CA1251113A - Surgical microclip - Google Patents
Surgical microclipInfo
- Publication number
- CA1251113A CA1251113A CA000469012A CA469012A CA1251113A CA 1251113 A CA1251113 A CA 1251113A CA 000469012 A CA000469012 A CA 000469012A CA 469012 A CA469012 A CA 469012A CA 1251113 A CA1251113 A CA 1251113A
- Authority
- CA
- Canada
- Prior art keywords
- clip
- pair
- legs
- ears
- bridge portion
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
- 210000005069 ears Anatomy 0.000 claims abstract description 16
- 238000002788 crimping Methods 0.000 claims abstract description 13
- 239000000463 material Substances 0.000 claims abstract description 11
- BASFCYQUMIYNBI-UHFFFAOYSA-N platinum Chemical compound [Pt] BASFCYQUMIYNBI-UHFFFAOYSA-N 0.000 claims description 10
- BQCADISMDOOEFD-UHFFFAOYSA-N Silver Chemical compound [Ag] BQCADISMDOOEFD-UHFFFAOYSA-N 0.000 claims description 5
- PCHJSUWPFVWCPO-UHFFFAOYSA-N gold Chemical compound [Au] PCHJSUWPFVWCPO-UHFFFAOYSA-N 0.000 claims description 5
- 229910052737 gold Inorganic materials 0.000 claims description 5
- 239000010931 gold Substances 0.000 claims description 5
- 229910052697 platinum Inorganic materials 0.000 claims description 5
- 229910052709 silver Inorganic materials 0.000 claims description 5
- 239000004332 silver Substances 0.000 claims description 5
- 108010007387 therin Proteins 0.000 claims 1
- 230000003872 anastomosis Effects 0.000 abstract description 17
- 238000000034 method Methods 0.000 description 16
- 210000001519 tissue Anatomy 0.000 description 15
- 230000002792 vascular Effects 0.000 description 9
- 230000035602 clotting Effects 0.000 description 6
- 206010053567 Coagulopathies Diseases 0.000 description 5
- 230000006378 damage Effects 0.000 description 4
- 238000001356 surgical procedure Methods 0.000 description 4
- 210000004204 blood vessel Anatomy 0.000 description 3
- 239000012528 membrane Substances 0.000 description 3
- 230000035515 penetration Effects 0.000 description 3
- 210000003989 endothelium vascular Anatomy 0.000 description 2
- 208000014674 injury Diseases 0.000 description 2
- 238000002406 microsurgery Methods 0.000 description 2
- 229910000510 noble metal Inorganic materials 0.000 description 2
- 241000282326 Felis catus Species 0.000 description 1
- 241000700159 Rattus Species 0.000 description 1
- 208000007536 Thrombosis Diseases 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 210000001367 artery Anatomy 0.000 description 1
- 230000017531 blood circulation Effects 0.000 description 1
- 230000036770 blood supply Effects 0.000 description 1
- 210000004556 brain Anatomy 0.000 description 1
- 230000003467 diminishing effect Effects 0.000 description 1
- 230000002708 enhancing effect Effects 0.000 description 1
- 210000001105 femoral artery Anatomy 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 230000000266 injurious effect Effects 0.000 description 1
- 230000000968 intestinal effect Effects 0.000 description 1
- 238000005304 joining Methods 0.000 description 1
- 230000007774 longterm Effects 0.000 description 1
- 229910052751 metal Inorganic materials 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 210000005036 nerve Anatomy 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 230000000149 penetrating effect Effects 0.000 description 1
- 229920003023 plastic Polymers 0.000 description 1
- 239000004033 plastic Substances 0.000 description 1
- 229920000642 polymer Polymers 0.000 description 1
- 230000000717 retained effect Effects 0.000 description 1
- 208000010110 spontaneous platelet aggregation Diseases 0.000 description 1
- 238000003892 spreading Methods 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
- 230000002227 vasoactive effect Effects 0.000 description 1
- 210000003462 vein Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
- A61B17/083—Clips, e.g. resilient
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1107—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels
Abstract
ABSTRACT
A surgical microclip particularly adapted for microvascular anastomoses is described as including a pair of arcuate legs interconnected by a bridging section. The clip is formed of a unitary piece of biologically acceptable, plastically deformable material, and further has two spaced "ears"
to facilitate handling and removal of the clip. Also disclosed is a tool for applying the clip, comprising a tweezer-like device having a pair of arms for crimping the microclip, with a fine suction conduit extending along a bisector of the angle between the arms to hold the clip prior to crimping.
