Abstract:
An apparatus for application of surgical clips to body tissue has a handle portion with a body extending distally from the handle portion defining a longitudinal axis and a plurality of surgical clips disposed within the body. The apparatus also has a jaw assembly mounted adjacent a distal end portion of the body with the jaw assembly including first and second jaw portions movable between a spaced-apart and an approximated position. The apparatus further has a wedge plate longitudinally movable between the first and the second jaw portions, and a clip pusher configured to individually distally advance a surgical clip to the jaw assembly while the jaw portions are in the spaced apart position with an actuator. The actuator is at least partially disposed within the body and longitudinally movable in response to actuation of the handle portion and has a cam link. The apparatus also has a jaw closure member positioned adjacent the first and second jaw portions to move the jaw portions to the approximated position. The cam link longitudinally moves wedge plate between the first and the second jaw portions.

Description:
CROSS REFERENCE TO RELATED PATENT APPLICATIONS 
       [0001]    The instant patent application claims priority to U.S. Provisional Patent Application Ser. No. 60/617,104 filed on Oct. 8, 2004 and U.S. Provisional Patent Application Ser. No. 60/617,016 filed on Oct. 8, 2004 which are both herein incorporated by reference in its entirety. 
     
    
     TECHNICAL FIELD 
       [0002]    The technical field relates to surgical clip appliers and more particularly to an endoscopic surgical clip applier having a mechanism for stabilizing the jaw structure during the insertion of a surgical clip. 
       DESCRIPTION OF THE RELATED ART 
       [0003]    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 using a trocar and for performing surgical procedures far removed from the incision. 
         [0004]    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 single clip appliers 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. 
         [0005]    One significant design goal is that the surgical clip be loaded between the jaws without any compression of the clip from the loading procedure. Such bending or torque of the clip during loading is disfavored and care is exercised to prevent any damage to the jaws and/or the clip or compression to the clip by a force during loading. This compression could slightly alter the alignment of the clip between the jaws, or damage the clip causing the surgeon to remove the clip from between the jaws for discarding the clip. Additionally such preloading compression may slight compress parts of the clip and change the geometry of the clip. This will cause the surgeon to remove the compressed clip from between the jaws for discarding the clip. Accordingly, there is a need for an apparatus that eliminates one or more of the aforementioned drawbacks and deficiencies of the art. 
       SUMMARY 
       [0006]    According to a first aspect of the present disclosure, there is provided an apparatus for application of surgical clips to body tissue. The apparatus has a handle portion with a body extending distally from the handle portion defining a longitudinal axis and a plurality of surgical clips disposed within the body. The apparatus also has a jaw assembly mounted adjacent a distal end portion of the body with the jaw assembly including first and second jaw portions movable between a spaced-apart and an approximated position. The apparatus further has a wedge plate longitudinally movable between the first and the second jaw portions, and a clip pusher configured to individually distally advance a surgical clip to the jaw assembly while the jaw portions are in the spaced apart position with an actuator. The actuator is at least partially disposed within the body and longitudinally movable in response to actuation of the handle portion and has a cam link. The apparatus also has a jaw closure member positioned adjacent the first and second jaw portions to move the jaw portions to the approximated position. The cam link longitudinally moves wedge plate between the first and the second jaw portions. 
         [0007]    According to another aspect of the present disclosure, the apparatus has the wedge plate biasing the first and the second jaw portions when said wedge plate is longitudinally moved between the first and the second jaw portions and the wedge plate maintains the first and the second jaw portions in a fixed predetermined relationship during loading of the clip. The fixed predetermined relationship prevents flexing of the first and the second jaw members during clip loading. 
         [0008]    According to another aspect of the present disclosure, the apparatus has the wedge plate with a rounded distal tip. 
         [0009]    According to another aspect of the present disclosure, the apparatus has the wedge plate with a first proximal window. The first proximal window is adapted to be engaged by a member disposed in the body with the member being configured to hold the wedge plate in a distal most position. The distal most position being between the first and the second jaw members. 
         [0010]    According to another aspect of the present disclosure, the apparatus has the wedge plate with a second proximal window. The second proximal window is adapted to be engaged by the member and the second proximal window is configured to hold the wedge plate in a proximal most position retracted from the first and the second jaw members. The proximal most position of the wedge plate is configured to allow the first and the second jaw members to be moved to the approximated position to compress the clip. 
         [0011]    According to another aspect of the present disclosure, the apparatus has the first proximal window connected to the second proximal window by a longitudinal slot. 
         [0012]    According to another aspect of the present disclosure, the apparatus has the member movable from the second proximal window to first proximal window by moving the wedge plate distally. 
         [0013]    According to still another aspect of the present disclosure, the apparatus has the cam link engageable with a cam slot in the wedge plate. The cam slot has a driving edge. 
         [0014]    According to another aspect of the present disclosure, the member is a flexible leg. 
         [0015]    According to another aspect of the present disclosure, the apparatus has the cam slot with a proximal side and a distal side. At the distal side, the cam link traverses past the driving edge at a demarcation line. At the demarcation line, the cam link terminates distal movement of the wedge plate. 
         [0016]    According to another aspect of the present disclosure, the apparatus has the wedge plate further comprising a biasing device. At the demarcation line, the disengagement between the cam link and the driving edge permits the biasing device to retract the wedge plate. 
         [0017]    According to another aspect of the present disclosure, the cam link disengages the wedge plate at the demarcation line, and the disengagement of the cam link permits retraction of the rounded distal end from between the first and the second jaw members. 
