# Patent

## Title
Surgical clip applier including clip relief feature

## Abstract

A surgical clip applier includes a jaw assembly having first and second jaws. Each jaw defines an opposed surface configured to receive a portion of a surgical clip. The jaws are moveable between a spaced-apart position and an approximated position for forming the surgical clip about tissue. Each jaw includes a relief element disposed on a surface adjacent to and substantially transverse relative to the opposed surface thereof. The relief elements are cooperable to define a relief recess upon movement of the jaws to the approximated position. The relief recess is configured to receive at least a portion of a previously formed surgical clip during formation of a subsequent surgical clip about tissue adjacent to the previously formed surgical clip.

## Background
CROSS REFERENCE TO RELATED APPLICATION
The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/480,432, filed on Apr. 29, 2011, the entire contents of which are incorporated herein by reference.


BACKGROUND
Technical Field
The present disclosure relates to surgical instruments. More particularly, the present disclosure relates to an endoscopic surgical clip applier.
Description of Related Art
Endoscopic staplers and 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 apply a surgical clip to a blood vessel or another duct to prevent the flow of body fluids therethrough during the procedure. An endoscopic clip applier is known in the art for applying a single clip or a series of clips during a surgical procedure. Such clips are typically fabricated from a biocompatible material and are usually compressed over a vessel. Once applied to the vessel, the compressed clip terminates the flow of fluid therethrough.
Endoscopic 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 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 surgical clip applier. The clip applier advances and forms multiple clips during a single insertion into the body cavity. This resterilizable 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.
However, during the application of multiple clips adjacent to one another, it has been found that the previously applied clips may become lodged between the jaws during application of subsequent clips or may otherwise interfere with the application of the subsequent clips. Such an occurrence may result in formation or even dislodging of the previously applied clip, inadequate application of the subsequent clip, and/or damage to the clip applier or tissue structure. It is therefore desirable to provide a surgical clip applier that inhibits the occurrence of interference by a previously applied clip with the subsequent application of clips adjacent thereto.
SUMMARY
In accordance with one embodiment of the present disclosure, a surgical clip applier is provided. The surgical clip applier includes a jaw assembly including first and second jaws. Each jaw defines an opposed surface configured to receive a portion of a surgical clip. The jaws are moveable between a spaced-apart position and an approximated position for forming the surgical clip about tissue. Each jaw includes a relief element disposed on a surface adjacent to and substantially transverse relative to the opposed surface thereof. The relief elements are cooperable with one another to define a relief recess upon movement of the jaws to the approximated position. The relief recess is configured to receive at least a portion of a previously formed surgical clip during formation of a subsequent surgical clip about tissue adjacent to the previously formed surgical clip.
In one embodiment, the surgical clip applier further includes a handle assembly and a shaft extending distally from the handle assembly. The jaw assembly is disposed at a distal end of the shaft.
