WO1992011812A1 - Applicateur de pinces - Google Patents

Applicateur de pinces

Info

Publication number
WO1992011812A1
WO1992011812A1 PCT/EP1992/000006 EP9200006W WO9211812A1 WO 1992011812 A1 WO1992011812 A1 WO 1992011812A1 EP 9200006 W EP9200006 W EP 9200006W WO 9211812 A1 WO9211812 A1 WO 9211812A1
Authority
WO
WIPO (PCT)
Prior art keywords
jaws
applicator according
clamp
open
scissors
Prior art date
Application number
PCT/EP1992/000006
Other languages
German (de)
English (en)
Inventor
Harald Heidmüller
Elke Heidmüller
Original Assignee
Heidmueller Harald
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Heidmueller Harald filed Critical Heidmueller Harald
Publication of WO1992011812A1 publication Critical patent/WO1992011812A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
    • A61B2017/292—Handles transmission of forces to actuating rod or piston details of linkages or pivot points connection of actuating rod to handle, e.g. ball end in recess
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft

Definitions

  • the invention relates to a clamp applicator for setting and closing blood vessel clamps or the like for laparotomy interventions, with an elongated shaft, two jaws arranged at its front end, movable about an axis of rotation relative to one another, spanning a variable opening angle, each having inwardly open recesses for receiving and holding an open blood vessel clamp, and a handle and actuating device arranged at the rear end thereof for closing the jaws, in particular against spring force, with a manipulation device for blood vessels or tissue structures, which is arranged laterally next to an opening plane spanned by the jaws and which by means of a telescopic arrangement guided in the shaft can be displaced between a front position projecting beyond the opening plane of the jaws and a rear position lying next to the opening plane of the 3-jaws.
  • Clamps of this type are described, for example, in DE 21 23 703 C and can then be designed as simple U-shaped brackets made of steel or tantalum, which are plastically deformable and, after being compressed around a blood vessel, solely due to their elastic properties in the closed position with adjacent legs remain. Titanium is also suitable as a material for such clamps.
  • Other clamps of the type mentioned are described in DE 30 22 087 C 2, according to which these are formed from biologically acceptable plastic materials and, at the front ends of their approximately U-shaped legs, locking means for locking after closing around a blood vessel with legs lying on top of each other exhibit. In addition to vessels, tissue structures can also be clamped in the same way.
  • the size of the clamps used can vary widely. In certain applications in surgery, they can be very small, but to close the ovic duct or the defensive duct they can be significantly larger than when used as normal blood vessel clamps.
  • a clamp applicator of the type mentioned at the beginning has been described, which comprises a manipulation device in the form of a hook, by means of which blood vessels can be grasped and drawn into the open jaws of the clamp applicator.
  • a kaken is in limited its application possibilities, in particular it is not very suitable for grasping tissue structures and pulling them back. Proceeding from this, the present invention is based on the object of providing a terminal applicator which is refined in its function and expanded in its possible uses.
  • the manipulation device is multi-parted and includes branches or jaws which are connected to one another in an articulated manner and span a variable opening angle.
  • a first concrete embodiment of this solution is that the manipulating device is designed as scissors, in particular as tubular shears.
  • the manipulating device is designed as scissors, in particular as tubular shears.
  • vessels or tissue structures that can be grasped by the open jaws of the clamp applicator with immediate access can be separated on one side immediately after the clamp has been pressed together, without the operator having to change the instrument as a whole, in particular, for example, from the open abdominal cavity and remove it another instrument must be introduced.
  • the scissors can in particular be designed as Pott scissors.
  • an outwardly directed, preferably rearwardly curved hook is provided on one of the jaws or branches of the scissors, which thus, in an expanded mode of operation, both grips and draws in blood vessels into the open jaws of the clamp, and then disconnects them of a pinched blood vessel or tissue area.
  • the manipulation device is designed as a pair of pliers that can be gripped better of tissue areas than is possible with a simple hook tool.
  • the pliers can be designed with jaws lying directly on top of one another or with hook-shaped jaws, which in contact with one another leave an open cross section, depending on the application. Subsequent cutting with the same instrument must be avoided, but this improves the options for handling the structures to be disconnected.
  • the clamp applicator can be equipped with interchangeable jaws for different forms of clamps.
  • the distribution of such an embodiment lies in the fact that the lying jaws, which have the recesses for receiving and holding an open blood vessel clamp, are each detachably connected to the jaw holders located behind, which sense the relative axis of rotation. This creates the possibility of making a corresponding clamp applicator usable for the use of different clamp types at low cost, namely by keeping different sets of jaws.
  • the jaws each have lugs lying in the direction of their extension, which can be inserted into a corresponding opening or bore in the jaw holder.
  • a rotation lock can be located, for example, in the combination of pin and bore on mutually facing end faces of the jaws and jaw holders that lie outside the lugs.
  • an axial securing of the lugs on the jaws is to be provided in the corresponding openings or bores of the jaw holders.
  • a first possibility for this is, for example, the securing by pure frictional forces, which e.g. can be increased if the jaw holders are slit lengthways and the approaches are pressed into the corresponding recesses with oversize.
  • Other forms of securing can lie in a simple grub screw in the jaw holder, which secures the attachment, or in a spring-loaded locking ball, which snaps into a counter recess.
  • the tool has an adjusting device for limiting the opening angle, since an adaptation to a special type of clamp is usually not only due to the outer shape of its legs but also by one Opening angle of the legs is determined in the open state. A change in the respective jaws can therefore also involve and include a change in the associated opening angle of the jaws.
  • the tool can be designed, in particular, for use in laparotomic operations, as a multi-joint pliers and a first part with a fixed jaw holder and a first handle part and a second jaw holder that is movable about a first axis of rotation and a second one about the first parallel axis of rotation movable, relative to the first resiliently supported second handle part, wherein the movable handle part and movable jaw holder are each articulated via a push rod essentially parallel to the longitudinal extent of the first part.
  • pliers represent a four-section, flat, non-rotatable gear with three swivel joints and one sliding joint.
  • the adjusting device can be a threaded sleeve attached to the first fixed handle part with an adjusting screw acting on the push rod.
  • an adjustment scale can be provided in an opening in the threaded sleeve.
  • the manipulation device comprises a rod arrangement which can be moved telescopically with respect to the first part of the tool, which in turn is in two parts and carries the two movable parts of the manipulation device at its front end.
  • the two-part design can either consist of a tube-in-tube or rod-in-tube arrangement, or it can be axially displaced relative to one another from two essentially semicirculars bars.
  • the manipulation device can be rotated, in particular by means of an outer rotary knob, the mutual longitudinal displaceability of the two parts of the rod body mentioned is preferably achieved by a two-part design of the rotary knob, each of the two annular parts of the rotary knob with one of the two parts of the rod body is connected.
  • FIG. 1 shows a side view of a clamp applicator
  • FIG. 2 shows a clamp applicator according to FIG. 1 in
  • FIG. 3 shows a tool according to FIG. 1 in cross section A-A
  • FIG. 4 shows a tool according to FIG. 1 on an enlarged scale
  • FIG. 5a shows a tool according to FIG. 1 in partial longitudinal section in the working position of the manipulation device
  • FIG. 5b shows a tool according to FIG. 1 in partial longitudinal section in the rest position of the manipulation device
  • FIG. 6 shows the detail according to FIG. 5a in plan view
  • FIG. 7 shows a detail of the pliers according to FIG. 1, 8 shows an alternative embodiment of the detail according to FIG. 7,
  • Fig. 9 shows another alternative in detail
  • a multi-joint pliers 1 can be seen with a first fixed grip part 43 and a grip part 44 that can be pivoted about an axis of rotation 45.
  • the fixed grip part 43 merges into an underflow 75; on this a fixed jaw holder 39 and a movable jaw holder 40 are arranged, which is pivotally mounted in an axis (not shown) lying parallel to the axis of rotation 43 in the lower reaches.
  • the jaw holder 39 carries an interchangeable jaw 41, the jaw holder 40 an interchangeable jaw 42.
  • the upper run 76 which runs parallel to the lower part 75 and is connected to the grip part 38, is displaceable, with this having an inner recess 79 into which the grip part 44 has its free end 38 engages.
  • Underflow 75 and overflow 76 are guided in parallel by means to be described in more detail.
  • the upper run 75 is connected to the movable jaw holder 40 via a further axis of rotation.
  • a setting device 46 is fastened to the grip part 43 and comprises a sleeve 47 and a threaded pin 48 adjustable therein.
  • the sleeve 47 has a window 49 with a scale division.
  • the grub screw 48 forms a stop for the free end 38 of the handle part 44, the handle parts 43 and 44 being supported against one another by springs 50, 51.
  • Lying to the side of the jaws 41, 42 is a two-part manipulation device 52, which is axially adjustable via a rotary knob 53 sliding on the upper and lower run, via an internal partial telescopic connection, not shown, as in a further position on the left the manipulation device 52 'is shown and can also be rotated.
  • the rotary knob 53 has two mutually axially adjustable ring pieces 54, 55, which are axially supported against one another via springs 55, 57 and can be locked in a position approximated to one another by a securing bracket 59 engaging in a slot 58. In this locked position, the manipulation device in this embodiment has the hook-like shape as shown in FIG. 1.
  • the manipulation device 52 is constructed in two parts and the two branches 60, 61 can form a pair of scissors movable via a two-part telescopic rod 62, which are closed against the spring force 56 by the movement of the rings 54, 55 can be.
  • These scissors can be used to separate the vessel after the vascular clamp has been set and closed without having to remove the multi-joint pliers or to use another instrument.
  • FIG. 8 shows a manipulation device in the form of a clamp with two clamps 53, 64, which are articulated around an axis 65 in order to draw a vessel into the vessel clamp. Subsequent separation of the vessel using the same tool is not possible.
  • FIG. 9 shows a manipulation device in the form of hook pliers with two hooks 65, 57 which are connected to one another via an axis of rotation 68, whereby this can be viewed as a second alternative for pulling a vessel into the hemostat.
  • Fig. 2 the same details as in Fig. 1 are given the same numbers. It can be seen that both the jaw holder 40 with the jaw 42 and the closed hook in its positions 52 and 52 'are each laterally offset from the center.
  • the axis of rotation 70 of the upper jaw holder 40 with respect to the displaceable upper run 76 is indicated as well as the axis of rotation 69 of the upper jaw holder with respect to the lower run 75.
  • Fig. 3 shows the upper run 75 and lower run 75 in an enlarged cross section according to the section line AA according to FIG. 1.
  • a T-shaped guide groove 78 can be seen on the upper run 75, into which one of a plurality of axially spaced T-shaped pins 77, which in the lower reaches 75 are inserted.
  • FIG. 4 shows the upper run 76 and lower run 75 in an enlarged cross section through the ring part 54 according to the section line ZZ according to FIG. 5a.
  • a telescopic tube 62 is shown, which consists of an outer tube 80 and an inner rod 81 and is located in an upwardly open longitudinal groove 85 in the lower run 75.
  • a tab 82 is arranged on the outer tube and engages in an adapted circular sector-shaped recess 83 in the ring body 54.
  • the recess 83 moves and takes the tab 82 into the position 82 'shown in broken lines.
  • a segment-like cutout 84 is provided in the upper reaches.
  • the inner rod 81 connected to the rear ring cable 55 is axially displaceable in the outer tube 80 for actuating the manipulator.
  • FIGS. 5a and 5b the front ring part 54 and the rear ring part 55 are shown in a partial longitudinal section, with the spring and the securing bracket being omitted.
  • the circular sector-shaped recess 83 and the corresponding cutout 84 in the upper run 76 can be seen on the ring part 54. Both are closed with a cover 87 to form a cavity closed to the rear.
  • the upper run 76 there is also a longitudinal groove 86, which is connected to the circular sector-shaped recess 84.
  • the recess 84 is followed by a transition slope 91 and the recess 89 is followed by a transition slope 92, the function of which is explained below.
  • FIG. 5a it can be seen in the advanced working position that the flag 82, which is connected to the outer tube 80 and a further flag 93, which is connected to the inner rod 81, each protrude into the recesses 83 and 88.
  • FIG. 5 again shows the ring part 54 with recess 83 and cover 87 and the ring part 55 with recess 88 and cover 90.
  • the recess 84 is also shown, into which the tab 82 protrudes and which continues to the rear with the run-on slope 91.
  • the recess 89 is shown in the upper run, into which the tab 93 extends and which has the run-on bevel 92 at the end. Basically, it would be sufficient to provide only one of the mentioned bevels, since the jaws of the manipulation device are connected via a front joint. In order to prevent torsional loads there, however, two run-on bevels which act uniformly on the tabs 82 and 93 of the outer tube 80 and the inner rod 81 must be provided.

