U.S. patent application number 13/080998 was filed with the patent office on 2012-10-18 for articulating steerable clip applier for laparoscopic procedures.
Invention is credited to Pavel Menn.
Application Number | 20120265220 13/080998 |
Document ID | / |
Family ID | 44763259 |
Filed Date | 2012-10-18 |
United States Patent
Application |
20120265220 |
Kind Code |
A1 |
Menn; Pavel |
October 18, 2012 |
Articulating Steerable Clip Applier for Laparoscopic Procedures
Abstract
A long articulating steerable clip applier affixed to a
user-operated handle. A surgical jaw assembly is attached to the
other end of the clip applier. The clip applier is composed of
articulating phalanges that are connected end to end by pivoting
links and capable of angulations relative to one another when
subjected to a tensile force. Each phalange has opposing s-shaped
exterior grooves that form two continuous spiral-shaped channels
for holding tension wires once the phalanges are assembled.
Multiple tension wires are attached to opposite ends of adjacent
phalanges. When each wire is pulled, this tensile force causes the
phalanges to pivot at equivalent angles with each other. As each
individual phalange pivots by an equivalent angle, the sum of these
angles causes the free end of the clip applier to pivot by a large
angle or a cascading actuation effect.
Inventors: |
Menn; Pavel; (Marblehead,
MA) |
Family ID: |
44763259 |
Appl. No.: |
13/080998 |
Filed: |
April 6, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61321233 |
Apr 6, 2010 |
|
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Current U.S.
Class: |
606/142 |
Current CPC
Class: |
A61B 2017/00314
20130101; A61B 17/1285 20130101; A61B 17/10 20130101; A61B
2017/00323 20130101 |
Class at
Publication: |
606/142 |
International
Class: |
A61B 17/10 20060101
A61B017/10 |
Claims
1. An endoscopic surgical tool having a handle and a shaft member
coupled to the handle and extending along a shaft axis from a
proximal end to a distal end, wherein the distal end of the shaft
member is adapted to receive an end effector, comprising: A. a
linear array of n phalanx sections, where n is an integer greater
than 2, wherein the linear array includes a sequentially aligned
proximal phalanx section, n-2 intermediate phalanx sections, and a
distal phalanx section, wherein the ith phalanx section, wherein i
is greater than or equal to 1 and less than or equal to n, extends
along an associated central axis CAi between a proximal end PEi and
a distal end DEL and includes: a tubular member TMi defining a. a
central void region CVRi extending along the central axis CAi
between the proximal end PEi and the distal end DEi, b. an exterior
surface ESi disposed about the central void region CVRi and
extending along the central axis CAi from the proximal end PEi to
the distal end DEi, wherein the n phalanx sections are aligned
whereby the central axis CAi of each phalanx section intersects
with the central axis of phalanx sections adjacent thereto in the
linear array, B. an end effector coupler EEC disposed at the distal
end of the distal phalanx section and adapted for coupling the
distal end to an end effector, C. a base coupling assembly BC
disposed at the proximal end of the proximal phalanx section and
adapted to couple to the proximal end of the proximal phalanx
section to the distal end of the shaft member, whereby the shaft
axis intersects the central axis of the proximal phalanx section
and whereby the proximal phalanx section is movable with respect to
the distal end of the shaft member substantially only in rotational
motion about a transverse axis TA0 perpendicular to the central
axis of the proximal phalanx section, D. n-1 phalanx section
coupling assemblies PC, wherein each phalanx section coupling
assembly is associated with an intermediate phalanx section and
wherein the coupling assembly PCi associated with the ith phalanx
section couples a distal end of the ith phalanx section to the
proximal end of the adjacent i+1th phalanx section whereby the
proximal end of the i+1th phalanx section is movable with respect
to the distal end of the ith phalanx section substantially only in
rotational motion about a transverse axis TAi perpendicular to the
central axis of the ith phalanx section, wherein TAi and TA0 are
mutually parallel, and wherein each of the base coupling assembly
and the n-1 phalanx coupling assemblies are operative whereby a
torque applied to the proximal end of the proximal phalanx section
about an axis parallel to transverse axis TA0, effects a
same-direction angular rotational displacement of each of the ith
phalanx sections with respect to the adjacent phalanx sections
about the respective transverse axes TAi.
2. An endoscopic surgical tool according to claim 1, wherein the
base coupling assembly BC is adapted to detachably couple the
proximal end of the proximal phalanx section to the distal end of
the shaft member.
3. An endoscopic surgical tool according to claim 1, wherein the
end effector coupling assembly EEC is adapted to detachably couple
the end effector to the distal end of the distal phalanx
section.
4. An endoscopic surgical tool according to claim 1, wherein at
least the ith phalanx section coupling assembly Ci includes: i. a
coupling cam surface CCSi disposed about a cam central axis CCAi
affixed to the distal end of the ith phalanx section, wherein the
cam central axis CCAi is substantially coaxial with the transverse
axis TAi, ii. a substantially non-stretchable link coupling a point
on the coupling cam surface of the ith phalanx section CCSPi with a
point EPi+2 on the proximal end of the i+2th phalanx section,
wherein point CCSPi and point EPi are disposed in a plane including
CAi+1 and perpendicular to the transverse axes TAi and TAi+2 and on
opposite sides central axis of the i+1 phalanx section CAi+1.
5. An endoscopic surgical tool according to claim 4, wherein the
link of coupling assembly Ci is a cable extending between point
CCSPi and point EPi+2.
6. An endoscopic surgical tool according to claim 5, wherein the
cable extends in a helical path about the central axis CAi+1
between point CCSPi and point EPi+2.
7. An endoscope surgical tool according to claim 6, wherein the
exterior surface ESi includes an open-faced helical channel HCi+1
disposed about the central axis CAi+1, and the cable of coupling
assembly Ci extends through the helical channel HCi+1.
8. An endoscope surgical tool according to claim 1, wherein the
same-direction angular rotational displacement of each of the ith
phalanx sections with respect to the adjacent phalanx sections are
equi-angle.
9. An endoscope surgical tool according to claim 1, wherein the
tubular members TMi are characterized by the same distance between
the proximal end PEi and the distal end Dei.
10. An endoscope surgical tool according to claim 1, wherein at
least two of the tubular members TMi are characterized by different
distances between their respective proximal ends PEi and distal
ends Dei.
11. An endoscope surgical tool according to claim 1, wherein the
cam surfaces CCSi are circular segments.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application claims the benefit of U.S. Provisional
Patent Application No. 61/321,233 filed on Apr. 6, 2010, the
contents of which are incorporated herein by reference.
FIELD OF THE INVENTION
[0002] This invention relates to a novel articulating steerable
clip applier for laparoscopic or endoscopic procedures.
BACKGROUND OF INVENTION
[0003] Laparoscopic and endoscopic procedures are conducted through
a small incision in the skin or natural body orifices.
[0004] In order to operate on a given tissue or a blood vessel,
surgeons must ligate or occlude blood vessels to prevent patient
blood loss. Surgical clip appliers are used in these surgeries for
the application of hemostatic clips to ligate vessels. Clip
appliers hold a surgical clip in an open position in a pair of
specially adapted jaws. Once these jaws, containing clips, are
positioned over a vessel, the clip is manually released over the
vessel to ligate it. Inaccuracies in movement or failure to
securely occlude the clip to the vessel can result damage to
vessels or tissues, internal bleeding, lethal drops in blood
pressure, infections, or longer recovery periods
[0005] These instruments need to provide precise and accurate
movement in order to ligate vessels within the body that are
difficult to access. Instruments are needed that are narrow enough
to be inserted through a small opening (such as an incision, trocar
or natural body orifice), long enough to reach the desired internal
tissues, and flexible enough to provide a wide range of motion to
navigate the distal end of a clip applier with jaws containing
loaded clips around body tissues to advance towards the internal
operation site.
[0006] Accordingly, the subject invention discloses an improved
steerable articulating surgical clip applier. It contains a long,
narrow, distal articulating disposable portion that is inserted
into a patient during surgery. This distal articulating portion is
removably attached to a proximal non-disposable control unit for
moving the long disposable portion within the patient and operating
actuators to control the articulation and ligation of the clip
applier.
[0007] By separating these two components, the risk of cross
contamination between separate patients or separate tissues on the
same patient is reduced. The non-disposable control unit does not
enter the patient and the contaminated long and narrow component is
simply disposed after each surgical procedure is completed. In
addition, costs are saved since medical providers only need to
replace the disposable component between surgical procedures.
SUMMARY OF THE INVENTION
[0008] There are additional features of the invention that will be
described hereinafter and which will form the subject matter of the
claims appended hereto. In this respect, before explaining at least
one embodiment of the invention in detail, it is to be understood
that the invention is not limited in its application to the details
of construction and to the arrangements of the components set forth
in the following description or illustrated in the drawings. The
invention is capable of other embodiments and of being practiced
and carried out in various ways. Also, it is to be understood that
the phraseology and terminology employed herein are for the purpose
of the description and should not be regarded as limiting.
[0009] The subject invention discloses an endoscopic surgical tool
having a handle and a shaft member coupled to the handle and
extending along a shaft axis from a proximal end to a distal end,
wherein the distal end of the shaft member is adapted to receive an
end effector, comprising: A. a linear array of n phalanx sections,
where n is an integer greater than 2, wherein the linear array
includes a sequentially aligned proximal phalanx section, n-2
intermediate phalanx sections, and a distal phalanx section,
wherein the ith phalanx section, wherein i is greater than or equal
to 1 and less than or equal to n, extends along an associated
central axis CAi between a proximal end PEi and a distal end DEL
and includes: a tubular member TMi defining a. a central void
region CVRi extending along the central axis CAi between the
proximal end PEi and the distal end DEL and b. an exterior surface
ESi disposed about the central void region CVRi and extending along
the central axis CAi from the proximal end PEi to the distal end
DEL wherein the n phalanx sections are aligned whereby the central
axis CAi of each phalanx section intersects with the central axis
of phalanx sections adjacent thereto in the linear array, B. an end
effector coupler EEC disposed at the distal end of the distal
phalanx section and adapted for coupling the distal end to an end
effector, C. a base coupling assembly BC disposed at the proximal
end of the proximal phalanx section and adapted to couple to the
proximal end of the proximal phalanx section to the distal end of
the shaft member, whereby the shaft axis intersects the central
axis of the proximal phalanx section and whereby the proximal
phalanx section is movable with respect to the distal end of the
shaft member substantially only in rotational motion about a
transverse axis TA0 perpendicular to the central axis of the
proximal phalanx section, D. n-1 phalanx section coupling
assemblies PC, wherein each phalanx section coupling assembly is
associated with an intermediate phalanx section and wherein the
coupling assembly PCi associated with the ith phalanx section
couples a distal end of the ith phalanx section to the proximal end
of the adjacent i+1th phalanx section whereby the proximal end of
the i+1th phalanx section is movable with respect to the distal end
of the ith phalanx section substantially only in rotational motion
about a transverse axis TAi perpendicular to the central axis of
the ith phalanx section, wherein TAi and TA0 are mutually parallel,
and wherein each of the base coupling assembly and the n-1 phalanx
coupling assemblies are operative whereby a torque applied to the
proximal end of the proximal phalanx section about an axis parallel
to transverse axis TA0, effects a same-direction angular rotational
displacement of each of the ith phalanx sections with respect to
the adjacent phalanx sections about the respective transverse axes
TAi.
[0010] In a further embodiment of the subject invention, the base
coupling assembly BC may be adapted to detachably couple the
proximal end of the proximal phalanx section to the distal end of
the shaft member.
[0011] In another embodiment of the subject invention, the end
effector coupling assembly EEC may be adapted to detachably couple
the end effector to the distal end of the distal phalanx
section.
[0012] In an additional embodiments of the subject invention, the
ith phalanx section coupling assembly Ci may include: i. a coupling
cam surface CCSi disposed about a cam central axis CCAi affixed to
the distal end of the ith phalanx section, wherein the cam central
axis CCAi is substantially coaxial with the transverse axis TAi, a
substantially non-stretchable link coupling a point on the coupling
cam surface of the ith phalanx section CCSPi with a point EPi+2 on
the proximal end of the i+2th phalanx section, wherein point CCSPi
and point EPi are disposed in a plane including CAi+1 and
perpendicular to the transverse axes TAi and TAi+2 and on opposite
sides central axis of the i+1 phalanx section CAi+1.
[0013] In a further embodiment of the subject invention, the link
of coupling assembly Ci may be a cable extending between point
CCSPi and point EPi+2.
[0014] In another embodiment of the subject invention, the cable
extends in a helical path about the central axis CAi+1 between
point CCSPi and point EPi+2.
[0015] In an additional embodiment of the subject invention, the
exterior surface ESi includes an open-faced helical channel HCi+1
disposed about the central axis CAi+1, and the cable of coupling
assembly Ci extends through the helical channel HCi+1.
[0016] In a further embodiment of the subject invention, the
same-direction angular rotational displacement of each of the ith
phalanx sections with respect to the adjacent phalanx sections are
equi-angle.
[0017] In another embodiment of the subject invention, the tubular
members TMi may be characterized by the same distance between the
proximal end PEi and the distal end Dei.
[0018] In a further embodiment of the subject invention, at least
two of the tubular members TMi may be characterized by different
distances between their respective proximal ends PEi and distal
ends Dei.
[0019] In an additional embodiment of the subject invention, the
cam surfaces CCSi may be circular segments.
[0020] The subject invention also discloses an endoscopic surgical
apparatus comprising: a handle having a front end and defining a
longitudinal axis; an actuation member associated with the handle;
an elongated articulating section comprising a plurality of
interconnected pivotable vertebrae extending distally from the
front end of said handle, wherein the plurality of pivotable
vertebrae comprises an exterior surface, further wherein the
plurality of pivotable vertebrae comprises an interior surface that
defines a channel extending distally from the front end of said
handle to a distal end to permit passage of surgical clips; and a
tensioning system selectively operable from the actuation member to
apply tensioning force to the plurality of interconnected pivotable
vertebrae such that the proximal end of each interconnected
pivotable vertebrae pivots at a substantially equivalent angle.
[0021] Another embodiment of the subject invention is an endoscopic
surgical apparatus comprising: a handle having a front end and
defining a longitudinal axis; an actuation member associated with
the handle; an elongated articulating section comprising a
plurality of interconnected pivotable vertebrae extending distally
from the front end of said handle, wherein the plurality of
pivotable vertebrae comprises an exterior surface, wherein each
pivotable vertebrae comprises a set of opposing spiral-shaped
grooves on the exterior surface such that the elongated
articulating section has contiguous set of opposing spiral-shaped
grooves, further wherein the plurality of pivotable vertebrae
comprises an interior surface that defines a channel extending
distally from the front end of said handle to a distal end to
permit passage of surgical clips; and a plurality of tension wires
inserted into the contiguous spiral-shaped grooves, wherein the
plurality of tension wire are selectively operable from the
actuation member to apply tensioning force to the plurality of
interconnected pivotable vertebrae such that the proximal end of
each interconnected pivotable vertebrae pivots at a substantially
equivalent angle.
[0022] An additional embodiment of the subject invention is an
endoscopic surgical apparatus comprising: a handle having a front
end and defining a longitudinal axis; an actuation member
associated with the handle; an elongated articulating section
comprising a plurality of interconnected pivotable vertebrae
extending distally from the front end of said handle, wherein the
plurality of pivotable vertebrae comprises an exterior surface,
wherein each pivotable vertebrae comprises a set of opposing
spiral-shaped grooves on the exterior surface such that the
elongated articulating section has contiguous set of opposing
spiral-shaped grooves, further wherein the plurality of pivotable
vertebrae comprises an interior surface that defines a channel
extending distally from the front end of said handle to a distal
end to permit passage of surgical clips; and a plurality of tension
wires inserted into the contiguous spiral-shaped grooves, wherein
the plurality of tension wire are selectively operable from the
actuation member to apply tensioning force to the plurality of
interconnected pivotable vertebrae such that the proximal end of
each interconnected pivotable vertebrae pivots at a substantially
equivalent angle.
[0023] A further embodiment of the subject invention discloses an
endoscopic surgical apparatus comprising: a handle having a front
end and defining a longitudinal axis; an actuation member
associated with the handle; an elongated articulating section
comprising a plurality of interconnected pivotable vertebrae
extending distally from the front end of said handle, wherein the
plurality of pivotable vertebrae comprises an exterior surface,
further wherein the plurality of pivotable vertebrae comprises an
interior surface that defines a channel extending distally from the
front end of said handle to a distal end to permit passage of
surgical clips; and a plurality of semi-circular ligaments placed
over the plurality of pivotable vertebrae, wherein the plurality of
semi-circular ligaments are selectively operable from the actuation
member to apply tensioning force to the plurality of interconnected
pivotable vertebrae such that the proximal end of each
interconnected pivotable vertebrae pivots at a substantially
equivalent angle.
[0024] Another embodiment of the subject invention is an endoscopic
surgical apparatus comprising: a handle having a front end and
defining a longitudinal axis; an actuation member coupled with the
handle; an elongated articulating shaft coupled to the handle with
a base coupling assembly and extending distally from the front end
of said handle from a proximal end to a distal end, wherein the
distal end of the articulating shaft is adapted to receive an end
effector, the articulating shaft comprising a linear array of
phalanx sections, wherein the linear array includes a sequentially
aligned proximal phalanx section coupled on a distal end to the
base coupling assembly, intermediate phalanx sections, and a distal
phalanx section adapted to receive the end effector on the distal
end, wherein each phalanx section comprises i) a proximal end and a
distal end; ii) a central cavity extending along a central axis
between the proximal end and the distal end; iii) an exterior
surface; and iv) a set of opposing substantially spiral-shaped
grooves on the exterior surface that extend along each phalanx from
the proximal end to the distal end, wherein each the distal end of
each phalanx section couples the proximal end of the adjacent
phalanx section, whereby the proximal end of the phalanx section is
movable with respect to the distal end of the phalanx section in
rotational motion , and a plurality of tension wires inserted into
the spiral-shaped grooves, wherein the plurality of tension wire
are operable from the actuation member to apply tensioning force to
the linear array of phalanx sections such that the proximal end of
each phalanx section pivots at a substantially equivalent
angle.
[0025] Another embodiment of the subject invention is an endoscopic
surgical apparatus comprising: a handle having a front end and
defining a longitudinal axis; an actuation member coupled with the
handle; an elongated articulating shaft coupled to the handle with
a base coupling assembly and extending distally from the front end
of said handle from a proximal end to a distal end, wherein the
distal end of the articulating shaft is adapted to receive an end
effector, the articulating shaft comprising a linear array of
phalanx sections, wherein the linear array includes a sequentially
aligned proximal phalanx section coupled on a distal end to the
base coupling assembly, intermediate phalanx sections, and a distal
phalanx section adapted to receive the end effector on the distal
end, wherein each phalanx section comprises i) a proximal end and a
distal end; ii) a central cavity extending along a central axis
between the proximal end and the distal end; iii) an exterior
surface; wherein each the distal end of each phalanx section
couples the proximal end of the adjacent phalanx section, whereby
the proximal end of the phalanx section is movable with respect to
the distal end of the phalanx section in rotational motion, and a
plurality of semi-cylindrical ligaments placed over the plurality
of phalanx sections, wherein the plurality of semi-cylindrical
ligaments are selectively operable from the actuation member to
apply tensioning force to the plurality of phalanx sections such
that the proximal end of each phalanx section pivots at a
substantially equivalent angle.
[0026] In embodiments of the subject invention, each phalanx or
pivotable vertebrae may comprise a substantially cylindrical
configuration.
[0027] In other embodiments of the subject invention, each phalanx
or pivotable vertebrae may comprise a single piece.
[0028] In further embodiments of the subject invention, each
phalanx or pivotable vertebrae may comprise two substantially
half-cylindrical pieces.
[0029] In additional embodiments of the subject invention, the
elongated articulating section may further comprise a distally
attached surgical jaws assembly. In another embodiment the subject
invention, the end effector may comprise a distally attached
surgical jaws assembly.
[0030] In other embodiments of the subject invention, each
pivotable vertebrae may project a first pivot member from the
proximal end and project a second pivot member from the distal end,
wherein the first pivot member of each pivotable vertebrae
pivotably couples about a rotational axis to the second pivot
member of a proximally adjacent pivotable vertebrae.
[0031] In further embodiments of the subject invention, the first
pivot member may comprise a substantially cylindrical protrusion
and the second pivot member may comprise a substantially
cylindrical bore adapted for receiving the substantially
cylindrical protrusion.
