MXPA06004252A - Surgical clip applier ratchet mechanism - Google Patents

Abstract

A surgical clip applier and methods for applying surgical clips to a vessel, duct, shunt, etc., during a surgical procedure are provided. In one exemplary embodiment, a surgical clip applier is provided having a housing with a trigger movably coupled thereto and an elongate shaft extending therefrom with opposed jaws formed on a distal end thereof. The trigger is adapted to advance a clip to position the clip between the jaws, and to move the jaws from an open position to a closed position to crimp the clip positioned therebetween.

Description

RATCHET MECHANISM OF THE SURGICAL CALIPER APPLICATOR FIELD OF THE INVENTION The present invention is broadly related to surgical devices, and in particular to methods and devices for applying surgical clamps for conduits, vessels, shunts, etc.

BACKGROUND OF THE INVENTION In recent years, surgery has progressed very markedly through the performance of laparoscopic and endoscopic procedures, such as cholecystectomies, gastrostomies, appendectomies and hernia repair. These procedures are accomplished through a trocar assembly, which is a surgical instrument used to pierce a body cavity. The trocar typically contains a sharp obturator tip and a trocar tube or cannula. The trocar cannula is inserted into the skin to access the body cavity, using the tip of the obturator to penetrate the skin. After penetration, the obturator is removed and the trocar cannula remains in the body. It is through this cannula that the surgical instruments are placed. A surgical instrument that is commonly used with a trocar cannula is a surgical tweezers applicator for ligating a blood vessel, a conduit, a shunt or a portion of the body tissue during surgery. Most clamp applicators typically have a handle with an elongate body having a pair of opposed moving jaws formed at one end thereof to hold and form a clamp for bonding therebetween. The jaws are placed around the vessel or conduit, and the clamp is pressed or formed in the vessel by closing the jaws. In many of the prior art gripper applicators, the feeding and forming mechanisms require precise timing and coordinated movement for the components to operate. This need for precise timing and control has resulted in the need for complex mechanical designs, thereby increasing the cost of the grippers applicators. Many prior art grippers applicators also use a spring-loaded clip advance assembly to advance one or more clips through the body of the device. As a result, the jaws must contain a mechanism to prevent accidental projection of the device clamp before the clamp is formed. Other disadvantages of current clip appliers include the inability to handle an overload applied to the jaws by the trigger under a variety of conditions. Many devices require the jaws to be fully closed, which results in an overload in the jaws when the cup or duct placed between them is too large to allow complete closure, or when a foreign object is placed between the jaws. Accordingly, there remains a need for improved methods and devices for applying surgical clips to vessels, conduits, leads, etc.

BRIEF DESCRIPTION OF THE INVENTION The present invention provides a method and devices for applying a surgical clamp to a vessel, conduit, derivation, etc. In an exemplary embodiment, a surgical clip applier is provided having a housing with a trigger movably coupled thereto, and an elongate body extending therefrom, with opposing jaws formed at a distal end thereof. The trigger is adapted to advance a clamp to place the clamp between the jaws, and to move the clamps from an open position to a closed position to fold the clamp placed between them. The surgical clamp applicator can have a variety of configurations, and can include a variety of features to facilitate the advancement and formation of a surgical clamp. In one embodiment, the surgical clip applier may include a feed shoe that is slidably positioned within the elongate body and that is adapted to drive at least one surgical clip through the elongate body. In an exemplary mode, the feeding shoe can be adapted to move only in a distal direction, so that proximal movement of the feeding shoe is substantially avoided. The elongated body may also include a track of the clip placed therein, and adapted to seat at least one surgical clip. The feed shoe can be slidably positioned within the clip track. A variety of techniques can be used to facilitate distal movement and prevent proximal movement of the feeding shoe. In an exemplary embodiment, the feed shoe may include a spike adapted to engage the track of the clip to prevent proximal movement of the feed shoe within the track of the clip, but allows distal movement of the feed shoe within of the clip track. The track of the clip may include several openings formed therein for receiving the pin, to prevent proximal movement of the feed shoe within the track of the clip. In yet another exemplary embodiment, the feeder shoe may include a pin and the feeder bar may include several detents formed therein and adapted to engage the pin to move the feeder shoe distally when the feeder bar moves distally. In another embodiment, the elongate body may include a feed bar slidably disposed therein and coupled to the trigger, so that movement of the trigger to a closed position is adapted to advance the feed bar distally, advancing through therefore the feeding shoe distally. By way of non-limiting example, the feed bar may be coupled to the trigger by a trigger insert which coincides with the trigger, and by a connection extending between the port of the trigger and the proximal end of the feed bar. The proximal end of the feed bar may include a coupler that is adapted to receive a portion of the connection. The feed bar may also include a distal end having an impeller that is adapted to engage the distal most clamp and drive the distal most clamp towards the jaws. In certain exemplary embodiments, the feed bar may be adapted to engage and initiate advancement of a clamp further distal in the jaws, to initiate advancement of the feed shoe. In another embodiment, an advancement assembly of the clamp is provided to advance a clamp through a surgical clamp applicator. The clamp advance assembly can be used with a variety of surgical clamp applicators, including those known in the art. In an exemplary embodiment, the advance assembly of the clip may include a clip track that is adapted to seat at least one clip, and a feeder shoe that is adapted to slidably match the clip's track and moving in a distal direction at least one clip placed within the clip track in a distal direction. The feed shoe may include, in an exemplary embodiment, a peg that is adapted to engage the track of the clip to prevent proximal movement of the feed shoe within the track of the clip, and which is adapted to allow the distal movement of the feeding shoe within the gripper track. The track of the clip may include a plurality of openings formed therein for receiving the pin, to prevent proximal movement of the feeder shoe within the track of the clip. The feed assembly of the clamp also includes a feed bar that is adapted to engage a movable trigger formed in a housing of a surgical clamp applicator, and which is adapted to move slidably distally when the trigger is closed to advance the feeding shoe and at least one clip placed inside the gripper track. The power bar can have a variety of configurations, and in an exemplary embodiment, the distal end of the feed bar may include an impeller that is adapted to engage the distalmost clip to drive the most distal clip of the clip track in the jaws formed at a distal end of a surgical clamp applicator. In another exemplary embodiment, the feed shoe may include a pin, and the feed bar may include a plurality of detents formed therein, which are adapted to engage the pin to move the feed shoe distally, when the bar of feeding moves distally. In use, the proximal end of the feed bar may include a coupler that is adapted to receive a connection for coupling the feed bar to a trigger of a surgical clip applier. An exemplary method for advancing a surgical tweezers through an gated body of a surgical tweezers applicator is also provided. In one embodiment, the feeding bar can be advanced distally within the gate body of a surgical tweezers applicator, to distally move a feeder shoe positioned within the gated body and thereby advance at least one clamp distally. The feed bar can be advanced distally, for example, by actuating a trigger coupled to a housing, which coincides with a proximal end of the gate body. In an exemplary embodiment, when the feed bar is advanced distally, an impeller at the distal end of the feed bar may engage a more distal clip and advance the clip between opposing jaws formed at a distal end of the gated body. The method may also include proximally retracting the feed bar within the gate body, while the feed shoe is maintained in a substantially fixed position. In another exemplary embodiment, a method for applying a surgical clip is provided and includes moving a trigger coupled to a housing, a first distance to a closed position, to actuate the forward assembly of the clip, positioned within the housing, advancing through thus a clamp in a jaw assembly formed at a distal end of the gated body, and further moving the trigger, a second distance towards the closed position to drive a clamp forming assembly, placed within the housing, thereby forming the clip placed inside the jaw assembly. The trigger is preferably flexible in relation to the advancing assembly of the clamp during the actuation of the assembly forming the clamp. The assembly that forms the clamp can also be flexible in relation to the assembly of the clamps during the actuation thereof. In other aspects, an overload mechanism is provided for use with a surgical device. In an exemplary embodiment, the overload mechanism may include a member that receives a force rotatably and slidable in a housing, and that. it has a surface with a first end and a second opposite end, and a bias assembly positioned in the housing and adapted to resist movement of the member receiving the force. In an exemplary embodiment, resistance increases from the first end to the second end. The member receiving the force may have a variety of configurations, but in one embodiment, the surface receiving the force formed therein is positioned within an opening in the housing. The surface that receives the force may include a first portion that is adapted to receive a force to rotationally move the force-receiving member within the housing, and a second portion that is adapted to receive a force to move in a slidable manner. the member that receives the force inside the housing. The offset assembly can also have a variety of configurations, but in an exemplary embodiment, the bias assembly may include a spring positioned around a post with springs, and a plunger slidably positioned relative to the post with springs and having a head formed therein, and adapted to compress the spring after the sliding movement of the piston towards the post with springs. In another embodiment, the housing can include a rotating assembly that is coupled between the force receiving member and the diverting assembly, so that the rotatable assembly is adapted to transfer a force applied to the member receiving the force to the mounting of the member. deviation, to overcome the resistance. In an exemplary embodiment, the rotary assembly may include an articulated connection that is rotatably attached to the member receiving the force, and a pivot connection that is rotatably coupled to the articulated connection and that is adapted to apply a force to the deflection assembly after the rotary movement of the same. In another embodiment, a surgical tweezers applicator having an overload mechanism is provided to prevent overload of a closing force applied to the jaws of the tweezer applicator. In an exemplary embodiment, the surgical clip applier may include a housing having a trigger, movably coupled thereto, an elongate body extending from the housing with opposing jaws formed at a distal end thereof, and being they move between an open position and a closed position, and a cam assembly positioned within the housing and the elongated body and coupled to the trigger. The cam assembly can be adapted to apply a clamping force to the jaws, upon actuation of the trigger to move the jaws from the open position to the closed position. The cam assembly may also be adapted to transfer the closing force to an overload mechanism placed within the housing, when the closing force is greater than a resistance of the overload mechanism that is applied to the cam assembly. In an exemplary embodiment, the resistance of the overload mechanism is correlated with a force required to move the jaws from the open position to the closed position. Although various techniques can be used to couple the cam assembly to the overload mechanism, in an exemplary embodiment, the cam assembly moves relative to a surface that receives the force of the overload mechanism, so that the clamping force of the assembly of cams is applied across the surface that receives the force of the overload mechanism, as the trigger is actuated to cause the cam assembly to move the jaws from the open position to the closed position. The surface that receives the force of the overload mechanism can be adapted to resist movement in a proximal direction and the resistance can be increased as the trigger is actuated to cause the cam assembly to move relative to the surface receiving the force, and move the jaws from the open position to the closed position.

