WO1992011812A1

WO1992011812A1 - Clamp applicator

Info

Publication number: WO1992011812A1
Application number: PCT/EP1992/000006
Authority: WO
Inventors: Harald Heidmüller; Elke Heidmüller
Original assignee: Heidmueller Harald
Priority date: 1991-01-07
Filing date: 1992-01-03
Publication date: 1992-07-23
Also published as: DE4100235A1

Abstract

A clamp applicator (37) for positioning and closing blood vessel clamps or the like for laparotomic operations, with a longitudinal shaft (75, 76), two jaws (41, 42) arranged at its forward end, mutually movable about an axis of rotation (69) and with a variable opening angle, which have recesses open on the inside to pick up and hold an open blood vessel clamp, and a gripping and actuating device (43, 44) at its rear end to close the jaws (41, 42) especially against the pressure of a spring (50, 51), with a manipulating device (52) for blood vessels or tissue structures which is arranged laterally beside an aperture plane of the jaws (41, 42) and which can be moved by means of a telescopic arrangement (62) guided in the shaft (75, 76) between a forward position projecting beyond the aperture plane of the jaws (41, 42) and a rear position beside the aperture plane of the jaws (41, 42), wherein the manipulating device (52) consists of several parts and comprises mutually articulated branches or jaws (60, 61; 63; 64; 66, 67) covering a variable angle of opening.

Description

Terminal applicator

description

The invention relates to a clamp applicator for setting and closing blood vessel clamps or the like for laparotomy interventions, with an elongated shaft, two jaws arranged at its front end, movable about an axis of rotation relative to one another, spanning a variable opening angle, each having inwardly open recesses for receiving and holding an open blood vessel clamp, and a handle and actuating device arranged at the rear end thereof for closing the jaws, in particular against spring force, with a manipulation device for blood vessels or tissue structures, which is arranged laterally next to an opening plane spanned by the jaws and which by means of a telescopic arrangement guided in the shaft can be displaced between a front position projecting beyond the opening plane of the jaws and a rear position lying next to the opening plane of the 3-jaws.

Clamps of this type are described, for example, in DE 21 23 703 C and can then be designed as simple U-shaped brackets made of steel or tantalum, which are plastically deformable and, after being compressed around a blood vessel, solely due to their elastic properties in the closed position with adjacent legs remain. Titanium is also suitable as a material for such clamps. Other clamps of the type mentioned are described in DE 30 22 087 C 2, according to which these are formed from biologically acceptable plastic materials and, at the front ends of their approximately U-shaped legs, locking means for locking after closing around a blood vessel with legs lying on top of each other exhibit. In addition to vessels, tissue structures can also be clamped in the same way.

The size of the clamps used can vary widely. In certain applications in surgery, they can be very small, but to close the ovic duct or the defensive duct they can be significantly larger than when used as normal blood vessel clamps.

In addition, their shape on the outside facing the jaws can also vary, as can be seen from the publications mentioned above. The jaws of a tool intended for setting and closing the clamps must be individually adapted to the respective clamp type, since falling out of the tool must be avoided in any case before the correct setting and closing, especially when used in laparotomy operations. This means that a large number of corresponding terminal applicators must be kept available at a corresponding cost.

A clamp applicator of the type mentioned at the beginning has been described, which comprises a manipulation device in the form of a hook, by means of which blood vessels can be grasped and drawn into the open jaws of the clamp applicator. Such a kaken is in limited its application possibilities, in particular it is not very suitable for grasping tissue structures and pulling them back. Proceeding from this, the present invention is based on the object of providing a terminal applicator which is refined in its function and expanded in its possible uses.

The solution to this lies in the fact that the manipulation device is multi-parted and includes branches or jaws which are connected to one another in an articulated manner and span a variable opening angle.

A first concrete embodiment of this solution is that the manipulating device is designed as scissors, in particular as tubular shears. According to this, vessels or tissue structures that can be grasped by the open jaws of the clamp applicator with immediate access can be separated on one side immediately after the clamp has been pressed together, without the operator having to change the instrument as a whole, in particular, for example, from the open abdominal cavity and remove it another instrument must be introduced. The scissors can in particular be designed as Pott scissors.

In a special development of the above-mentioned specification, an outwardly directed, preferably rearwardly curved hook is provided on one of the jaws or branches of the scissors, which thus, in an expanded mode of operation, both grips and draws in blood vessels into the open jaws of the clamp, and then disconnects them of a pinched blood vessel or tissue area.

