US 3270745 A
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Description (OCR text may contain errors)
Sept. 6, 1966 E. c. WOOD HEMQSTATIC CLIP CONSTRUCTION'S 5 Sheets-Sheet 1 Filed June 11, 1963 INVENTOR. firnest 6'. wood ZZZ) (Z/MM W "7 @9195 Sept. 6, 1966 E. c. WOOD HEMOSTATIC CLIP CONSTRUCTIONS Filed June 11, 1963 I5 Sheets-Sheet 2.
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Sept. 6, 1966 E. c. WOOD 3,270,745
HEMOSTATIC CLIP CONSTRUCTIONS Fild June 11, 1963 3 Sheets-Sheet 5 FIG, 16
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(fr-1165i 6 wood Wdbm aZ/MM ai'ys I r 1 mnnni United States Patent 3,270,745 HEMOSTATIC CLIP CONSTRUCTIONS Ernest Charla Wood, Los Angeles, Calif., assignor of onethird to Rene G. Le Vaux and one-third to Peter B.
Samuels Filed June 11, 1963, Ser. No. 287,133 4 Claims. (Cl. 128325) This invention relates to mechanisms for use in the strangulation of tubular members. The invention is specifically directed to mechanisms including hemostatic clips for use in the strangulation of blood vessels, especially at their open ends.
The particular application of this invention to the strangulation or closure of blood vessels will serve as an example of the illustration of the inventive concepts disclosed herein. It will be appreciated, however, that the mechanisms of this invention can be adapted for the closure of other tubular members near their open ends or at various intermediate points.
In the undertaking of a surgical operation, it is often necessary for the surgeon to sever one or more blood vessels. Since the flow of blood will interfere with the subsequent operation and since excessive loss of blood will endanger the patient, it is desirable to provide means for closing oif the severed ends of the blood vessels until the operation is completed.
Conventional techniques provide for the separate clamping of blood vessels after an incision has been made during the undertaking of an operation. After clamping of the vessels, they are each separately tied with a ligature or the like to strangula-te the vessel and to permit removal of the applied clamps. In some instances, an extremely large number of clamps must be applied, and one or two hours may be required to provide for proper closure of all the vessels whereby the operation can proceed. It will be apparent that a considerable expenditure in time from the standpoint of the surgeon and his assistants is necessary in such instances, and it will also be obvious that the delay will increase the danger to the patient undergoing the operation.
It is an object of this invention to provide improved mechanisms for use in the strangulation of blood vessels whereby the time required to close 01f the vessels is materially reduced and whereby the bleeding can be terminated without the use of an excessive combination of clamping and tieing operations.
It is a more particular object of this invention to provide improved mechanisms for the strangulation of blood vessels and the like whereby the blood vessels can be permanently sealed in a highly efficient manner to prevent bleeding during an operation and whereby the operation can proceed with a minimum loss of time and with a minimum loss of blood to thereby maintain conditions most favorable to the patient as well as to the surgeon and his assistants.
It is a specific object of this invention to provide an improved design for a hemostatic clip which is adapted to achieve the foregoing objects.
These and other objects of this invention will appear hereinafter, and for purposes of illustration but not of limitation, specific embodiments of this invention are shown in the accompanying drawings in which:
FIGURE 1 is a plan view of a hemostatic clip applicator construction;
FIGURE 2 is an enlarged fragmentary view of the jaw portion of the applicator;
FIGURE 3 is a view of one jaw portion taken about the line 33 of FIGURE 2 FIGURE 4 is an enlarged cross-sectional view taken about the line 4-4 of FIGURE 2;
FIGURE 5 is an enlarged fragmentary view taken about the line 55 of FIGURE 1 and illustrating stop means associated with the handle portions of the applicator;
FIGURE 6 is a side elevation of the applicator shown in FIGURE 1;
FIGURE 7 is an elevational view of a holding means for hemostatic clips utilized in accordance with this invention;
FIGURE 8 is an end elevation of the holding means shown in FIGURE 7;
FIGURE 9 is a view of the holding means taken about the line 9-9 of FIGURE 8;
FIGURE 10 comprises a cross-sectional illustration of the clip holding means and also illustrates a hemostatic clip construction of this invention;
FIGURE 11 comprises a cross-sectional illustration of a clip holding means and also illustrates the cooperating features of the clip applicator and hemostatic clip constructions;
FIGURE 12 is an enlarged fragmentary view illustrating the manner in which the jaw portions of the clip applicator provide for clamping of a clip;
FIGURE 13 is a perspective view of a hemostatic clip designed in accordance with the concepts of this invention;
FIGURE 14 illustrates a blood vessel having a clip clamped thereon;
FIGURE 15 illustrates a magazine holding construction adapted to hold a plurality of the clips of this invention;
FIGURE 16 is a perspective view of an alternative clip construction;
FIGURE 17 is a perspective view of the clip construction of FIGURE 16 partially closed about a tubular member;
FIGURE 18 is a perspective view of the same clip construction in the completely closed position;
FIGURE 19 is a fragmentary plan view, partly in section, of the clip construction of FIGURE 16 associated with a holder;
FIGURE 20 is a sectional elevation of the clip and holder assembly of FIGURE 19;
FIGURES 21 through 24 are detail views illustrating the clamping sequence which takes place in the use of the clip construction of FIGURE 16.
The hemostatic clip of this invention is adapted to be formed from a strip of nontoxic material whereby it can be safely .applied during an operation. The strip is formed whereby it defines a pair of arm portions with the interfaces of the arm portions being situated in an opposed relationship. These interfaces, when clamped by means to be described, engage the outer surfaces of a blood vessel for strangulating this vessel.
Protuberances are formed on the outer surfaces of the arm portions defined between clips. These protuberances serve to permit firm gripping of the clips by a clip applicator whereby the clips can be efficiently clamped by the applicator around the blood vessel. The applicator of this invent-ion includes jaw portions which define recesses for receiving the protuberances on the clip. When these protuberances are received by the jaw portions, the clip will be firmly held so that there is little tendency for the clip to be dislodged from the applicator before being applied to a blood vessel.
In order to further increase the efficiency during an oper-ation, novel holding means have been devised for the clip constructions. These holding means define slots into which the clips can be inserted. The holding means and associated clips can then be sterilized and packaged in sterile containers whereby they will be ready for use at any time. The slots defined in the holding :means are such that the jaws of the clip applicator can be received therein. Accordingly, the clips can be removed from the holding means by the clip applicator without the necessity of ever touching the clips after they have been sterilized.
The accompanying drawings will provide an illustration of examples of various mechanism characterized by the features of this invention. In FIGURES 1 through 6, there are illustrated an applicator'lt) and details of various portions thereof. A pivot 12 of the applicator divides the applicator into jaw portions 14 and handle portions 16. A leaf spring 18 is fastened to one jaw portion 16 at 19 and is movably connected to the other jaw portion.
As best shown in FIGURE 5, the end 20 of the spring 18 defines a slot 21 which is adapted to receive a hook 22 fixed to the handle portion 16. It will be apparent that when the handle portions are pressed together by means of the finger holes 23, the end 20 of the spring 18 will slide relative to its associated handle portion. When finger pressure is released, the end of the slot 21 will engage the hook 22 as illustrated in FIGURE and jaws 14.
Each of the jaws 14 define grooves 24 extending from the outer ends thereof. Recesses 26 extend downwardly from these grooves. As will appear hereinafter, the recesses and grooves provide for insertion of clips 28 into the jaws I4 and also provide for gripping of these clips when they are held by the jaws.
FIGURE 13 provides an illustration of the preferred construction of the clip 28. This clip includes a fold 30 having arm portions 32 extending angularly therefrom. Portions 34 extend from these angular portions and these portions are situated in a generally parallel relationship in respect to each other. Protuberances 36 are formed in the outer surface of these parallel portions while the opposed innerfaces 38 of these portions serve as the engaging means of the clip. These innerfaces can be serrated to provide a more desirable gripping action.
FIGURES 7 through illustrate individual holders 40 suitable for use in combination with the clips 28. These holders define slots 42 which comprise a narrow central portion 44 corresponding approximately to the thickness of the clips 28. Enlarged portions 46 of these slots are dimensioned whereby the jaws 14 of the applicator 10 can be received therein.
FIGURE illustrates a magazine construction adapted to hold a plurality of clips 28. As previously indicated, the holders for the clips are adapted to be sterilized along with the clips and then sealed in sterile packages whereby they can be held indefinitely until they are ready for use. It is preferred that the clips 28 be manufactured whereby they will firmly engage the walls of the slots 42 so that they will not become dislodged from the holders during handling.
In the use of the construction of this invention for the strangulation of a blood vessel such as shown at 56, the holders 40 or a magazine 43 is first made available. The jaws 14 of the applicator 10 are then inserted in the slots 42 as best shown in FIGURE 11. It will be noted that the grooves 24 are dimensioned approximately equal to the thickness of the clips 28. With this feature, the jaws of the applicator will be centered as they move into the slots 42, and, therefore, the protuberances 36 will naturally snap into the recesses 26. The applicator jaws can :then be withdrawn from the clip holders and the clips will remain firmly held thereby. It will be apparent that there is little tendency for the clips to fall away from the jaws .and, in this connection, there is no necessity for pressing the jaws together to hold the clips. Thus, the limited position which defines the spacing of the jaws 14 will normally be such that the jaw spacing will not greatly exceed the normal spread of the clip construction. With the provision of the protuberances 36, the clips will automatically be held by the spaced-apart jaws.
The open end of the clips can. be placed around the .severed end of a blOOd Yel 50 and when pressure is applied through the finger holes and handle portions of the applicator, the clip held by the jaws will be clamped as shown in FIGURE 14. The clips are adapted to tightly seal the blood vessel when clamped in the manner shown, and, therefore, the use of ligatures in an operation can be eliminated.
