JPH012639A - surgical clip attachment device - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] The present invention relates to a hemostatic clip attachment device.

More particularly, the present invention relates to a surgical hemostasis clip attachment device that automatically delivers clips contained within a clip-using instrument one at a time to the clip closure of the instrument.

Aligned feeding of clips in a surgical clip applicator is highly desirable because it eliminates the need for bulky clip magazines near the distal end of the instrument. Such magazines may obscure the jaws of the instrument from the surgeon's view when the instrument is used to apply hemostasis clips to human tissue in accordance with a surgical procedure. Although several techniques for performing surgical alignment have been developed, many are relatively complex and require numerous parts or components to advance the clip to the clip closure portion of the device.

SUMMARY OF THE INVENTION Accordingly, it is an object of the present invention to improve and simplify surgical clip attachment devices.

A more particular object of the present invention is to provide a surgical clip attachment system that is improved and simplified in aligning and feeding the clip to the clip closure.

These and other objects of the present invention are accomplished in accordance with the principles of the present invention by providing surgical clips that are releasably interconnected to form a linear array. The clip array is slidably disposed along the longitudinal axis of the clip applier. A button reciprocally mounted within the clip applier contacts the forwardmost clip in the row of clips and forces it distally toward the clip closure jaws of the device. The remaining clips in the row are forced forward together with the forwardmost clip, and as the forwardmost clip enters the jaw, it is separated from the remaining clips in the row and seated within the jaw. The jaws are then actuated to close the clip around the body tissue to effect the clipping. Then, when the button is released, the jaws release the just-closed clip.

The bushing then retracts proximally to the next clip, which is now the forwardmost clip in the row of clips. The instrument is now ready to repeat its operating cycle.

The clip can be made of biologically acceptable metal, but preferably biologically acceptable plastic,
Most preferably, it is made from a bioabsorbable plastic material. Plastic clips are preferred because, unlike metal clips, if left in the body after surgery, they will not affect later radiographic (X-ray) photographs. Bioabsorbable plastic clips also have the advantage that the clipped tissue is absorbed by the human body after application. This avoids the undesirable possibility of the clip migrating within the body months or years after surgery. If the clips are made of plastic (whether or not bioabsorbable), the normally free ends of the arms of each clip can be locked together and clipped together after the clips are closed as described above. It is preferable to have an element for holding the arms of each other together.

As shown in FIG. 1, the illustrated embodiment of the clip attachment device 10 of the present invention includes a main body 12 with two
Two ring nodules 14 and 16 are attached and project from the proximal end of the rear end of the main body. The ring handles 14, 16 are each adapted to receive the thumb and any other finger of one hand of the instrument operator. The device 10 behaves similar to a pair of scissors and can be operated completely with one hand. The main body 12 has two parts 12a and 12b
(see FIG. 7), these parts may be held together in any conventional manner, for example with a suitable adhesive.

A longitudinal shaft assembly 18 is mounted on the main body 12;
It extends forward or distally from the main body.

The shaft assembly 18 terminates in a pair of jaws 20.22 at the distal end of the device.

During operation of the instrument, these jaws 20.22 are placed around the body tissue (eg, blood vessel 24) to be clipped. Then, ring handle 14.
16 are squeezed together, the clip 26 (FIG. 13) is advanced along the shaft assembly 18 and positioned within the jaws 20.22. At this time, one arm of the clip is located within each jaw. As the ring handle continues to squeeze, the outer sleeve portion of the shaft assembly 18 moves distally relative to the jaws 20.22, squeezing the jaws together.

Releasing the ring handle 14.16 then reopens the jaws 20.22, releasing the clipped body tissue as shown in FIG. The device is now ready to begin the next operating cycle.

It will be obvious to those skilled in the art that clips made of other materials, such as metal, can be used;
For the most part, it will be described as attaching plastic clips.

