly therefrom. Note that 12 has. The detent D is preferably located on the outer surface 30 of the first leg 22 in the middle between the flexible hinge portion 26 and the female locking member 40. The detent D helps to straighten the first leg 22 while the surgical clip 12 is closed, and the surgical clip by an automatic clip applier such as ENDO 5 available from Pilling Weck Incorporated. As a result, the closing force required to close or lock 12 is reduced.

  FIGS. 3A to 3E show the closing and locking operations of a conventional surgical ligation clip C performed by the jaws of the automatic clip applier CA. FIGS. 4A to 4E illustrate the closing and locking operations of the clip 12 of the present disclosure with reduced closing force, as performed by the jaws of the automatic clip applier CA. FIGS. 5A to 5E show the closing and locking action of a conventional asymmetric polymer ligation clip C made by the jaws of the automatic clip applier CA, which is done around the tube V. FIG. The 6A to 6E are schematic diagrams illustrating the closing and locking action of the clip 12 of the present disclosure with reduced closing force, performed by the jaws of the automatic clip applier CA, the closing action and locking action being the tube V Made about.

  FIG. 7 is necessary to close and lock the clip 12 of the present disclosure with reduced closing force around the tube V relative to the force required to close and lock the conventional clip C. It is a graph which shows special force. As shown in FIG. 7, closing and locking the clip 12 with the reduced closing force requires more force than closing and locking the conventional asymmetric ligating polymer clip C. It is sufficient that a very low force is applied by the jaws of the automatic clip applier CA. FIG. 7A shows (1) tube V for closing and locking forces for both a conventional asymmetric ligating polymer clip C and the clip 12 of the present disclosure modified to reduce the closing force. And (2) a state where the periphery of the tube V is clamped.

  In particular, the detent D on the bottom surface of the first leg 22 serves to contact the lower jaw of the automatic clip mounter CA while the jaws of the automatic clip mounter CA are brought closer together. A conventional asymmetric ligating polymer clip C, when used in an automatic clip applier, closes the clip due to leg curvature caused by the loading of the spring feeder F applied to the hinge end of the clip C. Further force is required to lock (see FIG. 3). The curvature of the legs 22, 24 of the clip 12 can be further curved by the axial load of the spring feeder F. Further bending of the legs 22, 24 increases the interference of the hook 41 of the female locking member 40, so that more force is required to close the clip 12 and straighten the legs 22, 24 (FIG. 4).

The detent D of the clip 12 of the present disclosure is between the lower jaw of the automatic clip applier CA,
Give the leg 22 a better contact, thereby straightening the lower first leg 22 and reducing the curvature of the leg caused by the reaction of the force of the spring feeder F applied to the rear of the clip 12 by the automatic clip applier CA (See FIG. 4). The detent D is preferably in an intermediate position between the hinge 26 and the hook 41. This position applies a straightening force caused by the lower jaw to the detent D in the optimal position of the leg 22. The size of the detent D is a function of the geometric outline of the individual automatic clip applier. As shown in FIGS. 4 and 6, the clip 12 is swung over the detent D during the initial closing action that occurs by lifting the hook bosses 56, 58 by the lower jaw. The larger detent D causes the hook bosses 56, 58 to undesirably escape from the lower jaw. Therefore, the size of the detent D needs to be determined uniformly along with the geometric outline of the specific automatic clip applier CA used for the clip 12, which is outside the first leg 22. Preferably it does not protrude too far from the surface. Because the detents D projecting away from the outer surface of the first leg 22 may cause the first leg bosses 56, 58 to escape from the lower jaw of the clip applier CA. It is.

  As shown in FIG. 7A, when the conventional and improved asymmetric ligating polymer clips are closed without a tube between them, in other words, in dry fired, the peak of the closing force of the clip 12 is Is basically the same (see also FIGS. 3 and 4). The benefits of detent D are seen in FIGS. 7 and 7A when conventional asymmetric ligating polymer clip C and the improved asymmetric ligating polymer clip 12 of the present disclosure are clamped around tube V. (See also FIGS. 5 and 6). As shown in FIGS. 7 and 7A, using the improved clip 12 of the present disclosure, an approximately 16% reduction in the closing force peak was achieved.

