 medical device for engaging a tissue
专利摘要:
MEDICAL DEVICES WITH DETACHABLE ROTATING CLAWS. The present invention relates to medical devices, methods and systems for engaging a tissue, for example, for securing the tissue, closing a perforation or performing hemostasis. In general, the medical system includes a housing, first and second rotating jaws in relation to the housing, a driver and an elongated drive wire. The elongated drive wire can be disconnected from the driver, the first and second jaws and the housing, which are left in vivo attached to the tissue. 公开号:BR112013008763B1 申请号:R112013008763-3 申请日:2011-10-11 公开日:2021-02-17 发明作者:Michelle D. Martinez；Vihar C. Surti；Tyler Evans Mclawhorn 申请人:Cook Medical Technologies LLC.； IPC主号:
专利说明:
[0001] [0001] Conventionally, a clip can be inserted into a body cavity through an endoscope to secure living tissue in a body cavity for hemostasis, marking and / or ligation. Such clips are often known as surgical clips, endoscopic clips, hemostatic clips and vascular clips. In addition, the clips are now being used in various applications related to gastrointestinal bleeding such as peptic ulcers, Mallory-Weiss tears, Dieulafoy lesions, angiomas, post-papillary bleeding and small varicose veins with active bleeding. Attempts have been made to use the clips to close stomach perforations. [0002] [0002] Gastrointestinal bleeding is a serious and somewhat common condition that is often fatal if left untreated. This problem has motivated the development of several endoscopic therapeutic approaches to achieve hemostasis, such as the injection of sclerosing agents and contact thermocoagulation techniques. Although such approaches are often effective, bleeding continues for many patients and corrective surgery is therefore necessary. Due to the fact that surgery is an invasive technique that is associated with a high rate of morbidity and many other undesirable side effects, there is a need for less invasive, highly effective procedures. [0003] [0003] Mechanical hemostatic devices such as clips have been used in various parts of the body, including gastrointestinal applications. One of the problems associated with conventional hemostatic clips and devices, however, is that many devices are not strong enough to cause permanent hemostasis. Additionally, there have been attempts to use the clips to close perforations in gastrointestinal and stomach structures, but unfortunately, traditional clips have difficult placement and the ability to hold a limited amount of tissue, which potentially results in incomplete closure. SUMMARY [0004] [0004] The invention can include any of the following aspects in various combinations and can include any other aspect described below in the written description or in the accompanying drawings. [0005] [0005] In a first aspect, a medical device is provided to engage a tissue, the medical device including a housing, first and second jaws, a jaw pin and a driver. The housing defines an internal passage and a longitudinal axis that extends between the proximal and distal ends of the housing. The housing also defines a claw guide surface along the internal passage, the claw guide surface having a distal end. The first and second claws have a proximal end that is slidably and pivotally connected to the housing and are slidably received inside the internal passage for longitudinal movement along the claw guide surface between an extended position and a retracted position. The claw pin extends through the proximal ends of both the first and second claws and engages the claw guide surface of the housing. The driver is engaged with the proximal ends of the first and second jaws, by means of which the longitudinal movement of the driver moves the first and second jaws longitudinally along the guide surface of the jaw between the retracted and extended positions thereof. The longitudinal movement of the actuator also rotates the first and second jaws in relation to the housing when the first and second jaws are in their extended positions. [0006] [0006] According to more detailed aspects, the claw pin engages the distal end of the claw guide surface when the first and second claws are in their extended positions. The proximal ends of the first and second jaws include gears that have teeth, and the driver includes corresponding teeth that intertwine with the teeth of the jaws. The proximal ends of the first and second jaws are formed as pinions and the driver is formed as a shelf, whereby the longitudinal movement of the driver and shelf rotates the pinions and the first and second claws in their extended positions. The driver includes a central spine that extends longitudinally and teeth that extend in laterally opposite directions from the spine to form two sets of teeth, one of the two sets of teeth engaged with the pinion of the first claw, the other of the two sets of teeth attached to the pinion of the second claw. In one embodiment, the driver includes a center plate that has first and second ends and a first set of teeth extends laterally from the first end of the center plate and a second set of teeth extends laterally from the second end of the central plate , with the first and second sets of teeth extending in laterally opposite directions. The central plate preferably extends in a plane parallel to the longitudinal axis and may include a slot that extends through a distal end of the plate, the slot being dimensioned and positioned to receive the claw pin. A cross-section of the central plate and sets of teeth, in a plane perpendicular to the longitudinal axis, forms a Z-shape. [0007] [0007] In a second aspect, a medical device is provided to engage a tissue, the medical device including a housing, first and second jaws, a driver and a drive wire. The housing defines an internal passage and a longitudinal axis that extend between proximal and distal ends of the housing. The first and second claws are rotatable in relation to the housing and have proximal and distal ends. The driver is engaged with the proximal ends of the first and second jaws, by means of which the longitudinal movement of the driver rotates the first and second jaws in relation to the housing. The driver includes two locking tabs that form a socket facing the proximal side