# Patent

## Title
Surgical clip applier with dissector

## Abstract

A surgical clip applier is provided including a housing; at least one handle pivotably connected to the housing; a channel assembly extending distally from the housing; a jaw assembly including a pair of jaws extending from an end of the channel assembly, opposite the housing, the jaw assembly adapted to accommodate a clip of a plurality of clips loaded in the clip applier and being operable to effect formation of the clip in response to movement of the at least one handle; and a dissector bar supported on the housing and the channel assembly, wherein the dissector bar is actuatable from the housing and includes a proximal position wherein a distal end of the dissector bar is disposed proximal of a distal-most end of the jaw assembly, and at least one distal position wherein the distal end of the dissector bar projects beyond the distal-most end of the jaw assembly.

## Background
CROSS REFERENCE TO RELATED APPLICATION
The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/642,617, filed on May 4, 2012, the entire contents of which are incorporated herein by reference.


BACKGROUND
1. Technical Field
The present application relates to surgical instruments, and more particularly, to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures, and an incorporated dissector.
2. Discussion of Related Art
Surgical clip appliers are known in the art and have increased in popularity among surgeons by offering an alternative to conventional suturing of body tissues and vessels. Typical instruments are disclosed in U.S. Pat. No. 5,030,226 to Green et al. and U.S. Pat. No. 5,431,668 to Burbank III et al. These instruments generally provide a plurality of clips which are stored in the instrument and which are fed sequentially to the jaw mechanism at the distal end of the instrument upon opening and closing of the handles at the proximal end of the instrument. As the handles are closed, the jaws close to deform a clip positioned between the jaw members, and as the jaws are opened to release the deformed clip, a new clip is fed from the series to a position between the jaws. This process is repeated until all the clips in the series of clips have been used.
During surgical procedures, it is often desirable to use a dissector or the like to separate organs or vessels from underlying or overlying tissue, connective tissue or the like. At times, the surgical clip applier is used in lieu of a separate surgical instrument (e.g., dissector) in order to perform the function of separating of the organs or vessels from the underlying or overlying tissue, connective tissue or the like. In doing so, the surgical clip applier may become gummed up, or the jaws of the surgical clip applier may be splayed out of alignment thereby effecting a formation of surgical clips.
Accordingly, a need exists for a single surgical instrument that can apply surgical clips and that can perform the function of surgical dissection without effecting the construction and/or operation of the clip applying features.
SUMMARY
The present application relates to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical.
According to an aspect of the present disclosure, a surgical clip applier for performing a surgical procedure is provided and includes a housing; at least one handle pivotably connected to the housing; a channel assembly extending distally from the housing; a jaw assembly including a pair of jaws extending from an end of the channel assembly, opposite the housing, the jaw assembly adapted to accommodate a clip of a plurality of clips loaded in the clip applier and being operable to effect formation of the clip in response to movement of the at least one handle; and a dissector bar supported on the housing and the channel assembly, wherein the dissector bar is actuatable from the housing and includes a proximal position wherein a distal end of the dissector bar is disposed proximal of a distal-most end of the jaw assembly, and at least one distal position wherein the distal end of the dissector bar projects beyond the distal-most end of the jaw assembly.
The dissector bar may include a proximal-end portion at least partially slidably supported in the housing, and a distal-end portion extending from the housing and along a length of the channel assembly. The dissector bar may include a dissector extending distally from the distal-end portion thereof. The dissector may include a pair of transversely spaced-apart fingers extending in at least a substantially distal direction. The pair of fingers may be spaced apart by a transverse distance not to exceed a width of the channel assembly.
In use, when the dissector bar is in the proximal position, a distal end of the pair of fingers of the dissector bar do not extend beyond the distal-most end of the jaw assembly.
In use, when the dissector bar is in a distal position, at least a portion of a length of the pair of fingers of the dissector bar extend beyond the distal-most end of the jaw assembly.
The dissector bar may include a knob supported near the proximal-end thereof, and wherein the knob may extend through a slot formed in the housing. The slot formed in the housing may have a length and a width, and wherein the knob may have a transverse width that is greater than the width of the slot.
At least one side wall of the slot of the housing may include a resilient, deformable layer extending along a length thereof.
The elongate slot of the housing may define a plurality of discrete pockets defined by a plurality of discrete ridges formed along a length of the slot, wherein the ridges may extend into the slot toward the knob.
The ridges may extend by an amount sufficient to define ledges, wherein when the knob is disposed between adjacent ledges the knob is inhibited from distal and proximal movement and the dissector bar is held in place relative to the housing and channel assembly.
According to a further aspect of the present disclosure, a method of performing a surgical procedure is provided and includes the step of providing a surgical clip applier for applying at least one surgical clip to a target surgical site. The surgical clip applier includes a housing; at least one handle pivotably connected to the housing; a channel assembly extending distally from the housing; a jaw assembly including a pair of jaws extending from an end of the channel assembly, opposite the housing, the jaw assembly adapted to accommodate a clip of a plurality of clips loaded in the clip applier and being operable to effect formation of the clip in response to movement of the at least one handle; and a dissector bar supported on the housing and the channel assembly, wherein the dissector bar is actuatable from the housing and includes a proximal position wherein a distal end of the dissector bar is disposed proximal of a distal-most end of the jaw assembly, and at least one distal position wherein the distal end of the dissector bar projects beyond the distal-most end of the jaw assembly.
The method further includes the steps of actuating the dissector bar to extend the distal end of the dissector bar distally beyond the distal-most end of the jaw assembly; and performing a dissecting function at a desired target site with the distal end of the dissector of the surgical clip applier.
The dissector bar may include a proximal-end portion at least partially slidably supported in the housing, and a distal-end portion extending from the housing and along a length of the channel assembly, and wherein the method may further include the step of slidably actuating the dissector bar.
The dissector bar may include a dissector extending distally from the distal-end portion thereof, wherein the dissector may include a pair of transversely spaced-apart fingers extending in at least a substantially distal direction. The pair of fingers may be spaced apart by a transverse distance not to exceed a width of the channel assembly.
In use, when the dissector bar is in the proximal position, a distal end of the pair of fingers of the dissector bar do not extend beyond the distal-most end of the jaw assembly.
In use, when the dissector bar is in a distal position, at least a portion of a length of the pair of fingers of the dissector bar extend beyond the distal-most end of the jaw assembly.
The dissector bar may include a knob supported near the proximal-end thereof, and wherein the knob extends through a slot formed in the housing. The method may further include the step of actuating the knob to actuate the dissector bar.
The slot formed in the housing has a length and a width, and wherein the knob has a transverse width that is greater than the width of the slot.
At least one side wall of the slot of the housing includes a resilient, deformable layer extending along a length thereof.
The elongate slot of the housing defines a plurality of discrete pockets defined by a plurality of discrete ridges formed along a length of the slot, wherein the ridges extend into the slot toward the knob. The ridges may extend by an amount sufficient to define ledges, wherein when the knob is disposed between adjacent ledges the knob is inhibited from distal and proximal movement and the dissector bar is held in place relative to the housing and channel assembly.