A surgical microclip particularly adapted for microvascular anastomoses is described as including a pair of arcuate legs interconnected by a bridging section. The clip is formed of a unitary piece of biologically acceptable, plastically deformable material, and further has two spaced "ears"
to facilitate handling and removal of the clip. Also disclosed is a tool for applying the clip, comprising a tweezer-like device having a pair of arms for crimping the microclip, with a fine suction conduit extending along a bisector of the angle between the arms to hold the clip prior to crimping.
Description
~ . ~
~25~3 This invention relates generally to the field of surgery, and more particularly to the field of vascular microsurgery.
In various surgical procedures, it is necessary to unite or reunite very small blood vessels, nerves and the like. The procedure of joining blood vessels is known as vascular anastomosis. Particularly in neurosurgical procedures and in the reattachment of severed body members, the number of anastomoses required can be very numerous, and accordingly, it is advantageous and frequently necessary to perform each such connection quickly yet properly.
A prior art procedure and the present invention are discussed below in conjunction with the accompanying clrawings, in wllich:
- Figure 1 shows a prior art suturing procedure described above;
Figure 2 is an oblique view of the inventive microvascular surgical clip in its original position;
Figure 3 is a view similar to Figure 2 showing the clip in its crimped position;
Figure 4 is a profile view of a tool for applying the microsurgical clip; and Figure 5 is a view at an enlarged scale of a portion of Figure 4.
A conventional end-to-end anastomosis is illustrated in Figure 1, which shows a pair of vessels 1 and 2, each held by a respective clamp 3 or 4 while it is sutured around its circumference. The vessel ends are first approxilllated by inward traction on the two vascular clamps. The vessels may then be preliminarily interconnected by placing sutures cat two, three or four spaced locations around the circumference of the vessel--note the threads 5 and 6 in tension--whereafter the suturing 7 is completed with a needle 8.
Various suturing techniques are known, all of which are designed to: ~a) pro-vide a leak-proof connection; ~b) provide adequate tensile strength; ~c) avoid A-1613 - 1 - ~
unnecessary restriction of the vessel; (d) avoid unnecessary tearing and other trauma to the vessel; and ~e) promote rapid and thorough healing. Some of these objectives become increasingly difficult to satisy as smaller and smaller anastomoses are carried out; furthermore, the danger of accidentally catching the rear or distal wall of a vessel wlth the needle as the proximal wall is being sutured increases with diminishing vessel size.
With all vascular suturing techniques, thrombosis or clotting tends to occur at the points of needle penetration. While this clot.ting ~ould not usually be su:Eficient to occlude larger vessels, in smaller veins and arteries a significant constriction or complete occlusion o:E the vessel can result from clotting. In a recent article, the problem was summari7ed: "It is apparent to us that the damage to vascular endothelium caused by the microvascular needle perforation is considerable. The amount of subsequent platelet aggrega-tion and clot formation can be extensive, and these platelets are known to release vasoactive substances that can alter vessel diameter. This could diminish blood flow through a 1- to 2-mm vascular anastomosis expected to give immediate increased flow to an underperfused region of the brain." D. Pagnanelli et al, The Cutting Edge ~licrosurgical Needle, Journal of Neurosurgery, Volume 59, no. 3, pages 510-512 ~Sept. l9S3).
In addition to the physiological damage done by suturing, it is also significant that suturing, particularly of small vessels, is a very tedious time-consuming procedure which can preoccupy and :Ea-tigue a surgeon over the course of a long procedure. A more rapid way of performing microvascular anastomoses could free the surgeon for other tasks, and could shorten surgical procedures as well. The need for a workable, rapid, non-suturing technique for microsurgery is obvious.
~25~ 3 Various non-suture devices and techniques for per-forming anastomoses are known, particularly for intestinal and colorectal anastomoses, for which various stapling apparatus and methods have been known for some years. Known stapling techniques, require penetration of the organ wall, and if applied to vascular anastomoses, the problems of clotting and the like, as described above, could be expected to arise. For vascular anastomosis, various other non-suture mechanical clamps have been suggested. Such clamps frequentlyinclude a permanent or sacrificial ferrule or the like and means for clamping the vessel against the ferrule so that penetration of the vessel wall is avoided. However, clamps of this type have not gained wide-spread acceptance.
According to the invention, a surgical microclip comprises a bridge portion, and a pair of legs extending side by side from opposite ends of the bridge portion, each leg terminating at a tip rounded sufficiently in the plane of the microclip to avoid puncturing body tissue clamped between the two tips and the clip being constructed of a bilogically acceptable, plastically deformable, substantially non-elastically deformable material, whereby the clip may be permanently deformed by crimping to close the legs around, and hold together without the tips of the legs puncturing, approximated body tissues.
Use of the new clip enables a substantial increase in the speed of microvascular anastomoses while avoiding the clotting problems caused by conventional suturing procedures. Material costs and duration of microsurgical procedures may be reduced.
The new microsurgical clip may be permanently implanted for use in place of microvascular suturing. The clip can also be easily held and applied during vascular anastomoses.
The clip may be used in a surgical procedure such as an anastomosis wherein a pair of tissues is approximated, then partially everted, and then joined by placing the legs of the clip over the adjoined tissues and crimping the legs about the tissues in such a way as to hold the tissues together without penetrating them.
The biologically acceptab~le material from which the clip is made, may be a noble metal such as silver, gold or platinum.
The legs may be arcuate with the concave slides of the legs facing one another.
The clip preferably also includes a pair of ears extending generally parallel from opposite ends of the bridge portion in a direction opposite to that in which the legs project, whereby the ears facilitate manipulation of the clip prior to placement and further provide means for opening the clip if removal is desired. Furthermore, each ear constitutes a convenient means by which the clip may be held, e.g. by a vacuum conduit.
The clip may be applied by a tool comprising a pair of interconnected arms capable of pivoting motion with respect to one another. Each arm is curved inwardly at its lower 125~3 end with the distal portions of the arms directed substantially at one another so that one can crimp a microsurgical clip between the jaws of the tool by applying inward pressure on the arms.
A fine suction conduit, connected to the tool and extending generally along a bisector of the two arms, terminates slightly above the point of closure of the distal ends of the arms.
The inside diameter of the tube is sized to fit over one of the clip ears whereby the clip can be retained indefinately at the distal end of the tube by the vacuum therein. This facilitates manipulation of the clip in the surgical field as the clip is positioned astride abutting tissues and then crimped.
As shown in Figure 2, a surgical microclip embodying the invention is formed of a unitary piece of biologically accep-table, plastically deformable material such as a noble metal (i.e. gold, silver, platinum, etc.). While metal clips are presently preferred, it is contemplated that other materials -4a-such as suitable polymer plastics may be used. Whatever the material, it must be sufficiently ductile or plastically deformable so that when the clip is crimped there is minimal spring-back. Otherwise, possible injurious overcrimp-ing, to compensate for the spring-back, would be required.
Structurally, the clip includes a pair of inwardly curved legs 10 and 11 interconnected by a bridging section 12, the two legs extending generally parallel in one direction from the bridging section. The legs terminate at tips 15 and 16 which are rounded to prevent injury to the subject tlssue in accordancc Wit]l an object of this invention. The outer side of each leg ncar its mid-point is provided with a detent 17 or lS :Eor receiving the jaws of an applicator tool. Preferably, the clip further includes a pair of spaced ears 13 ancL l~ extending from the bridging section in a direction generally opposite that of the legs; however, the ears may not be necessary or desirable for certain applications, and earless clips are within the ambit of the invention in its broadest sense.
The size of the clip will naturally vary according -to the applica-tion, and it is not intended to limit the scope of this inven-tion to any particular size clip. }lowever, for the sake of illustration, for the anastomo-sis of a l-mm vessel an appropriate size clip has an overall height on the order of .030 inches and an overall thickness on the order of .006 inches. For this size clip, the radills of curvature of the tip of each leg is approximately .001 inches, and the radius o:E each detent is about .010 inches.
Figure 3 illustrates the shape of the clip once it has been deformed by crimping. Note that most or all of the permanent deformation occurs in the bridge section 12 ratller than the legs 10 and 11. Arrows C and D illustrate points at which inward force is applied when crimping the clip in place over a pair of adjoined membranes, which are designated by the reference numerals 20 and 21. These membranes could be the partially everted outer walls o a blood vessel, as illustrated in Figure 1, but inasmuch as the usefulness of the invention is not limited to anastomoses, the illustrated membranes could be non-vascular.
Figure 4 illustrates a tweezer-type tool for holding and crimping the microclips described above. The tool comprises two arms 30 and 31 which are resiliently interconnected at a head or handle 32. The distal ends oE the arms are curved inwarclly towarcls each other, terminating at tips 33 and 34 having roughly the same radius o.E curvature as the detents 17 and 18 they are intended to engage. In order to hold the microclips in position prior to crimp-ing, a vacuum conduit 35 is provided, which conduit is of very small diameter and extends generally along a bisector of the angle between the arms 30 and 31.
In Figure 5, a microclip is illustrated at the bottom end of conduit 35, this Figure showing the clip and portions of the tool at an enlarged scale.
Figure 5 shows the lower end of the conduit 35, the arrow indicat-ing the direction of a source of vacuum. As shown, a clip has been positioned at the bottom of the tube with one of the ears actually in the tube; the vacuum retains the clip in this position while it is being applied, thereby minimizing the likelihood o-f losing a clip within the surgical field.
In use, a pair of tissues to be joined are first drawn together in apposition (appro~imated} by suitable means. The edges of the tissues should be partially everted, that is, pursed outwardly, so that a clip can be placed over the tissue edges, with the legs of the clip astride the point of apposition.
Once the clip has been positioned properly with respect to the subject tissue, crimping is effected simply by squeezing together the arms 30 and 31 of the ,~
tool. This causes permanent deformation of the microclip bridge section 12, whereafter the clip retains the tissues in apposition without puncturing them. This procedure is repeated at as many points as needed to fully join the subject tissues. The clips, being biologically inertJ ordinarily may be left in place permanently. However, in the event that the clip must be removed, a plier tool or the like may be used to force the ears 13 and 1~ together~ there-by spreading the legs 10 and 11 and releasing the tissue therebetween.
The microclip and applier tool described above provide a sutureless means or the apposition of tissue whicll is substantially faster than conven-tional suturing methods, particularly in mlcrovascular anastomosis and which avoids the clotting problem caused by needle perforations. In testing on femoral arteries in rats, short and long term patency and remarkably little damage to the vascular endothelium have been observed.
An advantage of microclips over sutures is the predictability of results. In contrast to hand-made micro-suturing needles, the mass-produced microclips are uniform, producing more uniform results.
An additional advantage is that the speed of application reduces the time blood supply is interrupted, enhancing prospects for vessel patency.
It should be understood that the foregoing description and drawings describe and illustrate but one embodiment of the invention, whose scope should be measured by the following claims.
~25~3 This invention relates generally to the field of surgery, and more particularly to the field of vascular microsurgery.
In various surgical procedures, it is necessary to unite or reunite very small blood vessels, nerves and the like. The procedure of joining blood vessels is known as vascular anastomosis. Particularly in neurosurgical procedures and in the reattachment of severed body members, the number of anastomoses required can be very numerous, and accordingly, it is advantageous and frequently necessary to perform each such connection quickly yet properly.
A prior art procedure and the present invention are discussed below in conjunction with the accompanying clrawings, in wllich:
- Figure 1 shows a prior art suturing procedure described above;
Figure 2 is an oblique view of the inventive microvascular surgical clip in its original position;
Figure 3 is a view similar to Figure 2 showing the clip in its crimped position;
Figure 4 is a profile view of a tool for applying the microsurgical clip; and Figure 5 is a view at an enlarged scale of a portion of Figure 4.
A conventional end-to-end anastomosis is illustrated in Figure 1, which shows a pair of vessels 1 and 2, each held by a respective clamp 3 or 4 while it is sutured around its circumference. The vessel ends are first approxilllated by inward traction on the two vascular clamps. The vessels may then be preliminarily interconnected by placing sutures cat two, three or four spaced locations around the circumference of the vessel--note the threads 5 and 6 in tension--whereafter the suturing 7 is completed with a needle 8.
Various suturing techniques are known, all of which are designed to: ~a) pro-vide a leak-proof connection; ~b) provide adequate tensile strength; ~c) avoid A-1613 - 1 - ~
unnecessary restriction of the vessel; (d) avoid unnecessary tearing and other trauma to the vessel; and ~e) promote rapid and thorough healing. Some of these objectives become increasingly difficult to satisy as smaller and smaller anastomoses are carried out; furthermore, the danger of accidentally catching the rear or distal wall of a vessel wlth the needle as the proximal wall is being sutured increases with diminishing vessel size.
With all vascular suturing techniques, thrombosis or clotting tends to occur at the points of needle penetration. While this clot.ting ~ould not usually be su:Eficient to occlude larger vessels, in smaller veins and arteries a significant constriction or complete occlusion o:E the vessel can result from clotting. In a recent article, the problem was summari7ed: "It is apparent to us that the damage to vascular endothelium caused by the microvascular needle perforation is considerable. The amount of subsequent platelet aggrega-tion and clot formation can be extensive, and these platelets are known to release vasoactive substances that can alter vessel diameter. This could diminish blood flow through a 1- to 2-mm vascular anastomosis expected to give immediate increased flow to an underperfused region of the brain." D. Pagnanelli et al, The Cutting Edge ~licrosurgical Needle, Journal of Neurosurgery, Volume 59, no. 3, pages 510-512 ~Sept. l9S3).
In addition to the physiological damage done by suturing, it is also significant that suturing, particularly of small vessels, is a very tedious time-consuming procedure which can preoccupy and :Ea-tigue a surgeon over the course of a long procedure. A more rapid way of performing microvascular anastomoses could free the surgeon for other tasks, and could shorten surgical procedures as well. The need for a workable, rapid, non-suturing technique for microsurgery is obvious.
~25~ 3 Various non-suture devices and techniques for per-forming anastomoses are known, particularly for intestinal and colorectal anastomoses, for which various stapling apparatus and methods have been known for some years. Known stapling techniques, require penetration of the organ wall, and if applied to vascular anastomoses, the problems of clotting and the like, as described above, could be expected to arise. For vascular anastomosis, various other non-suture mechanical clamps have been suggested. Such clamps frequentlyinclude a permanent or sacrificial ferrule or the like and means for clamping the vessel against the ferrule so that penetration of the vessel wall is avoided. However, clamps of this type have not gained wide-spread acceptance.
According to the invention, a surgical microclip comprises a bridge portion, and a pair of legs extending side by side from opposite ends of the bridge portion, each leg terminating at a tip rounded sufficiently in the plane of the microclip to avoid puncturing body tissue clamped between the two tips and the clip being constructed of a bilogically acceptable, plastically deformable, substantially non-elastically deformable material, whereby the clip may be permanently deformed by crimping to close the legs around, and hold together without the tips of the legs puncturing, approximated body tissues.
Use of the new clip enables a substantial increase in the speed of microvascular anastomoses while avoiding the clotting problems caused by conventional suturing procedures. Material costs and duration of microsurgical procedures may be reduced.
The new microsurgical clip may be permanently implanted for use in place of microvascular suturing. The clip can also be easily held and applied during vascular anastomoses.
The clip may be used in a surgical procedure such as an anastomosis wherein a pair of tissues is approximated, then partially everted, and then joined by placing the legs of the clip over the adjoined tissues and crimping the legs about the tissues in such a way as to hold the tissues together without penetrating them.
The biologically acceptab~le material from which the clip is made, may be a noble metal such as silver, gold or platinum.
The legs may be arcuate with the concave slides of the legs facing one another.
The clip preferably also includes a pair of ears extending generally parallel from opposite ends of the bridge portion in a direction opposite to that in which the legs project, whereby the ears facilitate manipulation of the clip prior to placement and further provide means for opening the clip if removal is desired. Furthermore, each ear constitutes a convenient means by which the clip may be held, e.g. by a vacuum conduit.
The clip may be applied by a tool comprising a pair of interconnected arms capable of pivoting motion with respect to one another. Each arm is curved inwardly at its lower 125~3 end with the distal portions of the arms directed substantially at one another so that one can crimp a microsurgical clip between the jaws of the tool by applying inward pressure on the arms.
A fine suction conduit, connected to the tool and extending generally along a bisector of the two arms, terminates slightly above the point of closure of the distal ends of the arms.
The inside diameter of the tube is sized to fit over one of the clip ears whereby the clip can be retained indefinately at the distal end of the tube by the vacuum therein. This facilitates manipulation of the clip in the surgical field as the clip is positioned astride abutting tissues and then crimped.
As shown in Figure 2, a surgical microclip embodying the invention is formed of a unitary piece of biologically accep-table, plastically deformable material such as a noble metal (i.e. gold, silver, platinum, etc.). While metal clips are presently preferred, it is contemplated that other materials -4a-such as suitable polymer plastics may be used. Whatever the material, it must be sufficiently ductile or plastically deformable so that when the clip is crimped there is minimal spring-back. Otherwise, possible injurious overcrimp-ing, to compensate for the spring-back, would be required.
Structurally, the clip includes a pair of inwardly curved legs 10 and 11 interconnected by a bridging section 12, the two legs extending generally parallel in one direction from the bridging section. The legs terminate at tips 15 and 16 which are rounded to prevent injury to the subject tlssue in accordancc Wit]l an object of this invention. The outer side of each leg ncar its mid-point is provided with a detent 17 or lS :Eor receiving the jaws of an applicator tool. Preferably, the clip further includes a pair of spaced ears 13 ancL l~ extending from the bridging section in a direction generally opposite that of the legs; however, the ears may not be necessary or desirable for certain applications, and earless clips are within the ambit of the invention in its broadest sense.
