NL2035331B1

NL2035331B1 - Surgical Clip

Info

Publication number: NL2035331B1
Application number: NL2035331A
Authority: NL
Inventors: Bronkers Glenn; Cornelis Elisabeth Van Thoor Alexander
Original assignee: Amt Medical B V
Priority date: 2023-07-10
Filing date: 2023-07-10
Publication date: 2025-01-24
Also published as: WO2025012245A1

Abstract

The invention relates to a surgical clip 101, comprising three parts 102a, 102b, 1020. A first outer part, a second outer part, and a middle part, arranged to be rotatable relative to each other around a common axis 103. Each part comprises an operating arm 104a, 104b, 1040 and a clamping member 105a, 105b, 105c. The clip further has a spring 111. The operating arm of the middle part 102b is arranged in between the operating arm of the first outer part 102a and the operating arm of the second outer part 1020. The clamping member of the middle part is arranged in between the clamping member of the first outer part and the 10 clamping member of the second outer part. The operating arm of the middle part is arranged transverse with respect to a plane 112 defined by the clamping member of the middle part. (Fig. 1b)

Description

P36307NLO0O

Title: Surgical Clip

BACKGROUND

Surgical clips are used to clamp hollow organs, for example for clamping two vessels, for example two blood vessels such as a vein or an artery. The vessels may be natural vessels or artificial vessels. For example, a surgical clip is used to connect an artificial graft vessel to a blood vessel at one point along the blood vessel, and another surgical clip is used to connect the artificial vessel to the blood vessel at another point along the blood vessel, forming a bypass.

Vessels may be attached to each other by the surgical clips in different ways, end-to-end known as an ETE anastomosis, end-to-side known as an ETS anastomosis, or side-to-side known as a STS anastomosis. Such anastomoses are conventionally made by sewing vessels together end-to-end, end-to-side, or side-to-side, respectively. Also clips or connectors may be used.

For example, in and end-to-end connection, the end of a first vessel may be passed through a first ring of the surgical clip and turned inside out to be folded back around the (outside of the) ring. The end of a second vessel may be passed through a second ring of the surgical clip and turned inside out as well, to be folded back around the (outside of the) ring. The surgical clip is subsequently closed by pressing the first and second ring towards each other, connecting the first and the second vessel to each other at their ends.

For another example, in a side-to-side connection, a first fork attached to the surgical clip is passed through a wall of a first vessel. A second fork attached to the surgical clip is passed through the wall of a second vessel. These forks are pressed towards each other, and a part of the first vessel and the second vessel that extends parallel to the plane defined by the first fork and the second fork, respectively, is removed. Thereby, an opening in the walls of both vessels is created, which opening forms a passage in between the prongs of the fork, which passage connects the lumen of the first vessel with the lumen of the second vessel. The surgical clip is subsequently closed, connecting the first and the second vessel to each other at the openings that were created.

In a manner similar to the above examples, an end-to-side connection is also possible wherein the surgical clip has one ring and one fork. Then the fork and ring are pressed towards each other and vessel wall tissue between the prongs of the vessel into which the fork has been inserted is removed.

The forks and/or the rings of the surgical clip are the clamping members of the surgical clip. A third clamping member in the form of a ring may be provided between the above discussed clamping members, which then may be called a first outer clamping member and a second outer clamping member. In the closed state of the surgical clip and without any vessel being attached yet to the fork(s) and/or ring(s), the clamping members of the surgical clip abut against each other. In case of a first outer clamping member, a second outer clamping member, and a third/middle clamping member, the first outer clamping member may then abut against one side of the middle clamping member and the second outer clamping member may then abut against the opposing other side of the middle clamping member. A pre-tensioning clamping force may be exerted on the clamping members such that the surgical clip remains in its closed state.

The surgical clip may be opened by counteracting this pre-tensioning clamping force. Typically, the surgical clip comprises a number of operating arms that can either be spread apart or pressed together to open either one of the clamping members with respect to the other clamping member. Thereby, the clamping force is counteracted to mount a vessel to the opened clamping member temporarily. Once the vessel is mounted to the opened clamping member, the surgical clip is returned to its closed state.

Such surgical clips are typically used in surgical procedures, such as coronary artery bypass surgeries. These surgeries may be invasive, e.g., they may require open-heart surgery.

Such invasive surgeries typically take a long time, require extensive tooling, and impose a long recovery time on patients. Less invasive surgeries attempt to be more localized by working with small incisions in the body of the patient to reach the vessels inside the human body. However, due to the constrained space in which the surgical procedure must be performed, current surgical clips and other tools may not be useable as they were designed with invasive surgeries in mind.

Examples of such surgical clips can for example be found in patent documents US 10,226,252 B2 and US 10,881,415 B2.

It is the object of the invention to provide a surgical clip that is in particular suitable to be used in so called minimal invasive surgeries.

SUMMARY

According to the invention, the object is achieved by a surgical clip, comprising: + three parts: a first outer part, a second outer part, and a middle part, arranged to be rotatable relative to each other around a common axis, each part comprising an operating arm and a clamping member; and * a spring; wherein: « the operating arm of the middle part is arranged in between the operating arm of the first outer part and the operating arm of the second outer part;

+ the clamping member of the middle part is arranged in between the clamping member of the first outer part and the clamping member of the second outer part; « the spring is configured to pretension the three parts towards a closed clip position in which the clamping members of the two outer parts and the clamping member of the middle part abut against each other; characterized in that: * the operating arm of the middle part is arranged transverse with respect to a plane defined by the clamping member of the middle part.