In another exemplary embodiment, the overload mechanism may include a housing having a profile connection slidably and rotatably therein, and having the surface receiving the force formed therein and positioned adjacent to an aperture formed therein. accommodation. The surface receiving the force may include a first portion that is adapted to receive a force to rotationally move the force-receiving member within the housing, and a second portion that is adapted to receive a force to slidably move the member that is receiving the force. receives the force inside the housing. The overload mechanism may also include a deflection assembly that is adapted to apply a resistance to the profile connection. In an exemplary embodiment, the deflection assembly can be coupled to the profile connection by a rotary assembly, which is adapted to rotate after the rotational movement of the profile connection, and which is adapted to slide after the sliding movement of the connection of the profile. profile to apply a force to the deflection assembly, to overcome the resistance. Methods for applying a surgical clamp applicator, which has an overload mechanism, are also provided. In an exemplary embodiment, a closing force can be applied to a pair of opposed jaws formed in a surgical clip applier. The closing force may be effective to move the opposing jaws from an open position to a closed position. When the clamping force is greater than a threshold force of an overload mechanism, the clamping force is transferred to the overload mechanism placed inside the surgical clamp applicator. In an exemplary embodiment, the threshold force of the overload mechanism increases as the jaws move from an open position to the closed position. Although the overload mechanism may have a variety of configurations, in one embodiment, the overload mechanism may include an element that receives the force, which is adapted to receive the closing force, and a deflection assembly that is adapted to withstand the movement of the element that receives the force, in response to the closing force. The surgical tweezers applicator may include a cam assembly that is adapted to apply the clamping force to the jaws, and which includes a roller member that rolls through the member receiving the force as the clamping force is applied to the clamp member. the jaws. The threshold force of the overload mechanism may be increased as the roller member rolls through the element receiving the force. In particular, when the roller member rolls through a first portion of the element receiving the force, the elements receiving the force can rotate if the closing force is greater than the threshold force, and when the roller member rolls Through a second portion of the element receiving the force, the element receiving the force can slide if the closing force is greater than the threshold force. In an exemplary embodiment, the threshold force required to rotate the element receiving the force is less than the threshold force required to slide the element receiving the force. In other aspects, a surgical tweezers applicator is provided and may include an advancement assembly of the clip attached to a trigger and adapted to advance at least one surgical tweezers through an elongate body extending from a housing, and an assembly that forms the clip attached to a trigger and adapted to drive a jaw assembly formed at a distal end of the elongate body, to form a surgical clip. The trigger may be coupled to the housing and adapted to actuate the advancing assembly of the clamp and the mounting that forms the clamp. In an exemplary embodiment, the trigger has two sequential drive stages. The trigger may be effective to actuate the advance assembly of the clamp during the first drive stage, and may be effective to drive the assembly that forms the clamp during the second drive stage, while being flexible relative to the advance assembly. of the clamp.

BRIEF DESCRIPTION OF THE DRAWINGS The invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which: Figure 1A is a side view of an exemplary embodiment of a surgical clip applier; Figure 1 B is an exploded view of the surgical tweezers applicator shown in Figure 1A; Figure 2A is a top view of a clamp assembly of the jaws of the surgical clamp applicator shown in Figure 1A; The. Figure 2B is a bottom view of the clamp mounting of the jaws shown in Figure 2A; Figure 2C is a side view of the clamp mounting of the jaws shown in Figure 2B; Figure 2D is a cross-sectional view of the clamp mounting of the jaws shown in Figure 2C, taken through line D-D; Figure 3A is a top view of a supply shoe for use with the clamp mounting of the jaws shown in Figures 2A-2D; Figure 3B is a bottom view of the supply shoe shown in Figure 3A; Figure 4A is a side perspective view of a feed bar that is configured to advance the feed shoe of Figures 3A and 3B through the jaw clamp assembly shown in Figures 2A-2D; Figure 4B is a side view of the proximal end of the feed bar shown in Figure 4A and the proximal end of the jaw holder body shown in Figures 2A and 2B, showing the feed bar in a more proximal position; Figure 4C is a side view of the feed bar and clamp body shown in Figure 4B, showing the feed bar in a more distal position; Figure 4D is a side view of another embodiment of a proximal end of a feed bar shown with respect to the proximal end of the jaw holder body shown in FIGS.

Figures 2A and 2B, showing the feed bar in the most proximal position; Figure 4E is a side view of the feed bar and clamp body shown in Figure 4D, showing the feed bar in a more distal position; FIG. 4F is a side view of yet another embodiment of a proximal end of a feed bar, shown relative to the proximal end of the jaw holding body shown in FIGS.

Figures 2A and 2B, showing the feed bar in the most proximal position; Figure 4G is a side view of the feed bar and clamp body shown in Figure 4F, showing the feed bar in an intermediate position; Figure 4H is a side view of the feed bar and the clamp body shown in Figure 4F, showing the feed bar in a more distal position; Figure 5A is a side perspective view of an impeller that is configured to engage a distal end of the feed bar shown in Figure 4A; Figure 5B is a side perspective view of another embodiment of an impeller, which is configured to engage a distal end of the feed bar shown in Figure 4A; Figure 6A is a cross-sectional view of a clamp advance assembly, including the clamp mounting of the clamps shown in Figures 2A-2D, the feeder shoe shown in Figures 3A-3B, and the clamp bar. feed shown in Figure 4A, showing the feed bar in an initial, proximal position, relative to the gripper track of the clamp mounting of the jaws; Figure 6B is a cross-sectional view of the feed assembly of the clip shown in Figure 6A, showing the feed bar moved in a distal direction; Figure 6C is a cross-sectional view of the clamp advance assembly shown in Figure 6B, showing the feed bar moved more distally, thereby moving the feed shoe and gripper supply positioned distally of the shoe of feeding in a distal direction; Figure 6D is a cross-sectional view of the feed assembly of the clip shown in Figure 6C, showing the feed bar returned to the initial, proximal position, shown in the Figure 6A, while the feeding shoe and the gripper supply remain in the advanced position shown in Figure 6C; Figure 6E is a bottom perspective view of the impeller shown in Figure 5A, positioned within the gripper track of the clamp mounting of the jaws, shown in Figures 2A-2D, showing the impeller in a more proximal position; Figure 6F is a bottom perspective view of the impeller shown in Figure 6E, showing the impeller in a more distal position after advancing the clamp in the jaws of the surgical forceps applicator; Figure 7 is a side perspective view of a pair of jaws of the surgical clip applier shown in Figure 1 A; Figure 8 is a side perspective view of a cam for use with the jaws shown in Figure 7; Figure 9 is a top perspective view of a push rod that is adapted to engage the cam shown in Figure 8 to move the cam relative to the jaws shown in Figure 7; Figure 10A is a top view of the cam shown in Figure 8, coupled to the jaws shown in Figure 7, showing the cam in an initial position and the jaws open; Figure 10B is a top view of the cam shown in Figure 8, coupled to the jaws shown in Figure 7, showing the forward cam on the jaws and the jaws in a closed position; Figure 11 is a top perspective view of a tissue latch that is adapted to engage a distal end of the clamp track of the jaw clamp assembly shown in Figures 2A-2D; Figure 12 is a top view of a distal end of the surgical tweezers applicator shown in Figure 1A, showing the tissue lock shown in Figure 11 positioned between the jaws shown in Figure 7; Figure 13 is a partially cross-sectional, side view of a handle portion of the surgical clip applier shown in Figure 1A; Figure 14 is a side perspective view of a trigger insert of the surgical clip applier shown in Figure 1A; Figure 15A is a side perspective view of a half of the feed bar coupler of the surgical clip applier shown in Figure 1A; Figure 15B is a side perspective view of the other half of the feed bar coupler shown in Figure 15A; Figure 16 is a top perspective view of a flexible connection forming part of an advancing assembly of the forceps of the surgical forceps applicator shown in Figure 1A; Figure 17A is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 1A, showing an advance assembly of the clip in an initial position; Figure 17B is a partially cross-sectional, side view of a portion-of the handle of the surgical clip applier shown in Figure 17A, showing the advancing assembly of the partially driven clip; Figure 17C is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 17B, showing the advancement assembly of the fully actuated gripper; Figure 17D is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 17A, showing a mounting that forms the driven clip; Figure 18 is a side view of a roller of the closure connection forming part of an assembly forming the clamp of the surgical clamp applicator shown in Figure 1A; Figure 19 is a top perspective view of a closure connection that engages the roller of the closure connection shown in Figure 18, to form part of a mounting that forms the clip of the surgical clip applier shown in Figure 1A; Figure 20A is a top perspective view of a coupler of the closure connection that engages the closure connection shown in Figure 19, and that is also part of the mounting that forms the clip of the surgical clip applier shown in FIG. Figure 1A; Figure 20B is a bottom view of the closure connection shown in Figure 20A, coupled to the push rod of Figure 9, and having one embodiment of a diverting element positioned therein; Figure 20C is a bottom view of the closure connection shown in Figure 20A, coupled to the push rod of Figure 9, and having another embodiment of a diverting element positioned therein; Figure 21A is an enlarged side perspective view of an antiretome mechanism of the surgical tweezers applicator shown in FIG.

Figure 1A; Figure 21 B is a perspective view of a ratchet mechanism of the non-return mechanism shown in Figure 21 A; Figure 22A is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 1A, showing the anti-return mechanism in an initial position; Figure 22B is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 22A, showing the anti-return mechanism in a partially actuated position; Figure 22C is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 22B, showing the anti-return mechanism in a fully actuated position; Figure 22D is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 22C, showing the non-return mechanism returning to an initial position; Figure 22E is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 22D, showing the backstop mechanism returned to the initial position; Figure 23A is an exploded view of an overload mechanism of the surgical clip applier shown in Figure 1 A; Figure 23B is a partially cross-sectional view of the overload mechanism shown in Figure 23A, showing the roller of the closure connection that first comes into contact with the profile connection; Figure 23C is a partially cross-sectional view of the overload mechanism shown in Figure 23B, showing the roller of the closure connection applying a force to the profile connection, causing the profile connection to rotate; Figure 23D is a perspective view of another embodiment of an overload mechanism for use with a surgical tweezer applicator; Figure 24A is a side perspective view of an indicator wheel of the number of forceps of the surgical forceps applicator shown in Figure 1 A; Figure 24B is a side view of a wheel indicating the amount of clamps shown in Figure 24A; Figure 25 is a top perspective view of an actuator of the number of pliers for use with the indicator wheel of the number of pliers shown in Figure 24; Figure 26A is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 1A, showing the movement of the actuator of the number of grippers of Figure 25 and the indicator wheel of FIG. the number of clamps of Figure 24; and Figure 26B is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 26A, showing the additional movement of the actuator of the number of grippers of Figure 25 and the wheel Indicator of the number of clamps of Figure 24.

