Abstract:
The present invention relates to surgical clamps and clamp devices that provide a handle-free surgical field and to methods of operating such clamps and clamp devices. Such methods may include moving a second rotating element relative to a first rotating element such that the rotational axis of the second rotating element is not parallel to the rotational axis of the first rotating element and rotating the first rotating element about the rotational axis of the first rotating element to cause rotation of the second rotating element about the rotational axis of the second rotating element. The rotation of the second rotating element causes translation of a first actuation element along the rotational axis of the second rotating element. The translation of the first actuation element causes pivotal motion of the first jaw portion towards the second jaw portion. Other methods and devices are provided.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a divisional application of U.S. patent application Ser. No. 13/942,390 filed on Jul. 15, 2013, entitled “Handleless Clamping Device,” which is a continuation of the divisional application filed on Dec. 15, 2008 under U.S. patent application Ser. No. 12/335,431, (issued under U.S. Pat. No. 8,506,590 on Aug. 13, 2013) which claims priority to the non-provisional application filed on Mar. 25, 2003 as U.S. patent application Ser. No. 10/397,915 (issued under U.S. Pat. No. 7,588,585 on Sep. 15, 2009) and U.S. Provisional Application No. 60/368,074, filed Mar. 26, 2002, the disclosures of which are herein incorporated by reference in their entirety. 
     
    
     FIELD OF THE INVENTION 
       [0002]    This invention relates to surgical instruments for occluding and grasping hollow organs as well as grasping solid tissues. Specifically, various clamp devices designed for minimally invasive surgery or for maximizing space in the surgical field are described. 
       BACKGROUND OF THE INVENTION 
       [0003]    Surgical procedures often require retraction, grasping, and the full or partial occlusion of organs such as blood vessels, bile ducts, and intestines, and other various tissues. Traditionally, surgical clamps having pivotable jaws and a handle with a ratchet mechanism are used for this purpose, e.g., Kocher and Kelly clamps. The clamp jaws are actuated by manipulation of the handle at the proximal end of the clamp. However, these clamps are often bulky, and once deployed their handles usually get in the way, obstructing the surgeon&#39;s field of view or access to other locations at the surgical site. With the advent of less invasive surgical procedures, surgical sites are becoming smaller and smaller, and obstruction by clamp handles is becoming more problematic. Thus, it would be advantageous to provide a surgical clamp that reduced or even eliminated the bulky handle portion of traditional clamps. 
       SUMMARY OF INVENTION 
       [0004]    The present invention provides various surgical clamps that reside in a surgical field without a bulky handle portion. The surgical clamps generally include first and second body portions that are pivotally connected at their proximal ends. The first and second body portions further include first and second jaw portions extending from the first and second body portions respectively. The clamps include a moveable drive element connected between the first body portion and the second body portion such that movement of the drive element pivotally moves the body portions relative to one another. Movement of the drive element is typically either rotational or translational. 
         [0005]    The surgical clamps may be provided with, and releasably attached to, a clamp applier so that the drive element may be actuated from a position distal to the clamp jaw portions. In some instances, the clamp applier slidably engages a clamp along a wire. Once engaged, control arms on the clamp applier may be approximated to actuate the drive element. 
         [0006]    In one variation, the drive element includes an orthogonally situated threaded rod and thumbscrew. In another variation, the drive element includes a worm and worm wheel assembly. In a further variation, the drive element is composed of a threaded rod with a mounted nut that is longitudinally aligned with the clamp jaw portions. In yet another variation, the drive element includes a spring-loaded ratchet slide that closes a first jaw portion by proximal movement of the ratchet slide. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0007]      FIG. 1  is a perspective view of a surgical clamp according to one variation of the invention having a drive element situated orthogonal to the jaw portions. 
           [0008]      FIG. 2  is a partial cross-sectional view of a surgical clamp according to another variation of the invention having a drive element composed of a worm and worm wheel assembly. 
           [0009]      FIG. 3  is a partial cross-sectional view of a surgical clamp according to another variation of the invention having a drive element actuated by rotation of a threaded rod through a nut. 
           [0010]      FIG. 4  is a partial cross-sectional view of a surgical clamp according to another variation of the invention having a translationally actuated drive element. 
           [0011]      FIG. 5  is a perspective view of a clamp applier according to one variation of the invention. 
           [0012]      FIG. 6  is a perspective view of another clamp applier according to another variation of the invention disengaged from the clamp in  FIG. 3  having a rotationally actuated drive element. 
           [0013]      FIGS. 7A-7D  show a clamp applier according to another variation of the invention that slides along a wire to engage the surgical clamp of  FIG. 4  and actuate its drive element.  FIG. 7A  is a side view of the clamp and clamp applier disengaged, and the wire upon which the clamp applier slides.  FIG. 7B  is a cross-sectional view of the clamp applier.  FIG. 7C  is a perspective view of the clamp applier engaged with the clamp.  FIG. 7D  is a partial cross-sectional view of the applier engaged with the clamp. 
           [0014]      FIGS. 8A-8D  illustrate another variation of a clamp applier for translationally actuating a drive element.  FIG. 8A  shows a perspective view of the clamp and clamp applier disengaged along a wire.  FIG. 8B  is a side view of the clamp and clamp applier engaged.  FIG. 8C  is a partial cross-sectional view of the translationally actuated drive element.  FIG. 8D  is an enlarged side view of the gearbox. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0015]    The surgical clamp devices of this invention may take various forms, but as further described below, are generally designed to have first and second body portions that are pivotally connected at their proximal ends. The body portions further include first and second jaw portions that extend from the first and second body portions, respectively. Typically, the body portions are pivotally moved by rotational or translational actuation of a drive element. A clamp applier may also be used to deploy the clamp if desired. The surgical clamps of this invention can be used in a variety of open, laparoscopic, or endoscopic procedures, including those requiring occlusion of hollow organs, e.g., blood vessels, ureters, bile ducts, intestines, and the like. 
         [0016]    The surgical clamping devices may be made from any biocompatible material including, but not limited to, stainless steel and any of its alloys; titanium alloys, e.g., nickel-titanium alloys; polymers, e.g., polyethylene and copolymers thereof, polyethylene terephthalate or copolymers thereof, nylon, polyurethanes, fluoropolymers, poly (vinylchloride); and combinations thereof. 
       Surgical Clamps 
       [0017]    As shown in  FIG. 1 , the surgical clamps of this invention generally include a first body portion  14  and a second body portion  16 . First jaw portion  13  and second jaw portion  15  are connected to, and extend from first body portion  14  and second body portion  16 , respectively. Body portions  14  and  16  are linked together by, and pivotable about, pivot  18 . Pin  20  of the second body portion  16  is received within slot  22  of the first body portion  14  as a guide for rotation of the body portions about the pivot  18  and to restrict the range of rotational motion about the pivot  18 . 
         [0018]    Jaw portions  13 ,  15  and body portions  14 ,  16  may be sized, shaped, and/or aligned according to their intended use depending on such factors as the hollow organ or solid tissue clamped, surgeon preference, type of procedure involved, and the like. For example, jaw portions  13 ,  15  may be straight or curved, long or short, or designed such that when directly opposed, they are transversely or vertically aligned with each other. Depending on their material constitution, jaw portions  13 ,  15  may also be designed to have varying degrees of flexibility and stiffness along their lengths such that they are malleable at their distal ends, and can be shaped by the surgeon just prior to clamp deployment. 
         [0019]    In one variation, jaw portions  13 ,  15  include inserts  17 ,  19  that cushion a clamped tissue. The inserts  17 ,  19  may be formed of an elastomer or other like material and can further be textured to improve the grip of the insert on the clamped tissue. The inserts may be affixed to the jaw portions  13 ,  15  by techniques known in the art, such as those described in U.S. Pat. Nos. 6,099,539 and 6,206,896, each of which is incorporated herein by reference in its entirety. Preferably, the inserts are fixed to the jaw portions using a flexible elongate attachment member configured for receipt in a corresponding channel provided in the jaw portions, such as those described in U.S. Pat. Nos. 6,228,104 and 6,273,902, and U.S. application Ser. No. 09/594,291, each of which is incorporated herein by reference in its entirety. 
