Abstract:
A surgical clip applier is provided including a housing; at least one handle pivotably connected to the housing; a channel assembly extending distally from the housing; a plurality of clips loaded in the clip carrier; a drive channel translatably supported in the housing and the channel assembly, the drive channel being translated upon actuation of the at least one handle; and a counter mechanism supported in the housing, the counter mechanism including indicia visible through the housing, wherein the indicia corresponds to a quantity of clips loaded in the clip applier, wherein the indicia decrements upon each firing of the clip applier resulting in a reduction in the quantity of clips remaining of the plurality of clips.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/285,006, filed on Dec. 9, 2009, the entire content of which is incorporate herein by reference. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present application relates to surgical instruments, and more particularly, to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures. 
     2. Discussion of Related Art 
     Surgical clip appliers are known in the art and have increased in popularity among surgeons by offering an alternative to conventional suturing of body tissues and vessels. Typical instruments are disclosed in U.S. Pat. No. 5,030,226 to Green et al. and U.S. Pat. No. 5,431,668 to Burbank, III et al. These instruments generally provide a plurality of clips which are stored in the instrument and which are fed sequentially to the jaw mechanism at the distal end of the instrument upon opening and closing of the handles at the proximal end of the instrument. As the handles are closed, the jaws close to deform a clip positioned between the jaw members, and as the jaws are opened to release the deformed clip, a new clip is fed from the series to a position between the jaws. This process is repeated until all the clips in the series of clips have been used. 
     A need exists for a user of the clip applier to know how many clips remain in the clip applier and/or to know when a final clip of the plurality of clips has been fired. 
     SUMMARY 
     The present application relates to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures and their methods of use. 
     According to an aspect of the present disclosure, a surgical clip applier is provided including a housing; at least one handle pivotably connected to the housing; a channel assembly extending distally from the housing; a plurality of clips loaded in the clip carrier; a drive channel translatably supported in the housing and the channel assembly, the drive channel being translated upon actuation of the at least one handle; and a counter mechanism supported in the housing, the counter mechanism including indicia visible through the housing, wherein the indicia corresponds to a quantity of clips loaded in the clip applier, wherein the indicia decrements upon each firing of the clip applier resulting in a reduction in the quantity of clips remaining of the plurality of clips. 
     The counter mechanism may be rotatably supported in the housing and may include a uni-directional clutch member permitting rotation of the counter mechanism in a single direction. The counter mechanism may include a counter dial rotatably supported in the housing, wherein the counter dial includes the indicia thereof; and a counter clutch operatively connected to the counter dial such that rotation of the counter clutch in a first direction results in rotation of the counter dial in the first direction, and rotation of the counter clutch in second direction results in no rotation of the counter dial. 
     The counter mechanism may include a latch member operatively engaged with the counter dial. In use, the latch member permits rotation of the counter dial in the first direction and inhibits rotation of the counter mechanism in a direction opposite to the first direction. 
     The counter dial may include a plurality of grooves formed in an outer periphery thereof, and the latch member may include a resilient finger biased into engagement with the plurality of grooves of the counter dial. 
     The counter clutch may be concentrically, rotatably nested in a bore defined in the counter dial. The counter clutch may include at least one resilient finger extending therefrom for engagement with uni-directional teeth formed in a perimetrical surface of the bore of the counter dial. 
     The drive channel may define an angled slot therein, and the counter clutch may include a clutch pin extending from a surface thereof and may be slidably disposed in the angled slot of the drive channel. In use, translation of the drive channel in a first direction relative to the counter mechanism would cause the clutch pin to be cammed by the angled slot thereof thereby causing the counter clutch to rotate in the first direction, and translation of the drive channel in a second direction relative to the counter mechanism would cause the clutch pin to be cammed by the angled slot thereof thereby causing the counter clutch to rotate in the second direction. 
     The counter mechanism may include a latch member operatively engaged with the counter dial. In use, the latch member permits rotation of the counter dial in the first direction and inhibits rotation of the counter mechanism in a direction opposite to the first direction. 
     The counter mechanism may include a counter dial defining a lock out groove formed in an outer perimetrical edge thereof; and a lock out supported in the housing. The lock out may be biased such that a first catch thereof engages against the outer perimetrical edge of the counter dial. In use, as the counter dial is rotated and the lock out groove of the counter dial is brought into registration with the first catch of the lock out, the first catch of the lock out is urged into the lock out groove thereby preventing a rotation of the counter dial in an opposite direction. 