The size of the clip will naturally vary according -to the applica-tion, and it is not intended to limit the scope of this inven-tion to any particular size clip. }lowever, for the sake of illustration, for the anastomo-sis of a l-mm vessel an appropriate size clip has an overall height on the order of .030 inches and an overall thickness on the order of .006 inches. For this size clip, the radills of curvature of the tip of each leg is approximately .001 inches, and the radius o:E each detent is about .010 inches.
Figure 3 illustrates the shape of the clip once it has been deformed by crimping. Note that most or all of the permanent deformation occurs in the bridge section 12 ratller than the legs 10 and 11. Arrows C and D illustrate points at which inward force is applied when crimping the clip in place over a pair of adjoined membranes, which are designated by the reference numerals 20 and 21. These membranes could be the partially everted outer walls o a blood vessel, as illustrated in Figure 1, but inasmuch as the usefulness of the invention is not limited to anastomoses, the illustrated membranes could be non-vascular.
Figure 4 illustrates a tweezer-type tool for holding and crimping the microclips described above. The tool comprises two arms 30 and 31 which are resiliently interconnected at a head or handle 32. The distal ends oE the arms are curved inwarclly towarcls each other, terminating at tips 33 and 34 having roughly the same radius o.E curvature as the detents 17 and 18 they are intended to engage. In order to hold the microclips in position prior to crimp-ing, a vacuum conduit 35 is provided, which conduit is of very small diameter and extends generally along a bisector of the angle between the arms 30 and 31.
In Figure 5, a microclip is illustrated at the bottom end of conduit 35, this Figure showing the clip and portions of the tool at an enlarged scale.
Figure 5 shows the lower end of the conduit 35, the arrow indicat-ing the direction of a source of vacuum. As shown, a clip has been positioned at the bottom of the tube with one of the ears actually in the tube; the vacuum retains the clip in this position while it is being applied, thereby minimizing the likelihood o-f losing a clip within the surgical field.
In use, a pair of tissues to be joined are first drawn together in apposition (appro~imated} by suitable means. The edges of the tissues should be partially everted, that is, pursed outwardly, so that a clip can be placed over the tissue edges, with the legs of the clip astride the point of apposition.
Once the clip has been positioned properly with respect to the subject tissue, crimping is effected simply by squeezing together the arms 30 and 31 of the ,~
tool. This causes permanent deformation of the microclip bridge section 12, whereafter the clip retains the tissues in apposition without puncturing them. This procedure is repeated at as many points as needed to fully join the subject tissues. The clips, being biologically inertJ ordinarily may be left in place permanently. However, in the event that the clip must be removed, a plier tool or the like may be used to force the ears 13 and 1~ together~ there-by spreading the legs 10 and 11 and releasing the tissue therebetween.
The microclip and applier tool described above provide a sutureless means or the apposition of tissue whicll is substantially faster than conven-tional suturing methods, particularly in mlcrovascular anastomosis and which avoids the clotting problem caused by needle perforations. In testing on femoral arteries in rats, short and long term patency and remarkably little damage to the vascular endothelium have been observed.
An advantage of microclips over sutures is the predictability of results. In contrast to hand-made micro-suturing needles, the mass-produced microclips are uniform, producing more uniform results.
An additional advantage is that the speed of application reduces the time blood supply is interrupted, enhancing prospects for vessel patency.
It should be understood that the foregoing description and drawings describe and illustrate but one embodiment of the invention, whose scope should be measured by the following claims.
Claims (8)
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. A surgical microclip comprising a bridge portion, and a pair of legs extending side by side from opposite ends of the bridge portion, each leg terminating at a tip rounded sufficiently in the plane of the microclip to avoid puncturing body tissue clamped between the two tips and the clip being constructed of a biologically acceptable, plastically deformable, substantially non-elastically deformable material, whereby the clip may be permanently deformed by crimping to close the legs around, and hold together without the tips of the legs puncturing, approximated body tissues.
2. A clip according to claim 1, wherein the legs are arcuate with the concave sides of the legs facing one another.
3. A clip according to claim 1 or claim 2, further comprising a pair of ears extending generally parallel from opposite ends of the bridge portion in a direction opposite to -that in which the legs project, whereby the ears facilitate manipulation of the clip prior to placement and further provide means for opening the clip if removal is desired.
4. A clip according to claim 1 or 2, wherein the mat-erial is selected from the group consisting of silver, gold and platinum.
5. A clip according to claim 1 or claim 2, further comprising a pair of ears extending generally parallel from opposite ends of the bridge portion in a direction opposite to that in which the legs project, whereby the ears facilitate manipulation of the clip prior to placement and further provide means for opening the clip if removal is desired, wherein the material is selected from the group consisting of silver, gold and platinum.
