Search Images Maps Play YouTube News Gmail Drive More »
Sign in
Screen reader users: click this link for accessible mode. Accessible mode has the same essential features but works better with your reader.

Patents

  1. Advanced Patent Search
Publication numberUS20050090837 A1
Publication typeApplication
Application numberUS 10/867,501
Publication date28 Apr 2005
Filing date14 Jun 2004
Priority date25 Mar 2003
Also published asCA2509915A1, CA2509915C, CN1720856A, CN100515313C, DE602005019655D1, EP1607055A1, EP1607055B1
Publication number10867501, 867501, US 2005/0090837 A1, US 2005/090837 A1, US 20050090837 A1, US 20050090837A1, US 2005090837 A1, US 2005090837A1, US-A1-20050090837, US-A1-2005090837, US2005/0090837A1, US2005/090837A1, US20050090837 A1, US20050090837A1, US2005090837 A1, US2005090837A1
InventorsRobert Sixto, Kevin Smith, Juergen Kortenbach, Kristin Dawson, Scott Arp, Jose Francese, Matthew Palmer, Peter Kratsch, Carlos Rivera
Original AssigneeSixto Robert Jr., Smith Kevin W., Kortenbach Juergen A., Dawson Kristin N.W., Scott Arp, Francese Jose L., Palmer Matthew A., Kratsch Peter K., Carlos Rivera
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Endoscopic surgical instrument having a force limiting actuator
US 20050090837 A1
Abstract
A flexible endoscopic clip applier includes a flexible coil with a manual actuator coupled to one end and a jaw assembly coupled to the other end. A store of clips is arranged adjacent to the jaw assembly and a clip pusher is arranged adjacent to the store of clips. The actuator includes a lever for opening and closing the jaws, a knob for rotating the jaw assembly, and a crank for dispensing clips. The knob and the lever are coupled to a single control member which extends through the coil to a joiner where it is joined to a pair of pull wires coupled to the jaws. The crank is coupled to a second control member which is threaded along a distal portion. The threaded portion engages a threaded member near the pusher and is coupled to the pusher such that rotation of the threaded control member by the crank causes the pusher to be moved distally.
Images(49)
Previous page
Next page
Claims(17)
1. An endoscopic surgical instrument, comprising:
a flexible tube having a proximal end and a distal end;
an end effector coupled to said distal end;
an actuator coupled to said proximal end;
a control member extending through said flexible tube, said control member coupled to said end effector and to said actuator, wherein
said actuator has means for rotating said control member and means for translating said control member, said means for translating said control member including means for limiting force applied to said control member.
2. The instrument according to claim 1, wherein:
said means for limiting force includes a spring coupled between said control member and said actuator.
3. The instrument according to claim 2, wherein:
said spring is a compression spring.
4. The instrument according to claim 2, wherein:
said spring is a torsion spring.
5. The instrument according to claim 1, wherein:
said actuator includes a two part lever and said means for limiting force is a spring coupled to first and second parts of said two part lever.
6. The instrument according to claim 5, wherein:
said spring is a torsion spring.
7. The instrument according to claim 5, wherein:
said two part lever includes a rotation post about which said first part of said two part lever can rotate.
8. The instrument according to claim 7, wherein:
said actuator includes a ball which is coupled to said control member and to said second part of said two part lever.
9. The instrument according to claim 1, wherein:
said means for rotating is coupled to said control member by a spline coupling.
10. The instrument according to claim 1, wherein:
said means for limiting force includes a compression spring coupled between said flexible tube and said actuator.
11. The instrument according to claim 1, wherein:
said means for limiting force includes
spaced apart proximal coupling and distal coupling,
both coupled to said control member,
a compression spring located between said proximal coupling and distal coupling, a distal end of said compression spring coupled to said means for translating.
12. The instrument according to claim 1, wherein:
said means for limiting force includes
a compression spring having a proximal end and a distal end, said means for translating being coupled to said distal end of said spring, and
a shuttle member coupled to said control member, said shuttle member being located between said proximal end of said spring and said means for translating.
13. The instrument according to claim 11, wherein:
said means for limiting force includes
a cup located between said compression spring and said proximal coupling,
a rod coupled to said distal end of said compression spring and extending through said compression spring into said cup.
14. The instrument according to claim 13, wherein:
said means for limiting force includes
a member extending adjacent said compression spring, one end of said member being coupled to said distal end of said spring and the other end of said member being coupled to said means for translating.
15. The instrument according to claim 14, wherein:
said member extending adjacent said compression spring is a U-shaped member.
16. A method for applying an endoscopic clip, comprising:
delivering an endoscopic instrument through the lumen of an endoscope to a site for applying a clip, the instrument including a pair of manually operable jaws and a supply of clips; and
automatically limiting the force applied to the jaws while the instrument is being delivered through the endoscope.
17. The method according to claim 16, further comprising:
opening the jaws at the site for applying a clip;
positioning the open jaws about a tissue;
closing the jaws about the tissue; and
automatically limiting the force applied to the jaws when they are closed about the tissue.
Description
  • [0001]
    This application is a continuation-in-part of U.S. Ser. No. 10/396,962 entitled “Flexible Housing Element for a Surgical Tool” filed Mar. 25, 2003 which is hereby incorporated by reference herein in its entirety. This application is related to U.S. Ser. No. (Docket #ISD-083) entitled “SURGICAL CLIP”, filed on an even date herewith, the complete disclosure of which is hereby incorporated by reference herein.
  • BACKGROUND OF THE INVENTION
  • [0002]
    1. Field of the Invention
  • [0003]
    This invention relates broadly to surgical instruments. Particularly, this invention relates to flexible endoscopic instruments for use through an endoscope. More particularly, this invention relates to a surgical clip applier which is adapted for use through an endoscope and may be used to clamp and/or suture, ducts, vessels, and other tissues, to anchor a tissue, or to attach a foreign body to a tissue.
  • [0004]
    2. State of the Art
  • [0005]
    Surgical clips are generally used to apply clamping force to ducts, vessels, and other tissues. In addition, surgical clips are particularly useful in controlling bleeding of a tissue in lieu of suturing or stapling where suturing or stapling is difficult.
  • [0006]
    Surgical clips are typically applied to tissue by clip appliers. All of the currently available surgical multi-firing clip appliers are substantially rigid devices intended to extend through a trocar port or through an incision to a surgical site requiring application of a clip. The devices have been rigid because a stiff pushing element has been required in order to exert the required pushing force to move the clip over the tissue.
  • [0007]
    There is a substantial need for a flexible clip applier, particularly one insertable through a lumen of an endoscope. The ability to apply clips through an endoscope would permit myriad minimally invasive surgical solutions to medical problems, especially those of the gastrointestinal tract. However, it is accepted theory that the transmitted force required to advance or form a clip over tissue cannot be produced in the distal end of a long flexible device that is commonly constructed with a metal tubular coil, or polymer tube, such as an endoscopic device or catheter.
  • [0008]
    Generally a flexible endoscopic device (e.g., a biopsy forceps device) includes an outer tubular member, typically being constructed of a metal tubular coil or a polymer tube which is poor in transmitting forces that impart tensile stresses to the outer tubular member, a control element longitudinally movable relative to the tubular member, an end effector coupled to the distal ends of both the tubular member and the control element such that relative movement of the control element and the tubular member causes operation of the end effector, and a handle which moves the control element relative to the handle. This type of flexible endoscopic instrument is limited in the amount of pushing force it can generate for several reasons. First, compression of a flexible control element (pushing element) tends to cause the pushing element to buckle within the outer flexible sheath of the device. If a relatively larger diameter flexible pushing element is used such that it better resists buckling, the pushing element may impart too much stiffness to permit it to flex as it bends with the endoscopic instrument. Second, a flexible pushing element of larger diameter is subject to greater frictional forces within the outer sheath, which reduces the force transmitted from the handle to the end effector. If the flexible pushing element is made relatively smaller in diameter, it is subject to kinking, which will result in little to no force being transmitted to the distal end. Kinking is especially a problem in endoscopic instruments, because the endoscope and its lumen may be extended through a tortuous path. For most flexible devices, especially metal coils, the outer sheath begins to stretch when force is applied to the pushing element. This reduces or eliminates the force and relative movement of the pushing element. For these reasons and others, mechanical application of a relatively large distal end pushing force, and particularly clip application, have been absent from the capability of flexible endoscopic tools.
  • [0009]
    In addition, it is important that the tissue about which a clip is to be applied be substantially compressed. While the jaws apply a clamping force which compresses the tissue, large clamping forces are difficult to achieve because of the dimensions of the relatively small jaw assembly. That is, the dimensions are such that the lever arm between a pivot of the jaw assembly and each jaw tang is relatively short, limiting the mechanical leverage of the jaw assembly.
  • [0010]
    Our previous application Ser. No. 10/396,962, which is hereby incorporated by reference herein in its entirety, discloses a flexible clip applier that includes a ratchet mechanism adapted to locate a clip pusher to a known location after deployment of a clip. In addition, the clip applier includes a flexible housing into which a train of clips may be chambered. The flexible housing does not elongate when subject to tensile forces. In addition, the jaw assembly is adapted to have relatively high mechanical leverage which facilitates tissue compression prior to application of a clip.
  • [0011]
    Since the development of the clip applier disclosed in Ser. No. 10/396,962, we have developed an improved flexible endoscopic clip applier which is the subject of the instant application.
  • SUMMARY OF THE INVENTION
  • [0012]
    It is therefore an object of the invention to provide a flexible endoscopic clip applier.
  • [0013]
    It is also an object of the invention to provide a flexible endoscopic clip applier capable of dispensing multiple clips.
  • [0014]
    It is another object of the invention to provide a flexible endoscopic clip applier which limits the amount of force which can be applied to the jaws of the device.
  • [0015]
    It is still another object of the invention to provide a flexible endoscopic clip applier which limits the amount of force which can be applied to the jaws of the device while adjusting for relative changes in the length of the outer sheath due to tortuosity of the path of the endoscope.
  • [0016]
    It is a further object of the invention to provide a flexible endoscopic clip applier which has two jaws which are rotatable about different axes to improve the mechanical advantage of the jaws.
  • [0017]
    It is also an object of the invention to provide a flexible endoscopic clip applier which dispenses clips via smooth movement of a manual actuator.
  • [0018]
    It is an additional object of the invention to provide a flexible endoscopic clip applier which has an actuator that dispenses clips precisely one at a time.
  • [0019]
    Another object of the invention is to provide a flexible endoscopic clip applier which uses a single control wire to open and close jaws as well as to rotate them about the longitudinal axis.
  • [0020]
    A further object of the invention is to provide a flexible endoscopic clip applier having improved jaws.
  • [0021]
    An additional object of the invention is to provide a flexible endoscopic clip applier which prevents the accidental dispensing of the penultimate clip when the device is moved away from the ultimate clip after it is applied.
  • [0022]
    It is yet another object of the invention to provide a flexible endoscopic clip applier which forms clips as they are dispensed.
  • [0023]
    It is even another object of the invention to provide a flexible endoscopic clip applier having a handle having a resistance force which is substantially constant during a cycle of forming and applying a clip.
  • [0024]
    Yet another object of the invention is to provide a clip applier with clip-forming jaws which indicate a tissue fixation point for the applied clip.
