WO2000054662A1 - Instrument de chirurgie - Google Patents

Instrument de chirurgie Download PDF

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Publication number
WO2000054662A1
WO2000054662A1 PCT/AU2000/000195 AU0000195W WO0054662A1 WO 2000054662 A1 WO2000054662 A1 WO 2000054662A1 AU 0000195 W AU0000195 W AU 0000195W WO 0054662 A1 WO0054662 A1 WO 0054662A1
Authority
WO
WIPO (PCT)
Prior art keywords
jaw
jaw members
members
articulation
pivotal connection
Prior art date
Application number
PCT/AU2000/000195
Other languages
English (en)
Inventor
Damian Delio Marucci
John Anthony Cartmill
William Robert Walsh
Original Assignee
The University Of Sydney
Unisearch Limited
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
Priority claimed from AUPP9241A external-priority patent/AUPP924199A0/en
Priority claimed from AUPQ0927A external-priority patent/AUPQ092799A0/en
Application filed by The University Of Sydney, Unisearch Limited filed Critical The University Of Sydney
Priority to AU31359/00A priority Critical patent/AU3135900A/en
Priority to US09/936,606 priority patent/US6582451B1/en
Publication of WO2000054662A1 publication Critical patent/WO2000054662A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in 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
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
    • 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
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • 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
    • 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
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2939—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
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2944—Translation of jaw members