The design of the clip construction 28, which represents the preferred design, is particularly important. Thus, the provision of the parallel portions 34 serves to insure a firm gripping action by the applicator 10. These straight sections of the clip will easily slide into the grooves 24 in the jaws 14 to thereby insure receipt of the protuberances 36 into the recesses 26. When so received, the clips will remain stationary relative to the jaws since the protuberances prevent sliding movement while the grooves prevent rotary movement.
FIGURES 16 through 24 illustrate an alternative clip construction 60 and the manner in which this construction is utilized. In considering the following description, it will be noted that the applicator 10 illustrated in FIGURE 1 is also utilized in combination with this clip construction. Thus, the construction is provided with protuberanccs 62 which are adapted to be received in the recesses 26 formed in each of the jaws 14 of the applicator.
The clip construction 60 is of a generally V-shaped configuration and includes a fold 64 having arm portions 66 extending angularly therefrom. A first portion 68 extends outward-ly from one of the arms 66 and this portion terminates in an inwardly directed member 70. The member 70 forms a recess 72 in combination with the portion 68, which recess cooperates to provide a locking feature.
The other arm 66 of the clip 60 is integrally connected with the portion 74 which terminates in an outwardly extending end member 76. It will be noted that the portion 74 is substantially shorter in length than the portion 68 whereby the end member 76 is adapted to be received in the recess 72 when the clip 60 is bent about the fold 64.
FIGURES 19 and 20 illustrate a holder 78 which includes portions 80 designed in corresponding shape with the clips 60. Indentations 82 and 84 are defined in the portions 80 whereby the members 76 and 70, respectively, of each clip 60 can be held in position on the holder 78. The jaws 14 pick up the clips from the holder by engaging the protrusions 62 in the manner described with reference to the clips 28.
FIGURES 16 through 18 and 21 through 24 provide illustrations as to the configuration of the clip 60 during various stages of the clamping operation. As noted in FIGURES 17 and 22, the member 76 first clears the end of the member 70 and engages the inner surface of the portion 68. The member 76 is then adapted to be bent relative to the portion 74 as shown in FIGURE 23. A reduction in thickness of the clip at the junctures of the member 76 and the portion 74 may be provided as at 86 in order to facilitate this bending operation.
FIGURES 18 and 24 illustrate the clip after completion of the clamping operation. It will be noted that the upper jaw 14 will engage the member 70 and will bend this member down over the member 76. Accordingly, the two ends of the clip are locked together and this arrangement provides substantial insurance against the possibility of the clip sections spreading apart after application.
The clip of this invention is preferably formed of surgical metals which are nontoxic and which therefore can be tolerated within the body for indefinite periods of time. Representative of such metals are stainless steel, tantalum, and platinum. It is also contemplated that the clips be formed of less expensive materials such as plastic or of materials which are slowly absorbable in the body fluids such as collagen, gelatin, albumin, dried blood, synthetic materials and the like.
It will be understood that various changes and modifications can be made in the above described hemostatic clip construction which provides the characteristics of this invention without departing from the spirit thereof particularly as defined in the following claims.
That which is claimed is:
1. A hemost-atic clip comprising a strip of nontoxic material, said strip defining arm portions having opposed faces, a single protuberance formed on the outer surface of each of said arm portions at intermediate points along the lengths of the respective arm portions, one arm portion being longer than the other arm portion, said strip defining a V-shaped configuration which includes a central fold, said arm portions extending angularly from said fold and then bending into an approximately para1- lel relationship with said protuberances being formed on the parallel portions of said arms, an end member formed on each of said arm portions, said end members being bent toward each other and being parallel to each other, one of said end members formed on said one arm portion being directed inwardly toward the central fold of said V-shaped portion thereby defining a recess with said one arm portion, and the other end member comprising an outwardly directed end member formed on the other of said arm portions adapted to be received in said recess when said arm portions are clamped together, and wherein said end members are bent when said arm portions are clamped together with the end members being thereby pressed against each other.
2. A clip construction in accordance with claim 1 including serrations defined in the opposed faces of said parallel portions.
3. A clip construction in accordance with claim 1 in which said strip is formed of a surgical metal.
4. A clip construction in accordance with claim 1 in which said strip is formed of a material which is solely absorbable in the body fluids.
References Cited by the Examiner UNITED STATES PATENTS D. 190,787 6/ 1961 Schneider 128-346 X 1,066,025 7/1913 Lieberknecht 1349 2,123,890 7/1938 Gossrau 128325 2,123,891 7/1938 Gossrau 1349 2,758,302 8/1956 White 156 3,056,408 10/ 1962 Brown 128-325 3,086,208 4/ 196 3 Eby 1-56 RICHARD A. GAUDET, Primary Examiner.
G. MCNEILL, Assistant Examiner.