surgical clip applicator

专利摘要:
clip advance with locking mechanism. the present invention relates to a surgical clip applicator and methods for applying surgical clips to a vessel, duct, shunt, etc., during a surgical procedure. in one embodiment, a surgical clip applicator is provided and may include including a compartment that has a driver movably coupled to it and an elongated stem extending from it with opposite claws formed at a distal end thereof. the clip applicator may include a lead assembly disposed on the elongated rod and configured to advance a clip from a plurality of clips disposed on the elongated rod into the opposite claws. a feeding shoe can be arranged on the elongated rod and can be configured to engage and prevent movement of the lead assembly to a proximal position after the lead assembly moves to a distal position to advance a more proximal clip into the claws opposite. this may indicate to a user that a supply of clips from the surgical clip applicator is depleted.
公开号:BR112012008261B1
申请号:R112012008261
申请日:2010-10-04
公开日:2020-02-04
发明作者:T Nguyen Anthony；Z Herrera-Davis Denzel
申请人:Ethicon Endo Surgery Inc；
IPC主号:

专利说明:

Invention Patent Descriptive Report for SURGICAL CLIP APPLICATOR.
CROSS REFERENCE TO RELATED REQUESTS [0001] This application is a continuation-in part of US application No. 12 / 576,736 filed on October 9, 2009 and entitled Improved Clip Advancer which is hereby incorporated by way of reference, in its entirety. wholeness.
FIELD OF THE INVENTION [0002] The present invention relates generally to surgical devices and, in particular, to methods and devices for applying surgical clips to ducts, blood vessels, anastomoses, etc. BACKGROUND OF THE INVENTION [0003] Surgical clip applicators are commonly used for ligation of blood vessels, ducts, anastomoses, or a portion of body tissue during surgery. Most clip applicators typically have a handle with an elongated rod that has a pair of opposing movable claws formed on one end thereof, to hold and form a ligature clip between them. The claws are positioned around the blood vessel or duct, and the clip is crushed or formed on the vessel by closing the claws.
[0004] Clip applicators that are configured to provide multiple clips typically include a feed mechanism that sequentially advances the clips into the clip applicator's claws. A problem associated with advancing mechanisms is that there is generally no indication of when the clip applicator runs out. In the middle of a procedure, a surgeon or other user can continue to pull a clip applicator trigger to apply clips, even after the last clip has been applied. Without any indication to the contrary provided by the cliPetition applicator 870190088792, of 09/09/2019, pg. 4/93
2/83 feet, the surgeon may believe that he is closing an incision or other opening in tissues, when in fact he is not. This type of error could be dangerous for the patient and, at the very least, could cost the surgeon valuable time by having to repeat at least a portion of the closure procedure.
[0005] Consequently, there is a need for improved methods and devices for applying surgical clips to blood vessels, ducts, anastomoses, etc.
SUMMARY OF THE INVENTION [0006] The present invention provides methods and devices for applying a surgical clip to a blood vessel, duct, anastomosis, etc. In one embodiment, a surgical clip applicator is presented which may include a wrap that has a trigger movably coupled to it and an elongated stem extending from it with opposite claws formed on a distal end thereof. A forward assembly may be disposed within the elongated stem and may be configured to advance, into the opposing jaws, one of a plurality of clips disposed within the elongated stem. In some embodiments, the forward set may be able to move between a proximal and a distal position. The surgical clip applicator may also include a feeder shoe arranged on the elongated rod and configured to engage and prevent movement of the lead assembly to the proximal position after movement of the lead assembly to the distal position to advance a closer clip into the opposite claws.
[0007] In some embodiments, movement of the trigger from an open position to a closed position can be effective in moving the forward assembly from the proximal to the distal position. The surgical access device can also include a clip rail
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3/83 disposed within the elongated rod and having a plurality of clips housed therein, the feeder shoe being slidably disposable within the clip rail to distally advance the plurality of clips through the clip rail. In one embodiment, the lead assembly may include a recess formed therein, which is configured to be engaged by a lock on the feeder shoe to prevent the lead assembly from moving to the proximal position after the lead assembly has moved a clip further close into the opposite claws. The lock on the feeder shoe can be configured to move distally with the feeder shoe as it advances the plurality of clips through the clip rail.
[0008] The feeder assembly can have many configurations and can include a feeder bar attached to a feeder. The lead may have a distal end configured to contact, and advance, one of a plurality of clips into the opposing jaws. In some embodiments, the indentation can be formed through a distal portion of the feeder bar and a proximal portion of the feeder. A proximal portion of the latch can be connected to the feeder shoe and a distal portion of the latch can be disconnected from the feeder shoe and can extend a distance below a lower surface of the feeder shoe.
[0009] In other respects, a surgical clip applicator is presented which may include a cable compartment that has a trigger movably coupled to it, and an elongated rod extending distally from it. The elongated stem may have opposite claws at a distal end thereof. A clip advance assembly can be operatively associated with the trigger and configured to advance, into the opposite claws, a
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4/83 out of a plurality of clips disposed within the elongated stem. A locking mechanism can be configured to lock the clip-forward assembly in place after the clip-forward assembly has distally advanced a clip closer into the opposing jaws. The clip lead assembly can also be configured to lock the trigger in a triggered position when the clip lead assembly is locked in place by the locking mechanism.
[00010] In some embodiments, the surgical clip applicator may additionally include a tongue and ratchet mechanism arranged inside the cable compartment and operatively associated with the trigger. The tongue and ratchet mechanism may have an engaged configuration in which it controls the movement of the trigger and a disengaged configuration in which the trigger is independently movable from the tongue and ratchet mechanism. The locking mechanism can be configured to lock the latch and ratchet mechanism in an engaged configuration after the clip advance assembly has advanced a more proximal clip into the opposing jaws, thereby locking the trigger in an engaged position.
[00011] In one embodiment, the trigger may be able to move in a first direction, from a fully open position to a fully closed position, and a second direction from a fully closed position to a fully open position. The trigger can be limited to movements in only one of the first and second directions when the tongue and ratchet mechanism is in the engaged configuration. The trigger may be able to move freely in both the first and second directions, when the tongue and ratchet mechanism is in the disengaged configuration. In some embodiments, the ratchet mechanism may include a series of teeth for engaging the tongue.
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5/83 [00012] The clip advance set can have many configurations. For example, the clip lead assembly may include a feeder shoe and a lead assembly. In some embodiments, the locking mechanism may include a lock formed on the feeder shoe, which is configured for locking engagement with a recess formed in the forward assembly after it advances a more proximal clip into the opposite claws. A lower surface of the feeder shoe may be in sliding engagement with an upper surface of the forward assembly. In other embodiments, the opposing jaws can be configured to open and release a more proximal clip before the locking mechanism locks the clip advance assembly.
[00013] In another aspect, methods for advancing surgical clips are presented, which may include moving a trigger from a more open position to a more closed position, in order to correspondingly advance a more proximal clip of a plurality of clips inwardly opposite claws of a clip applicator. The method may additionally include releasing the trigger so that it is locked in a triggered position between the most open and most closed positions, to prevent the trigger from being moved to the most open position. A lock formed on a feeder shoe can be engaged by a recess formed in a forward assembly to lock the trigger. In some embodiments, moving the trigger from the most open to the most closed position can move the lead assembly distally over the feeder shoe to advance the most proximal clip into the opposite claws of the clip applicator. In addition, releasing the trigger can move the lead assembly proximally over the feeder shoe until the recess in the lead assembly engages the feeder shoe lock. The method may also include the release
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6/83 ration of the clip most proximal to the opposing claws of the clip applicator, before the trigger is locked in a triggered position between the most open and closed positions, to prevent the trigger from being moved to the most open position.
BRIEF DESCRIPTION OF THE DRAWINGS [00014] The invention will be understood more fully from the detailed description below, taken in conjunction with the accompanying drawings, in which:
[00015] Figure 1A is a side view of an exemplary embodiment of a surgical clip applicator, [00016] Figure 1B is an exploded view of the surgical clip applicator shown in Figure 1A, [00017] Figure 2A is a view view of a clamp retainer assembly of the surgical clip applicator shown in Figure 1A, [00018] Figure 2B is a bottom view of the clamp retainer assembly shown in Figure 2A, [00019] Figure 2C is a side view of the claw retainer assembly shown in Figure 2B, [00020] Figure 2D is a cross-sectional view of the claw retainer assembly shown in Figure 2C, taken over the DD line, [00021] Figure 3A is a top view of a feeder shoe for use with the jaw retainer assembly shown in Figures 2A to 2D, [00022] Figure 3B is a bottom view of the feeder shoe shown in Figure 3A, [00023] Figure 3C is a perspective view of another mode of a toad the feeder for use with the claw retainer assembly shown in Figures 2A to 2D, [00024] Figure 3D is a perspective view of the food shoe 870190088792, from 09/09/2019, pg. 9/93
7/83 Figure 3C, [00025] 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 claw retainer assembly shown in Figures 2A to 2D, [00026] Figure 4B is a side view of the proximal end of the feed bar, shown in Figure 4A, and the proximal end of the claw retainer rod, shown in Figures 2A and 2B, showing the feed bar in a more proximal, [00027] Figure 4C is a side view of the feed bar and claw retainer rod shown in Figure 4B, showing the feed bar in a more distal position, [00028] Figure 4D is a side view of another modality of a proximal end of a feeder bar shown in connection with the proximal end of the claw retainer rod shown in Figures 2A and 2B, showing the feeder bar in the most proximal position, [00029] A Fi Figure 4E is a side view of the feed bar and claw retainer rod shown in Figure 4D, showing the feed bar in a more distal position, [00030] Figure 4F is a side view of yet another embodiment of a proximal end of a feeder bar shown in connection with the proximal end of the claw retainer rod shown in Figures 2A and 2B, showing the feeder bar in the most proximal position, [00031] Figure 4G is a side view of the feeder bar and the retainer rod claw shown in Figure 4F, showing the feed bar in an intermediate position, [00032] Figure 4H is a side view of the feed bar and claw retainer rod shown in Figure 4F, showing the bar
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8/83 feeder in a more distal position, [00033] Figure 4I is a perspective view of another modality of a feeder bar that is configured to advance the feeder shoe of Figures 3C and 3D through the claw retainer assembly shown in Figures 2A to 2D, [00034] Figure 5A is a side perspective view of a feeder that is configured to mate with a distal end of the feed bar shown in Figure 4A, [00035] Figure 5B is a view side perspective view of another modifier of a feeder that is configured to couple with a distal end of the feed bar shown in Figure 4A, [00036] Figure 5C is a perspective view of yet another modality of a feeder that is configured to mate with a distal end of the feed bar shown in Figure 4I, [00037] Figure 5D is another perspective view of the Figure 5C forward, [00038] Figure 5E is a view a in perspective of the feed bar in Figure 4I and the lead of Figures 5C and 5D, fitted together, [00039] Figure 6A is a cross-sectional view of a clip lead assembly, which includes the claw retainer assembly shown in Figures 2A to 2D, the feeder shoe shown in Figures 3A to 3B, and the feeder bar shown in Figure 4A, showing the feeder bar in a starting position proximal to the clip rail of the claw retainer assembly, [00040] Figure 6B is a cross-sectional view of the clip advance assembly shown in Figure 6A, showing the feed bar moved in a distal direction, [00041] Figure 6C is a cross-sectional view of the assembly
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9/83 clip lead shown in Figure 6B, showing the feed bar moved more distally, thus moving the feed shoe and a supply of clips disposed distally to the feed shoe in a distal direction, [00042] Figure 6D is a section view view of the clip advance assembly shown in Figure 6C, showing the feed bar returned to the initial proximal position, shown in Figure 6A, while the feed shoe and clip supply remain in the forward position shown in Figure 6C, [00043] Figure 6E is a bottom perspective view of the lead shown in Figure 5A arranged inside the clip rail of the claw retainer assembly shown in Figures 2A to 2D, showing the lead in a more proximal position, [00044] Figure 6F is a view in bottom perspective of the lead shown in Figure 6E, showing the lead in a more distal position after advancing a clip into the claws d the surgical clip applicator, [00045] Figure 6G is a perspective view of a modality of a locking mechanism to indicate to a user that a supply of clips from an exemplary clip applicator is depleted, [00046] Figure 7 is a side perspective view of a pair of surgical clip applicator jaws shown in Figure 1A, [00047] Figure 8 is a side perspective view of a cam for use with the jaws shown in Figure 7, [00048] A Figure 9 is a top perspective view of a rod that is adapted to be coupled to the cam shown in Figure 8 in order to move said cam in relation to the claws shown in Figure 7, [00049] Figure 10A is a top view of the cam shown on
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10/83
Figure 8 coupled to the claws shown in Figure 7, showing the cam in an initial position and the claws open, [00050] Figure 10B is a top view of the cam shown in Figure 8 coupled to the claws shown in Figure 7, showing the forward cam over the jaws, and the jaws in a closed position, [00051] Figure 11A is a top perspective view of a tissue blocker that is adapted to be attached to a distal end of the clip rail of the jaw retainer assembly shown in Figures 2A to 2D, [00052] Figure 11B is a top perspective view of another modality of a tissue blocker that has a ramp formed over it, in order to guide a clip into the claws and stabilize it during the formation of the clip, [00053] Figure 11C is a side view of the tissue blocker shown in Figure 11B, [00054] Figure 11D is an enlarged view of the tissue blocker shown in Figures 11B and 11C, [00055] A Figu Figure 11E is a perspective view of another embodiment of a tissue blocker that is adapted to be attached to a distal end of the clip rail of the claw retainer assembly shown in Figures 2A to 2D, [00056] Figure 11F is another perspective view of the tissue blocker in Figure 11E, [00057] Figure 12A is a top view of a distal end of the surgical clip applicator shown in Figure 1A, showing the tissue blocker in Figure 11A positioned between the claws of the Figure 7, [00058] Figure 12B is a perspective view of the Figure 5C forward, advancing in a clip over the tissue blocker in Figure 11E,
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11/83 [00059] Figure 12C is a perspective view of the forward of Figure 5C in a distal position on the tissue blocker of Figure 11E, [00060] Figure 12D is a perspective view of the forward of Figure 5C bending over if under a more distal clip inside a channel formed in the tissue blocker in Figure 11E, [00061] Figure 12E is a perspective view of the forward of Figure 5C in a proximal position in the tissue blocker in Figure 11E, [00062 ] Figure 13 is a side view partially in cross-section of the handle portion of the surgical clip applicator shown in Figure 1A, [00063] Figure 14 is a side perspective view of a trigger insert of the surgical clip applicator. shown in Figure 1A, [00064] Figure 15A is a side perspective view of one half of a surgical clip applicator feeder coupler shown in Figure 1A, [00065] Figure 15B is a lat perspective view of the other half of the feeder bar coupler shown in Figure 15A, [00066] Figure 16 is a top perspective view of a flexible link that forms part of a clip lead assembly of the surgical clip applicator shown in Figure 1A, [ 00067] Figure 17A is a side view partially in cross section of a portion of the surgical clip applicator cable shown in Figure 1A, showing a clip forward assembly in an initial position, [00068] Figure 17B is a side view partially in cross section of a portion of the surgical clip applicator cable shown in Figure 17A, showing the clip advance assembly
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12/83 partially actuated, [00069] Figure 17C is a side view partly in cross section of a portion of the surgical clip applicator cable shown in Figure 17B, showing the fully actuated clip advance assembly, [00070] Figure 17D is a side view partially in cross section of a portion of the surgical clip applicator cable shown in Figure 17A, showing a driven clip forming assembly, [00071] Figure 18 is a side view of a closing link cylinder that forms part of a clip-forming assembly of the surgical clip applicator shown in Figure 1A, [00072] Figure 19 is a top perspective view of a closing link that attaches to the closing link cylinder shown in Figure 18 to form part of a clip-forming assembly of the surgical clip applicator shown in Figure 1A, [00073] Figure 20A is a top perspective view of a coupling of the closing link plate to the closing link shown in Figure 19, and which is also part of the clip forming assembly of the surgical clip applicator shown in Figure 1A, [00074] Figure 20B is a bottom view of the closing link coupler shown in Figure 20A , attached to the rod of Figure 9 and having a modality of an inclination element disposed in its interior, [00075] Figure 20C is a bottom view of the closing link shown in Figure 20A, attached to the rod of Figure 9 and which has a another embodiment of a tilt element arranged therein, [00076] Figure 20D is a graph showing the amount of force required to move the tilt element shown in Figure 20B,
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13/83 [00077] Figure 20E is a side view of another embodiment of a portion of a closing link coupler that has ridges formed in it, [00078] Figure 21A is an enlarged side perspective view of a mechanism non-return device of the surgical clip applicator shown in Figure 1A, [00079] Figure 21B is a perspective view of a tongue mechanism of the anti-return mechanism shown in Figure 21A, [00080] Figure 22A is a partially side view in cross-section of a portion of the surgical clip applicator cable shown in Figure 1A, showing the anti-return mechanism in an initial position, [00081] Figure 22B is a side view partially in cross-section of a portion of the applicator cable of surgical clip shown in Figure 22A, showing the non-return mechanism in a partially actuated position, [00082] Figure 22C is a side view partially in cross section of a portion of the applica surgical clip device shown in Figure 22B, showing the non-return mechanism in a fully actuated position, [00083] Figure 22D is a side view partially in cross section of a portion of the surgical clip applicator cable shown in Figure 22C, showing the non-return mechanism returning to an initial position, [00084] Figure 22E is a side view partially in cross section of a portion of the surgical clip applicator cable shown in Figure 22D, showing the anti-return mechanism back to starting position, [00085] Figure 22F is a perspective view of a modality of a compression spring designed to apply traction to the action 870190088792, from 09/09/2019, pg. 16/93
14/83 Figure 20A closing link plator, [00086] Figure 22G is a perspective view of the compression spring in Figure 22F, [00087] Figure 23A is an exploded view of a clip applicator overload mechanism surgery shown in Figure 1A, [00088] Figure 23B is a partially cross-sectional view of the overload mechanism shown in Figure 23A, showing the cylinder of the closing link making the first contact with the profile link, [00089] Figure 23C is a partially cross-sectional view of the overload mechanism shown in Figure 23B, showing the closing link cylinder applying force to the profile link and causing the profile link to rotate, [00090] Figure 23D is a view in perspective of another modality of an overload mechanism for use with a surgical clip applicator, [00091] Figure 24A is a side perspective view of a wheel indicating the number of clips in the surgical clip applicator. shown in Figure 1A, [00092] Figure 24B is a side view of a clip indicator wheel shown in Figure 24A, [00093] Figure 25 is a top perspective view of a clip quantity actuator for use with the clip number indicator wheel shown in Figure 24, [00094] Figure 26A is a side view partially in cross section of a portion of the surgical clip applicator cable shown in Figure 1A, showing movement of the clip number actuator of Figure 25 and the clip indicator wheel of Figure 24, [00095] Figure 26B is a side view partially in section
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15/83 cross section of a surgical clip applicator cable shown in Figure 26A, showing additional movement of the clip number actuator in Figure 25 and the clip number indicator wheel in Figure 24, and [00096] Figure 27A is an illustration in side view showing another modality of a feeder shoe having an A-shaped bend preformed in it and configured to create friction between the feeder shoe and the clip rail, [00097] Figure 27B is an illustration in side view of another modality of a feeder shoe having a preformed flexion in it and configured to create friction between the feeder shoe and the clip rail, [00098] Figure 28A is a top view in perspective of a portion of a clip rail having protuberances formed on it and configured to create friction with the feeder shoe, according to another embodiment of the invention, [ 00099] Figure 28B is a perspective end view of another embodiment of a feeder shoe having a latch formed on it and adapted to engage the surface formed protuberances present on the clip rail shown in Figure 28A, [000100 ] Figure 29A is a bottom perspective view of another embodiment of a feeder shoe having a retaining lip formed on a latch that is adapted to engage the corresponding groove formed on a feeder bar, [000101] Figure 29B is a top perspective view of another embodiment of a feed bar having a capture groove formed thereon and adapted to engage the retaining lip formed on the feed shoe latch shown in Figure 29A, and