and is constructed of a material that deforms plastically to adjust the size of the socket. The elongated drive wire is selectively connected to the driver for longitudinal movement with it. The drive wire has an enlarged portion close to a distal end of the drive wire and the socket receives the enlarged portion of the drive wire. [0008] [0008] According to more detailed aspects, the proximal extraction of the enlarged portion from the socket causes the actuator to deform plastically and the locking tabs to move laterally outwards. The housing includes a guide surface that guides the longitudinal movement of the actuator and the guide surface includes two surfaces on opposite sides of the housing that correspond to the two locking tabs. The guide surface preferably also includes a proximal portion, a distal portion and a shoulder in the transition between the proximal and distal portions. The shoulder is turned towards the proximal side, whereby the locking tabs are positioned to engage the shoulder to limit the longitudinal movement of the driver after having been moved laterally outward by the enlarged portion of the drive wire. [0009] [0009] In a third aspect, a medical device is provided to engage a tissue, the medical device including a housing, first and second jaws, a driver, a tilt strip and a drive wire. The housing defines an internal passage and a longitudinal axis that extend between the proximal and distal ends of the housing. The first and second claws are rotatable in relation to the housing and have proximal and distal ends. The driver is engaged with the proximal ends of the first and second jaws, by means of which the longitudinal movement of the driver rotates the first and second jaws in relation to the housing. The tilt strip is operatively connected to at least one of the first and second jaws to tilt the jaws radially. The elongated drive wire is selectively connected to the driver for longitudinal movement with it. [0010] [00010] According to more detailed aspects, a first end of the slope strip engages the first claw and a second end of the slope strip engages the second claw. An intermediate portion of the slope strip is attached to a distal end of the driver and moves with it. In another embodiment, the tilt strip is a first tilt strip and the device further includes a second tilt strip. The first tilt strip has one end attached to the first jaw and the other end attached slidably to the housing. Likewise, the second tilt strip has one end attached to the second jaw and the other end attached slidably to the housing. Here, an exterior of the housing includes first and second channels dimensioned to receive the first and second tilt strips. The first and second tilt strips are attached to the distal ends of the first and second jaws, respectively. BRIEF DESCRIPTION OF THE DRAWINGS [0011] [00011] The accompanying drawings incorporated in and forming a part of the specification illustrate various aspects of the present invention and, together with the description, serve to explain the principles of the invention. In the drawings: Figure 1 is a top view of a medical system that has a medical device for engaging a tissue, constructed in accordance with the teachings of the present invention; Figure 2 is a top view similar to Figure 1, but showing the outer structures in dotted lines and the inner sections in solid lines and partial cross section; Figure 3 is a side view of the medical system and device shown in Figure 1; Figure 4 is a side view similar to Figure 3, but showing the outer structures in dotted lines and the inner structures in solid lines and partial cross section. Figure 5 is a side view of a medical device that is part of the medical system represented in Figures 1 to 4; Figure 6 is a front view of a housing that forms a portion of the medical system and device shown in Figures 1 to 5; Figure 7 is a perspective view of the housing shown in Figure 6; Figures 8 to 12 are side views showing the operation of the medical system and device represented in Figures 1 to 5; Figures 13 and 14 are top views, partly in cross section, representing the operation of the medical system and device shown in Figures 1 to 4; Figures 15 and 16 are a cross-sectional view showing the operation of the medical system and device represented in Figures 1 to 4. Figures 17 and 18 are a perspective view of an alternative embodiment of a gripper that forms a portion of the medical system and device of Figure 1; Figure 19 is a plan view of an alternative embodiment of a driver that forms a portion of the medical system and device of Figure 1; Figure 20 is a perspective view of the driver of Figure 19 shown attached to a drive wire; Figure 21 is a side view of Figure 20; Figure 22a is a plan view of an alternative embodiment of the medical device of Figure 1, and Figure 22b is a plan view of the driver of Figure 19 shown attached to a strip and forming a portion of the medical device of Figure 22a; Figure 23 is a plan view of another alternative embodiment of the medical device shown in Figure 1; Figures 24 and 25 are perspective views showing the operation of the medical device shown in Figure 23; Figures 26 and 27 are seen in perspective and from the end, respectively, of another modality of a driver that forms a portion of the medical system and device represented in Figure 1; Figure 28 is a perspective view of the driver of Figures 25 to 26 shown attached to the claws; Figures 29 and 30 are plan views showing the operation of the driver and the claws shown in Figure 28; Figures 31 and 32 are a cross-sectional view of another embodiment of the medical system and device shown in Figure 1; and Figure 33 is a perspective view of the medical system and device shown in Figures 31 and 32. DETAILED DESCRIPTION OF THE INVENTION [0012] [00012] The terms "proximal" and "distal" as used in this document are intended to have a point of reference in relation to the user. Specifically, throughout the specification, the terms "distal" and "distally" must denote a position, direction, or orientation that is generally distant from the user and the terms "proximal" and "proximally" must denote a position, direction, or orientation which is usually towards the user. [0013] [00013] An exemplary medical system 20 that has a medical device 40 for engaging a T tissue (Figure 11) is shown in Figures 1 to 4. The medical system 20 and device 40 are generally dimensioned and structured for operation through the delivery channel. work of an endoscope (not shown) or other scope, although the system 20 and device 40 can still be used alone or in conjunction with other elongated devices such as catheters, fiber optic visualization systems, needles and the like. Generally, the medical system 20 includes a drive wire 22 slidably housed within the distal end 23 of an elongated catheter 24 for selective connection to, and operation of, the medical device 40. As will be described in further details herein, the medical device 40 generally includes a housing 42 which has a first jaw 44 and a second jaw 46 pivotally connected thereto to engage the T tissue. Generally, jaws 44, 46 have been shown to form forceps, although the claws are intended to be used to hold the tissue, for example, to close an opening or for hemostasis. Accordingly, it will be recognized that the shape and structure of the claws can take many forms and serve many purposes and functions, all in accordance with the teachings of the present invention. [0014] [00014] In medical system 20, the drive wire 22 extends slidably through catheter 24. Although the term "wire" is used to refer to drive wire 22, it will be recognized that any elongated control member that has the ability to transmit longitudinal force over a distance (as required in endoscopic, laparoscopic and similar procedures) can be used, and this includes plastic tubes or rods, single filament or multifilament yarns, metal rods and the like. The drive wire 22 may also have the ability to properly transmit a rotational / torsional force from the proximal end to the distal end to rotate the medical device 40 and the jaws 44, 46, and thus, it is currently preferable that the wire drive 22 is formed of nitinol (for example, a nitinol wire) or other superelastic alloy. A connection block 26 is slidably adjusted inside the distal end 23 of the catheter 24 and defines a hole 28 through which the drive wire 22 slidably receives. The outside of the connection block 26 includes a recessed portion 27 , and two pins 30 (for example, formed from stainless steel wire) are connected to catheter 24 and positioned inside the recessed portion 27 to limit the longitudinal movement of the connection block 26. [0015] [00015] The distal end of the drive wire 22 defines a distal head 32 that is dimensioned larger than the drive wire 22 and, likewise, larger than the hole 28 in the connection block 26. As will be described later in In this document, the distal head 32 is used to slide the connection block 26 inside the catheter 24 to disconnect the medical device 40 from the medical system 20. As seen further in Figures 1 to 4, the housing 42 of the medical device 40 is a tubular member defining an interior space 43. A proximal end of the housing 42 receives frictionally a distal end of the connection block 26 within the interior space 43 for selective connection therewith. [0016] [00016] The internal passage 43 of the housing 42 also receives the first and the second jaws 44, 46 and a driver 48 which is used to interconnect the drive wire 22 to the jaws 44, 46. As best seen in Figures 1, 2 and 5, the driver 48 has a proximal portion that defines a socket 50 sized to receive the enlarged distal head 32 of the drive wire 22. At the proximal entrance of the socket 50, the two flexible locking tabs 52 are formed which rotate with respect to the remainder of driver 48 to increase or decrease the size of socket 50. Locking tabs 52 can be formed separately and swiveled to driver 48, or they can be formed integrally with driver 48 and formed of a resistant material that flexes to allow rotation of the locking tabs 52 radially inward and radially outward. A distal portion of the driver 48 defines a shelf 54 for engaging and operating the claws 44, 46. In the embodiment shown, the shelf 54 includes a central spine 56 that has teeth 58 that protrude away from the central spine 56 and on opposite sides of the spine 56. One set of teeth 58 on one side of the spine 56 generally operates the first jaw 44 while the other set of teeth 58 on the other side of the spine 56 operates the second jaw 46. It will be recognized that the shelf 54 may include a single set of teeth or other meshed structures that interface with the claws 44, 46. [0017] [00017] As best seen in Figure 5, the first and second jaws 44, 46 include distal ends 60, 62 that are structured to hold and engage the fabric, generally, they have a jaw shape as revealed in document 61 / 141,934 deposited on December 31, 2008, the disclosure of which is incorporated into this document as a reference in its entirety. The proximal ends 64, 66 of the first and second jaws 44, 46 each include a pinion gear 68, 70 which has a series of teeth. The teeth of the pinion 68, 70 intertwine with the teeth of the shelf 54 of the driver 48 so that the longitudinal translation of the driver 48 induces rotation in the first and second jaws 44, 46 with respect to each other. Generally, the distal translation of the driver 48 causes the first and second jaws 44, 46 to rotate outwardly apart, while the proximal retraction of the driver 48 causes the first and second jaws 44, 46 to rotate inward. towards each other. The pins 80 are adjusted through each of the proximal ends of the claws 44, 46, to swivel the claws to the housing 42. Other structures for forming a swivel connection can be used and, preferably, the swivel connection is arranged centrally in relation to pinions 68, 70. [0018] [00018] In addition to the claws 44, 46 which are pivotally attached to the housing 42, the first and second claws 44, 46 are also slidably attached to the housing 42. As best seen in Figures 6 and 7 (and together with Figures 1 to 4) the housing 42 defines a first guide surface 82 for the first jaw 44, and a second guide surface 84 for the second jaw 46. As seen in Figure 3, the first and second guide surfaces 82, 84 are formed by elongated slits 82a, 82b, 84a, 84b formed on opposite sides of the housing 42 which leaves a thickness of the housing 42 exposed to serve as the guide surface. The slots 82a, 82b are aligned to receive the connector pin 80 of the first jaw 44, and likewise the slots 84a, 84b are aligned to receive the connector pin 80 of the second jaw 46. The ends of the slits, for example, the ends distal 92, 94 shown in Figure 7, serve to restrict the longitudinal movement of the claws 44, 46 in relation to the housing 42. The proximal ends 64, 66 of the claws 44, 46 include holes 72, 74 that receive pins 80 (Figures 1 , 2 and 3) which are used to swivel and slide the first and second claws 44, 46 to the housing 42. [0019] [00019] It can also be seen in Figures 6 and 7 that the housing 42 defines a third guide surface 86 that guides the longitudinal movement of the driver 48 inside the housing 42. The guide surface 86 in the embodiment shown includes a left guide surface 86a and a right guide surface 86b formed as C-shaped channels. As shown in Figure 7, the third guide surface 86 crosses from a smaller proximal width to a larger distal width to define a shoulder 88 in the transition, which will be described further in the present document below with reference to Figures 13 and 14. [0020] [00020] As further shown in Figure 6, the internal passage 43 of the housing 42 extends through the distal end of the housing, and through it the first and second jaws 44, 46 can extend. Additionally, as shown in Figures 1 and 2, the housing 42 defines opposite slots 45 which are sized to allow the first and second jaws 44, 46 to pass through them when they rotate radially outward. Accordingly, it is also clear from Figures 1 and 2 that housing 42 serves to block rotation of the first and second jaws 44, 46 when they are contained entirely or partially within the internal passage 43 of housing 42. Plastics suitable for forming the housing include, but are not limited to, polytetrafluoroethylene (PTFE), expanded polytetrafluoroethylene (EPTFE), polyethylene ether ketone (PEEK), polyvinyl chloride (PVC), polycarbonate (PC), polyamide, polyimide, polyurethane, polyethylene (density high, medium or low) and suitable metals include stainless steel, nitinol and alloys and metals of similar medical grade. [0021] [00021] The operation of the medical device 40 will now be described with reference to Figures 8 to 12. As shown in Figure 8, the first and second jaws 44, 46 are shown in a retracted position where they are substantially contained in the housing 42 Depending on the application, the distal ends 60, 62 of the claws 44, 46 may protrude slightly from the distal end of the housing 42 in their retracted positions, or they may be positioned entirely within the housing 42. When the wire drive 22 is moved distally (right on the page in Figure 8) the distal head 32 engages driver 48, driver 48 and jaws 44, 46 slide distally through housing 42. Driver 48 and jaws 44, 46 slide longitudinally before they rotate (although the shelf 54 of the actuator 48 is intertwined with the pinions 68, 70 at the proximal ends 64, 60 of the claws 44, 46) since the resistance to movement the longitudinal is less than the force required to rotate the claws 44, 46 (alternatively, the housing 42 can block the rotation of the claws 44, 46 when they are inside the housing 42). As mentioned earlier, this longitudinal movement is guided by the first and second guide surfaces 82, 84 which receive the pins 80 that swivel and slide the claws 44, 46 to the housing 42. [0022] [00022] As shown in Figure 9, the first and second jaws 44, 46 have an extended position in which the jaws project substantially from a distal end of the housing 42, and the proximal ends 64, 66 of them are positioned adjacent to the distal end of housing 42. Accordingly, it will be seen that the further distal advance of drive wire 22 and therefore drive 48 causes pinion 68 to rotate on teeth 58 on shelf 54. As best seen in Figure 10, the first and second jaws 44, 46 rotate radially out of each other in a tissue receiving position. Notably, due to the presence of slits 45 at the distal end of the housing 42, the claws 44, 46 are allowed to rotate through 90 ° completely, thus forming at least 180 ° between them. It will be recognized that, by dimensioning the slots 45 and constructing the shelf 54 and pinions 68, 70, the first and second jaws 44, 46 can rotate even further apart. [0023] [00023] In the fabric receiving the configuration shown in Figure 10, the medical device 40 and claws 44, 46 thereof can be positioned adjacent to the T fabric. As shown in Figure 11, the T fabric can be placed between the first and the second jaws 44, 46 and jaws 44, 46 rotated back towards their position shown in Figure 9. Fabric T has been shown as a single layer, although multiple layers can be trapped between jaws 44, 46. Generally , the proximal retraction of the drive wire 22 and the driver 48 again causes the first and second jaws 44, 46 to rotate to secure the T fabric between them. As shown in Figure 12, the additional proximal retraction of the drive wire 22 and driver 48 will cause the jaws 44, 46 to move longitudinally in a proximal direction (left on the page in Figure 12). [0024] [00024] In order for the medical device 40 to serve as a clip and keep the grip of it on the T fabric, or keep the grip of two layers of tissue against each other, the claws 44, 46 can be in a locked position and the drive wire 22 of the medical system 20 disconnected from the medical device 40. As shown in Figure 13, the third guide surface 86 (which guides the driver 48) includes a proximal portion 86p and a distal portion 86d. The proximal portion 86p of the third guide surface 86 has a width (measured above and below the page in Figure 13) that is greater than a width of the distal portion 86d of the third guide 86. As previously discussed, the third guide surface 86 is formed opposing C-shaped surfaces or channels 86a, 86b of the housing 42. The transition between the proximal portion 86p and the distal portion 86d defines a shoulder 88, and in particular two shoulders 88a, 88b on opposite sides of the housing 42. The shoulders 88a, 88b are dimensioned and positioned to engage the locking tabs 52 located on the driver 48. [0025] [00025] As shown in Figure 13, when the driver 48 is located inside the distal portion 86d of the third guide surface 86, the locking tabs 52 are forced radially inward in a firm frictional engagement with the drive wire 22. otherwise, the socket 50 formed by the driver 48 to receive the distal head 32 has an entrance which is narrowed by the deflection into the locking tabs 52. Preferably, the locking tabs 52 deform plastically instead of deforming elastically, and the tabs 52 can be curved inwardly around the distal head 32 during initial conjunction of the device, and thus dimensioned for the distal portion 86d of the third guide surface 86. In this state shown in Figure 13, the drive wire 22 is firmly engaged with the driver 48 and, consequently, the first and second jaws 44, 46. [0026] [00026] When the drive wire 22 and the driver 48 are retracted proximally, for example, by gripping the fabric as shown in Figure 12, the proximal end of the driver 48 is received inside the proximal portion 86p of the third guide surface 86 which has a wider width that allows the radial movement outward of the locking tabs 52. Accordingly, in the state shown in Figure 14, the locking tabs 52 can be loosely and detachably connected to the distal head 32 of the drive wire 22 That is, the proximal retraction of the claws 44, 46 will be limited by the T fabric that engages the distal end of the housing 42, or the pins 80 will be contiguous to the proximal ends of the slots 82a, 82b, 84a, 84b that define a first and second guide surfaces 82, 84. As such, when the proximal movement of the claws 44, 46 and the driver 48 are thus limited, the additional proximal movement of the drive wire 22 and the distal head 32 of the m They can even be used to remove the distal head 32 from socket 50 of driver 48. This operation can also be used to further deflect locking tabs 52 radially outward. An appropriate amount of force directed distally on the drive wire 22 causes the distal head 32 to move proximally through the locking tabs 52 and plastically deform them radially outwardly. In the event that the natural elasticity of the T fabric tends to pull the claws 44, 46 out of the housing towards their extended position, the locking tabs 52, 54 will be adjacent to the shoulders 88a, 88b of the third guide surface of the housing 42 to prevent further distal movement of the claws 44, 46. [0027] [00027] Turning now to Figures 15 and 16, by means of an even more proximal retraction of the drive wire 22 and distal head 32, the enlarged distal head 32 will be contiguous to the connection block 26 which is slidably adjusted inside the end distal 23 from catheter 24. Sufficient proximal force in the drive wire 22 will overcome the frictional fit between the connection block 26 and the proximal end of the housing 42, thus moving the connection block 26 proximally (right on the page in Figures 15 and 16) to retract the connection block 26 inside the tubular connector 24, as shown in Figure 16. The catheter 24 can be used to provide a counter force in the housing 42 while proximally retracting the drive wire 22 and connection block 26. Accordingly, the drive wire 22, the catheter 24 and the connection block 26 can be completely disconnected from the medical device 40, thereby leaving the first and second jaws 44, 46 and the housing the 42 in a state that has the T tissue trapped between the claws 44, 46 and retained in vivo. The connection block 26 is retained at the distal end 24 of the catheter 24 by means of the pins 30, which are positioned inside the recessed area 27 to engage the proximal and distal ends of the connection block 26 and limit its longitudinal movement. [0028] [00028] The elongated catheter 24 (or another elongated tubular member such as a liner, tube, scope or the like), which slidably covers the drive wire 22, extends proximally along it to a proximal end of the system 20 , and has a length suitable for placing the device 40 in any desired location within the body, while the proximal ends of the drive wire 22 and the catheter 24 are positioned outside the body for use by the medical professional. The control handles (not shown) for controlling the relative translation of the drive wire 22 and the catheter 24 are well known in the art and can be used at the proximal end of the system 20. [0029] [00029] Another modality and method of forming the grip jaws 44, 46 are shown in Figures 17 to 18. The claws of the previous modality were generally machined, however, the claws 44, 46 can still be formed by pressing. A flat piece of metal, preferably of medical grade stainless steel, is pressed into the shape 144 shown in Figure 17. The shape includes a slightly narrow distal end 160 which can then be curved into the shape shown in Figure 18 to grab and engage the fabric . The distal end 160 can be further pressed to include a serrated edge, or other edge characteristics or shapes depending on the application. The proximal end 164 generally includes two arms 166 leading to gears 168. As shown in Figure 18, gears 168 are secured and then rotated about 90 degrees, so that gears 168 extend in a plane that is perpendicular to the plane blade 144. Gears 168 further include a through hole 172 for receiving a guide pin. It will also be recognized that the claws 44, 46 in this embodiment can also be formed by a single arm 166 and a single gear 168. [0030] [00030] Another embodiment of a driver 148 and drive wire 122 is shown in Figures 19 to 22. Driver 148 generally includes a socket 150 formed by two locking tabs 152. In this mode, a proximal portion of the locking tabs defines shoulders inclined outwardly 154 to engage with the third guide surface 86 in housing 42 as previously discussed. The locking tabs 152 further include interior projections 153 that project laterally inward and separate socket 150 into a distal portion 150d and a proximal portion 150p. The driver 148 again includes a central spine 156 and opposing teeth 158. In this embodiment, the distal end 166 of the driver 148 includes a pocket 168 defined by two inwardly projecting flanges 170, as will be discussed further in this document. The two flanges 170 extend along a distal side of pocket 168 and leave a gap between them for access to pocket 168. [0031] [00031] As seen in Figures 20 and 21, this modality of the drive wire 122 includes a distal head 132 which is formed by curving the distal end of the drive wire 122 in a semicircular shape as shown, preferably