In another embodiment, each surgical clip includes a pair of legs interconnected by a backspan.
In another embodiment, the opposed surfaces of the jaws each define a clip track therein. The clip tracks are configured to guide translation of the legs of the surgical clip therealong as the jaws are moved from the spaced-apart position to the approximated position to form the surgical clip about tissue.
In still another embodiment, the relief recess is configured to receive the backspan of the previously formed surgical clip therein. More specifically, the relief recess may be shaped complementary to at least a portion of the surgical clip, e.g., the backspan of the surgical clip.
In yet another embodiment, the relief elements of the jaws each define at least a portion of the relief recess such that the portions of the relief recess cooperate with one another upon approximation of the jaw members to define the complete relief recess.
In still yet another embodiment, the relief elements each define an angled cam surface on an outwardly-facing surface thereof. The angled cam surfaces are configured to facilitate movement of the jaws to the approximated position.
A surgical jaw assembly for use in a surgical clip applier is also provided in accordance with an embodiment of the present disclosure. The surgical jaw assembly is adapted to store and fire a plurality of surgical clips in succession. The surgical jaw assembly includes first and second opposed jaws, each defining an opposed surface configured to receive a portion of a surgical clip. The jaws are moveable between a spaced-apart position and an approximated position for forming the surgical clip about tissue. Each jaw includes a raised element defining an angled cam surface on an outwardly-facing surface thereof that is configured to facilitate movement of the jaws to the approximated position. The raised elements are cooperable with one another upon approximation of the jaw members to define the a relief recess. The relief recess is configured to receive at least a portion of a previously formed surgical clip during formation of a subsequent surgical clip about tissue adjacent to the previously formed surgical clip.
In embodiments, the surgical clips are configured similarly as described above. As such, the relief recess may be configured to receive the backspan of the previously formed surgical clip therein. Further, the relief recess may be shaped complementary to the at least a portion of the previously formed surgical clip.
In another embodiment, the raised elements are disposed on surfaces adjacent to and substantially transverse relative to the opposed surface of the jaw thereof.
In still yet another embodiment, the raised elements each define at least a portion of the relief recess such that, upon approximation of the jaws, the portions of the relief recess cooperate to form the full relief recess.
A method of applying a plurality of surgical clips to tissue is also provided in accordance with the present disclosure. The method includes providing a surgical clip applier (or jaw assembly thereof) according to any of the embodiments above. Next, the jaws are positioned such that tissue is disposed therebetween and are moved from the spaced-apart position to the approximated position to form a first surgical clip about tissue. Thereafter, the jaws are positioned adjacent to the first surgical clip such that tissue is disposed between the jaws and are moved from the spaced-apart position to the approximated position to form a second surgical clip about tissue adjacent the first surgical clip and such that at least a portion of the first surgical clip is received within the relief recess during formation of the second surgical clip.