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16/83 [000102] Figure 29C is a side cross-sectional view of the feeding shoe of Figure 29A arranged inside the feeding bar of Figure 29B, and engaging with it.
DETAILED DESCRIPTION OF THE INVENTION [000103] The present invention generally provides a surgical clip applicator and methods for using a surgical clip applicator for applying surgical clips to a blood vessel, duct, anastomosis, etc., during a surgical procedure. An exemplary surgical clip applicator may include a variety of features to facilitate the application of a surgical clip, as described in the present invention and illustrated in the drawings. However, the person skilled in the art will understand that the surgical clip applicator may include only some of these features and / or may include a variety of other features known in the art. The surgical clip applicator described here is intended merely to represent certain exemplifying modalities.
[000104] Figure 1A illustrates an exemplary surgical clip 10 applicator. As shown, the clip applicator 10 generally includes a wrap 12 having a stationary cable 14 and a movable cable or trigger 16 that is pivotally coupled to the wrap
12. An elongated rod 18 extends from the wrap 12 and includes a pair of opposing claws 20 formed on a distal end thereof, to crimp a surgical clip. The elongated stem 18 can be rotationally coupled to the wrap 12, and may include a rotary button 22 for rotation of the stem 18 with respect to the wrap 12. Figure 1B illustrates an exploded view of the surgical clip applicator 10 shown in Figure 1A, and the various components will be described in more detail below.
[000105] Figures 2A to 12 illustrate exemplary modalities of the various components of stem 18 of the surgical clip applicator
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10. In general, with reference to Figure 1B, the stem 18 includes an outer tube 24 that houses the stem components, which may include a jaw retainer assembly 26 that has a jaw retainer stem 28 with a clip rail 30 and a channel for rod 32 formed thereon. The claws 20 can be configured to fit at a distal end of the clip rail 30. The stem assembly 18 may also include a clip advance assembly which, in an exemplary embodiment, may include a feeder shoe 34 that is adapted for be slidably arranged within the clip rail 30 to advance a series of clips 36 positioned therein, and a feed bar 38 which is adapted to guide the feed shoe 34 through the clip rail 30. The feed bar 38 can include a forward assembly 40 which is adapted to fit at a distal end thereof, so as to advance the most distal clip into the claws 20. The stem assembly 18 may also include a clip forming assembly or a assembly cam, which, in an exemplary embodiment, may include a cam 42 that is adapted to slide into claws 20, and a rod 44 that can be coupled moves to cam 42 to move said cam 42 with respect to grips 20. The stem assembly may also include a tissue blocker 46 that can fit to a distal end of the clip rail 30, in order to facilitate the positioning of the claws 20 in relation to a surgical site.
[000106] The various components of an example clip advance assembly are shown in more detail in Figures 2A to 5. First with reference to Figures 2A to 2D, the claw retainer assembly 26 is shown and it includes a rod of the elongated and substantially flat claw retainer 28, with a proximal end 28a that fits the outer tube 24, and an end
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18/83 distal 28b which is adapted to fit the claws 20. Although a variety of techniques can be used to fit the proximal end 28a of the claw retainer rod 28 to 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 inside corresponding holes or openings (not shown) formed in the outer tube 24, and a cutout 29 formed therein that allows the opposite sides of the proximal end 28a bend or form a spring. In particular, the cutout 29 allows the opposite sides of the proximal end 28a of the claw retainer rod 28 to be compressed towards each other when the claw retainer rod 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 claw retainer rod 28 will return to its original uncompressed configuration, thus causing the teeth 31 to extend into the corresponding openings to engage the tube external 24. As will be discussed in more detail below, in relation to Figure 4A, the device may also include a feature to prevent compression of the opposite sides of the proximal end 28a of the claw retainer rod 28 during use of the device, to prevent accidentally detaching the teeth 31 from the outer tube 24.
[000107] A variety of techniques can also be used to fit the distal end 28b of the claw retainer 28 to the claws 20, however in the illustrated embodiment the distal end 28b of the claw retainer 28 includes several indentations or formed teeth 78 in the same to fit with the corresponding protuberances or teeth 94 formed on the claws 20, which will be discussed in more detail below, in relation to Figure 7. Teeth 78 allow a proximal portion of the claws 20 to be substantialPetition 870190088792, from 09 / 09/2019, p. 21/93
19/83 co-planar with the claw retainer rod 28.
[000108] The claw retainer assembly 26 can also include a channel of the rod 32 formed in it to receive the slide 44, which is used to advance the cam 42 over the claws 20, as will be discussed in more detail below. The channel of rod 32 can be formed using a variety of techniques, and can have any shape and size, depending on the shape and size of rod 44. As shown in Figure 2D, the channel of rod 32 is fixedly attached, for example by welding, to an upper surface of the retaining rod 28, it has a substantially rectangular shape and defines a route 32a extending through it. The rod channel 32 may also extend over all or only a portion of the retaining rod 28. The skilled person will understand that the claw retainer assembly 26 does not need to include a rod channel 32 to facilitate the movement of the rod 44 inside the elongated nail 18 of the surgical clip applicator 10.
[000109] As additionally shown in Figures 2A to 2D, the gripper retainer assembly 26 may also include a clip rail 30 fitted to or formed on it. The clip rail 30 is shown attached to a lower surface of the claw retainer rod 28, and extends distally beyond the distal end 28b of the claw retainer rod 28, to allow a distal end 30b of the clip rail 30 is substantially aligned with the claws 20. During use, the clip rail 30 is configured to accommodate at least one and, preferably, a series of clips. Consequently, the clip rail 30 may include opposite side rails 80a and 80b which are adapted to accommodate opposite legs of one or more clips therein so that the clip legs are axially aligned with each other or
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20/83 tra. In an exemplary embodiment, the clip rail 30 can be configured to accommodate about twenty clips that are pre-arranged within the clip rail 30 during manufacture. The person skilled in the art will understand that the shape, size and configuration of the clip rail 30 can vary depending on the shape, size and configuration of the clips, or other closing devices such as clips, adapted to be received there. In addition, a variety of other techniques can be used, instead of a clip rail 30, to secure a supply of clips with the elongated rod 18.
[000110] The clip rail 30 may also include several openings 30c formed there to receive a lock 82a formed on a feeder shoe 34 adapted to be arranged inside the clip rail 30, as will be discussed in more detail below. In an exemplary embodiment, the clip track 30 includes an amount of openings 30c that corresponds to at least the number of clips adapted to be pre-arranged inside the device 10 and applied during use. The openings 30c are preferably equidistant from each other to ensure that the latch 82a on the feeder shoe 34 engages an opening 30c each time the feeder shoe 34 is advanced. Although not shown, the clip rail 30 can include holders instead of openings 30c, or it can include other features that allow the clip rail 30 to engage the feeder shoe 34 and prevent proximal movement, but allow distal movement, of the feeder shoe 34. The clip rail 30 may also include a locking latch 118 formed thereon, as shown in Figure 2B, which is effective to be engaged by a corresponding locking latch formed on the feeder foot 34 to prevent the movement of the feeder shoe 34 beyond a more distal position, as will be
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21/83 discussed below. Locking latch 118 can have a variety of configurations, but in an exemplary embodiment it is in the form of two adjacent flaps that extend towards each other to enclose a portion of the clip rail, thus allowing the clips to pass through the same.
[000111] An exemplary feeder shoe 34 is shown in more detail in Figures 3A and 3B, and can be adapted to direct the clips directly through the clip rail 30. Although the feeder foot 34 can have a variety of configurations, and a variety of other techniques can be used to guide clips through the clip track 30, in an exemplary embodiment the feeder shoe 34 has a generally elongated shape with proximal and distal ends 34a and 34b. The distal end 34b can be adapted to accommodate the most proximal clip on the clip track 30, to push one or more clips through the clip track 30. In the illustrated example, the distal end 34b is substantially V-shaped to accommodate a V-shaped fold portion of a clip. The distal end 34b also includes a rectangular shaped notch 34c formed therein to allow the fin 40 to engage a more distal clip and advance it into the claws 20, as will be discussed in more detail below. The distal end 34b can, of course, vary depending on the configuration of the clip or other closing mechanism being used with the device 10.
[000112] In another exemplary embodiment, the feeder shoe 34 can also include features to facilitate the distal movement of the feeder shoe 34 within the clip rail 30, and to substantially prevent the proximal movement of the feeder shoe 34 within the feeder rail. clips 30. This type of configuration will ensure the advance and proper positioning of the clips within the
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22/83 clips 30, thus allowing a more distal clip to be advanced between the claws 20 with each triggering of the trigger 16, as will be discussed in more detail below. In the illustrated exemplary embodiment, the feeder shoe 34 includes a lock 82a formed on an upper surface 34s thereof and proximally angled to engage one of the openings 30c formed on the clip rail 30. During use, the lock angle 82a allows the feeder shoe 34 to slide distally into the clip rail 30. Each time the feeder shoe 34 is advanced, the latch 82a will move in a distal direction from an opening 30c to the next opening 30c on the clip rail 30. Engaging latch 82a with opening 30c on clip rail 30 will prevent feeder shoe 34 from moving proximally to return to the previous position, as will be described in more detail below.
[000113] In order to facilitate the distal movement of the feeder shoe 34 within the clip rail 30, the feeder foot 34 can also include a latch 82b formed on the bottom surface 34i thereof, as shown in Figure 3B, to allow the feeder shoe 34 is engaged by feeder bar 38 (Figure 4A) as feeder bar 38 moves distally. The lower latch 82b is similar to the upper latch 82a in that it can be placed proximally at an angle. During use, each time the feeder bar 38 is moved distally, a holder 84 formed on the feeder bar 38 can engage the lower latch 82b and move the feeder shoe 34 distally by a predetermined distance within the clip rail 30. The feed bar 38 can then be moved proximally to return to its initial position, and the angle of the lower latch 82b will allow latch 82b to slide into the next stop 84 formed on the feed bar 38. As previously noted, you can use a variety of other re
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23/83 strokes, different from locks 82a and 82b and openings 30c or holders 84, to control the movement of the feeder shoe 34 within the clip rail 30.
[000114] As previously mentioned, the feeder shoe 34 can also include a lock formed thereon that is adapted to block the movement of the feeder shoe 34 when it is in the most distal position and there are no more clips on the device 10. Although the lock may have a variety of configurations, Figures 3A and 3B illustrate a third latch 82c formed on the feed shoe 34 and extending in a lower direction to engage the lock latch 118 (Figure 2B) formed on the clip rail 30. The third latch 82c is positioned in such a way that it will engage the lock latch 118 on the clip rail 30 when the feeder shoe 34 is in a more distal position, thereby preventing the distal movement of the feeder shoe 34 and the feeder bar 38 when the clip supply is depleted. [000115] In another embodiment, the surgical clip applicator may have a locking mechanism that can indicate to a user when a supply of clips from the surgical clip applicator is depleted. The locking mechanism can, for example, prevent the user from fully opening a surgical clip applicator trigger to thereby indicate that the last clip has been applied. This prevents the user from continuing to try to apply clips in the belief that units remain in the clip supply. The locking mechanism can have many configurations, but in an exemplary embodiment, the locking mechanism is configured to lock the clip advance assembly of the surgical clip applicator in a fixed position after a more proximal clip has been advanced into the opposite claws of the clip applicator. This, in turn, is effective for locking trigger 16 in a fixed position, which is operatively associated with the assembly
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24/83 clip advance. This way, as the user tries to release the trigger 16 of the clip applicator and return it to its open position, the locked feeder and feeder bar prevent the trigger from returning to its open position, thus indicating to the user that the supply of clips is depleted.
[000116] Although the locking mechanism can have any configuration and can be formed in several locations on the device, in one embodiment the locking mechanism is in the form of a latching feature formed on the feeder shoe and the feeder bar. Figures 3C and 3D illustrate an exemplary embodiment of a 34 '' 'feeder shoe that has a latching feature formed on it for coupling with a corresponding latching feature on the feeder bar, as will be discussed in more detail below. Similar to the previous modality, the illustrated 34 '' 'feeding shoe has a generally elongated shape with proximal and distal ends 34a' and 34b '. The distal end 34b 'is adapted to accommodate the most proximal clip on the clip rail 30, to push one or more clips through the clip rail 30. In this embodiment, the distal end 34b' is substantially V-shaped to accommodate a portion V-shaped corner of a clip. The distal end 34 'may also include a rectangular shaped notch 34c' formed therein to allow the lead 40, 40 '' to engage a more distal clip and advance it into the claws 20, as will be discussed in more detail below. The distal end 34b 'can, of course, vary depending on the configuration of the clip or other closing mechanism being used with the device 10.
[000117] The illustrated 34 '' 'feeder shoe may also include a number of features, such as locks similar to those discussed above in relation to the feeder shoe 34 shown in Figures
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3A and 3B, to facilitate the distal movement of the feeder shoe 34 '' 'within the clip rail 30, and to substantially prevent the proximal movement of the feeder shoe 34' '' within the clip rail 30. This type of configuration will ensure the advance and proper positioning of the clips within the clip rail 30, thus allowing a more distal clip to be advanced between the claws 20 with each triggering of the trigger 16, as will be discussed in more detail below. For example, one or more latches can be arranged on the feeder foot 34 '' 'to engage the clip rail 30. The latches can generally be rectangular in shape and can be formed by cutting three sides of a rectangle from the feeder shoe 34 '' 'and the deflection of this rectangle so as to move away from the feeder shoe 34' so as to form a projecting flap. The latches that are proximally angled may be spaced from an upper or lower surface of the feeder shoe 34 '' 'at its proximal end, so as to form a clip that will engage the clip rail 30 when the feeder shoe 34' '' is moved proximally. Likewise, the locks that are distally angled may be spaced in relation to an upper or lower surface of the feeder shoe 34 '' 'at its distal end, so as to form a clip that will engage the clip rail 30 when the 34 '' feeder shoe is moved distally. In the illustrated exemplary embodiment, the feeder shoe 34 '' includes a lock 82a 'which projects above an upper surface 34s' of the feeder shoe 34' '' and which is proximally angled to engage one of the openings 30c formed on the clip rail 30. During use, the angle of the lock 82a 'allows the feeder shoe 34' '' to slide distally into the clip rail 30. Each time the feeder shoe 34 '' 'is advanced, the lock 82a 'will move in a distal direction from an opening 30c to the pro
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26/83 maximum opening 30c in the clip rail 30 (shown in Figure 6A). Engaging latch 82a 'with opening 30c on clip rail 30 will prevent feeder shoe 34' '' from moving proximally to return to the previous position, as will be described in more detail below.
[000118] In order to facilitate the distal movement of the feeder shoe 34 '' 'within the track of clips 30, the feeder shoe 34' '' can also include a lock 82b 'that protrudes below the bottom surface 34i' thereof, as shown in Figure 3D, to allow the feeder foot 34 '' 'to be engaged by a feeder bar 38' as the feeder bar 38 'moves distally. The lower latch 82b 'is similar to the upper latch 82a' in that it can be placed proximally at an angle. During use, each time the feeder bar 38 'is moved distally, a stop 84 formed on the feeder bar 38' can engage the lower latch 82b 'and move the feeder foot 34' '' distally by a predetermined distance within of the clip rail 30. The feed bar 38 'can then be moved proximally to return to its initial position, and the angle of the lower lock 82b' will allow the lock 82b 'to slide into the next stop 84 formed on the feed bar 38 '. As previously noted, a variety of other features can be used, other than locks 82a 'and 82b' and openings 30c or holders 84, to control the movement of the feeder shoe 34 '' 'within the clip rail 30.
[000119] The feeder shoe 34 '' 'can also include a lock formed thereon which is adapted to block the distal movement of the feeder shoe 34' '' when it is in the most distal position and there are no more clips on the device 10. Although the lock can have a variety of configurations, Figures 3C and 3D illustrate a third latch 82c 'formed on the feeder shoe 34' '' that projects below the bottom surface and is in
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27/83 angle for engaging the locking latch 118 (Figure 2B) formed on the clip rail 30. The third latch 82c 'is positioned in such a way that it will engage the locking latch 118 on the clip rail 30 when the feeder shoe 34 '' 'is in a more distal position, thus preventing the distal movement of the 34' '' feeder shoe and the 38 feeder bar when the clip supply is depleted. [000120] The 34 '' 'feeder shoe can additionally include a locking mechanism which is adapted to lock a 40' feeder and the 38 'feeder bar, described in more detail below, in a fixed position after the 40 feeder '' having advanced the most proximal clip into the claws 20. This type of locking mechanism can provide tactile feedback to a user, to ensure that the user is aware that the clip supply is depleted. Although the locking mechanism can have many configurations, in the mode illustrated in Figures 3C and 3D, the feeder shoe 34 '' includes a fourth lock 82d 'that extends below the bottom surface and is distally angled. A proximal portion 83 of the lock 82d 'is connected with the feed shoe 34' '' while a distal portion 85 is not connected with the feed shoe 34 '' 'and is spaced a distance from the bottom surface. The latch 82d 'is positioned to engage a recess 51 formed in the forward 40' and the feed bar 38 'to thereby prevent the forward 40' 'and the feed bar 38' from moving proximally back to their position as will be described in more detail below.
[000121] Figure 4A illustrates an exemplary feed bar 38 for guiding the feed shoe 34 through the clip rail 30 of the gripper retainer assembly 26. As shown, the feed bar 38 has a generally elongated shape with proximal and distal ends 38a and 38b. The proximal end 38a of the bar
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28/83 feeder 38a may be adapted to fit a feeder bar coupler 50 (Figure 1B), which will be discussed in more detail below. The feed bar coupler 50 can be fitted to a feed link 52 which is effective, by triggering the trigger 16, to slide the feed bar 38 in a distal direction within the elongated rod 18. The distal end 38b of the bar feeder 38b can be adapted to fit a feeder 40 and 40 ', of which exemplary modalities are shown in Figures 5A and 5B, which is effective for guiding a more distal clip arranged inside the clip rail 30 into the claws 20, which will be discussed in more detail below.
[000122] 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 claw retainer rod 28 (Figures 2A and 2B) during use of the device, for prevent accidental detachment of teeth 31 from external tube 24. In an exemplary embodiment, shown in Figures 4A to 4C, the proximal end 38a of the feed bar 38 may include a protuberance 39 formed thereon, which is adapted to extend into the opening 29 formed at the proximal end 28a of the claw retainer rod 28. When the feed bar 38 is in a more proximal position (that is, when the trigger 16 is in an open position), the protrusion 39 will be positioned at the proximal end of opening 29, as shown in Figure 4B, allowing the proximal end 28a of the claw retainer rod 28 to compress to stand allow the rod 28 to slide into the outer tube 24. When the feed bar 38 is in a more distal position (that is, when the trigger 16 is in a position at least partially closed), the protrusion 39 will be positioned in one location intermediate adja
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29/83 close to teeth 31 as shown in Figure 4C, to prevent compression of the proximal end 28a of the claw retainer stem 28. This is particularly advantageous when using the device, as the protrusion 39 will prevent accidental disengagement of the stem of the claw retainer 28 from the outer tube 24, while using the device. Although Figures 4A to 4C illustrate a protuberance 39 with a shape in rectangular cross section with rounded edges, the protuberance 39 can 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 approximately triangular, with a tapered end that is adapted to extend between the teeth 31 to further ensure that the proximal end 28a of the claw retainer rod 28 cannot be compressed while using the device. You can also use more than one lump. For example, Figures 4F to 4H illustrate another embodiment in which the proximal end 38a 'of the feed bar 38 includes two protrusions 39a and 39b formed on it and spaced from each other by a distance. The two protrusions 39a and 39b will prevent compression of the proximal end 28a of the claw retainer rod 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. Compression of the proximal end 28a of the claw retainer rod 28 can occur only when the feed bar 38 is in an intermediate position, so that the teeth 31 are positioned between the protrusions 39a and 39b, as shown in Figure 4G.
