JP2014208038A - Clip applier for endoscope surgical operation - Google Patents

Abstract

PROBLEM TO BE SOLVED: To improve the operation of an instrument by providing indication to a user with any surgical event.SOLUTION: An apparatus for comfortable application of surgical clips to body tissue includes: a handle assembly; a shaft assembly including a housing and extending distally from the handle assembly; a plurality of surgical clips disposed within the shaft assembly; a jaw 106 mounted adjacently to a distal end portion of the shaft assembly and being movable between an open spaced-apart condition and a closed approximated condition; and a pusher bar 156 configured to load a distal-most surgical clip into the jaws during distal movement and remain connected to the housing of the shaft assembly and in a distally advanced position during an approximation of the jaws.

Description

(Citation of related application)
This application claims the benefit and priority of US Provisional Application No. 61 / 092,786, filed Aug. 29, 2008. The entire contents of this US provisional application are incorporated herein by reference.

(Technical field)
The present disclosure relates to surgical clip appliers and, more particularly, to a novel endoscopic surgical clip applier.

  Endoscopic staplers and clip appliers are known in the art and are used for a number of different useful surgical procedures. In the case of a laparoscopic surgical procedure, access to the inside of the abdomen is achieved through a narrow tube or cannula inserted through a small entrance incision in the skin. Minimally invasive procedures performed elsewhere in the body are often commonly referred to as endoscopic procedures. Typically, a tube or cannula device extends through the entrance incision into the patient's body and provides an access port. This port allows a surgeon to insert a number of different surgical instruments through the port using a trocar and to perform a surgical procedure at a location remote from the incision.

  During most of these procedures, surgeons often have to stop the flow of blood or other fluids through one or more vessels. Surgeons often apply surgical clips to a blood vessel or another tube to prevent fluid flow through that vessel or tube during the procedure. Endoscopic clip appliers for applying one clip while entering a body cavity are known in the art. One such clip is typically manufactured from a biocompatible material and is usually compressed onto the vessel. Once applied to a vessel, the compressed clip stops fluid flow through the vessel.

  Endoscopic clip appliers that can apply multiple clips in an endoscopic or laparoscopic procedure while once in a body cavity are disclosed in US Pat. These patent documents are hereby incorporated by reference in their entirety. Another multi-endoscopic clip applier is disclosed in commonly assigned US Pat. No. 6,057,028 to Pratt et al., The contents of which are also incorporated herein by reference in their entirety. These devices are typically used during a single surgical procedure, although this is not required. U.S. Patent No. 6,057,017 to Pier (the disclosure of which is incorporated herein by reference) discloses a re-sterilizable surgical clip applier. The clip applier advances and forms multiple clips while being inserted once into the body cavity. The re-sterilizable clip applier is configured to receive and cooperate with a replaceable clip magazine for advancing and forming a plurality of clips during a single entry into the body cavity. One important design objective is that the surgical clip is loaded between the jaws without any compression of the clip from the loading procedure. Such bending or torque of the loading clip often has a number of unintended consequences. Such compression during loading can slightly change the alignment of the clips between the jaws. This allows the surgeon to remove the clip from between the jaws in order to dispose of the clip. Further, such pre-loading compression may slightly compress a portion of the clip and change the clip geometry. This allows the surgeon to remove the compressed clip from between the jaws in order to dispose of the clip.

US Pat. No. 5,084,057 US Pat. No. 5,100,420 US Pat. No. 5,607,436 US Pat. No. 5,695,502

  Endoscopic or laparoscopic procedures are often performed at a location remote from the incision. As a result, the application of the clip can be complicated by a reduced field of view for the user at the proximal end or by a reduced tactile feedback of the device. Accordingly, it is desirable to improve instrument operation by providing the user with an indication of firing of individual clips, exhaustion of clips contained in the loading unit, or any other surgical event. To open the jaws of the surgical clip applier for the purpose of promoting the successful loading of the clip and preventing any damage or excessive compression of the clip and preventing the jaw from compressing the clip before firing It is also desirable to provide a surgical clip applier that is wedged and then loaded between the jaws.

In order to solve the above problems, the present invention provides, for example:
(Item 1)
A device for applying a surgical clip to body tissue, the device comprising:
Handle assembly;
A shaft assembly comprising a housing, the shaft assembly extending distally from the handle assembly and defining a longitudinal axis;
A plurality of surgical clips disposed within the shaft assembly;
A jaw placed adjacent to the distal end portion of the shaft assembly, the jaw being movable between an open spaced state and a closed proximal state; and A push rod that is reciprocally disposed within the housing of the shaft assembly and is removably connectable to the housing of the shaft assembly; During movement, the distal-most surgical clip is configured to be loaded into the jaw and remains connected to the housing of the shaft assembly and proximally during proximity of the jaw The push rod, which is configured to be in the advanced position
An apparatus comprising:

(Item 2)
An item as described above, wherein the push rod comprises a pusher formed at the distal end of the push rod, the pusher having a narrow profile for contacting a loaded surgical clip in one position. apparatus.

(Item 3)
The apparatus according to any of the preceding items, wherein the push bar defines a surface oriented substantially perpendicular to the surface of the loaded surgical clip.

(Item 4)
A connector plate reciprocally disposed within the shaft assembly, the connector plate removably connectable to the push rod, and the pusher plate during the first distal movement of the connector plate; The apparatus of any of the preceding items, wherein the bar is advanced distally and the connector plate is disconnected from the push bar during further distal movement of the connector plate.

(Item 5)
The push rod includes a first spring clip supported on the push rod, the first spring clip being provided within the housing of the shaft assembly when the push rod is in an advanced position. An apparatus according to any of the preceding items, connected to a feature and for maintaining the push bar in the advanced position.

(Item 6)
The push rod further comprises a second spring clip supported on the push rod, the second spring clip for engaging a first feature of the connector plate, the connector plate The device of any of the preceding items, wherein the first feature of the connector disengages from the second spring clip after an initial distal movement of the connector plate.

(Item 7)
An advance plate reciprocally disposed within the shaft assembly, the advance plate comprising at least one fin removably connectable to the shoulder of the push rod, the shoulder of the push rod being Engaging the at least one fin of the advancement plate during distal movement and proximal movement of the push rod to move the advancement plate distally and proximally The apparatus according to any of the preceding items, wherein one of them is performed.

(Item 8)
A clip follower slidably supported within the shaft assembly, the clip follower for propelling the plurality of surgical clips in a distal direction, the clip follower comprising: A first tab projecting from the first surface and a second tab projecting from the second surface, the first tab of the clip follower moving the advancement plate distally In some cases, engaging the advancement plate so that the clip follower moves distally to advance the plurality of surgical clips and the second tab of the clip follower is An apparatus according to any of the preceding items, wherein the advancement plate engages with a feature as it moves proximally, so that the clip follower remains stationary.

(Item 9)
A clip carrier disposed within the shaft assembly, the clip carrier configured to hold the plurality of surgical clips and the clip follower, and the second of the clip follower. The apparatus of any of the preceding items, wherein the tab engages a feature formed on the clip carrier.

(Item 10)
The apparatus of any of the preceding items, wherein the clip follower is incrementally advanced through the shaft assembly.

(Item 11)
The clip follower includes a catch extending from a surface of the clip follower, the catch engages the push rod after firing of the last surgical clip, and the push rod moves proximally A device according to any of the above items, which prevents this.

(Item 12)
The apparatus of any of the preceding items, further comprising a ratchet assembly disposed within the handle assembly, wherein the ratchet assembly is prevented from resetting if the push rod does not return to a proximal position. .

(Item 13)
The apparatus of any of the preceding items, further comprising a counter supported within the housing assembly, wherein the counter provides an indication when a surgical clip is fired.

(Item 14)
The indicator further comprises an indicator supported in the housing assembly when the surgical clip is loaded into the jaw, when the surgical clip is fired, and when the device is reset The device according to any of the preceding items, wherein at least one of them is provided with at least one of an audible indicator and a tactile indicator.

(Item 15)
And a wedge plate reciprocally disposed within the shaft assembly, the wedge plate having a distal end of the wedge plate disposed within the jaw and a distal end of the wedge plate disposed at the jaw. The apparatus according to any of the preceding items, wherein the apparatus is movable between a position deviated from the position.

(Item 16)
The wedge plate further comprises a third spring clip supported on the wedge plate, wherein the third spring clip is removably connected to a second feature of the connector plate; The apparatus according to any of the preceding items, wherein the second feature of the connector plate disengages from the third spring clip after an initial distal movement of the connector plate.

(Item 17)
The apparatus of any of the preceding items, further comprising a drive rod, the drive rod being actuatable by the handle assembly and connected to the connector plate for performing movement of the connector plate .

(Item 18)
A drive channel reciprocally disposed within the shaft assembly, the drive rod engaging the drive channel to translate the drive channel, the distal end of the drive channel being the drive channel; The device of any of the preceding items, wherein the device engages the surface of the jaw during distal advancement of the channel to cause proximity of the jaw.

(Item 19)
The drive channel activates a wedge plate lock upon distal movement, causing the wedge plate to move proximally, withdrawing the distal end of the wedge plate from the jaw, and the drive An apparatus according to any of the preceding items, wherein a channel allows the jaws to be in close proximity.

(Item 20)
The apparatus of any of the preceding items, wherein the shaft assembly is rotatable relative to the handle assembly about the longitudinal axis.

(Item 21)
The shaft assembly includes a guard supported within the shaft assembly, the guard extending the third spring clip outwardly as the third spring clip translates across the guard. A device according to any of the above items, which prevents.

(Item 22)
The apparatus of any of the preceding items, wherein the wedge plate is biased to a proximal position.

(Item 23)
The apparatus of any of the preceding items, wherein the drive channel is biased to a proximal position.

(Item 24)
A device for applying a surgical clip to body tissue, the device comprising a handle assembly;
A shaft assembly comprising a housing, the shaft assembly extending distally from the handle assembly and defining a longitudinal axis;
A plurality of surgical clips disposed within the shaft assembly;
A jaw placed adjacent to the distal end portion of the shaft assembly, the jaw being movable between an open spaced state and a closed proximal state; and A clip follower slidably supported within the shaft assembly, the clip follower for propelling the plurality of surgical clips in a distal direction, the clip follower comprising: A first tab protruding from a first surface of the clip follower and a second tab protruding from a second surface of the clip follower, the first tab of the clip follower being advanced Engaging the advancement plate as the plate moves distally so that the clip follower moves distally to advance the plurality of surgical clips and the clip follower The second tab is the forward play A clip follower, which engages with a feature as it moves proximally, so that the clip follower remains stationary,
An apparatus comprising:

(Item 25)
The advancement plate is reciprocally disposed within the shaft assembly, the advancement plate defining a plurality of windows formed along the length of the advancement plate, and the first tab of the clip follower The device according to any of the preceding items, wherein the device engages with one of the plurality of windows as the advancement plate reciprocates.