BRIEF DESCRIPTION OF THE DRAWINGS
Various embodiments of the subject instrument are described herein with reference to the drawings wherein:
FIG. 1 is a perspective view of a surgical clip applier;
FIG. 2 is a further perspective view of the surgical clip applier of FIG. 1, illustrating a rotation of a shaft thereof;
FIG. 3A is an enlarged, bottom, perspective view of the jaw assembly of the surgical clip applier of FIGS. 1-2;
FIG. 3B is an enlarged, bottom, perspective view of the jaws of the surgical clip applier of FIGS. 1-2 shown with a previously formed surgical clip disposed within a relief feature of the jaws;
FIG. 3C is a bottom, perspective view illustrating a driver assembly moving the jaw assembly to an approximated position;
FIG. 4A is a longitudinal, cross-sectional view of the jaw assembly, as taken through 4A-4A of FIG. 3B;
FIG. 4B is a transverse, cross-sectional view of the jaw assembly, as taken through 4B-4B of FIG. 3B;
FIG. 5 is a top view of a surgical clip for use with the surgical clip applier of FIGS. 1-2; and
FIGS. 6-10 illustrate a use of the surgical clip applier of FIGS. 1-5 in applying a series of surgical clips to a target surgical site.



DETAILED DESCRIPTION
Embodiments of a surgical clip applier 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 to FIGS. 1-2, a surgical clip applier in accordance with the present disclosure is generally designated as 100. Surgical clip applier 100 generally includes a handle assembly 102 and an endoscopic portion including a shaft assembly 104 extending distally from handle assembly 102 and having a jaw assembly 120 disposed at a distal end thereof. A stack of surgical clips (not explicitly shown) is typically loaded and/or retained within shaft assembly 104 in a manner so as to slide therewithin and/or therealong. A complete description of the inner-workings and operation of surgical clip applier 100 can be found in commonly-assigned U.S. patent application Ser. No. 12/055,446 to Whitfield et. al., the entire contents of which are hereby incorporated by reference herein.
With continued reference to FIGS. 1-2, jaw assembly 120 is mounted in the distal end of shaft assembly 104 such that jaws 120a, 120b are longitudinally stationary relative thereto. A knob 110 may be rotatably mounted on a distal end of handle assembly 102 and affixed to shaft assembly 104 to transmit and/or provide 360° rotation to shaft assembly 104 and jaws 120a, 120b about a longitudinal axis “X-X” thereof. As will be described in greater detail hereinbelow, jaws 120a and 120b of jaw assembly 120 are each configured to guide passage of a surgical clip “C” (FIG. 5) therethrough and are moveable relative to one another from a spaced-apart position (FIG. 3A) and an approximated position (FIG. 3B-3C) to crimp, or form the surgical clip “C” (FIG. 5) about tissue.
Turning now to FIGS. 3A-4B, jaws 120a, 120b of jaw assembly 120 each define a respective clip track 122a, 122b within an inwardly facing, or opposed surface 121a, 121b, respectively, thereof. Clip tracks 122a, 122b are configured to receive surgical clip “C” therethrough as jaws 120a, 120b are moved to the approximated position to form the surgical clip “C” about tissue disposed between jaws 120a, 120b. Further, each jaw includes a raised element 130a, 130b, respectively, disposed on an adjacent, transverse surface 131a, 131b thereof relative to opposed surfaces 121a, 121b, respectively. For example, in the orientation of jaw assembly 120 shown in FIGS. 3A-3C, opposed surfaces 121a, 121b, respectively, are positioned as inwardly-facing “side” surfaces, while the raised elements 130a, 130b are disposed on the adjacent and transversely-positioned “upper” surfaces 131a, 131b of jaws 120a, 120b, respectively. As can be appreciated, given that jaw assembly 120 may be rotated, e.g., via rotating knob 110 (FIG. 1) and/or by simply rotating the entire surgical clip applier 100 (FIG. 1), these orientation-indicating markers, e.g., upper, lower, and side, will not necessarily remain the same. However, the positioning of surfaces 121a, 121b and surfaces 131a, 131b adjacent to and transverse relative to one another will remain constant regardless of the orientation of jaw assembly 120.
With continued reference to FIGS. 3A-4B, raised elements 130a, 130b each include a distally and inwardly-facing recess 132a, 132b, respectively, defined therein. Recesses 132a, 132b are configured such that, upon approximation of jaws 120a, 120b, as best shown in FIG. 3B, recesses 132a, 132b cooperate with one another to form a combined recess 132. Recess 132 defines a generally horseshoe or u—shaped configuration, although other configurations are contemplated.
More specifically, recess 132 is configured to define a complementary-shaped configuration to that of backspan 220c of surgical clip “C” when surgical clip “C” is formed about tissue such that, as will be described in greater detail below, back span 220c of surgical clip “C” is capable of being received therein. As such, a diameter or width of recess 132 may be slightly larger that that of a formed surgical clip “C” such that a formed surgical clip “C” is receivable therein, but not too large such that substantial movement of the formed surgical clip “C,” when disposed therein, is inhibited.
Further, depending on the configuration of the surgical clip “C” used, the configuration of recess 132 may be altered accordingly, i.e., to maintain complementary-shaped configurations. For example, recess 132 may define a “V”-shaped configured for use with surgical clips having a “V”-shaped backspan in the formed condition. As will be described in greater detail below, and as shown in FIGS. 4A-4B, recess 132, formed via cooperation of recesses 132a, 132b of raised elements 130a, 130b of jaws 120a, 120b, upon approximation of jaws 120a, 120b, is configured to receive or retain an end of a previously formed surgical clip “C1” therein, while a second surgical clip “C2” is guided through clip tracks 122a, 122b of jaws 120a, 120b, respectively, as jaw members 120a, 120b are moved to the approximated position to form the second surgical clip “C2” about tissue in position adjacent the first, or previously formed surgical clip “C1.”
Referring now to FIG. 3C, raised elements 130a, 130b, disposed on surfaces 131a, 131b of jaws 120a, 120b, respectively, help impart an increased closing force to jaws 120a, 120b, thereby facilitating approximation of jaws 120a, 120b. More particularly, raised elements 130a, 130b each include an outwardly-facing, angled cam surface 133a, 133b tapering inwardly in a proximal direction. In use, upon actuation of jaws 120a, 120b, e.g., via depression of trigger 108, cam driver 50 is translated distally relative to jaws 120a, 120b, ultimately contacting angled cam surfaces 133a, 133b of raised elements 130a, 130b, respectively. Due to the distally and outwardly sloped angled surfaces 133a, 133b, of raised elements 130a, 130b, respectively, as cam driver 50 is translated further distally, raised elements 130a, 130b and, thus, jaws 120a, 120b are urged into approximation with one another. In the approximated position, as best shown in FIGS. 3B and 3C, raised elements 130a, 130b are disposed in close proximity to one another such that relief recesses 132a, 132b, respectively, thereof cooperate to form recess 132, the additional importance of which will be described in greater detail below.
Referring now to FIG. 5, a typical surgical clip “C” configured for use with surgical clip applier 100 (FIG. 1) is shown. Clip “C” includes a pair of legs 220a, 220b interconnected by a crown, crossbar, or backspan 220c. An inwardly facing surface 222a, 222b of each leg 220a and 220b, respectively, defines a generally flat geometry such that upon forming of clip “C” about a body tissue or vessel, inwardly facing surfaces 222a and 222b of legs 220a and 220b consistently and evenly clamp around the body tissue or vessel. Outwardly facing surfaces 224a and 224b of legs 220a and 220b, respectively, may define a generally circular transverse cross-sectional configuration, or any other suitable configuration. In particular, outwardly-facing surfaces 224a and 224b may be shaped complementarily to clip tracks 122a, 122b to facilitate translation through clip tracks 122a, 122b as jaws 120a, 120b are moved to the approximated position to form clip “C” about tissue. Backspan 220c may be configured similarly to legs 220a, 220b to form a substantially consistent configuration along the entire outwardly facing surface of clip “C,” although other configurations are contemplated.
The operation of surgical clip applier 100, to crimp, form, or form a plurality of surgical clips “C1” and “C2” about a target body tissue, e.g., a vessel “V” (FIGS. 6-10), in close proximity, i.e., adjacent, to one another will now be described with reference to FIGS. 1-10.
Initially, as seen in FIG. 6, clip applier 100 is positioned such that a tissue or a vessel “V” to be clamped is disposed between jaws 120a and 120b. As trigger 108 is squeezed or actuated, trigger 108 causes clip “C1” to translate distally into clip tracks 122a and 122b of opposed surfaces 121a, 121b of jaws 120a and 120b, respectively, such that at least a portion of leg 220a of clip “C1” is positioned within clip track 122a of jaw member 120a and such that at least a portion of leg 220b of clip “C1” is positioned within clip track 122b of jaw member 120b. Thus, legs 220a and 220b of clip “C1,” similar to jaws 120a and 120b, are now also positioned surrounding tissue or vessel “V” to be clamped.