  • [0025]
    Even another object of the invention is to provide a clip applier with a mechanism which stably advances clips through a coil and into an end effector.
  • [0026]
    A further object of the invention is to provide an endoscopic clip applier which can fire a clip only when the jaws of the applier are closed.
  • [0027]
    Another object of the invention is to provide an endoscopic clip applier which can fire only one clip at a time, i.e. between closing and opening the jaws.
  • [0028]
    An additional object of the invention is to provide an endoscopic clip applier which provides a visual indication to the practitioner of the number of clips which are left in the applier.
  • [0029]
    Still another object of the invention is to provide an endoscopic clip applier which stops operating after all of the clips have been dispensed.
  • [0030]
    In accord with these objects, which will be discussed in detail below, a flexible endoscopic clip applier according to the invention has a relatively long flexible coil (or tube) having a proximal end and a distal end. As used herein, the term proximal end means the end closest to the practitioner and the term distal means the end closest to the patient. A manual actuator is coupled to the proximal end of the coil and a pair of jaws is coupled to the distal end of the coil. A store of clips is disposed inside the coil adjacent to the jaws. The interiors of the jaws form anvils for bending a clip as it is pushed from the store into the closed jaws. The manual actuator has three controls: a lever for opening and closing the jaws, a knob for rotating the jaws (and a distal portion of the coil) about the longitudinal axis of the coil, and a crank for dispensing a clip. The lever and knob are coupled to a single first control member which extends through the coil to a point proximal of the store of clips. The crank is coupled to a second control member which extends through the coil up to a point adjacent to the store of clips and is threaded along a distal portion thereof.
  • [0031]
    According to the presently preferred embodiment, the lever is coupled to a force limiter which prevents too much force from being applied to the jaws when closing them. The force limiter also effectively adjusts for the relative changes in the length of the outer sheath with respect to the jaw control member. The knob is coupled to the first control member via a spline coupling. The crank is coupled to the second control member via a transmission and an energy storage device, e.g. a flywheel.
  • [0032]
    The first control member terminates proximal of the store of clips and is coupled to a joiner which is coupled to a pair of pull wires. The pull wires extend on opposite sides of the store of clips, each being coupled to one of the jaws.
  • [0033]
    According to the invention, the coil is bifurcated proximal of the store of clips and the two portions of the coil are joined by a rigid member having four bores, one of which is threaded. The rigid member is disposed distal of the joiner and the first control member extends into one of the bores of the rigid member. In this way, rotation of the first control member causes the rigid member to rotate which causes the distal portion of the coil and the jaws to rotate about the longitudinal axis. This helps orient the jaws properly before closing the jaws on a tissue to be clipped. The two pull wires extend through two other bores in the rigid member and the threaded portion of the second control member threadably engages the threaded bore of the rigid member. In this way, when the threaded control member is rotated (by the crank), it is translated distally. The distal end of the threaded control member is coupled to a clip pusher. The clip pusher is arranged adjacent to the proximally closest clip in the store of clips which are axially arranged one after the other. When the threaded control member is translated distally, the store of clips is moved distally until the ultimate clip (the one at the distal end of the store) enters the closed jaws and is applied to tissue through the bending of its ends by the interior anvils of the jaws.
  • [0034]
    The transmission and the pitch of the threads on the threaded portion of the second control member are arranged such that exactly one rotation of the crank causes exactly one clip to be dispensed. The crank is preferably provided with a detent lock which must be engaged to release the crank and which automatically stops the crank after one rotation.
  • [0035]
    Further according to the invention, the jaws are identical hermaphroditic jaws which are respectively rotatably coupled on offset axes to a clevis at the distal end of the distal coil. Each jaw has a distal tooth and a proximal tang. The tang is coupled to one of the pull wires and lies on one side of the longitudinal axis. The distal tooth of that jaw lies on the opposite side of the longitudinal axis, which prevents side-to-side misalignment of the jaws when they are closed.
  • [0036]
    The store of clips is housed in a “garage” which is coupled to the clevis and extends proximally therefrom. The garage is a substantially rigid rectilinear structure which keeps the clips properly aligned and allows them to be smoothly pushed out of the garage into the closed jaws. The distal portion of the garage is provided with a pair of biased stops which prevent the penultimate clip from moving out of the garage when the applier is moved away from the ultimate clip after it has been applied. In an alternate embodiment, the stops are made part of the clevis rather than the garage.
  • [0037]
    According to presently preferred embodiments, the crank is located on both sides of the manual actuator to accommodate left hand and right hand use. A counter mechanism is coupled to the crank and indicates the number of clips remaining in the garage. The detent lock is engagable by the lever so that the crank can only be operated when the jaws are closed. The crank is also provided with a ratchet mechanism so that it can only be rotated in one direction. The counter also includes a stop which prevents the crank from being rotated after all of the clips have been dispensed.
  • [0038]
    Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the provided figures.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0039]
    FIG. 1 is a partially disassembled side elevation view of a surgical clip applier according to the invention, shown with the lever and the jaws in an open position;
  • [0040]
    FIG. 2 is a partially disassembled perspective view of the manual actuator shown with the lever in the open position;
  • [0041]
    FIG. 3 is a longitudinal sectional view of the manual actuator shown with the lever in the open position;
  • [0042]
    FIG. 3A is a view similar to FIG. 3 but showing the force absorbing spring in a compressed state;
  • [0043]
    FIG. 4 is a longitudinal sectional view of the manual actuator shown with the lever in the closed position;
  • [0044]
    FIG. 4A is a view similar to FIG. 4 showing the force absorbing spring in a compressed state;
  • [0045]
    FIG. 4B is a schematic view of a first alternate force absorber arrangement;
  • [0046]
    FIG. 5 is a perspective view of the manual actuator showing the crank;
  • [0047]
    FIG. 6 is a sectional view through the crank illustrating the locking detent;
  • [0048]
    FIG. 7 is a broken partially disassembled view illustrating the coils, the jaws, and the distal end of the manual actuator;
  • [0049]
    FIG. 8 is a broken partially transparent perspective view of the control members, the joiner, the rigid member, one of the pull wires, the pusher, a portion of the garage and a portion of a clip;
  • [0050]
    FIG. 9 is a plan view of the rigid member;
  • [0051]
    FIG. 10 is a plan view of the joiner;
  • [0052]
    FIG. 11 is a broken partially transparent perspective view of the threaded control member, the pusher, a portion of a clip, and one of the pull wires;
  • [0053]
    FIG. 12 is a perspective view of the pusher;
  • [0054]
    FIG. 13 is a partially cut away perspective view of the garage, the clevis, the jaws and a clip in the applied configuration;
  • [0055]
    FIG. 14 is a perspective view of the garage;
  • [0056]
    FIG. 15 is an enlarged broken perspective view of the distal end of the garage illustrating the biased stops;
  • [0057]
    FIG. 16 is a broken plan view illustrating the clevis and portions of the jaws, pull wires, garage, and clips;
  • [0058]
    FIG. 17 is a broken partially transparent perspective view illustrating the clevis and portions of the jaws, pull wires, garage, and clips;
  • [0059]
    FIG. 18 is a broken perspective view of the clevis, open jaws and portions of a pull wire and garage;
  • [0060]
    FIG. 19 is a distal end view looking into the open jaws;
  • [0061]
    FIG. 20 is a broken side elevational view of the clevis, closed jaws, and an applied clip;
  • [0062]
    FIG. 21 is a perspective end view of the closed jaws, clevis, and the garage;
  • [0063]
    FIG. 22 is a broken longitudinal section illustrating the jaws closed, the clevis and a distal portion of the garage, with no clips;
  • [0064]
    FIG. 23 is a view similar to FIG. 22 but with three clips;
  • [0065]
    FIG. 24 is a plan view of the interior of a jaw; 1 FIG. 25 is a perspective view of the interior of a jaw;
  • [0066]
    FIG. 26 is a side elevational view of the clevis;
  • [0067]
    FIG. 27 is a distal end view of the clevis;
  • [0068]
    FIG. 28 is a schematic side elevation view in partial section of an alternate embodiment of “self-pushing” threaded clips coupled to a threaded control member;
  • [0069]
    FIG. 28 a is a longitudinal sectional view of a self-pushing clip;
  • [0070]
    FIG. 28 b is an end view of the clip of FIG. 28 a;
  • [0071]
    FIG. 29 is a perspective view of a shepard's crook;
  • [0072]
    FIG. 30 is a proximal end view of a presently preferred embodiment of the manual actuator;
  • [0073]
    FIG. 31 is a side elevation view of the presently preferred embodiment of the manual actuator;
  • [0074]
    FIG. 32 is an exploded perspective view of the presently preferred embodiment of the manual actuator;
  • [0075]
    FIG. 33 is a view similar to FIG. 31 with the crank transparent to illustrate the ratchet mechanism;
  • [0076]
    FIG. 34 is an enlarged view of the transmission and counter gears;
  • [0077]
    FIG. 35 is a view similar to FIG. 34 with the transmission gears removed showing the connection between the crank shaft and the counter gear;
  • [0078]
    FIG. 36 is an exploded perspective view of the presently preferred embodiment of the manual actuator showing the detent lock engagable by the lever;
  • [0079]
    FIG. 37 is an enlarged view of the lock mechanism of FIG. 36;
  • [0080]
    FIG. 38 is a partially disassembled perspective view of a manual actuator having an alternate embodiment of a force limiting spring assembly using a shuttle element;
  • [0081]
    FIG. 39 is a broken enlarged view of the spring assembly of FIG. 38;
  • [0082]
    FIG. 40 is an enlarged perspective view of an hermaphroditic part used to form the shuttle element;
  • [0083]
    FIG. 41 is a view similar to FIG. 38 showing an alternate embodiment of a force limiting device in the form of a spring-hinged lever;
  • [0084]
    FIG. 42 is a perspective view of the spring-hinged lever;
  • [0085]
    FIG. 43 is an enlarged perspective view of an hermaphroditic part used to form a ball joint coupling between the control member and the spring-hinged lever;
  • [0086]
    FIG. 44 is a view similar to FIG. 20 but of an alternate jaw embodiment; and
  • [0087]
    FIG. 45 is a view similar to FIG. 18 but of the alternate jaw embodiment of FIG. 44.
  • DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • [0088]
    Turning now to FIG. 1, a flexible endoscopic clip applier 10 according to the invention has a relatively long flexible coil (or tube) 12 having a proximal end 14 and a distal end 16. As used herein, the term “proximal” means closest to the practitioner and the term “distal” means closest to the patient. A manual actuator 18 is coupled to the proximal end 14 of the coil 12 and a pair of jaws 20 is coupled to the distal end 16 of the coil 12. The coil is preferably a flat wire coil having a friction reducing outer sheath (not shown). The invention will be described in detail referring to each of its major components starting at the proximal end and working toward the distal end.
  • [0000]
    The Manual Actuator
  • [0089]
    A first embodiment of a manual actuator is shown in FIGS. 1-6. A presently preferred embodiment of the manual actuator is shown in FIGS. 30-37 and described in detail below.
