Sterile occlusion fasteners and instrument and method for their placement

• US 5,681,330 A
• Filed: 10/04/1996
• Issued: 10/28/1997
• 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, Hughett, J. David
• Primary Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US08/726,141
• Time in Patent Office: 389 Days
• Field of Search: 606/143, 606/142, 606/139, 606/151, 227/175.1-182.1, 227/19, 227/901
• 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

Abstract

A 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. 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; and

a plurality of clips contained by said instrument, said clips each having an open position and a closed position and each clip being biased toward its closed position, said plurality of clips comprising a distal clip and a stack having a front end and a back end, said front end located adjacent said distal clip; and

a clip feeder for advancing a clip towards the distal end of the clip feeder and for advancing a clip into said tissue compressing portion, for effecting movement of the clip to its open position around tissue compressed at said business end, with the clip thereafter moving to its closed position, said feeder comprising;

a distal clip feed element for advancing said distal clip into said business end for placement around tissue to be occluded;

a stack feed element having an initial position and an advanced position said stack feed element for advancing the stack towards the business end of the device as the stack 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 for advancing with movement of the stack feed element to the advanced position advancing the stack to an advanced stack position towards the business end of the device as the stack feed element is moved from the initial position to the advanced position, and for holding the stack in the advanced stack position when the stack feed element returns to the initial position.

2. The instrument of claim 1 wherein said stack feed element is movably coupled to said distal clip feed element.

3. The instrument of claim 2 wherein said distal clip feed element comprises a first distal stroke portion and a second distal stroke portion, wherein during said first distal stroke portion, said distal clip feed element advances distally independently of said stack feed element, and wherein during said second distal stroke portion, said distal clip feed element engageably advanced with the stack feed element.

4. In combination, a surgical access tube and an instrument for applying surgical fasteners comprising:

a hollow tube for accessing a surgical site within a patient, said tube having an inner diameter, and said instrument having a shaft positionable within said hollow tube; and

a clip located in said instrument for applying surgical fasteners, said clip having a pair of leg members biased towards a closed position to define a closed fastener height corresponding to said closed position, said leg members defining therebetween a tissue occluding portion;

said closed fastener height defined by the greatest height of said clip at said tissue occluding portion of said clip when said clip is closed;

said instrument including means for retaining one of said leg members against opening movement and means for effecting opening movement of the other one of said leg members while said one leg member is retained; and

wherein said closed fastener height is such that the ratio of the tube inner diameter to the closed fastener height is less than or equal to 5.6.

5. The instrument and access tube of claim 4 wherein said closed fastener height is such that the ratio of the tube inner diameter to the closed fastener height is less than or equal to 3.2.

6. The instrument and access tube of claim 4 wherein said closed fastener height is such that the ratio of the tube inner diameter to the closed fastener height is less than or equal to 2.7.

7. The access tube and instrument of claim 4 wherein said access tube further comprises a trocar having a tissue dividing tip, said trocar removably inserted through said access tube inner diameter to expose said tip.

8. The access tube and instrument of claim 4 wherein said shaft comprises an actuating end and a fastener applying end opposite the actuating end;

said instrument further comprising a tissue compressing member located at the fastener applying end, for compressing tissue at the fastener applying end; and

an actuator coupled to said tissue compressing member and extending through said shaft to said actuating end, said actuator for actuating said tissue compressing member.

9. 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 advancer for advancing a clip to a first position around a tissue structure pressed between said surfaces; and

a clip disengager compressed between said surfaces, said clip disengager comprising a spring arranged to lift said clip from said instrument, said disengager for releasing the fastener from the first position to a tissue ligating position around tissue compressed by said surfaces, wherein said spring includes a blocking portion arranged to prevent re-engagement of said fastener with said instrument.

10. 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 fastener feeder extending into said shaft said feeder engageable with said distal-most fastener to simultaneously advance the distal-most fastener around tissue compressed by said compressing surfaces and to distally advance said stack; and

a disengager located at said fastener applying portion, said disengager comprising a spring arranged to lift said distal fastener from said fastener applying end, said spring including a blocking portion for preventing re-engagement of said distal fastener with said fastener applying end.

11. 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, each said jaw member having a tissue compressing surface to provide opposing tissue compressing surfaces, coupled to said actuator, said surfaces for precompressing tissue therebetween at least one of said jaw members comprising a tissue positioner comprised of interruptions in said surface of said at least one jaw member;

a surgical occlusion clip located in said instrument, said clip having a pair of leg members, at least one of which is movable relative to the other between an open position and a closed position, wherein said at least one leg member of said clip is biased in a closed direction;

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 into said business end, and for effecting relative movement of said at least one leg member of said clip to said open position around tissue compressed at said business end, wherein the actuator is operatively coupled to said feeder; and

a clip disengaging portion on said business end of the instrument, for receiving, opening and then releasing said clip advanced by said clip feeder, in a position over tissue precompressed by said tissue compressing surfaces, wherein said clip disengaging portion releases said clip in a position over the precompressed tissue, said disengaging portion including a spring portion biasing a said leg member while the tissue is positioned between said leg members and as said clip is released from said business end.