Repeating hemostatic clip applying instruments and multi-clip cartridges therefor

• US 4,412,539 A
• Filed: 05/11/1981
• Issued: 11/01/1983
• Est. Priority Date: 10/08/1976
• Status: Expired due to Fees

• Current Assignee: Edythe K. Jarvik, Robert K. Jarvik
• Original Assignee: United States Surgical Corporation (Medtronic Plc)
• Inventors: Jarvik, Robert K.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US06/262,759
• Time in Patent Office: 904 Days
• Field of Search: 128/325, 128/334 R, 227/19, 227/DIG. 1
• US Class Current: 606/143
• CPC Class Codes: A61B 17/128 for applying or removing clamps or clips

Abstract

The instrument is generally shaped and operated in the manner of prior clip applying instruments. Shaped like a pair of dog-nosed pliers, the outer ends of the jaws are adapted to hold a clip which may be applied to a blood vessel with the instrument. The rearward portion of the jaws overlap and a rectangular channel is formed in one of them through which clips may be pushed by a pusher extending down the center line of the instrument. One of the jaws is adapted to receive a cartridge containing a stack of U-shaped clips which may be pushed one at a time to the distal end of the jaws by the pusher.

The instrument basically comprises only three pivoted members, the pusher and its operating linkage, and one or two springs.

Several forms of pusher-actuating means are disclosed, two of these include a bell crank and cam so that the pusher will be operated before the jaws can be closed. The third comprises a free bell crank and a pair of unbalanced springs to achieve the same object.

The cartridge is provided with a spring for urging the U-shaped stack of clips down to the pusher channel, and a clip follower for preventing misalignment of the clips in the cartridge.

These above and various other features operate together in a synergistic manner to apply a plurality of hemostatic clips in a surprisingly simple, light, instrument providing an almost conventional "feel".

Claims

1. A repeating instrument for applying surgical clips to blood vessels or other body tissue, said instrument comprising:

an elongated main body portion;

first and second opposed jaws, said first jaw being formed at one end of said main body portion, said second jaw being mounted to said main body portion for arcuate movement, wherein said jaws are capable of movement relative to each other between an opened position sized to receive a surgical clip, and a closed position sized to clinch said surgical clip;

an elongated channel defined by said main body portion, said channel being of substantially constant cross-section for the passage of surgical clips to between said jaws;

pusher means, movable within said channel and operable between first and second positions, for advancing a surgical clip in said elongated channel, to between said jaws;

first and second lever arms pivotally mounted to said main body portion, the distal end of each arm terminating in a handle for receiving a manually applied force;

biasing means for normally biasing said lever arms away from said main body portion so that said lever arms assume an initial relative position with said handles being a first predetermined distance apart;

said lever arms being capable of moving relative to each other in response to a manual force applied to said handles to a final relative position wherein said handles are a second predetermined distance apart, said second distance being less than said first distance, and, upon moving said lever arms from said initial relative position to said final relative position, said lever arms pass through an intermediate relative position wherein said handles are a third predetermined distance apart, said third distance being less than said first distance and greater than said second distance;

pusher-sequencing means connecting one of said lever arms to said pusher means so that, during relative movement of said lever arms from said initial to said intermediate position, said pusher means advances from said first to said second position, wherein a surgical clip is advanced from said elongated channel to between said jaws, and during relative movement of said lever arms from said intermediate to said final position, said pusher means remains inactive, and during relative movement of said lever arms from said final position to said initial position, said pusher means moves from said second to said first position; and

jaw sequencing means connecting the other of said lever arms to said second jaw so that, during relative movement of said lever arms from said initial to said intermediate position, said jaws remain in said opened position, and during relative movement of said lever arms from said intermediate to said final position, said jaws move to said closed position, and during relative movement of said lever arms from said final to said initial position, said jaws move from said closed to said opened position.