Landscapes

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

Abstract

Applicateur de pinces (37) pour la mise en place et la fermeture de pinces à vaisseaux sanguins ou analogues, pour opérations laparotomiques, comprenant une tige allongée (75, 76), deux mâchoires (41, 42) montées à son extrémité avant, mobiles l'une par rapport à l'autre autour d'un axe de rotation (69) et formant un angle d'ouverture variable, ces mâchoires présentant chacune des évidements ouverts vers l'intérieur, destinés à loger et à maintenir une pince ouverte à vaisseaux sanguins, et un dispositif de préhension et d'actionnement (43, 44) monté à son extrémité arrière, pour la fermeture des mâchoires (41, 42), notamment à l'encontre d'une force de ressorts (50, 51), un dispositif manipulateur (52) pour les vaisseaux sanguins ou les structures de tissus, disposé latéralement à proximité d'un plan d'ouverture formé par les mâchoires (41, 42) et déplaçable par l'intermédiare de moyens télescopiques (62) guidés dans la tige (75, 76) entre une position avant, en saillie au-dessus du plan d'ouverture des mâchoires (41, 42) et une position arrière située à proximité du plan d'ouverture des mâchoires (41, 42), le dispositif manipulateur (52) étant à éléments multiples et comprenant des branches ou des mâchoires (60, 61; 63; 64; 66, 67) articulées entre elles et formant un angle d'ouverture variable.
PCT/EP1992/000006 1991-01-07 1992-01-03 Applicateur de pinces WO1992011812A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE19914100235 DE4100235A1 (de) 1991-01-07 1991-01-07 Klemmenapplikator
DEP4100235.0 1991-01-07

Publications (1)

Publication Number Publication Date
WO1992011812A1 true WO1992011812A1 (fr) 1992-07-23

Family

ID=6422625

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1992/000006 WO1992011812A1 (fr) 1991-01-07 1992-01-03 Applicateur de pinces

Country Status (2)

Country Link
DE (1) DE4100235A1 (fr)
WO (1) WO1992011812A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1994020034A1 (fr) * 1993-03-10 1994-09-15 Karl Storz Gmbh & Co. Pince medicale
CN106859732A (zh) * 2017-03-30 2017-06-20 中南大学湘雅三医院 一种可折叠的外科手术钳

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE4418449A1 (de) * 1993-11-02 1995-05-04 Storz Karl Gmbh & Co Instrument zur Applikation von Prothesen im Körperinneren
DE19926555A1 (de) 1999-06-11 2000-12-28 Storz Karl Gmbh & Co Kg Medizinisches Greifinstrument sowie Verfahren zur Verwendung dieses Greifinstruments
GB0417104D0 (en) * 2004-07-30 2004-09-01 Price Invena Aps Surgical clamp

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3777538A (en) * 1972-03-15 1973-12-11 Weck & Co Edward Surgical clip applicator
FR2245325A1 (fr) * 1973-09-28 1975-04-25 Inst Meditsinskoi Tekhniki
US3924629A (en) * 1973-01-20 1975-12-09 Taichiro Akiyama Method for closing a cut end of a blood vessel
WO1989005124A1 (fr) * 1987-12-09 1989-06-15 Mcfadden Joseph T Dispositif chirurgical de serrage articule rotatif
EP0389238A2 (fr) * 1989-03-21 1990-09-26 The Population Council, Inc. Dispositif pour fermer le canal déférent
DE9015046U1 (de) * 1990-07-30 1991-01-17 Ethicon GmbH & Co KG, 2000 Norderstedt Klammersetzgerät für Ligatur-Clips
US5026379A (en) * 1989-12-05 1991-06-25 Inbae Yoon Multi-functional instruments and stretchable ligating and occluding devices

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3777538A (en) * 1972-03-15 1973-12-11 Weck & Co Edward Surgical clip applicator
US3924629A (en) * 1973-01-20 1975-12-09 Taichiro Akiyama Method for closing a cut end of a blood vessel
FR2245325A1 (fr) * 1973-09-28 1975-04-25 Inst Meditsinskoi Tekhniki
WO1989005124A1 (fr) * 1987-12-09 1989-06-15 Mcfadden Joseph T Dispositif chirurgical de serrage articule rotatif
EP0389238A2 (fr) * 1989-03-21 1990-09-26 The Population Council, Inc. Dispositif pour fermer le canal déférent
US5026379A (en) * 1989-12-05 1991-06-25 Inbae Yoon Multi-functional instruments and stretchable ligating and occluding devices
DE9015046U1 (de) * 1990-07-30 1991-01-17 Ethicon GmbH & Co KG, 2000 Norderstedt Klammersetzgerät für Ligatur-Clips

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1994020034A1 (fr) * 1993-03-10 1994-09-15 Karl Storz Gmbh & Co. Pince medicale
US5817128A (en) * 1993-03-10 1998-10-06 Karl Storz Gmbh & Co. Medical tongs
CN106859732A (zh) * 2017-03-30 2017-06-20 中南大学湘雅三医院 一种可折叠的外科手术钳

Also Published As

Publication number Publication date
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