Clamp assembly and method of use

• US 5,626,607 A
• Filed: 02/01/1996
• Issued: 05/06/1997
• Est. Priority Date: 04/03/1995
• Status: Expired due to Term

• Current Assignee: Heartport, Inc. (Johnson & Johnson)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Gifford, Hanson S. III, Sterman, Wesley D., Miller, Scott H., Malecki, William W.
• Primary Examiner(s): Green, Randall L.
• Assistant Examiner(s): VANOVER, PERRY
• Application Number:
  US08/595,568
• Time in Patent Office: 460 Days
• Field of Search: 604/19, 604/27-28, 604/36, 604/93, 604/115-117, 604/164, 604/56, 604/51-53, 604/44, 604/4, 606/205-211, 128/751
• US Class Current: 606/205
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/1227 Spring clips
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 17/295 combined with cutting implements
• CPC Class Codes: A61B 17/34 Trocars; Puncturing needles pointed biopsy instruments A61B10/0233; devices for piercing the ear-lobes A44C7/001; seals or hemostasis valves A61M39/06
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00353 one mechanical instrument performing multiple functions, e.g. cutting and grasping channel for multiple instruments A61B2017/3445; instrument channel A61B2017/22072; replaceable heads A61B2017/2931; suction A61M1/00
• CPC Class Codes: A61B 2017/00544 pneumatically
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/2933 camming or guiding means
• CPC Class Codes: A61B 2017/2943 Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2945 Curved jaws
• CPC Class Codes: A61B 2017/2946 Locking means
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2018/1432 curved
• CPC Class Codes: A61M 2205/3344 : Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3355 : Controlling downstream pump pressure

Abstract

A clamp for clamping a body structure in a patient. The clamp includes a flexible cable housed within a sheath. The cable and sheath extend between a clamp and a handle. The cable actuator. The cable extends through a sheath which is anchored at the clamp and the actuator for actuating jaws from a proximal end of the clamp. A malleable positioner is provided for positioning the clamp about the body structure.

Claims

1. A method of clamping a structure in a patient, comprising the steps of:

providing a clamp, a cable puller, a flexible sheath, and a flexible cable, the handle having a first sheath holder and the clamp having a second sheath holder, the sheath extending between the first and second sheath holders, the cable being at least partially housed within the sheath and generally conforming to a shape of the sheath, the cable also being coupled to the cable puller and the cable puller being adapted to displace the cable relative to the sheath, the clamp having a first jaw and a second jaw, the first jaw being movable relative to the second jaw between an open position and a closed position, the first jaw being coupled to the cable so that the first jaw moves between the open and closed positions when the cable is moved by the cable puller, the first and second jaws having atraumatic contact surfaces, the flexible sheath and flexible cable being deformable so that the cable puller can move the cable relative to the sheath when the flexible sheath is curved;

introducing the clamp into a patient;

moving the cable puller thereby displacing the cable relative to the sheath and moving the first jaw to the open position;

positioning the body structure of a patient between the first and second jaws after the moving step;

clamping the body structure by moving the cable puller thereby closing the jaws around the body structure; and

moving the first and second jaws to the open position and unclamping the body structure, the atraumatic contact surfaces of the first and second jaws being configured to minimize damage to the body structure thereby leaving the body structure substantially in tact.

2. The method of claim 1, wherein:

the providing step is carried out with an introducer releasably coupled to the clamp; and

the positioning step is carried out by manipulating the introducer so that the first and second jaws are positioned around the body structure.

3. The method of claim 2, further comprising the step of:

disengaging the introducer from the clamp after the positioning step.

4. The method of claim 1, wherein:

the providing step is carried out with both the first and second jaws being movable between the open and closed positions.

5. The method of claim 1, further comprising the step of:

adjusting a force biasing the first and second jaws toward the closed position.

6. The method of claim 1, wherein:

the providing step is carried out so that the first and second jaws move substantially parallel to one another when moving from the open position to the closed position.

7. The method of claim 1, wherein:

the providing step is carried out with the contact surfaces comprising an elastomeric material.

8. The method of claim 1, further comprising the steps of:

holding the clamp with an introduction device during the positioning step; and

releasing the clamp from the introduction device after the clamping step.

9. A method of clamping a structure in a patient, comprising the steps of:

providing a clamp, a cable puller, a flexible sheath, and a flexible cable, the handle having a first sheath holder and the clamp having a second sheath holder, the sheath extending between the first and second sheath holders, the cable being at least partially housed within the sheath and being coupled to the cable puller, the cable puller being adapted to displace the cable relative to the sheath, the clamp having a first jaw and a second jaw, the first jaw being movable relative to the second jaw between an open position and a closed position, the first jaw being coupled to the cable so that the first jaw moves between open and closed positions when the cable is moved by the cable puller;

introducing the clamp into a patient;

moving the cable puller thereby displacing the cable relative to the sheath and moving the first jaw to the open position; and

positioning a body structure of a patient between the first and second jaws after the moving step; and

closing the jaws around the body structure by moving the cable puller;

the providing step being carried out with both the first and second jaws being movable between the open and closed positions;

the moving step being carried out with the first and second jaws having jaw surfaces remaining substantially parallel to one another when moving between the open and closed positions.

10. A method of clamping a structure in a patient, comprising the steps of:

providing a clamp, a cable puller, a flexible sheath, and a flexible cable, the handle having a first sheath holder and the clamp having a second sheath holder, the sheath extending between the first and second sheath holders, the cable being at least partially housed within the sheath and being coupled to the cable puller, the cable puller being adapted to displace the cable relative to the sheath, the clamp having a first jaw and a second jaw, the first jaw being movable relative to the second jaw between an open position and a closed position, the first jaw being coupled to the cable so that the first jaw moves between the open and closed positions when the cable is moved by the cable puller;

introducing the clamp into a patient;

moving the cable puller thereby displacing the cable relative to the sheath and moving the first jaw to the open position;

positioning a body structure of a patient between the first and second jaws after the moving step; and

closing the jaws around the body structure by moving the cable puller;

the positioning step being carried out with the body structure being an internal mammary artery.

11. A clamp for clamping a body structure in a patient, comprising:

a handle having a first sheath holder;

a clamp having a second sheath holder, a cable holder, a first jaw and a second jaw, the first jaw being movable relative to the second jaw between an open position and a closed position, at least the first jaw being operably coupled to the cable holder for moving the first jaw between the open and closed positions;

a flexible sheath extending between the first and second sheath holders;

a flexible cable at least partially housed within the sheath and generally conforming to a shape of the sheath;

a spring biasing the cable relative to the sheath, the spring biasing the first and second jaws toward the closed position; and

a cable puller movably coupled to the handle, the cable puller being configured to displace the cable relative to the sheath when the flexible sheath is curved.

12. The clamp of claim 11, wherein:

the second jaw is also movable between the open and closed positions relative to the first jaw.

13. The clamp of claim 12, wherein:

the first and second jaws remain substantially parallel to one another when moving between the open and closed positions.

14. The clamp of claim 11, wherein:

at least one of the cable and the cable puller extends at least partially through the spring.

15. The clamp of claim 11, further comprising:

a manually operable actuator movably coupled to the cable puller.

16. The clamp of claim 11, wherein:

the cable puller is slidable relative to the handle.

17. The clamp of claim 11, further comprising:

a first pin;

a second pin;

the first and second jaws each including a first slot, the first pin passing through the first slot in each of the first and second jaws;

the first and second jaws each including a second slot, the second pin passing through the second slot in each of the first and second jaws;

the first and second slots of each of the first and second jaws being parallel to one another.

18. The clamp of claim 11, wherein:

the handle includes first and second finger engaging members positioned on opposite sides of a proximal end of the cable and sheath.

19. The clamp of claim 11, wherein:

the first and second jaws each include a jaw member having a rounded bumper at a distal tip so that trauma to a patient is minimized during insertion of the clamp.

20. The clamp of claim 19, wherein:

the jaw member includes an atraumatic jaw surface integrally formed with the bumper.

21. The clamp of claim 11, further comprising:

a spring force adjusting member contacting the spring and being coupled to the cable puller, the spring force adjusting member being configured to adjust a closing force of the first and second jaws.

22. The device of claim 11, wherein:

the first and second jaws have atraumatic contact surfaces.

23. The device of claim 11, wherein:

the first and second jaws remain substantially parallel to one another when moving from the open position to the closed position.

24. The clamp of claim 11, wherein:

the cable puller is linearly slidable relative to the handle;

the handle having means for preventing rotation of the cable puller.

25. The clamp of claim 11, further comprising:

first and second links coupled to one another at a first pivot, the first and second jaws being coupled to one another at a second pivot;

the cable being coupled to at least one of the first and second pivots for moving the first jaw from the open position to the closed position.

26. A clamp for clamping a body structure in a patient, comprising:

a handle having a first sheath holder;

a clamp having a second sheath holder, a cable holder, a first jaw and a second jaw, the first jaw being movable relative to the second jaw between an open position and a closed position, at least the first jaw being operably coupled to the cable holder for moving the first jaw between the open and closed positions;

a flexible sheath extending between the first and second sheath holders;

a flexible cable at least partially housed within the sheath; and

a cable puller movably coupled to the handle, the cable puller being configured to displace the cable relative to the sheath;

the cable including an end which is detachable from the clamp.

27. A clamp for clamping a body structure in a patient, comprising:

a handle having a first sheath holder;

a clamp having a second sheath holder, a cable holder, a first jaw and a second jaw, the first jaw being movable relative to the second jaw between an open position and a closed position, at least the first jaw being operably coupled to the cable holder for moving the first jaw between the open and closed positions;

a flexible sheath extending between the first and second sheath holders;

a flexible cable at least partially housed within the sheath;

a cable puller movably coupled to the handle, the cable puller being configured to displace the cable relative to the sheath;

a spring biasing the cable relative to the sheath, the spring biasing the first and second jaws toward the closed position;

a spring force adjusting member contacting the spring and being coupled to the cable puller, the spring force adjusting member being configured to adjust a closing force of the first and second jaws; and

an actuator movably coupled to the handle, the actuator being connected to the cable puller and contacting the spring, the actuator being movable relative to the handle between a first position, in which a first clamping force is applied to the actuator by the spring when the jaws are in the closed position, and a second position, in which a second clamping force is applied by the spring when the first and second jaws are in the closed position, the first clamping force being larger than the second clamping force.

28. A clamp, comprising:

a clamp body having a distal end; and

a jaw member coupled to the clamp body, the jaw member having an atraumatic jaw surface and a bumper, the bumper extending substantially around a distal end for reducing trauma when the clamp is inserted into a patient, the bumper being integrally formed with the atraumatic jaw surface;

the jaw member including a retention member extending from the atraumatic surface at the distal end of the clamp body, the retention member being integrally formed with the atraumatic jaw surface and the bumper.

29. A clamp for clamping a body structure in a patient, comprising:

a handle having a first sheath holder;

a clamp having a second sheath holder, a cable holder, a first jaw and a second jaw, the first jaw being movable relative to the second jaw between an open position and a closed position, at least the first jaw being operably coupled to the cable holder for moving the first jaw between the open and closed positions, the first and second jaws remaining substantially parallel to one another when moving from the open position to the closed position;

a flexible sheath extending between the first and second sheath holders;

a flexible cable at least partially housed within the sheath and generally conforming to a shape of the sheath; and

a cable puller movably coupled to the handle, the cable puller being configured to displace the cable relative to the sheath when the flexible sheath is curved.

30. The device of claim 29, wherein:

the first and second jaws have atraumatic contact surfaces.

31. A clamp for clamping a body structure in a patient, comprising:

a handle having a first sheath holder;

a clamp having a second sheath holder, a cable holder, a first jaw and a second jaw, the first jaw being movable relative to the second jaw between an open position and a closed position, at least the first jaw being operably coupled to the cable holder for moving the first jaw between the open and closed positions;

a flexible sheath extending between the first and second sheath holders;

a flexible cable at least partially housed within the sheath;

a cable puller movably coupled to the handle, the cable puller being configured to displace the cable relative to the sheath; and

an introducer releasably attached to the clamp.

32. The clamp of claim 31, wherein:

the introducer is releasably attached to the handle.

33. The clamp of claim 31, wherein:

the introducer is malleable so that the introducer may be deformed.