U.S. patent number 3,882,854 [Application Number 05/390,861] was granted by the patent office on 1975-05-13 for surgical clip and applicator.
This patent grant is currently assigned to Research Corporation. Invention is credited to George Selden Clemens, Jaroslav Fabian Hulka.
United States Patent |
3,882,854 |
Hulka , et al. |
May 13, 1975 |
Surgical clip and applicator
Abstract
A surgical clip, particularly adapted to produce necrosis in
Fallopian tube tissue, consists of jaws hinged adjacent one end and
a U-shaped spring which holds the jaws open in one position and
exerts a closing pressure on the jaws in another position. The clip
is particularly adapted to be applied to tube tissue, through a
laparoscope designed to have a pair of slidable actuators one of
which closes the clip jaws and assists in retaining the clip in
proper location at the distal end of the laparoscope and the other
actuator is adapted to position the U-shaped spring in the jaw
closing position.
Inventors: |
Hulka; Jaroslav Fabian (Chapel
Hill, NC), Clemens; George Selden (Northfield, IL) |
Assignee: |
Research Corporation (New York,
NY)
|
Family
ID: |
23544237 |
Appl.
No.: |
05/390,861 |
Filed: |
August 23, 1973 |
Current U.S.
Class: |
600/104; 606/157;
600/182; 606/142 |
Current CPC
Class: |
A61B
17/1285 (20130101); A61F 6/204 (20130101); A61B
1/303 (20130101) |
Current International
Class: |
A61B
17/12 (20060101); A61B 17/128 (20060101); A61F
6/00 (20060101); A61F 6/20 (20060101); A61B
1/303 (20060101); A16b 001/06 (); A61b 017/08 ();
A61b 017/10 () |
Field of
Search: |
;128/6,303.15,321,325,346 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
"Fiber Optic Laparoscope," brochure of American Cystoscope Makers,
Inc., Pelham Manor, New York. Feb. 1972..
|
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Stowell; Harold L.
Government Interests
The principal rights to this invention are subject to subsequent
assignment to the United States Government.
Claims
We claim:
1. A surgical clip and actuator for occluding tubes in a living
animal said clip comprising first and second jaw members; means
adjacent one end of each jaw member pivotally mounting the other
ends of said jaw members for movement toward and away from each
other; a generally U-shaped spring member engaging remote surfaces
of each jaw member and slidable from a first position on one side
of the said pivotal mounting, to urge said jaw members into the
open arrangement, to a second position on the other side of the
said pivotal mounting, to urge said jaw members into the closed
position; and said actuator including a cradle for said clip and
first and second manually operable rods; said first rod adapted to
contact a top surface of said first jaw member and to urge said jaw
member toward said second jaw member against the urging of said
U-shaped spring when said spring is in said first position; and
said second rod positioned to urge said U-shaped spring into said
second position.
2. A surgical clip for occluding tubes in a living animal
comprising first and second jaw members; means adjacent one end of
each jaw member pivotally mounting the other ends of said jaw
members for movement toward and away from each other; a generally
U-shaped spring member engaging remote surfaces of each jaw member
and slidable from a first position on one side of the said pivotal
mounting, to urge said jaw members into the open arrangement, to a
second position on the other side of the said pivotal mounting to
urge said jaw members into the closed position.
3. An actuator for a surgical clip comprising an elongate tubular
body portion, a clip receiving cradle having a bottom wall and an
end wall extending longitudinally from one end of the tubular body,
first and second manually operable rods mounted in said tubular
body and for reciprocation relative thereto, said first rod having
an actuating head positioned in a plane immediately above the
cradle and reciprocal in said plane over said cradle, a first
actuating member mounted at the opposite end of the first rod at
the end of the tubular body remote from the cradle, said second rod
having an actuating head aligned with said cradle and movable
immediately over the bottom wall of the cradle, and a second
actuating member mounted at the opposite end of the second rod at
the end of the tubular body remote from the cradle.
4. A surgical clip as defined in claim 2 wherein the opposed
surfaces of each jaw member are provided with a plurality of
opposed interfitting tube gripping elements.
5. The invention defined in claim 4 wherein said opposed alternate
interfitting elements comprises cooperating cones and conical
bores.