       Drive Elements 
       [0020]    A moveable drive element is usually positioned between, and connects, the first and second body portions. The drive element may be configured to be distal or proximal to elements such as pin  20  and slot  22  in the body portions, as shown in  FIG. 1 . Actuation of the drive element, either by a rotational movement or a translational movement, pivotally moves the body portions, thereby opening or closing the jaw portions. When appropriate, the drive elements are configured to be non-back drivable, e.g., by making a fine pitch between screw threads. 
         [0021]    In one variation, provided in  FIG. 1 , the drive element comprises a threaded rod  30  which is situated orthogonal to the jaw  13 ,  15  and body  14 ,  16  portions, and which is integrally connected to a thumbscrew  32  at approximately the midpoint of the rod  30 . The rod  30  has a left hand thread on one side of the thumbscrew and a right hand thread on the other side. Rod ends  34 ,  36  are threaded through nuts  38  and  40  which are disposed within channels  42  and  44  that extend through body portions  14  and  16 , respectively. The nuts are mounted within the channels such that they remain aligned with the screw axis when body portions rotate about pivot  18 . To actuate the clamp and thereby move the jaw portions either together or apart, the thumbscrew  32  is rotated, which in turn rotates the rod  30 . As the rod  30  rotates, it threads through and applies an axial force on the nuts  38 ,  40 , which in turn apply a force onto each body portion  14 ,  16  and jaw portion  13 ,  15 . The direction of thumbscrew rotation will determine whether the jaws portions open or close. The clamp may also be ergonomically designed to enable the surgeon to hold the clamp in one hand and rotate the thumbscrew with a single digit, e.g., a thumb or forefinger. 
         [0022]    In another variation, as shown in  FIG. 2 , the drive element includes a worm  200  and worm wheel  202  for actuating the jaw portions  204 ,  206 . In such a variation, first and second body portions  208 ,  210  are again pivotally connected. The worm  200  is rotatably mounted in the first body portion  208  with an axis of orientation generally parallel to the first jaw portion  204 . The worm  200  is connected to a drive shaft  212  which extends proximally from the first body portion  208  and is coupled to an actuating knob  214 . The rotational axis of the actuating knob  214  coincides with the drive shaft and worm axis. The worm wheel  202  is typically integrally formed with the second body portion  210  and includes gear teeth  216  arranged in an arc about the pivot  220  that couples the first and second body portions  208 ,  210  together. Gear teeth  218  on the worm  200  mesh with the gear teeth  216  of the worm wheel  202 . Rotation of the actuating knob  214  turns the drive shaft  212 , which in turn rotates the worm  200 . Rotation of the worm  200  drives the worm wheel  202  and causes movement of the second body portion  210  about the pivot  220 , thus moving the second jaw  206  toward or away from the first jaw  204 , depending on the direction of rotation of the worm  200 . 
         [0023]    In a further variation, shown in  FIG. 3 , the drive element of clamp  301  includes a threaded rod  300  which is axially aligned with the first and second jaw portions  302 ,  304  when they are in the clamped position. The rod  300  is connected to a drive shaft  314  which extends proximally from the drive element. The drive shaft  314  couples an actuating knob  312  mounted on the drive shaft  314  to the rod  300 . The rod  300  is threaded through a nut  306  which is disposed between the first and second body portions  308 ,  310 . To actuate the drive element and open or close the jaw portions  302 ,  304 , the actuating knob  312  is rotated, which in turn rotates threaded rod  300 . As rod  300  rotates, it threads through and applies an axial force on the nut  306 , which in turn applies a force onto body portions  308 ,  310 . The direction of rotation of the actuating knob  312  determines whether the jaw portions  302 ,  304  open or close. 
         [0024]    In yet a further variation, the drive element includes a spring loaded ratchet slide. As shown in  FIG. 4 , the drive element of clamp  401  is axially aligned with the first and second jaw portions  400 ,  402  when the jaws are in the clamped position, and is actuated by proximal movement of a ratchet slide  404 . A spring  406  having a distal end  405  and a proximal end  403  is concentrically mounted on the ratchet slide  404  and fixedly attached to the distal end  411  of the ratchet slide  404  at its distal end  405 . The proximal spring end  403  is free to slide along the ratchet slide  404  and engage the engaging arm  413  of the first body portion  414  when the ratchet slide  404  is moved proximally. One way to move the ratchet slide  404  is by applying an axial force to a wire  407  attached to the proximal end  409  of the ratchet slide. When the wire is moved proximally, the ratchet slide  404  is also moved proximally, and the proximal end  403  of the spring  406  engages and compresses itself against engaging arm  413 , exerting a force on the first body and first jaw portion  400 , to thereby bring the first jaw portion  400  together with the second jaw portion  402 . The spring  406  also serves to increase the clamping force resolution. Another spring  412  may be coupled to the first body portion  414  to aid in movement of the first jaw portion  400 . A pawl  408  keeps the jaw portions  400 ,  402  closed. The pawl  408  rotates with respect to a pin  417  which is connected to the second body portion  418 . To release the pawl  408  and open the jaw portions  400 ,  402 , a generally rotational force sufficient to counter the force supplied by a leaf spring  416  is applied to the pawl  408  to disengage it from the ratcheted portion  410  of the ratchet slide. 
       Clamp Appliers 
       [0025]    As will be appreciated, it may be desirable to deploy the surgical clamps of this invention using a clamp applier, e.g., when the surgical field or access to an organ or tissue is limited. The clamp appliers are generally releasably attached to one or more applier areas on the surgical clamps, e.g., the actuating knob, the drive shaft, the first body portion, and/or the second body portion, and may employ a rotational or translational movement to actuate the drive elements, but in all instances, actuate drive elements from a position distal to the first and second jaw portions. 
         [0026]    In one variation, as shown in  FIG. 5 , a clamp applier configured for use with a surgical clamp having a worm and worm wheel assembly ( FIG. 2 ) or a longitudinally aligned threaded rod and nut ( FIG. 3 ) is provided. The clamp applier includes a rotating shaft  500  that terminates at its distal end in a drive head  502  configured for receipt of a drive element, e.g., a clamp actuating knob (element  312  in  FIG. 3 ) or a drive shaft (element  212  in  FIG. 2 ). When secured to such an element as a clamp actuating knob  214 ,  312 , the clamp applier may be aligned along the rotational axis of the knob or within about 15 degrees, within about 30 degrees, or within about 45 degrees of the rotational axis of the knob. The proximal end of the rotating shaft  500  includes a handle  504  and a handle actuating knob  506  distal to the handle  504 . The handle actuating knob  506  is connected to the rotating shaft  500  at its proximal end such that rotation of the knob  506  rotates the shaft  500 . In use, the drive head  502  of the rotating shaft  500  is releasably attached to, e.g., a clamp actuating knob. The handle actuating knob  506  is manually rotated relative to the handle, which in turn rotates the clamp actuating knob  214 ,  312  to actuate the clamp jaws portions  204 ,  206 ,  302 ,  304  as described above. Or, if the drive head  502 , the rotating shaft  500 , and the handle  504  are fixedly connected, and the actuating knob is rotatably connected to the handle  504 , the drive element may be actuated by holding the actuating knob  506  stationary and rotating as a single unit, the handle  504 , rotating shaft  500 , and drive head  502  relative to the actuating knob  506 . A bracket assembly (not shown), being fixedly connected to the handle, may be used to restrain the body portions of the clamp from rotating if desired. The handle  504  and handle actuating knob  506  may also be variously shaped and sized depending, e.g., on the method of clamp deployment, surgeon preference, or type of procedure. 
         [0027]      FIG. 6  shows another variation of a clamp applier. In this variation, the distal portion  602  of clamp applier  600  is sized and shaped to grasp an applier area of surgical clamp  604 . For example, distal portion  602  is shown to be curved in  FIG. 6  so that it may grasp clamp  604  along its cylindrical V-groove  606  when control arms  608  are approximated (to bring them together). Once releasably attached to clamp  604 , the clamp  604  may be positioned, e.g., from a location distal to the surgical field. A component  610  similar to the clamp applier in  FIG. 5  is coupled to the body  612  of the clamp applier  600 . The component  610  includes a drive head  614 , a rotating shaft  616 , and an actuating knob  618 , typically fixedly connected. The component  610  is coupled to the body  612  of the clamp applier  600  at least at one position along the rotating shaft  616 . In use, after clamp  604  has been positioned, the drive head  614  releasably engages any part of a rotationally actuated drive element, e.g., the drive shaft ( 212 ) in  FIG. 2 . Rotation of the actuating knob  618  rotates the rotating shaft  616  and drive head  614 , which thereby rotates the drive element. 
