Anastomosis clip

Abstract

The invention relates to an anastomosis clip (100; 200), the anastomosis clip (100; 200) for connecting the first vessel to the side wall of the second vessel. The clip comprises: a double tines fork (2) having a fork base (3) and two tines (4, 5) extending from the fork base (3) to a tapered end portion (6) with a sharp tip (7); a ring (1); and a clamping structure (10; 60), the clamping structure (10; 60) grips the fork towards the ring. The ring and the fork are movable relative to each other from an open position to a closed position. In the closed position, the tines extend along the ring plane. For each of the tines, the ring has an associated bearing region (21, 22). In the closed position, the tapered portion of the tines is supported by its associated support region such that the sharp tips are occluded by the associated support region.

Description

Technical Field

[0001] The present invention relates to the field of anastomotic clips for connecting vessels in the human or animal body. The vessels may be blood vessels, such as natural vessels and / or artificial blood vessels. In the case of natural vessels, these natural vessels may be the patient's own natural vessels, or these natural vessels may be donor vessels obtained from other people or animals. In both cases of natural vessels or donor vessels, the vessels may optionally have been processed. Background Art

[0002] Anastomoses can be subdivided into three groups: ETS anastomosis (ETS=end-to-side), STS anastomosis (STS=side-to-side) and ETE anastomosis (ETE=end-to-end).

[0003] Traditionally, anastomosis is created by suturing two vessels together. This is laborious. Many anastomotic tools, such as clips, have been developed to facilitate or even avoid this labor-intensive suturing process.

[0004] Some examples of such tools and clips can be found in EP 2.265.192, EP 2.663.243, WO-2011 / 0642495 and WO 2013 / 105.848. These tools / clips have a ring structure and a double-pointed fork, which has a sharp tip at the free end of the tine. The double-pointed fork penetrates the inside of the vessel through the side wall of the blood vessel from the outside-the S vessel of the ETS anastomosis or STS anastomosis-and can also penetrate (return) the outside of the vessel through the side wall from the inside of the vessel. The ring structure is used as an auxiliary device for attaching another vessel of the anastomosis to be established. Another vessel in the vessel can be attached to the ring structure, or the ring structure can be said to be located between the first vessel of the anastomosis and the second vessel of the anastomosis and help to establish the middle part of the anastomosis. Before and during the anastomosis and after the anastomosis has been established, the sharp tip at the free end of the tine may cause damage to the vessel (to be) connected or the surrounding tissue. Summary of the invention

[0005] It is an object of the present invention to provide an alternative and / or improved anastomotic clip.It is another object of the present invention to provide an anastomotic clip that overcomes the above-mentioned problems associated with the sharp tips of the tines.

[0006] According to the present invention, one or more of the above objects is achieved by providing an anastomotic clip for connecting a first vessel to a side wall of a second vessel.

[0007] The anastomotic clips include:

[0008] - a first double-pronged fork having a fork base and two tines extending from the fork base to a tapered end portion, the tapered end portion tapering from the tapered base to a sharp tip,

[0009] - a ring structure defining a ring plane, and

[0010] - a clamping structure configured to clamp the first prong towards and / or against the ring structure in a closed position with a first clamping force;

[0011] wherein the ring structure and the first prong are movable relative to each other from an open position to a closed position;

[0012] wherein, in the open position, the ring structure and the first prong are arranged at a distance from each other;

[0013] Where, in the closed position:

[0014] - the tines of the first fork extend along the plane of the ring, and

[0015] - the fork base of the first fork is located at the base side of the ring structure, while the tapered end portion of the tine of the first fork is located at the tine end side of the ring structure, the tine end side being opposite to the base side when viewed along the ring plane;

[0016] wherein, for each of said tines of the first fork, the ring structure has an associated bearing area associated with said tine of the first fork;

[0017] Wherein, each of the support areas:

[0018] - has a distal end and a proximal end, viewed relative to the base of the first fork, and

[0019] - configured to support a portion of an associated tine when the first prong is clamped in a closed position toward the ring structure with a first clamping force; and

[0020] Wherein, in the closed position, a first distance measured from the fork base of the first fork to the sharp tip of the tapered end portion of the tine is at most as long as a second distance measured from the fork base of the first fork to the distal end of the associated support area, so that when viewed in a lateral direction transverse to the ring plane, each of the sharp tips is obscured and / or supported by its associated support area.

[0021] According to the present invention, both the first vessel and the second vessel of the anastomosis may be blood vessels. According to the present invention, both vessels may be natural vessels, both vessels may be artificial vessels, or one vessel may be a natural vessel and the other vessel an artificial vessel. In the case of natural vessels, according to the present invention, the vessels may be natural vessels from the patient - optionally obtained from somewhere other than the anastomosis site of the patient - or donor vessels. In both cases of natural vessels or donor vessels, the vessels may optionally have been treated.

[0022] In the first case, the clamping structure may clamp the first prong towards and / or against the ring structure. When the anastomosis is established, the vessel wall of one of the anastomosing vessels will typically be located between the first prong and the ring structure. Furthermore, according to the present invention, the clamping may be established in any manner that allows the first prong and the ring structure to hold the first prong and the ring structure in a fixed position relative to each other, with the vessel wall located between the first prong and the ring structure. The clamping may:

[0023] - According to the first example of the invention, the spring force that clamps the ring structure and the first fork together is established, for example by a spring, and / or

[0024] --According to a second example of the present invention, established by a snapping action of one or more first snapping members provided on one of the ring structure and the first fork and one or more second snapping members provided on the other of the ring structure and the first fork, and / or

[0025] According to a third example of the invention, it is established by one or more clamping brackets engaging on the ring structure and the first fork to hold them together.

[0026] In the closed position, the ring structure and the first fork will be connected to each other to form a unit. In the open position of the ring structure and the first fork:

[0027] - these may form a unit, the ring structure and the first fork being connected, for example, by a hinge and / or a spring, or

[0028] - These may be separate components that are connected to each other during creation of the anastomosis, for example by means of one or more sets of cooperating snap-fit ​​members and / or one or more clamping brackets.

[0029] By configuring the support area and the first fork in a relationship to each other so that a first distance measured from the fork base of the first fork to the sharp tip of the tapered end portion of the tine is at most as long as a second distance measured from the fork base of the first fork to the distal end of the associated support area, it is ensured that the sharp tip is shielded by the associated support area and that the tapered end portion finds support on the associated support area, at least after the anastomosis has been established, because the end portion of the tapered end portion is overlapped by the associated support area when viewed transversely to the annular plane. The shielding of the tip prevents the tip from damaging the anastomosed vessels and other tissues. The overlap of the end portion of the tapered end portion by the associated support area prevents the tapered end portion from being deformed or bent due to the clamping force applied by the clamping structure.

[0030] According to another embodiment of the invention, the "end portion of the tapered end portion overlapped by the associated support area" may have a length - viewed in the length direction of the tine - of about 35% or more, such as 50% or more, of the length of the taper of the tapered end portion, in other words, the associated support area overlaps at least about 35%, such as at least about 50%, of the tapered end portion. In the closed position, the support area may overlap, for example, about 75% or more of the associated tapered end portion. Regarding the tapered end portion, it should be noted that, due to the tapering, the cross-section of the tine - transversely to the length direction of the tine - decreases in the distal direction, with the result that these tapered portions are more easily deformed and / or bent. Such deformation / bending may result in the sharp tip pointing away from the ring structure and thereby increasing the risk of damaging the vessel or surrounding tissue.

[0031] The support region defines a region length, viewed from the proximal end of the support region to the distal end of the support region. According to embodiments of the invention, the region length may have approximately the same length as the length of the tapered end portion - arguably in the range of 95% to 105% of the length of the tapered end portion.

[0032] According to another additional or alternative embodiment of the invention, the bearing area can protrude beyond the associated sharp tip when viewed in the closed position and in the distal direction. This ensures that the sharp tip is well shielded by the vascular tissue and other surrounding tissues.

[0033] According to another embodiment, the region length may be at least 1.5 times the thickness of the tines of the fork. In one example, the region length may be at least 2.0 times the thickness of the tines of the first fork. In another example, the region length may be at least 2.5 times the thickness of the tines of the first fork.

[0034] According to another embodiment, the region length may be at most 6 times the thickness of the tines of the first fork. For example, the region length may be at most 5 times the thickness of the tines of the first fork.

[0035] According to another embodiment of the invention, the region length is equal to or greater than the length of the tapered end portion. This ensures that the tapered end portion is well supported.

[0036] According to another embodiment, the region length may be at least 110% of the length of the tapered end portion. At the same time, the region length may also be at most 120% or at most 115% of the length of the tapered end portion.

[0037] According to another embodiment, the region length may be at least 115% of the length of the tapered end portion. At the same time, the region length may also be at most 125% or at most 120% of the length of the tapered end portion.

[0038] According to another embodiment, the region length may be at least 120% of the length of the tapered end portion. At the same time, the region length may also be at most 130% or at most 125% of the length of the tapered end portion.

[0039] According to another embodiment, the region length may be at least 125% of the length of the tapered end portion. At the same time, the region length may also be at most 135% or at most 130% of the length of the tapered end portion.

[0040] According to another embodiment of the invention, in the closed position, a third distance from the fork base of the first fork to the tapered base of the tapered end portion of the tine is at least as long as a fourth distance from the fork base of the first fork to the proximal end of the associated support area, so that each of the tapered bases is supported by its associated support area, as viewed in the transverse direction. By configuring the support area and the first fork in a relationship such that the third distance measured from the fork base of the first fork to the tapered base of the tapered end portion of the tine is at least as long as the fourth distance measured from the fork base of the first fork to the proximal end of the associated support area, it is ensured that, (at least) after the anastomosis has been established, not only the sharp tip is shielded by the associated support area, but also that substantially the entire tapered end portion, as viewed transversely to the ring plane, is well and reliably overlapped by the associated support area. The substantially complete overlap of the tapered end portion by the associated support area prevents the tapered portion from being deformed or bent due to the clamping force applied by the clamping structure. With respect to "substantially completely overlapping", it should be noted that each associated support area may be a discontinuous support area having, for example, two support sub-areas separated by a gap, above which the support is actually interrupted.

[0041] According to another embodiment of the invention, the tapered end portions of the tines of the first fork each have a first tapered portion with a first tapered direction and a second tapered portion with a second tapered direction, wherein the first tapered direction is different from the second tapered direction, and wherein, viewed in the length direction of the tines, the second tapered portion has a length shorter than the length of the first tapered portion. Providing the tapered end portion with an additional tapered portion, the second tapered portion, having a tapered direction different from the direction of the first tapered portion and having a tapered length less than the tapered length of the main tapered portion, additionally sharpens the sharp tip without substantially reducing the strength of the sharp tip. In this application, the tapered direction should be understood as a direction transverse to the length direction of the tines, in which the cross section decreases due to the corresponding tapering. According to an example of this embodiment, when in the closed position, the first tapered direction is towards the associated support area, and the second tapered direction is away from the associated support area. According to another alternative or complementary example of this embodiment, the first tapered direction, the first tapered direction and the second tapered direction are at an angle relative to each other, such as perpendicular to each other.

[0042] According to another embodiment of the invention, the tapered end portions of the tines of the first fork each have a surface facing the ring, which in the closed position faces the associated support area; and, in the closed position, the surface facing the ring of each of the tines of the first fork or at least a majority of the surface facing the ring is positioned parallel to the associated support area and optionally against the associated support area (wherein optionally, the vessel wall is located between the surface facing the ring and the ring structure when the anastomosis is established). In this case, "most of" should be understood as at least 75%, such as at least 80% or 85% of the surface facing the ring. For at least most of the time, ensuring that the surface facing the ring and the associated support area are parallel ensures that the tapered end is well supported and well prevented from deforming / bending the tapered end.

[0043] According to another embodiment of the invention, the support area is recessed in the side of the tine end of the ring structure. The recessed support area provides lateral support - in a direction parallel to the ring surface - for the tapered end portion.

[0044] According to another embodiment of the present invention, the clip may have a second bicuspid fork for attachment to the second vessel of the anastomosis and a first bicuspid fork for attachment to the first vessel of the anastomosis. In this embodiment, the clip further comprises:

[0045] - a second double-pronged fork having a fork base and two tines extending from the fork base to free end portions, the free end portions of the tines of the second fork tapering to sharp tips,

[0046] - a further clamping structure configured to clamp the second prong against the ring structure of the first prong in a closed position,

[0047] wherein the loop structure and the second prong are movable relative to each other between an open position and a closed position;

[0048] wherein, in the open position, the ring structure and the second fork are arranged at a distance from each other;

[0049] Where, in the closed position and viewed relative to / along the ring plane:

[0050] - the first fork is arranged on one side of the ring plane and the second fork is arranged on the other side of the ring plane;

[0051] - the tines of the second fork extend along the plane of the ring, and

[0052] - the fork base of the second fork is located at the base side of the ring structure, while the free end portion of the tine of the second fork is located at the tine end side of the ring structure;

[0053] - The free end portions of the tines of the second prong are positioned immersed or recessed in the internal space defined by the ring structure, so that in the closed position the sharp tips of the second prong are concealed by the ring structure.

[0054] Although this embodiment has the second tine with a sharp tip, damage to the vessel wall and surrounding tissue is prevented by submerging the free end portion of the second tine, which carries the sharp tip, in the inner space defined by the ring structure.

[0055] According to another embodiment of the present invention having a second fork, in the closed position, the second fork is clamped against the first fork with a second clamping force, which is directed opposite to the first clamping force and is smaller than the first clamping force. The second clamping force being smaller than the first clamping force prevents the first tine of the first fork from loosening or releasing relative to the ring structure.

[0056] According to another embodiment of the present invention, the ring structure further has a left side portion connecting the base side with the tine end side, and a right side portion opposite to the left side portion connecting the base side with the tine end side.

[0057] According to another embodiment of the present invention having a left part and a right part, when observed in the radial direction of the ring structure, the left part and the right part have a radial thickness, and the length of the support area is greater than the radial thickness, such as at least 1.5 times the radial thickness, such as at least 1.75 times the radial thickness RT or at least 2 times the radial thickness RT.

[0058] According to another embodiment of the present invention having a left side portion and a right side portion, in the closed position, a section of the right tine of the tines of the first fork extends parallel to and / or adjacent to the right side portion of the ring structure, while a section of the left tine of the tines of the first fork extends parallel to and / or adjacent to the left side portion of the ring structure.

[0059] According to another embodiment of the invention having a left and a right part, in the closed position said section of the right tine of the first fork and said section of the left tine of the first fork are positioned immersed or recessed in the inner space defined by the ring structure.

