This invention relates to feeding arrangements for medical clip and stapling devices, and more particularly to a surgical stapler for the pinching, stapling, metal suturing or clipping of blood vessels or for the closure of wounds, in which the surgical stapler includes a ladder-type feeding mechanism. The invention also relates to the ladder-type feeding mechanism and cartridge containing the ladder and clips.
Surgical staplers and clips have been used with increasing frequency to replace suturing and/or for closing wounds or to tie-off blood vessels during a surgical procedure or other traumatic medical event. Such surgical staplers generally have a pair of jaws at a distal end of the surgical stapler (that is, the end opposite the handle, trigger, or other actuation assembly for manipulation by the user), which crimp a generally U-shaped clip flatly across the tissues to be tied or sutured. Typically, the clips are arranged in a tube or barrel of the surgical stapler in a sequential manner, the clips being fed serially to the jaws with each actuation of the surgical stapler, for example.
The tools typically in use dispense the clips to the jaws sequentially such that when operated, the distalmost clip is pinched, and then the next adjacent clip immediately therebehind is advanced to the foremost position so that it may be applied next. For example, a clip feeding and dispenser mechanism may use a spring to force the movement of clips in line with an applicator.
Some such surgical staplers include a ladder which pushes a train of such clips forward, one-at-a-time, as the surgical stapler is operated (e.g., serially pushing one of the clips with each squeeze of the actuation assembly). Use of a ladder for pushing the clips is advantageous because the ladder contains several slots (for example, square or rectangular holes) spaced regularly in sequence along the ladder, so that various mechanisms within the surgical stapler can discretely advance the ladder one slot at a time.
However, because the ladder typically has a mass sufficient to slide the ladder along the barrel of the surgical stapler when gravity or inertia acts upon the ladder, there is the possibility that the ladder may slip forward inadvertently while the surgical stapler is in use—for example when the surgeon using the surgical stapler tilts the surgical stapler at an angle steep enough to cause gravity to slide the ladder distalward (that is, toward the distal end) down the barrel. As such, clips may be unintentionally pushed by the ladder and dropped from the surgical stapler, which can complicate the surgical process and which can lead to increased costs.
Furthermore, in some such surgical staplers as shown in
Hereinafter, an example of a stapling gun 14 which may be outfitted with a ladder as described above is discussed, in reference to
The housing 18 has an opening 22 through which a proximal end 25 of a barrel 24 is supported. The barrel 24 also has a distal end 26 (in other words, the end farther from the handle 16 than the proximal end) where the jaws 12, utilized for feeding and pinching the clips or staples 28, are located. A generally U-shaped or C-shaped frame member 40 (see, for example,
The frame member 40 has several portions along its length on its lowermost side, having elongated slots 38 therein, as may be seen in
The barrel 24 may be arranged to receive a clip cartridge 30 at its rearmost opening 22 at the housing 18 in the handle 16 (as an alternative, for example, the clip cartridge 30 may be inserted into the barrel or from the distal end, inter alia). The frame member 40 may be arranged to receive the generally U-shaped or C-shaped (cross-section) clip or staple cartridge 30 which may include one or more medical clips or staples 28 and an elongated ladder 42, as illustrated in
The clips 28 and the elongated ladder 42 may be slidably movable within the generally U-shaped frame member 40 and/or the cartridge 30, which provides their enclosure in the package. The elongated ladder 42 may have side rails 43 extending on each side of the ladder 42 and extending along the length of the ladder 42, as well as cross rails 45 connected orthogonally between the side rails 45 and forming a stepladder-like structure including a plurality of elongated slots or holes 44 of generally rectangular shape arranged longitudinally down the middle portion of the ladder 42, as illustrated in
The ladder 42 has a distal end 48, which abuts the last (i.e., proximalmost) clip 28 within the cartridge 30. As an example, about twenty clips or staples 28 may be held seriatim in the cartridge 30; alternatively, however, the cartridge may hold just one clip, or it may hold any particular number of clips which suitably fit within the space available within the frame member 40. Each clip 28 preferably abuts its immediate neighbors and may be disposed in a pushing arrangement with its adjacent distal clip 28, for example.
