Apparatus and method for applying surgical clips in laparoscopic or endoscopic procedures

• US 5,084,057 A
• Filed: 05/30/1990
• Issued: 01/28/1992
• Est. Priority Date: 07/18/1989
• Status: Expired due to Term

• Current Assignee: United States Surgical Corporation (Medtronic Plc)
• Original Assignee: United States Surgical Corporation (Medtronic Plc)
• Inventors: Bolanos, Henry, Ratcliff, Keith, Young, Wayne P., McGarry, Richard A., Green, David T., Heaton, Lisa W.
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): Jackson, Gary
• Application Number:
  US07/530,652
• Time in Patent Office: 608 Days
• Field of Search: 606/143, 606/142, 227/175-180, 227/19, 604/93, 128/4, 128/6
• US Class Current: 606/142
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery

Abstract

A disposable apparatus is disclosed for applying surgical clips to body tissue in endoscopic surgical procedures. The apparatus includes a frame which is adapted to be gripped by hand, and an endoscopic section permanently connected to the handle and capable of storing surgical clips in preparation for clipping arteries or other body tissue. The apparatus includes means for advancing each clip sequentially to a pair of distal jaws and means for closing the jaws about the clip. When the jaws are closed, the clip advancing means is simultaneously positioned to advance the next clip. When all clips are spent the apparatus becomes automatically locked against further advancement of the clip advancing means as well as further closing of the clip closing jaws. The present apparatus also makes it possible to partially close a clip without interfering with the sequential movement of the clip advancing mechanism.

Claims

1. An apparatus for endoscopic application of surgical clips to body tissue which comprises:

a) frame means;

b) endoscopic means connected to said frame means of generally elongated configuration and extending distally from said frame means and including;

i) means for storing a plurality of surgical clips;

ii) means for individually advancing said clips to the distal portion of said endoscopic means for positioning adjacent the body tissue to be clipped;

iii) means for at least partially closing each said clip at least sufficient to grip the body tissue after the clip has been advanced distally to said distal portion of said endoscopic means; and

iv) gaseous sealing means.

2. The apparatus according to claim 1 wherein said gaseous seal means comprises silicone grease.

3. The apparatus according to claim 1 further comprising locking means positioned about said endoscopic section to selectively prevent entry of said endoscopic section into a tubular member in dependence upon the size of the tubular member with respect to the size of said endoscopic section.

4. The apparatus according to claim 3 wherein said locking means comprises a collar configured and dimensioned to be disposed about said endoscopic section.

5. The apparatus according to claim 4 wherein said safety locking means comprises members adapted to be releasably engaged with said endoscopic section to retain said collar in locked relation to said endoscopic section.

6. The apparatus according to claim 5 wherein said safety locking means comprises a plurality of resilient members adapted for releasable engagement with an outer surface portion of said endoscopic section, said members being adapted to be released by means associated with a trocar guide tube dimensioned and configured to engage and release said members when said endoscopic section is inserted into a trocar guide tube of predetermined size corresponding to the size of the endoscopic section.

7. A disposable apparatus for endoscopic application of surgical clips to body tissue which comprises:

a) a frame;

b) an elongated endoscopic section connected at the proximal end thereof to said frame and extending distally from said frame, said endoscopic section including;

i) means for storing a plurality of surgical clips;

ii) a pair of jaws positioned at the distal portion of said endoscopic section and adapted for reception of said clips;

iii) means for individually advancing said clips distally for positioning within said pair of jaws to be positioned adjacent the body tissue to be clipped; and

iv) means for at least partially closing said jaws about each said clip to close said clips at least partially about the body tissue; and

v) gaseous sealing means.

8. A disposable apparatus for endoscopic application of surgical clips to body tissue which comprises:

a) a frame configured and dimensioned for manual gripping;

b) an elongated endoscopic section connected at the proximal end thereof to said frame and extending distally therefrom, said endoscopic section including;

i) means for storing a plurality of surgical clips in generally aligned relation facing the distal portion thereof;

ii) jaw means positioned at the distal end thereof and adapted for sequential reception of said clips;

iii) means for individually advancing said clips distally as to be positioned between said jaw means for positioning adjacent the body tissue to be clipped;

iv) means for selectively at least partially closing said jaw means about each said clip after the clip is advanced therebetween while simultaneously repositioning said clip advancing means for distal advancement of the next clip.

9. The apparatus according to claim 8 wherein said frame further comprises an instrument body and an actuating handle mounted to said instrument body.

10. The apparatus according to claim 9 further comprising first transmission means for linearly transferring motion from said actuating handle to said clip advancing means.

11. The apparatus according to claim 10 further comprising means to close said jaw means.

12. The apparatus according to claim 10 further comprising second transmission means for linearly transferring motion from said actuating handle to said jaw closing means.

13. The apparatus according to claim 12 further comprising means for locking said handle such that after actuating said handle to close said jaws said handle cannot be actuated unless said locking means is released.

14. The apparatus according to claim 13 wherein said endoscopic section is rotatable independent of said handle.

15. The apparatus according to claim 14 further comprising means to selectively lock said endoscopic section at a predetermined angular orientation relative to said handle.

16. The apparatus according to claim 15 further comprising means to release said lock means of said endoscopic section so as to permit rotation thereof relative to said handle.

17. The apparatus according to claim 16 wherein said handle locking means comprises a first resilient catch movable in response to actuation of said handle from an unlocked position to a locked position wherein said first transmission means is advanced and locked, release means adapted to release said first resilient catch, said first resilient catch being returnable to the unlocked position in response to actuation of said release means, and a second resilient catch movable in response to actuation of said handle from an unlocked position to a locked position wherein it engages and locks said second transmission means, said second resilient catch being resiliently returnable to the unlocked position in response to the release of said resilient catch.