In a second specification, the manipulation device is designed as a pair of pliers that can be gripped better of tissue areas than is possible with a simple hook tool. The pliers can be designed with jaws lying directly on top of one another or with hook-shaped jaws, which in contact with one another leave an open cross section, depending on the application. Subsequent cutting with the same instrument must be avoided, but this improves the options for handling the structures to be disconnected.

In a special development of the invention, the clamp applicator can be equipped with interchangeable jaws for different forms of clamps. The distribution of such an embodiment lies in the fact that the lying jaws, which have the recesses for receiving and holding an open blood vessel clamp, are each detachably connected to the jaw holders located behind, which sense the relative axis of rotation. This creates the possibility of making a corresponding clamp applicator usable for the use of different clamp types at low cost, namely by keeping different sets of jaws. In addition, it is even possible to adapt the tool to future developments of new clamp shapes by using appropriate jaws, so that this situation can also be solved at low cost.

In a favorable embodiment of the invention, the jaws each have lugs lying in the direction of their extension, which can be inserted into a corresponding opening or bore in the jaw holder.

Approaches of this type can be rotationally aerodynamic, in particular cylindrical or conical, in which case they are preferably supplemented by an anti-rotation device. A Such a rotation lock can be located, for example, in the combination of pin and bore on mutually facing end faces of the jaws and jaw holders that lie outside the lugs.

In the case of a polygonal cross section of the lugs, such an anti-rotation device may be missing. It is expedient if the approaches are shaped in cross-section so that incorrect assembly of the jaws is avoided, e.g. through a rectangular cross-sectional shape.

In a further embodiment of the invention, an axial securing of the lugs on the jaws is to be provided in the corresponding openings or bores of the jaw holders. A first possibility for this is, for example, the securing by pure frictional forces, which e.g. can be increased if the jaw holders are slit lengthways and the approaches are pressed into the corresponding recesses with oversize. Other forms of securing can lie in a simple grub screw in the jaw holder, which secures the attachment, or in a spring-loaded locking ball, which snaps into a counter recess.

The geometrical reversal of all the details described here between approaches on the jaws and recesses in the jaw holders is of course possible without restriction.

In a further embodiment of the invention, it can be provided that the tool has an adjusting device for limiting the opening angle, since an adaptation to a special type of clamp is usually not only due to the outer shape of its legs but also by one Opening angle of the legs is determined in the open state. A change in the respective jaws can therefore also involve and include a change in the associated opening angle of the jaws.

According to an advantageous embodiment, the tool can be designed, in particular, for use in laparotomic operations, as a multi-joint pliers and a first part with a fixed jaw holder and a first handle part and a second jaw holder that is movable about a first axis of rotation and a second one about the first parallel axis of rotation movable, relative to the first resiliently supported second handle part, wherein the movable handle part and movable jaw holder are each articulated via a push rod essentially parallel to the longitudinal extent of the first part. Kinematically, such pliers represent a four-section, flat, non-rotatable gear with three swivel joints and one sliding joint.

In adaptation to this, the adjusting device can be a threaded sleeve attached to the first fixed handle part with an adjusting screw acting on the push rod. Here, for example, an adjustment scale can be provided in an opening in the threaded sleeve.

In a preferred embodiment, the manipulation device comprises a rod arrangement which can be moved telescopically with respect to the first part of the tool, which in turn is in two parts and carries the two movable parts of the manipulation device at its front end. The two-part design can either consist of a tube-in-tube or rod-in-tube arrangement, or it can be axially displaced relative to one another from two essentially semicirculars bars. By means of a flag attached radially at the rear end, the manipulation device can be rotated, in particular by means of an outer rotary knob, the mutual longitudinal displaceability of the two parts of the rod body mentioned is preferably achieved by a two-part design of the rotary knob, each of the two annular parts of the rotary knob with one of the two parts of the rod body is connected.

Preferred embodiments of the invention are explained in more detail with reference to the drawings attached here.