6. The invention defined in claim 4 wherein said generally U-shaped
spring member is of ribbon configuration and the remote faces of
the jaw members are provided with elongated slots within which the
ribbon-like U-shaped spring is adapted to slidably traverse.
7. The invention defined in claim 6 including turned in tip
elements on said U-shaped spring and cooperating transverse slots
in said grooves of each jaw member to secure the U-shaped spring
when said spring is in the position to urge the jaw members into
their closed position.
8. The invention defined in claim 3 wherein said tubular body
includes a surgical microscope and a source of light therefor.
9. The invention defined in claim 8 wherein said light source
includes a bundle of light transmitting fibers.
10. The invention defined in claim 9 wherein said light
transmitting bundle of fibers are arranged in an oval
configuration.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention generally appertains to new and useful improvements
in clamping devices, especially those designed for closing or
shutting off flexible tubular conduits, and is particularly
directed to a new and useful clamping instrument for use for
occluding Fallopian tubes and other ducts in an animal or a human
body.
2. State of the Art
Devices currently available and used for occluding Fallopian tubes
are U-shaped clips or clamps. Applied by being inserted over the
tubes and then compressed or flattened mechanically to achieve
occlusion, they are often difficult and cumbersome to handle and
position correctly. If the compression pressure is so strong that
the clips are completely flattened, one or both of two possible
application failures may occur. First, the tubes may be severed and
hemorrhaging occur. Second, since the clips are generally only 1mm
wide, if any part of a tube is severed, it can readily bypass the
narrow clip, re-anastomose and render the patient fertile once
again.
On the other hand, if the mechanical compression pressure on such
clips is not strong enough, they will not be completely flattened,
thus leaving small openings for the Fallopian tube, sufficient to
allow passage of the microscopicsized ova.
SUMMARY OF THE INVENTION
An important object of the present invention is to provide a hinged
jaw type clip or clamp designed such that the upper and lower jaws
of the clip are closed down on the Fallopian tube to an open height
of 1mm at the forward end of the clip, at which point a light
compressive force is applied through a U-shaped spring. This force
causes gradual necrosis and dissipation of the tissue between the
jaws so that the clip effects a complete closure, upon completion
of the necrosis of the tube, both without hemorrhaging and without
any open spaces through which live tissue and/or ova could
pass.
A further object is to provide such a Fallopian tube clip or clamp
having a width of, for example, 3mm and height of about 4mm to
reduce to a minimum the possibility that the clamped Fallopian tube
will re-anastomose around the clip.
Another object is to provide such a clip and applicator therefor
which can be used to perform sterilization on women under local
anesthesia and with minimum interference with the patient's
occupation or home duties.
In general the clamp of the present invention comprises a pair of
cooperating jaw members hinged adjacent one end, a generally
U-shaped spring, and means on the remote faces of each jaw member
to slidably receive the U-shaped spring in jaws open and jaws
closed positions. More specifically, the clip or clamp consists of
two Lexan plastic or other body compatible jaws hinged around a
stainless steel pin. The clip is held open by a stainless steel
U-shaped spring which is gold plated, and is held closed by the
same spring when the spring is pushed over the jaws and exerts
pressure on the end of the jaws distal to the hinge. A Silastic
filler is attached to the metal spring to fill up all remaining
dead space so as to minimize the possibility of infection.
In general the clip applicator comprises a laparoscope adapted to
receive the clip at its extended end and a pair of jaw and spring
actuating rams. The laparoscope may also include a surgical
microscope and a source of light which may comprise a light
transmitting fiber optical bundle.
DESCRIPTION OF THE DRAWING
The invention will be more particularly described in reference to
the accompanying drawing wherein:
FIG. 1 is an enlarged partial sectional view of an embodiment of a
tube clip of the invention with the clip jaws in the open position
and being retained therein by a generally U-shaped spring;
FIG. 2 is a view of the clip shown in FIG. 1 with the jaws in the
closed position and being retained therein by the U-shaped
spring;
FIG. 3 is a top plan view of the structure shown in FIG. 1;
FIG. 4 is a top plan view of the structure shown in FIG. 2;
FIG. 5 is an illustration of an improved laparoscope for use with
the clip shown in FIGS. 1 through 4;
FIG. 6 is an enlarged end view of the instrument shown in FIG. 5;
and
FIGS. 7, 8, 9, 10 and 11 are diagrammatic fragmentary views of the
use of a clip of the invention and modified laparoscope during the
application of a clip to a Fallopian tube.
