Hemostatic Clip Applicator

Abstract

An applicator for hemostatic clips of unitary U-shaped construction. This applicator is formed with facing recesses in the jaws which are adapted to receive, retain and apply a hemostatic clip. The recesses are isolated from the rearward portion of the jaw faces by means of notches cut into the faces at the rearward end of the recesses.

Description

FIELD OF THE INVENTION

This invention relates in general to mechanisms useful in the strangulation of flexible tubular members and more specifically is directed toward an applicator useful with hemostatic clips of specific configurations for the strangulation of fluid ducts such as blood vessels in humans and animals.

DISCUSSION OF THE PRIOR ART

In the course of a surgical operation, a surgeon must often sever one or more blood vessels, sometimes as many as several dozen. It is necessary to provide means for closing the ends of severed vessels, at least until the end of the operation, to stop bleeding which could interfere with the performance of the operation as well as preventing unnecessary risk to the patient.

Conventionally, surgeons have used ligatures or the like tied about the individual vessels at the desired point of strangulation. This requires great dexterity and speed in order to tie off each blood vessel while keeping the surgery time within reasonable limits. More recently, however, hemostatic clips which are formed from a single strip of deformable nontoxic material into a substantially U-shape have been used to quickly and efficiently strangulate blood vessels and other fluid ducts. These hemostatic clips, in conjunction with a specially constructed forceps-type applicator, have been described in U.S. Pat. No. 3,326,216 and No. 3,363,628, issued June 20, 1967 and Jan. 16, 1968 respectively, to Ernest C. Wood. The invention disclosed herein is an improvement over the hemostatic clip applicator shown in the above patents.

The jaws of the applicators disclosed in the patents referred to above were formed with grooves having substantially perpendicular forward ends and rearward portions which simply became gradually shallower. The techniques required for manufacturing such devices were necessarily complicated and relative expensive. Furthermore, after extensive use of these prior applicators, it became apparent that disproportionately large forces were required for the final increment of closure of the hemostatic clip. This was traced to the fact that a relatively large amount of the material of the clip became crowded at the bending point due to the fact that the bend was sharp and the structure quite small. Moreover, this fact of crowding of material at the bend of the hemostatic clip resulted in a certain small factor of spring action whereby the clip tended to open slightly after the closing forces were removed. Although this was not generally detrimental to the closure of fluid ducts, in certain instances this slight opening prevented complete and positive strangulation with the consequent danger that the hemostatic clip might accidentally be removed from the duct.

SUMMARY OF THE INVENTION

It is a primary object of this invention to provide an improved hemostatic clip applicator which is simple to manufacture while providing positive and efficient closure of the hemostatic clips with which it is intended to operate.

Broadly speaking, the novel applicator of this invention comprises two pivotally joined elongated members having cooperating jaw portions on one side of the pivot and cooperating handle portions on the opposite side. Means are provided to resiliently urge the jaw portions away from each other between certain limits. The jaw portions are specifically formed to receive a hemostatic clip of generally U-shaped configuration and to tightly close the same about a fluid duct, generally referred to herein as a blood vessel, while avoiding the problem of crowding of the material of the clip together at the point of bending. The results of the use of this applicator with the hemostatic clips described and claimed in U.S. Pat No. 3,363,628 and U.S. Pat. No. 3,326,216 are that the hemostatic clips are properly and fully closed through the use of reduced closing forces and with substantially no tendency to spring open upon release of the applicator after closure. In addition, the applicator constructed in accordance with the principles of this invention is simpler and more economical to manufacture than are the applicators disclosed in the above patents.

BRIEF DESCRIPTION OF THE DRAWING

The features and advantages of this invention will be readily understood when the detailed description thereof is read in conjunction with the drawing wherein:

FIG. 1 is a plan view of a hemostatic clip applicator constructed in accordance with the principles of this invention;

FIG. 2 is an elevational view of the applicator of FIG. 1;

FIG. 3 is an enlarged perspective view of one of the jaws of the applicator of FIG. 1;

FIG. 4 is an enlarged sectional view of one of the jaws of the applicator of FIG. 1;

FIG. 5 is a view of a portion of the resilient handle separating means shown in FIG. 1;

FIG. 6 is a perspective view of a magazine adapted to hold a plurality of hemostatic clips configured to cooperate with the applicator of FIG. 1;

FIG. 7 is a sectional view similar to FIG. 4 together with a section of the magazine of FIG. 6 showing the applicator jaws in relation to the magazine just prior to removal of a hemostatic clip therefrom;

FIG. 8 is a sectional view similar to FIG. 7 after removal of the clip from the magazine showing the hemostatic clip at its initial point of closure;

FIG. 9 is a sectional view similar to FIG. 8 showing the hemostatic clip which has completely closed upon a blood vessel;

FIG. 10 is an enlarged perspective of the closed blood vessel of FIG. 9; and

FIG. 11 is a perspective of the hemostatic clip of FIG. 10 without the blood vessel between the arms thereof.

