JPS60500705A - Safety device for surgical occlusion cutting device - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] The original U.S. patent application for this application is U.S. Patent Application No. This is a continuation-in-part of No. 480.532.

Background of the invention The present invention relates to a surgical device, particularly for occluding or ligating and dividing body tissue. Relates to a safety mechanism for use within a surgical device.

Surgical instruments for ligature division are typically used to ligate organic tissue structures such as blood vessels. Contains metal staples, fasteners, or ligatures used in This kind of system One such system is disclosed in U.S. Patent No. 3. ．． Disclosed in No. 955,581 has been done. The device disclosed in this patent is based on the metal stable [1 carton]. It operates in three stages to actively control the 11 functions of the cartridge. Cartori 7shi The main body of the anvil is moved towards the anvil assembly fixed on the instrument. By Kartli, encircle the organizational structure in the show. Next, a pair of metal The stable is pushed forward and surrounds the tissue structure at a distance. stay the pull is crimped or folded against the fixed anvil assembly; Ligate the tissue at the staple location. Finally, the knife plate is attached to the fixed anchor. Advance to the building assembly and divide the tissue structure midway between the two staples.

U.S. Pat. No. 4.086.926 to Green et al. 2 illustrates another metal staple carrying cartridge that operates. next to two A spaced apart metal stable is attached to the tissue structure by a fixed anvil assembly. formed around and thus ligate the tissue structure. The knife is then placed in a fixed position. Advance to building assembly and split ligated structure between staples do. The staple feeder in this device is equipped with a pair of healds, each of which Holds multiple staples.

Using a metal stable as a ligature and a fixed anvil assembly, this anchor Another ligation splitting instrument with which the staples are formed opposite the building assembly is No. 4,349,028 to Green et al.

For some surgical procedures, X-ray transparent plastic materials or plastic A ligature in the form of a fastener or clip of shaped material is a metal stave that is not transparent to X-rays. may be preferable to For convenience, such plastics are referred to herein as All types of plastic or plastic-like materials are commonly referred to as plastic-like materials. and mention it. In addition to being X-ray transparent, clips made of plastic-like materials are biologically transparent. It has the advantage that it can be made chemically absorbable.

Plastic-like material clips bend or crimp metal stables Plus, since it cannot be closed by folding or crimping in a Clips of tick-like material replace metal stables in prior art ligature splitting devices. cannot be easily replaced with . Unlike metal stables, plastic-like A clip of material will retain its deformed shape unless its parts are mechanically assembled together. Not retained. Therefore, folding or crimping the metal stable around the tissue The device used in the prior art ligature splitting device is made of plastic-like material. Clips are not suitable for use. Clearance of plastic-like material The storage and supply problems are different from those associated with metal stables.

2 before allowing the knife to cut the tissue between the clips. Ligation with a device to ensure attachment of two spaced clips to the tissue It is desirable to provide a dividing device. Some of the prior art ligature splitting devices are However, these prior art safety mechanisms are based on plastic-like materials. It is completely unsuitable for use in ligature splitting instruments using clips. The reason The difference between metal clips and plastic clips and/or these different types This is due to the difference in the structure used to apply the type of clip. For example, plastic The mechanism used to apply the clip is more elaborate and requires a lip butcher. Therefore, in some prior art ligature splitting devices, if the clip If either or both are placed in front of each other, the device will be effectively locked. Therefore, the clip button itself cannot be used.

It is therefore an object of the present invention to provide an improved safety mechanism for ligature splitting instruments. It is.

Another object of the invention is to perform ligature splitting in the form of applying plastic clips. The objective is to provide a safety mechanism for the instrument.

The concise world of invention According to the present invention, two spaced apart surgical clips are applied to the Mi tissue of the body, and the two The 'A' shell for cutting the tissue between the two clips is about to start and senses the presence of two clips to be applied the amount of instrument operation cycles in progress. of the knife if one or both of the clips are missing. It includes a device for stopping the Rif base from 1 (■), and this device converts the clip to 111 base. It is different from the elements that

The present invention is for use in ligature splitting instruments that apply clips of plastic-like material. However, the present invention has been developed for the application of clips of other materials such as metal. Equally suitable for ligation splitting devices Available for use.

Sarasarabei H solo Asari The above objects and other objects and advantages of the present invention will be realized with reference to the following detailed description and accompanying drawings. It will be easier to understand and become clearer.

FIG. 1 is a perspective view of a surgical instrument according to the present invention.

Figure 2 is an exploded perspective view of a portion of the instrument of Figure 1;

FIG. 3 is an exploded perspective view of the two track and trigger assemblies of the instrument of FIGS. 1 and 2; Ru.

FIG. 4 is an exploded perspective view of the right track and knife assembly of the instrument of FIGS. 1-3; FIG.

FIG. 5 is an exploded perspective view of the right track and anvil bar assembly of the instrument of FIGS. 1-4; FIG. Ru.

FIG. 6 is an exploded perspective view of the right track and anvil assembly of the instrument of FIGS. 1-5; FIG. .

FIG. 7 is a view taken along line 7-7 in FIG. 6 in the direction of the arrow.

