U.S. patent number 3,856,016 [Application Number 05/303,314] was granted by the patent office on 1974-12-24 for method for mechanically applying an occlusion clip to an anatomical tubular structure.
Invention is credited to Hugh J. Davis.
United States Patent |
3,856,016 |
Davis |
December 24, 1974 |
METHOD FOR MECHANICALLY APPLYING AN OCCLUSION CLIP TO AN ANATOMICAL
TUBULAR STRUCTURE
Abstract
An occlusion clip which includes two laterally spaced clip
portions interconnected at both ends by connecting portions and
provided with indexing means in one connecting portion, and an
instrument for applying the occlusion clip which includes two jaws
movable relative to one another adjacent one end of a tubular
structure in such a manner as to close the occlusion clip in a
predetermined manner, one of the jaws, particularly the movable jaw
being provided with a complementary indexing means and the tubular
structure accommodating, if necessary, an optical viewing device as
well as a means for emitting a beam of light within the area of the
jaws.
Inventors: |
Davis; Hugh J. (Baltimore,
MD) |
Family
ID: |
37011999 |
Appl.
No.: |
05/303,314 |
Filed: |
November 3, 1972 |
Current U.S.
Class: |
128/831; 24/23W;
606/158; 600/104; 24/30.5W; 72/409.01 |
Current CPC
Class: |
A61B
17/122 (20130101); A61B 1/303 (20130101); A61F
6/204 (20130101); Y10T 24/1467 (20150115); Y10T
24/152 (20150115); F02B 3/06 (20130101); A61B
17/32 (20130101) |
Current International
Class: |
A61B
17/122 (20060101); A61B 17/12 (20060101); A61F
6/00 (20060101); A61F 6/20 (20060101); A61B
1/303 (20060101); A61b 017/12 (); A61b 017/10 ();
B21d 005/16 () |
Field of
Search: |
;72/409,410 ;24/23W,3.5W
;128/1R,2R,6,7,8,9,33R,321,322,325,330,346,6 ;251/9,10 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
"Fiber Optic Laparoscope," Brochure of American Cystoscope Makers,
Inc., Pelham Manor, N.Y., February 1972..
|
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Stewart and Kolasch, Ltd.
Claims
What I claim is:
1. A method for mechanically applying an occlusion clip to an
anatomical tubular structure which comprises the steps of securely
mounting an occlusion clip onto a tubular instrument having
clip-receiving jaws located near one end thereof and disposed in an
open clip-receiving position, inserting said end of the tubular
instrument having the jaws with the clip mounted thereon through an
opening in an anatomical body and while viewing through an optical
viewing means disposed near the other end of said tubular
instrument and provided with illumination for illuminating the area
of the jaws and the areas distally thereof, positioning the open
jaws and the clip mounted thereon in a proper position over the
anatomical tubular structure and thereafter closing the clip to
produce an occlusion in said anatomical structure.
2. The method of claim 1, werein viewing of the tubular structure
is made through the tubular instrument and through the open jaws
thereof.
3. A method according to claim 2, including the step of viewing
through two spatially separated occlusion clip portions securely
held in position on the jaws by complementary indexing means.
4. A method according to claim 3, including the step of applying
the occlusion clip to a Fallopian tube through an opening made in
the umbilicus.
5. A method according to claim 2, including the step of applying
the occlusion clip to a Fallopian tube through an opening made in
the umbilicus.
Description
The present invention relates to an occlusion clip and to an
instrument to apply the occlusion clip.
Various clips are known in the prior art for causing an occlusion
of anatomical tubular structures such as blood vessels, veins, etc.
A clip designated "Hemoclip" is known in the art which consists of
a thin wire bent into approximately U-shape. While this "Hemoclip"
has been used with some success, certain problems nevertheless
exist with this prior art type of occlusion clip because, if the
wire is applied too tightly, it will cut into the tubular
structure. Furthermore, if the wire of this prior art clip is too
narrow, as is the case, then the specific pressure becomes
excessively high. Since a certain width is necessary to assure a
satisfactory occlusion, it is customary to apply two or three of
these so-called "Hemoclips" to a given anatomical tubular
structure. Additionally, these prior art occlusion clips are
susceptible, by reason of their construction, of slipping off from
the anatomical tubular structure while being applied or even
thereafter, i.e., there is always the danger that these prior art
clips do not stay in the desired position, thereby resulting in
eventual failure of the occlusion.