The surgical clip according to the invention can be in a closed clip position and in an open clip position. The first outer part can move with respect to the middle part and/or second outer part from a closed position to an open position, and vice versa. And also the second outer part can move with respect to the middle part and/or first outer part from a closed position to an open position, and vice versa. When one of the outer parts is in its open position and the other of the outer parts is in its closed position, the surgical clip can be said to be in a half opened position. When both outer parts are in their open position (with respect to the middle part), the surgical clip can be said to be in its fully open position. Although the fully open position may be possible, in practice the fully open position will in general not be used.

In the closed clip position, the clamping members of the two outer parts and the clamping member of the middle part abut against each other. With respect to this abutting it is noted, that this abutting may be a directly abutting in absence of any tissue, but, once the clip is in use for connecting vessels, tissue may be present between the clamping members resulting in a indirectly abutting via tissue in between adjacent clamping members.

Further, the spring engages the two outer parts. In the closed clip position, the spring force acts on the two outer parts, resulting in: — clamping the clamping members of the two outer parts together against the clamping member of the middle part, or — clamping the clamping member of the two outer parts against each other, while the clamping members of the two outer parts are, at least partly, nested within the clamping member of the middle part.

As already said, in use, optionally the clamping members of the parts do not directly touch each other in the closed clip position. Rather, tissue may be arranged in between the clamping members of the parts. For example, the tissue is tissue from a blood vessel.

In the closed clip position, the clamping members of all parts are arranged in an about same plane or in mutually about parallel planes. This plane, respectively, these planes are defined by the (plane of the) clamping member of the middle part, which clamping member can be said to remain within that plane even in the open clip position.

In the closed clip position, the operating arm of the middle part is arranged transverse with respect to the plane defined by the clamping member of the middle part. Said in other words, viewed from the common axis, the operating arm of the middle part extends in a direction transverse to the plane defined by the clamping member of the middle part.

In a further embodiment, the operating arm of each part may be arranged to extend, in the closed clip position, transverse with respect to the plane defined by the clamping member of the middle part. In other words, in the closed clip position, the operating arm of each part may be arranged transverse with respect to the plane defined by the clamping member of the middle part.

The surgical clip according to the invention is usable in minimal invasive procedures and surgeries. It was found that, by arranging the operating arm of the middle part transverse with respect to a plane defined by the clamping member of the middle part, the operating arms are located closer towards the clamping members of the parts. Therefore, the operating arms may more easily be reached through a smaller incision during the surgical procedure, while simultaneously being able to reach the clamping members in order to mount the vessels onto the clamping members.

In an embodiment according to the invention, the clamping member of the first outer part and the clamping member of the second outer part are configured to be opened relative to the clamping member of the middle part by moving the operating arm of the first outer part, respectively the operating arm of the second outer part, relative to the operating arm of the middle part against the force of the spring.

To open the surgical clip, a side of one of the operating arms of the first outer part or the second outer part is engaged together with the opposite side of the middle operating arm, thereby moving the one of the operating arms of the first outer part or the second outer part towards the middle operating arm. Due to the movement of the engaged operating arm relative to the middle operating arm, the clamping member of the respective outer part is moved away from the clamping member of the middle part against the force of the spring. For example, a forceps engages a side of the operating arm of the first outer part and the opposite side of the middle operating arm to move the operating arm of the first outer part towards the operating arm of the middle part when the forceps is squeezed. As a result, the clamping member of the first outer part is moved away from the clamping member of the middle part, thereby opening the surgical clip. While the clamping member of one of the outer parts is opened with respect to the clamping member of the middle part, the clamping member of the other outer part may remain closed with respect to the middle part. Therefore, the surgical clip allows for a first vessel to be clamped between the clamping member of the first outer part and the clamping member of the middle part. Subsequently, while the first vessel is being clamped, the surgical clip allows for the clamping member of the second outer part to be opened with respect to the clamping member of the middle part. As a result, two vessels are simultaneously clamped to the clip.

In the opened clip position, optionally the clamping member of both the outer parts are 5 opened with respect to the clamping member of the middle part.

In an embodiment according to the invention, the operating arm of the first outer part and the operating arm of the second outer part are arranged to be moveable away from the operating arm of the middle part against the force of the spring.

In this embodiment, the operating arms of the two outer parts are arranged such that they may be moved away from the operating arm of the middle part. For the operating arms to be reachable, the operating arms of the outer parts are arranged at an angle with respect to the operating arm of the middle part in the closed clip position. In use, the operating arm of an outer part is rotated away from the operating arm of the middle part, for example by a so called inverse forceps, i.e. a forceps in which the gripper parts move away from each other (instead of towards each other) when the handle parts are squeezed. As a result, the clamping member of the respective outer part is moved away from the clamping member of the middle part. Thereby, the surgical clip is brought to the open clip position.

In an embodiment according to the invention, the operating arm of the first outer part and the operating arm of the second outer part are arranged to be moveable towards the operating arm of the middle part against the force of the spring.

In this embodiment, the operating arms of the two outer parts are arranged such that they are rotatable towards the operating arm of the middle part. Thus, the operating arms of the outer parts are arranged at an angle with respect to the operating arm of the middle part other in the closed clip position. For example, the operating arms of the outer parts are, in the closed clip position, arranged at a same angle with respect to the operating arm of the middle part in the closed clip position. The angle between the operating arms of the parts is for example measured between imaginary lines extending from midpoints of the top side of each respective operating arm through the common axis of rotation. Preferably, the operating arms of the outer parts are, in the closed clip position, arranged at an angle between 10° and 50° with respect to the operating arm of the middle part. More preferably, the operating arms of the outer parts are, in the closed clip position, arranged at an angle between 15° and 45° with respect to the operating arm of the middle part. More preferably, the operating arms of the outer parts are arranged at an angle between 35° and 45° with respect to the operating arm of the middle part. For example, the operating arms of the outer parts may be arranged at an angle of about 35° or about 40° or about 45° with respect to the operating arm of the middle part.

