Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or 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
  • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
  • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
  • A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
  • A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
  • A61B17/12113—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel within an aneurysm
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
  • A61B17/122—Clamps or clips, e.g. for the umbilical cord
  • A61B17/1227—Spring clips

Definitions

• the present invention relates to a surgical clip comprising a first clamp arm, a second clamp arm and a biasing member, which first clamp arm defines a first clamp surface, which second clamp arm defines a second clamp surface, and which biasing member defines the first clamp surface and the second clamp surface in one
• the basic position holds against each other, in particular under bias, wherein the first and the second clamping arm against each other against the action of the biasing element are pivotable, wherein the biasing element is in the form of a helical spring which defines a helical spring longitudinal axis and a first coil spring end and a second screw spring end, wherein the coil spring between the first coil spring end and the second coil spring end comprises at least one turn extending over a circumferential angle of more than 360 °, wherein the first coil spring end via a The second screw spring end is connected to the second clamping arm via a second connecting section and wherein the clamping surfaces held in the basic position define a clamping plane.
• aneurysm clips for example, aneurysms, that is, detachments of hollow organs, such as, for example, blood vessels, are disconnected by clamping off the outer surface between the clamping surfaces of the two clamping arms.
• the helical spring is formed by winding between the two connecting sections.
• the angle at which the two connecting sections of the coil spring so that at least one turn is formed which extends over a circumferential angle of more than 360 °, for example over a circumferential angle of more than 500 °.
• the helical spring longitudinal axis is therefore not inclined relative to the clamping plane by about 15 ° as described above, but now runs exactly parallel to the clamping plane. This avoids that, unlike the mutually inclined clamping surfaces of conventional clips, the screw spring does not experience a theoretically ideal working direction inclined by 15 ° force component, which can cause the coil spring with her at least one turn "on block "is pressed. In other words, due to the special orientation of the longitudinal axis of the helical spring parallel to the clamping plane, it is precisely this that acts on the at least one turn. kende force component reduced.
• an expansion of the helical spring parallel to the helical spring longitudinal axis can thus also be minimized.
• the described alignment of the helical spring longitudinal axis results in a more efficient introduction of force into the helical spring.
• especially lower torsional stresses in the coil spring ensure greater safety and a larger working range of the same.
• By a smaller extension of the coil spring parallel to the helical spring longitudinal axis results in applying the surgical clip better visibility for a surgeon.
• the described "scissoring effect" can be reduced in particular, since the helical spring always acts in such a way that the clamping surfaces of the two clamping arms are pressed perpendicular to one another.
• the first clamping arm has a first free end, which points away in a direction away from the biasing element or substantially away from the biasing element. This embodiment makes it possible in particular to guide the surgical clip laterally over a hollow organ to be clamped.
• the second clamping arm has a second free end which points away in a direction away from the biasing element or substantially away from the biasing element. This makes it possible, in particular, to form a surgical clip which can be guided laterally over a hollow organ in order to clamp it off.
• the clip comprises an intersection region and if the first connection section and the second connection section intersect in the intersection region.
• such an embodiment makes it possible to open the clip towards each other by moving the two connecting sections.
• the clip can be easily and safely handled by a surgeon.
• the first connecting section and / or the second connecting section have a flattening pointing towards the other connecting section.
• two flattenings may be provided, which abut one another or are spaced apart from one another by a narrow gap. In this way, a particularly compact surgical clip can be formed.
• the flattening of the first and / or second connecting section defines a flattening plane and if the flattening plane runs parallel or substantially parallel to the clamping plane. In this way, the surgical clip can in particular be safely opened and closed without it being absolutely necessary for the two connecting sections to come into contact.
• the flattenings can in particular also serve as mutual guidance of the connecting sections during opening and closing of the surgical clip.
• the clamping arms can abut each other substantially along their entire longitudinal extension with the two clamping surfaces in the basic position.
• first connecting portion between the first clamping arm and the first helical spring end is angled at a first bending angle and / or when the second connecting portion is angled between the second clamping arm and the second helical spring end by a second bending angle.
• This embodiment makes it possible in particular to form the first coil spring end and the second coil spring end offset by a circumferential angle of about 180 ° to each other and to connect to the first and second connecting portion.
• the first bend angle corresponds to the second bend angle or essentially corresponds.
• the first and / or second kink angles define an interior angle in a range of about 90 ° to about 120 °. In this way, a particularly compact surgical clip can be formed.
• the first connecting portion is angled in the transition region to the first clamping arm by a third bending angle and / or when the second connecting portion is angled in the transition region to the second clamping arm by a fourth bending angle.
• the connecting section in such a way that it has subsections spaced from one another when the clamping surfaces abut each other in the basic position. These sections can then be moved against each other to open the clip. At the same time, these subsections can in particular also form stops against one another in order to limit the opening of the surgical clip.
• the third buckling angle corresponds or substantially corresponds to the fourth buckling angle.
• a symmetrical clip can be formed in this way.
• the third bend angle and / or the fourth bend angle correspond to the first and / or second bend angle.
• the first and second bend angles on the one hand and the third and fourth bend angles on the other hand can define change angles in the mathematical sense.
• first connection section is bent in the transition region to the first helical spring end and / or if the second connection is bent. section is bent off in the transition region to the second coil spring end.
• One or two such offsets in the two described transition regions in particular to a level which corresponds to half of an extension of the helical spring parallel to the helical spring longitudinal axis, allows alignment of the helical spring longitudinal axis parallel to the clamping plane in a simple manner.
• a force pressing against each other at least one turn of the helical spring and also an expansion of the helical spring in a direction parallel to the helical spring longitudinal axis can be minimized.
• Under cranking is in particular a single or double bend of the respective connecting portion to the respective coil spring end to understand in particular the helical spring longitudinal axis aligned parallel to the clamping surface.
• the at least one winding at least a first winding section and at least a second winding section to summarizes and that the at least one first winding section a defines first winding section plane and / or that the at least one second winding section defines a second winding plane and that the at least one first winding section and the at least one second winding section are connected to one another via a crank section remote from the first coil spring end and the second coil spring end.
• the embodiment described makes it possible, in particular, to space the two turn sections apart from one another by forming the offset section so that they do not touch each other.
• the offset section which connects the at least one first turn section and the at least one intermediate turn section, is arranged between them and in this way establishes a direct connection between the at least one first turn section and the at least one turn section forms a second Windungsabitess.
• the configuration of the first and second winding sections makes it possible to define in each case a winding section plane such that, given an acting force for opening the surgical clip, the helical spring can no longer twist, but a contraction of the helical spring substantially only in each case the planar winding sections can take place.
• a desired distance between the at least one first turn section and the at least one second turn section can be adjusted by a length and a shape of the offset section.
• crank portion may form a spacer member to keep the at least one first turn portion and the at least one second turn portion spaced so that they do not touch, particularly regardless of whether the clip is closed or opened is.
• the surgical clip may also include a coil spring having more than two turns.
• two adjacent winding sections are then connected to one another via a cranking section connecting them.
• the surgical clip can be embodied in a particularly simple manner if the crown section is rectilinear or has a substantially rectilinear shape and is angled at a first offset end to the at least one first turn section and angled at a second bend section end to the at least one second turn section. section is connected.
• the bend between the crank portion end and the respective turn portion is identical.
• the cranking section extends transversely to the first and / or second Windungsabitessebene.
• it can run at a Kröpfungs- section angle of about 45 °. This makes it possible, in particular, to form the helical spring without excessive plastic deformation in the desired manner, namely with spaced-apart turn sections.
• first winding section plane and / or the second winding section plane run perpendicular to the longitudinal axis of the screw spring.
• the at least one first turn section extends over a first turn section circumference angle of less than 360 °, in particular less than 300 °, and / or if the at least one second turn section extends over a second turn section circumference angle of less than 360 ° °, in particular less than 300 °.
• a helical spring can be formed in particular with at least two such winding sections, which are aligned parallel to one another and define winding section planes which run perpendicular to the longitudinal axis of the screw spring.
• the coil spring may also comprise three, four or more such turn sections.
• this embodiment has the advantage that when the clip is opened, which has intersecting connecting sections, the helical spring in the
• the turn section gap can have a width in a range between 0 mm and approximately 1 mm.
• the helical spring defines a helical spring diameter if the first clamping arm and the second clamping arm have a clamping arm length and if the helical spring diameter is smaller than the clamping arm length.
• the helical spring diameter is understood in particular to mean a diameter which is defined by the at least one turn of the helical spring, that is to say a diameter in a plane which runs perpendicular to the clamping plane and perpendicular to the helical spring longitudinal axis.
• the first clamping surface and / or the second clamping surface have a clamping surface structure.
• the clamping surface structure can be formed macroscopically and / or microscopically. In this way, in particular slipping of the surgical clip can be avoided by the hollow organ to be clamped.
• the surgical clip can be easily formed if the
• Clamping surface structure comprises clamping projections and / or clamping recesses.
• the clamping projections and / or the clamping recesses can be arranged or formed in a line and / or punctiform manner.
• the surgical clip can be designed simply and cost-effectively if it is formed in one piece, in particular monolithic. For example, it can be formed monolithically from a single blank. It is favorable if the clip is formed from a spring steel wire by forming. In particular, the spring steel wire may have a circular or substantially circular cross-section. The forming can be done in particular by compression molding. Thus, the surgical clip can be formed in particular from a blank made of a spring steel wire. In particular, the surgical clip can be made entirely manually or completely by machine.
• a cross-sectional area of the clip is smaller in the area of the screw spring than in the area of the first and / or second connecting portion and / or in the area of the first and / or the second clamping arm.
• this makes it possible to form a particularly compact helical spring which, for example, also permits an improved view when the surgical clip is applied to a flea member.
• FIG. 1 a shows a perspective view of a surgical clip, as is known from the prior art, before the two connecting sections or the two clamping arms are crossed over;
• Figure lb a view of the arrangement of Figure la in the direction of arrow A;
• FIG. 2 is a perspective view of a first embodiment of an improved surgical clip
• Figure 3 is a view of the clip of Figure 2 in the direction of arrow B;
• Figure 4 is a view of the clip of Figure 3 in the direction of arrow C
• Figure 5 is a view of the clip of Figure 4 in the direction of arrow D;
• Figure 6 is a sectional view taken along line 6-6 in Figure 4;
• Figure 7 is a sectional view taken along line 7-7 in Figure 4;
• Figure 8 is a perspective view of a second embodiment of an improved surgical clip;
• FIG. 9 is a view of the clip of Figure 8 in the direction of arrow E;
• FIG. 10 shows a view of the clip from FIG. 9 in the direction of the arrow F;
• Figure 11 is a view of the clip of Figure 10 in the direction of arrow G;
• Figure 12 is a sectional view taken along line 12-12 in Figure 10;
• Figure 13 is a sectional view taken along line 13-13 in Figure 10;
• FIG. 14 is a perspective view of a third embodiment of an improved surgical clip;
• Figure 15 is a view of the clip of Figure 14 in the direction of arrow H;
• Figure 16 is a view of the clip of Figure 15 in the direction of arrow I;
• Figure 17 is a view of the clip of Figure 16 in the direction of arrow K;
• Figure 18 is a sectional view taken along line 18-18 in Figure 16; and
• FIG. 19 a sectional view along line 19-19 in FIG. 16.
• FIGS. 1 and 2 show, by way of example, a surgical clip designated as a whole by reference numeral 10, as known from the prior art. It comprises a first clamping arm 12 with a first clamping surface 14 and a second clamping arm 16 with a second clamping surface 18. Furthermore, the clip 10 comprises a prestressing element 20, which is designed in the form of a helical spring 22.
• the biasing element 20 serves to hold the first clamping surface 14 and the second clamping surface 18 in a basic position against each other, in particular under bias.
• FIGS. 1 a and 1 b the clip 10 is not shown in the basic position, but instead with clamping surfaces 14 and 18 which are not in contact with each other directly after the clip 10 has been positioned.
• the clamping arms 12 and 16 are due to the action of the helical spring 22 slightly apart from each other. After crossing over the clamping arms 12 and 16, the screw spring 22 presses the clamping surfaces 14 and 18 under pretension against each other.
• the coil spring 22 defines a helical spring longitudinal axis 24.
• the coil spring 22 has a first coil spring end 26 and a second coil spring end 28.
• the helical spring 22 comprises at least one turn 30 which extends over a circumferential angle of more than 360 °, in the embodiment illustrated in FIGS. 1a and 1b over a circumferential angle of approximately 520 °.
• the first coil spring end 26 is connected via a first connecting portion 32 with the first clamping arm 12.
• the second coil spring end 28 is connected via a second connecting portion 34 with the second clamping arm 16. If the connecting sections 32 and 34 are moved toward one another so that the second clamping arm 16 can engage under the first clamping arm 12, the clip 10 assumes the basic position. The clamping surfaces 14 and 18 then substantially abut each other and are held pressed by the coil spring 22 under bias against each other.
• Figure 1b shows a significant problem with surgical clips known in the art.
• the clip 10 is formed from a blank of spring steel wire, in such a way that the clamp arms 12 and 16 are formed with parallel clamping surfaces 14 and 18 at free ends of the wire blank, the winding of the coil spring 22 causes the clamping surfaces 14 and 18 are inclined by an angle 36 against each other.
• This has the consequence that the clamping surfaces 14 and 18 in the basic position just not flat abut each other, but essentially only linear.
• a corresponding force component acts at an angle of about 15 °, which presses adjacent areas of the helical spring against one another.
• FIGS. 2 to 7 now show a first exemplary embodiment of an improved surgical clip, which is also designated by the reference numeral 10. Identical parts of the clips shown in FIGS. 2 to 7, which are already present in the clip 10 shown in the prior art and shown in FIGS. 1a and 1b, are designated by the same reference numerals for the sake of clarity.
• the clip 10 differs from the clip of FIGS. 1 a and 1 b in particular in that the clamping surfaces 14 and 18 lie flat against one another in the basic position shown in FIG. 2 and define a clamping plane 38.
• the first helical spring end 26 is bent in the transition region to the first connecting section 32.
• a first bend 40 is formed to align the first connecting portion with the coil spring 22.
• a transition region between the second helical spring end 28 and the second connecting section 34 is bent, so that a second bend 42 is formed.
• FIGS. 5 and 6 it can be clearly seen in FIGS. 5 and 6 that the two clamping arms 12 and 16 are arranged symmetrically relative to a helical spring plane 44 defined by the helical spring 22 by the two offsets 40 and 42.
• a maximum thickness 46 of the helical spring 22 parallel to the helical spring axis 24 is therefore smaller than in the helical spring 10 known from the prior art, which is illustrated in FIGS. 1 a and 1 b.
• the first connecting portion 32 comprises two rectilinear portions 48 and 50, which are angled relative to each other by a first bending angle 52.
• the second connecting portion 34 comprises two rectilinear sections 54 and 56, which are angled relative to each other by a second bending angle 58.
• the section 48 connects directly to the first bend 40, the section 54 to the second bend 42.
• the section 50 is angled relative to the first clamping arm 12 by a third bend angle 60.
• the portion 56 is angled relative to the second clamping arm 16 by a fourth bending angle 62.
• the first connection section 32 is provided starting from the first clamp arm 12 to the section 48 with a flattening 64.
• the second connecting section 34 starting from the second clamping arm 16, is provided with a further flattening 66 as far as the section 54.
• the flats 64 and 66 face each other and define a common flattening plane 68, which extends both perpendicular to the helical spring longitudinal axis 24 and to the clamping plane 38.
• the flattening plane 68 and the coil spring plane 44 coincide.
• the connecting sections 32 and 34 intersect in the region of the flats 64 and 66, whereby an intersection region 92 is defined.
• the offsets 40 and 42 serve to align parallel to each other in the clip 10 according to the prior art, as exemplified in Figures la and lb, not mutually parallel clamping surfaces 14 and 18, to the advantages described above by this Ausgestal - reach.
• the helical spring 22 is formed identically in the clip 10 shown in FIGS. 2 to 7, as in the case of the clip 10 in FIGS. 1 a and 1 b.
• FIGS. 8 to 13 show, by way of example, a second exemplary embodiment of an improved surgical clip designated as a whole by the reference numeral 10. It differs from the clip 10 illustrated in FIGS. 2 to 7 by the design of the helical spring 22.
• the coil spring 22 in the exemplary embodiment of the clip 10 illustrated in FIGS. 8 to 13 comprises a first turn section 70 and a second turn section 72.
• the first turn section 70 defines a first turn section plane 74
• the second turn section 72 defines a second turn section plane 76.
• the first winding section 70 connects to the first bend 40, the second winding section 72 to the second bend 42. Further, the first turn portion 70 and the second turn portion 72 are directly connected to each other via a crank portion 78.
• the cranking section 78 is thus arranged or formed directly between the first winding section 70 and the second winding section 72.
• the crank portion 78 is substantially rectilinear and extends transversely to the two turn portion planes 74 and 76, in the embodiment of the clip 10 shown in FIGS. 8 to 13, at a crank portion angle 80 of about 45 °.
• crank portion 78 is angled at a first offset portion end 94 and connected to the first turn portion 70. Further, the crank portion is bent at a second bend portion end and connected to the second turn portion 72.
• Windungsabitessebenen 74 and 76 are parallel to each other and perpendicular to the helical spring longitudinal axis 24th
• the winding sections 70 and 72 each extend over a circumferential angle of less than 360 °, in particular less than 300 °. It is rather only about 200 °.
• the two Windungsabitese 70 and 72 are spaced from each other and separated by a Windungsabitessspalt 82 from each other.
• FIGS. 14-19 A third embodiment of an improved surgical clip 10 is shown schematically in FIGS. 14-19. It is identical in its construction substantially with the second embodiment of the improved clip 10, as shown in Figures 8 to 13 match.
• the clip 10 as shown in Figures 8 to 13, combines the particular properties of the coil spring 22 of the clip 10, as shown in Figures 2 to 7, with the particular properties of the helical spring 22 of the clip 10th , as shown in Figures 14 to 19.
• All embodiments of clips 10 shown in the figures mean that the first clamping arm 12 has a first free end 84 and the second clamping arm 16 has a second free end 86.
• first clamping surface 14 and / or the second clamping surface 18 may have a clamping surface structure not shown in the figures. This may in particular be formed macroscopically or microscopically.
• the clamping surface structure may in particular comprise clamping projections and / or clamping recesses. These may be formed in particular linear and / or punctiform.
• All improved clips 10 are integrally formed, namely monolithic.
• All of the improved clips 10 are formed from a blank of spring steel wire having a circular or substantially circular cross-section.
• the improved clips 10 are formed by forming the blank, in particular by press molding.
• a cross-sectional area of the improved clips 10 in the area of the helical spring 22 is smaller than in the area of the clamping arms 12 and 16.
• a Klemmarmin 88 of the clamping arms 12 and 16 is greater than a coil spring diameter 90 of the coil spring 22nd

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• Health & Medical Sciences (AREA)
• Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Heart & Thoracic Surgery (AREA)
• Molecular Biology (AREA)
• Vascular Medicine (AREA)
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• Biomedical Technology (AREA)
• Reproductive Health (AREA)
• Medical Informatics (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
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• 2018
  • 2018-02-21 DE DE102018103903.4A patent/DE102018103903A1/de not_active Withdrawn
• 2019
  • 2019-02-21 WO PCT/EP2019/054274 patent/WO2019162359A1/de not_active Ceased
  • 2019-02-21 JP JP2020543990A patent/JP7357627B2/ja active Active
  • 2019-02-21 ES ES19706969T patent/ES2990044T3/es active Active
  • 2019-02-21 EP EP19706969.3A patent/EP3755242B1/de active Active
  • 2019-02-21 CN CN201980014376.9A patent/CN112040887B/zh active Active
• 2020
  • 2020-08-11 US US16/947,638 patent/US11642136B2/en active Active

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