U.S. patent application number 10/446290 was filed with the patent office on 2005-12-15 for surgical clip, clip applicator and method therefor.
Invention is credited to Levinson, Melvin E..
Application Number | 20050277958 10/446290 |
Document ID | / |
Family ID | 27760067 |
Filed Date | 2005-12-15 |
United States Patent
Application |
20050277958 |
Kind Code |
A1 |
Levinson, Melvin E. |
December 15, 2005 |
Surgical clip, clip applicator and method therefor
Abstract
The surgical clip includes a U or a V shaped body having clip
legs extending from its apex and terminal ends having a lateral
span extending outboard from the clip. The terminal ends are shaped
as triangles, ovals, a T, oblong or a wide end hexagonal shape.
Sometimes, the terminal ends define outboard directed hooks. The
clip's inboard surface may have gripping grooves. A clip applicator
includes clip carrying jaws pivotally coupled and forming a mouth.
Keyways capture clip ends. If the clip is hooked, the jaws define
complementary latch openings. A system for closing the clip jaws
may be linked scissor-like members, cam actuators and followers or
cam follower surfaces. The clip applier may include tactile
response indicators for the user to indicate partial or full jaw
closure and full open-clip release positions.
Inventors: |
Levinson, Melvin E.; (Miami,
FL) |
Correspondence
Address: |
ROBERT C. KAIN, JR.
750 SOUTHEAST THIRD AVENUE
SUITE 100
FT LAUDERDALE
FL
333161153
|
Family ID: |
27760067 |
Appl. No.: |
10/446290 |
Filed: |
May 27, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10446290 |
May 27, 2003 |
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09692050 |
Oct 19, 2000 |
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6610073 |
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60160387 |
Oct 19, 1999 |
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Current U.S.
Class: |
606/151 ;
606/139; 606/142 |
Current CPC
Class: |
A61B 2017/291 20130101;
A61B 17/122 20130101; A61B 17/2804 20130101; A61B 17/1285 20130101;
A61B 17/2833 20130101; A61B 2017/292 20130101 |
Class at
Publication: |
606/151 ;
606/139; 606/142 |
International
Class: |
A61B 017/10 |
Claims
What is claimed is:
1. A surgical clip comprising a substantially U or a V shaped body
defined by clip legs extending from an apex and respective terminal
ends on corresponding clip legs, said clip legs lying in a clip
defined plane and each said terminal end having a lateral span
extending outboard from said clip plane.
2. A surgical clip as claimed in claim 1 wherein each said terminal
end has a lateral end shape of a triangle, an oval, T-shape, an
oblong, and wide end hexagonal shape.
3. A surgical clip as claimed in claim 2 wherein each respective
said clip leg includes a inboard surface with a longitudinal center
channel and at least one X-shaped channel, a vertex of said
X-shaped channel being coextensive with said longitudinal center
channel.
4. A surgical clip as claimed in claim 3 including a plurality of
X-shaped channel formed on said inboard clip leg surfaces.
5. A surgical clip comprising a substantially U or a V shaped body
defining an apex and having two terminal ends opposite said apex,
said body having a length and a lateral width, each said terminal
end having a lateral width which is larger than said body
width.
6. A surgical clip as claimed in claim 5 wherein each said terminal
end has a lateral end shape of a triangle, an oval, T-shape, an
oblong, and wide end hexagonal shape.
7. A surgical clip as claimed in claim 6 wherein said body includes
clip legs extending from said apex to said terminal ends, said clip
legs having an inboard surface with a longitudinal center channel
and at least one X-shaped channel, a vertex of said X-shaped
channel being coextensive with said longitudinal center
channel.
8. A surgical clip comprising a substantially U or a V shaped body
having an apex and two terminal ends opposite said apex, said body
having a substantially uniform lateral span and each said terminal
end having a lateral span larger than said body lateral span.
9. A surgical clip as claimed in claim 8 wherein each said terminal
end has a lateral end shape of a triangle, an oval, a T-shape, an
oblong, and wide end hexagonal shape.
10. A surgical clip as claimed in claim 9 wherein said body
includes clip legs extending from said apex to said terminal ends,
said clip legs having an inboard surface with a longitudinal center
channel and at least one X-shaped channel, a vertex of said
X-shaped channel being coextensive with said longitudinal center
channel.
11. A surgical clip comprising a substantially U or a V shaped body
defined by clip legs extending from an apex and respective terminal
ends on corresponding clip legs, each terminal end including a
outboard hook, said clip legs, terminal ends and outboard hooks
lying in a singular, clip defined plane.
12. A surgical clip as claimed in claim 11 wherein said V-shape or
U-shape clip body define, with said clip legs, a wide clip mouth,
each said hook defines a hook mouth disposed on opposing sides of
said clip mouth and begin being open opposite said clip mouth.
13. A surgical clip as claimed in claim 12 wherein each said hook
mouth is smaller than said clip mouth.
14. A surgical clip as claimed in claim 11 wherein each respective
said clip leg includes a inboard surface with a longitudinal center
channel and at least one X-shaped channel, a vertex of said
X-shaped channel being coextensive with said longitudinal center
channel.
15. A surgical clip as claimed in claim 14 including a plurality of
X-shaped channel formed on said inboard clip leg surfaces.
16. A surgical instrument for applying at least one surgical clip
onto a blood vessel or other organic body, said clip having a
substantially U or a V shaped body defined by clip legs each having
a respective terminal clip end, said clip legs lying in a clip
defined plane and each said terminal clip end having a lateral span
extending outboard from said clip plane, the surgical clip applying
instrument comprising: a first and a second clip carrying jaw
pivotally coupled together and forming a clip jaw mouth
therebetween, each jaw having a distal end and a proximal end; said
distal end of each said jaw having an open ended channel formed as
a keyway thereon, each said keyway sized to capture a respective
terminal clip end therein and a respective terminal clip end
adapted to act as a key for a corresponding keyway when said clip
is retained in said clip jaw mouth; means for closing said first
and second clip carrying jaw onto each other.
17. A surgical instrument as claimed in claim 16 wherein each said
keyway is open at said distal end of said corresponding jaw and
each said keyway forms, in conjunction with the respective terminal
clip end, a loose tongue and groove lock on opposing lateral sides
of said keyway.
18. A surgical instrument as claimed in claim 17 wherein said first
and second clip jaws form respective anvil surfaces in said clip
mouth adapted to crush said clip legs therebetween during
attachment to said blood vessel or other organic body, said anvil
surfaces proximally disposed with respect to said keyways.
19. A surgical instrument as claimed in claim 16 wherein each said
keyway has a corresponding roof and a floor, said clip jaws and
said corresponding keyways operate in a full open position, a
partially closed, instrument insertion position, a fully closed
position and a post deposition clip release position, in said
partially closed, instrument insertion position, said corresponding
floor of said respective keyway adapted to compress said respective
terminal clip end, in said post deposition release position, said
corresponding floor and roof of said respective keyway adapted to
be spaced apart from said terminal clip ends thereby enabling
proximal withdrawal of said clip jaws from the deposited clip.
20. A surgical instrument as claimed in claim 19 including tactile
response indicators for said partially closed, instrument insertion
position, fully closed position and post deposition clip release
position.
21. A surgical instrument as claimed in claim 20 wherein said
tactile response indicators are disposed on one of said clip jaws,
a segment of said clip jaws proximal to a pivotal axis between said
first and second clip jaw, and a proximally disposed handle, said
handle being part of said means for closing.
22. A surgical instrument as claimed in claim 16 wherein the
instrument is elongated, said clip jaws being distally located on
said elongated instrument, said means for closing including a user
compressible handle at a proximal end of said instrument, said
handle coupled to means for transferring compressive force from
said handle to said clip jaws such that said clip jaws close said
clip jaw mouth.