An exemplary surgical clip 26 is shown in FIGS. 12-14 and includes a row of such lips, e.g.
This is shown in FIG. Each clip includes a base 30 and two arms 32 . extending from each end of the base.
34.

The base and arm lie in a common plane.

The clip is made in such a way that the normally free ends 36.33 of the arms are elastically pressed apart, as shown, for example, in FIG. The outer periphery of the base of each clip is provided with two laterally projecting ears 42,44,
Each ear is adjacent a respective end of the base 30. Alternatively, ears 42.44 may be provided along each arm 32.34. On the inner periphery of the normally free end 36.38 of each arm is a respective slot) 46.4
8 is a provision. When physically separated individual clips are assembled together in a row, for example as shown in FIG. 15, the ears 42.4 of each clip.
4 are slots 46 . 4 in the immediately following clip, respectively.
48 and engages therewith. The arms of each clip are prevented from further separation by the surrounding structure of the device. Thus, when the foremost clip in a row is pushed distally, as described in more detail below, all subsequent clips in the row are pushed simultaneously.

The normally free end 36,38 of each clip arm includes:
The arm 32 is provided with a corresponding latch element 32a, and the arm 34 is provided with a corresponding latch element 34a, 34C.

When the arms of the clip are squeezed together as shown in FIG. 14, latch elements 32a, 34c overlap and lock together, and latch elements 32C, 34C overlap and lock together. Once these latching elements interlock, the clip will be held in the closed position. The direction in which the latch elements 32a134a overlap is opposite to the direction in which the latch elements 32C and 34C overlap. For example, when clip 26 is viewed from above as shown in FIG. 14, latch element 32a is above latch element 34a and latch element 32c is below latch element 34C. This greatly reduces inadvertent opening of the clip by keeping the arms 32,34 in the same plane.

Considering the structure of the instrument 10 in more detail with reference to FIG. Almost cylindrical knob 5 under the action
2 is pivotally mounted within the main body 12. If desired, a pin or screw 54 is installed coaxially in each of the pivot points to extend through the main body 12 and the corresponding knob 52;
It may also assist in retaining the ring handle 14,16 within the main body 12. Pivoted links 56,58 respectively between the ring handles 14,16 and the sleeve 6
It is connected to the proximal end of 0. The link 56 is pivotally connected to the nozzle 14 by a pin 62, and the link 58 is pivotally connected to the nozzle 14 by a pin 62.
4 to the nozzle 16, and both links to the sleeve 60 by pins 66. Sleeve 60 is mounted for reciprocating longitudinal movement relative to housing 12. Links 56,58 drive sleeve 60 distally when handles 14,16 are squeezed together.

The sleeve 60 is elastically pressed in the proximal direction by a compression coil spring 68. This spring/'%Using 12
3.4) and the proximal end of the bore 72 of the sleeve 60. The proximal resilient biasing of the sleeve 60 also resiliently biases the handles 14.16 in the direction of separation. The outward movement of the handle 14.16 causes the third
As shown in the figure, the handle shaft is stopped by contact with the side surface of the main body housing 12. Thus, the spring 68
becomes the main return spring of the instrument.

As best seen in FIG. 8, sleeve 60 is essentially a channel-shaped member, preferably made of metal.

A jaw member 74 is inserted into the groove formed by the sleeve 60,
The jaw member is secured to the housing 12 by housing ears 76a, 76b cooperating with holes 78a, 78b in the proximal end of jaw member 74. -Ear part 7
6 passes freely through the distal end of hole 72 in sleeve 60.

The distal end of the jaw member 74 is bifurcated to define two generally parallel spaced apart arms 82,84. Jaws 20.22 are attached to the distal ends of arms 82.84, respectively. Jaw member 74 is preferably made of a resilient metal such that when it is deflected, arms 82,84 can flex toward each other as will be explained in more detail below.
and returns to its initial spacing when the force on the arm is removed.

