Abstract:
A medical instrument including a first joint including a first member and a second member, the first member configured to be repositionable with respect to the second member in a first degree of freedom, a second joint operatively coupled to the first joint, the second joint including a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a second degree of freedom, a pair of repositionable jaws operatively coupled to the first joint and the second joint, an open-ended occlusion clip detachably mounted to the pair of repositionable jaws, and a controller operatively coupled to the first joint, the second joint, and the pair of repositionable jaws, the controller including a control with a line operatively coupled to the first and second jaws in at least a gun tackle pulley configuration.

Description:
INTRODUCTION TO THE INVENTION 
     The present disclosure is directed to medical instruments and, more specifically, to an applier that may be used to apply a left atrial appendage occlusion clip. 
     It is a first aspect of the present invention to provide a medical instrument comprising: (a) a first joint comprising a first member and a second member, the first member configured to be repositionable with respect to the second member in a first degree of freedom; (b) a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a second degree of freedom; (c) a pair of repositionable jaws operatively coupled to the first joint and the second joint; (d) an open-ended occlusion clip detachably mounted to the pair of repositionable jaws; and, (e) a controller operatively coupled to the first joint, the second joint, and the pair of repositionable jaws, the controller including a first control configured to direct repositioning of at least one of the first member and the second member, and a second control configured to direct repositioning of at least one of the third member and the fourth member, and a third control configured to direct repositioning of the pair of repositionable jaws, the third control including a line operatively coupled to the first and second jaws in at least a gun tackle pulley configuration. 
     In a more detailed embodiment of the first aspect, the first control comprises a first active control configured to be repositionable among an infinite number of positions, where each of the infinite number of positions orients the first member with respect to the second member within the first degree of freedom, and the second control comprises a second active control configured to be repositionable among an infinite number of positions, where each of the infinite number of positions orients the third member with respect to the fourth member within the second degree of freedom. In yet another more detailed embodiment, the first active control includes a first wheel around which is partially wound a first line operatively coupled to at least one of the first member and the second member so that rotation of the first wheel translates into movement of at least one of the first member and the second member, and the second active control includes a second wheel around which is partially wound a second line operatively coupled to at least one of the third member and the fourth member so that rotation of the second wheel translates into movement of at least one of the third member and the fourth member. In a further detailed embodiment, the medical instrument further includes a repositionable lock in selective communication with at least one of the first control and the second control to retard movement in at least one of the first degree of freedom and the second degree of freedom. In still a further detailed embodiment, the repositionable lock is in selective communication with both the first control and the second control to retard movement of the first joint in the first degree of freedom and the second joint in the second degree of freedom. In a more detailed embodiment, the first control includes a plurality of first teeth, the second control includes a plurality of second teeth, and the repositionable lock includes a catch that concurrently engages at least one of the plurality of first teeth and at least one of the plurality of second teeth. In a more detailed embodiment, the controller is operatively coupled to a hand-held housing, and the repositionable lock is repositionably mounted to the hand-held housing. In another more detailed embodiment, the first control is operatively coupled to a hand-held housing and includes at least one of a pivoting, a sliding, and a rotating first projection extending from the hand-held housing, the second control is operatively coupled to the hand-held housing and includes at least one of a pivoting, a sliding, and a rotating second projection extending from the hand-held housing, and the repositionable lock is operatively coupled to the hand-held housing and includes at least one of a pivoting, a sliding, and a rotating third projection extending from the hand-held housing. In yet another more detailed embodiment, the first control includes a rotating first projection that comprises a first wheel, the second control includes a rotating second projection that comprises a second wheel, the repositionable lock includes a sliding third projection. In still another more detailed embodiment, the medical instrument further includes a longitudinal conduit extending between the controller and the first joint. 
     In yet another more detailed embodiment of the first aspect, the first member comprises a clevis, and the second member comprises a universal. In yet another more detailed embodiment, the universal includes at least one of a first cavity and a first projection, as well as at least one of a second cavity and a second projection, the clevis includes the other of at least one of the first cavity and the first projection, as well as the other of the second cavity and the second projection, the first projection is configured to be repositionable within the first cavity, and the second projection is configured to be repositionable within the second cavity, in order to allow repositioning of the clevis with respect to the universal within the first degree of freedom. In a further detailed embodiment, the third member comprises the universal, and the fourth member comprises a yoke. In still a further detailed embodiment, the universal includes at least one of a third cavity and a third projection, as well as at least one of a fourth cavity and a fourth projection, the yoke includes the other of at least one of the third cavity and the third projection, as well as the other of the fourth cavity of the fourth projection, the third projection is configured to be repositionable within the fourth cavity, and the fourth projection is configured to be repositionable within the fourth cavity, in order to allow repositioning of the universal with respect to the yoke within the second degree of freedom. In a more detailed embodiment, the medical instrument further includes a first connection extending along the longitudinal conduit connecting the first control to at least one of the first member and the second member, and a second connection extending along the longitudinal conduit connecting the second control to at least one of the third member and the fourth member. In a more detailed embodiment, the medical instrument further includes a third connection extending along the longitudinal conduit connecting the first control to at least one of the first member and the second member, and a fourth connection extending along the longitudinal conduit connecting the second control to at least one of the third member and the fourth member. In another more detailed embodiment, the first connection, the second connection, the third connection, and the fourth connection each comprise a line. In yet another more detailed embodiment, the controller further includes a fourth control configured to detachably mount the occlusion clip to the pair of repositionable jaws. In still another more detailed embodiment, the fourth control includes a line concurrently mounted to the occlusion clip and the pair of repositionable jaws. 
     In a more detailed embodiment of the first aspect, the line comprises at least a first line and a second line, the first line is concurrently mounted to the occlusion clip and a first of the pair of repositionable jaws, the second line is concurrently mounted to the occlusion clip and a second of the pair of repositionable jaws, the fourth control is repositionable to selectively dismount the first line from at least one of the occlusion clip and the first of the pair of repositionable jaws, and is repositionable to selectively dismount the second line from at least one of the occlusion clip and the second of the pair of repositionable jaws. In yet another more detailed embodiment, the fourth control includes a tab mounted to the first line and the second line, and the tab is selectively detachable from a hand-held housing. In a further detailed embodiment, the tab is rotationally repositionable with respect to the hand-held housing. In still a further detailed embodiment, the line extends along the longitudinal conduit and operatively couples the third control to the pair of repositionable jaws. In a more detailed embodiment, the medical instrument further includes pulleys operatively coupled to the pair of repositionable jaws, the pair of repositionable jaws being repositionable between an open non-parallel position and a closed position. In a more detailed embodiment, a first of the repositionable jaws is mounted to a first of the pulleys, a second of the repositionable jaws is mounted to a second of the pulleys, and the line of the third control engages the first and second pulleys. In another more detailed embodiment, the first repositionable jaw is mounted to the first and a third of the pulleys, the second repositionable jaw is mounted to the second and a fourth of the pulleys, and the line of the third control engages the first repositionable jaw and the third and fourth pulleys. 
     In a more detailed embodiment of the first aspect, each of the pair of repositionable jaws includes a channel configured to receive a deployment line associated with a fourth control, the fourth control operative to selectively disengage the open-ended occlusion clip from the pair of repositionable jaws. In a more detailed embodiment, the third control comprises a repositionable handle operatively coupled to a hand-held housing of the controller. In another more detailed embodiment, the third control includes a slide arm concurrently mounted to the repositionable handle and the first connection. In yet another more detailed embodiment, the third control includes a spring to bias at least one of the slide arm and the handle, and the third control includes a trigger to selectively unlock the orientation of the handle with respect to the slide arm. In still another more detailed embodiment, the first line comprises a first pair of lines partially wound around the first wheel, where the first pair of lines is mounted to the second member, and the second line comprises a second pair of lines partially wound around the first wheel, where the second pair of lines is mounted to the third member. 
     In yet another more detailed embodiment of the first aspect, the first wheel around which the first pair of lines are partially wound around has a first diameter, the second wheel around which the second pair of lines are partially wound around has a second diameter, where the first diameter is larger than the second diameter. 
     It is a second aspect of the present invention to provide a method of controlling an end effector of a medical instrument that includes a first jaw and a second jaw, the medical instrument including a hand-held device operatively coupled to the end effector, comprising: (a) providing a first control of the hand-held device configured to direct repositioning of at least one of a first member and a second member of a first joint of the end effector, the first member and second member being repositionable with respect to one another in a first degree of freedom; (b) providing a second control of the hand-held device configured to direct repositioning of at least one of a third member and a fourth member of a second joint of the end effector, the third member and fourth member being repositionable with respect to one another in a second degree of freedom different from the first degree of freedom; and, (c) providing a third control of the hand-held device configured to direct repositioning of the first jaw with respect to the second jaw, wherein the third control includes a line operatively coupled to the first and second jaws in at least a gun tackle pulley configuration. 
     In a more detailed embodiment of the second aspect, the method further includes providing a fourth control of the hand-held device configured to selectively disengage an open-ended occlusion clip operatively coupled to a folding support. In yet another more detailed embodiment, the first control includes a first wheel having a first line partially wound therearound, where the first line is also operatively coupled to at least one of the first member and the second member of the first joint of the end effector, and the second control includes a second wheel having a second line partially wound therearound, where the second line is also operatively coupled to at least one of the third member and the fourth member of the second joint of the end effector. In a further detailed embodiment, the third control includes a repositionable handle operatively coupled to the hand-held device, the repositionable handle operatively coupled to a line to reposition the first and second jaws between an open non-parallel position and a closed parallel position. 
     It is a third aspect of the present invention to provide a medical instrument end effector comprising: (a) a first joint comprising a first member and a second member, the first member configured to be repositionable with respect to the second member in a first degree of freedom; (b) a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a second degree of freedom; (c) a pair of repositionable jaws operatively coupled to the first joint and the second joint; and, (d) a line operatively coupled to the pair of repositionable jaws in at least a gun tackle pulley configuration. 
     In a more detailed embodiment of the third aspect, the end effector further includes an occlusion clip detachably mounted to the pair of repositionable jaws. In yet another more detailed embodiment, the end effector further includes a controller including a first control configured to direct repositioning of the first joint, a second control configured to direct repositioning of the second joint, and a third control configured to direct repositioning of the pair of repositionable jaws, and a longitudinal conduit extending between the controller and the first joint. In a further detailed embodiment, the first member comprises a clevis, and the second member comprises a universal. In still a further detailed embodiment, the universal includes at least one of a first cavity and a first projection, as well as at least one of a second cavity and a second projection, the clevis includes the other of at least one of the first cavity and the first projection, as well as the other of the second cavity and the second projection, and the first projection is configured to be repositionable within the first cavity, and the second projection is configured to be repositionable within the second cavity, in order to allow repositioning of the clevis with respect to the universal within the first degree of freedom. In a more detailed embodiment, the third member comprises the universal, and the fourth member comprises a yoke. In a more detailed embodiment, the universal includes at least one of a third cavity and a third projection, as well as at least one of a fourth cavity and a fourth projection, the yoke includes the other of at least one of the first cavity and the first projection, as well as the other of the second cavity and the second projection, the third projection is configured to be repositionable within the second cavity, and the fourth projection is configured to be repositionable within the fourth cavity, in order to allow repositioning of the universal with respect to the yoke within the second degree of freedom. In another more detailed embodiment, a line concurrently mounts the occlusion clip to the pair of repositionable jaws. 
     In yet another more detailed embodiment of the third aspect, the medical instrument further includes pulleys operatively coupled to the pair of repositionable jaws, the pair of repositionable jaws being repositionable between an open non-parallel position and a closed position. In yet another more detailed embodiment, a first of the repositionable jaws is mounted to a first of the pulleys, a second of the repositionable jaws is mounted to a second of the pulleys, and the line of the third control engages the first and second pulleys. In a further detailed embodiment, the first repositionable jaw is mounted to the first and a third of the pulleys, the second repositionable jaw is mounted to the second and a fourth of the pulleys, the line of the third control engages the first repositionable jaw and the third and fourth pulleys. In still a further detailed embodiment, the first repositionable jaw is pivotally mounted to the fourth member, the second repositionable jaw is pivotally mounted to the fourth member, and the first repositionable jaw pivotally engages the second repositionable jaw. In a more detailed embodiment, each of the pair of repositionable jaws includes a channel configured to receive a deployment line associated with a fourth control, the fourth control operative to selectively disengage the open-ended occlusion clip from the pair of repositionable jaws. 
     It is a fourth aspect of the present invention to provide a method of deploying an occlusion clip comprising: (a) inserting an open-ended occlusion clip and deployment device having repositionable jaws into and through a 12 millimeter trocar or smaller, the occlusion clip and deployment device mounted to one another when inserted into and through the trocar; (b) repositioning the deployment device to position the occlusion clip in an open orientation; (c) repositioning the deployment device to direct the occlusion clip in the open orientation so an open end of the open-ended occlusion clip is interposed by a left atrial appendage without passing a tip of the left atrial appendage between opposing beams of the occlusion clip; (d) repositioning the deployment device to position the occlusion clip in a clamped orientation so that portions of the occlusion clip clamp a portion of the left atrial appendage therebetween; (e) removing the deployment device from the occlusion clip; and, (f) withdrawing the deployment device from partially circumscribing the left atrial appendage without passing the tip of the left atrial appendage between the repositionable jaws. 
     It is a fifth aspect of the present invention to provide a method of deploying an occlusion clip comprising: (a) inserting an open-ended occlusion clip removably mounted to an end effector deployment device having repositionable jaws through at least one of an incision and a trocar, the occlusion clip and the end effector deployment device mounted to one another when inserted into and through at least one of the incision and the trocar; (b) repositioning the end effector deployment device to reposition the occlusion clip so an open end of the open-ended occlusion clip is interposed by a portion of a left atrial appendage interposing a base and a tip of the left atrial appendage without passing a tip of the left atrial appendage between opposing clamping surfaces of the occlusion clip and without piercing the left atrial appendage between the occlusion clip; (c) clamping the left atrial appendage with the open-ended occlusion clip to occlude the left atrial appendage; (d) disengaging the open-ended occlusion clip from the end effector deployment device; and, (e) withdrawing the end effector deployment device through at least one of the incision and the trocar. 
     In a more detailed embodiment of the fifth aspect, the inserting step occurs during at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach. In yet another more detailed embodiment, the method further includes insufflating a thoracic space prior to the inserting step. In a further detailed embodiment, the method further includes making an incision as part of a procedure comprising at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach, and introducing a trocar through the incision. In still a further detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, and repositioning the end effector deployment device step includes actuating at least one of a first control and a second control associated with the hand-held device to actively reposition the end effector within at least one of an X-Y plane and a Y-Z plane with respect to the hand-held device. In a more detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, the method further comprising repositioning the open-ended occlusion clip from a compressed position to an expanded position prior to interposing a portion of the left atrial appendage between the opposing clamping surfaces. In a more detailed embodiment, the method further includes actuating a handle associated with the hand-held device to direct repositioning of the open-ended occlusion clip between the compressed position and the expanded position. In another more detailed embodiment, actuating the handle causes a pair of jaws associated with the end effector to reposition with respect to one another, and the pair of jaws is mounted to the open-ended occlusion clip. In yet another more detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, the method further comprising rotationally repositioning the open-ended occlusion clip with respect to the left atrial appendage by rotating the hand-held device. In still another more detailed embodiment, the method further includes grasping the left atrial appendage concurrent with repositioning the end effector deployment device to reposition the occlusion clip so the open end of the open-ended occlusion clip is interposed by the portion of the left atrial appendage. 
     In yet another more detailed embodiment of the fifth aspect, the method further includes repeating the repositioning and clamping steps prior to the disengaging step. In yet another more detailed embodiment, the method further includes confirming a clamping position of the open-ended occlusion clip is operative to occlude the left atrial appendage using at least one of visualization and a transesophageal echocardiogram. In a further detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, and disengaging the open-ended occlusion clip from the end effector deployment device includes actuating a control associated with the hand-held device. In still a further detailed embodiment, the control comprises a repositionable tab operatively coupled to a wire, which is operatively coupled the end effector and the open-ended occlusion clip, and removing the repositionable tab from the hand-held device repositions the wire with respect to at least one loop encompassing at least one of the open-ended occlusion clip and the end effector deployment device in order to disengage the open-ended occlusion clip from the end effector deployment device. In a more detailed embodiment, the inserting step includes inserting the open-ended occlusion clip and the end effector deployment device through the trocar, the withdrawing step includes withdrawing the end effector deployment device through the trocar, and the trocar comprises a twelve millimeter or less diameter orifice. In a more detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, and the step of repositioning the end effector deployment device to reposition the occlusion clip includes locking a position of the end effect deployment device in at least one of an X-Y plane and a Y-Z plane with respect to the hand-held device. 
     It is a sixth aspect of the present invention to provide a medical instrument comprising: (a) an end effector including a pair of repositionable jaws at least operatively coupled to a controller, the controller including a jaw control configured to direct repositioning of the pair of repositionable jaws, the jaw control including a line at least operatively coupled to the first and second jaws in at least a gun tackle pulley configuration; and, (b) an open-ended occlusion clip detachably mounted to the pair of repositionable jaws. 
     In a more detailed embodiment of the sixth aspect, the controller includes a first control, a first joint and a second joint interpose the controller and the end effector, the first joint comprises a first member and a second member, the first member configured to be repositionable with respect to the second member in a first degree of freedom, and the second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a second degree of freedom. In yet another more detailed embodiment, the first control comprises a first active control configured to be repositionable among an infinite number of positions, where each of the infinite number of positions orients the first member with respect to the second member within the first degree of freedom, and the second control comprises a second active control configured to be repositionable among an infinite number of positions, where each of the infinite number of positions orients the third member with respect to the fourth member within the second degree of freedom. In a further detailed embodiment, the first active control includes a first wheel around which is partially wound a first line operatively coupled to at least one of the first member and the second member so that rotation of the first wheel translates into movement of at least one of the first member and the second member, and the second active control includes a second wheel around which is partially wound a second line operatively coupled to at least one of the third member and the fourth member so that rotation of the second wheel translates into movement of at least one of the third member and the fourth member. In still a further detailed embodiment, the controller further includes a repositionable lock in selective communication with at least one of the first control and the second control to retard movement in at least one of the first degree of freedom and the second degree of freedom. In a more detailed embodiment, the repositionable lock is in selective communication with both the first control and the second control to retard movement of the first joint in the first degree of freedom and the second joint in the second degree of freedom. In a more detailed embodiment, the first control includes a plurality of first teeth, the second control includes a plurality of second teeth, and the repositionable lock includes a catch that concurrently engages at least one of the plurality of first teeth and at least one of the plurality of second teeth. In another more detailed embodiment, the controller is operatively coupled to a hand-held housing, and the repositionable lock is repositionably mounted to the hand-held housing. In yet another more detailed embodiment, the first control is operatively coupled to a hand-held housing and includes at least one of a pivoting, a sliding, and a rotating first projection extending from the hand-held housing, the second control is operatively coupled to the hand-held housing and includes at least one of a pivoting, a sliding, and a rotating second projection extending from the hand-held housing, and the repositionable lock is operatively coupled to the hand-held housing and includes at least one of a pivoting, a sliding, and a rotating third projection extending from the hand-held housing. In still another more detailed embodiment, the medical instrument further includes a longitudinal conduit at least operatively coupled to the end effector and the controller. 
     In yet another more detailed embodiment of the sixth aspect, the first control includes a rotating first projection that comprises a first wheel, the second control includes a rotating second projection that comprises a second wheel, and the repositionable lock includes a sliding third projection. In yet another more detailed embodiment, the first member comprises a clevis, and the second member comprises a universal. In a further detailed embodiment, the universal includes at least one of a first cavity and a first projection, as well as at least one of a second cavity and a second projection, the clevis includes the other of at least one of the first cavity and the first projection, as well as the other of the second cavity and the second projection, and the first projection is configured to be repositionable within the first cavity, and the second projection is configured to be repositionable within the second cavity, in order to allow repositioning of the clevis with respect to the universal within the first degree of freedom. In still a further detailed embodiment, the third member comprises the universal, and the fourth member comprises a yoke. In a more detailed embodiment, the universal includes at least one of a third cavity and a third projection, as well as at least one of a fourth cavity and a fourth projection, the yoke includes the other of at least one of the first cavity and the first projection, as well as the other of the second cavity and the second projection, and the third projection is configured to be repositionable within the second cavity, and the fourth projection is configured to be repositionable within the fourth cavity, in order to allow repositioning of the universal with respect to the yoke within the second degree of freedom. In a more detailed embodiment, the medical instrument further includes a first connection extending along the longitudinal conduit connecting the first control to at least one of the first member and the second member, and a second connection extending along the longitudinal conduit connecting the second control to at least one of the third member and the fourth member. In another more detailed embodiment, the medical instrument further includes a third connection extending along the longitudinal conduit connecting the first control to at least one of the first member and the second member, and a fourth connection extending along the longitudinal conduit connecting the second control to at least one of the third member and the fourth member. In yet another more detailed embodiment, the first connection, the second connection, the third connection, and the fourth connection each comprise a line. In still another more detailed embodiment, the controller further includes a release control configured to detachably mount the occlusion clip to the pair of repositionable jaws. 
     In a more detailed embodiment of the sixth aspect, the release control includes a line concurrently mounted to the occlusion clip and the pair of repositionable jaws. In yet another more detailed embodiment, the line comprises at least a first line and a second line, the first line is concurrently mounted to the occlusion clip and a first of the pair of repositionable jaws, the second line is concurrently mounted to the occlusion clip and a second of the pair of repositionable jaws, and the release control is repositionable to selectively dismount the first line from at least one of the occlusion clip and the first of the pair of repositionable jaws, and is repositionable to selectively dismount the second line from at least one of the occlusion clip and the second of the pair of repositionable jaws. In a further detailed embodiment, the release control includes a tab mounted to the first line and the second line, and the tab is selectively detachable from a hand-held housing. In still a further detailed embodiment, the tab is rotationally repositionable with respect to the hand-held housing. In a more detailed embodiment, the line extends along the longitudinal conduit and operatively couples the jaw control to the pair of repositionable jaws. In a more detailed embodiment, each of the pair of repositionable jaws includes a channel configured to receive a deployment line associated with a release control, the release control operative to selectively disengage the open-ended occlusion clip from the pair of repositionable jaws. In another more detailed embodiment, the jaw control comprises a repositionable handle operatively coupled to a hand-held housing of the controller. In a more detailed embodiment, the jaw control includes a slide arm concurrently mounted to the repositionable handle and the first connection. In another more detailed embodiment, the jaw control includes a spring to bias at least one of the slide arm and the handle, and the jaw control includes a trigger to selectively unlock the orientation of the handle with respect to the slide arm. In yet another more detailed embodiment, the first line comprises a first pair of lines partially wound around the first wheel, where the first pair of lines is mounted to the second member, and the second line comprises a second pair of lines partially wound around the first wheel, where the second pair of lines is mounted to the third member. In still another more detailed embodiment, the first wheel around which the first pair of lines are partially wound around has a first diameter, the second wheel around which the second pair of lines are partially wound around has a second diameter, and the first diameter is larger than the second diameter. 
     It is a seventh aspect of the present invention to provide a method of deploying an occlusion clip comprising: (a) inserting an open-ended occlusion clip removably mounted to an end effector deployment device having repositionable jaws through at least one of an incision and a trocar, the occlusion clip and the end effector deployment device mounted to one another when inserted into and through the trocar; (b) repositioning the end effector deployment device to reposition the occlusion clip so an open end of the open-ended occlusion clip is interposed by a portion of a left atrial appendage interposing a base and a tip of the left atrial appendage without passing the tip of the left atrial appendage between opposing clamping surfaces of the occlusion clip and without piercing the left atrial appendage between the occlusion clip; (c) clamping the left atrial appendage with the open-ended occlusion clip in an initial position; (d) assessing the operability of the open-ended occlusion clip in the initial position to occlude the left atrial appendage; and, (e) repositioning the end effector deployment device to reposition the open-ended occlusion clip to a subsequent position, different from the initial position, to clamp the left atrial appendage, where repositioning the open-ended occlusion clip from the initial position to the subsequent position is repeatable without affecting the structural integrity of the left atrial appendage. 
     It is an eighth aspect of the present invention to provide a method of deploying an occlusion clip comprising: (a) inserting an open-ended occlusion clip removably mounted to an end effector deployment device, having repositionable jaws, through at least one of an incision and a trocar, the open-ended occlusion clip biased to a clamping position; (b) repositioning the end effector deployment device to counteract a bias of the open-ended occlusion clip and reposition the open-ended occlusion clip to a tissue insertion position where the full bias of the open-ended occlusion clip is not applied to a left atrial appendage tissue; (c) repositioning the end effector deployment device to reposition the open-ended occlusion clip in the tissue insertion position so a portion of a left atrial appendage between a base and a tip of the left atrial appendage interposes the open-ended occlusion clip without ever having a tip of the left atrial appendage interpose the open-ended occlusion clip; and, (d) repositioning the open-ended occlusion clip to apply the full bias to the left atrial appendage. 
     In a more detailed embodiment of the eighth aspect, the method further includes disengaging the open-ended occlusion clip from the end effector deployment device, and withdrawing the end effector deployment device through at least one of the incision and the trocar. In yet another more detailed embodiment, the inserting step occurs during at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach. In a further detailed embodiment, the method includes insufflating a thoracic space prior to the inserting step. In still a further detailed embodiment, the method further includes making an incision as part of a procedure comprising at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach, and introducing a trocar through the incision. In a more detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, and repositioning the end effector deployment device step includes actuating at least one of a first control and a second control associated with the hand-held device to actively reposition the end effector within at least one of an X-Y plane and a Y-Z plane with respect to the hand-held device. In a more detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, the method further comprising repositioning the open-ended occlusion clip from a compressed position to an expanded position prior to interposing a portion of the left atrial appendage between the opposing clamping surfaces. In another more detailed embodiment, the method further includes actuating a handle associated with the hand-held device to direct repositioning of the open-ended occlusion clip between the compressed position and the expanded position. In yet another more detailed embodiment, actuating the handle causes a pair of jaws associated with the end effector to reposition with respect to one another, and the pair of jaws is mounted to the open-ended occlusion clip. In still another more detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, the method further comprising rotationally repositioning the open-ended occlusion clip with respect to the left atrial appendage by rotating the hand-held device. 
     In yet another more detailed embodiment of the eighth aspect, the method further includes grasping the left atrial appendage concurrent with repositioning the end effector deployment device to reposition the occlusion clip so the open end of the open-ended occlusion clip is interposed by the portion of the left atrial appendage. In yet another more detailed embodiment, the method further includes confirming application of the full bias of the open-ended occlusion clip is operative to occlude the left atrial appendage using at least one of visualization and a transesophageal echocardiogram. In a further detailed embodiment, the method further includes disengaging the open-ended occlusion clip from the end effector deployment device, where the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, and disengaging the open-ended occlusion clip from the end effector deployment device includes actuating a control associated with the hand-held device. In still a further detailed embodiment, the control comprises a repositionable tab operatively coupled to a wire, which is operatively coupled to the end effector and the open-ended occlusion clip, and removing the repositionable tab from the hand-held device repositions the wire with respect to at least one loop encompassing at least one of the open-ended occlusion clip and the end effector deployment device in order to disengage the open-ended occlusion clip from the end effector deployment device. In a more detailed embodiment, the inserting step includes inserting the open-ended occlusion clip and the end effector deployment device through the trocar, and the trocar comprises a twelve millimeter or less diameter orifice. In a more detailed embodiment, the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, and the step of repositioning the end effector deployment device to reposition the open-ended occlusion clip includes locking a position of the end effect deployment device in at least one of an X-Y plane and a Y-Z plane with respect to the hand-held device. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is an elevated perspective view of an exemplary surgical tool in accordance with the instant disclosure. 
         FIG. 2  is an elevated perspective view of the end effector of  FIG. 1 , shown in the collapsed position after having deployed an occlusion clip. 
         FIG. 3  is an exploded view of the end effector of  FIG. 2  with the occlusion clip. 
         FIG. 4  is an elevated perspective view from a distal end of an exemplary clevis in accordance with the instant disclosure. 
         FIG. 5  is an elevated perspective view from a proximal end of the exemplary clevis of  FIG. 4 . 
         FIG. 6  is a cross-sectional view of the exemplary clevis of  FIG. 5  taken along line  6 - 6 . 
         FIG. 7  is a cross-sectional view of the exemplary clevis of  FIG. 4  taken along line  7 - 7 . 
         FIG. 8  is an elevated perspective view from a distal end of an exemplary universal in accordance with the instant disclosure. 
         FIG. 9  is a profile view of the exemplary universal of  FIG. 8 . 
         FIG. 10  is a cross-sectional view of the exemplary universal of  FIG. 8  taken along line  10 - 10 . 
         FIG. 11  is a cross-sectional view of the exemplary universal of  FIG. 9  taken along line  11 - 11 . 
         FIG. 12  is an elevated perspective view from a distal end of an exemplary yoke in accordance with the instant disclosure. 
         FIG. 13  is a distal end view of the exemplary yoke of  FIG. 12 . 
         FIG. 14  is a proximal end view of the exemplary yoke of  FIG. 12 . 
         FIG. 15  is a top view of the exemplary yoke of  FIG. 12 . 
         FIG. 16  is a cross-sectional view of the exemplary yoke of  FIG. 15  taken along line  16 - 16 . 
         FIG. 17  is a cross-sectional view of the exemplary yoke of  FIG. 15  taken along line  17 - 17 . 
         FIG. 18  is an elevated perspective view from an interior, proximal end of a first jaw in accordance with the instant invention. 
         FIG. 19  is an exterior profile view of the first jaw of  FIG. 18 . 
         FIG. 20  is a bottom view of a second jaw in accordance with the instant disclosure. 
         FIG. 21  is an elevated perspective view from an interior, proximal end of the second jaw of  FIG. 20 . 
         FIG. 22  is an elevated perspective view from a distal end, taken of a portion of an exemplary end effector without the exemplary universal to show orientation and positioning of deployment wires and control wires for the exemplary clevis and yoke in accordance with the instant disclosure. 
         FIG. 23  is an elevated perspective view from a proximal end, taken of the exemplary end effector to show orientation and positioning of deployment wires and control wires for the exemplary universal, yoke, and jaws in accordance with the instant disclosure. 
         FIG. 24  is an elevated perspective view from a proximal end, taken of a portion of an exemplary end effector without the exemplary clevis, universal, and yoke to show orientation and positioning of deployment wires and control wires for the exemplary jaws in accordance with the instant disclosure. 
         FIG. 25  is an elevated perspective view from a proximal end, taken of a portion of an exemplary end effector without the exemplary clevis and universal to show orientation and positioning of deployment wires and control wires for the exemplary yoke and jaws in accordance with the instant disclosure. 
         FIG. 26  is a perspective view of the interior of a left side housing in accordance with the instant disclosure. 
         FIG. 27  is a perspective view of the interior of a right side housing in accordance with the instant disclosure. 
         FIG. 28  is a profile view of the interior of the right side housing of  FIG. 27  and components housed therein in accordance with the instant disclosure. 
         FIG. 29  is an elevated perspective view of an exterior side of a first wheel in accordance with the instant disclosure. 
         FIG. 30  is an elevated perspective view of an interior side of the first wheel of  FIG. 29 . 
         FIG. 31  is an elevated perspective view from an exterior surface of a first pulley and associated wires in accordance with the instant disclosure. 
         FIG. 32  is an exploded view of the components of  FIG. 31 , less the wires. 
         FIG. 33  is an elevated perspective view from an interior surface of the first pulley of  FIG. 31 . 
         FIG. 34  is an elevated perspective view from an exterior surface of a second pulley in accordance with the instant disclosure. 
         FIG. 35  is an elevated perspective view from an interior surface of the second pulley of  FIG. 34  and associated wires in accordance with the instant disclosure. 
         FIG. 36  is an exploded view of the components of  FIG. 35 , less the wires. 
         FIG. 37  is an elevated perspective view of an exterior side of a second wheel in accordance with the instant disclosure. 
         FIG. 38  is an elevated perspective view of an interior side of the second wheel of  FIG. 37 . 
         FIG. 39  is a profile view of an exemplary repositionable lock in accordance with the instant disclosure. 
         FIG. 40  is an exploded view of the exemplary components of  FIG. 39 . 
         FIG. 41  is a cross-sectional view of the exemplary thumb button of  FIG. 39  taken along line  45 - 45 . 
         FIG. 42  is an exploded view of an exemplary control for repositioning the end effector jaws in accordance with the instant disclosure. 
         FIG. 43  is an assembled view of the exemplary control of  FIG. 42 . 
         FIG. 44  a cross-sectional view of the exemplary control of  FIG. 43  taken along line  48 - 48 . 
         FIG. 45  is an elevated perspective view of an exemplary shaft assembly along with associated control and deployment wires in accordance with the instant disclosure. 
         FIG. 46  is an end view taken from a distal end of an exemplary repositionable tab in accordance with the instant disclosure. 
         FIG. 47  is an end view taken from a distal end of a further exemplary repositionable tab in accordance with the instant disclosure. 
         FIG. 48  is an elevated perspective view of a portion of an exemplary end effector in accordance with the instant disclosure shown mounted to an exemplary occlusion clip. 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of the present disclosure are described and illustrated below to encompass devices, methods, and techniques relating to surgical procedures. 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 disclosure. It is also to be understood that variations of the exemplary embodiments contemplated by one of ordinary skill in the art shall concurrently comprise part of the instant disclosure. 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 disclosure. 
     Referencing  FIG. 1 , an exemplary surgical tool  10  includes a user control  20  mounted to a shaft assembly  30 , which is mounted to an exemplary minimally invasive surgical end effector  100 . The user control  20  includes a first wheel control  40  to vary the yaw of the end effector  100 , while the user control  20  further includes a second wheel control  50  to vary the pitch of the end effector. A user of the control  20  may manipulate the roll of the end effector  100  simply by rolling the user control. In order to selectively inhibit manipulation of the wheel controls  40 ,  50 , a repositionable lock  60  is also provided. A proximal end of the user control  20  further includes a repositionable tab  70  that may be utilized to, in exemplary form, disengage a left atrial appendage (LAA) occlusion clip from the end effector  100 . In addition, the user control  20  includes a lever control  80  that is operative to control repositioning of the jaws of the end effector  100  with respect to one another. Several of the components of the lever control  80 , the wheel controls  40 ,  50 , and the repositionable lock  60  at least partially reside within a grip housing  90 . A more detailed discussion of the exemplary components of the surgical tool  10  will be discussed successively. 
     Referring to  FIGS. 1-3 , the exemplary end effector  100  may be used in minimally invasive surgical procedures to allow deployment of an LAA occlusion clip  102  with respect to a left atrial appendage (not shown). U.S. Provisional Patent Application No. 62/091,230, which describes an exemplary LAA occlusion clip  102 , is incorporated herein by reference. As will be apparent to those skilled in the art after reviewing the instant disclosure, the end effector  100  and surgical tool  10  may be utilized in capacities other than LAA occlusion clip deployment, each of which is within the scope of this disclosure. 