23. A surgical instrument as claimed in claim 22 wherein each said
keyway has a corresponding roof and a floor, said clip jaws and
said corresponding keyways operate in a full open position, a
partially closed, instrument insertion position, a fully closed
position and a post deposition clip release position, in said
partially closed, instrument insertion position, said corresponding
floor of said respective keyway adapted to compress said respective
terminal clip end, in said post deposition release position, said
corresponding floor and roof of said respective keyway adapted to
be spaced apart from said terminal clip ends thereby enabling
proximal withdrawal of said clip jaws from the deposited clip.
24. A surgical instrument as claimed in claim 23 including tactile
response indicators for said partially closed, instrument insertion
position, fully closed position and post deposition clip release
position.
25. A surgical instrument as claimed in claim 24 wherein said
tactile response indicators are disposed on one of said clip jaws,
a segment of said clip jaws proximal to a pivotal axis between said
first and second clip jaw, and said proximally disposed handle.
26. A surgical instrument for applying at least one surgical clip
onto a blood vessel or other organic body, said clip having a
substantially U or a V shaped body defined by clip legs extending
from an apex and respective terminal ends on corresponding clip
legs, each terminal end including a outboard clip end hook, said
clip legs, terminal ends and outboard clip end hooks lying in a
singular, clip defined plane, the surgical clip applying instrument
comprising: a first and a second clip carrying jaw pivotally
coupled together and forming a clip jaw mouth therebetween, each
jaw having a distal end and a proximal end; said distal end of each
said jaw having a corresponding latch opening for a respective clip
end hook when said clip is retained in said clip jaw mouth; means
for closing said first and second clip carrying jaw onto each
other.
27. A surgical instrument as claimed in claim 26 wherein each said
latch is defined by a cavity open at said corresponding distal end
of said respective jaw.
28. A surgical instrument as claimed in claim 27 wherein first and
second clip jaws form respective anvil surfaces in said clip mouth
adapted to crush said clip legs therebetween during attachment to
said blood vessel or other organic body, said anvil surfaces
proximally disposed with respect to said latch cavities.
29. A surgical instrument as claimed in claim 26 wherein said clip
end hooks have a hook mouth span, wherein each said latch cavity
has a latch bar intermediate said latch cavity and said clip mouth,
said latch bar having a depth less than said corresponding hook end
mouth span.
30. A surgical instrument as claimed in claim 29 wherein said clip
jaws and said corresponding latch cavities and latch bars operate
in a full open position, a partially closed, instrument insertion
position, a fully closed position and a post deposition clip
release position, in said partially closed, instrument insertion
position, said clip jaws adapted to compress said clip legs, and in
said post deposition release position, said corresponding latch
bars of said respective latch cavities adapted to be spaced
intermediate said respective clip end hook mouths, thereby enabling
proximal withdrawal of said clip jaws from the deposited clip.
31. A surgical instrument as claimed in claim 30 including tactile
response indicators for said partially closed, instrument insertion
position, fully closed position and post deposition clip release
position.
32. A surgical instrument as claimed in claim 31 wherein said
tactile response indicators are disposed on one of said clip jaws,
a segment of said clip jaws proximal to a pivotal axis between said
first and second clip jaw, and a proximally disposed handle, said
handle being part of said means for closing.
33. A surgical instrument as claimed in claim 26 wherein the
instrument is elongated, said clip jaws being distally located on
said elongated instrument, said means for closing including a user
compressible handle at a proximal end of said instrument, said
handle coupled to means for transferring compressive force from
said handle to said clip jaws such that said clip jaws close said
clip jaw mouth.
34. A surgical instrument as claimed in claim 33,wherein each said
latch is defined by a cavity open at said corresponding distal end
of said respective jaw, wherein said clip end books have a hook
mouth span, and wherein each said latch cavity has a latch bar
intermediate said latch cavity and said clip mouth, said latch bar
having a depth less than said corresponding hook end mouth
span.
35. A surgical instrument as claimed in claim 34 wherein said clip
jaws and said corresponding latch cavities and latch bars operate
in a full open position, a partially closed, instrument insertion
position, a fully closed position and a post deposition clip
release position, in said partially closed, instrument insertion
position, said clip jaws adapted to compress said clip legs, and in
said post deposition release position, said corresponding latch
bars of said respective latch cavities adapted to be spaced
intermediate said respective clip end hook mouths, thereby enabling
proximal withdrawal of said clip jaws from the deposited clip.
36. A surgical instrument as claimed in claim 35 including tactile
response indicators for said partially closed, instrument insertion
position, fully closed position and post deposition clip release
position.
37. A surgical instrument as claimed in claim 36 wherein said
tactile response indicators are disposed on one of said clip jaws,
a segment of said clip jaws proximal to a pivotal axis between said
first and second clip jaw, and said proximally disposed handle.
38. A clip applying surgical instrument for clipping a blood vessel
or other organic body, comprising: a surgical clip having a U or a
V shaped body defined by clip legs each having a respective
terminal clip end, said clip legs lying in a clip defined plane and
each said terminal clip end having a lateral span extending
outboard from said clip plane; a first and a second clip carrying
jaw pivotally coupled together and forming a clip jaw mouth
therebetween, each jaw having a distal end and a proximal end; said
distal end of each said jaw having an open ended channel formed as
a keyway thereon, each said keyway sized to capture a respective
terminal clip end therein and a respective terminal clip end
adapted to act as a key for a corresponding keyway when said clip
is retained in said clip jaw mouth; means for closing said first
and second clip carrying jaw onto each other.
39. A surgical instrument as claimed in claim 38 wherein each said
keyway is open at said distal end of said corresponding jaw and
each said keyway forms, in conjunction with the respective terminal
clip end, a loose tongue and groove lock on opposing lateral sides
of said keyway.
40. A surgical instrument as claimed in claim 39 wherein said first
and second clip jaws form respective anvil surfaces in said clip
mouth adapted to crush said clip legs therebetween during
attachment to said blood vessel or other organic body, said anvil
surfaces proximally disposed with respect to said keyways.
41. A surgical instrument as claimed in claim 38 wherein each said
keyway has a corresponding roof and a floor, said clip jaws and
said corresponding keyways operate in a full open position, a
partially closed, instrument insertion position, a fully closed
position and a post deposition clip release position, in said
partially closed, instrument insertion position, said corresponding
floor of said respective keyway adapted to compress said respective
terminal clip end, in said post deposition release position, said
corresponding floor and roof of said respective keyway adapted to
be spaced apart from said terminal clip ends thereby enabling
proximal withdrawal of said clip jaws from the deposited clip.
42. A surgical instrument as claimed in claim 41 including tactile
response indicators for said partially closed, instrument insertion
position, fully closed position and post deposition clip release
position.
43. A surgical instrument as claimed in claim 42 wherein said
tactile response indicators are disposed on one of said clip jaws,
a segment of said clip jaws proximal to a pivotal axis between said
first and second clip jaw, and a proximally disposed handle, said
handle being part of said means for closing.
44. A surgical instrument as claimed in claim 38 wherein the
instrument is elongated, said clip jaws being distally located on
said elongated instrument, said means for closing including a user
compressible handle at a proximal end of said instrument, said
handle coupled to means for transferring compressive force from
said handle to said clip jaws such that said clip jaws close said
clip jaw mouth.
45. A surgical instrument as claimed in claim 44 wherein each said
keyway has a corresponding roof and a floor, said clip jaws and
said corresponding keyways operate in a full open position, a
partially closed, instrument insertion position, a fully closed
position and a post deposition clip release position, in said
partially closed, instrument insertion position, said corresponding
floor of said respective keyway adapted to compress said respective
terminal clip end, in said post deposition release position, said
corresponding floor and roof of said respective keyway adapted to
be spaced apart from said terminal-clip ends thereby enabling
proximal withdrawal of said clip jaws from the deposited clip.
46. A surgical instrument as claimed in claim 45 including tactile
response indicators for said partially closed, instrument insertion
position, fully closed position and post deposition clip release
position.
47. A surgical instrument as claimed in claim 46 wherein said
tactile response indicators are disposed on one of said clip jaws,
a segment of said clip jaws-proximal to a pivotal axis between said
first and second clip jaw, and said proximally disposed handle.
48. A clip applying surgical instrument for clipping a blood vessel
or other organic body, comprising: a surgical clip having a
substantially U or a V shaped body defined by clip legs extending
from an apex and respective terminal ends on corresponding clip
legs, each terminal end including a outboard clip end hook, said
clip legs, terminal ends and outboard clip end hooks lying in a
singular, clip defined plane; a first and a second clip carrying
jaw pivotally coupled together and forming a clip jaw mouth
therebetween, each jaw having a distal end and a proximal end; said
distal end of each said jaw having a corresponding latch opening
for a respective clip end hook when said clip is retained in said
clip jaw mouth; means for closing said first and second clip
carrying jaw onto each other.
49. A surgical instrument as claimed in claim 48 wherein each said
latch is defined by a cavity open at said corresponding distal end
of said respective jaw.
50. A surgical instrument as claimed in claim 49 wherein first and
second clip jaws form respective anvil surfaces in said clip mouth
adapted to crush said clip legs therebetween during attachment to
said blood vessel or other organic body, said anvil surfaces
proximally disposed with respect to said latch cavities.
51. A surgical instrument as claimed in claim 48 wherein said clip
end hooks have a hook mouth span, wherein each said latch cavity
has a latch bar intermediate said latch cavity and said clip mouth,
said latch bar having a depth less than said corresponding hook end
mouth span.
52. A surgical instrument as claimed in claim 51 wherein said clip
jaws and said corresponding latch cavities and latch bars operate
in a full open position, a partially closed, instrument insertion
position, a fully closed position and a post deposition clip
release position, in said partially closed, instrument insertion
position, said clip jaws adapted to compress said clip legs, and in
said post deposition release position, said corresponding latch
bars of said respective latch cavities adapted to be spaced
intermediate said respective clip end hook mouths, thereby enabling
proximal withdrawal of said clip jaws from the deposited clip.
53. A surgical instrument as claimed in claim 52 including tactile
response indicators for said partially closed, instrument insertion
position, fully closed position and post deposition clip release
position.
54. A surgical instrument as claimed in claim 53 wherein said
tactile response indicators are disposed on one of said clip jaws,
a segment of said clip jaws proximal to a pivotal axis between said
first and second clip jaw, and a proximally disposed handle, said
handle being part of said means for closing.
55. A surgical instrument as claimed in claim 48 wherein the
instrument is elongated, said clip jaws being distally located on
said elongated instrument, said means for closing including a user
compressible handle at a proximal end of said instrument, said
handle coupled to means for transferring compressive force from
said handle to said clip jaws such that said clip jaws close said
clip jaw mouth.
56. A surgical instrument as claimed in claim 55 wherein each said
latch is defined by a cavity open at said corresponding distal end
of said respective jaw, wherein said clip end hooks have a hook
mouth span, and wherein each said latch cavity has a latch bar
intermediate said latch cavity and said clip mouth, said latch bar
having a depth less than said corresponding hook end mouth
span.
57. A surgical instrument as claimed in claim 56 wherein said clip
jaws and said corresponding latch cavities and latch bars operate
in a full open position, a partially closed, instrument insertion
position, a fully closed position and a post deposition clip
release position, in said partially closed, instrument insertion
position, said clip jaws adapted to compress said clip legs, and in
said post deposition release position, said corresponding latch
bars of said respective latch cavities adapted to be spaced
intermediate said respective clip end hook mouths, thereby enabling
proximal withdrawal of said clip jaws from the deposited clip.
58. A surgical instrument as claimed in claim 57 including tactile
response indicators for said partially closed, instrument insertion
position, fully closed position and post deposition clip release
position.
59. A surgical instrument as claimed in claim 58 wherein said
tactile response indicators are disposed on one of said clip jaws,
a segment of said clip jaws proximal to a pivotal axis between said
first and second clip jaw, and said proximally disposed handle.
60. A method of placing a surgical clip onto a blood vessel of
other organic body via a clip applier having clip jaws on its
distal end which carrying said surgical clip, said clip applier
extending through a cannula, the method comprising the steps of:
partially closing said surgical clip by compressing said clip jaws
prior to insertion into said cannula; opening said surgical clip
after exiting said cannula; placing said opened surgical clip about
said blood vessel or other organic body; compressing and fully
closing said surgical clip by closure of said clip jaws thereby
depositing said surgical clip on said blood vessel or other organic
body; partially opening said clip jaws and then proximally
withdrawing said clip jaws from the closed surgical clip; and
withdrawing said clip jaws proximally through said cannula.
61. A method as claimed in claim 60 wherein said step of partially
closing said surgical clip prior to insertion into said cannula
places said clip jaws in an instrument insertion position, and the
method includes the step of further placing said clip jaws in said
instrument insertion position after said step of partially opening
said clip jaws and proximally withdrawing said clip jaws but before
said step of withdrawing said clip jaws proximally through said
cannula
Description
[0001] The present patent application is a divisional patent
application based upon application Ser. No. 09/692,050 filed Oct.
19, 2000, now pending, which was a regular patent application and
claiming the benefit of provisional patent application Ser. No.
60/160,387 filed Oct. 19, 1999, now pending.
[0002] The present invention relates to a surgical clip designed to
be inserted into a small size access port on cannula, an associated
clip applicator and a method therefor
BACKGROUND OF THE INVENTION
[0003] The current trend in minimally invasive surgery is to
utilize smaller and smaller ports for access to the surgical site
via cannulae or small tubes for insertion into body cavities.
Currently, 5 mm ports are being utilized instead of the original 10
mm port for instrument access in laparoscopy and other types of
minimally invasive surgery. In addition, 2 to 3 mm ports are being
used for access and, as a result, smaller instruments are required
to operate through these smaller ports and cannulae.
[0004] A frequently used instrument in minimal access surgery is a
clip applier or clip applicator. This instrument is utilized in
most operations for the ligation of vessels, tubular structures and
other organs or organic bodies. One of the problem encountered by
the reduction in size of the clip applier is that there is an
irreducible dimension between the legs of the clip which is
required to enable the clip to encircle the target structure (i.e.;
blood vessel or other organic body). Since most clips are applied
to the blood vessel or body in an open, incipient, clip-on position
(excluding springs clips), the dimension exceeds 5 mm, precluding
access through a 5 mm or smaller access port on cannulae. Clips
small enough to be introduced through a small port (5 mm or less)
lose their utility because the small opening between the jaws or
the legs of the clip minimize the usefulness or utility of the
clip.
[0005] The following patent disclosures show surgical clips: U.S.
Pat. No. 3,326,216 to Wood; U.S. Pat. No. 4,188,953 to Klieman et
al.; U.S. Pat. No. 4,449,530 to Bendel et al.; U.S. Pat. No.
4,844,066 to Stein; U.S. Pat. No. 4,971,198 to Mericle; U.S. Pat.
No. 4,972,949 to Peiffer; U.S. Pat. No. 5,192,288 to Thompson et
al.; U.S. Pat. No. 5,330,442 to Green et al.
[0006] The following patent disclosures show surgical instrument
handles: U.S. Pat. No. 5,582,615 to Foshee et al. and U.S. Pat. No.
5,709,706 to Kienzle et al.
OBJECTS OF THE INVENTION
[0007] It is an object of the present invention to correct or
circumvent the major problem of utilizing smaller and smaller
access ports on cannulae by providing a specially designed surgical
clip and an associated clip applicator.
[0008] It is another object of the present invention to provide a
surgical clip which can be partially closed to reduce the clip leg
span thereby permitting insertion into small access ports.
