Surgical clip applier with serpentine spring clip feeder

An instrument is provided for applying ligating clips seriatim and includes first and second handles mounted together for pivotal movement. Each handle extends beyond the pivot axis to form a clip closing jaw. The first handle includes a guideway for receiving a plurality of open clips. A pushing mechanism motivated by a serpentine spring is provided within the first handle to feed the clips to the jaw region. One of the jaws includes a lip for preventing discharge of the open front clip from the instrument. A mechanism is provided for at least temporarily maintaining the spring in a compressed position to permit loading of the instrument with clips and to permit transport and storage of the instrument without the feeding force acting on the clips.

TECHNICAL FIELD 
This invention relates to a surgical instrument for repeatedly applying 
surgical clamps or clips to tissue, blood vessels, and the like. 
BACKGROUND OF THE INVENTION 
Clips have been devised for clamping or strangulating various organs, 
vessels, and other tissue. Clips have been developed for use specifically 
in strangulating blood vessels in the human body. Such clips are known as 
hemostatic or ligating clips. The clips may be fabricated from absorbable 
or nonabsorbable polymeric materials as well as from metal. 
A ligating clip is typically C-shaped, U-shaped, or V-shaped with two 
spaced-apart or diverging legs connected together at one end in a manner 
that permits the clip to be squeezed together so that the legs of the clip 
may be clamped around the tissue or blood vessel so as to tightly 
constrict the tissue or blood vessel. This prevents a substantial amount 
of fluid from passing through the tissue or blood vessel from one side of 
the closed clip to the other side of the closed clip. 
Typically, the clip is made of a material and/or has a configuration that 
enables the clip, once it has been forced closed, to remain set or latched 
closed and maintain the closed orientation without outside intervention. 
For example, if the clip is made from a metal material, the clip can be 
deformed to the closed position. If the clip is made from a thermoplastic 
material, the legs may be connected by a resilient hinge portion and the 
distal ends of the legs may be provided with latch means for holding the 
legs together in a closed position when the legs of the clip are squeezed 
together around the tissue or blood vessel. 
A variety of instruments for applying such surgical clips have been 
developed or proposed in the past. A number of such instruments are 
discussed and disclosed in the copending patent application Ser. No. 
208,368 filed on Nov. 19, 1980. Such instruments typically include a 
magazine or cartridge which may or may not be disposable and which holds a 
plurality of clips. The clips are supplied from the cartridge to jaws of 
the instrument one at a time for application to the tissue or blood 
vessel. 
U.S. Pat. No. 3,006,344 discloses an instrument for applying a ligating 
clip to a blood vessel. The clip is formed of flat metal or like stock and 
has a pair of legs extending outwardly in a generally V-shape. The clips 
are arranged in two parallel grooves in a magazine. A slide is positioned 
in each groove and is urged by a suitable conventional spring to advance 
the clips along the magazine toward the jaws. The clips are arranged in 
each row with one end of one clip abutting the connecting rear portion of 
the next adjacent front clip. The clips are not nestably arranged with the 
connecting portion of each clip received between the open legs of the next 
adjacent clip. Rather, the distal end of one of the legs of one clip abuts 
the rear connecting portion of the next adjacent clip. 
U.S. Pat. No. 3,753,438 discloses an applicator for applying clips to 
suturing thread during the suturing of skin wounds. The clips are carried 
in a cartridge in the instrument. A clip is forced forwardly from the 
cartridge to a position between the instrument jaws by a slide which is 
operated by a handle. After the clip is positioned within the jaws, the 
handles of the instrument are squeezed together to squeeze the clip legs 
together. 
U.S. Pat. No. 2,968,041 discloses a trigger actuated "gun" type of clip 
applicator wherein a flat, sinuous, stainless steel spring is provided to 
close the jaws when the trigger is pulled. However, the clips are merely 
loosely contained in a magazine and slide forward in the applicator under 
the influence of gravity when the applicator is tilted. 
It would be desirable to provide an improved instrument for accommodating a 
plurality of clips and for automatically feeding the clips seriatim into 
jaws where the clips may be compressed about tissue, such as blood vessels 
and the like. 
It would also be desirable to provide an instrument for applying clips 
wherein the clips could be arranged in a relatively compact orientation in 
order to provide an efficient and economical structure. 
