Note: Descriptions are shown in the official language in which they were submitted.
DESCRIPTI~N
LIGATING CLIP AMD
APPLIER INSTRUMENT THEREFOR
WITH CLIP ENGAGING ESCAPEMENT
Technical Field
This invention relates to hemostatic or
ligating clips and to surgical instruments for
repeatedly applying such clips to tissue, blood
vessels, and the like.
Background o~ the Invention
Clips have been devised for clamping or
strangulating various organs, vessels, and other
tissue. Clips have been developed for use
speciically in strangulating blood vessels in the
human body. Such clips are known as hemostatic or
ligating clips. The clips may be fabricated from
absorbable or nonabsorbable polymeric materials as
well as from metal.
A ligating clip is typically C-shaped,
U-shaped, or V-shaped with two spaced-apart or
diverging legs connected together at one end in a
manner that permits the clip to be squeezed together
so that the legs of the clip may be clamped around
the tissue or blood vessel so as to tightly constrict
the tissue or blood vessel. This prevents a
substantial amount of fluid from passing through the
tissue or ~lood vessel from one side of the closed
cli~ to the other side of the closed clip.
Typically, the clip is made of a material
and/or has a configuration that enables the clip,
once it has been forced closed, to remain set or
latched and maintain the closed orientation without
outside intervention. For example, if the clip is
made from a metal material, the clip can be deformed
to the closed position. If the clip is made from a
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thermoplastic material, the legs may be conn~cted by
a resilient hinge portion and the distal ends of the
legs may be provided with latch means for holding the
legs together in a closed position when the legs of
S the clip are squeezed together around the tissue or
blood vessel.
Some types of surgical clips have been
proposed wherein one of the legs of the cli~ is
especially adapted for being engaged by, and
supporting the clip in, an applier instrument. See,
for example, U.S. Patent Nos. 3,780,416 and 3,882,854
which each disclose an asymmetric clip having two
differently shaped legs with one of the legs being
adapted to be received in a carrier or lower jaw of
the applier instrument.
It would be desirable to provide a ligating
clip which could be easily applied by an instrument
to tissue, such as a blood vessel and the like.
Further, it would be desirable to provide such a clip
with a configuration that would permit a plurality of
such clips to be loaded into, and contained within,
the instrument for applying the clips. Further, it
would be beneficial if the clip could be accommodated
in the instrument and moved forward within the
instrument to the clip applying jaws of the
instrument by a relatively simple and trouble free
mechanism. Also, it would be advantageous if such a
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clip had a configuration which would permit it to be
restrained within the clip applying instrument and to
be guided by the clip applying instrument to the jaws
of the instrument.
A variety of instruments for applying such
surgical clips ha~e been developed or proposed in the p2st. Such
instruments typically include a magazine or cartridge
which may or may not be disposable and which holds a
plurality of clips. The clips are supplied from the
cartridge to jaws of the instrument one at a time for
application to the tissue or blood vessel.
U.S. Patent No. 3,006,344 discloses an
instrument for applying a ligating clip to a blood
vessel. The clip is formed of flat metal or like
stock and has a pair of legs extending outwardly in a
generally V-shape. The clips are arranged in two
parallel grooves in a magazine. A slide is
positioned in each groove and is urged by a suitable
conventional spring to advance the clips along the
magazine toward the jaws. The clips are arranged in
each row with the distal end of one of the legs of
one clip abutting the rear connecting hinge portion
of the next adjacent clip.
U.S. Patent No. 3,753,438 discloses an
applicator for applying clips to suturing thread
during the suturing of skin wounds. The clips are
carried in a cartridge in the instrument. A clip is
forced forwardly from the cartridge to a position
between the instrument jaws by a slide which is
operated by a handle. After the clip is positioned
within the jaws, the handles of the instrument are
squeezed together to squeeze the clip legs together.
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It would be desirable to provide an improved
instrument for accommodating a plurality of ligating
clips and for automatically feeding the clips
seriatim into jaws where a clip can be compressed
about tissue, such as a blood vessel or the like.
Further, it would be advantageous if the clips could
be retained within the instrument and moved forward
within the instrument toward the jaws of the
instrument by an effective, yet relatively simple,
mechanism. Additionall~, it would be desirable to
provide means in the instrument for ensuring that
only one clip at a time is positioned in the jaws of
the instrument for application to the tissue.
Summary of the Invention
A preferre~ embodiment of the present
invention is incorporated in a medical instrument~for
applying clips, including ligating clips made from a
thermoplastic material. The clips each typically
have two legs connected together at one end of the
clip and are adapted to assume an initial open or
spread apart configuration at the other end.
Each clip preferably includes first and
second legs joined at their proximal ends by a
resilient hinge and terminating at their distal ends
in a latch means for holding the clip latched closed
when the clip legs are squeezed together. Each leg
has a vessel clamping inner face in opposition to a
vessel clamping inner face of the other leg.
A base is provided on the clip first leg and
extends along a length of the first leg from the
distal end of the first leg for onl~ a portion of the
length of the leg. The base terminates short of the
hinge so that the hinge extends rearwardly beyond the
base to define an open recess adjacent the rearward
end of the base belo~t the hinge.
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The base includes a guide means for engaging
portions of an instrument ~hat may be used to apply
the clip. -Such guide means can include a channel
along each side of the clip base. Alternatively,
such guide means can include portions of the base
that extend laterally from the first leg on each side
of the first leg. Another form of the clip may have
a member projecting downwardly from the base to be
engaged by an escapement mechanism in the clip
applier instrument.
The preferred embodiment of the clip
applying instrument includes first and second handles
mounted together ~or pivotal movement about an axis.
Each handle extends forwardly beyond the 2ivot axis
to form a clip closing jaw. The jaws have opposing
inner clip engagin~ faces.
The first handle includes a guideway for
receiving a plurality of the opened clips in a single
row with the clips arranged in end-to-end
relationship with the distal end of the first leg of
one clip abutting the leg connection end or hinge of
the next Eorwardly adjacent clip. The first handle
also includes a clip retaining means along the
guideway for engaging the guide means of each clip.
In a preferred embodiment, the instrument is
used with the type of clip in which the base has
portions extending laterally outwardly from the first
leg on each side of the first leg. The in,trument
guide means for retaining the clips in sliding
engagement with the first handle includes opposed,
spaced-apart, flanges or walls projecting nwardly
from the guideway in the first handle. The ~langes
overlie the laterally outwardly projecting base
portions of the clips and retain the clips within the
guideway, permitting on~y forward or rearward
movement of the clips withln the guidewayu
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A means is provided for moving the clips
forwardly along the guideway to the ja~"s. ~n the
preferred embodiment, a flexible pusher member, such
as a perforated tape, is provided wi~hin the first
handle and extends into the guideway for pushing
against the rear end of the base of the last clip in
the row of clips within the clip guideway.
A means i5 provided for urging the flexible
pusher member forwardly along the guideway to move
the row of clips forwardly along the first handle to
the jaws. In the preferred embodiment, wherein the
pusher member is a perforated tape, the means for
urging the pusher member forwardly includes a wheel
mounted for rotation in the handle and having a
plurality of circumferentially spaced and radially
outwardly projecting pins. The pins are adapted to
engage the apertures in the tape during rotation of
the wheel. In order to advance the tape, the wheel
is continuously urged to rotate by means of a cord
that is wound around the hub of the wheel and that is
pulled to unwind from the wheel hub by a tension
spring secured at one end to the cord and at the
other end to the instrument.
An escapement mechanism is provided in the
first handle jaw to 1) properly position a clip in
the jaws, 21 subsequently permit discharge of the
clip after it has been latched closed while
preventing discharge of the trailing, open clips, and
3) subsequently properly position the next clip in
the jaws.
In a preferred embodiment of the instrument,
the escapement includes a gate in the form of a spool
is mounted for rotation about an axis in the ~irst
handle jaw below the clip enyaging face of the first
handle jaw. The spool is adapted to rotate between a
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first orientation and a second orienta~ion. The
spool includes a forward flange on a forward end
adjacent the forward end of the first handle jaw.
The forward flange projects in front of the guideway
and defines a cut away segment to permit passage of a
clip from the instrument when the spool is in the
first orientation. The forward flange prevents
passage of a clip therepast when the spool is in the
second orientation.
The spool also has a rearward flange spaced
from the forward flange by a distance equal to the
length of the base of a ligating clip. The rearward
flange projects into the guideway and defines a cut
away segment that permits the passage of a clip
therepast when the spool is in the second orientation
and that prevents the passage of a clip therepast
when the spool is in the first orientation.
A rod extends rearwardly from the spool
along the first handle and is adapted to rotate about
a longitudinal axis coincident with the longitudinal
axis of the spool. The rod has a drive portion
projecting laterally at an angle relative to the
longit~dinal axis of the rod.
An upper engaging member and a lower
engaging member are carried by the second handle.
The first and second engaging members are spaced
apart and receive between them the drive portion of
the rod. When the handles are moved apart, the upper
engaging member engages the drive portion of the rod
and rotates the rod to rotate the spool to the second
orientation in which the forward flange blGcks
further forward feeding of the first clip in the row
of clips to thereby maintain the first clip in the
region of the jaws.
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When the first and second handles are moved
toward one another, the front clip in the row of
clips within the region of the jaws is squeezed
together and is latched closed. At the same time,
the lower engaging member on the second handle
engages the drive portion of the rod and rotates the
rod to rotate the spool in a second, opposite
direction to the first orientation in which the
forward flange permits passage of the clip beyond the
forward flange as ~he jaws are subsequently opened by
moving the handles apart an amount sufficient to
provide clearance around the closed clip but by an
amount insufficient to again engage the drive portion
of the rod with the upper engaging member.
Numerous other advantages and features of
the present invention will become readily apparent
from the following detailed description of the
invention and embodiments thereof, from the claims
and from the accompanying drawings.
Brief Description of the Drawings
In the accompanying drawings forming part of
the specification, and in which like numerals are
employe~ to designate like parts throughout the same,
Figure lA is a perspective view of a first
embodiment of an open ligating clip of the present
invention;
Figure lB is a perspective view of a second
embodiment of an open ligating clip of the present
invention;
Figure 2 is a side view of a medical
instrumer.t for repeatedly applying a plurality of
ligating clip5 of the type of the first embodiment
illustrated in Figure lA;
Figure 2~ is a greatly enlarged,
cross-sectional view taken generally along the plane
2A-2A in Figure 2;
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Figure 2B is a greatly enlarged,
~ragmentary, cross-sectional view taken generally
along the plane 2B-2B in Figure 3;
Figure 2C is a greatly enlarged end view
S taken generally along the plane 2C-2C in Figure 3;
Figure 3 is a top view of the instrument of
Figu~e 2 with a portion broken away and internal
parts being illustrated in cross-section;
Figure 4 is an enlarged, fragmentary view of
the instrument illustrated in Figure 3 but showing
the instrument latching a clip closed about a blood
vessel;
Figure 5 is an enlarged, fragmentary,
cross-sectional view taken generally along the planes
5-5 in Figure 4;
Figure 6 is a view similar to Figure 4 but
showing the instrument partially opened to permit the
release of the latched closed clip;
Figures 7-9 are greatly enlarged,
fragmentary, perspective views of the instrument with
most of the jaw structure eliminated to better
illustrate the escapement or gate mechanism, Figure 7
showing the instrument in the fully opened posltion,
Figure 8 showing the instrument in the fully closed
position, and Figure 9 showing the instrument in the
partially opened position;
Pigures lOA, lOB, and lOC are enlarged,
fragmentary, perspective views of first, second, and
third embodiments, respe^tively, of a flexible pusher
tape that may be used in various forms of the
instrument of the present invention;
Pigure 11 is a fragmentary, reduced vie-
~similar to Figure 3 but showing an alternate form of
a means for driving the flexible pusher tape and an
alternate form of a spring for biasing the instrument
handles to an open position;
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Figure 12 is a ~ragmentary, reduced vie~
similar to Figure 3 but showing yet another alternate
form of a means for driving the flexible pusher tape;
Figure 13 is a perspective view of a third
embodiment of an open clip of the present invention;
Figure 14 is a fragmentary end view taken
generally along the plane 14-14 in Figure 13;
Figure 15 is a fragmentary, cross-sectional
view of the jaws of an instrument similar to the
embodiment illustrated in Figure 3 but showing an
alternate form of the escapement mechanism; and
Figure 16 is a fragmentary, cross-sectional
view taken generall~ along the plane 16-16 in
Figure 15.
Description of the Preferred Embodiments
While this invention is susceptible of
embodiment in many different forms, there are shown
in the drawings and will herein be described in
detail preferred embodiments of the invention. It
should be understood, however, that the present
disclosure is to be considered as an exemplification
of the principles of the,invention and is not
intended to limit the invention to the embodiments
illustrated.
The precise shapes and sizes of the
components herein described are not essential to the
invention unless otherwise indicated. Unless
otherwise indicated, the particular shapes and sizes
are sho~n to best illustrate the principles of the
invention.
A first preferred embodiment of the ligating
clip 10 of the present invention is illustrated in
Figure lA. The clip 10 has a first leg 11 and a
second leg 12. The legs 11 and 12 of the open clip
are joined at the leg connection end of the clips.
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Preferably, the legs 11 and 12 are joined at their
proximal ends by a resilient hinge, hinge means, or
hinge section 13 which permits the legs 11 and 12 to
be pivoted toward each other to a closed position.
Until the clip 10 is closed in a manner to be
described in detail hereinafter, the hinge 13 has
sufficient resiliency to maintain the legs 11 and 12
in the angled open position illustrated in Figure lA.
The first leg 11 terminates at the distal
end thereof in a hook member 14 having a downwardly
facing inner face lS substantially parallel to an
upwardly facing inner face 16 of the first leg 11 and
forming an acute angle with an end face 170
The second leg 12 terminates at the distal
end in an end face 19 which forms an obtuse angle
with an inner face 18 of the leg 12. The end face l9
of the second leg 12 is formed at an angle zelative
to a squared off face 25 which forms a substantially
right angle with an upper surface 20.
The length and width of the face 16 of the
first leg 11 and of the face 18 of the second leg 12
are substantially equal, and the face 15 of the hook
member 14 is spaced from face 16 of the leg 11 by a
distance corresponding to the thickness of the leg 12
between the plane of inner face 18 and upper
surface 20.
The clip 10 can be closed or set by pivoting
the legs 11 and 12 about hinge 13 to bring the faces
18 and 16 into opposition. The hook member 14 is
deflected by the end face 19 of the second leg 12
until the distal end of the second leg 12 snaps under
the hook member 14 and is thereby locked in place.
Such a closure of the clip 10 is illustrated in
Figure 6 wherein the clip 10 is shown latched or
locked closed about a blood vessel 200.
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The end face 17 of the hook member 14 andthe end face 19 of the second leg 12 are angled as
illustrated to facilitate the passage of the second
leg 12 past the hook member 14 during closure of the
clip 10.
When the clip 10 is closed over a blood
vessel 200 as illustrated in Figure 6, the surfaces
16 and 18 engage and compress the vessel 200 to close
the lumen thereof. The surfaces 16 and 18 may be
smooth as illustrated in Figure lA, or may be
provided with ridges or grooves to increase vess21
holding power.
The first leg 11 may also be undercut at the
juncture of the hook member 14 and the surface 16 as
illustrated in Figure lA to increase deflectability
of the hook member 14 and increase the space between
the hook member 14 and the leg 11, thereby
compensating for any inward deflection of the hook
member 14 during closure of the clip which might
reduce the clearance between the hook member surface
15 and the first leg surface 16 and otherwise
interfere with the latching of the clip 10.
The clip 10 may also include an outside
cylindrical boss 21 extending across the width of the
second leg 12 near the distal end thereof. The boss
21 is spaced from surface 25 a distance sufficient to
permit full engagement of the hook member 14 by the
leg 12 when the clip 10 is in a closed and latched
position.
The clip 10 is provided with a base 40
extending along the length of the first leg 11 from
the distal end of the first leg 11 for only a portion
of the length of the clip. The base 40 basically
serves for being engaged by, and for supporting the
clip 10 in, an instrument that may be used to apply
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the clip. One such instrument is discussed in detail
hereinafter,
The base 40 terminates short of the leg
connection end or resilient ninge 13 whereby the leg
connection end or resilient hinge 13 extends
rearwardly beyond the base 40 to define an open
recess adjacent the rearward end of the base 40 below
the hinge 13. At the front of the clip, the base 40
terminat~s in an engagement means or front face 39
~Figure 7) that defines a plane generally normal to
the length of the clip.
The base has a generally right rectangular
prism or parallelpiped configuration with portions 41
of the base 40 extending laterally outwardly from the
first leg ll on each side of the first leg. The
portions 41 of the base 40 extending laterally
outwardly function as a guide means for engaging
portions of the clip applier instrument as described
in detail hereinafter.
Figure lB shows a second embodiment of a
clip 10' that is similar to the clip 10 described
above with reference to Figure lA. The clip 10' is
illustrated as being a little shorter and a little
wider than clip 10. The clip 10' includes a first
leg 11' and a second leg 12' joined at their proximal
ends by a resilient hinge 13' in the same manner as
that discussed above for the legs ll and 12 of the
first embodiment of the clip 10 illustrated in
Figure lA.