[0009] It is another object of the present invention wherein
surgical clips, classified as medium, medium large, or large sizes
(all currently requiring the use of larger than Smyn access ports),
can be inserted into 5mm access ports (or smaller) when the clips
are constructed in accordance with the principles of the present
invention.
[0010] It is a farther object of the present invention to provide
surgical clips having terminal ends with a lateral span being
larger than the span of the clip leg body such that the flare ends
coact with channels on the clip jaws of the clip applier thereby
permitting the clip applier to partially close the captured clip
prior to insertion through a small access port, then permitting
expansion of the surgical clip after the clip and the clip jaws
pass through the distal port on the cannula such that the clip can
be opened to a full clip leg span and then applied, by compression,
onto the blood vessel or other organic body.
[0011] It is a further object of the present invention to provide
clip applier or clip applicator designs utilizing the specially
designed surgical clips.
[0012] It is an additional object of the present invention to
provide one tactile response to the operator indicative of a
partially closed, insertion position or a fully closed position or
a post deposition clip release position.
SUMMARY OF THE INVENTION
[0013] The surgical clip includes a U or a V shaped body having
clip legs extending from its apex. The clip legs lie in an
imaginary clip defined plane and the terminal ends of each clip leg
have a lateral span extending outboard from the clip defined plane.
The terminal ends, in certain embodiments, take the shape of a
triangle, an oval, a T-shape, an oblong and a wide end hexagonal
shape. In another embodiment, the clip's terminal ends include
outboard directed hooks. The inboard surface of the surgical clip
may have gripping grooves thereon. A clip applicator is utilized to
carry the surgical clip to the surgical site. The clip applicator
includes a first and a second clip carrying jaw pivotally coupled
together to form a clip jaw mouth therebetween. At the distal end
of each clip jaw, an open ended channel is formed as a keyway. The
keyway is sized to capture a respective terminal clip end therein
such that the terminal clip end acts as a key for the keyway when
the clip is retained in the clip jaw mouth. If the clip defines
hooked terminal ends, the clip jaws define complementary latch
openings. The clip applier also includes a system for closing the
clip jaws onto each other. The system for closing includes a
variety of structures including linked scissor-like members, cam
actuators and cam follower channels or cam follower surfaces
responding to longitudinal movement of the cam actuators. In a
preferred embodiment, the surgical instrument or clip applier
includes tactile response indicators (which may be detents on the
clip jaws or proximal jaw bodies) providing an indicator to the
user that the clip jaws are in a partially closed, instrument
insertion position or a fully closed clip compression position or a
post deposition clip release position.
BRIEF DESCRIPTION OF THE DRAWINGS
[0014] Further objects and advantages of the present invention can
be found in the detailed description of the preferred embodiments
when taken in conjunction with the accompanying drawings in
which:
[0015] FIGS. 1A-1C diagrammatically illustrate surgical clips with
flared terminal ends;
[0016] FIG. 2 diagrammatically illustrates a U-shaped clip in
accordance with the principles of the present invention;
[0017] FIG. 3A diagrammatically illustrates a surgical clip wherein
the terminal clip end includes an outboard hook and wherein the
clip carrying jaws of the clip applier are shown in broken
lines;
[0018] FIGS. 3B and 3C diagrammatically illustrate a surgical clip
with a hooked end wherein FIG. 3B shows a U-shaped clip and FIG. 3C
diagrammatically illustrates a detail view of the clip applier
wherein the surgical clip is shown in broken lines;
[0019] FIG. 4 diagrammatically illustrates a different construction
for the clip applier wherein the surgical clip is shown in broken
lines;
[0020] FIGS. 5A, 5B and 5C diagrammatically illustrate various
constructions of the open ended channel on the clip jaws (FIG. 5B
shows the clip in the clip jaw mouth);
[0021] FIGS. 6A, 6B, 6C, 6D and 6E diagrammatically illustrate
various aspects of the channel on the clip applier jaws;
[0022] FIGS. 7A, 7B, 7D, 7E, 7F and 7G diagrammatically illustrate
various operational positions of the clip carrying jaws and FIG. 7C
diagrammatically illustrates one embodiment of the tactile response
for the partially closed, instrument insertion position illustrated
in FIG. 7B;
[0023] FIG. 8A and FIG. 9A diagrammatically illustrate a fully
closed and compressed clip on a blood vessel or other organic body
wherein the clip is a hooked end clip and a flare end clip,
respectively (FIG. 7F diagrammatically illustrates the clip applier
in the closed clip position);
[0024] FIG. 8B diagrammatically illustrates a side view of the hook
end clip in the compressed clip or closed clip position;
[0025] FIGS. 8C, 9B and 9C diagrammatically illustrate the post
deposition clip release position for the hook end clip (FIG. 8C)
and the flare end clip (FIGS. 9B, 9C);
[0026] FIGS. 9D and 9E diagrammatically illustrate withdrawal of
the clip applicator jaws (shown in broken lines) from the clip;
[0027] FIGS. 10A-10C diagrammatically illustrate tactile response
indicators for the partially closed, instrument insertion position
and the fully closed clip compressed position and the post
deposition clip release position (excepting FIG. 10C which shows a
two position tactile response indicator);
[0028] FIG. 11A diagrammatically shows a closure system indicative
of a plurality of links and pivots having a handle on a proximal
end of the instrument and the clip applier jaws at a distal end of
the instrument;
[0029] FIG. 11B diagrammatically illustrates tactile response
indicators on the handle grip of FIG. 11A.
[0030] FIG. 12A diagrammatically illustrates a side view of a
surgical clip;
[0031] FIG. 12B diagrammatically illustrates the surgical clip with
two X-shaped channels on the terminal planar facial segment;
[0032] FIG. 12D diagrammatically illustrates a perspective view of
the surgical clip showing the X-shaped channel on the terminal,
planar facial segment and the longitudinal center channel;
[0033] FIG. 12E diagrammatically illustrates a cross-section of the
clip from the perspective of section line 12E'-12E" in FIG.
12A;
[0034] FIG. 13A diagrammatically illustrates one embodiment of a
handle for the surgical instrument and one type of tactile response
surface;
[0035] FIG. 13B diagrammatically illustrates the coupling between a
handle actuator member and the longitudinally movable rod, and
particularly shows the ability of the operator to rotate the
elongated tube thereby rotating the attached end piece;
[0036] FIGS. 14 and 15 diagrammatically illustrate a clip applier
closure system utilizing a cam longitudinally moving-in a cam
follower channel; and
[0037] FIGS. 16A through 16C diagrammatically illustrate exterior
cam surfaces on clip jaws which are closeably actuated by the
longitudinal extension of a rod, tube or extending actuation
member.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0038] The present invention relates to a surgical clip, an
associated clip applicator and a method therefor.
[0039] The present invention generally relates to a specially
modified clip that has been designed for small access port
insertion. The clip is constructed of the biocompatible material
(titanium, stainless steel, etc.) and utilizes annealed or
compressible metals or plastic materials. The distal tips of the
legs of the clip are modified to a slightly expanded shape as
compared to the remainder of the clip body so that a small portion
of the terminal end of the legs of the clip are wider than the rest
of the clip producing a slight "wedge" or "wing" configuration.
This modification allows the clip to be held securely in a channel
on the clip carrying jaws of the clip applier wherein the channel
is slightly wider at the distal end. Utilizing this innovation, the
clip can be picked up (individually or from a clip cartridge)
compressed into the closed position, thereby minimizing its open
clip profile and width of jaw distance, inserted through a small
cannula, then opened to its incipient clip-on position and useful
size by reopening the jaws of the applicator which pry the clip
apart into its formerly open position.
[0040] It is in this configuration that the clip is applied to the
structure (blood vessel or other organic body) and is then
compressed again by the jaws of the clip applying instrument.