[0032] In other embodiments of the subject invention, each
pivotable vertebrae may project a plurality of first pivot members
from the proximal end and project a plurality of second pivot
members from the distal end, wherein the plurality of first pivot
members of each pivotable vertebrae pivotably couples about a
rotational axis to the plurality of second pivot members of
proximally adjacent pivotable vertebrae.
[0033] In additional embodiments of the subject invention, each
phalanx section or pivotable vertebrae may be composed of
injected-molded plastic.
[0034] In embodiments of the subject invention, the plurality of
pivotable vertebrae fits within 3 mm to 10 mm envelope of MIS
instrumentation.
[0035] In other embodiments of the subject invention, the plurality
of tension wire may comprise a material selected from the group
consisting of nickel titanium alloy, braided stainless steel, a
single stainless steel wire, Kevlar, a high tensile strength
monofilament thread, or combinations thereof.
[0036] In further embodiments of the subject invention, each
tension wire attaches on a proximal end to a pivotable vertebrae
proximate to the handle, extends through the spiral shaped grooves
on a first subsequent adjacent distal pivotable vertebrae, and
attaches on a distal end to a second subsequent adjacent distal
pivotable vertebrae.
[0037] In additional embodiments of the subject invention, each
tension wire proximally attaches on one side of the elongated
articulating section to a pivotable vertebrae proximate to the
handle, extends through the spiral shaped grooves on a subsequent
adjacent distal pivotable vertebrae, and distally attaches on the
opposing side of elongated articulating section to an opposing side
of second subsequent adjacent distal pivotable vertebrae.
[0038] In other embodiments of the subject invention, applying
force in the proximal direction to the proximal end of each tension
wire rotates the second subsequent adjacent distal pivotable
vertebrae, further wherein the direction of rotation is away from
the side on the elongated articulating section that attaches to the
proximal end of the tension wire.
[0039] In embodiments of the subject invention, applying force in
the proximal direction to the proximal end of each tension wire
rotates the second subsequent adjacent distal pivotable vertebrae,
further wherein the direction of rotation is toward the side on the
elongated articulating section that attaches to the distal end of
the tension wire.
[0040] There has thus been outlined, rather broadly, the more
important features of the invention in order that the detailed
description thereof that follows may be better understood, and in
order that the present contribution to the art may be better
appreciated. There are additional features of the invention that
will be described hereinafter and which will form the subject
matter of the claims appended hereto.
[0041] These together with other objects of the invention, along
with the various features of novelty, which characterize the
invention, are pointed out with particularity in the claims annexed
to and forming a part of this disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
[0042] Advantages of the present invention will be apparent from
the following detailed description of embodiments thereof, which
description should be considered in conjunction with the
accompanying drawings, in which:
[0043] FIG. 1 illustrates a top view of the articulating steerable
clip applier showing the separate angles of movement by different
phalanges with covers.
[0044] FIG. 2 illustrates a side view of the articulating steerable
clip applier showing the separate angles of movement by different
phalanges within a cover.
[0045] FIG. 3 illustrates a cross-sectional top view of the
articulating steerable clip applier along the line 8 of FIG. 2.
[0046] FIG. 4 illustrates an enlarged cross-sectional top view of
line 15 of FIG. 3 showing the pivotable connection between two
phalanges on the articulating steerable clip applier.
[0047] FIG. 5 illustrates another top view of the articulating
steerable clip applier showing the separate angles of movement by
individual phalanges guided by tension wires connected from a first
phalange traversing through opposing spiraled grooves on the next
distal phalange to attach to a second distal phalange.
[0048] FIG. 6 illustrates another top view of the articulating
steerable clip applier showing the separate angles of movement by
individual phalanges with opposing spiraled grooves for holding the
tension wires.
[0049] FIG. 7 illustrates a top view of connected adjacent
phalanges of the articulating steerable clip applier without covers
showing the separate angles of movement by different adjacent
phalanges by flexible tension wires.
[0050] FIG. 8 illustrates the attachments of separate flexible
tension wires on the separate phalanges of the articulating
steerable clip applier, wherein each tension wire connects on its
proximal end to one side of a first phalange, traverses through
opposing spiraled grooves on the next distal phalange and attaches
on its distal end to the opposing side of a second distal
phalange.
[0051] FIG. 9 illustrates a side view of the articulating steerable
clip applier showing the opposing spiraled grooves which contain
the tension wires.
[0052] FIG. 10 illustrates a vertical cross-sectional view of an
individual phalange at line 18 of FIG. 9 which contains a lumen
that allows actuators, surgical clips, surgical clip carrying
assemblies and other functional elements to pass through and
operate to control clip movement, clip ligation or phalange
articulation.
[0053] FIG. 11 illustrates a perspective view of the articulating
steerable clip applier showing an individual phalange separated
into the top and bottom half-phalanges.
[0054] FIG. 12 illustrates a perspective view of a top
half-phalange and a bottom half phalange of the articulating
steerable clip applier.
[0055] FIG. 13 illustrates a perspective view of a phalange
comprising assembled top half and bottom half phalanges of the
articulating steerable clip applier.
[0056] FIG. 14 illustrates a side view of a top and bottom
semi-circular connecting ligaments of an individual phalange.
[0057] FIG. 15 illustrates a front view of a top and bottom
semi-circular connecting ligaments of an individual phalange.
[0058] FIG. 16 illustrates a side view of a top semi-circular
connecting ligament of an individual phalange.
[0059] FIG. 17 illustrates a side view of a substantially circular
elongate tubing that covers each individual phalange.
[0060] FIG. 18 illustrates a front view of a substantially circular
elongate tubing that covers each individual phalange.
[0061] FIG. 19 illustrates a side view of an articulating steerable
clip applier operatively attached on the proximal end to a
user-operated handle.
DETAILED DESCRIPTION OF THE EMBODIMENTS
[0062] While several variations of the present invention have been
illustrated by way of example in particular embodiments, it is
apparent that further embodiments could be developed within the
spirit and scope of the present invention, or the inventive concept
thereof. However, it is to be expressly understood that such
modifications and adaptations are within the spirit and scope of
the present invention, and are inclusive, but not limited to the
following appended claims as set forth.
[0063] FIGS. 1-3, 5, 6 and 11 illustrate a distal end 2 of the
articulating steerable clip applier 1. The clip applier 1 is a
long, narrow structure with a free distal end 2 adapted for
coupling to an end effector, such as a surgical jaw assembly 3, and
a proximal end 101 operatively coupled to a user-operated handle
100 (as shown in FIG. 19). The clip applier 1 is composed of a
plurality of relatively short articulating members or phalanges 4
that are connected end to end by pivoting links 5 and capable of
angulations 6 relative to one another when subjected to a tensile
force. FIG. 3 illustrates a cross-sectional top view of the
articulating steerable clip applier along the line 8 of FIG. 2.
FIG. 4 illustrates an enlarged cross-sectional top view of pivoting
point 5 showing the pivotable connection between two phalanges 4 on
the articulating steerable clip applier 1 from line 15 of FIG.
3.
[0064] A sheath of elongate tubing 7 covers each individual
phalange 4 such that the flexible joints of the phalange 4 are
exposed. In one embodiment of the subject invention, this tubing 7
is composed of flexible materials. In another embodiment of the
subject invention, this tubing 7 is composed of inflexible
materials. Accordingly, the plurality of phalanges 4 is covered
with a plurality of tubings 7. One embodiment of the tubing 7 is
shown in FIGS. 17 and 18. A single flexible tubing (not shown) may
cover the entire plurality of phalanges of the clip applier 1.
[0065] The distal end 2 of the articulating steerable clip applier
1 contains a final phalange 9. The final phalange 9 has a distal
end 10 adapted for coupling to an end effector, such as a surgical
jaw assembly 3, and a proximal end 11 that is attached to an
adjacent proximal phalange 12. The distal tip 13 of the jaw
assembly 3 is a surgical clip applicator for applying a surgical
clip to a blood vessel (not shown).
[0066] The proximal end of the articulating steerable clip applier
1 contains an initial phalange 14. The initial phalange 14 has a
proximal end 101 operatively coupled to a user-operated handle 100
and a distal end 16 that is attached to an adjacent first distal
phalange 17.
[0067] FIGS. 11-13 illustrate individual phalanges 4 spaced apart,
but the phalanges 4 are disposed in the articulating clip applier 1
so that the distal end of each proximal phalange 4 co-acts with the
proximal end of the adjacent distal phalange 4.
[0068] Each phalange 4 has a generally cylindrical configuration
and is symmetrical about a longitudinal axis. Each phalange 4 has
an exterior surface 18, described more fully below, and an interior
surface 19 that defines a lumen 20 extending between the proximal
end 21 and distal end 22. FIG. 10 illustrates a vertical
cross-sectional view of an individual phalange 4 at line 18 of FIG.
9. The plurality of lumens 20 of each phalange 4 forms an internal
longitudinal passage 23 in the articulating clip applier 1.
Longitudinal passage 23 permits actuators, surgical clips, surgical
clip carrying assemblies and other functional elements to pass
through clip applier 1 and to control the operation of clip
movement, clip ligation or phalange articulation. Each phalange 4
is composed of two half phalanges 24. As shown in FIG. 12, each
half phalange 24 has the same structure: a curved exterior surface
18 and a generally planar interior surface 19. Each half phalange
24 has a substantially half-round or half-elliptical
cross-sectional configuration so that an assembled phalange 4 has a
substantially cylindrical configuration. The interior surface 19 of
each half phalange 24 contains a longitudinal channel 27.
[0069] The proximal end 21 of the exterior surface 18 of each half
phalange 24 contains an extension 29. The extension 29 may have
angled sides 30 that form a curved end 31. The top surface 32 of
each extension 29 has a curvature that is substantially the same as
the curvature of the exterior surface 18. The bottom 33 of each
extension 29 has a substantially flat planar surface 34. The bottom
34 of each extension 29 further has a substantially cylindrical
protrusion 35.
[0070] The distal end 22 of each half phalange 24 contains a
substantially flat planar surface 37 that is lowered from the
curved exterior surface 18. The substantially flat planar surface
37 has a substantially circular internal bore 38 with a diameter
that is generally larger than the diameter of the cylindrical
protrusion 35.
[0071] A phalange 4 is assembled by attaching the interior surfaces
19 of two half phalanges 24 to one another so that the two
longitudinal channels 27 on each interior surface 19 of each half
phalange 24 form the lumen 20. An assembled phalange 4 will have
two extensions 29 on the proximal end 21, with their respective
substantially cylindrical protrusions 35 facing each other. The
substantially flat planar surfaces 37 of the distal end 22 will be
on opposing sides of the assembled phalange 4.
