WO2016192096A1

WO2016192096A1 - Endoscopic reposable surgical clip applier

Info

Publication number: WO2016192096A1
Application number: PCT/CN2015/080845
Authority: WO
Inventors: Shunhong Xu; Longsheng CAI; Encheng HU
Original assignee: Covidien Lp; Covidien (China) Medical Devices Technology Co., Ltd.
Priority date: 2015-06-05
Filing date: 2015-06-05
Publication date: 2016-12-08

Abstract

A reposable surgical clip applier (10) is provided and includes a handle assembly (100), an endoscopic assembly (200) selectively connectable to a housing (102) of the handle assembly (100), and a clip cartridge assembly (300) selectively loadable in and connectable to the endoscopic assembly (200).

Description

ENDOSCOPIC REPOSABLE SURGICAL CLIP APPLIER

BACKGROUND Technical Field

The technical field relates to surgical clip appliers. More particularly, the present disclosure relates to endoscopic reposable surgical clip appliers having a reusable handle assembly, a reusable shaft assembly, and a disposable clip cartridge assembly.

Description of Related Art

Endoscopic staplers and clip appliers are known in the art and are used for a number of distinct and useful surgical procedures. In the case of a laparoscopic surgical procedure, access to the interior of an abdomen is achieved through narrow tubes or cannulas inserted through a small entrance incision in the skin. Minimally invasive procedures performed elsewhere in the body are often generally referred to as endoscopic procedures. Typically, a tube or cannula device is extended into the patient′s body through the entrance incision to provide an access port. The port allows the surgeon to insert a number of different surgical instruments therethrough using a trocar and for performing surgical procedures far removed from the incision.

During a majority of these procedures, the surgeon must often terminate the flow of blood or another fluid through one or more vessels. The surgeon will often apply a surgical clip to a blood vessel or another duct to prevent the flow of body fluids therethrough during the procedure. An endoscopic clip applier is known in the art for applying a single clip during an entry to the body cavity. Such clips are typically fabricated from a biocompatible material and are usually compressed over a vessel. Once applied to the vessel, the compressed clip terminates the flow of fluid therethrough.

Endoscopic clip appliers that are able to apply multiple clips in endoscopic or laparoscopic procedures during a single entry into the body cavity are described in commonly-assigned U.S. Pat. Nos. 5,084,057 and 5,100,420 to Green et al., which are both incorporated by reference in their entirety. Another multiple endoscopic clip applier is disclosed in commonly-assigned U.S. Pat. No. 5,607,436 by Pratt et al., the contents of which is also hereby incorporated by reference herein in its entirety. These devices are typically, though not necessarily, used during a single surgical procedure. U.S. Pat. No. 5,695,502 to Pier et al., the disclosure of which is hereby incorporated by reference herein, discloses a resterilizable surgical clip applier. The clip applier advances and forms multiple clips during a single insertion into the body cavity. This resterilizable clip applier is configured to receive and cooperate with an interchangeable clip magazine so as to advance and form multiple clips during a single entry into a body cavity.

During endoscopic or laparoscopic procedures it may be desirable and/or necessary to use different size surgical clips depending on the underlying tissue or vessels to be ligated. In order to reduce overall costs of a surgical clip applier, it is desirable for a single surgical clip applier to be loadable with and capable of firing different size surgical clips as needed.

Accordingly, a need exists for endoscopic surgical clip appliers that include reusable handle assemblies, reusable shaft assemblies, and disposable clip cartridge assemblies, with each clip cartridge assembly being loaded with a particularly sized clip (e.g., relatively small, relatively medium, or relatively large) .

SUMMARY

The present disclosure relates to reposable endoscopic surgical clip appliers.

According to an aspect of the present disclosure, a reposable surgical clip applier is provided and includes a handle assembly, an endoscopic assembly selectively connectable to a housing of the handle assembly, and a clip cartridge assembly selectively loadable in and connectable to the endoscopic assembly.

The handle assembly includes a housing, a trigger pivotally supported on and extending from the housing, and a drive assembly supported within the housing and operatively actuatable by the trigger.

The endoscopic assembly is selectively connectable to the housing of the handle assembly. The endoscopic assembly includes a knob assembly configured and adapted for selective connection to the housing of the handle assembly, and an outer tube connected to and extending from the knob assembly. The outer tube defines a window in a distal end thereof. A pair of jaws is supported in the outer tube and extends from the distal end of the outer tube. A jaw closure tube is slidably supported within the outer tube, the jaw closure tube being operatively connected to the trigger of the handle assembly upon a connection of the endoscopic assembly to the handle assembly. A clip pusher bar is slidably supported within the jaw closure tube, the clip pusher bar being operatively connected to the drive assembly of the handle assembly upon a connection of the endoscopic assembly to the handle assembly, wherein the clip pusher bar effectuates a closure of the pair of jaws upon an actuation of the trigger.

The clip cartridge assembly is selectively loadable in and connectable to the window of the outer tube of the endoscopic assembly. The clip cartridge assembly includes a clip tray including a base wall and a pair of side walls defining a channel therein. A cartridge clip pusher bar is disposed adjacent the clip tray and slidable relative thereto. A proximal end of the cartridge clip pusher bar is configured for selective connection with the clip pusher bar of the endoscopic assembly. A plurality of surgical clips is slidably disposed within the channel of the clip tray and interposed between the cartridge clip pusher bar and the base wall of the clip tray. A clip follower is slidably disposed within the channel of the clip tray and is disposed proximal of the plurality of surgical clips. A biasing member acts on the clip follower to distally advance the clip follower and the plurality of clips during any distal movement of a distal-most clip of the plurality of clips.

The biasing member of the clip cartridge assembly may be a constant force spring. The constant force spring of the clip cartridge assembly may include a coiled proximal end disposed proximal of the clip follower, and a distal end extending along the plurality of surgical clips and being anchored within clip cartridge assembly.

The clip cartridge assembly may include a cover disposed adjacent the cartridge clip pusher bar, wherein the cover may include a hook projecting therefrom for securing the distal end of the constant force spring.

The cartridge clip pusher bar of the clip cartridge assembly may include a coupling stem at a proximal end thereof, and wherein the clip pusher bar of the endoscopic assembly may include a distal coupling window formed therein for mechanically coupling with the coupling stem of the cartridge clip pusher bar when the clip cartridge assembly is loaded in the endoscopic assembly.

The cartridge clip pusher bar of the clip cartridge assembly may include a lock button accessible through the cover of the clip cartridge assembly. The lock button may include a first, un-locked position permitting loading and unloading of clip cartridge assembly in the window of the outer tube of the endoscopic assembly. A second, locked position is provided wherein a tab of the lock button extends into the outer tube of the endoscopic assembly, when the clip cartridge assembly is loaded in the window of the outer tube of the endoscopic assembly, to secure the clip cartridge assembly within the window of the outer tube of the endoscopic assembly.

The clip cartridge assembly may include a lock spring supported in the clip tray. The lock spring may be engaged by the lock button to restrict movement of the lock button. The lock spring may be configured to permit the lock button to move from the first, un-locked position to the second, locked position relatively easier than from the second, locked position to the first, un-locked position.

The drive assembly of the handle assembly may include a jaw pusher tube slidably supported within the housing and axially translatable upon an actuation of the trigger. The jaw pusher tube may define a lumen extending axially therethrough. A distal end of the jaw pusher tube may be configured for selective connection to the jaw closure tube of the endoscopic assembly.

The drive assembly of the handle assembly may include a clip pusher bar slidably disposed within the lumen of the jaw pusher tube. The clip pusher bar of the drive assembly may include a distal end configured for selective connection to the clip pusher bar of the endoscopic assembly, and a proximal end extendable from a proximal end of the jaw pusher tube.

The drive assembly of the handle assembly may also include a release lever pivotably connected to the jaw pusher tube. The release lever may include a proximal end extending proximally of a pivot point. The proximal end of the release lever has a tooth projecting therefrom that extends into the lumen of the jaw pusher tube. A distal end extends distally of the pivot point of the release lever, the distal end of the release lever has a nub projecting therefrom.

