US 3777355 A
A surgical clip applier for surgical wounds is disclosed which is semi-automatic in operation, operated with one hand, easily disassembled or assembled without tools as for cleansing or sterilizing in an autoclave and includes a low cost disposable clip magazine. Individual clips are advanced to a position where they are applied selectively to the wounded area and, as soon as one has been applied and the mechanism released, the applier operates automatically to be ready for the next application. This enables the surgeon to close a wounded area in much shorter time than could be done by suturing, or by individually applying each clip.
Claims available in
Description (OCR text may contain errors)
United States Patent 91 Cooke [451 Dec. 11, 1973 1 SURGICAL WOUND CLIP APPLIER WITH DISPOSABLE CLIP MAGAZINE  Inventor: John R. Cooke, Four Mile Canyon,
Boulder, Colo. 80302  Filed: July 24, 1972  Appl. No.: 274,503
 U.S. Cl. 29/243.56, 72/410  int. Cl... B23p 11/00, E05b 19/06, EOSb 19/26  Field of Search 29/243.56, 212 D; 72/410; 227/108, 19
 References Cited UNITED STATES PATENTS 3,015,824 1/1962 Richardson 72/410 X 3,646,801 3/1972 Caroli 227/19 2,735,322 2/1956 Meisler 29/243.56
2,897,502 8/1959 Schafroth.... 227/108 3,526,944 9/1970 Cherup 29/212 D Primary Examiner-James L. Jones, Jr. Attorney-Wm. Griffith Edwards  ABSTRACT A surgical clip applier for surgical wounds is disclosed which is semi-automatic in operation, operated with one hand, easily disassembled or assembled without tools as for cleansing or sterilizing in an autoclave and includes a low cost disposable clip magazine. Individual clips are advanced to a position where they are applied selectively to the wounded area and, as soon as one has been applied and the mechanism released, the applier operates automatically to be ready for the next application. This enables the surgeon to close a wounded area in much shorter time than could be done by suturing, or by individually applying each clip.
13 Claims, 19 Drawing Figures 'PATENTEU DEC '1 I $975 SHEET 10F 4 FIG. 2
PATENIEDUEC 11 1975 3777355 SHEET 2 0F 4 PATENTEDBEB 1 1 i975 SHEET 3 OF 4 FIG.4
F IG. l4
PMENTED DEC 1 1 I975 SHEET QUF Q FIG.8
FIGII FIG. IO
SURGICAL WOUND CLIP APPLIER WITH DISPOSABLE CLIP MAGAZINE My invention relates to the application of metal clips to close surgical wounds and particularly to an improved device for applying such clips in rapid succession to speed and facilitate the closing of a wound.
Metal clips applied one at a time have come into use for closing surgical wounds and are particularly useful in facilitating closures and for favorable post operative cosmetics. Various devices have been provided for bending or closing surgical clips in position to grip the tissue adjacent to a wound, and some such devices have been provided which include a magazine from which clips are delivered to a clip closing mechanism. It is desirable to provide effective and reliable magazine type clip applying devices which may be readily disassembled for autoclaving and for servicing and, accordingly, it is an object of my invention to provide an improved surgical clip applying device.
It is another object of my invention to provide a magazine type device for applying surgical clips which is easily assembled and readily disassembled for purposes of servicing and for autoclaving.
It is another object of my invention to provide an improved clip magazine equipped surgical clip applier which may easily be manipulated and used with one hand.
It is another object of my invention to provide an improved applier for surgical clips of the type having ears or lugs separated during the closing ofthev clip and which facilitate adjustment, or opening of the clip when a a wound has healed.
It is a further object of my invention to provide an improved device for applying surgical clips which is positive and reliable in operation.
It is a further object of my invention to provide a manually actuated device for applying surgical clips to the lips of wounds including an improved arrangement for holding the device and for applying finger pressure during application of the clips.
Briefly, in carrying out the objects of my invention in one embodiment thereof, I provide a clip holding and applying structure including stamped metal front and rear wall members which are formed to provide finger grips or catches and an actuating member slidable between the two wall members for actuating a forceps also located between the members. Interengaging cam surfaces on the forceps and on the actuating member together with cam or guide surfaces on one of the wall surfaces cause the forceps to move downwardly to a position externally of the structure. Surgical clips are supplied to the bottom zone of the structure where they are gripped one at a time by the forceps and moved downwardly from the structure into position to attach to the lips of a wound as the forceps are operated. The clip applier assembly may be taken apart easily by releasing resilient catch portions of one of the wall members so that the assembly is readily serviced and the unassembled parts may be autoclaved when separated. A magazine type clip supply device extends outwardly from the lower zone of the wall members and is readily detachable. The clip magazine is also made up of materials not affected by autoclave temperatures and is easily sterilized.
The features of novelty which characterize my invention are pointed out with particularity in the claims appended to and forming a part of this specification. My
invention itself, however, both as to its organization and manner of operation, together with further objects and advantages thereof, may best be understood by reference to the following description taken in connection with the accompanying drawings in which:
FIG. 1 is an isometric view of a surgical clip applier embodying my invention;
FIG. 2 is a sectional side elevation taken along the line 22 of FIG. 1;
FIG. 3 is an exploded isometric view of the applier of FIG. 1;
FIG. 4 is a sectional view along the line 44 of FIG.
FIG. 5 is an enlarged side elevation view of a portion of the structure of FIG. 1;
FIGS. 6, 7 and 8 are sectional views of the portion shown in FIG. 5 illustrating three steps in the assembly of the applier;
FIGS. 9, 10 and 11 are enlarged sectional elevation views of the lower part of the portion of FIG. 5 illustrating three stages in the attaching of the clip magazine to the applier;
FIG. 12 is a rear elevation view of the portion shown in FIG. 11;
FIG. 13 is an enlarged elevation view of a portion of the bottom left end of the device shown in FIG. 2;
FIG. 14 is an enlarged sectional view taken along the line 14-14 of FIG. 4; and
. FIGS. 15A through 15E illustrate successive stages in operation of the clip closing forceps.
Referring now to the drawings, the surgical clip applier illustrated in FIG. 1 comprises an upright body portion 10 and a horizontally extending clip magazine 11 which is detachably secured to the lower end of the body 10. The body portion 10 comprises front and back outer walls 12 and 13 which terminate upwardly in arcuate outwardly extending finger grips l4 and 15,
' respectively. Slidably mounted within the body 10, be-
thumb plate 17 extends directly over the actuator. The
actuator is biased upwardly by a spring 20 attached thereto and bearing on the top surface of the finger member 15 of the rear wall. A string of parallel laterally adjacent aligned clips is contained within the magazine 11 and is pressed forward by a spring which urges a pressure member, or follower, 21 toward the body 10 to supply clips as they are used one at a time by operation of the actuator l6. This arrangement of the string of clips and the follower 21' is shown in FIG. 2, which illustrates the follower pressing against clips 22 fourteen of which are illustrated in the string. The follower is urged toward the applier by a spring indicated at 23. The spring engages a seat 24 on the follower and extends rearwardly within the magazine and extends into a reduced portion 25 thereof.
A clip closing forceps 26, shown in FIGS. 2 and 3, comprises two jaws 27 and 28 pivoted together on a pin 30 and mounted between the actuator 16 and the front wall 12. The front wall 12 is provided with'a vertical slot 31 extending therethrough, and the pin 30 extends through the slot into engagement with a leaf spring 32 which is securely attached to front wall 12 by a rivet 33 and a bent lip or flange 34 which extends into a slot 35 in the wall 12. The spring 32 is provided to press the forceps against the actuator 16 and to retain the forceps pin 30 either at the top of the slot 31 in an upper position in an outwardly humped portion 32a of the spring as shown in FIG. 2, or in a lower position at the bottom end of the slot where they are retained by an outwardly curved portion 36 of the spring.