An elongated cycling clip feeder member or bar 50 may be arranged within the barrel 24 and may be supported beneath the frame member 40 therewithin. The clip feeder member or bar 50 may have a distalmost finger 52 of ramp-like configuration, having a short pin 54 extending from each transverse side thereof, as may be seen in
The elongated clip feeder bar 50 is movable distally and proximally according to the actuation of the trigger mechanism 20 within the handle 16 of the clip device 14. The proximate finger 60 also has a pin (not shown), extending transversely from each side thereof in a manner similar to that of the distalmost finger 52. The pins 54 on the fingers 52 and 60 cam the fingers 52 and 60 out of engagement with the clips 28 through sliding engagement with the ramps 66 and 68 adjacent the slots 38 in the frame member 40, as the feeder bar 50 is drawn proximally.
The squeezing of the trigger mechanism 20 cycles the longitudinal distal advancement of the elongated clip feeder bar 50 relative to the frame member 40. Release of that trigger simultaneously advances the proximal finger with the distal finger 52, and the proximal finger 60 is permitted by the upward spring action thereof, to enter one of the holes 44 of the elongated ladder 42 corresponding to the location of the slot opening (also referred to as a central trench) in the lower mid portion of the cartridge 30 and frame member 40, as exemplified in
Release of the trigger mechanism 20 opens the jaws 12 (which are one example of a clip applicator, inter alia) and advances the proximal finger 60, which has by then traveled the length of the rectangular hole 44 in the ladder 42 at its location adjacent its opening in the frame member 40. As the proximal finger 60 engages the distal end of that rectangular hole 44 in the ladder 42, it then begins to push the ladder 42 distally a spaced distance, to push upon the entire series of clips 28 within the cartridge 30 and thus effecting delivery of the next available staple or clip 28 to its “stand-by” position at the distal end 26 of the barrel 24 after the former end or distalmost clip 28 has been pushed between the jaws 12 by the distalmost finger 52.
Movement of the trigger mechanism 20 effects rearward or proximate cycle of movement of the clip feeder bar 50, and the side pins 54 of each respective finger 52 and 60 engaging the lower side of the ramps 66 and 68 adjacent the slot 38 on the lower side of the frame member 40, so as to bias the fingers 52 and 60 downward and out of the way of the respective clips 28 and ladder openings or holes 44 respectively adjacent thereto as the feeder bar 50 cycles rearwardly completing a generally oval path. The clip finger bar 50 is then returned to its proximalmost location with the pins 54 riding under the feeder guide plate 66, to await a further actuation of the trigger mechanism 20, which would recycle the entire clip cartridge 20 and feeder bar mechanisms 50 accordingly.
However, as discussed above, use of a such a clip applying device with inadequate sliding movement control includes the risk that a staple or clip may be inadvertently ejected or dropped from the distal end of the barrel, because the ladder (which may have a not-insignificant mass and thus be susceptible to sliding due to gravity or inertia) can slide within the frame of the barrel when gravity or inertia are exerted on the ladder, such as can occur when the user of the clip applying device causes the barrel to tilt downward or when the clip applying device is rapidly moved, for example. When the ladder slides because of such a force, it may press against the clips to the extent that one or more of the clips may unintentionally emerge from the distal tip of the barrel, for example. Furthermore, the use of a “tail” or “finger” on the ladder which presses downwardly against the cartridge and/or the frame of the barrel can generate undesirably warping of the ladder.
Accordingly, it is a feature of the present invention to generate appropriate resistance to sliding movement of a ladder in a surgical stapler and/or clip applying device.
According to an aspect of the present invention, a clip applying device may include a barrel having a first end and a second end, a clip applicator affixed to the second end of the barrel and which can apply a clip during a surgical procedure, an actuation assembly attached to the first end of the barrel and which can actuate the ladder and clip applicator when operated by a user, a cartridge disposed within the barrel extending generally from the first end of the barrel to the second end of the barrel, and a ladder slidably disposed within the cartridge and including a first protrusion extending laterally outward from a central axis of the ladder.
The clip applying device may also include a second protrusion extending laterally outward from a central axis of the ladder in a direction generally opposite from the first protrusion; the cartridge may have a cross-section generally similar to a letter ‘C’ and include first and second inner side surfaces, and the first and second protrusions of the ladder may frictionally abut the first and second inner side surfaces, respectively; the ladder may be substantially flat when disposed in the cartridge; the ladder may include a clip abutment portion having the first protrusion and which can abut a first clip nearest the actuation assembly among a plurality of clips, and in which the first clip has a shape that can conform to the clip abutment portion of the ladder; the cartridge may be insertable into and removable from the clip applying device, may be capable of housing the ladder therein, and may be capable of containing two or more clips, in which the cartridge can be inserted into the first end of the barrel; and/or the first protrusion may extend from at least one of a distal end of the ladder farthest from the actuation assembly, a proximal end of the ladder nearest to the actuation assembly, and/or a point between the proximal and distal ends.
In accordance with another aspect of the present invention, a clip applying device may include a barrel having a first end and a second end, a clip applicator affixed to the second end of the barrel and which can apply a clip during a surgical procedure, an actuation assembly attached to the first end of the barrel and which can actuate the ladder and clip applicator when operated by a user, a cartridge disposed within the barrel extending generally from the first end of the barrel to the second end of the barrel, and a ladder slidably disposed within the cartridge and including a side rail extending longitudinally within the cartridge, a first protrusion extending from a top of the rail and a second protrusion extending from a bottom of the rail at a position opposite the first protrusion, in which the first and second protrusions can abut the cartridge.
In regards the above-noted clip applying device, the cartridge may have a cross-section generally similar to a letter ‘C’ and include a bottom inner surface and a top inner surface generally parallel to the bottom surface, and the first and second protrusions of the ladder may frictionally abut the top inner surface and the bottom inner surface, respectively; the first protrusion may exert a downward force and the second protrusion may exert an upward force, in which the upward force and the downward force impart generally no net torque to the ladder; the ladder may be substantially flat when disposed in the cartridge; the clip applying device may further include a clip abutment portion which can abut a first clip nearest the actuation assembly among a plurality of clips, and in which the first clip may have a shape which can conform to the clip abutment portion of the ladder; the cartridge may be insertable into and removable from the clip applying device, may be capable of housing the ladder therein, and may be capable of containing two or more clips and of being inserted into the first end of the barrel; and/or the first and second protrusions may extend from a distal end of the ladder farthest from the actuation assembly, a proximal end of the ladder nearest to the actuation assembly, and/or a point between the proximal and distal ends.
In accordance with yet another aspect of the present invention, a ladder for use with a clip applying device may include first and second protrusions extending from an end of the ladder along a lateral plane generally coplanar with the ladder or an orthogonal plane generally orthogonal to the ladder, in which the ladder which can serially urge a clip outward from the clip applying device, and in which the first and second protrusions may abut a cartridge in which the ladder is disposed.
In regards to the above-noted cartridge, the cartridge may engage a cartridge within a barrel of the clip applying device, in which the cartridge has a cross-section generally similar to a letter ‘C’ and includes first and second inner side surfaces, and in which the first and second protrusions of the ladder frictionally abut the first and second side surfaces, respectively; the ladder may include a plastic material; the cartridge may engage a cartridge within a barrel of the clip applying device, in which the cartridge has a cross-section generally similar to a letter ‘C’ and includes an inner bottom surface and an inner upper surface, and in which the first and second protrusions of the ladder include vertical risers which can frictionally abut the inner bottom surface and the inner upper surface, respectively; the ladder may include a clip abutment portion including the first and second protrusions, in which the clips have a generally parabolic shape which can conform to the clip abutment portion of the ladder; and/or the cartridge may further include third and fourth protrusions extending from an end of the ladder generally opposite the first and second protrusions and which can abut the cartridge in which the ladder is disposed.
It is noted that although a surgical or medical clip applicator which is reusable and receives a cartridge to reload clips has been described as an example, the present invention is not limited to a reusable clip applying device but may also be used in a single-use clip applying device or any other suitable type of clip applying device, for example.
Other exemplary embodiments and advantages of the present invention may be ascertained by reviewing the present disclosure and the accompanying drawings, and the above description should not be considered to limit the scope of the present application.
The present invention is further described in the detailed description which follows, in reference to the noted drawings, by way of non-limiting examples of certain embodiments of the present invention, in which the numerals represent like elements throughout the several views of the drawings, and in which:
The particulars shown herein are by way of example and for purposes of illustrative discussion of the embodiments of the present invention only, and are presented for providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the present invention. In this regard, no particular attempt is made to show structural details of the present invention in more detail than is necessary for the fundamental understanding of the present invention, the description taken with the drawings making apparent to those skilled in the art how the several forms of the present invention may be embodied in practice, although certain examples may be described in fuller detail in order to convey certain aspects of embodiments of the present invention.
Furthermore, although some embodiments of the present invention may include certain features generally similar to those discussed above with regard to the Background of the Invention, the present invention is not limited to the examples discussed therein but rather encompasses all configurations and/or designs which embody the present invention, such as (but not limited to) the exemplary embodiments discussed below, for example.
In accordance with a first embodiment of the present invention, a stapling gun 14 (as shown in
The barrel 24 may be flexible or, alternatively, may be rigid, for example, or may have any appropriate properties of flexibility and/or rigidity. Also, the barrel 24 may have a cross-section of any suitable shape or form. As illustrated in
The ladder 42 may include first and second proximal protrusions 201 a and 201b (see
When the ladder 42 is slidably disposed in the cartridge 30, and the cartridge 30 is inserted into the barrel 24, the outward protrusion or bias of the proximal protrusions 201 exert a force laterally against inner side walls 30a of the cartridge 30—i.e., laterally outward from a central lengthwise axis of the cartridge (as exemplified by line A-A in
It is to be understood that the phrase “laterally protruding,” as generally used herein unless otherwise noted, refers to, for example, extension in a direction generally coplanar with the broadest plane of the ladder. For example,
Furthermore, the terms “lateral” and “laterally” are generally understood to be considered relative to a reference object or reference direction, such as, for example, the flat plane of the ladder 42 (as discussed above, for example), and is used for convenience herein with respect to such reference object or reference member but is not in any way intended to be necessarily limited to an absolute or fixed geometrical frame of reference (although such a fixed frame of reference is also understood to fall within the use herein of the terms “lateral” and “laterally,” as such a situation can also properly correspond to aspects and/or embodiments of the present invention). Rather, it is to be understood that if a particular reference object, such as the ladder, corresponding to a use of the term “lateral” changes its geometrical position and/or orientation with respect to a local, area-wide and/or global frame of reference, and/or with respect to another object such as the rest of the clip applying device 14, if appropriate, that the term “lateral” is understood to still be properly interpreted with respect to the particular reference object, for example.
Also, it is further to be understood that the term “protrusion” as generally used herein is an inclusive term intended to denote any and all protruding portions, and is not intended to be limited to any particular example of a protrusion. For example, a “protrusion” can refer to either the rounded ends 201a and 201b, which extend laterally outward beyond the outermost lateral extent of the side rails 43 of the ladder 42, and/or may also refer to both the rounded ends 201a and 201b and the extension members 202 as shown in
In some variations and/or embodiments of the present invention, the rounded protrusions (such as 201a and/or 201b) at the tip of the extension members 202 may be omitted; alternatively (or additionally), in some variations and/or embodiments, the extension members 202 may be generally straight and oriented generally parallel to the central axis of the ladder 42, with the rounded protrusions (such as 201a and/or 201b) extending outward (as illustrated in
Furthermore, the frictional force generated by the proximal protrusions 201 abutting the cartridge 30 may be selected (by, for example, choosing the angle of protrusion of the proximal protrusions 201 and/or a shape of a frictional contact surface of the ladder 42, choosing a material having a particular elasticity, and/or choosing a material for the ladder 42 and/or cartridge 30 having a particular coefficient of friction—at least for the frictional surface which contacts a wall of the cartridge 30, inter alia) such that the frictional force is sufficient to produce the beneficial speed-reducing effect, but which nonetheless does not inhibit or suppress the intended functionality of the medical stapler 14 to apply a clip 28 to the jaws 12 when the trigger is operated by the user, for example.
Also,
As an alternative to having two protrusions, a ladder in accordance with a variation of the first embodiment (and/or other embodiments) may include one protrusion, for example (as discussed above). In a non-limiting example of such a variation of the first embodiment, a ladder having one protrusion may include the protrusion which laterally abuts an inner side surface of the cartridge (or any other appropriate surface of the cartridge), and opposite the protrusion the ladder may simply have a side rail or any other appropriate member. As the one protrusion abuts the cartridge, the side rail or other member which is positioned opposite the one protrusion may also be urged against the cartridge because the force applied by the one protrusion against the cartridge would be distributed between both the one protrusion and the side rail or other member positioned opposite the one protrusion. Therefore, a ladder having even one protrusion may provide elastic force in order to generate frictional contact (between the cartridge and either the protrusion or the side rail, or both, for example) between the ladder and the cartridge, for example.