BRIEF DESCRIPTION OF THE DRAWINGS
The present clip applier will be more fully appreciated as the same becomes better understood from the following detailed description when considered in connection with the following drawings, in which:
FIG. 1 is a perspective view of a surgical clip applier according to an embodiment of the present disclosure;
FIG. 2 is a perspective view, with parts separated, of a dissector bar of the surgical clip applier of FIG. 1;
FIG. 3 is a longitudinal, cross-sectional view of the surgical clip applier of FIG. 1, as taken through 3-3 of FIG. 1;
FIG. 4 is a top, plan view of a distal portion of the surgical clip applier of FIG. 1, illustrating the dissector bar in a proximal-most position;
FIG. 5 is a top, plan view of a distal-portion of the surgical clip applier of FIG. 1, illustrating the dissector bar in at least one distal position;
FIG. 6 is perspective view of the surgical clip applier of the present disclosure shown in use;
FIG. 7 is a top, plan view of a distal portion of a surgical clip applier in accordance with another embodiment of the present disclosure; and
FIG. 8 is a top, plan view of a distal portion of a surgical clip applier in accordance with yet another embodiment of the present disclosure.



DETAILED DESCRIPTION OF EMBODIMENTS
Embodiments of 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.
FIGS. 1-6 illustrate a surgical clip applier in accordance with an embodiment of the present disclosure and is generally designated as 100. Reference may be made to U.S. Patent Publication No. 2011/0144665, filed on Nov. 10, 2010, entitled “Surgical Clip Applier” and U.S. Patent Publication No. 2010/0137886, filed on Jan. 21, 2010, entitled “Surgical Clip Applier,” the entire contents of each of which being incorporated herein by reference, for a detailed discussion of exemplary structure, operation, and method of assembly of surgical clip applier 100.
Generally, as seen in FIGS. 1-6, surgical clip applier 100 is a surgical instrument including a handle assembly 102 including a housing 104 having an upper housing half and lower housing half. Handle assembly 102 further includes a pair of handles 106 pivotably secured to housing 104 and extending outwardly therefrom. A channel assembly 108 is fixedly secured to housing 104 and extends outwardly therefrom, terminating in a jaw assembly 110.
The housing halves of clip applier 100 may fit together by snap fit engagement with one another. Housing 104 defines an elongate, longitudinally extending slot 104a formed in the lower housing half for passage of a knob (not shown) of a dissector bar 152 therethrough, as will be discussed in greater detail below. Housing 104 is formed of a suitable plastic material.
Handles 106 may be pivotally secured to housing 104. Handle assembly 102 may include link members pivotally connected to each handle 106 at a pivot point. A distal end of each link member may be pivotally connected to a pivot point formed in a drive channel via a drive pin. In use, as handles 106 are squeezed, the link members push the drive channel distally to effectuate closure of jaw assembly 110.
Channel assembly 108 includes a channel or cartridge cover 130 and an outer or lower channel 132 each having a proximal end retained in housing assembly 102, between the upper and lower housing halves.
As seen in FIGS. 1 and 2-6 and 8, surgical clip applier 100 includes a jaw assembly having a pair of jaws 120 mounted on or at a distal end of channel assembly 108 and actuatable by handles 106 of handle assembly 102. Jaws 120 are formed of a suitable biocompatible material such as, for example, stainless steel or titanium.
Jaws 120 may be mounted in a distal end of the drive channel via one or more connectors (e.g., rivets or the like) extending through the drive channel such that jaws 120 are longitudinally stationary relative to outer channel 132 and the drive channel.
In accordance with the present disclosure, as seen in FIGS. 1-6, clip applier 100 includes a dissector bar 150 for selective operation (i.e., deployment and retraction) by an end user to perform a dissection function with clip applier 100 without the need to use jaws 120 of clip applier 100 to perform said dissection function. With particular reference to FIGS. 1 and 2, dissector bar 150 includes an elongate body portion 152 having a proximal-end portion 152a extending into housing assembly 102, and a distal-end portion 152b extending out of housing assembly 102 and overlying channel assembly 108.
Dissector bar 150 includes a knob 154 secured to proximal-end portion 152a of body portion 152. In accordance with an embodiment of the present disclosure, knob 154 may include an enlarged head portion 154a, having a transverse dimension that is larger than a width of slot 104a of housing 104; and a neck portion 154b, having a transverse dimension that is smaller than the width of slot 104a of housing 104.
Dissector bar 150 includes a dissector having a pair of arms or fingers 156a, 156b extending distally from distal-end portion 152b of body portion 152. The pair of fingers 156a, 156b are off-set laterally from one another by an amount not to exceed an overall width of channel assembly 108. Additionally, the pair of fingers 156a, 156b are off-set laterally from one another by an amount sufficient to not obstruct the operation or functionality of jaw assembly 110 and/or the visibility of jaw assembly 110 by the end user.
Proximal-end portion 152a of body portion 152 extends into handle assembly 102 by an amount sufficient to extend below and be in registration with slot 104a of housing 104.
