Patent Document

BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     The present invention is related to a an apparatus alignment device, and more particularly relates to an alignment device for a cartridge of a medical clip applying device that is able to accept more than one type of clip cartridge.  
         [0003]     2. Background and Material Information  
         [0004]     Laparoscopic surgery is generally defined as minimally invasive surgery upon a patient, utilizing small or miniaturized medical devices by which body tissue is cut, removed or cauterized by small manipulable tools/devices through small incisions or openings within the patient&#39;s body. One such tool is a clip applier, which is used to grasp and/or crimp/seal tissue by the single hand of an operating surgeon., and is described in commonly-assigned U.S. Patent Publication No. 2003/0040759 and U.S. Pat. No. 6,277,131, the entire contents of both documents being expressly incorporated by reference herein.  
         [0005]     Prior art clip appliers have a patient-engaging distalmost end with a pair of squeezable jaws arranged on the distal end of an elongated channel or frame. The elongated channel is surrounded by an elongated tube, which elongated tube and elongated channel are secured at their respective proximalmost ends to the distal end of a pistol-like handle grip assembly. The handle grip assembly includes an arcuately movable squeezable trigger. By squeezing the trigger towards a housing portion of the handle grip assembly, a clip is advanced through the elongated channel and into the jaws from an elongated ladder-like clip supply cartridge disposed through the elongated housing. The actuating sequence includes the squeezing of the trigger to close the jaws and thus crimp the clip between the jaws, then releasing the trigger to advance a new clip into location between the jaws awaiting the next squeezing of the trigger. The elongated clip supply cartridge is fed into a receiving slot or port in the proximal end of the handle grip assembly. Once all of the clips have been discharged from the cartridge, the cartridge may be removed from the clip applier and discarded, and the clip applier may be sterilized and reused.  
         [0006]     It is also noted that manufacturers of cartridges for reusable clip appliers typically produce different clip supply cartridges each having a differently sized and/or shaped set of clips for use with different clip appliers. Depending on the type of surgery, the surgeon may specify a clip of a specific size, ranging from small to large. Sizes may vary depending on factors such as width (i.e., the gap between the prongs of the clip) and gauge of material. Only a single-sized series of clips may fit into a specific cartridge: if the clips are too small, then they cannot be securely held within the cartridge, and if the clips are too large, then they will not fit within the confines of the cartridge.  
         [0007]     For example, it is also known that a cartridge containing medium-sized clips can be used only with a medium-sized clip applier that accepts medium-sized clip cartridges, and the medium-sized clip applier can only hold medium-sized clip cartridges. Similarly, a cartridge containing large-sized clips can be used only with a large-sized clip applier that accepts large-sized clip cartridges, and the large-sized clip applier can only hold large-sized clips. For example, if the cartridge is too small, then the cartridge cannot be securely held within receiving slot or port, and if the cartridge is too large, then it will not fit within the cartridge.  
         [0008]     Therefore, if the nature of a surgeon&#39;s practice dictates that different sized clips be used for various surgical procedures, then a surgeon must keep an inventory of differently sized clip appliers, which results in increased cost and inventory time. Additionally, if a single surgical procedure requires the use of two different sized clips, then the surgeon must use two different clip appliers, and switching between clip appliers is a time-consuming process. Therefore, a need has arisen for a clip applier that can accept and align cartridges containing differently-sized and/or shaped clips.  
       SUMMARY OF THE INVENTION  
       [0009]     A non-limiting embodiment of the present invention provides an alignment device for an apparatus, the apparatus configured to selectively receive a first implement having a first width and a second implement having a second width, the first and second widths extending in a radial (or transverse) direction generally orthogonal to an insertion axis direction of the first and second implements. The device has a pair of generally parallel spaced-apart elongated rails defining at least two channels, the at least two channels comprising a first channel having a first channel width, and a second channel having a second channel width, the first and second channel widths being different, the first channel being configured to centrally hold the first implement in the radial direction, and the second channel being configured centrally hold the second implement in the radial direction.  
         [0010]     Another feature may include a transition area between the first and second channels, the transition area configured to guide the insertion of the first implement into the first channel, the transition area being further configured to block insertion of the second implement into the second channel.  
         [0011]     An additional feature may include a tapered distal end configured to be inserted into a body cavity, and a further feature may include a generally semi-cylindrically-shaped outer surface. Additionally, the second channel may be located proximally of the first channel.  
         [0012]     In a further feature, the first implement is a first cartridge type containing a plurality of crimpable clips of a first size, and the second implement is a second cartridge type containing a plurality of crimpable clips of a second size, the first size being different from the second size.  
         [0013]     Yet another feature may include a cavity configured to accept the insertion and retraction of a clip-engaging feeder, the feeder configured to retrieve and load a clip of the plurality of crimpable clips of the first size and the second size.  
         [0014]     Still yet another feature may include a ramp portion configured to inclinedly slide a clip of the plurality of crimpable clips of the first size and the second size toward a pair of clip-crimping jaws.  
         [0015]     In another feature the apparatus includes an elongated channel configured to selectively receive the first implement and the second implement, and the elongated rails further define a third channel therebetween configured securely and centrally hold an elongated channel member in the radial direction, the elongated channel member selectively housing the first implement and the second implement and further housing controls for at least one of a clip-engaging feeder or clip-crimping jaws. Additionally, the second channel may be located proximally of the first channel, and the third channel may be located proximally of the second channel.  
         [0016]     A feature of the invention provides a method for aligning, in an apparatus, a first implement having a first width and a second implement having a second width, the first and second widths extending in a radial direction generally orthogonal to an insertion axis direction of the first and second implements. The method may include selectively inserting, in the insertion axis direction, the first implement in the apparatus between a pair of elongated rails of the apparatus that define a first channel therebetween such that the first implement is securely and centrally held in the radial direction, and the second implement in the apparatus between the pair of elongated rails that further define a second channel therebetween such that the second implement is securely and centrally held in the radial direction.  
         [0017]     In another feature, the apparatus further includes a transition area between the first and second channels, and the method further includes selectively guiding, via the transition area, the insertion of the first implement into the first channel, and blocking insertion of the second implement into the second channel. In a further feature, the apparatus has a tapered distal end, and the method further includes inserting at least the tapered end into a body cavity.  
         [0018]     In still another feature, the first implement is a first cartridge type containing a plurality of crimpable clips of a first size, and the second implement is a second cartridge type containing a plurality of crimpable clips of a second size, the first size being different from the second size.  
         [0019]     In yet a further feature, the apparatus further includes a cavity, and the method further includes insertion and retracting of a clip-engaging feeder. Also, a ramp portion may be provided which inclinedly slides a clip of the plurality of crimpable clips of the first size and the second size toward a pair of clip-crimping jaws.  
         [0020]     Additionally, the apparatus may include an elongated channel configured to selectively receive the first implement and the second implement, and the method may further include securely and centrally holding an elongated channel member in the radial direction between a third channel defined by the elongated rails.  