An instrument called "Laparoscope" is known in the art for purposes
of sterilization by cauterizing fallopian tubes. After causing
ballooning of the abdominal wall, a narrow slit is made through the
umbilicus to thereafter insert the Laparoscope, and with the
assistance of fiber-optics, cauterization is effected. However,
this method of sterilization is fraught with certain dangers as
some difficulties exist in controlling the degree and extent of
cauterization in order to avoid accidental burning of adjacent
parts, such as intestinal portions.
The present invention is concerned with the task of providing an
occlusion clip which includes means to lock the clip in position
during its application so that the clip cannot come off the
instrument used for applying the same.
Another advantage of the occlusion clip of the present invention
resides in its particular structure forming, in effect, two
occlusion clips spaced from one another, thus preventing with
certainty re-fertilization without the need of installing two
separate clips, as required by the prior art. This is achieved in
that the occlusion clip of the present invention is provided with
two side portions adjoined by end portions to form a unitary
structure installed, as such, on the fallopian tubes or the like
which causes simultaneous occlusion at two spaced points.
The instrument in accordance with the present invention is provided
with relatively movable jaws at the free end of a tubular member
adapted to be inserted through an opening, for example, through the
umbilicus whereby the jaws are provided with means to lock the
occlusion clip in position while being inserted into the opening
formed in the human body for eventual emplacement over the
fallopian tubes or the like. By providing one of the jaws with a
projecting nose portion and the occlusion clip with a complementary
slot, the occlusion clip in accordance with the present invention
is securely held in position until actually installed over the
anatomical tubular structure.
A further feature of the present invention resides in an instrument
which permits direct visual observation by means of an optical
system thus assuring a good view during the entire operation, not
only for purposes of properly locating the place where the
occlusion clip is to be applied but also permitting visual
observation during the closing of the occlusion clip by the
provision of an appropriate aperture in the movable jaw.
Another advantage of the present invention resides in the
particular construction of the jaws to illuminate the area of
application and permit viewing through the center of the clip, thus
permitting also the application of larger clips.
A further advantage of the instrument in accordance with the
present invention resides in the particular location of the fulcrum
for the movable jaw to assure a closing of the free end of the
lower jaw first, thereby assuring an occlusion without cutting into
any tissues.
Another feature of the present invention resides in the simplicity
of the instrument used for applying the occlusion clip which has a
convenient pistol grip and permits a good view through its tubular
member even when the jaws are closed, thus enabling accurate
control in the positioning and application of the occlusion
clip.
Accordingly, it is an object of the present invention to provide an
occlusion clip and instrument for applying the same which avoid by
simple means the aforementioned shortcomings and drawbacks
encountered in the prior art.
It is another object of the present invention to provide an
occlusion clip and instrument for applying the same which
substantially eliminate failures in the occlusion due to faulty
application.
A further object of the present invention resides in an occlusion
clip and instrument for applying the same which will provide
occlusion at spaced points to minimize the likelihood of eventual
failure of the occlusion.
Still another object of the present invention resides in an
occlusion clip of the type described above which permits permeation
likely to encourage fibrosis to assure a permanent interruption in
the anatomical tubular structure.
Still a further object of the present invention resides in an
occlusion clip and instrument for applying the same which assure
reliable locking of the clip onto the instrument during the
operation.
A still further object of the present invention resides in an
occlusion clip which is relatively simple in construction yet
assures an occlusion at two spatially separated points, thus
obviating the need for the application of several clips to
guarantee the success of the occlusion.
Another object of the present invention resides in an instrument
for applying the occlusion clip of the present invention which is
simple in construction, reliable in operation and permits easy
handling by the availability of an optical viewing system enabling
the doctor to visually follow the positioning and application of
the clip throughout the entire operation.
These and further objects, fearures and advantages of the present
invention will become more apparent from the following description
when taken in connection with the accompanying drawing which shows,
for purposes of illustration only, several embodiments in
accordance with the present invention, and wherein:
FIG. 1 is a plan view of an occlusion clip blank in accordance with
the present invention;
FIG. 2 is a perspective view of a clip formed from the blank of
FIG. 1 by bending the blank back upon itself into a configuration
ready for insertion into the open jaws of the instrument;
FIG. 3 is a somewhat schematic side view illustrating the
application of the occlusion clip shown in FIG. 2 on an anatomical
tubular structure;
FIG. 4 is a fragmentary view showing the occlusion clip clamped on
the anatomical tubular structure of FIG. 3;
FIG. 5 is a side view of an instrument in accordance with the
present invention for applying the occlusion clip of FIG. 2 on the
anatomical tubular structure;
FIG. 6 is a fragmentary view, partially in longitudinal cross
section, through certain parts of the instrument of FIG. 5;
FIG. 7 is an exploded perspective view of the distal part of the
instrument of FIGS. 5 and 6;
FIG. 8 is enlarged side view of the distal part of the instrument
of FIG. 5 illustrating the jaw portions thereof;
FIG. 9 is a perspective, exploded view of the proximal part of the
instrument shown in FIG. 5;
FIG. 10 is a cross-sectional view, on an enlarged scale, through
the instrument of the present invention taken along line X--X of
FIG. 6;
FIG. 11 is a perspective view, on an enlarged scale, of the distal
part of the instrument in accordance with the present
invention;
FIG. 12 is a perspective view of the occlusion clip in relation to
the anatomical tubular structure at the beginning of its
application;
FIG. 13 is a perspective view, similar to FIG. 12 and showing the
relationship of the occlusion clip to the anatomical tubular
structure as the application proceeds;
FIG. 14 is a perspective of the distal part of a modified
embodiment of an instrument in accordance with the present
invention; and
FIGS. 15a and 15b are schematic side views comparing the installed
clip of the present invention with the installed clip of the prior
art, respectively.
Referring now to the drawing wherein like reference numerals are
used throughout the various views to designate like parts, the
occlusion clip blank generally designated by reference numeral 10
is in the form of a unitary structure which includes two lateral
portions 24 and 25, constituting in effect two occlusion clip
members spatially separated from one another, a connecting portion
26 at the upper end, as viewed in FIG. 1 which connects the side
portions 24 and 25 and a connecting portion 27 connecting the side
portions 24 and 25 at the lower end. An indexing aperture 14 is
also provided in the lower connecting portion 27 which is intended
to engage with an indexing projection 38 (FIGS. 3, 8, and 11)
provided on the fixed jaw 34 of the instrument of this invention
for positioning the occlusion clip 10 in relation to the instrument
and to thereby secure the same in position.
It will be appreciated that the occlusion clip of FIGS. 1 and 2
provides in effect for an elongated opening or hiatus 12 defining a
herniating portion between the laterally spaced clip members 24 and
25. A transverse divider portion 18 thereby separates this hiatus
12 from the indexing aperture 14.
For purposes of use with the instrument in accordance with the
present invention, the occlusion clip blank 10 made of suitable
flexible material is bent back upon itself about the flex line 16
to provide two half portions generally designated by reference
numerals 20 and 22 such as illustrated in FIG. 2. The blank 10
should thereby be bent only to such an extent that the two portions
20 and 22 subtend therebetween an angle slightly larger than the
angle of the two jaws 32 and 34 when in the fully opened position
as shown in FIG. 3 so that the occlusion clip will securely
retained in place by engagement of its aperture 14 with the
nose-like indexing projection 38.
It may also be appropriate to impart a curved configuration to the
portion 22 when bending the blank 10 back upon itself as shown in
FIG. 3. Additionally, it may also be convenient to permit the
portion 22 to be slightly longer than the portion 20, for example,
by an amount of about one twenty-fourth to one thirty-second
inch.
Of course, in lieu of the approximately oval shape of the blank 10
it is also possible to make the blank 10 of any other
configuration, for example, of substantially rectangular
configuration, in which case the occlusion clip portions 24 and 25
would be parallel to one another while the end portions 26 and 27
as well as the separating portion 18 would be at right angle
thereto.