As trigger 108 is squeezed further, jaws 120a and 120b are moved from the spaced-apart position toward the approximated position, thereby beginning to form surgical clip “C1” therebetween. As discussed above, upon actuation of trigger 108, cam driver 50 is translated distally into contact with angled cam surfaces 133a, 133b of raised elements 130a, 130b to facilitate movement of jaws 120a, 120b to the approximated position. During formation of clip “C1,” the flat, inwardly facing surfaces 222a and 222b of legs 220a and 220b of clip “C1” are approximated toward each other to thereby effect clamping of vessel “V.” Alternatively, inwardly facing surfaces 222a, 222b may include one or more features to promote a secure and effective clamp about tissue or vessel “V.” Once clip “C1” has been clamped about vessel “V,” as shown in FIG. 7, trigger 108 may be released, allowing jaw assembly 120 to return back to the spaced-apart position.
Once the first clip “C1” has been formed about vessel “V,” as shown in FIG. 7, a second clip “C2” may be formed about vessel “V” adjacent to first clip “C1.” In order to apply second clip “C2”, clip applier 100 is once again positioned such that vessel “V” is disposed between jaws 120a and 120b, directly adjacent the previously-formed first clip “C1,” as shown in FIG. 8. Once in position, trigger 108 is squeezed causing clip “C2” to translate distally into clip tracks 122a and 122b and, ultimately, to be formed about vessel “V” as jaws 120a and 120b are moved from the spaced-apart position to the approximated position.
During approximation of jaws 120a, 120b to form clip “C2” about tissue, as best shown in FIGS. 3B, 4A-4B and 9, raised elements 130a, 130b are approximated relative to one another. More specifically, as raised elements 130a, 130b are approximated relative to one another, backspan 220c of clip “C1” is received within recess 132 formed by the approximation of recesses 132a, 132b of raised elements 130a, 130b, respectively. Accordingly, raised elements 130a, 130b and, thus, jaws 120a 120b are permitted to move to the fully approximated position, while backspan 220c of surgical clip “C1” is received within recess 132 of jaw assembly 120. In other words, recess 132 provides a relief, or cut-out such that backspan 220c of formed clip “C1” does not interfere with the approximation of raised elements 130a, 130b during formation of second clip “C2.”
As can be appreciated, this configuration permits formation of clips “C1” and “C2” in close proximity to one another while inhibiting dislodging or deformation of first clip “C1” and also helping to ensure that second clip “C2” is adequately and properly formed about vessel “V.” In particular, with backspan 220c of first surgical clip “C1” retained within recess 132 of jaw assembly 120, first surgical clip “C1” remains displaced from the inter-jaw space as well as the space between raised elements 130a, 130b, thus allowing jaws 120a, 120b to fully approximate, ensuring adequate application of second surgical clip “C2” about tissue and inhibiting damage to or malformation of clips “C1” or “C2” and/or surgical clip applier 100 that may result from first surgical clip “C1” interfering with the movement of jaws 120a, 120b and/or the advancement of second surgical clip “C2” therethrough during a placement/formation of second surgical clip “C2” adjacent and in close proximity to first surgical clip “C1.”
Once second clip “C2” has been clamped about vessel “V,” as shown in FIG. 10, trigger 108 may be released, allowing jaw assembly 120 to return back to the spaced-apart position. Subsequent clips “C” may then be applied similarly as described above.
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, comprising:
a jaw assembly including first and second jaws, each jaw defining an opposed surface configured to receive a portion of a surgical clip, the jaws moveable between a spaced-apart position and an approximated position for forming the surgical clip about tissue, each jaw including a relief element disposed on a surface adjacent to and substantially transverse relative to the opposed surface thereof, each relief element movable with the respective jaw thereof relative to the other jaw and the relief element thereof, each relief element defining a relief recess portion therein having an arcuate configuration such that, upon movement of the jaws to the approximated position, the relief recess portions cooperate to form a relief recess defining a U-shaped configuration configured to complimentarily receive a U-shaped portion of a previously formed surgical clip during formation of a subsequent surgical clip about tissue adjacent the previously formed surgical clip.

2. The surgical clip applier according to claim 1, further comprising a handle assembly and a shaft extending distally from the handle assembly, the jaw assembly disposed at a distal end of the shaft.

3. The surgical clip applier according to claim 1, wherein each surgical clip includes a pair of legs interconnected by a backspan.

4. The surgical clip applier according to claim 3, further comprising a clip track defined within the opposed surface of each of the jaws, the clip tracks configured to guide translation of the legs of the surgical clip therealong as the jaws are moved from the spaced-apart position to the approximated position to form the surgical clip about tissue.

5. The surgical clip applier according to claim 3, wherein the relief recess is configured to complimentarily receive the backspan of the previously formed surgical clip therein, the backspan of the previously-formed surgical clip defining the U-shaped portion of the previously formed surgical clip.

6. The surgical clip applier according to claim 1, wherein the relief elements each define an angled cam surface on an outwardly-facing surface thereof, the angled cam surfaces configured to facilitate movement of the jaws to the approximated position.

7. A surgical clip applier adapted to store and fire a plurality of surgical clips in succession, the surgical clip applier comprising:
a cam driver; and
first and second opposed jaws, each jaw defining an opposed surface configured to receive a portion of a surgical clip, the jaws moveable relative to one another, in response to urging from the cam driver, between a spaced-apart position and an approximated position for forming the surgical clip about tissue, each jaw including a raised element disposed thereon and movable with the respective jaw thereof relative to the other jaw and the raised element thereof between the spaced-apart position and the approximated position, each raised element defining an angled cam surface on an outwardly-facing surface thereof, wherein the cam driver is configured to contact and cam along the angled cam surfaces to facilitate movement of the jaws to the approximated position, the raised elements cooperable with one another upon approximation of the jaw members to define a relief recess having a U-shaped configuration, the relief recess configured to complimentarily receive a U-shaped portion of a previously formed surgical clip during formation of a subsequent surgical clip about tissue adjacent to the previously formed surgical clip.

8. The surgical clip applier according to claim 7, wherein each surgical clip includes a pair of legs interconnected by a backspan.

9. The surgical clip applier according to claim 8, wherein the relief recess is configured to complimentarily receive the backspan of the previously formed surgical clip therein, the backspan of the previously-formed surgical clip defining the U-shaped portion of the previously formed surgical clip.

10. The surgical clip applier according to claim 7, wherein each raised element is disposed on a surface adjacent to and substantially transverse relative to the opposed surface of the jaw thereof.

11. The surgical clip applier according to claim 7, wherein the raised elements of the jaws each define at least a portion of the relief recess, the portions of the relief recess cooperating to define the relief recess upon movement of the jaws to the approximated position.

12. A method of applying a plurality of surgical clips to tissue, the method comprising:
providing a jaw assembly including first and second jaws defining opposed surfaces configured to receive a surgical clip therebetween, each jaw including a relief element disposed on a surface adjacent to and substantially traverse relative to the opposed surface thereof, the relief elements movable relative to one another in response to movement of the jaws relative to one another such that the relief elements cooperate to define a relief recess in an approximated position of the jaws, the relief recess defining a U-shaped configuration;
positioning the jaws such that tissue is disposed therebetween;
moving the jaws from a spaced-apart position to the approximated position to form a first surgical clip about tissue;
positioning the jaws adjacent to the first surgical clip and such that tissue is disposed between the jaws; and
moving the jaws from the spaced-apart position to the approximated position to form a second surgical clip about tissue adjacent the first surgical clip such that a U-shaped portion of the first surgical clip is complimentarily received within the relief recess during formation of the second surgical clip.

13. The method according to claim 12, wherein the first and second surgical clips each include a pair of legs interconnected by a backspan, the backspan of the first surgical clip defining the U-shaped portion thereof.

14. The method according to claim 13, wherein the legs of each surgical clip translate along guide tracks defined within the opposed surfaces of the jaws as the jaws are moved from the spaced-apart position to the approximated position to form the surgical clip about tissue.

15. The method according to claim 12, wherein the relief elements each define an angled cam surface on an outwardly-facing surface thereof, the angled cam surfaces configured to facilitate movement of the jaws to the approximated position.

16. The method according to claim 12, wherein the relief elements of the jaws each define at least a portion of the relief recess such that moving the jaws to the approximated position moves the portions of the relief recess into cooperation with one another to define the relief recess.