US3683927A - Method and cartridge for ligating organic tubular structures - Google Patents

Method and cartridge for ligating organic tubular structures Download PDF

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Publication number
US3683927A
US3683927A US64749A US3683927DA US3683927A US 3683927 A US3683927 A US 3683927A US 64749 A US64749 A US 64749A US 3683927D A US3683927D A US 3683927DA US 3683927 A US3683927 A US 3683927A
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Prior art keywords
staple
guide track
cartridge
anvil
pusher
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US64749A
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Douglas G Noiles
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United States Surgical Corp
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United States Surgical Corp
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10TTECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00Metal working
    • Y10T29/53Means to assemble or disassemble
    • Y10T29/53709Overedge assembling means
    • Y10T29/53787Binding or covering

Definitions

  • the organic tubular structure is loosely confined within an area which is variable in accordance with the position of the ligating surgical staples.
  • the staples being U-shaped are moved toward the organic tubular structure, thereby decreasing the confining area, until the arms of the staples begin to bend around the structure.
  • the staple arms are bent until they encircle the tubular structure and contact one another; then the staples are further deformed, by acting on the surfaces remote from the contacting arms, until the tubular structure is completely sealed.
  • the periphery of the tubular structure is positively controlled by the ligating cartridge, thereby ensuring the integrity of the structure.
  • a ligating surgical cartridge which operates by first constricting the organic tubular structure to be ligated, between its jaws, and by then bending a pair of relatively linear staples around the structure until the structure is sealed off.
  • a ligating surgical cartridge which operates by first constricting the organic tubular structure to be ligated, between its jaws, and by then bending a pair of relatively linear staples around the structure until the structure is sealed off.
  • portions of the tubular structure which are out of the control of the cartridge. That is, there are portions of the tubular structure which are free from the positive constraining effects of the cartridge jaws, and which, therefore, are able to flex as a result of forces centered about other portions thereof. Due to this lack of positive control, the danger exists that the staples, when encircling the tubular structure, may pierce or scratch the structure. And when dealing with organic structures, such as blood vessels, punctures and surface damage may lead to severe problems.
  • the present invention relates to a method and a cartridge for applying a pair of ligating surgical staples to an organic tubular structure in such a manner that the integrity of the structure is ensured. More particularly, the inventive method and cartridge eliminate the drawbacks of the prior art by providing positive control of the entire surface of the tubular structure during the staple-bending portion of the ligating operation. In this manner, the ligating staples encircle the organic tubular structure without the danger of piercing or scratching the surface thereof.
  • the present invention contemplates that the organic tubular structure to be ligated, be loosely positioned within the jaws of a ligating cartridge.
  • their arms With continued movement of the staples, their arms are bent around the anvil, encircle the tubular structure, and close upon one another. Then, the region of each staple remote from the point of contact between the staple arms is deformed and urged toward the contacting staple arms, this deformation continuing until the organic tubular structure is completely sealed.
  • the entire periphery of the organic tubular structure is positively controlled.
  • Still a further object of the present invention is to provide a method and an apparatus for safely andefficiently ligating an organic tubular structure by means of surgical staples, by controlling the surface area of the tubular structure at all times during the ligation.
  • FIG. 1 is a side view of a surgical cartridge, showing a portion of an associated firing instrument, designed in accordance with the teachings of the present invention
  • FIG. 2 is a cross-section of the cartridge taken along line 2-2 of FIG. 1;
  • FIG. 3 is a side view of the main body of the surgical cartridge illustrated in FIG. 1;
  • FIG. 4 is a top view of the main body illustrated in FIG. 3;
  • FIG. 5 is a top view of the inventive cartridge illustrated in FIG. 1;
  • FIG. 6 is a cross-section of the inventive cartridge taken along line 66 of FIG. I
  • FIG. 7 is a cross-section of the cartridge taken along line 7-7 of FIG. 6;
  • FIG. 8 is a cross-section similar to FIG. 7 but showing a portion of the inventive cartridge during the early stages of ligation;
  • FIGS. 9 through 12 are enlarged cross-sections through the inventive cartridge showing the staple formation during various stages of the ligation.
  • FIG. 13 is a front view of a staple showing the manner in which the mating of the staple arms takes place.
  • the cartridge is shown generally at and comprises a three-piece main body portion 12, a pair of three-piece rail assemblies 14 and a pair of pushers 16.
  • the firing instrument is shown generally at 18.
  • the firing instrument 18 may be of the type described in either U.S. Pat. application Ser. No. 766,680 or U.S. Pat. application Ser. No. 32,247, each mentioned above; and for purposes of description, only a portion of the firing instrument 18 will be described.
  • the instrument 18, at its forward end, is provided with a groove 20 and a thumb-operated cover plate 22; and as seen in FIGS. 1 and 5, the cartridge 10, at the rear end of the rail assemblies 14, is provided with a coupling bar 24.
  • Bar 24 is adapted to mate with the groove 20 and is held in position by the cover-plate 22.
  • the three elements of each rail assembly 14 are maintained in proper alignment by a plastic form 26, and the coupling bar 24 ensures unity between the rail assemblies and the form 26.
  • Cover plate 22 contacts the lower surface of the form 26.
  • the output of the firing instrument 18 takes the form of a pair of shafts 28 and 30, each movable with respect to the front nose 32 of the firing instrument 18.
  • Shaft 28 lies within hollow shaft 30 and is movable with respect thereto.
  • On the forward end of the shaft 28 are positioned a pair of shoulders 34, and on the forward end of the shaft 30 are positioned a pair of shoulders 36. While the complete operation of the firing instrument 18 is not herein explained, suffice it to say that upon activation of the instrument 18, the shafts 28 and 30, with their respective shoulders 34 and 36, move in unison, away from the front nose 32 of the instrument 18.
  • a biasing spring operates between the shafts 28 and 30 and consequently between the shoulders 34 and 36.
  • the rear region of the body 12 is provided with a depression 38 adapted to mate with the forwardmost of the two shoulders 36.
  • the other shoulder 36 contacts the rear of the main body 12.
  • the rear region of each pusher 16 is provided with a notch 40, adapted to mate with the forwardmost of the two shoulders 34.