spanning an arc of 180 360 degrees. Accordingly, it can be seen that the distal head 132 defines an opening 133 which is sized to receive the interior projections 153 of the locking tabs 152. As shown, the distal portion 150d of socket 150 receives the most distal part of the curved distal head 132, while the proximal portion of the distal head 132 projects through the proximal portion 150p of socket 150 and proximally distant from it. As noted above, the locking tabs 152 here are structured to be plastically deformed and thus, after formation and connection to the drive wire 122 as shown in Figure 19, the tabs 152 are curved inwardly to secure the projections 153 on the interior of the opening 133 of socket 132. In this state, the outer shoulders 154 of the locking tabs 152 are dimensioned to fit within the third guide surface 86 and, more particularly, in the distal portion 86d of the third guide surface 86 without further deformation. [0032] [00032] As shown in Figures 22a and 22b, another embodiment of the medical device 140 may include the housing 142, gripping arms 144, 146 as in the previous embodiment, but in that embodiment include the reciprocating actuator 148 and an additional tilt element, namely an inclination strip 190. As best seen in Figure 22b, the distal end 166 of the driver 148 receives the inclination strip 190 inside pocket 168. Flanges 170 are curved inwardly and proximally, as shown, to firmly engage the metal strip 190 and fix it to the driver 148. The slope strip 190 is preferably a thin strip formed from a sheet of resistant material and, more preferably, a metal strip, for example, formed of stainless steel, nitinol or another superelastic alloy that is biocompatible. Accordingly, it will be recognized that as the actuator 148 is moved proximally to cause the claws 144, 146 to close, the slope strip 190 will be forced into a V-shape or U-shape, as shown by the dotted lines in Figure 22a. That is, the slope strip 190 has a straight shape in its natural configuration, not inclined, and when curved in the V shape it exerts a radially outward force on the claws 144, 146. This sloping force provides the claws 144, 146 with smooth rotation and transition between open and closed positions. It will also be recognized that the slope strip 190 may still have its original non-slanted position formed as a V-shape or a U-shape, and be affixed to the claws 144, 146 so that it exerts a sloping force radially to inside. The free ends 192 of the metal strip 190 simply press against the jaws 44, 46, but are not fixed or rigidly attached to them. [0033] [00033] Turning to Figure 23, another embodiment of medical device 240 is shown, again including a housing 242 and opposing jaws 244, 246 which are slidably attached thereto. The housing 242 again includes the first and second guides 282, 284 to guide the movement of the jaws 244, 246. In this embodiment, however, each jaw 244, 246 includes an inclination strip 290a, 290b, respectively. The distal ends 291 of the strips 290a, 290b are fixedly attached to the outside of the claws 244, 246, preferably at the distal ends thereof, and preferably by means of an adhesive technique, welding technique, welding technique, or other technique of known connection. As best seen in Figures 24 and 25, housing 240 includes two outer channels 294 on opposite sides of housing 240 (one that is shown in Figures 24 and 25) that are sized to receive the resistant strips 290a, 290b so that they pulled with the outer surface of the housing in the closed / retracted configuration. The proximal ends 293 of the strips 290a, 290b include a T shape formed by a base 295 and crossbar 296. The base 295 extends through a smaller slot 296 formed through the housing 240. The slots 296 coincide in extension with the channels 294. The crossbar 296 passes along the interior of the housing 240 and maintains the sliding connection between the strips 290 and the housing 240. Accordingly, it can be seen that the proximal ends 293 of the strips 290a, 290b are slidably attached and pivot to housing 240 through channel 294 and slot 296 thereof, allowing strips 290a, 290b to travel with clamping jaws 44, 46 as shown between their open and closed positions, as shown in Figures 24 and 25. [0034] [00034] Turning now to Figures 26 to 30, another modality of a trigger 348 is shown. As best seen in Figures 26 and 27, actuator 348 again includes a socket 350 formed by two locking tabs 352 which have interior projections 353 and outer shoulders 354, and which divide socket 350 into a distal portion 353 and a proximal portion 350p . Unlike the previous modes of the actuator, in this mode the distal portion defines a meshed shelf that has a Z shape. Generally, a central plate 356 replaces the central spine 56, 156 of the previous modalities and plate 356 extends in a plane that it is parallel to the plane of the longitudinal housing 342 (Figure 29). The plane of the central plate 356 is still perpendicular to a plane of the proximal half of the driver 348 (i.e., which includes socket 350 and tabs 352). A first set of teeth 358a protrudes laterally away from the central plate 356 in a first direction, while a second set of teeth 358b protrudes laterally away from the central plate 356 in a second direction. The first and second sets of teeth 358a, 358b extend from opposite ends of the central plate 356, and the first and second directions are generally opposite from each other. The tooth sets 358a, 358b are each securely held to the central plate 356 by two outer frames 360 extending around the periphery of teeth 358a, 358b. [0035] [00035] Accordingly and as best seen in Figure 28, medical device 340 includes the first and second clamping jaws 344, 346 each having a proximal end 366 and gear teeth 368 which has been curved to project orthogonally distant from a main body of the jaw 344. Accordingly, the first set of teeth 358a receives gear 368 from the second jaw 346, while the second set of teeth 358b receives gear 368 from the first jaw 344. Notably, having the proximal ends 366 of the jaws 344, 346 if curved laterally / orthogonally as shown allows a single pin 380 to be passed through gears 368 and thus shared by both claws 344, 346. Even further and as shown in Figure 29, housing 342 can thus include only a single guide surface 382 formed by a single slot and each side of the housing 342 to receive the ends of the single pin 380. It can be seen that the first and second claws 344, 346 thus share a single guide surface 382 (a claw guide surface) and guide slit, thus ensuring their coordinated operation and smooth opening and closing. [0036] [00036] As shown in Figure 29, a slot 357 is formed in the central plate 356 and is aligned with the pin 380 and the claw guide surface 382 to receive the pin 380 as the driver 348 moves forward in relation to to jaws 344, 346. As discussed above and shown in Figure 30, when pin 380 (shared by proximal ends 366 and gears 368 of jaws 344, 346) reaches the distal end of the single jaw guide surface 382, driver 348 will continue moving distally to cause the gears 368 to rotate through the shelf / teeth 358a, 358b of the driver 348, thereby inducing the rotation of the jaws 344, 346. [0037] [00037] Turning to Figures 31 to 33, another embodiment of the medical system 420 and medical device 440 are represented. In this embodiment, the medical system 420 again includes a drive wire 422 that has a distal head 432 that is formed by curving the distal end of the drive wire 422 in the shape shown. The medical system 420 further includes a catheter fixator 430 which is generally a tubular member that is connected to the distal end of catheter 24 and is used to slide the connection block 426 slidably. The catheter fixator 430 includes a pair of openings 434 to provide access to control wire 422 and connection block 426, whereby a tool can be used to hold connection block 426 in an extended or retracted position, as further described in copending North American Order No. 61 / 391,878 filed simultaneously to the present, and North American Order No. 61 / 391,875 filed simultaneously to the present, whose disclosures are incorporated into the present as a reference in its entirety. [0038] [00038] The medical device 440 includes a housing 442 which is detachably connected to catheter 24 and to catheter fixator 430 thereof via connection block 426. Housing 442 slidably receives the pair of claws 444 which are connected to the drive wire 422 by means of the driver 448. As with the previous modalities, the driver 448 includes a socket 450 defined by locking tabs 452 that releasably engage the distal head 432 of the drive wire 422. The distal portion of the Actuator 448 includes a plurality of teeth 458 that define a gear or shelf that serves to drive the rotation of the claws 444 as described above. The distal end 466 of the driver 448 includes a pocket defined by flanges that are used to securely engage the slope strip 490. The housing 442 additionally defines a pair of surfaces or guide slots 482 that guide the longitudinal and rotational movement of the claws 444 . [0039] [00039] In this embodiment, the claws 444 and the housing 442 are structured so that, in the fully retracted position (shown), the claws 44 protrude (at least partially) out of distally from the end of the housing 442. As best seen in Figure 32, as the distal head 432 is pushed through the locking tabs 452, they are plastically deformed outwardly to engage the shoulders 446 in the housing and the claws 444 are retracted completely. In this way, the length of the housing 442 can be shortened, as well as the guide slots 482 in it to guide the claws 444. It can also be seen in Figure 32 that the distal ends of the claws 444 include serrations 445 or other structures that can assist in the gripping of fabric. [0040] [00040] It can also be noted that, in this modality, as in all previous modalities, the drive wire 422 has the capacity to transmit force and rotational torque (for example, from the proximal operating end of the 20/420 system ) through the distal head 432 and the driver 448 for the claws 444. As such, the medical device 440 can be rotated by rotating the drive wire 422, that is, the claws 444, the claw pin (for example, 80), housing 442 and actuator 448 all rotate as a unit with respect to catheter 24. As long as housing 442 can still be connected non-rotatively to connection block 426 (for example, depending on the friction between the the connection block 426 can still rotate inside the catheter fixator 430 (or the catheter, for example 24) when the catheter fixator 430 is not used. Accordingly, the orientation of the claws 444 can be rotated by rotating the proximal end of the drive wire 422 to orient the claws with respect to the fabric or material that is fixed or secured. It was observed that the formation of the drive wire 422 out of a solid nitinol wire provided good torque transmission for rotation of the medical device 440. [0041] [00041] It has also been observed that having the claws 444 that project at least partially out of the housing 442 in the completely retracted position of them allows the orientation of the claws 444 to be viewed so that it is easier to rotate the claws 444 before opening and closing them around the fabric. In addition, the additional fabric can be encapsulated in the jaws 444 before the fabric adjoins a distal end of the housing 442. The distance at which the jaws 444 protrude from the housing 442 can vary depending on a particular application, i.e. , sized to match the thickness of the fabric or the type of procedure that is formed to ensure good spacing between the distal ends of the claws 444 and the distal end of the housing 442. [0042] [00042] The foregoing description of various embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be complete or to limit the invention to the precise revealed modalities. Several modifications or variations are possible in light of the above teachings. The modalities discussed were chosen and described to provide the best illustration of the principles of the invention and the practical application of them, thereby enabling an individual of ordinary skill in the art to use the invention in various modalities and with various modifications as appropriate to the private use contemplated. All such modifications and variations are within the scope of the invention as determined by the appended claims when interpreted in accordance with the extent to which they are attributed in a reasonable, legal and equitable manner.
权利要求:
Claims (10) [0001] Medical device (340) for engaging a tissue (T), the medical device (340) comprising: a housing (342) defining an internal passage and a longitudinal axis extending between proximal and distal ends of the housing (342), the housing (342) defining a claw guide surface (382) along the internal passage, the claw guide surface (382) having a distal end; a first claw (344) having a proximal end (366) slidably and pivotally connected to the housing (342), the first claw (344) is received slidably within the inner passage for longitudinal movement along the guide surface claw (382) between an extended position and a retracted position; a second claw (346) having a proximal end (366) slidably and pivotally connected to the housing (342), wherein the second claw (346) is slidably received within the inner passage for longitudinal movement along the surface grapple guide (382) between an extended position and a retracted position; a claw pin (380) extending through the proximal end (366) of the first claw, the claw pin (380) engages the claw guide surface (382) of the housing (342); and a driver (348) engaged with the proximal end of the first jaw, in which the longitudinal movement of the driver (348) moves the first jaw (344) longitudinally along the guide surface of the jaw (382) between its retracted and extended positions, the movement longitudinally of the actuator (348) rotates the first jaw (344) in relation to the housing (342) when the first jaw (344) is in its extended position; characterized by the fact that the claw pin (380) further extends through the proximal end (366) of the second claw (346); and the driver (348) is additionally engaged with the proximal end (366) of the second claw (346); wherein the longitudinal movement of the driver (348) moves the second claw (346) longitudinally along the claw guide surface (382) between its retracted and extended position, the longitudinal movement of the driver (348) by rotating the second claw (346) ) in relation to the housing (342) when the second claw (346) is in its extended position. [0002] Medical device (340) according to claim 1, characterized in that the claw pin (380) engages the distal end of the claw guide surface (382) when the first and second claws (344, 346) are in their extended positions. [0003] Medical device (340) according to claim 1, characterized in that the proximal ends (366) of the first and second jaws (344, 346) include gears having teeth (368), and in which the driver ( 348) includes corresponding teeth (358a, 358b) that intertwine with the teeth (368) of the claws (344, 346). [0004] Medical device (340) according to claim 3, characterized in that the proximal ends (366) of the first and second jaws (344, 346) are formed as pinions, and in which the driver (348) is formed as a shelf, in which the longitudinal movement of the actuator (348) and the shelf rotates the pinions and the first and second claws (344, 346) in their extended positions. [0005] Medical device (340) according to claim 4, characterized in that the actuator (348) includes a central plate (356) that has first and second ends, and in which a first set of teeth (358a) extends laterally from the first end of the central plate (356) and a second set of teeth (358b) which extends laterally from the second end of the central plate (356), the first and second sets of teeth (358a, 358b) extend in laterally opposite directions. [0006] Medical device (340) according to claim 5, characterized in that the first and second sets of teeth (358a, 358b) each include a frame (360) extending around the teeth (358a , 358b). [0007] Medical device (340) according to claim 5, characterized by the fact that the central plate (356) extends in a plane parallel to the longitudinal axis. [0008] Medical device (340) according to claim 5, characterized in that the central plate (356) includes a slot (357) that extends through a distal end of the plate (356), the slot (357) ) is sized and positioned to receive the claw pin (380). [0009] Medical device (340) according to claim 5, characterized by the fact that a cross section of the central plate (356) and the sets of teeth (358a, 358b), in a plane perpendicular to the longitudinal axis, form a shape of Z. [0010] Medical device (340) according to any one of the preceding claims, characterized in that the claw pin (380) is provided as a single claw pin.
类似技术:
公开号 | 公开日 | 专利标题 BR112013008763B1|2021-02-17|medical device for engaging a tissue BR112014001291B1|2021-04-27|MEDICAL DEVICE FOR FABRIC HITCH WITH DETACHABLE ROTATING CLAWS BR112013008751B1|2021-04-27|MEDICAL SYSTEM FOR HITTING TISSUE BR112013015246B1|2020-11-24|medical device for engaging tissue BR112012018338B1|2021-03-02|medical devices with rotatable and detachable claws AU2011316684B2|2014-10-30|Medical devices with detachable pivotable jaws US10010336B2|2018-07-03|Medical devices with detachable pivotable jaws EP3305222B1|2020-06-03|Medical devices with detachable pivotable jaws DK2627268T3|2017-07-10|MEDICAL DEVICES WITH REMOVABLE TIRED CLIP TRAYS
同族专利:
公开号 | 公开日 CN105769275A|2016-07-20| WO2012051200A2|2012-04-19| US10792046B2|2020-10-06| US10548612B2|2020-02-04| JP6166738B2|2017-07-19| PL2627268T3|2017-10-31| JP2017131695A|2017-08-03| EP3205287B1|2018-11-21| CN105769275B|2018-07-06| US20160220253A1|2016-08-04| US9339270B2|2016-05-17| EP2627268B1|2017-04-12| AU2011316696B2|2015-07-02| CN103260531A|2013-08-21| CN108742757A|2018-11-06| JP5681292B2|2015-03-04| JP2017131696A|2017-08-03| EP3378414A1|2018-09-26| AU2011316696A1|2013-05-02| SI2627268T1|2017-10-30| US20160220260A1|2016-08-04| EP3378414B1|2019-11-20| US20120089158A1|2012-04-12| US20200138444A1|2020-05-07| JP6294531B2|2018-03-14| CN108742757B|2021-08-27| EP2627268B8|2017-07-26| JP6383453B2|2018-08-29| EP3205287A3|2017-10-18| WO2012051200A3|2012-11-01| BR112013008763A2|2016-06-28| EP2627268A2|2013-08-21| JP2015119976A|2015-07-02| CN103260531B|2016-04-27| EP3205287A2|2017-08-16| JP2013544128A|2013-12-12|
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firing| KR20210005926A|2018-05-01|2021-01-15|보스톤 싸이엔티픽 싸이메드 인코포레이티드|Tissue retraction device and delivery system| CN109044490B|2018-09-05|2020-08-04|郑州大学第一附属医院|Foreign body forceps for digestive system department| US11259807B2|2019-02-19|2022-03-01|Cilag Gmbh International|Staple cartridges with cam surfaces configured to engage primary and secondary portions of a lockout of a surgical stapling device| CN111700660B|2020-05-22|2021-06-15|中国人民解放军陆军军医大学第一附属医院|Compression hemostasis device|
法律状态:
2018-12-26| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]| 2020-07-21| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]| 2020-12-01| B09A| Decision: intention to grant [chapter 9.1 patent gazette]| 2021-02-17| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 11/10/2011, OBSERVADAS AS CONDICOES LEGAIS. |
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申请号 | 申请日 | 专利标题 US39188110P| true| 2010-10-11|2010-10-11| US61/391,881|2010-10-11| US12/971,873|2010-12-17| US12/971,873|US8771293B2|2009-12-22|2010-12-17|Medical devices with detachable pivotable jaws| PCT/US2011/055800|WO2012051200A2|2010-10-11|2011-10-11|Medical devices with detachable pivotable jaws| 相关专利
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