Note: Descriptions are shown in the official language in which they were submitted.
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ATRAUMATIC SURGICAL CLAMPING INSTRUMENT
BACKGROUND OF THE INVENTION
Field of the Invention
This invention relates generally to surgical grasping,
retracting and occluding devices having opposing jaws, and
s more specifically to such devices which are provided with
atraumatie inserts which extend in oppOSlng relatlOIlShlp
along the jaws.
Discussion of the Prior Art
io
clamps and clips have been used in surgical procedures
to engage and release various body structures Such aS
organs and conduits. Such instruments are commonly
referred to by the function that they perform once the
15 Organ haS been engaged. Thus, the prior art includes
graspers which engage the organ, retractors which are used
to move the organ to a different location, and occluders
which are used to close body conduits. All Of these
instruments include opposing jaws which are movable
20 relatlVe to each other between a proximate position wherein
the organ is engaged, and a spaced position wherein the
organ is released.
Where the organ is particularly fragile, these
25 elampinc> devices have been prflYlded Wlth atraumatic inserts
which are mountable on the jaws of the device, and include
a COfipreSSlble elastomerie material which softens the grip
OI1 the organ. Unfortunately, these inserts have added
greatly to the profile of these devices. Where such
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devices have been used in open surgery, spacial limitations
have easily accommodated the relatively large profile.
However, in more confined surgeries, such as laparoscopic
procedures, the relatively high profiles have not been
tolerable.
One such laparoscopic surgery involves the removal of
the gall bladder. When this organ is diseased, use of a
grasper or retractor without inserts can result in tearing
the organ. This not only releases toxic bile into the
abdominal cavity, but also can release gall stones into the
pneumoperitoneum. In either case, the procedure is
dramatically complicated simply because soft jaw inserts
producing a high clamp profile which cannot be used in this
type of surgery.
The high clamp profiles have resulted not only from
the configuration of the inserts, but also from the
structure relied on for attaching these inserts to the
associated jaws. In the latter regard, holes have been
drilled into the supporting surface of the associated jaw.
Oversized projections on the insert have been forced into
these holes to maintain the insert and jaw in a fixed
relationship. Unfortunately, drilling a hole into the
supporting surface of the jaw has substantially weakened
the jaw particularly in the direction of closure w:~ich
extends between the jaws. To overcome this weakness, an
additional depth of material has been required along the
plane of closure to add structural integrity to the jaws.
The inserts of the prior art have included an insert
base which generally extends along the direction of closure
away from the supporting surface. Side walls of the insert
base have extended toward the opposing jaw to further
increase the profile of the clamping device.
'SHEET
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A third element adding to this profile is the depth of
the elastomeric material which is celled On for the
atraumatic feature of the insert. This depth Of
elastomeric material has been accommodated almost totally
In the space extending between the insert base and the
second jaw.
Each of these structural limitations has added to the
profile of the clamping devices of the past. Where these
features have appeared in combination, atraumatic clamping
has only been possible in open surgeries.
SUMMARY OF THE INVENTION
In accordance with the present invention, surgical
clamping devices can now be provided with a relatively low
profile facilitating their use in procedures offering
limited space, such as laparoscopic surgeries. An insert
is provide which includes an insert base formed with a
2o center wall and a pair of spaced opposing side walls.
These three walls form a longitudinal channel in the insert
base which is sized and configured to receive the
associated jaw of the clamping device. The elastomeric
material is disposed on the side of the center wall
opposite the side walls.
with the side walls of the base insert extending
generally parallel to the plane of closure, the insert 1S
structurally inhibited from bending in the direction of
ClOSUre. However, with the side walls extending away from
the S2COnd jaw, this structural integrity is achieved
without a sacrifice to the profile of the insert_
The center wall of the insert base can also be formed
with holes so that the elastic material extends through the
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center wall to the supporting surface of the jaw. This
accommodates a greater thickness of the elastOmerlc
material, thereby adding to the atraumatic characteristics
Of the Insert. This feature is accomplished without a
sacrifice to the profile, since the depth of the
elastomeric material is accommodated without regard for the
thickness of the center wall.
Removable attachment of the insert to the jaw is
faC111tated by a detent mechanism which extends between the
side walls of the insert and the side surfaces of the
associated jaw. Placing the detent in this region, enables
the supporting surface of the jaw to be maintained in a
continuous, unbroken surface which enhances the strength Of
the jaw. Where the detent attachment mechanism includes a
projection and an associated recess, the recess can be
formed In the side of the jaw leaving the jaw with an "I-
beam~~ construction which maximizes the strength of the jaw
in the plane of closure.
All of these features can be combined to enhance the
structural integrity of both the jaw and the insert while
at the same time significantly reducing the profile of the
clamping device.