[0072] In one embodiment of the subject invention, the phalanges 4
are composed of injected-molded plastic.
[0073] As shown in FIGS. 3 and 11, the plurality of phalanges 4 is
connected end to end by pivoting links 5 in the following
manner:
[0074] The initial phalange 14 has a proximal end 101 attached to a
user-operated handle 100 (shown in FIG. 19). The distal end 16 of
the initial phalange 14 has substantially flat planar surfaces 39
on the top and bottom of the exterior surface 18. The substantially
flat planar surfaces 39 each have a substantially circular internal
bore 41 with a diameter that is generally larger than the diameter
of the cylindrical protrusion 35.
[0075] The clip applier 1 is assembled by placing the two
substantially cylindrical protrusions 35 on the proximal end 21 of
the first distal phalange 17 into the internal bores 41 on opposing
sides on the distal end 16 of the initial phalange 14. This
pivoting link 5 attaches the first distal phalange 17 to the
initial phalange 14.
[0076] The proximal end 21 of the first distal phalange 17 may
pivot with respect to the initial phalange 14. The two
substantially cylindrical protrusions 35 may rotate within the
internal bores 41. The substantially flat planar surfaces 34 of
each extension 29 rotate freely on the substantially flat planar
surfaces 39 on opposing sides of the initial phalange 14.
[0077] Second, third and subsequent distal phalanges 4, as desired,
are added to the first distal phalange 17 as follows: the two
substantially cylindrical protrusions 35 on the proximal end 21 of
a subsequent phalange 4 are placed into the internal bores 38 on
opposing sides on the distal end 22 of the preceding proximal
phalange 4.
[0078] As shown in FIGS. 1, 3, 5, 6 and 7, the proximal ends 21 of
all subsequent distal phalanges 4 may pivot with respect to distal
ends 22 of their respective adjacent proximal phalanges 4. The
protrusions 35 on the proximal end 21 of each subsequent distal
phalange 4 may rotate within the internal bores 38 on the distal
end 22 of the adjacent proximal phalange 4. The substantially flat
planar surfaces 34 of each extension 29 rotate freely on the
substantially flat planar surfaces 37 of the adjacent proximal
phalange 4.
[0079] As shown in FIGS. 9, 12 and 13, the exterior surface 18 of
each half phalange 24 contains at least one axially extending
s-shaped groove 42 or channel. The curve of the s-shaped groove 42
traverses the width and length of the exterior surface 18 of the
half phalange 24. The s-shaped groove 42 begins on one side of the
exterior surface 18 at the proximal end 21 of the half phalange 24,
axially extends and curves over the exterior surface 18 to the
opposing side of the exterior surface on the distal end 22 of the
half phalange 24.
[0080] Once a phalange 4 is assembled, it has two grooves 42 on
both exterior surfaces 18 that axially extend in the phalange 4 in
opposing s-shaped curves. Once the plurality of phalanges 4 is
assembled, the two s-shaped grooves 42 form two continuous axially
extending spiral shaped channels 43 that curve in opposing
directions from each other.
[0081] A tension cable or wire is inserted into each spiral shaped
channel 43, to provide steering control for the plurality of
phalanges 4. Tension wire is preferably made from a superelastic
material, e.g., nickel titanium alloy, braided stainless steel, a
single stainless steel wire, Kevlar, a high tensile strength
monofilament thread, or combinations thereof.
[0082] As shown in FIGS. 5, 7 and 8 a first set of two wires 45a
and 45b are connected on their respective proximal ends 46a and 46b
to the initial phalange 14 and connected on their respective distal
ends 47a and 47b to the proximal end 21 of the adjacent first
distal phalange 17. The proximal end 46a of wire 45a is attached to
one side 14a of the initial phalange 14 and the distal end 47a of
wire 45a is attached to the side 17a of the first distal phalange
17 on its proximal end 21. The proximal end 46b of wire 45b is
attached to the opposing side 14b of the initial phalange 14 and
the distal end 47b of wire 45b is attached to the side 17b of the
first distal phalange 17 on its proximal end 21. When wire 45a is
pulled, this tensile force causes the first distal phalange 17 to
pivot back and forth at its proximal end 21 towards side 17a, away
from side 14b. When wire 45b is pulled, this tensile force causes
the first distal phalange 17 to pivot back and forth at its
proximal end 21 towards side 17b, away from side 14a. Furthermore,
each subsequently attached phalange 4 is moved by the same pivoted
angle above, when either wire 45a or 45b is pulled.
[0083] A second set of two wires 48a and 48b are connected on their
respective proximal ends 49a and 49b to the initial phalange 14 and
connected on their respective distal ends 50a and 50b to the
proximal end 51 of the second distal phalange 52, which is adjacent
to phalange 17. The wires 48a and 48b are inserted into the two
spiral shaped channels 43 that curve in opposing directions. The
proximal end 49a of wire 48a is attached to one side 14a of the
initial phalange 14 and the distal end 50a of wire 48a is attached
to the opposing side 52b of the second distal phalange 52 on its
proximal end 51. The proximal end 49b of wire 48b is attached to
the opposing side 14b of the initial phalange 14 and the distal end
50b of wire 48b is attached to the opposing side 52a of the second
distal phalange 52 on its proximal end 51. When wire 48a is pulled,
this tensile force causes the second distal phalange 52 to pivot
back and forth at its proximal end 51 towards side 52b, away from
side 14a. When wire 48b is pulled, this tensile force causes the
second distal phalange 52 to pivot back and forth at its proximal
end 51 towards side 52a, away from side 14b. Furthermore, each
subsequently attached phalange 4 is moved by the same pivoted angle
above, when either wire 48a or 48b is pulled. Since the proximal
end and the distal end of each wire 48a or 48b is attached to
opposing sides of the initial phalange 14 and the second distal
phalange 52, pulling either wire 48a or 48b causes the second
distal phalange 52 to pivot in the direction of the distal end of
the wire and away from the proximal end of the wire.
[0084] A third set of two wires 53a and 53b are connected on their
respective proximal ends 54a and 54b to the first distal phalange
17 and connected on their respective distal ends 55a and 55b to the
proximal end 56 of the third distal phalange 57, which is adjacent
to second distal phalange 52. The wires 53a and 53b are inserted
into the two spiral shaped channels 43 that curve in opposing
directions. The proximal end 54a of wire 53a is attached to one
side 17a of the first distal phalange 17 and the distal end 55a of
wire 53a is attached to the opposing side 57b of the third distal
phalange 57 on its proximal end 56. The proximal end 54b of wire
53b is attached to the opposing side 17b of the first distal
phalange 17 and the distal end 55b of wire 53b is attached to the
opposing side 57a of the third distal phalange 57 on its proximal
end 56. When wire 53a is pulled, this tensile force causes the
third distal phalange 57 to pivot back and forth at its proximal
end 56 towards side 57b, away from side 17a. When wire 53b is
pulled, this tensile force causes the third distal phalange 57 to
pivot back and forth at its proximal end 56 towards side 57a, away
from side 17b. Furthermore, each subsequently attached phalange 4
is moved by the same pivoted angle above, when either wire 53a or
53b is pulled. Since the proximal end and the distal end of each
wire 53a or 53b is attached to opposing sides of the first distal
phalange 17 and the third distal phalange 57, pulling either wire
53a or 53b causes the third distal phalange 57 to pivot in the
direction of the distal end of the wire and away from the proximal
end of the wire.
[0085] Additional sets of two wires may be connected on their
proximal ends to a proximal phalange and connected on their distal
end to the proximal end of phalange that is two phalanges distal
from the proximal phalange. The wires are inserted into the two
spiral shaped channels 43 that curve in opposing directions. The
proximal end of each wire is attached to one side of the proximal
phalange. The distal end of each wire is attached to the opposing
side of the phalange that is two phalanges distal from the proximal
phalange. When each wire is pulled, this tensile force causes the
phalange that is two phalanges distal from the proximal phalange to
pivot back and forth at its proximal end. The direction of this
pivoting is towards the distal end attachment of each wire and away
from the proximal end attachment of each wire.
[0086] A user may actuate the wires above to pivot all the
remaining phalanges 4 such that the angle 6 between the distal end
of a preceding phalange and the proximal end of the subsequent
phalange in the clip applier is substantially equivalent. FIGS. 1
and 2 illustrate the separate, but identical, angles of movement 6
by individual phalanges 4.
[0087] As each individual phalange 4 pivots by an equivalent angle
6, the sum of these angles 6 causes the distal end 2 of the clip
applier 1 to pivot by a large angle or a cascading actuation
effect, as shown in FIG. 1.
[0088] In another embodiment of the subject invention, as shown in
FIGS. 14-16, the tension wires above may be replaced by
semi-circular connecting ligaments 61. Each individual phalange 4
may be substantially covered with two semi-circular connecting
ligaments 61. FIGS. 14 and 15 illustrate two semi-circular
connecting ligaments 61 in an opposing top-bottom configuration 61a
to cover an individual phalange (not shown).
[0089] Each semi-circular connecting ligament 61 has a flexible tip
62 on its proximal end and a flexible tip 63 on its distal end.
Furthermore, flexible tips 62 and 63 are on opposing sides of each
semi-circular connecting ligament 61.
[0090] In the opposing top-bottom configuration 61a, flexible tips
62 are attached to the distal end of a proximal phalange on
opposing sides, an adjacent distal phalange is substantially
covered by the two opposing semi-circular connecting ligaments 61,
and flexible tips 63 are attached to the proximal end of a second
distal phalange on opposing sides.
[0091] Each flexible tip 62 is attached to one side of the proximal
phalange and each flexible tip 63 is attached to the opposing side
of the second distal phalange. When a flexible tip 62 is pulled,
this force causes the second distal phalange to pivot at its
proximal end. The direction of this pivoting is away from the
flexible tip 62 that is pulled.
[0092] A user may actuate the flexible tips 62 above to pivot all
the remaining phalanges 4 such that the angle 6 between the distal
end of a preceding phalange and the proximal end of the subsequent
phalange in the clip applier is substantially equivalent. FIGS. 1
and 2 illustrate the separate, but identical, angles of movement 6
by individual phalanges 4.
[0093] In one embodiment of the subject invention, the narrow
plurality of phalanges 4 may easily fit within respective envelopes
of 10 mm and 3 mm MIS instrumentation, while retaining flexible
movements within a patient.
* * * * *