A clip row container 90 is fixed to the upper surface of the jaw member 74. As best seen in FIG. 10, the clip row receptacle 90 is a C-shaped channel whose longitudinal axis is aligned with the longitudinal axis of the jaw member 74. The groove of the clip row container 90 accommodates a plurality of clips 26,
These clips are arranged in interlocking linear rows as previously described in detail (see FIG. 15).

The normally free end 36,38 of each clip faces distally and the row of clips is aligned with the longitudinal axis of the clip row receptacle 90. The clip row receptacle 90 has a nub or detent 92 near the end of its groove that aids in separating the distal clip from the clip row as will be explained in more detail below. The clip row container 9 also has a leaf spring portion 94 that projects upwardly within the groove and acts as a pawl member to prevent proximal movement of the clip row. By depressing the clip as it passes this pawl spring, the clip distally moves past the pawl spring 94.
can be moved through. However, the clip cannot return proximally because the pawl spring 94 contacts the base 30 of the clip approaching from the distal side and prevents further proximal movement of the clip (Figures 23.24). reference). By providing an inwardly biasing leaf spring element 96 near the end of the container 90, the clip is prevented from inadvertently falling off the end of the container 90.

As best seen in FIG. 8, the top of the clip row receptacle 90 is open so that the button finger 102 at the distal end of the button member 100 projects downwardly into the receptacle 9° and at the base of the distalmost clip within the receptacle 90. I am trying to make contact with 30 people. The bushing member 100 is mounted above the clip row container 90 such that it can reciprocate longitudinally relative thereto. The bushing portion +4100 is connected to the groove-shaped member 6G by a joint 110 and a compression coil spring 120. Fitting 110 fits within the proximal end of IA 60 and includes a pair of laterally extending ears 112a, 112b. These ears fit into slots 7) 114a and 114b provided in the channel member 60, respectively, and
As a result, the joint 110 reciprocates in the longitudinal direction together with the channel member 60. The proximal end of the bushing member 100 is provided with a downwardly directed finger 104, which is located in the fitting (fits into the fitting 110 proximally of the yellow direction bar 116).Finger 1.04 Compression coil spring 12
0 in the distal direction against the transverse bar 116. Compression coil spring 120 also joint 110
and acts between the proximal end of the joint and the finger 104. A spring guard 122 is provided below the fitting 110, which retains the spring 120 within the fitting 110. A hole 124 in the spring guard 122 connects the lower end of the finger 104 of the bushing member 100 to the hole 78 in the jaw member 74.
c (see Figure 4).

The above-mentioned connection of the bushing member 100 and the groove-shaped member 60 performs the following operation. The channel member 60 is the handle 14
．． Movement distally in response to manipulation of 16 causes fitting 110 to move distally.
and spring 120 move button member 100 with channel member 60 until finger 104 moves jaw member 7.
It contacts the end 7'8d of the hole 78c of No.4. after that,
Further distal movement of bushing member 100 is prevented by this contact of finger 104 with surface 78d.

Channel member 60 continues to move distally, but button member 100 stops. Spring 120 acts to allow this differential movement of element 60.100. Handle 14.
16 is released, the channel member 60 returns proximally and the button member 100 connects the transverse bar 116 and the finger 1.
04, it is pulled rearward together with the channel member 60.

The shaft assembly 18 is covered by a cover 130 (FIG. 8) which is attached to the channel 60 by the cooperation of its tongues 132 and holes 134 in the channel 60 (see FIG. 8). Figure 10).

The sequence of operation of the device in response to squeezing and then releasing the handles 14,16 is best seen in Figures 15-24. Figures 15 and 16 show the device before throttling of the handle is initiated. Channel member 60, joint 100, and bushing member 100 are all in the proximal-most position. Butcher fingers 102 are proximal to the most distal clip 26 in the clip array. The jaws 20.22 are open and positioned around the body tissue 24 to be clipped.

