Note: Descriptions are shown in the official language in which they were submitted.
This invention relates to a clip cartridge for repeating hemostatic
clip applyin~ instruments. More particularly, it relates to the rapid and
repeated ligation of so called bleeders in surgical procedures.
After a surgeon has made his incision, it is necessary to clamp
the tissue wherever blood is being lost due to the cutting of blood vessels.
The usual technique is to clamp each so-called bleeder with a hemostat
(locking dog-nosed pliers) as soon after the vessel is severed as possible.
This controls the loss of blood until a ligature can be tied around the vessel.
As many as 20 or more bleeders may be clamped by as many hemostats in common
surgical procedures before they are tied. Thus, a single operation often
requires the use of a large num~er of hemostats. These are handed to the
surgeon and his assistants, one at a time, by the scrub nurse.
The surgical field often becomes cluttered with hemostats, which
interfere with the surgeon's view and hinder the convenient application of
additional hemostats. However, a good surgical practice requires the appli-
cation of hemostats to all bleeders before a~y are tied.
The tying process requires one hand to hold the hemostat and two
hands to pass the suture material around the hemostat and to form the
ligature by tying a knot. This procedure thus requires two people. In
addition, the ligatures must be cut and the excess suture material removed
., .
from the incision. The used hemostats must be handed to the scrub nurse and
be readied for reuse. Thus, this entire technique for the achievement of
hemostasis requires the coordination and teamwork of at least three people.
The speed with which the bleeders may be tied off is often the determining
factor in the time required for the opening stages of many surgical operations.
Many instruments have been disclosed in the prior art for ligating
bleeders. However, none of these have come into general use, due to inherent
deficiencies. Instruments such as disclosed in United States Patent Nos.
3,033,204, 3,040,747, and 3,169,526, issued to E.C. Wood; United States
Patent No. 2,268,755, issued to S.F. Li; and United States Patent No.
1,635,6Q2, issued to G. Gould et al, have been designed for aiding the
surgeon in applying a single pretied length of suture material to a bleeder.
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Other instruments, such as that disclosed in United States Patent No.
2,371,082 issued to F. Vistreich are designed to apply a single collar of
resilient material to a deep bleeder. However, these instruments, since they
apply only one ligature at a time after which another preformed ligature must
be affixed to the instrument before it can then be applied to the next
bleeder, do not materially reduce the amount of time or effort required in a
surgical procedure. Other more complex instruments, such as disclosed in
United States Patent Nos. 2,8g8,915 and 2,898,916, issued to K. Kammer, have
been devised for automatically tying a successive plurality of ligatures from
a spool of suture material. I disclosed a repeating ligature gun for apply-
ing a plurality of pretied or preformed ligatures (United States Patent No.
3,687,138). However, these prior art instruments are complex, are difficult
to load with the suture material, and, being complicated, are hard to dis-
assemble and sterilize. None of the above prior art instruments has come
into general use.
In order to obviate some of the above problems in the prior art,
hemostatic clips have come into widespread use in surgery in recent years.
In current surgical practice, these clips are used not only for occluding
blood vessels but also for application to other structures such as nerves;
for example, in vagotomy. A number of efforts have been made to facilitate
loading of the clips into the instrument. This generally is done one at a
time by a scrub nurse who then hands the instrument to the surgeon for
application and receives the empty instrument back for reloading with another
single clip. As the clips are small and difficult to handle, cartridges which
hold the clips and then aid in loading the clips one at a time into the
instrument have been developed. Since the clips are not firmly held in the
instruments, they sometimes fall out during handling of the instrument by the
scrub nurse and the surgeon prior to application.
What is needed is an instrument which will rapidly and repeatedly
clamp and ligate bleeders; an instrument that can be operated with one hand;
an instrument which does not leave any excess material, such as cut ends in
the incision; an instrument which may be reloaded by means of a cartridge with
" :
a plurality of preformed ligatures repeatedly during an operation; and an
instrument which is easy to disassemble and sterilize.
It is also desirable that the instrument handle as much as possible
in the same manner as prior art surgical instruments such as towel clamps,
hemostats, and clip appliers. Furthermore 9 it would be a highly desirable
feature of such an instrument if it were adapted to apply a hemostatic clip
which has already been accepted in surgical practice and in particular
approved by the Food and Drug Administration (FDA) for retention in the human
body as the provision of any other material or even shape of clip or pre-
formed ligature may be occasioned with years of tests and delay before FDA
approval may be secured.
Summary of the Invention
The invention provides a hemostatic clip cartridge adapted to be
removably mounted on a repeating hemostatic clip applying instrument, said
cartridge comprising:
A. a plurality of generally U-shaped planar hemostatic clips in
vertical alignment forming a U~shaped stack, sa:Ld clips adapted to be crushed
about tissue one at a time by the instrument;
B. stack-guide means for confining and guiding said U-shaped
stack for motion along the vertical axis of said stack;
C. spring means for biasing said stack downward;
D. stop means at the bottom of said stack-guide means for preventing
Raid stack from further downward motion, said stop means cooperating with said ~-
staclc-guide means to form a rearward aperture for receiving a clip pusher
member of the instrument and a forward rectangular slot for passing a single
clip; and
E. clip-guide means comprising a channel member extending
hori~ontally from said forward slot, the width of said forward slot correspond-
ing to the width of the channel in said clip-guide means;
whereby said clip pusher member of the instrument upon which the
cartridge is to be mounted may push the lowermost clip of said stack through
said forward slot and into said clip-guide means.
... . ' . ' ~ '~ ~.
The replaceable cartridge containing a plurality of clips is
disposable, and may be simply and quickly affixed to and removed from the
instrument.
In general the cartridge comprises means for holding a stack of
generally U-shaped clips aligned perpendicular to the plane of the pusher
channel, a spring to push the clips toward the pusher channel, a bottom stop
for preventing the clips from falling out of the cartridge, interlocking
mechanism for interlocking the cartridge with the instrument, a clip follower
between the stack of clips and the spring mechanism, and finger grips for
ease of application and removal of the cartridge to or from the instrument.
As used herein, U-shaped indicates a clip having two substantially parallel
arms connected by a bight of constant radius, by a V-shaped section, or by
any variation of these.
The clips are preferably rectangular in cross section and provided
with a knurled pattern on the inside surface to help retain tissue. A
rectangular cross section having a height/wiclth ratio of 2/1 is particularly
preferred to prevent ~he clips from twisting as they are closed and to provide
the closed clip with a square cross section. The clip may be of any conven-
ient size and constructed of any biomedically acceptable material. A particu-
larly preferred clip is one formed of tantalum and having a uniform rectangular
cross secti~n of 0.015 in. wide by 0.030 in. high. The inside surface of the
clip is preferably coined in a diamond knurl pattern to increase the gripping
power of the clip on the tissue.
In general, the instrument disclosed herein is similar in function
to existing single clip applying instruments such as disclosed in United
States Patent ~o. 3~713,533 in that with one actuation of the instrument, one
clip is applied to tissue by being crushed thereabout by a pair of jaws. The
clips are preferably also of substantially the same material size and shape
when closed about the tissue as the formed clips disclosed in that patent.
The instrument is so designed that in its preferred embodiment it is sub-
stantially similar in shape to present single clip applying instruments which
are, in fact, designed ~Nch like numerous types of hemostats and other
surgical clamps, having two ring handles and a generally elongated form
which permits controlled handling and good visibility at the tip.
The present invention differs from single clip applying instruments
in that a disposable cartridge is provided which holds a plurality of clips
and feeds them to the instrument one at a time. Other instruments have been
patented for repeatedly applying surgical clips or ligatures such as dis-
closed in United States Patent Nos. 2,277,139, 2,968,041, 3,082,426, 3,844,289,
3,638,847 and my Patent No. 3,841,521. However, although the need for a
repeating hemostatic clip applying instrument has been recognized for decades,
none is presently in the market or in clinical use.
Deficiencies in prior art repeating instruments which have led to
their nonuse in clinical practice may be categorized as: overly complex
instrumellts with a very large number of parts; instruments which obscure the
physicians' field of view; gun type instruments which meet great resistance on
the part of surgeons used to ring-handled plier type instruments; instruments
with a great many small moving interfaces between parts which make them sub-
ject to Erictional Eailure, extremely difficult to sterilize without dis-
assembly, and extremely difficult to disassemble and re-assemble for good
sterilization practice; lack of simple replaceable cartridges; operation
which requires pulling of tissue into the instrument; and complex cartridge
mechanisms which lead to prohibitive cartridge costs.
The inventor has recognized that optimal visibility to the tip,
incorporation of an inexpensive multiple clip containing cartridge which can
be rapidly changed, and completely automatic one hand operation, preferably
with a ring handle configuration, are crucial if the instrument is to be
clinically useful.
A new principle unique to all clip applying instruments is employed.
The disposable cartridge, removably mounted on the instrument, holds a
plurality of clips in alignment with a channel on the instrument. The instru-
- 30 ment then removes the clips~ one at a time, from the cartridge and feeds them
through the channel to the jaws for application to the tissue. This principle
of having the cartridge feed the clips to a position on the instrument remote
~ z~
from the jaws and then having the instrument feed each clip to the jaws
permits the cartridge to be placed remote from the jaws, out of the line of
visibility. It also permits the simplest possible construction of the jaws,
that is, of only two pieces, which further aids visibility.
The instrument thus has a pair of clip applying jaws with a channel
leading thereto from a remote position where the cartridge containing a
plurality of clips may be removably affixed. It, in addition, has a clip
feed mechanism and appropriate sequencing and spring return means so that,
in operation, when a pair of ring handles are squeezed together, the forward-
most clip is removed from the cartridge, fed to the jaws and clamped about
tissue positioned therebetween, and, upon release, the instrument returns to
a position ready to repeat.
The instrument is basically comprised of four main portions:
(1) a first pivoted member comprising a ring handle with a wide distal
portion terminating in one jaw member; (2) a second pivotal member having a
wide distal portion terminating in the other jaw member; (3) a clip pushing
mechanism; and (4) an elongated ring handle. One of the distal portions is
provided with a channel for a pusher to push the hemostatic cllps to the jaws.
This distal portion also has a cartridge receiving portion. The other distal
portion acts as a cover for the channel. A linkage is provided bet~een the
ring handles and the clip pushing mechanism for pushing the clip out of the
cartridge, forward to the jaws and then allowing the jaws to close. This
i5 accomplished in two embodiments of the invention by providing a rotating
bell crank on a proximal extension of the pusher channel member.
The bell cranks each have a cam which is engaged by an extension
on one of the ring handles and is operated by an extension on the other ring
handle to rotate when the handles are first closed to operate the push member.
The cam has a cut away portion into ~Yhich the extension on the opposite ring
handle then falls to allow the handle to close and close the jaws.
In another embodiment, the bell crank is free floating and is con-
; nec~ed by its center pivot to one ring handle and at one of its outer pivots
to the other ring handle~ and at the other outer pivot to a link connected to
.~
the pusher. This free floating bell crank linkage, by its geometry, causes
the pusher to be operated agPinst the force of a weak spring. Thereafter
the ring handle to which no jaw is connected, biased by another spring, is
able to come down against a surface of the jaw mechanism to which no ring
handle is connected to close the jaws.
The invention accordingly comprises articles of manufacture
possessing the features, properties and the relations of elements which
will be exemplified in the articles hereinafter described, and apparatus
comprising the features of construction, combinations of elements and arrange-
ments of parts which will be exemplified in the constructions hereinafter
set forth. The scope of the invention is indicated in the claims.
The Drawings
For a fuller understanding of the nature and objects of the inven-
tion, reference should be had to the following detailed description taken in
connection with the accompanying drawings in ~hich:
FIGURE 1 is a top perspective view of a repeating hemostatic clip
applying instrument and multi-clip cartridge therefor assembled and ready for
operation.
FIGURE 2 is a top view of the instrument shown in FIGURE 1 in
partial cross section along the plane 2-2 of FIGURE 1.
