Abstract:
A handle assembly for a clip applier includes a housing having a stationary handle and a barrel supported on the stationary handle. The barrel defines a lumen having a proximal portion and a distal portion configured to releasably receive an adapter assembly. A is operably coupled to the housing and includes a gripping portion and a stem portion movable distally through the proximal portion of the lumen in response to movement of the gripping portion towards the stationary handle. A plunger assembly is removably positionable within the proximal portion of the lumen and configured to operably couple the stem portion with an adapter assembly such that distal movement of the stem portion actuates the adapter assembly. A plug is removably engagable within the proximal end of the barrel to retain the stem portion, the plunger assembly, and the adapter assembly in operable relation relative to one another.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/068,341, filed on Oct. 24, 2014, and incorporated herein by reference in its entirety. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The technical field relates to surgical clip appliers. More particularly, the present disclosure relates to a reposable multiplatform endoscopic surgical clip applier having a handle assembly configured for use with a plurality of different adapter assemblies and/or clip cartridge assemblies for firing different types and/or sizes of clips. 
         [0004]    2. Description of Related Art 
         [0005]    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&#39;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 for performing surgical procedures far removed from the incision. 
         [0006]    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 during an entry to the body cavity. 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. 
         [0007]    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., the contents of which are both incorporated herein 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 are also hereby incorporated by reference herein. These devices are typically, though not necessarily, used during a single surgical procedure. U.S. patent application Ser. No. 08/515,341 now U.S. Pat. No. 5,695,502 to Pier et al., the disclosure of which is hereby incorporated by reference herein in its entirety, discloses a resterilizable surgical clip applier. 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. 
         [0008]    During endoscopic or laparoscopic procedures it may be desirable and/or necessary to use different size surgical clips depending on the underlying tissue or vessels to be ligated. In order to reduce overall costs of a surgical clip applier, it is desirable for a single surgical clip applier to be loadable with and capable of firing different size surgical clips as needed. 
         [0009]    Accordingly, a need exists for endoscopic surgical clip appliers that include handle assemblies configured for use with different adapter assemblies and/or clip cartridge assemblies for firing different types and/or sizes of clips. 
       SUMMARY 
       [0010]    Reposable endoscopic surgical clip appliers including handle assemblies configured for use with different adapter assemblies and/or clip cartridge assemblies for firing different types and/or sizes of clips are provided in accordance with the present disclosure. To the extent consistent, any of the aspects or features of the present disclosure may be used in conjunction with any of the other aspects and features of the present disclosure. 
         [0011]    A handle assembly for a reposable endoscopic surgical clip applier provided in accordance with the present disclosure includes a housing, a trigger, a plunger assembly, and a plug. The housing includes a stationary handle and a barrel supported on the stationary handle. The barrel includes a proximal end, a distal end, and a longitudinal axis. The barrel further defines a lumen extending between the proximal and distal ends thereof. The lumen is aligned on the longitudinal axis and includes a proximal portion and a distal portion. The distal portion of the lumen is configured to releasably receive an adapter assembly operably associated with a clip cartridge assembly, an end effector, and/or a surgical tool. The trigger is operably coupled to the housing and includes a gripping portion and a stem portion. The gripping portion is movable relative to the stationary handle from an un-actuated position to an actuated position to move the stem portion distally through the proximal portion of the lumen. The plunger assembly is removably positionable within the proximal portion of the lumen and is configured to operably couple the stem portion with an adapter assembly received within the distal portion of the lumen such that distal movement of the stem portion through the proximal portion of the lumen actuates the adapter assembly. The plug is removably engagable within the proximal end of the barrel to close off the proximal portion of the lumen, thereby retaining the stem portion, the plunger assembly, and the adapter assembly in operable relation relative to one another. 
         [0012]    In aspects of the present disclosure, the plunger assembly includes a plunger having a head and a shaft extending distally from the head. In such aspects, upon distal movement of the stem portion through the proximal portion of the lumen, the stem portion is urged into contact with the head to thereby urge the plunger distally to actuate the adapter assembly. 
         [0013]    In aspects of the present disclosure, the plunger assembly further includes a flange slidably disposed about the shaft and a biasing member disposed about the shaft and positioned between the flange and the head. In such aspects, the flange may be configured to abut a shoulder defined within the proximal portion of the lumen when the plunger assembly is positioned therein such that the biasing member is compressed upon distal movement of the plunger through the proximal portion of the lumen. 