         [0018]    According to another aspect of the present disclosure, there is provided an apparatus for application of surgical clips to body tissue. The apparatus has a handle portion and a body extending distally from the handle portion and defining a longitudinal axis with a plurality of surgical clips disposed within the body and a jaw assembly mounted adjacent a distal end portion of the body. The jaw assembly has first and second jaw portions movable between a spaced-apart and an approximated position. The apparatus also has a clip pusher configured to individually distally advance a surgical clip to the jaw assembly while the jaw portions are in the spaced apart position and an actuator at least partially disposed within the body and longitudinally movable in response to actuation of the handle portion. The actuator is biased to longitudinally move proximally. The apparatus also has a jaw closure member positioned adjacent the first and second jaw portions to move the jaw portions to the approximated position and a rack having a plurality of ratchet teeth being connected to the actuator with a pawl biased to the handle portion. The pawl has at least one tooth configured to engage the ratchet teeth. As the actuator is moved longitudinally, the plurality of ratchet teeth are passed over the pawl and the pawl is configured to prevent inadvertent return of the actuator before full actuation of the apparatus. 
         [0019]    According to another aspect of the present disclosure, the pawl is biased by a spring and the spring is connected to the handle portion to bias the pawl into engagement with the rack. 
         [0020]    According to another aspect of the present disclosure, the apparatus has the pawl is pivotally mounted in the handle portion. 
         [0021]    According to another aspect of the present disclosure, when actuation of the handle portion is terminated in mid stroke, the ratchet teeth restrain the pawl against proximal motion, and any inadvertent partial actuation of the jaw assembly is prevented. 
         [0022]    According to another aspect of the present disclosure, the apparatus has the first jaw and second portions moved to the approximated position and the ratchet teeth are advanced a predetermined distance past the pawl to permit retraction of the actuator. 
         [0023]    According to another aspect of the present disclosure, there is provided an apparatus for application of surgical clips to body tissue. The apparatus has a handle assembly with a handle and a trigger movable relative to the handle, and a body extending distally from the handle portion and defining a longitudinal axis. The apparatus also has a plurality of surgical clips disposed within the body and a jaw assembly mounted adjacent a distal end portion of the body with the jaw assembly including first and second jaw portions movable between a spaced-apart and an approximated position. The apparatus further has a clip pusher configured to individually distally advance a surgical clip to the jaw assembly while the jaw portions are in the spaced-apart position and an actuator at least partially disposed within the body and longitudinally movable in response to actuation of the handle portion. The apparatus also has a link connected at a first end to the actuator and connected at a second end to the trigger with a jaw closure member positioned adjacent the first and second jaw portions to move the jaw portions to the approximated position. 
         [0024]    According to another aspect of the present disclosure, the link is connected to a rack having a plurality of ratchet teeth and the ratchet teeth are connected to a pawl and are configured to prevent inadvertent return of the actuator before full actuation of the apparatus. 
         [0025]    According to another aspect of the present disclosure, the apparatus has the pawl biased to the handle. As the trigger is actuated the link is advanced distally and the link advances the rack distally. The pawl ratchet teeth slide along the pawl. 
         [0026]    According to another aspect of the present disclosure, the apparatus has the pawl is pivotally connected to the handle. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0027]    A particular embodiment of a surgical clip applier is disclosed herein with reference to the drawings wherein; 
           [0028]      FIG. 1  is a perspective view of a surgical clip applier; 
           [0029]      FIG. 2  is another perspective view of the surgical clip applier of  FIG. 1 ; 
           [0030]      FIG. 3  is an enlarged perspective view of the jaw structure of the surgical clip applier; 
           [0031]      FIG. 4  is a top view of the surgical clip applier; 
           [0032]      FIG. 5  is a side view of the surgical clip applier; 
           [0033]      FIG. 6  is a side view, with half of the body removed, of the handle assembly of the surgical clip applier; 
           [0034]      FIG. 7  is an exploded perspective view of the handle of the clip applier, with shaft assembly; 
           [0035]      FIG. 8  is a perspective view of a pawl; 
           [0036]      FIG. 9  is a perspective view of a yoke; 
           [0037]      FIG. 10  is an exploded perspective view of the shaft assembly of the surgical clip applier; 
           [0038]      FIG. 10A  is a perspective view of a feed bar; 
           [0039]      FIG. 10B  is a perspective view of a follower and surgical clips; 
           [0040]      FIGS. 10C and 10D  are opposite perspective views of a trip block; 
           [0041]      FIG. 10E  is a perspective view of a spindle; 
           [0042]      FIG. 10G  is an enlarged area of detail of  FIG. 10E ; 
           [0043]      FIG. 10F  is an enlarged area of detail of  FIG. 10E ; 
           [0044]      FIG. 11  is a perspective view of the distal end of the spindle and a driver; 
           [0045]      FIG. 12  is a perspective view of a trip lever mechanism on the spindle; 
           [0046]      FIG. 13  is a perspective view of a wedge plate and biasing spring; 
           [0047]      FIGS. 14 and 15  are opposite perspective views of a filler component; 
           [0048]      FIG. 16  is a perspective view of the rotation knob and shaft assembly; 
           [0049]      FIG. 17  is a perspective view of the overpressure assembly; 
           [0050]      FIG. 18  is a perspective view of the spindle and jaw assembly; 
           [0051]      FIG. 19  is an enlarged area of detail of the spindle and jaw assembly of  FIG. 18 ; 
           [0052]      FIG. 20  is an enlarged area of detail of the spindle and trip lever of  FIG. 18 ; 
           [0053]      FIG. 21  is an enlarged view of the distal end of the surgical clip applier with outer tube removed; 
           [0054]      FIG. 22  is a perspective view of the surgical clip applier shaft assembly with parts removed; 
           [0055]      FIG. 23  is an enlarged area at detail of  FIG. 22 ; 
           [0056]      FIG. 24  is an enlarged area of detail of  FIG. 22 ; 
           [0057]      FIG. 25  is an enlarged area of detail of  FIG. 22 ; 
           [0058]      FIG. 26  is a perspective view of the spindle, driver and jaw assembly; 
           [0059]      FIG. 27  is an enlarged area of detail of  FIG. 26 ; 
           [0060]      FIG. 27A  is a cross-sectional view taken along line  27 A- 27 A of  FIG. 27 . 
