Surgical clamp and surgical clamp installation tool

A surgical clamp in certain embodiments may be configured to operate with a surgical installation tool. The clamp may have two elongated members with a bight portion that joins the two elongated members at a proximal end of the clamp and that may bias the two elongated members in an open position at a distal end. The bight portion may have one or more engagement features, such as a slotted aperture or other engagement or coupling feature. A clasp mechanism at the distal end of the clamp may have a male or first component disposed on or adjacent one of the two elongated members and a female or second component disposed on or adjacent the other of the two elongated members at the distal end of the clamp. The installation tool may include an elongated member with a proximal end and a distal end that has an engagement feature to engage the clamp, such as at the bight portion. A handle in one embodiment may be provided at the proximal end of the installation tool, while a head at the distal end may be configured to receive and/or engage the proximal end of the clamp and may also be operable to articulate in at least one plane.

PRIORITY CLAIM

The present application is a non-provisional of U.S. Provisional Patent Application No. 61/299,725 filed Jan. 29, 2010, currently pending, the disclosure of which is hereby incorporated by reference.

FIELD

The present disclosure relates generally to surgical clamps and surgical clamp installation tools.

BACKGROUND

Recently, there has been increased interest in employing surgical clamps to partition sections of a stomach. An example of a bariatric surgical clamp can be found in Jacobs et al., U.S. patent application Ser. No. 11/984,452 and Jacobs et al., U.S. patent application Ser. No. 11/797,537. The aforementioned patent applications are incorporated by reference herein in their entirety for any purpose.

SUMMARY

In one embodiment, a surgical clamp is configured to operate with an installation tool. The clamp in this embodiment may include two elongated members with a bight portion that joins the two elongated members at a proximal end of the clamp and may bias the two elongated members in an open position at a distal end of the clamp. The bight portion may have one or more engagement features. A clasp mechanism at the distal end of the clamp may include a male component or first component disposed on one of the two elongated members and a female component or second component disposed on the other of the two elongated members at the distal end. The installation tool may include an elongated member with a proximal end and a distal end that has an engagement feature. A handle in this one embodiment may be connected to the proximal end of the installation tool, while a head at the distal end may be configured to receive and/or engage the proximal end of the clamp and may also be operable to articulate in at least one plane.

ForFIGS. 5-9, dimensions are given in inches. However, it should be understood that various embodiments are not limited to the dimensions provided. Such dimensions are purely illustrative.

ForFIGS. 4(b),4(c),17(a)-17(d),21,23, and24, broken lines indicate variability in length of the discontinuous portions.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood at the outset that although an exemplary implementation of the present invention is illustrated below, the present invention may be implemented using any number of techniques, whether currently known or in existence. The present invention should in no way be limited to the exemplary implementations, drawings, and techniques illustrated below, including the exemplary design and implementations illustrated and described herein. Additionally, the drawings contained herein are not necessarily drawn to scale, and may be provided in a variety of different dimensions, shapes and configurations. Any provided dimensions are provided only to illustrate a particular exemplary implementation, and in no way construed to limit the present invention absent an explicit recitation of such dimensions and then only with respect to the claim or claims reciting the dimension or dimensions.

Referring toFIG. 1, an embodiment of a surgical clamp100engages with an embodiment of a surgical clamp installation tool102. In these embodiments, the clamp100and the installation tool102are designed for performing bariatric surgery through a surgical trochar. The clamp100, in a preferred embodiment, may be approximately fifteen to thirty centimeters in length to accommodate partitioning of a human stomach. To accommodate insertion through a trochar, the closed clamp100will preferably have a diameter or circumference less than fifteen millimeters over the entirety of its length or along the majority of its length. A non-handle section of the installation tool102intended for insertion through the trochar has a similar diameter or a smaller diameter. It is envisioned that other embodiments of the clamp and installation tool can be of other sizes. It is additionally envisioned that the clamp may be articulated in at least one plane to provide different angles and lengths of partition to the stomach. It is also envisioned that other embodiments of the clamp and installation tool can be for clamping other parts of the human body and/or for clamping other types of bodies or structures.