Referring now to FIGS. 5-11, the instrument for applying the
occlusion clip according to this invention is in the form of an
elongated tubular structure generally designated by reference
numeral 30 (FIG. 5) which is provided at the left end thereof as
viewed in FIG. 5 with jaws 32 and 34. In the illustrated
embodiment, the jaw 34 is formed as an integral part of the tubular
member 50 adjacent the left end thereof as viewed in FIG. 5. On the
other hand, the jaw 32 is pivotal about an axis 52 (FIGS. 7 and 11)
between its open, clip receiving position (shown in full line in
FIG. 8) and the clip-applying position shown in dash line in FIG.
8. Due to the slight eccentricity of the pivot axis 52, the closing
movement of the jaw 32 is such that the free end of the jaws 34 and
32 will come into abutment against one another while also forming a
narrow tapering space increasing in the direction toward the
gripping portion generally designated by reference numeral 108.
This particular closing movement assures that the free ends
constituted by the connecting portions 26 and 27 are closed before
the entire occlusion clip is more or less flattened out, thereby
preventing a slipping off of the occlusion clip from the anatomical
tubular structure such as a fallopian tube, when being applied and
assuring other advantages as will be described more fully
hereinafter by reference to FIGS. 15a and 15b.
On the side of the tubular member 50, opposite the jaws 34 and 32,
i.e., on the right side as viewed in FIG. 5 is provided the handle
generally designated by reference numeral 108 which includes an
actuating member 54 in the form of a trigger, connected with the
movable jaw 32 by way of the control linkage as will be described
more fully hereinafter.
A separate tube 58 (FIG. 6) is provided on the inside of the
tubular structure 50 for receiving and positioning an optical
device of conventional construction, the front end of which is
schematically indicated and designated in FIG. 6 by reference
numeral 60. At its opposite end, the tube 58 is provided with a
conventional eye piece 60' which may be adjustable if so desired.
The viewing means 58, 60 and 60' permits the user of the instrument
to view between the opened jaws as well as between the separated
clamping portions 24 and 25 of the occlusion clip when in the
initial position during the application as shown in FIG. 3, thus
permitting a continuous viewing of the insertion of the instrument
through the opening in the umbilicus and during the positioning
thereof over the fallopian tube. The instrument also includes
further means to produce a light beam 61 (FIG. 3) to illuminate the
area between the jaws and in front thereof so as to facilitate the
proper positioning and application of the occlusion clip over the
anatomical tubular structures, especially the fallopian tube. These
illuminating means may be of any conventional type, for example, in
the form of another tube 62 which extends through the tube 50 and
includes a light source, for instance in the form of a small lamp
designated in FIG. 6 by reference numeral 64, by means of which a
beam of light 61 is produced to assure sufficient illumination to
facilitate the positioning and application of the occlusion clip.
However, in lieu of utilizing a light source 64 located at the end
of the tube 62, it is preferable to use a light source in the form
of conventional fiber-optics and constituted by the tube 62 with
the primary light source for the fiber-optics located internally or
preferably externally at any appropriate place on the instrument.
Since such fiber-optical illuminating devices are known as such, a
detailed description thereof is dispensed with herein.
As shown in FIG. 9, a pair of support projections 68 and 70 for the
handle structure are secured to the tube 50 by conventional means.
These supporting projections 68 and 70 are thereby located on both
sides of an elongated recess 72 in the tube 50. The recess 72
slidably receives a slidable control member generally designated by
reference numeral 74 and enables reciprocation thereof in the axial
direction of the tube 50 between the two supporting projections 68
and 70. The slidable control member 74 includes a U-shaped upper
body part formed by leg portions 76 and 76' connected by web
portion 77 in such a manner that a substantially U-shaped recess 78
is formed. This recess 78 is so shaped as to receive the tubular
member 62 for the illuminating device so that the slidable control
member 74 is guided in its to and fro movement on the tube 62 when
the control member is assembled in its position as shown in FIGS. 6
and 10. Additionally, the slidable control member 74 includes a
pair of depending leg portions 80 and 82 spaced from one another to
receive the body portion 84 of the trigger member 54. The body
portion 84 is provided with a rectangular notch 86 to receive a pin
88 which extends across the U-shaped channel between the projecting
leg portions 80 and 82. When the trigger member 54 is installed so
that the pin 88 comes to lie in slot 86, the slidable control
member 74 and trigger member 54 are in effect pivotally connected
with each other. The trigger plate 84 is further provided with a
corner 90 which, as shown in FIG. 6, is adapted to engage with the
surface 70' of the supporting projection 70 so that in case of
application of a force in the direction of arrow A (FIGS. 6 and 9),
the corner 90 will abut at the surface 70' and thus constitutes a
fulcrum about which the trigger member 54 will rotate in the
counterclockwise direction, thereby imparting a sliding movement to
the slidable control member 74 toward the left direction, as viewed
in FIG. 6, which is made possible by the pivotal connection 86, 88,
between these two parts. Thus, the camming action between corner 90
and surface 70' translates the force A into sliding movements of
the slidable control member 74.
