(19)
(11)EP 3 437 571 B1

(12)EUROPEAN PATENT SPECIFICATION

(45)Mention of the grant of the patent:
17.06.2020 Bulletin 2020/25

(21)Application number: 18194861.3

(22)Date of filing:  17.12.2010
(51)Int. Cl.: 
A61B 17/122  (2006.01)
A61B 17/10  (2006.01)
A61B 17/29  (2006.01)
A61B 17/12  (2006.01)
A61B 17/128  (2006.01)
A61B 17/08  (2006.01)
A61B 17/00  (2006.01)

(54)

MEDICAL DEVICES WITH DETACHABLE PIVOTABLE JAWS

MEDIZINISCHE VORRICHTUNGEN MIT ABNEHMBAREN DREHBAREN BACKEN

DISPOSITIFS MÉDICAUX AVEC MÂCHOIRES PIVOTANTES DÉTACHABLES


(84)Designated Contracting States:
AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR

(30)Priority: 22.12.2009 US 28929709 P

(43)Date of publication of application:
06.02.2019 Bulletin 2019/06

(62)Application number of the earlier application in accordance with Art. 76 EPC:
10801324.4 / 2515770

(73)Proprietor: Cook Medical Technologies LLC
Bloomington, IN 47404 (US)

(72)Inventors:
  • Surti, Vihar C.
    Winston-Salem, North Carolina 27104 (US)
  • Martinez, Michelle D.
    Winston-Salem, North Carolina 27104 (US)

(74)Representative: Wächter, Jochen et al
Kroher-Strobel Rechts- und Patentanwälte PartmbB Bavariaring 20
80336 München
80336 München (DE)


(56)References cited: : 
DE-A1-102006 003 548
US-A1- 2005 101 991
US-A1- 2003 191 494
US-A1- 2006 155 308
  
      
    Note: Within nine months from the publication of the mention of the grant of the European patent, any person may give notice to the European Patent Office of opposition to the European patent granted. Notice of opposition shall be filed in a written reasoned statement. It shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention).


    Description

    BACKGROUND



    [0001] Conventionally, a clip may be introduced into a body cavity through an endoscope to grasp living tissue of a body cavity for hemostasis, marking, and/or ligating. Such clips are often known as surgical clips, endoscopic clips, hemostasis clips and vascular clips. In addition, clips are now being used in a number of applications related to gastrointestinal bleeding such as peptic ulcers, Mallory-Weiss tears, Dieulafoy's lesions, angiomas, post-papillotomy bleeding, and small varices with active bleeding. Clips have also been attempted for use in closing perforations in the stomach.

    [0002] Gastrointestinal bleeding is a somewhat common and serious condition that is often fatal if left untreated. This problem has prompted the development of a number of endoscopic therapeutic approaches to achieve hemostasis such as the injection of sclerosing agents and contact thermo-coagulation techniques. Although such approaches are often effective, bleeding continues for many patients and corrective surgery therefore becomes necessary. Because surgery is an invasive technique that is associated with a high morbidity rate and many other undesirable side effects, there exists a need for highly effective, less invasive procedures.

    [0003] Mechanical hemostatic devices such as clips have been used in various parts of the body, including gastrointestinal applications. One of the problems associated with conventional hemostatic devices and clips, however, is that many devices are not strong enough to cause permanent hemostasis. Further, clips have also been attempted for use in closing perforations in the stomach or gastrointestinal structures, but unfortunately traditional clips suffer from difficult placement and the capability to grasp a limited amount of tissue, potentially resulting in incomplete closure.

    [0004] In order to subsequently apply multiple hemostatic clips without removing the entire endoscopic system, US 2006/0155308 A1 discloses an apparatus for deployment of multiple hemostatic clips comprising a magazine disposed on a distal end, the magazine containing a plurality of clips arranged in a chain. Each of the clips comprises two jaws, which are movable between a closed configuration and an open configuration, wherein the clips are biased toward the open configuration. The magazine is sized to hold the clips in the closed configuration. Moving the clips distally by means of a drive wire causes the distal-most clip to pass through a distal opening of the magazine allowing the jaws to return to the open configuration.

    [0005] US 2005/0101991 A1 discloses a surgical instrument comprising an elongated tube and first and second jaws pivotally connected to each other. The tube houses a camming rod having a camming pin and a camming projection. Each of the jaws is provided with a cam slot, an interior and an exterior camming surface. The camming pin rides along the first and second jaw's interior camming surfaces and operates to close the jaws when the camming rod is moved proximally. The camming projection rides on the first and second jaw's exterior camming surfaces and operates to open the jaws when the camming rod is moved distally.

    SUMMARY



    [0006] The invention is defined by the subject-matter of claim 1. Preferred embodiments are subject of the dependent claims.

    BRIEF DESCRIPTION OF THE DRAWING



    [0007] The accompanying drawings incorporated in and forming a part of the specification illustrate several aspects of the present invention, and together with the description serve to explain the principles of the invention. In the drawings:
    FIG. 1
    is a top view of a medical system having a medical device for engaging tissue, constructed in accordance with the teachings of the present invention;
    FIG. 2
    is a top view similar to FIG. 1, but showing the outer structures in dotted lines and the interior sections in solid lines and partial cross section;
    FIG. 3
    is a side view of the medical system and device depicted in FIG. 1;
    FIG. 4
    is a side view similar to FIG. 3, but showing the outer structures in dotted lines and the interior structures in solid lines and partial cross section;
    FIG. 5
    is a side view of a medical device that is part of the medical system depicted in FIGS. 1-4;
    FIG. 6
    is a front view of a housing forming a portion of the medical system and device depicted in FIGS. 1-5;
    FIG. 7
    is a perspective view of the housing depicted in FIG. 6;
    FIGS. 8-12
    are side views showing operation of the medical system and device depicted in FIGS. 1-5;
    FIGS. 13 and 14
    are top views, partially in cross-section, depicting operation of the medical system and device depicted in FIGS. 1-4;
    FIGS. 15 and 16
    are cross-sectional views showing operation of the medical system depicted in FIGS. 1-4; and
    FIG. 17
    is a side view of a handle forming a portion of the medical system of FIG. 1.

    DETAILED DESCRIPTION



    [0008] The terms "proximal" and "distal" as used herein are intended to have a reference point relative to the user. Specifically, throughout the specification, the terms "distal" and "distally" shall denote a position, direction, or orientation that is generally away from the user, and the terms "proximal" and "proximally" shall denote a position, direction, or orientation that is generally towards the user.

    [0009] An exemplary medical system 20 having a medical device 40 for engaging tissue T (FIG. 11) is shown in FIGS. 1 through 4. The medical system 20 and device 40 are generally sized and structured for operation through the working channel of an endoscope (not shown) or other scope, although the system 20 and device 40 may also be used in conjunction with other elongate devices such as catheters, fiber-optic visualization systems, needles and the like. Generally, the medical system 20 includes a drive wire 22 slidably housed by a sheath 23 and having a tubular connector 24 at the distal end for selective connection to, and operation of, the medical device 40. As will be described in further detail herein, the medical device 40 generally includes a housing 42 having a first jaw 44 and a second jaw 46 pivotally connected thereto for engaging the tissue T. Generally, the jaws 44, 46 have been shown as forming grasping forceps, although the jaws are intended to be used to clip tissue, e.g. to close an opening or for hemostasis. Accordingly, it will be recognized that the shape and structure of the jaws may take many forms and serve many purposes and functions.

    [0010] In the medical system 20, the drive wire 22 slidably extends through the tubular connector 24. Although the term "wire" is used to refer to the drive wire 22, it will be recognized that any elongate control member capable of transmitting longitudinal force over a distance (such as is required in typical endoscopic, laparoscopic and similar procedures) may be used, and this includes plastic rods or tubes, single filament or multi-filament wires and the like. A connection block 26 is slidably fitted within the tubular connector 24 and defines a bore 28 therethrough which slidably receives the drive wire 22. The exterior of the connection block 26 includes a recessed portion 27, and a pin 30 is connected to the tubular connector 24 and fits within the recessed portion 27 to limit the longitudinal movement of the connection block 26.

    [0011] A distal end of the drive wire 22 defines a distal head 32 that is sized larger than the drive wire 22, and likewise larger than the bore 28 and the connection block 26. As will be described later herein, the distal head 32 is used to slide the connection block 26 within the tubular connector 24 to disconnect the medical device 40 from the medical system 20. As also seen in FIGS. 1-4, the housing 42 of the medical device 40 is a tubular member defining an interior space 43. A proximal end of the housing 42 frictionally receives a distal end of the connection block 26 within the interior space 43 for selective connection therewith.

    [0012] The internal passageway 43 of the housing 42 also receives the first and second jaws 44, 46 and a driver 48 which is used to interconnect the drive wire 22 to the jaws 44, 46. As best seen in FIGS. 1, 2 and 5, the driver 48 has a proximal portion which defines a socket 50 sized to receive enlarged distal head 32 of the drive wire 22. At the proximal entrance of the socket 50, two deflectable locking tabs 52 are formed which rotate relative to the remainder of the driver 48. The locking tabs 52 may be separately formed and pivotally attached to the driver 48, or may be integrally formed with the driver 48 and of a resilient material which flexes to permit rotation of the locking tabs 52 radially inwardly and radially outwardly. A distal portion of the driver 48 defines a rack 54 for engaging and operating the jaws 44, 46. In the depicted embodiment, the rack 54 includes a central spine 56 having teeth 58 projecting away from the central spine 56 and on opposite sides of the spine 56. One set of teeth 58 on one side of the spine 56 generally operate the first jaw 44 while the other set of teeth 58 on the other side of the spine 56 operate the second jaw 46. It will be recognized that the rack 54 may include a single set of teeth or other geared structures that interface with the jaws 44, 46.

