Abstract:
An occlusion assembly comprising: (a) a tissue occlusion device comprising a first linear clamping portion and a second linear clamping portion, the first and second linear clamping portions oriented to overlap and be parallel to one another in a clamped position, the tissue occlusion device further including a spring concurrently coupled to and interposed by the first and second linear clamping portions to bias the first and second linear clamping portions toward the clamped position; and, (b) an endoscopic rein coupled to the tissue occlusion device and configured to facilitate repositioning of the tissue occlusion device toward an occlusion position where the first and second linear clamping portions are interposed by tissue, where the endoscopic rein includes a flexible wire coupled to the clamping device and configured to facilitate repositioning of the tissue occlusion device toward the occlusion position.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of nonprovisional patent application Ser. No. 12/944,430, filed Nov. 11, 2010, now U.S. Pat. No. ______, the disclosure of which is incorporated herein by reference. 
     
    
     RELATED ART 
     Field of the Invention 
       [0002]    The present invention is directed to applicators for clamps and, more specifically, for applicators that may be utilized in minimally invasive procedures to position and apply the occlusion clamps. 
       INTRODUCTION TO THE INVENTION 
       [0003]    It is a first aspect of the present invention to provide a removable deployment device for a clamp comprising: (a) a first retainer bar including a line coupled thereto; (b) a second retainer bar including a second line coupled thereto, where the first retainer bar is coupled to the second retainer bar. 
         [0004]    In a more detailed embodiment of the first aspect, the first retainer bar includes a first depression on its exterior surface, and the first line extends across the first depression. In yet another more detailed embodiment, the second retainer bar includes a second depression on its exterior surface, and the second line extends across the second depression. In a further detailed embodiment, the first retainer bar includes a projection extending therefrom, the projection including a crucifix. In still a further detailed embodiment, the second retainer bar includes a projection extending therefrom, the projection including a first segment extending perpendicularly from the second retainer bar, and a second segment including a hook mounted to the first segment. 
         [0005]    In yet another more detailed embodiment of the first aspect, the second retainer bar includes a projection extending therefrom, the projection including a hook. In yet another more detailed embodiment of the first aspect, the engagement feature may be a hole into or through one or both retaining bars. In still another more detailed embodiment, the first retainer bar includes a first through hole, the second retainer bar includes a second through hole, and a third line is concurrently received within the first through hole and the second through hole to couple the first and second retainer bars. In a further detailed embodiment, an extraction tab is coupled to the third line. In still a further detailed embodiment, at least one of the first line, the second line, and the third line comprises a suture. In a more detailed embodiment, the first line comprises a first suture, the second line comprises a second suture, and the third line comprises a third suture. 
         [0006]    It is a second aspect of the present invention to provide a clamp assembly comprising: (a) a clamp including at least first and second elongate clamping portions biased toward one another; (b) a first retainer bar including a first line removably coupling the first retainer bar to the first elongate clamping portion; (c) a second retainer bar including a second line removably coupling the second retainer bar to the second elongate clamping portion, where the first retainer bar is coupled to the second retainer bar. 
         [0007]    In a more detailed embodiment of the second aspect, the first retainer bar includes a first depression on its exterior surface, and the first line extends across the first depression. In yet another more detailed embodiment, the second retainer bar includes a second depression on its exterior surface, and the second line extends across the second depression. In a further detailed embodiment, the first retainer bar includes a projection extending therefrom, the projection including a crucifix. In still a further detailed embodiment, the second retainer bar includes a projection extending therefrom, the projection including a first segment extending perpendicularly from the second retainer bar, and a second segment including a hook mounted to the first segment. In a more detailed embodiment, the second retainer bar includes a projection extending therefrom, the projection including a hook. 
         [0008]    In yet another more detailed embodiment of the second aspect, the first retainer bar includes a first through hole, the second retainer bar includes a second through hole, and the third line is concurrently received within the first through hole and the second through hole. In still another more detailed embodiment, an extraction tab is coupled to the first and second retainer bars. In a further detailed embodiment, at least one of the first line, the second line, and the third line comprises a suture. In still a further detailed embodiment, the first line comprises a first suture, the second line comprises a second suture, and the third line comprises a third suture. In a more detailed embodiment, the clamp comprises a first and second elongate clamping portions respectively having ends coupled together with respective resilient urging members configured to urge the first and second elongate clamping portions toward one another. In a more detailed embodiment, the clamp further comprises a fabric covering over the first and second elongate clamping portions. 
         [0009]    It is a third aspect of the present invention to provide a method of fabricating a clamp comprising: (a) mounting a first retainer bar to a first elongate clamping portion of a clamp using a first line, the clamp also including a second elongate clamping portion, where the first and second elongate clamping portions are biased toward one another; (b) mounting a second retainer bar to the second elongate clamping portion of the clamp using a second line; (c) mounting the first retainer bar to the second retainer bar, where the first and second elongate clamping portions each include proximal and distal longitudinal ends, where the proximal longitudinal ends are coupled to a first spring, and where the distal longitudinal ends are coupled to a second spring. 
         [0010]    In a more detailed embodiment of the third aspect, the first line comprises a suture. In yet another more detailed embodiment, mounting the first retainer bar to the first elongate clamping portion includes looping the first line around the first elongate clamping portion and tying the first line to the first retainer bar, and mounting the second retainer bar to the second elongate clamping portion includes looping the second line around the second elongate clamping portion and tying the second line to the second retainer bar. In a further detailed embodiment, tying the first line to the first retainer bar includes forming a plurality of half hitch knots, and tying the second line to the second retainer bar includes forming a plurality of half hitch knots. In still a further detailed embodiment, tying the first line to the first retainer bar includes forming a timberline knot, and tying the second line to the second retainer bar includes forming a timberline knot. In a more detailed embodiment, mounting the first retainer bar to the second retainer bar includes using a third line coupled to both the first retainer bar and the second retainer bar. In a more detailed embodiment, the first elongate clamping portion and the second elongate clamping portion are coupled together using at least one line. In a more detailed embodiment, at least one of the first retainer bar and the second retainer bar includes a crucifix projection adapted to be gripped by endoscopic graspers. In another more detailed embodiment, the first retainer bar includes a first projection adapted to be gripped by endoscopic graspers, where the first projection is directed away from the clamp, and the second retainer bar includes a second projection adapted to be gripped by endoscopic graspers, where the second projection is directed away from the clamp. The endoscopic graspers may be manual or robotically driven. 
         [0011]    It is a fourth aspect of the present invention to provide a clamp assembly comprising: (a) a clamping device biased toward a closed position; (b) a first retainer bar removably coupled to the clamping device; (c) a second retainer bar removably coupled to the clamping device, where the first retainer bar and the second retainer bar are oriented in parallel to one another and, where the first retainer bar and the second retainer bar each include an engagement feature to facilitate grasping by a grasping device. 
         [0012]    In a more detailed embodiment of the fourth aspect, the first retainer bar includes a first depression on its exterior surface, the first retainer bar includes a first line removably coupling the first retainer bar to the clamping device and, the first line extends across the first depression. In yet another more detailed embodiment, the second retainer bar includes a second depression on its exterior surface, the second retainer bar includes a second line removably coupling the second retainer bar to the clamping device and, the second line extends across the second depression. In a further detailed embodiment, the first retainer bar includes a projection extending therefrom, the projection including a crucifix. In still a further detailed embodiment, the second retainer bar includes a projection extending therefrom, the projection including a first segment extending perpendicularly from the second retainer bar, and a second segment including a hook mounted to the first segment. In a more detailed embodiment, the second retainer bar includes a projection extending therefrom, the projection including a hook. 
         [0013]    In yet another more detailed embodiment of the fourth aspect, the first retainer bar includes a first through hole, the second retainer bar includes a second through hole and, a line is concurrently received within the first through hole and the second through hole. In still another more detailed embodiment, the clamp assembly includes an extraction tab coupled to the line. In a further detailed embodiment, at least one of the first retainer bar and the second retainer bar is removably coupled to the clamping device using a suture. In still a further detailed embodiment, the first retainer bar is removably coupled to the clamping device using a first suture and, the second retainer bar is removably coupled to the clamping device using a second suture. In a more detailed embodiment, the clamping device comprises a first and second elongate clamping portions respectively having ends coupled together with respective resilient urging members configured to urge the first and second elongate clamping portions toward one another. In a more detailed embodiment, the clamping device further comprises a fabric covering over the first and second elongate clamping portions. 
         [0014]    It is a fifth aspect of the present invention to provide a clamp assembly comprising: (a) a clamping device biased toward a closed position; (b) a first retainer bar removably coupled to the clamping device; (c) a second retainer bar removably coupled to the clamping device and, where the first retainer bar and the second retainer bar are oriented in parallel to one another. 
         [0015]    In a more detailed embodiment of the fifth aspect, at least one of the first retainer bar and the second retainer bar includes a line to removably couple at least one of the first retainer bar and the second retainer bar to the clamping device. In yet another more detailed embodiment, the line lies across a cutting zone. In a further detailed embodiment, the cutting zone comprises a depression formed within an exterior of the least one of the first retainer bar and the second retainer bar. In still a further detailed embodiment, the line comprises at least one of a suture, a cable, a strap, and a thread. In a more detailed embodiment, at least one of the engagement features includes a projection. In a more detailed embodiment, the projection comprises at least one of a cruciform and a hook. In another more detailed embodiment, each engagement feature includes a projection and, the projection of the first retainer bar is different from the projection of the second retainer bar. In yet another more detailed embodiment, at least one of the engagement features includes a through hole. In still another more detailed embodiment, the engagement feature of the first retainer bar includes a through hole and, the engagement feature of the second retainer bar includes a through hole. 
         [0016]    In yet another more detailed embodiment of the fifth aspect, the first retainer bar is coupled to the second retainer bar using a retainer. In still another more detailed embodiment, the retainer comprises a line. In a further detailed embodiment, the line comprises at least one of a suture and a cable. In still a further detailed embodiment, the first retainer bar and the second retainer bar each include an engagement feature to facilitate grasping by a grasping device. In a more detailed embodiment, at least one of the first retainer bar and the second retainer bar includes a line to retrieve the retainer bar post decoupling at least one of the first retainer bar and the second retainer bar from the clamping device. In a more detailed embodiment, the clamping device comprises a first and second elongate clamping portions respectively having ends coupled together with respective resilient urging members configured to urge the first and second elongate clamping portions toward one another. In another more detailed embodiment, the clamping device further comprises a fabric covering over the first and second elongate clamping portions. In yet another more detailed embodiment, the clamping assembly further comprises at least one limiting line coupled to the clamping device, wherein the clamping device comprises a first and second elongate clamping portions configured to move toward and away from one another, the at least one limiting line limiting how far the first and second elongate clamping portions can move away from one another. In still another more detailed embodiment, the at least one limiting line is coupled to the first and second retainer bars. In still a further more detailed embodiment, the at least one limiting line is coupled to the first and second elongate clamping portions. In yet a further more detailed embodiment, the at least one limiting line is further coupled to the clamping device to continue the coupling of the at least one limiting line with the first and second elongate clamping portions. 
         [0017]    As used herein, the term “line” means or includes a tether such as, without limitation, a cable, a string, a thread, and/or a suture. 
         [0018]    As used herein, the term “grasper” means any device capable of grasping or gripping and includes, without limitation, endowrist jawed devices such as endoscopic graspers, minimally invasive graspers, tongs, and forceps. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0019]      FIG. 1  is an elevated perspective view of an exemplary occlusion clamp in accordance with the present disclosure. 
           [0020]      FIG. 2  is an elevated perspective view of the exemplary occlusion clamp of  FIG. 1  with a pair of exemplary retainer bars. 
           [0021]      FIG. 3  is an elevated perspective view of the exemplary occlusion clamp and exemplary retainer bars of  FIG. 2  being coupled together using lines. 
           [0022]      FIG. 4  is an elevated perspective view of an exemplary occlusion clamp and applicator assembly, along with a partial view of a pair of endoscopic graspers. 
           [0023]      FIG. 5  is an underneath, perspective view of the exemplary occlusion clamp and applicator assembly, along with a partial view of a pair of endoscopic graspers, of  FIG. 4 . 
       
    
    
     DETAILED DESCRIPTION 
       [0024]    The exemplary embodiments of the present invention are described and illustrated below to encompass methods and devices for opening and closing clamps/clips such as, without limitation, occlusion clamps. Of course, it will be apparent to those of ordinary skill in the art that the embodiments discussed below are exemplary in nature and may be reconfigured without departing from the scope and spirit of the present invention. However, for clarity and precision, the exemplary embodiments as discussed below may include optional steps, methods, and features that one of ordinary skill should recognize as not being a requisite to fall within the scope of the present invention. 
         [0025]    Referencing  FIGS. 1-5 , an exemplary occlusion clamp  100 , as shown and described in U.S. patent application Ser. No. 11/994,725, filed on Jul. 8, 2008, the disclosure of which is incorporated herein by reference, includes an applicator assembly  102  in order to reposition and deploy the occlusion clamp. The exemplary applicator assembly  102  includes a pair of retainer bars  104 ,  106  mounted to a fabric cover material  108  using sutures  110 ,  112 . In this exemplary embodiment, the fabric cover material  108  may be made of a material such as polyester having been sewn around the clamping portions  114 ,  116  and the urging members  118 ,  120 . 
         [0026]    Each retainer bar  104 ,  106  includes complementary depressions  122 ,  124  formed into the circumferential surface on opposite sides at two different longitudinal locations. Two primary through holes  126 ,  128  are longitudinally outset from each set of depressions  122 ,  124  and extend perpendicularly through the bar  104 ,  106 . The bars  104 ,  106  can contain more or less than two through holes. These primary through holes  126 ,  128  are also centered from side to side with respect to the diameter of the retainer bars  104 ,  106  so that the central axis of each hole intersects the central, longitudinal axis of the retainer bar. More specifically, each primary through hole  126 ,  128  includes complementary top and bottom openings that are on the same sides as the depressions  122 ,  124 . In other words, the rounded sides of the retainer bars  104 ,  106  that are offset approximately ninety degrees from the depressions  122 ,  124  are also offset approximately 90 degrees from the top and bottom openings of each primary through hole  126 ,  128 . Inset from the ends  130  of each retainer bar  104 ,  106  are secondary through holes  132  extending perpendicularly through the bar and are centered from side to side. But these secondary through holes  132  are perpendicular with respect to, but do not intersect, the primary through holes  126 ,  128 . As with the primary through holes  126 ,  128 , the secondary through holes  132  also have opposed top and bottom openings. As will be discussed in more detail below, the holes  126 ,  128  accommodate sutures  110 ,  112  to couple the bars  104 ,  106  to the occlusion clamp  100 . 
         [0027]    While the retainer bars  104 ,  106  are similar, there are some distinct differences between the two. For example, the retainer bars  104 ,  106  need not be exact compliments or mirrors of each other. In this exemplary embodiment, the second retainer bar  106  includes a projection  134  shaped to conform to the jaws  136  of a first endoscopic grasper  138 . An exemplary endoscopic grasper  138  that may be used coincident with the applicator assembly  102  includes, without limitation, the da Vinci surgical system available from Intuitive Surgical, Inc. (www.intuitivesurgical.com/products/davinci_surgicalsystem/index.aspx). This projection  134  extends perpendicularly away from the retainer bar  106  in a direction opposite the occlusion clamp  100 . In this exemplary embodiment, the projection  134  extends from the same side of the retainer bar  106  as where the depressions  122  are formed. The projection  134  includes a cylindrical post  140  having mounted thereto a crucifix  142 . The crucifix is oriented so that one set of coaxial projections  144  is parallel to the longitudinal axis of the retainer bar  106 , while a second set of coaxial projections  146  is perpendicular to the longitudinal axis. The length of the post  140  allows the jaws  136  of the endoscopic grasper  138  to sandwich the first set of coaxial projections  144 , while the second set of coaxial projections  146  extend through a respective oblong opening  148  of each endoscopic grasper  136 . In particular, as shown in  FIG. 4 , the shape of the crucifix  142  is well suited for gripping by the jaws  136  and accommodating tension forces when the jaws  136  are repositioned to open the occlusion clamp  100  while a second endoscopic grasper  150  is coupled to the first retainer bar  104 . It should also be noted that the retainer bars  104 ,  106  can be of varying or equivalent cross-sectional geometry. 
         [0028]    The first retainer bar  104  may differ from the second retainer bar  106  in the shape of its projection  152 . The projection  152  includes a longitudinal flange  154  having a perpendicular end plate  156  that is tapered and rounded over at its ends to form a pair of stops  158 . These stops  158  generally face the longitudinal flange  154  and are oriented toward the retainer bar  104 , thereby forming a pair of hooks. In other words, the projection includes a T-shaped cross-section and extends perpendicularly away from the retainer bar  104  in a generally opposite direction from the other projection  134 . In this exemplary embodiment, the longitudinal flange  154  is generally rectangular in shape and is dimensioned to allow for gripping by the jaws  162  of the second endoscopic grasper  150 . An exemplary endoscopic grasper  150  that may be used coincident with the applicator assembly  102  includes, without limitation, the da Vinci surgical system available from Intuitive Surgical, Inc. (www.intuitivesurgical.com/products/davinci surgicalsystem/index.aspx). 
         [0029]    By way of example, the jaws  136 ,  162  of the endoscopic graspers  138 ,  150  comprise a pair of individual jaws  170  pivoting around a common axis. Each jaw  170  includes a cylindrical base  172  having a bar  174  coupled to an oblong frame  176  extending perpendicularly away from the bar. The oblong frame  176  outlines the central opening  148  and is serrated on one side to facilitate gripping. As is shown in the figures, two of the jaws  170  are stacked upon one another so that the cylindrical bases  172  are aligned to be coaxial. In an exemplary configuration, the jaws  170  are oriented so that the oblong openings  148  overlap one another when the jaws  136 ,  162  are closed. Because of the openings  148  in the jaws  170 , the jaws are able to receive portions of the projections  134 ,  152  and capable of exerting tensile forces against aspects of the projections in addition to possibly exerting compressive (i.e., gripping) forces on the projections. 
         [0030]    Referring back to  FIGS. 3, 4 and 5 , the end plate  156  is dimensioned to extend far enough beyond the longitudinal flange  154  to accommodate the jaws  162  on opposing sides. Likewise, the height of the stops  158  and the tapered nature of the stops are dimensioned to pass into the through opening of one of the jaws  170 . As will be discussed in more detail below, the jaws  162  of the second endoscopic grasper  150  grip the projection  152  and pull the projection in a direction generally opposite to the direction of the first endoscopic grasper  138  pulling on the first projection  134 . This action operates to open the occlusion clamp  100 . 
         [0031]    Five distinct sutures  110 ,  112 ,  180 ,  182 ,  214  are utilized as part of the applicator assembly  102 . The first suture  110  is coupled to the second retainer bar  106 , while the other second suture  112  is coupled to the first retainer bar  104 . In contrast, the third suture  180  is concurrently mounted to corresponding near ends of the first retainer  104  and the second retainer bar  106 . The fourth suture  182  loosely circumscribes the clamping portions  114 ,  116  and is mounted to at least one of the clamping portions in close proximity to the urging member  118  using a subordinate suture (not shown). The fifth suture  214  also loosely circumscribes the clamping portions and is mounted to at least one of the clamping portions in close proximity to the urging member  120  using a subordinate suture (not shown). Both the fourth and fifth sutures are adapted to remain attached to the clamping portions  114 ,  116  post clamp  100  deployment. As will be discussed in more detail below, the third suture  180  is adapted to remain attached to the retainer bars  104 ,  106  in order to withdraw the retainer bars after the occlusion clamp  100  has been positioned to sandwich the appropriate tissue. Conversely, the first and second sutures are adapted to be severed to disengage the retainer bars  104 ,  106  from the occlusion clamp  100  post positioning. The cutting zones for severing the sutures are demarcated by the depressions  122 . 
         [0032]    In this exemplary embodiment, the manner in which the sutures  110 ,  112  are mounted to the retainer bars  104 ,  106  will now be discussed, starting with the second retainer bar  106 . The second retainer bar  106  is positioned to be longitudinally parallel with the clamping portion  114  so the ends of the retainer bar are generally centered along the longitudinal length of the clamping portion  114 . At the same time, the retainer bar  106  is positioned so that the projection  134  extends away from the other clamping portion  114 . Likewise, the retainer bar  106  is positioned so that one opening of each of the primary through holes  126 ,  128  also faces toward the clamping portion  114  and the second opening of each of the primary holes faces away from the clamping portion. Finally, when the retainer bar  106  is properly positioned, the first suture  110  is concurrently attached to the retainer bar and the first clamping portion  114 . 
         [0033]    Initially, a predetermined length of suture  110  is positioned so that its midpoint is generally positioned to be on top of the cylindrical post  140  of the projection  134 , with the suture being extended longitudinally to lie in parallel with the clamping portion  114 . In this position, the suture  110  lies on top of the retainer bar  106  so that that suture extends across the top depressions  122 . Each end of the suture  110  is then threaded through the nearest 126 of the primary holes so that the suture lies across the nearest of the two clamping portions  114 ,  116  (in this case, clamping portion  114 ). The ends of the suture  110  are then looped around the clamping portion  114  and then threaded through the farthest  128  of the primary holes and drawn taught. In this manner, the suture  110  has circumscribed the outside of the clamping portion  114 . After the suture  110  is drawn taught, having been threaded through the farthest  128  of the primary holes, a first half hitch knot  190  is tied. Thereafter, a second  192  and a third  194  half hitch knots are tied in the ends of the suture  110  toward the ends of the retainer bar  106 . After the three hitch knots are tied, the ends of the suture  110  are then utilized to tie a timberline knot  196 , with any excess suture being removed at the end of the timberline knot. Methods of knot tying can be found in numerous resources, as can many types of knots that may be used to secure the retainer bars  104 ,  106  to the occlusion clamp  100  using sutures  110 ,  112 . 
         [0034]    An adhesive may be placed on the knots  190 ,  192 ,  194 ,  196  to secure the knots and eliminate or limit fraying and migration. Alternative methods of knot tying or retainer bar design may eliminate or decrease utilization of adhesives on the knots. For example, a compressive or constriction type of knot may also be used to secure the suture to the bar  104 ,  106 . In addition, or in the alternative, heat staking or other methods of combining, lapping, and/or fixating suture-to-suture, suture-to-metal, or suture-to-plastic may be used. When the knots  190 ,  192 ,  194 ,  196  are completed, the suture  110  is generally taught around the retainer bar  106  and clamping portion  114  so that pulling on the retainer bar  106  away from the clamping portion  114  is operative to reposition the clamping portion  114 . 
         [0035]    The foregoing process is generally repeated for the first retainer bar  104  by positioning the retainer bar to be longitudinally parallel with the first clamping portions  116  so the ends of the retainer bar are generally centered along the longitudinal length of the clamping portion  116 . At the same time, the retainer bar  104  is positioned so that the projection  152  extends away from the clamping portion  116 . Likewise, the retainer bar  104  is positioned so that one opening of each of the primary through holes  126 ,  128  also faces toward the clamping portion  116  and a second opening of each of the primary holes faces away from the clamping portions. Finally, when the retainer bar  104  is properly positioned, the second suture  112  is attached using the following process. 
         [0036]    Initially, a predetermined length of suture  112  is positioned so that its midpoint is generally positioned to be on top of the longitudinal flange  154  of the projection  152 , with the suture being extended longitudinally to lie in parallel with the clamping portion  116 . In this position, the suture  112  lies on top of the retainer bar  104  so that that suture extends across the top depressions  122 . Each end of the suture  112  is then threaded through the nearest 126 of the primary holes so that the suture lies across the nearest of the two clamping portions  114 ,  116  (in this case, clamping portion  116 ). The ends of the suture  112  are then looped around the clamping portion  116  and then threaded through the farthest  128  of the primary holes and drawn taught. In this manner, the suture  112  has circumscribed the outside of the clamping portion  116 . After the suture  112  is drawn taught, having been threaded through the farthest  128  of the primary holes, a first half hitch knot  200  is tied. Thereafter, a second  202  and a third  204  half hitch knots are tied in the ends of the suture  112  toward the ends of the retainer bar  104 . After the three hitch knots are tied, the ends of the suture  112  are then utilized to tie a timberline knot  206 , with any excess suture being removed at the end of the timberline knot. When the knots are completed, the suture  112  is generally taught around the retainer bar  104  and clamping portion  116  so that pulling on the retainer bar  104  away from the clamping portion  116  is operative to reposition the clamping portion  116 . 
         [0037]    In this exemplary embodiment, the manner in which the suture  180  is mounted to the retainer bars  104 ,  106  will now be discussed. The first retainer bar  104  and the second retainer bar  106  each include a secondary through hole  132  located proximate each longitudinal end. These through holes  132  are adapted to receive predetermined lengths of suture  180  in order to couple the retainer bars  104 ,  106  to one another. As will be discussed in more detail below, the suture  180  is not adapted to be severed, but instead remains coupled to the retainer bars  104 ,  106  after the sutures  110 ,  112  are severed to remove the retainer bars  104 ,  106  and remaining sutures  110 ,  112  attached to the retainer bars subsequent to deployment of the occlusion clamp  100 . 
         [0038]    In exemplary form, the third suture  180  is threaded through one of the secondary through holes  132  of the second retainer bar  106  so that the end of the suture extending from the opening nearest the urging member  120  is wrapped around the outside of the retainer bar  106  (and held in position) and is in proximity to the other end of the suture  180  exiting the opening facing away from the urging member  120 . The end of the suture  180  exiting the opening that faces away from the urging member  120  travels across the ends of the two clamping portions  114 ,  116  and is threaded into the an opening of the nearest secondary through hole  132  of the first retainer bar  104 , where the opening faces away from the urging member  120 . When the suture  180  is threaded into this through hole  132 , the end of the suture  180  travels through the hole  132  and exits nearer to the urging member  120 . This free end  180  is then looped around the outside of the first retainer bar  104  and meets the other end of the suture  180  that was previously held in position to create a knot  210  to close the third suture  180 , thereby forming a closed loop. In this exemplary embodiment, the third suture  180  loop is coupled to a tab  212  that provides a quickly apparent attachment point for one of the endoscopic graspers  138 ,  150  to grasp and withdraw the remaining sutures and retainer bars  104 ,  106  after the occlusion clamp  100  is deployed. 
         [0039]    The fourth and fifth limiting lines or sutures  182 ,  214  are respectively loosely looped around the two clamping portions  114 ,  116  proximate the urging members  118 ,  120 . A subordinate suture (not shown) is used to couple the sutures  182 ,  214  to the fabric cover material  108 . In exemplary form, the length of the sutures  182 ,  214  is chosen to that when taught, the sutures operate to limit the travel of the clamping portions  114 ,  116 . In other words, the sutures  182 ,  214  constrain just how far apart the clamping portions  114 ,  116  may be repositioned. It should be noted that the sutures may or may not be removed post occlusion clamp  100  deployment. 
         [0040]    An exemplary deployment of the occlusion clamp  100  using the applicator assembly  102  presumes the sutures  110 ,  112  have been attached to the retainer bars  104 ,  106  as discussed above. Likewise, the exemplary deployment explanation also presumes that the sutures  180 ,  182 ,  214  have been respectively attached to the retainer bars and the clamping portions  114 ,  116 . In exemplary form, deployment of the occlusion clamp  100  in a surgical procedure includes positioning the clamp in proximity to tissue to be clamped. Exemplary tissue that may be clamped by the occlusion clamp  100  includes, without limitation, the left atrial appendage of the heart. After the clamp  100  has been introduced proximate the tissue to be occluded, the endoscopic graspers  138 ,  150  are utilized to grasp the applicator assembly  102  in order to more precisely position the clamp  100 . 