         [0021]     A further feature provides an alignment device for an apparatus, the apparatus configured to selectively receive a first implement having a first width and a second implement having a second width, the first width being less than the second width, the first and second widths extending in a radial direction generally orthogonal to an insertion axis direction of the first and second implements. The device may include a body and a pair of elongated rails, each elongated rail of the pair of elongated rails extending in the insertion axis direction and along opposite sides of the body, wherein the pair of elongated rails each includes a first rail portion defining a first channel therebetween configured to securely hold the first implement in the radial direction, such that the first implement is centered in the radial direction with respect to the apparatus; and a second rail portion defining a second channel therebetween, a width of the first channel being less than a width of the channel, the second channel, the second channel configured to securely hold the second implement in the radial direction, such that the first implement is centered in the radial direction with respect to the apparatus.  
         [0022]     According to an additional feature, each elongated rail includes a transition area between the first rail portion and the second rail portion and configured to guide the insertion of the first implement into the first channel, the transition area being further configured to block insertion of the second implement into the first channel.  
         [0023]     A feature additionally provides a medical clip applying device for crimping a clip onto tissue. The device may have a body assembly having a handle and a squeezable trigger, a tube having a first end extending into the body assembly, a pair of jaws arranged on a second end of the tube, the jaws actuable by squeezing action of the trigger, the second end of the tube and the pair of jaws configured to be inserted into a body cavity, and an alignment device arranged on the second end of the tube and configured to be inserted into the body cavity, a loading port in communication with the tube, wherein the tube is configured to selectively receive, through the loading port (a) a first implement having a first width, or (b) a second implement having a second width, the first and second widths extending in a radial direction generally orthogonal to an insertion axis direction of the first and second implements, and wherein the alignment device has a pair of elongated rails defining a first channel therebetween configured to securely and centrally hold the first implement in the radial direction, the pair of elongated rails further defining a second channel therebetween configured to securely and centrally hold the second implement in the radial direction.  
         [0024]     Other exemplary embodiments and advantages of the present invention may be ascertained by reviewing the present disclosure and the accompanying drawings, and the above description should not be considered to limit the scope of the present invention. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0025]     The present invention is further described in the detailed description which follows, in reference to the noted plurality of drawings, by way of non-limiting examples of preferred embodiments of the present invention, in which like characters represent like elements throughout the several views of the drawings, and wherein:  
         [0026]      FIG. 1  is a sectional view of a medical clip applying device according to an embodiment of the present invention, showing a large cartridge inserted therein;  
         [0027]      FIG. 2  is a bottom plan view of a distal end of the medical clip applying device, showing a medium-large clip inserted therein;  
         [0028]      FIG. 3  is a bottom plan view of a distal end of the medical clip applying device, showing a large clip inserted therein;  
         [0029]      FIG. 4  is a perspective view of a medium-large clip supply cartridge for use with an embodiment of the present invention;  
         [0030]      FIG. 5  is a perspective view of a large clip supply cartridge for use with an embodiment of the present invention;  
         [0031]      FIG. 6  is a side sectional view of an elongated tube of an embodiment of the present invention, showing a medium-large clip supply cartridge inserted therein;  
         [0032]      FIG. 7  is another side sectional view of an elongated tube of an embodiment of the present invention, showing a medium-large clip supply cartridge inserted therein;  
         [0033]      FIG. 8  is a side sectional view of an elongated tube of an embodiment of the present invention, showing a large clip supply cartridge inserted therein;  
         [0034]      FIG. 9  is another side sectional view of an elongated tube of an embodiment of the present invention, showing a large clip supply cartridge inserted therein;  
         [0035]      FIG. 10  is a perspective view of a jaw assembly and cinch of an embodiment of the present invention;  
         [0036]      FIG. 11  is a perspective view of the underside of a jaw assembly of an embodiment of the present invention;  
         [0037]      FIG. 12  is an enlarged sectional view of a handle grip assembly of an embodiment of the present invention;  
         [0038]      FIG. 13  is a perspective view of the underside of a cinch of an embodiment of the present invention;  
         [0039]      FIG. 14  is a perspective view of the underside of the cinch in an intermediate position;  
         [0040]      FIG. 15  is a plan view of the underside of the cinch of an embodiment of the present invention, in a proximal position;  
         [0041]      FIG. 16  is a top plan view of the of the cinch of an embodiment of the present invention, in the proximal position;  
         [0042]      FIG. 17  is a plan view of the underside of the cinch and jaw assembly of an embodiment of the present invention, when the jaws are in a partially-closed position;  
         [0043]      FIG. 18  is a plan view of the jaw assembly and cinch of an embodiment of the present invention, when the jaws are in a closed position;  
         [0044]      FIG. 19  is an isometric view of the jaw assembly of an embodiment of the present invention;  
         [0045]      FIG. 20  is an upper isometric view of the cinch of an embodiment of the present invention;  
         [0046]      FIG. 21  is a lower isometric view of the cinch of an embodiment of the present invention;  
         [0047]      FIG. 22  is a side elevational view of the jaw assembly;  
         [0048]      FIG. 23  is a perspective view of a cartridge alignment device of an embodiment of the present invention;  
         [0049]      FIG. 24  is a frontal view of the cartridge alignment device of an embodiment of the present invention;  
         [0050]      FIG. 25  is another perspective view of the cartridge alignment device of an embodiment of the present invention;  
         [0051]      FIG. 26  is a bottom perspective view of the cartridge alignment device of an embodiment of the present invention;  
         [0052]      FIG. 27  is a perspective, sectional view of a slider of an embodiment of the present invention;  
         [0053]      FIG. 28  is a front cross-sectional view of the elongated tube taken along the lines of  28 - 28  in  FIG. 6 ;  
         [0054]      FIG. 29  is a sectional view of a slider toggle in an upright position;  
         [0055]      FIG. 30  is an enlarged sectional view of the slider toggle shown in  FIG. 29 ;  
         [0056]      FIG. 31  is a sectional view of the slider toggle in a lowered position;  
         [0057]      FIG. 32  is an enlarged sectional view of the slider shown in  FIG. 31 ;  
         [0058]      FIG. 33  is a bottom plan view of the slider;  
         [0059]      FIG. 34  is a top plan view of the slider;  
         [0060]      FIG. 35  is a perspective view of the underside of the slider;  
         [0061]      FIG. 36  is a perspective view of the top of the slider;  
         [0062]      FIG. 37  is a bottom plan view of the slider attached to an underside of a spine and in a distally-moved position;  
         [0063]      FIG. 38  is a bottom perspective view of the slider attached to an underside of a spine and in a distally-moved position;  
         [0064]      FIG. 39  is a bottom perspective view of the slider attached to an underside of a spine and in a proximally-moved position;  
         [0065]      FIG. 40  is a bottom perspective view of the slider attached to an underside of a spine and in a proximally-moved and locked position;  
         [0066]      FIG. 41  is a plan view of an uncrimped clip for use in an embodiment of the present invention;  
         [0067]      FIG. 42  is a plan view of a partially crimped clip for use in an embodiment of the present invention;  
         [0068]      FIG. 43  is a plan view of a generally fully crimped clip for use in an embodiment of the present invention;  
         [0069]      FIG. 44  is an enlarged perspective sectional view of an indicating arrangement according to an embodiment of the present invention in a partially-crimped position; and  
         [0070]      FIG. 45  is an enlarged perspective sectional view of an indicating arrangement according to an embodiment of the present invention in a generally fully-crimped position.  
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0071]     The particulars shown herein are by way of example and for purposes of illustrative discussion of the embodiments of the present invention only and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the present invention. In this regard, no attempt is made to show structural details of the present invention in more detail than is necessary for the fundamental understanding of the present invention, the description taken with the drawings making apparent to those skilled in the art how the several forms of the present invention may be embodied in practice.  
         [0072]     Referring to the drawings, wherein like characters represent like elements,  FIG. 1  shows a clip applying device  50  for applying medical tissue-pinching clips  52   a ,  52   b  to tissue. The clip applying device  50  has a patient-engaging distalmost end  54  with a pair of squeezable jaw members (jaws)  56  arranged thereon. An elongated channel member or frame (also referred to as the spine)  58  is surrounded by an elongated tube  60 , which elongated tube  60  and elongated channel member  58  are secured at their respective proximalmost ends to the distal end of a generally pistol-like handle grip assembly  62 . The handle grip assembly  62  includes an arcuately movable squeezable trigger  64  that pivots about pivot shaft  64 P. By releasing the squeezed trigger  64  away from a housing portion  66  of the handle grip assembly  62 , a clip  52   a  (shown in  FIG. 2 ),  52   b  (shown in  FIG. 3 ) is advanced through the distal end of the elongated channel member  58  and into the jaws  56  from an elongated ladder-like clip supply cartridge  68   a  (shown in  FIG. 4 ),  68   b  (shown in  FIG. 5 ), disposed through the elongated channel  58 . The elongated clip supply cartridge  68   a ,  68   b  is fed into a receiving slot or port  70  in the proximal end of the handle grip assembly  62 , the receiving slot being in communication with the elongated channel  58 .  
         [0073]     A rotatable enclosure barrel (also referred to as a tube)  72  is rotatably supported within the handle grip assembly  62 . The rotatable enclosure barrel  72  is connected to the proximal end of the elongated channel  58 . The enclosure barrel  72  has an annular distal bearing (first bearing)  74  slidably disposed thereon and an annular proximal bearing (second bearing)  76  slidably disposed thereon. While the figures show a cylindrical barrel (i.e., a round cross-section), it should be readily appreciable by those skilled in the art that the barrel may have alternative shapes, including but not limited to oval, square and triangular cross sections. The distal bearing  74  has a compression spring  78  arranged against its distalmost surface  80 . The compression spring  78  releases a cinch  86  after the jaws  56  have been closed and a clip  52   a ,  52   b  has been crimped, and also provides a proximally-directed bias against the distal bearing  74 .  
         [0074]     The distal bearing  74  has an elongated cinch rod  84  (shown in  FIGS. 6-9 ) extending distally therefrom. The cinch rod  84  extends through the length of the elongated channel  58  (and its surrounding protective enclosure tube  60 ). The cinch  86  (shown in  FIG. 10 ) is generally semi-cylindrically-shaped and arranged on the distal end of the cinch rod  84 . The cinch  86  is slidably arranged on the distal end of the elongated channel  58  and is reciprocally slidable in axial direction X to engage the jaws  56  which are squeezably arranged on the distal end of the clip applying device. The each jaw member  56  is located on a respective jaw arm  256 , and the jaws  56  and jaw arms are part of a jaw assembly  156 . The jaw arms  256  are biased outwardly (i.e.,the jaws  56  are biased open). Distal and proximal movement of the cinch  86  in axial direction X and with respect to the elongated channel  58  effects the respective squeezing closure and biased opening of the jaws  56  at the distal end of the elongated channel  58 . The cinch rod  84  moves in axial direction X to slide the cinch  86  distally and proximally corresponding to the direction of movement of the distal bearing  74  on the distal end of the enclosure barrel  72 .  
         [0075]     The distal bearing  74  is biased proximally by the compression spring  78 , effecting a proximal motion to the distal bearing  74 . The distal bearing  74  is operatively connected to the trigger  64  by a distal paddle  23 , and the proximal bearing  76  is operatively connected to a proximal paddle  25 , which is in turn connected to the trigger by a trigger linkage  98 . Thus, the proximal bearing  76  is biased distally by the compression spring via the trigger linkage  98 .  
         [0076]     An elongated pusher rod  88  extends adjacent to the lower side of the elongated channel  58  (as shown, e.g., in FIGS.  1 ,  6 - 9  and  37 ). The elongated pusher rod  88  has a proximal end connected to the proximal bearing  76  surrounding the enclosure barrel  72  at the proximal end of the handle grip assembly  62 . The pusher rod  88  is connected to a clip-engaging feeder  90  (shown in  FIGS. 2-3 ). The feeder  90  is movable in axial direction X in relation to the clip-loaded cartridge  68   a ,  68   b  disposed within the elongated channel  58 ; however, the pusher rod is disposed below the elongated channel  58  (shown in  FIG. 6 ). Proximal motion of the feeder  90  is effected by proximal motion of the proximal bearing  76  around the enclosure barrel  72  within the handle grip assembly  62 . As the trigger  64  is squeezed (i.e., as the trigger is moved toward the housing portion  66  and pivoted about pivot shaft  64 P), the pusher rod  88  distally retracts in the axial direction X due to distal movement of the distal bearing  74 , which distally moves feeder  90  to retrieve a distalmost clip  52   a ′,  52   b ′ of the plurality of clips that are serially loaded in respective clip cartridges  68   a ,  68   b , in order to prepare (upon release of the trigger) to load the distalmost clip  52   a ′,  52 ′ into guide slots  194  (shown in  FIGS. 10-11  and  19 ), in the opposed faces of the respective jaws  56 . The term “plurality” as used throughout the specification is to be interpreted to mean greater than one and within a number understood by those skilled in the art.  
         [0077]     The trigger  64  is biased toward the unsqueezed position by the compression spring  78  (shown in  FIG. 1 ). Upon release of the trigger  64 , the distal bearing  74  is biased to move proximally, resulting in proximal (rearward) movement of the cinch  86  by the proximal movement of the cinch rod  84 , which permits the jaws  56  to bias themselves open, and the feeder  90  (pushed by the pusher rod  88 ) to push the next available (distalmost) clip  52   a ′,  52   b ′ into the guide slots  194  of the respective jaws  56  as the jaws  56  open fully, as the trigger  64  is permitted to open fully (shown in  FIG. 1 ) from the handle  66  portion of the handle grip assembly  62 . Release of the trigger  64  (after the trigger  46  has been initially squeezed towards the handle  66 ) will automatically advance the next available distalmost clip  52   a ′,  52   b ′ within the cartridge  68   a ,  68   b.    