The drive assembly of the handle assembly may further include a biasing member acting on the release lever to maintain the proximal end of the release lever in relative close proximity to the lumen of the jaw pusher tube.

The handle assembly may include a biasing member connected to the clip pusher bar of the drive assembly, wherein the biasing member tends to maintain the clip pusher bar of the drive assembly in a proximal position.

The handle assembly may include a camming pin supported in the housing, wherein the camming pin acts on the nub of the release lever as the jaw pusher tube is moved in a distal direction.

In use, as the jaw pusher tube is moved in the distal direction, the tooth of the release lever may pull the clip pusher bar of the drive assembly in a distal direction, and as the clip pusher bar of the drive assembly is moved in the distal direction, the biasing member may be stretched.

Also, in use, as the nub of the release lever engages the camming pin, the camming pin may actuate the release lever to disengage the tooth of the release lever from the proximal end of the clip pusher bar of the drive assembly. In so doing, the biasing member may withdraw the clip pusher bar of the drive assembly in a proximal direction.

The drive assembly of the handle assembly may include a biasing member acting on the jaw pusher tube to maintain the jaw pusher tube in a proximal position.

The handle assembly may include a ratchet assembly having a pawl pivotably supported in the housing； a biasing member acting on the pawl； and a rack of teeth connected to the jaw pusher tube of the drive assembly, wherein the ratchet assembly may prevent any partial actuation of the trigger. The rack of teeth may be in axial alignment with the nub of the release lever of the drive assembly.

The endoscopic assembly may include a slider joint supported on a distal end of jaw closure bar thereof, wherein the slider joint may delay closure of the pair of jaws for a dwell period following initial actuation of the trigger of the handle assembly.

The endoscopic assembly may include a camming tip in operative association with the pair of jaws, and distally spaced from the slider joint prior to an actuation of the trigger of the handle assembly.

In use, during an initial actuation of the trigger, the slider joint may be approximated toward the camming tip, through the dwell period.

Also in use, following the dwell period, continued actuation of the trigger may result in the slider joint distally advancing the camming tip.

Each jaw of the pair of jaws may include a camming wedge, and wherein the camming tip may define a camming channel configured to act on the camming wedges of the pair of jaws to approximate the pair of jaws during distal advancement of the camming tip relative to the pair of jaws.

The clip tray of the clip cartridge assembly may include a resilient finger extending distally from each side wall. Each resilient finger may extend into the channel of the clip tray, and wherein each resilient finger may engage a respective leg of a distal-most surgical clip.

BRIEF DESCRIPTION OF THE DRAWINGS

A particular embodiment of a surgical clip applier is disclosed herein with reference to the drawings wherein:

FIG. 1 is a perspective view of a reposable endoscopic surgical clip applier, according to the present disclosure；

FIG. 2 is an enlarged view of the indicated area of FIG. 1；

FIG. 3 is a top view of the surgical clip applier of FIG. 1；

FIG. 4 is a side, elevational view of the surgical clip applier of FIGS. 1 and 2；

FIG. 5 is a perspective view of the surgical clip applier of FIGS. 1, 3 and 4, with an endoscopic assembly separated from a handle assembly, and with a surgical clip cartridge assembly separated from the endoscopic assembly；

FIG. 6 is a perspective view of the handle assembly of FIG. 5, with a left side half-section removed therefrom；

FIG. 7 is a rear, perspective view of the handle assembly of FIG. 5 with a housing thereof shown in phantom；

FIG. 8 is a perspective view, with parts separated, of the handle assembly illustrated in FIG. 7；

FIG. 9 is a rear, perspective view of the endoscopic assembly of the surgical clip applier of FIG. 1；

FIG. 10 is a front, perspective view of the endoscopic assembly illustrated in FIG. 9；

FIG. 11 is a perspective view, with parts separated, of endoscopic assembly of FIGS. 9 and 10；

FIG. 12 is an enlarged view of the indicated area of detail of FIG. 11；

FIG. 13 is an enlarged view of the indicated area of detail of FIG. 11；

FIG. 14 is a bottom, perspective view of the surgical clip cartridge assembly of the surgical clip applier of FIG. 1；

FIG. 15 is a top, perspective view of the surgical clip cartridge assembly of FIG. 14；

FIG. 16 is an enlarged view of the indicated area of detail of FIG. 15；

FIG. 17 is a perspective view, with parts separated, of the surgical clip cartridge assembly of FIGS. 15 and 16；

FIG. 18 is an enlarged view of the indicated area of detail of FIG. 17；

FIG. 19 is a cross-sectional view of the surgical clip cartridge assembly, as taken through 19-19 of FIG. 15；

FIGS. 20-22 are top, plan cross-sectional views illustrating the operation of clip cartridge assembly lock button；

FIG. 23 is a perspective view illustrating a connection of the endoscopic assembly to the handle assembly；

FIGS. 24-26 are cross-sectional views illustrating the connection of the endoscopic assembly to the handle assembly；

FIGS. 27-29 illustrate a loading of the surgical clip cartridge assembly into the endoscopic assembly；

FIG. 30 is a cross-sectional view of the surgical clip cartridge assembly, as taken through 30-30 of FIG. 27；

FIG. 31 is a cross-sectional view of the endoscopic assembly, as taken through 30-30 of FIG. 27；

FIG. 32 is a longitudinal, cross-sectional, elevational view of the reposable endoscopic surgical clip applier, shown in an un-actuated condition；

FIG. 33 is an enlarged view of the indicated area of detail of FIG. 32；

FIG. 34 is a cross-sectional view as taken through 34-34 of FIG. 33；

FIG. 35 is an enlarged view of the indicated area of detail of FIG. 32；

FIG. 36 is an enlarged view of the indicated area of detail of FIG. 35；

FIG. 37 is an enlarged view of the indicated area of detail of FIG. 35；

FIG. 38 is a cross-sectional, elevational view of the handle assembly, shown during an initial actuation of the trigger；

FIG. 39 is an enlarged view of the indicated area of FIG. 38；

FIG. 40 is a detailed view of the operation of a ratchet assembly during the initial actuation of the trigger；

FIG. 41 is a top, plan view of a distal end of the endoscopic assembly during the initial actuation of the trigger；

FIG 42 is a longitudinal, cross-sectional, elevational view of the distal end of the endoscopic assembly during the initial actuation of the trigger；

FIG. 43 is a detailed view of indicated area 39 of FIG. 38 of the handle assembly, shown during a further actuation of the trigger；

FIG 44 is a longitudinal, cross-sectional, elevational view of the distal end of the endoscopic assembly during the further actuation of the trigger；

FIG 45 is a front, perspective view of the distal end of the endoscopic assembly during the further actuation of the trigger；

FIG. 46 is a cross-sectional, elevational view of the handle assembly, shown during a final actuation of the trigger；

FIG. 47 is an enlarged view of the indicated area of FIG. 46；

FIG. 48 is a top, plan view of the distal end of the endoscopic assembly during the final actuation of the trigger；

FIG. 49 is a cross-sectional, elevational view of the handle assembly, shown following a complete actuation of the trigger；

FIG. 50 is a detailed view of the ratchet assembly following the complete actuation of the trigger；

FIG. 51 is a top, plan view of the distal end of the endoscopic assembly following the complete actuation of the trigger；

FIG. 52 is a perspective view illustrating a surgical clip formed on a target vessel； and

FIG. 53 is a detailed view of the ratchet assembly during a release of the trigger.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of reposable endoscopic surgical clip appliers, in accordance with the present disclosure, will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument， the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further away from the user.

Referring now to FIGS. 1-5, an endoscopic surgical clip applier in accordance with an embodiment of the present disclosure is generally designated as 10. Surgical clip applier 10 generally includes a handle assembly 100, an endoscopic assembly 200 including a shaft assembly 210 selectively connectable to and extendable distally from handle assembly 100； and at least one surgical clip cartridge assembly 300 selectively loadable into shaft assembly 210 of endoscopic assembly 200.

