Abstract:
One example of surgical apparatus for treating tissue may include an effector including at least two jaws movable toward one another, where the effector holds and is configured to deploy a of clips in a clip application mode, and where the jaws are configured to deliver energy to coagulate tissue in a coagulation mode, where said effector is switchable between clip application mode and coagulation mode. Another example of surgical apparatus for treating tissue may include an effector holding clips, and two fingers movable toward one another to close the clips one at a time, where each finger is a different pole of a bipolar coagulator. An exemplary method for treating tissue with a surgical apparatus may include placing the surgical apparatus adjacent to tissue at a location, selecting one of a plurality of operational modes of the surgical apparatus, where the operational modes include clip application mode and coagulation mode, and actuating the surgical apparatus according to the selected operational mode.

Description:
FIELD OF THE INVENTION 
     The present invention relates generally to a surgical clip applier and a method for surgical clip application. 
     BACKGROUND 
     Surgical clip appliers have been utilized to overcome some of the difficulties associated with suturing. However, a large subset of clip appliers known in the art are single-use devices, capable of deploying only a single clip or set of clips at one time. To deploy another clip or set of clips, a new device must be utilized, or the device must be reloaded with another cartridge of clips. Where multiple clips must be placed at different locations in the body, such use of multiple tools is time consuming, expensive and wasteful. Some surgical clip appliers known in the art are capable of deploying multiple clips, one after the other, in different locations in the body. However, such tools are complex and bulky, and may be incapable of deploying clips properly sized to be useful in some minimally invasive surgical procedures. 
     Coagulation-based devices for dissecting tissue also are known and used in surgical procedures. These devices clamp tissue, deliver energy such as RF energy or ultrasound to tissue in order to cause coagulation to heat seal the tissue, then use a knife to cut the tissue. A surgeon may use such a device, for example, to separate side branches from a saphenous vein during endoscopic vein harvesting in preparation for coronary artery bypass graft (CABG) surgery. However, in the course of using a coagulation-based device, the surgeon may encounter blood vessels that are larger than a coagulation-based device can safely handle. Consequently, the surgeon must then set aside the coagulation device and switch to a separate clip applier. Switching between tools is time-consuming, expensive, and inconvenient, particularly in minimally-invasive, laparoscopic, or port-access surgical procedures, where the tissue to be dissected can be lost upon withdrawal of the tool such that the surgeon must spend time finding that tissue again upon the insertion of a different tool. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of an exemplary surgical clip applier. 
         FIG. 2  is a cutaway perspective view of the distal end of an exemplary effector of the surgical clip applier of  FIG. 1 . 
         FIG. 2A  is a side cutaway view of the exemplary effector of the surgical clip applier of  FIG. 1 . 
         FIG. 3  is a perspective view of a portion of the distal end of the exemplary effector of the surgical stapler of  FIG. 1 , with a clip in ready position. 
         FIG. 4  is a top view of the distal end of the exemplary effector of the surgical stapler of  FIG. 1 , with the jaws open. 
         FIG. 5  is a perspective view of a portion of the distal end of the exemplary effector of the surgical stapler of  FIG. 1 , with a closed clip between the jaws. 
         FIG. 6  is a top view of a portion of the distal end of the exemplary effector of the surgical stapler of  FIG. 1 , with a closed clip between the jaws. 
         FIG. 7  is a perspective view of the exemplary effector of the surgical clip applier of  FIG. 1 . 
         FIG. 8  is a side view of a handle of an exemplary hybrid clip applier. 
         FIG. 9  is a detail perspective view of the end of one of the jaws of the exemplary hybrid clip applier of  FIG. 8 . 
     
    
    
     The use of the same reference symbols in different figures indicates similar or identical items. 
     DETAILED DESCRIPTION 
     Clip Applier 
     Referring to  FIG. 1 , a surgical clip applier  2  includes a handle  4  connected to an effector  6 . With regard to the application of clips, the clip applier  2  may be substantially as described in U.S. patent application Ser. No. 12/370,576, filed on Feb. 12, 2009, which is hereby incorporated by reference in its entirety. The handle  4  may be connected directly to the effector  6 , or may be connected to a shaft  8  that in turn is connected to the effector  6 . The shaft  8  may be rigid, articulated or flexible. The handle  4  may have any suitable configuration, as described in greater detail below. The effector  6  may be sized to pass through an access port in a patient for use in a minimally-invasive surgical procedure. The effector  6  may be sized and shaped to allow it to be inserted through an access port in a patient of 5 mm in diameter or less. Alternately, the effector  6  may be sized and/or shaped differently. The effector  6  may be substantially rigid, substantially flexible, or a combination of both. The handle  4  may include one or more triggers, levers, knobs, buttons or other input features used to actuate and/or control the effector  6 . 
     Referring to  FIG. 2 , the effector  6  may hold one or more clips  10  within a passage  12  in a housing  14 . The housing  14  may be elongated longitudinally, and may have a longitudinal centerline. The passage  12  in the housing  14  may itself have a longitudinal centerline that is offset from and generally parallel to the longitudinal centerline of the housing  14 . Alternately, the passage  12  may be located in and/or oriented within the housing  14  in any other suitable manner. The passage  12  may have a lower surface  16  and an upper surface  18 . One or more clips  10  are located within the passage  12 . The clips  10  may be oriented at an angle to the longitudinal centerline of the passage  12  and/or the longitudinal centerline of the housing  14 . The clips  10  may be constrained within the passage  12  by the surfaces  16 ,  18 , as well as the lateral surfaces of the passage  12 . The clips  10  may be independent from one another, and placed adjacent to one another. Alternately, the clips  10  may be connected to or associated with one another in any suitable manner. As one example, the clips  10  may be coated with parylene such that they are held together as a single assembly, in order to facilitate manufacture of the clip applier  2 . As another example, one or more clips  10  may be frangibly connected to a wire or backbone (not shown) from which each clip  10  may be sheared upon deployment, in order to facilitate manufacture of the clip applier  2 . 
     Referring also to  FIG. 2A , a clip pusher  20  may be located in the passage  12 , proximal to the clip or clips  10 . The clip pusher  20  may contact the most proximal clip  10  in the passage  12 , and exert a force on that most proximal clip  10  in the distal direction. The distal force may be transmitted from each clip  10  to the clip  10  distally next in line, such that the clip pusher  20  exerts a distal force on all of the clips  10 . The clip pusher  20  may be biased distally, or may be selectively urged distally. Where the clip pusher  20  is biased distally, such bias may be provided by a compression spring  22 , by a pneumatic force, by a magnetic or electromagnetic actuator, a solenoid, or any other suitable structure or mechanism. The distal end of the compression spring  22  may abut or may be fastened to the clip pusher  20 , and the proximal end of the compression spring  22  may abut or be fixed to a wall  24  or other portion of the housing  14  such that the proximal end of the compression spring  22  is held in a substantially fixed location. However, the compression spring  22  may be arranged differently relative to the housing  14 , if desired. Where the clip pusher  20  is selectively urged distally, the handle  4  may be used to control the timing of the application of distal force to the clip pusher  20 , which may be applied by a compression spring  22 , by a pneumatic force, by a magnetic or electromagnetic actuator, a solenoid, or any other suitable structure or mechanism. 
     A lower ramp  26  may be located at the distal end of the passage  12 . The lower ramp  26  advantageously is oriented at the same angle to the longitudinal centerline of the housing  16  as the clip or clips  10 . The distalmost clip  10  in the passage may be pressed against the ramp  26  by the compressive force applied to that clip  10  by the clip pusher  20 . A upper ramp  28  may be generally parallel to the lower ramp  26 , and spaced apart from the lower ramp  26  by a distance slightly greater than the thickness of the clip or clips  10 . Friction between the distalmost clip  10  and the ramps  26 ,  28  holds the distalmost clip  10  in place. Optionally, a detent or other mechanism may be used to hold the distalmost clip in place. An opening  30  is located between the distal ends of the ramps  26 ,  28 . Clips  10  are sequentially urged through that opening  30 , as described in greater detail below. 
     A pusher  32  is slidable along a pusher slot  34  in the housing  14 . The pusher  32  may be generally elongated, and may have a generally rectangular cross-section. Alternately, the pusher  32  may be shaped differently. The pusher slot  34  may be generally parallel to and underneath the passage  12 . Alternately, the pusher slot  34  may be located and/or oriented differently. The distal end of the pusher slot  34  includes an aperture  36  connecting the pusher slot  34  to the passage  12 . The aperture  36  is preferably oriented such that the distal end of the pusher  32  extends out of the aperture  36  onto the lower ramp  26 . Alternately, the pusher slot  34  is omitted, and the pusher  32  is slidable along a trench or other feature in the housing  14 . 
     Referring also to  FIGS. 3-6 , the effector  6  includes an actively-controlled crimper  40 . The crimper  40  includes a first jaw  42 , a second jaw  44 , and a control arm  46 . Each jaw  42 ,  44  may be substantially planar, and the jaws  42 ,  44  may be positioned such that the second jaw  44  rests on the upper surface of the first jaw  42 . Alternately, at least one jaw  42 ,  44  may be shaped or oriented differently. The proximal end of each jaw  42 ,  44  may be configured to pivot about a post  48  within the housing  14 , where the post  48  has a substantially fixed location within the housing  14 . For example, the proximal end of each jaw  42 ,  44  may include a generally circular opening  50  that receives the post  48  therein. Moving distally to a middle portion of each jaw  42 ,  44 , an angled control slot  52  is defined in each jaw  42 ,  44 . The control slot  52  of each jaw  42 ,  44  is oriented such that the distal end of the control slot  52  is located laterally outward from the proximal end of the control slot  52 . The control slot  52  of the first jaw  42  may be oriented laterally in the opposite direction as the control slot  52  of the second jaw  44 . Moving distally, each jaw  42 ,  44  ends in a finger  60 , where the fingers  60  are configured to receive a clip  10  therebetween. Each finger  60  may be angled relative to the longitudinal centerline of the effector  6  approximately the same amount as the lower ramp  26 , and may extend outward from the opening  30  such that a clip  10  can slide smoothly along the lower ramp  26 , out of the opening  30 , and into the space between the fingers  60 . The inner surface of each finger  60  may include a trench  62  defined therein. Each trench  62  may be sized to be substantially as wide as a clip  10 . Each trench  62  may be deep enough such that the distal end  64  of each trench  62  acts as a stop, such that a clip  10  is advanced between the fingers  60  until the distal end of the clip  10  encounters the ends  64  of the trenches  62  in the fingers  60 . 
     The arm  46  may extend generally parallel to the jaws  42  along at least part of its length. The distal tip  66  of the arm  46  is bent downward or otherwise configured to enter both control slots  52  of the jaws  42 ,  44 . Initially, the distal tip  66  of the arm  46  is located at the proximal end of each slot  52 , and the fingers  60  of the jaws  42 ,  44  are spaced apart from one another. Alternately, a feature  66  is located on the control arm  46  other than at its distal end, and extends downward into both control slots  52  of the jaws  42 ,  44 . 
     The clips  10  may be generally U-shaped, or otherwise configured. Each clip  10  may lie substantially in a single plane. That is, each clip  10  is shaped such that a single plane extends through and substantially bisects the entire clip  10 . Alternately, at least one clip  10  does not lie substantially in a single plane. The longitudinal and lateral dimensions of the clips  10  overall may both be substantially larger than the height of the clips  10 . Alternately, the clips  10  may be sized differently. Advantageously, the clips  10  may be plastically deformable. That is, the clips  10  may undergo a permanent deformation when subjected to a stress exceeding its yield value. In other words, plastic deformation is deformation that remains after the load that caused it is removed, or that would remain if the load were removed. If so, the clips  10  may be fabricated from stainless steel, titanium or any other suitable plastically-deformable material. Alternately, the clips  10  may be elastically deformable. If so, the clips  10  may be fabricated from nickel-titanium alloy or any other suitable elastic or superelastic material. Each clip  10  may be fabricated from a single wire or other piece of material, having a rectangular, circular or other cross-section. However, the clips  10  may be fabricated in any suitable manner. The cross-section of each clip  10  may be substantially constant along the entire clip  10 , or may vary at different locations along the clip  10 . For example, the cross-sectional area of the clip  10  at certain locations may be less than at other locations, in order to promote bending in those locations having a lesser cross-sectional area. The cross-sectional shape of the clip  10  may be square, rectangular, circular, oval or any other suitable shape, and may be substantially constant along the entire clip  10  or vary at different locations along the clip  10 . 
     The handle  4  may include any mechanism, mechanisms, structure or structures configured to actuate the effector  6 . Referring to  FIG. 7 , the proximal end of the pusher  32  and the proximal end of the control arm  46  may extend proximally out of the effector  6 . The handle  4  may be configured in any suitable manner to control the motion of the pusher  32  and control arm  46 . As one example, the pusher  32  and/or control arm  46 , or structures or mechanisms connected to them, may extend through the shaft  8  to the handle  4 . The handle  4  may include any suitable mechanism or mechanisms that provide for control of the pusher  32  and control arm  46 , and may include a source of stored energy for actuating the effector  6 . The source of stored energy may be mechanical (such as a spring), electrical (such as a battery), pneumatic (such as a cylinder of pressurized gas) or any other suitable source of stored energy. The source of stored energy, its regulation, and its use in actuating an effector  6  may be as described in U.S. patent application Ser. No. 10/392,336, filed on Mar. 19, 2003, or U.S. patent application Ser. No. 11/054,265, filed on Feb. 9, 2005, which are herein incorporated by reference in their entirety. The handle  4  may instead, or also, include a connector or connectors suitable for receiving stored energy from an external source, such as a hose connected to a hospital utility source of pressurized gas or of vacuum, or an electrical cord connectable to a power source. 
     Alternately, the handle  4  may be omitted, and the effector  6  may be actuated directly by a surgical robot such as the DaVinci® surgical robot of Intuitive Surgical, Inc. of Sunnyvale, Calif. The shaft  8  may be utilized, if desired, or the effector  6  may be mounted directly on an arm of the surgical robot. The surgical robot may provide all energy needed to actuate the effector  6 , and may directly control the actuation of the effector  6 . 
     Optionally, the effector  6  may include a cutaway, trough, lumen, ring or other feature (not shown) to allow the effector  6  to follow a guidewire to a treatment site. 
     Hybrid Clip Applier 
     Referring to  FIGS. 8-9 , another embodiment of the clip applier  2  is configured to utilize one or more fingers  60  to coagulate tissue, as well as to close clips  10 . The clip applier  2  is configured to either coagulate tissue in a coagulation mode or to deploy clips in a clip application mode. The two modes are mutually exclusive, to prevent electrical or other energy from traveling through a clip  10  that is being deployed or that has been deployed, which may result in injury to the patient and/or damage to the clip applier  2 . Referring in particular to  FIG. 9 , at least one coagulation surface  70  may be located on an inner surface of at least one finger  60 , facing the other finger  60 . For example, at least one coagulation surface  70  may be located on an inner surface of at least one finger  60 , above and/or below the trench  62  defined in that finger  60 . As another example, at least one coagulation surface  70  may be located on an inner surface of at least one finger  60 , distal to the trench  62  defined in that finger  60 . Each coagulation surface  70  may be oriented generally longitudinally along the corresponding finger  60 . Alternately, the entire inner surface  16  of the finger  60  may be a coagulation surface  70 . 
     Each coagulation surface  70  is connected to an energy source in the handle  4  in any appropriate manner. For example, one or more wires  72  or waveguides may extend from a coagulation surface  70  through the shaft  8  to the energy source in the handle  4 . The energy source connected to each coagulation surface  70  may be different from the energy source used to deploy clips  10 , where such an energy source is utilized to deploy clips  10 . For example, the handle  4  may include a cylinder of pressurized gas, a spring, or other source of stored energy used to deploy clips  10 , and a connection to an electric power source for actuating the coagulation surfaces  70 . The energy source connected to each coagulation surface  70  instead may be the same as the energy source used to deploy clips  10 . Alternately, the energy source is not in the handle  4 , but rather is external to the clip applier  2 , such that energy passes from outside the clip applier  2  through the handle  4  to the coagulation surfaces  70  via a wire, wires, waveguide or waveguides  72 , or such that energy passes from a source outside the clip applier  2  directly to the coagulation surfaces  70  via a wire, wires, waveguide or waveguides  72 . 
     Each coagulation surface  70  may be configured in any suitable manner to deliver RF energy, ultrasound, heat, electricity or any other kind of energy to tissue. For example, at least one coagulation surface  70  may be a complete mechanism or other device configured to convert electrical or other energy into a different kind of energy suitable for causing coagulation. Such mechanisms and devices are known in the art. Each coagulation surface  70  may be a pole of a bipolar coagulator, or each may be unipolar. Bipolar cutting and coagulation is known in the art, and is described in, for example, U.S. Pat. No. 5,281,216 to Klicek, which is hereby incorporated by reference in its entirety. Advantageously, the coagulation surface or surfaces  70  on one finger  60  form one pole, and the coagulation surface or surfaces  70  on the other finger  60  form the other pole. Alternately, where multiple coagulation surfaces  70  are provided on at least one finger  60 , at least one of those coagulation surfaces  70  has a different pole than at least one other coagulation surface  70  on that finger  60 . 
     The clip applier  2  may be configured to deploy clips  10  or to apply energy to the coagulation surfaces  70 , based on the selection of the user. Referring also to  FIG. 9 , as one example, the handle  4  may include a trigger  74  used for deploying clips  10  and a switch  76  for actuating the coagulating surfaces  70 . Alternately, the switch  76  may be located elsewhere than the handle  4 , and be connected to the clip applier  2  in any suitable manner. For example, the switch  76  may be a foot pedal connected electrically to the coagulation surfaces  70 , whether via the handle  4  or directly to the coagulation surfaces  70  via the wires or waveguides  72 . Such a switch  76  may be mechanical, electrical, a combination thereof, or a different kind of switch. Optionally, motion of the switch  76  may physically lock out the clips  10  from firing, such as by moving a tab into engagement with the trigger  74  to prevent actuation of the trigger  74 . Alternately, a separate lock  78  may be provided on the handle  4 , where that lock  78  is actuated (optionally or as an affirmative requirement) to lock out the clips  10  from firing prior to application of energy to the actuation surfaces. Alternately, the switch  76  is used to toggle between clip application mode and coagulation mode, and the trigger  74  is then used to actuate the clip applier  2  in each mode. Alternately, a master switch  82  is provided for toggling between clip application mode and coagulation mode, after which the trigger  74  is used to deploy clips  10  or the switch  76  is used to deliver energy to the coagulation surfaces  70 . Alternately, the handle  8  may include any other features that allow the user to selectively deploy staples and coagulate tissue. Alternately, the clip applicator  2  may be configured to deploy clips  10  and apply energy to the coagulation surfaces  70  at the same time, either at the selection of the user, or as the only mode of operation of the clip applier  2 . Alternately, the clip applier  2  may automatically toggle between clip application mode and coagulation mode based on feedback from compression of the tissue between the fingers  60 , such that the user does not select the mode of operation of the clip applier  2 . 
     The handle  4  may include a dial  80  for rotating the shaft  8  relative to the handle  4 . The shaft  8  may extend into the handle  4 , and the dial  80  may be directly fixed to the shaft  8 , such that rotation of the dial  80  causes rotation of the shaft  8 . The dial  80  may extend through an opening in the surface of the handle  4 . Alternately, at least one gear is interposed between the dial  80  and the shaft  8 . In this way, the user can rotate the shaft  8  and thus the end effector  6  relative to the handle  4 , such that the user need not rotate the entire clip applier  2  to properly orient the effector  6  relative to tissue to be treated. 
     As another example of a clip applier  2 , referring to  FIG. 4 , each jaw  42 ,  44  may be conductive and may be a different pole of a bipolar coagulating system. Consequently, the fingers  60  at the ends of the jaws  42 ,  44  are different poles of a bipolar coagulating system. Energy may be transmitted to the jaws  42 ,  44  in substantially the same manner described above in which energy is transmitted to discrete coagulation surfaces  70 , such as through wires or waveguides  72 . Where the jaws  42 ,  44  form separate poles, an insulator or dielectric may be interposed between them within the effector  6 , in order to prevent unintended energy flow between the jaws  42 ,  44 . Further, the post  48  and the arm  46  are advantageously nonconductive for the same reason. The jaws  42 ,  44  may be actuated to coagulate tissue in substantially the same manner described above in which the coagulation surfaces  70  are actuated. 
     Operation 
     The operation of the clip applier  2  is described with regard to a generic surgical procedure. The clip applier  2  may be used in the course of any suitable surgical procedure, whether that surgical procedure is minimally-invasive or open, and whether the clip applier  2  is configured for manual or robotic actuation. For example, the surgical stapler  2  may be used to staple wounds or incisions in the skin together, for cardiac surgery, for hernia repair, for abdominal wall closure, for anti-reflux or other bariatric procedures, for intestinal repair, for dura mater surgery or other brain surgery, for aneurysm closure, for anastomosis, or for any other suitable medical use. 
     The distal end of the effector  6  may be placed in proximity to the tissue to be clipped. For example, the fingers  60  may be placed around a blood vessel. For clarity in describing the operation of the stapler  2 , that tissue is not shown in the figures. Referring to  FIGS. 2 and 4 , the effector  6  is in an initial state. In the initial state, the fingers  60  are spaced apart from one another in an open configuration, prepared to receive a clip  10 . The user then actuates the handle  4  and/or other component of the clip applier  2  to begin the deployment sequence. As described above, the handle  4  or other mechanism controls the motion of the components of the effector  6  in any suitable manner. First, the pusher  32  is advanced distally. As the pusher  32  advances, it contacts the proximal surface of the distalmost clip  10 , then pushes that clip along the lower ramp  26  and through the opening  30 . As the clip  10  moves through the opening  30 , the lateral surfaces of the clip  10  enter the trenches  62  of the fingers  60 , such that the fingers  60  can effectively hold the clip  10  therebetween. Motion of the clip  10  ceases when the pusher  32  ceases its distal motion, or when the distal end of the clip  10  encounters the distal end  64  of at least one trench  62 . The clip  10  is thereby in position for placement on tissue. This position of the clip  10  may be referred to as the “ready position.” The clip  10  may be placed around a blood vessel, onto tissue, or in any other suitable position before or after the clip  10  has reached the ready position. 
     The control arm  46  is then actuated to move distally; advantageously, the control arm  46  also moves substantially linearly. As the control arm  46  moves distally, the distal tip  66  of the control arm  46  moves distally as well. The distal tip  66  is located within the control slots  52  of the jaws  42 ,  44 . As that distal tip  66  moves distally along a generally straight line, it encounters the inner surface of each angled control slot  52 , thereby causing each jaw  42 ,  44  to move inward such as by rotating about the post  48 . Thus, as the distal tip  66  moves distally, the fingers  60  move closer together, closing the clip  10 . The distal tip  66  may travel all the way to the distal end of at least one control slot  52 , or may be controlled by the handle  4  to move a shorter distance along at least one control slot  52 . The distal tip  66  moves distally until the clip  10  is completely closed. After that deployment, the distal tip  66  is moved proximally, causing the fingers  60  to move apart and release the clip  10 . The control arm  46  is moved proximally until the jaws  42 ,  44  return to their initial, open position in which the fingers  60  can receive another clip  10  between them. The jaws  42 ,  44  may be actively controlled at all times. “Active control” means that the opening and closing of the jaws  42  is controlled solely by the control arm  46 , and is not dependent on or responsive to other input, such as contact between one or more of the fingers  60  and tissue. Alternately, the jaws  42 ,  44  may be otherwise controlled. 
     The pusher  32  is also moved proximally to its initial position. This motion may occur at any time after the clip  10  has been pushed into its ready position between the fingers  60 . For example, the pusher  32  may move proximally before, during or after the distal tip  66  of the control arm  46  moves distally to close the clip  10  between the fingers  60 . The clip pusher  20  may apply a compressive force collectively to all of the clips  10  in the passage before, during and after each distalmost clip  10  is urged into the ready position. As a result, as the pusher  32  moves proximally, the distalmost remaining clip  10  in the passage  12  is urged distally against the pusher  32 . When the distal tip of the pusher  32  moves beneath the distalmost remaining clip  10 , all of the clips  10  advance in the passage  12 , such that the distalmost remaining clip  10  is pushed against the lower ramp  26 . Thus, the clips  10  may be advanced without the need for a belt, carrier or other mechanism to engage them each individually and separately and move them distally. The pusher  32  may then cease its proximal motion. At the time the pusher  32  ceases to move proximally, the distal end of the pusher  32  may be located in the passage  12 , or may be located in the pusher slot  34 . At this time, the effector  6  is ready for another actuation at any other suitable location in the patient. 
     Operation—Hybrid Clip Applier 
     The clip applier  2  with both clip application and coagulation modes is actuated substantially as described above with regard to clip application. Where a dial  80  is provided, the dial  80  may be rotated to orient the shaft  8  and thus the effector  6  in the desired position. Depending on the particular control scheme of the clip applier  2 , the trigger  74  is simply squeezed. Alternately, the master switch  82  is actuated to select clip application mode prior to squeezing the trigger  74 . Alternately, any other suitable control or controls may be used to deploy one or more clips  10 . If the clip applier  2  is set to coagulation mode, then the trigger  74  may be locked out as described above until clip application mode is selected. 
     In order to actuate the coagulation surfaces  70 , the clip applicator  2  is placed in coagulation mode. This may be done in any suitable manner, as set forth above. As one example, the switch  76  is simply depressed, and energy is applied to the coagulation surfaces  70 . The fingers  60  may be moved toward one another to compress tissue therebetween as a consequence of actuating the switch  76 . Alternately, the fingers  60  may be moved together by a partial squeeze of the trigger  74  sufficient to close the jaws  42 ,  44  toward one another, where motion of a clip  10  between the jaws  42 ,  44  is locked out in any suitable manner. Energy is transmitted to the coagulation surfaces  70  via the wires or waveguides  72 , causing the tissue between the fingers that is in contact with the coagulation surfaces  70  to coagulate and seal. The energy transmitted to the coagulation surfaces  70  may also cut through the tissue between the fingers  60 , such that application of energy to the coagulation surfaces  70  both seals and cuts tissue. The effector  6  is then moved away from the tissue. The user can then reposition the effector  6  at a different location in the patient to treat different tissue, whether than location is immediately adjacent to the previous location, or at a different location in the body altogether. The clip applier  2  can thus be used repeatedly in the patient to treat tissue at multiple surgical sites, both with clips and with coagulation. The user may continue in this manner until the clips are exhausted or until the treatment of tissue in the body is complete. In this way, the time and material needed to treat tissue within the patient may be reduced compared to conventional medical devices. 
     The terms “upper,” “lower,” “upward,” “downward,” “up,” “down,” “below,” “above” and the like are used solely for convenience in this document; such terms refer to directions on the printed page and do not limit the orientation of the clip applier  2  as a whole, or of the handle  4 , effector  6  and/or shaft  8 , in use. While the invention has been described in detail, it will be apparent to one skilled in the art that various changes and modifications can be made and equivalents employed, without departing from the present invention. It is to be understood that the invention is not limited to the details of construction, the arrangements of components and/or the details of operation set forth in the above description or illustrated in the drawings. Headings and subheadings are for the convenience of the reader only. They should not and cannot be construed to have any substantive significance, meaning or interpretation, and should not and cannot be deemed to be limiting in any way, or indicate that all of the information relating to any particular topic is to be found under or limited to any particular heading or subheading. The contents of each section of this document are merely exemplary and do not limit the scope of the invention or the interpretation of the claims. Therefore, the invention is not to be restricted or limited except in accordance with the following claims and their legal equivalents.