Patent Publication Number: US-2023157701-A1

Title: Medical devices with detachable pivotable jaws

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a Divisional of U.S. patent application Ser. No. 16/720,637, filed Dec. 19, 2019, which is a Divisional of U.S. patent application Ser. No. 15/095,798, filed Apr. 11, 2016, now U.S. Pat. No. 10,548,612 issued Feb. 4, 2020, which is a Divisional of U.S. patent application Ser. No. 13/270,851 filed Oct. 11, 2011, now U.S. Pat. No. 9,339,270 issued May 17, 2016, which is a Continuation-In-Part of U.S. patent application Ser. No. 12/971,873 filed on Dec. 17, 2010, now U.S. Pat. No. 8,771,293 issued Jul. 8, 2014, which claims priority to U.S. Application Ser. No. 61/289,297 filed Dec. 22, 2009. This application (and application Ser. No. 13/270,851) also claim the benefit of U.S. Provisional Patent Application Ser. No. 61/391,881 filed on Oct. 11, 2010. All of the foregoing applications are hereby incorporated by reference. 
    
    
     BACKGROUND 
     Conventionally, a clip may be introduced into a body cavity through an endoscope to grasp living tissue of a body cavity for hemostasis, marking, and/or ligating. Such clips are often known as surgical clips, endoscopic clips, hemostasis clips and vascular clips. In addition, clips are now being used in a number of applications related to gastrointestinal bleeding such as peptic ulcers, Mallory-Weiss tears, Dieulafoy&#39;s lesions, angiomas, post-papillotomy bleeding, and small varices with active bleeding. Clips have also been attempted for use in closing perforations in the stomach 
     Gastrointestinal bleeding is a somewhat common and serious condition that is often fatal if left untreated. This problem has prompted the development of a number of endoscopic therapeutic approaches to achieve hemostasis such as the injection of sclerosing agents and contact thermo-coagulation techniques. Although such approaches are often effective, bleeding continues for many patients and corrective surgery therefore becomes necessary. Because surgery is an invasive technique that is associated with a high morbidity rate and many other undesirable side effects, there exists a need for highly effective, less invasive procedures. 
     Mechanical hemostatic devices such as clips have been used in various parts of the body, including gastrointestinal applications. One of the problems associated with conventional hemostatic devices and clips, however, is that many devices are not strong enough to cause permanent hemostasis. Further, clips have also been attempted for use in closing perforations in the stomach or gastrointestinal structures, but unfortunately traditional clips suffer from difficult placement and the capability to grasp a limited amount of tissue, potentially resulting in incomplete closure. 
     SUMMARY 
     The invention may include any of the following aspects in various combinations and may also include any other aspect described below in the written description or in the attached drawings. 
     In one aspect, a medical device is provided for engaging tissue, the medical device including a housing, first and second jaws, first and second biasing strips, and a driver. The housing defines an internal passageway and a longitudinal axis extending between proximal and distal ends of the housing. The first and second jaws are rotatable relative to the housing and have proximal and distal ends. The driver is engaged with the proximal ends of the first and second jaws, wherein longitudinal movement of the driver rotates the first and second jaws relative to the housing. The first biasing strip has one end fixed to the first jaw and the other end slidably attached to the housing, while the second biasing strip has one end fixed to the second jaw and the other end slidably attached to the housing. The first and second biasing strips bias the first and second jaws radially. 
     According to more detailed aspects, the other ends of the first and second biasing strips may be slidably and pivotally attached to the housing. The first and second biasing strips may be fixed to the distal ends of the first and second jaws, respectively. An exterior of the housing preferably includes first and second channels sized to receive the first and second biasing strips. In a retracted configuration, the jaws are rotated towards each other and substantially located within the housing, and preferably the first and second channels receive the first and second biasing strips in the retracted configuration such that the first and second biasing strips are flush with an exterior surface of the housing. The other ends of the first and second biasing strips may have a T-shape defining a crossbar, wherein the housing includes first and second slots coextensive with the first and second channels, and wherein the crossbars pass through the first and second slots. In one form, the distal ends of the first and second jaws are curved radially inwardly, and the one ends of the first and second biasing strips are curved radially inwardly to match the curvature of the first and second jaws. In one form, the proximal ends of the first and second jaws include gears having teeth, and the driver includes corresponding teeth that mesh with the teeth of the jaws, whereby the biasing of the first and second jaws removes slack from the meshing teeth to provide smooth rotation of the first and second jaws. In another aspect, a medical device is provided for engaging tissue, the medical device including a housing, first and second jaws, a biasing strip, and a driver. The housing defines an internal passageway and a longitudinal axis extending between proximal and distal ends of the housing. The first and second jaws are rotatable relative to the housing and have proximal and distal ends, the proximal ends formed as a pinions having teeth. The driver is engaged with the proximal ends of the first and second jaws, the driver including a rack having teeth that mesh with the teeth of the pinions such that longitudinal movement of the driver rotates the first and second jaws relative to the housing. The biasing strip is operatively connected to the rack and pinions to provide a biasing force in a direction of rotation of the pinions. According to a more detailed aspect, the biasing strip is directly attached to the driver.
 
In another aspect, a medical device is provided for engaging tissue. The medical device includes a housing, first and second jaws, an elongated drive wire, and a driver. The housing defines an internal passageway and a longitudinal axis extending between proximal and distal ends of the housing. The first and second jaws are rotatable relative to the housing and have proximal and distal ends. The driver is engaged with the proximal ends of the first and second jaws, whereby longitudinal movement of the driver rotates the first and second jaws relative to the housing. The driver includes two locking tabs forming a socket facing proximally. The elongated drive wire is selectively connected to the driver for longitudinal movement therewith, the socket of the driver receiving the distal end of the drive wire. The inner surface of the internal passageway guides longitudinal movement of the driver and includes a proximal portion and a distal portion. The distal portion of the inner surface has a width smaller than the proximal portion, the distal portion sized to press the locking tabs into engagement with the drive wire.
 
According to more detailed aspects, when the locking tabs are positioned in the distal portion of the inner surface, the locking tabs are firmly pressed into frictional engagement with the drive wire. The distal end of the drive wire may define an enlarged distal head, and the locking tabs are preferably pressed into engagement with the drive wire at a position proximal to the distal head. The inner surface may include two surfaces on opposing sides of the housing corresponding to the two locking tabs, and the two surfaces may be formed as grooves. The inner surface may include a shoulder at the transition between of the proximal and distal portions, the shoulder facing proximally. Here, the locking tabs are positioned to engage the shoulder to limit longitudinal movement of the driver after they have been moved laterally outwardly by the enlarged portion of the drive wire.
 
     According to still further aspects, the medical device is operable between first, second and third configurations. The driver is non-detachably connected to the drive wire in the first configuration, the driver is detachably connected to the drive wire in the second configuration, and the driver is detached from the drive wire in the third configuration. The locking tabs are preferably positioned at an entrance to the socket and move to vary the size of the entrance, wherein the entrance has a smallest size in the first configuration, and a largest size in the third configuration. The locking tabs are preferably pressed against the drive wire in the first configuration. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings incorporated in and forming a part of the specification illustrate several aspects of the present invention, and together with the description serve to explain the principles of the invention. In the drawings: 
         FIG.  1    is a top view of a medical system having a medical device for engaging tissue, constructed in accordance with the teachings of the present invention; 
         FIG.  2    is a top view similar to  FIG.  1   , but showing the outer structures in dotted lines and the interior sections in solid lines and partial cross section; 
         FIG.  3    is a side view of the medical system and device depicted in  FIG.  1   ; 
         FIG.  4    is a side view similar to  FIG.  3   , but showing the outer structures in dotted lines and the interior structures in solid lines and partial cross section 
         FIG.  5    is a side view of a medical device that is part of the medical system depicted in  FIGS.  1 - 4   ; 
         FIG.  6    is a front view of a housing forming a portion of the medical system and device depicted in  FIGS.  1 - 5   ; 
         FIG.  7    is a perspective view of the housing depicted in  FIG.  6   ; 
         FIGS.  8 - 12    are side views showing operation of the medical system and device depicted in  FIGS.  1 - 5   ; 
         FIGS.  13  and  14    are top views, partially in cross-section, depicting operation of the medical system and device depicted in  FIGS.  1 - 4   ; 
         FIGS.  15  and  16    are cross-sectional views showing operation of the medical system and device depicted in  FIGS.  1 - 4   . 
         FIGS.  17  and  18    are a perspective view of an alternate embodiment of a grasping jaw forming a portion of the medical system and device of  FIG.  1   ; 
         FIG.  19    is a plan view of an alternate embodiment of a driver forming a portion of the medical system and device of  FIG.  1   ; 
         FIG.  20    is a perspective view of the driver of  FIG.  19    shown attached to a drive wire; 
         FIG.  21    is a side view of  FIG.  20   ; 
         FIG.  22   a    is a plan view of an alternate embodiment of the medical device of  FIG.  1   , and  FIG.  22   b    is a plan view of the driver of  FIG.  19    shown attached to a strip and forming a portion of the medical device of  FIG.  22     a;    
         FIG.  23    is a plane view of another alternate embodiment of the medical device depicted in  FIG.  1   ; 
         FIGS.  24  and  25    are a perspective views showing operation of the medical device depicted in  FIG.  23   ; 
         FIGS.  26  and  27    are perspective and end views, respectively, of another embodiment of a driver forming a portion of the medical system and device depicted in  FIG.  1   ; 
         FIG.  28    is a perspective view of the driver of  FIGS.  25 - 26    shown attached to the jaws; 
         FIGS.  29  and  30    are plan views showing operation of the driver and jaws depicted in  FIG.  28   ; 
         FIGS.  31  and  32    are cross-sectional views of another embodiment of the medical system and device depicted in  FIG.  1   ; and 
         FIG.  33    is a perspective view of the medical system and device depicted in  FIGS.  31  and  32   . 
     
    
    
     DETAILED DESCRIPTION 
     The terms “proximal” and “distal” as used herein are intended to have a reference point relative to the user. Specifically, throughout the specification, the terms “distal” and “distally” shall denote a position, direction, or orientation that is generally away from the user, and the terms “proximal” and “proximally” shall denote a position, direction, or orientation that is generally towards the user. 
     An exemplary medical system  20  having a medical device  40  for engaging tissue T ( FIG.  11   ) is shown in  FIGS.  1  through  4   . The medical system  20  and device  40  are generally sized and structured for operation through the working channel of an endoscope (not shown) or other scope, although the system  20  and device  40  may also be used alone or in conjunction with other elongate devices such as catheters, fiber-optic visualization systems, needles and the like. Generally, the medical system  20  includes a drive wire  22  slidably housed within the distal end  23  of an elongated catheter  24  for selective connection to, and operation of, the medical device  40 . As will be described in further detail herein, the medical device  40  generally includes a housing  42  having a first jaw  44  and a second jaw  46  pivotally connected thereto for engaging the tissue T. Generally, the jaws  44 ,  46  have been shown as forming grasping forceps, although the jaws are intended to be used to clip tissue, e.g. to close an opening or for hemostasis. Accordingly, it will be recognized that the shape and structure of the jaws may take many forms and serve many purposes and functions, all in accordance with the teachings of the present invention. 
     In the medical system  20 , the drive wire  22  slidably extends through the catheter  24 . Although the term “wire” is used to refer to the drive wire  22 , it will be recognized that any elongate control member capable of transmitting longitudinal force over a distance (such as is required in typical endoscopic, laparoscopic and similar procedures) may be used, and this includes plastic rods or tubes, single filament or multi-filament wires, metal rods and the like. The drive wire  22  should also be capable of properly transmitting a rotational/torsional force from the proximal end to the distal end to rotate the medical device  40  and jaws  44 ,  46 , and thus it is currently preferred that the drive wire  22  is formed from nitinol (e.g. a nitinol wire) or other superelastic alloy. A connection block  26  is slidably fitted within the distal end  23  of the catheter  24  and defines a bore  28  therethrough which slidably receives the drive wire  22 . The exterior of the connection block  26  includes a recessed portion  27 , and two pins  30  (e.g., formed from stainless steel wire) are connected to the catheter  24  and positioned within the recessed portion  27  to limit the longitudinal movement of the connection block  26 . 
     A distal end of the drive wire  22  defines a distal head  32  that is sized larger than the drive wire  22 , and likewise larger than the bore  28  in the connection block  26 . As will be described later herein, the distal head  32  is used to slide the connection block  26  within the catheter  24  to disconnect the medical device  40  from the medical system  20 . As also seen in  FIGS.  1 - 4   , the housing  42  of the medical device  40  is a tubular member defining an interior space  43 . A proximal end of the housing  42  frictionally receives a distal end of the connection block  26  within the interior space  43  for selective connection therewith. 
     The internal passageway  43  of the housing  42  also receives the first and second jaws  44 ,  46  and a driver  48  which is used to interconnect the drive wire  22  to the jaws  44 ,  46 . As best seen in  FIGS.  1 ,  2  and  5   , the driver  48  has a proximal portion which defines a socket  50  sized to receive enlarged distal head  32  of the drive wire  22 . At the proximal entrance of the socket  50 , two deflectable locking tabs  52  are formed which rotate relative to the remainder of the driver  48  to increase or decrease the size of the socket  50 . The locking tabs  52  may be separately formed and pivotally attached to the driver  48 , or may be integrally formed with the driver  48  and formed of a resilient material which flexes to permit rotation of the locking tabs  52  radially inwardly and radially outwardly. A distal portion of the driver  48  defines a rack  54  for engaging and operating the jaws  44 ,  46 . In the depicted embodiment, the rack  54  includes a central spine  56  having teeth  58  projecting away from the central spine  56  and on opposite sides of the spine  56 . One set of teeth  58  on one side of the spine  56  generally operate the first jaw  44  while the other set of teeth  58  on the other side of the spine  56  operate the second jaw  46 . It will be recognized that the rack  54  may include a single set of teeth or other geared structures that interface with the jaws  44 ,  46 . 
     As best seen in  FIG.  5   , the first and second jaws  44 ,  46  include distal ends  60 ,  62  that are structured to grasp and engage tissue, generally they have a talon shape as disclosed in U.S. Pat. No. 8,317,820, the disclosure of which is incorporated herein by reference in its entirety. The proximal ends  64 ,  66  of the first and second jaws  44 ,  46  each include a pinion gear  68 ,  70  having a series of teeth. The teeth of the pinion  68 ,  70  mesh with the teeth of the rack  54  of the driver  48  such that longitudinal translation of the driver  48  induces rotation in the first and second jaws  44 ,  46  relative to one another. Generally, distal translation of the driver  48  causes the first and second jaws  44 ,  46  to rotate outwardly away from each other, while proximal retraction of the driver  48  causes the first and second jaws  44 ,  46  to rotate inwardly toward one another. Pins  80  are fitted through each the proximal ends of the jaws  44 ,  46 , to pivotally connect the jaws to the housing  42 . Other structures for forming a pivotal connection may be used, and preferably the pivotal connection is centrally arranged relative to the pinions  68 ,  70 . 
     In addition to the jaws  44 ,  46  being pivotally attached to the housing  42 , the first and second jaws  44 ,  46  are also slidably attached to the housing  42 . As best seen in  FIGS.  6  and  7    (and in conjunction with  FIGS.  1 - 4   ) the housing  42  defines a first guide surface  82  for the first jaw  44 , and a second guide surface  84  for the second jaw  46 . As seen in  FIG.  3   , the first and second guide surfaces  82 ,  84  are formed by elongated slots  82   a ,  82   b ,  84   a ,  84   b  formed in opposing sides of the housing  42  which leaves a thickness of the housing  42  exposed to serve as the guide surface. The slots  82   a ,  82   b  are aligned to receive the connecting pin  80  of the first jaw  44 , and likewise the slots  84   a ,  84   b  are aligned to receive the connecting pin  80  of the second jaw  46 . The ends of the slots, for example distal ends  92 ,  94  shown in  FIG.  7   , serve to restrict the longitudinal movement of the jaws  44 ,  46  relative to the housing  42 . The proximal ends  64 ,  66  of the jaws  44 ,  46  include apertures  72 ,  74  which receive the pins  80  ( FIGS.  1 ,  2  and  3   ) that are used to slidably and pivotally connect the first and second jaws  44 ,  46  to the housing  42 . 
     It can also be seen in  FIGS.  6  and  7    that the housing  42  defines a third guide surface  86  which guides the longitudinal movement of the driver  48  within the housing  42 . The guide surface  86  in the depicted embodiment includes a left guide surface  86   a  and a right guide surface  86   b  formed as C-shaped channels. As shown in  FIG.  7   , the third guide surface  86  transitions from a smaller proximal width to a larger distal width to define a shoulder  88  at the transition, which will be further described hereinbelow with reference to  FIGS.  13  and  14   . 
     As also shown in  FIG.  6   , the internal passageway  43  of the housing  42  extends through the distal end of the housing, and through which the first and second jaws  44 ,  46  can extend. Additionally, as shown in  FIGS.  1  and  2   , the housing  42  defines opposing slots  45  which are sized to permit the first and second jaws  44 ,  46  to pass therethrough when they rotate radially outwardly. Accordingly, it is also clear from  FIGS.  1  and  2    that the housing  42  serves to block rotation of the first and second jaws  44 ,  46  when they are entirely or partially contained within the internal passageway  43  of the housing  42 . Suitable plastics for forming the housing include, but are not limited to, polytetrafluorethylene (PTFE), expanded polytetrafluorethylene (EPTFE), polyethylene ether keytone (PEEK), polyvinylchloride (PVC), polycarbonate (PC), polyamide, polyimide, polyurethane, polyethylene (high, medium or low density), and suitable metals include stainless steel, nitinol and similar medical grade metals and alloys. 
     Operation of the medical device  40  will now be described with reference to  FIGS.  8 - 12   . As shown in  FIG.  8   , the first and second jaws  44 ,  46  are shown in a retracted position where they are substantially contained within the housing  42 . Depending on the application, the distal ends  60 ,  62  of the jaws  44 ,  46  may slightly project from the distal end of the housing  42  in their retracted positions, or they may be entirely positioned within the housing  42 . When the drive wire  22  is translated distally (to the right on the page in  FIG.  8   ) the distal head  32  engages the driver  48 , the driver  48  and jaws  44 ,  46  slide distally through the housing  42 . The driver  48  and jaws  44 ,  46  slide longitudinally before they rotate (even though the rack  54  of the driver  48  is meshed with the pinions  68 ,  70  at the proximal ends  64 ,  60  of the jaws  44 ,  46 ) since the resistance to longitudinal movement is less than the force required to rotate the jaws  44 ,  46  (alternatively, the housing  42  can block rotation of the jaws  44 ,  46  when they are within the housing  42 ). As previously mentioned, this longitudinal movement is guided by the first and second guide surfaces  82 ,  84  which receive the pins  80  that slidably and pivotally connect the jaws  44 ,  46  to the housing  42 . 
     As shown in  FIG.  9   , the first and second jaws  44 ,  46  have an extended position where the jaws substantially project from a distal end of the housing  42 , and their proximal ends  64 ,  66  are positioned adjacent the distal end of the housing  42 . Accordingly, it will be seen that further distal advancement of drive wire  22 , and hence the driver  48 , causes the pinion  68  to rotate over the teeth  58  of the rack  54 . As best seen in  FIG.  10   , the first and second jaws  44 ,  46  rotate radially outwardly from each other into a tissue receiving position. Notably, due to the presence of slots  45  at the distal end of the housing  42 , the jaws  44 ,  46  are permitted to rotate a full 90°, thus forming at least a 180° between them. It will be recognized that through the sizing of the slots  45  and the construction of the rack  54  and pinions  68 ,  70 , the first and second jaws  44 ,  46  may rotate even further away from each other. 
     In the tissue receiving configuration shown in  FIG.  10   , the medical device  40  and its jaws  44 ,  46  may be positioned adjacent tissue T. As shown in  FIG.  11   , the tissue T may be placed between the first and second jaws  44 ,  46  and the jaws  44 ,  46  rotated back towards their position shown in  FIG.  9   . The tissue T has been shown as a single layer, although multiple layers may be clipped between the jaws  44 ,  46 . Generally, proximal retraction of the drive wire  22  and the driver  48  again causes rotation of the first and second jaws  44 ,  46  to grasp the tissue T therebetween. As shown in  FIG.  12   , further proximal retraction of the drive wire  22  and driver  48  will cause the jaws  44 ,  46  to move longitudinally in a proximal direction (to the left on the page in  FIG.  12   ). 
     In order for the medical device  40  to serve as a clip and maintain its grasp on the tissue T, or to maintain the clipping of two layers of tissue against each other, the jaws  44 ,  46  may be locked in position and the drive wire  22  of the medical system  20  disconnected from the medical device  40 . As shown in  FIG.  13   , the third guide surface  86  (which guides the driver  48 ) includes a proximal portion  86   p  and a distal portion  86   d . The proximal portion  86   p  of the third guide surface  86  has a width (measured up and down on the page in  FIG.  13   ) that is greater than a width of the distal portion  86   d  of the third guide  86 . As previously discussed, the third guide surface  86  is formed by opposing surfaces or C-shaped channels  86   a ,  86   b  of the housing  42 . The transition between the proximal portion  86   p  and distal portion  86   d  defines a shoulder  88 , and namely two shoulders  88   a ,  88   b  on opposing sides of the housing  42 . The shoulders  88   a ,  88   b  are sized and positioned to engage the locking tabs  52  located on the driver  48 . 
     As shown in  FIG.  13   , when the driver  48  is located within the distal portion  86   d  of the third guide surface  86 , the locking tabs  52  are forced radially inwardly into firm frictional engagement with the drive wire  22 . Stated another way, the socket  50  formed by the driver  48  to receive the distal head  32  has an entrance which is narrowed by the inward deflection of the locking tabs  52 . Preferably, the locking tabs  52  plastically deform rather than elastically deform, and the tabs  52  may be bent inwardly around the distal head  32  during initial assembly of the device, and thus sized for the distal portion  86   d  of the third guide surface  86 . In this state depicted in  FIG.  13   , the drive wire  22  is firmly engaged with the driver  48  and hence the first and second jaws  44 ,  46 . 
     When the drive wire  22  and driver  48  are retracted proximally, for example upon grasping tissue as shown in  FIG.  12   , the proximal end of the driver  48  is received within the proximal portion  86   p  of the third guide surface  86  which has a larger width that permits radially outward movement of the locking tabs  52 . Accordingly, in the state depicted in  FIG.  14   , the locking tabs  52  may be loosely and detachably connected to the distal head  32  of the drive wire  22 . That is, the proximal retraction of the jaws  44 ,  46  will be limited by either the tissue T engaging the distal end of the housing  42 , or the pins  80  will abut the proximal ends of the slots  82   a ,  82   b ,  84   a ,  84   b  defining a first and second guide surfaces  82 ,  84 . As such, when proximal movement of the jaws  44 ,  46  and the driver  48  are thus limited, further proximal movement of the drive wire  22  and its distal head  32  may be used to withdraw the distal head  32  from the socket  50  of the driver  48 . This operation may also be used to further deflect the locking tabs  52  radially outwardly. An appropriate amount of proximally directed force on the drive wire  22  causes the distal head  32  to move proximally through the locking tabs  52  and plastically deform them radially outwardly. In the event the natural elasticity of the tissue T tends to pull the jaws  44 ,  46  out from the housing towards their extended position, the locking tabs  52 ,  54  will abut the shoulders  88   a ,  88   b  of the third guide surface of the housing  42  to prevent further distal movement of the jaws  44 ,  46 . 
     Turning now to  FIGS.  15  and  16   , upon still further proximal retraction of the drive wire  22  and distal head  32 , the enlarged distal head  32  will abut the connection block  26  which is slidably fitted within the distal end  23  of the catheter  24 . Sufficient proximal force on the drive wire  22  will overcome the frictional fit between the connection block  26  and the proximal end of the housing  42 , thus moving the connection block  26  proximally (to the right on the page of  FIGS.  15  and  16   ) to retract the connection block  26  within the tubular connector  24 , as shown in  FIG.  16   . The catheter  24  can be used to provide a counterforce on the housing  42  while proximally retracting the drive wire  22  and connection block  26 . Accordingly, the drive wire  22 , catheter  24  and connection block  26  may be fully disconnected from the medical device  40 , thereby leaving the first and second jaws  44 ,  46  and the housing  42  in a state having the tissue T clipped between the jaws  44 ,  46  and retained in vivo. The connection block  26  is retained at the distal end  24  of the catheter  24  via the pins  30 , which are positioned within the recessed area  27  to engage the proximal and distal ends of the connection block  26  and limit its longitudinal movement. 
     The elongated catheter  24  (or other elongate tubular member such as a sheath, tube, scope or the like), which slidably encases the drive wire  22 , extends proximally therealong to a proximal end of the system  20 , and has a length suitable for placing the device  40  at any desired location within the body, while the proximal ends of drive wire  22  and catheter  24  are positioned outside of the body for use by the medical professional. Control handles (not shown) for controlling relative translation of the drive wire  22  and catheter  24  are well known in the art, and may be employed at the proximal end of the system  20 . 
     Another embodiment and method of forming the grasping jaws  44 ,  46  are shown in  FIGS.  17 - 18   . The jaws of the prior embodiment were generally machined, however the jaws  44 ,  46  may also be formed by stamping. A flat piece of metal preferably of medical grade stainless steel, is stamped into the shape  144  shown in  FIG.  17   . The shape includes a slightly narrow distal end  160  which then can be bent into the shape shown in  FIG.  18    for grasping and engaging tissue. The distal end  160  may also be stamped to include a serrated edge, or other shapes or edge features depending upon the application. The proximal end  164  generally includes two arms  166  which lead to gears  168 . As shown in  FIG.  18   , the gears  168  are grasped and then rotated about 90 degrees such that the gears  168  extend in a plane that is perpendicular to the plane of the sheet  144 . The gears  168  also include a through-hole  172  for receiving a guiding pin. It will also be recognized that the jaws  44 ,  46  in this embodiment may also be formed of a single arm  166  and single gear  168 . 
     Another embodiment of a driver  148  and drive wire  122  are shown in  FIGS.  19 - 22   . The driver  148  generally includes a socket  150  formed by two locking tabs  152 . In this embodiment, a proximal portion of the locking tabs define slanted shoulders  154  which slope laterally outwardly for engagement with the third guide surface  86  in the housing  42  as previously discussed. The locking tabs  152  also include inner projections  153  which project laterally inwardly and separate the socket  150  into a distal portion  150   d  and a proximal portion  150   p . The driver  148  again includes a central spine  156  and opposing teeth  158 . In this embodiment, the distal end  166  of the driver  148  includes a pocket  168  defined by two inwardly projecting flanges  170 , as will be discussed further herein. The two flanges  170  extend along a distal side of the pocket  168 , and leave a gap therebetween for access to the pocket  168 . 
     As seen in  FIGS.  20  and  21   , this embodiment of the drive wire  122  includes a distal head  132  which is formed by bending the distal end of the drive wire  122  into a semi-circular shape as shown, preferably spanning an arc of 180 degrees to 360 degrees. Accordingly, it can be seen that the distal head  132  defines an opening  133  that is sized to receive the inner projections  153  of the locking tabs  152 . As shown, the distal portion  150   d  of the socket  150  receives the distal-most part of the curved distal head  132 , while the proximal portion of the distal head  132  projects through the proximal portion  150   p  of the socket  150  and proximally away therefrom. As noted above, the locking tabs  152  here are structured to be plastically deformed, and thus after formation and connection to the drive wire  122  as shown in  FIG.  19   , the tabs  152  are bent radially inwardly to secure the projections  153  within the opening  133  of the socket  132 . In this state, the exterior shoulders  154  of the locking tabs  152  are sized to fit within the third guide surface  86 , and more particularly the distal portion  86   d  of the third guide surface  86  without further deformation. 
     As shown in  FIGS.  22   a  and  22   b   , another embodiment of the medical device  140  may include the housing  142 , grasping arms  144 ,  146  just as in the prior embodiment, but in this embodiment include the alternate driver  148  and an additional biasing element, namely a biasing strip  190 . As best seen in  FIG.  22   b   , the distal end  166  of the driver  148  receives the biasing strip  190  within the pocket  168 . The flanges  170  are bent inwardly and proximally as shown to firmly engage the metal strip  190  and fix it to the driver  148 . The biasing strip  190  is preferably a thin strip formed from a sheet of resilient material, and more preferably a metal strip, e.g. formed of stainless steel, nitinol or other super elastic alloy that is biocompatible. Accordingly, it will be recognized that as the driver  148  is moved proximally to cause the jaws  144 ,  146  to close, the biasing strip  190  will be forced into a V-shape or U-shape, as shown by the dotted lines in  FIG.  22   a   . That is, the biasing strip  190  has a straight shape in its natural, unbiased, configuration, and when bent into the V-shape it exerts a radially outward force on the jaws  144 ,  146 . This biasing force provides the jaws  144 ,  146  with smooth rotation and transition between the open and closed positions. It will also be recognized that the biasing strip  190  could also have its original, unbiased position formed as a V-shape or a U-shape, and be affixed to the jaws  144 ,  146  such that it exerts a radially inward biasing force. The free ends  192  of the metal strip  190  simply press against the jaws  144 ,  146 , but are not fixed or rigidly attached thereto. 
     Turning to  FIG.  23   , another embodiment of the medical device  240  is shown, again including a housing  242  and opposing jaws  244 ,  246  that are slidably attached thereto. The housing  242  again includes first and second guides  282 ,  284  for guiding movement of the jaws  244 ,  246 . In this embodiment however, each jaw  244 ,  246  includes a biasing strip  290   a ,  290   b , respectively. The distal ends  291  of the strips  290   a ,  290   b  are fixedly attached to the exterior of the jaws  244 ,  246 , preferably at their distal ends, and preferably by way of an adhesive, soldering, welding, or other known bonding techniques. As best seen in  FIGS.  24  and  25   , the housing  240  includes two exterior channels  294  on opposite sides of the housing  240  (one being shown in  FIGS.  24  and  25   ) which are sized to receive the resilient strips  290   a ,  290   b  such that they are flush with the exterior surface of the housing in the closed/retracted configuration. The proximal ends  293  of the strips  290   a ,  290   b  include a T-shaped formed by a base  295  and cross bar  296 . The base  295  extends through a smaller slot  296  formed through the housing  240 . The slots  296  are coextensive with the channels  294 . The cross bar  296  rides along the interior of the housing  240  and maintains the slidable connection between the strips  290  and the housing  240 . Accordingly, it can be seen that the proximal ends  293  of the strips  290   a ,  290   b  are slidably and pivotably attached to the housing  240  via the channel  294  and its slot  296 , allowing the strips  290   a ,  290   b  to travel with the grasping jaws  44 ,  46  as shown between their open and closed positions as shown in  FIGS.  24  and  25   . 
     Turning now to  FIGS.  26 - 30   , another embodiment of a driver  348  is shown. As best seen in  FIGS.  26  and  27   , the driver  348  again includes a socket  350  formed by two locking tabs  352  which have inner projections  353  and outer shoulders  354 , and which divide the socket  350  into a distal portion  353  and a proximal portion  350   p . Unlike the prior embodiments of the driver, in this embodiment the distal portion defines a geared rack that has a Z-shape. Generally, a central plate  356  replaces the central spine  56 ,  156  of the prior embodiments, and the plate  356  extends in a plane that is parallel to the longitudinal plane of the housing  342  ( FIG.  29   ). The plane of the central plate  356  is also perpendicular to a plane of the proximal half of the driver  348  (i.e. that which includes the socket  350  and tabs  352 ). A first set of teeth  358   a  project laterally away from the central plate  356  in a first direction, while a second set of teeth  358   b  project laterally away from the central plate  356  in a second direction. The first and second sets of teeth  358   a ,  358   b  extend from opposite ends of the central plate  356 , and the first and second directions are generally opposite each other. The sets of teeth  358   a ,  358   b  are each securely held to the central plate  356  by two outer frames  360  which extend around the periphery of the teeth  358   a ,  358   b.    
     Accordingly, and as best seen in  FIG.  28   , the medical device  340  includes first and second grasping jaws  344 ,  346  each having a proximal end  366  and gear teeth  368  which have been bent to project orthogonally away from a main body of the jaw  344 . Accordingly, the first set of teeth  358   a  receive the gear  368  of the second jaw  346 , while the second set of teeth  358   b  receive the gear  368  of the first jaw  344 . Notably, having the proximal ends  366  of the jaws  344 ,  346  bent laterally/orthogonally as shown allows a single pin  380  to be passed through the gears  368  and thus shared by both jaws  344 ,  346 . Still further, and as shown in  FIG.  29   , the housing  342  may thus include only a single guide surface  382  formed by a single slot on each lateral side of the housing  342  for receiving the ends of the single pin  380 . It can be seen that the first and second jaws  344 ,  346  thereby share a single guide surface  382  (a jaw guide surface) and guide slot, thus ensuring their coordinated operation and smooth opening and closing. 
     As also shown in  FIG.  29   , a slot  357  is formed in the central plate  356 , and is aligned with the pin  380  and jaw guide surface  382  to receive the pin  380  as the driver  348  moves forwardly relative to the jaws  344 ,  346 . As discussed above and shown in  FIG.  30   , when the pin  380  (shared by proximal ends  366  and gears  368  of the jaws  344 ,  346 ) has hit the distal end of the single jaw guide surface  382 , the driver  348  will continue moving distally to cause the gears  368  to rotate via the rack/teeth  358   a ,  358   b  of the driver  348 , thereby inducing rotation of the jaws  344 ,  346 . 
     Turning to  FIGS.  31 - 33   , another embodiment of the medical system  420  and medical device  440  are depicted. In this embodiment, medical system  420  again includes a drive wire  422  having a distal head  432  which is formed by bending the distal end of the drive wire  422  into the shape shown. The medical system  420  also includes a catheter attachment  430  which is generally a tubular member that is connected to the distal end of the catheter  24  and is used to slidably receive the connection block  426 . The catheter attachment  430  includes a pair of openings  434  to provide access to the control wire  422  and the connection block  426 , whereby a tool may be used to hold the connection block  426  in either a retracted or extended position, as further described in copending U.S. Appl. No. 61/391,878 filed concurrently herewith, and Appl. No. 61/391,875 filed concurrently herewith, the disclosures of which are hereby incorporated by reference in their entirety. 
     The medical device  440  includes a housing  442  which is detachably connected to the catheter  24  and its catheter attachment  430  via the connection block  426 . The housing  442  slidably receives the pair of jaws  444  which are connected to the drive wire  422  via the driver  448 . As with the previous embodiments, the driver  448  includes a socket  450  defined by locking tabs  452  which releasably engage the distal head  432  of the drive wire  422 . The distal portion of the driver  448  includes a plurality of teeth  458  which define a gear or rack which serves to drive rotation of the jaws  444  as previously described. The distal end  466  of the driver  448  includes a pocket defined by flanges which are used to fixably engage the biasing strip  490 . The housing  442  further defines a pair of guiding surfaces or slots  482  which guide the longitudinal and rotational movement of the jaws  444 . 
     In this embodiment, the jaws  444  and housing  442  are structured such that in the fully retracted position (shown), the jaws  444  project (at least partially) out distally from the end of the housing  442 . As best seen in  FIG.  32   , as the distal head  432  is pushed through the locking tabs  452  they are plastically deformed outwardly to engage the shoulders  446  in the housing, and the jaws  444  are fully retracted. In this way, the length of the housing  442  can be shortened, as can the guiding slots  482  therein for guiding the jaws  444 . It can also be seen in  FIG.  32    that the distal ends of the jaws  444  include serrations  445  or other structures which may aid in gripping tissue. 
     It is also noted that in this embodiment, as with all prior embodiments, the drive wire  422  is capable of transmitting rotational force and torque (e.g. from the proximal operating end of the system  20 / 420 ) through the distal head  432  and the driver  448  to the jaws  444 . As such the medical device  440  may be rotated via rotation of the drive wire  422 , i.e. the jaws  444 , jaw pins (e.g.  80 ), housing  442 , and driver  448  all rotate as a unit relative to the catheter  24 . In as much as the housing  442  may also be non-rotatably connected to the connection block  426  (e.g. depending on the friction therebetween), the connection block  426  may also rotate within the catheter attachment  430  (or the catheter, e.g.  24 , when the catheter attachment  430  is not used). Accordingly, the orientation of the jaws  444  may be rotated through rotation of the proximal end of the drive wire  422  to orient the jaws relative to the tissue or material being grasped or clipped. It has been found that forming the drive wire  422  out of a solid nitinol wire has provided good torque transmission for rotation of the medical device  440 . 
     It has also been found that having the jaws  444  project at least partially out of the housing  442  in their fully retracted position allows the orientation of the jaws  444  to be visualized so that it is easier to rotate the jaws  444  prior to opening and closing them around tissue. Still further, additional tissue may be encapsulated in the jaws  444  before the tissue abuts the distal end of the housing  442 . The distance which the jaws  444  project from the housing  442  may be varied depending upon a particular application, i.e. sized to correspond to the thickness of the tissue or the type of procedure being performed to insure good spacing between the distal ends of the jaws  444  and the distal end of the housing  442 . 
     The foregoing description of various embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise embodiments disclosed. Numerous modifications or variations are possible in light of the above teachings. The embodiments discussed were chosen and described to provide the best illustration of the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated. All such modifications and variations are within the scope of the invention as determined by the appended claims when interpreted in accordance with the breadth to which they are fairly, legally, and equitably entitled.