Definitions

  • the present invention relates generally to a surgical instrument for manipulating, grasping, cutting, cauterising, clipping, stapling, spreading, retracting or clamping tissues in the body of a patient or animal, or as a platform for diagnostic and therapeutic modalities and for applications to achieve cutting, haemostasis, sealing and joining of tissues. More specifically, the present invention relates to such a surgical instrument when adapted for use in the performance of minimally invasive or open procedures.
  • the jaw members of such surgical instruments are brought relatively towards and away from each other through articulation of the respective proximal ends of the jaw members about a single pivot point or hinge.
  • the jaw structure has been manufactured to incorporate more than one pivot point.
  • the jaw opens in such a way that the respective distal ends of the jaw members move relatively apart while the respective proximal ends articulate about the pivot point.
  • the distance between the distal ends of the jaw members exceeds the distance between the proximal ends.
  • the gripping pressure made on the tissue adjacent the proximal end exceeds that made by the jaw members adjacent their distal ends.
  • the risk of unintentional trauma to the tissue positioned adjacent the respective proximal ends of the instrument's jaw members is very high. This is particularly the case in endoscopic procedures where visibility and accessibility is limited. Further, the pivotal action can lead to tissue positioned between the jaw members being squeezed out of the jaw away from the pivot point.
  • the present invention is a device for manipulating tissues in the body of a patient or animal, the device including:- a support means: a reciprocating member which moves relative to the support means; an articulated jaw structure having: a first and at least a second jaw member, each jaw member having a proximal end and a constraining surface adjacent its proximal end: and an articulating means for articulating the jaw members in response to reciprocation of the reciprocating member, the articulating means including: first and second connecting members, and at least first and second articulation members, wherein the first and second connecting members are each connected by a first pivotal connection to the reciprocating member and extend to respective second and third pivotal connections, and the first and second articulation members are connected together intermediate their respective ends by a fourth pivotal connection mounted to the support means, the first articulation member extending from said second pivotal connection to a fifth pivotal connection with the second jaw member distal its proximal end, and the second articulation member extending from said third pivotal connection
  • the second pivotal connection being adapted to engage the constraining surface of the first jaw member and the third pivotal connection being adapted to engage the constraining surface of the second jaw member, such that on relative movement of the reciprocating member towards or away from the fourth pivotal connection, the second and third pivotal connections are caused to move relatively away from or towards one another, so moving the entire jaw members relatively away from or towards one another.
  • the configuration of the articulating means according to the above aspect enables relative movement of the reciprocating member towards or away from the fourth pivotal connection. As a result of such movement, the second and third pivotal connections are caused to move relatively away from or towards one another, so changing the configuration of the articulating means in a concertina fashion from a first to at least a second orientation.
  • corresponding points on each of the jaw members are separated by a first distance: and similarly, when in the second orientation, corresponding points on each of the jaw members are separated by a second different distance.
  • Two particular points on the respective jaw members are taken to be corresponding points as defined herein if. throughout the entire range of movement of the two jaw members, those two particular points maintain a constant positional relationship with one another. That is. those two particular points will always come back to the same relational positions with respect to one another, once the jaw members are moved back into the position which they were in when those two particular points were originally identified.
  • reciprocation of the reciprocating member can result in movement of the jaw members in parallel relation to one another.
  • both jaw members will move equal distances away from and towards each other.
  • one jaw member may remain stationary while the other jaw member moves relative to it.
  • the jaw member which remains stationary may be connected to. or be an integral part of, the support means.
  • the surfaces of the two jaw members which face one another can be parallel.
  • the faces can maintain an angular relationship with respect to one another, irrespective of the particular moving relationship between the two jaw members.
  • the present invention can utilise a mechanism to achieve movement of the jaw members relatively toward and relatively away from one another, but wherein such movement is not restricted to being parallel.
  • an additional constraining surface may be incorporated into each of the articulation members.
  • the pivotal connection between said articulation members can be adapted to engage both of their respective constraining surfaces simultaneously. While reciprocation of the reciprocating member will cause relative movement between the jaw members, the angular relationship of the latter will depend on where the pivotal connection of the two articulation members is located in both constraining surfaces of said articulation members.
  • the position of the pivotal connection connecting the articulation members could be adjusted in a number of ways.
  • such adjustment could be achieved through manipulation of an adjustment means capable of changing the positional relationship between said pivotal connection and the support means.
  • Such adjustment means could take the form of a pin extending from said pivotal connection to a point of engagement with a slot, or other similar constraining surface, in the support means: wherein the pin would be slidably engaged with the slot or other appropriate constraining surface.
  • the adjustment means could be such that an extension from the pivotal connection between the articulation members is threadably attached to an elongate member: which itself extends through or alongside a lumen in the reciprocating member, and has a fixed positional relationship with the support means. In this embodiment of the invention, rotation of the elongate member results in movement of said pivotal connection relative to both slots of the articulation members simultaneously.
  • the jaw members move in parallel relation to one another; and when said pivotal connection is in a different location within the slots of the articulation members, movement of the jaw members by reciprocation of the reciprocating member will result in the jaw members arcing out a radius of curvature with respect to one another.
  • the moving relationship between the jaw members can be changed at any time by adjusting the position of the pivotal connection within the two slots of the articulation members. This may be advantageous in situations where the surgeon wishes to change the relative orientation of the jaw members for either precision gripping or retraction.
  • the device according to this invention may be used in a range of surgical procedures. However, it is of particular value when used in the performance of minimally invasive surgery. While the device is capable of grasping and manipulating many different kinds of tissues in the body of a patient in a minimal access setting, it can also be used to clamp vessels during open procedures, for example, the performance of a vascular anastomosis. In this embodiment, the device allows for an even application of pressure to the vessel wall. It also minimises the potential damage to adjacent structures as the jaw members only have to open as wide as the diameter of the vessel, and no further, in order to receive the vessel.
  • the use of the device is not limited to those applications only. It may. for example, further be used as a dilating means, capable of dilating any vessel in the body of a patient including, but not limited to. those vessels comprising the vasculature. the hepatobiliary tract and the genitourinary tract: or as a delivery means, capable of delivering a particular device, such as an implant, a graft or a stent. to a desired location in the body of a patient.
  • a dilating means capable of dilating any vessel in the body of a patient including, but not limited to. those vessels comprising the vasculature. the hepatobiliary tract and the genitourinary tract: or as a delivery means, capable of delivering a particular device, such as an implant, a graft or a stent. to a desired location in the body of a patient.
  • the device can be used to dilate vessels or any other hollow viscus.
  • the device provides an even expansive force on the tissue through an outer surface of the jaw members.
  • the distance between the jaw members during such dilatation provides a route for blood (or any other fluid) to flow during the procedure. In the case of angioplasty, this limits the amount of ischaemic damage done to the distal tissues, as blood flow is not interrupted.
  • Another advantage of this mechanism as a dilating means is that the force applied to the vessel can be measured through strain gauges or other load measuring devices mounted to the articulating means.
  • the device in another embodiment can be used to crush and/or remove fragments of bone or soft tissue, such as an intervertebral disc.
  • the device is to be used for manipulating, grasping, cutting, cauterising, clipping, spreading, retracting, stapling or clamping tissues during an open surgical procedure, such as a laparotomy
  • its size is not of particular importance. It should, however, be manufactured such that it is of an appropriate and convenient size.
  • the device is to be used for manipulating, grasping, cutting, cauterising, retracting, clipping, stapling or clamping tissues during a laparoscopic, arthroscopic. or any other minimally invasive procedure, it should be adapted for incorporation into a conventional laparoscopic grasper, or other appropriate laparoscopic or minimally invasive surgical instrument, which provides a means through which a surgeon can manipulate the reciprocating member.
  • Minimally invasive instruments are necessarily of a small diameter.
  • the articulating members, connecting members and constraining surfaces of the device can be elongated such that the jaw members can separate a relatively wide distance apart.
  • the advantage of a device according to this embodiment, wherein the jaw members are capable of opening widely once inside a cavity (whether that cavity is the abdomen, chest, knee or any other limited space within the body), is that the jaw members can open to a size capable of receiving large structures. It is, therefore, not necessary for a device according to this invention to have a large diameter in order to be capable of manipulating large organs.
  • the jaw members of a relatively small device are capable of being moved great distances apart. This is particularly advantageous in grasping an organ for stapling and cutting.
  • the ability to widely separate the jaw members is important in using the device as a retractor.
  • the outer surfaces of the jaw members can be used to push tissue out of the way. Other instruments can then be used to manipulate the operative site, which is located in the space opened up between the jaw members.
  • the surgeon is able to gain access to the operative site via a lumen through or beside the reciprocating member; or alternatively, such access may be gained through or beside the lumen of the support means.
  • various devices can be passed through either or both of these lumens to manipulate the operative site between the jaw members.
  • Such devices may include a camera, diagnostic probes, suction and irrigation means, biopsy forceps, biopsy needles or any other delivery means of diagnostic or therapeutic modalities.
  • the outer surfaces of the jaw members may be used to separate vertebral bodies during minimal access spinal surgery.
  • the jaw members give mechanical support to the spinal column or body structure.
  • a cage, or other vertebral support means, can then be deployed through the lumen of the instrument into the space provided by the retracting jaws.
  • the device may be delivered to a site by an appropriate delivery means.
  • the articulating means may then be locked such that the jaw members are fixed in an open position, and the device can then be detached from the delivery means and left in situ to provide ongoing mechanical retraction or support.
  • the support means comprises a cylinder with a lumen having a proximal end and a distal end.
  • the device according to the present invention can be at least partly located within the lumen of the support means and secured thereto, at least by a pin passing through the fourth pivotal connection of the first and second articulation members.
  • the location of the device within the lumen can be further such that at least the fourth pivotal connection between the first and second articulation members is proximate the distal end of the support means.
  • said pivotal connection can. in some way. be secured to the support means.
  • the proximal end of the reciprocating member preferably extends proximally beyond the proximal end of the support means, and the distal ends of the jaw members preferably extend distally beyond the distal end of the support means.
  • both the distal ends of the jaw members and the distal end of the reciprocating member can be respectively proximate the distal end of the support means and distal the proximal end of the support means.
  • the distal ends of the jaw members can be proximate the distal end of the support means and the proximal end of the reciprocating member can be proximate the proximal end of the support means.
  • the cross-sectional diameter of the support means may be considerably smaller than that of the embodiments described in the preceding paragraph.
  • the cross-sectional diameter of the support means can be slightly larger than that of the greatest cross-sectional length of the reciprocating member, thereby ensuring that the reciprocating movement of the latter is not restricted.
  • the cross-sectional diameter of the support means may vary along its length.
  • the support means may gradually taper from a larger cross-sectional diameter at a region adjacent its proximal end (ie the proximal region), to a smaller cross-sectional diameter at a region adjacent its distal end (ie the distal region).
  • the reverse may also occur.
  • the tapering of the cross-sectional diameter may occur at any point along the length of the support means. It may be gradual or may occur very rapidly. In another embodiment, there may be no tapering, and the cross-sectional diameter may change from one size to another, thereby forming a circumferential step in the support means.
  • a slot can be provided in said distal end which is adapted to receive the connecting members and the articulation members. This ensures that movement of these latter members is unrestricted.
  • the cross-sectional diameter of the distal end of the support means is large enough to encompass the entire device it is. of course, unnecessary to incorporate such a slot.
  • the distal region of the support means can be planar and in the same plane as the connecting members and articulating members.
  • the support means can taper along its length from a cylindrical shape at its proximal region to said planar shape in its distal region.
  • the support means can extend distally from its connection with the articulating means. This extension of the support means can act as a tissue guard to prevent tissue entering the region between the jaw members and being damaged by the articulation members on movement of the jaw members.
  • the jaw members can have a variety of functions and. therefore, be used in a variety of ways.
  • the jaw members may act as platforms for diagnostic or therapeutic modalities including, but not limited to: ultrasound, lithotripsy, radiotherapy, radiofrequency. unipolar and dipolar electrocautery. stapler- cutters and/or for the application of clips.
  • an outer surface of each jaw member which is likely to come into contact with body tissues can have a radius of curvature. Consequently, when the device has its jaw members in a closed position, the distal end of the device will preferably be smoothly rounded, and. therefore, unlikely to do damage when advanced into contact with tissues.