It would be beneficial if the instrument could be provided with means for 
biasing the clips forwardly to the jaws but in a manner that would prevent 
the front clip from being urged or biased against the tissue. This would 
avoid imposition of an undesired force on the tissue during application of 
the clip. 
It would be advantageous to provide such an instrument with means for 
releasing the forward biasing force at least temporarily to permit 
reloading of the instrument with new clips. 
It would also be desirable to provide an instrument for applying ligating 
clips in which the instrument could be actuated by means of scissors-type 
handles in the same manner as a number of other widely used surgical 
instruments and in the manner to which surgeons have become accustomed 
over the years. 
SUMMARY OF THE INVENTION 
A preferred embodiment of the present invention is incorporated in a 
medical instrument for applying clips, including ligating clips made from 
a thermoplastic material. The clips each typically have two legs connected 
together at one end of the clip and are adapted to assume an initial open 
or spread-apart configuration at the other end. 
In the preferred embodiment, the ligating clips are made from a 
thermoplastic material and that have first and second legs joined at their 
proximal ends by a resilient hinge. The clip legs are spaced apart at 
their distal ends and each leg has a latch means at its distal end to 
engage the other leg of the clip for holding the clip closed in clamping 
engagement about tissue, such as a blood vessel, when the legs are 
squeezed together. 
Each clip includes a base extending along at least a portion of the first 
leg and includes means for being guided, by for being retained by, and for 
supporting the clip in, the instrument. 
The instrument includes first and second handles mounted together for 
pivotal movement about a pivot axis. Each handle extends forwardly beyond 
the pivot axis to form a clip closing jaw. The jaws have opposing clip 
engaging faces. 
Means associated with the first and second handles is provided for limiting 
the pivoting movement of the handles to a maximum opening of the jaws. 
The first handle includes a guideway for receiving a plurality of open 
clips in a single row with the clips arranged in end-to-end relationship 
with the distal end of the first end of one clip abutting the hinge of the 
next forwardly adjacent clip. The first handle includes a clip retaining 
means along the guideway for engaging the clip base to retain the clip in 
sliding engagement with the first handle in the guideway. 
Means is provided on the second handle jaw for engaging the second leg of 
the front clip in the row of clips when the jaws are at the maximum 
opening and when the open front clip is positioned between the open jaws 
whereby discharge of the front clip from the open jaws is prevented. 
A last clip engaging member is disposed within the guideway and is adapted 
to bear against the last clip in the row of clips. 
A serpentine spring is disposed within the guideway and is adapted to be 
compressed behind the last clip engaging member for moving the row of 
clips forwardly along the guideway to the jaws. 
The invention of the apparatus herein described resides in the novel 
combination, construction, arrangement, and disposition of various 
component parts and elements incorporated in the apparatus in accordance 
with the principles of the invention. 
The present invention will be better understood and important features 
other than those specifically enumerated above will become apparent when 
consideration is given to the following details and description which, 
when taken in conjunction with the drawings, describes, discloses, 
illustrates, and shows a preferred embodiment of the present invention and 
what is presently believed to be the best mode of practicing the 
principles of the invention. Other embodiments and modifications may be 
suggested to those having the benefit of the teachings herein, especially 
as they fall within the scope and spirit of the sub-joined claims.

DESCRIPTION OF THE PREFERRED EMBODIMENT 
This invention may be used in many different forms. The specification and 
the accompanying drawings discloses a specific embodiment as an example of 
the use of the invention. The invention is not intended to be limited to 
the embodiment illustrated, and the scope of the invention will be pointed 
out in the appended claims. 
The precise shapes and sizes of the components herein described are not 
essential to the invention unless otherwise indicated. The particular 
shapes and sizes are shown to best illustrate the principles of the 
invention. 
A variety of materials may be used for constructing the illustrated 
instrument as those skilled in the art will appreciate. 
One type of clip or clamp that may be applied with the instrument of the 
present invention is shown in FIG. 6 and is designated therein generally 
by the reference numeral 10. Two clips 10 are illustrated as being open 
and aligned end-to-end in a row as they would be positioned in the 
instrument of the present invention that is described in detail 
hereinafter. 
The clip 10 is seen to be formed with two legs or leg segments 11 and 12 
connected at the proximal ends thereof by a hinge, a hinge portion, or a 
hinge section 13. The leg segment 12 terminates at the distal end thereof 
in a hook member 14 having an inner face 15 substantially parallel to an 
inner face 18 of the leg segment 12 and forming an acute angle with an end 
face 17. 
The leg segment 11 terminates at the distal end in an end face 19 which 
forms an obtuse angle with an inner face 16 of the leg segment 11. 
Additionally, the leg segment 11 is squared off at a face 25 to form a 
substantially right angle with a bottom face 20. 
The length and width of the inner faces 16 and 18 are substantially equal 
and the face 15 of the hook member 14 is spaced from the inner face 18 of 
the leg segment 12 by a distance corresponding to the thickness of the leg 
segment 11 between the planes of the inner face 16 and the bottom face 20. 
When the leg segments 11 and 12 are pivoted about the hinge section 13 to 
bring the inner faces 18 and 16 into opposition, the hook member 14 is 
deflected by the end face 19 of the leg segment 11 until the distal end of 
the leg segment 11 snaps under the hook member 14 and is thereby locked in 
place. The end face 17 of the hook member 14 and the end face 19 of the 
leg segment 11 are angled as illustrated in FIG. 6 to facilitate the 
passage of the hook member 14 past the leg segment 11 during clip closure. 
The surfaces of the inner faces 16 and 18 may be smooth as illustrated in 
FIG. 6, or may be provided with ridges or grooves to increase vessel 
holding power. The leg segment 12 may also be undercut at the juncture of 
the hook member 14 and the inner face 18 as illustrated in FIG. 6 to 
increase the deflectability of the hook member 14 and increase the space 
between the hook member 14 and the leg segment 12. This compensates for 
any inward deflection of the hooked member 14 during closure which might 
reduce the clearance between the surfaces 15 and 18 and otherwise 
interfere with the latching of the clip. 
The clip 10 also has a novel base 45 extending along a portion of either 
one of the two legs, such as the first leg 11 as illustrated. The base 45 
terminates in a front face 47 short of the distal end of the first leg 11 
whereby an open recess is defined adjacent the front face 47 and below the 
first leg 11. The recess provides clearance for latching the hook member 
14. 
Flanges 48 are provided on a portion of the base 45. The flanges 48 extend 
rearwardly from a front face 47 and terminate short of the first leg 
proximal end. The flanges 48 extend laterally outwardly beyond both sides 
of the first leg 11 to function as guide means for engaging portions of 
the instrument as will be explained in detail hereinafter. The portion of 
the base that extends rearwardly from the flanges 48 to the proximal end 
of the clip first leg 11 has a width not greater than the width of the 
first leg 11. 
The rear end of clip 10, including the hinge section 13 and the back of the 
base 45, defines a flat surface 44. Thus, the first leg front face 25 of 
one clip can abut the rear surface 44 of the next forwardly adjacent clip 
when the clips are open and arranged end-to-end in a row. 
A second form of a ligating clip that may be used with the instrument of 
the present invention is illustrated in FIG. 7 and is designated generally 
therein by reference numeral 10'. Two clips 10' are illustrated as being 
opened and aligned end-to-end in a row as they would be positioned in the 
instrument of the present invention that is described in detail 
hereinafter. 
Each clip 10' has a basic structure substantially similar to that of the 
clip 10 described above with reference to FIG. 6, except for the base 
portion 46 of clip 10' which is different than the base 45 of the clip 10. 
The features of clip 10', other than the base 46, are substantially 
identical in configuration and function to the features of clip 10 
illustrated in FIG. 6. Accordingly, the structural features of clip 10' of 
FIG. 7 that are identical to structural features of clip 10 of FIG. 6 are 
designated by the same reference numerals used in FIG. 6 for clip 10, but 
with the addition of a prime mark following each such reference numeral. 
The base 46 of clip 10' extends rearwardly along the length of the first 
leg 11' to the end of the first leg 11'. The base 46 serves to support the 
clip in the instrument of the present invention that may be used to apply 
the clip 10' and which is described in detail hereinafter. The base 46 
also serves for being engaged by and for being guided by the instrument. 
The base 46 terminates short of the distal end of the first leg 11' to 
define a recess for accommodating the latching of the hook member 14' of 
the second leg 12'. 