These ana other features and advantages of the
invention will become more apparent with the description Of
preferred embodiments and the best mode of the invention,
dnd reference t0 the associated drawings.
DESCRIPTION OF THE DRAWINGS
Fig. i is a siae elevation view of a clamping device
having a pair of opposing jaws and more speclflcdlly do
atraumatic occluding device of the present invel'ztioiZj
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Fig. 2 is a side elevation view of a laparoscopic
grasper In an additional embodiment of the invention;
Fig. 3 is a side elevation view of a vascular clip in
5 a further embodiment of the invention;
Fig_ 4a is an elevation view of one of the jaws
associated with the clamping device of the present
invention;
to
Fig. 4b is a top plan view of the jaw illustrated in
Fig. 4a;
Flg. 4C is a cross section view taken along lines 4c-
4c of Fig. 4a;
Fig. 5a is a top plan view of a jaw insert associated
with the present invention;
Fig. 5b is an axial cross section view taken along
lines 5b-5b of Fig. 5a;
Fig. sc is a radial cross section view taken along
lines 5c-5c of Fig. 5bj
Fig. 6a is a side elevation view illustrating an
insert being mounted on a clamping jaw associated with the
present invention;
ao Fig. 6b is a side elevation view of the lnSert m0unt2d
in an operative Position Gi1 the associated jawj and
Fig. 6c is a cross section view taken along lines 6c-
6C of Fig. 1 and Fig. 6b.
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DESCRIPTION OF PREFERRED EMBODIMENTS
AND BEST MODE OF THE INVENTION
A clamping device is illustrated in Figures 1, 2 and
3 and designated generally by the reference numeral 10. In
Figure 1, the device 10 is in the form of a vessel occluder
12. A similar device 10 is illustrated in Figure 2 in the
form of a laparoscopic retractor 14. Still a further
1o clamping device 10 is illustrated in Figure 3 in the form
of a vessel clip 16.
These clamping devices 10 are similar in that they
each include a pair of opposing jaws 18 and 19 with an
assoClated insert 20, 22. These jaws 18, 19 and inserts
20, 22 are movable between a proximate position and a
spaced position. In the proximate position, the jaws 18,
19 and inserts 20, 22 are closely Spaced or contacting to
engage a body structure such as an organ or a conduit, for
example a vessel 23 as illustrated in Figure 1. In the
released position, the jaws 18, 19 and inserts 20, 22 are
spaced, thereby permitting release of the body organ, such
as the vessel 23.
The clamping device 10 represented by the oCCluder 12,
retractor 14, and clip 16, are dissimilar in their
meChariiSm for moving the jaws 18 and 19 between the
proximate and spaced position. In the case of the occluder
12 illustrated in Figure 1, a pair of crossing handles 25
so and 27 pivot at a fulcrum pin 3o and terminate at
respective thumb lvvps 32 and 34. A pdlr Of rdtChet tdbS
36 and 38 associated with the respective handles 25 and 27~
proVlde means for locking the jaws 18 and 19 in a preferred
relationship. Iri this embodiment, the means for moving the
]aWS 18, 19 functions as a scissors.
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In the case of the laparoscopic retractor 14, the
means for moving the jaws 18, 19 includes a longitudinal
tube 41 having a distal end 43 and a proximal end 45. The
jaws 18, 19 are disposed at the distal end 43, while the
handles 25, 27 are disposed at the proximal end 45. One of
the jaws 18, 19 is attached to a shaft 47 which is axially
movable within the longitudinal tube 41. At the proximal
end 45, the shaft 47 is attached to and movable with one of
the handles 25 and 27. Operation of the handles 25 and 27
to in a scissors fashion, results in movement of the jaws 18
and 19 between the proximate and spaced positions.
The vessel clip 16 illustrated in Figure 3 can include
similar jaws 18, 19. However in this embodiment, the means
for moving the jaws 18, 19 includes telescoping cylinders
50, 52 each of which is attached to an associated one of
the jaws 18, 19. The telescoping movement of these
cylinders 50, 52 against the bias of a spring 54 results in
relative movement of the jaws 18, 19.
The remainder of the disclosure will be presented with
reference to the vessel occluder 12 of Figure 1. However,
it will be apparent that the invention is equally
applicable to retractors, clips, graspers, and other
clamping devices 10 which have opposing jaws. This is
without regard to the particular mechanism which is relied
on for movement of those opposing jaws between the
proximate and spaced positions. The disclosure will also
be referenced to a single one of the jaws 18, 19 realizing
3o that in a typical embodiment, the opposing jaw 18 may have
a similar configuration.
The dimension of the jaw structure which is of
particular interest to the present invention is the
dimension which occurs in a direction of closure that
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extends between adjacent points on the opposing jaws 18 and
19. When the jaws 18, 19 are straight, this direction of
closure extends along a plane 56 which is illustrated in
Figure 4b as a line. It will be understood that if the
jaws 18, 19 are curved, this direction of closure will also
be curved, but nevertheless will extend between adjacent
points on the opposing jaws 18 and 19.
Referring now to the preferred embodiment of Figure 1,
it can be seen that the jaw 19 may include a relatively
thick section 61 and a relative thin section 63. In the
side view of Figure 4a, a distally facing shoulder 65
separates the two sections 61 and 63. In the pldn VleW Of
Figure 4b, distally facing shoulders 67 and 70 separate the
two sections 61 and 63. Thus it can be seen that in this
embodiment, the relatively thin section 63 is reduced in
both height and width with respect to the thick section 61.
As best illustrated in Figure 4a, the thin section 63
is characterized by a longitudinal configuration with a top
supporting surface 72 and a bottom opposing surface 74.
Side surfaces 76 and 78 are best shown in the cross-
sectional view of Figure 4c.
At the distal tip of the jaw 19, a beveled or
otherwise reduced surface 81 extends from the suppOrtl.ng
surface 72 to the opposing surface 74 in a proximal
direction. Thus, the distal tip of the jaw 19 tends to
form a prOj2CtlOn 83 where the surface 81 intersects the
3o supporting surface 72.
At least fine and preferably two recesses S5 dilC1 S7 CdI1
be formed along the side surfaces 76 and 78 in general
proximity to the shoulders 65-70~ in the manner described
11'1 greater detail below. These recesses 85 and 87 function
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ds part of a system for removably attaching the insert 22
to the jaw 19. Importantly, the supporting-surface 72 and
opposing surface 74 remain continuous and unbroken in this
embodiment. Additionally, the recesses can be placed as
shown in the relatively thick section 61. As a result, the
strength of the jaw in the plane of closure 56 remains
unaffected by the recesses 85 and 87 in the side Wall 76
and 78, respectively. The resulting ~~I-beam~~ cross
section, well-known for its resistance to bending, is best
illustrated in the crOSS S2Ctlorial vleW of Figure 4c.
A preferred embodiment of the insert 22 1s illustrated
in Figures 5 and 6. The insert 22 includes an insert base
90, typically formed from a hard plastic such as
polypropylene, and a pad 92, typically formed from an
elastomeric material such as latex or thermoplastic
elastomer. In a preferred embodiment, the insert base 90
includes a center wall 94 which extends longitudinally
between edges 96 and 98. A center line 101 extends
2o intermediate the edges 96 and 98 and is disposed in the
plane of Closure 56 when the insert 22 is operatively
disposed on the jaW 19. The Center wall 94 has an upwardly
facing surface 103 and a dOWl7Wardly facing surface 105.
A pair of side walls 11o and 112 are also included in
the insert base 90. These side walls 11o and 112 extend in
a common direction, downwardly in Figure 5b, from the
respective edges 96 and 98 of the center wall 94. Thus,
the side w~ll5 llo and 112 are spaced from each ether and
form with the center wall 94 a Chdnnel 114 Glhleh extends
along the length of the insert 22. ThlS Ch8?11121 114 is
best illustrated in Figure 5c. At the distal end of the
insert base 90, the channel 114 is closed and forms an
undercut 116.
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In the illustrated embodiment, the center wall 94 is
provided with holes 102 along the center line 101. These
holes 102 extend at least a portion of the distance from
the upwardly facing surface 103 to the downwardly facing
5 surface 105. In the preferred embodiment illustrated, the
holes io2 extend entirely through the center wall 94.
It is the holes 102 which facilitate several functions
associated with the elastomeric pad 92 of the present
10 invention. In a preferred method of manufacture, this pad
92 is generally molded onto the upwardly facing surface
103. since this surface is broken by the holes 102, a
portion of the elastomeric material forming the pad 92
flows into the holes 102 thereby assisting in anchoring the
elastomeric pad 92 to the base 90 of the insert 22.
The holes 102 also contribute to the elastomeric
characteristic of the pad 92. In the illustrated
embodiment, the thickness of the elastomeric pad 92 is
locally increased by the depth of the holes 102. This
additional thickness provides an increased degree of
softness for the insert 22 thereby contributing to the
atraumatic characteristics of the clamping device lo.
At the distal end of the insert 22, the elastomeric
material 92 can extend beyond the insert base 90 to form a
soft nose 118 at the distal tip of the insert 22 and the
distal end of the clamping device 10.
