Tissue clamp

[0001] This application claims the priority of U.S. Provisional Application No. 60/732,748 filed Nov. 2, 2005, the whole of which is hereby incorporated by reference herein.

[0002] In vascular surgical procedures, the surgeon needs to control the vessel undergoing treatment, repair, or reconstruction. The vessel typically needs to be dissected and isolated to provide for the requisite controlled manipulation. Once isolated, the vessel needs to be clamped to stop blood flow while performing a bypass or other surgical manipulation of the artery or vein. Clamps can also be used to temporarily or permanently prevent the flow of blood into a vascular aneurysm or to align tissue such as nerve endings or the urethra.

[0003] The clamp is generally held by forceps and handed to the surgeon for placement. The surgeon then manipulates the clamp to achieve the correct orientation for proper placement on the vessel. Existing clamps and the forceps used to hold them make it difficult to securely hold the clamps, which may slip out of the forceps during use. Existing clamps typically have two arms that are connected to a spring-loaded hub. The proximal ends are manually compressed together to open the distal ends.

[0004] However, due to the limited ability of current forceps to manipulate and stably apply clamps, there is an ongoing need for improvements in vascular clamp operation to improve safety and ease of use.

[0005] The system and method of the present invention includes a tissue clamp having a fixture or peg that protrudes from the proximal end of the clamp. This feature provides for the clamp to be grasped and securely placed about tissue such as an artery. A preferred embodiment of the invention utilizes a tool that engages the fixture to prevent premature release of the clamps during placement. An example of a tool is a pair of forceps having an opening or eyelet at the distal end that is shaped to securely engage the fixture on the clamp. The tool and fixture can be configured to allow the user to rotate the clamp in the tool and thereby select the rotational orientation of the clamp to the tool.

[0006] A preferred embodiment of the invention utilizes a fixture that has one or more channels or grooves that allow the tool to more securely engage the clamp fixture. This can also provide a particular orientation of the tool relative to the clamp. The opening or eyelet of the tool can be provided with members such as ridges or teeth that are sized to mate with the channels or grooves on the clamp fixture. A surgeon can select a particular orientation of the tool to the clamp and thereby provide a preferred orientation of the clamp to grasp the vessel. The surgeon can also rapidly realign or adjust the angular orientation during placement.

[0007] In another preferred embodiment, the opening on the tool that receives the fixture can be larger and of a different shape than the fixture so as to allow the user to grasp the clamp with the tool at different positions and/or orientations. Alternatively, the fixture can be circular, oval or a simple peg with a smooth cylindrical or cone shape extending from a surface of the clamp arm that mates exactly the shape of the opening in the forceps. The opening on the forceps can extend along an axis that is at an oblique angle relative to the longitudinal axis of the forceps arm to provide a further range of orientation options during placement. The forceps or other type of grasping clamp can be provided with a threaded screw locking device or ribbed jaws extending from the forceps arms that engage and lock such that when the user presses the arms or handles of the tool together that grasp the clamp in a locked position. This allows the tool and clamp to be passed from one person to another without risk of releasing the clamp inadvertently before proper placement.

[0008] In another embodiment a reverse hinge and clip lock forceps can be used to grasp the clamp. In this embodiment the resting state of the forceps is closed. Thus, the hinge is pushed to open the forceps and enable the user to pick up the clamp. By releasing the pressure exerted to open the forceps, the distal arms or jaws of the forceps engage the fixture on the clamp.

[0009] The clamps can be provided in various sizes and shapes to accommodate use thereof for various applications including vascular procedures such as cardiovascular and microvascular surgery, nerve approximation surgery or urethral repair. The clamps and tools of the present invention can be made using metal and/or plastic components. The foregoing and other features and advantages of the system and method for using vascular clamps will be apparent from the following more particular description of preferred embodiments of the system and method as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views.

[0023] Illustrated in FIGS. 1-4 is a vascular clamp 10 having a fixture 20 on an arm 12 of the clamp that allows the clamp to be grasped by a tool that can be used by a surgeon, for example, to securely grasp and place the clamp during a surgical procedure. A preferred embodiment uses a second fixture 22 on the second arm 14 of the clamp so that a tool can securely grasp both arms.

[0024] The clamp is preferably used with a tool having elements that grasp fixtures 20, 22 and press the proximal ends of arms 12, 14 together to open the distal ends 18. The clamp is then positioned in proximity to a surgical site such that the open distal ends of arms 12, 14 can be positioned on opposite sides of an artery to be clamped. The surgeon then releases pressure exerted by the tool on the proximal ends of the arms of the clamp thereby allowing the distal ends to grasp and occlude the artery. This prevents blood flow to the surgical site such as a location for a graft, which can then be sutured onto the artery without loss of blood or visual obstruction of the procedure.

[0025] A preferred embodiment of the invention utilizes a fixture 20 having features on its surface that mate with features of the tool used to grasp the clamp. These features can be seen in the enlarged perspective view of the fixture 20 shown in FIG. 2. The fixture 20 has a top 28, a sidewall 24, a plurality of channels or grooves 26 and a base 25. The sidewall slopes at an angle between 60 and 80 degrees with an increasing diameter toward the base.

[0026] Another preferred embodiment of the fixture can include an aperture or opening in one or both arms that can also be engaged by forceps or tool that grasps one or both arms of the clamp. The distal end of the tool can have features that mate with channels or features associated with the aperture, opening or other feature of the clamp to provide a fixed orientation between the tool and the clamp.

[0027] The top view of FIG. 3 shows a generally circular shape of the fixture 20. The side view of the clamp 10 shown in FIG. 4 shows the distance 40 that the user can squeeze the arms together. The sidewall 24 can slope at angle 27 as described above.

[0028] Illustrated in FIGS. 5-8 is a clamping forceps tool 50 that can be used to grasp the vascular clamp 10. The forceps 50 uses a connecting element 52 that engages the fixture 20 on the clamp. The forceps 50 has arms 54, 56 which are secured at one end 51 and are biased in an open position at the distal end so that they will easily fit around the clamp fixtures 20, 22 in the open positions. The arms 54,56 can then be pressed together causing the distal ends of the clamp to open.

[0029] A locking element 58 can be used to secure the arms 54, 56 in a fixed position relative to each other. This allows the user to grasp the clamp with the forceps and lock the clamp in an open position until the clamp is positioned properly to grasp the artery or nerve of the patient, for example.

[0030] As shown in FIG. 6, the connecting element in a preferred embodiment includes a circular eyelet 64 having an opening 62 that mates with an upper or lower fixture of the clamp 10. The inner wall can have ridges 60 that correspond to channels 26 in the sidewall of the fixture. In this particular embodiment, eight ridges are shown; however, one or more ridges can be used.

[0031] A perspective view of the forceps 50 is shown in FIG. 7. The forceps 50 can be aligned with the longitudinal axis of the clamp for placement. The locking element 58 can include a coupling or locking member 57,59 on each arm. Alternatively, the tool 50 can be positioned off-axis with the clamp 10 at oblique angle 55 as shown generally in FIG. 8. Thus, the orientation of the tool to the clamp can be selected to provide for ease of access to the surgical site. The ridges allow the orientation of the clamp relative to the grasping tool to be selected by the user. As illustrated the number of ridges is eight, however, other embodiments can incorporate more ridges using a saw tooth design having up to one hundred or more teeth thus allowing a greater number of angles that can be selected by the user. As illustrated in FIG. 8., the height of the fixture 61 is greater than the width of the tool extending over the fixture. As illustrated in FIGS. 1-4, the fixture can have a lower profile having a height that matches the width of the tool eyelet thus making it easier for the user to turn the tool to a different angle relative to the clamp.

[0032] Another preferred embodiment is shown in FIGS. 9 and 10 in which a forceps 70 has an oval shaped opening 72 with ridges 74 to engage the fixture. The angle 76 between the forceps arm and the connecting placement can be manufactured at different oblique angles to provide different orientations. A threaded locking device can be used or a pair of ribbed jaws extending toward each other from the arms of the forceps can be pressed together and thereby lock the arms in a fixed position. Note that a scissor-type of forceps with grasping jaws extending from a hinge can also be used.

[0033] In another embodiment a reverse hinge forceps can also be used to grasp the clamp. Instead of being manufactured to be at rest in the open position, the forceps can be formed as a spring at rest in the closed position. In this embodiment, the user presses the arms together to open the forceps to enable the user to grasp the fixture on the vascular clamp. The user then relaxes their grip such that the distal opening on the forceps securely grasps the fixture in a rest position.

[0034] Shown in FIG. 11 is a preferred embodiment in which a plurality of clamps are connected together to provide a clamp device 80 that can be used to position tissue such as nerve sections or vascular sections 90, 92 which can be aligned with respect to one another to enable surgical repair. The device 80 can be used with other body lumens such as the urethra or other tubular structures such as those in the gastrointestinal system. In this particular embodiment, a pair of clamps 82, 84 are connected by a bar 86 or other connector. The arms of the clamps 82, 84 each have fixtures 94, 96 to grasp the clamp with a tool as described previously herein.

[0035] A method 100 of using a clamp device for a surgical procedure is illustrated in FIG. 12. First, the clamp fixture is grasped 102 with a tool at a selected orientation. The clamp can be optionally locked 104 in the open position during placement. The surgeon or other user then positions 106 the open distal ends of the clamp about the tissue such as an artery or nerve. The clamp is attached 108 to the tissue and the tool removed. The procedure 110 is then performed and the clamp removed, if necessary.

[0036] The claims should not be read as limited to the described order or elements unless stated to that effect. Therefore, all embodiments that come within the scope and spirit of the following claims and equivalents thereto are claimed as the invention.