6. A clip according to claim 1 or claim 2, wherein the outer side of each leg has a detent therein for receiving a respective one of a pair of jaws of a crimping tool.
7. A clip according to claim 1 or claim 2, further comprising a pair of ears extending generally parallel from opposite ends of the bridge portion in a direction opposite to that in which the legs project, whereby the ears facilitate manipulation of the clip prior to placement and further provide means for opening the clip if removal is desired, wherein the outer side of each leg has a detent therein for receiving a respective one of a pair of jaws of a crimping tool.
8. A clip according to claim 1 or claim 2, further comprising a pair of ears extending generally parallel from opposite ends of the bridge portion in a direction opposite to that in which the legs project, whereby the ears facilitate manipulation of the clip prior to placement and further provide means for opening the clip if removal is desired, wherein the material is selected from the group consisting of silver, gold and platinum and wherein the outer side of each leg has a detent therin for receiving a respective one of a pair of jaws of a crimping tool.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US06/556,917 US4586503A (en) | 1983-12-01 | 1983-12-01 | Surgical microclip |
| US556,917 | 1983-12-01 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1251113A true CA1251113A (en) | 1989-03-14 |
Family
ID=24223343
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000469012A Expired CA1251113A (en) | 1983-12-01 | 1984-11-30 | Surgical microclip |
Country Status (7)
| Country | Link |
|---|---|
| US (1) | US4586503A (en) |
| CA (1) | CA1251113A (en) |
| DE (1) | DE3443367A1 (en) |
| FR (1) | FR2557448B1 (en) |
| GB (1) | GB2150440B (en) |
| IT (1) | IT1181465B (en) |
| SE (1) | SE454321B (en) |
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| US10470759B2 (en) | 2015-03-16 | 2019-11-12 | Edwards Lifesciences Corporation | Suture securement devices |
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| RU2690914C1 (en) * | 2018-02-22 | 2019-06-06 | федеральное государственное бюджетное учреждение "Российский научный центр "Восстановительная травматология и ортопедия" имени академика Г.А. Илизарова"Министерства здравоохранения Российской Федерации, ФГБУ "РНЦ "ВТО" им. акад. Г.А. Илизарова" Минздрава России | Set of instruments for vascular anastomosis |
| AU2019243731A1 (en) | 2018-03-28 | 2020-10-08 | Datascope Corp. | Device for atrial appendage exclusion |
| US20210212673A1 (en) * | 2018-06-11 | 2021-07-15 | University Of Louisville Research Foundation, Inc. | Trocar site closure clip |
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| US1514259A (en) * | 1923-01-25 | 1924-11-04 | Peters Gustav | Surgical implement for applying clips to wounds |
| US1728316A (en) * | 1927-07-02 | 1929-09-17 | Kirurgiska Instr Fabriks Aktie | Wound clasp |
| US2201610A (en) * | 1938-05-20 | 1940-05-21 | Jr James C Dawson | Wound clip |
| GB549942A (en) * | 1940-09-27 | 1942-12-15 | Seymour Schumann | An improved surgical clip |
| FR1075529A (en) * | 1952-03-24 | 1954-10-18 | Technical Oil Tool Corp | Improvements in staples for sutures, staple holders used to hold a stack of such staples and extractors used to remove the latter |
| GB742403A (en) * | 1952-03-24 | 1955-12-30 | Technical Oil Tool Corp | Improvements in or relating to wound clips, a rack for holding a stack of wound clips, and an extractor for removing said wound clips |
| US2662524A (en) * | 1952-08-07 | 1953-12-15 | Archibald P Hudgins | Tenacular needle |
| US2887110A (en) * | 1956-10-12 | 1959-05-19 | Benno K A Roeschmann | Forceps for removing skin clips |
| US3273562A (en) * | 1960-02-24 | 1966-09-20 | Rene G Le Vaux | Skin and surgical clips |
| US3082426A (en) * | 1960-06-17 | 1963-03-26 | George Oliver Halsted | Surgical stapling device |