         [0041]    Specifically, the jaws  136  of the first endoscopic grasper  138  are opened so that the openings  148  of each jaw overlap the coaxial projections  146  of the crucifix  142  and are thereafter shut or brought closer together to grasp the coaxial projections  144 . In such an orientation, the jaws  136  of the endoscopic grasper  138  are able to pull on the crucifix  142  in a direction opposite, and coaxial with, the longitudinal direction of the cylindrical post  140 . Concurrently, the jaws  162  of the second endoscopic grasper  150  are opened and oriented so that the openings  148  completely overlap the end plate  156  and stops  158 . Thereafter, the jaws  162  are shut or brought closer together to grasp the longitudinal flange  154  of the projection  152 . It should be noted that when the openings of the jaws  162  are oriented to completely overlap the end plate  156  and stops  158 , this orientation coincides with the second endoscopic grasper  150  being oriented generally in parallel with the first retainer bar  104 . After the endoscopic graspers  138 ,  150  have been positioned to grasp the projections  134 ,  152 , the endoscopic graspers are repositioned to open the clamp  100 . 
         [0042]    By way of example, the second endoscopic grasper  150  may remain stationary, while the first endoscopic grasper  138  pulls on the projection  134  in a direction away from the clamp  100 . This force mustered by the endoscopic graspers  138 ,  150  working in tandem is greater than the spring force associated with the urging members  118 ,  120 , which results in the clamping portions  114 ,  116  being repositioned to create a gap therebetween. While this gap is maintained, using the relative position of the endoscopic graspers  138 ,  150 , the clamp  100  is repositioned so that the tissue to be occluded is directed between the clamping portions  114 ,  116 . After the tissue is placed between the clamping portions  114 ,  116  to the satisfaction of the surgeon, the endoscopic graspers  138  are repositioned toward one another so that the spring force of the clamping portions  114 ,  116  is applied to the tissue in question. Thereafter, surgical snips (not shown) are introduced, while the clamp  100  is positioned to clamp the tissue in question, to sever the sutures  110 ,  112 . Specifically, the snips are introduced proximate the depressions  122  on each of the retainer bars  104 ,  106  to sever the sutures  110 ,  112 , thereby creating a new pair of free ends for each suture. But it should be noted that the sutures  180  remain, thereby linking the retainer bars  104 ,  106  to one another. It is the new free ends of the sutures  110 ,  112  that discontinue the sutures being taught and the coupling between the retainer bars  104 ,  106  and the clamping portions  114 ,  116 . In this manner, a surgeon grasps the tab  212  and pulls the retainer bars  104 ,  106  from the surgical region and the clamp  300 . Because the tab  212  remains attached to the retainer bars  104 ,  106  by way of the suture  180 , and because the sutures  110 ,  112  remain attached to the retainer bars by way of the knots  190 ,  192 ,  194 ,  196 ,  200 ,  202 ,  204 ,  206 , pulling on the tab  212  removes concurrently removes the retainer bars and the sutures. In exemplary form, the tab  212  is adapted to be positioned at all times outside of the body cavity. 
         [0043]    The foregoing components may be fabricated from any surgical grade material. By way of example, the retainer bars  104 ,  106  are fabricated from a metal, such as stainless steel, aluminum, or titanium, while the sutures can be obtained commercially from Ethicon (J&amp;J) or fabricated for use. Whilst not necessary to use adhesive on the knots, a person skilled in knot tying may create a compressive or constrictive type of knot in order to eliminate or reduce the amount of adhesive. Adhesives for use with the foregoing exemplary embodiments may include CA, UV-CA, or other medical or non-medical grade adhesives. The projections can be of similar geometry or differing geometries. The retainer bars  104 ,  106  can be of varying or equivalent cross-sectional geometries. 
         [0044]    Following from the above description and invention summaries, it should be apparent to those of ordinary skill in the art that, while the methods and apparatuses herein described constitute exemplary embodiments of the present invention, the invention contained herein is not limited to this precise embodiment and that changes may be made to such embodiments without departing from the scope of the invention as defined by the claims. Additionally, it is to be understood that the invention is defined by the claims and it is not intended that any limitations or elements describing the exemplary embodiments set forth herein are to be incorporated into the interpretation of any claim element unless such limitation or element is explicitly stated. Likewise, it is to be understood that it is not necessary to meet any or all of the identified advantages or objects of the invention disclosed herein in order to fall within the scope of any claims, since the invention is defined by the claims and since inherent and/or unforeseen advantages of the present invention may exist even though they may not have been explicitly discussed herein.