A return spring 92 is interposed between the trigger plate 84 and
the relatively stationary support member 70 and engages at its left
end in a recess 94 provided in the trigger plate 84 and at the
right end in the recess 96 provided in the supporting member
70.
The handle structure 108 further includes a pair of cover plates 98
and 100 (FIGS. 9 and 10), each provided with a recess 102 and 102',
recess 102 being shown clearly in FIG. 9. The recesses 102 and 102'
are intended to receive the leg portions 80 and 82 of the slidable
control member 74. Additionally, the cover members 98 and 100 are
provided with depending plate-like leg portions 104 and 106 which
act as guide means for the trigger plate 84 when the parts are in
the assembled position thereof as shown in FIG. 10. The handle
assembly further includes a cover structure generally designated by
reference numeral 108 which has a pair of parallel-spaced cover
plate portions 110 and 110' connected by means of a rib 112 (FIG.
6). The cover plates 98 and 100 and the cover plate portions 110
and 110' as well as the rib 112 of the cover structure 108 are
secured to the support members 68 and 70 by means, for example, of
screws which extend through screw holes as indicated. However, any
other suitable fastening means may also be used to hold the parts
in their assembled position. The rib 112 is also held fast in its
proper position by the two-point connection constituted by the
pin-type pivotal connection 112' and the screw extending through
aligned holes 110a and 112a and the hole 110a' (not shown) in the
cover portion 110'.
As shown in particular in FIGS. 7, 8 and 11, the jaw 34 is formed
as an integral part of the exterior tube 50 adjacent its left end
as viewed in FIGS. 5 and 6, and includes inwardly thereof lug
portions 114 for pivotally supporting thereon by means of screws or
the like the movable jaw 32. The lug portions 114 which are of
approximately partially circular shape, provide guide surfaces 114'
for the pivotal movement of the movable jaw member 32 which is also
guided along the guide surfaces 114" (FIG. 8) constituted by the
cut-out portions provided in the fixed jaw 34 to accommodate the
side members 32' and 32" of the movable jaw 32. As shown
particularly in FIG. 11, the fixed jaw 34, in addition to the
nose-like indexing projection 38 is also provided with an aperture
35.
The movable jaw 32 includes a transverse end portion 116 and spaced
side portions 118 and 120 each provided with bearing portions 122
and 124 at the side members 32' and 32" thereof and adapted to
engage with the stationary bearing surfaces 114". The jaw 32 is
thereby pivotally supported on the lug portions 114 by any suitable
means such as screws. Below the bearing surfaces 122 and 124 the
leg portions 32' and 32" are provided with the opposite aligning
recesses 126 and 128 to receive a reciprocal, slidable control
member generally designated by reference numeral 130 which is
pivotally connected with the side members 32' and 32" by means of a
pivot pin 132. The slidable control member 130 has an exterior
configuration 134 at the bottom thereof to permit substantial
alignment with and sliding movement along the inner surface of the
outer tube 50. Additionally, the slidable control member 130 has an
interior cylindrical recess 136 to provide for a substantially
cylindrical aperture adjacent the jaw end of the tubular structure
50.
The slidable control member 130 is connected with the slidable
control member 74 by means of a pair of elongated members 56 such
as steel wires which are sufficiently stiff and rigid to cause the
sliding control member 130 to partake in the reciprocation of the
sliding control member 74 in response to actuation of the trigger
54.