The angle between the operating arms of the parts is for example measured between an imaginary line extending from the midpoint of the top side of an operating arm through the common axis of rotation and an imaginary line extending from the midpoint of the top side of another operating arm through the common axis of rotation.

The angle with which the operating arm of the outer parts are arranged with respect to the operating arm of the middle part defines the angle with which the clamping members of the outer parts are moved away from the clamping member of the middle part as a result of the operating arm of a respective outer part being moved towards the operating arm of the middle part. For example, if the operating arm of the outer parts are arranged at an angle of 35° with respect to the operating arm of the middle part, then the clamping members of the outer parts may be moved away from the clamping member of the middle part at an angle of 35° as well.

Therefore, the greater the angle between the operating arms of the outer parts is, the farther the clamping members of the outer parts may be moved away from the clamping member of the middle part.

In an embodiment according to the invention, the operating arm of the middle part is arranged at an angle in a range of 70° to 130°, preferable in a range of 80° to 120°, preferably in a range of 90° to 110°, with respect to the plane defined by the clamping member of the middle part.

The angle between the operating arms of the parts and the plane defined by the clamping member of the middle part is for example measured between an imaginary line extending from the midpoint of the top side of a respective operating arm through the common axis of rotation and the plane defined by the clamping member of the middle part.

For example, the operating arm of the middle part is arranged at an angle of 90° or 95° or 105° or 110° or 99° with respect to the plane defined by the clamping member of the middle part in the closed clip position. Preferably, the operating arm of the middle part is arranged at an angle of about 100° with respect to the plane defined by the clamping member of the middle part in the closed clip position.

In the closed clip position, the operating arm of each part is arranged at an angle in a range of 45° to 160°, optionally in a range of 50° to 150°, optionally in a range of 60° to 140°, with respect to the plane defined by the clamping member of the middle part.

For example, the operating arm of the first outer part is arranged at an angle of 130° or 135° or 145° or 150° or 137° with respect to the plane defined by the clamping member of the middle part in the closed clip position. Preferably, the operating arm of the first outer part is arranged at an angle of about 140° with respect to the plane defined by the clamping member of the middle part in the closed clip position. For example, the operating arm of the second outer part is arranged at an angle of 50° or 55° or 65° or 70° or 61° with respect to the plane defined by the clamping member of the middle part in the closed clip position.

Preferably, the operating arm of the second outer part is arranged at an angle of about 60° with respect to the plane defined by the clamping member of the middle part in the closed clip position.

In an embodiment according to the invention, each part further comprises a clamping arm. The clamping arm and the operating arm of each part are rigidly connected to each other at the common axis. The clamping arm and clamping member of one or more said parts, such as each part, are provided with a coupling assembly configured to mount the clamping member to the clamping arm.

Optionally, the operating arms of each part are arranged at an angle with respect to the clamping arm of the middle part. The angle between the operating arms of the parts and the clamping arm of the middle part is for example measured between an imaginary line extending from the midpoint of the top side of a respective operating arm through the common axis of rotation and an imaginary line extending from the midpoint of the side of the clamping arm comprising the coupling assembly through the common axis of rotation.

For example, the operating arm of the first outer part is arranged at an angle in a range of 60° to 90° with respect to the clamping arm of the middle part. Optionally, the operating arm of the first outer part is arranged at an angle of 65° or 70° or 75° or 80° or 85° with respect to the clamping arm of the middle part. For example, the operating arm of the second outer part is arranged at an angle in a range of 135° to 165° with respect to the clamping arm of the middle part. Optionally, the operating arm of the second outer part is arranged at an angle of 140° or 145° or 148° or 150° or 155° or 160° with respect to the clamping arm of the middle part. For example, the operating arm of middle part is arranged at an angle in a range of 95° to 135° with respect to the clamping arm of the middle part. Optionally, the operating arm of the second outer part is arranged at an angle of 100° or 105° or 108° or 110° or 115° or 120° or 125° or 1309 with respect to the clamping arm of the middle part.

In an embodiment according to the invention, the coupling assembly comprises a receptacle and an insert part receivable in the receptacle to mount the clamping member to the clamping arm. The receptacle is provided on one of the clamping arm and clamping member. The insert part is provided on the other one of the clamping arm and clamping member.

In an embodiment according to the invention, each part comprises a circular element between the clamping arm and the operating arm, the circular element rigidly connecting the clamping arm and the operating arm to each other. The first outer part and the second outer part each comprise a circular recess along a portion of the circular element. The outer diameter of the circular element of each part is identical to the inner diameter of the circular recess of both the first outer part and the second outer part.

In a variant of this embodiment, the circular element of the first outer part and the circular element of the second outer part is provided at one of the two axial sides of the respective outer part. The first outer part and the second outer part each comprise a protrusion which protrudes radially inward along the portion of the circular element and which protrusion is provided at the other axial side of the two axial sides of the respective outer part.

The circular element of the first outer part and the circular element of the second outer part and the circular element of the middle element are fitted between the protrusion and the circular element of the other outer part.

In an embodiment according to the invention, the clamping member of at least one said three parts is designed as a ring.

In a variant of this embodiment, the clamping member of each said three parts is designed as a ring and the openings of the rings are, in the closed clip position, aligned to form a passage.

