Abstract:
An endoscopic multi-clip dispensing apparatus has elongated inner and outer conduits sleeved together, wherein the inner conduit reciprocates between extension and retraction. A plunger rod pushes a line of clips through the core of the inner conduit at an indexed rate of one clip at a time. Each C-shaped clip has a pair of elongated jaws mated together at a hinge end. The clips are loaded into the inner conduit in head to tail fashion, with the jaw ends of a trailing clip pushing the hinge end of a leading clip. There further is a pair of wedge-shaped flared structures proximate the dispensing end of the conduits, for prying open the jaws of the lead clip during the progression of it being dispensed. Ultimately, after the lead clip passes clear of the flared structures, its jaws are free to snap shut and ‘bite’ into a target anatomy.

Description:
CROSS-REFERENCE TO PROVISIONAL APPLICATION(S) 
       [0001]    This application is a continuation-in-part of U.S. patent application Ser. No. 14/276,513, filed May 13, 2014; which claims the benefit of U.S. Provisional Application No. 61/961,842, filed Oct. 24, 2013; U.S. Provisional Application No. 61/957,306, accorded filing date of Jun. 29, 2013; and, U.S. Provisional Application No. 61/855,313, accorded filing date of May 14, 2013. The foregoing disclosures are incorporated herein by this reference thereto. 
     
    
     BACKGROUND AND SUMMARY OF THE INVENTION 
       [0002]    The invention relates to surgery and, more particularly, to endoscopic multi-clip dispensing apparatus. 
         [0003]    It is an object of the invention to line up a series of surgery clips in accordance with the invention in a line where the head of each clip is pushing into the tail of each preceding clip, until the leadmost clip. 
         [0004]    It is another object of the invention to provide a dispensing apparatus in accordance with the invention for dispensing, at first, the leadmost clip, and then serially each succeeding clip thereafter when and where chosen by the operator (eg., surgeon). 
         [0005]    A number of additional features and objects will be apparent in connection with the following discussion of the preferred embodiments and examples with reference to the drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0006]    There are shown in the drawings certain exemplary embodiments of the invention as presently preferred. It should be understood that the invention is not limited to the embodiments disclosed as examples, and is capable of variation within the scope of the skills of a person having ordinary skill in the art to which the invention pertains. In the drawings, 
           [0007]      FIG. 1A  is a perspective view of a first embodiment of endoscopic multi-clip dispensing apparatus in accordance with the invention for dispensing a first embodiment of C-shaped surgery clips in accordance with the invention, as snaked through an operating channel of an endoscope, wherein proximate the terminal end of the endoscope, only the outline of the endoscope as well as the control wires for flexing (ie., curling) the endoscope are shown in dashed lines; 
           [0008]      FIG. 1B  is a perspective view of the endoscope of  FIG. 1A ; 
           [0009]      FIG. 1C  is an enlarged scale section view taken along the line  1 C- 1 C in  FIG. 1B , with only the outline of the endoscope shown in dashed lines; 
           [0010]      FIG. 2  is an enlarged scale perspective view of one such surgery clip, as with its jaws forced open; 
           [0011]      FIG. 3  is a perspective view comparable to  FIG. 2  except showing the clip in the state of normally snapped shut; 
           [0012]      FIG. 3A  is a sectional view taken along line IIIA-IIIA in  FIG. 3 ; 
           [0013]      FIG. 3B  is a perspective view comparable to  FIG. 3  except showing the composite construction of the clip wherein the spring portion is shown in solid lines (and is preferably a spring material like a spring steel) and the remaining portions shown in dashed lines might comprise a different material, such as non-spring stainless steel; 
           [0014]      FIG. 4  is an enlarged scale perspective view of the dispensing end of said endoscopic multi-clip dispensing apparatus, wherein the outline of the endoscope as well as the control wires for flexing (ie., curling) the endoscope are shown in dashed lines; 
           [0015]      FIG. 5  is a perspective view comparable to  FIG. 4  except showing a lead clip being advanced through the dispensing end of endoscopic multi-clip dispensing apparatus and out through the very end margin of the dispensing end&#39;s tubewall, wherein wedge-shaped, jaw-spreading flared ends of a pair of actuator arms are also extending through a driven extension stroke to project out the end of the dispenser; 
           [0016]      FIG. 6  is a perspective view comparable to  FIG. 5  except showing further advance of the process of dispensing of the lead clip; 
           [0017]      FIG. 7  is a perspective view comparable to  FIG. 6  except showing the lead clip being pushed further forward such that the wedge-shaped flared ends of the actuator arms have spread open wide the jaws of the clips (note, this is accomplished by the left and right flanges riding over the left and right flared ends); 
           [0018]      FIG. 8  is an enlarged scale sectional view taken along the line VIII-VIII from  FIG. 4 ; 
           [0019]      FIG. 9  is an enlarged scale end elevational view taken in the direction of arrows IX-IX from  FIG. 8 ; 
           [0020]      FIG. 10  is an enlarged scale sectional view taken along the line X-X from  FIG. 8 ; 
           [0021]      FIG. 11  is an enlarged scale sectional view taken along the line XI-XI from  FIG. 8 ; 
           [0022]      FIG. 12  is an enlarged scale sectional view taken along the line XII-XII from  FIG. 8 ; 
           [0023]      FIG. 13  is a side elevational view, partly in section, take along line from  FIG. 8 ; 
           [0024]      FIG. 14  is a side elevational view, partly in section, comparable to  FIG. 13  except showing the coordinated extension of one flared end of one of the pair of actuator arms and projection of the lead clip out the dispensing end; 
           [0025]      FIG. 15  is a side elevational view, partly in section, comparable to  FIG. 14  except showing the end of travel for the extension of the one flared end of the one of the pair of actuator, arms, in contrast to, the continued travel of the lead clip out the dispensing end; 
           [0026]      FIG. 16  is a side elevational view, partly in section, comparable to  FIG. 15  except showing the continued travel of the lead clip out of the dispensing end relative to the now stationary one flared end of the one of the pair of actuating arms, wherein the lead clip&#39;s flanges have engaged the wedge-shaped flared end and have been wedged apart such the jaws of the lead clip are spread wide open; 
           [0027]      FIG. 17  is a side elevational view, partly in section, comparable to  FIG. 16  except showing not only the clearance of the lead clip out of the dispensing end but also the clearance of the flanges past the one flared end of the one of the pair of actuating arms, whereby the jaws of the clip automatically start to spring shut; 
           [0028]      FIG. 18  is a side elevational view, partly in section, comparable to  FIG. 13  except omitting the illustration of any clip; and 
           [0029]      FIG. 19  is an enlarged scale sectional view taken along line XIX-XIX from  FIG. 1A  and showing the abutting end of the urging follower that pushes on the last clip of the indefinitely long series of the first embodiment clips in accordance with the invention that would be loaded into the first embodiment endoscopic multi-clip dispensing apparatus in accordance with the invention; 
           [0030]      FIG. 20  is a perspective view of another embodiment of endoscopic multi-clip dispensing apparatus in accordance with the invention for dispensing another embodiment of C-shaped surgery clips also in accordance with the invention; 
           [0031]      FIG. 21  is an enlarged scale perspective view of one such surgery clip, as with its jaws in the state of normally snapped shut; 
           [0032]      FIG. 22  is a perspective view comparable to  FIG. 21  except showing the clip with its jaws in the state of forced open; 
           [0033]      FIG. 23  is a top plan view of  FIGS. 21 ; 
           [0034]      FIG. 24  is a side elevational view of  FIG. 23 , wherein dashed lines at the tail end show that varying the thickness of the tail end varies the clamping power of said clip; 
           [0035]      FIG. 25A  is an enlarged scale perspective view of the dispensing end of the dispensing apparatus of  FIG. 20  and showing aspects of the dispensing arms of said dispensing apparatus, as snaked through an operating channel of an endoscope, wherein only the outline of the endoscope as well as the control wires for flexing (ie., curling) the endoscope are shown in dashed lines; 