DESCRIPTION OF THE PREFERRED EMBODIMENT

With reference to the drawing and more particularly to FIGS. 1 through 5 thereof, the details of a hemostatic clip applicator constructed in accordance with the principles of this invention are shown. The applicator is referred to generally by reference numeral 21 and comprises elongated member 22 rotatably secured to complementary elongated member 23 by means of pivot 24. Elongated member 22 is formed with handle portion 25 and jaw portion 26 while elongated member 23 is formed with similar handle portion 27 and jaw portion 28. The respective jaw portions cooperate to engage, retain and apply a hemostatic clip as described below. Handle portions 25 and 27, and consequently jaw portions 26 and 28 are forced apart within specific limits by resilient member 31 which is secured to handle portion 23 by suitable means such as screw 32 and is removably and slidably secured to handle member 25 by means of hook 33. The operation of this resilient member will be discussed in further detail below.

Referring now to FIGS. 3 and 4, it may be seen that jaws 26 and 28 are similarly constructed, having cooperative face portions, and therefore only jaw 26 will be described in detail. Jaw 26 generally comprises body 34 and lip 35. Lip 35 is disposed at an angle with respect to body 34 and has parallel sides, as is best shown in FIG. 2. The face of the lip portion of jaw 26 is formed with a forward ridge 36 and notches 37, 38 separated by land 41. Land 41 has a groove 42 and planar surfaces 43. Although groove 42 is shown having a V-shaped cross section, it may have any suitable cross section to fit a specific type of hemostatic clip. It can be seen in FIG. 3 that notches 37, 38 are deeper than groove 42. The details of the function of this construction will be discussed below.

The specific hemostatic clip described and claimed in U.S. Pat. No. 3,363,628 is shown in FIGS. 6 through 11. FIG. 6 shows a magazine 44 having several hemostatic clips 45 stored therein for easy access for use with applicator 21. In FIG. 7 jaws 26 and 28 are shown in engagement with clip 45 which is still seated in a groove in magazine 44 just prior to removal therefrom. As the clip and applicator are removed from magazine 44, the clip is retained between the applicator jaws as shown in FIG. 7 due to the biasing action of resilient member 31. The clip is then in condition to be applied to a blood vessel for purposes of closing it to stop the further flow of blood therethrough. In FIG. 8 the jaws of applicator 21 are shown to have been closed slightly from the position shown in FIG. 7. Because of the specific configuration of the lips of the jaws and the cooperating shape of the hemostatic clip, the previously separated ends of clip 45 have come together to form a closed semielliptical opening between the arms of the clip. If, prior to the initial closing step shown in FIG. 8, the clip had been positioned around a blood vessel 46, the blood vessel would then be fully enclosed between the arms of the hemostatic clip as shown, and there would be no tendency, when the clip is completely closed, for the blood vessel to slide forward within the clip or to in any way escape from between the arms thereof. In FIG. 9, the hemostatic clip is shown completely closed about blood vessel 46, thereby preventing further flow of blood therethrough. Although the ends of clip 45 have again become separated, blood vessel 46 is tightly and positively held between the straight and nearly parallel arms of the clip.

With specific reference to FIGS. 9, 10 and 11, it is readily apparent that rearward notches 38 in the applicator jaws cooperate with the folded end 47 of clip 45 to allow that end to assume a natural configuration upon complete closure of the clip. That is, instead of forcing the clip to make a sharp, extremely tight bend which substantially deforms and crowds the material, the inside of the bend is allowed to remain somewhat rounded and material deformation is significantly reduced. By allowing end 47 of the hemostatic clip to enter notches 38 while the arms of the clip are forced together, hemostatic clip 45 can be closed with considerably less force than would be necessary in the absence of notches 38.

From the above description it may be seen that the applicator of this invention causes the hemostatic clip shown in the drawing to fully surround the blood vessel before closing upon it, and to safely, positively and efficiently strangulate the blood vessel with a relatively small amount of closing force while reducing any tendency of the hemostatic clip to spring apart after the closing force has been removed. It can readily be appreciated that the manufacture of the lips of the applicator having a groove 42 is greatly simplified by forming notches 37, 38 at each end of the groove. Without such notches it would be necessary for the groove to have at least a forward vertical wall in order to properly engage and retain the hemostatic clip, which is provided by the flat rearward wall of ridge 36 as shown in the drawing.

Although forward notches 37 serve to simplify the manufacture of the applicator herein described, they are not essential to the invention since they serve no purpose in grasping or closing hemostatic clips. Conversely, rearward notches 38 cooperate with groove 42 and hemostatic clip 45 to make the closure of such clips more efficient and positive. If desired for any purpose, notches 37 may be omitted from the applicator jaws and groove 42 will then end in a perpendicular wall at ridge 36.

The construction and function of resilient member 31 may be readily described with reference to FIGS. 1, 2 and 5. Resilient member 31 is shown as a spring-steel band which is fixed to handle 27 by suitable means such as screw 32, and bears against the opposite surface of handle 25 to force the handles apart. In order to restrict the distance which handles 25, 27 are biased apart, resilient member 31 is formed with an opening 51 having a rearwardly extending slot 52, the transition between opening 51 and slot 52 providing lateral shoulders which removably engage hook 33 on handle 25. This prevents the handles and jaws of applicator 21 from being unintentionally separated a greater distance than is required for lips 35 to firmly engage hemostatic clip 45 in magazine 44. The biasing action of member 31 maintains sufficient pressure upon the clip by jaws 26, 28 so that it is retained by the applicator after removal from the magazine. However, in order to facilitate separation of the applicator handles by a greater distance for such purposes as sterilizing and cleaning the jaws, member 31 is made suitably flexible and slot 52 is appropriately wide so that it may be opened sufficiently to allow hook 33 to pass through it merely by substantially increasing the forces which tend to urge the handles apart. Thus, resilient member 31 is so constructed that, in normal operation, it urges the handles apart a predetermined distance but prevents their unintentional separation by a greater distance, while at the same time it permits the handles to be further separated by the exertion of an increased separating force causing resilient member 31 to become disengaged from hook 33.

The foregoing is a complete description of a preferred embodiment of a hemostatic clip applicator constructed in accordance with the principles of this invention. It is likely that changes and modifications will occur to those skilled in this art which are within the inventive concepts disclosed herein.

Claims

What is claimed is:

1. A surgical instrument adapted to engage, retain and apply a U-shaped hemostatic clip of the type having substantially parallel, normally separated arm portions interconnected at one end thereof and being adapted to strangulate fluid ducts in the body, said instrument comprising:

a first elongated member formed with a handle portion and a jaw portion;

a second elongated member formed with a handle portion and a jaw portion;

said first elongated member being adapted to cooperate with said second elongated member so that said jaw portions may operate upon said hemostatic clip; and

means for pivotally connecting said first and second elongated members together intermediate their respective handle and jaw portions so that said handle portions may be cooperatively manipulated to open and close said jaw portions;

said jaw portions having confronting faces, said faces being substantially parallel when said jaws are closed, each said face being formed with a longitudinal groove adapted to receive said arm portions in said normally separated condition, a transverse notch across said face rearward of said groove and extending into said face a distance greater than the depth of said groove, and a transverse wall at the forward end of said groove substantially perpendicular to the plane of said face, thereby providing an abutment for the end of one arm of said hemostatic clip when said arm is seated within said groove, said groove being shorter than said hemostatic clip so that upon closure of said hemostatic clip by positive displacement of said jaw portions toward each other to deform said hemostatic clip, the outer extremities of said arms are displaced to a position closer together than the outer extremities of said interconnecting end of said hemostatic clip, said interconnecting end remaining rounded and extending substantially normally to the plane of said face into said notch.

2. The surgical instrument recited in claim 1, wherein:

said face is further formed with a transverse notch across said face forward of said groove and rearward of said transverse wall.

3. The surgical instrument recited in claim 1, and further comprising:

resilient means for biasing said handle portions a predetermined distance apart; and

means for normally preventing said handle portions from separating by an amount greater than said predetermined distance.