In the illustrated embodiment, the illuminating device is in the
form of an elongated tubular cable protective structure 62 for
conducting by means of a cable disposed therewithin the supply
voltage to a small electric bulb arranged at the front end thereof
and indicated schematically by reference numeral 64 in FIG. 6.
Appropriately the rear end of the cable protective structure or of
the cable itself which extends through the tube 62, is bent
downwardly as shown at 142 in FIG. 9 to be received between the
side plates 110 and 112 so as to be protected thereby and held in
position by means of a leaf spring 144 or the like. A power supply
such as a battery can be connected to the lower end at 146 (FIG.
9).
However, as mentioned above, in lieu of the electrical connection
extending through the tube 62, and the bulb 64, conventional
fiber-optical means are preferably used to produce the desired
illumination. The light source in the form of a suitable small
incandescent high power lamp or the like may then be located in any
suitable place, for example, externally of the tubular member 50,
e.g., at the end of the portion 142, thereby obviating the need for
the electrical cable and the bulb and the problem of replacing the
same if wear occurs.
The optical device to be used with the instrument of the present
invention, is in the form of an elongated structure and includes a
number of optical lenses of conventional type as known in the art.
Since the optical device, except for its particular location and
association with the instrument of the present invention forms no
part thereof, a detailed description is dispensed with herein.
As will be understood from the foregoing description of the
instrument and occlusion clip of the present invention, the clip
may be applied under direct continuous vision through the optical
system during the operation. To that end, the movable jaw 32 is
also provided with an aperture 33 so that continued viewing is made
possible even after the free end of the movable jaw 32 abuts at the
free end of the fixed jaw 34.
In actual use, the occlusion clip is positioned between the jaws as
shown in FIG. 3 with the indexing projection 38 engaging in the
indexing aperture 14 of the occlusion clip. After the introduction
of the instrument through the umbilicus, it is properly positioned
over the fallopian tube or the like, and with the aid of the
illumination and the optical device, the location of the fallopian
tube or other anatomical tubular structure becomes an easy matter
for a trained surgeon. Since the fallopian tube can be observed
directly through the opening 12 of the occlusion clip, i.e.,
through the spacing between the lateral clip portions 24 and 25, it
is also easy to properly approach the anatomical tubular structure
as well as to ascertain when the clip is in proper position
relative thereto as shown in FIG. 12. In this position, the trigger
54 is actuated and the occlusion clip is closed on the tube 40 as
shown in FIG. 13.
As can be seen from FIGS. 6, 8 and 11, the pivot point of the
movable jaw 32 is slightly eccentric. This eccentricity in
combination with the configuration of the portion 22 of the
occlusion which, as mentioned hereinabove may be slightly curved,
provides for safe closing of the clip on the tube without crushing
the tube to an extent that might otherwise cause damage or slipping
off. This is a very important feature since the particular
angulation of the jaws 32 and 34 and/or the height of the indexing
tooth 38 permit that the separation of the occlusion clip arms, in
the applied position, can be precisely predetermined. This is
illustrated in FIGS. 15a and 15b, illustrating respectively
somewhat schematic side elevational views of a clip in accordance
with the present invention and of a clip of the prior art type,
both when in the applied condition. In the clip 10 according to the
present invention a predetermined separation or gap g exists
between the two arm portions 20 and 22, when applied, within the
area receiving the anatomical structure. This separation g, which
can be precisely predetermined by the design of the instrument of
this invention, i.e., by the eccentricity of the pivot point of the
movable jaw 32 and/or the height of the indexing tooth 38, may be
about 0.8 mm which has been determined optimum for certain
applications, and can be varied in a simple manner, if necessary,
to a value greater or smaller than 0.8 mm, for example, to 0.5 mm
if the thickness of the anatomical structure or of its tissue walls
so demands. This is very important because if a clip is closed
fully flat, as is the case in the prior art, illustrated in FIG.
15b where similar reference numerals of the 200-series are applied
to similar parts, the tissue is crushed, thereby becomes avascular,
necroses and cuts through, resulting in fistule formation and
failures. In contrast to the present invention the prior art offers
no means of controlling the closure by simple means and therewith
offers no means effectively avoiding such failures.