In Figure 17.18, gripping of the handle 14.16 begins. Accordingly, the groove 60 moves distally, and the joint 110 and the bushing member 1 are connected thereto.
Move 00. Since the butcher finger 102 contacts the base of the most distal clip 26 in the clip array, it will advance all clips, including this clip, in a distal direction. When the device reaches the stage shown in Figure 17.18, the distal-most clip passes through the detent 92 just outside the clip row receptacle 90 and begins to enter the jaw 20.22 so that one arm of the clip is attached to the human body. Located on each side of tissue 24. The jaws 20.22 each have longitudinal slots 143.145 for receiving the arms of the clip to maintain proper position and orientation of the clip.

Also, as the distal-most clip enters the jaws, the outer peripheries of the clip arms 32, 34, respectively, move into the jaws 20.
contact the inclined cam surfaces 142, 144 at 22; This causes the arms of the distal-most clips to pivot slightly toward each other, displacing the ears 42, 44 toward each other and separating the distal-most clip from the following clip. At the same time, subsequent distal-most clips contact detents 92, increasing the resistance to distal movement of the clip array and assisting in separation of the distal-most clip from the clip array. FIG. 17 shows the distalmost clip just separated from the clip array as described above. It should be noted here that only the detent 92
is sized and positioned to provide resistance to the clip array. At other positions on the clip row, the detents 92 do not make any contact with the clip row.

As a possible alternative, the most distal clip may be separated by squeezing its arms while the arms of the next most distal clip are widened. This can be accomplished by pushing the side walls of the clip row container 90 apart at the desired location.

Figure 19.20 shows the device when the handle 14.16 is further squeezed. Element 60.110 and 1
00 continues further in the distal direction. The butcher fingers 102 have now pushed the distal-most clip 26 completely out of the clip row container 90 and completely into the jaws 20.22. The clip is prevented from falling off the end of the jaws 20.22 by inwardly projecting clip stops 146, 148 near the ends of the jaws. As for the remaining clips in the clip row, the distalmost clip has separated from the clip row as shown in FIG. Therefore, it remains stationary. The distal end of the channel member 60 is connected to the inclined cam surface 152 of the jaw B20.22.
．． I have just made contact with each of the 154. Further, the lower end of the finger 104 of the button member 100 is also connected to the jaw member 7.
4 has just come into contact with the end 78d of the hole 78c. This prevents further distal movement of the bushing member 100 even as the handle 14,16 continues to be squeezed.

The state of the device according to the final part of the throttle operation of the handle 14.16 is shown in FIG. 21.22.

Elements 60 and 110 continue to move distally, but bushing member 100 is prevented from moving further distally by finger 104 contacting surface 78d. Therefore, no further distal movement of the distal-most clip occurs either. The distal ends of the channel members 60 engage the camming surfaces 152, 154 of the jaw members 74 and cooperate with these surfaces to squeeze the jaws 20, 22 toward each other. This causes the arms of the distal clip to constrict and ultimately the clip elements 32a, 32c, 34a, 34c to interlock to hold the clip closed around the body tissue 24. Holes 32b and 3 are provided in the arms of the clip, respectively.
4b may be provided to release the pressure applied to the human body tissue to some extent.

However, it is desirable for the clip to be able to apply sufficient pressure to the tissue to achieve hemostasis without tissue destruction.

The instrument clip installation process is now complete. Handle 1
4.16 cannot be narrowed down any further.

This is because the handle stops 14a, 16a (FIGS. 1-2) come into contact with the proximal projection 12C of the main body 12.

When the operator releases pressure on the handle 14.16, the main return spring 68 returns the channel 60 in the proximal direction. This opens the jaws 20.22 and opens the jaws 23.24.
Release the closed clip as shown. This also pulls the bushing member 100 rearwardly so that the bushing finger 102 rides up on the base 30 of the clip, which is now the terminal clip within the clip row container 90. The clip row is prevented from moving proximally by a pawl spring element 94 at the bottom of the clip row container 90. When the handle 14.16 is fully released, the device is returned to the state shown in Figure 15.16 and is ready to begin the next operating cycle. Thus, the button finger 102 is positioned at the position where the button finger 102 is located between the most distal clip and the next most distal clip at the position where the clip row remains when the previous distalmost clip leaves the clip row. Movement is restricted between the proximal position and (2) the distal-most position in which the distal-most clip is completely recessed within the jaws N20.22. Bushy Finger 1
The proximal-most neck of the 02 is defined by the contact of the ring knob 14, 16 with the main body, 1% housing 12, as shown in FIG.

