Abstract:
A repeating multi-clip applier for surgery with scissor-type or pistol grip operating handles, and a clip feeding and applying mechanism actuated by linear reciprocating movement generated by the handles. A unitary linear actuating rod and clip supply channel together with clip feed mechanisms reciprocate rearward-to-forward as the handles move for applying a clip in surgery and for advancing clips into the applying jaws.

Description:
BACKGROUND OF THE INVENTION 
     The present invention relates to an appliance for affixing surgical or ligating clips and more particularly to an appliance for rapidly employing several clips at a surgical site. There are many different designs for surgical clip applicators for a variety of surgical procedures including laproscopy in which a clipping appliance fits through a trocar tube into a body cavity where the clips are applied. 
     This invention provides a repeating multi-clip applier having a simplified mechanism for applying clips which mechanism is suitable for the full spectrum of clip appliers including laparoscopy. The applier mechanism is particularly adaptable to the disposable cartridge/fixed handle design. The simplified mechanism reduces tooling and assembly requirements, provides high operating reliability at lower product cost. 
     SUMMARY OF THE INVENTION 
     A surgical clip applicator according to the invention comprises an operating handle and clip applying mechanism having an operating cycle in which operating levers are squeezed together and released. In this cycle, a clip is applied in surgery and the clip applicator is reloaded from a clip supply channel for clip application in the next cycle. 
     The applicator provides a moveable clip supply channel containing a line of clips that are released seriatim. The supply channel integrates a clip pusher and an escapement or clip stop spring in a single stamped unit. 
     Clip crimping jaws apply a clip with a rearward movement of a camming member thereby allowing the functions of clip loading and jaw closure to be coordinated and operated by a single sliding bar moving reciprocally to load and fire clips. 
     A preferred embodiment of the clip actuating mechanism includes a combined actuating rod and in-line clip supply channel together with clip indexing mechanisms arranged so that with a squeeze of the operating levers, the actuating rod moves rearward in the appliance to apply a clip in surgery, capture the next in-line clip, indexes a line of clips rearward away from the clip jaws, and that with release of the operating levers, the jaws open, the next in-line clip is loaded into the jaws, the second next in-line clip is separated from the line, and the clip indexing movement is reset for the next cycle. 
     The clip applicator provides a novel mechanism with minimal complexity especially suited to disposable cartridge for fixed handle appliances. 
     A clip applicator according to the invention employs low operating force without recoil, a clip counter, jaw lockout after the last clip and is adaptable for use as a quick snap-in disposable cartridge with a fixed non-disposable operating handle. An operating handle that provides linear reciprocating motion including scissors-type or pistol grip may be used in the invention. 
     OBJECTS OF THE INVENTION 
     An object of the invention is to provide a novel clip applicator with minimum complexity and with adaptability to a complete range of clip applicators including laproscopic use. 
     Another object of the invention is to provide a clip applicator adaptable for use with a replaceable cartridge. 
     Another object of the invention is to provide a clip applicator in which clip feed and applying mechanisms are driven by an actuator having a linear reciprocating motion generated by operating handles. 
     Another object of the invention is to provide a surgical clip applier useful with a variety of operating handle designs. 
     Other and further objects of the invention will become apparent with an understanding of the following detailed description of the invention or upon employment of the invention in practice. 
     A preferred embodiment of the invention has been chosen for detailed description to enable those having ordinary skill in the art to which the invention appertains to readily understand how to construct and use the invention and is shown in the accompanying drawing in which: 
     FIG. 1 is a plan view of a surgical clip applicator according to the invention. 
     FIG. 2 is an exploded perspective view of the components of a preferred embodiment of surgical clip applicator. 
     FIGS. 3 a - 3   c  are sequential fragmentary perspective views of a surgical clip applicating mechanism according to the invention. 
     FIGS. 4 a - 4   b  are sequential plan views of a preferred embodiment clip applicator jaws in open and closed positions, respectively. 
     FIGS. 5 a - 5   b  are sequential plan views of a modified embodiment clip applicator jaws in open and closed positions, respectively. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     Referring to the drawing, a preferred embodiment of the repeating multi-clip applier  10  comprises handle  12  and clip applicator  14 . 
     The handle  12  (FIG. 2) includes a central casing  16  formed of upper  16   a  and lower  16   b  shells each having aligned confronting journal pin guiding slots  16   c.  The shells are joined to each other along edges  16   d  to define an enclosure  16   e  for receiving handle components  18  including actuating levers  18   a-b  pivotally mounted on adjacent posts  18   c-d,  links  18   e-f  joined to each other by journal pin  18   g  and connected by pivot pins  18   h-i  to levers  18   a-b,  and compression spring  20 . 
     In assembly, the compression spring is mounted on actuating rod  30  with one spring end  20   a  abutting rod shoulders  30   s  and the other spring end  20   b  abutting a rear face  20   c  of a spring housing  20   d.  The end  30   a  of the actuating rod extends through the spring for connection to links  18   e-f  by means of journal pin  18   g.  The exposed ends of the journal pin fit into the guiding slots  16   c  which define the axial excursion of the actuating rod. When assembled, the spring urges the actuating rod forward in a straight line and (by means of actuating rod connection at  30   a  to the journal pin  18   g  and links  18   e-f ) urges the actuating levers  18   a-b  to pivot outward from the casing to normal position. In use, the levers with finger loops are moved together (inward) against the spring for the purpose of applying a clip and moved apart (outward) to reload the applicator jaws with a clip. 
     It is to be understood that the links-actuating rod journal pin  18   g  moves in a rearward then forward linear excursion within the guiding slots for each inward-to-outward cycle of the operating levers. This reciprocating linear motion serves to operate the clip applicator  14  by means of the actuating rod  30 . 
     In practice the clip applicator  14  can be used with any suitable handle that provides linear reciprocating motion. The description of a scissors-type handle is illustrative. 
     The clip applicator  14  comprises an applicator housing  22  including cover  24  and base  26  connected to the forward end  16   f  of the handle casing with the applicator housing enclosing and forming part of a clip applicator mechanism  28 . In the following description, the applicator housing cover and base are regarded as stationary in relation to movement of the applicator mechanism components. 
     The applicator housing base  26  is an elongate open ended channel secured at its rear end  26   a  to the operating handle casing and having an anchor pin  26   b  affixed to the channel base  26   c.    
     The elongate actuating rod  30  is located in the applicator base channel  26   c  with the rod connected at its rear end  30   a  to the handle link journal  18   g  for receiving linear reciprocating motion with respect to the stationary base channel  26   c  for each cycle of the handle operating levers. The actuating rod at its front end includes upstanding cooperating cam members  30   c-d  for closing and opening clip applicator jaws  32 . The actuating rod also includes an anchor pin slot  30   e  to accommodate reciprocal movement of the rod in the base channel and a circular hole  30   f  to receive a retaining pin  38   a  fitted to the clip supply channel as described below. 
     Clip applying jaws  32  comprising spring biased arms  32   a-b  (FIGS. 2,  4   a-b ) are mounted at hole  32   c  to anchor pin  26   b  on the applicator base with the jaws  32   d-e  projecting from the front end of the channel. 
     The applicator jaws are affixed to the base channel so that as the actuator rod reciprocates, cam means  30   c-d  (FIGS. 2,  4   a-b ) forming part of the actuating rod ride along cam surfaces  32   f-g  of the applicator jaws for closing the jaws to apply a clip and for opening the jaws to receive another clip. The normal position for the actuating rod and jaws occurs with the actuating rod at the forward end of linear excursion, with the jaws open and with the actuating rod cam means in an inactive position with respect to applicator jaws. 
     Preferred and modified applicator jaws are illustrated in FIGS. 4 a-b  and  5   a-b.    
     FIGS. 4 a-b  illustrate spring biased applicator jaws  32  affixed at a rear point  32   c  to the applicator housing anchor pin  26   b  with spring biased arms able to move from open-to-closed-to-open positions in applying a clip. The inner surfaces  32   h-i  of the jaws are recessed to form cooperating channels for movement of each clip into the jaws. The outer surfaces of the jaws have aligned recesses  32   f-g  defining cam surfaces cooperating with aligned cam members  30   c-d  affixed to the actuating rod  30  for the purpose of closing the jaws for each rearward excursion of the actuating rod (FIG. 4 b ). The jaws are released to spring open on the forward excursion of the actuating rod placing the cam members within the recesses (FIG. 4 a ). 
     FIGS. 5 a-b  illustrate pivoted applicator jaws  34  with pivot arms  34   a-b  affixed at aligned central pivot points  34   c-d  to the applicator housing base  26   c.  The rearward inner surfaces of the jaws have aligned recesses defining cam surfaces  34   e-f  cooperating with cam member  30   g  affixed to the actuating rod  30  for the purpose of closing the jaws for each rearward excursion of the actuating rod (FIG. 5 b ). The jaw arms move from open-to-closed-to-open positions in applying a clip. The jaws are moved to normally open position by means of a spring (not shown) or by a positive displacement cam means. The forward inner surfaces  34   g-h  of the jaws are recessed to form cooperating channels for holding each clip in the jaws as the jaws close. The jaws move open on the forward excursion of the actuating rod and cam member  30   g  (FIG. 5 a ). A sinuous interface  34   i  of the jaw arms ensures true rocking or pivoting movement of the jaw arms from open to closed positions. 