         [0078]     The embodiments disclosed herein are configured to accept more than one type of cartridge (e.g., cartridges having different sizes and/or shapes). It is noted that throughout the specification, the term “size” to describe the different clips and/or the cartridges also includes shape as well. In a non-limiting embodiment, the clip applying device  50  of present invention accepts a clip cartridge  68   a  containing a series of medium-large sized clips  52   a , and can also accept a clip cartridge  68   b  containing a series of large-sized clips  52   b . It should be readily appreciable by those skilled in the art, however, that in alternative embodiments, the present invention may be configured to accept various other types of clip cartridges, including but not limited to small and medium cartridges, medium and medium-large cartridges, and small and large cartridges. Additionally, while the figures show the clip applying device  50  being able to work with two types of cartridges, it should be readily appreciable by those skilled in the art, however, that in alternative embodiments more than two types of cartridges may be accepted.  
         [0079]     Referring to  FIGS. 6-9 , when the clip applying device  50  is loaded with a cartridge  68   a ,  68   b , there is a predetermined distance Da, Db between the proximal bearing  76  and distal bearing  74 , this distance being determined by a stop key  13  located in the enclosure barrel  72 .  
         [0080]     When the clip cartridge  68   b  is inserted into the receiving slot or port  70  of the clip applying device  50 , the cartridge is slid along axial direction X until it reaches a stop (not shown) and the cartridge can no longer be slid. The stop key  13  is then lowered into a stop keyhole  34  (shown in  FIG. 5 ) of the cartridge  68   b  by pivoting action of the stop key (shown in  FIGS. 8-9 ). When the trigger  64  is released (i.e., when the clip applying device  50  is at rest, shown in  FIG. 1 ), the proximal bearing  76  and distal bearing  74  move towards each other such that the stop key  13  is sandwiched therebetween to create a distance Db between the proximal bearing and distal bearing. The distance Db results from the distal bearing  74  contacting a first distal face  13   a  of the stop key  13 , and the proximal bearing  76  contacting a first proximal face  13   b  of the stop key.  
         [0081]     When the clip cartridge  68   a  is inserted by the user into the receiving slot or port  70  of the clip applying device  50 , the cartridge slides along axial direction X until it reaches a stop and the cartridge can no longer move axially. The clip cartridge  68   a  (shown in  FIG. 4 ) does not have a stop keyhole for the lowering of the stop key  13  therein. Thus, when the trigger  64  is released (i.e., when the clip applying device  50  is at rest), the proximal bearing  76  and distal bearing  74  move towards each other such that the stop key  13  is sandwiched therebetween to create a distance Da between the proximal bearing and distal bearing (shown in  FIGS. 6-7 ). The distance Da results from the distal bearing  74  contacting a second distal face  13   c  of the stop key  13 , and the proximal bearing  76  contacting a second proximal face  13   d  of the stop key. The distance Da is less then the distance Db because the proximal bearing  76  and distal bearing  74  are closer to each other in the axial direction X.  
         [0082]     Additionally, due to the configuration of the face surfaces  13   a - d  of the stop key, when the cartridge  68   a  is inserted into the clip applying device  50 , the proximal bearing  76  and distal bearing are both located more distally than when the cartridge  68   b  is inserted into the clip applying device. Thus (as shown in  FIG. 2-3 ), when the cartridge  68   a  is inserted into the clip applying device  50 , the cinch is advanced in the distal direction to narrow the jaws to a width Wa, and when the cartridge  68   b  is inserted into the clip applying device  50 , the cinch  86  is advanced (a lesser amount than when the cartridge  68   a  is inserted) in the distal direction to narrow the jaws to a width Wb. The width Wa is narrower than the width Wb because when the cartridge  68   a  is inserted into the clip applying device, the cinch  86  is distally advanced a greater amount in the axial direction X than when the cartridge  68   b  is inserted into the clip applying device. As described further hereinbelow, each jaw member  56  is increasingly tapered from a proximal point along the axial direction X to a distalward point where a maximum width portion  56 W is located. Thus, the more the cinch  86  is advanced distally toward the maximum width portion  56 W, the narrower the width between the jaws. In this way (shown in  FIG. 2 ), the narrower width Wa allows the jaws  56  to securely accommodate medium-large clips  52   a  in the guide slots  194 .  
         [0083]     Similarly (shown in  FIG. 3 ), when the cartridge  68   b  is inserted into the clip applying device  50 , since the cinch  86  is advanced a lesser amount than when the cartridge  68   a  is inserted, the jaws are opened wider to width Wb to allow the jaws  56  to securely accommodate large clips  52   b  in the guide slots  194 , which may have a width larger than smaller clips (e.g., medium-large clips  52   a ).  
         [0084]     Further (as shown in  FIG. 2-3 ), when the cartridge  68   a  is inserted into the clip applying device  50 , the feeder  90  is advanced to the proper position to load the clip  52   a , and when the cartridge  68   b  is inserted into the clip applying device  50 , the feeder  90  is advanced (a lesser amount than when the cartridge  68   a  is inserted) to properly load the larger clip  52   b . In other words, when the cartridge  68   b  is inserted, the feeder  90  does not distally advance as much as when the cartridge  68   a  is inserted, because the feeder must be further back to accommodate the larger clip  52   b  (shown in  FIG. 3 ), which may have a longer length than smaller clips (e.g., medium-large clips  52   a ).  
         [0085]     In the above-described embodiment, the position in the axial direction X of both the cinch  86  and the feeder  90  is determined by the stop key  13 ; however, it is appreciable by those skilled in the art that in alternative embodiments, the position in the axial direction X of only one of the cinch  86  and the feeder  90  may be determined by the stop key, i.e., the stop key may be differently configured to allow varied displacement between the proximal bearing  76  and distal bearing  74 . For example, when two clip types of different widths but of the same lengths are respectively used in two different cartridge types, the displacement in the axial direction X of only the cinch may be varied depending on which cartridge type is used, because the feeder is displaced by the same amount in either clip type. Similarly, when two clip types of different lengths but of the same widths are respectively used in two different cartridge types, the displacement in the axial direction X of only the feeder may be varied depending on which cartridge type is used, because the distance between the jaws does not need to be adjusted.  
         [0086]     It is noted that in a non-limiting embodiment, either or both cartridges  68   a ,  68   b  may contain safety keyholes  77   a  and  77   b  (shown in  FIGS. 4-5 ) which do not interact with the stop key  13 , but rather accept a safety key  110 , in order to prevent insertion or withdrawal of the clip cartridge  68   a ,  68   b  unless the trigger  64  is generally fully squeezed rearwardly toward the handle  66  of the handle grip assembly  62  in a manner similar to that disclosed in commonly-assigned U.S. Patent Publication No. 2003/0040759.  