Referring toFIG. 2, the surgical clamp100has two elongated members104A and104B. A bight portion106joins the two elongated members at a proximal end of the clamp100and biases the two elongated members in an open position at a distal end of the clamp100. As used herein, a bight is a loop, bend, hinge, corner angle, hollow, fold, or similar structure. The bight portion has one or more engagement features, such as, for example, a slotted aperture108such as that shown inFIG. 2(b). A clasp mechanism, in one embodiment, has a male component110disposed on one of the two elongated members at the distal end, and a female component112disposed on the other of the two elongated members at the distal end.

Particularly to partially partition a stomach in performing bariatric surgery, spacing between the two elongated members104A and104B effects two or more clamp sections as best shown inFIG. 2(e). At least one of the sections is a partition forming section105A located nearer the distal end of the clamp100than the proximal end of the clamp100. At least another of the sections is a passage forming section105B located nearer the proximal end of the clamp100, such as near the bight portion106, than the distal end of the clamp100.

In order to reduce injury to the partitioned organ, a padding material116can be connected to one or more of the two elongated members. For example, padding material116can connect to the elongated member104B at least at a location corresponding to at least part of the partition forming section. In some embodiments, the padding material can be composed predominantly of silicone or fully of silicone. It is also envisioned that the opposing limbs of the clamp may be fitted with magnets to facilitate closure.

In some embodiments, the engagement feature at the proximal end of the clamp100can be a slotted aperture108as shown inFIG. 2(b) having a width and a length larger in size than the width. The length of the slotted aperture can be oriented perpendicular or angled with reference to a longitudinal axis of the clamp100. It is envisioned that other types engagement features can be employed, such as a socket, a loop, a hook, a clasp, a string, magnetic, etc.

In some embodiments, the male component110of the clasp at the distal end of the clamp can be an end of the elongated member104A that flares away from a longitudinal axis of the clamp when the clamp is forced to a closed position. Accordingly, the female component112can be a loop attached to the end of the elongated member104B and disposed to engage the male component110of the elongated member104A when the clamp is forced to the closed position. This can be seen more clearly in connection withFIG. 2(e). It is envisioned that other types of clasp components can be employed, such as those found in a hinge, such as a living hinge, hook and loop, spring ring, lobster or trigger, toggle, tube, bolt and bolt hole, screw and threaded aperture, or any other type of closure arrangement.

Returning toFIG. 1and referring generally to bothFIG. 1andFIG. 2, the clamp100, in use, engages with the installation tool by the slotted aperture108. For example, the installation tool102has an elongated member, such as a pull-rod138, having a proximal end and a distal end that has an engagement feature. The distal end of the elongated member of the installation tool102engages with the proximal end of the clamp100through the slotted aperture108of the bight portion106. In some embodiments, the engagement feature takes the form of a T-bar118. This T-bar118is sized and shaped to allow insertion thereof through the slotted aperture108to engage the clamp100. It is envisioned that another engagement feature may have an X-shape, and be sized for insertion through an X-shaped slot in the clamp. Other shapes are also possible.

The installation tool102may include a lever radially engaged with the pull-rod at its proximal end at a handle122that may be configured as a thumbwheel120that extends out of the handle122of the installation tool102through an aperture. While the T-bar118is inserted through the slotted aperture108, actuating the thumbwheel120can cause the T-bar118to rotate ninety degrees as illustrated in one embodiment from a first position shown inFIG. 2(c) and in a second position as shown inFIG. 2(d).

At this point, retracting the pull rod, which may be achieved by squeezing a trigger128to retract the pull rod, forces the proximal end of the clamp100up against and progressively further between guide members of the surgical clamp installation tool102, such as a pair of wedges124A and124B, formed in the articulating head of the installation tool102. A curvature or incline imparted to the articulating head of the installation tool102by the pair of wedges can be keyed to a curvature or incline of the bight portion106of the clamp100in such a way that fully or more fully retracting the pull-rod forces the normally open clamp100to a closed position such as that shown inFIG. 2(e).

Turning toFIGS. 2(f)-2(k), the various clamp features can be readily appreciated. These features include bight portion106, slotted aperture108, male component110, female component112, and padding material116. It should be readily understood that the padding material116can be configured as a pair sleeves as shown, but that other configurations may also be employed. Moreover, non-linear shapes may be utilized for various types of applications in clamping various types of organs, as desired.