In accordance with a second embodiment of the present invention, for example, the distal end 103 of the ladder 42 includes distal protrusions 48a and 48b extending from both side-rails of the ladder 42 (see
In such a state, the elasticity of the distal protrusions 48a and 48b (see
Moreover, because the distal protrusions 48a and 48b are biased away from the central axis of the ladder 42 generally only in the substantially flat lateral plane of the ladder 42, as a result little or no directional component of the force exerted by the elasticity of the distal protrusions 48a and 48b enclosed by the cartridge 30 is directed in a directional orthogonal to the plane of the ladder 42. Therefore, warping or bending of the ladder 42 along the length of the ladder 42 may be reduced or eliminated (as shown in
The ladder 42 may be formed of a single material (plastic, polyvinyl chloride, polyethylene, polystyrene, polymer or any other suitable material, for example) therethroughout, by molding or casting, for example; or, alternatively, the distal protrusions 48a and 48b may otherwise be formed of a different material from the main body of the ladder 42 and later adhered or otherwise affixed to the ladder 42, for example.
Also, in an alternative configuration, the ladder 42 may include both proximal protrusions such as 201a and 201b at the proximal end 203 of the ladder 42, as shown in
In accordance with at least one variation of the second and/or other embodiments, the protrusions—such as, for example, either the proximal protrusions 201a and 201b or the distal protrusions 48a and 48b, or both—may be disposed at any point between the proximal end 203 and the distal end 103, for example.
Referring to
Because of the conformation of the clips 28 to the abutment portion of the ladder 42, the appropriate alignment of the clips 28 may be bolstered by the shape of the abutment portion of the ladder 42.
A fifth embodiment of the present invention is exemplified in
It is noted that as used herein, directional terms such as “upper” and “lower,” “upward” and “downward,” are generally to be interpreted relative to a reference object or reference frame, as appropriate, and are not necessarily limited to any particular global or fixed frame of reference (although such terms also not necessarily exclude such a global, area-wide, local, or fixed frame of reference, for example). It is further understood that such terms may be appropriately geometrically translated and/or interpreted relative to the appropriate reference object or reference frame, and thus may retain their proper interpretations, even if the reference frame or reference object changes its position and/or orientation relative any other particular object or frame; such directional terms are not intended as terms of limitation, but rather simply to exemplify such features as they describe.
In contrast to the “finger” or “tail” configuration shown in
For example, a ladder 42 as shown in
As illustrated in
Also, the orthogonal vertical risers 49 may include substantially the a same material as the ladder 42, or may include a different material; furthermore, for example, the orthogonal vertical risers 49 may include an elastic member such as a spring (which also may be made of the same material the ladder 42 or of a different material, such as metal, for example).
In addition, the elasticity for providing the frictional force between the ladder 42 and the cartridge 30 may be inherent to the cartridge 30 and/or the ladder 42 (or its components, such as the orthogonal vertical risers 49, the distal or proximal protrusions 48a and 48b or 201a and 201b). For example, the orthogonal vertical risers 49 may be made of a generally rigid material, while the cartridge 30 may have a generally ‘C’-shaped cross-section and include a flexible metallic or polymer material, such that the upper lips of the cartridge 30 can elastically flex to accommodate the ladder 42 and orthogonal vertical risers 49. In such an arrangement, the elasticity of the cartridge 30 may provide the frictional force between the orthogonal vertical risers 49 and the cartridge 30. As a benefit, for example, the fabrication costs of the ladder 42 and/or cartridge 30, may be reduced.
It is noted that the foregoing examples have been provided merely for the purpose of explanation and are in no way to be construed as limiting of the present invention. While the present invention has been described with reference to certain embodiments, it is understood that the words which have been used herein are words of description and illustration, rather then words of limitation. Changes may be made, within the purview of the appended claims, as presently stated and as amended, without departing from the scope and spirit of the present invention in its aspects. Although the present invention has been described herein with reference to particular means, materials and embodiments, the present invention is not intended to be limited to the particulars disclosed herein; rather, the present invention extends to all functionally equivalent structures, methods and uses, such as are within the scope of the appended claims.