  • the other shoulder 34 contacts the rear of the pusher 16. Therefore, the shoulders 34 and 36 serve, respectively, as saddles within which the pushers l6 and the main body 12 are seated and controlled.
  • the three-piece main body 12 takes the form of a central body member 42 sandwiched between a pair of cover plates 44.
  • the central body member 42 and the cover plates 44 are held together by means of four rivets or bolts 46.
  • the central body member 42 when covered by plates 44, is provided with a first elongated groove 48 and a second elongated groove 50, groove 48 being the deeper of the two.
  • the groove 48 may be termed a rail guiding groove and the groove 50 may be termed a staple and pusher guiding groove.
  • the forward endof the central body member 42 is thin, is elongated, and is tapered at its extremity, as indicated by the numeral 52. Slightly rearward of the taper 52, for reasons which will become apparent from the following, a section is removed from each side of the forward end of the main body member 42. Each side of the main body member 42, where a section is removed, has defined therein an angled sloping indented wall 54.
  • the rear portion of the central body member 42 which is adapted to mate with the firing instrument 18, is open as shown at 55. In this manner, the shafts 28 and 30, and their associated shoulders 34 and 36, are easily associated with the main body.
  • the cartridge 10 includes a pair of rail assemblies 14, each of these assemblies being of three-piece construction.
  • Each rail assembly 14 comprises a central guide rail 56, an outer restraining plate 58 and an inner restraining plate 60.
  • Inner restraining plate 60 is wider than outer restraining plate 58, so as to ensure that the guide rails 14 remain in the rail guiding grooves 48, defined between the central body member 42 and the cover plates 44.
  • the integrity of each three-piece rail assembly 14 is ensured by a pin 61 passing through the outer restraining plate 60, at the forward end thereof, and the plastic form 26, with its bar 24, at the rear thereof.
  • the respective forward ends of the outer restraining plate 58 and the inner restraining plate 60 are cut at an angle, as shown at 66, so as to mate with the sloping wall 52 on the central body member 42.
  • the forward end of the guide rail 56 is cut at an angle, as shown at 64, so as to mate with the taper 54 on the central body member 42. Therefore, and as illustrated in FIG. 8, the mating of the faces 52 and 66 and the mating of the faces 54 and 64 is smooth and positive, so that the rail assembly 14 mates with the main body 12 defining a continuous anvil region 86.
  • Each pusher 16 is elongated, is of a height substantially equal to that of the staples and that of the pusher guiding groove 50, and is of a width slightly in excess of the thickness of a staple, shown at 68.
  • the forward end of each pusher 16 is diminished in height from the remaining portions of the pusher and is rounded as shown at 70 in FIG. 10.
  • the rounded portion of each pusher takes a shape so as to comfortably unite with the rounded anvil regions 86.
  • the radius of the curved pusher faces is, however, less than the radius of the curved anvils so as to allow for the intermediate positioning of the organic tubular structure and two thicknesses of the staple.
  • a circular restraining disc 72 is secured on each flat side of the rounded projection 70 .
  • the discs 72 ensure that the staples 68 are held in proper alignment with the rounded projections 70 of the pushers l6, and as can be seen in FIG. 2, the shape of the grooves 50 allows for the presence of these discs.
  • the width of the pushers 16 is equal to the width of the respective central guide rails 56. Therefore, the bottom portions of the pushers 16 are guided by the guide rails 56. The pushers are restrained against unwanted transverse motion by the shape of the groove 50 and the restraining plates 58 and 60.
  • the inventive cartridge is made removable from the firing instrument, is made disposable, and may be presterilized and packaged for shipment to the surgical arena.
  • FIGS. 1 and 8 through 12 For a discussion of the cartridge operation, the attention of the reader is directed to FIGS. 1 and 8 through 12.
  • an organic tubular structure 76 such as a blood vessel, is inserted between the open respective ends of the rail assemblies 14 and the main body 12 (FIG. 1).
  • Arrow 74 indicates the manner in which the structure 76 is inserted.
  • the surgeon activates the firing instrument 18.
  • the initial action of the surgeon-operated firing instrument 18 is to simultaneously move the shafts 28 and 30, and thus the shoulders 34 and 36, away from the front nose 32 of the firing instrument 18.
  • the main body 12 of the cartridge 10 in unison with the pushers 16, move relative to the rail assemblies 14. That is, the main body 12 and the pushers 16 move in the direction of arrows 78 (FIG. 6), the rail assembly 14 remaining stationary, being rigidly secured to the firing instrument 18. This relative motion continues until the mating of the main body 12 with the rail assemblies 14, as illustrated in FIG. 8.
  • the main body 12 and the rail assemblies 14 Once the mating faces of the main body 12 and the rail assemblies 14 come into contact with one another, the main body can no longer move in the direction of the arrow 78. Accordingly, continued force exerted on the firing instrument 18 by the surgeon results in no relative motion of elements until the differential force between the shafts 28 and 30 is reached. However, once this differential force is reached, the shaft 28 moves forward within and with respect to the shaft 30. Accordingly, shoulders 34 move away from shoulders 36. Since the shoulders 34 are in direct association with the pushers 16, the pushers 16 move in the direction of arrow shown in FIG. 8, the main body 12 and the rail assemblies remaining stationary.
  • a pair of staples 68 are carried by the pushers along their respective guide tracks 82 and 84, shown in FIGS. 7 and 8.
  • the organic tubular structure 76 is loosely housed within the closed area defined by the guide tracks 84, the anvil regions 86 and the inner walls of the central body member 42.
  • the confining area is then defined by the guide tracks 84, the anvil regions 86 and the inner walls of the U-shaped staples 68.
  • the limiting confining area, before staple bending, is illustrated in FIG. 9.
  • the staples 68 From the initial movement of the staples 68 until the arms of the staples contact the anvil regions 86, pusher movement merely moves the staples in the direction of arrow 80 and diminishes the area in which the tubular structure is housed.
  • the organic structure 76 is positively controlled in all regions of its periphery, by the anvil regions 86 and the inner walls of the staples 68. See FIG. 9.. While it is preferable that the tubular structure be of a size substantially as shown in FIG. 9, this sizing is not absolutely essential.
  • the extremities of the staple arms are preferably shaped as shown in FIG. 13.