It should also be mentioned that the opening 12 in the clip 10
performs the important function in the applied condition. On the
one hand it acts as a pressure relief means and on the other,
assists in locking the clip in position on the anatomical
structure. The openings 33 and 35 in jaws 32 and 34 perform similar
functions during the application. These two functions are only
schematically indicated in dash and dot lines in FIG. 15a, showing
the possibility of parts of the tissues of the anatomical
structures to pass through opening 12.
While the mutually facing surfaces of the two jaws 32 and 34 are
flat and parallel to one another, it may also be advantageous to
use a different arrangement. For example, the surfaces need not be
parallel to one another but may form a slight angle therebetween by
appropriate beveling of one or both jaws in such a manner that the
separation g is, for example, about 0.8 mm on one side of the clip
and say 0.5 mm, on the other side. Furthermore, the surfaces need
not necessarily be flat for this purpose. However, it is quite
apparent that the "controlled closure" is still present in the
non-parallel arrangement of the jaw surfaces, resulting in the
avoidance of the failures of the prior art.
It will thus also be appreciated that slippage of the anatomical
tubular structure during the clamping operation is prevented
because of the herniation of the tissue during the earliest phase
of closure and the particular closing movement of the jaws causing
a near closing at the free ends of the jaw members 32 and 34 before
final closing of the occlusion clip.
Though the occlusion clip of FIG. 1 is particularly desirable
because of its two spaced clip portions 24 and 25, other types of
occlusion clips having spaced clip members may be employed within
the scope of this invention. A possible modification is shown in
FIG. 14 which shows the front end of the instrument with an
occlusion clip in the form of two completely separate narrow clip
members 150 and 152 positioned relative to the jaws by means of
individual indexing means 154 and 156. This will permit the
application of entirely separate clips in one and the same
operation.
Additionally, it is also possible within the scope of this
invention to modify the occlusion clip shown in FIGS. 1 and 2 by
leaving out the connecting portion 26 or 27 and/or the divider 18.
In that case, an indexing means in one of the jaws may be in the
form of a rib which extends transversely to the jaw adjacent the
edge thereof operable to engage the edge of the connecting portion
26 left between the side members 24 and 25.
Furthermore, it is also possible to construct the instrument with
jaws extending substantially perpendicular to the longitudinal axis
of the tubular structure 50. In that case, it will only be
necessary to include a prism or the like in the optical system to
conduct the light rays around the then existing corner.
While the present invention finds particular application for
purposes of sterlization in connection with the fallopian tubes,
its application is not limited thereto. For example, in smaller
versions, the present invention can also be used for ligations, for
example, blood vessels or the like. In that case, the present
invention still entails the advantage of requiring only a single
application in lieu of the need for a repeated application of two
or more clips.
Furthermore, through the use of the instrument through the
umbilicus has been described, its use is not limited thereto but
could be used equally successfully for sterlization after the
delivery when the fallopian tubes can be made accessible by merely
a small incision due to the enlarged condition of the uterus.
Furthermore, in addition to the direct application to the fallopian
tubes, the instrument may be used also for purposes of ligation of
vas deferens in males. In all of these and other "cover" uses of
the clip, the instrument can be simplified by omitting its optical
system and/or its light source, thus resulting in a less costly
instrument, still entailing the same advantage of "controlled
closure" of the clip. Furthermore, the instrument is not limited to
the particular actuating mechanism as shown and described but any
other actuating mechanism may be equally used which converts the
actuating movement into pivotal movement of the movable jaw. For
example, in an instrument without optical system and light source,
the tubular structure 50 can be omitted and the means for actuating
the movable jaw can then be greatly modified and simplified in a
conventional manner, substituting another type of actuating
mechanism for the one illustrated herein.
Finally, the present invention is equally applicable under
culdoscopy for application through a culdoscope or similar
device.
Any suitable material having the requisite physical properties may
be used for the occlusion clip in accordance with the present
invention, tantalum being among the preferred materials.
While I have shown and described several embodiments in accordance
with the present invention, it is understood that the same is not
limited thereto but is susceptible of numerous changes and
modifications as known to those skilled in the art, and I therefore
do not wish to be limited to the details shown and described
herein, but intend to cover all such changes and modifications as
are encompassed by the scope of the appended claims.
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