Clip-applying Surgical Instrument

Abstract

A surgical instrument for applying an occlusion clip to a blood vessel including a pair of telescoping members, a hook on one of the members, the other member having an end portion adjacent the hook, the hook and the end portion being adapted to engage and operate arms of the clip for opening and closing the clip and means for telescopically moving the members to operate the clip.

Description

This invention relates to a surgical instrument for handling and applying a clamp or clip during a surgical operation. More particularly, this invention relates to an instrument for applying a clip to a blood vessel such as an artery for occluding an aneurism of an artery in the brain or the like.

An instrument for applying such a clip is shown in Kees U.S. Pat. No. 2,876,778. The instrument of that patent applies a clip satisfactorily to an artery when the aneurism is in such a position on the artery that the clip can be applied in a direction along the axis of the instrument. However, where an aneurism is on another side of the artery, it is desirable to apply the clip from a side and transversely of the axis of the instrument. An object of this invention is to provide an instrument for applying a clip to a blood vessel in a direction transversely of the axis of the instrument.

A further object of this invention is to provide an instrument of this type which holds a clip firmly until the clip is applied and which can be released quickly and automatically as the clip is applied to the blood vessel.

Briefly, this invention provides a clip-applying instrument which includes a pair of elongated members which slide telescopically. At one end of one of the members is a hook which faces transversely of the instrument. The hook receives a spring clip. The other member has an end which engages a side of the clip to cooperate with the hook for opening the clip. Spring means urges the members to an open position. A latch holds the instrument in an intermediate position so that the clip is held therein until the clip is opened by means of the instrument and is applied. The clip is applied transversely of the axis of the instrument and, when the instrument is in open position, the instrument can be withdrawn.

The above and other objects and features of the invention will be apparent to those skilled in the art to which this invention pertains from the following detailed description and the drawing in which:

FIG. 1 is a plan view of a clip-applying instrument constructed in accordance with an embodiment of this invention, the instrument being shown in open position;

FIG. 2 is a view in side elevation of the clip-applying instrument shown in FIG. 1 in open position;

FIG. 3 is a view in side elevation of the instrument in an intermediate position, a clip being shown in dotted lines in association therewith;

FIG. 4 is a view in side elevation of the instrument in clip-open position, the clip being shown in association therewith in dotted lines;

FIG. 5 is a view in section taken generally on the line 5--5 in FIG. 4;

FIG. 6 is a view in side elevation of the spring clip of FIGS. 3 and 4 on an enlarged scale, the clip being shown partly open, a fragmentary part of the instrument being shown in association therewith;

FIG. 7 is a view in front elevation of the clip shown in FIG. 6, a portion of a blood vessel being shown in dot-dash lines in association therewith;

FIG. 8 is a view in end elevation of the spring clip in partly open position, a fragmentary part of the instrument being shown in association therewith;

FIG. 9 is a fragmentary plan view on an enlarged scale looking in the direction of the arrows 9--9 in FIG. 2 of the instrument in open position;

FIG. 10 is a fragmentary plan view on an enlarged scale of the instrument in clip-open position;

FIG. 11 is a view in section taken on the line 11--11 in FIG. 10; and

FIG. 12 is a fragmentary view in side elevation of an instrument constructed in accordance with another embodiment of this invention, the instrument being shown in association with a clip of a differing construction.

In the following detailed description and the drawing, like reference characters indicate like parts.

In FIGS. 1-4 inclusive is shown a surgical clip-applying instrument 15 constructed in accordance with an embodiment of this invention. The instrument 15 includes a body 17 formed of spring metal and including a main arm or member 18, a crosspiece 19 (FIGS. 2-4 inclusive) and a lower arm 21. A flange 22 at a free end of the lower arm 21 can engage the main arm 18 to limit swinging of the lower arm 21 toward the main arm 18 as shown in FIG. 4. Resilience of the body urges the lower arm 21 away from the main arm 18 toward the position shown in FIG. 2. At a free end of the main arm 18 is located a hook 24, which is adapted to receive a spring clamp or clip 26, as shown in FIG. 6.

A sliding bar member 28 is mounted on and moves telescopically with relation to the main arm 18 between the position shown in FIG. 2 and that shown in FIG. 4. As shown in FIG. 6, an end face 31 of the sliding bar member 28 is engageable with the clip or clamp 26, the clip being opened as the sliding bar 28 moves upwardly as shown in FIG. 6 with reference to the hook 24. The end face 31 and an inner face 32 of an outer arm 33 of the hook 24, which engage the clip, diverge in the direction of a bottom 34 of the hook at angles of approximately 10.degree. to a line 36 perpendicular to the axes of the members 18 and 20 so that, as the clip is engaged and opened, it is urged toward the bottom of the hook to rest thereagainst.

The sliding bar member 28 is drawn back and forth by means of a link 37 (FIGS. 2-4 inclusive), one end of which is pivotally attached to the lower arm 21 upon a hinge pin 38 mounted thereon intermediate the ends of the lower arm 21. The other end of the link 37 is provided with bifurcations 39 and 41 (FIG. 10) which extend upwardly on opposite sides of the bar main arm or member 18 adjacent shoulders 44 and 46 thereat and are received in slots 47 and 48 of a T-shaped head 49 of the sliding bar member 28 so that, as the lower arm 21 is squeezed inwardly from the FIG. 2 position to the FIG. 4 position, the sliding bar member 28 moves from the FIG. 9 position to the FIG. 10 position. When the lower arm 21 is released, the sliding bar member 28 returns to the FIG. 9 position at which the bifurcations 39 and 41 can engage the shoulders 44 and 46. A tongue 51 (FIGS. 2-4 inclusive) on the link is curved under the bifurcations and forms a guide on which the main arm or member 18 rests as the sliding bar member 28 slides therealong. The sliding bar member 28 can be held in an intermediate position as shown in FIG. 3. A hook ring 53 pivotally mounted on the lower arm 21 can be received on an arm 54 of a generally Z-shaped bracket 56 attached to the main arm 18 to hold the instrument in the intermediate position. Inwardly directed flanges 58 and 59 on the bifurcations 39 and 41, respectively, overlie a portion of the head of the sliding bar member 28, as shown in FIG. 11 to hold the members 18 and 28 in flatwise face-to-face relation remote from the hook 24. A sleeve 62 mounted on the members 18 and 28 adjacent the hook 24 holds the members 18 and 28 in flatwise face-to-face relation adjacent the hook 24. The sleeve can be attached to one of the members with the other member sliding therethrough telescopically.

The clip 26 (FIG. 6) can be of the type used with the instrument of the aforementioned U.S. Pat. No. 2,876,778 and includes a U-shaped body 71 and generally semicircular jaws 72 and 73 integral therewith. Pressure on angles 74 and 76 of the clip urges the clip to open position. Resilience thereof urges the clip to closed position. A strip of graft-forming fabric 77, which can be formed of one of the synthetic plastic materials known as Teflon or Dacron, is mounted on the jaws and, when the jaws are closed, the strip 77 can surround a blood vessel 81 (FIG. 7) being held in place therearound by the clip in position to seal off an aneurism 82 on the blood vessel.

The operation of the instrument can be best understood by reference to FIGS. 2, 3, and 4. The clip 26 is placed in position inside the hook 24 and the lower arm 21 is pushed upwardly toward the main member 18 until the hook ring 53 can be swung to the FIG. 3 position at which the clip 26 is engaged by the members 18 and 28 and held thereby as shown in FIG. 3. When the clip is to be applied to the blood vessel, the lower arm 21 is pushed further toward the main arm or member 18 to the FIG. 4 position at which the jaws of the clip are held open and the clip 26 can be advanced onto the blood vessel. The hook ring 53 can be allowed to fall to the released FIG. 4 position, whereupon the lower arm 21 can be released to permit the clip to close around the blood vessel with edges of the jaws sealing off the aneurism and the instrument 15 can be withdrawn from the blood vessel.

In FIG. 12 is shown a fragmentary portion of a clip-applying instrument 84 which includes a main arm or member 86 and a sliding bar member 88, one of which slides telescopically with regard to the other in a sleeve 89. Heads 91 and 92 on the members 86 and 88, respectively, are engageable in sockets in arms 93 and 94, respectively, of a spring-operated clip 96 of another known construction. Other parts of the instrument 84 can be similar to parts of the instrument described hereinabove, and the operation of the instruments are similar.

The clip-applying instruments illustrated in the drawing and described above are subject to structural modification without departing from the spirit and scope of the appended claims.

Claims

Having described our invention, what we claim as new and desire to secure by Letters Patent is:

1. A surgical instrument for applying an occlusion clip having outwardly extending arms which are squeezable for opening jaws of the clip to a blood vessel which comprises a pair of members having elongated portions thereof mounted in sliding, overlapping, facial relation with each other, one of the members adjacent an end thereof having a looped formation providing a hook opening onto the face of the member to receive a clip member projecting therefrom, the other member having a terminal movable over the opening to engage the clip, resilient means for urging the members to a clip-released position, the members being movable to bring the hook and the terminal toward each other to engage the arms of the clip for opening the clip, means for holding the members in an intermediate position at which the clip is engaged and held thereby, the hook and the terminal being adapted to engage and squeeze the arms of the clip for opening the jaws of the clip, the clip being arranged to close when the arms are released, and means for slidably moving the members to operate the clip.

2. A surgical instrument as in claim 1 wherein the means for moving the members slidably includes an actuator arm mounted for movement toward and away from the members, a link extending from said actuator arm to one of the members so that movement of the actuator arm toward and away from the members causes slidable advance of the members in clip opening and releasing direction, means for resiliently urging the actuator arm in clip-releasing direction, and means for holding the actuator arm in an intermediate position in which the clip is held by the members.