           [0036]      FIG. 25B  is a perspective view of the terminal end of the endoscope of  FIG. 25A ; 
           [0037]      FIG. 25C  is an enlarged scale section view taken along the line XXVC-XXVC in  FIG. 25B , with only the outline of the endoscope shown in dashed lines; 
           [0038]      FIG. 26  is a sectional view taken along line XXVI-XXVI in  FIG. 25A , except with the clip(s) removed from the view; 
           [0039]      FIG. 27  is a sectional view taken along line XXVII-XXVII in  FIG. 26 ; 
           [0040]      FIG. 28  is a sectional view comparable to  FIG. 26 , except with the lead clip entering the ejection station for the dispensing end of said dispensing apparatus in accordance with the invention; 
           [0041]      FIG. 29  is an enlarged scale end elevational view taken in the direction of arrows XXIX-XXIX from  FIG. 28  and to show better show the ovate-shaped, jaw-spreading flared-ends of the actuator arms of said dispensing apparatus in accordance with the invention; 
           [0042]      FIG. 30  is an enlarged scale sectional view taken in the direction of the arrows XXX-XXX from  FIG. 28 ; 
           [0043]      FIG. 31  is an enlarged scale sectional view taken along the line XXXI-XXXI from  FIG. 28 ; 
           [0044]      FIG. 32  is an enlarged scale sectional view taken along line XXXII-XXXII in  FIG. 35  and comparable to  FIG. 31  except wherein the lead clip has been advanced down the hollow passage of the flexible conduit of said dispensing apparatus in accordance with the invention (ie., by means of for example and without limitation being pushed from behind), and wherein the jaws of the lead clip have opened slightly; 
           [0045]      FIG. 33  is an enlarged scale sectional view taken along line XXXIII-XXXIII in  FIG. 35  and comparable to  FIG. 32  except showing the plunger rod which serves as the pressure-urging follower that follows the trailing clip of the series of clips loaded head to tail in the hollow passage of the flexible conduit of said dispensing apparatus in accordance with the invention, wherein said plunger rod advances the whole series of clips forward in unison by abutting and applying pressure against the tail end of the trailing clip (see, eg.,  FIG. 35 ); 
           [0046]      FIG. 34  is a perspective view comparable to  FIG. 25  except showing the ejection process of the lead clip advancing through the dispensing end of the conduit such that the lead clip has moved relatively forward and that the actuator arms have thrust relative forward such that the ovate-shaped, jaw-spreading flared-ends thereof extend outside the dispensing end of said dispensing apparatus in accordance with the invention; 
           [0047]      FIG. 35  is a perspective view comparable to  FIG. 34  except showing the ejection process of the lead clip advancing through the dispensing end of the conduit such that the lead clip has moved relatively forward and that the ovate-shaped, jaw-spreading flared-ends of the actuator arms have begun to urge the jaws of the clip relatively apart; 
           [0048]      FIG. 36  is a sectional view partly comparable to  FIG. 27  except showing the arms partly advanced forward and showing the relative position of the lead clip; 
           [0049]      FIG. 37  is a sectional view partly comparable to  FIG. 36  except showing further advance of the arms and lead clip; 
           [0050]      FIG. 38  is a sectional view partly comparable to  FIG. 37  except showing further advance lead clip only, wherein the arms advanced to their further extension point in  FIG. 37 , and here in  FIG. 38  the flared ends of the arms are in the middle of being spread apart from a normal position of flexed inward toward each other (see, eg.,  FIGS. 36 or 37 ); 
           [0051]      FIG. 39  is a sectional view partly comparable to  FIG. 38  except showing further advance of the lead clip wherein, again, the arms do not advance any further, but, the flared ends do spread apart ever so slightly more; 
           [0052]      FIG. 40  is a sectional view partly comparable to  FIG. 28  except corresponding to the disposition of things in  FIG. 36 ; 
           [0053]      FIG. 41  is a sectional view partly comparable to  FIG. 40  except corresponding to the disposition of things in  FIG. 37 ; 
           [0054]      FIG. 42  is a sectional view partly comparable to  FIG. 41  except corresponding to the disposition of things in  FIG. 38 ; 
           [0055]      FIG. 43  is a sectional view partly comparable to  FIG. 42  except corresponding to the disposition of things in  FIG. 39 ; 