  In summary, when the spring feeder F pushes a conventional ligation clip C, the lower first leg tends to bend relative to the lower jaw of the automatic clip applier CA. The detent D of the clip 12 of the present disclosure is not bent over the second leg 24, but rather results in the lower leg 22 resulting in bending or straightening outward. Helps to change the pivot axis of the first leg 22 below the clip 12, thereby reducing the force required to close and lock the clip 12 by the jaws of the automatic clip applier CA.

  Prior art clips similar to clip 12 are described in detail in commonly assigned Oh et al. US Pat. No. 4,834,096 and US Pat. No. 5,062,846. The disclosures of US Pat. No. 4,834,096 and US Pat. No. 5,062,846 are incorporated in their entirety into this document. In addition, HEM-O-LOK® clips are commercially available from assignees of the subject matter disclosed herein. These clips are currently available in "M", "ML", "L", and "XL" sizes. The conventional clip cartridge described below can accommodate any commercially available HEM-O-LOK® clip, not just the clip 12 of the present disclosure.

Clip cartridge

  8A-8C, a preferred embodiment of a conventional clip cartridge, generally designated 100, is shown for use with clip 12. FIG. The clip cartridge 100 is preferably constructed of a single-molded plastic body with several features formed. In particular, the clip cartridge 100 includes a number of clip holding chambers or compartments 111 partitioned along a longitudinal axis L of the clip cartridge 100. Each clip section 111 is substantially identical and suitable for holding one clip 12. FIG. 8A shows a state in which one clip 12 is stored in one clip section 111. Of course, however, the clip cartridge 100 of the preferred embodiment includes a number of clip compartments 111 storing a number of clips 12. For example, the clip cartridge 100 is suitable for storing six clips 12 even though other embodiments are provided that store more or less clips 12. Desirably, an adhesive backing (not shown) may be provided on the bottom surface of the clip cartridge 100 in order to fix the clip cartridge 100 to a tray or other supporting component used during use.

  FIGS. 8A-8C also illustrate the tip of a typical clip attachment device used for clip 12, generally indicated at 120. The clip applier includes opposing pivotable jaws 125A and 125B. The jaws 125A, 125B have jaw recesses 127A, 127B, respectively, suitable for engaging and holding the bosses 56, 58, 62 and 64 of the clip 12 (see FIG. 1-2). According to the method shown in this document, FIG. 8A shows the clip attachment device 120 in the upper position of the clip 12 before inserting the clip attachment device 120 into the selected clip section 111. FIG. 8B shows that the clip attachment device 120 is selected for loading into the clip attachment device 120 (with the bosses 56, 58, 62 and 64 held by the jaw recesses 127A, 127B) that engage the clip 12 in a locked state. The inserted state is shown in the clip section 111. FIG. 8C shows the next step of withdrawing the clip 12 from the clip cartridge 100 by removing the clip 12 loaded therein with the clip mounting device 120.

  It will be appreciated that various details of the subject matter disclosed herein may be modified without departing from the scope of the present disclosure. Furthermore, the above description is for illustrative purposes only and is not intended to be limiting. That is, the invention is defined by the claims.

FIG. 1 is a perspective view showing a ligation clip with reduced closing force according to the present disclosure. FIG. 2 is a side view of a ligation clip with reduced closing force showing a detent at the bottom of the leg. FIG. 3A is a schematic view showing the operation of closing a conventional asymmetrical ligation clip by a jaw of an automatic clip applier. FIG. 3B is a schematic diagram showing the operation of closing a conventional asymmetric ligation clip by the jaws of the automatic clip applier. FIG. 3C is a schematic view showing the operation of closing a conventional asymmetric ligation clip by the jaw of the automatic clip applier. FIG. 3D is a schematic diagram showing the operation of a conventional asymmetric ligation clip closing by a jaw of an automatic clip applier. FIG. 3E is a schematic diagram illustrating the operation of a conventional asymmetric ligation clip closing by a jaw of an automatic clip applier. FIG. 4A is a schematic view showing an operation in which an asymmetric ligation clip with reduced closing force is closed by a jaw of an automatic clip mounter. FIG. 4B is a schematic view showing the operation of closing the asymmetric ligation clip with reduced closing force by the jaw of the automatic clip applier. FIG. 4C is a schematic view showing the operation of closing the asymmetric ligation clip with reduced closing force by the jaw of the automatic clip applier. FIG. 4D is a schematic diagram showing the operation of closing the asymmetric ligation clip with reduced closing force by the jaw of the automatic clip applier. FIG. 4E is a schematic diagram showing the operation of closing the asymmetric ligation clip with reduced closing force by the jaw of the automatic clip applier. FIG. 5A is a schematic diagram showing the operation of a conventional asymmetric ligation clip closing around a tube by the jaws of an automatic clip applier. FIG. 5B is a schematic diagram illustrating the operation of a conventional asymmetric ligating clip closing around a tube by the jaws of an automatic clip applier. FIG. 5C is a schematic diagram illustrating the operation of a conventional asymmetric ligation clip closing around a tube by the jaws of an automatic clip applier. FIG. 5D is a schematic diagram illustrating the operation of a conventional asymmetric ligation clip closing around a tube by the jaws of an automatic clip applier. FIG. 5E is a schematic diagram illustrating the operation of a conventional asymmetric ligation clip closing around a tube by the jaws of an automatic clip applier. FIG. 6A is a schematic diagram showing the operation of the asymmetric ligation clip with reduced closing force being closed around the tube by the jaws of the automatic clip applier. FIG. 6B is a schematic view showing the operation of the asymmetric ligation clip with reduced closing force being closed around the tube by the jaws of the automatic clip applier. FIG. 6C is a schematic diagram illustrating the asymmetric ligation clip with reduced closing force being closed around the tube by the jaws of the automatic clip applier. FIG. 6D is a schematic view showing the asymmetric ligation clip with reduced closing force being closed around the tube by the jaw of the automatic clip applier. FIG. 6E is a schematic diagram illustrating the asymmetric ligation clip with reduced closing force closing around the tube by the jaws of the automatic clip applier. FIG. 7 is a graph showing the force required to close a conventional surgical clip and a surgical clip of the present disclosure with reduced closing force (around the tube) by an automatic clip applier. The force required to close the conventional surgical clip and the ligation clip with reduced closing force, both when the tube is not between them and when the tube is between them Graph showing. FIG. 6 is a perspective view of a clip applier inserted into a clip cartridge compartment to engage a surgical ligation clip equipped to conform to the present disclosure. FIG. 8B is another perspective view of a clip applier engaged with a surgical ligation clip loaded within one of the compartments of the clip cartridge shown in FIG. 8A. FIG. 8B is another perspective view of the clip applier that is removing the surgical clip from the compartment of the clip cartridge shown in FIG. 8A.

Claims (23)

