Abstract:
An instrument for applying clips in surgery having an operating handle with operating components and a removable clip cartridge with clip applying mechanism. The handle operating components generate reciprocal linear motion imparted to the clip applying mechanism and accommodate rotation of the cartridge about a cartridge axis. An anti-backup mechanism constrains operating components to complete first and second strokes of reciprocal linear motion. The clip applying mechanism actuated by received reciprocal motion applies a clip in surgery, isolates the next clip, and prepares for loading the isolated clip into the jaws on a first stroke, and on the second stroke, opens the jaws and pushes the isolated clip into the open jaws.

Description:
BACKGROUND OF THE INVENTION  
         [0001]    The present invention relates to surgical clip appliers embodied as an instrument having a supply of clips for rapidly deploying several clips in closing severed blood vessels and other small fluid carrying ducts in surgical procedures. There are many different designs for surgical clip applicators for a variety of surgical procedures including both open surgery and laparoscopy in which a clipping appliance fits through a trocar tube into a body cavity where the clips are applied.  
           [0002]    This invention comprises improvements in repeating multi-clip appliers of the kind described and claimed in my co-pending application Ser. No. 09/521,444 filed Mar. 7, 2000, now U.S. Pat. No. ______. A surgical clip applicator described in the co-pending application comprises an operating handle and clip applying mechanism having an operating cycle in which operating levers are squeezed together and released. In this operating cycle, a clip is applied in surgery and the clip applicator is reloaded with a single clip from a clip supply channel for clip application in the next cycle. The applicator provides a moveable clip supply channel containing a line of clips that are released seriatim. The supply channel integrates a clip pusher and an escapement or clip stop spring in a single unit.  
           [0003]    Clip crimping jaws apply a clip with a rearward movement of a camming member thereby allowing the functions of clip loading and jaw closure to be coordinated and operated by a single sliding bar moving reciprocally to load and fire clips.  
           [0004]    The clip actuating mechanism includes a combined actuating rod and in-line clip supply channel together with clip indexing mechanisms arranged so that with a squeeze of the operating levers, the actuating rod moves rearward in the appliance to apply a clip in surgery, capture the next in-line clip, index a line of clips rearward away from the clip jaws; and that with release of the operating levers, the jaws open, the next in-line clip is loaded into the jaws, the second next in-line clip is separated from the line, and the clip indexing movement is reset for the next cycle. The clip applicator includes a novel mechanism with minimal complexity especially suited for a disposable cartridge for fixed handle appliances.  
           [0005]    A clip applicator of the co-pending application also employs low operating force without recoil, a clip counter, jaw lockout after the last clip and is adaptable for use as a quick snap-in disposable cartridge with a fixed non-disposable operating handle. An operating handle that provides linear reciprocating motion including scissors-type or pistol grip is used with that invention.  
           [0006]    In practice, clip cartridges are ordinarily used a single time and discarded. Operating handles, on the other hand, may be disposed of after use with a single cartridge, may be used with a plurality of cartridges in a single surgical procedure and then discarded, or may be autoclaved after each surgical procedure and used over and over again.  
           [0007]    This invention provides improvements for a repeating multi-clip applier having a simplified mechanism for applying clips which mechanism is suitable for the full spectrum of clip appliers including open surgery and laparoscopy. The applier mechanism is particularly adaptable to the disposable cartridge/fixed handle design. The simplified mechanism reduces tooling and assembly requirements, provides high operating reliability at lower product cost.  
         SUMMARY OF THE INVENTION  
         [0008]    A preferred embodiment of repeating multi-clip applier according to the present invention comprises an instrument having an operating handle housing and a removable, fully rotatable and disposable clip applying cartridge. A full squeeze and release of operating handles applies a clip to a surgical site and reloads another clip into clip applying jaws of the instrument.  
           [0009]    The operating handle housing preferably accommodates a pistol grip set of handles which provide linear reciprocating motion by means of a spring biased translator slide for actuating the clip applying mechanism within the cartridge. The operating handle housing includes a rotary thumb wheel hub and rotatable drum subassembly which receive the clip cartridge for 360° rotation about the cartridge axis and which link the cartridge clip applying mechanism to the translator slide.  
           [0010]    The operating handle housing accommodates an anti-backup mechanism to prevent a partial pull and release of the operating handles. A well-known hazard with clip appliers is a condition of releasing a partially closed clip in a surgical site. This condition results when operating handles are given a partial pull or closing and then released. The partial pull crimps but does not close a clip located in the instrument jaws. When partially pulled handles of some older instruments are released, the instrument jaws re-open and the partially closed clip falls from the jaws into the surgical site. The present invention prevents occurrence of this condition by means of an anti-backup mechanism to ensure that when the appliance handles are pulled, the handles must be given a full pull to execute a complete cycle of the clip applier mechanism. If a partial pull of the appliance handles occurs, the anti-backup mechanism retains or holds the clip applier mechanism in fixed position without possibility of backup or reverse. The anti-backup “hold” is released simply by giving the handles a complete pull. When a partial pull occurs and the anti-backup mechanism holds the clip applying mechanism in place, the instrument jaws remain partially closed holding a partially closed clip thereby preventing the clip from falling into a surgical site. The anti-backup mechanism also functions in the opposite, or release, motion of operating handles. That is, the operating handles when being released are constrained by the anti-backup mechanism to undergo a full release motion. The anti-backup mechanism prevents partial release and re-pull of the trigger thereby to prevent double loading of a clip into the crimping jaws, a condition that would jam the instrument.  
           [0011]    The clip applying mechanism includes a combined actuating rod and in-line clip supply cartridge together with clip advancing mechanisms arranged so that with a squeeze of the operating handle, the actuating rod moves rearward in the instrument to apply a clip in surgery, capture the next in-line clip, retain and move a line of clips rearward away from the clip jaws, and that with release of the operating levers, the jaws open, the next in-line clip is loaded into the jaws, the second next in-line clip is separated from the line, and the clip retaining means is reset for the next cycle.  
           [0012]    The clip applying mechanism of the invention may include a flexible shaft interposed between operating handle and clip cartridge. The flexible shaft is capable of bending as desired up to 360° with respect to its handle as the clip cartridge maintains full operational clip applying integrity.  
           [0013]    The clip applying cartridge according to the invention may be used with any kind of operating handle that can provide linear reciprocating motion to the actuating rod or puller bar of the cartridge clip applying mechanism. The clip applying cartridge may be used with a pistol grip operating handle as disclosed, a scissor type handle, or with a surgical robot such as used in a da Vinci™ surgical system.  
           [0014]    Specific examples are included in the following description for purposes of clarity, but various details can be changed within the scope of the present invention.  
         OBJECTS OF THE INVENTION  
         [0015]    An object of the invention is to provide a novel clip applicator with minimum complexity and with adaptability to a complete range of clip applicators including open and laproscopic surgery.  
           [0016]    Another object of the invention is to provide a clip applicator adaptable for use with a replaceable cartridge.  
           [0017]    Another object of the invention is to provide a clip applicator having an operating handle that provides anti-backup linear reciprocating motion and accommodates rotary motion of a clip applying cartridge.  
           [0018]    Another object of the invention is to provide a clip applicator in which clip feed and applying mechanisms are driven by an actuator having a linear reciprocating motion generated by operating handles.  
           [0019]    Another object of the invention is to provide a surgical clip applier with an anti-backup means to prevent release of partially closed clips at a surgical site.  
           [0020]    Another object of the invention is to provide a surgical clip applier with clip applying cartridge rotatable through 360°.  
           [0021]    Another object of the invention is to provide a surgical clip applier with a flexible shaft capable of bending as desired up to 360° interposed between clip applying cartridge and operating handles.  
           [0022]    Another object of the invention is to provide a clip applying cartridge which can be used with various operating handle configurations including pistol grip, scissor type, and surgical robot.  
           [0023]    Other and further objects of the invention will become apparent with an understanding of the following detailed description of the invention or upon employment of the invention in practice. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWING  
       [0024]    A preferred embodiment of the invention has been chosen for detailed description to enable those having ordinary skill in the art to which the invention appertains to readily understand how to construct and use the invention and is shown in the accompanying drawing in which:  
         [0025]    [0025]FIG. 1 is a perspective view of a preferred embodiment of surgical clip applicator according to the invention with location of A-A′ and B-B′ axes.  
         [0026]    [0026]FIG. 2 is an exploded perspective view of the handle components of surgical clip applicator of FIG. 1 including handle subassembly locating trigger pivot A-A′ axis, and subassembly of fixed translator, rotary translator, anti-backup mechanism, rotatable drum, and thumb wheel aligned on B-B′ axis.  
         [0027]    [0027]FIG. 3 is a side elevation view of the applicator of FIG. 1 with the operating handle housing partially in section and with handles in release position.  
         [0028]    [0028]FIG. 4 is a side elevation view of the applicator of FIG. 1 with the operating handle housing partially in section and with handles in pull position.  
         [0029]    [0029]FIG. 5 a  is a side elevation of a rotary translator.  
         [0030]    [0030]FIG. 5 b  is section view taken along line  5   b - 5   b  of FIG. 5 a.    
         [0031]    [0031]FIG. 5 c  is a front elevation of rotary translator.  
         [0032]    [0032]FIG. 6 a  is a side elevation view of the rotary drum.  
         [0033]    [0033]FIG. 6 b  is a longitudinal section view of the rotary drum of FIG. 6 a.    
         [0034]    [0034]FIG. 6 c  is an elevational view of the front face of the rotary drum of FIG. 6 a.    
         [0035]    [0035]FIG. 6 d  is an elevational view of the rear face of the rotary drum of FIG. 6 a.    
         [0036]    [0036]FIG. 7 is a front elevation of anti-backup disc.  
         [0037]    [0037]FIG. 8 a  is a side elevation view of thumb wheel hub.  
         [0038]    [0038]FIG. 8 b  is a longitudinal section view of the thumb wheel hub of FIG. 8 a.    
         [0039]    [0039]FIG. 8 c  is an elevational view of the the front face of the thumb wheel hub of FIG. 8 a.    
         [0040]    [0040]FIG. 8 d  is an elevational view of the the rear face of the thumb wheel hub of FIG. 8 a.    
         [0041]    [0041]FIGS. 9 a - g  are sequential views of anti-backup mechanism with disc in ( a ) rear groove, ( b )&amp;( c ) between grooves, ( d ) in front groove, ( e )&amp;( f ) between grooves, and ( g ) again in rear groove, and with arrows indicating directions of permitted and prevented movement of operating handle and cartridge mechanism.  
         [0042]    [0042]FIGS. 10 a, b  and  c  are fragmentary perspective views of the sequence for inserting a clip applying cartridge magazine into a handle assembly housing.  
         [0043]    [0043]FIG. 11 is a perspective view of individual cartridge mechanism components.  
         [0044]    [0044]FIGS. 12 a - b  are sequential fragmentary perspective views of puller bar/cam puller “lost motion” with related cartridge components.  
         [0045]    [0045]FIG. 13 is an enlarged section view taken along line  13 - 13  of FIG. 11.  
         [0046]    [0046]FIGS. 14 a, b, c, d  and  e  are fragmentary section views of the sequence of ( a ) a clip loaded in the jaws ready to fire and clip fired, ( b ) next-in-line clip being detained, ( c ) line of clips in cartridge being indexed rearward, ( d ) next-in-line clip moved downward into loading position, and ( e ) next-in line-clip loaded into the jaws ready for firing.  
         [0047]    [0047]FIGS. 15 a  and  b  are perspective views of a repeating multi-clip applier according to the invention having a flexible shaft interposed between cartridge and pistol grip handle.  
         [0048]    [0048]FIGS. 16 a  and  b  are perspective views of a repeating multi-clip applier according to the invention having a flexible shaft interposed between cartridge and scissors operating handle. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0049]    Referring to the drawing, a preferred embodiment of the repeating multi-clip applier  10  comprises operating handle housing  12  and clip applicator cartridge  14 .  
         [0050]    The operating handle housing  12  shown in FIGS.  1 - 4  comprises left  12   a  and right  12   b  handle members defining a depending grip  12   c , a center section  12   d  defining a central chamber  12   e , and a forward cylindrical portion  12   f  defining a forward chambfffer  12   g . Preferably, the interior defining surfaces  12   e ,  12   g  of the right handle member shown in FIG. 2 are substantially the same as the corresponding interior surfaces of the left handle member. The handle members are joined along a mid-plane and together receive handle operating components within the central and forward chambers. The handle members define a depending pistol type grip which receives a bar spring  16  forming part of the applier mechanism.  
         [0051]    A trigger  18  for actuating applier mechanisms is mounted on the housing for pivotal movement about axis A-A′. The trigger includes a depending grip portion  18   a  integral with upwardly extending arms  18   b  fitted with pivot pins  18   c  received in corresponding hubs  12   h  located within housing central chamber and defining the A-A′ axis. The outer surfaces  18   d  of the trigger arms are in surface contact with the adjacent inner surfaces  12   m  of the housing central chamber so as to confine trigger movement to a smooth circular movement about axis A-A′.  
         [0052]    The trigger has a forwardly projecting shoulder  18   e  for engaging a plate  12   i  affixed to the housing at the central chamber for the purpose of establishing the forward limit of travel of the trigger about axis A-A′ under the force of the bar spring  16  acting through fixed translator  20 .  
         [0053]    The trigger when pulled transmits motion to the clip cartridge mechanism  14   a  (FIG. 11) through the intermediation of fixed translator slide  20  and a rotary translator  22 . The trigger cooperates with the fixed translator slide  20  to provide reciprocal rectilinear motion of predetermined excursion along B-B′ axis, and the fixed translator slide cooperates with the rotary translator  22  to transmit reciprocal rectilinear motion of predetermined excursion and to accommodate 360° rotation about the B-B′ axis of the rotary translator. In this way, the actuating mechanism  14   a  of the clip cartridge receives reciprocating rectilinear motion of fixed excursion while the clip cartridge is free to rotate 360° in either direction about the applicator B-B′ axis.  
         [0054]    The fixed translator  20  functions as a slide which determines its contour. The fixed translator has an elongate body  20   a  with depending leg  20   b  having an open slot  20   c  defining a drive pin recess, an upper block  20   d , a spring recess  20   e , and an open front cage  20   f . The fixed translator and the trigger form a subassembly with the translator located between the arms  18   b  of the trigger, and with the drive pin recess  20   c  fitted over a drive pin  18   f  (FIGS. 3, 4) positioned between the trigger arms. The location of the fixed translator between the upwardly extending arms of the trigger helps prevent the trigger arm pivot pins from popping out of their A-A′ axis hubs  12   h . When assembled with the operating handle housing, the fixed translator slides along central chamber surfaces  12   m  on either side of the trigger subassembly. The central chamber also accommodates the upper block  20   d  which in cooperation with the chamber walls limits forward and rearward movement of the trigger/fixed translator subassembly. The upper tip  16   a  of the bar spring fits into the spring recess  20   e  to provide a forward bias to the subassembly. So a pull of the trigger against the spring produces a circular trigger motion, i.e., a pivoting motion about axis A-A′, which is received by the fixed translator as a rectilinear movement of excursion fixed by the interior contours of the central chamber and the upper block of the fixed translator. The drive pin recess  20   c  accommodates curvilinear movement of the trigger drive pin  18   f  and rectilinear movement of the translator. The front cage  20   f  of the fixed translator has an open front  20   g , interior lip  20   h , and open side  20   i  to receive and retain rotary translator  22 .  
         [0055]    The rotary translator  22  (FIGS. 2, 3 and  5 ) forms a subassembly with an anti-backup mechanism  24 , a rotatable drum  26 , and a thumb wheel hub  28  which subassembly interconnects the fixed translator  20  and the clip cartridge  14  for performing the functions of transmitting reciprocating rectilinear motion with a fixed excursion, accommodating rotary motion of the clip cartridge, enabling mounting and disconnecting of the clip cartridge from the operating handle, and providing an anti-backup capability for the operating handle and cartridge mechanism.  
         [0056]    The rotary translator  22  (FIGS. 2, 5) comprises an elongate generally cylindrical shaft  22   a  with a rear flange  22   b  for connection to the fixed translator cage  20   f  so as to accommodate rectilinear motion of the rotary translator and fixed translator as a unit, and to accommodate rotary motion of the translator about the B-B′ axis independent of the fixed translator. The center section  22   c  of the rotary translator shaft has spaced anti-backup grooves  22   d ,  22   e  with the distance between the grooves being approximately equal to the distance of reciprocating rectilinear motion of the fixed translator and, as becomes clear below, equal to the rectilinear excursion of the clip applicator mechanism. The intermediate cylindrical surface  22   c  of the rotary translator cooperates with an anti-backup disc  24  described more particularly next below. The rotary translator further includes a front end cage  22   f  for connection to the clip cartridge mechanism  14   a . The front end cage is defined by a front flange  22   g  with a key hole  22   h  through its front face, a set of four interior, longitudinally extending shoulders  22   i , and a pair of knobs  22   k  projecting radially from the flange rim. The rotary translator fits within a rotatable drum  26  (FIGS. 2, 6) which drum integrates subassembly components.  
         [0057]    The rotary drum  26  is in the general form of a cylindrical sleeve  26   a  for orientation along the B-B′ axis, with diametrically opposed interior grooves  26   b  extending the full length of the interior surface  26   c  of the sleeve, a pair of radially opposed slots  26   d ,  26   e  extending through the sleeve wall  26   a , an integral wall spring  26   f  (FIG. 2) adjacent one of the slots  26   d , a front end flange  26   g , and an enlarged rear end flange  26   h . The front flange includes a key hole  26   j  in front face  26   k.    
         [0058]    The rotary drum subassembly  22 ,  24 ,  26  comprises the rotary translator  22  positioned axially within the drum  26  with knobs  22   k  in interior grooves  26   b . An anti-backup disc  24  (FIGS. 2, 3 and  7 ), defined by an open center  24   a  and slots extending radially from the center to define a plurality of inwardly directed spring fingers  24   c , fits onto the rotary translator  22  and is assembled to the enlarged rear end flange  26   h  of the rotary drum by means of a drum cap  26   i . In normal position of the clip applicator with the trigger released, the anti-backup spring fingers  24   c  are located in the rear anti-backup groove as shown in FIG. 3.  
         [0059]    This rotary drum subassembly is then assembled into the forward chamber  12   g  of the operating handle housing with drum cap  26   i  fitted into chamber recess  12   n  (FIG. 2), with the drum front end flange  26   g  abutting a front rim of the front chamber, and with the rear flange  22   b  of the rotatable translator positioned within the cage  20   f  of the fixed translator.  
         [0060]    A thumb wheel hub  28  (FIGS. 2, 3, and  8 ) with cylindrical interior surface  28   a , tapered fluted exterior  28   b , and front end retaining lip  28   c  fits over the handle front chamber  12   f  in abutment with housing exterior shoulder  12   k  and in abutment with the rotary drum front flange  26   g.    
         [0061]    The rotary drum subassembly within the operating handle housing is now ready to receive the removable clip cartridge and to impart both reciprocating rectilinear movement to the cartridge and to accommodate rotary movement of the cartridge.  
         [0062]    The operation of the anti-backup mechanism is illustrated in FIGS. 9 a - g.    
         [0063]    As pointed out above, the center section  22   c  of the rotary translator shaft has spaced anti-backup grooves  22   d ,  22   e  with the distance between the grooves being approximately equal to the distance of reciprocating rectilinear motion of the fixed translator and equal to the rectilinear excursion of the clip applicator mechanism.  
         [0064]    In the mechanism position of FIGS. 3 and 9 a , the handle trigger  18  is in released position with the anti-backup disc  24  in registry with the rear anti-backup groove  22   d  of the rotary translator  22 . When the trigger is pulled (FIG. 4) (for crimping and applying a clip at a surgical site), the rotary translator moves in the direction of arrow  9   a . As the rotary translator continues movement, the spring fingers  24   c  of the disc engage the outer surface  22   c  of the rotary translator in the manner shown in FIGS. 9 b - c . The anti-backup mechanism applied by the canted spring fingers  24   c  (FIGS. 9 b - c ) to the outer surface  22   c  of the rotary translator permits continued movement in the direction of arrow  9   a  and prevents movement in the opposite direction of arrow  9   b . If a surgeon releases the trigger with less than a full pull stroke leaving anti-backup components in the position of FIG. 9 c , for example, the anti-backup mechanism holds the rotary translator in position against the bias of bar spring  16  which tends to return the trigger to release position. In this FIG. 9 c  hold position, the applicator jaws retain the partially crimped clip preventing it from falling into a surgical site. A continuing pull of the trigger (in direction of arrow  9   a ) moves the rotary translator through the position of FIG. 9 c  to the position of FIG. 9 d  in which the spring fingers  24   c  enter the forward groove  22   e.    
         [0065]    In this position (FIG. 9 d ), the rotary translator may now be moved forward (by releasing the trigger and by force of return spring  16 ) in the direction of arrow  9   c . In this forward movement, the spring fingers  24   c  are effective to allow continued forward movement while preventing movement in the direction of arrow  9   e . If the handle trigger is held by a surgeon with components as in FIG. 9 f , the anti-backup mechanism will prevent the surgeon from pulling the trigger in the direction of arrow  9   e . The surgeon must allow full release of the trigger to component position of FIG. 9 g . Direction of movement can be changed again when the spring fingers  24   c  enter the rear groove  22   e  as in FIG. 9 g.    
         [0066]    The clip cartridge  14  (FIGS. 10 a - c ) includes a tube  14   b  with its handle end having radially projecting positioning pins  14   c  emerging from end slots  14   d  (FIG. 11) in the tube, and an end  14   e  (FIG. 12) slot for passing the end of a puller bar  30  while maintaining radial alignment of the pins and puller bar. The puller bar terminates in a T shape flange  30   a.    
         [0067]    Referring to FIGS. 2, 5,  6  and  10   a - c,  for assembly of clip cartridge  14  and operating handle  12 :  
         [0068]    (a) the clip cartridge  14  is inserted through keyhole  26   j  into the front end of the rotary drum  26  with cartridge positioning pins  14   c  entering interior drum slots  26   b;    
         [0069]    (b) the T flange  30   a  projecting through cartridge end slot is in fixed radial orientation in relation to the positioning pins  14   c;    
         [0070]    (c) the T flange approaches end face  22   m  of the rotary translator with the T flange in axial registry with the keyhole  22   h  in the front face of cage flange  22   f  (FIG. 2);  
         [0071]    (d) the T flange passes through the keyhole  22   h  into the rotary translator cage  22   f ; and  
         [0072]    (e) the cartridge is rotated (arrow  10   a ) on B-B′ axis with cartridge pins  14   c  entering radial drum slots  26   d ,  26   e  (FIG. 6) and the T flange coming to rest against the rotary translator interior cage shoulders  22   i  (FIG. 5).  
         [0073]    The slot spring  26   f  (FIG. 2) engages one of the pins  14   c  to hold the clip cartridge in assembled position with the handle.  
         [0074]    The cartridge and operating handle are taken apart by reversing the assembly sequence.  
         [0075]    In this clip applier assembly FIGS. 10 a - c , the operating handle housing  12  may be considered stationary. The rotary drum subassembly (rotary translator  22 , anti-backup mechanism  24  and rotary drum) together with thumb wheel hub  28  and the clip cartridge  14  are rotatable about the B-B′ axis by manual application of torque to the thumb wheel and with the rear flange  22   b  of the rotary translator rotating freely in fixed translator cage  20   f . In this way the cartridge is rotatable clockwise and counterclock wise as desired.  
         [0076]    A pull on the trigger against the force of bar spring produces unitary rearward rectilinear movement of the fixed translator, the rotary translator passing through the stationary spring fingers of the anti-backup disc, and the puller bar emerging from within the cartridge casing until the trigger and fixed translator reach the end of travel and with the anti-backup disc spring fingers positioned at the front groove. The rearward excursion is now complete, and when the trigger is released, the bar spring urges the fixed translator forward until all components reach normal position.  
         [0077]    In the event a pull on the trigger is released without reaching the full extent of rectilinear motion, the anti-back up spring fingers will not have reached their front groove remaining instead in contact with the outer surface of the rotary translator. The spring fingers in contact with outer surface function as a brake against the action of the bar spring tending to force the released components to return to normal position. In this partial pull condition of the trigger a clip has been crimped in the instrument jaws which clip will fall out of the jaws into a surgical site if the jaws reopen by return of the mechanism to normal position. So the anti-backup mechanism retains the instrument in “partial pull position” against the normalizing force of the bar spring and most importantly prevents fallout from the jaws of a partially crimped clip. The anti-backup device retaining action is removed simply by means of a full pull on the trigger causing the spring fingers to enter the forward groove where they can go “over center” thereafter permitting the rotary translator to pass through the spring fingers. It is to be noted that the anti-backup mechanism is effective in both directions. The anti-backup mechanism has effect when the trigger is released after a full pull so that if there is a “partial release” of the trigger, the trigger must nonetheless return to normal position with full release of the trigger before allowing the trigger to be pulled. The design requirement for full release achieved by the anti-backup mechanism prevents double loading of clips into cartridge jaws.  
         [0078]    It is a further aspect of the anti-backup mechanism that the cartridge may be rotated on the B-B′ axis as the anti-backup mechanism holds the instrument in partial pull position enabling a surgeon to adjust cartridge or jaw position even after a partial pull has occurred.  
         [0079]    The clip cartridge  14  FIGS.  11 - 14   a - e  comprises an applicator housing tube  32 , upper cartridge shell  34  and lower cartridge shell  36  connected to the operating handle housing as described above. The applicator housing upper  34  and lower  36  shells are elongate open ended channels having locating pins  14   c  serving to connect the cartridge to the handle as described above. The channels together define the end slot  14   e  (FIG. 12) through which the puller bar end  30   a  extends into the operating handle. The clip applicator housing encloses and forms part of a clip applicator mechanism  14   a . In the following description, the applicator housing upper and lower shells  34 ,  36  are regarded as stationary in relation to movement of the applicator mechanism components.  
         [0080]    The lower cartridge shell  36  has an anchor pin  36   a  affixed to the channel base interior  36   b . The lower cartridge shell receives a cam puller bar  38  and coil spring  38   a  for sliding movement, and clip applicator jaws  40  mounted on the anchor pin  36   a . The cartridge puller bar  30  overlies the cam puller bar  38 .  
         [0081]    The elongate cartridge puller bar  30  is located in the applicator lower shell  36   c  with the bar connected at its T shape rear end  30   a  to the rotary translator for receiving linear reciprocating motion with respect to the stationary lower shell  36  for each cycle of the handle operating trigger. The cartridge puller bar toward its front end includes laterally extending tabs  30   b  which cooperate with the cam puller bar  38 . The cartridge puller bar also has a round hole  30   c  for receiving a magazine pin  42   a  depending from the underside of a clip magazine  42  by which the cartridge puller bar actuates the clip magazine. The magazine pin also passes through an elongate slot in a stationary clip plate  41 .  
         [0082]    The cam puller  38  occupies the lower shell beneath the cartridge puller bar and the clip applicator jaws. The cam puller bar is fitted with upstanding cooperating cam members  38   b  for closing and opening the clip applicator jaws  40 . The cam puller bar includes a rear tang  38   c  and coil spring  38   a  accommodated in a recess  36   b  in the lower shell. The cam puller further includes an anchor pin slot  38   d  to accommodate reciprocal movement of the cam puller past the anchor pin  36   a  in the base channel and a cartridge pin slot  38   e  for accommodating movement of the cam puller past the cartridge pin  42   a  fitted to the underside of the clip supply magazine. The cam puller is fitted with spaced sets of upwardly extending tabs  38   f  and  38   g  for cooperating with the cartridge puller bar lateral tabs  30   b.    
         [0083]    So, the cam puller  38  is urged by coil spring  38   a  toward the foward end (i.e., the jaws end) of the clip cartridge so as to leave the clip applicator jaws  40  normally open. The cartridge puller bar  30  is normally forward under the influence of the handle bar spring with puller tabs  30   b  abutting the forward set of cam puller tabs  38   f . When the trigger handle is pulled (FIG. 12 a ), the cartridge puller bar  30  moves rearward (with lost motion or dwell between cam puller bar forward  38   f  and rear  38   g  tab sets) until the cartridge puller tabs  30   b  engage the rear set  38   g  of cam puller tabs thereby drawing the cam puller  38  to the rear against its coil spring for closing the applicator jaws. The cartridge pin slot  38   e  accommodates cam puller movement past the cartridge channel pin  42   a  during the time of lost motion between the cartridge puller bar  30  and cam puller tab sets  38   f - g.    
         [0084]    Lost motion of the cam puller bar ensures that the applicator jaws remain open for a portion of the rearward movement of the cartridge puller bar before the jaws close and crimp a clip in surgery. It is desirable to crimp the clip at the end of rearward travel so as to provide the surgeon with a natural feel for releasing the handle. Lost motion also has significance on the forward stroke of the clip applicator mechanism by ensuring the applicator jaws are open to receive a clip during the forward stroke of the applicator mechanism, as is to be fully understood with description of the clip supply magazine and associated mechanisms below.  
         [0085]    Clip applying jaws  40  comprising spring biased arms  40   c - d  are mounted at opening  40   e  to anchor pin  36   a  on the applicator lower shell with the jaws projecting from the front end of the base channel.  
         [0086]    [0086]FIGS. 11 and 12 a - b  illustrate spring biased applicator jaws affixed to the applicator housing anchor pin  36   a  with spring biased arms  40   c - d  able to move from open-to-closed-to-open positions in applying a clip. The inner surfaces  40   f  of the jaws are recessed to form cooperating channels for movement of each clip into the jaws. The outer surfaces of the jaws have aligned recesses  40   b  and inclined cam surfaces  40   g  cooperating with aligned cam members  38   b  affixed to the cam puller for the purpose of closing the jaws for each rearward excursion of the cartridge puller bar  30 . The jaws are released to spring open on the forward excursion of the cam puller placing the cam members within the recesses  40   b . The normal position for the cam puller  38  and jaws  40  occurs with the cam puller at the forward end of linear excursion, with the jaws open and with the cam puller cam members  38   b  in an inactive position with respect to applicator jaws as in FIG. 12 b.    
         [0087]    The cartridge applicator mechanism includes a clip supply magazine  42  (FIGS. 11, 13 and  14   a - e ) which is affixed to and reciprocates with the cartridge puller bar  30  by means of magazine pin  42   a  at the underside the magazine fitting into hole in the puller bar. The clip supply magazine and cartridge puller bar are separated by a stationary clip plate  41  having a central slot  41   a  to accommodate sliding movement of the clip supply magazine  42  and its pin  42   a  by means of the cartridge puller bar. The clip plate  41  includes a cam slot  41   b  and front end clip ramp  41   c  cooperating with the clip supply channel as described below.  
         [0088]    The clip supply magazine  42  (FIGS. 11, 13) includes an elongate base plate  42   b  with upstanding sides  42   c  to define a central channel  42   d  for receiving and retaining a line of clips C. A dome  42   e  extends between the sides for receiving an elongate clip follower  42   f  and coil spring  42   g . The clip follower is positioned and retained in the clip supply magazine in engagement with the last clip C Z  (FIG. 14) and is urged forward by the coil spring for advancing the line of clips along the supply channel. The clip follower has forwardly directed fingers  42   h  for engaging clip shoulders for constantly maintaining a force on the line of clips by means of the coil spring.  
         [0089]    The clip supply magazine  42  (FIG. 11) has an integral forwardly extending pusher plate  42   i  preferably with notched front edge  42   h  conforming to clip contour for the purpose of pushing each clip into the jaws as it leaves the supply magazine.  
         [0090]    A clip stop spring  42   k  (FIGS. 11, 14) with vertical tip  42   m  is formed integral in the base plate  42   b  of the clip magazine for gripping the leading clip C L  at midpoint. The clip stop spring has a “spring set” wherein the spring is normally positioned or biased below the surface  42   n  of base plate (as in FIG. 14 a ) with the spring being accommodated in the cam slot  41   b  (FIGS. 11 and 14) of stationary clip plate  41  located underneath the magazine.  
         [0091]    The clip plate  41  is fixed to the stationary housing by suitable means so that the back edge of the cam slot  41   b  urges the clip stop spring  42   k  and its tip upward into the path of clips C when the clip magazine moves rearward with the cartridge puller bar (FIGS. 14 a - c ). As noted above, the slot  41   a  in the clip plate accommodates reciprocal movement of the clip magazine/puller bar connecting pin  42   a.    
         [0092]    The housing upper shell  34  has depending from its inner surface a clip detent spring  44  (FIGS. 11, 14) and a guide ramp surface  34   a  for positioning clips for movement into clip applying jaws. The clip detent spring comprises a leaf spring  44   a  with spaced depending panels  44   b - c  of identical edge contour terminating in forwardly directed notches  44   d  for engaging the shoulders of a lead clip C L  to separate the lead clip from the line as the line of clips and the clip magazine are pulled rearward by clip stop spring  44   k  and cartridge puller bar  30  with a pull of the operating trigger. On release of the trigger and consequent forward movement of the clip magazine (FIGS. 14 d - e ), the cartridge pusher plate  42   i  engages the rear surface of the detained lead clip C L  and pushes it into the crimping jaws.  
         [0093]    The action of clip moving components is shown in FIGS. 14 a - e  starting with FIG. 14 a  which shows components in forward position and a clip C J  in the instrument jaws.  
         [0094]    Referring to FIG. 14 a , a first in line of clips C F  is at rest under the detent spring notches  44   d  for the purpose of separating clip C F . The detent spring  44  is stationary in that it is affixed to the under side of the housing cover in position to capture and hold the lead clip C F  at the end of the forward excursion of the cartridge puller bar and clip supply magazine. The detent spring takes and separates the lead clip C F  from the clip line in preparation for movement of the lead clip into the applicator jaws on a subsequent applicator cycle. The detent spring separates clip C F  by reaction as the inclined rear edges ride up (FIG. 14 e ) on forwardly moving clip C F  and snap down (FIG. 14 a ) as the clip passes the shoulders. Such clip capture occurs as the puller bar and clip magazine reciprocate during operation of the applicator, as detailed below.  
         [0095]    From the position of FIG. 14 a , a rearward pull of the trigger begins immediate rearward sliding movement of clip supply magazine  42  with respect to stationary upper shell  42  and stationary clip plate  41 . The clip detent spring  44  holds and separates clip C F  from the line of clips. The line of clips moves rearward with the clip cartridge as clip stop spring  42   k  is cammed upward (FIG. 14 b ) by cam slot  41   b  in clip plate  41 . As movement continues (FIG. 14 c ), the cartridge pusher plate  42   i  also moves rearward sliding underneath clip C F  and coming to rest behind the clip (FIG. 14 d ) at the end of the rearward stroke of the operating handles. As pusher plate  42   i  slides behind clip C F , the clip detent spring  44  (having a normal downward spring force) pushes clip C F  downward into contact with clip ramp  41   c . When the operating handles are released, beginning from the position of FIG. 14 d  and continuing to FIG. 14 e , the clip cartridge pusher plate  42   i  engages clip C F , pushes it forward between upper shell ramp surface  34   a  and clip plate ramp  41   c  and on into the instrument jaws. As this forward motion occurs, the clip detent spring  44  rides up on clip C L  with notches  44   d  coming to rest behind the clip shoulder as illustrated in FIG. 14 a.    
         [0096]    The operation of the clip applicator is as follows. The housing upper and lower shells are stationary with respect to movements of the component parts of the actuating mechanism. At the beginning of an operating cycle (or normal position), the handle trigger is in forward or release position, the cartridge puller bar and clip supply magazine are in forward position, the jaws are open holding a clip in position for surgical application, jaw actuating cam puller means are in inactive position, the lead clip in the capture position under clip detent spring, the cartridge pusher plate lies under the captured lead clip, the clip stop spring is inactive and lies in the clip plate cam slot below the surface of the pusher plate, the spring loaded clip follower engages the last in line clip, and the spring biased line of clips is in contact with lead clip C F .  
         [0097]    By squeezing the trigger, the puller bar and clip magazine move rearward relative to the stationary upper and lower shells and stationary clip plate to accomplish:  
         [0098]    a. movement of the magazine pusher plate out of the jaws,  
         [0099]    b. continued movement of the pusher plate relative to the clip plate whereby the stop spring is cammed up so its tip grips the next in line clip C L  and by continued rearward movement the stop spring separates the clip stack from the lead clip C F ;  
         [0100]    c. after an initial lost motion or dwell phase during which the jaws are open, engagement of cartridge puller bar tabs and cam puller tabs for pulling cams means along jaw cam surfaces to close the jaws and crimp a clip in surgical application,  
         [0101]    d. the captured clip C F  is held in place under the clip detent spring;  
         [0102]    e. movement of the cartridge pusher plate from underneath captured clip C F  into position behind clip C F ;  
         [0103]    f. downward movement of clip detent spring and clip C F  on to the clip plate ramp and in front of the clip pusher plate;  
         [0104]    and by releasing the trigger, the cartridge puller bar and clip supply magazine move forward in relative movement to the stationary upper and lower shells and stationary clip plate to accomplish:  
         [0105]    g. disengagement of the cartridge puller bar tabs from the cam puller tabs and forward movement of the cam puller bar under the influence of its coil spring thereby moving cam means along the jaws cam surfaces into inactive position thereby opening the jaws;  
         [0106]    h. movement of the cartridge pusher plate to advance the captured clip C F  into the jaws; and  
         [0107]    i. the cartridge pusher plate and stop spring move relative to the clip plate with the stop spring reentering its slot in the clip plate out of the path of the clip line so as to permit the next in line clip C L  to advance along the surface of the pusher plate to deflect the clip detent spring and be captured as C F .  
         [0108]    The invention provides that the clip applicator of FIG. 2 of the drawing can be made as a disposable cartridge to be inserted into a non-disposable handle with the cartridge removed from the handle and discarded after its clips are consumed. In a cartridge arrangement both the cartridge housing and rear end of the actuating rod have plug-in connections to the handle housing and link journal respectively.  
         [0109]    In accordance with the invention, the magazine pusher plate acts as a lock-out of the jaws after all the clips in the cartridge magazine have been used and there are none left. Such lock-out action occurs as the pusher plate without a clip to push itself enters the space between the crimping jaws and prevents the jaws from closing thereby indicating to the surgeon that there are no more clips to be applied.  
         [0110]    The clip applying mechanism of the invention may include a flexible shaft interposed between operating handle and clip cartridge. As shown in FIGS. 15 a - b  and  16   a - b,  a flexible shaft  46  comprising a sheath  46   a , interior flexible wire  46   b , and T-shape end  46   c  interconnects operating handle  12  in the form of a pistol grip and in the form of a scissor  13  with the clip applying cartridge  14 . The flexible shaft  46  is capable of bending as desired up to 360° with respect to its handle as the clip cartridge maintains full operational clip applying integrity.  
         [0111]    A clip applicator according to the invention has a simplified construction and low cost of manufacture at high production rates, low operating force without recoil, a clip counter, jaw lockout after the last clip, an anti-backup mechanism, a 360° rotatable clip cartridge, and is adaptable for use as a quick snap-in disposable cartridge with a fixed non-disposable operating handle. An operating handle that provides linear reciprocating motion including scissors-type, pistol grip, and surgical robot may be used in the invention. The applicator according to the invention is adaptable for use with surgical clips in a range of sizes.  
         [0112]    Various changes may be made to the structure embodying the principles of the invention. The foregoing embodiments are set forth in an illustrative and not in a limiting sense. The scope of the invention is defined by the claims appended hereto.