           [0056]      FIG. 44  is a sectional view partly comparable to  FIG. 43  except showing further advance of the lead clip, and, the beginning of the forcing apart the jaws thereof; and 
           [0057]      FIG. 45  is a sectional view partly comparable to  FIG. 43  except showing still further advance of the lead clip, and, the maximum extent of the forcing apart the jaws of the clip, after which said lead clip has been ejected clear of said dispensing apparatus and is free to clamp (eg., ‘bite’) on the target tissue which the user (eg., surgeon) has presumably taken aim upon (target tissue not shown); 
           [0058]      FIG. 46  is a perspective view of a further embodiment of endoscopic multi-clip dispensing apparatus in accordance with the invention for dispensing a further embodiment of endoscopic surgery clips also in accordance with the invention; 
           [0059]      FIG. 47  is an enlarged scale perspective view of one such surgery clip, as with its jaws spread open in state of full extension about 180° open wide; 
           [0060]      FIG. 48  is a perspective view comparable to  FIG. 47  except showing the surgery clip with its jaws in the process of clamping shut, but still about 30° apart; 
           [0061]      FIG. 49  is an exploded perspective view of the clip, showing that its two jaws are resiliently biased to a shut (eg., clamping) position therefor by a torsion spring; 
           [0062]      FIG. 50A  is a perspective view of a series of such clips loaded head to tail in the hollow passage of the flexible conduit of said further embodiment of said dispensing apparatus in accordance with the invention, wherein a plunger rod advances the whole series of clips forward in unison by abutting and applying pressure against the tail end of the trailing clip (see, eg.,  FIG. 35 ), and all as snaked through an operating channel of an endoscope, wherein only the outline of the endoscope as well as the control wires for flexing (ie., curling) the endoscope are shown in dashed lines; 
           [0063]      FIG. 50B  is a perspective view of the terminal end of the endoscope of  FIG. 50A ; 
           [0064]      FIG. 50C  is an enlarged scale section view taken along the line LC-LC in  FIG. 50B , with only the outline of the endoscope shown in dashed lines; 
           [0065]      FIG. 51  is a side elevational view of  FIG. 47 ; 
           [0066]      FIG. 52  is a side elevational view of  FIG. 48 ; 
           [0067]      FIG. 53  is a top plan view of  FIG. 51 ; 
           [0068]      FIG. 54  is a bottom plan view of  FIG. 51 ; 
           [0069]      FIG. 55  is a side elevational view of the opposite side of  FIG. 51 ; 
           [0070]      FIG. 56  is a left end elevational view of  FIG. 51 ; 
           [0071]      FIG. 57  is a right end elevational view of  FIG. 51 ; 
           [0072]      FIG. 58  is a sectional view taken along line LVIII-LVIII in  FIG. 51 ; 
           [0073]      FIG. 59  is a sectional view taken along line LIX-LIX in  FIG. 51 ; 
           [0074]      FIG. 60  is an elevational view, partly in section, of the dispensing end of  FIG. 46  and/or somewhat of  FIG. 50 ; 
           [0075]      FIG. 61  is a section view taken along line LXI-LXI in  FIG. 60 ; 
           [0076]      FIG. 62  is an elevational view, partly in section, and comparable to  FIG. 60  except showing the advance of the lead clip out of the dispensing end of the conduit of said dispensing apparatus; 
           [0077]      FIG. 63  is an elevational view, partly in section, and comparable to  FIGS. 60 and 62  except showing the ejection of the lead clip out of the dispensing end of the conduit of said dispensing apparatus, wherein this view presupposes that the operator (eg., surgeon) of this dispensing apparatus has hooked the lead hook-end of the clip on some target anatomy (not shown), which is why the lead hook-end of the clip remains axially aligned with the core of the conduit of the dispensing apparatus and it is the trailing hook-end of the clip which swings around to ‘bite into’ (eg., form a clamp with) the lead hook-end; 
           [0078]      FIG. 64  is an exploded perspective view comparable to  FIG. 49 , except of still another embodiment of an endoscopic surgery clip in accordance with the invention, which like the clip of  FIG. 49  has two jaws which are torsionally-biased toward each other, and which can be spread 180° apart, except wherein the torsion applicator is bar of resilient material (which is shown suspended in isolation between the two jaws of the clip); 
           [0079]      FIG. 65  is an enlarged-scale side elevational view comparable to  FIG. 50 , except of the clip of  FIG. 64 , and of more particularly the hinge portion thereof; 
           [0080]      FIG. 66  is a sectional view taken along line LXVI-LXVI in  FIG. 65 , wherein the torsional resilient bar has been twisted into at least one full coil, whereby the uncoiling thereof into half a coil swings the jaws from wide open at 180° apart to shut at about 0° apart; 
           [0081]      FIG. 67  is a perspective view comparable to  FIG. 47 , except of yet another embodiment of a clip in accordance with the invention for dispensing out of a multi-clip dispensing apparatus in accordance with the invention wherein the clips are loaded in a line in a core of an axially-elongated conduit of the dispensing apparatus, in a head to tail line up; 
           [0082]      FIG. 68  is a side elevational view thereof, with a leading hook-end for a leading jaw to the left in the view and a trailing hook-end for a trailing jaw shown to the right in the view; 
           [0083]      FIG. 69  is a side elevational view comparable to  FIG. 68  except showing the jaws of the clip flexed open beyond a mere 180° apart, and, instead to nearly 225° apart, wherein this view presupposes that the leading jaw has cleared the dispensing end of the dispensing apparatus and the operator (eg., surgeon) of the dispensing apparatus has hooked the lead hook-end of the clip on some target anatomy (not shown), which is why the lead hook-end of the clip is bent upward of axis of the core of the conduit of the dispensing apparatus (as the trailing hook-end, which is still confined therein, remains axially-aligned with such core of the conduit of the dispensing apparatus); 
           [0084]      FIG. 70  is a side elevational view comparable to  FIG. 69  except showing the progression of the trailing jaw after it has cleared the dispensing end of the dispensing apparatus, ie., the jaws snap shut and “bite” into (eg., apply a clamping force on) the target tissues aimed at by the operator of the dispensing apparatus (eg., a surgeon); around to ‘bite into’ (eg., form a clamp with) the lead hook-end; 
           [0085]      FIG. 71  is a side elevational view comparable to  FIG. 68 , except including the illustration of the dispensing end of the elongated conduit of the dispensing apparatus; 
           [0086]      FIG. 72  is a side elevational view comparable to  FIG. 69 , except including the illustration of the dispensing end of the elongated conduit of the dispensing apparatus; 
           [0087]      FIG. 73  is a side elevational view comparable to  FIG. 70 , except including the illustration of the dispensing end of the elongated conduit of the dispensing apparatus; and 
           [0088]      FIG. 74  is an enlarged-scale side elevational view comparable to  FIG. 69 , and focusing in on the hinge-portion of said clip; 
           [0089]      FIG. 75  is a perspective view comparable to any of  FIG. 7 or 35  except of a different embodiment of a clip and dispensing apparatus in accordance with the invention, wherein unlike  FIGS. 1-45  in which the clips have just a pair of jaws, the clip in this view has three jaws (ie., it is more of a claw) and the dispensing apparatus is arranged with three arms formed with flared ends to manage the opening of the jaws/claws of this clip, however, like the clips of  FIGS. 1-45  the clips of this view does travel through the inner tubular conduit of the dispensing apparatus with the jaws/claws facing forwardly; and 
           [0090]      FIG. 76  is a section view taken along line LXXVI-LXXVI in  FIGS. 75 . 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0091]    The drawing figures show various embodiments of a series of surgery clips  100 ,  102 ,  104 ,  106  and  108  in accordance with the invention which are formed in a line in a tubular conduit  130  of endoscopic multi-clip dispensing apparatus  110 ,  112 ,  114  and/or  118  in accordance with the invention. 
         [0092]    Referring to  FIGS. 1A-19 and 20-45  show a first and second embodiment respectively wherein the clips  100  and  102  have a pair of jaws  120  and  122 , respectively, which face forwardly when loaded in the dispensing apparatus  110  and  112 , respectively.  FIGS. 75 and 76  comparably discloses a third embodiment of a clip  108  when loaded in the dispensing apparatus  118 .  FIGS. 46-74  will be dealt with more particularly below. 
         [0093]    With general reference to  FIGS. 1A-45 , the clip  100  or  102  may comprise a composite construction  134  and  136  comprising tissue biting jaws permanently biased shut by a clamping spring  136  which has a C-shaped profile from the side (see, eg.,  FIG. 3B ). Alternatively, the clips  110  or  102  may comprise a monolithic construction of a single material  134  (see, eg.,  FIGS. 21-24 ). 
         [0094]    The endoscopic multi-clip dispensing apparatus  110  or  112  in accordance with the invention preferably comprises a sleeve inside a sleeve construction, with an inner tubular conduit  140  inserted inside an outer tubular conduit  130 . The outer tubular conduit  130  serves as the frame of reference for the actuation and movement of the other parts of the multi-clip dispensing apparatus  110  or  112 . The outer tubular conduit  130  originates in a manual actuator  142  and terminates in a dispensing end  144 . 
         [0095]    The inner tubular conduit  140  has a reciprocation action inside the outer tubular conduit  130 , reciprocating between extended and retracted extremes. The inner tubular conduit  140  has a sidewall defining an axial lumen. The series of clips  100  or  102  are loaded in the axial lumen of the inner tubular conduit  140 . The series of clips are pushed from behind by an elongated flexible plunger rod  146  serving as a pressure-urging follower. The plunger rod  146  can be indexed through the inner tubular conduit  140  in increments corresponding to the axial length of each clip  100  or  102 . That way, the plunger rod  146  pushes forward the line of clips  100  or  102  the increment of one clip&#39;s length at a time. Thus the plunger rod  146  forces the dispensing of a single clip  100  or  102  at a time. 
         [0096]    The plunger rod  146  is indexed continually forward at one increment at a time until the last clip  100 ST or  102 ST is dispensed. Then the plunger rod  146  may be retracted all the way back to an original starting point, such as for (needless to say) the reloading of a fresh line of clips  100  or  102 . This can be likened to and without limitation as the way a caulk gun operates on a tube of caulk. The caulk gun plunger rod is ratcheted continually forward in the tube of caulk, forcing the dispensing of caulk out the dispensing end. Once the caulk gun plunger rod reaches the end, and the tube of caulk is depleted, the caulk gun plunger rod is released to be retracted all the way back to the starting point. The depleted tube of caulk is discarded, and a fresh tube of caulk is loaded. 
         [0097]    As mentioned, the inner tubular conduit  140  has a reciprocation cycle inside the outer tubular conduit  130 . The inner tubular conduit  140  normally rests in its retracted extreme. During an actuation cycle, the inner tubular conduit  140  extends through an extension stroke to an extended extreme. It momentarily holds stationary in the extended extreme as the lead clip  100 LD or  102 LD is ultimately ejected, after which, the inner tubular conduit  140  returns to rest in its retracted extreme. 
         [0098]    The inner tubular conduit  140  has a terminal end  152  which is axially spaced away and inside of the dispensing end  144  of the outer tubular conduit  130 . Hence, resting in the retracted extreme, the terminal end  152  of the inner tubular conduit  140  is gapped away from the dispensing end  144  and inside the core of the outer tubular conduit  130  by a given distance. During the actuation cycle, the terminal end  152  of the inner tubular conduit  140  travels about half that given distance to come closer to the dispensing end  144  of the outer tubular conduit  130 . But, the terminal end  152  of the inner tubular conduit  140 , when reaching the extended extreme, does not travel so far as to actually protrude out of the dispensing end  144 . 
         [0099]    Hence the foregoing defines an “ejection station”  154  inside the dispensing end  144  of the outer tubular conduit  130 . That is, the axial length in the core of the outer tubular conduit  130  between its dispensing end  144 , and, the terminal end  152  of the inner tubular conduit  140  in the extended extreme, defines the “ejection station”  154 . 
         [0100]    It is in the ejection station  154  that the lead clip  100 LD or  102 LD is ultimately spread open, ejected, and allowed to form a “bite” of clamping pressure on some target tissue:—which target tissue is targeted by the operator of said endoscopic multi-clip dispensing apparatus  110  or  112  in accordance with the invention (eg., a surgeon). 
         [0101]    While the inner tubular conduit  140 —speaking strictly of it alone—does not extend out the dispensing end  144  of the outer tubular conduit  130 , the inner tubular conduit  140  does have a pair of arms  160  or  162 :—which do. That is, the inner tubular conduit  140  has protruding from its terminal end  152  a pair of arms  160  or  162  (at least a pair of arms). That is, if the clips  100  or  102  only have a pair of jaws  120  or  122  (eg., see,  FIGS. 1A-45 ) then the inner tubular conduit  140  will have just a pair of arms  160  or  162 . However, if the clips  108  have three jaws  128  (eg., see,  FIGS. 75 and 76 ), then the inner tubular conduit  140  will have three arms  168 . And so on, the number of arms roughly corresponding to the number of jaws. 
         [0102]    The arms  160  or  162  project from base ends anchored in the inner tubular conduit  140  proximate the terminal end  152  thereof, to free ends  170  or  172 . When the inner tubular conduit  140  is resting in its retracted position, the free ends  170  or  172  of the arms  160  or  162  lie just inside the dispensing end  144  of the outer tubular conduit  130 . When the inner tubular conduit  140  is extended to its extended extreme, the free ends  170  or  172  of the arms  160  or  162  do indeed project outside of the dispensing end  144  of the outer tubular conduit  130 . 
         [0103]    The free ends  170  or  172  of the arms  160  or  162  are formed in wedge-shaped flared ends  170  or  172 , which also are flexed in toward each other, each at the end of a respective arm  170  or  172 . Preferably the arms  160  or  162  are produced out of not only a resilient material but a durable material too, one which resists erosion after the scraping passage thereover of numerous clips  100  or  102 . It is preferred without limitation that the arms  160  or  162  are produced of spring steel. 
         [0104]    The drawings figures provide several sequences of views showing how one clip  100  or  102  is ultimately dispensed. See, eg.,  FIGS. 4-7 , and/or  FIGS. 13-17 , and/or  FIGS. 34-35 , and/or  FIGS. 36-39 , and/or  FIGS. 40-45 , and so on. 
         [0105]    Therefore, any of the foregoing sequences of views show a progression comprising the lead clip  100 LD or  102 LD of a series of clips  100  or  102 , respectively, in accordance with the invention being dispensed out the dispensing end  144  of the endoscopic multi-clip dispensing apparatus  110  or  112 , respectively, in accordance with the invention. 
         [0106]    The dispensing apparatus  110  or  112  is shown in section in the various sequences identified above, and from various perspectives, or from vertical and horizontal cutting planes through the longitudinal axis thereof. The series of clips  100  or  102  are typically shown in a head to tail line up (ie., wherein the head end is lead by the jaws  102  or  122  and the tail end is where the spring  136  is disposed), which each sequence beginning with the lead clip  100 LD or  102 LD in position for dispensing. 
         [0107]    The sequences show the progression of changes the lead clip experiences through the process of being dispensed. The lead clip  100 LD or  102 LD is being pushed from behind by a considerable thrusting force on the line of clips  100  or  102 , respectively, in the dispenser&#39;s inner tubular conduit  140 . As do all of the clips  100  or  102 , the lead clip  100 LD or  102 LD has upper and lower jaws  120  or  122 , respectively, giving the clip  100 LD or  102 LD an overall C-shape. Both the upper and lower jaws  120  or  122 , respectively, have turned-in flanges or turned-in channels defining eaves  180  or  182 , respectively, or tracks that ride along the edges up the wedge-shaped flared ends  170  or  172  of the arms  160  or  162 , respectively. With the eaves or tracks  180  or  182  of the C-shaped clip  100 LD or  102 LD, respectively, being spread open by scraping transit over the wedge-shaped flared ends  170  or  172  of the arms  160  or  162 , respectively, the tissue biting jaws  120  or  122  of the lead clip  100 LD or  102 LD open, and, open wide. 
         [0108]    Moreover, the whereby the arms of the tubular conduit and flanges of the lead clip cooperate to prevent relative spinning. 