         [0087]     It is also noted that in a non-limiting embodiment, the trigger  64  may be squeezed to allow the insertion of the cartridge  68   a ,  68   b  and/or to crimp a clip  52   a ,  52   b ; however, it should be appreciated that in alternative embodiments, other structure may be used (e.g., a separate or integral tab, button, lever or switch), which may be activated to allow the cartridge  68   a ,  68   b  to be inserted (and/or to crimp a clip  52   a    52   b ), such that the position in the axial direction X of the proximal bearing  76  or the distal bearing  74  may be determined.  
         [0088]     The cinch  86  and jaw assembly  156  of the present invention allow full, positive and consistent control of the opening and closing of the jaws  56  in direction Z (shown in  FIGS. 2 and 10 ), hereinafter referred to as radial or transverse movement, movement in the radial direction or movement in the transverse direction. Because the clip applying device  50  is able to accept two different types of clip cartridges  68   a ,  68   b , and the jaws  56  thus move radially over a greater distance than other clip appliers, such full, positive and consistent control of the jaws  56  is required. Further, limited travel in the axial direction X of a cinch is normally not enough to cover this increased radial travel of the jaws  56 . In other words, there is no single surface of the cinch  86  or jaw assembly  156  to completely and accurately control the opening and closing of the cinch.  
         [0089]     An embodiment of the present invention includes a cinch  86  that allows for greater radial movement of the jaws  56  by engaging different jaw engagement surfaces  156   a ,  156   b ,  156   c ,  156   d ,  156   e ,  156   f  of each jaw arm  256 . The generally semi-cylindrically-shaped cinch  86  has a pair of control fingers (or control members)  30  (shown in  FIG. 13 ) on the underside thereof which engage inner engagement surfaces  156   e  and outer engagement surfaces  156   f  of the jaw arms. In a non-limiting embodiment, the inner and outer engagement surfaces  156   e ,  156   f , as well as the control fingers  30 , may be tapered or angled.  
         [0090]      FIG. 14  shows the cinch  86  in an intermediate position, where the control fingers  30  are intermediate the respective inner engagement surfaces  156   e  and outer engagement surfaces  156   f . In this position (in a non-limiting embodiment), medium-large clips  52   a  may be loaded and the jaw arms may be at rest (i.e., spring forces of the jaw arms are acting neither inwardly nor outwardly in the radial direction Z).  
         [0091]     When the cinch is moved proximally in the axial direction X from the intermediate position, outer control surfaces  30   e  of the control fingers  30  respectively engage the inner engagement surfaces  156   e  to widen the gap between the jaws  56  (e.g., to a width Wb, in order to accommodate cartridge  68   b  containing large sized clips  52   b ), while inner control surfaces  30   f  of the control fingers are brought out of contact with respective outer engagement surfaces  156   f , as shown in  FIGS. 15 and 17 . Conversely, when the cinch is moved distally from a proximalmost position toward the intermediate position, the outer control surfaces  30   e  of the control fingers respectively slide along the inner engagement surfaces  156   e  to gradually (due to the angled configuration) let the jaw arms  256  bias themselves inward.  
         [0092]     Similarly, when the cinch is moved distally in the axial direction X from the intermediate position, inner control surfaces  30   f  of the control fingers  30  respectively engage the inner engagement surfaces  156   e  to narrow the gap between the jaws  56  (e.g., to a width Wa, to accommodate cartridge  68   a  containing medium-large sized clips  52   a , or to begin a clip-crimping operation), while outer control surfaces  30   e  of the control fingers are brought out of contact with respective outer engagement surfaces  156   e , as shown in  FIGS. 15 and 17 . In a non-limiting embodiment, in order to ensure smooth transfer of control throughout the range of movement of the cinch  86 , the control fingers  30  are preferably always in contact with at least one of the inner or outer engagement surfaces  156   e ,  156   f  (as shown in  FIG. 14 ).  
         [0093]      FIG. 18  shows the cinch  86  in a fully distal position in which a clip  52   a ,  52   b  may be fully crimped closed. In a non-limiting embodiment, in order to move the cinch  86  from the fully-distal position along the axial direction X, the cinch includes a generally arcuate central block  32  having opposed ends which respectively engage second inner engagement surfaces  156   d  located on an upper surface of each jaw arm  256  (shown in  FIGS. 16 and 19 ), which may be tapered or angled in a non-limiting embodiment. The central block  32  ensures accurate and precise transition of the control surfaces of the cinch  86  when the jaws  56  begin to open (i.e. when the cinch moves proximally along axial direction X) from the closed jaw position. For example, when the cinch  86  begins to open from the closed jaw position (shown in  FIG. 18 ), a proximal facing surface  32   d  of the central block  32  engages the second inner engagement surfaces  156   d  commence an opening operation of the jaws. After the cinch  86  moves proximally partway along the axial direction X toward the intermediate position, control of the opening of the jaws  56  is “handed off” to the inner control surfaces  30   f  of the control fingers  30 , which respectively slide along the outer engagement surfaces  156   f  to gradually (due to the angled configuration) provide for outward movement of the jaw arms  256  (in direction Z). Although the central block  32  is shown in the figures as being arcuate, it should be understood by those skilled in the art that the central block may take a variety of shapes, including but not limited to, e.g., a wedge, circle, a V or W shape.  
         [0094]     In a non-limiting embodiment, the cinch  82  may include a pair of inwardly facing guide walls  34  (shown in  FIGS. 20-21 ) configured to respectively slidingly engage one or more outer side engagement surfaces  156   a - c  (shown in  FIGS. 19 and 22 ) of each jaw arm  256  to provide further control of (e.g., pitch in the radial direction) the jaw assembly  156  by the cinch. With such a configuration it may not be necessary for the jaw assembly  156  to remain at rest in the intermediate position. Additionally, since the control fingers  30  protrude inwardly, a gap or channel G may be present between the control finger  30  and the ceiling  82   c  of the cinch  82 . A portion of each jaw arm  256  may then be sandwiched between a respective control finger  30  and the ceiling  82   c  of the cinch  82 , thereby providing control and stability (by e.g., preventing dive) of the jaws in a Y-axis direction as the cinch slides in the X-axis direction.  
         [0095]     In  FIGS. 2 and 10 , the radial opening and closing direction of the jaws  56  appears to be orthogonal to the axial direction X (i.e., it appears to be parallel to the axial direction Z); however, it should be understood by those skilled in the art that orthogonal radial movement of the jaws is neither necessary nor required. As shown in  FIG. 10 , in a non-limiting embodiment, the jaw arms  156  may pivot about pivot point P and as such, may result in the radial movement of the jaws being oblique (i.e., in a radial oblique direction) to the axial direction X.  
         [0096]     It is also noted that the cinch control arrangement of the present invention is not limited to a medical clip applier device. Rather, it should be understood by those skilled in the art that the above-described cinch control arrangement of present invention may be used in other clip-applying devices, and may also be used in other devices where a cinch is moved axially to widen and/or narrow a gap between a pair of jaws or other members.  
         [0097]     As described above, the clip applying device  50  of the present invention is able to accept at least two different types of clip cartridges  68   a ,  68   b , and as such, the present invention also provides a cartridge alignment device  36  (shown in  FIGS. 23-26 ) that can center (along central axis CX) clip cartridges  68   a ,  68   b  within the elongated tube  60  in a width, or transverse direction (or radial direction) Z of the cartridges. In other words, the alignment device  36  can maintain the loaded cartridges  68   a  and  68   b  in a central position in relation to the sides (i.e., equidistant to the sidewalls of the tube  60  in the radial orthogonal Z axis direction) of the elongated tube  60  (i.e., so that a sagittal plane defined by the X-Y axis bisecting the cartridges  68   a ,  68   b  is substantially coplanar with a sagittal plane X-Y that bisects the elongated tube. With such an arrangement, the clip cartridge  68   a ,  68   b  can be centered within the elongated tube and the clip cartridge  68   a ,  68   b  and the elongated tube, are aligned in the axial direction X (i.e., along the central axis CX). Thus, a clip  52   a ,  52   b  can be accurately loaded in the jaws  56  and accurately crimped thereby.  
         [0098]     The alignment device  36  has a pair of elongated rails  38  extending in the axial direction X. The rails  38  each have a distal (first) region  38   a  defining a first channel Ca therebetween, a middle (second) region  38   b  defining a second channel Cb therebetween, and a proximal (third) region  38   c  defining a third channel Cc therebetween. Each channel Ca, Cb and Cc successively extends in communication and in the axial direction X. In a non-limiting embodiment, the distal channel Ca is narrower than the middle channel Cb, which in turn is narrower than the proximal channel Cc. The alignment device also has a pair of transition areas  38   t  (each located between a respective distal region  38   a  and middle region  38   b ) which may be tapered or angled to accurately guide the insertion of cartridge  68   a  (which is inserted along axial direction X, also referred to as an insertion axis direction) into the distal channel Ca, where the cartridge  68   a  is securely held and centrally aligned therein in the radial or transverse direction Z (i.e., cartridge  68   a  is sandwiched between both distal regions  38   a ), due to the extending of the distal channel Ca in the axial direction X. In situations where the cartridge  68   b  is wider in radial direction Z than the cartridge  68   a , the cartridge  68   b  cannot fit within the distal channel  68   a . Rather, the transition area blocks the cartridge  68   b  from being inserted in the distal channel  68   a , and also prevents damage to the cartridge  68   b  during the insertion process. Thus, the cartridge  68   b  is securely held and centrally aligned in the channel Cb in the radial direction Z (i.e., the cartridge  68   b  is sandwiched between both middle regions  38   b ), due to the extension of the middle channel Cb in the axial direction X.  
         [0099]     The proximal channel Cc is configured to hold the elongated channel member  58  (through which the cartridge  68   a ,  68   b  is inserted in the insertion axis direction), which is inserted therein during the manufacturing/assembly process. Thus, the elongated channel member  58  is also securely held and centrally aligned in the proximal channel Cc in the radial direction Z (i.e., the elongated channel member  58  is sandwiched between both proximal regions  38   c ), due to the extension of the middle channel Cb in the axial direction X. Additionally, the alignment device  36  also includes a stop region  36   s  which prevents distal displacement in the axial direction X of the elongated channel member  58 . The thickness of a lower portion of the elongated channel member  58  is preferably the same thickness as the lower portion of the stop region, thereby ensuring smooth loading of the cartridges  68   a ,  68   b  into their respective channels Ca, Cb.  
         [0100]     The alignment device  36  may further include an axially-extending cavity  40  configured to accept the insertion and retraction of the clip-engaging feeder  90  when it loads a clip  52   a ,  52   b  (i.e., the cavity  40  can accommodate the feeder  90  therein, between the rails  38 ), and may further include a ramp portion  42  configured to facilitate the sliding and loading of a clip  52   a ,  52   b  into guide slots  194  of the jaws  56 . The alignment device may also include a middle inclined region  84 , located distally of the cavity  40  and extending in the axial direction X, to assist in the upward distal sliding in the axial direction X of the feeder  90 . Further, the alignment device  36  may have an angled or tapered surface  44  at the distal end thereof and/or a semi-cylindrical outer surface  48 , to facilitate the insertion of the alignment device, and therefore the clip-applying device  50 , into the body cavity.  
         [0101]     An advancement block (also referred to as a slider)  12  (shown in  FIGS. 27 and 29 - 36 ) is attached between the pusher rod  88  and clip-engaging feeder  90  (shown in  FIGS. 2-3  and  37 ). The feeder  90  is movable in axial direction X in relation to the clip-loaded cartridge  68   a ,  68   b  disposed within the elongated channel  58 ; however, the pusher rod is disposed below the elongated channel  58  (shown in  FIGS. 6 and 28 ). The slider  12  has a ladder-engaging toggle  14 , which is configured to sequentially engage a series of openings in ladder member  33   a ,  33   b  (respectively shown in  FIGS. 4-5 ) slidably arranged within a respective clip cartridge  68   a ,  68   b . The ladder member  33   a ,  33   b , which is engaged by the toggle  14  of the slider  12  (the slider being operatively connected to pusher rod  88  as shown in  FIG. 37 ) is pushed in the distal direction (along axial direction X) to in turn push against the proximalmost or last clip  52   a ″,  52   b ″ in the cartridge  68   a ,  68   b , so as to also push distally the next adjacent clip(s)  52   a ,  52   b  within that cartridge  68   a ,  68   b . Forward (or distal) advance of the series of clips  52   a ,  52   b  loaded within the cartridge  68  is thus effected.  
         [0102]     As shown in  FIGS. 27 and 29 - 36 , the ladder-engaging toggle  14  pivots in both directions about a pivot shaft  20 , at least a portion of the pivot shaft generally extending in the orthogonal radial direction Z (i.e., generally orthogonal to the axial direction X). Thus, the toggle is pivotable about the Z axis. As best shown in  FIGS. 33-36 , the pivot shaft  30  may be generally shaped like a U or J, so that the pivot shaft does not slide out of the slider  12 . Alternatively, the pivot shaft may have elongated shaft ends, rivets and the like to prevent such sliding out of the slider  12 .  
         [0103]     In a non-limiting embodiment, the toggle  14  is generally shaped like a right triangle, but it should be readily appreciable by those skilled in the art that the toggle can take any variety of desirable shapes and configurations. The toggle  14  has a ridge  14   a  that engages a toggle spring  16  affixed to the slider  12 . The spring  16  may be a leaf spring (but can be other biasing devices including but not limited to a coil spring or other spring-like members formed, e.g., of an elastomeric material), which engages the ridge  14   a  to bias the toggle in an upright (second) position, shown in  FIGS. 30-31  and  36 . In a non-limiting embodiment and as shown in  FIG. 28 , the channel is generally U-shaped, and as described above, the slider  12  proximally and distally slides below and adjacent to the channel  58  in the axial direction X. The channel  58  additionally includes a toggle aperture  58 C 1  in the bottom portion thereof, through which a portion of the toggle  14  is inserted, when the toggle is in the upright position.  
         [0104]     Operation of the clip advancement arrangement according to an embodiment of the present invention will now be described. When the trigger  64  is squeezed, the slider  12  is moved proximally in the axial direction X (since the slider is operably connected to the pusher rod  88 , which is in turn connected to the proximal bearing  76 ). As the slider  12  is moved proximally, an edge-engaging face  14   b  of the toggle  14  engages an edge  58   e  of the channel  58 , such that the channel edge  58   e  (which generally extends in the Z axis direction) pushes the toggle  14  to rotate in a first direction (e.g., counterclockwise when viewing  FIGS. 31-32 ) to a lowered (first) position and against the biasing force of the toggle spring  16 , shown in  FIGS. 31-32 . In the first position, the toggle  14  slides in the axial direction X and below the channel  58 , with at least a portion of the edge-engaging face  14   b  contacting the underside of the channel  58 . It is noted that the channel edge  58   e  may be angled or tapered to increase the surface area thereof, thereby ensuring smooth and precise pivoting action of the toggle  14 .  
         [0105]     When the trigger  64  is released, the slider  12  begins to distally move in the axial direction X. The edge-engaging face  14   b  contacts the underside of the channel  58  until the toggle  14  reaches the toggle aperture  58 C 1 , at which point the edge-engaging face  14   b  contacts the channel edge  58   e  and allows the toggle spring  16  to urge the toggle into the upright position (shown in  FIGS. 30-31  and  36 ) and between rungs  33   a R,  33   b R of the ladder member  33   a ,  33   b , the rungs having rung gaps  33   a G,  33   b G therebetween. Thus, the toggle  14  rotates in a second direction (clockwise when viewing  FIGS. 29-30 ). Pivoting of the toggle  14  in the second direction is stopped when a heel portion  14   d  engages a stop portion  18  located on the slider  12 .  
         [0106]     Once in the upright position, the toggle  14  continues to move distally through the toggle aperture  58 C 1  (and within a rung gap  33   a G,  33   b G) in the axial direction X such that a pushing face  14   c  contacts a rear (proximal) side of a rung  33   a R,  33   b R of the ladder member  33   a ,  33   b . Thus, the toggle  14  pushes the ladder member  33   a ,  33   b  in the distal direction (along axial direction X) to in turn push against the proximalmost or last clip  52   a ″,  52   b ″ in the cartridge  68   a ,  68   b  to also push distally the next adjacent clip(s)  52   a ,  52   b . It is noted that while the rungs  33   a R,  33   b R of the figures extend in the Z axis direction, those skilled in the art will readily appreciate that the rungs could be differently configured in alternative embodiments, including but not limited to, e.g., angled and arcuate.  
         [0107]     The above process may be repeated by continually squeezing and releasing the trigger  64 , which in turn continually distally advances the ladder member  33   a ,  33   b  to distally push clips  52   a  and  52   b , until the last clip  52   a ″,  52   b ″ is loaded into and applied by the jaws  56 .  
         [0108]     It is noted that while many of the figures show the clip advancement arrangement of the present invention being used in a clip applying device  50  that can accept more than one type of clip supply cartridge  68   a ,  68   b , it should be readily understood by those skilled in the art that the clip advancement arrangement of present invention may be used in a clip applying device that can accept only a single type of cartridge, or alternatively, may be used in a clip applying device having clips pre-installed therein.  
         [0109]      FIG. 37  shows a trigger lockout arrangement  11 . As described above, the slider  12  is attached between the pusher rod  88  and clip-engaging feeder  90 . The trigger lockout arrangement  11  serves to lock movement of the trigger  64  when the last clip  52   a ″,  52   b ″ of the cartridge  68   a ,  68   b  has been applied by the jaws  56 , thereby reducing the likelihood of tissue damage by squeezing jaws without a staple therein, and alerting the surgeon that additional clips are required.  
         [0110]     Also as discussed above, when the trigger  64  is squeezed, the slider  12  proximally moves in the axial direction X, and when the trigger is released, the slider moves in the axial direction X such that the toggle  14  distally advances the ladder member  33   a ,  33   b  by one clip and such that the feeder  90  loads the distalmost clip  52   a ′,  52   b ′ between the jaws  56 .  
         [0111]     The channel member  58  also includes a block  91  affixed to the underside of the channel member via a flexible rod  92 , and additionally has a block aperture  58 C 2 , located above the block  91  in the Y-axis direction, for accepting insertion of at least a portion of the block  91  therein. At rest, the flexible rod  92  is biased to generally extend in the axial direction X. The slider  12  also has a tooth  93  that contacts the block  91  when the slider is proximally or distally moved in the axial direction X. While the block  91  is shown as being cubical in arrangement, it should be understood by those skilled in the art that in alternative embodiments the block can take a variety of shapes, including but not limited to, e.g., a trapezoid, frustum or ovoid.  
         [0112]     Specifically, as shown in  FIG. 38 , when the trigger  64  is squeezed and the slider  12  moves proximally in the axial direction X (to approach the block  91  from the front, shown in  FIGS. 37-38 ), a rear surface  93   a  of the tooth  93  engages a front surface  91   a  of the block  91  to move the block in radial direction Z while the slider continues to move proximally. The rear surface  93   a  of the tooth  93  is angled to facilitate movement of the block  91  in the radial direction Z. Once the slider  12  passes the block  91 , the block returns to its original rest position due to the biasing action of the rod  92 .  
         [0113]     When the trigger  64  is released, the slider  12  begins to move distally in the axial direction X and approaches the block  91  from the rear (shown in  FIG. 39 ). If a cartridge  68   a ,  68   b  having a plurality of clips  52   a ,  52   b  has been loaded into the clip applier  50 , the slider moves distally such that a front surface  93   b  (best shown in  FIG. 38 ) of the tooth  93  engages a rear surface  91   b  of the block  91  to push the block upward in the Y-axis direction (i.e., into the page of  FIG. 37 ). Specifically, the upward movement of the block  91  causes a portion of the block to pass through the block aperture  58 C 2  of the channel  58  and be inserted between the rungs  33   a R,  33   b R of the ladder member  33   a ,  33   b  (i.e., the portion of the block is inserted into a rung gap  33   a G,  33   b G), thereby creating clearance for the tooth  93  to pass over the block  91  as the slider continues to move in the distal direction. Once the tooth  93  has passed over the block  91 , the rod  92  urges the block downwardly, since the rod  92  is biased in the axial direction X and to keep the block out of the ladder gap  33   a G,  33   b G.  
