Patent Description:
In the surgical field, instruments, devices, or processes are used to examine the interior of living organisms and for surgical interventions. Surgical instruments include all medical instruments that are primarily used in surgery. A specific subcategory of surgical instruments, known as gripping or clamping instruments, are used for tying off or pressing together tubular- or hose-shaped body parts such as blood vessels. Gripping or clamping instruments commonly used in cardiac, thoracic, and vascular surgery are available in a wide variety of types and are well known in the art.

In an ordinary cardiac and thoracic surgery, an open operation is carried out in which access to the heart is created by opening the thorax. Typically, a surgeon may access the heart by means of a median sternotomy, which requires making a longitudinal incision approximately twenty-five (<NUM>) centimeters long through the sternum to open the chest. In a thoracotomy, a surgeon may further access the thorax through an intercostal incision, which is a small incision made in the space between the ribs. The opening created by the sternotomy or intercostal incision is kept open by means of a rib spreader, which expands the chest and keeps it open. Once the opening has been secured, the surgeon carries out interventions on organic body parts through the opening created in the chest with the help of a variety of different surgical instruments. For example, if the patient's heart is exposed, various catheters, cannulas, and clamps are placed directly on the heart and large blood vessels. Typically, the aorta is occluded around the ascending aorta with a hemostat to isolate the coronary arteries from the rest of the arterial system.

Instrument use during cardiothoracic surgery presents two problems. First, the surgical instruments occupy space within the surgical opening, effectively reducing the size of the opening. In turn, the reduced size of the surgical opening impedes the surgeon's field of vision within the operating field and hinders his or her work. Second, the size of the surgical opening and the associated tissue damage directly impacts how quickly a patient may recover from surgery. Thus, increasing the size of the surgical opening to accommodate traditional surgical instruments delays a patient's recovery from the surgery.

The latest developments in cardiac, thoracic, and vascular surgery relate to minimally invasive surgery techniques. Such techniques reduce the size of the surgical opening to reduce tissue damage and surgical trauma, facilitating faster patient recovery. Unfortunately for the surgeon, conventional surgical instruments placed in small access openings reduce the size of the surgeon's operating and visual field, making the operation more difficult, or sometimes impossible. Thus, minimally invasive surgery necessitates the use of surgical instruments that are adapted for use in smaller surgical openings.

As such, in minimally invasive surgeries, surgeons have turned to surgical clamps and gripping devices that occupy a smaller portion of the operating field. An example of such a device is illustrated in <CIT>. The instrument described in <CIT> features an actuating device, a gripping device, and a joint arranged on an instrument shaft. The actuating device provides an interface through which the surgeon can operate the gripping device that is used to occlude blood vessels. The joint allows the surgeon to pivot the actuating end of the instrument out of his field of view. Since the surgeon has a better view of the operating field after pivoting the actuating end of the instrument, the surgeon can more easily carry out surgical interventions without increasing the size of the surgical opening. In addition, the device of <CIT> features a locking system that prevents operation of the joint system. Only when the surgeon disengages the locking system may he or she pivot the actuating end of the instrument out of his field of view.

While the device described in <CIT> is adapted for use in minimally invasive surgeries, its design presents issues that hinder its effectiveness. First, when the surgeon disengages the locking system, the gripping device is still capable of releasing its grip on the occluded body part. Thus, it is possible for a surgeon to accidently reopen the occluded body part when moving the actuating end of the device from his field of view. Accidently reopening an occluded body part could severely harm the patient. Second, the locking system in the prior art requires the surgeon use both of his hands to operate the instrument: one hand is needed to hold or maneuver the surgical instrument, and the surgeon's other hand is required to disengage the locking system.

Thus, the market calls for a surgical instrument in which the surgeon can, using only one hand, engage or disengage a locking system of the instrument while also ensuring that the surgeon does not reopen the occluded body part when the instrument is pivoted out of the surgical field.

