Patent Publication Number: US-10765435-B2

Title: Reposable clip applier

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a Continuation of U.S. patent application Ser. No. 14/886,203 filed Oct. 19, 2015, which claims the benefit of and priority to U.S. Provisional Patent Application No. 62/100,632, filed Jan. 7, 2015, the entire disclosure of which is incorporated by reference herein. 
    
    
     BACKGROUND 
     Technical Field 
     The present disclosure relates to surgical clip appliers. More particularly, the present disclosure relates to reposable endoscopic surgical clip appliers. 
     Description of Related Art 
     Clip appliers are used in surgical procedures to apply a surgical clip to a blood vessel or another duct to prevent the flow of body fluids therethrough. Clip appliers are used during a variety of surgical procedures, some of which include, open surgery, endoscopic procedures, and robotically controlled procedures. Clip appliers that apply multiple clips generally provide a plurality of surgical clips stored in a clip cartridge mounted at the distal end of the clip applier. The clips from the clip cartridge are fed sequentially to jaws defined by a jaw blade at the distal end of the instrument upon actuation of handles at the proximal end of the instrument. As the handles are closed, the jaws close to deform a surgical clip positioned between the jaws, and as the jaws are opened to release the deformed surgical clip, a new surgical clip is fed from the clip cartridge to a position between the jaws. This process is repeated until all the surgical clips in the clip cartridge have been applied. A new clip cartridge can then be positioned on the clip applier. 
     Some clip appliers include complicated internal structure(s) that prevent effective re-sterilization and are therefore single use, disposable instruments. Reposable clip appliers are instruments having a body that can be re-sterilized and re-used a number of times. It would be desirable to provide improved clip cartridge and jaw blade components for a reposable surgical clip applier to facilitate simple and easy disassembly and re-assembly of the instrument during sterilization. 
     SUMMARY 
     In accordance with an aspect of the present disclosure, a surgical clip applier is provided. The surgical clip applier comprises an actuation mechanism, a body portion, a jaw blade, and a clip cartridge. The jaw blade being removably disposed within the body portion and including first and second opposed jaws operably connected to the actuation mechanism for selective movement between a spaced apart position and an approximated position to effectuate closure of a surgical clip. The first and second opposed jaws of the jaw blade connected to each other at a proximal end by a shank section. The clip cartridge being removably disposed within the body portion adjacent the jaw blade and configured to store at least one surgical clip therein. The clip cartridge having a first nub and a second nub, wherein the first nub of the clip cartridge abuts a first end of the shank section of the jaw blade, and the second nub of the clip cartridge abuts a second end of the shank section of the jaw blade. 
     In one embodiment, the second nub of the clip cartridge is disposed between the proximal ends of the first and second opposed jaws. 
     In another embodiment, the first and second opposed jaws of the jaw blade are symmetrically disposed along a longitudinal axis of the shank section. 
     In another embodiment, the first and second opposed jaws of the jaw blade define an open cavity, such that the open cavity tapers to the second end of the shank section of the jaw blade. 
     In a further embodiment, the spaced apart position of the opposed jaws of the jaw blade defines a width and the at least one surgical clip disposed in the clip cartridge has an unformed width, such that the width defined by the opposed jaws corresponds to the unformed width of the at least one surgical clip. 
     In yet another embodiment, at least one of the first and second nubs of the clip cartridge is a cylindrical pin. 
     In accordance with another aspect of the present disclosure, a method of applying a surgical clip is provided. The method includes providing a surgical clip applier, the surgical clip applier including an actuation mechanism and a body portion. The method may also include providing a jaw blade, the jaw blade being removably disposed within the body portion and including first and second opposed jaws operably connected to the actuation mechanism for selective movement between a spaced apart position and an approximated position to effectuate closure of a surgical clip. The first and second opposed jaws of the jaw blade connected to each other at a proximal end by a shank section. The method may further include providing a clip cartridge, the clip cartridge being removably disposed within the body portion adjacent the jaw blade and configured to store at least one surgical clip therein. The clip cartridge having a first nub and a second nub, such that the first nub of the clip cartridge abuts a first end of the shank section of the jaw blade, and the second nub of the clip cartridge abuts a second end of the shank section of the jaw blade. The method may include, inserting the jaw blade into the body portion of the surgical clip applier and inserting the clip cartridge into the body portion. Lastly, the method may include, actuating the actuation mechanism of the surgical clip applier, the actuation directing the surgical clip disposed in the clip cartridge to be loaded into the opposing jaws of the jaw blade, the actuation further causing cooperative movement of the opposing jaws of the jaw blade from the spaced apart position to the approximated position effectuating closure of the surgical clip disposed therein. 
     In yet another aspect of the present disclosure, the method further includes, providing a plurality of clip cartridges, wherein each respective clip cartridge includes a surgical clip having a different unformed width disposed therein. The method may also include providing a plurality of jaw blades, such that a width defined by the opposing jaws of a respective jaw blade in the spaced apart position corresponds respectively to the different widths of the unformed surgical clips disposed within the provided clip cartridges. The method may further include selecting a specific surgical clip width and a corresponding surgical clip cartridge, and selecting a jaw blade wherein the width of the opposing jaws correspond to the selected surgical clip cartridge. The method may also include inserting the selected jaw blade into the body portion of the surgical clip applier, and inserting the selected clip cartridge into the body portion. Lastly, the method may include actuating the actuation mechanism of the surgical clip applier, the actuation mechanism directing the surgical clip disposed in the selected clip cartridge to be loaded into the opposing jaws of the selected jaw blade, the actuation mechanism further causing cooperative movement of the opposing jaws of the selected jaw blade from the spaced apart position to the approximated position effectuating closure of the surgical clip disposed therein. 
     In yet another aspect of the present disclosure, a kit is provided. The kit includes a package containing, a clip cartridge loaded with a plurality of surgical clips, wherein each surgical clip defines a width, and a jaw blade including first and second opposed jaws. The jaw blade being configured for selective connection to an actuation mechanism of a surgical clip applier for selective movement between a spaced apart position and an approximated position to effectuate closure of a surgical clip. A width defined by the opposing jaws of the jaw blade, when in the spaced apart position, corresponds respectively to the width of the surgical clips of the clip cartridge. The kit may further include in the package a clip applier, the clip applier including an actuation mechanism and a body portion, the body portion being configured to removeably receive the jaw blade and the clip cartridge therein. The kit may also include in the package a plurality of clip cartridges, wherein each respective clip cartridge includes a surgical clip disposed therein defining a respective unformed surgical clip width, and a plurality of jaw blades, such that the width defined by the opposing jaws of the jaw blades correspond to the respective widths of the unformed surgical clips disposed within the plurality of clip cartridge. The kit may also include in the package instructions for use. 
     In yet another aspect of the present disclosure, a kit is provide including a package containing a clip cartridge loaded with a plurality of surgical clips, wherein each surgical clip defines a width, and a jaw blade including first and second opposed jaws. The jaw blade being configured for selective connection to an actuation mechanism of a surgical clip applier for selective movement between a spaced apart position and an approximated position to effectuate closure of a surgical clip, wherein a width defined by the opposing jaws of the jaw blade, when in the spaced apart position, corresponds respectively to the width of the surgical clips of the clip cartridge. The kit may further include a plurality of clip cartridges, wherein each respective clip cartridge includes a surgical clip disposed therein defining a respective unformed surgical clip width, and a plurality of jaw blades, such that the width defined by the opposing jaws of the jaw blades correspond to the respective widths of the unformed surgical clips disposed within the plurality of clip cartridge. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various embodiments of the subject instrument are described herein with reference to the drawings wherein: 
         FIG. 1  is a perspective view of a surgical clip applier according to an embodiment of the present disclosure; 
         FIG. 2  is a side view of the distal end of the elongated body portion of the surgical clip applier of  FIG. 1  with a removable clip cartridge and a jaw blade loaded therein; 
         FIG. 3  is a plan view of the distal end of the elongated body with the removable clip cartridge and removable jaw blade of  FIG. 2  loaded therein; 
         FIG. 4A  is a cross-sectional view, as taken through  4 - 4  of  FIG. 2 , of the distal end of the elongated body, and the jaw blade; 
         FIG. 4B  is a plan view of one embodiment of an unformed surgical clip of the present disclosure; 
         FIG. 5  is a side view of one embodiment of the removable clip cartridge of the present disclosure; 
         FIG. 6  is a plan view of one embodiment of the jaw blade of the present disclosure; 
         FIG. 7  is a side view, with parts separated, of the jaw blade and clip cartridge; 
         FIG. 8  is a cross-sectional view, as taken through  8 - 8  of  FIG. 3 , of the jaw blade and clip cartridge; 
         FIG. 9A  is a kit in accordance with an embodiment of the present disclosure including a jaw blade, clip cartridge, and instructions for use; 
         FIG. 9B  is a kit in accordance with an embodiment of the present disclosure including a jaw blade, a clip cartridge, a surgical clip applier, and instructions for use; 
         FIG. 9C  is a kit in accordance with an embodiment of the present disclosure including multiple jaw blades, multiple clip cartridges, and instructions for use; and 
         FIG. 9D  is a kit in accordance with an embodiment of the present disclosure including multiple jaw blades, multiple clip cartridges, a surgical clip applier, and instructions for use. 
     
    
    
     DETAILED DESCRIPTION 
     Embodiments of a surgical clip applier in accordance with the present disclosure will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further away from the user. 
     Referring briefly to  FIGS. 1-3 , a surgical clip applier in accordance with the present disclosure is generally designated as  100 . Surgical Clip applier  100  generally includes an actuation mechanism and a body portion  110  extending distally from the actuation mechanism. The actuation mechanism may take a variety of forms, such as, a handle assembly or a robotically assisted surgical system which permits remote operation and control of surgical instruments. 
     With reference to  FIGS. 1-3 , an embodiment of surgical clip applier  100  including a handle assembly  102 , will be described. Handle assembly  102  includes a moveable handle  104  and a stationary hand grip  106 . Handle assembly  102  supports a body portion  110  having a proximal end  112  and a distal end  114 . The body portion defines an open cavity  116  disposed at or near distal end  114  thereof. Surgical clip applier  100  includes or is capable of receiving a clip cartridge  150  and a jaw blade  160  in cavity  116  disposed at distal end  114  of the body portion  110 . Clip cartridge  150  and jaw blade  160  are both removable from within open cavity  116  of body portion  110 . During use, multiple surgical clips are typically loaded and/or retained within clip cartridge  150 . Clip cartridge  150  and jaw blade  160  are disposed within the open cavity  116  at the distal end  114  of the body portion  110 , and upon actuation of the moveable handle  104  in direction “A”, towards stationary hand grip  106 , clip cartridge  150  and jaw blade  160  cooperatively engage to load a unformed surgical clip between first and second jaw sections  192 ,  194  of the jaw blade  160  and clamp a surgical clip. A complete description of the inner-workings and operation of an exemplary surgical clip applier  100  can be found in commonly-assigned U.S. Patent Publication No. 2008/0243145 A1 to Whitfield et. al., the entire contents of which are hereby incorporated by reference herein. 
     Referring briefly to  FIG. 4A , a cross-sectional view of the distal end  114  of the body portion  110  is shown without clip cartridge  150  installed. Jaw blade  160  is disposed at the distal end  114  such that a portion of jaw blade  160  extends past the distal end  114  of the body portion  110 . 
     Turning now to  FIG. 5 , clip cartridge  150  includes a first extrusion or nub  152  and a second extrusion or nub  154  extending from a channel, body, or the like  151  of clip cartridge  150 . First nub  152  and second nub  154  are longitudinally spaced apart from one another and protrude in a common direction from body  151  of clip cartridge  150 . 
     As seen in  FIGS. 6 and 8 , jaw blade  160  includes a shank section  162  having a first end  164  and a second end  166 , a first leg member  170  which extends distally from the second end  166  of the shank section  162 , and a second leg member  180  which extends distally from the second end  166  of the shank section  162 . In embodiments, first and second leg members  170 ,  180  are symmetrically disposed along longitudinal axis “A” defined by jaw blade  160 . First leg member  170  and second leg member  180  have a respective proximal end  172 ,  182 , and a respective distal end  174 ,  184 . Jaw blade  160  further includes a first jaw section  192  and a second jaw section  194 , which together form or define jaw  190 . First jaw section  192  and second jaw section  194  are disposed at the distal end  174 ,  184  of the first and section leg member,  170 ,  180 , respectively. During actuation of the actuation mechanism, the first jaw section  192  and second jaw section  194  of jaw  190  come together to clamp or form a surgical clip “C” disposed or loaded therebetween as shown in  FIG. 4A . 
     With reference to  FIGS. 7 and 8 , the interaction of clip cartridge  150  and jaw blade  160  are described. In one embodiment of the present disclosure, with jaw blade  160  mounted within open cavity  116  at the distal end  114  of the body portion  110 , and clip cartridge  150  loaded into open cavity  116  at the distal end  114  of the body portion  110 , the first nub  152  of clip cartridge  150  abuts the first end  164  of the shank section  162  of jaw blade  160  while the second nub  154  of clip cartridge  150  abuts the second end  166  of the shank section  162  of jaw blade  160  such that the second nub  154  of clip cartridge  150  extends between the proximal end  172 ,  182  of first and second leg member  170 ,  180 , respectively. Once clip cartridge  150  and jaw blade  160  are disposed or loaded into the open cavity  116  at the distal end  114  of the body portion  110 , first and second nubs  152 ,  154  of clip cartridge  150  act to arrest, prevent, or otherwise block longitudinal and vertical movement of the jaw blade  160  while still allowing first and second jaw sections  192 ,  194  to open and close to form a surgical clip “C” positioned therebetween. 
     Specifically, when jaw blade  160  is coupled with clip cartridge  150 , movement of jaw blade  160  will be arrested, prevented, or otherwise blocked along the longitudinal axis “A” defined by jaw blade  160 , shown in  FIGS. 6 and 8 . Further, vertical movement of jaw blade  160  will be arrested, prevented, or otherwise blocked along axis “B”, shown in  FIG. 8 , which lies perpendicular to the longitudinal axis “A”. With jaw blade  160  and clip cartridge  150  coupled, during actuation of handle  102  of the actuation mechanism, jaw blade  160  is only capable of transverse motion of the first and second leg members  170 ,  180  of jaw blade  160  for the opening and closing of first and second jaw sections  192 ,  194  to clamp or form at least one surgical clip. 
     As seen in  FIGS. 5-7 , first and second nubs  152 ,  154  of clip cartridge  150  may be cylindrical pins. It is envisioned, that first and second nubs  152 ,  154  of clip cartridge  150  are any geometric shape capable of engaging the shank section  162  of jaw blade  160 , such that when clip cartridge  150  abuts jaw blade  160 , longitudinal and vertical motion of jaw blade  160  is arrested, prevented, or otherwise blocked. 
     First and second leg members  170 ,  180  have a first condition (as seen in  FIGS. 4A and 6 ) and a second condition (not shown). In the first condition, the distal ends  174 ,  184  of the first and second leg members  170 ,  180  define a jaw space opening  196  therebetween having a width “JW” (as seen in  FIG. 4A ). In the second condition the distal ends  174 ,  184  of the first and second leg members  170 ,  180  are in close proximity, or in abutting relationship to one another, thus reducing the jaw space opening  196 . As seen in  FIGS. 3, 4A, and 6 , the actuation mechanism is in a pre-actuation condition, the first and second leg members  170 ,  180  of jaw blade  160  are in the first condition. 
     The method of applying a surgical clip using the surgical clip applier in accordance with the present disclosure will be described with reference to  FIGS. 1-8 . An operator is provided with surgical clip applier  100 , a clip cartridge  150 , and a jaw blade  160 . The operator will first insert jaw blade  160  into the open cavity  116  at the distal end  114  of the body portion  110 . The operator will next insert clip cartridge  150  into open cavity  116  at the distal end  114  of the body portion  110 , such that clip cartridge  150  abuts jaw blade  160  as noted above. Once assembled, longitudinal and vertical movement of jaw blade  160  will be arrested, prevented, or otherwise blocked. Jaw blade  160 , when disposed at the distal end  114  of the body portion  110 , is operably connected to an actuation mechanism for selective closure of the first and second jaw section  192 ,  194  upon activation of the actuation mechanism. In one embodiment of the present disclosure, the actuation mechanism of surgical clip applier  100  takes the form of handle assembly  102 . Clip cartridge  150 , when disposed at the distal end  114  of the body portion  110 , abuts jaw blade  160 , such that first nub  152  abuts the first end  164  of the shank section  162  of jaw blade  160 , and second nub  154  abuts the second end  166  of the shank section  162  of jaw blade  160 . 
     It is further envisioned, in accordance with the present disclosure, that the operator of surgical clip applier  100  will have a variety of surgical clip widths to choose from. Specially, a plurality of clip cartridges  150  are provided, wherein a respective clip cartridge  150  contains a surgical clip “C” having a respective unformed clip width “CW” disposed therein, as shown in  FIG. 4B . A plurality of jaw blades are provided, such that width “JW” defined by jaw space opening  196  of the provided jaw blades  160  correspond to the provided variety of unformed surgical clip widths “CW” disposed in the respective clip cartridges  150  provided. Based on the surgical procedure and needs of the operator, the operator selects a specific clip cartridge  150 , having the desired unformed surgical clip width “CW” disposed therein. Based on the selected unformed surgical clip width “CW”, the operator selects the jaw blade  160  with the corresponding jaw width “JW”. 
     In accordance with the present disclosure, a kit will be described with reference to  FIGS. 1-9 . The kit includes a clip cartridge  150  and a jaw blade  160  in a common package  300  to be used with or in a clip applier, as shown in  FIG. 9A . The kit may include surgical clip applier  100 , as shown in  FIG. 9B . In embodiments, the kit may include a plurality of clip cartridges  150   a - c  contained in a common package  300 , wherein each respective clip cartridge  150  contains at least one surgical clip “C” having a different unformed surgical clip width “CW” disposed therein respectively, as shown in  FIGS. 9C and 9D . The kit may also include a plurality of jaw blades  160   a - c  corresponding to the plurality of clip cartridges  150   a - c  and the variety of surgical clip widths “CW” provided therein, as shown in  FIGS. 9C and 9D . The kit may also include instructions for use  310 , as shown in  FIGS. 9A-D . The common package  300  may include a thermoformed plastic tray and/or other packaging materials within the view of those skilled in the art. 
     The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the surgeon and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc. 
     The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely controls the instruments via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients. 
     The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s). 
     The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon&#39;s ability to mimic actual operating conditions. 
     A medical work station generally may include a plurality of robot arms, a control device, and an operating console coupled with the control device. The operating console may include a display device, which may be set up in particular to display three-dimensional images, and manual input devices, by means of which a person, for example a surgeon, may be able to telemanipulate the robot arms in a first operating mode. 
     Each of the robot arms may include a plurality of members, which are connected through joints, and an attaching device, to which may be attached, for example, a surgical tool supporting an end effector, in accordance with any one of several embodiments disclosed herein, as will be described in greater detail below. 
     The robot arms may be driven by electric drives that are connected to the control device. The control device (e.g., a computer) may be set up to activate the drives, in particular by means of a computer program, in such a way that the robot arms, their attaching devices, and thus the surgical tool (including the end effector) execute a desired movement according to a movement defined by means of the manual input devices. The control device may also be set up in such a way that it regulates the movement of the robot arms and/or of the drives. 
     The medical work station may be configured for use on a patient lying on a patient table to be treated in a minimally invasive manner by means of the end effector. The medical work station may also include more than two robot arms, the additional robot arms likewise being connected to the control device and being telemanipulatable by means of the operating console. A medical instrument or surgical tool (including an end effector) may also be attached to the additional robot arm. The medical work station may include a database, in particular coupled to the control device, in which are stored, for example, pre-operative data from the patient/living being and/or anatomical atlases. 
     It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure.