WO1995010241A2

WO1995010241A2 - Surgical instrument holders

Info

Publication number: WO1995010241A2
Application number: PCT/GB1994/002085
Authority: WO
Inventors: Peter Moran
Original assignee: Surgical Innovations Limited
Priority date: 1993-10-09
Filing date: 1994-09-26
Publication date: 1995-04-20
Also published as: WO1995010241A3; GB9320830D0

Abstract

An operating member (5) relative to a tube (3) and gripping jaws (1) and (2) pivot relative to a housing and are driven further into the housing thereby causing a very firm grip to be applied to the instrument in the jaws. A bolt (31) moves along a slot (4) to guide the movement of the operating member (5). With an instrument firmly clamped in the jaws (1) and (2), the instrument can be manoeuvred to the desired orientation by making loose the clamp that holds the tube (17) to the bar coming from the table clamp to achieve a coarse degree of adjustment either in an angular orientation of the holder or by longitudinal movement of the tube (17) or both. Movement of the holder about an axis coincident with the longitudinal axis of the tube (3) is achieved by causing relative rotation between a shaft (6) and a mounting (9) after releasing a hollow conical locking member (12).

Description

SURGICAL INSTRUMENT HOLDERS

The present invention relates to a surgical instrument holder, a method of holding a surgical instrument and a method of moving a surgical instrument.

The invention is particularly, although not exclusively applicable to instruments for use in endoscopic surgery.

In a known clamp for use in surgery, a spring loaded pair of jaws are used to hold the instrument in place. If an excessive load is applied to the instrument either in the direction through the jaws or transverse thereto such that the spring force is overcome then slippage through or out of the jaws can occur.

Adjustment is provided in a known holder whereby the jaws holding the instrument can be pivoted about an axis remote from the jaws. The adjustment is enabled by frictional slippage occurring- between two plates that are biased against each other. The tighter these plates are biased against each other the less likely they are to slip accidentally. However, the tighter the plates are the more difficult it is to move the jaws about the axis with any degree of fine control and the jaws may sometimes jerk to a new position. This can damage the organs in the working region of the instrument.

According to one aspect of the present invention a surgical instrument holder includes a clamp arranged, in use, to hold a surgical instrument in place relative to a part of a body, the clamp comprising at least two jaws arranged to grip an instrument and movable relative to each other from a first position in which an instrument can be inserted between and removed from the jaws and a second position in which the jaws are arranged to hold a surgical instrument the clamp being arranged to urge the jaws into engagement with a surgical instrument and to prevent the jaws from moving back towards the first position.

Such a clamp may prevent inadvertent sliding or twisting of an instrument held in the jaws as a result of the jaws being moved apart by forces exerted by the instrument.

The jaws may be arranged to exert a grip on surgical instruments of different dimensions when in the second position by selecting one of a plurality of cooperating instrument engaging portions on the jaws. The jaws are arranged to exert a grip on surgical instruments of different dimensions when in the second position by locating an insert on at least one of the jaws. Alternatively or additionally the jaws may be arranged to grip surgical instruments of different dimensions by being held in one of a plurality of second positions.

The jaws may be prevented from moving back towards the first position by a friction force.

Movement of the jaws from the first to the second position may be achieved by causing translational movement of at least one of the jaws relative to another part of the holder. The relative translational movement may be arranged to cause a part of at least one jaw to abut a cooperating surface of a part of the holder to urge that jaw towards the other jaw, for instance about a pivot. That pivot may connect the jaws.

Relative translational movement may be arranged to be caused by effecting relative movement of an operating - D - holder from one condition to the other. At least one of the portions may be biased towards a position in which the holder is placed in one condition.

Two adjustment means may be provided that afford, in the released condition, different movement of a surgical instrument, for instance rotational movement about transverse axes.

According to another aspect of the present invention, a method of moving a surgical instrument held in a holder comprises moving adjustment means from a locked condition to a released condition, moving the instrument, and then moving the adjustment means back to the locked condition to prevent further such movement.

The method may comprise effecting the movement with a pair of hands with, for instance, one hand moving the adjustment means from the locked to the released condition and the other hand effecting the movement.

The present invention also includes a method of moving a surgical instrument held in a holder as herein referred to.

The present invention includes any combination of the herein referred to features.