  • [0090]
    The manual actuator 18 of FIGS. 1-6 has three controls: a lever 22 for opening and closing the jaws 20, a knob 24 for rotating the jaws 20 (and a distal portion of the coil 12) about the longitudinal axis of the coil, and a crank 26 for dispensing a clip. It will be appreciated that the manual actuator 18 has a generally pistol shape which is similar to other endoscopic actuators. A finger grip 28 is provided opposite the lever 22 which has a thumb grip 30. Engaging hooks 32, 34 on the lever and the finger grip allow the lever to be locked as shown in FIG. 4. Those skilled in the art will further appreciate that the general operation of the clip applier 10 involves closing the jaws (optionally by locking the lever 22), delivering the jaws 20 through the lumen of an endoscope to the surgical site, opening the jaws as shown in FIG. 1, positioning the jaws 20 through movement of the coil 12 and rotation of the knob 24 so that tissue to be clipped is located between the jaws, locking the lever 22 to close the jaws on the tissue, turning the crank 26 to apply a clip, and then releasing the jaws from the clip and tissue.
  • [0091]
    Turning now to the details of the manual actuator 18 and with continued reference to FIGS. 1-6, and FIG. 3 in particular, the lever 22 and the knob 24 are coupled to a single first control member 36. The lever 22 is rotatable about axle 23 and coupled to the control member 36 via a force limiting mechanism 37. The force limiting mechanism includes spring 38, a proximal coupler 38 a, a force limiter cap 38 b, a force limiting cup 38 c, an overload nut 38 d, a distal coupler 38 e, and an overload shaft 38 f. The overload shaft 38 f is coupled to overload nut 38 d and extends inside the spring 38 and partially into the force limiting cup 38 c.
  • [0092]
    The lever 22 is coupled to the distal end of the spring 38 by a linkage 44 seen best in FIG. 2. In particular, the linkage 44 includes a U-shaped member 44 a which fits over the spring 38 and its associated elements 38 a-38 f. A pin 44 b couples the proximal end of the U-shaped member 44 a to a slot 22 a in the upper part of the lever 22 and a second pin 44 c couples the distal end of the U-shaped member 44 a to the overload nut 38 d.
  • [0093]
    With the provided arrangement, movement of the lever 22 towards the finger grip 28 causes the linkage 44 to move proximally which moves the overload nut 38 d proximally. The overload nut 38 d in turn pushes against the spring 38 moving it proximally. The spring 38 pushes against the cup 38 c which presses against the limiter cap 38 b which in turn presses against the proximal coupling 38 a. Since the proximal coupling 38 a is affixed to the control member 36, proximal movement of the proximal coupling 38 a causes proximal movement of the control member 36. Effectively, then, the entire force limiting assembly 37 is moving proximally and pulls the control member 36 proximally.
  • [0094]
    If at any time during the closing of the jaws the tension on the control member 36 exceeds a predetermined force limit of the spring 38 (e.g., seventeen pounds), the spring force of the spring 38 will be overcome such that the spring 38 will compress and the overload shaft 38 f and the overload nut 38 d will move away from the distal coupler 38 e without moving the control member 36 as seen in FIG. 3A. In this force overload situation, the shaft 38 f is received into the hollow 38 c′ of the overload cup 38 c.
  • [0095]
    FIG. 3A shows the force limiting spring 38 in the compressed position during closing of the jaws. This will occur when the control member 36 is pulled beyond the distance normally necessary to close the jaws (e.g. when the jaws are prevented from closing all the way because they are surrounding a very thick or very hard tissue, or if the tortuosity of the path of the coil causes an effective lengthening of the coil, effective shortening of the control member 36, thereby increasing the stroke of the lever 22, shortening the stroke required to close the jaws). The spring 38 prevents the jaws, the tissue and/or the control member 36 from being damaged due to excessive loads while allowing the lever 22 to be fully actuated to the latched position.
  • [0096]
    If, after the lever 22 has moved to a position as shown in FIG. 4 where the jaws have been closed, excessive force is applied to the control member 36 (e.g., while delivering the jaws to the surgical site through a tortuous endoscopic path), the force limiting mechanisms 37 will also operate to prevent damage to the control member 36. In particular, as seen in FIG. 4A, if the control wire is pulled distally after the jaws have been closed, and the force on the control wire 36 exceeds the predetermined limit of spring 38, the proximal coupling 38 a which is fixedly coupled to the control member 36 will be moved distally against the cap 38 b and the force limiting cup 38 c. The force limiting cup, in turn will move distally, compressing the spring 38 against the nut 38 d which is fixed in place because of its linkage to lever 22 which is locked.
  • [0097]
    In either case, when the lever 22 is released, the spring 38 will decompress by linkage 44 causing the nut 38 d to move distally until it abuts the distal coupling 38 e (which is coupled to the control member 36). The distal movement of the nut 38 d causes distal movement of the distal coupling 38 e which is coupled to the control member 36 causing the control member 36 to move distally.
  • [0098]
    According to the presently preferred embodiment, the spring is always compressed when the lever 22 is moved to the locked position.
  • [0099]
    To permit rotation of the control member 36, the knob 24 is coupled to the control member 36 via a spline 40 mounted in a shaft bearing 24 a held by a clamp 24 b. The proximal end of the control member 36 is bent into a shepherd's crook 36 a which slidably engages the spline 40 coupled to the knob 24. A shepherd's crook is illustrated in FIG. 29. Rotation of the knob 24 thus causes rotation of the control member 36.
  • [0100]
    It should be noted that in the force limiting mechanism 37, the distal coupling 38 e and the proximal coupling 38 a are assembled in such a way as to allow clearance with the rest of the force limiting assembly 37. This clearance allows for ease of rotation since and friction created by the preloaded spring 38 is not translated into torsional resistance.
  • [0101]
    FIG. 4B shows a first alternate embodiment of a force limiting mechanism 137. Here, the coil 112 is provided with a proximal bushing 113. The manual actuator or handle 118 is provided with a recess 119 which is dimensioned to receive the bushing 113, a washer/spacer 115, and a compression spring 138 therebetween. Those skilled in the art will appreciate that if, during closing of the jaws, an obstacle prevents the jaws from closing fully, the proximal force applied to the control member 136 will be applied to the distal clevis 182, the coil 112, and the handle 118. The handle will exert an equal and opposite force in the distal direction against the washer spacer 113. As a result, when the spring force of the compression spring 138 is exceeded, the proximal end of the coil will move the bushing 113 against the spring 138.
  • [0102]
    Still referring to FIGS. 1-6, and particularly FIG. 4, the crank 26 is coupled to a transmission 46 which is coupled to a second control member 48. More particularly, the transmission includes an input spur gear 47 which is coupled to the crank, a step-up spur gear 49 coupled to the input spur gear, and a crown gear 50 which is coupled to the step-up spur gear. The crown gear engages a pinion 52 coupled to a cylinder 54 having a keyed interior which engages the second control member 48 which is provided with a shepherd's crook 48 a (also as illustrated in FIG. 29) at or near its proximal end. The cylinder 54 is mounted on two bearings 55, 57 which are held by clamps 55 a, 57 a. The second control member 48 (as discussed in detail below with reference to FIGS. 8-11) is threaded along a distal portion thereof. From the discussion which follows, it will be appreciated that the length of the cylinder 54 is sufficient to allow distal movement of the second control member 48 until all of the clips have been dispensed. According to the presently preferred embodiment, the control member 48 is made from 17-7 PH stainless steel wire.
  • [0103]
    According to the presently preferred embodiment, an energy storing flywheel 56 is coupled to the cylinder 54. Alternatively, the flywheel and cylinder could be a single molded part. The flywheel smoothes the operation of the crank which would otherwise require the application of increasing force through its rotation, as in the beginning of its rotation, the control member is causing a clip to be advanced, whereas at the end of its rotation, the control member is causing the clip to be formed by pushing it against an anvil in the end effectors (as discussed in more detail below). Those skilled in the art will appreciate that in order to be effective, the flywheel is preferably provided with a relatively large rotational mass for energy storage. When the flywheel is spun (rotated) by rotation of the crank, a certain amount of energy is invested which increases the kinetic energy (mass×velocity) of the flywheel. Some of this energy is lost over time to friction; however, some of the energy used to spin the flywheel is stored in the form of kinetic energy. Later, it is possible to retrieve this energy through direct mechanical translation. In the case of the present invention, when the crank 26 is first rotated, the control member 48 offers little resistance (as the clips are moving forward easily) and most of the energy applied to the crank is used to put the flywheel 56 in rotation. Near the end of the crank's rotation, torsional resistance is built up by the control member 48 because it is near the end of the cycle where the clip is being bent into its final shape. At this point, the kinetic energy in the flywheel is released and eases the remainder of the crank cycle. Preferably, according to the invention, the flywheel 56 is chosen so that the force which is applied to the crank 26 is substantially even (e.g., does not change by more than 25%) over the entire movement of the crank 26 necessary to dispense a single clip.
  • [0104]
    As seen best in FIGS. 5 and 6, the crank 26 is provided with a detent lock 58 which must be released before the crank 26 can be turned and which automatically locks the crank 26 after one rotation. Preferably, the crank 26 is also provided with a ratchet mechanism (not shown) which prevents it from being rotated backwards. The crank is also preferably provided with a lock (not shown) which prevents it from being turned until the jaws are closed. The crank may also be provided with a revolution counter (not shown) which can be coupled to the input spur gear and which counts the number of times the crank has been rotated and thus indicates the number of clips which have been dispensed. The revolution counter may also be used to prevent the crank from rotating after all of the clips have been dispensed. Ideally, the crank is also provided with a lockout mechanism which prevents it from being rotated twice without opening and closing the jaws between rotations of the crank.
  • [0105]
    According to the embodiment illustrated in FIGS. 5 and 6, the crank 26 has a plurality of spaced apart peripheral finger grips 26 a and a knurled outer periphery 26 b. The crank handle 26 c is optionally removable so that the crank can be rotated like a knob if desired. The detent lock 58 includes a push button 58 a having a flange 58 b, a lock pin 58 c having a flange 58 d and a spring 58 e. The lock pin 58 c is disposed in a stepped bore 58 f and is biased by the spring 58 e into the stepped bore 26 d in the crank 26. When the button 58 a is pressed, the lock pin 58 c is moved against the spring 58 e and out of the bore 26 d, freeing the crank to rotate.
  • [0106]
    According to an exemplary embodiment, the transmission causes the second control member to be rotated 58.1875 revolutions when the crank is turned one revolution. The pitch of the threads on the control member result in the control member advancing 0.285 inches when the crank is turned one revolution. The gears and the thread pitch are selected for a particular clip length. According to the presently preferred embodiment, it is only necessary to change the crown gear (by increasing or decreasing the number of teeth) to accommodate clips of different length.
  • [0107]
    As illustrated in FIGS. 1-4 and 4 a, the distal end of the manual actuator 18 has a pair of vertical slots 15 which capture a coil connector (not shown) that is attached to the proximal end of the coil.
  • [0000]
    The Control Members
  • [0108]
    Referring now to FIGS. 7-10, the control members 36, 48 extend through a flexible coil 12 coupled to the distal end of the manual actuator 18. According to the invention, the coil 12 has two parts: a proximal part 12 a and a distal part 12 b which are coupled to each other by a rigid member 60. The rigid member 60 is substantially cylindrical having a center portion 60-1 of larger diameter than the end portions 60-2, 60-3. The end portions 60-2, 60-3 are dimensioned to fit inside the coils 12 a, 12 b and the central portion 60-1 is dimensioned to have an outer diameter substantially the same as the outer diameter of the coils 12 a, 12 b. The rigid member 60 has four bores 60 a-60 d. One of the bores, 60 d, is threaded and engages the threaded portion of the second control member 48. Because the rigid member 60 is fixed relative to the coils 12 a, 12 b, it will be appreciated that this threaded engagement causes the second control member 48 to move distally through the rigid member 60 when it is rotated by the crank 26 (FIG. 2).
  • [0109]
    Two of the other holes, 60 a and 60 b, in the rigid member 60 allow the passage of a pair of pull wires 62, 64 which are described in more detail below with reference to FIGS. 16 and 17. The proximal ends of the pull wires are coupled to a joiner 66 which has four bores 66 a-66 d. One pull wire is coupled to bore 66 a and the other is coupled to bore 66 b. The first control member 36 extends through and is coupled to the bore 66 c, and the threaded control member 48 freely passes through the bore 66 d. In this manner, longitudinal movement of the first control member 36 causes longitudinal movement of the pull wires 62, 64. The portion 36 a of the control member 36 which extends through the joiner 66 extends into the bore 60 c of the rigid member 60. The length of this portion 36 a is sufficient to engage the bore 60 c throughout the range of movement of the control member 36. In this manner, rotation of the control member 36 with the knob 24 (FIG. 1) causes rotation of the rigid member 60 which causes rotation of the distal portion 12 b of the coil 12 which results in rotation of the jaws 20 and the store of clips about the longitudinal axis of the coil.
  • [0110]
    As seen best in FIG. 8, the control members 36 and 48 are protected by a dual lumen flexible sheath 68 inside the proximal portion 12 a of the coil 12. The sheath 68 reduces friction between the control members and the interior of the coil. The sheath 68 also prevents buckling or kinking of the control members. It should also be noted that a friction-reducing sheath is preferably provided along the entire exterior surface of the coil to reduce friction between the coil and the lumen of the endoscope through which it is delivered and to protect the lumen of the endoscope from damage.
  • [0111]
    According to a presently preferred embodiment, both control members have smaller diameters in their distal portions to add flexibility and larger diameters in the proximal portions to optimize torque transmission.
  • [0000]
    The Pusher
  • [0112]
    Turning now to FIGS. 11-13, the distal end of the threaded control member 48 is coupled to a clip pusher 70. As seen best in FIG. 12, the pusher 70 is a generally rectilinear member having an off-axis bore 70 a intersected by a notch 70 b. A pair of inwardly curved distally extending fingers 70 c, 70 d are separated from a distal mouth 70 e by shoulders 70 f, 70 g. As seen best in FIG. 11, the distal end of the threaded control member 48 extends through the bore 70 a and is coupled to a cylinder 72 which is captured in the notch 70 b. The cylinder 72 may be crimped or welded to the control member 48. The coupling of the pusher and the control member is such that the control member can freely rotate relative to the pusher. As seen best in FIG. 11, the distal end 48 b of the control member 48 is sharpened to a point and the distal end of the throughbore 70 a is provided with a conical wall 70 h. The apex angle of the conical wall 70 h is larger than the apex angle of the point 48 b. From the foregoing, those skilled in the art will appreciate that when the control member 48 is rotated, it moves distally, pushing the pusher distally. It will also be appreciated that the frictional engagement of the control member 48 with the pusher 70 is limited to the small area of engagement of the point 48 b with the apex of the cone 70 h.
  • [0113]
    As seen best in FIG. 13, the clip pusher 70 is arranged adjacent to the proximally closest clip 74 in the store of clips 76 which are axially arranged one after the other proximal to the jaw assembly 20. When the control member 48 is translated distally, the store of clips 76 is moved distally until the ultimate clip 78 (the one at the distal end of the store) enters the closed jaws and is applied to tissue through the bending of its ends by the interior anvils of the jaws. FIG. 13 shows the jaws open after the clip 78 was applied.
  • [0114]
    As seen best in FIG. 11, the clip 74 (which is identical to all of the other clips) has a proximal tail 74 a which is engaged by the mouth 70 e and shoulders 70 f, 70 g of the pusher 70. The fingers 70 c and 70 d constrain the clip from vertical movement and allow the pusher to lightly grab the clip, which facilitates clip loading during assembly. Additional details of the clip may be appreciated upon review of previously incorporated U.S. Ser. No. (Docket ISD-083).
  • [0115]
    Those skilled in the art will appreciate that the arrangement of threads could be changed while still achieving the same or similar results. For example, rather than arranging the threaded control member to advance distally, threads could be supplied on the pusher with the threaded control member being translationally stationary. In this arrangement, rotation of the threaded control member causes the pusher to be translated along the control member.
  • [0000]
    The Garage
  • [0116]
    As seen best in FIGS. 13 and 16, the store of clips 76 is housed in a garage 80 inside the distal portion 12 b of the coil 12 proximal to the jaw assembly 20. Details of the garage 80 are seen in FIGS. 14-17. The garage 80 generally comprises a plurality of parallel side walls 80 a-80 l and pair of distally extending fingers 80 m, 80 n which are orthogonal to the side walls. Each side wall has a plurality of outwardly directed spacers, e.g. 80 c-1, 80 c-2, 80 c-3, 80 c-4. These spacers engage the interior of the coil and assure space between the coil and the garage for the passage of the pull wires 62, 64 (see FIG. 16). Formation of the outwardly directed spacers results in narrow strips, e.g. 80 ab, 80 bc, 80 cd, etc., which add flexibility to the garage. The flexibility at the distal end of the instrument can be important in cases where the endoscope is retroflexed. As seen best in FIG. 16, when the clips are arranged in the garage, the abutment of one clip against another lies in this narrowed region. Thus the clips can flex at their abutment.
  • [0117]
    As seen best in FIG. 15, the distally extending fingers 80 m, 80 n each have an outwardly extending distal lip 80 m-1, 80 n-1 and an inwardly extending proximal stop 80 m-2, 80 n-2. The fingers 80 m, 80 n help orient the garage relative to the clevis. The distal lips help the garage engage the clevis as described below and the proximal stops prevent unwanted movement of the penultimate clip as described below. Opposite pairs of parallel fingers 80 p and 80 q are arranged in spaced apart planes orthogonal to the planes of the fingers 80 m, 80 n. These fingers 80 p, 80 q extend from a proximal collar 80 r and engage the clevis as seen best in FIG. 17, described in detail below.
  • [0118]
    According to the presently preferred embodiment, the garage is made from a single piece of stamped and folded stainless steel.
  • [0119]
    Unlike our earlier clip appliers, there is no need to chain the clips together so that they can be pulled back. There is also no need to pull any of the clips back at any time.
  • [0000]
    The Jaw Assembly
  • [0120]
    FIGS. 17-27 illustrate details of the jaw assembly 20 which includes a clevis 82 and a pair of jaws 84, 86. The jaws are hermaphroditic mating jaws, i.e. the jaws are identical and arranged to mate with each other. Each has a proximal tang 84 a, 86 a, a plurality of side teeth 84 b, 86 b, which are offset one half pitch from each other on opposite sides of the longitudinal axis of the jaw, a distal tooth 84 c, 86 c, and a mounting hole 84 d, 86 d. The jaws are coupled to the clevis via their mounting holes. As seen best in FIG. 27, the clevis 82 has two off-axis bosses 82 a, 82 b upon which the jaws are mounted and held in place by rivets. The distal ends of the pull wires 62, 64 are bent into dogs-legs which are coupled to respective tangs 84 a, 86 a of the jaws. It will thus be appreciated that distal movement of the pull wires will cause the jaws to open as shown in FIGS. 18 and 19 and proximal movement of the pull wires will cause the jaws to close as shown in FIGS. 20 and 21. The use of offset bosses increases the mechanical advantage of the jaws. The clevis also is provided with a pair of stops 82 e, 82 f (best seen in FIG. 26) which engage ears 84 a-1, 86 a-1 on the tangs of the jaws and which allow the jaws to be deflected 45-60 degrees off axis when they are closed and which also allows for an approximately ten degree over-rotation of the jaws. This allows the closed jaws to traverse a tortuous path through the lumen of an endoscope.
  • [0121]
    As seen best in FIG. 19, the proximal tang and the distal tooth of each jaw lie on opposite sides of the longitudinal axis of the jaw assembly. This arrangement provides stability to the end effector arrangement. In particular, there is a certain amount of clearance between the jaws and the clevis so that the jaws can rotate easily open and closed. This clearance may allow the jaws to rock horizontally on the clevis creating the possibility of jaw misalignment. In the illustrated embodiment, the jaws are forced toward each other horizontally as they are being closed rather than away from each other. This is because the forming anvils act in opposition to the horizontal moments generated by the pull wires.
  • [0122]
    The interior surfaces of the distal teeth are forming anvils which cause the two tines of the clip to be bent through approximately 90-180° as shown in FIGS. 20 and 23. In particular, as seen in FIGS. 19 and 21, the distal teeth define two curvature paths, parallel to each other. This allows the two tines of the clip to be bent into parallel semi-circles. The distal teeth also function as a tissue fixation point indicator as the point(s) where the teeth meet are adjacent the location where the tines of the clips pierce the tissue.
  • [0123]
    As seen best in FIG. 23, after the distal-most (ultimate) clip 78 has been applied, the adjacent or penultimate clip 78 a is held by the stops 80 m-2 and 80 n-2 in the garage 80 and the tines of the clip 78 a embrace the tail of the clip 78. When the jaws are opened, the jaw assembly can be moved away from the ultimate clip 78 without releasing the penultimate clip 78 a. As seen best in FIG. 18, with the jaws open, the tines of the penultimate clip 78 a are shielded by distal fins 82 c, 82 d of the clevis 82. However, if the clevis is dimensioned differently, these fins 82 c, 82 d are not necessary because the tines of the clip will not extend out of the clevis until it is being applied. Other illustrations of the clevis (e.g. FIG. 26) do not show the fins.
  • [0124]
    As shown in FIG. 17, the garage mates with the clevis in three places in order to secure the garage relative to the clevis. A distal mating is obtained with distal lips 80m-1 and 80 n-1 engaging lips 82 e and 82 f of clevis 82 (shown best in FIG. 22). A proximal mating is obtained with fingers 80 p and 80 q engaging lateral recesses or bores 82 g, 82 h. The third mating is provided by sandwiching the proximal collar 80 r between the clevis core and the distal end of the coil.
  • [0000]
    Alternate Embodiment, Self-Pushing Clip
  • [0125]
    Referring now to FIGS. 28-30, alternate embodiments of a clip 301 and a clip advancement mechanism are shown. The clip 301 has substantially the same configuration as the clip described above except that it has a threaded hole 301 a in its proximal end. FIG. 28 shows a plurality of clips 301-304 threadably mounted on the threaded end 148 a of rotatable control member 148. The control member 148 is similar to the control member 48 described above except that it is mounted in a way that it does not translate relative to the coil or the actuator. In particular, control member 148 is mounted in a thrust collar 310 set in a thrust bearing 312 which is located between the proximal and distal coils (not shown). When the control member 148 is rotated, the clips 301-304 which cannot rotate because of the garage (not shown) are translated through the garage because of their threaded engagement with the control member.
  • [0000]
    The Presently Preferred Manual Actuator
  • [0126]
    FIGS. 30-37 illustrate the presently preferred manual actuator 418. Similar reference numerals, increased by 400, refer to similar parts to the manual actuator 18 of FIGS. 1-6. The manual actuator 418 includes a lever 422, a knob 424, and a crank 426. According to a first aspect of this embodiment, a second crank 426′ is provided on the opposite side of the actuator. As seen best in FIGS. 30 and 32, the “cranks” 426, 426′ are knurled and do not have crank handles like the crank 26. Like the actuator 18, and as seen in FIGS. 31-33, the actuator 418 is provided with a finger grip 428 and a lever 422 having a thumb grip 430. Engaging hooks 432, 434 allow the lever to be releasably locked in the closed position as shown in FIG. 32.
  • [0127]
    As seen best in FIG. 32, a polygonal crank shaft 500 extends transversely through the actuator 418 and is engaged on opposite ends by the cranks 426, 426′. The crank shaft 500 is surrounded by a cylindrical structure 502, 504 on opposite sides of the actuator 418. According to a second aspect of this embodiment, one of the cylinder structures 504 is provided with a plurality of ratchet teeth 506, and as seen in FIG. 33, the crank 426′ has a peripheral post 508 upon which a ratchet pawl 510 is mounted. Those skilled in the art will appreciate that the ratchet and pawl prevent both cranks 426, 426′ from being rotated backward, i.e., clockwise in the illustrated embodiment.
  • [0128]
    According to a third aspect of this embodiment, as seen best in FIGS. 34 and 35, the transmission 446 is coupled to a counter gear 512. In this embodiment, the transmission gears are arranged slightly differently than in the embodiment of FIGS. 1-6. In particular, the crank shaft 500 is coupled to a small hub gear 514 which engages the counter gear 512 as shown in FIG. 35. The crank shaft is also coupled to an input spur gear 447 which drives a step up spur gear 449 which is flipped over as compared to the gear 49 shown in FIG. 4. The spur gear 449 drives the crown gear 450 which is coupled to the pinion 452. The pinion 452 is coupled to the cylinder 454 which is turn is coupled to the flywheel 456.
  • [0129]
    The counter gear 512 is provided with indicia 516, preferably on both sides, and a standing rib 518. The body of the actuator 418 is provided with at least one, but preferably two windows 520, 522 (see FIGS. 31-33, 36 and 37) through which the indicia 516 of the counter gear can be viewed (one at a time). The illustrated counter is for use with a store of five clips. When the garage is full, the portion of the counter between the standing rib 518 and the numeral “4” is visible through the window. In order to accommodate space for the standing rib, the number of teeth on the counter gear is chosen so that one rotation of the hub gear causes slightly less than ⅕ rotation of the counter gear. As clips are dispensed, the counter gear rotates clockwise counting down the number of clips remaining. When there are “0” clips remaining, the “0” indicia is visible through the window. In addition, when in this position, the standing rib 518 abuts a structure inside the actuator, e.g. a wall of the window opening. This prevents the counter gear and the cranks from advancing further. Preferably, the counter gear 512 is provided with an index hole 524 which is used to properly orient the gear during assembly.
  • [0130]
    Those skilled in the art will appreciate that means other than the standing rib 518 could be used to stop rotation. For example, the threads on the control member 48 can be arranged to run out upon dispensing the last clip. Alternatively, a bump can be provided on the control member 48 at a location to be stopped by engaging the rigid member 60 upon dispensing the last clip. Still another alternative is to arrange the pusher 70 to engage and lock on the detent fingers 80 m, 80 n after the last clip has been fired. The purpose of the stop is to prevent the pusher from entering the jaws and to indicate that all of the clips have been used.
  • [0131]
    According to a fourth aspect of this embodiment and as illustrated in FIGS. 36 and 37, the crank detent lock 458 is engaged by the lever 422 such that the crank can only be turned when the jaws are closed. In particular, the floor of the previously identified cylindrical structure 502 is provided with a ramp 526 which rises to a step 528. The crank 426 and/or the crank shaft 500 are/is coupled to a leaf spring 530 which extends generally radially out from the axis of the crank shaft and terminates with an upturned lip 532. FIGS. 36 and 37 illustrate the crank/crank shaft in the locked position with the leaf spring 530 lying adjacent the step 528. If the crank were operated to dispense a clip, rotation of the crank would be stopped by the leaf spring 530 hitting the step 528.
  • [0132]
    The lever 422 has a tongue 534 with a lifting ramp 536 at its end. A mouth 538 opens into the cylindrical structure 502 adjacent to the step 528. The tongue 534 is arranged so that it enters the mouth 538 when the lever 422 is moved to the closed position, closing the jaws. When the tongue 534 enters the mouth 538, the lifting ramp 536 engages the upturned lip 532 and raises the leaf spring 530 above the step 528. In this position, the leaf spring and the step no longer impede rotation of the cranks, and a clip may be dispensed. Rotation of the crank moves the leaf spring down the ramp 526 onto the floor of the cylindrical structure where it is free to move around in a complete rotation. The tongue 534 is provided with a lower recess 540 which allows the leaf spring 530 to pass under it at the end of a single rotation of the crank, at which point the spring will once again abut the step 528. The tongue 534 is resilient enough so that the recess 540 can pass over the upturned lip 532 when the lever 422 is moved back to open the jaws. Thus, the crank will move exactly one rotation after the jaws are closed and will not move again until the jaws are opened and then closed again.
  • [0000]
    Alternate Embodiments of Force Limiting Springs
  • [0133]
    FIGS. 38-40 illustrate a first alternate embodiment of a force limiting spring in a manual actuator 600 which in other respects is substantially the same as the actuator described above. The actuator 600 has a thumb lever 602 which is coupled to a linkage 604. The distal end of the linkage 604 engages the distal end of a spring 606. A washer 608 is located adjacent the proximal end of the spring 606 and a “shuttle” 610 is located proximal of the washer 608 and abuts a stop wall 611 on the linkage 604. The control member 612 extends through the linkage 604, the spring 606, the washer 608, and is coupled to the shuttle 610. The shuttle 610 is composed of two identical pieces illustrated in FIG. 40. Each piece 610 is generally semi-cylindrical, has a pair of locking nubs 610 a, 610 b and a pair of nub-receiving sockets 610 c, 610 d. The interior of the piece 610 has an off center wire engaging tongue 610 e and each end is provided with an axial half bore 610 f, 610 g. From the foregoing, those skilled in the art will appreciate that when a control wire is placed between the two pieces of the shuttle and they are pressed together, the control wire will be bent into an S shape by the two tongues 610 e and the shuttle will be fixed relative to the control wire.
  • [0134]
    With the foregoing in mind, it will also be appreciated that when the lever 602 is moved from the open position (FIG. 39) toward the closed position shown in FIG. 38, the linkage 604 moves the spring 606 and washer 608 proximally against the shuttle 610 pulling the control wire 612 proximally until the control wire can be pulled no more, or until a predetermined tension is placed on the wire. At that point, further closure of lever 602 continues to move the linkage 604 and spring 606 proximally. However, because the wire 612, washer 608, and shuttle 610 will not move (or because the spring constant is less than the tension on the wire), the spring 606 begins to compress between the linkage 604 and the washer 608 and remains compressed when the lever is locked. The amount of compression will depend on the tortuosity of the path of the control wire. According to the presently preferred embodiment, there is always some spring compression when the lever is locked as shown in FIG. 38. When the lever 602 is released, at first, the linkage 604 will move distally relative to the washer and shuttle and the spring will expand. Eventually, the stop wall 611 on the linkage 604 will reach the shuttle 610 and push the shuttle distally, thereby causing the control wire 612 to move distally.
  • [0135]
    It will be appreciated by those skilled in the art that the function of the washer 608 is to provide a positive interference between the spring 606 and the shuttle 610. One manner of providing the positive interference is to partially close the end of spring 606 by bending the end of the spring 606 into an “e” shape. Alternatively, the end of the spring wire can be flattened and broadened to interfere with the shuttle. It will also be appreciated by those skilled in the art that instead of providing a stop wall 611 on the linkage 604 for the shuttle 610, the lever 602 can be arranged to directly push the shuttle (and hence wire 612) distally upon the release of the lever from the closed position.
  • [0136]
    FIGS. 41-43 illustrate a second alternate embodiment of a force limiting spring in a manual actuator 700 which in other respects is substantially the same as the actuator described above. The actuator 700 has a thumb lever 702 which is formed in two parts 702 a, 702 b coupled to each other by a torsion spring 706. As seen best in FIG. 42, the upper part 702 b of the lever 702 has a socket 702 c for receiving a ball 710 coupled to the control wire (not shown) and two spaced apart legs 702 d, 702 e. The lower part 702 a of the lever has an upper finger 702 f which extends between the legs 702 d, 702 e. The torsion spring 706 is mounted on a pivot post 703 which extends through the upper finger 702 f and the legs 702 d, 702 e. The back of the spring 706 a engages the back of the finger 702 f and the front of the spring 706 b engages the upper part of the lever 702 b. The ball is made of two identical pieces illustrated in FIG. 43. The piece is generally hemispherical but is similar to the previously described shuttle in that it has a pair of locking nubs 710 a, 710 b and a pair of nub-receiving sockets 710 c, 710 d. The interior of the piece 710 has an off center wire engaging tongue 710 e and a pair of diametrically opposed half bores 710 f, 710 g are provided coaxial with the tongue 710 e. From the foregoing, those skilled in the art will appreciate that when a control wire is placed between the two pieces of the ball and they are pressed together, the control wire will be bent into an S shape by the two tongues 710 e and the ball will be fixed relative to the control wire.
  • [0137]
    With the foregoing in mind, it will be appreciated that when the lever 702 is moved from an open position toward the closed position shown in FIG. 41, the upper part 702 b of the lever and the control wire (not shown) are moved proximally until the control wire cannot be pulled further. At this point, the upper part 702 b of the lever remains stationary. However, in order to reach a fully closed lever position, the lower lever part 702 a can continue to rotate about the pivot axle 703 and cause the finger 702 f to exert force against the back part 706 a of the spring 706, thereby causing the spring finger 706 b to spread away from spring finger 706 a and top lever part 702 b. When the lever is eventually released from its fully closed position, at first the force of finger 702 f against the spring is released and the ball 710 and wire will not move. Eventually, when spring finger 706 b hits the top lever part 702 b, the entire lever, the ball 710 and the control wire is moved distally.
  • [0000]
    Pre-Loaded Clip Ejector
  • [0138]
    In the presently preferred embodiment, at least a distal portion of the flexible coil (in this case the distal coil 12 b) is pre-loaded to provide sufficient columnar stiffness. When the jaws 84, 86 are closed, the pull wire(s) increase the load between the clevis and the nut. After the clip is deployed, the pull wires are actuated distally to open the jaws. The force of the compressed clip train, and if necessary, the force from the pull wires is sufficient to overcome the pre-load of the distal coil so that the jaws and clevis move away from the tines of the clip, which have been compressed against the forming anvils of the jaws. An alternate embodiment of this concept provides oblong holes in the jaws for attachment to the bosses on the clevis. When the jaws are closed, the pull wires move the jaws proximally with respect to the clevis. When the pull wires are released from tension and actuated distally, the jaws are also able to move distally with respect to the clevis to release the compressive load on the tines of the clip.