     The applicator mechanism  28  also includes a clip supply channel  38  (FIGS. 2,  3   a-c ) which is affixed to and reciprocates with the actuating rod  30  by means of an anchor pin  38   a  at the underside the channel which fits into hole  30   f  in the actuating rod. The supply channel  38  includes an elongate base plate  38   b  with upstanding sides  38   c  to define a central channel  38   d  and includes flanges  38   e  defining inwardly directed side channels  38   f-g  for receiving and retaining a line of clips C. The clip supply channel has an integral forwardly extending pusher plate  38   h  preferably with notched front edge conforming to clip contour for the purpose of pushing each clip into the jaws as it leaves the supply channel. A clip stop spring  38   m  with vertical tip  38   n  is formed integral in the base plate  38   b  for gripping the leading clip C L  at midpoint. The clip stop spring has a “spring set” wherein the spring is normally positioned or biased below the surface of base plate  38   c  with the spring being accommodated in a slotted cam plate  39  located underneath the channel. 
     The cam plate  39  (FIG. 2) is fixed to the stationary housing by means of tabs  39   t  or mounted at hole  39   a  to anchor pin  26   b,  so that the back edge of the slot  39   b  acts as a cam to urge the clip stop spring and its tip  38   n  upward into the path of clips C when the clip cartridge  38  moves rearward with the actuating rod  30 . A slot  39   c  in the cam plate accommodates reciprocal movement of the clip cartridge/actuating rod connecting pin  38   a.    
     The housing cover  24  has an elongate transparent slot  24   a  (FIG. 1) through which a user can see the supply of clips. The cover may also have count marks  24   b  indicating the number of clips remaining in the applicator. The cover (FIGS. 3 a-c ) also has on its inner surface a clip block  24   c,  a clip capture spring  36  and a guide ramp  24   d  for positioning clips for movement into clip applying jaws as more fully described below. The underside surface of the cover may also have a set of longitudinally extending ratchet teeth  24   e  (FIG. 3 b ) forming a part of a clip advancing mechanism described below. 
     A clip advancing mechanism  40  (FIG. 3 b ) is positioned and retained in the clip supply channel  38   d  and side channels  38   f-g  in engagement with the last clip C Z  for advancing the line of clips along the supply channel. The clip advancing mechanism includes a clip follower  40   a  with forwardly directed fingers  40   b-c  for engaging clip shoulders for constantly maintaining a force on the line of clips, a sinuous compression spring  40   d,  and a ratchet head  40   e.  The ratchet head is provided with upper  40   f  and lower  40   g  tangs or spring biased ratchet pawls for engagement, respectively, with ratchet edges or teeth  24   e  in the under side of the housing cover and ratchet openings  38   p  in the supply channel base plate  38   b.    
     The ratchet head, the clip follower and follower spring by their design and operation, and in cooperation with the movable clip stop spring  38   m,  regulate step-by-step or indexing movement of a line of clips through the supply channel toward the applicator jaws. 
     In normal (or forward) position of the actuating rod  30  and supply channel  38  (which are affixed to each other), the bias spring  40   d,  clip follower  40   a  and ratchet head  40   e  maintain contact and force on the clip line urging the line toward the clip stop spring  38   m  by means of upper pawl  40   f  engagement with ratchet teeth  24   e  in the housing cover and by means of lower pawl  40   g  engagement with ratchet openings  38   p  in the supply channel base plate while the clips are at rest in the supply channel. 
     The clip advance mechanism, the bias spring and clip follower, the cover ratchet teeth, the base plate ratchet openings, and the clip stop spring act together for step-by-step or indexed movement of the clips down the supply channel as now described. 
     With the actuating rod and supply channel in forward or normal position, the upper pawl and compression spring hold the clip line stationary against the clip stop spring  38   m.  When the actuating rod  30  and supply channel  38  move rearward with squeeze of the operating levers, the ratchet head and upper pawl remain stationary while the compression spring accommodates rearward movement of the clip stop spring and the contiguous line of clips. The rearwardly moving supply channel slips over the lower pawl  40   g  bringing the next forward ratchet opening  38   p  into contact with the lower pawl thereby indexing forward by one step the relative position of the ratchet head and the supply channel. 
     Next the actuating rod and supply channel and line of clips move forward as a unit into normal position. During this forward movement, the upper pawl  40   f  slips one notch along the under side of the housing cover into engagement with the next ratchet tooth  24   e.    