  • the surfaces of the jaw members which face one another can comprise a curved surface or have a radius of curvature to minimise tissue trauma.
  • the curved surface can constitute a portion of spherical surface, an oblate spherical surface, a cylindrical surface, a parabolic surface, or any other curved surface which meets the requirement of ensuring that the device has no sharp edges.
  • the material from which at least the surfaces of the jaw members of the device are constructed can be such that it reflects the likely viscoelastic properties of the tissue into which the device is to come into contact during an operation.
  • the stiffness of such material comprising at least the surfaces of the jaw members of the device when adapted to manipulate stiff tissue should be more than that comprising the surfaces of jaw members on the device when adapted to manipulate a relatively less stiff tissue.
  • such surfaces could be made of a viscoelastic or compliant material, such as silicone. or could be capped with an appropriately moulded section of such material.
  • a surface of each of the jaw members may be lined with a plurality of gripping members.
  • the surfaces of the jaw members to be lined by such gripping members are those between which tissue will be grasped or clamped, namely, the surface of each of the jaw members which face one another.
  • One preferable pattern for the gripping members can comprise a series of parallel rows of gripping members cross-hatched with a further series of parallel rows of gripping members, such that there is an angle between the perpendicular axes of the two rows.
  • This particular pattern would assist to prevent "marching" of the device along the walls of an artery which it is being used to clamp during, for example, an arteriotomy. It is important to note, however, that the scope of this invention is not limited to circumstances wherein gripping members are of the particular shape, and/or line the surfaces of the jaw members with the particular pattern, just disclosed. Indeed, alternative embodiments of the invention include gripping members of all shapes, which can be arranged to line the appropriate surfaces of the jaw members in an unlimited variety of patterns.
  • an additional or alternative means for grasping or clamping tissues between the jaw members can be utilised.
  • One or both of the jaw members can have a chamber, an opening at the proximal end and a plurality of perforations on the surface of the jaw member that opposes the corresponding surface of the other jaw member. Accordingly, the space between the jaw members, the chamber inside of one or both jaw members and an area proximate the proximal end of the jaw members are all in fluid communication with one another.
  • tissue can be caused to remain in contact with the surface of the jaw member having a plurality of perforations by creating a negative pressure inside the jaw member.
  • the construction of the articulating means is such that the connecting members and the articulation members are pivotally attached in a configuration in which there are more than two connecting members and more than two articulation members Howevei. subject to making a few minor practical alterations to the design, an articulating means comprising any even number (greater than two) of articulation members will
  • Each constraining surface is preferably located adjacent the proximal end of its respective jaw member
  • Each constraining surface can constitute a slot which, when the device is viewed in side elevation, has a longitudinal axis and two ends Each end of the slot can have a radius of curvatme It is further preferable for the longitudinal axis of each constraining surface to be m the same plane as a longitudinal axis of the jaw member to which it is connected, or with which it forms an integral part
  • the slot may be substantially rectangular, or any other shape which will provide for longitudinal movement of the pivotal connection between the corresponding connection membei and aiticulation membei
  • the constraining surface may be wholly encased within the substance of the jaw membei. such that tissue cannot get caught between the pivotal connection and the constraining surface
  • each jaw membei can be identical in shape, such that the movement of each of the pivotal connections between the two sets of corresponding connection membei and aiticulation membei conesponds with the othei
  • shape of each constraining surface may be different Howevei. the diffeience in shape must be such that, on reciprocation of the reciprocating member, movement of the jaw members relatively toward or away from one another is possible.
  • the pivotal connection between one connecting member and its corresponding articulation member is adapted to engage each constraining surface.
  • said pivotal connection may slidably engage the constraining surface.
  • said movement may occur by rolling of the pivotal connection along the constraining surface.
  • the articulating means can be positioned in such a way that although positioned substantially between the surfaces of the jaw members which face one another, it does not impact on the ability of the jaw members to move relatively away from, or relatively toward, one another.
  • the device may. however, be constructed such that the articulating means is located adjacent or at one side of the device, namely lateral to either one of the jaw members.
  • four connecting pins can be utilised to mount the jaw members to the articulating means.
  • a first pin can extend from the second pivotal connection between the first connecting member and the first articulation member to engage the constraining surface of the first jaw member.
  • a second pin can extend from the third pivotal connection between the second connecting member and the second articulation member to engage the constraining surface of the second jaw member.
  • a third pin can constitute the fifth pivotal connection and extend between the first articulating member to a position on the second jaw member distal its proximal end.
  • a fourth pin can constitute the sixth pivotal connection and extend between the second articulating member to a position on the first jaw member distal its proximal end.
  • the pivotal connection between the two articulating members would not necessarily extend across the midline in this embodiment, in order to allow for the passage of materials from the proximal end to the distal end of the jaw members, or vice versa.
  • Such a configuration would provide bilateral stability and a central channel through which such procedures as stapling, cutting or clip applying could occur, and through which any diagnostic or therapeutic modality, biopsy device or sensing probe could be deployed.
  • the reciprocating member may be uniaxial or biaxial to allow for clips or a blade or any other therapeutic or diagnostic device to be stored or deployed in the proximal part of the instrument prior to advancement.
  • a plurality of devices as described above, can be connected to one another side-by-side in the device.
  • a plurality of pins can be used to connect the appropriate pivot means of each articulation means together, thereby ensuring that only one reciprocating member is required to control the movement of the jaw members of each device relatively away from or relatively toward one another.
  • the device can be considered in a closed position when the jaw members are lying flat against one another, and in an opened position when there is a space between the jaw members.
  • the device is preferably opened when the reciprocating member is pushed relatively forward (in a direction toward the distal end of the device) and closed when the reciprocating member is pulled relatively backward (in a direction toward the proximal end of the device).
  • variations in construction may render it possible to open the device by pulling the reciprocating member relatively backward and close it by pushing the reciprocating member relatively forward.
  • different movements of the reciprocating member could be utilised to achieve opening and closure of the device including, for example, by rotating the reciprocating member.
  • the articulation means is located lateral to either one of the jaw members, as disclosed in a preferred embodiment above, or if two articulation means are located either side of the midline of the instrument, a significant advantage arises:
  • the articulation means is to one side or on both sides of the midline, the space between the surfaces of the jaw members which face one another will always be empty while the jaw members are relatively apart (provided, of course, that there is no tissue therebetween).
