Surgical Clip Applicator

Abstract

A surgical instrument specifically constructed for the application of fluid duct strangulation clips in human body locations which were heretofore substantially inaccessible for this type of surgical procedure. The applicator comprises an elongated barrel mounted to a pistol grip actuating handle with the applicator jaws acting cooperatively at the distal end of the barrel.

Description

FIELD OF THE INVENTION

This invention relates generally to surgical instruments and more particularly involves instruments which are used for the application of surgical clips for such purposes as strangulation of flexible tubular members in the human body.

DISCUSSION OF THE PRIOR ART

Surgical clip applicators of the forceps type have been available for medical use for some time. Such an applicator is shown in U.S. Pat. No. 3,631,707, issued Jan. 4, 1972, and owned by the assignee of the present invention. That patent discloses how forceps type surgical clip applicators normally operate. It may be observed that any type of forceps has a general shape of increasing width from the tips toward the handles and require a significant amount of space for proper operation. In order for these types of devices to be used within the human body, especially deep within the body, the opening through which they must pass is of necessity relatively large. It has been medically established that for any surgical operation, the smaller the body opening created and the less time involved between the initial incision and the final suturing, the better the patient's chances are for recovery without complications. Furthermore, if the surgical opening can be made small, there is less physiological repair for the body to perform.

SUMMARY OF THE INVENTION

Broadly speaking, this invention comprises a pistol grip handle, a rod secured to the handle and having mating jaws at the distal end thereof and a tubular barrel enclosing the rod and mounted for longitudinal movement with respect to the handle and jaws. The forward portion of the jaws are biased toward the open or separated condition and are adapted to fit within the distal end of the barrel so that when the barrel slides forward, the jaws are forced to come together. In the normal condition, the jaws are held a predetermined distance apart by proper engagement of the outwardly biased portion of the jaws with the distal end of the barrel. This surgical clip applicator is also structured so that the jaws, which have their working tips formed at an angle with the rod to which they are attached, may be oriented at any desired 90.degree. interval of rotation with respect to the barrel. That is, the jaws may be directed leftward, rightward, upward or downward.

The structure of this invention has several advantages over prior surgical clip applicators. It may be used for acoustical surgery or neurosurgery in that a relatively small hole is required in the skull in order to reach and clip off the necessary blood or other vessels therein. Furthermore, during thoracic surgery fluid ducts deep within the chest cavity may easily be reached by means of this instrument without disturbing other organs. With other types of instruments which tend to expand toward the handles, a greater opening and disturbance of adjacent organs is normally necessary for such surgical procedures. Otologic surgery cannot presently make full use of the surgical clips of the type shown in the previously mentioned patent because of the relative size of the applicators involved. It has been medically proven that use of such clips has shortened and simplified many operations and the present invention permits an expansion of their applicability.

It is expected that one of the significant uses for the applicator of this invention is as an instrument for birth control through simplified female tubectomy procedures. Through the use of this instrument, the present tubectomy operation which requires entry into the body through the stomach wall, may now be performed as an out-patient or office procedure. By making a small incision adjacent the cervix in the vaginal cavity, surgical clips may be applied to the Fallopian tubes by inserting this instrument through the vagina. The incision may be very small and the surgical procedure thus very greatly simplified.

BRIEF DESCRIPTION OF THE DRAWING

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

FIG. 1 is a perspective view of a surgical clip applicator constructed in accordance with the principles of the present invention;

FIG. 2 is an enlarged partially broken away perspective of the barrel, rod and jaws of this applicator;

FIG. 3 is an enlarged sectional view taken through plane 3--3 of FIG. 1;

FIG. 4 is a further enlarged sectional view of the rear barrel and handle portion of the invention taken through plane 4--4 of FIG. 3;

FIG. 5 is an exploded view of the elements comprising the surgical clip applicator of this invention; and

FIG. 6 is a partial sectional view of the jaws of the applicator engaging a surgical clip therebetween.

DESCRIPTION OF THE PREFERRED EMBODIMENT

With reference now to the drawing, there is shown a surgical clip applicator 11 comprising a stationary handle member 12 including a cylindrical housing 14, trigger member 13 pivotably mounted to the handle member, a barrel 15, an internal rod 16 and jaws 17. Trigger 13 is pivoted to handle member 12 by means of pivot pin 21, and is biased away from handle member 12 by cooperating leaf springs 22, 23. These springs are shown for purposes of example only and include a tongue and groove engagement at their common point, the other ends being secured to the respective handle and trigger portions. Any other type of effective biasing device could be used as an alternative to that shown in the drawing. Trigger portion 13 is provided with a yoke extension 24 (FIG. 3) which passes through a slot 25 in housing 14 and a second slot 26 in barrel 15 which is aligned with slot 25. Extension 24 pivotally engages pivot pin 27 which is secured across barrel 15 near the rearward end thereof. From the structure described it is evident that if one grasps the instrument pistol grip handle below rearward projection 31 of handle portion 12, and squeezes so that trigger portion 13 moves rearwardly toward handle 12, barrel 15 will move forward within housing 14. Slot 25 in housing 14 is longer than slot 26 in order to permit the necessary forward movement of extension 24 of trigger member 13.

Rod 16 is mounted within barrel 15 and is adjustably secured to housing 14 by means of screw 32. This rod is formed with a bore 34 therethrough adjacent its proximal end and a second bore 35 spaced forward and angularly displaced 90.degree. therefrom. One side of housing 14 is formed with two holes 36, 37 which are longitudinally spaced from one another by the same distance as are bores 34, 35 in rod 16. The holes 36, 37 shown in the drawing and the bores 34, 35 through rod 16 are clear holes, while there are mating tapped holes (not shown) opposite holes 36, 37 in housing 14 adapted to receive the threads of screw 32. The purpose and advantages of these openings will be discussed in greater detail hereinbelow.

Rod 16 is formed with grooves 41 on either side extending rearwardly from the forward end thereof as is clearly shown in FIGS. 2 and 5. Jaws 17 are preferably formed of spring steel and have rearwardly extending shanks 42 which are configured to fit within grooves 41, the outward facing surfaces thereof being rounded to substantially correspond with the size and shape of the rod. These jaws are secured to rod 16 by suitable means such as by brazing or through the use of pin 43, or both. Grooves 41 in rod 16 form U-shaped channels for guiding the position of the shanks 42 of jaw members 17. The forward lip portions 45 of the jaw members are formed with V-shaped grooves 46 and lateral slots 47 similar to those disclosed in U.S. Pat. No. 3,631,707, previously identified. At the rearward end of each of lips 45 is enlarged portion 51. As shown in FIG. 2, jaw members 17 are biased outwardly at forward portions 53, the outside surfaces of which make contact with the inner surfaces of barrel end 52. It should be noted that the rearward shanks of jaws 17 are undercut as at 54 in order to accommodate the thickness of rod 16 between grooves 41. Forward of undercuts 54 the inner faces of the jaws are substantially parallel and in confronting contact or nearly so when the jaws are closed.

As previously described, when the pistol grip of this applicator is squeezed, barrel 15 moves longitudinally forward. It is now apparent that when this happens, the inner surface of end 52 of the barrel makes sliding contact with surfaces 53, thereby causing the jaws to move toward one another. When the pistol grip is released, springs 22, 23 cause handle members 12, 13 to separate, thereby moving barrel 15 rearwardly and allowing jaws 17 to open again due to the biasing which is built into these elements. It is evident from FIG. 5 that jaws 17 are relatively wide apart when unconstrained by end 52 of the barrel. These jaw members, being made of spring steel or other suitable material, are formed to normally separate from one another until acted upon by outside means such as the distal end of barrel 15.

Because rod 16 fits within barrel 15 but is secured to housing 14 by means of screw 32, slot 55 is provided through both sides of the barrel to allow longitudinal motion thereof.

Certain dimensional relationships exist between the various elements of the invention which permit proper operation of the instrument. With reference to FIGS. 1, 3 and 6, it may be seen that when the instrument is in its normal position with the jaws open under the influence of springs 22, 23, rearward end 56 of barrel 15 rests positively against the inner surface of the closed end 57 of housing 14. In this position the total length of barrel 15 is such that end 52 confines the forward portions 53 of the jaws to separate lips 45 by a distance which is slightly less than the distance between the two parallel arms 61 of clip 62. Although the jaws themselves are biased so that they would separate farther in the absence of any constraining forces, the length of barrel 15 is properly calibrated to provide the proper normal opening between the jaws. The spread of the jaws and the inside diameter of the distal end 52 of the barrel are such that normal forward movement of the barrel will cause the jaws to close and substantially flatten clip 62.

The clips are preferably mounted in a cartridge such as shown in the aforementioned patent so that they are readily accessible for engagement by jaws 17. When it is desired to engage such a clip, jaws 17 are forced over the V-shaped end of clip 62 until the clip snaps into place within grooves 46. The structure is such that the jaws may spring apart sufficiently to engage the clip. Of course, the clips may have other cross-sectional shapes and the grooves in the jaws would thereby have a correspondingly modified configuration. In order to strangulate a fluid duct such as a blood vessel, the clip which has been engaged by jaw 17 is placed in a position to surround the duct. Handle members 12, 13 are then squeezed together moving tube 15 forward, sliding along forward portions 53 and causing the jaws to close the clip upon the vessel. The clip first captures the vessel by closing at its tips, then flattening for full strangulation. Releasing the handles allows the jaws to spring open and the instrument to be removed from the area of operation. It is important to note that when the jaws are fully opened as shown in FIG. 1, rearwardly extending shanks 42 still reside within grooves 41, confined by the confronting sides thereof so that when the jaws are forced together, they always meet squarely and without any tendency to scissor. Without the sides of grooves 41, it is possible that the jaws would not meet properly and the clip could become unintentionally disengaged.

Another feature of the invention is that with the placement of the pivot 21 as shown, if the instrument is grasped in the vicinity of pivot 21 above rearward extension 31, there is no danger whatever of applying a closing force to the jaws. This is the way the instrument should be grasped when it is desired to engage a clip and when transporting the instrument from the time of engaging the clip until the clip is surgically employed.

In the drawing, the jaws 17 extend at an angle toward the right as the instrument would normally be held. If it is desired to use the instrument in such an area that it would be advantageous to have the jaws angled toward the left, screw 32 may be removed, rod 16 rotated 180.degree. and screw 32 reinserted into hole 36 and through bore 34 in the rod. The jaws would then angle toward the opposite direction. If, however, it is desired that the jaws be upwardly oriented, screw 32 is removed from hole 36, rod 16 and the jaws are rotated 90.degree. and the screw is then inserted into hole 37 and through bore 35 in the rod. The same procedure would be followed if it was desired to have the jaws oriented downward for a certain surgical procedure.

It is important to note that there are relatively complex inter-relationships which determine the normal opening between jaws 17 and which determine the amount of forward motion of the barrel necessary to close the jaws. For example, with a predetermined inner diameter of the barrel and a specific spread angle of forward portions 53, the amount of opening between the jaws may be changed by substituting a barrel of different length. Alternatively, when assembly takes place a modification could be made in the distance between forward portions 53 and bores 34, 35 in rod 16. Also, the amount of bias built into jaws 17 and their shanks is easily adjustable to make the proper jaw separation in the normal condition. The fact that these inter-relationships exist leads to a positive advantage in the manufacture of this instrument. Tolerances need not be as strict as might be expected because each instrument can easily be adjusted in its final assembly stage by modifying any of the dimensions and configurations referred to above.

Having described a preferred embodiment of the present invention, many changes and improvements are likely to occur to those skilled in the art which are within the scope of this invention.

Claims

What is claimed is:

1. A surgical clip applicator comprising:

a handle member;

a housing fixed to said handle member;

a trigger member pivotally connected to said handle member and extending within said housing;

means for biasing said trigger member in one direction with respect to said handle member;

an elongated tubular barrel having the proximal end within said housing, said proximal end being engaged by said trigger member, said barrel being longitudinally movable and non-rotatable;

a rod removably secured to said housing and extending forward through said barrel, said rod being longitudinally and rotationally fixed with respect to said housing; and

jaws secured to the distal end of said rod a predetermined distance from said housing and extending forward of said barrel at a predetermined angle to the axis of said rod, said jaws being adapted to receive and maintain a surgical clip therebetween;

said jaws being normally biased apart at the forward end and including outwardly facing portions adapted to be engaged by the distal end of said barrel, said jaws being separated by a first predetermined distance when normally engaged by the distal end of said barrel, whereby upon longitudinal motion of said barrel said jaws are forced together.

2. The surgical clip applicator recited in claim 1 wherein:

said housing has two clear holes through the wall on one side longitudinally spaced a second predetermined distance apart, and two tapped holes in the wall on the opposite side in respective registration with said clear holes;

said barrel having elongated slots through opposite sides of the wall spaced forwardly from the proximal end thereof;

said rod having first and second bores therethrough adjacent the proximal end thereof, said bores being longitudinally spaced by said second predetermined distance and being angularly displaced 90.degree. from each other;

said applicator further comprising a screw adapted to selectively pass through one of said holes and bores and said slots to engage the respective tapped hole;

whereby said rod is secured to said housing by said screw, said slots permitting longitudinal movement of said barrel with respect to said housing and said rod.

3. The surgical clip applicator recited in claim 1 wherein:

the rearward end of said housing is substantially closed, the proximal end of said barrel normally resting against the inner surface of said closed end of said housing, the distal end of said barrel engaging the biased forward portions of said jaws so as to permit said jaws to be separated only by said predetermined distance.

4. The surgical clip applicator recited in claim 1 wherein:

said distal end of said rod is formed with opposing U-shaped grooves extending rearwardly along said rod, said grooves having confronting sides;

said jaws are formed with elongated shanks fitting longitudinally within said grooves;

the proximal ends of said shanks being retained in said U-shaped channels and guided by said confronting sides thereof throughout their normal operating movement.

5. The surgical clip applicator recited in claim 4 wherein said jaws are formed with undercuts in confronting inner surfaces starting at a point just forward of said distal end of said rod and extending rearwardly therefrom, said undercuts permitting said jaws to come substantially together in confronting relationship.