DETAILED DESCRIPTION OF THE INVENTION The present invention generally provides a surgical tweezers applicator and methods for using a surgical tweezers applicator to apply surgical tweezers to a vessel, conduit, bypass, etc., during a surgical procedure. An exemplary surgical clip applier may include a variety of features to facilitate the application of a surgical clip, as described herein and illustrated in the drawings. However, a person skilled in the art will appreciate that the surgical clip applier may include only some of these features and / or may include a variety of other features known in the art. The surgical tweezers applicator described herein is intended simply to represent certain exemplary embodiments. Figure 1A illustrates an exemplary surgical clip applier. As shown, the clip applier 10 generally includes a housing 12 having a stationary handle 14 and a movable handle or trigger 16 that is rotatably coupled to the housing 12. An elongated body 18 extends from the housing 12 and includes a pair of opposed jaws 20 formed at a distal end thereof for folding a surgical clip. The elongated body 18 may be rotatably coupled to the housing 12, and may include a rotation knob 22 for rotating the body 18 relative to the housing 12. Figure 1 B illustrates an exploded view of the surgical clamp applicator 10 shown in Figure 1A, and the various components will be described in more detail below. Figures 2A-12 illustrate exemplary embodiments of the various components of the body 18 of the surgical clip applier 10. In general, referring to Figure 1B, the body 18 includes an outer tube 24 housing the body components, which may include a jaw clamp assembly 26 having a clamp body 28 with a clamp track 30 and a push rod channel 32 formed therein. The jaws 20 can be configured to coincide with a distal end of the track of the clip 30. The body assembly 18 can also include an advance assembly of the clip, which, in an exemplary embodiment, can include a feeder shoe. 34 which is adapted to be slidably positioned within the track of the clamp 30 to advance a series of clamps 36 placed thereon, and a feed bar 38 which is adapted to drive the feed shoe 34 through the clip track 30. The feed bar 38 may include an impeller assembly 40 that is adapted to mate with a distal end thereof, to advance a distal most clamp in the jaws 20. The body assembly 18 may also include a assembly for forming or driving the clip with cams, which, in an exemplary embodiment, can include a cam 42 which is adapted to slidably match the jaws 20, and a rod A pusher 44 that can engage the cam 42 to move the cam 42 relative to the jaws 20. The body assembly can also include a tissue latch 46 that can match a distal end of the clip track 30. , to facilitate the positioning of the jaws 20 in relation to a surgical site. The various components of an exemplary clip advance assembly are shown in more detail in Figures 2A-5. Referring first to Figures 2A-2D, the clamp assembly of the jaws 26 is shown and includes an elongate substantially flat jaw body 28 having a proximal end 28a, which coincides with the outer tube 24, and a distal end 28b which is adapted to coincide with the jaws 20. Although a variety of techniques can be used to match the proximal end 28a of the clamp body 28 with the outer tube 24, in the illustrated embodiment, the proximal end 28a includes teeth 31 formed on opposite sides thereof, which are adapted to be received within corresponding holes or openings (not shown), formed in the outer tube 24, and a cut 29 formed therein, which allows the opposite sides of the proximal end 28a to flex or form a spring. In particular, the cut 29 allows opposite sides of the proximal end 28a of the clamping body of the jaws 28 to be compressed towards each other when the clamping body of the jaws 28 is inserted into the outer tube 24. Once the teeth 31 are aligned with the corresponding openings in the outer tube 24, the proximal end 28a of the clamping body of the jaws 28 will return to its original, uncompressed configuration, thereby causing the teeth 31 to extend into the corresponding openings for coupling the tube 24. As will be discussed in more detail below with respect to Figure 4A, the device may also include a feature to prevent compression of opposite sides of the proximal end 28a of the clamp body 28 during use of the device. , to prevent accidental uncoupling of the teeth 31 from the outer tube 24. A variety of techniques can also be used for The distal end 28b of the clamping body 28 of the clamps 28 with the jaws 20, however, in the illustrated embodiment, the distal end 28b of the clamping body of the jaws 28 includes several cuts or teeth 78 formed therein. to match the corresponding protrusions or teeth 94 formed in the jaws 20, which will be discussed in more detail below with respect to Figure 7. The teeth 78 allow a proximal portion of the jaws 20 to be substantially coplanar with the fastener body of the jaws. the jaws 28. The clamp assembly of the jaws 26 may also include a channel of the push rod 32 formed therein, to slidably receive the push rod 44, which is used to advance the cam 42 over the jaws. 20 jaws, as will be discussed in more detail below. The push rod channel 32 can be formed using a variety of techniques, and can have any shape and size depending on the shape and size of the push rod 44. As shown in Figure 2D, the channel of the rod of push 32 is fixedly attached, for example, by welding, to an upper surface of the body of the fastener 28, and has a substantially rectangular shape, and defines a path 32a extending therethrough. The channel of the push rod 32 may also extend along all or only a portion of the body of the fastener 28. A person skilled in the art will appreciate that the clamp assembly of the jaws 26 need not include a channel of the rod. of push 32 to facilitate movement of the push rod 44 within the elongate body 18 of the surgical clip applier 10. As further shown in Figures 2A-2D, the clamp assembly of the jaws 26 may also include a track of the clip 30, which coincides therewith or formed therein. The track of the clip 30 is shown to coincide with a lower surface of the clamping body of the jaws 28, and extends distally beyond the distal end 28b of the clamping body of the jaws 28 to allow a distal end 30b of the track of the clamp 30 substantially aligns with the jaws 20. In use, the track of the clamp 30 is configured to seat at least one, and preferably a series of clamps therein. Accordingly, the track of the clip 30 may include opposite side rails 80a, 80b that are adapted to seat opposite ends of one or more clips therein, so that the tips of the clips are aligned axially with one another. In an exemplary mode, the gripper track 30 can be configured to seat approximately twenty grippers that are pre-positioned within the track of the clip 30 during manufacture. A person skilled in the art will appreciate that the shape, size and configuration of the gripper track 30 may vary depending on the shape, size and configuration of the grippers, or other closure devices such as staples, adapted to be received in the same In addition, a variety of other techniques may be used, instead of a track of the clip 30, to maintain a supply of clips with the elongated body 18. The track of the clip 30 may also include several openings 30c formed therein, for receiving a spigot 82a formed on a feed shoe 34 adapted to be placed within the track of the clip 30, as will be discussed in more detail below. In an exemplary embodiment, the track of the clip 30 includes a number of openings 30c that correspond to at least the number of clips adapted to be pre-positioned within the device 10 and applied during use. The openings 30c are preferably equidistant from one another to ensure that the pin 82a on the feed shoe 34 engages an opening 30c each time the feed shoe 34 is advanced. Although not shown, the track of the clip 30 may include seals, rather than openings 30c, or may include other features that allow the track of the clip 30 to engage the feed shoe 34 and prevent distal movement, but it allows proximal movement of the feed shoe 34. The track of the clip 30 may also include a tang of the lock 118 formed therein, as shown in Figure 2B, which is to be effectively engaged with the ear of the clip. corresponding lock formed in the feed shoe 34, to prevent movement of the feed shoe 34 beyond a more distal position, as will be discussed below. The tang of the latch 118 may have a variety of configurations, but in an exemplary embodiment it is in the form of two adjacent tabs extending towards each other to enclose a portion of the clamp track, thereby allowing the clamps to pass through the clamp. through. An exemplary feed shoe 34 is shown in more detail in Figures 3A and 3B, and can be adapted to directly drive the pliers through the track of the clip 30. Although the feed shoe 34 may have a variety of configurations, and a variety of other techniques can be used to drive the clamps through the track of the clamp 30, in an exemplary embodiment, the feeder shoe 34 has a generally elongated shape with proximal and distal ends 34a, 34b. The distal end 34b may be adapted to accommodate the most proximal gripper in the track of the clip 30 to push the clips through the track of the clip 30. In the exemplary embodiment illustrated, the distal end 34b is substantially v-shaped to Set a v-shaped bend portion of a clamp. The distal end 34b also includes a rectangular shaped notch 34c formed therein to allow the driver 40 to engage the distalmost clamp and advance it towards the jaws 20, as will be discussed in more detail below. The distal end 34b may, of course, vary depending on the configuration of the clamp, or other closure mechanism, that is being used with the device 10. In another exemplary embodiment, the supply shoe 34 may also include features to facilitate the distal movement of the feed shoe 34 within the track of the clip 30, and to substantially prevent proximal movement of the feed shoe 34 within the track of the clip 30. Such a configuration will ensure the advancement and proper positioning of the clips within the track of the clip 30, thereby allowing a more distal clip to be advanced between the jaws 20, with each actuation of the trigger 16, as will be discussed in more detail below. In the exemplary embodiment illustrated, the feed shoe 34 includes a pin 82a formed on the upper surface 34s thereof, and angled proximally to engage one of the openings 30c formed in the track of the clip 30. In use, the angle of the pin 82a allows the feed shoe 34 to slide distally into the track of the clip 30. Each time the feed shoe 34 is advanced, the pin 82a will move in a distal direction from an opening 30c to the next opening 30c in the track of the clip 30. The engagement of the pin 82a with the opening 30c in the track of the clip 30, will prevent the feed shoe 34 from moving proximally to return to the previous position, as will be described with more detail below.