Slight recoil of the clip applier jaws to a detent allows the
applying instrument to slide off backwards from the closed clip. In
order to facilitate this action, slack is provided between the
expanded tip of the clip legs and its enclosing clip applier jaw
channel so that no reopening of the clip occurs as the jaws recoil.
The instrument is then slid backwards extricating the closed clip
from the clip applier jaws and leaving it in the desired location
and position.
[0041] The clip design utilizes clip shapes that can be compressed
and then reopened to their previous shape and dimension. Such
designs include a "U" shaped or a "V" shaped surgical clip. These
designs serve this purpose well. Also, by providing appropriate
detents in the clip applying instrument, partial closure only can
be accomplished, thereby deforming the clip minimally to a
partially open, clip insertion position prior to cannula insertion,
final application and compression. Closure sufficient to reduce the
clip span and instrument to the internal diameter of the required
port of the cannula is all that is necessary to achieve the
required results.
[0042] The invention described herein provides a unique method for
applying surgical clips of any reasonable size through extremely
small access ports. This development is in keeping with the trend
of utilizing smaller and smaller ports for minimally invasive
surgery such as laproscopy, etc. Drawings provided herewith
illustrate some applicable clip and instrument designs, but other
designs are encompassed by the method of inserting the malleable
clip and clip applier in a closed or partially closed position
until the small dimensions of the access port are cleared. The clip
is then opened by the jaws of the clip applicator, applied to the
appropriate site and then compressed. This principle is
incorporated into several clip and instrument designs for use in
minimal access surgery.
[0043] FIG. 1A diagrammatically illustrates surgical clip 10 having
clip legs 12, 14 defining an apex 15 at one end thereof. Clip legs
12, 14 have a lateral width w which is substantially equal.
Accordingly, the clip legs lie in an imaginary plane defined by the
clip legs. The clip defined plane is normal or perpendicular to
dimension w and both legs 12, 14 lie in the plane. Clip 10 includes
terminal ends 16, 18 and these terminal ends have a lateral span I
which extends outboard from the clip defined plane formed by legs
12, 14. In other words, terminal ends 16, 18 are wider (l) than the
lateral span w of clip legs 12, 14. Clip 10 has a clip body defined
by legs 12, 14 and apex 15. Similar numerals designate similar
items throughout the drawings.
[0044] FIG. 1B diagrammatically illustrates surgical clip 10
wherein terminal ends 16, 18 have an oval or an oblong shape. In
FIG. 1A, terminal ends 16, 18 have a generally triangular
shape.
[0045] FIG. 1C diagrammatically illustrates surgical clip 10
wherein terminal ends 16, 18 have a T-shape. The horizontal portion
of the T-shape is established by lateral wings identified as wings
20, 22 in connection with terminal end 16. FIGS. 1A-1C illustrate
V-shaped surgical clip 10.
[0046] FIG. 2 shows a U-shaped surgical clip 10. Terminal ends 16,
18 define a wide end hexagonal shape. The wide end, hexagonal shape
is established by terminal end surface 24, terminal side surfaces
25, 26, proximal angled surfaces 27, 28 and an imaginary rear end
which is integral with clip leg 12. Preferably, surgical clip 10 is
a one piece, integral body.
[0047] As used herein, the term "distal" refers to a feature of an
item that is further removed from the surgeon or the user who
operates the clip applier at a remote distance from the surgical
site, that is, on a proximal end of the clip applicator or applier.
As discussed later in connection with FIG. 7E, surgical clip 10 is
compressed about a blood vessel or other organic body and terminal
ends 16, 18 typically are remotely disposed at a distal end of the
surgical instrument or clip applier.
[0048] As used herein, the term "substantially U or V-shaped body"
refers to a clip which wraps upon itself such that the clip legs
can be opened or closed. Further, the specific configuration of the
terminal ends of the clip can take a variety of forms. One
important feature with respect to the clip shown in FIGS. 1A-2 is
that the terminal ends have lateral wings or laterally extending
tabs, features or protrusions which act as keys fitted into keyways
defined in the terminal end of clip jaws. The features are
discussed later in connection with FIGS. 4, 5A, 5C and 6A-6E. The
clips illustrated in FIGS. 1A-2 have flared terminal ends.
[0049] FIG. 3A diagrammatically illustrates surgical clip 10 having
hook ends 30, 32 at terminal ends 16, 18. Surgical instrument or
clip applicator 40 is shown in broken lines. Clip applier 40
includes first and second clip jaws 42, 44 which, in the
illustrated embodiment, pivot about common axis 46. Essentially,
hook ends 30, 32 wrap around the terminal ends of clip jaws 42,
44.
[0050] FIG. 3B diagrammatically illustrates a U-shaped surgical
clip 10 with outboard hook ends 30, 32 retained at the distal end
of clip applicator clip jaws 42, 44.
[0051] FIG. 3C diagrammatically illustrates clip jaws 42, 44
carrying clip 10 in clip jaw mouth 43. In the illustrated
embodiment, surgical clip 10, shown in broken lines in FIG. 3C, has
a clip leg 14 disposed in a shallow depth channel 43.
Alternatively, inboard surfaces 48, 49 of clip jaws 42, 44,
respectively, may provide an anvil surface without channel 43.
[0052] Clip jaws 42, 44 include distal ends 50, 52. Distal ends 50,
52 define latch openings 54, 56 which are generally complementary
to outboard extending hooks 30, 32. In other words, hooks 30, 32
form hook mouths, one of which is hook mouth 33 shown in connection
with hook 32. In the illustrated embodiment, latch opening 54 has a
front end recess 56 generally equivalent to thickness or span 60 of
hook 30 on clip leg 12 shown in FIG. 3B. In other words, terminal
end surface 62 of hook end 30 shown in FIG. 3C is generally
co-planar to terminal end surface 50 of clip jaw 42.
[0053] In FIG. 3B, the latch opening does not include sidearms.
Sidearms 64, 66 are shown in FIG. 3C defining side walls of latch
54 and front end recess 56. Sidearms 64, 66 provide lateral
stability to retain hook clip 10 on jaw 42. Further details of
latch 54 are discussed later in connection with FIGS. 8A-8C.
[0054] FIG.4 diagrammatically illustrates clip 10 shown in broken
lines and retained by clip jaws 42, 44. Clip jaws 42, 44 form a
clip jaw mouth 43 therebetween. The distal ends 50, 52 of jaws 42,
44 are cut-away to form open ended channels 70, 72 which define
keyways sized to capture terminal clip ends 16, 18 therein.
Essentially, open ended channels 70, 72 form a respective keyway
for a corresponding key configuration established by terminal clip
ends 16, 18. As discussed later in connection with FIGS. 5A-5C and
6A-6E, the key and keyway created by terminal ends 16, 18 and open
ended channels 70, 72 retain surgical clip 10 in clip jaw mouth 43.
If the system is oriented with the longitudinal aspect of clip
applier 40 on an imaginary x axis, side arms or side walls 64, 66
are displaced along they axis and the hook ends 30,32 extend in the
z axis. As explained below, the clip 10 is loosely retained in the
z axis. To adequately retain the clip in clip jaw mouth 43, the
clip may be closely retained in the x and y axis.
[0055] FIG. 5A and 5B diagrammatically illustrate open ended
channels 70, 72 defined on distal end surfaces 50, 52 of clip jaws
42, 44. FIG. 5B shows surgical clip 10 loosely retained in a z axis
in open ended channels 70, 72. In the embodiment illustrated in
FIG. 5A, channel 70 or keyway 70 is formed by roof elements 80, 82,
sidewalls 84, 86 and a floor element 88. Floor element 88 slopes
upwards until it reaches slope break line 89 separating the keyway
or open ended channel 70 from anvil surface 48 of clip leg 42.
Anvil surface 49 and slope break tine 91, separating the floor from
keyway 72, is shown in connection with lower clip jaw 44. Keyway or
open ended channel 72 has a similar configuration as keyway 70.