The basic structural features of the clip
10' in Figure lB are identical to that of the clip 10
illustrated in Figure lA except for the base 40' of
the clip 10'. In the clip 10 illustrated in Figure
lA, the base 40 extends laterally outwardly beyond
the sides of the first leg ll. In contrast, the base
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40' of the clip 10' illustrated in Figure 1~ dses not
extend beyond the sides of the first leg 111. The
width of the base 40' is the same as that of the
first leg 111.
Further, there is a channel 42' defined
along the length of the base 40' on each side of the
clip 10'. The channels 421 function as a guide means
for engaging portions of an instrument that may be
used to apply the clip 10'. Such an instrument,
although not illustrated, is described hereinafter.
The clip 10' is illustrated as having
slightly dif~erent proportions than clip 10. If
desired, clip 10' may have the same proportions as
clip 10 and may be the same size as, or a different
size than, clip 10.
Each o the above-described novel clip
structures~ when fabricated from a suitable
thermoplastic material, is biased to the open
position by the resilient hinge portion. Thus, if
force is applied to the distal ends of the legs of
the open clip so as to move the legs toward one
another (but not far enough to latch the clip), then
upon removal of the force from the clip legs, the
clip legs will return to the substantially fully open
orientation.
It is believed that this phenomenon can be
used to advantage in certain types of clip applier
instruments for guiding and holding the clip in the
instrument. Specifically, the legs of the clip may
be deflected inwardly toward one another a small
amount in a magazine, guide channel, or jaw structure
of a clip applier instrument. Owing to the
resilience of the hinge joining the two legs, the t~o
legs will exert a force outwardly against the
magazine, channel, or jaw structure to thereby
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provide a small friction holding force which may
serve to help maintain the clip in the proper
orientation or position within the instrument.
The above-described action of the resilient
hinge plastic clip is in contrast with conventional
ligating clips fabricated from relatively small
diameter wire-like stock. Such metal clips can
tolerate substantially no inward deflection of the
legs without undergoing permanent deformation.
Consequently, such metal clips exhibit no useful
degree of resiliency and thus do not have the same
inherent capability for providing the frictional
holding force that is found in the above-described
type of plastic clip.
A scissors-type medical instrument 50,
generally illustrated in Figures 2 and 3, is adapted
for holding a supply o ligating clips, each clip
having the structure of the ligating clip 10
described above with reference to Figure lA, and for
applying the clips seriatim to tissue.
The instrument has a first handle 51 and a
second h~ndle 52. The first handle 51 has a finger
or thumb ring 54 and the second handle also has a
finger or thumb ring S6. The first and second
handles 51 and 52 are mounted together for pivotal
movement about a pivot axis designated generally at
reference numeral 60 in Figure 3. Each handle 51 and
S2 extends forwardly beyond the pivot axis 60 to form
a clip closing jaw--a first handle lower jaw 61 and a
second handle upper jaw 62 as illustrated best in
Figure 3. As can best be seen in Figure 2, the jaws
61 and 62 are preferably curved toward one side.
The second handle 52 preferably has a pair
of spaced-apart sidewalls 64 and 66 as best
illustrated in Figures 2 and 3. The sidewalls 64 and
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66 project upwardly ~nd receive be~ween them the
first handle 51.
The first handle 51 defines a chamber,
channel, or guideway 70 as best illustrated in Figure
3 for receiving a plurality of the opened clips 10 in
end-to-end relation-hip with the distal end of the
first leg of one clip abutting the leg connection end
or hinge of the next forwardly adjacent clip. As
best illustrated in Figure 2C, the clips 10 are
received in the guideway 70 in a manner that permits
forward movement of the clips 10 along the guideway
70.
Specifically, the guideway 70 includes a
bottom channel 72 for receiving the base 40 of each
clip 10. The instrument 50 includes inwardly
projecting flanges 74 above the bottom channel 72.~
The flanges 74 of the guide~7ay 70 function to engage
the bases of the clips when the instrument 50 is
tilted or turned to any position other than the
horizontal position illustrated in Figure 3. l'he
flanges 74 can thus engage the bases of the clips and
retain the clips within the instrument 50. The
channel 72, in cooperation with the flanges 74,
permits sliding movement of the clips 10 forwardly
along the guideway 70.
As best illustrated in Figure 3, when the
clips 10 are disposed within the guideway 70 in the
opened position, the boss 21 of each clip is in
contact with the top of the guideway 70. Owing to
the resilient nature of the clip hinge 13, the boss
21 of each clip is biased upwardly in the guideway
70. The clip hosses are thus forced against the top
of the guide~7ay 70 except in ~he region just forward
of the pivot axis 60. At this point, the top o~ the
guideway 70 terminates, since the first handle 51
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extends forwardly of the pivot axis 60 only belo~,7 the
first handle 52.
The clips 10 are moved forwardly along the
guideway 70 to the region of the jaws 61 and 62 by a
novel flexible pusher member 80 as best illustrated
in Figure 3. The pusher member 80 is preferably a
flexible, perforated tape defining a plurality of
e~ually spaced apertures 81 extending along the
length of the tape. As best illustrated in Figure
lOA, the flexible pusher member tape 80 preferably
has a generally rectangular cross section and is
adapted to be received within the channel 72.
Preferably, a portion of the ~ape 80 is disposed in a
spiral coil configuration 82 within a receiving
chamber 84 in the first handle 51. A leading portion
of the tape 80 is unwound from the spiral coil 82 and
extends into the clip guideway 70 for abutting the
rear end of the base 40 of the last clip in the row
of clips within the guideway 70.
The instrument 50 further preferably
includes a means for feeding the tape 80 forwardly
along the guideway 70 to move the row of clips 10
forwardly along the first handle 51 to the jaws 61
and 62. Specifically, a sprocket wheel 90 is mounted
for rotation relative to the first handle 51 within a
cylindrical chamber 92. The sprocket wheel 90 has a
plurality of circu~ferentially spaced and radially
outwardly projecting pins 94 which are adapted to
engage the perforations or apertures 81 in the
tape 80.
