US20040133215A1 - Clip applying apparatuses and methods for vascular ligation - Google Patents

Abstract

An apparatus and method for applying ligating clips to perform minimally invasive vascular ligation. An actuating assembly contacts a clip applier to actuate the clip applier among at least a first position, a second position and a third position. The clip applier is capable of receiving a first ligating clip when the clip applier is in the first position and a second ligating clip when the clip applier is in the second position. The actuating assembly actuates the clip applier to the third position to close the ligating clip being held by the clip applier.

Description

BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0001]
• The present invention relates generally to vascular ligation, and more specifically to clip appliers for vascular ligation.[0002]
• 2. Background Information[0003]
• Vascular ligation is an important component of a number of surgical procedures. For example, vascular ligation is part of the process of endoscopic vessel harvesting, such as harvesting of the saphenous vein to perform a coronary bypass procedure. Vascular ligation is also an integral part of vein harvesting performed in situ or during a femoral popliteal bypass procedure. Specifically, the tributaries of the saphenous vein must be ligated before the harvesting of the vein can actually occur. Common techniques for performing vascular ligation involve the use of ligating clips and clip appliers. However, current clip appliers are often suited for only open surgery. In addition, ligating clips are often formed in different sizes such that vessels of varying dimensions can be ligated.[0004]
• Vein harvesting is typically a traumatic procedure, and the common techniques for positioning and applying ligating clips can contribute to the invasiveness of the vein harvesting procedure. Increased trauma to the patient's body can be dangerous and often leads to a longer recovery period for the patient. Thus, being able to position and apply ligating clips in a minimally invasive manner is desirable because of the need to limit the trauma to a patient's body.[0005]
SUMMARY OF THE INVENTION
• The present invention provides in one embodiment a clip applier in contact with an actuating assembly which actuates the clip applier among at least a first position, a second position and a third position. The clip applier can receive a first ligating clip when the clip applier is in the first position, and the clip applier can receive a second ligating clip when the clip applier is in the second position.[0006]
• In one embodiment of the present invention, the clip applier includes a jaw having first and second movable sections adjacent to each other. In another embodiment, the first section is rotatably coupled to the second section, which is translatably actuated by the actuating assembly. In yet another embodiment, the first and second movable sections are resilient and are urged together by the actuating assembly.[0007]
• Additional features and benefits of the present invention will become apparent from the detailed description, figures and claims set forth below.[0008]
BRIEF DESCRIPTION OF THE DRAWINGS
• Various embodiments of the present invention will be described in detail with reference to the following drawings in which like reference numerals refer to like elements. The present invention is illustrated by way of example and not limitation in the accompanying figures.[0009]
• FIG. 1A shows a side view of one embodiment of a clip applier and actuating assembly in accordance with the teachings of the present invention.[0010]
• FIG. 1B shows a partial cutaway view of the clip applier and actuating assembly shown in FIG. 1A.[0011]
• FIGS.[0012]2A-2C show side, top and bottom views, respectively, of a clip applier in accordance with the teachings of the present invention.
• FIGS.[0013]3A-3C show varying positions of a clip applier in accordance with the teachings of the present invention.
• FIGS.[0014]4A-4C show a clip applier engaging a ligating clip in successive positions in accordance with the teachings of the present invention.
• FIG. 5A shows a side view of another embodiment of a clip applier and actuating assembly in accordance with the teachings of the present invention.[0015]
• FIG. 5B shows a partial cutaway view of the clip applier and actuating assembly shown in FIG. 5A.[0016]
• FIGS. 6A and 6B show side and top views, respectively, of a clip applier in accordance with the teachings of the present invention.[0017]
• FIGS.[0018]7A-7C show varying positions of a clip applier in accordance with the teachings of the present invention.
DETAILED DESCRIPTION
• The following description provides embodiments of the present invention. However, it will be appreciated that other embodiments of the present invention will become apparent to those of ordinary skill in the art upon examination of this description. Thus, the present description and accompanying drawings are for purposes of illustration and are not to be used to construe the invention in a restrictive manner.[0019]
• The present invention provides a clip applier that is in actuatable contact with an actuating assembly that actuates the clip applier among a variety of positions. Because the clip applier can be positioned variously, it is capable of holding one at a time ligating clips of different sizes and applying them to the target vessel. The clip applier includes a jaw having first and second movable sections adjacent to each other. In one embodiment of the present invention, the first movable section is rotatably coupled to the second movable section, which is translatably actuated by the actuating assembly. The movement, and hence position, of the first movable section is dictated by the movement of the second movable section. In another embodiment of the present invention, the first and second movable sections are resilient and are urged by the actuating assembly to different positions.[0020]
• FIGS. 1A and 1B show a side view and a partial cutaway view, respectively, of one embodiment of a clip applier and actuating assembly according to the present invention. A clip applier[0021]10 includes afixed support member16 and a jaw having a rotatingsection12 and a translatingsection14.Section12 is rotatably coupled tosection14 by a pin18a.Section12 is also rotatably coupled tomember16 by a pin18b.Member16 is fixed to the inner surface of ahousing20 via any suitable means such as, for example, a screw or an adhesive.Member16 could also be integrally formed with and extending from an end ofhousing20.Housing20 is an elongated, rigid or flexible shaft which is coupled to ahandle22. It is appreciated thathousing20 can be integrally formed withhandle22.
• [0022]Handle22 is in a scissors-like form and includes astationary member24 and an actuatingmember26 which is rotatably coupled tostationary member24 via apin28. Anactuating rod30 is attached to, or integrally formed with, actuatingmember26.Rod30 extends throughhousing20 and is coupled to an end of translatingsection14. In one embodiment,rod30 is coupled tosection14 in any suitable manner such thatrod30 can push and pullsection14 in a translating fashion.Housing20 not onlyhouses actuating rod30 but also acts as an anchor for fixedsupport member16.Housing20 androd30 can be flexible to provide greater accessibility to target vessels, but it should be noted thatrod30 is also rigid enough to provide a pushing force tosection14. It is appreciated thathousing20 androd30 can be formed in various lengths depending on the expected distance between the target vessels and the insertion point on the patient's body. Furthermore, the cross sectional shape ofhousing20 can be a variety of shapes including circular.
• [0023]Sections12 and14 andmember16 can be made of surgical steel, stainless steel, plastic or similar materials.Rod30 can also be made of surgical steel or a similar material.Housing20 can be made of plastic, stainless steel or other appropriate materials.
• Because[0024]sections12 and14 can be actuated remotely viarod30, andclip applier10 andhousing20 are elongated with a thin profile, the present invention can be used minimally invasively to perform vascular ligation. This will help prevent the vascular ligation procedure from exacerbating the invasiveness associated with vein harvesting procedures.
• FIGS.[0025]2A-2C show side, top and bottom views, respectively of a clip applier similar to the one shown in FIGS. 1A and 1B. The clip applier includes a fixedsupport member36 and a jaw having a rotatingsection32 and a translatingsection34. Aflange39 extending fromsection32 is rotatably coupled tosection34 by a pin38a.Flange39 extending fromsection32 is also rotatably coupled tomember36 by a pin38b. Agap35 inmember36 accommodatesflange39. Agap37 insection34 also accommodatesflange39.Gaps35 and37 are large enough to allowflange39, and hencesection32, to be rotated.Member36 is attached tohousing40 as described above in conjunction withmember16 andhousing20.Member36 is shown extending from withinhousing40, but it is appreciated thatmember36 can be integrally formed withhousing40 such thatmember36 extends from an end ofhousing40.
• FIGS.[0026]3A-3C show varying positions of a clip applier according to the present invention. FIG. 3A shows a clip applier in a closed position. The clip applier includes a fixedsupport member46 and a jaw having a rotatingsection42 and a translatingsection44.Sections42 and44 are formed withnotches43 and45, respectively. Aflange49 extending from rotatingsection42 is rotatably coupled tosection44 by a pin48a.Flange49 is also rotatably coupled tomember46 by a pin48b.Member46 is attached tohousing50 as described above with respect to similar embodiments.