Turning now toFIG. 3and referring generally toFIG. 1andFIG. 3, retraction of the pull-rod of the installation tool102is accomplished by actuation or movement of another lever or trigger that is engaged to the proximal end of the pull-rod, such as through an axial engagement. This lever can be configured as the trigger128that extends out of the handle122through an aperture or slotted opening. The shape of the handle and disposition of the trigger are, preferably, ergonomically configured to allow the surgeon to hold the installation tool parallel to the ground near waist level to grip the handle122and the trigger128in one hand. The thumbwheel120is disposed to be within easy reach of the thumb of that hand to facilitate holding of the clamp100by the surgeon in the other hand while engaging the clamp to the articulating head126. The thumbwheel120may be conveniently adjusted to rotate the T-bar118to a desired position to lock the T-bar118to the clamp100at the bight portion106through the slotted aperture108. In one embodiment, the thumbwheel120may rotate the T-bar118by ninety degrees.

Once the surgeon has rotated and retracted the pull-rod using T-bar118and trigger128with one hand, the surgeon's other hand becomes free for other tasks, such as actuating yet another lever protruding from the handle122and configured, for example, as a dial130. With the clamp100pulled closed or partially closed against the pair of wedges, the head126can be articulated from side to side by rotating this dial130. The motion of the articulating head126through rotation of the dial130is illustrated in one embodiment in the top view of the installation tool102inFIG. 3(b) at arrow300showing a range of motion or articulation in one embodiment.

Turning now toFIG. 4, in some embodiments, turning the dial130can turn a hub132or connector inside or adjacent the handle122that is connected to a pair of guidelines134A and134B. These guidelines134A and134B, together with pull-rod138, may extend through an elongated, rigid sleeve, such as a cylindrical tube136, for connection on either side of a swivel mount of the articulating head126. It is envisioned that the guidelines can be flexible or rigid, that the cylindrical tube136can be rigid or semi-rigid, and that the pull-rod138can be rigid or semi-rigid. By semi-rigid, it is meant that the pull-rod138can be flexible or partially flexible at least in the plane of articulation along at least part of its length near the distal end of the installation tool102, but still axially and rotationally rigid or semi-rigid along its length. Thus, when the installation tool102and clamp100are held parallel to the ground, the pull-rod138can be rotated and retracted by actuation of the thumbwheel120and trigger128, and the head126can be articulated in a plane orthogonal to the gravity vector by manipulation of the dial130. The plane of articulation may be adjustable in certain embodiments, or may be set in a desired plane that is not orthogonal to the gravity vector.

Turning now toFIG. 5, other embodiments of the clamp200and installation tool202can include a clamp200made of multiple pieces, a longer main tube204, and a thumb lever206on the dial130to articulate the head of the tool102that is attached to the clamp200. In some embodiments, the clamp200can be a three-piece clamp. A ratchet release208can also be provided on the installation tool202that, when pressed, allows the pull rod to extend, which in turn will release the clamp200allowing it to reopen. In other words, as the surgeon presses on the trigger210, causing the pull-rod to retract and the clamp200to close, a ratchet mechanism catches the trigger210in the pressed in position. Thus, the pull-rod will remain retracted and clamp200will not reopen even if the surgeon releases pressure on the trigger210.

Turning now toFIG. 6, and referring generally toFIGS. 6A-6D, one piece of a three-piece clamp can be a rigid member212having a male clasp end214. As will be described further below with reference toFIG. 9, this rigid member212serves as one of the elongated members of the clamp200for forming the partition that divides the stomach. It can be made of plastic, metal, or any other rigid material. An example material is hardened titanium.FIG. 6(c) demonstrates an exemplary contour of male clasp end214, whileFIG. 6(d) demonstrates an exemplary contour rigid member212. It should be readily understood that the exemplary contour of rigid member212renders it concave on an inner surface to be disposed toward an outer surface of an organ to be clamped, and convex on an outer surface for engagement with a spring component. However, other shapes may be used as desired.

Turning next toFIG. 7, and referring generally toFIGS. 7A-7D, another piece of the three-piece clamp can be a rigid member216having a female clasp end218that includes a hinged loop220. As will be described further below with reference toFIG. 9, this rigid member216serves as one of the elongated members of the clamp for forming the partition that divides the stomach. It can be made of plastic, metal, or any other rigid material. An example material is hardened titanium. Similarly, the loop220can be made of various materials, an example of which is titanium wire.

Turning next toFIG. 8, and referring generally toFIGS. 8A-8D, a third piece of the three-piece clamp can be a spring member222having a slotted bight portion224. As will be further described below with reference toFIG. 9, the spring member engages with the rigid members to form the clamp and provides the bight portion that permits formation of a passage between the two partitioned regions of the clamped stomach. It can be made of plastic, metal, or any other springy material. An example material is spring tempered titanium.

Turning now toFIG. 9, and referring generally toFIGS. 9A-9D, the three-piece clamp can be assembled by engaging the rigid members212and216to the spring member222. For example, the rigid members can be welded or coupled to arms of spring member at various locations226. In one embodiment, the rigid members212and216can be attached to interior surfaces of the arms of spring member222, with the loop220arranged to hinge towards and engage the male clasp end214of the distal end of rigid member212. Thus, the rigid members212and216are employed to form a partition, while the spring member222forms a passage between the partitioned regions of an organ or body as shown inFIG. 10. These rigid members212and216may be of non-uniform thickness to accommodate gradual closing of the clamp from the proximal end towards the distal end in such a manner that a non-uniform thickness of an organ, such as walls of a stomach, can be clamped without injury. Alternatively or additionally, sleeves of padding material can be slid over the arms of the clamp, and the padding material can be of non-uniform thickness as desired. It is envisioned that rigid members212and216and padding material of varying lengths, contours, and thicknesses may be provided to accommodate needs of different patients as desired.

Turning now toFIG. 10, some embodiments of the surgical clamp installation tool can be used to install the clamp100within an abdominal cavity in order to perform bariatric surgery. In particular, the clamp can be positioned, closed, and latched to partition the stomach into a small vertical pouch500and an excluded section502. The vertical pouch500receives food at504, but the food is not able to enter the excluded section502. Using the installation tool102(or202) to engage with the bight portion106of the clamp100, the clamp100may be installed in a substantially vertical position on the stomach in one embodiment. That is, if the human patient having the clamp100installed were to stand upright, the longitudinal axis of the clamp100would be substantially parallel to the gravity vector. Thus, a passage forming section formed in the bottom of the stomach by the clamp allows gastric juices to flow at506from the excluded section502into the vertical pouch500.

Turning toFIG. 11, a method for clamping an internal organ can include inserting a surgical clamp through an opening into a body of a living organism at block150. Then the two elongated members of the surgical clamp are positioned on opposite sides of an internal organ of the living organism at block152. At block154, closing and latching the surgical clamp to partition a cavity inside the internal organ includes clamping the exterior of the internal organ with the two elongated members.

As mentioned above, the internal organ can be a human stomach. In this case, closing and latching the clamp can include installing the clamp in a substantially vertical or angled position with a passage forming section of the clamp located towards a bottom of the stomach. This positioning can create a small, vertical stomach pouch and thereby limit the intake of food into an excluded section or portion of the stomach, but still allow gastric juices from the excluded portion of the stomach to flow into the vertical stomach pouch. This partitioning can alter the production of hormones, enzymes and chemicals that affect metabolism, energy levels, hunger, digestion, and absorption of nutrients that are affected by exclusion of gastric fundus and body of the stomach by the partitioning. Sheathing the elongated members of the clamp in silicone padding material along a majority of their length is intended to reduce trauma and/or necrosis of the stomach or other internal organ and enable successful reversal of the surgery. Thus, the method can further include reversing the surgery by removing the clamp.

Inserting the surgical clamp can include performing natural orifice transluminal endoscopic surgery (NOTES). Alternatively, or additionally, it can include performing a combination of NOTES and an assistant trochar placed into an abdominal cavity. This combination can include two or more of a conventional, laparoscopic, NOTES, and one port technique. The NOTES technique can include at least one of transgastric, transvaginal, transrectal, transcolonic, or combinations thereof. The one port technique is used for the introduction of several instruments, and encompasses a one port abdominal (including umbilical), perineal, retroperitoneal approaches, or combinations thereof.