As best illustrated in Figures 2 and 3, the
sprocket wheel 90 includes a hub 96 for rota~ing with
the wheel 90 relative to the first handle 51. A
flexible cord ga is wrapped or wound around the hub
35 96 and is secured to one end of a tension spring 100
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disposed within a bore 102 in the first handle 51.
The other end of the tension spring 100 is secured at
post or pin 104 to the first handle 51. The spring
100 thus pulls the cord 98 from the hub 96 to thereby
S rotate the hub 96 and the wheel 90 to drive the tape
80 forwardly in the clip guideway 70.
A novel escapement mechanism is provided for
preventing the clips 10 from being pushed out of the
end of the jaws 61 and 62 until after the jaws are
actuated and for ensuring that only one clip at a
time is properly latched closed about a blood vessel
200 and discharged from the instrument 50.
Specifically, with reference to Figures 2C, 3, and
7-9, a gate or spool 110 is mounted for rotation
about a longitudinal axis in the first handle lower
jaw 61 below the upwardly facing clip engaging face
63 (Figure 2C) of the jaw 61. The spool 110 is
adapted to rotate within the jaw 61 between a first
orientation (Figures 4, 6, 8, and 9) and a second
orientation (Figures 3 and 7).
The spool 110 has a forward flange 112 on
the forward end adjacent the forward end of the first
handle jaw 61. The forward flange 112 projects in
front or the guideway 70 and defines a segment cut
2S away at face 114 (Figure 8) to permit passage of a
clip 10 when the spool 110 is in the first
orientation.
The spool 110 has a rearward flange 116
which is spaced from the forward flange 112 by a
distance equal to the length of the base 40 of clip
10. The rearward flange 116 projects into the
guideway 70 and defines a segment cut away at face
118 (Figure 7) to permit passage of a clip 10
therepast when the spool 110 is in the second
orientation.
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~ s best illustrated in Figure 8, ~hen the
spool 110 is in the first orientation to permit
passage of a clip 10 past the first flange 112, the
second flange 116 is oriented to block passage of the
next rearward clip into the jaw region. Similarly,
when the spool 110 is in the second orientation
illustrated in Figure 7 wherein the forward flange
112 blocks the guideway, the rearward flange 116 is
oriented to permit passage therepast of a clip into
the jaw region behind the forward flange 112.
As best illustrated in Figure 3, a rod 120
extends rearwardly ~rom the spool 110 within a
cylindrical bore 122 (Figure 2A) in the first handle
51 and is adapted to rotate about a longitudinal axis
coincident with the longitudinal axis of the spool
110. As best illustrated in Figures 3 and 5, the rod
120 extends beyond the rear end of the first handle
51 and has a laterally projecting drive portion 124.
The laterally projecting drive portion 124 is
disposed at a 90 degree angle relative to the
longitudinal axis of the rod 120.
A novel actuating structure is provided for
engaging the drive portion 124 of the rod 120 and for
rotating the drive portion 124, the rod 120, and the
25 spool 110 so as to orient the spool 110 in either the
first orientation tFigures 4, 6, 8, and 9) or the
second orientation (Figures 3 and 7). Specifically,
as best illustrated in Figures 3 and 5, a plate
structure 130 is mounted to the second handle 52 by
30 means of a screw 132. Another plate 134 is secured
to the plate 130 by means of two screws 136 (Figure
3). The screws 136 extend through an elongate slot
138 in the plate 134 and are threadingly engaged in
the plate 130. The heads of the screws 136 engage
35 the surface of the plate 134 around the slot 138.
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The slot 138 permits the plate 134 to be adjus'ed
vertically relative to the plate 130.
The plate 130 has at its top end an upper
engaging member 140 and the plate 134 has at its top
end a lower engaging member 142. The upper engaging
member 140, the lower engaging member 142, and the
plate 130 together define a generally C-shaped
configuration.
The upper engaging member 140 is adapted to
engage and pivot the drive portion 124 of the drive
member 120 from the upwardly inclined orientation
illustrated in Figure 5 to the downwardly inclined
orientation illustrated in Figure 3. Conversely, the
lower engaging member 142 is adapted to engage and
pivot the drive portion 124 of the rod 120 from the
downwardly inclined orientation illustrated in Figure
3 to the upwardly inclined orientation illustrated in
Figure 5. As the drive portion 124 of the rod 120 is
pivoted between these two orientations, the rod 120
the spool 110, necessarily rotate about the
longitudinal axis.
As best illustrated in Figures 7 and 8,
there is a particular relationship between the
laterally angled drive portion 124, the spool
rearward flange 116, and the spool forward flange
112. This can be seen with reference to Figures 3
and 7 which illustrate the instrument when the
handles 51 and 52, and hence the jaws 61 and 62, are
in a fully opened position. In this position, the
upper engaging member 140 has engaged the drive
portion 124 and pivoted the drive portion 124 to the
downwardly inclined orientation. This rotates the
spool 110 to the second orientation wherein the
forward flange 112 prevents forward movement of a
clip out of the region of the jaws. Specifically,
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the clip engagement means or front face 39 of the
base is engaged by, or abuts, the flange 112.
In Figures 4 and 8, the handles 51 and 52
are closed and the lower engaging member 142 has
engaged and pivoted the drive portion 124 of the ro2
120 to the upwardly inclined orientation. This
rotates the spool 110 to the first orientation in
which the forward flange 112 permits passage of a
clip out of the jaw region.