         [0109]    In order for the jaws  120  or  122  to open that wide, the wedge-shaped flared ends  170  or  172  of the arms  160  or  162  have to reciprocate through a cycle of extension and retraction strokes. The flared ends  170  or  172  extend outside of the dispensing end  144  of the outer tubular conduit  130  in order to give the tail end of the clip  100 LD or  102 LD sufficient clearance to flex open wide. Otherwise, if confined in the ejection station  154 , the lead clip  100 LD or  102 LD would not be able to open as wide. As the eaves or tracks  180  or  182  of the lead clip  100 LD or  102 LD ultimately pass by the flared ends  170  or  172  of the extended arms  160  or  162 , the jaws  120  or  122  of the lead clip  100 LD or  102 LD are free to snap shut. At the same time, the lead clip  100 LD or  102 LD is released from any further contact with the dispenser  110  or  112  or line of trailing clips  100  or  102 . The lead clip  100 LD or  102 LD is free to bite firmly on any tissue which the operator has aimed the lead clip  100 LD or  102 LD at (eg., an example operator is a surgeon). In the last stage of the ejection of the lead clip  100 LD or  102 LD, the line of trailing clips  100  or  102  from behind move forward until what becomes the succeeding new lead clip is trapped in a ready-to-go, next-to-be ejected position by the retracting arms  160  or  162  and inward flexing flared ends  170  or  172  of inner tubular conduit  140 . That is, the wedge-shaped flared-ends  170  or  172  retract by the retraction stroke of the inner tubular conduit  140  and form somewhat of a clapped together embrace with each other by the resiliency in the arms  160  or  162 . This clapping embrace of the flared ends  170  or  172  can be likened to, and without limitation, a single clap of a person&#39;s hand. 
         [0110]    To turn now to  FIGS. 46-74 , these views show several embodiments of clips  104  and  106 , and, dispensing apparatus  114  arranged wherein the jaws  124  or  126 , respectively, open to about 180° apart when loaded in the tubular conduit  140  of the dispensing apparatus  114 . In such an arrangement, one jaw  124  or  126  is the lead jaw  186  and the other jaw  124  or  126  is the trailing jaw  188 . The leading jaw  186  has a leading hook-end  192  and the trailing jaw  188  has a trailing hook-end  194 . During the progression of dispensing the leading clip  104 LD or  106 LD out of the dispenser end  144 , the leading clip  104 LD or  106 LD′s leading end  192  extends out first. Preferably the leading hook-end  192  of the leading jaw  186  is latched onto some target tissue (not shown) so the that clip  104 LD or  106 LD does not wastefully close on itself without clamping any tissue. Then when the trailing jaw  188  clears the dispensing end  144  of the dispensing apparatus  114 , the trailing jaw  188  snaps shut toward the leading jaw  186 , and thereby forms the intended clamping action. 
         [0111]    The dispensing apparatus  114  only needs a single tubular conduit  130 , and not a sleeve-inside-a sleeve configuration as before. However, the dispensing apparatus  114  still needs a plunger rod (not shown) incrementally forcing each clip  104  or  106  in series out of the dispensing end  144 , one clip at a time. Preferably any give clip  104  or  106  ahead of another in the line of clips  104  or  106 , respectively, is pushed forward by the leading end  192  of the trailing clip  104  or  106  bearing against the hinge  196  of the leading clip  104  or  106 , respectively. 
         [0112]    It is further preferred if the core of the tubular conduit  130  had a metering device (not shown) such as and without limitation a miniature turn-stile or the like proximate the dispensing end  144 . The metering device would preferably meter the dispensing of the clips  104  or  106  to one clip at a time. That is, as soon as the current-lead clip  100 LD or  106 LD is ejected, the metering device holds back or offers resistance to the next clip  104 NX or  106 , NX, respectively. However, the means holding back the next clip  104 NX or  106 NX or offering the resistance can be overcome after a moment&#39;s wait to thereby allow the operator (eg., surgeon) to eject the next clip. 
         [0113]    The invention having been disclosed in connection with the foregoing variations and examples, additional variations will now be apparent to persons skilled in the art. The invention is not intended to be limited to the variations specifically mentioned, and accordingly reference should be made to the appended claims rather than the foregoing discussion of preferred examples, to assess the scope of the invention in which exclusive rights are claimed.