WO2016192718A2

WO2016192718A2 - Clip, clip applier, system composed of clip applier and at least one clip, and clip magazine

Info

Publication number: WO2016192718A2
Application number: PCT/DE2016/100255
Authority: WO
Inventors: Behzad Sahabi; Arnold Pier
Original assignee: Behzad Sahabi; Arnold Pier
Priority date: 2015-06-02
Filing date: 2016-06-01
Publication date: 2016-12-08
Also published as: WO2016192718A3

Abstract

The invention relates to a surgical clip (10) for a clip applier (1), comprising a clip body (100) with at least two limbs (141, 142), which have a closure element (161, 162) of a closing device (106) at the free distal ends and are connected in an articulated manner on the opposite proximal ends. It is provided that each limb (141, 142) has at least one guide element (147, 148, 157, 158) which is suitable to pivot at least one limb (141, 142) relative to the opposite limb (142, 141) outwardly in order to open the clip (10) and/or inwardly in order to lock the closing device 106). In the case of a surgical clip applier (1) which comprises a shaft tube (6), guide devices (19a, 19b) which are stationarily arranged in the shaft tube (6) and extend in the longitudinal direction of the shaft tube (6), which are suitable to guide at least one clip (10) having two limbs (141, 142) in the shaft tube (6), and a thrust element (25) which is longitudinally displaceable in the shaft tube (6) and suitable to displace at least one clip (10) in the distal direction, it is proposed that the guide devices (19a, 19b) extend in one section in a diverging manner and extend in an indirectly or directly following section in a converging manner when seen in the distal direction. A shaft (6) of the clip applier (1) can be divisible, wherein a detachable part can serve as a clip magazine (300).

Description

Staple, staple applicator, system of staple applicator and at least one staple and staple cartridge

The invention relates to a surgical clip according to the preamble of claim 1, a surgical clip applicator according to the preamble of claim 14, a system of clip applicator and at least one clip according to the preamble of claim 25 and a clip magazine for use as part of a clip applicator.

Such surgical staples, staple magazines, staple applicators, and staple applicator systems and at least one staple are used, for example, for laparoscopic or endoscopic surgery, but can also be used for open surgery.

In laparoscopic or endoscopic surgery, for example, the staple applicator is inserted through a trocar sleeve into the abdominal area.

By means of so-called staple applicators, as are known, for example, from DE 101 20 367, the surgical staples are applied.

The surgical clips can be used for example for the closure of hollow bodies or vessels such as veins or arteries or else the uterine tubule, the cystic duct and the deferent duct.

One or more of the above-described surgical staples are longitudinally displaceable in the open spread initial state in a staple cartridge of the staple applicator. A front opening of the staple applicator allows insertion, eg of vessels, wherein a staple is pushed forward by actuation of a push rod of the staple applicator in the opened state. Surgical braces, a staple applicator and a system of the type mentioned are known from DE 101 20 367 A1. Such a surgical stapling applicator is constituted by a shaft tube, guide means for a staple stationarily arranged at the distal end of the shaft tube, with at least one surgical staple with at least two legs longitudinally displaceably held in a plane between the guide means at the distal end of the steerer tube longitudinally displaceable thrust element is displaceable.

The staple applicator additionally has a closing device for the staples, which is formed for example via a constriction at the distal opening of the shaft tube. Upon further advancement of the staple towards the distal opening, the legs of the staple are compressed by the closing means and thereby closed, the vessel being enclosed in the staple and stapled accordingly. The interlocking closure elements of the clip come into engagement while keeping the clip permanently closed. The staple is expelled from the staple applicator after closure and remains closed at the site of application.

The one-piece surgical clips according to the known prior art according to DE 33 47 987 have two legs which are connected at one end via a web. The opposite ends of the legs are initially free and spread apart from each other in the unloaded initial state, wherein the legs and the web lie in one plane. In the unloaded initial state include the two legs of the brackets a mutual angle, which allows the insertion of a vessel to be closed between the staple legs. The surgical clips according to the known prior art have in the initial state in the plane of the legs on a U- or V-shape. At the free ends of the legs interlocking closure elements may be formed which lock the legs after closing the clip.

From DE 33 47 987 C2 is also known to produce the surgical clips from a bioabsorbable plastic, so that they can be left in the body after surgery. The absorbable plastic braces have the advantage that they can be repaired after the healing of the stapled tissue. be absorbed by the body. A staple applicator known from DE 33 47 987 C2 has a magazine for a plurality of staples. Upon actuation of the staple applicator, the foremost open staple is slid between two jaws of the staple applicator which, after two legs of the staple comprise a vessel to be occluded, close on further actuation whereby the legs of the foremost staple engage. Thus, the foremost tip of the staple applicator has to make its own closing movement to close the staple.

A disadvantage of the known one-piece surgical staples is that they are transferred for application from an unloaded splayed initial state to achieve the closed state in a prestressed state. In the closed state, in which the clamp closes the biological vessel, the stresses in the clamp are further increased by the inclusion of the vessel. With a time-dissolving dissolving clip, the increased stresses within the clip material can result in undesirable premature opening of the clip.

Due to the one-piece design of the known surgical staples, the staple closing operation is accomplished via elastic deformation of the staple material. The occurring loads or stresses are highest in the closed state of the clip. The tensions can initially be reduced only by local plastic deformation or by a flow of the staple material. This can lead to an undesirable local deformation or widening of the clip, which is detrimental to the secure fit of the clip at the site of application and can result in undesirable rebleeding.

When using bioabsorbable plastics, the present stresses cause a negative change in the dissolution properties of the clip. The clamp begins to flow faster in the region of highest voltages, as well as decompose faster, to relieve the existing stresses in the closed state. Due to the length of the legs to the connecting web, the highest stresses occur at the interlocking closure elements at the free ends of the clip.

Already by low local flow processes, the closure elements can deform and loosen. The desired secure closure or retention of the clip at the application site can thus no longer be ensured. Due to the aforementioned effect, undesirable secondary bleeding of the treated biological tissue can occur, which jeopardizes the success of the treatment or even requires further medical intervention.

Also known in the art are two-piece surgical staples for the field of minimally invasive surgery made of bioabsorbable plastic. The selected two-part design of the surgical clip to avoid the disadvantages of the one-piece surgical staples mentioned above and ensure a secure closure of the clip.

During the closing operation of the two-part surgical clip, a further V-shaped locking element is pushed over the unloaded initial state U-shaped surgical clip with legs spread apart. By pushing the locking element, the legs of the clip from the open, U-shaped initial state are transferred to the closed state and locked by means of the deferred element at the same time. The locking element remains in the closed state permanently on the bracket.

The two-part design of the surgical clip has the disadvantage that during the closing operation and thus the pushing of the outer part, the actual clip can slip. There is thus the risk that the clamp is not in the closed state at the desired application site and possibly removed and another additional clip must be attached. The two-piece surgical staples have the further disadvantage that they can only be used in a single-release stapling applicator. Such a staple applicator for use with a two-piece surgical staple is known, for example, from DE 697 33 084 T2.

The staple applicator has the disadvantage that, after application of a single surgical two-part staple for reuse, it must be equipped with a new surgical staple.

When using such a staple applicator in the field of minimally invasive surgery, loading with a new staple requires that the staple applicator be first removed from the body of the patient to be treated via the trocar sleeve. The staple applicator can then be reloaded outside the patient's body with a new surgical staple.

Once the staple applicator has been loaded, it must be returned to the desired site of application in the patient's body and positioned.

The aforementioned method is very time consuming due to the need to reload the staple applicator outside of the patient's body, and additionally carries the risk of patient injury due to frequent insertion and removal of the staple applicator by the trocar sleeve.

From DE 38 52 609 T2 a one-piece surgical clip of the aforementioned type is known, which has on the legs in each case on the outside an engagement element which serves for engagement of jaws of a staple applicator. The jaws must be pressed to close the clamp.

From US 2004/0097971 A1 a staple applicator with a staple cartridge is known in which also front jaws make their own closing movement to close a surgical staple in engagement with the jaws can. The brackets are brought into a closed position by a complex mechanism, which also includes a rotational movement of the clip.

US 5,366,458 A discloses a one-piece surgical clip which has on its two legs inside projections which lie directly against each other when the clip is closed in order to close a vessel can safely. However, the arrangement could damage it due to the strong crushing of the vessel thereby caused. The bracket also has laterally projecting engagement members for engaging a staple applicator.

The invention has for its object to provide a surgical clip, a staple applicator for the surgical staple, a system of staple applicator and at least one clip and a staple magazine available, which exclude the aforementioned disadvantages of the prior art. In particular, the security of the application should be increased.

To achieve this object are the features of claim 1, 14, 25 and 32. Preferred embodiments of the invention will become apparent from the dependent claims.

The invention advantageously provides with respect to the clip that each leg of the surgical clip has at least one guide element, the legs being expandable from a nearly closed initial state against a restoring force of the clip by means of guide elements of a staple applicator relative to each other or against one lower oppositely directed return force of the clip can be closed. The surgical clip is almost closed in the unloaded initial state, so that the closure elements of the locking device are just not engaged. For the introduction of biological hollow bodies, eg vessels, into the surgical clamp, the latter must first be opened by swiveling the legs outwards or their interstices widened. For the subsequent confinement of the body vessel in the clip, the two legs are swung back inwards until the closure elements of the closure device come into mutual engagement and close the clip. Due to the almost closed execution of Staple in the unloaded initial state, the largest loads or highest voltages occur in the short-extended or open state of the bracket. The voltages in the closed state of the clip are thereby significantly lower than in originally widely spread brackets according to the prior art.

The reduced closed state tensions prevent premature disengagement of the clip connection and allow the clip resolution process to be more accurately predicted and constrained. This increases the security of the clip application.

The clip with at least one guide element interacts with the guide devices of a clip applicator such that when the clip is first advanced, at least one leg is first pivoted away from the opposite leg and then pivoted back until the closing device engages.

The surgical staples, in the unloaded initial state, may have a length measured from the proximal to the distal end of the staple in the range of 5 mm to 15 mm, preferably a length in the range of 7.5 mm to 9.0 mm and / or 1 1, 0 mm to 13.0 mm. In a particularly preferred embodiment, the clips have a length of about 8.5 mm or about 12 mm.

The guide elements are preferably formed on the legs, more preferably on the free distal ends of the legs of the clip and adapted in terms of dimensions and shape to guide means of the staple applicator. The arrangement of the guide elements in the region of the free ends and their adaptation to the guide means in a staple chute of the staple applicator makes it possible to perform a simple widening and shooting of the staple by means of staple applicator in conjunction with the advancement of the staple. Due to the large lever arm between the guide elements and the articulated connection at the proximal ends of the clamp, the applied forces for expanding the clamp during the feed remain low. Particularly preferably, at least one proximal guide element is formed on the articulated proximal ends of the legs, which is adapted to further guide means of the staple applicator. The arrangement of the proximal guide element on the clip enables secure guidance of the clip within the clip slot of the clip applicator. The clip can thus no longer slip out of the guide means in the clip applier and twisting of the clip in the plane of the legs is prevented. The arrangement of guide elements at the proximal and distal ends of the clip ensures compliance with a defined position of the clip via appropriately adapted guide elements of the clip applicator.

In a preferred embodiment, the legs of the clip in a non-loaded state include a small mutual angle, so that the legs have no or only a small distance at the free distal ends. Due to the almost closed design of the clamp in the unloaded state, the necessary elastic deformations and / or forces to close the clamp are low. The resulting due to the elastic deformation of the clamp loads or stresses in the closed state of the legs are thus also low. The fact that the brackets are almost closed in the initial state, the space required in the staple chute is reduced, whereby the staple applicator can be made more stable.

Between the legs remains in the closed state of the clip particularly preferably a gap of predetermined width for receiving a hollow body or hollow organ to be closed. At the end of the gap facing the articulated proximal ends, at least one locking device can be arranged. The remaining gap in the closed state of the surgical staple permits secure closure of the hollow body without crushing the trapped biological tissue between the legs of the staple. The danger on the one hand of bleeding and on the other hand of necrosis due to the bruising of the biological tissue is thus avoided. Rather, by choosing the dimensions of the remaining gap, taking into account the elasticity of the trapped tissue and the staple a defined holding force of the clip can be adjusted towards the enclosed tissue.

The provision of a locking device on at least one leg prevents the penetration of biological tissue into the proximal portion of the clip. This allows a secure closing of the enclosed biological tissue of the hollow body by means of the surgical clip and reduces the risk of possible rebleeding.

In a preferred embodiment, the legs and the closing means of the surgical clip are made in one piece from a material.

In an alternative embodiment, the legs consist of at least two parts which are connected to each other proximally via at least one joint. In the multi-part embodiment of the legs, the stresses occurring for widening the clamp are significantly reduced compared to the one-piece design.

The staple body of the one-piece and multi-part staples can be made of biologically harmless metals. Preferably, this can be made of a biologically harmless plastic, in particular of a bioabsorbable plastic. As bioabsorbable plastics, for example, polyglycolic acids (copolymers of glycolytic or lactide) and / or polymers of dioxanone or polydioxanone can be used for the production of the staples. It is also conceivable to produce the surgical clip from a mixture of the aforementioned clip materials, wherein the mixing ratio can be selected on the basis of the desired mechanical properties and / or desired absorption properties.

The clips made of the bioabsorbable material should preferably be fractionated after application in a human or animal body after a maximum period of 27 days, ideally already completely absorbed or dissolved at this time. In a particularly preferred embodiment, the earliest fractionation of the bioabsorbable material begins at the earliest after 14 days. The given resolution times should be bringing the surgical staples into a human or animal body preferably at core body temperatures in the range of 36.3 ° C to 37.3 ° C, more preferably in the range 37.3 ° C to 38 ° C and more preferably 39 ° C, be respected.

In a further preferred embodiment, the closure elements of the closure device at the free distal ends of the legs at least one pair of hooks adapted to each other.

At least one of the legs may particularly preferably have friction-increasing elevations on the mutually facing inner surfaces of the surgical clips. The protuberances may be used to form structures on the insides of the staples that allow for better adhesion between the surgical staple and the trapped body tissue. It is also conceivable to adapt the elevations of the opposite sides to one another, so that the elevations in the closed state opposite or alternatively engage the elevations of the first leg in recesses of the second opposite leg of the surgical clip. When viewed in the longitudinal direction of the legs, the elevations of the one leg can also be arranged next to the elevations of the other leg, so that the stapled vessel or the clamped hollow body runs in a meandering manner in the region of the stapling transversely to this longitudinal direction. This provides a particularly effective closure.

Between the elevations in each of the above-described arrangements, a defined gap may remain between the elevations of different legs, so that the stapled biological tissue of the hollow body is firmly locked, but neither crushed nor decaptiert.

It may also be advantageous to give at least one of the elevations in cross section a trapezoidal shape. The trapezoidal cross-section can be both in the direction of view in the longitudinal direction of the legs and in a plane which is parallel to a plane spanned by the longitudinal directions of the legs. Tapered Boundary walls of the bumps may create a space for stapled tissue to avoid destructive bruising.

In a particularly preferred embodiment, reinforcing webs are formed on the legs substantially in the longitudinal direction of the legs. The reinforcing webs allow an increase in the bending stiffness of the staple legs by a targeted local material reinforcement. In this case, arranged in the region of the legs reinforcing webs can simultaneously form the guide elements of the clip, via which at least one leg relative to the opposite leg can be pivoted outwardly to open the clip and / or inwardly to lock the locking device.

Alternatively, in order to increase the bending stiffness in the region of the legs, additional rigid or solid materials can be introduced. For example, biocompatible fibers with a thin diameter can be embedded or attached substantially in the longitudinal direction of the legs. By the above measures for increasing the stiffness of the legs, the deflection of the staple legs is reduced when the biological tissue is included in the staple. Preferably, the material reinforcements are arranged parallel to the gap between the legs on the side surfaces of the legs in the vicinity of the gap.

At the shaft tube of the staple applicator can be integrally formed on the proximal end of a handle, which has an actuating device with at least one trigger lever. Upon actuation of the trigger lever, the longitudinally displaceable pusher member or a transmission rod acting on the pusher member is displaced toward the distal end of the shaft tube and the clamps. The handle can be made in one piece with the shaft tube or be separably connected thereto.

In an alternative embodiment, the shaft tube can be arranged in the handle rotatably about the longitudinal axis of the shaft tube. Thus, the connection between the handle and the shaft tube may be formed for example from a circumferential groove around the shaft tube tongue and groove. In a rotatable embodiment of the shaft tube can be rotatably connected to the shaft tube, a rotary ring over which the surgeon can cause the rotation of the shaft tube relative to the handle. In this case, this rotary ring is particularly preferably arranged at the proximal end of the shaft tube adjacent to the handle.

The release handle of the staple applicator can cooperate with a third, arranged in the handle locking element, which gives the surgeon an audible and / or haptic feedback upon actuation of the release lever. In this case, the actuating device can have a release lever mounted in an articulated manner in the grip piece, whose stroke acting on the thrust element is adapted in the longitudinal direction of the shaft tube to at least the length of a clamp.

The object with regard to a clip applicator is achieved with the features of claim 14.

The staple applicator can be used in laparoscopic or endoscopic surgery and, alternatively, in open surgery. The staple applicator together with the matching staple form a coordinated system. The stapling is done by simple mechanical means in a very reliable manner, wherein the opening of the clamp for receiving the tissue to be stapled and closing for the stapling operation due to the interaction between guide means and guide elements is achieved solely by the advancement of the clip without the staple applicator in Shaft in addition to the necessary elements for the feed moving parts needed. Previously, this was possible at best for a pure closing movement of the clip. Without an opening movement but one is forced to supply the clip in a sufficient for receiving the tissue state, which would require a correspondingly wide design of the shaft tube. The further disadvantage of a stronger material deformation on the clamp during the closing process has already been shown above.

The at least one clip has guide elements which are adapted to the guide devices, the clip being displaced by the shoe during push displacement. Belement the guide elements in engagement with the guide means first exert a spreading and successively a closing movement of the at least one leg of the clip.

The staple cartridge for use with a staple applicator has a housing forming the distal portion of the stem tube and releasably connected to the proximal portion of the stem tube, wherein the guide means are disposed within the housing and wherein the housing receives a plurality of staples disposed one behind the other.

Due to the intended arrangement of several surgical staples in succession in the region of the distal part of the shaft tube or in the staple cartridge, it is possible to apply a plurality of surgical staples directly one after the other. The surgical staples may particularly preferably consist of a bioabsorbable plastic. The provision of multiple surgical, bioabsorbable staples makes it possible to apply a plurality of bioabsorbable staples one after another with a surgical stapling applicator without removing the staple applicator from the body when used in the field of endoscopic or laparoscopic surgery. This has the special advantage that repositioning of the staple applicator at the desired application location is eliminated, since the staple applicator does not have to be reloaded externally outside the body to be treated, but rather contains its own supply of applicable staples.

Particularly preferably, the guide means of the staple applicator and / or the staple magazine extend on both sides to the longitudinal axis of the shaft tube and / or on both sides of a plane formed by the legs of the staple.

The guide means may comprise, in the advancing direction of the pusher, a first portion of constant pitch, a second succeeding portion with a diverging distance, and a last portion prior to ejection of the staple at a converging distance. Upon advancement of the staples from the proximal to the distal end of the shaft tube, the Leg of the clip initially spread in the region of the diverging distance and closed in a last section by the converging distance of the guide means again until the locking device closes the clamp. While the clamp is in the spread state, the biological body to be clamped is introduced. Thereafter, closing the staple during advancement of the staple locks the body between the legs of the staples. Upon completion of the closing operation of the staple, it is ejected from the staple applicator. Particularly preferably, between the first section with the diverging and the last section with the converging distance of the guide means may have a further section with a constant distance.

The guide means can be arranged between the legs above and / or below the plane formed by the legs, which act on the guide elements and have a diverging distance in the feed direction of the thrust element in a first section.

Particularly preferred in the guide means a plurality of brackets are arranged longitudinally displaceable one behind the other, wherein the thrust element abuts the proximal end of the last staple in the feed direction and the thrust element advances all staples. Preferably, the guide means in a portion of the staple chute on a constant mutual distance in a plane parallel to the plane of the legs of the clip plane. In the portion of the constant distance of the guide means a plurality of brackets can be arranged longitudinally displaceable one behind the other.

Preferably, a number of brackets in the range of 4 to 15, particularly preferably 7 to 9 or 1 1 to 13 in the shaft tube can be arranged one behind the other. In a preferred embodiment, 4 or 8 or 12 clamps are arranged in the shaft tube.

Due to the constant distance of the guide means no opening or closing of the clip takes place in this section. The section with constant spacing serves for the internal storage of surgical staples. numbers. These can be applied by the staple applicator immediately after each other.

It is particularly advantageous that the brackets are arranged in the magazine directly behind one another and that each rear bracket can immediately push the arranged in front of her bracket. Advantageously, the brackets can be advanced in a nearly closed condition, preferably simultaneously unloaded in the joint at the proximal end, so that the distal ends of the legs of the posterior staple engage the proximal end of the anterior staple. Special measures, the parentheses for the feed mesh or special thrust elements that engage in each clip, so that is not required. Another advantage of being able to use almost closed staples in the stapling applicator is given by a possible particularly narrow construction, which is particularly desirable for minimally invasive procedures.

The guide elements are particularly preferably transverse, preferably orthogonal, from a plane formed by the legs. Preferably, the guide means extend parallel above and / or below the plane of the legs in the walls of a staple chute.

In a preferred embodiment, the clip has further guide devices, which are adapted to at least one proximally arranged guide element of the clip and extend substantially in the longitudinal direction of the clamp shaft located in the shaft tube.

In a further particularly preferred embodiment, the thrust element has a plurality of detent positions at a distance of a staple length and cooperates with a stationary in the shaft tube arranged first detent element which allows movement of the thrust element in the feed direction by at least one and preferably at most one clip length and counteract a movement of the thrust element allows the feed direction only between two locking positions when the locking element is not engaged in a locking position. According to a further preferred embodiment, the thrust element is coupled via a second latching element with a displaceably guided in the shaft tube thrust sleeve, wherein the thrust sleeve drives the guided in the shaft tube thrust element.

Preferably, the thrust element cooperates via a second latching element with a displaceably arranged in the shaft tube transmission element.

The second locking element allows movement of the thrust element relative to the transmission element in the feed direction by at least one staple length and allows movement of the thrust element against the feed direction only between two locking positions.

In a further particularly preferred embodiment, a compression spring element acting on the transmission element in the longitudinal direction of the shaft tube is arranged between the shaft tube and the push sleeve.

The shaft tube is preferably formed in the longitudinal direction of two separable parts. The distal part of the shaft tube is separably connected to the proximal part of the shaft tube. In this way, the clip applicator after removal of the distal part of the shaft tube only a few mechanical parts that can be sterilized easily. In the distal part of the shaft tube while the brackets are mounted with the thrust element and the first locking element.

After applying all the brackets located in the distal shaft tube, the distal part can be discarded. After sterilization of the staple applicator, a new sterile distal part can be placed on the stem tube, allowing the sterilized staple applicator to be reused.

The shaft tube can be formed particularly preferably in the longitudinal direction of three separable parts. The distal part of the shaft tube is separable with a central part of the shaft tube and this in turn separably connected to the proximal part of the shaft tube. In the distal part of the shaft tube, a plurality of brackets can be displaced one behind the other in the longitudinal direction between guide devices be stored. The distal part of the shaft tube may have the guide means, via which the spreading and / or closing movement of the legs of the clip are performed. Furthermore, it is possible for the distal part of the shaft tube to have a proximal opening, via which the distal part of the shaft tube can be filled with a plurality of staples arranged one behind the other. The distal part of the shaft tube can also form the staple cartridge. In the middle part of the shaft tube, the first locking element may be arranged, which cooperates with the locking positions of the thrust element. The first latching element is fixedly mounted in the middle part of the shaft tube, due to the connection of the central part with the distal and the proximal part of the shaft tube, the first latching element is also stored stationary in the entire shaft tube. In the proximal part of the shaft tube, the transmission element, the thrust element can be arranged with the second latching element.

Alternatively, the shaft tube of the staple applicator is made in one piece and is completely disposed of after the application of the staples.

In a further particularly preferred embodiment, the transmission element is formed in two parts from a transmission rod and a union nut. The transmission rod can be made tubular, at least in the region of the distal end, so that the thrust element can be introduced at least into the distal part of the transmission element. In this case, the thrust element is mounted longitudinally displaceable relative to the transmission element. The thrust element is coupled to the transmission element via a second detent element. The second latching element can be mounted within the union nut, which is screwed to the distal end of the transmission element. The union nut also has a central opening for the passage of the pusher element.

The shaft tube particularly preferably has a flattened distal end with a front recess. The flattening of the distal end of the shaft tube allows the surgeon when using the staple applicator in the field of endoscopic or laparoscopic surgery to throw as unobstructed view of the clamp to be applied. In addition, the flattening to better position the staple applicator at the site of application.

The biological tissue to be stapled is introduced into the anterior opening of the distal end of the shaft tube. The surgical clip is displaced by means of the pusher element into the area of the front opening, wherein the clip is first opened in a first section with a diverging distance of the clip guiding devices. During the opening of the staple, it is advanced further so that the biological tissue is inserted into the opened staple. In a last section of the opening, in which the staple guide means have a converging distance, the staple is closed with the enclosed biological tissue. In this case, the front opening of the shaft tube is particularly preferably adapted to the length of the clip so that the biological tissue can only reach the front distal region of the clip. In addition, on the clamping side, a locking device prevents the penetration of the biological into the proximal part of the clamp, which prevents the closure of the hollow body to be closed in the proximal end of the gap of the distally foremost staple during the staple-closing operation.

Further particularly preferably, the shaft tube or at least a part of the shaft tube is formed from an upper and lower shell. The upper and lower shell can thus be produced preferably by injection molding.

In a preferred embodiment, the shaft tube has an outer diameter in the range of 5 mm to 15 mm, particularly preferably an outer diameter in the range of 9 mm to 1 1 mm.

In a further preferred embodiment, at least one viewing window is formed in the distal region of the shaft tube. The viewing window allows during the operation to determine whether there are still enough staples in the staple cartridge. The viewing window can also be provided with a numbering, so that the surgeon can read the number of remaining brackets in the staple magazine directly. The viewing window can also be provided in the flattened area of the distal end of the shaft tube. This configuration allows the surgeon a simplified view of the body to be clamped, as well as simultaneously on the viewing window.

Instead of the last proximal clip, a displaceably mounted blocking element can be used in the guide means of the shaft tube. The locking part prevents the triggering of the staple applicator when all staples have been applied. In this case, the blocking element can be embodied in a signal color, so that the surgeon can directly read the number of remaining staples via the viewing window by means of an additional numbering or can see via a viewing window that all staples have been applied.

In the following, embodiments of the invention will be explained in more detail with reference to the drawings.

Show it:

Fig. 1 shows a first embodiment of a one-piece surgical clip in

Side view in the unloaded initial state,

Fig. 2 shows a first embodiment of a one-piece surgical clip in

Side view when closed,

Fig. 3 shows a first embodiment of a two-part surgical clip in

Side view in the unloaded initial state,

Fig. 4 shows a second embodiment of a one-piece surgical clip in

Side view in the unloaded initial state,

5 is a rear view of the second embodiment of the surgical clip,

6 shows a section through the surgical clip of the second embodiment along the line Vl-Vl in Fig. 4, 7 is a front view of the second embodiment of the surgical clip,

8a is a perspective view of the second embodiment of the surgical clip in the open state with inserted biological tissue,

8b is a perspective view of the second embodiment of a one-piece tissue-inserted surgical staple in the closed state;

9 shows a third embodiment of a one-piece surgical clip in FIG

Side view in the unloaded initial state,

10 is a perspective view of a staple applicator,

10a is a plan view of the distal end of the staple applicator according to FIG. Fig. 10

Fig. 10b is a section through the shaft tube of the staple applicator along the line

XlVb-XlVb,

Fig. 1 1 is a longitudinal section through a staple applicator with a one-piece

Steerer

Fig. 1 1 a is a longitudinal section through a staple applicator with a two-part

Steerer

Fig. 1 1 b is a longitudinal section through a staple applicator with a three-part

Shaft tube, a longitudinal section through the distal end of a two-part shaft tube of a staple applicator, 13 is a plan view of the distal end of a two-part shaft tube of a staple applicator,

FIGS. Partial sections through two different embodiments of

14a, 14b clip appliers, and

Fig. 15 is a perspective view of a staple applicator for open surgery.

The one-piece surgical clip 10 shown in FIG. 1 essentially has two legs 141 and 142, at the free distal ends of which in each case a closure element 161, 162 of a closure device 106 are arranged and which are hinged together at the opposite proximal ends.

Fig. 1 shows the surgical clip 10 with a clamp body 100 in the unloaded initial state, in which the clip is almost closed. For enclosing a biological hollow body, at least one leg 141,

142 are pivoted relative to the opposite leg 141, 142 to the outside. For this purpose, the surgical clip shown in FIG. 1 has guide elements 147, 148 which, in cooperation with corresponding guide devices 19 of a clip applicator 1, open the clip by pivoting the legs 141, 142 outward and / or closing the clip 10 by means of locking the locking device 106 via a pivoting of the legs 141, 142 allow inward. The clip 10 shown has a gap 101 between the legs 141, 142 in which the biological hollow body, e.g. a vessel is picked up. At the gap 101 facing inner surfaces

143 of the legs 141, 142 are arranged in the region of the proximal end of a locking device 102 and in the central region of the legs 141, 142 elevations 144 which increase in friction. In addition, reinforcing webs 145, 146 extending substantially in the longitudinal direction of the legs are arranged on the legs 141, 142, which effect an increase in the flexural rigidity of the legs 141, 142 in the plane of the clip 10 and thus elastic deformations of the clip in the region of the reinforcing webs 145, 146 reduce. The clip shown in Fig. 1 is made in one piece from a staple material 104. The opening and closing the one-piece clip is done, for example, via an elastic deformation of the staple material on the articulated connection.

Fig. 2 shows the one-piece surgical clip 10 of Fig. 1 in the closed state, in which the closure elements 161, 162 of the closure means 106 are in mutual engagement.

In the closed state, the gap 101 for receiving the biological tissue of the hollow body is divided by the blocking device 102 into a proximal part 101 b and into a distal part 101 a. In this case, the locking device 102 is designed so that it engages during the closing operation of the clip 10 from a certain closure angle of the legs 141, 142 and the proximal portion 101 b of the gap blocks, so that the biological tissue of the hollow body only in the distal part 101 a of the clip 10 can be inserted.

FIG. 3 shows a further embodiment of an at least two-part surgical clip 10 with two legs 141, 142, which are connected to each other proximally via a joint 105. The two-part design and connection by means of the joint 105 makes it possible to pivot the two legs 141, 142 by means of the guide elements 147, 148 against each other, without causing significant elastic deformations of the clip occur. The multi-part embodiment of the clip 10 with the joint 105 makes it possible that the stresses occurring in the closed state only from the interaction of the enclosed biological tissue of the hollow body with the inner surfaces 143 of the legs 141, 142 result.

Fig. 4 shows a preferred further embodiment of a one-piece surgical clip 10. The clip 10 consists essentially of two legs 141, 142 which are hinged together at the proximal ends, wherein at the proximal end of a proximal guide member 107 is formed and the two legs 141, 142 each have closure elements 161, 162 of a closing device 106 which are adapted to each other at the distal ends. At the distal ends of the legs 141, 142, the guide elements 147, 148 are arranged, which in cooperation with corresponding guide means 19 of a staple applicator 1 can cause the opening and closing of the clip 10. An optional proximal guide member 107 is adapted to the geometry of a corresponding optional further guide means 9 of the staple applicator 1 and allows more accurate guidance and displacement of the staple 10 within the staple applicator.

The bracket 10 may have on the inner surfaces 143 of the legs 141, 142 via matched friction-increasing elevations 144 and in the proximal portion of the gap 101 via a locking device 102. The friction-increasing elevations 144 of the facing inner surfaces 143 are adapted to one another such that a protrusion 144 of the one leg 141 of an elevation 144 of the other leg 142, e.g. is contrasted, but remains a gap and in the closed state of the clip 10, the trapped biological tissue of the hollow body is not crushed, but the hollow body is securely closed due to the elevations and depressions. Alternatively, when viewing FIG. 4 with the clamp 10 closed, the elevations 144 of different limbs 141 and 142 may also be arranged one behind the other as viewed on the plane of the drawing. This is e.g. in the case of the clip 10 shown in Fig. 8a, which will be described later.

The reinforcing webs 145, 146 extending substantially in the longitudinal direction of the legs 141, 142 increase the bending stiffness of the clip 10 in the region of the elevations, so that bending of the legs 141, 142 in the closed state due to the interaction of the enclosed biological tissue of the Hollow body with the bracket 10 is largely prevented.

The closure elements 161, 162 of the closure device 106 have a geometry adapted to each other and extend substantially over the entire thickness of the surgical clip, so that the closure elements can be made solid and solid. The closure elements 161, 162 are preferably hook-shaped in the plane of the legs 141, 142 designed and form a preferably irreversible latching connection. FIG. 5 shows a rear view of the proximal end of the clip 10 from FIG. 4. The distal guide elements 147, 148 project laterally from the clip 10 such that they can engage in correspondingly adapted web-shaped guide devices 19a, 19b of the clip applicator 1.

Preferably, the guide elements 147, 148 are orthogonal from a plane formed by the legs 147, 148. In the rear view, the optional proximal guide element 107 has essentially a geometry which is preferably circular in cross-section, with corresponding sections of the circular arc protruding from the clamp 10 so that these guide devices 9 of the clip applicator 1 adapted to the guide element 107 can be guided. It is understood that the guide member 107 may protrude only one side of the bracket 10 and may be in engagement with a single guide means 9. In addition, the Schenkeispreizung and -Locking can also be done with a single guide member 147 or 148 in conjunction with the guide member 107 and the associated guide means 9 and 19a, 19b, if only one leg 141, 142 to be pivoted.

In an alternative embodiment, the guide means 19a, 19b of the staple applicator 1 need not necessarily be designed as web or groove-shaped devices. Rather, the guide means 19a, 19b may also be embodied as inwardly projecting from the wall of the shaft tube, adapted to the shape of the guide elements 147, 148, 157, 158 of the bracket 10, e.g. as a bridge. The guide means 19a, 19b may initially have an expanding shape in the direction of advance of the clamp, over which the clamp is spread and subsequently have a tapering shape over which the clamp is in turn closed.

6 shows a section through the clamp 10 along the dashed line VI-VI in FIG. 4 in the direction of the distal end of the clamp 10. The two limbs 141, 142 have laterally protruding reinforcing webs 145, 146, which provide the flexural rigidity of the respective legs 141, 142 increase. The limbs 141, 142 have friction-increasing elevations 144 facing the gap 101.

From Fig. 6 it can be seen that the friction-increasing elevations 144 of the opposite legs 141, 142 are adapted to each other, so that a secure closure of the hollow body is made possible within the clip and slippage of the clip due to the increase in friction is avoided. In this case, the friction-increasing elevations 144 in the closed state of the clip against each other at a defined distance. This gap serves to receive the hollow body to be enclosed, without squeezing or severing it.

FIG. 7 shows the one-piece surgical clip 1 according to FIG. 4 with guide devices 107, 147 and 148 projecting from the legs 141, 142 and closing device 106 in a distal view.

8 a shows a perspective view of a surgical staple 10 in the opened state with an inserted biological tissue of a hollow vessel 200. The inserted hollow vessel 200 may be, for example, a vein or artery which is to be closed by the surgical staple 10.

Fig. 8b shows the unitary surgical clip 10 in the closed state.

9 shows a further preferred embodiment of a one-piece surgical clip 10 with a clip body 100. The clip 10 consists essentially of two legs 141, 142, which are hinged together at the proximal ends via a web. The two legs 141, 142 have in their longitudinal direction a slight curvature or deflection towards the clip interior or to the gap 101 formed by the legs 141, 142. On the legs 141, 142, the reinforcing webs 145, 146 are arranged, which cause an increase in the bending stiffness of the legs 141, 142 in the plane of the clip 10. The reinforcing webs 145, 146 may have a straight or arcuate shape in the longitudinal direction of the legs. The reinforcing webs 145, 146 at the same time form the guide elements 157, 158, which are connected to the guides. tion devices 19a, 19b of the staple applicator 1 cooperate. The two legs 141, 142 can be pivoted against each other by means of the guide elements 157, 158 in conjunction with the guide means 19a, 19b of the staple applicator. The clip has a closing device 106, which is formed from the closure elements 161, 162. Furthermore, the legs 141, 142 are provided with friction-increasing elevations on the inner surfaces 143 facing the gap 101. Due to the bent-through design of the legs 141, 142 of the clip during the closing operation, the elevations increasing the friction initially engage in the proximal part of the clip. During the further completion of the closing operation of the clamp 10, the friction-increasing elevations 144 come from the proximal to the distal part of the staple sequentially in the end position for stapling, for example, are opposite to each other or side by side or engage each other, so that an on - Closing of the body from the proximal end of the staple towards the distal end of the staple is performed successively.

10 shows a clip applicator 1 with a one-piece shaft tube 6, a handle 2 with an actuating device 4. In this case, the shaft tube 6 is arranged rotatably relative to the handle 2 by means of the rotary ring 7. Due to the length of the shaft tube, the surgical stapling applicator 1 according to FIG. 10 is suitable for the field of laparoscopic or endoscopic surgery, wherein the staple applicator can be passed through a trocar sleeve, e.g. is introduced in the abdominal area.

Fig. 10a shows a plan view of the flattened distal end 13 of the shaft tube 6. Wherein the flattenings as shown in Fig.10a as shown by oblique planes or alternatively by concave and / or convex surfaces can be formed. In this case, the inclined planes of the flattenings in FIG. 14 a are mirror-symmetrical to the longitudinal axis of the shaft tube 6. The flattened, concave and / or convex surfaces, however, can be designed differently on the top and bottom of the shaft tube.

FIG. 10b shows a section through the shaft tube 6 and one in the shaft tube 6 in guide devices 19a, 19b and optionally further guide devices 9 Guided bracket 10. The guide elements 147 and 148 engage in the guide means 19a, 19b and the proximal guide member 107 in the further optional guide means 9 a.

The staple applicator 1 is inserted through a trocar, not shown, for example, in the abdominal area. In this case, it is desirable for the surgeon to have a plurality of staples 10 for carrying out the operation without renewed removal and insertion of the staple applicator 1 through the trocar sleeve. For this purpose, several staples can be arranged one behind the other in the stapling applicator in a stapling tray 5, which staples can be used successively by the surgeon.

1 1 shows a longitudinal section through a clip applicator with a one-piece shaft tube. 6

At the distal end of the shaft tube 6, guide devices 19a, 19b which are stationarily arranged in the staple shaft 5 and optional further guide devices 9 for guiding at least one staple 10 are formed. At least one clip 10 with at least two legs 141, 142 held longitudinally displaceably in a plane between the further guide devices at the distal end of the shaft tube 6 is held displaceably by means of at least one push element 25 which is longitudinally displaceable in the shaft tube 6. The at least one clip 10 in this case has guide elements 147, 148 which are adapted to the guide devices 19a, 19b and which, in conjunction with the guide devices 19a, 19b, perform a spreading and / or closing movement of the legs 141, 142 during a push displacement of the clip 10 by the push element 25 effect. The guide means 19a, 19b extend parallel to the plane of the legs 141, 142 of the clamp 10 substantially in the longitudinal direction relative to the longitudinal axis of the shaft tube 6. The guide means 19a, 19b relative to the plane of the legs 141, 142 arranged in the orthogonal direction opposite be, so that a total of four guide devices 19 run side by side. The guide means 19a, 19b have in the feed direction from the proximal to the distal end of the shaft tube 6 a in the plane of the clamp 10 constant distance and subsequently have a divergent in a section 20 and in a last Section 21 on a converging distance. The surgical clips 10 are arranged in a longitudinally displaceable manner in the section 31 one behind the other and guided longitudinally displaceably within the shaft tube within the guide devices 19a, 19b and optionally by means of the further guide devices 9. The thrust element 25 rests against the proximal end of the last staple 10 in the feed direction and pushes all clamps 10 distally in the event of a shear displacement. The push element 25 is driven by the release lever 4, which acts on the push element 25 via a transmission rod 26 and the push sleeve 27. The guide elements 147, 148 of the clip 10 extend orthogonally to the plane of the legs 141, 142. The optional further guide means 9 of the clip applicator 1 are adapted to the at least one proximal guide element 107 of the clip 10 and extend substantially linearly in the longitudinal direction of the Shaft tube 6.

The thrust element 25 has a plurality of latching positions 24, which are arranged at a distance of a staple length. The detent position 24 of the transmission rod 25 are formed by notches extending in the feed direction, e.g. conical, taper, so that the locking elements 22, 23 can be overcome in displacement of the thrust element 25 only in the feed direction, in the opposite direction, however, a blocking takes place.

The locking elements 22, 23 may for example consist of spring-like spring rings.

In this case, the thrust element 25 cooperates with a stationary in the shaft tube 6 arranged first locking element 23 which allows movement of the thrust element 25 in the direction of movement by at least one clip length and movement of the thrust element 25 against the direction of movement only between two locking positions 24 permits, so that the thrust element 25 at each actuation, in which a clip 10 is ejected by a latching position 24 is irreversibly advanced until no more staple 10 in the staple applicator 1 is present. The thrust element 25 continues to act together via a second latching element 22 with a displaceably arranged in the shaft tube 6 transmission element 8, which drives the thrust element 25 in the feed direction.

The locking element 22 allows a movement of the thrust element 25 relative to the transmission element 8 in the feed direction by at least one staple length and a movement of the thrust element 25 against the direction of movement only between two locking positions.

The transmission element 8 is in the embodiment of FIG. 1 1 in two parts from the transmission rod 26 and the thrust sleeve 27 is formed.

Between the shaft tube 6 and the thrust sleeve 22 of the transmission element 8 a force acting in the longitudinal direction of the shaft tube 6 compression spring element 16 is arranged, which causes a return movement of the transmission element 8, and the sliding sleeve 27, the transmission rod 26 and the release lever 4.

The shaft tube 6 has at the distal end 13 a front opening 15, the geometry of which is designed so that during the staple closing process penetration of body tissue in the proximal end of the gap 101 b of the distal foremost staple 10 is prevented.

The staple applicator 1 further comprises a handle 2. In the handle 2, the shaft tube 6 is rotatably mounted. The transmission rod 26 of the transmission element 8 extends longitudinally displaceable in the handle 2, wherein the proximal end of the transmission rod 26 abuts against the release lever 4 of the actuator 4a. In the actuator 4a has a handle-piece articulated lever-like release handle 4 with the transmission rod in the direction of the distal end 13 can be moved. In this case, a spring device 32 is disposed on the actuating device 4a, which engages upon actuation of the actuator 4a in a toothing on the trigger handle 4a, on the one hand to generate a noise and on the other hand to transmit a tactile feedback for the feed on the trigger lever 4. Fig. 1 a shows a longitudinal section through a staple applicator with a two-part shaft tube 6d, 6p. The shaft tube is formed from a proximal part 6p and a distal part 6d, wherein the distal part of the shaft tube 6d is detachably connected to the proximal part of the shaft tube 6p by a screw or bayonet connection. In the distal part 6 d of the shaft tube, the brackets 10, the push rod 25, and the first locking element 23 are arranged. In the proximal part of the shaft tube 6p, the compression spring element 16, and the transmission element 8 are arranged. The transmission element 8 consists in the embodiment of FIG. 1 1 a of a transmission rod 8a with sleeve-shaped front part and a screw-on cap nut 8b. Between the transmission rod 8a and the union nut 8b, the second locking element 22 is arranged stationary. The division of the shaft tube into a proximal part 6p and a distal part 6d makes it possible to carry out the distal part of the staple applicator 1 as a disposable part, the proximal part of the staple applicator being designed as a sterilisable and reusable part. Due to the two-part design of the shaft tube, it is also possible to use different distal shaft tubes with the same proximal shaft tube (applicator). For example, different numbers of staples 10 arranged one behind the other can be provided in the distal part of the shaft tube 6d. Also, brackets of different dimensions, such as different lengths in the direction of advance may be provided, all of which may be used with a proximal shaft tube.

Alternatively, it is also possible to provide different, adapted to the particular application, adapted proximal shaft tubes.

1 1 b shows a further embodiment of a staple applicator in a longitudinal section with a three-part shaft tube. The shaft tube consists of a distal part 6d, a middle part 6m and a proximal part of the shaft tube 6p. The distal part of the shaft tube 6d is separably connected to the middle part of the shaft tube 6m, this is in turn separably connected to the proximal part of the shaft tube 6p. The separation points between the proximal part of the shaft tube 6p and the middle part of the shaft tube 6m, as well as the distal shaft Pipe 6d can be provided, for example, as a positive plug connection and / or as a bayonet closure and / or as a screw connection.

Fig. 12 shows a longitudinal section through an embodiment with a two-part shaft tube 6, which is formed from two parts 17 and 18. In the distal part 17 of the shaft tube 6, the brackets 10, consisting of the thrust element 25 and the sliding sleeve 27 transmission element 8 and the compression spring element 16 are arranged. The two parts 17 and 18 of the shaft tube 6 are connected separable from each other. This two-part embodiment of the shaft tube 6 makes it possible to manufacture the distal part 17 of the shaft tube 6 as a disposable part, so that after use the distal part 17 can be disposed of. The proximal part 18 of the shaft tube 6, which is connected to the handle 2, can be sterilized after use and reused, so that only an exchange of the distal part

17 of the shaft tube 6 is necessary. The proximal part 18 of the shaft tube 6 can be reused with the handle 2.

13 shows a plan view in a plane parallel to the brackets 10 of the embodiment of FIG. 11 with a two-part configuration of the shaft tube 6. Here, the distal part of the shaft tube 17 is with the proximal part of the shaft tube

18 separably connected via a connecting element 1 1.

Fig. 13 shows an embodiment of the connecting element 1 1 in the manner of a bayonet closure.

A viewing window 30, which opens up a view of the surgical clips 10 located in the shaft tube 6, is arranged in the distal region of the shaft tube 6.

The Fign. FIGS. 14 a and 14 b show two further exemplary embodiments of the stapling applicator 1 with an integral shaft tube 6, which is rotatably arranged in the gripping piece 2. The rotation takes place by means of rotary ring 7, which is rotatably connected to the shaft tube 6. In Fig. 14a, the guide means 19 in the course from the proximal end to the distal end a portion 31 with a constant, then a portion 20 with a diverging distance and finally a portion 21 with a converging distance, whereas in the embodiment According to FIG. 14b, between the section 20 with the diverging distance and the section 21 with the converging distance, a further additional section 31 with a constant spacing is inserted. The different courses of the guide devices 19 make it possible to realize different lengths of the clamps 10 or a longer opening duration of the clamp 10, without changing the outer diameter of the shaft tube 6.

The embodiments according to FIGS. 14a and 14b have the clip lengths adapted to different distances of the detent positions 24 on the thrust element 25, wherein the distance between two detent positions 24 in the longitudinal direction of the shaft tube 6 corresponds to the length of a bracket 10.

Furthermore, the release lever 4 are adapted to the differently used clip lengths to the effect that the upper stroke of the release lever 4 in the longitudinal direction of the shaft tube 6 corresponds to at least one clip length.

Fig. 15 shows an embodiment of a staple applicator 1 with an alternative actuator that can be used for open surgery. In this case, the shaft tube 6 is connected to a handle 2, which has two actuators 4a. The clip 10 is displaced distally via a pusher member by means of a scissors-like motion. The arranged in the shaft tube 6 elements correspond to the elements of the embodiments described above.

The staple applicator 1 can be operated as follows:

Upon actuation of the trigger lever 4, the lever part located in the handle 2 acts on a transmission rod 26, which transmits the force of the trigger lever 4 with its distal end to the proximal end of the sliding sleeve 27. The thrust sleeve 27 is in its position on the second latching device 22 is coupled to the thrust element 25 such that the thrust element 25 can be advanced in the distal direction by a latching position 24. The advance of the thrust element 25 takes place during the movement of the release lever 4 until a latching position 24 located in front of the latching device 22 engages with the first latching element 23, so that the thrust element 25 is displaced distally by exactly one latching position 24. As a result, a clamp 10 is moved distally forward, being first opened in a section 20 and then closed in a section 21 until the locking device 106 is locked. After locking, the ejection of the clip 10 takes place from the shaft tube 6 of the clip applicator 1.

While the pusher element 25 remains in the now assumed position, the compression spring 16 mounted in the shaft tube 6 effects a return of the push sleeve 27 with the second latching device integrated therein, which engages again in the next proximal latching position 24 of the pusher element 25. Thus, the thrust sleeve 27 is back in its initial position, so that when re-actuation of the trigger lever 4, a further clip 10 can be moved distally forward. The spacing of the detents 22, 23 is greater than a staple length and is preferably e.g. exactly two clip lengths. The thrust sleeve 27 has at its distal end a stop collar, which cooperates with the housing of the shaft tube 6 and forms a proximal stop. The compression spring 16 coaxially surrounds the thrust element 25 and is supported distally on the one hand on the housing of the shaft tube 6 and on the other hand proximally on the thrust sleeve 27th

Claims

claims

1 . A surgical stapler (10) for a staple applicator (1), comprising a staple body (100) having at least two legs (141, 142) having a closure member (161, 162) of closure means (106) at the free distal ends and to the are hingedly connected to opposite proximal ends,

characterized in that

each leg (141, 142) comprises at least one guide element (147, 148, 157, 158) adapted to guide at least one leg (141, 142) outwardly relative to the opposite leg (142, 141) to open the clip (14). 10) and / or to pivot inwardly to lock the locking device (106).

2. Surgical clip (10) according to claim 1, characterized in that the guide elements (147, 148, 157, 158) on the legs (141, 142), preferably at the free distal ends of the legs (141, 142) integrally formed are and are adapted to first guide means (19a, 19b) of the staple applicator (1).

3. A surgical clip (10) according to any one of claims 1 or 2, characterized in that at the articulated proximal ends of the legs (141, 142) at least one proximal guide element (107) is formed and to second guide means (9) of the staple applicator (1) is adjusted.

Surgical clip (10) according to any one of claims 1 to 3, characterized in that the legs (141, 142) of the clip (1) enclose a mutual angle, such that the legs (141, 142) engage the free distal ones Ends have no or only a small distance.

5. A surgical clamp (10) according to any one of the preceding claims, characterized in that on opposite inner sides (143) of the legs (141, 142) elevations (144) are provided.

6. Surgical clip (10) according to claim 5, characterized in that the elevations (144) are arranged such that when the clip (10) and viewing direction in the longitudinal direction of the clip (10), the elevations (144) of the one leg ( 141, 142) are arranged adjacent to the elevations (144) of the other of the legs (141, 142).

7. Surgical clip (10) according to claim 6, characterized in that when projecting the elevations (144) of both legs (141, 142) on a plane which is parallel to a plane spanned by the leg longitudinal central axes plane, with the clip ( 10) the elevations (144) are spaced apart in the projection plane, preferably by at least 0.05 mm, more preferably by at least 0.07 mm, more preferably by at least 0.1 mm.

8. Surgical clip (10) according to any one of claims 5 to 7, characterized in that when projecting the elevations (144) of both legs (141, 142) on a plane which is perpendicular to a plane spanned by the leg longitudinal central axes plane, when the clamp (10) is closed, the elevations (144) in the projection plane are spaced from one another, preferably by at least 0.05 mm, more preferably by at least 0.07 mm, more preferably by at least 0.1 mm.

Surgical clamp (10) according to claim 5, characterized in that, with the clamp (10) closed, the elevations (144) of one of the legs (141, 142) reach the elevations (144) of the other of the legs (141, 142). spaced apart in the direction of the closing movement, preferably by at least 0.05 mm, more preferably by at least 0.07 mm, more preferably by at least 0.1 mm.

10. Surgical clip (10) according to claim 5, characterized in that with the clamp closed (10) at least one of the elevations (144) of one of the legs (141, 142) in a recess of the elevations (144) of the other of the legs ( 141, 142) engages, wherein for the protection of the tissue to be clamped between the walls of the interlocking elevations (144) remains a circumferential gap.

1 1. Surgical clip (10) according to any one of claims 5 to 10, characterized in that the elevations (144) have a trapezoidal cross section different from a rectangle in the direction perpendicular to a plane spanned by the leg longitudinal central axes.

12. Surgical clip (10) according to claim 1 1, characterized in that the cross section is isosceles.

13. Surgical staple (10) according to one of the preceding claims, characterized in that the staple body (100) consists of a resorbable material.

14. Surgical stapling applicator (1) with

a shaft tube (6),

in the shaft tube (6) arranged in the longitudinal direction of the shaft tube (6) extending guide means (19a, 19b) which are adapted to guide in the shaft tube (6) at least one clamp (10) with two legs (141, 142) and

a push element (25) which is longitudinally displaceable in the shaft tube (6) and which is suitable for displacing at least one clip (10) in the distal direction,

characterized in that

the guide means (19a, 19b) seen in the distal direction diverging in a section and converge in an indirectly or immediately following section.

15. staple applicator (1) according to claim 14, characterized in that before the section with divergent course, a section with a parallel course of the guide means (19a, 19b) is given.

16. clip applier (1) according to claim 14 or 15, characterized in that at least one of the guide means (19a, 19b) is web or groove-shaped.

17. staple applicator (1) according to any one of claims 14 to 16, characterized in that at least one of the guide means (19a, 19b) above, in particular web-shaped.

18. staple applicator (1) according to one of claims 14 to 17, characterized in that the guide means (19a, 19b) are provided on both sides of a longitudinal center plane of the shaft tube (6).

19. stapling applicator according to one of claims 14 to 18, characterized in that the thrust element (25) has a plurality of latching positions (24) whose distance from one another is each a staple length, and with a stationary in the shaft tube (6) mounted first latching element (23) interacts.

20. staple applicator according to one of claims 14 to 19, characterized in that an actuating device (4) with a in the shaft tube (6) guided transmission element (8) is coupled, wherein the transmission element (8) guided in the shaft tube (6) Pushing element (25) drives in the feed direction.

21. Staple applicator according to one of claims 19 or 20, characterized in that the thrust element (25) cooperates via a second detent element (22) with the displaceable in the shaft tube (6) arranged transmission element (8).

22. staple applicator according to claim 20 or 21, characterized in that in the shaft tube (6) between the shaft tube (6) and the transmissive Transmission element (8) in the longitudinal direction of the shaft tube (6) acting compression spring element (16) is arranged.

23. staple applicator according to one of claims 20 to 22, characterized in that the transmission element (8) has a suitable for enclosing the thrust element (25) thrust sleeve (27).

24. staple applicator according to claim 23, characterized in that the transmission element (8) is a combination of the thrust sleeve (27) with one of the thrust sleeve (27) separated or on the thrust sleeve (27) releasably fixed transmission rod (26)

25. System comprising a surgical clip applicator (1) and at least one surgical clip (10), wherein the clip applicator (1)

a shaft tube (6),

guide means (19a, 19b) stationarily arranged in the shaft tube (6) for the at least one clamp (10) with two limbs (141, 142) guided in the shaft tube (6)

includes and

- The at least one clip (10) at the distal end of the shaft tube (6) held longitudinally displaceable in a plane and by means of a longitudinally displaceable in the shaft tube (6) thrust element (25),

characterized in that

the guide elements (147, 148, 157, 158) adapted to the guide devices (19a, 19b) have at least one clip (10), the guide elements (147, 148, 147) being displaced by the push element (25) when the clip (10) is displaced by a sliding movement. 157, 158) in engagement with the guide means (19a, 19b) first a spreading and successively a closing movement of the at least one leg (141, 142) of the clip (10) exercise.

26. System according to claim 25, characterized in that the guide means (19a) on both sides to the longitudinal axis of the shaft tube (6) and / or on both sides of the legs (141, 142) of the clip (10) formed Level extend, and / or that the guide means (19b) on one side and / or on both sides of a plane formed by the legs (141, 142) of the clip (10) extend.

27. System according to one of claims 25 or 26, characterized in that the guide means (19a) in the feed direction of the thrust element (25) a first portion with a constant distance a second subsequent section (20) with a diverging distance and a last section (21 ) prior to ejection of the staple (10) at a converging distance.

28. System according to any one of claims 25 to 27, characterized in that the guide means (19b) between the legs (141, 142) are arranged above and / or below the plane formed by the legs (141, 142) on the Guide elements (147, 148) act and have a diverging distance in the feed direction of the thrust element (25) in a first section.

29. System according to any one of claims 25 to 28, characterized in that the guide elements (147, 148, 157, 158) protrude transversely, preferably orthogonally, from the plane formed by the legs (141, 142).

30. System according to any one of claims 25 to 29, characterized in that the clip applicator (1) is designed according to one of claims 14 to 24.

31. System according to one of claims 25 to 30, characterized in that the clamp (10) or at least one of the clamps (10) is designed according to one of claims 1 to 13.

A staple cartridge (300) for use as part of a stapling applicator (1) according to any one of claims 14 to 24 or as part of a system according to any of claims 25 to 31, comprising a housing (301) defining a distal portion (6d) of the Shaft tube (6) forms and separable with the proximal part (6p) of the Shaft tube (6) is connected, wherein the guide means (19a, 19b) are arranged in the housing (301) and the housing (301) a plurality of successively arranged brackets (10) receives.