(Item 26)
A push rod reciprocally disposed within the shaft assembly, the push rod being adapted to load the most distal surgical clip on the jaw when the jaw is in the open state; And the device according to any of the preceding items configured to remain in contact with the loaded surgical clip during proximity of the jaw.

(Item 27)
The advancement plate comprises at least one fin engageable by a shoulder of the push rod, the shoulder of the push rod being moved distally and proximally of the push rod; The apparatus according to any of the preceding items, wherein the apparatus engages the at least one fin of the advance plate to perform one of a distal movement and a proximal movement of the advance plate.

(Item 28)
Of the above items, the push rod comprises a pusher formed at a distal end of the push rod, the pusher having a narrow profile for contacting the loaded surgical clip in one position The apparatus in any one of.

(Item 29)
The apparatus of any of the preceding items, wherein the pusher defines a surface oriented substantially perpendicular to the surface of the loaded surgical clip.

(Item 30)
A connector plate reciprocally disposed within the shaft assembly, the connector plate removably connected to the push rod, and the pusher during the first distal movement of the connector plate; The apparatus of any of the preceding items, wherein the bar is advanced distally and the connector plate is disconnected from the push bar during further distal movement of the connector plate.

(Item 31)
The push rod includes a first spring clip supported on the push rod, the first spring clip engaging a stationary feature of the housing of the shaft assembly when the push rod is in an advanced position. The apparatus according to any of the preceding items, wherein the apparatus is for maintaining the push bar in the advanced position.

(Item 32)
The push rod further comprises a second spring clip supported by the push rod, the second spring clip for removably engaging a first feature of the connector plate; The apparatus of any of the preceding items, wherein the first feature of the connector plate disengages from the second spring clip after an initial distal movement of the connector plate.

(Item 33)
A clip carrier disposed within the shaft assembly, the clip carrier configured to hold the plurality of surgical clips and the clip follower, the second of the clip follower being The apparatus of any of the preceding items, wherein the tab engages a feature formed on the clip carrier.

(Item 34)
The apparatus of any of the preceding items, wherein the clip follower is incrementally advanced through the shaft assembly.

(Item 35)
The clip follower includes a catch extending from a surface of the clip follower, the catch engages the push rod after firing of the last surgical clip, and the push rod moves proximally A device according to any of the above items, which prevents this.

(Item 36)
The apparatus of any of the preceding items, further comprising a ratchet assembly disposed within the handle assembly, wherein the ratchet assembly is prevented from resetting if the push rod does not return to a proximal position. .

(Item 37)
The apparatus of any of the preceding items, further comprising a counter supported within the housing assembly, the counter providing an indication when a surgical clip is fired.

(Item 38)
The indicator further comprises an indicator supported in the housing assembly when the surgical clip is loaded into the jaw, when the surgical clip is fired, and when the device is reset The apparatus according to any of the preceding items, wherein at least one of them is provided with at least one of an audible indicator or a tactile indicator.

(Item 39)
And a wedge plate reciprocally disposed within the shaft assembly, the wedge plate having a distal end of the wedge plate disposed within the jaw and a distal end of the wedge plate disposed at the jaw. The apparatus according to any of the preceding items, wherein the apparatus is movable between a position deviated from the position.

(Item 40)
The wedge plate further comprises a third spring clip supported on the wedge plate, the third spring clip for selectively engaging a second feature of the connector plate; The apparatus according to any of the preceding items, wherein the second feature of the connector plate disengages from the third spring clip after an initial distal movement of the connector plate.

(Item 41)
The apparatus of any of the preceding items, further comprising a drive rod, the drive rod being actuatable by the handle assembly and connected to the connector plate for performing movement of the connector plate .

(Item 42)
And further comprising a drive channel reciprocally disposed within the shaft assembly, the drive rod engaging the drive channel to translate the drive channel, the distal end of the drive channel being the drive channel A device according to any of the preceding items, wherein the device engages the surface of the jaw during the distal advancement of the jaw to effect proximity of the jaw.

(Item 43)
The drive channel activates a wedge plate lock upon distal advancement of the drive channel to cause proximal movement of the wedge plate, withdrawing the distal end of the wedge plate from the jaw; An apparatus according to any of the preceding items, wherein the drive channel allows the jaws to be brought into close proximity.

(Item 44)
The apparatus of any of the preceding items, wherein the shaft assembly is rotatable relative to the handle assembly about the longitudinal axis.

(Item 45)
The shaft assembly includes a guard supported within the shaft assembly, the guard extending the third spring clip outwardly as the third spring clip translates across the guard. A device according to any of the above items, which prevents.

(Item 46)
The apparatus of any of the preceding items, wherein the wedge plate is biased to a proximal position.

(Item 47)
The apparatus of any of the preceding items, wherein the drive channel is biased to a proximal position.

(Item 48)
A device for applying a surgical clip to body tissue, the device comprising:
A handle assembly comprising a trigger and a drive rod reciprocally translated by the trigger upon activation of the trigger;
A shaft assembly extending distally from the handle assembly and defining a longitudinal axis, the shaft assembly comprising:
housing;
A plurality of surgical clips disposed within the housing;
A jaw placed adjacent to the distal end portion of the housing, the jaw being movable between an open spaced state and a closed proximal state;
A push rod reciprocally disposed within the housing, wherein the push rod loads a distal-most surgical clip into the jaw while the jaw is in the open state; And a push rod configured to remain in contact with the surgical clip loaded during proximity of the jaw;
An advance plate reciprocally disposed within the housing adjacent to the push rod, the advance plate comprising at least one fin engageable by a shoulder of the push rod; The shoulder engages with the at least one fin of the advancement plate during the distal and proximal movement of the push rod to move the advancement plate distally and proximally. An advance plate that performs one of the movements to
A clip carrier disposed within the housing adjacent to the advancement plate, wherein the clip carrier is configured to hold the plurality of surgical clips;
A clip follower slidably supported within the clip carrier at a proximal position of the plurality of surgical clips, the clip follower distally extending the plurality of surgical clips; The clip follower includes a first tab projecting from the first surface of the clip follower and a second tab projecting from the second surface of the clip follower. The first tab of the clip follower engages the advancement plate as the advancement plate moves distally, so that the clip follower moves distally and the plurality And the second tab of the clip follower engages the clip carrier as the advancement plate moves proximally, so that the clip follower is Remain stationary, chestnut Flop follower;
A drive channel reciprocally disposed within the housing adjacent to the clip carrier, the drive rod selectively engaging the drive channel to translate the drive channel; A distal end of the drive channel engages the surface of the jaw to provide proximal proximity of the jaw during distal advancement of the drive channel; and within the housing, to the drive channel A wedge plate reciprocally disposed adjacent to the wedge plate, wherein the wedge plate has a distal end disposed within the jaw, and the wedge plate distal end deviates from the jaw. Wedge plate, movable between different positions,
A shaft assembly comprising:
An apparatus comprising:

(Item 49)
Of the preceding items, the push bar comprises a pusher formed at the distal end of the push bar, the pusher having a narrow profile for contacting the loaded surgical clip in one position The device according to any one of the above.

(Item 50)
The apparatus of any of the preceding items, wherein the pusher defines a surface oriented substantially perpendicular to the surface of the loaded surgical clip.

(Item 51)
The push bar includes a first spring clip supported on the push bar, the first spring clip being removable from the stationary feature of the housing of the shaft assembly when the push bar is in the advanced position. The device according to any of the preceding items, wherein the device is for connecting to and maintaining the push bar in the advanced position.

(Item 52)
A connector plate reciprocally disposed within the housing of the shaft assembly, wherein the push rod further comprises a second spring clip supported by the push rod, the second spring clip comprising the A releasable connection to a first feature of the connector plate, the first feature of the connector plate being removed from the second spring clip after the first distal movement of the connector plate; The apparatus according to any of the preceding items, wherein the apparatus is disengaged.

(Item 53)
The apparatus of any of the preceding items, wherein the clip follower is progressively advanced through the shaft assembly.

(Item 54)
The clip follower includes a catch extending from a surface of the clip follower, the catch engages the push rod after firing of the last surgical clip, and the push rod moves proximally A device according to any of the above items, which prevents this.

(Item 55)
Any of the preceding items, wherein the handle assembly further comprises a ratchet assembly disposed within the handle assembly, the ratchet assembly being prevented from resetting if the push rod does not return to a proximal position. A device according to the above.

(Item 56)
The apparatus of any of the preceding items, wherein the handle assembly further comprises a counter supported within the housing assembly, the counter providing an indication when a surgical clip is fired. .

(Item 57)
The handle assembly further comprises an indicator supported within the handle assembly, wherein the indicator is loaded when a surgical clip is loaded into the jaw, when the surgical clip is fired, and when the device is The apparatus according to any of the preceding items, wherein at least one of the cases to be reset provides at least one of an audible indicator and a tactile indicator.

(Item 58)
The wedge plate further comprises a third spring clip supported on the wedge plate, the third spring clip for engaging a second feature of the connector plate, the connector plate The device of any of the preceding items, wherein the second feature of the connector disengages from the third spring clip after the connector plate is first moved distally.

(Item 59)
The shaft assembly includes a wedge plate lock, and the drive channel activates the wedge plate lock upon distal advancement, causing the wedge plate to move proximally and the wedge plate distally. An apparatus according to any of the preceding items, wherein the distal end is withdrawn from the jaw and the drive channel allows the jaw to be brought into close proximity.

(Item 60)
The apparatus of any of the preceding items, wherein the shaft assembly is rotatable relative to the handle assembly about the longitudinal axis.

(Item 61)
The shaft assembly includes a guard supported within the housing, the guard extending the third spring clip outwardly as the third spring clip translates across the guard. A device according to any of the above items, which prevents.

(Item 62)
The apparatus of any of the preceding items, wherein the wedge plate is biased to a proximal position.

(Item 63)
The apparatus of any of the preceding items, wherein the drive channel is biased to a proximal position.

  An apparatus is provided for applying a surgical clip to body tissue, the apparatus comprising a handle assembly; a shaft assembly comprising a housing, extending distally from the handle assembly and defining a longitudinal axis; A shaft assembly; a plurality of surgical clips disposed within the shaft assembly; a jaw positioned adjacent to a distal end portion of the shaft assembly, in an open spaced-apart and closed proximity A jaw that is movable between states; and a push rod, reciprocally disposed within the housing of the shaft assembly, and removably connectable to the housing of the shaft assembly, During distal movement, load the most distal surgical clip into the jaw and these Of in proximity includes remains connected to the housing of the shaft assembly, and is configured to be in a position advanced distally, pusher bar, the.

(Summary)
The present disclosure relates to a novel endoscopic surgical clip applier.

  According to one aspect of the present disclosure, an apparatus for applying a surgical clip to body tissue is provided. The apparatus includes a handle assembly; a shaft assembly extending distally from the handle assembly and defining a longitudinal axis; a plurality of surgical clips disposed within the shaft assembly; adjacent to a distal end of the shaft assembly A jaw, installed between the open and spaced apart jaws, and a push rod disposed reciprocally within the shaft assembly; This push rod is loaded with surgical clips loaded in the most distal surgical clips on the jaws while the jaws are open and in the proximity of these jaws. A push rod configured to remain in contact with the.

  The push rod may comprise a pusher formed at its distal end. The pusher may have a narrow profile for contacting the loaded surgical clip at one location. The pusher may define a surface disposed substantially perpendicular to the surface of the loaded surgical clip.

  The apparatus may further comprise a connector plate reciprocally disposed within the shaft assembly. The connector plate can be selectively connected to the push rod. In use, during the first distal movement of the connector plate, the push rod may be advanced distally, and during the further distal movement of the connector plate, the connector plate Can be disconnected from.

  The push rod may include a first spring clip supported on the push rod, the first spring clip selectively engaging features of the shaft assembly when the push rod is in the advanced position. Thus, the push rod is selectively maintained at the forward position. The push rod may further comprise a second spring clip supported on the push rod, the second spring clip for selectively engaging a first feature of the connector plate. . The first feature of the connector plate may be selectively disengaged from the second spring clip after the first distal movement of the connector plate.

  The apparatus may further comprise an advancement plate reciprocally disposed within the shaft assembly. The advancement plate may comprise at least one fin that can be selectively engaged by the shoulder of the push bar. In use, the shoulder of the push bar engages with at least one fin of the advance plate and moves distally of the advance plate during distal and proximal movement of the push bar. One of the movement and the proximal movement.

  The apparatus may further comprise a clip follower slidably supported on the shaft assembly, the clip follower for propelling a plurality of surgical clips in the distal direction. The clip follower may comprise a first tab protruding from its first surface and a second tab protruding from its second surface. In use, the first tab of the clip follower may engage the advance plate as the advance plate moves distally, so that the clip follower moves distally, A plurality of surgical clips are advanced and the second tab of the clip follower can engage a stationary feature as the advancement plate moves proximally, so that the clip follower is Stay stationary.

  The apparatus may further comprise a clip carrier disposed on the shaft assembly, the clip carrier configured to hold a plurality of surgical clips and clip followers, and a second of the clip followers. The tab may engage a feature formed on the clip carrier.

  The clip follower may be incrementally advanced through the shaft assembly. The clip follower may include a catch extending from the surface, the catch may engage the push bar after firing of the last surgical clip, and the push bar moves proximally Can prevent.

  The apparatus may further comprise a ratchet assembly disposed on the handle assembly. The ratchet assembly can be prevented from resetting if the push rod does not return to the proximal position.

  The apparatus may further comprise a counter supported on the housing assembly. This counter may provide an indication when the surgical clip is fired.

  The apparatus may further comprise an indicator supported on the housing. This indicator is an audible or tactile indicator when at least one of the surgical clips is loaded into the jaw, when the surgical clip is fired, and when the device is reset. At least one of the following.

  The apparatus can further comprise a wedge plate reciprocally disposed within the shaft assembly. The wedge plate may be movable between a position where the distal end of the wedge plate is located in the jaw and a position where the distal end of the wedge plate is off the jaw. The wedge plate may further comprise a third spring clip supported on the wedge plate, the third spring clip for selectively engaging a second feature of the connector plate; The second feature of the connector plate selectively disengages from the third spring clip after the connector plate is first moved distally.

  The apparatus may further comprise a drive rod that is actuatable by the handle assembly and connected to the connector plate for movement of the connector plate. The apparatus may further comprise a drive channel reciprocally disposed within the shaft assembly, the drive rod selectively engaging the drive channel to effect translation of the drive channel. The distal end of the drive channel may engage the jaw surfaces during distal advancement of the drive channel to provide proximity of the jaws.

  The drive channel may activate a wedge unlocking mechanism upon distal advancement of the drive channel, causing the wedge plate to move proximally, and withdrawing the distal end of the wedge plate from the jaw , And the drive channel may allow the jaws to be in close proximity.

  The shaft assembly may be rotatable about a longitudinal axis relative to the handle assembly. The shaft assembly may include an internally supported guard that prevents the third spring clip from spreading outward as the third spring clip translates across the guard. obtain.

  The wedge plate and / or drive channel can be biased to a proximal position.

  According to another aspect of the present disclosure, an apparatus for applying a surgical clip to body tissue is provided. The apparatus includes a handle assembly; a shaft assembly extending distally from the handle assembly to define a longitudinal axis; a plurality of surgical clips disposed within the shaft assembly; adjacent to a distal end portion of the shaft assembly And a jaw follower slidably supported within the shaft assembly, the jaw being movable between an open spaced apart state and a closed proximal state; A clip follower is provided for propelling the plurality of surgical clips in the distal direction. The clip follower includes a first tab protruding from its first surface and a second tab protruding from its second surface. The first tab of the clip follower engages the advance plate as the advance plate moves distally, so that the clip follower moves distally to provide a plurality of surgical clips. And the second tab of the clip follower engages a stationary feature as the advancement plate moves proximally, so that the clip follower remains stationary.

  The apparatus may further comprise an advancement plate reciprocally disposed within the shaft assembly. The advancement plate may define a plurality of windows formed along its length. In use, the first tab of the clip follower may selectively engage one of the plurality of windows as the advancement plate reciprocates.

  The apparatus may further comprise a push rod that is reciprocally disposed on the shaft assembly. The push rod is loaded with the distal surgical surgical clip loaded into the jaws while the jaws are open and while the jaws are in close proximity. It can be configured to remain in contact with the surgical clip.

  The advancement plate may comprise at least one fin that can be selectively engaged by the shoulder of the push bar. The push rod shoulder engages the at least one fin of the advance plate during distal and proximal movement of the push rod to move the advance plate distally and One of the proximal movements may be performed.

  The push rod may comprise a pusher formed at its distal end, the pusher having a narrow profile for contacting the loaded surgical clip in one position. The pusher may define a surface oriented substantially perpendicular to the surface of the loaded surgical clip.

  The apparatus may further comprise a connector plate reciprocally disposed within the shaft assembly. The connector plate can be selectively connected to the push rod. In use, during the first distal movement of the connector plate, the push rod may be advanced distally, and during the further distal movement of the connector plate, the connector plate Can be disconnected from.

  The push rod may include a first spring clip supported on the push rod, the first spring clip being removably connected to the features of the shaft assembly when the push rod is in the advanced position. Thus, this push rod is for maintaining the forward position. The push rod may further comprise a second spring clip supported on the push rod, the second spring clip being for removably connecting with the first feature of the connector plate. . The first feature of the connector plate is disconnected from the second spring clip after the first distal movement of the connector plate.

  The apparatus can further comprise a clip carrier disposed within the shaft assembly. The clip carrier can be configured to maintain a plurality of surgical clips and clip followers. The second tab of the clip follower may engage a feature formed on the clip carrier. The clip follower can be incrementally advanced through the shaft assembly. The clip follower may include a catch that extends from the surface. The catch may engage the push bar after the last surgical clip is fired and may prevent the push bar from moving proximally.

  The apparatus can further comprise a ratchet assembly disposed within the handle assembly. The ratchet assembly may prevent resetting if the push rod does not return to the proximal position.

  The apparatus can further comprise a counter supported within the housing assembly, which can provide an indication when a surgical clip is loaded or fired. The apparatus may further comprise an indicator supported within the housing assembly, the indicator being reset when the surgical clip is loaded into the jaw, when the surgical clip is fired, and when the apparatus is reset. In at least one of the cases, at least one of an audible indicator or a tactile indicator may be provided.

  The apparatus can further comprise a wedge plate reciprocally disposed within the shaft assembly. The wedge plate may be movable between a position where its distal end is located within the jaw and a position where its distal end is off the jaw. The wedge plate may further comprise a third spring clip supported on the wedge plate, the third spring clip for selectively engaging a second feature of the connector plate; The second feature of the connector plate can be selectively disengaged from the third spring clip after the first distal movement of the connector plate.

  The apparatus may further comprise a drive rod that is activatable by the handle assembly and is connected to the connector plate for movement of the connector plate. The apparatus can further include a drive channel reciprocally disposed within the shaft assembly, the drive rod can selectively engage the drive channel to translate the drive channel, and the The distal end of the drive channel may engage the jaw surfaces to provide proximity of these jaws during their distal advancement. The drive channel may activate a wedge plate lock upon its distal advancement, causing the wedge plate to move proximally, withdrawing the distal end of the wedge plate from the jaw, and the drive channel It may be possible to bring the jaws close together.

  The shaft assembly may be rotatable about a longitudinal axis relative to the handle assembly. The shaft assembly can include an internally supported cuff that can prevent the third spring from spreading outwardly as the third spring clip translates across the cuff. .

  The wedge plate and / or drive channel can be biased to a proximal position.

  According to a further aspect of the present disclosure, an apparatus for applying a surgical clip to body tissue is provided that includes a handle assembly and a shaft extending distally from the handle assembly and defining a longitudinal axis. Provide assembly. The handle assembly includes a trigger and a drive rod that can be reciprocally translated by the trigger upon activation of the trigger. The shaft assembly includes a housing; a plurality of surgical clips disposed within the housing; a jaw disposed adjacent to a distal end portion of the housing, open spaced apart and closed Jaws movable between adjacent positions; push rods reciprocally disposed within the housing, the most distal surgical operation on these jaws while the jaws are open A push rod configured to load a surgical clip and remain in contact with the loaded surgical clip during proximity of the jaws; adjacent to the push rod within the housing; A reciprocating advance plate, the advance plate comprising at least one fin selectively engageable by the push rod mold, the push rod shoulder having the push rod of Engaging the at least one fin of the advancement plate during the forward movement and the proximal movement to perform one of a distal movement and a proximal movement of the advancement plate; An advance plate; a clip carrier disposed within the housing and adjacent to the advance plate, the clip carrier configured to hold a plurality of surgical clips; a plurality of clip carriers within the clip carrier; A clip follower slidably supported at a proximal position of the surgical clip, the clip follower configured to propel a plurality of surgical clips in a distal direction, The clip follower comprises a first tab protruding from its first surface and a second tab protruding from its second surface, the first tab of this clip follower being The advancement plate engages with the advancement plate as it moves distally so that the clip follower moves distally to advance a plurality of surgical clips and the clip follower The second tab engages with the clip carrier as the advancement plate moves proximally so that the clip follower remains stationary; within the housing, the clip follower A drive channel reciprocally disposed adjacent to the clip carrier, the drive rod selectively engaging the drive channel to translate the drive channel, the distal end of the drive channel; A drive channel that engages the surfaces of the jaws to provide proximity to the jaws as the drive channel is advanced distally; and to the drive channel within the housing; An adjacent reciprocating wedge plate, the wedge plate being movable between a position where its distal end is located in the jaw and a position where its distal end is off the jaw A wedge plate.

