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.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    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 
       [0002]    1. Technical Field 
         [0003]    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. 
         [0004]    2. Discussion of Related Art 
         [0005]    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. 
         [0006]    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. 
         [0007]    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 
       [0008]    The present application relates to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical. 
         [0009]    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. 
         [0010]    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. 
         [0011]    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. 
         [0012]    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. 
         [0013]    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. 
         [0014]    At least one side wall of the slot of the housing may include a resilient, deformable layer extending along a length thereof. 
         [0015]    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. 
         [0016]    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. 
         [0017]    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. 
         [0018]    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. 
         [0019]    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. 
         [0020]    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. 
         [0021]    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. 
         [0022]    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. 
         [0023]    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. 
         [0024]    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. 
         [0025]    At least one side wall of the slot of the housing includes a resilient, deformable layer extending along a length thereof. 
         [0026]    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 
         [0027]    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: 
           [0028]      FIG. 1  is a perspective view of a surgical clip applier according to an embodiment of the present disclosure; 
           [0029]      FIG. 2  is a perspective view, with parts separated, of a dissector bar of the surgical clip applier of  FIG. 1 ; 
           [0030]      FIG. 3  is a longitudinal, cross-sectional view of the surgical clip applier of  FIG. 1 , as taken through  3 - 3  of  FIG. 1 ; 
           [0031]      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; 
           [0032]      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; 
           [0033]      FIG. 6  is perspective view of the surgical clip applier of the present disclosure shown in use; 
           [0034]      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 
           [0035]      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 
       [0036]    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. 
         [0037]      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 . 
         [0038]    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 . 
         [0039]    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  104   a  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. 
         [0040]    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 . 
         [0041]    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. 
         [0042]    As seen in FIGS.  1  and  2 - 6  and  19 , 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. 
         [0043]    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. 
         [0044]    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  152   a  extending into housing assembly  102 , and a distal-end portion  152   b  extending out of housing assembly  102  and overlying channel assembly  108 . 
         [0045]    Dissector bar  150  includes a knob  154  secured to proximal-end portion  152   a  of body portion  152 . In accordance with an embodiment of the present disclosure, knob  154  may include an enlarged head portion  154   a , having a transverse dimension that is larger than a width of slot  104   a  of housing  104 ; and a neck portion  154   b , having a transverse dimension that is smaller than the width of slot  104   a  of housing  104 . 
         [0046]    Dissector bar  150  includes a dissector having a pair of arms or fingers  156   a ,  156   b  extending distally from distal-end portion  152   b  of body portion  152 . The pair of fingers  156   a ,  156   b  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  156   a ,  156   b  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. 
         [0047]    Proximal-end portion  152   a  of body portion  152  extends into handle assembly  102  by an amount sufficient to extend below and be in registration with slot  104   a  of housing  104 . 
         [0048]    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  104   a  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  104   a  of housing  104 . 
         [0049]    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  156   a ,  156   b  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  156   a ,  156   b  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 . 
         [0050]    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 . 
         [0051]    As can be appreciated by one of skill in the art, the relative dimensions and/or lengths of slot  104   a  of housing  104 , of body portion  152  of dissector bar  150 , of the pair of arms  156   a ,  156   a  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 . 
         [0052]    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. 
         [0053]    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  104   a  of housing  104 . Gasket  105  may comprise an over-molding of resilient, deformable material extending along at least the sides of slot  104   a  of housing  104 . Gasket  105  narrows a width of slot  104   a  of housing  104  to have a width dimension that is less than a diameter or transverse width dimension of neck portion  154   b  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  154   b  of knob  154 . The particular dimensions and tolerances of slot  104   a , with gasket  105 , and neck portion  154   a  may be selected such that a force required to move knob  154  along slot  104   a  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 . 
         [0054]    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  104   a  of housing  104 . As seen in  FIG. 7 , gasket  205  may be contoured to define a plurality of discrete ledges  205   a  along one side of slot  104   a  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  104   a , to a desired location or deployment of dissector  156  and then place knob  154  onto a ledge  205   a  most closely in registration with the axial position of knob  154  in slot  104   a.    
         [0055]    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  104   a  of housing  104 . As seen in  FIG. 8 , gasket  305  may be contoured to define a plurality of discrete pockets  305   a  as defined by a series of axially spaced apart ridges  305   b  extending along a length of slot  104   a  of housing  104 . In use, as the end user moves knob  154  axially along the length of slot  104   a , to a desired location or deployment of dissector  156 , knob  154  is moved passed ridges  305   b  and is held axially in place, in pocket  305   a , by the ridges  305   a  that are distal and proximal of knob  154  and pocket  305   a.    
         [0056]    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. 
         [0057]    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.