A hub assembly for use with an endoscopic assembly of a reposable surgical clip applier includes an outer housing defining a channel therethrough, a stationary gear fixedly disposed within the channel, a display drum rotatably and slidably supported within the channel and in mechanical communication with the stationary gear, a sliding gear slidably supported within a portion of the stationary gear, and a rotating gear rotatably and slidably supported within a portion of the display drum. The rotating gear is rotatably coupled to the display drum. The display drum is caused to be rotated a first predetermined amount during each distal advancement of the sliding gear.

BACKGROUND

Technical Field

The present disclosure relates to surgical clip appliers. More particularly, the present disclosure relates to endoscopic reposable surgical clip appliers having a reusable handle assembly, at least one reusable shaft assembly, and at least one disposable clip cartridge assembly.

Description of Related Art

Endoscopic surgical staplers and surgical clip appliers are known in the art and are used for a number of distinct and useful surgical procedures. In the case of a laparoscopic surgical procedure, access to the interior of an abdomen is achieved through narrow tubes or cannulas inserted through a small entrance incision in the skin. Minimally invasive procedures performed elsewhere in the body are often generally referred to as endoscopic procedures. Typically, a tube or cannula device is extended into the patient's body through the entrance incision to provide an access port. The port allows the surgeon to insert a number of different surgical instruments therethrough using a trocar and for performing surgical procedures far removed from the incision.

During a majority of these procedures, the surgeon must often terminate the flow of blood or another fluid through one or more vessels. The surgeon will often use a particular endoscopic surgical clip applier to apply a surgical clip to a blood vessel or another duct to prevent the flow of body fluids therethrough during the procedure.

Endoscopic surgical clip appliers having various sizes (e.g., diameters), that are configured to apply a variety of diverse surgical clips, are known in the art, and which are capable of applying a single or multiple surgical clips during an entry to the body cavity. Such surgical clips are typically fabricated from a biocompatible material and are usually compressed over a vessel. Once applied to the vessel, the compressed surgical clip terminates the flow of fluid therethrough.

Endoscopic surgical clip appliers that are able to apply multiple clips in endoscopic or laparoscopic procedures during a single entry into the body cavity are described in commonly-assigned U.S. Pat. Nos. 5,084,057 and 5,100,420 to Green et al., which are both incorporated by reference in their entirety. Another multiple endoscopic surgical clip applier is disclosed in commonly-assigned U.S. Pat. No. 5,607,436 by Pratt et al., the contents of which is also hereby incorporated by reference herein in its entirety. These devices are typically, though not necessarily, used during a single surgical procedure. U.S. Pat. No. 5,695,502 to Pier et al., the disclosure of which is hereby incorporated by reference herein, discloses a resterilizable endoscopic surgical clip applier. The endoscopic surgical clip applier advances and forms multiple clips during a single insertion into the body cavity. This resterilizable endoscopic surgical clip applier is configured to receive and cooperate with an interchangeable clip magazine so as to advance and form multiple clips during a single entry into a body cavity.

During endoscopic or laparoscopic procedures it may be desirable and/or necessary to use different size surgical clips or different configured surgical clips depending on the underlying tissue or vessels to be ligated. In order to reduce overall costs of an endoscopic surgical clip applier, it is desirable for a single endoscopic surgical clip applier to be loadable with and capable of firing different size surgical clips as needed.

Accordingly, a need exists for endoscopic surgical clip appliers that include reusable handle assemblies, reusable shaft assemblies, and disposable clip cartridge assemblies, with each clip cartridge assembly being loaded with a particularly sized clip (e.g., relatively small, relatively medium, or relatively large).

SUMMARY

The present disclosure relates to reposable endoscopic surgical clip appliers.

According to an aspect of the present disclosure, a hub assembly for use with an endoscopic assembly of a reposable surgical clip applier is provided. The hub assembly includes an outer housing defining proximal and distal end surfaces that define a channel therethrough, a stationary gear fixedly disposed within the channel, a display drum rotatably and slidably supported within the channel and in mechanical communication with the stationary gear, a sliding gear slidably supported within a portion of the stationary gear, and a rotating gear rotatably and slidably supported within a portion of the display drum. The rotating gear is rotatably coupled to the display drum. The display drum is caused to be rotated a first predetermined amount during each distal advancement of the sliding gear.

In aspects, the display drum may be caused to be rotated a second predetermined amount during each proximal retraction of the sliding gear.

In other aspects, the stationary gear may define a plurality of teeth on a distal portion thereof.

In certain aspects, the sliding gear may define a plurality of teeth on a distal portion thereof.

In other aspects, the plurality of teeth of the sliding gear may be disposed proximal of the plurality of teeth of the stationary gear when the sliding gear is in an initial, proximal position.

In aspects, the rotating gear may define a plurality of teeth on a proximal portion thereof. In certain aspects, the plurality of teeth of the sliding gear may be configured to engage the plurality of teeth of the rotating gear when the sliding gear is placed in a second, advanced position to cause rotation of the rotating gear the first predetermined amount during engagement therewith.

In other aspects, the plurality of teeth of the stationary gear may be configured to engage the plurality of teeth of the rotating gear when the rotating gear is placed in the first, initial position to cause rotation of the rotating gear the second predetermined amount during engagement therewith.

In certain aspects, the hub assembly may include a spring clip slidably coupled to the rotating gear at a first portion thereof and fixedly coupled to the display drum at a second, opposite portion thereof to rotatably couple the display drum to the rotating gear.

In aspects, the outer surface of the display drum may define a first contrasting color and a second contrasting color.

In other aspects, the outer housing may define a plurality of windows therethrough, wherein the first contrasting color is visible through the plurality of windows after a third predetermined amount of rotation of the display drum.

In aspects, the second contrasting color may be visible through the plurality of windows after a fourth predetermined amount of rotation of the display drum.

In certain aspects, an outer surface of the stationary gear may define an annular cam slot therein. In aspects, an inner surface of the display drum may define a post extending radially inward therefrom that is configured to be slidably received within the cam slot.

In other aspects, the annular cam slot may define a first longitudinal portion at a first radial position and a second longitudinal portion at a second radial position.

In aspects, the post of the display drum may translate within the first longitudinal portion of the cam slot after the third predetermined amount of rotation of the display drum.

In other aspects, the post of the display drum may translate within the second longitudinal portion of the cam slot after the fourth predetermined amount of rotation of the display drum.

In certain aspects, each engagement of the plurality of teeth of the sliding gear with the plurality of teeth of the rotating gear may cause the rotating gear to rotate 1/24thof a rotation.

In aspects, each engagement of the plurality of teeth of the stationary gear with the plurality of teeth of the rotating gear may cause the rotating gear to rotate 1/24thof a rotation.

In other aspects, the post of the display drum may be received within the first longitudinal portion of the cam slot after the display drum has rotated 270 degrees and the post of the display drum is received within the second longitudinal portion of the cam slot after the display drum has rotated a further 90 degrees from the first longitudinal portion.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of reposable endoscopic surgical clip appliers, in accordance with the present disclosure, will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further away from the user.

Referring now toFIGS. 1-29, an endoscopic surgical clip applier in accordance with an embodiment of the present disclosure, and assembly in a particular configuration, is generally designated as10. Surgical clip applier10generally includes a reusable handle assembly or actuation assembly100, at least one disposable or reusable endoscopic assembly200selectively connectable to and extendable distally from handle assembly100; and optionally at least one disposable surgical clip cartridge assembly (not shown) selectively loadable into a shaft assembly of a respective endoscopic assembly200.

Briefly, the shaft assembly of endoscopic assembly200may have various outer diameters such as, for example, about 5 mm or about 10 mm, depending on intended use. Further, the shaft assembly may have various relatively elongated or shortened lengths depending on intended use, such as, for example, in bariatric surgery. In one embodiment, in bariatric surgery, the shaft assembly may have a length of between about 30 cm and about 40 cm. Further, the shaft assembly may be configured to fire and form a specific type of surgical clip, either individually or multiply. However one skilled in the art should appreciate that the shaft assembly may have any length in excess of about 30 cm and the present disclosure is not limited to any of the above identified lengths.

In accordance with the present disclosure, as will be discussed in greater detail below, an endoscopic assembly or a surgical clip cartridge assembly (not shown) may be loaded with a particularly sized set of surgical clips (e.g., relatively small surgical clips, relatively medium surgical clips, or relatively large surgical clips). It is contemplated that clip cartridge assemblies may be configured to be selectively loaded into the shaft assembly of a respective endoscopic assembly200, and to be actuated by the same or common handle assembly100, to fire and form the surgical clip(s) loaded therein onto underlying tissue and/or vessels.