The most distal position of Butsusha finger 102 is finger 10
4 and the surface 78d.

Thus, one clip is pushed into the jaws 20.22 during each operating cycle of the device.

Clip 26 has a single dimension depending on its intended use. A typical lip is approximately 10m long before closing.
m, width 3 mm. Smaller chestnut knobs are also used in some microsurgical applications. Larger lips are used for surgeries such as the vas deferens and fallopian tubes. The clip attachment device is dimensioned appropriately depending on the clip used.

As mentioned above, clip 26 may be metal or plastic, and may or may not be bioabsorbable. Preferred absorbable polymers include homopolymers and copolymers of glycolide, lactide, and p-dioxanone.

Preferred nonabsorbable polymers include nylon, polyester, and polypropylene. Typical metals include aluminum, magnesium, stainless steel, tantalum, and various alloys of these metals, some of which are also bioabsorbable.

Using a device that advances the clip row by applying a pushing force to the most distal clip in the row avoids the problems that occur when trying to push a negative row of plastic clips from behind, making the use of plastic clips easier. It becomes quite easy.

When pushed from the rear, the negative row of clips tends to twist and can become jammed.

Also, due to the nature of plastic clips, the rows of clips compress when pushed from behind, keeping the clips aligned with their surroundings to properly feed one clip into the jaws with each movement of the device. This becomes difficult or impossible.

The entire device may be economically disposed of after each surgical procedure or when the clips in the clip array container 90 are used up. This avoids the labor and expense associated with cleaning, sterilizing, and reloading the device for reuse. Since the channel member 60 acts as a reciprocating sleeve and closes the jaws 20.22, most of the actuating elements of the device are subject to tensile forces and not bending moments as in instruments operating like scissors or pliers. It is supposed to transmit only compressive force. The device is therefore extremely light and can be of elongated construction. The relatively small amount of material required and the simplicity of the design of the device allow it to be economically constructed as an article that can be disposed of as desired. For this purpose, the main body 12 and the handle 14.16
They can also be made from inexpensive plastic materials. Alternatively, the device may be of permanent, reusable construction, if desired. In any case, feed the crimp in alignment,
The elongated construction of the shaft assembly 18 allows the jaws to remain within view. This is highly desirable in delicate surgical procedures.

It should be appreciated that the individual clips and/or banks of clips of the present invention can be used with other than the specific ones described above. For example, Applicant's rsurgical C11p ApplyingAp
Paratus Having Fixed Jaws
U.S. Patent Application No. 429,249 (D
No. 1 SSC1030) illustrates a clip attachment device having fixed jaws and capable of using the adhesive lip array of the present invention (particularly No. 1 of this U.S. patent application).
(Please refer to Figure 17). In addition, this US patent application is adopted as a reference sample in this application. Illustrated here,
Other modifications of the particular embodiments described are within the spirit and scope of the invention. For example, instead of the ring handle 14,16 in the device of Figures 1-24, other types of actuator elements may be used, such as a pistol grip trigger arrangement.