FIGURE 3 is an enlarged top view, partially cut away, of the instru-
ment shown in FIGURE 1 with the cross section of FIGURE 2 extended and the
-lnstrument partially actuated to move a clip from the cartridge to the clip
applying jaws.
FIGURE ~ is an enlarged top view, partially in cross section, similar
to FIGURE 3 showing the instrument ully actuated to close the clip between
the jaws.
FIGURE S is an enlarged cut away view showing a detail of the jaws.
FIGURE 6 is a cross-sectional view, partially cu~ away, taken
along the line 6-6 of FIGURE 2.
FIGURE 7 is an enlarged exploded perspective cut away view of the
clip applying jaws and a portion of the cartridge mount.
S6~
FIGURE 8 is an exploded diagrammatic view showing the small number
of basic parts of the instrument of FIGURE 1.
FIGURE 9 is an enlarged cross-sectional cut away view taken along
the plane 9-9 of FIGURE 2.
FIGURE 10 is a top cross-sectional cut away view taken along the
line 10-10 of FIGURE 9.
FIGURE 11 is a cross-sectional view taken along the line 11-11 of
FIGURE 9.
FIGURE 12 is an enlarged top perspective view of the cartridge of
the invention shown in FIGURE 1.
FIGURE 12A is an end plan view of the cartridge shown in FIGURE 12.
FIGURE 13 is an enlarged perspective bottom view similar to
FIGURE 12.
FIGURE 14 is an enlarged perspective diagrammatic -top view of the
clips and clip follower of the cartridge of FIGURE 1.
FIGURE 15 is a partial cross-sectional top view, partially cut
away, similar to FIGURE 2, of an alternative embodiment of the invention
having a different clip advancing mechanism.
FIGURE 16 is a top view partially in cross-section and partially
cut away similar to FIGURE 15 showing the alternative embodiment with the
clip advance mechanism fully advanced.
FIGURE 17 is a partial cross-sectional view partially cut away
taken along the line 17-17 of FIGURE 15.
FIGURE 18 is a top perspective view similar to FIGURE 1, partially
` cut away, of an alternative embodiment of the invention having curved jaws
for improved handling and visibility.
! FIGURE 19 is a top plan view of another alternative embodiment of
the invention having a single pivot and a floating bell crank pusher actuating
mechanism.
FIGURE 20 is a top plan diagrammatic view of an alternative form
of clip cartridge.
FIGURE 21 is a top plan view of a U-shaped clip having a V-shaped
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connecting section.
The same reference characters refer to the same elements throughout
the several views of the drawings.
. ~ ~. 9
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Specific Description
More particularly, referring to FIGURE 1, a repeating hemostatic
clip applying instrument according to the invention is generally indicated at
42. It comprises a left and a right jaw 44 and 46 at the end of left and
right distal end portions 48 and 50.
Referring to FIGURFS 1 and 8, left jaw 44 is mounted to the distal
end ~8 of a left jaw actuating member generally indicated at 52 comprising
the aforesaid distal end 48, pivot hole 54, handle shaft 56, handle ring 58,
and sequencing stop extension 60. Distal end 48 is provided with a cartridge
clearance cut out 62 (see also FIGURES 7 and 9). A jaws return spring 64 is
attached to the handle shaft 56 by means of appropriate rivets, screws, or
the like 66.
Still referring to FIGIJRES 1 and 89 particularly FIGURE 8, the
right jaw 46 and right distal extension 50 are part of a single main body
generally indicated at 68. Main body 68 has a pivot hole 70, commonly pivoted
to pivot hole 54 on left jaws actuating member 52 around a pivot 72 shown in
FIGURE 1. The main body 68 has a channel formed therein by alternating slots
74 in the bottom thereof and 76 in the top thereof which overlap to Eorm a
continuous channel which terminates at an elongated cut out 78 for receiving
the cartridge generally indicated at 80.
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The pusher channel is extended as clip channel 82 on the bottom
side of the distal end 50 of the main body 68 to the right jaw 46.
The main body 68 is also provided with stabilizing flanges 84,
bell crank pivot hole 86, a pusher actuating member stop 88, a pusher actuat-
ing member pivot 90 to which a pusher actuating member, generally indicated
at 92, is pivoted by means of a pivot hole 94 therein, and a pivot 96
(FIGURE 1).
Still referring to FIGURES 1 and ~, particularly FIGURE 8, the ;~
pusher actuating member 92 comprises a handle shaft 96, a ring handle 98,
and a bell crank actuator extension 100 having a bell crank pivot slot 102
therein. The pusher actuating member 92 is provided with a pusher return
spring 104 which :Ls preferably ].ess strong than the jaws return spring 64.
Still referring to FIGURES 1 and 8~ particularly FIGURE 8, a clip
pusher, generally indicated at 106, is preferably provided with a thin for-
ward portion 108 and thick rearward portion llO. It is connected by means of
pivot 112 to a pusher link 114, which in turr~ is connected by means of a
pivot 116 to a bell crank, generally indicated at 118. As best seen in
FIGU~E 1, bell crank 118 is provided at one end with a bifurcated arm 122
straddling a narrow portion of pusher link 114 and at its opposite end with
a bifurcated arm 124 straddling bell crank actuator extension 100. Pivot
--11-- .
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pin 126 is fixed in arm 124 and rides in bell crank pivot slot 102
(FIGURE 8).
Still referring to FIGURES 1 and 8, the bell crank 118 is provided
with a sequencing stop surface 128 on which sequencing stop extension 60
rides, a sequencing drop-off cut out 130 and a main pivot 132 pivoted to the
bell crank pivot hole 86 by means of pivot 13~ (FIGURE 1) - sequencing stop
surface 128 and cut out 130 forming a cam.
The main body 68 is relieved at 95 for rotation of bell crank 118
and at 95' for rotation of the link 11~ and rotation of bell crank 118
~FIGURES 1 and 2).
Now refer~ing to FIGURES 9 through 13, a plurality of U-shaped
hemostatic clips, generally indicated at 136, are stacked vertically in clip
chamber 170 of cartridge 80 formed by guide means 158, 160 and 166. Clip
stack 136 is perpendicular to the plane of pusher 106 with lowermost clip
-12-
;
142 resting in the plane of pusher 106 on clip stop platform 162. Platform
162 cooperates with clip chamber guide means to form a rearward aperture for
receiving pusher 106 and a forward rectangular slot 169 for passing clip 142
from the cartridge. Clip guide means 152 which also functions as an inter-
locking mechanism for interlocking the cartridge with the instrument, has a
channel corresponding in width to the width of clips 136 and slot 169 for
guiding and aligning clip 142 as it is pushed from the clip stack into clip
channel 82 by pusher 106. Lowermost clip 142 resting on platform stop 162,
forward slot 169 and the channel in clip guide 152, are all aligned with
clip channel 82 extending to jaws 44 and 46 when cartridge 80 is mounted on
instrument 42 as best seen in FIGURE 9.
In operation, with the cartridge 80 mounted to the instrument 42
as illustrated in FIGURES 1 through 4, the pusher 106 extends to just behind
the clips 136. The surgeon places the jaws 44-46 about tissues to be
cllpped. He then
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102-033I-l
closes the two ring handles 58-98. First the pusher actuating .
member 92 moves about pivot 97 against pusher return spring
104, this rotates the bell crank counter-clockwise pushing .
the pusher 106 by means of pusher link 114 to cause the
lowermost clip 142 (FIGURE 9) in the clip stack 136 to be
advanced through slot 169 and the channel of clip guide
. means 152 into channel 82 to between the jaws 44 and 46 as
shown in FIGURE 3.- Since the jaws 44-46 surround tissue,
the clip 142 is pushed around the -tissue and remains in the
jaws. As shown in FIGURES 5 and 7, the jaws 44-46 are
preferably provided with clip slots 138 extending from the
. clip channel 82 and opening at a two degree angle therefrom.
This angle assures that the jaws will be parallel when closed.
Small detents (not shown) may be disposed at the forwardmost
end of the clip slots 138 (FIGURE 7) to stop distal motion
` of the clip.
~ During the above action, and referring to FIGU~E 3 r the
;` sequencing stop extension 60 has been riding on the sequencing
stop surface 128 of the bell crank 118. However, once the
pusher 106 has advanced to its farthest position (at this
position pusher actuating member handle shaft.96 contorts
stop 88), the sequencing stop extension 60 drops into the
SequenGing drop cutoff 130 on the bell crank 118. This allows
the left jaw actuating member 52 to rotate about pivot pin 72
thereby bringing the left ja~ 44 against the right jaw 46,
to close the clip 142 all as shown in FIGURE 4. The sequencing
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drop cutoff 130 positively prevents return of the pusher 106
so that the clip is positively locked between tissue, jaws
44-46, and the distal end of the pusher 106 until the jaws -
are closed.
When the surgeon now releases the pressure on the ~ :
handle shafts 56 and 96 of the left jaw actuating member 52
and pusher actuating member 92, the jaw return spring 64
first rotates left jaw actuating member 52 ahout pivot pin
72 under action of the jaws return spring 64 until.it comes
against the head of adjustment screw 144 mounted to the main ~ ~:
: body 68. Cam surface 130, being released by stop extension
60, rotates about pivot 134 and pusher actuating member 92,
under the action of pusher return spring 10~, rotates about
pivot 97 returning the instrument to its rest position shown
in FIGURE 2.
~ :The clips may also be mounted in the cartridge 80 with~
their open ends slightly resiliently pressed together 50 ; ~
that they tend to widen when released. This allows them to :
widen when they reach the jaws ~4-46 and to be resiliently : : ,`
~20 retained therein. Alternatlvely, the clearance between the
jaws may be.made smaller than the channel through which the .
.
- : clips are pushed, so that they are resiliently squeezed down
when they reach the ~a~ls to be retained therein. The clip
slots may also be provided with transversely oriented serrations~
:
or retalnin~ the clips therein, in the manner disclosed in
U. S. Patent No. 3,713,533.
:. .
102-033I-l
Again, referring to FIGURES 9 through 13, the cartridge
~0 comprises a main body portion 146, preferably of trans-
parent plastic material for low cost manufacture and to
al.low the user to see the number of clips 136 remaining in
the stack or magazine and a leaf spring 148 mounted thereto,~
by suitable attachment means, for example, a screw 150.
Those skilled in the art will unaerstand that spring 148 may
be attached by means of a heat sealed plastic rivet or might
even be integrally molded with the body 146 if a suitable
plastic were employed. The cartrldge ~0 fits snugly into
cartridge cut out 78 in right jaw extension 50. The forward
end of the cartridge body 146 is provided with a forward ~;
clip guide means and retention tongue 152. Since the cartridge
close1y fits into the cut out 78, no other retention means
is re~uired. Eowever, a detent and recess may be provided . :
at the rear extension 154 o the cartridge body 146 and the ;
rear end 156 of the cut ou* 78, or on other suitable parts
of the cartridge and adjacent parts of the instrument. -~
.
The cartridge:body is provided with guide surfaces 158 ~ :
and 160 for guiding the clip magazine or stack 136 and at
.
~ 20 the bottom thereof with a clip plat~orm-stop 162, which fits :~
-
. into the cartridge clearance cut out 62 in the distal left
~aw entension 48. The end of the spring 164 preferably
extends through a cut out 166 to provide a visual indication .
~ ~ of the number of clips remaining in the stack 136.
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Spring pressure and friction prevents bottom clip 142 from moving
either forward or rearward when the cartridge is out of the instrument. A
clip follower 172 is provided for applying the force of the spring 148
against the clip stack 136 in an even manner. To this end, the clip follower
172 is provided with a clip follower fulcrum ridge 174 within a clip follower
spring guide slot generally indicated at 176. Since the clip follower fulcrum
ridge 174 is at the middle of the clip follower 172, the force is applied
evenly to the clip stack 136 and the clip stack cannot rock out of alignment
with the clip channel extension 82.
An alternative form sequencing mechanism is employed in the
alternative embodiment illustrated in FIGURES 15, 16, and 17. Here, the
bell crank, generally indicated at 180, is provided with a sequencing stop
extension accepting slot 182 for receiving an elongated sequencing stop
extension 184 mounted to the handle shaft 56 of the left jaw actuating member
generally indicated at 52. The pusher slide channel 186 is formed in two
pieces, 188 and 190, joined together by a plurality of fasteners 192. A
single spring 194 is employed which is mounted to handle 56 by rivets or
~/ ~
screws 196 and acts between handle 56 and bell crank actuator extension 100
by means of ears 198 acting on extended pivot pin 200.
Referring to FIGURE 17 in this embodiment of the invention, the
bell crank 180 is provided with a narrow arm 202 which fits into a slot 204
formed in the bell crank actuator extension 100.
In another alternative form of the invention, illustrated in
FIGUR~ 18, the thin forward portion 108 of the clip pusher 106 (not shown)
is made flexible and the distal extensions 50 and 48 are curved for better
visibility of the tip for use by surgeons who are used to curved or offset
hemostatic instruments. The cartridge 80 may be, but need not be, conformed
to this curvature which may be restricted to the portion of the instrument
between the jaws 44 and 46 and the rearward end of the cartridge 80.
Now referring to FIGURE 8, those skilled in the art will understand,
; upon reflection, that the two pivot points of pivot holes 54 and 70 and pivot
holes 90 and 94 respectively, could be combined into common axis. That is,
pivot hole 70 could be eliminated and pivot hole 54 moved down until it was
in line with pivot holes 90 and 94 when the instrument was assembled.
Furthermore, the cartridge cut out 50 and main body 68 could be formed as
part of the left jaws actuating member in which case the right jaws actuating
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~Z5~
member would comprise only the right jaw 46, the distal extension 50, the
pivot hole 90, and the pusher actuating member stop 88, which also acts as
the right jaws actuating member when contacted by the handle shaft 96 of the
pusher actuating member 92.
Now referring to FIGURE 19, a single pivot instru~ent is generally
indicated at 220. It comprises a main body 222 having a jaws extension 224
terminating in lower jaw 2260 The upper finger loop extension 228 is
integral with the main body 222 and terminates in upper finger loop 230.
Lower finger loop extension 232 is pivoted to the main body at pivot 234 and
terminates in lower finger loop 236. Upper jaw 238 is mounted to an arm also
pivoted at pivot 234 and terminating at an asymmetrical T-shaped extension
generally indicated at 240. The lowermost extension 242 is contacted with
lower finger loop extension 232 when the two finger loops 230 and 236 are
brought together and this causes the T-shape extension 240 and the upper jaw
238 to pivot about pivot 234 against the action of a spring 244 mounted at
one end to finger loop extension 228 and engaging the uppermost portion 246
of the T shaped extension 240.
'
--19--
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102-033I-l
The pusher mechanism is moun-ted in the main body 222
and a portion of the pusher channel 248 may be seen. The
distal end of the pusher 250 is pivoted at pivot 252 to link
254. Link 254 is pivoted at pivot 256 to floating bell
crank 258 which is pivoted at pivot 260 and connec-ted at its
other end at plVOt 262 to lowermost finger loop extenslon
232. Pivot 260 is connected to link 264 which in turn is
connected at its other end at pivot 266 to spring 265 which
may be integral with spring 244 both being,mounted to uppermost
finger loop extension 228. Travel of spring 265 is preferabIy
limited by stop 268 integrally formed with uppermost finger
loop extension 228.
When the two finger loops 230 and 236 are brought
: together pivot 260 moves to position 260' and the linkages
and~other pivots move to the positions shown by the~dotted
lines and circles connected to point 260'. This causes the
pùsher to move fully forward pushing the clip from the
cartridge 269 forward in between the jaws 226 and 238. As : ~
the fron~. end of finger loops 230 ~nd 236 are brought closer.~ .'
: 20 together, pivot 266 moves to point 266' and lowermost finger
loop extenslon 232 moves to position 232' shown by dotted
lines thus engaging the T-extension 240 and closing the
uppermost jaw 238 against the lower jaw 226.
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102-033I-l
Now referring to FIGURE 20, an alternative form of clip
cartridge 270 having clipstack 272 therein may be provided
with an internal clip leg or with supporting flanges 274 to
prevent the clips 272 from bending inward within the cart-
ridge 270. It will be understood that the walls of the
cartridge 276 and 278 which engage the back bight 280 of the
clipstack 272 need not continue all the way around the clips
but merely need to engage the bac~ of the clips to prevent
them from moving backward in the stac]c.
In FIGURE 21 there is shown a preferred form of U~shaped
clip 300 having straight legs 302 and a V-shaped bight 304.
The apex 306 of the bight 30~ prov:ides a crease which insures
that the clip will close at the apex. This provides smoother
operation of the instrument and insures that the legs 302,
when closed on a bleeder, are of the same length. Otherwise,
clip 300 is the same as those previously described.
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102-033I-l
Referring again to FIGURES 1 through 4, those skilled
in the art will also understand that the pusher return
spring 104 acting between the main body 68 and the pusher
actuating member 92, could be located anywhere in the operating
chain between the bell crank actuator extensionj the bell
crank 118, the pusher link 114 or the clip pusher 106, and
the main body 68. All that is required is that a force
cause the pusher member 106 to return to its normal position.
This will also cause the entire mechanism including the
pusher actuating member 92 to return to its normal rest
position. Thus a compression spring may be located within
the main body operating directly on the pusher 106 or the
link pin 112 or a coil spring may operate between the main
body 68 and the bell crank 118, or between the bell crank
and the pusher link, or between the bell crank and the bell
actuator extension. Similarly, the jaws return spring 64
may be replaced by any spring providing ultimately a rotational
foxce between the left jaw actuating member 52 and the right ~;
~aw 46. Thus, compression springs may be mounted between -~
~20 the main body 68 and the handle shaft 56 or between the
distal extension 48 and 50, or a coil spring may act at the
pivot hole or at the pivot 72 (FIGURE l). Simiiarly, a coil
spring acting at the pivot 97, between the main body 68 and
the pusher actuating member 92 could replace the pusher
return spring 104.
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Those skilled in the art will also understand that many different
sequencing mechanisms could be employed, which, upon bringing the two ring
handles 58 and 98 together, would cause the pusher 106 to advance the lower-
most clip 142, and then the jaws 44 and 46 to close, closing the clip. One
such instrument employing a free floating bell crank is illustrated in
Figure 19. This instrument also employs a single pivot. Now referring to
Figure 19, many other sequencing mechanisms will come to mind, for example,
a rack and gear mechanism for advancing the pusher. However, it will be
noted by those skilled in the art that I have provided simple mechanisms
employing only rotary contacts for low friction and smooth operation5 which
also provide very long pusher travel for relatively small closure travel
between the ring handles.
I have thus provided repeating clip applying instruments and
cartridges therefor, which may be employed during an operation to apply any
number of hemostatic clips by merely changing pre-sterilized cartridges
containing a plurality of the clips.
It will thus be seen that the objects set Eorth above, among those
made apparent from the preceding description, are efEiciently attained and
since certain changes may be made in the above articles and constructions
without departing from the scope of the invention, it is intended that all
matter contained in the above description or shown in the accompanying draw-
ings shall be interpreted as illustrative and not in a limiting sense.
For example, all of the clips in the cartridge need not be stacked
as I have shown in FIGURE 9. All that is necessary is that the bottom most
clip 142 be presented at the end of the pusher and the beginning of the
clip channel leading to the jaws. Thus, the clips might be mounted
horizontally in a plane above the pusher, all biased by a spring forward,
and another spring would be provided for biasing the forwardmost clip down-
ward against the clip platform stop so that it would be in position at the
forward end of the pusher for being pushed into the clip channel. Many
other variations will readily come to mind upon reflection.
Moreover, it will be seen that I have provided a repeating hemo-
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static clip applying instrument involving very few parts, which is simple to
operate and use, convenient to sterilize and ~surprisingly provides this in
an instrument which handles in the manner in which surgeons have desired for
many years. I have achieved this surprising result by a cunning choice of
elements that synergistically work together.
It is to be understood that the following claims are intended to
cover all of the generic and specific features of the invention herein
described, and all statements of the scope of the invention which, as a matter
of language, might be said to fall therebetween.
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