The present invention may be carried into practice in various ways but one embodiment will now be described by way of example and with reference to the accompanying drawings, in which:

Figure 1 is a perspective view of a surgical instrument holder 25; - 6 -

Figures 2a and 2b are detailed views of the part of the holder that affords adjustment about a first, upwardly extending axis.

Figures 3a and 3b are exploded detail views of the part of the holder that affords adjustment of the holder about a second axis transverse to the first axis together with detail on the gripping arrangement for the jaws 1 and 2;

Figure 4 is a view of the jaws 1 and 2 in the open position, and

Figure 5 is a detail of a modification that can be made to one or both of the jaws.

The holder 25 is arranged to be used in surgical operations. The patient is located on an operating table and instruments such as retractors are reguired to be held in place during an operation. The operation may comprise open surgery or more commonly may comprise endoscopic surgery.

Before the holder can be used it is necessary to fix the holder in place relative to the table. This is effected by clamping the holder to a bar that is secured to the side of the operating table. That bar may extend vertically upwards from the side of the table and be directly secured to the holder or a further bar may be connected to the bar coming from the side with the further bar extending partially over the table. The bar is clamped to a tube 17 of the holder by conventional means such as by tightening a threaded member to draw together two parts of a clamp to grip the tube firmly onto the rod. - 3 - holder from one condition to the other. At least one of the portions may be biased towards a position in which the holder is placed in one condition.

Figure 1 is a perspective view of a surgical instrument holder 25; Figures 2a and 2b are detailed views of the part of the holder that affords adjustment about a first, upwardly extending axis.

Figure 4 is a view of the jaws 1 and 2 in the open position, and

Before the holder can be used it is necessary to fix the holder in place relative to the table. This is effected by clamping the holder to a bar that is secured to the side of the operating table. That bar may extend vertically upwards from the side of the table and be directly secured to the holder or a further bar may be connected to the bar coming from the side with the further bar extending partially over the table. The bar is clamped to a tube 17 of the holder by conventional means such as by tightening a threaded member to draw together two parts of a clamp to grip the tube firmly onto the rod. Clamping movement to secure the instrument to the jaws 1 and 2 will now be described. The jaws 1 and 2 are pivotally connected together by a pin. When no external forces act on the jaws, they are biased to the position shown in Figure 4 by a spring 16. In this configuration surgical instruments can be inserted between or removed from the jaws. It can be seen that the jaws can accommodate various sizes of instrument by selecting opposed clamping channels 27 or 28.

The pin 26 passes through aligned openings 29 in a shaft 6 to fix the jaws within a slot 30 in the end of the shaft. The shaft 6 is located within a tube 3 by a threaded bolt 31 that passes through a knurled operating member 5, through a guide slot 4 and into a threaded opening 32 in the shaft. When the operating member is pushed towards the front of the tube 3 the jaws protrude further from the tube to take up the position shown in Figure 4. However, when the operating member 5 is slid back over the tube 3 the shaft 6 is also moved back thereby pulling the jaws 1 and 2 further into the tube. As the outwardly facing tapered surfaces 33 and 34 of the jaws engage the conical tapering surface 35 of the tube 3 the jaws are forced back towards each other.

During initial rearwards movement of the operating member, the jaws move straight back into the tube. However, when the bolt 31 has moved along the axial extent 36 of the slot 4 it comes to an angled section 37 of the slot that has a much greater radial extent than it does axial extent. Accordingly, by gripping and turning the operating member 5 relative to the tube 3, and the jaws turn relative to the housing and are also driven further into the housing thereby causing a very firm grip to be applied to the instrument in the jaws. The bolt 31 can be allowed to travel to the end of the angled section 37 of the slot or may stop part way along the extent. Accordingly different sized instruments can be gripped in each of the opposed channels with the grip being firm with the different jaw spacings being accommodated by the bolt 31 stopping at a different point along the slot 37. In an alternative embodiment (not shown) , the slot 36 can also extend at an angle to the elongate axis at a lesser angle than the slot 37 whereby turning movement of the tube 3 can cause the bolt 31 to move relative to the tube along both the slot 36 and the slot 37. The slot 36 may extend 90° around the tube 3. The considerable radial extent of the section 37 allows an extremely large clamping force to be applied to the instrument because of the mechanical advantage thereby afforded. Furthermore, friction between the bolt and the slot prevents the jaws from being able to be moved apart by the application of any force at the jaws and disengagement of the grip can only be achieved by turning back the operating member 5.