2. A repeating hemostatic clip applying instrument for applying undeformed open ended clips capable of passage through a channel, said instrument comprising:

A. a first member,

a. formed at one end into a jaw, and

b. formed into means, leading from a point remote from said jaw to said jaw, for receiving a plurality of heomstatic clips, and

c. having an elongated channel of substantially constant cross-section for the passage of the hemostatic clips through said channel to said jaw, said channel formed in said first member having internal dimensions to accommodate the outer cross-section of the hemostatic clips to be applied by the instrument as they pass through said channel open end first;

B. a second member,

a. pivoted with respect to said first member

b. formed at one end into a jaw,

C. a pusher for advancing clips in sequential order one at a time through said channel to between said jaws;

D. clip engagement means, formed on said pusher, having the capability of advancing clips through said channel and into the jaws of the instrument in one continuous motion;

E. pusher actuating means operatively connected to and adapted to cause said pusher to push a hemostatic clip from said channel to a position between said jaws and to assume a fixed position relative to said clip that is positioned between said jaws as said jaws are closed, and to prevent the clip from moving back toward said channel as said clip is deformed by the jaw closure; and

F. a pair of handle shafts,

a. one of said handle shafts being integral with one of said members,

b. the other of said handle shafts pivoted with respect to the other of said members,

c. and said handle shafts being operatively connected to said pusher actuating mechanism and adapted to operate the same, and then to actuate said other member to effect jaw closure, whereby when said handle shafts are closed in one continuous motion, first, a clip is pushed from the channel to a position between said jaws and, second, said jaws are closed to deform and apply the clip whie said pusher remains against the rearward end of the clip during deformation preventing movement of the clip back toward said channel.

3. In a hemostatic clip applying instrument having a pair of jaws for applying hemostatic clips, a pair of closable handle shafts operated in a manner similar to the handle shafts of a conventional hemostat, a channel member having a channel for hemostatic clips leading to the jaws, and a pusher having a jaw end and a remote end for advancing a clip down said channel;

a reciprocating mechanism operated by closing the pair of handle shafts comprising;

A. a bell crank having;

1. a pivot related to said channel member for at least a portion of the pivotal movement of the bell crank;

4. a first element of a cam system, said system comprising:

a. a cam means characterized by a surface of constant radius with a drop-off and

b. a cam follower means; and

3. two lever arms, one of said lever arms connected to one of said handle shafts;

B. means pivotally connecting the other of said lever arms to the remote end of said pusher, and

C. the second element of said cam system being mounted to the other of said handle shafts and adapted to cooperate with said first element of said cam system, with said cam follower means riding on the constant radius surface of said cam means during the first part of the closing motion between said handle shafts and to then drop into said drop-off during the second part of the closing motion between said handle shafts.

5. In a hemostatic clip applying instrument having a pair of jaws for applying hemostatic clips, a pair of closable handle shafts operated in a manner similar to the handle shafts of a conventional hemostat, a channel member having a channel for hemostatic clips leading to the jaws and a pusher for advancing a clip down said channel toward said jaws;

a reciprocating mechanism operated by closing the handle shafts for reciprocating the pusher along the center line thereof, comprising;

pivotal means for effecting a pivotal connection to the end of said pusher remote from said jaws;

anmd

a bell crank rotatable about an axis fixed with respect to said channel for at least a portion of the rotatable movement of said bell crank, and having one leg pivotally connected to said pivotal means, and another leg being associated with one of said handle shafts so that said bell crank can be rotatably actuated thereby.

6. In a hemostatic clip applying instrument having a pair of jaws for applying hemostatic clips, a pair of closable handle shafts operated in a manner similar to the handle shafts of a conventional hemostat upon application of a manually applied force, a channel member having a channel for hemostatic clips leading to the jaws and a pusher for advancing a clip down said channel toward said jaws;

a reciprocating mechanism operated by closing the handle shafts for reciprocating the pusher along the center line thereof, comprising;

pivotal means for effecting a pivotal connection to the end of said pusher remote from said jaws;

a bell crank having first and second legs, said bell crank rotatable about an axis floating with respect to said channel;

means for connecting said first leg to said pivotal means;

means for associating said second leg of said bell crank with one of said handle shafts so that said bell crank can be rotatably actuated in response to application of manually applied force to said handle shafts.