Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
1067784
The present invention relates generally to the surgical field, and
more particularly to a novel blood vessel occluding instrument which provides
for atraumatic occlusion of blood vessels without using large cumbersome
clamps or clips. It is particularly useful for smaller vessels.
The necessity for an atraumatic means of occluding small vessels
has greatly increased with the advent of coronary artery surgery. The anatomyJ
location and fragile nature of the coronary vessels precludes the use of
conventional instruments such as clamps and clips for the routine occlusion
of such vessels.
: 10 To obtain a secure anastomosis, the periarterial tissue must be ;~
left in place. Accordingly, the dissection of an artery in order to obtain a
..... . .
sufficient length of the artery to apply a conventional occluding device such
as a clamp, significantly increases the technical difficulty of obtaining a
secure anastomosis.
It is an object of the present invention, therefore, to provide a
novel vessel occluding instrument for the atraumatic occlusion of small
: .: ..
vessels, which is light in weight, of low profile, and which causes no distor-
tion of the vessel.
Another object is to provide such an instrument which is relatively ~-
simple in construction and which can be produced in large quantities at a
relatively low cost.
A further object is to provide such a novel occluding instrument
:, .
`~ which provides for the occlusion of an artery in an anterior posterior direc-
: :
; tion without significant distortion of an arterial wall except at two points.
Yet another object is to provide a vessel occluding instrument in
which the vessel is entrapped and occluded between two resilient surfaces, one
of which is relatively large compared to the other, whereby the trauma usually
accociated with unyielding materials is significantly diminished.
An additional object is to provide such a vessel occluding instru-
ment which includes means for manipulating vessels, as by pulling them from
:'" -1- ;~
'.~.
, . . .
~067784
side to side or elevating them in order to obtain an unobstructed view of the
vessel and without the necessity of pinching the structure between the fingers.
More particularly, it is an object to provide such an instrument in which the
aforementioned resilient surface forms an obtuse angle with the surgical tape
to facilitate such manipulations.
I have discovered that the above objects and advantages are achiev-
ed by a vessel occluding instrument which includes a rigid body member which
. .
has two lengths of resilient tape extending from the surfaces thereof adjacent
one end, a resilient pad in engagement with the bottom surface, and a slot at
the other end of the body member for receiving and releasably holding one
length of said tape in a selected adjusted position to occlude a vessel be-
tween the pad and said one length of tape.
In the accompanying drawings, which illustrate embodiments of the
invention:
Figure 1 is a perspective view of one form of a vessel occluding
instrument constructed in accordance with the teachings of the present inven-
tion;
Figure 2 is a vertical sectional view taken on the line 2-2 in
Figure 1, with the tape shown in elevation;
Figure 3 is a side elevational view, taken from the same position
as in Figure 2 showing the instrument in vessel occluding position;
Figure 4 is an enlarged, vertical sectional view taken on the line
4-4 in Figure 2;
Figure 5 is a perspective view similar to Figure 1, showing a mo-
dified form of instrument;
Figure 6 is a side elevational view of the vessel occluding instru-
ment of Figure 5, as it would appear during usage;
Figure 7 is a vertical sectional view taken on the line 7-7 in
Figure 5; and
Figure 8 is a view similar to Figure 7, schematically illustrating
--2--
` 1(~67784
the diminsional relationship between the tape and the passageway prior to the
"crimping" or pressure applying step.
Referring to the drawing more particularly by reference numerals,
the number 10 indicates one form of a novel vessel occluding instrument em-
-; bodying the teachings of the present invention, which includes an elongated
body member 12 with a longitudinally extending axis A, and a length of resi-
lient tape 14.
The body melrber is made of a substantially rigid yet slightly resi-
lient material, preferably plastic, and is elongated and generally rectangu- -
10 lar in f~ross-section with top and bottom surfaces 16 and 18, respectively,
opposed side walls 20, and first and second rounded ends 22 and 24, respec-
tively.
~ Each of the side walls contains a longitudinally extending recess
I
; 26 which extends from adjacent the first end 22 t~ adjacent the second end 24.
A first passageway 28 extends through the body member between the `
~, top and bottom surfaces adjacent to the first end 22 substantially normal to
the longitidinal axis A, and a second passagemay 30 extends from the first
end 22 and intersects the passageway at approximately a ninety degree angle,
i.e. in general alignment with said longitudinal axis.
~xtending inwardly from the second end 24 is a slot 32, the walls
, ;~ of which diverge outwardly adjacent the second end 24 to provide a throat 34
for a pu~pose to appear.
A relatively large resilient pad 36 is fastened to the bottom sur-
I face 18 by means of a suitable adhesive, the pad preferably being made from a
: ~ soft rubber material and having a bottom surface 38, opposed side surfaces 40,
~ and opposed end surfaces 42 .. all of which surfaces are roughened to reduce
,,~ the degree of movement of a vessel being occluded. The width of the pad 36
~i is at least equal toanapreferably slightly greater than the width of the
,~ body member 12, the length of the pad is at least equal to the distance be-
30 tween the end 22 and the inner end of the slot 32, and the side and end sur-
,, ~
-~ _3_
. . .
.
. , , , ., , , , , ,,:
~067784
faces 40 and 42 are preferably rounded.
The resilient tape 14 is preferably of tubular construction and
made from a conventional white silicone rubber. In the assembled instrument,
the tape includes a first length 44 which extends downwardly from the body
member, and a second length 46 which extends axially therefrom. Fastened to
the free end of the first length 44 is a one-half circle blunt needle ~8.
Referring to Figure 2, the body member 12 can be fastened adjacent
the center portion of the tape 14 by inserting the first length 44 through
the passageway 30 and thence upwardly through the upper end of the passage-
way 28. After approximately one-half of the tape has been pulled through the
aforementioned passageways, a simple knot 50 is tied in the tape, and the
first length inserted downwardly through the passageway 28 and through an
aligned similar passageway 28' contained in the pad 36, until the knot 50 is
adjacent the upper surface 16 of the body member. The second length 46 is
then pulled outwardly to draw the knot 50 tightly against said upper surface.
In use, after an incision has been made, the artery is identified
and the blunt needle 48 carefully passed about the artery and pulled through,
the first length 44 of the tape passing through the tissue without resistance.
; The needle may pass around both the coronary artery and its associated vein.
The tape is pulled through until the body member 12 approaches the
coronary artery. A forceps is then used to grasp the body member at the
; grooves 26 to maintain it in position, and the first length 44 of the tape is
pulled through the throat 34 and into the slot 32 in a holding relationship
; with the body member.
The artery is then entrapped and occluded between two resilient
surfaces, i.e. the first length 44 of the tape and the bottom surface 38 of
the resilient pad 36. The use of the two such resilient surfaces significant-
ly diminishes the trauma usually associated witll unyielding materials.
- Also, the artery is occluded in an anterior posterior direction
without significant distortion of the arterial wall, except at two points.
' '
. .
,,, : : , . : ~ . . ~ -
~067784
The novel vessel occluding instrument described herein can also be
:; .x.,
used for manipulating vessels, prior or subsequent to occlusion. Thus, by
A passing one end of the tapelabout the vessel, the vessel can be moved from
side to side and elevated to provide an unobstructed view of the vessel
-- without the necessity of pinching it between the fingers. Then, when it is
desired to occlude the vessel, one end of the tape is pulled so as to move
the body member 12 adjacent to the vessel, the body member is held in position
,, -.- .
; with a forceps and the first length of the tape pulled through the throat 34
and into the opening 32, all as previo~sly described.
. ~ .
It should also be noted that traction on the resilient tape can be -
increased to any desired level so that partial or total occlusion of a tubular
; structure such as a vessel, can be easily accomplished. ;-
It is also significant that because of the manner in which the body
; member 12 is fastened to the tape 14, with the second length 46 of the tape ;
extending from the end 22 of the body member substantially in axial alignment ~-
with the longitudinal axis A, the latter forms an obtuse angle with the first
` length 44 of the tape when the two free ends of the tape are grasped by the
;l surgeon and pulled outwardly, as the first step in manipulating a vessel.
Obviously, this reduces the angle of inclination between the tape and the body
member, and thereby reduces the distance the end 24 extends away from the tape
~ 14 during this manoeuver.
q,r, ::
Referring to Figures 5 through 8, the number 100 indicates a modi-
,i~ fied form of vessel occluding instrument embodying the teachings of the pre-
^~ sent invention, which is less expensive to produce than the embodiment pre-
viously described, but which is similar to it in many ways.
Thus, the modified instrument 100 includes a body member 112 and a
length of resilient tape 114.
The body member is made of a substantially rigid yet slightly resi-
lient material, preferably plastic, and is also elongated and generally rec-
-, : -
tangular in cross-section with a longitudinally extending axis A', top and
-5-
. .
~67784
bottom surfaces 116 and 118, respectively, opposed side walls 120, and first
and second rounded ends 122 and 124, respectively.
In like manner, each of the side walls contains a longitudinally ex-
tending recess 126, and the body member contains a slot 132 with a throat 134
at the end 124.
As with the first embodiment, the modified vessel occluding instru-
ment 100 includes a relatively large resilient pad 136 which is fastened to
the bottom surface 118, and which includes a bottom surface 138, opposed side
surfaces 140, and end surfaces 142 ... all of which surfaces are preferably
roughened, as previously described. Also, the width of the pad 136 is at
least equal to the width of the body member, and extends from the end 122 to
the inner end of the slot 132.
~ owever, the modified instrument 100 differs from the first embodi-
ment 10 in that instead of utilizing the right-angle passageways 28 and 30,
there is provided a single passageway 128 at the end 122, which forms an acute
angle with the top surface 116 and the longitudinally extending axis A', the
lower end of the passageway 128 exiting from the bottom surface 118 at the
edge of the end 122.
The resilient tape 114 is the same as previously described, i.e.
of tubular construction and made from white silicone rubber.
To fasten the body member 112 to the tape 114, the latter is pulled
through the passageway 128 ... the tape and the passageway being of approxima-
tely the same size ... until the body member is adjacent the center of the
tape. The portion of the body member 112 adjacent the end 122 is then placed
in a pressure applying device which engages the wide walls 120 adjacent the
- passageway 128, and moves them inwardly (Figure 8) as indicated by the opposed
arrows P, to form indentations 150, thereby causing the passageway 128 to `-
,;,
; be constricted or reduced in width as indicated by the number 128' in Figure 7,
so as to "crimp" or wedgethe body member 112 onto the tape 114.
This results in a first length 144 which extends in a downwar~ di-
6-
~ 1067784
.~`.' .
rection and which has a one-half circle blunt needle 148 fastened to the free
'~ end thereof, and a second length 146 which extends in an upward direction from
... ..
-~ the upper surface 116 of the body member. As shown in Figures 5 and 6, the
. ~ , . .
, second length 146 of tape extends at an acute angle relatively ~o the upper
. : ~
~ surface 116 of the body member and the longitudinally extending axis A' there- ;
: . .
of, whereby the distance the body member projects relative to the tape is
restricted when the ends of the tape are grasped by a surgeon, in the same
manner as previously described with the first embodiment.
:, :
Thus, it is apparent that there have been provided two embodiments
of a novel vessel occluding instrument which fulfill all of the objects and `,
:. . .
v advantages sought therefor.
: . . .
,;~ ,: ~.
.. ,,. . : '
:~ :
. . ~ .
... . .
, ~` ~ .:
~J~ '' ..
,.~,1~ ..
, . .
., ~ .
.,~ .
.. ", .
:'.', ~
... , .
~! .
`:i 1 ,:
'! -
; ,~.j ~ : -
, .
. ..................................................................... .
.'` I ,
_7_
.~ . .
;. . :
1., .
,...................................................................... . .
, .. . ., , .. . ,, . . , . . . :