     The end effector  100  comprises a clevis  110  that is mounted proximally to the shaft assembly  30  and distally to a proximal portion of a universal  120 , which is rotatably repositionable within an X-Y plane with respect to the clevis. A distal portion of the universal  120  is mounted to a proximal portion of a yoke  130  that is rotatably repositionable within a Y-Z plane with respect to the universal. A distal portion of the yoke  130  has mounted to it a first pin  140  and a second pin  150  that extend through corresponding proximal openings of a first jaw  160  and a second jaw  170 . In this fashion, the jaws  160 ,  170  are rotatably repositionable with respect to the yoke  130  and with respect to one another. Each jaw  160 ,  170  includes a pair of U-shaped proximal projections that overlap one another and each include a through opening aligned with one another configured to receive a respective third pin  180  and fourth pin  190 . The spacing between the U-shaped projections is sufficient to each accommodate a respective pair of pulleys  200 ,  210  that rotate about a respective pin  180 ,  190 . As will be discussed in more detail hereafter, a control wire  1364  (see  FIG. 24 ) is fed around the pulleys  200 ,  210  and is utilized to cause the jaws  160 ,  170  to pivot with respect to one another for opening and closing in a non-parallel fashion. In order to further regulate the opening and closing of the jaws  160 ,  170 , a bias spring  220  interposes the jaws and is concurrently mounted thereto. A more detailed discussion of the component parts of the end effector  100  follows. 
     As shown in  FIGS. 4-7 , the clevis  110  includes an outer shell  400  that defines a longitudinal passage  402  extending therethrough. A proximal end  404  of the shell  400  includes an inner, cylindrical surface  406  that circumscribes an elongated shaft  1390  of the shaft assembly  30  (see  FIG. 45 ) and retains the shaft therein via a compression fit. This inner, cylindrical surface  406  abuts a dam  408  that inhibits further distal repositioning of the shaft  1390 . Extending through the dam  408  are a pair of cylindrical through holes  410  interposed by an elongated through hole  412 . In exemplary form, as shown in  FIG. 22 , separate control wires  1272 ,  1274  extend through each cylindrical hole  410  and are coupled to the universal  120  and to the first wheel control  40  so that manipulation of the first wheel control is operative to reposition the universal with respect to the clevis  110 . In addition, another group of wires  1172 ,  1174 ,  1364 ,  1402 ,  1404  extend through the elongated hole  412 . A more detailed discussion of the wires and the structures to which each is mounted will be discussed hereafter. 
     On a distal side of the holes  410 ,  412 , an overhang  416  and corresponding underhang  418 , along with corresponding interior walls  422 , partially define a distal opening. In particular, the overhang  416  and underhang  418  are mirror images of one another and include an arcuate profile that curves away from the dam  408  until terminating at opposing planar upper and lower walls  424 . Inset within each of the interior walls  422  is a C-shaped depression  426 , where the open end of the C-shape faces distally. As will be discussed in more detail hereafter, a peripheral surface  430  partially delineating the C-shaped depression  426  bridges between the interior wall  422  and a step wall  432 , and provides a camming surface against which the universal  120  rotates. In this exemplary embodiment, the interior walls  422  are planar and parallel to one another, as are the step walls  432 , in addition to the interior walls being parallel to the step walls. Interposing the upper and lower walls  424  are convex side surfaces  436 , where the convex side surfaces abut distal curved surfaces  438  that partially delineate the C-shaped depression  426  and likewise extend between the upper and lower walls. Extending proximally, the upper and lower walls  424  and the convex side surfaces  436  transition from a generally rectangular exterior cross-section to a circular cross-section at a proximal end  440  via a series of tapered walls  442 . Extending distally from the clevis  110  is the universal  120 . 
     Referring to  FIGS. 8-11 , the universal  120  comprises a pair of projections  450  extending outward from opposing right and left side surfaces  452 . In this exemplary embodiment, the projections  450  include a plateau surface  454  that is generally planar and parallel with the planar surface of the nearest side surface  452 . A peripheral shape of each projection  450  is rounded on a proximal end and comes to a point on a distal end  451  that is generally centered with a midline extending through the universal  120 . In particular, the peripheral surface  456  of each projection  450  is intended to contact and ride against the peripheral surface  430  of the clevis  110  (see  FIG. 4 ) in order to allow pivotal motion between the clevis and universal  120 . But the pointed shape of each projection  450 , as embodied by two linear segments of the peripheral surface  456 , is operative to provide opposing stops that prevent complete rotation of the universal  120  with respect to the clevis  110 . By way of example, the linear segments of the peripheral surface  456  are angled approximately ninety degrees with respect to one another so that the universal  120  can rotate ±forty-five degrees with respect to a longitudinal axis extending through the clevis  110  in the proximal-distal direction. Each projection  450  is generally centered between opposing top and bottom surfaces  460  and distally inset from a proximal end  462 . 
     The proximal end  462  of the universal  120  is semicircular in profile to ride against the overhang  416  and underhang  418  of the clevis  110  when the universal is rotated with respect to the clevis. In particular, the proximal end  462  includes a central U-shaped channel  466  that terminates at corresponding key-shaped through openings  468  extending through the top and bottom surfaces  460  and into an interior of the universal  120 . The key-shaped opening  468  includes a cylindrical, enlarged opening  469  that is configured to accept an enlarged end of a control wire  1172 ,  1174  (see  FIG. 22 ). Once passing through the cylindrical opening, the enlarged end of the control wire is retained within a capture, which is partially delineated via a depression  464 , that inhibits throughput of the enlarged end of the control wire through the smaller height aspect of the key-shaped through openings  468 . A height of the U-shaped channel  466  extending along the top and bottom is sufficient to accommodate the width of a control wire, but not so high as to allow throughput of the enlarged end of the control wire, with the exception of through the enlarged cylindrical opening. Corresponding interior surfaces  470  delineating a portion of the U-shaped channel  466  are convex and arcuate in shape. Extending co-planar with the U-shaped channel  466  is a through opening  474  is sized to accommodate throughput of further control wires. The base of the U-shaped channel and the through opening  474  interpose opposing left and right side channels  476 ,  478 . 
     A proximal end of each of the channels  476 ,  478  is delineated by spaced apart, arcuately shaped complementary walls  482 ,  484 . As mentioned previously, a peripheral surface of these walls  482 ,  484  rides against the overhang  416  and underhang  418  of the clevis  110 . Each of the channels  476 ,  478  tapers from proximal to distal and creates a dedicated through opening that extends through the universal  120  and into an internal region partially bounded by opposing distal extensions  490 . 
     Inset within each interior wall  492  of the distal extensions  490  is a Y-shaped depression  496 , where the open end of the Y-shape faces distally. As will be discussed in more detail hereafter, a peripheral surface  498  partially delineating the Y-shaped depression  496  bridges between the interior wall  492  and a step wall  502 , and provides a camming surface against which the yoke  130  rotates. In this exemplary embodiment, the interior walls  492  are planar and parallel to one another, as are the step walls  502 , in addition to the interior walls being parallel to the step walls. The step walls  502  and the top and bottom surfaces  460  converge at respective distal ends of the distal extensions  490  to form a semicircular edge  504 , which is interposed by the yoke  130 . 
     As shown in  FIGS. 12-17 , the yoke  130  includes a pair of projections  510  extending outward from opposing top and bottom exterior surfaces  512 . In this exemplary embodiment, the projections  510  include a plateau surface  514  that is generally planar and parallel with the planar surface of the nearest top/bottom surface  512 . A peripheral shape of each projection  510  is rounded embodying a cylindrical projection that is generally centered with a midline extending through the yoke  130 . In particular, a portion of the peripheral surface  516  of each projection  510  is intended to contact and ride against the peripheral surface  498  of the universal  120  in order to allow pivotal motion between the yoke  130  and universal  120 . Each projection  510  is generally centered between opposing right and left sides  520  and distally inset from a proximal end  522 . 
     The proximal end  522  of the yoke  130  has semicircular in profile. In particular, the proximal end  522  includes a miniature U-shaped channel  526  that terminates at corresponding openings  528  extending through the left and right side surfaces  520  and into an interior of the yoke  130 . Each opening  528  is configured to allow throughput of a separate control wire  1272 ,  1274 , but prohibit an enlarged end of that control wire from passing therethrough (see  FIG. 24 ). And a height of the U-shaped channel  526  extending along the left and right side surfaces  520  is sufficient to accommodate the width of a control wire  1272 ,  1274 , but not so high as to allow throughput of the enlarged end of the control wire. In exemplary form, each control wire is inserted through one of the openings  528  (smaller diameter end first) so that the remainder of the control wire extends proximally and a distal, enlarged end of the control wire is too large to pass through the opening  528  and is retained within an interior space of the yoke  130  when the wire is tensioned. Tensioning of both control wires  1272 ,  1274  is operative to seat the enlarged end of the control wire within a depression  540  formed into the yoke  130 . 
     Adjacent the miniature U-shaped channel  526  and extending through the yoke  130  is a central through channel  546 . The central through channel  546  is sized to accommodate a control wire  1364  coupled to the pulleys  200 ,  210  (see  FIG. 24 ). As will be discussed in more detail hereafter, repositioning of the control wire  1364  with respect to the yoke  130  and pulleys  200 ,  210  results in component motion operative to increase or decrease the distance between the distal ends of the opposing jaws  160 ,  170  (when the occlusion clip  102  is mounted to the jaws  160 ,  170 , this component motion is also operative to open or close the clip). 
     In exemplary form, a distal end of the yoke  130  include a pair of outer retention arms  530 ,  532  each include opposed exterior and interior planar surfaces  554 ,  556 , that are bridged laterally by complementary arcuate surfaces  558 . A distal most portion of each retention arm  530 ,  532  includes a planar surface  560  normal to the interior and exterior planar surfaces  554 ,  556 . In this exemplary embodiment, the retention arms  530 ,  532  have a rounded, rectangular footprint typified by the interior surfaces  556  having a rounded rectangular footprint slightly larger than the exterior surfaces  554  rounded rectangular footprint. Proximate the distal, rounded corners of the retention arms  530 ,  532  are corresponding through holes  564  that extend between the interior and exterior surfaces  554 ,  556 . Each through hole  564  is sized to receive at least one of the first pin  140  and the second pin  150  in order to pivotally mount a corresponding jaw  160 ,  170  to the yoke  130 . In this exemplary embodiment, each through hole  564  is sized to retain a corresponding pin  140 ,  150  therein via a friction fit so that the pin does not rotate with respect to the yoke  130 , though fits other than a friction fit may be utilized. 
     Referencing  FIGS. 18-21 , the jaws  160 ,  170  are structurally mirror images of one another, with the exception of the cams  600 ,  602 . Consequently, the following discussion of the structure of a jaw is generally applicable to both the first and second jaws  160 ,  170  unless otherwise noted. 
     Each jaw  160 ,  170  includes a rounded proximal end  660  that transitions distally into a rectangular cross-section with an openings  662 , extending between opposing top and bottom surfaces  666 ,  668 , and having a cylindrical shape configured to receive one of the first and second pins  140 ,  150 . In this fashion, the first and second jaws  160 ,  170  may be rotationally repositionable with respect to the yoke  130  by pivoting about the first and second pins  140 ,  150 . A corresponding cam  600 ,  602  extends from an interior surface  670  spanning between the top and bottom surfaces  666 ,  668 . The cams  600 ,  602  engage one another to guide pivoting of the jaws  160 ,  170  with respect to one another. In exemplary form, the first cam  600  of the first jaw  160  has a rounded rectangular profile but for a U-shaped cavity  674  formed therein, with spaced apart ends  672  that are rounded. This U-shaped cavity  674  is configured to receive a corresponding rounded projection  676  of the second cam  602 . Moreover, rounded shoulders  678  of the second cam  602  are configured to engage the rounded ends  672  of the first cam  600  in order to provide corresponding range of motion stops. In particular, the distal most rounded end  672  of the first cam  600  will engage the distal most rounded shoulder  678  of the second cam  602  to limit the pivotal motion of the jaws  160 ,  170  toward one another. Similarly, the proximal most rounded end  672  of the first cam  600  will engage the proximal most rounded shoulder  678  of the second cam  602  to limit the pivotal motion of the jaws  160 ,  170  away from one another. In other words, the rounded ends  672  of the first cam  600  do not engage the rounded shoulders  678  of the second cam  602  until an end of the range of motion of the jaws  160 ,  170  is reached. Conversely, the surface of the first cam  600  delineating the U-shaped cavity  674  is configured to maintain contact with the surface delineating the rounded projection  676  of the second cam  602  through the pivotal range of motion of the jaws  160 ,  170  with respect to one another. 
     As part of repositioning the jaws  160 ,  170  with respect to one another, the proximal end  660  of each jaw includes a cavity  680  that is sized to receive a corresponding pair of pulleys  200 ,  210 . In order to mount the pulleys  200 ,  210  to the jaws  160 ,  170 , a pair of through openings  682  extends through portions of the jaws, where the through openings  682  are longitudinally aligned. More specifically, the through openings  682  are configured to receive a corresponding third or fourth pin  180 ,  190  that concurrently extends through the corresponding pulleys  200 ,  210  in order to mount the pulleys to a jaw. In this exemplary embodiment, each through opening  682  is sized to retain a corresponding pin  180 ,  190  therein via a friction fit so that the pin does not rotate or move longitudinally with respect to the jaw  160 ,  170 , though fits other than a friction fit may be utilized, while allowing the pulleys  200 ,  210  to rotate with respect to the pin and jaw. Unlike the second jaw  170 , the first jaw  160  includes a through opening  684  extending between the interior surface  670  and an exterior surface  671  of the rectangular-shape profile section. This through opening  684  is sized to receive an end of a control wire  1364  and allow the control wire to pass therethrough, but not so large as to allow an enlarged end of the control wire to pass therethrough. Accordingly, as the control wire  1364  is tensioned, the structure delineating the through opening  684  acts as an anchor to hold an end of the control wire in place. Thus, the pulleys  200 ,  210  are positioned in a double tackle configuration. As used herein, “tackle” refers to a rope, wire, or other connector section threaded between two blocks, where “block” refers to a pulley mounted on a single axle. As known by those skilled in the art, tackles may be duplicated to create greater and greater mechanical advantage. By way of example, a double tackle configuration comprises four rope sections of the tackles, whereas a luff tackle comprises three rope sections, and a gun tackle comprises two rope sections. In this manner, a luff tackle and a double tackle inherently include a gun tackle. 
     Though the foregoing exemplary embodiment has been described using four pulleys  200 ,  210  in a double tackle configuration, it should be noted that other pulley configurations may be used, such as, without limitation, a gun tackle configuration, a watch/Luff tackle configuration, a Gyn tackle configuration, and a three fold purchase configuration, as well as combinations and duplications of the foregoing. 
     Extending distally past the rectangular cross-section, each jaw  160 ,  170  includes an arcuate profile that is slightly convex on an exterior surface  692  and concave on an interior surface  690 . Opposing top and bottom surfaces  696 ,  698  surfaces are essentially planar and extend parallel to one another. Perimeter surfaces  694  extending between the interior surface  690  and corresponding top and bottom surfaces  696 ,  698  have an arcuate shape in the longitudinal direction (proximal to distal) and these surfaces cooperate to delineate an interior recess  700  that is sized to receive a corresponding portion of the occlusion clip  102 . On the opposite exterior surface  692 , a channel  702  is sized and configured to receive a respective deployment wire  1402 ,  1404 , whereas the openings  686  are sized to accommodate throughput of a suture retainer coupled to the left atrial occlusion clip  102 . 
     Referring to  FIGS. 1-25 and 48 , an exemplary assembly sequence for the exemplary end effector  100  will now be described. Initially, the control and deployment wires  1172 ,  1174 ,  1272 ,  1274 ,  1364 ,  1402 ,  1404  are routed through the clevis  110 . Specifically, the longitudinal passage  402  at the proximal end  404  of the clevis receives the wires  1172 ,  1174 ,  1272 ,  1274 ,  1364 ,  1402 ,  1404 , which are then redirected so that the control wires  1272 ,  1274  individually extend through a respective through hole  410  of the clevis, while the other wires  1172 ,  1174 ,  1364 ,  1402 ,  1404  extend through the elongated through hole  412  of the clevis. After routing the wires through the clevis  110 , the universal  120  is mounted to the clevis so that the projections  450  of the universal are received within respective C-shaped depressions  426 . In order to retain the universal  120  in an engaged position with respect to the clevis, the control wires  1172 ,  1174  are individually fed through one of the cylindrical, enlarged openings  469  of the universal  120  and knotted or otherwise processed to enlarge the ends of each control wire sitting within a respective depression  464 . The control wires  1172 ,  1174  are then tensioned and mounted to the first wheel control  40  so that rotation of the wheel control  40  will cause pivoting motion of the universal  120  with respect to the clevis  110  in an X-Y plan or a first degree of freedom. Likewise, the other control wires  1272 ,  1274  are fed through a respective channel  476 ,  478  of the universal  120 , while the other wires  1364 ,  1402 ,  1404  extend through the opening  474  of the universal. 
     After routing the wires through the universal  120 , the yoke  130  is mounted to the universal so that the projections  510  of the yoke are received within respective Y-shaped depressions  496 . In order to retain the yoke  130  in an engaged position with respect to the universal  120 , the control wires  1272 ,  1274  are individually fed through one of the openings  528  of the yoke and knotted or otherwise processed to enlarge the ends of each control wire sitting on the other side of the U-shaped channel  526 . The control wires  1272 ,  1274  are then tensioned and mounted to the second wheel control  50  so that rotation of the wheel control  50  will cause pivoting motion of the yoke  130  with respect to the universal  120  in a Y-Z plane or second degree of freedom. Conversely, the other wires  1364 ,  1402 ,  1404  extend through the channel  546  of the yoke  130 . 
     Each jaw  160 ,  170  is then prepared for mounting to the yoke  130 . In preparation for mounting to the yoke  130 , the jaws  160 ,  170  are mounted to a respective set of pulleys  200 ,  210 . Specifically, the first set of pulleys  200  are inserted into the proximal end cavity  680  so that the openings through the pulleys are aligned with corresponding openings  682  of the first jaw  160 . Thereafter, the third pin  180  is inserted into the openings  682  and through the pulleys  200  in order to mount the pulleys to the first jaw  160 . Similarly, the second set of pulleys  210  are inserted into the proximal end cavity  680  of the second jaw  170  so that the openings through the pulleys are aligned with corresponding openings  682  of the second jaw. Thereafter, the fourth pin  190  is inserted into the openings  682  and through the pulleys  210  in order to mount the pulleys to the second jaw  170 . After the pulleys  200 ,  210  are mounted to a respective jaw  160 ,  170 , the control wire  1364  is threaded around the pulleys  200 ,  210  so that a distal end extends through the opening  684  of the first jaw  160 . The control wire  1364  may then be processed (such as by attaching a spherical retainer) to enlarge the distal end prohibiting throughput of an end portion of the control wire through the opening  684 . Likewise, the deployment wires  1402 ,  1404  are directed into corresponding channels  702  of the jaws  160 ,  170 . 
     Post preparation, each jaw  160 ,  170  is mounted to the yoke  130 . In exemplary form, the interiors of each jaw  160 ,  170  are oriented to face one another and the openings  662  of each jaw are aligned with a respective through hole  564  of the yoke  130 . Thereafter, first and second pins  140 ,  150  are inserted through the holes  564  and through the openings  662  so that the jaws  160 ,  170  are pivotally mounted to the yoke  130 . The size of the pins  140 ,  150  is such that the pins frictionally fit with respect to the yoke  130 , but are not large enough in diameter to inhibit rotation of the jaws  160 ,  170  when the control wire  1364  is repositioned with respect to the pulleys  200 ,  210 . In this alignment, the cams  600 ,  602  engage one another to guide rotational repositioning of the jaws  160 ,  170  with respect to one another. More specifically, the U-shaped cavity  674  of the first cam  600  receives the rounded projection  676  of the second cam  602 . 
     After the jaws  160 ,  170  have been mounted to the yoke  130 , the occlusion clip  102  may be mounted to the jaws. In exemplary form, the occlusion clip  102  is oriented so that its parallel beams are longitudinally aligned and inset with respect to the jaws  160 ,  170 , and so that the open end of the occlusion clip is adjacent the open end of the jaws. A series of suture loops  725  (e.g., retainer loops) are longitudinally spaced apart and extend along a length of each beam of the occlusion clip  102 , where a portion of each retainer extends through a corresponding opening  686  of an adjacent jaw  160 ,  170  so that a suture loop  725  extends through each opening  686  and exits on an exterior of a respective jaw. Thereafter, a respective deployment wires  1402 ,  1404  is fed into a respective channel  702  so that the deployment wire extends through each of the suture loops  725 . In this fashion, the occlusion clip  102  is inhibited from detaching from the jaws  160 ,  170  until the deployment wires  1402 ,  1404  are withdrawn from the retainer loops, thus allowing the loops to be pulled through the openings  686  to free the occlusion clip from the jaws. And the deployment wires  1402 ,  1404  along with the control wires  1174 ,  1272 ,  1274 ,  1364  are manipulated via the user control  20 . 
     Turning to  FIGS. 1 and 26-28 , a more detailed discussion of the user control  20 , the first wheel control  40 , the second wheel control  50 , the repositionable lock  60 , the repositionable tab  70 , the lever control  80 , and the grip housing  90  follows. 
     The grip housing  90  comprises respective left and right side housing halves  1000 ,  1002 . The left side housing  1000  includes a generally convex exterior surface  1004  and an opposite interior concave surface  1006 . The interior and exterior surfaces  1004 ,  1006  join one another at a peripheral surface  1008  that delineates the general outline of the left side housing  1000 . This left side peripheral surface  1008  cooperates with a right side peripheral surface  1010  (which bridges opposing interior and exterior surfaces  1012 ,  1014  of the right side housing  1002 ) to delineate five openings  1016 - 1024  that allow through put of various components. It should be noted that the left side housing peripheral surface  1008  may include a lip that is corresponding received within a recess of the right side housing peripheral surface  1010  to facilitate alignment of the housings when mounted to one another. More specifically, the right side peripheral surface  1010  partially overlaps the left side peripheral surface  1008  when the housings are mounted to one another as shown in  FIG. 1 . 
     By way of example, a first opening  1016  occurs at a distal end of the housings and is sized and shaped in a circular fashion to circumscribe and retain a proximal portion of the elongated cylindrical shaft  30 . As will be discussed in greater detail hereafter, the elongated cylindrical shaft  30  includes longitudinal cut-outs  1392  that receive a pair of retention plates  1026  extending from the interior surface  1012  of the right side housing  1002 . 
     The second opening  1018  occurs on an underside of the housing halves  1000 ,  1002 . This second opening  1018  is sized to accommodate a portion of the lever control  80 . Inset from a distal end of the second opening is an integral, hollow axle  1028  extending from the interior surface  1012  of the right side housing  1002 . As will be discussed in more detail hereafter, a portion of the lever control  80  rotates about the axle  1028  when the lever control is repositioned. In order to retain this portion of the lever control rotating about the axle  1028 , the left side housing  1000  includes a retention pin  1030  that is received by the hollow axle  1028  and operates to mount adjacent portions of the housings  1000 ,  1002  to one another. Inset from a proximal end of the second opening is an integral spring retainer projection  1032  extending from the interior surface  1012  of the right side housing  1002 . As will be discussed in more detail hereafter, a spring of the lever control  80  is mounted to the spring retainer projection  1032 . In order to retain the spring mounted to the spring retainer projection  1032 , the left side housing  1000  includes a retention cylinder  1034  that is hollow and sized to receive the spring retainer projection  1032  and mount adjacent portions of the housings  1000 ,  1002  to one another. 
     The third opening  1020  occurs at a proximal end  1036  of the housings  1000 ,  1002  and is sized to receive a portion of the repositionable tab  70 . By way of example, the third opening  1020  is circular in nature and sized to retain a cylindrical portion of the repositionable tab  70  as part of a friction fit that may be overcome by a user withdrawing the cylindrical portion from the grip housing  90 . It should be noted, however, that other shapes besides circular openings may be used as part of the third opening  1020 . As shown in  FIGS. 46 and 47 , the repositionable tab  70  may embody any number of shapes including, without limitation, an hourglass shape (see  FIG. 46 ), a helical thread shape (see  FIG. 47 ), and a triangular shape that requires rotation of the repositionable tab  70  with respect to the grip housing  90  in order to insert and extract the repositionable tab from the grip housing. 
     Extending distally from the third opening  1020 , the left side housing  1000  includes a linear projection  1038 , extending proximal to distal, that is configured to guide motion of a portion of the lever control  80 . Generally opposite this linear projection  1038 , extending from the interior surface  1012  of the right side housing  1002  is an oblong, hollow ridge  1040  that is sized to receive a portion of the lever control  80 , yet allow this portion of the lever control to move therein within a predetermined range of motion. 
     Above the second opening  1018  and extending proximally from the fourth opening  1022  of the right side housing  1002  interior surface  1012  is a control wire guide  1042  comprising three cylindrical projections spaced apart from one another vertically to allow a first gap between the first and second projections and a second gap between the second and third projections. As will be discussed in more detail hereafter, a control wire coupled to the lever control  80  extends between the second and third projections, while a pair of deployment wires coupled to the repositionable tab  70  extends between the first and second projections. In order to ensure the control wire and deployment wires stay in the aforementioned gaps, the left side housing  1000  includes a ring  1044  extending from the interior surface  1006  that circumscribes the control wire guide  1042  to retain the wires with a respective gap. 
     The fourth opening  1022  occurs on a top side of the housings halves  1000 ,  1002 . This opening  1022  is sized to accommodate a portion of the repositionable lock  60 . Positioned underneath the bounds of the fourth opening  1022  are complementary left and right ledges  1048 ,  1050  upon which the repositionable lock  60  sits. Each of the housing halves  1000 ,  1002  also includes a triangular cavity  1054  that is configured to receive a portion of the repositionable lock  60 . 
     A fifth opening  1024  also occurs on a top side of the housing halves  1000 ,  1002  and distal to the fourth opening  1022 . This fifth opening  1024  is sized to accommodate a portion of the first wheel control  40 . In particular, a portion of the first wheel  1110  and the control knob  1160  extend above the housings  1000 ,  1002  in order to allow a user to manipulate the control knob and resultantly rotate the first wheel. 
     Adjacent the fifth opening is a sixth opening  1052  that extends completely though the top surface of the right side housing  1002 . Interposing the fifth and sixth openings  1024 ,  1052  is an arcuate divider comprised exclusively of the right side housing  1002 . This sixth opening  1052  is sized to accommodate a portion of the second wheel control  50 . In particular, a portion of the second wheel  1140  and the control knob  1260  extend above the housing  1002  in order to allow a user to manipulate the control knob and resultantly rotate the second wheel. 
     Extending outward from the interior surface  1006  of the left side housing  1000  is a pair of vertical guides  1056  that mirror a pair of vertical guides  1058  extending from the interior surface  1012  of the right side housing  1002 . The left side vertical guides  1056  are adapted to contact the exterior track  1152  of the first wheel  1110  and allow the track to rotationally slide against the vertical guides. Similarly, the right side vertical guides  1058  are adapted to contact the exterior track  1252  of the second wheel  1140  and allow the track to rotationally slide against the vertical guides. In this fashion, the vertical guides  1056 ,  1058  act as lateral boundaries for the wheels  1110 ,  1140  as well as the pulleys  1120 ,  1130 . Interposing the vertical guides  1056 ,  1058  are respective hollow cylinders  1060 ,  1062  extending from respective interior surfaces  1006 ,  1012 . Each hollow cylinder  1060 ,  1062  is sized to receive a portion of an axle  1420  that extends through the wheels  1110 ,  1140  and the pulleys  1120 ,  1130 . Though not necessary, the dimensions of each hollow cylinder  1060 ,  1062  may be such that the axle  1420  is retained therein via a friction fit and the axle is unable to rotate with respect to the hollow cylinders, but still allow the wheel controls  40 ,  50  to be repositioned. 
     As discussed previously, the user control  20  includes a first wheel control  40  to vary the yaw of the end effector  100 , while the user control  20  further includes a second wheel control  50  to vary the pitch of the end effector. In order to selectively inhibit manipulation of the wheel controls  40 ,  50 , a repositionable lock  60  is also provided. A proximal end of the user control  20  further includes a repositionable tab  70  that may be utilized to, in exemplary form, disengage a left atrial appendage (LAA) occlusion clip  102  from the end effector  100 . In addition, the user control  20  includes a lever control  80  that is operative to control repositioning of the jaws of the end effector  100  with respect to one another. Several of the components of the lever control  80 , the wheel controls  40 ,  50 , and the repositionable lock  60  at least partially reside within the grip housing  90 . 
     As shown in  FIGS. 1 and 28-38 , the first and second wheel controls  40 ,  50  rotate about an axle  1420  received within corresponding cavities  1024 ,  1056  delineated by hollow cylinders  1060 ,  1062  extending from the right and left side housing halves  1000 ,  1002 . The axle  1420  is cylindrical in shape and extends through the center of a first wheel  1110 , a first pulley  1120 , a second pulley  1130 , and a second wheel  1140 . The first wheel  1110  and the first pulley  1120  are components of the first wheel control  40 , whereas the second wheel  1140  and the second pulley  1130  are components of the second wheel control  50 . 
     In exemplary form, referring to  FIGS. 29 and 30 , the first wheel  1110  comprises a unitary structure having a generally circular shape and including a central opening  1150  accommodating throughput of the axle  1420 . Radially outward from this opening  1150  and partially circumscribing the opening is a track  1152  extending outward from an exterior, side surface  1154 . Adjacent this exterior, side surface  1154  is a peripheral surface  1156 , with an arcuate transition surface  1158  interposing the side and circumferential surfaces. Extending radially outward from the peripheral surface  1156  is a control knob  1160  with indicia  1162  on the top of the control knob providing a user with an indication that rotation of the first wheel  1110  is operative to reposition the end effector  100  laterally within an X-Y plane. In order to transfer rotation of the first wheel  1110  into lateral motion of the end effector  100 , the first wheel also includes a pair of protrusions  1166  on opposing radial sides of the opening  1150 . As will be discussed in more detail hereafter, these protrusions  1166  are received within corresponding pockets of the first pulley  1120  so that rotational motion of the first wheel  1110  is transferred into rotational motion of the first pulley. Radially outset from the opening  1150  and one of the protrusions  1166  are a plurality of teeth  1170  circumferentially inset and distributed about ninety degrees of the circumference that are adapted to be engaged by the repositionable lock  60 . 
     Referring to  FIGS. 31-33 , a second component of the first wheel control  40 , the first pulley  1120 , is operative to convert rotational motion of the first wheel  1110  into longitudinal motion of at least one of a first pair of control wires  1172 ,  1174 . The control wires  1172 ,  1174  are mounted to the first pulley  1120  using a clamp plate  1176  and a set screw  1178 . In exemplary form, the first pulley  1120  includes a first through opening  1180  sized and configured to receive throughput of the axle  1420  so that the first pulley may rotate about the axle, in addition to a second through opening  1182  sized and configured to receive an upstanding cylinder  1186  of the clamp plate  1176 . But the second through opening  1182  is too small to allow throughput of a backing plate  1188  of the clamp plate  1176 . Accordingly, a rear of the first pulley  1120  includes a recess  1190  sized and configured to receive the backing plate  1188  and inhibit rotation of the backing plate with respect to the first pulley  1120 . The rear of the first pulley  1120  also includes a semi-circular spacer  1191  partially delineating the first through opening  1180  and extending laterally away from a center of the first pulley. The spacer  1191  is operative to provide a gap between the first and second pulleys  1120 ,  1130 . 
     The upstanding cylinder  1186  includes an axial through opening  1192  that is threaded to engage the threads of the set screw  1178 , as well as four radial openings  1194  that are sized and configured to receive at least one of the control wires  1172 ,  1174 . By way of example, the four radial openings  1194  are circular and radially distributed to be equidistantly spaced from one another about the circumference of the upstanding cylinder  1186 . A first and second of the radial openings  1194  are located proximate first and second openings  1198  extending through a wall  1200  extending laterally outward and adjacent the second through opening  1182 . 
     In exemplary form, the first control wire  1172  is routed over a first arcuate surface  1202  that extends laterally outward from the first pulley  1120  so that the free end of the first control wire interposes between a radial wall  1204  and a first guide  1206 . The free end of the first control wire  1172  is then directed through a bottom opening (second opening)  1198  and directed through the nearest radial opening  1194 . After passing beyond the nearest radial opening, the free end of the first control wire  1172  is passed through the radial opening opposite (180 degrees opposed) from the radial opening the first control wire already extends through. Similarly, the second control wire  1174  is routed over a second arcuate surface  1212  that extends laterally outward from the first pulley  1120  so that the free end of the second control wire interposes between the radial wall  1204  and a second guide  1216 . The free end of the second control wire  1174  is then directed through a top opening (first opening)  1198  and directed through the nearest radial opening  1194 . After passing beyond the nearest radial opening, the free end of the second control wire  1174  is passed through the radial opening opposite (180 degrees opposed) from the radial opening the first control wire already extends through. After both control wires  1172 ,  1174  have passed through the radial openings  1194 , the set screw  1178  is threaded into the axial through opening  1192  to crimp the control wires in place. This crimping operation is undertaken while both control wires  1172 ,  1174  are put into a predetermined amount of tension and the end effector  100  is in a neutral position within the X-Z plane. 
     Turning to  FIGS. 1 and 34-38 , the second wheel  1140  of the second wheel control  50  comprises a unitary structure having a generally circular shape and including a central opening  1250  accommodating throughput of the axle  1420 . Radially outward from this opening  1250  and partially circumscribing the opening is a track  1252  extending outward from an exterior, side surface  1254 . Adjacent this exterior, side surface  1254  is a peripheral surface  1256 , with an arcuate transition surface  1258  interposing the side and circumferential surfaces. Extending radially outward from the peripheral surface  1256  is a control knob  1260  with indicia  1262  on the top of the control knob providing a user with an indication that rotation of the second wheel  1140  is operative to reposition the end effector  100  vertically within a Y-X plane. In order to transfer rotation of the second wheel  1140  into vertical motion of the end effector  100 , on an opposite side of the second wheel is a cylindrical projection  1266  with three spokes equidistantly spaced from one another and radially extending around the opening  1250 . As will be discussed in more detail hereafter, the cylindrical projection  1266  and spokes are received within corresponding pockets of the second pulley  1130  so that rotational motion of the second wheel  1140  is transferred into rotational motion of the second pulley. Radially outset from the opening  1250  and the cylindrical projection  1266  are a plurality of teeth  1270  circumferentially inset and distributed about ninety degrees of the circumference that are adapted to be engaged by the repositionable lock  60 . 
     A second component of the second wheel control  50 , the second pulley  1130 , is operative to convert rotational motion of the second wheel  1140  into longitudinal motion of at least one of a first pair of control wires  1272 ,  1274 . The control wires  1272 ,  1274  are mounted to the second pulley  1130  using a clamp plate  1276  and a set screw  1278 . In exemplary form, the second pulley  1130  includes a first through opening  1280  sized and configured to receive throughput of the axle  1420  so that the second pulley may rotate about the axle, in addition to a second through opening  1282  sized and configured to receive an upstanding cylinder  1286  of the clamp plate  1276 . But the second through opening  1282  is too small to allow throughput of a backing plate  1288  of the clamp plate  1276 . Accordingly, a front of the second pulley  1130  includes a recess  1290  sized and configured to receive the backing plate  1288  and inhibit rotation of the backing plate with respect to the second pulley  1130 . The front of the second pulley  1130  also includes a depression  1291  that is sized to receive the cylindrical projection  1266  and the spokes of the second wheel  1140 . 
     The upstanding cylinder  1286  of the clamp plate  1276  includes an axial through opening  1292  that is threaded to engage the threads of the set screw  1278 , as well as four radial openings  1294  that are sized and configured to receive at least one of the control wires  1272 ,  1274 . By way of example, the four radial openings  1294  are circular and radially distributed to be equidistantly spaced from one another about the circumference of the upstanding cylinder  1286 . A first and second of the radial openings  1294  are located proximate first and second openings  1298  extending through a wall  1300  extending laterally outward and adjacent the second through opening  1282 . 
     In exemplary form, the first control wire  1272  is routed over a first arcuate surface  1302  that extends laterally outward from the second pulley  1140  so that the free end of the first control wire interposes between a radial wall  1304  and a first guide  1306 . The free end of the first control wire  1272  is then directed through a bottom opening (second opening)  1298  and directed through the nearest radial opening  1294 . After passing beyond the nearest radial opening, the free end of the first control wire  1272  is passed through the radial opening opposite (180 degrees opposed) from the radial opening the first control wire already extends through. Similarly, the second control wire  1274  is routed over a second arcuate surface  1312  that extends laterally outward from the second pulley  1140  so that the free end of the second control wire interposes between the radial wall  1304  and a second guide  1316 . The free end of the second control wire  1274  is then directed through a top opening (first opening)  1298  and directed through the nearest radial opening  1294 . After passing through the nearest radial opening, the free end of the second control wire  1274  is passed through the radial opening opposite (180 degrees opposed) from the radial opening the first control wire already extends through. After both control wires  1272 ,  1274  have passed through the radial openings  1294 , the set screw  1278  is threaded into the axial through opening  1292  to crimp the control wires in place. This crimping operation is undertaken while both control wires  1272 ,  1274  are put into a predetermined amount of tension and the end effector  100  is in a neutral position within the Y-Z plane. After crimping, rotation of the wheels  1110 ,  1140  is operative to change the lateral and vertical position of the end effector  100 . And these positions when achieved by user manipulation to a predetermined location may be retained using the repositionable lock  60 . 
     Turning to  FIGS. 39-41 , the repositionable lock  60  includes a thumb button  1320  that is spring biased with respect to a base plate  1322 . In exemplary form, the thumb button  1320  includes a hollow cavity  1334  open on an underneath side of thumb button that is sized to receive a portion of a spring  1324  and a pylon  1326 . Assembly of the repositionable lock  60  includes feeding a tapered end  1328  of the pylon  1326  through an opening  1330  extending through the base plate  1322  so that a flange  1332  at an opposing end of the pylon inhibits complete throughput of the pylon. After having the pylon  1326  extend through the base plate  1322 , the spring  1324  is positioned to circumscribe the majority of the longitudinal length of the pylon. Thereafter, the tapered end  1328  of the pylon  1326 , along with a portion of the spring  1324 , is inserted into the hollow cavity  1334  open on an underneath side of thumb button  1320 . 
     When the repositionable lock  60  is mounted to the housings  1000 ,  1002 , a bottom of the base plate  1322  is seated upon the complementary left and right ledges  1048 ,  1050 . In order to maintain the repositionable lock  60  in a biased state, the fourth opening  1022  lateral or widthwise dimension is smaller than the lateral or widthwise dimension of a base  1336  of the thumb button  1320 , thereby precluding vertical removal of the thumb button (and repositionable lock  60  internal components) from the interior of the housings  1000 ,  1002  when the housings are mounted to one another. In other words, the housings  1000 ,  1002  ledges  1048 ,  1050  and peripheral surfaces  1008 ,  1010  operate to sandwich the repositionable lock  60  components therebetween (but for a thump pad  1340  of the thumb button  1320 ). A portion of each housing  1000 ,  1002  delineating the fourth opening  1022  operate as overhangs so that the triangular cavity  1054  of each housing is longitudinally aligned with corresponding triangular projections  1338  of the thumb button  1320 . In this fashion, the repositionable lock  60  is longitudinally repositionable (in a proximal-distal direction) with respect to the housings  1000 ,  1002  within a predetermined range of motion. At a proximal end of the range of motion, the triangular projections  1338  of the thumb button  1320  are received within the triangular cavities  1054  of the housings  1000 ,  1002 . When in this position, the repositionable lock  60  is beyond an area of travel of the first and second wheel controls  40 ,  50 . But when the thump pad  1340  of the thumb button  1320  is depressed and moved distally, causing the thumb button to slide on top of the ledges  1048 ,  1050  and underneath the peripheral surfaces  1008 ,  1010 , the triangular projections  1338  are removed from the triangular cavities  1054  of the housings  1000 ,  1002 . Upon reaching the distal end of the range of motion for the repositionable lock  60 , a distal tapered end  1342  of the base plate  1322  interposes two adjacent teeth of each plurality of teeth  1170 ,  1270 , thereby inhibiting rotational motion of both wheels  1110 ,  1140  and rotational motion of both pulleys  1120 ,  1130 . In this distal position, the repositionable lock  60  is operative to lock the vertical position and the lateral position of the end effector  100 . It is envisioned that while in this locked position, the end effector  100  may manipulated using the lever control  80  to reposition the jaws  160 ,  170  of the end effector  100  to open the occlusion clip  102 . 
     Referring to  FIGS. 42-44 , the lever control  80  comprises a handle  1350  pivotally mounted to the hollow axle  1028  (see  FIG. 28 ) extending from the interior surface  1012  of the right side housing  1002 . A trigger  1352  is concurrently pivotally mounted to the hollow axle  1028  and interposes spaced apart loops  1354  of the handle  1350 . The trigger  1352  is repositionable with respect to the handle  1350  in order to lock and selectively unlock a position of the handle with respect to a slide arm  1356 . In exemplary form, the slide arm  1356  is pivotally mounted to the handle  1350  using a pin  1358  and is concurrently mounted to a bobbin  1360  that is configured to slide within the oblong, hollow ridge  1040  of the right side housing  1002  in proximal and distal directions. A spring  1362 , mounted to the slide arm  1356  and to the spring retainer projection  1032  of the right side housing  1002 , operates to bias the slide arm  1356  in its most distal position. But this spring bias may be overcome by a user pulling upward on the handle  1350  (toward the second opening  1018 ), thereby causing the handle to pivot and reposition the slide arm  1356  proximally. As the slide arm  1356  is repositioned, so too is the bobbin  1360  and a control wire  1364  mounted to the bobbin. More specifically, as the bobbin  1360  is repositioned proximally from the handle  1350  being pulled toward the housings  1000 ,  1002 , the control wire  1364  is repositioned proximally as a result of being placed under greater tension. Upon the bobbin  1356  reaching near or at the most proximal of its range of motion, the trigger  1352  engages the slide arm  1356  to inhibit motion that would result in the bobbin moving distally. In this fashion, the trigger  1352  operates to lock the position of the slide arm  1356  and the bobbin  1360 , which in exemplary form corresponds to the end effector  100  opening the jaws  160 ,  170  and the occlusion clip  102  for positioning about a left atrial appendage. 
     The handle  1350  has a generally arcuate shape, with a concave rear profile and a convex front profile. On this front profile are a series of raised juts  1366  that more readily allow a user to grip the handle  1350 . The rear profile is majorly delineated by a pair of spaced apart struts  1368  that are interposed by a series of ribs  1370  that cooperate to form a series of hollows. Each strut  1368  includes a through orifice aligned with the other strut and sized to receive the pin  1358  about which the slide arm  1356  rotates. And each strut  1368  terminates at a spaced apart loop  1354  that facilitates mounting the handle  1350  to the housings  1000 ,  1002 , while concurrently unimpeding rotation of the slide arm  1356 . 
     In exemplary form, the slide arm  1356  includes a head  1372  with an orifice that receives the pin  1358 , where the head is connected to a body  1374  of the slide arm via neck  1376 . Proximate where the head  1372  and neck  1376  join one another on the top side of the slide arm  1356  is a V-shaped cavity  1380 , which is accompanied by a catch  1382  formed into the head. As will be discussed in more detail hereafter, the V-shaped cavity  1380  is intended to receive a portion of a rider  1384  of the trigger  1352  as the handle is in an extended position. But as the handle  1350  is rotated upward, the rider  1384  slides against the top surface of the slide arm  1356  and out of the V-shaped cavity  1380  and becomes seated within the catch cavity  1382  when the handle is fully or almost fully brought adjacent the housings  1000 ,  1002  (indicative of the slide arm  1356  being positioned proximally to tension the control wire  1364  and, in exemplary form, operative to move the jaws  160 ,  170  apart from one another to open the occlusion clip  102 ). In order to release the handle from this rotated position adjacent the housings  1000 ,  1002 , a forward end  1386  of the trigger  1352  is depressed, thereby causing the rider  1384  to move out of the catch cavity  1382  and into the V-shaped cavity  1380 . When this occurs (in addition to slacking the control wire  1364  and move the jaws  160 ,  170  toward one another), presuming the user is not pulling upward on the handle  1350 , the spring bias resulting from the spring  1362  being in tension causes the slide arm  1356  to move distally and pivot about the handle  1350 , thereby moving the handle away from the housings  1000 ,  1002 . A more detailed discussion of the control, deployment wires, and the shaft assembly  30  follows. 
     Referring to  FIGS. 1, 22-25, and 45 , the shaft assembly  30  couples the end effector  100  to the user control  20 . In exemplary form, the shaft assembly includes an elongated shaft  1390  having a pair of longitudinal cut-outs  1392  sized to receive the pair of retention plates  1026  extending from the interior surface  1012  of the right side housing  1002 . The retention plates  1026  mount the shaft assembly  30  to the user control  20  and also operate to inhibit proximal-distal repositioning of the shaft assembly independent of the user control. The elongated shaft  1390  is cylindrical in shape and extends in a generally linear direction. An interior of the elongated shaft  1390  is hollow and includes opposing proximal and distal circular openings  1394  at each end. The proximal opening  1394  is sized to allow insertion of a wire alignment guide  1398  (which also has corresponding cut-outs to receive the retention plates  1026 ) having three dedicated through channels  1406 ,  1408 , and  1410 . Each through channel is configured to receive at least two wires and operates to inhibit tangling of adjacent wires. More specifically, the first channel  1406  receives the control wires  1172 ,  1174  mounted to the first pulley  1120 . A second channel  1408  receives the deployment wires  1402 ,  1404  mounted to the repositionable tab  70 , as well as receiving control wire  1364  mounted to the bobbin  1360 . Finally, the third channel  1410  receives the control wires  1272 ,  1274  mounted to the second pulley  1130 . The wire alignment guide  1398  need not extend the entire length of the elongated shaft  1390  so that the distal end opening  1396  provides for throughput of all of the wires  1172 ,  1174 ,  1272 ,  1274 ,  1364 ,  1402 ,  1404  where the wires are segregated using the clevis  110 , which circumscribes and mounts to the elongated shaft via friction fit. More specifically, the longitudinal passage  402  at the proximal end  404  of the clevis  110  is sized to receive the distal end of the elongated shaft  1390 . In this manner, the control wires  1272 ,  1274  individually extend through a respective through hole  410  of the clevis  110 , while the other wires  1172 ,  1174 ,  1364 ,  1402 ,  1404  extend through the elongated through hole  412  of the clevis. Downstream from the clevis  110 , the control wires  1272 ,  1274  are individually fed through one of the cylindrical, enlarged openings  469  of the universal  120  and correspondingly mounted to the universal. Likewise, the control wires  1172 ,  1174  individually extend through a respective channel  476 ,  478  of the universal  120 , while the other wires  1364 ,  1402 ,  1404  extend through the opening  474  of the universal. Downstream from the universal  120 , the control wires  1172 ,  1174  are individually fed through one of the openings  528  of the yoke  130  and correspondingly mounted to the yoke. Conversely, the other wires  1364 ,  1402 ,  1404  extend through the channel  546  of the yoke  130 . Downstream from the yoke  130 , the control wire  1364  is mounted to the pulleys  200 ,  210 , while the deployment wires  1402 ,  1404  are respectively directed through openings  674  of the jaws  160 ,  170 . 
     Turning back to  FIGS. 26-45 , assembly of the exemplary user control  20  will be described in more detail. In exemplary form, the wires  1172 ,  1174 ,  1272 ,  1274 ,  1364 ,  1402 ,  1404  are routed through the elongated shaft  1390  and the wire alignment guide  1398  and into the interior of the housings  1000 ,  1002 . In particular, the deployment wires  1402 ,  1404  are routed to the proximal end of the user control  20  and attached to the repositionable tab  70 . In exemplary fashion, the repositionable tab  70  may be frictionally seated within the proximal opening  1020  or may be otherwise attached so that removal of the repositionable tab requires rotational motion. In addition to the deployment wires  1402 ,  1404  being routed, so too is the deployment wire  1364 . By way of example, the trigger  1352  and the handle  1350  are aligned so that the hollow axle  1028  of the right side housing  1002  extends through both components. Likewise, the slide arm  1356  is pivotally mounted to the handle  1350  via the pin  1358 . An opposing portion of the slide arm  1356  is mounted to the bobbin  1360  so that a portion of the bobbin is seated within a cavity within the right side housing  1002  delineated by the hollow ridge  1040 . The deployment wire  1364  is mounted to the bobbin  1360 , while the slide arm  1356  and bobbin are spring biased by way of engagement between the spring  1362 , which is also mounted to the right side housing  1002 . In this fashion, the lever control  80  is spring biased and operative to open and close the jaws  160 ,  170 . 
     Four of the control wires  1172 ,  1174 ,  1272 ,  1274  are associated with the first and second wheel controls  40 ,  50 . Specifically, assembly of the wheel controls  40 ,  50  includes positioning the second wheel  1140  to extend through the sixth opening  1052  of the right side housing  1002 . The axle is positioned to extend through the center of the second wheel  1140  and be received within the hollow cylinder  1062  of the housings  1000 ,  1002 . Before assembling the housings  1000 ,  1002 , however, the axle  1420  receives in succession the second pulley  1130 , the first pulley  1120 , and the first wheel  1110 . After the pulleys  1120 ,  1130  are received on the axle  1420 , the control wires  1172 ,  1174 ,  1272 ,  1274  are mounted thereto while ensuring the end effector  100  is in a yaw and pitch neutral position. As discussed previously, two control wires  1172 ,  1272  go over top of a respective pulley  1120 ,  1130 , while the other two control wires  1174 ,  1274  go under a respective pulley and are secured thereto via a clamp plate  1176 ,  1276  and a set screw  1178 ,  1278 . In this fashion, when a user decides to change the yaw of the end effector  100 , the user engages the control knob  1160  of the first wheel  1110  to rotate the first wheel clockwise or counterclockwise. In exemplary fashion, clockwise rotation of the first wheel  1110  (moving the control knob proximally) operates to pivot the universal  120  with respect to the clevis  110  to the right, whereas counterclockwise rotation of the first wheel (moving the control knob  1260  distally) operates to pivot the universal with respect to the clevis to the left. Moreover, when a user decides to change the pitch of the end effector  100 , the user engages the control knob  1260  of the second wheel  1140  to rotate the second wheel clockwise or counterclockwise. In exemplary fashion, clockwise rotation of the second wheel  1140  (moving the control knob  1260  proximally) operates to pivot the yoke  130  upward with respect to the universal  120 , whereas counterclockwise rotation of the second wheel (moving the control knob distally) operates to pivot the yoke  130  downward with respect to the universal  120 . 
     In order to retard unwanted rotation of the first and second wheels  1110 ,  1140 , installation of the repositionable lock  60  includes seating the base plate  1336  upon the corresponding ledges  1048 ,  1050  (initially upon the right side ledge  1048 ) after already having assembled the repositionable lock as discussed above. When installed properly, only the thumb pad  1340  of the thumb button  1320  extends above the housings  1000 ,  1002 . And proximal and distal motion of the repositionable lock  60  are available, where a most distal position of the repositionable lock places the base plate  1342  to interpose corresponding teeth  1170 ,  1270  of the wheels  1110 ,  1140 , thereby inhibiting further rotation of the wheels to lock the end effector  100  in position within the X-Y and Y-Z planes or degrees of freedom. The repositionable lock  60  may be disengaged simply by moving the thumb pad  1340  proximally until the base plate  1342  no longer engages corresponding teeth  1170 ,  1270  of the wheels  1110 ,  1140 . 
     After the associated components have been installed and mounted to the right side housing  1002 , the left side housing  1000  may be repositioned to close the interior and contain the desired portions of the components. In order to ensure continued closure of the housings  1000 ,  1002 , it is within the scope of the invention to weld or otherwise fasten the peripheral surfaces of the housings using any number of options such as, without limitation, press fit, screws/fasteners, adhesives, ultrasonic welding, heat welding, and laser welding. 
     The following is an exemplary procedure for utilizing the exemplary surgical tool  10  to deploy the occlusion clip  102  to occlude a left atrial appendage (LAA). Initially, an incision is made on either the left or right side of the chest wall in an intercostal space that is appropriate for the desired angle of approach to a LAA. The incision may be made through the chest wall or through the abdomen (or through the back) as part of various procedures that include, without limitation, an open sternotomy, a left thoracotomy, a right thoracotomy, a left port, a right port, a subxiphoid approach, and a transdiaphragmatic approach. Post incision, a trocar (e.g., 12 millimeter or smaller) may be inserted through the incision to extend into the thoracic cavity. In certain instances, it may be preferred to insufflate the thoracic space subsequent to trocar insertion using known techniques. Using at least one of the incision and trocar, surgical instruments are introduced into the thoracic space in order to perform a series of dissections, including dissection of the pericardium, to provide egress to the LAA. After having access to the LAA, the end effector  100  of the surgical tool  10  may be inserted into the thoracic cavity by way of the incision or trocar. 
     The end effector  100  is passed through the trocar or incision and the user manipulates the user controls  20  to navigate the end effector proximate the LAA. By way of example, the first wheel control  40  is operative to vary the yaw of the end effector  100  within an X-Y plane (e.g., depending upon the frame of reference, the first wheel control  40  provide lateral adjustability of the end effector  100  with respect to the housings  1000 ,  1002 ), as well as the second wheel control  50  being operative to vary the pitch of the end effector within an Y-Z plane (e.g., depending upon the frame of reference, the second wheel control  50  provides up and down adjustability of the end effector with respect to the housings). Specifically, a user grasping the user control  20  is able to rotate the first wheel  1110  to change the lateral position of the end effector  100 , to which the LAA occlusion clip  102  is mounted, by tensioning a control wire  1172 ,  1174  extending though the clevis  110  and mounted to the universal  120 . Likewise, the user grasping the user control  20  is able to rotate the second wheel  1140  to change the vertical position of the end effector  100  by tensioning a control wire  1272 ,  1274  extending though the clevis  110  and universal  120  that is mounted to the yoke  130 . If desired, the user of the surgical tool  10  may use the thumb button  1320  of the repositionable lock  60  to lock the end effector  100  in place (to fix the X-Y and Y-Z orientations) to create a single position, rigid surgical tool  10 . After navigating the LAA occlusion clip  102  proximate the LAA, the occlusion clip is opened prior to deployment on the LAA. 
     Opening the LAA occlusion clip  102  is carried out by actuating the lever control  80 . In particular, the handle  1350  is pivotally repositioned toward the housings  1000 ,  1002 , which is operative to tension the control wire  1364  and cause the end effector  100  to further separate its jaws  160 ,  170  from one another and open the clip  102 . Post opening of the LAA occlusion clip  102 , the clip is advanced from a side of the LAA, proximate the base of the LAA, to ensure an entire circumference of the LAA interposes corresponding occlusion surfaces of the clip. It should be noted that forceps may be used to grasp a portion of the LAA when positioning the LAA occlusion clip  102 . After the clip  102  has been positioned at the base of the LAA, with the LAA interposing corresponding occlusion surfaces of the clip, the user of the surgical tool  10  may close the clip  102  to sandwich the LAA between the occlusion surfaces. 
     Closing the LAA occlusion clip  102  is also carried out by actuating the lever control  80 . Specifically, the user depresses the trigger  1352  to allow the handle  1352  (which is biased to move away from the housings  1000 ,  1002 ) to reposition away from the housings  1000 ,  1002  and thereafter guide the handle away from the housings. By repositioning the handle  1352  away from the housings  1000 ,  1002 , the control wire  1364  is repositioned and facilitates the jaws  160 ,  170  of the end effector  100  moving closer to one another (from the bias of the clip  102  while the clip is mounted to the end effector  100 ), thereby sandwiching the clip around the LAA without piercing the LAA. It should be noted that various steps may be undertaken to ensure the entire periphery of a portion of LAA is sandwiched by the clip  102  such as, without limitation, direct visual verification and utilization of a transesophageal echocardiogram. If any problems are determined with respect to clip  102  placement, the opening and closing clip sequence may be repeated to adjust the positioning of the clip with respect to the LAA. Upon closing the LAA occlusion clip  102  around a periphery of a portion of the LAA, proximate the LAA base, as well as confirming the placement of the closed clip being operative to occlude the LAA, the surgeon may release the clip from the end effector  100 . 
     To release the clip  102  from the end effector  100 , the user removes the repositionable tab  70  from the proximal end of the user control  20 . This removal of the repositionable tab  70  causes the deployment wires  1402 ,  1404  to be repositioned proximally and discontinue engagement with the suture loops  725 . When the engagement with the suture loops  725  is discontinued, the occlusion clip  102  is no longer fastened to the jaws  160 ,  170  (i.e., the jaws can be opened and closed without repositioning the clip). As discussed previously, the repositionable tab  70  may be withdrawn from the user control  20  in a straight pull fashion by overcoming a friction fit force or may be withdrawn via other movements including, without limitation, rotation and a combination of rotation and a straight pull that may make use of threads or detents. After disengagement between the occlusion clip  102  and the end effector  100 , the end effector is removed from the cardiac space. 
     Removal of the end effector  100  from the patient&#39;s body is controlled by the user. Because the end effector  100  is open-ended, there is no need to reposition the end effector upward along the LAA because the end effector can be withdrawn laterally, thus reducing the potential for contact between the end effector and the LAA. In other words, the end effector  100  may be removed from around the LAA without having a tip of the LAA passing between the jaws  160 ,  170 . As part of removing the end effector  100  from the cardiac and thoracic space, the user manipulates the user control  20  and causes repositioning of the end effector  100  to allow withdrawal from the patient&#39;s body cavity via the incision or trocar. By way of example, it is envisioned that the user repositions the first and second wheel controls  40 ,  50  in order to longitudinally align the end effector  100  with the shaft assembly  30  prior to removing the end effector through the trocar or incision. 
     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, it is to be understood that the inventions contained herein are not limited to the above precise embodiment and that changes may be made without departing from the scope of the invention as defined by the following proposed points of novelty. 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 the invention, since inherent and/or unforeseen advantages of the present invention may exist even though they may not have been explicitly discussed herein.