Abstract:
An elongated endoscopic apparatus has an elongated catheter provided with a snare provision for performing a snaring procedure, a surgery clip, and a clip applier for clipping the wound left by the snaring procedure with the surgery clip. Preferably the elongated catheter is formed with an elongated inner tubular conduit that can accommodate a plurality of surgery clips, each having a C-shape characterized by a pair of elongated jaws mated together at a hinge end, wherein the jaws have tip ends forming the head end for the clip and hinge end forms the tail end for the clip when said plurality of clips are loaded into core of the inner tubular conduit in head to tail procession. The clip applier dispenses the clips a single at a time.

Description:
CROSS-REFERENCE TO PROVISIONAL APPLICATION(S) 
       [0001]    This application claims the benefit of U.S. Provisional Application No. 62/002,691, filed May 23, 2014; and U.S. Provisional Application No. 62/016,717, filed Jun. 25, 2014. 
         [0002]    This application is a continuation-in-part of U.S. patent application Ser. No. 14/276,513, filed May 13, 2014, which claims the benefit of U.S. Provisional Application No. 61/961,842, filed Oct. 24, 2013; U.S. Provisional Application No. 61/957,306, accorded filing date of Jun. 29, 2013; and, U.S. Provisional Application No. 61/855,313, accorded filing date of May 14, 2013. 
     
    
       [0003]    The foregoing disclosures are incorporated herein by this reference thereto. 
       BACKGROUND AND SUMMARY OF THE INVENTION 
       [0004]    The invention relates to surgical instruments and, more particularly, to endoscopic apparatus in which a snare provision for performing polypectomy procedures and the like is combined with a clip applier for clipping the wound left by the snaring operation. 
         [0005]    A number of additional features and objects will be apparent in connection with the following discussion of the preferred embodiments and examples with reference to the drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0006]    There are shown in the drawings certain exemplary embodiments of the invention as presently preferred. It should be understood that the invention is not limited to the embodiments disclosed as examples, and is capable of variation within the scope of the skills of a person having ordinary skill in the art to which the invention pertains. In the drawings, 
           [0007]      FIG. 1  is a perspective view of the terminal end of an elongated endoscopic apparatus in accordance with the invention, comprising an elongated catheter in which a snare provision for performing polypectomy procedures (or the like) is combined with a clip applier for clipping the wound left by the snaring procedure by a surgery clip; 
           [0008]      FIG. 2  is a perspective view comparable to  FIG. 1  except showing the snare provision extended out the terminal end of the endoscopic apparatus; 
           [0009]      FIG. 3  is a perspective view comparable to  FIG. 2  except showing the extended snare looped over the bulb end of a target piece of anatomy (eg., a peduncular-style polyp) to sever it off at the stem, and furthermore showing the extension of a surgery clip in accordance with the invention out of a passageway that is hollow axially through the elongated endoscopic apparatus; 
           [0010]      FIG. 4  is a perspective view comparable to  FIG. 3  except showing the snare tightening around the stem proximate the bulb and showing the jaws of the clips embracing the stem of polyp proximate the anatomical wall it is attached to; 
           [0011]      FIG. 5  is a section view of taken along line V-V in  FIG. 2  and through the passageway for the clips in the endoscopic apparatus, showing that the passageway is loaded with a series of such surgery clips in a line where the head of each clip is pushing into the tail of each preceding clip, until the leadmost clip, which is disposed at an ejection station; 
           [0012]      FIG. 6  is a section view comparable to  FIG. 5  except showing the lead clip in the beginning stages of being dispensed out the dispensing end of clip passageway; 
           [0013]      FIG. 7  is a perspective view of the lead clip and second clip of the series of clips in  FIG. 6 , and in which view the endoscopic apparatus is rendered substantially in hidden lines to show only the general overall outline thereof and the outline of the passageway for the series of clips arranged in the head to tail procession; 
           [0014]      FIG. 8  is an enlarged-scale end elevation view of  FIG. 1 ; 
           [0015]      FIG. 9  is an enlarged-scale perspective view of one such surgery clip in accordance with the invention, in isolation; 
           [0016]      FIG. 10  is a top plan view of  FIG. 9 , except with the jaws shown straightened; 
           [0017]      FIG. 11  is an elevational view, partly in section, taken along offset line XI-XI from  FIG. 10 ; 
           [0018]      FIG. 12  is a top plan view comparable to  FIG. 10  except by showing in one set of dashed lines that the jaws of the clip naturally want to close after ejection from the dispensing end of the passageway, thereby clamping on the embraced anatomy; 
           [0019]      FIG. 13  is a top plan view comparable to  FIG. 12  except showing a second embodiment of the clip and also showing in dashed line that the jaws of the clip can be spread apart by an applied pinching force on the trailing lever protrusions of the clip; 
           [0020]      FIG. 14  is a perspective view comparable to  FIG. 9  except of a third embodiment of a surgery clip in accordance with the invention; 
           [0021]      FIG. 15  is a sectional view taken along line XV-XV in  FIG. 14 ; 
           [0022]      FIG. 16  is a sectional view comparable to  FIG. 15  except of a fourth embodiment of a surgery clip in accordance with the invention; 
           [0023]      FIG. 17  is a perspective view comparable to  FIGS. 9 and 13  except of a fifth embodiment of a surgery clip in accordance with the invention; 
           [0024]      FIG. 18  is a sectional view taken along line XVIII-XVIII in  FIG. 17 ; 
           [0025]      FIG. 19  is an elevational view, partly in section, taken along line XIX-XIX from  FIG. 17 ; 
           [0026]      FIG. 20  is a perspective view of the terminal end of an alternate embodiment of an elongated endoscopic apparatus in accordance with the invention, and comprising an elongated catheter in which a snare provision for performing polypectomy procedures (or the like) is combined with a clip applier for clipping the wound left remaining by the snaring procedure by a surgery clip, and as issuing from a common single lumen; 
           [0027]      FIG. 21  is a perspective view comparable to  FIG. 20  except showing the snare provision extending out of the common single lumen shared by both the snare and the clip applier; 
           [0028]      FIG. 22  is a perspective view comparable to  FIGS. 9 ,  13  and  17  except of a sixth embodiment of a surgery clip in accordance with the invention; 
           [0029]      FIG. 23  is a an enlarged-scale, end elevational view taken in the direction of arrows XXIII-XXIII in  FIG. 20 ; 
           [0030]      FIG. 24  is a an enlarged-scale, end elevational view taken in the direction of arrows XXIV-XXIV in  FIG. 22 ; 
           [0031]      FIG. 25  is a top plan view of  FIG. 22 ; 
           [0032]      FIG. 26  is a perspective view comparable to  FIGS. 9 ,  13 ,  17  and  22  except of a seventh embodiment of a surgery clip in accordance with the invention; 
           [0033]      FIG. 27  is a top plan view of  FIG. 26 ; and 
           [0034]      FIG. 28  is a section view comparable to  FIG. 5  and through the passageway for the clips in the endoscopic apparatus of  FIG. 20 , and for the clip of  FIG. 26 , showing that the passageway is loaded with a series of such surgery clips in a line where the head of each clip is pushing into the tail of each preceding clip, until the leadmost clip, which is disposed at an ejection station. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0035]      FIGS. 1 through 4  show the terminal end of an elongated endoscopic apparatus  200  in accordance with the invention, comprising a catheter  202  in which a snare provision  204  for performing polypectomy procedures (or the like) is combined with a clip applier  206  for clipping the wound left by the snaring procedure with a clip  211 , and more preferably still, a clip  211  in accordance with the invention. 
         [0036]      FIG. 8  is an end elevation view on an enlarged scale of the catheter  202  of  FIG. 1 . 
         [0037]      FIG. 8  shows better the following:
       the lower ovate opening comprises the dispensing end  220  of the passageway  222  for the procession of surgery clips  211 , and the lead clip  211 LD is visible too;   the central opening is the access opening  224  for the extension and retraction of the snare provision  204 ;   the upper left set of concentric circles represents a camera  226 ;   the upper right pair of concentric circles represents a source  228  of illumination; and   the thin rectangular slot above the snare provision comprises a water nozzle  232  for irrigation purposes.       
