Abstract:
A laparoscopic device comprising: (a) a housing operatively coupled to a first control and a second control; (b) an end effector operatively coupled to the first control, the end effector comprising a first component and a second component selectively repositionable with respect to one another within an X-Y plane, the end effector also including a third component selectively repositionable with respect to the second component within an Y-Z plane; (c) a laparoscopic conduit extending between the housing and the end effector; and, (d) an occlusion clip deployment device operatively coupled to the end effector and the second control.

Description:
FIELD OF THE INVENTION 
       [0001]    The present disclosure relates to deployment of an occlusion clip and, more specifically, to devices and methods utilized to deploy an occlusion clip using a handheld device. 
       INTRODUCTION TO THE INVENTION 
       [0002]    The exemplary embodiments disclosed herein include one or more active or passive repositioning mechanisms. As will be discussed in more detail hereafter, an active repositioning mechanism provides for infinite adjustments as the user is physically operating a control to directly manipulate the repositioning of an end effector or a device mounted to an end effector. In contrast, a passive repositioning mechanism can be thought of as acting similar to a light switch, either off or on. In this manner, the passive repositioning mechanism either allows or disallows repositioning of the end effector or a device mounted to the end effector, but is not responsible for actively manipulating the aspect ultimately repositioned. Put another way, the passive repositioning system allows for free movement of the end effector or a device mounted to the end effector within the relevant range of motion when the mechanism is in the “on” position, but locks movement when the mechanism is in the “off” position. In exemplary form, a laparoscopic device may incorporate passive repositioning mechanisms to control movements in different directions, such as pitch and yaw. 
         [0003]    It is a first aspect of the present invention to provide a laparoscopic device comprising: (a) a housing operatively coupled to a first control and a second control; (b) an end effector operatively coupled to the first control, the end effector comprising a first component and a second component selectively repositionable with respect to one another within an X-Y plane, the end effector also including a third component selectively repositionable with respect to the second component within an Y-Z plane; (c) a laparoscopic conduit extending between the housing and the end effector; and, (d) an occlusion clip deployment device operatively coupled to the end effector and the second control. 
         [0004]    In a more detailed embodiment of the first aspect, the handle housing is operatively coupled to a third control, the third control is operatively coupled to the occlusion clip and the occlusion clip deployment device, and the third control controls disengagement of the occlusion clip from the occlusion clip deployment device. In yet another more detailed embodiment, the first control includes a first passive constraint and a second passive constraint, the first passive constraint in an unlocked position allows free motion between the first component and the second component within the X-Y plane, the first passive constraint in a locked position retards free motion between the first component and the second component within the X-Y plane, the second passive constraint in an unlocked position allows free motion between the second component and the third component within the Y-Z plane, and the second passive constraint in a locked position retards free motion between the second component and the third component within the Y-Z plane. In a further detailed embodiment, the first passive constraint includes at least one connection wire in tension that is operatively coupled to the second component and to the housing, and the second passive constraint includes at least one connection wire in tension that is operatively coupled to the third component and to the housing. In still a further detailed embodiment, the first control includes a repositionable button selectively coupled to a first reel and a second reel, where the button is repositionable between a locked and an unlocked position, where the locked position retards rotation of the first reel and the second reel, and where the unlocked position allows rotation of the first reel and the second reel, the first reel is operatively coupled to a first connection line operatively coupled to the first component, the second reel is operatively coupled to a second connection line operatively coupled to the second component, and wherein the first reel is independently repositionable with respect to the second reel. 
         [0005]    In yet another more detailed embodiment of the first aspect, the second control includes a lever operatively coupled and selectively repositionable with respect to the housing, the lever being operatively coupled to a first connection line operatively coupled to the occlusion clip deployment device so that movement of the lever is operative to reposition at least a portion of the occlusion clip deployment device, the lever is repositionable between a locked and an unlocked position, the unlocked position allows the lever to be repositioned, and the locked position retards the lever from being repositioned. In still another more detailed embodiment, the laparoscopic device further includes a third control operatively coupled to the housing, wherein the third control is operatively coupled to a first connection line operatively coupled to the occlusion clip deployment device so that movement of the third control is operative to reposition at least a portion first connection line with respect to the occlusion clip deployment device. In a further detailed embodiment, the third control includes a plug detachable from the housing, the plug is repositionable from an attached position coupled to the housing to a detached position decoupled from the housing, and repositioning the plug from the attached position to the detached position causes more of the first connection line to be drawn into the housing and further away from the occlusion clip deployment device. In still a further detailed embodiment, the laparoscopic device further includes an occlusion clip operatively coupled to the clip deployment device using the first connection line. In a more detailed embodiment, the end effector includes a robotic grasping feature to facilitate grasping and repositioning of the end effector by a robotic grasper. 
         [0006]    It is a second aspect of the present invention to provide a laparoscopic device comprising: (a) a housing operatively coupled to a first control; (b) an end effector operatively coupled to the first control, the end effector comprising a clevis selectively repositionable with respect to a dual pivot joint within an X-Y plane, the dual pivot joint selectively repositionable with respect to a yoke within an Y-Z plane; (c) a laparoscopic conduit extending between the housing and the end effector. 
         [0007]    In a more detailed embodiment of the second aspect, the first control includes a first line and a second line extending along the laparoscopic conduit concurrently coupled to the dual pivot joint, the first line impacting movement of the dual pivot joint with respect to the clevis in a first direction within the X-Y plane, the second line impacting movement of the dual pivot joint with respect to the clevis in a second direction, generally opposite the first direction, within the X-Y plane, and the first control includes a third line and a fourth line extending along the laparoscopic conduit concurrently coupled to the yoke, the third line impacting movement of the yoke with respect to the dual pivot joint in a third direction within the Y-Z plane, the fourth line impacting movement of the yoke with respect to the dual pivot joint in a fourth direction, generally opposite the third direction, within the Y-Z plane. In yet another more detailed embodiment, the first line and the second line are coupled to a first actuator mounted to the housing, the first actuator is repositionable and operative to reposition the first line and the second line in order to create movement between the clevis and dual pivot joint, the third line and the fourth line are coupled to a second actuator mounted to the housing, the second actuator is repositionable and operative to reposition the third line and the fourth line in order to create movement between the yoke and dual pivot joint. In a further detailed embodiment, the first actuator comprises a first reel upon which at least a portion of the first line and the second line are wound, the second actuator comprises a second reel upon which at least a portion of the third line and the fourth line are wound, repositioning of the first reel is operative to distally reposition one of the first line and the second line, while repositioning of the first reel is operative to proximally reposition the other of the first line and the second line, repositioning of the second reel is operative to distally reposition one of the third line and the fourth line, while repositioning of the second reel is operative to proximally reposition the other of the third line and the fourth line. 