When the handles 51 and 52 are not being
held closed, they are normally urged to the outwardly
open position illustrated in Figure 3 by a helical
compression spring 150 disposed between the first and
second handles 51 and 52 rearwardly of the pivot axis
60. When the handles 51 and 52 are s~ueezed
together, overcoming the biasing effect of the spring
150, the closure movement is limited by an abutment
member 156 as best illustrated in Figure 2B and
Figure 4. Specifically, the abutment member 156 is
mounted to the second handle 52. To this end, the
abutment member 156 has a saddle-shaped configuration
with a first leg 158 on one side of the second handle
52 and with a second leg 160 on the other side of the
second handle 52. Each leg 158 and 160 of the
abu~ment member 156 defines an elongate slot, such as
the slot 162 visible in Figures 3 and 4 in the leg
15~. The slots are in registr~ and permit the
passage therethrough of a screw 164. The screw 164
is secured ~lith a nut 165 which is against the leg
160 of the abutment member 156. The slots, such as
slot 162, permit adjustment of the abutment member
156 on the second handle 52.
When the handles 51 and 52 are squeezed
together as illustrated in Figure 4, the abutment
member 156 abuts the bottom surface of the first
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35~l
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handle 51 and prevents further closure movemen~.
This limits the closure of the jaws 61 and 62 and
also prevents the lower engaging member 142 from
pivoting the drive portion 124 of the rod 120 beyond
the angle illustrated in Figures 4 and 5.
The handles 51 and 52 cannot be opened any
further than shown in Figure 3. This is because an
abutment face 170 tFigures 3 and 4) behind the upper
jaw 62 of the second handle 52 engages an abutment
172 on the first handle 51 above, and slightly
forward of, the pivot axis 60. This prevents the
upper engaging member 140 from pivoting the drive
portion 124 of the rod 120 beyond the angled position
illustrated in Figure 3.
The sequence of operation of the instrument
50 will next be described in detail. When the
instrument 50 is in the fully opened position
illustrated in Figure 3, the spool 110 is in the
second orientation wherein the forward flange 112
blocks the further forward feeding of the clips 10.
In this position, the drive portion 124 of the rod
120 is in its most downwardly inclined orientation.
Further, in this position, the flexible tape 80 urges
the row of clips 10 forwardly so that the distal end
of the first leg of each clip abuts the hinge of the
next forwardly adjacent clip.
As illustrated in Figures 3 and 7, the front
clip 10 in the row of clips is positioned between the
open jaws 61 and 62 but is prevented from moving
further forwardly by the flange 112 on the spool
110. The distal end of the first leg of the next
rearwardly adjacent clip abuts the hinge of the front
clip. Owing to the fact that the base 40 of the
front clip terminates short of the hinge 13 of the
front clip, there is an open recess beneath the hinge
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,ll,f~ 3~
of the front clip between the rear end of th base 40
of the front clip and the front end of the base of
the next rearwardly adjacent clip. This open recess
can accommodate the subsequent rotation of the spool
rearward flange 116 between the two clips.
With the front clip 10 positioned in the
open jaws 61 and 62 as illustrated in Figures 3 and
7, the instrument 50 may be carried by the surgeon to
the region of the blood vessel 200. The instrument
50 is positioned so that the jaws 61 and 62 locate
the first, open clip 10 about the blood vessel 200.
Next, the surgeon closes the handles 51 and 52
together to squeeze the clip closed as illustrated in
Figure 4. As this occurs, the lower engaging member
142 engages and pivots the drive portion 124 of the
drive rod 120 into the upwardly inclined orientation
illustrated in Figures 4 and 8. The maximum closure
is determined by the abutment of the member 156 with
the bottom of ~he first handle 51 as illustrated in
~igure 4.
When the instrument 50 has been fully closed
as illustrated in Figure 4, the spool 110 has
necessarily been rotated from the second orientation
to the first orientation wherein the forward flange
112 o~ the spool 110 will now permit passage of the .
~ront, closed clip beyond the forward ~lange 112.
The rearward flangQ 116 has been simultaneously
rotated into position to block the ~orward movement
o~ the next rearwardly adjacent clip. However, at
this point, the jaws 61 and 62 are still closed and
thus the instrument 50 cannot yet be disengaged from
the closed clip 10.
The instrument 50 is removed from the closed
clip 10 and ligated blood vessel 200 by subsequently
partially opening the handles 51 and 52 to thereby
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3~
24-
partially open the jaws 61 and 62. This is
illustrated in Figures 6 and 9 where the handl~s 51
and 52 have been partially opened so that the jaws 61
and 62 are spaced apart an amount sufficient to
provide clearance around the latched closed clip 10.
However, the handles 52 and 52 have been opened an
amount insufficient to engage the drive portion 124
of the rod 120 with the upper engaging member 140.
So long as the drive portion 124 is not engaged and
pivoted by the upper engaging member 140, the spool
110 remains in the first orientation to 1) permit
passage of the closed clip beyond the forward flange
112 and 2) block movement of the next rearwardly
adjacent clip into the jaw region~
With the instrument 50 partially open as
illustrated in Figures 6 and 9, the instrument 50 is
withdrawn by the surgeon from the region of the
ligated blood vessel 200. As ~he instrument 50 is
being withdrawn, or after the instrument 50 has been
completely withdrawn, from the latched closed clip
about the vessel 200, the handles 51 and 52 may be
further opened to the fully opened position
illustrated in Figures 3 and 7. In this fully open
position, the upper engaging member 140 has engaged
and pivoted the drive portion 124 of the rod 120 to
rotate the spool 110 to the second orientation
wherein the rearward 1ange 116 permits passage of
the next clip 10 into the jaw region but prevents
passage of that clip out of the jaw region beyond the
blocking forward flange 112. The clips 10 in the row
in the guideway 70 are urged forwardly by the tape 80
so that the new first or front clip becomes properly
positioned within ~he jaw region in abutting
relationship with the blocking forward flange 112~
3~ The instrument S0 is now ready for applying this clip.
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Although the preferred embodiment of the
pusher member 80 has been illustrated as a perfora~ced
tape having apertures 81 to receive the wheel drive
pins 94, it is to be realized that the tape may
instead be slotted, embossed, or otherwise provided
with suitable means for being engaged by a rotating
wheel structure similar to the wheel 90.
One such alternate embodiment of the pusher
member 80 is illustrated in Figure 10B and is
designated generally therein by reference numeral
80A. The pusher member 80~ is a flexible tape having
a generally rectangular cross section and defining
therein a plurality of spaced-apart rectangular
apertures 81A. The instrument 50 illustrated in
Figures 2 and 3 could be modified for use with such a
tape 80A by providing the wheel 90 with rectangular
prism projections instead of the cylindrical pins 94.
Another alternate form of the pusher member
80 is shown in Figure 10C and is designated generally
therein by the reference numeral 80B. The pusher
member 80B is a flexible tape having a generally
rectangular cross section. The tape 80B does not
have apertures. ~ather, the tape 80B is provided
with spaced-apart, upwardly projecting cylindrical
bosses 81B. The tape 80B could be used with the
instrument 50 illustrated in Figures 2 and 3 if the
wheel 90 were modified to replace the pins 94 with
cylindrical recesses for receiving the bosses 81~.
~lthough the preferred embodiment has been
illustrated with the drive wneel 90 being rotated by
the cord 98 which is connected to the helical tension
spring 100, it is to be realized that other suitable
mechanisms for rotating the wheel 90 may be employed.
Specifically, Figure 11 illustra~es an
3; alternate form of a means for driving the flexible
q
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,~,.f~t~353~
pusher tape within an alternate embodiment o~ the
instrument designated generally by reference numeral
50'. The instrument 50' is generally similar to the
first embodiment of the instrument 50 described above
with reference to Figures 2 and 3. The instrument
50' includes a first handle 51' and a second handle
52'. ~ cavity 102' is provided within the first
handle 51' for receiving a compression spring 100'.
The compression spring 100' bears at its rearward end
against the first handle 51' and is secured at its
forward end to a cord 98'. The cord 98' is secured
to the hub of a wheel 90' that is identical to the
wheel 90 described above with reference to the first
embodiment of the instrument 50 illustrated in
Figures 2 and 3.
Since the compression spring 100' is biased
forwardly along the first handle 51', the cord 98' is
continuously urged to unwind from the wheel 90', thus
advancing a perforated flexible tape 80' that pushes
against the last clip 10.
The embodiment of the instrument 50'
illustrated in Figure 11 may also have a metal or
plastic leaf spring 150', as illustrated, in place of
the helical compression spring 150 used in the first
embodiment of the instrument 50 illustrated in
Figures 2 and 3. The leaf spring lS0' may be
fabricated from a thermoplastic material, and if
desired, may be integrally molded from the
thermoplastic material with either of the handles 51'
and 52'.
Figure 12 illustrates another embodiment 50"
of an instrument for applying clips 10. The
instrument 50l' in Figure 12 is substantially similar
to the first embodiment of the instrument 50
illustrated in Figures 2 and 3, except that the
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mechanism for advancing the pusher tape is
different. Specifically, the instrument 50" in
Figure 12 has a first handle 51'' with a chamber 92 "
for receiving a wheel 90'' that is substantially
identical to the wheel 90 in the first embodiment of
the instrument 50 illustrated in Figures 2 and 3. As
in the flrst embodiment, the wheel 90~' of this
alternate embodiment is engaged with a flexible
pusher tape 80" for advancing the flexible pusher
tape 80" along the first handle 51 " and against the
last ~lip 10 in the row of clips. The chamber 92"
also ~eceives a clock sprinq 100" which is secured at
its inner end to the hub of the wheel 90" and which
is restrained at its outer end in a small cavity
102". Thus, the clock spring 100 " continuously
urges the wheel 90" to rotate and advance the
flexible pusher tape 80" against ~he last clip 10 in
the row of clips.
Although the pusher member embodiments have
been described above as being formed from a flexible
tape, it is to be realized that the pusher member 80
may be a riqid member and that the means for
advancing the pusher member along the guideway 70 may
include a suitable spring mechanism in place of the
wheel 90 and cord 98.
In the illustrated preferred embodiment of
the instrument 50, the spool 110 is shown with a
forward flange 112 and a rearward flange 116. ~t is
to be realized that other gate-type configurations
may also be used.
The instrument 50 can be modified ~o
accommodate the second embodiment of the clip 10'
discussed above with reference to Figure lB.
Specifically, the cross section of the guideway 70
~illustrated in Figure 2A) in the lower jaw 61 can be
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modified to accept the clip 10' (Figure lB) inste~d
of the clip 10 (Figure lA). Specifically, ~,1ith the
clip lO', there is no need to provide the wider,
lo~er channel 72 in the guideway 70. Instead~ the
guideway 70 can have a constant width from top to
bottom except where the flanges 74 project inwardly.
The flanges 74 can be positioned slightly lower in
the guideway 70 so as to enter into the channels 42'
of the ~lip 10'. Of course, the width of ~he
guideway 70 would be such as to accommodate the
ac~ual width clip 10l ~which may be narrower or wider
than clip 10). Also, the distance between the spool
flanges 11? and 116 would be such as to properly
accommodate the length of the clip 10'.
li A third embodiment of a clip, similar to
clip 10 illustrated in Figure lA is illustrated in
Figures 13 and 1~ and is designated generally therein
by reference numeral lOn. The clip 10" includes a
first leg 11" and a second leg 12" joined at their
proximal ends by a resilient hinge 13" and functions
in the same manner as dis~ussed above for the first
embodiment of the clip 10 illustrated in Figure lA.
The basic structural features of the clip
10" in Figure 13 are identical to that of clip 10
illustrated in Figure lA except for the base 40" of
the clip 10". In the clip 10 illus~rated in Figure
lA, the base 40 extends to the distal end of the
first leg 11 but terminates short of the resilient
hinge 13. In contrast, the base 40" of the clip 10"
illustrated in Figure 13 does not extend all the way
to the front or distal end of the first leg 11''.
Further, the base ~0" extends rearwardly beyond the
first leg 11" and hinge 13".
The base 40" can be regarded as having an
upper portion with a generally right rectangular
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prism configuration and an associa~ed engagement
means 39~ that comprises a lower portion of the base
projecting from the upper portion and having a length
less than the length of the upper portion.
Preferably, the engagement means 39" is a
frustoconical projection below the upper portion of
the base 40".
A novel instrument 50 "' is illustrated in
Figures 15 and 16 for applying the clip 10". The
instrument includes an upper jaw 62 " ' and a lower
jaw 61'''. The lower jaw 61''' extends from a first
handle (not visible in Figure 15) that is similar to
the first handle 51 of the embodiment of the
instrument 50 illustrated in Figure 3. Similarly,
li the upper jaw 62''' extends from a second handle (not
visible in Figure 15) that is similar to the second
handle 52 of the first embodiment o~ the instrument
50 illustrated in Figure 3. The basic construction
of the instrument 50''' is similar to the first
embodi~ent of the instrument 50 described above with
reference to Figure 3 except that the escapement
means and the escapement actuator of the instrument
50''' are different than the escapement means or
spool 110 and the escapement actuator of the first
embodiment of the instrument 50.
Specifically, the instrument 50 "' is
provided with an escapement means in the form of a
worm gear 110"' disposed in the recess 111''' in the
lower jaw 61'''. A rod 120'~' extends rearwardly
from the worm gear 110"' in the same manner as the
rod 120 of the first embodiment of the ins~rument 50
described above with reference to Figure 3. However,
the rearward end of the rod 120''' is connected with
a suitable conventional mechanism (not illustrated in
35 Figures 15 and 16) which 1) effects a rotation of the
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_30_
worm gear in only one direction and only when the
jaws are being moved open and 2) causes no rotation
of the worm gear 110'" when the jaws are being moved
closed. Portions of such a conventional actuating
mechanism may be mounted on the handles associated
with the jaws 61''' and 62 " ' so as to convert the
opening motion of the handles to a one-way rotation
of the rod 120'" . The mechanism would be
inoperative as the handles are being closed.
As in the case of the first embodiment of
the instrument 50 described above with reference to
Figure 3, the embodimer.t of the instrument 50'''
includes a flexible pusher tape 80 "' ~o push the
clips 10" forwardly into the region of the jaws 61l''
lS and 62'''. As best illustrated in Figure 16, the
base 40" of each clip is received within a channel
72''' of the lower jaw 61'''. The lower jaw 61'''
also defines a second channel 73''' opening upwardly
to the first channel 72 "'. The frustoconical
engagement means 39" of each clip 10" is received
within the channel 73'''.
As best illustrated in Figure 15, the clips
are aligned in end-to-end relationship and the hinge
portion of each clip is abutted by the forward distal
end portion of the first leg 11" of the next
rearwardly adjacent clip. In operation, the flexible
pusher tape 80 "' pushes the row of clips along the
instrument 50 "' to maintain the engagement means 39"
of the front clip in the row in engagement with the
thread on the worm gear 110"'. In Figure 15, the
jaws 61''' and 62''' are shown partially closed with
the front clip 10 " positioned between the jaws and
ready to be squeezed closed about a blood vessel (not
shown). At this point, the jaws have been moved
together a small amount su~ficient to just bring the
520
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upper jaw 62''' into contact with the top of ~he cli~
second leg 12n.
With the instrument oriented as illustrated
in Figure 15, the clip 10" may be located about a
blood vessel and then the instrument 50''' may be
actuated to fully close the jaws and latch the clip
10" about the vessel. As the jaws are closed, the
rod 120 "' and the worm gear 110"' are not rotated,
since the above-described actuating mechanism (not
illustrated) does not operate to effect rotation of
the rod 120"' during the closing movement of the
jaws.
After the clip 10" has been latched closed
about the blood vessel, the jaws are opened and the
actuating mechanism then operates the rod means
120''' to rotate the worm gear 110''' in a direction
to advance the front clip 10" out of the jaw 61' ".
As the jaws 61''' and 62''' are continued to be moved
to the fully opened position, the next rearwardly
adjacent clip 10" is urged into engagement with the
still rotating worm gear 110''' for direct
advancement by the worm gear. When the jaws 61 " '
and 62''' have been moved to the full open position
(further apart than shown in Figure 15), the new
front clip has been moved into the middle of the worm
gear thread (the fully advanced position illustrated
for the front clip 10" in Figure 15) and the rotation
of the worm gear 110" ' terminates.
Subsequent partial closure of the jaws ma~
be effected (without rotating the worm gear 110''')
to bring the upper jaw 62''' into contact with the
new front clip second leg 12'' as illustrated in
Pigure 15. The new front clip is then ready to be
applied to a blood vessel.
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520
~'~f~
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With the novel escapement mechanism of the
instrument 50''', it is seen that as the latched
closed front clip is positively ejected from the
instrument 50"' (first by the worm gear 110"' and
finally by the tape-driven advancernent of the entire
row of clips). However, the next rearwardly adjacent
(open) clip in the instrument cannot also be
inadvertently ejected from the instrument since the
next clip is necessarily first engaged by the worm
gear 110"' within the jaws.
The embodiments of the instrument of the
present lnvention may be used to apply other types of
clips having an appropriate base structure, including
metal clips. For example, such clips, while not
having a resilient hinges, may be formed of tantalum
or stainless steel. These clips could be deformed
into the closed position and would possess sufficient
strength to retain the deformation when clamped about
a duct, such as a blood vessel.
From the foregoing, it will be observed that
numerous variations and modifications may be effected
without departing from the true spirit and scope of
the novel concept of the invention. It is to be
understood that no limitation with respect to the
specific apparatus illustrated herein is intended or
should be inferred. It is, of course, intended ~o
cover by the appended claims all such modifications
as fall ~7ithin the scope of the claims.
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