 
         [0043]      FIG. 2  shows that the snare provision  204  comprises both the snare  234  proper, which might be a wire noose, and a sleeve  236  therefor. Both the snare  234  and the sleeve  236  are extendible beyond the terminal end  238  of the catheter  202  of the endoscopic apparatus  200 . Indeed, it is preferred if the snare  234  and sleeve  236  are independently extendible and retractable. The extension and retraction of the snare  234  and sleeve  236  are controlled by manual controls (not shown) on the opposite end of the catheter  202  of the elongated endoscopic apparatus  200 . It is presumed that, the typical person operating the the endoscopic apparatus  200  in accordance with the invention is a surgeon. 
         [0044]      FIG. 3  shows the extended snare  234  is looped over the bulb end  242  of a target piece of anatomy  244  (eg., a peduncular-style polyp). The object of the procedure is to sever off the bulb  242  at the stem  246 , and, apply a clip  211  on the stem  246 .  FIG. 3  furthermore shows the extension of a surgery clip  211 LD in accordance with the invention out of a passageway  222  formed axially through the catheter  202  of the elongated endoscopic apparatus  200 . 
         [0045]      FIG. 5  is a section view of taken along line V-V in  FIG. 2  and through the clip passageway  222  in the catheter  202  of the elongated endoscopic apparatus  200 . The clip passageway  222  is loaded with a procession of a plurality of such surgery clips  211  in a series where the head  252  of each clip  211  is pushing into the tail  254  of each preceding clip  211 , until the leadmost clip  211 LD, which is disposed at an ejection station  256 . 
         [0046]      FIG. 9  is an enlarged-scale perspective view of one such surgery clip  211  in accordance with the invention, as shown in isolation.  FIG. 10  is a top plan view of  FIG. 9 , except with the jaws  258  shown straightened.  FIG. 11  is elevational view, partly in section, taken along offset line XI-XI from  FIG. 10 . 
         [0047]    Returning to  FIG. 10 , it shows that the clip  211  comprises a composite construction, namely, an encasement  262  resulting in the body and skin of the clip  211  as well as a series of springs  264  and  266  buried inside the encasement  262 . Preferably the encasement  262  is constructed of a relatively softer pliant material. For example and without this being any limitation whatsoever other than an illustrative suggestion, the material  262  might comprise a medium density silicone rubber or the like. However, the clip  211  furthermore includes the springs  264  and  266 . Preferably, there are three such springs  264  and  266 . There is one horseshoe shaped spring  264  at the pivot (or hinge) between the jaws  258  and proximate the tail end  254  of the clip  211 . Then there are two other springs  266  buried in the jaws  258  that are proximate the head end  252  of the clip  211 . 
         [0048]      FIG. 11  shows better that preferably these springs  264  and  266  are constructed not only of a material which is resilient and allows pre-biasing, but also of material which is likely of a higher density. 
         [0049]      FIG. 12  is a top plan view comparable to  FIG. 10  except showing by one set of dashed lines that the jaws  258  of the clip  211  naturally want to close after ejection from the dispensing end  220  of the passageway  222  (eg., see  FIG. 3  or  4 ), and thereby clamp on the embraced anatomy  246 . Preferably this is accomplished by the horseshoe shaped spring  264  at the pivot (or hinge) between the jaws  258  and proximate the tail end  254  of the clip  211 . 
         [0050]    So in  FIG. 12 , there is a first set of dashed lines which represent the encased springs  264  and  266 , except showing the disposition of the springs  264  and  266  for the clip  211  as drawn in solid lines. The second set of dashed lines shows the relaxed shaped or position for the jaws  258 , which is the shape or position that the jaws  258  naturally want to return to after ejection from the passageway  222  (eg., see  FIG. 3  or  4 ). This shape is obtained by shaping the springs  264  and  266  this way for their ‘at rest’ position. 
         [0051]    To return to  FIG. 5 , it shows a procession of a plurality of clips  211  loaded into the passageway  222  for the clips formed in the elongated endoscopic apparatus  200 . The clips  211  do not look like the dashed line rendition in  FIG. 12 . In fact, the clips  211  are in a flexed position when loaded inside the passageway  222  as shown by  FIG. 5 . It is only when a clip  211  is ejected that it flares its ‘gums’  268  apart at the head end  252  and bites with its ‘molars’  270  in the middle, and as shown in dashed lines in  FIG. 12 . 
         [0052]    In  FIG. 5 , two factors are constraining the clips  211  in that flexed position. Whereas  FIG. 5  seems to show the clips  211  in an un-flexed position, the opposite is true. The clips  211  are constrained to adopt that shape. 
         [0053]    Briefly, the clips  211  comprise jaws  258  which lead the way in the procession, and behind the jaws  258  the clips  211  then have trailing lever protrusions  272 , wherein the jaws  258  and lever protrusions  272  meet at the pivot (or a hinge) therebetween. The lever protrusions  272  of the lead clip  211 LD are stuffed into the jaws  258  of the second clip  211 NX (ie., the succeeding clip). Thus the natural bias of the horseshoe-shaped spring  264  cannot force the ‘molars’  270  of the second clip  211 NX to close. Also, the passageway  222  is very close fitting around the procession of the clips  211 . Thus also, the natural bias of the two springs  266  that want to flare open the ‘gums’  268  of the clips  211  are constrained as well. 
         [0054]    At last, attention can be returned to  FIG. 4 . It is a perspective view comparable to  FIG. 3  except showing the snare  234  tightening around the stem portion  246  of the target anatomy  244  (eg., polyp) proximate the bulb  242 , and also showing the jaws  258  of the clips  211  embracing the stem  246  of polyp  244  proximate the anatomical wall it is attached to. As  FIG. 6  shows better, as soon as the jaws  258  of the lead clip  211 LD clear the dispensing end  220  of the passageway  222 , the ‘gums’  268  of the clip  211 LD flare. However, the lever protrusions  272  of the lead clip  211 LD are still forced inside the jaws  258  of the second clip  211 NX (ie., the succeeding clip). Therefore, the action of the horseshoe-shaped spring  264  wanting to cause the ‘molars’  270  of the clip  211 LD to bite is overcome. 
         [0055]      FIG. 4  shows allows imagination of the progression of events in dispensing the lead clip  211 LD. The lead clip  211 LD starts to poke out of the dispensing end  220  of the passageway  222  and initially the ‘gums’  268  flare. That is, the jaws  258  of the lead clip  211 LD open wider than how constrained in the passageway  222 . This allows the operator (eg., surgeon) to embrace the target anatomy  244 / 246  between the wide open jaws  258 . 
         [0056]    While so embraced, the operator (eg., surgeon) then executes the closing of the noose of the snare  234 , thereby severing off the bulb  242 . If the operator can withdraw the terminal end  238  from the lead clip  211 LD, and leave it there in place, then the lead clip  211 LD might stay in place. As soon as the trailing lever protrusions  272  of the lead clip  211 LD slip out of the jaws  258  of the second clip  211 NX, then the ‘molars’  270  of the lead clip  211 LD ‘bite,’ ie., apply a clamping pressure on the stem  246  of the polyp  244 . 
         [0057]    The dispensing end  220  of the clip passageway  222  of the endoscopic apparatus  200  in accordance with the invention could be provided with the following. That is, the dispensing end  220  could be provided with a mechanism for positively launching the lead clip  211 LD (ie., separating it from the second clip  211 NX or, if the last clip  211 ST of procession, the urging/ejecting plunger  274  on the last clip  211 ST, and see  FIGS. 5 and 6  for such a plunger  274 ). 
         [0058]      FIGS. 5 and 6  also better show that, the jaws  258  are provided with ‘molar’ teeth  270  which do the work of retaining the clip  211  on the clamped stem  246 . 
         [0059]      FIG. 13  is a top plan view comparable to  FIG. 12  except showing a second embodiment of the clip  212 . That is, this clip  212  has two ‘molars’  270  on each jaw  258 .  FIG. 12  also shows, in dashed line, that the jaws  258  of the clip  212  can be spread apart by an applied pinching force on the trailing lever protrusions  272  of the clip  212 . For example, if the operator (eg., surgeon) did not like the placement of the lead clip  212 , the clip  212  can be released by a miniature plier-like tool, and the operator (eg., surgeon) can re-do a second clip  212  in place of the first. 
         [0060]      FIGS. 14 and 15  show a third embodiment of a surgery clip  213  in accordance with the invention. These clips do not have ‘molars’ shaped as barbs as shown previously. Instead, the ‘molars’ are formed as sets of axial ridges  276 .  FIGS. 14 and 15  also show that, preferably the axial ridges  276  are intermeshing.  FIG. 16  shows a fourth embodiment of a surgery clip  214  in accordance with the invention, which again has axial ridges  276 , but which however are opposing and not intermeshing. 
         [0061]      FIGS. 17 through 19  show a fifth embodiment of a surgery clip  215  in accordance with the invention. The chief distinction is best shown in  FIG. 19 . That is,  FIG. 19  is an elevational view, partly in section, taken along line XIX-XIX from  FIG. 17 . 
         [0062]    In all the clips  211  through  215 , the jaws meet at a U-shaped bight which forms the pivot (or hinge) for the jaws  258 . In  FIGS. 17-19 , this U-shaped bight is a little different. In  FIG. 19 , the upper surface of the clip  215  is the surface proximate the snare  234  (not shown in  FIGS. 17 through 19 , but see  FIG. 3 ). The U-shaped bight proximate the upper surface is formed with a razor edge  278 . 
         [0063]    That way, the following sequence of events can take place. The snare  234  is looped over the bulb  242  of the polyp  244 , and then brought to encircle the stem  246  proximate the bulb  242 . The lead clip  215  can be extended and positioned to have its flaring jaws  258  embrace the stem  246 . After that, the snare  234  can be tightened in an ever closing noose at the same time that the tightening snare  234  tugs the stem  246  against the razor edge  278  at the back of the U-shaped bight of the clip  215 . 
         [0064]    In other words, there are two things working together to do the one job of severing the bulb  242  (or whatever other target anatomy). The tightening encirclement of the snare  234 , also pulling the stem  246  against the razor edge  278  at the back of the U-shaped bight of the clip  215 . 
         [0065]      FIGS. 20 through 28  show an alternate embodiment of an elongated endoscopic apparatus  280  in accordance with the invention, and comprising a catheter  282  in which a snare provision  284  for performing polypectomy procedures (or the like) is combined with a clip applier  286  for clipping the wound left remaining by the snaring procedure with a clip  216  or  217 , and more preferably still, a clip  216  or  217  in accordance with the invention. 
         [0066]    In these views, the snare provision  284  and the dispensing of clips  216 / 217  is accomplished as both issuing from a common single lumen  288  in the catheter  282  of the elongated endoscopic apparatus  280  in accordance with the invention. 
         [0067]    FIGS.  22  and  24 - 27  show how the clips  216 / 217  are modified for this implementation by having a recessed groove  290  in them for the snare  234  (or a sleeve for the snare, not shown but see  FIG. 2 ) to occupy therein. The snare  234  and/or sleeve might travel axially in this procession of recessed grooves  290  formed by the procession of clips  216  or  217 . Indeed, the snare  234  and/or sleeve might reciprocate axially therein. 
         [0068]      FIG. 25  shows how a counterpart spring  292  to the U-shaped springs shown previously and which is embedded in the tail  294  of this clip  216  in  FIG. 25 , simulates the bite of a clothespin. However, In  FIG. 25 , this counterpart spring  292  is not a simple U-shape. Indeed, the U-shape is defined the extensions which extend into the jaws  258  of the clip  216  only. That is, the U-shape is oriented laying on one side. If the U-shape of the spring  292  were oriented such that the bight opened downwardly, this would more naturally resemble an Ω-shape (ie., the capital Greek letter Omega). However, this Ω-shaped portion of the spring  292  has two lever provisions  296  emanating from spaced positions on the crown of the Ω-shape. Overall, this ‘dual-levered Ω-shaped’ spring  292  operates in much the same way as a clothespin. When the lever provisions  296  are pinched, the lower extensions of the the Ω-shape (eg., jaw extensions  298 ) open up. When the lever provisions  296  are released, the the lower extensions  298  of the the Ω-shape (eg., jaw extensions) close due to the inherent resiliency of the crown of the Ω-shape. 
         [0069]    The invention having been disclosed in connection with the foregoing variations and examples, additional variations will now be apparent to persons skilled in the art. The invention is not intended to be limited to the variations specifically mentioned, and accordingly reference should be made to the appended claims rather than the foregoing discussion of preferred examples, to assess the scope of the invention in which exclusive rights are claimed.