Referring now toFIGS. 1-14, handle assembly100of surgical clip applier10is shown and will be described. Handle assembly100includes a housing102having a first or right side half-section102aand a second or left side half-section102b. Housing102of handle assembly100further includes or defines, as seen inFIGS. 3 and 4, a nose102c. Housing102of handle assembly100may be formed of a suitable plastic or thermoplastic material. It is further contemplated that housing102of handle assembly100may be fabricated from stainless steel of the like.

Handle assembly100includes a trigger104pivotably supported between right side half-section102aand left side half-section102bof housing102. Trigger104is biased by a biasing member104a(e.g., a return spring, compression spring or torsion spring) to an un-actuated condition. Specifically, biasing member104a(FIG. 4) acts on a feature of trigger104and on a feature of housing102to bias or urge trigger104to the un-actuated condition. Trigger104includes a drive arm104bextending therefrom. Drive arm104bmay be integrally formed therewith or may be separately and fixedly secured to trigger104. Drive arm104bmay define a curved, radii used or filleted upper distal surface.

As illustrated inFIGS. 3, 4 and 8-14, trigger104supports or is provided with at least one linear rack152of teeth152aof a ratchet assembly150, as will be described in detail below.

With reference toFIGS. 3, 4, 11, handle assembly100includes a drive plunger120operatively connected to trigger104. Specifically, drive plunger120is slidably supported within housing102and defines a pair of opposed, axially extending slots120aformed in an outer surface thereof. Slots120aof drive plunger120are configured to slidably engage or receive opposed tabs102dof housing102. Drive plunger120further defines a proximally extending trigger slot120bformed in a proximal portion thereof for operatively receiving drive arm104bof trigger104. Trigger slot120bdefines a distal surface or wall120cagainst which a distal surface of drive arm104bof trigger104contacts in order to distally advance drive plunger120during an actuation of trigger104.

Drive plunger120further includes a tooth120d(FIG. 11) projecting into trigger slot120b. Tooth120dprojects substantially toward trigger104and includes a distal surface or wall120d1(spaced proximally from distal surface or wall120cof drive plunder120), and a proximal, angled wall120d2tapering to a relatively smaller height in a proximal direction.

Drive plunger120additionally includes a tab or fin120eprojecting from a surface thereof. Tab120eof drive plunger120may be substantially aligned or in registration with tooth120dof drive plunger120. Tab120eof drive plunger120may project in a direction substantially opposite to tooth120dof drive plunger120or to trigger104.

With reference toFIGS. 1-4 and 11, handle assembly100includes an endoscopic assembly release lever130pivotally supported on and connected to housing102via a pivot pin132. Pivot pin132is supported in housing102. Release lever130includes a proximal end130aextending proximally of pivot pin132. Proximal end130aof release lever130includes a wall130cdimensioned to extend toward a pawl switch140of handle assembly100, as will be described in greater detail below.

Release lever130includes a distal end130bextending distally of pivot pin132. Distal end130bof release lever130includes a catch or tooth130dprojecting therefrom, in a direction towards drive plunger120. Catch130dmay be located distal of drive plunger120.

A biasing member134, in the form of a leaf spring, may be provided which tends to bias distal end130band catch130dof release lever130towards drive plunger120of handle assembly100, and tends to bias proximal end130aof release lever130away from pawl switch140. Specifically, biasing member134tends to maintain catch130dof release lever130in engagement with an engagement feature (e.g., annular channel212c) of endoscopic assembly200, as will be described in greater detail below.

With reference toFIGS. 3, 4 and 11-14, as mentioned above, handle assembly100includes a ratchet assembly150supported within housing102. Ratchet assembly150includes, as also mentioned above, at least one linear rack152of teeth152asupported on and projecting from trigger104. Ratchet assembly150further includes a ratchet pawl154pivotally connected to housing102by a pawl pin at a location wherein pawl154is in substantial operative engagement with rack152. Ratchet assembly150further includes a pawl spring156configured and positioned to bias pawl154into operative engagement with rack152. Pawl spring156functions to maintain the tooth or teeth154aof pawl154in engagement with teeth152aof rack152, as well as to maintain pawl154in a rotated or canted position.

Pawl154is engagable with rack152to restrict longitudinal movement of rack152and, in turn, trigger104. In use, as trigger104is actuated (from a fully un-actuated position), rack152is also moved, into engagement with pawl154. Rack152has a length which allows pawl154to reverse and advance back over rack152, when rack152changes between proximal or distal movement, as trigger104reaches a fully actuated or fully un-actuated position. The relative lengths and sizes of rack152of ratchet assembly150, trigger104and drive plunger120define a stroke length of trigger104, drive plunger120or handle assembly100(e.g., a “full stroke”).

Turning now toFIGS. 1, 2, 4, 11 and 18, handle assembly100includes a rotation knob160rotatably supported on nose102cof housing102. Rotation knob160includes a central axial bore160ahaving an annular array of longitudinally extending grooves160b(FIG. 18) formed in a surface thereof. Grooves160bof rotation knob160function as clocking and alignment features for the connection of endoscopic assembly200with handle assembly100. Rotation knob160further includes a plurality of finger grip ribs160cprojecting from an outer surface thereof.

With reference toFIGS. 3 and 4-14, handle assembly100further includes a pawl switch140and a pawl actuator142each pivotally supported in housing102. Pawl switch140is operatively connected to pawl actuator142and is operable to selectively move pawl actuator142into or out of engagement with pawl spring156, and in turn pawl154, of ratchet assembly150whereby pawl154may be selectively engaged by pawl spring156. In this manner, when pawl154is moved out of engagement with pawl spring156, trigger104is free to open and close as needed due to pawl154having minimal blocking effect on rack152of ratchet assembly150. As such, trigger104may be partially actuated (without having to be fully actuated), and may be returnable to a fully un-actuated position. Such a feature permits the user to partially squeeze or actuate trigger104for performing a cholangiogram procedure or the like.

Pawl switch140includes a finger lever140aprojecting from housing102, whereby pawl switch140may be actuated by a finger of a user. Housing102of handle assembly100may be provided with guard walls102ddisposed on opposed sides of finger lever140ain order to inhibit inadvertent actuation of pawl switch140. Pawl switch140is movable, upon actuation of finger lever140a, between a first position in which ratchet assembly150is “on” or “activated”, and a second position in which ratchet assembly150is “off” or “de-activated.” It is contemplated that pawl switch140, and in turn ratchet assembly150, default to the first position.

Pawl switch140further includes a first flange140bprojecting a first distance from a pivot point thereof, and a second flange140cprojecting a second distance from the pivot point thereof, wherein the projection of the second flange140cis greater than the projection of the first flange140b. First flange140bof pawl switch140is selectively engagable by wall130cof proximal end130aof release lever130. In this manner, each time an endoscopic assembly200is attached to handle assembly100, and release lever130is actuated, wall130cof release lever130engages first flange140bof pawl switch140to move pawl switch to the first position (FIGS. 19-22).

Pawl switch140also includes a ramp or camming surface140dprojecting therefrom which selectively engages a tab or finger142aof pawl actuator142to slidably move pawl actuator142, and in turn pawl spring156, into and out of operative engagement/registration with/from pawl154.

Pawl actuator142is pivotally connected to housing102and operatively connected to pawl switch140such that actuation of pawl switch140actuates pawl actuator142. Pawl actuator142is slidably supported on a pair of support pins143a,143b, and a biasing member144is provided to bias pawl actuator142against pawl switch140. In operation, with reference toFIGS. 11-14, when pawl switch140is actuated to the second position, ramp or camming surface140dof pawl switch140acts on tab142aof pawl actuator142to transversely slide pawl actuator142along support pins143a,143band move pawl spring156out of operative engagement/registration with pawl154, thereby disabling the operability of ratchet assembly150. Also, as pawl actuator142is slid transversely along support pins143a,143b, pawl actuator142biases biasing member144.

Further in operation, with reference toFIGS. 8-10, when pawl switch140is actuated to the first position, ramp or camming surface140dof pawl switch140is moved to permit biasing member144to expand and transversely slide pawl actuator142along support pins143a,143b, whereby pawl spring156is moved back into operative engagement/registration with pawl154, thereby enabling or re-enabling the operability of ratchet assembly150.

Turning now toFIGS. 1, 2, 16 and 17, an embodiment of an endoscopic assembly200, of surgical clip applier10, is shown and described. Endoscopic assembly200includes a hub assembly210, a shaft assembly220extending from hub assembly210, and a pair of jaws250pivotally connected to a distal end of shaft assembly220. It is contemplated that endoscopic assembly200may be configured to close, fire or form surgical clips similar to those shown and described in U.S. Pat. No. 4,834,096, the entire content of which is incorporated herein by reference.

Hub assembly210functions as an adapter assembly which is configured for selective connection to rotation knob160and nose102cof housing102of handle assembly100. Hub assembly210includes an outer housing212having a cylindrical outer profile. Outer housing212includes a first or right side half section212a, and a second or left side half section212b. Outer housing212of hub assembly210defines an outer annular channel212cformed in an outer surface thereof, and at least one (or an annular array) of axially extending ribs212dprojecting from an outer surface thereof. Outer annular channel212cof outer housing212of endoscopic assembly200is configured to receive catch130dof release lever130of handle assembly100(FIGS. 19-22) when endoscopic assembly200is coupled to handle assembly100.

Ribs212dof outer housing212function as a clocking/alignment feature during connection of endoscopic assembly200and handle assembly100with one another, wherein ribs212dof outer housing212of endoscopic assembly200are radially and axially aligned with respective grooves160bof rotation knob160of handle assembly100. During connection of endoscopic assembly200and handle assembly100, ribs212dof outer housing212of endoscopic assembly200are slidably received in respective grooves160bof rotation knob160of handle assembly100.

The connection of hub assembly210of endoscopic assembly200with rotation knob160of handle assembly100enables endoscopic assembly200to rotate 360°, about a longitudinal axis thereof, relative to handle assembly100.

Outer housing212of hub assembly210further defines an open proximal end212econfigured to slidably receive a distal end of drive plunger120of handle assembly100, when endoscopic assembly200is coupled to handle assembly100and/or when surgical clip applier10is fired.

As mentioned above, endoscopic assembly200includes a shaft assembly220extending distally from hub assembly210. Shaft assembly220includes an elongate outer tube222having a proximal end222asupported and secured to outer housing212of hub assembly210, a distal end222bprojecting from outer housing212of hub assembly210, and a lumen222c(FIGS. 15 and 17) extending longitudinally therethrough. Distal end222bof outer tube222supports or defines an outer clevis222dfor pivotally supporting a pair of jaws250, as will be described in greater detail below.

Shaft assembly220further includes an inner shaft224slidably supported within lumen222cof outer tube222. Inner shaft224includes a proximal end224aprojecting proximally from proximal end222aof outer tube222, and a distal end224bdefining an inner clevis224cfor supporting a cam pin224dwhich engages camming slots252c,254cof a pair of jaws250, as will be described in greater detail below.

With reference toFIGS. 15 and 17, hub assembly210includes a drive assembly230supported within outer housing212thereof. Drive assembly230includes a cartridge cylinder232having a cup-like configuration, wherein cartridge cylinder232includes an annular wall232a, a proximal wall232bsupported at and closing off a proximal end of annular wall232a, an open distal end232c, and a cavity or bore232ddefined therewithin.

Drive assembly230also includes a cartridge plunger234slidably supported within bore232dof cartridge cylinder232. Cartridge plunger234is fixedly supported on inner shaft224, at the proximal end224athereof. Cartridge plunger234is sized and configured for slidable receipt within bore232dof cartridge cylinder232of drive assembly230. A ring, flange or the like235may be fixedly supported at a distal end of bore232dof cartridge cylinder232, through which proximal end224aof cartridge plunger234extends and which functions to maintain cartridge plunger234within bore232dof cartridge cylinder232.

Drive assembly230includes a first biasing member236(e.g., a compression spring) disposed within bore232dof cartridge cylinder232. Specifically, first biasing member236is interposed between proximal wall232bof cartridge cylinder232and a proximal surface of cartridge plunger234. First biasing member236has a first spring constant “K1” which is relatively more firm or more stiff, as compared to a second spring constant “K2” of a second biasing member238, as is described in detail below.

Drive assembly230further includes a second biasing member238(e.g., a compression spring) supported on proximal end224aof inner shaft224. Specifically, second biasing member238is interposed between a proximal flange222dof outer tube222and a distal surface of cartridge plunger234. Second biasing member238has a second spring constant “K2” which is relatively less firm or less stiff, as compared to the first spring constant “K1” of first biasing member236.

As illustrated inFIGS. 15 and 17, endoscopic assembly200includes a pair of jaws250pivotally supported in a clevis222dat distal end222bof outer tube222by a pivot pin256. The pair of jaws250includes a first jaw252and a second jaw254. Each jaw252,254includes a respective proximal end252a,254a, and a respective distal end252b,254b, wherein proximal ends252a,254aand distal ends252b,254bof jaws252,254are pivotable about pivot pin256. Each proximal end252a,254aof respective jaws252,254defines a cam slot252c,254ctherein which is sized and configured to receive cam pin224dof inner shaft224. In use, as inner shaft224is axially displaced relative to outer shaft222, inner shaft224translated cam pin224dthereof through cam slot252c,254cof jaws252,254to thereby open or close the pair of jaws250.

When the pair of jaws250are in an open position, and a new, unformed or open surgical clip (not shown) is located or loaded within the distal ends252b,254bof jaws252,254of the pair of jaws250, as inner shaft224is moved distally relative to outer shaft222, cam pin224dis translated through cam slots252c,254cof jaws252,254. As cam pin224dis translated through cam slots252c,254cof jaws252,254the distal ends252b,254bof jaws252,254are moved to the closed or approximated position to close and/or form the surgical clip located or loaded therewithin.

The dimensions of jaws252,254and of cam slots252c,254cof jaws252,254determines an overall length required to move jaws252,254from a fully open position to a fully closed position, defining a closure stroke length of the pair of jaws250.

With reference now toFIGS. 19-25, an operation or firing of surgical clip applier10, including endoscopic assembly200operatively connected to handle assembly100, is shown and described. With endoscopic assembly200operatively connected to handle assembly100, and with a new, unformed or open surgical clip (not shown) is located or loaded within the distal ends252b,254bof jaws252,254of the pair of jaws250, as trigger104of handle assembly100is actuated drive bar104bof trigger104acts on drive plunger120to distally advance drive plunger120. As trigger104is actuated, pawl154of ratchet assembly150begins to engage rack152thereof. With pawl154engaged with rack152, trigger104may not return to a fully unactuated position until trigger104completes a full actuation or stroke thereof.

As drive plunger120is distally advanced, a distal end of drive plunger120presses against proximal wall232bof cartridge cylinder232of drive assembly230of endoscopic assembly200to distally advance cartridge cylinder232. Due to first spring constant “K1” of first biasing member236being larger or greater than second spring constant “K2” of second biasing member238, as cartridge cylinder232is advanced distally, cartridge cylinder232distally advances first biasing member236, which in turn acts on cartridge plunger234to distally advance cartridge plunger234. As cartridge plunger234is distally advanced, cartridge plunger234distally advances inner shaft224relative to outer shaft222. Being that second biasing member238is interposed between proximal flange222dof outer tube222and distal surface of cartridge plunger234, as cartridge plunger234is distally advanced, cartridge plunger234also compresses second biasing member238.

As inner shaft224is distally advanced relative to outer shaft222, inner shaft224distally advances cam pin224dthrough cam slot252c,254cof jaws252,254to close the pair of jaws250and to close and/or form the surgical clip (not shown) loaded within the pair of jaws250. Cam pin224dof inner shaft224is advanced distally until cam pin224dreaches an end of cam slots252c,254cof jaws252,254of the pair of jaws250and/or until the distal ends252b,254bof jaws252,254of the pair of jaws250are fully approximated against one another (e.g., in contact with one another or fully closed on the surgical clip (not shown)), whereby cam pin224dmay not have reached the end of cam slots252c,254cof jaws252,254. This position may be considered a hard stop of the pair of jaws250. The axial distance that cam pin224dhas traveled from a proximal-most position thereof to when cam pin224dreaches the end of cam slots252c,254cof jaws252,254or when the distal ends252b,254bof jaws252,254of the pair of jaws250are fully approximated against one another, may also define the closure stroke length of the pair of jaw250.

When the pair of jaws250have reached the hard stop, or when the cam pin224dhas reached an end of the closure stroke length, pawl154of ratchet assembly150of handle assembly100may not have cleared rack152thereof, and thus blocks or prevents trigger104from returning to a fully unactuated position thereof. Since the pair of jaws250cannot close any further, and since cam pin224dcannot be advanced distally any further, inner shaft222is also stopped from further distal advancement. However, as mentioned above, in order to return trigger104to the fully unactuated position, trigger104must first complete the full actuation stroke thereof. As such, as trigger104is further actuated to complete the full stroke thereof, as drive plunger120is continued to be driven distally, the distal end of drive plunger120continues to press against proximal wall232bof cartridge cylinder232of drive assembly230of endoscopic assembly200to continue to distally advance cartridge cylinder232.

With inner shaft222, and in turn cartridge plunger234, stopped from any further distal advancement, as cartridge cylinder232is continued to be advanced distally, cartridge cylinder232begins to and continues to compress first biasing member236until such time that pawl154of ratchet assembly150of handle assembly100clears and disengages rack152thereof. With pawl154of ratchet assembly150clear and disengaged from rack152, trigger104may be released and returned to the fully unactuated position by hand, by a return spring104aof trigger104and/or by first biasing member236and second biasing member238of endoscopic assembly200.

In accordance with the present disclosure, the trigger stroke length for trigger104of handle assembly100is constant or fixed, while the closure stroke length of the pair of jaws250may vary depending on the particular endoscopic assembly200connected to handle assembly100. For example, particular endoscopic assemblies200may require the pair of jaws250thereof to travel a relatively greater or smaller distance in order to complete a full opening and closing thereof. As such, various sized and dimensioned endoscopic assemblies, including a hub assembly in accordance with the present disclosure, substantially similar to hub assembly210, may be connected to the universal handle assembly100and be actuatable by the universal handle assembly100.

Accordingly, various endoscopic assemblies, constructed in accordance with the principles of the present disclosure, may be provided which are also capable of firing or forming or closing surgical clips of various sizes, materials, and configurations, across multiple platforms for multiple different manufactures.

Turning now toFIGS. 26-29, an endoscopic surgical clip applier, in accordance with the present disclosure, and assembly in another configuration, is generally designated as10′. Surgical clip applier10′ generally includes reusable handle assembly100, at least one disposable or reusable endoscopic assembly400selectively connectable to and extendable distally from handle assembly100; and optionally at least one disposable surgical clip cartridge assembly (not shown) selectively loadable into a shaft assembly of a respective endoscopic assembly400.

Turning now toFIGS. 1, 2, 16 and 17, an embodiment of an endoscopic assembly400, of surgical clip applier10′, is shown and described. Endoscopic assembly400includes a hub assembly410, a shaft assembly420extending from hub assembly410, and a pair of jaws450pivotally connected to a distal end of shaft assembly420. It is contemplated that endoscopic assembly400may be configured to close, fire or form surgical clips similar to those shown and described in U.S. Pat. Nos. 7,819,886 or 7,905,890, the entire contents of each of which is incorporated herein by reference.

Hub assembly410also functions as an adapter assembly which is configured for selective connection to rotation knob160and nose102cof housing102of handle assembly100. Hub assembly410includes an outer housing412having a cylindrical outer profile. Outer housing412includes a first or right side half section412a, and a second or left side half section412b. Outer housing412of hub assembly410defines an outer annular channel412cformed in an outer surface thereof, and at least one (or an annular array) of axially extending ribs412dprojecting from an outer surface thereof. Outer annular channel412cof outer housing412of endoscopic assembly400is configured to receive catch130dof release lever130of handle assembly100(FIGS. 28 and 29) when endoscopic assembly400is coupled to handle assembly100.

Ribs412dof outer housing412function as a clocking/alignment feature during connection of endoscopic assembly400and handle assembly100with one another, wherein ribs412dof outer housing412of endoscopic assembly400are radially and axially aligned with respective grooves160bof rotation knob160(FIG. 18) of handle assembly100. During connection of endoscopic assembly400and handle assembly100, ribs412dof outer housing412of endoscopic assembly400are slidably received in respective grooves160bof rotation knob160of handle assembly100.

The connection of hub assembly410of endoscopic assembly400with rotation knob160of handle assembly100enables endoscopic assembly400to rotate 360°, about a longitudinal axis thereof, relative to handle assembly100.

Outer housing412of hub assembly410further defines an open proximal end412econfigured to slidably receive a distal end of drive plunger120of handle assembly100, when endoscopic assembly400is coupled to handle assembly100and/or when surgical clip applier10′ is fired.

As mentioned above, endoscopic assembly400includes a shaft assembly420extending distally from hub assembly410. Shaft assembly420includes an elongate outer tube422having a proximal end422asupported and secured to outer housing412of hub assembly410, a distal end422bprojecting from outer housing412of hub assembly410, and a lumen422c(FIG. 27) extending longitudinally therethrough. Distal end422bof outer tube422supports a pair of jaws450.

Shaft assembly420further includes an inner shaft424slidably supported within lumen422cof outer tube422. Inner shaft424includes a proximal end424aprojecting proximally from proximal end422aof outer tube422, and a distal end424bconfigured to actuate the pair of jaws450to form a surgical clip (not shown) that has been loaded into the pair of jaws450. Proximal end424a, as illustrated inFIGS. 28 and 29, may define a hook424cor other translational force coupling feature.

With reference toFIGS. 27-29, hub assembly410includes a drive assembly430supported within outer housing412thereof. Drive assembly430includes a cartridge cylinder432having a cup-like configuration, wherein cartridge cylinder432includes a longitudinally split annular wall432a, a proximal wall432bsupported at and closing off a proximal end of annular wall432a, an open distal end432c, a cavity or bore432ddefined therewithin, and a pair of axially extending slits432e. Cartridge cylinder432includes an annular flange432fprovided at distal end432cthereof. A ring, flange or the like435may be fixedly supported at a proximal end of cartridge cylinder432.

Drive assembly430also includes a cartridge plunger or key434slidably supported within bore432dand within slits432eof cartridge cylinder432. Cartridge plunger434is selectively connectable to proximal end424aof inner shaft424. Cartridge plunger434is sized and configured for slidable receipt within slits432eand bore432dof cartridge cylinder432of drive assembly430. Cartridge plunger434includes an elongate stem or body portion434ahaving a proximal end434b, and a distal end434c, wherein distal end434cof cartridge plunger434is configured for selective connection to proximal end424aof inner shaft424. Cartridge plunger434further includes a pair of opposed arms434dsupported at the proximal end434bthereof and which extend in a distal direction along stem434aand towards distal end434c. Each arm434dterminates in a radially extending finger434e, wherein fingers434eproject from cartridge cylinder432when cartridge plunger434is disposed within cartridge cylinder432.

Drive assembly430may also include a collar437defining a lumen therethrough and through with inner shaft424and stem434aof cartridge plunger434extend. Collar437includes an outer annular flange437aextending therefrom.

Drive assembly430includes a first biasing member436(e.g., a compression spring) disposed about cartridge cylinder432. Specifically, first biasing member436is interposed between ring435supported on cartridge cylinder432and fingers434eof cartridge plunger434. First biasing member436has a first spring constant “K1” which is relatively more firm or more stiff, as compared to a second spring constant “K2” of a second biasing member438, as is described in detail below.

Drive assembly430further includes a second biasing member438(e.g., a compression spring) supported on stem434aof cartridge plunger434and on collar437. Specifically, second biasing member438is interposed between a flange437aof collar437and proximal end434bof cartridge plunger434. Second biasing member438has a second spring constant “K2” which is relatively less firm or less stiff, as compared to the first spring constant “K1” of first biasing member436.

Turning now toFIGS. 26-41, shaft assembly420of endoscopic assembly400includes at least a spindle440slidably supported in lumen422cof outer tube422, a wedge plate460slidably supported within lumen422cof outer tube422and interposed between the pair of jaws450and spindle440; a clip channel470fixedly supported in lumen422cof outer tube422and disposed adjacent the pair of jaws450(supported in and extending from distal end422bof outer tube422) on a side opposite wedge plate460, and a pusher bar480slidably supported in lumen422cof outer tube422and being disposed adjacent clip channel470.

Spindle440includes a proximal end440defining an engagement feature (e.g., a nub or enlarged head) configured to engage a complementary engagement feature provided in distal end424bof inner shaft424. Spindle440further includes a distal end440boperatively connected to a jaw cam closure wedge442via a slider joint444. Jaw cam closure wedge442is selectively actuatable by spindle440to engage camming features of the pair of jaws450to close the pair of jaws450and form a surgical clip “C” loaded therewithin.

Slider joint444supports a latch member446for selective engagement with spindle440. Latch member446may be cammed in a direction toward spindle440, wherein latch member446extends into a corresponding slot formed in spindle440during actuation or translation of spindle440. In operation, during distal actuation spindle400, at a predetermined distance, latch member446is mechanically forced or cammed into and engage a channel of spindle440. This engagement of latch member446in the channel of spindle440allows slider joint444to move together with jaw cam closure wedge442. Jaw cam closure wedge442thus can engage the relevant surfaces of the pair of jaws450to close the pair of jaws450.

As illustrated inFIGS. 28 and 39, slider joint444is connected, at a proximal end444athereof, to a channel formed in spindle440. A distal end444bof slider joint444defines a substantially T-shaped profile, wherein the distal end444bthereof is connected to jaw cam closure wedge442. Latch member446functions as a linkage and is disposed to move through an aperture444cin slider joint444to link with another fixed member and prevent slider joint444from advancing jaw cam closure wedge442, and thus preventing the camming of jaw cam closure wedge442from camming the pair of jaws450to a closed condition during an initial stroke of trigger104.