[0060] According to another embodiment of the present invention having a left side portion and a right side portion, in the closed position, a section of the right tine of the second fork extends parallel to and / or adjacent to the right side portion of the ring structure, while a section of the left tine of the second fork extends parallel to and / or adjacent to the left side portion of the ring structure.

[0061] According to another embodiment of the invention having a left and a right part, in the closed position said section of the right tine of the second fork and said section of the left tine of the second fork are positioned immersed or recessed in the inner space defined by the ring structure. BRIEF DESCRIPTION OF THE DRAWINGS

[0062] The present invention will be further explained with reference to the accompanying drawings. In these drawings:

[0063] FIG. 1 schematically shows a first exemplary embodiment of an anastomotic clip according to the invention, in which the anastomotic clip has a “double-tine” fork, in which:

[0064] - Figure 1A An anastomotic clip having a (first) bi-pronged fork and ring structure as two separate parts and in an open position is shown in a side view;

[0065] - Figure 1B Shown in side view Figure 1A anastomotic clips in which two separate parts are assembled together and remain in an open position;

[0066] - Figure 1C The closed position is shown in side view. Figure 1B anastomotic clips;

[0067] - Figure 1D It shows that according to arrow I - see Figure 1C ——a bottom view of the anastomotic clip of FIG. 1 ;

[0068] - Figure 1E It shows that according to arrow I - see Figure 1C——a bottom view of the ring structure of the anastomotic clip of FIG. 1 ; and

[0069] - Figure 1F It shows that according to arrow I - see Figure 1C ——Top view on the (first) double-pointed tine fork of the anastomosis clip of Figure 1.

[0070] FIG. 2 schematically shows a second exemplary embodiment of an anastomotic clip according to the invention, in which the anastomotic clip has two “double-tooth” forks, in which:

[0071] - Figure 2A An anastomotic clip having a first bi-pronged tine fork and a second bi-pronged tine fork and a ring structure is shown in a side view in an open position;

[0072] - Figure 2B Shown in side view Figure 2A anastomotic clip, wherein the first bi-pronged fork, the second bi-pronged fork and the ring structure are in a closed position;

[0073] - Figure 2C Shown according to arrow II - see Figure 2B --of Figure 2B A top view of the anastomotic clip;

[0074] - Figure 2D Shown according to arrow III - see Figure 2B --of Figure 2B Bottom view of the anastomotic clip;

[0075] - Figure 2E Shown according to arrow II - see Figure 2B ——A top view on the ring structure of the anastomotic clip of FIG. 2 ;

[0076] - Figure 2F It is shown that according to arrow IV - see Figure 2C ——A side view of the ring structure of the anastomotic clip of FIG. 2 ;

[0077] - Figure 2G Shown according to arrow II - see Figure 2B ——A top view of the first double-tine fork of the anastomotic clip of FIG. 2 ;

[0078] - Figure 2H shows the arrow IV - see Figure 2C ——A side view of the first double-pointed fork of the anastomotic clip of FIG. 2 , in FIG. 2H :

[0079] - Figure 2H-1 is a side view of the complete first fork, and

[0080] - Figure 2H-2is an enlarged side view of a detail of the first fork, which is the tip of the first fork

[0081] the distal end of the tooth;

[0082] - Fig.2I Shown according to arrow II - see Figure 2B ——a top view on the second double-pronged fork of the anastomotic clip of FIG. 2 ; and

[0083] - Figure 2J It is shown that according to arrow IV - see Figure 2C ——A side view on the second double-pointed tine fork of the anastomotic clip of Figure 2.

[0084] Figure 3 A schematic perspective view showing the ring structure according to FIG. 1 inserted into a vessel according to a first example;

[0085] Figure 4 shows a schematic perspective view of the ring structure according to FIG. 1 being inserted into a vessel according to a second example;

[0086] Figure 5 shows a schematic perspective view of the ring structure according to FIG. 1 being inserted into a vessel according to a third example;

[0087] FIG6 shows a schematic perspective view of the first double-pronged fork according to FIG1 being inserted into a vessel according to a third example. In the figure:

[0088] - Fig. 6A showing a first bi-pronged fork in a first position relative to a vessel; and

[0089] - Figure 6B The first bi-pronged fork is shown in a second position relative to the vessel. DETAILED DESCRIPTION

[0090] As an example of the present invention, FIG. 1 shows several views, namely Figures 1A to 1F A first exemplary embodiment 100 of anastomotic clip 100 according to the present invention is shown.

[0091] The anastomotic clip according to FIG. 1 comprises as a first component a first double-pronged fork 2—shown in grey—having a fork base 3 and two tines 4, 5 extending from the fork base 3 to a tapered end portion 6. The tapering of the tapered end portion 6 begins substantially at the tapered base 17. The tapered end portion 6 tapers from the tapered base 17 to a sharp tip 7.

[0092] The anastomotic clip according to Fig. 1 further comprises as a second component a ring structure 1 - shown in white - which defines a ring plane. The ring plane is essentially the plane in which the ring extends. The ring plane can be a flat plane or a curved plane.

[0093] The anastomotic clip according to FIG. 1 further comprises a clamping structure 10 as a third component, which is configured to clamp the first prong 2 towards the ring structure 1 in a closed position with a first clamping force. In the absence of any vessel, when in the closed position, the clamping structure can clamp the first prong 2 directly against the ring structure 1. Under application conditions, when in the closed position, the clamping structure can clamp the first prong 2 indirectly against the ring structure 1 through one or two vessel walls between the first prong 2 and the ring structure 1, for example, in conjunction with FIG. 6 Figures 3 to 5 .

[0094] The ring structure 1 and the first fork 2 can be moved relative to each other from an open position - see Figure 1B See also Figure 1A -- Move to closed position -- See Figure 1C .

[0095] If you can Figure 1A and Figure 1B As shown in FIG. 1 , the ring structure 1 and the first bicuspid fork 2 of the anastomotic clip according to the present invention (the first exemplary embodiment 100 of the present invention) can be used as case a) - two separate parts - see Figure 1A - or as case b) - a unit is available to the surgeon.

[0096] In case a), the surgeon may first attach the ring structure 1 to one of the two anastomosing vessels - see Figures 3 to 5 , and the double-pronged fork 2 is attached to the other of the two anastomosing vessels - see Figure 6 - and then the ring structure 1 and the first double-pronged fork 2 are joined into one unit. This joining can be achieved in several ways. According to one example, this joining is achieved by inserting the proximal end 27 of the ring structure 1 into a recess or slit 26 provided at the proximal end 39 of the first fork 2. According to this example, the ring structure 1 and the first double-pronged fork 2 can be fixed relative to each other by means of an elastic lip 37 or rib provided in the proximal end 39 of the first fork 1, which elastic lip 37 is engaged in a recess 36 provided in the proximal end 27 of the first fork - see Figure 1E , or - not shown - in the opposite way by means of an elastic lip or rib provided on the proximal end 27 of the ring structure 1, which engages in a recess in a recess / slot 26 provided in the proximal end 39 of the first prong 2. The engagement of the first prong with the ring structure to form a unit can also be achieved in other ways. Such an engagement of the first prong 2 with the ring structure 1 may result in Figure 1B As will be clear, the recess / slit 26 and lip 37 may alternatively be provided at the proximal end 27 of the ring structure 1 .

[0097] In case b), the first prong 2 and the ring structure 1 are available to the surgeon as a unit, e.g. a prefabricated unit. In case b), the recess / slit 26 and / or the lip / rib 37 and / or the recess 36 may not be present. The first prong 2 and the ring structure 1 may, for example, be welded, glued, bolted or screwed to each other. However, any other technique for joining the first prong 2 and the ring structure 1 may also be used.

[0098] like Figure 1A and Figure 1B As can be seen in both, the ring structure 1 and the first fork 2 are arranged at a distance from each other in the open position.

[0099] Figure 1C The closed position is shown. Figure 1C As can be seen in the figure, in the closed position, the tines 4, 5 of the first fork extend along the ring plane, and the fork base 3 of the first fork 2 is located at the base side 8 of the ring structure 1, while the tapered end portions 6 of the tines 4, 5 of the first fork 2 are located at the tine end side 9 of the ring structure 1, and the tine end side 9 is opposite to the base side 8 when viewed along the ring plane.

[0100] Reference Figure 1E , for each of said tines 4, 5 of the first fork 2, the ring structure 1 has a first bearing area 21 associated with the first tine 4 and a second bearing area 22 associated with the second tine 5. Figure 1E In the example of FIG. 1 , the first support area 21 is shown in grey to clarify the support area. With regard to the second support area, this grey has been omitted. Figure 1E As can be further seen in the example of, the first support area and the second support area each include two sub-areas 21a, 21b and 33a, 22b, respectively, and the two sub-areas 21a, 21b and 33a, 22b are separated by an intermediate space. However, it will be understood that each support area can also include a single area or three sub-areas or more sub-areas.

[0101] Reference Figure 1E , each of said bearing areas 21, 22 has a distal end 23 and a proximal end 25, viewed relative to the fork base 3 of the first fork 2. Furthermore, as can generally be seen in FIG. 1 , each bearing area 21, 22 is configured to bear against a portion of the associated tine when the first fork is clamped towards the ring structure with a first clamping force in the closed position.

[0102] Reference Figure 1C, in the closed position, a first distance D1, measured from the fork base 3 of the first fork 2 to the sharp tips 7 of the tapered end portions of the tines 4, 5, is at most as long as a second distance D2, measured from the fork base 3 of the first fork 2 to the distal end of the associated bearing area 21, 22. This results in that, viewed in a transverse direction transverse to the ring plane, each of the sharp tips 7 is obscured by its associated bearing area 21 or 22.

[0103] Reference Figure 1C and Figure 1E , the third distance D3, measured from the fork base 3 of the first fork 2 to the tapered base 17 of the tapered end portion of the tines 4, 5, is at least as long as the fourth distance D4, measured from the fork base 3 of the first fork 2 to the proximal end 25 of the associated support area 21, 22. This has the result that, viewed in the transverse direction, each of the tapered bases 17 is supported by its associated support area 231 or 22.

[0104] As shown in Figure 1 - Figures 1A to 1F As can be seen in the figure, the clamping structure 10 can, for example, include a passage 12 arranged in the ring structure 1 and a snap member 11 arranged on the first fork 2. As will be understood, this can also be the other way around, that is, the passage 12 is arranged in the first fork 1 and the snap member 11 is arranged on the ring structure. More generally, the clamping structure can also be arranged in other ways.

[0105] Reference Figure 1E , viewed from the proximal end 25 of the support region 21, 22 to the distal end 23 of the support region 21, 22, the support region 21, 22 has a region length L. The region length L may be equal to or greater than the length of the tapered end portion 6. According to an embodiment, the region length L may be at least 110% of the length of the tapered end portion, for example at least 115% of the length of the tapered end portion 6, or at least 120% of the length of the tapered end portion 6, or at least 125% of the length of the tapered end portion 6. Additionally or alternatively, according to another corresponding alternative embodiment, the region length L may be the thickness T of the tines 4, 5 of the first fork 2 - see Figure 1A ——at least 2 times, for example at least 2.5 times the thickness T of the tines 4, 5 of the first fork 2, or at least 3.0 times the thickness T of the tines 4, 5 of the first fork 2. According to another additional or alternative embodiment, the area length L can be at most 6 times the thickness T of the tines 4, 5 of the first fork 2, for example at most 5 times the thickness T of the tines 4, 5 of the first fork 2.

[0106] Reference Figure 1B, the tapered end portions 6 of the tines 4, 5 of the first fork 2 each have a ring-facing surface 24 which, in the closed position, faces the associated bearing area 21, 22. Figure 1C As can be seen in the drawing, in the closed position, the ring-facing surface 24 of each of said tines 4, 5 of the first fork 2 or at least a portion of the ring-facing surface 24 is positioned parallel to and optionally against the associated support area 21, 22.

[0107] As an example of the present invention, FIG. 2 shows several views, namely FIG. 2A to FIG. 2J A second exemplary embodiment 200 of anastomotic clip according to the present invention is shown.

[0108] As with the first exemplary embodiment 100 of FIG. 1 , the anastomotic clip according to FIG. 2 comprises as a first component a first double-pronged fork 2 having a fork base 3 and two tines 4, 5 extending from the fork base 3 to a tapered end portion 6. The tapering of the tapered end portion 6 begins substantially at the tapered base 17. The tapered end portion 6 tapers from the tapered base 17 to a sharp tip 7.

[0109] As with the first exemplary embodiment 100 of Fig. 1 , the anastomotic clip according to Fig. 2 further comprises as a second component a ring structure 1 which defines a ring plane. The ring plane is essentially the plane in which the ring extends. The ring plane may be a flat plane or a curved plane.

[0110] As with the first exemplary embodiment 100 of FIG. 1 , the anastomotic clip according to FIG. 2 further comprises a clamping structure 60 as a third component, which is configured to clamp the first prong 2 toward the ring structure 1 in a closed position with a first clamping force. In the absence of any vessel, when in the closed position, the clamping structure can clamp the first prong 2 directly against the ring structure 1. Under application conditions, when in the closed position, the clamping structure can clamp the first prong 2 indirectly against the ring structure 1 via one or two vessel walls between the first prong 1 and the ring structure 2, for example, as shown in conjunction with FIG. 6 Figures 3 to 5 .

[0111] In addition to the first exemplary embodiment 100 of FIG. 1 , the anastomotic clip according to the exemplary embodiment of FIG. 2 further includes, as a fourth component, a second double-pronged fork 52 having a fork base 53 and two tines 54, 55 extending from the fork base 53 to a tapered end portion 56. The tapering of the tapered end portion 56 substantially starts at the tapered base 67. The tapered end portion 56 tapers from the tapered base 67 to the sharp tip 57.

[0112] In addition to the first exemplary embodiment 100 of FIG. 1 , the anastomotic clip according to the exemplary embodiment of FIG. 2 further comprises, as a fifth component, another clamping structure 70, which is configured to clamp the second prong 52 toward the ring structure 1 in a closed position with a second clamping force. In the absence of any vessel, when in the closed position, the another clamping structure 70 can clamp the second prong 2 directly against the ring structure 1. Under application conditions, when in the closed position, the another clamping structure 70 can clamp the second prong 52 indirectly against the ring structure 1 through one or two vessel walls between the second prong 52 and the ring structure 2. This is similar to Figures 3 to 5 In conjunction with the example of FIG. 6 , this is shown with respect to the first exemplary embodiment 100 .

[0113] The ring structure 1 and the first fork 2 can be moved relative to each other from an open position - see Figure 2A -- Move to closed position -- See Figure 2B In addition, the ring structure 1 and the second fork 52 can be moved relative to each other from an open position - see Figure 2A -- Move to closed position -- See Figure 2C The first fork 2 and the second fork 52 may move independently of each other relative to the first ring structure 1, or may move simultaneously relative to the ring structure, such as partially simultaneously. Figure 1A As can be seen in the figure, by pushing the gripping portions 61 and 63 toward the central portion / gripping portion 62, the first fork 2 and the second fork 52 can be in an open position relative to the ring structure 1. Pushing the gripping portion 61 toward the gripping portion 62 can resist the first elastic force applied by the spring 60, and pushing the gripping portion 63 toward the gripping portion 62 can resist the second elastic force applied by the spring 70. The gripping portions 61 and 63 can be pushed toward the central portion / gripping portion 62 simultaneously or independently of each other.

[0114] It should be noted that the clamping structures 60, 70 of the second exemplary embodiment 200 can also be configured differently. For example, it is conceivable that these clamping structures 60, 70 are configured similarly to the clamping structure 10 of the exemplary embodiment according to FIG. 1. In this case, the proximal end of the ring structure 1 can, for example, be provided with a body having a first slit 26 for receiving the proximal end of the fork 2 and a similar second slit for receiving the proximal end of the second fork 52. In order to ensure locking, the second fork 52 or the proximal end of the ring structure 1 can be provided with a lip / rib as in the first exemplary embodiment 100 - similar to the lip / rib 37. It is also conceivable that - similar to the first exemplary embodiment 100 - the ring structure 1, the first fork 2 and the second fork 3 can be used by the surgeon as a unit. In order to provide a clamping structure, both the first fork 2 and the second fork 52 can be provided with a snap member 11 that cooperates with the snap member 12 provided on the ring structure.

[0115] Similar to the first exemplary embodiment 100 , not only are the ring structure 1 and the first prong 2 movable relative to each other between an open position and a closed position, but also the ring structure 1 and the second prong 52 are movable relative to each other between an open position and a closed position.

[0116] Furthermore, similarly to the first exemplary embodiment 100 , not only are the ring structure 1 and the first fork 2 arranged at a distance from one another in the open position, but the ring structure 1 and the second fork 52 are also arranged at a distance from one another in the second position.

[0117] In the case of the second exemplary embodiment 200 in the closed position, the first fork 2 is arranged at one side of the ring plane and the second fork 52 is arranged at the other side of the ring plane. In the case of the second exemplary embodiment 200 in the closed position, the fork base 53 of the second fork 52 is located at the base side 8 of the ring structure, while the free end portions 56 of the tines 54, 55 of the second fork 52 are located at the tine end side 9 of the ring structure 1.

[0118] Although in the closed position, the tapered end portion 56 of the second fork 52 can be supported by an associated support area provided on the ring structure 1 similar to the tapered end portion of the first fork 2, wherein the sharp tip 57 is shielded by the associated support area provided on the ring structure 1, according to the second exemplary embodiment 200, in the closed position, since the free end portions 56 of the tines 54, 55 are positioned to be immersed in the internal space 30 defined by the ring structure 1, the surrounding tissue is protected from the influence of the sharp tip 57.

[0119] In this second exemplary embodiment 200 , it is conceivable according to further elaboration that the first prong 2 is provided with an associated support area which supports the second prong 52 when the second prong 52 is in its closed position.

[0120] In this second exemplary embodiment 200, it is envisaged according to additional or alternative further elaborations that in the closed position, the second fork 52 is clamped against the first fork 2 with a second clamping force F2, which is directed opposite to the first clamping force F1 and is smaller than the first clamping force F2. The second clamping force F2 is smaller than the first clamping force F1, thereby preventing the second fork 52 from lifting the first fork 2 toward the open position of the first fork.

[0121] See also Figure 2E, the ring structure 1 - not only according to the second exemplary embodiment but also according to the first exemplary embodiment - also has a left side portion 31 connecting the base side 8 with the tine end side 9, and a right side portion 32 opposite to the left side portion 31 connecting the base side 8 with the tine end side 9.

[0122] In addition, refer to Figure 2E , viewed in the radial direction of the ring structure 1, the left part 31 and the right part 32 of the ring structure 1 - not only according to the second exemplary embodiment but also according to the first exemplary embodiment - can optionally have a radial thickness RT, while the length L of the support areas 21, 22 is greater than the radial thickness RT, for example at least twice as great as the radial thickness RT. Experimental practice has shown that the tapered end portion 6 is well prevented from bending in the closed position when the length L of the support areas 21, 22 is longer than the radial thickness, in particular at least twice as long.

[0123] like Figure 1D and Figure 2C As can be seen in FIG. 1 , according to another embodiment, in the closed position, a section of the right tine 4 of the tine of the first fork 2 can extend parallel to the right side portion 32 of the ring structure 1, while a section of the left tine 5 of the tine of the first fork can extend parallel to the left side portion 31 of the ring structure 1. Figure 2D According to another embodiment, a segment of the right tine 54 of the tines of the second fork 52 can - in the closed position - similarly extend parallel to the right side portion 32 of the ring structure 1, while a segment of the left tine 55 of the tines of the second fork 52 can extend parallel to the left side portion 31 of the ring structure 1.

[0124] like Figure 2C and Figure 2B As shown in , the section of the right tine 4 in the closed position parallel to the right side of the ring structure and the section of the left tine 5 in the closed position parallel to the left side of the ring structure 1 can be optionally positioned to be immersed in the inner space 30 defined by the ring structure 1. This applies not only to the second exemplary embodiment 200 but also to other embodiments of the present invention, such as the first exemplary embodiment 100. Figure 2C and Figure 2E The rib 33 may be arranged adjacent to the bearing area 22, 24 so that the tapered end portion is located, as it were, in the recess. This prevents the tapered end portion 6 of the tines 4, 5 from moving in the lateral direction when in the closed position.

[0125] like Figure 2D and Figure 2BAs shown in , a section of the right tine 54 in the closed position parallel to the right side of the ring structure 1 and a section of the left tine 55 in the closed position parallel to the ring structure 1 can optionally be positioned to be immersed in the internal space 30 defined by the ring structure 1.

[0126] like Figure 2A , Figure 2C , Figure 2G , Figure 2H-1 and Figure 2H-2 As can be seen in FIG. 1 , the tapered end portions 6 of the tines 4, 5 of the first fork 2 can - according to another embodiment - each have three tapering portions. See also Figure 2H-2 The tapered end has a main taper 67 starting at 77, an additional taper 35 having its taper base at 17, and another additional taper 38 starting at 87. Figure 2C As can be seen in FIG. 1 , the additional taper 35 with its tapered base at 17 is almost completely overlapped by the associated bearing areas 21 , 22 . In one embodiment, the portion of the tine with the additional taper 35 can be considered as the tapered end portion 6 . Figure 2C It can be seen in FIG. 5 that approximately 40% to 50% of the main taper 67 overlaps the associated bearing area 21 , 22 . In another embodiment of the invention, the portion of the tine having the additional taper 67 may be considered as a tapered end portion 66 .

[0127] The main taper 67 has a main taper direction S1 and one or more further tapers 35, 38 have further taper directions S2, S3 - see also Figure 2H-2 67. The further tapers 35, 38 have a length that is shorter than the length of the main taper 67, as viewed in the length direction of the tine. Furthermore, the additional taper direction S2 of the taper 35 is different from the additional taper direction S3 of the taper 38. As viewed in the length direction of the tine, the further taper 38 has a length that is shorter than the length of the further taper 35. Although this is shown in relation to the second exemplary embodiment 200, it will be clear that this may also be the case in other embodiments of the invention, such as the first exemplary embodiment.

