WO2016017663A1

WO2016017663A1 - Surgical clip

Info

Publication number: WO2016017663A1
Application number: PCT/JP2015/071441
Authority: WO
Inventors: 堀川馨
Original assignee: 株式会社シャルマン
Priority date: 2014-07-30
Filing date: 2015-07-29
Publication date: 2016-02-04
Also published as: JPWO2016017663A1; JP6546921B2

Abstract

Provided is a surgical clip that has a largely improved pinching force and can more powerfully pull an internal organ, etc. so as to secure a sufficiently large operational area without damaging the internal organ, etc. The surgical clip (1) for pulling an internal organ or another body tissue during a surgery to thereby secure an area required for the surgery, said surgical clip comprising pinching parts (2a, 2b) for pinching the internal organ or another body tissue, handle parts (3a, 3b) opening and closing the pinching parts, and tooth rows (4a, 4b) that are formed in the pinching parts and arranged in the same direction as the pulling direction, is configured in such a manner that the tooth rows comprise a number of teeth (T) biting the internal organ or another body tissue and grooves (6) dividing the teeth are formed in the tooth rows.

Description

Surgical clip

The present invention relates to a surgical clip for securing an area necessary for surgery by pulling an organ or other body tissue during surgery.

During a surgical operation, organs and other body tissues that are not subject to surgery may become an obstacle and hinder the surgeon's operation. Therefore, in such a case, the organ or body tissue that is obstructing the operation is pulled using a surgical clip to secure an area necessary for the operation (for example, Patent Document 1). reference).

In this type of surgical clip, as shown in FIGS. 1 and 2 of Patent Document 1, a protrusion is formed on the inner side (the holding surface) of the holding portion, and this protrusion is formed on an organ or other body tissue. Biting. When it is desired to secure a large surgical area, it is necessary to pull the surgical clip with a large force. However, it is necessary to prevent the surgical clip from being easily detached from the organ and other body tissues. For this purpose, for example, a dentition composed of a large number of triangular teeth may be formed on the clamping surface as in the clips described in Patent Document 2 and Patent Document 3.

Special table 2010-50554 Utility Model Registration No. 3157486 (see drawing) Japanese Patent Laying-Open No. 2012-45397 (see FIGS. 2, 3, 5, and 9)

By the way, in this type of surgical clip, it is a precondition that an organ or other body tissue is not damaged.
However, as described in paragraph 0001, the clip of Patent Document 2 is mainly for controlling blood flow by sandwiching a blood vessel, and for securing a surgical region by pulling an organ or other body tissue. Is not. The clip of Patent Document 3 is also intended to hold or fix body tissue, and is not intended to secure an operation area by pulling an organ or other body tissue. Therefore, the dentition of the clip described in

Patent Documents

2 and 3 cannot be directly applied to this type of surgical clip.
Further, even if a large number of triangular teeth such as clips described in Patent Document 2 and Patent Document 3 are formed on the clamping surface, there is a problem that there is a limit in improving the clamping force without damaging an organ or other body tissue. is there.
Furthermore, as described in Non-Patent Document 1, for example, in a surgical operation using a laparoscope, a clip is inserted into an affected part using a tubular body cavity insertion device called a trocar. Although a clip as described in Patent Document 1 can be used for a 12 mm diameter trocar, this type of clip cannot be used for a small diameter trocar such as a 5 mm diameter. There is a problem that only a clip having a simple structure called an end crop as described in 3 can be used.

The present invention has been made to solve the above-described problems, and without greatly damaging the organs and other body tissues, the clamping force is greatly improved to pull the organs and other body tissues with a stronger force. To provide a surgical clip capable of securing a sufficiently large surgical area and to provide a surgical clip that can be applied to a small-diameter trocar having a sufficient clamping force even if it is small. .

In order to achieve the above object, the present invention provides a surgical clip for securing an area necessary for surgery by pulling an organ or other body tissue during a surgical operation. A clamping unit; a handle unit that opens and closes the clamping unit; and a dental row formed in the clamping unit and formed in the same direction as the pulling direction, and the dental row bites the organ and other body tissues. A plurality of teeth are formed, and a groove for dividing the teeth is formed in the dentition.
The divided tooth rows located on both sides of the groove, that is, the first partial tooth row and the second partial tooth row may be arranged to be shifted back and forth in the pulling direction.
In this way, by forming a groove in the dentition and dividing one tooth into multiple pieces, even if the clip is pulled with a strong force, the teeth bite into the organ etc. without damaging the organ or other body tissues A sufficiently large surgical area can be secured without the clip being pulled out.
Further, a hole for allowing a part of the organ or other body tissue to enter and bite between the dentitions of the clamping portion may be formed.

It is also possible to further increase the clamping force by forming the teeth so as to be inclined in a direction that inhibits removal. The inclination angle is preferably in the range of 15 ° to 23 ° with respect to the normal line. Further, the pinching force can be increased by appropriately selecting the tip angle of the tooth. The tip angle should be in the range of 30 ° to 35 °.
In addition, by forming a forceps engaging portion capable of engaging forceps with the handle portion, it is possible to open and close the clip with the forceps without requiring a dedicated instrument such as a clip applier.

Since the present invention is configured as described above, it is possible to greatly improve the clamping force and ensure a sufficiently wide surgical area without damaging an organ or other body tissue. Further, according to the present invention, an organ or other body tissue can be pulled reliably and firmly without using a dedicated forceps or instrument or using a clip with a strong spring force.
In addition, the surgical clip of the present invention can exhibit a sufficiently large clamping force even if it is small, so that it can be used by being inserted into a cylindrical medical instrument having an inner diameter of 5 mm or less, for example. .

A preferred embodiment of the surgical clip of the present invention will be described in detail with reference to the drawings.
1A and 1B show an embodiment of a surgical clip according to the present invention, in which FIG. 1A is a front view showing a state in which the holding portion is closed, FIG. 1B is a front view showing a state in which the holding portion is opened, and FIG. It is a top view for demonstrating the dentition.
The surgical clip 1 includes clamping parts 2a and 2b for clamping organs and other body tissues (hereinafter referred to as organs), and handle parts 3a and 3b for opening and closing the clamping parts 2a and 2b. Each of the handle portions 3a and 3b is connected to the

tooth rows

4a and 4b formed in the portions 2a and 2b and formed in the same direction as the pulling direction (the direction indicated by the symbol X in FIG. 1A). It has a string-like spring part 5 that urges the clamping parts 2a and 2b in a direction that always closes. The surgical clip 1 can be pulled by connecting or engaging a thread or other pulling member to the spring portion 5.

The clamping parts 2a and 2b are provided so as to be opened and closed by applying a pressing force P to the handle parts 3a and 3b from both sides. In the illustrated example, a long hole 7 for biting into an organ or the like is formed through the center of the sandwiching portions 2a and 2b between the

tooth rows

4a and 4a and / or between the

tooth rows

4b and 4b. The elongated hole 7 bites into the organ or the like when a relatively soft organ enters between the

tooth rows

4a and 4a and / or between the

tooth rows

4b and 4b, and cooperates with the

tooth rows

4a and 4b. Thus, it is formed to further increase the biting force on the organ or the like of the surgical clip 1. Further, the amount of biting into the organ or the like can be visually confirmed through the long hole 7.
The handle portions 3a and 3b are provided with concave and convex

forceps engaging portions

3c and 3d with which forceps can be engaged. By engaging forceps (not shown) with the

forceps engaging portions

3c and 3d, The surgical clip 1 can be opened and closed with forceps.

The

tooth rows

4a and 4b are provided along both side edges of the mutually opposing surfaces (clamping surfaces) of the clamping portions 2a and 2b. That is, in the illustrated example, two

tooth rows

4a and 4a are formed in the sandwiching portion 2a, and two

tooth rows

4b and 4b are formed in the sandwiching portion 2b. Each of the

tooth rows

4a, 4a, 4b, and 4b is formed by arranging a plurality of teeth T that bite into an organ or the like in the same direction as the pulling direction X and extending in the pulling direction X as shown in FIG. 6 is formed so as to divide the teeth T.

The groove 6 is formed for the purpose of increasing the biting force of the tooth T by dividing the tooth T without damaging an organ or the like. Therefore, it is preferable to select the optimum dimension in the width direction of the groove 6 (dimension in the direction orthogonal to the X direction) through experiments and the like. The groove 6 may have a dimension that roughly divides the width of the tooth T into three equal parts. Then, the experiment is repeated in consideration of the biting force of the tooth T on the organ and the like and the difficulty of damaging the organ and the like, and the dimension as the reference is increased or decreased.
As a specific example, when the width S of the teeth T is about 3.5 mm, the total length L of the

tooth rows

4a and 4b is about 7.5 mm, and the number of teeth T is six (pitch 1.5 mm). The groove 6 having a width of about 1 mm may be formed. Under these conditions, the width of the long hole is preferably about 2 mm.

As shown in FIG. 3, the teeth T may be inclined in a direction that inhibits removal from an organ or the like, that is, in the same direction as the pulling direction X shown in FIG.
If the inclination angle α (angle formed with the normal Z direction orthogonal to the pulling direction X) and the tooth tip angle β are selected as appropriate values, the resilience of the spring 6 and the size and number of teeth T can be determined. The biting power can be increased without damaging the organs without changing. Appropriate values for the inclination angle α and the tip angle β of the tooth T can be determined by experiment.
The relationship between the inclination angle α and the tip angle β will be described with reference to FIG.

4A shows an example in which the inclination is not inclined (inclination angle α = 0 °), the tip angle β is 55 °, and the pitch is 1.18 mm, and FIG. 4B is no inclination. (Inclination angle α = 0 °), the tip angle β is 53.1 °, and the pitch is 0.8 mm. FIG. 4 (c) shows the tip angle β with the inclination angle α being 18.5 °. Is 33 ° and the pitch is 1.5 mm.
In each example, an experiment was conducted to determine how many gf of load can be withstood on a leather belt that looks like an organ and pulled in the X direction. The experiment was repeated 10 times and the average was obtained.
Table 1 shows the result of comparing the example of FIG. 4 (a) with the example of FIG. 4 (b), and Table 2 shows the result of comparison of the example of FIG. 4 (a) and the example of FIG. 4 (c). .

From Table 1, it can be seen that changing the tooth tip angle β changes the biting force on the organ, etc., and the bite angle is higher when β = 53.1 ° than when the tip angle β = 55 °. You can see that the power is improving.
Further, it can be seen from Table 2 that the biting force is further increased by inclining the teeth T, and in the case of this comparative example, it is increased by about 1.4 times as compared with the case of FIG.
In this way, by selecting one of the inclination angle α and the tooth tip angle β to an appropriate value, or by making the combination of the inclination angle α and the tooth tip angle β appropriate, the size and number of the teeth T can be obtained. Even if the spring force is not changed or the spring force of the spring 6 is not increased, the biting force can be increased and the pulling force can be increased without damaging the organ or the like.

The preferable ranges of the inclination angle α and the tip angle β are α = 15 to 23 ° and β = 30 ° to 35 °.
As described above, the surgical clip 1 of the present invention can obtain a sufficiently large clamping force even if it is downsized by the combination of the inclination angle α of the groove 6 and the tooth T, the tooth tip angle β, and the long hole 7. . Therefore, it can be applied to, for example, a surgical clip having a maximum width of 5 mm or less, and can be used for a trocar having a diameter of 5 mm by setting the maximum width to 5 mm or less.

Although a preferred embodiment of the present invention has been described, the present invention is not limited to the above description.
For example, as shown in FIG. 5 (a), a row of divided teeth (indicated by reference numeral T ') located on both sides of the groove 6 (one is a first partial tooth row and the other is a second partial tooth row). May be shifted in the pulling direction X back and forth.
In the above description, the number of the grooves 6 that divide the teeth T is described as one for each

tooth row

4a, 4a, 4b, 4b. However, two or three or more grooves 6 may be formed. Further, the number of the grooves 6 may be different in each of the

tooth rows

4a and 4a and the

tooth rows

4b and 4b, or as shown in FIG. 5B, some tooth rows (the example shown is the tooth row 4a). ), The groove 6 may not be formed.
Further, the long hole 7 does not need to be particularly formed when a sufficient clamping force can be obtained by forming the

tooth rows

4a and 4b. Further, the shape is not limited to a long hole shape, and may be an elliptical shape, a circular shape, a rectangular shape, or the like, and a plurality of such holes may be formed.
Further, depending on the surgical site where the surgical clip is used and the content of the surgery, the clamping portions 2a and 2b may be bent or curved at the midpoint as shown in FIG.

The present invention can be widely applied to a surgical operation for securing an area necessary for an operation by pulling an organ or other body tissue, and can be applied to an animal operation as well as a human operation. Further, it can be used as an instrument for lifting an organ or body tissue instead of the forceps.

FIG. 4A is a front view of a surgical clip according to an embodiment of the present invention, in which FIG. It is a top view for demonstrating the dentition of a clamping part. 4 is an enlarged side view of a tooth portion for explaining an inclination angle and a tip angle of a tooth T. FIG. It is a figure explaining the comparison of the pulling force at the time of changing an inclination angle and a tooth tip angle. It is a top view for demonstrating the tooth row and groove | channel of a clamping part concerning other embodiment of this invention. It is a front view of the state which applied to the surgical clip of other embodiment of this invention, and closed the clamping part.

1: Surgical clips 2a, 2b: clamping portions 3a, 3b: handle

portions

4a, 4b: tooth row 5: spring portion 6: groove 7: long hole T: tooth T ': tooth portion divided by groove 6

Claims

In a surgical clip for securing an area necessary for surgery by pulling an organ or other body tissue during surgery,
A clamping part for clamping organs and other body tissues;
A handle portion for opening and closing the clamping portion;
A tooth row formed in the clamping portion and formed in the same direction as the pulling direction;
The dentition is formed from a plurality of teeth that bite into the organ and other body tissues, and the dentition is formed with a groove for dividing the teeth,
Surgical clip characterized by.
The surgical clip according to claim 1, wherein a hole for biting the organ or other body tissue is formed between the dentitions of the clamping portion.
The surgical clip according to claim 1 or 2, wherein the first partial dentition and the second partial dentition located on both sides of the groove are arranged so as to be shifted back and forth in the pulling direction.
The surgical clip according to any one of claims 1 to 3, wherein the teeth are formed to be inclined in a direction that inhibits removal.
The surgical clip according to claim 4, wherein the inclination angle is in a range of 15 to 23 ° with respect to a normal line.
The surgical clip according to any one of claims 1 to 5, wherein a tip angle of the tooth is in a range of 30 ° to 35 °.
The surgical clip according to any one of claims 1 to 6, wherein a forceps engaging portion to which forceps can be engaged is formed on the handle portion.