The base 46 has a generally right rectangular parallelpiped or prism 
configuration with portions 49 extending laterally outwardly from the 
first leg 11' on each side of the first leg. The portions 49 of the base 
46 extending laterally outwardly function as a guide means for engaging 
portions of the clip applier instrument. 
Each of the above-described two novel clip structures, when fabricated from 
a suitable thermoplastic material, is biased to the open position by the 
resilient hinge portion. Thus, if force is applied to the distal ends of 
the legs of the open clip so as to move the legs toward one another (but 
not far enough to latch the clip), then upon removal of the force from the 
clip legs, the clip legs will return to the substantially fully open 
orientation. 
It is believed that this phenomenon can be used to advantage in certain 
types of clip applier instruments for guiding and holding the clip in the 
instrument. Specifically, the legs of the clip may be deflected inwardly 
toward one another a small amount in a magazine, guide channel, or jaw 
structure of a clip applier instrument. Owing to the resilience of the 
hinge joining the two legs, the two legs will exert a force outwardly 
against the magazine, channel, or jaw structure to thereby provide a small 
friction holding force which may serve to help maintain the clip in the 
proper orientation or position within the instrument. 
The above-described action of the resilient hinge plastic clip is in 
contrast with conventional ligating clips fabricated from relatively small 
diameter wire-like stock. Such metal clips can tolerate substantially no 
inward deflection of the legs without undergoing permanent deformation. 
Consequently, such metal clips exhibit no useful degree of resiliency and 
thus do not have the same inherent capability for providing the frictional 
holding force that is found in the above-described type of plastic clip. 
FIG. 1 illustrates one form of an instrument 50 of the present invention 
for applying clips, such as the ligating clips 10 and 10' described above 
with reference to FIGS. 6 and 7. The instrument 50 includes a first 
scissors-type handle 51 and a second scissors-type handle 52 that are 
mounted together for pivotal movement, about a pivot axis defined by a pin 
or a shaft 54, between an open position and a closed position. The shaft 
54 has a head 56 on either side of the second handle 52 as best 
illustrated in FIGS. 2 and 4. 
The first handle 51 extends rearwardly of the pivot shaft 54 and includes a 
finger or thumb ring 56. Similarly, the second handle 52 extends 
rearwardly of the pivot shaft 54 and includes a finger or thumb ring 58. 
The first handle 51 extends forwardly of the pivot shaft 54 and defines a 
lower jaw 61. Similarly, the second handle 52 extends forwardly of the 
pivot shaft 54 and defines an upper jaw 62. 
As best illustrated in FIGS. 1, 2, and 3, the second handle 52 includes a 
pair of spaced-apart sidewalls 64 and 66 which extend for a portion of the 
length of the second handle 52 and which merge above the pivot shaft 54 to 
form the upper jaw 62. Preferably, as best illustrated in FIG. 2, a 
substantial portion of the length of each of the handles 51 and 52 lies in 
a common plane. However, the jaws 61 and 62 curve laterally outwardly. 
Preferably, means is provided for biasing the first and second handles 51 
and 52, respectively, to a fully open position as illustrated in solid 
line in FIG. 1. Specifically, the biasing means is designated generally by 
reference numeral 70 in FIGS. 1 and 3 and is preferably a helical 
compression spring disposed between the first and second handles 51 and 
52, respectively, rearwardly of the pivot shaft 54. 
The spring 70 biases the handles 51 and 52 apart, and hence the jaws 61 and 
62, to a maximum opening as determined by a means associated with the 
first and second handles for limiting the pivoting movement. Specifically, 
with reference to FIG. 4, the means associated with the first and second 
handles for limiting the pivoting movement of the handles includes an 
abutment surface 72 on the first handle 51 and an engaging surface 74 on 
the second handle 52. The second handle engaging surface 74 is oriented at 
an angle relative to the first handle abutment surface 72 when the handles 
51 and 52 are closed. However, when the handles are opened to the maximum 
opening of the jaws illustrated in FIG. 1, the surface 74 is oriented 
substantially parallel with, and is in contact with, the first handle 
abutment surface 72. 
As best illustrated in FIGS. 2 and 3, the first handle 51 includes two 
mating pieces or halves 51A and 51B which are secured together by a 
suitable conventional means, such as by screws or snap-fit connections 
(not illustrated). 