  • one arm of the staple 68 is V-shaped while the other arm is pointed.
  • the dimensions of the points are matched to the dimensions of the V thereby ensuring positive contact therebetween.
  • the forward ends of the staple arms may be wedge-shaped so as to ensure that the organic tubular structure is pushed out of the way of the closing staples.
  • the staples are made resilient and are made to have a relaxed arm-to-arm dimension in excess of the distance between the tracks in which they ride. In this manner, the staples are biased against the guide tracks at all times during their advancement and during the bending operation.
  • the inventive cartridge comprises a pair of rail assemblies, a pair of pushers, and is designed to eject a pair of staples for each activation of the firing instrument.
  • a pair of spaced apart staples close the tubular structure in two spaced locations. Therefore, it is then possible to sever the tubular structure at any point intermediate the two staple positions without significant loss of blood.
  • the instrument is preferably provided with a knife 88 which may be associated with an externally positioned thumb-operated control bar 90.
  • control bar 90 may be moved forward until the knife 88 severs the associated tubular structure intermediate the pair of staples. Then, for example, the surgeon is able to clear the interfering tubular structure from the surgical field.
  • the cartridge comprising: a first guide track assembly; a second guide track assembly movable relative to said first guide track assembly; said first and said second guide track assemblies being shaped and associated in such a manner as to define first and second positions; staple guide means extending along the length of said first and said second guide track assemblies for guiding the movement of and the bending of'a surgical staple; curved anvil means on said first guide track assembly; said first and second guide track assemblies and said curved anvil means defining, when said first and said second guide track assemblies are in their first position, an open housing; and said first and said second guide track assemblies and said curved anvil means defining, when said first and said second guide track assemblies are in their second position, a continuous U-shaped guide path; and pusher means adapted for movement along and in the
  • first and second guide discs associated with said curved pusher means for ensuring positive contact and alignment between said pusher means and said staple.
  • a method of surgically ligating an elongated organic structure of a patient by the use of a surgical staple comprising the steps of; incising the patient to expose the elongated organic structure to be ligated; positioning a ligating instrument in the region of said organic structure; freeing and inserting said organic structure in a closed housing of the ligating instrument defined by the walls of a U-shaped guide track and an opposing U-shaped surgical staple; closing the area wherein said organic structure is housed by moving said U-shaped surgical staple in said guide path; initially bending said U-shaped surgical staple, along said U-shaped guide path, until the extremities of the arms thereof contact one another; collapsing the bridge of said U-shaped staple until the collapsed staple takes a C-shape and ligates said organic structure; removing the ligating instrument from the region of said organic structure; and closing the incision made in the patient.

Abstract

A method and a staple cartridge for ligating a hollow organic tubular structure by means of surgical staples. The organic tubular structure is loosely confined within an area which is variable in accordance with the position of the ligating surgical staples. The staples, being U-shaped are moved toward the organic tubular structure, thereby decreasing the confining area, until the arms of the staples begin to bend around the structure. The staple arms are bent until they encircle the tubular structure and contact one another; then the staples are further deformed, by acting on the surfaces remote from the contacting arms, until the tubular structure is completely sealed. During the staplebending operation, the periphery of the tubular structure is positively controlled by the ligating cartridge, thereby ensuring the integrity of the structure.

Description

United States Patent Noiles [54] METHOD AND CARTRIDGE FOR LIGATING ORGANIC TUBULAR STRUCTURES [72] Inventor: Douglas G. Noiles, New Canaan,
Conn.
[73] Assignee: United States Surgical Corporation,
Baltimore, Md.
[22] Filed: Aug. 18, 1970 [21] Appl. No.: 64,749
[56] References Cited UNITED STATES PATENTS 2/1961 Kelen ..29/243.57 X 10/ 1961 Vogelfanger 128/326 X 4/ 1953 Garland ..128/346 X 3/1963 Babkin ..29/243.57 6/1971 Green 128/305 1151 3,683,927 1 51 Aug. 15, 1972 3,545,444 12/1970 Green ..129/305 3,120,230 2/1964 Skold ..128/325 Primary Examiner-Dalton L. Truluck Attorney-Fleit, Gipple & Jacobson [57] ABSTRACT A method and a staple cartridge for ligating a hollow organic tubular structure by means of surgical staples. The organic tubular structure is loosely confined within an area which is variable in accordance with the position of the ligating surgical staples. The staples, being U-shaped are moved toward the organic tubular structure, thereby decreasing the confining area, until the arms of the staples begin to bend around the structure. The staple arms are bent until they encircle the tubular structure and contact one another; then the staples are further deformed, by acting on the surfaces remote from the contacting arms, until the tubular structure is completely sealed. During the staple-bending operation, the periphery of the tubular structure is positively controlled by the ligating cartridge, thereby ensuring the integrity of the structure.
l4 Claim, 13 Drawing Figures Patented Aug. 15, 1972 3 Sheets-Sheet 1 v l l l I Ill||||l|||AIILIIIIIIIIIIIIIIIDl' DOUGLAS G. NOILES BY N @ fii,
ATTORNEYS Patented Aug. 15, 1972 3 Sheets-Sheet 2 INVENTOR DOUGLAS G. NOILES BY a 0 0%? f/f/ ATTORNEYS Patented Aug. 15, 1972 3,683,927
3 Sheets-Sheet 5 FIG. 13
l6 FIG. 12
INVENTOR DOUGLAS G. NOILES METHOD AND CARTRIDGE FOR LIGATING v ORGANIC TUBULAR STRUCTURES BACKGROUND OF THE INVENTION In recent years, the use of staples in surgery has grown considerably in'popularity. For example, there are several automatic stapling instruments and cartridges which have been designed for ligating and dividing hollow tubular organic structures. Three known cartridges, which will be described below, operate by first constricting the structure to be ligated between the jaws of the cartridge and then encircling the structure with a pair of surgical staples until the structure is sealed. Each of these known cartridges sufiers from one serious drawback.
In copending US. Pat. application Ser. No. 672,362, filed on Oct. 2, 1967, now US. Pat. No. 3,545,444, and assigned to the present assignee, a ligating surgical cartridge is disclosed which operates by first constricting the organic tubular structure to be ligated, between its jaws, and by then bending a pair of relatively linear staples around the structure until the structure is sealed off. During the bending of the staples, there are portions of the tubular structure which are out of the control of the cartridge. That is, there are portions of the tubular structure which are free from the positive constraining effects of the cartridge jaws, and which, therefore, are able to flex as a result of forces centered about other portions thereof. Due to this lack of positive control, the danger exists that the staples, when encircling the tubular structure, may pierce or scratch the structure. And when dealing with organic structures, such as blood vessels, punctures and surface damage may lead to severe problems.
In copending US. Pat. Application Ser. No. 766,680, filed Oct. 1 l, 1968, now Pat. No. 3,584,628, and copending US. Pat. application Ser. No. 32,247, filed Apr. 27, 1970, each assigned to the present assignee, two improved ligating cartridges are disclosed. In each of the improved cartridges, the shape of the unbent staples is made non-linear, thereby resulting in a more effective closure of the organic tubular structure. However, notwithstanding the more effective staple shape, there are still areas of the tubular structure which remain out of the control of the surgical cartridge. And, as described above, this lack of control carries with it the danger that the organic tubular structure may be pierced or scratched by the ligating staples.
It is toward the elimination of these prior art drawbacks that the present invention is directed.
SUMMARY OF THE INVENTION The present invention relates to a method and a cartridge for applying a pair of ligating surgical staples to an organic tubular structure in such a manner that the integrity of the structure is ensured. More particularly, the inventive method and cartridge eliminate the drawbacks of the prior art by providing positive control of the entire surface of the tubular structure during the staple-bending portion of the ligating operation. In this manner, the ligating staples encircle the organic tubular structure without the danger of piercing or scratching the surface thereof.
The present invention contemplates that the organic tubular structure to be ligated, be loosely positioned within the jaws of a ligating cartridge. The area within which the tubular structure :is maintained, being defined by a pair of linear side walls of the cartridge, a curved anvil integral with the cartridge, and a pair of movable U-shaped staples, is then gradually reduced by moving the U-shaped staples toward the anvil. With continued movement of the staples, their arms are bent around the anvil, encircle the tubular structure, and close upon one another. Then, the region of each staple remote from the point of contact between the staple arms is deformed and urged toward the contacting staple arms, this deformation continuing until the organic tubular structure is completely sealed. During the staple-bending portion of the ligation, the entire periphery of the organic tubular structure is positively controlled.
In the manner described above, the danger of piercing or mairing the surface of the organic tubular structure is eliminated. By positively controlling the entire surface area of the tubular structure, during the staplebending stage of the procedure, it is possible to safely bend a surgical staple entirely around the structure, even with the staple contacting the structure during the bending operation. This principle of operation of the present invention can easily be demonstrated by the reader with the aid of his finger, a. pin and a smooth surface. If the reader presses his finger against a smooth surface, he is able to slide a pin between his finger and the smooth surface, without injury, if he maintains the point of the pin in contact with the smooth surface. Similarly, with the arms of the U-shaped staples in continuous contact with the U-shaped anvils during the bending of the staple arms around the organic tubular structure, the staples are bent without injury to the tubular structure.
Accordingly, it is the main object of the present invention to provide a method and an apparatus for ligat-. ing an organic tubular structure with a surgical staple, in a manner which ensures the integrity of the organic structure.
It is another object of the present invention to provide a method and an apparatus for safely ligating organic tubular structures by means of surgical staples and by doing so in an extremely simple manner.
Still a further object of the present invention is to provide a method and an apparatus for safely andefficiently ligating an organic tubular structure by means of surgical staples, by controlling the surface area of the tubular structure at all times during the ligation.
These and other objects of the present invention, as well as many of the attendant advantages thereof, will become more readily apparent when reference is made to the following description taken in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side view of a surgical cartridge, showing a portion of an associated firing instrument, designed in accordance with the teachings of the present invention;
FIG. 2 is a cross-section of the cartridge taken along line 2-2 of FIG. 1;
FIG. 3 is a side view of the main body of the surgical cartridge illustrated in FIG. 1;
FIG. 4 is a top view of the main body illustrated in FIG. 3;
FIG. 5 is a top view of the inventive cartridge illustrated in FIG. 1;
FIG. 6 is a cross-section of the inventive cartridge taken along line 66 of FIG. I
FIG. 7 is a cross-section of the cartridge taken along line 7-7 of FIG. 6;,
FIG. 8 is a cross-section similar to FIG. 7 but showing a portion of the inventive cartridge during the early stages of ligation;
FIGS. 9 through 12 are enlarged cross-sections through the inventive cartridge showing the staple formation during various stages of the ligation; and
FIG. 13 is a front view of a staple showing the manner in which the mating of the staple arms takes place.
DETAILED DESCRIPTION OF THE DRAWINGS With reference first to FIGS. 1 and 2, the basic cartridge and its attachment to the firing instrument will be described. The cartridge is shown generally at and comprises a three-piece main body portion 12, a pair of three-piece rail assemblies 14 and a pair of pushers 16. The firing instrument is shown generally at 18.
The firing instrument 18 may be of the type described in either U.S. Pat. application Ser. No. 766,680 or U.S. Pat. application Ser. No. 32,247, each mentioned above; and for purposes of description, only a portion of the firing instrument 18 will be described.
The instrument 18, at its forward end, is provided with a groove 20 and a thumb-operated cover plate 22; and as seen in FIGS. 1 and 5, the cartridge 10, at the rear end of the rail assemblies 14, is provided with a coupling bar 24. Bar 24 is adapted to mate with the groove 20 and is held in position by the cover-plate 22. The three elements of each rail assembly 14 are maintained in proper alignment by a plastic form 26, and the coupling bar 24 ensures unity between the rail assemblies and the form 26. Cover plate 22 contacts the lower surface of the form 26.
The output of the firing instrument 18 takes the form of a pair of shafts 28 and 30, each movable with respect to the front nose 32 of the firing instrument 18. Shaft 28 lies within hollow shaft 30 and is movable with respect thereto. On the forward end of the shaft 28 are positioned a pair of shoulders 34, and on the forward end of the shaft 30 are positioned a pair of shoulders 36. While the complete operation of the firing instrument 18 is not herein explained, suffice it to say that upon activation of the instrument 18, the shafts 28 and 30, with their respective shoulders 34 and 36, move in unison, away from the front nose 32 of the instrument 18. A biasing spring operates between the shafts 28 and 30 and consequently between the shoulders 34 and 36. Therefore, when a differential force is exerted between the shafts 28 and 30, of a magnitude greater than that of the biasing spring, relative motion takes place and the shoulders 34 move away from the shoulders 36. The operation of the firing instrument 18, as it affects the operation of the cartridge 10, will be explained below.
As clearly seen in FIGS. 1 and 3, the rear region of the body 12 is provided with a depression 38 adapted to mate with the forwardmost of the two shoulders 36. The other shoulder 36 contacts the rear of the main body 12. And, as seen in FIG. 1, the rear region of each pusher 16 is provided with a notch 40, adapted to mate with the forwardmost of the two shoulders 34. The other shoulder 34 contacts the rear of the pusher 16. Therefore, the shoulders 34 and 36 serve, respectively, as saddles within which the pushers l6 and the main body 12 are seated and controlled.
Now, with reference to FIGS. 2 through 7, the elements of the cartridge 10 will be described.
The three-piece main body 12, as shown best in FIGS. 2 and 7, takes the form of a central body member 42 sandwiched between a pair of cover plates 44. The central body member 42 and the cover plates 44 are held together by means of four rivets or bolts 46. As seen best in FIGS. 2 and 3, the central body member 42, when covered by plates 44, is provided with a first elongated groove 48 and a second elongated groove 50, groove 48 being the deeper of the two. The groove 48 may be termed a rail guiding groove and the groove 50 may be termed a staple and pusher guiding groove.
The forward endof the central body member 42 is thin, is elongated, and is tapered at its extremity, as indicated by the numeral 52. Slightly rearward of the taper 52, for reasons which will become apparent from the following, a section is removed from each side of the forward end of the main body member 42. Each side of the main body member 42, where a section is removed, has defined therein an angled sloping indented wall 54.
The rear portion of the central body member 42, which is adapted to mate with the firing instrument 18, is open as shown at 55. In this manner, the shafts 28 and 30, and their associated shoulders 34 and 36, are easily associated with the main body.
With reference now to FIGS. 5 through 7, the construction of the rail assemblies 14 will be described. As can be seen in FIGS. 5 and 7, the cartridge 10 includes a pair of rail assemblies 14, each of these assemblies being of three-piece construction. Each rail assembly 14 comprises a central guide rail 56, an outer restraining plate 58 and an inner restraining plate 60. Inner restraining plate 60 is wider than outer restraining plate 58, so as to ensure that the guide rails 14 remain in the rail guiding grooves 48, defined between the central body member 42 and the cover plates 44. The integrity of each three-piece rail assembly 14 is ensured by a pin 61 passing through the outer restraining plate 60, at the forward end thereof, and the plastic form 26, with its bar 24, at the rear thereof.
As best seen in FIG. 6, the respective forward ends of the outer restraining plate 58 and the inner restraining plate 60 are cut at an angle, as shown at 66, so as to mate with the sloping wall 52 on the central body member 42. Similarly, the forward end of the guide rail 56 is cut at an angle, as shown at 64, so as to mate with the taper 54 on the central body member 42. Therefore, and as illustrated in FIG. 8, the mating of the faces 52 and 66 and the mating of the faces 54 and 64 is smooth and positive, so that the rail assembly 14 mates with the main body 12 defining a continuous anvil region 86.
Now, with reference to FIGS. 2 and through 10, the construction of the pushers 16 will be described. Each pusher 16 is elongated, is of a height substantially equal to that of the staples and that of the pusher guiding groove 50, and is of a width slightly in excess of the thickness of a staple, shown at 68. The forward end of each pusher 16 is diminished in height from the remaining portions of the pusher and is rounded as shown at 70 in FIG. 10. For reasons which will become clear from the following, the rounded portion of each pusher takes a shape so as to comfortably unite with the rounded anvil regions 86. The radius of the curved pusher faces is, however, less than the radius of the curved anvils so as to allow for the intermediate positioning of the organic tubular structure and two thicknesses of the staple. On each flat side of the rounded projection 70 a circular restraining disc 72 is secured. As best seen in'FIGS. 7, 9 and 10, the discs 72 ensure that the staples 68 are held in proper alignment with the rounded projections 70 of the pushers l6, and as can be seen in FIG. 2, the shape of the grooves 50 allows for the presence of these discs. The width of the pushers 16 is equal to the width of the respective central guide rails 56. Therefore, the bottom portions of the pushers 16 are guided by the guide rails 56. The pushers are restrained against unwanted transverse motion by the shape of the groove 50 and the restraining plates 58 and 60.
Now, the operation of the inventive cartridge will be explained. As can be seen in FIG. 1, and like the cartridges disclosed in the above-mentioned copending patent applications, the inventive cartridge is made removable from the firing instrument, is made disposable, and may be presterilized and packaged for shipment to the surgical arena.
For a discussion of the cartridge operation, the attention of the reader is directed to FIGS. 1 and 8 through 12. With the cartridge 10 mounted on the firing instrument 18, an organic tubular structure 76, such as a blood vessel, is inserted between the open respective ends of the rail assemblies 14 and the main body 12 (FIG. 1). Arrow 74 indicates the manner in which the structure 76 is inserted. When the structure is in position, as shown in phantom in FIG. 1, the surgeon activates the firing instrument 18.
The initial action of the surgeon-operated firing instrument 18 is to simultaneously move the shafts 28 and 30, and thus the shoulders 34 and 36, away from the front nose 32 of the firing instrument 18. As a result of the integrity between the shoulders 34 and the pushers l6, and the integrity between the shoulders 36 and the main body 12, the main body 12 of the cartridge 10, in unison with the pushers 16, move relative to the rail assemblies 14. That is, the main body 12 and the pushers 16 move in the direction of arrows 78 (FIG. 6), the rail assembly 14 remaining stationary, being rigidly secured to the firing instrument 18. This relative motion continues until the mating of the main body 12 with the rail assemblies 14, as illustrated in FIG. 8.
Once the mating faces of the main body 12 and the rail assemblies 14 come into contact with one another, the main body can no longer move in the direction of the arrow 78. Accordingly, continued force exerted on the firing instrument 18 by the surgeon results in no relative motion of elements until the differential force between the shafts 28 and 30 is reached. However, once this differential force is reached, the shaft 28 moves forward within and with respect to the shaft 30. Accordingly, shoulders 34 move away from shoulders 36. Since the shoulders 34 are in direct association with the pushers 16, the pushers 16 move in the direction of arrow shown in FIG. 8, the main body 12 and the rail assemblies remaining stationary.
Once the pushers 16 begin to move relative to the main body 12, a pair of staples 68 are carried by the pushers along their respective guide tracks 82 and 84, shown in FIGS. 7 and 8. At this time, the organic tubular structure 76 is loosely housed within the closed area defined by the guide tracks 84, the anvil regions 86 and the inner walls of the central body member 42. When the staples are moved in the direction of arrow 80 and reach the inner walls of the member 42, the confining area is then defined by the guide tracks 84, the anvil regions 86 and the inner walls of the U-shaped staples 68. The limiting confining area, before staple bending, is illustrated in FIG. 9.
From the initial movement of the staples 68 until the arms of the staples contact the anvil regions 86, pusher movement merely moves the staples in the direction of arrow 80 and diminishes the area in which the tubular structure is housed. Preferably, by the time when the arms of the staples contact the anvil regions, the organic structure 76 is positively controlled in all regions of its periphery, by the anvil regions 86 and the inner walls of the staples 68. See FIG. 9.. While it is preferable that the tubular structure be of a size substantially as shown in FIG. 9, this sizing is not absolutely essential.
When the pusher 16 moves from the position shown in FIG. 9, that wherein the staple arms meet the anvil regions, into the position shown in FIG. 10, the arms of the U-shaped staples 68 ride along the curved walls of the anvils 86 and are bent by the anvils. At first, the staples bend as shown in FIG. 10, but further pusher movement forces the mating arms of the staples 68 to take the shape of the anvils 86. Then, the respective regions of the staples remote from the mating walls begin to collapse, the staples taking the form shown in FIG. 11. Here it can be seen how the arms of the U-shaped staples are forced tightly against the curved anvil 86 and how the bridges of the staples begin to collapse. With continued movement of the pushers 16, the associated staples collapse until the tubular structure 76 is completely closed within the pair of collapsed staples 68, as shown in FIG. 12.
To ensure that the arms of the staples 68 properly mate with one another and to ensure that the staple collapse is proper, the extremities of the staple arms are preferably shaped as shown in FIG. 13. In this Figure, it is seen that one arm of the staple 68 is V-shaped while the other arm is pointed. The dimensions of the points are matched to the dimensions of the V thereby ensuring positive contact therebetween. And, as seen in FIGS. 9 through 12, the forward ends of the staple arms may be wedge-shaped so as to ensure that the organic tubular structure is pushed out of the way of the closing staples. The staples are made resilient and are made to have a relaxed arm-to-arm dimension in excess of the distance between the tracks in which they ride. In this manner, the staples are biased against the guide tracks at all times during their advancement and during the bending operation.
As described above, the inventive cartridge comprises a pair of rail assemblies, a pair of pushers, and is designed to eject a pair of staples for each activation of the firing instrument. In this manner, when a unitary tubular structure is positioned within the jaws of the inventive cartridge and the associated instrument is fired, a pair of spaced apart staples close the tubular structure in two spaced locations. Therefore, it is then possible to sever the tubular structure at any point intermediate the two staple positions without significant loss of blood. For this purpose, the instrument is preferably provided with a knife 88 which may be associated with an externally positioned thumb-operated control bar 90. Therefore, once the pair of staples is secured in the structure 76, thus closing same in two positions, the control bar 90 may be moved forward until the knife 88 severs the associated tubular structure intermediate the pair of staples. Then, for example, the surgeon is able to clear the interfering tubular structure from the surgical field.
Above, a specific embodiment of the present invention has been described. It should be appreciated, however, that this embodiment is described for purposes of illustration only and that numerous alterations "and modifications may be practiced by those skilled in the art without departing from the spirit and scope of the invention. Accordingly, it is the intent that the invention not be limited by the above but be limited only as defined in the appended claims.
What is claimed is:
1. A cartridge adapted for removable insertion on a medical instrument and having the capability of confining an organic tubular structure in a closed area, causing the encirclement of the structure with a surgical staple, and causing the ligation of the structure with said surgical staple, the cartridge comprising: a first guide track assembly; a second guide track assembly movable relative to said first guide track assembly; said first and said second guide track assemblies being shaped and associated in such a manner as to define first and second positions; staple guide means extending along the length of said first and said second guide track assemblies for guiding the movement of and the bending of'a surgical staple; curved anvil means on said first guide track assembly; said first and second guide track assemblies and said curved anvil means defining, when said first and said second guide track assemblies are in their first position, an open housing; and said first and said second guide track assemblies and said curved anvil means defining, when said first and said second guide track assemblies are in their second position, a continuous U-shaped guide path; and pusher means adapted for movement along and in the plane of said guide path when said first and said second guide track assemblies are in their second position; wherein said pusher means has a curved face adjacent the curved face of said anvil means; wherein the curvature of said anvil means is less severe than the curvature of said pusher means; and wherein said first and said second guide track assemblies, said anvil means and said pusher means are shaped and associated so that when a U-shaped surgical staple is positioned in said guide track means with the arms thereof extending toward said anvil means, and when said staple is urged toward said anvil means by said pusher means, the arms of said staple are guided by said guide path until they contact one another and are bent into the shape of said rounded anvil means, the bridge of said staple remote from the contacting arms thereof is collapsed, and the staple is deformed between said anvil means and said pusher means into a C-shape sealing said organic tubular structure.
2. The cartridge defined in claim 1, and further comprising: respective second sets of guide track assemblies, anvil means and pusher means, spacially aligned with respect to the first sets thereof; said first and said second sets for sealing said organic tubular structure at first and second locations; and knife means for dividing said sealed organic tubular structure intermediate said first and second positions.
3. The cartridge recited in claim 1, wherein said first guide track assembly is adapted to be securely mounted on a medical instrument; wherein said second guide track assembly is slidably mounted with respect to said first guide track assembly; and wherein said pusher means is slidably mounted for movement relative both to said first and said second guide track assemblies.
4. The invention set forth in claim 3, wherein said pusher means slides between said first and said second guide track assemblies.
5. The cartridge recited in claim 1, and further comprising: means on said first and said second guide track assemblies for ensuring smooth mating therebetween when said guide tract assemblies are moved from their first position to their second position.
6. The cartridge defined in claim 1, wherein said second guide track assembly is integral with a main body portion; wherein said first guide track assembly is slidably mounted in said main portion; and wherein said pusher means is slidably mounted within said main body portion.
7. The cartridge'recited in claim 6, and further comprising: respective second sets of guide track assemblies, anvil means and pusher means, spacially aligned with respect to the first sets thereof; said first and said second sets for sealing said organic tubular structure at first and second locations; and knife means for dividing said sealed organic tubular structure intermediate said first and second positions.
8. The cartridge recited in claim 1, wherein the face of said anvil means conforms to the circumference of a first circle; wherein the face of said pusher means conforms to the circumference of a second circle; and wherein the radius of said first circle is larger than the radius of said second circle by an amount at least equal to two staple thicknesses.
9. The cartridge defined in claim 1, and further comprising: first and second guide discs associated with said curved pusher means for ensuring positive contact and alignment between said pusher means and said staple.
10. A method of surgically ligating an elongated organic structure of a patient by the use of a surgical staple, the method comprising the steps of; incising the patient to expose the elongated organic structure to be ligated; positioning a ligating instrument in the region of said organic structure; freeing and inserting said organic structure in a closed housing of the ligating instrument defined by the walls of a U-shaped guide track and an opposing U-shaped surgical staple; closing the area wherein said organic structure is housed by moving said U-shaped surgical staple in said guide path; initially bending said U-shaped surgical staple, along said U-shaped guide path, until the extremities of the arms thereof contact one another; collapsing the bridge of said U-shaped staple until the collapsed staple takes a C-shape and ligates said organic structure; removing the ligating instrument from the region of said organic structure; and closing the incision made in the patient.
11. The surgical method recited in claim 10, wherein the U-shaped guide track terminates in a curved anvil surface; and wherein the U-shaped staple is moved and bent by a pusher having a curved face.
12. The surgical method recited in claim 11, wherein the curvature of said anvil face is less severe than is the curvature of said pusher face.
13. The surgical method defined in claim 12, wherein the curvature of said anvil face conforms to the circum- I

Claims (14)

1. A cartridge adapted for removable insertion on a medical instrument and having the capability of confining an organic tubular structure in a closed area, causing the encirclement of the structure with a surgical staple, and causing the ligation of the structure with said surgical staple, the cartridge comprising: a first guide track assembly; a second guide track assembly movable relative to said first guide track assembly; said first and said second guide track assemblies being shaped and associated in such a manner as to define first and second positions; staple guide means extending along the length of said first and said second guide track assemblies for guiding the movement of and the bending of a surgical staple; curved anvil means on said first guide track assembly; said first and second guide track assemblies and said curved anvil means defining, when said first and said second guide track assemBlies are in their first position, an open housing; and said first and said second guide track assemblies and said curved anvil means defining, when said first and said second guide track assemblies are in their second position, a continuous U-shaped guide path; and pusher means adapted for movement along and in the plane of said guide path when said first and said second guide track assemblies are in their second position; wherein said pusher means has a curved face adjacent the curved face of said anvil means; wherein the curvature of said anvil means is less severe than the curvature of said pusher means; and wherein said first and said second guide track assemblies, said anvil means and said pusher means are shaped and associated so that when a U-shaped surgical staple is positioned in said guide track means with the arms thereof extending toward said anvil means, and when said staple is urged toward said anvil means by said pusher means, the arms of said staple are guided by said guide path until they contact one another and are bent into the shape of said rounded anvil means, the bridge of said staple remote from the contacting arms thereof is collapsed, and the staple is deformed between said anvil means and said pusher means into a C-shape sealing said organic tubular structure.
2. The cartridge defined in claim 1, and further comprising: respective second sets of guide track assemblies, anvil means and pusher means, spacially aligned with respect to the first sets thereof; said first and said second sets for sealing said organic tubular structure at first and second locations; and knife means for dividing said sealed organic tubular structure intermediate said first and second positions.
3. The cartridge recited in claim 1, wherein said first guide track assembly is adapted to be securely mounted on a medical instrument; wherein said second guide track assembly is slidably mounted with respect to said first guide track assembly; and wherein said pusher means is slidably mounted for movement relative both to said first and said second guide track assemblies.
4. The invention set forth in claim 3, wherein said pusher means slides between said first and said second guide track assemblies.
5. The cartridge recited in claim 1, and further comprising: means on said first and said second guide track assemblies for ensuring smooth mating therebetween when said guide tract assemblies are moved from their first position to their second position.
6. The cartridge defined in claim 1, wherein said second guide track assembly is integral with a main body portion; wherein said first guide track assembly is slidably mounted in said main portion; and wherein said pusher means is slidably mounted within said main body portion.
7. The cartridge recited in claim 6, and further comprising: respective second sets of guide track assemblies, anvil means and pusher means, spacially aligned with respect to the first sets thereof; said first and said second sets for sealing said organic tubular structure at first and second locations; and knife means for dividing said sealed organic tubular structure intermediate said first and second positions.
8. The cartridge recited in claim 1, wherein the face of said anvil means conforms to the circumference of a first circle; wherein the face of said pusher means conforms to the circumference of a second circle; and wherein the radius of said first circle is larger than the radius of said second circle by an amount at least equal to two staple thicknesses.
9. The cartridge defined in claim 1, and further comprising: first and second guide discs associated with said curved pusher means for ensuring positive contact and alignment between said pusher means and said staple.
10. A method of surgically ligating an elongated organic structure of a patient by the use of a surgical staple, the method comprising the steps of; incising the patient to expose the elongated organic structure to be ligated; positioning a ligatiNg instrument in the region of said organic structure; freeing and inserting said organic structure in a closed housing of the ligating instrument defined by the walls of a U-shaped guide track and an opposing U-shaped surgical staple; closing the area wherein said organic structure is housed by moving said U-shaped surgical staple in said guide path; initially bending said U-shaped surgical staple, along said U-shaped guide path, until the extremities of the arms thereof contact one another; collapsing the bridge of said U-shaped staple until the collapsed staple takes a C-shape and ligates said organic structure; removing the ligating instrument from the region of said organic structure; and closing the incision made in the patient.
11. The surgical method recited in claim 10, wherein the U-shaped guide track terminates in a curved anvil surface; and wherein the U-shaped staple is moved and bent by a pusher having a curved face.
12. The surgical method recited in claim 11, wherein the curvature of said anvil face is less severe than is the curvature of said pusher face.
13. The surgical method defined in claim 12, wherein the curvature of said anvil face conforms to the circumference of a first circle; wherein the curvature of said pusher face conforms to the circumference of a second circle; and wherein the radius of said first circle is greater than the radius of said second circle by at least two staple widths.
14. The surgical method according to claim 10, and further comprising the steps of: simultaneously ligating the elongated organic structure with a second staple spaced from the first staple: and dividing the elongated organic structure at a location intermediate said first staple and said second staple.
US64749A 1970-08-18 1970-08-18 Method and cartridge for ligating organic tubular structures Expired - Lifetime US3683927A (en)

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US4349028A (en) * 1980-10-03 1982-09-14 United States Surgical Corporation Surgical stapling apparatus having self-contained pneumatic system for completing manually initiated motion sequence
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US4532927A (en) * 1983-06-20 1985-08-06 Ethicon, Inc. Two-piece tissue fastener with non-reentry bent leg staple and retaining receiver
US4534350A (en) * 1983-06-20 1985-08-13 Ethicon, Inc. Two-piece tissue fastener with compressible leg staple and retaining receiver
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US4693248A (en) * 1983-06-20 1987-09-15 Ethicon, Inc. Two-piece tissue fastener with deformable retaining receiver
US5192288A (en) * 1992-05-26 1993-03-09 Origin Medsystems, Inc. Surgical clip applier
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US20060064117A1 (en) * 2004-09-23 2006-03-23 Ernest Aranyi Clip applying apparatus and ligation clip
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US3844289A (en) * 1973-04-13 1974-10-29 Surgical Corp Hemostat and attachment for suturing organic tubular structures
US4086926A (en) * 1976-10-08 1978-05-02 United States Surgical Corporation Ligating and dividing organic structures
US4349028A (en) * 1980-10-03 1982-09-14 United States Surgical Corporation Surgical stapling apparatus having self-contained pneumatic system for completing manually initiated motion sequence
US4492232A (en) * 1982-09-30 1985-01-08 United States Surgical Corporation Surgical clip applying apparatus having fixed jaws
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US4573469A (en) * 1983-06-20 1986-03-04 Ethicon, Inc. Two-piece tissue fastener with coinable leg staple and retaining receiver and method and instrument for applying same
US4548202A (en) * 1983-06-20 1985-10-22 Ethicon, Inc. Mesh tissue fasteners
US4534350A (en) * 1983-06-20 1985-08-13 Ethicon, Inc. Two-piece tissue fastener with compressible leg staple and retaining receiver
US4532927A (en) * 1983-06-20 1985-08-06 Ethicon, Inc. Two-piece tissue fastener with non-reentry bent leg staple and retaining receiver
US4693248A (en) * 1983-06-20 1987-09-15 Ethicon, Inc. Two-piece tissue fastener with deformable retaining receiver
US4532926A (en) * 1983-06-20 1985-08-06 Ethicon, Inc. Two-piece tissue fastener with ratchet leg staple and sealable latching receiver
US4556058A (en) * 1983-08-17 1985-12-03 United States Surgical Corporation Apparatus for ligation and division with fixed jaws
US5547474A (en) * 1992-05-26 1996-08-20 Origin Medsystems, Incorporated Surgical clip closure apparatus with safety stop
WO1993024059A2 (en) * 1992-05-26 1993-12-09 Origin Medsystems, Inc. Surgical clip applier
US5269792A (en) * 1992-05-26 1993-12-14 Origin Medsystems, Inc. Surgical clip
US5282808A (en) * 1992-05-26 1994-02-01 Origin Medsystems, Inc. Closure prevention apparatus for surgical clip applier
WO1993024059A3 (en) * 1992-05-26 1994-03-03 Origin Medsystems Inc Surgical clip applier
US5192288A (en) * 1992-05-26 1993-03-09 Origin Medsystems, Inc. Surgical clip applier
US7582095B2 (en) 1993-08-25 2009-09-01 Apollo Camera, L.L.C. Surgical ligation clip and method for use thereof
US5769857A (en) * 1996-06-11 1998-06-23 Mgf Group Inc. Ligating clip applier
US7678125B2 (en) 2002-11-12 2010-03-16 Apollo Camera, L.L.C. Surgical ligation clip
US8568430B2 (en) 2002-11-12 2013-10-29 Microline Surgical, Inc. Surgical ligation clip
US8172870B2 (en) 2003-06-09 2012-05-08 Microline Surgical, Inc. Ligation clip applier
US7572266B2 (en) 2003-10-21 2009-08-11 Young Wayne P Clip applier tool having a discharge configuration
US20060064117A1 (en) * 2004-09-23 2006-03-23 Ernest Aranyi Clip applying apparatus and ligation clip
US8652152B2 (en) * 2004-09-23 2014-02-18 Covidien Lp Clip applying apparatus and ligation clip
CN102949224A (en) * 2011-08-23 2013-03-06 财团法人精密机械研究发展中心 Vessel supporting structure supporting the use of haemostatic forcep
WO2017107947A1 (en) * 2015-12-22 2017-06-29 苏州天臣国际医疗科技有限公司 Tissue closure device, tissue closure component, and medical equipment
US10835244B2 (en) 2015-12-22 2020-11-17 Touchstone International Medical Science Co., Ltd. Tissue closure device, tissue closure component, and medical instrument

Also Published As

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DE2141219A1 (en) 1972-03-23
JPS557257B1 (en) 1980-02-23
CA977642A (en) 1975-11-11
DE2141219B2 (en) 1975-11-20
GB1352780A (en) 1974-05-08

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