3o At the proximal end of the insert base 90, the side
walls llo and 112 can extend beyond the center wall 94 to
fe~-m respective flanges 121 and 123. Inwardly fdclng
projections 125 and 127 extend toward each other from the
inner surfaces of the respective flanges 121 and 123.
These projections 125 and 12?, which take the form of
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spheres in a preferred embodiment, are part of a detent
mechanism 130 which aids in attaching the insert 22 to the
jaw 19.
The mounting of the insert 22 on the associated jaw 19
is preferably accomplished as illustrated in Figure 6a.
Initially, the projection 83 at the end of the jaw 19 is
seated in the undercut 116 at the end of the channel 114 of
the insert 22. The insert 22 is then rotated downwardly
until the detent mechanism 130 is actuated to mount the
insert 22 in a snap fit relationship on the jaW 19.
Initially the projections 125, 127 cause the flanges 121,
123 t0 Spread as they slide along the associated side
surfaces 76, 78 of the jaw 19. When these projections 125,
127 reach the recesses 85 and 87, the flanges 121, 123 snap
inwardly to seat the jaw 19 into the channel 114 of the
insert 22.
The features associated with this construction are of
2o particular interest as they result in a low profile for the
inserts 20, 22 and associated jaws 18, 19. This low
profile is achieved without any sacrifice in the strength
or integrity of the resulting structure.
It will first be noted that the center wall 94 of the
insert 22 Can be relatively thin in profile since the side
walls ilo, 112 can be relied on to maintain the structural
rigidity of the base 90. And While the Slde Walls 110, 112
maintain the structural integt'lty Of the insert 22, th2y
8r2 positioned to extend away from the eldstOmei'1C pdd 92.
Accordingly, they make no contribution to the thlGKnesS Of
the jdWjlnSert COfibination along the plane of closure 56.
This profile is further reduced by permitting the
elastomeric material of the pad 92 to extend through the
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center wall 94 to the supporting surface 72 of the jaw 19.
Given this additional thickness for the pad 92, substantial
elastomeric properties can be achieved with only a thin
layer of the pad 92 extending beyond the upwardly facing
surface 103 of the center wall 94.
Formation of the detent mechanism 130 between the side
walls 110, 112 and the associated side surfaces 76, 78 of
the jaw 19 facilitates attachment of the insert 22 to the
jaw 19, again without sacrificing the structural integrity
of the jaw 19. With this detent mechanism 130, additional
material that might add to the profile, is not needed to
enhance the structure of the jaw 19.
The resulting low profile associated with the clamping
device 10 will be particularly appreciated in those
surgical erivlronments which do not provide an abundance of
space. Particularly in those procedures associated with
laparoscopic surgery, the clamping device 10 such as the
retractor 14 illustrated in Figure 2 Can be prOVlded Wlth
the low profile inserts 20 and 22 in order to provide
atraumatic clamping.
It will be apparent that various modifications to the
foregoing embodiments can be made to achieve other
advantages associated with the invention. For example, the
detent mechanism 130 can be modified so that the
projections 125, 127 and recesses, 85~ 87 are reversed.
ThlS Would add additional material to the haw 19 even
further enhancing the structural integrity of this element_
other forms of projections and recesses can be used to
attach the inserts 20, 22 t0 the dSSOCIdt2C1 jdWS 18, 19.
As long as any recesses, such as the recesses 85 and 87,
are formed aloncJ the side suz'faces 76 ~ ?8, the "I-bedm"
Cross section of the haw 19 will not be sacrificed.
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The materials associated with the various elements
described can also be modified. In general, the base 90 of
the insert 22 can be formed from any material providing
some degree of rigidity for the Insert 22 as well as also
a degree of flexibility as required by the attachment
mechanism, such as the detent mechanism 130. It Wlll be
apparent that the elastomeric material forming the pad 92
can also vary eonslderably. The elastomeric properties of
course contribute to the atraumatie characteristics of the
l0 inserts 20, 22, but other materials such as fibers can also
achieve this advantage. The pad 92 can also be molded to
any base, such as the base 90, having a profile which
facilitates use of the clamping device to in a particular
environment.
The configuration of the Center wall 94 of the insert
22 can also vary considerably. Since this wall 94 is
relied on primarily to support the pad 92 and to form the
channel 114 with the side walls llo, 112, its shape and
2o thickness can vary significantly with different
embodiments. Also, the formation of the holes 102 in
various sizes and shapes may enhance the atraumatic and low
profile characteristics of a particular Construction.
Given these wide variations, which are all Within the
Scope of this concept, one is cautioned not t0 restrict the
invention to the embodiments which have been specifically
disclosed and illustrated, but rather encouraged to
deterlttln2 the scope of the invention only with reference to
3 o the f O110W11'1g claims _
