Sterile occlusion fasteners and instruments and method for their placement

• US 5,601,573 A
• Filed: 03/15/1995
• Issued: 02/11/1997
• Est. Priority Date: 03/02/1994
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Murray, Michael A., Stefanchik, David, Braddock, C. Kerwin, Boehm, Michael E., Hughett, J. David, Fogelberg, Mark
• Primary Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US08/404,662
• Time in Patent Office: 699 Days
• Field of Search: 606/143, 606/142, 606/139, 227/175-182, 227/19, 227/901, 227/902
• US Class Current: 606/143
• CPC Class Codes: A61B 17/1227 Spring clips
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: Y10S 227/901 Surgical clip appliers
• CPC Class Codes: Y10S 227/902 Surgical clips or staples

Abstract

A clip, clip applier and method for ligating a tissue structure is provided. The applier has a two stage actuation. In the first stage, a tissue structure is positioned into the jaws of the clip applier The jaws close and lock to a preset force to compress and temporarily occlude the tissue structure. If satisfactorily positioned, the second stage is initiated in which a clip is advanced through the shaft of the clip applier in a closed position. At the distal end of the clip applier, the clip is opened slightly to capture the pre-compressed tissue structure, and is placed over the structure. The clip is then dissociated from the business end of the instrument. Preferably the clip comprises two leg members disposed in close proximity to one another joined from opposing directions by a connecting element. The connecting element restricts separation of the leg members with opposing spring members so as to provide substantially uniform parallel deflection of the leg members from each other.

Claims

1. An instrument for applying surgical clips comprising:

an instrument shaft having a lumen extending therethrough and a distal end;

opposed tissue compressing surfaces coupled to the distal end of the instrument shaft;

a clip advancing device for advancing a clip in a position over a compressed tissue structure compressed between said surfaces; and

a clip disengaging device arranged to disengage the clip from a first open position to a tissue ligating position over tissue compressed by said tissue compressing surfaces, said clip disengaging device comprising a spring arranged to lift said clip from said instrument.

2. An instrument for applying a plurality of surgical fasteners comprising:

a shaft having a distal end;

a fastener applying portion located at the distal end of the shaft, the fastener applying portion including tissue compressing surfaces;

a stack of fasteners located in said shaft, said stack having a distal end;

a distal-most fastener adjacent said stack distal end;

a feeding device extending into said shaft, said feeding device engageable with said distal-most fastener to simultaneously advance the distal-most fastener over tissue compressed by said compressing surfaces, and engageable with said stack to distally advance said stack; and

a disengaging device located at said fastener applying end, said disengaging device comprising a spring arranged to release said distal fastener from said fastener applying end.

3. A tissue fastener applying instrument comprising:

a housing;

an actuator associated with said housing;

a business end coupled to the housing and located at a distal end of the instrument, said business end comprising a tissue compressing portion movably coupled to said actuator to compress tissue at said business end, said housing including a clip opener at said business end; and

a clip feeder operatively coupled to said actuator, said clip feeder for advancing a normally closed clip towards the distal end of the clip feeder and for advancing a clip into said tissue compressing portion and into engagement with said clip opener to position said clip over tissue compressed at said business end;

a plurality of clips contained by said instrument, said plurality of clips comprising a stack having a distal end and a proximal end; and

wherein said clip feeder comprises;

a feed element having an initial position and an advanced position, said feed element arranged to advance the stack towards the business end of the device as the feed element is moved from the initial position to the advanced position; and

a ratchet element located at the back end of the stack, said ratchet element arranged to advance with movement of the feed element to the advanced position and to hold the stack in its advanced position when the feed element returns to the initial position.

4. A clip applying instrument comprising:

a handle;

a trigger associated with the handle;

a business end coupled to the handle, said business end comprising a tissue compressing portion including a pair of jaw members having respective tissue compressing surfaces, said trigger operatively coupled to said compressing surfaces, said compressing surfaces adapted to precompress a tissue structure located therebetween at the business end of the instrument, at least one of said jaw members being mounted for movement relative to the other jaw member between an open tissue receiving position and a closed tissue compressing position; and

a clip feeder to advance a clip towards the distal end of the device and to a position within said tissue compressing portion and over the precompressed tissue structure, said feeder associated with said trigger;

wherein said trigger has a trigger stage comprising a first portion and a second portion;

wherein said first portion couples a first trigger actuation force to move said at least one jaw member and cause the tissue compressing surfaces to precompress tissue therebetween; and

wherein said second portion couples a second, subsequent trigger actuation force to the clip feeder.

5. The instrument of claim 4 wherein said trigger further comprises a stop separating the first trigger stage portion from the second trigger stage portion.

6. A tissue fastener applying instrument comprising:

a hollow tubular shaft having an actuating end and a fastener applying end, said tubular shaft having an outer diameter;

said actuating end and said applying end being connected by said hollow tubular shaft;

jaw members comprising opposing tissue compressing surfaces for compressing a tissue structure therebetween to a preset force by movement of at least one of said jaw members toward the other;

an actuating device for actuating said tissue compressing device, said actuating device coupled to said tissue compressing device and extending through said shaft to said actuating end; and

a fastener located in said instrument, said fastener positionable within said shaft, and said fastener having a closed position and a closed fastener height corresponding to said closed position;

wherein said fastener is biased toward said closed direction; and

wherein said closed fastener height is such that the ratio of the shaft outer diameter to the closed fastener height is less than or equal to 5.2

a fastener feeder arranged to advance the fastener to the distal end of the instrument between said jaw members and over a compressed tissue structure; and

a release portion formed in said jaws for releasing the fastener from said applying end.

7. The instrument of claim 6 further comprising:

wherein said fastener feeder further comprises a fastener spreading element adapted to cause said fastener to move from said closed position to said open position to provide an opening within said fastener wherein said tissue is situated within said opening.

8. A method for occluding a tissue structure, the method comprising the steps of:

providing a fastener comprising a first member having a proximal portion and a distal portion, a second member having a proximal portion and a distal portion, and a connecting element connected to the first member at the proximal portion and the second member at the distal portion, the connecting element resiliently biasing the first member and the second member toward each other;

compressing a tissue structure between a pair of jaw members at least one of which is movable relative to the other; and

effecting relative movement between the first and second clip members and placing the fastener between said jaw members and over the compressed tissue structure between the first member and the second member.

9. A method of applying a surgical fastener comprising the steps of:

providing a fastener applying instrument having an actuating device and a business end, said business end comprising a tissue compressing portion including a pair of jaw members with opposing tissue compressing surfaces, at least one of said jaw members being movable relative to the other one of said jaw members;

providing a fastener, associated with said applying instrument and having an initial position in said instrument, said fastener comprised of;

a first tissue ligating surface having a length,

a second tissue ligating surface having a length, and a connecting element connecting said first and second tissue ligating surfaces, said connecting element biasing said first ligating surface and said second ligating surface towards each other;

compressing a tissue structure to a predetermined force with said tissue compressing surfaces of said jaw members; and

advancing and placing said clip by;

applying a force to said fastener to move said fastener from the initial position into said jaws, and separating the ligating surfaces to form an opening between said ligating surfaces;

situating the ligating surfaces within said tissue compressing portion so that the compressed tissue structure is situated between said ligating surfaces; and

disassociating the fastener from the jaws to permit the ligating surfaces to move towards the initial position.

10. A device for applying a surgical clip to a tissue structure, the device comprising:

a housing having a fastener end, the fastener end comprising a tissue compressing portion including jaw members having a pair of opposing tissue occluding surfaces for compressing and occluding a tissue structure therebetween, at least one of said jaw members being mounted for movement relative to the other jaw member generally within a plane between an open tissue receiving position and a closed tissue receiving position;

at least one surgical clip contained by said instrument, the clip comprising a first tissue occluding member having a proximal portion and a distal portion, a second tissue occluding member having a proximal portion and a distal portion, and a connecting element connected to the first member at the proximal portion and to the second member at the distal portion, the connecting element resiliently biasing the first member and the second member toward each other to define a tissue occluding portion of said clip and

an advancer movably positioned within the housing and associated with the clip, said advancer having means for advancing said clip to the fastener end into said tissue compressing portion, and means for opening said clip by movement of said first member away from said second member in substantially the same plane of movement as said at least one jaw member as said clip is advanced for application to said tissue structure compressed between said surfaces of said jaw members.

11. The device according to claim 10, including an actuator operatively connected to the advancer for effecting advancement of the clip upon actuation of the actuator.

12. The device according to claim 10, wherein the housing includes a fastener containing portion connected to the fastener end, the clip being located in the fastener containing portion.

13. The device according to claim 12, wherein the fastener containing portion has an outer diameter and the clip has a closed fastener height defined by the greatest height of said clip at said tissue occluding portion of said clip when said clip is closed.

14. The device according to claim 13, including a ratio of the portion height to the closed fastener height being no more than 5.2.

15. The device according to claim 13, including a ratio of the portion height to the closed fastener height being no more than 3.0.

16. The device according to claim 13 including a ratio of the portion height to the closed fastener height being no more than 2.6.

17. The device according to claim 10 in which said housing has a longitudinally extending axis, and wherein said axis is disposed within said plane.

18. A clip applying instrument comprising:

a business end comprising jaw members, each jaw member including a tissue compressing surface, at least one of said jaw members arranged to move from an open position to a closed position and to accept and compress a tissue structure to be ligated between said surfaces;

an actuating end including an actuator to move at least one jaw member from said open position to said closed position and thereafter to advance a clip to a position within said jaw members of said business end,

at least one clip located in said instrument, said clip comprising;

a first leg member having a distal portion, a proximal portion and a first tissue ligating surface,

a second leg member having a distal portion, a proximal portion and a second tissue ligating surface, and

a connecting element connecting said first and second leg members, said connecting element being coupled to the proximal portion of the first leg member, and said connecting element being coupled to the second leg member at the distal portion thereof;

wherein said first leg member and said second leg member are resiliently biased towards each other;

the first leg member of said clip being movable to a position wherein said first and second ligating surfaces are spaced from one another as said clip is advanced toward the business end by said actuator, so that the compressed tissue to be ligated is disposed between said first and second ligating surfaces, the first leg member being resiliently biased toward the second leg member upon further advancing of said clip, so that said first and second ligating surfaces are disposed in litigating engagement with the tissue compressed between said tissue compressing surfaces.

19. The instrument of claim 18 further comprising:

a clip feeder to advance said clip to said business end; and

wherein said jaw members comprise a clip release portion from which said clip is released from said jaw members.

20. The instrument of claim 18 wherein:

the distal portions of the first and second leg members of the clip directionally correspond to the distal portion of the instrument and wherein the proximal portions of the first and second leg members of the clip directionally correspond to the proximal portion of the instrument.

21. The instrument of claim 20 comprising a plurality of clips arranged from end to end.

22. An instrument for applying surgical fasteners comprising:

a hollow tubular shaft having an actuating end and a fastener applying end opposite the actuating end, said tubular shaft having an outer diameter;

a tissue compressing member located at the fastener applying end, for compressing tissue at said fastener applying end;

an actuator coupled to said tissue compressing member and extending through said shaft to said actuating end, said actuator being movable within said shaft and comprising means for actuating said tissue compressing member; and

a fastener located in said instrument, said fastener positionable within said shaft, and said fastener having an open position and a closed position and a closed fastener height corresponding to said closed position;

wherein said fastener is biased towards said closed position and maintained in said closed position, wherein said actuator includes means for moving said fastener to said open position and for positioning said fastener within said tissue compressing member of application of said fastener to tissue; and

wherein said closed fastener height is such that the ratio of the shaft outer diameter to the closed fastener height is less than or equal to 5.2.

23. The instrument of claim 22 wherein said closed fastener height is such that the ratio of the shaft outer diameter to the closed fastener height is less than or equal to 3.0.

24. The instrument of claim 22 wherein said closed fastener height is such that the ratio of the shaft outer diameter to the closed fastener height is less than or equal to 2.6.

25. The instrument of claim 22 comprising a plurality of fasteners.

26. The instrument of claim 22 further comprising:

a fastener feeder arranged to feed said fastener through the tubular shaft to the applying end of the instrument while the fastener is in said closed position.

27. A surgical clip applying instrument comprising:

a housing;

an actuator associated with said housing;

a business end coupled to the housing and located at a distal end of the instrument, said business end comprising a pair of jaw members coupled to said actuator and having respective tissue compressing surfaces for precompressing tissue therebetween;

a surgical occlusion clip located in said instrument, said clip having an open position and a closed position, wherein said clip is biased toward said closed position;

a clip feeder disposed in said instrument, said clip feeder for advancing a clip in said closed position towards the distal end of the clip feeder and then into said business end between said jaw members, wherein the actuator is operatively coupled to said clip feeder; and

a clip disengaging portion of said business end of the instrument for receiving and releasing said clip advanced by said clip feeder in a position between said jaw members and over tissue precompressed by said tissue compressing surfaces.

28. The instrument of claim 27 wherein said actuator comprises at least one trigger associated with the housing.

29. The instrument of claim 27

wherein said actuator comprises a first trigger and a second trigger;

wherein said first trigger is operatively coupled to said tissue compressing surfaces to transfer a first trigger actuation force to said tissue compressing surfaces to cause said tissue compressing surfaces to compress tissue therebetween; and

wherein said second trigger is operatively coupled to said clip feeder to transfer a second trigger actuation force to said clip feeder to cause said clip feeder to advance a fastener towards the business end and to place a fastener over the compressed tissue.

30. The instrument of claim 27 further comprising a plurality of fasteners.

31. The instrument of claim 27 wherein said business end further comprises an opening for viewing a said fastener as it is fed to said distal end of said instrument when said tissue is compressed by said surfaces.

32. The instrument of claim 27 wherein said jaw members comprise a stationary jaw member and a movable jaw member arranged to move toward and away from said stationary jaw member wherein said compressing surfaces are located on said jaw members.

33. The instrument of claim 27

wherein said actuator comprises a first trigger having a trigger stage comprising a first portion and a second portion;

wherein said first stage portion couples a first trigger actuation force to said tissue compressing surfaces to cause the tissue compressing surfaces to precompress tissue therebetween; and

wherein said second portion is operatively coupled to said clip feeder to couple a second, subsequent trigger actuation force to the clip feeder to cause said clip feeder to advance a fastener towards the business end and to place a fastener over the compressed tissue.