U.S. patent number 3,777,355 [Application Number 05/274,503] was granted by the patent office on 1973-12-11 for surgical wound clip applier with disposable clip magazine.
Invention is credited to John R. Cooke.
United States Patent |
3,777,355 |
Cooke |
December 11, 1973 |
SURGICAL WOUND CLIP APPLIER WITH DISPOSABLE CLIP MAGAZINE
Abstract
A surgical clip applier for surgical wounds is disclosed which
is semi-automatic in operation, operated with one hand, easily
disassembled or assembled without tools as for cleansing or
sterilizing in an autoclave and includes a low cost disposable clip
magazine. Individual clips are advanced to a position where they
are applied selectively to the wounded area and, as soon as one has
been applied and the mechanism released, the applier operates
automatically to be ready for the next application. This enables
the surgeon to close a wounded area in much shorter time than could
be done by suturing, or by individually applying each clip.
Inventors: |
Cooke; John R. (Boulder,
CO) |
Family
ID: |
23048465 |
Appl.
No.: |
05/274,503 |
Filed: |
July 24, 1972 |
Current U.S.
Class: |
29/243.56;
72/409.15 |
Current CPC
Class: |
A61B
17/0682 (20130101); Y10T 29/53783 (20150115) |
Current International
Class: |
A61B
17/068 (20060101); B23p 011/00 (); E05b 019/06 ();
E05b 019/26 () |
Field of
Search: |
;29/243.56,212D ;72/410
;227/108,19 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Jones, Jr.; James L.
Claims
I claim:
1. A surgical clip applier for closing surgical wounds,
comprising:
a rigid body member having spaced front and back portions and an
actuator member slidably mounted between said portions,
a pair of forceps pivoted together and slidably mounted between
said members and adjacent said actuator member for sliding movement
in the same direction as said actuator member,
means for biasing said actuator member upwardly away from the
bottom end of said body,
stop means for limiting the length of the path of movement of said
forceps,
camming means interconnecting said forceps and said actuator member
for moving said forceps outwardly from the bottom end of said body
while closing said forceps,
means detachably secured to the lower end of said body for
supplying surgical clips to the interior thereof, each clip in turn
being positioned in alignment with said forceps and in position to
be closed by closing of said forceps, said forceps having a
configuration for gripping a clip and holding it while it is being
closed by closing of the forceps,
said actuator upon downward movement separating the front clip from
the next adjacent clip in said supplying means, and
means for manually holding said body member and for pressing said
actuator downwardly therein against said biasing means to bend and
close a clip at a position beyond the lower end of said body.
2. A surgical clip applier as set forth in claim 1 wherein said
members include quickly detachable means for holding said front and
back members in assembled relationship with said forceps and said
actuator.
3. A surgical clip as set forth in claim 2 wherein said quickly
detachable means comprises:
a resilient part of said back portion and a spaced projection on
said front portion engaging one another when said members are
assembled and a foot on said resilient part hooking over said
projection to lock said assembly together and
stop means for preventing release of said foot by relative sliding
movement of said front and back portions.
4. A surgical clip applier as set forth in claim 3 wherein said
resilient portion further engages and holds said detachable clip
supplying means when positioned on said assembly, said supplying
means having a flange held against said projection by said
resilient portion.
5. A surgical clip applier as set forth in claim 1 including a
flexible lip on said detachable clip supplying means for holding
the front clip in position in said body member for engagement by
said forceps, said lip being flexed out of the path of the clip by
downward movement of said actuator.