As seen in FIGS. 1, 3 and 4, dissector bar 150 has an overall length such that when dissector bar 150 is in a relatively proximal or proximal-most position, knob 154 is disposed at a location proximal of a distal-most end of slot 104a of housing 104; and, as seen in FIGS. 5 and 6, when dissector bar 150 is in a relatively distal-most position, knob 154 may be disposed at a relatively distal or distal-most end of slot 104a of housing 104.
Additionally, as seen in FIGS. 1, 3 and 4, dissector bar 150 has an overall length such that when dissector bar 150 is in a relatively proximal or proximal-most position, the pair of fingers 156a, 156b of dissector 156 is disposed at a location proximal of a distal-most end of clip applier 100, channel assembly 108 and/or jaws 120; and, as seen in FIGS. 5 and 6, when dissector bar 150 is in a relatively distal-most position, the pair of fingers 156a, 156b of dissector 156 is disposed to extend or project distally beyond distal-most end of clip applier 100, channel assembly 108 and/or jaws 120.
As seen in FIG. 6, during a surgical procedure, if the user of clip applier 100 needs or desires to perform a dissection on an underlying tissue, the user advances body portion 152 of dissector bar 150 by advancing knob 154 distally, relative to handle assembly 104, as indicated by arrows “A” of FIG. 5, to distally advance and/or deploy dissector 156 distally beyond distal-most end of clip applier 100, channel assembly 108 and/or jaws 120. With dissector 156 so deployed, the user may perform any dissecting function, at the target surgical site, such as, for example, the function of separating of the organs or vessels “V” from the underlying or overlying tissue “T”, connective tissue or the like, as seen in FIG. 6.
As can be appreciated by one of skill in the art, the relative dimensions and/or lengths of slot 104a of housing 104, of body portion 152 of dissector bar 150, of the pair of arms 156a, 156a of dissector 156, of channel assembly 108 and of jaw assembly 110 will determine the overall maximum projection of dissector 156 beyond distal-most end of clip applier 100, channel assembly 108 and/or jaws 120.
As seen in FIGS. 1 and 3-6, clip applier 100 may include a strap 158 or the like, connected to outer channel 132 and extending across body portion 152 of dissector bar 150. Strap 158 functions to help maintain body portion 152 of dissector bar 150 against the surface of or in relative close proximity to channel assembly 108. While a strap has been shown and is described, it is envisioned that any structure capable of maintaining maintain body portion 152 of dissector bar 150 against the surface of or in relative close proximity to channel assembly 108 can be utilized, such as, for example, a peg extending through an elongate slot formed in the body portion of dissector bar and which is secured to channel assembly.
In accordance with an aspect of the present disclosure, it is contemplated that handle assembly 102 may include a rubber gasket 105 or other resilient, deformable material lining at least the sides of slot 104a of housing 104. Gasket 105 may comprise an over-molding of resilient, deformable material extending along at least the sides of slot 104a of housing 104. Gasket 105 narrows a width of slot 104a of housing 104 to have a width dimension that is less than a diameter or transverse width dimension of neck portion 154b of knob 154. In this manner, dissector bar 150 is held against movement by a frictional force created by gasket 105 acting on neck portion 154b of knob 154. The particular dimensions and tolerances of slot 104a, with gasket 105, and neck portion 154a may be selected such that a force required to move knob 154 along slot 104a is relatively comfortable for an end user and sufficient to hold dissector bar 150 in place without the need for the end user to hold on to or exert a force on knob 154.
Turning now to FIG. 7, in an embodiment, it is contemplated that handle assembly 102 may include a rubber gasket 205 or other resilient, deformable material lining at least the sides of slot 104a of housing 104. As seen in FIG. 7, gasket 205 may be contoured to define a plurality of discrete ledges 205a along one side of slot 104a of housing 104 against which knob 154 may rest or be placed. In use, the end user, may move knob 154 axially along the length of slot 104a, to a desired location or deployment of dissector 156 and then place knob 154 onto a ledge 205a most closely in registration with the axial position of knob 154 in slot 104a. 
Turning now to FIG. 8, in yet another embodiment, it is contemplated that handle assembly 102 may include a rubber gasket 305 or other resilient, deformable material lining at least the opposed sides of slot 104a of housing 104. As seen in FIG. 8, gasket 305 may be contoured to define a plurality of discrete pockets 305a as defined by a series of axially spaced apart ridges 305b extending along a length of slot 104a of housing 104. In use, as the end user moves knob 154 axially along the length of slot 104a, to a desired location or deployment of dissector 156, knob 154 is moved passed ridges 305b and is held axially in place, in pocket 305a, by the ridges 305a that are distal and proximal of knob 154 and pocket 305a. 
In an embodiment it is contemplated that a biasing element, such as, for example, a spring or the like, may be attached to dissector bar 150 and a feature of housing assembly 102 or channel assembly 108, which biasing element functions to maintain dissector bar 150 in a proximal position.
It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure.