Figure 5 shows the use of an lining 50 that can be bonded on one or both jaws to allow the jaws to clamp firmly on instruments of different size. The lining 50 is approximately 0.5 mm thick.

With the instrument firmly clamped in place manoeuvring of the instrument to the αesired orientation and location can commence. Alternatively the instrument can be manoeuvred into the desired location and then the clamp can be applied to the instrument and the clamp can be fixed firmly at its orientation and location.

The first adjustment that can be done is to loosen the clamp that holds the tube 17 to the bar coming from the table clamp. That can achieve a relatively coarse degree of adjustment either in angular orientation of the holder or by longitudinal movement of the tube 17 or both. Then the instrument can be pivoted about an axis coincident with the longitudinal axis of the tube 3 or perpendicular thereto, about the longitudinal axis of a tube 11.

Movement about an axis coincident with the longitudinal axis of the tube 3 is achieved by causing relative rotation between the shaft 6 and a mounting 9. A bolt 8 holds the shaft and the mounting 9 axially fast together. One end of the bolt 8 threadably engages the shaft 6. The shank of the bolt 8 passes through a narrow passage 38 from the mounting with the head being located in a recess located within the mounting. As the head of the bolt is of greater size than the opening 38, the shaft 6 is held onto the mounting 9.

A hollow conical locking member 12 shown in Figure 3b is constrained to rotate with the shaft 6 by means of grub screws 39 that engage with threaded holes in the locking member and extend into axial slots 40 in the shaft 6. A spring 7 acts between an axially facing surface on the shaft 6 and an opposing surface 41 in the region of internal splines 42 of the locking member 12 to urge the locking member to the right to a locked position, when viewed in Figures 3a, 3b and 4. The splines 42 mesh with corresponding splines 43 on the mounting 9.

The locking member 12 can be urged forward against the action of the spring 7 with the grub screws sliding in the slots 40 to disengage the splines 42 and 43 and allow rotation of the shaft 7 and therefore also of the jaws 1 and 2. When the desired degree of rotation has occurred the locking member is allowed to travel back to again mesh the splines.

It will be appreciated that rotation about the axis of the tube 3 can be achieved by a single hand releasing the locking member and effecting the rotation.

Accordingly the surgeon himself can effect this adjustment.

Pivotal adjustment about the axis of the tube 11 will now be described.

The mounting 9 is fast with a toothed cog 10. The tube 11 rotatably locates the cog 10 between two plates 44 that are part of a housing 20 that is fast with the tube 17. In the normal position, the cog 10 is prevented from rotating about the tube 11 by a toothed latch 15. The latch 15 is prevented from rotating about the tube 11 by engagement of the side walls of a lug 45 of the latch with a socket in the housing 20. The latch is held in engagement with the cog by the end of a rod 18 that extends through the tube 17 bearing against the end of the lug 45.

In order to release the latch and allow the cog to rotate about the tube 11 a knurled operating knob 19 at the free end of the tube 17 is rotated. This causes outwards axial movement of the knob and therefore makes room for the tube 18 to move to the right. The tube is caused to move to the right by a spring 14 that urges the teeth of the latch 15 off the cog. The spring is held in place by a pin 13 that a reduced circumferential recess 46 of the cog located between the teeth is able to slide over. A part of the pin extends within the spring. When the cog 10 and therefore the instrument have been pivoted through the reguired amount (which may be up to 280°) , the latch is again brought into engagement with the cog by tightening the knob 19.

It can thus be seen that a single pair of hands can achieve the adjustment about the longitudinal axis of the tube 17.

Accordingly the holder provides an arrangement which the surgeon alone can manipulate the instrument about at least two transverse axes with means for positively engaging the instrument to prevent unwanted movement from the selected position. This positive engagement of an instrument is of particular advantage where a retractor may be being used to hold back an internal organ of a body as the holder prevents any movement of the instrument as a result of the sideways force that is exerted by the organ on the retractor.

Claims

1. A surgical instrument holder including a clamp arranged, in use, to hold a surgical instrument in place relative to a part of a body, the clamp comprising at least two jaws arranged to grip an instrument, the jaws being moveable relative to each other from a first position in which an instrument can be inserted between and removed from the jaw and a second position in which the jaws are arranged to hold a surgical instrument, the clamp being arranged to urge the jaws into engagement with a surgical instrument and to prevent the jaws from moving back towards the first position.

2. A holder as claimed in claim 1 in which the jaws are arranged to exert a grip on surgical instruments of different dimensions when in the second position by selecting one of a plurality of cooperating instrument engaging portions on the jaws.

3. A holder as claimed in claim 1 or claim 2 in which the jaws are arranged to exert a grip on surgical instruments of different dimensions when in the second position by locating an insert on at least one of the jaws.

4. A holder as claimed in any preceding claim in which the jaws are arranged to grip surgical instruments of different dimensions by being held in one of a plurality of second positions.

5. A holder as claimed in any preceding claim in which the jaws are prevented from moving back towards the first position by a friction force.

6. A holder as claimed in any preceding claim in which movement of the jaws from the first to the second position is achieved by causing translational movement of at least one of the jaws relative to another part of the holder.

7. A holder as claimed in claim 6 in which the relative translational movement is arranged to cause a part of at least one jaw to abut a cooperating surface of a part of the holder to urge that jaw towards the other jaw.

8. A holder as claimed in claim 7 in which the jaw that is urged towards the other jaw is arranged to be so urged about a pivot.

9. A holder as claimed in claim 8 in which the pivot connects the jaws.

10. A holder as claimed in any preceding claim in which relative translational movement is arranged to be caused by effecting relative movement of an operating member on the holder.

11. A holder as claimed in claim 10 in which the relative translational movement includes sliding or turning the operating member relative to the holder at least partly in the direction of relative translational movement of one of the jaws.

12. A holder as claimed in claim 11 in which the relative translational movement includes sliding the operating member relative to the holder at least partly in a direction transverse to the direction of relative translational movement of one of the jaws.

13. A holder as claimed in any of claims 10 to 12 in which the relative movement in the transverse direction is considerably greater in the translational direction at least during the final movement of the operating member to bring the jaws into the second position.

14. A holder as claimed in claim 13 in which the transverse movement provides the frictional force that holds the jaws in engagement.

15. A holder as claimed in any preceding claim including a guide arranged to control the movement of the operating member.

16. A method of holding a surgical instrument in place relative to a part of a body comprising locating a part of an instrument between at least two jaws of a clamp of the holder; causing relative movement of the jaws into engagement with the instrument and preventing the jaws from unwanted movement out of engagement with the instrument.

17. A method as claimed in claim 16 comprising twisting an operating member of the holder relative to another part of the holder in order to bring the jaws fully into engagement with the instrument.

18. A method of holding a surgical instrument when using a surgical instrument holder as claimed in any of claims 1 to 15.

19. A surgical instrument holder arranged, in use, to hold a surgical instrument, the holder including adjustment means movable from a locked condition in which relative movement afforded by the adjustment means of an instrument in the holder is prevented and a released condition in which movement of the instrument held by the holder is permitted by the adjustment means.

20. A holder as claimed in claim 19 in which the adjustment means is arranged to prevent inadvertent slippage or movement of an instrument held by the holder caused by a slippage of the adjustment means.

21. A holder as claimed in claim 19 or 20 in which the adjustment means are arranged to be retained in the locked condition.

22. A holder as claimed in any of claims 19 to 21 in which the adjustment means are arranged to be retained in the released condition.

23. A holder as claimed in any of claims 19 to 22 in which the adjustment means are arranged to be maintained in the locked condition by abutment of first and second portions, with one of those portions, in the released condition, being constrained to move with a part of the holder that moves with an instrument being held and the other of those portions being constrained not to so move.

24. A holder as claimed in any of claims 19 to 23 in which the movement in the released condition afforded by the adjustment means is arranged to be rotational.

25. A holder as claimed in claim 23 or claim 24, when dependent upon claim 23, in which one of the first or second portions is arranged to move in a direction transverse to the relative movement afforded by the adjustment means in order to move the holder from one condition to the other.

26. A holder as claimed in Claim 25 in which at least one of the portions is biased towards a position in which the holder is placed in one or other of the conditions.

27. A holder as claimed in any of claims 19 to 26 in which two adjustment means are provided that afford, in the released condition, different movement of a surgical instrument.

28. A method of moving a surgical instrument held in a holder comprising moving adjustment means from a locked condition to a released condition, moving the instrument, and then moving the adjustment means back to the locked condition to prevent further such movement.

29. A method as claimed in claim 28 comprising effecting the movement by a hand with the hand moving the adjustment means from the locked condition to the released condition and the hand also effecting the movement.

30. A method of moving a surgical instrument when using a surgical instrument holder as claimed in any of claims 19 to 27.