6. A surgical clip applier for closing surgical wounds,
comprising:
a body having a hollow base member and an upright hollow member at
a forward end of said base member and formed of a material capable
of withstanding sterilizing temperatures without deterioration;
a surgical clip magazine assembly seated in the hollow portion of
the base for holding a string of clips and including means for
urging the string forwardly toward said upright member so as to
maintain an end clip in the upright member at the forward end of
the base member;
said upright member having a cam cover at its forward end,
including an upper grip portion and a lower slot, said upright
member having a slide guide at its rear end joined to the base
member and including an upper grip portion, and having a sliding
blade, including an upper spring portion, supported for manual
depressing movement along the slide guide to separate the forward
end clip from the next adjoining clip in said magazine assembly,
and retractable by action of said upper spring portion upon
termination of the manual movement;
two cooperative forceps jaws mounted for pivotal movement on a
pivot extending through the slot in said cam cover, each jaw having
a cam surface; and
cooperative means on said sliding blade for engaging said cam
surfaces during the depressing movement and moving said jaws in
gripping relation to the separated clip whereby said clip has its
extremities closed in guided clamping juxtaposition about tissue
adjoining a wound and is released from clamping contact with said
forceps by retracting movement of said blade after the clip is
clamped.
7. A clip applier as recited in claim 6, in which a clip string is
detachably secured within said hollow portion of the base member
for replacement and removal as required.
8. A clip applier as recited in claim 6, including spring means for
mounting said pivot in alternative upper and lower positions in the
slot in said cover and in which said pivot on which the jaws are
mounted is retained during initial action of said cooperative
forceps jaws and then to the lower position so as to properly align
the jaws over the ends of the clip.
9. A clip applier as recited in claim 6, in which the cam cover,
sliding blade and slide guide are confined at their sides by
structure normally clamped onto the slide guide and manually
removable from the slide guide for cleaning, inspection or
replacement of the cover, sliding blade and slide guide.
10. A clip applier as recited in claim 6, in which the grip portion
of the slide guide limits the extent of movement of the spring
portion of the sliding blade.
11. A clip applier as recited in claim 6, in which the sliding
blade terminates at its lower end in a cutting edge.
12. A clip applier as recited in claim 6, in which the forceps jaws
are of the same configuration and afford interchangeable mounting
of the jaws.
13. A clip applier as recited in claim 6, including means for
limiting upward movement of the sliding blade.
Description
My invention relates to the application of metal clips to close
surgical wounds and particularly to an improved device for applying
such clips in rapid succession to speed and facilitate the closing
of a wound.
Metal clips applied one at a time have come into use for closing
surgical wounds and are particularly useful in facilitating
closures and for favorable post operative cosmetics. Various
devices have been provided for bending or closing surgical clips in
position to grip the tissue adjacent to a wound, and some such
devices have been provided which include a magazine from which
clips are delivered to a clip closing mechanism. It is desirable to
provide effective and reliable magazine type clip applying devices
which may be readily disassembled for autoclaving and for servicing
and, accordingly, it is an object of my invention to provide an
improved surgical clip applying device.
It is another object of my invention to provide a magazine type
device for applying surgical clips which is easily assembled and
readily disassembled for purposes of servicing and for
autoclaving.
It is another object of my invention to provide an improved clip
magazine equipped surgical clip applier which may easily be
manipulated and used with one hand.
It is another object of my invention to provide an improved applier
for surgical clips of the type having ears or lugs separated during
the closing of the clip and which facilitate adjustment, or opening
of the clip when a a wound has healed.
It is a further object of my invention to provide an improved
device for applying surgical clips which is positive and reliable
in operation.
It is a further object of my invention to provide a manually
actuated device for applying surgical clips to the lips of wounds
including an improved arrangement for holding the device and for
applying finger pressure during application of the clips.
Briefly, in carrying out the objects of my invention in one
embodiment thereof, I provide a clip holding and applying structure
including stamped metal front and rear wall members which are
formed to provide finger grips or catches and an actuating member
slidable between the two wall members for actuating a forceps also
located between the members. Interengaging cam surfaces on the
forceps and on the actuating member together with cam or guide
surfaces on one of the wall surfaces cause the forceps to move
downwardly to a position externally of the structure. Surgical
clips are supplied to the bottom zone of the structure where they
are gripped one at a time by the forceps and moved downwardly from
the structure into position to attach to the lips of a wound as the
forceps are operated. The clip applier assembly may be taken apart
easily by releasing resilient catch portions of one of the wall
members so that the assembly is readily serviced and the
unassembled parts may be autoclaved when separated. A magazine type
clip supply device extends outwardly from the lower zone of the
wall members and is readily detachable. The clip magazine is also
made up of materials not affected by autoclave temperatures and is
easily sterilized.