| US3110899A (en) * | 1962-04-12 | 1963-11-19 | Ethicon Inc | Surgical clip applier |
| US3131448A (en) * | 1962-05-09 | 1964-05-05 | Edward J Glatz | Poultry clip device |
| US3326216A (en) * | 1964-03-30 | 1967-06-20 | Peter B Samuels | Hemostatic clip constructions |
| GB1030556A (en) * | 1964-09-08 | 1966-05-25 | Marthe Erdos Brown | A clip holder and applicator |
| US3363628A (en) * | 1964-09-28 | 1968-01-16 | Peter B Samuels | Hemostatic clip |
| US3463156A (en) * | 1965-05-27 | 1969-08-26 | Edward B Mcdermott | Hemostatic clip and applicator |
| US3446212A (en) * | 1965-07-19 | 1969-05-27 | New Research & Dev Lab Inc | Hemostatic clip and applicator therefor |
| US3361133A (en) * | 1965-07-22 | 1968-01-02 | Canadian Patents Dev | Vacuum artery clamp |
| GB1085559A (en) * | 1966-03-11 | 1967-10-04 | Parke Davis & Co | Surgical clip |
| US3487836A (en) * | 1968-07-16 | 1970-01-06 | Benjamin W Niebel | Surgical strip stitch |
| FR1589824A (en) * | 1968-10-23 | 1970-04-06 | ||
| US3604425A (en) * | 1969-04-11 | 1971-09-14 | New Research And Dev Lab Inc | Hemostatic clip |
| BE754137A (en) * | 1969-07-29 | 1971-01-29 | Ici Ltd | FORCEPS TO APPLY SURGICAL CLIPS |
| US3807406A (en) * | 1971-06-25 | 1974-04-30 | Bio Medicus Inc | Instrument surgical with suction device |
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| BE793463A (en) * | 1971-12-29 | 1973-06-28 | Ici Ltd | STAPLE REMOVAL INSTRUMENT |
| DE2308846C3 (en) * | 1972-02-24 | 1979-11-29 | Pierre Perisse | Device for ligation of blood vessels |
| US3825009A (en) * | 1973-03-19 | 1974-07-23 | J Williams | Method of surgically repairing damaged ear drums |
| US3916909A (en) * | 1973-08-01 | 1975-11-04 | Bio Medicus Inc | Suction surgical instrument of the forceps type |
| US3980086A (en) * | 1974-02-28 | 1976-09-14 | Bio-Medicus, Inc. | Fluid conveying surgical instrument |
| US4096864A (en) * | 1975-03-26 | 1978-06-27 | Bio-Medicus, Inc. | Fluid carrying surgical instrument of the forceps type |
| SU566574A1 (en) * | 1975-05-04 | 1977-07-30 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Apparatus for applying linear agraffe suture on organs and tissue |
| US4049002A (en) * | 1975-07-18 | 1977-09-20 | Bio-Medicus, Inc. | Fluid conveying surgical instrument |
| SU1088712A1 (en) * | 1979-11-14 | 1984-04-30 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Apparatus for circular suture of blood vessels |
| US4324248A (en) * | 1980-05-30 | 1982-04-13 | Metatech Corporation | Microsurgical clip |
| US4397312A (en) * | 1981-06-17 | 1983-08-09 | Dittmar & Penn Corp. | Clip applying forceps |
| US4465071A (en) * | 1981-10-26 | 1984-08-14 | Samuels Peter B | Method of applying skin clips |
-
1983
- 1983-12-01 US US06/556,917 patent/US4586503A/en not_active Expired - Lifetime
-
1984
- 1984-11-14 GB GB08428755A patent/GB2150440B/en not_active Expired
- 1984-11-28 DE DE19843443367 patent/DE3443367A1/en active Granted
- 1984-11-30 SE SE8406053A patent/SE454321B/en not_active IP Right Cessation
- 1984-11-30 IT IT84146/84A patent/IT1181465B/en active
- 1984-11-30 FR FR848418256A patent/FR2557448B1/en not_active Expired - Lifetime
- 1984-11-30 CA CA000469012A patent/CA1251113A/en not_active Expired
Also Published As
| Publication number | Publication date |
|---|---|
| SE454321B (en) | 1988-04-25 |
| FR2557448A1 (en) | 1985-07-05 |
| SE8406053D0 (en) | 1984-11-30 |
| US4586503A (en) | 1986-05-06 |
| GB2150440A (en) | 1985-07-03 |
| GB8428755D0 (en) | 1984-12-27 |
| IT8484146A0 (en) | 1984-11-30 |
| DE3443367A1 (en) | 1985-06-13 |
| SE8406053L (en) | 1985-06-02 |
| DE3443367C2 (en) | 1989-03-09 |
| GB2150440B (en) | 1987-02-18 |
| IT1181465B (en) | 1987-09-30 |
| FR2557448B1 (en) | 1990-03-30 |
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Legal Events
| Date | Code | Title | Description |
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| MKEX | Expiry |