DEVICE TO DISPENSING SURGICAL FASTENERS INSIDE A PATIENT'S BODY

专利摘要:
devices for dispensing surgical fasteners into tissue while simultaneously generating external marks that mirror the number and location of the dispensed surgical fasteners. The present invention relates to a device (20) that dispenses surgical fasteners inside a body and generates marks outside the body indicating where the surgical fasteners were dispensed inside the body. the device includes a first element (22) having a surgical clamp dispenser opening (84) and a second element (36) coupled with the first element, the second element having a distal end that opposes the clamp dispenser opening. surgical. the device includes a marking assembly (142) secured to the distal end of the second member. the marking assembly is movable in the opposite direction from and towards the surgical clamp dispenser opening. the marking assembly is adapted to generate marks on an outer surface that mirror the location of each surgical fastener dispensed from the surgical fastener dispenser opening. the device may include a claw for compressing tissue between the marking assembly and the surgical fastener dispenser.
公开号:BR112014022936B1
申请号:R112014022936-8
申请日:2013-03-13
公开日:2021-08-24
发明作者:Brian Auer；Michael Cardinale；Simon Cohn；Jens-Peter Straehnz；Doug Souls
申请人:Ethicon, Inc；
IPC主号:

专利说明:

REFERENCE TO RELATED DEPOSIT REQUESTS
[001] The present application refers to the patent application assigned to the same applicant US Serial No. 13/421,975, filed on the same date as the present, entitled "CLAMPING DEVICES FOR DISPENSING SURGICAL FASTENERS INTO SOFT MEDIA," (No. attorney document: ETH5616USNP) the description of which is incorporated herein by reference. BACKGROUND OF THE INVENTION Field of the invention
[002] The present invention relates to the dispensing of surgical fasteners and more specifically is related to dispensing devices for surgical fasteners. Description of the related technique
[003] Hernia is a condition in which a small loop of the intestine protrudes through a weak spot or defect in a patient's abdominal muscle wall or groin. Hernias can result from a birth defect, or they can be caused by straining or lifting heavy objects. A hernia can leave the patient with an unpleasant-looking volume of intestinal tissue that protrudes through the defect and can cause pain, reduced lifting capacities, bowel impaction, or possibly other complications if blood flow is interrupted to the protruding tissue.
[004] Surgery may be necessary to repair a hernia. During hernia repair procedure, the defect is accessed and carefully examined through an open incision or endoscopically through a trocar. In any case, careful examination is necessary due to the delicate network of vessels and nerves that surround the defect area. As such, surgeons must perform hernia repair procedures with great skill and care.
[005] Repairing a hernia may involve closing the defect with sutures or fasteners. The hernia repair procedure may also involve placing a surgical prosthetic device such as a mesh patch over the open defect and securing the mesh patch to the abdominal wall or inguinal floor with conventional sutures or surgical fasteners. The mesh patch acts as a barrier and prevents bowel expulsion through the defect.
[006] A common type of hernia is a ventral hernia. This type of hernia typically occurs in the abdominal wall and can be caused by an anterior incision or puncture, or by an area of tissue weakness that is tight. There are several repair procedures that can be employed by the surgeon, depending on the individual characteristics of the patient and the nature of the hernia. In an Intra-peritoneal Onlay Mesh Repair (IPOM) technique, a specific mesh is used with a flat repair layer fused with an anchoring layer around the perimeter. The securing layer has an opening to facilitate insertion of an anchoring device between the layers. During an IPOM repair, an incision is made directly over the ventral hernia site. The mesh is rolled up and inserted through the incision and hernia into the preperitoneal space. The net is then positioned centrally under the hernia with the repair layer down, facing the viscera. Support sutures can be placed to position the net. Next, a fixation device is used to secure the fixation layer to the abdominal wall. Attaching the upper repair layer will also attach the lower repair layer. After the net is fixed and is flat against the abdominal wall, the hernia defect and skin incision can be closed using sutures.
[007] Currently, there are a variety of surgical instruments and fasteners used to fix plasters to tissue. One of the earlier types of surgical instruments used is a surgical stapler, whereby a stack of staples is contained in a staple cartridge, and is sequentially advanced with the instrument by a spring mechanism. A secondary mechanism is employed to separate the most distal staple from the stack, retain the remainder of the staples in the stack, and feed the most distal staple into the staple-forming mechanism. Feed mechanisms of this type are found in U.S. Patent Nos. 5,470,010 and 5,582,616 of Rothfuss et al.
[008] Another hernia mesh fixation instrument uses a helical wire fastener that resembles a small section of a spring. Multiple helical wire fasteners are stored in series on a 5mm shank and are spiraled into the fabric. A loading spring is used to feed the plurality of helical fasteners distally into the stem. A protrusion extends into the stem to prevent the stack of fasteners from being ejected by the loading spring to allow passage of a swivel fastener. Instruments and fasteners of these types are found in U.S. Patent Nos. 5,582,616 and 5,810,882 to Bolduc et al. and US Patent No. 5,830,221 to Stein et al.
[009] Other surgical fasteners used for hernia net fixation utilize a refillable single-shot instrument or a rotating cartridge that contains a small number of fasteners. These types of surgical fixation instruments are disclosed in U.S. Patent Nos. 5,203,864 and 5,290,297 to Edward Phillips. These instruments have not been well accepted by the surgeon community, possibly due to their single-shot capabilities and the large size of the rotating cartridge, which can restrict use of such an instrument to an open procedure.
[0010] U.S. Patent Nos. 5,601,573; 5,833,700; and 5,921,997 to Fogelberg et al disclose a cleat applicator with a feed mechanism that uses a reciprocating feed bar to feed a stack of cleats. A feeder shoe operatively engages with and moves with the distally moving feed bar and slidingly engages with the proximally moving feed bar. The feeder shoe pushes the clip stack distally with the distally moving feed bar and remains stationary relative to the proximally moving feed bar. A valve mechanism separates the most distal clip from the stack, keeps the stack stationary when the most distal clip can be dispensed over a vessel.
[0011] U.S. Patent No. 4,325,376 to Klieman et al teaches a clip applier that stores a stack of clips in a serial mode in a clip cartridge. The most proximal clip is pushed distally by a tab which is leveraged distally by a reciprocating element with each actuation of the instrument. As the pawl extends distally, it pushes the clip stack distally.
The patent application publication assigned thereto U.S. 2002/0068947, the disclosure of which is incorporated herein by reference, teaches a device for releasing a plurality of individual surgical fasteners. In one embodiment, the delivery device includes a drive mechanism that has both distal and proximal ends. The drive mechanism has a moving element and a fixed opposite element, so that the moving element can be moved proximally and distally with respect to the delivery device. The moving element has a sharpened distal end for piercing tissue. The device includes at least one surgical fastener located between the first and second elements. Each of the surgical fasteners has a proximal end and a distal end. The device also has an actuator that has at least two sequential positions. A first position for advancing the moving element distally and piercing tissue and a second position for moving the moving element proximally, thereby implanting the distal end of the fastener.
[0013] The instruments described above dispense surgical fasteners along an axis that is parallel to the longitudinal axis of the instrument. In some cases, this dispensing angle makes it difficult for medical personnel to insert surgical fasteners along axes that are perpendicular to the tissue surface receiving the fasteners. In addition, conventional instruments require the operator to use their hand as a support to provide an opposing force on the fabric receiving the fasteners. This often results in medical personnel being bitten by the sharp edges of surgical fasteners.
[0014] In view of the above deficiencies, there is a need for improved systems, devices and methods to cost-effectively and effectively secure prosthetic devices using surgical fasteners. In particular, there is a need for instruments that easily dispense surgical fasteners at angles that are perpendicular to the surface of the tissue receiving the fasteners. There is also a need for instruments that do not require medical personnel to use a second hand as an anvil for tissue receiving the surgical fastener. There is also a need for an instrument that does not require a surgical fastener when sufficient compression has been applied and that provides an indication that a predetermined level of compression has been achieved. There is also a need for a device that provides a clear map of the patient's outer skin surface that indicates where the surgical fasteners have been inserted, as well as the total number of surgical fasteners that have been dispensed into the tissue. SUMMARY OF THE INVENTION
[0015] During hernia repair procedures, surgical fasteners are used to secure implants, such as mesh implants, into tissue. Medical devices, such as applicator guns, are typically used to dispense surgical fasteners through the implant and into tissue to secure the implant over the hernia defect. When placing surgical fasteners in the surgical site, it is critical that there is adequate spacing between adjacent surgical fasteners. If the gap between adjacent fasteners exceeds 2 cm, the risk of entrapment between the abdominal wall and the implant increases dramatically. This can adversely impact tissue ingrowth or cause serious complications.
[0016] During laparoscopic procedures, surgical personnel can clearly see the place of placement for surgical fasteners. As a result, it is easy for surgical personnel to properly position and space surgical fasteners in the surgical site. This is not the case for open IPOM procedures. Typically, in open IPOM procedures, the positioning and placement of surgical fasteners is done blindly using tactile feedback. Tactile feedback is needed to verify that enough surgical fasteners have been placed for adequate fixation with no gaps between adjacent surgical fasteners. Verifying where surgical fasteners have already been placed is nearly impossible. As a result, precise control and placement of surgical fasteners at the surgical site is more difficult to achieve. Despite the difficulties described above, with open IPOM procedures, the precise placement of surgical fasteners remains absolutely critical.
[0017] In response to the above-described problems, the present invention provides a marking assembly for surgical fastener fixtures, such as a claw-like fixture or an applicator gun. For claw-like fixtures, the marking assembly can be easily affixed to a modified claw replica. In gun applicator devices, the marking assembly may be coupled with an elongated dispensing tube or a cable portion of the device.
[0018] With a marking assembly directly attached to the surgical fastener fixation device, surgical personnel are able to see over the skin where the surgical fastener has been placed "internally". On the outer surface of the skin, the marking assembly will generate a copy or image of where the surgical fasteners were attached to the abdominal wall. In addition, medical personnel can check how many surgical fasteners have already been placed on the tissue.
[0019] In one embodiment, the marking assembly can be directly connected to a grip device. In one embodiment, the marking assembly can be connected to a cannula-like device using an elongated element or arm. In one embodiment, the elongated element or arm may be solid, but it may also have sufficient flexibility to allow external marking on the skin. In one embodiment, the arm is connected to the cable of the cannula-like device through a claw. The marking assembly preferably includes a frame to be held by the fingers or hands of surgical personnel. In one embodiment, the marking assembly is not connected to the grip device or grip-like device. In this embodiment, the marking assembly is a separate element that can be used externally to mark the outer surface of the skin to indicate the number of surgical fasteners inserted into tissue and the spacing between adjacent surgical fasteners.
[0020] In one embodiment, the marking assembly includes a pen, ink marker, pencil or craion. In one embodiment, the marking assembly utilizes a thorn or needle that pierces the outer surface of the skin. In this embodiment, the marking assembly includes a round cylindrical element having multiple parts. A first part is moved against a second part after applying pressure to the outer surface of the skin. As the first and second parts move towards each other under pressure, a thorn or needle in the second part is pushed through a central opening in the first part to pierce the skin to leave a mark. The marking assembly including a spine or needle can be connected directly to a claw fixation device, or used with a cannula-like fixation device.
[0021] In one embodiment, a device is adapted to dispense surgical fasteners within a body while generating off-body marks that indicate how many and where surgical fasteners have been dispensed within the body. Markings generated on an outer surface of the body (eg, outer surface of the skin) allow medical personnel to continuously monitor how many surgical fasteners have been dispensed into the body and the exact placement and spacing between the surgical fasteners. The device preferably includes a first element having a surgical fastener dispenser opening at a distal end thereof adapted to dispense surgical fasteners into tissue and a second element coupled with the first element, the second element having an opposing distal end. to opening of surgical clamp dispenser. The device desirably has a marking assembly attached to the distal end of the second member. In one embodiment, the marking assembly is hingedly attached to the distal end of the upper arm. In one embodiment, the marking assembly is movable in the opposite direction from and toward the surgical fastener dispenser opening. The marking assembly is adapted to generate marks on an outer surface that mirrors the location of each surgical fastener dispensed from the surgical fastener opening at the distal end of the first element.
[0022] In one embodiment, the surgical fastener dispenser opening is adapted for insertion into a surgical opening formed in the body to dispense the surgical fasteners into tissue within the surgical opening with the marking assembly positioned outside the surgical opening and on an external surface of the body.
[0023] In one embodiment, the first element includes a lower arm that has a distal end with the surgical clamp dispenser opening and the second element includes an upper arm that has a proximate end that is coupled with the lower arm through a connection pivoting. In one embodiment, a surgical clamp dispenser is attached to the distal end of the lower arm. The surgical clamp dispenser desirably includes the surgical clamp dispenser opening.
[0024] In one embodiment, the device has an actuator coupled with the upper and lower arms to selectively move the arms between an open position in which the marking assembly is spaced from the surgical fastener dispenser and a closed position in which the assembly The marker assembly is closest to the surgical clamp dispenser for clamping tissue between the marking assembly and the surgical clamp dispenser.
[0025] In one embodiment, the marking assembly includes a marker adapted to contact the outer surface outside the surgical opening to generate the marks on the outer surface. The outer markings mirror the location of the surgical fasteners dispensed into the tissue within the surgical opening.
[0026] The marker is preferably adapted to generate a visible pattern of markings on the outer surface indicating the number and location of surgical fasteners applied to tissue within the surgical opening. The marker can be any item used to mark a surface such as a pen, felt-tip marker, pencil, craion, needle and/or thorn.
[0027] In one embodiment, the marking assembly includes a block connected to the distal end of the upper arm. The block preferably has a lower surface adapted to apply a clamping force and an opening is formed in the lower surface of the block. In one embodiment, the marker is coupled to the block and has a marking surface accessible through the opening formed in the lower surface of the block to mark the outer surface.
[0028] In one embodiment, when the device is closed, the lower surface of the block desirably applies clamping force onto the outer surface which, in turn, applies a compressive force through the tissue and onto the fastener dispenser surgical fastener to apply one of the surgical fasteners from the surgical fastener dispenser opening and to tissue within the surgical opening.
[0029] In one embodiment, the device may be a cannula-like device (eg, as an applicator gun), whereby the first element is an elongated tube that has the surgical clamp dispenser opening at the distal end thereof. The second element may have a proximal end coupled with the first element and a distal end that opposes the surgical clamp dispenser opening.
[0030] In one embodiment, the device may include a cable connected to a proximal end of the elongated tube, so that the second element is secured to the cable. In one embodiment, the second element is preferably flexible to move the distal end of the second element to and away from the surgical fastener dispenser opening at the distal end of the elongated tube.
[0031] In one embodiment, a device is adapted to apply surgical fasteners to tissue within a surgical opening while simultaneously generating marks on an external surface outside the surgical opening. The device desirably includes a lower arm having a proximal end and a distal end including a surgical fastener dispenser opening adapted to apply surgical fasteners and an upper arm coupled with the lower arm and having a distal end that opposes the opening. of surgical clamp dispenser at the distal end of the lower arm. A marking assembly is desirably affixed to the distal end of the upper arm and opposes the surgical fastener dispenser opening at the distal end of the lower arm. In one embodiment, the distal ends of the upper and lower arms are movable between an open position and a closed position. In one embodiment, when the upper and lower arms are in the closed position the marking device is adapted to generate a mark on the external surface outside the surgical opening each time a surgical fastener is applied to tissue in the surgical opening. Each of the marks desirably mirrors the location of one of the surgical fasteners applied within the surgical opening.
[0032] In one embodiment, the marker is adapted to make contact with the outer surface each time one of the surgical fasteners is applied to tissue within the surgical opening to provide a visible pattern of markings on the outer surface indicating the number and location of each surgical fastener applied to tissue within the surgical opening.
[0033] In one embodiment, the device may include an actuator coupled with the upper and lower arms to selectively move the upper and lower arms between an open position in which the marking assembly is spaced from the surgical fastener dispenser and a closed position in which tissue is clamped between the marking assembly and the surgical fastener dispenser. In one embodiment, the actuator desirably has a hand grip attached to the lower arm, and an actuator mounted on the lower arm and connected with the upper arm, so that the actuator is adapted to be pulled towards the hand grip for move the arms to the closed position and the actuator is adapted to move in the opposite direction from the hand grip to move the arms to the open position. The device desirably has an actuator return spring coupled with the actuator to normally induce the actuator to move in the opposite direction from the hand grip.
[0034] In one embodiment, a device attaches surgical fasteners to the inner tissue within a surgical opening while simultaneously generating external marks on an outer surface outside the surgical opening. The markings on the outer surface desirably mirror the location of each surgical fastener applied. In one embodiment, the fixation device desirably includes a first arm including a first arm including a surgical fastener dispenser, a second arm opposite the first arm, and a marking assembly attached to the second arm to generate external markings on the external surface. . In one embodiment, the surgical clamp dispenser is attached to a distal end of the first arm and the marking assembly is attached to a distal end of the second arm. The surgical fastener dispenser preferably has a surgical fastener dispenser opening through which the surgical fasteners are applied to the inner tissue within the surgical opening.
[0035] In one embodiment, the device preferably includes an actuator coupled with the first and second arms to selectively move the first and second arms between an open position in which the marking assembly is spaced from the surgical fastener dispenser and a closed position in which tissue is compressed between the marking assembly and the surgical fastener dispenser. In one embodiment, as tissue is compressed between the distal ends of the arms at the working end of the device, a surgical fastener is applied to tissue within the surgical opening and the marking assembly makes an external mark on an outer surface of the skin. which indicates the exact location of the surgical clamp applied. The fixture is designed to make an external mark each time one of the surgical fasteners is applied so that medical personnel can track the total number of surgical fasteners that have been applied and the exact location of each surgical fastener applied.
[0036] In one embodiment, a fixation device is adapted to apply surgical fasteners to tissue within a surgical opening while simultaneously generating external marks on an outer surface outside the surgical opening that mirror the location of each applied surgical fastener. The fixation device desirably includes a lower arm having a proximal end, a distal end and a longitudinal axis extending between the proximal and distal ends and a surgical clamp dispenser attached to the distal end of the lower arm, the surgical clamp dispenser including a surgical fastener dispenser opening. In one embodiment, the fixation device desirably includes an upper arm coupled with the lower arm and having a distal end that opposes the distal end of the lower arm and a marking assembly connected to the distal end of the upper arm and opposes to the surgical clamp dispenser.
[0037] In one embodiment of the present invention, a fixation device includes a surgical fastener dispenser adapted to apply surgical fasteners in a soft medium to secure prosthetic devices, such as surgical mesh implants, to the soft medium. Specifically, the modality can be used for securing layered mesh implants during an IPOM repair. The securing device preferably includes a pair of opposing arms that are adapted to be positioned on opposite sides of the target soft medium. A first of the arms can be positioned within a surgical opening to oppose an inner surface of the soft middle (eg, the peritoneum of the inner abdominal wall) and the second of the arms can be positioned outside the surgical cavity to oppose an outer surface of the middle. soft (eg, the outer surface of a patient's skin).
[0038] In one embodiment, the securing device preferably includes a fixed lower arm having a pistol grip handle and a slide trigger coupled with a trigger assembly used to close the distal ends of the upper and lower arms and to generate a clamping force on opposing surfaces of the target medium. During a fixation operation, the fixation device desirably performs three functions, viz., fixation of the soft medium, applying surgical fasteners one at a time to the soft medium at an angle that is perpendicular to the surface of the soft medium to secure a device. prosthesis to the soft medium, and prepare the fixture to apply another surgical fastener during the next discharge cycle. In one embodiment, the fixation device can deliver surgical fasteners into the soft medium at an angle that is not normal or perpendicular to the surface of the soft medium.
[0039] In one embodiment, the surgical fastener dispenser preferably includes a sterile cartridge body that contains a predetermined number of surgical fasteners (e.g., 20) preloaded into the cartridge body to provide the fixture with multiple download capabilities. In one embodiment, the cartridge body can be sterilized as a separate component before being loaded onto the lower arm, such as the distal end of the lower arm.
[0040] The fixation device disclosed in the present invention desirably applies surgical fasteners in a consistent, controlled and repeatable manner from the distal end of the fixation device. It is preferred that all surgical fasteners are inserted into the soft medium with the same force and at the same angle. In one embodiment, the distal end of the surgical fastener dispenser preferably has a spacer or alignment element that is first positioned against the seam or edge of a mesh patch (e.g., the seam of a layered mesh pocket ) to ensure that the surgical clamp applied from the surgical clamp dispenser is provided at a location that is a fixed distance away from the splice. The spacer allows surgical personnel to safely and repeatedly supply surgical fasteners at a fixed distance in the opposite direction of the splice.
[0041] In one embodiment, during initial insertion and positioning of the surgical clamp dispenser in a surgical opening, the spacer at the distal end of the cartridge body preferably conceals the surgical clamps and an insertion fork used to insert the surgical clamps. Surgical clamps and insertion fork are preferably exposed only after the lower arm and surgical clamp dispenser have been properly inserted and positioned. In one embodiment, the cartridge body is pivotally connected with a surgical clamp dispenser support tray and the distal end of the cartridge body deflects or pivots downward during compression of the fixture to expose a surgical clamp loaded over the insertion fork.
[0042] In one embodiment, a force limiting system prevents a user from exerting excessive compressive forces and undue stress on surrounding tissue. In one embodiment, the clamping device preferably includes a preloaded extension spring connecting two ends of one of the clamping arms. In one embodiment, the extension spring is desirably fixed at an angle, thus creating torque between the two components. The spring allows the clamping device to close until the torque value is reached. At that point, the compressive force exceeds the preload level on the extension spring and the spring begins to absorb any remaining compressive forces, thereby preventing further displacement of the distal end of the arm while allowing the proximal end of the arm to continue. the displacement.
[0043] In one embodiment, the fixture jaws provide a sizable opening and can include adjustable features that compensate for a range of patient tissue and mesh thicknesses that have different sizes, shapes, and dimensions. In addition, the fastening device disclosed in the present invention can be used with flat rolled nets and layered nets with flaps.
[0044] In one embodiment, the fixture preferably includes a block attached to a distal end of one of the arms. The block self-adjusts to provide an opposing force to the surgical clamp dispenser. The auto-adjustment pad also facilitates one-handed use as there is no need to provide counter pressure with a user's second hand. In one embodiment, the block is a pivoting block attached to the distal end of one of the arms. In one embodiment, the block is attached to one of the arms using a linear mechanism.
[0045] In one embodiment, the clamping device has a sliding grip handle that preferably provides secure control and allows for one-handed use. The sliding grip cable also preferably allows the user's hand to be free of obstructions and provides an unobstructed line of sight for inserting the distal end of the device into a cavity. In one embodiment, the clamping device is preferably driven by transferring linear force onto the driver through a rack and pinion system to generate rotating torque.
[0046] In one embodiment, the fixture may include a pivot-style handle that is offset from the arms for ergonomic one-handed use. The arms pivot, preferably around a main pivot point, which results in torque being supplied to the clamping ends of the arms.
[0047] In one embodiment, the pivot block desirably includes a marker that allows a surgeon to determine and see on the skin where the surgical fasteners have been positioned internally. Because the marker lines up with the dispenser opening when a surgical clamp is applied, the marker produces an exact copy or image of the location of the surgical clamp that has been inserted into the abdominal wall. In addition, the marker system also preferably provides an indication of the total number of surgical fasteners that have been applied to the abdominal wall.
[0048] In one embodiment, a fixation device for applying surgical fasteners preferably includes a lower arm having a proximal end, a distal end and a longitudinal axis extending between the proximal and distal ends and an upper arm pivotally connected with the lower arm and having a distal end that opposes the distal end of the lower arm. The upper arm is preferably curved and has a concave surface that opposes the lower arm. The fixture desirably includes an actuator coupled with the upper and lower arms to move the distal ends of the upper and lower arms towards each other to close the fixture.
[0049] In one embodiment, a surgical fastener dispenser is preferably attached to the distal end of the lower arm to apply surgical fasteners. The surgical clamp dispenser desirably includes a cartridge body having an upper surface with a surgical clamp dispenser opening formed therein. A plurality of surgical fasteners are desirably preloaded into the cartridge body to be applied one at a time through the dispenser opening. The securing device preferably includes a block pivotally connected to the distal end of the upper arm, the block having a lower surface that opposes the dispenser opening. In one embodiment, when the fixture is closed, the block pivots to self-adjust so that the lower surface of the block applies a compressive force on the upper surface of the cartridge body to apply one of the surgical fasteners from the dispenser opening.
[0050] In one embodiment, the actuator preferably includes a hand grip attached to the lower arm and an actuator mounted on the lower arm and attached to the upper arm. The actuator is adapted to be pulled towards the hand grip to close the clamping device to generate clamping force and apply a surgical clamp. The actuator is adapted to move in the opposite direction from the hand grip to open the clamping device in order to release clamping force. In one embodiment, the actuator desirably includes an actuator return spring coupled with the trigger to normally induce the actuator to move in the opposite direction from the hand grip.
[0051] The actuator may also include a rack and pinion system connecting the actuator with the upper arm. In one embodiment, the rack and pinion system desirably includes a rack that has teeth. The rack slides along the longitudinal axis of the lower arm. The proximal end of the upper arm includes a pinion which has teeth that mesh with the teeth on the rack.
[0052] In one embodiment, the surgical clamp dispenser preferably includes a support tray that has a proximal end connected with the distal end of the lower arm and a distal end including an insertion fork that extends along an axis that is perpendicular to the longitudinal axis of the lower arm so that the cartridge body overlaps the support tray. In one embodiment, the cartridge body preferably has a proximal end pivotally connected with the proximal end of the support tray and a distal end movable freely relative to the distal end of the support tray, the upper surface of the cartridge body. extending between the proximal and distal ends of the cartridge body and the dispenser opening being in alignment with the insertion fork. The surgical clamp dispenser also preferably includes a cartridge body return spring in contact with the cartridge body and the support tray to normally bias the distal end of the cartridge body away from the support tray, so that the surgical fasteners are arrayed in a series to be applied one at a time from the dispenser opening, and so that each of the surgical fasteners has an insertion end oriented towards the upper surface of the cartridge body. . In one embodiment, the cartridge body return spring preferably engages the cartridge body and the support tray to normally bias the upper surface of the cartridge body into a plane that is parallel to the longitudinal axis of the lower arm. In one embodiment, the cartridge body is not hingedly counted to the support tray and the cartridge body is adapted to move up and down relative to the support tray.
[0053] In one embodiment, the surgical fastener dispenser may include a surgical fastener advance spring in communication with the surgical fasteners to bias the surgical fasteners toward the distal end of the cartridge body. The surgical fastener advance spring is preferably adapted to induce a front surgical fastener to move into engagement with the insertion fork at the distal end of the support tray to be applied through the dispenser opening of the cartridge body. The surgical fasteners preferably extend along planes that are parallel to each other and perpendicular to the longitudinal axis of the lower arm. In one embodiment, the insertion fork is desirably adapted to contain and apply the surgical fasteners along an axis that is perpendicular to the longitudinal axis of the lower arm.
[0054] In one embodiment, the cartridge body is pivotable, preferably between an extended position in which the upper surface of the cartridge body is parallel with the longitudinal axis of the lower arm and a depressed position in which the upper surface of the cartridge body is inclined in relation to the longitudinal axis of the lower arm. In one embodiment, the cartridge body is under compression by the block when in the depressed position. The cartridge body return spring is preferably compressed when the cartridge body is in the depressed position.
[0055] In one embodiment, the front surgical fastener in the surgical fastener series and the insertion fork are covered by the cartridge body when the cartridge body is in the extended position. When the cartridge body is in the depressed position, the front surgical fastener and insertion fork are at least partially exposed through the dispenser opening to insert the surgical fastener into the soft middle.
[0056] In one embodiment, the cartridge body preferably has a spacer that protrudes from a distal end thereof that extends beyond the distal end of the support tray to space the dispenser opening from a further end. distal part of the surgical clamp dispenser. The spacer facilitates alignment of the surgical fastener dispenser relative to an edge or splice of a surgical net to ensure that the surgical fasteners are inserted an appropriate distance away from the edge or splice.
[0057] In one embodiment, the block on the upper arm desirably includes a marker accessible on the lower surface that is aligned with the dispenser opening when the fixture is closed. The marker is desirably adapted to produce a visual indicator on the outer surface of a patient's skin which mirrors the location of one of the surgical fasteners inserted into the inner surface of the patient.
[0058] In one embodiment, the block desirably includes a bevel washer adapted to generate an audible clicking sound when the clamping force between the block and the cartridge body reaches a predetermined level. The clicking sound provides an indication that sufficient compressive force has been applied to the soft medium to apply one of the surgical fasteners to the soft medium.
[0059] In one embodiment, a fixation device for applying surgical fasteners preferably includes a lower arm having a proximal end, a distal end and a longitudinal axis extending between the proximal and distal ends and an upper arm pivotally connected with the lower arm and having a distal end that opposes the distal end of the lower arm. The clamping device desirably has an actuator coupled with the upper and lower arms to move the distal ends of the upper and lower arms towards each other to close the clamping device to generate a clamping force therebetween.
[0060] A surgical clamp dispenser can be attached to the distal end of the lower arm. The surgical fastener dispenser desirably has a plurality of surgical fasteners loaded onto it. The surgical fastener dispenser preferably includes a dispenser opening adapted to apply the surgical fasteners one at a time.
[0061] The fixture desirably includes a block pivotally connected to the distal end of the upper arm, the block having a lower surface that opposes the dispenser opening, so that when the fixture is closed, the surface The bottom of the block applies an opposing clamping force on the upper surface of the surgical clamp dispenser to apply one of the surgical clamps along an axis that is perpendicular to the longitudinal axis of the lower arm.
[0062] In one embodiment, the surgical clamp dispenser desirably includes a support tray that has a proximal end connected with the distal end of the lower arm and a distal end including an insertion fork that extends along an axis that is perpendicular to the longitudinal axis of the lower arm. The dispenser preferably includes a cartridge body overlying the support tray, the cartridge body having a proximal end pivotally connected with the proximal end of the support tray, a distal end movable freely with respect to the distal end of the tray. of support, an upper surface extending between the proximal and distal ends of the cartridge body and the surgical fastener dispenser opening formed in the upper surface and being in alignment with the insertion fork. The surgical clamp dispenser also desirably includes a cartridge body return spring in contact with the cartridge body and the support tray to normally bias the distal end of the cartridge body away from the support tray.
[0063] In one embodiment, a plurality of surgical fasteners may be disposed within the cartridge body, with the surgical fasteners arrayed in a series to be applied one at a time from the dispenser opening. Each of the surgical fasteners preferably has an insertion end oriented towards the upper surface of the cartridge body. In one embodiment, when the clamping device is closed, the lower surface of the block applies a clamping force to the upper surface of the cartridge body. The cartridge body is pivotable between an extended position in which the upper surface of the cartridge body is parallel with the longitudinal axis of the lower arm and a depressed position in which the upper surface of the cartridge body is inclined relative to the longitudinal axis of the arm. bottom.
[0064] These and other preferred embodiments of the present invention will be as described in detail below. BRIEF DESCRIPTION OF THE DRAWINGS
[0065] Figure 1 shows a right side view of a fixture for applying surgical fasteners including a lower arm, a surgical fastener dispenser attached to a distal end of the lower arm and an upper arm opposing the surgical fastener dispenser for producing a clamping force, in accordance with an embodiment of the present invention.
[0066] Figure 2 shows a cross-sectional view of a left side of the fixture shown in Figure 1.
[0067] Figure 3A shows a left side view of the surgical clamp dispenser shown in Figures 1 and 2.
[0068] Figure 3B shows a cross-sectional view of the surgical clamp dispenser shown in Figure 3A.
[0069] Figure 4A shows a perspective view of a surgical fastener loaded in the surgical fastener dispenser of Figures 3A and 3B, in accordance with an embodiment of the present invention.
[0070] Figure 4B shows a top plan view of the surgical fastener shown in Figure 4A.
[0071] Figure 4C shows a right side elevation view of the surgical fastener shown in Figure 4A.
[0072] Figure 4D shows a left side elevation view of the surgical clamp shown in Figure 4A.
[0073] Figure 5 shows an insertion fork of the surgical clamp dispenser of Figures 3A and 3B in line with the surgical clamp shown in Figures 4A-4C.
[0074] Figures 6A to 6C show a method of using the surgical fastener dispenser of Figures 3A and 3B to implant a surgical fastener in soft media.
[0075] Figure 7 shows a cross-sectional view of a block adapted to be pivotally connected to a distal end of the upper arm of the fixture shown in Figure 1.
[0076] Figure 8 shows the fixation device of Figure 1 in a fixation position to apply a surgical fastener to fix a surgical net to the soft medium, in accordance with an embodiment of the present invention.
[0077] Figure 9 shows the fastening device of Figure 1 in a fastening position for fastening a net with flap to the soft medium, according to an embodiment of the present invention.
[0078] Figure 10 shows the fixation device of Figure 1 in an open position, ready for firing during a surgical procedure to secure a flat surgical net to the soft medium, in accordance with an embodiment of the present invention.
[0079] Figures 11A to 11C show a block having a marker, the block being pivotally connectable with a distal end of the upper arm of the fixture shown in Figure 1, in accordance with an embodiment of the present invention.
[0080] Figures 12A to 12C show a block having a marker, the block being pivotally connectable with a distal end of the upper arm of the fixture shown in Figure 1, in accordance with another embodiment of the present invention.
[0081] Figure 13 shows a fixation device for applying surgical fasteners including a lower arm and an upper arm, according to another embodiment of the present invention.
[0082] Figure 14A shows the fixation device of Figure 13 with a surgical clamp dispenser attached to a distal end of the lower arm and a force-limiting mechanism installed on the lower handle that is engaged with the upper arm, according to a modality of the present invention.
[0083] Figure 14B shows the fixation device of Figure 14A in a closed position for applying a surgical fastener in a soft medium, according to an embodiment of the present invention.
[0084] Figure 15 shows a schematic view of a fastening device including a lower arm and an upper arm joined by a jack mechanism and having in-line cables, according to an embodiment of the present invention.
[0085] Figure 16 shows a schematic view of a fastening device including a lower arm and an upper arm joined by a jack mechanism and having offset cables, according to an embodiment of the present invention.
[0086] Figure 17 shows a schematic view of a fastening device including a lower arm and an upper arm joined by a parallel link mechanism, according to an embodiment of the present invention.
[0087] Figure 18 shows a schematic view of a clamping device including a lower arm and an upper arm joined by a rack and pinion gear mechanism, according to an embodiment of the present invention.
[0088] Figures 19A and 19C show a device for applying surgical fasteners that has a marking assembly coupled therewith, in accordance with an embodiment of the present invention.
[0089] Figures 20A and 20C show a device for applying surgical fasteners that have a marking assembly coupled therewith, according to another embodiment of the present invention.
[0090] Figures 21A and 21C show a demarcation assembly, according to an embodiment of the present invention. DETAILED DESCRIPTION
[0091] Referring to Figure 1, in one embodiment, a clamping device 20 for applying surgical fasteners in a soft medium preferably includes a lower arm 22 having a proximal end 24 and a distal end 26 and a surgical fastener dispenser 28 affixed to the distal end 26 of the lower arm 22. The surgical clamp dispenser has a distal end 30 which is adapted to apply a single surgical clamp during each discharge cycle, as will be described in detail in the present invention. Lower arm 22 desirably extends along a longitudinal axis A1-A1. The securing device 20 preferably includes a handle 32 provided at the proximal end 24 of the lower arm 22 and a driver 34 which is adapted to slide relative to the lower arm, preferably along the longitudinal axis A1-A1, to operate. the fixing device. The handle 32 preferably has a forwardly angled angle toward the distal end 26 of the lower arm 22, which ensures that the user's hand and wrist can be in a more favorable ergonomic position during operation of the fixture 20.
[0092] In one embodiment, the securing device 20 preferably includes an upper arm 36 having a proximal end 38 and a distal end 40. The proximal end 38 of the upper arm 36 is pivotally secured to the lower arm 22, preferably through a rack and pinion system. In one embodiment, the upper arm 36 defines an arc or curve. The fastening device 20 desirably includes a block 42 pivotally connected to the distal end 40 of the upper arm 36. The block 42 pivots, preferably so that the block can self-adjust to oppose the upper surface of the surgical clamp dispenser 28 when the distal end 40 of the upper arm 36 is pivoted toward the cartridge assembly 28 to be moved to a locked, locked position.
[0093] Referring to Figure 2, in one embodiment, the lower arm 22 preferably includes the cable 32 and a slideable actuator 34 coupled thereto. Slide actuator 34 desirably includes a lower end 50 that is secured to a rack 52 of a rack and pinion system through a fastener 54. Rack 52 preferably includes rack teeth 56 that engage pinion teeth 58 at a pinion 60, which is preferably secured to the proximal end 38 of the upper arm 36. The securing device 20 desirably includes an actuator return spring 62 extending between a proximal end of the rack 52 and an insertable spring tensioner 64 in an opening in a proximal end 24 of the lower arm 22.
[0094] In operation, as the actuator 34 is pulled towards the proximal end 24 of the lower arm 22, the actuator 34 and the rack 52 move along the axis A1-A1 towards the proximal end 24 of the lower arm 22 Rack 52 rotates pinion 60 in a counterclockwise direction, which swings the distal end 40 of the upper arm 36 and the block 42 toward the distal end 30 of the surgical clamp dispenser 28. As the distal end 40 of the Upper arm 36 moves toward cartridge assembly 28, block 42 preferably moves into opposite alignment with distal end 30 of surgical clamp dispenser 28. As driver 34 moves toward handle 32, the spring The actuator return spring 62 is preferably compressed between the rack 52 and the spring tensioner 64. When the actuator 34 is released, the energy stored in the actuator return spring 62 causes the actuator 34 to slide along axis A1. -A1 in towards the distal end 26 of the lower arm 22.
[0095] Referring to Figures 3A and 3B, in one embodiment, the surgical clamp dispenser 28 preferably includes a clamping arm 66 that is attachable to the distal end 26 of the lower arm 22 of the clamping device 20. (Figure 2 ). The surgical clamp dispenser 28 desirably has a support tray 68 projecting distally from the fixation arm 66. The support tray 68 preferably has a proximal end 70 adjacent to the fixation arm 66, a distal end. 72 spaced apart from the proximal end 70 and an insertion fork 74 projecting upward from the distal end 72 of the support tray 68. In one embodiment, the clamping arm 66 and the support tray 68 preferably extend along the longitudinal axis A1-A1 of the lower arm 22 (Figure 2), and the fork 74 preferably extends along a vertical axis Y1-Y1 that is perpendicular to the axis A1-A1. As will be described in more detail in the present invention, the insertion fork 74 is adapted to engage a surgical fastener to drive the surgical fastener into soft media such as tissue.
[0096] In one embodiment, the surgical fastener dispenser 28 desirably includes a cartridge body 76 having a plurality of surgical fasteners 78 loaded therein. Cartridge body 76 preferably has a proximal end 80 which is pivotally secured to the proximal end 70 of the support tray 68 via pivot pin 81 and a distal end 82 which is free to pivot towards and away from. from distal end 72 of support tray 68. Cartridge body 76 preferably has a dispenser opening 84 adjacent to distal end 82 thereof through which the fork 74 and surgical fasteners 78 can pass. In one embodiment, as distal end 82 of cartridge body 76 moves downwardly toward distal end 72 of support tray 68, insertion fork 74 and a front surgical fastener loaded onto the insertion fork pass through the opening. of dispenser 84 in cartridge body 76. Distal end 82 of cartridge body 78 desirably includes a spacer 86 which projects a distance D1 beyond distal end 72 of support tray 68. As will be described in detail in the present invention, the spacer 86 preferably ensures that the dispenser opening 84 in the cartridge body 78 is positioned within a peripheral edge or splice of a prosthesis device, such as the peripheral edge or splice of a surgical mesh so that a surgical fastener not be secured over the edge or splice of the prosthetic device.
[0097] In open IPOM procedures, the placement of surgical fasteners or tacks used for fixation is absolutely critical. Surgical fasteners must be placed the correct distance from the edge of the net. If an excessive gap (>5 mm) occurs, the risk of tissue entrapment between the abdominal wall and the prosthesis network will increase. This can have an impact on inner growth behavior and possibly lead to serious complications. In open IPOM procedures, it is difficult to control the correct placement of surgical fasteners as visual control is much more difficult compared to laparoscopic procedures in which surgical personnel have a clear view and control of the medical devices. The present invention provides a fixation device that overcomes the deficiencies found in prior art devices.
[0098] In one embodiment, the surgical clamp dispenser 28 preferably includes a cartridge body return spring 88 extending between the support tray 68 and the cartridge body 76 to normally induce the cartridge body 76 to move to the initial, extended position shown in Figures 3A and 3B. When a downward force (generally along the Y1-Y1 axis) is applied to the upper surface 83 of the cartridge body 76, the cartridge return spring 88 is compressed between the cartridge body 76 and the support tray 68. force is removed, the cartridge return spring 88 causes the cartridge body 76 to pivot back to the initial position shown in Figures 3A and 3B, so that the upper surface 83 of the cartridge body is parallel to the axis A1-A1 .
[0099] In one embodiment, the surgical fastener dispenser 28 preferably includes a surgical fastener advance 90 that is adapted to bias the surgical fasteners 78 towards the distal end 82 of the cartridge body 76 to be engaged by the insertion fork 74. The surgical fastener dispenser 30 also desirably includes a surgical fastener abutment spring 92 which extends between the abutment 90 and a spring stop 94.
[00100] In one embodiment, surgical fasteners 78 are loaded in series into the cartridge body 76 of the surgical fastener dispenser 28. The surgical fastener return spring 92 desirably biases the series of surgical fasteners 78 towards the distal end 82 of the cartridge body 28. After the insertion fork 74 has applied a front surgical fastener to the soft middle, the next surgical fastener is distally advanced towards the distal end 82 of the cartridge body 76 to be aligned with the insertion fork 74 of so that another clamp and apply cycle can begin. The application process can be repeated until all surgical fasteners 78 in cartridge body 76 have been applied from surgical fastener dispenser 28. A single fastener is dispensed each time the device is secured over the soft medium.
[00101] Referring to Figures 4A to 4D, in one embodiment, the fixation device preferably applies surgical fasteners 78 adapted for insertion into a soft medium such as tissue. Surgical fasteners 78 are preferably designed to secure a surgical net to tissue. The surgical fasteners and the fixation device for inserting the surgical fasteners may incorporate one or more of the features disclosed in assigned US Patent Application Serial No. 12/464,143, filed May 12, 2009, Patent Application US Patent Application Serial No. 12/464,151, filed May 12, 2009, US Patent Application Serial No. 12/464,165, filed May 12, 2009 and US Patent Application Serial No. 12/ 464,177, filed May 12, 2009, the descriptions of which are incorporated herein by reference.
[00102] In one embodiment, surgical fastener 78 desirably includes a distal end 100 and a proximal end 102, a first leg 104 that has a first tip 106 provided at a distal end of the first leg, and a second leg 108 that has a second tip 110 provided at a distal end of the second leg. In one embodiment, the cross-sectional dimensions of the first and second legs 104, 108 decrease as they move from the proximal ends toward the distal ends of the legs. Surgical clamp 78 preferably includes a bridge 112 adjacent to the proximal end 102 of the surgical clamp that connects the proximal ends of the first and second legs 104, 108. In one embodiment, the bridge may be positioned anywhere between the proximal ends. and distal from the surgical clamp as long as it interconnects the first and second legs. Surgical fastener 78 preferably includes at least one first barb 114 projecting rearwardly from the first tip 106 and at least one second barb 116 projecting rearwardly from the second tip 110. Although only one barb is shown on each leg, other surgical fasteners may have multiple barbs on each leg or tip. In one embodiment, the first and second prongs 106, 110 may be conical in shape. The tips can be formed with sharp leading points or they can be more obtuse.
[00103] In one embodiment, the first and second spikes 106, 110 have distal piercing tips that are slanted with respect to the longitudinal axes of the respective first and second legs 104, 108. In one embodiment, the distal piercing tips are slanted outwardly with respect to the longitudinal axes of the first and second legs. The distance between the tips is preferably greater than the distance between the legs to increase the probability of capturing the fibers of a prosthetic device being the legs. In one embodiment, the first and second prongs 106, 110 have blind, distal piercing points that allow the surgical fastener to penetrate tissue while minimizing unwanted penetration into an operator's hand.
[00104] Referring to Figure 4B, in one embodiment, the bridge 112 preferably includes a concave inner surface 118 facing toward the distal end 100 of the surgical fastener 78 and a convex outer surface 120 facing toward the proximal end 102 of the surgical fastener. The first leg 104 has an outer wall that has a first rib 122 that extends along a longitudinal axis A2-A2 of the first leg, and the second leg 108 includes an outer wall that has a second rib 124 that extends along the longitudinal axis. A3-A3 of the second leg 108. In one embodiment, the distance D2 between the piercing points at the distal ends of the first and second prongs 106, 110 is preferably greater than the distance D3 between the opposite inner surfaces of the first and second legs. 104, 108. The greater relative distance between the distal piercing points of the first and second prongs 106, 110 preferably ensures that the surgical fastener 78 engages filaments of a porous prosthesis device, such as the filaments of a surgical net used to perform a procedure for hernia. In one embodiment, the outwardly angled distal piercing tips provide increased ability to capture surgical mesh fibers when the mesh fibers are separated from one another without the need to increase the gap between each leg.
[00105] Referring to Figure 4C, in one embodiment, the first leg 104 has the first rib 122 extending along the longitudinal A2 of the first leg. When viewed from the side as shown in Figure 4C, the first rib 122 is preferably in substantial alignment with a distal point of the first piercing tip 106. Referring to Figure 4D, in one embodiment, the second leg 108 has a second rib 124 extending along the longitudinal axis A3 of second leg 108. When viewed from the side as shown in Figure 4D, second rib 124 is preferably aligned with a distal point of second spike 110.
[00106] Referring to Figure 5, in one embodiment, surgical fastener 78 is preferably advanced for alignment with insertion fork 76 located at the distal end 72 of support tray 68 (Figures 3A and 3B). In one embodiment, the insertion fork 76 preferably includes an upper end 130 adapted to engage one or more surfaces of the surgical fastener 78 to guide the insertion of the surgical fastener into the soft medium. In one embodiment, the upper end 130 of insertion yoke 76 includes a first tooth 132 having a first inner lip 134 formed therein and a second tooth 136 having a second inner lip 138 formed therein. In one embodiment, the inner edges 134, 138 preferably oppose each other and extend along the Y1-Y1 axis which is perpendicular to the longitudinal axis A1-A1 of the first arm 22 of the fastening device 20 (Figures 1 and 2). In operation, the opposing inner lips 134, 138 of the first and second teeth 132, 136 are preferably adapted to engage the ribs on the respective first and second legs 104, 108 of the surgical fastener 78. The engagement of the inner lips 134, 138 with the The ribs preferably align the surgical fastener 86 with the distal end 130 of the fork 76 and stabilize the surgical fastener during implantation into tissue. Surgical fastener 78 is brought into contact with inner lips 134, 138 by surgical fastener advance spring 92. Surgical fasteners 78 are carried along axis A1-A1 until they contact lips 134, 138. The angle of 90 ° between insertion fork and axis A1-A1 ensures that surgical fasteners are inserted into the soft medium at an angle that is perpendicular to the surface of the soft medium. In one embodiment, the most distal ends of the first and second teeth 132, 136 are advanced until they are in boundary position against convex seating surfaces provided near the distal ends of the first and second legs 104, 108.
[00107] Although the present invention is not limited by any specific theory of operation, it is believed that providing an insertion fork 76 with grooved teeth that engage ribs on the outer surfaces of the legs of the surgical fastener 78 will improve stability and control of the surgical clamp by applying the surgical clamp from the surgical clamp dispenser 28 (Figures 3A and 3B) of the clamp. Furthermore, at least a portion of the insertion force is provided closer to the distal ends of the legs 104, 108 of the surgical fastener 78 and not just the proximal end of the surgical fastener, as is the case with prior art fasteners. Providing insertion force into the surgical fastener near the distal end of the fastener can allow the use of smaller and/or lower profile surgical fasteners because, among others, the surgical fastener can be inserted using less force.
[00108] Referring to Figures 6A to 6C, in one embodiment, the surgical fastener dispenser 28 is adapted to provide surgical fasteners 78 in soft media such as tissue. Referring to Figure 6A, cartridge return spring 88 normally biases cartridge body 76 to an initial, undeflected position so that upper surface 83 of cartridge body 76 is parallel with longitudinal axis A1- A1 of the lower arm 22 (Figure 1). In the initial, undeflected position, none of the surgical fasteners 78 are exposed outside of the cartridge body 76. In addition, the spacer 86 at the distal end 82 of the cartridge body 76 covers the front surgical fastener 78A mounted on the insertion yoke 74. When cartridge body 76 is in the home position, spacer 86 has a forward surface that is preferably spaced a distance D1 from insertion fork 74, which ensures that surgical fasteners 78, when applied, are spaced apart to inside from a peripheral edge or splice of a prosthetic device, such as a surgical mesh used to repair a hernia.
[00109] Referring to Figure 6B, in one embodiment, when the fixture is closed, a downward force F1 is exerted on the upper surface 83 of the cartridge body 76, after which the distal end 82 of the cartridge body 76 pivots around pivot pin 81 to move the cartridge body to a deflected position. In the deflected position, the upper surface 83 of the cartridge body 76 defines an angle with the longitudinal axis A1-A1. As the distal end 82 of the cartridge body 76 pivots toward the distal end 72 of the support tray 68, the front surgical clamp 78A and the top of the insertion fork 74 pass through the dispenser opening 84 in the cartridge body. 76 and into the soft middle. The fork 74 preferably stabilizes the exposed surgical fastener 78A to control the angle and orientation of the surgical fasteners as it is urged into the soft medium. As cartridge body 76 pivots, cartridge return spring 88 is compressed to store energy therein. In one embodiment, at the end of a discharge cycle, when the downward force F1 is removed, the cartridge return spring 88 returns the cartridge body to the initial undeflected position shown in Figure 6A, after which the top surface 83 of cartridge body 76 is parallel to axis A1-A1.
[00110] Referring to Figure 6C, after the front surgical fastener has been applied from the fork 74, the fixture 20 (Figure 1) opens to remove the downward force F1 on the cartridge body 76. When the downward force is removed, cartridge return spring 88 releases energy stored therein to return cartridge body 76 to the initial undeflected position shown in Figure 6A. As cartridge body 76 returns to the undeflected position shown in Figure 6A, reload spring 92 induces advancer 90 to move toward distal end 82 of cartridge body 76 to advance second surgical fastener 78B into engagement. with insertion fork 74. As second surgical fastener 78B is loaded onto insertion fork 74, cartridge body 76 returns to the initial, undeflected position shown in Figure 6A. At this stage, the fixation device is ready for another fixation and discharge cycle to insert the second surgical fastener 78B into tissue.
[00111] With reference to Figures 1 and 7, in one embodiment, the block 42 is hingedly connected with the distal end 40 of the upper arm 36 of the fixture 20 through a fixture flange 150 having an opening 152 adapted to receive a pivot pin (not shown). Block 42 desirably includes a lower surface 154 adapted to oppose the surgical clamp dispenser 28 and an upper surface 156 that faces away from the lower surface. Block 42 preferably includes an internal cavity 158 adapted to receive a bevel washer 160 that provides tactile feedback (e.g., a clicking sound) when sufficient compressive force has been applied by the fixture 20 to properly release a surgical fastener. . In one embodiment, the bevel washer 160 desirably produces a clicking sound when compressed, which provides an audible signal to the surgical personnel that sufficient compressive force has been applied by the fixture to adequately provide a surgical fastener for the tissue. Block 42 may include an opening 162 formed in the top surface 156 thereof to allow the clicking sound generated by washer 160 to pass therethrough.
[00112] Referring to Figure 8, in one embodiment, the fixation device 20 can be used to secure a prosthetic device, such as a surgical mesh implant 160, to the abdominal tissue 162. In one embodiment, a surgical opening 164 is formed in soft medium 162 to access a region of a patient's inner body. The surgical mesh 161 is positioned against an interior surface of the abdominal tissue 162. The fixation device 20 can then be used to apply surgical fasteners 78 from the surgical fastener dispenser 28 attached to the distal end of the lower arm 22. The fasteners Surgical nets 78 are used to secure the surgical net 160 to the soft medium 162.
[00113] In one embodiment, the lower arm 22 carrying the surgical clamp dispenser 28 is inserted through the surgical opening 164 and into the patient. The upper arm 36 of the fixation device remains outside the patient with the block 42 opposing the distal end 30 of the surgical clamp dispenser 28. The driver 34 can be pulled towards the hand grip 32 to slide the rack 52 towards the end. proximal 24 of the lower arm 22. As rack 52 moves proximally, rack teeth 56 engage pinion teeth 58 to rotate pinion 60 in a counterclockwise direction, which in turn rotates the distal end 40 of upper arm 36 toward distal end 30 of surgical clamp dispenser 28. As driver 34 is pulled, lower surface 154 of block 42 pivots and self-adjusts to engage outer surface of soft means 162 The pivotal connection of block 42 with distal end 40 of upper arm 36 ensures that lower surface 154 of block 42 remains substantially perpendicular to the vertical orientation of insertion yoke 74 and secures. surgical holder 78. The actuator 34 is pulled until sufficient downward force is applied to the cartridge body 76 to deflect the cartridge body towards the support tray 68 so that the front surgical holder 78 can be urged by the insertion fork 74 through surgical mesh 161 and into soft means 162. Bevel washer 160 within block 42 preferably provides an audible clicking sound when sufficient compression has been applied across the distal ends of lower arm 22 and upper arm 36.
[00114] After the front surgical clamp 78 on the surgical clamp dispenser has been applied, trigger 34 can be released. Energy stored in actuator return spring 62 slides rack 52 toward the distal end of lower arm 22, which pivots distal end 40 of upper arm 36 in the opposite direction from distal end 30 of cartridge assembly 28. cartridge body 76 is then free to pivot in the opposite direction from support tray 68 so that the next surgical fastener 78 can be advanced into engagement with insertion fork 74. The cycle described above may be repeated to apply surgical fasteners from the surgical clamp dispenser 28 of the fixture 20.
[00115] Referring to Figure 9, in one embodiment, the fixation device 20 can be used to secure a surgical net with skirt 161' to the soft medium 162'. In Figure 9, the lower arm 22 and the surgical clamp dispenser 28 are passed through a surgical opening 164'. Spacer 86 at the distal end of surgical clamp dispenser 28 is advanced through layers of surgical mesh with skirt 161' until spacer 86 abuts against the outer peripheral seam of mesh 161'. Spacer 86 ensures that opening 84 at distal end 82 of surgical clamp dispenser 28 is positioned within outer perimeter 166' of surgical mesh 161'. The driver of the clamping device 20 can be pulled to pivot the distal end 40 of the upper arm 36 towards the distal end 82 of the surgical clamp dispenser 28. The upper and lower arms 36, 22 are closed towards each other until sufficient clamping force is applied through the distal ends of the respective arms to tamp the cartridge body into the surgical clamp dispenser to apply a surgical clamp. An audible click can be produced by a chamfered washer located on pivot block 42 to indicate that sufficient compression has been applied by the fixture.
[00116] The application cycle described above is repeated until surgical fasteners are applied around the entire outer perimeter 166' of the surgical network 161'. In one embodiment, the surgical fasteners are spaced no more than two centimeters apart to ensure that no gap develops between the surgical mesh 161' and the soft medium 162'.
[00117] Referring to Figure 10, in one embodiment, the fixture 20 is used in a 161" surgical net that has a 168'' bent edge. The cartridge assembly is preferably advanced between the 161" surgical net and the folded edge 168" until the spacer 86 abuts against the outer peripheral edge 166" of the surgical net 161". The fastening device 20 can be closed so that the distal end 40 of the upper arm 36 pivots towards the dispensing device. surgical clamp 28 secured to the distal end of the lower arm 22. Compressive forces are applied through the distal ends of the respective upper and lower arms 22, 36 until a surgical clamp is dispensed from the surgical clamp dispenser 28. Surgical personnel can discern when sufficient compressive forces have been applied to dispense a surgical fastener when an audible click is produced by a chamfered washer disposed in the connected block of f hinged shape 42. The above-described process is preferably repeated around the outer periphery 166'' of the surgical mesh 161'' to dispense a plurality of fasteners around the outer periphery of the mesh.
[00118] Referring to Figures 11A to 11C, in one embodiment, a block 142 is adapted to be pivotally connected with the distal end 40 of the upper arm 36 of the fixture 20 shown in Figures 1 and 2. The block 142 includes a pair of flanges 150A, 150B which have aligned openings 152A, 152B passing therethrough which are adapted to receive a pivot pin for pivotally connecting block 142 with distal end 40 of upper arm 36 (Figure 1).
[00119] Referring to Figure 11B, block 142 preferably includes a lower surface 154 adapted to be in a boundary position against an outer surface of the soft medium, such as the outer surface of the patient's skin. Referring to Figure 11C, in one embodiment, block 142 preferably includes an inner portion 180 secured to flange 150A, 150B. The inner portion 180 includes a marker 182 provided at a lower end thereof. Marker 182 may be an ink marker adapted to form an ink mark on the surface of a patient's skin. Block 142 preferably includes a lower portion 184 that extends around upper portion 180. Lower portion 184 includes lower surface 154 of block 142. Lower surface 154 preferably includes an aperture 185 formed therein. allows marker 182 to pass through. When compressive forces are applied to the lower surface 154 of the lower member 184, the lower surface 154 of the lower member 184 preferably slides toward the upper surface 156 of the upper member 180 so that the marker 182 projects through the opening 185 in the bottom surface 154 to mark a surface. Block 142 preferably includes a stop 186 and for sliding movement of lower surface 154 toward upper surface 156.
[00120] When a surgical fastener is applied using the fixture disclosed in the present invention, the lower surface 154 of block 142 desirably opposes the distal end of the cartridge body from which the surgical fastener is dispensed. Marker 182 is preferably aligned with opening 84 provided at distal end 82 of cartridge body 76. Marker areas provided on the patient's skin surface by marker 182 provide an exact mirror image of where the surgical fastener was. inserted in the soft middle. In this way, surgical personnel are provided with an accurate methodology to track how many surgical fasteners were dispensed and the exact location of each surgical fastener.
[00121] Figures 12A through 12C show another block 242 that has a marker 282 that can be used to mark a patient's skin surface where a surgical fastener has been inserted into the patient's tissue. With reference to Figures 12A and 12B, block 242 preferably includes a pair of securing flanges 250A, 250B which have aligned openings 252A, 252B, respectively, which are adapted to receive a pivot pin to secure block 242 at one end. distal to the upper arm of the fixture shown in Figures 1 and 2. Block 242 preferably includes a tube 255 that is adapted to receive a marker 282.
[00122] Figure 12C shows marker 282 inserted into tube 255 of block 242. Block 242 has a lower surface 254, an upper surface 256 and an aperture 285 that extends between the lower and upper surfaces 254, 256. of marker 282 preferably extends into opening 285 to mark the surface of a patient's skin when block 242 is pressed against the surface of the patient's skin. As indicated above, marker 282 provides an efficient and highly accurate methodology for identifying where a surgical fastener has been inserted into a patient's tissue, and for indicating the total number of surgical fasteners inserted into the patient's tissue.
[00123] Referring to Figure 13, in one embodiment, a fixture 320 for dispensing surgical fasteners preferably includes a lower arm 322 extending along a longitudinal axis A4-A4 and an attached surgical fastener dispenser 328 to the distal end of the lower arm 322. The surgical fastener dispenser 328 includes a support tray 368 having a distal end 372 including a fork 374 adapted to urge surgical fasteners into the soft medium. Insertion fork 374 preferably extends along an axis Y1-Y1 that is substantially perpendicular to the longitudinal axis A4-A4 of lower arm 322 and support tray 368. Lower arm 322 is preferably coupled with a cable. of hand 332.
[00124] The securing device 320 preferably includes an upper arm 336 that is pivotally connected with the lower arm 322. The upper arm 336 has a proximal end 338 pivotally coupled with the lower arm 322 and an end distal 340 remote from it. A block 342 is pivotally connected with the distal end 340 of the upper arm 336. The upper arm 336 is desirably connected with a driver 334.
[00125] In operation, the actuator 334 can be pulled toward the handle 332 to move the distal end 340 of the upper arm 336 toward the distal end 372 of the support tray 368. The actuator 334 preferably includes a spring for internal extension 362 which is installed under a load that is released through a cable system through the arms until sufficient compression of the arms has been obtained. At this point, additional pull of the actuator 334 towards the cable 332 will not result in additional compressive forces being exerted through the distal ends of the upper and lower arms. Instead, internal extension spring 362 continues to extend.
[00126] Referring to Figure 14A, in one embodiment, surgical fastener dispenser 328 preferably includes a cartridge body 376 that is pivotally coupled with support tray 368. Cartridge body 376 has preferably, a spacer 386 at a distal end thereof that projects beyond distal end 372 of support tray 368. Cartridge body 376 preferably has a plurality of surgical fasteners (not shown) loaded thereon. During a discharge cycle, when actuator 334 is pulled towards hand grip 332, compressive forces are applied between block 342 and surgical clamp dispenser 328 until one of the surgical clamps is dispensed from an opening in the dispenser at the distal end 382 of cartridge body 376.
[00127] Figure 14B shows the fixture 320 in a closed position with the hingedly connected block 342 opposing the dispenser opening 384 at the distal end 382 of the cartridge body 376. As the soft medium is compressed between block 342 and cartridge body 376, distal end 382 of cartridge body 376 pivots in a downward direction toward support tray 368 until the insertion fork at the distal end of support tray 368 pushes a front surgical fastener through the dispenser opening 384 for insertion into the soft medium.
[00128] Other embodiments of the present invention may include connections that vary from the linear mechanism shown in Figures 1 and 2 of the present application. In these alternative embodiments, the cable elements pivot relative to each other while the upper and lower arms move towards and away from each other in a linear or parallel fashion. Figures 15 to 18 are schematic drawings showing only the connections coupling the upper and lower arms and the pivoting cables. Although not shown, it is contemplated that the embodiments shown in Figures 15 to 18 may include one or more of the features shown and described above for Figures 1 to 10.
[00129] Referring to Figure 15, in one embodiment, a fixture 420 for dispensing surgical fasteners in the soft medium preferably includes a lower arm 422 and an upper arm 436 that are joined together with a jack coupling 455. The securing device 420 has first and second cables 432, 434 that are in line with the respective lower and upper arms 422, 436. As the first and second cables 432, 434 pivot toward each other to close the securing device. attachment 420, the jack coupling moves the lower and upper arms 422, 436 towards each other in a linear or parallel fashion to dispense a front surgical fastener (for example, see Figure 6B).
[00130] Referring to Figure 16, in one embodiment, a fixture 520 for dispensing surgical fasteners in soft media preferably includes a lower arm 522 and an upper arm 536 that are joined together with a jack coupling 555. The clamping device 520 has first and second cables 532, 534 that are offset from the lower and upper arms 522, 536, respectively. As the first and second cables 532, 534 pivot towards each other to close the fixture 520, the jack coupling moves the lower and upper arms 522, 536 towards each other in a linear fashion (i.e. , parallel) to dispense a front surgical clamp (for example, see Figure 6B).
[00131] Referring to Figure 17, in one embodiment, a fixture 620 for dispensing surgical fasteners into the soft medium preferably includes a lower arm 622 and an upper arm 636 that are joined together with a parallel hook arrangement 655 The fixture 620 has first and second cables 632, 634 which are adapted to pivot relative to one another. As the first and second cables 632, 634 pivot towards each other to close the fixture 620, the parallel link arrangement 655 moves the lower and upper arms 622, 636 towards each other in a parallel fashion for dispensing. a front surgical fastener (for example, see Figure 6B).
[00132] Referring to Figure 18, in one embodiment, a fixture 720 for dispensing surgical fasteners in soft media preferably includes a lower arm 722 and an upper arm 736 that are joined together with a rack gear mechanism and pinion 755. The fixture 720 has first and second cables 732, 734 that are adapted to pivot relative to one another. As the first and second cables 732, 734 pivot toward each other to close the clamping device 720, the rack and pinion gear mechanism 755 moves the lower and upper arms 722, 736 toward each other in a mode parallel to dispense a front surgical clamp (for example, see Figure 6B).
[00133] The couplings shown and described here are not the only types of mechanisms that can be used to provide linear movement between the upper and lower arms of the fixture. Other embodiments may have a jack mechanism with a plurality of couplings that resemble an accordion-shaped system. In one embodiment, an endless gear mechanism can be employed. In these embodiments, the cable elements desirably pivot towards and away from each other as the upper and lower arms move in a linear/parallel fashion.
[00134] In one embodiment, sliding guides can be used to move an upper arm and an upper cable connected thereto towards a lower arm and a lower cable connected thereto, while maintaining linear/parallel movement between the upper and lower arms . In this mode, the upper arm/upper cable component moves in a linear/parallel mode with respect to the lower arm/lower cable.
[00135] In one embodiment, a marking assembly as described above in Figures 11A to 11C and 12A to 12C can be attached to the distal end of an arm coupled with a dispensing instrument that has a handle and an elongated tube for dispensing surgical fasteners. Referring to Figures 19A to 19C, in one embodiment, a device 820 for dispensing surgical fasteners into tissue preferably includes a tubular member 822 having a proximal end 824, a distal end 826 and a surgical fastener dispenser opening 828 at the distal end that is adapted to apply surgical fasteners to tissue. Dispensing device 820 preferably includes a handle 830 secured to proximal end 824 of tubular member 822 and an actuator (not shown) that can be engaged to dispense a surgical clamp from surgical clamp dispenser opening 828 at the distal end. of tubular member 822. In one embodiment, a surgical fastener is dispensed each time the actuator is engaged. Dispensing device 820 may incorporate one or more features of dispensing instruments disclosed in assigned US Patent Application Nos. serial 12/464,143; 12/464,151; 12/464,165; and 12/464,177, the descriptions of which are incorporated herein by reference.
[00136] In one embodiment, the dispensing device 820 preferably includes an upper arm 836 having a proximal end 838 and a distal end 840. The distal end 840 of the upper arm 836 is preferably adapted to swing in the opposite direction. from and toward the surgical clamp dispenser opening 828 at the distal end 826 of the tubular member 822. In one embodiment, the proximal end 838 of the upper arm 836 is pivotally secured to the handle 830. In one embodiment, the upper arm 836 defines an arc or curve. The dispensing device 820 desirably includes a marking assembly 842 connected to the distal end 838 of the upper arm 836. The marking assembly 842 is movable away from and toward the surgical clamp dispenser opening 828 adjacent the distal end of the element. tubular 822.
[00137] In operation, the distal end 826 of the dispenser device 820 is inserted into a surgical opening to dispense surgical fasteners through the surgical fastener dispenser opening 828 and into tissue to secure an implant to tissue. In one embodiment, each time the actuator on housing 830 is pulled, the marking assembly 842 on the distal end 838 of the upper arm 836 is moved toward the distal end of the tubular member 822 and into alignment with the surgical fastener dispenser opening 828 to mark a location on the outer surface that mirrors where the surgical clamp was positioned within the surgical opening.
[00138] Referring to Figures 20A to 20C, in one embodiment, a device 920 for dispensing surgical fasteners into tissue preferably includes a tubular element 922 having a proximal end 924 and a distal end 926 having a dispenser opening of surgical fastener 928 at the distal end which is adapted to dispense surgical fasteners into tissue. Dispenser device 920 preferably includes a handle 930 secured to the proximal end 924 of tubular member 922 and an actuator (not shown) as an actuator, which can be engaged to dispense a surgical clamp from the surgical clamp dispenser opening. 928 at the distal end of tubular member 922. In one embodiment, a surgical fastener is dispensed each time the actuator on handle 930 is engaged.
[00139] In one embodiment, the dispensing device 920 preferably includes an upper arm 936 having a proximal end 938 and a distal end 940. move away from and toward the surgical clamp dispenser opening 928 at the distal end of the tubular member 922. In one embodiment, the proximal end 938 of the upper arm 936 is secured to the handle 930 via a pivotal connection. In one embodiment, the upper arm 936 defines an arc or curve. The dispensing device 920 desirably includes a marking assembly 942 connected to the distal end 938 of the upper arm 936. In one embodiment, the marking assembly 942 is pivotally attached to the distal end 940 of the upper arm 936. The marking assembly is movable away from and towards the surgical clamp dispenser opening 928 adjacent the distal end of the tubular member 922 to mark an outer surface as described above for the dispensing and marking device shown in Figures 19A to 19C.
[00140] Referring to Figures 21A to 21C, in one embodiment, a marking assembly 942 includes a base 944 and a pair of attachment flanges 950A, 950B having aligned openings that are adapted to receive a pivot pin to secure the base 944 to the distal end of the upper arm 936 of the dispensing device 920 shown in Figures 20A to 20C. Marking device 942 preferably includes a tube 955 extending upwardly from base 944 that is adapted to receive a marker 982.
[00141] In one embodiment, the base 944 has a lower surface 954, an upper surface 956 and an opening 985 extending between the lower and upper surfaces 954, 956. The lower end of marker 982 is preferably accessible at the end. bottom of opening 985 for generating markings on a patient's skin surface when base 944 is pressed against the patient's skin surface. As indicated above, marker 982 provides an efficient and highly accurate methodology for identifying where a surgical fastener has been inserted into a patient's tissue and for indicating the total number of surgical fasteners inserted into the patient's tissue.
[00142] Although the foregoing is directed to embodiments of the present invention, other additional embodiments of the invention can be invented without deviating from the basic scope of the same, which is limited only by the scope of the following claims. For example, the present invention contemplates that any of the features shown in any of the embodiments described herein, or incorporated herein by reference, may be incorporated with any of the features shown in any other of the embodiments described herein, or incorporated herein by reference, and still fall within the scope of the present invention.

权利要求:
Claims (15)
[0001]
1. Device (20) for dispensing surgical fasteners (78) within a patient's body and generating marks outside the body indicating where the surgical fasteners (78) were dispensed within the body, the device comprising: a first element that has a surgical fastener dispenser opening (84) at a distal end thereof adapted for dispensing surgical fasteners (78); a second element coupled with the first element, the second element having a distal end opposing the surgical fastener opening surgical fastener (84); It is characterized by the fact that a marking assembly is attached to the distal end of the second element, wherein the marking assembly is movable in the opposite direction to and towards the surgical clamp dispenser opening (84), and wherein the marking assembly is adapted to generate marks on an outer surface that mirror the location of each surgical fastener (78) dispensed from the surgical fastener opening (84) at the distal end of the first element.
[0002]
2. Device according to claim 1, characterized in that the surgical fastener dispenser opening (84) is adapted for insertion into a surgical opening (164) formed in the body to dispense the surgical fasteners (78) into the tissue (162) within the surgical opening (164) with the marking assembly positioned outside the surgical opening (164) and on the outer surface of the body.
[0003]
3. Device according to claim 1, characterized in that the first element comprises a lower arm (22) having a distal end (26) including the surgical clamp dispenser opening (84), and wherein the second element comprises an upper arm (36) having a proximal end (38) that is coupled with the lower arm (22) via a pivotal connection.
[0004]
4. Device according to claim 3, characterized in that it comprises a surgical clamp dispenser (28) attached to the distal end (26) of the lower arm (22) wherein the surgical clamp dispenser (28) includes the surgical clamp dispenser opening (84).
[0005]
5. Device according to claim 4, characterized in that it further comprises an actuator coupled with the upper (36) and lower (22) arms to selectively move the arms (36, 22) between an open position in which the The marking assembly is spaced from the surgical fastener dispenser (28) and a closed position in which the marking assembly is closest to the surgical fastener dispenser (28) to secure tissue (162) between the marking assembly and the dispenser of surgical fastener (28).
[0006]
6. Device according to claim 4, characterized in that the surgical clamp dispenser (28) is adapted for insertion into the surgical opening (164) while the marking assembly remains outside the surgical opening (164).
[0007]
7. Device according to claim 4, characterized in that the marking assembly comprises a marker (182) adapted to contact the outer surface of the body outside the surgical opening (164) to generate the markings on the surface external to mirror the surgical fasteners (78) dispensed into tissue (162) within the surgical opening, preferably wherein the marker (182) is adapted to generate a visible pattern of markings on the outer surface of the body indicating the number and location of the fasteners surgical procedures (78) dispensed into the tissue (162) within the surgical opening (164).
[0008]
8. Device according to claim 4, characterized in that the marking assembly is hingedly fixed to the distal end (40) of the upper arm (36).
[0009]
9. Device according to claim 7, characterized in that the marker (182) is selected from the group of markers consisting of a pen, a felt marker, a pencil, a craion, a needle and a thorn.
[0010]
10. Device according to claim 8, characterized in that the marking assembly comprises: a block (42) connected to the distal end (40) of the upper arm (36); the block (42) having a lower surface (154) adapted to apply a clamping force; an aperture (185) formed in the lower surface (154) of the block (42); the marker (182) being coupled with the block (42) and having a marking surface accessible through it. of the opening (185) formed in the lower surface (154) of the block (42) to mark the outer surface of the body, wherein when the device is closed the lower surface (154) of the block (42) applies clamping force on the outer surface of the body which, in turn, applies a clamping force through the tissue (162) onto the surgical clamp dispenser (28) to dispense one of the surgical clamps (78) from the surgical clamp dispenser opening (84 ) and into the tissue (162) within the surgical opening to (164).
[0011]
11. Device according to claim 1, characterized in that the first element is an elongated tube (822) having the surgical clamp dispenser opening (828) at the distal end (826) thereof and the second element has a proximal end (838) coupled with the first member (822) and a distal end (840) that opposes the surgical clamp dispenser opening (828).
[0012]
12. Device according to claim 11, characterized in that the device further comprises a cable (830) connected to a proximal end (824) of the elongated tube (822) and wherein the second element (836) is fixed to the handle (830), wherein the second element (836) is flexible to move the distal end (840) of the second element (836) towards and away from the surgical clamp dispenser opening (828) at the distal end. (826) of the elongated tube (822).
[0013]
13. Device according to claim 4, characterized in that the marking assembly is adapted to contact the outer surface of the body each time one of the surgical fasteners (78) is dispensed into the tissue (162) within of a surgical opening (164) to provide a visible pattern of markings on the outer surface of the body, indicating the number and location of each surgical fastener (78) dispensed into tissue (162) within the surgical opening (164).
[0014]
14. Device according to claim 5, characterized in that the actuator comprises a hand cable (32) attached to the lower arm (22), an actuator (34) mounted on the lower arm (22) and connected to the upper arm (36), wherein the actuator (34) is adapted to be pulled towards the hand cable (32) to move the arms (22, 36) in the closed position, and away from the hand cable (32) to moving the arms (22,36) to the open position, and an actuator return spring (62) coupled to the actuator (34) to normally bias the actuator (34) away from the hand grip (32).
[0015]
15. Device according to claim 4, characterized in that the surgical clamp dispenser (28) comprises: a support tray (68) having a proximal end (70) connected with the distal end (26) of the arm lower (22), and a distal end (72) including an insertion yoke (74) which extends along a predetermined axis with respect to a longitudinal axis of the lower arm (22); a cartridge body (76) over the support tray (68), the cartridge body (76) having a proximal end (80) pivotally connected with the proximal end (70) of the support tray (68), and a freely movable distal end (82) with respect to the distal end (72) of the support tray (68), and an upper surface (83) extending between the proximal (80) and distal (82) ends of the cartridge body (76) and the dispenser opening (84) is in line with the insertion fork (74); a body return spring a cartridge (88) in contact with the cartridge body (76) and the support tray (68) to normally press the distal end (82) of the cartridge body (76) away from the support tray (68); and a plurality of surgical fasteners (78) arranged in a series to be dispensed one at a time from the dispenser opening (84), each of the surgical fasteners (78) having an insertion end oriented toward the upper surface. (83) of the cartridge body (76).

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同族专利:

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公开号 | 公开日

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AU2013232269A1|2014-10-23|

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RU2626119C2|2017-07-21|

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CA2867485A1|2013-09-19|

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BR112014022936A2|2017-06-20|

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CA2867485C|2020-03-24|

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MX351213B|2017-10-04|

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MX2014011101A|2015-05-07|

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CN104168842B|2017-03-01|

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WO2013138403A1|2013-09-19|

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US20130245681A1|2013-09-19|

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US8740919B2|2014-06-03|

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JP2015511864A|2015-04-23|

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AU2013232269B2|2016-12-22|

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EP2825103A1|2015-01-21|

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RU2014141642A|2016-05-10|

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JP6138905B2|2017-05-31|

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CN104168842A|2014-11-26|

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IN2014DN07713A|2015-05-15|

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EP2825103B1|2016-07-13|

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NZ629196A|2015-08-28|

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法律状态:
2018-12-04| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-12-31| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2021-07-13| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-08-24| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 13/03/2013, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US13/422,003|US8740919B2|2012-03-16|2012-03-16|Devices for dispensing surgical fasteners into tissue while simultaneously generating external marks that mirror the number and location of the dispensed surgical fasteners|

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US13/422,003|2012-03-16|

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PCT/US2013/030644|WO2013138403A1|2012-03-16|2013-03-13|Devices for dispensing surgical fasteners into tissue while simultaneously generating external marks that mirror the number and location of the dispensed surgical fasteners|

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