CA2060280A1

CA2060280A1 - Endoscopic clip appliers

Info

Publication number: CA2060280A1
Application number: CA002060280A
Authority: CA
Inventors: Curtis W. Thornton
Original assignee: Individual
Current assignee: Edward Weck Inc
Priority date: 1991-04-05
Filing date: 1992-01-29
Publication date: 1992-10-06
Also published as: EP0507537A1; AU1041392A; AU638666B2; US5112343A; JPH0592006A

Abstract

ABSTRACT OF THE DISCLOSURE

A hemostatic clip applier is disclosed showing improvements which enable the user to selectively trigger the feeding of a clip to the jaws of the applier when desired.
cantilevered trigger button is integrally formed with the housing of the applier so as to be depressible by the user.
The trigger button is provided with an internal cam surface which cooperates with a pawl and ratchet mechanism to release the pawl at a selected point in the cycle of operation of the applier and thereby feed a clip to the applier jaws.

Description

2 ~

I~PROVElg~NTS IN ENDOSC:OPIC CLIP APPLI~3RS

BAcl~GRo~ OP T~E INVENTIO~

FI:E:LD OP T~ JEIITIO~

The ~nvention ralates generally to endoscopic type medical devices incorpor~ting a body or housing to which is attached sOD~e actuating mechanism at one, proximal end and a working mechanisDI at the othQr, distal end, the working mechanism being ~uitable for eith~r applying surgi¢al ligating clips, use as forceps, etc. More particularly, the invention relates to an improve~ent in endoscopic typ~ str~am~nts which enables the lnstrument to operat~ in its normal mode only after a trigger mechani~;m i~ selectlv~ly activateid.

:
~ ~ ~ }3SCRIP~ION OF T~ PP~IOR AR~r : ~ ~ Surylcal ligating or hemostatic clip~ are used to ligat~ blood vess~ls, ducts or other ti~ue during surgery.
The terms ~'ligating" and "hamostatic" are used interchangeably herein.` The clip8 generally have two parallel legs which are crimped in place~ about tha tissue to b~ ligated and are applied with a clip applying i~s~rument used ~o crimp the clip :;

leg6 togei:her~ When ~ir~t introduced many year~ ago, each clip to be applied had to be picked up ~ndividually by the jaws of a so-called "manual" clip apply~ng, forceps-type ~nstru~ent, often from a separate clip cartridge or dispensar prior to each use. While manual applier~ axe still u~ed, subseguent ~nstruments producéd were "automatic" clip appliers (some of them disposable) and incorporated a clip dispen~er as part of the clip applying instrument. Since di~ferent surgical procedures requ~re the use of vaxying numbers o~ ligating clips, the automatic appliers come pre loaded with di~ferent numbers o~ clip3 and ~n vary~ng si~es. See, for example, U.S.
Patent 4,712,549 (Peter~ et ~1.), aasigned to the assignee of this invention.
In addltion to th~ clip dispenser, the automatic ~nstruments genera11y ~ncludQ a pair of jaw~ for receiving, holding and crimping a single cl~p at a time and a feeding mQans l~or fe~ding a clip f rom the di~penser to the jaws. The jæLWs and fe~der are activated in proper sequ~nce by an activating n~eans uaually lncluding a pair of handles coupled mechanically to ~he ~eedar and ~aws.
It ha~ been noted by thos~ skilled in the art that the use o~ h~mo~tatic clip appli~r~ in e~doscopic surgical procedure3 r~quire~3 ~o~e additional precaut~ on~ over and above those ava; 1 ablQ in applier~ de~cribed above which are primarily intended for u8e~ in open ~urgical procedures. For example, in endoscopic surgical procedures it iQ desirable l~or the surgeon to select the po~nt in time when a ligating clip is to be fed between ~he jaw~3 o~ the clip appller. This prevents the po66ibility that a clip would be waiting between the jaw~ of a clip appli.er (as in 50~ne con~rerltional clip appliers u ed in open surgical procedure~) and thereby run the risk of becoming dislodged ar~d falling uncontroll~bly into the body. Retrieving such accidentally dislodged clips Ln open surgical proc~dures is relatively ea~y, i~ nece~6ary, althsugh much more difficult in endoscopic procedures.
The as~ign~e of the present lnvention has a pending U.S. patent applicat~on Serial No. 375,174, iiled July 3, 1~89 which disclo~es an automatic hemo~tatic clip applier which has a uniquia operating mechanism employing a "ratchet" yoke mechanism interposed b~tween th~a activating handles of the applier and th~ clip feeding and ~ ~ clo~ing structure in order to prevent unde~ired fe~ding o~ ~h~ cllp to the jaws during a port~ on of the operating cycle of the applier. This in~tnlmen~ autoanatically enables th~ ~eeding o~ a clip at a certain part of tha cycl~3 o~ operation of the applier. The pre~ent invent~on i8 an i~provement on thi~ a~orementioned d~vica in that ~ giv~ th~ us~ar control over th~ ieed~ng of the cllp and, consequently, produce~3 an applier su~:~abl6~ ~or s~ ~

use in endoscopic as well as open procedurea. The pr~sent application ~ncorporates th~ prior application by reference ~n its entirety.
It is an object of this invention to produce a clip applier which enable~ thQ surgeon to select the poin in time at which a ligating or hemostatic clip is to be placed ~n proper po~ition for use.
It i~ a further object of this invention to produce a ligat~ng or hemostatic clip applier suitable for use in endoscopic surgical procedure~.

,, S~Ml~ARY OF THE INV~NTION
-These and other obiect~ of th~a invention are achieved by the pre~erred eDIbodiment which i~ an improvement ~n a ligat~ng clip applier which enables th~ user to select the point in ti3le wh2n a clip i~ to be placed in po~ition for crimping. The invention la ~ bodied irl an in trument for apply~ng ligating clip~, th~ instrument compris~ng a housing, a first activat:ing mechanism for feed~g the clips successively to a po~ition ~n which they may be crimped and a second activating ~nechanism for c:rimping a cllp at sa~d po~ition. 'rh~ l~provam~nt comprise~ a trigger mean~ for selectively enabllng th~ operation o~ th~a first act$vating mechani~m, th~ trigger m~an~ coDIpri~ g pawl ~ean~ operatively 2 ~

secured to the first a~::tivating ~echanis~ and adapted to slide along a pred~termined track. A pawl post is attac:hed to the pawl means and is la~erally de~lecl:able ~rom a normal, unbiased position to a biased position as the pawl means slldes in the track. A ramp ~ans is fixedly situatQd relatiYe to the traclc and i9 adapted to have the pawl post slidably ~AOve along th~ ramp means a~ the pawl mean~ slides proximally. A stop means is provided to prevent the pawl post from moving distally beyond a prede~Qr~ined point and a d~ ~engage~nent means is provlded to dl~engage the pawl post ~rom thc stop means.

BRIEF DESCRIPTION 01~ T~ E3 DRAWI~GS

Figure 1 i3 a plan vi~w of an endoscopic hemostatic clip applier construt::ted in accordanc~ with ~he principles of this invention.
Flgure 2 i~ a side elevational vi~w of Figure 1.
Figur~ 3 i~ an exploded percpective view o~ the endo~c:opic hemosta~ic clip applier o~ Figure 1.
Flgure 4 i3 a plan view of a portion of the housing of the endoscopic: clip appli2r showrl in Flgure 1.
Flgure 5 ~ s a plan view o~ the housing portion shown in Figure 4 wi~h a pawl yoke mambQr in place.

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Figure 6 is a ~ide elevational view of Figure 5.
Figure 7 is a E~lan view of another portion o~ the housing of the endoscopic clip applier shown in Figure 1.
Figure 8 is a side elevational view of Figure 7.
Figure 9 is a cross-sectiorlal view of Figure 5 takPn along the line 9-9.
Figure 10 i9 a side elevational vi~w of the pawl yoke me~ber used in the endoscopic clip applier and shown ~n some of the aforementloned drawing~.
Figure 11 i8 a side elevatlonal view of on~ portion o~ the pawl ~ember shown Ln Figure 10.
Figur~ 12 is a plan view of the pawl ~nember portion shown in FigurQ 11. ~
Figure 13 i~ a side elevational view o~ another por~ion of the pawl member shown in Figure 10.
Figure 14 is a plan view o~ the pawl member portion shown in Figur~ 13.
Figure 15 i9 a f ront elevational view of the pawl member ~hown in Figure 10.
Figure 16 is a cros~-~ec:tional view o~ Figure 6 taken along the line 16-16.
Figure 17 i~ a vi~w of Figure~ 16 showing the placement of th~ compon~nt~ in a particular part of their cycle of oparation.

2 ~ ~

Figure 18 is a view of Figure 16 taken along the l~ne 18- 18 .

DESCRIPTION O~ T~ PREFERR:æD EMBODI~13NT

The present invention is embodied in an endoscopic hemostatic clip applier designa~ed gerlerally a~ 10 shown in plan and sids elevati~nal view~ in Figure~ 1 and 2 and in an exploded persp~cti~ e view ~n Figure 3. 13pplier 10 comprises a housing 12 having bottom and ltop portion~ 14 and 16, r~spectively, and a pair o~ ring h~ndles 18 and 20 which are pivotally attached to the housing 12. Th~ hou~ing and ring handle~ ar~ preferably made o~ a moldabl~ plastic such as polycarbonate but could bQ ~etal or any other ~uitable matorial. A pair o~ pivot post~ 22 and 23 ris~ up ~rom the dista} end portion o~ bottom housing por~ion 14 and each post pass~s through a hole 24, 25, r~sp~cl:~vely, at th~ distal end of rirlg handles 18, 20. Top housing portion 16 has a pair of pins 26 and 27 which are adapt~3d to b~ in~erted into holes in th~ corresponding pi~tot po~a 22 and 23, re~pectively.
Rlng handles 18 and 20 ar~ also coupled to housing 12 a~ well a~ to other component~ de~crib~d below by a pair o~
llnX: ~members 28 and 29, respectiv~ly. On~, distal end of each link memb~r 28, 2~ i~ coupled ~o the m~dial portion of its corresponding ring handl~ by a E~ivo~ pin 28a, 2~a, respectively, ~ituated di~tally o~ the ring portions 18a and 20a of handle~ 18 and 20. The other, proximal end of each lLnk member 28 and 29 has an aperture by which it is coupled to a pawl yoke member 44 (be~t s~en ~ Figures 8-133, the operation of which w~l b2 explained b~low.
Extending distally from housing 12 wlthin cylindrical tube 30 are the working component~ o~ the applier which enable i~ to operate a~ mtended, these component~ comprise closure member 31, jaw member 32, dr~ve link 33, clip storage/
dispen~ing cartridge 34 and jaw ~tabilizer 35. Gasket/spacer lnserts 37a and 37b are Lnterposed between the interior o~
cyllndrical tube 30 and the clo~ure me~ber 31 and driv~ link 33 m order to support th~&e co~ponents and provide an additional seal against e~cap~ o~ ga~es utilized during the endoscopic procedur~. Additional gasket~ (not shown) may be used in other portions o~ applier 10 to provide additional s~al~ and a front end taper~d tlp co~ponant 38 m~y be used to secure th~ distal tip o~ ths various ao~ponents and provide a smooth transition to ~acil~tate ins2r~ion o~ applier 10 into a cannula. While th~ pref~rred embodiment disclosQd herem is shown as an endoscopic clip applier, it will be understood by those skill~d in th~ art that the appller oould easily be used for open surgical procedur~ a~ well. ~he working components o~ applier 10 are joined to yoke 44 by mean~ o~ the connection 2 ~
bPtween yoke 44 and drive link 33 explained more fully below.
Drive link 33 passes from the interior of housing 12 to the exterior through longitudinal track 60 described below and adapter 36. Adapter 3 6 provides a unique means by which the rectil~near wor)cing components o~ the applier may be easily joined to housing 12. For example, a sLngle housing 12 with its associated mov mg components may be employed wi~h a differently sized adapter ~6 and other working components 30 through 38 in order to produce an endoscopic clip applier suitable for use with dif~erently sized cannulas.
~: Housing 12 has a longitudinal track 60 formed by the cooperative action of top and bottom housm g portions 14 and 16 along the longit~inal axis of the applier. Bottom housing portion 14, best seen in Figure6 7 and 8, has seve~al contiguous, axially aligned tr ck portions including dlstal-most portion 64, de~ined in part by spaced apart walls 66 and 68, a center portion 70, defined by parallel wall~ 72 an~ 74, and a proximal portion 76, d~ined by walls 78 and 80. Top housing partion 16, beet seen in Figures 4, 5 and 6, serves as a longitudinal track oover 62 dGsigned to cooperate with botto~n housing porl:ion 14 to form an enclosed longitu-` ~ dinal traak 60 for receiving adap~er 36 and other componen~s of ~he applier d~scribed below. Track cover 62 comprise~
di~tal portion 63 intend~d to coop~rate with distal portion S4, int~rmediate portion 69 intended to cooperate with center .. g _ 8 ~

portion 70 and proximal portion 75 intanded to cooperate with proximal portion 76. As will be best seen ~n Figure 6, track cover portions 63 and 69 do not extend significantly above the plane of the body of housing portion 16 wh;le proximal portion 75 does contain and receive components described be~ow which extend aboYe the plane of hou~ing portion 16 and are intended to cooperate with ele~ent6 of proximal port:ion 76 associated with housing portion 14.
Distal track portion 64 is sized to recei~e adapter 36 and central track portion 70 is sized to receive compression spring 71 which, in conjunction with spring 71a between jaw member 32 and closure member 31 provides biacing forces wi~hin applier 10 ~rs a conventional manner.
Proximal track portion 75 comprises a pair of parallel walls 77 and 79 spaced on either side o~ khe longitudinal axis of housing portion 16, and ramp or ratchet member 90 having a surface 92 crossing and laterally inclined relative to the axis o~ the housing, a surface 94 parallel to and spaced ~rom the axi~ of the housing and a stop surface 96 transverse to the axis and extending on ~oithar side thereof.
Situated proximally of surface 96 is an aperture 98 extending through th~ body o~ top housing portion 16 into which extends an actuatlng trigger button 100 situated at the end of a cantilevered arm 102. The internal sur~ace of button 100 is provided wikh an a~ym~etrical ramp sur~ace 104 (best seen ~n 1~ -2 ~ ~
Figures 16 and 17) the purpose of which ~rill be described below .
As shown in Figures 8-13 pawl yoke member 44 comprises a generally U-shaped member having a top leg ~6 and a bottom leg 54. As best seen ~n Figure 12, top leg 46 has a distal portion provided with a laterally extending bar 4 having ends 50 and 51 which slide between walls 78 and 80 of bottom housing 14, an intexmediate body portion provided with a pin 55 extending normally therei~rom, and a proximal end provided with a pivot pin 53 parallel to pin 55. Bottom leg 54 ha~ a pawl post 52 located at its distal end, an intermediate body portion provided with an ~perture 56 and a proximal end provid~d with a notch 53a. ~n the preferred embodiment, top and bottom legs 46 and 54 are separately formed and joined by the cooperative action of pin 55 and aperture 56, and p~n 53 and notch 53a. The components of yvke 44 are pre~erably molded fro~ materials which make yoke 44 resilient and flexible such that tDp leg 46 can be twisted out o~ its normal, axial alignment with bottom leg 54 and return into axial alignment with the bottom le~ when the twisting force is removed.
A~ beEt se~n Ln Figure 3, the proxi~al ends o~ dr.ive link 33 and link ~embers 38a and 38b are pivotally connected to pawl yoke 44 between it~ top and bottom leg by pin 55 passing thxough aligned holes in the proximal ends of the 2 ~ ~
drive link and link members.
The operation o~ the invention may best be understood by reference to Figures 5 and 15-18. It will be understood that the operation of applier 10 is cyclical and, for ease of explanation the beginn~ng of the cycl~ will be chosen as the point where the handles 18, 20 are ~n their axtreme open position. At this point pawl yoke 44 will be at its dlstal-most position withm track 60 with crossbar 48 being distal of ramp member 90. Because o~ the connection between handles 18 and 20 and pawl yoke 44, as the handles ara ~ueezed together the pawl yoke will move proximally fro~ a position where crossbar 48 is distal o~ ra~p 90 to a position proximal of ramp 90 ~ shown ~n Figure~ S and 9. In a manner analogous to th~ operation o~ the clip applier described in the aforemsntioned copending applicatlon, as yoke member 44 move~ distally, post 52 will ride up surface 92 until it clears the rear o~ ramp me~nb~r 90 at which point, because of th~ inherent rea~ienc~ of yok~ memb~r 44, post 52 will return to i~s normal alignment with the axis o~ the applier and position itsel~ on the centerline in contiguous, abutting enyagement with surface 96. Thi~ position i5 best shown in Figures 16 and 18. At thi~ point in the cycle of operation of the applier the spring 71 is compressed (hy tabs 91 and 93 on drive link 33) and yoke 44 is urged against surface 96. It will be understood th~t stop surfaca 96 prevents distal motion 2 ~
of yoke member 44 and all components connected to it including the drive lLnk and feeding components connected to it (not shown). When a user desires to feed a clip he must do so by actuat1ng the drive lm k by depressmg button 100 to a position as shown in Figure 17 at which the internal ramp surface 104 of button 100 urges po~t 52 laterally, twisting yoke member 44 to a point where post 52 will clear the edge of stop surface 96. Spring 71 will then cause dri~e link 33 to move distally to feed a clip as described in the aforemen-tioned copending application. Continual s~ueezin~ of the ring handles clo~es the jaWc as in the prior embodiDI~nt.
While the preferred embodiment ut~lize~ a combination of elements that requir~ po~t 52 to b~ pushed laterally Ln order to disengagQ it fro~ stop surface 96, other designs would be equally workable. For example, a ramp surface (analogous to ~urface) 92 could be transversely inclLned and the post could be pressed transv~rsely to clear a stop ~ur~ace and perform a si~i7ar function to that o~ th~ preferred embodiment.
Durin~ the 1rst portion of the cycle of operation of applier 10, a~ handles 18 and 20 are squeezed together the ~aw~ o~ the applier ar~ urged together whether or no~ a clip is in position between the jaw~. Closure o~ the jawæ occurs essentially becausQ o~ the proxi~al m~tion o~ the jaw member 32. While the normal operation of a cllp appliex Lntended for 2~3~

open surgery (such a~ that described in the aforementioned copending patent application) may be to have the drive link move proximally along with the jaw member~: as the handles are being squeezed together and subsequently have the drive link feed a clip between ~he jaws as the handles are open, in the present invention the opening of the handles and, consequently, the forward movement of the dri~re link and the associated feeding of the clip i5 prevented by the abutting engagement between pin 52 and stop surface 96.
While in the prior embodi~ent (disclosed in the ~:aforementioned copending application~ the activating and ssguencing means activated th~ ~eeder to mov a clip into the jaws as the lever m~ans was returned from the clos~d position to the open posi~ion, the subject invention does not have such automatic feed m g. As the lever means is moved from the open position to the closed posi~ion, the pawl member 44 engages a stop surfac~ 96 which prevents the lever means fro~ activating the feeder as tension on the lever handle~ is relaxed~ While in t~e prior embodiment means were provided ~or prevented feeding of another clip inko the jaws until after the lever handles were moved ~nto the closed position (the means comprising a detent in the ca~ track in the body housing and a cam track follower coupled to the lever means) it is desirable in endoscopic applications ~o have the surgeon con~rol the feeding of the clip rather than havLng this feeding be 2~3~
automatic. Consequently, the present invention i~ intended to produce an instrument which requires the operator to actively trigger some~hing to release this mechanism.
It will be understood by those skilled in the art that numerous modifications and improvements may be made to the preferred embodiment of the invention described herein without departing rrOm ~he spirit and scope thereof.

Claims

1. In an instrument for applying surgical ligating clips, said instrument comprising a housing, a first activating mechanism for feeding the clips successively to a position in which they may be crimped and a second activating mechanism for crimping a clip at said position, the improvement comprising:
trigger means for selectively enabling the operation of said first activating mechanism, said trigger means comprising:
pawl means operatively secured to said first activating mechanism and adapted to slide within said housing along a predetermined track:
a pawl post attached to said pawl means and deflectable from a normal, unbiased position to a biased position as said pawl means slides proximally;
ramp means fixedly situated relative to said predetermined track and adapted to have said pawl post slidably move along said ramp means as said pawl means slides proximally:
stop means to engage said pawl post to prevent it from moving distally beyond a predetermined point along said track;
means operable by a user of said instrument to disengage said pawl post from said stop means.

2. An instrument according to claim 1 wherein said pawl means is in its normal, unbiased position when it is in engagement with said stop means and wherein said disengagement means comprises means to deflect said pawl means to a predetermined, biased position at which it will be clear of said stop means and free to move distally thereof.

3. An instrument according to claim 1 wherein said stop means is a wall situated astride the axis of said predetermined track, normal thereto, and wherein said pawl means during part of its cycle of operation is urged distally against said stop means by a spring operatively associated with said first activating mechanism.

4. An instrument according to claim 1 wherein said disengagement means comprises a trigger accessible from the exterior of said housing, said trigger comprising a cantilevered arm integrally formed with said housing and a cam surface situated at the free end of said arm and facing into the interior of said housing and adapted to engage said pawl post when it is engaged with said stop means, whereupon motion of said cam surface into the interior of said housing will cause disengagement of said pawl post from said stop means.

5. An instrument according to claim 4 wherein said pawl post is laterally deflectable and said disengagement means is adapted to laterally deflect same to disengage it from said stop means.

6. An instrument according to claim 4 wherein said pawl post is transversely deflectable and said disengagement means is adapted to transversely deflectable said to disengage it from said stop means.