The features of novelty which characterize my invention are pointed
out with particularity in the claims appended to and forming a part
of this specification. My invention itself, however, both as to its
organization and manner of operation, together with further objects
and advantages thereof, may best be understood by reference to the
following description taken in connection with the accompanying
drawings in which:
FIG. 1 is an isometric view of a surgical clip applier embodying my
invention;
FIG. 2 is a sectional side elevation taken along the line 2--2 of
FIG. 1;
FIG. 3 is an exploded isometric view of the applier of FIG. 1;
FIG. 4 is a sectional view along the line 4--4 of FIG. 2;
FIG. 5 is an enlarged side elevation view of a portion of the
structure of FIG. 1;
FIGS. 6, 7 and 8 are sectional views of the portion shown in FIG. 5
illustrating three steps in the assembly of the applier;
FIGS. 9, 10 and 11 are enlarged sectional elevation views of the
lower part of the portion of FIG. 5 illustrating three stages in
the attaching of the clip magazine to the applier;
FIG. 12 is a rear elevation view of the portion shown in FIG.
11;
FIG. 13 is an enlarged elevation view of a portion of the bottom
left end of the device shown in FIG. 2;
FIG. 14 is an enlarged sectional view taken along the line 14--14
of FIG. 4; and
FIGS. 15A through 15E illustrate successive stages in operation of
the clip closing forceps.
Referring now to the drawings, the surgical clip applier
illustrated in FIG. 1 comprises an upright body portion 10 and a
horizontally extending clip magazine 11 which is detachably secured
to the lower end of the body 10. The body portion 10 comprises
front and back outer walls 12 and 13 which terminate upwardly in
arcuate outwardly extending finger grips 14 and 15, respectively.
Slidably mounted within the body 10, between the walls 12 and 13,
is an actuator 16 which terminates in a thumb pressure plate 17
positioned over the top of the applier centrally of the grips 14
and 15, the upper portion of the actuator 16 being bent at an angle
as indicated at 18 so that it is offset and the thumb plate 17
extends directly over the actuator. The actuator is biased upwardly
by a spring 20 attached thereto and bearing on the top surface of
the finger member 15 of the rear wall. A string of parallel
laterally adjacent aligned clips is contained within the magazine
11 and is pressed forward by a spring which urges a pressure
member, or follower, 21 toward the body 10 to supply clips as they
are used one at a time by operation of the actuator 16. This
arrangement of the string of clips and the follower 21 is shown in
FIG. 2, which illustrates the follower pressing against clips 22
fourteen of which are illustrated in the string. The follower is
urged toward the applier by a spring indicated at 23. The spring
engages a seat 24 on the follower and extends rearwardly within the
magazine and extends into a reduced portion 25 thereof.
A clip closing forceps 26, shown in FIGS. 2 and 3, comprises two
jaws 27 and 28 pivoted together on a pin 30 and mounted between the
actuator 16 and the front wall 12. The front wall 12 is provided
with a vertical slot 31 extending therethrough, and the pin 30
extends through the slot into engagement with a leaf spring 32
which is securely attached to front wall 12 by a rivet 33 and a
bent lip or flange 34 which extends into a slot 35 in the wall 12.
The spring 32 is provided to press the forceps against the actuator
16 and to retain the forceps pin 30 either at the top of the slot
31 in an upper position in an outwardly humped portion 32a of the
spring as shown in FIG. 2, or in a lower position at the bottom end
of the slot where they are retained by an outwardly curved portion
36 of the spring.