    [0013] As best seen in FIG. 5, the first and second jaws 44, 46 include distal ends 60, 62 that are structured to grasp and engage tissue, and preferably they have a talon shape as disclosed in 61/141,934 filed December 31, 2008. The proximal ends 64, 66 of the first and second jaws 44, 46 each include a pinion gear 68, 70 having a series of teeth. The teeth of the pinion 68, 70 mesh with the teeth of the rack 54 of the driver 48 such that longitudinal translation of the driver 48 induces rotation in the first and second jaws 44, 46 relative to one another. Generally, distal translation of the driver 48 causes the first and second jaws 44, 46 to rotate outwardly away from each other, while proximal retraction of the driver 48 causes the first and second jaws 44, 46 to rotate inwardly toward one another. Pins 80 are fitted through each the proximal ends of the jaws 44, 46, to pivotally connect the jaws to the housing 42. Other structures for forming a pivotal connection may be used, and preferably the pivotal connection is centrally arranged relative to the pinions 68, 70.

    [0014] In addition to the jaws 44, 46 being pivotally attached to the housing 42, the first and second jaws 44, 46 are also slidably attached to the housing 42. As best seen in FIGS. 6 and 7 (and in conjunction with FIGS. 1-4) the housing 42 defines a first guide surface 82 for the first jaw 44, and a second guide surface 84 for the second jaw 46. As seen in FIG. 3, the first and second guide surfaces 82, 84 are formed by elongated slots 82a, 82b, 84a, 84b formed in opposing sides of the housing 42 which leaves a thickness of the housing 42 exposed to serve as the guide surface. The slots 82a, 82b are aligned to receive the connecting pin 80 of the first jaw 44, and likewise the slots 84a, 84b are aligned to receive the connecting pin 80 of the second jaw 46. The ends of the slots, for example distal ends 92, 94 shown in FIG. 7, serve to restrict the longitudinal movement of the jaws 44, 46 relative to the housing 42. The proximal ends 64, 66 of the jaws 44, 46 include apertures 72, 74 which receive the pins 80 (FIGS. 1, 2 and 3) that are used to slidably and pivotally connect the first and second jaws 44, 46 to the housing 42.

    [0015] It can also be seen in FIGS. 6 and 7 that the housing 42 defines a third guide surface 86 which guides the longitudinal movement of the driver 48 within the housing 42. The guide surface 86 in the depicted embodiment includes a left guide surface 86a and a right guide surface 86b formed as C-shaped channels. As shown in FIG. 7, the third guide surface 86 transitions from a smaller distal width to a larger proximal width to define a shoulder 88 at the transition, which will be further described hereinbelow with reference to FIGS. 13 and 14. Various combinations of slots, guide surfaces, pins and other slidable engagement structures can be employed to connect the jaws to the housing.

    [0016] As also shown in FIG. 6, the internal passageway 43 of the housing 42 extends through the distal end of the housing, and through which the first and second jaws 44, 46 can extend. Additionally, as shown in FIGS. 1 and 2, the housing 42 defines opposing slots 45 which are sized to permit the first and second jaws 44, 46 to pass therethrough when they rotate radially outwardly. Accordingly, it is also clear from FIGS. 1 and 2 that the housing 42 serves to block rotation of the first and second jaws 44, 46 when they are entirely or partially contained within the internal passageway 43 of the housing 42.

    [0017] Operation of the medical device 40 will now be described with reference to FIGS. 8-12. As shown in FIG. 8, the first and second jaws 44, 46 are shown in a retracted position where they are substantially contained within the housing 42. Depending on the application, the distal ends 60, 62 of the jaws 44, 46 may slightly project from the distal end of the housing 42 in their retracted positions, or they may be entirely positioned within the housing 42. When the drive wire 22 is translated distally (to the right on the page in FIG. 8) the distal head 32 engages the driver 48, and since the rack 54 of the driver 48 is meshed with the pinions 68, 70 at the proximal ends 64, 60 of the jaws 44, 46, the driver 48 and jaws 44, 46 slide distally through the housing 42 because the housing 42 blocks their rotation. As previously mentioned, this longitudinal movement is guided by the first and second guide surfaces 82, 84 which receive the pins 80 that slidably and pivotally connect the jaws 44, 46 to the housing 42.

    [0018] As shown in FIG. 9, the first and second jaws 44, 46 have an extended position where the jaws substantially project from a distal end of the housing 42, and their proximal ends 64, 66 are positioned adjacent the distal end of the housing 42. Accordingly, it will be seen that further distal advancement of drive wire 22, and hence the driver 48, causes the pinion 68 to rotate over the teeth 58 of the rack 54. As best seen in FIG. 10, the first and second jaws 44, 46 rotate radially outwardly from each other into a tissue receiving position. Notably, due to the presence of slots 45 at the distal end of the housing 42, the jaws 44, 46 are permitted to rotate a full 90°, thus forming at least a 180° between them. It will be recognized that through the sizing of the slots 45 and the construction of the rack 54 and pinions 68, 70, the first and second jaws 44, 46 may rotate even further away from each other.

    [0019] In the tissue receiving configuration shown in FIG. 10, the medical device 40 and its jaws 44, 46 may be positioned adjacent tissue T. As shown in FIG. 11, the tissue T may be placed between the first and second jaws 44, 46 and the jaws 44, 46 rotated back towards their position shown in FIG. 9. The tissue T has been shown as a single layer, although multiple layers may be clipped between the jaws 44, 46. Generally, proximal retraction of the drive wire 22 and the driver 48 again causes rotation of the first and second jaws 44, 46 to grasp the tissue T therebetween. As shown in FIG. 12, further proximal retraction of the drive wire 22 and driver 48 will cause the jaws 44, 46 to move longitudinally in a proximal direction (to the left on the page in FIG. 12).

    [0020] In order for the medical device 40 to serve as a clip and maintain its grasp on the tissue T, or to maintain the clipping of two layers of tissue against each other, the jaws 44, 46 may be locked in position and the drive wire 22 of the medical system 20 disconnected from the medical device 40. As shown in FIG. 13, the third guide surface 86 (which guides the driver 48) includes a proximal portion 86p and a distal portion 86d. The proximal portion 86p of the third guide surface 86 has a width (measured up and down on the page in FIG. 13) that is greater than a width of the distal portion 86d of the third guide 86. As previously discussed, the third guide surface 86 is formed by opposing surfaces or C-shaped channels 86a, 86b of the housing 42. The transition between the proximal portion 86p and distal portion 86d defines a shoulder 88, and namely two shoulders 88a, 88b on opposing sides of the housing 42. The shoulders 88a, 88b are sized and positioned to engage the opposing locking tabs 52 located on the driver 48.

    [0021] As shown in FIG. 13, when the driver 48 is located within the distal portion 86d of the third guide surface 86, the locking tabs 52 are forced radially inwardly into firm frictional engagement with the drive wire 22. Stated another way, the socket 50 formed by the driver 48 to receive the distal head 32 has an entrance which is narrowed by the inward deflection of the locking tabs 52. In this state depicted in FIG. 13, the drive wire 22 is firmly engaged with the driver 48 and hence the first and second jaws 44, 46. When the drive wire 22 and driver 48 are retracted proximally, for example upon grasping tissue as shown in FIG. 12, the proximal end of the driver 48 is received within the proximal portion 86p of the third guide surface 86 which has a larger width that permits outward movement of the locking tabs 52. Accordingly, in the state depicted in FIG. 14, the locking tabs 52 may be loosely and detachably connected to the distal head 32 of the drive wire 22. That is, the proximal retraction of the jaws 44, 46 will be limited by either the tissue T engaging the distal end of the housing 42, or the pins 80 will abut the proximal ends of the slots 82a, 82b, 84a, 84b defining a first and second guide surfaces 82, 84. As such, when proximal movement of the jaws 44, 46 and the driver 48 are thus limited, further proximal movement of the drive wire 22 and its distal head 32 may be used to withdraw the distal head 32 from the socket 50 of the driver 48. This operation may also be used to further deflect the locking tabs 52 radially outwardly. In the event the natural elasticity of the tissue T tends to pull the jaws 44, 46 out from the housing towards their extended position, the locking tabs 52, 54 will abut the shoulders 88a, 88b of the third guide surface of the housing 42 to prevent further distal movement of the jaws 44, 46.

    [0022] In one preferred embodiment the locking tabs 52 are plastically deformable, and may be bent around the distal head 32 of the drive wire 22 during manufacture. The driver 48 and its tabs 52 may thus have an initial size to slide within the distal portion 86d of the third guide surface 86, and proximal retraction of the drive wire 22 and distal head 32 of a predetermined force will plastically deform the locking tabs 52 outwardly into a position to engage the shoulders 88a, 88b and lock the clip by preventing distal movement of the jaws 44, 46 therebeyond.

    [0023] Turning now to FIGS. 15 and 16, upon still further proximal retraction of the drive wire 22 and distal head 32, the enlarged distal head 32 will abut the connection block 26 which is slidably fitted within the tubular connector 24. Sufficient proximal force on the drive wire 22 will overcome the frictional fit between the connection block 26 and the proximal end of the housing 42, thus moving the connection block 26 proximally (to the right on the page of FIGS. 15 and 16) to retract the connection block 26 within the tubular connector 24. An elongate sheath 23 slidably encases the drive wire 22, and extends proximally therealong to the proximal end of the device. The sheath 23 can be used to provide a counterforce on the connector 24 and housing 42 while proximally retracting the drive wire 22 and connection block 26. Accordingly, the drive wire 22, tubular connector 24 and connection block 26 may be fully disconnected from the medical device 40, thereby leaving the first and second jaws 44, 46 and the housing 42 in a state having the tissue T clipped between the jaws 44, 46 and retained in vivo.

    [0024] It will be recognized by those skilled in the art that the drive wire 22 and its distal head 32 could again be connected to the driver 48 and its socket 50, thus permitting additional manipulation of the medical device to adjust the clipped tissue T. Likewise, additional medical devices may be attached to the drive wire 22 and tubular connector 24 of the medical system 20 for deployment of the additional medical devices, e.g. multiple devices 40 for clipping the tissue T may be used to close a perforation or achieve hemostasis. Generally, the support ring 34 (FIGS. 1-4) fixed on the drive wire 22 can be used to limit the distal movement of the drive wire 22, and can be distally advanced to a position abutting the connection block 26. As such, the drive wire 22 and support ring 34 can be used to push the connection block 26 distally out of the tubular connector 24 so that it can be attached to the housing (e.g. 42) of a new medical device (e.g. 40), or the previously placed medical device 40. Alternatively, the user may manually press (i.e. with fingers or a tool) the connection block 26 distally out of the tubular connector 24 for connection to another medical device.

    [0025] The medical system 20 also includes a proximal end device for operating the medical device 40, and preferably a handle 90 as shown. The handle 90 includes an outer member 92 slidably receiving an inner member 94. The outer member 92 is a tubular member defining a passageway that receives the inner member 94, and includes a spool 96 formed on the outer surface which is shaped to be gripped by the fingers of the medical professional. The inner member 94 may be tubular or rod shaped, and includes a thumb ring 98 at its proximal end for gripping by the professional. The outer member 92 is attached to the sheath 23, which is preferably a coated coiled wire catheter as is known in the art. The inner member 94 is connected to the drive wire 22. In this way, translation of the inner member 94 and thumb ring 98 relative to the outer member 92 and spool 96 causes relative translation of the drive wire 22 relative to the sheath 23. This in turn operates the medical device 40, namely the clip defined by the housing 42 and jaws 44, 46 which rotate relative thereto, as previously described. A side port 100 may also be provided in communication with the interior passageway of the outer member 92 and sheath 23 for injection of fluids or other agents for facilitating hemostasis, closure, cleaning or other aspects related to the methods described above.

    [0026] It will be recognized by those skilled in the art that, while the methods described above generally include placing the tissue devices in tissue through an internal bodily lumen, it will be recognized that the systems, devices and methods may be used on any layer of material (e.g. fabrics, cloth, polymers, elastomers, plastics and rubber) that may or may not be associated with a human or animal body and a bodily lumen. For example, the systems, devices and methods can find use in laboratory and industrial settings for clipping (or cutting, ligating, grasping) one or more layers of material that may or may not find application to the human or animal body, and likewise closing holes or perforations in layers of material that are not bodily tissue. Some examples include sewing or stitching and related manufacturing, working with synthetic tissues, connecting or repairing polymeric sheets, animal studies, veterinary applications, and post-mortem activities.

    [0027] The foregoing description has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise embodiments disclosed. Numerous modifications or variations are possible in light of the above teachings. The embodiments discussed were chosen and described to provide the best illustration of the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated. All such modifications and variations are within the scope of the invention as determined by the appended claims when interpreted in accordance with the breadth to which they are fairly, legally, and equitably entitled.


    Claims

    1. A medical device (40) for engaging tissue (T), the medical device (40) comprising:

    a housing (42) defining an internal passageway (43) and a longitudinal axis extending between proximal and distal ends of the housing (42), the housing (42) defining first and second guide surfaces (82, 84) along the internal passageway (43);

    a first jaw (44) slidably and pivotally connected to the housing (42), the first jaw (44) having proximal and distal ends (60, 64), the first jaw (44) being slidably received within the internal passageway (43) for longitudinal movement along the first guide surface (82) between an extended position and a retracted position;

    a second jaw (46) slidably and pivotally connected to the housing (42), the second jaw (46) having proximal and distal ends (62, 66), the second jaw (46) being slidably received within the internal passageway (43) for longitudinal movement along the second guide surface (84) between an extended position and a retracted position;

    wherein the housing (42) is structured to block rotation of the first and second jaws (44, 46) when they are in their retracted positions, and wherein the housing (42) is structured to permit rotation of the first and second jaws (44, 46) when they are in their extended positions; and a driver (48) engaged with the proximal ends (64, 66) of the first and second jaws (44, 46), wherein longitudinal movement of the driver (48) moves the first and second jaws longitudinally along the first and second guide surfaces (82, 84) between their retracted and extended positions

    characterized in that

    the proximal ends (64, 66) of the first and second jaws (44, 46) include geared teeth (68, 70), and the driver (48) includes corresponding teeth (58) that mesh with the geared teeth (68, 70) of the jaws (44, 46), wherein longitudinal movement of the driver (48) rotates the first and second jaws (44, 46) relative to the housing (42) when the first and second jaws (44, 46) are in their extended positions.


     
    2. The medical device (40) of claim 1, wherein the proximal ends (64, 66) of the first and second jaws (44, 46) are formed as pinions (68, 70), and wherein the driver (48) is formed as a rack (54), wherein longitudinal movement of the driver (48) rotates the pinions (68, 70) and the first and second jaws (44, 46) in their extended positions.
     
    3. The medical device (40) of claim 2, wherein the driver (48) includes a central spine (56) extending longitudinally and the teeth (58) of the driver (48) extend laterally from the central spine (56).
     
    4. The medical device (40) of claim 3, wherein the driver (48) includes pairs of said teeth (58) extending in laterally opposite directions from the spine (56) to form two sets of teeth (58), wherein one of the two sets of teeth (58) is engaged with the pinion (68) of the first jaw (44), and wherein the other of the two sets of teeth (58) is engaged with the pinion (70) of the second jaw (46).
     
    5. The medical device (40) of claim 1, wherein the proximal ends (64, 66) of the first and second jaws (44, 46) are located adjacent the distal end of the housing (42) when the first and second jaws (44, 46) are in their extended positions.
     
    6. The medical device (40) of claim 1, wherein the housing (42) defines a shoulder (88) within the internal passageway (43), and wherein the driver (48) includes a locking tab (52) positioned to engage the shoulder (88) to limit longitudinal movement of the driver (48) and the first and second jaws (44, 46).
     
    7. The medical device (40) of claim 6, wherein the housing (42) defines a third guide surface (86), wherein the third guide surface (86) guides longitudinal movement of the driver (48) within the housing, wherein the third guide surface (86) defines the shoulder (88).
     
    8. The medical device (40) of claim 1, wherein the first and second guide surfaces (82, 84) are formed by first and second pairs of elongated slots (82a, 82b; 84a, 84b) formed in opposing sides of the housing (42);
    wherein the proximal ends (64, 66) of the first and second jaws (44, 46) include apertures (72, 74) which receive connection pins (80) slidably and pivotally connecting the first and second jaws (44, 46) to the housing (42);
    wherein the first pair of elongated slots (82a, 82b) is aligned to receive the connection pin (80) of the first jaw (44) and the second pair of elongated slots (84a, 84b) is aligned to receive the connection pin (80) of the second jaw (46); and wherein the distal ends (92, 94) of the slots (82a, 82b; 84a, 84b) restrict the longitudinal movement of the first and second jaws (44, 46) relative to the housing (42).
     


    Ansprüche

    1. Medizinische Vorrichtung (40) zum Eingreifen in Gewebe (T), wobei die medizinische Vorrichtung (40) umfasst:

    ein Gehäuse (42), das einen internen Durchgang (43) und eine Längsachse definiert, die sich zwischen einem proximalen und distalen Ende des Gehäuses (42) erstrecken, wobei das Gehäuse (42) eine erste und zweite Führungsfläche (82, 84) entlang des internen Durchgangs (43) definiert;

    eine erste Backe (44), die verschiebbar und drehbar mit dem Gehäuse (42) verbunden ist, wobei die erste Backe (44) ein proximales und ein distales Ende (60, 64) aufweist, wobei die erste Backe (44) verschiebbar innerhalb des internen Durchgangs (43) aufgenommen ist zur Längsbewegung entlang der ersten Führungsfläche (82) zwischen einer ausgefahrenen Position und einer eingefahrenen Position;

    eine zweite Backe (46), die verschiebbar und drehbar mit dem Gehäuse (42) verbunden ist, wobei die zweite Backe (46) ein proximales und ein distales Ende (62, 66) aufweist, wobei die zweite Backe (46) verschiebbar innerhalb des internen Durchgangs (43) aufgenommen ist zur Längsbewegung entlang der zweiten Führungsfläche (84) zwischen einer ausgefahrenen Position und einer eingefahrenen Position;

    wobei das Gehäuse (42) so gestaltet ist, dass es eine Rotation der ersten und zweiten Backe (44, 46) blockiert, wenn sie sich in ihren eingefahrenen Positionen befinden, und wobei das Gehäuse (42) so gestaltet ist, dass es eine Rotation der ersten und zweiten Backe (44, 46) ermöglicht, wenn sie sich in ihren ausgefahrenen Positionen befinden; und

    einen Mitnehmer (48), der mit den proximalen Enden (64, 66) der ersten und zweiten Backe (44, 46) in Eingriff steht, wobei die Längsbewegung des Mitnehmers (48) die erste und zweite Backe in Längsrichtung entlang der ersten und zweiten Führungsfläche (82, 84) zwischen ihren eingefahrenen und ausgefahrenen Positionen bewegt,

    dadurch gekennzeichnet, dass

    die proximalen Enden (64, 66) der ersten und zweiten Backe (44, 46) Getriebezähne (68, 70) umfassen und der Mitnehmer (48) korrespondierende Zähne (58) umfasst, die mit den Getriebezähnen (68, 70) der Backen (44, 46) in Eingriff stehen, wobei die Längsbewegung des Mitnehmers (48) die erste und zweite Backe (44, 46) relativ zum Gehäuse (42) dreht, wenn sich die erste und zweite Backe (44, 46) in ihren ausgefahrenen Positionen befinden.


     
    2. Medizinische Vorrichtung (40) nach Anspruch 1, wobei die proximalen Enden (64, 66) der ersten und zweiten Backe (44, 46) als Zahnräder (68, 70) ausgebildet sind, und wobei der Mitnehmer (48) als eine Zahnstange (54) ausgebildet ist, wobei eine Längsbewegung des Mitnehmers (48) die Zahnräder (68, 70) und die erste und zweite Backe (44, 46) in ihre ausgefahrenen Positionen dreht.
     
    3. Medizinische Vorrichtung (40) nach Anspruch 2, wobei der Mitnehmer (48) einen zentralen Steg (56) umfasst, der sich in Längsrichtung erstreckt, und wobei sich die Zähne (58) des Mitnehmers (48) seitlich von dem zentralen Steg (56) erstrecken.
     
    4. Medizinische Vorrichtung (40) nach Anspruch 3, wobei der Mitnehmer (48) Paare der Zähne (58) umfasst, die sich in seitlich entgegengesetzten Richtungen des Steges (56) erstrecken, um zwei Gruppen von Zähnen (58) zu bilden, wobei eine der zwei Gruppen von Zähnen (58) mit dem Zahnrad (68) der ersten Backe (44) in Eingriff steht, und wobei die andere der zwei Gruppen von Zähnen (58) mit dem Zahnrad (70) der zweiten Backe (46) in Eingriff steht.
     
    5. Medizinische Vorrichtung (40) nach Anspruch 1, wobei die proximalen Enden (64, 66) der ersten und zweiten Backe (44, 46) angrenzend an das distale Ende des Gehäuses (42) angeordnet sind, wenn sich die erste und zweite Backe (44, 46) in ihren ausgefahrenen Positionen befinden.
     
    6. Medizinische Vorrichtung (40) nach Anspruch 1, wobei das Gehäuse (42) eine Schulter (88) innerhalb des internen Durchgangs (43) definiert, und wobei der Mitnehmer (48) eine Verriegelungslasche (52) umfasst, die so positioniert ist, dass sie mit der Schulter (88) in Eingriff kommt, um die Längsbewegung des Mitnehmers (48) und der ersten und zweiten Backe (44, 46) zu begrenzen.
     
    7. Medizinische Vorrichtung (40) nach Anspruch 6, wobei das Gehäuse (42) eine dritte Führungsfläche (86) definiert, wobei die dritte Führungsfläche (86) die Längsbewegung des Mitnehmers (48) innerhalb des Gehäuses führt, wobei die dritte Führungsfläche (86) die Schulter (88) definiert.
     
    8. Medizinische Vorrichtung (40) nach Anspruch 1, wobei die erste und zweite Führungsfläche (82, 84) durch ein erstes und ein zweites Paar von länglichen Schlitzen (82a, 82b; 84a, 84b) gebildet sind, die in sich gegenüberliegenden Seiten des Gehäuses (42) ausgebildet sind;
    wobei die proximalen Enden (64, 66) der ersten und zweiten Backe (44, 46) Öffnungen (72, 74) umfassen, die Verbindungsstifte (80) aufnehmen, die verschiebbar und drehbar die erste und zweite Backe (44, 46) mit dem Gehäuse (42) verbinden;
    wobei das erste Paar von länglichen Schlitzen (82a, 82b) ausgerichtet ist, um den Verbindungsstift (80) der ersten Backe (44) aufzunehmen, und das zweite Paar von länglichen Schlitzen (84a, 84b) ausgerichtet ist, um den Verbindungsstift (80) der zweiten Backe (46) aufzunehmen; und wobei die distalen Enden (92, 94) der Schlitze (82a, 82b; 84a, 84b) die Längsbewegung der ersten und zweiten Backe (44, 46) relativ zum Gehäuse (42) begrenzen.
     


    Revendications

    1. Dispositif médical (40) destiné à venir en contact avec un tissu (T), le dispositif médical (40) comprenant :

    un boîtier (42) définissant un passage interne (43) et un axe longitudinal s'étendant entre les extrémités proximale et distale du boîtier (42), le boîtier (42) définissant des première et deuxième surfaces de guidage (82, 84) le long du passage interne (43) ;

    une première mâchoire (44) reliée de manière coulissante et pivotante au boîtier (42), la première mâchoire (44) ayant des extrémités proximale et distale (60, 64), la première mâchoire (44) étant reçue de manière coulissante à l'intérieur du passage interne (43) pour un mouvement longitudinal le long de la première surface de guidage (82) entre une position déployée et une position rétractée ;

    une seconde mâchoire (46) reliée de manière coulissante et pivotante au boîtier (42), la seconde mâchoire (46) ayant des extrémités proximale et distale (62, 66), la seconde mâchoire (46) étant reçue de manière coulissante à l'intérieur du passage interne (43) pour un mouvement longitudinal le long de la deuxième surface de guidage (84) entre une position déployée et une position rétractée ;

    le boîtier (42) étant structuré pour bloquer la rotation des première et seconde mâchoires (44, 46) lorsqu'elles sont en position rétractée, le boîtier (42) étant structuré pour permettre la rotation des première et seconde mâchoires (44, 46) lorsqu'elles sont en position déployée ; et

    un élément d'entraînement (48) en contact avec les extrémités proximales (64, 66) des première et seconde mâchoires (44, 46), dans lequel le mouvement longitudinal de l'élément d'entraînement (48) déplace les première et seconde mâchoires longitudinalement le long des première et deuxième surfaces de guidage (82, 84) entre leurs positions rétractée et déployée,

    caractérisé en ce que les extrémités proximales (64, 66) des première et seconde mâchoires (44, 46) comprennent des dents à engrenage (68, 70), et l'élément d'entraînement (48) comprend des dents correspondantes (58) qui s'engrènent avec les dents à engrenage (68, 70) des mâchoires (44, 46), dans lequel le mouvement longitudinal de l'élément d'entraînement (48) fait tourner les première et seconde mâchoires (44, 46) par rapport au boîtier (42) lorsque les première et seconde mâchoires (44, 46) sont en position déployée.


     
    2. Dispositif médical (40) selon la revendication 1, dans lequel les extrémités proximales (64, 66) des première et seconde mâchoires (44, 46) sont réalisées sous forme de pignons (68, 70), et dans lequel l'élément d'entraînement (48) est réalisé sous forme de crémaillère (54), dans lequel le mouvement longitudinal de l'élément d'entraînement (48) fait tourner les pignons (68, 70) et les première et seconde mâchoires (44, 46) en position déployée.
     
    3. Dispositif médical (40) selon la revendication 2, dans lequel l'élément d'entraînement (48) comprend une colonne centrale (56) s'étendant longitudinalement et les dents (58) de l'élément d'entraînement (48) s'étendent latéralement à partir de la colonne centrale (56).
     
    4. Dispositif médical (40) selon la revendication 3, dans lequel l'élément d'entraînement (48) comprend des paires desdites dents (58) s'étendant dans des directions latéralement opposées à partir de la colonne (56) pour former deux ensembles de dents (58), dans lequel l'un des deux ensembles de dents (58) est en contact avec le pignon (68) de la première mâchoire (44), et dans lequel l'autre des deux ensembles de dents (58) est en contact avec le pignon (70) de la seconde mâchoire (46).
     
    5. Dispositif médical (40) selon la revendication 1, dans lequel les extrémités proximales (64, 66) des première et seconde mâchoires (44, 46) sont situées à proximité de l'extrémité distale du boîtier (42) lorsque les première et seconde mâchoires (44, 46) sont en position déployée.
     
    6. Dispositif médical (40) selon la revendication 1, dans lequel le boîtier (42) définit un épaulement (88) à l'intérieur du passage interne (43), et dans lequel l'élément d'entraînement (48) comprend une languette de verrouillage (52) positionnée pour venir en contact avec l'épaulement (88) afin de limiter le mouvement longitudinal de l'élément d'entraînement (48) et des première et seconde mâchoires (44, 46).
     
    7. Dispositif médical (40) selon la revendication 6, dans lequel le boîtier (42) définit une troisième surface de guidage (86), dans lequel la troisième surface de guidage (86) guide le mouvement longitudinal de l'élément d'entraînement (48) à l'intérieur du boîtier, dans lequel la troisième surface de guidage (86) définit l'épaulement (88).
     
    8. Dispositif médical (40) selon la revendication 1, dans lequel les première et deuxième surfaces de guidage (82, 84) sont formées par des première et seconde paires de fentes allongées (82a, 82b; 84a, 84b) formées dans des côtés opposés du boîtier (42) ;
    dans lequel les extrémités proximales (64, 66) des première et seconde mâchoires (44, 46) comportent des ouvertures (72, 74) qui reçoivent des broches de connexion (80) reliant de manière coulissante et pivotante les première et seconde mâchoires (44, 46) au boîtier (42) ;
    dans lequel la première paire de fentes allongées (82a, 82b) est alignée pour recevoir la broche de connexion (80) de la première mâchoire (44) et la seconde paire de fentes allongées (84a, 84b) est alignée pour recevoir la broche de connexion (80) de la seconde mâchoire (46) ; et dans lequel les extrémités distales (92, 94) des fentes (82a, 82b; 84a, 84b) limitent le mouvement longitudinal des première et seconde mâchoires (44, 46) par rapport au boîtier (42).
     




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    REFERENCES CITED IN THE DESCRIPTION



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    Patent documents cited in the description