A ring may be for example be shaped as a circle, an oval, a rectangle, a square, or any other suitable ring shape.

The ring is suitable for a vessel, such as a blood vessel, to be passed through and wrapped around the outside of the ring for an end-to-end or end-to-side connection of two vessels.

In an embodiment according to the invention, the clamping member of at least one said three parts is designed as a fork.

The fork is suitable for insertion into a vessel, such as a blood vessel, for a side-to- side or end-to-side connection of two vessels.

In an embodiment according to the invention the clamping member of the middle part is designed as a ring. In a further embodiment of this embodiment, the clamping members of the first outer part and the second outer part may both be designed as a fork. This embodiment is particularly suitable for side-to-side connection of two vessels.

In a variant of this embodiment, the clamping members of the first outer part and the second outer part are embedded into the opening of the ring in the closed clip position, forming a passage.

In an alternative other further embodiment of the embodiment in which the middle part is designed as a ring, the clamping members of the first and second outer part may both be designed as a ring. This is in particular suitable for an end-to-end connection of two vessels.

According to another alternative of the embodiment in which the middle part is designed as a ring, the clamping members of the first outer part may be designed as a ring and the clamping member of the second outer part may be designed as a fork, or the other way around. This is in particular suitable for an end-to-side connection of two vessels.

In an embodiment according to the invention the spring comprises two spring ends.

The spring ends engage on the first outer part and the second outer part to effect the pretension and closing action.

In other wards, one spring end engages on the first outer part to pretension the clamping member attached to the first outer part towards the clamping member attached to the middle part. The other spring end engages on the second outer part to pretension the clamping member attached to the second outer part towards the clamping member attached to the middle part. Thereby, the spring ends effect the pretension action. Further, the pretension force is capable of keeping the clip in closed position and may be overcome by exerting a force on an operating arm of one of the outer parts to move the operating arm of the respective part towards the operating arm of the middle part, thereby opening the surgical clip, ie, thereby effecting an opening action whilst increasing the tension of the spring.

Further, the spring ends engage on the first outer part and the second outer part to effect an closing action. When the surgical clip is (partially) opened, a closing action is effected by the spring when the force exerting on the operating arm of the one of the outer parts is released. Thereby, the surgical clip is returned to its closed clip position by the spring force which moves the clamping member of the one of the outer parts back towards the clamping member of the middle part until the clamping member of the one of the outer parts and the clamping member of the middle part abut against each other and are held in the closed position by the pretension force of the spring.

In a variant of this embodiment, the spring ends are connected to the first outer part and the second outer part, respectively, in a material-bonding manner, the material-boding manner preferably being welding.

In a variant of this embodiment, the spring is designed as a torsion spring and the winding body of the spring is at least partially accommodated in a common opening of the parts corresponding to the common axis.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is described below with reference to the figures. These figures serve as examples to illustrate the invention and will not be construed as limiting the scope of the claims.

Inthe different figures, like features are indicated by the like reference numerals.

In the figures:

Fig. 1a schematically shows a side view of a surgical clip according to an embodiment of the invention in an open clip position.

Fig. 1b schematically shows a side view of a surgical clip according to an embodiment of the invention in a closed clip position.

Fig. 2a schematically shows a perspective view of a surgical clip according to an embodiment of the invention in an open clip position.

Fig. 2b schematically shows a side view of a surgical clip according to an embodiment of the invention in an open clip position.

Fig. 3a schematically shows a top view of a surgical clip according to an embodiment of the invention in a closed clip position.

Fig. 3b schematically shows a bottom view of a surgical clip according to an embodiment of the invention in a closed clip position.

Figs. 4a-4c schematically show a side view of a portion of the first outer part, a portion of the middle part, and a portion of the second outer part of a surgical clip according to an embodiment of the invention, respectively.

Figs. 5a-5¢ schematically show a perspective view of a portion of the first outer part, a portion of the middle part, and a portion of the second outer part of a surgical clip according to an embodiment of the invention, respectively.

Fig. 6a schematically shows incision points in which the surgical clips are inserted during a surgical procedure.

Fig. 6b schematically shows a surgical clip according to an embodiment of the invention in use during a surgical procedure.

DETAILED DESCRIPTION

Fig. 1a schematically shows a side view of a surgical clip 101 according to an embodiment the invention in an (half) open position and Fig. 1b schematically shows a side view of the surgical clip according to the embodiment of the invention in a closed position. Fig. 2a schematically shows a perspective view of the surgical clip according to the embodiment of the invention in the (half) open clip position in which one clamping member 105a is opened with respect to clamping member 105b. Fig. 2b schematically shows a side view of the surgical clip according to the embodiment of the invention in the (fully) open clip position in which clamping members 105a and 105c are both opened with respect to clamping member 105b.

The surgical clip 101 comprises three parts 102a, 102b, 102c: a first outer part 102a, a second outer part 102c, and a middle part 102b, arranged to be rotatable relative to each other around a common axis 103.

The first outer part 102a comprises an operating arm 104a and a clamping member 105a. In this embodiment, the clamping member 105a is designed as a fork with two prongs.

The first outer part 102a further comprises a clamping arm 106a. The clamping arm 106a and the clamping member 105a are provided with a coupling assembly 108a, configured to mount the clamping member 105a to the clamping arm 106a. In this embodiment, the coupling assembly 108a comprises a receptacle 107a provided on the clamping arm 106a and an insert part 109a provided on the clamping member 105a. The insert part 1094 is receivable in the receptacle 107a to mount the clamping member 105a to the clamping arm 106a.

The second outer part 102c comprises an operating arm 104c and a clamping member 1035c. In this embodiment, the clamping member 105c is designed as a fork with two prongs. The second outer part 102c further comprises a clamping arm 106c. The clamping arm 106c and the clamping member 105c are provided with a coupling assembly 108c, configured to mount the clamping member 105c to the clamping arm 108c. In this embodiment, the coupling assembly 108c comprises a receptacle 107c provided on the clamping arm 106¢ and an insert part 109c provided on the clamping member 105c. The insert part 109c is receivable in the receptacle 107c to mount the clamping member 105c to the clamping arm 106¢.

The middle part 102b comprises an operating arm 104b and a clamping member 105b.

In this embodiment, the clamping member 105b is designed as a ring. The middle part 102b further comprises a clamping arm 106b. The clamping arm 106b and the clamping member 105b are provided with a coupling assembly 108b, configured to mount the clamping member 105b to the clamping arm 106b. In this embodiment, the coupling assembly 108b comprises a receptacle 107b provided on the clamping arm 106b and an insert part 109b provided on the clamping member 105b. The insert part 109b is receivable in the receptacle 107b to mount the clamping member 105b to the clamping arm 106b.

The clamping arm 106a, 106b, 106c and the operating arm 104a, 104b, 104c of each part are rigidly connected to each other at the common axis 103. A more detailed view of an example of the rigid connection between the clamping arm 108a, 106b, 106c and the operating arm 104a, 104b, 104c of each part is provided in Figs. 4a-4c and Figs. 5a-5c. As can be seen in

Figs. 4a-4c and Figs. 5a-5c, the rigid connection may for example be provided by a ring-shaped member formed integrally with the associated clamping arm and the associated operating arm.

The three parts shown in Fig. 4a (one of the three parts), Fig. 1b (the second one of the three parts), and Fig. 1c (the third one of the three parts) may each be made from a metal or metal alloy, which metal/metal alloy may comprise one or more of the following: titanium, copper, aluminium, platinum, palladium, tantalum, cobalt chromium, and stainless steel.

The surgical clip further comprises a spring 111. In this embodiment, the spring 111 is designed as a torsion spring. The winding body of the spring 111 is accommodated in a common opening 112 of the parts 102a, 102b, 102c corresponding to the common axis 103.

The spring 111 comprises two spring ends 110a, 110b (not shown in this perspective). Spring end 110a is connected to the first outer part 102a in a material-bonding manner, the material- boding manner preferably being welding. Spring end 110b is connected to the second outer part 102b (not shown in this perspective) in a material-bonding manner, the material-boding manner preferably being welding. The spring is configured to pretension the three parts 102a, 102b, 102c towards the closed clip position shown in Fig. 1b. In the closed clip position, the clamping members of the two outer parts 102a, 102¢ and the clamping member of the middle part 102b abut against each other (in absence of any tissue). In this embodiment, the clamping member 105a of the first outer part 102a and the clamping member 105c of the second outer part 102c are embedded into the opening of the clamping member 105b of the middle part in the closed clip position, forming a passage 201.

Spring end 110a engages on the first outer part 104a and spring end 110b engages on the second outer part 102c (not shown in this perspective) to effect the pretension action: due to the spring force of the torsion spring 111, a clamping force is generated that clamps the clamping members 105a and 105c together in the closed clip position. Thereby, in use, vessels may be connected by the surgical clip 101 by mounting a first vessel to clamping member 105a and mounting a second vessel to clamping member 105b. In the closed clip position, then, a connection is formed between the first vessel and the second vessel because the clamping members 105a, 105b, and 105c abut against each other and are kept in this closed clip position by the spring force of the spring 111. The connection between the first vessel and the second vessel allows for free flow of liquid such as blood because of the passage 201.

Spring end 110a engages on the first outer part 104a and spring end 110b engages on the second outer part 102c (not shown in this perspective) also to effect the closing action effected by the spring when tensioned or pre-tensioned: in the opened position, either the clamping member 105a or the clamping member 105c is opened relative to the clamping member 105b by operating the operating arm 104a or the operating arm 104c, respectively. For example, to open the clamping member 1054 with respect to the clamping member 105b means that the clamping member 1054 is moved away from the clamping member 105b, as shown in

Fig. 2. To achieve this, the operating arm 1044 is moved towards the operating arm 104b against the force of the spring 111, for example by a forceps which engages on a side of the operating arm 104a and an opposite side of the operating arm 104b. Similarly, to open the clamping member 105c with respect to the clamping member 105b means that the clamping member 105c is moved away from the clamping member 105b. To achieve this, the operating arm 104c is moved towards the operating arm 104b against the force of the spring 111, for example by a forceps which engages on a side of the operating arm 104c and an opposite side of the operating arm 104b.

The clamping member 105b defines a plane 112. Referring to Fig. 1b this plane 112 extends transverse to the sheet of paper and in the direction of the double arrow 112. More specifically, the plane 112 defined by the clamping member 105b is the plane defined by the ring of the clamping member 105b. In the closed position shown in Fig. 1b, the operating arms 104a, 104b and 104c are arranged transverse with respect to the plane 112. In this embodiment, the operating arm 104a is arranged at an angle of approximately 60° with respect to the plane 112. In this embodiment, the operating arm 104b is arranged at an angle of approximately 100° with respect to plane 112. In this embodiment, the operating arm 104c is arranged at an angle of approximately 140° with respect to the plane 112. As shown in Fig. 1b, for each operating arm the angle with respect to the plane 112 is defined by the imaginary line 4a, 4b, 4c extending through the common axis 103 and the midpoints of the top side of each respective operating arm 104a, 104b, and 104c, respectively.