The present invention is a surgical instrument according to the features of the independent claim which is capable of being operated with one hand by an operator such as a surgeon. The surgical instrument may occlude body parts and be maneuvered out of the surgeon's field of view during surgery. The surgical instrument includes an instrument shaft having an actuating device on a first end of the instrument shaft and a gripping device on the second end of the instrument shaft, opposite the first end. A joint system on the instrument shaft separates the two ends and provides a pivot point about which the surgical instrument may rotate. The gripping device is composed of gripping elements that can occlude blood vessels, while the actuating device may feature handle elements that can be used by a surgeon to maneuver the instrument and operate the gripping elements of the gripping device.

Further, the surgical instrument is equipped with a locking system. In one embodiment, the locking system may include a movable bolt. In at least one configuration, the movable bolt is positioned to prevent a pivoting movement about the joint system. In another configuration, the movable bolt is positioned to allow for operation of the joint system such that the surgeon may pivot the actuating device out of the surgical field. In some embodiments, when the moveable bolt is in a second position, it may also lock the handle elements of the actuating device in place, preventing the surgeon from disengaging the gripping elements and reopening an occluded body part.

To operate the surgical instrument, the surgeon may begin by placing the movable bolt in a first position to lock the joint system. Then, the surgeon may maneuver the surgical instrument inside the operating field. When the surgeon is ready to occlude a blood vessel, the surgeon may operate the actuating end of the instrument to open the gripping device. Next, the surgeon may maneuver the interior surfaces of the gripping elements around the blood vessel and close the gripping elements to occlude the vessel. Once the blood vessel is occluded, the surgeon may use a finger to displace the movable bolt from the first position to a second position. This action preferably locks the handle elements of the actuating device in place (preventing operation of the gripping device) and allows the surgeon to move the actuating end of the surgical instrument out of the field of view. Once the surgery is complete, the surgeon may remove the surgical instrument by reversing each of the steps previously described. Eventually, blood flow through the blood vessel may be restored.

For a better understanding of the present invention, reference may be made to the following accompanying drawings.

The present invention will now be described with reference to the drawing figures, in which like reference numerals refer to like parts throughout. For purposes of clarity in illustrating the characteristics of the present invention, proportional relationships of the elements have not necessarily been maintained in the drawing figures.

<FIG> illustrates a surgical instrument <NUM> that may be used to occlude tubular- or hose-shaped body parts. As illustrated and described herein, the surgical instrument <NUM> is scaled for occluding blood vessels, specifically arteries, but in alternative embodiments it may be scaled for occluding other tube-shaped body parts, as would be appreciated by those skilled in the art.

As illustrated in <FIG>, the surgical instrument <NUM> includes an instrument shaft <NUM> extending along a first axis <NUM>.

The instrument shaft <NUM> is generally composed of a first branch <NUM>, a second branch <NUM>, a proximal end <NUM>, and a distal end <NUM>. The proximal end <NUM> and the distal end <NUM> of the surgical instrument <NUM> are separated by a joint system <NUM>. An actuating device <NUM> is located at the proximal end <NUM> and a gripping device <NUM> is located at the distal end <NUM> of the surgical instrument <NUM>. The actuating device <NUM> is composed of handle elements <NUM> and <NUM> and the gripping device <NUM> is composed of gripping elements <NUM> and <NUM>. The handle elements <NUM> and <NUM> of the actuating device extend along a plane <NUM> created by the first axis <NUM> and a second axis <NUM> that is perpendicular to the first axis <NUM>.

The components of instrument shaft <NUM> allow an operator, such as a surgeon, to operate the actuating device <NUM> to transmit an actuating movement to operate the gripping device <NUM>, both of which move along the plane <NUM>, pivoting about a third axis <NUM> extending into and out of the page. Subsequently, an operator may remove the actuating device <NUM> from the operating field after the gripping device <NUM> occludes a blood vessel.

The gripping device in <FIG> is illustrated in a closed position. Operation of the actuating device <NUM> opens and closes the gripping device <NUM>. More particularly, a surgeon may grasp the handle elements <NUM> and <NUM> to operate the actuating device <NUM>. The handle element <NUM> may be integrally formed with the first branch <NUM>. The handle element <NUM> may be movably connected to the first branch <NUM> via a fastener or connector and rotatably attached to the second branch <NUM> via a fastener or connecter, as would be appreciated by those skilled in the art. When operating the surgical instrument <NUM>, the surgeon may apply a rotational force to the handle element <NUM> to operate the gripping device <NUM>, both along the plane <NUM>, about the third axis <NUM>. The surgeon may instead apply a force perpendicular to the plane <NUM>, causing a pivoting movement in a plane formed by the first axis <NUM> and the third axis <NUM>, about the second axis <NUM> to pivot the actuating device <NUM> out of the operating field.

The pivoting motion about the second axis <NUM> of the actuating device <NUM> is facilitated by the joint system <NUM>. The joint system <NUM> may be composed of a first joint <NUM> disposed on the first branch <NUM> and a second joint <NUM> disposed on the second branch <NUM>. When the surgeon applies a rotational force about the second axis <NUM> to the actuating device <NUM>, the actuating device <NUM> may rotate in the plane formed between the first axis <NUM> and the third axis <NUM>. When rotation occurs about the joint system <NUM>, the rotational force is applied to the joint system <NUM>, such that the gripping device <NUM> does not shred or tear the occluded body part. Further, the joint system <NUM> is designed to be self-locking, so that the actuating device <NUM> can only be pivoted about the joint system <NUM> after the surgeon applies a force to the surgical instrument <NUM>. Such joint systems that can effectuate the pivoting movement described here are well known in the art and the joint system illustrated herein is not limited to any particular embodiment.

Turning to <FIG>, the gripping device <NUM> is illustrated in an open position. The gripping element <NUM> is movably arranged on the first branch <NUM> and rotatably connected to the second branch <NUM> via fasteners, such as bolts, screws, or pins, that are known by those skilled in the art. The gripping element <NUM> may be formed from one piece. When the surgeon applies a rotational force to the handle element <NUM> about the third axis <NUM>, the handle element <NUM> rotates in a clockwise direction in the plane <NUM> away from the first axis <NUM>. The applied rotational force is transmitted through the instrument shaft <NUM> to rotate the gripping element <NUM> in a clockwise direction in the plane <NUM> away from the first axis <NUM>, thereby opening the gripping device <NUM>.

As illustrated in <FIG>, when the handle element <NUM> is at its greatest angle of rotation away from the first axis <NUM>, the gripping element <NUM> is also at its maximum angle of rotation away from the first axis <NUM>. As would be appreciated by those skilled in the art, the gripping device <NUM> may also be placed in a plurality of positions between its open and closed position by rotating the handle element <NUM> varying degrees of rotation away from the first axis <NUM>.

When the handle element <NUM> rotates in a clockwise direction in the plane <NUM> away from the first axis <NUM>, the first branch <NUM> and the first joint <NUM> may be displaced towards the proximal end <NUM>. The second branch <NUM> and the second joint <NUM> may not be displaced as the handle element <NUM> rotates. As the first branch <NUM> is displaced towards the proximal end <NUM>, the gripping element <NUM> may rotate in a clockwise direction in the plane <NUM> away from the first axis <NUM>, opening the gripping device <NUM>.

Each of the gripping elements <NUM> and <NUM> may have interior surfaces <NUM> and <NUM>, and outer surfaces <NUM> and <NUM>, respectively. When the gripping device <NUM> is in the open position, the surgeon may position a blood vessel between the interior surfaces <NUM> and <NUM> of gripping elements <NUM> and <NUM>. After placing the blood vessel between the interior surfaces <NUM> and <NUM>, the surgeon may use the actuating device <NUM> to place the gripping device <NUM> into the closed position, thus occluding the blood vessel. In some embodiments, the interior surfaces <NUM> and <NUM> may be coated with a non-abrasive material or equipped with a non-abrasive design to protect fragile blood vessels from tearing or other damage. To reopen the blood vessel, the surgeon may use the actuating device <NUM> to rotate the gripping element <NUM> in the clockwise direction in the plane <NUM> away from the first axis <NUM>, returning the gripping device <NUM> to the open position.

In some embodiments, the actuating device may also be equipped with a ratchet system <NUM>. The ratchet system <NUM> may include a first ratchet arm <NUM> and a second ratchet arm <NUM>, which are preferably coupled to handle elements <NUM> and <NUM>, respectively. The first ratchet arm <NUM> has an anterior surface <NUM> and a posterior surface <NUM> (illustrated in <FIG>) and the second ratchet arm <NUM> has an anterior surface <NUM> (illustrated in <FIG>) and a posterior surface <NUM>. The posterior surface <NUM> of the first ratchet arm <NUM> may have a plurality of detent teeth <NUM> facing a first direction, and the posterior surface <NUM> of the second ratchet arm <NUM> may have a plurality of detent teeth <NUM> facing a second direction. When the actuating device <NUM> is in the closed position, the detent teeth <NUM> of the first ratchet arm <NUM> and the detent teeth <NUM> of the second ratchet arm <NUM> preferably engage with one another. The engagement of the detent teeth <NUM> and <NUM> prevents the handle element <NUM> from rotating in the clockwise direction in the plane <NUM> away from the first axis <NUM>, thus temporarily locking the actuating device <NUM> in place. This in turn prevents the operation of the gripping device <NUM>. To disengage the detent teeth <NUM> and <NUM>, and thereby disengage the ratchet system <NUM>, the surgeon may use his palm to apply a force in the direction of the third axis <NUM>, lifting the detent teeth <NUM> and <NUM> out of alignment. Further, the surgeon may selectively engage each individual tooth of the detent teeth <NUM> and <NUM> to incrementally adjust the position of the handle element <NUM>, which in turn incrementally adjusts the gripping device <NUM> within the open and closed positions.

<FIG> illustrates an embodiment of a locking system <NUM> of the surgical instrument <NUM>. The locking system <NUM>, when in a first position (as illustrated in <FIG>) prevents the rotation of the surgical instrument <NUM> about the joint system <NUM>. In the first position, the locking system <NUM> may keep the actuating device <NUM> and gripping device <NUM> of the surgical instrument <NUM> aligned with the first axis <NUM>.

In the embodiment illustrated in <FIG>, the locking system <NUM> is generally composed of a movable bolt <NUM> and raised ring structures <NUM> and <NUM>. Generally, the movable bolt has a proximal end <NUM> and a distal end <NUM>. When the movable bolt <NUM> is in the first position, a portion of the distal end <NUM> extends into the raised ring structures <NUM> and <NUM> and over the joint system <NUM>. The remaining portion of the movable bolt <NUM> lies over the proximal end <NUM> of the instrument shaft <NUM>. When a force is applied to the movable bolt <NUM> toward the proximal end <NUM>, the moveable bolt <NUM> can slide towards the actuating device <NUM> and into a second position. When in the second position, the distal end of the movable bolt <NUM> is no longer within the raised ring structure <NUM> nor over the joint system <NUM>. The movable bolt <NUM> may be returned to the first position by sliding it towards the distal end <NUM> of the instrument shaft <NUM>. To further secure the movable bolt <NUM> such that it is aligned with the first branch <NUM>, a third raised ring structure <NUM> may be positioned near the actuating device <NUM>.

As also illustrated in <FIG>, the movable bolt <NUM> may include raised grooves <NUM>. Preferably, the raised grooves <NUM> are located near the midpoint of the movable bolt <NUM> or on the proximal end <NUM>. The raised grooves <NUM> facilitate one-handed operation of the surgical instrument <NUM> by providing a surface that facilitates the generation of a static frictional force between the movable bolt <NUM> and the surgeon's finger. The static frictional force helps ensure that the surgeon's finger does not slip from the movable bolt <NUM> as the surgeon slides the movable bolt <NUM>. Further, the raised grooves <NUM> may be positioned to facilitate one-handed operation of the surgical instrument <NUM> by ensuring that the raised grooves <NUM> are within reach of a finger of the hand the surgeon uses to grip the actuating device <NUM>.

As illustrated in <FIG>, the raised ring structures <NUM> and <NUM> may be placed near the joint system <NUM>. Preferably, if a plurality of rings is used for the raised ring structures <NUM> and <NUM>, only a small amount of space is placed between each individual ring. The embodiment illustrated in <FIG> includes one raised ring within the raised ring structure <NUM> and three raised rings within the raised ring structure <NUM>. However, in alternative embodiments more or fewer raised rings may be provided to guide the movable bolt <NUM> and keep the movable bolt <NUM> aligned with the instrument shaft <NUM>, as would be appreciated by those skilled in the art.

In a preferred embodiment, the motion of the movable bolt <NUM> along the first axis <NUM> is restricted. By restricting the motion of the movable bolt <NUM> along the first axis <NUM>, a surgeon may be prevented from disconnecting the movable bolt <NUM> from the surgical instrument <NUM>. As illustrated in <FIG>, the movable bolt <NUM> has a posterior surface <NUM>. The posterior surface <NUM> of the movable bolt <NUM> may include a raised protrusion <NUM>. When the movable bolt <NUM> is in the first position, the raised protrusion <NUM> engages with the raised ring structure <NUM> to prevent the movable bolt <NUM> from sliding any farther towards the distal end <NUM> of the instrument shaft <NUM>. Advantageously, restricting the sliding motion of the movable bolt <NUM> towards the distal end <NUM> also prevents the raised grooves <NUM> from moving beyond the reach of the surgeon's fingers, which could impede one-handed operation of the surgical instrument <NUM>.

The ability of the movable bolt <NUM> to slide towards the proximal end <NUM> of the instrument shaft <NUM> may also be restricted. As illustrated in <FIG>, the proximal end <NUM> of the movable bolt <NUM> may feature a lip element <NUM> having an interior surface <NUM> (illustrated in <FIG>). When the actuating device <NUM> is closed and the movable bolt <NUM> is in the second position, the interior surface <NUM> of the lip element <NUM> may engage with the ratchet system <NUM>. Specifically, the interior surface <NUM> may engage with the anterior surface <NUM> of the first ratchet arm <NUM> and the anterior surface <NUM> of the second ratchet arm <NUM>. Once the lip element <NUM> is engaged with the ratchet system <NUM>, the movable bolt <NUM> may not slide any farther towards the proximal end <NUM> of the instrument shaft <NUM>.

Advantageously, the engagement of the lip element <NUM> with the rachet system <NUM> helps to prevent the surgeon from inadvertently disengaging the ratchet system <NUM>, which in turn prevents rotation of the handle element <NUM> in the clockwise direction in the plane <NUM> away from the first axis <NUM>. Thus, when the lip element <NUM> is engaged with the ratchet system <NUM>, the surgeon need not worry about accidently freeing the occluded blood vessel from the gripping device <NUM>.

Other constructions of the proximal end <NUM> of the movable bolt <NUM> that function in the same manner as the lip element <NUM> described above would be appreciated by those skilled in the art. In addition, there are alternative embodiments of the invention with regards to the position of the locking system <NUM> on the surgical instrument <NUM>. In the embodiment captured in <FIG>, the instrument shaft <NUM> of the surgical instrument <NUM> has an anterior surface <NUM> (not shown) and a posterior surface <NUM>. In <FIG>, the movable bolt <NUM> and raised ring structures <NUM>, <NUM>, and <NUM> are affixed to the posterior surface <NUM> of the instrument shaft <NUM> and to the first branch <NUM>. However, the locking system <NUM> may be located on the second branch <NUM>, or the anterior or posterior surface of the instrument shaft <NUM>, as would be appreciated by those skilled in the art.

<FIG> illustrates the engagement of the lip element <NUM> and the ratchet system <NUM> from a top view of the surgical instrument <NUM>. In this figure, like in <FIG>, the actuating device <NUM> is closed and the movable bolt <NUM> is in the second position.

Once the surgeon has occluded a blood vessel, he may desire to pivot the actuating device <NUM> out of his field of view. The pivoting ability of the joint system <NUM>, illustrated in <FIG>, is especially important in minimally invasive surgeries since the surgeon's field of view is very restricted as compared to traditional surgery. In <FIG>, the actuating device <NUM> is not in the plane <NUM> (not illustrated) between the first and second axes <NUM> and <NUM>, and the position of the actuating device <NUM> on the third axis <NUM> has changed relative to its position before its rotation about the joint system <NUM>. Thus, in the configuration illustrated in <FIG>, the actuating device may no longer be in the surgeon's field of view.

At the end of the surgery, the surgical instrument <NUM> is typically removed from the surgical opening. To do so, the surgeon may first maneuver the actuating device <NUM> so that it is in alignment with the first axis <NUM>. Then, the surgeon may return the movable bolt <NUM> to the first position to prevent rotation about the joint system <NUM>. Once the movable bolt <NUM> is returned to the first position, the surgeon may use the actuating device <NUM> to open the gripping device <NUM>, freeing the occluded blood vessel. The surgeon may then remove the surgical instrument <NUM> from the operating field.

From the foregoing, it will be seen that the various embodiments of the present invention are well adapted to attain all the objectives and advantages hereinabove set forth together with still other advantages which are obvious and which are inherent to the present structures. It will be understood that certain features and sub-combinations of the present embodiments are of utility and may be employed without reference to other features and sub-combinations. The various constructions described above and illustrated in the drawings are presented by way of example only and are not intended to limit the concepts, principles, and scope of the present invention.

Claim 1:
A surgical instrument (<NUM>) for occluding tubular organic body parts, the surgical instrument (<NUM>) comprising:
an instrument shaft (<NUM>) extending about a first axis (<NUM>) including:
a first branch (<NUM>);
a second branch (<NUM>); and
a joint system (<NUM>) between a proximal end (<NUM>) and a distal end (<NUM>) of the surgical instrument (<NUM>), wherein the instrument shaft (<NUM>) is pivotable about the joint system (<NUM>) about a second axis (<NUM>) that is perpendicular to the first axis (<NUM>);
a gripping device (<NUM>) located at the distal end (<NUM>) of the surgical instrument (<NUM>) for selectively occluding tubular organic body parts, the gripping device (<NUM>) comprising:
a first gripping element (<NUM>) arranged on the first branch (<NUM>); and
a second gripping element (<NUM>) arranged on the second branch (<NUM>);
an actuating device (<NUM>) located at the proximal end (<NUM>) of the surgical instrument (<NUM>), the actuating device (<NUM>) in mechanical connection with the gripping device (<NUM>) via at least the instrument shaft (<NUM>), the actuating device (<NUM>) configured to open and close the gripping device (<NUM>);
a locking system (<NUM>) extending along at least a portion of the instrument shaft (<NUM>);
wherein when the locking system (<NUM>) is in a first position, the locking system (<NUM>) prevents the instrument shaft (<NUM>) from being pivotable around the j oint system (<NUM>); and
wherein when the locking system (<NUM>) is in a second position, the instrument shaft (<NUM>) is pivotable around the joint system (<NUM>),
characterized in that when the locking system (<NUM>) is in the second position, the actuating device (<NUM>) is unable to open or close the gripping device (<NUM>).