[0056] In FIG. 5B, flared terminal clip ends 16, 18 are disposed in
keyways 70, 72 thereby establishing flared ends 16, 18 as keys
complementary in shape to keyways 70, 72. Roof elements 80, 82
enable the operator, by moving clip jaws 40, 42 in the z axis, to
open clip 10 as necessary. Floor 88 forming keyway 70 and the
corresponding floor for keyway 72 enable the operator, via clip
jaws 42, 44, to close either partially or completely clip 10
disposed in clip jaw mouth 43. The anvil surface or proximal clip
jaw portions are also utilized to close and compress the clip.
[0057] FIG. 5C shows a slightly different configuration for keyways
70, 72. Rather than a sloped surface established by floor 88, floor
88 is stepped or separated from anvil surface 48 by a step surface
or step wall 93.
[0058] FIG. 6A diagrammatically illustrates a detail, partial,
cross-sectional view of the distal end of clip jaw 42. Keyway 70
includes roof element 80, floor 88, sidewall 84 and rear end
sidewall or step 93. Sidewall step 93 is disposed proximally
inboard with respect to distal end surface 50 of clip jar 42.
[0059] FIG. 6B shows a top, plane view of keyway 70 and shows that
roof elements 80, 82 protrude laterally inboard into keyway 70 over
sidewall surfaces 84, 86. FIG. 6A is a view from the perspective of
section line 6A'-6A" in FIG. 6B.
[0060] FIG. 6C shows a modification of keyway 70 wherein sidewalls
84, 86 are angled towards the longitudinal center line such that
the open ended mouth of keyway 70 is laterally larger (y axis) than
the proximal inboard portion of keyway 70 adjacent sidewall step
93. It should be noted that sidewall step 93 in FIG. 6C may be
replaced by the slope break line 89 which separates keyway 70 in
FIG. 5A from anvil surface 48 of clip leg 42.
[0061] FIG. 6D shows flared terminal clip end 16, shown as a broken
line, disposed in keyway 70. The lateral extensions 2, 4 of
terminal end 16 are captured beneath roof segments 80, 82 of keyway
70.
[0062] FIG. 6E shows that lateral tabs or extensions 2, 4 of flared
terminal end 16 of clip 10 are closely captured and mate with
sidewalls 84, 86 of keyway 70. This mating of side surfaces of the
lateral flared tabs 2, 4 of terminal end 16 enable clip jaw 42 to
capture clip 10 and position the clip at the terminal end surface
50 of clip jaw 42. FIG. 6D shows a loose fit (z axis) between
flared end wings 2, 4 of clip end 16 as compared with sidewalls 84,
86.
[0063] FIGS. 7A-7G generally show the operation of clip jaws 42, 44
and the clip action of clip 10 on a blood vessel or other organic
body. FIG. 7C shows a tactile response mechanism configured as a
detent providing a tactile response to the operator that the
surgical clip is in a partially closed, instrument insertion
position.
[0064] The following Closure Position Table (Operational Sequence)
generally shows the sequential operation of the clip applier 40 in
the present invention. The table immediately following entitled
Closure Position Table (Mechanical Positions), lists the four (4)
primary mechanical positions of the clip applier 40 ignoring the
operational sequence shown in the earlier table.
[0065] Closure Position Table (Operational Sequence)
[0066] Full open (FIG. 7A)
[0067] Partially closed for insertion (FIG. 7B)
[0068] Full close for deposition on vessel or structure (FIG.
7F)
[0069] Partial release for withdrawal of clip from jaw (FIG.
7G)
[0070] Closure Position Table (Mechanical Positions)
[0071] Full open
[0072] Partial close for insertion
[0073] Partial clip release position
[0074] Full close for clip deposition
[0075] FIG. 7A diagrammatically shows clip applier 40 retaining
surgical clip 10 in clip jaw mouth 43. Although surgical clip 10 is
a hook end surgical clip is shown in FIG. 7A, a flared end surgical
clip, similar to the one shown in FIGS. 1A-1C in FIG. 2, may be
utilized. FIG. 7A diagrammatically illustrates clip jaws 42, 44 in
a fully open position. In this fill open position, clip jaw mouth
43 is open a distance 110. Clip 10 is disposed in clip jaw mouth 43
by an appropriate methodology discussed in connection with various
clip holders. Persons of ordinary skill in the art understand this
methodology.
[0076] In FIG. 7A, clip 10 is fully open since clip jaws 42, 44 are
in their fully open position. In FIG. 7B, clip jaws 42, 44 are
partially closed to a partially closed, instrument insertion
position such that the span 112 of clip jaws 42, 44 (as well as the
span of surgical clip 10) is small enough to enable insertion into
a small access port and cannula for laproscopic or minimally
invasive surgical procedures. Preferably, span distance 112 is
smaller than 5mm and possibly smaller than 2-3 mm. Clip jaws 42, 44
pivot about common axis 46. A small mechanical stop 113 in FIG. 7A
limits the span 110 of clip jaws 42, 44. Returning to FIG. 7B, the
operator is provided a tactile response by an indicator 114. As
shown in FIG. 7A, indicator 114 on the proximal segment of jaw 44
cooperates with indicator 116 on the proximal segment of jaw 42.
FIG. 7C shows that indicator 116 is a depression and indicator 114
is a protrusion or bump. In other words, tactile indicator response
surfaces 116, 114 operate as detents in other to tactily inform the
user that surgical instrument or clip applier 40 is in the
partially closed, instrument insertion position. After full
insertion through the cannula and after clip jaws 42, 44 extend
distally beyond the distal end or exit port of the cannula (not
shown), clip jaws 42, 44 maybe opened to span 118 (FIG. 7D) which
is large enough to engage blood vessel 120 or other organic body
element sought to be clipped by surgical clip 10. This is shown in
FIG. 7D. Although a blood vessel 120 is shown in FIG. 7D, it should
be understood by persons with ordinary skill in the art that other
organic body structures may be clipped by surgical clip 10.
[0077] In FIG. 7E, clip jaws 42,44 are partially closed thereby
partially closing clip 10 about blood vessel 120.
[0078] FIG. 7F diagrammatically shows the fully closed or clip
compressed position of clip jaws 42, 44. In this position, clip jaw
span 124 is a minimal span distance.
[0079] FIG. 7G diagrammatically shows clip jaws 42, 44 slightly
expanded such that clip jaw span 126 is larger than clip jaw span
124 shown in FIG. 7F. FIG. 7G shows clip jaws 42, 44 in a post
deposition clip release position. This post deposition clip release
position is discussed later in connection with FIGS. 8C and 9C.
[0080] FIGS. 8A-8C show the hook end surgical clip (see FIG. 3A) in
the clip compression position (FIGS. 8A, 8B) and in the post
deposition clip release position (FIG. 8C).
[0081] FIG. 9A shows a flared end clip in a keyway in a fully
compressed position and FIGS. 9B and 9C show the jaws in the post
deposition clip release position.
[0082] In FIGS. 8A-8C, the hook ends of clip 10 are disposed in
latch openings 54, 56. As best shown in FIG. 8B, hook ends 30, 32
define hook mouths which are larger (on a z axis) than latch
openings 54, 56. Hook mouths 35, 33 are shown in connection with
hook ends 30, 32 in FIG. 8C. In FIGS. 8A and 8B, clip jaws 42, 44
flatten or compress clip 10 on blood vessel 120. Although blood
vessel 120 is shown in these drawings, clip 10 could be placed on
any other organic body structure. As shown in FIG. 8B, latch
openings 54, 56 provide a space in the hook mouths defined by hook
ends 30, 32. In FIG. 8C, clip jaws 42, 44 have been slightly opened
to a post deposition clip release position such that the up turned
extensions of hook ends 30, 32 (in the z axis) are essentially
midway in latch mouths 54, 56. In other words, hook ends 30, 32,
which establish hook mouths 35, 33, are larger in the z axis than
the forward extensions 130, 132 defining latch openings 54, 56. In
the post deposition clip release position, when the clip jaws are
slightly opened a distance 126 shown in FIG. 7G, the latch openings
54, 56 enable the surgeon or user to proximally withdraw the clip
jaws 42, 44 away from the clip 10 which has been deposited on blood
vessel 120. Thereafter, the clip appliance 40 is placed in the
partially closed for insertion position shown in FIG. 7B and the
clip applier 40 is proximally withdrawn through the cannula by the
surgeon or user.
[0083] FIGS. 9A-9C diagrammatically illustrate clip 10 in a
compressed position (FIG. 9A) and in the post deposition clip
release position (FIG. 9B and 9C). FIG. 9A diagrammatically
illustrates clip 10 having flare ends 2, 4 disposed in the keyway
established by keyway floor 88, keyway sidewalls 84, 86 and keyway
roof elements one of which is roof element 80. Clip 10 has been
fully collapsed onto blood vessel 120. This position is similar to
that shown in connection with FIG. 7F. FIGS. 9B and 9C show flare
ends 2, 4 of clip 10 essentially midway in keyway 70. In other
words, in the fully compressed operational mode shown in FIG. 9A,
flare ends 2, 4 and the other portions of the terminal ends of clip
10 are closer to floor elements 88, 89 as compared with roof
elements 80, 81. In contrast in FIG. 9B, clip flare elements 2, 4
are closer to the roof element 82 as compared to floor element 88
of keyway 70. This spacial situation is shown in detail in FIG. 9C.
Clip flare element 2 is illustrated at a midway position in keyway
70, approximately midway between floor 88 of keyway 70 and roof
element 80 of keyway 70. In this configuration, which is the post
deposition clip release position, the clip jaws can be withdrawn
proximally thereby removing or withdrawing the over hang of roof
elements 84, 86 from flare elements 2, 4 of the clip. This movement
is in an x axis direction or longitudinally.
[0084] FIGS. 9D and 9E diagrammatically illustrate the movement of
clip jaw 42, shown in broken lines, away from flare clip end 16. In
FIG. 9D, clip jaw 42 has not been moved proximally away from flare
clip end 16. In FIG. 9E, sidewalls 84, 86 of clip 42 are moved away
from flare elements 2, 4 of clip end 16. The resulting freedom of
the clip jaws enables the operator to further open the clip jaws
42, 44 as necessary. To extract the jaws, the jaws must be in the
partially closed instrument insertion position shown in FIG.
7B.
[0085] FIGS. 10A-10C diagrammatically show tactile response
indicators for the fully opened position (FIG. 10A), and partially
closed insertion position (FIG. 10C). In FIG. 10A, three tactile
response units 114A are formed on proximal section 42B of clip jaw
42. A complementary group of tactile response units 116A are formed
on proximal segment 44B of clip jaw 44. In FIG. 10B, three tactile
response units 114A are formed on proximal segment 42B and only a
single tactile response unit 116 is formed on proximal segment 44B
of the other clip jaw. These tactile response units may take any
complementary form, such as bumps, ribs or corresponding recesses
in the opposite surface such that the user is tactily informed when
the system reaches the partially closed instrument insertion
position (FIG. 7B), the fully closed position (FIG. 7F), and the
post deposition clip release position (FIG. 7G and FIGS. 9B and
8C). In FIG. 10C, a single tactile response unit 114A is utilized
in connection with complemental tactile response units 116C, 116D.
Two tactile response systems are utilized to show the partially
closed instrument insertion position in the post deposition clip
release position. The surgeon or the operator should be able to
determine the fully closed position since that fully closed
position would be beyond the "two click" position. As shown in the
Closure Position Table (Mechanical Positions), the two clicks are
represented by the partial close for insertion and the partial clip
release position. From mechanical standpoint, the full closure for
clip deposition is beyond the partial close for insertion and the
partial clip release position. Hence, two tactile response
indicators may be provided since the surgeon can easily determine
that an additional compressive force is required to fully compress
the clip on blood vessel 120 which is beyond the "two click"
position. Alternatively, response point 116D may operate as a
detent which temporarily stops further clip jaw open movement after
complete clip compression. During clip compression (FIG. 7F), the
clip jaws may recoil open. Response point 116D may operate as a
detent to temporarily latch the jaws at the post deposition
position.
[0086] FIG. 11A diagrammatically shows the surgical instrument
which closes clip jaws 42, 44 like a scissor about common axis 46.
A link and pivot mechanical system to transmit the compressive
force longitudinally from the handle is diagrammatically
illustrated along elongated segment 140. Other mechanical
transmission systems may be utilized. At the proximal end of the
instrument, handles 142, 146 are provided. By compressing handles
142, 146 together as shown by the arrow indicators in FIG. 11A, the
mechanical linkage system 140 causes clip jaws 42, 44 to rotate
about common axis 46 thereby closing jaws 42, 44 and the captured
clip 10.
[0087] FIG. 11B shows a tactile response system which may be
configured on spanning member 148 intermediate handles 142, 146.
Spanning member 148 consists of surface 150 and surface 152.
Surface 150 includes tactile response units 153,154 and 156.
Surface 152 includes tactile response unit 158. When tactile
response unit 158 moves over response surfaces 153, 154 and 156,
the user is provided with a tactile response indicator which is
indicative of the open or close position of clip jaws 42, 44. These
closure positions represent the closure positions of the clip jaws
42, 44 discussed above.
[0088] The present invention may be utilized in conjunction with
surgical clips having certain gripping surfaces on the inboard
side. Other surgical clip gripping surfaces may be utilized. The
grip surfaces shown in FIGS. 12A-12E provide an example.
[0089] FIGS. 12A-12E diagrammatically illustrate the surgical
clips. As shown in FIG. 12A, surgical clip 1301 is generally
U-shaped. The clips have a clip face 1302 and near terminal facial
segments 1304, 1306. Clip 1301 has intermediate facial segments
1308, 1310. Clip 1301 is bent in region 1312 Facial segments 1304,
1306, 1308 and 1310 are generally planar, that is, the clip
portions that interface with the blood vessel are primarily planar
except for the triangular or V-shaped channels cut or formed
therein. Near terminal planar facial segment 1306 is shown in FIG.
12B. The clip face 1302 includes a longitudinal center channel 1320
which has a triangular or V-shaped cross-section. The triangular
cross-section of center channel 1320 is shown in FIG. 12E. FIG. 12E
is a cross-sectional view of clip 1301 from the perspective of
section line 12E'-12E" in FIG. 12A. The longitudinal center channel
1320 extends through all of the planar facial segments 1304, 1306,
1308 and 1310.
[0090] In FIG. 12D, terminal planar facial segment 1306 includes an
X-shaped channel 1322. The vertices of this X-shaped channel 1322
are coextensive with the longitudinal center channel 1320.
[0091] In FIG. 12B, terminal planar facial segment 1306 includes a
first and a second X-shaped channel 1322, 1324. The legs of the
X-shaped channel are angularly disposed at approximately 1200. The
X-shaped channels have a triangular cross-sectional shape as shown
at channel end segments 1340, 1341 on clip 1301 shown in FIG.
12E.
[0092] Clip 1301 includes a chamfer 1342, 1344 at its outer,
opposing, lateral edges.
[0093] In a preferred embodiment, the clips are constructed in
three sizes, small, medium and large. The legs of the clip are not
parallel but are abducted to fit a clip holder. The X-shaped
channels on the terminal planar facial segments and the
longitudinal center channel provide a tire grip providing high
traction for the clip on the blood vessel or organic structure. The
lines of this X-shaped pattern with its coextensive vertices along
the longitudinal center channel provide depressions in bas relief
on the active clip faces which increase the frictional grip of the
clip on the blood vessel from all angles.
