JP4313195B2 - Surgical clamp - Google Patents

Description

  The present invention relates to a clamp for both human and veterinary surgical applications. More particularly, the present invention is a clamp that is used to perform bypass grafts on coronary arteries to occlude coronary arteries and other arteries, and has other dimensions that are generally similar in humans or animals. The present invention relates to a clamp that is suitable for use with other blood vessels or tubular structures to compress the structure and prevent the passage of blood or other fluids.

  When performing “off-pump” coronary artery bypass surgery (CAGS), the intent is to perform bypass without stopping the heart. It is therefore necessary to occlude the coronary artery with clamps on both sides of a small incision made in the coronary artery to be sutured by the bypass artery conduit. Thus, blood flow to a portion of the heart is temporarily blocked while the transplant is being performed. Subsequently, after each clamp is removed, the coronary artery receives a supplemental blood flow through the graft.

  One form of existing clamp for this purpose is a plastic derivative of an assault metal "bulldog" clamp that is smaller and lighter. It works by being opened by finger pressure and closing by the inherent elasticity of the material. In many cases, the clamping pressure provided is not sufficient to properly control blood flow. Since it is also relatively long, easy fitting into the stabilizing arm of the associated retractor device is difficult. Since it can be displaced perpendicular to the heart, it impedes the surgeon's field of view during grafting as well as suture capture. The metal clamps are also disadvantageous due to their weight, resulting in counter-forces caused by the inertia of the clamps when attached to a moving heart. Therefore, they are also often removed. In addition, since they are larger in size, it is more difficult to place them in a limited space.

  Existing clamps used on conduits (ie, arteries to be used as grafts) tend to be either metal “bulldog” clamps or plastic spring-loaded clamps. The weight of the metal clamp results in considerable “drag” against the conduit during implantation, increasing the difficulty of implantation. Thus, the plastic spring-loaded clamp has a spring-loaded vise-like gripping part and is even larger, and because of its volume, is not very suitable in a confined space, so that each conduit is On the other hand, if more than one implantation is performed (in a series of anastomoses), additional and redundant lengths of conduit are required.

  According to the present invention, a clamping member that is disposed so as to be pivotable relative to each other between the opened state and the closed clamping state, and each of the clamping members to be held in the selected closed clamping state. A clamp for surgical applications is provided comprising a ratchet device that acts during the closing movement.

  Preferably, the ratchet device comprises a series of ratchet teeth in an arcuate arrangement centered on the pivotal axis of each clamping member, and one clamping member of each clamping member is the other. One ratchet tooth portion movable along with the one of the holding members when pivoting with respect to the holding member, and moves along the arrangement of the ratchet tooth portions, and the ratchet teeth at the selected holding position And one ratchet tooth portion held by the arrangement of the portions.

  A particularly preferred embodiment of the present invention provides for the pivoting movement between adjacent ends for a pivotal movement between an open configuration in which the pair of arms define a V-shaped configuration and a closed configuration in which the arms are substantially parallel. A pair of arms pivotally interconnected at one of the arms, the one ratchet tooth at the end of the arm remote from the pivot And the other arm is the ratchet tooth with which the one ratchet tooth engages when the two arms are closed at the end of the arm farther from the pivot part. Each of the holding members includes a pair of arms that are supported by each of the two arms.

  Preferably, each of the clamping members has a post-like shape extending in a plane transverse to a plane including the arms of the clamp.

  Particularly preferably, the sandwiching surfaces of the sandwiching members placed opposite to each other are inclined with respect to each other so as to converge in a direction toward the tip portion of each sandwiching member. In one embodiment, each of the clamping surfaces is inclined at an angle of about 4-6 ° relative to the perpendicular to converge at an included angle of about 8-12 °. This convergence facilitates the holding of the clamp.

  Preferably, the clamp is formed as a single piece plastic molding and the pivot is a flexible web made of plastic material interconnecting the adjacent ends of the two arms. It is formed by the hinge part which consists of.

  According to another aspect of the present invention, there is a sandwiching post disposed and disposed to be positioned on both sides of the artery in order to sandwich the artery between the sandwiched surfaces of the sandwiched post. Each post can be moved into a clamping relationship with respect to the artery by arcuate movement of one post around the hinge region with respect to the other arteries, and each of the posts in a selected clamping position. And a device for releasably securing the clamping post, wherein the arterial clamp is formed as a one-piece plastic molding.

  In the following, embodiments of the present invention will be described by way of example only with reference to the accompanying drawings.

  The arterial clamp according to a preferred embodiment of the present invention is formed as a suitable plastic monolithic piece (such as a homopolymer polypropylene or acetal copolymer, for example) and is shown in FIG. Hinge portion 6 formed of a flexible thin body made of a plastic material so as to be movable from a substantially V-shaped open configuration as described above to a closed clamping configuration in which the arms 2 and 4 are substantially parallel to each other. Consists of opposing arms 2 and 4 pivoted at one end. A projecting limb 8 having a group of ratchet teeth 10 on the inner surface is formed on the outer end of the arm 2, and each tooth 10 connects the two arms 2, 4. The hinge part 6 extends along a curved path having a center on the pivot axis. One ratchet tooth portion 12 that cooperates with the ratchet tooth portion 10 is formed at the outer end portion of the arm 4. Each of the arms 2, 4 is formed with a clamping post 14 that projects substantially perpendicular to the plane of the arms 2, 4, and these posts 14 form the actual clamping member of the clamp. In use, the two posts 14 are positioned on both sides of the artery, and the arms 2 and 4 are securely held in the required clamping state by the one-way action of the ratchet teeth to clamp the artery. The two arms are moved by the pivoting movement around the hinge 6 while the ratchet teeth 12 at the end of the arm 4 are moved along the ratchet teeth 10 on the projecting arcuate part 8 until the required clamping state is achieved. 2 and 4 are closed.

  The clamp can be positioned, manipulated and closed by forceps that engage the outer parts of the two arms 2 and 4, but for this purpose the outer part is preferably suitable for easy holding by forceps. Comprises a series of small protrusions 16 along their length. Each of the arms 2, 4 is also provided with a hole 18 for receiving the forceps tip to provide additional flexibility.

  The clamp described above allows the surgeon to apply any clamping pressure that appears to be appropriate to stop fluid flow and, if applied, that pressure is provided by the interengaging teeth 10,12. The ratchet action is maintained with the locking effect provided by the two arms 2,4. All that is necessary to release the clamp is to disengage the tooth portion 10 from engagement with the tooth portion 12 by displacing the protruding arcuate portion 8 laterally from the plane of the second arm 4. . This can be easily achieved by the inherent flexibility of the plastic material.

  In the embodiment shown, the two clamping posts 14 have a tapered shape that becomes narrower towards their ends. The clamping surface 14a of each post 14 is a flat surface and the post 14 has a long cross section, and this long dimension serves to maximize the resistance of the clamping post 14 against bending under clamping pressure. The sandwich surface 14a may be formed with a series of ridges or recesses that are very small to facilitate excellent grip between the surface and the tissue. The end or tip of each clamping post 14 can also be provided with a small lip to aid retention. The clamping posts 14 may extend in a plane perpendicular to the plane of the arms 2, 4, but alternatively they are planes inclined from their 90 ° plane and spaced from the ratchet arc 8 The ratchet arc 8 is “lifted” slightly further away from the clamping area of the two clamping posts 14 because it can be positioned inside.

  In the illustrated embodiment, the clamping surfaces 14a of the two posts 14 are substantially parallel and perpendicular to the planes of the arms 2 and 4, but the two clamping surfaces are in a direction toward their tips. It has been confirmed that convergence is particularly suitable. Typically, each clamping surface is tilted inward by about 4-6 ° relative to the perpendicular to provide a converging groove angle of about 8-12 ° between the two clamping surfaces. To do. Although this convergence is relatively small, it causes a greater clamping force at each tip, which significantly promotes retention on the artery. In the fully closed state of the clamp, the tips of the posts 14 are engaged with their clamping surfaces and slightly deflected.

  By way of example, the length of the clamp from the hinge 6 to the outer part of the ratchet arc 8 is about 10 mm, which is considerably smaller than the existing clamp configurations discussed above. However, this considerable size reduction is realized by a basic shape as shown by incorporating a locking ratchet mechanism. Thus, the ratchet mechanism is used not only to allow control and maintenance of the clamping force, but also to significantly reduce the overall length to allow easier positioning in the localized space.

  Because of the clamp shape, there is little tendency to protrude perpendicular to the surface of the heart, so there is less tendency to capture the suture material while constructing the anastomosis. Also, because the plastic construction described above is significantly reduced in weight compared to metal, the clamp moves easily with the heart and is less likely to come off due to cardiac motion; it is used to occlude the conduit. If so, it will not overload the conduit.

  The clamp is only intended for single use and is not intended for re-washing and re-sterilization. In fact, re-sterilization is very difficult due to the presence of the recess / hole deployed to allow positioning and tightening as the clamp is gripped by forceps or other devices, and proper cleaning of the clamp And removal of blood from the clamp is inhibited.

  It is contemplated that two such clamps will be used to occlude a single coronary artery and an additional one for the conduit. In each operation, the clamp can be used for one or more coronary arteries.

  The size of the coronary artery in which the graft is placed is 1.0 mm to 2.5 mm in diameter, and most is 1.5 to 2.0 mm. The size of the conduit is usually 1.75 mm to 3-4 mm. These sizes are relatively similar to many arteries or veins used in other forms of vascular or plastic surgery where the arteries are joined or transplanted together. In other surgical fields, arteries of this size are often encountered, and in certain cases these arteries are temporarily occluded or alternatively joined together for various reasons. Thus, without any modification, the clamp may have the potential to be used other than “off-pump CAGS”. With size or other minor changes to the design aspect, the clamp can be applied more extensively to other surgical procedures for humans and animals.

  The above embodiments have been described only as examples, and modifications can be made within the scope of the present invention.

FIG. 1 is a plan view of a clamp according to a preferred embodiment of the present invention. FIG. 2 is a schematic view of the clamp viewed in the direction of arrow A in FIG. FIG. 3 is a detailed view showing the clamping post as seen in the direction of arrow B in FIG. FIG. 4 is a detailed view of the clamping post in a direction perpendicular to FIG. FIG. 5 is a cross-sectional view of the sandwiching post.

Claims (7)

A clamp for surgical use, the clamp comprising:
A pair of arms that pivot between adjacent ends so as to pivot in one plane between an open configuration in which the arms form a V-shaped configuration and a closed configuration in which the arms are substantially parallel. A pair of dynamically interconnected arms;
A ratchet device positioned substantially opposite the interconnection of the arms, the ratchet device acting during a closing movement to hold the arm in a selected closed state;
Each arm is a post-shaped clamping member positioned on the arm between the arm interconnect and the ratchet device, extending from the arm substantially perpendicular to the plane of the pivoting motion. A post-shaped clamping member with the end of the post extending outside the plane, each of the two posts having a clamping surface, and when the arm moves to the closed configuration A clamp for surgical applications in which an artery can be clamped between the clamping surfaces of the two posts . The clamp of claim 1, wherein each clamping surface is each inclined at an angle of about 4-6 ° with respect to the axis of the post to converge at a groove angle of about 8-12 ° . The clamp according to claim 1, wherein a clamping surface of each clamping post converges in a direction toward the end of the post . The clamp according to claim 3 , wherein each clamping surface is in a substantially flat form. The clamp according to claim 4 , wherein each of the clamping posts has a tapered shape that becomes narrower toward its end . The clamp is formed as a single piece plastic molding with a pivot, which is a hinge made of a flexible thin body made of plastic material that interconnects the adjacent ends of the two arms. The ratchet device is formed by an interengageable ratchet tooth formed on each of the arms, the tooth being an intrinsically acceptable plastic material that forms the clamp. The clamp according to claim 4, wherein the engagement is disengageable to release the clamp by a flexing motion permitted by flexibility . Wherein each arm comprises a hole for receiving a distal end of the forceps in order to enable the positioning of the clamp and clamping What Re or clamp according to one of claims 1 to 6.

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