In order to facilitate the proximal movement of the feed shoe 34 within the track of the clip 30, the feed shoe 34 can also include a pin 82b formed on the bottom surface 34i thereof, as shown in FIG. Figure 3B, to allow the feed shoe 34 to be engaged by the feed bar 38 (Figure 4A) as the feed bar 38 moves distally. The lower pin 82b is similar to the upper pin 82a in that it can be angled proximally. In use, each time the feed bar 38 moves distally, a retainer 84 formed in the feed bar 38 can engage the lower pin 82b and move the feed shoe 34 distally, a predetermined distance within the track of the feed. clamp 30. The feed bar 38 can then be moved proximally to return to its initial position, and the angle of the lower pin 82b will allow the pin 82b to slide towards the next detent 84 formed in the feed bar 38. As it was previously indicated, a variety of other features than spikes 82a, 82b and openings 30c or detents 84 can be used to control the movement of feed shoe 34 within the track of clip 30. As previously mentioned, the feed shoe 34 may also include a lock formed therein, which is adapted to stop the movement of the feed shoe 34 when the shoe Feeding leg 34 is in the most distal position and there are no clips remaining in the device 10. Although the safety can have a variety of configurations, Figures 3A and 3B illustrate a third peg 82c formed in the feed shoe 34 and that extends in a downward direction to engage the pin of the lock 118 (Figure 2B), formed in the track of the clip 30. The third pin 82c is positioned so that it will engage the pin of the lock 118 in the track of the clip 30 when the feed shoe 34 is in a more distal position, thus preventing the movement of the feed shoe 34 and the feed bar 38 when the supply of grippers is terminated. Figure 4A illustrates an exemplary feed bar 38 for driving the feed shoe 34 through the track of the clip 30 of the clamp assembly of the jaws 26. As shown, the feed bar 38 has a generally elongated shape with ends proximal and distal 38a, 38b. The proximal end 38a of the feed bar 38a may be adapted to coincide with a coupler of the feed bar 50 (Figure 1B), which will be discussed in more detail below. The feed bar coupler 50 may coincide with a feed connection 52 which is effective, upon actuation of the trigger 16, to slidably move the feed bar 38 in a distal direction within the elongate body 18. The distal end 38b of the feed bar 38b can be adapted to match an impeller 40, 40S the exemplary embodiments of which are shown in Figures 5A and 5B, which is effective to drive a more distal plier positioned within the track of the clip 30 in the jaws 20, which will be discussed in more detail below. As previously mentioned, the proximal end 38a of the feed bar 38 may include a feature to prevent compression of the opposite sides of the proximal end 28a of the clamping body of the jaws 28 (Figures 2A and 2B) during the use of the device, to prevent accidental uncoupling of the teeth 31 from the outer tube 24. In an exemplary embodiment, shown in Figures 4A-4C, the proximal end 38a of the feed bar 38 may include a protrusion 39 formed therein, which is adapted to extend towards the opening 29 formed in the proximal end 28a of the clamping body of the jaws 28. When the feed bar 38 is in a more proximal position (i.e., when the trigger 16 is in an open position), the protrusion 39 will be placed at the proximal end of the opening 29, as shown in Figure 4B, allowing the proximal end 28a of the jaw holding body 28 to be compressed to allowing the body 28 to slide in the outer tube 24. When the feed bar 38 is in a more distal position (i.e., when the trigger 16 is in an at least partially closed position), the protrusion 39 will be placed in a intermediate location adjacent the teeth 31, as shown in Figure 4C, to avoid compression of the proximal end 28a of the clamping body of the jaws 28. This is particularly advantageous during the use of the device, since the protrusion 39 will prevent uncoupling of the clamping body of the clamps 28 of the outer tube 24 during the use of the device. Although Figures 4A-4C illustrate a protrusion 39 having a rectangular cross-sectional shape with rounded edges, the protrusion 39 may have a variety of other shapes and sizes. For example, as shown in Figures 4D and 4E, the protrusion 39 'has a cross-sectional shape that is somewhat triangular with a tapered end that is adapted to extend between the teeth 31 to further ensure that the proximal end 28a of the body jaws 28 clamp, can not be compressed during the use of the device. You can also use more than one bulge. For example, Figures 4F-4H illustrate another embodiment, in which the proximal end 38a 'of the feed bar 38 includes two protuberances 39a, 39b formed therein, and spaced apart from one another. The two protuberances 39a, 39b will prevent compression of the proximal end 28a of the clamping body of the jaws 28 when the feed bar 38 is in a more proximal position, as shown in Figure 4F, and when the feed bar 38 is in a more distal position, as shown in Figure 4H. The compression of the proximal end 28a of the clamping body of the jaws 28 can occur only when the feed bar 38 is in an intermediate position, so that the teeth 31 are positioned between the protuberances 39a, 39b, as shown in Figure 4G .

As also mentioned previously, the feed bar 38 may include one or more detents 84 formed therein, for coupling the lower peg 82b formed in the feed shoe 34. The number of detents 84 may vary, but in an exemplary embodiment , the feed bar 38 has a number of detents 84 that corresponds to, or is greater than, an amount of grippers adapted to be supplied by the device 10, and more preferably, has a retainer 84 more than the number of adapted grippers to be supplied by the device 10. By way of non-limiting example, the feed bar 38 may include eighteen detents 84 formed therein, to supply seventeen clamps that are pre-positioned within the track of the clamp 30. Such configuration allows that the feed bar 38 advances the feed shoe 34 seventeen times, thus advancing seventeen clamps to the jaws 20 pa the application. The detents 84 are also preferably, equidistant from each other, to ensure that the feed shoe 34 is engaged and advanced by the feed bar 38 each time the feed bar 38 is advanced. The power bar 38. it may also include a feature to control the amount of movement of the feed bar 38, relative to the track of the clip 30. Such a configuration will ensure that the feed shoe 34 is advanced a predetermined distance each time the trigger 16 is it actuates, thereby advancing a single clamp towards the jaws 20. Although a variety of techniques can be used to control the distal movement of the feed bar 38, in an exemplary embodiment, the feed bar 38 may include a protuberance 86 formed therein, which is adapted to be slidably received within a corresponding slot 88 (FIG. 2B), formed in the clamping body of the jaws 28. The length of the slot 88 is effective to limit the movement of the protrusion 86 in FIG. the same, thus limiting the movement of the feed bar 38. Accordingly, in use, the feed bar 38 can slide between a fixed proximal position and a fixed distal position with respect to the track of the clip 30, thereby allowing the feed bar 38 to advance the feed shoe 34 a predetermined distance, with each advance of the feed bar 38. Figure 5A illustrates an exemplary embodiment of an impeller 40, which is adapted to match the distal end 38b of the feed bar 38 and which is effective to drive a clamp more distally from the track of the gripper 30 toward the jaws 20. A variety of techniques may be used to match the impeller 40 to the feed bar 38, but in the illustrated embodiment, the proximal end 40a of the impeller 40 is in the form of a female connector that is adapted to receive the male connector formed in the distal end 38b of the feed bar 38. The impeller 40 preferably matches in a fixed manner with the feed bar 38, however, it can optionally, being integrally formed with the feed bar 38. The distal end 40b of the feed bar 38 is preferably adapted to advance a clamp towards the jaws 20 and therefore, the distal end 40b of the impeller 40 may include, for example, a member that pushes the clamp 90 formed therein. The member that pushes the clip 90 may have a variety of shapes and sizes, but in an exemplary embodiment, it has an elongated shape with a recess 92 formed in the distal end thereof, to seat the bend portion of a clip. The shape of the recess 92 may vary depending on the particular configuration of the clamp. The member that pushes the clamp 90 can also extend at an angle in a superior direction with respect to a longitudinal axis A of the impeller 40. Such configuration allows the member that pushes the clamp 90 to extend toward the track of the clamp 30 to engage a clamp, while the rest of the impeller 40 extends substantially parallel to the track of the clamp 30. FIG. 5B illustrates another exemplary embodiment of a member that pushes the clamp 90 'of an impeller 40'. In this embodiment, the member that pushes the clip 90 'is slightly narrower and has a small recess 92' formed at the most distal end thereof. In use, the impeller 40 can couple and advance only the most distal clamp positioned within the track of the clamp 30 in the jaws 20. This is due to the placement of the feed bar 38, which moves in a slidable manner. between the fixed proximal and distal positions, as previously discussed.

Figures 6A-6G illustrate the advance assembly of the clamp in use, and in particular Figures 6A-6D illustrate the movement of the feed bar 38 within the track of the clamp 30 to advance the feed shoe 34 and the supply of clamps 36, and Figures 6E-6F illustrate the movement of the impeller 40 to advance a clamp further distal towards the jaws 20. The components in the housing 12 that are used to drive the clamp advance assembly will be discussed in more detail below. As shown in Figure 6A, in the rest position, the feed bar 38 is in a more proximal position so that the protrusion 86 is positioned proximally within the elongated slot 88 in the clamping body of the jaws 28. The feed shoe 34 is positioned within the track of clip 30 and, assuming device 10 has not been used yet, feed shoe 34 is in a more proximal position, so that upper pin 82a in the shoe of feed 34, is coupled with the first opening or the most proximal 30c-? formed in the track of the clip 30, to prevent proximal movement of the feed shoe 34, and the lower pin 82b in the feed shoe 34, is placed between the first detent 84-? and the second detent 842 on the feed bar 38, so that the lower pin 82b is deflected in a higher direction by the feed bar 38. The detents 84 on the feed bar are sequentially marked as 84- ?, 842, etc., and the openings 30c in the track of the clip 30 are sequentially marked as 30c- ?, 30c2, etc. As shown further in Figure 6A, a series of clips 36, sequentially marked as 36 ?, 362,. . . 36x, with 36x being the most distal clamp, is placed within the track of the clamp 30 distal to the feed shoe 34. Upon actuation of the trigger 16, the feed bar 38 is advanced distally, causing the protuberance 86 slides distally into the slot 88. As the feed bar 38 moves distally, the lower pin 82b of the feed shoe 34 will slide on the first detent 84? in the feed bar 38. The further distal movement of the feed bar 38 will cause the first detent 84- to engage with the lower pin 82b, as shown in Figure 6B, and to move the feed shoe 34 and the supply of clips 36- ?, 362, etc., in a distal direction. As shown in Figure 6C, when the protrusion 86 comes into contact with the distal end of the elongated slot 88 in the clamping body of the jaws 28, the feed bar 38 is prevented from moving distally in a further manner. In this position, the feed shoe 34 has advanced a predetermined distance to advance the supply of grippers 36- ?, 362, ... 36, within the track of the gripper 30 a predetermined distance. The upper pin 82a of the feed shoe 34 has been advanced towards the second opening 30c2 in the track of the clip 30 to prevent proximal movement of the feed shoe 34, and the lower pin 82b of the feed shoe 34 is still coupled by the first retainer 84-? on the power bar 38.