     In lieu of the clip advancing mechanism  40 , an elongate compression spring  41  (FIG. 2) may be employed for advancing clips in the clip supply channel. As shown, a compression spring attached to a channel back wall  38   r  and to a spring head  41   a  lies in the clip channel for engaging and moving a line of clips C in the channel by spring force. 
     Referring to FIGS. 3 a-c , with forward movement of the supply channel and coherent line of clips, a first in line of clips C F  comes to rest against the clip block  24   c.  The capture spring  36  straddles the clip block and separates clip C F . The capture spring  36  is stationary in that it is affixed to the under side of the housing cover in position to capture and hold the lead clip at the end of the forward excursion of the actuating rod and supply channel. The capture spring takes and separates the lead clip from the clip line in preparation for movement of the lead clip into the applicator jaws on a subsequent applicator cycle. 
     The capture spring in preferred form is generally U-shaped with front tabs  36   a-b  affixed to the cover, with spaced shoulders  36   e-f,  and with inclined rear end  36   g.  The spring captures clip C F  by reaction as the inclined end rides up on forwardly moving clip C F  and snaps down as the clip passes the shoulders. Such clip capture occurs as the actuating rod and supply channel reciprocate during operation of the applicator, as detailed below. 
     At the end of rearward excursion of the supply channel (FIG. 3 b ), the capture spring  36  pushes clip C F  downward and out of engagement with the clip block  24   c  and into the path of the pusher plate  38   h.  The pusher plate then engages the rear of captured clip C F  with its contoured edge to advance clip C F  into the applicator jaws on forward movement of actuating rod and supply channel. The guide ramp  24   d  on the cover guides clip C F  into the jaws. 
     The operation of the applicator is as follows. Referring to FIGS. 1,  3   a  and  4   a,  the housing cover and base are stationary with respect to movements of the component parts of the actuating mechanism. At the beginning of an operating cycle (or normal position), the handle actuating levers are positioned apart, the actuating rod and supply channel are in forward position, the jaws are open holding a clip in position for surgical application, jaw actuating cam means are in inactive position, the lead clip in the capture position, the pusher plate lies under the lead clip, the clip stop spring is inactive and lies in the cam plate recess below the surface of the pusher plate, and the clip follower engages the last in line clip, the spring biased line of clips is in contact with lead clip C F , the lower pawl engages a corresponding supply channel ratchet edge, and the upper pawl engages a cover ratchet tooth. 
     By squeezing the handle levers together (FIGS. 3 b  and  4   b ), the actuating rod and supply channel move rearward relative to the stationary cover and base to accomplish: 
     a. retraction of the actuating rod cam means along the jaws cam surfaces to close the jaws and apply a clip; 
     b. movement of the pusher plate relative to the cam plate whereby the stop spring is cammed up so its tip grips the next in line clip C L  and by rearward movement the stop spring separates the clip stack from the lead clip C F ; 
     c. the captured clip C F  is held in place under the capture spring; 
     d. movement of the pusher plate from underneath into position behind the captured clip C F ; 
     e. the upper pawl of the ratchet head is in engagement with a ratchet tooth of the housing cover as the clip follower and follower spring maintain back pressure on the clip line in the supply channel thereby holding the ratchet head stationary with respect to the upper housing cover as the staple supply channel moves rearward with the actuating rod, 
     f. indexing the lower pawl one step of relative movement between the ratchet head and the supply channel; 
     and by releasing the handle levers to move apart, the actuating rod and supply channel move forward in relative movement to the stationary cover and base to accomplish: 
     g. movement of the pusher plate to advance the captured clip C F  into the jaws; 
     h. movement of the actuating rod cam means along the jaws cam surfaces into inactive position opening the jaws; 
     i. with the lower pawl in engagement with a ratchet edge of the supply channel advance the ratchet head and the clip line and the supply channel for moving the clip line and the lead clip C L  toward capture position; 
     j. indexing the upper pawl one step along the cover ratchet teeth; and 
     k. the pusher plate and stop spring moving relative to the cam plate with the stop spring reentering is slot in the cam plate out of the path of the clip line so as to permit the next in line clip C L  to advance along the surface of the pusher plate to deflect the capture spring and be captured as C F . 
     The invention provides that the clip applicator of FIG. 2 of the drawing can be made as a disposable cartridge to be inserted into a non-disposable handle with the cartridge removed from the handle and discarded after its clips are consumed. In a cartridge arrangement both the cartridge housing and rear end of the actuating rod have plug-in connections to the handle housing and link journal respectively. 
     Various changes may be made to the structure embodying the principles of the invention. The foregoing embodiments are set forth in an illustrative and not in a limiting sense. The scope of the invention is defined by the claims appended hereto.