[000123] As previously mentioned, the feed bar 38 may include one or more holders 84 trained in the
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30/83 same to engage the lower latch 82b formed on the feeder shoe 34. The number of holders 84 can vary but, in an exemplary embodiment, the feeder bar 38 has a number of holders 84 that corresponds to, or is greater than, a number of clips adapted to be applied by device 10 and, more preferably, has a holder 84 more than the number of clips adapted to be applied by device 10. As a non-limiting example, the feed bar 38 may include eighteen holders 84 formed in it for the application of seventeen clips that are pre-arranged inside the clip rail 30. This type of configuration allows the feed bar 38 to advance the feed shoe 34 seventeen times, thus advancing seventeen clips into the claws 20 for application. Holders 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.
[000124] The feed bar 38 can also include a feature to control the amount of movement of the feed bar 38 in relation to the clip rail 30. This type of configuration will ensure that the feed shoe 34 is advanced by a predetermined distance at each once the trigger 16 is pulled, thus advancing only a single clip into the claws 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 protrusion 86 formed on top of it, which is adapted to be received slidingly inside a corresponding slot 88 (Figure 2B) formed on the claw retainer rod 28. The length of the slot 88 is effective in limiting the movement of the protrusion 86 in the thus limiting the movement of the feed bar 38. Consequently, during the
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31/83 use the feed bar 38 can slide between a fixed proximal position and a fixed distal position in relation to the clip rail 30, thus allowing the feed bar 38 to advance the feed shoe 34 by a predetermined distance with each feed bar advance 38.
[000125] Figure 4I illustrates another exemplary embodiment of a feed bar 38 '. In the illustrated embodiment, the feed bar 38 'is the same as that of the embodiment described in Figure 4A, except for its distal end 38b'. The distal end 38b 'can be configured to fit the feeder 40' 'which will be described in more detail below, and can be used with the feeder shoe 34' described above. As noted above, the feeder shoe 34 'may have a locking mechanism that is capable of locking the feeder 40' 'and the feeder bar 38' in place after a more proximal clip has been advanced into the grips 20. The feed mechanism the lock may be, for example, a latch 82d 'formed on the feed shoe 34' which is adapted to engage a recess 51a formed on the feed bar 38 ', as shown in Figure 4I. The recess 51a, in combination with the recess 51b, is configured to capture and secure the lock 82d 'as the feeder 40' 'and the feed bar 38' are moved over the feeder shoe 34 '. The recesses 51a and 51b can be of any size, as needed, and can be formed on the same side of the feed bar 38 'with the holders 84. In the illustrated embodiment, the recesses 51a and 51b are in the shape of a square and have side walls configured to receive the lock 82d 'between them. Once engaged, lock 82d 'is unable to move out of recesses 51a and 51b, thereby locking forward 40' 'and feeder bar 38' in a locked position. The feed bar 38 'may also include an elongated recess
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32/83 of the 57 formed at its distal end 38b 'to receive the proximal end 53 of the forward 40' 'so that the two components can be fitted together, as described below. [000126] Figure 5A illustrates an exemplary embodiment of a feeder 40 which is adapted to fit the distal end 38b of the feed bar 38 and which is effective for guiding a more distal clip from the clip rail 30 into the claws 20. A variety of techniques can be used to attach the striker 40 to the feed bar 38, but in the illustrated embodiment the proximal end 40a of the striker 40 is in the form of a female connector that is adapted to receive the male connector formed at the distal end 38b of the feed bar 38. Preferably, the feeder 40 is fixedly attached to the feed bar 38 but can optionally be integrally formed with the feed bar 38. The distal end 40b of the feed bar 38 is preferably adapted for advancing a clip into the jaws 20, and thus the distal end 40b of the lead 40 may include, for example, a clip propeller element 90 formed in the same. The clip propulsion element 90 may have a variety of shapes and sizes, but in an exemplary embodiment, it has an elongated shape with a recess 92 formed at the distal end thereof to accommodate the fold portion of a clip. The shape of recess 92 may vary depending on the specific configuration of the clip. The clip drive element 90 can also extend at an angle in a higher direction relative to a longitudinal axis A of the fin 40. This type of configuration allows the clip drive element 90 to extend into the clip rail 30 to engage a clip, while the remainder of the fin 40 extends substantially parallel to the clip rail 30.
[000127] Figure 5B illustrates another exemplary modality
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33/83 of a clip driving element 90 'of a forward 40'. In this embodiment, the clip propelling element 90 'is slightly narrower and has a small recess 92' formed at its most distal end. During use, the forwarder 40 can engage and advance only the most distal clip arranged inside the clip rail 30 into the claws 20. This is due to the positioning of the feed bar 38, which is able to move in a sliding way between fixed proximal and distal positions, as previously discussed.
[000128] Figures 5C and 5D illustrate yet another exemplary embodiment of a clip propelling element or distal tip 90 '' of a 40 '' forwarder. In this modality, the clip propelling element or the 90 '' distal tip has been modified to allow the apex of a surgical clip to be advanced into the claws to move in the upper and lower directions, while still maintaining contact with the apex of the surgical clip. In addition, and as noted above, the lead 40 '' may include a recess 51b formed near the proximal end 53 thereof. The recess 51b can be of any size and shape, as needed to capture and maintain the latch 82d 'formed on the feed shoe 34' so that the feeder 40 '', as well as the feeder bar 38 'to which the feeder 40' ' is engaged, locked in position and unable to move to an open position after a more proximal clip has been advanced into the claws 20.
[000129] Regarding the distal tip 90 '', in general, the distal tip 90 '' has an elongated configuration with a proximal end 90p '' which is coupled to a body portion or stem 42 '' of the forward 40 '' The stem 42 '' can have different shapes and sizes, but in the illustrated embodiment, the stem 42 '' has a generally flat configuration with upper and lower surfaces 42s '' and 42i ''. The configuration
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34/83 specific rod 42 '', with the exception of the distal tip 90 '', may be similar to that of the modalities previously described here. In an exemplary embodiment, the distal tip 90 '' and the stem 42 '' can be formed as a single integral component, but each component can be formed from different materials. For example, the distal tip 90 '' can be formed from a metal, while the entire stem 42 '' or a portion of the stem 42 '' can be formed from a plastic that is integral to the feed bar 38 and overmoulded to the 90 '' distal metal tip. Regardless of the specific material used, the distal tip 90 '' is preferably formed from a flexible material that allows the tip 90 '' to curve in upper and lower directions in relation to the stem 42 ''. In certain exemplary embodiments, the distal tip 90 '' can be formed by perforating a predetermined shape from a flat sheet of metal and then folding the opposite sides of the shape together to form the tip as shown, with the bottom surface being hollow.
[000130] As indicated above, the distal tip 90 '' can be configured to allow an apex of a surgical clip to be advanced into the jaws by the tip, to move in the upper and lower directions while still maintaining contact with the apex of the clip. In other words, the distal tip 90 '' may have a height that is greater than a height of the apex, as measured in the upper / lower direction (i.e., transverse to the longitudinal axis of the forward 40 ''). This will allow the apex of the clip to slide up and down along the tip. In particular, as shown in Figure 5D, a surface facing the distal side 41 of the clip propelling element 90 '' can have a height H, measured in an upper / lower direction, which is greater than a height (as measured in the same direction) of a clip apex pushed by the 90 '' clip propeller element,
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35/83 as will be described in more detail below. The increased height may result from a distal slope surface 43, formed on a lower surface of the tip 90 '' and situated adjacent to the distal end 90d '' of the tip 90 ''. The distal slope surface 43 can be in the form of a ramp portion or a surface feature. As additionally shown in Figures 5C and 5D, the distal tip 90 '' can also include a proximal tilt surface 45 formed on a lower surface of the tip 90 '' and located adjacent to the proximal end 90p '' of the tip 90 ''. The two inclination surfaces 43 and 45 can be configured to interact with the tissue blocker, as will be described in detail below, and thus to deflect in the upper and lower directions in relation to the tissue blocker. The flexible or resilient material used to form the 90 '' forward tip can facilitate repeated flexing of the distal 90 '' tip. As additionally shown in Figures 5C and 5D, an upper or top portion 47 of the 90 '' clip propeller element may be substantially straight and may extend upward at an angle between the proximal end 90p '' of the tip 90 '' and the distal end 90d '' from the tip 90 ''. The person skilled in the art will understand that the specific configuration of the 90 '' distal tip may vary depending on the desired movement of the tip during use.
[000131] Figure 5E illustrates the forwarder 40 '' and the feed bar 38 'fitted together. As shown, the distal end 53 of the lead 40 '' is disposed within the recess 57 formed in the feed bar 38 '. The two can be attached to each other using any known technique including, but not limited to, pressure or interference fit, adhesives, fasteners, etc. The recesses 51a and 51b can extend fully through the proximal end 53 of the forward 40 '', and can extend into the distal end 38b 'of the feed bar
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38 '.
[000132] Figures 6A to 6F illustrate the clip advance assembly in use and, in particular, Figures 6A to 6D illustrate the movement of the feed bar 38 inside the clip rail 30 to advance the feed shoe 34 and the supply of clips 36, while Figures 6E to 6F illustrate the movement of the fin 40 to advance a more distal clip into the claws 20. The components in the wrap 12 which are used to drive the clip advance assembly will be discussed in more detail below.
[000133] As shown in Figure 6A, in the resting position the feeder bar 38 is in a more proximal position, so that the protrusion 86 is positioned proximally within the elongated slot 88 in the rod of the claw retainer 28. The feeder shoe 34 is arranged inside the clip rail 30 and, assuming that the device 10 has not yet been used, the feeder shoe 34 is in a more proximal position, so that the upper lock 82a on the feeder shoe 34 is engaged with the most open opening. proximal, or first opening, 30c1 formed on the clip rail 30 to prevent the proximal movement of the feeder shoe 34, while the lower latch 82b on the feeder shoe 34 is positioned between the first holder 841 and the second holder 842 on the feeder bar 38, so that the lower latch 82b is forced in an upper direction by the feed bar 38. The holders 84 on the feed bar are identified sequentially such as 84i, 842, etc., and the openings 30c in the clip rail 30 are identified sequentially as 30ci, 30c2, etc. As additionally shown in Figure 6A, a series of clips 36, identified sequentially as 361, 362,. . . 36x, with 36x being the most distal clip, are positioned inside the clip rail 30, distal in relation to the feeder shoe 34.
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37/83 [000134] By activating the trigger 16, the feed bar 38 is advanced distally, causing the protrusion 86 to slide distally into the slot 88. As the feed bar 38 moves distally, the lower lock 82b on the shoe feeder 34 will slide into first holder 841 on feeder bar 38. Additional distal movement of feeder 38 will cause first holder 841 to engage with bottom latch 82b, as shown in Figure 6B, and move feeder shoe 34 and supply of clips 36i, 362, etc. in a distal direction. As shown in Figure 6C, when the protrusion 86 is contiguous with the distal end of the elongated slot 88 on the claw retainer rod 28, the feed bar 38 is prevented from making any further distal movement. In that position, the feeder shoe 34 advanced a predetermined distance in order to advance the supply of clips 36i, 362, ... 36x inside the clip rail 30 for a predetermined distance. The upper latch 82a of the feeder shoe 34 has been advanced into the second opening 30c2 in the clip rail 30 to prevent proximal movement of the feeder foot 34, and the lower latch 82b on the feeder foot 34 is still engaged with the first holder 841 on the bar feeder 38.
[000135] The movement of the feeder bar 38 from the most proximal starting position, shown in Figure 6A, to the most distal final position, shown in Figure 6C, will also advance the most distal clip 36x into the claws 20. In particular, as shown in Figure 6E, the distal movement of the feed bar 38 will cause the clip propeller element 90 of the feeder 40, which is attached to the distal end of the feed bar 38, to engage the most distal clip 36x disposed within the clip rail. 30, and advance said clip 36x into the claws 20, as shown in Figure 6F. In an exemplary modality, the forward 40 will engage and
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38/83 will start advancing the most distal clip 36x before engaging and starting advancing the feeder shoe 34. As a result, the most distal clip 36x will advance a distance that is greater than the distance traveled by the feeder shoe 34. This type of configuration allows only the most distal clip 36x to be advanced into the claws 20 without accidentally advancing an additional clip into the claws 20.
[000136] Once the 36x clip has been partially or fully formed, trigger 16 can be released to release the formed 36x clip. Releasing trigger 16 will also retract feeder bar 38 in a proximal direction, until protuberance 86 returns to the most proximal initial position within elongated slot 88, as shown in Figure 6D. As the feeder bar 38 is proximally retracted, the feeder foot 34 will not move proximally, as the upper latch 82a will engage the second opening 30c2 on the clip rail 30. The lower latch 82b will not interfere with the proximal movement of the feeder bar 38 and, once the feed bar 38 is in the most proximal starting position, as shown, the lower latch 82b will be positioned between the second holder 842 and the third holder 843 on the feed bar 38.
[000137] The process can be repeated to advance another clip into the claws 20. With each actuation of the trigger 16, the lower lock 82b will be engaged by the next holder, that is, the holder 842 formed in the feed bar 38, the upper lock 82a in the feeder shoe 34 will be moved distally to the next opening, i.e., the opening 30cs in the clip rail 30, and the most distal clip will be advanced into the claws 20 and released. In cases where the device 10 includes a predetermined number of clips, for example, seventeen clips, the trigger 16 can be operated seventeen times. Once the last clip has been applied, the lock, for example
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39/83 For the third latch 82c, the feed shoe 34 can engage the lock latch 118 on the clip rail 30 to prevent any further distal movement of the feed shoe 34.
[000138] As explained above, in another embodiment the clip applicator may include a locking mechanism that is effective for locking the trigger 16 in a partially open position after the last clip has been applied, thus indicating to a user that the last clip was applied. Figure 6G illustrates the use of a locking mechanism formed between the feed bar 38 'of Figure 4I and the feed shoe 34' '' of Figures 3C and 3D. During use, when the last clip is applied to the fabric, the locking mechanism can lock the forward 40 '' (shown in Figures 5C-E) and the feed bar 38 'in place in relation to the feed foot 34' '' for thus preventing the trigger 16 from opening to its starting position. In particular, as the 34 '' 'feeding shoe advances the most proximal clip (that is, the last remaining clip on the clip track) to the position to be advanced into the claws 20, it moves in a sliding hitch with the 40 '' forwarder. Trigger 16 can be triggered from its initial position to cause the feeder 40 '' to move the most proximal clip into the claws 20. As the feeder 40 '' and the feed bar 38 'move distally adjacent to the feed shoe 34 '' 'to move the most proximal clip into the claws 20, the recesses 51a and 51b move distally over the lock 82d'. Moving distally, recesses 51a and 51b do not engage with latch 82d 'because latch 82d' is distally angled. As the trigger 16 is released, however, the lead 40 '' and the feed bar 38 'begin to move proximally adjacent to the feed shoe 34' ''. Once the recesses 51a and 51b reach the lock 82d ', it will extend into the recesses 51a and 51b and will engage them to lock the forwarder
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40 '' and the feed bar 38 '' in a fixed position, preventing further proximal movement. This engagement between recesses 51a and 51b and lock 82d 'preferably occurs before the trigger is fully open. In other words, engagement preferably occurs when trigger 16 is in a partially open position. The engagement between the feeder foot 34 '', the feeder 40 '' and the feed bar 38 '' also preferably occurs when a tongue and ratchet mechanism associated with the trigger is in a position in which the tongue is prevented from turning, as will be discussed in more detail below. This will prevent further movement of the trigger 16 in any direction. Consequently, the inability of the trigger to move in any direction will indicate to a user that the clip supply is depleted.
[000139] The feeder foot 34, the feeder bar 38, and / or the clip rail 30 can also optionally include features to prevent accidental or unintentional movement of the feeder foot 34, for example during transport of the device. This is particularly advantageous, since the migration of the feeder shoe 34, particularly before the first use of the device, can cause it to malfunction. For example, if the feeder shoe 34 migrates distally, it will advance two clips into the jaws simultaneously, thus resulting in the application of two malformed clips. As needed, in an exemplary embodiment the feeder shoe 34, feeder bar 38, and / or the clip rail 30 can include a latching mechanism and / or can be configured to generate a frictional force between them that is sufficient to resist movement, but which can be overcome by triggering the trigger 16, to allow the feed bar to advance the feed shoe 34 through the clip rail 30.
[000140] Although several techniques can be used to prevent the
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41/83 undesirable migration of the feeder shoe 34 within the clip rail 30, Figures 27A to 29C illustrate various modalities exemplifying techniques for creating friction or an engagement mechanism between the feeder foot 34, the feeder bar 38, and / or the clip rail 30. First with reference to Figure 27A, an exemplary embodiment of a feeder shoe 34 'is shown that has a preformed configuration in cantilever or arched in a free state (that is, when the feeder shoe 34' is removed from the clip rail 30), so that the feeder foot 34 'forms a cantilever spring when disposed within the clip rail 30. In particular, a portion of the feeder foot 34' may include a bend 35 'formed in the same, so that the opposite ends 34a 'and 34b' of the feeder shoe 34 'are at an angle to each other. Flexion 35 'can cause the height hb of the feeder shoe 34' to be greater than the height of the clip rail 30. Although the height hb may vary, in an exemplary embodiment the flexion 35 'is configured to increase a height of the shoe feeder 34 'in an amount that is sufficient to create a frictional drag force between the feeder shoe 34' and the clip rail 30, but still allows the feeder shoe 34 'to slide inside the clip rail 30 when the trigger 16 is triggered. In an exemplary embodiment, the height of the feeder shoe 34 'is increased by at least about 30% or, more preferably, about 40%. During use, the clip rail 30 will force the feeder shoe 34 'into a substantially flat configuration, so that the feeder foot 34' is forced against the clip rail 30 when disposed thereon. The flexion 35 'of the feeder foot 34', as well as the end ends 34a 'and 34b' of the feeder foot 34 ', will therefore apply a force to the clip rail 30, thus creating a frictional drag force between the feeder foot
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34 'and the clip rail 30. The frictional force will prevent the feeder shoe 34' from migrating in relation to the clip rail 30 unless trigger 16 is pulled, in which case the force applied by the trigger 16 will overcome the frictional forces .
[000141] The person skilled in the art will understand that flexion 35 'can have a variety of configurations, and can be formed at any point along the length of the feeder shoe 34'. In Figure 27A, the flexion 35 'is formed in the middle portion of the feeder shoe 34', or close to it. Flexion 35 'can also extend in several directions. Although Figure 27A illustrates flexion 35 'extending in a direction perpendicular to the geometric axis, so that flexion 35' and ends 34a 'and 34b' apply force to the clip rail 30, flexion 35 'can alternatively extend along a longitudinal axis of the feeder foot 34 ', so that the feeder foot 34' applies a force to the opposite side rails 80a and 80b (Figure 2D) of the clip rail 30. Bending 35 'can also place the ends opposite 34a 'and 34b' at an angle in a downward direction, as shown in Figure 27A, so that the feeder shoe 34 'is substantially A-shaped or, alternatively, flexion 35' 'can place opposite ends 34a' ' and 34b '' at an angle in an upward direction, as shown in Figure 27B, so that the feeder shoe 34 '' is substantially V-shaped. The feeder shoe 34 'can also include any number of flexions formed in the same . The person skilled in the art will understand that the specific configuration of one or more flexions can be modified based on the properties of the feeder shoe 34 'and the clip rail 30, to obtain a desired amount of frictional force between them.
[000142] Figures 28A and 28B illustrate another modality of a technique for creating frictional forces between the feeding shoe
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43/83 dora and the clip rail. In this embodiment, the clip rail 30 'and / or the feeder shoe 34x may include one or more surface protuberances formed thereon. As shown in Figure 28A, two surface protrusions 82d1 and 82d2 are formed on the clip rail 30 '. Although surface protrusions 82d1 and 82d2 can be formed at various locations on the 30 'clip rail, including within the opposite side rails or along the total length of the 30' clip rail, or at various locations on the 34x feeder shoe on the illustrated embodiment two protuberances 82d1 and 82d2 are formed at a point adjacent to the proximal end of the 30 'clip rail, and are positioned so as to prevent the initial migration of the feeder shoe before use, for example, during transport. The size of protrusions 82d1 and 82d2 can vary depending on the amount of frictional force required to prevent unintentional migration from the 34x feeder shoe.
[000143] Although protrusions 82d1 and 82d2 can be configured to provide a sufficient amount of friction to avoid unintentional migration of the 34x feeder shoe, the 34x feeder shoe and / or the 30 'clip rail can optionally include a feature that is adapted to engage the corresponding surface protuberances. Figure 28B illustrates opposite latches 82e1, 82e2 formed on a distal portion of the feeder shoe 34x to engage protrusions 82d1, 82d2 on the clip rail 30 '. Latches 82e1, 82e2 may vary in shape and size, and may include a lip or other protrusion configured to engage or capture protrusions 82d1, 82d2. As shown in Figure 28B, the latches 82e1, 82e2 extend towards each other from opposite side walls of the 34x feeder shoe. [000144] Figures 29A to 29C illustrate another modality of a technique to prevent unintentional migration of the food shoe
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44/83 tadora. In this modality, friction is generated between the feeder shoe and the feeder bar. In particular, the feeder shoe 34y includes a lock 82f with a rim 82g formed thereon, as shown in Figure 29A, and the feeder bar 38y includes a corresponding groove 84y formed therein. During use, as shown in Figure 29C, flange 82g is configured to engage groove 84y to prevent unintentional migration of the feeder shoe 34y. The edge 82g and the groove 84y, however, are configured to allow movement of the feeder shoe 34y when sufficient force is applied to the feeder shoe 34y by triggering the trigger 16.
[000145] The person skilled in the art will understand that a variety of other techniques can be used to prevent the unintentional migration of a feeder shoe or other clip advance mechanism within a clip rail, and that any combination of features can be used and positioned in several places on one or both components.
[000146] Figures 7 to 9 illustrate several exemplifying components of a clip forming assembly. First with reference to Figure 7, an exemplary embodiment of the claws 20 is shown. As previously mentioned, the claws 20 may include a proximal portion 20a that has teeth 94 for coupling with corresponding teeth 78 formed on the claw retainer rod 28. Others techniques can, however, be used to fit the claws 20 to the claw retainer rod 28. For example, you can use a dovetail fitting, a male-female connection, etc. Alternatively, the claws 20 can be integrally formed with the retaining rod 28. The distal portion 20b of the claws 20 can be adapted to receive a clip between them, and thus, the distal portion 20b can include first and second claw elements.
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45/83 opposites 96a and 96b which are mobile relative to each other. In an exemplary embodiment, the claw elements 96a and 96b are forced into an open position, and a force is required to move the claw elements 96a and 96b towards each other. Each of the claw elements 96a and 96b can include a groove (only a groove 97 is shown) formed on opposite internal surfaces thereof, intended to receive the legs of a clip in alignment with the claw elements 96a and 96b. Each of the claw elements 96a and 96b can also include a cam track 98a and 98b formed thereon to allow the cam 42 to engage the claw elements 96a and 96b and move them towards each other. In an exemplary embodiment, the cam track 98a and 98b is formed on an upper surface of the clamping elements 96a and 96b.
[000147] Figure 8 illustrates an exemplary cam 42 for sliding coupling and engaging claw elements 96 and 96b. The cam 42 can have a variety of configurations, but in the illustrated embodiment it includes a proximal end 42a which is adapted to fit a rod 44, discussed in more detail below, and a distal end 42b which is adapted to engage. claw elements 96a and 96b. A variety of techniques can be used to attach the cam 42 to the rod 44, but in the illustrated exemplary embodiment the cam 42 includes a female or lock cutout element 100 formed therein and adapted to receive a male or key element 102 formed in the distal end 44b of rod 44. Male element 102 is shown in more detail in Figure 9, which illustrates rod 44. As shown, male element 102 has a shape that corresponds to the shape of cutout 100, to allow the two elements 42 and 44 fit together. The person skilled in the art will understand that the cam 42 and the rod 44 can optionally be integrally formed with the
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46/83 other. The proximal end 44a of the rod 44 can be adapted to fit a closing link assembly, discussed in more detail below, to move the rod 44 and the cam 42 with respect to the claws 20.
[000148] As additionally shown in Figure 8, cam 42 may also include a protrusion 42c formed thereon, which is adapted to be slidably received inside an elongated slot 20c formed in the claws 20. During use, the protrusion 42c and slit 20c can work to form a proximal block for the clip forming assembly.
[000149] Referring again to Figure 8, the distal end 42b of cam 42 can be adapted to engage claw elements 96a and 96b. Although a variety of techniques can be used, in the exemplary embodiment illustrated, the distal end 42b includes a cam channel or a tapered recess 104 formed therein to slide the cam track 98a and 98b into the gripper elements 96a and 96b. During use, as shown in Figures 10A and 10B, cam 42 can be advanced from a proximal position in which the claw elements 96a and 96b are spaced apart from each other, to a distal position in which the elements jaws 96a and 96b are positioned adjacent to each other and in a closed position. As the cam 42 is advanced over the clamping elements 96a and 96b, the tapered recess 104 will push the clamping elements 96a and 96b towards each other, thus crimping a clip arranged between them.
[000150] As previously mentioned, the surgical clip applicator 10 may also include a tissue blocker 46 to facilitate the positioning of the tissue at the surgical site within the claws 20. Figure 11A shows an exemplary embodiment of a tissue blocker 46 having proximal end and dis end
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47/83 such 46a and 46b. The proximal end 46a can be adapted to fit a distal end of the clip rail 30 for positioning the tissue blocker 46 adjacent to the claws 20. However, the tissue blocker 46 can be integrally formed with the clip rail 30, or it may be adapted to fit, or be integrally formed with, a variety of other stem components 18. The distal end 46b of tissue blocker 46 may be shaped that is adapted to accommodate a blood vessel between them, a duct, an anastomosis, etc. to position and align the claws 20 in relation to the target site. As shown in Figure 11A, the distal end 46b of the tissue blocker 46 is substantially V-shaped. The distal end 46b may also have a curved configuration to facilitate positioning the device through a trocar or other access tube.
[000151] The tissue blocker, or other device components, can also optionally include features to support and stabilize a clip during the formation of the clip. When a clip is being formed between the claws, the clip may rotate and become misaligned. In particular, as the claws are closed, the terminal end of each clip leg will be moved towards each other. As a result, the claws will only engage a flexed portion on each leg, thus allowing the terminal ends of the legs and the apex of the clip to escape alignment with the claws, that is, to rotate vertically in relation to the claws. Additional closing of the claws can thus result in a malformed clip. Consequently, the device may include features to align and guide the clip into the jaws, and to prevent the clip from rotating or otherwise becoming misaligned during the formation of the clip.
[000152] Although the alignment feature can have a variety of configurations, and can be formed into several components of the
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48/83 device, Figure 11A illustrates a central lock 47 formed in a middle portion of the distal end 46b of the tissue blocker 46, to maintain a clip in alignment with the tip of the forward assembly 40. In particular, the central lock 47 can allow the apex of a clip to slide along it, thereby preventing the clip from becoming misaligned in relation to the forward assembly 40 which is pushing the clip in a distal direction. The person skilled in the art will understand that the tissue blocker 46 may have a variety of other configurations, and may include a variety of other features to facilitate the advancement of a clip through it.
[000153] Figure 12A illustrates tissue blocker 46 during use. As shown, tissue blocker 46 is positioned just below the claws 20 and in a location that allows a blood vessel, duct, anastomosis, etc. is received between the claws 20. As additionally shown, a surgical clip 36 is positioned between the claws 20 so that the fold portion 36a of the clip 36 is aligned with the tissue blocker 46. This will allow the legs 36b of the clip 36 are fully positioned around the blood vessel, duct, anastomosis or other target site.
[000154] Figures 11B to 11D illustrate another exemplary embodiment of a tissue blocker 46 'having an alignment feature or guide element formed on it and adapted to align and guide the clip into the claws and, with more preferably, to keep the clip in alignment with the claws while forming the clip. In this embodiment, the alignment feature is in the form of a ramp element 47 'extending longitudinally along a central geometric axis of the tissue blocker 46' and projecting above an upper surface of the tissue blocker 46 ' . The ramp element 47 'is preferably rigid and increases in height from a proximal end 46a'
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49/83 to a distal end 46b 'of tissue blocker 46'. The angle may vary, however, depending on the specific angle of the claws. The ramp element 47 'preferably ends adjacent to the tissue receiving recess 46c' formed at the distal end of the tissue blocker 46 '. As a result, the ramp element 47 'is positioned adjacent to the claws 20, allowing the ramp element 47' to guide a clip, as well as the tip of the forward assembly 40 that is pushing the clip, into the claws 20 at an angle appropriate. During use, the ramp element 47 'may be in a boundary position against the lower apex surface of a clip disposed between the claws 20 to prevent the clip from rotating vertically as the claws 20 are closed to form the clip. In particular, when the forward assembly 40 is moved to the most distal position along the ramp element 47 ', the apex of the clip will be in a boundary position against the surface of the ramp element 47'. As the clip is compressed between the claws 20 and the legs of the clip move towards each other, the jaws 20 will only engage a flexed portion on each leg. As a result, the clip's legs and apex are free to rotate vertically. However, as the apex is resting against the upper surface 47a 'of the ramp element 47', it will prevent the apex from moving vertically in a downward or downward direction, thereby preventing the clip's legs from moving vertically in one direction. upwards or higher, that is, the ramp element 47 'will prevent the clip from oscillating within the claws 20. Thus, the ramp element 47' is effective in preventing or limiting the harmful rotational forces generated when the jaws 20 are closed to form the clip. The clip is thus kept in alignment with the jaws 20.
[000155] The person skilled in the art will understand that the shape, size and configuration of the ramp element may vary depending
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50/83 depending on the specific configuration of the jaws and other components of the clip applicator. In an exemplary embodiment, the ramp element 47 'may have a maximum height hRmax of about 0.635 mm (0.025), as measured from a central plane extending through the tissue blocker 46'. More preferably, the height hRmax is in the range of about 0.203 mm (0.008) to 0.508 mm (0.020) and, most preferably, the height hRmax is in the range of about 0.254 mm (0.010) to 0.381 mm (0.015) ). The inclination angle or of the ramp element 47 'can also vary, but in an exemplary embodiment, the ramp element 47' has an inclination angle in the range of about 5 ° to 45 °, more preferably 5 ° at 30 ° and, most preferably, 10 ° to 20 °. The width wr of the ramp element 47 'may also vary, but in an exemplary embodiment, the ramp element 47' preferably has a width wr which is slightly less than a space between the claws 20 in the fully closed position.
[000156] Figures 11E and 11F illustrate another exemplary embodiment of a tissue blocker 46 '' having proximal and distal ends 46a '' and 46b ''. The proximal end 46a '' can be adapted to fit a distal end of the clip rail 30 for positioning the tissue blocker 46 '' adjacent to the claws 20. In other embodiments, however, the tissue blocker 46 '' can be integrally formed with the clip rail 30, or may be adapted to fit, or integrally formed with, a variety of other stem components 18. The distal end 46b '' of the tissue blocker 46 '' may have a shape that is adapted to accommodate a blood vessel, a duct, an anastomosis, etc. to position and align the claws 20 in relation to the target site. For example, the tissue blocker 46 '' may have a V-shape that is defined, at least in part, by priPetition 870190088792, of 09/09/2019, pg. 53/93
51/83 first and second arms 39a and 39b.
[000157] In this modality, the tissue blocker 46 '', also called the guide element or guide of the forwarder, is particularly configured for use with the forwarder 40 '' shown in Figures 5C and 5D. In particular, the 46 '' tissue blocker includes features to accommodate the increased height of the forward tip 90 '' as previously discussed. As shown in Figures 11E and 11F, the tissue blocker 46 '' can include an opening or channel 49 formed therein and adapted to allow the distal tip 90 '' of the forward 40 '' to flex in a lower direction, i.e. , into or through channel 49, during the movement of the forward 40 '' between the proximal and distal positions. Although channel 49 can be located in any position in the tissue blocker 46 '', in the modality channel 49 is arranged in a location between central and proximal, longitudinally along the tissue blocker 46 ''. Channel 49 may also be located on a recessed rail 46t formed on an upper surface 46s of the tissue blocker 46 '', so that channel 49 is located at a distance and below from the upper surface 46s. The recessed rail 46t may be in the form of a longitudinally extending cutout formed along a substantial portion of the tissue blocker 46 '' so as to create opposing side rails 46r extending longitudinally over a substantial length 46 '' tissue blocker. The guide rails 46r allow the forwarder 40 '' to slide along it, in a location above channel 49.
[000158] As additionally shown in Figures 11E and 11F, the recessed rail 46t can include a sloped or ramp surface adjacent to the proximal and distal ends of channel 49, so that said channel 49 includes a distal ramp 51 and a proximal ramp 53. The distal ramp 51 can increase in height from the bottom to the
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52/83 superior, from a proximal end to a distal end. The distal ramp 51 can work to deflect the tip of the forward 90 '' in a superior direction, as the forward 40 '' is distally advanced. The proximal ramp 53 can increase in height from bottom to top, from a distal end to a proximal end. The proximal ramp 53 can work to deflect the tip of the forward 90 '' in a superior direction, as the forward 40 '' is proximally advanced.
[000159] As additionally shown in Figures 11E and 11F, the tissue blocker 46 '' may also include a groove 55 extending longitudinally located distal to channel 49 and adjacent to the distal end. Groove 55 can extend along the longitudinal geometric axis of the tissue blocker 46 '' in a substantially central location, laterally between the first and second arms 39a and 39b, and can be positioned substantially and directly in line with channel 49 , so that the distal tip 90 '' running distally up the distal ramp 51 and out of the channel 49, can continue to pass in a straight line along the groove 55 to move a clip over the tissue blocker 46 ''. In other words, the groove 55 substantially prevents the distal tip 90 '' from moving laterally relative to the opposite side sides of the tissue blocker 46 '' to keep the tip 90 '' in alignment with the apex of the clip. In some embodiments, the groove 55 may be recessed below a top surface of the first and second arms 39a and 39b, to accommodate the increased height H of the distal tip 90 ''. As the apex of a clip usually travels a distance above the tissue blocker 46 '', this allows a height H of a distal tip 90 '' to extend both above and below the apex of the clip.
[000160] As noted above, when it is pushed to den
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53/83 section of the claws 20 the clip needs to reorient to accommodate the angle of the claws 20. This reorientation can cause an apex of the clip to fall vertically or rotate downward (in a lower direction) relative to the opposite legs of the clip . This drop can prevent the clip from being positioned properly within the claws 20. For example, in some cases the apex of the clip may fall below a distal end of the clip propulsion element, so that the clip propulsion element passes through the clip and move over the top of your summit. The clip drive element would then be unable to properly position the clip within the claws 20. The height H of the clip drive element 90 '' in the mode shown in Figures 5C and 5D, however, in combination with the groove 55 in the blocker of 46 '' fabrics in the modality shown in Figures 11E and 11F, provides a solid surface against which the apex of the clip can move if it rotates in the upper and / or lower directions. If the apex of the clip falls off while being pushed into the grips 20, the surface facing the distal side 41 of the distal tip 90 '' can provide a solid surface that extends downward and into the recessed groove 55, thereby preventing the tip of the clip to slide down the distal tip 90 ''. In this way, an apex of a clip cannot fall below a lower surface of the surface facing the distal side 41, thus allowing the clip to always maintain contact with the distal tip 90 '' and, therefore, always be positioned properly inside the claws 20.
[000161] Figures 12B to 12E illustrate in more detail an exemplary interaction between the tissue blocker 46 "and the distal tip 90". In Figure 12B, the distal tip 90 '' is close to the beginning of the clip formation cycle. The distal tip 90 '' is shown by pushing the most distal clip C into the claws 20. The next clip C1 can be in a distal position on the 30 clip rail.
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54/83 the surface facing the distal side 41 of the distal tip 90 '' is in contiguity with an apex of the clip C and has a height H that is substantially greater than a height of the apex. The surface facing the distal side 41 of the distal tip 90 '' can move within the groove 55 of the tissue blocker 46 '' as it pushes the clip C into the claws 20. Thus, according to the legs of the clip C rotate slightly upwards (in an upper direction) to enter the claws 20, the apex of the clip C will always be in a borderline position against the surface facing the distal side 41, even if the apex rotates downwards in the lower direction. More particularly, the lower surface of the distal tip 90 '' is in contact with the groove 55 and, therefore, the apex of the clip C will never fall below the lower surface of the distal tip 90 ''. In this way, the surface facing the distal side 41 is able to maintain contact with the apex of clip C at all times, therefore being able to position the clip C properly inside the claws 20. The surface facing the distal side 41 it can also maintain contact with the apex of clip C at all times, during the formation of clip C between the jaws 20, to ensure that clip C does not move proximally.
[000162] As illustrated in Figure 12C, once the clip C has been formed inside the claws 20 and released, the distal tip 90 '' starts to move proximally from its most distal position inside the groove 55, so to be positioned behind or near the next clip Ci. At that point in the clip formation cycle, the distal tip 90 '' is positioned distally to the next clip Ci, and the highest point on the upper surface 47 of the distal tip 90 '' is at substantially the same height as the upper surface of the clip Ci. Consequently, as the distal tip 90 '' moves proximally to contact the clip Ci, the upper surface 47 of the distal tip 90 '' can come into contact with a surface bottom of a clip apex
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Ci. Since clip Ci is rigidly held within clip rail 30, clip Ci produces a downward force on the distal tip 90 '' to deflect down the resilient distal tip 90 ''. As the clip Ci and the upper surface 47 of the distal tip 90 '' come into contact with each other, the distal tip 90 '' is moving towards the distal ramp 5i. In this way, the downward force applied by the clip Ci can cause the distal tip 90 '' to deflect downwards in a lower direction, so that the distal tilt surface 43 of the distal tip 90 '' moves downward through the distal ramp 5i and in, or partially through, channel 49. With the distal tip 90 '' running proximally in channel 49, its upper surface 47 is lower than a lower surface of the apex of clip Ci and can thus move proximally under the lower surface of the apex of clip Ci, as shown more clearly in Figure 12D.
[000163] As the distal tip 90 '' continues to move proximally within channel 49, the surface facing the distal side 4i moves proximally to the apex of clip C1. As it moves proximally, the proximal slope surface 45 comes into contact with the proximal ramp 53 and begins to move upwards through the proximal ramp 53. Since the upper surface 47 of the distal tip 90 '' is no longer in contact with the surface bottom of clip C1, when the proximal inclination surface 45 moves upward along the proximal ramp 53, the distal tip 90 '' deflects upward again in a superior direction, so that it is at a substantially uniform height with the apex of clip C1 again, as shown with maximum clarity in Figure 12E. The distal tip 90 '' is now in its most proximal position and is ready to start the clip formation cycle again. This way, as the forward 40 '', and therefore the distal tip 90 '', are moved distally, the distal inclination surface 43 over the distal tip 90 '' will move distally
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56/83 along the distal ramp 51 to cause the distal tip 90 '' to deflect upwards in the upper direction, thus ensuring that contact is maintained between the apex of the clip and the surface facing the distal side 41 of the tip distal 90 ''.
[000164] Figures 13 to 26B illustrate several internal components exemplifying the wrap 12 to control the advance and the formation of the clip. As previously discussed, the surgical clip applicator 10 can include some or all of the features presented in the present invention, and can include a variety of other features known in the art. In certain exemplary embodiments, the internal components of the clip applicator 10 may include a clip advance assembly that mates with the stem advance clip assembly 18, to advance at least one clip through the elongated stem 18 and position the clip between the claws 20, and a clip-forming assembly that engages the clip-forming assembly of the rod 18, to close the jaws 20 to form a partial or fully closed clip. Other exemplifying features include a non-return mechanism to control the movement of the trigger 16, an overload mechanism to prevent overloading of the force applied to the grips 20 by the clip forming assembly, and an indicator of the number of clips to indicate the number of clips remaining on device 10.
[000165] Figures 13 to 16D illustrate an exemplary embodiment of a wrapper clip forward assembly 12 to effect a movement of the feed bar 38 within the rod 18. In general, the clip forward assembly may include an insert element trigger 48 which is coupled to trigger 16, a feeder bar coupler 50 that can fit to a proximal end 38a of feeder bar 38, and a feeder link 52 which is adapted to extend between the trigger insert 48
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57/83 and the feeder bar coupler 50 to transfer movement from the trigger insert 48 to the feeder coupler 50.
[000166] Figure 14 illustrates in more detail the trigger insert 48. The shape of the trigger insert 48 can vary depending on the other components of the wrap 12, but in the illustrated embodiment the trigger insert 48 includes an central portion 48a that is adapted to pivotably engage the casing 12, and an elongated portion 48b that is adapted to extend into and engage the trigger 16. The central portion 48a may include a hole 106 extending through it, intended to receive a rod to pivotably engage the trigger insert 48 to the casing
12. The central portion 48a may also include a first recess 108 formed at an upper side edge, intended to receive a portion of the feed link 52. The first recess 108 is preferably of a size and shape that allows a portion the feed link 52 extends therein so that the feed link 52 is forced to rotate when the trigger insert 48 rotates due to the 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, intended to accommodate a rod formed on a proximal end of the feeder link 52, as will be discussed in more detail with reference to Figure 16. The trigger insert 48 may also include a second recess 110, formed on a rear lateral edge, to receive a cylinder of the closing link 54 which is coupled to the propulsion bar 44 for to move the cam 42 and close the claws 20, and ratchet teeth 112 formed on the lower lateral edge of the same for coupling to a tongue 60 in order to
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58/83 control the movement of the trigger 16, as will be discussed in more detail below.
[000167] The exemplary feeder bar coupler 50 is shown in more detail in Figures 15A and 15B, and can be adapted to couple the proximal end of feeder bar 38 to the distal end of feeder link 52. Although a variety of techniques can be used to fit 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 and 50b, which fit together to keep between them the proximal end 38a of the feed bar 38. When engaged, the two halves 50a and 50b together define a central rod 50c having substantially circular flanges 50d and 50e formed on opposite ends thereof, and defining a recess 50f between them to accommodate a distal portion of the feeder link 52. The central rod 50c defines a lumen 50g through it to receive the extension proximal remedy 38a of the feed bar 38 and to lock the feed bar 38 in a substantially fixed position with respect 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 coupling with feeder link 52.
[000168] Figure 16 illustrates an exemplary feeder link 52, which can extend between the trigger insert 48 and the feeder coupler 52. In general, feeder link 52 may have an elongated substantially flat shape with proximal ends and distal 52a and 52b. The proximal end 52a is adapted to rotate within the first recess 108 of the trigger insert 48 and therefore conforms
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59/83 m and previously discussed, it may include a stem 53 (Figure 1B) extending through it. The stem 53 can be adapted to pivot within the first recess 108 of the trigger insert 48, thus allowing the trigger insert 48 to rotate the feed link 52. The distal end 52b of the feed link 52 can be adapted to be coupled to the coupler of the feeder bar 50 and, therefore, in an exemplary embodiment, opposite arms 114a and 114b formed therein are included, and defining an opening 116 between them to accommodate a central rod 50a of the coupler of the feeder bar 50. The arms 114a and 114b are effective for engaging and moving the coupler 50 as the feed link 52 rotates about a pivot axis X. The pivot axis X can be defined by the location in which the feed link 52 engages the wrap 12, and it can be positioned anywhere on the feeder link 52, but in the illustrated embodiment it is positioned adjacent to the proximal end 52a of the feeder link 52.
[000169] In an exemplary embodiment, the feeder link 52 can be flexible to eliminate the need to calibrate the clip advance assembly and the clip forming assembly. In particular, feeder link 52 allows trigger 16 to continue to move in the direction of a closed position, even after feeder bar 38 and feeder coupler 50 are in a more distal position, and provides some freedom to assemblies clip former and clip advance. In other words, the trigger 16 is flexible in relation to the feed bar 38 during the closing of the trigger. [000170] The specific stiffness and strength of feeder link 52 may vary depending on the configuration of the clip advance assembly and the clip-forming set, but in an exemplary embodiment the feeder link 52 has a stiffness that is in the range of
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131.3 to 192.6 Newton per centimeter (75 to 110 lbs per inch), and more preferably about 162.9 N / cm (93 lbs per inch) (as measured at the interface between link 52 and the coupler) feed bar 50), and has a resistance that is in the range of 111.2 N / cm (25 lbs) and 222.4 N / cm (50 lbs), more preferably about 155.67 N (35 lbs). Feeder link 52 can also be formed from a variety of materials, including a variety of polymers, metals, etc. An exemplary material is a glass-reinforced imide polyether, but a number of reinforced thermoplastics could be used, including glass-reinforced liquid crystal polymers, glass-reinforced nylon and carbon fiber-reinforced versions of these thermoplastics and the like. Fiber-reinforced thermoset polymers, such as thermosetting polyesters, could also be used. Feeder link 52 could also be manufactured from a metal, such as spring steel, to obtain the desired combination of limited flexibility and controlled resistance.
[000171] Figures 17A to 17D illustrate the example clip advance set during use. Figure 17A shows an initial position, in which the trigger 16 is resting in an open position, the coupler of the feed bar 50 and the feed bar 38 are in a more proximal position, and the feed link 52 extends between the insertion element of the trigger 48 and the coupler of the feed bar 50. As previously discussed, in the initial open position the protuberance 86 on the feed bar 38 is positioned at the proximal end of the elongated slot 88 on the claw retainer rod 28. A first tilt element, for example, a spring 120, is coupled to the trigger insert 48 and the wrap 12 to hold the trigger insert 48 and trigger it 16 in the open position, and a second tilt element, e.g. spring 122 , extends between a coupler of the
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61/83 rod 124, which swivels rod 18 to wrap 12, and feeder coupler 50 to keep feeder coupler 50 and feeder 38 in the most proximal position.
[000172] When the trigger 16 is pulled and moved towards the closed position, that is, towards the stationary cable 14, to overcome the tilt forces applied by the springs 120 and 122, the trigger insert 48 starts to rotate in a counterclockwise direction, as shown in Figure 17B. As a result, feeder link 52 is forced to rotate in a counterclockwise direction, thus moving the feeder bar coupler 50 and feeder bar 38 in a distal direction. The protrusion 86 on the feed bar 38 thus moves distally into the elongated slot 88 in the claw retainer rod 28, thus advancing the feed shoe 34 and the clips 36 arranged inside the clip rail. The spring 120 is extended between the casing and the trigger insert 48, and the spring 122 is compressed between the feed bar coupler 50 and the stem coupler 124.
[000173] As the trigger 16 is additionally activated and the trigger insert 48 continues to rotate, the feed bar coupler 50 and feed bar 38 will eventually reach a more distal position. In that position, the protrusion 86 on the feed bar 38 will be positioned at the distal end of the slot 88 on the claw retainer rod 28 and a clip will be positioned between the claws 20, as previously discussed. The spring 122 will be fully compressed between the stem coupler 124 and the feed bar coupler 50, and the feed link 52 will flex, as shown in Figures 17C and 17D. As feeder link 52 flexes, and more preferably once feeder link 52 is fully flexed, the clip forming assembly will be triggered to
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62/83 close the jaws 20. The feeder link 52 will remain flexed during the activation of the clip-forming assembly, for example the second stage of the actuation, so that the trigger insert 48 is flexible in relation to the clip advance assembly and, in particular, the feed bar 38.
[000174] An exemplary clip-forming set for wrap 12 is shown in more detail in Figures 18 to 20. In general, the clip-forming set is disposed inside wrap 12 and is effective for moving rod 44 and the cam 42 with respect to the claws 20, in order to move the claws 20 to a closed position and thereby crimp a clip positioned between them. Although the clip-forming assembly may have a variety of configurations, the illustrated exemplary clip-forming assembly includes a closing link cylinder 54 that is slidably coupled to the trigger insert 48, a closing link 56 that is adapted to be coupled to the cylinder of the closing link 54, and a closing coupler 58 that is adapted to be coupled to the closing link 56 and the rod 44.
[000175] Figure 18 illustrates the closing link cylinder 54 in more detail and, as shown, the closing link cylinder 54 includes a central rod 54a having substantially circular flanges 54b and 54c formed adjacent the opposite end ends thereof. . The central stem 54a can be adapted to lie within the second recess 110 in the trigger insert 48 so that flanges 54b and 54c are received on opposite sides of the trigger insert 48. The central stem 54a can also be adapted to fit opposite arms 126a and 126b of the closing link 56, to position the arms on opposite sides of the trigger insert 48.
[000176] An exemplary modality of a closing link
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63/83 is shown in more detail in Figure 19, and as shown it has opposite arms 126a and 126b that are spaced apart from each other. Each arm 126a and 126b includes a proximal end 128a and 128b which is adapted to engage the central rod 54a of the closing link cylinder 54, and a distal end 130a and 130b which is adapted to fit the closing coupler 58 to couple the cylinder of the closing link 54 and the closing link 56 to the rod 44. In an exemplary embodiment, the proximal end 128a and 128b of each arm 126a and 126b is adapted to pivotally fit to the cylinder of the link link closure 54, and thus arms 126a and 126b may include, for example, hook-shaped elements 132a and 132b formed thereon, to engage central rod 54a. The hook-shaped elements 132a and 132b extend in opposite directions to facilitate engagement between the closing link 56 and the closing link cylinder 54. The distal ends 130a and 130b of the arms 126a and 126b can be fitted together , and may include a lumen 134 extending therethrough to receive a rod that is adapted to pivotally engage the closing link 56 to the closing coupler 58. One skilled in the art will understand that a variety of other techniques can be used to attach the closing link 56 to the closing link cylinder 54 and to the closing coupler 58.
[000177] An exemplary closing coupler 58 is shown in more detail in Figure 20A, and as shown includes a proximal portion 58a that has two arms 136a and 136b with lumens 138a and 138b extending through them and adapted to be aligned with the lumen 134 in the closing link 56 to receive a rod designed to fit two components. The closing coupler 58 may also include a distal portion 58b that
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64/83 is adapted to fit the proximal end 44a of rod 44 (Figure 9). In an exemplary embodiment, the closing coupler 58 includes a cutout 59 (Figures 20B and 20C) formed therein and having a shape that is adapted to accommodate the proximal end 44a of the rod 44. The distal portion 58b of the closing coupler 58 can also be configured to receive a coupler portion of the feed bar 50 when the trigger 16 is in the open position. The person skilled in the art will understand that a variety of other coupling techniques can be used to attach the closing coupler 58 to the rod 44, and that the closing coupler 58 and the rod 44 can optionally be integrally formed together. The closing coupler 58 may additionally include side flaps 71a and 71b. The flap 71a may be in contact with a compression spring 81, described in more detail below, to proximally force the closing coupler 58 as the trigger 16 is squeezed.
[000178] In other exemplary embodiments, a preloaded joint can be formed between rod 44 and closing coupler 58 to prevent accidental release of a clip from the jaws, particularly during the early stages of closing, if the user loosen trigger 16 a little. In particular, although the anti-return mechanism, discussed in more detail below, can be adapted to prevent trigger 16 from opening until trigger 16 reaches a predetermined position, the anti-return mechanism may allow some small movement of the trigger 16. Thus, if a user loosens the trigger 16 slightly and a small opening occurs, the preloaded joint will force the rod 44 in a distal direction, thus keeping the rod 44 in a substantially fixed position , while closing coupler 58 is allowed to move proximally until trigger 16 is in compliance 870190088792, of 09/09/2019, pg. 67/93
65/83 triggered by the non-return mechanism.
[000179] Although the preloaded joint may have a variety of configurations, and may be positioned at various locations throughout the clip forming assembly, in an exemplary embodiment the preloaded joint may be in the form of a tilt element arranged inside the cutout 59 to force the rod 44 in a distal direction. Although a variety of tilt elements can be used, in the embodiment shown in Figure 20B the tilt element is a cantilever bar 61 that is positioned between the proximal end 44a of the rod 44 and the rear wall of the recess 59 to distally force the rod 44. The cantilever bar 61 can be formed from a material with a shape memory, such as Nitinol, which allows the bar 61 to flex or flatten when a proximally directed force is applied to it. The bar 61 can also be formed from a variety of other materials, such as spring steel or reinforced polymers, and more than one bar can be used. Figure 20C illustrates another embodiment of a tilt element that is in the form of a spiral or other type of spring 63. As shown, the spring 63 is disposed between the proximal end 44a of the rod 44 and the rear wall of the recess 59 to force the rod 44 distally. The spring 63 is adapted to compress when a proximally directed force is applied to it. The person skilled in the art will understand that a variety of other tilt elements can be used, including elastomeric compression elements.
[000180] The preloaded joint can also optionally include features to optimize the performance of the cantilever bar or spring during the clip forming process. In the embodiment shown in Figure 20B, the load of the cantilever bar 61 remains primarily uniform while the cantilever bar is compressed
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66/83 during closing, but the load increases significantly during the final stages of closing. This is illustrated in Figure 20D, which shows a graph of the load / displacement curve of the cantilever bar 61 shown in Figure 20B. The left end of the curve represents the unloaded height of the cantilever bar 61, while the right end of the curve represents the point at which the cantilever bar 61 is fully compressed or flattened. The upper curve represents the resultant force as the cantilever bar 61 is compressed during a typical closing stroke, with the exception that the force is measured from a free state of the cantilever bar 61, while the cantilever bar 61 is initially partially compressed when it is arranged inside the closing coupler 58. As shown, the load remains substantially constant (excluding the initial stages of compression), increasing only slightly during the closing stroke, while the cantilever bar 61 is being compressed. However, the load increases significantly in the final stages of closure when the cantilever bar 61 is completely flat. This is due to the deflection of the cantilever bar 61 which causes the load to be transferred from the terminal ends of the cantilever bar 61 inward. As the cantilever bar 61 deflects and the load is transferred inward, the effective length of the cantilever bar 61 is reduced, thus increasing the load. In order to avoid this, the preloaded joint can optionally include features to optimize the performance of the cantilever bar or spring and, in particular, to maintain a substantially constant load during the formation of the clip.
[000181] Figure 20E illustrates a modality exemplifying a technique to enhance the performance of the cantilevered bar or spring. As shown, the recess 59 'in the female coupler
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67/83 chamento 58 'includes two ridges 59a' and 59b 'formed on the rear surface thereof, so that the ridges 59a' and 59b 'are positioned under or behind the cantilever bar (not shown). The ridges 59a 'and 59b' are spaced from each other by a distance, and each ridge 59a 'and 59b' is at least about 0.127 mm (0.005) high to prevent the cantilever bar from flattening completely against the surface of the recess. As a result, the ridges 59a 'and 59b' will prevent the cantilever bar from deflecting, thereby preventing the load from the spring or cantilever bar from being transferred from the end ends inward. The person skilled in the art will understand that the specific location, quantity and size of the ridges 59a 'and 59b' may vary depending on the configurations of the preloaded hinge, as well as the forces necessary to prevent the clip from falling during closing.
[000182] During use, again with reference to Figures 17A to 17D, as the trigger 16 is initially moved from the open position towards the closed position, the cylinder of the closing link 54 will rotate inside the recess 110 in the insertion element of the trigger 48. Once the feed bar 38 and the feed bar coupler 50 are in the most distal position, as shown in Figure 17C, further activation of the trigger 16 will cause the recess 110 in the trigger insert 48 to engage to the cylinder of the closing link 54, forcing it to rotate with the trigger insert 48, as shown in Figure 17D. As a result, the closing coupler 58 will move distally, thus causing rod 44 to move distally. As the rod 44 advances distally, the cam 42 is advanced over the claws 20 to close them and crimp the clip positioned between them. Trigger 16 can optionally be partially closed to only partially close claws 20 and thereby
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68/83 partially crimp a clip arranged between them. Exemplary techniques to facilitate the partial and total selective closure of the clip will be discussed in more detail below. Once the clip is applied, trigger 16 can be released, thus allowing spring 120 to pull trigger insert 48 back to its initial position, and allowing spring 122 to force feeder coupler 50 and the feed bar 38 back to the proximal position. As the trigger insert 48 returns to its initial position, the cylinder of the closing link 54 is also moved back to its initial position, thus pulling proximally the closing link 56, the closing coupler 58 and the propulsion bar 44.
[000183] The surgical clip applicator 10 can also include a variety of other features to facilitate the use of the device 10. In an exemplary embodiment, the surgical clip applicator 10 can include a non-return mechanism to control the movement of the device. trigger 16. In particular, the non-return mechanism can prevent trigger 16 from opening during the course of a partial closure. However, once the trigger reaches a predetermined position, at which point the clip positioned between the jaws can be partially crimped, the non-return mechanism can release the trigger, allowing it to open and release the clip, or to close to fully crimp the clip as desired by the user.
[000184] Figures 21A and 21B 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 on the trigger insert 48, and a tongue 60 that is adapted to be pivotally arranged inside the wrap 12, and positioned adjacent to the insert element of the trigger 48, so that closing the trigger 16 and pivoting the trigger insert 48 cause
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69/83 the tongue 60 engages with the teeth 112. The teeth 112 can be configured to prevent the rotation of the tongue 60 until it reaches a predetermined position, at which point the tongue 60 is free to rotate, thus allowing the trigger 16 open or close. The predetermined position preferably corresponds to a position in which the claws 20 are partially closed. As shown, in an exemplary embodiment, teeth 112 include a first set of teeth 112a, for example, ten teeth, with a size that prevents the rotation of the tongue 60 in relation to them, thus preventing the trigger 16 from opening when the tongue 60 is engaged with the first set 112a of teeth 112. The teeth 112 may also include a final or terminal tooth, called the closing tooth 112b, which has a size that allows the tongue 60 to rotate relative to it when said tongue 60 is engaged with closing tooth 112b. In particular, the closing tooth 112b is preferably of a size that is substantially larger 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 closure 112b. The notch 140 has a size that allows the tongue 60 to rotate in it, thus allowing the tongue 60 to be selectively moved past the closing tooth 112b or back towards the first set of teeth 112a. The person skilled in the art will understand that the closing tooth 112b can be the same size or a smaller size than the first ten teeth 112a, while still having a notch 140 formed between them, allowing the rotation of the tongue 60.
[000185] Figures 22A to 22D illustrate the ratchet mechanism in use. When trigger 16 is initially moved toward a closed position, as shown in Figure 22A, tongue 60 moves
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70/83 engages the first set of teeth 112a, thereby preventing the trigger 16 from opening. The additional actuation of the trigger 16 will cause the tongue 60 to advance beyond the first set of teeth 112a, until the tongue 60 reaches the notch 140 next to the closing tooth 112b. Once the tongue 60 reaches the closing tooth 112b, at which point the claws 20 are partially closed due to the partially distal movement of the cam 42 on the claws 20, the tongue 60 is free to rotate, thus allowing the trigger 16 to move open or close, as desired by the user. Figure 22C illustrates the trigger 16 in a fully closed position, and Figures 22D and 22E illustrate the trigger 16 returning to the open position.
[000186] As previously explained in the present invention, in other embodiments the clip applicator may include a locking mechanism to indicate to a user when the supply of clips is depleted. In an exemplary embodiment, the locking mechanism can be operatively associated with the ratchet mechanism to help maintain the trigger in a fixed position partially open after the last clip has been applied. In particular, the locking mechanism can be configured to activate when the tongue 60 is engaged with the teeth 112a, and before the tongue 60 reaches the notch during the course of the opening. In this position, the tongue 60 is unable to rotate in any direction, thus preventing the trigger 16 from moving, and thus providing feedback to the user, through the trigger 16, that the supply of clips is depleted. As previously described, in one embodiment the locking mechanism can be in the form of a lock 82d 'formed on the feeder shoe 34' '', and of the recesses 51a and 51b formed on the feeder 40 '' and feeder bar 38 '' . After forming the most proximal clip, trigger 16 can be released
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71/83 to move from the fully closed position to the open position, thus causing the feed bar 38 'and the feeder 40' 'to retract proximally. The proximal movement of the feed bar 38 '' will cause the tongue 60 to reengage teeth 122b and 112a. With the tongue 60 engaged with the teeth 112a, and before the tongue 60 reaches the notch 140, the recesses 51a and 51b formed in the feeder 40 '' and in the feed bar 38 'will engage with the lock 82d' on the feeder shoe 34 ' '' to prevent additional proximal movement of the feed bar 38 'and the forwarder 40'. The fixed or locked position of the feed bar 38 'and the feeder 40' 'thus prevents tongue 60 from reaching notch 140. As a result, tongue 60 cannot rotate and therefore trigger 16 is prevented from opening or close, therefore being locked in a partially closed fixed position that prevents further use of the device.
[000187] Although trigger 16 is locked in a partially open position, after the last clip is applied, claws 20 need to open fully to allow the clip to be released. This can be achieved by adding a tilt element, such as a compression spring 81 as shown in Figures 22F and 22G, which forces the rod 44 to the proximal position. The spring 81 can be arranged anywhere inside the wrap 12, but in the illustrated embodiment the spring 81 is arranged between a wall 91 of the wrap 12 and a flap 71a formed in the closing coupler 58. A distal end of the spring 81 can be in a boundary position against the wall 91 of the wrapper 12, and a proximal end of the spring 81 may be in a boundary position against the flap 71a of the closing coupler 58, to force the closing coupler 58 in a proximal direction which, in turn, forces a proximal end 44a of rod 44 in a proximal direction. Thus, when trigger 16 is fully closed, spring 81 is compressed between
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72/83 the wall 91 of the wrapper 12 and the flap 71a, proximally forcing the closing coupler 58 and therefore the rod 44. Trigger 16, however, prevents any proximal movement of the closing coupler 58 and the rod 44. According to the trigger 16 is partially released from its fully closed position, the spring 81 moves proximally the closing coupler 58 and thus the rod 44, to allow the claws 20 to open and release the clip. In this way, the claws 20 will open before the trigger 16 is fully open and, in particular, before the trigger 16 is locked by the locking mechanism. [000188] The ratchet mechanism can also be configured to emit an audible sound that indicates the position of the claws 20. For example, a first sound can be made when the tongue 60 engages with the first set of teeth 112a, and a second sound different, for example a louder sound, can be emitted when the tongue 60 engages the closing tooth 112b. As a result, when the trigger 16 reaches the predetermined position in which the tongue 60 is engaged with the closing tooth 112b, the sound indicates to the user that the jaws 20 are in the partially closed position. The user can thus release trigger 16 to release a partially closed clip, or can fully close trigger 16 to fully close the clip.
[000189] In another exemplary embodiment, the surgical clip applicator 10 may include an overload mechanism that is adapted to prevent the overload of a force applied to the claws 20 by the trigger 16. Typically, during the application of a surgical clip, a some force is needed to close the claws 20 and crimp the clip around the fabric positioned between them. As the forming process continues and the clip is at least partially closed, the force required to continue to close the claws 20 around the clip increases significantly. Consequently, in
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73/83 an exemplary modality, the overload mechanism may have a resistance that correlates with the force necessary to close the claws 20. In other words, the resistance of the overload mechanism may increase as the force necessary to close the claws 20 increases. The resistance, however, is preferably slightly greater than the force necessary to close the claws 20, in order to avoid accidental activation of the overload mechanism. As a result, if the jaws 20 are prevented from closing when the trigger 16 is initially operated, the force required to overcome the resistance of the overload mechanism is relatively low. This is particularly advantageous, as the claws 20 are more susceptible to being deformed when they are open or only partially closed. The overload mechanism will activate more readily in the initial stages of the clip formation, to avoid deformation of the claws. On the other hand, when the jaws 20 are substantially closed, the resistance is relatively high, so that the overload mechanism can be activated only by applying significant force to the jaws 20.
[000190] Figure 23A illustrates an exemplary embodiment of an overload mechanism 62, showing an exploded view. In general, the overload mechanism may include an overload wrap 64 formed from two halves 64a and 64b, and containing a profile link 66, a toggle link 68, a pivot link 70, and a drive assembly 72 The drive assembly 72 may include a spring column 150 which is coupled to the casing 64 and which includes a hole extending through it to receive a plunger 154. A spring 152 is arranged around the spring column 150, and the plunger 154 extends through the spring column 150 and includes a head 154a formed therein, which is adapted to be in a boundary position against the spring 152. The pivot link 70 can be generically
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74/83 L-shaped and can be coupled to the casing 64 by a pivot pin 156 extending through it. A proximal end 70a of the pivot link 70 can come into contact with the head 154a of the plunger 154, and a distal end 70b of the pivot link 70 can be pivotally coupled to the toggle link 68 by means of a pivot pin 166 The alternating link 68, in turn, can be coupled to the profile link 66, which can be positioned slidably and pivotally within the casing 64 adjacent to an opening 64d formed in the casing. The pivoting movement of the profile link 66 inside the casing 64 can be achieved, for example, by means of a pivot pin 158 that extends through the profile link 66 and is arranged inside a first slot 160a (only one slit is shown) formed in each half 64a and 64b of the casing 64, while the sliding movement of the profile link 66 inside the casing 64 can be obtained, for example, by means of opposite protrusions 168a and 168b formed on the profile link 66 which are received inside a second slot 160b (only one slot is shown) formed in each half 64a and 64b of the casing 64.
[000191] During use, the profile link 66 can be adapted to receive a force from the clip forming assembly, and to counter that force with the resistance of the drive assembly 72. In particular, the overload mechanism 62 uses spring 152 together with toggle link 68 and pivot link 70 to prevent profile link 66 from rotating around pivot pin 158 or sliding against casing 64. For the rotational aspect, the force exerted by the compressed spring 152 is transferred through the alternating link 68 and the pivot link 70, so that a rotational moment is applied to the profile link 66 against the envelope 64. In this way, this set makes the profile link 66 resist rotation in relation to the envelope 64. If the moment generated by a radial load from the cylinder of the
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75/83 closing 54 against the profile link 66 exceeds the moment of the pivot link 70 and the toggle link 68, the profile link 66 begins to rotate, twisting the toggle link 68 and causing the pivot link 70 further compress the spring 152. For the slip aspect, the pivot link 70, the toggle link 68 and the profile link 66 are aligned so that the slip force (slip resistance) is the force necessary to twist the alternating link 68 and pivot link 70. If the radial load of the cylinder of the closing link 54 against the profile link 66 exceeds the torsional force of the links, then the pivot link 70 additionally compresses the spring 152, according to the profile link 66 slides proximally.
[000192] This is shown in more detail in Figures 23B to 23C and, as shown, opening 64d in casing 64 allows the cylinder of the closing link 54 of the clip forming assembly to rotate against the profile link 66. As a result , when the trigger 16 is pulled and moved towards the closed position, the cylinder of the closing link 54 applies a force to the profile link 66. The resistance of the overload spring 152, however, will keep the profile link 66 in a position substantially fixed, unless the force applied by the closing link cylinder 54 increases to a force that is greater than the resistance, for example a limit force. This can be caused, for example, by a foreign object positioned between the claws 20, or when the claws 20 are fully closed with the clip and the blood vessel, duct, anastomosis, etc. between them. When the claws 20 cannot be additionally closed, the force applied to the cylinder of the closing link 54, from the movement of closing the trigger 16 will be transferred to the profile link 66, which will then rotate and slide inside the envelope 64, making thus rotating the pivot link 70, which forces the plunger 154 to compress the overload spring 152.
[000193] As previously noted, the strength needed to
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76/83 r triggering the overload mechanism can be correlated to the force necessary to close the claws 20, which increases as the trigger 16 is moved to the closed position. This can be achieved due to the configuration of the profile link 66. In particular, when the cylinder of the closing link 54 first contacts the profile link 66, thus being in a lower position, the profile link 66 can rotate in. of envelope 64, as shown in Figure 23B. As the cylinder of the closing link 54 moves upwards along with the profile link 66, the force necessary to overcome the resistance of the overload mechanism increases, as the profile link 66 must slide inside the envelope 64, as shown in Figure 23C. The force required to rotate the profile link 66 may be less than the force required to slide the profile link 66. Consequently, if the claws 20 are prevented from closing, for example due to a foreign object, such as the trigger is initially actuated , minimal force will be required to cause the cylinder of the closing link 54 to transfer the force to the lower portion of the profile link 66, causing it to rotate. When the jaws 20 are substantially closed and the trigger 16 is almost fully engaged, a significant amount of force is required to cause the cylinder of the closing link 54 to transfer the force to the upper portion of the profile link 66, doing so slide inside the casing 64 to overcome the resistance of the overload spring 152. Although the amount of force required to drive the overload mechanism may be greater than, and may increase over, the amount of force required to close the claws 20 , the force is preferably only slightly greater than the force necessary to close the jaws 20, in order to avoid the occurrence of deformation or other damage to the jaws 20. The skilled person will understand that the resistance can be adjusted based on the necessary force to close the claws 20.
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77/83 [000194] The profile link 66 and, in particular, the surface facing the distal side 66s of the profile link 66, can also have a shape that facilitates the correlation between the force required to drive the overload mechanism and the force necessary to close the claws 20. For example, in cases where the force necessary to close the claws 20 increases at a linear rate, the surface facing the distal side 66s of the profile link 66 can be flat to prevent the profile link 66 interferes with the movement of the cylinder of the closing link 54 therein, and to allow a linear force to be applied to the trigger 16 to close the claws 20. On the other hand, in cases where the force necessary to close the claws 20 are non-linear as the trigger 16 is moved to the closed position, the profile link 66 may have a non-linear shape that corresponds to the non-linear force. This type of configuration will prevent the forces necessary to close cam 42 (Figure 8) from becoming too high.
[000195] As a non-limiting example, the force required to close the claws 20 can be non-linear due to the shape of the recess 104 in the cam 42 which is adapted to push the claw elements 96a and 96b towards each other . As shown in Figure 8, the recess 104 can have a curved configuration, so that the force varies as the cam 42 passes over the gripper elements 96a and 96b. The profile link 66 can therefore have a corresponding curved surface facing the distal side, so that the force also varies as the cylinder of the closing link 54 passes over it. As shown in Figures 23A and 23B, the profile link 66 is curved, so that the lower portion of it is substantially convex and the upper portion of it is substantially concave. The person skilled in the art will understand that the profile link 66 can have a variety of other shapes, and that a variety of other techniques can be used to optimize the strength required.
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78/83 laugh to close the claws 20 and the force necessary to activate the overload mechanism.
[000196] The skilled person will also understand that the overload mechanism can have a variety of other configurations. As a non-limiting example, Figure 23D illustrates an overload mechanism that is in the form of a cantilevered bar 170 to receive a force applied by the cylinder of the closing link 54. The bar 170 may have a substantially curved member 172 with a support 174 coupled to one end thereof. The curved member 172 may have a bending moment so that, when loaded with a force greater than said bending moment, it yields to assume a condition of low stiffness. The support 174 can provide more rigidity to the curved element 172, so that the bending moment increases in the position adjacent to the support 174. During use, the bar 170 can be loaded inside the wrapper 12 of the clip applicator 10, so that the cylinder of the closing link 54 comes into contact with the concave surface, and the bar 170 can be positioned at an angle such that the cylinder of the closing link 54 is further away from the bar when the trigger 16 is initially activated, leaving the cylinder of the closing link 54 closest to the bar as the trigger 16 moves to the closed position. As a result, the warp resistance will increase as the cylinder of the closing link 54 moves away and the trigger 16 of the clip applicator is moved to the closed position. Although not shown, multiple bars could optionally be used in a stacked manner, and the terminal or free end of them could be bypassed to adjust the warping load to a specific point along the length of the bar.
[000197] In another exemplary embodiment, the surgical clip applicator 10 can include an indicator of the number of clips for
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79/83 ra indicate the number of clips remaining on the device 10. Although several techniques can be used to indicate the number of clips remaining, Figures 24A to 25 illustrate an exemplary modality of an indicator of the number of clips that has an indicator wheel 74 and an indicator actuator 76.
[000198] Indicator wheel 74 is shown in detail in Figures 24A and 24B and, as shown, has a generally circular or cylindrical shape that defines a central geometric axis Y around which wheel 74 is adapted to rotate. The wheel 74 includes teeth 142 formed around it and adapted for engagement with the indicator actuator 76, and an indicator element 144. The indicator element 144 can have a variety of configurations, but in an exemplary embodiment the indicator element 144 is under the shape of a block of contrasting color having a color, for example orange, red, etc., which differs from the rest of the indicator wheel 74.
[000199] Figure 25 illustrates in more detail the example 76 indicator actuator. The actuator 76 is adapted to be slidably arranged inside a wrapper 12 and to be coupled to the feeder link coupler 50 and to move as the feeder bar 50 and feeder bar 38 are moved. Consequently, the actuator of indicator 76 may include a protrusion 146, of which only a portion is shown, formed on a lower surface thereof, to extend into the recess 50f formed between the circular flanges 50d and 50e of the feeder bar coupler 50. A protrusion 146 allows the actuator of indicator 76 to be engaged with the coupler of the feed bar 50 and to be moved with it. The indicator actuator 76 may also include an engagement mechanism 148 formed on it and adapted to engage the teeth 142 formed on the indicator wheel 74. As shown in Figure 25, the engagement mechanism
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80/83
148 of the indicator actuator 76 is in the form of an arm that has a flap formed over the end thereof, intended for engaging teeth 142.
[000200] During use, the indicator wheel 74 is swiveled inside the wrapper 12, as shown in Figures 26A and 26B, and the indicator actuator 76 is slidably arranged inside the wrapper 12, so that the locking mechanism 148 is positioned adjacent to the indicator wheel 74 and the protuberance 146 extends into the feeder bar coupler 50. The wrapper 12 includes a window 12a, formed there to provide visual access to the indicator wheel 144. According to trigger 16 is moved to the closed position and the feed bar coupler 50 is moved distally, the indicator actuator 76 will move distally with the feed bar 38 and the feed bar coupler 50. As a result, the latch mechanism 148 over the actuator of the feeder indicator 76 will engage teeth 142 on indicator wheel 74, thus causing wheel 74 to rotate as a clip is advanced into claws 20. Each Once trigger 16 is pulled to advance a clip 20 into the claws 20, the indicator actuator 74 rotates the indicator wheel 76. When the clip supply has two or three clips remaining, the contrasting color block 144 on the wheel indicator 74 will start to appear in window 12a formed in wrapper 12, thus indicating to the user that only a few clips remain. The contrasting color block 144 can be adapted to occupy the entire window 12a when the supply of clips is depleted.
[000201] 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, for example, in a counterclockwise direction, after being advanced .
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81/83
Although the backstop mechanism can have a variety of configurations, in the embodiment shown in Figure 24B the indicator wheel 74 includes opposing arms 73a and 73b that extend substantially parallel to the Y geometric axis. Each arm 73a and 73b has a tongue 75a and 75b formed on a more distal end thereof, which is adapted to engage the corresponding teeth formed in the casing 12. Although not shown, the corresponding teeth can be formed within a circular protuberance formed on an inner portion of the casing 12 adjacent to window 12a. When the indicator wheel 74 is arranged inside the casing 12, the arms 73a and 73b extend into the circular protrusion formed around the inner circumference thereof. As a clip is applied and the indicator wheel 74 is rotated, the arms 73a and 73b can deflect over the teeth in the wrap to move to the next position. When the indicator actuator 76 slides proximally to return to its initial position, the arms 73a and 73b will engage with the teeth in the wrap to prevent the indicator wheel 74 from turning in a reverse direction, i.e., returning to the previous position. The person skilled in the art will understand that a variety of other techniques can be used to prevent the return of the indicator wheel 74.
[000202] As previously mentioned, the surgical clip applicator 10 can be used to apply a partial or fully closed clip to a surgical site, such as a blood vessel, duct, anastomosis, etc. In laparoscopic and endoscopic surgeries, a small incision is made in the patient's body to provide access to the surgical site. A cannula or access port is typically used to define a working channel extending from the skin incision to the surgical site. During surgical procedures, it is often necessary to interrupt blood flow through vessels or other ducts,
Petition 870190088792, of 09/09/2019, p. 84/93
82/83 and some procedures may require the use of an anastomosis. A surgical clip can thus be used to clip the blood vessel or attach the anastomosis to said vessel. Therefore, a surgical clip applicator, such as the clip applicator 10, can be introduced through the cannula or otherwise introduced into the surgical site to position the claws 20 around the blood vessel, anastomosis or other duct. The tissue blocker 46 can facilitate the positioning of the claws 20 around the target site. Trigger 16 can then be operated to cause a clip to be advanced between the claws and positioned around the target site, and to cause the claws 20 to close to secure the clip. Depending on the intended use of the clip, the trigger 16 may be partially activated, as indicated by the audible sound of the tongue 60 hitting the closing tooth 112b, or it may be fully activated. Trigger 16 is then released to release the clip partially or fully closed, and the procedure can be repeated if necessary to apply additional clips.
[000203] Various surgical clip applicators and methods are also described in US Patent No. 7,297,149 entitled Surgical Clip Applier Methods and filed on April 14, 2005, US Patent No. 7,288,098 entitled Force Limiting Mechanism For Medical Instrument and filed April 14, 2005, US patent No. 7,261,724 entitled Surgical Clip Advancement Mechanism and filed on April 14, 2005, US publication No. 2006/0235440 entitled Surgical Clip Applier Ratchet Mechanism and filed on April 14, 2005 , US publication No. 2006/0235441 entitled Surgical Clip Advancement and Alignment Mechanism and filed April 14, 2005, US publication No. 2006/0235442 entitled Clip Applier With Migrational Resistance Features and filed September 15, 2005, US publication n ° 2006/0235443 entitled Clip Applier Configured to Pre
Petition 870190088792, of 09/09/2019, p. 85/93
83/83 vent Clip Fallout and filed on September 15, 2005, US publication No. 2006/0235444 entitled Clip Advancer Mechanism With Alignment Features and filed on September 15, 2005, US publication No. 2008/0015615 entitled Surgical Clip Advancement Mechanism and filed on July 23, 2007, US publication No. 2008/0004639 entitled Force Limiting Mechanism for Medical Instrument and filed on September 14, 2007, US publication No. 2008/0027465 entitled Surgical Clip Applier Methods and filed on October 9 2007, US publication No. 2008/0027466 entitled Surgical Clip Applier Methods and filed on October 9, 2007, and US application No. 12 / 576,736 entitled Improved Clip Advancer and filed on October 9, 2009, all of which are here incorporated, as a reference, in their entirety.
[000204] The person skilled in the art will appreciate other aspects and advantages of the invention based on the modalities described above. Accordingly, the invention should not be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are hereby expressly incorporated, by reference, in their entirety.

权利要求:
Claims (11)
[1]
1. Surgical clip applicator (10) comprising:
a compartment (12) that has a driver (16) movably coupled to it and an elongated rod (18) extending from it with opposite claws (20) formed at a distal end of it, a set of forward ( 40,40 ') coupled to the actuator, arranged on the elongated rod and configured to advance one of the plurality of clips (36) arranged on the elongated rod into the opposite claws, with the forward set being movable between a proximal position and a position distal, and a feeder shoe (34) disposed on the elongated rod characterized by the fact that the elongated shoe comprises a lock (82d ') configured to engage the forward assembly to lock the forward assembly, and thus the driver (16), in respective partially advanced positions to prevent the forward set from moving to the proximal position, and thus prevent the driver (16) from moving to a fully open position, after the forward set r moved to a distal position to advance a closest clip (36) into the opposite claws.
[2]
2. Surgical clip applicator, according to claim 1, characterized by the fact that the movement of the actuator from the closed position is effective to move the advance assembly from the proximal position to the distal position.
[3]
3. Surgical clip applicator according to claim 1, characterized by the fact that it still comprises a clip track (30) disposed on the elongated stem and having a plurality of clips (36) disposed on it.
[4]
4. Surgical clip applicator, according to claim 3, characterized by the fact that the feeding shoe is available
Petition 870190088792, of 09/09/2019, p. 87/93
2/3 slidably placed on the clip track to advance the plurality of clips (36) distally through the clip track (30).
[5]
5. Surgical clip applicator according to claim 1, characterized by the fact that the lead assembly includes a recess (51a, 51b) formed in it that is configured to be engaged by a lock on the feeder shoe to prevent movement of the forward set to the proximal position after the forward set moved a clip closer into the opposite claws.
[6]
6. Surgical clip applicator, according to claim 5, characterized by the fact that the lock on the feeder shoe is configured to move distally with the feeder shoe as the feeder shoe advances the plurality of clips through the clip track.
[7]
7. Surgical clip applicator according to claim 5, characterized by the fact that the feeder assembly comprises a feeder bar (38.38 ') coupled to a feeder, the feeder having a distal end (40b) configured to be contact and advance a clip of a plurality of clips into the opposite claws.
[8]
8. Surgical clip applicator, according to claim 7, characterized by the fact that the recess is formed through a distal portion (38b) of the feeder bar and a proximal portion (40a) of the forward.
[9]
9. Surgical clip applicator according to claim 5, characterized by the fact that a proximal portion (83) of the lock is connected to the feeder shoe and a distal portion (85) of the lock is disconnected from the feeder shoe and extends a distance below a lower surface of the feeder shoe.
[10]
10. Surgical clip applicator, according to any
Petition 870190088792, of 09/09/2019, p. 88/93
3/3 one of claims 1 to 9, characterized by the fact that the clip advance assembly is operatively associated with the actuator and configured to lock the actuator in a triggered position when the actuator assembly is locked in place.
[11]
11. Surgical clip applicator according to claim 10, characterized by the fact that the opposing jaws are configured to open and release a more proximal clip before the clip lead assembly is locked.

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同族专利:

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公开号 | 公开日

---

US8267945B2|2012-09-18|

---

AU2010303726B2|2013-11-07|

---

CA2777040C|2018-01-23|

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EP2485659B1|2016-03-30|

---

RU2012118651A|2013-11-20|

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BR112012008261A2|2016-03-15|

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CN102781344A|2012-11-14|

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EP2485659A1|2012-08-15|

---

RU2549990C2|2015-05-10|

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WO2011044039A1|2011-04-14|

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AU2010303726A1|2012-05-03|

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US20110087243A1|2011-04-14|

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US8496673B2|2013-07-30|

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US20110218556A1|2011-09-08|

---

CA2777040A1|2011-04-14|

---

CN102781344B|2015-11-25|

---

EP2485659B9|2016-05-11|

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US11051827B2|2018-01-16|2021-07-06|Covidien Lp|Endoscopic surgical instrument and handle assemblies for use therewith|

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US10993721B2|2018-04-25|2021-05-04|Covidien Lp|Surgical clip applier|

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US10786273B2|2018-07-13|2020-09-29|Covidien Lp|Rotation knob assemblies for handle assemblies|

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US11259887B2|2018-08-10|2022-03-01|Covidien Lp|Feedback mechanisms for handle assemblies|

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US11246601B2|2018-08-13|2022-02-15|Covidien Lp|Elongated assemblies for surgical clip appliers and surgical clip appliers incorporating the same|

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US11219463B2|2018-08-13|2022-01-11|Covidien Lp|Bilateral spring for surgical instruments and surgical instruments including the same|

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US11253267B2|2018-08-13|2022-02-22|Covidien Lp|Friction reduction mechanisms for handle assemblies|

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US11033256B2|2018-08-13|2021-06-15|Covidien Lp|Linkage assembly for reusable surgical handle assemblies|

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US11051828B2|2018-08-13|2021-07-06|Covidien Lp|Rotation knob assemblies and surgical instruments including same|

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WO2020051864A1|2018-09-14|2020-03-19|台湾先进手术医疗器材股份有限公司|Continuous clip feeding apparatus of vascular clip applier|

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US11147566B2|2018-10-01|2021-10-19|Covidien Lp|Endoscopic surgical clip applier|

法律状态:
2019-01-08| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-07-16| B06T| Formal requirements before examination [chapter 6.20 patent gazette]|

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2019-12-03| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2020-02-04| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 04/10/2010, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US12/576,736|US8262679B2|2009-10-09|2009-10-09|Clip advancer|

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US12/628,662|US8267945B2|2009-10-09|2009-12-01|Clip advancer with lockout mechanism|

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PCT/US2010/051314|WO2011044039A1|2009-10-09|2010-10-04|Clip advancer with lockout mechanism|

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