The movement of the feed bar 38 from the most proximal, initial position, shown in Figure 6A, to the most distal, end position, shown in Figure 6C, will also advance the most distal clip 36x toward the jaws 20. In particular, as shown in Figure 6E, the distal movement of the feed bar 38 will cause the pushing member 90 of the driver 40, which is attached to the distal end of the feed bar 38, to engage with the most distal clip 36x positioned within the track of the clip 30 and advance the clip 36x towards the jaws 20, as shown in Figure 6F. In an exemplary mode, the impeller 40 will engage and initiate the advancement of the most distal clamp 36x before engaging and starting feed of the feed shoe 34. As a result, the most distal 36x clamp will advance a distance that is greater than a distance displaced by the Feeding shoe 34. Such configuration allows only the most distal clamp 36x to advance towards the jaws 20, without accidentally advancing an additional clamp towards the jaws 20. Once the 36x clamp has been partially or completely formed, the trigger 16 can be released to release the formed 36x clamp. the release of the trigger 16 will retract the feed bar 38 in a proximal direction, until the protrusion 86 returns to the initial most proximal position within the elongated slot 88, as shown in Figure 6D. As the feed bar 38 retracts proximally, the feed shoe 34 will not move proximally since the upper pin 82a will engage the second opening 30c2 in the track of the clip 30. The lower pin 82b will not interfere with the proximal movement of the feed bar 38, and once the feed bar 38 is in the most proximal, initial position, as shown, the lower pin 82b will be placed between the second detent 842 and the third detent 843 in the feed bar 38. The process can be repeated to advance another clamp towards the jaws 20. With each actuation of the trigger 16, the lower pin 82b will be engaged by the next detent, that is, the retainer 842 formed in the feed bar 38, the upper pin 82a in the feed shoe 34, it will move distally towards the next opening, i.e., the opening 30c3 in the track of the clip 30, and the most distal clip will be advanced towards the jaws and it will be released. Where the device 10 includes a predetermined number of pliers, for example seventeen pliers, the trigger 16 can be operated seventeen times. Once the last clamp has been applied, the latch, for example, the third spigot 82c in the supply shoe 34, can engage the latch pin 118 in the track of the clamp 30, to prevent further distal movement of the clamp. Feeding shoe 34. Figures 7-9 illustrate several exemplary components of a mount that forms the clamp. Referring first to Figure 7, an exemplary embodiment of the jaws 20 is shown. As previously mentioned, the jaws 20 may include a proximal portion 20a having teeth 94 to coincide with the corresponding teeth 78 formed in the clamp body of the jaws. 28. However, other techniques can be used to match the jaws 20 with the clamping body of the jaws 28. For example, a dovetail connection, a male-female connection can be used. Alternatively, the jaws 20 can be formed integrally with the retaining body 28. The distal portion 20b of the jaws 20 can be adapted to receive a clip therebetween, and thus the distal portion 20b can include first and second opposing jaw members. 96a, 96b that move one relative to the other. In an exemplary embodiment, the jaw members 96a, 96b are biased to an open position, and a force is required to move the jaw members 96a, 96b toward each other. The jaw members 96a, 96b may each include a slit (only a slit 97 is shown), formed therein on the opposing internal surfaces thereof, to receive the limbs of a clip in alignment with the jaw members 96a 96b. The jaw members 96a, 96b may also include a cam track 98a, 98b formed therein, to allow the cam 42 to engage the jaw members 96a, 96b and move the jaw members 96a, 96b one toward the jaw member 96a, 96b. other. In an exemplary embodiment, the cam track 98a, 98b is formed on an upper surface of the jaw members 96a, 96b. Figure 8 illustrates an exemplary cam 42 for slidably matching with, and coupling the jaw members 96, 96b. The cam 42 may have a variety of configurations, but in the illustrated embodiment, it includes a proximal end 42a that is adapted to match a push rod 44, discussed in more detail below, and a distal end 42b that is adapted to coupling the jaw members 96a, 96b. A variety of techniques can be used to match the cam 42 with the push rod 44, but in the exemplary embodiment illustrated, the cam 42 includes a female or wedged cut 100 formed therein and adapted to receive a male or wedge member. 102 formed at the distal end 44b of the push rod 44. The male member 102 is shown in more detail in Figure 9, which illustrates the push rod 44. As shown, the male member 102 has a corresponding shape. with the shape of the cut 100 to allow the two members 42, 44 to coincide. A person skilled in the art will appreciate that the cam 42 and the push rod 44 can optionally be integrally formed with one another. The proximal end 44a of the push rod 44 can be adapted to coincide with a closure connection assembly, discussed in more detail below, to move the push rod 44 and the cam 42 relative to the jaws 20. As shown furthermore in Figure 8, the cam 42 may also include a protrusion 42c formed therein, which is adapted to be slidably received within an elongated slot 20c formed in the jaws 20. In use, the protrusion 42c and the slot 20c They can work to form a proximal safety for the assembly that forms the clamp. Referring again to Figure 8, the distal end 42b of the cam 42 can be adapted to engage the jaw members 96a, 96b.

Although a variety of techniques may be used, in the exemplary embodiment illustrated, the distal end 42b includes a cam channel or tapered recess 104 formed therein, to desirably receive the cam tracks 98a, 98b from the jaw members 96a 96b. In use, as shown in Figures 10A and 10B, the cam 42 can be advanced from a proximal position, in which the jaw members 96a, 96b are spaced apart from each other, towards a distal position, in which the jaw members 96a, 96b are positioned adjacent to each other and in a closed position. As the cam 42 is advanced over the jaw members 96a, 96b, the tapered recess 104 will push the jaw members 96a, 96b toward each other, thereby folding a clip placed therebetween. As previously mentioned, the surgical clip applier 10 may also include a tissue lock 46 to facilitate tissue placement at the surgical site within the jaws 20. Figure 11 shows an exemplary embodiment of a tissue lock 46 having a proximal end and distal ends 46a, 46b. The proximal end 46a may be adapted to coincide with a distal end of the track of the clip 30 to place the tissue lock 46 adjacent the jaws 20. However, the tissue lock 46 may be integrally formed with the clip track 30. , or may be adapted to coincide or be integrally formed with a variety of other body components 18. The distal end 46b of the tissue lock 46 may have a shape that is adapted to seat a vessel, conduit, bypass, etc., therebetween. , to position and align the jaws 20 relative to the target site. Shown in Figure 11, the distal end 46b of the tissue lock 46 substantially has a v-shape. The distal end 46b may also have a curved configuration to facilitate placement of the device through a trocar or other access tube. The distal end 46b of the tissue lock 46 may also optionally include other features to facilitate movement of the clip thereon. For example, as shown in Figure 11, the fabric lock 46 includes a ramp 47 formed in a middle portion of the distal end 46b to hold a clip in alignment with the tip of the drive assembly 40. In particular, the ramp 47 can allowing the tip of a clip to be mounted lengthwise, thereby preventing the clip from misaligning relative to the drive assembly 40, that is, pushing the clip in a distal direction. A person skilled in the art will appreciate that the tissue latch 46 can have a variety of other configurations, and can include a variety of other features to facilitate the advancement of a collet across. Figure 12 illustrates the tissue lock 46 in use. As shown, the tissue lock 46 is positioned just inferior to the jaws 20 and in a location that allows a vessel, conduit, shunt etc. to be received between the jaws 20. As shown further, a surgical clip 36 it is positioned between the jaws 20, so that the bend portion 36a of the clip 36 is aligned with the tissue lock 46. This will allow the tips 36b of the clip 36 to be completely placed around the vessel, conduit, bypass, or another objective site. Figures 13-26B illustrate several exemplary internal components of the housing 12 for controlling the advancement and formation of the gripper. As previously described, the surgical clip applier 10 may include some or all of the features described herein, and may include a variety of other features known in the art. In certain exemplary embodiments, the internal components of the gripper applicator 10 may include an advance assembly of the gripper, which engages the advancing assembly of the gripper of the body 18, to advance at least one gripper through the elongate body 18., to place the clamp between the jaws 20, and a mounting that forms the clamp, which engages the assembly that forms the body clamp 18, to close the jaws 20 to form a partial or completely closed clamp. Other exemplary features include a non-return mechanism for controlling the movement of the trigger 16, an overload mechanism to prevent overload of the force applied to the jaws 20 by the mounting that forms the gripper, and an indicator of the amount of grippers to indicate a number of clips remaining in the device 10. Figures 13-16D illustrate an exemplary embodiment of a feed assembly of the housing clip 12 to effect movement of the feed bar 38 within the body 18. In general, assembly of the clamp advance may include a trigger insert 48 which is coupled to the trigger 16, a feed bar coupler 50 which may coincide with a proximal end 38a of the feed bar 38, and a feed connection 52 which is adapted to extend between the insert of the trigger 48 and the coupler of the feed bar 50, to transfer the movement from the stop of the trigger 48 to the ac feed bar 50. Figure 14 illustrates the insert of the trigger 48 in more detail. The shape of the trigger insert 48 may vary depending on the other components of the housing 12, but in the illustrated embodiment, the trigger insert 48 includes a central portion 48a that is adapted to rotatably match the housing 12, and a portion thereof. elongated 48b which is adapted to extend within and coincide with the trigger 16. The central portion 48a may include a hole 106 extending through to receive a body to rotatably match the port of the trigger 48 with the housing 12. The central portion 48a may also include a first recess 108 formed in the edge of the upper side to receive a portion of the supply connection 52. The first recess 108 preferably has a size and shape that allow a portion of the connection 52 extends therein, so that the feed connection 52, will be driven to rotate when the insert of the trigger or 48 rotates due to movement of the trigger 16. As shown in Figure 14, the first recess 108 is substantially elongated and includes a substantially circular portion formed therein, for seating a body formed at a proximal end of the feed connection. 52, as will be discussed in more detail with respect to Figure 16. The trigger insert 48 may also include a second recess 110 formed in the edge of the rear side to receive a roller of the closure connection 54, which is engaged with the push bar 44 for moving the cam 42, for closing the jaws 20, and ratchet teeth 112 formed on the edge of the bottom side thereof, to coincide with a pawl 60 for controlling the movement of the trigger 16, as will be discussed with more detail below. The exemplary feed bar coupler 50 is shown in more detail in Figures 15A and 15B, and can be adapted to couple the proximal end of the feed bar 38 with the distal end of the feed connection 52. Although they can be used a variety of techniques for matching the feed bar coupler 50 to the proximal end 38a of the feed bar 38, in an exemplary embodiment, the feed bar coupler 50 is formed from two separate halves 50a, 50b, which coincide together to maintain the proximal end 38a of the feed bar 38 therebetween. When they coincide, the two halves 50a, 50b together define a central body 50c having substantially circular ridges 50d, 50e formed at opposite ends thereof, and defining a recess 50f therebetween for seating a distal portion of the connection feed 52. The central body 50c defines an opening 50g through to receive the proximal end 38a of the feed bar 38 and to lock the feed bar 38 in a relatively fixed position, relative to the feed bar coupler 50. The feed bar coupler 50 may, however, be integrally formed with the feed bar 38, and may have a variety of other shapes and sizes to facilitate matching with the power connection 52. Figure 16 illustrates an exemplary power connection 52, which may extend between the port of the trigger 48 and the coupler of the feed bar 52. In general, the power connection 52 may have an elongated shape substantially flat with proximal and distal ends 52a, 52b. The proximal end 52a is adapted to be rotatably seated within the first recess 108 of the trigger insert 48 and thus, as previously discussed, may include a body 53 (Figure 1B), which extends through. The body 53 can be adapted to rotate within the first recess 108 of the insert of the trigger 48, thereby allowing the port of the trigger 48 to rotate the feed connection 52. The distal end 52b of the feed connection 52 can be adapted for coupling to the coupler of the feed bar 50 and thus, in an exemplary embodiment, includes opposing arms 114a, 114b formed therein, and defining an opening 116 therebetween, for seating the central body 50a of the coupler of the feed bar 50. The arms 114a, 114b are effective for coupling and moving the coupler 50 as the feed connection 52 rotates about a pivot axis X. The pivot axis X can be defined by the location at which the feed connection 52 engages the housing 12, and can be placed anywhere on the power connection 52, but in the illustrated embodiment, is positioned adjacent the proximal end 52a of the connection Power supply 52. In an exemplary embodiment, the power connection 52 can be flexible to eliminate the need to calibrate the advance assembly of the clamp and the mounting that forms the clamp. In particular, the power connection 52 allows the trigger 16 to continue moving to a closed position, even after the feed bar 38 and the feed bar coupler 50 are in a more distal position, and provides some freedom to the assemblies that form the clamp and advance the clamp. In other words, the trigger 16 is flexible relative to the feed bar 38 during the closing of the trigger. The particular stiffness and strength of the feed connection 52 may vary depending on the configuration of the feed assembly of the clamp and the mounting that forms the clamp, but in an exemplary embodiment, the feed connection 52 has a stiffness that is at the range of 1339.34 to 1964.37 kilograms per meter (75 to 110 pounds per inch), and most preferably is approximately 1660.79 kilograms per meter (93 pounds per inch) (as measured at the interface between connection 52 and the coupler of the feed bar 50), and has a strength that is in the range of 11.35 kilograms and 22.7 kilograms (25 pounds and 50 pounds), and most preferably is about 15.89 kilograms (35 pounds). The power connection 52 can also be formed from a variety of materials, including a variety of polymers, metals, etc. An exemplary material is polyetherimide reinforced with glass, but various reinforced thermoplastics can be used, including glass reinforced liquid crystal polymers, glass reinforced nylon and carbon fiber reinforced versions of these thermoplastics and the like. Fiber-reinforced thermosetting polymers such as thermosetting polyesters can also be used. The power connection 52 can also be made of metal, such as spring steel, to achieve the desired combination of limited flexibility and controlled resistance. Figures 17A-17D illustrate the advance assembly of the exemplary clip in use. Figure 17A shows an initial position, wherein the trigger 16 is resting in an open position, the coupler of the feed bar 50 and the feed bar 38 are in the most proximal position, and the feed connection 52 extends between the insert of the trigger 48 and the feed bar coupler 50. As previously discussed, in the initial open position, the protrusion 86 on the feed bar 38 is positioned at the proximal end of the elongated slot 88 in the clamping body of the jaws 28. A first deviation member, for example, a spring 120, is coupled to the insert of the trigger 48 and the housing 12, to maintain the insert of the trigger 48 and the trigger 16 in the open position, and a second biasing member, for example, the spring 122, extends between the coupling of the body 124, which rotatably matches the body 18 with the housing 12, and the coupler of the feed bar 50 to maintain the coupling of the feed bar 50 and the feed bar 38 in the most proximal position. When the trigger 16 is actuated and moved to the closed position, i.e. to the stationary handle 14, to overcome the deflection forces applied by the springs 120, 122, the trigger insert 48 begins to rotate in a counter direction. of the clock hands, as shown in Figure 17B. As a result, the power connection 52 is driven to rotate in a counterclockwise direction, thereby moving the coupler of the feed bar 50 and the feed bar 38 in a distal direction. The protrusion 86 on the feed bar 38 thus moves distally within the elongated slot 88 in the clamping body of the jaws 28, thereby advancing the feed shoe 34 and the clamps 36 positioned within the track of the clamp. . The spring 120 extends between the housing and the insert of the trigger 48, and the spring 122 is compressed between the coupler of the feed bar 50 and the coupler of the body 124. As the trigger 16 is further actuated and the trigger insert 48 continues to rotate, the coupler of the feed bar 50 and the feed bar 38, will eventually reach a more distal position. In this position, the protrusion 86 on the feed bar 38 will be placed at the distal end of the slot 88 in the clamping body of the jaws 28 and the clamp will be placed between the jaws 20, as previously discussed. The spring 122 will be fully compressed between the body coupler 124 and the feed bar coupler 50, and the feed connection 52 will flex, as shown in Figures 17C and 17D. As the feed connection 52 flexes, and more preferably, once the feed connection 52 is fully flexed, the clip forming assembly will be actuated to close the jaws 20. The feed connection 52 will remain flexed during the feeding. actuation of the assembly forming the clamp, for example, the second actuation stage, so that the insert of the trigger 48 is flexible relative to the advance assembly of the clamp, and in particular with the feed bar 38. An assembly that The exemplary clamp of housing 12 is shown in more detail in Figures 18-20. In general, the clip-forming assembly is positioned within the housing 12 and is effective to move the push rod 44 and the cam 42 relative to the jaws 20, to move the jaws 20 to a closed position and thereby fold a clamp placed between them. Although the mounting that forms the clip may have a variety of configurations, the assembly that forms the exemplary clip illustrated, includes a roller of the closure connection 54, which is slidably coupled to the port of the trigger 48, a closure connection. 56 which is adapted to be coupled to the roller of the closing connection 54, and a closure coupler 58 which is adapted to be coupled to the closure connection 56 and the push rod 44. Figure 18 illustrates the roller of the closure connection 54 in more detail, and as shown, the roller of the closure connection 54 includes a central body 54a having substantially circular ridges 54b, 54c, formed adjacent to opposite end ends thereof. The central body 54a can be adapted to settle within the second recess 1 10 in the insert of the trigger 48, so that the ridges 54b, 54c are received on opposite sides of the trigger insert 48. The central body 54a can also be adapted to match with the opposite arms 126a, 126b of the closure connection 56 for placing the arms on opposite sides of the trigger insert 48. An exemplary embodiment of a closure connection 56 is shown in more detail in Figure 19, and as shown , has opposite arms 126a, 126b that are spaced apart from one another. Each arm 126a, 126b includes a proximal end 128a, 128b which is adapted to couple the central body 54a of the roller of the closure connection 54, and a distal end 130a, 130b which is adapted to match a closure coupler 58 for coupling the roller of the closing connection 54 and the closing connection 56 to the push rod 44. In an exemplary embodiment, the proximal end 128a, 128b of each arm 126a, 126b is adapted to rotatably coincide with the roller of the closure connection 54, and thus, arms 126a, 126b may include, for example, hook-shaped members 132a, 132b formed therein, for coupling central body 54a. The hook-shaped members 132a, 132b extend in opposite directions to facilitate coupling between the closure connection 56 and the roller of the closure connection 54. The distal end 130a, 130b of the arms 126a, 126b may coincide with one another. the other, and may include an opening 134 extending through to receive a body that is adapted to rotatably match the closure connection 56 with the closure coupler 58. A person skilled in the art will appreciate that it can be used a variety of other techniques for matching the closure connection 56 with the roller of the closure connection 54 and the closure coupler 58. An exemplary closure coupler 58 is shown in more detail in Figure 20A, and as shown , includes a proximal portion 58a having two arms 136a, 136b with openings 138a, 138b extending through and adapted to be aligned with the opening 134 in the closure connection 56 to receive a body to match the two components. The lock coupler 58 may also include a distal portion 58b that is adapted to coincide with the proximal end 44a of the push rod 44 (Figure 9). In an exemplary embodiment, the closure coupler 58 includes a cut-out 59 (Figures 20B and 20C) formed therein and having a shape that is adapted to seat the proximal end 44a of the push rod 44. The distal portion 58b of the Closing coupler 58 can also be configured to receive a portion of the coupler of the feed bar 50 when the trigger 16 is in the open position. A person skilled in the art will appreciate that a variety of other matching techniques can be used to match the lock coupler 58 with the push rod 44, and that the lock coupler 58 and the push rod 44 can optionally, be integrally formed one with the other.

In other exemplary embodiments, shown in Figures 20B and 20C, a biasing member may be positioned within the cut 59 to deflect the push rod 44 in a distal direction. Such a configuration will prevent the accidental release of a clamp from the jaws, particularly during the initial stages of closure, if the user releases the trigger 16. In particular, although the anti-return mechanism, discussed in more detail below, can be adapted to prevent the trigger 16 is opened until trigger 16 reaches a predetermined position, the anti-return mechanism may allow some minor movement of trigger 16. Thus, in the event that a user releases trigger 16 and a smaller opening of trigger 16 occurs, the member The deflection rod will deflect the push rod 44 in a distal direction, thereby maintaining the push rod 44 in a substantially fixed position. Although a variety of biasing members may be used, in the embodiment shown in Figure 20B, the biasing member is a cantilevered beam 61 that is positioned between the proximal end 44a of the push rod 44 and the rear wall of the recess 59 to deflect the push rod 44 distally. The cantilevered beam 61 may be formed of a shape memory material, such as Nitinol, which allows the beam 61 to flex or flatten when a proximally directed force is applied to it. The beam 61 may also be formed from a variety of other materials, such as spring steel or reinforced polymers, and more than one beam may be used. Figure 20C illustrates another embodiment of a biasing member that is in the form of a spiral or other type of spring 63. As shown, the spring 63 is positioned between the proximal end 44a of the push rod 44 and the rear wall of the recess 59 to deflect the push rod 44 distally. The spring 63 is adapted to be compressed when a proximally directed force is applied to it. A person skilled in the art will appreciate that a variety of other biasing members, including elastomeric compression members, can be used. In use, referring again to Figures 17A-17D, as the hood 16 initially moves from the open position to the closed position, the roller of the closure connection 54 will roll within the recess 110 in the port of the trigger 48. A once the feed bar 38 and the feed bar coupler 50 are in the most distal position, as shown in Figure 17C, further actuation of the trigger 16 will cause the recess 110 in the port of the trigger 48 to engage the roller of the closing connection 54, forcing it to rotate with the trigger insert 48, as shown in Figure 17D. As a result, the closure coupler 58 will move distally, thereby causing the push rod 44 to move distally. As the push rod 44 advances distally, the cam 42 is advanced over the jaws 20 to close the jaws 20 and to fold the clip placed therebetween. The louver 16 can optionally be partially closed to only partially close the jaws 20 and thus fold, partially a clamp placed between them. Exemplary techniques to facilitate complete and partial selective clamping of the clamp will be discussed in more detail below. Once the clip is applied, the trigger 16 can be released, then allowing the spring 120 to pull the trigger 48 back into its initial position, and allowing the spring 122 to drive the coupler of the feed bar 50 and the feed bar 38 back to the proximal position. As the insert of the trigger 48 returns to its initial position, the roller of the closing connection 54 moves back to its initial position as well, thereby pulling the closing connection 56, the closing coupler 58, and the push bar 44 proximally. The surgical tweezers applicator 10 may also include a variety of other features to facilitate the use of the device 10. In an exemplary embodiment, the surgical tweezer applicator 10 may include a non-return mechanism to control the movement of the trigger 16. In particular, the The non-return mechanism can prevent the trigger 16 from opening during a partial closing run. However, once the trigger reaches a predetermined position, at which point the clamp placed between the jaws can be partially folded, the anti-return mechanism can release the trigger, allowing the trigger to open and release the clamp or to close for fold the clamp completely, as desired by the user. Figures 21 A and 21 B illustrate an exemplary embodiment of a non-return mechanism in the form of a ratchet. As shown, the ratchet includes a set of teeth 112 formed in the trigger insert 48, and a pawl 60 that is adapted to be rotatably positioned within the housing 12 and positioned adjacent the trigger insert 48, so that the closure of the trigger 16 and the rotational movement of the trigger insert 48 will cause the ratchet 60 to engage the teeth 112. The teeth 112 can be configured to prevent rotation of the pawl 60 until the pawl 60 reaches a predetermined position, at which point the pawl 60 is free to rotate, thus allowing the hood 16 to open or close. The predetermined position preferably corresponds to a position in which the jaws 20 are partially closed. In an exemplary embodiment, as shown, the teeth 112 include a first set of teeth for example, ten teeth, which have a size that prevents rotation of the ratchet 60 relative thereto, thus preventing the trigger 16 from opening when the ratchet 60 is engaged with the first set 112a of teeth 112. The teeth 112 may also include a final or terminal tooth, referred to as a "tock" tooth having a size that allows the ratchet 60 to rotate relative thereto when the ratchet 60 is coupled with the "tock" tooth 112b. In particular, the "tock" tooth 112b preferably has a size that is substantially greater than the size of the first set of teeth 112a, so that a relatively large notch 140 is formed between the first set of teeth 112a and the tooth "tock" 112b. The notch 140 has a size that allows the pawl 60 to rotate therein, thereby allowing the pawl 60 to move selectively beyond the tock tooth 112b or back toward the first set of teeth 112a. A person skilled in the art will appreciate that the "tock" tooth 112b may be the same size or size smaller than the first ten teeth 112a, while still providing a notch 140 formed therebetween which allows the ratchet 60 to rotate in the same. Figures 22A-22D illustrate the ratchet mechanism in use.