Referring to the drawings and in particular FIGS. 1 through 4, 10
generally designates the improved Fallopian tube clip or clamp. The
clip 10 includes an upper jaw member 12, a lower jaw member 14 and
a U-shaped spring assembly 16. The upper and lower jaws 12 and 14
of the clip are hinged together by a hinge pin 18 which pin may be
made of stainless steel, gold, plastic or other bicompatible
material while the jaws 12 and 14 are also formed of a
biocompatible material. Lexan plastic has been found to be very
suitable, and comprises a thermoplastic polycarbonate resin
manufactured by General Electric Company.
The upper jaw 12 is molded or formed with a plurality of depending
conical spikes 20a, b, c and d arranged in two rows with spikes 20a
and c aligned in one row and 20b and d in opposite row. Further,
the surface 22 of upper jaw 12 is provided with four conical bores
24a, 24b, 24c and 24d with bores 24a and 24c being in the same row
with conical spikes 20b and 20d and conical bores 24b and 24d being
in the same row as conical spikes 20a and 20c as more clearly shown
in FIG. 4 of the drawings. The spikes prevent the clip from
slipping off the slippery Fallopian tube as the jaws of the clip
are closed by the closure tool, and prevent extrusion of the
Fallopian tube from the forward end of the clip.
The lower jaw 14 is also provided with alternate spikes and bores
spaced and arranged such that when the jaws are closed as shown in
FIGS. 2 and 3 spikes in the top jaw engage bores in the lower jaw
and vice versa. In the bottom jaw the spikes are designated 26a,
26b, 26c, and 26d and the conical bores in the bottom jaw are
designated 28a, 28b, 28c and 28d.
The upper jaw 12 is provided with a groove 30 in its top surface 32
which extends from adjacent to the rear end 34 to a transverse slot
36. The groove 30 and the transverse slot 36 are sized to receive
the U-shaped spring 16 to be more fully described hereinafter. A
similar groove 38 and slot 40 are formed in the bottom wall 42 of
the lower jaw 14 of the clip. Further, the lower jaw 14 is provided
with an upstanding end element 43 which as more clearly shown in
FIG. 2 assists in providing the closed clip with a relatively
smooth contour and assists in retention of a Fallopian tube within
the jaws when the jaws are in the closed position.
The U-shaped spring assembly 16 includes a metallic ribbon-like
spring 44 having the ends of its legs turned in as at 46 and 48.
The width of the spring 44 is such that it is slidably receivable
in the grooves 30 and 38 in the respective jaws 12 and 14 and the
spring has a thickness so that the turned in ends 46 and 48 may be
received in their respective slots 36 and 40 in jaws 12 and 14.
The bridge portion of the U-shaped spring assembly 16 is provided
with a fillet or filler element 50 shaped such that when the clamps
are closed as shown in FIGS. 2 and 4 the fillet 50 fills in the
open space of the hinge arrangement of the pair of jaws to thereby
reduce to a minimum zones for the collection of matter which might
be the locus of infections. The fillet 50 generally includes a back
piece 52 and a pair of generally triangular shaped wings 54 and 56.
The fillet may be formed of the same material as used in the
formation of the jaws or a dissimilar material.
Referring now to FIGS. 5, 6 and 7, 100 generally designates a
laparoscope clip applicator which includes a tubular body portion
102 fitted at its extended end 104 with a headpiece 106 provided
with a cradle 108 shaped to receive one of the clips 10 with the
hinge end thereof positioned outwardly and the forward end of the
clip nested against the curved recess 110 of the cradle 108. The
laparoscope includes a pair of rams or applicators 112 and 114 with
the ram 112 adapted to retain the clip 10 in its nested position in
the cradle 108 and to permit opening and closing of the top jaw 12
thereof while the lower ram 114 is adapted to actuate the U-shaped
spring 50 from its retracted position shown in FIGS. 1 and 3 to its
closed position shown in FIGS. 2 and 4.
The ram 112 is connected to a slide member 116 at the opposite end
of the instrument 100 while ram 114 is connected to its slide
member 118. Upper and lower finger engaging stabilizing rings 119a
and 119b are provided by the instrument.
In FIG. 5 it will be noted that a latch member 120 for ram 112
actuating member 116 is provided. The latch member 120 cooperates
with edge 122 of actuator 116 to prevent accidental withdrawal of
ram 112 beyond the position shown in FIG. 8 until the clip has been
positively attached to the Fallopian tube to thereby minimize
accidental displacement of the clip from its cradle during use of
the device. When the clip is fully attached release of the latch
member 120 permits withdrawal of the ram 112 so that the clip can
be separated from the laparoscope as to be more fully described
hereinafter.
The laparoscope also includes a surgical microscope having an
eyepiece 128, FIG. 5, and an objective lens 130, FIG. 6.
Surrounding the objective lens of the surgical scope is a bundle
132 of light transmitting fibers. The fiber optical bundle 132, as
more clearly shown in FIG. 6, is arranged in an elliptical
configuration so that adequate light can be conveyed to the subject
without interferring with the clip and clip cradle and without the
necessity of using a trocar sleeve for the laparoscope of greater
diameter than 10mm as to be more fully described hereinafter.
The laparoscope is also provided with a tap 130' which receives the
external fiber optic bundle 132 which is connected to a source of
controlled light not shown. The laparoscope also includes the
conventional means 134 for directing air or other gases to and from
the operation zone.
The length, width and height of the clip would vary depending on
the intended use of the clip; however, it has been found where the
clip is to be used to occlude Fallopian tubes in adult women, a
clip 3mm wide, 4mm high, and having a length of about 16mm and
internal jaw lengths of about 1cm has provided very satisfactory
results.
Use of the clip and applicator will be described in reference to
FIGS. 7 through 11. One of the clips 10 with its spring assembly 16
in the rearward position is placed in the cradle 108 of the
laparoscope 100 and after insertion ram or actuator 112 is moved to
a forward position so that the clip and forward end of the
laparoscope are in the mode shown in FIG. 7. After the instrument
is inserted into a trocar, placed in an incision in the patient's
abdomen, the ram or actuator 112 is moved rearwardly to the
position illustrated in FIG. 8 whereby the jaws 12 and 14 of the
clip 10 are in their fully opened position; however, the clip is
still retained in the cradle 106 by the presence of the tip 112a of
ram 112.
With the clip in this position the surgeon locates the Fallopian
tube A with the aid of the microscope and fiber optic lighting
system and positions the open-jawed clip about the selected zone of
the Fallopian tube having the opening B therein. This aspect of the
operation of the device is illustrated in FIG. 9. After the
Fallopian tube is properly located between the jaws of the clip 10,
ram 112 is urged forwardly to the position shown in FIG. 7 and the
Fallopian tube is urged into a collapsed position as shown in FIG.
10. While the tube is in the collapsed position ram actuator 114
shoves the spring assembly 16 forwardly to seat the inwardly curved
tips 46 and 48 thereof into engagement in their respective slots 36
and 40 and the fillet member 50 into the space rearwardly of the
hinge pivot 18 of the clip. This is shown in FIG. 10.
with the spring securely in place the spring exerts a continuing
closing force upon the jaws further constricting the Fallopian
tube. Next the latch member 120, FIG. 5 of the drawings, is
released and ram 112 is withdrawn from the tip of the laparoscope
freeing the clip from its saddle 106 as shown in FIG. 11 so that
the surgeon may carefully manipulate the device and proceed to
insert a second clip on the other tube of the female patient.
Since the entire instrument is contained within a 10mm trocar it
has been found possible to perform the operation while the patient
is only under a local anesthetic.
From the foregoing description of the improved Fallopian tube clip
and applicator, it will be seen by those skilled in the art that
the aims and objects of the present invention are fully
accomplished. It will be further recognized that various
modifications may be made in the form of the clip and its
applicator without departing from the scope of the appended
claims.
* * * * *