By arranging the operating arms 104a, 104b, 104c transverse with respect to the plane 112, the operating arms are more easily reachable during use of the surgical clip, e.g., when opening the surgical clip in a so-called minimal-invasive surgical procedure while the surgical clip is inside of the human body and only reachable through a narrow incision.

Since the clamping member 105a and the clamping member 105c are both designed as a fork each having two prongs, the surgical clip 101 is particularly suited for side-to-side connection of two vessels.

In use, the surgical clip 101 is for example used to connect two vessels, for example an artificial vessel to a blood vessel, or a first blood vessel to a second blood vessel.

To connect two vessels, first the clamping member 105a of the first outer part 102a is opened relative to the clamping member 105b of the middle part 102b by moving the operating arm 104a of the first outer part 102a relative to the operating arm 104b of the middle part 102b against the force of the spring 111. This results in an open clip position as shown in Fig. 1a. Then, the vessel is mounted to the clamping member 105a by first inserting the clamping member 105a, which is designed as a fork, into the vessel. Then, a part of the vessel that extends parallel to the plane defined by the clamping member 105a is removed, thereby creating an opening in the vessel which forms a channel together with the clamping member 105a. Then, the surgical clip 101 is returned to the closed clip position by releasing the force with which the operating arm 104a of the first outer part 102a was moved relative to the operating arm 104b of the middle part 102b against the force of the spring 111. This results in a closed clip position as shown in Fig. 1b.

Then, the clamping member 105c of the second outer part 102c is opened relative to the clamping member 105b of the middle part 102b by moving the operating arm 104c of the second outer part 102c relative to the operating arm 104b of the middle part 102b against the force of the spring 111. Then, the vessel is mounted to the clamping member 105¢ by first inserting the clamping member 105c, which is designed as a fork, into the vessel. Then, a part of the vessel that extends parallel to the plane defined by the clamping member 105c is removed, thereby creating an opening in the vessel which forms a channel together with the clamping member 105c. Then, the surgical clip 101 is returned to the closed clip position by releasing the force with which the operating arm 104c of the second outer part 102c was moved relative to the operating arm 104b of the middle part 102b against the force of the spring 111. This results in a closed clip position as shown in Fig. 1b.

As a result, the two vessels are connected to each other at a location corresponding to the passage 201 formed by the clamping member 105a of the first outer part 102a and the clamping member 105c of the second outer part 102c, which are embedded into the opening of the clamping member 105b of the middle part 102b in the closed clip position.

The clip 101 shown in Figs. 1a-1b is particularly suitable to connect two vessels, for example coronary vessels, during coronary surgery such as a coronary bypass. In such a surgery, a donor vessel which may be an artificial vessel or a vessel taken from another part of the body is first mounted to the clamping member 105c. Then, an acceptor vessel, such as a coronary vessel, for example a coronary blood vessel or coronary artery, is mounted to the clamping member 105a. To perform this last step, the surgical clip 101 is moved together with the donor vessel which was mounted on it towards the heart and the clamping member 105c is inserted in the acceptor vessel. Once openings are made in the donor vessel and the acceptor vessel in the area of the clamping member 1054 and 105c respectively, and the surgical clip 101 is returned to its closed clip position, a passage is formed, connecting the donor vessel to the acceptor vessel.

Fig. 3a schematically shows a top view of a surgical clip according to an embodiment of the invention in a closed clip position. Fig. 3b schematically shows a bottom view of the surgical clip according to the embodiment of the invention in a closed clip position.

The embodiment schematically shown in Figs. 3a-3b is identical to the embodiment schematically shown in Figs. 1a-1b and Fig. 2, except that the clamping member 105a of the first part 102a is designed as a ring. Therefore, the surgical clip 101 is particularly suited for end-to- side connection of two vessels.

To connect two vessels, first the clamping member 105a of the first outer part 102a is opened relative to the clamping member 105b of the middle part 102b by moving the operating arm 104a of the first outer part 102a relative to the operating arm 104b of the middle part 102b against the force of the spring 111. This results in an open clip position as shown in Fig. 1a. Then, the vessel is mounted to the clamping member 105a by first guiding an open vessel end of the vessel through the opening of the clamping member 105a, which is designed as a ring. Then, the open vessel end is turned inside out around the opening of the clamping member 105a. Then, the surgical clip 101 is returned to the closed clip position by releasing the force with which the operating arm 104a of the first outer part 102a was moved relative to the operating arm 104b of the middle part 102b against the force of the spring 111.

This results in a closed clip position as shown in Fig. 1b.

Then, the clamping member 105c of the second outer part 102c is opened relative to the clamping member 105b of the middle part 102b by moving the operating arm 104c of the second outer part 102c relative to the operating arm 104b of the middle part 102b against the force of the spring 111. Then, the vessel is mounted to the clamping member 105c by first inserting the clamping member 105c, which is designed as a fork, into the vessel. Then, a part of the vessel that extends parallel to the plane defined by the clamping member 105c is removed, thereby creating an opening in the vessel which forms a channel together with the clamping member 105c. Then, the surgical clip 101 is returned to the closed clip position by releasing the force with which the operating arm 104c of the second outer part 102c was moved relative to the operating arm 104b of the middle part 102b against the force of the spring 111. This results in a closed clip position as shown in Fig. 1b.

Figs. 4a-4c schematically show a side view of a portion of the first outer part 102a, a portion of the middle part 102b, and a portion of the second outer part 102c, respectively. Figs. 5a-5c schematically show a perspective view of the portion of the first outer part, the portion of the middle part, and the portion of the second outer part, respectively.

As shown in Figs. 4a-4c, the operating arm 1044, 104b, 104c of each part 1024, 102b, 102c is arranged transverse with respect to the clamping arm 106b.

The operating arm 104a is arranged transverse with respect to the clamping arm 106b, i.e., at an angle with respect to the clamping arm 106b. In this embodiment, the operating arm 104a is arranged at an angle of approximately 70° with respect to the clamping arm 106v. The operating arm 104b is arranged transverse with respect to the clamping arm

106b, i.e., at an angle with respect to the clamping arm 106b. In this embodiment, the operating arm 104b is arranged at an angle of approximately 110° with respect to the clamping arm 106b. The operating arm 104c is arranged transverse with respect to the clamping arm 106b, i.e., at an angle with respect to the clamping arm 106b. In this embodiment, the operating arm 104c is arranged at an angle of approximately 145° with respect the clamping arm 106b.

The first outer part 102a comprises a circular element 401a between the clamping arm 106a and the operating arm 1044, the circular element 401a rigidly connecting the clamping arm 104a and the operating arm 1064 to each other. The circular element 401a is provided at one of the two axial sides of the first outer part 102a. The second outer part 102a comprises a circular element 401a between the clamping arm 1064 and the operating arm 104a, the circular element 401a rigidly connecting the clamping arm 104a and the operating arm 106a to each other. The first outer part 102a comprises a circular element 401a between the clamping arm 106a and the operating arm 104a, the circular element 401a rigidly connecting the clamping arm 104a and the operating arm 106a to each other. The circular element 401¢ is provided at one of the two axial sides of the second outer part 102c.

The first outer part 102a comprises a circular recess 501a along a portion of the circular element 401a. The second outer part 102c comprises a circular recess 501b along a portion of the circular element 401c. The outer diameter of the circular element 401a is identical to the inner diameter of the circular recess 5014 and the outer diameter of the circular element 4014 is identical to the inner diameter of the circular recess 501b. The outer diameter of the circular element 401b is identical to the inner diameter of the circular recess 5014 and the outer diameter of the circular element 401b is identical to the inner diameter of the circular recess 501b. The outer diameter of the circular element 401c is identical to the inner diameter of the circular recess 5014 and the outer diameter of the circular element 401c is identical to the inner diameter of the circular recess 501b.

The first outer part 1024 comprises a protrusion 502a which protrudes radially inward along the portion of the circular element 4014. The protrusion 502a is provided at an axial side of the first outer part 1024 opposite the axial side of the first outer part 120a at which the circular element 4014 is provided. The second outer part 102c comprises a protrusion 502b which protrudes radially inward along the portion of the circular element 401c. The protrusion 502b is provided at an axial side of the second outer part 120c opposite the axial side of the second outer part 102c at which the circular element 4014 is provided.

When assembled, the three parts 1024, 102b, 102c form the surgical clip 101 as shown in Figs. 1a-1b and Fig. 2. When assembled, the circular element 4014 of the first outer part 102a is fitted together with the circular element 401b of the middle element 102b between the protrusion 502b and the circular element 401c of the second outer element 102c. The parts are precisely manufactured so that the parts fit precisely into each other. Therefore, it is not possible to move the parts 102a, 102b, 102c transversely to the plane defined by circular elements 401a, 401b, 401c.

Fig. 6a schematically shows a chest area of a patient of a coronary bypass surgery performed on the heart 607 of the patient. Three incisions 606a, 806b, and 606¢ are shown, through which the surgery will be performed. Thus, instead of open-heart surgery wherein substantially the whole heart 607 is accessible, the surgery is performed less invasively through incisions 606a, 606b, and 606c. The surgical clip 101 is particularly suitable for use in such a surgery, since its operating arms are more easily reachable by a forceps through the incisions 606a, 606b, and 606c.

Fig. 6b schematically shows a surgical clip according to the invention in use during a surgical procedure.

In the figure, a part of the human body 601 is shown in which an incision 605 has been made. For example, the incision was made in a chest area of the body. A surgical clip 101 according to the invention has been inserted into the body. A first vessel 603, for example an artificial vessel or a blood vessel, has been mounted on the clamping member 105a of the first outer part 102a of the surgical clip 101. The clamping member 105a is designed as a ring, and thus an open end of the vessel 603 was passed through the opening of the clamping member 1054 and wrapped around the opening of the clamping member 105a. In Fig. 8, presently the surgical clip 101 is in an open position wherein the clamping member 105c of the second outer part 102c of the surgical clip 101 is opened with respect to the clamping member 105b of the middle part 102b. The surgical clip 101 is opened in this position by a forceps 602 which is inserted into the human body through the incision 605 and engages a side of the operating arm 104c of the second outer part 102c and an opposite side of the operating arm 104b of the middle part 102b. The clamping member 105c of the second outer part 105c is designed as a fork and is inserted into the wall of a second vessel 604, for example a blood vessel, to mount the second vessel onto the clamping member 105c.

The operating arm 1044, 104b, 104c of each part 102a, 102, 102c is arranged transverse with respect to a plane defined by the clamping member 105bof the middle part 102b. Thereby, the operating arms 1044, 104b, and 104b are easily reachable by the forceps 602 from outside of the part of the human body 801. Simultaneously, the vessels 603, 604 can also be reached by, e.g., other tools or directly by the surgeon. Thereby, the opening and closing of the surgical clip 101 can be performed simultaneously with the mounting of the vessels 603, 604 on the clamping members 603, 604 without the need for an invasive surgery in which the incision 605 is made much larger or in which the procedure is (partly) performed outside of the human body.

As required, this document describes detailed embodiments of the present invention.

However, it must be understood that the disclosed embodiments serve exclusively as examples, and that the invention may also be implemented in other forms. Therefore, specific constructional aspects which are disclosed herein should not be regarded as restrictive for the invention, but merely as a basis for the claims and as a basis for rendering the invention implementable by the average skilled person. Furthermore, the various terms used in the description should not be interpreted as restrictive but rather as a comprehensive explanation of the invention. The word "a" used herein means one or more than one, unless specified otherwise. The phrase "a plurality of’ means two or more than two. The words "comprising" and "having" do not exclude the presence of more elements. Reference figures in the claims should not be interpreted as restrictive of the invention. Particular embodiments need not achieve all objects described. The mere fact that certain technical measures are specified in different dependent claims still allows the possibility that a combination of these technical measures may advantageously be applied.

Claims

CONCLUSIONS

1. A surgical clamp (101), comprising: « three parts (102a, 102b, 102c): a first outer part, a second outer part, and a middle part, arranged to be rotatable relative to each other about a common axis (103), each part comprising an actuating arm (104a, 104b, 104c) and a clamping element (1054, 105b, 105c); and + a spring (111); wherein: the actuating arm of the middle part (102b) is disposed between the actuating arm of the first outer part (102a) and the actuating arm of the second outer part ({102c); + the clamping element of the middle part is disposed between the clamping element of the first outer part and the clamping element of the second outer part; + the spring is arranged to bias the three parts to a closed clamping position in which the clamping elements of the two outer parts and the clamping element of the middle part abut against each other; characterised in that: + the actuating arm of the middle part is disposed transversely with respect to a plane (112) defined by the clamping element of the middle part.

2. A surgical clamp according to claim 1, wherein: + the clamping element of the first outer part and the clamping element of the second outer part are adapted to be opened relative to the clamping element of the middle part by moving the operating arm of the first outer part and the operating arm of the second outer part, respectively, relative to the operating arm of the middle part against the force of the spring.

3. The surgical clamp of claim 1 or claim 2, wherein: +» the first outer member actuating arm and the second outer member actuating arm are arranged to be movable away from the middle member actuating arm against the force of the spring.

4. The surgical clamp of claim 1 or claim 2, wherein: + the actuating arm of the first outer member and the actuating arm of the second outer member are arranged to be movable toward the actuating arm of the middle member against the force of the spring.

5. A surgical clamp according to any preceding claim, wherein: + the actuating arm of the middle part, in the closed clamping position, is disposed at an angle in a range of 70° to 130°, preferably in a range of 80° to 120°, preferably in a range of 90° to 110°, relative to the plane defined by the clamping element of the middle part.

6. A surgical clamp according to any preceding claim, wherein: + each part further comprises a clamp arm (106a, 106b, 106c); + the clamp arm and the actuating arm of each part are rigidly connected to each other at the common axis; and « the clamp arm and the clamping element of one or more of the parts, such as of each part, are provided with a coupling assembly (1084, 108b, 108c) adapted to attach the clamping element to the clamp arm.

7. The surgical clamp of claim 8, wherein: + the coupling assembly comprises a receiving portion (1074, 107b, 107c) and an insert (1094, 109b, 109c), the insert being receivable in the receiving portion to secure the clamping element to the clamp arm.

8. A surgical clamp according to any one of claims 6 to 7, wherein: * each portion comprises a circular element (4014, 401b, 401c) between the clamp arm and the actuating arm, the circular element rigidly connecting the clamp arm and the actuating arm; + the first outer portion and the second outer portion each comprise a circular recess (5014, 501b) along a portion of the circular element; and + the external diameter of the circular element of each portion is equal to the internal diameter of the circular recess of both the first outer portion and the second outer portion.

9. The surgical clip of claim 8, wherein: + the circular element of the first outer portion and the circular element of the second outer portion are provided at one of the two axial sides of the respective outer portion; + the first outer portion and the second outer portion each include a projection (502a, 502b) extending radially inwardly along the portion of the circular element and wherein the projection is provided at the other axial side of the two axial sides of the respective outer portion;

+ the circular element of the first outer part and the circular element of the second outer part and the circular element of the middle element are disposed between the protrusion and the circular element of the other outer part.

10. Surgical clamp according to any of the preceding claims, wherein: + the clamping element of at least one of the parts is designed as a ring.

11. Surgical clamp according to any of the preceding claims, wherein: + the clamping element of at least one of the parts is designed as a fork.

12. A surgical clamp according to any preceding claim, wherein: * the clamping element of the middle part is designed as a ring; and * the clamping element of the first outer part and the second outer part are designed as a fork.

13. A surgical clamp according to any preceding claim, wherein: + the clamping element of the first outer portion and the clamping element of the second outer portion are embedded in an opening of the clamping element of the middle portion in the closed clamping position, thereby forming a passage (201).

14. A surgical clamp according to claim 10, wherein: + the clamping element of each part is designed as a ring; and + the openings of the rings form a passage in the closed clamping position.

15. A surgical clamp according to any preceding claim, wherein: + the spring comprises two spring ends (1104, 110b); and the spring ends are coupled to the first outer portion and the second outer portion to effect the pre-tensioning.

16. A surgical clip according to claim 15, wherein: + the spring ends are connected in a material bonding manner to the first outer portion and the second outer portion, respectively, wherein the material bonding manner is preferably welding.

17. Surgical clamp according to any of claims 15-16, wherein: + the spring is designed as a torsion spring, and

+ the winding body of the spring is at least partly accommodated in a common opening (112) of the parts corresponding to the common axis.