US 2940451 A
Description (OCR text may contain errors)
June 14, 1960 1. J. VOGELFANGER EI'AL 2,940,451
SUTURING APPARATUS 2 Sheets-Sheet 1 Filed Feb. 26, 1958 June 14, 1960 Filed Feb. 26, 1958 l. J. VOG'ELFANGER EI'AL srmmmc APPARATUS 2 Sheets-Sheet 2 INVENTOR lecaqc Joel Vogzl-f-angqf William Gordon Eazqtm. Georg; Johann Klgm I Antoni Jozef Smoky/5K! chrlato hzr Ludwlg Flschcr ATTORNEY United States Patent SUTURING APPARATUS Isaac Joel Vogelfauger, William Gordon Beattie, George Johann Klein, and Antoni Jozef Smialowski, all of Ottawa, Ontario, and Christopher Ludwig Fischer, Eastview, Ontario, Canada, assignors to Canadian Patents and Development Limited, Ottawa, Ontario, Canada Filed Feb. 26, 1958, Ser. No. 717,656
13 Claims. (Cl. 128-.-334) This invention relates to an apparatus for effecting a suturing operation.
When a blood vessel is severed, either as a result of an accident or in the course of a surgical operation, repairs to restore flow through the vessel without delay may be imperative in order to save a limb or the life of the patient.
The usual manner of joining the two parts of a severed blood vessel involves a very slow and difficult operation requiring highly specialized skill on the part of the surgeon. Many surgical operations would be greatly facilitated if it were possible to join severed blood vessels, regardless of their size, in a rapid and convenient manner.
It is an object of this invention to provide a means for efiecting a suturing operation in a greatly reduced period of time and in such a manner that its execution is not diificult thereby avoiding strain on the patient and surgeon.
Another object is to provide an apparatus which will make it possible to carry out operations, the performance of which is now substantially impossible because of the necessity of maintaining blood supply to vital organs.
Another object is to provide an apparatus which will enable a surgeon to perform peripheral vascular surgery without the necessity of specialized training in this field and to perform such surgery in a much reduced period of time.
Another object is to provide an apparatus which will permit the suturing of blood vessels as small as approximately two millimeters and possibly even smaller.
Another object is to provide an apparatus which will enable surgeons to produce peripheral vascular sutures of an exceptionally high degree of perfection.
The invention resides in a suturing apparatus comprising a hollow cylindrical clip-driving assembly having two half sections arranged to surround one end portion of a severed blood vessel, a cylindrical anvil member having two half sections arranged to surround the other end portion of said severed blood vessel, a holder having a pair of pivotally mounted jaws for engagement with said two sections of said clip-driving assembly, a second holder having a pair of pivotally mounted jaws for engagement with said two sections of said anvil member, means removably connecting said holders for limited swinging movement with respect to each other in the axial direction of said assembly and anvil member, and means for effecting said limited swinging movement.
The invention will be described with reference to the accompanying drawings, in which:
Figure 1 is a longitudinal sectional elevation of the cylindrical members of the apparatus in accordance with the invention, showing such members in operational engagement with a severed blood vessel, 7
Figure 2 is an end elevation of the clip-driving assembly,
Figure 3 is an end elevation of the anvil cylindrical member,
Figure 4 is a partial side view, partly in section, of the anvil cylindrical member,
Figure 5 is a side elevation of a tubular guide form--' ing part of the clip-driving assembly,
Figure 6 is an end elevation of the complete apparatus in accordance with the invention,
Figure 7 is a side elevation of the apparatus,
Figure 8 is a partial side elevation of a sleeve forming another part of the clip-driving assembly, I
Figure 9 is a plan view of a holder locking means,
Figure 10 is a side elevation of a clip suitable for use with the apparatus illustrated,
Figures 11 and 12 are side elevations of the clip in two forms of clinched condition,
Figure 13 is an end elevation of the apparatus showing a modified form of press tool,
Figure 14 is a side elevation of the apparatus and press tool shown in Figure 13,
Figure 15 is a sectional view on line 15-15 of Figure 14,
Figure 16 is a transverse sectional view of the clipdriving assembly, showing a modified form of locking member,
Figure 17 is a partial side elevation of a modified portion of the clip-driving sleeve, and
Figure 18 is a plan view of the modified portion shown in Figure 17.
In the drawings, 1 is a cylindrical clip-driving assembly which may be formed of suitable metal, combination of metal and plastic composition or the like and comprises a tubular guide 2 having a plurality of axially extending raised portions 3 on the external surface thereof. Each portion 3 is of generally T-shaped cross-sec tion to provide a groove 4 in each side surface thereof. It will be observed that each portion 3 extends from one end of the guide 2 to a point intermediate the ends of the guide. In the embodiment shown, each portion 3 extends to a point somewhat less than half the length of the guide. It will also be observed that each space between each adjacent pair of portions 3 forms vw'ththe grooves 4 a T-shaped slot 5. The assembly also includes a sleeve 6 having a radial flange 7 extending outwardly therefrom and a plurality of axially extending fingers 8 of T-shaped cross-section and each arranged for reception in a respective slot 5. The sleeve 6 is thus arranged for longitudinal sliding or reciprocal movement on'the guide 2 but is restrained from rotative movement by the fingers 8. The sleeve 6 on guide 2 with fingers 8 in slots '5 slides freely but with substantially little play with respect thereto. The guide 2 and sleeve 6 are formed in two separate complementary half sections, as shown.
The guide 2 is adapted to receive a plurality of clips 9, one in each of the wider portions of slots 5 (sleeve 6 with fingers 8 being withdrawn sufficiently to permit insertion of the clips).
Each clip 9 is preferably formed from round section wire, which may be of a material which .is neutral with respect to the body, such as tantalum, whereby it can be left permanently in the patients body without ill effects. The clip, as shown, is U-shaped with legs 10 and a connecting part 11 hereinafter referred to as the head. The head 1'1 is preferably slightly arched in the plane of the legs thereof and is also slightly arched in a direction at right angles to such plane whereby it may fit the armate wall of the slot 5. Each leg 10 is preferably also slightly arched outwardly in the plane of the legs and the end of each leg is sharpened to a knife edge preferably in the plane of the legs, as shown. The free end of the broader part of each finger 8 may be slightly concave as indicated at 51 for engagement with the arched head of a clip 9 and the free end of the narrower part of the finger may overhand such concave surface to provide a V 1 retaining and supporting lip tively, the same retaining andsupporting etfectmay be obtained by concave bevelling the entire end face of the free end of each finger 8 to suit the arch of the head of the clip, as indicated at 66 in'Figuresl7 and 18; Each clip 'is placed in a slot with the pointed ends 9 of its legs adjacent to, but not protruding beyond the end of the slot coinciding with theend of the guide 2.
* Thenormal maximum 'width of the clip, which occurs .near the midlength of the legs, is slightly greater than the width of theunder portion ofslot 5 whereby it is necessary, to spring the legs ltlslightly towards each otherlin order to place the'clip in the slot; Thus, the slightly flexed legs exert'a'light spring load on the walls of the slot, and the clip is thereby held in position in the guide 2.
A cylindrical anvil member 12 comprises two complenientaryfhalf sectionsrformed of a suitable metal, combination of metal and plastic compositiongor the like.
' The member 12 has a' radially outwardly extending flange 13 adjacent one end thereofand a plurality of sets of 52 for the clip. Alterna- 2,949,451 7 ii i 4 holders 17 and to move the clip-driving assembly 1 and anvil member 12 towards each' other compr ses a press tool 38. Tool 38 comprises a pair of arms 39 rock- .ably connected together intermediate their'ends by means of a pair of'links 40. One'end of each arm 39 has a pair of laterally extending jaws 41 for engagement with one or the other of a pair of shoulders 42 on arms 18 and 26. Means for moving said jaws v41 towards each other comprises a screw 43 carried by the other end portioniof one, arm 39, such screw having an operating handle 44and an end portion 45 engageable'in a socket 46 the corresponding end portion of the other arm 39. Means for limiting-the stroke applied to jaws 41 comprises a pin 47 carried by the latter arm 39 and extending through an opening 48 in the'first arm 39. Pin 47 carries a stop or head 49 engageable with such first arm 39 to limit outward movement thereof. 'Pin 47 has screwwards a common apex 16. It will be apparent that a set of anvil recesses 14 is adapted to be provided opposite each; of the slots 5 for reception of the ends of a; clip 9 in such slot 5. 7
' A holder 17 is provided for the clip-driving assembly 1, such holder being of the pincer type and comprising .a of arms 18 pivoted together at 19 to provide a pair of gripping jaws 20. Each jaw 20 has an 'arcuate groove 20a to receive a'portion of radial flange 7 of the clip-driving assembly 1. -Means for locking the holder 17 in closed orgripping position comprises a toggle mechanisrn 21 of conventional form and having, as shown, a
7 A holder 25 is provided for the anvil member 12, such holder being closely similar to'holder 17 and comprising threaded mounting in arm 39whereby its length may be adjusted thereby to adjust the length of stroke of jaws 41 and consequently jaws 20 and 28. Head 49 is preferably provided with an indicating dial '50 to facilitate the setof pin 47. Referring to Figures 13, and 14, an alternative and preferred form of press tool is therein illustrated. The
tool is' indicated generally at 67 and includes a pair of arms 68 and 69 pivoted together at 70. One end of each arm '68 and 69 has a pair of laterally extending jaws 71 for engagement with one or other of the pair of'shoulders 42 on arms 18 and 26. It will be apparent that the tool is operable in the conventional manner of afplier type of tool; The hand gripping portions 72 and 73 of the arms are preferably somewhat offset from the pivot 70 and jaws 71 as clearly shown in Figure 14. It will be apparent that, since the tool is operable directly by the hand of the user, it'is unnecessary to provide a stroke-limiting stop since the operator will be able to feel the progress and conclusion of the stroke, However,a stop 74 may be provided on the arm 68 for engagement by the other arm to define an extreme limit of the stroke.
a pair of arms 26 pivoted together at 27 to provide-a pairlof gripping jaws 28. 8 Each jaw 28 has an arcuate groove 28a to receive a portion of ra'dial flange 13 of member 12. The holder'25 is also provided with looking" toggle mechanism 29. V 1 7 v means fortheclip-dr-iving assembly 1 and anvilmember' 12 comprises a boss 53 onione of the gripping jaws '20 arranged to enter one of a pair of comple- 'mentary notches 54in radial flange 7, and boss 55on one of the gripping jaws 28 arranged to enterone of a pair of complementary notches 56 in radial flange 13 *Means'are preferably provided for defining the normal open or at rest position of the tool and comprises, in the embodiment shown, a coil spring 75 located in recesses 76 and 77 in'the engaging inner surfaces of arms 68 and 69, respectively adjacent the pivot70. I-t willlbe observed 'that the spring'75 will urge the arms 68 andv 69 into open position wherein the recesses 76 and 77 are in registry, j as shown in Figure 15. When the gripping portions 72 and 73 .are moved towards each other, the recesses will Mea'ns are provided for separably connecting holders 1 17 and 25 in accurate alignment and forlimited swingmg movement towards and away from each other com prises a pair of connectors 30.- Each connector 30 'comprises a pin 31 fixed to an arm 26 adjacent its'free end and having, as shown, a partly spherical head '32 and,'adja- 'cent to the head, a conical neck section 33 Each arm 18 has a complementary socket 34 to receive the head 32 ofa respective pin 31, such head being releasably retained in'the socket by means of a flat spring .me'rnber 35 mounted on each arm 18 by a retainer plate 36 and having a pair'of opposed spring 'fingers 37 arranged to be forced apart to permit passage therebetween of the head 32 and to'thereafter springtogether to engage the i conical neck .33 and'force the head 32 of the pin to seat tightly in socket 34. The connectors described, while 7 serving to 'releasably connect the holders, restrain the holders from undesirable side play. 7 7
It rsmlportant that, when the holders 17 and 25 'are a 7 locked in gripping position by means of 'the toggles 21 move' out of registry and compressthe spring. When the gripping'portions 72 and 73, are released the spring will move the arms 68 and 69( with jaws 71) back to the position shown in Figure 114.
'lTo facilitate handlingof theclip-drivingassemibly l, the two-half sections thereof may be temporarily conin Figure l, and thus preclude premature ejection of the clips, from the slots 5. The spring clamp is also provided with a lug which serves as a means to facilitate removal of 'the' spring clamp in order to unlock the sleeve at the appropriate time during the suturing operation. Another suitableform oftemporarylock is shown in Figure 16 and consistsof a rernovable short length of wire 78 threaded through small holes 79 in the sleeve 6 and corresponding holes in thelguide 2. 7
- :To facilitate handling ofthe anvil member, the two 'half sections thereof may be temporarily connected together by means of a spring clamp of any conventional Q m- V In operation, and referring to Figure l'ja suitable length of. the'severed vessel 57 made free of surrounding tissue, and the two ends of the vessel are temporarily tion by the spring clamp and loaded with a complete set of clips, is mounted in holder 17, and the holder locked in gripping engagement therewith. Similarly, anvil member 12 is mounted in holder 25 which is locked in gripping engagement therewith. At this point the spring clamp is removed from the anvil member only. The ends of the severed vessel 57 are then respectively threaded through the clip-driving assembly and the anvil member, a short end portion of the vessel, as indicated at 59, being doubled back on the outer surface of the respective clipdriving assembly and anvil member.
in order to retain the everted ends of the vessel on the assembly 1 and anvil member 12 sharpened projections 60 are provided on the outer surfaces thereof.
The holders 17 and 25 are now connected together by means of the connectors 30 and the ends of the vessel brought into engagement as shown in Figure 1. At this point the spring clamp is removed from the clip-driving assembly 1. After the stop 49 has been adjusted to suit the wall thickness of the vessel, the press tool 38 is placed in the position shown in Figures 6 and 7 with jaws 4-1 in engagement with shoulders 42. The operating screw 43 is actuated to impart an inward driving stroke to assembly 1 and member 12. The clip ends thus pierce the contacting ends of the vessel and are clinched by engagement with the walls of anvil recesses 14 to fasten together the vessel ends. It will be understood that the holders 17 and 25, and their operating relation to each other, are such that, at the end of the clip driving stroke, when the assembly 1 and member 12 are separated by a distance slightly less than twice the thickness of the vessel wall, the adjacent faces thereof are closely parallel and concentric.
The apparatus is then withdrawn by first removing the press tool 38. The toggle mechanisms 21 and 29 are released and the holders 17 and 25 removed as a unit. The two parts of the anvil member 12 are then removed and the everted ends of the vessel rolled oil the driving assembly 1 and over the other everted end of the vessel. The two sections of the assembly 1 and the two hemostatic clamps 58 are now removed, thus completing the suturing operation.
It is important that the clips 9 adequately clamp, but do not crush, the vessel Walls. It has been found that a clip, such as illustrated, with suitable control of its pressure stroke into the anvil recesses 14, and with use of a recess wall profile as illustrated, will be deformed into a clincher form such as shown in Figures 11 and 12, wherein the legs 10 do not exert an undue crushing action with respect to head 11 of the clip. However, it be apparent that various other shapes of clips and of anvil recess profiles may be employed to achieve the desired purpose.
It is within the contemplation of the present invention to provide a series of clip-driving assemblies 1 and anvil members 12 of various sizes in order to meet varying conditions of use as normally encountered in suturing operations of the type described. The holding flanges 7 and 13 of such series may be of standardized dimensions in order to fit the jaws of holders 17 and 25 and the positioning bosses thereon.
It will be understood that, while the apparatus shown has been designed to employ a series of six clips, it would be a simple matter to design an apparatus for use with any desired number of clips.
It will also be apparent that various forms of the press tool 38 or 67 may be employed to carry out its functions.
1. A suturing apparatus comprising a cylindrical clipdriving assembly having blood vessel-surrounding sections, a cylindrical anvil member having blood vessel-surrounding sections, a holder having a pair of pivotally mounted jaws removably engaging said clip-driving assembly, a second holder having a pair of pivotally mounted jaws removably engaging said anvil member, a connector releasably connecting together said holders to place said clip-driving assembly and said anvil member in axial alignment, said holders having limited swinging movement with respect to each other in the axial direction of said clip-driving assembly and anvil member, and a pressure-applying device removably engaging said holders to efiect said limited swinging movement.
2. A suturing apparatus as defined in claim 1, said clip-driving assembly comprising a tubular guide, a sleeve reciprocally mounted on said guide, and a plurality of axially extending raised portions on the external surface of said guide forming a groove between each adjacent pair of said raised portions, said sleeve having a plurality of axially directed fingers each arranged to extend into one of said grooves, each said groove being arranged to receive a clip for driving engagement by one of said fingers.
3. A suturing apparatus as defined in claim 1, said clip-driving assembly comprising a tubular guide having on the external surface thereof a plurality of axially extending raised portions of T-shaped cross-section forming a T-shaped groove between each adjacent pair of said raised portions, and a sleeve reciprocally mounted on said guide and having a plurality of axially directed fingers each arranged to extend into one of said grooves, each said groove being arranged to receive a clip for driving engagement by one of said fingers.
4. A suturing apparatus as defined in claim 2, said anvil member having a plurality of clip-receiving recesses in one end thereof, each said recess having a bottom wall for engagement with the ends of a clip to impart a clinching movement thereto.
5. A suturing apparatus as defined in claim 1, each said holder having a pair of arms swingable to open and close said jaws, and mechanism connecting the free ends of said arms to lock said jaws in closed position.
6. A suturing apparatus as defined in claim 1, each said holder having a pair of arms swingable to open and close said jaws, and means for locking said arms in jawclosing position, said connector comprising a snap fastener on each of the arms of one of said holders, each of the arms of the other of said holders having a socket receiving said snap fastener.
7. A suturing apparatus as defined in claim 5, said pressure applying device comprising a pair of arms pivotally connected together intermediate their ends, and jaws mounted on adjacent ends of said pivotally connected arms and each engageable with one of said holders to swing said holders towards each other, each said am having a gripping portion for manual application of an inward stroke thereto and to said holders.
8. A suturing apparatus as defined in claim 7, including spring means mounted in said arms for urging said arms into open position.
9. A suturing apparatus as defined in claim 5, said pressure applying device comprising a pair of arms rockably connected together intermediate their ends, jaws mounted on adjacent ends of said rockably mounted arms and each engageable with one of said holders to swing said holders towards each other, an operating screw carried adjacent the other end of one of said rockably mounted arms and engaging the other of said rockably mounted arms to impart an inward swinging stroke to said holders, and a stop carried by one of said rockably mounted arms to limit the extent of said stroke.
10. A suturing apparatus as defined in claim 1, each said clip-driving assembly and anvil member having an outwardly radially directed flange thereon, each said jaw having a groove for reception of said flange to facilitate clamping engagement of said jaws, and means carried by each said pair of jaws for maintaining alignment of said clip-driving assembly and said anvil member.
V l Asnturingrapparatus as defined insclaim 2, include mg -sharpened projections on the. outer surfaces of'said clip drivinggasse'rnbly and anvil member for retaining the s 'evertedends of ahldodveswl-therieoni- 1 i V 12, A snt fn g apparatus comp sing acyliridricel driving assemblyhavingi'bl'ood vessel-surrounding sec:
7 tiong a cylindrical :anviLmembenhavifig blood vessel-' sm'rounding sections, a holder having gripping 'jaws: re-
movably engaging saidclip-driving assembly, a second holder having gripping jaws removably engaging said anvil member, a connector connecting together 'said holders to place said clip-driving assembly and said anvil member inf axial alignment, said holders having limited 7 movement with respect 'to' each other in'the axial directionof said clip-driving assembly and said anvil member,
' and a pressure-applying device removably engaging said holders to effect said limited movement.
1 3. .A suturing apparatuscomprisinga cylindrical clipj driving assemblvhaving bloodvessel-surrounding secripp liawsjjengaging sai anv l em ia, mn i c p 5 eonnectingtog'ether sa i s p a e a efi ng I assembly 1:;n 11': lw said anvil member in'axial alignment, said holders.havingiiimitedmovement l e p'ee t adl other. in the axial direction of said clip-driving assembly andsaid anvil member, and a pressure-applying device 0 engagingssaid holjdel s to effect said limitedrmoveqnent.
Referencescited in the file of thisrp atent 7 .11: 7 'UNITED STATES PATENTS?" V