           [0061]      FIG. 28  is a perspective view of the cam link and wedge plate assembly; 
           [0062]      FIG. 29  is an enlarged area of detail of  FIG. 28 ; 
           [0063]      FIG. 30  is an enlarged area of detail of  FIG. 29 ; 
           [0064]      FIG. 31  is a perspective view of the filler component and jaw assembly; 
           [0065]      FIG. 32  is an enlarged perspective view of the jaw assembly of  FIG. 31 ; 
           [0066]      FIGS. 33 and 34  are perspective views of the distal end of the spindle including wedge plate and driver; 
           [0067]      FIG. 35  is a side view, partially shown in section, of the surgical clip applier in a pre-fired condition; 
           [0068]      FIG. 36  is in enlarged area of detail of  FIG. 35 ; 
           [0069]      FIG. 37  is an enlarged area of detail of  FIG. 35 ; 
           [0070]      FIG. 38  is in enlarged area of detail of  FIG. 37  showing the trip lever; 
           [0071]      FIG. 39  is an enlarged area of detail of  FIG. 37  showing the follower; 
           [0072]      FIG. 40  is an enlarged the area of detail of  FIG. 37 ; 
           [0073]      FIG. 41  is enlarged area of detail of  FIG. 40 ; 
           [0074]      FIG. 42  is a side view, shown in section, of the distal end of the surgical clip applier of  FIG. 37 ; 
           [0075]      FIG. 43  is a perspective view of the wedge plate and jaw assembly; 
           [0076]      FIG. 44  is an enlarged area of detail of  FIG. 43  showing the wedge plate and jaw members; 
           [0077]      FIG. 45  is a top view of  FIG. 43  taken along line  45 - 45 ; 
           [0078]      FIG. 46  is an enlarged area of detail of  FIG. 45  showing the jaw and the wedge plate; 
           [0079]      FIG. 47  is an enlarged area of detail of  FIG. 45  showing the wedge plate and cam link; 
           [0080]      FIG. 48  is a side view, shown in section, of the handle housing at the beginning of an initial stroke; 
           [0081]      FIG. 49  is an enlarged area of detail of  FIG. 48  showing the rack and pawl; 
           [0082]      FIG. 50  is an enlarged area of detail of  FIG. 48  similar to  FIG. 49 ; 
           [0083]      FIG. 51  is a side view, shown in section, of the feed bar and trip lever; 
           [0084]      FIG. 52  is a side view, shown in section, of the follower; 
           [0085]      FIG. 53  is a side view, shown in section, of the endoscopic portion of the surgical clip applier; 
           [0086]      FIG. 54  is an enlarged area of detail of  FIG. 53  illustrating the spindle movement; 
           [0087]      FIG. 55  is a top view of the wedge plate and filler component illustrating the movement of the cam link; 
           [0088]      FIG. 56  is a side view, shown in section, illustrating the feed bar advancing a clip; 
           [0089]      FIG. 57  is a top view of the wedge plate and cam link moving distally; 
           [0090]      FIG. 58  is a side view, shown in section, showing the movement of the flexible leg cammed out of a wedge plate window; 
           [0091]      FIG. 59  is a side view, shown in section, illustrating a clip entering the jaws; 
           [0092]      FIG. 60  is a further top view of the cam link and wedge plate movement; 
           [0093]      FIG. 61  is a side view, shown in section, of the flexible leg and wedge plate disengagement; 
           [0094]      FIG. 62  is a top view of the wedge plate entering the jaw structure; 
           [0095]      FIG. 63  is a perspective view illustrating the wedge plate camming open the jaw structure; 
           [0096]      FIG. 64  is a top view illustrating further advancement of the cam link in the wedge plate; 
           [0097]      FIG. 65  is a side view, shown in section, illustrating the trip lever engaged with the feed bar; 
           [0098]      FIG. 66  is a side view, shown in section, illustrating the spindle camming the flexible leg out of engagement with the wedge plate; 
           [0099]      FIG. 67  is a side view, shown in section, illustrating the feed bar loading a clip into the jaw structure; 
           [0100]      FIG. 68  is a side view, shown in section, illustrating the trip lever being cammed out of engagement with the feed bar by means of a trip block; 
           [0101]      FIG. 69  is a side view, shown in section, illustrating the retraction of the wedge plate and feed bar; 
           [0102]      FIG. 70  is a side view, shown in section, illustrating further advancement of the spindle; 
           [0103]      FIG. 71  is a side view, shown in section, illustrating the retraction of the wedge plate and further advancement of the spindle; 
           [0104]      FIG. 72  is a perspective view of the wedge plate retracting from the jaw structure; 
           [0105]      FIG. 73  is a side view, shown in section, with the spindle engaging the driver and a latch retractor engaging the spindle; 
           [0106]      FIG. 74  is a side view of the handle housing with the trigger at full stroke; 
           [0107]      FIG. 75  is an enlarged area of detail of  FIG. 74  with the pawl clearing the ratchet rack; 
           [0108]      FIG. 76  is a side view, shown in section, of the driver camming the jaws closed about a surgical clip; 
           [0109]      FIGS. 77 to 79  are sequential views of the driver camming the jaws closed about a surgical clip; 
           [0110]      FIG. 80  is a view, shown in section, of the overpressure mechanism including the impact spring; 
           [0111]      FIG. 81  is a perspective view of a surgical clip formed on a vessel; 
           [0112]      FIG. 82  is an enlarged area of detail of the ratchet mechanism resetting; 
           [0113]      FIG. 83  is a side view, shown in section, illustrating the latch retractor resetting; 
           [0114]      FIG. 84  is a side view, shown in section, illustrating the spindle retracting; and 
           [0115]      FIGS. 85 and 86  are top views illustrating the cam link resetting within the wedge plate. 