  • [0139]
    According to an alternative embodiment, the distal coil 12 b is pre-loaded to spring distally. When the jaws 84, 86 are closed, the pull wire(s) 62 pull against the distal coil, shortening the distal coil against its pre-load. After the clip is dispensed, the jaws are opened. When the jaws are opened, the pre-load on the distal coil causes the clevis 82, jaws 84, 86, and garage 80 all to move a slight distance distally. At the same time, the clips do not move, as they are freely disposed in the garage which is moving over them. This action has the effect of separating the distal anvils on the jaws from the tines on the formed clip, thereby easing the opening of the jaws.
  • [0140]
    The pre-loading of the distal coil provides the coil with sufficient columnar strength to allow for tangential bites, prevents buckling during jaw closure, and provides reaction force to overcome frictional forces as the jaws open.
  • [0000]
    Alternate Jaw Embodiment
  • [0141]
    FIGS. 44 and 45 illustrate an alternate embodiment of jaws 184, 186 which are substantially the same as the jaws 84, 86 but for their mounting holes 184 d, 186 d. In this embodiment, the mounting holes 184 d, 186 d are not circular. They are oblate or “slotted”. This allows the jaws to slide distally and proximally as they are opened and closed. Thus, when the jaws are closed as shown in FIG. 44, they are pulled proximally. In this position, the clip is fired into the closed jaws which act as forming anvils as described above. When the jaws are opened as shown in FIG. 45, they slide distally away from the formed clip separating the distal anvils on the jaws from the tines on the formed clip, thereby easing the opening of the jaws.
  • [0142]
    There have been described and illustrated herein several embodiments of a flexible endoscopic clip applier. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. Thus, while the coils of the invention have been described as being formed from flat stock, it will be appreciated that the stock can be of circular or other cross-section. Also, while particular materials have been described as preferred in making various of the elements of the invention, it will be appreciated that other materials can be utilized. Further, while the invention has been described as utilizing a gear arrangement which provides a specific number of turns to a wire control element for advancing the clips, it will be appreciated that other gear arrangements which provide the same or different numbers of turns of the wire control element can be provided. Further, while the invention has been disclosed in conjunction with two different kinds of end effectors, i.e. the jaws and the clip pusher, other components of the invention may be used with different end effectors. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as claimed.
Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US4038987 *4 Feb 19752 Aug 1977Olympus Optical Co., Ltd.Forceps device for endoscope
US4367746 *8 Dec 198011 Jan 1983Derechinsky Victor EClip-holder instrument for clipping blood vessels
US5009661 *24 Apr 199023 Apr 1991Michelson Gary KProtective mechanism for surgical rongeurs
US5049133 *23 Jan 199017 Sep 1991Villen Pascual Joee ASingle-use safety syringe
US5156609 *3 May 199120 Oct 1992Nakao Naomi LEndoscopic stapling device and method
US5170800 *27 Dec 199115 Dec 1992Symbiosis CorporationHermaphroditic endoscopic claw extractors
US5222961 *8 Jan 199229 Jun 1993Naomi NakaoEndoscopic stapling device and related staple
US5383880 *16 Dec 199224 Jan 1995Ethicon, Inc.Endoscopic surgical system with sensing means
US5403326 *1 Feb 19934 Apr 1995The Regents Of The University Of CaliforniaMethod for performing a gastric wrap of the esophagus for use in the treatment of esophageal reflux
US5433721 *15 Jul 199318 Jul 1995Ethicon, Inc.Endoscopic instrument having a torsionally stiff drive shaft for applying fasteners to tissue
US5460168 *23 Dec 199324 Oct 1995Olympus Optical Co., Ltd.Endoscope cover assembly and cover-system endoscope
US5484451 *3 Sep 199316 Jan 1996Ethicon, Inc.Endoscopic surgical instrument and staples for applying purse string sutures
US5497933 *8 Oct 199312 Mar 1996United States Surgical CorporationApparatus and method for applying surgical staples to attach an object to body tissue
US5499998 *10 Mar 199519 Mar 1996Microsurge, Inc.Endoscoptic surgical instrument with guided jaws and ratchet control
US5562699 *30 Mar 19958 Oct 1996Richard Wolf GmbhForceps
US5601224 *10 Jun 199411 Feb 1997Ethicon, Inc.Surgical instrument
US5662662 *16 Sep 19962 Sep 1997Ethicon Endo-Surgery, Inc.Surgical instrument and method
US5667517 *26 May 199516 Sep 1997Ethicon, Inc.Endoscopic surgical system with sensing means
US5707392 *29 Sep 199513 Jan 1998Symbiosis CorporationHermaphroditic stamped forceps jaw for disposable endoscopic biopsy forceps and method of making the same
US5725537 *13 Sep 199610 Mar 1998United States Surgical CorporationMethod of performing a vessel anastomosis using a surgical clip applier
US5769857 *11 Jun 199623 Jun 1998Mgf Group Inc.Ligating clip applier
US5797536 *30 Mar 199525 Aug 1998Ethicon, Inc.Endoscopic surgical instrument with pivotable and rotatable staple cartridge
US5833695 *19 Jan 199510 Nov 1998Yoon; InbaeSurgical stapling system and method of applying staples from multiple staple cartridges
US5849019 *7 Oct 199715 Dec 1998Yoon; InbaeMultifunctional spring clips and cartridges and applications therefor
US5865724 *7 Jul 19972 Feb 1999Symbiosis Corp.Flexible microsurgical instruments incorporating a sheath having tactile and visual position indicators
US5904693 *23 Nov 199418 May 1999American Cyanamid CompanyAutomatic laparoscopic ligation clip applicator
US5921993 *1 May 199713 Jul 1999Yoon; InbaeMethods of endoscopic tubal ligation
US5941439 *14 May 199724 Aug 1999Mitek Surgical Products, Inc.Applicator and method for deploying a surgical fastener in tissue
US5993465 *12 Dec 199630 Nov 1999Apollo Camera, LlcMethod of ligating a vessel or duct
US6193651 *26 Feb 199727 Feb 2001United States Surgical CorporationSurgical retractor
US6269819 *25 Jun 19987 Aug 2001The Trustees Of Columbia University In The City Of New YorkMethod and apparatus for circulatory valve repair
US6331165 *15 May 199818 Dec 2001Scimed Life Systems, Inc.Biopsy instrument having irrigation and aspiration capabilities
US6350269 *1 Mar 199926 Feb 2002Apollo Camera, L.L.C.Ligation clip and clip applier
US6352503 *15 Jul 19995 Mar 2002Olympus Optical Co., Ltd.Endoscopic surgery apparatus
US6423079 *7 Mar 200023 Jul 2002Blake, Iii Joseph WRepeating multi-clip applier
US6530933 *15 Sep 199911 Mar 2003Teresa T. YeungMethods and devices for fastening bulging or herniated intervertebral discs
US6533157 *22 Feb 200018 Mar 2003Power Medical Interventions, Inc.Tissue stapling attachment for use with an electromechanical driver device
US6544271 *18 Jul 20008 Apr 2003Scimed Life Systems, Inc.Device for full-thickness resectioning of an organ
US6824548 *6 Dec 200130 Nov 2004Ethicon Endo-Surgery, Inc.Flexible surgical clip applier
US6905057 *29 Sep 200314 Jun 2005Ethicon Endo-Surgery, Inc.Surgical stapling instrument incorporating a firing mechanism having a linked rack transmission
US6926676 *16 Oct 20019 Aug 2005Boston Scientific Scimed, Inc.Biopsy instrument having irrigation and aspiration capabilities
US7223272 *14 Jun 200429 May 2007Ethicon Endo-Surgery, Inc.Endoscopic clip applier with hermaphroditic jaws mounted on non-collinear axes
US20020138086 *20 May 200226 Sep 2002Robert SixtoSurgical clips particularly useful in the endoluminal treatment of gastroesophageal reflux disease (GERD)
US20020198539 *6 Dec 200126 Dec 2002Robert SixtoSurgical clip applier having jaws adapted to guide and deform a clip
US20020198541 *6 Dec 200126 Dec 2002Smith Kevin W.Flexible surgical clip applier
US20030191478 *25 Mar 20039 Oct 2003Inscope Development, LlcSurgical tool having a distal ratchet mechanism
US20040193185 *25 Mar 200330 Sep 2004Inscope Development, LlcSurgical jaw assembly with increased mechanical advantage
US20040199182 *8 Jan 20027 Oct 2004Keith MillimanAnastomosis instrument and method for performing same
US20050049616 *14 Jun 20043 Mar 2005Carlos RiveraClip ejector for endoscopic clip applier
US20050277951 *14 Jun 200415 Dec 2005Smith Kevin WRotational, translational and torqueing control members for an endoscopic instrument
US20050277952 *14 Jun 200415 Dec 2005Scott ArpEndoscopic clip applier with threaded clip
US20050277954 *14 Jun 200415 Dec 2005Smith Kevin WEndoscopic clip applier actuator
US20050277955 *14 Jun 200415 Dec 2005Palmer Matthew AEndoscopic surgical instrument having a rotational actuator with an energy storage element
US20050277956 *14 Jun 200415 Dec 2005Francese Jose LClip storage for endoscopic clip applier
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US733196814 Jun 200419 Feb 2008Ethicon Endo-Surgery, Inc.Endoscopic clip applier with threaded clip
US735780614 Jun 200415 Apr 2008Ethicon Endo-Surgery, Inc.Clip ejector for endoscopic clip applier
US736793914 Jun 20046 May 2008Ethicon Endo-Surgery, Inc.Rotational, translational and torqueing control members for an endoscopic instrument
US765500415 Feb 20072 Feb 2010Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US773710929 Apr 200315 Jun 2010Temple University Of The Commonwealth System Of Higher EducationObesity controlling method
US78156628 Mar 200719 Oct 2010Ethicon Endo-Surgery, Inc.Surgical suture anchors and deployment device
US78198862 Oct 200626 Oct 2010Tyco Healthcare Group LpEndoscopic surgical clip applier
US786250326 Oct 20074 Jan 2011Ethicon Endo-Surgery, Inc.Rotational, translational and torqueing control members for an endoscopic instrument
US79058907 Oct 200515 Mar 2011Tyco Healthcare Group LpEndoscopic surgical clip applier
US795115716 May 200731 May 2011C.R. Bard, Inc.Tissue capturing and suturing device and method