         [0008]    In yet another more detailed embodiment of the second aspect, the first control includes a brake that may be selectively applied to the first actuator and the second actuator to retard movement of the dual pivot joint with respect to the clevis within the X-Y plane and movement of the yoke with respect to the dual pivot joint within the Y-Z plane. In still another more detailed embodiment, the brake comprises a spring biased button operatively coupled to a series of teeth, the first reel includes a series of teeth, the second reel includes a series of teeth, and engagement between at least one of the series of teeth operatively coupled to the spring biased button and at least one of the series of teeth of the first reel and least one of the series of teeth of the second reel is operative to retard movement of the dual pivot joint with respect to the clevis within the X-Y plane and movement of the yoke with respect to the dual pivot joint within the Y-Z plane. In a further detailed embodiment, the laparoscopic device further includes an occlusion clip deployment device operatively coupled to the end effector and to a second control, where the housing is operatively coupled to the second control, and the second control includes a clip repositioning line extending along the laparoscopic conduit, the clip repositioning line impacting movement of the occlusion clip deployment device between a first position and a second position. In still a further detailed embodiment, the second control includes a lever operatively coupled and selectively repositionable with respect to the housing, the lever being operatively coupled to the clip repositioning line so that movement of the lever is operative to reposition the occlusion clip deployment device, the lever is repositionable between a locked and an unlocked position, the unlocked position allows the lever to be repositioned, and the locked position retards the lever from being repositioned. In a more detailed embodiment, the laparoscopic device further includes a deployment control operatively coupled to the housing, the deployment control including a deployment line extending along the laparoscopic conduit and concurrently mounted to a deployment plug removably fastened to the housing. In a more detailed embodiment, the laparoscopic device further includes an occlusion clip operatively coupled to the occlusion clip deployment device using the deployment line. In another more detailed embodiment, the occlusion clip includes a first jaw opposing a second jaw, a first retainer loop at least partially circumscribes the first jaw, at least a portion of the occlusion clip deployment device, and at least a portion of the deployment line, a second retainer loop at least partially circumscribes the second jaw, at least a portion of the occlusion clip deployment device, and at least a portion of the deployment line. In yet another more detailed embodiment, the end effector includes a robotic grasping feature to facilitate grasping and repositioning of the end effector by a robotic grasper. 
         [0009]    It is a third aspect of the present invention to provide a laparoscopic device comprising: (a) a laparoscopic handle; (b) a laparoscopic conduit operatively coupled to the laparoscopic handle; (c) a laparoscopic end effector operatively coupled to the laparoscopic conduit; (d) a passive control allowing repositioning of an end effector with respect to the laparoscopic conduit within an X-Y plane and a Y-Z plane when the passive control is disengaged and retarding repositioning of the end effector with respect to the laparoscopic conduit within the X-Y plane and the Y-Z plane when the passive control is engaged. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]      FIG. 1  is an elevated perspective view of an exemplary laparoscopic device in accordance with the instant disclosure. 
           [0011]      FIG. 2  is an elevated perspective view of the proximal end of the exemplary laparoscopic device of  FIG. 1 . 
           [0012]      FIG. 3  is an elevated perspective view of the proximal end of the exemplary laparoscopic device of  FIG. 2 , without the left side housing. 
           [0013]      FIG. 4  is a profile view of the proximal end of the exemplary laparoscopic device of  FIG. 2 , without the left side housing and without some of the internal components in order to show the axle in a distal portion of a through hole in the repositionable button. 
           [0014]      FIG. 5  is an elevated perspective view of a distal portion of the proximal end of the exemplary laparoscopic device of  FIG. 2 , without the left side housing and without the clip release wires and the draw wires, and with the pitch and yaw controls in an unlocked position. 
           [0015]      FIG. 6  is a profile view of a distal portion of the proximal end of the exemplary laparoscopic device of  FIG. 2 , without the left side housing and without the clip release wires and the draw wires, and with the pitch and yaw controls in a locked position. 
           [0016]      FIG. 7  is a profile view of a distal portion of the proximal end of the exemplary laparoscopic device of  FIG. 2 , without the left side housing and without the clip release wires and the draw wires, and with the pitch and yaw controls in the unlocked position. 
           [0017]      FIG. 8  is a profile view of a distal portion of the proximal end of the exemplary laparoscopic device of  FIG. 2 , without the left side housing, the clip release wires, the draw wires, and the yaw control. 
           [0018]      FIG. 9  is an elevated perspective view of a distal portion of the proximal end of the exemplary laparoscopic device of  FIG. 2 , without the left side housing, the clip release wires, the draw wires, and the yaw control. 
           [0019]      FIG. 10  is an elevated perspective view of a distal portion of the proximal end of the exemplary laparoscopic device of  FIG. 2 , without the left side housing, the clip release wires, the draw wires, and the control button. 
           [0020]      FIG. 11  is an end view, from the proximal end, of an exemplary clevis of the exemplary laparoscopic device of  FIG. 1 . 
           [0021]      FIG. 12  is an end view, from the distal end, of the exemplary clevis of  FIG. 11 . 
           [0022]      FIG. 13  is a profile view of the exemplary clevis of  FIG. 11 . 
           [0023]      FIG. 14  is an elevated perspective view of the exemplary clevis of  FIG. 11 . 
           [0024]      FIG. 15  is an elevated perspective view, from a distal end, of an exemplary dual pivot joint of the exemplary laparoscopic device of  FIG. 1 . 
           [0025]      FIG. 16  is a profile view of the exemplary dual pivot joint of  FIG. 15 . 
           [0026]      FIG. 17  is an elevated perspective view, from a proximal end, of the exemplary dual pivot joint of  FIG. 15 . 
           [0027]      FIG. 18  is a top view of the exemplary dual pivot joint of  FIG. 15 . 
           [0028]      FIG. 19  is an end view, from the proximal end, of the exemplary dual pivot joint of  FIG. 15 . 
           [0029]      FIG. 20  is another elevated perspective view, from a distal end, of the exemplary dual pivot joint of  FIG. 15 . 
           [0030]      FIG. 21  is an elevated perspective view, from a proximal end, of an exemplary yoke of the exemplary laparoscopic device of  FIG. 1 . 
           [0031]      FIG. 22  is a top view of the exemplary yoke of  FIG. 21 . 
           [0032]      FIG. 23  is an underneath perspective view, from a lateral side, of the exemplary yoke of  FIG. 21 . 
           [0033]      FIG. 24  is a distal view of the exemplary yoke of  FIG. 21 . 
           [0034]      FIG. 25  is a bottom view of the exemplary yoke of  FIG. 21 . 
           [0035]      FIG. 26  is another underneath perspective view, from the opposite lateral side, of the exemplary yoke of  FIG. 21 . 
           [0036]      FIG. 27  is an elevated perspective view, from the proximal end, of the exemplary dual pivot joint and yoke mounted to a clip deployment device, where the view shows the both sets of connection wires, the draw wires, and the clip release wires. 
           [0037]      FIG. 28  is an elevated perspective view, from the proximal end, of the exemplary yoke mounted to a clip deployment device, where the view shows one set of connection wires, the draw wires, and the clip release wires. 
           [0038]      FIG. 29  is an elevated perspective view, from the proximal end, of the exemplary clevis, dual pivot joint, and yoke mounted to a clip deployment device and an occlusion clip, where the yoke is being grasped by a robotic grasper. 
           [0039]      FIG. 30  is an elevated perspective view, from the distal end, of the exemplary yoke mounted to a clip deployment device, where the view is devoid of the draw wires and the clip release wires. 
           [0040]      FIG. 31  is an underneath perspective view, from the distal end, of the exemplary yoke mounted to a clip deployment device, where the view is devoid of the draw wires and the clip release wires. 
           [0041]      FIG. 32  is an elevated perspective view, from the proximal end, of the exemplary clip deployment device and retention dowels, where the view is devoid of the draw wires and the clip release wires. 
           [0042]      FIG. 33  is an elevated perspective view, from the proximal end and lateral side, of the exemplary clevis, dual pivot joint, and yoke mounted to a clip deployment device and an occlusion clip, where the draw wires and the clip release wires are shown. 
           [0043]      FIG. 34  is an elevated perspective view, from the proximal end and lateral side, of the exemplary clevis, dual pivot joint, and yoke mounted to a clip deployment device and an occlusion clip, where the draw wires, the clip release wires, and the suture loops are shown. 
           [0044]      FIG. 35  is a magnified elevated perspective view showing the attachment between the occlusion clip and the clip deployment device, as well as the interaction of the draw wires and the clip release wires. 
           [0045]      FIG. 36  is a perspective view of an exemplary clamp in an open position that may be used with the exemplary laparoscopic device of  FIG. 1 . 
           [0046]      FIG. 37  is a perspective view of the exemplary clamp of  FIG. 36  in a closed position. 
           [0047]      FIG. 38  is a cross-sectional view of the exemplary clamp of  FIG. 36  in its open configuration, showing the wire member, rigid tubular members, and the urging members. 
           [0048]      FIG. 39  is a cross-sectional view of the exemplary clamp of  FIG. 37  in its closed configuration, showing the wire member, rigid tubular members, and the urging members. 
           [0049]      FIG. 40  is a perspective view of the exemplary claims of  FIGS. 36-39  and showing the ability to close in a non-parallel fashion. 
           [0050]      FIG. 41  is a perspective view of the first stage of assembly of an alternate embodiment of a clamp, showing a wire member surrounded by rigid tubular members. 
           [0051]      FIG. 42  is a perspective view of the second stage of assembly of the clamp of  FIG. 73 , in which platens have been added over the rigid tubular members. 
           [0052]      FIG. 43  is a perspective view of the clamp of  FIGS. 73 and 74 , once an outer fabric covering has been disposed over the entire surface of the clamp. 
       
    
    
     DETAILED DESCRIPTION 
       [0053]    The exemplary embodiments of the present disclosure are described and illustrated below to encompass surgical equipment and, more specifically, to surgical equipment that may be used in minimally invasive procedures. The disclosure also relates to surgical equipment to facilitate the positioning and deployment of an atrial appendage occlusion device. In addition, the disclosure relates to surgical equipment that is adapted to accommodate or work in tandem with flexible endoscopes. 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. 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. 
         [0054]    Referring to  FIG. 1 , an exemplary clip deployment apparatus  100  comprises a controller  110  mounted to a proximal portion of a rigid or semi-rigid conduit  112  that is relatively linear. The controller  110  includes various controls in order to manipulate a repositionable mechanism operatively coupled to an end effector  118 , where the repositionable mechanism is mounted to a distal portion of the conduit  112 . In this exemplary embodiment, the repositionable mechanism is coupled to an end effector comprising a clip deployment device  118 . But as will be discussed in more detail hereafter, the end effector  118  may comprise any number of devices such as, without limitation, forceps, ablation rails, jaws, linear cutters, ablation pens, ablation clamps, illuminated dissectors, and non-illuminated dissectors. 
         [0055]    The exemplary repositionable mechanism incorporates a dual passive mechanism. The first passive mechanism is operative to control the pitch (i.e., up and down) of the end effector  118 , while the second passive mechanism is operative to control the yaw (i.e., side to side) of the end effector. 
         [0056]    Referencing  FIGS. 1-10 , the controller  110  is coupled to the conduit  112  in order to manipulate a repositionable mechanism operatively coupled to the end effector  118 . The controller  110  comprises a right side housing  130  and a left side housing  132  that cooperatively define an internal cavity and corresponding openings to accommodate throughput of certain controls. A first of these openings is a dorsal opening  134  that accommodates throughput of a repositionable button  136 . As will be discussed in more detail hereafter, the repositionable button  136  may be manipulated vertically to lock and unlock the repositionable mechanisms, as well as forward-to-rearward to lock and unlock the position of the button itself, in order to provide for or constrain lateral and vertical adjustability of the end effector  118 . 
         [0057]    The repositionable button  136  comprises a proximal-to-distal arcuate top  138  that includes bumps and a proximal ridge to accommodate the thumb of a user being positioned on top of the button. The medial-to-lateral width of the arcuate top  138  is generally constant and overlaps a vertical, planar appendage  142  that extends from the underside of the arcuate top. This vertical appendage  142  has a relatively constant and minimal medial-to-lateral dimension, but includes a proximal-to-lateral dimension that tapers from a maximum where the appendage extends from the arcuate top, to a minimum where the appendage ends. Extending through this vertical appendage  142  is a U-shaped through hole  144  that is partially occupied by an axle  164 . This U-shaped through hole  144  allows the button  136  to be vertically repositioned with respect to the axle  164  so that active pressure is required to maintain a depressed button position when the axle is in a distal portion of the through hole. Instead of having to maintain pressure upon the button  136  to sustain it in a depressed position, the user may choose to rotate the button with respect to the axle  164  in order to seat the axle in a proximal portion of the through hole  144 , thus effectively locking the button in the depressed position. In order to unlock the button  136 , a user simply rotates or pushes the button proximally to cause the axle  164  into the distal portion of the through hole  144 . 
         [0058]    At the end of the appendage  142 , a pair of tooth receivers  146  extend outward in the medial and lateral directions from opposing sides of the appendage. The tooth receivers  146  each include a series of longitudinal pyramidal shapes  148  that are in parallel and radially arranged in order to define a series of corresponding longitudinal pyramidal cavities  150 . At the medial end of the medial tooth receiver  146  and at the lateral end of the lateral tooth receiver  146  is a cylindrical projection  152  that is received within corresponding vertical, oblong grooves  154  on the interior of the housings  130 ,  132 . These grooves  154  inhibit significant medial-to-lateral and proximal-to-distal travel of the tooth receivers  146  as the tooth receivers are vertically repositioned. In other words, as the button  136  is depressed vertically, the toothed receivers  146  are vertically repositioned in a corresponding vertical manner. In this way, the movement of the toothed receivers  146  is directly attributable to the movement of the button  136  as the toothed receivers are indirectly mounted to the button via the appendage  142 . 
         [0059]    The button  136  is biased vertically to its highest vertical position shown in  FIG. 6 . To achieve this bias, the housings  130 ,  132  include parallel walls  158  that cooperate to form medial-to-lateral trench within which at least one spring  160  is seated. The spring  160  is rated at a sufficient spring force to overcome the weight of the button  136 , appendage  142 , tooth receivers  146 , and cylindrical projections  152  to force the button to its highest vertical position. But the spring force is not so great that it requires too great a force from a user&#39;s thumb to depress the button  136  and overcome the bias of the spring  160 . 