       
    
    
     DETAILED DESCRIPTION 
       [0116]    There is disclosed a novel endoscopic surgical clip applier having a jaw control mechanism configured to maintain jaws of the surgical clip applier in a spaced apart and stable position during insertion of a surgical clip. It should be noted that, while the disclosed jaw control mechanism is shown and described in an endoscopic surgical clip applier, the disclosed jaw control mechanism is applicable to any surgical clip applier or other instrument having a pair of compressible jaws. 
         [0117]    Referring now to  FIGS. 1-5 , surgical clip applier  10  generally includes a handle assembly  12  and an endoscopic portion including an elongated tubular member  14  extending distally from handle assembly  12 . Handle assembly  12  is formed of a plastic material while elongated tubular member  14  is formed of a biocompatible material such as stainless steel. A pair of jaws  16  are mounted on the distal end of elongated tubular member  14  and are actuated by a trigger  18  movably mounted in handle assembly  12 . Jaws  16  are also formed of a biocompatible material such as stainless steel or titanium. A knob  20  is rotatably mounted on a distal end of handle assembly  12  and affixed to elongated tubular member  14  to provide 360 degree rotation of elongated tubular member  14  and jaws  16  about its longitudinal axis. Referring for the moment to  FIG. 3 , jaws  16  define a channel  22  for receipt of a surgical clip therein. 
         [0118]    Referring now to  FIGS. 6 and 7 , handle assembly  12  of clip applier  10  is shown. Handle assembly  12  includes a longitudinally movable yoke  24  connected to trigger  18  by a link  26 . Handle assembly  12  includes housing channels  28  to guide yoke wings  30  of yoke  24  within handle assembly  12  during actuation of clip applier  10 . Yoke  24  is connected to the drive mechanisms and is biased to a proximal position by a return spring  32 . Knob  20  includes a flange  34  which is rotatably mounted in a journal  36  in housing  12 . 
         [0119]    Referring to  FIGS. 6-9 , in order to prevent inadvertent return of trigger  18  and yoke  24  before full actuation of surgical instrument  10 , yoke  24  includes a rack  38  having rack teeth  40 . A pawl  42  is pivotally mounted in handle assembly  12  and includes pawl teeth  44  engageable with rack teeth  40 . Pawl  42  is biased into engagement with rack  38  by a spring  46 . Rack  38  and pawl  42  prevent release of trigger  18  before full actuation in a manner described in more detail hereinbelow. 
         [0120]    Combinations of the various elements and mechanisms associated with clip applier  10  will now be described. 
         [0121]    Referring to  FIG. 10 , a bushing  48 , including retention pins  50 , is provided to secure the bushing  48  to the knob  20 . A drive link  52  is connected, typically with a snap type connection, to yoke  24  such that a proximal end of drive link  52  engages yoke  24 . 
         [0122]    An over pressure mechanism including an impact spring  56  is provided about outer tube  14 , between bushing  48  and housed in a bore of knob  20  to prevent over compression of jaws  16  during actuation of the instrument in a manner described in more detail hereinbelow. Drive link  52  extends through a bore  58  in knob  20 . 
         [0123]    A flange located at a proximal end of elongated tube member  14  abuts a proximal end of bushing  48 . 
         [0124]    In order to actuate the various components there is provided an actuation mechanism or spindle  60  mounted for longitudinal movement through elongated tubular member  14 . Spindle  60  includes a boss  62  at its proximal end which is engageable with a recess  64  on the distal end of drive link  52 . A camming mechanism including a driver  66  and a slider joint  68  extend from a distal end of spindle  60  to cam closed jaws  16  about a surgical clip. 
         [0125]    Clip applier  10  is configured to retain a plurality of surgical clips for application to tissue. Clip applier  10  includes an elongated channel member  70  configured to retain a plurality of surgical clips  72  and convey surgical clips  72  to jaws  16 . It should be noted that channel member  70  and jaws  16  do not move longitudinally relative to elongated tubular member  14 . A follower  74  is biased by a spring  76  to urge surgical clips  72  distally within channel member  70 . A channel cover  78  overlies channel  70  to retain and guide spring  76  and surgical clips  72  therein. A nose  80  is provided at a distal end of channel cover  78  to assist in directing surgical clips  72  into jaws  16 . 
         [0126]    A feeder mechanism including a feed bar  82  is provided for longitudinal movement relative to channel cover  78  in order to advance individual clips  72  into jaws  16 . A trip block  84  having a guide pin  86  and a feed bar spring  88  are provided adjacent the proximal end of channel cover  78  to bias feed bar  82  in a proximal direction. Specifically, a proximal end  90  of guide pin  86  is interconnected with a hook  92  on an underside of feed bar  82  ( FIGS. 38A  &amp; B) and through slot  94  in trip block  84 . (See also  FIGS. 10  A, C, &amp; D) In order for spindle  60  to move feed bar  82 , spindle  60  is provided with a trip lever  96  and a biasing spring  98 . Trip lever  96  is engageable with a proximal end of feed bar  82  in a manner described in more detail herein below. 
         [0127]    A notable advantage of presently disclosed clip applier  10  is that it is provided with a wedge plate  100  which is configured to advance into jaws  16  during actuation of surgical clip applier  10  and maintain jaws  16  in a spaced apart condition while receiving a surgical clip  72 . Cam slot  136  ( FIG. 13 ), described in detail hereinbelow, formed through wedge plate  100  and a filler component  102  mounted within elongated tubular member  14 , cooperate in connection with a cam link  104 , provided on spindle  60 , to move wedge plate  100  relative to filler component  102  and jaws  16 . Filler component  102  is positioned directly behind jaws  16  and does not move relative to elongated tubular member  14 . 
         [0128]    Turning to  FIG. 10A , and as noted above, feed bar  82  is provided to move surgical clips  72  into jaws  16 . Feed bar  82  is driven by trip lever  96  on spindle  60 . (See  FIG. 10 .) Specifically, feed bar  82  is provided with an elongated window  106  which is configured to be engaged by trip lever  96  as spindle  60  is driven distally. To facilitate insertion of the clip into jaws  16 , feed bar  82  is provided with a pusher  108  at its distal end which is configured to advance an individual clip  72  out of the line of clips  72  and into jaws  16 . As shown in  FIG. 10B , follower  74  is positioned behind the line of clips to advance clips  72  through surgical clip applier  10 . 
         [0129]    Referring to  FIG. 10C , as noted above, trip block  84  includes a slot  94  to receive hook  92  of feed bar  82 . In order to disengage trip lever  96  from window  106  and thus feed bar  82 , trip block  84  is provided with an angled surfaces  110  which is configured to engage trip lever  96  and disengage it from window  106  of feed bar  82  as best shown in  FIG. 10D . 
         [0130]    Referring now to  FIGS. 10E-10G , various features of spindle  60  will now be described. A perspective view of spindle  60 , isolated from other components is shown in  FIG. 10E . With specific reference to  FIG. 10F , at a proximal end, spindle  60  includes a pivot point  112  for attachment of trip lever  96  at its proximal end. Additionally, a boss  114  is provided in spindle  60  for attachment of biasing spring  98  to bias trip lever  96  into engagement with window  106  of feed bar  82 . Similarly, with respect to  FIG. 10G , at a distal end, spindle  60  is provided with a boss  116  for mounting cam link  104 . Spindle  60  is additionally provided with a raised feature  118  which functions to disengage filler component  102  from wedge plate  100  in a manner described in hereinbelow. 
         [0131]    Referring to  FIG. 11 , spindle  60  is provided to advance driver  66  into engagement with jaws  16  to close jaws  16  about a surgical clip after the surgical clip has been positioned within jaws  16 . A distal end  120  of slider joint  68  resides in a recess  122  in driver  66 . A proximal projection  124  of slider joint  68  rides within a longitudinal slot  126  in the distal end of spindle  60 . The length of longitudinal slot  126  allows spindle  60  to move a predetermined longitudinal distance before engaging and moving driver  66  longitudinally to close jaws  16  about a clip  72 . A latch retractor  128  is provided within a slot  130  in slider joint  68  so as to allow driver  66  to be driven distally after wedge plate  100  has been allowed to retract proximally in a manner described in more detail hereinbelow. A spindle guard  132  is provided between latch retractor  128  and the surface of spindle  60  to prevent damage to the plastic surface of spindle  60  by the surface of latch retractor  128 . 
         [0132]    Referring now to  FIG. 13 , wedge plate  100  will be described in more detail. As noted above, wedge plate  100  is provided to maintain jaws  16  in a spaced apart condition during loading of a surgical clip  72  within jaws  16 . Additionally, the presence of wedge plate  100  provides stability to jaws  16  to prevent them from flexing during loading of surgical clip  72 . As shown, wedge plate  100  includes a distal tip  134  which is configured to engage and cam jaws  16  open and maintain them in a spaced condition. Additionally, wedge plate  100  includes a cam slot  136  which is configured to cooperate with cam link  104  mounted on spindle  60  to control the motions of wedge plate  100  as discussed in more detail below. Further, distal and proximal windows  138  and  140 , respectively, are provided to engage flexible structure on the filler component  102 . A biasing spring  142  is provided on a mount  144  to bias wedge plate  100  generally proximally within elongated tubular member  14 . Finally, a stop  146  is configured to engage corresponding structure on filler component  102 . 
         [0133]    Referring now to  FIGS. 14 and 15 , various aspects of filler component  102  will now be described. Filler component  102  includes a flexible leg  152  which is configured to engage distal and proximal windows  138  and  140  in wedge plate  100 . Filler component  102  also includes an elongated cam slot  148  configured to receive part of cam link  104 . A disengaging edge  150  is provided within cam slot  148  to facilitate disengaging cam link  104  from within cam slot  136  in wedge plate  100 . Filler component  102  additionally includes a recess  154  for engagement with stop  146  on wedge plate  100  ( FIG. 13 ), to limit the proximal retraction of wedge plate  100 , as well as a longitudinal recess  156  to accommodate the length of return spring  142  of wedge plate  100 . 
         [0134]      FIGS. 16 and 17  illustrate the position of impact spring  56  relative to rotation knob  20 . As noted above, impact spring  56  is provided as an over pressure mechanism to prevent over compression of jaws  16  during the crimping of a surgical clip  72  as described in more detail below with respect to the operation of surgical clip applier  10 . The over pressure mechanism is designed to prevent overstroke of trigger  18  applied by the surgeon and ultimately prevent damage to jaws  16 . 
         [0135]    Referring to  FIGS. 18-20 , spindle  60  and related drive components are shown with elongated tubular member  14  removed. Specifically, with regard to  FIG. 19 , pusher  108  of feed bar  82  extends through a slot  158  in nose  80  to engage a surgical clip  72 . Similarly, as shown in  FIG. 20 , at a proximal end of spindle  60 , trip lever  96  extends through window  106  in feed bar  82 . In this position, trip lever  96  can engage an edge of slot  106  to drive feed bar  82  distally along with spindle  60  through elongated tubular member  14 . 
         [0136]    Referring to  FIG. 21 , there is a view similar to  FIG. 19 , however, nose  80  has been removed to illustrate pusher  108  engaging a surgical clip  72  located in channel  70 . 
         [0137]    Referring now to  FIG. 22 , spindle  60  and associated components are shown with feed bar  82  removed. 
         [0138]    Referring to  FIG. 23 , there are illustrated multiple clips  72  positioned within channel  70  for supply to jaws  16  at a distal end of spindle  60 . Clips  72  are arranged in longitudinal alignment within channel  70 . Retention fingers  71  are provided at a distal end of channel  70  to restrain a stack of clips  72  within channel  70  until advanced into jaws  16  by feed bar  82 . 
         [0139]    Referring to  FIG. 24 , there is illustrated an intermediate section of spindle  60  assembled with follower  74  and follower spring  76 . As noted, spring  76  biases follower  74  distally relative to spindle  60 . 
         [0140]    With reference to  FIG. 25 , there is illustrated spindle  60  assembled with trip lever  96  and biasing spring  98 , with trip lever  96  being biased into a upward most position by biasing spring  98 . 
         [0141]    Referring to  FIGS. 26 and 27 , an opposed side of spindle  60  assembled with driver  66  about jaws  16  is illustrated. As noted above, driver  66  is configured to cam jaws  16  closed about a surgical clip. Thus, jaws  16  include angled camming surfaces  160  for receipt of corresponding camming surfaces  184  ( FIG. 34 ) of driver  66 . A pocket  187  ( FIG. 31 ) in the proximal end of jaws  16  limits the retraction of driver  66 . Specifically, protrusion  186  of slider joint  68  engages pocket  187  of jaws  16 . (See  FIGS. 31 &amp; 34 ). 
         [0142]    Referring for the moment to  FIG. 27A , camming surfaces  160  on jaws  16  and corresponding camming surfaces  184  of driver  66  are smoothly rounded, curved or radiused. By forming these camming surfaces in this manner, the friction between camming surfaces  160  and  184  is greatly reduced providing an improved smooth closure of jaws  16  about clip  72 . 
         [0143]    Referring to  FIGS. 28-30 , the relative assembled positions of channel  70 , trip lock  84 , wedge plate  100  and filler component  102  will now be described. Referring initially to  FIGS. 29 and 30 , filler component  102  is positioned on channel  70 . Proximal end of filler component  102  abuts a stop  162  positioned on channel  70 . The wedge plate  100  lies over filler component  102  in the manner shown. As best shown in  FIG. 30 , filler component  102  includes a cam slot  148  having a disengaging edge  150  formed within cam slot  148 . Similarly, wedge plate  100  includes a cam slot  136 . As noted above, a cam link  104  is provided attached to spindle  60  (not shown) in order to drive wedge plate  100  distally. To facilitate driving wedge plate  100 , cam link  104  is provided with a cam link boss  164  which rides in cam slots  136  and  148  of wedge plate  100  and filler component  102  respectively. As cam link  104  is advanced distally relative to wedge plate  100  cam link boss  164  engages a driving edge  166  of wedge plate  100  to drive wedge plate  100  distally. In the manner described hereinafter, once cam link  104 , and in particular cam link boss  164 , engages disengaging edge  150  of filler component  102  cam link boss  164  is cammed out of engagement of driving edge  166 . 
         [0144]    Referring to  FIG. 30 , filler component  102  is provided with a flexible leg  152  which is movable between distal and proximal windows  138 ,  140 , respectively, of wedge plate  100 . In order to cam flexible leg  152  out of one of the proximal or distal windows, there is provided a cam surface  168  on flexible leg  152  which cams flexible leg  152  out of the windows in response to relative movement of wedge plate  100  relative to filler component  102 . 
         [0145]    As noted hereinabove, jaws  16  are provided to receive and crimp surgical clips  72  positioned therein. Referring to  FIGS. 31 and 32 , jaws  16  generally include a pair of flexible legs  170  fixed to a base  172 . Jaw members  16 A and  16 B are located at a distal end of flexible legs  170 . A pair of locking arms  174  extend distally from base  172  and terminate in tabs  176 . Tabs  176  are configured to engage corresponding holes  177  on elongated tube  14  ( FIG. 10 ) to secure jaws  16  to elongated tube  14 . Jaws  16  include channel  22  for receipt of surgical clips  72 . As shown, filler component  102  is positioned directly behind jaws  16  and, as with jaws  16 , does not move longitudinally relative to outer tubular member  14 . 
         [0146]    Referring for the moment to  FIG. 32 , jaws  16  are configured to receive wedge plate  100  such that the distal tip  134  of wedge plate  100  is used to initially separate jaws section  16   a  and  16   b  and maintain them in a separated and aligned configuration during insertion of a surgical clip into jaws  16 . As noted, this prevents any torquing or flexing of jaw  16   a  relative to jaw  16   b  while a surgical clip  72  is being loaded therein. Each of flexible legs  170  includes a cam edge  178  (see  FIGS. 44 &amp; 63 ) to guide distal tip  134  of wedge plate  100  within jaws  16 . 
         [0147]    Referring to  FIG. 33 , wedge plate  100  is illustrated positioned on spindle  60  such that latch retractor  128  extends through a slot  182  in wedge plate  100 . As best shown in  FIG. 34 , with wedge plate  100  removed, it can be seen that a distal end of driver  60  is provided with camming surfaces  184 . Camming surfaces  184  cooperate with cam surfaces  160  on jaws  16 , (see  FIG. 27 ), to cam jaws  16  together in response to longitudinal movement of driver  60  relative to jaws  16 . Protrusion  186  on slider joint  68  extends through a slot  188  in wedge plate  100  to limit retraction of slider joint  68  relative to jaws  16 . 
         [0148]    The operation of surgical clip applier  10  to crimp a surgical clip around a target tissue, such as, for example, a vessel, will now be described. With reference to  FIGS. 35 and 36 , trigger  18  is in a generally uncompressed state with yoke  24  biased to a proximal-most position by return spring  32 . As best shown in  FIGS. 37-42 , and with initial reference to  FIG. 38 , in an unfired state, trip lever  96  carried by spindle  60 , biased upwardly by biasing spring  98 , is positioned adjacent to, and in contact with, a slot in feed bar  82 . Trip block  84  is in a distal position relative to trip lever  96 . 
         [0149]    Referring to  FIG. 39 , follower  74  is biased distally by a spring  76  such that clips  72  are biased in a distal direction. 
         [0150]    Referring to  FIG. 40 , spindle  60  and feed bar  82  are stationery with latch retractor  128  biased to an upward position. 
         [0151]    Referring to  FIG. 41 , flexible leg  152  of filler component  102  is in the distal window  138  of wedge plate  100 . Raised feature  118  on spindle  60  is proximal of flexible leg  152 . 
         [0152]    As best shown in  FIG. 42 , at the distal end of surgical clip applier  10 , when at rest in an unfired state, wedge plate  100  and feed bar  82  are in a proximal-most position relative to jaws  16 . 
         [0153]      FIGS. 43-47  illustrate the initial at rest position of the wedge plate  100 , jaws  16  and filler component  102 . 
         [0154]    Referring initially to  FIGS. 43 and 44 , as shown, wedge plate  100  is in a proximal-most position relative to jaws  16 . As shown in  FIG. 43 , flexible leg  152  is in distal window  138  of wedge plate  100 , while cam link  104  is in a proximal-most position relative to cam slot  136  in wedge plate  100 . 
         [0155]    As best shown in  FIGS. 45 and 46 , wedge plate  100  is in a proximal most position relative to jaws  16  with distal tip  134  proximal of cam edges  178  of jaws  16 . 
         [0156]    Referring to  FIG. 47 , wedge plate  100  is in a proximal-most position relative to filler component  102 , such that driving edge  166  of wedge plate  100  is proximal of disengaging edge  150  of filler component  102 . 
         [0157]    Referring to  FIG. 48 , to initiate actuation of clip applier  10 , trigger  18  is moved through an initial swing as shown by arrow A such that link  26  drives yoke  24  distally as shown by arrow B. As best shown in  FIG. 49 , as yoke  24  is driven distally in the direction of arrow C, rack teeth  40  on rack  38  slide over pawl teeth  44  on pawl  42 . With reference for the moment to  FIG. 50 , if the trigger  18  is released at this point, rack teeth  40  would restrain pawl teeth  44  against proximal motion, preventing release of trigger  18  and partial or inadvertent partial actuation of surgical clip applier  10 . 
         [0158]    During the initial stroke, spindle  60  moves a predetermined distance. With regard to  FIG. 51 , as spindle  60  is driven an initial distal distance, trip lever  96  engages elongated window  106  feed bar  82  and moves feed bar  82  distally a similar distance. As shown in  FIGS. 42 &amp; 51 , as feed bar  82  is driven distally and a clip  72  is driven into jaws  16 , follower  74  moves distally ( FIG. 52 ) due to the bias of spring  76  to urge the stack of surgical clips  72  distally. 
         [0159]    Referring to  FIGS. 53 and 54 , as spindle  60  and feed bar  82  move distally, spindle  60  drives cam link  104  distally an initial distance such that cam link boss  164  on cam link  104  engages wedge plate  100 . As shown, flexible leg  152  of filler component  102  is positioned in distal-most window  138  of wedge plate  100 . 
         [0160]    As shown in  FIG. 55 , as cam link  104  moves distally with spindle  60 , cam link boss  164  engages driving edge  166  on wedge plate  100  to urge wedge plate  100  distally relative to filler component  102 . 
         [0161]    Referring to  FIG. 56 , as feed bar  82  moves distally, pusher  108  at the distal end of feed bar  82  engages a clip  72  and begins to urge clip  72  into jaws  16 . Notably, at this point, spindle  60  has not yet contacted driver  66 , thereby preventing compression of jaws  16  prior to full insertion of surgical clip  72 . 
         [0162]    Turning again to  FIG. 55 , as surgical clip applier  10  is actuated through a further second predetermined distance, cam boss  164  on cam link  104  continues to drive wedge plate  100  distally and flexible leg  152  is cammed out of distal window  138  and into proximal window  140  by cam surface  168  to engage wedge plate  100  with filler component  102 . As shown in  FIGS. 57 &amp; 58 , at this point, feed bar  82 , wedge plate  100 , spindle  60 , clips  72  and follower  74  ( FIG. 52 ) are all moving in a distal-most direction. 
         [0163]    Referring to  FIG. 59 , feed bar  82  continues to urge pusher  108  at the distal end of feed bar  82  against a surgical clip  72  to urge clip  72  into channel  22  in jaws  16 . Surgical clips  72  contained in channel  70  are biased in a distal direction by follower  74  ( FIG. 52 ) and wedge plate  100  ( FIG. 54 ) continues to move distally while driver  66  remains stationery relative to elongated tubular member  14 . 
         [0164]    Referring to  FIG. 60 , as spindle  60  is moved further, cam boss  164  of cam link  104  is cammed out of engagement with driving edge  166  of wedge plate  100  by means of disengaging edge  150  formed in filler component  102  as best shown by the arrows in  FIG. 60 . During this further stroke of a predetermined distance, flexible leg  152  of filler component  102  snaps into proximal window  140  of wedge plate  100 , thereby preventing retraction of wedge plate  100  from its distal-most position. 
         [0165]    As shown in  FIG. 61 , flexible leg  152  is positioned within proximal window  140  of wedge plate  100 , thereby restraining wedge plate  100  against retraction, while feed bar  82  and spindle  60  continue to move in a distal direction as shown by the arrows. 
         [0166]    As shown in  FIGS. 62-63 , distal tip  134  of wedge plate  100  urges jaw members  16   a  and  16   b  apart by engaging cam surfaces  178  in jaw members  16   a  and  16   b . As noted above, by positioning wedge plate  100  in cam surfaces  178  of jaw members  16   a  and  16   b , wedge plate  100  not only spreads the jaws  16  apart to properly receive surgical slip  72 , but additionally restrains each individual jaw member  16   a  and  16   b  from flexing with respect to each other, thereby preventing any torque of clip  72  as it is being inserted into jaws  16 . 
         [0167]    Referring to  FIG. 64 , as noted above, flexible leg  152  restrains wedge plate  100  from proximal retraction while cam link  104  continues to advance through slots  148  and  136  in filler component  102  ( FIG. 64 ) and wedge plate  100 . 
         [0168]    As best shown in  FIG. 65 , as spindle  60  continues to move distally through the stroke, trip lever  96  is urged distally with spindle  60  until trip lever  96  engages camming surface  110  (See  FIG. 10D ) of trip block  84 . As camming surface  110  of trip block  84  is urged against trip lever  96 , trip lever  96  will be cammed out of engagement with elongated window  106  of feed bar  82  allowing feed bar  82  to return to a proximal position due to the bias of feed bar spring  88  (see  FIG. 10 ). 
         [0169]    Referring for the moment to  FIG. 66 , as spindle  60  continues to move through its stroke, raised feature  118  on spindle  60  begins to cam flexible leg  152  out of proximal window  140  of wedge plate  100 , so that the wedge plate  100  will be able to retract prior to, and so that, surgical clip  72  is crimped between jaws  16 . This is best illustrated in  FIG. 67  where feed bar  82  has fully inserted clip  72  within jaws  16  and wedge plate  100  has retracted to a proximal-most position. 
         [0170]      FIG. 68  illustrates trip lever  96  being cammed out of engagement with feed bar  82  by camming surface  110  of trip block  84  and against the bias of biasing spring  98  such that feed bar  82  is disengaged from trip lever  96  and feed bar  82  can start to retract proximally. As shown, in  FIG. 69 , pusher  108  of feed bar  82  is retracted to a proximal position behind the next distal most clip  72  as wedge plate  100  retracts leaving clip  72  inserted into jaws  16 . 
         [0171]    Referring to  FIG. 70 , trip lever  96  is completely cammed down by cam surface  110  on trip block  84  and spindle  60  continues to move distally through a further predetermined stroke. 
         [0172]    Referring for the moment to  FIG. 71 , as wedge plate  100  retracts proximally while spindle  60  continues to move distally, flexible leg  152  on filler component  102  snaps into distal window  138  of wedge plate  100 . As shown in  FIG. 72 , wedge plate  100  is retracted to a proximal position relative to jaws  16 . 
         [0173]    Referring to  FIG. 73 , when latch retractor  128  is cammed downwardly relative to spindle  60 , spindle  60  has moved distally to a predetermined distance. The action of spindle  60 , now engaging driver  66 , pushes driver  66  distally. Driver  66  draws slider joint  68  and simultaneously slider joint  68  drags latch retractor  128  distally mechanically forcing cam surface no. of latch retractor  128  downward to underside of jaw pad  172  and engaging latch retractor  128  with slot  126  of spindle  60 . 
         [0174]    Referring to  FIGS. 74-75 , as trigger  18  is fully compressed to drive spindle  60  to a distal-most position, rack  38  clears pawl  42  so that the entire drive assembly can retract when the trigger is released. Notably, a full stroke of the spindle  60  is required to take a clip  72  from an initial position to a fully inserted position in the jaws  16 . As spindle  60  moves through its distal-most position, it moves driver  66  in the manner described hereinabove to crimp a surgical clip  72 . For example, referring to  FIGS. 76-79 , driver  66  advances distally relative to camming surfaces  160  on jaws  16   a  and  16   b , such that camming surfaces  184  on driver  66  cam jaws  16   a  and  16   b  closed thereby closing surgical clip  72  contained therebetween. 
         [0175]    Referring for the moment to  FIG. 80 , a security mechanism is provided to prevent an overstroke condition and thereby excessive compression of clip  72  from damaging tissue, jaws  16  or driver  66 . If trigger  18  is continued to be squeezed past a stroke required for a full forming of clip  72  impact spring  56  compresses within the space defined between knob  20  and bushing  48  thereby preventing any further distal movement of spindle  60 . 
         [0176]    A fully formed clip formed about vessel V is illustrated in  FIG. 81 . 
         [0177]    Referring to  FIG. 82 , as trigger  18  is released (not shown), pawl  42  rotates against the bias of pawl spring  46  such that pawl teeth  44  ride along rack teeth  40  to reset the handle assembly. As shown in  FIG. 83 , when driver  66  retracts, latch retractor  128  is again biased up into its upper-most position, thereby, resetting the drive mechanism. 
         [0178]    Referring to  FIGS. 84-86 , as spindle  60  retracts, raised feature  118  of spindle  60  moves past flexible leg  152  in filler component  102 . It should be noted that wedge plate  100  does not move as it has already fully retracted. As spindle  60  retracts, it draws cam link  104  proximally within slots  136  and  148  of wedge plate  100  and filler component  102  to its initial position. As best seen in  FIG. 86 , in this position, clip applier  10  is again in an initial position to be refired and thus to attach another clip to a vessel.