  • Such a space creates a central channel through which other devices can be passed.
  • this particular construction provides access for a vast array of surgical instruments including, for example, catheters and any other means to provide suction and/or irrigation, blades and other cutting instruments, staplers, stapler/cutter combination devices, cameras, sensing probes, electrocautery, biopsy forceps or needles and devices for applying clips.
  • clips could be stored within or beside a lumen of the reciprocating member or within or beside a lumen of the support means and advanced as the clips are required.
  • clips could be deployed within the jaw members of the instrument once the instrument is within the body cavity.
  • the use of these embodiments of the invention are not, however, limited to circumstances in which such devices, staplers, needles, etc. are deployed via the device itself, but also include circumstances in which they are deployed into the operative field by alternative means. Having the articulation means to one side also allows side engagement of the jaw members with tissue.
  • Another desired feature of the invention is that the gripping surface of the jaw members remain parallel to one another throughout the full range of motion of the jaw structure, from a closed position to a fully open position.
  • This feature renders it possible to adapt the invention for a variety of purposes and for use in a variety of ways. For example, by mounting a calibrated measuring scale onto the device, it is possible to measure the thickness of any tissue grasped between its jaw members. In prior art disclosures, where jaw members of related surgical devices open and close about a single pivot point, such a calibrated measuring scale would only be able to provide an estimate of the dimensions of tissue grasped between its jaws. This is because of the indeterminability of the exact point along the length of the jaw members where the tissue would actually be grasped.
  • the device may also be adapted to measure the stiffness and other mechanical properties of the tissue being grasped. This may be achieved by adding strain gauges or other load measuring devices to the jaw members, articulation members and/or connecting members which would measure the load being applied to the tissue as well as the corresponding compressive displacement caused to the tissue by means of the jaw members as they close around it.
  • the use of a calibrated measuring scale can provide a means for making incisions or cuts of precise dimensions.
  • a blade of any shape can be connected to the surface of the first jaw member which faces the corresponding surface of the second jaw member; and the second jaw member can be constructed such that its said corresponding surface has a receptacle of a corresponding shape to the blade on the first jaw member, and is capable of receiving the blade when the device is closed and the surfaces of the jaw members which face one another are in contact.
  • the calibrations on the measuring scale are adapted to correspond to calibrations on the blade. Accordingly, as the device is closed and the blade is gradually received by the receptacle, the tissue caught therebetween is cut. and the dimensions of the cut are precisely controlled by the surgeon who is able to refer to the calibrated measuring scale while advancing the reciprocating member relatively toward the fourth pivotal connection, thereby closing the device.
  • the invention is adapted for incorporating components of the particular imaging modality equipment into its jaw members.
  • the emitter could be incorporated into the first jaw member, while the receiver is incorporated into the second jaw member: or alternatively, a pulse-echo ultrasound transducer/receiver could be incorporated into the first jaw member, while the second jaw member is used to secure tissue to the first.
  • a pulse-echo ultrasound transducer/receiver could be incorporated into the first jaw member, while the second jaw member is used to secure tissue to the first.
  • Such an ability would be of particular value in, for example, the performance of a laparoscopic cholecystectomy, where identification of the anatomical relationship between the cystic duct and surrounding vessels is crucial.
  • the device can further be adapted for administering radiotherapy or other forms of electromagnetic radiation or performing lithotripsy or therapeutic ultrasound.
  • the preferred parallel relation of the jaw members is also of particular value since one jaw member can act as an emitter while the other acts as a shield. This makes it possible to administer a very high concentration of radiotherapy or lithotripsy to a specified site of action, without fear of damaging surrounding tissues.
  • the device may be controlled from a remote location, for example, by means of remote robotic actuation by a surgeon in a different location to the patient.
  • a remote robotic actuation by a surgeon in a different location to the patient.
  • it will be necessary to rely on feedback from pressure sensors.
  • Surgical instruments in which jaw members open and close about a single pivot point will not provide an appropriate structure for using pressure sensors. This is due to the fact that once tissue has been grasped, a pressure differential exists along the length of the jaw members, from their point of meeting to their distal ends.
  • the jaw members preferably remain parallel at all times, there is no pressure differential along their length and. therefore, no difficulty in incorporating pressure sensors into the design.
  • the device is being used as a delivery means, capable of delivering, further devices, such as, implants, grafts or s tents, to a desired location in the body of a patient
  • further devices such as, implants, grafts or s tents
  • the feature that the jaw members move in parallel relation to one another is particularly advantageous as it allows for different mechanisms to carry such devices.
  • the graft or stent be in a radially compressed state before being deployed from the delivery means.
  • the graft or stent may initially be compressed to a radially compressed state between the jaw members, and allowed to spring out to a radially expanded state upon release from the grip of the jaw members.
  • a graft or stent is manufactured such that it is initially in a radially compressed state and may be expanded to a radially expanded state by physical dilatation, then prior to delivery of the graft or stent.
  • the jaw members of the device should be in a closed position whereby they can be inserted into the lumen of the graft or stent.
  • the jaw members of the device may be opened, thereby causing the graft or stent to be expanded to a radially expanded state.
  • Such an embodiment may also involve the stent being loaded onto the jaw members which are in an open state. The stent would therefore be deployed by closing the jaw members, once the stent was firmly in place, leaving it behind as the device is removed from within it.
  • blood and fluid are able to flow freely through the lumen of the device whilst it is being used. This is especially important where the device is being used to compress material in the wall of the vessel, as occurs during angioplasty.
  • a compliant extension member having a longitudinal axis, a distal end and a tip. extends from each of the distal ends of the jaw members.
  • Such compliant extension members can provide the device with the ability to substantially replicate forceps and. therefore, render it capable of grasping small amounts of tissue in a precise manner at the distal extremity of the instrument.
  • the compliant extension members are generally of a material and construction which causes their distal ends to have a tendency to bend away from their longitudinal axis and towards each other.
  • the orientation for each compliant member, when extending from the distal end of each jaw member is such that when the respective distal ends of the compliant members are bent, their tips can come into contact with one another.
  • the compliant extension members On moving the jaw members relatively toward one another beyond the point at which the tips of the compliant members are in contact, causes the distal ends of the respective compliant members to gradually flex into line with their longitudinal axes, and does not prevent the device from closing. Indeed, when the jaw members lie flat against one another, the compliant extension members also preferably lie flat against one another.
  • the components of the device may be formed of an appropriate solid surgical material including stainless steel, atraumatic plastic, or one of various alloys. In alternative embodiments, however, the device may be manufactured such that each component is made up of a different material to the others. A further advantage of the present invention arises when the instrument is to be used for clamping an artery during arteriotorny.
  • the pulsatile pressure of the blood against the jaw members of the instrument can create further problems, which may not be adequately overcome with conventional patterns of conventionally shaped teeth. If the grip is inadequate, each pulsatile push of blood may cause the instrument to move toward the arteriotorny site. This is known as "marching", and causes the length of artery with which the surgeon can work to progressively decrease, and the risk of the clamp falling off the end of the arteriotorny site (resulting in potentially substantial blood loss) to considerably increase.
  • the construction of the present device ensures that sufficient grip can be applied to an artery to prevent marching while at the same time minimising the chance of trauma to the artery.
  • the construction of the present device enables it to incorporate various diagnostic, therapeutic and mechanical property testing modalities that maximises its utility.
  • it is useful to correlate any diagnostic information with what the surgeon sees on the monitor during the procedure to give an enhanced "virtual" perspective of the operative field.
  • the present invention consists in a device for manipulating tissues in the body of a patient, the device including:- a support means: a reciprocating member which moves relative to the support means; and an articulated jaw structure having at least two jaw members and an articulating means, the jaw members each having a proximal end, a constraining surface adjacent the proximal end and a rotating-pivot means distal the proximal end.
  • the articulating means having at least two connecting members and at least two articulation members, the connecting members and the articulation members being pivotally attached to one another in a configuration which can be changed from a first to at least a second orientation by relative movement of the reciprocating member, wherein when in the first orientation, corresponding points on each of the jaw members are separated by a first distance, and when in the second orientation, corresponding points on each of the jaw members are separated by a second different distance.
  • Fig. la is an exploded perspective view of one embodiment of the device according to the present invention:
  • Fig. lb is a perspective view of the assembled device of Fig. la:
  • Fig. lc is a schematic view of the assembled device of Fig. la:
  • Fig. id is a plan view of the device of Fig. la:
  • Fig. Ie is a side elevational view of the device of Fig. la depicted with the jaw members in an opened position:
  • Fig. if is an end elevational view of the device depicted in Fig. Ie:
  • Fig. lg is a side elevational view of the device of Fig. la depicted with the jaw members in a closed position:
  • Fig. lh is an end elevational view of the device depicted in Fig. lg:
  • Fig. 2a is an exploded perspective view of a second embodiment of the device according to the present invention:
  • Fig. 2b is a perspective view of the assembled device of Fig. 2a:
  • Fig. 2c is a schematic view of the assembled device of Fig. 2a:
  • Fig. 2d is a plan view of the device of Fig. 2a:
  • Fig. 2e is a side elevational view of the device of Fig. 2a depicted with the jaw members in an opened position;
  • Fig. 2f is an end elevational view of the device depicted in Fig. 2e:
  • Fig 2g is a side elevational view of the device of Fig. 2a depicted with the jaw members in a closed position,
  • Fig 2h is an end elevational view of the device depicted in Fig. 2g;
  • Fig 3a is an exploded perspective view of a third embodiment of the device according to the present invention.
  • Fig 3b is a perspective view of the assembled device of Fig. 3a.
  • Fig 3c is a schematic view of the assembled device of Fig 3a
  • Fig 3d is a plan view of the device of Fig. 3a.
  • Fig 3e is a side elevational view of the device of Fig. 3a depicted with the jaw members in an opened position
  • Fig 3f is an end elevational view of the device depicted in Fig. 3e:
  • Fig 3g is a side elevational view of the device of Fig. 3a depicted with the jaw members in a closed position.
  • Fig 3h is an end elevational view of the device depicted in Fig 3g.
  • Fig 4 is a cross-sectional view of the jaw members of another embodiment in which the device is to be used as a cutter (for reasons of clarity, the articulation means and reciprocating member are not shown in this Figure) .
  • Fig 5a is a cross-sectional view of an embodiment of the invention in which a compliant extension member extends from the distal end of each jaw member and the device is closed with the jaw members lying flat against one another (for reasons of clarity, the articulation means and reciprocating member aie not shown in this Figure) .
  • Fig 5b is a further cross-sectional view of the device of Fig 5a wherem the device is in an open position and the jaw members are relatively apart from one another, and
  • Fig 6 is a side elevational view of an embodiment of the device adapted for use with, and incorporated into, a conventional laparoscopic grasper Preferred Mode of Carrying Out the Invention
  • FIG. 10 One embodiment of a surgical instrument according to the present invention is depicted generally as 10 in Figs la to lh
  • the instrument 10 is adapted for incorporation into a minimally invasive grasper 40 as illustrated in Fig 6 It will, however, be appreciated that the instrument 10 can be incoiporated into devices other than the depicted minimally invasive grasper
  • the instrument 10 includes a support 11. an articulated jaw structure 12. and a reciprocating rod 14.
  • the articulated jaw structure 12 comprises firstly a first jaw member 15a and a second jaw member 15b.
  • the jaw structure 12 also includes two connecting members 24a, 24b, and two articulation members 25a, 25b. Both the proximal end of the first connecting member 24a and the proximal end of the second connecting member 24b are pivotally attached by common pivot pin 26 to the distal end of the reciprocating member 14.
  • the first and second connecting members 24a, 24b respectively extend to distal ends that are pivotally attached to respective proximal ends of the first and second articulation members 25a, 25b.
  • a pivot pin 27a connects the first connection member 24a and the first articulation member 25a.
  • the pivot pin 27a is also adapted to engage the constraining surface 18a of the first jaw member 15a.
  • a pivot pin 27b connects the second connection member 24b and the second articulation member 25b and is adapted to engage the constraining surface 18b of the second jaw member 15b.
  • the first and second articulation members 25a, 25b each respectively extend to distal ends that are pivotally attached to respective pivot pins 19b.19a mounted to the second and first jaw members 15b, 15a, respectively.
  • the first and second articulation members 25a, 25b are pivotally attached where they cross one another by pin 28 mounted to the support 11.
  • the reciprocating rod 14 As the reciprocating rod 14 is pivotally attached by common pivot pin 26 with the first and second connecting members 24a.24b, it can be moved relatively forward (in a direction toward the distal end of the device 10) and relatively backward (in a direction toward the proximal end of the device 10), in the same plane as the device 10. Such movement of the reciprocating rod 14 leads to the articulated jaw structure 12 changing configuration in a concertina fashion from a first to at least a second orientation. In the depicted instrument 10. when the reciprocating rod 14 is pushed relatively forward, the jaw members 15a.15b are caused to move apart, thereby opening the jaw members 15a.15b of the instrument 10.
  • the support 11 is cylindrical with a lumen 70. a proximal end 72. and a distal end 74.
  • the support 11 is mountable to a cylindrical extender 13 that also has a lumen 70.
  • the distal ends of the jaw members 15a,15b extend distally beyond the distal end 74 of the support 11. It will be appreciated that in other embodiments, the support 11 could extend beyond the distal ends of the jaw members 15a.15b.
  • Such an extension of the support 11 can act as a tissue guard and help prevent tissue entering the region between the jaw members 15 a.15b and being damaged by the articulation members 25a.25b on movement of the jaw members 15a, 15b.
  • the diameter of the support means 11 could gradually taper from a larger cross-sectional diameter at its proximal end 72 to a smaller cross-sectional diameter at its distal end 74.
  • the reverse may be the case.
  • the tapering of the cross-sectional diameter may occur at any point along the length of the support 11. The tapering may be gradual or may occur very rapidly.
  • the diameter may not taper and instead may change from one size to another, thereby forming a circumferential step in the support 11.
  • Each of the jaw members 15a, 15b have respective smoothly curved surfaces 17a.17b and respective orifices 19c.19d distal their proximal ends.
  • the orifices 19c.19d are adapted to receive pivot pins 19a, 19b. respectively to allow pivotal connection of articulating members 25b.25a to the jaw members 15a.15b. respectively.
  • the jaw members 15a.15b can be said to have clamping surfaces 2 la.2 lb. respectively. These clamping surfaces may, if necessary, be lined with a plurality of gripping members. Such gripping members may comprise several rows of teeth and could include cross- hatched rows of teeth.
  • the connecting members 24a.24b and articulating members 25a, 25b are mounted along one side of the jaw members 15a.15b. It will be appreciated that the instrument 10 could be constructed such that the connecting members 24a.24b and articulating members 25a.25b are mounted to the other side of the jaw members 15a, 15b to that depicted in Figs, la-lh.
  • the articulation means 16 is located lateral to the jaw members 15a.15b, a significant advantage arises: when the articulation means 16 is to one side, the volume between the clamping surfaces 21a.21b while the jaw members 15a and 15b are apart (provided, of course, that there is no tissue therebetween) is left empty. Such a space creates a central channel 80 through which other instruments can be passed through the instrument 10.
  • the construction of the articulated jaw structure 12 is such that the clamping surfaces 21a.21b of the jaw members 15a.15b remain parallel to one another throughout the full range of motion of the jaw members, from a closed position to a fully open position.
  • This feature of the instrument 10 renders it possible to adapt the instrument for a variety of purposes and for use in a variety of ways beyond its depicted use as grasper.
  • a calibrated measuring scale onto the instrument 10. it is possible to measure the thickness of any tissues grasped between the jaw members 15a.15b.
  • a calibrated measuring scale would only be able to provide an estimate (at very best) of the size of tissue grasped between its jaws. This is because of the indeterminability of the exact point along the length of the jaw members where the tissue would actually be grasped. In the present invention, it is not important to determine at what location, along the length of the jaw members 15a.15b. the tissue is actually grasped in order to obtain an accurate measurement of the tissue thickness.
  • the instrument 10 can be adapted to measure the stiffness and/or other mechanical properties of the tissue being grasped. This may be achieved by adding strain gauges to the jaw members 15a.15b, articulation members 25a.25b and/or connecting members 24a.24b to measure the load being applied to the tissue as well as the corresponding compressive displacement caused to the tissue by means of the jaw members 15a.15b as they close around the tissue.
  • the use of a calibrated measuring scale can provide a means for making incisions or cuts of precise dimensions.
  • a blade 81a of appropriate shape can be connected to the surface 21a of the first jaw member 15a, and the second jaw member 15b can be constructed such that its said corresponding surface 21b has a receptacle 81b of a corresponding shape to the blade 81a and is capable of receiving the blade 81a when the instrument 10 is closed (see Fig. 4).
  • the calibrations on the measuring scale can be adapted to correspond to calibrations on the blade 81a. Accordingly, as the jaw members 15 a.15b are closed and the blade 81a is gradually received by the receptacle 81b. the tissue caught therebetween is cut, and the dimensions of the cut are precisely controlled by the surgeon who is able to refer to the calibrated measuring scale while advancing the reciprocating member 14 relatively toward the pivot pin 28 mounted to support 11, thereby closing the instrument 10.
  • the instrument 10 is modified to incorporate components of the particular imaging modality equipment into each of its jaw members 15 a.15b.
  • the emitter could be incorporated into the first jaw member 15a. while the receiver is incorporated into the second jaw member 15b. so that the active surfaces of both the emitter and receiver face the same direction as the clamping surfaces 21a.21b respectively of their corresponding jaw members 15a.15b. This would provide the surgeon with, for example, an ability to determine the exact location where the tissue is being grasped along the length of the jaw members 15a.15b.
  • the instrument 10 can similarly be adapted for administering radiotherapy or performing lithotripsy with high dose concentrations, where an emitter is incorporated into the first jaw member 15a. while a shield is incorporated into the second jaw member 15b.
  • compliant extension members 90a.90b having respective distal tips 91a.9lb. extend from each of the distal ends of the jaw members 15a and 15b.
  • the compliant extension members 90a.90b provide the instrument 10 with the ability to substantially replicate the action of forceps and. therefore, render it capable of grasping small amounts of tissue in a precise manner.
  • the compliant extension members 90a.90b are generally of a material and construction which causes their distal tips 91a.91b respectively to have a tendency to bend away from their respective longitudinal axes and towards each other. When the instrument 10 is open to its maximum extent, the tips 92a, 92b will normally still have a space therebetween.
  • the instrument 10 can also be adapted such that it can be controlled from a remote location.
  • the clamping surfaces 2 la, 2 lb can be lined with pressure sensors. Such sensors would provide a surgeon, that is at a remote location from the patient, with immediate electronic feedback on the amount of pressure a remotely controlled robot is applying to the tissue being manipulated, grasped or clamped by the instrument 10.
  • an alternative construction of an instrument according to the present invention is depicted generally as 110 in Figs. 2a to 2h.
  • the articulated jaw structure 12 comprises two sets of connecting members 24a.24b and articulating members 25a, 25b. with one set disposed on each side of the jaw members 15a, 15b.
  • pivot pins 26. 27a. 27b. 28. 19a and 19b are modified from those utilised in instrument 10 such that the respective pins each are connected to the two sets of connecting members and articulating members.
  • the articulated jaw structure 12 of instrument 110 ensures a more even application of gripping pressure to tissue clamped between the jaw members 15a.15b.
  • the instrument 110 can also be utilised in situation where a more robust instrument is required, such as where the device is being used to manipulate or crush bone or bone fragments.
  • FIG. 120 Another alternative construction of an instrument according to the present invention is depicted generally as 120 in Figs. 3a to 3h. Those features of instrument 120 that correspond to those of instrument 10 have been identically numbered.
  • the articulated jaw structure 12 comprises a set of connecting members 24a.24b and articulating members
  • the position of the articulated structure 12 provides even control of the range of motion of the jaw members 15a, 15b on reciprocation of rod 14. This position is useful if the instrument 120 is to be used as a grasper or clamp.
  • the positioning of the articulated structure 12 does, however, occupy the volume between the jaw members 15 a.15b that can be utilised when using instruments 10 and 110 by other devices, such as catheters, cameras and the like.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
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Abstract

L'invention concerne un instrument de chirurgie permettant de manipuler le tissu du corps d'un patient présentant des mâchoires (15a, 15b) qui se séparent en suivant un mouvement parallèle. Les moyens de pivot des mâchoires sont dotés d'une articulation à la manière de ciseaux (24a, 24b, 25a, 25b) sous contrainte dans un support (1). Le mouvement des mâchoires (15a, 15b) est actionné par une tige alternative (14) agissant sur une extrémité de cette articulation à la manière de ciseaux.
PCT/AU2000/000195 1999-03-16 2000-03-16 Instrument de chirurgie WO2000054662A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU31359/00A AU3135900A (en) 1999-03-16 2000-03-16 Device for use in surgery
US09/936,606 US6582451B1 (en) 1999-03-16 2000-03-16 Device for use in surgery

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
AUPP9241 1999-03-16
AUPP9241A AUPP924199A0 (en) 1999-03-16 1999-03-16 Parallel-action device for use in surgery
AUPQ0927 1999-06-11
AUPQ0927A AUPQ092799A0 (en) 1999-06-11 1999-06-11 Device for use in surgery

Publications (1)

Publication Number Publication Date
WO2000054662A1 true WO2000054662A1 (fr) 2000-09-21

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ID=25646008

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AU2000/000195 WO2000054662A1 (fr) 1999-03-16 2000-03-16 Instrument de chirurgie

Country Status (1)

Country Link
WO (1) WO2000054662A1 (fr)

Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040215216A1 (en) * 2002-07-02 2004-10-28 Jamy Gannoe Method and device for use in tissue approximation and fixation
US7211099B2 (en) * 2000-12-07 2007-05-01 Karl Storz Gmbh & Co. Kg Medical instrument
CN104540461A (zh) * 2012-06-29 2015-04-22 伊西康内外科公司 具有定位在远侧的换能器的超声外科器械
KR20160015989A (ko) * 2014-08-01 2016-02-15 인제대학교 산학협력단 조직 채취용 기구
US9375218B2 (en) 2006-05-03 2016-06-28 Datascope Corp. Systems and methods of tissue closure
DE10332613B4 (de) * 2002-07-17 2016-08-18 Hoya Corp. Behandlungsinstrument für ein Endoskop
US9545318B2 (en) 2001-03-08 2017-01-17 Spine Wave, Inc. Expandable interbody fusion device
US9687246B2 (en) 2013-10-17 2017-06-27 Cook Medical Technologies Llc Release mechanism
US10485545B2 (en) 2013-11-19 2019-11-26 Datascope Corp. Fastener applicator with interlock
EP3821832A1 (fr) * 2019-11-15 2021-05-19 Covidien LP Préhenseur chirurgical
EP3117781B1 (fr) * 2015-07-15 2022-01-12 AtriCure Inc. Outil chirurgical
US11653928B2 (en) 2018-03-28 2023-05-23 Datascope Corp. Device for atrial appendage exclusion
CN117357210A (zh) * 2023-12-07 2024-01-09 北京大学第三医院（北京大学第三临床医学院） 能够产生持续稳定吸力的关节内游离体夹取钳

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US5122130A (en) * 1988-03-23 1992-06-16 Waldemar Link Gmbh & Co. Forceps for inserting intervertebral device
DE4412171A1 (de) * 1994-04-08 1995-10-12 Stefan Koscher Chirurgisches Instrument
US5618307A (en) * 1995-04-03 1997-04-08 Heartport, Inc. Clamp assembly and method of use

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Publication number Priority date Publication date Assignee Title
US5122130A (en) * 1988-03-23 1992-06-16 Waldemar Link Gmbh & Co. Forceps for inserting intervertebral device
DE4412171A1 (de) * 1994-04-08 1995-10-12 Stefan Koscher Chirurgisches Instrument
US5618307A (en) * 1995-04-03 1997-04-08 Heartport, Inc. Clamp assembly and method of use

Cited By (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7211099B2 (en) * 2000-12-07 2007-05-01 Karl Storz Gmbh & Co. Kg Medical instrument
US9545318B2 (en) 2001-03-08 2017-01-17 Spine Wave, Inc. Expandable interbody fusion device
EP1534145A2 (fr) * 2002-07-02 2005-06-01 Satiety, Inc. Procede et dispositif de rapprochement et de fixation de tissus
EP1534145A4 (fr) * 2002-07-02 2009-07-29 Satiety Inc Procede et dispositif de rapprochement et de fixation de tissus
US20040215216A1 (en) * 2002-07-02 2004-10-28 Jamy Gannoe Method and device for use in tissue approximation and fixation
DE10332613B4 (de) * 2002-07-17 2016-08-18 Hoya Corp. Behandlungsinstrument für ein Endoskop
US10595861B2 (en) 2006-05-03 2020-03-24 Datascope Corp. Systems and methods of tissue closure
US11992211B2 (en) 2006-05-03 2024-05-28 Datascope Corp. Systems and methods of tissue closure
US9375218B2 (en) 2006-05-03 2016-06-28 Datascope Corp. Systems and methods of tissue closure
US11369374B2 (en) 2006-05-03 2022-06-28 Datascope Corp. Systems and methods of tissue closure
CN104540461A (zh) * 2012-06-29 2015-04-22 伊西康内外科公司 具有定位在远侧的换能器的超声外科器械
US9687246B2 (en) 2013-10-17 2017-06-27 Cook Medical Technologies Llc Release mechanism
US10485545B2 (en) 2013-11-19 2019-11-26 Datascope Corp. Fastener applicator with interlock
US11564689B2 (en) 2013-11-19 2023-01-31 Datascope Corp. Fastener applicator with interlock
KR101674722B1 (ko) * 2014-08-01 2016-11-09 인제대학교 산학협력단 조직 채취용 기구
KR20160015989A (ko) * 2014-08-01 2016-02-15 인제대학교 산학협력단 조직 채취용 기구
EP3117781B1 (fr) * 2015-07-15 2022-01-12 AtriCure Inc. Outil chirurgical
US11653928B2 (en) 2018-03-28 2023-05-23 Datascope Corp. Device for atrial appendage exclusion
EP3821832A1 (fr) * 2019-11-15 2021-05-19 Covidien LP Préhenseur chirurgical
CN117357210A (zh) * 2023-12-07 2024-01-09 北京大学第三医院（北京大学第三临床医学院） 能够产生持续稳定吸力的关节内游离体夹取钳
CN117357210B (zh) * 2023-12-07 2024-02-13 北京大学第三医院（北京大学第三临床医学院） 能够产生持续稳定吸力的关节内游离体夹取钳

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