1 shows a side view of a clamp applicator,

FIG. 2 shows a clamp applicator according to FIG. 1 in

Top view,

3 shows a tool according to FIG. 1 in cross section A-A,

FIG. 4 shows a tool according to FIG. 1 on an enlarged scale

Cross section Z-Z according to FIG. 5a,

5a shows a tool according to FIG. 1 in partial longitudinal section in the working position of the manipulation device,

5b shows a tool according to FIG. 1 in partial longitudinal section in the rest position of the manipulation device,

6 shows the detail according to FIG. 5a in plan view,

7 shows a detail of the pliers according to FIG. 1, 8 shows an alternative embodiment of the detail according to FIG. 7,

Fig. 9 shows another alternative in detail

Fig. 7.

1 and 2, a multi-joint pliers 1 can be seen with a first fixed grip part 43 and a grip part 44 that can be pivoted about an axis of rotation 45. The fixed grip part 43 merges into an underflow 75; on this a fixed jaw holder 39 and a movable jaw holder 40 are arranged, which is pivotally mounted in an axis (not shown) lying parallel to the axis of rotation 43 in the lower reaches. The jaw holder 39 carries an interchangeable jaw 41, the jaw holder 40 an interchangeable jaw 42. The upper run 76, which runs parallel to the lower part 75 and is connected to the grip part 38, is displaceable, with this having an inner recess 79 into which the grip part 44 has its free end 38 engages. Underflow 75 and overflow 76 are guided in parallel by means to be described in more detail. The upper run 75 is connected to the movable jaw holder 40 via a further axis of rotation. A setting device 46 is fastened to the grip part 43 and comprises a sleeve 47 and a threaded pin 48 adjustable therein. The sleeve 47 has a window 49 with a scale division. The grub screw 48 forms a stop for the free end 38 of the handle part 44, the handle parts 43 and 44 being supported against one another by springs 50, 51. Lying to the side of the jaws 41, 42 is a two-part manipulation device 52, which is axially adjustable via a rotary knob 53 sliding on the upper and lower run, via an internal partial telescopic connection, not shown, as in a further position on the left the manipulation device 52 'is shown and can also be rotated. With the aid of this manipulation device 52, a vessel can be drawn into the open jaws 41, 42, wherein the structures to be clamped can be better grasped by rotating them 90 °. The rotary knob 53 has two mutually axially adjustable ring pieces 54, 55, which are axially supported against one another via springs 55, 57 and can be locked in a position approximated to one another by a securing bracket 59 engaging in a slot 58. In this locked position, the manipulation device in this embodiment has the hook-like shape as shown in FIG. 1.

Referring now to FIG. 7, it will now be explained that the manipulation device 52 is constructed in two parts and the two branches 60, 61 can form a pair of scissors movable via a two-part telescopic rod 62, which are closed against the spring force 56 by the movement of the rings 54, 55 can be. These scissors can be used to separate the vessel after the vascular clamp has been set and closed without having to remove the multi-joint pliers or to use another instrument.

8 shows a manipulation device in the form of a clamp with two clamps 53, 64, which are articulated around an axis 65 in order to draw a vessel into the vessel clamp. Subsequent separation of the vessel using the same tool is not possible.

FIG. 9 shows a manipulation device in the form of hook pliers with two hooks 65, 57 which are connected to one another via an axis of rotation 68, whereby this can be viewed as a second alternative for pulling a vessel into the hemostat.

In Fig. 2, the same details as in Fig. 1 are given the same numbers. It can be seen that both the jaw holder 40 with the jaw 42 and the closed hook in its positions 52 and 52 'are each laterally offset from the center. The axis of rotation 70 of the upper jaw holder 40 with respect to the displaceable upper run 76 is indicated as well as the axis of rotation 69 of the upper jaw holder with respect to the lower run 75.

Fig. 3 shows the upper run 75 and lower run 75 in an enlarged cross section according to the section line AA according to FIG. 1. Here, a T-shaped guide groove 78 can be seen on the upper run 75, into which one of a plurality of axially spaced T-shaped pins 77, which in the lower reaches 75 are inserted.

FIG. 4 shows the upper run 76 and lower run 75 in an enlarged cross section through the ring part 54 according to the section line ZZ according to FIG. 5a. In detail, a telescopic tube 62 is shown, which consists of an outer tube 80 and an inner rod 81 and is located in an upwardly open longitudinal groove 85 in the lower run 75. A tab 82 is arranged on the outer tube and engages in an adapted circular sector-shaped recess 83 in the ring body 54. When the ring body is rotated 90 ° counterclockwise, the recess 83 moves and takes the tab 82 into the position 82 'shown in broken lines. For this purpose, a segment-like cutout 84 is provided in the upper reaches. Regardless of the position of the tab 82, the inner rod 81 connected to the rear ring cable 55 is axially displaceable in the outer tube 80 for actuating the manipulator. In FIGS. 5a and 5b, the front ring part 54 and the rear ring part 55 are shown in a partial longitudinal section, with the spring and the securing bracket being omitted. The circular sector-shaped recess 83 and the corresponding cutout 84 in the upper run 76 can be seen on the ring part 54. Both are closed with a cover 87 to form a cavity closed to the rear. In the upper run 76 there is also a longitudinal groove 86, which is connected to the circular sector-shaped recess 84. On the rear ring part 55 there is a recess 88 corresponding to the recess 83 and a corresponding recess 89 in the upper run, which is closed by a corresponding cover 90. As can be seen in particular in FIG. 5b, the recess 84 is followed by a transition slope 91 and the recess 89 is followed by a transition slope 92, the function of which is explained below. In FIG. 5a it can be seen in the advanced working position that the flag 82, which is connected to the outer tube 80 and a further flag 93, which is connected to the inner rod 81, each protrude into the recesses 83 and 88. When the telescopic tube 62 is pulled back by means of the two ring parts 54 and 55, the flags 82 and 93 are forcibly returned to the position rotated by 90 ° within the longitudinal groove 86 shown in FIG. 5b through the run-on bevels 91, 92. In this position, the manipulator must be pulled back past the applicator jaws.

5 again shows the ring part 54 with recess 83 and cover 87 and the ring part 55 with recess 88 and cover 90. In the upper course, the recess 84 is also shown, into which the tab 82 protrudes and which continues to the rear with the run-on slope 91. Furthermore, the recess 89 is shown in the upper run, into which the tab 93 extends and which has the run-on bevel 92 at the end. Basically, it would be sufficient to provide only one of the mentioned bevels, since the jaws of the manipulation device are connected via a front joint. In order to prevent torsional loads there, however, two run-on bevels which act uniformly on the tabs 82 and 93 of the outer tube 80 and the inner rod 81 must be provided.

Claims

1. Clamp applicator (37) for setting and closing blood vessel clamps or the like for laparctomy, with an elongated shaft (75, 76), two at its front end, movable about an axis of rotation (69) relative to each other, spanning a variable opening angle Jaws (41, 42), each having inwardly open recesses for receiving and holding an open blood vessel clamp, and a handle and actuating device (43, 44) arranged at the rear end thereof for closing the jaws, in particular against spring force, with a manipulation device (52) for blood vessels or tissue structures, which is arranged laterally next to an opening plane spanned by the jaws (41, 42) and which is guided by means of a telescopic arrangement (62) guided in the shaft (75, 76) between a front protruding beyond the opening plane of the jaws Position and a rear, next to the opening level of the jaws n position can be shifted, characterized in that the manipulation device is multi-sectioned and articulated, branches or jaws (50, 61; 63, 64; 65, 67).

2. Applicator according to claim 1, characterized in that the manipulating device (52) is designed as scissors, in particular as tubular shears.

3. Applicator according to claim 2, characterized in that the scissors are designed as Pctt's scissors.

4. Applicator according to claim 2, characterized in that the scissors on a branch (60) is provided with a hook.

5. Applicator according to claim 1, characterized in that the manipulating device (52) is designed as pliers.

6. Applicator according to claim 5, characterized in that the pliers are designed with hook-shaped cheeks (56, 57) which leave an open cross-section in contact with one another.

7. Applicator according to one of claims 1 to 6, characterized in that the telescopic device (62) consists of coaxial rod (80) and tube (81).

8. Applicator according to one of claims 1 to 6, characterized in that the telescopic device (62) consists of centrally divided upper and lower run.

9. Applicator according to one of claims 7 or 8, characterized in that the telescopic device (62) is rotatable and has a radial tab (82), dis engages in a radial recess (83) on part of a rotary knob (53).

10. Applicator according to one of claims 7 to 9, characterized in that the shaft is formed from the longitudinally mutually displaceable lower run (75) and upper run (75) which are moved by means of the handle and actuating device (43, 44) and with the jaws (41, 42) are connected to open and close the same, and that in the lower run (75) a length groove (85) is provided, through which the tab (S3) engages longitudinally displaceably and at an angle and that in the upper run (75) an enlarged one Recess (34) is provided, in which the tab can be rotated in a variable angle.