A surgical clip having a combined cutting guide comprising:
(A) a first leg and a second leg, each leg having an inner tube clamping surface, an outer surface, and a pair of opposing side surfaces disposed on the inner surface and the outer surface; The inner surfaces are a first leg and a second leg in positions facing each other;
(B) a flexible hinge portion that is integrally disposed between the base side ends of the first and second legs and that joins the base side ends of the first and second legs;
(C) a female locking member at the distal end of the first leg and a male locking member at the distal end of the second leg, wherein the first and second leg members are in the hinge portion On the other hand, when moving from the open position to the closed position, the male lock member engages the female lock member to lock, and in the closed position, the first and second legs of the surgical clip. The female and male locking members configured to removably lock the members;
(D) a detente on the outer surface of the first leg and projecting outward therefrom, at a position between the flexible hinge and the female locking member; A detent disposed on the outer surface of the first leg;
Comprising
The detent is a surgical clip that straightens the first leg while the surgical clip is closed, thereby facilitating closing and locking of the surgical clip by a clip applier.   The surgical clip according to claim 1, wherein the detent is disposed on the outer surface of the first leg at an intermediate position between the flexible hinge and the female locking member.   The surgical clip according to claim 2, wherein the detent comprises an arcuate protrusion.   A pair of bosses coupled to opposite sides of the first leg between the hinge portion and the end of the first leg, and the second leg at the position of the end of the second leg. The surgical clip of claim 1, further comprising a pair of bosses coupled to opposing sides of the leg.   The surgical clip according to claim 4, wherein a position where the pair of bosses are coupled to the first leg extends beyond the outer surface of the first leg so as to form a bridge.   The surgical clip according to claim 4, wherein the pair of bosses on the second leg each have a tissue penetrating tooth extending outwardly therefrom and toward the first leg.   The inner surface of the first leg has a concave radius of curvature between the hinge portion and a distal end of the first leg, and the outer surface of the first leg has the hinge portion and the first leg. A convex radius of curvature between the end of one leg and the inner surface of the second leg having a convex radius of curvature between the hinge and the end of the second leg. The surgical clip according to claim 1, wherein the outer surface of the second leg has a concave radius of curvature between the hinge portion and a distal end of the second leg.   At least one of the inner surfaces of the clip has a plurality of protrusions extending from the inner surface, the plurality of protrusions being in a tube when attempting to close the clip or closing the clip. The surgical clip of claim 1, wherein the surgical clip is provided to improve retention.   The surgical clip of claim 8, wherein both of the inner surfaces of the surgical clip have the plurality of protrusions.   The surgical clip according to claim 1, wherein the hinge portion has a continuous concave inner surface and a continuous convex outer surface.   The surgical clip according to claim 1, wherein the female locking member has a resilient hook that is bent inwardly and the hook is bent toward the second leg member.   The male locking member is complementary to the hook of the female locking member, whereby when the first and second leg members move from an open position to a closed position with respect to the hinge portion, The resilient hook of the female locking member contacts the male locking member and is urged to open to receive the male locking member and in the closed position the first of the surgical clip. The surgical clip according to claim 11, wherein the second leg member is removably locked. A surgical clip having a combined cutting guide comprising:
(A) a first leg and a second leg, each leg having an inner tube clamping surface, an outer surface, and a pair of opposing side surfaces disposed on the inner surface and the outer surface; The inner surfaces are a first leg and a second leg in positions facing each other;
(B) a flexible hinge portion that is integrally disposed between the base side ends of the first and second legs and that joins the base side ends of the first and second legs;
(C) a female locking member at the distal end of the first leg and a male locking member at the distal end of the second leg, wherein the first and second leg members are in the hinge portion On the other hand, when moving from the open position to the closed position, the male lock member engages the female lock member to lock, and in the closed position, the first and second legs of the surgical clip. The female and male locking members configured to removably lock the members;
(D) a detent on the outer surface of the first leg and projecting outward therefrom, at an intermediate position between the flexible hinge portion and the female locking member; A detent disposed on the outer surface of one leg;
Comprising
The detent is a surgical clip that causes the first leg to be straight while the surgical clip is closed, thereby facilitating closing and locking of the surgical clip by a clip applier.   The surgical clip according to claim 13, wherein the detent comprises an arcuate protrusion.   A pair of bosses coupled to opposite sides of the first leg between the hinge portion and the end of the first leg, and the second leg at the position of the end of the second leg. The surgical clip according to claim 13, further comprising a pair of bosses coupled to opposite sides of the leg.   The surgical clip according to claim 15, wherein the position at which the pair of bosses are coupled to the first leg extends beyond the outer surface of the first leg to form a bridge.   The surgical clip according to claim 15, wherein the pair of bosses on the second leg each have a tissue penetrating tooth extending outwardly therefrom and toward the first leg.   The inner surface of the first leg has a concave radius of curvature between the hinge portion and a distal end of the first leg, and the outer surface of the first leg has the hinge portion and the first leg. A convex radius of curvature between the end of one leg and the inner surface of the second leg having a convex radius of curvature between the hinge and the end of the second leg. The surgical clip according to claim 13, wherein the outer surface of the second leg has a concave radius of curvature between the hinge portion and a distal end of the second leg.   At least one of the inner surfaces of the clip has a plurality of protrusions extending from the inner surface, the plurality of protrusions being in a tube when attempting to close the clip or closing the clip. The surgical clip according to claim 13, wherein the surgical clip is provided to improve retention.   The surgical clip of claim 19, wherein both of the inner surfaces of the surgical clip have the plurality of protrusions.   The surgical clip according to claim 13, wherein the hinge portion has a continuous concave inner surface and a continuous convex outer surface.   The surgical clip according to claim 13, wherein the female locking member has a resilient hook that is bent inwardly and the hook is bent toward the second leg member.   The male locking member is complementary to the hook of the female locking member, whereby when the first and second leg members move from an open position to a closed position with respect to the hinge portion, The resilient hook of the female locking member contacts the male locking member and is urged to open to receive the male locking member and in the closed position the first of the surgical clip. The surgical clip according to claim 22, wherein the second leg member is removably locked.

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