Spindle440is provided with a camming feature configured to move a cam link448(pivotably connected to a filler component466, as will be described in greater detail below) a perpendicular manner relatively to a longitudinal axis of spindle440during a distal advancement of spindle440.

Clip channel470of shaft assembly420slidably retains a stack of surgical clips “C” therein for application, in seriatim, to the desired tissue or vessel. A clip follower472is provided and slidably disposed within clip channel470at a location proximal of the stack of surgical clips “C”. A biasing member474is provided to spring bias clip follower472, and in turn, the stack of surgical clips “C”, distally. A clip channel cover476is provided that overlies clip channel470to retain and guide clip follower472, biasing member474and the stack of surgical clips “C” in clip channel470.

As mentioned above, shaft assembly420includes a pusher bar480for loading a distal-most surgical clip “C1” of the stack of surgical clips “C” into the pair of jaws450. Pusher bar480includes a pusher480aat a distal end thereof for engaging a backspan of the distal-most surgical clip “C1” and urging the distal-most surgical clip “C1” into the pair of jaws450. Pusher bar480includes a fin or tab480bextending therefrom and extending into a slot482aof a trip block482. Fin480bof pusher bar480is acted upon by a biasing member (not shown) that is supported in trip block482to bias pusher bar480in a proximal direction.

In operation, in order for spindle440to advance pusher bar480during a distal movement thereof, spindle440supports a trip lever484and a biasing member486(e.g., leaf spring). During a distal movement of spindle440, as illustrated inFIG. 31, a distal nose or tip484aof trip lever484selectively engages pusher bar480to distally advance pusher bar480and load distal-most surgical clip “C1” into the pair of jaws450.

Also as mentioned above, shaft assembly420further includes a wedge plate460that is biased to a proximal position by a wedge plate spring462. Wedge plate460is a flat bar shaped member having a number of windows formed therein. Wedge plate460has a distal-most position wherein a tip or nose of wedge plate460is inserted between the pair of jaws450to maintain the pair of jaws450in an open condition for loading of the distal-most surgical clip “C1” therein. Wedge plate460has a proximal-most position, maintained by wedge plate spring462, wherein the tip or nose of wedge plate460is retracted from between the pair of jaws450.

As illustrated inFIGS. 28 and 38, wedge plate460defines a “U” or “C” shaped aperture or window460bin a side edge thereof. The “C” shaped aperture or window460bof wedge plate460selectively engages a cam link448supported on a filler plate466. Cam link448selectively engages a surface of “C” shaped aperture or window460bof wedge plate460to retain wedge plate460in a distal-most position such that a distal tip or nose460aof wedge plate460is maintained inserted between the pair of jaws450to maintain the pair of jaws450splayed apart.

Shaft assembly420further includes a filler component466interposed between clip channel470and wedge plate460, at a location proximal of the pair of jaws450. Filler component466pivotably supports a cam link448that is engagable with wedge plate460. In operation, during a distal advancement of spindle440, a camming feature of spindle440engages a cam link boss of cam link448to thereby move cam link448out of engagement of wedge plate460and permit wedge plate460to return to the proximal-most position as a result of biasing member462.

Trip block482defines an angled proximal surface482bfor engagement with a corresponding surface of trip lever484that will be discussed herein. As mentioned above, notch or slot482aof trip block482is for receipt of fin480bof pusher bar480. In order to disengage trip lever484from a window480c(FIG. 31) of pusher bar480, and allow pusher bar480to return to a proximal-most position following loading of a surgical clip “C” into the pair of jaws450, angled proximal surface482btrip block482engages trip lever484to cam trip lever484out of window480cof pusher bar480. It is contemplated that spindle440may define a first cavity and a second cavity therein for receiving trip lever484and trip lever biasing spring486, respectively. The first cavity may be provided with a pivoting boss to allow trip lever484to pivot between a first position and a second position. Trip lever biasing spring486may rest in the second cavity.

Trip lever biasing spring486functions to maintain a tip of trip lever484in contact with pusher bar480, and more specifically, within window480cof pusher bar480(FIG.31) such that distal advancement of spindle440results in distal advancement of pusher bar480, which in turn results in a loading of a distal-most surgical clip “C1” in the pair of jaws450.

With reference toFIGS. 28, 33 and 36, clip applier10′ also has a lockout bar490. Lockout bar490includes a first end, and a second opposite hook end. The second hook end of lockout bar490is adapted to engage clip follower472of shaft assembly420. Lockout bar490is pivotally retained in a slot formed in clip follower472. Lockout bar490does not by itself lockout clip applier10′, but instead cooperates with the ratchet mechanism150of handle assembly100to lock out clip applier10′.

Lockout bar490is adapted to move distally with clip follower472each time clip applier10′ is fired, and clip follower472is advanced distally. In operation, each time a surgical clip “C” is fired from clip applier10′, clip follower472will advance distally relative to the clip channel470.

Pusher bar480defines a distal window therein (not shown). In operation, when clip follower472is positioned beneath pusher bar480(e.g., when there are no remaining surgical clips), a distal end490aof lockout bar490will deflect upward (due to a biasing of a lockout biasing member492), and enter a distal window480dof pusher bar480to engage pusher bar480at a distal end of distal window480d. Further, a proximal end490bof lockout bar490, defines a hook (FIG. 37), which is rotated into and engages an aperture defined in a floor of clip channel470.

With the distal end of pusher bar480disposed within distal window480dof pusher bar480, pusher bar480, and in turn, spindle440cannot return to a fully proximal position. Since spindle440cannot return to the fully proximal position, pawl152of ratchet mechanism150of handle assembly100cannot return to the home or initial position relative to rack154thereof. Instead, pawl154will remain in an intermediate position along rack154, thus preventing trigger104from returning to a fully unactuated position.

With continued reference toFIGS. 26-29, an operation or firing of surgical clip applier10′, including endoscopic assembly400operatively connected to handle assembly100, is shown and described. With endoscopic assembly400operatively connected to handle assembly100, as trigger104of handle assembly100is actuated drive bar104bof trigger104acts on drive plunger120to distally advance drive plunger120. As trigger104is actuated, pawl154of ratchet assembly150begins to engage rack152thereof. With pawl154engaged with rack152, trigger104may not return to a fully unactuated position until trigger104completes a full actuation or stroke thereof.

As drive plunger120is distally advanced, a distal end of drive plunger120presses against proximal wall432bof cartridge cylinder432of drive assembly430of endoscopic assembly400to distally advance cartridge cylinder432. Due to first spring constant “K1” of first biasing member436being larger or greater than second spring constant “K2” of second biasing member438, as cartridge cylinder432is advanced distally, ring435acts on first biasing member436which in turn acts on fingers434eof cartridge plunger434to push cartridge plunger434distally. As cartridge plunger434is distally advanced, cartridge plunger434distally advances inner shaft424relative to outer shaft422. Being that second biasing member438is interposed between a flange437aof collar437and proximal end434bof cartridge plunger434, as cartridge plunger434is distally advanced, cartridge plunger434also compresses second biasing member438.

As inner shaft424is distally advanced relative to outer shaft422, inner shaft424actuates a clip pusher (not shown) which in turn acts on a distal-most surgical clip (not shown) of a stack of surgical clips (not shown) to distally advance the distal-most surgical clip into the pair of jaws450. Following loading of the distal-most surgical clip into the pair of jaws450, the distal advancement of inner shaft424effects a closure of the pair of jaws450to form the surgical clip loaded therewithin.

When the pair of jaws450have fully closed to form the surgical clip loaded therein, or when the pair of jaws450have reached a hard stop, pawl154of ratchet assembly150of handle assembly100may not have cleared rack152thereof, and thus blocks or prevents trigger104from returning to a fully unactuated position thereof. Since the pair of jaws450cannot close any further, inner shaft422is also stopped from further distal advancement. However, as mentioned above, in order to return trigger104to the fully unactuated position, trigger104must first complete the full actuation stroke thereof. As such, as trigger104is further actuated to complete the full stroke thereof, as drive plunger120is continued to be driven distally, the distal end of drive plunger120continues to press against proximal wall432bof cartridge cylinder432of drive assembly430of endoscopic assembly400to continue to distally advance cartridge cylinder432.

With inner shaft422, and in turn cartridge plunger434, stopped from any further distal advancement, as cartridge cylinder432is continued to be advanced distally relative to cartridge plunger434, cartridge cylinder432begins to and continues to compress first biasing member436until such time that pawl154of ratchet assembly150of handle assembly100clears and disengages rack152thereof. With pawl154of ratchet assembly150clear and disengaged from rack152, trigger104may be released and returned to the fully unactuated position by hand, by a return spring (not shown) of trigger104or handle assembly100and/or by first biasing member436and second biasing member438of endoscopic assembly400.