US802950410 Dec 20094 Oct 2011Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US80375912 Feb 200918 Oct 2011Ethicon Endo-Surgery, Inc.Surgical scissors
US805656511 Aug 200915 Nov 2011Tyco Healthcare Group LpSurgical clip applier and method of assembly
US807075930 May 20086 Dec 2011Ethicon Endo-Surgery, Inc.Surgical fastening device
US807557226 Apr 200713 Dec 2011Ethicon Endo-Surgery, Inc.Surgical suturing apparatus
US807557317 May 200413 Dec 2011C.R. Bard, Inc.Single intubation, multi-stitch endoscopic suturing system
US810092227 Apr 200724 Jan 2012Ethicon Endo-Surgery, Inc.Curved needle suturing tool
US811407230 May 200814 Feb 2012Ethicon Endo-Surgery, Inc.Electrical ablation device
US81141199 Sep 200814 Feb 2012Ethicon Endo-Surgery, Inc.Surgical grasping device
US812864316 Oct 20076 Mar 2012Tyco Healthcare Group LpApparatus for applying surgical clips
US815282121 Feb 200810 Apr 2012C.R. Bard, Inc.Endoscopic tissue apposition device with multiple suction ports
US815783425 Nov 200817 Apr 2012Ethicon Endo-Surgery, Inc.Rotational coupling device for surgical instrument with flexible actuators
US817277211 Dec 20088 May 2012Ethicon Endo-Surgery, Inc.Specimen retrieval device
US81728579 Mar 20058 May 2012Davol, Inc.Endoscopic tissue apposition device and method of use
US821111914 Jun 20043 Jul 2012Ethicon Endo-Surgery, Inc.Endoscopic surgical instrument having a rotational actuator
US821112515 Aug 20083 Jul 2012Ethicon Endo-Surgery, Inc.Sterile appliance delivery device for endoscopic procedures
US821625514 Jun 200410 Jul 2012Ethicon Endo-Surgery, Inc.Endoscopic clip applier actuator
US824120429 Aug 200814 Aug 2012Ethicon Endo-Surgery, Inc.Articulating end cap
US825205730 Jan 200928 Aug 2012Ethicon Endo-Surgery, Inc.Surgical access device
US826256314 Jul 200811 Sep 2012Ethicon Endo-Surgery, Inc.Endoscopic translumenal articulatable steerable overtube
US826265521 Nov 200711 Sep 2012Ethicon Endo-Surgery, Inc.Bipolar forceps
US826268010 Mar 200811 Sep 2012Ethicon Endo-Surgery, Inc.Anastomotic device
US826794411 Aug 200918 Sep 2012Tyco Healthcare Group LpEndoscopic surgical clip applier with lock out
US826794613 Oct 201018 Sep 2012Tyco Healthcare Group LpEndoscopic surgical clip applier
US828265523 Dec 20099 Oct 2012Tyco Healthcare Group LpEndoscopic surgical clip applier
US831780630 May 200827 Nov 2012Ethicon Endo-Surgery, Inc.Endoscopic suturing tension controlling and indication devices
US833655626 Sep 201125 Dec 2012Covidien LpSurgical clip applier and method of assembly
US83373941 Oct 200825 Dec 2012Ethicon Endo-Surgery, Inc.Overtube with expandable tip
US835348717 Dec 200915 Jan 2013Ethicon Endo-Surgery, Inc.User interface support devices for endoscopic surgical instruments
US83571709 Jul 200822 Jan 2013Ethicon Endo-Surgery, Inc.Devices and methods for placing occlusion fasteners
US835717121 Apr 201022 Jan 2013Covidien LpEndoscopic surgical clip applier
US836106612 Jan 200929 Jan 2013Ethicon Endo-Surgery, Inc.Electrical ablation devices
US836111227 Jun 200829 Jan 2013Ethicon Endo-Surgery, Inc.Surgical suture arrangement
US838277326 Mar 200826 Feb 2013Covidien LpEndoscopic surgical clip applier
US838863220 Feb 20085 Mar 2013C.R. Bard, Inc.Tissue capturing and suturing device and method
US84039265 Jun 200826 Mar 2013Ethicon Endo-Surgery, Inc.Manually articulating devices
US840394511 Jan 201126 Mar 2013Covidien LpArticulating endoscopic surgical clip applier
US84039462 Jun 201126 Mar 2013Covidien LpArticulating clip applier cartridge
US84092003 Sep 20082 Apr 2013Ethicon Endo-Surgery, Inc.Surgical grasping device
US840922218 Mar 20092 Apr 2013Covidien LpEndoscopic surgical clip applier
US840922311 Aug 20092 Apr 2013Covidien LpEndoscopic surgical clip applier with clip retention
US841975212 Aug 200916 Apr 2013Covidien LpEndoscopic surgical clip applier with connector plate
US842550525 Aug 201123 Apr 2013Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US84495332 May 201228 May 2013Ceterix Orthopaedics, Inc.Devices, systems and methods for meniscus repair
US844953827 Jan 201028 May 2013Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US846550213 Aug 200918 Jun 2013Covidien LpSurgical clip applier and method of assembly
US84655052 May 201218 Jun 2013Ceterix Orthopaedics, Inc.Suture passer devices and methods
US846999317 Feb 200425 Jun 2013Boston Scientific Scimed, Inc.Endoscopic instruments
US848065731 Oct 20079 Jul 2013Ethicon Endo-Surgery, Inc.Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ
US84806892 Sep 20089 Jul 2013Ethicon Endo-Surgery, Inc.Suturing device
US848609116 Aug 201216 Jul 2013Covidien LpEndoscopic surgical clip applier
US849160827 Mar 201223 Jul 2013Covidien LpEndoscopic surgical clip applier with clip retention
US849657417 Dec 200930 Jul 2013Ethicon Endo-Surgery, Inc.Selectively positionable camera for surgical guide tube assembly
US850080910 Jan 20126 Aug 2013Ceterix Orthopaedics, Inc.Implant and method for repair of the anterior cruciate ligament
US850656418 Dec 200913 Aug 2013Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US850658010 Apr 200813 Aug 2013Covidien LpSurgical clip applier
US852956325 Aug 200810 Sep 2013Ethicon Endo-Surgery, Inc.Electrical ablation devices
US854548610 Nov 20101 Oct 2013Covidien LpSurgical clip applier
US855112013 Sep 20128 Oct 2013C.R. Bard, Inc.Tissue capturing and suturing device and method
US85626319 Nov 201022 Oct 2013Ceterix Orthopaedics, Inc.Devices, systems and methods for meniscus repair
US856841025 Apr 200829 Oct 2013Ethicon Endo-Surgery, Inc.Electrical ablation surgical instruments
US857989721 Nov 200712 Nov 2013Ethicon Endo-Surgery, Inc.Bipolar forceps
US857991817 May 201012 Nov 2013Covidien LpEndoscopic surgical clip applier
US858571711 Aug 200919 Nov 2013Covidien LpSingle stroke endoscopic surgical clip applier
US860310926 Jan 201210 Dec 2013Covidien LpApparatus for applying surgical clips
US86086525 Nov 200917 Dec 2013Ethicon Endo-Surgery, Inc.Vaginal entry surgical devices, kit, system, and method
US865215030 May 200818 Feb 2014Ethicon Endo-Surgery, Inc.Multifunction surgical device
US866325319 Apr 20114 Mar 2014Ceterix Orthopaedics, Inc.Methods of meniscus repair
US867900330 May 200825 Mar 2014Ethicon Endo-Surgery, Inc.Surgical device and endoscope including same
US870273124 May 201122 Apr 2014Ceterix Orthopaedics, Inc.Suturing and repairing tissue using in vivo suture loading
US87082105 Oct 200629 Apr 2014Covidien LpMethod and force-limiting handle mechanism for a surgical instrument
US87344695 Oct 201027 May 2014Covidien LpSuture clip applier
US87474236 Feb 201310 Jun 2014Covidien LpEndoscopic surgical clip applier
US877126030 May 20088 Jul 2014Ethicon Endo-Surgery, Inc.Actuating and articulating surgical device
US880829930 Apr 201319 Aug 2014Ceterix Orthopaedics, Inc.Devices, systems and methods for meniscus repair
US88215185 Nov 20082 Sep 2014Ceterix Orthopaedics, Inc.Suture passing instrument and method
US882803112 Jan 20099 Sep 2014Ethicon Endo-Surgery, Inc.Apparatus for forming an anastomosis
US884565921 Feb 201330 Sep 2014Covidien LpArticulating endoscopic surgical clip applier
US888879214 Jul 200818 Nov 2014Ethicon Endo-Surgery, Inc.Tissue apposition clip application devices and methods
US888884813 May 201318 Nov 2014Ceterix Orthopaedics, Inc.Implant and method for repair of the anterior cruciate ligament
US889466512 Aug 200925 Nov 2014Covidien LpEndoscopic surgical clip applier
US890025311 Mar 20042 Dec 2014Covidien LpClip applying apparatus with angled jaw
US89060354 Jun 20089 Dec 2014Ethicon Endo-Surgery, Inc.Endoscopic drop off bag
US89114564 Feb 201316 Dec 2014Ceterix Orthopaedics, Inc.Methods and devices for preventing tissue bridging while suturing
US89204412 May 201230 Dec 2014Ceterix Orthopaedics, Inc.Methods of meniscus repair
US89398974 Feb 201127 Jan 2015Ethicon Endo-Surgery, Inc.Methods for closing a gastrotomy
US896154220 Feb 201324 Feb 2015Covidien LpArticulating clip applier cartridge
US89683372 Jun 20113 Mar 2015Covidien LpArticulating clip applier
US898619917 Feb 201224 Mar 2015Ethicon Endo-Surgery, Inc.Apparatus and methods for cleaning the lens of an endoscope
US900519829 Jan 201014 Apr 2015Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US90114314 Sep 201221 Apr 2015Ethicon Endo-Surgery, Inc.Electrical ablation devices
US901145430 Apr 201421 Apr 2015Ceterix Orthopaedics, Inc.Suture passer with radiused upper jaw
US90114642 Aug 201121 Apr 2015Covidien LpSelf-centering clip and jaw
US901146520 Dec 201221 Apr 2015Covidien LpEndoscopic surgical clip applier
US90173456 Oct 200628 Apr 2015Covidien LpCoil fastener applier with flexible shaft
US902848318 Dec 200912 May 2015Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US904998715 Mar 20129 Jun 2015Ethicon Endo-Surgery, Inc.Hand held surgical device for manipulating an internal magnet assembly within a patient
US9066710 *8 Mar 201330 Jun 2015St. Jude Medical, Cardiology Division, Inc.Apparatus and method for heart valve repair
US90786623 Jul 201214 Jul 2015Ethicon Endo-Surgery, Inc.Endoscopic cap electrode and method for using the same
US908933419 Jan 201228 Jul 2015Covidien LpEndoscopic surgical clip applier with connector plate
US91138928 Jan 201325 Aug 2015Covidien LpSurgical clip applier
US91138939 Jul 201325 Aug 2015Covidien LpEndoscopic surgical clip applier with clip retention
US91256531 Mar 20138 Sep 2015St. Jude Medical, Cardiology Division, Inc.Flexible nosecone for percutaneous device
US914927025 Apr 20126 Oct 2015Davol, Inc. (a C.R. Bard Company)Endoscopic tissue apposition device and method of use
US91861364 Nov 201017 Nov 2015Covidien LpSurgical clip applier
US918615323 Nov 201117 Nov 2015Covidien LpLocking cam driver and jaw assembly for clip applier
US921111915 Mar 201315 Dec 2015Ceterix Orthopaedics, Inc.Suture passers and methods of passing suture
US922052620 Mar 201229 Dec 2015Ethicon Endo-Surgery, Inc.Rotational coupling device for surgical instrument with flexible actuators