[Brief explanation of the drawing]

FIG. 1 is a perspective view of an illustrative embodiment of the surgical clip attachment apparatus of the present invention. FIG. 2 is a top view of the device of FIG. 1 with some of the upper portion removed to expose some of the internal components. FIG. 3 is a view similar to FIG. 2 with some elements cut away to expose other internal elements. FIG. 4 is a sectional view taken along line 4--4 in FIG. 3. 5 and 6 are cross-sectional views taken along lines 5-5 and 6-6 in FIG. 3, respectively. FIG. 7 is a partially exploded perspective view of the apparatus shown in FIGS. 1-6. 8 is another exploded perspective view of a portion of the apparatus of FIG. 7; FIG. FIG. 9 is an exploded view of the device of FIG. 8. Figures 10 and 11 are lines 10-10 in Figure 9, respectively.
FIG. 11 is a cross-sectional view taken along line 11-11. FIG. 12 is an enlarged plan view of an illustrative surgical clip for use with the apparatus of FIGS. 1-11. FIG. 13 is a perspective view of the clip of FIG. 12 in a position where it is attached to body tissue, showing the clip attachment device surrounding the clip during attachment of the clip to body tissue to most clearly show the clip itself; Not shown. FIG. 14 is a view similar to FIG. 13, but showing the clip attached to human tissue. 15.17.19.2123 is a series of diagrams similar to portions of FIG. 3 illustrating the sequence of operation of the device. Figures 16.18, 20.24 and 15.17.
19.20.23 Lines 16-16, 18-18, 2
It is a sectional view along the 0-20 line, the 22-22 line, and the 24-24 line. Written amendment (method) Yoshi, Commissioner of the Patent Office 1) Takeshi Moon 1, Indication of the case Patent Application No. 6751 of 1988 2
, Title of the invention Device 3 for attaching surgical clips
, Relationship with the case of the person making the amendment Applicant 4, Agent 5, Date of amendment order June 28, 1985 6, Subject of amendment (1) Column for a brief explanation of the drawing in specification n (
2) All drawings

Claims (6)

[Claims] (1) a pair of laterally spaced and distally positioned jaws; and a pair of jaws positioned at the proximal end of the jaws for moving the clip into the jaws by a relatively short distal movement relative to the jaws. a clip pushing member positioned at a proximal end of the jaw for forcing the jaw into engagement with the clip in response to movement of the latter half of a relatively long distal movement relative to the jaw; a jaw closure member for closing the clip pusher member; and actuator means for moving the clip pusher member and the jaw closure member distally relative to the jaws, the actuator means comprising: a jaw closure member for closing the clip pusher member; Both the clip pushing member and the jaw closing member are moved together during a relatively short distal movement, and then the clip pushing member is stopped and only the jaw closing member is moved distally to close the second half. An attachment device for a surgical clip, characterized in that the device advances the movement of a surgical clip. (2) said actuator means is mounted for distal movement relative to said jaw, said actuator member for proportional distal movement of said jaw closure member relative to said jaw; and said clip pushing member; resilient means for coupling said actuator member to said clip pushing member such that said actuator member causes proportional movement of said clip pushing member in a distal direction relative to said jaw until said actuator member is stopped by said actuator means; The device according to claim (1), characterized in that: (3) The device according to claim (2), wherein the elastic means comprises a compression coil spring. (4) sequentially attaching a plurality of surgical clips from a row of clips aligned in the distal axial direction of the device; After preparing to install the next clip during a movement, the clip pushing member and the jaw closing member are returned to their original positions, and the clip pushing member closes the aligned clip during each distal movement relative to the jaw. distally pushing a predetermined portion of the most distal clip of the clips, the relatively short distal length of movement of the clip pushing member relative to the jaws being greater than the spacing between the predetermined portions of two adjacent aligned clips; , smaller than the spacing between predetermined portions of two alignment clips separated from each other by a third clip. (5) The jaws are elastically biased in a direction away from each other, and in response to movement of the latter half of the distal movement of the jaw closing member, the jaws cooperate with the jaw closing member to open one of the jaws. Device according to claim 2, characterized in that it has a cam surface for moving the jaw towards the other jaw. (6) the cam surface is inclined in a direction opposite to the distal direction; 2 surfaces, the first surface and the second surface being laterally fixed to each other so as to cooperate with the cam surface to force the jaws into alignment with each other. The device according to claim (5).