Patent Publication Number: US-11653930-B2

Title: Robotic assisted clip applier

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The instant application is a division of U.S. patent application Ser. No. 15/231,777, filed on Aug. 8, 2016, now U.S. Pat. No. 10,201,352, the disclosure of which is incorporated herein by reference. 
    
    
     INTRODUCTION TO THE INVENTION 
     The present disclosure is directed to medical instruments and, more specifically, to an applier that may be used to apply a left atrial appendage occlusion clip. 
     It is a first aspect of the present disclosure to provide a medical instrument comprising an end effector comprising a pair of repositionable jaws operatively coupled to an open-ended occlusion clip devoid of a handle control. 
     In a more detailed embodiment of the first aspect, the end effector includes a line concurrently mounted to the open-ended occlusion clip and the pair of repositionable jaws. In yet another more detailed embodiment, the line comprises at least a first line and a second line, the first line is concurrently mounted to the open-ended occlusion clip and a first of the pair of repositionable jaws, the second line is concurrently mounted to the open-ended occlusion clip and a second of the pair of repositionable jaws, and the first and second lines are repositionable to selectively dismount the first line from at least one of the open-ended occlusion clip and the first of the pair of repositionable jaws, and to selectively dismount the second line from at least one of the open-ended occlusion clip and the second of the pair of repositionable jaws. In a further detailed embodiment, the end effector includes pulleys operatively coupled to at least one of the pair of repositionable jaws. In still a further detailed embodiment, the first of the repositionable jaws is mounted to a first of the pulleys, the second of the repositionable jaws is mounted to a second of the pulleys, and a line engages the first and second pulleys. In a more detailed embodiment, the first repositionable jaw is mounted to a first and a third of the pulleys, the second repositionable jaw is mounted to a second and a fourth of the pulleys, and a line engages the first, second, third, and fourth pulleys. In a more detailed embodiment, each of the pair of repositionable jaws includes a channel configured to receive a deployment line, the deployment line operatively coupled to one of the pair of repositionable jaws and the open-ended occlusion clip. In another more detailed embodiment, the end effector includes at least one of a cavity and a projection configured to be engaged by a robotic grasper. In yet another more detailed embodiment, the end effector includes at least one of a plurality of projections and a plurality of cavities configured to be engaged by a robotic grasper. In still another more detailed embodiment, the open-ended occlusion clip comprises: (i) a first elongated occlusion arm; (ii) a second elongated occlusion arm; (iii) a first elongated biasing arm coupled to a distal portion of the first elongated occlusion arm; and, (iv) a second elongated biasing arm coupled to a distal portion of the second elongated occlusion arm, where a proximal portion of the first elongated biasing arm is coupled to a proximal portion of the second elongated biasing arm, where the first elongated occlusion arm extends parallel to the first elongated bias arm along a majority of its length, and where the second elongated occlusion arm extends parallel to the second elongated bias arm along a majority of its length. 
     It is a second aspect of the present invention to provide a medical instrument comprising an end effector comprising a first jaw configured to be repositionable with respect to a second jaw, the first and second jaws removably mounted to an open-ended occlusion clip, the end effector configured to configured to be removably coupled to an open-ended occlusion clip with a pair of terminal ends and first and second robotic arms, and wherein the end effector includes at least one of a cavity and a projection configured to be engaged by at least one of the first and second robotic arms. 
     In a more detailed embodiment of the second aspect, the end effector further comprises at least a first line and a second line, the first line is concurrently mounted to the open-ended occlusion clip and the first jaw, the second line is concurrently mounted to the open-ended occlusion clip and the second jaw, and the first and second lines are selectively repositionable to dismount the first and second lines from the open-ended occlusion clip and the first and second jaws. In yet another more detailed embodiment, the end effector includes pulleys operatively coupled to the first and second jaws. In a further detailed embodiment, the first jaw is mounted to a first of the pulleys, the second jaw is mounted to a second of the pulleys, and a line engages the first and second pulleys. In still a further detailed embodiment, the open-ended occlusion clip comprises: (i) a first elongated occlusion arm; (ii) a second elongated occlusion arm; (iii) a first elongated biasing arm coupled to a distal portion of the first elongated occlusion arm; and, (iv) a second elongated biasing arm coupled to a distal portion of the second elongated occlusion arm, where a proximal portion of the first elongated biasing arm is coupled to a proximal portion of the second elongated biasing arm, where the first elongated occlusion arm extends parallel to the first elongated bias arm along a majority of its length, where the second elongated occlusion arm extends parallel to the second elongated bias arm along a majority of its length. 
     It is a third aspect of the present invention to provide a method of fabricating an end effector that includes a first jaw repositionable with respect to a second jaw, the first and second jaws removably coupled to an open-ended occlusion clip with dual terminal ends, the method comprising: (a) detachably mounting the open-ended occlusion clip to the first and second jaws using a first line; (b) threading at least one pulley mounted to each of the first and second jaws with a second line, where the line extends from a first pulley of the first jaw to a second pulley of the second jaw; and, (c) directing the first and second lines through a portion of the end effector. 
     In a more detailed embodiment of the third aspect, the act of threading at least one pulley includes threading multiple pulleys associated with each of the first and second jaws to create a double tackle configuration. In yet another more detailed embodiment, the act of detachably mounting the open-ended occlusion clip includes threading the first line through a plurality of loops extending through at least one of the first and second jaws, the plurality of loops being mounted to the open-ended occlusion clip. 
     It is a fourth aspect of the present invention to provide a necrosis clip and applier comprising: (a) an open-ended necrosis clip comprising a first beam longitudinally aligned with and spaced apart from a second beam, the first beam operatively coupled to and longitudinally aligned with a third beam, the second beam operatively coupled to and longitudinally aligned with a fourth beam, where the third and fourth beams are coupled to one another, and where the first and second beams each include an unattached terminal end; (b) an end effector including a first jaw and a second jaw repositionably mounted to a housing, the first and second jaws operatively coupled to at least a gun tackle pulley configuration utilized to reposition at least one of the first and second jaws with respect to one another, where the first and second jaws are detachably mounted to the open-ended necrosis clip; and, (c) a robotic coupling feature associated with the end effector and configured to be engaged by a robotic surgical instrument to removably couple the robotic surgical instrument to the end effector. 
     In a more detailed embodiment of the fourth aspect, the robotic coupling feature includes at least one of a cavity and a projection configured to be engaged by the robotic surgical instrument. In yet another more detailed embodiment, the end effector includes a first detachment line in operative engagement with the first jaw of the end effector and the necrosis clip, and the end effector includes a second detachment line in operative engagement with the second jaw of the end effector and the necrosis clip. In a further detailed embodiment, the first jaw and the second jaw each include a channel configured to receive at least one of the first detachment line and the second detachment line. In still a further detailed embodiment, the first detachment line extends through a first loop coupled to the first j aw when the open-ended necrosis clip is detachably mounted to the first jaw, the second detachment line extends through a second loop coupled to the second jaw when the open-ended necrosis clip is detachably mounted to the second jaw, the first detachment line does not extend through the first loop coupled to the first jaw when the open-ended necrosis clip is detached from to the first jaw, and the second detachment line does not extend through the second loop coupled to the second jaw when the open-ended necrosis clip is detached from to the second jaw. In a more detailed embodiment, the first jaw includes a first channel configured to receive the first detachment line, the first jaw includes a first orifice configured to receive the first loop, the second jaw includes a second channel configured to receive the second detachment line, and the second jaw includes a second orifice configured to receive the second loop. In a more detailed embodiment, at least the gun tackle pulley configuration includes a first pulley, a second pulley, and a third pulley, the first jaw is mounted to the first pulley and the third pulley, the second jaw is mounted to the second pulley, and the line is fixedly coupled to the second jaw and repositionably engages the first pulley, the second pulley, and the third pulley. In another more detailed embodiment, at least the gun tackle pulley configuration includes a first pulley, a second pulley, a third pulley, and a fourth pulley, the first jaw is mounted to the first pulley and the third pulley, the second jaw is mounted to the second pulley and the fourth pulley, and the line is fixedly coupled to the first jaw and repositionably engages the first pulley, the second pulley, the third pulley, and the fourth pulley. In yet another more detailed embodiment, the first jaw pivotally engages the second jaw. 
     It is a fifth aspect of the present invention to provide a method of deploying an occlusion clip comprising: (a) inserting an open-ended occlusion clip with dual terminal ends removably mounted to an end effector through at least one of an incision and a trocar, the end effector devoid of a handle control, the open-ended occlusion clip and the end effector operatively coupled to one another prior to insertion into and through at least one of the incision and the trocar; (b) repositioning the end effector using a first robotic tool to reposition the open-ended occlusion clip so the open-ended occlusion clip is interposed by a portion of a left atrial appendage between a base and a tip of the left atrial appendage without needing to pass a tip of the left atrial appendage between opposing clamping surfaces of the open-ended occlusion clip and without needing to pierce the left atrial appendage; (c) clamping the left atrial appendage with the open-ended occlusion clip to cause necrosis to the left atrial appendage by repositioning a second robotic tool with respect to the end effector; (d) discontinuing operative coupling between the open-ended occlusion clip and the end effector; and, (e) withdrawing the end effector through at least one of the incision and the trocar. 
     In a more detailed embodiment of the fifth aspect, the inserting step occurs during at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach. In yet another more detailed embodiment, the method further includes insufflating a thoracic space prior to the inserting step. In a further detailed embodiment, the method further includes making an incision as part of a procedure comprising at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach, in addition to introducing a trocar through the incision. In still a further detailed embodiment, a first line is operatively coupled the end effector. In a more detailed embodiment, the end effector includes a first jaw operatively coupled to the open-ended occlusion clip, the end effector includes a second jaw operatively coupled to the open-ended occlusion clip, and repositioning the end effector to reposition the open-ended occlusion clip includes tensioning the first line to cause increased spacing between the first jaw and the second jaw. In a more detailed embodiment, the method further includes grasping the left atrial appendage concurrent with repositioning the end effector deployment device to reposition the occlusion clip so the open end of the open-ended occlusion clip is interposed by the portion of the left atrial appendage. In another more detailed embodiment, the method further includes repeating the repositioning and clamping steps prior to the disengaging step. In yet another more detailed embodiment, the method further includes confirming a clamping position of the open-ended occlusion clip is operative to cause necrosis to the left atrial appendage using at least one of visualization and a transesophageal echocardiogram. In still another more detailed embodiment, the inserting step includes inserting the open-ended occlusion clip and the end effector through the trocar, the withdrawing step includes withdrawing the end effector through the trocar, and the trocar comprises a twelve millimeter or less diameter cross-section. 
     It is a sixth aspect of the present invention to provide a method of deploying a necrosis clip comprising: (a) inserting an open-ended necrosis clip having dual terminal ends through a trocar, the open-ended necrosis clip removably mounted to an end effector at least partially including at least a gun tackle pulley configuration; (b) repositioning the end effector using a robotic arm to spatially reposition the open-ended necrosis clip proximate a portion of a left atrial appendage; (c) opening the open-ended necrosis clip using at least the gun tackle pulley configuration of the end effector to allow an open end of the open-ended necrosis clip to be interposed by a portion of a left atrial appendage, the portion of the left atrial appendage being between a base and a tip of the left atrial appendage, without passing the tip of the left atrial appendage between opposing clamping surfaces of the open-ended necrosis clip; (d) repositioning the end effector using the first robotic tool so the portion of the left atrial appendage interposes the opposing clamping surfaces of the open-ended necrosis clip; (e) clamping the left atrial appendage in an initial position between the opposing clamping surfaces of the open-ended necrosis clip by repositioning a second robotic tool; (f) assessing the operability of the open-ended necrosis clip in the initial position to cause necrosis of the left atrial appendage; and, (g) repositioning the open-ended necrosis clip to a subsequent position, different from the initial position, where the left atrial appendage is clamped between the opposing clamping surfaces of the open-ended necrosis clip, where repositioning the open-ended necrosis clip from the initial position to the subsequent position is repeatable without affecting the structural integrity of the left atrial appendage. 
     In a more detailed embodiment of the sixth aspect, the method further includes disengaging the open-ended necrosis clip from the end effector post initiation of necrosis of the left atrial appendage tip, and withdrawing the end effector through at least one of the incision and the trocar post disengaging the open-ended necrosis clip from the end effector. In yet another more detailed embodiment, the inserting step occurs during at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach. In a further detailed embodiment, the method further includes insufflating a thoracic space prior to the inserting step. In still a further detailed embodiment, the method further includes making an incision as part of a procedure comprising at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach, and introducing a trocar through the incision. In a more detailed embodiment, the method further includes grasping the left atrial appendage concurrent with repositioning the end effector deployment device to reposition the necrosis clip so the open end of the open-ended necrosis clip is interposed by the portion of the left atrial appendage. In a more detailed embodiment, the method further includes confirming application of the full bias of the open-ended necrosis clip is operative to cause necrosis of the left atrial appendage using at least one of visualization and a transesophageal echocardiogram. In another more detailed embodiment, the method further includes disengaging the open-ended necrosis clip from the end effector, wherein disengaging the open-ended necrosis clip from the end effector includes disengaging at least one wire operatively coupled to end effector and the open-ended necrosis clip. In yet another more detailed embodiment, the inserting step includes inserting the open-ended necrosis clip and the end effector through the trocar, and the trocar comprises a twelve millimeter or less diameter orifice. 
     It is a seventh aspect of the present invention to provide a necrosis clip and applier comprising: (a) an open-ended necrosis clip comprising a first beam longitudinally aligned with and spaced apart from a second beam, the first beam operatively coupled to and longitudinally aligned with a third beam, the second beam operatively coupled to and longitudinally aligned with a fourth beam, where the third and fourth beams are coupled to one another, and where the first and second beams each include an unattached terminal end; (b) an end effector including a first jaw and a second jaw repositionably mounted to a housing, where the first and second jaws are detachably mounted to the open-ended necrosis clip, the end effector also including a mechanical including component parts that are configured to allow rotational and angular repositioning with respect to a longitudinal axis extending through the mechanical joint. 
     In a more detailed embodiment of the seventh aspect, the mechanical joint includes a ball and socket joint. In yet another more detailed embodiment, the end effector includes at least one of a cavity and a projection configured to be engaged by a robotic grasper. In a further detailed embodiment, the first and second jaws are operatively coupled to at least a gun tackle pulley configuration utilized to reposition at least one of the first and second jaws with respect to one another, wherein the end effector further includes a line in communication with at least the gun tackle pulley configuration, and wherein the line extends beyond the bounds of the end effector. In still a further detailed embodiment, the apparatus further includes a first connector in operative engagement with at least one of the open-ended necrosis clip and the end effector. In a more detailed embodiment, the first connector includes a first detachment line in operative engagement with the first jaw of the end effector and the open-ended necrosis clip, and the first connector includes a second detachment line in operative engagement with the second jaw of the end effector and the open-ended necrosis clip. In a more detailed embodiment, the first jaw and the second jaw each include a channel configured to receive at least one of the first detachment line and the second detachment line. In another more detailed embodiment, the first detachment line extends through a first loop coupled to the first jaw when the open-ended necrosis clip is detachably mounted to the first jaw, the second detachment line extends through a second loop coupled to the second jaw when the open-ended necrosis clip is detachably mounted to the second jaw, the first detachment line does not extend through the first loop coupled to the first j aw when the open-ended necrosis clip is detached from to the first jaw, and the second detachment line does not extend through the second loop coupled to the second jaw when the open-ended necrosis clip is detached from to the second jaw. In yet another more detailed embodiment, the first jaw includes a first channel configured to receive the first detachment line, the first jaw includes a first orifice configured to receive the first loop, the second jaw includes a second channel configured to receive the second detachment line, and the second jaw includes a second orifice configured to receive the second loop. In still another more detailed embodiment, at least the gun tackle pulley configuration includes a first pulley, a second pulley, and a third pulley, the first jaw is mounted to the first pulley and the third pulley, the second jaw is mounted to the second pulley, and the line is fixedly coupled to the second jaw and repositionably engages the first pulley, the second pulley, and the third pulley. 
     In yet another more detailed embodiment of the seventh aspect, at least the gun tackle pulley configuration includes a first pulley, a second pulley, a third pulley, and a fourth pulley, the first jaw is mounted to the first pulley and the third pulley, the second jaw is mounted to the second pulley and the fourth pulley, and the line is fixedly coupled to the first jaw and repositionably engages the first pulley, the second pulley, the third pulley, and the fourth pulley. In yet another more detailed embodiment, first jaw pivotally engages the second jaw. In a further detailed embodiment, the end effector includes a pair of projections configured to be grasped by a robotic fenestrated grasper. 
     It is an eighth aspect of the present invention to provide a medical instrument comprising: (a) a pair of repositionable jaws; (b) an occlusion clip detachably mounted to the pair of repositionable jaws; (c) a folding support concurrently mounted to the pair of repositionable jaws, the folding support repositionable between a folded position and an unfolded position, where the folded position has the pair of repositionable jaws in closer proximity to one another than in the unfolded position, and a first connection operatively coupled to the folding support and configured to be repositioned by an instrument otherwise untethered from the folding support, the first connection repositionable with respect to the folding support to facilitate repositioning of the folding support between the folded position and the unfolded position. 
     In a more detailed embodiment of the eighth aspect, the apparatus further comprises a second connection operatively coupled to the occlusion clip and at least one of the pair of repositionable jaws when the occlusion clip is mounted to the pair of repositionable jaws, the second connection being configured to be repositioned and discontinue operative coupling between at least one of the occlusion clip and at least one of the pair of repositionable jaws. In yet another more detailed embodiment, the second connection comprises a line. In a further detailed embodiment, the line includes a first wire and a second wire, the first wire is concurrently mounted to the occlusion clip and a first of the pair of repositionable jaws, the second wire is concurrently mounted to the occlusion clip and a second of the pair of repositionable jaws, the line is repositionable to selectively dismount the first wire from at least one of the occlusion clip and the first of the pair of repositionable jaws, and is repositionable to selectively dismount the second wire from at least one of the occlusion clip and the second of the pair of repositionable jaws. In still a further detailed embodiment, the line includes a first wire, the first wire is concurrently mounted to the occlusion clip and a first of the pair of repositionable jaws at a first location, and concurrently mounted to the occlusion clip and a second of the pair of repositionable jaws at a second location, the line is repositionable to selectively dismount the occlusion clip and the first of the pair of repositionable jaws, as well as repositionable to selectively dismount the occlusion clip and the second of the pair of repositionable jaws. In a more detailed embodiment, the folding support is operatively coupled to a pulley and the first link. In a more detailed embodiment, the folding support includes: (i) a first link concurrently repositionably and operatively coupled to a first of the pair of repositionable jaws; (ii) a second link concurrently repositionably and operatively coupled to a second of the pair of repositionable jaws; (iii) a third link concurrently repositionably and operatively coupled to the first of the pair of repositionable jaws and the second link; and, (iv) a fourth link concurrently repositionably and operatively coupled to the second of the pair of repositionable jaws and the first link, where the third link is repositionably and operatively coupled to the fourth link. In another more detailed embodiment, the folding support includes a fifth link concurrently repositionably and operatively coupled to a sixth link and to the first link, wherein the sixth link is concurrently repositionably and operatively coupled to the fifth link and to the second link. In yet another more detailed embodiment, the fifth and sixth links are both mounted to and repositionable with respect to a pulley. In still another more detailed embodiment, the second joint includes a first camming surface to facilitate repositioning of the fifth link, and the second joint includes a second camming surface to facilitate repositioning of the sixth link. 
     In yet another more detailed embodiment of the eighth aspect, the first connection is operatively coupled to the fifth and sixth links. In yet another more detailed embodiment, the first connection includes a pulley operatively coupled to the fifth and sixth links. In a further detailed embodiment, the folding support comprises a folding pantograph support. 
     It is a ninth aspect of the present invention to provide a method of deploying an occlusion clip comprising: (a) inserting an occlusion clip removably mounted to an end effector deployment device having repositionable jaws through at least one of an incision and a trocar, the occlusion clip and the end effector deployment device mounted to one another when inserted into and through at least one of the incision and the trocar, the end effector deployment device including a folding support concurrently mounted to the pair of repositionable jaws, the end effector deployment device also including at least one of a projection and a cavity configured to be engaged by a first surgical otherwise untethered to the end effector deployment device; (b) repositioning the end effector proximate a left atrial appendage by using a second surgical device; (c) repositioning the folding support by using a second surgical device, which is otherwise untethered from the end effector deployment device, to reposition the occlusion clip so the occlusion clip is interposed by a part of a left atrial appendage in between a base and a tip of the left atrial appendage by passing the tip of the left atrial appendage between opposing clamping surfaces of the occlusion clip; (d) repositioning the folding support by using the second surgical device in order for the occlusion clip to clamp the left atrial appendage and occlude a portion of the left atrial appendage without piercing the left atrial appendage; (e) disengaging the occlusion clip from the end effector deployment device; and, (f) withdrawing the end effector deployment device through at least one of the incision and the trocar. 
     In a more detailed embodiment of the ninth aspect, the inserting step occurs during at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach. In yet another more detailed embodiment, the method further includes insufflating a thoracic space prior to the inserting step. In a further detailed embodiment, the method further includes making an incision as part of a procedure comprising at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach, and introducing a trocar through the incision. In still a further detailed embodiment, the method further includes grasping the left atrial appendage concurrent with repositioning the end effector deployment device to reposition the occlusion clip so the occlusion clip is interposed by the portion of the left atrial appendage. In a more detailed embodiment, the method further includes repeating the repositioning and clamping steps prior to the disengaging step. In a more detailed embodiment, the method further comprising confirming a clamping position of the occlusion clip is operative to occlude the portion of the left atrial appendage using at least one of visualization and a transesophageal echocardiogram. In another more detailed embodiment, the inserting step includes inserting the occlusion clip and the end effector deployment device through the trocar, the withdrawing step includes withdrawing the end effector deployment device through the trocar, and the trocar comprises a twelve millimeter or less diameter orifice 
     It is a tenth aspect of the present invention to provide a method of deploying an occlusion clip comprising: (a) inserting an occlusion clip removably mounted to an end effector deployment device having repositionable jaws through at least one of an incision and a trocar, the occlusion clip and the end effector deployment device mounted to one another when inserted into and through at least one of the incision and the trocar, the end effector deployment device including a folding support concurrently mounted to the pair of repositionable jaws; (b) repositioning the end effector deployment device to reposition the occlusion clip so the occlusion clip is interposed by a portion of a left atrial appendage interposing a base and a tip of the left atrial appendage by passing the tip of the left atrial appendage between opposing clamping surfaces of the occlusion clip; (c) clamping the left atrial appendage with the occlusion clip in an initial position without piercing the left atrial appendage between the occlusion clip; (d) assessing the operability of the occlusion clip in the initial position to occlude the left atrial appendage; and, (e) repositioning the end effector deployment device to reposition the occlusion clip to a subsequent position, different from the initial position, to clamp the left atrial appendage, where repositioning the occlusion clip from the initial position to the subsequent position is repeatable without affecting the structural integrity of the left atrial appendage. 
     It is an eleventh aspect of the present invention to provide a method of deploying an occlusion clip comprising: (a) inserting an occlusion clip removably mounted to an end effector deployment device, including repositionable jaws and a folding support concurrently mounted to the repositionable jaws, through at least one of an incision and a trocar, the occlusion clip biased to a clamping position; (b) repositioning the end effector deployment device to counteract a bias of the occlusion clip and reposition the occlusion clip to a tissue insertion position where the full bias of the occlusion clip is not applied to a left atrial appendage tissue; (c) repositioning the end effector deployment device to reposition the occlusion clip in the tissue insertion position so a portion of a left atrial appendage between a base and a tip of the left atrial appendage interposes the occlusion clip by having the tip of the left atrial appendage pass between opposing beams of the occlusion clip; (d) repositioning the occlusion clip to apply the full bias to the left atrial appendage; and (e) removing the end effector deployment device from around the left atrial appendage without passing the tip of the left atrial appendage between the repositionable jaws. 
     In a more detailed embodiment of the eleventh aspect, the method further includes disengaging the occlusion clip from the end effector deployment device, and withdrawing the end effector deployment device through at least one of the incision and the trocar. In yet another more detailed embodiment, the inserting step occurs during at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach. In a further detailed embodiment, the method further includes insufflating a thoracic space prior to the inserting step. In still a further detailed embodiment, the method further includes making an incision as part of a procedure comprising at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach, and introducing a trocar through the incision. In a more detailed embodiment, the method further includes grasping the left atrial appendage concurrent with repositioning the end effector deployment device to reposition the occlusion clip so the open end of the occlusion clip is interposed by the portion of the left atrial appendage. In a more detailed embodiment, the method further includes confirming application of the full bias of the occlusion clip is operative to occlude the left atrial appendage using at least one of visualization and a transesophageal echocardiogram. In another more detailed embodiment, the inserting step includes inserting the occlusion clip and the end effector deployment device through the trocar, and the trocar comprises a twelve millimeter or less diameter orifice. In yet another more detailed embodiment, the repositionable jaws include a pair of jaws that at least one of parallel open and parallel close, the pair of jaws comprise a first jaw and a second jaw, the first jaw is pivotally mounted to a first drive link and a first parallel link, the second jaw is pivotally mounted to a second drive link and a second parallel link, at least two of the first drive link, the second drive link, the first parallel link, and the second parallel link are pivotally mounted to a pulley. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    is an elevated perspective view of a first exemplary end effector coupled to a clip in a closed position in accordance with the instant disclosure shown coupled to first and second robotic graspers. 
         FIG.  2    is an elevated perspective view of the first exemplary end effector of  FIG.  1   , while coupled to a clip, shown with the clip in an open position in accordance with the instant disclosure when coupled to first and second robotic graspers. 
         FIG.  3    is an exploded view of the first exemplary end effector of  FIG.  1    with the occlusion clip. 
         FIG.  4    is a top view of an exemplary housing comprising part of the first exemplary end effector of  FIG.  1   . 
         FIG.  5    is a profile view of the exemplary housing of  FIG.  4   . 
         FIG.  6    is a proximal end view of the exemplary housing of  FIG.  4   . 
         FIG.  7    is a cross-sectional view of the exemplary housing of  FIG.  4    taken along line  4 - 4 . 
         FIG.  8    is a cross-sectional view of portions of the exemplary end effector of  FIG.  9    taken along line  9 - 9 . 
         FIG.  9    is an elevated perspective view of portions of the exemplary end effector in a closed position. 
         FIG.  10    is an elevated perspective view from an interior, proximal end of a first jaw in accordance with the instant invention. 
         FIG.  11    is an exterior side view of the first jaw of  FIG.  10   . 
         FIG.  12    is a bottom view of a second jaw in accordance with the instant disclosure. 
         FIG.  13    is an elevated perspective view from an interior, proximal end of the second jaw of  FIG.  12   . 
         FIG.  14    is an elevated perspective view from a proximal end, taken of a portion of the first exemplary end effector without the exemplary housing to show orientation and positioning of deployment wires and control wires for the exemplary jaws in accordance with the instant disclosure. 
         FIG.  15    is an elevated perspective view of the end effector of  FIG.  1    shown partially mounted to an occlusion clip via one jaw, while the second jaw is not shown to depict the position of the suture loops with respect to the clip when otherwise mounted to the dual jaws when the jaws are in an open position. 
         FIG.  16    is a profile view of a first alternate exemplary embodiment of an end effector for deploying an occlusion clip. 
         FIG.  17    is an elevated perspective view of a second exemplary end effector for deploying a clip in accordance with the instant disclosure shown mounted to first and second robotic tools with the clip in an open position. 
         FIG.  18    is an elevated perspective view of the end effector of  FIG.  1   , with the clip in a closed position. 
         FIG.  19    is an exploded view of the end effector of  FIGS.  1  and  2    with the occlusion clip. 
         FIG.  20    is an elevated perspective view from a proximal end of an exemplary linkage housing in accordance with the instant disclosure. 
         FIG.  21    is an elevated perspective view from a distal end of the exemplary linkage housing of  FIG.  20   . 
         FIG.  22    is a cross-sectional view of the exemplary linkage housing of  FIG.  21    taken along line  21 - 21 . 
         FIG.  23    is an elevated perspective view from a proximal end of an exemplary drive link in accordance with the instant disclosure. 
         FIG.  24    is an elevated perspective view from a distal end of the exemplary drive link of  FIG.  23   . 
         FIG.  25    is a profile view of the exemplary drive link of  FIG.  23   . 
         FIG.  26    is an elevated perspective view from a distal end of a first jaw in accordance with the instant invention. 
         FIG.  27    is profile view of a second jaw in accordance with the instant invention. 
         FIG.  28    is an elevated perspective view from a proximal end of an exemplary parallel link in accordance with the instant disclosure. 
         FIG.  29    is an elevated perspective view from a side of the exemplary parallel link of  FIG.  28   . 
         FIG.  30    is a bottom view of the exemplary parallel link of  FIG.  28   . 
         FIG.  31    is an elevated perspective view from a side showing the exemplary parallel links aligned with one another in a compact position. 
         FIG.  32    is an elevated perspective view from a distal end of an exemplary toggle in accordance with the instant disclosure. 
         FIG.  33    is an elevated perspective view from a bottom of the exemplary toggle of  FIG.  32   . 
         FIG.  34    is a profile view of the exemplary toggle of  FIG.  32   . 
         FIG.  35    is an elevated perspective view showing assembly of the toggles and drive links. 
         FIG.  36    is an elevated perspective view showing assembly of the toggles, parallel links, and drive links. 
         FIG.  37    is an elevated perspective view of an exemplary end effector having mounted thereto an occlusion clip in a closed position. 
         FIG.  38    is an elevated perspective view of the exemplary end effector and occlusion clip of  FIG.  37    shown without repositionable jaws. 
         FIG.  39    is an elevated perspective view of the exemplary end effector and occlusion clip of  FIG.  37    shown without repositionable jaws, first and second drive links, and first and second parallel links. 
         FIG.  40    is an elevated perspective view of the exemplary end effector and occlusion clip of  FIG.  37    shown without repositionable jaws, first and second drive links, first and second parallel links, and first and second toggles. 
         FIG.  41    is an elevated perspective view of an exemplary occlusion clip in accordance with the instant disclosure shown in an open position. 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of the present disclosure are described and illustrated below to encompass devices, methods, and techniques relating to surgical procedures. Of course, it will be apparent to those of ordinary skill in the art that the embodiments discussed below are exemplary in nature and may be reconfigured without departing from the scope and spirit of the present disclosure. It is also to be understood that variations of the exemplary embodiments contemplated by one of ordinary skill in the art shall concurrently comprise part of the instant disclosure. However, for clarity and precision, the exemplary embodiments as discussed below may include optional steps, methods, and features that one of ordinary skill should recognize as not being a requisite to fall within the scope of the present disclosure. 
     Referencing  FIGS.  1 - 3   , a first exemplary robotic end effector  100  may be used in minimally invasive surgical procedures to allow deployment of an LAA occlusion clip  102  with respect to a left atrial appendage (not shown) with the assistance of a surgical position, such as a robotic arm having a robotic grasper  104  provided as part of the da Vinci surgical system available from Intuitive Surgical. U.S. Provisional Patent Application No. 62/091,230, and U.S. Nonprovisisonal patent application Ser. No. 14/964,930, which each describe an exemplary LAA occlusion/necrosis clip  102 , are incorporated herein by reference. As will be apparent to those skilled in the art after reviewing the instant disclosure, the end effector  100  may be utilized in capacities other than LAA occlusion clip deployment, each of which is within the scope of this disclosure. 
     The end effector  100  comprises a housing  130  that is mounted distally to a first pin  140  and a second pin  150  that extend through corresponding distal openings  662  of a first jaw  160  and a second jaw  170  (see  FIG.  10   ). In this fashion, the jaws  160 ,  170  are rotatably repositionable with respect to the housing  130  and with respect to one another. Each jaw  160 ,  170  includes a set of U-shaped proximal projections that overlap one another and each include a through opening  682  aligned with one another configured to receive a respective third pin  180  and fourth pin  190  (see  FIG.  10   ). The spacing between the U-shaped projections is sufficient to each accommodate a respective pair of pulleys  200 ,  210  that rotate about a respective pin  180 ,  190 . As will be discussed in more detail hereafter, a control wire  1364  is fed around the pulleys  200 ,  210  and is utilized to cause the jaws  160 ,  170  to pivot with respect to one another and with respect to the housing  130  for opening and closing in a non-parallel fashion. More specifically, when a first fenestrated robotic grasper  80  sandwiches the housing  130 , and a second fenestrated robotic grasper  90  captures an enlarged portion  1365  of the control wire  1364 , continued tensioning of the control wire resulting from movement of the second fenestrated robotic grasper away from the housing  130  causes the first and second jaws  160 ,  170  to pivot with respect to one another and cause the occlusion/necrosis clip  102  mounted thereto to progressively open.  FIG.  1    depicts the occlusion/necrosis clip  102  in a closed position, while  FIG.  2    depicts the occlusion/necrosis clip  102  in an open position. A more detailed discussion of the component parts of the end effector  100  follows. 
     As shown in  FIGS.  4 - 7   , the housing  130  includes an outer shell  400  that defines a longitudinal passage  402  extending therethrough. The longitudinal passage  402  is sized to accommodate the control wire  1364  coupled to the pulleys  200 ,  210  (see  FIG.  3   ) in addition to a pair of deployment wires  1402 ,  1404  (see  FIG.  14   ) used to selectively couple the occlusion clip  102  to the respective jaws  160 ,  170 . As will be discussed in more detail hereafter, repositioning of the control wire  1364  with respect to the housing  130  and pulleys  200 ,  210  results in component motion operative to increase or decrease the distance between the distal ends of the opposing jaws  160 ,  170  (when the occlusion clip  102  is mounted to the jaws  160 ,  170 , this component motion is also operative to open or close the occlusion clip). 
     The outer shell  400  also includes a ledge  420  on its proximal end from which extend opposing projections  422 . The projections  422  are sized to allow grasping by the first fenestrated robotic grasper  80 , such as a robotic grasper provided as part of the da Vinci surgical system available from Intuitive Surgical. As will be discussed in more detail hereafter, first fenestrated robotic grasper  80  is intended to direct repositioning of the end effector  100  independent of the position of the second fenestrated robotic grasper  90 . Opposite the proximal end, the outer shell  400  is configured to be repositionably mounted to the jaws  160 ,  170  on its distal end. 
     In exemplary form, a distal end of the housing  130  includes a pair of outer retention arms  530 ,  532  each including facing interior planar surfaces  554 , that are bridged laterally by complementary arcuate surfaces  558  and opposing exterior surfaces  556 . A distal most portion of each retention arm  530 ,  532  includes a planar surface  560  normal to the interior and exterior surfaces  554 ,  556 . In this exemplary embodiment, the retention arms  530 ,  532  have a rounded, rectangular footprint typified by the interior surfaces  554  having a rounded rectangular footprint slightly larger than the exterior surfaces  556  rounded rectangular footprint. Proximate the distal, ninety degree corners of the retention arms  530 ,  532  are corresponding through holes  564  that extend between the interior and exterior surfaces  554 ,  556 . 
     Each through hole  564  is sized to receive at least one of the first pin  140  and the second pin  150  in order to pivotally mount a corresponding jaw  160 ,  170  to the housing  130  (see  FIG.  3   ). In this exemplary embodiment, each through hole  564  is sized to retain a corresponding pin  140 ,  150  therein via a friction fit (though fits other than a friction fit may be utilized) so that the pin does not rotate with respect to the housing  130 , but nonetheless the jaws  160 ,  170  are able to rotate about the pins  140 ,  50 . It should be noted that alternatively, for example, the through holes  564  may be sized to allow rotation of a corresponding pin  140 ,  150  therein so that the pins and jaws  160 ,  170  rotate together with respect to the housing  130  (in which case the pin  140 ,  150  received by a respective jaw  160 ,  170  may not be independently rotationally repositionable with respect to that jaw). 
     Referencing  FIGS.  8 - 14   , the jaws  160 ,  170  are structurally mirror images of one another, with the exception of the cams  600 ,  602 . Consequently, the following discussion of the structure of a jaw is generally applicable to both the first and second jaws  160 ,  170  unless otherwise noted. 
     Each jaw  160 ,  170  includes a rounded proximal end  660  that transitions distally into a rectangular cross-section with an openings  662 , extending between opposing top and bottom surfaces  666 ,  668 , and having a cylindrical shape configured to receive one of the first and second pins  140 ,  150 . In this fashion, the first and second jaws  160 ,  170  may be rotationally repositionable with respect to the housing  130  by pivoting about the first and second pins  140 ,  150 . A corresponding cam  600 ,  602  extends from an interior surface  670  spanning between the top and bottom surfaces  666 ,  668 . The cams  600 ,  602  engage one another to guide pivoting of the jaws  160 ,  170  with respect to one another. In exemplary form, the first cam  600  of the first jaw  160  has a rounded rectangular profile but for a U-shaped cavity  674  formed therein, with spaced apart ends  672  that are rounded. This U-shaped cavity  674  is configured to receive a corresponding rounded projection  676  of the second cam  602 . Moreover, rounded shoulders  678  of the second cam  602  are configured to engage the rounded ends  672  of the first cam  600  in order to provide corresponding range of motion stops. In particular, the distal most rounded end  672  of the first cam  600  will engage the distal most rounded shoulder  678  of the second cam  602  to limit the pivotal motion of the jaws  160 ,  170  toward one another. Similarly, the proximal most rounded end  672  of the first cam  600  will engage the proximal most rounded shoulder  678  of the second cam  602  to limit the pivotal motion of the jaws  160 ,  170  away from one another. In other words, the rounded ends  672  of the first cam  600  do not engage the rounded shoulders  678  of the second cam  602  until an end of the range of motion of the jaws  160 ,  170  is reached. Conversely, the surface of the first cam  600  delineating the U-shaped cavity  674  is configured to maintain contact with the surface delineating the rounded projection  676  of the second cam  602  through the pivotal range of motion of the jaws  160 ,  170  with respect to one another. 
     As part of repositioning the jaws  160 ,  170  with respect to one another, the proximal end  660  of each jaw includes a cavity  680  that is sized to receive a corresponding pair of pulleys  200 ,  210 . In order to mount the pulleys  200 ,  210  to the jaws  160 ,  170 , a pair of through openings  682  extends through portions of the jaws, where the through openings  682  are longitudinally aligned. More specifically, the through openings  682  are configured to receive a corresponding third or fourth pin  180 ,  190  that concurrently extends through the corresponding pulleys  200 ,  210  in order to mount the pulleys to a jaw. In this exemplary embodiment, each through opening  682  is sized to retain a corresponding pin  180 ,  190  therein via a friction fit so that the pin does not rotate or move longitudinally with respect to the jaw  160 ,  170 , though fits other than a friction fit may be utilized, while allowing the pulleys  200 ,  210  to rotate with respect to the pin and jaw. Unlike the second jaw  170 , the first jaw  160  includes a through opening  684  extending between the interior surface  670  and an exterior surface  671  of the rectangular-shape profile section. This through opening  684  is sized to receive an end of the control wire  1364  and allow the control wire to pass therethrough, but not so large as to allow an enlarged end of the control wire to pass therethrough. Accordingly, as the control wire  1364  is tensioned, the structure delineating the through opening  684  acts as an anchor to hold an end of the control wire in place. Thus, the pulleys  200 ,  210  are positioned in a double tackle configuration. As used herein, “tackle” refers to a rope, wire, or other connector section threaded between two blocks, where “block” refers to a pulley mounted on a single axle. As known by those skilled in the art, tackles may be duplicated to create greater and greater mechanical advantage. By way of example, a double tackle configuration comprises four rope sections of the tackles, whereas a luff tackle comprises three rope sections, and a gun tackle comprises two rope sections. In this manner, a luff tackle and a double tackle inherently include a gun tackle. Wires can be single strand metal wire (stainless, music wire, copper, aluminum) or a thin plastic rod made from monofilament flexible plastics such as UHMW, nylon, Teflon, urethane, PET etc., or braided ropes such as metallic (e.g., stainless steel, nitinol, etc.), plastic, and composite. 
     Though the foregoing exemplary embodiment has been described using four pulleys  200 ,  210  in a double tackle configuration, it should be noted that other pulley configurations may be used, such as, without limitation, a gun tackle configuration, a watch/Luff tackle configuration, a Gyn tackle configuration, and a three fold purchase configuration, as well as combinations and duplications of the foregoing. 
     Extending distally past the rectangular cross-section, each jaw  160 ,  170  includes an arcuate profile that is slightly convex on an exterior surface  692  and concave on an interior surface  690 . Opposing top and bottom surfaces  696 ,  698  are essentially planar and extend parallel to one another. Perimeter surfaces  694  extending between the interior surface  690  and corresponding top and bottom surfaces  696 ,  698  have an arcuate shape in the longitudinal direction (proximal to distal) and these surfaces cooperate to delineate an interior recess  700  that is sized to receive a corresponding portion of the occlusion clip  102 . On the opposite exterior surface  692 , a channel  702  is sized and configured to receive a respective deployment wire  1402 ,  1404  (see  FIG.  14   ), whereas the openings  686  are sized to accommodate throughput of a suture retainer coupled to the occlusion clip  102 . 
     Referring to  FIGS.  1 - 3  and  14   , an exemplary assembly sequence for the exemplary end effector  100  will now be described. Initially, the control and deployment wires  1364 ,  1402 ,  1404  are routed through the housing  130 . Specifically, the wires  1364 ,  1402 ,  1404  extend through the longitudinal passage  402  of the housing  130 . It should be noted that for simplicity, the deployment wires  1402 ,  1404  have been omitted from  FIGS.  1 - 3    to show operation of the deployment wire  1364  to open and close the jaws  160 ,  170 . 
     Each jaw  160 ,  170  is prepared for mounting to the housing  130  by mounting each jaw to a respective set of pulleys  200 ,  210 . Specifically, the first set of pulleys  200  are inserted into the proximal end cavity  680  so that the openings through the pulleys are aligned with corresponding openings  682  of the first jaw  160 . Thereafter, the third pin  180  is inserted into the openings  682  and through the pulleys  200  in order to mount the pulleys to the first jaw  160 . Similarly, the second set of pulleys  210  are inserted into the proximal end cavity  680  of the second jaw  170  so that the openings through the pulleys are aligned with corresponding openings  682  of the second jaw. Thereafter, the fourth pin  190  is inserted into the openings  682  and through the pulleys  210  in order to mount the pulleys to the second jaw  170 . After the pulleys  200 ,  210  are mounted to a respective jaw  160 ,  170 , the control wire  1364  is threaded around the pulleys  200 ,  210  so that a distal enlarged end extends through the opening  684  of the first jaw  160 . The control wire  1364  may then be processed (such as by attaching a spherical retainer) to enlarge the distal end prohibiting throughput of an end portion of the control wire through the opening  684 . Likewise, the deployment wires  1402 ,  1404  are directed into corresponding channels  702  (see  FIG.  11   ) of the jaws  160 ,  170 . 
     Referring to  FIGS.  1 - 3  and  7 - 15   , post preparation, each jaw  160 ,  170  is mounted to the housing  130 . In exemplary form, the interiors of each jaw  160 ,  170  are oriented to face one another and the openings  662  of each jaw are aligned with a respective through hole  564  of the housing  130 . Thereafter, first and second pins  140 ,  150  are inserted through the holes  564  and through the openings  662  so that the jaws  160 ,  170  are pivotally mounted to the housing  130 . The size of the pins  140 ,  150  is such that the pins are press fit in the jaws and slip fit with respect to the housing  130 , but are not large enough in diameter to inhibit rotation of the jaws  160 ,  170  when the control wire  1364  is repositioned with respect to the pulleys  200 ,  210 . In this alignment, the cams  600 ,  602  engage one another to guide rotational repositioning of the jaws  160 ,  170  with respect to one another. More specifically, the U-shaped cavity  674  of the first cam  600  receives the rounded projection  676  of the second cam  602 . 
     After the jaws  160 ,  170  have been mounted to the housing  130 , the occlusion clip  102  may be mounted to the jaws. In exemplary form, the occlusion clip  102  is oriented so that its parallel beams are longitudinally aligned and inset with respect to the jaws  160 ,  170 , and so that the open end of the occlusion clip is adjacent the open end of the jaws. A series of suture loops  725  (e.g., retainer loops) are longitudinally spaced apart and extend along a length of each beam of the occlusion clip  102 , where a portion of each retainer extends through a corresponding opening  686  of an adjacent jaw  160 ,  170  so that a suture loop  725  extends through each opening  686  and exits on an exterior of a respective jaw. Thereafter, a respective deployment wire  1402 ,  1404  is fed into a respective channel  702  so that the deployment wire extends through each of the suture loops  725 . In this fashion, the occlusion clip  102  is inhibited from detaching from the jaws  160 ,  170  until the deployment wires  1402 ,  1404  are withdrawn from the retainer loops, thus allowing the loops to be pulled through the openings  686  to free the occlusion clip from the jaws. And the deployment wires  1402 ,  1404  along with the control wire  1364  are manipulated via the user control  20 . 
     The following is an exemplary procedure for utilizing the exemplary end effector  100  to deploy the occlusion clip  102  to occlude a left atrial appendage (LAA). Initially, an incision is made on either the left or right side of the chest wall in an intercostal space that is appropriate for the desired angle of approach to a LAA. The incision may be made through the chest wall or through the abdomen (or through the back) as part of various procedures that include, without limitation, an open sternotomy, a left thoracotomy, a right thoracotomy, a left port, a right port, a subxiphoid approach, and a transdiaphragmatic approach. Post incision, a trocar (e.g., 12 millimeter or smaller) may be inserted through the incision to extend into the thoracic cavity. In certain instances, it may be preferred to insufflate the thoracic space subsequent to trocar insertion using known techniques. Using at least one of the incision and trocar, surgical instruments are introduced into the thoracic space in order to perform a series of dissections, including dissection of the pericardium, to provide egress to the LAA. After having access to the LAA, the end effector  100  may be inserted into the thoracic cavity by way of the incision or trocar. 
     After the end effector  100  is passed through the trocar or incision, the surgeon may utilize a first fenestrated robotic grasper  80  to grasp the outer housing  130 . In exemplary form, the first fenestrated robotic grasper  80  may include a pair of bounded openings sized to receive the opposing projections  422  of the outer housing  130 . In this fashion, once the robotic grasper  80  grasps the outer housing  130  so that the opposing projections  422  are received within the bounded openings, the robotic grasper controls repositioning of the end effector  100  (but not opening and closing of the jaws  160 ,  170  or clip  102  deployment from the end effector). As a result, the user controlling the position of the robotic grasper  80  is operative to navigate the end effector  100  (and occlusion clip  102 ) proximate the LAA. By way of example, the robotic grasper  80  is operative to vary the yaw of the end effector  100  within an X-Y plane, as well as being operative to vary the pitch of the end effector within a Y-Z plane. After navigating the LAA occlusion clip  102  proximate the LAA, the occlusion clip is opened prior to deployment on the LAA. 
     Opening the LAA occlusion clip  102  is carried out by using a second fenestrated robotic grasper  90 . In particular, robotic grasper  90  circumscribes the enlarged end  1365  of the control wire  1364  while the jaws of the robotic grasper sandwich a portion of the control wire therebetween. In this fashion, as the robotic grasper is repositioned away from the proximal end of the outer housing  130 , the control wire  1364  is tensioned and pulled proximally. This proximal movement of the control wire  1364  causes the control wire extending between the pulleys  200 ,  210  to decrease, thereby causing the proximal ends of its jaws  160 ,  170  to move toward one another. This movement of the proximal ends of the jaws  160 ,  170  toward one another coincides with the distal ends of the jaws (comprising the far end of the end effector  100 ) moving away from one another to effectively open the jaws and correspondingly opens the clip  102 , which is suture  725  tied to the jaws at this point. Post opening of the LAA occlusion clip  102 , the clip is repositioned using the first robotic grasper  80  is repositioned (in concert with the second robotic grasper  90  to maintain the control wire  1364  in tension to maintain the open position of the jaws  160 ,  170 ) so that the open end of the occlusion clip is advanced from a side of the LAA, proximate the base of the LAA, until an entire circumference of the LAA interposes corresponding occlusion surfaces of the clip. It should be noted that forceps may be used to grasp a portion of the LAA (proximate the LAA tip) when repositioning the LAA occlusion clip  102  via the robotic grasper  80 . After the clip  102  has been positioned at the base of the LAA, with the LAA interposing corresponding occlusion surfaces of the clip, second robotic grasper  90  may be repositioned toward the outer housing  130 , which results in a greater amount of control wire between the pulleys  200 ,  210 , thus allowing the proximal ends of the jaws to move away from one another, thereby moving the distal ends of the jaws toward one another and eventually closing the clip  102  to sandwich the LAA between the occlusion clip surfaces. It should be noted that various steps may be undertaken to ensure the entire periphery of a portion of LAA is sandwiched by the clip  102  such as, without limitation, direct visual verification and utilization of a transesophageal echocardiogram. If any problems are determined with respect to clip  102  placement, the opening and closing clip sequence may be repeated along with repositioning of the end effector  100  and clip  102  using the robotic graspers  80 ,  90  to adjust the positioning of the clip with respect to the LAA. Upon closing the occlusion clip  102  around a periphery of a portion of the LAA, proximate the LAA base, as well as confirming the placement of the closed clip being operative to occlude the LAA, the surgeon may release the clip from the end effector  100 . 
     To release the clip  102  from the end effector  100 , the deployment wires  1402 ,  1404  are repositioned proximally and discontinue engagement with the suture loops  725  that were previously concurrently attached to the deployment clip  102  and the jaws  160 ,  170 . When the engagement between the deployment wires  1402 ,  1404  and the suture loops  725  is discontinued, the occlusion clip  102  is no longer fastened to the jaws  160 ,  170  (i.e., the jaws can be opened and closed without repositioning the clip). In exemplary form, after the second robotic grasper  90  is finished with grasping the control wire  1364  to open and close the jaws  160 ,  170 , the second robotic grasper may be utilized to grasp the exposed portions of the deployment wires  1402 ,  1404  extending proximally from the jaws. The second grasper  90  may grasp one or both deployment wires  1402 ,  1404  and be pulled away from the outer housing  130  in a straight pull fashion until each wire no longer engages the suture loops  725 . After disengagement between the occlusion clip  102  and the end effector  100 , the end effector is may be repositioned from proximate the LAA by repositioning the first robotic grasper  80 , thereby removing the end effector from the cardiac space. 
     Removal of the end effector  100  from the patient&#39;s body may be controlled via any number of methods. Because the end effector  100  is open-ended, there is no need to reposition the end effector upward along the LAA tip because the end effector can be withdrawn laterally, thus reducing the potential for contact between the end effector and the LAA. In other words, the end effector  100  may be removed from around the LAA without having a tip of the LAA passing between the jaws  160 ,  170 . 
     Turning to  FIG.  16   , an alternate exemplary end effector  100 ′, which may be utilized in lieu of the first exemplary end effector  100 , comprises a two piece housing  130 ′ which is slightly different from the single piece outer housing  130  previously discussed. Unless otherwise noted, the structures of the housings  130 ,  130 ′ are the same. The housing  130 ′ includes an outer shell  400 ′ that defines a longitudinal passage  402 ′ extending therethrough. A proximal end  404 ′ of the shell  400 ′ that partially delineates the longitudinal passage  402 ′ includes a spherical projection  300  that is repositionable with respect to a receiver  302 , which is configured to be grasped by a first fenestrated grasper  80 . In exemplary form, the receiver  302  includes a bowl  304  that delineates a semi spherical depression into which the projection  300  is received. More specifically, the projection  300  is repositionably coupled to the receiver  302  so that the projection is rotationally repositionable about an X-axis  306  that extends axially through the receiver  302 . In addition, the projection  300  is angularly repositionable with respect to the X-axis  304  between zero and fifty-five degrees. The longitudinal passage  402 ′ is also partially delineated by the receiver  302  in order to allow throughput and repositioning of the deployment wires  1402 ,  1404  and control wire  1364 , which are respectively mounted to the jaws  160 ,  170  and pulleys  200 ,  210  (not shown in  FIG.  16   ). 
     The receiver  302  includes an inner, cylindrical surface  406  that circumscribes a distal end  1390  (see  FIG.  3   ) of the flexible tubing  30  and retains the distal end of the flexible tubing therein via a compression fit or adhesive fit, for example. As was discussed previously, repositioning of the control wire  1364  may result in component motion operative to increase or decrease the distance between the distal ends of the opposing jaws  160 ,  170  (when the occlusion clip  102  is mounted to the jaws  160 ,  170 , this component motion is also operative to open or close the occlusion clip). 
     As with the first exemplary housing  130 , the receiver  302  of this alternate exemplary housing  103 ′ includes a ledge on its proximal end from which extend opposing projections (not shown). The projections are sized to allow grasping by a surgical grasping and repositioning tool  104 , such as a robotic grasper provided as part of the da Vinci surgical system available from Intuitive Surgical. As discussed previously, the surgical grasping and repositioning tool  104  is intended to direct repositioning of the end effector independent of the position of the user control  20  by taking into account the properties of the flexible tube  30 . 
     As with the first exemplary housing  130 , the outer shell  400 ′ includes a pair of outer retention arms  530 ,  532  each including opposed exterior and interior planar surfaces  554 ,  556 , that are bridged laterally by complementary arcuate surfaces  558 . A distal most portion of each retention arm  530 ,  532  includes a planar surface  560  normal to the interior and exterior planar surfaces  554 ,  556 . In this exemplary embodiment, the retention arms  530 ,  532  have a rounded, rectangular footprint typified by the interior surfaces  556  having a rounded rectangular footprint slightly larger than the exterior surfaces  554  rounded rectangular footprint. Proximate the distal, ninety degree corners of the retention arms  530 ,  532  are corresponding through holes  564  that extend between the interior and exterior surfaces  554 ,  556 . 
     As depicted in  FIG.  16   , analogous to the first exemplary end effector  100 , each through hole  564  is sized to receive at least one of the first pin  140  and the second pin  150  in order to pivotally mount a corresponding jaw  160 ,  170  to the housing  130 . In this exemplary embodiment, each through hole  564  is sized to retain a corresponding pin  140 ,  150  therein via a friction fit (though fits other than a friction fit may be utilized) so that the pin does not rotate with respect to the housing  130 , but nonetheless the jaws  160 ,  170  rotate about the pins  140 ,  50 . It should be noted that alternatively, for example, the through holes  564  may be sized to allow rotation of a corresponding pin  140 ,  150  therein so that the pins and jaws  160 ,  170  rotate together with respect to the housing  130  (in which case the pin  140 ,  150  received by a respective jaw  160 ,  170  may not be independently rotationally repositionable with respect to that jaw). 
     An exemplary assembly sequence for the alternate exemplary end effector  100 ′ includes mounting the outer shell  400 ′ to the receiver  302 . More specifically, the projection  300  of the outer shell  400 ′ is received within the bowl  304  to create a snap-fit connection as a result of the bowl circumscribing more than 180 degrees of the spherical projection. Yet in this snap-fit connection, the projection  300  is repositionably coupled to the receiver  302  so that the projection is rotationally repositionable about the X-axis  304  and angularly repositionable with respect to the X-axis  304  between zero and fifty-five degrees. Post mounting the outer shell  400 ′ to the receiver  302 , the control and deployment wires  1364 ,  1402 ,  1404  may be routed through the housing  130 ′ along the longitudinal passage  402 ′ and through the flexible tube  30 . Specifically, the wires  1364 ,  1402 ,  1404  extend through the longitudinal passage  402 ′ of the housing  130 ′, through the hollow flexible tube  30 , and into the interior of the user control  20 . 
     Each jaw  160 ,  170  is prepared for mounting to the outer shell  400 ′ of the housing  130 ′ by mounting each jaw to a respective set of pulleys  200 ,  210 . Specifically, the first set of pulleys  200  are inserted into the proximal end cavity  680  so that the openings through the pulleys are aligned with corresponding openings  682  of the first jaw  160 . Thereafter, the third pin  180  is inserted into the openings  682  and through the pulleys  200  in order to mount the pulleys to the first jaw  160 . Similarly, the second set of pulleys  210  are inserted into the proximal end cavity  680  of the second jaw  170  so that the openings through the pulleys are aligned with corresponding openings  682  of the second jaw. Thereafter, the fourth pin  190  is inserted into the openings  682  and through the pulleys  210  in order to mount the pulleys to the second jaw  170 . After the pulleys  200 ,  210  are mounted to a respective jaw  160 ,  170 , the control wire  1364  is threaded around the pulleys  200 ,  210  so that a distal end extends through the opening  684  of the first jaw  160 . The control wire  1364  may then be processed (such as by attaching a spherical retainer) to enlarge the distal end prohibiting throughput of an end portion of the control wire through the opening  684 . Likewise, the deployment wires  1402 ,  1404  are directed into corresponding channels  702  of the jaws  160 ,  170 . 
     Post preparation, each jaw  160 ,  170  is mounted to the outer shell  400 ′ of the housing  130 ′. In exemplary form, the interiors of each jaw  160 ,  170  are oriented to face one another and the openings  662  of each jaw are aligned with a respective through hole  564  of the outer shell  400 ′. Thereafter, first and second pins  140 ,  150  are inserted through the holes  564  and through the openings  662  so that the jaws  160 ,  170  are pivotally mounted to the outer shell  400 ′. The size of the pins  140 ,  150  is such that the pins frictionally fit with respect to the outer shell  400 ′, but are not large enough in diameter to inhibit rotation of the jaws  160 ,  170  when the control wire  1364  is repositioned with respect to the pulleys  200 ,  210 . In this alignment, the cams  600 ,  602  engage one another to guide rotational repositioning of the jaws  160 ,  170  with respect to one another. More specifically, the U-shaped cavity  674  of the first cam  600  receives the rounded projection  676  of the second cam  602 . 
     After the jaws  160 ,  170  have been mounted to the outer shell  400 ′, the occlusion clip  102  may be mounted to the jaws. In exemplary form, the occlusion clip  102  is oriented so that its parallel beams are longitudinally aligned and inset with respect to the jaws  160 ,  170 , and so that the open end of the occlusion clip is adjacent the open end of the jaws. A series of suture loops  725  (e.g., retainer loops) are longitudinally spaced apart and extend along a length of each beam of the occlusion clip  102 , where a portion of each retainer extends through a corresponding opening  686  of an adjacent jaw  160 ,  170  so that a suture loop  725  extends through each opening  686  and exits on an exterior of a respective jaw. Thereafter, a respective deployment wires  1402 ,  1404  is fed into a respective channel  702  so that the deployment wire extends through each of the suture loops  725 . In this fashion, the occlusion clip  102  is inhibited from detaching from the jaws  160 ,  170  until the deployment wires  1402 ,  1404  are withdrawn from the retainer loops, thus allowing the loops to be pulled through the openings  686  to free the occlusion clip from the jaws. And the deployment wires  1402 ,  1404  along with the control wire  1364  are manipulated via the user control  20 . 
     Consistent with the foregoing exemplary discussion for utilizing the first exemplary end effector  100 , the second exemplary end effector  100 ′ may be similarly utilized in lieu of the first exemplary end effector  100  and, consequently, a detailed explanation of utilizing the second exemplary end effector  100  has been omitted in furtherance of brevity. 
     Referring to  FIGS.  17 - 40   , an exemplary end effector  2100  may be used in minimally invasive surgical procedures to allow deployment of an LAA occlusion clip  2102  with respect to a left atrial appendage (not shown). United States Patent Application Publication number  2012 / 0059400 , which describes an exemplary LAA occlusion clip  2102 , is incorporated herein by reference. As will be apparent to those skilled in the art after reviewing the instant disclosure, the end effector  2100  may be utilized in capacities other than LAA occlusion clip deployment, each of which is within the scope of this disclosure. 
     The end effector  2100  comprises a linkage housing  2130 , where a medial portion of the linkage housing  2130  has mounted to it a first pin  2160  that extends through a first drive link  2140  and a second drive link  2150 . In this fashion, the first drive link  2140  and the second drive link  2150  are rotatably repositionable with respect to the linkage housing  2130  and with respect to one another along a common axis longitudinally aligned with the first pin  2160 . A distal portion of the linkage housing  2130  has mounted to it a second pin  2170  and a third pin  2230  that extends through proximal ends of a first parallel link  2180  and a second parallel link  2190 . In this fashion, the first parallel link  2180  and the second parallel link  2190  are rotatably repositionable with respect to the linkage housing  2130  and with respect to one another along a common axis longitudinally aligned with the second and third pins  2170 ,  2230 . 
     Interposing the proximal ends of the first and second parallel links  2180 ,  2190  are a first toggle  2200 , a second toggle  2210 , and a pulley  2220 . The pulley  2220  includes a pair of cylindrical projections extending in opposite directions along a rotational axis of the pulley, where the first toggle  2200  is mounted to a first of the cylindrical projections and the second toggle  2210  is mounted to a second of the cylindrical projections. A distal end of the first drive link  2140  is mounted to a proximal end of a first jaw  2240 , whereas a distal end of the second drive link  2150  is mounted to a proximal end of a second jaw  2250 . In this fashion, the first drive link  2140  is rotatably repositionable with respect to the first jaw  2240  along a common axis longitudinally aligned with a fifth pin  2260  that concurrently extends through the first drive link and the first jaw. Similarly, the second drive link  2150  is rotatably repositionable with respect to the second jaw  2250  along a common axis longitudinally aligned with a sixth pin  2270  that concurrently extends through the second drive link and the second jaw. 
     Near the proximal end of the first jaw  2240 , inset distally from the location where the first drive link  2140  is mounted, the distal end of the first parallel link  2180  is mounted to the first jaw. In this fashion, the first parallel link  2180  is rotatably repositionable with respect to the first jaw  2240  along a common axis longitudinally aligned with a seventh pin  2290  that concurrently extends through the first parallel link and the first jaw. In corresponding fashion, the proximal end of the second jaw  2250 , inset distally from the location where the second drive link  2150 , is mounted to the distal end of the second parallel link  2190 . Similarly, the second parallel link  2190  is rotatably repositionable with respect to the second jaw  2250  along a common axis longitudinally aligned with an eighth pin  2300  that concurrently extends through the second parallel link and the second jaw. 
     In this exemplary end effector  2100 , the jaws  2240 ,  2250  are repositioned toward and away from one another while maintaining a parallel orientation. In order to reposition the first and second jaws  2240 ,  2250  with respect to one another, the first and second drive links  2140 ,  2150  as well as the first and second parallel links  2180 ,  2190  are rotated with respect to the linkage housing  2130 . To facilitate this repositioning of the jaws  2240 ,  2250  with respect to one another, the distal ends of the first and second toggles  2200 ,  2210  are mounted to medial portions of respective drive links  2140 ,  2150 . In particular, the distal end of the first toggle  2200  is mounted to a medial portion of the first drive link  2140  via a ninth pin  2310 . Accordingly, the first toggle  2200  is rotatably repositionable with respect to the first drive link  2140  along a common axis longitudinally aligned with the ninth pin  2310 . In addition, the distal end of the second toggle  2210  is mounted to a medial portion of the second drive link  2150  via a tenth pin  2320 . Consequently, the second toggle  2210  is rotatably repositionable with respect to the second drive link  2150  along a common axis longitudinally aligned with the tenth pin  2320 . A more detailed discussion of the component parts of the end effector  2100  follows. 
     As shown in  FIGS.  20 - 22   , the linkage housing  2130  includes a pair of elongated projections  2510  extending outward from a trapezoidal block  2511  extending laterally, proximally, and distally offset from a midline and from opposing top and bottom exterior surfaces  2512  of the linkage housing. In this exemplary embodiment, the projections  2510  include a plateau surface  2514  that is generally planar and angled other than parallel with respect to the planar top/bottom surface  2512 . A peripheral shape of each projection  2510  is rectangular on a proximal end  2513  and is rounded on a distal end  2515  and generally centered with respect to the trapezoidal block  2511 . In particular, a peripheral surface  2516  of each projection  2510  has a substantially constant height from distal to proximal to provide a uniform height of the projection  2510  proximal to distal. 
     A proximal end  2522  of the linkage housing  2130  is semicircular in profile. In particular, the proximal end  2522  includes a miniature channel  2526  that terminates at a corresponding through opening  2546  extending into an interior of the linkage housing  2130 . The through opening  2546  extends distally and terminates in between a pair of inner arms  2534 ,  2536 . The central through opening  2546  is sized to accommodate a control wire  3364  coupled to the pulley  2220  (see  FIG.  17   ). As will be discussed in more detail hereafter, repositioning of the pulley  2220  with respect to the linkage housing  2130  results in component motion operative to increase or decrease the distance between the opposing jaws  2240 ,  2250  responsive to components being pivotally connected to a pair of outer retention arms  2530 ,  2532  and the inner arms  2534 ,  2536 . 
     In exemplary form, the outer retention arms  2530 ,  2532  each include a respective interior wall surface  2552  that provides a camming surface against which the parallel links  2180 ,  2190  rotate. In this exemplary embodiment, the interior wall surfaces  2552  are planar and parallel to one another. A distal orifice  2568  extends through the entire outer retention arm  2530 ,  2532 . The distal orifice  2568  is sized to accommodate one of the second pin  2170  and the third pin  2230  in order to allow pivotal motion between the linkage housing  2130  and the parallel links  2180 ,  2190 . By way of example, the distal orifices  2568  of the outer retention arms  2530 ,  2532  are cylindrical and have axial centers that lie along a common axis. In addition to the distal orifice, each outer retention arm  2530 ,  2532  also includes a proximal orifice  2570  that extends entirely through the outer retention arm. The proximal orifice  2570  is sized to accommodate the first pin  2160  in order to allow pivotal motion between the linkage housing  2130  and the drive links  2140 ,  2150 . By way of example, the proximal orifices  2570  of the outer retention arms  2530 ,  2532  are cylindrical and have axial centers that lie along a common axis. 
     The inner arms  2534 ,  2536  extend distally and are generally parallel with the outer retention arms  2530 ,  2532 , with spacing between each set of adjacent arms. In exemplary form, the inner arms  2534 ,  2536  each include a single hole  2580  that extends laterally through the arm and is cylindrical in shape. A central axis extending through each hole  2580  is coaxial with the counterpart central axis of the other hole. Likewise, the central axis of the holes  2580  is coaxial with the common axis of the proximal orifices  2570  so that the holes and orifices are sized to accommodate the first pin  2160  in order to allow pivotal motion between the linkage housing  2130  and the drive links  2140 ,  2150  (compare  FIGS.  17  and  18   ). The spacing between the arms  2534 ,  2536  allows for proximal-to-distal motion of the pulley  2220  therebetween, while prohibiting motion of the toggles  2200 ,  2210  therebetween. Rather, the first arm  2534  includes a triangular projection extending distally, the hypotenuse of which comprises a first surface  2582  that is angled to generally face the top surface  2512 . Similarly, the second arm  2536  includes a triangular projection extending distally, the hypotenuse of which comprises a second surface  2584  that is angled to generally face the bottom surface  2512 . In this exemplary embodiment, the surfaces  2582 ,  2584  are perpendicular to one another and, as will be discussed in more detail hereafter, the toggles  2200 ,  2210  contact these surfaces in order to limit repositioning of the toggles as the pulley  2220  is repositioned. 
     Referencing  FIGS.  19  and  23 - 25   , the first and second drive links  2140 ,  2150  as well as the first and second parallel links  2180 ,  2190  are rotationally repositionable and mounted to the linkage housing  2130 . In exemplary form, the first and second drive links  2140 ,  2150  are structurally identical, but differ only in operation based upon the components mounted thereto. Consequently, the following discussion of the structure of a drive link is applicable to both the first and second drive links  2140 ,  2150 . 
     Each drive link  2140 ,  2150  comprises a unitary structure including a pair of spaced apart, tilted uprights  2590 ,  2592  that are angled approximately forty-five degrees with respect to corresponding longitudinal extensions  2594 ,  2596 . The base of the uprights  2590 ,  2592  are joined to one another via a bridge  2598 . In exemplary form, each upright  2590 ,  2592  includes a rounded proximal end  2600  that interposes opposing planar surfaces  2604 ,  2606 . Extending completely through each upright  2590 ,  2592  is a hole  2610  partially bounded by the opposing planar surfaces  2604 ,  2606  and having a cylindrical shape that is sized to accommodate throughput of the first pin  2160  and allow rotational repositioning of each upright around the first pin. Each upright  2590 ,  2592  also includes a step  2612  recessed distally beyond the proximal end  2600  and the hole  2610 . The step  2612 , as will be discussed in more detail hereafter, is inset to approximately half of the thickness of the widest portion of the upright  2590 ,  2592 . Extending distally from the step  2612 , each upright  2590 ,  2592  seamlessly transitions into a respective longitudinal extension  2594 ,  2596 . The bridge  2598  is positioned approximate the transition region between the uprights  2590 ,  2592  and the longitudinal extensions  2594 ,  2596  and recessed with respect to bottom planar surfaces  2614  of the longitudinal extensions. On the top side  2616  of each drive link  2140 ,  2150 , the bridge  2598  seamlessly transitions into the longitudinal extensions  2594 ,  2596  an embodies an arcuate, convex longitudinal profile so that the top of each longitudinal extension includes a longitudinal ridge  2618  extending from the bridge  2598  distally toward a distal rounded end  2620  of each longitudinal extension. Along the longitudinal length of each longitudinal extension  2594 ,  2596  is a pair of openings  2622 ,  2624  extending completely through the longitudinal extensions between opposing lateral inner and exterior sides  2628 ,  2630 . Each opening  2622 ,  2624  has a cylindrical shape and is configured to receive at least one of the fifth, sixth, ninth, and tenth pins  2260 ,  2270 ,  2310 ,  2320 . In this fashion, the first and second toggles  2200 ,  2210  as well as the first and second jaws  2240 ,  2250  may be rotationally repositionable with respect to one of the drive links  2140 ,  2150 . 
     Referring to  FIGS.  19  and  32 - 34   , the first and second toggles  2200 ,  2210  as well as the first and second jaws  2240 ,  2250  are rotationally repositionable and mounted to the drive links  2140 ,  2150 . In exemplary form, the first and second toggles  2200 ,  2210  are structurally identical, but differ only in operation based upon the components mounted thereto. Consequently, the following discussion of the structure of a toggle is applicable to both the first and second toggles  2200 ,  2210 . 
     Each toggle  2200 ,  2210  comprises a unitary structure including toggle connector portion  2640  and a drive link connector portion  2642 . In exemplary form, the toggle connector portion includes a rounded end  2644  with a substantially constant width that is approximately half of the width of the drive link connector portion  2642 . Along the longitudinal length of the toggle connector portion  2640 , an arcuate profile exists. This toggle connector portion  2640  includes a through opening  2646  having a cylindrical shape and configured to receive a cylindrical projection of the pulley  2220  so that the toggle  2200 ,  2210  is rotationally repositionable about the pulley  2220 . 
     Opposite the toggle connector portion  2640 , the drive link connector portion  2642  includes an offset  2648  extending widthwise beyond the width of the toggle connector. An opening  2650  extends through the drive link connector portion  2642  and the offset  2648  having a cylindrical shape and configured to receive one of the ninth and tenth pins  2310 ,  2320  so that the toggle  2200 ,  2210  is rotationally repositionable about a drive link  2140 ,  2150 . A partial circumferential groove  2652  exists on the rounded end  2654  of the drive link connector portion  2642 . This groove  2652  is configured to receive a portion of a deployment wire  3402 ,  3404  (see  FIG.  39   ) in order to allow the deployment wire to contact and be unimpeded by motion of the toggle  2200 ,  2210  when the toggle is repositioned and/or when the deployment wire is repositioned with respect to the jaws  2240 ,  2250  in order to detach, for example, a left atrial occlusion clip  2102  temporarily mounted to the jaws. 
     As shown in  FIGS.  26  and  27   , the jaws  2240 ,  2250  are structurally mirror images of one another. Consequently, the following discussion of the structure of a jaw is generally applicable to both the first and second jaws  2240 ,  2250 . 
     Each jaw  2240 ,  2250  includes a rounded proximal end  2660  that transitions distally into a rectangular cross-section with a pair of openings  2662 ,  2664  extending between opposing top and bottom surfaces  2666 ,  2668  each having a cylindrical shape and being configured to receive at least one of the fifth, sixth, seventh, and eighth pins  2260 ,  2270 ,  2290 ,  2300  (see  FIG.  19   ). In this fashion, the first and second jaws  2240 ,  2250  may be rotationally repositionable with respect to the drive links  2140 ,  2150  and the parallel links  2180 ,  2190 . The rectangular cross-section also includes one of a series of openings  2670  on an interior surface  2672  in communication with a plurality of openings  2674  and channels  2676  formed into the opposing exterior surface  2678 . In this exemplary embodiment, the channels  2676  are sized and configured to receive a respective deployment wire  3402 ,  3404 , whereas the openings  2670 ,  2674  are sized to accommodate throughput of a suture retainer coupled to the left atrial occlusion clip  2102 . The interior surface  2672  also has formed therein a LAA spring depression  2676  sized and configured to receive a biasing spring of the left atrial occlusion clip  2102  (see  FIG.  37   ). This LAA spring depression  2679  is in communication with a longitudinal depression  2677  formed into the interior surface  2672  and the bottom surface  2668 . And this longitudinal depression  2677  is sized and configured to receive occlusion bars of the left atrial occlusion clip  2102 . Each jaw  2240 ,  2250  tapers longitudinally from proximal to distal after passing beyond the LAA spring depression  2679  to terminate at a rounded distal end  2680 . As part of repositioning the jaws  2240 ,  2250  with respect to one another, the parallel links  2180 ,  2190  are also repositioned with respect to one another. 
     Referring to  FIGS.  19  and  28 - 31   , the first and second parallel links  2180 ,  2190  are structurally identical, but differ only in operation based upon the components mounted thereto. Consequently, the following discussion of the structure of a parallel link is applicable to both the first and second parallel links  2180 ,  2190 . 
     Each parallel link  2180 ,  2190  comprises a unitary structure including a pair of spaced apart heads  2700 ,  2702  that are angled approximately forty-five degrees with respect to corresponding longitudinal legs  2704 ,  2706 . Near a base, the heads  2700 ,  2702  are joined to one another via a link  2710 . In exemplary form, each head  2700 ,  2702  includes a tapered proximal end  2714 , which is rounded at a far proximal tip, that includes a hole  2716  partially bounded by opposing interior and exterior planar surfaces  2718 ,  2720 , as well as an arcuate exterior surface  2722 . The hole  2716  has a cylindrical shape that is size to accommodate throughput of at least one of the seventh and eighth pin  2290 ,  2300  and allow rotational repositioning of a respective parallel link  2180 ,  2190  around a respective jaw  2240 ,  2250 . Each head  2700 ,  2702  includes an S-shaped profile  2722  on one widthwise side that is configured to track an inverse S-shaped profile  2724  associated with an opposite side of the same head  2700 ,  2702 . In this fashion, as shown in  FIG.  31    when the parallel links  2180 ,  2190  are positioned adjacent one another and the jaws  2240 ,  2250  are least spaced apart, the S-shaped contour  2722  of one side of the first head  2700  of the first parallel link  2180  tracks the inverse S-shaped contour  2724  of a second side of the second head  2702  of the second parallel link  2190 . Each head  2700 ,  2702  also includes a width that is roughly twice the width of the corresponding longitudinal legs  2704 ,  2706 . In this fashion, the portion of heads  2700 ,  2702  with the inverse S-shaped profile  2724  is offset in a widthwise dimension from the corresponding longitudinal leg  2704 ,  2706 . 
     The corresponding longitudinal legs  2704 ,  2706  extend parallel and spaced apart from one another in the widthwise direction. The only meaningful difference between the corresponding longitudinal legs  2704 ,  2706  is that the first longitudinal leg  2704  includes a widthwise offset  2728  that extends away from the second longitudinal leg  2706  proximate the rounded distal tip  2730 . Each longitudinal leg includes parallel, planar inner and outer surfaces  2732 ,  2734 . A first hole  2736  extends through the second longitudinal leg  2706  proximate the distal tip  2730 , that is generally equidistantly spaced from the distal tip  2730  and corresponding upper and lower surfaces  2740 ,  2742 . The first hole  2736  has a cylindrical shape and is configured to receive at least one of the second and third pins  2170 ,  2230  in order to allow the parallel links  2180 ,  2190  to rotate with respect to the linkage housing  2130 . A second hole  2746  extends through the first longitudinal leg  2704  and offset  2728  proximate the distal tip  2730 , that is generally equidistantly spaced from the distal tip  2730  and corresponding upper and lower surfaces  2740 ,  2742 . The second hole  2746  has a cylindrical shape and is configured to receive at least one of the second and third pins  2170 ,  2230  in order to allow the parallel links  2180 ,  2190  to rotate with respect to the linkage housing  2130 . 
     Referring to  FIGS.  17 - 40   , an exemplary assembly sequence for the exemplary end effector  2100  will now be described. Initially, the control and deployment wires  3164 ,  3402 ,  3404  are routed through the opening  2546  of the linkage housing  2130 . At this point, the tilted uprights  2590 ,  2592  of the drive links  2140 ,  2150  are offset and aligned with one another to fit between the linkage housing  2130  proximate the orifices  2570 . More specifically the holes  2610  of the tilted uprights  2590 ,  2592  are longitudinally aligned with the holes  2580  and the orifices  2570  of the linkage housing  2130  in order to receive the first pin  2160 , which extends completely through the linkage housing and the drive links  2140 ,  2150 . 
     The toggles  2200 ,  2210  are also mounted to a respective drive link  2140 ,  2150 , as well as concurrently to the pulley  2220 . Specifically, the through opening  2650  of the first toggle  2200  is oriented between and coaxially aligned with the openings  2622  extending through the first drive link  2140 . When aligned, the ninth pin  2310  is inserted through the openings  2622 ,  2650  to mount the first toggle  2200  to the first drive link  2140 . Similarly, the through opening  2650  of the second toggle  2210  is oriented between and coaxially aligned with the openings  2622  extending through the second drive link  2150 . When aligned, the tenth pin  2320  is inserted through the openings  2622 ,  2650  to mount the second toggle  2210  to the second drive link  2150 . The opposing ends of the toggles  2200 ,  2210  are mounted to opposing ends of the pulley  2220 . More specifically, each toggle through opening  2646  receives a respective cylindrical lateral end of the pulley  2220  in order to rotationally mount the toggles  2200 ,  2210  to the pulley. At this time, the pulley  2220  is also mounted to the control wire  3364  so that repositioning of the control wire in tension is operative to reposition the pulley and correspondingly other components in order to move the jaws  2240 ,  2250  toward or away from one another in a parallel open/close fashion. 
     Each jaw  2240 ,  2250  is then mounted to a respective drive link  2140 ,  2150 , and parallel link  2180 ,  2190 . In exemplary form, a first of the openings  2662  of a respective jaw  2240 ,  2250  is aligned with a respective opening  2624  of a respective drive link  2140 ,  2150 . After being aligned, a fifth pin  2260  and a respective sixth pin  2270  are inserted through the openings  2624 ,  2662  in order to pivotally mount a jaw  2240 ,  2250  to a respective drive link  2140 ,  2150 . Similarly, a second of the openings  2664  of a respective jaw  2240 ,  2250  is aligned with a respective hole  2716  of a respective parallel link  2180 ,  2190 . After being aligned, a seventh pin  2290  and a respective eighth pin  2300  is inserted through the openings  2664 ,  2716  in order to pivotally mount a jaw  2240 ,  2250  to a respective parallel link  2180 ,  2190 . Also, the opposing ends of the parallel links  2180 ,  2190  are offset and aligned with one another to fit between the linkage housing  2130  proximate the orifices  2568 . When aligned, second and third pins  2170 ,  2230  are mounted to individual ends of the parallel links  2180 ,  2190  and to the linkage housing  2130  to provide for pivotal motion between the parallel links and the linkage housing. Before, during, or after mounting the jaws  2240 ,  2250  to the drive links  2140 ,  2150  and the parallel links  2180 ,  2190 , the deployment wires  3402 ,  3404  are respectively directed through openings  2674  of the jaws  2240 ,  2250 . 
     The following comprises a description of exemplary processes for utilizing the exemplary end effector  2100 . Initially, an incision is made on either the left or right side of the chest wall in an intercostal space that is appropriate for the desired angle of approach to a left atrial appendage (LAA). The incision may be made through the chest wall or through the abdomen (or through the back) as part of various procedures that include, without limitation, an open sternotomy, a left thoracotomy, a right thoracotomy, a left port, a right port, a subxiphoid approach, and a transdiaphragmatic approach. Post incision, a trocar (e.g., 10 mm or larger) may be inserted through the incision to extend into the thoracic cavity. In certain instances, it may be preferred to insufflate the thoracic space subsequent to trocar insertion using known techniques. Using at least one of the incision and trocar, surgical instruments are introduced into the thoracic space in order to perform a series of dissections, including dissection of the pericardium, to provide egress to the LAA. After having access to the LAA, the end effector  100  of the surgical tool  10  may be inserted into the thoracic cavity by way of the incision or trocar. 
     The end effector  2100  is passed through the trocar or incision and a robotic instrument or other means is used to navigate the end effector proximate the LAA. After navigating the LAA occlusion clip  2102  proximate the LAA, the occlusion clip  2102  is opened prior to deployment on the LAA. 
     Opening the LAA occlusion clip  2102  is carried out while a first robotic arm  4000  is coupled to the linkage housing  2130 . More specifically, the first robotic arm  4000  includes a grasper  4010  comprised of a pair of repositionable, fenestrated jaws. In exemplary form, each opening of the fenestrated jaws is sized to circumscribe one of the elongated projections  2510  so that clamping of the fenestrated jaws clamps down on the trapezoidal block  2511  is operative to mount the end effector  2100  to the first robotic arm  4000  in a relatively secure position substantially free from significant play. While the first robotic arm  4000  is coupled to the end effector  2100 , a second robotic arm  4020  and its grasper  4030  is repositioned to grasp an end of the control wire  3364  and thereafter moved away from the end effector  2100  to tension the control wire  3364 , causing the end effector  2100  to further separate its jaws  2240 ,  2250  from one another and open the clip  2102 . More specifically, tensioning the control wire  3364  is operative to reposition the pulley  2220  proximally. Because a respective cylindrical lateral end of the pulley  2220  is received in a through opening  2646  of a respective toggle  2200 ,  2210 , when the pulley  2220  is repositioned proximally, so too are the toggles repositioned proximally (toward the linkage housing  2130 ) as well as rotating about an axis extending through the opening  2646 . In particular, the proximal motion and rotation of the toggles  2200 ,  2210  operates to push against the first and second drive links  2140 ,  2150  via the ninth and tenth pins  2310 ,  2320  causing the drive links to move away from one another. But the connection between the first and second drive links  2140 ,  2150  and the linkage housing  2130 , via the first pin  2160 , causes the drive links to pivot with respect to the linkage housing about the first pin when the drive links are attempted to be moved away from one another via the motion of the toggles  2200 ,  2210 . 
     The pivoting motion of the drive links  2140 ,  2150  is transferred to the jaws  2240 ,  2250  via the connection therebetween, facilitated by the fifth and sixth pins  2260 ,  2270 . More specifically, the pivoting of the drive links  2140 ,  2150  away from one another causes the jaws  2240 ,  2250  to move away from one another. But the movement of the jaws  2240 ,  2250  away from one another is constrained by the connection of the jaws to the first and second parallel links  2180 ,  2190 , which are themselves pivotally mounted to the linkage housing  2130 . The additional constraint offered by the parallel links  2180  results in motion of the jaws  2240 ,  2250  that maintains the jaws in a generally parallel relationship as the jaws are moved from a closed position (adjacent one another with spacing to accommodate the clip  2102 ) to a fully open position (spaced away from one another to open the clip to a predetermined maximum extent necessary to position the clip on a LAA). This fully open position of the jaws  2240 ,  2250  coincides with the surface of the toggle connector portions  2640  contacting the first and second surfaces  2582 ,  2584  of the inner arms  2534 ,  2536 , thus stopping further proximal and pivoting motion of the toggles  2200 ,  2210 . In other words, the inner arms  2534 ,  2536  of the linkage housing  2130  operate to limit the travel of the toggles  2200 ,  2210 , thereby setting the maximum spacing between the jaws  2240 ,  2250  in a fully open position. 
     As long as the jaws  2240 ,  2250  are attached to the occlusion clip  2102 , the motion of the jaws results in corresponding motion of the occlusion clip. More specifically, when the jaws are in a closed position (see  FIG.  18   ) and mounted to the occlusion clip  2102 , the bias of the occlusion clip retains the jaws in the closed position. But when one wants to open the occlusion clip  2102  in anticipation of positioning the clip around a LAA, one must overcome the bias of the occlusion clip. In order to do this, the end effector  2100  incorporates structures that provide a mechanical advantage allowing the user to tension the control wire  3364 , which as discussed in greater detail previously, ultimately causing the jaws  2240 ,  2250  to separate from one another and correspondingly separate the parallel beams of the occlusion clip  2102  from one another. 
     Post opening of the LAA occlusion clip  2102 , the first robotic arm  4000  and grasper  4010 , as well as the second robotic arm  4020  and its grasper  4030 , are moved in concert to reposition the end effector  2100  and advance the clip  2102  over the distal tip of the LAA with the LAA passing between corresponding occlusion beams of the clip, stopping only upon reaching the base of the LAA. It should be noted that forceps may be used to grasp a portion of the LAA when positioning the LAA occlusion clip  2102 . After the clip  2102  has been positioned at the base of the LAA, with the LAA interposing corresponding occlusion beam surfaces of the clip, the user may close the clip  2102  to sandwich the LAA between the occlusion surfaces. 
     Closing the LAA occlusion clip  2102  is also carried out by decreasing the tension on the control wire  3364 , thereby allowing the bias of the clip  2102  to cause the jaws  2240 ,  2250  of the end effector  2100  moving closer to one another, thus sandwiching the clip around the LAA. More specifically, the second robotic arm  4020  and its grasper  4030  is repositioned toward the end effector  2100  to decrease the tension on the control wire  3364 . By decreasing the tension of the control wire  3364 , the bias of the clip  2102  dominates and causes jaws  2240 ,  2250  (which are mounted to the clip  2102 ) to be repositioned toward one another, coinciding with closing of the occlusion clip  2102 . In exemplary form, the dominant biasing force of the occlusion clip  2102  is operative to reposition the jaws  2240 ,  2250 , which in turn causes the first and second drive links  2140 ,  2150  to pivot toward one another, coinciding with the parallel links  2180 ,  2190  pivoting toward one another. Likewise, the toggles  2200 ,  2210  are pivoted and repositioned distally, as is the pulley  2220 , ultimately leading to the component positions shown in  FIG.  18   . 
     After the occlusion clip  2102  is positioned about the LAA, various steps may be undertaken to ensure the entire periphery of a portion of LAA is sandwiched by the clip  2102  such as, without limitation, direct visual verification and utilization of a transesophageal echocardiogram. If any problems are determined with respect to the clip  2102  placement, the opening and closing clip sequence may be repeated to adjust the positioning of the clip with respect to the LAA. Upon closing the LAA occlusion clip  2102  around a periphery of a portion of the LAA, proximate the LAA base, as well as confirming the placement of the closed clip being operative to occlude the LAA, the surgeon may release the occlusion clip from the end effector  2100 . 
     To release the clip  2102  from the end effector  2100 , the second robotic arm  4020  and its grasper  4030  releases the control wire  3364  and grasps the deployment wires  3402 ,  3404 . Post grasping of the deployment wires  3402 ,  3404 , the second robotic arm  4020  and its grasper  4030  is moved away from the end effector  2100  to tension the deployment wires and reposition the deployment wires proximally, ultimately leading to discontinuing engagement with the suture loops  3412 . When engagement between the suture loops  3412  and the deployment wires  3402 ,  3404  is discontinued, the occlusion clip  2102  is no longer fastened to the jaws  2240 ,  2250  (i.e., the jaws can be opened and closed without repositioning the clip). After disengagement between the occlusion clip  2102  and the end effector  2100 , the end effector may be removed from the cardiac space, as well as the deployment wires  3402 ,  3404  using the first and second robotic arms  4000 ,  4020 . 
     Removal of the end effector  2100  from the patient&#39;s body may be controlled by repositioning of the first robotic arm  4000 . Because the end effector  2100  is open-ended, there is no need to reposition the end effector upward along the LAA because the end effector can be withdrawn laterally, thus reducing the potential for contact between the end effector and the LAA. In other words, the end effector  2100  may be removed from around the LAA without having a tip of the LAA passing between the jaws  2240 ,  2250 . As part of removing the end effector  2100  from the cardiac and thoracic space, the first robotic arm  4000  may be withdrawn from the patient&#39;s body cavity via the incision or trocar while coupled to the end effector  2100 . 
     In exemplary form, the occlusion clip  102  in accordance with the instant disclosure may include a U-shaped section  2110  that is integrally coupled to a pair of elongated biasing/spring arms  2120 ,  2130 . Each elongated biasing arm  2120 ,  2130  may be integrally coupled to its own elongated occlusion arm  2140 ,  2150  that extends toward the U-shaped section  2110 . In particular, the U-shaped section  2110  comprises a first turn having a change of direction between approximately 145 to 215 degrees measured between the pair of elongated biasing arms  2120 ,  2130 . Moreover, the transition between the first elongated biasing arm  2120  and the first elongated occlusion arm  2140  comprises a second turn  2114  having a change of direction between approximately 145 to 215 degrees measured between the first elongated biasing arm  2120  and the first elongated occlusion arm  2140 . Similarly, the transition between the second elongated biasing arm  2130  and the second elongated occlusion arm  2150  comprises a third turn  2116  having a change of direction between approximately 145 to 215 degrees measured between the second elongated biasing arm  2130  and the second elongated occlusion arm  2150 . At the second and third turns  2114 ,  2116 , the height of a planar surface is maximized. In other words, the height of the planar surface at the end of the turns  2114 ,  2116  is approximately equal to the height of the elongated biasing arms  2120 ,  2130 , in addition to the height of the occlusion arms  2140 ,  2150 , in addition to the height of a gap  2240  between the elongated biasing arms  2120 ,  2130  and the occlusion arms  2140 ,  2150 . Conversely, the maximum height of the planar surfaces decreases slightly until reaching a distal end  2250 . 
     Each elongated occlusion arm  2140 ,  2150  is substantially rigid (i.e., inflexible) and includes a terminal end, with the terminal ends comprising the beginning and end of a course of material constituting the exemplary occlusion clip  102 . In this exemplary embodiment, each occlusion arm  2140 ,  2150  includes a tissue engaging surface  2180  that is convex. In exemplary form, the convex nature of the tissue engaging surface  2180  is substantially constant along a longitudinal length (dominant dimension along the X-axis) of a respective occlusion arm  2140 ,  2150 . More specifically, the profile of the tissue engaging surface  2180  embodies an arc of a circle. 
     The arcuate profile of the tissue engaging surfaces  2180  decreases the thickness of the occlusion clip  102  (in the Z-direction) until reaching zero at an apex  2230 . In other words, the apex  2230  of each tissue engaging surface  2180  occurs midway along a thickness dimension of the occlusion clip so that in the closed position the tissue engaging surfaces  2180  are parallel to one another and the apexes contact one another or are spaced apart from one another a uniform distance. 
     Following from the above description and invention summaries, it should be apparent to those of ordinary skill in the art that, while the methods and apparatuses herein described constitute exemplary embodiments of the present invention, it is to be understood that the inventions contained herein are not limited to the above precise embodiment and that changes may be made without departing from the scope of the invention as defined by the following proposed points of novelty. Likewise, it is to be understood that it is not necessary to meet any or all of the identified advantages or objects of the invention disclosed herein in order to fall within the scope of the invention, since inherent and/or unforeseen advantages of the present invention may exist even though they may not have been explicitly discussed herein.