Abstract:
A surgical clip applier is provided including a housing, at least one handle pivotably connected to the housing, an outer support channel extending distally from the housing, a drive channel sliadably disposed within the outer support channel, a jaw assembly including a first and second pair of jaws extending from an end of the outer support channel in a parallel configuration, and an integrated cutting mechanism disposed within a gap defined between the first and second pair of jaws. The jaw assembly is capable of effectuating formation of a pair of clips disposed within a respective first and second pair of jaws in response to movement of the at least one handle and the cutting mechanism is independently operable of the at least one handle. At least one jaw member of each of the pair or jaws includes a curved distal end. A method of operating same is also provided.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62/108,582 filed Jan. 28, 2015, the entire disclosure of which is incorporated by reference herein. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present application relates to surgical instruments, and more particularly, to surgical clip appliers capable of applying one or more clips to body tissues and vessels simultaneously and thereafter, transecting body tissues and/or vessels during surgical procedures. 
         [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. One example of such an instrument is disclosed in U.S. Pat. No. 3,735,762 to Bryan et al. Although capable of applying multiple clips simultaneously, and thereafter, transecting tissue, instruments such as the one disclosed in the Bryan et al. patent perform the steps of ligating and transecting the tissue in a single motion (i.e., in one continuous motion). This continuous motion makes it difficult for the surgeon to inspect the quality of ligation before transecting the tissue. 
         [0006]    Although instruments such as these reduce the complexity and overall time required to complete the operation, there remains a need for a clip applier having the ability to apply multiple clips simultaneously, while being able to transect tissue independently of clip application. 
       SUMMARY 
       [0007]    The present application relates to surgical clip appliers capable of applying one or more clips to body tissues and vessels simultaneously and thereafter, transecting body tissues and/or vessels during surgical procedures and their methods of use. 
         [0008]    According to an aspect of the present disclosure, a surgical clip applier is provided including a housing, at least one handle pivotably connected to the housing, an outer support channel extending distally from the housing, a drive channel slidably disposed within the outer support channel, a jaw assembly including a first and second pair of jaws extending from an end of the outer support channel in a parallel configuration, and a cutting mechanism disposed within a gap defined between the first and second pair of jaws. The drive channel is in mechanical communication with the at least one handle. The cutting mechanism extends from an end of the outer support channel and includes a pair of elongate members capable of movement relative to each other. The cutting mechanism is capable of operation independent of the at least one handle. Each of the first and second pair of jaws is configured to receive a respective clip therein. The jaw assembly is operable to effect formation of each respective clip in response to movement of the at least one handle and the drive channel and at least one jaw member of each of the pair of jaws includes a curved distal end extending towards the opposite one of the at least one jaw member. 
         [0009]    The clip applier may further include a biasing element disposed within the drive channel. The biasing element may be in operable communication with the at least one handle such that the at least one handle is biased towards a first, open position. 
         [0010]    The clip applier may further include a clip loaded into each jaw of the first and second pairs of jaws. The clip may include first and second arms extending distally from a crown. The arms may extend distally in a parallel configuration and the first arm may include a transverse extension on a distal end thereof extending towards the second arm. 
         [0011]    The first arm of the clip may include a cutout adapted to receive a tapered distal end of the second arm when the clip is fully formed. 
         [0012]    The clip applier may further include a trigger lock capable of retaining the at least one handle in a second position wherein the jaw assembly is in an approximated position. 
         [0013]    The trigger lock may be manually releasable. 
         [0014]    The clip applier may further include a shuttle slidably disposed within the outer support channel. The shuttle may be in mechanical cooperation with the cutting mechanism. 
         [0015]    The shuttle may include an actuating pin disposed on opposing sides of a proximal end thereof. 
         [0016]    The shuttle may further include a V-shaped notch defined through opposing sides of a distal end thereof. The V-shaped notch may be configured to engage the pair of elongate members of the cutting mechanism. 
         [0017]    A distal end of each of the pair of elongate members of the cutting mechanism may include a sharpened edge capable of transecting tissue. The sharpened edges may be in juxtaposed relation to one another. 