Turning toFIG. 12, a method for clamping an internal organ can include engaging a surgical clamp to a head of a surgical clamp installation tool at block160. At block162, the surgical clamp installation tool can be employed to close the clamp and insert the clamp through an opening in a body cavity of a living organism. Then the tool can be employed at block164to reopen the clamp and to position elongated members of the clamp on opposite sides of an internal organ within the body cavity. Next, at block166, the tool can be employed to close the clamp upon the internal organ and thereby partition a cavity inside the internal organ. The limbs, arms, or elongated members of the clamp close in such a fashion as causing a gradual diminishing space between the two limbs, as the space opening extends proximally, accounting for the different thickness of the stomach. The clamp closes in a fashion that exerts enough pressure to maintain the opposite walls closed to each other without creating damage/trauma/ischemia to the stomach or other organ walls themselves. Then at block168, the clamp can be latched to fix it in position to partition the internal organ and the cavity inside the internal organ. Also, at block170, the clamp can be disengaged from the head of the surgical clamp installation tool, and the tool can be retracted from the body cavity at block172. It is envisioned that the clamp may be configured to latch automatically when the clamp is fully closed. Alternatively, the tool may first be disengaged and removed, and the clamp subsequently latched using an additional tool. Moreover, additional steps may be employed to secure the clamp in place, such as using sutures.

As already described above, padding material can be employed on surfaces of the elongated members of the surgical clamp to reduce damage to the internal organ that would prevent reversal of the surgical procedure. In other embodiments, the thickness or surface contour of the elongated members or arms of the surgical clamp may be provided to align with the particular organ or body being clamped so as to provide the desired pressure or force at each location of the organ or body being clamped. Additionally, engaging the surgical clamp to the head of the surgical clamp installation tool may include passing a T-bar adjacent the end of a pull rod of the installation tool through a slotted aperture formed in a bight portion of the clamp, and rotating the T-bar using a lever or dial. Also, employing the surgical clamp installation tool to close and reopen the clamp may include operating a lever or trigger on a handle of the installation tool to pull and release the pull rod. Further, employing the surgical clamp installation tool to position the elongated members of the surgical clamp may include manipulating a dial on a handle of the installation tool to articulate the head from side to side in a desired plane(s).

Turning now toFIG. 13, another embodiment of a surgical clamp600and surgical installation tool602is similar in structure and function to those embodiments described above. One notable difference from the embodiments previously described is that the articulating head604of the surgical installation tool602is keyed with a curvature or radius configured to hold the clamp600securely in place while permitting the clamp600to remain in an open position. This configuration permits a surgeon holding the installation tool602in one hand to hold the clamp600securely in the articulating head604of the tool602while pressing the distal ends of the clamp600together with the other end for entry to a trochar. Once the distal ends of the clamp600have entered the trochar, the trochar then holds the ends shut, and permitting the surgeon free use of the other hand. Upon entry to the abdominal cavity, the clamp naturally springs open for engagement with a bodily organ, such as the stomach, and the surgeon can articulate the head from side to side while it is held securely in the head604while still in the open position. Once in position, the surgeon can close the clamp using sutures and/or by applying pressure externally or internally using other surgical tools. Thus, the installation tool602may not be employed to close the clamp on an internal organ of the patient, but may be employed to hold, insert, and articulate the clamp into position.

Referring now toFIG. 14, clamp600can have a three piece design similar to that described above. In other words, it can have a spring member606that is comprised predominantly of spring steel, and that is engaged with lower and upper rigid members608and610. These rigid members608and610can be comprised primarily of titanium, and they can have a concavity that increases their rigidity. In addition, suture holes612A-612E can be provided in upper rigid member610, as well as in an upper portion of spring member606. A surgeon can employ these suture holes612to secure the clamp600in place on a stomach or other bodily organ. It is envisioned that additional or alternative suture holes612can be provided, such as in lower rigid member608and lower portion of spring member606, and that positions of the suture holes612can be different from those shown. However, as will be more fully described below with reference toFIGS. 19-27, the placement of suture holes in the upper rigid member608and upper portion of spring member606can permit suturing of the clamp600in place prior to application of a silicone sleeve (seeFIGS. 19-27) that slides onto the clamp via the un-sutured lower rigid member608and lower portion of spring member606. Yet, once the sleeve is installed, it should be understood that additional suture holes612provided in lower rigid member608and/or lower portion of spring member606may prove useful in a subsequent application of additional sutures.

Turning now toFIGS. 15(a)-15(f) and referring generally thereto, it should be appreciated that a double row of suture holes612A-612H can be provided in spring member606and upper rigid member610, a distal portion of which can exhibit a male clasp feature614positioned to engage a female clasp feature, such as a wire loop616, of lower rigid member608. Suture holes612D and612E can be positioned on spring member606at a location that lies between a position at which upper rigid member610is engaged to spring member606, and a position at which a slot618is formed in a bight portion of spring member606. In the case that the distal end of upper rigid member610exhibits a male clasp feature614, such as a planular curvature away from a plane in which the upper rigid member610predominantly lies, a complimentary female clasp feature can be exhibited by a distal end of lower rigid member608, such as the aforementioned rectangular wire loop616engaged by a hinge formation620provided in the distal end of lower rigid member608. It should be readily understood that the same functionality can be achieved if upper rigid member610exhibits the female clasp feature, and lower rigid member608exhibits male clasp feature614. Thus, the positions of the clasp features can be reversed in other embodiments.

Turning now toFIG. 16, another additional feature of clamp600can be a detent that is622formed in hinge formation620, and that engages wire loop616of the female clasp feature. This detent622can be positioned on the hinge formation620at a location that is most distal when the clamp600is held in a closed position, and it can be sized and shaped to hold the wire loop616in a lowered position at which the loop616lies in a plane parallel to a plane in which lower rigid member608predominantly lies. A similar or identical detent (not shown) can be provided on an opposite side of hinge formation620, and it can be similarly distally positioned to assist in holding the wire loop616in the aforementioned lowered position. This lowered position allows the clamp600to be inserted through a trochar and guided to enclose a bodily organ, such as a stomach, at which point the aforementioned silicone sleeve (seeFIGS. 19-27) can be partially applied. Then, before the silicone sleeve is fully engaged to the clamp600, wire loop616can be forced out of detent622into a raised position at which it engages the male clasp feature614of the clamp600.

Before raising the wire loop616, it is envisioned that the clamp600can be pressed into a closed position by use of two or more graspers inserted into the abdominal cavity through additional trochars (i.e., multiport technique). Then, a suture tag pre-applied to wire loop616can be used to force wire loop616out of detent622into the raised position, resulting in the wire loop616engaging the male clasp feature614and holding the clamp600in the closed position without assistance from the two or more graspers. Alternatively or additionally, it is envisioned that closing and latching of the clamp600can be achieved by utilizing any suitable endoscopic surgical tools and techniques as will be readily apparent to one skilled in the art from the present disclosure.

Turning now toFIGS. 17(a)-17(f) and referring generally thereto, an endoscopic surgical installation tool for engaging and manipulating the clamp can be similar to those described above. For example, the installation tool can have a handle650, trigger652, pull rod, T-bar654, cylindrical tube656, dial658(e.g., with thumb lever), hub, guidelines, and articulating head604that are identical or similar to those described above. However, as previously described, a curvature or incline imparted to the head604by wedges of the head604can be keyed to a bight portion of the previously described clamp so as to hold the clamp in a fully open or predominantly open position when T-bar654has been fully retracted by actuation of trigger652. Additionally, a latch release660can be provided that can extend from both sides of handle650for ergonomic, ambidextrous operation.

Turning now toFIG. 17, the latch release660can have a hinged plate with a retention spring that forces the latch release660upwards to engage a latch662provided at a proximal end of pull rod664. In use, a surgeon can engage the T-bar to the clamp600by rotating the clamp600and/or installation tool in a common longitudinal axis until the T-bar fits through the notch in the bight portion of the clamp600, and then rotating the clamp600and/or installation tool an integer multiple of ninety degrees until a length direction of the T-Bar is perpendicular to a length direction of the notch. Then, actuation of trigger652can retract pull rod until opposing latch surfaces (e.g., edges, extensions, faces, flanges, gouges, hooks, inclines, ledges, lips, notches, overhangs, projections, protrusions, ribs, ridges, skirts, serrations, slits, slots, teeth, wedges, and combinations thereof) of the latch662and release660can catch and hold the pull rod664in a fully retracted or predominantly retracted position.

Once the latch662is engaged, the clamp600is ready to be inserted into an inflated abdominal cavity through a trochar as described above, and a seal provided between cylindrical tube656and clevis668can prevent out gassing from the abdominal cavity through the head604and/or cylindrical tube656. Alternatively, the seal can be provided anywhere inside cylindrical tube656. In some embodiments, the seal is achieved by using a circular silicone die having a slit and a hole in the middle, with the pull rod664threaded through the hole.

Once the clamp600is in position within the abdominal cavity to enclose and partition the stomach or other organ, pressing down on latch release660can permit automatic extension of pull rod664by action of a torsion spring provided to trigger screw666to force de-actuation of trigger652. The T-bar can then be disengaged from the clamp by rotating the installation tool along its longitudinal axis an integer multiple of ninety degrees and removing it from the trochar. Thus, it should be apparent that, in some embodiments, the pull rod may not be configured to rotate as in alternative embodiments described above, but only to retract and to extend.

Turning now toFIG. 19, a silicone sleeve700can be configured to engage clamp600. In some embodiments, silicone sleeve700can be formed to cover primarily an upper arm and both ends of clamp600. This silicone sleeve700can be used as padding to protect surrounding organs from irritation or damage. Thickness of the silicone can be varied for different applications, such as partitioning an organ, stomach, or vessel.

Turning now toFIGS. 20-27and referring generally thereto, the silicone sleeve700can have tubular section702at a proximal end that slides onto the lower arm of clamp and can be manipulated into position to encapsulate the previously described bight portion of the clamp. The clamp can then be closed and latched as described above. Presuming that the upper arm of the clamp has already been sutured to the organ, stomach, or vessel, a distal end of the sleeve700can then be engaged to encapsulate the distal end of the clamp. For this purpose, the distal end of the sleeve700can be configured as a latch cap704that is form fitted to the closed latch features (seeFIG. 25). A padding strip706situated between the tubular section702and latch cap704can be sized to a length of the clamp so as to be stretched taught across the upper arm of the clamp once the sleeve700is installed. A slot engaging feature708formed inside of tubular section702can be provided to engage with the previously described slot in the bight portion of the clamp by plugging the slot, and thus hold the tubular section of the sleeve700in place on the bight portion of the clamp.

Turning now toFIG. 28, a method of performing surgery can begin at step750by engaging the previously described clamp to the previously described surgical installation tool in one or more of the previously described manners. Thereafter, the clamp can be inserted through a trochar at step752, and positioned to enclose an organ (e.g., stomach, vessel, etc.) at step754. Next, at step756, an upper arm of the clamp can be sutured to the organ though suture holes supplied in the clamp as previously described, and the installation tool can be disengaged and removed from the trochar at step758. Thereafter, the previously described silicone sleeve can be slid over a lower arm of the clamp at step760as previously described, and the clamp can be closed and latched at step762. Finally, at step764, a latch cap of the silicone sleeve can be fit over the latch of the clamp, and additional sutures can be applied if desired. It should be understood that the sequence of the aforementioned steps can vary in additional or alternative embodiments, and that additional or alternative steps can be employed as will be readily apparent to one skilled in the art.

A number of additional and alternative embodiments of the surgical clamp and installation tool can have characteristics that are different from those described above. For example, it is envisioned that a surgical clamp not intended for bariatric surgery might not have a passage forming section, and that such a clamp might be smaller or larger, depending on the purpose of the clamp. For example, the clamp can be one-tenth of an inch in length to partition a blood vessel, or twenty-two centimeters in length to partition a stomach. Moreover, the clamp can be configured to partition any internal organ, and can vary in length accordingly between these two example lengths, or be longer or shorter as required. Also, the guide members might have one or more protrusions aligned with the engagement feature and configured for insertion into the slot formed in the bight portion of the clamp. Moreover, it is envisioned that the installation tool can be integrated with an endoscope and/or surgical robot, and that appropriate robotic elements can be included in place of or in addition to those described above. These and other features can be included in various combinations without departing from the scope of the invention as defined in the following claims.