Abstract:
An endoscopic surgical apparatus is configured to be loaded with a replaceable cartridge. The cartridge is loaded with a single-file line-up of a series of endoscopic clips. The endoscopic surgical apparatus is furthermore configured to apply (ie., dispense) each clip serially in the line-up, one clip at a time, wherever and whenever the user (eg., surgeon) chooses.

Description:
CROSS-REFERENCE TO PROVISIONAL APPLICATION(S) 
       [0001]    This application claims the benefit of U.S. Provisional Application No. 62/081,755, filed Nov. 19, 2014, U.S. Provisional Application No. 62/076,149, filed Nov. 6, 2014, U.S. Provisional Application No. 62/073,664, filed Oct. 31, 2014, and U.S. Provisional Application No. 62/040,908, filed Aug. 22, 2014. 
         [0002]    This application is a continuation-in-part of U.S. patent application Ser. No. 14/721,312, filed May 26, 2015, which claims the benefit of U.S. Provisional Application No. 62/002,691, filed May 23, 2014; and U.S. Provisional Application No. 62/016,717, filed Jun. 25, 2014; 
         [0003]    and which is also a continuation-in-part of U.S. patent application Ser. No. 14/276,513, filed May 13, 2014, which claims the benefit of U.S. Provisional Application No. 61/961,842, filed Oct. 24, 2013; U.S. Provisional Application No. 61/957,306, accorded filing date of Jun. 29, 2013; and, U.S. Provisional Application No. 61/855,313, accorded filing date of May 14, 2013. 
         [0004]    The foregoing patent disclosures are incorporated herein by this reference thereto. 
     
    
     BACKGROUND AND SUMMARY OF THE INVENTION 
       [0005]    The invention relates to surgical instruments and, more particularly, to endoscopic surgical apparatus which accept a replaceable cartridge that has multi-clip endoscopic clip dispensing and applying provisions, and which endoscopic surgical apparatus are adapted to actuate the multi-clip endoscopic clip dispensing and applying provisions of the replaceable cartridge. 
         [0006]    A number of additional features and objects will be apparent in connection with the following discussion of the preferred embodiments and examples with reference to the drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0007]    There are shown in the drawings certain exemplary embodiments of the invention as presently preferred. It should be understood that the invention is not limited to the embodiments disclosed as examples, and is capable of variation within the scope of the skills of a person having ordinary skill in the art to which the invention pertains. In the drawings, 
           [0008]      FIG. 1  is a perspective view of an endoscopic surgical apparatus in accordance with the invention which is loaded with a replaceable cartridge with multi-clip dispensing provisions likewise in accordance with the invention; 
           [0009]      FIG. 2  is a perspective view of a first embodiment of a surgery clip in accordance with the invention; 
           [0010]      FIG. 3  is a side elevation view of the surgery clip of  FIG. 2 ; 
           [0011]      FIG. 4  is an end elevation view of the surgery clip taken in the direction of arrows IV-IV in  FIG. 3 ; 
           [0012]      FIG. 5  is an end elevation view of the surgery clip taken in the direction of arrows V-V in  FIG. 3 ; 
           [0013]      FIG. 6  is a perspective view of the cartridge in accordance with invention and a load of ten clips in accordance with the invention as lined up in a single file (or, column); 
           [0014]      FIG. 7  is a perspective view of the cartridge in accordance with the invention as disassembled apart into two pieces; 
           [0015]      FIG. 8  is an enlarged-scale perspective view of the slide; 
           [0016]      FIG. 9  is an enlarged-scale perspective view of the respective dispensing ends of (i) the tubular sidewall of the catheter and (ii) the magazine canister (both of which are partly broken away), as well as (iii) the slide ejector, which is also partly broken away but which is moreover illustrated withdrawn from the other two; 
           [0017]      FIG. 10  is an end elevation view taken in the direction of arrows X-X in  FIG. 9 ; 
           [0018]      FIG. 11  is a section view taken along line XI-XI of  FIG. 8 ; 
           [0019]      FIG. 12  is a section view taken along line XII-XII of  FIG. 9 ; 
           [0020]      FIG. 13  is a section view taken along line XIII-XIII of  FIG. 8 ; 
           [0021]      FIG. 14  is an end elevation view taken in the direction of arrows XIV-XIV of  FIG. 8 ; 
           [0022]      FIG. 15  is an end elevation view taken in the direction of arrows XV-XV of  FIG. 8 ; 
           [0023]      FIG. 16  is a sectional view of taken along an axial plane of symmetry through  FIG. 9 ; 
           [0024]      FIG. 17  is a sectional view comparable to  FIG. 16  except also including the loading of a column of clips of in accordance with the invention; 
           [0025]      FIG. 18  is a section view taken along line XVIII-XVIII in  FIG. 17 ; 
           [0026]      FIG. 19  is an enlarged scale section view of detail XIX-XIX in  FIG. 16 ; 
           [0027]      FIG. 20  is a section view taken along line XX-XX in  FIG. 18 , wherein  FIG. 20  serves to rotate the section views subsequently hereof to a new orientation as shown previously, 
           [0028]    wherein all section views shown previously had a channel for an arm of the slide ejector shown in the 12 o&#39;clock position, henceforth, a groove for a prong of a clip will take the 12 o&#39;clock position, the orientation between previous section views and subsequent section views being rotated about 45° counter-clockwise (or 135° and/or 225° or else 315° given the symmetry hereof), 
           [0029]    and wherein this  FIG. 20  shows better the flaring apart of the dove-tailed grooves for the dove-tailed prongs of the clips at the dispensing end of the magazine canister; 
           [0030]      FIGS. 21-24  are a series of partial sectional views forming a slideshow and showing the dispensing of the lead clip of the column of clips, and each of these views are comparable to  FIG. 17  except the orientation of the section views has been rotated consistent with as described in connection with  FIG. 20 ; wherein: 
           [0031]      FIG. 21  shows a start position (SP) for the stroke of the slide; 
           [0032]      FIG. 22  shows about a 66% extension position of the full stroke; 
           [0033]      FIG. 23  shows about a 75% extension position of the full stroke; and 
           [0034]      FIG. 24  shows about 100% extension of the full stroke; 
           [0035]      FIG. 25  is a side elevational view of the dispensed lead clip from  FIG. 24 ; 
           [0036]      FIG. 26  is section view comparable to  FIG. 17 , except on a much reduced scale relative to  FIG. 17 ; 
           [0037]      FIG. 27  is section view comparable to  FIG. 26  except of the manually-actuated plunger of the elongated endoscopic apparatus of  FIG. 1 ; 
           [0038]      FIG. 28  is a perspective view of a second embodiment of a surgery clip in accordance with the invention; 
           [0039]      FIG. 29  is a perspective view of a third embodiment of a surgery clip in accordance with the invention; 
           [0040]      FIG. 30  is a rear elevational view taken in the direction of arrows XXX-XXX in  FIG. 29  clip; 
           [0041]      FIG. 31  is a reduced scale perspective view of a column or load-formation of ten such clips as shown in  FIG. 29 ; 
           [0042]      FIG. 32  is an enlarged scale detail view (in perspective) of two such clips in the column in  FIG. 31 ; 
           [0043]      FIG. 33  is a perspective view of a fourth embodiment of a clip in accordance with the invention, while also showing only a second embodiment of a dispensing provision in accordance with the invention; 
           [0044]      FIG. 34  is a perspective view partly in section comparable to  FIG. 33  except showing better the three rings comprising (A) the catheter, which is the outer ring, (B) the middle ring occupied by both (i) a column or load of clips and (ii) the a plunger/driver conduit which only has a forward stroke; as well as (C) the central strand which is which terminates in a bulbed terminal end that is stationary relative to the end of the catheter; 
           [0045]      FIG. 35  is an enlarged scale perspective view, partly exploded, to show that the central strand threads into the hollow lumen of the plunger/driver conduit; 
           [0046]      FIG. 36  is front elevational view of any of the clips of  FIGS. 33 and 34 ; 
           [0047]      FIG. 37  is a side elevational view of  FIG. 36 ; 
           [0048]      FIG. 38  is a rear elevational view of  FIG. 37 ; 
           [0049]      FIG. 39  is a side elevational view comparable to  FIG. 37  except showing that another preferred size for the clip is 5 mm long by 3 mm outside diameter (ie., the full inside diameter of the catheter&#39;s hollow passageway therefor); 
           [0050]      FIG. 40  is a side elevational view comparable to  FIGS. 37 and 39  except showing that a further preferred size for the clip is 6 mm long by 3 mm outside diameter (ie., the full inside diameter of the catheter&#39;s hollow passageway therefor); 
           [0051]      FIG. 41  is an enlarged scale sectional view taken along line XLI-XLI in  FIG. 36 ; 
           [0052]      FIG. 42  is a sectional view comparable  FIG. 41  except showing that a longer clip may afford opportunity for two barbs on each prong; 
           [0053]      FIGS. 43 through 48  comprise a series of comparable sectional views to show the manner in which this version of a dispensing mechanism dispenses this version of a clip; wherein: 
           [0054]      FIG. 43  is a reduced scale partial sectional view of  FIG. 34 , except in elevation (and with the clip floating out in front of the catheter removed from view); 
           [0055]      FIG. 44  is a partial sectional view comparable to  FIG. 43  except showing the plunger/driver conduit driving forward, pushing the trailing clip to ultimately push the lead clip such that the prongs of the lead clip are widened apart by the bulbed head of the central strand; 
           [0056]      FIG. 45  is a comparable view to  FIG. 44  except showing further forward travel of the plunger/driver conduit, forcing the lead clip to progress further over the bulbed head of the central strand, which the barbs of the prongs have passed across; 
           [0057]      FIG. 46  is a partial sectional view comparable to  FIG. 45  except showing the clips in solid line, and showing widening apart of the longitudinal through-slot in the constant-wall thickness, slotted-collar portion of the clip; 
           [0058]      FIG. 47  is a view comparable to  FIG. 45  except showing the butt end of the lead clip about to pass the widest circumference of the bulbed head of the central strand; 
           [0059]      FIG. 48  shows that the lead clip has at last cleared past the widest circumference of the bulbed head of the central strand; 
           [0060]      FIG. 49  is an elevational view, partly in section, comparable to  FIG. 48  except showing that the prongs have not only pierced into tissue (such as for example and without limitation, the stomach wall), but also clenched back into themselves from their formerly flared out formation; 
           [0061]      FIG. 50  is a partial sectional view comparable to  FIG. 46  except starting a series of views, namely, along with  FIGS. 51 and 52 , to show the dispensing of the last clip in the former column of clips which have since been dispensed; 
           [0062]      FIG. 51  is a side elevation view comparable to  FIG. 49 , again showing the snapping back into toward themselves of the four prongs of the last clip, and thereby pinching the pierced tissue in a fast grasp; 
           [0063]      FIG. 52  is a view comparable to  FIG. 51  except showing withdrawal of the catheter; 
           [0064]      FIG. 53  shows the preferred result of the clips and dispenser in accordance with the invention; 
           [0065]      FIG. 53A  is an enlarged scale plan view of the detail LIII(A)-LIII(A) in  FIG. 53 ; 
           [0066]      FIG. 54  is a side elevational views comparable to any of  FIGS. 37 ,  39  and  40  (and most particularly closest to  FIG. 40 ), except showing that the (diagonally tracking) through slot shown in  FIGS. 37 ,  39  and  40  can alternatively be given a non-linear course; 
           [0067]      FIG. 55  is a side elevational views comparable to  FIG. 54  except showing an alternate curvature to the slot; 
           [0068]      FIGS. 56 through 58  comprise a series of side elevational views showing an alternative embodiment of the a clip in accordance with the invention; wherein: 
           [0069]      FIG. 56  shows the clip at rest with the sacrificial span intact; 
           [0070]      FIG. 57  shows how the sacrificial span has the effect of forcing the prongs to flare out wider as the prongs transit past the bulbed terminal end of the stationary (relative to the catheter) central strand; 
           [0071]      FIG. 58  shows how the sacrificial span is eventually severed by the bulbed terminal end of the stationary central strand, thereby releasing the prongs to snap shut; 
           [0072]      FIGS. 59 through 61  show a plurality of spacers in accordance with invention in alternation with a plurality of clips in the single file line-up loaded in the cartridge; wherein: 
           [0073]      FIG. 59  is a side elevational view showing a single file series of a clip, then a spacer, then a clip again (and so on); 
           [0074]      FIG. 60  is a side elevational view comparable to  FIG. 59  except showing a shorter clip; and 
           [0075]      FIG. 61  is a side elevational view comparable to  FIGS. 59 and 60  except showing a longer clip than both. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0076]      FIG. 1  is a perspective view of an endoscopic surgical apparatus  402  in accordance with the invention which is loaded with a replaceable cartridge  404  likewise in accordance with the invention, wherein the loaded cartridge  404  is barely in view and on a miniature scale in the open end of the slender and flexible tubular sidewall  406  of the catheter  402 , but a carrying case  408  is shown independently to the side and containing ten such cartridges  404 , it being an aspect of the invention that both the endoscopic apparatus  402  and the cartridge(s)  404  have provisions for multi-clip endoscopic-clip dispensing and applying, preferably one clip  400 A at a time (see  FIG. 2 ). 
         [0077]      FIG. 2  is a perspective view of a first embodiment of a surgery clip  400 A in accordance with the invention, wherein this clip  400 A comprises a coin-like base  412 , and from which base  412  there are four barbed prongs  414  extending straight forward (wherein the direction ‘forward’ is non-limiting and is merely relative a given point-of-view). The prongs  414  have barbs  416 . 
         [0078]      FIG. 3  is a side elevation view of the surgery clip  400 A of  FIG. 2 , wherein the base  412  comprises a rear surface  418  serving as the butt end therefor. 
         [0079]      FIG. 4  is an end elevation view of the surgery clip  400 A taken in the direction of arrows IV-IV in  FIG. 3  (eg., the ‘forward’ end), and which shows that each of the four prongs  414  present a dove-tailed tongue profile. 
         [0080]      FIG. 5  is an end elevation view of the surgery clip  400 A taken in the direction of arrows V-V in  FIG. 3  (eg., the ‘rear’ or ‘butt’ end  418 ), and which shows four tabs  422 , each of which tabs  422  serves as the base portion for one of the respective four prongs  414 , wherein the tabs  422  continue the dove-tailed tongue profile of the prongs  414 . 
         [0081]      FIG. 6  is a perspective view of the cartridge  404  in accordance with invention and a load of ten clips  400 A in accordance with the invention as lined up in a single file (or, column), wherein the column of clips  400 A are shown to the side of the cartridge  404  to indicate how such a column of clips  400 A load should be chambered into the cartridge  404 . 
         [0082]      FIG. 7  is a perspective view of the cartridge  404  in accordance with the invention as disassembled apart into two pieces, namely (i) a stationary magazine canister  424  and (ii) a reciprocating ejector slide  426 ; wherein ejector slide  426  has a ring base  428  from which four slender and elongate arms  432  project forwardly therefrom, each arm  432  having a detent  434  formed on the outer sidewall  436  thereof proximate but spaced away from the ring base  428 , the magazine canister  424  having two sets of four-per-set axially-elongated channels or grooves  438 , 440  formed on the inside wall thereof, one of which sets of channels  438  are spaced and sized for the arms  432  of the slide ejector  426  to reciprocate therein, 
         [0083]    whereby the magazine canister  424  has each channel  438  for the arms  432  of the slide ejector  426  further formed with a relatively deepened section  444  indicated in dashed lines in  FIG. 7 , wherein the deepened sections  444  not only allow the reciprocation therein of the detents  434  on the arms  432  of the slide ejector  426  but also enable the magazine canister  424  to be withdrawn completely out of the slender and flexible tubular sidewall (see  454  of  FIG. 8 ) of the endoscope  402  out of the very back end thereof (which back end  446  is shown in  FIG. 27 ). 
         [0084]      FIG. 8  is an enlarged-scale perspective view of the slide  426 , shown foreshortened to illustrate better how the ring base  428  of the slide  426  is formed with L-shaped slots  448  typical of bayonet-style connections for coupling with the radially disposed pins  452  on the outside wall  454  of a manually-driven plunger/driver conduit  456 , 
         [0085]    wherein magazine canister  424  that encircles the slide  426 , as well as the slender (and flexible) tubular sidewall  406  of the catheter  402  which encircles all, are both shown in dashed lines. 
         [0086]      FIG. 9  is an enlarged-scale perspective view of the respective dispensing ends  462 ,  464  and  466 , respectively, of (i) the tubular sidewall  406  of the catheter  402  and (ii) the magazine canister  424  (both of which are partly broken away), as well as (iii) the slide ejector  426 , which is also partly broken away but which is moreover illustrated withdrawn from the other two. 
         [0087]      FIG. 10  is an end elevation view taken in the direction of arrows X-X in  FIG. 9 , and which shows that the magazine canister  424  has a first set of four channels  438  spaced 90° apart from each other and disposed at the 12 o&#39;clock, 3 o&#39;clock, 6 o&#39;clock and 9 o&#39;clock positions relative to each other, thereby being spaced and sized for the four arms  432  of the slide ejector  426 , and which four channels  438  are indeed occupied by a respective one of the arms  432  of the slide ejector  426 , 
         [0088]    and wherein the magazine canister  424  has a second set of four channels or grooves  440  at the 1:30, 4:30, 7:30 and 10:30 positions of an imaginary clock dial (relative to and without limitation the orientation of  FIG. 10 ), which grooves  440  present a dove-tailed groove profile so as to provide a dove-tailed tongue and dove-tailed groove interaction between the prongs  414  of the clip  400 A (not shown) and the grooves  440  therefor in the sidewall  442  of the magazine canister  424  as described more particularly in connection with  FIGS. 22-25 . 
         [0089]      FIG. 11  is a section view taken along line XI-XI of  FIG. 8  (or, in the alternative, in the reverse direction of the arrows for line XII-XII of  FIG. 9 ), 
         [0090]    wherein the arms  432  of the slide ejector  426  are in substantial part (in this  FIG. 11 ) depicted in section shading, however, the portions of the arms  432  of the slide ejector depicted as solid line comprise the detents  434  as more particularly described in connection with  FIG. 7 . 
         [0091]      FIG. 12  is a section view taken along line XII-XII of  FIG. 9 , wherein both the first and second sets of four channels  438  and  440  present a dove-tailed groove profile. 
         [0092]      FIG. 13  is a section view taken along line XIII-XIII of  FIG. 8 , and in contrast to  FIG. 11  is taken across the deepened sections  444  of the four channels  438  shaped and sized for the four arms  432  of the slide ejector  426  to slide therein, 
         [0093]    wherein the arms  432  of the slide ejector  426  are in substantial part (in this  FIG. 13 ) depicted in section shading, however, the portions of the arms  432  of the slide ejector  426  depicted as solid comprise the detents  434  as more particularly described in connection with  FIG. 7  (ie., the white space between the outer sidewall of the slide arm  432  portions depicted in section shading and the inner sidewall  442  of the magazine canister  424 , also depicted in section shading, is solid depiction of the detents). 
         [0094]      FIG. 14  is an end elevation view taken in the direction of arrows XIV-XIV of  FIG. 8  and comprising an end elevational view of the ring base  428  of the slide ejector  426  (which hides the rear end of the magazine canister  424  (not in view) from this vantage point), showing not only the detents  434  of the arms  432  of the slide ejector  426  but also the L-shaped slots  448  typical of bayonet-style connections as more particularly described in connection with  FIG. 8 , wherein the tubular sidewall  406  of the elongated catheter is minimized in significance in this view by being shown in dashed lines. 
         [0095]      FIG. 15  is an end elevation view taken in the direction of arrows XV-XV of  FIG. 8  and comprising an end elevational view of the coupling end  468  of the manually-driven plunger/driver conduit  456 , showing (among other things) the radial pin  452  placement typical of bayonet-style connections as more particularly described in connection with  FIG. 8 , wherein the tubular sidewall  406  of the elongated catheter  402  is minimized in significance in the view by being shown in dashed lines. 
         [0096]      FIG. 16  is a sectional view of taken along an axial plane of symmetry through  FIG. 9 , except wherein the slide ejector  426  (ie., it being the third item in the list for the figure description for  FIG. 9  above) has been re-united with (i) the tubular sidewall of the catheter  406  and (ii) the magazine canister  424 , 
         [0097]    wherein this view shows better three more other distinctions (among other distinctions):
       the dispensing end  462  of the elongated catheter sidewall  406  terminates in a circular in-turned rim  472  for retaining the magazine canister  424  from pushing past this rim  472 , however, the reciprocation of the slide ejector  426  (which action dispenses the clips  400 A (not shown) in the forward stroke and returns to a starting position in the return stroke) does not tend to withdraw the magazine canister  424  from its abutment with the circular in-turned rim  472  of the catheter sidewall  406  as shown here—that is, the magazine canister  424  does not tend move back until withdrawn in the manner with the detents  434  described above in connection with  FIG. 7 ,   the channels  438  for the arms  432  of the slide ejector  426  remain axially straight all the way through the dispensing end  464  of the magazine canister  424 ,   while in contrast, the dove-tailed grooves  440  for the prongs ( 414 , not shown) of the clips ( 400 A, not shown) which have a counterpart dove-tailed profile, such dove-tailed grooves  440  in the inner sidewall  442  of the magazine canister  424  flare outwardly (ie., flare profile indicated by reference numeral  474 ) at the dispensing end  464  of the magazine canister  424 .       
 
         [0101]      FIG. 17  is a sectional view comparable to  FIG. 16  except also including the loading of a column of clips of in accordance with the invention. 
         [0102]      FIG. 18  is a section view taken along line XVIII-XVIII in  FIG. 17 . 
         [0103]      FIG. 19  is an enlarged scale section view of detail XIX-XIX in  FIG. 16 , wherein this view introduces the matter concerning flexible resilient pawls  476 , 
         [0104]    that is, this view shows one of four resilient drive pawls  476  (one drive pawl  476  is formed in each of the four arms  432  of the slide ejector  426 ), and which drive pawls  476  engage the butt end ( 418 , not shown in this view, but see  FIG. 17 ) of the lead clip (clips are indicated by reference numeral  400 A, none shown in this view, but see  FIG. 17 ) in the column to dispense the lead clip when given manual actuation by the plunger ( 456 , not shown in this view). 
         [0105]      FIG. 20  is a section view taken along line XX-XX in  FIG. 18 , wherein  FIG. 20  serves to rotate the section views subsequently hereof to a new orientation as shown previously, 
         [0106]    wherein all section views shown previously had a channel  438  for an arm  432  of the slide ejector  426  shown in the 12 o&#39;clock position, while henceforth, a groove  440  for a prong  414  of a clip  400 A will take the 12 o&#39;clock position, the orientation between previous section views and subsequent section views being rotated about 45° counter-clockwise (or 135° and/or 225° or else 315° given the symmetry hereof), 
         [0107]    and wherein this  FIG. 20  shows better the flaring apart (ie., flaring profile  474 ) of the dove-tailed grooves  440  for the dove-tailed prongs  414  of the clips  400 A at the dispensing end  464  of the magazine canister  424 . 
         [0108]      FIGS. 21-24  are a series of partial sectional views forming a slideshow and showing the dispensing of the lead clip of the column of clips  400 A, and each of these views are comparable to  FIG. 17  except the orientation of the section views has been rotated consistent with as described in connection with  FIG. 20 , whereby:
         FIG. 21  shows a start position (SP) for the plane  480  at the interface where the drive pawls  476  of the arms  432  of the slide ejector  426  are in engagement with the butt end  418  of the lead clip of the column of clips  400 A, and wherein the prongs  414  of the lead clip of the column of clips  400 A are pointing straight forward, whereby this start position plane (SP) is a stationary reference plane relative the terminal end of the catheter sidewall  406  (ie., the dispensing end  462  of the catheter  402 ),     FIG. 22  is partial sectional view comparable to  FIG. 21  except on a relatively enlarged scale, and except showing that the slide ejector  432  has advanced to about a 66% extension position of its full stroke, as measured by the advancement of the interface  480  where the drive pawls  476  of the arms  432  of the slide ejector  426  are in engagement with the butt end  418  of the lead clip of the column of clips  400 A, and wherein the prongs  414  of the lead clip  400 A are being forced to flare apart by a dove-tailed tongue and dove-tailed groove interaction between the prongs  414  of the lead clip  400 A and the flare profile  474  of the grooves  440  therefor in the sidewall  442  of the magazine canister  424 ,     FIG. 23  is more or less on the same scale of  FIG. 22  and shows that the slide ejector  426  has advanced to about a 75% extension position of its full stroke, as measured by the advancement of the interface  480  where the drive pawls  474  of the slide ejector  426  are in engagement with the butt end  418  of the lead clip of the column of clips  400 A, and wherein the prongs  414  of the lead clip are being forced to flare further apart by the aforementioned dove-tailed tongue and dove-tailed groove interaction between the prongs  414  of the lead clip and the flare profiled  474  of the grooves  440  therefor in the sidewall  442  of the magazine canister  424  (target tissue is indicated by reference numeral  482 ), and     FIG. 24  is also is more or less on the same scale as  FIGS. 22 and 23 , and shows that the slide ejector  426  has extended to about the end (eg., about the 100% position) of its full stroke, as measured by the advancement of the interface  480  where the drive pawls  474  of the slide ejector  426  are in engagement with the butt end  418  of the lead clip of the column of clips  400 A, except that by now the prongs  414  of the lead clip have advanced past the dove-tailed tongue and dove-tailed groove interaction between the prongs  414  of the lead clip and the flared profile  474  of the grooves  440  therefor in the sidewall  442  of the magazine canister  424 , which in consequence releases the prongs  414  to restore themselves inherently their straight-forward pointing position (target tissue is indicated by reference numeral  482 ).       
 
         [0113]      FIG. 25  is a side elevational view of the dispensed lead clip of the column of clips  400 A from  FIG. 24 , it having been released from the dove-tailed tongue and dove-tailed groove interaction between the prongs  414  of the clip  400 A and the flared profile  474  of the grooves  440  therefor in the sidewall  442  of the magazine canister  424 , by about some position contemporary with  FIG. 23  (the magazine canister  424  is not shown in this view, only the dispensed lead clip of the column of clips  400 A is shown), 
         [0114]    wherein the open arrows  484  are indicators of the inherent restoring force of the dispensed lead clip  400 A to restore its prongs  414  to a more shut position relative to a maximum flared apart position as shown in  FIG. 23  (and indicated in dashed lines in this view). 
         [0115]      FIG. 26  is section view comparable to  FIG. 17 , except on a much reduced scale relative to  FIG. 17 , 
         [0116]    wherein this  FIG. 26  has all three of (i) the slide ejector  426 , (ii) the magazine canister  424  and (iii) the catheter sidewall  406  re-rotated back to the angular orientation of  FIG. 17  and not  FIG. 20  (but it&#39;s hard to tell with the catheter sidewall  406 ), but not the clip  400 A:—the clip  400   a  remains rotated to the angular rotation set by  FIG. 20 , 
         [0117]    wherein this  FIG. 26  illustrates the bayonet-style connection between the ring base  428  of the slide ejector  426  and the coupling end  468  of the plunger/driver conduit  456 , albeit on a minuscule scale compared to  FIG. 8  (which shows the connection uncoupled), 
         [0118]    and wherein this  FIG. 26  further shows that the plunger/driver conduit  456  is hollow, whereby it can be filled with a constantly-urging spring  486  that constantly urges against the butt end  418  of the last-in-line of the column of clips  400 A (this is not shown). 
         [0119]      FIG. 27  is section view comparable to  FIG. 26  except of the manually-actuated plunger  456  of the elongated endoscopic apparatus  402  of  FIG. 1 , wherein the arrow  488  that corresponds to the length of the stroke also corresponds to the length of one clip  400 A (not shown). 
         [0120]      FIG. 28  is a perspective view of a second embodiment of a surgery clip  400 B in accordance with the invention, wherein this second embodiment  400 B has two prongs  414  in contrast with the four prongs of the first embodiment  400 A, but still has a comparable dove-tailed tongue and dove-tailed groove interaction between the prongs  414  of this clip  400 B and the and the flared profile  474  of the grooves  440  therefor in the sidewall  442  of the magazine canister  424 , as described in connection with  FIGS. 22-25 . 
         [0121]      FIG. 29  is a perspective view of a third embodiment of a surgery clip  400 C in accordance with the invention, comprising a single, barbed spike  492 . 
         [0122]      FIG. 30  is a rear elevational view taken in the direction of arrows XXX-XXX in  FIG. 29  clip  400 C, showing dove-tailed tabs  494  on the coin-like base  496 . 
         [0123]      FIG. 31  is a reduced scale perspective view of a column or load-formation of ten such clips  400 C as shown in  FIG. 29  clip, showing dove-tailed tabs  494  on the coin-like base  496 . 
         [0124]      FIG. 32  is an enlarged scale detail view (in perspective) of two such clips  400 C in the column in  FIG. 31 . 
         [0125]      FIG. 33  is a perspective view of a fourth embodiment of a clip  500 A in accordance with the invention, while also showing only a second embodiment of dispensing apparatus  502  in accordance with the invention. This view shows better the terminal end  5 . 04  (and dispensing end  504 ) of the catheter  510  of the dispensing apparatus  502 . This catheter  510  is simulative of modern endoscopic apparatus. That is, modern endoscopic apparatus (not shown) would typically have multiple conduits for optics, illumination and so on (again, not shown). It is conventional nowadays that the conduit reserved for clip dispensing is 3 mm inside diameter (˜⅛th of an inch). 
         [0126]    Hence the catheter  510  forms the outer ring of three concentric rings:—namely  510 ,  500 A/ 512  and  514 . The middle ring  500 A/ 512  is occupied by both (i) a load of clips  500 A and (ii) a plunger/driver conduit  512  which only has a forward stroke. The inner ring  514  is occupied by a stationary (relative to the catheter  510 ) central strand  514  which has a bulbed terminal end  516  which each clip  500 A must pass when being dispensed. 
         [0127]      FIG. 34  is a perspective view partly in section comparable to  FIG. 33  except showing better the three rings comprising (A) the catheter  510 , which is the outer ring, (B) the middle ring occupied by both (i) a column or load of clips  500 A and (ii) the a plunger/driver conduit  512  which only has a forward stroke; as well as (C) the central strand  514  which is which terminates in a bulbed terminal end  516  that is stationary relative to the end of the catheter. 
         [0128]      FIG. 35  is an enlarged scale perspective view, partly exploded, to show that the central strand  514  threads into (ie., extends centrally through) the hollow lumen of the plunger/driver conduit  512 . 
         [0129]      FIG. 36  is front elevational view of any of the clips  500 A shown in  FIGS. 33 and 34 . 
         [0130]      FIG. 37  is a side elevational view of  FIG. 36  and showing the single longitudinal through-slot  518  formed in the cylindrical sidewall  522  of the clip  500 A, and extending on an offset (eg., diagonal) track from (a) the web  524  of one of the inter-prong interspaces  526  to (b) the rear end (butt end)  528  of the clip. One preferred size for the clip  500 A is 4 mm long by 3 mm outside diameter (ie., the full inside diameter of the catheter  510 &#39;s hollow passageway therefor). 
         [0131]    The clip  500 A is essentially a cylindrical spring, such as on the principles of a ring spring for placing on the outside wall of a pipe, or a retainer clip for placing again on the outside wall of a shaft. That is, the clip  500 A in accordance with the invention is capable of angularly expanding to travel over the enlarged bulb head  516  of the central strand (see  FIGS. 43 through 52 ). The clip  500 A in this  FIG. 37  comprise four prongs  532  separated apart by four inter-prong interspaces  526  and protruding forward from a constant thickness slotted collar portion  534 . 
         [0132]      FIG. 38  is a rear elevational view of  FIG. 37  and showing the butt end  528  of the clip  500 A, with the single longitudinal through-slot  518  formed therethrough. 
         [0133]      FIG. 39  is a side elevational view comparable to  FIG. 37  except showing that another preferred size for a clip is clip  500 B which is 5 mm long by 3 mm outside diameter (ie., the full inside diameter of the catheter  510 &#39;s hollow passageway therefor). 
         [0134]      FIG. 40  is a side elevational view comparable to  FIGS. 37 and 39  except showing that a further preferred size for a clip is clip  500 C which is 6 mm long by 3 mm outside diameter (ie., the full inside diameter of the catheter  510 &#39;s hollow passageway therefor), and so on. 
         [0135]      FIG. 41  is an enlarged scale sectional view taken along line XLI-XLI in  FIG. 36 , and showing that clip  500 A has an longitudinally-varying internal contour which preferably includes barbs  544  near the end of the prongs  532 . 
         [0136]      FIG. 42  is a sectional view comparable  FIG. 41  except showing that a longer clip (eg.,  500 C) may afford opportunity for two barbs  544  and  546  on each prong  532 . 
         [0137]      FIGS. 43 through 48  comprise a series of comparable sectional views to show the manner in which this version of a dispensing mechanism  502  dispenses this version of a clip  500 A,  500 B and/or  500 C and so on. 
         [0138]      FIG. 43  is a reduced scale partial sectional view of  FIG. 34 , except in elevation (and with the clip floating out in front of the catheter  510  removed from view). The lead clip is the clip  500 A about to be dispensed. The trailing clip  500 A has the front rim  552  of the plunger/driver conduit  512  abutted up against this trailing clip  500 A&#39;s butt end  528 . Only two clips  500 A are shown in the column but preferably numerous clips could be formed in such a column, preferably and without limitation as many as ten. The plunger/driver conduit  512  is provided with an imaginary target  554  to trace its forward motion during clip dispensing. 
         [0139]      FIG. 44  is a partial sectional view comparable to  FIG. 43  except showing the plunger/driver conduit  512  driving forward, pushing the trailing clip  500 A to ultimately push the lead clip  500 A such that the prongs  532  of the lead clip  500 A are widened apart by the bulbed head  516  of the central strand  514 . 
         [0140]      FIG. 45  is a comparable view to  FIG. 44  except showing further forward travel of the plunger/driver conduit  512 , forcing the lead clip  500 A to progress further over the bulbed head  516  of the central strand  514 , which the barbs  544  of the prongs  532  have passed across. 
         [0141]      FIG. 46  is a partial sectional view comparable to  FIG. 45  except showing the clips  500 A in solid line, and showing widening apart of the longitudinal through-slot  518  in the constant-wall thickness, slotted-collar portion  534  of the lead clip  500 A. The lead clip  500 A&#39;s prongs  532  flare apart along an opening conic form. The lead clip  500 A&#39;s butt end  528 &#39;s rim warps so that the butt end  528  is not contained in a perpendicular plane to the elongate axis. Instead, the butt end  528  of the lead clip  500 A is warped on another conic form that flares out rearwardly, and albeit on a very shallow angle. 
         [0142]      FIG. 47  is a view comparable to  FIG. 45  except showing the butt end  528  of the lead clip  500 A about to pass the widest circumference of the bulbed head  516  of the central strand  514 . 
         [0143]      FIG. 48 , the last in sequence of this series of  FIGS. 43-48 , shows that the lead clip  500 A has at last cleared past the widest circumference of the bulbed head  516  of the central strand  514 . The prongs  532  of the lead clip  500 A have clenched back into themselves. 
         [0144]      FIG. 49  is an elevational view, partly in section, comparable to  FIG. 48  except showing that the prongs  532  of the lead clip  500 A have not only pierced into tissue  556  (such as for example and without limitation, the stomach wall), but also clenched back into themselves from their former flared out formation. Thus the prongs  532  of the lead clip  500 A have clenched and hold in a fast grasp a pinch of tissue  556  as shown (ie., the tissue is represented by the vertical dash line). 
         [0145]      FIG. 50  is perhaps a duplicate of  FIG. 46 . It emphasizes again how the offset (diagonally tracking) through slot  518  enables the lead clip  500 A to not only pass over the widest circumference of the bulbed head  516  of the central strand  514 , but be flared out along a forward-opening conic form as a whole. The slot  518  does not uniformly widen apart. Instead, the slot  518  widens apart with the opposite side edges on two different helixes of different pitch. In this  FIG. 50 , it appears if the lower side edge of the slot  518  would align on a coarser screw pitch than the upper side edge. 
         [0146]      FIG. 51  is a side elevation view comparable to  FIG. 49 , again showing the snapping back into toward themselves of the four prongs  532  of the lead clip  500 A, pinching the pierced tissue  556  in a fast grasp. 
         [0147]      FIG. 52  is a view comparable to  FIG. 51  except showing withdrawal of the catheter  510 . The plunger/drive conduit ( 512 , but not shown in this view) has been stationary relative to the central strand  514  and catheter  510  since  FIG. 51 . The plunger/driver conduit ( 512 , again, not shown in this view) does not have a retraction stroke. Instead, the plunger/drive conduit ( 512 , not shown in this view) only has a series of extension (drive) strokes in the increments of the length of one clip  500 A at a time. The catheter  510  is immediately available for re-use for dispensing a successive clip  500 A. 
         [0148]      FIG. 53  shows the preferred result of the clips  500 A and dispenser ( 502 , not shown in this view) in accordance with the invention. A wound in a stomach wall  558  is closed by an array of multiple ones of these endoscopic clips  500 A in accordance with the invention. 
         [0149]      FIG. 53A  is an enlarged scale plan view of the detail LIII(A)-LIII(A) in  FIG. 53 . 
         [0150]      FIGS. 54 and 55  are side elevational views comparable to any of  FIGS. 37 ,  39  and  40  (and most particularly closest to  FIG. 40 ), except showing that the (diagonally tracking) through slot  518  shown in  FIGS. 37 ,  39  and  40  can alternatively be given a non-linear course.  FIG. 54  shows clip  500 D with slot  562 .  FIG. 55  shows clip  500 E with slot  564 . That way, the characteristics of how the prongs  532  flare can be manipulated by changing the curvature of the through slot  518 ,  562  and/or  564 . 
         [0000]    + FIGS. 56 through 58  comprise a series of side elevational views showing an alternative embodiment of the a clip  600 A in accordance with the invention. Instead of having a through slot with open ends at both ends, the clip  600 A has a closed-ended slot  612 . Wherein, the open end of slot  518  (not shown here) that formerly opened into the web  614  of the inter-prong inter-space  616  is now closed by a sacrificial span  620 . 
         [0151]      FIG. 56  shows the clip  600 A at rest with the sacrificial span  620 . 
         [0152]      FIG. 57  shows how the sacrificial span  620  has the effect of forcing the prongs  624  to flare out wider as the prongs transit past the bulbed terminal end  516  of the stationary (relative to the catheter  510 , not shown) central strand  514 . 
         [0153]      FIG. 58  shows how the sacrificial span  620  is eventually severed by the bulbed terminal end  516  of the stationary central strand  514 , thereby releasing the prongs  624  to snap shut. 
         [0154]      FIGS. 59 through 61  show a plurality of spacers  640  in accordance with invention in alternation with a plurality of clips  600  in the single file line-up loaded in the cartridge. 
         [0155]      FIG. 59  is a side elevational view showing a single file series of a clip  600 B, then a spacer  640 , then a clip  600 B again (and so on). 
         [0156]      FIG. 60  is a side elevational view comparable to  FIG. 59  except showing a shorter clip  600 C. 
         [0157]      FIG. 61  is a side elevational view comparable to  FIGS. 59 and 60  except showing a longer clip  600 D than both. 
         [0158]    One spacer  640  is inserted between each clip  600 . The spacer  640  extends between a leading end  642  and a trailing end  644 . The leading end  642  has projecting pin  646 . The pin  646  inserts in the back end of the clip  600  just ahead of the spacer  640 . The spacer  640 &#39;s trailing end  644  has a spherical cavity  648  (see  FIGS. 60 and 61 ) formed into it. The prongs  624  of the clip  600  immediately behind the spacer  640  nest in this spherical cavity. 
         [0159]    It is an aspect of the invention that the spacer  640  has ends  642  and  644  shaped each independently shaped for the purpose of fitting better the geometries for the front end and back end of the clips  600  respectively. 
         [0160]    As  FIGS. 60 and 61  show better, the prongs  624  of the clip  600  immediately behind each spacer  640  nest into and push the spacer  640  by abutting in the spherical cavity  648 . This drives the lead clip  600  to be dispensed preferably as disclosed by  FIGS. 56 through 58 . After the lead clip  600  is dispensed, there is a slight possibility that the spacer  640  will remain stuck on the prongs  624  of the clip  600  immediately behind the spacer  640 . However, as this trailing clip  600  is cycled through the process of being dispensed, this trailing clip  600 &#39;s prongs  624  will flare outwardly as shown by  FIG. 57 . The stuck spacer  640  will have long before this, been flung off. 
         [0161]    Hence it is an aspect of the invention that the spacer  640  is self-clearing off the trailing clip  600 . Thus the spacer  640  provides geometries to better let each clip  600  be pushed from behind, and to better let the trailing clips  600  in the line to push forwardly. And again, it is a further aspect of the invention that the spacer  640  is self-clearing, before the dispensing (eg., ejection) of the clip  600  behind it. 
         [0162]    The invention having been disclosed in connection with the foregoing variations and examples, additional variations will now be apparent to persons skilled in the art. The invention is not intended to be limited to the variations specifically mentioned, and accordingly reference should be made to the appended claims rather than the foregoing discussion of preferred examples, to assess the scope of the invention in which exclusive rights are claimed.