18. The apparatus according to claim 17 wherein said first transmission means comprises means responsive to actuation of said release means to release said second transmission means.

19. The apparatus according to claim 18 wherein said jaw means comprises a pair of jaws positioned in spaced relation and configured and dimensioned for reception of a surgical clip therebetween, said jaws being resiliently movable toward and away from each other in response to distal movement of a camming means from a proximal position to a distal position.

20. The apparatus according to claim 19 wherein said camming means comprises a channel member slidably mounted with said endoscopic section and longitudinally movable in response to actuation of said handle, said channel member having at least two distal camming surfaces for biasing the jaws into said closed position.

21. The apparatus according to claim 20 wherein said means for storing surgical clips comprises a track for holding a longitudinal array of surgical clips, and spring means located proximal to the array of surgical clips for biasing said surgical clips toward the distal direction.

22. The apparatus according to claim 16 further comprising a clip track positioned between said jaw means and said clip follower.

23. The apparatus according to claim 22 wherein said means for advancing the surgical clips comprises a pusher bar for advancing the distal-most clip in the area of said pair of jaws, said pusher bar being longitudinally slidable in response to actuation of said handle, and escapement means located at the distal end of the array of clips for preventing the next clip from being dislocated prior to advancement into said jaw means.

24. The apparatus according to claim 23 wherein said escapement means comprises at least one projection upstanding from said clip track and extending into the clip path to prevent proximal movement of a clip after advancement into said jaw means.

25. The apparatus according to claim 24 wherein said first transmission means comprises a pusher bar, and a proximal pusher tube connected to the proximal end of said pusher bar.

26. The apparatus according to claim 25 wherein said pusher bar is movable between a first position wherein the distal end of said pusher bar is located proximally of the surgical clip to be advanced, and a second position wherein said distal end of said pusher bar advances the surgical clip to said jaw means.

27. The apparatus according to claim 26 wherein said first pusher tube having mounting means for rotatably connecting said pusher bar thereto.

28. The apparatus according to claim 27 wherein said mounting means of said pusher tube comprises a generally circular shaped projection dimensioned for reception and engagement of at least one cooperating projection on said pusher bar.

29. The apparatus according to claim 17 wherein said second transmission means comprises a channel member positioned within said endoscopic section, a proximal channel tube connected to the proximal end portion of said channel member, and a channel tube adapted for rotatably connecting said channel member thereto, said channel member being connected to said camming means for closing said jaw means.

30. The apparatus according to claim 29 wherein said jaw means comprises a jaw blade fixed to the endoscopic section and having a pair of distal spaced jaws which are resiliently movable between a closed position for closing a surgical clip and an open position for reception of the surgical clip, and said camming means comprised of a channel member having camming surfaces movable from a first position proximal of said jaws, and a second distal position wherein said camming surfaces of said channel member move said jaws to the closed position, said channel member being connected at its proximal end to said channel tube.

31. The apparatus according to claim 30 wherein said second transmission means comprises a channel tube having rotatable mounting means for rotatably connecting same to said camming means for closing the jaw means.

32. The apparatus according to claim 31 wherein said rotatable mounting means of said channel tube comprises a circumferential projection dimensioned for engaging at least one cooperating notch in said camming means.

33. The apparatus according to claim 32 wherein said endoscopic section is rotatable about a longitudinal axis extending relative to said frame.

34. The apparatus according to claim 33 wherein said endoscopic portion is rotatable between a plurality of click-stop settings.

35. A disposable apparatus for endoscopic application of surgical clips to body tissue which comprises:

a) a frame adapted to be gripped by hand;

b) an elongated endoscopic section connected to said frame and capable of rotation to a plurality of selectable angular positions relative thereto, said endoscopic section including;

i) means for storing a plurality of surgical clips;

ii) a pair of jaws at the distal end portion of said endoscopic section configured and dimensioned for sequential reception and clamping of said clips;

iii) means for advancing said clips into said jaws;

an

iv) means for moving said jaws toward each other for closing a clip positioned therebetween; and

v) gaseous seal means;

c) said frame including;

i) first transmission means connected to said clip advancing means for sequentially advancing clips into said jaws;

ii) second transmission means connected to said jaw closing means for closing said jaws about a clip positioned therebetween;

iii) handle means connected to said second transmission means and movable manually from a first position whereby said jaws are open to a second position whereby said jaws are closed;

said handle means further being connected to said first transmission means and adapted to move said clip advancing means from a first position distal of said handle section to a second locked position proximal of the next clip to be advanced, while said second transmission means is actuated to close said clip closing means about a clip positioned within said jaws;

iv) means to release said locked position of said clip advancing means;

v) means to resiliently advance said clip advancing means to advance the next clip distally into the jaws of said clip closing means;

vi) a pusher tube connected to said clip advancing means;

vii) a channel tube connected to said clip closing means;

viii) means to move said pusher tube and said channel tube between respective first and second positions; and

ix) means to lock said pusher tube and said channel tube in one of said first and second positions.

36. A method for endoscopically applying surgical clips on an apparatus having a frame adapted to be gripped by hand and on endoscopic section connected to said frame and rotatable to selected positions relative to said frame, comprising:

a) storing the clips in said endoscopic section, said endoscopic section including a gaseous seal means;

b) advancing a clip distally by clip advancing means positioned within said endoscopic section to a pair of jaws positioned at the distal end of said endoscopic section;

c) positioning the clip adjacent body tissue to be clipped;

d) closing the jaws about the clip while simultaneously repositioning said clip advancing means to a position proximal of the next clip to be advanced; and

e) releasably locking said clip advancing means in said position until released to advance the next clip.