         [0018]    Advancement of the shuttle may cause the V-shaped notch to engage a proximal end of each of the pair of elongate members, thereby causing the distal end of each of the pair of elongate members to move from a first, open, position, to a second, approximated, position. 
         [0019]    According to another aspect of the present disclosure, a method of ligating and transecting tissue is also provided, including selecting a surgical clip applier including a housing, at least one handle pivotably connected to the housing, an outer support channel extending distally from the housing, a drive channel slidably disposed within the outer support channel, a jaw assembly including a first and second pair of jaws extending from an end of the outer support channel in a parallel configuration, and a cutting mechanism disposed within a gap defined between the first and second pair of jaws. The drive channel is in mechanical communication with the at least one handle. The cutting mechanism extends from an end of the outer support channel and includes a pair of elongate members capable of movement relative to each other. The cutting mechanism is capable of operation independent of the at least one handle. Each of the first and second pair of jaws is configured to receive a respective clip therein. The jaw assembly is operable to effect formation of each respective clip in response to movement of the at least one handle and the drive channel and at least one jaw member of each of the pair of jaws includes a curved distal end extending towards the opposite one of the at least one jaw member. 
         [0020]    The method further includes loading a pair of clips within a respective first and second pair of jaws, advancing the first and second pair of jaws of the clip applier within an incision of a patient, disposing target tissue into the jaw assembly and into the cutting mechanism, actuating the at least one handle to advance the drive channel, and actuating the cutting mechanism independent of the at least one handle, thereby transecting the target tissue. Advancing the drive channel causes the first and second pairs of jaws to move from an open position to an approximated position, thereby effectuating formation of the pair of clips. 
         [0021]    The actuation of the cutting mechanism may further include advancing a shuttle slidably disposed within the outer support housing. The shuttle may include a V-shaped cutout defined in opposing sides of the shuttle dimensioned to move the elongate members of the cutting mechanism from a first, open position, to a second, approximated position, thereby transecting the target tissue. 
         [0022]    The method may further include releasing a trigger lock to return the at least one handle to a first, open position. 
         [0023]    Although the above aspects and embodiments are described separately for convenience and clarity, it is contemplated that the above aspects and embodiments may be combined without departing from the scope of the present disclosure. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0024]    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: 
           [0025]      FIG. 1  is a top, plan view, of a surgical clip applier according to an embodiment of the present disclosure; 
           [0026]      FIG. 2  is an enlarged top, plan view, of a handle assembly of the surgical clip applier of  FIG. 1 ; 
           [0027]      FIG. 3  is a top, plan view, of the surgical clip applier of  FIG. 1 , showing a return spring thereof; 
           [0028]      FIG. 4  is an enlarged top, plan view, of the handle assembly of  FIG. 2 , showing the surgical clip applier of  FIG. 1  in an approximated position; 
           [0029]      FIG. 5  is a front, perspective view, of a distal end of the surgical clip applier of  FIG. 1 ; 
           [0030]      FIG. 6  is a front, perspective view, of a single jaw member and a surgical clip of the surgical clip applier of  FIG. 1 ; 
           [0031]      FIG. 7  is a front, perspective view, of the distal end of the surgical clip applier of  FIG. 1 , shown disposed on a body vessel; 
           [0032]      FIG. 8  is a top, plan view, of the surgical clip applier of  FIG. 1  showing the jaw members and an integrated cutting mechanism in an open position; 
           [0033]      FIG. 9  is a top, plan view, of the surgical clip applier of  FIG. 1 , shown with the jaw members in an approximated position; 
           [0034]      FIG. 10  is a top, plan view, of the surgical clip applier of  FIG. 1  showing a shuttle in an advanced position; 
           [0035]      FIG. 11  is a top, plan view, of the surgical clip applier as shown in  FIG. 9 , showing the cutting mechanism in an approximated position and the jaw members in an open position; and 
           [0036]      FIG. 12  is a rear, perspective view, of a surgical clip according to an embodiment of the present disclosure. 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0037]    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. 
         [0038]    Referring now to  FIG. 1 , a surgical clip applier in accordance with an embodiment of the present disclosure is generally designated as  100 . It is contemplated that any of the components of surgical clip applier  100  may be formed from any suitable biocompatible material such as stainless steel, titanium, or the like. Surgical clip applier  100  generally includes a handle assembly  102  including a housing  104  having upper housing half  104   a  and lower housing half  104   b . Handle assembly  102  further includes a pair of handles  106  pivotably secured to housing  104  and extending outwardly therefrom. An outer support channel  108  is fixedly secured to housing  104  and extends distally therefrom. Housing halves  104   a  and  104   b  may be joined through one or more screws, rivets, or the like, or through the use of glues or other adhesives. 
         [0039]    Continuing with  FIG. 1 , handles  106  are pivotably secured to housing  104  by handle pivot pins (not shown) extending between upper and lower housing halves  104   a ,  104   b  through respective apertures  106   a  formed in handles  106 . Handle pivot pins may be any suitable fastener, such as a roll pin, rivet, screw, or the like. Handle assembly  102  includes a link member  122  pivotally connected, by means of a retaining pin (not shown), to each handle  106  at a pivot point  106   b  formed in a lug disposed on a respective handle  106 . Although generally shown as being formed in a lug, it is contemplated that pivot point  106   b  may be integrally formed through inner and outer surfaces of a respective handle  106 . A distal end of each link member  122  is pivotally connected to a pivot point  142  formed in a drive channel  140  via a drive pin (not shown). The drive pin and retaining pins may be any suitable pin, such as a roll pin, rivet, screw, or the like. 
         [0040]    A return spring  144  ( FIG. 3 ) is disposed about pivot point  142  within drive channel  140  and includes spring arms  144   a  extending proximally therefrom. Spring arms  144   a  are compressed by handles  106 , as handles  106  are squeezed, and provide a biasing force in a direction maintaining handles  106  in an open position. 
         [0041]    Handle assembly  102  further includes trigger lock  146  ( FIG. 4 ). Trigger lock  146  includes upper and lower ends and defines a longitudinal axis extending therebetween. Trigger lock  146  is rotatably secured to a handle  106  at an upper end and includes a locking arm  146   a  on the lower end extending in a direction normal to the longitudinal axis. Locking arm  146   a  engages the opposite handle  106  when handles  106  are in an approximated position ( FIG. 2 ), thereby prohibiting return spring  144  from returning handles  106  to an open position. Trigger lock  146  is manually released, such that handles  106  may only return to an open position after locking arm  146   a  is manipulated to release handle  106 . 
         [0042]    With reference to  FIGS. 1 and 8 , outer support channel  108  is generally shown as having a substantially quadrilateral cross section; however, it is contemplated that outer support channel  108  may have any suitable shape, such as circular, oval, or the like. Drive channel  140  is slidably supported within a lumen  108   a  ( FIG. 8 ) defined through proximal and distal ends of outer support channel  108 . Although generally shown as having a cross section complimentary to that of outer support channel  108 , it is contemplated that drive channel  140  may have any suitable shape, such as rectangular, square, circular, or the like. A distal end of drive channel  140  is substantially box shaped or rectangular for receiving jaw assembly  150  and for actuating jaw assembly  150  upon translation of drive channel  140  relative to jaw assembly  150 . 
         [0043]    Referring now to  FIGS. 5 and 6 , an illustration of jaw assembly  150  is shown. Jaw assembly  150  includes two pairs of jaws  152 ,  153  mounted on or at a distal end of outer support channel  108  and actuatable by handles  106 , as will be discussed in further detail herein. As shown in  FIG. 5 , each one of the pair of jaws  152 ,  153  is arranged in a side-by-side configuration, separated by a channel or gap  154 . Jaws  152 ,  153  are formed from any suitable biocompatible material such as stainless steel, titanium, or the like. Jaws  152 ,  153  are mounted within a distal end of outer support channel  108  via any suitable means capable of retaining jaws  152 ,  153  at a position longitudinally stationary relative to outer support channel  108 , such as screws, rivets, or the like. 
         [0044]    In the interest of brevity, jaw  152  is similar to jaw  153  and thus only the details of jaw  152  will be described in further detail herein. As shown in  FIG. 6 , the distal end of jaw  152  includes a first jaw portion  152   a  having a straight configuration and a second jaw portion  152   b  having a curved configuration such that the distal end of second jaw portion  152   b  curves towards first jaw portion  152   a . The curved distal end of second jaw portion  152   b  extends past or across first jaw portion  152   a  such that first jaw portion  152   a  nests within second jaw portion  152   b  when jaw  152  is in an approximated position. The curved distal end of second jaw portion  152   b  permits easier access to the target tissue by encouraging the tissue to be scooped into the jaw assembly  150 , facilitates retention of a surgical clip  160  within respective jaw  152 ,  153 , and facilitates proper formation of surgical clip  160 . Jaw  152  defines a channel  152   c  between first and second jaw portions  152   a ,  152   b  for manually receiving a surgical clip  160  therein. 
         [0045]    Continuing with  FIG. 6 , during actuation of handles  106  of clip applier  100 , the distal end of drive channel  140  is distally advanced and acts against a tapered portion  156  of each of the pair of jaws  152 ,  153 , thereby causing each of the pair of jaws  152 ,  153  to transition from an open position to an approximated position, which in turn, forms the surgical clip  160  disposed between the respective first and second jaw portions thereof. 
         [0046]    With reference to  FIG. 9 , an illustration of an integrated cutting mechanism  170  of the clip applier  100  is shown. Integrated cutting mechanism  170  is disposed between the pair of jaws  152 ,  153 , and includes a pair of elongate members  170   a , hingedly connected about a hinge pin (not shown). The hinge pin is disposed within a bore  170   b  defined through a center region of each of the pair of elongate members  170   a  and is retained within a through-hole  108   b  defined through inner and outer side surfaces of outer support channel  108 . The hinge pin may be any suitable pin, such as a roll pin, rivet, screw, or the like. As shown in  FIG. 9 , the pair of elongate members  170   a  are oriented substantially in an “x” configuration, such that an application of opposing forces on the proximal end of each of the pair of elongate members  170   a  causes the pair of elongate members  170   a  to rotate about the hinge pin, thereby causing the distal end of each of the pair of elongate members  170   a  to move from an open position to an approximated position (i.e., in a scissoring manner). The inner edges of the distal end of the pair of elongate members  170   a  may include a sharpened edge  170   c  to facilitate transecting or cutting of tissue disposed therebetween. It is contemplated that sharpened edge  170   c  may be disposed on each of the pair of elongate members  170   a  in juxtaposed relation to each other. 
         [0047]    Referring now to  FIG. 10 , an illustration of a shuttle  174  of clip applier  100  is shown. Shuttle  174  is disposed within outer support channel  108  and is dimensioned to be slidably supported therein, such that shuttle  174  may be operated independent of any actuation of handles  106 . A proximal end of shuttle  174  includes actuating pins  174   a  disposed on opposing sides thereof. Actuating pins  174   a  may be integral to shuttle  174  or may be any suitable pin retained within a through-bore (not shown) defined within shuttle  174 . Alternatively, a single actuating pin may extend completely through shuttle  174  and project from opposed sides thereof. Actuating pins  174   a  extend through slots  110  defined through opposing sides of outer support channel  108 , thereby enabling a clinician to grasp and advance shuttle  174  within outer support channel  108 . A distal end of shuttle  174  includes a V-shaped cutout or notch  174   b  defined through opposing sides of shuttle  174 . As seen in  FIG. 11 , V-shaped cutout  174   b  is configured to impart a force upon the proximal end of the pair of elongate members  170   a  of the integrated cutting mechanism  170  as shuttle  174  is advanced, thereby causing the elongate members  170   a  to move from an open position, to an approximated position. 
         [0048]    An embodiment of a surgical clip  160 , according to the present disclosure, is illustrated in  FIG. 12 . Surgical clip  160  includes parallel first and second arms  160   a ,  160   b  extending in a common direction from a crown  160   c , thereby forming a generally U-shaped configuration. The free end of second arm  160   b  extends further than opposing first arm  160   a  and includes a transverse extension  160   d , extending in a direction towards first arm  160   a , such that the target tissue or vessel “V” may be secured therein before the surgical clip  160  is fully formed, thereby reducing the possibility that the target tissue or vessel “V” will slip out of the surgical clip  160 . A cutout or recess  160   e  is defined within the intersection of second arm  160   b  and transverse extension  160   d , and is configured to receive a tapered free end  160   f  of first arm  160   a  when surgical clip  160  is fully formed, increasing the amount of force required for the target tissue or vessel “V” to be pulled out of the surgical clip  160  (i.e., decreasing the probability that the target tissue or vessel “V” may be pulled out of the surgical clip  160 ). Surgical clip  160  is dimensioned to be received within channel  152   c  of jaws  152 ,  153  such that when surgical clip  160  is advanced within channel  152   c , transverse extension  160   d  abuts the curved distal end of second jaw portion  152   b , thereby preventing surgical clip  160  from further advancing. Surgical clip  160  may be formed from any suitable biocompatible material, such as stainless steel, titanium, or the like. 
         [0049]    With reference to  FIGS. 1-12 , the operation of clip applier  100  is provided. Prior to any initial squeezing of handles  106  of clip applier  100 , a pair of clips  160  are loaded into the jaw assembly  150  by advancing each clip within a respective channel  152   c  of first and second jaws  152 ,  153  until transverse extension  160   d  of surgical clip  160  abuts the curved distal end of respective second jaw portion  152   b  ( FIG. 6 ) (i.e., until transverse extension  160   d  of surgical clip  160  is disposed proximal to the curved distal end of second jaw portion  152   b ). Clip applier  100  is then advanced within an incision of a patient, and using the curved distal end of second jaw portion  152   b , the clinician may scoop the target tissue or vessel “V” within the jaws  152 ,  153 . The curved distal end of each second jaw portion  152   b  inhibits the target tissue or vessel “V” from becoming dislodged from the jaws  152 ,  153  of the clip applier  100 . 
         [0050]    As handles  106  are squeezed an initial amount, link members  122  push drive pin  142  distally ( FIG. 3 ). As drive pin  142  is pushed distally, drive channel  140  is also translated distally within outer support channel  108 . As handles  106  are squeezed further, drive channel  140  advances distally such that the distal end of drive channel  140  comes into contact with tapered portion  156  of jaws  152 ,  153 . With continued squeezing of handles  106 , the distal end of drive channel  140  cams the tapered portion  156  of jaws  152 ,  153 , causing jaws  152 ,  153  to move from an open position to an approximated position ( FIG. 5 ). Manipulating jaws  152 ,  153  from an open position to an approximated position forms surgical clip  160  about the target tissue or vessel “V” such that the tapered distal end  160   f  of first arm  160   a  nests within cutout  160   e  of second arm  160   b , thereby inhibiting the target tissue or vessel “V” from becoming dislodged from the surgical clip  160  ( FIG. 8 ). 
         [0051]    Once handles  106  are fully squeezed such that the surgical clip  160  is fully formed, locking arm  146   a  of trigger lock  146  may be engaged, thereby preventing handles  106  from returning to the open position ( FIG. 4 ). Once trigger lock  146  is engaged, the clinician may inspect each surgical clip  160  to ensure proper ligation. Thereafter, if the surgical clips  160  are adequately formed, actuating pin  174   a  is advanced distally along outer support channel  108  ( FIG. 10 ). As actuating pin  174   a  is advanced, shuttle  174  is advanced causing V-shaped cutout  174   b  to engage the proximal end of the pair of elongate members  170   a  of the integrated cutting mechanism  170  ( FIG. 9 ). As actuating pin  174   a  is further advanced, the pair of elongate members  170   a  move from an open position to an approximated position (i.e., in a scissoring action), where the sharpened edges  170   b  transect or cut the target tissue or vessel “V” ( FIG. 11 ). After transecting the target tissue or vessel “V”, actuating pin  174   a  is retracted proximally to return the integrated cutting mechanism  170  to the open position. Thereafter, the trigger lock  146  is manually released, thereby allowing return spring  144  to return handles  106  to the open position, releasing the target tissue or vessel “V” from jaws  152 . 
         [0052]    After handles  106  are returned to the initial or original position, clip applier  100  is ready to apply additional surgical clips  160  to tissue or vessels in the manner described above. 
         [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.