[0128] 2H, the direction of the main tapered portion 67 is Figure 2H-2 The arrow S1 in FIG. 1 indicates that the direction of the additional tapered portion 38 may be toward the associated bearing area. Figure 2H-2The arrow S2 in the figure indicates that the tapered end portion 57 may be in a direction away from the associated bearing area. The additional tapered portion 38 allows the sharp tip 57 to be sharpened over a shorter tine length. Depending on the material of the tine, the thickness of the tine and the clamping force, the risk of bending / deformation of the tapered end portion may exist primarily in the additional tapered portion 35, rather than already in the area where the main tapered portion 67 begins.

[0129] Reference Figure 2G and Figure 2H-2 Additionally or alternatively, the direction of the main taper 6 and the direction of the further taper 35 may also be at an angle relative to each other, for example perpendicular to each other - as indicated in the rear view by means of arrow S3, which is perpendicular to the drawing plane and points to the drawing plane.

[0130] Figure 3 FIG. 6 to FIG. 6 show an example of using the first exemplary embodiment 100 . Figures 3 to 5 The difference lies in how the vessels are attached to the ring structure 1.

[0131] exist Figure 3 In the embodiment of the present invention, the ring structure 1 is mounted to the open end of the vessel 43, wherein the distal end of the ring structure is said to be inside the open end of the vessel 43. The edge of the vessel wall surrounding the open end of the vessel 43 can be glued or sutured to the ring structure, for example, to provide a seal around the entire periphery. However, the vessel 43 can also be attached to the ring structure in another way. The vessel 43 can be a natural vessel or an artificial vessel. In the case of an artificial vessel, the open end of the vessel 43 can be attached along the ring of the ring structure by various mounting techniques. It is also conceivable that the ring of the ring structure 1 is combined with the end of the artificial vessel 43 or combined in the end of the artificial vessel 43.

[0132] exist Figure 4 4, the ring structure 1 is mounted to the open end of the vessel 44, wherein the distal end of the ring structure protrudes beyond the open end of the vessel 44, as it were. As shown, a suture 40 may be used to attach the vessel end to the ring structure. For this purpose, one or more holes 41 may be provided in the ring structure, for example a plurality of holes 41 distributed along the circumference of the ring of the ring structure. Glue / adhesive may be used to ensure a good seal around the entire circumference of the ring of the ring structure. The vessel 43 may be a natural vessel or an artificial vessel.

[0133] exist Figure 3 and Figure 4 In the figure, vessel 43 and vessel 44 are the T parts of ETS anastomosis or ETE anastomosis, respectively.

[0134] exist Figure 5 In the example, vessel 45 is one of the S parts of the STS anastomosis. In this example, the side wall of vessel 45 will be provided with an orifice surrounding the ring structure. Figure 3 and Figure 4 As in the embodiment, the vessel 45 can be a natural vessel or an artificial vessel. Figure 3 and Figure 4 As in the embodiment of the present invention, the vessel may be attached to the ring structure by means of glue / adhesive and / or sutures and / or other attachment means.

[0135] In Figure 6, it is shown how the first fork 2 is mounted to the vessel 46. The sharp tip 7 pierces the wall of the vessel 46 - see Fig. 6A - and then bringing the tines of the fork into a position parallel to the wall of the vessel 46 .

[0136] As will be clear to the skilled person, the first and second prongs may be provided to the surgeon as a unit or - as Figure 3 To that shown in Figure 6 - the two parts are mounted together by inserting the distal end 27 of the ring structure 1 into the slit 26 in the distal end of the first prong.

[0137] As will be further apparent to the skilled person, Figure 5 The vessel 46 may also be mounted on the second fork 52 in a manner similar to that shown in FIG. 6 , thereby producing an anastomotic clip according to a second exemplary embodiment of the present invention.

[0138] Embodiments and further embodiments of the present invention may be expressed using the terms set forth in the following clauses:

[0139] Item 1] An anastomotic clip (100; 200) for connecting a first vessel to a side wall of a second vessel,

[0140] Wherein, the anastomotic clip comprises:

[0141] - a first double-pronged fork (2) having a fork base (3) and two tines (4, 5) extending from the fork base (3) to a tapered end portion (6), the tapered end portion (6) tapering from the tapered base (17) to a sharp tip (7),

[0142] - a ring structure (1), said ring structure (1) defining a ring plane, and

[0143] - a clamping structure (10; 60) configured to clamp the first prong (2) towards the ring structure (1) in a closed position with a first clamping force;

[0144] wherein the ring structure (1) and the first fork (2) are movable relative to each other from an open position to the closed position;

[0145] wherein, in the open position, the ring structure (1) and the first fork (2) are arranged at a distance from each other;

[0146] Wherein, in the closed position:

[0147] - said tines (4, 5) of said first fork extend along said annular plane, and

[0148] - the fork base (3) of the first fork (2) is located at the base side (8) of the ring structure (1), while the tapered end portions (6) of the tines (4, 5) of the first fork (2) are located at the tine end side (9) of the ring structure (1), the tine end side (9) being opposite to the base side (8) when viewed along the ring plane;

[0149] wherein, for each of the tines (4, 5) of the first fork (2), the ring structure (1) has an associated bearing area (21, 22) associated with the tine (4, 5) of the first fork (2);

[0150] Wherein, each of the supporting areas (21, 22):

[0151] - has a distal end (23) and a proximal end (25) viewed relative to the fork base (3) of the first fork (2), and

[0152] - configured to support a portion of an associated tine when the first prong is clamped in the closed position toward the ring structure with the first clamping force; and

[0153] Wherein, in the closed position, a first distance (D1) from the fork base (3) of the first fork (2) to the sharp tip (7) of the tapered end portion of the tines (4, 5) is at most as long as a second distance (D2) from the fork base (3) of the first fork (2) to the distal end of the associated support area (21, 22), so that when viewed in a lateral direction transverse to the ring plane, each of the sharp tips is obscured by the associated support area of ​​the sharp tip.

[0154] Clause 2] The anastomotic clip (100, 200) according to clause 1, wherein, in the closed position, the associated support area overlaps at least about 35%, such as at least about 50%, of the tapered end portion.

[0155] Clause 3] The anastomotic clip (100, 200) according to clause 1 or 2,

[0156] Therein, the bearing region has a region length (L), viewed from a proximal end of the bearing region to a distal end of the bearing region.

[0157] Clause 4] The anastomotic clip (100, 200) according to clause 3,

[0158] Therein, the zone length (L) is at least 1.5 times, such as at least 2.0 times or at least 2.5 times, the thickness (T) of the tines (4, 5) of the first fork (2).

[0159] Clause 5] The anastomotic clip (100, 200) according to one of clauses 3 to 4,

[0160] Therein, the region length (L) is at most 6 times, for example at most 5 times, the thickness (T) of the tines (4, 5) of the first fork (2).

[0161] Clause 6] The anastomotic clip (100, 200) according to one of clauses 3 to 5,

[0162] Wherein, the region length (L) is equal to or greater than the length of the tapered end portion.

[0163] Clause 7] The anastomotic clip (100, 200) according to one of clauses 3 to 6,

[0164] Therein, the region length (L) is at least 110%, such as at least 115% or 120% or 125% of the length of the tapered end portion.

[0165] Clause 8] An anastomotic clip (100, 200) according to one of the preceding clauses, wherein, in the closed position, a third distance (D3) from the fork base (3) of the first fork (2) to the tapered base (17) of the tapered end portion of the tines (4, 5) is at least as long as a fourth distance (D4) from the fork base (3) of the first fork (2) to the proximal end (25) of the associated support area (21, 22), so that, viewed in the transverse direction, each of the tapered bases (17) is supported by the associated support area of ​​the tapered base (17).

[0166] Clause 9] The anastomotic clip (100, 200) according to one of the preceding clauses,

[0167] wherein the tapered end portions (6) of the tines (4, 5) of the first fork (2) each have a first tapered portion with a first tapered direction (S1) and a second tapered portion with a second tapered direction (S2, S3); wherein the first tapered direction (S1) is different from the second tapered direction (S2, S3); and wherein, viewed in the length direction of the tines (4, 5), the second tapered portion has a length shorter than that of the first tapered portion.

[0168] Item 10] An anastomotic clip according to Item 9, wherein, when viewed in the closed position, the first tapering direction (S1) is toward the associated support area (21, 22), and the second tapering direction (S2) is away from the associated support area (21, 22).

[0169] Clause 11] An anastomotic clip according to clause 9 or 10, wherein the first tapering direction (S1) and the second tapering direction (S3) are at an angle relative to each other, such as perpendicular to each other.

[0170] Clause 12] The anastomotic clip (100, 200) according to one of the preceding clauses,

[0171] wherein the tapered end portions (6) of the tines (4, 5) of the first fork (2) each have a ring-facing surface (24) which faces the associated bearing area (21, 22) in the closed position; and

[0172] Wherein, in the closed position, the ring-facing surface (24) of each of the tines (4, 5) of the first fork (2) or at least a portion of the ring-facing surface (24) is positioned parallel to the associated support area (21, 22) and optionally abuts against the associated support area (21, 22).

[0173] Clause 13] The anastomotic clip (100, 200) according to one of the preceding clauses,

[0174] Therein, the bearing areas (21, 22) are recessed into the tine end sides (9) of the ring structure (1).

[0175] Clause 14] The anastomotic clip (200) according to one of the preceding clauses,

[0176] Wherein, the clip (200) further comprises:

[0177] - a second double-pronged fork (52) having a fork base (53) and two tines (54, 55) extending from the fork base (53) to a free end portion (56), the free end portion (56) of the tines (54, 55) of the second fork (52) tapering to a sharp tip (57),

[0178] a further clamping structure (70) configured to clamp the second prong (52) towards the ring structure (1) of the first prong (2) in a closed position,

[0179] wherein the ring structure (1) and the second fork (52) are movable relative to each other between an open position and a closed position;

[0180] wherein, in the open position, the ring structure (1) and the second fork (52) are arranged at a distance from each other;

[0181] Therein, in the closed position and viewed relative to the ring plane:

[0182] - the first fork (2) is arranged on one side of the ring plane and the second fork (52) is arranged on the other side of the ring plane;

[0183] - said tines (54, 55) of said second fork extend along said annular plane, and

[0184] - the fork base (53) of the second fork (52) is located at the base side (8) of the ring structure (1), while the free end portions (56) of the tines (54, 55) of the second fork (52) are located at the tine end side (9) of the ring structure (1);

[0185] - the free end portions (56) of the tines (54, 55) of the second fork (52) are positioned immersed in the internal space (30) defined by the ring structure (1), so that in the closed position the sharp tip (56) of the second fork (52) is hidden by the ring structure (1).

[0186] Clause 15] The anastomotic clip (200) according to clause 14,

[0187] wherein, in the closed position, the second fork (52) is clamped toward the first fork (2) with a second clamping force (F2), the second clamping force (F2) being directed opposite to the first clamping force (F1); and

[0188] Wherein, the second clamping force (F2) is smaller than the first clamping force (F1).

[0189] Clause 16] The anastomotic clip (100, 200) according to one of the preceding clauses,

[0190] The ring structure (1) further comprises a left side portion (31) connecting the base side portion (8) with the tine end side portion (9), and a right side portion (32) opposite to the left side portion (31) connecting the base side portion (8) with the tine end side portion (9).

[0191] Clause 17] The anastomotic clip (100, 200) according to clause 16,

[0192] wherein, viewed in the radial direction of the ring structure (1), the left portion (31) and the right portion (32) have a radial thickness (RT), and

[0193] Therein, the length (L) of the support area (21, 22) is greater than the radial thickness (RT), for example, at least 1.5 times greater than the radial thickness (RT), for example, at least 1.75 times greater than the radial thickness (RT), or at least 2 times greater than the radial thickness (RT).

[0194] Clause 18] The anastomotic clip (100, 200) according to clause 16 or 17,

[0195] Wherein, in the closed position, a portion of the right tine (4) of the tine of the first fork (2) extends parallel to the right side portion (32) of the ring structure (1), and a portion of the left tine (5) of the tine of the first fork extends parallel to the left side portion (31) of the ring structure (1).

[0196] Clause 19] The anastomotic clip (100, 200) according to clause 18,

[0197] Wherein, in the closed position, the section of the right tine (4) of the first fork (2) and the section of the left tine (5) of the first fork (2) are positioned immersed in the internal space (30) defined by the ring structure (1).

[0198] Clause 20] The anastomotic clip (100, 200) according to a combination of one of clauses 16 to 19 and one of clauses 14 to 15,

[0199] In which, in the closed position, a portion of the right tine (54) of the tines (54, 55) of the second fork (52) extends parallel to the right side portion (32) of the ring structure (1), and a portion of the left tine (55) of the tines (54, 55) of the second fork (52) extends parallel to the left side portion (31) of the ring structure (1).

[0200] Clause 21] The anastomotic clip (100, 200) according to clause 20,

[0201] Wherein, in the closed position, the section of the right tine (54) of the second fork (52) and the section of the left tine (55) of the second fork (52) are positioned to be immersed in the internal space (30) defined by the ring structure (1).

[0202] Where the terms proximal and / or distal are used in this application, these terms are used relative to the longitudinal direction of the tines of the fork, the distal end corresponding to the side of the free end of the fork and the proximal end corresponding to the side of the fixed end of the fork.

Claims

1. An anastomotic clip (100; 200), the anastomotic clip (100; 200) being used to connect a first vessel to a side wall of a second vessel, in, The anastomotic clip comprises: - a first double-pronged fork (2) having a fork base (3) and two tines (4, 5) extending from the fork base (3) to a tapered end portion (6), the tapered end portion (6) tapering from the tapered base (17) to a sharp tip (7), - a ring structure (1), said ring structure (1) defining a ring plane, and a clamping structure (10; 60) configured to clamp the first prong (2) towards the ring structure (1) in a closed position of the first prong with a first clamping force; wherein the ring structure (1) and the first fork (2) are movable relative to each other from an open position of the first fork to a closed position of the first fork; wherein, in the open position of the first fork, the ring structure (1) and the first fork (2) are arranged at a distance from each other; Wherein, in the closed position of the first fork: - said tines (4, 5) of said first fork extend along said annular plane, and - the fork base (3) of the first fork (2) is located at the base side (8) of the ring structure (1), while the tapered end portion (6) of the tines (4, 5) of the first fork (2) is located at the tine end side (9) of the ring structure (1), the tine end side (9) being opposite to the base side (8) when viewed along the ring plane; wherein, for each of the tines (4, 5) of the first fork (2), the ring structure (1) has an associated bearing area (21, 22) associated with the tine (4, 5) of the first fork (2); Wherein, each of the supporting areas (21, 22): - has a distal end (23) and a proximal end (25) viewed relative to the fork base (3) of the first fork (2), and - configured to support a portion of an associated tine when the first prong is clamped in a closed position of the first prong towards the ring structure with the first clamping force; and Wherein, in the closed position of the first fork, a first distance (D1) from the fork base (3) of the first fork (2) to the sharp tip (7) of the tapered end portion of the tines (4, 5) is at most as long as a second distance (D2) from the fork base (3) of the first fork (2) to the distal end of the associated support area (21, 22), so that when viewed in a lateral direction transverse to the ring plane, each of the sharp tips is obscured by the associated support area of ​​the sharp tip.

2. The anastomotic clip (100, 200) according to claim 1, wherein: In the closed position of the first prong, the associated bearing area overlaps at least about 35%, such as at least about 50%, of the tapered end portion.

3. The anastomotic clip (100, 200) according to claim 1 or 2, in, The bearing region has a region length (L), viewed from a proximal end of the bearing region to a distal end of the bearing region.

4. The anastomotic clip (100, 200) according to claim 3, in, The zone length (L) is at least 1.5 times, such as at least 2.0 times or at least 2.5 times, the thickness (T) of the tines (4, 5) of the first fork (2).

5. The anastomotic clip (100, 200) according to one of claims 3 to 4, in, The zone length (L) is at most 6 times, such as at most 5 times, the thickness (T) of the tines (4, 5) of the first fork (2).

6. The anastomotic clip (100, 200) according to one of claims 3 to 5, in, The region length (L) is equal to or greater than the length of the tapered end portion.

7. The anastomotic clip (100, 200) according to one of claims 3 to 6, in, The region length (L) is at least 110%, such as at least 115% or 120% or 125% of the length of the tapered end portion.

8. The anastomotic clip (100, 200) according to one of the preceding claims, wherein: In the closed position of the first fork, a third distance (D3) from the fork base (3) of the first fork (2) to the tapered base (17) of the tapered end portion of the tines (4, 5) is at least as long as a fourth distance (D4) from the fork base (3) of the first fork (2) to the proximal end (25) of the associated support area (21, 22), so that, viewed in the transverse direction, each of the tapered bases (17) is supported by the associated support area of ​​the tapered base (17).

9. The anastomotic clip (100, 200) according to one of the preceding claims, in, The tapered end portions (6) of the tines (4, 5) of the first fork (2) each have a first tapered portion with a first tapered direction (S1) and a second tapered portion with a second tapered direction (S2, S3); wherein the first tapered direction (S1) is different from the second tapered direction (S2, S3); and wherein, viewed in the length direction of the tines (4, 5), the second tapered portion has a length shorter than that of the first tapered portion.

10. The anastomotic clip according to claim 9, wherein: Viewed in the closed position of the first fork, the first tapering direction (S1) is towards the associated support area (21, 22) and the second tapering direction (S2) is away from the associated support area (21, 22).

11. The anastomotic clip according to claim 9 or 10, wherein: The first tapering direction (S1) and the second tapering direction (S3) are at an angle relative to each other, such as perpendicular to each other.

12. The anastomotic clip (100, 200) according to one of the preceding claims, in, The tapered end portions (6) of the tines (4, 5) of the first fork (2) each have a ring-facing surface (24) which, in the closed position of the first fork, faces the associated bearing area (21, 22); and Wherein, in the closed position of the first fork, the ring-facing surface (24) of each of the tines (4, 5) of the first fork (2) or at least a portion of the ring-facing surface (24) is positioned parallel to the associated support area (21, 22) and optionally abuts against the associated support area (21, 22).

13. The anastomotic clip (100, 200) according to one of the preceding claims, in, The bearing areas (21, 22) are recessed into the tine end sides (9) of the ring structure (1).

14. The anastomotic clip (200) according to one of the preceding claims, in, The clip (200) further comprises: - a second double-pronged fork (52) having a fork base (53) and two tines (54, 55) extending from the fork base (53) to a free end portion (56), the free end portion (56) of the tines (54, 55) of the second fork (52) tapering to a sharp tip (57), a further clamping structure (70) configured to clamp the second prong (52) towards the ring structure (1) of the first prong (2) in a closed position of the second prong, wherein the ring structure (1) and the second prong (52) are movable relative to each other between an open position of the second prong and a closed position of the second prong; wherein, in the open position of the second fork, the ring structure (1) and the second fork (52) are arranged at a distance from each other; Therein, in the closed position of the second fork and viewed relative to the ring plane: - the first fork (2) is arranged on one side of the ring plane and the second fork (52) is arranged on the other side of the ring plane; - said tines (54, 55) of said second fork extend along said annular plane, and - the fork base (53) of the second fork (52) is located at the base side (8) of the ring structure (1), while the free end portions (56) of the tines (54, 55) of the second fork (52) are located at the tine end side (9) of the ring structure (1); - the free end portions (56) of the tines (54, 55) of the second fork (52) are positioned immersed in the internal space (30) defined by the ring structure (1) so that in the closed position of the second fork, the sharp tip (56) of the second fork (52) is hidden by the ring structure (1).

15. The anastomotic clip (200) according to claim 14, in, In the closed position of the second fork, the second fork (52) is clamped toward the first fork (2) with a second clamping force (F2), the second clamping force (F2) being directed opposite to the first clamping force (F1); and Wherein, the second clamping force (F2) is smaller than the first clamping force (F1).

16. The anastomotic clip (100, 200) according to one of the preceding claims, in, The ring structure (1) also has a left side portion (31) connecting the base side (8) and the tine end side (9), and a right side portion (32) opposite to the left side portion (31) connecting the base side (8) and the tine end side (9).

17. The anastomotic clip (100, 200) according to claim 16, in, When viewed in the radial direction of the ring structure (1), the left portion (31) and the right portion (32) have a radial thickness (RT), and Therein, the length (L) of the support area (21, 22) is greater than the radial thickness (RT), for example, at least 1.5 times greater than the radial thickness (RT), for example, at least 1.75 times greater than the radial thickness (RT), or at least 2 times greater than the radial thickness (RT).

18. The anastomotic clip (100, 200) according to claim 16 or 17, in, In the closed position of the first fork, a section of the right tine (4) of the tines of the first fork (2) extends parallel to the right side portion (32) of the ring structure (1), and a section of the left tine (5) of the tines of the first fork extends parallel to the left side portion (31) of the ring structure (1).

19. The anastomotic clip (100, 200) according to claim 18, in, In the closed position of the first fork, the section of the right tine (4) of the first fork (2) and the section of the left tine (5) of the first fork (2) are positioned immersed in the internal space (30) defined by the ring structure (1).

20. The anastomotic clip (100, 200) according to one of claims 16 to 19 in combination with one of claims 14 to 15, in, In the closed position of the second fork, a portion of the right tine (54) of the tines (54, 55) of the second fork (52) extends parallel to the right side portion (32) of the ring structure (1), while a portion of the left tine (55) of the tines (54, 55) of the second fork (52) extends parallel to the left side portion (31) of the ring structure (1).

21. The anastomotic clip (100, 200) according to claim 20, in, In the closed position of the second fork, the section of the right tine (54) of the second fork (52) and the section of the left tine (55) of the second fork (52) are positioned immersed in the internal space (30) defined by the ring structure (1).

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