         [0028]    The clamp applier may also slide along a wire secured to the clamp to releasably attach itself to the clamp. The clamp appliers in these instances include control arms that are approximated to actuate the drive element. In one variation, as shown in  FIGS. 7A-7D , the clamp applier  700  includes a handle attachment  702 , a spring-loaded rear snap  704 , an outer tube  712 , an inner tube  716 , a rotator knob  718  concentrically mounted on the proximal end  708  of the outer tube, and a release disc  720  having raised areas  722  concentrically mounted on the distal end  710  of the outer tube. The clamp applier  700  may be configured for use with clamps having drive elements as described in  FIG. 4 . When wire fitting  706  engages the spring-loaded rear snap  704 , the clamp applier  700  is releasably attached to the clamp  401 . Pressing down on the rear snap  704  and pulling the clamp applier  700  away from the clamp  401  then disengages the applier  700  from the clamp  401 . For example, as provided in  FIG. 7D , a wire  407  coupled to the ratchet slide  404  is placed under tension and moved proximally as the pair of control arms  714  are squeezed together. Proximal movement of the ratchet slide  404  exerts a compressive force on a spring  406  concentrically mounted on the ratchet slide  404  to exert a force on a first jaw portion  400  to bring it together with the second jaw portion  402 . The spring-loaded pawl  408  works to prevent the jaw portions from opening as described above. To release the pawl  408 , the rotator knob  718  is rotated, which in turn rotates the outer tube  712  and release disc  720  on the outer tube  712 . Rotation of the release disc  720  thereby causes the raised areas  722  on the release disc  720  to exert a downward and rotational force on the pawl  408  to release it. 
         [0029]    Another variation, particularly useful with a clamp such as shown in  FIG. 3 , is provided in  FIGS. 8A-8D . In this variation, the clamp applier  800  is also slid along a wire  802  to releasably attach to the clamp  301 . The front and rear control arms  804  and  806 , respectively, of the clamp applier  800  are then also squeezed together to actuate the drive element of the clamp  301 , but they are translationally approximated instead of rotationally approximated. As shown in  FIG. 8B , after slidably engaging the clamp  301 , the clamp jaw portions  302 ,  304  are closed by translationally approximating control arms  804 ,  806 . The linear motion of a rack  808  on the rear control arm  806  through a gearbox  810  causes rotation of an inner shaft  812  of the clamp applier  800  and rotation of a screw head  814  connected to the inner shaft  812 . This in turn exerts a force on a nut  816 , which exerts a force on the first jaw portion  302 , causing it to close. A slot  818  in the second body portion  820  constrains the nut  816  to only move horizontally. Gearbox  810  is shown in greater detail in  FIG. 8D , and generally includes a gear shaft  824 , a pinion gear  826 , a first bevel gear  828 , and a second bevel gear  830 . The pinion gear  826  and first bevel gear  828  are connected to gear shaft  824 . The second bevel gear  830  is connected to inner shaft  812 . Pinion gear  826 , first and second bevel gears  828 ,  830 , and rack  808  have teeth. The teeth of the first and second bevel gears contact each other, and the teeth of the pinion gear  826  and rack  808  contact each other. Linear movement of the rack  808  to approximate the control arms  804 ,  806  rotates the pinion gear  826  which rotates the gear shaft  824  and first bevel gear  828 , which rotates the second bevel gear  830  and the inner shaft  812  connected to the second bevel gear  830  to actuate the drive element. Pulling the rear control arm  806  away from the front control arm  804  opens the first and second jaw portions  302 ,  304 . A spring-loaded release button  822  is axially fixed to the gear shaft  830  but is free to rotate about the gear shaft axis. The release button  822  may be pressed to temporarily disengage the gears in the gearbox  810 , allowing the user to slide the rear control arm  806  to a different position without actuating the jaw portions. 
         [0030]    All publications, patents, and patent applications cited herein are hereby incorporated by reference in their entirety for all purposes to the same extent as if each individual publication, patent, or patent application were specifically and individually indicated to be so incorporated by reference. Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, it will be readily apparent to those of ordinary skill in the art in light of the teachings of this invention that certain changes and modifications may be made thereto without departing from the spirit and scope of the appended claims.