Briefly, shaft assembly 210 of endoscopic assembly 200 may have various outer diameters such as, for example, about 5mm or about 10mm, depending on intended use. Further, shaft assembly 210 may have various relatively elongated or shortened lengths depending on intended use, such as, for example, in bariatric surgery. In one embodiment, in bariatric surgery, shaft assembly 210 may have a length of between about 30cm and about 40cm. However one skilled in the art should appreciate that shaft assembly 210 may have any length in excess of about 30cm and the present disclosure is not limited to any of the above identified lengths.

In accordance with the present disclosure, as will be discussed in greater detail below, each surgical clip cartridge assembly 300 may be loaded with a particularly sized set of surgical clips (e.g., relatively small surgical clips, relatively medium surgical clips, or relatively large surgical clips) . Each clip cartridge assembly 300 is configured to be selectively loaded into shaft assembly 210 of endoscopic assembly 200, and to be actuated by handle assembly 100 to fire and form the surgical clips loaded therein onto underlying tissue and/or vessels.

Referring now to FIGS. 1-8, handle assembly 100 of surgical clip applier 10 is shown. Handle assembly 100 includes a housing 102 having a first or right side half-section 102a and a second or left side half-section 102b. Handle assembly 100 includes a trigger 104 pivotably supported between right side half-section 102a and left side half-section 102b of housing 102. Trigger 104 is biased by a biasing member 104a (e.g., a return spring) to an un-actuated condition. Specifically, biasing member 104a acts on a jaw pusher tube 130 (as will be described in greater detail below) , which is connected to trigger 104 by a pair of

link arms

122, 124.

Housing 102 of handle assembly 100 may be formed of a suitable plastic or thermoplastic material. It is further contemplated that housing 102 of handle assembly 100 may be fabricated from stainless steel of the like. Housing 102 of handle assembly 100 further includes, as seen in FIGS. 5-8, a nose 102c.

With reference to FIGS. 6-8, handle assembly 100 includes a drive assembly 120 operatively connected to trigger 104. Specifically, drive assembly 120 includes a distal link arm 122 extending from trigger 104, and a proximal link arm 124 interconnecting distal link arm 122 and jaw pusher tube 130. Distal link arm 122 includes a distal coupling portion 122a fixedly connected to or keyed to trigger 104 for concomitant pivoting upon a pivoting of trigger 104, and a proximal coupling portion 122b pivotally connected to proximal link arm 124. Proximal link arm 124 includes a distal coupling portion 124a pivotally connected to proximal coupling portion 122b of distal link arm 122, and a proximal coupling portion 124b pivotally connected to a jaw pusher tube or cylinder 130. A first pin 126a pivotally connects distal link arm 122 and proximal link arm 124 to one another. A second pin 126b pivotally connects proximal coupling portion 124b of proximal link arm 124 to jaw pusher tube 130. Second pin 126b is also slidably disposed within opposed longitudinal channels 102d formed in opposed handle half-

sections

102a, 102b. In this manner, as trigger 104 is actuated, second pin 126b rides along longitudinal channels 102d (FIG. 8) , thereby transferring actuation forces from trigger 104 to jaw pusher tube 130.

As seen in FIGS. 6-8, drive assembly 120 further includes jaw pusher tube 130 slidably supported within housing 102 of handle assembly 100. Jaw pusher tube 130 includes a proximal end 130a and a distal end 130b, and defines a longitudinally extending passageway or lumen 130c therethrough for receipt of and slidable passage of clip pusher bar 140 therein. As described above, a proximal coupling portion 124b of proximal link arm 124 is pivotally connected to jaw pusher tube or cylinder 130, at a location between proximal end 130a and distal end 130b of jaw pusher tube 130. Distal end 130b of jaw pusher tube 130 projects distally from nose 102c of housing 102 and defines an annular race or channel 130d formed in an outer surface thereof.

Biasing member 104a may be interposed between a distal inner surface of housing 102 and distal surface of a flange 130e projecting from jaw pusher tube 130. Biasing member 104a tends to maintain jaw pusher tube 130 at a proximal position, and, in turn, trigger 104 in an un-actuated condition.

As illustrated in FIGS. 6-8, jaw pusher tube 130 includes at least one linear rack 152 of teeth 152a of a ratchet assembly 150, as will be described in detail below. Drive assembly 120 includes a clip pusher bar release lever 132 pivotally supported on and connected to jaw pusher tube 130 via a pivot pin 134. Pivot pin 134 is disposed along rack 152. Release lever 132 includes a proximal end 132a extending proximally of pivot pin 134 and extending proximally of proximal end 130a of jaw pusher tube 130. Proximal end 132a of release lever 132 includes a tooth 132c and dimensioned to extend at least partially across and/or into proximal end 130a and/or lumen 130c of jaw pusher tube 130. Release lever 132 includes a distal end 132b extending distally of pivot pin 134. Distal end 132b of release lever 132 includes a nub or ramp 132d projecting therefrom, in a direction opposite to the direction of tooth 132c. Nub 132d may be located along a length of rack 152 of ratchet assembly 150.

A biasing member 134, in the form of a leaf spring, may be provided which tends to bias proximal end 132a of release lever 132 towards lumen 130c of jaw pusher tube 130, and tends to bias distal end 132b of release lever 132 away from jaw pusher tube 130. Specifically, biasing member 134 tends to maintain tooth 132c of release lever 132 in engagement with proximal end 140a of clip pusher shaft 140, as will be described in greater detail below.

In use, as will be described in greater detail below, as jaw pusher tube 130 is advanced distally through housing 102, due to an actuation of trigger 104, as jaw pusher tube 130 approaches a camming feature 136 (e.g., a pin extending across housing 102) , ramp 132d of distal end 132b of release lever 132 will engage pin 136 and be deflected, pushed or cammed toward jaw pusher tube 130, overcoming the bias of biasing member 134, and moving proximal end 132a of release lever away from jaw pusher tube 130, and out of engagement with clip pusher shaft 140.

With continued reference to FIGS. 6-8, drive assembly 120 further includes a clip pusher shaft 140 slidably supported within and through lumen 130c of jaw pusher tube 130. Clip pusher shaft 140 includes a proximal end 140a projecting proximally from proximal end 130a of jaw pusher tube 130, and a distal end 140b projecting distally from distal end 130b of jaw pusher tube 130. Distal end 140b defines a coupling tip 140c. Proximal end 140a of clip pusher shaft 140 may be tubular and define a longitudinally extending bore therein, distal end 140b of clip pusher shaft 140 may be solid, and a longitudinally extending slot 140d may be provided along a length thereof to slidably accommodate second pin 126b.

A biasing member 142 (e.g., a tension spring) is interposed between and secured to housing 102 of handle assembly 100 and clip pusher shaft 140. Specifically, a distal end of biasing member 142 is fixed or secured within the tubular proximal end 140a of clip pusher shaft 140, and a proximal end of biasing member 142 is fixed or secured to a feature in a proximal end of housing 102.

Biasing member 142 acts on clip pusher shaft 140 to bias or urge clip pusher shaft 140 in a proximal direction or to a proximal position. When jaw pusher tube 130 and clip pusher shaft 140 are located at a respective proximal position, tooth 132c of proximal end 132a of release lever 132 extends across and into engagement with proximal end 140a of clip pusher shaft 140.

In use, as will be described in greater detail below, with tooth 132c of proximal end 132a of release lever 132 extending across and into engagement with proximal end 140a of clip pusher shaft 140, as trigger 104 is actuated to distally advance jaw pusher tube 130, tooth 132c of release lever 132 grabs onto or engages proximal end 140a of clip pusher shaft 140 to distally advance clip pusher shaft 140. As clip pusher shaft 140 is advanced distally, biasing member 142 is extended, stretched or otherwise biased.

As illustrated in FIGS. 6-8, handle assembly 100 includes a stop block, plate or the like 144 supported in housing 102. Stop block 144 is disposed proximal of clip pusher shaft 140 with biasing member 142 extending through an opening or slot 144a formed therein, or with biasing member 142 extending alongside stop block 144. It is contemplated that the opening or slot 144a formed in stop block 144 is dimensioned such that proximal end 140a of clip pusher shaft 140 abuts against a surface (e.g., distal surface) of stop block 144 when clip pusher shaft 140 is in a proximal-most position. Also, when clip pusher shaft 140 is in the proximal-most position, in abutment with stop block 144, biasing member 142 is maintained biased or in tension, whereby biasing member 142 tends to maintain a tension on clip pusher shaft 140 such that clip pusher shaft 140 is in abutment with stop block 144.

In use, as will be described in greater detail below, as jaw pusher tube 130 and clip pusher shaft 140 are advanced distally, jaw pusher tube 130 is advanced distally through housing 102, due to an actuation of trigger 104, as jaw pusher tube 130 approaches pin 136 (as described above) , ramp 132d of distal end 132b of release lever 132 engages pin 136 and is deflected toward jaw pusher tube 130, overcoming the bias of biasing member 134, and moving proximal end 132a of release lever 132 away from jaw pusher tube 130, and moving tooth 132c of release lever 132 out of engagement with proximal end 140a of clip pusher shaft 140. When tooth 132c of release lever 132 disengages clip pusher shaft 140, biasing member 142, acting on clip pusher shaft 140, withdraws clip pusher shaft 140 into abutment with stop block 144.

With continued reference to FIGS. 6-8, handle assembly 100 includes a ratchet assembly 150 supported within housing 102. Ratchet assembly 150 includes, as mentioned above, at least one linear rack 152 of teeth 152a supported on and projecting from jaw pusher tube 130. Ratchet assembly 150 further includes a ratchet pawl 154 pivotally connected to housing 102 by a pawl pin at a location wherein pawl 154 is in substantial operative engagement with rack 152. Ratchet assembly 150 further includes a pawl spring 156 configured and positioned to bias pawl 154 into operative engagement with rack 152. Pawl spring 156 functions to maintain the tooth or teeth 154a of pawl 154 in engagement with teeth 152a of rack 152, as well as to maintain pawl 154 in a rotated or canted position.

Pawl 154 is engagable with rack 152 to restrict longitudinal movement of rack 152 and, in turn, jaw pusher tube 130. In use, as jaw pusher tube 130 is moved axially, rack 152 is also moved. Rack 152 has a length which allows pawl 154 to reverse and advance back over rack 152 when rack 152 changes between proximal and distal movement as jaw pusher tube 130 reaches a proximal-most or distal-most position.

Turning now to FIGS. 5-9, handle assembly 100 includes a lock knob 160 rotatable supported on nose 102c of housing 102. Lock knob 160 includes a proximal annular portion 160a defining finger gripping features, and a distal portion 160b supporting a pair of diametrically opposed connection bosses 160c projecting radially therefrom. Lock knob 160 is dimensioned such that distal end 130b of jaw pusher tube 130 and distal end 140b of clip pusher shaft 140 each extend distally from distal portion 160b of lock knob 160.

Turning now to FIGS. 5 and 9-13, endoscopic assembly 200 of surgical clip applier 10 is shown. Endoscopic assembly 200 includes a knob assembly 202 configured for selective connection to lock knob 160 of handle assembly 100. Knob assembly 202 includes an outer knob collar 204, and an inner knob collar 206 configured for receipt in a bore 204a of outer knob collar 204. Outer knob collar 204 defines a pair of diametrically opposed bayonet grooves 204b (FIGS. 9 and 23) formed in an inner surface of bore 204a. Bayonet grooves 204b are configured and dimensioned for selective engagement with connection bosses 160c of lock knob 160 of handle assembly 100 to selectively secure and connect endoscopic assembly 200 to handle assembly 100.

In use, to connect endoscopic assembly 200 to handle assembly 100, as illustrated in FIG. 23, connection bosses 160c of lock knob 160 of handle assembly 100 are aligned with an open end of bayonet grooves 204b of outer knob collar 204 of endoscopic assembly 200, and handle assembly 100 and endoscopic assembly 200 are approximated toward one another until connection bosses 160c of lock knob 160 are at least partially received within bayonet grooves 204b of outer knob collar 204. Then, while holding an angular position of lock knob 160 relative to housing 102, handle assembly 100 and endoscopic assembly 200 are rotated relative to one another to move connection bosses 160c of lock knob 160 radially within bayonet grooves 204b of outer knob collar 204. It is contemplated that bayonet grooves 204b of outer knob collar 204 may be defined with a lip or the like over which connection bosses 160c of lock knob 160 pass and whereby connection bosses 160c of lock knob 160 are retained within bayonet grooves 204b of outer knob collar 204.

A first biasing member (not shown) may be provided to assist in maintaining outer knob collar 204 connected to lock knob 160.

The connection of knob assembly 202 with lock knob 160 of handle assembly 100 enables endoscopic assembly 200 to rotate 360°, about a longitudinal axis thereof, relative to handle assembly 100.

With reference momentarily to FIG. 33, inner knob collar 206 and outer knob collar 204 of knob assembly 202 are dimensioned such that inner knob collar 206 is axially slidably supported within outer knob collar 204. An annular recess 205 is defined between inner knob collar 206 and outer knob collar 204, and between a distal annular shoulder 204c projecting from an inner surface of outer knob collar 204, and a proximal annular shoulder 206c projecting from an outer surface of inner knob collar 206. A second biasing member 208, for example, an over-stroke compression spring, may be disposed within annular recess 205 of knob assembly 202.

The second biasing member 208 will help to maintain outer knob collar 204 connected to lock knob 160. Specifically, when connecting endoscopic assembly 200 to handle assembly 100, connection bosses 160c of lock knob 160 are slid through bayonet grooves 204b of outer knob collar 204. In so doing, lock knob 160 will push inner knob collar 206 of endoscopic assembly 200 distally. Then, second biasing member 208 is activated or engaged to help maintain outer knob collar 204 connected to lock knob 160.

In use, during a firing of surgical clip applier 10, if the closure of the pair of jaws 214 should become stuck or otherwise prevented from closing completely (e.g., where the pair of jaws 214 are closing onto bone or onto another surgical clip) , a forward stroke of drive assembly 120 of handle assembly 100 may be fully completed (wherein a distal driving force of jaw pusher tube 130 is transmitted to inner knob collar 206, and wherein the second biasing member 208 is axially compressed) in order to permit a re-set or a reversal of ratchet assembly 150 and permit trigger 104 to open.

Returning to FIGS. 5 and 9-13, endoscopic assembly 200 includes a shaft assembly 210 extending from knob assembly 202. Shaft assembly 210 includes an outer tube 212 having a proximal end portion 212a fixedly secured to inner knob collar 206 of knob assembly 202, and a distal end portion 212b extending from inner knob collar 206 of knob assembly 202. Distal end portion 212b of outer tube 212 defines a channel or window 212c formed in a side thereof. Outer tube 212 includes a distal shroud 212d extending across window 212c at a distal location of window 212c.

Shaft assembly 210 includes a pair of jaws 214 mounted in channel 212c of outer tube 212 and actuatable by an actuation of trigger 104 of handle assembly 100. The pair of jaws 214 is formed of a suitable biocompatible material such as, for example, stainless steel or titanium. The pair of jaws 214 may be removably or fixedly mounted in channel 212c of outer tube 212.

Referring momentarily to FIGS. 11 and 13, the pair of jaws 214 defines a channel 214c therebetween for receipt of a surgical clip “C” therein. The pair of jaws 214 include a pair of camming wedge surfaces 214d projecting therefrom. As will be described in detail below, the pair of camming wedge surfaces 214d is acted upon by a jaw closure bar 216 to actuate the pair of jaws 214 to a closed position.

With reference to FIGS. 9-11, shaft assembly 210 includes a jaw closure tube 216 slidably supported within outer tube 212. Jaw closure tube 216 includes a proximal end portion 216a fixedly supporting a coupling hub 217, and a distal end portion 216b configured to engage and act on the pair of jaws 214. Specifically, distal end portion 216b of jaw closure tube 216 connects to a slider joint 215 (FIG. 11) that connects to a camming tip 213 that is configured and dimensioned to engage the outer surfaces of the pair of camming wedge surfaces 214b of the pair of jaws 214 as the jaw closure tube 216 is moved in a distal direction, relative to the pair of jaws 214, to approximate the pair of jaws 214. Specifically, camming tip 213 defines a distally oriented, tapering channel 213a having a pair of side walls 213b configured to engage a respective one of the pair of camming wedge surfaces 214b of the pair of jaws 214.