With reference toFIGS. 42-54B, another embodiment of an endoscopic assembly is provided and generally identified by reference numeral500. The endoscopic assembly500is similar to the endoscopic assembly400, and therefore, for purposes of brevity, only the differences therebetween are described in detail hereinbelow.

The hub assembly510of the endoscopic assembly500includes an outer housing512having a first or right side half section512aand a second or left side half section512b. Although generally illustrated as having a cylindrical profile, it is contemplated that the outer housing may include any suitable profile, such as rectangular, square, octagonal, etc. An outer surface of the outer housing512of the hub assembly510defines an outer annular channel512ctherein to receive the catch130dof the release lever130of the handle assembly100(FIGS. 28 and 29) when the endoscopic assembly500is coupled to the handle assembly100.

An inner surface514(FIG. 44) of the outer housing512of the hub assembly510defines a channel516therethrough extending through proximal and distal end surfaces thereof. A proximal portion516aof the channel516is configured to slidably receive a portion of a cartridge cylinder520(FIG. 45) therein. A middle portion516bof the channel516is disposed adjacent to and distal from the proximal portion516a. The greater width of the middle portion516bdefines a distal facing surface516cat an intersection of the proximal portion516aand the middle portion516b. The inner surface514of the channel516defines a first annular flange516dat a middle portion thereof extending radially inward therefrom, although it is contemplated that the first annular flange516dmay be disposed on the inner surface514at any suitable longitudinal location.

Distal of the annular flange516d, the inner surface514of the channel516defines a chamber516ehaving a greater width than that of the middle portion516bof the channel516. The inner surface514of the channel516defines a second annular flange516fextending radially inward therefrom at a proximal portion of the chamber516e. The second annular flange516fis spaced apart from an intersection of the chamber516eand the middle portion516bsuch that a gap516gis formed therebetween that is configured to receive a portion of the stationary gear540therein.

The inner surface514of the outer housing512defines a plurality of windows516htherethrough at a proximal portion of the chamber516e, but distal of the second annular flange516f. As will be described in further detail hereinbelow, the plurality of windows516henable a contrasting color (FIG. 50) disposed on the display gear560to be visible therethrough when a final surgical clip (not shown) of a plurality of surgical clips has been formed. A distal most portion516iof the channel516is configured to slidably receive a portion of the outer shaft422of the endoscopic assembly400therethrough.

With reference toFIGS. 46 and 46A, the cartridge cylinder520includes an elongate body520adefining a proximal end wall520band a distal end wall520c(FIG. 46A). The proximal end wall520bis configured to engage the drive plunger120of the handle assembly100, such that distal advancement of the drive plunger120causes a corresponding distal advancement of the cartridge cylinder520within the proximal portion516aand the middle portion516bof the channel516. The elongate body520adefines a radially extending flange522adjacent to the distal end wall520cand defines a proximally facing surface522a. As illustrated inFIG. 43, the proximally facing surface522ais configured to abut the distal facing surface516cof the middle portion516bwhen the cartridge cylinder520is in an initial, proximal position and inhibit further proximal translation thereof. The distal end wall520cof the cartridge cylinder520defines a longitudinally extending boss524that extends in a distal direction therefrom. An outer surface524aof the longitudinally extending boss524defines a transverse bore524btherethrough configured to receive a cartridge pin592therein. A distal facing surface524cof the longitudinal extending boss524defines a blind hole524dtherein configured to slidably receive a portion of the spindle530therein.

The distal end wall520cof the cartridge cylinder520further defines a pair of longitudinally extending tabs526thereon that extend in a distal direction therefrom. Although generally illustrated as having a complimentary shape to that of the cartridge cylinder520(e.g., cylindrical), it is contemplated that the pair of longitudinally extending tabs526may include any suitable shape, such as square, rectangular, octagonal, oval, or the like. The pair of longitudinally extending tabs526is concentric with, and spaced apart, from the longitudinally extending boss524defining an annular groove528therebetween. An outer surface522bof the radially extending flange522defines a pair of opposed reliefs522cthereon that extend through the pair of longitudinally extending tabs526.

With reference toFIG. 47, the spindle530defines a generally cylindrical profile extending between proximal and distal end portions530aand530b, respectively, although it is contemplated that the spindle530may define other suitable profiles, such as elliptical, rectangular, square, etc. An outer surface530cof the spindle530defines a pair of opposed flats532thereon. A proximal portion of the outer surface530cof the spindle530defines a relief stem530dthereon defining a generally cylindrical profile having a width that is substantially similar to the width of the pair of opposed flats532. The relief stem530ddefines a longitudinal slot534therethrough configured to slidably receive the cartridge pin592(FIG. 45) therein. Although generally illustrated as being oriented perpendicular to the pair of opposed flats532, it is contemplated that the longitudinal slot534may be disposed in any suitable orientation relative to the pair of opposed flats532.

The pair of opposed flats532define a channel536through a middle portion thereof that is configured to slidably receive a sliding gear pin594(FIG. 45) therein. The outer surface530cof the spindle530defines a relief538therein interposed between each flat of the pair of opposed flats532(e.g., transverse to the channel536). The relief538is configured to selectively receive a lockout clip580(FIG. 45) therein once the final surgical clip (not shown) of the plurality of surgical clips has been formed. As can be appreciated, the relief538is disposed on the spindle530at any suitable location capable of capturing the lockout clip580therein after the final surgical clip of the plurality of surgical clips has been formed.

Turning now toFIGS. 48, 48A, and 48B, the hub assembly510of the endoscopic assembly500includes a stationary gear540fixedly disposed therein. The stationary gear540defines a generally cylindrical profile extending between proximal and distal end surfaces540aand540b, respectively. The proximal and distal end surfaces540a,540bof the stationary gear540define an aperture542(FIG. 48A) therethrough that is configured to slidably receive the spindle530therein. The proximal end surface540aof the stationary gear540defines a circumferential relief540cextending distally therefrom and terminating at a proximal facing surface540d. The circumferential relief540cdefines a first annular groove540eadjacent to, and proximal of the proximal facing surface540d. An outer surface540fof the stationary gear540defines a second annular groove540gthereon distal of the proximal facing surface540d, thereby defining a flange540g. The outer surface540fof the stationary gear540defines a cam slot546therein extending circumferentially thereabout. The cam slot546defines a first portion546aextending circumferentially about the outer surface540fof the stationary gear540for approximately 270 degrees. The cam slot546defines a second portion546bextending longitudinally from the first portion546ain a proximal direction. The cam slot546defines a third portion546cextending circumferentially about the outer surface540ffor approximately 90 degrees from the second portion546band is disposed parallel to, and spaced apart from, the first portion546a. The cam slot546defines a fourth portion546dextending longitudinally from the third portion546cin a proximal direction parallel to the second portion546b. The cam slot546is configured to slidably receive a portion of the display drum560therein, such that the longitudinal location of the display drum560relative to the stationary gear540is driven by the location of a display drum pin564b(FIG. 50A) within the cam slot546.

The distal end surface540bof the stationary gear540defines a plurality of teeth548arranged circumferentially thereon. The plurality of teeth548is configured to engage a corresponding plurality of teeth defined on the rotatable gear570(FIG. 45. The distal end surface540bdefines a counterbore540htherein configured to slidably receive the sliding gear550therein. An inner surface540iof the counterbore540hdefines a pair of opposed longitudinal channels540jtherein configured to slidably engage a portion of the sliding gear550to inhibit rotation thereof relative to the stationary gear540.

With reference toFIGS. 49 and 49A, the hub assembly510of the endoscopic assembly500includes a sliding gear550slidably disposed within the stationary gear540. The sliding gear550defines a generally cylindrical profile extending between proximal and distal end surfaces550aand550b, respectively. The proximal and distal end surfaces550a,550bdefine a throughbore552therethrough that is configured to slidably receive the spindle530therein. An outer surface550cof the sliding gear550defines a pair of opposed bosses554thereon disposed adjacent to, and extending distally from, the proximal end surface550a. Each boss of the pair of opposed bosses554is configured to be slidably received within a respective channel of the pair of opposed longitudinal channels540jof the stationary gear540. In this manner, the sliding gear550is permitted to translate in a proximal or distal direction within the counterbore540hof the stationary gear, but is inhibited from rotating relative to the stationary gear540. The outer surface550cof the sliding gear550defines a plurality of teeth556therein extending circumferentially thereabout. As illustrated inFIG. 49A, the plurality of teeth556of sliding gear550is defined on the outer surface550cthereof such that a distal-most portion of the plurality of teeth556is proximally spaced apart from the distal end surface550bof the sliding gear550, defining a gap therebetween. In embodiments, the distal end surface550bmay define a chamfer or radius558at the intersection between the distal end surface550band the outer surface550cto aid alignment of the sliding gear550with the rotating gear570during engagement therewith.

With reference toFIGS. 50 and 50A, the hub assembly510of the endoscopic assembly500includes a display drum560slidably and rotatably disposed within the chamber516eof the channel516. The display drum560defines a generally cylindrical profile extending between proximal and distal end surfaces560aand560b, respectively. The proximal and distal end surfaces560a,560bdefine an aperture562therethrough configured to slidably receive the spindle530therein. The proximal end surface560adefines a counterbore564therein configured to slidably and rotatably receive the rotating gear570therein. The distal end surface560bdefines a slot566therein configured to receive a portion of a spring clip580therein. The slot566defines a corresponding recess566aadjacent to the aperture562such that the spring clip580does not extend distal of the distal end surface560bwhen the spring clip580is received within the slot566. An outer surface560cof the display drum560defines first and second circumferential stripes568aand568b.

The first circumferential stripe568ais disposed adjacent the proximal end surface560aand the second circumferential stripe568bis disposed adjacent to and distal of the first circumferential stripe568a. The first circumferential stripe568aof display drum560defines a contrasting color to the remainder of the outer surface560cof the display drum560, such as yellow or the like. The second circumferential stripe568bof display drum560defines a contrasting color that is darker than the first circumferential stripe568a, such as red or the like. Although generally described has the second circumferential stripe568bhaving a darker color than that of the first circumferential stripe568a, it is contemplated that each stripe of the first and second circumferential stripes568a,568bmay be any color suitable for indicating to the user that the number of clips remaining is low. As can be appreciated, the second circumferential stripe568bmay include a color that has a greater ability to alert the clinician that the final surgical clip of the plurality of surgical clips has been formed. In this manner, the first circumferential stripe568aindicates that there are few clips remaining of the plurality of surgical clips, and in one non-limiting embodiment, the first circumferential stripe568aindicates that there are three surgical clips remaining. The second circumferential stripe568bindicates that the final surgical clip of the plurality of surgical clips has been formed and there are no surgical clips remaining.

An inner surface564aof the counterbore564defines a post564bextending radially inward therefrom at a proximal portion thereof. The post564bis configured to be slidably received within the cam slot546, such that rotation of the display drum560about the stationary gear540causes the post564bto slide within the cam slot546, which in turn, cams the post564b, and therefore the display drum560, in a proximal direction at the second and third portions546b,546dof the cam slot546, respectively.

With reference toFIGS. 51-53, the hub assembly510of the endoscopic assembly500includes a rotating gear570slidably disposed within the counterbore564of the display drum560. The rotating gear570defines a generally cylindrical profile extending between proximal and distal end surfaces570aand570b, respectively. The proximal and distal end surfaces570a,570bdefine a throughbore572therethrough that is configured to slidably receive the spindle530therein. The proximal end surface570adefines a counterbore570c(FIG. 53) therein configured to selectively receive a portion of the sliding gear550therein. As can be appreciated, the counterbore increases the ability of the sliding gear550and the rotating gear570to remain concentric with one another during engagement therebetween. The counterbore570cterminates at a proximal facing surface570dconfigured to abut a rotating gear biasing element596.

An outer surface570eof the rotating gear570defines a radially extending flange574thereon adjacent the proximal end surface570a. The radially extending flange574defines a distal facing surface574aconfigured to abut the rotating gear biasing element580. The distal facing surface574adefines a concentric boss574bthereon extending in a distal direction therefrom. The concentric boss574bis configured to be received within an inner diameter of the rotating gear biasing element596to aid in locating and retaining the rotating gear biasing element596thereon. The outer surface570eof the rotating gear570defines a longitudinal channel576therethrough extending from the distal facing surface572aof the radially extending flange572and through the distal end surface570b. The longitudinal channel576is configured to receive the spring clip580therein such that rotation of the rotating gear570causes a corresponding rotation of the spring clip580.

The proximal end surface570aof the rotating gear570defines a plurality of teeth578disposed circumferentially thereon and configured to selectively engage the plurality of teeth548of the stationary gear540and the plurality of teeth556of the sliding gear550. The plurality of teeth578of the rotating gear570is oriented with respect to the plurality of teeth548and the plurality of teeth556of the stationary gear540and the sliding gear550, respectively, such that engagement with the plurality of teeth556of the sliding gear550causes the rotating gear570to rotate 1/24thof a rotation and subsequent engagement with the plurality of teeth548of the stationary gear causes the rotating gear570to rotate an additional 1/24thof a rotation.

With reference toFIGS. 54A and 54B, the spring clip580defines elongate body580ahaving a generally elongated “Z” shape profile extending between proximal and distal end portions580band580c, respectively. The proximal end portion580bdefines a proximal tab582extending generally perpendicular from the elongate body580a. The proximal tab582is configured to be received within the relief538of the spindle530when the final surgical clip of the plurality of surgical clips (not shown) has been formed.

The distal end portion580cof spring clip580defines a distal tab584extending generally perpendicular from the elongate body580ain an opposite direction to that of the proximal tab582. The distal tab584defines a generally hook or U-shape profile having a laterally extending portion584aand a proximal extending portion584bdisposed thereon such that a channel584cis formed between the proximal extending portion584band the elongate body580a. In embodiments, the distal tab584may include a pair of wings or opposing tabs584d(FIG. 54b) disposed on opposed sides of the laterally extending portion584ato provide additional support as rotation of the spring clip580causes a corresponding rotation of the display drum560.

The spring clip580is configured to be received within the longitudinal slot576of the rotating gear570such that when the proximal tab582is received within the relief538of the spindle530, the spindle530is locked relative to the spring clip580to inhibit further translation of the spindle530. The distal tab584is configured to be received within the slot566of the display drum560such that the spring clip580is locked in position relative to the display drum560(e.g., the spring clip580and the display drum560may not move relative to one another). In this manner, rotation of the spring clip580causes a corresponding rotation of the display drum560.

The spring clip580is configured to be received within the longitudinal slot576of the rotating gear570(e.g., a nested configuration) such that the spring clip580is captured within the longitudinal slot576when the rotating gear570is disposed within the counterbore564of the display drum560. As will be described in further detail hereinbelow, due to the spring clip580being captured within the longitudinal slot576of the rotating gear570and the distal tab584of the spring clip580being captured within the slot566of the display drum560, rotation of the rotating gear570effectuates a corresponding rotation of the spring clip580, which in turn, effectuates a corresponding rotation of the display drum560.

Returning toFIG. 43, the rotating gear biasing element596is disposed within the counterbore564of the display drum560and concentrically disposed over the outer surface570eof the rotating gear570such that the rotating gear biasing element596is interposed between the distal facing surface572aof the rotating spring570and the proximal facing surface564cof the display drum560. As can be appreciated, the rotating gear biasing element596biases the rotating gear570in a proximal direction and is compressed as the rotating spring570is urged in a distal direction by the sliding gear550. Although generally illustrated as being a coil spring, it is contemplated that the rotating gear biasing element596may be any suitable biasing element capable of biasing the rotating gear570in a proximal direction, such as a Belleville washer, gas spring, elastomer spring, etc.

With continued reference toFIG. 43, a return biasing element590is disposed within the middle portion516bof the outer housing512and interposed between the first annular flange516dand the distal end wall520cof the cartridge cylinder520, such that the cartridge cylinder520is biased in a proximal direction. As can be appreciated, distal translation of the cartridge cylinder520effectuates compression of the return biasing element590. Although generally illustrated as being a coil spring, it is contemplated that the return biasing element590may be any suitable biasing element capable of biasing the cartridge cylinder520in a proximal direction, such as a Belleville washer, gas spring, elastomer spring, or the like.

As illustrated inFIGS. 43 and 45, a display drum biasing element598is interposed between the distal end surface560bof the display drum560and the inner surface514of the channel516of the outer housing512adjacent to the distal most portion516iof the channel516. The display drum biasing element598biases the display drum560in a proximal direction to maintain engagement between the display drum pin564b(FIG. 50A) and the cam slot546of the stationary gear540. Although generally illustrated as being a coil spring, it is contemplated that the display drum biasing element598may be any suitable biasing element capable of biasing the display drum560in a proximal direction, such as a Belleville washer, gas spring, elastomer spring, or the like.

With reference toFIGS. 43, 45, and 55a-60, in operation and in an initial state, the return biasing element590biases the cartridge cylinder520in a proximal direction to an initial, retracted position. In this initial position, a distal portion of the channel536of the spindle530abuts the sliding gear pin594to cause the sliding gear to be placed in an initial, proximal position, the display drum spring598biases the display drum to an initial position within the cam slot546of the stationary gear540, and the rotating gear biasing element586biases the rotating gear570to an initial, proximal position, such that the plurality of teeth578of the rotating gear570engage the plurality of teeth548of the stationary gear540.

As the clinician actuates the trigger104of the handle assembly100, the drive plunger120is driven in a distal direction and abuts the proximal end wall520bof the cartridge cylinder520(FIG. 55A). Continued actuation of the trigger104causes the drive plunger120, and thereby the cartridge cylinder520, to further advance in a distal direction and compress the return biasing element590(FIG.55B). The spindle pin592is initially disposed at a distal location within the longitudinal slot534of the spindle530such that as the cartridge cylinder520, and thereby the spindle pin592, is distally advanced, the spindle pin592translates within the longitudinal slot534without causing a corresponding distal advancement of the spindle530. Continued distal advancement of the cartridge cylinder520causes the spindle pin592to translate within the longitudinal slot534of the spindle530until the spindle pin592abuts a distal portion of the longitudinal slot534. The distal advancement of the cartridge cylinder520without a corresponding distal advancement of the spindle530is a first dwell period.

Additional actuation of the trigger104causes the spindle pin592to urge the spindle530is a distal direction to load a distal-most surgical clip of the plurality of surgical clips (not shown) into the pair of jaws450. During initial advancement of the spindle530, the sliding gear pin594translates within the channel536of the spindle530to allow distal advancement of the spindle530without causing a corresponding distal advancement of the sliding gear550(FIG. 56A). The distal advancement of the spindle530without a corresponding distal advancement of the sliding gear550is a second dwell period that ensures that the sliding gear550is not driven in a distal direction until the end of the firing stroke of the spindle530.

As the trigger104is further actuated, the sliding gear pin594abuts a distal portion of the channel536and causes the sliding gear550to also advance in a distal direction (FIG. 56B). Continued actuation of the trigger104causes further distal advancement of the spindle530and a corresponding distal advancement of the sliding gear550until the sliding gear550engages the rotating gear570. During engagement of the sliding gear550with the rotating gear570, the plurality of teeth556of the sliding gear550engage the plurality of teeth578of the rotating gear570and causes the plurality of teeth578of the rotating gear570to disengage from the plurality of teeth548of the stationary gear540. Further actuation of the trigger104causes the sliding gear550to further translate in a distal direction and cause the rotating gear570, and thereby the display drum560, to rotate 1/24thof a rotation (e.g., 15 degrees) (FIG. 57). Although generally illustrated as rotating in a counterclockwise direction, it is contemplated that the rotating gear570may also be caused to rotate in a clockwise direction.

Once the surgical clip has been formed and the clinician releases the trigger104of the handle housing100, the return biasing element590biases the cartridge cylinder520in a proximal direction enabling the rotating gear biasing element596to bias the rotating gear570in a proximal direction. The proximal translation of the rotating gear570urges the sliding gear550in a corresponding proximal direction until the plurality of teeth578of the rotating gear570engage the plurality of teeth548of the stationary gear540and disengage from the plurality of teeth556of the sliding gear550. Further proximal translation of the rotating gear570causes the rotating gear570, and thereby the display drum560, to rotate a further 1/24thof a rotation (e.g., 15 degrees) (FIG. 58).

This process is repeated each time the clinician actuates the trigger104of the handle housing100to form a surgical clip of the plurality of surgical clips. During each rotation of the display drum560relative to the stationary gear540, the post564bof the display drum560translates a corresponding 1/12thof a rotation within the cam slot546. After nine surgical clips have been formed and the display drum560has rotated 270 degrees, the post564bof the display drum560is aligned with the second portion546bof the cam slot546thereby enabling the display drum biasing element598to bias the display drum560proximally therewithin, from a position where the first and second circumferential stripes568a,568bare not visible (FIG. 59A), to a position that reveals the first circumferential stripe568aof the display drum within the plurality of windows516hof the outer housing512to indicate that three surgical clips remain of the plurality of surgical clips (FIG. 59B). Once the final surgical clip has been formed and the display drum560has rotated an additional 90 degrees (e.g., a further three surgical clips have been formed), the post564bof the display drum560is aligned with the fourth portion546dof the cam slot546, enabling the display drum biasing element598to bias the display drum560proximally therewithin to reveal the second circumferential stripe568bto indicate to the clinician that the final surgical clip of the plurality of surgical clips has been formed (FIG. 59C).

After the formation of the final surgical clip of the plurality of surgical clips and as the display drum560is biased in the proximal direction, proximal tab582of the spring clip580is aligned with the relief538of the spindle530, such that the proximal tab582of the spring clip580is received within the relief538(FIG. 60) to inhibit proximal and distal translation of the spindle530(e.g., locking the spindle530in place) such that if the clinician actuates the trigger104of the handle assembly100again, the clinician is unable to actuate the trigger104and close the pair of jaws450of the endoscopic assembly400to prevent injury to the patient and medical personnel and prevent damage to the surgical clip applier10′.

In accordance with the present disclosure, the trigger stroke length for trigger104of handle assembly100is constant or fixed, while the closure stroke length of the pair of jaws450of endoscopic assembly400connected to handle assembly100is different than, for example, the closure stroke of the pair of jaws250of endoscopic assembly200. For example, endoscopic assembly400may require the pair of jaws450thereof to travel a relatively greater or smaller distance as compared to the pair of jaws250of endoscopic assembly200in order to complete a full opening and closing thereof. As such, universal handle assembly100may be loaded with, and is capable of firing, either endoscopic assembly200or endoscopic assembly400.

In accordance with the present disclosure, while the trigger stroke length of trigger104of handle assembly100is constant, the closure stroke length for the pair of jaws250,450of each endoscopic assembly200,400is unique for each respective endoscopic assembly200,400. Accordingly, each drive assembly230,430of respective endoscopic assemblies200,400functions to accommodate for the variations in the closure stroke lengths for the pair of jaws250,450of respective endoscopic assemblies200,400.

To the extent consistent, handle assembly100and/or endoscopic assemblies200,400may include any or all of the features of the handle assembly and/or endoscopic assemblies disclosed and described in International Patent Application No. PCT/CN2015/080845, filed Jun. 5, 2015, entitled “Endoscopic Reposable Surgical Clip Applier,” International Patent Application No. PCT/CN2015/091603, filed on Oct. 10, 2015, entitled “Endoscopic Surgical Clip Applier,” and/or International Patent Application No. PCT/CN2015/093626, filed on Nov. 3, 2015, entitled “Endoscopic Surgical Clip Applier,” the entire content of each of which being incorporated herein by reference.

Surgical instruments such as the clip appliers described herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the surgeon and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.

The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon's ability to mimic actual operating conditions.

Referring toFIG. 61, a medical work station is shown generally as work station1000and generally may include a plurality of robot arms1002,1003; a control device1004; and an operating console1005coupled with control device1004. Operating console1005may include a display device1006, which may be set up in particular to display three-dimensional images; and manual input devices1007,1008, by means of which a person (not shown), for example a surgeon, may be able to telemanipulate robot arms1002,1003in a first operating mode.

Each of the robot arms1002,1003may include a plurality of members, which are connected through joints, and an attaching device1009,1011, to which may be attached, for example, a surgical tool “ST” supporting an end effector1100, in accordance with any one of several embodiments disclosed herein, as will be described in greater detail below.

Robot arms1002,1003may be driven by electric drives (not shown) that are connected to control device1004. Control device1004(e.g., a computer) may be set up to activate the drives, in particular by means of a computer program, in such a way that robot arms1002,1003, their attaching devices1009,1011and thus the surgical tool (including end effector1100) execute a desired movement according to a movement defined by means of manual input devices1007,1008. Control device1004may also be set up in such a way that it regulates the movement of robot arms1002,1003and/or of the drives.

Medical work station1000may be configured for use on a patient1013lying on a patient table1012to be treated in a minimally invasive manner by means of end effector1100. Medical work station1000may also include more than two robot arms1002,1003, the additional robot arms likewise being connected to control device1004and being telemanipulatable by means of operating console1005. A medical instrument or surgical tool (including an end effector1100) may also be attached to the additional robot arm. Medical work station1000may include a database1014, in particular coupled to with control device1004, in which are stored, for example, pre-operative data from patient/living being1013and/or anatomical atlases.

Reference is made herein to U.S. Pat. No. 8,828,023, the entire content of which is incorporated herein by reference, for a more detailed discussion of the construction and operation of an exemplary robotic surgical system.

It is contemplated, and within the scope of the present disclosure, that other endoscopic assemblies, including a pair of jaws having a unique and diverse closure stroke length thereof, may be provided with a drive assembly, similar to any of the drive assemblies described herein, for accommodating and adapting the closure stroke length for the pair of jaws thereof to the constant trigger stroke length.

Accordingly, various endoscopic assemblies, constructed in accordance with the principles of the present disclosure, may be provided which are also capable of firing or forming or closing surgical clips of various sizes, materials, and configurations, across multiple platforms for multiple different manufactures.