## Claims

1. A surgical clip applier for performing a surgical procedure, the surgical clip applier comprising:
a housing;
at least one handle pivotably connected to the housing;
a channel assembly extending distally from the housing;
a jaw assembly including a pair of jaws extending from an end of the channel assembly, opposite the housing, the jaw assembly adapted to accommodate a clip of a plurality of clips loaded in the clip applier and being operable to effect formation of the clip in response to movement of the at least one handle; and
a dissector bar supported on the housing and contacting an outer surface of the channel assembly, wherein the dissector bar is actuatable from the housing and includes a proximal position wherein a distal end of the dissector bar is disposed proximal of a distal-most end of the jaw assembly, and at least one distal position wherein the distal end of the dissector bar projects beyond the distal-most end of the jaw assembly.

2. The surgical clip applier according to claim 1, wherein the dissector bar includes a proximal-end portion at least partially slidably supported in the housing, and a distal-end portion extending from the housing and along a length of the channel assembly.

3. The surgical clip applier according to claim 2, wherein the dissector bar includes a dissector extending distally from the distal-end portion thereof.

4. The surgical clip applier according to claim 3, wherein the dissector includes a pair of transversely spaced-apart fingers extending in at least a substantially distal direction.

5. The surgical clip applier according to claim 4, wherein when the dissector bar is in the at least one distal position, the pair of jaws are disposed between the pair of fingers.

6. The surgical clip applier according to claim 4, wherein when the dissector bar is in the proximal position, a distal end of the pair of fingers of the dissector bar do not extend beyond the distal-most end of the jaw assembly.

7. The surgical clip applier according to claim 4, wherein when the dissector bar is in the at least one distal position, at least a portion of a length of the pair of fingers of the dissector bar extend beyond the distal-most end of the jaw assembly.

8. The surgical clip applier according to claim 2, wherein the dissector bar includes a knob supported near the proximal-end thereof, and wherein the knob extends through a slot formed in the housing.

9. The surgical clip applier according to claim 8, wherein the knob is configured to translate axially along the slot formed in the housing to actuate the dissector bar.

10. The surgical clip applier according to claim 8, wherein the slot formed in the housing has a length and a width, and wherein the knob has a transverse width that is greater than the width of the slot.

11. The surgical clip applier according to claim 10, wherein at least one side wall of the slot of the housing includes a resilient, deformable layer extending along a length thereof.

12. The surgical clip applier according to claim 11, wherein the slot of the housing defines a plurality of discrete pockets defined by a plurality of discrete ridges formed along the length of the slot, wherein the ridges extend into the slot toward the knob.

13. The surgical clip applier according to claim 12, wherein the ridges extend by an amount sufficient to define ledges, wherein when the knob is disposed between adjacent ledges the knob is inhibited from distal and proximal movement and the dissector bar is held in place relative to the housing and channel assembly.

14. A method of performing a surgical procedure, including the steps of:
providing a surgical clip applier for applying at least one surgical clip to a target surgical site, the surgical clip applier comprising:
a housing;
at least one handle pivotably connected to the housing;
a channel assembly extending distally from the housing;
a jaw assembly including a pair of jaws extending from an end of the channel assembly, opposite the housing, the jaw assembly adapted to accommodate a clip of a plurality of clips loaded in the clip applier and being operable to effect formation of the clip in response to movement of the at least one handle; and
a dissector bar supported on the housing and contacting an outer surface of the channel assembly, wherein the dissector bar is actuatable from the housing and includes a proximal position wherein a distal end of the dissector bar is disposed proximal of a distal-most end of the jaw assembly, and at least one distal position wherein the distal end of the dissector bar projects beyond the distal-most end of the jaw assembly;

actuating the dissector bar to extend the distal end of the dissector bar distally beyond the distal-most end of the jaw assembly; and
performing a dissecting function at a desired target site with the distal end of the dissector bar of the surgical clip applier.

15. The method according to claim 14, wherein the dissector bar includes a proximal-end portion at least partially slidably supported in the housing, and a distal-end portion extending from the housing and along a length of the channel assembly, and wherein the method further includes the step of slidably actuating the dissector bar.

16. The method according to claim 15, wherein the dissector bar includes a dissector extending distally from the distal-end portion thereof, wherein the dissector includes a pair of transversely spaced-apart fingers extending in at least a substantially distal direction.

17. The method according to claim 16, wherein when the dissector bar is in the at least one distal position, the pair of jaws are disposed between the pair of fingers.

18. The method according to claim 16, wherein when the dissector bar is in the proximal position, a distal end of the pair of fingers of the dissector bar do not extend beyond the distal-most end of the jaw assembly.

19. The method according to claim 16, wherein when the dissector bar is in the at least one distal position, at least a portion of a length of the pair of fingers of the dissector bar extend beyond the distal-most end of the jaw assembly.

20. The method according to claim 15, wherein the dissector bar includes a knob supported near the proximal-end thereof, and wherein the knob extends through a slot formed in the housing, wherein the method further includes the step of actuating the knob to actuate the dissector bar.

21. The method according to claim 20, wherein the slot formed in the housing has a length and a width, and wherein the knob has a transverse width that is greater than the width of the slot.