In use, as will be described in greater detail below, with coupling hub 217 of jaw closure tube 216 connected to coupling tip 130d of jaw pusher tube 130, axial translation of jaw pusher tube 130 results in axial translation of jaw closure tube 216.

With continued reference to FIGS. 9-13, shaft assembly 210 of endoscopic assembly 200 includes a clip pusher bar 218 slidably supported within jaw closure tube 216. Clip pusher bar 218 includes a proximal end portion 218a defining a proximal coupling 218c, and a distal end portion 218b defining a distal coupling 218d configured to engage and act on a cartridge clip pusher bar 304 of clip cartridge assembly 300, as will be described in greater detail below. Proximal coupling 218c of clip pusher bar 218 is configured to selectively connect to coupling tip 140c of clip pusher bar 140 of drive assembly 120 of handle assembly 100. In use, with proximal coupling 218c of clip pusher bar 218 connected to coupling tip 140c of clip pusher shaft 140, axial translation of clip pusher shaft 140 of handle assembly 100 results in axial translation of clip pusher bar 218 of endoscopic assembly 200. It is contemplated that proximal coupling 218c of clip pusher bar 218 and coupling tip 140c of clip pusher shaft 140 may have a dovetail-type configuration of the like.

Referring momentarily to FIGS. 11 and 23, coupling hub 217 of jaw closure tube 216 is configured to selectively connect to coupling tip 130d of jaw pusher tube 130 of drive assembly 120 of handle assembly 100. Specifically, coupling hub 217 has a substantially U-shaped configuration for slidably connecting (laterally or from the side) onto coupling tip 130d of jaw pusher tube 130, in the manner of a yoke. It is contemplated that coupling hub 217 of jaw closure tube 216 and coupling tip 130d of jaw pusher tube 130 may have a dovetail-type configuration or the like.

To connect endoscopic assembly 200 to handle assembly 100, with reference to FIGS. 23-26, outer knob collar 204 is moved distally, together with outer tube 212 and inner knob collar 206, relative to jaw closure tube 216, to thereby expose coupling hub 217 of jaw closure tube 216. With coupling hub 217 of jaw closure tube 216 exposed, coupling hub 217 is slidably connected onto coupling tip 130d of jaw pusher tube 130 by laterally sliding coupling hub 217 onto coupling tip 130d. Additionally, with coupling hub 217 of jaw closure tube 216 exposed, proximal coupling 218c of clip pusher bar 218 of endoscopic assembly 200 is slidably connected into coupling tip 140c of clip pusher shaft 140 by laterally sliding proximal coupling 218c into coupling tip 140c. With coupling hub 217 of jaw closure tube 216 connected to coupling tip 130d of jaw pusher tube 130, outer knob collar 204 and inner knob collar 206 are moved proximally, along jaw closure tube 216, and outer knob collar 204 is coupled to lock collar 160, as described above.

With reference to FIGS. 10 and 13, shaft assembly 210 further includes a clip logic feature 220 associated with the pair of jaws 214 which functions to maintain the pair of jaws 214 in a fully open condition prior to a loading of a surgical clip into the pair of jaws 214. Specifically, clip logic feature 220 includes a rib, nub or

rail

220a, 220b projecting from a

respective jaw leg

214a, 214b of the pair of jaws 214. Clip logic feature 220 further includes a pair of ribs or rails 220c, 220d disposed along opposed lateral sides of the distal end portion of slider joint 215.

The pair of

rails

220a, 220b of the pair of jaws 214 or the pair of

rails

220c, 220d of slider joint 215 are dimensioned such that as jaw closure tube 216 is distally advanced, from a proximal-most position, the pair of

rails

220c, 220d of slider joint 215 cam against the pair of

rails

220a, 220b of the pair of jaws 214 to splay the pair of jaws 214 to a fully open condition, while a surgical clip “C” is loaded into channel 214c of the pair of jaws 214. Thereafter, the pair of

rails

220c, 220d of slider joint 215 disengage from the pair of

rails

220a, 220b of the pair of jaws 214, to permit the pair of jaws 214 to be approximated to form the surgical clip “C” loaded therein.

Turning now to FIGS. 5 and 14-22, clip cartridge assembly 300 of surgical clip applier 10 is shown. As mentioned above, clip cartridge assembly 300 is configured and dimensioned for selective loading into channel 212c formed in distal end portion 212b of outer tube 212 of endoscopic assembly 200, and is configured and dimensioned to selectively connect or couple to distal coupling 218d of clip pusher bar 218, as will be discussed in greater detail below.

Clip cartridge assembly 300 includes a clip tray 302 including base wall 302a, and a pair of spaced apart side walls or rails 302b supported on base wall 302b, with base wall 302a and side walls 302b defining a clip channel 302c.

A distal end of base wall 302a of clip tray 302 includes, as best illustrated in FIG. 16, a resilient central tang 302d. Tang 302d is configured and adapted to selectively engage a backspan “C_B” of a distal-most surgical clip “C₁” of the stack of surgical clips “C” retained within clip tray 302 to thereby retain the stack of surgical clips “C” within clip tray 302 of clip cartridge assembly 300.

Each side wall 302b terminates in a distally extending resilient finger 302e, wherein each resilient finger 302e projects into clip channel 302c. Each resilient finger 302e is aligned or in registration with a respective clip leg “C_L” ， wherein each clip leg “C_L” extends from opposite sides of backspan “C_B” . For example, each resilient finger 302e may be angled at approximately 60° relative to the horizontal. A relative stiffness of each resilient finger 302e may be adjusted by varying a thickness and/or width of the resilient finger, or an angle of the resilient finger relative to the horizontal.

Clip cartridge assembly 300 includes a cartridge clip pusher bar 304 slidably disposed adjacent clip tray 302. Cartridge clip pusher bar 304 includes a proximal end 304a having a coupling stem, head or boss 304c projecting therefrom and being configured to selectively connect with distal coupling 218d of clip pusher bar 218 of endoscopic assembly 200. Cartridge clip pusher bar 304 further includes a distal end portion 304b defining a pusher 304d configured to engage a distal-most clip “C₁” of a stack of clips “C” for loading the distal-most clip “C₁” into the pair of jaws 214 of the endoscopic assembly 200. Clip pusher bar 304 further defines an elongate window 304d therein for operative receipt of a proximal end of a constant force spring 308 therein, as will be discussed in greater detail below.

Clip cartridge assembly 300 includes a stack of surgical clips “C” interposed between clip tray 302 and cartridge clip pusher bar 304. Clip cartridge assembly 300 may be loaded with “10” surgical clips “C” ， or， in embodiments， clip cartridge assembly 300 may be loaded with any number of surgical clips C”， provided clip cartridge assembly 300 and endoscopic assembly 200 are appropriately configured and dimensioned. Surgical clips “C” may be fabricated from materials know by those skilled in the art, including and not limited to stainless steel, titanium, or other metal alloys. In an embodiment it is contemplated that at least a final surgical clip of the stack of surgical clips “C” may be dyed a particular color to indicate to the user when a final surgical clip of clip cartridge assembly 300 is loaded into the pair of jaws 214.

Clip cartridge assembly 300 further includes a clip follower 306 at least partially slidably disposed within clip channel 302c of clip tray 302. As will be described in greater detail below， clip follower 306 is positioned proximally of the stack of surgical clips “C” and is provided to urge the stack of surgical clips “C” forward during an actuation of surgical clip applier 10. Additionally, as will also be described in greater detail below, clip follower 306 is actuated by a constant force spring 308 upon the advancement, by clip pusher bar 304, of the distal-most surgical clip “C_d” into the pair of jaws 214， during a firing of surgical clip applier 10.