         [0060]    An axle  164  extends in the medial-to-lateral direction within the interior cavity cooperatively defined by the housings  130 ,  132 . This axle  164  is cylindrical in shape and includes a constant longitudinal diameter, thereby giving the axle a circular circumference. In exemplary form, the medial and lateral ends of the axle  164  are received within corresponding cylindrical cavities (not shown) on the interior of the housings. The depth of these cavities is not so great as to cover the majority of the axle  164 . The exposed cylindrical portion of the axle  164  is operative to receive a pair of toothed assemblies  168 ,  170  that are interposed by the appendage  142 , which itself includes a vertical, oblong orifice (not shown) to accommodate throughput of the axle and vertical travel of the appendage with respect to the axle, which has a fixed orientation. In exemplary form, the toothed assemblies  168 ,  170  include a through cylindrical orifice  172  allowing the assemblies to rotate on the outside of the axle. 
         [0061]    Each of the toothed assemblies  168 ,  170  are identical to each other. Accordingly, a redundant description of the second toothed assembly has been omitted in furtherance of brevity. The toothed assemblies  168 ,  170  include a wheel  176  having circumferentially distributed teeth  178  that are sized to engage a respective tooth receivers  146  and be received within the longitudinal pyramidal cavities  150  when the tooth receivers in a raised vertical position (see  FIG. 6 ). In exemplary form, the spring rate of the spring  160  is chosen to allow the tooth receivers  146  to be depressed by forces applied to the toothed assemblies  168 ,  170  above a predetermined threshold. For example, a high load applied to the end effector in any one direction may result in repositioning of one or both of the toothed assemblies  168 ,  170 , thereby causing a wheel  176  and its teeth  178  to rotate and correspondingly depress against the corresponding tooth receiver  146 , which depresses against the spring  160  to compress the spring, thus allowing one or both wheels to rotate to avoid breaking any of the components. 
         [0062]    The wheel  176  has a generally uniform width but for a pair of outgrowths  180 ,  182 . The first outgrowth  180  is generally centered radially with respect to the wheel and partially defines the through orifice  172  that receives the axle  164 . This first outgrowth  180  is semicircular in shape extends medially from the wheel  176  and includes a corresponding top and bottom arcuate surfaces  184 ,  186  that are radially inset with respect to the wheel. These arcuate surfaces  184 ,  186  act as camming surfaces for respective connection wires  188 ,  190  that extend from the second outgrowth  182 . The first outgrowth  180  also includes a pair of vertical flanges  194  that extend from the arcuate surfaces  184 ,  186  and cooperate with the circumferential ends of the wheels in order to provide medial and lateral guides for the connection wires  188 ,  190  so that the connection wires stay therebetween. The second outgrowth  182  is proximally oriented with respect to the first outgrowth  180  and includes a rectangular profile with a pair of L-shaped walls  192  and floor  196  cooperating to define an internal cavity. An opening (not shown) extends through the floor and into the cavity. This opening receives a fastener (such as a screw)  200  around which the connection wires  188 ,  190  are wound and secured in place. The fastener  200  is also recessed within the cavity so that the L-shaped walls  192  extend laterally beyond the end of the fastener. Accordingly, the connection wires  188 ,  190  extending from the fastener are threaded through a gap between the L-shaped walls  192 , with one of the wires being threaded over the top arcuate surface  184 , while the second wire is threaded under the bottom arcuate. surface  186 . Thereafter, the wires  188 ,  190  extend distally and taper to extend through a respective eyelet opening at the proximal end of the conduit  112 . 
         [0063]    Each of the toothed assemblies  168 ,  170  is independently rotatably repositionable with respect to one another. The first toothed assembly  168  is operative provide part of a passive repositionable mechanism in order to control the pitch (i.e., up and down) of the end effector  118 , while the second toothed assembly  170  is operative to provide part of a passive repositionable mechanism in order to control the yaw (i.e., side to side) of the end effector. In exemplary form, when the button  136  is not depressed, the spring  160  is operative to bias the toothed receivers  146  into engagement with the teeth  178  of the toothed assemblies  168 ,  170 , thereby inhibiting rotation of the toothed assemblies around the axle  164 . When the tooth assemblies  168 ,  170  are locked in position (see  FIG. 6 ) the end effector  118  cannot be repositioned in the vertical direction (i.e., affecting pitch) or in the medial-to-lateral direction (i.e., affecting yaw). Thus, when the tooth assemblies  168 ,  170  are locked in position (see  FIG. 6 ), so too is the end effector  118  locked in position. 
         [0064]    In order to change the vertical or medial-to-lateral position of the end effector  118 , a user would depress the button  136 . By depressing the button  136 , the toothed receivers  146  are operative to further compress the spring  160  and disengage the toothed assemblies  168 ,  170 . More specifically, the longitudinal pyramidal shapes  148  and corresponding longitudinal pyramidal cavities  150  no longer engage the teeth  178  of the toothed assemblies  168 ,  170 , thereby allowing rotation of the toothed assemblies around the axle  164 . By allowing free rotation of the toothed assemblies  168 ,  170  around the axle  164 , the connection wires  188 ,  190  linking the end effector  118  and the toothed assemblies may be repositioned, which allows the end effector to be freely repositionable in the vertical direction (i.e., affecting pitch) and in the medial-to-lateral direction (i.e., affecting yaw). After the respective vertical and medial-to-lateral position of the end effector  118  has been reached, the user would discontinue depressing the button  136  to lock in the relative vertical and medial-to-lateral positions. In order to lock in the positions, the spring  160  forces the toothed receivers  146  upward and into engagement with the toothed assemblies  168 ,  170 . Because the toothed assemblies  168 ,  170  include teeth  178  that engage the longitudinal pyramidal shapes  148  of the toothed receivers  146 , the spring  160  will direct the toothed receivers upward and cause the toothed assemblies to possibly rotate slightly about the axle  164  so that the teeth are fully received within the longitudinal pyramidal cavities  150 . If the position of the end effector  118  is such that the teeth  178  are aligned with the longitudinal pyramidal cavities  150 , then the vertical and medial-to-lateral positions will be precisely maintained because of the tension on the connection wires  188 ,  190 . But if the position of the end effector  118  is such that the teeth  178  are slightly misaligned with the longitudinal pyramidal cavities  150 , then the vertical and medial-to-lateral positions will be changed as the toothed assemblies  168 ,  170  rotate slightly about the axle  164  so that the teeth are fully received within the longitudinal pyramidal cavities  150 . After the teeth  178  are aligned and received within the longitudinal pyramidal cavities  150 , the vertical and medial-to-lateral positions will be precisely maintained because of the tension on the connection wires  188 ,  190 . 
         [0065]    In order to maintain the orientation of the semi-rigid conduit (which carries the connection wires  188 ,  190 ) with respect to the housings  130 ,  132 , a distal portion of the right side housing  130  includes a pair of detents  202  that engage the conduit  112 . These detents  202  inhibit longitudinal movement of the conduit  112  with respect to the controller  110 . Both detents  202  extend in parallel to one another and extend from an interior circumferential surface of the right side housing  130 . 
         [0066]    The right and left side housings  130 ,  132  cooperate to delineate a handle mechanism port  210  and a proximal port  212  open to the interiors of the respective housings. The handle mechanism port  210  accommodates throughput of a portion of a handle mechanism  218  that comprises a repositionable lever  220 , a drive plate  222 , a return spring  224 , and a wire retainer  226 . As will be discussed in more detail hereafter, the wire retainer  226  is concurrently coupled to draw wires  228  and the drive plate  222  so that movement of the lever  220  is operative to open and close an occlusion clip  1160  (compare  FIGS. 29 and 34 ), such as during an atrial appendage occlusion clip deployment surgical procedure. A more detailed explanation of the respective components of the handle mechanism  218  follows. 
         [0067]    The repositionable lever  220  includes an arcuate, ventral gripping surface that may include a series of convex bumps longitudinally spaced apart to facilitate gripping by a user. Opposite the ventral gripping surface is a corresponding interior surface from which a pair of spaced apart, parallel vertical walls  230 ,  232  extend. The vertical walls  230 ,  232  are also connected to one another via a plurality of cross walls  234 . The vertical walls  230 ,  232  each include a distal upstanding loop  238  that provides a through opening in the medial-to-lateral direction to receive a axle  240  extending from the right side housing  130  around which the lever  220  rotates. Extending distally from the loop  238 , the walls  230 ,  232  include a circular opening extending in the medial-to-lateral direction that receives a pin  244  in order to repositionably mount the drive plate  222  to the lever  220 . 
         [0068]    The exemplary drive plate  222  comprises an arcuate, flat plate sized to fit between the walls  230 ,  232  of the lever  220 . A distal end of the plate  222  includes an opening to receive the pin  244 . Extending proximally from the opening is an elongated, arcuate opening  246  adapted to receive a dowel  248  extending from the interior of the right side housing  130 . In this manner, the dowel  248  is repositioned with respect to the opening  246  as the lever  220  repositions the drive plate  222 . In exemplary form, the opening is partially defined by a lip  250  that acts to retain the dowel  248  in a static position after the lever  220  is fully closed. At the same time, the proximal end of the drive plate  222  includes an orifice  252  that receives a portion of the spring  224  in order to bias the lever  220  to the open position shown in  FIG. 3 . The opposing end of the spring  224  is mounted to a dowel  254  that extends from the interior of the right side housing  220 . 
         [0069]    The controller  110  also includes a removable stem  260  that is seated within the proximal port  212  of the housings  130 ,  132 . The removable stem  260  is coupled to one or more clip release wires  292  (in this case, two clip release wires) that act to disconnect an occlusion clip from the clip deployment device  118 . In this manner, the stem  260  may be removed from the proximal end of the controller  110 , thereby drawing the release wire(s) proximally and disconnecting the occlusion clip from the clip deployment device  118 . In this exemplary embodiment, the stem  260  is secured within the proximal port  212  via a friction fit that may be overcome by the user applying pressure to the stem to move it proximally with respect to the controller  110 . But it is also within the scope of the disclosure to use detents or other affirmative release mechanisms to release the stem  260  from the controller  110 . 
         [0070]    The controller  110  is mounted to a rigid or semi-rigid conduit  112  that is relatively linear and has a relatively constant circular cross section. In this exemplary embodiment, the conduit  112  is fabricated from stainless steel and includes a proximal circular opening and a distal circular opening. The proximal circular opening provides access between the interior of the conduit  112  and the interior of the controller  110 . More specifically, the hollow interior of the conduit  112  accommodates throughput of the connection wires  188 ,  190  and the clip release wires  292 . The conduit  112  includes a proximal section having a pair of rectangular, arcuate cut-outs providing respective recesses for the detents  202  of the right side housing  130  to occupy and mount the conduit  112  to the housings  130 ,  132 . 
         [0071]    In addition, the conduit  112  may be relatively linear but include two additional orifices that accommodate a separate conduit (not shown) adapted to provide a separate avenue for an exploratory tool. Exemplary exploratory tools for use with the instant semi-rigid conduit include, without limitation, forceps, ablation rails, jaws, linear cutters, ablation pens, ablation clamps, illuminated dissectors, and non-illuminated dissectors. The exemplary exploratory tool may be used in combination with the end effector, which is manipulated by the repositionable mechanism. 
         [0072]    Referring to  FIGS. 11-14 , a distal portion of the exemplary repositionable mechanism comprises a clevis  302  having a partially enclosed proximal section  304  that delineates a cavity  306  receives a distal section of the conduit  112  to mount the clevis to the conduit. On the interior of the cavity  306  are four equidistantly, radially spaced apart ribs  308  that extend longitudinally and in parallel to one another. The ribs  308  operate to decrease the diameter of the cavity  306  so that the ribs contact the exterior, circumferential surface of the conduit  112  to mount the conduit to the clevis  302  via a friction fit. Each of the ribs  308  terminates distally at a wall  310  extending normal to the longitudinal direction of the ribs. The wall  310  includes a series of orifices  312 ,  314 ,  316  that accommodate throughput of the connection wires  188 ,  190  and the clip release wires  292 . In exemplary form, the first orifice  312  accommodates throughput of the first connection wire  188 , while the second orifice  314  accommodates throughput of the clip release wires  292 , while the third orifice  316  accommodates throughput of the second connection wire  190 . The wall  310  also bridges the proximal section  304  and a distal section  320  of the clevis  302 . 
         [0073]    Te distal section  320  of the clevis  302  includes a pair of distal projections  324 ,  326  extending away from the wall  310  to create a ceiling and floor. The projections  324 ,  326  are oriented to provide a gap therebetween extending in proximal-to-distal direction and in a medial-to-lateral direction. Each projection  324 ,  326  includes a mildly convex outer surface  330  that is jointed by a peripheral surface  332  that is rounded to at the distal tip. The peripheral surfaces  332  are jointed by respective exterior side surfaces  334 . Each projection  324 ,  326  includes a depression  336  that originates at the distal tip of the clevis  302  and extends proximally. The bounds of the depression  336  are delineated by a planar bottom surface  340 , a horseshoe (i.e., semicircular) peripheral surface  342 , and a planar base surface  344 . The arcuate contour of the peripheral surface  342  is operative to allow a dual pivot joint to  350  to pivot in a single plane with respect to the clevis  302 . 
         [0074]    Referring to  FIGS. 15-20 , the dual pivot joint  350  comprises a proximal section  352  having a pair of plateaus  354  that extend in opposite directions from one another. Each plateau  354  includes a teardrop shaped circumferential surface  356  with the rounded portion of the surface adapted to have an arcuate curvature that approximates the arcuate curvature of the peripheral surface  342  of the clevis  302 . The plateaus  354  are interposed by a platform  358  having opposed, generally planar parallel surfaces  360 . Accordingly, the dual pivot joint  350  may pivot with respect to the clevis  302  by the plateaus  354  pivoting or rotating with respect to the peripheral surface  342 , while the planar surfaces  360  contact the planar base surfaces  344  of the clevis to limit significant vertical play between the clevis and dual pivot joint. The pointed aspect of each circumferential surface  356  cooperates with the straight walls of the peripheral surface  342  of the clevis  302  to provide stops that limit the pivotal motion of the dual pivot joint  350  with respect to the clevis  302  to no more than fifty-five degrees from center (total range of motion of approximately  110  degrees). As will be understood by those skilled in the art, the range of travel may be increased by increasing the angle of the pointed aspect of the circumferential surfaces. Conversely, the range of travel may be decreased by decreasing the angle of the pointed aspect of the circumferential surfaces. 
         [0075]    A proximal aspect of the platform  358  is rounded and includes two pair of arcuate walls  364  that are spaced apart from one another to create a gap  368  that tapers distally to create a cylindrical through hole  376  extending into the interior of a distal aspect  370  of the dual pivot joint. The tapered feature of each gap  368  is partially defined by a pair of angled faces  372  that operate to allow the connection wires  188  to be fed in between the walls  364 , through the cylindrical hole  376  and into the interior of the distal aspect, where the wires are ultimately connected to a yoke  380 . The tapered nature of each gap  368  ensures that the connection wires  188  do not become bound up by pivoting action of the dual pivot joint  350  with respect to the clevis  302 . But for the tapered nature of the gap  368 , pivoting action beyond center of the dual pivot joint  350  with respect to the clevis  302  would cause the path of the connection wires  188  to be lengthened, thereby resulting in pivoting of the yoke  380  with respect to the dual pivot joint. 
         [0076]    Interposing the two pair of arcuate walls  364  and respective gaps  368  is a centered gap  384  that also tapers distally to create a through hole  386  having a rectangular, rounded cross-section that extends into the interior of the distal aspect  370  of the dual pivot joint. The tapered feature of this centered gap  384  is partially defined by a pair of angled faces  388  that operate to allow the draw wire  228  and clip release wires  292  to be fed in between the walls  364 , through the hole  386 , and into the interior of the distal aspect, where the wires are ultimately fed through a clip deployment frame  520 . The tapered nature of this gap  384  ensures that the draw wire  228  and clip release wires  292  do not become bound up by pivoting action of the dual pivot joint  350  with respect to the clevis  302 . But for the tapered nature of the gap  384 , pivoting action beyond center of the dual pivot joint  350  with respect to the clevis  302  would cause the path of the draw wire  228  and clip release wires  292  to be lengthened, thereby potentially resulting in premature release of the clip  1160  and opening of the clip. 
         [0077]    Adjoining the angled faces  388  is an arcuate wall  390  that curves around a lateral edge of the proximal section  352  and extends into the interior of the distal section  370 . The arcuate wall  390  is inset within the proximal section  352  to create a lateral trench  392  on the right and left sides. Each lateral trench  392  ends distally proximate a lateral, longitudinal opening  396  extending through right and left side paddles  402 . This pair of lateral trenches  390  respectively receives one of the connection wires  190  so that the ends of each connection wire extend into the interior of the distal section  370 . Each end of the connection wire  190  is enlarged to prohibit the end from passing through the longitudinal opening  396 . In other words, the longitudinal opening  396  is sized to allow throughput of the connection wire  190  along the longitudinal length of the connection wire, but is sized to prohibit throughput of the enlarged end of the connection wire. In this manner, tension can be applied the connection wires  190  in order to cause the dual pivot joint  350  to pivot with respect to the clevis  302 . By applying tension to the right side connection wire  190 , the dual pivot joint pivots to the right side. Conversely, by applying tension to the left side connection wire  190 , the dual pivot joint pivots to the left side. 
         [0078]    The right side paddle  402  is a mirror image of the left side paddle. Accordingly, for purposes of explanation, only a single paddle will be described. Each paddle  402  includes a lateral exterior surface  406  that is substantially planar but for a pair of projections  408  that are spaced apart from one another by the longitudinal opening  396  extending therebetween. Each projection  408  includes a linear aspect  410  that extends in parallel with the longitudinal opening  396  and a curved aspect  412 . As will be discussed in more detail hereafter, the curved aspect  412  has a curvature that mirrors the arcuate motion of the yoke  380 . The paddle  402  includes a vertical height extending above and below the proximal section  352 . The top and bottom surfaces  414  of the paddle  402  are generally planar and are bridged by a curved circumferential surface  418 . The lateral or widthwise dimension of the paddle  402  is substantially uniform, from proximal to distal, but for an interior depression  420  that is open on the distal end of the paddle and extends proximally to intersect the longitudinal opening  396 . The depression  420  is partially defined by a planar wall  424  that is perpendicular to a second planar wall  426  with an arcuate transition therebetween. At the same time, a third wall  428  is also perpendicular to the planar wall  424  and includes an arcuate profile that corresponds to the arcuate profile of a plateau of the yoke  380 . An interior planar wall  430  of each paddle  402  intersects a pair of rectangular projections  432 . Each rectangular projection  432  includes a distal wall  436  that is arcuate from right to left. The arcuate curvature of the distal wall generally tracks the arcuate profile of a portion of the yoke  380 . 
         [0079]    Referring to  FIGS. 21-26 , the yoke  380  comprises a hollow box having a roof  440 , a floor,  442 , a right side wall  444 , and a left side wall  446 . The front of the box is open and reveals the interior cavity. Extending laterally outward from the right and left side walls  444 ,  446  are respective right and left wings  448 ,  450 . 
         [0080]    Each wing  448 ,  450  includes a pair of circumferential projections  452  that extend vertically therethrough to protrude above and below the wing. In this exemplary embodiment, the projections are sized and spaced apart to facilitate grasping of the yoke  380  by a robotic grasper  456  (see  FIG. 29 ). A distal portion of the each wing  448 ,  450  is generally flush with walls defining a distal recess  458  within the respective right and right and left side walls  444 ,  446 . As will be discussed in more detail hereafter, the distal recess is sized to accommodate partial insertion of the clip deployment frame  520 . 
         [0081]    The right wing  448  is laterally widest at its distal end and tapers in a widthwise dimension, bounded by an arcuate peripheral surface  460 . The proximal portion of the right wing  448  extends proximally beyond the hollow box and includes a planar guide  464  that is parallel to a right side plateau  466  extending from a proximal section  468  of the yoke  380 . A hole  470  extends through the planar guide  464  and extends into communication with an underneath trench  472  formed into the bottom surface  474  of the right wing. This underneath trench  472  terminates distally at the distal end of the right wing  448 . In particular, one of the clip deployment wires  292  is fed past the proximal section  468 , through the hole  470 , and along this underneath trench  472  to exit and extend distally from the trench. 
         [0082]    The proximal section  468  includes right and left side plateaus  466 ,  476  that extend in opposite directions from one another. Each plateau  466 ,  476  includes a teardrop shaped circumferential surface  478  with the rounded portion of the surface adapted to have an arcuate curvature that approximates the arcuate curvature of the third wall  428  of the dual pivot joint  350 . The plateaus  466 ,  476  are interposed by a platform.  482  having opposed, generally planar parallel surfaces  484 . Accordingly, the yoke  380  may pivot with respect to the dual pivot joint  350  by the plateaus  466 ,  476  pivoting or rotating with respect to the third wall  428 . The pointed aspect of each circumferential surface  478  cooperates with the straight walls of the second planar wall  426  of the dual pivot joint  350  to provide stops that limit the pivotal motion of the dual pivot joint with respect to the yoke to no more than fifty-five degrees from center (total range of motion of approximately 110 degrees). As will be understood by those skilled in the art, the range of travel may be increased by increasing the angle of the pointed aspect of the circumferential surfaces. Conversely, the range of travel may be decreased by decreasing the angle of the pointed aspect of the circumferential surfaces. 
         [0083]    A proximal aspect of the platform  482  is rounded and includes two pair of arcuate, solid walls  486  that are spaced apart from one another to create a gap  488  that tapers distally to create a through hole  490  extending into the interior of the hollow box. The tapered feature of this gap  488  is partially defined by a pair of angled faces that operate to allow the draw wires  228  to be fed in between the walls  486 , through the hole  490  and fed through the clip deployment frame  520 , where the wires are ultimately connected to an occlusion clip  1160  (see  FIG. 30 ). The tapered nature of this gap  488  ensures that the draw wires  228  do not become bound up by pivoting action of the yoke  380  with respect to the dual pivot joint  350 . But for the tapered nature of the gap  488 , pivoting action beyond center of the yoke  380  with respect to the dual pivot joint  350  would cause the path of the draw wires  228  to be lengthened, thereby resulting in potentially premature opening of the occlusion clip  1160 . 
         [0084]    Interposing the solid walls  486  and inset therein are top and bottom arcuate walls  492 ,  494 . The arcuate nature of these walls  492 ,  494 , teamed with being inset in between the solid walls  486  creates a groove that feeds respective top and bottom holes  498 ,  500  that are open to the interior of the hollow box. In exemplary form, each connection wire  188  is received within the respective grooves so that the distal ends of the connection wires extend into the interior of the hollow box. Each end of the connection wires  188  is enlarged to prohibit the end from passing through the top and bottom holes  498 ,  500 . In other words, the holes  498 ,  500  are sized to allow throughput of the connection wires  188 , but are sized to prohibit throughput of the enlarged end of the connection wires. In this manner, tension can be applied the connection wires  188  in order to cause the yoke  380  to pivot with respect to the dual pivot joint  350 . By applying tension to the top side connection wire  188 , the yoke pivots upward with respect to the dual pivot joint  350 . Conversely, by applying tension to the bottom connection wire  188 , the yoke pivots downward with respect to the dual pivot joint  350 . 
         [0085]    Adjacent the platform  482 , on the left side, is the left wing  450 . The left wing  450  is laterally widest at its distal end and tapers in a widthwise dimension, bounded by an arcuate peripheral surface  504 . The proximal portion of the left wing  450  extends proximally beyond the hollow box and includes a planar guide  506  that is parallel to the left side plateau  476 . A hole  508  extends through the planar guide  506  and extends into communication with an underneath trench  510  formed into the bottom surface  512  of the left wing. This underneath trench  510  terminates prior to reaching the distal end of the left wing  450 . In particular, the trench  510  terminates and feeds into a distal tunnel  514  that extends through a distal portion of the left wing  450 . In this exemplary embodiment, a second of the clip deployment wires  292  is fed past the proximal section  468 , through the hole  508 , along this underneath trench  510 , through the tunnel  514  and exits distally from the tunnel. 
         [0086]    Referring to  FIGS. 27-35 , the clip deployment device  118  is partially received within the interior of the hollow box. In exemplary form, the clip deployment device  118  includes a rectangular frame  520  having parallel longitudinal sides  524 ,  526  that are connected to one another via a distal cross-member  527  with rounded corners therebetween. In this exemplary embodiment, each parallel side  524 ,  526  includes a substantially planar interior wall  528  and a concave exterior wall  530 , opposite the interior wall. The concave nature of the exterior wall  530  creates a longitudinal channel, with one exterior channel receiving a first of the clip deployment wires  292 . In addition, the parallel sides  524 ,  526  may include one or more through orifices extending through the interior and exterior walls  528 ,  530 . 
         [0087]    The proximal end of the rectangular frame  522  includes a pair of rounded corners that extend from the parallel sides  524 ,  526 . Each rounded corner on the proximal end forms part of an S-shaped retainer  540 ,  542  that is partially received within the hollow box interior of the yoke  380 . More specifically, both S-shaped retainers  540 ,  542  comprise a first rounded corner that transitions into a straight segment  546 , which transitions into a semicircular segment  548 . The S-shaped retainers  540 ,  542  are mirror images of one another, except that the one retainer  540  includes an orifice  550  that extends through the interior and exterior surfaces and along the majority of the straight and semicircular segments  546 ,  548 . 
         [0088]    In order to secure the clip deployment device  118  to the yoke  380 , two dowels  560  are inserted through corresponding holes  562  in the top and bottom surfaces  440 ,  442  of the yoke. The holes  562  are sized to retain the dowels  560  in position. But before the dowels  560  are inserted into the holes  562 , the S-shaped retainers  540 ,  542  are inserted into the interior of the yoke  380 . In exemplary form, the vertical dimension of the S-shaped retainers  540 ,  542  is such that the retainers are wedged in between the top and bottom walls  440 ,  442  of the yoke  380 . Moreover, the collective lengthwise dimension of the S-shaped retainers  540 ,  542  is such that the retainers are wedged in between the right and left side walls  444 ,  446 . In this manner, even absent the dowels  560 , there is not significant play between the clip deployment device  118  to the yoke  380  in the vertical and lateral directions. In order to reduce play in the proximal-to-distal direction, the dowels  560  are inserted through the holes  562  after the semicircular segment  548  of each S-shaped retainers  540 ,  542  is positioned to partially outline an imaginary cylinder extending through the holes. This locks the S-shaped retainers  540 ,  542  in position with respect to the yoke  380 , thereby mounting the clip deployment device  118  to the yoke. 
         [0089]    The orifice  550  of the one retainer  540  provides an egress hole through which a second of the clip deployment wires  292  passes through. The second of the clip deployment wires  292  extends into the interior of the rectangular frame  522  and passes longitudinally along the exterior of an elongated deployment plate  566 . The deployment plate  566  includes a pair of orifices  568  near the proximal and distal ends of the plate. As will be discussed in more detail hereafter, the orifices  568  receive suture loops  570  that are captured by the clip deployment wire  292  passing therethrough. 
         [0090]    The orifice  550  also provides an egress hole through which the draw wires  228  pass through. The draw wires  228  are initially routed into the interior of the rectangular frame  522  to pass through an orifice  572  in one of the proximal rounded corners. Both wires  228  extend along the longitudinal channel of one of the parallel sides  524  created by the concave exterior wall  530 . One of the wires passes through a first proximal orifice  576  in the first parallel side  524 , while the second wire continues to extend along the longitudinal channel until reaching a second distal orifice  578 . Both wires  228  then extend into the interior of the rectangular frame  522  and pass perpendicularly through a second set of orifices  580  of the elongated deployment plate  566 . This second set of orifices  580  are inset with respect to the pair of orifices  568  near the proximal and distal ends of the plate. The wires are joined and create a closed loop coupled to the deployment plate  566 . 
         [0091]    Referring to  FIGS. 36-38  show one embodiment of a left atrial appendage occlusion clamp  1110  in an open position with spaced apart rigid clamping portions  1102 ,  1104  and resilient or elastic urging members  1106 ,  1108  at opposite ends of each clamping portion  1102 ,  1104 . Clamping portions  1102 ,  1104  may be tubular, and both clamping portions  1102 ,  1104  may be at least substantially parallel to each other when arrest, i.e., when they are not being used to clamp tissue. Clamping portions  1102 ,  1104  may also be of substantially equal length or of different length, and each may be of larger outer diameter than the wire that may be used to form each of the urging members  1106 ,  1108 . In this regard, the wire forming urging members  1106 ,  1108  can extend through the hollow interiors of the clamping portions  1102 ,  1104 . In this illustrative example, the urging members  1106 ,  1108  are each shaped as a loop. The planes defined by the looped configuration of each of the urging members  1106 ,  1108  may be substantially parallel to each other and, in turn, substantially perpendicular to each of the clamping portions  1102 ,  1104 . Of course, other angular orientations are possible as well. 
         [0092]      FIGS. 37-39  show the same clamp  1110  of  FIGS. 36-38  with the clamping portions  1102 ,  1104  in their normally biased together positions. Contact between the clamping portions  1102 ,  1104  may occur initially along their entire parallel lengths as shown. Of course, when clamping portions  1102 ,  1104  are covered in fabric or other material as later described, contact may occur between the fabric or other material instead. In  FIGS. 36-39 , only the structure and relative positions of the rigid members  1102 ,  1104  and urging members  1106 ,  1108  are shown. The final assembly is depicted in  FIGS. 40-42  which, although describing a slightly different embodiment, show the general steps in the construction of each embodiment. The clamping portions  1102 ,  1104  may be made from rigid tubes  1112 ,  1114  of a rigid metal such as titanium disposed over a wire member  1116 . In this embodiment, titanium is used for its compatibility with MRI imaging, its biocompatibility and its galvanic compatibility with the wire member  1116  when the wire member  1116  is formed from superelastic materials such as a nickel titanium alloy. This embodiment and the other embodiments disclosed herein may use a superelastic material such as a nickel titanium alloy to form the urging members  1106 ,  1108 . Superelastic properties will allow the material to be greatly extended to open the clamping portions  1106 ,  1108  of the clamp  1110  without permanently deforming the material. These superelastic materials can also be compatible with MRI imaging and easily tolerated as an implant material in the body. The rigid tubular members  1112 ,  1114  of this embodiment are mechanically fastened to the underlying wire member  1116  preferably by mechanically swaging the titanium tubes  1112 ,  1114  to the wire members  1116 . Although a single, continuous wire member is shown directed through both clamping portions  1102 ,  1104  and urging members  1106 ,  1108 , the clamp  1110  of this embodiment may also be made with two or more wires, or with any other suitable components. 
         [0093]    As shown in  FIG. 40 , in addition to being able to close on tissue or anatomical structure in a parallel fashion, the clamp  1110  can also apply force to the anatomical structure in a nonparallel clamping fashion. This allows the clamp  1110  to accommodate non-uniform tissue thickness over the length of the clamping portions  1102 ,  1104 . In addition, with separate urging members  1106 ,  1108  at opposite ends of the clamping portions  1102 ,  1104  the nonparallel clamping can originate from either side of the clamp  1110 . The non-parallel clamping feature of this embodiment allows the clamp  1110  to accommodate a wide range of hollow anatomical structures with varying wall thicknesses throughout its length and breadth. For example, some anatomical structures such as atrial appendages of the heart have internal structures called trabeculae, which are non-uniform and very often cause variable thicknesses across one or more of their dimensions. Nonuniform clamping, therefore, can be advantageous in this application for this reason or for other reasons. 
         [0094]      FIG. 41  shows an alternate embodiment of a clamp  1160  including two urging members  1166 ,  1168  shaped to resemble a letter “U” instead of the more circular loop configuration of the embodiment of  FIGS. 36-39 . As is the case with the first clamp  1110 , the U-shaped urging members  1166 ,  1168  of clamp  1160  may also lie in planes generally parallel to each other and perpendicular to the axes of the clamping portions  1162 ,  1164 . A potential use of the embodiment of  FIG. 41  may lie in the lesser force exerted by U-shape urging members  1166 ,  1168  on the clamping portions  1162 ,  1164  with respect to the force exerted by the loop-shape urging members  1106 ,  1108  of clamp  1110  in  FIGS. 36-39 , making it more suitable for clamping of anatomical structures not requiring a relatively high clamping force. The U-shape configuration of the urging members  1166 ,  1168  generally requires less space in the direction perpendicular to the axes of the clamping portions  1162 ,  1164 .  FIG. 41  shows a first stage of assembly of the clamp  1160 , where the rigid tubular members  1163 ,  1165  are joined with the superelastic wire member  1161 . In this embodiment, mechanical swaging is used to join the tubular members  1163 ,  1165  to the wire  1161 . However, adhesives or laser welding or other methods of attachment could be easily used instead. Similarly, it will be appreciated that rigid tubular members  1163 ,  1165  may not necessarily need to be bonded to wire member  1161  at all. One may rely, for example, on designing the rigid tubular members  1163 ,  1165  so that their inside diameters simply closely fit over the wire  1161 . In addition, the rigid tubular members  1163 ,  1165  could take on many different cross sectional shapes. Cross-sectional shapes such as ovals, triangles or rectangles with rounded edges could be preferable and may eliminate the addition of the load spreading platens  1167 ,  1169  shown in  FIG. 42 , as these alternate shapes may provide a larger area of contact against the anatomical structure to be engaged by the clamp  1150 . Since different anatomical structures greatly vary from subject to subject, it is advantageous to have a manufacturing method in which the length  1171  of the clamp  1160  can be easily varied. By cutting rigid members  1163 ,  1165  to various different lengths, different size assemblies can be configured. 
         [0095]      FIG. 42  shows the next step in the assembly of the clamp. Load spreading platens  1167 ,  1169  made of plastic or other biocompatible material such as urethane, may be slipped over the titanium or other suitable material tubing that forms rigid tubular members  1163 ,  1165 , to provide a resilient surface  1173  to spread the load out onto a larger surface area, thereby preventing point source loading of the tissue which might otherwise result in cutting of the tissue before it has had a chance to become internally fused. The platens  1167 ,  1169  can be assembled and applied over the rigid tubular members  1163 ,  1165  prior to the swaging step or platens  1167 ,  1169  can alternatively be manufactured in such a way so as to have a longitudinal split which allows the material to be opened and forced onto the rigid tubular members  1163 ,  1165 . 
         [0096]      FIG. 43  shows the clamp  1160  after a fabric cover material  1174  made of material such as polyester has been sewn around the clamping portions  1162 ,  1164  and urging members  1166 ,  1168 . It will be appreciated that this material or any other similar materials may be used as a full or partial covering in any of the disclosed embodiments. Such a material is preferably suitable to engage the tissue of the anatomical structure being clamped as well as that of surrounding areas. Preferably, the material  1174  is circular warp knit fabric tube, with a diameter of approximately 4 to 5 mm and made from a combination of 4/100, 2/100 and 1/100 textured polyester. The material  1174  may also be heat-treated to cause a velour effect. The fabric or other material  1174  is furthermore sewn or otherwise applied over the urging members  1166 ,  1168 . In addition, fabric pieces  1177  may be attached at opposite respective ends of clamping portions  1162 ,  1164  to prevent any part of the engaged anatomical structure from escaping the annular occlusion area between the clamping portions  1162 ,  1164 . In other words, fabric pieces  1177  act as tissue blocking members or dams at opposite ends of the clamp. This or another tissue blocking feature may also be implemented into any other embodiment. This is desirable as it minimizes the probability of unintentionally leaving any part of the engaged anatomical structure unclamped. The material  1177 , like material  1174 , can also promote tissue in-growth. 
         [0097]    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.