     The lock out may include a second catch. In use, the second catch of the lock out moves into a path of a translating member of the clip applier when the first catch of the lock out is moved into the lock out groove of the counter dial, thereby inhibiting a translation of the translating member of the clip applier. 
     The lock out groove of the counter dial may move into registration with the first catch of the lock out when a final clip of the plurality of clips has been fired. The lock out groove of the counter dial may be associated with an indicia on the counter mechanism indicating that the final clip has been fired. The indicia on the counter mechanism, indicating that the final clip of the plurality of clip has been fired, may be represented by the number “zero.” 
     The clip applier may further include a ratchet mechanism having a ratchet pawl pivotably supported in the housing; and a rack member provided on the translating member. The rack member may be in operative registration with the ratchet pawl. In use, the rack member translates across the ratchet pawl as the translating member translates. The ratchet mechanism may be prevented from re-setting when the rack member has not completed a fully translation. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present clip applier will be more fully appreciated as the same becomes better understood from the following detailed description when considered in connection with the following drawings, in which: 
         FIG. 1  is a perspective view of a surgical clip applier according to an embodiment of the present disclosure; 
         FIG. 2  is a top, plan view of the surgical clip applier of  FIG. 1 ; 
         FIG. 3  is an enlarged view of the indicated area of detail of  FIG. 2 ; 
         FIG. 4  is a perspective view of a mechanical counter assembly of the surgical clip applier of  FIGS. 1 and 2 ; 
         FIG. 5  is an exploded perspective view of the surgical clip applier of  FIGS. 1-4 ; 
         FIG. 6  is a perspective view of a handle assembly with a housing half-section removed therefrom and illustrating a counter of the mechanical counter assembly engaged with a drive channel; 
         FIG. 7  is a perspective view of a handle assembly with a housing half-section and drive channel removed therefrom and illustrating the counter of the mechanical counter assembly engaged with a ratchet; 
         FIG. 8  is an enlarged view of the indicated area of detail of  FIG. 7 ; 
         FIG. 9  is a perspective view of a handle assembly with a housing half-section, the drive channel, and the ratchet removed therefrom; 
         FIG. 10  is a front, perspective view, with parts separated, of a counter and a clutch of the mechanical counter assembly; 
         FIG. 11  is a rear, perspective view, with parts separated, of the counter and the clutch of the mechanical counter assembly of  FIG. 10 ; 
         FIG. 12  is a rear, perspective view of the counter and the clutch of the mechanical counter assembly of  FIGS. 10 and 11 ; 
         FIG. 13  is a perspective view of a lock-out of the clip applier of  FIGS. 1-4 ; 
         FIG. 14  is a top plan, schematic illustration of the mechanical counter assembly operatively connected to the drive channel when the clip applier is in an original unactuated position; 
         FIG. 14A  is a side view of the mechanical counter assembly as viewed along  14 A- 14 A of  FIG. 14 ; 
         FIG. 14B  is an enlarged view of the indicated area of detail of  FIG. 14 ; 
         FIG. 14C  is a cross-sectional view of the mechanical counter assembly as taken along  14 C- 14 C of  FIG. 14A ; 
         FIG. 15  is a top plan, schematic illustration of the mechanical counter assembly operatively connected to the drive channel when the clip applier is initially actuated; 
         FIG. 15A  is an enlarged view of the indicated area of detail of  FIG. 15 ; 
         FIG. 15B  is a cross-sectional view of the mechanical counter assembly as taken along  14 C- 14 C of  FIG. 14A , during the initial actuation of the clip applier; 
         FIG. 16  is a top plan, schematic illustration of the mechanical counter assembly operatively connected to the drive channel when the clip applier is fully actuated; 
         FIG. 16A  is an enlarged view of the indicated area of detail of  FIG. 16 ; 
         FIG. 16B  is a cross-sectional view of the mechanical counter assembly as taken along  14 C- 14 C of  FIG. 14A , following the full actuation of the clip applier; 
         FIG. 17  is a top plan, schematic illustration of the mechanical counter assembly operatively connected to the drive channel when the clip applier is released after full actuation; 
         FIG. 17A  is an enlarged view of the indicated area of detail of  FIG. 17 ; 
         FIG. 17B  is a cross-sectional view of the mechanical counter assembly as taken along  14 C- 14 C of  FIG. 14A , during a release of the clip applier following full actuation; 
         FIG. 18  is a cross-sectional view of the mechanical counter assembly as taken along  14 C- 14 C of  FIG. 14A , illustrating the mechanical counter assembly fully re-set; 
         FIG. 19  is a top, plan view of the mechanical counter assembly, illustrating the counter at a “zero” position and locked out; 
         FIG. 19A  is a cross-sectional view of the mechanical counter assembly as taken along  14 C- 14 C of  FIG. 14A , illustrating the counter at a “zero” position and locked out; and 
         FIG. 19B  is an enlarged view of the indicated area of detail of  FIG. 19A . 
