US2707783A - Applicator for inserting preformed metallic sutures - Google Patents

Applicator for inserting preformed metallic sutures Download PDF

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US2707783A
US2707783A US185716A US18571650A US2707783A US 2707783 A US2707783 A US 2707783A US 185716 A US185716 A US 185716A US 18571650 A US18571650 A US 18571650A US 2707783 A US2707783 A US 2707783A
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suture
clips
prongs
clip
applicator
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Norman M Sullivan
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Norman M Sullivan
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0684Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying above the tissue during stapling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B17/0644Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position

Description

May 10, 1955 N. M. SULLIVAN APPLICATOR FOR INSERTING PREFORMED METALLIC SUTU Filed Sept. 20, 1950 3 Sheets-Sheet 1 I N VE NTOR firmanMJzQZ/zvan ATTORNEY N. M. SULLIVAN APPLICATOR FOR INSERTING PREFORMED METALLIC SUTURES iled Sept. 20} 1950 3 Sheets-Sheet 2 J a 2 u w h Er w J i 9 a a, 7 6 z Z w /N(@ i M M a L p x w 2 w a 5 Z/am G W 4/ 3 7 Z .7 .v ala a z I/ m w F Af r-m anMSuZZz'van ATTORNEY y 1955 N. M. SULLIVAN 2,707,783

APPLICATOR FOR INSERTING PREFORMED METALLIC SUTURES Filed Sept. 20, 1950 3 Sheets-Sheet 3 Juli-J EE: 9

INVFNTOR V Mrmezn MSuZZavan ATTORNEY United States Patent Q APPLECATOR FOR INSERTING PREFORMED METALLIC SUTURES Norman M. Suiiivan, Cincinnati, Ohio Application September 2t), 1950, Serial No. 185,716

9 -Ciaims. (Cl. 1-49.11)

This invention relates to an improved surgical suture and in other of its aspects to a novel method and means for applying and utilizing the suture. More particularly, my invention is concerned with sutures of the metallic type, as distinguished from thread or other readily flexi ole sutures.

In suturing surgical and other bodiiy incisions or wounds with the use of threads or wires, there is a decided tendency on the part of such sutures to cut or shear the flesh. The ordinary looped suture, such as that pro duced by a thread or wire, usually exerts a cutting or sawing action, so that the tissue is apt to shear between the openings therein through which the sutures pass and the wound or incision to be closed. Such wound disrupture by conventional sutures is deemed to be at least in part attributable to the rounded substantially U-shaped formation of the looped ends of the suture in the regions where the same pass through flesh openings produced by needles employed in advancing the sutures through the tissue. The U-shaped loops of such sutures are thought to restrict blood circulation, causing accelerated tissue disintegration, so that ordinary tension or pull on the sutures produces a cutting action which causes the sutures to become loosened in the tissue, thereby losing their securing or holding properties.

An object of the invention, therefore, is to provide an improved suture or ligature embodying a preformed metallic clip, and wherein the clip is so constructed as to offer through its functional design high resistance to wound disrupture, that is, to forces tending to cause the suture to cut the flesh and pull out of position before the wound or incision closed thereby is completely healed.

Another object of the invention is to provide a metallic suture clip presenting a straight longitudinally extending body which at its ends terminates in spaced downwardly directed legs having inturned feet, the arrangement being such that the spacing between the body of the clip and the inturned feet will receive, when the clip is operatively applied, ilesh strata penetrated by the clip, with the leg portions of the clip maintained in extended surface engagement with the flesh tissue, whereby to hold thecontiguous edges of the wound or incision against separation and preventing the suture from exerting forces which are apt to produce tissue disintegration and suture release.

it is a further object of the invention to provide a suture clip of the character set forth which includes a straight longitudinally extending body-forming web so shaped that its ends terminate in inwardly directed substantially U-shaped hooks, the latter being laterally offset in part with respect to the plane of the body-forming web in order that the offset portions of the flanged or hooked ends of the clip may offer a frictional binding resistance in the guides of the applicator tool through which the clips are advanced, whereby to require the application of positive forces on the part of the applicator tool in eifecting movement of said clips toward the region of clip application. g g

It is another object of the invention to provide an ap- "ice plicator appliance for advancing said suture clips one by one through positive operation of the appliance into secure incision-closing engagement with the membranous tissue in which said clips are to be embedded.

It is another object of the invention to provide an applicator appliance for dispensing successively metallic suture clips, and wherein the appliance is so constructed that a surgeon using the appliance may at all times obtain a full and clear vision of the flesh tissue in which the clips are to be inserted.

Still another object of the invention is to provide an applicator in which manually operated ejection means are provided, the same being so formed as to require positive operation to advance the clips through the applying head of the tool, the construction being such as to insure for each operation of the tool the delivery of but one suture clip to the region of application.

A further object is to provide a magazine-type suture applicator which involves in its construction the employment of relatively stationary and movable tissue-penetrating prongs in which clip-guiding channels are formed, the tool further including manually operated means for moving said prongs toward and away from each other in the use of the applicator.

It is another object of the invention to provide an applicator tool for handling in grouped order suture or ligalure clips of the character set forth, and wherein the tool includes a clip-ejecting plunger or ram in effecting the final positive advance of a forward or terminal clip through the channels of the tissue-penetrating prongs of the tool, the said plunger or ram possessing magnetic properties when in contact with a metallic suture clip to cause the latter to move in unison with the ram or plunger, preventing failing or other uncontrolled movement on the part of the clip.

It is another object of the invention to provide an ap plicator tool having tissue-penetrating prongs formed with guide channels for the passage of the suture clips from a storage magazine, contained in the body of the tool, to the ends of the prongs for application to the tissue at the site of the wound or incision, and wherein provision is made for causing the clips to move in said guide channels during such transit thereof between positions of storage or retention and application.

Other objects and advantages of the invention will appear in the following description.

illustrative embodiments of the invention are shown in the accompanying drawings, in which:

Fig. 1 is a view in side elevation of a suture clipapplying tool formed in accordance with the present invention;

Fig. 2 is a top plan view of the tool;

Fig. 3 is a front elevational view of the tool;

Fig. 4 is a transverse vertical sectional view taken through the tool on the plane indicated by the line 4-4 of Fig. 1;

Fig. 5 is a similar view on the plane indicated by the line 5-5 of Fig. i;

Fig. 6 is a transverse sectional view on the line 6-6 of Fig. 1;

Fig. 7 is a transverse vertical sectional view takm through the forward end of the tool and disclosingthe tissue-penetrating prongs when initially inserted into the tissue preparatory to the application of a suture clip, the prongs being shown in their separate order;

Fig. 8 is a similar view disclosing the prongs of the applicator tool when brought together to place the tissue between the prongs under compression and to thereby crowd and close the adjacent edges of. an incision;

Fig. 9 is a similar view disclosing the prongs of the tool in a position receiving and advancing longitudinally 3 through the guide channels thereof from the magazine of the tool one of the suture clips;

Fig. 10 is a similar view disclosing the suture clip in its position of application retaining the walls of an incision against separation and permitting of the removal from the tissue of the prong members of the applicator tool;

Fig. 11 is a horizontal sectional view taken through the prongs of the applicator tool on the line 1111 of Fig. 10;

Fig. 12 is a similar view disclosing a modified form of prong in which the latter is of the rounded or spreading type;

Fig. 13 is a side elevational view of one of the suture clips of the present invention:

Fig. 14 is a top plan view thereof;

Fig. 15 is a transverse horizontal sectional view taken on the plane indicated by the line 15-15 of Fig. 7;

Fig. 16 is a detail vertical sectional view disclosing a modified form of prong construction.

Fig. 17 is a detail longitudinal sectional view taken through the forward end of the implement on an enlarged scale and on the plane indicated by the line 1717 of Fig. 2;

Fig. 18 is a detail transverse sectional view taken through the handle portion of the implement on the line 1818 of Fig. 1;

Fig. 19 is a detail horizontal sectional view taken through the head of the instrument on the plane disclosed by the line 1919 of Pig. 7.

Referring to the drawings, the numeral 1 designates the hollow handle of a suture-containing and applying tool incorporating therein the features of the present invention. The handle terminates forwardly in a downwardly curved region 2, the latter, in turn, terminating in a forwar ly directed foot extension 3. region 2 of the tool (Fig. 1) is a substantially rectangular vertically disposed slot 4. In this slot there is positioned a transversely extending rod 5 on which is mounted for rocking movement the hub portion of an oscillatory lever 6. This lever includes an arcuate finger-engaging extension 7 which is disposed beneath the curved region 2 of the tool body in a position so that one grasping the handle 1 of the tool in one hand may, with the fingers of that hand, engage the extension '7 to rock the lever 6 about its pivotal mounting provided by the rod 5. The swinging movement which may thus be imparted to the lever is utilized for the purpose of advancing suture clips 8 to positions of use and also for operating a movable suture clip inserting jaw member 9.

The body extension 3 includes a horizontally extending oar-shaped region It and a pair oi spaced depending vertical side flanges 11. One of the flanges, as shown in Figs. 1 and 17, terminates short of the forward end of the tool in an angular surface 11a. Mounted for oscillating movement on the under surface of the bar region it is the movable jaw member 9, the latter turning about the cylindrical portion 12 of a headed stud 13, the latter being formed with a threaded end which is received within a correspondingly formed opening provided in the bar region 10.

At its forward end, the region 1.! terminates in an integral horizontal stationary jaw member 14 which cooperates with the forward movable end 14:: of the jaw member 9. The members 141 and 14.11 are each formed with a circular opening 15 (Fig. 15) which communicates with a transversely disposed open-ended slit 16. Positioned in each of the openings 15 is the headed upper end 17 of a tissue-penetrating prong or needle 18, one of the latter being carried by each of the jaw members, so that said prongs are transversely spaced from each other and the spacing is capable of being increased or diminished by the movement of the jaw member 9, as will be presently explained. The headed end of each prong is retained in association with its receiving opening 15 by means of a set screw indicated at i These set screws are threaded Formed in the (ill into the jaw members with their inner ends engaging the headed upper end 17 of said prongs to retain the latter positively in mounted positions within the openings 15 of said jaw members.

it will be noted that in registry with the slit 16, the said prongs have their inner faces formed with longitudinally extending guide channels 20 for the travel of the suture clips shown at 8, the clips being advanced from a magazine structure, forming a part of the applicator tool, through the guide channels of the prongs to positions of insertion in membranous tissues. In transverse cross section, the prongs may be substantially triangular to produce the sharp cutting edges 21 indicated in Fig. 11 of the drawings or the same may be semicircular or half rounded as indicated in Fig. 12. Also, the outer surfaces of the prongs are offset or laterally shouldered as at 22 (Fig. 7). The shoulders 22 act as stops in limiting the insertive movement of the sharpened lower ends of the prongs into the tissues.

The operation of my improved applicator is perhaps best illustrated in Figs. 7 through 10 of the drawings. in Pig. 7, it will be observed that the channeled prongs or needles 18 of the applicator have been inserted through the cutaneous membrane or tissues indicated at 23, with the prongs entering the membrane or tissues on opposite sides of a surgical incision or other similar wound 24 present in the membrane or tissue. In Fig. 7, the prong members have been shown as first inserted and in their relatively separated positions, with a forward or terminal suture clip held in the magazine portion of the applicator tool above the slit 16 and the upper ends of the guide channels 29. In this position, the forward terminal clip is retained in part in a supported position by magnetic attraction exerted on the clip by the flexible steel ram 25, which is positioned for sliding movement in appropriate guideways provided in the stationary head 26 of the applicator.

Fig. 8 discloses the next stage of operation of the applicator and shows the movable jaw member in the position which it occupies in response to rocking movement applied thereto by the manually operated lever 6, disclosing the forward end 14a of the movable jaw member in its position of greatest approach to the stationary jaw member 14. This movement of the movable jaw member causes the tissue confined between the prongs or needles 18 to be forced together, producing crowding and some overlapping of the contiguous edges of the incision 24.

Following such movement of the jaw members and the prongs carried thereby toward each other, continued movement of the lever 6 results in the reciprocation of the flexible ram 25, which advances the pilot suture clip engaged with the ram from the magazine region of the applicator tool through the channels 20 of said prongs or needles until the hook-shaped inturned ends 27 of the thus advanced suture clip are in horizontal registry with the edges of the openings 28 (Fig. 9) formed in the tissue through the penetration of the prongs or needles 18.

Thereafter, following release of the lever 6 (Fig. 10) and the return of the latter to a normal position under spring pressure, as will be presently explained, the jaw members again separate while the prongs are retained in the tissue relieving the compression on that region of the tissue embraced by the suture clip. The hook-shaped ends of the latter, however, are locked around the edges of the openings 28 so that when the applicator tool is removed, the suture clips remain in their positions of application, holding the edges of the incision or wound 24 against separation. It will be observed from the construction thus described, that the suture clips in their movement through the tool are guided by the channels in the prongs or needles 18 and this fact accounts in large measure for the positive and reliable operation of the instrumentality.

If desired, I can by imparting permanent magnetic a qualities to the ram 25, or to the head 26, cause the metal aromas suture clips to be attracted and held thereby so that the clip in engagement with the forward or lower edge of the ram will not fall or wedge into the channel guides, but will be advanced in a horizontal plane without tilting in the channel guides to a position of application. It is preferable in some instances, see Fig. 14, to offset slightly the hooked ends 27 of the clips with reference to the vertical plane occupied by the straight longitudinally extending webs 29 of said clips. Such offsetting produces a frictional binding action between the ends of the clips and the channel walls, so that positive movement on the part of the ram is necessitated in moving the clips into positions of use.

In Figs. 7 through 10, it will be noted that the shoulders 22 on the prongs or needles engage the outer surface of the cutaneous membrane or tissue penetrated thereby limiting the insertive movement of the prongs. This is particularly true when the shoulders 22 are adjusted through actuation of set screws 19 so that said shoulders are positioned below the plane defining the bottoms of the fixed and movable jaws of the implement in which the prongs 18 are contained.

The transverse cross-sectional shape of the prongs or needles, as shown in Figs. 11 and 12, is in my opinion of importance, in that the shape of these parts is such as to stretch the tissue or membrane being penetrated tightly across the face of the prong or needle, so that no tongue" or tissue protrusion extends into the channel guides, since such a tongue or protrusion would tend to interfere with the movement of the clip and the insertion thereof. The stop shoulders 22 on the outside of the prongs or needles serve, as previously stated, to definitely limit the degree of tissue insertion of the instrument in relation to the outer penetrated surface of the membrane, and at the same time provide a desirable view to the doctor or operator of the area about to be sutured.

With reference to the suture clip itself, attention is again directed to its angularly offset hook-shaped ends which produce a twist in the wire clip, causing it to exert a binding action within the channels of the needles or prongs through which it is advanced. By this means, the possibility of dropping a suture clip is eliminated, it being necessary to force the suture clip to effect its movement through the prongs. The hooked ends of the prongs may be barbed as at 30, if desired, to enhance its holding properties. After the incision has healed, the metallic suture clips may be removed if externally accessible by severing their webs in the center thereof which facilitates manipulation of the separated ends, allowing the same to be readily withdrawn from the membrane. If inserted under the skin in muscular tissue, the clips remain permanently in place.

The construction of the applicator tool for the suture clips, as above defined, provides for a crowded adjacent positioning of the adjoining edges of the incision of the membrane in their required relative order upon inserting the suture. The applicator tool is designed to pull the edges of the incision together and overlapping them somewhat to permit insertion of the suture, and thereafter allow the edges to return to proper position and to be held in such position by the suture after the applicator tool has been withdrawn. These steps are believed to constitute a novel mode of procedure in mechanically suturing surgical incisions.

Another interesting feature of the invention is the capacity of the suture to hold, when applied, without a tendency to cut or shear the skin. The ordinary looped suture, such as that produced by a thread or flexible tightening wire, exerts a cutting or sawing action so that the tissue is apt to shear between the opening in the skin or tissue through which the suture passes and the incision. However, I have found that this tendency can be largely overcome and the condition improved by the employment of the side arms shown at 31 on the hook-shaped ends on the suture clips.

It will be observed that these arms are of some considerable height and extend substantially at an angle of 82 degrees to the webs 29, thus producing an elongated surface area of membrane contact which overcomes the shearing effect of the rounded or looped type of suture. This shape of the hooked ends of the suture clip is of importance in the reduction of wound disrupture. By this, I refer to the particular capacity of the suture to resist pulling or cutting out before the wound is completely healed. This is a serious problem in certain classes of surgical work and considerable medical research has been done thereon. It is believed that the holding power of my improved suture clips, as compared with clips of conventional design, comprises a distinct improvement in the art.

To oscillate the movable jaw member, my improved applicator tool is constructed so that the rear end of the movable jaw member includes a cam surface 32, which is adapted to be disposed in the path of oscillation of a cam 32a provided in connection with one of a pair of upright arms 33 carried by or integrally formed with the lever 6. As the finger engaging portion 7 of the lever is moved upwardly, the arm or arms 33 swing forwardly and a web 34 of said lever on which the cam 32a is formed contacts the cam surface 32 on pivoted jaw 9, causing the latter to shift laterally about the axis provided by the headed stud 13, such movement being against the resistance offered to movement of the jaw member by a coil spring shown at (Fig. 2), the latter being confined in the slot 4 between one of the stationary walls thereof and an adjoining side of the jaw member. Thus initial movement of the lever 6 causes the outer end 14a of the jaw member to move inwardly, effecting relative approach between the prongs or needles 1 8, as previously described. The construction and registration of the cam surface 32 and the cam 32a is such that when the lever 6 is first oscillated, the initial movement thereof, as shown in Figs. 7 and 8 moves the movable jaw member 14a so that the prong 18 carried thereby will have its clip passage outlet or channel 20 brought into registration with a channel provided in a guide insert 22:: formed in connection with the inwardly disposed walls of the head 26. After the initial movement of the lever 6 effects adjustment of the jaw member 14a and prong 20 to cause the same to assume the position of Fig. 8 by the contact of the cam surface 32 with cam 32a, the developed shape of the cam surface is such that further rocking movement of the lever 6 in the same direction has no effect on the movable jaw. Such further movement, however, of the lever 6 through the arm 33 moves the advancing ram 25 from the positions disclosed in Figs. 7 and 8 to the position of Fig.

9, in which it will be noted that the clip 8 is in position for final engagement with the skin tissue adjoining an incision. Thus a lost motion connection is provided which permits of operation of the lever of extension 7 in a given direction by which initial movement of the lever 7 controls the movement of the movable jaw of the implement and additional or continued movement of the lever 7 produces final operation of the clip-advancing ram.

Also, the arms 33 of the levers 6 are connected at their upper ends, as at 37', with a ram-operating rod 36. This rod has its forward end pivotally secured as at 37 to the rear end of a sliding block 38 on which the flexible steel ram 25 is attached at its rear end. The rod 36, contiguous to its pivotal connection with the arms 33, is provided with a nut 39 which acts as a seat for one of a coil spring 40, this spring surrounding the rod 36 and has its forward end positioned against a seat provided by the rear curved end of the stationary head 26. Thus, as the lever 6 is manually oscillated, its movement is resisted by the spring 40, but reciprocating movement is imparted to the block 38, causing the flexible ram to move from the magazine region of the tool to guide and force a suture clip through the prongs 18 of the tool.

The ram 25 is preferably in the form of a resilient steel reed and as the same is advanced, it is flexed around curved head surfaces, shown at 41, so that said ram is positioned substantially vertically as it is moved to advance a clip through the prong channels. A leaf spring, shown at 42, may be applied to the outer surface of the forward end of the head 26, with the free end of the spring provided with a lip, indicated at 43, to hold the suture clips on a fixed magazine bar 44. As the ram is actively advanced, a terminal clip is removed from the forward end of the bar 44, forced past the lip 43 and moved into the channels of the prongs.

The clips are arranged in grouped or side by side order on the magazine bar 44, with the hook ends of the clips entering grooves 45 provided in the side walls of said bar. A sliding follower 46 is mounted on the rear end of said bar for engagement with the clips to force the latter forwardly as the same are used into registration with the head 26 and the ram 25. The follower may be spring-pressed by providing the same with a stud 47 to which is pivotally connected the forward end of a rod 48, the latter being supported in part in the hollow handle structure 1 of the tool. In this instance, the rod is provided with a nut or collar 49 against which is seated the forward end of a coil spring 50 which surrounds said rod, the opposite end of the spring 50 having seating engagement with a spider 51 formed in the handle. By this construction, the tendency of the spring 50 is to apply forwardly directed sliding movement to the rod 48, and this movement, in turn, is imparted to the follower and the clips positioned on the magazine bar 44. The suture clips are adapted in practice to be mounted in aligned side by side order on a holder, not shown, and with the follower 46 retracted and removed from the bar 44 the clips are, by group sliding movement, removed from the holder and positioned on the bar. The follower 46 is then restored to its operative position on the bar 44 to advance the clips longitudinally thereon.

The head of the applicator is so constructed as to insure the feeding of but one suture with each operation of the appliance. The construction is such that a suture can not accidentally become freed and drop uncontrollably, or without being noticed, into a body region undergoing suturing. Such accidental release or falling of the suture is prevented by: one, the action of the spring detent 42; two, the magnetic ram strip 25; third, by the angularly offset formation of the legs of the side arms or legs 31 of the suture clips, the latter exerting resiliently a binding action on the walls of the guides or channels through which the clips are advanced by the ram, this frictional action being sufficient in itself to prevent the clips from 'falling freely through the head of the appliance.

Preferably, the side arms or legs 31 of the suture clips are, when viewed in front elevation, inclined inwardly, for example, at an angle of approximately 82 degrees with respect to the plane of the straight body portions 29. Thus, when a pull, caused by respiration or normal tension of the membranes, is applied to the clips, the inclination of the side arms or legs moves the tissue somewhat toward the body webs 29, enabling said straight webs to absorb more fully the pulling forces applied to the suture which said webs can do to better advantage than the laterally extending side arms or legs 31.

Another feature of advantage resides in the horizontal cross-sectional configuration of the prong or prongs 18 and 130, which configuration is such as to stretch the tissue over the open sides of the guide channels through which the clips pass when being advanced from magazine positions within the applicator tool to their points of use. By reason of the construction, the channels are maintained free and open for the travel of the clips and the protrusion of obstructing matters, such as flesh tabs, is avoided.

In the modified form of the invention illustrated in Fig. 16, the needles or prongs 18 are provided with downwardly and angularly diverging external surfaces 18'.

When the needles or prongs are withdrawn from the body tissue, the surfaces 18' serve to stretch or place the membrane 23 under tension, drawing the same positively into the hooked ends 31 of the suture clips, so that said clips are retained against loss of position during withdrawal movement of the tool.

While I have described my improved fastening applying tool as being specifically adapted for the application of wound ligatures or sutures, it will be understood that I reserve the right to employ the appliance in any capacity to which it may find application. Also while I have set forth herein certain explanations and reasons underlying the constructional features of my improved appliance, nevertheless, it will be understood that such reasons are offered by way of explanation and to facilitate a further understanding of my invention, and if any of the hypotheses and theories offered should be proved to be incorrect, the same will not necessarily have any effect on the operation of my improved instrument as a whole.

I claim:

1. A suturing clip applicator comprising: a longitudinally extending body member formed at its forward end with a head and at its rear end with a handle; a clip holder formed with said body for the reception of a plurality of suture clips disposed in sliding longitudinally aligned order; yieldable retaining means carried by said head and engaging with a forward or terminal clip on said holder to maintain the same in removably held order on the holder, spring means urging said clips forwardly and longitudinally on said holder to maintain terminal clips in engagement with said retaining means; a manually operated lever rockably mounted on said body member; slidable ram means movable in said head, means linking said lever and ram means to actuate the latter upon rocking movement of said lever; a tissue-penetrating prong rigidly carried by and depending from said head; a jaw movably carried by said head; a second tissue-penetrating prong carried by and depending from said jaw in spaced parallel order with said first-named prong; said prongs having inwardly facing surfaces provided with complemental clipreceiving guide channels; and spring means resisting rocking movement of said lever.

2. A suture applicator comprising: a longitudinally extending body member formed at one end with a head; a holder provided in said head for the sliding reception of a plurality of suture clips arranged in longitudinally disposed order with a forward or terminal clip in vertical registry with a clip outlet provided in said head; resilient means engaging a forward or terminal clip to retain the same on said holder in alignment with said outlet; spaced tissue-penetrating prongs carried by said head, and manually eperated ejector means for moving such a forward or terminal clip from its retained position in connection with said holder into engagement with said prongs.

3. A device for applying suturing clips and the like comprising: a longitudinally extending body formed at one end with a head; a stationary prong carried by and depending from said head; a member movably mounted on said body; a prong carried by the forward end of said movable member in parallel relationship with and transversely spaced from said stationary prong; a holder carried by said body for the sliding reception of a plurality of suture clips disposed in longitudinal order; means urging the clips on said holder forwardly of the device; a movable clip ejector carried by said body for advancing said clips from the forward portion of said holder into active positions between said prongs; manually actuated lever means movably mounted on said body; and means controlled by the operation of said lever means for effecting relative movement of said prongs and the positive advancement of clips from said holder into engagement with said prongs.

4. A device for applying suturing clips and the like as set forth in claim 3 in combination with spring means acting on said movable member to maintain said prongs normally at their maximum distance of relative spacing provided by the device; and cam means actuated by said lever means for moving said movable member against the resistance of said spring means to bring said prongs into their closest position of relative approach provided by the clip ejector carried by said body for advancing said slips from the forward portion of said holder into active positions of insertion lying between said prongs, said ejector including a flexible ram confined for longitudinal movement in curvilineal guides formed internally of said head; and manually operated means for imparting movement to said ejector.

6. A device for applying suturing clips and the like as defined in claim 5, and wherein the flexible ram of said ejector is magnetized.

7. In a suturing clip applicator, a longitudinally extending body formed at its forward end with a head having an outlet slot therein, holder means formed with said body for the reception of a plurality of suturing clips, manually actuated means carried by said body for removing in single successive order suturing clips from said holder means and transferring the same to said outlet slot, a stationary tissue-penetrating prong carried by and depending from said head; a complemental movable prong arranged in parallel relationship with and transversely spaced from said stationary prong, the spacing of said prongs when the same occupy their closest positions of relative approach approximating the length of each of said clips, said prongs having inner faces formed with guide channels arranged in vertical registry with the clip outlet slot of said head; and means carried by said body for moving said movable prong toward and away from said stationary prong.

8. In a suturing clip applicator as specified in claim 7 and wherein said prongs are provided intermediately of their lengths with lateral shoulders for governing the depth of insertion of the prongs into tissues undergoing suture.

9. In a suturing clip applicator as defined in claim 7 and wherein said prongs are formed with outer surfaces diverging downwardly and angularly from the portions of said prongs adjoining said head.

References Cited in the file of this patent UNITED STATES PATENTS 770,693 Nourse Sept. 20, 1904 1,282,845 Johnson Oct. 29, 1918 1,343,289 Suchy June 15, 1920 2,008,086 Sounson July 16, 1935 2,012,027 Taylor Aug. 20, 1935 2,080,634 Schafroth May 18, 1937 2,275,683 Rutledge Mar. 10, 1942 2,308,611 La Place Ian. 19, 1943 2,488,940 Schafroth Nov. 22, 1949

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US4391402A (en) * 1980-05-27 1983-07-05 American Cyanamid Company Surgical stapling control means
US4406392A (en) * 1980-05-27 1983-09-27 American Cyanamid Company Surgical stapling instrument
US4458835A (en) * 1980-09-26 1984-07-10 American Cyanamid Company Surgical stapling control means
US4591086A (en) * 1980-09-26 1986-05-27 American Cyanamid Company Surgical stapling instrument
US4645111A (en) * 1981-07-08 1987-02-24 Howmedica, Inc. Surgical stapler with retractable anvil
US4576167A (en) * 1981-09-03 1986-03-18 United States Surgical Corporation Surgical stapler apparatus with curved shaft
US4646745A (en) * 1981-09-03 1987-03-03 United States Surgical Corporation Surgical stapler apparatus with curved shaft
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US4410125A (en) * 1981-10-02 1983-10-18 United States Surgical Corporation Surgical stapler apparatus with curved staple pusher
US4513746A (en) * 1981-10-09 1985-04-30 United States Surgical Corp. Instrument for applying plastic-like surgical fastening devices
EP0087941A2 (en) * 1982-02-26 1983-09-07 Ethicon Inc. Ligating clip with flanged base
EP0087941A3 (en) * 1982-02-26 1984-02-15 Ethicon Inc. Ligating clip with flanged base
EP0087940A3 (en) * 1982-02-26 1984-02-01 Ethicon Inc. Ligating clip and applier instrument therefor with clip engaging escapement
EP0087940A2 (en) * 1982-02-26 1983-09-07 Ethicon Inc. Ligating clip and applier instrument therefor with clip engaging escapement
US4535926A (en) * 1983-11-30 1985-08-20 Japan Bano'k Co., Ltd. Fastener dispensing device
US4583670A (en) * 1983-12-23 1986-04-22 Alfredo Alvarado Surgical stapling
US4887756A (en) * 1984-05-07 1989-12-19 Puchy David P Surgical stapler providing variable degree of staple closure
US5425489A (en) * 1990-12-20 1995-06-20 United States Surgical Corporation Fascia clip and instrument
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