When the trigger 16 initially moves to a closed position, as shown in Figure 22A, the pawl 60 will engage the first set of teeth 112a thereby preventing the trigger 16 from opening. Further actuation of the trigger 16 will cause the pawl 60 to advance beyond the first set of teeth 112a until the pawl 60 reaches the notch 140 adjacent the tock tooth 112b. Once the ratchet 60 reaches the "tock" tooth 112b, at which point the jaws 20 are partially closed due to the partial distal movement of the cam 42 on the jaws 20, the ratchet 60 is free to rotate, thereby allowing that the trigger 16 be opened or closed, as desired by the user. Figure 22C illustrates the trigger 16 in a fully closed position, and Figures 22D and 22E illustrate the shutter 16 by returning to the open position. The ratchet mechanism may also be configured to emit an audible sound indicating the position of the jaws 20. For example, a first sound may be emitted when the ratchet 60 engages the first set of teeth 112a, and a second sound, different, by For example, a stronger sound can be emitted when the ratchet 60 engages the "tock" tooth 112b. As a result, when the trigger 16 reaches the predetermined position in which the pawl 60 is engaged with the tock tooth 112b, the sound indicates to the user that the jaws 20 are in a partially closed position. The user can thus release the trigger 16 to release a partially closed clip, or can completely close the trigger 16 to completely close the clip. In another exemplary embodiment, the surgical clip applier 10 may include an overload mechanism that is adapted to prevent overloading of a force applied to the jaws 20 by the trigger 16. Typically, during the application of a surgical clip, a some force to close the jaws 20 and to fold the clip around the tissue placed between them. As the forming process proceeds and the clip is at least partially closed, the force required to continue closing the jaws 20 around the clip increases significantly. Accordingly, in an exemplary embodiment, the overload mechanism can have a resistance that correlates with the force required to close the jaws 20. In other words, the resistance of the overload mechanism can be increased according to the force required to close the jaws. it increases. The resistance is, however, preferably slightly greater than the force required to close the jaws 20 to prevent accidental actuation of the overload mechanism. As a result, if the jaws 20 are prevented from closing when the trigger 16 is initially driven, the force required to overcome the resistance of the overload mechanism is relatively low. This is particularly advantageous since the jaws 20 are more susceptible to deform when they are open or only partially closed. The overload mechanism will be more easily activated in the initial stages of the clamp formation to avoid deformation of the jaws. Conversely, when the jaws 20 are substantially closed, the resistance is relatively high, so that the overload mechanism can only be actuated upon application of a significant force applied to the jaws 20. Figure 23A illustrates an exemplary embodiment of a overload mechanism 62, which shows an exploded view. In general, the overload mechanism may include an overload housing 64 formed of two halves 64a, 64b and containing a profile connection 66, an articulated connection 68, a pivot connection 70, and a deviation assembly 72. The Deviation assembly 72 may include a spring post 150 which is coupled with housing 64 and which includes a bore extending through, to receive a plunger 154. A spring 152 is positioned around the post with springs 150, and the plunger 154 extends through the spring post 150 and includes a head 154a formed therein that is adapted to be brought into abut contact. against the spring 152. The pivot connection 70 may be generally L-shaped and may be coupled to the housing 64 by a pivot pin 156 extending therethrough. A proximal end 70a of the pivot connection 70 may come into contact with the head 154a of the plunger 154, and a distal end 70b of the pivot connection 70 may be rotatably coupled with the hinged connection 68 by a pivot pin 166. The articulated connection 68, in turn, can be coupled with the connection of the profile 66, which can be slidably and rotatably positioned within the housing 64, adjacent an opening 64d formed in the housing. The rotational movement of the profile connection 66 within the housing 64 can be achieved by, for example, a pivot pin 158 extending through the connection of the profile 66 and being positioned within a first slot 160a (only one is shown). slot) formed in each half 64a, 64b of the housing 64, and the sliding movement of the profile connection 66 within the housing 64 can be achieved by, for example, opposing protuberances 168a, 168b formed in the profile connection 66, which are received Within a second slot 160b (only one groove is shown) formed in each half 64a, 64b of the housing 64. In use, the connection of the profile 66 can be adapted to receive a clamping force forming force and counteract the force with the resistance of the deflection assembly 72. In particular, the overload mechanism 62 utilizes the spring 152 together with the hinged connection 68 and the pivot connection 70 to deflect the connection of the profile 66 to rotate about the pivot pin 158 or to slide against the housing 64. For the rotational aspect, the force exerted by the compressed spring 152 is transferred through the articulated connection 68 and the pivot connection 70, so that a rotational moment is applied to the connection of the profile 66 against the housing 64. Thus, this assembly causes the connection of the profile 66 to resist rotation with respect to the housing 64. If the moment generated by a radial load of the roller of the connection closing 54 against the connection of the profile 66 exceeds the moment of the pivot connection 70 and the articulated connection 68, the connection of the profile 66 starts to rotate, deforming the articulated connection 68 and causing the pivot connection 70 to further compress the spring 152 For the sliding aspect, the pivot connection 70, the articulated connection 68 and the connection of the profile 66 are aligned so that the sliding force (resistance a to sliding) is the force required to deform the hinged connection 68 and the pivot connection 70. If the radial load of the roller of the closing connection 54 against the connection of the profile 66 exceeds the deformation force of the connections, then the Pivot connection 70 further compresses the spring 152 as the connection of the profile 66 slides proximally. This is shown in more detail in Figures 23B-23C, and as shown, the opening 64d in the housing 64 allows the roller of the closure connection 54 of the clip-forming assembly to roll against the connection of the profile 66. As As a result, when the trigger 16 is driven and moved to the closed position, the roller of the closing connection 54 applies a force to the connection of the profile 66. The resistance of the spring of the overload 152, however, will maintain the connection of the profile 66 in a substantially fixed position unless the force applied by the roller of the closing connection 54 is increased to a force that is greater than the resistance, for example, a threshold force. This can be caused, for example, a foreign object placed between the jaws 20 or when the jaws 20 are completely closed and with the clamp and the cup, conduit, derivation, etc., between them. When the jaws 20 can not be closed anymore, the force applied to the roller of the closing connection 54 of the closing movement of the trigger 16, will be transferred to the connection of the profile 66, which will then rotate and slide inside the housing 64, thus causing the pivot connection 70 to rotate, which urges the plunger 154 to compress the spring of the overload 152. As previously indicated, the force required to drive the overload mechanism can be correlated with the force required to close the jaws 20, which increases as the trigger 16 moves to the closed position. This can be achieved due to the configuration of the connection of the profile 66. In particular, when the roller of the closing connection 54 first comes into contact with the connection of the profile 66 and is therefore in a lower position, the connection of the profile 66 can rotate within housing 64, as shown in Figure 23B. As the roller of the closing connection 54 moves upwards together with the connection of the profile 66, the force required to overcome the resistance of the overload mechanism increases, because the connection of the profile 66 must slide within the housing 64, as shown in Figure 23C. The force required to rotate the connection of the profile 66 may be less than the force required to slide the connection of the profile 66. Accordingly, if the jaws 20 are prevented from closing, for example, by a foreign object, as the trigger is initially actuated, a minimum force will be required to cause the roller of the closing connection 54 to transfer the force to the lower portion of the connection of the profile 66, causing the connection of the profile 66 to rotate. When the jaws 20 are substantially closed and the hood 16 is almost completely actuated, a significant force capacity is required to cause the roller of the closure connection 54 to transfer the force to the upper portion of the connection of the profile 66, causing the connection of the profile 66 slides within the housing 64 to overcome the resistance of the spring of the overload 152. Although the amount of force required to drive the overload mechanism may be greater than and may be increased in relation to the amount of force required for closing the jaws 20, the force is preferably only slightly greater than the force required to close the jaws 20 to prevent deformation or other damage to the jaws 20. A person skilled in the art will appreciate that the resistance can be adjusted based on the force required to close the jaws 20. The connection of the profile 66, and in particular the super The distal end 66 of the profile connection 66 may also have a shape that facilitates the correlation between the force required to drive the overload mechanism and the force required to close the jaws 20. For example, where the force required to close the jaws 20 is increased to a linear proportion, the distal surface 66s of the connection of the profile 66 can be planar, to prevent the connection of the profile 66 from interfering with the movement of the roller of the closure connection 54 above, and to allow a linear force is applied to the trigger 16 to close the jaws 20. Conversely, when the force required to close the jaws 20 is not linear, as the hood 16 moves to the closed position, the connection of the profile 66 may have a non-linear force that corresponds to the non-linear force. Such a configuration will prevent the forces required to close the cam 42 (Figure 8) from becoming too high. By way of non-limiting example, the force required to close the jaws 20 may be non-linear due to the force of the recess 104 in the cam 42, which is adapted to push the jaw members 96a, 96b toward each other. As shown in Figure 8, the recess 104 may have a curved configuration so that the force will vary as the cam 42 passes over the jaw members 96a, 96b. The connection of the profile 66 can, therefore, have a corresponding curved distal surface, so that the force will also vary as the roller of the closing connection 54 passes over. As shown in Figures 23A and 23B, the connection of the profile 66 is curved, so that the lower portion of the connection of the profile 66 is substantially convex and the upper portion of the connection of the profile 66 is substantially concave. A person skilled in the art will appreciate that the connection of the profile 66 can take a variety of other forms, and that a variety of other techniques can be used to optimize the force required to close the jaws 20 and the force necessary to drive the mechanism of overload. A person skilled in the art will also appreciate that the overload mechanism can have a variety of other configurations. By way of non-limiting example, Figure 23D illustrates an overload mechanism that is in the form of a cantilevered beam 170 to receive a force applied by the roller of the closure connection 54. The beam 170 may have a substantially curved member 172 with a clamp 174 coupled to one end thereof. The curved member 172 may have a bending moment, which when deformed with a force greater than the bending moment, deforms, to adopt a condition of low stiffness. The clamp 174 can provide more rigidity to the curved member 172, so that the bending moment increases adjacent to the clamp 174. In use, the beam 170 can be loaded into the housing 12 of the gripper applicator 10, so that the roller of the closure connection 54 comes into contact with the concave surface, and the beam 170 can be positioned at an angle so that the roller of the closure connection 54 is further away from the beam when the trigger 16 is initially actuated, and the The roller of the closing connection 54 is closer to the beam as the trigger 16 moves to the closed position. As a result, the resistance to deformation will increase as the roller of the closing connection 54 moves therefrom and the trigger 16 of the gripper applicator moves towards the closed position. Although not shown, multiple beams could optionally be used, in a stacked manner and the terminal or free end of the beams could be contoured to conform to the strain load at a particular point along the beam. In another exemplary embodiment, the surgical clip applier 10 may include an indicator of the number of clips to indicate the number of clips remaining in the device 10. Although several techniques may be used to indicate the number of clips remaining, FIGS. 24A-25 illustrate an exemplary embodiment of an indicator of the number of pliers having an indicator wheel 74 and an indicator actuator 76. The indicator wheel 74 is shown in detail in the Figures 24A and 24B, and as shown, has a generally circular or cylindrical shape defining a central axis Y around which the wheel 74 is adapted to rotate. The wheel 74 includes teeth 142 formed around and adapted to be coupled by the indicator actuator 76, and an indicator member 144. The indicator member 144 may have a variety of configurations, but in an exemplary embodiment, the indicator member 144 is in the form of a contrasting color pad having a color, eg, orange, red, etc., which differs from the rest of the indicator wheel 74. Figure 25 illustrates the exemplary flag actuator 76 in more detail. The actuator 76 is adapted to be slidably positioned within the housing 12 and to engage the coupler of the feed connection 50 and to move as the coupler of the feed bar 50 and the feed bar 38 move. Accordingly, the indicator actuator 76 may include a protrusion 146, only a portion of which is shown, formed on a lower surface thereof, to extend into the recess 50f formed between the circular flanges 50d, 50e in the coupler of the feed bar 50. The protrusion 146 allows the indicator actuator 76 to be engaged by the coupler of the feed bar 50 and moved therewith. The indicator actuator 76 may also include a coupling mechanism 148 formed therein, and adapted to engage the teeth 142 formed on the indicator wheel 74. As shown in Figure 25, the coupling mechanism 148 on the indicator actuator 148 76 is in the form of an arm having a tongue formed at the end thereof for engaging the teeth 142. In use, the indicator wheel 74 is rotatably positioned within the housing 12, as shown in Figures 26A-26B , and the indicator actuator 76 is slidably positioned within the housing 12, so that the coupling mechanism 148 is positioned adjacent the indicator wheel 74 and the protrusion 146 extends towards the coupler of the feed bar 50. housing 12 includes a window 12a formed therein, to provide visual access to the indicator wheel 144. As the trigger 16 moves to the closed position and the The feed bar coupler 50 moves distally, the indicator actuator 76 will move distally with the feed bar 38 and the feed bar coupler 50. As a result, the coupling mechanism 148 on the indicator actuator 76, the teeth 142 will be engaged in the indicator wheel 74, thereby causing the wheel 74 to rotate as the clamp is advanced towards the jaws 20. Each time the trigger 16 is actuated to advance a clamp 20 towards the jaws 20, the indicator actuator 74 rotates indicator wheel 76. When the gripper supply has two or three grippers, the contrasting color pad 144 on indicator wheel 74 will begin to appear in window 12a formed in housing 12, thereby indicating the user that only a few tweezers remain. The contrasting color pad 144 can be adapted to occupy the entire window 12a when the grip supply is exhausted. In another exemplary embodiment, the indicator wheel 74 may include a non-return mechanism that is adapted to prevent the indicator wheel 74 from rotating in a reverse direction, e.g., a counterclockwise direction, after being advanced. . Although the backstop mechanism may have a variety of configurations, in the embodiment shown in Figure 24B, the indicator wheel 74 includes opposing arms 73a, 73b, extending substantially parallel to the axis Y. Each arm 73a, 73b has a pawl 75a, 75b formed at the most distal end thereof, which is adapted to couple the corresponding teeth formed in the housing 12. Although not shown, the corresponding teeth may be formed within a circular protrusion formed in an internal portion of the housing 12 adjacent to the window 12a. When the indicator wheel 74 is placed inside the housing 12, the arms 73a, 73b extend towards the circular protrusion formed around the circumference formed by it. As a clamp is applied and the indicator wheel 74 rotates, the arms 73a, 73b can flex on the teeth in the housing to move to the next position. When the actuator of the indicator 76 slides proximally to return to its initial position, the arms 73a, 73b will engage the teeth in the housing to prevent the indicator wheel 74 from rotating in a reverse direction, ie, returning to the previous position. A person skilled in the art will appreciate that a variety of other techniques can be used to prevent the return of the indicator wheel 74. As previously mentioned, the surgical clip applier 10 can be used to apply a partial or fully closed clip to a site. surgical, such as a vessel, conduit, derivation, etc. In laparoscopic and endoscopic surgery, a small incision is made in the patient's body to provide access to the surgical site. Typically, an access port or cannula is used to define a working channel that extends from the incision in the skin to the surgical site. Frequently, during surgical procedures, it is necessary to stop the flow of blood through the vessels or other ducts, and some procedures may require the use of a shunt. A surgical clamp can then be used to fold the vessel or to ensure bypass to the vessel. Accordingly, a surgical clamp applicator, such as the clamp applicator 10, can be inserted through the cannula or otherwise introduced into the surgical site to place the clamps 20 around the vessel, bypass or other conduit. The tissue lock 46 can facilitate the placement of the jaws 20 around the target site. The trigger 16 can then be operated to cause a clamp to advance between the jaws and to be placed around the target site, and to cause the jaws 20 to close to fold the clamp. Depending on the intended use of the clamp, the trigger 16 may be partially driven, as indicated by the audible sound of the ratchet 60 upon reaching the "tock" tooth 112b, or it may be completely actuated. The louver 16 is then released to release the clamp partially or completely closed, and the procedure may be repeated if necessary to apply additional clamps. One of skill in the art will appreciate the advantages and additional features of the invention, based on the embodiments described above. Accordingly, the invention is not limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety.

Claims (18)

NOVELTY OF THE INVENTION CLAIMS

1. - A surgical clip applier, comprising: a handle housing having a moving trigger in a first direction from an open position to a closed position, and a second direction from the closed position to the open position, the trigger includes a position partially closed located between the open and closed positions; an elongate body extending from the handle housing and having opposing jaws formed at a distal end thereof, the trigger effective to move the opposing jaws between an open position and a closed position; and a trigger control mechanism positioned within the handle housing and adapted to limit movement of the trigger to the first direction when the trigger is positioned between the open position and the partially closed position, and adapted to allow free movement of the trigger in the first and second directions between the partially closed position and the closed position.

2. The surgical clip applier according to claim 1, further characterized in that the trigger control mechanism comprises a ratchet mechanism.

3. The surgical clip applier according to claim 2, further characterized in that the ratchet mechanism includes a series of teeth formed in a trigger insert rotatably positioned within the housing of the handle, and a ratchet positioned in a manner rotating inside the handle housing and adapted to engage a series of teeth formed in the ratchet.

4. The surgical clip applier according to claim 3, further characterized in that the series of teeth comprises a first set of teeth adapted to limit the movement of the trigger to the first direction when the trigger is placed between the open position and the partially closed position, and a final tooth adapted to allow free movement of the trigger in the first and second directions when the trigger is placed between the partially closed position and the closed position.

5. The surgical clip applier according to claim 4, further characterized in that the first set of teeth is adapted to prevent rotation of the pawl relative to it, and the final tooth is adapted to allow rotation of the pawl relative to the pawl. same.

6. The surgical clip applier according to claim 4, further characterized in that the first set of teeth has a size that is smaller than a final tooth size.

7. The surgical clip applier according to claim 4, further characterized in that the audible sound is omitted after the coupling of the ratchet and the first set of teeth, and where a different audible sound is emitted after the ratchet coupling and the final tooth.

8. A ratchet mechanism for controlling movement of a trigger in a surgical clip applier, the ratchet mechanism comprising: a ratchet rotatably positioned within a housing of the handle; and a trigger insert rotatably disposed within the handle housing and coupled to a trigger, the trigger insert includes a first set of teeth adapted to ensure a full scale of movement of the trigger from an open position to a partially closed position. when the first set of teeth is engaged by the ratchet, and a final tooth adapted to allow free movement of the trigger between the partially closed position and the fully closed position when the final tooth is engaged by means of the ratchet.

9. Ratchet mechanism according to claim 8, further characterized in that the first set of teeth is adapted to limit the rotation of the ratchet relative to it, and wherein the final tooth is adapted to allow free rotation of the ratchet with relation to it

10. The ratchet mechanism according to claim 8, further characterized in that the first set of teeth has a size that is smaller than the size of the final tooth.

11. The ratchet mechanism according to claim 8, further characterized in that an audible sound is emitted following the coupling of the ratchet and the first set of teeth, and wherein a different audible sound is emitted following the engagement of the ratchet and the ratchet. final tooth.

12. A method for applying a surgical clamp, comprising: moving a trigger rotatably coupled to a housing of the handle in a first direction from an open position to a partially closed position, thereby partially closing a surgical clamp placed between the legs. opposing jaws formed at one end of the body extending from the handle housing; and selectively moving the trigger from the partially closed position to a fully closed position, wherein the partially closed surgical clamp placed between the opposing jaws is completely closed, and the open position, wherein the partially closed surgical clamp placed between the opposing jaws is closed. free

13. The method according to claim 12, further characterized in that the handle housing includes a ratchet mechanism placed therein and adapted to control the movement of the trigger between the open position, the partially closed position, and the position totally closed.

14. The method according to claim 13, further characterized in that the ratchet mechanism is adapted to limit the movement of the trigger to a single direction when the trigger moves between the open position and the partially closed position.

15. - The method according to claim 13, further characterized in that the ratchet mechanism comprises a pawl rotatably positioned within the housing of the handle, and a series of teeth formed in a trigger insert rotatably positioned within the housing of the handle. the handle and coupled to the trigger.

16. The method according to claim 15, further characterized in that the series of teeth comprises a first set of teeth adapted to prevent rotation of the ratchet when the ratchet engages with it, and a final tooth adapted to allow free rotation of the tooth. Ratchet when the ratchet engages with it.

17. The method according to claim 15, further characterized in that the first set of teeth has a size that is smaller than a final tooth size.

18. The method according to claim 15, further characterized in that the audible sound is emitted after the coupling of the ratchet and the first set of teeth, and where a different audible sound is emitted after the coupling of the ratchet and the final tooth .