• FIG. 3B shows the clip applier in a slightly open position. As translating[0027]section44 translates away fromhousing50, rotatingsection42 rotates away fromsection44 due to the movement ofsection44 and the coupling offlange49 tosection44 andmember46 via pins48aand48b, respectively, to create an opening betweensections42 and44. This opening can receive aligating clip52, which is held securely by the mating of protrusions onclip52 withnotches43 and45. An example of such a ligating clip with protrusions is the ABSOLOK line of ligating clips by Ethicon, Inc. If the ligating clip does not have protrusions ornotches43 and45 are otherwise unnecessary, it is appreciated that the surfaces ofsections42 and44 can be textured to provide a better mechanical or friction fit between the clip andsections42 and44.
• FIG. 3C shows the clip applier in a more pronounced open position. As translating[0028]section44 translates farther away fromhousing50, rotatingsection42 rotates farther away fromsection44 to enlarge the opening betweensections42 and44. Because of the increased space in the opening betweensections42 and44, alarger ligating clip54 can be held in the opening betweensections42 and44. Thus, in accordance with the teachings of the present invention, the jaw of the clip applier can be actuated to different positions to accommodate ligating clips of different sizes.
• FIGS.[0029]4A-4C show the clip applier shown in FIG. 3C engagingligating clip54 in successive positions to closeligating clip54. As translatingsection44 moves towardhousing50, rotatingsection42 rotates towardsection44 due to the movement ofsection44 and the coupling offlange49 tosection44 andmember46 via pins48aand48b, respectively. Assection42 rotates towardsection44,section42 applies a force to the contacted portion ofclip54 to graduallyclose clip54. Assumingclip54 is positioned around the target vessel (not shown) whileclip54 is open,clip54 will be clamped over the target vessel when it is closed. Onceclip54 is deployed, rotatingsection42 can be opened according to the above description to allow the clip applier to be disengaged fromclip54. Once the clip applier is removed from the patient's body, the clip applier can be engaged with another ligating clip of the same or different size.
• It is appreciated that the shape and configuration of the jaw sections typically depends on factors such as the size and shape of the ligating clips to be used and the desired secureness with which the clips are held during the transit and application of the clips. Thus, the shape and configuration of the jaw sections shown in the figures are to be understood as examples of the present invention.[0030]
• FIGS. 5A and 5B show a side view and a partial cutaway view, respectively, of another embodiment of a clip applier and actuating assembly according to the present invention. A[0031]clip applier60 includes a jaw having a firstresilient section62 and a secondresilient section64.Sections62 and64 have stems63 and65, respectively, that are housed within an actuatinghousing66, which is translatably housed within amain housing70.Sections62 and64 and stems63 and65 can be made of surgical steel, stainless steel or similar materials. Actuatinghousing66 can also be made of surgical steel or a similar material.Main housing70 can be mad of plastic, stainless steel or other appropriate materials.Sections62 and64 extend out from actuatinghousing66, which is typically in the shape of an elongated tube.Main housing70 is also typically in the shape of an elongated tube such thatmain housing70 and actuatinghousing66 are in a substantially concentric relationship. It is appreciated thatmain housing70 and actuatinghousing66 need not be tubular.Main housing70 and actuatinghousing66 can be shaped variously to allow actuatinghousing66 to move withinmain housing70. Furthermore,main housing70 and actuatinghousing66 can be slightly flexible to provide greater accessibility to target vessels.
• [0032]Main housing70 is coupled to ahandle base72 having ahandle73 and atrigger74 extending from withinhandle73. Alternatively,main housing70 is integrally formed withhandle base72.Trigger74 can be part of any conventional trigger mechanism located withinhandle73 and handlebase72 such that whentrigger74 is depressed, actuatinghousing66 translates away fromhandle base72, and whentrigger74 is released, actuatinghousing66 translates towardhandle base72. The trigger mechanism has not been shown so as not to obscure the present invention. It should be noted that stems63 and65 are typically anchored withinmain housing70 or handlebase72 such thatresilient sections62 and64 do not move back and forth as actuatinghousing66 moves back and forth.
• Because[0033]sections62 and64 can be actuated remotely via actuatinghousing66, andclip applier60 andhousing70 are elongated with a thin profile, the present invention can be used minimally invasively to perform vascular ligation. This will help prevent the vascular ligation procedure from exacerbating the invasiveness associated with vein harvesting procedures.
• FIGS. 6A and 6B show side and top views, respectively, of a[0034]clip applier80 similar to the one shown in FIGS. 5A and 5B.Clip applier80 includes a jaw having a firstresilient section82 and a secondresilient section84.Sections82 and84 have stems (not shown) similar to stems63 and65 that are housed within an actuatinghousing86, which is translatably housed within amain housing90. The angle and shape ofsections82 and84 can be varied depending on factors such as the size and shape of the ligating clips to be used and the desired secureness with which the clips are held during the transit and application of the clips.
• FIGS.[0035]7A-7C show varying positions of the clip applier of FIGS. 5A and 5B engaging ligating clips of different sizes. FIG. 7A shows the clip applier in a substantially open position. Whenresilient sections82 and84 are in their natural positions, the space betweensections82 and84 is large enough to accommodate larger ligating clips such asligating clip92. Onceligating clip92 is fitted betweensections82 and84,sections82 and84 can be urged (i.e., pushed) closer together by moving actuatinghousing86 towardligating clip92 to grip ligatingclip92 more securely.
• FIG. 7B shows the clip applier in a slightly closed position. As actuating[0036]housing86 moves out frommain housing90, actuatinghousing86contacts sections82 and84 and urges them concurrently to close the gap betweensections82 and84. Assections82 and84 are urged closer together by actuatinghousing86, a smaller ligating clip such asligating clip94 can be held securely by the clip applier while ligatingclip94 is positioned around the target vessel.
• FIG. 7C shows the clip applier in a more pronounced closed position. Actuating[0037]housing86 moves out frommain housing90 and concurrently urgessections82 and84 to further close the gap betweensections82 and84. Aligating clip96, which is smaller than ligatingclip94, can then be fitted securely betweensections82 and84. Once a ligating clip is held withinsections82 and84 and positioned around the target vessel, actuatinghousing86 is moved in the direction indicated in FIGS.7A-7C until the clip is closed. It is appreciated thatsections82 and84 can be formed with notches to provide a more secure fit for a ligating clip by mating with protrusions on the ligating clip.Sections82 and84 can also be textured to provide greater hold on a ligating clip. Furthermore, actuatinghousing86 can have a bigger or smaller opening, depending on howmuch sections82 and84 need to be urged together in order to close the ligating clips to be used. For example, for more pronounced urging in conjunction with a smaller ligating clip, the inner diameter (assuming actuatinghousing86 is in the shape of a tube) of actuatinghousing86 would be smaller.
• It should be noted that actuating[0038]housing86 typically is not translatable to the point where actuatinghousing86 completely hidessections82 and84. If actuatinghousing86 is capable of moving to such a point, then actuatinghousing86 could run into and possibly damage the target vessel when a ligating clip is being applied. Furthermore,sections82 and84 typically do not translate back and forth because such movement could damage the target vessel when a ligating clip is being applied. Thus,sections82 and84 are typically anchored withinmain housing90 or the handle base (see FIGS. 5A and 5B) such thatsections82 and84 do not engage in translating movement when actuatinghousing86 is moving back and forth.
• It is appreciated that the present invention can be used as a stand-alone device or be used in working lumens such as the VASOVIEW UNIPORT® by Origin Medsystems, Inc. of Menlo Park, Calif. Furthermore, the present invention can include an actuation limiter to lock the clip applier jaw in varying positions such that the ligating clip is not inadvertently closed or disengaged from the jaw.[0039]
• In the foregoing detailed description, the apparatus and method of the present invention have been described with reference to specific exemplary embodiments. However, it will be evident that various modifications and changes may be made without departing from the broader scope and spirit of the present invention. The present specification and figures are accordingly to be regarded as illustrative rather than restrictive.[0040]

Claims (22)

What is claimed is:

1. A surgical apparatus comprising:

a clip applier; and

an actuating assembly contacting said clip applier for actuating said clip applier among at least a first position, a second position and a third position.

2. An apparatus as inclaim 1 wherein said clip applier comprises a jaw having a first portion adjacent to a second portion.

3. An apparatus as inclaim 2 wherein said first portion is rotatably coupled to said second portion of said jaw.

4. An apparatus as inclaim 3 wherein said actuating assembly is coupled to said second portion of said jaw such that said second portion is translatable.

5. An apparatus as inclaim 2 wherein said first and second portions are resilient.

6. An apparatus as inclaim 5 wherein said actuating assembly concurrently urges said first and second portions of said jaw toward each other.

7. An apparatus as inclaim 1 wherein said clip applier is capable of receiving a first ligating clip when said clip applier is in said first position, and wherein said clip applier is capable of receiving a second ligating clip when said clip applier is in said second position, said first and second ligating clips having different sizes.

8. An apparatus as inclaim 1 wherein said first and second positions are open positions and said third position is a closed position.

9. An apparatus as inclaim 1 further comprising a housing disposed around said actuating assembly.

10. A surgical apparatus comprising:

a housing;

a jaw having first and second movable sections, said jaw mateable with a plurality of ligating clips having different sizes; and

an actuating mechanism disposed substantially within said housing and contacting said jaw.

11. An apparatus as inclaim 10 wherein said housing is tubular.

12. An apparatus as inclaim 10 wherein said actuating mechanism comprises a translatable tube disposed within said housing and surrounding said jaw, said translatable tube concurrently urging said first and second sections of said jaw when said translatable tube is translated toward a distal end of said jaw.

13. An apparatus as inclaim 10 wherein said actuating mechanism comprises a rod coupled to said second movable section of said jaw, said first moveable section of said jaw rotatably coupled to both said second movable section and a support member fixed to said housing.

14. An apparatus as inclaim 10 wherein said actuating mechanism comprises a handle coupled to said housing, said handle and said jaw located at opposite ends of said housing.

15. A surgical apparatus comprising:

an elongated housing having a first end and a second end;

an actuating assembly having a translatable member extending through said housing and a handle coupled to said translatable member adjacent to said first end of said housing;

a fixed member coupled to said housing at said second end; and

a jaw having first and second sections, said first section rotatably coupled to said fixed member and said second section, said second section coupled to said translatable member and extending away from said second end of said housing, said first section having a first range of movement and said second section having a second range of movement, said first range of movement dictated by said second range of movement.

16. An apparatus as inclaim 15 wherein said first section of said jaw rotates through said first range of movement as said second section of said jaw translates through said second range of movement.

17. A surgical apparatus comprising:

an elongated outer housing having a first end and a second end;

an actuating assembly having a translatable elongated inner housing disposed within said outer housing and a handle coupled to said inner housing adjacent to said first end of said outer housing; and

a jaw having a first resilient portion and a second resilient portion, said first and second resilient portions disposed within said inner housing and extending away from said second end of said outer housing;

said inner housing concurrently urging said first and second resilient portions of said jaw toward each other when said inner housing translates through said outer housing.

18. A method comprising:

actuating a clip applier to a first position;

mating said clip applier with a first ligating clip such that said first ligating clip is held by said clip applier;

moving said clip applier adjacent to a first vessel; and

applying said first ligating clip to said first vessel by actuating said clip applier to a second position.

19. A method as inclaim 18 further comprising:

unmating said clip applier from said first ligating clip after said applying;

actuating said clip applier to a third position;

mating said clip applier with a second ligating clip such that said second ligating clip is held by said clip applier;

moving said clip applier adjacent to a second vessel;

applying said second ligating clip to said second vessel by actuating said clip applier to said second position.

20. A method as inclaim 19 wherein said first and third positions are open positions and said second position is a closed position.

21. A method as inclaim 18 wherein actuating said clip applier to said first position comprises translating an actuating member toward said clip applier and wherein actuating said clip applier to said second position comprises translating said actuating member away from said clip applier.

22. A method as inclaim 18 wherein actuating said clip applier to said first position comprises translating an actuating member away from said clip applier and wherein actuating said clip applier to said second position comprises translating said actuating member toward said clip applier.

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