Method and apparatus for vascular and visceral clipping

Abstract

Devices and methods for achieving hemostasis and leakage control in hollow body vessels such as the small and large intestines, arteries, and veins as well as ducts leading to the gall bladder and other organs. The devices and methods disclosed are especially useful in the emergency, trauma surgery, or military setting. In such cases, the patient may have received trauma to the abdomen, extremities, neck or thoracic region. The devices utilize removable or permanently implanted, broad, soft, parallel jaw clips with minimal projections to maintain vessel contents without damage to the tissue comprising the vessel. These clips are applied using devices that are subsequently removed leaving the clips implanted, on a temporary or permanent basis, to provide for hemostasis or leakage prevention, or both. The clips come in a variety of shapes and sizes. The clips may be placed and removed by open surgery or laparoscopic access.

What is claimed is: 
     
         1 . A method of achieving wound closure in a body vessel or lumen comprising the steps of:
 accessing a wound in a body vessel or lumen;   providing a clip comprising at least two jaws configured to open and close about a hinge further comprising a jaw hinge axis, wherein the clip comprises at least two tabs, each tab being rotationally connected to the jaws about a tab hinge axis;   applying force to the tabs to open the jaws of the clip;   applying said clip to the body vessel or lumen;   closing the jaws of the clip to treat spillage of contents from the wound in the body vessel or lumen, wherein the jaws of the clip are spring biased closed; and   folding the tabs back onto the jaws of the clip to substantially reduce the projection of the tabs away from the clip;   wherein the jaws of the clip maintain approximately parallel tissue-contacting surfaces when in the closed position.   
     
     
         2 . The method of  claim 1  wherein the step of closing the jaws of the clip further comprises the step of limiting pressure applied to the body vessel or lumen by the jaws of the clip to between 2 and 50 mm Hg. 
     
     
         3 . The method of  claim 1  wherein the step of closing the jaws of the clip comprises compressing the body vessel or lumen with jaws that are ring-shaped. 
     
     
         4 . The method of  claim 1  further comprising the step of removing the clip from the body vessel or lumen. 
     
     
         5 . The method of  claim 1  further comprising the step of resorbing the clip from the body vessel or lumen. 
     
     
         6 . The method of  claim 1  wherein the step of folding the tabs back onto the jaws creates a clip geometry that is substantially atraumatic to surrounding tissue. 
     
     
         7 . The method of  claim 1  wherein the step of closing the jaws totally occludes the body vessel or lumen. 
     
     
         8 . The method of  claim 1  wherein the step of closing the jaws partially occludes the body vessel or lumen. 
     
     
         9 . The method of  claim 1  wherein the step of closing the jaws of the clip further comprises the step of limiting pressure applied to the body vessel or lumen by the jaws of the clip to between 100 and 300 mm Hg. 
     
     
         10 . The method of  claim 1  wherein the step of closing the jaws totally occludes and seals both ends of a completely severed vessel. 
     
     
         11 . The method of  claim 1  wherein the step of closing the jaws comprises compressing said tissue surrounding the wound with jaws that have an opening in a central region. 
     
     
         12 . The method of  claim 1  further comprising the step of grasping the tabs using a grasping instrument. 
     
     
         13 . The method of  claim 1  wherein the step of closing the jaws totally occludes and seals a wound in a body vessel or lumen that is perforated but not severed. 
     
     
         14 . The method of  claim 1  wherein the step of closing the jaws closes and seals a wound in a body vessel or lumen but permits some flow of material through a portion of the body vessel or lumen. 
     
     
         15 . The method of  claim 1  wherein at least one tab hinge axis is oriented substantially perpendicular to the jaw hinge axis. 
     
     
         16 . The method of  claim 1  wherein at least one tab hinge axis is oriented substantially parallel to the jaw hinge axis.