Abstract:
The present application relates to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures and their methods of use and specifically to a reusable counter mechanism for use with a surgical clip applier. The surgical clip applier includes a housing, at least one handle pivotably connected to the housing, a channel assembly extending distally from the housing, a plurality of clips loaded in the channel assembly, a drive channel translatably supported in the housing and the channel assembly and being translatable upon actuation of the at least one handle, and a reusable counter mechanism removably insertable into a counter slot extending into the housing and engagable with the drive channel. The counter mechanism is configured display indicia corresponding to a quantity of clips and to update the indicia upon translation of the drive channel.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/561,994, filed on Nov. 21, 2011, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present application relates to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures and their methods of use. More specifically the present application relates to a reusable counter mechanism for use with a surgical clip applier. 
         [0004]    2. Discussion of Related Art 
         [0005]    Surgical clip appliers are known in the art and have increased in popularity among surgeons by offering an alternative to conventional suturing of body tissues and vessels. Typical instruments are disclosed in U.S. Pat. No. 5,030,226 to Green et al. and U.S. Pat. No. 5,431,668 to Burbank, III et al. These instruments generally provide a plurality of clips which are stored in the instrument and which are fed sequentially to the jaw mechanism at the distal end of the instrument upon opening and closing of the handles at the proximal end of the instrument. As the handles are closed, the jaws close to deform a clip positioned between the jaw members, and as the jaws are opened to release the deformed clip, a new clip is fed from the series to a position between the jaws. This process is repeated until all the clips in the series of clips have been used. 
         [0006]    A need exists for a user of the clip applier to know how many clips remain in the clip applier, how many clips have been fired and/or when a final clip of the plurality of clips has been fired. 
       SUMMARY 
       [0007]    The present application relates to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures and their methods of use. More specifically the present application relates to a reusable counter mechanism for use with a surgical clip applier. 
         [0008]    In an aspect of the present disclosure, a surgical clip applier includes a housing, at least one handle pivotably connected to the housing, a channel assembly extending distally from the housing, a plurality of clips loaded in the channel assembly, a drive channel translatably supported in the housing and the channel assembly and being translatable upon actuation of the at least one handle, and a reusable counter mechanism removably insertable into a counter slot extending into the housing and engagable with the drive channel. The counter mechanism is configured to display indicia corresponding to a quantity of clips and to change the indicia upon translation of the drive channel. 
         [0009]    In an aspect of the present disclosure, the counter mechanism is a digital counter. 
         [0010]    The drive channel may include a nub and the counter mechanism may include a contact. The nub is configured to engage the contact during translation of the drive channel to cause the contact to complete a circuit with the counter mechanism. The counter mechanism may includes a battery and the battery may be rechargeable. 
         [0011]    In an aspect of the present disclosure, the counter mechanism is an analog counter. The counter mechanism may include a counter dial rotatably supported in the housing and including the indicia thereon and a counter clutch operatively connected to the counter dial such that rotation of the counter clutch in a first direction results in rotation of the counter dial in a first direction, and rotation of the counter clutch in a second direction results in no rotation of the counter dial. The drive channel may define an angled slot therein, and the counter clutch may include a clutch pin extending from a surface thereof and slidably engagable with the angled slot of the drive channel when the counter mechanism is inserted into the counter slot of the housing. Translation of the drive channel causes the clutch pin to be caromed by the angled slot to rotate the counter clutch in the first and second directions respectively. 
         [0012]    In an aspect of the present disclosure, the counter mechanism is securable in the counter slot by a snap-fit mechanism. 
         [0013]    In an aspect of the present disclosure, a method of preparing a surgical clip applier for a surgical procedure includes the steps of: determining when a reusable counter mechanism is necessary for the surgical procedure; inserting the counter mechanism into a counter slot of the clip applier to engage a drive bar of the clip applier when the counter mechanism is determined to be necessary; performing the surgical procedure; and removing the counter mechanism from the counter slot of clip applier after the surgical procedure is complete. 
         [0014]    In an aspect of the present disclosure, the method includes the step of removing a plug from the counter slot of the clip applier prior to the step of inserting the counter mechanism. 
         [0015]    In an aspect of the present disclosure, the method includes the step of resetting the counter mechanism to an initial state prior to the step of inserting the counter mechanism. 
         [0016]    In an aspect of the present disclosure, the step of determining when a counter mechanism is necessary includes choosing between one of a digital counter, an analog counter, and no counter. 
         [0017]    In an aspect of the present disclosure, the step of inserting the counter mechanism includes inserting the counter mechanism into the counter slot until the counter mechanism is secured in the counter slot by a snap-fit mechanism and the step of removing the counter mechanism includes releasing the snap-fit mechanism. 
         [0018]    In an aspect of the present disclosure, a method of preparing a surgical clip applier for a surgical procedure includes the steps of: making a determination, by a surgeon, in the operating room, when a reusable counter mechanism is necessary for the surgical procedure; inserting the counter mechanism into a counter slot of the clip applier to engage a drive bar of the clip applier when the surgeon determines that the counter mechanism is necessary; performing the surgical procedure; and removing the counter mechanism from the counter slot of clip applier after the surgical procedure is complete. 
         [0019]    In an aspect of the present disclosure, the method includes the step of removing a plug from the counter slot of the clip applier prior to the step of inserting the counter mechanism. 
         [0020]    In an aspect of the present disclosure, the method includes the step of resetting the counter mechanism to an initial state prior to the step of inserting the counter mechanism. The step of resetting the counter may occur in the operating room. 
         [0021]    In an aspect of the present disclosure, the step of making a determination by a surgeon includes the surgeon choosing between one of a digital counter, an analog counter, and no counter. 
         [0022]    In an aspect of the present disclosure, the step of inserting the counter mechanism includes inserting the counter mechanism into the counter slot until the counter mechanism is secured in the counter slot by a snap-fit mechanism and the step of removing the counter mechanism includes releasing the snap-fit mechanism. 
         [0023]    Although described separately, the above aspects may be combinable with any other aspect of the present disclosure. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0024]    The present clip applier will be more fully appreciated as the same becomes better understood from the following detailed description when considered in connection with the following drawings, in which: 
           [0025]      FIG. 1  is a perspective view of a surgical clip applier according to an embodiment of the present disclosure; 
           [0026]      FIG. 2  is a top, plan view of the surgical clip applier of  FIG. 1 ; 
           [0027]      FIG. 3  an exploded perspective view of the surgical clip applier of  FIGS. 1-2 ; 
           [0028]      FIG. 4A  is a front, perspective view of a re-usable mechanical counter insertable into the surgical clip applier of FIGS. I and  2 ; 
           [0029]      FIG. 4B  is a rear, perspective view of the re-usable mechanical counter of  FIG. 4A ; 
           [0030]      FIG. 4C  is a perspective view of the re-usable mechanical counter of  FIGS. 4A-4B , illustrating the clutch inserted into the bore of the counter dial; 
           [0031]      FIG. 5A  is a side, cross-sectional view of a re-usable digital counter insertable into the surgical clip applier of  FIGS. 1 and 2 ; 
           [0032]      FIG. 5B  is a side, cross-sectional view of a re-usable digital counter of  FIG. 5A , illustrating the contact engaging the contact plate; 
           [0033]      FIG. 6  is a perspective view of the mechanical counter of  FIG. 4A  engaging a drive member of the clip applier of  FIGS. 1 and 2 ; 
           [0034]      FIG. 7  is a perspective view of a handle assembly with a housing half-section removed therefrom and illustrating the mechanical counter engaged with a drive channel; 
           [0035]      FIG. 8  is a perspective view of a handle assembly with a housing half-section and drive channel removed therefrom and illustrating the mechanical counter engaged with a ratchet; 
           [0036]      FIG. 9  is an enlarged view of the indicated area of detail of  FIG. 8 ; 
           [0037]      FIG. 10A  is a top plan, schematic illustration of the mechanical counter operatively connected to the drive channel when the clip applier is in an original unactuated position; 
           [0038]      FIG. 10B  is a side view of the mechanical counter as viewed along  10 B- 10 B of  FIG. 10A ; 
           [0039]      FIG. 10C  is an enlarged view of the indicated area of detail of  FIG. 10A ; 
           [0040]      FIG. 10D  is a cross-sectional view of the mechanical counter as taken along  10 D- 10 D of  FIG. 10B ; 
           [0041]      FIG. 11A  is a top plan, schematic illustration of the mechanical counter operatively connected to the drive channel when the clip applier is initially actuated; 
           [0042]      FIG. 11B  is an enlarged view of the indicated area of detail of  FIG. 11A ; 
           [0043]      FIG. 11C  is a cross-sectional view of the mechanical counter as taken along  10 D- 10 D of  FIG. 10B , during the initial actuation of the clip applier; 
           [0044]      FIG. 12A  is a top plan, schematic illustration of the mechanical counter operatively connected to the drive channel when the clip applier is fully actuated; 
           [0045]      FIG. 12B  is an enlarged view of the indicated area of detail of  FIG. 12A ; 
           [0046]      FIG. 12C  is a cross-sectional view of the mechanical counter as taken along  10 D- 10 D of  FIG. 10B , following the full actuation of the clip applier; 
           [0047]      FIG. 13A  is a top plan, schematic illustration of the mechanical counter operatively connected to the drive channel when the clip applier is released after full actuation; 
           [0048]      FIG. 13B  is an enlarged view of the indicated area of detail of  FIG. 13A ; 
           [0049]      FIG. 13C  is a cross-sectional view of the mechanical counter as taken along  10 D- 10 D of  FIG. 10B , during a release of the clip applier following full actuation; 
           [0050]      FIG. 14A  is a side, cross-sectional view of the digital counter inserted into the clip applier when the drive channel is in an original unactuated position; and 
           [0051]      FIG. 14B  is a side, cross-sectional view of the digital counter when the clip applier has been actuated and the nub of the drive channel is engaged with the contact of the digital counter to complete a circuit. 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0052]    Embodiments of surgical clip appliers in accordance with the present disclosure will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further away from the user. 
         [0053]    Referring now to  FIGS. 1-3 , a surgical clip applier in accordance with an embodiment of the present disclosure is generally designated as  100 . Surgical clip applier  100  may be disposable and generally includes a handle assembly  102  including a housing  104  having an upper housing half  104   a  and lower housing half  104   b.  Handle assembly  102  further includes a pair of handles  106  pivotably secured to housing  104  and extending outwardly therefrom. A channel assembly  108  is fixedly secured to housing  104  and extends outwardly therefrom, terminating in a jaw assembly  110 . 
         [0054]    As seen in  FIGS. 1-3 , housing halves  104   a  and  104   b  of clip applier  100  fit together by snap fit engagement with one another. Housing  104  defines a counter slot  104   c  formed in lower housing half  104   b  for receiving a counter mechanism  190 , as will be discussed in greater detail below. Counter slot  104   c  may initially include a removable plug  192  received therein. 
         [0055]    As seen in  FIG. 3 , handles  106  are secured to housing  104  by handle pivot posts  104   d  extending from lower housing half  104   b  and into respective apertures  106   a  formed in handles  106 . Handle assembly  102  includes a link member  122  pivotally connected to each handle  106  at a pivot point  106   b  formed in a respective handle  106 . A distal end of each link member  122  is pivotally connected to a pivot point formed in a drive channel  140  via a drive pin  124 . Each end of drive pin  124  is slidably received in an elongate channel formed in a respective upper and lower housing half  104   a,    104   b.  In use, as will be described in greater detail below, as handles  106  are squeezed, link members  122  push drive channel  140  distally via drive pin  124 . 
         [0056]    Channel assembly  108  includes a channel or cartridge cover  130  and an outer or lower channel  132  each having a proximal end retained in housing assembly  102 , between upper and lower housing halves  104   a,    104   b.    
         [0057]    As seen in  FIG. 3 , clip applier  100  includes a clip pusher bar  160  slidably disposed beneath cartridge cover  130 , a stabilizer  162  configured to overlie and engage pusher bar  160 , a motion multiplier system  155  supported in housing  104 , a clip carrier  170  disposed within channel assembly  108  and beneath pusher bar  160 , a stack of surgical clips “C” loaded and/or retained within clip carrier  170  in a manner so as to slide therewithin and/or therealong, a clip follower  174  slidably disposed within clip carrier  170  and positioned behind the stack of surgical clips “C,” a wedge plate  180  slidably disposed within handle assembly  102  and channel assembly  108 , a wedge plate pivot arm  179  pivotally supported in lower housing half  104   b  of housing  104  for transmitting translation of drive channel  140  to translation of wedge plate  180 , a drive channel  140  reciprocally supported in and extending between housing  104  of handle assembly  102  and channel assembly  108 , an audible/tactile indicator  148  connected to drive channel  140  via drive pin  124 , and a jaw assembly  110  ( FIG. 1 ) mounted on or at a distal end of channel assembly  108  and actuatable by handles  106  of handle assembly  102 . 
         [0058]    Clip applier  100  also includes a ratchet rack member  141  slidably disposed in lower housing half  104   b.  Rack member  141  is pinned to drive pin  124  such that translation of drive pin  124  relative to housing  104  results in concomitant translation of rack member  141 . Rack member  141  includes ratchet teeth  141   a  formed along an edge thereof and are configured and adapted to engage with a ratchet pawl  142  supported in housing  104 . Rack member  141  and pawl  142  define a ratchet mechanism  144 . 
         [0059]    In use, as drive channel  140  is moved axially by drive pin  124 , rack member  141  is also moved. Rack teeth  141   a  of rack member  141  has a length which allows pawl  142  to reverse and advance back over rack member  141  when rack member  141  changes between proximal and distal movement as drive channel  140  reaches a proximal-most or distal-most position. 
         [0060]    Pawl  142  is pivotally connected to lower housing half  104   b  by a pawl pin at a location wherein pawl  142  is in substantial operative engagement with rack member  141 . Pawl  142  is engageable with rack member  141  to restrict longitudinal movement of rack member  141  and, in turn, drive channel  140 . Ratchet mechanism  144  further includes a pawl spring  145  configured and positioned to bias pawl  142  into operative association with rack member  141 . Pawl spring  145  functions to maintain the teeth of pawl  142  in engagement with the teeth  141   a  of rack member  141 , as well as to maintain pawl  142  in a rotated or canted position. 
         [0061]    Reference may be made to U.S. patent application No. 12/540,475 filed on Aug. 13, 2009, entitled “Surgical Clip Applier;” U.S. patent application Ser. No. 12/539,006, filed on Aug. 11, 2009, entitled “Surgical Clip Applier and Method of Assembly;” U.S. patent application Ser. No. 12/939,296, filed on Nov. 4, 2010 , entitled “Surgical Clip Applier”, and U.S. patent application Ser. No. 12/943,045, filed on Nov. 10, 2010 , entitled “Surgical Clip Applier”, the entire contents of each of which being incorporated herein by reference, for a detailed discussion of the structure, operation, and method of assembly of various components surgical clip applier  100 . 
         [0062]    In accordance with the present disclosure, clip applier  100  is configured to receive a counter mechanism  190  in counter slot  104   c.  Counter mechanism  190  may be a mechanical or analog counter  200 , as seen in  FIGS. 4A-4C ,  6 - 9 ,  10 A- 10 D,  11 A- 11 C,  12 A- 12 C and  13 A- 13 C, or may be a digital counter  300  as seen in  FIGS. 5A-5B  and  14 A- 14 B. 
         [0063]    Referring now to  FIGS. 4A-4C , mechanical counter  200  is insertable into counter slot  104   c  and includes a counter dial  202  rotatably disposed within a counter housing  204 , a counter clutch  206  operatively connected to counter dial  202  and configured to permit uni-directional rotation of counter dial  202 , and a latch member  208  ( FIG. 4B ) configured to engage counter dial  202 . Counter dial  202  includes a first face  202   a  disposed adjacent a window  204   a  formed in counter housing  204 . First face  202   a  includes a plurality of indicia  202   b,  in the form of sequential numbers disposed thereof and substantially around a radial periphery thereof. Indicia  202   b  may correspond to the number of clips that are loaded in clip applier  100 , may correspond to the number of clips that have been used in a surgical procedure, or may correspond to the number of clips to be used during a surgical procedure. The surgeon may reset or pre-set mechanical counter  200  by rotating counter dial  202  prior to inserting the counter mechanism  190  into the counter slot  104   c.  By way of example only, indicia  202   b  may be numerals from “0-22.” Indicia  202   b  are located on first face  202   a  so as to be in registration with window  204   a  formed in counter housing  204 . Counter dial  202  includes a second face  202   c,  opposite first face  202   b,  and defining a bore  202   d  therein. Bore  202   d  includes a radial array of uni-directional teeth  202   e  formed therein. Counter dial  202  further includes a first or outer rim defining a plurality of grooves  202   f  formed around an outer periphery thereof, and a second or inner rim formed in an outer periphery thereof. 
         [0064]    With continued reference to  FIGS. 4A-4C , counter clutch  206  is concentrically and rotatably nested in bore  202   d  of counter dial  202 . Counter clutch  206  of mechanical counter  200  includes a body portion  206   a  configured and dimensioned for rotatable disposition in bore  202   d  of counter dial  202 . Counter clutch  206  includes a pair of opposed resilient fingers  206   b ,  206   c  extending substantially tangentially from body portion  206   a.  Resilient fingers  206   b,    206   c  extend from body portion  206   a  by an amount sufficient so as to resiliently engage uni-directional teeth  202   e  of dial  202 . Counter clutch  206  includes a clutch pin  206   d  extending from body portion  206   a  and projecting out of bore  202   d  of counter dial  202 . Clutch pin  206   d  extends through a clutch slot  204   b  of counter housing  204 . 
         [0065]    As seen in  FIG. 4B , latch member  208  of mechanical counter  200  is secured to an inner wall of counter housing  204 . Latch member  208  includes a resilient finger  208   a  configured to contact and selectively engage grooves  202   f  formed around the outer periphery of counter dial  202 . 
         [0066]    As seen in FIGS.  3  and  6 - 9 , drive channel  140  defines an angled slot  140   a  formed therein at a location so as to slidably receive clutch pin  206   d  extending from body portion  206   a  of counter clutch  206 . Angled slot  140   a  of drive channel  140  extends in a direction away from a longitudinal axis of clip applier  100  from a proximal to a distal direction. Rack member  141  is disposed in housing  104  such that clutch pin  206   d  of counter clutch  206  rides along or contacts a side edge  141   b  thereof. 
         [0067]    Referring now to  FIGS. 5A ,  5 B,  14 A and  14 B, digital counter  300  is insertable into counter slot  104   c  and includes a display  302 , a processor  304 , and an energy source  306  in the form of a battery or the like. Display  302  is a liquid crystal display that displays one or more operating parameters of clip applier  100  to the surgeon. The operating parameter displayed may be an amount or number of remaining clips, a number of clips that have been used, a position parameter, a surgical time of usage, or any other parameter of the procedure. Energy source  306  may be rechargeable and/or replaceable where, for example, energy source  306  may be recharged or replaced between uses of digital counter  300 . 
         [0068]    As seen in  FIGS. 14A and 14B , digital counter  300  is actuated by nub  140   e  formed in drive channel  140 . In use, as drive channel  140  is translated axially, nub  140   e  thereof engages a contact  308  of digital counter  300  causing contact  308  to engage a contact pad  310  of digital counter  300  to complete a circuit with energy source  306  and trigger processor  304  to perform a function (e.g., updating the number appearing on display  302  by a given increment or decrement value). It is contemplated that digital counter  300  may be dimensioned for insertion into counter slot  104   a  such that contact  308  is suitably aligned with nub  140   e.  Counter slot  104   c  and digital counter  300  may be configured and dimensioned such that digital counter  300  is insertable into counter slot  104   c  in only one orientation. 
         [0069]    For a more detailed discussion of a similar mechanical counter, please refer to commonly owned U.S. patent application Ser. No. 12/943,045, mentioned above. For a more detailed discussion of a similar digital counter, please refer to commonly owned U.S. patent application Ser. Nos. 12/540,475 and 12/539,006, mentioned above. 
         [0070]    Turning now to  FIGS. 10A-10D ,  11 A- 11 C,  12 A- 12 C,  13 A- 13 C and  14 A- 14 B, the operation of clip applier  100  is provided. Prior to any initial squeezing of handles  106  of clip applier  100 , with clip applier  100  loaded with clips “C,” drive channel  140  is located at a proximal-most position, as seen in FIG. I OA. According to the present disclosure, prior to any use of clip applier  100 , the surgeon determines whether to include a counter mechanism  190  in clip applier  100 , and “if so” which type of counter mechanism (e.g., analog/mechanical or digital) to include. For example, if the surgical procedure requires the use of only a few clips, such as one or two clips, the surgeon may not wish to include any counter and would instead leave plug  192  in place in counter slot  104   c.  On the other hand, if the surgical procedure requires the use of a larger number of clips, some or all of clip applier  100 ′s capacity for example, the surgeon may wish to utilize one of counter mechanisms  190 . When choosing between mechanical counter  200  and digital counter  300  the surgeon may consider a number of factors including, for example, whether additional functionality is required (e.g., digital counter  300  may, for example, allow the surgeon to switch display  302  between clips remaining and clips fired or may provide the surgeon with additional information related to the surgery such as, for example, elapsed time, etc), ease of use, cost of maintenance, etc. 
         [0071]    Mechanical counter  200 , digital counter  300  and surgical clip applier  100  may each be re-usable or disposable. 
         [0072]    If the surgeon chooses mechanical counter  200 , the surgeon resets mechanical counter  200  to an initial state, for example, with the indicia  202   d  visible in window  204   a  displaying the number of clips “C” loaded into the clip applier, displaying the numeral “0” if mechanical counter  200  will increment during use, or displaying the total number of clips “C” to be used in the surgical operation or the total number of clips “C” available, if mechanical counter  200  will decrement during use. 
         [0073]    For example, the surgeon may reset the mechanical counter  200  by actuating the clutch pin  206   d  of the counter clutch  206  until the desired number is visible through window  204   a.  As seen in  FIG. 10A , for example, in the present instance, the clip applier  100  is fully loaded with twenty-two (22) clips, and the indicia  202   d  visible through window  204   a  formed in counter housing  204  is the numeral “ 22 ”, as seen in  FIG. 10C . Also, as seen in  FIG. 10C , resilient finger  208   a  of latch member  208  is engaged in a groove  202   f  formed around the outer periphery of counter dial  202 . 
         [0074]    The surgeon then inserts mechanical counter  200  into counter slot  104   c  such that clutch pin  206   d  is inserted into angled slot  140   a,  as seen in  FIG. 7 . It is contemplated that mechanical counter  200  may include identification on its counter housing  204  of the proper orientation for insertion into counter slot  104   c  of housing  104  or that mechanical counter  200  may be dimensioned in relation to counter slot  104   c  such that only one orientation is possible for insertion. 
         [0075]    As seen in  FIG. 10D , prior to any squeezing of handles  106 , clutch pin  206   d  of counter clutch  206  is disposed at a distal end of angled slot  140   a  of drive channel  140 . 
         [0076]    As seen in  FIGS. 11A-11C , during an initial squeeze of handles  106 , as indicated by arrow “Al,” drive pin  124  translates drive channel  140  and rack member  141  in a distal direction, as indicated by arrow “B 1 .” As drive channel  140  is translated in a distal direction, angled slot  140   a  of drive channel  140  is moved in a distal direction relative to clutch pin  206   d  of counter clutch  206 , clutch pin  206   d  is caromed through angled slot  140   a  of drive channel  140  causing counter clutch  206  to rotate in the direction of arrow “C 1 .” As counter clutch  206  is rotated in the direction of arrow “C 1 ,” as seen in  FIG. 11C , resilient fingers  206   b,    206   c  thereof engage uni-directional teeth  202   e  of dial  202 , thereby causing dial  202  to also rotate in the direction of arrow “C 1 .” 
         [0077]    As dial  202  is rotated in the direction of arrow “C 1 ,” as seen in  FIG. 11B , indicia  202   b  is moved relative to window  204   a  formed in counter housing  204 , thereby beginning to increment or decrement mechanical counter  200 . Additionally, as dial  202  is rotated in the direction of arrow “C 1 ,” resilient finger  208   a  of latch member  208  begins to disengage the groove  202   f  formed around the outer periphery of counter dial  202 . 
         [0078]    As seen in  FIGS. 12A-12C , during a final or complete squeeze of handles  106 , as indicated by arrow “A 1 ,” drive pin  124  further translates drive channel  140  and rack member  141  in a distal direction, as indicated by arrow “B 1 .” As drive channel  140  is further translated in a distal direction, angled slot  140   a  of drive channel  140  is further moved in a distal direction relative to clutch pin  206   d  of counter clutch  206 , clutch pin  206   d  is further earned through angled slot  140   a  of drive channel  140  causing counter clutch  206  to further rotate in the direction of arrow “C 1 .” As counter clutch  206  is further rotated in the direction of arrow “C 1 ,” as seen in  FIG. 12C , resilient fingers  206   b,    206   c  continue to cause dial  202  to rotate in the direction of arrow “C 1 .” 
         [0079]    As dial  202  is further rotated in the direction of arrow “C 1 ,” as seen in  FIG. 12B , indicia  202   b  of numeral “ 22 ” is completely moved out of view of window  204   a  fowled in counter housing  204  and new numeral “21” is moved into view of window  204   a,  thereby fully being decremented. As discussed above, other numerals, such as, for example, the numeral “0” may initially be visible through window  204   a  and, for example, mechanical counter  200  may increment from the numeral “0” to the numeral “1” instead of being decremented. This change of numeral coincides with a formation and/or firing/ejection/release of a clip from clip applier  100 . In this manner, the user is shown the number of clips remaining in clip applier  100 , the number of clips used during the procedure, or the number of clips remaining to be used. Additionally, as dial  202  is further rotated in the direction of arrow “C 1 ,” resilient finger  208   a  of latch member  208  moves into engagement in a groove  202   f  adjacent to groove  202   f  formed around the outer periphery of counter dial  202 . 
         [0080]    Turning now to  FIGS. 13A-13C , during an opening of handles  106 , as indicated by arrow “A 2 ,” drive pin  124  translates drive channel  140  and rack member  141  in a proximal direction, as indicated by arrow “B 2 .” As drive channel  140  is translated in a proximal direction, angled slot  140   a  of drive channel  140  is moved in a proximal direction relative to clutch pin  206   d  of counter clutch  206 , clutch pin  206   d  is cammed through angled slot  140   a  of drive channel  140  causing counter clutch  206  to rotate in the direction of arrow “C 2 ,” opposite to “C 1 .” As counter clutch  206  is rotated in the direction of arrow “C 2 ,” as seen in  FIG. 13C , resilient fingers  206   b,    206   c  are caused to deflect and snap over uni-directional teeth  202   e  of dial  202 . As seen in  FIG. 13B , any frictional forces tending to cause dial  202  to also rotate in the direction of arrow “C 2 ” are negated by the engagement of resilient finger  208   a  of latch member  208  in groove  202   f  formed around the outer periphery of counter dial  202 , thereby maintaining the rotational orientation of dial  202 . 
         [0081]    With dial  202  being held or maintained in this rotational orientation, the new indicia  202   b  of numeral “21” if decrementing from numeral “22”, or numeral “1” if incrementing from the numeral “0”, is maintained in view in window  204   a.    
         [0082]    When drive channel  140  has been moved back to the fully proximal position, resilient fingers  206   b,    206   c  of counter clutch  206  are re-set in engagement with adjacent uni-directional teeth  202   e  of dial  202 . Additionally, as dial  202  is further rotated in the direction of arrow “C 1 ,” resilient finger  208   a  of latch member  208  moves into engagement in a groove  202   f ′ adjacent to groove  202   f  formed around the outer periphery of counter dial  202 . 
         [0083]    The surgeon may continue to actuate handles  106  until the final clip “C” is fired with the indicia  202   b  visible through window  204   a  either incrementing or decrementing to inform the surgeon of the number of clips “C” that have been used or the number of clips “C” remaining to be used or. Once the final clip “C” has been fired, a lockout mechanism (not shown) may be used to prevent further actuation of handles  106 , prevent jaw assembly  110  from closing, and prevent clip applier  100  from being fired. A suitable lockout mechanism can be found, for example, in U.S. patent application Ser. Nos. 12/540,475, 12/539,006, and 12/943,045, mentioned above. 
         [0084]    If the surgeon chooses digital counter  300 , the surgeon resets digital counter  300  to an initial state, for example, with the display  302  displaying the number of clips “C” loaded into the clip applier, displaying the numeral “0”, or the number of clips “C” to be used in the surgical operation. 
         [0085]    The surgeon then inserts digital counter  300  into counter slot  104   c  such that contact  308  is axially aligned with nub  140   e  of drive bar  140 , as seen in  FIG. 14   a . During actuation of handles  106 , as described above, drive bar translates distally and nub  140   e  engages contact  308  and drives contact  308  to engage contact plate  310  ( FIG. 14   b ). Engagement of contact  308  with contact plate  310  completes a circuit with energy source  306  and triggers processor  304  to perform a function. As described above, processor  304  may, for example, increment the numeral displayed on display  302 , decrement the numeral displayed on display  302 , or perform other functions required by the surgeon. Digital counter  300  may also be manipulated by the surgeon to display one or more pieces of information at the same time such as, for example, the remaining number of clips “C”, the number of clips “C” fired, the elapsed time, etc. The numeral displayed on display  302  may be changed when contact  308  engages contact plate  310  or alternatively may be change when contact  308  disengages from contact plate  310 , such as when drive bar  140  translates proximally due to opening of handles  106  at the end of the firing process. 
         [0086]    After the surgical procedure is complete, counter mechanism  190  may be removed from clip applier  100  and sanitized/stored for re-use. For example, energy source  306  of digital counter  300  may be replaced or be recharged and digital counter  300  may be inserted into a docking or recharging station (not shown) for recharging. 
         [0087]    It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure.