Patent Publication Number: US-2021177633-A1

Title: Clamp installation tool

Description:
RELATED APPLICATIONS 
     This application is a continuation of U.S. Pat. No. 10,932,938 (application Ser. No. 16/044,382), filed Jul. 24, 2018 and issuing Mar. 2, 2021, entitled “IMPROVED CLAMP INSTALLATION TOOL” and naming C. Kenneth French as an inventor, and claims the benefit of and priority from U.S. Provisional Pat. App. No. 62/536,364, filed Jul. 24, 2017, entitled “IMPROVED CLAMP INSTALLATION TOOL” and naming C. Kenneth French as an inventor, the entirety of all of which are incorporated herein by reference for all purposes. 
    
    
     FIELD 
     The present disclosure relates to surgical clamps and surgical clamp installation tools. 
     BACKGROUND 
     The statements in this section merely provide background information related to the present disclosure and may not constitute prior art. 
     Recently, there has been increased interest in employing surgical clamps to partition sections of a stomach. An example of a bariatric surgical clamp can be found in Jacobs et al., U.S. Pat. No. 8,920,305 (U.S. patent application Ser. No. 11/984,452), Jacobs et al., U.S. patent application Ser. No. 11/797,537 and Jacobs et al., U.S. Pat. No. 8,529,585 (U.S. patent application Ser. No. 13/017,666). The aforementioned patents/patent applications are incorporated by reference herein in their entirety for any purpose. In various instances, there is a need for a tool to install surgical clamps to partition sections of a stomach. 
     SUMMARY 
     A clamp installation tool is provided. The clamp installation tool may have a longitudinal main body with an elongate member having a longitudinal support platform configured to support a clamp. The clamp installation tool may have a selectable retention mechanism with a plurality of bosses configured to be received into corresponding apertures of the clamp. The clamp installation tool may have a tip manipulation member coupled to a distal end of the longitudinal main body and arcuately articulable relative to the longitudinal main body. 
     Referring now to further example embodiments of the clamp installation tool, the clamp installation tool may include wherein the longitudinal main body is made of plastic. In various embodiments, the tool is a single-use tool. In various embodiments, the tool is reusable. The clamp installation tool may also have a sealing channel including a cylindrical tube receivable over the clamp installation tool and insertable into a trocar. 
     The selectable retention mechanism having a plurality of bosses may also include a distal boss extending from the longitudinal main body at a position closer to the tip manipulation member than an intermediate boss, and the intermediate boss extending from the longitudinal main body at a position farther from the tip manipulation member than the distal boss. 
     The longitudinal main body may also include a control rod channel configured to receive a control rod extending through the longitudinal main body and connecting the tip manipulation member to a control aspect and a main body attachment mechanism configured to attach to the tip manipulation member. 
     The main body attachment mechanism may include a cantilevered boss extending from the longitudinal main body, a first main body side flange and a second main body side flange extending from the cantilevered boss and defining a main body flange channel disposed between the first main body side flange and the second main body side flange, and a retention pin configured to retain the tip articulation member in attachment to the main body attachment mechanism. 
     The tip manipulation member may include a manipulation member main body extending outwardly from an attachment mechanism configured to connect to the main body attachment mechanism, and a retention hook extending from the manipulation member main body and configured to receive a tip retention aperture of a clamp. 
     The tip manipulation member may include an attachment mechanism having a first side flange and a second side flange extending outwardly from the manipulation member main body and spaced apart to provide a flange channel, an attachment mechanism flange web connecting the first side flange and the second side flange, a retention aperture disposed through the first side flange and the second side flange and configured to receive the retention pin of the main body attachment mechanism to permit articulation of the tip manipulation member about an axis provided by the retention pin and along an articulation path, and an offset articulation aperture spaced an articulation offset radius from the retention aperture and configured to connect to the control rod. 
     The tip manipulation member may include an angled tip including a safety dome at the outermost distal end of the tip manipulation member, the safety dome including a half-hemisphere. 
     A further clamp installation tool is provided. The further clamp installation tool may have a longitudinal main body with an elongate member having a longitudinal support platform configured to support a clamp, a selectable retention mechanism configured to connect to the clamp, and a tip manipulation member coupled to a distal end of the longitudinal main body and arcuately articulable relative to the longitudinal main body. 
     In various embodiments, a clamp installation tool may also include a control aspect configured to articulate the tip manipulation member. The control aspect may have a single use grip including an actuator configured to articulate the tip manipulation member, and a safety configured to inhibit operation of the actuator. 
     Moreover, the selectable retention member may also include an end point ramp configured to receive an aft end retention nub of the clamp. The selectable retention mechanism may include an aft nub capture boss having a clamp receiving passage configured to receive an aft end retention nub of the clamp. The selectable retention mechanism may have a lateral reaction plate including a reaction wall configured to press against an aft end retention nub of the clamp. 
     A method of bariatric clamp installation using a clamp installation tool is provided. The method may include connecting a distal retention aperture of a clamp to a distal boss of a selectable retention mechanism of the clamp installation tool, connecting an intermediate retention aperture of the clamp to an intermediate boss of the selectable retention mechanism of the clamp installation tool, and connecting a tip retention aperture of the clamp to a retention hook of a tip manipulation member of the clamp installation tool. In various instances, the clamp installation tool is configured in a coaxial configuration wherein the tip manipulation member is at least partially coaxial with a longitudinal main body of the clamp installation tool. The method may also include inserting the clamp installation tool through an incision and proximate to an organ to be clamped, actuating the clamp installation tool by a control aspect to an actuated configuration wherein the tip manipulation member is not at least partially coaxial with the longitudinal main body of the clamp installation tool, and grasping the clamp proximate to the tip retention aperture and selectably disconnecting the tip retention aperture from the clamp installation tool. The method may further include actuating the clamp installation tool by the control aspect to the coaxial configuration, and retracting the clamp installation tool from the body cavity leaving the clamp emplaced within the body cavity. 
     The method may further include inserting the clamp installation tool through a sealing channel having a cylindrical tube receivable over the clamp installation tool and insertable into a trocar within the incision, and inserting the combination of the sealing channel disposed over the clamp installation tool into the trocar. 
     Further embodiments and apparatuses, including other areas of applicability, will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure in any manner. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       For a more complete understanding of various embodiments of the present invention and the advantages thereof, reference is now made to the following brief description, taken in connection with the accompanying drawings and detailed description, wherein like reference numerals represent like parts, and in which: 
         FIG. 1  is a view of an example embodiment of aspects of a clamp installation tool; 
         FIG. 2  is a first end view of an example embodiment of aspects of a clamp installation tool; 
         FIG. 3  is a second end view of an example embodiment of aspects of a clamp installation tool showing an opposite end of the clamp installation tool of  FIG. 2 ; 
         FIG. 4  is an isometric view of a tip manipulation member of a clamp installation tool; 
         FIG. 5  is a side view of a tip manipulation member of a clamp installation tool; 
         FIG. 6  is a top view of a tip manipulation member of a clamp installation tool; 
         FIG. 7  is a bottom view of a tip manipulation member of a clamp installation tool; 
         FIG. 8  is an isometric view of an aspect of a longitudinal main body of a clamp installation tool configured to mechanically connect to a tip manipulation member of a clamp installation tool; 
         FIG. 9  depicts various example clamp installation tools and a clamp separate from a clamp installation tool; 
         FIG. 10  depicts various example clamp installation tools and a clamp emplaced on a clamp installation tool; 
         FIG. 11  depicts a clamp installation tool in simulated use with a trocar and inserted into the trocar; 
         FIG. 12  depicts a clamp installation tool in simulated use with a trocar prior to insertion into the trocar; 
         FIG. 13  depicts a close up view of a clamp installation tool with a sealing channel and a clamp; 
         FIG. 14  depicts a clamp installation tool in simulated use with a trocar and inserted into the trocar and with a clamp, wherein the clamp installation tool is in a coaxial configuration; 
         FIG. 15  depicts a clamp installation tool in simulated use with a trocar and inserted into the trocar and with a clamp, wherein the clamp installation tool is in an actuated configuration; 
         FIG. 16  depicts a close up view of a tip manipulation member of a clamp installation tool in simulated use with a trocar and partially inserted into the trocar, and with a clamp; 
         FIG. 17  depicts a close up view of aspects of a selectable retention mechanism of a clamp installation tool with a clamp and without a clamp 
         FIG. 18  depicts a close up of a tip manipulation member of a clamp installation tool with a clamp and without a clamp, wherein the clamp installation tool is in a coaxial configuration; 
         FIG. 19  depicts a close up of a tip manipulation member of a clamp installation tool with a clamp and without a clamp, wherein the clamp installation tool is in an actuated configuration; 
         FIG. 20  depicts a close up of a tip manipulation member of a clamp installation tool with a clamp and without a clamp, wherein the clamp installation tool is in an actuated configuration and wherein the clamp is partially disconnected from the clamp installation tool; 
         FIG. 21  depicts aspects of a partially disassembled trocar; 
         FIG. 22  depicts a view of an example embodiment of aspects of a clamp installation tool having a selectable retention mechanism with an end point ramp; 
         FIG. 23  depicts another view of an example embodiment of aspects of a clamp installation tool having a selectable retention mechanism with an end point ramp; 
         FIG. 24  depicts a view of an example embodiment of aspects of a tip articulation member of a clamp installation tool; 
         FIG. 25  depicts a side view of an example end point ramp of a selectable retention mechanism of a clamp installation tool; 
         FIG. 26  depicts another view of an example embodiment of aspects of a clamp installation tool having a selectable retention mechanism with an end point ramp and a tip articulation member wherein the clamp installation tool is in an actuated position; 
         FIG. 27  depicts yet another view of an example embodiment of aspects of a clamp installation tool having a selectable retention mechanism with an end point ramp and a tip articulation member wherein the clamp installation tool is in an actuated position; 
         FIG. 28  depicts a top view of an example end point ramp of a selectable retention mechanism of a clamp installation tool; 
         FIG. 29  depicts still yet another view of an example embodiment of aspects of a clamp installation tool having a selectable retention mechanism with an end point ramp and a tip articulation member wherein the clamp installation tool is in an actuated position; 
         FIGS. 30-32  depict views of another example embodiment of a clamp installation tool having a selectable retention mechanism with an aft nub capture boss; 
         FIGS. 33-35  depict views of another example embodiment of a clamp installation tool having a selectable retention mechanism with an aft lateral reaction plate; and 
         FIGS. 36-37  depict views of an example embodiment of a clamp installation tool having a single use grip. 
     
    
    
     DETAILED DESCRIPTION 
     The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood at the outset that although an exemplary implementation of the present invention is illustrated below, the present invention may be implemented using any number of techniques, whether currently known or in existence. The present invention should in no way be limited to the exemplary implementations, drawings, and techniques illustrated below, including the exemplary design and implementations illustrated and described herein. Additionally, the drawings contained herein are not necessarily drawn to scale, and may be provided in a variety of different dimensions, shapes and configurations. Any provided dimensions are provided only to illustrate a particular exemplary implementation, and should in no way be construed to limit the present invention absent an explicit recitation of such dimensions and then only with respect to the aspect or aspects reciting the dimension or dimensions. 
     Referring to  FIGS. 1-27 , an embodiment of a clamp  88  (also referred to herein as a bariatric clamp  88 ) engages with an embodiment of a clamp installation tool  2 . In various embodiments, the clamp  88  and the clamp installation tool  2  are designed for performing bariatric surgery through a trocar  84 . The clamp  88 , in one or more embodiment, may be approximately fifteen to thirty centimeters in length to accommodate partitioning of a human stomach. To accommodate insertion through a trocar  84 , the closed clamp  88  will preferably have a diameter or circumference less than fifteen millimeters over the entirety of its length or along the majority of its length. A section of the clamp installation tool  2  intended for insertion through the trocar  84  has a similar diameter or a smaller diameter. It is envisioned that other embodiments of the clamp  88  and installation tool can be of other sizes. It is additionally envisioned that the clamp  88  may be articulated in at least one plane to provide different angles and lengths of partition to the stomach. It is also envisioned that other embodiments of the clamp  88  and installation tool can be used for clamping other parts of the human body and/or for clamping other types of bodies or structures. Finally, it should be understood that the clamp installation tool  2  may be used to install embodiments of the surgical clamp  88  other than those explicitly illustrated in the figures. 
     Some embodiments of the clamp installation tool  2  can be used to install the clamp  88  within an abdominal cavity in order to perform bariatric surgery. In particular, the clamp  88  can be positioned, closed, and latched to partition the stomach into a small vertical portion or pouch and an excluded section. The vertical pouch receives food, but the food is not able to enter the excluded section. Using the clamp installation tool  2  to engage with the clamp  88 , the clamp  88  may be installed in a substantially vertical position on the stomach in one embodiment. That is, if the human patient having the clamp  88  installed were to stand upright, the longitudinal axis of the clamp  88  would be substantially parallel to the gravity vector. Thus, a passage forming section formed in the bottom of the stomach by the clamp  88  allows gastric juices to flow from the excluded section into the vertical pouch. 
     Various embodiments of clamps  88  and systems and methods for installation thereof are taught in U.S. Pat. No. 10,420,664 (U.S. patent application Ser. No. 14/836,621) entitled “Bariatric Clamp with Suture Portions, Magnetic Inserts, and Curvature” and incorporated by reference herein. 
     A method for clamping an internal organ can include inserting a surgical clamp  88  through an opening into a body of a living organism. Then the two elongated members of the surgical clamp  88  are positioned on opposite sides of an internal organ of the living organism. Closing and latching the surgical clamp  88  to partition a cavity inside the internal organ includes clamping the exterior of the internal organ with the two elongated members. 
     As mentioned above, the internal organ can be a human stomach. In this case, closing and latching the clamp  88  can include installing the clamp  88  in a substantially vertical or angled position with a passage forming section of the clamp  88  located towards a bottom of the stomach. This positioning can create a small, vertical stomach pouch and thereby limit the intake of food into an excluded section or portion of the stomach, but still allow gastric juices from the excluded portion of the stomach to flow into the vertical stomach pouch. This partitioning can alter the production of hormones, enzymes and chemicals that affect metabolism, energy levels, hunger, digestion, and absorption of nutrients that are affected by exclusion of gastric fundus and body of the stomach by the partitioning. Sheathing aspects of clamp  88  in silicone padding material may reduce trauma and/or necrosis of the stomach or other internal organ and enable successful reversal of the surgery. Thus, the method can further include reversing the surgery by removing the clamp  88 . 
     Inserting the surgical clamp  88  can include performing natural orifice transluminal endoscopic surgery (NOTES). Alternatively, or additionally, it can include performing a combination of NOTES and an assistant trocar placed into an abdominal cavity. This combination can include two or more of a conventional, laparoscopic, NOTES, and one port technique. The NOTES technique can include at least one of transgastric, transvaginal, transrectal, transcolonic, or combinations thereof. The one port technique is used for the introduction of several instruments, and encompasses a one port abdominal (including umbilical), perineal, retroperitoneal approaches, or combinations thereof. 
     A method for clamping an internal organ can include engaging a surgical clamp  88  to a clamp installation tool  2 . The surgical clamp  88  installation tool can be employed to insert the clamp  88  through an opening in a body cavity of a living organism. Then the tool can be employed to position the clamp  88  on opposite sides of an internal organ within the body cavity. The clamp  88  can be latched to fix it in position to partition the internal organ and the cavity inside the internal organ. The clamp  88  can be disengaged from the clamp installation tool  2 , and the tool can be retracted from the body cavity. Moreover, additional steps may be employed to secure the clamp  88  in place, such as using sutures. 
     With reference now to  FIGS. 1-20 , a clamp installation tool  2  is provided. A clamp installation tool  2  may be configured to facilitate the insertion of a clamp  88  through a trocar  84  and into a body cavity for clamping a bodily organ. In various instances, a sealing channel  86  is further provided. For instance, the sealing channel  86  may enhance the fluidic sealing of the body cavity from the external environment as the clamp installation tool  2  penetrates through the trocar  84  to emplace the clamp  88 . 
     In various instances, a clamp installation tool  2  may be reusable. For instance, a clamp installation tool  2  may be used repeatedly during multiple procedures. As such, the articulating aspects of the clamp installation tool  2  (discussed elsewhere herein) may be repeatedly articulable. In further instances, a clamp installation tool  2  may be a single-use tool. In various instances, the articulating aspects of the single-use clamp installation tool  2  may not be repeatedly articulable, or may be formed of material having less resiliency than the reusable clamp installation tool  2 . 
     A clamp installation tool  2  may have a longitudinal main body  4 . The longitudinal main body  4  may provide a primary support of the clamp installation tool  2 . In various instances, the longitudinal main body  4  comprises an elongate member, for instance, a relatively long and slender member shaped to be insertable through a trocar  84 . The longitudinal main body  4  may support a selectable retention mechanism  8 . 
     A selectable retention mechanism  8  may comprise an aspect extending from the longitudinal main body  4  and configured to selectably connect to and disconnect from a clamp  88 . The selectable retention mechanism  8  may be engaged to a clamp  88  for insertion of the clamp  88  through a trocar  84  and positioning of the clamp  88  inside the body. Thereafter, all or part of the selectable retention mechanism  8  may be selectably disengaged from the clamp  88  in order to emplace different aspects of the clamp  88  in position relative to an organ to be clamped. The selectable retention mechanism  8  may comprise a plurality of bosses configured to be received into corresponding apertures of a clamp. In this manner, the selectable retention mechanism  8  is said to be “selectable.” 
     The longitudinal main body  4  may support a tip manipulation member  10 . A tip manipulation member  10  may comprise a member coupled to the longitudinal main body  4 , for instance, at a distal end of the longitudinal main body  4 . The tip manipulation member  10  may be articulable relative to the longitudinal main body  4  in at least one plane of motion. The tip manipulation member  10  may be attached to a distal end of the longitudinal main body  4  and rotatable about the point of attachment in the same plane in which the longitudinal main body  4  lies (i.e., arcuately articulable relative to the longitudinal main body  4 ). For instance, the tip manipulation member  10  may be movable between different positions. For instance, the tip manipulation member  10  may be movable from being aligned co-axially with the longitudinal main body  4  so that longitudinal axes of each are coincident and parallel, to being aligned at an angle relative to the longitudinal main body  4 , so that the longitudinal axes of each are at an angle, for instance, intersecting at a point and extending at an acute angle relative to one another, or a right angle, or an obtuse angle, or another angle as desired. In various instances, the tip manipulation member  10  is articulable from being aligned with the longitudinal main body  4  and being at a right angle to the longitudinal main body  4 . 
     The longitudinal main body  4  may support a control aspect  12 . For example, a control aspect  12  may provide a mechanism whereby an operator may grip the clamp installation tool  2  and/or may control the articulation of the tip manipulation member  10 . In various instances, the control aspect  12  comprises scissor-style grips, although in further instances, different configurations are contemplated. The control aspect  12  may be coupled to the longitudinal main body  4 , for instance, at a distal end of the longitudinal main body  4 , such as an opposite distal end relative to the tip manipulation member  10 . With momentary reference to  FIGS. 36-37 , the control aspect  12  may comprise a single use grip  243  for a clamp installation tool  2  designed to be used a limited number of times, for instance, once. The single use grip  243  may comprise a plastic grip, for instance, a molded plastic grip. The single use grip  243  may further comprise an actuator  241  comprising a squeezable aspect articulable by an operator by squeezing of the operator&#39;s hand. The single use grip  243  may further comprise a safety  242  configured to selectably inhibit or allow operation of the actuator  241 . In various instances, the orientation of the safety  242  and actuator  241  may be as depicted in  FIG. 36-37 , although in further instances, they may be reversed so that the actuator  241  is operated by an index finger and the safety  242  operated by a gripping action. 
     With specific reference now to  FIGS. 1, 2, 8, 9, and 13, 22, 24, 26, 29-37 , the longitudinal main body  4  may have further aspects. For example, the longitudinal main body  4  may comprise a longitudinal support platform  14  ( FIGS. 1, 2, 8, 9, 13 ). A longitudinal support platform  14  may comprise a surface of the longitudinal main body  4  extending parallel to a longitudinal axis of the longitudinal main body  4 , such as extending along the length of the longitudinal main body  4 . The longitudinal support platform  14  comprises a surface of the longitudinal main body  4  shaped to provide support to a clamp  88  when the clamp  88  is emplaced on the clamp installation tool  2 . In various instances, the longitudinal support platform  14  comprises a planar surface. For example, a longitudinal main body  4  may comprise a generally cylindrical member, whereas the longitudinal support platform  14  comprises an area of flattening of the generally cylindrical member. As such, a clamp installation tool  2  may comprise a longitudinal main body  4  comprising a partial cylinder whereas the longitudinal support platform  14  may comprise a planar platform with lateral edges coinciding with the endpoints of line tracing the circumferential arc of the profile of the longitudinal main body  4 . In further embodiments, such as wherein the longitudinal main body  4  comprises a flat bar member having a rectangular profile, the longitudinal support platform  14  may comprises a side of the longitudinal main body  4 . In yet further embodiments, such as wherein the longitudinal main body  4  comprises an oval member having an oval profile, the longitudinal support platform  14  may be non-planar, such as having a curved shape. 
     The longitudinal main body  4  may comprise a control rod channel  16 , such as that shown in  FIGS. 3 and 8 . A control rod channel  16  may comprise an internal passage of the longitudinal main body  4  configured to guide a control rod and/or cable from the control aspect  12  to the tip manipulation member  10  to facilitate movement of the tip manipulation member  10  in response to operation of the control aspect  12 . In various instances, the control rod channel  16  comprises a cylindrical channel defined through the longitudinal main body  4  from apertures at each distal end of the longitudinal main body  4 , although in further instances, the control rod channel  16  may comprise a rectangular channel, or an oval channel, or an irregularly shaped channel, or a keyed channel, or any shape channel as desired. 
     The longitudinal main body  4  may comprise a main body attachment mechanism  6  such as that shown in  FIGS. 1, 8-10, and 18 . A main body attachment mechanism  6  comprises a mechanical connection between the longitudinal main body  4  and the tip manipulation member  10 . The main body attachment mechanism  6  comprises a mechanical connection configured to retain the tip manipulation member  10  to the distal end of the longitudinal main body  4  and permit articulation of the tip manipulation member  10  relative to the longitudinal main body  4 , for instance, permitting arcuate motion about an axis of rotation proximate to the distal end of the longitudinal main body  4  and proximate to a distal end of the tip manipulation member  10 . 
     With reference to  FIGS. 1, 9, 10, and 17  as well as  22 ,  26 ,  29 - 37 , and having discussed specific aspects of the longitudinal main body  4 , attention is now directed to specific aspects of the selectable retention mechanism  8 . A selectable retention mechanism  8  may comprise one or more bosses extending outward away from the longitudinal main body  4  and configured to be received into an aspect of the clamp  88  to retain the clamp  88  in selectable mechanical communication with the longitudinal main body  4 . Alternatively, a selectable retention mechanism  8  may comprise one or more apertures extending into the longitudinal main body  4  and configured to receive an aspect of the clamp  88  to retain the clamp  88  in selectable mechanical communication with the longitudinal main body  4 . 
     The selectable retention mechanism  8  may comprise bosses extending in a direction normal to the plane of the longitudinal support platform  14 . In instances in which the longitudinal support platform  14  is non-planar, the selectable retention mechanism  8  may comprise bosses extending in a direction normal to a tangent of the longitudinal support platform  14 . In various embodiments, the selectable retention mechanism  8  may comprise bosses extending radially outward with respect to the longitudinal main body  4 . 
     Yet furthermore, the selectable retention mechanism  8  may comprise one or more bosses with apertures therein and in yet further instances may include one or more plates extending in a direction normal to a tangent of the longitudinal support platform and oriented laterally (e.g., generally perpendicular to the longitudinal axis of the longitudinal main body). 
     The selectable retention mechanism  8  may comprise an intermediate boss  26  and a distal boss  28 . The intermediate boss  26  may comprise a trapezoidal boss. For instance, the intermediate boss  26  may comprise a rectangular boss. In further instances, the intermediate boss  26  may comprise a square boss, or a cylindrical boss, or an arbitrarily shaped boss, or any shape as desired. The intermediate boss  26  may comprise a boss formed to have a shape corresponding to an aperture of the clamp  88  and configured to be received by the aperture of the clamp  88 . The intermediate boss  26  may be located between a distal boss  28  and the control aspect  12  ( FIGS. 1, 9, 10 ) of the clamp installation tool  2 . 
     The distal boss  28  may comprise a trapezoidal boss. For instance, the distal boss  28  may comprise a square boss. In further instances, the distal boss  28  may comprise a rectangular boss, or a cylindrical boss, or an arbitrarily shaped boss, or any shape as desired. The distal boss  28  may comprise a boss shaped to have a shape corresponding to an aperture of the clamp  88  and configured to be received by the aperture of the clamp  88 . The distal boss  28  may be located between an intermediate boss  26  of the selectable retention mechanism  8  and the tip manipulation member  10  ( FIGS. 1, 2, 4, 5, 6, 7, 9, 10, 16, and 20 ) of the clamp installation tool  2 . The distal boss  28  may be smaller than the intermediate boss  26 , though each boss may be any size as desired to correspond to aspects of the clamp  88  ( FIGS. 9-15, 17-20 ). 
     With particular emphasis on  FIGS. 25-29 , the selectable retention mechanism  8  may comprise an end point ramp  200 . An end point ramp may comprise a boss located closest to a control aspect  12 . In various instances, the intermediate boss  26  and distal boss  28  are omitted and the end point ramp  200  connects to one end of a clamp  88  and the tip manipulation member  10  connects to the other end of the clamp  88 . 
     With particular emphasis on  FIGS. 30-32 , in various instances the selectable retention mechanism  8  may comprise an aft nub capture boss  222 . An aft nub capture boss  222  may comprise a boss, such as a trapezoidal boss, having an opening disposed therein and shaped to receive an aspect of a clamp  88  into the opening. For example, an aft nub capture boss  222  may comprise a clamp receiving passage  223  configured to receive a projection from a clamp  88  extending generally normal to a surface of the clamp  88  to retain an end of the clamp  88  in connection to the aft nub capture boss  222  while the clamp  88  is stretched along the longitudinal main body  4 . 
     With particular emphasis on  FIGS. 33-35 , in various instances the selectable retention mechanism  8  may comprise an aft lateral reaction plate  230 . An aft lateral reaction plate  230  may comprise a reaction wall  231  extending in a direction normal to a tangent of the longitudinal support platform  14  and oriented laterally to the longitudinal main axis of the longitudinal main body  4 , so as to retain an end of the clamp  88  in connection to the reaction wall  231  while the clamp  88  is stretched along the longitudinal main body  4 . For example, the reaction wall  231  may press against an aft end retention nub  202  of a clamp  88 . 
     With particular emphasis on  FIGS. 36-37 , the selectable retention mechanism  8  may comprise one or more clip  244 . A clip  244  may comprise an structure projecting outwardly from the longitudinal main body  4  and defining an aperture to selectably retain the clamp  88  proximate to the longitudinal main body  4 , and yet also release the clamp  88  in response to a releasing force. For instance, the clip  244  may comprise two curved aspects partially enclosing the clamp  88  and springable to permit the clamp to pass through a space of the clip  244 . 
     Turning now to  FIGS. 25, 26, and 28-32 , the selectable retention mechanism  8  may comprise an end point ramp  200 . In various instances the intermediate boss  26  ( FIG. 1, 9, 10, 17 ) and distal boss  28  ( FIG. 1, 9, 10 ) are omitted in lieu of the end point ramp  200 . The end point ramp  200  connects to one end of a clamp  88  and the tip manipulation member  10  connects to the other end of the clamp  88 . An end point ramp may be configured to receive an aspect of a clamp  88 , for instance, an aspect of an end of the clamp  88  such as an aft end retention nub  202 . In various instances, the end point ramp  200  comprises an aft removal slide  206 . An aft removal slide  206  may comprise an inclined plane surface of the end point ramp  200  extending outwardly from the longitudinal main body  4  and terminating at one end closest the control aspect  12  ( FIGS. 1, 9, 10, 29-37 ) in connection to the longitudinal main body  4  and terminating at another end closest the tip manipulation member  10  ( FIGS. 1, 2, 4-7, 9, 10, 16, 20, 22, 23, 26-27, 39, 30-37 ) at a forward face  220 . The forward face  220  may thusly extend radially and/or normally outward from the longitudinal main body  4 . Extending between an edge of the aft removal slide  206  and the longitudinal main body  4  may be a first lateral wall  208 . Similarly, extending between an opposite edge of the aft removal slide  206  and the longitudinal main body  4  may be a second lateral wall  210 . The first lateral wall  208  and second lateral wall  210  may provide structural support and rigidity to the end point ramp  200 . In various embodiments, a first lateral wall passage  212  comprises an aperture extending through the first lateral wall  208 , the aperture lying in a plane parallel the longitudinal axis of the longitudinal main body  4 . In various embodiments, a second lateral wall passage  214  comprises an aperture extending through the second lateral wall  210 , the aperture laying in a plane parallel the longitudinal axis of the longitudinal main body  4 . A center point of first lateral wall passage  212  and center point of the second lateral wall passage  214  may be coaxially aligned along a shared line perpendicular to the longitudinal main body  4 . The aperture of the first lateral wall passage  212  may have an edge aspect  216  comprising a curvature, chamfer, edge radius and or the like. Similarly, the aperture of the second lateral wall passage  214  may have an edge aspect  218  comprising a curvature, chamfer, edge radius and or the like. Finally, a clamp receiving passage  223  may be disposed in a surface of the end point ramp  200 , for instance, the aft removal slide  206 , and configured to receive the aft end retention nub  202  of the clamp  88  therein. Similarly, the clamp receiving passage  223  may have an edge aspect  221  comprising a curvature, chamfer, edge radius and or the like. 
     Attention is directed to  FIGS. 1, 2, 4, 5, 6, 7, 9, 10, 16, and 20 , as well as  22 ,  24 ,  26 ,  27 , and  29 - 37  for a detailed discussion of the tip manipulation member  10 . With momentary emphasis on  FIG. 5 , the tip manipulation member  10  may have a tip manipulation member major longitudinal axis  30 . The tip manipulation member major longitudinal axis  30  comprises an axis extending through the tip manipulation member main body  33  ( FIG. 5 ) of the tip manipulation member  10  coincident with its center at all points along the axis. 
     The tip manipulation member  10  may include a retention hook  32  ( FIGS. 4-7, 9-10, 16, 18, 24 ). The retention hook  32  may comprise a combination of structures and apertures shaped to receive an aspect of the clamp  88 . For instance, the clamp  88  may have a tip retention aperture  100  ( FIGS. 9, 10, 19, 22, 23 ) extending through the clamp  88 . The retention hook  32  comprises a combination of structures and apertures to selectably connect to the clamp  88  and capable of exerting a tension force on the clamp  88  when the tip manipulation member  10  is in one or more position, such as the coaxial configuration  80  ( FIG. 14 ) of the clamp installation tool  2 . 
     The tip manipulation member  10  may comprise a tip manipulation member main body  33  ( FIGS. 4-7, 9-10, 16, 18, 24 ). The tip manipulation member main body  33  may comprise a cylinder. For example, the tip manipulation member main body  33  may comprise a cylinder of same diameter as the longitudinal main body  4  ( FIGS. 1, 2, 3, 8, 9, 10, 13 ). The tip manipulation member main body  33  may connect the tip manipulation member attachment mechanism  36  ( FIGS. 4-7, 10, 16, 18 ) of the tip manipulation member  10  to the retention hook  32  ( FIGS. 4-7, 9, 10, 16, 18, 24 ) of the tip manipulation member  10 . The tip manipulation member main body  33  may provide spacing between the tip manipulation member attachment mechanism  36  ( FIGS. 4-7, 10, 16, 18 ) of the tip manipulation member  10  and the retention hook  32  ( FIGS. 4-7, 9, 10, 16, and 18 ) of the tip manipulation member  10 , such that the retention hook  32  ( FIGS. 4-7, 9, 10, 16, 18, 24 ) travels in an arcuate path orbitally relative to the tip manipulation member attachment mechanism  36  as the clamp installation tool  2  changes from a coaxial configuration  80  ( FIG. 14 ) to an actuated configuration  82  ( FIGS. 15, 29 ). 
     The tip manipulation member  10  may comprise an angled tip  34 . The angled tip  34  may comprise a cylinder that is unitary with the tip manipulation member main body  33  and extending outwardly from the tip manipulation member main body  33  at an angle. For example, the angled tip  34  may be at an opposite end of the tip manipulation member main body  33  from the tip manipulation member attachment mechanism  36 . The angled tip  34  may form aspects of the retention hook  32 , such as bounding one or more aperture configured to receive the clamp  88  in mechanical communication. 
     Finally, the tip manipulation member  10  may comprise a tip manipulation member attachment mechanism  36  ( FIGS. 4-7, 9-10, 16, 18 ). A tip manipulation member attachment mechanism  36  comprises a structure extending from a distal end of the tip manipulation member main body  33  and joining the tip manipulation member  10  to the longitudinal main body  4  ( FIGS. 1-3, 8-10, 13, 22, 24, 26, 29-37 ) of the clamp installation tool  2 . The tip manipulation member attachment mechanism  36  is also configured to interface with the control aspect  12  ( FIGS. 1, 9, 10, 29-37 ) in order to move the tip manipulation member  10  so that the clamp installation tool  2  transitions between a coaxial configuration  80  ( FIG. 14 ) and an actuated configuration  82  ( FIGS. 15, 29 ). 
     With reference to  FIGS. 8-10, and 18 , attention is redirected to the main body attachment mechanism  6 , and the specific features of the main body attachment mechanism  6  in various example embodiments. For example, a main body attachment mechanism  6  may include a cantilevered boss  18 . 
     A cantilevered boss  18  may comprise a boss extending at least partially coaxially outward from the longitudinal main body  4  at least partially longitudinally. The boss may cantilever from a distal end of the longitudinal main body  4 , for instance, the end opposite the control aspect  12  ( FIGS. 1, 9, 10, 29-37 ). 
     A first main body side flange  20  and a second main body side flange  22  may extend further distally outward from the cantilevered boss  18 . The first main body side flange  20  and the second main body side flange  22  may comprise cantilevered flanges extending parallel to one another, such as to receive, or to be received into an aspect of the tip manipulation member  10 , such as the tip manipulation member attachment mechanism  36  ( FIGS. 4-7, 9-10, 16, 18 ). 
     A main body flange channel  23  may comprise a channel defined by the first main body side flange  20  and the second main body side flange  22  between the first main body side flange  20  and the second main body side flange  22 . In various embodiments, the tip manipulation member attachment mechanism  36  ( FIGS. 4-7, 9-10, 16, 18 ) has at least one aspect received into the main body flange channel  23 . 
     Finally, the main body attachment mechanism  6  may comprise a retention pin  24  as shown in  FIG. 8 . The retention pin  24  comprises a shaft extending between the first main body side flange  20  and the second main body side flange  22  through the main body flange channel  23 . The retention pin  24  may extend through a corresponding aperture of the tip manipulation member attachment mechanism  36  ( FIGS. 4-7, 9-10, 16, 18 ) of the tip manipulation member  10  ( FIGS. 1, 2, 4-7, 9-10, 16, 20, 22, 24, 26, 27, 29, 30-37 ), so as to maintain mechanical communication of the tip manipulation member  10  and the longitudinal main body  4  and yet permit the rotational movement of the tip manipulation member  10  about an axis provided by the retention pin  24 . Thus, the retention pin  24  may comprise an axis of rotation of the tip manipulation member  10  relative to the longitudinal main body  4 . 
     With reference to  FIGS. 4-7, 9-10, 16, 18, and 24 , the retention hook  32  is now discussed in further detail. In various instances, a retention hook  32  may include a finger aspect  40 . A finger aspect  40  may comprise a cantilevered boss extending at least partially collinear with an angled tip minor longitudinal axis  48  ( FIGS. 5, 18 ) of an angled tip  34 . In various embodiments, the finger aspect  40  may comprise a cantilevered boss extending at least partially to at least partially enclose a portion of a clamp channel  43  ( FIGS. 5, 16, 18, 24 ) of a retention hook  32 . The finger aspect  40  may comprise a member configured to selectably retain a clamp  88  ( FIGS. 9-15, 17-20, 22-23, 36-37 ) in mechanical communication with the tip retention aperture  100  ( FIGS. 9, 10, 19, 22, 23 ) by extending through a tip retention aperture  100  ( FIGS. 9, 10, 19, 22, 23 ) of the clamp  88  ( FIGS. 9-15, 17-20, 22-23, 36-37 ). 
     With reference to  FIGS. 4, 5, 6, 16, and 24 , in various instances, the retention hook  32  also includes a finger aspect placement boss  42 . The finger aspect  40  may be spaced apart from the angled tip  34  of the tip manipulation member  10  so as to provide a boundary of the clamp channel  43  opposite the angled tip  34 . To effectuate this spacing, there may be a local thickening of the tip manipulation member main body  33  connecting the finger aspect  40  to the tip manipulation member main body  33  and spacing the finger aspect  40  apart from the angled tip  34 . This local thickening may be the finger aspect placement boss  42 . In various embodiments, the finger aspect placement boss  42  comprises a ramp angled parallel to an aspect of the angled tip  34 , such as being parallel to the angled tip minor longitudinal axis  48  ( FIGS. 5, 18 ). The ramp may have an at least partially cylindrical profile, for instance, having a partially hemispheric cross-section of increasing radius at points approaching the finger aspect along the angled tip minor longitudinal axis, or having a constant radius but rising further from the tip manipulation member main body  33  such that the cross-sectional profile of the finger aspect placement boss  42  has an increasing arc length. 
     With particular focus now on  FIGS. 6 and 7 , in various instances the finger aspect  40  comprises a first finger aspect convergent side  66  and a second finger aspect convergent side  68 . Each of the first finger aspect convergent side  66  and the second finger aspect convergent side  68  comprise opposite edges of the finger aspect  40  extending along the longer edges of the finger aspect  40  (e.g., the lateral sides relative to the longitudinal direction). In various instances, the first finger aspect convergent side  66  and the second finger aspect convergent side  68  angle toward one another along the length of the finger aspect  40 , narrowing toward the distal cantilevered tip of the finger aspect  40 . In this manner, the finger aspect  40  tapers, facilitating insertion of the clamp  88  ( FIGS. 9-15, 17-20, 22-23, 36-37 ) into the clamp channel  43  of the retention hook  32 . 
     In various embodiments, the retention hook  32  further comprises a clamp channel  43 , as shown in  FIGS. 5, 16, 18, and 24 . The clamp channel  43  comprises an opening defined on one side by the guidance ramp  38 , on another side by the finger aspect  40  and potentially on another side by the angled tip  34  and configured to receive an aspect of a clamp  88  ( FIGS. 9-15, 17-20, 22-23, 36-37 ) such as a tip retention aperture  100  ( FIGS. 9, 10, 19, 22, 23 ) in selectable mechanical communication as the clamp installation tool  2  actuates, such as between a coaxial configuration  80  ( FIG. 14 ) and an actuated configuration  82  ( FIG. 15, 29 ). The clamp channel  43  may have a clamp channel opening  47  comprising a passage whereby the clamp  88  may be selectably inserted between the finger aspect  40  and the angled tip  34 , then slidably transitioned off-axis from the travel path that it followed while being inserted between the finger aspect  40  and the angled tip  34 , slidably transitioning into a retention space  49 . The retention space  49  may be disposed medially between the clamp channel opening  47  and the clamp channel floor  51 , such that a tension induced by stretching of the clamp  88  causes the clamp  88  to be biased toward the clamp channel floor  51 , thereby being selectably retained within the clamp channel  43 . 
     Finally, and with reference to  FIGS. 4, 6, 7, 16, 18, and 24 , the retention hook  32  may comprise a clamp release aperture  44 . A clamp release aperture  44  may comprise an aperture extending through the angled tip  34  and into the clamp channel  43 . The clamp release aperture  44  facilitates the selectable release of the clamp  88  from within the clamp channel  43  such as by setting an amount of static friction between the clamp  88  and the clamp channel  43  in response to the clamp release aperture  44  sizing and/or such as by facilitating the insertion of a tool to urge the clamp  88  out of the clamp channel  43 . 
     Returning attention to  FIGS. 4-7, 9, 16, and 18 , the angled tip  34  is now discussed in greater detail, and reference is made to the safety dome  46 . The angled tip  34  may comprise a safety dome  46  at the outermost distal end of the angled tip  34 . The safety dome  46  may comprise a half-sphere structure disposed at the distal end of the tip manipulation member  10  opposite the tip manipulation member attachment mechanism  36 . The safety dome  46  may, in further embodiments, comprise a chamfer, a rounding, an oval, a spheroid, or any shape as desired to soften a force concentration associated with the distal end of the tip manipulation member  10 . For instance, as the clamp installation tool  2  is inserted into a body cavity, the safety dome  46  softens a force concentration associated with contact of the distal end of the tip manipulation member  10  to a body organ, diminishing the likelihood of catching against or scraping an organ, or penetrating a membrane. 
     Focusing on  FIGS. 5 and 18 , the angled tip  34  may have an angled tip minor longitudinal axis  48 . An angled tip minor longitudinal axis  48  may comprise an axis extending through the angled tip  34  ( FIGS. 4-9, 9, 16, 18 ) of the tip manipulation member  10  coincident with its center at all points along the axis. 
     A tip angle  70  may be defined between the angled tip minor longitudinal axis  48  and the tip manipulation member major longitudinal axis  30 . In various embodiments, the tip angle  70  comprises an acute angle. In further instances, the tip angle  70  comprises a zero degree angle, such that the angled tip minor longitudinal axis  48  and the tip manipulation member major longitudinal axis  30  are coincident. In further instances, the tip angle  70  comprises a zero degree angle, such that the angled tip minor longitudinal axis  48  and the tip manipulation member major longitudinal axis  30  are parallel. In still further instances, the tip angle  70  comprises an obtuse angle, or a right angle, or any angle as desired. In various instances, the tip angle  70  is selected such that the clamp installation tool  2  is passable through a trocar  84  when in the coaxial configuration  80  ( FIG. 14 ), and yet, such that the clamp  88  is not distorted by contact at the tip retention aperture  100  ( FIGS. 9 ,  10 ,  19 ) of the clamp  88  with the clamp installation tool  2 , but extends linearly from the tip retention aperture  100  ( FIGS. 9, 10, 19 ). In further embodiments, the tip angle  70  is selected so that the clamp installation tool  2  is passable through a trocar  84  when in the coaxial configuration  80  ( FIG. 14 ), and yet, such that the clamp  88  is spaced away from the clamp installation tool  2  at least along a portion of the length of the clamp  88 . 
     In various embodiments, the angled tip  34  may comprise a relief inset  50 . For instance, with reference to  FIG. 5 , a relief inset  50  comprises a chamfer, cutaway, or other localized thinning of the angled tip  34 . In various instances, the relief inset  50  is oriented opposite the clamp channel  43 . In further instances, the relief inset  50  is oriented opposite the clamp channel  43  and the clamp release aperture  44  extends from the relief inset  50  into the clamp release aperture  44 . 
     Turning now to  FIGS. 4, 5, 6, and 18 , the tip manipulation member attachment mechanism  36  may comprise various aspects which will be detailed. For example, the tip manipulation member attachment mechanism  36  may comprise a first side flange  52  and a second side flange  54 . Each of the first side flange  52  and second side flange  54  comprises a plate extending longitudinally outward from a distal end of the tip manipulation member main body  33 . Each of the first side flange  52  and second side flange  54  extend parallel to the tip manipulation member major longitudinal axis  30  ( FIG. 5 ). In various instances, a single first side flange  52  extends centered on the tip manipulation member major longitudinal axis  30 , whereas in further instances, a first side flange  52  and second side flange  54  are spaced apart on opposite sides of the center of the tip manipulation member main body  33 . The first side flange  52  and second side flange  54  extend from the end of the tip manipulation member  10  and are configured to be received within an aspect of the longitudinal main body  4  ( FIGS. 1-3, 8-10, 13, 22, 24, 26, 29-37 ) such as the main body attachment mechanism  6  ( FIGS. 1, 8-10, 18 ). 
     Referencing  FIGS. 4, 6, and 18 , the tip manipulation member attachment mechanism  36  includes a flange channel  56 . A flange channel  56  comprises a space defined between the first side flange  52  and the second side flange  54  and further extending inwardly into the tip manipulation member main body  33  of the tip manipulation member  10  forming a cavity defined into the tip manipulation member main body  33 . In various instances, the flange channel  56  has two portions, an offset channel section  74  comprising the portion of the flange channel  56  defined between the first side flange  52  and the second side flange  54 , and an inset channel section  72  comprising the portion of the flange channel  56  defined inwardly into the tip manipulation member main body  33  of the tip manipulation member  10 . 
     Referencing  FIGS. 4, 5, 6, and 7 , the tip manipulation member attachment mechanism  36  further includes an attachment mechanism flange web  58 . The attachment mechanism flange web  58  comprises a web extending from the first side flange  52  to the second side flange  54 . The attachment mechanism flange web  58  may have a longer side extending in a direction generally parallel to the longitudinal direction of the tip manipulation member  10 , such as parallel the tip manipulation member major longitudinal axis  30 . The attachment mechanism flange web  58  thus joins the first side flange  52  and the second side flange  54  to form a side of the flange channel  56 . The attachment mechanism flange web  58  may comprise any shape configured to strengthen the first side flange  52  and the second side flange  54 . In various instances, the attachment mechanism flange web  58  is omitted (see  FIG. 18 ), such as depending on the material used to fabricate the tip manipulation member attachment mechanism  36 . 
     With reference to  FIGS. 4-5 , the tip manipulation member attachment mechanism  36  may include a retention aperture  60 . A retention aperture  60  may extend laterally (e.g., perpendicular to the tip manipulation member major longitudinal axis  30 ) through the first side flange  52  and the second side flange  54 . The retention aperture  60  is configured to receive the retention pin  24  ( FIG. 8 ) of the main body attachment mechanism  6  ( FIG. 8 ) of the longitudinal main body  4  ( FIG. 8 ). The retention aperture  60  may comprise an axis about which the tip manipulation member  10  may actuate relative to the longitudinal main body  4  ( FIG. 8 ). 
     The tip manipulation member attachment mechanism  36  may also include an offset articulation aperture  62 . The offset articulation aperture  62  may extend laterally (e.g., perpendicular to the tip manipulation member major longitudinal axis  30 ) through one or both of the first side flange  52  and the second side flange  54 . The offset articulation aperture  62  is configured to receive a portion of a control aspect  12  ( FIGS. 1, 9, 10 ) such as a control rod, control cable and/or the like that runs through the control rod channel  16  ( FIGS. 2, 8 ) of the longitudinal main body  4  ( FIGS. 2, 8 ). The offset articulation aperture  62  may be configured to receive a force, such as along a direction tangential to an arc centered on the retention aperture  60 . As such, the pushing and/or pulling of the control aspect  12  ( FIGS. 1, 9, 10 ) on the offset articulation aperture  62  may induce the tip manipulation member  10  to rotate about an axis provided by the retention aperture  60 , actuating between a coaxial configuration  80  ( FIG. 14 ) and an actuated configuration  82  ( FIG. 15 ). The offset articulation aperture  62  may be spaced an articulation offset radius  78  from the retention aperture  60 , the articulation offset radius  78  comprising a distance configured to provide a torque arm (e.g., a lever) whereby the linear travel of the control rod or cable is translated in to an arcuate motion of the offset articulation aperture  62  orbitally about the retention aperture  60  along an articulation path  76  comprising an arc. 
     Finally, with reference to  FIGS. 4, 5, 6, 7, and 18 , in various instances, an attachment butt plate  64  of the tip manipulation member attachment mechanism  36  comprises a face of the tip manipulation member main body  33  from which the first side flange  52  and/or second side flange  54  extends outward. In various embodiments, the attachment butt plate  64  comprises a contacting surface configured to contact against the longitudinal main body  4  and configured to limit the travel of the tip manipulation member  10  and thus the offset articulation aperture  62  along the articulation path  76 , so that the orientation of the actuated configuration  82  ( FIG. 15, 29 ) and/or coaxial configuration  80  ( FIG. 14 ) is established. 
     With specific reference to  FIGS. 9-11, and 13 , a sealing channel  86  is provided. A sealing channel  86  comprises a hollow structure through which the clamp installation tool  2  may be inserted. For instance, in various embodiments, a clamp installation tool  2  with and/or without a clamp  88  attached thereto, may be desired to be inserted through a trocar  84 . However, the shape of the clamp installation tool  2  and/or clamp  88  may cause unwanted fluid leakage (for instance, pressurized gas) through the trocar  84  alongside the clamp installation tool  2  and/or clamp  88 . A sealing channel  86  may provide a shape configured to diminish this unwanted fluid leakage. For example, a sealing channel  86  may comprise a cylindrical tube. The sealing channel  86  may be slidably disposed over the clamp installation tool  2  while a clamp  88  is attached thereto, leaving only a small sealing channel gap  94  between the clamp  88  and/or clamp installation tool  2  and the sealing channel  86  so that only a minimal amount of fluid may escape. The combination of sealing channel  86 , clamp installation tool  2 , and clamp  88 , may be slidably insertable into a trocar  84 , for instance, with reference to  FIGS. 11, 12, 14, 15, and 21 , a trocar  84  having a first seal  90  and a second seal  92 . In this manner, leakage of fluid through the trocar  84  is ameliorated. 
     The sealing channel  86  may comprise a sealing channel fastener  95 . A sealing channel fastener  95  may comprise a mechanism whereby the sealing channel  86  is selectably engagable to the clamp installation tool  2 . For example, the sealing channel  86  may be frictionally engagable to the clamp installation tool  2 . In various embodiments, the sealing channel fastener  95  comprises a finger-tightenable bolt extending inwardly through the sealing channel  86  into the internal area of the sealing channel  86  and capable of pressing against the clamp installation tool  2 . 
     Finally, and with reference to  FIGS. 9-15, and 17-20 , a clamp  88  is provided. The clamp  88  may be insertable into a body by the clamp installation tool  2  and installed on an organ. The clamp  88  may have aspects configured to interface with aspects of the clamp installation tool  2 , such as to selectably retain the clamp  88  in mechanical communication with the clamp installation tool  2  during emplacement, then to selectably release the clamp  88  from mechanical communication with the clamp installation tool  2  once emplaced. 
     As mentioned, the clamp  88  may have a distal retention aperture  96 , an intermediate retention aperture  98 , and a tip retention aperture  100 . The clamp  88  may be installed onto the clamp installation tool  2 , with the distal retention aperture  96  attached to the distal boss  28  of the selectable retention mechanism  8  of the clamp installation tool  2 , with the intermediate retention aperture  98  attached to the intermediate boss  26  of the selectable retention mechanism  8  of the clamp installation tool  2 , and with the tip retention aperture  100  attached to the retention hook  32  of the tip manipulation member  10  of the clamp installation tool  2 . The clamp installation tool  2  may be configured in the coaxial configuration  80  ( FIG. 14 ). As such, a tension may be exerted on the clamp  88 . A first tensioned clamp section  102  of the clamp  88  extends between the tip retention aperture  100  and the distal retention aperture  96 . A second tensioned clamp section  104  of the clamp  88  extends between the distal retention aperture  96  and the intermediate retention aperture  98 . The tension within each of the first tensioned clamp section  102  and the second tensioned clamp section  104  may be the same and/or may be different. The clamp installation tool  2  may be inserted through a trocar  84  into a body cavity and proximate to an organ desired to be clamped. The clamp installation tool  2  may be actuated by a control aspect  12  so that the clamp installation tool  2  changes from a coaxial configuration  80  to an actuated configuration  82 . In the actuated configuration  82 , the tension in the first tensioned clamp section  102  extending between the tip retention aperture  100  may unload, so that the tip retention aperture  100  is more loosely connected to the retention hook  32 . However, the tension in the second tensioned clamp section  104  extending between the intermediate retention aperture  98  and the distal retention aperture  96  may increase, securely retaining the clamp  88  in position relative to the clamp installation tool  2  while the loosened tip retention aperture  100  is manipulated. In various embodiments, a separate tool may be used to grasp the clamp  88  proximate to the tip retention aperture  100  and selectably disconnect the tip retention aperture  100  from the clamp installation tool  2 . The separate tool may be used to further position the clamp  88  relative to the organ. The clamp  88  may be emplaced and subsequently disconnected from the clamp installation tool  2 . The clamp installation tool  2  is thereafter actuated to the coaxial configuration  80  and retracted from the body cavity through the trocar  84 , leaving the clamp  88  emplaced within the body cavity. 
     In further instances, the clamp  88  may have an aft end retention nub  202  comprising an extension projecting normal to a surface of the clamp  88  at an end of the clamp  88 . The aft end retention nub  202  may be receivable by an aspect of the selectable retention mechanism  8 , such as an end point ramp  200  ( FIG. 25, 26, 29 ) while the tip retention aperture  100  ( FIG. 9, 10, 19, 22, 23 ) is attachable to the tip manipulation member  10  so that the intervening bosses of the selectable retention mechanism  8  may be omitted. As the clamp installation tool  2  articulates between coaxial configuration and actuated configuration, tension may be released along the entire length of the clamp  88 . 
     In still further instances, the clamp  88  may be retained proximate to the clamp installation tool  2  by one or more clip  244  ( FIG. 36-37 ). In various embodiments, clip  244  ( FIG. 36-37 ) is a metal clip. Clip  244  ( FIG. 36-37 ) may be a metal clip. Clip  244  ( FIG. 36-37 ) may be C-shaped. 
     A number of additional and alternative embodiments of the surgical clamps, installation tools and methods for installing can have characteristics that are different from those described above. For example, it is envisioned that a surgical clamp  88  not intended for bariatric surgery might not have a passage forming section, and that such a clamp  88  might be smaller or larger, depending on the purpose of the clamp  88 . For example, the clamp  88  can be one-tenth of an inch in length to partition a blood vessel, or twenty-two centimeters in length to partition a stomach. Moreover, the clamp  88  can be configured to partition any internal organ, and can vary in length accordingly between these two example lengths, or be longer or shorter as required. Moreover, it is envisioned that the clamp installation tool  2  can be integrated with an endoscope and/or surgical robot and that appropriate robotic elements can be included in place of or in addition to those described above. These and other features can be included in various combinations without departing from the scope of the invention as defined in the following aspects.