  The push rod may comprise a pusher formed at its distal end. The pusher may have a narrow profile for contacting the loaded surgical clip in one position. The pusher may define a surface oriented substantially perpendicular to the surface of the loaded surgical clip. The push rod may include a first spring clip supported on the push rod, the first spring clip being selective to the housing features of the shaft assembly when the push rod is in the advanced position. To selectively maintain the push bar in the advanced position. The push rod may further comprise a second spring clip supported on the push rod, the second spring clip for selectively engaging the first feature of the connector plate; The first feature of the connector plate selectively disengages from the second spring clip after the initial distal movement of the connector plate.

  The clip follower may be incrementally advanced through the shaft assembly. The clip follower may include a catch extending from the surface. In use, the catch may engage the push rod after firing the last surgical clip and prevent the push rod from moving proximally.

  The handle assembly may further comprise a ratchet assembly disposed therein. In use, the ratchet assembly may prevent resetting if the push rod does not return to the proximal position. The handle assembly may further comprise a counter supported within the housing assembly, which may provide an indication when the surgical clip is fired. The handle assembly may further comprise an indicator supported therein. The indicator may provide at least one of an audible indicator and a tactile indicator indicative of the event. For example, the event may be at least one of a surgical clip loaded into the jaw, a surgical clip fired, and the device reset.

  The wedge plate may further comprise a third spring clip supported on the wedge plate, the third spring clip for selectively engaging a second feature of the connector plate. In use, the second feature of the connector plate can be selectively disengaged from the third spring clip after the first distal movement of the connector plate.

  The shaft assembly may include a wedge plate lock. In use, the drive channel may activate the wedge plate lock upon its distal advancement to cause proximal movement of the wedge plate, withdrawing the distal end of the wedge plate from the jaw. And this drive channel allows these jaws to be brought into close proximity.

  The shaft assembly may be rotatable about a longitudinal axis relative to the handle assembly. The shaft assembly may include a cuff supported within the housing, the cuff extending outward when the third spring clip translates across the cuff. To prevent that.

  The wedge plate and / or drive channel can be biased to a proximal position.

  The present invention provides the user with an indication of firing individual clips, depletion of clips contained in the loading unit, or any other surgical event, improving instrument operation. To open the jaws of the surgical clip applier for the purpose of promoting the successful loading of the clip and preventing any damage or excessive compression of the clip and preventing the jaw from compressing the clip before firing A surgical clip applier is also provided that wedges and then loads the clip between the jaws.

FIG. 1 is a front perspective view of a surgical clip applier according to one embodiment of the present disclosure. FIG. 2 is a rear perspective view of the clip applier of FIG. 1 illustrating rotation of the shaft assembly. FIG. 3 is a front perspective view of the distal end of the shaft assembly of the clip applier of FIGS. 1 and 2. FIG. 4 is a top plan view of the clip applier of FIGS. 1 and 2. FIG. 5 is a side elevational view of the clip applier of FIGS. 1 and 2. FIG. 6 is a perspective view of the handle assembly of the clip applier of FIGS. 1-5, with the left housing half-section removed. 7 is a perspective view of the handle assembly of the clip applier of FIGS. 1-5, with the right housing half-section removed. FIG. 8 is a perspective view with parts separated of the handle assembly of the clip applier of FIGS. FIG. 8A is a perspective view of the handle assembly of FIGS. 6-8 with the trigger removed. FIG. 8B is a perspective view of the feedback member of the handle assembly of FIGS. FIG. 9 is a perspective view with parts separated of the shaft assembly of the clip applier of FIGS. 10 is a right front perspective view of the shaft assembly of FIG. 9 shown in an assembled state. FIG. 11 is an enlarged view of the detailed area shown in FIG. FIG. 12 is a right front perspective view of the shaft assembly of FIGS. 9-11, with the upper housing removed. FIG. 13 is an enlarged view of the detailed area shown in FIG. FIG. 14 is an enlarged view of the detailed area shown in FIG. FIG. 15 is an enlarged view of the detailed area shown in FIG. FIG. 16 is a perspective view with parts separated of the push rod proximal end and snap clip of the shaft assembly of FIGS. FIG. 17 is a bottom plan view of the shaft assembly of FIGS. 9-15 illustrating the proximal end of the push rod and snap clip disposed within the upper housing. 18 is a right front perspective view of the shaft assembly of FIGS. 9-17, with the upper housing and push rod removed. FIG. 19 is an enlarged view of the detailed area shown in FIG. FIG. 20 is an enlarged view of the detailed area shown in FIG. FIG. 21 is a right front perspective view of the shaft assembly of FIGS. 9-20, with the upper housing, push rod and advancement plate removed. FIG. 22 is an enlarged view of the detailed area shown in FIG. FIG. 23 is a perspective view of the clip follower and the lockout plate with parts separated. FIG. 23A is a top perspective view of the clip follower and lockout plate of FIG. 23 assembled. 24 is a bottom perspective view of the clip follower of FIG. 25 is a right front perspective view of the distal end of the shaft assembly of FIGS. 9-23, with the upper housing, push rod, advancement plate, and clip carrier removed. FIG. 26 is a right front perspective view of the distal end of the shaft assembly of FIG. 25 with the upper housing, push rod, advance plate, clip carrier and advance channel shown removed. FIG. 27 is a left front perspective view of the shaft assembly of FIGS. 9-26 with the upper housing, push rod, advancement plate, clip carrier, drive channel and wedge plate removed. FIG. 28 is an enlarged view of the detailed area shown in FIG. FIG. 29 is an enlarged view of the detailed area shown in FIG. 30 is a left front perspective view of the lower housing of the shaft assembly of FIGS. FIG. 31 is an enlarged view of the detailed area shown in FIG. FIG. 31A is an enlarged view of the detailed area shown in FIG. 32 is a longitudinal cross-sectional view of the clip applier of FIGS. 1-31A illustrating the clip applier in an unactuated state. FIG. 33 is an enlarged view of the detailed area shown in FIG. 34 is a longitudinal cross-sectional view of the distal end of the shaft assembly of the clip applier of FIGS. 1-31A. 35 is a cross-sectional view taken through 35-35 of FIG. FIG. 36 is an enlarged view of the detailed area shown in FIG. 37 is a cross-sectional view taken through 37-37 of FIG. FIG. 38 is an enlarged view of the detailed area shown in FIG. FIG. 39 is a cross-sectional view taken through 39-39 of FIG. FIG. 40 is an enlarged view of the detailed area shown in FIG. 41 is a cross-sectional view taken along line 41-41 in FIG. FIG. 42 is an enlarged view of the detailed area shown in FIG. 43 is a cross-sectional view taken along line 43-43 of FIG. FIG. 44 is a longitudinal cross-sectional view of the clip applier of FIGS. 1-43 illustrating the clip applier during initial activation. 45 is an enlarged view of the detailed area shown in FIG. FIG. 46 is an enlarged view of the indicated detail region 36 of FIG. 34 during the initial activation of the clip applier. FIG. 47 is an enlarged view of the indicated detail area 40 of FIG. 34 during the initial activation of the clip applier. FIG. 47A is a top plan view of a push bar illustrating the movement of the push bar during the initial activation of the clip applier. 47B is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the wedge plate during the initial activation of the clip applier. FIG. 47C is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the wedge plate during the initial activation of the clip applier. 48 is an enlarged view of the section of the shaft assembly during initial activation of the clip applier, taken through 41-41 of FIG. 49 is an enlarged view of the section of the shaft assembly during the initial activation of the clip applier, taken through 41-41 of FIG. 50 is an enlarged view of the indicated detail area 42 of FIG. 34 during the initial activation of the clip applier. FIG. 51 is a bottom left perspective view of the distal end of the shaft assembly during initial activation of the clip applier. FIG. 52 is a longitudinal cross-sectional view of the shaft assembly illustrating further movement of the wedge plate during initial activation of the clip applier and disengagement of the stem of the connector plate from the snap clip of the wedge plate. FIG. 53 is a longitudinal cross-sectional view of the shaft assembly illustrating further movement of the wedge plate during the initial activation of the clip applier and disengagement of the stem of the connector plate from the snap clip of the wedge plate. FIG. 54 is a longitudinal cross-sectional view of the shaft assembly illustrating further movement of the wedge plate during initial activation of the clip applier, and disengagement of the stem of the connector plate from the snap clip of the wedge plate. FIG. 55 is a longitudinal cross-sectional view of the clip applier of FIGS. 1 to 54 illustrating the clip applier during further activation. FIG. 56 is an enlarged view of the detailed area shown in FIG. FIG. 56A is a right perspective view of the shaft assembly with the upper housing removed illustrating the movement of the push rod during further activation of the clip applier. FIG. 56B is a bottom plan view of the advancement plate illustrating the movement of the advancement plate during further activation of the clip applier. FIG. 56C is a bottom plan view of the advancement plate illustrating the movement of the advancement plate during further activation of the clip applier. FIG. 57 is an enlarged view of the indicated detail region 36 of FIG. 34 during further activation of the clip applier. FIG. 58 is an enlarged view of the indicated detail area 40 of FIG. 34 during further activation of the clip applier. FIG. 59 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the push rod during further activation of the clip applier and the connection of the clip supported by this push rod to the boss of the upper housing. FIG. 60 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the push rod during further activation of the clip applier and the connection of the clip supported by this push rod to the boss of the upper housing. FIG. 61 is an enlarged view of the indicated detail region 40 of FIG. 34 during further activation of the clip applier. FIG. 62 is an enlarged view of the indicated detail area 42 of FIG. 34 during further activation of the clip applier. FIG. 63 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the drive rod during further activation of the clip applier. 64 is an enlarged cross-sectional view of the shaft assembly during further activation of the clip applier, taken through 41-41 of FIG. Fig. 65 is an enlarged view of the cross-section of the shaft assembly during further activation of the clip applier, taken through 41-41 of Fig. 40. FIG. 66 is a top left perspective view of the distal end of the shaft assembly during further activation of the clip applier. FIG. 67 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the connector plate during further activation of the clip applier. FIG. 67A is a longitudinal cross-sectional view of a shaft assembly illustrating the movement of a connector plate during further activation of a clip applier according to an alternative embodiment of the present disclosure. FIG. 68 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the connector plate during further activation of the clip applier. FIG. 68A is a longitudinal cross-sectional view of a shaft assembly illustrating the movement of a connector plate during further activation of a clip applier according to an alternative embodiment of the present disclosure. FIG. 69 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the connector plate during further activation of the clip applier. FIG. 69A is a longitudinal cross-sectional view of a shaft assembly illustrating the movement of a connector plate during further activation of a clip applier according to an alternative embodiment of the present disclosure. FIG. 70 is a longitudinal cross-sectional view of the clip applier of FIGS. 1-69 illustrating the clip applier during final activation. 71 is an enlarged view of the detailed area shown in FIG. FIG. 72 is an enlarged view of the indicated detail area 42 of FIG. 34 during the final activation of the clip applier. FIG. 73 is a front perspective view of the distal end of the shaft assembly illustrating the activation of the jaws during the final activation of the clip applier. FIG. 74 is a front perspective view of the distal end of the shaft assembly illustrating the activation of the jaws during the final activation of the clip applier. FIG. 75 is a perspective view illustrating a surgical clip applied to a vessel. FIG. 76 is an enlarged view of the indicated detail area 71 of FIG. 70 during release of the clip applier trigger. FIG. 76A is a side elevation view of the handle assembly during release of the trigger after full activation. FIG. 77 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the connector plate during release of the trigger. FIG. 78 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the push rod during release of the trigger and the disconnection of the clip supported by the push rod from the boss of the upper housing. FIG. 79 is a right perspective view of the shaft assembly with the upper housing removed illustrating the movement of the push rod during the release of the trigger. FIG. 80 is an enlarged view of the indicated detail area 40 of FIG. 34 during trigger release. FIG. 81 is a longitudinal cross-sectional view of the shaft assembly illustrating the reconnection of the stem of the connector plate to the push clip snap clip during release of the trigger. FIG. 82 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the wedge plate during trigger release and the re-engagement of the stem of the connector plate to the snap clip of the wedge plate. FIG. 83 is a longitudinal cross-sectional view of the shaft assembly illustrating the movement of the wedge plate during release of the trigger and the re-engagement of the stem of the connector plate to the snap clip of the wedge plate. FIG. 84 is a front perspective view of the distal end of the shaft assembly when the clip applier is in a locked state. FIG. 85 is an enlarged view of the detail area 42 shown in FIG. 34 when the clip applier is in a locked state. FIG. 86 is an enlarged view of the detailed area 71 shown in FIG. 70 when the clip applier is in a locked state.

  The clip applier of the present invention, when considered in combination with the following drawings, will be more fully appreciated when it is better understood from the following detailed description.

(Detailed description of embodiment)
Embodiments of a surgical clip applier according to the present disclosure will now be described in detail with reference to the drawings. In the drawings, like reference numbers indicate similar or identical elements. The term “proximal” refers to the user of the device when referring to the relative position in the surgical instrument, as is traditional, as shown in the drawings and described throughout the following description. The term “distal” refers to the end remote from the user of the device.

  With reference now to FIGS. 1-5, a surgical clip applier according to an embodiment of the present disclosure is shown generally as 100. The clip applier 100 includes an endoscope portion that includes a handle assembly 102 and a shaft assembly 104 extending distally from the handle assembly 102.

  The shaft assembly 104 has an outer diameter of about 10 mm. The shaft assembly 104 can have various lengths that are longer or shorter depending on the intended application (eg, bariatric surgery).

  As seen in FIGS. 1-5, the surgical clip applier 100 includes a pair of jaws 106 that are located at the distal end of the shaft assembly 104 and the trigger 108 of the handle assembly 102. It can be started by. The jaw 106 is formed from a suitable biocompatible material (eg, stainless steel or titanium) and defines a channel 106a between the jaws for receiving a surgical clip “C” therein. The width of the jaws 106 is greater than the outer diameter of the shaft assembly 104 when the jaws 106 are in an open state or not in close proximity to each other.

  The jaw 106 is placed at the distal end of the shaft assembly 104 so as to rest longitudinally relative to the shaft assembly 104. A knob 110 can be rotatably mounted at the distal end of the handle assembly 102 and can be secured to the shaft assembly 104 to transmit and / or rotate the shaft assembly 104 and jaws 106 around the longitudinal axis. Or provide (see FIG. 2).

  Referring now to FIGS. 1-8, the handle assembly 102 of the surgical clip applier 100 is shown. The handle assembly 102 includes a housing 103 having a first or right half section 103a and a second or left half section 103b. The handle assembly 102 includes a trigger 108 that is pivotally supported between a right half section 103a and a left half section 103b. The handle assembly 102 defines a window 103c formed in the housing 103, which is for supporting and displaying the counting mechanism, as will be discussed in more detail below. The housing 103 of the handle assembly 102 may be formed from a suitable plastic material.

  The housing 103 supports the drive assembly 120 between the right half section 103a and the left half section 103b. The drive assembly 120 includes a wishbone link 122 having a first end pivotally connected to the trigger 108 and a second end pivotally connected to the crank plate 124. Have. As seen in FIGS. 6-9, the drive assembly 120 includes a drive connector 134 rotatably connected to the crank plate 124, a plunger 135 interconnected to the drive connector 134, and a spring supported by the drive connector 134. 136. Plunger 135 defines a longitudinal slot 135a configured and adapted to receive the proximal end of drive rod 140 therein.

  The drive rod 140 is connected to the plunger 135 via the integral pin 135b (see FIG. 9). A cap 144 is provided through which the plunger 135 extends. A seal (not shown) is provided to create a hermetic seal between the plunger 135 and the outer tube 150.

  As seen in FIGS. 6-8, the handle assembly 102 further comprises a rack 124a. The rack 124a is formed on the interior / surface of the crank plate 124 such that the rack 124a is movable with the crank plate 124. The rack 124a includes a plurality of teeth that are interposed between a distal recess 124b and a proximal recess 124c defined in the crank plate 124. Recesses 124b and 124c allow pawl 224 to flip back and over the teeth of rack 124a when crank plate 124 changes between proximal and distal movement. Provided to.

  Handle assembly 102 further includes a pawl 224 pivotally connected to housing 130 by pawl pin 226 in a position where pawl 224 is in substantially operable engagement with rack 124 a of crank plate 124. The pawl 224 includes pawl teeth 224 a that can be selectively engaged with the teeth of the rack 124 a of the crank plate 124. The pawls 224a engage the rack teeth to limit longitudinal movement of the rack 124a and then the crank plate 124 within the handle assembly 102. A pawl spring 228 is provided to bias pawl 224 into operative engagement with rack 124 a of crank plate 124.

  As seen in FIGS. 6 to 8, the crank plate 124 is pivotally connected to the wishbone link 122 via a pin 123. Crank plate 124 defines a series of ratchet teeth 124 a for selective engagement with pawl 224.

  As seen in FIGS. 8, 8A and 8B, the handle assembly further comprises an audible / tactile feedback member 126, which, together with the trigger 108, is activated when the trigger 108 is activated. It is operatively associated with trigger 108 for rotation about a common axis. The feedback member 126 defines a race 126a that defines a plurality of ratchets or steps 126b. A bendable arm 127 is provided, the bendable arm operably connected to or disposed on the race 126a of the feedback member 126 to contact the step 126b and a first end connected to the housing 103. With two ends. In operation, when the trigger 108 is activated, the arm 127 moves through and / or along the race 126a formed in the feedback member 126. As discussed in more detail below, as arm 127 moves past step 126b of feedback member 126, arm 127 snaps to step 126b and is audible / click and / or tactile. Causes vibration.

  The audible / tactile feedback member 126 may be loaded after the clip is fully loaded into the jaws of the surgical clip applier 100, after the loaded clip is formed by the jaws of the surgical clip applier 100, and the surgical clip. There is sufficient step 126b to produce an audible / tactile indicator after the applier 100 is reset to the home position and ready to fire / form another clip.

  As seen in FIGS. 6, 7, 8, and 8A, the handle assembly 102 of the surgical clip applier 100 further comprises a counting mechanism 132 that is supported within the housing 103. And through a window 103 c defined in the housing 103. The counting mechanism 132 includes an energy source (not shown) in the form of a display 132a, a processor 132b, and a battery.

  Display 132a can be any device known in the art that provides an indication of an event. This event may be related to the procedure or operation of clip applier 100. The display 132a is a liquid crystal display (LCD).

  Display 132a displays one or more operating parameters of clip applier 100 to the surgeon. The operational parameters displayed by the display 132a may include the amount or number of clips remaining, the number of clips used, the position parameters, the duration of surgery, or any other procedural parameter.

  Mylar or other polymer insulating material is placed between the battery or energy source and the contacts of the processor 132b, and this material prevents the battery or energy source from depleting during storage. A tab extends from the housing 103 of the surgical clip applier 100 for the purpose of allowing easy removal of the tab. Once this tab is removed, a battery or other energy source is in electrical contact with the contacts of the processor 132b and then supplies energy to the display 132a.

  As seen in FIGS. 6, 7, 8, and 8A, the handle assembly 102 of the surgical clip applier 100 further comprises a counter activation mechanism that includes a first arm 130a. The first arm is configured and adapted to operatively and selectively engage the processor 132b of the counter mechanism 132. The counter activation lever 130 further includes a second arm 130 b, which is operatively slidably engaged with a slot 128 a formed in an actuator plate 128 slidably supported within the housing 103. Constructed and adapted to fit.

  In operation, as described in more detail below, when the trigger 108 is grasped, the trigger 108 advances the wishbone link 122 distally and advances the crank plate 124 distally. As the arm 124d of the crank plate 124 advances a predetermined distance, the arm 124d engages or contacts the finger 128b of the actuator plate 128. As the crank plate 124 advances further distally, the crank plate 124 applies or pulls the actuator plate 128 in the distal direction, thereby activating the counter drive lever 130 and activating the counter mechanism 132. Let

  Specifically, when the actuator plate 128 moves distally a sufficient distance, the second arm 130b of the counter activation lever 130 cams within its slot 128a and rotates the counter activation lever 130; As a result, the first arm 130a of the counter activation lever 130 engages the counter mechanism 132, thereby causing a change in the display. When the actuator plate 128 moves proximally a sufficient distance, the second arm 130b of the counter activation lever 130 returns to the home position, so that the first arm 130a of the counter activation lever 130 is moved to the counter mechanism. Disengage from 132.

  With reference to FIGS. 9-31A, a shaft assembly 104 of a surgical clip applier 100 is shown and described herein below. The shaft assembly 104 and its components may be formed from a suitable biocompatible material (eg, stainless steel, titanium, plastic, etc.). The shaft assembly 104 includes an outer tube 150 having a proximal end 150a, a distal end 150b supported within the housing 103, and a lumen 150c extending through the outer tube. The outer tube 150 is fixed in the housing 103 by a flange protruding from its outer surface. The shaft assembly 104 further includes an upper housing 152a and a lower housing 152b, each disposed within the lumen 150c of the outer tube 150. The rear upper housing 154 is disposed inside the outer tube 150 and proximal to the upper housing 152a.

  As seen in FIGS. 9, 12 and 13, the shaft assembly 104 further includes a push rod 156 slidably supported within the upper housing 152 a and the rear upper housing 154. Push bar 156 includes a distal end 156a that defines a narrow profile pusher 156c that selectively engages / moves with the most distal clip “C1” of the stack of clips “C”. Configured and adapted to (ie, advance distally) and remain in contact with this distal-most clip “C1” during the initial formation of the distal-most clip “C1” Yes. The push rod 156 further comprises a proximal end 156b. The push rod 156 is located proximal to the distal window 156d with the catch 156e, a pair of recesses 156f located proximal to the distal window 156d and formed on each side edge thereof, and the side recess 156f. An elongated slot 156g and a most proximal window 156h located proximal to the slot 156g are defined.

  As seen in FIGS. 9 and 14, the push rod 156 supports the first snap clip 157a along its upper surface at a location distal of the side recess 156f of the push rod 156. The first snap clip 157a is configured in such a way that its branches protrude or are spaced from the upper surface of the push bar 156 by a certain amount.

  As seen in FIGS. 9 and 15, push bar 156 supports second snap clip 157 b along its lower surface at a location proximal to the most proximal window 156 h of push bar 156. The second snap clip 157b is oriented in such a manner that its branches protrude in a sufficient amount to overlie the most proximal window 156h of the push bar 156. The branches of the second snap clip 157b are spaced from each other by an amount less than the width of the most proximal window 156h of the push bar 156.

  As seen in FIGS. 9 and 16-20, the shaft assembly 104 further comprises an advance plate 162 that is reciprocally supported under the push bar 156. As seen in FIGS. 16 and 17, a fourth snap clip 157 d is supported at the proximal end of the advancement plate 162. The snap clip 157d includes a pair of branches that are removably connected within a proximal retaining groove 152m and a distal retaining groove 152n formed in the upper housing 152a. In this manner, the snap clip 157d removably engages the proximal retention groove 152m and the distal retention groove 152n to maintain the advancement plate 162 in the proximal or distal position. As the advancement plate 162 is advanced distally, the branches of the snap clip 157d cam inward and allow the advancement plate 162 to continue to move more distally.

  As seen in FIGS. 18-20, the advancement plate 162 includes a series of windows 162a formed therein and extending along its length. As seen in FIG. 19, each window 162a defines a proximal edge that extends below the surface of the advancement plate 162, thereby defining a lip or ledge 162c. The advance plate 162 further includes a pair of side fins 162b that extend in the direction from the side edges toward the upper housing 152a. As seen in FIG. 15, the pair of side fins 162b are slidably disposed in the side recess 156f of the push rod 156.

  As seen in FIGS. 9 and 21-22, the shaft assembly 104 further comprises a clip carrier 164 disposed within the upper housing 152 a and below the advance plate 162. Clip carrier 164 is a generally box-like structure and has an upper wall, a pair of side walls, and a lower wall to define a channel through the clip carrier. The clip carrier 164 includes a plurality of spaced windows 164a formed in its lower wall and extending longitudinally along its length (see FIG. 9). Clip carrier 164 includes an elongated window formed in the upper wall thereof and extending longitudinally along its length.

  As seen in FIGS. 9 and 21, the stack of surgical clips “C” is loaded and loaded into the channel of the clip carrier 164 in such a manner that it slides into and / or along this channel. / Or retained. The channel of the clip carrier 164 is configured and dimensioned to hold a plurality of surgical clips “C” slidably in an internally aligned fashion.

  As seen in FIG. 19, the distal end of clip carrier 164 includes a pair of spaced apart elastic cores 164b. Core 164b is configured to removably engage the backspan of the most distal surgical clip “C1” of the stack of surgical clips “C” retained within clip carrier 164. And adapted.

  As seen in FIGS. 9 and 21-24, the shaft assembly 104 of the clip applier 100 further includes a clip follower 166 slidably disposed within the channel of the clip carrier 164. As will be described in more detail below, the clip follower 166 is positioned behind the stack of surgical clips “C” and propels the clip stack “C” forward during activation of the clip applier 100. Provided to do. As will be described in more detail below, the clip follower 166 is activated by a forward and backward reciprocation of the advancement plate 162.

  As seen in FIGS. 23, 23A and 24, the clip follower 166 has a body portion 166a, a distal tab 166b extending substantially upward and rearward from the body portion 166a, and a substantially downward direction from the body portion 166a. And a rearwardly extending proximal tab 166c.

  The distal tab 166b of the clip follower 166 is configured and dimensioned to selectively engage the ledge 162c of the window 162a of the advancement plate 162. In use, the engagement of the distal tab 166b of the clip follower 166 with the ledge 162c of the window 162a of the advance plate 162 causes the clip follower to follow the advance plate 162 as the advance plate 162 advances or moves distally. Child 166 is progressively advanced or moved distally.

  Proximal tab 166c is configured and dimensioned to selectively engage a window 164a formed in clip carrier 164. In use, the engagement of the proximal tab 166c of the clip follower 166 into the window 164a formed in the clip carrier 164 prevents the clip follower 166 from moving or moving proximally.

  The clip follower 166 includes a lockout plate 165 that is supported by the clip follower or is formed integrally with the clip follower. The lockout plate 165 includes an elastic tail 165a that defines a window 165d extending therefrom, the elastic tail pointing upward and rearward from the body portion 166a of the clip follower 166.

  As seen in FIGS. 9, 25 and 38, the shaft assembly 104 further includes a drive channel 168 that is reciprocally supported within the channel assembly 104 at a position below the clip carrier 164. The The drive channel 168 is a substantially U-shaped channel and includes a pair of side walls 168b spaced from its backspan 168c in a direction away from the clip carrier 164 in a direction toward the lower housing 152b. The drive channel 168 further comprises a tab 168d that protrudes from the backspan 168c at a location proximal to the slot 168a and extends in the direction of the sidewall 168b. As seen in FIG. 41, the drive channel 168 defines a slot or window 168e formed in one of the side walls 168b, which selectively selects the teeth 194c of the wedge plate release mechanism 194. It is for acceptance.

  As seen in FIGS. 9 and 25, the shaft assembly 104 of the clip applier 100 includes a drive channel strap 167 secured to the drive channel 168. The strap 167 is secured to this side wall so as to extend across the side wall 168 b of the drive channel 168. Strap 167 is secured to drive channel 168 at a location distal to elongate slot 168a. Strap 167 is secured to drive channel 168 such that wedge plate 172 extends between backspan 168 c of drive channel 168 and jaw 106.

  As seen in FIGS. 9, 26 and 27, clip applier 100 includes a pair of jaws 106 that are located at the distal end of shaft assembly 104 and can be actuated by trigger 108. is there. The jaw 106 is formed from a suitable biocompatible material (eg, stainless steel or titanium).

  The jaw 106 is placed adjacent to the distal end of the drive channel 168 via a boss formed in the lower housing 152b. These bosses engage a receiving slot formed in the jaw 106 so that the jaw 106 is held stationary relative to the drive channel 168. As seen in FIG. 25, jaw 106 defines a channel 106a therebetween for receiving a surgical clip “C”.

  As seen in FIGS. 9, 25, and 26, the shaft assembly 104 of the clip applier 100 further includes a wedge plate 172 that is interposed between the drive channel 168 and the jaw 106. , And a proximal end extending through the shaft assembly 104. The wedge plate 172 includes a substantially tapered distal end 172a for selectively operatively interposing between the jaws 106. As seen in FIG. 26, the wedge plate 172 defines a fin or tab 172b that protrudes from its lower surface. As seen in FIG. 22, the wedge plate 172 defines a proximal most slot 172c formed therein for slidably receiving the second stem 174c of the connector plate 174 therein. belongs to.

  As seen in FIG. 22, the third snap clip 157 c is supported at the proximal end of the wedge plate 172. The third snap clip 157c is oriented in such a manner that its branches protrude in a sufficient amount to overlie the most proximal window 172c formed in the wedge plate 172. The branches of the third snap clip 175c are spaced from each other by an amount less than the width of the most proximal window 172c of the wedge plate 172.

  As seen in FIGS. 9, 18, 20, and 36, the shaft assembly 104 of the clip applier 100 further includes a connector plate 174 that slides between the push bar 156 and the wedge plate 172. Is movably interposed and removably connectable to each of the push rod 156 and the wedge plate 172. Connector plate 174 includes a tapered distal end 174a, a first stem 174b extending from an upper surface thereof, and a second stem 174c extending from a bottom surface thereof. Each stem 174b, 174c has a substantially teardrop shaped profile, and the distal end of each stem 174b, 174c is larger than its proximal end.

  In operation, the first stem 174b of the connector plate 174 is configured and dimensioned to removably connect with the second snap clip 157b secured to the push rod 156, and the second of the connector plate 174 The stem 174c is configured and dimensioned for releasable connection with a third snap clip 157c secured to the wedge plate 172.

  As seen in FIGS. 22, 36 and 37, the second stem 174 c of the connector plate 174 extends into the window 140 b defined in the drive rod 140. In this manner, when the drive rod 140 also reciprocates, the connector plate 174 reciprocates with it.

  As seen in FIG. 31A, the guard 198 maintains a relative distance between the branches of the third snap clip 157c within the lower housing 152b during the first distal advancement of the third snap clip 157c. It is supported in such a position. In this manner, the second stem 174b of the connector plate 174 cannot prematurely disengage from the third snap clip 157c until the third snap clip 157c exceeds the guard 198.

  As seen in FIGS. 9, 27, 29 and 41, the shaft assembly 104 of the clip applier 100 further comprises a slider joint 180 slidably supported within the channel of the lower housing 152b. The slider joint 180 includes a body portion 182 and a rod 184 extending from the body portion. When properly positioned within the channel of the lower housing 152b, the rod 184 of the slide joint 180 extends substantially distally. The rod 184 of the slider joint 180 is formed in the lower housing 152b and slidably passes through a stub 152d extending from the channel of the lower housing 152b (see FIG. 29). The shaft assembly 104 further includes a biasing member 186 in the form of a compression spring that is supported by the rod 184 and between the stub 152d of the lower housing 152b and the body portion 182 of the slider joint 180. Intervene.

  The body portion 182 of the slider joint 180 includes a boss 182a formed near its proximal end, which is configured and adapted to slidably engage the elongated slot 140a of the drive rod 140 (see FIG. See Figure 29). The body portion 182 of the slide joint 180 further comprises a pocket 182b formed near its distal end that is configured and adapted to receive the tab 168d of the drive channel 168 therein (FIG. 38). And see FIG. 39).

  As seen in FIGS. 9, 27 and 28, the shaft assembly 104 of the clip applier 100 further comprises a wedge plate lock 190 slidably supported within the channel and drive channel 168 of the lower housing 152b. The wedge plate lock 190 extends from a body portion 190a, a rod 190b extending distally from the body portion 190a, a tail 190c extending proximally from the body portion 190a, a pocket 190d formed on the upper surface of the body portion 190a, and a tail 190c. A stem or tooth 190e is provided. The shaft assembly 104 further includes a biasing member 192 in the form of a compression spring, which is supported by the bar 190b and is interposed between the lower housing 152b and the body portion 190a of the wedge plate lock 190.

  The shaft assembly 104 of the clip applier 100 further includes a wedge plate release mechanism 194 that is rotatably supported in the channel of the lower housing 152b. The wedge plate releasing mechanism 194 is engaged with the teeth 190e extending from the tail 190c of the wedge plate lock 190, and extends outwardly from the stem 194a toward the tail 190c of the wedge plate lock 190. Hammer 194b and teeth 194c extending from stem 194a in a direction away from tail 190c of wedge plate lock 190 are provided.

  Operation of the surgical clip applier 100 to form or crimp the surgical clip to the target tissue (eg, a vessel) will now be described. Referring to FIGS. 32-43, surgical clip applier 100 is shown prior to its operation or use. As seen in FIGS. 32 and 33, prior to use or firing of the clip applier 100, the trigger 108 is generally in an uncompressed or unactivated state. Accordingly, the crank plate 124 of the drive assembly 120 is in the retracted position or the most proximal position, and thus the plunger 135 and the drive rod 140 are also in the retracted position. When the crank plate 124 is in the retracted position, the pawl 224 is disposed in the distal recess 124 b defined in the crank plate 124.

  When drive assembly 120 and drive rod 140 are in the retracted position, connector plate 174 is in the retracted position or the most proximal position, as seen in FIGS. With the connector plate 174 in the retracted or most proximal position, the push rod 156 is also in the retracted or most proximal position and the first teardrop stem of the connector plate 174 174b is located at the proximal end of the most proximal window 156h of the push bar 156 and is maintained in snap-fit engagement with the branch of the second snap clip 157b. Also, with the connector plate 174 in the retracted or most proximal position, the wedge plate 172 is also in the retracted or most proximal position and the second teardrop of the connector plate 174 Mold stem 174c is disposed at the proximal end of the most proximal window 172c of wedge plate 172 and is maintained in snap-fit engagement with the branch of third snap clip 157c.

  As seen in FIGS. 36 and 37, when drive assembly 120 and drive rod 140 are in the retracted position, tab 182a of slider joint 182 is located at the most distal position of elongate slot 140a of drive rod 140. To do.

  As seen in FIGS. 38 and 39, when the drive assembly 120 and drive rod 140 are in the retracted position, the clip follower 166 is located at the most proximal end of the channel of the clip carrier 164 and the clip The distal tab 166b of the follower 166 is operably disposed within the most proximal window 162a of the advancement plate 162, and the proximal tab 166c is operatively disposed within the most proximal window 164a of the clip carrier 164. Be placed.

  With continued reference to FIGS. 38 and 39, when drive assembly 120 and drive rod 140 are in the retracted position, slider joint 180 is in the most proximal position and tab 168d of drive channel 168 is As disposed within the pocket 182b of the slider joint 180, the drive channel 168 is also located in the most proximal position. As seen in FIGS. 38 and 39, the slider joint 180 abuts a physical stop 152e (see FIG. 30) protruding from the lower housing 152b.

  As seen in FIGS. 40 and 41, when drive assembly 120 and drive rod 140 are in the retracted position, wedge plate lock 190 is located in the most proximal position and consequently extends from its tail 190c. The teeth 190e are disposed proximal to an inclined ledge 152f formed in the lower housing 152b (see FIGS. 30 and 31). As seen in FIG. 41, the wedge plate lock 190 abuts a physical stop 152g protruding from the lower housing 152b. As can also be seen in FIG. 41, the wedge plate release mechanism 194 is positioned in a first position such that its teeth 194c protrude into a window 168e formed in the side wall 168b of the drive channel 168.

  As seen in FIGS. 42 and 43, when the drive assembly 120 and drive rod 140 are in the retracted position, the pusher 156c of the push rod 156 has the most distal clip “C1 held by the clip carrier 164. Is located proximal to the backspan. The most distal clip “C1” is held in the channel of the clip carrier 164 by the clip carrier core 164b. Also in this position, as described above, the wedge plate 172 is located in the most proximal position, so that its distal end 172a is located proximal to the jaw 106.

  As seen in FIG. 43, with the drive channel 168 in the most proximal position, its distal end disengages from the proximal camming surface 106 b of the jaw 106.

  Referring now to FIGS. 44-54, when the trigger 108 is grasped or activated from its initial position, during the first phase of the first stroke, the trigger 108 causes the crank plate 124 to engage the wishbone link 122. Moving in the distal direction, this in turn moves the drive connector 134 and plunger 135 distally, and moves the drive rod 140 distally. As plunger 135 moves distally, spring 136 is compressed by an initial amount.

  At the same time, as the crank plate 124 moves distally, as the pawl 224 moves or rotates from the distal recess 124a of the crank plate 124, the teeth of the rack 124a engage the teeth 224a of the pawl 224. In this manner, the crank plate 124 cannot return to its most proximal position without completing a complete distal stroke.

  As seen in FIG. 44, when the trigger 108 is grasped by the initial amount, the arm 127 begins to translate through the race 126a of the feedback member 126.

  As seen in FIG. 46, as drive rod 140 moves distally, drive rod 140 pushes connector plate 174 distally. The push bar 156 is selectively connected to the connector plate 174 via the second snap clip 157b so that the push bar 156 is advanced or pulled in the distal direction. Also, since wedge plate 172 is selectively connected to connector plate 174 via third snap clip 157c, wedge plate 172 is also advanced or pulled distally.

  As drive rod 140 moves distally, its elongated slot 140a also moves distally so that tab 182a of slider joint 182 translates proximally relative to this elongated slot.

  As seen in FIGS. 47-49, as the wedge plate 172 moves distally, the tab 172b of the wedge plate 172 is held in the pocket 190d of the wedge plate lock 190 so that the wedge plate lock 190 is , Moved or pulled in the distal direction, causing the teeth 190e of the tail 190c to cam on the inclined ledge 152f formed in the lower housing 152b, thereby moving the inclined ledge from a position proximal to the inclined ledge 152f. Move to the distal position of 152f. As wedge plate lock 190 moves distally, biasing member 192 is compressed by an initial amount. As seen in FIG. 49, the wedge plate lock 190 moves distally until the wedge plate lock 190 abuts the physical stop formed in the lower housing 152b.

  As seen in FIG. 47A, as the push bar 156 moves distally, the push bar until the fin 162b of the advancement plate 162 contacts or engages the proximal end of the side recess 156f of the push bar 156. 156 translates a predetermined distance within the side recess 156f.

  As seen in FIGS. 47B and 47C, as the wedge plate 172 moves distally, due to the connection between the second stem 174c of the connector plate 174 and the third snap clip 157c, the connector plate 174 The second stem 174c is prevented by the guard 198 from being prematurely disconnected from the third snap clip 157c. Specifically, the guard 198 acts on the tip of the branch of the third snap clip 157c to generate a distal force generated by the second stem 174c as the connector plate 174 moves distally. Prevents the branches from spreading outward due to the forces acting on these branches.

  As seen in FIG. 50, as push rod 156 moves distally, its pusher 156c engages the backspan of the most distal clip “C1” and the distal most clip “C1” Start pushing in the distal direction. As the push bar 156 moves the distal-most clip “C1” distally, the distal-most clip “C1” unsnaps from behind the core 164b of the clip carrier 164 and the channel of the jaw 106 It begins to enter into 106a.

  As seen in FIG. 51, as the wedge plate 172 moves distally, its distal end 172a enters between the jaws 106 and widens the jaws 106 outward.

  As seen in FIGS. 52-54, the wedge plate 172 is prevented from further distal movement once the wedge plate lock 190 abuts the physical stop formed in the lower housing 152b. However, the drive rod 140 continues to move the connector plate 174 in the distal direction. Since the connector plate 174 continues to be applied distally, once the tip of the branch of the third snap clip 157c moves distally beyond the guard 198, the force acting on the second stem 174c is: It is sufficient to spread the branches of the third snap clip 157c outward and the second stem 174c to unsnap from between these branches, thereby keeping the connector plate 174 moving distally. Make it possible.

  Referring now to FIGS. 55-69, when the trigger 108 is further grasped or activated from the first stage of the first stroke through the second stage of the first stroke, the trigger 108 is moved to the wishbone link 122. First, the crank plate 124 is moved further distally, which in turn moves the drive connector 134 and subsequently the plunger 135 further distally and the drive rod 140 further distally. As plunger 135 moves distally, spring 136 is compressed by an additional amount.

  At the same time, as the crank plate 124 moves distally, the teeth of its rack 124a move further distally relative to the teeth 224a of the pawl 224. Thus, the crank plate 124 still cannot return to its most proximal position without completing a complete distal stroke.

  As seen in FIG. 55, as the crank plate 124 moves distally, its arm 124d engages or contacts the finger 128b of the actuator plate 128 after a predetermined distance. As the crank plate 124 advances further distally, the crank plate 124 applies or pulls the actuator plate 128 in a distal direction, thereby activating the counter activation lever 130 and activating the counter mechanism 132. Let

  Specifically, when the actuator plate 128 moves a sufficient distance distally, the second arm 130b of the counter activation lever 130 is propelled to cam and rotate within its slot 128a, resulting in The first arm 130a of the counter activation lever 130 engages the counter mechanism 132, thereby causing a change in its display. Specifically, this display displays the number of clips remaining in the surgical clip applier 100 and decreases by one. Alternatively, the clip counter mechanism increments by one or produces some other change.

  As the trigger 108 is further grasped, the arm 127 continues to translate through the race 126a of the feedback member 126. At this point while holding the trigger 108, a surgical clip is loaded into the jaw 106. Accordingly, arm 127 interacts with step 126b formed in race 126a of feedback member 126 and produces an audible / tactile indicator to inform the user that the clip has been loaded into the jaw.

  As seen in FIG. 57, as drive rod 140 moves further distally, drive rod 140 continues to push connector plate 174 distally. Since the push bar 156 remains selectively connected to the connector plate 174 via the second snap clip 157b, the push bar 156 is further advanced or pulled in the distal direction. However, since the third snap clip 157c of the wedge plate 172 is disconnected from the second stem 174c of the connector plate 174, the wedge plate 172 is neither advanced nor pulled further in the distal direction.

  As seen in FIGS. 56A-56C, as the push rod 156 continues to move distally, the pair of fins 162b of the advancement plate 162 are engaged by the proximal end of the side recess 156f of the push rod 156. In this state, push bar 156 advances or pulls advance plate 162 distally.

  As seen in FIGS. 56B and 56C, as the advancement plate 162 is advanced distally, the snap clip 157d disengages from the proximal retention groove 157m and the distal retention groove 157n formed in the upper housing 152a. Engage with.

  As seen in FIG. 57, the drive rod 140 moves distally until the tab 182a of the slider joint 182 translates relatively to the most proximal position of the elongated slot 140a of the drive rod 140.

  As push rod 156 continues to move distally, push rod 156 continues to push advance plate 162 distally through fins 162b. As seen in FIG. 58, as the advancement plate 162 moves distally, the distal tab 166b of the clip follower 166 pushes the clip follower 166 distally relative to the clip carrier 164. , Engaged by the proximal edge of the window 162a that receives the distal tab 166b of the clip follower 166, thereby advancing the stack of clips “C” by an incremental amount. As the clip follower 166 moves distally, its proximal tab 166c moves from the relatively proximal window 164a of the clip carrier 164 to the relatively distal window 164a of the clip carrier 164. Is moved distally by one of these.

  As seen in FIGS. 58-60, as the push rod 156 moves distally, the first snap clip 157a supported by the push rod 156 snaps to the boss 152h of the upper housing 152a, thereby The push rod 156 is maintained in the forward position.

  Further, as seen in FIG. 61, as the push rod 156 continues to move in the distal direction, the stack of clips “C” is moved in the distal direction.

  As seen in FIG. 62, as push rod 156 moves distally, its pusher 156c moves distally until the most distal clip “C1” fully enters channel 106a of jaw 106. Continue moving clip “C1” in the distal direction. In operation, the pusher 156c pusher 156c provides stability to the loaded clip "C" and during the formation of the clip "C" in order to maintain the proper position of the clip "C" Remain in contact with the backspan.

  As seen in FIG. 63, as drive rod 140 moves further in the distal direction, its shoulder 140c contacts the most proximal end of drive channel 168. In this manner, the drive rod 140 moves or propels the drive channel 168 in the distal direction as the drive rod 140 moves further in the distal direction.

  As seen in FIG. 64, as drive channel 168 moves distally, the proximal edge of window 168e formed in sidewall 168b of drive channel 168 contacts teeth 194c of wedge plate 194, and wedge plate The release mechanism 194 is rotated. As the wedge plate release mechanism 194 rotates, its hammer 194b pushes the teeth 190e of the wedge plate lock 190 and propels or expels the teeth 190e away from the rear inclined ledge 152f. During this time, as seen in FIG. 65, the biasing member 192 is released from compression, thereby moving the wedge plate lock 190 in the proximal direction. As can be seen in FIG. 66, as the wedge plate lock 190 moves in the proximal direction, the wedge plate 172 moves in the proximal direction because the wedge plate 172 is connected to the wedge plate lock 190. Its distal end 172a is withdrawn from engagement with the jaw 106.

  As seen in FIGS. 58 and 67-69, the push rod 156 is maintained in the distal position by the connection of the boss 152h and the first snap clip 157a, so that the drive rod 140 is further in the distal direction. The force acting on the connector plate 174 causes the second snap clip 157b to disengage from the first stem 174b of the connector plate 174, thereby continuing to move the connector plate 174 in the distal direction. Make it possible.

  As seen in FIGS. 67A-69A, in one embodiment, the tip of the branch of the second snap clip 157b can be configured to project outward, thereby allowing the rear upper housing 154 (FIG. 9 Engaging the surface), thereby preventing the second snap clip 157b from prematurely disengaging from the first stem 174b of the connector plate 174. In this embodiment, a recess can be formed in the surface of the rear upper housing 154, the position of which coincides with the position where the branch of the second snap clip 157b can spread outward, and thus the first of the connector plate 174 The stem 174b of the detachment can disengage and continue to move distally.

  As seen in FIGS. 70-75, as the trigger 108 is activated through the final stage of the first stroke, the trigger 108 further moves the crank plate 124 distally to the wishbone link 122, This in turn moves the drive connector 134 and plunger 135 further distally and the drive rod 140 further distally. As drive connector 134 moves distally, spring 136 is compressed by an additional amount.

  At the same time, as the crank plate 124 moves distally, the teeth of its rack 124a move further distally relative to the teeth 224a of the pawl 224 so that the teeth 224a of the pawl 224 move proximally of the crank plate 124. Upon entering 124c, the teeth of the rack 124a disengage from the teeth 224a of the pawl 224 and are thus in a position to be reset. Thus, the crank plate 124 can return to the most proximal position upon release of the trigger 108.

  As seen in FIGS. 72-74, during the final phase of the first stroke of trigger 108, drive channel 168 and strap 167 move distally relative to jaw 106, resulting in drive channel 168. The distal edge engages the camming surface 106b of the jaw 106, causing the jaw 106 to close and form a clip "C1" located between the jaws. As seen in FIG. 74, pusher 156c of push bar 156 remains in the distal position and is in contact with the backspan of this clip “C” during formation of clip “C”.

  As seen in FIG. 55, when the trigger 108 is grasped by the final amount, the arm 127 continues to translate through the race 126a of the feedback member 126. At this point while holding the trigger 108, the surgical clip “C 1” is completely formed by the jaw 106. Thus, the arm 127 interacts with another step 126b formed in the race 126a of the feedback member 126 and produces an audible / tactile indicator, so that the surgical clip “C1” is provided by the jaw 106 to the user. Tell them that it was formed.

  As seen in FIG. 75, surgical clip “C1” may be formed or crimped on vessel “V” or any other biological tissue.

  Referring now to FIGS. 76-84, the operation of the clip applier 100 is shown when the trigger 108 is returned to an ungripped or non-actuated position. As can be seen in FIG. 76, as the trigger returns to the ungripped position, the spring is uncompressed, thereby moving the crank plate 124 in the proximal direction, which in turn moves the plunger closer. And move the drive rod proximally. As the pawl 224 has been reset, the crank plate 124 is now moved proximally until the teeth 224a of the pawl 224 reenter the distal recess of the crank plate 124.

  As seen in FIG. 76A, as the crank plate 124 moves proximally, its arms 124d disengage from the fingers 128b of the actuator plate 128, allowing the actuator plate 128 to move proximally. . As the actuator plate 128 moves proximally, the second arm 130b of the counter activation lever 130 cams within its slot 128b and is propelled to rotate, so that the counter activation lever 130 first One arm 130a is disengaged from the counter mechanism 132.

  As seen in FIG. 77, as drive rod 140 moves proximally, drive rod 140 pulls connector plate 174 through first stem 174b. As the connector plate 174 moves proximally, the first stem 174b engages the branch of the second snap clip 157b and pushes the push bar 156 proximally through the second snap clip 157b. To do.

  As seen in FIG. 78, as the force acting on push bar 156 moves push bar 156 proximally, this force is applied to first snap clip 157a along with boss 152h of upper housing 152a. The retention force is exceeded, thereby releasing the first snap clip 157a from the boss 152h and allowing the push bar 156 to move proximally.

  As seen in FIG. 79, as push rod 156 continues to move proximally, the distal end of its side recess 156f engages fin 162b of advancement plate 162 and moves advancement plate 162 in the proximal direction. Move to. As push bar 156 moves proximally, push bar nose 156c snaps behind the most distal clip in the remaining clip stack “C”, thereby creating a new most distal clip “ C1 ".

  As seen in FIG. 80, the proximal tab 166c of the clip follower 166 is clipped to maintain the relative position of the clip follower 166 within the clip carrier 164 as the advancement plate 162 moves proximally. Engage with the proximal edge of window 164a of carrier 164. As the advancement plate 162 moves proximally, its distal tab 166b moves from the relatively proximal window 162a of the advancement plate 162 to the relatively distal window 162a of the advancement plate 162. Is advanced distally by one.

  As seen in FIG. 81, when the push bar 156 stops its proximal movement and engages a boss protruding from the inner surface of the upper housing half 152a, the connector plate 174 continues to move proximally. Re-engage the first stem 174b with the second snap clip 157b. With the proximal movement of the push rod 156 stopped, the continuous proximal movement of the connector plate 174 re-engages the first stem 174b with the second snap clip 157b.

  As seen in FIGS. 82 and 83, as the connector plate 174 moves in the proximal direction, as a result of the proximal movement of the drive rod 140, the second stem 174c has a branch of the third snap clip 157c. And pushes wedge plate 172 proximally through third snap clip 157c. As the wedge plate 172 moves proximally, the wedge plate lock 190 moves until the wedge plate lock 190 contacts the physical stop of the lower housing half 152b, thereby stopping the wedge plate 172 from moving proximally. Move in the proximal direction. Once the tip of the branch of the third snap clip 157c has moved proximally beyond the guard 198 and the wedge plate 172 has stopped its proximal movement, the connector plate 174 continues to move proximally. Re-engage the second stem 174c with the third snap clip 157c.

  When the trigger 108 is returned to the non-actuated position, the arm 127 translates through the race 126a of the feedback member 126 and interacts with another step 126b formed in the race 126a of the feedback member 126 and is audible / A tactile indicator is generated to inform the user that the surgical clip applier 100 has been reset and is ready to fire again.

  Referring now to FIGS. 84-85, the configuration of the surgical clip applier 100 is shown after the last surgical clip “C” has been applied. As seen in FIGS. 84 and 85, when the last surgical clip has been advanced and formed, the clip follower 166 has its lockout with the push bar 156 still in the advanced or distal position. Plate 165 is incrementally advanced by indexing plate 158 in an amount sufficient to be biased upward through window 162a of advance plate 162 and into distal window 156d of push bar 156. Positioning the lockout plate 165 within the distal window 156d of the push bar 156 allows its catch 156e to enter and engage the window 165b of the lockout plate 165. In this manner, the clip follower 166 is maintained in a distal position by its proximal tab 166c engaging the distal window 164a of the clip carrier 164, so that the lockout plate 165 can catch the push bar 156. 156e is engaged and prevents push bar 156 from returning to its most proximal position and resetting pawl 224.

  As seen in FIG. 86, the pawl 224 engaged with the rack 124a of the crank plate 124 because the push bar 156 cannot move to its most proximal position or is prevented from moving. Remains and is not allowed to enter the proximal recess 124c and is therefore not reset. Since the pawl 224 cannot be reset, the crank plate 124 is locked or stopped from moving distally or proximally.

  It should be understood that the above description is illustrative of the books of the present disclosure. Various changes 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 alterations, modifications and variations. The embodiments described with reference to the accompanying drawings are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques not substantially different from those described above and / or in the appended claims are also intended to be within the scope of the disclosure.

100 Clip applier 102 Handle assembly 103 Housing 103a, 103b Half section 103c Window 104 Shaft assembly 106 Jaw 106a Channel 108 Trigger 110 Knob 120 Drive assembly 122 Wishbone link 124 Crank plate 134 Drive connector 135 Plunger 136 Spring 140 Drive rod

Claims (1)

Invention described in the specification.

Images