The forceps jaws 27 and 28 as shown in FIG. 3 are provided with cam
surfaces 37 and 38 into which project the pins 40 and 41 on the
actuator 16, the upper end of the forceps jaws have rounded
portions 42 and 43, respectively, which are arranged to engage cam
surfaces 44 and 45, respectively, formed in the front wall 12. The
jaws 27 and 28 are provided with inwardly facing recesses or seats
46 and 47 which are positioned to receive the outer ends of
surgical clips supplied thereto from the magazine 11. The manner in
which the forceps are actuated by movement of the actuator 16 is
described in detail hereinafter. The magazine or cartridge 11 as
shown in FIGS. 1 to 4 comprises top and bottom wall members 48 and
49 which are formed to provide guides for the travel of the
follower 21 and which are shaped to guide the string of surgical
clips. The follower 21 extends across the magazine 11 and its outer
ends ride in slots formed by upwardly offset lower portions 51 of
the top wall 48 as clearly indicated in FIG. 1. The follower 21
moves in these slots and may be pressed against the pressure spring
23 until it reaches a position at the far righthand end of the slot
where there are upward and downward offsets of the slots indicated
at 52 and 53. These offsets allow the follower 21 to be tipped
about its lower edge, indicated as of rocker configuration at 54,
and when tipped the spring urges the follower against forward stops
formed by the offsets of the casing and holds the follower in
position so that the clips may be freely moved in and out of the
magazine.
Each clip when it enters the zone below the actuator is in the
position indicated by the clip 56 in FIG. 2. The actuator is
provided with a blade or knife 57 along its bottom edge and when it
is pressed down this blade separates the clip 56 from the next
adjacent clip in the magazine, then, as the actuator moves farther
down it strikes a retaining lip or tab 58 formed on the actuator
end of the bottom half of the magazine 49. The lip 58 holds the
clip 56 in position until it can be gripped by the jaws 46 and 47
and then proceed downwardly to bend the lip 58 down and back
against the magazine to allow the clip to proceed outwardly from
the ends of walls 12 and 13 into a position to be clamped about the
lips of a wound which is to be closed. The manner in which the
forceps operate upon depression of the actuator 16 is described in
detail below.
FIG. 5 illustrates the assembled upright unit and in this figure
the back wall 13 which has two side pieces or legs 60 and 61 (both
shown in FIG. 3) secured along the edge of the wall along the front
corners to provide guides for the slide 16 includes rearwardly bent
lower portions 62 and 63 which, as shown in FIG. 5, are used as
locks. In FIG. 5 the portion 63 is illustrated and this figure
shows a foot 64 at the bottom of this portion and in engagement
with an inwardly extending portion 65 of a lower rearward extension
66 on the front wall 12. This lower portion is shown in FIG. 3. The
other side of the lower end of the wall 12 is constructed similarly
to the righthand side illustrated, and the far side of the wall 13
as viewed in FIG. 3 also includes a foot at the lower end of the
bent portion 62 as indicated at 67. When the unit is to be
assembled it is understood that the front spring 32 has been
riveted securely in place on the front side of the wall 12. The
forceps are then placed in position against the inner side of the
wall 12 with the pin 30 in the upper end of the slot 31 engaging
the upper stop or top portion of 32a of the spring. The slide or
actuator 16 is then placed over the forceps with the pins 40 and 41
in engagement with the cam recesses 37 and 38, respectively. The
assembly is then completed by placing the back wall 13 over the
slide 16 so that the slide lies between the guide members 60 and
61. The initial position for insertion of the back wall 13 in this
matter is illustrated in FIG. 6 where the foot 64 of the bent
portion 63 is shown at the upper end of the inturned portion 65 of
the large section 66 on the wall 12. The wall 13 is then pressed
into position with the slide 16 lying between the side guides 60
and 61, and with slots 69 and 70 in the upper side edges of the
guides 60 and 61, in alignment with outwardly and inwardly
extending retaining lugs on the wall 12, one of these lugs being
shown at 71 on the righthand side of the wall as viewed in FIG. 3.
The cutaway portions 69 and 70 of the guides 60 and 61 allow the
guides to be moved past the lugs on the upper ends of the wall 12
so that the wall can be straightened to a position parallel to the
front wall 12 as shown in FIG. 7. The wall 13 is then moved
downwardly so that the edge of the wall above the recesses 69 and
70 moves past the inturned lugs on the wall 12, as exemplified by
the lug 71, and the wall 13 is then returned to a straight
position. This wall is then moved downwardly until the foot 64
passes the lower end of the lug 65 on the wall 12 and snaps to a
locked position as illustrated in FIG. 8. When the wall 13 reaches
this position forwardly projecting lugs 72 and 73 at the tops of
the guides 60 and 61, respectively, engage the tops of the wall 12
facing the inturned portions exemplified by the portion 71. The
wall 13 is thus locked against removal. When it is desired to take
the applier apart again, the foot 64 is pressed forwardly until it
clears the wall projection 65 whereupon the wall 13 may be moved
upwardly until the side recesses 69 and 70 allow it to move away
from the wall 12.
The sloping guides 44 and 45 which are used in guiding the movement
of the forceps 26 are stamped in the wall 12 to provide upper and
lower side walls on both sides, the ones on the near side in FIG. 3
being indicated at 74 and 75, respectively, the sloping portion 45
joining these two upright walls and the catch or lug 71 being
formed on a portion of the wall adjacent the upper portion 74.
The clip magazine portion 11 may, by way of example, be made from
plastic materials which are able to withstand autoclaving
temperatures. By way of example, one material useful for this
purpose is polypropylene, a synthetic plastic, which is flexible
and has good hinging characteristics and is dimensionally and
chemically stable at autoclaving temperatures. The top 48 as shown
in FIG. 3 is molded with a longitudinal ridge 77 which is in
alignment with a raised ridge 78 in the lower portion of 49. The
ridge 78 provides grooves 80 and 81 in the lower portion and these
grooves receive the outer ends of the surgical clips, the upwardly
extending ears or releasing members lying in the outer extending
groove formed by the ridge 77. The spring assembly and the follower
21 are arranged between the halves 48 and 49 of the magazine
housing and the edges of the housing are welded or otherwise
suitably bonded together to form the complete structure. The
complete magazine may be autoclaved or may be handled as a
disposable item, each item being loaded at the factory with the
required number of surgical clips, and the front or open end of the
cartridge sealed by a removable plastic wall.
The walls 48 and 49 include vertical flanges at their front ends,
these being indicated at 82 and 83 respectively. The clip retaining
lip 58 is molded as a portion of the front wall 83 of the lower
half wall 49. The lip 58 forms, in effect, an extension of the wall
forming the ridge 78 in the member 49 and is V-shaped in cross
section starting at the top of 78 and forming a V as clearly
indicated in FIG. 2, where the V is indicated at 84.
When the magazine 11 is to be attached to the clip applier 10 it is
first placed in a position illustrated in FIG. 9 in which the
downwardly extending flange 83 of the half 49 of the magazine is
immediately above the lug or stop 65 of the front wall. The flange
83 is then pressed down between the stop 65 and the lower end 63 of
the guide 61 so that it is in a position such as illustrated in
FIG. 10. It is then pressed down until it hits the foot 64 of the
guide 61 and then is rotated upwardly, the flange 82 then lying
below and in contact with the lower edge of the rear of the back
wall 13. The thickness of the flange 83 is less than the length of
the foot 64 so that when it is in place, as shown in FIG. 11, the
foot 64 still engages the stop 65 and prevents removal of the back
wall of the applier. The magazine is then locked in place and ready
for delivery of the clips one at a time to the clip applying device
10. In FIG. 12 the spaces between the dotted lines 86 and 87 and
the solid lines representing the sides of the wall 13 indicate the
overlap between the wall 13 and the guides 60 and 61,
respectively.