The forceps jaws 27 and 28 as shown in FIG. 3 are provided with cam surfaces 37 and 38 into which project the pins 40 and 41 on the actuator 16, the upper end of the forceps jaws have rounded portions 42 and 43, respectively, which are arranged to engage cam surfaces 44 and 45, respectively, formed in the front wall 12. The jaws 27 and 28 are provided with inwardly facing recesses or seats 46 and 47 which are positioned to receive the outer ends of surgical clips supplied thereto from the magazine 11. The manner in which the forceps are actuated by movement of the actuator 16 is described in detail hereinafter. The magazine or cartridge 1 l as shown in FIGS. 1 to 4 comprises top and bottom wall members 48 and 49 which are formed to provide guides for the travel of the follower 21 and which are shaped to guide the string of surgical clips. The follower 21 extends across the magazine 11 and its outer ends ride in slots formed by upwardly offset lower portions 51 of the top wall 48 as clearly indicated in FIG. 1. The follower 21 moves in these slots and may be pressed against the pressure spring 23 until it reaches a position at the far righthand end of the slot where there are upward and downward offsets of the slots indicated at 52 and 53. These offsets allow the follower 21 to be tipped about its lower edge, indicated as of rocker configuration at 54, and when tipped the spring urges the follower against forward stops formed by the offsets of the casing and holds the follower in position so that the clips may be freely moved in and out of the magazine.
Each clip when it enters the zone below the actuator is in the position indicated by the clip 56 in FIG. 2. The
actuator is provided with a blade or knife 57 along its bottom edge and when it is pressed down this blade separates the clip 56 from the next adjacent'clip in the magazine, then, as the actuator moves farther down it strikes a retaining lip or tab 58 formed on the actuator end of the bottom half of the magazine 49. The lip 58 holds the clip 56 in position until it can be gripped by the jaws 46 and 47 and then proceed downwardly to bend the lip 58 down and back against the magazine to allow. the clip to proceed outwardly from the ends of walls 12 and 13 into a position to be clamped about the lips of a wound which is to be closed. The manner in which the forceps operate upon depression of the actu ator 16 is described in detail below.
FIG. illustrates the assembled upright unit and in this figure the back wall 13 which has two side pieces or'legs 60 and 61 (both shown in FIG. 3) secured along the edge of the wall along the front corners to provide guides for the slide 16 includes rearwardly bent lower portions 62 and 63 which, as shown in FIG. 5, are used as locks. In FIG. 5 the portion 63 is illustrated and this figure shows a foot 64 at the bottom of this portion and in engagement with an inwardly extending portion 65 of a lower rearward extension 66 on the front wall 12. This lower portion is shown in FIG. 3. The other side of the lower end of the wall 12 is constructed similarly to the righthand side illustrated, and the far side of the wall 13 as viewed in FIG. 3 also includes a foot at the lower end of the bent portion 62 as indicated at 67. When the unit is to be assembled it is understood that the front spring 32 has been riveted securely in place on the front side of the wall 12. The forcepsare then placed in position against the inner side of the wall 12 with the pin 30 in the upper end of the slot 31 engaging the upper stop or top portion of 32a of the spring. The slide or actuator 16 is then placed over the forceps with the pins 40 and 41 in engagement with the cam recesses 37 and 38, respectively. The assembly is then completed by placing the back wall 13 over the slide 16 so that the slide lies between the guide members 60 and 61. The initial position for insertion of the back wall 13 in this matter is illustrated in FIG. 6 where the foot 64 of the bent portion 63 is shown at the upper end of the inturned portion 65 of the large section 66 on the wall 12. The wall 13 is then pressed into position with the slide 16 lying between the side guides 60 and 61, and with slots 69 and 70 in the upper side edges of the guides 60 and 61, in alignment with outwardly and inwardly extending retaining lugs on the wall 12, one of these lugs being shown at 71 on the righthand side of the wall as viewed in FIG. 3. The cutaway portions 69 and 70 of the guides 60 and 61 allow the guides to be moved past the lugs on the upper ends of the wall 12 so that the wall can be straightened to a position parallel to the front wall 12 as shown in FIG. 7. The wall 13 is then moved downwardly so that the edge of the wall above the recesses 69 and 70 moves past the inturned lugs on the wall 12, as exemplified by the lug 71, and the wall 13 is then returned to a straight position. This wall is then moved downwardly until the foot 64 passes the lower end of the lug 65 on the wall 12 and snaps to a locked position as illustrated in FIG. 8. When the wall 13 reaches this position forwardly projecting lugs 72 and 73 at the tops of the guides 60 and 61, respectively, engage the tops of the wall 12 facing the inturned portions exemplified by the portion 71. The wall 13 is thus locked against removal. When it is desired to take the applier apart again, the foot 64 is pressed forwardly until it clears the wall projection 65 whereupon the wall 13 may be moved upwardly until the side recesses 69 and 70 allow it to move away from the wall 12.