The first handle halves 51A and 51B define a chamber, channel, or guideway 
76 as best illustrated in FIGS. 1 and 3. The upper portion of the guideway 
76 has a generally rectangular cross section that communicates along its 
bottom with a lower channel 78 that is wider than the upper part of the 
guideway 76. The guideway 76 receives a plurality of the open clips (e.g., 
clip 10 of FIG. 6) in end-to-end relationship with the distal end of the 
first leg of one clip abutting the leg connection end or hinge of the next 
forwardly adjacent clip. The clips 10 are moved forwardly along the 
guideway 76 by means described hereinafter in detail. 
As best illustrated in FIGS. 3 and 4, the lower or bottom channel 78 
receives the clip base 45 and base flanges 48 of each clip 10. The 
interior portions of the handle 51 that define the upper part of the 
guideway 76 above the lower channel 78 project inwardly over the lower 
channel 78 and function as a clip retaining means along the guideway for 
engaging the clip flanges 48 to retain the clips in sliding engagement 
with the first handle 51 in the guideway 76. 
As best illustrated in FIG. 1, the guideway 76 is defined at the rear end 
of the handle 51 by a rear wall 75. The upper sides of the first handle 51 
that define the guideway 76 do not extend forwardly beyond the handle 
pivot shaft 54. In the region of the jaw 61, the opening into the channel 
78 is defined by inwardly projecting flanges 77 on either side as best 
illustrated in FIG. 4. These flanges 77 thus continue to retain the clips 
within the channel 78 forward of the pivot shaft 54. 
The clips 10 are moved forwardly along the guideway 76 to the region of the 
jaws 61 and 62 by a novel pusher mechanism. Specifically, a last clip 
engaging member 80 is disposed within the guideway 76 and is adapted to 
bear against the last clip in the row of clips. Preferably, the last clip 
engaging member 80 defines a bearing surface 82 conforming to the 
exterior, rearwardly facing surfaces of at least a portion of the second 
leg and hinge of the last clip when the last clip is in the open position 
as illustrated in FIG. 1. With reference to FIG. 6, the rear surface 44 of 
the clip 10, as well as the exterior surface of the leg 12 of the clip 10, 
would be engaged by the member 80. 
A flat, serpentine spring 84 is disposed within the guideway 76, against 
rear wall 75, and is adapted to be compressed behind the last clip 
engaging member 80 for moving the row of clips forwardly along the 
guideway 76 to the jaws 61 and 62. Preferably, the flat, serpentine spring 
84 has a relatively high compression ratio and one end may be secured to, 
or at least bear against, the last clip engaging member 80. 
The serpentine spring 84, generally occupying a volume in the shape of a 
right rectangular prism, is conveniently received and captured in the clip 
guideway 76, thus eliminating the necessity for providing suitable guiding 
structures that might be required if another type of spring were used. 
The serpentine spring 84 is shown in a compressed state in FIG. 1. FIG. 5A 
is an enlarged view of the serpentine spring 84 also in the compressed 
state. In a specific embodiment of the instrument 50, such as illustrated 
in FIG. 1, the spring 84 may be made from a suitable flat spring stock 
(e.g., ASTM A228-47) having a thickness of about 0.003 inch. Such a spring 
84 preferably has a closed pitch of 0.036 inch and an open pitch of 0.385 
inch. When the spring 84 is in the open, uncompressed state, the height of 
the spring is 0.187 inch, the radius at each bend is about 0.015 inch, and 
the angle between the two diverging legs at each bend is about 90 degrees. 
FIG. 5B illustrates an alternate embodiment of a spring 84', shown in an 
open (uncompressed) state, which functions in a manner similar to the 
spring 84 illustrated in FIG. 5A. Each pair of diverging legs in the 
spring 84' is joined by a circular arc bend 85'. When the spring 84' is in 
the open, uncompressed state as illustrated, the bend defines an arc 85' 
greater than 180 degrees but the legs diverge from the arc at an included 
angle of less than 90.degree.. 
Other suitable serpentine spring designs may be used instead of the designs 
illustrated in FIGS. 5A and 5B. 
As best illustrated in FIGS. 1 and 2, the first handle half 51A and the 
first handle half 51B each define a bore 88. The bores 88 of the first 
handle halves 51A and 51B are aligned on a common longitudinal axis and 
each bore 88 extends through the handle half from the exterior of the 
handle to the guideway 76. 
The last clip engaging member 80 defines a transverse bore 90 (FIG. 1) that 
can be aligned with the first handle bores 88 by locating the last clip 
engaging member 80 in the guideway 76 as illustrated in FIG. 1 wherein the 
spring 84 is substantially compressed. With the member 80 at this 
position, a pin 92 can be at least temporarily disposed through the first 
handle bores 88 and through the last clip engaging member bore 90 so as to 
lock the last clip engaging member 80 at that position. This permits the 
portion of the guideway 76 that is forward of the last clip engaging 
member 80 to be loaded with a plurality of the open clips 10. 
The clips 10 may be loaded into the instrument 50 by pushing the clips 10 
rearwardly through the open jaws. The second leg of each open clip will be 
temporarily deflected toward the first leg as the clip is forced past the 
jaws. Alternatively, the clips may be loaded into the instrument during 
the initial fabrication of the instrument before the two first handle 
halves 51A and 51B are secured together. Also, the instrument can be 
designed for easy disassembly (by removing the pivot shaft 54, removing 
the first handle 51 from the second handle 52, and by then separating the 
first handle halves 51A and 51B). This would permit loading of the clips 
into the disassembled instrument. 
In addition to facilitating the loading of the instrument with open clips, 
the above-described temporary locking mechanism permits the fully loaded 
instrument to be stored and/or transported without the spring load being 
imposed upon the clips 10. When the instrument is to be used, the pin 92 
is removed to permit the spring to establish the forward biasing force on 
the row of clips in the instrument. 
The second handle upper jaw 62 includes means for engaging the second leg 
of the front clip in the row of clips when the jaws 61 and 62 are at the 
maximum opening (FIG. 1) and when the front clip is open and positioned 
between the open jaws. This prevents discharge of the open front clip from 
the open jaws. Specifically, the engaging means on the second handle upper 
jaw 62 includes a downwardly projecting lip 94 as best illustrated in FIG. 
1. The lip 94 extends forwardly beyond the distal end of the first handle 
lower jaw 61 and would overlap the lower jaw 61 if the jaws were closed 
without a clip between the jaws. 
When the instrument is opened so that the jaws 61 and 62 are at the maximum 
opening as illustrated in FIG. 1, the lip 94 prevents the front clip from 
being discharged from the instrument until the front clip is latched 
closed. When the front clip is latched closed, the height of the closed 
clip is less than the maximum opening of the jaws 61 and 62 so that the 
closed clip can be discharged from the instrument when the jaws are 
subsequently opened to release the closed clip. 
In normal operation, the instrument 50 is actuated by closing the handles 
51 and 52 to latch closed the front clip about a blood vessel or other 
tissue. Subsequent opening of the handles, and withdrawal of the 
instrument 50 rearwardly, effects a complete discharge of the latched 
closed clip from the jaws and permits the next rearwardly adjacent clip to 
be fed forwardly, along with the entire row of clips. With the next clip 
in position at the jaws and retained by the second jaw lip 94, the 
instrument 50 is again ready for applying the next clip. 
After all of the clips 10 have been applied, the last clip engaging member 
80 advances into the region between the jaws 61 and 62. Preferably, the 
last clip engaging member 80 is fabricated from a substantially rigid 
material and resists any attempt to further close the jaws. This signals 
the surgeon that all of the clips have been used. 
Although the instrument 50 has been described above as being adapted to 
apply clips having the configuration of clips 10 and 10' illustrated in 
FIGS. 6 and 7, it is to be realized that clips having other suitable 
configurations may be applied with the instrument. For example, metal 
hemostatic clips with appropriate base structures may be utilized. Such 
clips, while not having resilient hinges, may be formed of tantalum or 
stainless steel. These clips could be deformed into the closed position 
and would possess sufficient strength to retain the deformation when 
clamped about a duct, such as a blood vessel. 
From the foregoing, it will be observed that numerous variations and 
modifications may be effected without departing from the true spirit and 
scope of the novel concept of the invention. It is to be understood that 
no limitation with respect to the specific apparatus illustrated herein is 
intended or should be inferred. It is, of course, intended to cover by the 
appended claims all such modifications as fall within the scope of the 
claims.