Tissue apposition clip application devices and methods

• US 8,888,792 B2
• Filed: 07/14/2008
• Issued: 11/18/2014
• Est. Priority Date: 07/14/2008
• Status: Active Grant

• Current Assignee: Cilag Gmbh International (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Harris, Jason L., Spivey, James T.
• Primary Examiner(s): Dornbusch, Dianne
• Application Number:
  US12/172,766
• Publication Number:
  US 20100010511A1
• Time in Patent Office: 2,318 Days
• Field of Search: 606/139, 606/142, 606/143
• US Class Current: 606/142
• CPC Class Codes: A61B 17/083 Clips, e.g. resilient
• CPC Class Codes: A61B 17/10 for applying or removing wound clamps, e.g. containing only one clamp or staple A61B17/076 takes precedence; containing multiple wound clamps A61B17/068; Wound clamp magazines containers, packaging elements or packages specially adapted for particular articles or with special means for dispensing contents B65D83/00, B65D85/00
• CPC Class Codes: A61B 17/105 Wound clamp magazines for packaging sharps A61B50/3001
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00818 Treatment of the gastro-intestinal system

Abstract

Surgical instruments and methods for closing a gastrotomy. In various embodiments, the surgical instrument may comprise an overtube that supports a clip magazine therein that houses a plurality of tissue apposition clips in an orientation wherein the upper and lower clip arms thereof are releasably supported in an open orientation. Various embodiments are configured to operably accommodate one or more tissue grasping members for grasping the tissue. Other embodiments comprise clip dispensing adapters that may be affixed to the distal end of an endoscope. The various adapters are configured to support a tissue apposition clip such that the upper and lower clip arms thereof are initially supported in an open orientation relative to each other to enable grasped tissue to be drawn therein. Various tissue apposition clips are disclosed which may be used in connection with conventional tissue anchors and/or sutures.

Claims

1. A clip application device, comprising:

an elongate clip magazine having an axial clip passage therein for receiving a plurality of tissue apposition clips therein, wherein each of said tissue apposition clips define a hole therethrough;

at least one grasper lumen in said elongate clip magazine apart from said axial clip passage and configured to movably accommodate a corresponding grasper device therethrough to manipulate tissue relative to a distal end of said elongate clip magazine, wherein each of said grasper lumen passes through said elongate clip magazine and said holes in the tissue apposition clips; and

an advancement member for applying an advancement motion to the tissue apposition clips in said axial clip passage to cause the tissue apposition clips to move out of said axial clip passage in seriatum.

2. The clip application device of claim 1 further comprising at least one camera lumen in said elongate clip magazine for receiving a camera therein.

3. The clip application device of claim 1 wherein the tissue apposition clips each have two clip arms and wherein said axial clip passage is configured to orient the tissue apposition clips to advance onto a portion of each of the grasper devices such that the clip arms of each said tissue apposition clip are biased to an open position away from each other as each of the tissue apposition clips is advanced out of said axial clip passage.

4. The clip application device of claim 1 further comprising an overtube for receiving said elongate clip magazine therein.

5. The clip application device of claim 4 wherein said overtube has a steerable distal end portion.

6. An adapter for installing a tissue apposition clip having upper and lower clip arms onto tissue, said adapter comprising:

a body portion couplable to a distal end of an endoscope having a longitudinal axis;

an upper support arm protruding from said body portion along said longitudinal axis;

a lower support arm protruding from said body portion along said longitudinal axis and having a fixed spacing from said upper support arm to enable a tissue apposition clip to be supported therebetween, wherein said upper and lower support arms are stationary;

an upper retention lug on said upper support arm configured to releasably engage the upper clip arm of the tissue apposition clip;

a lower retention lug on said lower support arm configured to releasably engage the lower clip arm of the tissue apposition clip, said upper and lower retention lugs configured to releasably retain the tissue apposition clip in an open position to enable tissue to be drawn therebetween and thereafter enable the tissue apposition clip to be released therefrom onto the tissue upon application of an advancement force to the tissue apposition clip, wherein said upper and lower retention lugs are selectively movable from a retention position to a releasing position upon application of a release force thereto; and

a tension member corresponding to each said upper and lower retention lug, each said tension member extending through a corresponding flexible tube coextensive with said endoscope.

7. The adapter of claim 6 wherein said body portion is attached to the distal end of the endoscope by a fastener arrangement selected from a group of fastener arrangements consisting of:

threads, slide-on type connections, and ratchet connections.

8. The adapter of claim 6 further having an opening through said body portion through which surgical tools may pass.

9. A surgical kit comprising:

a tissue grasping device; and

an adapter of claim 6.

10. A clip application device, comprising:

an elongate clip magazine having an axial clip passage therein, wherein said axial clip passage comprises;

a central passage portion; and

four leg passage segments, wherein two leg passage segments are located at an upper end of said central passage portion and two leg passage segments are located at a lower end of said central passage portion, wherein said leg passage segments protrude laterally from said central passage portion;

wherein said axial clip passage is configured to receive a plurality of tissue apposition clips comprising a base portion, an upper clip arm, a lower clip arm, and two laterally extending protrusions, wherein said leg passage segments are configured to slidably receive said laterally extending protrusions and said central passage portion is configured to slidably receive said base portion;

at least one grasper lumen in said elongate clip magazine apart from said axial clip passage and configured to movably accommodate a corresponding grasper device therethrough to manipulate tissue relative to a distal end of said elongate clip magazine; and

an advancement member for applying an advancement motion to said tissue apposition clips in said axial clip passage to cause said tissue apposition clips to move out of said axial clip passage in seriatum.

11. The clip application device of claim 10 further comprising at least one camera lumen in said elongate clip magazine for receiving a camera therein.

12. The clip application device of claim 10 wherein the tissue apposition clips each have two clip arms and wherein said axial clip passage is configured to orient the tissue apposition clips to advance onto a portion of each of the grasper devices such that the clip arms of each said tissue apposition clip are biased to an open position away from each other as each of the tissue apposition clips is advanced out of said axial clip passage.

13. The clip application device of claim 10 further comprising an overtube for receiving said elongate clip magazine therein.

14. The clip application device of claim 13 wherein said overtube has a steerable distal end portion.