     
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
     Embodiments of surgical clip appliers in accordance with the present disclosure will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further away from the user. 
     Referring now to  FIGS. 1-5 , a surgical clip applier in accordance with an embodiment of the present disclosure is generally designated as  100 . Surgical clip applier  100  generally includes a handle assembly  102  including a housing  104  having an upper housing half  104   a  and lower housing half  104   b . Handle assembly  102  further includes a pair of handles  106  pivotably secured to housing  104  and extending outwardly therefrom. A channel assembly  108  is fixedly secured to housing  104  and extends outwardly therefrom, terminating in a jaw assembly  110 . 
     As seen in  FIGS. 1-5 , housing halves  104   a  and  104   b  of clip applier  100  fit together by snap fit engagement with one another. Housing  104  defines a window  104   c  formed in lower housing half  104   b  for supporting and displaying a counter mechanism, as will be discussed in greater detail below. 
     As seen in  FIG. 4 , handles  106  are secured to housing  104  by handle pivot posts  104   d  extending from lower housing half  104   b  and into respective apertures  106   a  formed in handles  106 . Handle assembly  102  includes a link member  122  pivotally connected to each handle  106  at a pivot point  106   b  formed in a respective handle  106 . A distal end of each link member  122  is pivotally connected to a pivot point formed in a drive channel  140  via a drive pin  124 . Each end of drive pin  124  is slidably received in an elongate channel formed in a respective upper and lower housing half  104   a ,  104   b . In use, as will be described in greater detail below, as handles  106  are squeezed, link members  122  push drive channel  140  distally via drive pin  124 . 
     Channel assembly  108  includes a channel or cartridge cover  130  and an outer or lower channel  132  each having a proximal end retained in housing assembly  102 , between upper and lower housing halves  104   a ,  104   b.    
     As seen in  FIG. 5 , clip applier  100  includes a clip pusher bar  160  slidably disposed beneath cartridge cover  130 , a stabilizer  162  configured to overlie and engage pusher bar  160 , a motion multiplier system  155  supported in housing  104 , a clip carrier  170  disposed within channel assembly  108  and beneath pusher bar  160 , a stack of surgical clips “C” loaded and/or retained within clip carrier  170  in a manner so as to slide therewithin and/or therealong, a clip follower  174  slidably disposed within clip carrier  170  and positioned behind the stack of surgical clips “C,” a wedge plate  180  slidably disposed within handle assembly  102  and channel assembly  108 , a wedge plate pivot arm  179  pivotally supported in lower housing half  104   b  of housing  104  for transmitting translation of drive channel  140  to translation of wedge plate  180 , a drive channel  140  reciprocally supported in and extending between housing  104  of handle assembly  102  and channel assembly  108 , an audible/tactile indicator  148  connected to drive channel  140  via drive pin  124 , and a jaw assembly  110  mounted on or at a distal end of channel assembly  108  and actuatable by handles  106  of handle assembly  102 . 
     Reference may be made to U.S. Provisional Application No. 61/091,467, filed on Aug. 25, 2008, entitled “Surgical Clip Applier” and U.S. Provisional Application No. 61/091,485, filed on Aug. 25, 2008, entitled “Surgical Clip Applier and Method of Assembly,” the entire contents of each of which being incorporated herein by reference, for a detailed discussion of the structure, operation, and method of assembly of various components surgical clip applier  100 . Reference may also be made to U.S. Provisional Application No. 61/286,569, filed on Dec. 15, 2009, entitled “Surgical Clip Applier”, the entire contents of which is incorporated herein by reference, for additional detailed discussion of the structure, operation, and method of assembly of various components of surgical clip applier  100 . 
     As seen in  FIGS. 1-12 , clip applier  100  further includes a mechanical counter mechanism  190  supported in housing  104  of handle assembly  102 . Counter mechanism  190  includes a counter dial  192  rotatably disposed within housing  104  so as to overlie window  104   c  formed in lower housing half  104   b , a counter clutch  194  operatively connected to counter dial  192  and configured to permit uni-directional rotation of counter dial  192 , and a latch member  196  configured to engage counter dial  192 . 
     As seen in  FIGS. 4-11 , counter dial  192  includes a first face  192   a  disposed adjacent window  104   c  formed in lower housing half  104   b . First face  192   a  includes a plurality of indicia  192   b , in the form of sequential numbers disposed thereof and substantially around a radial periphery thereof. Indicia  192   b  may correspond to the number of clips that are loaded in clip applier  100 . By way of example only, indicia  192   b  may be numerals from “0-22.” Indicia  192   b  are located on first face  192   a  so as to be in registration with window  104   c  formed in lower housing half  104   b . Counter dial  192  includes a second face  192   c , opposite first face  192   b , and defining a bore  192   d  therein. Bore  192   d  includes a radial array of uni-directional teeth  192   e  formed therein. Counter dial  192  further includes a first or outer rim defining a plurality of grooves  192   f  formed around an outer periphery thereof, and a second or inner rim defining a single groove  192   g  formed in an outer periphery thereof. 
     With continued reference to  FIGS. 4-11 , counter clutch  194  is concentrically and rotatably nested in bore  192   d  of counter dial  192 . Counter clutch  194  of mechanical counter mechanism  190  includes a body portion  194   a  configured and dimensioned for rotatable disposition in bore  192   d  of counter dial  192 . Counter clutch  194  includes a pair of opposed resilient fingers  194   b ,  194   c  extending substantially tangentially from body portion  194   a . Resilient fingers  194   b ,  194   c  extend from body portion  194   a  by an amount sufficient so as to resiliently engage uni-directional teeth  192   e  of dial  192 . Counter clutch  194  includes a clutch pin  194   d  extending from body portion  194   a  and projecting out of bore  192   d  of counter dial  192 . 
     As seen in  FIGS. 4-9 , latch member  196  of mechanical counter mechanism  190  is secured to lower housing half  104   b . Latch member  196  includes a resilient finger  196   a  configured to contact and selectively engage grooves  192   f  formed around the outer periphery of counter dial  192 . 
     As seen in  FIGS. 5 and 6 , drive channel  140  defines an angled slot  140   a  formed therein at a location so as to slidably receive clutch pin  194   d  extending from body portion  194   a  of counter clutch  194 . Angled slot  140   a  of drive channel  140  extends in a direction away from a longitudinal axis of clip applier  100  from a proximal to a distal direction. 
     As seen in  FIGS. 4 ,  5 ,  7  and  8 , clip applier  100  includes a ratchet rack member  141  slidably disposed in lower housing half  104   b . Rack member  141  is pinned to drive pin  124  such that translation of drive pin  124  relative to housing  104  results in concomitant translation of rack member  141 . Rack member  141  is disposed in housing  104  such that clutch pin  194   d  of counter clutch  194  rides along or contacts a side edge  141   b  thereof. Rack member  141  includes ratchet teeth  141   a  formed along an edge thereof and are configured and adapted to engage with a ratchet pawl  142  supported in housing  104 . Rack member  141  and pawl  142  define a ratchet mechanism  144 . 
     In use, as drive channel  140  is moved axially by drive pin  124 , rack member  141  is also moved. Rack teeth  141   a  of rack member  141  has a length which allows pawl  142  to reverse and advance back over rack member  141  when rack member  141  changes between proximal and distal movement as drive channel  140  reaches a proximal-most or distal-most position. 
     Pawl  142  is pivotally connected to lower housing half  104   b  by a pawl pin at a location wherein pawl  142  is in substantial operative engagement with rack member  141 . Pawl  142  is engageable with rack member  141  to restrict longitudinal movement of rack member  141  and, in turn, drive channel  140 . Ratchet mechanism  144  further includes a pawl spring  145  configured and positioned to bias pawl  142  into operative association with rack member  141 . Pawl spring  145  functions to maintain the teeth of pawl  142  in engagement with the teeth  141   a  of rack member  141 , as well as to maintain pawl  142  in a rotated or canted position. 
     As seen in  FIGS. 4 ,  5 ,  7 - 9  and  13 , clip applier  100  further includes a lock out  146  pivotally connected or supported in housing  104 . Lock out  146  includes a body portion  146   a , a first catch  146   b  formed at one and of body portion  146   a , and a second catch  146   c  extending from a side edge of body portion  146   a . First catch  146   b  is configured and dimensioned to engage groove  192   g  formed in the outer periphery of the inner rim of counter dial  192 . Second catch  146   c  is configured and dimensioned to engage a notch  141   c  formed in a side edge of rack member  141 . A biasing member  147  is provided to maintain first catch  146   b  of lock out  146  in contact with the outer periphery of the inner rim of counter dial  192 . 
     Turning now to  FIGS. 14-19B , the operation of clip applier  100  is provided. Prior to any initial squeezing of handles  106  of clip applier  100  and with clip applier  100  fully loaded with clips “C,” as seen in  FIGS. 14-14C , drive channel  140  is located at a proximal-most position, indicia  192   b  of counter dial  192  of mechanical counter mechanism  190 , relating to a fully loaded clip applier  100 , in the present instance being fully loaded with twenty-two (22) clips, is visible through window  104   c  formed in housing half  104   b . Accordingly, as seen in  FIG. 14B , the numeral “22” is visible through window  104   c . Also, as seen in  FIG. 14B , resilient finger  196   a  of latch member  196  is engaged in a groove  192   f  formed around the outer periphery of counter dial  192 . 
     As seen in  FIG. 14C , prior to any squeezing of handles  106 , clutch pin  194   d  of counter clutch  194  is disposed at a distal end of angled slot  140   a  of drive channel  140 . Also, first catch  146   b  of lock out  146  is in contact with the outer periphery of the inner rim of counter dial  192  so that second catch  146   c  of lock out  146  is disengaged from rack member  141 . Moreover, prior to any squeezing of handles  106 , and when clip applier  100  is fully loaded with clips, groove  192   g  farmed in the outer periphery of the inner rim of counter dial  192  is oriented distal of first catch  146   b  of lock out  146 . 
     As seen in  FIGS. 15-15B , during an initial squeeze of handles  106 , as indicated by arrow “A 1 ,” drive pin  124  translates drive channel  140  and rack member  141  in a distal direction, as indicated by arrow “B 1 .” As drive channel  140  is translated in a distal direction, angled slot  140   a  of drive channel  140  is moved in a distal direction relative to clutch pin  194   d  of counter clutch  194 , clutch pin  194   d  is cammed through angled slot  140   a  of drive channel  140  causing counter clutch  194  to rotate in the direction of arrow “C 1 .” As counter clutch  194  is rotated in the direction of arrow “C 1 ,” as seen in  FIG. 15B , resilient fingers  194   b ,  194   c  thereof engage uni-directional teeth  192   e  of dial  192 , thereby causing dial  192  to also rotate in the direction of arrow “C 1 .” Moreover, as dial  192  is rotated in the direction of arrow “C 1 ,” groove  192   g  formed in the outer periphery of the inner rim of counter dial  192  is rotated away from first catch  146   b  of lock out  146  as first catch  146   b  continues to ride along the outer periphery of the inner rim of counter dial  192 . 
     As dial  192  is rotated in the direction of arrow “C 1 ,” as seen in  FIG. 15A , indicia  192   b  of numeral “22” is moved relative to window  104   c  formed in housing half  104   b , thereby beginning to decrement. Additionally, as dial  192  is rotated in the direction of arrow “C 1 ,” resilient finger  196   a  of latch member  196  begins to disengage the groove  192   f  formed around the outer periphery of counter dial  192 . 
     As seen in  FIGS. 16-16B , during a final or complete squeeze of handles  106 , as indicated by arrow “A 1 ,” drive pin  124  further translates drive channel  140  and rack member  141  in a distal direction, as indicated by arrow “B 1 .” As drive channel  140  is further translated in a distal direction, angled slot  140   a  of drive channel  140  is further moved in a distal direction relative to clutch pin  194   d  of counter clutch  194 , clutch pin  194   d  is further cammed through angled slot  140   a  of drive channel  140  causing counter clutch  194  to further rotate in the direction of arrow “C 1 .” As counter clutch  194  is further rotated in the direction of arrow “C 1 ,” as seen in  FIG. 16B , resilient fingers  194   b ,  194   c  continue to cause dial  192  to rotate in the direction of arrow “C 1 .” Moreover, as dial  192  is further rotated in the direction of arrow “C 1 ,” groove  192   g  formed in the outer periphery of the inner rim of counter dial  192  is further rotated away from first catch  146   b  of lock out  146  as first catch  146   b  further continues to ride along the outer periphery of the inner rim of counter dial  192 . 
     As dial  192  is further rotated in the direction of arrow “C 1 ,” as seen in  FIG. 16A , indicia  192   b  of numeral “22” is completely moved out of view of window  104   c  formed in housing half  104   b  and new numeral “21” is moved into view of window  104   c , thereby fully being decremented. This change of numeral, or decrementing, coinciding with a formation and/or firing/ejection/release of a clip from clip applier  100 . In this manner, the user is shown the number of clips remaining in clip applier  100  and available to fire. Additionally, as dial  192  is further rotated in the direction of arrow “C 1 ,” resilient finger  196   a  of latch member  196  moves into engagement in a groove  192   f  adjacent to groove  192   f  formed around the outer periphery of counter dial  192 . 
     Turning now to  FIGS. 17-18 , during an opening of handles  106 , as indicated by arrow “A 2 ,” drive pin  124  translates drive channel  140  and rack member  141  in a proximal direction, as indicated by arrow “B 2 .” As drive channel  140  is translated in a proximal direction, angled slot  140   a  of drive channel  140  is moved in a proximal direction relative to clutch pin  194   d  of counter clutch  194 , clutch pin  194   d  is cammed through angled slot  140   a  of drive channel  140  causing counter clutch  194  to rotate in the direction of arrow “C 2 ,” opposite to “C 1 .” As counter clutch  194  is rotated in the direction of arrow “C 2 ,” as seen in  FIG. 17B , resilient fingers  194   b ,  194   c  are caused to deflect and snap over uni-directional teeth  192   e  of dial  192 . as seen from  FIG. 17A , any frictional forces tending to cause dial  192  to also rotate in the direction of arrow “C 2 ” and negated by the engagement of resilient finger  196   a  of latch member  196  in groove  192   f  formed around the outer periphery of counter dial  192 , thereby maintaining the rotational orientation of dial  192 . 
     With dial  192  being held or maintained in this rotational orientation, indicia  192   b  of numeral “21” is maintained in view in window  104   c.    
     As seen in  FIG. 18 , when drive channel  140  has been moved back to the fully proximal position, resilient fingers  194   b ,  194   c  of counter clutch  194  are re-set in engagement with adjacent uni-directional teeth  192   e  of dial  192 . 
     Additionally, as dial  192  is further rotated in the direction of arrow “C 1 ,” resilient finger  196   a  of latch member  196  moves into engagement in a groove  192   f  adjacent to groove  192   f  formed around the outer periphery of counter dial  192 . 
     Turning now to  FIGS. 19-19B , during the squeezing of handles  106 , upon the firing of a final clip loaded in clip applier  100 , indicia  192   b  of dial in the form of numeral “0” is completely moved into view of window  104   c  formed in housing half  104   b , thereby indicating to the user that no more clip are present in clip applier  100 . When dial  192  has been rotated to this position, as seen in  FIGS. 19A and 19B , groove  192   g  formed in the outer periphery of the inner rim of counter dial  192  is rotated into registration with first catch  146   b  of lock out  146 . In this position, biasing member  147 , acting on lock out  146 , urges first catch  146   b  of lock out  146  into groove  192   g  of dial  192 . 
     Additionally, in the present position, second catch  146   c  of lock out  146  is moved into notch  141   c  formed in side edge of rack member  141  and thus into the path of proximal translation of rack member  141 . Accordingly, as handles  106  are released and drive pin  124  begins to move rack member  141  in a proximal direction, notch  141   c  of rack member  141  engages second catch  146   c  of lock out  146  thereby prohibiting rack member  141  from returning to a proximal most or home position. With rack member  141  being inhibited or blocked from returning to the proximal most position, ratchet pawl  142  of ratchet mechanism  144  (see  FIG. 5 ) is prevented from resetting itself. Since pawl  142  is prevented from resetting itself, handles  106  can not be re-actuated or re-squeezed since they have only been partially opened. Once again, reference may be made to U.S. Provisional Application No. 61/091,467, filed on Aug. 25, 2008, entitled “Surgical Clip Applier;” U.S. Provisional Application No. 61/091,485, filed on Aug. 25, 2008, entitled “Surgical Clip Applier and Method of Assembly;” and U.S. Provisional Application No. 61/286,569, filed on Dec. 15, 2009, entitled “Surgical Clip Applier”, for a detailed discussion of the structure, operation, and method of assembly of various components of surgical clip applier  100 . 
     It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure.