Patent Publication Number: US-2023149025-A1

Title: Ligation clip applier with clip retaining end effector

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Patent Application Serial No. 63/280,343, filed Nov. 17, 2021, the entire contents of which are hereby incorporated by reference herein. 
    
    
     FIELD 
     This disclosure is directed to ligation clip appliers for applying ligation clips to tissue and, more particularly, to multi-fire ligation clip appliers including an end effector for retaining the ligation clip within the end effector. 
     BACKGROUND 
     Ligation clip appliers for applying ligation clips to tissue are used during a variety of different types of surgical procedures to ligate body vessels. Some ligation clip appliers include clip cartridges that hold a plurality of ligation clips that can be sequentially fed to jaws of the clip applier to allow the clip applier to apply a plurality of clips onto tissue without removing the clip applier from a surgical site. These clip appliers are called multi-fire ligation clip appliers. 
     Multi-fire ligation clip appliers typically include an actuator handle, and elongated body, and an end effector supported on a distal end portion of the elongated body. The end effector includes first and second jaws that are movable in relation to each other between open and clamped positions. The elongated body supports a supply of ligation clips that are fed sequentially from the elongated body of the ligation clip applier into the end effector. When one of the clips is received within the end effector, the ligation clip must be properly supported between the jaws to allow application of the ligation clip to tissue. If the ligation clip is not properly supported between the jaws, the ligation clip can fall from between the jaws of the end effector or become disengaged from the jaws of the end effector such that the ligation clip cannot be properly applied to tissue. 
     SUMMARY 
     One aspect of the disclosure is directed to a ligation clip applier including an end effector and an elongated shaft assembly. The end effector includes a first jaw member and a second jaw member. The elongated shaft assembly defines a longitudinal axis and is configured to support a plurality of clips. The elongated shaft assembly is secured to the first and second jaw members. The elongated shaft assembly includes an outer tube and an inner tube supported within the outer tube. The outer tube is movable relative to the inner tube to move the first and second jaw members relative to one another. The elongated shaft assembly includes a stationary tab assembly and a movable tab assembly supported within the inner tube and configured to engage the plurality of clips. The movable tab assembly is axially movable relative to the stationary tab assembly to move the plurality of clips relative to the end effector. The movable tab assembly includes a flexible finger assembly supported on a distal end portion of the movable tab assembly and is positionable in a first position to load a first clip of the plurality of clips into the end effector when the movable tab assembly is advanced distally to a second position. The flexible finger assembly is pivotable relative to a second clip of the plurality of clips when the movable tab assembly is retracted proximally from the second position to the first position. The flexible finger assembly is configured to selectively load the second clip into the end effector when retracted back to the first position. 
     In aspects, the first jaw member may include a first jaw and mounting legs extending proximally from the first jaw. The mounting legs may be coupled to a jaw retainer secured to the inner tube. The first jaw may include an inner surface that defines a clip slot configured to support one clip of the plurality of clips at a time. The first jaw may include an outer surface having a proximal closing surface and a distal clamping mound that are engageable with the outer tube. The outer tube may include a distal finger that is engageable with the proximal closing surface to move the first jaw member from an open position to a closed position for supporting the one clip between the first and second jaw members in an unclamped position. The distal finger may be engageable with the distal clamping mound to move the first jaw member from the closed position to a clamping position for clamping a first leg and a second leg of the one clip together into a clamped position. 
     In aspects, the ligation clip applier may further include a lateral stability arm extending from the elongated shaft assembly and configured to engage a proximal end portion of the one clip. 
     In aspects, the movable tab assembly may include an elongated bar defining a plurality of interconnected tab sections, each tab section including a first tab that is angled inwardly toward the plurality of clips. Each tab section may further include a second tab that is angled inwardly toward the plurality of clips and a second elongated rib that is disposed between the first and second tabs. 
     In aspects, the ligation clip applier may further include flexible retainers secured to the first and second jaw members to facilitate securement of the first or second clips within the end effector. 
     Another aspect of this disclosure is directed to a surgical device including an end effector and an elongated shaft assembly. The end effector includes a first jaw member and a second jaw member. The elongated shaft assembly defines a longitudinal axis and is configured to support a plurality of clips. The elongated shaft assembly is secured to the end effector. The elongated shaft assembly includes a tube movable relative to the end effector. The elongated shaft assembly includes a movable tab assembly supported within the tube and including a plurality of tabs configured to engage the plurality of clips. The movable tab assembly is axially movable relative to the longitudinal axis to move the plurality of clips relative to the end effector. The movable tab assembly is positionable to load a first clip of the plurality of clips into the end effector when the movable tab assembly is advanced distally to a second position. The tube is engageable with the first and second jaw members to clamp the first clip between the first and second jaw members. 
     In aspects, the first jaw member may include a first jaw and mounting legs extending proximally from the first jaw. The mounting legs may be coupled to a jaw retainer supported within the tube. The first jaw may include an inner surface that defines a clip slot configured to support one clip of the plurality of clips at a time. The first jaw may include an outer surface having a proximal closing surface and a distal clamping mound that are engageable with the tube. The tube may include a distal finger that is engageable with the proximal closing surface to move the first jaw member from an open position to a closed position for supporting the one clip between the first and second jaw members in an unclamped position. The distal finger may be engageable with the distal clamping mound to move the first jaw member from the closed position to a clamping position for clamping a first leg and a second leg of the one clip together into a clamped position. 
     In aspects, the surgical device may further include a lateral stability arm extending from the elongated shaft assembly and configured to engage a proximal end portion of the one clip. 
     In aspects, the movable tab assembly may include an elongated bar defining a plurality of interconnected tab sections, each tab section including a plurality of tabs that is angled inwardly toward the plurality of clips. 
     In aspects, the surgical device may further include flexible retainers secured to the first and second jaw members to facilitate securement of the first clip within the end effector. 
     According to another aspect, this disclosure is directed to a surgical device including a plurality of clips, a first jaw member, a second jaw member, and an elongated shaft assembly. Each clip includes a hook and a catch configured to interlock with one another. The elongated shaft assembly is secured to the first and second jaw members and defines a longitudinal axis. The elongated shaft assembly includes a tube supporting the plurality of clips therein. The elongated shaft assembly includes a tab assembly supported within the tube and includes a plurality of angled tabs engaged with the plurality of clips for moving the plurality of clips through the tube in response to movement of the tab assembly relative to the tube. The tab assembly is positionable to load a distal-most clip of the plurality of clips into the end effector when the tab assembly moves relative to the tube. The tube is selectively engageable with an outer surface of the first and second jaw members to clamp the distal-most clip between the first and second jaw members such that the hook and the catch of the distal-most clip interlock with one another. 
     Other features of the disclosure will be appreciated from the following description. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various aspects of the disclosed ligation clip applier are described herein below with reference to the drawings, wherein: 
         FIG.  1    is a perspective view of a ligation clip applier according to exemplary aspects of the disclosure; 
         FIG.  2    is an enlarged view of the indicated area of detail shown in  FIG.  1    illustrating an end effector of the ligation clip applier of  FIG.  1    supporting a distal-most clip in an opened position; 
         FIG.  3    is another view of  FIG.  2    with portions thereof shown in phantom for clarity; 
         FIG.  4    is a perspective view of a distal portion of the ligation clip applier of  FIG.  1    with portions removed and/or shown in phantom for clarity; 
         FIG.  5    is an enlarged view of the indicated area of detail shown in  FIG.  4    illustrating a clip for loading into the end effector; 
         FIG.  6    is an enlarged, top, perspective view of a distal portion of the ligation clip applier of  FIG.  1    with portions thereof shown in phantom for clarity; 
         FIG.  7    is a perspective view, with parts separated, of a distal portion of the ligation clip applier of  FIG.  1   ; 
         FIGS.  8 ,  9 , and  11    are enlarged, perspective views, with parts separated, of the respective indicated areas of detail shown in  FIG.  7    illustrating various components of the distal portion of the ligation clip applier of  FIG.  1   ; 
         FIG.  10    is an enlarged, top, perspective view of a jaw member of the end effector of  FIG.  2   ; 
         FIG.  12    is a perspective view of the distal end portion of the of the ligation clip applier of  FIG.  1    with the jaw members of the end effector shown in an open position without a clip disposed therebetween; 
         FIG.  13    is an enlarged, cross-sectional view of  FIG.  12    as taken along section line  13 - 13 ; 
         FIGS.  14 - 25    are progressive views illustrating the ligation clip applier of  FIG.  1    being actuated for applying clips thereof to tissue; 
         FIG.  26    is a perspective view of a distal end portion of another ligation clip applier according to exemplary aspects of the disclosure, the distal end portion having an end effector with jaw members thereof shown in an open position; 
         FIG.  27    is an enlarged, top, perspective view of a jaw member of the ligation clip applier of  FIG.  26   ; 
         FIG.  28    is an enlarged, perspective view of a distal portion of  FIG.  27   , with parts separated; 
         FIG.  29    is a perspective view of the distal end portion of the ligation clip applier of  FIG.  26    with the jaw members thereof shown in a closed position without a clip therebetween; 
         FIG.  30    is an enlarged, cross-sectional view as taken along section line  30 - 30  of  FIG.  29   ; 
         FIGS.  31 - 33    are progressive views illustrating a clip being advanced into the end effector of the ligation clip applier of  FIG.  26    and between the jaw members; 
         FIG.  34    is a perspective view of a distal end portion of yet another ligation clip applier according to exemplary aspects of the disclosure, the distal end portion having an end effector with jaw members thereof shown in an open position and supporting a clip therebetween in an open position thereof; 
         FIG.  35    is a perspective view of lateral stability members of the ligation clip applier of  FIG.  34   ; 
         FIG.  36    is a top view of the distal end portion of the litigation clip applier of  FIG.  34    with portions thereof removed for clarity; 
         FIG.  37    is a perspective view of a distal end portion of still another ligation clip applier according to exemplary aspects of the disclosure, the distal end portion having an end effector with jaw members thereof shown in an open position and supporting a clip therebetween in an open position thereof; 
         FIG.  38    is an enlarged, perspective view of lateral stability members of the ligation clip applier of  FIG.  37   ; 
         FIG.  39    is a top view of the distal end portion of the litigation clip applier of  FIG.  37    with portions thereof removed for clarity; 
         FIG.  40    is a perspective view of a distal end portion of one ligation clip applier according to exemplary aspects of the disclosure, the distal end portion having an end effector with jaw members thereof shown in an open position and supporting a clip therebetween in an open position thereof; 
         FIG.  41    is an enlarged, perspective view of lateral stability members of the ligation clip applier of  FIG.  40   ; 
         FIG.  42    is a top view of the distal end portion of the litigation clip applier of  FIG.  40    with portions thereof removed for clarity; 
         FIG.  43    is a perspective view of a distal end portion of another ligation clip applier according to exemplary aspects of the disclosure, the distal end portion having an end effector with jaw members thereof shown in a closed position and supporting a clip therebetween in a closed position thereof; 
         FIG.  44    is a cross-sectional view of  FIG.  43    as taken along section line  44 - 44 ; 
         FIG.  45    is a cross-sectional view of  FIG.  44    as taken along section line  45 - 45 ; 
         FIG.  46    is a perspective view of a distal end portion of still another ligation clip applier according to exemplary aspects of the disclosure, the distal end portion having an end effector with jaw members thereof shown in an open position and supporting a clip therebetween in an open position thereof; 
         FIG.  47    is a cross-sectional view of  FIG.  46    as taken along section line  47 - 47 ; and 
         FIGS.  48 - 51    are progressive view of a distal end portion of yet another ligation clip applier according to exemplary aspects of the disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     The disclosed ligation clip applier will now be described in detail with reference to the drawings in which like reference numerals designate identical or corresponding elements in each of the several views. However, it is to be understood that aspects of the disclosure are merely exemplary of the disclosure and may be embodied in various forms. Well-known functions or constructions are not described in detail to avoid obscuring the disclosure in unnecessary detail. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the disclosure in virtually any appropriately detailed structure. In addition, directional terms such as distal, proximal, and similar terms are used to assist in understanding the description and are not intended to limit the disclosure. 
     In this description, the term “proximal” is used generally to refer to that portion of the device that is closer to a clinician, while the term “distal” is used generally to refer to that portion of the device that is farther from the clinician. In addition, the term “clinician” is used generally to refer to medical personnel including doctors, nurses, and support personnel. 
     With reference to  FIGS.  1 - 25   , a ligation clip applier  1  includes a handle assembly  10 , an elongated shaft assembly  20  extending distally from handle assembly  10 , and an end effector  30  supported on a distal end portion of elongated shaft assembly  20 . Handle assembly  10  has a stationary handle  12  and one or more triggers  14  that are movable relative to stationary handle  12 , as indicated by arrows “A,” for actuating ligation clip applier  1 . Handle assembly  10  further includes a rotatable knob  16  supported on a proximal end portion of elongated shaft assembly  20  to facilitate rotation of elongated shaft assembly  20  and end effector  30  about a longitudinal axis “L-L” defined therethrough. 
     End effector  30  of ligation clip applier  1  includes a first jaw member  32  and a second jaw member  34  that have proximal end portions secured to a distal end portion of elongated shaft assembly  20 . First and second jaw members  32 ,  34  are movable between an open position ( FIG.  2   ) and a closed position ( FIG.  14   ) to selectively secure clips  50 , one at a time, to tissue “T” (see  FIGS.  23  and  25   ). Clips  50  are supported in elongated shaft assembly  20 , in a longitudinal arrangement (e.g., tip-to-tail). Clips  50  are configured for sequential distal advancement through elongated shaft assembly  20  and into end effector  30  between first and second jaw members  32 ,  34  such that each clip of clips  50  becomes a distal-most clip  50   d  of clips  50  that can be fired from end effector  30  when loaded therein. 
     Elongated shaft assembly  20  of ligation clip applier  1  includes an outer tube  22 , an inner tube  24 , a jaw retainer  25 , tube spacers  26  that separate outer and inner tubes  22 ,  24 , a stationary tab assembly  27 , and a movable tab assembly  28 . 
     Outer tube  22  of elongated shaft assembly  20  has a rectangular body  22   a , which may be any suitable shape, that extends distally to distal fingers  22   b . Distal fingers  22   b  have teeth  22   c  ( FIG.  16   ) that are disposed in mirrored relationship to one another and are configured to selectively engage proximal end portions of first and second jaw members  32 ,  34  as outer tube  22  moves relative to end effector  30 . 
     Inner tube  24  of elongated shaft assembly  20  has a rectangular body  24   a , which may be any suitable shape, and which is supported within outer tube  22 . Rectangular body  24   a  defines spacer slots  24   b  at spaced apart locations along rectangular body  24   a , and which may extend through both sides of rectangular body  24   a , to facilitate securement of segments of tube spacers  26  thereto. 
     Tube spacers  26  of elongated shaft assembly  20  have segments  26   a , which may be C or U-shaped, that connect together about inner tube  24 . As best seen in  FIG.  11   , each segment  26   a  includes spaced apart prongs  26   b  extending from an inner surface thereof. Prongs  26   b  are receivable within spacer slots  24   b  of inner tube  24  to secure segments  26   a  to the respective sides of inner tube  24 . 
     Stationary tab assembly  27  of elongated shaft assembly  20  is configured to resist movement of clips  50  in a proximal direction and includes an elongated bar  27   a  defining a plurality of interconnected tab sections  27   b . Each tab section  27   b  includes a base  27   c  having a central elongated rib  27   d  extending distally from base  27   c  and separating first and second tabs  27   e ,  27   f  disposed on opposite sides of central elongated rib  27   d . First and second tabs  27   e ,  27   f  are angled inwardly (e.g., at an acute angle relative to base  27   c  and central elongated rib  27   d ) toward clips  50  and movable tab assembly  28  of elongated shaft assembly  20  to assist in retaining clips  50  in position prior to loading into end effector  30 . A distal most tab section  27   b  of elongated bar  27   a  includes an abutment  27   g  extending from a distal end portion of the central elongated rib  27   d  thereof. Abutment  27   g  extends transverse to central elongated rib  27   d  and curls inwardly (see  FIG.  8   ). 
     Movable tab assembly  28  of elongated shaft assembly  20  cooperates with stationary tab assembly  27  to support and advance clips  50  through ligation clip applier  1 . Movable tab assembly is configured to move (e.g., translate) in an axial direction relative to stationary tab assembly  27 . Movable tab assembly  28  is substantially structurally similar to stationary tab assembly  27  except movable tab assembly  28  includes a flexible finger assembly  29  (instead of an abutment) that extends distally from the central elongated rib  27   d  of a distal most tab section  27   b  of movable tab assembly  28 . Flexible finger assembly  29  includes an angled base  29   a  that extends distally from central elongated rib  27   d  and is angled inwardly toward clips  50  at an acute angle from distal most tab section  27   b  of movable tab assembly  28 . Flexible finger assembly  29  further includes a central linear digit  29   b  that extends distally from angled base  29   a  in an axial direction, and transverse digits  29   c  that are disposed on opposite sides of central linear digit  29   b , and which extend in a transverse direction (e.g., across the longitudinal axis “L-L”) relative to central linear digit  29   b  (see  FIG.  8   ). Central linear digit  29   b  is configured to provide lateral support to a proximal end portion of the distal most clip  50   d  when clip  50   d  is supported between first and second jaw members  32 ,  34  ( FIG.  17   ). 
     Jaw retainer  25  of elongated shaft assembly  20  includes segments  25   a , which may be C or U-shaped (although any suitable shape may be provided), that connect together about inner tube  24  on a distal end portion thereof adjacent first and second jaw members  32 ,  34 . As best seen in  FIG.  9   , each segment  25   a  includes spaced apart prongs  25   b  extending from a proximal end portion of an inner surface of the respective segment  25   a . Prongs  25   b  are receivable within spacer slots  24   b  of inner tube  24  to secure segments  25   a  to the respective sides of inner tube  24 . Each segment  25   a  defines support channels  25   c , which may be T-shaped (although any suitable shape may be provided), in a distal end portion of the inner surface thereof. The support channels  25   c  are spaced apart from one another and positioned to receive proximal end portions of first and second jaw members  32 ,  34  therein for securing first and second jaw members  32 ,  34  to jaw retainer  25 . 
     First and second jaw members  32 ,  34  of end effector  30  are substantially identical and each includes a jaw  33  having mounting legs  33   a  extending from a proximal end portion of jaw  33  to mounting feet  33   b  on a proximal end of mounting legs  33   a . Mounting feet  33   b , which may be T-shaped (although any suitable shape may be provided), are receivable within support channels  25   c  of jaw retainer  25  to secure first and second jaw members  32 ,  34  between inner tube  24  and jaw retainer  25 . Jaw  33  has an inner surface  33   x  that defines a clip slot  33   c  configured to receive clips  50  therein and an outer surface  33   y  configured to engage teeth  22   c  of distal fingers  22   b  of outer tube  22 . Clip slot  33   c  of inner surface  33   x  includes opposing lateral recess  33   d , a clip trap  33   e  in a central distal end portion of jaw  33 , and clip stop  33   f  at a distal end portion of jaw  33 . Outer surface  33   y  of jaw  33  includes a proximal closing surface  33   p  and a distal clamping mound  33   z  configured to cooperate with distal fingers  22   b  of outer tube  22  for selectively approximating first and second jaw members  32 ,  34  together (e.g., closing and/or clamping thereof). 
     Each clip  50  of ligation clip applier  1  includes a first leg  52 , a second leg  54 , and a curved backspan  56  that pivotably connects first and second legs  52 ,  54  together on a proximal end portion thereof. First leg  52  includes a transverse guide rod  52   a  on an outer surface thereof and a hook  52   b  a distal end portion thereof. Second leg  54  includes distal guides  54   a  disposed on opposed side surfaces of second leg  54 , and a catch  54   b  disposed between distal guides  54   a  and in registration with hook  52   b  of first leg  52 . Distal guides  54   a  may have a pear or tear drop shape. First and second legs  52 ,  54  include a plurality of spaced apart grips  57  supported on inner surfaces thereof. 
     In use, outer tube  22  is advanced distally toward end effector  30 , as indicated by arrows “A” shown in  FIGS.  14 - 16   , such that distal finger  22   b  of outer tube  22  cams over proximal closing surface  33 p of first and second jaw members  32 ,  34  to cause first and second jaw members  32 ,  34  to pivot, from an open position thereof, toward one another, as indicated by arrows “B,” and into a closed position thereof ( FIG.  16   ). In the closed position, the first and second jaw members  32 ,  34  are disposed in a parallel and spaced-apart relationship to one another sufficient to receive the distal-most clip  50   d  of clips  50  therebetween. Movable tab assembly  28  can then be distally advanced relative to stationary tab assembly  27 , as indicated by arrow “C” shown in  FIGS.  17  and  18   , to advance clips  50  distally, as indicated by arrows “D” shown in  FIG.  19   , so that distal-most clip  50   d  is received in clip slots  33   c  of first and second jaw members  32 ,  34 . In particular, transverse digits  29   c  of finger assembly  29  contact and distally urge the proximal end of distal-most clip  50   d  while first and second tabs  27   e ,  27   f  of movable tab assembly  28  contact and distally urge transverse guide rod  52   a  of first leg  52  and distal guides  54   a  of second leg  54  of each respective clip  50  to distally advance clips  50  along inner tube  24  of elongated shaft assembly  20 . 
     Once the distal-most clip  50   d  of clips  50  is fully seated within end effector  30  (e.g., where transverse guide rod  52   a  of first leg  52  and distal guides  54   a  of second leg  54  of distal-most clip  50   d  are engaged with clip stops  33   f  of first and second jaw members  32 ,  34 ), movable tab assembly  28  is then retracted proximally, as indicated by arrows “E” shown in  FIG.  20   . As movable tab assembly  28  retracts, a distally penultimate clip  50   p  engages flexible finger assembly  29  and causes flexible finger assembly  29  to pivot or flex outwardly about the distal end of central elongated rib  27   d  to which flexible finger assembly  29  is mounted, as indicated by arrow “F” shown in  FIG.  20   . Further retraction causes, first and second tabs  27   e ,  27   f  of each tab sections  27   b  of movable tab assembly  28  to engage a respective one of the remaining clips  50  (namely, the respective transverse guide rod  52   a , distal guides  54   a  thereof) that are proximal to the penultimate clip  50   p  so that the respective first and second tabs  27   e ,  27   f  likewise pivot or flex outwardly about the respective bases  27   a  thereof, as indicated by arrow “G” shown in  FIG.  21   . Once, movable tab assembly  50  retracts proximally a length of one clip of clips  50 , flexible finger assembly  29  and all first and second tabs  27   e ,  27   f  of movable tab assembly  28  are urged back or biased toward an initial or unflexed position, as indicated by arrows “H” and “I,” respectively, so that transverse digits  29   c  of flexible finger assembly  29  is in contact with the proximal end of distally penultimate clip  50   p  and first and second tabs  27   e ,  27   f  of movable tab assembly  28  are engaged with a respective one of the clips  50  proximal to the distally penultimate clip  50   p  as shown in  FIG.  22    (e.g., transverse guide rod  52   a  and distal guides  54   a  thereof). 
     Then, outer tube  22  can be retracted proximally relative to end effector  30 , as indicated by arrows “J” shown in  FIG.  23   , to enable first and second jaw members to move or pivot away from one another (e.g., open), as indicated by arrows “K,” so that distal-most clip  50   d  can open for capturing tissue “T” therebetween. Outer tube  22  can then distally advanced distally toward end effector  30 , as indicated by arrows “M” shown in  FIG.  24   , such that distal finger  22   b  of outer tube  22  cams over proximal closing surface  33 p and distal clamping mound  33 z of first and second jaw members  32 ,  34  to cause first and second jaw members  32 ,  34  to pivot, from an open position thereof, toward one another, as indicated by arrows “N,” beyond a closed position ( FIG.  16   ), and into a clamping position thereof ( FIG.  24   ), so that hook  52 b and catch  54   b  of distal-most clip  50   d  are interlocked to secure the tissue “T” between first and second legs  52 ,  54  of distal-most clip  50   d . Outer tube  22  is then retracted proximally relative to end effector  30  to enable first and second jaw members  32 ,  34  to pivot to the open position thereof for releasing distal-most clip  50   d  from ligation clip applier  1 . This process can be repeated as desired to sequentially fire each clip  50  from ligation clip applier  1 . 
     With reference to  FIGS.  26 - 33   , end effector  30  can include flexible retainers  60 ,  62  that are supported within first and second jaw members  32 ,  34  for supporting clips  50  within end effector  30 . Flexible retainer  60  includes a hook  60 a that is configured to engage transverse guide rod  52   a  of clips  50  and flexible retainer  62  includes a hook  62 a that is configured to engage distal guides  54   a . To enable distal-most clip  50   d  to fully seat within end effector  30 , flexible retainers  60 ,  62  are configured to flex or pivot outwardly, as indicated by arrows “ 0 ,” so transverse guide rod  52   a  and distal guides  54   a  of distal-most clip  50   d  can be advanced into end effector  30  and distally past flexible retainers  60 ,  62 , as indicated by arrows “P” shown in  FIG.  32   . Flexible retainers  60 ,  62  will bias or pivot inwardly back to an initial or unflexed position thereof, once distal-most clip  50   d  is fully seated within end effector  30 , as seen in  FIG.  33   . These retainers  60  are configured to retain clips  50  in end effector  30  and to limit movement of clips  50  with respect to first and second jaw members  32 ,  34  in longitudinal (e.g., proximal—distal) and vertical (e.g., from first to second jaw members  32 ,  34  or vice versa) directions. These retainers  60  are sufficiently strong to retain transverse guide rod  52   a  and distal guides  54  of clips  50  prior to a closing of such clip  50 . These retainers  60  are also sufficiently resilient to bend/deflect. 
     As seen in  FIGS.  34 - 51   , the ligation clip applier  1  can further include lateral stability arms, such as lateral stability arms  70 ,  80 ,  90 ,  100 , and  110  that provide lateral support to a proximal end portion of the distal-most clip  50   d  supported in end effector  30  through a range of clip movement (e.g., translation of clip  50 ). Advantageously, these features also minimize impact on clip firing while maintaining lateral stability of clip. For instance, lateral stability arms  70  may include an array of spaced-apart transverse support bars  72  (e.g., brush-like) or a pair of spaced-apart flexible wings  82  that extend laterally from a distal end portion of arms  70  or  80 . In aspects, lateral stability arms  100  may be coupled to the jaw retainer  25  and may be spring-biased by a spring  102  supported in the jaw retainer  25  (e.g., via retention block  104 ) to enable lateral stability arms  100  to translate between proximal and distal positions, as indicated by arrows “Q” shown in  FIGS.  46  and  47   , as clip  50  moves between proximal and distal positions. In some aspects, lateral stability arms  110  can include a compliant mechanism  112  (e.g., leaf springs) formed in the lateral stability arms  110  to enable arms  110  to move between extended ( FIG.  50   ) and retracted positions ( FIG.  48   ) as compliant mechanism  112 , namely, segments thereof, move between elongated ( FIG.  50   ) and retracted ( FIG.  48   ) positions. 
     In aspects, the first and/or second jaw members may include stainless steel, spring steel, titanium, other metal, polymer, resilient polymer, or combination of materials. In aspects, the first and/or second jaw members may be machined, welded, stamped, metal injection molded, injection molded, additive manufactured, etc. 
     In aspects, the outer tube may include stainless steel, titanium, or other metal, and/or a combination of metal end components which interact with the first and/or second jaw members and may include a polymer and/or a composite material. 
     In aspects, the tube spacers may be polymer. 
     In aspects, the inner tube may include stainless steel, titanium, or other metal. 
     In aspects, the stationary tab assembly may include metal or polymer or composite. 
     In aspects, the moving tab assembly may include metal (e.g., stainless steel), a composite, and/or may be overmolded. 
     In aspects, the jaw retainers may be a polymer, a metal, a composite, and/or integral to the inner tube or another component. 
     In aspects, the spacers may include polymer (likely ultra-high molecular weight polyethylene (UHMWPE) for lubricity and wear resistance), metal, or even may be integral to the inner tube or another component. 
     In aspects, the retention features may be a resilient material (polymer, elastomer, spring metal, Nitinol, etc.) or combination of materials. Depending on the material and the jaw material, the retention features may be attached to the jaw member by weld, overmold, adhesive, mechanical means, etc., or combinations thereof. 
     In aspects, the lateral stability arms may include a resilient material such as polymer, elastomer, or combination of materials. 
     Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary aspects of the disclosure. It is envisioned that the elements and features illustrated or described in connection with one exemplary aspect of the disclosure may be combined with the elements and features of another without departing from the scope of the disclosure. As well, one skilled in the art will appreciate further features and advantages of the disclosure based on the above-described aspects of the disclosure. Accordingly, the disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.