Abstract:
A surgical clamp allows for mobilization of an organ or hollow viscus of a patient during a surgical procedure with minimization of trauma to the organ or hollow viscus. The surgical clamp includes at least one handle adapted to be gripped by the user for manipulation of the surgical clamp and the engaged organ or hollow viscus, and at least on jaw attached to the handle, wherein the jaw is adapted to substantially encircle the engaged organ or hollow viscus of the patient. The clamp may be sized to fit through a conventional trocar such that the surgical procedure may be a laparoscopic procedure for operating on the organ or hollow viscus, such as the bowel.

Description:
This application claims the benefit of U.S. Provisional Patent Application Ser. No. 60/061,455, filed on Oct. 8, 1997, entitled “Bowel Clamp”, which is incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     My invention relates to surgical clamps for organ manipulation, more particularly my invention relates to non-traumatic laparoscopic bowel clamps which encircle the bowel. 
     2. Background Information 
     During many surgical procedures it is necessary to mobilize and move the bowel. This is particularly true during resection of the bowel. During open surgical procedures, the surgeon can accomplish the movement of the bowel manually without significant risk of damaging the bowel. However, during laparoscopic surgical procedures, manual movement of the bowel is no longer possible. In order to achieve movement of the bowel during laparoscopic procedures, various bowel engaging clamps have been developed. One such clamp is known as the Babcock clamp, which fits through the trocar and grips directly onto the bowel. The surgeon will utilize the clamp for moving the bowel appropriately during operative procedures. 
     The existing bowel clamps are designed to clamp directly on the bowel. The direct clamping or pinching engagement with the bowel wall results in a significant number of drawbacks. The engagement of the clamp on the bowel can puncture the bowel wall. Additionally, the movement of the bowel by using the engaged clamp can tear the bowel. This is due, in part, to the minimal surface engagement between the clamp and the bowel wall. 
     When the bowel wall is compromised, whether by the bowel engaging clamp or otherwise, numerous complications can arise. First, the contamination of the interior body cavity with the dirty contents of the bowel interior can increase the risk of infection and other adverse affects. Furthermore, once a puncture or tear has occurred, the surgeon has to take appropriate remedial measures. These remedial measures may include further resection of the bowel to include the bowel segment which has been damaged, or separately stitching or otherwise closing the puncture or tear in the bowel to repair the damage caused by the clamp. Either of these remedial measures increases the time of the surgery. Additionally, both of these remedial measures increase the risk of infection and the like to the patient by exposing the contents in the interior of the bowel to the interior of the body cavity. Therefore, this damage to the bowel needs to be avoided. 
     It is an object of the present invention to overcome the drawbacks of the prior art. It is a further object of the present invention to provide a bowel clamp which can be easily used in laparoscopic or open procedures for engaging and moving the bowel while significantly reducing the risk of damaging the bowel. 
     SUMMARY OF THE INVENTION 
     The above objects are achieved by a bowel clamp according to my invention. A bowel clamp according to my invention is designed to not clamp directly onto the bowel, but instead is designed to substantially encircle the bowel. In operation, the bowel clamp of my invention can be inserted through a small opening in the mesentery of the bowel so that when the bowel clamp is closed, the bowel will rest completely inside the jaw face of the bowel clamp. The bowel clamp of my invention evenly distributes the forces associated with movement or mobilization of the bowel across the bowel wall to minimize damage of the bowel wall. In this manner when the bowel is moved by the bowel clamp in any direction, the bowel will not be damaged, perforated or torn. 
     The bowel clamp of my invention may be designed to compress or slightly crimp the bowel while encircling the bowel in order to better reinforce the bowel wall to further minimize potential damage and increase mobility of the bowel while using the bowel clamp of the present invention. 
     The bowel clamp of my invention may include a jaw formed of a first jaw member pivotally connected to a second jaw member at a pivot point at one end of the jaw members. Each jaw member may includes a jaw tip at a distal end thereof. The jaw tips are adapted to abut against each other when the jaw members are in a closed position. When the jaw members are in the closed position, the jaw members combine to define a bowel encircling opening between the jaw members, the pivot and the tips. 
     In one embodiment, the bowel clamp includes cross-pivoted handles attached to each jaw member on opposite sides of the pivot. Additionally, one jaw member may form a cradle for receiving the bowel prior to closing. The bowel clamp of the present invention is preferably closable to 10-12 mm for easy use in laparoscopic procedures. 
     In another embodiment of my invention, the entire jaw of the bowel clamp is pivotable about a pivot point. The entire jaw may also be rotatable about the jaw pivot point. The articulation and rotation of the entire jaw provides the mobility needed for manipulating the clamped bowel. Preferably the articulation and rotation of the jaw as well as the closing of the individual jaw members can be controlled remotely through a trocar. 
     In one embodiment of my invention the jaw of the bowel clamp is a flexible member, such as a tube or strap, extending from the handle. The handle may also include a clasping member to secure the flexible member to the handle after the flexible member has formed a loop around the bowel. 
     These and other advantages of the present invention will be clarified in the Description of the Preferred Embodiments taken together with the attached figures wherein like reference numerals represent like elements throughout. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a side view schematically illustrating a bowel clamp according to my invention; 
     FIG. 2 is a side view of the bowel clamp in the first position according to my invention; 
     FIG. 3 is a top view of the bowel clamp illustrated in FIG. 2; and 
     FIG. 4 is a side view of an alternative embodiment of the bowel clamp according to my invention; 
     FIG. 5 is a schematic side view of an alternative embodiment of the bowel clamp according to my invention; and 
     FIGS. 6 a  and  6   b  are schematic side views of an alternative embodiment of the bowel clamp according my invention. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     FIGS. 1-3 illustrate a bowel clamp  10  according to a first embodiment of my invention. As shown in FIG. 2, the bowel clamp  10  includes a jaw  11  formed of jaw members  12  and  14  pivotally attached together at one end thereof by pivot  16 . Each jaw member  12  and  14  preferably extends far enough from the pivot  16  to traverse the bowel  18  as shown in FIGS. 1-3. At the distal end of each jaw member  12  and  14  is a blunted tip  20 . The tips  20  are adapted to abut against each other when the bowel clamp  10  is moved in the closed position as illustrated in FIG.  2 . The forming of the tips  20  as rounded, relatively flat members minimizes the risk of puncturing the bowel  18  during the clamping operation if the jaw members  12  and  14  have not been positioned properly to extend completely across the bowel  18 . The blunted tips  20  may be formed of any size and of alternative shapes. The tips  20  may be formed with interengaging recesses and projections to provide a secure jaw  11  in the clamped position for movement of the bowel. Additionally, the tips  20  may be provided with an adjustment mechanism, such as a set screw extending toward the other tip  20 , to adjust the clamped distance between the jaw members  12  and  14 . The bowel clamp  10  includes attached handles  22  and  24  (shown for illustrative purposes only) attached to the jaw members  14  and  12 , respectively, for opening and closing of the jaw members  12  and  14 . The handles  22  and  24  may be replaced with more conventional handle members which can extend through a trocar for remote operation of the jaw members  12  and  14 . 
     The jaw members  12  and  14 , the tips  20  and the handles  22  and  24  may be formed of any conventional material such as metal or plastic. 
     The jaw  11  of the bowel clamp  10  includes a bowel encircling opening  26  formed by the jaw members  12  and  14 , between the jaw members  12  and  14 , pivot  16  and the engaged tips  20  as shown in FIGS. 1 and 2. Each of the jaw members  12  and  14  preferably have rounded edges to avoid surfaces which could damage the wall of the bowel  18 . The jaw members  12  and  14  may also be coated with a softer material (i.e. rubber, foam element, plastic) which further reduces stress on the engaged bowel. The widths of the jaw members  12  and  14  should be relatively substantial in order to increase the surface contact area between the bowel  18  and the bowel clamp  10  to further distribute the stresses between the bowel clamp  10  and the bowel  18 . This will further minimize the risk of damage to the bowel  18 . The face of each jaw member engaging with the bowel may be smooth or may be grooved to be less traumatic to the engaged portion of the bowel. 
     As shown in FIG. 1, the lower jaw member  14  is asymmetrical to the upper jaw member  12  forming a general J-shape providing a cradle  28  for receiving and positioning the bowel  18  during the clamping operation. The height  30  of the bowel clamp  10  is preferably sized appropriately to allow for fitting the bowel clamp  10  through an associated trocar for use in laparoscopic procedures. For example, the height  30  of the bowel clamp  10  may be 10-12 mm allowing the bowel clamp  10  to fit through an associated 12 mm trocar. Separately sized clamps  10  will be associated with conventionally sized trocars, such as 12 mm, 11 mm, 10 mm, 5 mm, 3 mm, and 2 mm. Additionally, the clamps  10  may be sized for the intended use. For example, difficult sizes would be associated with pediatric applications or a dilated bowel. The construction of the clamps  10  of these dimensions will include the construction of jaw members  12  and  14  with a length and height which accommodates conventional bowels. The smaller sizes may require a jaw  11  construction which expands after it has passed through the associated trocar. Appropriate expansion may be accomplished through the use of an elastically deformable material, such as spring steel, or a shape memory alloy which recovers an expanded shape. 
     The bowel clamp  10  of my invention operates as follows. Bowel clamp  10  is designed to encircle the bowel  18  through a small opening in the mesentery of the bowel  18 . The bowel  18  will be positioned in the cradle  28  of the lower jaw member  14  prior to moving of the upper jaw  12  to the closed position. The positioning of the bowel  18  in the cradle  28  is preferably observed directly by the surgeon prior to closing of the bowel clamp  10 . With the bowel  18  in the cradle  28 , the bowel clamp  10  is moved to the closed position so that the tips  20  are abutting against each other and the bowel clamp  10  completely encircles the bowel  18 . The bowel  18  may be slightly crimped and is held in the bowel encircling opening  26  within the jaw of the bowel clamp  10 . The bowel clamp  10  of my invention may slightly crimp the bowel  18  to further reduce the risk of damage to the bowel  18 . The bowel clamp  10  of my invention does not clamp directly onto the bowel  18  as in prior art. As discussed above, the bowel clamp  10  of my invention is designed to encircle the bowel  18  and to slightly crimp the bowel  18 . These features of my invention provide a bowel clamp  10  resulting in greater mobility of the bowel  18  with significantly reduced damage to the bowel  18 . The encircling of the bowel  18  eliminates the risk of puncturing the bowel  18  during the clamping procedure. Additionally, the encircling of the bowel increases the surface contact area between the clamp  10  and the bowel  18  better distributing the forces during movement of the bowel  18  by the bowel clamp  10 . Furthermore, the clamping of the bowel  18  within the jaw  11  adds further support to the bowel  18  to further reduce the risk of damage. With the bowel clamp  10  in the operative position, the bowel  18  can be easily moved in any direction as needed by the surgeon. 
     Many modifications may be made to the bowel clamp of my invention. FIG. 4 illustrates a modification which allows the bowel clamp  40 , illustrated therein, to provide a jaw  11  of greater height. The bowel clamp  40 , illustrated in FIG. 4, includes all the features of the bowel clamp  10 , illustrated in FIG. 1, except that jaw members  12 ′ and  14 ′ are illustrated as substantially identical. Additionally, the pivot  16 ′ of the bowel clamp  40  together with the construction of the jaw members  12 ′ and  14 ′ allows the respective jaw members  12 ′ and  14 ′ to be moved out of plane and in overlapping arrangement as illustrated in FIG.  4 . The overlapping arrangement allows the bowel clamp  40  to be easily moved through an associate trocar. After being moved through the trocar, the jaw members  12 ′ and  14 ′ are moved back into the same plane so that the respective tips  20  can engage to completely encircle the bowel  18  in the same manner as discussed above in connection with bowel clamp  10 . The overlapping of the jaw members  12 ′ and  14 ′ may be provided by forming the jaw members  12 ′ and  14 ′ from elastic material (e.g. spring steel, plastic, or the like). 
     FIG. 5 is a schematic side view of an alternative embodiment of a bowel clamp  60  according to my invention. The bowel clamp  60 , illustrated in FIG. 5, includes all the features of the bowel clamp  10 , illustrated in FIG.  1 . The jaw actuating components for the bowel clamp  60  differs from the simpler construction of the cross-pivotal handles shown in FIGS. 1-4. Bowel clamp  60  includes a flexible actuating cable attached to jaw member  14  for actuating the jaw  11 . Additionally, the entire jaw  11  of the bowel clamp  60  is pivotable about a pivot point  62  spaced behind pivot point  16 . The entire jaw  11  is also rotatable as shown by the arrow in FIG.  5 . The articulation and rotation of the entire jaw  11  provides the mobility needed for manipulating the clamped bowel. Preferably the articulation and rotation of the jaw  11  as well as the closing of the individual jaw members  12  and  14  can be controlled remotely through a trocar using known types of controls. 
     FIGS. 6 a  and  6   b  are schematic side views of an alternative embodiment of a bowel clamp  80  according my invention. The bowel clamp  80  forms the jaw  11  from a flexible member  82  extending from a handle  84 . The flexible member  82  includes a plurality of segments  86  and a tip  88 . A cord  90  is arranged inside the segments  86  and an end of the cord  90  is attached to the tip  88  of the flexible member. By pulling on the cord  90 , the segments  86  will slide into each other on one side  92  of the segments  86  and the segments will stay in abutting contact with each other on the other side  94  of the segments  86 . Essentially, the segments  86  are pivotably connected to each other on one side  94  thereof. Because of this, the flexible member  82  will curl around, for example, the bowel, as shown in FIG. 6 b.    
     The flexible member  82  may also be an inflatable tube incorporating a spring which biases or curls the flexible member  82  toward the operative position. The flexible member  82  may be straightened by inflating the tube with, for example, compressed air. The handle  84  may include a clasp (not shown) which can secure the flexible member  82  to the handle  84  after the flexible member  82  has formed a loop around the bowel  18  as shown in FIG.  6 B. Clamp  80  is illustrative of the breadth of my invention. Many variations of the clamp according to my invention are possible. The main object of my invention is to provide a bowel clamp which substantially completely encircles the bowel and does not clamp directly onto the bowel. 
     It would be apparent to those of ordinary skill in the art that further modifications may be made to my invention without departing from the spirit and scope thereof. My present invention is primarily a bowel clamp which encircles the bowel for increased mobility of the bowel during operation with decreased risk of puncture, tearing or other damage to the bowel. However, the clamp of my invention may be used on other organs to avoid puncturing, tearing or other damage to the organ. For example, the clamp of my invention may be designed to encircle the appendix for manipulation and removal of the appendix during an appendectomy. The clamps may be designed and sized for other organs or any hollow viscus, such as the esophagus, blood vessels or ureter. The organ claim of my invention encircles the organ rather than clamping directly onto the organ. 
     The above-described examples are merely illustrative of my present invention and not restrictive thereof. Consequently, the scope of my invention is defined by the appended claims and equivalents thereto.