Clip follower 306 includes an elongate body 306a having a distal end portion 306b configured and dimensioned for passage through clip channel 302c of clip tray 302. Distal end portion 306b of clip follower 306 is configured to seat against a backspan of a proximal-most clip “C_p” of the stack of surgical clips “C” .

Clip follower 306 includes a proximal fin 306d projecting transversely from a proximal end portion 306c thereof. Proximal fin 306d defines a proximal surface 306d₁ having a concave arcuate profile configured to receive and seat with a coiled or spooled portion 308c of a constant force spring 308.

Clip cartridge assembly 300 includes a cartridge cover 310 configured for connection to and supported on clip tray 302. Cartridge cover 310 includes a substantially distally extending hook or tine 310a (FIG. 18) which projects from an inner surface thereof. Hook 310a is configured to receive and retain a distal end 308b of constant force spring 308. Cartridge cover 310 may be fabricated from a transparent material, allowing the user to clearly see the stack of surgical clips “C” in the stack of clips.

With continued reference to FIGS. 14-18, clip cartridge assembly 300 includes, as mentioned above, a constant force spring 308 supported in clip channel 302c of clip tray 302. Constant force spring 308 is in the form of a ribbon including a body portion 308a having a distal end 308b, and a proximal end 308c coiled onto itself to form a spool.

Body portion 308a and distal end 308b of constant force spring 308 are disposed within clip channel 302c of clip tray 302 such that body portion 308a and distal end 308b of constant force spring 308 are interposed between cartridge cover 310 and clip pusher bar 304. Distal end 308b of constant force spring 308 is secured to tine 310a of clip cartridge cover 310, as mentioned above. In particular, as illustrated in FIG. 18, distal end 308b of constant force spring 308 defines an opening 308b₁ that is slipped over a distally extending tine 310a of clip cartridge cover 310. In this manner, tine 310a of clip cartridge cover 310 prevents distal end 308b of constant force spring 308 from moving proximally.

Proximal coiled or spooled end 308c of constant force spring 308 is disposed proximally of proximal fin 306d of clip follower 306. Due to a memory of constant force spring 308, proximal coiled or spooled end 308c thereof tends to want to roll-up along body portion 308a.

Constant force spring 308 is a pre-stressed flat strip of spring material which is formed into a virtually constant radius coil, wherein distal end 308b of constant force spring 308 is secured to tine 310a of clip cartridge cover 310 as described above, and wherein proximal coiled or spooled end 308c of constant force spring 308 is disposed proximally of proximal fin 306d of clip follower 306 as described above.

Constant force spring 308 functions to maintain a constant pressure or distal force on clip follower 306, and in turn on the stack of surgical clips “C” such that the stack of surgical clips “C” are pressed against resilient central tang 302d of clip tray 302. In this manner, in operation, as will be described in greater detail below， the stack of surgical clips “C” advances distally on demand as the distal-most surgical clip “C₁” is advanced any amount, and in particular, past resilient central tang 302d by clip pusher bar 304.

With reference to FIGS. 19-22 and 27-31, a loading of clip cartridge assembly 300 to endoscopic assembly 200 is shown and described. In order to load clip cartridge assembly 300 into channel or window 212c of outer tube 212 of endoscopic assembly 200, a user first inserts a distal end or tip 300a of clip cartridge assembly 300 into window 212c of outer tube 212 of endoscopic assembly 200, such that the distal end 300a of clip cartridge assembly 300 is retained and beneath distal shroud 212d of outer tube 212. With the distal end 300a of clip cartridge assembly 300 retained beneath distal shroud 212d of outer tube 212, a proximal end 300b of clip cartridge assembly 300 is inserted into window 212c of outer tube 212 of endoscopic assembly 200. As the proximal end of clip cartridge assembly 300 is inserted into window 212c of outer tube 212 of endoscopic assembly 200, coupling stem, head or boss 304c of cartridge clip pusher bar 304 is inserted into distal coupling 218d of clip pusher bar 218 of endoscopic assembly 200.

In so doing, clip cartridge assembly 300 is loaded into channel or window 212c of outer tube 212 of endoscopic assembly 200, and cartridge clip pusher bar 304 of clip cartridge assembly 300 is coupled to clip pusher bar 218 of endoscopic assembly 200.

With reference to FIGS. 19-22 and 29, clip cartridge assembly 300 includes a lock button 320 and a lock spring 330. Lock button 320 and lock spring 230 cooperate with one another to secure clip cartridge assembly 300 within window 212c of endoscopic assembly 200 when clip cartridge assembly 300 is loaded into window 212c of endoscopic assembly 200.

Specifically, lock button 320 of clip cartridge assembly 300 is slidably supported in clip tray 302 and cover 310 between a distal, un-locked position, and a proximal, lock position. Lock button 320 includes a stem 322 configured for engagement with lock spring 230 of endoscopic assembly 200. Stem 322 of lock button 320 has a substantially flat distal surface 322a, and a tapered proximal surface 322b, to define a modified pentagon transverse cross-sectional profile.

Lock spring 330 is fixedly supported within clip tray 302 and includes a pair of adjacent resilient

leaf spring members

330a, 330b defining a substantial dog bone shape having enlarged distal and proximal end portions interconnected by a tapered middle portion. The enlarged distal and proximal end portions are configured and sized to receive stem 322 of lock button 320 therein. Specifically, the enlarged distal end portion of lock spring 330 has a substantially modified pentagon profile for receiving stem 322 of lock button 320 therein when lock button 320 is in the distal, un-locked position. With clip cartridge assembly 300 loaded into endoscopic assembly 200, and with stem 322 of lock button 320 located in distal end portion of lock spring 330, lock button 320 may be actuated from the distal, un-locked portion to the proximal, lock position, wherein stem 322 of lock button 320 traverses tapered middle portion of lock spring 330 (deflecting

leaf spring members

330a, 330b outward) to be received in proximal end portion of lock spring 330. When lock button 320 is moved from the distal, un-locked position to the proximal, lock position, a proximally extending tab 324 (see FIGS. 15, 17 and 30) of lock button 320 is extending into and within outer tube 212 of endoscopic assembly 200.

Due to the relative shape of stem 322 of lock button 320, and the shapes of enlarged distal and proximal end portions of lock spring 330, movement of lock button 320 from the distal, un-locked position to the proximal, lock position is relatively easier than movement of lock button 320 from the proximal, lock position to the distal, un-locked position.

With continued reference to FIGS. 1-31, and with additional specific reference to FIGS. 32-53, an exemplary mode of operation of clip applier 10 is shown and described. As shown in FIGS. 32-37, clip applier 10 is illustrated with endoscopic assembly 200 connected to handle assembly 100 (as described above) , and with clip cartridge assembly 300 loaded in endoscopic assembly 200 (as described above) .

Specifically, with trigger 104 of handle assembly in an unactuated condition, jaw pusher tube 130 and clip pusher shaft 140 of handle assembly 100, jaw closure bar 216 and clip pusher bar 218 of endoscopic assembly 200, and cartridge clip pusher bar 304 of clip cartridge assembly 300 are in an unactuated or proximal-most position. As so positioned, with reference to FIG. 33, tooth 132c of release lever 132 extends across and into engagement with proximal end 140a of clip pusher shaft 140.

Additionally, with reference to FIG. 36, with trigger 104 of handle assembly 100 in an unactuated condition, pusher 304d of cartridge clip pusher bar 304 of clip cartridge assembly 300 is disposed proximal of distal-most surgical clip “C₁” of the stack of surgical clips “C” (FIG. 17) .

As described above, and as illustrated in FIGS. 35 and 37, with clip cartridge assembly 300 loaded into endoscopic assembly 200, stem 304c of cartridge clip pusher bar 304 of clip cartridge assembly 300 located in distal coupling 218d of clip pusher bar 218 of endoscopic assembly 200.

With continued reference to FIGS. 1-31, and with additional specific reference to FIGS. 38-42, an initial firing stroke of surgical clip applier 10 is shown and described below. With clip cartridge assembly 300 loaded in endoscopic assembly 200, as trigger 104 of handle assembly 100 is actuated to an initial amount, a distal-most clip “C₁” of the stack of surgical clips “C” is loaded into and formed by the pair of jaws 214 of endoscopic assembly 200.

More specifically, as trigger 104 is actuated the initial amount, in the direction of arrow “B” of FIG. 38, trigger 104 acts on distal link arm 122, which in turn acts on proximal link arm 124, which in turn acts on jaw pusher tube 130, to distally advance jaw pusher tube 130. As jaw pusher tube 130 is advanced distally, as shown in FIGS. 38 and 39, being that tooth 132c of release lever 132 extends across and into engagement with proximal end 140a of clip pusher shaft 140, clip pusher shaft 140 is also distally advanced. Also, as clip pusher shaft 140 is moved in a distal direction, biasing member 142 is caused to be stretched or extended.

As clip pusher shaft 140 of handle assembly 100 is moved in a distal direction, as illustrated in FIGS. 41 and 42, clip pusher shaft 140 moves clip pusher bar 218 of endoscopic assembly 200 in a distal direction, which in turn, acts on cartridge clip pusher bar 304 of clip cartridge assembly 300 to move cartridge clip pusher bar 304 in a distal direction to load distal-most clip “C₁” into the pair of jaws 214.

Additionally, as shown in FIG. 41, as jaw pusher shaft 130 is advanced in a distal direction, jaw pusher shaft 130 acts on jaw closure bar 216 to move jaw closure bar 216 in a distal direction, and in turn to move slider joint 215 in a distal direction (through a dwell period “D” ) ， whereby camming tip 213 is held stationary and does not yet move distally.

During distal advancement of jaw closure bar 216, and slider joint 215, through dwell period “D” ， the opposed lateral sides of slider joint 215 act on the

rails

220a, 220b of clip logic feature 220 of

respective jaw legs

214a, 214b of the pair of jaws 214 to splay the pair of jaws 214 open, while distal-most clip “C₁” is loaded into the pair of jaws 214.

Additionally, and simultaneously with a distal movement of the distal-most clip “C₁” ， as cartridge clip pusher bar 304 of clip cartridge assembly 300 moves in a distal direction, constant force spring 308 acts on clip follower 306 (FIG. 37) to urge the remaining stack of clips “C” in a distal direction. The remaining stack of clips “C” is distally advanced until the next distal-most clip “C” comes into abutment with tang 302d of clip tray 302.

As illustrated in FIG. 40, as trigger 104 is actuated the initial amount, pawl 154 of ratchet assembly 150 engages teeth 152a of rack 152 provided on jaw pusher tube 130. Once pawl 154 of ratchet assembly 150 engages rack 152 of jaw pusher tube 130, trigger 104 is prevented from returning to a fully un-actuated position upon any release thereof, unless or until trigger 104 is fully actuated, or until pawl 154 clears a distal end of rack 152.

With reference to FIGS. 43-45, as trigger 104 is actuated an additional or second amount， in the direction of arrow “B” (FIG. 38) , trigger 104 continues to distally advance jaw pusher tube 130 of handle assembly 100. As jaw pusher tube 130 is further advanced distally, jaw pusher tube 130 approaches camming pin 136. Meanwhile, clip pusher shaft 140 continues to move clip pusher bar 218 of endoscopic assembly 200 in a distal direction, which in turn, acts on cartridge clip pusher bar 304 of clip cartridge assembly 300 to move cartridge clip pusher bar 304 in a distal direction to complete loading of distal-most clip “C₁” into the pair of jaws 214. As clip pusher shaft 140 moves distally, clip pusher bar 140 causes biasing member 142 to stretch.

With reference to FIGS. 46-45, as trigger 104 is actuated a further or third amount, in the direction of arrow “B” , trigger 104 continues to distally advance jaw pusher tube 130 of handle assembly 100. As jaw pusher tube 130 is further advanced distally, ramp 132d of distal end 132b of release lever 132 engages pin 136 and is deflected, pushed or cammed toward jaw pusher tube 130, overcoming the bias of biasing member 134, and moving proximal end 132a of release lever away from jaw pusher tube 130, and moving tooth 132c of release lever 132 out of engagement with proximal end 140a of clip pusher shaft 140. When tooth 132c of release lever 132 disengages clip pusher shaft 140, biasing member 142 is free to contract and withdraw clip pusher shaft 140 into abutment with stop block 144.

As clip pusher shaft 140 is withdrawn in a proximal direction, clip pusher shaft 140 acts on clip pusher bar 218 of endoscopic assembly 200 to move clip pusher bar 218 in a proximal direction (not shown) , which, in turn acts on cartridge clip pusher bar 304 of clip cartridge assembly 300 to move cartridge clip pusher bar 304 in a proximal direction (not shown) . As cartridge clip pusher bar 304 is moved in a proximal direction, pusher 304d of cartridge clip pusher bar 304 is withdrawn from between the pair of jaws 214, and placed proximal of the next distal-most clip of the stack of clips “C” (not shown) .

Additionally, during the third amount of actuation of trigger 104, slider joint 215 has advanced through dwell period “D” and the opposed lateral sides of slider joint 215 are moved distally beyond the

rails

220a, 220b of clip logic feature 220 of

respective jaw legs

214a, 214b of the pair of jaws 214.

With reference to FIGS. 46-52, as trigger 104 is actuated a final or fourth amount, in the direction of arrow “B” ， trigger 104 continues to distally advance jaw pusher tube 130 of handle assembly 100. As jaw pusher tube 130 is further advanced distally, jaw pusher shaft 130 acts on jaw closure bar 216 to move jaw closure bar 216 in a distal direction, jaw closure bar 216 moves slider joint 215 and camming tip 213 distally. As camming tip 213 is moved in a distal direction, open-ended channel 213c of distal end portion 213b of camming tip 213 engage the outer surfaces of the pair of camming wedge surfaces 214b of the pair of jaws 214 to approximate the pair of jaws 214 and form the distal-most clip “C₁” that has been loaded therein.

As trigger 104 is actuated the final or fourth amount, as illustrated in FIG. 50, pawl 154 of ratchet assembly 150 disengages rack 152 provided on jaw pusher tube 130. Once pawl 154 of ratchet assembly 150 disengages rack 152 of jaw pusher tube 130, trigger 104 is permitted to return to a fully un-actuated position upon any release thereof.

During the total distal advancement of jaw pusher tube 130, biasing member 104a is compressed between the distal inner surface of housing 102 and distal surface of a flange 130e projecting from jaw pusher tube 130.

With reference to FIGS. 38-51, with a surgical clip “C” formed， trigger 104 may be released and returned to an unactuated position either by or with the assistance of trigger biasing member 104a (see FIG. 49) . As trigger 104 is returned to an unactuated position, jaw pusher tube 130 is moved in a proximal direction until and such that tooth 132c of release lever 132 extends across and into re-engagement with proximal end 140a of clip pusher shaft 140.

As jaw pusher tube 130 is moved in a proximal direction, jaw pusher tube 130 acts on jaw closure bar 216 of endoscopic assembly 200 to withdrawn jaw closure bar 216. As jaw closure bar 216 is moved in a proximal direction, slider joint 215 is withdrawn (through a dwell period “D” ) until a tooth 215b of a link bar 215a (FIGS. 13 and 31) extending from camming tip 213. In this manner, a shoulder of slider joint 215engages tooth 215b of link bar 215a to withdraw camming tip 213. As camming tip 213 is withdrawn, camming tip 213 disengages from the pair of camming wedge surfaces 214b of the pair of jaws 214 enabling the pair of jaws 214 to return to an open condition due to a spring bias thereof.

With reference to FIG. 53, as jaw pusher tube 130 is moved in a proximal direction, pawl 154 of ratchet assembly 150 re-engages rack 152 provided on jaw pusher tube 130. With pawl 154 re-engaged with rack 152, trigger 104 may not be re-actuated until pawl 154 clears or is disposed distal of rack 152.

Clip applier 10 is now reset for firing of another surgical clip “C” .

In accordance with the present disclosure, it is contemplated that surgical clip applier 10 includes a reusable and sterilizable handle assembly 100 that may be used for multiple surgical procedures； a reusable and sterilizable endoscopic assembly 200 that may also be used for multiple surgical procedures； and a disposable, single use clip cartridge assembly 300 (e.g., wherein the clip cartridge assembly 300 is disposed of when unloaded from endoscopic assembly 200) . It is contemplated that endoscopic assembly 200 may be disposed of following the particular surgical procedure and not reused or sterilized.

It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure.

Claims

A reposable surgical clip applier, comprising:

a handle assembly including:

a housing；

a trigger pivotally supported on and extending from the housing； and

a drive assembly supported within the housing and operatively actuatable by the trigger；

an endoscopic assembly selectively connectable to the housing of the handle assembly, the endoscopic assembly including:

a knob assembly configured and adapted for selective connection to the housing of the handle assembly；

an outer tube connected to and extending from the knob assembly, the outer tube defining a window in a distal end thereof；

a pair of jaws supported in the outer tube and extending from the distal end of the outer tube；

a jaw closure tube slidably supported within the outer tube, the jaw closure tube being operatively connected to the trigger of the handle assembly upon a connection of the endoscopic assembly to the handle assembly； and

a clip pusher bar slidably supported within the jaw closure tube, the clip pusher bar being operatively connected to the drive assembly of the handle assembly upon a connection of the endoscopic assembly to the handle assembly, wherein the clip pusher bar effectuates a closure of the pair of jaws upon an actuation of the trigger； and

a clip cartridge assembly selectively loadable in and connectable to the window of the outer tube of the endoscopic assembly, the clip cartridge assembly including:

a clip tray including a base wall and a pair of side walls defining a channel therein；

a cartridge clip pusher bar disposed adjacent the clip tray and slidable relative thereto, a proximal end of the cartridge clip pusher bar being configured for selective connection with the clip pusher bar of the endoscopic assembly；

a plurality of surgical clips slidably disposed within the channel of the clip tray and interposed between the cartridge clip pusher bar and the base wall of the clip tray；

a clip follower slidably disposed within the channel of the clip tray and disposed proximal of the plurality of surgical clips； and

a biasing member acting on the clip follower to distally advance the clip follower and the plurality of clips during any distal movement of a distal-most clip of the plurality of clips.
The reposable surgical clip applier according to claim 1, wherein the biasing member of the clip cartridge assembly is a constant force spring.
The reposable surgical clip applier according to claim 2, wherein the constant force spring of the clip cartridge assembly includes a coiled proximal end disposed proximal of the clip follower, and a distal end extending along the plurality of surgical clips and being anchored within clip cartridge assembly.
The reposable surgical clip applier according to claim 3, wherein the clip cartridge assembly includes a cover disposed adjacent the cartridge clip pusher bar, wherein the cover includes a hook projecting therefrom for securing the distal end of the constant force spring.
The reposable surgical clip applier according to claim 1, wherein the cartridge clip pusher bar of the clip cartridge assembly includes a coupling stem at a proximal end thereof, and wherein the clip pusher bar of the endoscopic assembly includes a distal coupling window formed therein for mechanically coupling with the coupling stem of the cartridge clip pusher bar when the clip cartridge assembly is loaded in the endoscopic assembly.
The reposable surgical clip applier according to claim 4, wherein the cartridge clip pusher bar of the clip cartridge assembly includes a lock button accessible through the cover of the clip cartridge assembly, wherein the lock button includes:

a first, un-locked position permitting loading and unloading of clip cartridge assembly in the window of the outer tube of the endoscopic assembly； and

a second, locked position wherein a tab of the lock button extends into the outer tube of the endoscopic assembly, when the clip cartridge assembly is loaded in the window of the outer tube of the endoscopic assembly, to secure the clip cartridge assembly within the window of the outer tube of the endoscopic assembly.
The reposable surgical clip applier according to claim 6, wherein the clip cartridge assembly includes a lock spring supported in the clip tray, wherein the lock spring is engaged by the lock button to restrict movement of the lock button.
The reposable surgical clip applier according to claim 7, wherein the lock spring is configured to permit the lock button to move from the first, un-locked position to the second, locked position relatively easier than from the second, locked position to the first, un-locked position.
The reposable surgical clip applier according to claim 1, wherein the drive assembly of the handle assembly includes:

a jaw pusher tube slidably supported within the housing and axially translatable upon an actuation of the trigger, the jaw pusher tube defining a lumen extending axially therethrough, a distal end of the jaw pusher tube being configured for selective connection to the jaw closure tube of the endoscopic assembly；

a clip pusher bar slidably disposed within the lumen of the jaw pusher tube, the clip pusher bar of the drive assembly including a distal end configured for selective connection to the clip pusher bar of the endoscopic assembly, and a proximal end extendable from a proximal end of the jaw pusher tube；

a release lever pivotably connected to the jaw pusher tube, the release lever including:

a proximal end extending proximally of a pivot point, the proximal end of the release lever having a tooth projecting therefrom that extends into the lumen of the jaw pusher tube； and

a distal end extending distally of the pivot point of the release lever, the distal end of the release lever having a nub projecting therefrom； and

a biasing member acting on the release lever to maintain the proximal end of the release lever in relative close proximity to the lumen of the jaw pusher tube.
The reposable surgical clip applier according to claim 9, wherein the handle assembly includes a biasing member connected to the clip pusher bar of the drive assembly and tending to maintain the clip pusher bar of the drive assembly in a proximal position.
The reposable surgical clip applier according to claim 10, wherein the handle assembly includes a camming pin supported in the housing, wherein the camming pin acts on the nub of the release lever as the jaw pusher tube is moved in a distal direction.
The reposable surgical clip applier according to claim 11, wherein as the jaw pusher tube is moved in the distal direction, the tooth of the release lever pulls the clip pusher bar of the drive assembly in a distal direction, and as the clip pusher bar of the drive assembly is moved in the distal direction, the biasing member is stretched.
The reposable surgical clip applier according to claim 12, wherein as the nub of the release lever engages the camming pin, the camming pin actuates the release lever to disengage the tooth of the release lever from the proximal end of the clip pusher bar of the drive assembly, whereby the biasing member withdraws the clip pusher bar of the drive assembly in a proximal direction.
The reposable surgical clip applier according to claim 9, wherein the drive assembly of the handle assembly includes a biasing member acting on the jaw pusher tube to maintain the jaw pusher tube in a proximal position.
The reposable surgical clip applier according to claim 9, wherein the handle assembly includes a ratchet assembly having；

a pawl pivotably supported in the housing；

a biasing member acting on the pawl； and

a rack of teeth connected to the jaw pusher tube of the drive assembly, wherein the ratchet assembly prevents any partial actuation of the trigger.
The reposable surgical clip applier according to claim 15, wherein the rack of teeth is in axial alignment with the nub of the release lever of the drive assembly.
The reposable surgical clip applier according to claim 1, wherein the endoscopic assembly includes a slider joint supported on a distal end of jaw closure bar thereof, wherein the slider joint delays closure of the pair of jaws for a dwell period following initial actuation of the trigger of the handle assembly.
The reposable surgical clip applier according to claim 17, wherein the endoscopic assembly includes a camming tip in operative association with the pair of jaws, and distally spaced from the slider joint prior to an actuation of the trigger of the handle assembly.
The reposable surgical clip applier according to claim 18, wherein, during an initial actuation of the trigger, the slider joint is approximated toward the camming tip, through the dwell period.
The reposable surgical clip applier according to claim 19, wherein, following the dwell period, continued actuation of the trigger results in the slider joint distally advancing the camming tip.
The reposable surgical clip applier according to claim 20, wherein each jaw of the pair of jaws includes a camming wedge, and wherein the camming tip defines a camming channel configured to act on the camming wedges of the pair of jaws to approximate the pair of jaws during distal advancement of the camming tip relative to the pair of jaws.
The reposable surgical clip applier according to claim 1, wherein the clip tray of the clip cartridge assembly includes a resilient finger extending distally from each side wall, wherein each resilient finger extends into the channel of the clip tray, and wherein each resilient finger engages a respective leg of a distal-most surgical clip.