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WO1996011636A1 - Instrument endoscopique chirurgical - Google Patents

Instrument endoscopique chirurgical Download PDF

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Publication number
WO1996011636A1
WO1996011636A1 PCT/US1995/012523 US9512523W WO9611636A1 WO 1996011636 A1 WO1996011636 A1 WO 1996011636A1 US 9512523 W US9512523 W US 9512523W WO 9611636 A1 WO9611636 A1 WO 9611636A1
Authority
WO
WIPO (PCT)
Prior art keywords
instrument
jaw
tissue
axis
arm
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US1995/012523
Other languages
English (en)
Inventor
Maciej J. Kieturakis
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US08/324,998 external-priority patent/US5752973A/en
Priority claimed from US08/327,154 external-priority patent/US5549627A/en
Application filed by Individual filed Critical Individual
Priority to AU37601/95A priority Critical patent/AU3760195A/en
Publication of WO1996011636A1 publication Critical patent/WO1996011636A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
    • A61B2017/2825—Inserts of different material in jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2918—Handles transmission of forces to actuating rod or piston flexible handles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
    • A61B2017/292—Handles transmission of forces to actuating rod or piston details of linkages or pivot points connection of actuating rod to handle, e.g. ball end in recess
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
    • A61B2017/2922—Handles transmission of forces to actuating rod or piston details of linkages or pivot points toggle linkages
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2934—Transmission of forces to jaw members camming or guiding means arcuate shaped guiding means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2936—Pins in guiding slots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2939—Details of linkages or pivot points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B2017/32006—Surgical cutting instruments with a cutting strip, band or chain, e.g. like a chainsaw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for

Definitions

  • This invention relates to surgical instrumentation and more particularly to an instrument for gripping and retracting tissue in an anatomic workspace.
  • An instrument of the present invention has an elongate introducer sleeve that is coupled to an articulating jaw assembly by a ball and socket-type joint that allows the jaw assembly to articulate and rotate about a second axis relative to the primary axis of the introducer sleeve.
  • a ball and socket-type joint that allows the jaw assembly to articulate and rotate about a second axis relative to the primary axis of the introducer sleeve.
  • This instrument further includes a "flex jaw” feature, by which is meant the jaw working faces are somewhat free to rotate relative to the jaw arms.
  • the jaw working faces rotate to accommodate tissue thickness and density thereby uniformly applying engaging pressures.
  • the "flex-jaw” feature results from a plurality of pivoting points associated with the jaw assembly. The jaw arms open or close around a first proximal pivot while the jaw working faces rotate within limits around a second distal pivot.
  • this instrument provides an instrument for gripping and retracting tissue in which the jaw working faces close on an axis that will articulate to align itself with the direction of retraction forces.
  • the present invention also provides an instrument in which the jaw assembly may rotate about the axis defined by the jaw assembly relative to the axis defined by the introducer member.
  • the present invention provides an instrument for retracting tissue in which the articulating jaw assembly is self-centering when the jaws are in an open position to align the secondary axis of the jaw assembly with the primary axis of the introducer member.
  • the present invention also provides an instrument in which the articulating jaw assembly is self-centering when the jaws are in a closed position in the absence of retracting forces.
  • the present invention also provides an instrument permitting the jaws to be locked in any articulated configuration after the jaws have engaged tissue.
  • the present invention also provides an instrument that allows the secondary axis defined by the jaw assembly to be locked in parallel alignment with the primary axis of the elongate introducer member.
  • the present invention provides an instrument for gripping tissue that includes a "flex jaw” feature for applying engaging pressure on tissue uniformly over the jaw working ends regardless of the thickness of the engaged tissue.
  • the present invention also provides an instrument in which the jaw working faces apply engaging pressure on tissue by utilizing a first pivot for rotating the jaw arms and a second pivot for rotating the jaw working faces.
  • a traction-applying instrument for applying traction on tissue in an endoscopic workspace, includes an elongate introducer sleeve that carries a distal jaw structure incorporating cooperating "rolling tracks" having tissue-gripping serrations for applying continuous traction on tissue.
  • the handle includes a jaw- actuating mechanism to close the jaws and the rolling tracks around tissue and to maintain the jaws in any pivoted position.
  • the handle further includes a track drive mechanism to roll the rolling tracks.
  • counter-rotation of the cooperating tracks causes tissue to be progressively gripped and pulled into the "throat" or bore of the introducer sleeve.
  • the jaws are double-pivoting whereby the jaw working ends rotate around distal pivots and the jaw forearms rotate around proximal pivots thus providing rolling tracks that remain generally parallel no matter the thickness of the tissue engaged.
  • the handle includes a 360° drive mechanism that is particularly suitable for endoscopic instruments and includes flexible bows adapted for squeezing. Applying and releasing inwardly-directed force on the bows causes the proximal part of the handle to separate from the distal part of the handle, thus reciprocating a track drive member that rolls the rolling tracks.
  • the handle includes a plurality of opposing bows so that the surgeon may rotate the instrument 360° to align the jaws with tissue and thereafter actuate the drive mechanism in any angular position with a simple squeezing force.
  • a second embodiment of the traction instrument includes an elongate introducer sleeve with a single "rolling track" that may be pressed against delicate tissue to continuously apply traction.
  • the rolling track is rolled unidirectionally by successively actuating a drive mechanism, thus retracting tissue progressively without axial movement of the instrument.
  • the axis of the rolling track also may be articulated from the axis of the introducer sleeve to better engage tissue planes that lie at an angle relative to that of the introducer sleeve.
  • the present invention provides an instrument and method for applying progressive intracorporeal traction on tissue without manipulation of the instrument relative to its axis.
  • the present invention provides an instrument and method for applying intracorporeal traction on tissue with a rolling track that incorporates tissue-gripping serrations.
  • the present invention also provides an instrument with cooperating first and second rolling tracks incorporated into a opposing jaws for engaging tissue from opposing sides to apply intracorporeal traction.
  • the present invention provides an instrument with cooperating first and second rolling tracks that retracts tissue into a "throat" or bore of the instrument for removal from an endoscopic workspace.
  • the present invention provides an instrument for applying intracorporeal traction on tissue that includes a double-pivot jaw structure that maintains the jaw working ends generally parallel from one another to grip tissue uniformly over the jaw working ends regardless of the thickness of the engaged tissue.
  • the present invention also provides an instrument in which the jaw working ends may be releasably locked in any parallel position for any particular thickness of tissue.
  • the present invention provides a handle with a drive mechanism that may be actuated with a single hand by squeezing inwardly on the handle no matter how the handle is rotated.
  • FIG. 1 is an elevational view of an articulated jaws instrument in accordance with the present invention.
  • FIG. 2 is an exploded isometric view of an assembly of the instrument of FIG. 1 taken along line 2-2 of FIG. 1 rotated 90°
  • FIG. 3A is a longitudinal partial sectional view of the assembly of FIG. 2 taken along line 3A-3A of FIG. 2 in a certain position.
  • FIG. 3B is a transverse sectional view of the assembly of FIG. 3A taken along line 3B-3B of FIG. 3A.
  • FIG. 4A is a longitudinal partial sectional view of the assembly of FIG. 2 taken along line 3A-3A of FIG. 2 in an alternative position.
  • FIG. 4B is a transverse sectional view of the assembly of FIG. 4A taken along line 4B-4B of FIG. 4A.
  • FIG. 5A is a longitudinal partial sectional view of the assembly of FIG. 2 taken along line 3A-3A of FIG. 2 in an alternative position.
  • FIG. 5B is a transverse sectional view of the assembly of FIG. 5A taken along line 5B-5B of FIG. 5A.
  • FIG. 6A is a longitudinal partial sectional view of the assembly of FIG. 2 taken along line 3A-3A of FIG. 2 in an alternative position.
  • FIG. 6B is a transverse sectional view of the assembly of FIG. 6A taken along line 6B-6B of FIG. 6A rotated 90°.
  • FIGS. 7-8 are longitudinal sectional views illustrating a component part of the subassembly of FIG. 2 taken along line 7-7 of FIG. 2 in alternative positions .
  • FIG. 9 is a longitudinal partial sectional view of a second embodiment of gripping assembly similar to the views of FIGS. 4A-6A.
  • FIG. 10 is a longitudinal partial sectional view of the assembly of FIG. 9 in another position.
  • FIG. 11 is a longitudinal partial sectional view of the assembly of FIG. 9 in yet another position.
  • FIG. 12 is an isometric view of a component part of the second embodiment of FIG. 9.
  • FIG. 13 is a partial sectional view of the handle of the second embodiment referred to in FIGS 9-12.
  • FIG. 14 is a partial sectional view of a portion of a third embodiment of gripping instrument .
  • FIG. 15 is an elevational view of a first embodiment of the present traction applying instrument in accordance with the invention.
  • FIG. 16 is an isometric view of a portion of the instrument of FIG. 15 taken along line 2-2 of FIG. 15 rotated 90°.
  • FIG. 17 is a longitudinal partial sectional view of a portion of FIG. 16 taken along line 3-3 of FIG. 16.
  • FIG. 18 is a longitudinal partial sectional view similar to FIG. 17 in another position.
  • FIG. 19 is a longitudinal partial sectional view similar to FIG. 17 in another position.
  • FIG. 20 is a longitudinal partial sectional view of the handle of the instrument taken along line 6-6 of FIG. 15 rotated 90°.
  • FIG. 21 is a partial sectional of the handle of FIG. 20 in another position.
  • FIG. 22 is a transverse sectional view the handle taken along line 8-8 of FIG. 20.
  • FIG. 23 is a transverse sectional view the handle taken along line 9-9 of FIG. 21.
  • FIG. 24 is an enlarged sectional view of the drive mechanism within the handle taken along line 10-10 of FIG. 20.
  • FIG. 25 is a partial longitudinal sectional view of an alternative embodiment of a handle and drive mechanism.
  • FIG. 26 is a partial sectional view of the handle and drive mechanism of FIG. 25 in another position.
  • FIG. 27 is a partial sectional view of a second embodiment of the rolling track jaws invention.
  • DESCRIPTION OF PREFERRED EMBODIMENTS 1. Articulated Flex Jaws Instrument
  • FIG. 1 depicts instrument 5 with handle assembly 8 coupled to elongate introducer sleeve 10.
  • Sleeve 10 with proximal and distal ends respectively 11 and 12, has a cylindrical shape extending along axis 15 with an overall length of approximately 200 mm. (not limiting) .
  • the outside diameter of sleeve 10 is approximately 10 mm. (not limiting) to cooperate with a standard 10-11 mm. inside diameter cannula.
  • Sleeve 10 is made of any suitable material such as injection-molded plastic or a combination of metal and plastic. Bore 17 extends through sleeve 10. Referring to FIGS.
  • jaw assembly 20 is carried at distal end 12 of sleeve 10 and includes cooperating left-hand and right hand jaw elements, 22a and 22b, respectively.
  • the jaw elements, 22a and 22b are made of any suitable material such as e.g. injection-molded plastic or metal.
  • Actuator disc 25 fits between jaw elements, 22a and 22b, and disc 25 is made of e.g. an injection-molded plastic that has resilient characteristics, such as Delrin.
  • the proximal hemispherical portions 32a and 32b of jaw elements 22a and 22b have opposing flat faces 33a and 33b respectively.
  • proximal hemispherical portions 32a and 32b of the jaw elements together with actuator disc 25 form a spheroid-shaped portion 35 of assembly 20 (see FIGS. 3A-3B) .
  • Spheroid-shaped portion 35 of assembly 20 slip fits in cooperating spheroid-shaped socket 36 formed within distal end of bore 17 of sleeve 10 (see FIGS. 2 and 3A-3B) .
  • a plurality of longitudinal slots 38 allow for flexing of longitudinally-extending socket portions 39 in sleeve 10.
  • Such socket portions 39 may flex slightly radially outward to insert spheroid-shaped portion 35 into spheroid-shaped socket 36.
  • jaw assembly 20, and more particularly spheroid-shaped portion 35 may articulate and rotate in socket 36.
  • jaw elements 22a and 22b have distal jaw arms 42a and 42b. Arms 42a and 42b are connected to proximal hemispherical portions 32a and 32b, respectively, by web portions 44a and 44b.
  • the jaw elements, and more particularly the jaw arms 42a and 42b, converge on or separate from secondary axis 45 of jaw assembly 20.
  • the arms of each jaw element are configured to extend laterally across secondary axis 45 such that working faces 49a and 49b mate symmetrically relative to secondary axis 45 (see FIGS. 2 and 6A) .
  • a mechanism is provided to actuate jaw assembly 20 between an open position (see FIG. 3A) and a closed position (see FIG. 4A) .
  • the jaw actuating mechanism includes flexible cable 50 with proximal and distal ends respectively 51 and 52, that extends through flexible cable housing 55.
  • Cable 50 is made of any suitable material such as braided stainless steel and extends through aperture 57 in actuator disc 25 and thereafter into longitudinal slot 60 in disc 25.
  • the distal end 52 of cable 50 is press fit with crimp nut 61 and the crimp nut 61 is press fit into cylindrical cross-bar 66.
  • Cross-bar is dimensioned to slide to and fro in elongate slot 60 in actuator guide disc 25.
  • Cross-bar 66 has left and right ends 69a and 69b respectively, that extend beyond the respective flat sides of guide disc 25.
  • the left end 69a of cross-bar 66 engages arcuate slot 70a in flat face 33a of left-hand jaw 22a.
  • the right end 69b of cross-bar 66 engages arcuate slot 70b in flat face 33b of right-hand jaw 22b.
  • Trigger 75 is provided within handle 8 to apply axial forces on cable 50 to actuate the jaw elements between open and closed positions. Referring to FIG. 1, the proximal end 51 of cable 50 along with cable housing 55 extends through bore 17 into the hollow core of plastic handle 8 that is made of mating halves.
  • Trigger 75 rotates around pivot pin 76 to pull cable 50 in the proximal direction. More particularly, the proximal end 51 of cable 50 is fixed in upper arm portion 77 of trigger 75 with crimp nut 79. Cable housing 55 is fixed in molded cable stop 82 within handle 8. Thus, squeezing trigger 75 causes cable 50 to move proximally relative to cable housing 55. Compression spring 85, shown in phantom view in FIG. 1, urges trigger 75 toward the non-depressed (jaw-open) position. Referring now to FIGS. 3A-3B and 4A-5B, it can be seen that the proximal and distal movement of cable 50 relative to cable housing 55 causes left-hand and right-hand jaw elements 22a and 22b to open and close. FIGS.
  • 3A-3B and 4A-4B are sectional views taken along flat face 33a of left hand jaw element 22a looking away depicting left-hand arcuate slot 70a in plan view.
  • cooperating elongate slot 60 and arcuate slot 70b of right-hand jaw element 22b are shown in phantom view for explanatory purposes .
  • spring 85 has urged cable 50 and cross-bar 66 distally relative to the distal end of cable housing 55 that abuts the proximal part of guide disc 25.
  • FIG. 3A shows cross-bar 66 in a distal position in longitudinal slot 60 with left and right ends 69a and 69b of cross-bar 66 having a camming effect as the cross-bar contacts the edges of arcuate slots 70a and 70b.
  • the camming effect of cross ⁇ bar 66 within arcuate slots 70a and 70b causes left- hand and right-hand jaw elements 22a and 22b, and more particularly the hemispherical proximal portions 32a and 32b, to counter-rotate in socket 36.
  • Such counter- rotation causes jaw arms 42a and 42b to open away from secondary axis 45.
  • jaw assembly 20 includes an "open-jaw self-centering" mechanism.
  • self-centering it is meant that a mechanism is provided to align secondary (jaw) axis 45 with primary axis 15 of introducer sleeve 10 when the jaws are actuated to the open position (see FIG. 3A) .
  • This feature is desirable since the jaw elements are in the closed position (see FIG. 4A) for introduction through a cannula.
  • the secondary (jaw) axis 45 preferably is aligned with primary axis 15 for approaching tissue to be gripped. As can be seen in FIG.
  • FIGS. 5A-5B and 6A-6B it is now possible to describe jaw assembly 20 as it articulates to align itself and secondary axis 45 with the direction of retraction forces.
  • FIG. 5A depicts tissue 90 engaged between working faces 49a and 49b of jaw elements 22a and 22b, respectively, as tissue 90 is being retracted. Since spheroidal-shaped portion 35 of jaw assembly 20 enjoys a slip-type fit in spheroid- shaped socket 36, axis 45 naturally will align itself with the direction of retraction forces. Note that cable 50 and cable housing 55 have sufficient slack in overall length with bore 17 to not interfere with the articulation of jaw assembly 20.
  • FIG. 5B shows the limit of articulation as web 44a abuts the circular periphery of aperture 88.
  • jaw assembly 20 may rotate in 360° relative to sleeve 10.
  • FIGS. 6A shows jaw assembly 20 articulating at a different angle from that shown in FIG. 5A.
  • FIG. 6B shows the limit of articulation as web 44a abuts the circular periphery of aperture 88 at a different angle.
  • the tissue may be retracted in any direction, or the direction of retraction may be varied, and jaw assembly 20 will articulate and/or rotate allowing axis 45 to remain continuously aligned with the direction of retraction forces.
  • jaw assembly 20 includes a "closed-jaw self- centering" mechanism to maintain secondary axis 45 in alignment with primary axis 15 when the jaw elements are in the closed position as shown in FIG. 6A.
  • This feature is desirable, for example, when jaw elements 22a and 22b are actuated to the closed position for introduction through a cannula, in which case it is desirable to have jaw assembly 20 stabilized rather than free to articulate.
  • the closed-jaw centering mechanism maintains jaw assembly 20 in the "centered" position of FIG. 6A, but such "centered” position can be overcome by a slight force.
  • actuator disc 25 is injection-molded of resilient plastic material and formed with spring arms 91a and 91b.
  • the spring arms have tips, 92a and 92b, that extend slightly outward beyond the circular periphery of disc 25.
  • the tips 92a and 92b abut the wall of sleeve 10 that defines bore 17 adjacent to proximal edge 95 of socket 36 as shown in FIG. 7 to maintain the secondary (jaw) axis 45 in alignment with primary axis 15.
  • actuator disc 25 will remain in the "centered" position.
  • FIG. 8 depicts tip 92b of spring arm 91b bending to fit in socket 36 as jaw assembly 20 articulates.
  • Such overcoming forces are preferably slight and depend only on the spring constant formed into spring arms 91a and 91b.
  • FIG. 9 depicts a second embodiment of gripper 105 with an articulating jaw assembly in which like reference numerals refer to elements common to the previously described first embodiment of FIGS. 1-6B.
  • Gripper 105 differs from the first-described embodiment principally in that it incorporates jaw elements that have a "flex-jaw” feature, by which is meant the jaw elements uniformly apply engaging pressure on tissue along the length of the jaw working faces.
  • the alternative jaw assembly 120 is similar to the first-described embodiment including left-hand and right-hand jaw elements 122a and 122b, proximal hemispherical portions 132a and 132b, and jaw arms 142a and 142b that are e.g. unitary molded plastic (e.g., Delrin) .
  • the jaw arms are connected to proximal hemispherical portions 132a and 132b by rigid webs 144a and 144b respectively.
  • working faces 149a and 149b are connected to jaw arms 142a and 142b by unitary flexible hinge portions 150a and 150b.
  • FIG. 9 is a sectional view of working faces 149a and 149b in a repose position with gap "G" indicating a limit on flexing the working faces.
  • FIG. 10 depicts jaw working faces 149a and 149b gripping tissue 160 that is thin in cross-section with the working faces pivoting slightly around hinge portions 150a and 150b thus applying engaging pressure over the length of the working faces . As can be seen in FIG. 10, gap "G” is reduced in dimension to accommodate rotation of the working faces.
  • FIG. 11 depicts working faces 149a and 149b gripping tissue 161 that is thick in cross-section with working faces rotated around hinge portions 150a and 150b with gap "G” shown in a corresponding reduced dimension.
  • left-hand and right-hand jaw elements 122a and 122b may be injection-molded sequentially from a single mold.
  • left-hand jaw element 122a with arcuate slot 70a is shown in isometric view. It can be seen that the left-hand jaw element 122a can be flipped over thus providing a right-hand jaw element 122b (not shown) with slot 70a then re-designated as slot 70b.
  • using a single mold for both left-hand and right-hand jaw elements is best utilized with somewhat smooth jaw working faces, because "alligator-tooth" working faces then will not mesh. Referring to FIGS.
  • FIG. 9 shows in phantom view an extension spring 165 disposed in longitudinal slot 60.
  • Spring 165 is connected to and pulls cross ⁇ bar 66 in the distal direction thus actuating the jaw elements to the open position by means of the camming effect on arcuate slots 70a and 70b as described above.
  • trigger 175 pivoting around pivot pin 176 is provided within handle 180 and may additionally apply springing axial forces on cable 450 as described in the first embodiment.
  • Trigger 175 may be urged toward the non-depressed "A" position in plan view in FIG. 13 by extension spring 185 (in phantom view) thus additionally actuating the jaw elements toward the open position.
  • the second embodiment of gripper 105 provides an alternative "self-centering" mechanism to maintain secondary axis 45 in alignment with primary axis 15 in both the open-jaw and closed- jaw positions.
  • the self-centering mechanism comprises conical-shaped helically wound spring 195.
  • the proximal end of spring 197 generally is press fit in bore 17 of sleeve 10 while distal end 198 generally is press fit around the distal end of cable housing 55.
  • articulation of jaw assembly 120 tensions spring 195 by lateral movement of distal end 198 and spring 195 will urge the jaw assembly back toward the "centered" position as shown in FIG. 10.
  • gripper 105 offers a locking mechanism to lock jaw assembly 120 in an articulated position or a non-articulated position. Such a locking mechanism may be utilized, for example, to lock and rotate tissue while being retracted laterally to better dissect around the tissue.
  • the distal end 12 of sleeve 10 is configured with a distal inclined portion 200 that exhibits a slight increase in cylindrical dimension toward the distal direction.
  • the longitudinal slots 38 define longitudinal-extending socket portions 39.
  • a reciprocating sleeve 205 with bore 207 is made of thin- wall metal or plastic and is slidably disposed around introducer sleeve 10.
  • FIG. 11 it can be seen that the distal sliding of reciprocating sleeve 205 will press the socket portions radially inward to frictionally grip spheroid-shaped portion 35 of jaw assembly 120.
  • Reciprocating sleeve 205 is actuated proximally or distally by means within handle 180 (see FIG. 13) .
  • FIG. 13 shows the proximal end of reciprocating sleeve 205 mounted around introducer sleeve 10.
  • Sleeve 10 is fixed in relationship to handle 180 by elements extending through slots in reciprocating sleeve 205 (not visible) .
  • Reciprocating sleeve 205 is urged toward the proximal position by compression spring 215 abutting unitary flange 216 formed into sleeve 205.
  • Trigger 175 actuates reciprocating sleeve 205 distally to lock jaw assembly 120 in any articulated position (see FIG. 11) when upper trigger arm 227 abuts and pushes distally the proximal end 229 of sleeve 205.
  • FIG. 13 shows trigger 175 in plan view in a non- depressed "A” position, with phantom views of trigger 175 in an intermediate "B” position and a fully depressed “C” position.
  • Trigger 175 actuates the jaw elements from the open to closed position as it moves from the "A" position to the "B" position.
  • a jaw element with a "flex-jaw” feature similar to jaw element 220a may be made with a pin-type hinge (not shown) as a pivot point between jaw arm 244a and working face 249a and be within the scope of the present invention.
  • the previously-described actuation mechanism for jaw structures that includes a camming cross-bar 66 and arcuate slots 70a and 70b may be utilized in grippers that do not include an articulating jaw assembly.
  • a gripper may have left-hand and right-hand jaw elements similar to element 122a of FIG. 12 except that the proximal portions of the left-hand and right- hand jaw elements form a cylindrical shape that rotates in cooperating cylindrical-shaped socket.
  • FIG. 14 illustrates a third embodiment of gripper 305 that incorporates an introducer sleeve 310 extending along primary axis 315 coupled to jaw assembly 320 that closes on secondary axis 325.
  • the secondary axis 325 may articulate relative to primary axis 315.
  • the flexible connection between sleeve 310 and jaw assembly 320 is a flexible universal joint 330 made of any suitable resilient material such as urethane.
  • FIG. 14 it can be seen that jaw elements 333a and 333b rotate around pin 334. The jaw elements are urged to the open position by torsion spring 335 shown in phantom view.
  • Flexible braided steel cables 340a and 340b are disposed in cable housing 344 for actuating the jaws to the closed position.
  • gripper 305 may be fitted with a metal universal-type joint (not shown) of the type that has multiple pivots and be within the scope of the present invention. It should be further appreciated that gripper 305 may be fitted with a universal-type joint (not shown) of the type that has a helically-wound spring connecting proximal and distal portions of an introducer sleeve thus providing flexibility and be within the scope of the present invention.
  • thin-wall reciprocating sleeve 365 may be slidably mounted around introducer sleeve 310.
  • reciprocating sleeve 365 is slid distally to extend over universal joint 330 and maintained in such a position as shown in phantom view, the flexibility of universal joint 330 will be disabled.
  • a single gripper 305 is provided that selectively offers either a rigid-axis jaw assembly or an articulating-axis jaw assembly.
  • reciprocating sleeve 365 may have a distal rest position thereby disabling universal joint 330 and the sleeve 365 may be actuatable in the proximal direction by the trigger mechanism (not shown) that actuates jaw elements 333a and 333b toward the closed position.
  • the trigger mechanism (not shown) that actuates jaw elements 333a and 333b toward the closed position.
  • universal joint 330 may be disabled while said jaws move from the open position toward the closed position until a certain degree of closure is reached, after which universal joint 330 is free to articulate as sleeve 365 moves proximally.
  • FIG. 15 depicts a traction jaws instrument 405 with plastic handle assembly 407 including proximal handle member 408 and distal handle member 409.
  • Distal handle member 409 is fixed to elongate inner sleeve 410 by adhesives or other suitable means.
  • Inner sleeve 410 with proximal and distal ends 411 and 412, has a cylindrical shape extending along axis 415 with "throat" or bore 417.
  • Sleeve 410 is made of a somewhat flexible plastic such as Delrin ® .
  • Outer sleeve 420 is made of any suitable material such as thin-wall metal or plastic and has an outer diameter of approximately 10 mm. (not limiting) to cooperate with a standard 10-11 mm. inside diameter cannula.
  • jaw assembly 430 is incorporated into the distal end 412 of sleeve 410 and includes first and second opposing jaw structures in which each jaw structure is double-pivoting.
  • each jaw structure includes a pivotable distal jaw working arm and a pivotable proximal forearm.
  • distal jaw working arms 432a and 432b pivot around pins 433a and 433b, respectively.
  • Jaw working arms 432a and 432b are made of any suitable material such as injection-molded plastic and extend along axes 435a and 435b, respectively.
  • proximal forearms 442a and 442b are molded portions of the injection- molded inner sleeve 410 and pivot around resilient hinge portions 443a and 443b, although pin-type hinges are within the scope of the invention.
  • Forearms 442a and 442b extend along axes 444a and 444b respectively (see FIGS 17-19) .
  • each jaw structure is provided to align jaw working arms 432a and 432b generally parallel with one another as tissue is engaged to evenly distribute pressure over tissue, no matter the thickness of tissue as shown in FIGS. 18-19.
  • the even distribution of engaging pressure is to be contrasted with single pivot jaw structures in which the proximal portion of a jaw closes on tissue before the distal portion of the jaw.
  • Rolling tracks 445a and 445b are formed in a loop and are made of flexible material such as polyurethane and may be similar to the composite construction of 3 mm. to 6 mm. wide Flex-E-Grip ® belts available from W.M. Berg, Inc. of East Rockaway, New York. Rolling tracks 445a and 445b are impressed with tissue-gripping serrations 449 molded into the tracks' surfaces. Tracks 445a and 445b are dimensioned in width to fit within bore 417 of inner sleeve 410 and to roll around distalmost rollers 450a and 450b of jaw working arms 432a and 432b.
  • the loops of track 445a and 445b also roll around proximal rollers 452a and 452b within handle 407 (see FIG. 6) .
  • a drive mechanism for rolling the tracks 445a and 445b is described in detail below.
  • a jaw-actuating mechanism is provided to rotate jaw working arms 432a and 432b around their respective pivots, 433a and 433b.
  • the jaw-actuating mechanism also rotates jaw forearms 442a and 442b around their respective pivots 443a and 443b.
  • jaw-actuation is provided by the reciprocation of outer sleeve 420 over inner sleeve 410. Referring to FIG.
  • the jaw working arms 432a and 432b are urged to an open “A” position by torsion springs 455a and 455b.
  • the "A” position of FIG. 17 refers to the maximum angle “A” between instrument axis 415 and jaw working axes 435a and 435b which is approximately 40° (not limiting) .
  • outer sleeve 420 causes sleeve distal end 422 to contact cam surfaces 457a and 457b of jaw working ends 432a and 432b and to rotate the jaw working ends around their respective pivots, 433a and 433b, to achieve an intermediate closed “B” position.
  • the "B" position of FIG. 18 refers to angle “B” between instrument axis 415 and jaw working axes 435a and 435b which then is 0° or parallel.
  • FIG. 19 illustrates that further distal sliding of outer sleeve 420 causes its distal end 422 to force cam surfaces 457a and 457b inward toward axis 415 as jaw forearms 442a and 442b rotate around their respective hinge portions 443a and 443b, to a fully closed “C” position.
  • the "C” position of FIG. 19 refers to the maximum angle “C” between axis 415 and jaw forearm axes 444a and 444b which is approximately 5° to 10° (not limiting) .
  • the jaw-actuating mechanism and more particularly the reciprocation of the outer sleeve 420, is operable from handle 407 as shown in FIGS. 15 and 20.
  • Plastic thumb grip 460 is fixed by any suitable means such as adhesives to proximal end 421 of outer sleeve 420.
  • Thumb grip 460 and sleeve 420 are releasably maintainable in any axial position by annular ribs 464 within counterbore 465 in thumb grip 460 that engage cooperating annular indents 466 in the distal reduced- diameter portion 467 of handle member 409 (see FIG. 21) .
  • the thumb grip is made of resilient plastic such as Delrin ® and a plurality of flexing slots 469 (see FIG. 15) allows proximally-extending portions 470 of the thumb grip to flex radially outward slightly as it is slid to and from over indents 466 (see FIG. 21) of handle member 409.
  • a drive mechanism is provided to roll the tracks 445a and 445b around distal rollers 450a and 450b, and proximal rollers 452a and 452b. Referring to FIGS. 20-21, the drive mechanism includes bow member 472 with six (not limiting) flexible bows 475a-475f.
  • the flexible bows 475a-475f are portions of a unitary injection-molded resilient plastic bow member 472 in which the intermediate portions 476 of each bow have a uniform thickness to provide uniform bending.
  • the bows have proximal hinge portions 477a-477f, and distal hinge portions 479a-479f, that are reduced in sectional dimension to induce bending at the hinge portion (see FIG. 20) .
  • bows with pin- type hinges are within the scope of the present invention.
  • the proximal tube portion 480 of bow member 472 is fixed to proximal handle 408.
  • the distal tube portion 482 of bow member 472 is fixed to proximal handle 409. In the sequence of FIGS.
  • proximal handle member 408 to separate from distal handle member 409.
  • the travel of proximal handle 408 causes drive member 483 to transmit force to tracks 445a and 445b as further described below.
  • a drive mechanism utilizing a plurality of flexible bows allows the surgeon to rotate the handle 360° within one hand to align the jaws with tissue and thereafter to actuate the instrument by a squeezing motion no matter how the instrument is rotated.
  • a squeeze-actuated drive mechanism is to be contrasted with a pistol grip which may require awkward wrist movements to both rotate and actuate the instrument.
  • the flexible bows 475a-475f are urged to the expanded position of FIG. 20 by compression spring 485 that is disposed around inner sleeve 410 and within bore 486 in telescoping sleeve 488. Referring to FIG. 21, it can be seen that spring 485 exerts pressure on flange 489 of sleeve 410 and flange 490 of telescoping sleeve 488.
  • Drive member 483 is made of resilient plastic such as Delrin ® that includes resilient spring legs 491a and 491b that are adapted to engage serrations 449 impressed into tracks 445a and 445b (see FIG. 24) .
  • spring legs 491a and 491b are in a repose state and engage serrations 449 thereby causing tracks 445a and 445b to roll.
  • spring 485 moves causes drive member 483 to travel distally and spring legs 491a and 491b bend around hinge portions 493a and 493b respectively to flattened configuration and slide over serrations 449.
  • Drive member 483 may be moved proximally so that spring legs 491a and 491b are proximal from proximal rollers 452a and 452b (see FIG. 24) and out of engagement with the rolling tracks thus permitting the tracks to roll freely to release grip on tissue.
  • Inner sleeve 410 and outer sleeve 420 of the instrument may be fabricated of transparent medical grade plastic to view the quantity of tissue retracted into bore 417.
  • Jaw arms 432a and 432b and the rolling tracks also maybe made of clear plastic.
  • the sides of outer sleeve 420 may have slotted sides (not shown) to cooperate with the space between jaw forearms 442a and 442b (see FIG. 16) . Operation and use of the instrument of FIG. 15 in performing a method in accordance with the present invention can be described briefly as follows with reference to FIGS. 18-19.
  • the surgeon grasps the instrument in one hand and with his thumb slides thumb grip 460 distally to the "C" position to close jaw working ends 432a and 432b in order to permit the instrument to be introduced through a cannula into an endoscopic workspace.
  • the surgeon slides thumb grip 460 to the "A" position to open jaw assembly 430.
  • the surgeon advances jaw working ends 432a and 432b toward tissue to be engaged then slides thumb grip 460 distally to close jaw working ends 432a and 432b on opposing sides of the tissue.
  • surgeon may successively apply and release inwardly-directed force on opposing bows 475a-475f thereby causing tissue to be gripped by tracks 445a and 445b and progressively drawn into the "throat" or bore 417 or inner sleeve 410.
  • surgeon may re-adjust the closure of the jaw working ends 432a and 432b to suitably grip tissue 499 by sliding thumb grip 460 either proximally or distally.
  • FIGS. 25-26 illustrate a second embodiment of a gripping instrument 505 in which like reference numbers refer to elements common to the first-described instrument 405.
  • Instrument 505 differs only in the use of a secondary flexing bow drive mechanism for actuating the instrument's jaw structure.
  • This variation of a flexing bow drive includes a locking mechanism.
  • the resilient material of the flexing bows has a spring constant to urge the drive mechanism toward the expanded position from the contracted position.
  • distal proximal handle portion 508 of inner sleeve 510 carries secondary bow member 572.
  • the flexible bows 575a-575f are portions of a unitary injection-molded resilient plastic bow member 572 in which the intermediate portions 576 each serve as a leaf-type spring and urge each bow to the expanded position of FIG. 25.
  • the bows have proximal hinge portions 577a-577f, and distal hinge portions
  • the proximal tube portion 580 of bow member 572 is fixed distal handle portion 508 of sleeve 510.
  • the distal tube portion 582 of bow member 572 is fixed to outer sleeve 520.
  • FIGS. 25-26 it can be seen that squeezing any opposing bows 575a-575f, inward toward axis 415 will cause outer sleeve 520 to move distally relative to distal handle portion 508 and sleeve 510 to actuate jaw structure 430.
  • flexible bows 575a-575f may be made of a spring-type metal with a spring constant incorporated in each such bow.
  • metal bows would include a pin-type proximal and distal hinges for pivoting.
  • proximal handle member 408 includes a mechanism for releasably locking bow member 572 in any actuated position between the expanded and contracted positions.
  • Distal tube portion 582 of bow member 572 includes opposing resilient latch arms 580a and 580b, with teeth 584a and 584b that engage one of the annular indents 585 in distal handle portion 508 of sleeve 510.
  • the proximalmost ends of latch arms 580a and 580b may be depressed to pivot around respective resilient pivots 587a and 587b, to lift teeth 584a and 584b out of engagement with annular indents 585 and thus allow the spring constant of flexible bows 575a-575f to return bow member 572 to the expanded position.
  • FIG. 27 depicts a second embodiment of retraction instrument 605 having a single rolling track.
  • Instrument 605 includes plastic handle assembly 607 coupled to inner sleeve 610 that has proximal and distal ends 611 and 612, and extends along axis 615.
  • Sleeve 610 with longitudinal bore 617 is made of any suitable material such as plastic or metal.
  • the proximal end 611 of sleeve 610 is fixed in counterbore
  • track arm 632 is pivotably coupled to distal end 612 of sleeve 610 and rotates around pin 633.
  • Rolling track 645 with serrations 649 is similar the first-described embodiment and rolls around distal roller 650 and proximal roller 652 in handle 607.
  • An arm-actuating mechanism is provided to articulate track arm 632 around pivot pin 633 to align track arm axis 655 generally parallel to tissue.
  • track arm 632 is urged toward the articulated "X" position by torsion spring 656.
  • Track arm 432 may be articulated to the straight "Y" position shown in phantom view by the reciprocation of outer sleeve 620 relative to inner sleeve 610.
  • distal end 622 of sleeve 620 abuts cam surface 657 of track arm 632 causing the track arm to pivot around pin 633.
  • Sleeve 620 is slid to and fro over inner sleeve
  • lever grip 660 rotating around pivot 662 in handle 607.
  • Grip 660 and more particularly its upper lever arm portion 665 is flexibly coupled to proximally-extending tongue 666 that extends from proximal end 611 of plastic outer sleeve 620.
  • the flexible coupling between arm portion 665 and tongue 666 may be any suitable connection and is shown as a ball and socket-type joint 668 that snap-fits together.
  • Sleeve 620 is maintained in any reciprocated position between the "X” and “Y” positions by sharp edge 669 that springably engages cooperating indents 670 that are molded into plastic handle 607.
  • Spring gap 672 in tongue 666 allows resilient plastic edge 669 to flex inwardly toward axis 615 to move between indents 670.
  • a drive mechanism is provided to roll track 645 around proximal and distal rollers respectively 650 and 652.
  • the drive mechanism includes plastic trigger 675 made of a resilient plastic such as Delrin ® that is slidably disposed in slot 677 molded into handle 607. Compression spring 679 urges trigger 675 to its distalmost position.
  • Slanted resilient plastic spring legs 680 are molded into trigger 675 and are adapted to engage serrations 646 in track 645 as the trigger is depressed (proximally) thus causing the track to roll in a clockwise direction as seen in FIG. 27.
  • a mechanism is provided to prevent track 645 from rolling counter-clockwise in the view of FIG. 27 and includes resilient plastic cog 685 molded into handle 607. Cog 685 flexes outwardly as serrations 646 pass underneath it when the track rolls in a clockwise direction as seen in FIG. 27 and thereafter cog 685 will flex inwardly to engage serrations 649 to prevent track 445 from rolling counter-clockwise as trigger 465 is released.

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  • Health & Medical Sciences (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • General Health & Medical Sciences (AREA)
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Abstract

L'invention porte sur un instrument chirurgical (5) permettant de saisir des tissus à l'intérieur d'un espace d'intervention endoscopique. L'instrument présente une gaine d'introduction allongée (10) s'étendant le long d'un axe principal (15). Un ensemble de mâchoires articulées (20), fixé à l'extrémité distale de la gaine, est munie d'une articulation à rotule (35, 36) qui agit sur des mâchoires (22a, 22b) qui s'ouvrent et se referment autour d'un axe secondaire (45). L'instrument se caractérise par ailleurs par ses mâchoires flexibles (150a, 150b) qui confèrent aux surfaces de préhension (149a, 149b) un certain degré de liberté en rotation par rapport aux branches des mâchoires (142a, 142b). Dans une variante, la gaine d'introduction allongée (410) est munie d'une structure distale de mâchoires comportant des éléments à roulement en forme de chenilles coopérantes (445a, 445b) pourvue de dentelures (449) permettant de serrer le tissu et de lui appliquer une traction continue.
PCT/US1995/012523 1994-10-18 1995-10-16 Instrument endoscopique chirurgical Ceased WO1996011636A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU37601/95A AU3760195A (en) 1994-10-18 1995-10-16 Endoscopic surgical instrument

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US08/324,998 US5752973A (en) 1994-10-18 1994-10-18 Endoscopic surgical gripping instrument with universal joint jaw coupler
US324,998 1994-10-18
US327,154 1994-10-21
US08/327,154 US5549627A (en) 1994-10-21 1994-10-21 Surgical instruments and method for applying progressive intracorporeal traction

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WO1996011636A1 true WO1996011636A1 (fr) 1996-04-25

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Cited By (12)

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WO1999040854A1 (fr) * 1997-02-28 1999-08-19 Lumend, Inc. Actionneur manuel pour un systeme de catheter permettant de traiter les occlusions vasculaires
US5968064A (en) * 1997-02-28 1999-10-19 Lumend, Inc. Catheter system for treating a vascular occlusion
US6010449A (en) * 1997-02-28 2000-01-04 Lumend, Inc. Intravascular catheter system for treating a vascular occlusion
US6120516A (en) * 1997-02-28 2000-09-19 Lumend, Inc. Method for treating vascular occlusion
EP0888746A3 (fr) * 1997-07-02 2001-01-24 Aesculap AG & Co. KG Instrument chirurgical à tige tubulaire
US6217549B1 (en) 1997-02-28 2001-04-17 Lumend, Inc. Methods and apparatus for treating vascular occlusions
WO2005004965A3 (fr) * 2003-06-10 2005-04-07 Lumend Inc Systemes de catheter et methodes de traversee d'occlusions vasculaires
WO2006075153A1 (fr) * 2005-01-11 2006-07-20 Anthony Blacker Forceps laparoscopique
DE102014009893A1 (de) 2014-07-04 2016-01-07 gomtec GmbH Endeffektor für ein Instrument
CN106333728A (zh) * 2013-11-29 2017-01-18 重庆西山科技股份有限公司 医用磨削刀具的磨头
CN106859732A (zh) * 2017-03-30 2017-06-20 中南大学湘雅三医院 一种可折叠的外科手术钳
WO2025048830A1 (fr) * 2023-09-01 2025-03-06 Imacular Regeneration Llc Forceps articulé

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US5209747A (en) * 1990-12-13 1993-05-11 Knoepfler Dennis J Adjustable angle medical forceps
US5383888A (en) * 1992-02-12 1995-01-24 United States Surgical Corporation Articulating endoscopic surgical apparatus

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Publication number Priority date Publication date Assignee Title
US5209747A (en) * 1990-12-13 1993-05-11 Knoepfler Dennis J Adjustable angle medical forceps
US5383888A (en) * 1992-02-12 1995-01-24 United States Surgical Corporation Articulating endoscopic surgical apparatus

Cited By (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999040854A1 (fr) * 1997-02-28 1999-08-19 Lumend, Inc. Actionneur manuel pour un systeme de catheter permettant de traiter les occlusions vasculaires
US5968064A (en) * 1997-02-28 1999-10-19 Lumend, Inc. Catheter system for treating a vascular occlusion
US6010449A (en) * 1997-02-28 2000-01-04 Lumend, Inc. Intravascular catheter system for treating a vascular occlusion
US6120516A (en) * 1997-02-28 2000-09-19 Lumend, Inc. Method for treating vascular occlusion
US6217549B1 (en) 1997-02-28 2001-04-17 Lumend, Inc. Methods and apparatus for treating vascular occlusions
EP0888746A3 (fr) * 1997-07-02 2001-01-24 Aesculap AG & Co. KG Instrument chirurgical à tige tubulaire
AU2004255154B2 (en) * 2003-06-10 2009-08-20 Lumend, Inc. Catheter systems and methods for crossing vascular occlusions
WO2005004965A3 (fr) * 2003-06-10 2005-04-07 Lumend Inc Systemes de catheter et methodes de traversee d'occlusions vasculaires
US8702679B2 (en) 2003-06-10 2014-04-22 Cordis Corporation Catheter systems and methods for crossing vascular occlusions
WO2006075153A1 (fr) * 2005-01-11 2006-07-20 Anthony Blacker Forceps laparoscopique
CN106333728A (zh) * 2013-11-29 2017-01-18 重庆西山科技股份有限公司 医用磨削刀具的磨头
DE102014009893A1 (de) 2014-07-04 2016-01-07 gomtec GmbH Endeffektor für ein Instrument
DE102014009893B4 (de) * 2014-07-04 2016-04-28 gomtec GmbH Endeffektor für ein Instrument
US10124493B2 (en) 2014-07-04 2018-11-13 Abb Gomtec Gmbh End effector for an instrument
CN106859732A (zh) * 2017-03-30 2017-06-20 中南大学湘雅三医院 一种可折叠的外科手术钳
WO2025048830A1 (fr) * 2023-09-01 2025-03-06 Imacular Regeneration Llc Forceps articulé

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