The sloping guides 44 and 45 which are used in guiding the movement of the forceps 26 are stamped in the wall 12 to provide upper and lower side walls on both sides, the ones on the near side in FIG. 3 being indicated at 74 and 75, respectively, the sloping portion 45 joining these two upright walls and the catch or lug 71 being formed on a portion of the wall adjacent the upper portion 74.
The clip magazine portion 11 may, by way of example, be made from plastic materials which are able to withstand autoclaving temperatures. By way of example, one material useful for this purpose is polypropylene, a synthetic plastic, which is flexible and has good hinging characteristics and is dimensionally and chemically stable at autoclaving temperatures. The top 48 as shown in FIG. 3 is molded with a longitudinal ridge 77 which is in alignment with a raised ridge 78 in the lower portion of 49. The ridge 78 provides grooves 80 and 81 in the lower portion and these grooves receive the outer endsof the surgical clips, the upwardly extending ears or releasing members lying in the outer extending groove formed by the ridge 77. The spring assembly and the. follower 21 are arranged between the halves 48 and 49 of the magazine housing and the edges of the housing are welded or otherwise suitably bonded together to form the complete structure; The complete magazine may be autoclaved or maybe handled as a disposable item, each item being loaded at the factory with the required number of surgical clips, and the front or open end of the cartridge sealed by a removable plastic wall.
The walls 48 and 49 include vertical flanges at their front ends, these being indicated at 82 and 83' respectively. The clipretaining lip 58 is molded as a portion of the front wall 83 of the lower half wall 49. The lip 58 forms, in effect, an extension of the wall forming the ridge 78 in the member 49 and is V-shaped in cross section starting at the top of 78 and forming a V as clearly indicated in FIG. 2, where the V is indicated at 84.
When the magazine 11 is to be attached to the clip applier it is first placed in a position illustrated in FIG. 9 in which the downwardly extending flange 83 of the half 49 of the magazine is immediately above the lug or stop 65 of the front wall. The flange 83 is then pressed down between the stop 65 and the lower end 63 of the guide 61 so that it is in a position such as illustrated in FIG. 10. It is then pressed down until it hits the foot 64 of the guide 61 and then is rotated upwardly, the flange 82 then lying below and in contact with the lower edge of the rear of the back wall 13. The thickness of the flange 83 is less than the length of the foot 64 so that when it is in place, as shown in FIG. 11, the foot 64 still engages the stop 65 and prevents removal of the back wall of the applier. The magazine is then locked in place and ready for delivery of the clips one at a time to the clip applying device 10. In FIG. 12 the spaces between the dotted lines 86 and 87 and the solid lines representing the sides of the wall 13 indicate the overlap between the wall 13 and the guides 60 and 61, respectively.
FIG. 13 is an enlarged side elevation view of the holding tab or lip 58 and its V-shaped connection to the top of the central wall 78 of the lower half 49 of the magazine, the parts being shown in their compressed position when the actuator blade 16 has moved downwardly past the normal position of the lip 58, which is indicated in dotted lines. The plastic forming the lip 58 and the V 84 is provided with transverse holes or recesses 88 and 89 which provide a weaker cross section to assure a more effective operating hinge. When the blade 16 is again retracted, the next clip on the ridge 78 moves into position and is held by the lip 58 until the blade 16 is again actuated to retract the lip and move the clip downwardly into clamping position.
When it is desired to compress the spring 23 and prevent discharge of the clips carried in the magazine, the clip follower 21 is moved by gripping itsend pieces on either sideof the magazine and moving the follower 21 back against the pressure of the'spring until it reaches the catches or stops 52 and 53 and is turned counterclockwise as shown in FIG. 14 to engage the stops and prevent forward movement of the follower. An upward blade 92 extends from the rocker 84 vertically and rides in the inverted trough 77 of the upper wall member 48. The rocker 54 and the projection 92 act together to engage the clips and move them forward in the magazine.
plate 17. Each time the surgeon wishes to place a clip in position on a wound, he holds the lower end of the applier at the desired position of the wound and presses the actuator 16 downwardly to force a clip held by the forceps downwardly into position and on forward pressure to close the clip about the two lips of the wound and then releases the clip to leave it in place. This operation is repeated as often as necessary to place therequired number of clips for the wound.
The manner in which the forceps are actuated to effect the foregoing operation of the surgical clip applier is indicated in FIGS. 15A through 15E. FIG. 15A illustrates the forceps in the completely retracted position of the actuator 16. A clip 94 from the magazine has been moved into the zone between the jaws of the forceps and is in spaced relationship to the clipping recesses 46 and 47. Upon initial downward movement of the actuator 16 the pins 40 and 41 move over the cam surfaces 37 and 38 a sufficient distance to bring the recesses of the jaws into engagement with the ends of the clip. The actuator 16 is then moved downwardly until the pin of the forceps has been snapped out of the top recess of the spring 32 and has moved'down in the slot 31 near the bottom thereof.- In this position the upper ends of the forceps indicated at 42 and 43 have just reached the outwardly and downwardly extending surfaces of the cam guides 44 and 45, the blade has descended and separated the clip from thenext adjacent clip and has bent the lip 58 downwardly so that the clip has moved past the lip 58 as the forceps move down. Further downward movement of the actuator 16 presses the forceps jaws together and they compress the clip to bring its pointed ends or spurs together at the rim of the wound. The upper ends or cars 95 of the clip part as the clip is closed on the wound and are thus available to be squeezed by a forceps or other instrument and moved apart when it is desired to adjust or remove the clip from the wound after healing. The actuator 16 is then withdrawn whereupon the jaws are moved apart to release the clip and move upwardly past the sloping guides 44 and 45 and toward the original position of the forceps. In moving to their original position the forceps are moved upwardly so that the spring 32 bends outwardly to allowthe pin 30 to pass upwardly to its original position. Thus the two positions of the pin 30 determined by the spring 32 provide positions wherein the force of the actuator utilizes the cam surfaces to actuate the forceps both in the forward and During the use of the surgical clip applier, as de- 6 scribed above and shown in the drawings, the surgeon holds the clip between two fingers engaging the finger grips 14 and 15 and his thumb engaging the thumb retracting directions.
The metal parts of the applier are made from stainless ,steel sheet or other suitable non-corrodible metal so that autoclaving is effective to sterilize the metal parts and the parts do not corrode from use.
While the invention has been described in connection with a specific embodiment and application, various other embodiments will occur to those skilled in the art. Therefore, it is not desired that the invention be limited to the details illustrated and described and it is intended by the appended claims to cover all modifications which fall within the spirit and scope of the invention as determined by the prior art.
I claim: 4
1. A surgical clip applier for closing surgical wounds, comprising:
a rigid body member having spaced front and back portions and an actuator member slidably mounted between said portions,
a pair of forceps pivoted together and slidably mounted between said members and adjacent said actuator member for sliding movement in the same direction as said actuator member,
means for biasing said actuator member upwardly away from the bottom end of said body,
stop means for limiting the length of the path of movement of said forceps,
camming means interconnecting said forceps and said actuator member for moving said forceps outwardly from the bottom end of said body while closing said forceps,
means detachably secured to the lower end of said body for supplying surgical clips to the interior thereof, each clip in turn being positioned in alignment with said forceps and in position to be closed by closing of said forceps, said forceps having a configuration for gripping a clip and holding it .while it is being closed by closing of the forceps,
said actuator upon downward movement separating the front clip from the next adjacent clip in said supplying means, and
means for manually holding said body member and for pressing said actuator downwardly therein against said biasing means to bend and close a clip at a position beyond the lower end of said body.
2. A surgical clip applier as set forth in claim 1 wherein said members include quickly detachable means for holding said front and back members in assembled relationship with said forceps and said actuator.
3. A surgical clip as set forth in claim 2 wherein said quickly detachable means comprises:
a resilient part of said back portion and a spaced projection on said front portion engaging one another when said members are assembled and a foot on said resilient part hooking oversaid projection to lock said assembly together and stop means for preventing release of said foot by relative sliding movement of said front and back portions.
4. A surgical clip applier as setforth in claim 3 wherein said resilient portion further engages and holds said detachable clip supplying means when positioned on said assembly, said supplying means having a flange held against said projection by said resilient portion.
5. A surgical clip applier as set forth in claim 1 including a flexible lip on said detachable clip supplying means for holding the front clip in position in said body member for engagement by said forceps, said lip being flexed out of the path of the clip by downward movement of said actuator.
6. A surgical clip applier for closing surgical wounds, comprising:
a body having a hollow base member and an upright hollow member at a forward end of said base member and formed of a material capable of withstanding sterilizing temperatures without deterioration;
a surgical clip magazine assembly seated in the hollow portion of the base for holding a string of clips and including means for urging the string forwardly toward said upright member so as to maintain an end clip in the upright member at the forward end of the base member; I
said upright member having a cam cover at its forward end, including an upper grip portion and a lower slot, said upright member having a slide guide at its rear end joined to the base member and including an upper grip portion, and having a sliding blade, including an upper spring portion, supported for manual depressing movement along the slide guide to separate the forward end clip from the next adjoining clip in said magazine assembly, and retractable by action of said upper spring portion upon termination of the manual movement;
two cooperative forceps jaws mounted for pivotal movement on a pivot extending through the slot in said cam cover, each jaw having a cam surface; and
cooperative means on said sliding blade for engaging said cam surfaces during the depressing movement and moving said jaws in gripping relation to the separated clip whereby said clip has its extremities closed in guided clamping juxtaposition about tissue adjoining a wound and is released from clamping contact with said forceps by retracting movement of said blade after the clip is clamped.
7. A clip applier as recited in claim 6, in which a clip string is detachably secured within said hollow portion of the base member for replacement and removal as required.
8. A clip applier as recited in claim 6, including spring means for mounting said pivot in alternative upper and lower positions in the slot in said cover and in which said pivot on which the jaws are mounted is retained during initial action of said cooperative forceps jaws and then to the lower position so as to properly align the jaws over the ends of the clip.
9. A clip applier as recited in claim 6, in which the cam cover, sliding blade and slide guide are confined at their sides by structure normally clamped onto the slide guide and manually removable from the slide guide for cleaning, inspection or replacement of the cover, sliding blade and slide guide.
10. A clip applier as recited inclaim 6, in which the grip portion of the slide guide limits the extent of movement of the spring portion of the sliding blade.
11. A clip applier as recited in claim 6, in which the sliding blade terminates at its lower end in a cutting edge.
l2.-A clip applier as recited in claim 6, in which the forceps jaws are of the same configuration and afford interchangeable mounting of the jaws.
13. A clip applier as recited in claim 6, including means for limiting upward movement of the sliding blade.