FIG. 13 is an enlarged side elevation view of the holding tab or
lip 58 and its V-shaped connection to the top of the central wall
78 of the lower half 49 of the magazine, the parts being shown in
their compressed position when the actuator blade 16 has moved
downwardly past the normal position of the lip 58, which is
indicated in dotted lines. The plastic forming the lip 58 and the V
84 is provided with transverse holes or recesses 88 and 89 which
provide a weaker cross section to assure a more effective operating
hinge. When the blade 16 is again retracted, the next clip on the
ridge 78 moves into position and is held by the lip 58 until the
blade 16 is again actuated to retract the lip and move the clip
downwardly into clamping position.
When it is desired to compress the spring 23 and prevent discharge
of the clips carried in the magazine, the clip follower 21 is moved
by gripping its end pieces on either side of the magazine and
moving the follower 21 back against the pressure of the spring
until it reaches the catches or stops 52 and 53 and is turned
counterclockwise as shown in FIG. 14 to engage the stops and
prevent forward movement of the follower. An upward blade 92
extends from the rocker 84 vertically and rides in the inverted
trough 77 of the upper wall member 48. The rocker 54 and the
projection 92 act together to engage the clips and move them
forward in the magazine.
During the use of the surgical clip applier, as described above and
shown in the drawings, the surgeon holds the clip between two
fingers engaging the finger grips 14 and 15 and his thumb engaging
the thumb plate 17. Each time the surgeon wishes to place a clip in
position on a wound, he holds the lower end of the applier at the
desired position of the wound and presses the actuator 16
downwardly to force a clip held by the forceps downwardly into
position and on forward pressure to close the clip about the two
lips of the wound and then releases the clip to leave it in place.
This operation is repeated as often as necessary to place the
required number of clips for the wound.
The manner in which the forceps are actuated to effect the
foregoing operation of the surgical clip applier is indicated in
FIGS. 15A through 15E. FIG. 15A illustrates the forceps in the
completely retracted position of the actuator 16. A clip 94 from
the magazine has been moved into the zone between the jaws of the
forceps and is in spaced relationship to the clipping recesses 46
and 47. Upon initial downward movement of the actuator 16 the pins
40 and 41 move over the cam surfaces 37 and 38 a sufficient
distance to bring the recesses of the jaws into engagement with the
ends of the clip. The actuator 16 is then moved downwardly until
the pin 30 of the forceps has been snapped out of the top recess of
the spring 32 and has moved down in the slot 31 near the bottom
thereof. In this position the upper ends of the forceps indicated
at 42 and 43 have just reached the outwardly and downwardly
extending surfaces of the cam guides 44 and 45, the blade has
descended and separated the clip from the next adjacent clip and
has bent the lip 58 downwardly so that the clip has moved past the
lip 58 as the forceps move down. Further downward movement of the
actuator 16 presses the forceps jaws together and they compress the
clip to bring its pointed ends or spurs together at the rim of the
wound. The upper ends or ears 95 of the clip part as the clip is
closed on the wound and are thus available to be squeezed by a
forceps or other instrument and moved apart when it is desired to
adjust or remove the clip from the wound after healing. The
actuator 16 is then withdrawn whereupon the jaws are moved apart to
release the clip and move upwardly past the sloping guides 44 and
45 and toward the original position of the forceps. In moving to
their original position the forceps are moved upwardly so that the
spring 32 bends outwardly to allow the pin 30 to pass upwardly to
its original position. Thus the two positions of the pin 30
determined by the spring 32 provide positions wherein the force of
the actuator utilizes the cam surfaces to actuate the forceps both
in the forward and retracting directions.
The metal parts of the applier are made from stainless steel sheet
or other suitable non-corrodible metal so that autoclaving is
effective to sterilize the metal parts and the parts do not corrode
from use.
While the invention has been described in connection with a
specific embodiment and application, various other embodiments will
occur to those skilled in the art. Therefore, it is not desired
that the invention be limited to the details illustrated and
described and it is intended by the appended claims to cover all
modifications which fall within the spirit and scope of the
invention as determined by the prior art.
* * * * *