US922677230 Jan 20095 Jan 2016Ethicon Endo-Surgery, Inc.Surgical device
US923324118 Jan 201212 Jan 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US924793413 May 20132 Feb 2016Ceterix Orthopaedics, Inc.Suture passer devices and methods
US924793523 Sep 20142 Feb 2016Ceterix Orthopaedics, Inc.Arthroscopic knot pusher and suture cutter
US92541415 Mar 20139 Feb 2016St. Jude Medical, Inc.Apparatus and method for heart valve repair
US925416928 Feb 20119 Feb 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US927795715 Aug 20128 Mar 2016Ethicon Endo-Surgery, Inc.Electrosurgical devices and methods
US93142344 Feb 201319 Apr 2016Ceterix Orthopaedics, Inc.Pre-tied surgical knots for use with suture passers
US931462028 Feb 201119 Apr 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US933298028 Jan 201510 May 2016Ceterix Orthopaedics, Inc.Arthroscopic knot pusher and suture cutter
US935801119 Jun 20157 Jun 2016Covidien LpEndoscopic surgical clip applier with connector plate
US935801512 Aug 20097 Jun 2016Covidien LpEndoscopic surgical clip applier with wedge plate
US936421612 Nov 201214 Jun 2016Covidien LpSurgical clip applier with integrated clip counter
US936423912 Nov 201214 Jun 2016Covidien LpJaw closure mechanism for a surgical clip applier
US936424024 Oct 201314 Jun 2016Covidien LpEndoscopic surgical clip applier
US93752689 May 201328 Jun 2016Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US939302415 Sep 201419 Jul 2016Covidien LpArticulating endoscopic surgical clip applier
US939891716 Jul 201426 Jul 2016Covidien LpEndoscopic surgical clip applier
US940861012 Apr 20139 Aug 2016Covidien LpSurgical clip applier with dissector
US94148442 Jul 201416 Aug 2016Covidien LpSurgical clip appliers
US942725514 May 201230 Aug 2016Ethicon Endo-Surgery, Inc.Apparatus for introducing a steerable camera assembly into a patient
US943965112 May 201013 Sep 2016Ethicon Endo-Surgery, LlcMethods for cryptographic identification of interchangeable parts for surgical instruments
US943965413 Jun 201313 Sep 2016Covidien LpEndoscopic surgical clip applier
US94804775 Nov 20131 Nov 2016Covidien LpApparatus for applying surgical clips
US949216216 Dec 201415 Nov 2016Ceterix Orthopaedics, Inc.Automatically reloading suture passer devices and methods
US949822728 Jun 201322 Nov 2016Covidien LpSurgical clip applier
US94982287 May 201422 Nov 2016St. Jude Medical, Inc.Apparatus and method for heart valve repair
US952650116 Sep 201327 Dec 2016Covidien LpSurgical clip applier
US953278718 Apr 20133 Jan 2017Covidien LpEndoscopic clip applier
US95452543 May 201617 Jan 2017Covidien LpEndoscopic surgical clip applier with connector plate
US954529030 Jul 201217 Jan 2017Ethicon Endo-Surgery, Inc.Needle probe guide
US95497419 May 201324 Jan 2017Covidien LpSurgical clip applier and method of assembly
US955480327 Dec 201331 Jan 2017Ethicon Endo-Surgery, LlcElectrically self-powered surgical instrument with manual release
US95726232 Aug 201221 Feb 2017Ethicon Endo-Surgery, Inc.Reusable electrode and disposable sheath
US961008225 Jan 20134 Apr 2017St. Jude Medical, Inc.Apparatus and method for heart valve repair
US962274413 Mar 201318 Apr 2017Ethicon Endo-Surgery, LlcElectrical surgical instrument with one-handed operation
US96361285 Feb 20142 May 2017Covidien LpMethod and force-limiting handle mechanism for a surgical instrument
US964262723 Mar 20159 May 2017Covidien LpSelf-centering clip and jaw
US96427063 Mar 20149 May 2017St. Jude Medical, LlcApparatus and method for heart valve repair
US96621162 Dec 201330 May 2017Ethicon, LlcElectrically self-powered surgical instrument with cryptographic identification of interchangeable part
US96622051 Mar 201330 May 2017St. Jude Medical, Cardiology Division, Inc.Apparatus and method for heart valve repair
US96753488 May 201313 Jun 2017Ethicon LlcElectrical surgical instrument with knife return
US968185721 May 201320 Jun 2017Boston Scientific Scimed, Inc.Endoscopic instruments and methods of manufacture
US96818734 Jun 201020 Jun 2017Ethicon LlcElectrical surgical stapling instrument with tissue compressive force control
US968723419 Sep 201227 Jun 2017Ethicon L.L.C.Electrical surgical instrument with optimized power supply and drive
US968724724 Nov 201427 Jun 2017Covidien LpApparatus for applying surgical clips
US970029912 Dec 201111 Jul 2017Ceterix Orthopaedics, Inc.Suture passer devices and methods
US971347316 Apr 201325 Jul 2017Ethicon Endo-Surgery, Inc.Active braking electrical surgical instrument and method for braking such an instrument
US971750513 Jan 20151 Aug 2017Covidien LpArticulating clip applier cartridge
US97240979 Apr 20158 Aug 2017Covidien LpCoil fastener applier with flexible shaft
US973731013 Feb 201522 Aug 2017Covidien LpArticulating clip applier
US97505002 Jan 20145 Sep 2017Covidien LpSurgical clip applier
US97571271 Aug 201412 Sep 2017Ethicon LlcElectrical surgical instrument with optimal tissue compression
US976366820 Mar 201519 Sep 2017Covidien LpEndoscopic surgical clip applier
US977562327 Feb 20123 Oct 2017Covidien LpSurgical clip applier including clip relief feature
US977562426 Jun 20143 Oct 2017Covidien LpSurgical clip applier
US978888518 Feb 201617 Oct 2017Ethicon Endo-Surgery, Inc.Electrosurgical system energy source
US97888888 Jun 201517 Oct 2017Ethicon Endo-Surgery, Inc.Endoscopic cap electrode and method for using the same
US979543522 May 201524 Oct 2017Covidien LpSurgical instruments and methods for performing tonsillectomy, adenoidectomy, and other surgical procedures
US20040009224 *9 Aug 200115 Jan 2004Miller Larry SObesity controlling method
US20040037865 *29 Apr 200326 Feb 2004Miller Larry SherwinObesity controlling method
US20040260198 *17 Feb 200423 Dec 2004Elliott RothbergEndoscopic instruments
US20040260337 *14 May 200423 Dec 2004Scimed Life Systems, Inc.Endoscopic instruments and methods of manufacture
US20050049616 *14 Jun 20043 Mar 2005Carlos RiveraClip ejector for endoscopic clip applier
US20050277951 *14 Jun 200415 Dec 2005Smith Kevin WRotational, translational and torqueing control members for an endoscopic instrument
US20050277952 *14 Jun 200415 Dec 2005Scott ArpEndoscopic clip applier with threaded clip
US20050277954 *14 Jun 200415 Dec 2005Smith Kevin WEndoscopic clip applier actuator
US20050277956 *14 Jun 200415 Dec 2005Francese Jose LClip storage for endoscopic clip applier
US20060047289 *9 Mar 20052 Mar 2006Roberto FogelEndoscopic tissue apposition device and method of use
US20070104756 *29 Jun 200610 May 2007Temple University Of The Commonwealth System Of Higher EducationObesity controlling method
US20080051808 *30 Oct 200728 Feb 2008Carlos RiveraClip Ejector for Endoscopic Clip Applier
US20080083813 *5 Oct 200610 Apr 2008Michael ZemlokMethod and force-limiting handle mechanism for a surgical instrument
US20080086154 *6 Oct 200610 Apr 2008Taylor Eric JCoil fastener applier with flexible shaft
US20080147095 *20 Feb 200819 Jun 2008C. R. Bard, IncTissue capturing and suturing device and method
US20080215069 *21 Feb 20084 Sep 2008C.R. Bard, Inc.Endoscopic tissue apposition device with multiple suction ports
US20090012538 *3 Jul 20078 Jan 2009Justin SalimanMethods and devices for continuous suture passing
US20090143794 *29 Nov 20074 Jun 2009Conlon Sean PTissue resection device
US20100010510 *9 Jul 200814 Jan 2010Ethicon Endo-Surgery, Inc.Devices and methods for placing occlusion fastners
US20100087813 *10 Dec 20098 Apr 2010Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US20100130990 *17 Nov 200927 May 2010Saliman Justin DMethods of suturing and repairing tissue using a continuous suture passer device
US20100204673 *25 Sep 200912 Aug 2010Temple University-Of The Commonwealth System Of Higher EducationObesity controlling method
US20110087246 *17 Dec 201014 Apr 2011Saliman Justin DMethods and devices for continuous suture passing
US20110112556 *9 Nov 201012 May 2011Saliman Justin DDevices, systems and methods for meniscus repair
US20110130773 *14 Jan 20112 Jun 2011Saliman Justin DMethods for continuous suture passing
US20110152892 *17 Dec 201023 Jun 2011Saliman Justin DSuture passing instrument and method
US20110218557 *19 Apr 20118 Sep 2011Saliman Justin DMethods of meniscus repair
US20140114403 *8 Mar 201324 Apr 2014St. Jude Medical, Cardiology Division, Inc.Apparatus and method for heart valve repair
US20160287318 *14 Jun 20166 Oct 2016Covidien LpSurgical instrument with stamped double-flange jaws and actuation mechanism
US20160338762 *22 May 201524 Nov 2016Covidien LpSurgical instruments and methods for performing tonsillectomy, adenoidectomy, and other surgical procedures
CN106413509A *31 Aug 201515 Feb 2017奥林巴斯株式会社Dialing unit and introduction device
EP3095399A3 *20 May 20164 Jan 2017Covidien LPSurgical instruments for performing tonsillectomy, adenoidectomy, and other surgical procedures
WO2009061504A1 *5 Nov 200814 May 2009Revolutionary Surgical Device, LlcSuture passing instrument and method
Classifications
U.S. Classification606/139
International ClassificationA61B19/00, A61B1/00, A61B17/28, A61B17/128, A61B17/12
Cooperative ClassificationA61B2090/0803, A61B2017/292, A61B2017/2902, A61B2017/2923, A61B90/03, A61B2017/2905, A61B17/1285
European ClassificationA61B17/128E
Legal Events
DateCodeEventDescription
7 Oct 2004ASAssignment
Owner name: ETHICON ENDO-SURGERY, INC., OHIO
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:SIXTO, ROBERT JR.;SMITH, KEVIN W.;KORTENBACH, JUERGEN A.;AND OTHERS;REEL/FRAME:015227/0244;SIGNING DATES FROM 20040611 TO 20040902
28 Nov 2015ASAssignment
Owner name: ETHICON ENDO-SURGERY, LLC, PUERTO RICO
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ETHICON ENDO-SURGERY, INC.;REEL/FRAME:037161/0276
Effective date: 20151106
27 Feb 2017ASAssignment
Owner name: ETHICON LLC, PUERTO RICO
Free format text: CHANGE OF NAME;ASSIGNOR:ETHICON ENDO-SURGERY, LLC;REEL/FRAME:041821/0186
Effective date: 20161230