[0094] The clips are constructed of titanium or tantalum. The clips
are also designed with a greater angle to the diverging leg
segments defining terminal planar facial segments 1304, 1306, in
order to fit the clip jaws. Alternatively, the cross-sectional
aspect of clip 1301 (shown as a triangle in FIG. 12E) may be
rectilinear. The flared ends or hook ends are not shown in FIGS.
12A-12E.
[0095] Surgical instrument 10 may also utilize a handle providing
additional tactile responses. One such handle is shown in FIGS. 13A
and 13B.
[0096] FIG. 13A diagrammatically illustrates handle 1012. Handle
1012 includes stationary grip member 1022 and movable handle member
1020. Movable member 1020 is pivotally mounted to stationary member
1022 via pivot pin or bolt 1028. Stem 1032 of movable member 1020
is movably coupled to an actuator rod 1034. Stem 1032 is biased
toward handle stop 1601 due to biasing spring 1036. Of course,
other biasing mechanisms could be utilized such as leaf spring and
pneumatic or hydraulic springs or mechanisms. In this manner,
movable handle member 1020 is biased in the "full open" direction
shown by arrow 1602.
[0097] Movable handle 1020 includes a tactile response surface
1604. In the illustrated embodiment, tactile response surface 1604
is an undulated or wavy surface. Other types of tactile response
surfaces could be utilized. Handle 1012 includes a racket system
1011 which includes fine tooth gear 1013, swing lock bar 1015 and
control button 1017. The racket locks the handle in a compressed
mode and the operator releases the lock by moving control bar
rearward. Tactile surface 1604 could be a plurality of nubs or
protrusions which ride on and bump against tactile response wall
1606 of stationary handle member 1022.
[0098] FIG.13B diagrammatically illustrates details of the coupler
section between handle 1012 and the elongated tube 1024 as well as
the longitudinally movable rod 1026. Inboard handle segment has a
male threaded joint 1038 which threads onto a female threaded
section 1609. Female threaded section, at its inboard side,
includes a rotatable coupling illustrated, in this embodiment, as a
radially protruding ridge 1610. Outer rotating coupling 1042 forms
a channel 1612 within which is captured radially extending ridge
1610. In this manner, the user can rotate female rotating unit 1042
relative to male rotating coupler 1610 as shown by the double
headed arrow 1046. This rotation in direction 1046 rotates the
elongated tube 1024 and therefore rotates the clip jaws.
[0099] Actuator rod 1034, in this illustrated embodiment, includes
a ball and socket joint within which ball 1040 of movable rod 1026
is placed. In this manner, when actuator 1034 is retracted as shown
by arrow 1614, rod 1026 is also retracted. The dimensions and the
sizing of various components in FIG. 13B do not reflect actual size
or dimensional relationships of the components. For example,
movable rod 1026 may be closely captured by tube 1024. In this
manner, rod 1026 may have various types of cross-sectional
configurations. However, the ability of the operator to move the
clip jaws by rotating female coupler 1042 may be affected by the
cross-sectional configuration of rod 1026.
[0100] In operation, when the operator compresses handle 1020
toward stationary handle 1022 (a direction opposite arrow 1602),
the user feels tactile response surface 1604 as it bumps against
response wall 1606. Response wall 1606 is defined in the stationary
handle member 1022. This informs the operator via tactile sensation
that rod 1026 has retracted to a certain linear position which may
be compressed to a first close position.
[0101] FIGS. 14 and 15 diagrammatically illustrate one embodiment
to convert longitudinal movement into pivotal or rotational
movement about jaw axis 46. In FIGS. 14 and 15, clip jaws 42, 44
have proximal segments 42B and 44B which respectively define cam
following channels 160, 162. Clip 10 is retained in clip jaw mouth
43 by an appropriate channel system as described above. Clip jaws
42, 44 rotate about common axis 46. This rotation or pivotal
movement is accomplished by a cam moving through cam follower
channels 160, 162. In the illustrated embodiment, cam follower
channels 160, 162 are segmented into regions 164, 165, 166 and 167
representing different speeds and degrees of compression. In other
words, clip jaws 42, 44 close at a certain rate when the cam moves
through initial cam follower channel 164, at a different rate when
the cam moves through cam follower channel 165, at a further
different rate when the cam moves through cam follower 166 and a
different rate when the cam follower moves through cam follower
channel 167.
[0102] FIG. 15 shows cam 170 which moves through cam follower
channel 162 and cam follower channel 160. Cam 170 is attached to a
slender bar 180 which, in turn, is attached to a longitudinal
actuator 182. Actuator 182 may be connected to actuator rod 1026 in
FIG. 13B. Bar 180 moves within slot 184. Bar 180 and cam 170 and
actuator 180 move longitudinally with respect to stationary member
186 and elongated, stationary tube 188. Common axis 46 is mounted
in a stationary position by attachment to stationary member 186 and
stationary tube 188. The handle, discussed above and other handles
known to persons of ordinary skill in the art, can provide
longitudinal movement of longitudinal actuator rod 182 relative to
stationary member 186. When cam 170 connected to movable rod 182
moves longitudinally and cam follower channels 160, 162, clip jaws
42, 44 open and close.
[0103] In another embodiment, cam follower channels 160, 162 are
linear. In this embodiment, the closure rate of clip jaws 42, 44
based upon longitudinal movement of cam 170 in the clip follower
channels is uniform. Channels 160, 162 do not bend and are
exclusively linear. Cam 170 is typically a laterally positioned rod
or pin for both embodiments.
[0104] FIGS. 16A-16C diagrammatically illustrate side views of
appliance clip jaws with cam follower surfaces. FIG. 16A
diagrammatically illustrates appliance jaws 1810 in a fully opened
position; FIG. 16B diagrammatically illustrates appliance jaws 1810
partially closed; and FIG. 16C diagrammatically illustrates the
appliance jaws in a substantially closed position. The primary
difference between cam actuated clip jaws 1810 and the clip jaws
shown in FIGS. 14 and 15 is the utilization of clip action cam
follower surfaces rather than clip action cam follower channels. In
FIGS. 16A-16C, surgical appliance 1492 includes a stationary tube
or elongated member 2226 and a longitudinally movable cam actuator
member 2340. Cam actuator member 2340 includes a forwardly disposed
cam surface 1812 which operates on cam follower surfaces 1814 and
1816 on the jaws. The lower jaw member has a cam follower surface
1816. Surfaces 1814, 1816 may be complementary shaped such that the
jaw members 1820, 1822 close substantially simultaneously. Jaw
members 1820, 1822 are pivotally disposed about common lateral axis
1825. Common lateral axis 1825 is maintained in a stationary
position with respect to elongated tube 2226 of surgical appliance
1492. Cam actuator 2340 may have side slots for pivot pin 1825
mounted on stationary tube 2226.
[0105] As cam actuator member 2340 moves longitudinally outboard or
forward, extending as shown by arrow 1830, initially jaw members
1820, 1822 close. This is shown diagrammatically in FIG. 16A. Cam
surface 1814 includes a lateral extension or hump at that
particular longitudinal position of movable rod or cam actuator
member 2340. This provides a tactile response to the operator. The
longitudinal position of actuator 2340 is noted with respect to
stationary rod or tube 2226. Essentially, cam actuator member
forward surface 1812 has not engaged the outboard extending surface
of the tactile response bump at that longitudinal extension
position.
[0106] In FIG. 16C, cam actuator member surface 1812 has moved
beyond the closure point after acting upon lateral extensions or
humps on the cam follower surface 1814, 1816. It should be noted
that multiple closure rates and times (based upon longitudinal
extension positions) may be programmed or cut into or formed by the
cam follower surfaces 1816, 1814.
[0107] Other clip jaw closure systems may be utilized.
[0108] The claims appended hereto are meant to cover modifications
and changes within the scope and spirit of the present
invention.
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