         [0014]    In aspects of the present disclosure, the plug is configured for threaded engagement within the proximal end of the barrel. 
         [0015]    In aspects of the present disclosure, a lock collar is provided. The lock collar is rotatably coupled to the barrel and extends distally therefrom. The lock collar is rotatable relative to both the barrel and the adapter assembly to releasably engage the adapter assembly within the distal portion of the lumen. 
         [0016]    In aspects of the present disclosure, the housing, the trigger, the plunger assembly, and the plug are configured as resterilizable, reusable components. 
         [0017]    A reposable endoscopic surgical clip applier provided in accordance with aspects of the present disclosure includes a handle assembly and a plurality of adapter assemblies. The handle assembly includes a housing, a trigger, a plunger assembly, and a plug. The housing includes a stationary handle and a barrel supported on the stationary handle. The barrel includes a proximal end, a distal end, and a longitudinal axis. The barrel defines a lumen extending between the proximal and distal ends thereof. The lumen is aligned on the longitudinal axis and includes a proximal portion and a distal portion. The trigger is operably coupled to the housing and movable relative to the stationary handle from an un-actuated position to an actuated position. The plunger assembly is removably positionable within the proximal portion of the lumen and is configured to operably couple to the trigger such that movement of the trigger from the un-actuated position to the actuated position advances the plunger assembly distally though the proximal portion of the lumen. The plug is removably engagable within the proximal end of the barrel to close off the proximal portion of the lumen, thereby retaining the trigger in operable relation relative to the plunger assembly. 
         [0018]    Each of the adapter assemblies is operably associated with a clip cartridge assembly, an end effector, and/or a surgical tool and is configured for releasable receipt with the distal portion of the lumen in operable relation relative to the plunger assembly such that distal movement of the plunger assembly through the proximal portion of the lumen actuates the clip cartridge assembly, end effector, or surgical tool associated with that adapter assembly. At least one adapter assembly of the plurality of adapter assemblies has a stroke length which is different from a stroke length of the remaining adapter assemblies. 
         [0019]    In aspects of the present disclosure, the trigger includes a gripping portion and a stem portion. The gripping portion of the trigger is movable relative to the stationary handle from the un-actuated position to the actuated position to move the stem portion distally through the proximal portion of the lumen to advance the plunger assembly distally though the proximal portion of the lumen. 
         [0020]    In aspects of the present disclosure, the plunger assembly includes a plunger having a head and a shaft extending distally from the head. Upon distal movement of the stem portion through the proximal portion of the lumen, the stem portion is urged into contact with the head to thereby urge the plunger distally. 
         [0021]    In aspects of the present disclosure, the plunger assembly further includes a flange slidably disposed about the shaft and a biasing member disposed about the shaft and positioned between the flange and the head. In such aspects, the flange may be configured to abut a shoulder defined within the proximal portion of the lumen when the plunger assembly is positioned therein such that the biasing member is compressed upon distal movement of the plunger through the proximal portion of the lumen. 
         [0022]    In aspects of the present disclosure, the handle assembly further includes a lock collar rotatably coupled to the barrel and extending distally therefrom. With one of the adapter assemblies inserted into the distal portion of the lumen, the lock collar is rotatable relative to the barrel and that adapter assembly to releasably engage that adapter assembly within the distal portion of the lumen. 
         [0023]    In aspects of the present disclosure, one or more of the adapter assemblies includes an outer shell, a collar slidably disposed within the outer shell, a shaft engaged with the collar and extending distally from the collar and the outer shell, and a plunger assembly slidably disposed within the outer shell. In such aspects, the plunger assembly of the adapter assembly may include a stem and a plunger slidable relative to the stem and including a head and a shaft extending distally from the head. Further still, in such aspects, the plunger assembly may include a biasing member disposed about the stem and the shaft of the plunger and positioned between the collar and the head of the plunger such that slidable insertion of the shaft of the plunger into the stem compresses the biasing member. 
         [0024]    In aspects of the present disclosure, distal movement of the plunger of the handle assembly urges the plunger of the adapter assembly distally to actuate the clip cartridge assembly, end effector, or surgical tool associated with that adapter assembly. 
         [0025]    A method of assembling a reposable endoscopic surgical clip applier provided in accordance with aspects of the present disclosure includes inserting a plunger assembly into a proximal portion of a lumen defined within a barrel of a housing. The housing further includes a stationary handle supporting the barrel thereon. The method further includes engaging a plug within the proximal portion of the lumen of the barrel to close off the proximal portion of the lumen of the barrel and retain the plunger assembly therein, inserting an adapter assembly into a distal portion of the lumen of the barrel such that the adapter assembly is operably positioned relative to the plunger assembly, and engaging the adapter assembly within the distal portion of the lumen of the barrel. 
         [0026]    In aspects of the present disclosure, the method further includes, prior to engaging the plug, moving a gripping portion of a trigger operably associated with the housing towards the stationary handle such that a stem portion of the trigger abuts a proximal end of the plunger assembly. 
         [0027]    In aspects of the present disclosure, engaging the adapter assembly within the distal portion of the lumen of the barrel includes rotating a lock collar relative to both the adapter assembly and the barrel. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0028]    Aspects and features of the present disclosure are described herein with reference to the accompanying drawings, wherein: 
           [0029]      FIG. 1  is an exploded, perspective view of a handle assembly of a reposable endoscopic surgical clip applier provided in accordance with aspects of the present disclosure; 
           [0030]      FIG. 2  is a partial longitudinal, cross-sectional view of the handle assembly of  FIG. 1 , with a first adapter assembly operably engaged therein; 
           [0031]      FIG. 3  is a perspective view of a proximal end of the first adapter assembly of  FIG. 2  and a proximal end of a second adapter assembly provided in accordance with aspects of the present disclosure and configured for use with the handle assembly of  FIG. 1 ; 
           [0032]      FIG. 4  is a perspective view of the proximal end of the first adapter assembly of  FIG. 2  with the outer tubular shell removed to illustrate the internal components thereof; 
           [0033]      FIG. 5  is a perspective view of the proximal end of the first adapter assembly of  FIG. 2  with a portion of the outer tubular shell removed to illustrate the internal components thereof; and 
           [0034]      FIG. 6  is a perspective view of the second adapter assembly of  FIG. 3  illustrating the tubular shaft thereof extending distally from the outer tubular shell thereof. 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0035]    Embodiments of reposable endoscopic surgical clip appliers provided 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 or component thereof which is closer to the user and the term “distal” refers to the end of the apparatus or component thereof which is further from the user. 
         [0036]    Turning to  FIGS. 1-3 , an endoscopic surgical clip applier provided in accordance with the present disclosure is generally designated as  10 . Surgical clip applier  10  generally includes a handle assembly  100  and a plurality of adapter assemblies, e.g., adapter assemblies  400 ,  500  ( FIG. 3 ), configured for releasable engagement and use with handle assembly  100 . Each adapter assembly  400 ,  500  is configured for actuating one or more particular clip cartridge assemblies (not shown), end effectors (not shown), or surgical tools (not shown). The adapter assemblies  400 ,  500  may be reusable components configured for releasable engagement and use with one or more disposable clip cartridge assemblies, disposable/reusable end effectors, and/or disposable/reusable surgical tools. Alternatively, the adapter assemblies  400 ,  500  may be integral with corresponding clip cartridge assemblies, end effectors, or surgical tools and, together, may be reusable or disposable. Handle assembly  100  is configured as a reusable component. 
         [0037]    With reference to  FIG. 1 , handle assembly  100  of surgical clip applier  10  includes a housing  102 , a trigger  104 , a plug  106 , and a plunger assembly  110 . Housing  102  includes a stationary handle portion  102   a , and a barrel portion  102   b  supported on stationary handle portion  102   a . Barrel portion  102   b  defines a lumen  102   c  ( FIG. 2 ) therethrough. In some embodiments, barrel portion  102   b  includes a lock collar  120  rotatably coupled to barrel portion  102   b  and extending distally therefrom. Housing  102  of handle assembly  100  may be formed of a suitable plastic or thermoplastic material, or from stainless steel or the like. 
         [0038]    Trigger  104  of handle assembly  100  is pivotably connected to stationary handle portion  102   a  of housing  102 . Trigger  104  includes a finger grip portion  104   a  projecting from stationary handle portion  102   a  and/or barrel portion  102   b  of housing  102 , and an actuation stem  104   b  configured to move into lumen  102   c  ( FIG. 2 ) of barrel portion  102   b  of housing  102 , as detailed below. Trigger  104  may be formed of a suitable plastic or thermoplastic material, or from stainless steel or the like. 
         [0039]    Plug  106  of handle assembly  100  is releasably securable within a proximal end of barrel portion  102   b  of housing  102  for closing the proximal end of barrel portion  102   b  and lumen  102   c  ( FIG. 2 ) of housing  102 . Plug  106  may be connectable to barrel portion  102   b  of housing  102  via screw threads, a bayonet-type arrangement, or other suitable releasable engagement structure. Plug  106  may be formed of a suitable plastic or thermoplastic material, or from stainless steel or the like. 
         [0040]    Plunger assembly  110  of handle assembly  100  is removably supported within lumen  102   c  ( FIG. 2 ) of barrel portion  102   b  of housing  102 . Plunger assembly  110  includes a plunger  112  having a head portion  112   a  and a shaft portion  112   b  extending distally from head portion  112   a . Plunger assembly  110  further includes a flange  114  slidably supported on shaft portion  112   b  at a location proximal of a distal tip of shaft portion  112   b . The distal tip of shaft portion  112   b  may have an enlarged radial profile, or other suitable feature, thereby preventing flange  114  from being removed from the distal end of shaft portion  112   b . Head portion  112   a  of plunger  112  inhibits flange  114  from being removed from the proximal end of shaft portion  112   b . A biasing member  116  of plunger assembly  110  is disposed about shaft portion  112   b  and interposed between head portion  112   a  of plunger  112  and flange  114  to bias flange  114  distally relative to shaft portion  112   b . The components of plunger assembly  110  may be formed of a suitable plastic or thermoplastic material, or from stainless steel or the like. 
         [0041]    With additional reference to  FIG. 2 , when plunger assembly  110  is loaded into lumen  102   c  of barrel portion  102   b  of housing  102 , the distal tip of shaft portion  112   b  of plunger  112  slidably extends through an aperture in a support wall  102   d  of housing  102 , and flange  114  rests adjacent to or in contact with a proximal surface of support wall  102   d  of housing  102 . Following loading of plunger assembly  110  into lumen  102   c  of barrel portion  102   b  of housing  102 , trigger  104  is pivoted until actuation stem  104   b  of trigger  104  is moved into lumen  102   c  of barrel portion  102   b  adjacent to or in contact with head portion  112   a  of plunger  112 . Plug  106  may then be connected to barrel portion  102   b  of housing  102  to maintain actuation stem  104   b  of trigger  104  adjacent to or in operative contact with head portion  112   a  of plunger  112 . At this point, actuation stem  104   b  is inhibited from returning proximally and is only permitted to move distally upon actuation of trigger  104  towards stationary handle  102   a  of housing  102 . 
         [0042]    Turning to  FIGS. 2-6 , as mentioned above, surgical clip applier  10  may include a plurality of adapter assemblies, e.g., a first adapter assembly  400  and a second adapter assembly  500 , each configured for operable coupling with handle assembly  100  and interfacing with one or more specific clip cartridge assemblies, end effectors, and/or surgical tools. 
         [0043]    With particular reference to  FIGS. 2, 4, and 5 , first adapter assembly  400  includes an outer tubular shell  402 , a tubular shaft  404 , and a plunger assembly  410 . Shell  402  defines a lumen  402   a  therethrough. Shell  402  is configured and dimensioned for selective receipt within and connection to a distal portion of lumen  102   c  of barrel portion  102   b  of housing  102 . Lumen  402   a  of shell  402  includes a relatively larger diameter proximal portion, and a relatively smaller diameter distal portion. 
         [0044]    Shaft  404  of first adapter assembly  400  is fixedly secured to and extends distally from shell  402 . Shaft  404  includes a proximal end disposed within the relatively smaller diameter distal portion of shell  402  and extending at least partially into the relatively larger diameter proximal portion of shell  402 . A collar  406  is disposed within the relatively larger diameter proximal portion of shell  402  to which the proximal end of shaft  404  is fixedly secured. 
         [0045]    Plunger assembly  410  of first adapter assembly  400  is disposed within the relatively larger diameter proximal portion of shell  402 . Plunger assembly  410  includes a stem  412  disposed proximally of collar  406 . Stem  412  defines a lumen  412   a  therethrough which is axially aligned with shaft  404 . Plunger assembly  410  further includes a plunger  414  having a head portion  414   a  and a shaft portion  414   b  extending from head portion  414   a . Shaft portion  414   b  extends into lumen  412   a  of stem  412  and is slidable relative thereto. Plunger assembly  410  also includes a biasing member  416  disposed about stem  412  of shaft portion  414   b  of plunger  414  and interposed between head portion  414   a  of plunger  414  and collar  406  so as to bias plunger  414  proximally relative to collar  406 . 
         [0046]    First adapter assembly  400  may be connected to handle assembly  100  by a bayonet-type arrangement by inserting shell  402  into the distal portion of lumen  102   c  of barrel portion  102   b  of housing  102 , and then rotating shell  402  of first adapter assembly  400  relative to barrel portion  102   b  of housing  102  to engage the thread(s) within the corresponding groove(s) of the bayonet coupling (not shown). Alternatively, first adapter assembly  400  may be connected to handle assembly  100  by inserting shell  402  into the distal portion of lumen or passage  102   c  of barrel portion  102   b  of housing  102 , and then rotating lock collar  120  of handle assembly  100  relative to both housing  102  and shell  402  to engage the thread(s) with the corresponding groove(s) of the bayonet coupling. Other suitable releasable engagement structures, e.g., mechanical latches, snap-fit connections, etc., are also contemplated. 
         [0047]    As best shown in  FIG. 3 , shell  402  of first adapter assembly  400  may be provided with a longitudinally extending rib  402   b . Rib  402   b  of shell  402  acts like a clocking feature to radially orient and align first adapter assembly  400  with handle assembly  100  for proper connection or coupling of first adapter assembly  400  and handle assembly  100 . Handle assembly  100  may include a complementary recess (not shown) or other suitable feature configured to receive rib  402   b  and align first adapter assembly  400  relative to handle assembly  100 . In embodiments where rib  402   b  is provided, lock collar  120  may also be provided such that lock collar  120  may be rotated relative to both housing  102  and shell  402  (while housing  102  and shell  402  remain stationary relative to one another) to engage first adapter assembly  400  with handle assembly  100 , as noted above, thereby maintaining the proper orientation of first adapter assembly  400  relative to handle assembly  100 . 
         [0048]    Referring to  FIGS. 1-5 , in operation, with first adapter assembly  400  coupled with handle assembly  100  as detailed above, with plunger assembly  110  loaded in housing  102  as also detailed above, and with a clip cartridge assembly, end effector, or surgical tool connected or coupled to first adapter assembly  400 , surgical clip applier  10  is ready for use. In use, as trigger  104  of handle assembly  100  is actuated towards stationary handle portion  102   b  of housing  102 , stem  104   b  of trigger  104  engages head portion  112   a  of plunger  112  of plunger assembly  110  and distally advances plunger  112 , thereby compressing biasing member  116  between flange  114  and head portion  112   a  of plunger  112  of plunger assembly  110 . As plunger  112  is advanced distally, shaft portion  112   b  of plunger  112  engages and acts on head portion  414   a  of plunger assembly  410  of first adapter assembly  400 . 
         [0049]    With shaft portion  112   b  of plunger assembly  112  engaging and acting on head portion  414   a  of plunger  414  of plunger assembly  410  of first adapter assembly  400 , plunger  414  is advanced distally, thereby compressing biasing member  416  between collar  406  and head portion  414   a  of plunger  414 . As plunger  414  is advanced in a distal direction, shaft portion  414   b  of plunger  414  is advanced in a distal direction through lumen  412   a  of stem  412 . 
         [0050]    Upon sufficient distal advancement of shaft portion  414   b  of plunger  414 , a distal end of shaft portion  414   b  of plunger  414  is sufficiently advanced through or beyond lumen  412   a  of stem  412  so as to act on or otherwise engage the clip cartridge assembly, end effector, or surgical tool operatively connected to first adapter assembly  400  to actuate the respective clip cartridge assembly, end effector, or surgical tool. 
         [0051]    Referring to  FIGS. 3 and 6 , in accordance with the present disclosure, first adapter assembly  400  may be replaced by second adapter assembly  500 , or any other suitable adapter assembly having a particular clip cartridge assembly, end effector, or surgical tool operably associated therewith. By replacing first adapter assembly  400  with, for example, second adapter assembly  500 , handle assembly  100  ( FIG. 1 ) is capable of actuating the corresponding clip cartridge assembly, end effector, or surgical tool operably associated with second adapter assembly  500 , e.g., to actuate different types and/or sizes of clips. 
         [0052]    In accordance with the present disclosure, each adapter assembly, for example, adapter assemblies  400  and  500 , may have a different or unique stroke length from one another in order to accommodate a particular function of the adapter assembly  400  or  500 . 
         [0053]    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.