Surgical clip applier

• US 5,720,756 A
• Filed: 09/13/1996
• Issued: 02/24/1998
• Est. Priority Date: 10/09/1992
• Status: Expired due to Term

• Current Assignee: LeMaitre Vascular, Incorporated
• Original Assignee: United States Surgical Corporation (Medtronic Plc)
• Inventors: Geiste, Robert J., Maffei, Frank C., Bolanos, Henry, Toso, Kenneth E., Alesi, Daniel E., Green, David T.
• Primary Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US08/713,771
• Time in Patent Office: 529 Days
• Field of Search: 606/1, 606/205-208, 606/139, 606/142, 606/143, 606/151, 227/901, 227/19, 227/175.1-182, 29/243.56
• US Class Current: 606/143
• CPC Class Codes: A61B 17/08 Wound clamps or clips, i.e. not or only partly penetrating the tissue suture bridges A61B17/0466; Devices for bringing together the edges of a wound
• CPC Class Codes: A61B 17/083 Clips, e.g. resilient
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61B 2017/2913 cams or guiding means
• CPC Class Codes: A61B 2017/2916 pins in guiding slots
• CPC Class Codes: A61B 2017/2929 with a head rotatable about the longitudinal axis of the shaft
• CPC Class Codes: Y10S 227/901 Surgical clip appliers

Abstract

A surgical clip applier comprising a housing, a pair of handles pivotally connected to opposite sides of the housing, and a jaw blade assembly fixedly connected to the housing. The jaw blade assembly includes a pair of jaws for receiving and deforming a clip therebetween and a clip carrier for supplying a series of clips to the jaws. A channel assembly is slidably mounted with respect to the housing and envelops the jaw blade assembly for camming the jaws closed upon closing of the handles. The clips may be fed to the jaws by a spring biased feed bar which operates upon closing of the handles, or may be urged by pusher bar which provides a biasing force to the clips to be retained by the jaws. The instrument may be used in conventional surgical procedures, or may be adapted for endoscopic and laparoscopic surgical procedures requiting the application of microsurgical clips.

Claims

1. A surgical clip applicator comprising:

a housing;

an endoscopic body portion extending distally from the housing;

a pair of handles pivotally connected to the housing, each of the handles having a proximal end and a distal end and being pivotally mounted to the housing at their proximal ends, the handles being actuable in a tweezer-like manner;

a pair of jaws extending from the endoscopic body portion, the jaws being configured to receive a clip from a series of clips and being movable between an open position and a closed position to deform a clip positioned therebetween;

a pusher bar engaging a proximalmost clip to urge the series of clips towards the pair of jaws; and

an actuating mechanism operably connected to the handles, the actuating mechanism being movable to move the jaws between the open and closed positions.

2. A surgical clip applicator as defined in claim 1, further comprising a biasing member positioned to urge the pusher bar and the series of clips towards the jaws to position the distal-most clip of the series of clips between the pair of jaws when the jaws are in the open position.

3. A surgical clip applicator as defined in claim 1, further comprising a channel assembly slidably positioned within the housing and being movable into engagement with the jaws to move the jaws from the open position to the closed position.

4. A surgical clip applicator as defined in claim 3, wherein the actuating mechanism includes a forming cam operatively connected between the channel assembly and the pair of handles, the forming cam being configured to move the channel assembly distally in response to inward pivoting of the handles.

5. A surgical clip applicator as defined in claim 4, wherein the forming cam includes at least one cam slot and is slidably positioned in the housing, the pair of handles having at least one pin positioned within the cam slot.

6. A surgical clip applicator as defined in claim 4, wherein the forming cam includes a pair of cam slots and each of the handles includes a pin positioned within a respective one of the cam slots.

7. A surgical clip applicator as defined in claim 3, further comprising a rotatable member rotatably connected to the housing and having a throughbore configured to support the endoscopic body portion, the channel assembly, the pair of jaws, and the pusher bar to facilitate rotation thereof, wherein the channel assembly and the pusher bar extend through the endoscopic body portion.

8. A surgical clip applicator as defined in claim 7, wherein the actuating mechanism includes a non-rotatable link operatively connected to the channel assembly to permit rotation of the channel assembly, the link being slidable longitudinally to permit longitudinal movement of the channel assembly.

9. An endoscopic surgical clip applicator comprising:

a housing and an elongated body portion extending from the housing;

a pair of handles pivotally connected to the housing;

a pair of jaws having a clip receiving portion positioned distally of the elongated body portion, the jaws being relatively movable from an open position to a closed position;

a series of microclips arranged in end-to-end relation in a row in the elongated body portion, wherein in the open position, the jaws are configured to receive a microclip from the series of microclips and in the closed position, the jaws deform the microclip positioned therebetween;

a pusher bar mounted for movement only in the distal direction to urge the series of microclips towards the jaws; and

a biasing member cooperating with the pusher bar, the biasing member being positioned to urge the pusher bar and the series of microclips towards the jaws to position a distal-most microclip from the series of microclips between the jaws when the jaws are in the open position.

10. A surgical clip applicator as defined in claim 9, further comprising a channel assembly positioned within the housing and being movable into engagement with the jaws to move the jaws from the open position to the closed position.

11. A surgical clip applicator as defined in claim 10, further comprising a rotatable member having a throughbore supported on the housing, the channel assembly, the pair of jaws, and the pusher bar being secured within the throughbore to facilitate rotation thereof.

12. A surgical clip applicator as defined in claim 9, further comprising an endoscopic body portion extending distally from the housing, wherein the series of microclips, the pusher bar, and the biasing member are enclosed within the endoscopic body portion.

13. An apparatus for endoscopically applying surgical clips in vascular surgical procedures comprising:

a handle portion;

an elongated body portion extending from said handle portion and defining a longitudinal axis;

a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip, said jaw mechanism being disposed at an angle with respect to longitudinal axis of said body portion;

a plurality of clips disposed within said body portion;

means for advancing said plurality of clips to urge a clip into said jaw mechanism, said advancing means comprising a pusher bar member and a biasing member, the biasing member being positioned to continuously urge the pusher bar and the series of clips towards the jaw mechanism to position and maintain a distal-most clip from the series of clips in the jaw mechanism as the jaw mechanism is moved between the open position and the closed position; and

retaining means disposed on said jaw mechanism for holding a clip in said jaw mechanism;

wherein said retaining means, said advancing means and said angle of said jaw mechanism cooperate to urge a clip into said jaw mechanism and to prevent said clip from being advanced distally through said jaw mechanism.

14. An apparatus according to claim 13, wherein, said pusher bar member includes means at a distal end for permitting flexing of said pusher bar member when disposed in said angle of said jaw mechanism.

15. An apparatus according to claim 14, wherein said means for flexing said pusher bar member includes at least one transverse groove adjacent said distal end.

16. An apparatus according to claim 13, further comprising a rotation knob mechanism for rotating said body portion and said jaw mechanism with respect to said handle portion.

17. An apparatus according to claim 13, wherein said body portion includes a seal means for preventing leakage of gas and fluids through said body portion.

18. An apparatus according to claim 13, wherein said retaining means comprises a portion of said jaw mechanism having a shape complementary to a shape of said clip for receiving and retaining said clip.

19. An apparatus according to claim 18, wherein said portion of said jaw mechanism comprising said retaining means defines an arcuate shape along said longitudinal axis, said clips being C-shaped and defining leg portions complementary in shape to said arcuate retaining means.

20. An apparatus for endoscopically applying surgical clips in vascular surgical procedures comprising:

a handle portion;

an elongated body portion extending from said handle portion;

a pair of jaw members extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip, said open position defining a gap between said jaw members;

a plurality of clips disposed within said body portion;

a pusher bar member movable only in the distal direction to advance said plurality of clips to urge a clip into said jaw members; and

a camming mechanism associated with said body portion for camming said jaw members from said open position to said closed position; and

said pusher bar member urging said plurality of clips such that each clip in said plurality of clips is contacted by at least one other clip, and said clips cooperate to urge a distalmost one of said clips between said jaw members and to maintain said distalmost clip between said jaw members while said jaw members are moved from said open position to said closed position.

21. An apparatus according to claim 20, wherein said body portion includes a channel assembly which is slidable with respect to said handle portion and said jaw members to move said jaw members to said closed position to form a clip positioned therebetween.

22. An apparatus according to claim 21, further comprising a rotation knob for rotating said body portion and said jaw members with respect to said handle portion.

23. An apparatus according to claim 22, wherein said camming mechanism includes a link member joining said handle portion to said body portion, said link member permitting rotational movement of said body portion and longitudinal movement of said channel assembly within said body portion.

24. An apparatus according to claim 21, wherein said camming mechanism joins said channel assembly to said handle portion.

25. An apparatus according to claim 20, wherein said handle portion includes a pair of handle members pivotably connected to said handle portion at a proximal end thereof, said handle members each including a gripping portion at a distal end thereof, said gripping portions being disposed adjacent said body portion.

26. An apparatus according to claim 20, wherein said jaw members are angled with respect to a longitudinal axis of said body portion.

27. An apparatus according to claim 20, wherein said pusher bar member is spring biased.

28. An apparatus according to claim 20, wherein said jaw members include a retaining means complementary in shape to said clips for retaining said clips in said jaw members prior to forming.

29. A method for performing anastomosis procedures in endoscopic vascular surgery, comprising the steps of:

a) incising a patient'"'"'s skin to provide access for at least a vascular clip applying instrument;

b) providing a vascular clip applying instrument;

c) inserting said vascular clip applying instrument into said patient;

d) everting respective ends of first and second vessel portions;

e) positioning the evened ends in contacting adjacent relation with respect to each other;

f) positioning said clip applying instrument adjacent the everted ends, the instrument including an endoscopic portion and a jaw assembly having a pair of jaws extending from the endoscopic portion, and a series of vascular clips supported in the endoscopic portion, the instrument further including a handle assembly having a pair of handle members, the handle members being pivotable in a tweezer like manner to close the jaws to crimp a vascular clip positioned therebetween;

g) positioning the pair of jaws of the instrument over a first portion of the everted end of the vessel portions;

h) closing the handle assembly of the instrument in a tweezer like manner to close the pair of jaws and crimp a vascular clip positioned therebetween about the first portion of the everted ends;

i) opening the handle assembly of the instrument to release the crimped vascular clip and to allow the foremost clip of the series of clips to be fed between the jaws;

j) repositioning the pair of jaws over another portion of the everted ends of the vessel portions and applying the foremost vascular clip to such portion of the everted ends of the vessel portions; and

k) repeating step i)-j) to apply a plurality of clips to other portions of the everted ends of the vessel portions to anastomose the vessels.

30. The method according to claim 29, further comprising the steps of inserting a cannula sleeve into each of said incisions, and inserting said instruments through said cannula sleeves into said patient.

31. The method according to claim 29, further comprising the steps of removing said instruments following anastomosis of the vessels, and closing said incisions in the patient.

32. A surgical clip applicator comprising:

a housing and an elongated body portion extending from the housing;

a handle assembly pivotally connected to the housing;

a jaw assembly having a clip receiving portion positioned distally of the elongated body portion, the jaw assembly being relatively movable from an open position to a closed position;

a series of clips arranged in end-to-end relation, wherein in the open position, the jaw assembly is configured to receive a clip from the series of clips and in the closed position, the jaw assembly deforms the clip positioned therebetween;

a pusher bar movable toward the jaw assembly to urge the series of clips towards the jaw assembly; and

a spring biasing member cooperating with the pusher bar, the biasing member being positioned to urge the pusher bar and the series of clips towards the jaw assembly to position a distal-most clip from the series of clips within the jaw assembly when the jaw assembly is open and to maintain the distal-most clip in position within the jaw assembly at least until the distal-most clip has been partially deformed.

33. A surgical clip applicator as defined in claim 32, further including a jaw blade extending from the distal end of the housing, the jaw assembly being positioned at the distal end of the jaw blade.

34. A surgical clip applicator as defined in claim 33, wherein the series of clips is supported on the jaw blade.

35. A surgical clip applicator as defined in claim 32, wherein the clips are serially arranged such that each clip in the series of clips is positioned to continuously engage adjacent clips.

36. A surgical clip applicator as defined in claim 32, wherein the handle assembly comprises a pair of handles, each of the handles having a proximal end and a distal end, the proximal end of the handles being pivotably mounted to the housing such that the handles are actuable in a tweezer-like manner.

37. A surgical clip applicator as defined in claim 32, further comprising a channel assembly slidably mounted with respect to the housing and the jaw assembly and adapted for slidable movement into engagement with the jaw assembly to move the jaw assembly from the open position to the closed position to deform a clip positioned therebetween.

38. A surgical clip applicator as defined in claim 37, further comprising a forming cam operatively connected between the channel assembly and the handle assembly such that when the handle assembly is pivoted toward the housing, the forming cam is moved distally to move the channel assembly distally.

39. A surgical clip applicator as defined in claim 38, wherein the forming cam includes at least one cam slot which interacts with a pin connected to the handle assembly to move the channel assembly distally.

40. A surgical clip applicator as defined in claim 38, further comprising a spring positioned to bias the handle assembly outwardly to move the channel assembly and the forming cam in a proximal direction.

41. A surgical clip applicator as defined in claim 37, further comprising a window formed in the housing and a rotatable member having a throughbore positioned in the window, the channel assembly, jaw assembly, and pusher bar being secured within the throughbore to facilitate rotation thereof.

42. A surgical clip applicator as defined in claim 32, wherein the biasing member is positioned within the housing, and wherein the applicator further comprises a rod extending between the biasing member and the pusher bar to urge the pusher bar distally.

43. A surgical clip applicator as defined in claim 32, wherein the pusher bar is positioned proximal of and engages the proximal-most clip from the series of clips and remains engaged with the proximalmost clip as it urges the distal-most clip into position between the jaws.

44. An apparatus for endoscopically applying surgical clips in vascular surgical procedures comprising:

a handle portion;

an elongated body portion extending from said handle portion and defining a longitudinal axis;

a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, said jaw mechanism being disposed at an angle with respect to longitudinal axis of said body portion;

a plurality of clips disposed within said body portion;

means for advancing said plurality of clips to urge a clip into said jaw mechanism, said advancing means comprising a pusher bar member and a biasing member, the biasing member being positioned to urge the pusher bar and the series of clips towards the jaw mechanism to position and maintain a distal-most clip from the series of clips in the jaw mechanism as the jaw mechanism is moved between the open position and the closed position; and

retaining means disposed on said jaw mechanism for holding a clip in said jaw mechanism;

wherein said retaining means, said advancing means and said angle of said jaw mechanism cooperate to urge a clip into said jaw mechanism and to prevent said clip from being advanced distally through said jaw mechanism; and

wherein said body portion includes a channel assembly which is slidable with respect to said handle portion and said jaw members to move said jaw members to said closed position to form a clip positioned therebetween.

45. An apparatus for endoscopically applying surgical clips in vascular surgical procedures comprising:

a handle portion;

an elongated body portion extending from said handle portion and defining a longitudinal axis;

a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, said jaw mechanism being disposed at an angle with respect to longitudinal axis of said body portion;

a plurality of clips disposed within said body portion;

means for advancing said plurality of clips to urge a clip into said jaw mechanism, said advancing means comprising a pusher bar member and a biasing member, the biasing member being positioned to urge the pusher bar and the series of clips towards the jaw mechanism to position and maintain a distal-most clip from the series of clips in the jaw mechanism as the jaw mechanism is moved between the open position and the closed position; and

retaining means disposed on said jaw mechanism for holding a clip in said jaw mechanism;

wherein said retaining means, said advancing means and said angle of said jaw mechanism cooperate to urge a clip into said jaw mechanism and to prevent said clip from being advanced distally through said jaw mechanism; and

wherein said handle portion includes a pair of handle members pivotably connected to said handle portion at a proximal end thereof, said handle members each including a gripping portion at a distal end thereof, said gripping portions being disposed adjacent said body portion.

46. A surgical clip applicator comprising:

a housing;

a handle assembly pivotally connected to the housing;

a jaw assembly extending from a distal end of the housing, the jaw assembly being relatively movable from an open position to a closed position;

a series of clips arranged in end-to-end relation, wherein in the open position, the jaw assembly is configured to receive a clip from the series of clips and in the closed position, the jaw assembly deforms the clip positioned therebetween;

a pusher bar movable toward the jaw assembly to urge the series of clips towards the jaw assembly; and

a biasing member cooperating with the pusher bar, the biasing member being positioned to urge the pusher bar and the series of clips towards the jaw assembly to position a distal-most clip from the series of clips within the jaw assembly when the jaw assembly is open and to maintain the distal-most clip in position within the jaw assembly at least until the distal-most clip has been partially deformed; and

a channel assembly slidably mounted with respect to the housing and the jaw assembly and adapted for slidable movement into engagement with the jaw assembly to move the jaw assembly from the open position to the closed position to deform a clip positioned therebetween.

47. A surgical clip applicator as defined in claim 46, wherein the handle assembly includes a pair of handles, each of the handles having a proximal end and a distal end, the proximal end of the handles being pivotably mounted to the housing such that the handles are actuable in a tweezer-like manner.

48. A surgical clip applicator as defined in claim 46, further comprising a rotatable member supported on the housing, the jaw assembly being operably connected to the rotatable member to facilitate rotation of the jaw assembly.

49. A surgical clip applicator as defined in claim 46, wherein the pusher bar is positioned proximal of and engages the proximal-most clip from the series of clips and remains in this position as it urges the distal-most clip from the series of clips between the jaws.