FIG. 8 is a view taken along line 8-8 in FIG. 6 in the direction of the arrow.

9 is a bottom view of the clip storage assembly of the instrument of FIGS. 1-8; FIG.

FIG. 10 is an exploded perspective view of the right track assembly of the instrument of FIGS. 1-9;

FIG. 10a is a detailed view taken along line 10A-10A in FIG. 7 in the direction of the arrow. Ru.

FIG. 11 depicts the operation of the instrument of FIGS. 1-10 prior to beginning a cycle of operation of the instrument; FIG. 3 is a cross-sectional side view of the assembly.

FIG. 12 is a sectional view taken along line 12-12 in FIG. 11 in the direction of the arrow.

Figure 13 is a view similar to Figure 11 showing the instrument when the trigger is fully actuated; be.

FIG. 14 is a view taken along line 14-14 in FIG. 13 in the direction of the arrow.

15 to 19 show an apparatus according to the invention showing five successive stages of operation of the instrument. It is a partial cross-sectional top view of the tool.

Figure 20 is a diagram similar to the 15th to 19th [J], and shows how to prevent incorrect feeding of surgical clips. Indicates the safety mechanism.

Figures 21-23 show three successive stages during a ligature splitting operation using surgical clips. It is a perspective view showing a floor.

24-28 are lines 24-24.25-25.2 in FIGS. 15-19. 6-26, 27-27, and 28-28 in the cross-sectional view seen in the direction of the arrow, respectively. be.

FIG. 29 is a cutaway perspective view of the distal end of the clip storage assembly of the instrument of the present invention; Shows normal safety effects.

FIG. 30 is a diagram similar to FIG. 29 showing safety effects during misfeeding.

Detailed description of preferred embodiments Before proceeding with a detailed description of the invention, it should be understood that the present invention does not differ from what is shown in the accompanying drawings. Other embodiments, changes and modifications are possible and can be implemented in various ways; The invention is limited in its application or use to the details of the construction and arrangement of parts shown in the accompanying drawings. It is not something that can be done. Furthermore, the words and terms used in the specification are for illustration and example purposes only. It should be understood that it is intended to be illustrative and not limiting.

For purposes of explanation herein, the same reference numerals are used to denote common elements shown in various figures. Use.

In FIG. 1, a surgical instrument for ligature division according to the invention is shown generally at reference numeral 10. It is shown. A hand 12 is shown grasping the handle 14 with a hollow trigger 16 attached thereto. ing. Trigger 16 is shown in the open position prior to performing the ligation and division surgical procedure. It is. Handle 14 forms part of the body of instrument 10 that includes the actuation assembly. There is.

A clip storage assembly is indicated generally by the reference numeral 18 and is operated by an actuation mechanism. It is attached to the handle 14. The two tracks 20 and 22 define the longitudinal axis of the instrument 10. extends parallel to. The vertical axis is indicated by the dashed line 8 in FIG. The orbits are separated It has a transverse groove 24 formed in the track at a location where the clip storage Receive the tabs on the metal housing or wrap 94 of the storage assembly 18 and remove the wrap 94. This is for fixing to 1llI24.

Tissue gathering or tissue restraining assembly 26 may be used to connect blood vessels, ducts, or other organ structures. It is shown in an initial open position for receiving a tubular conduit 28, such as a structure. Book As used herein, the term tubular conduit refers to arteries, veins, umbilicus, capillaries. , or any flexible and/or deformable tl, f that can be clamped and cut is intended to mean a woven structure.

This will be explained with reference to FIG. An assembled drawing of a portion of the device 10 is shown generally at reference numeral 30. The trigger assembly shown in FIG. Trigger assembly 30 includes hollow trigger 16 and trigger assembly 30. It consists of a gas insert body 32. Trigger insert 32 includes an upper rod portion 33 and a hollow trigger. 16 (shown in this figure) extending into the hollow trigger along substantially the entire length of the have not). The lower portion of the trigger insert 32 may be made of glue, glue, or other material. to the hollow trigger 16 by conventional means.

The body of the instrument 10, which includes a handle 14 and a trigger I6, is manufactured by BorgWarner (B. Plastic material such as ABS supplied by org-11arner Manufactured from materials. Clip storage assembly 18 and tissue restraint assembly 26 are Polycarbonate, such as LEXAN polymer manufactured by Le Electric Manufactured from wood or similar materials. Trigger assembly 30 has a pivot pin 34 and A pivot pin 34 attaches trigger assembly 30 to handle 14 .

The handle 14 has two substantially equal and symmetrical halves 14a and 14b. It will be. Thus, the instrument 10 is substantially symmetrical with respect to a vertical plane passing through the longitudinal axis 8. It is a name. There are some exceptions to the overall symmetry of instrument IO. These exceptions are , will become clear as the explanation progresses.

The two halves 14a and 14b of the handle are attached by ultrasonic welding or gluing or They may be joined together by any other suitable means such as rivets. right half of the handle The portion 14a has cast ribs 15a and 15b which are attached to the tissue restraint assembly. It is a stopper for the stick. Both halves of the handle 14 are attached to the clip storage assembly. It also has cast ribs 15C of 1 to 15 buckwheat (see FIG. 15).

The right half 14a of the handle is aligned between the longitudinal vertical axis of the handle I4 and the longitudinal axis of the instrument 10. It has a pin 36 that projects perpendicularly to both.

One end of the tissue restraint assembly return spring 38 is attached to the pin 36.

This return spring 38 is a prestressed tension coil spring. spring 38 The other end couples to a spring retainer slot 40 (shown in phantom) of the tissue restraint assembly. has been done. A slot '40 is formed within the L-shaped tissue restraint assembly bar 45. has been done. Similarly, one end of knife return spring 42 is coupled to pin 36.

Spring 42 is another prestressed tension coil spring.

The other end of spring 42 is coupled to knife spring retainer slot 43.

FIG. 3 shows a trigger assembly 30 and a trigger assembly for tracks 2o and 22 of instrument 1o. The relationship between solid bodies 30 is shown.

The upper bar portion 33 of the trigger insert 32 has a curved camming surface 44 . upper bar Portion 33 has a button pin 46 attached by conventional means, which The shaft pin 46 is inserted into the slot 48a of the left button 50 and the slot 48a of the right button 52. They are respectively mounted in the seat 48b. Pu nosha rods 50 and 52 are the left orbit 2o and the right orbit A relatively thin metal beam disposed and housed within the channel 22. Slots 48a and 4 8b is an oval cutout at the proximal end of the bushing rods 5o and 52, each slot The upper portion of the kit is oriented more proximally than the lower portion.

The knife bar is designated by the reference numeral 54 in this preferred embodiment. However Therefore, in addition to knife cutting or laser plate cutting, the division of the conduit can also be performed by tissue reconstruction. This can be done in many ways such as laser destruction or chemical destruction or tearing. should be understood. All such splitting mechanisms are considered within the scope of this invention. Should be.

A flange 56 is formed at the proximal end of knife rod 54. The knife stick 54 It has a scalpel or knife blade 58 mounted vertically at its distal end. centre Lunge 56 extends from the curved cam surface of upper bar portion 33 upon actuation of trigger assembly 30. It is adapted to mate with surface 44. Trigger assembly 30 is actuated by hand. Squeeze the trigger 16 toward the handle 14 and advance the upper bar portion 33 distally. It is caused by The flange 56 is aligned with the orientation of the right button slot 48b. Almost the opposite is true. That is, the upper portion of flange 56 is more distal than the lower portion. It's on the side.

The clip storage assembly 18 includes (1) a left track 20 that accommodates the left push rod 5o; (2) It has a right track 22 that accommodates the right button rod 52. Also, the knife blade A knife rod 54 having a handle 58 is located within the clip storage assembly 18. Organizational constraints Bundle assembly 26 is part of clip storage assembly 18. Below, the right orbit 22 I will explain the details in detail. The structure and operation of the left orbit 20 are similar to that of the right orbit 22. It should be understood that

FIG. 4 shows clip storage assembly 18 and tissue restraint assembly frame 60 disassembled. has been done. The tissue restraint assembly frame 6o is made up of a right push-pull shear rod 52 and a knife rod 54. A metal beam is positioned parallel to the right push rod 52 in between. tissue restraint assembly The frame 6o is configured to engage a button pin 46 (FIG. 3) of the trigger assembly 30. It has a flange 62. The flange 62 is attached to the right Pnonya rod slot 481). oriented at a similar angle. That is, the tenth part of the flange 62 is lower than the lower part. It's in the proximal direction.

This will be explained with reference to FIG. The tissue restraint assembly frame 6o is inside the tissue restraint assembly frame 60. by a vertical upward protrusion 63 in tissue restraint assembly 26 that engages slot 64 of It is coupled to tissue restraint assembly 26 for movement therewith. organizational restraint The distal-most vertical downward protrusion 66 on the assembly frame 6o is located within the tissue restraint assembly 26. Consolidates in the same way as slots.

This will be explained with reference to FIG. The tissue restraint assembly 26 is connected to the rail 76 of the right track 22. It now slides along the rail 76 of the left track 20 (not shown in this figure). The lower tissue restraint assembly surface 74 has a lower tissue restraint assembly surface 74.

In FIG. 7, the right pusher rod 52 is shown in more detail. The right button stick 52 is Clip storage assembly for positioning the proximal end of the right button return spring 7o 18 with a spring retainer 78 parallel to the longitudinal axis. Vertical axis of clip storage assembly 18 Another spring retainer 80, parallel to the line and part of the right pusher rod 52, The distal end of the right button return spring 70 is temporarily positioned prior to assembly. outfit When the station is assembled, the distal end of spring 70 stops at a stop surface that is part of right track 22. Press on 72.

Distal to the stop surface 72 is an anti-jamming mechanism 81 . This anti-jamming mechanism 81 As will be described in detail below with reference to FIG. 10 and FIG. (2) a lamp assembly 84 coupled to the right track 22; do. A cross clip spring holder, detailed below with reference to FIG. 8, is designated by the reference numeral 85. It's been done.

This will be explained with reference to FIG. Surgical ligatures or crevices made of plastic-like materials The clips 86 can be individually dispensed, but can be combined with each other in stacks or rows of clips. is shown. In a preferred embodiment, the clip 86 is made of lactide. Made from a biologically absorbable copolymer that is a polyester derivative with glycolide. It will be done. Such materials are absorbable by the body and transparent to radiation. child These clips 86 are made of polymeric materials for injection molding of resorbable surgical devices. Co-pending US patent application filed on October 22, 1982, and assigned to the applicant. It is described in National Patent Application No. 436.056. Of course, it can be absorbed by the body. Any plastic or plastic that may form a bump on the lip, whether or not Materials such as sticks can be used.

Such materials are, for example, polyester, polyamide and the like . All such materials are generally referred to herein as plastic-like materials. to mention.

The clip 86 is described below with respect to the twenty-first method and equipment for applying clips, and the name of the clips and clip sequences used in the equipment. Pending U.S. patent application filed September 30, 1982 and assigned to applicant. releasably interlocked with each other as described in Application No. 429.250. . The clips 86 are sequentially pressed by the ends of the clip buttons 92. This end is the most distal end of the right bar 52 and the most distal clip in the row. Press the base of. The clip with the latest value among the clips 86 is the U-shaped clip guy I. ” 88 j/( is filled in. The clip guide 88 is The last one or two clips in the back row are released in the device when all of the clips have been used. prevent this from happening. To give the clip row an initial push distally , between the chestnut guide 88 and the clip spring boulder 85 (Figures 7 and 10). A compression coil spring 90 is prestressed in between. If two or three clips are used After being used, spring 90 serves no further purpose.

FIG. 9 shows a bottom view of the instrument 10, showing the assembled left track 20 and right track. 22 and a relatively thin metal housing or wire wrap 94 surrounding both tracks. It shows. Both sides of the wire wrap 94 have interlocking protrusions 96 and slots 98. The safety mechanism 100 is shown in phantom lines in this figure. and will be explained in detail below.

The tissue restraint assembly 26 includes a cutting post or tube 102 that prevents the knife blade from splitting during the splitting operation. The card 58 (FIG. 3) is pushed against the tube 102. The cutting column 102 is Preferably, it is a hollow cylinder piece made from PVC material.

FIG. 10 shows an assembly of the right track 22. The right side of the ear wrap 94, the right button button 52 with the right button button return spring, and the right button button 52 with the right button button return spring. A cover 106 for insulating the operation of the right pusher rod 52 from the row of lips; Stacking of matching clips 86, clip guides 88, and clips on clip guides 88 The guide spring 90 that fits on the pillar 108, the clip spring holder 85, and the right track 2 2, with a ramp 84 and a clip location toward the distal-most end of the inner wall 91. It has a claw 110. The operation of the claw 110 will be explained in detail below with reference to Fig. 24 etc. Explain. The cover 106 has a pair of detents or small resistance formed within the cover. The detent 107 has a detent 107 which is located at the end of the row of clips as described below. This is to assist in disengaging the distal clip.

In FIG. 11, the actuator assembly is indicated generally by the reference numeral 112. . Actuator assembly 112 includes trigger assembly 30, knife bar 54, and right arm. The push rod 52, the left push rod 50, and the associated push rod return spring (not shown in this diagram) (not shown), buttshaft pin 46, knife return spring 42, and right buttshaft bar and a return spring 70.

In FIG. 12, two trajectories 20 and 22 are shown. Between orbits 20 and 22 , a vertical knife blade 58 and a tissue restraint assembly frame 60. right and left clip The ends of 86 are also shown in this figure and are disposed within left groove 114 and cloth guide 116, respectively. There is. Grooves 114 and 116 are used to insulate the movement of push rods 50 and 52 (Fig. 3). It is formed by a cover 106 and an inner wall 91. The row of clips 86 is a11 4 and 116, respectively.

FIG. 13 shows that the ligation and division cycle has been completed but the trigger assembly 30 is released. The device 10 is shown before being installed. Figure 14 is along line 14-14 in Figure 13. 1 is a view of the distal-most end of instrument 10 looking in the direction of the arrow; FIG.

To describe the operation of instrument 10 at various stages during completing a surgical procedure, Please refer to the remaining figures 15-30.

During operation, when the trigger 16 is squeezed toward the handle 14, discrete stages of activity occur. occurs. thus indicating the position of each of the elements before starting the ligation and division cycle. Reference should be made to previous figures, especially FIG. 11.

This will be explained with reference to FIG. Before starting the surgical procedure, the tubular conduit 28, etc. The tissue is placed within the tissue restraint assembly 26 of the device 10. Knife stick 54 and blade 58, as well as the left button rod 50, the right button rod 52, the left track 20, and the right track 22. are all in their most proximal or retracted position. tissue restraint assembly 26 is also in its most distal position. In this regard, trigger 16 (FIG. 11) is in its open position.

This will be explained with reference to FIG. Trigger 16 reaches approximately 36% of the road to be closed. When the trigger assembly 30 is squeezed toward the handle 14 at the is rotated counterclockwise. This rotation causes the button pin 4 on the trigger insert 32 to 6 into the respective slots 48a in the left and right pusher rods 50 and 52. and 48b respectively. Therefore, the push rods 50 and 52 are pushed far away. Start moving towards the position. Right button return spring 70 (Figure 5) and left button return spring The prestress compressive force exerted by the knife return spring 4 (not shown) less than the prestress tensile force exerted by 2. Therefore, left orbit 20 and right orbit The channel 22 moves with the bushing rod 50.52 so that the entire housing is assembled into a tissue restraint assembly. advancing distally with respect to tissue restraint assembly 26 and clip storage assembly 18; and the remainder of the tissue 28 to grasp the tissue. Upward protrusion on knife bar 54 The slot 21 (second (Fig.), the knife rod 54 and knife blade 58 are It moves distally with path 20.22. The knife return spring 42 is as described above. During distal movement of the track 20.22, the tissue restraint return spring 38 is extended, but the tissue restraint return spring 38 is It does not extend during this stage of the device's operating cycle.

Approximately 36% of the path of the trigger 16 towards the closed position with respect to the handle 14 - 1 When squeezed, the tissue clamping operation is complete as shown in FIG. Orbit 2 0 and 22 come to hit the stopper 15C. Grip the handle 14 even more. 17, the bushing rods 50 and 52 are at a distance with respect to the trajectory 20.22, as shown in FIG. moved towards the position. This begins to compress the right button return spring 70, and the clip Butcher 92 begins to advance distal-most clip 86 with respect to track 22 . Of course , the same thing is happening on the left hand side of the instrument at the same time.

Shortly after the bushing rod 50.52 begins to move distally with respect to the trajectory 20.22. The cam surface 44 of the upper bar portion 33 of the trigger insert 32 is aligned with the flange of the knife bar 54. 56. This pushes the knife rod 54 and causes the tissue to open as shown in FIG. 28 and tissue restraint assembly 26 begins to be advanced distally. The knife stick 54 is The bushing rod moves forward at a speed greater than 50.52. Accordingly, if the knife returns The thread 42 is extended.

Just before reaching the stage shown in FIG. proximal flange 62 of. This causes rod 60 and tissue restraint assembly 26 to The L-shaped protrusion of the tissue restraint assembly frame begins to move distally, and the steps shown in FIG. After the spring 45 has moved a distance "d" from the stopper 15a, the tissue restraint assembly 26 It ends up having traveled a similar distance "d" with respect to trajectories 20 and 22. organizational restraint Assembly return spring 38 (FIG. 2) is extended by distal movement of tissue restraint assembly frame 60. be done.

Clip 86 is then formed and closes around tissue 28 and 2 as described below. Tissue 28 is ligated at two spaced locations. Tissue restraint assembly frame 60 and tissue restraint assembly The body 26 moves distally during this step of the procedure to stretch the tissue before cutting it. Without loosening the clip, insert the closed clip 86 into the clip forming jaws as described below. It will be possible to release it completely.

If the trigger 16 is further squeezed toward the handle 14, the lever will move as shown in FIG. Ifblade 58 cuts tissue 28 opposite tube 102 . During the cutting process, the If rod 54 and plate 58 push tube 102 of tissue restraint assembly 26 distally. movement to separate tissue restraint assembly frame 60 from pin 46. Therefore, pin 46 is also Although it no longer engages the tissue restraint assembly frame 60, the tissue restraint assembly nevertheless Body 26 continues to be forced distally by knife bar 54 and plate 58. 2 The two closed clips 86 are completely released from the clip forming jaws described below. Ru. When the L-shaped protrusion 45 contacts the tissue restraint assembly stopper 15b, the tissue restraint Assembly frame 60 stops moving distally. This means that the trigger 16 is It corresponds to being closed.

When trigger 16 is released from the closed position with respect to handle 14, the instrument all components of the spring 38.42.70 Return to the initial position. Tissue restraint assembly 26 extends proximally to track 20.22. does not move, thereby keeping the tissue and its attached clip 86 from the instrument 10. can be removed from

FIG. 20 shows the knife brake when misfeeding of the clip 86 occurs in the right track 22. A safety mechanism (detailed below) is shown to prevent passage of the code 58.

An exemplary ligature or clip 86 is shown in FIGS. 21 and 22. Each group The lip 86 includes a hair 130 and two lips extending from respective opposite ends of the hair 130. It has arms 132 and 134. Heath 130 and arm 13 of each clip 86 2.134 are in a common plane. Each clip 86 connects the arms 132, 134 to Usually the free end portions 136, 138 are made to be resiliently deflected apart. . Laterally extending ears 142 and 144 are disposed along the arms 132 and 34, respectively. It is. The inner circumference of the normally free end portion 136,138 of each arm 132,134 Slots 146, 148 are provided on the husband.

Physically separate individual chests, blocks 8G, or arranged in rows with each other as shown in Figure 10, for example. When attached, the ears 142 and 144 of each clip 86 are directly connected to each other. are releasably received and engaged within slots 146 and 148, respectively, in clip 86. will be combined.

The arms 132, 134 of each clip 86 are separated by the surrounding structure of the instrument IO. Prevented from spreading. Therefore, the most distal clip 86 in the row will be When pushed in the distal direction, all subsequent clips 86 in the row simultaneously Pressed by 1&.

Resistance recess 107 (FIG. 10) prevents the clip from advancing when distal-most clip 86 is advanced. It slows down the advancement of the remaining clips in the row of clips, thus reducing the clips distal to the row of clips. Help get Ri, Pu to leave.

The normally free end portions 136 and 138 of the arms of each clip 86 The complementary hooks on the top have gold elements 132a, 132b and the complementary hooks on the arm 134 have metal elements 132a, 132b. gold elements 134a and 134b. Arms 132 and 134 of clip 86 When squeezed together as shown in FIG. Similarly, the metal elements 132b and 134b overlap each other. Combine. Once these hooks are combined with gold elements, these hooks are Keep the top 86 closed. The hook is the direction in which the metal elements 132a and 134a overlap. In this case, the hook is opposite to the overlapping direction of the metal elements 132b and 134b. The overlap of the , by helping to keep arms 132 and 134 in the same plane. 86 from being inadvertently reopened.

FIG. 23 shows tubular conduit 28 ligated at two spaced locations with clip 86. The position of the two closed clips 86 after being divided in the middle with the clip 8G is It shows.

Clip 86 may be of various sizes depending on its intended use.

A typical lip has a length of approximately ioam and a width (before closed) of 8I1m. I don't like it. A much smaller clitoris for use in microsurgery. You can use it. For other purposes such as closing the fallopian tubes or vas deferens, It is best to use a large clip. The device 10 is suitable for use with clips without application. It is dimensioned exactly.

Figures 24-28 depict instruments during various stages of a surgical procedure to ligate and divide tissue. The operation of the distal end of tool 10, particularly clip storage assembly 18, is illustrated. Hardening of surgical instruments surgical clip 8 by forcing surgical clip 86 through defined jaws. Closing or forming the 6. The application was filed on September 30, 1982 under the name ``Device'' and the applicant received 8 As described in detail in assigned and co-pending U.S. Patent Application No. 429.249. Ru.

The initial state of the device is shown in FIG. A plurality of clips 86 are provided as described above. The sea urchins are connected together in two rows, with a left groove 114 and a cloth guide 116 (Fig. 12). The open side of each clip 86 is disposed in the grooves 1]4 and 116 facing each other. facing distally toward a set of jaws 160 shown in phantom arranged as . - The set of jaws 160 consists of an upper member and a lower member, and has valley grooves 114 and 116. placed inside. Thus, there are four job members 16 within the clip storage assembly 18. There is 0.

The hair 130 of the most distal clip 86 in the row in 4116 initially It is located on the distal side of the pushbutton 92 and the claw 110. All other clicks in lecture 116 The hair i30 of the clip 8G is located on the proximal side of the clip button 92 and the claw 110. right The Punonya rod 52 is at its most recent value position, and this position is connected to the trigger 1G and the hand. 14 (Fig. 1) is the farthest position (i.e., the 0th position of the path toward the closed position). %). The left side of the device is similarly constructed and works, but will not be described in detail here. Ru.

Two flag stop assemblies 158, 159 each include a knife blade 58 ( 3) and are arranged on both sides thereof for the purpose described below.

When the clip 86 is required, the body tissue 28 to be ligated is shown in FIG. As shown in FIG. It is decided. When you squeeze trigger 16 and notle 14 together, the right button 52 is driven in the distal direction. As the right button rod 52 moves distally, The right clip button 92 then extends far past the distal end of the clip positioning pawl 110. Compare Figures 25 and 26 and refer to Figures 16 and 17) Contact the proximal side of the hairs 130 of the distal-most clip 86 and Advance distally along g116. All other clips in the row are pressed together with the distal clip. The same procedure is performed on the left side of the instrument in the left orbit 20. Of course, it will become popular.

The arms of each clip are on each side of the tissue 28, as shown in FIG. Each arm 132 and 134 of distal clip 8G attaches to a respective one of jaws 160. enter. Each of the jaws 160 is configured to receive and guide an arm of the clip 86. It has a vertical jaw groove 162. Joe course 162, Krinoff plaster) 6. The length that finishes closing , maintain each clip 8G in the correct orientation within the instrument.

The normally free distal most portion of the arm 132,134 of the distal most clip 86 is Clip 86 begins to close on tissue 28 as it comes into contact with gathering jaw surface 164. As shown in FIG. a -1. When 132 and 134 come together towards each other, the ears of the most distal clip 8G-1 142 and 144 are the slots 14G located in the next most distal clip 86, respectively. , 148 and thereby the most distal clip from the remaining clips in the column. Let 86 leave. Resistance recess 107 (10th (Fig.) or arms 132, 134 of the distal-most clip, the next succeeding clip of the clip 86. and prevents further distal movement of the distal-most next clip. most distal The hair 130 of the next clip moves distally of the distal end of the claw 110. However, the hair 130 of the other clip is distal to the distal end of the claw 110. This disengagement of the distal-most clip occurs before it has finished moving sideways. This allows the instrument to During each operating cycle, one click is applied to each side of the knight's blade 58 up to the jaws 160. clip and is guaranteed to advance only one clip.

When continuing to squeeze the trigger 16 and handle 14 together, the right push rod 52 and The lip pusher 92 pushes the distal-most clip 86 further into the jaws 160. Keep putting it in. The jaw surfaces 164 converge on the arms 132 of the distal-most clip 86. and 134 together.

When instrument 10 reaches the state shown in FIG. 27, distal-most clip 86 is fully closed. As you know, the hooks are metal elements 132a and 132b (Fig. 21), and the hook is the metal element 134a. and 134b to hold the clip closed. closed clip 8 6 is L5 twenty minutes to stop blood circulation without causing undue damage to tissue. Preferably, no significant pressure is exerted on the tissue 28.

until the preceding clip is completely closed and ejected from the groove 114,116. Prevents another clip 86 from being advanced within either groove 114 or 116. To prevent this, an anti-jamming mechanism (FIGS. 7, 10, and 10a) is provided. operation When the cycle begins, flag 82 is set as shown in Figure 7 and as shown in Figure 10a. It is located with respect to a ramp assembly 84, indicated by reference numeral 82a. Butsusha rod 52 is As the distal end of clip button 92 begins to move forward with respect to path 22, the distal end of clip button 92 touches pawl 110. Shortly after moving distally past the distal end, flag 82 is in the position of FIG. 10a. Move to 82b.

In this position 82b, the latch on the ramp assembly 84 is Prevents flag 82 from retracting in a proximal direction even if gas 16 is released prematurely. Stop. This causes the clip button 92 to be retracted into a position proximal to the distal end of the pawl 110. This prevents clips that the button 92 has already begun to advance from being completely pushed forward. Connect the other clip to the pink amplifier until after it is closed and released from the device. Ru.

The clip pusher 92 pushes the fully closed clip into the jaws 16 as described above. When discharging from 0, the flag 82 is set as shown at position 82c in FIG. 10a. around the distal end of ramp assembly 84. Following the release of the closed clip When the trigger 16 is released, the flag 82 is set as shown in FIG. 10a at 82d. 840 across the opposite side of the ramp assembly 840 shown in FIG. When returning to the position, the flag 82 returns to its initial position if 82a.

From the foregoing description, it can be seen that the anti-jamming mechanism 81 can cause the device to malfunction and jam. It can be seen that this prevents double feeding of clips with .

In FIG. 29, safety mechanism 100 is located at a distal location within clip storage assembly 18. is positioned. Safety mechanism 100 is intended for organization 28 (FIG. 1). This prevents the tissue 28 from being divided before it is ligated on both sides of the division point. Ligation and division In surgical procedures, a tubular conduit, such as a blood vessel, is divided midway between two locations. It is often important to have a good ligation at these locations beforehand. What if? If one or both ligations do not function properly, uncontrolled bleeding from the duct can occur. A large flow of fluid (eg, blood) will occur upon division of the conduit.

Safety mechanism 100 has a substantially flat head 170, which has a left perpendicular to the plane formed by the track 20 and the right track 22 and the longitudinal axis 8 of the instrument is parallel to The heath 170 straddles both tracks 20.22 and the knife bar 54. ing. Heath 170 has a relatively clean surface due to the end bending of the safety mechanism. It has manufacturing detents 172 on each side to make it easier to maintain. safety mechanism 100 heaths 170 are supported on the inner wall 91. Safety mechanism 100 remains stationary with respect to trajectory 20.22 and moves distally during manipulation of instrument 10. prevented from moving.

Arms 176, 178 extending along the longitudinal axis of the clip storage assembly 18 are attached to both sides of the base 170. Arms 176 and 178 are deflected outwardly. , extending into the upper portions of the right clip a 114 and the left clip groove 116, respectively.

Arms 176 and 178 are proximate to cover 106. However, surgical procedures When the top 86 is placed in the grooves 114 and 116, the arm 176 of the safety mechanism 178 contacts the upper clip arm 132 and is thereby centered. It is forced inwardly towards the knife rod 54 and plate 58.

The free end of each arm 176 and 178 extends substantially perpendicular to the longitudinal axis 8 of the instrument IO. It's bent. Either arm 176 or 178 of the safety mechanism is attached to cover 106. When in close proximity, the knife bar 54 and blade 58 extend downwardly to prevent their advancement. Flags 180 and 182 are located at the free ends of arms 176 and 178, respectively.

Flags 180 and 182 overlap so that they do not interfere with the pressure relief of the other. So This clips the flag 182 attached to the right arm 178 of the safety mechanism. Right arm 1 is positioned proximal to flag 180 within assembly 18. 78 is bent within a protruding U-shaped hinge 184. However Therefore, to prevent dislodgement, both arms 176 and 178 of the safety mechanism are The protruding U-shaped hinge 184 allows the instrument 10 to be positioned at substantially the same distance from the distal-most end. It comes into contact with the chestnut knob 86 when it is released.

During operation, when the clip 86 advances along the right clip a116, the clip 8 6 pushes the free end of the right arm 178 of the safety mechanism and moves it towards the knife bar 54.

The right flag 182 advances from the straight path of the knife blade 58 and 8 continues its advance and becomes able to engage with the Mi weave 28.

Similarly, as the clip 86 advances along the human body 114, the left arm of the safety mechanism 176 is deflected toward the knife bar 54, pushing the left flag 180 and causing the knife to flex. out of the straight path of the card 58.

FIG. 30 shows the safety mechanism when the surgical clip 86 is incorrectly fed in the right a116. Shows the effect of 100. The right arm 178 of the safety mechanism is There is even. The right flag 182 remains in its normally undeflected position, Advancement of the distal edges of the rod 54 and blade 58 is immediately inhibited. Of course, safety mechanism 1 00 is the same when all surgical clips 86 have been successfully ejected from the instrument IO. It acts on Therefore, the division procedure should only be performed after the ligation procedure has been successfully performed. I can do it.

Other modifications and changes to suit particular operating requirements and environments will be apparent to those skilled in the art. As such, the invention is not intended to be limited to the embodiments selected for the purpose of disclosure. All changes and modifications that should not be considered and do not depart from the true spirit and scope of the invention. This includes: For example, clip 86 may be bioabsorbable as described above. or may be made of non-absorbable plastic-like material.

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Claims (1)

[Claims] 1. A surgical instrument for ligating and dividing organ structures, the instrument comprising two It has spaced apart grooves such that the valley groove distributes the ligature from a distribution location on the groove. in a surgical instrument, wherein said instrument has a cutting device in the middle of said groove: one Cutting of the organ structure occurs only when the ligature is placed upstream of the distribution location of each of the grooves. directly engageable with the cutting device and working in both the grooves to enable cutting. Dynamically coupled safety devices; Surgical instruments for ligature division, including: 2. The cutting device is a cutting blade adapted to divide a tubular conduit. A surgical instrument for dividing ligatures according to scope 1. 3. The safety device prevents the tubular ligature from discharging when the ligature is not upstream of the distribution location of one of the grooves. The ligating and dividing device according to claim 2, which is adapted to prevent the division of the conduit. Scientific equipment. 4. The ligature is adapted to be absorbed by living organs. A surgical instrument for dividing ligatures according to scope 3. 5. The cutting blade is configured to move along a path, and the safety device is configured to operation of the cutting blade until the ligature is advanced to a position upstream of the dispensing location of each of said grooves; The cutter blade may include a stop device normally placed in the path of the cutting blade to prevent A surgical instrument for dividing ligatures according to item 3. 6. The stopping device is substantially aligned with respect to the plane formed by the path of the cutting blade. A surgical instrument for ligature division according to claim 5, which is vertical. 7. The safety device: i) A heath that connects the base 1 and the chest 2 and the pigeon: 11) One end is the first tip of the heath. a first stop operatively coupled to the end and with the other end normally disposed in the path of the cutting blade; a first leg coupled to the material; iii) a second leg disposed oppositely and symmetrically with respect to the first leg; , the second leg is operatively coupled at one end to the second tip of the hair. , a second stop member having the other end of the second leg normally disposed in the path of the cutting blade; a second leg coupled to; iv) each of said legs is respectively disposed proximate each of said grooves, and a ligature is disposed in said groove; said groove when advanced along each of said grooves into respective engagement with each of said legs; Each of the legs includes a groove to deflect the respective stop member from the path of the cutting blade. operatively associated with a groove upstream of a dispensing location; Surgical instrument for ligature division according to item 5. 8. Used in surgical instruments designed to distribute ligatures and divide tissue. a misfeed detection device for detecting misfeeding, the surgical instrument having a longitudinal axis and receiving the ligature; two spaced apart grooves for inserting the In an erroneous feed detection device having a knife blade provided in the middle: a first arm dynamically coupled and adapted to engage a distal-most ligature within the groove; b) operatively coupled to the second groove and engaged with the distal-most ligature within the groove; C) the absence of a ligature within the first groove; directly into and through the path of the knife blade so as to cause disabling of the knife blade. a first flag mounted on a first arm disposed substantially vertically; 26 d) The absence of a ligature in the second groove causes disabling of the knife blade. disposed directly within and substantially perpendicular to the path of the knife blade such that a second flag mounted on the second arm; An erroneous feed detection device including: 9. Misfeeding according to claim 8, wherein the ligature is absorbable by the body. Detection device. 10. A ligature storage and dispensing device and a movable tissue cutting device for dividing body tissue. and a tissue restraint device operatively coupled to the cutting device. , the safety device: a) determines whether a ligature is in the ligature storage and dispensing device; the ligature storage and dispensing device G is operatively coupled to a ligature detection device; ; h) Transfer of the cutting device only when a ligature is detected in the ligature storage and dispensing device. the tissue restraining device and the cutting device to enable movement of the tissue; a movable interposition device operatively coupled to the ligature detection device; Occlusion cutting instrument.