         [0114]     To facilitate precise movement of the block  91  in the Y-axis direction, the front surface  93   b  of the tooth  93  and/or the rear surface  91   b  of the block  91  may be angled. Additionally, one or more bands  95  to slidably secure the slider  12  against the underside of the channel  58  may be provided, thereby securing the slider against movement in the Y-axis direction, when the slider moves in the axial direction X. The presence of the block  91  between the rungs  33   a R,  33   b R of the ladder member  33   a ,  33   b  does not interfere with the distal movement of the ladder member by the toggle, since these two operations are out of phase, i.e., during distal movement of the slider  12 , the toggle  14  does not engage a rung  33   a R,  33   b R until after the tooth  93  has passed over the block  91  and the block has withdrawn from the ladder gap  33   a G,  33   b G.  
         [0115]     As described above, the slider may be continually moved proximally and distally by respective continual squeezing and releasing of the trigger  64 , until the last clip  52   a ″,  52   b ″ is loaded into and applied by the jaws  56 . While the last clip  52   a ″,  52   b ″ is being loaded into the jaws  56  by the feeder  90  (and thus no more clips  52   a ,  52   b  are serially loaded within the cartridge  68   a ,  68   b ), the toggle  14  engages the rung  33   a R,  33   b R, thereby advancing the ladder member  33   a ,  33   b  a final time and exposing a solid surface  96  of the ladder member beneath the block aperture  58 C 2  (i.e., there is no longer a ladder gap  33   a G,  33   b G beneath the block  91 ). The clip applying device  50  is now ready for one final clip crimping process. During the final clip crimping process, the trigger  64  is squeezed to proximally move the slider  12  (and to thereby bring the tooth  91  thereof behind the block, as described above) and to distally move the cinch  86  to crimp the last clip  52   a ″,  52   b″.    
         [0116]     As shown in  FIG. 40 , when the trigger  64  is released after the last clip  52   a ″,  52   b ″ has been crimped, the compression spring  78  urges the trigger toward the open position, which (as described above) moves the slider  12  distally so that the tooth  93  engages the block  91 . However, the solid surface  96  of the ladder member  33   a ,  33   b  prevents displacement of the block  91  by the tooth  93  in the Y-axis direction (since there is no ladder gap  33   a G,  33   b G for the block to enter. Thus, the tooth  93  abuts against the block and is prevented from distally moving in the axial direction X, thereby locking the trigger in the closed position and alerting the surgeon that the last clip  52   a ″,  52   b ″ has been applied. As noted above, the bands  95  prevent the slider (and thereby the tooth  93 ) from being displaced in the Y-axis direction so that the tooth does not “leap over” the block  91 , when the slider moves in the axial direction X. It is noted, however, that the trigger  64  is permitted to be slightly unsqueezed so that the last clip  52   a ″,  52   b ″ and any tissue can be released from the jaws  56 . Once the cartridge  68   a ,  68   b  has been removed from the clip applying device  50 , the trigger  64  is free to again move to the unsqueezed position, since the solid surface  96  is no longer present.  
         [0117]     An embodiment of the present invention uses cartridges  68   a ,  68   b  having twenty clips  52   a ,  52   b , however, it should be understood by those skilled in the art that the present invention may use cartridges having fewer or greater than twenty clips. Additionally, while an embodiment of the trigger lockout arrangement  11  of the present invention locks the trigger  64  after all of the clips  52   a ,  52   b  have been applied, it should be understood by those skilled in the art that the trigger lockout arrangement may lock the trigger when one or more clips  52   a ,  52   b  remains in the cartridge  68   a ,  68   b  or the clip applying device  50 .  
         [0118]     It is noted that while many of the figures show the trigger lockout arrangement of the present invention being used in a clip applying device  50  that can accept more than one type of clip supply cartridge  68   a ,  68   b , it should be readily understood by those skilled in the art that the trigger lockout arrangement of present invention may be used in a clip applying device that can accept only a single type of cartridge, or alternatively, may be used in a clip applying device having clips pre-installed therein.  
         [0119]     Another feature of an embodiment of the present invention includes a system for indicating to the surgeon when the clip  52   a ,  52   b  has been partially crimped (shown in  FIG. 42 ) and/or when the clip  52   a ,  52   b  has been generally fully crimped (shown in  FIG. 43 ).  FIG. 41  shows an uncrimped clip. During surgery, a surgeon may want to apply a clip  52   a ,  52   b , yet still leave a gap between the legs of the clip to allow passage of a blood vessel therethrough, thereby allowing blood to flow through the vessel unobstructed. When a surgeon partially squeezes the trigger  64 , the jaws  56  are only partially closed and the clip  52   a ,  52   b  may thus be applied in a partially crimped configuration. This partially-squeezed position is referred to as the cholangio zone. It is thus desirable to alert the surgeon (visually, audibly and/or tactilely) as to when the clip applying device  50  is in the cholangio zone (shown in  FIGS. 12 and 44 ). It is further desirable to alert the surgeon (visually, audibly and/or tactilely) as to when the clip applying device is in fully squeezed position (shown in  FIG. 45 ).  
         [0120]     The clip applying device  50  may include a visual slider  102  (housed within the handle grip assembly  62 ) which slides along an indicator path by way of indicator shaft  104  in an inclined direction with respect to the longitudinal axis X, although it should be understood by those skilled in the art that the indicator shaft  104  may be parallel or declined with respect to longitudinal axis X in alternative embodiments. The visual slider is biased in the general distal direction by a shaft spring  106  which may be disposed about the proximal end of the indicator shaft. Alternatively, the shaft spring  106  may be disposed at the distal end of the indicator shaft  104  to “pull” the visual slider toward the distal end of the grip assembly  62 .  
         [0121]     The visual slider  102  includes three indicator regions  102   a ,  102   b ,  102   c , each having different indicia for indicating the position of the trigger, for example, the color, pattern or wording on each region may be different. Each region  102   a ,  102   b ,  102   c  is alternatively visible through a window  111  located in the top of the grip assembly. As a non limiting example, indicator region  102   a  (indicating the open trigger position) may be green, indicator region  102   b  (indicating the cholangio zone) may be yellow, and indicator region  102   c  (indicating the generally fully-squeezed position) may be red. Alternatively, each indicator region  102   a ,  102   b ,  102   c  may show, e.g., different wording (e.g., “open,” “partial,” “closed”), a different symbol, or a different pattern.  
         [0122]     In the unsqueezed position (shown in  FIG. 1 ), a first abutment surface  102   d  of the visual slider  102  abuts against a first end  112   a  of a pivotable trip switch  112  to maintain the visual slider in its distalmost position (against the distal biasing force of the shaft spring  106 ), and indicator region  102   a  is displayed through the window  110 . The trip switch  112  has a trip switch spring  114  which is affixed to the grip assembly  62  to bias the trip switch to pivot in the counterclockwise direction (when viewed in  FIG. 1 ). Additionally, a second end  112   b  of the trip switch  112  engages an outer surface of the distal bearing to prevent further counterclockwise pivoting of the trip switch.  
         [0123]     When the trigger  64  is squeezed toward the cholangio zone (and the distal bearing begins to move distally along axial direction X), the visual slider  102  remains in position (due to the continued engagement of the first abutment surface  102   d  with the first end  112   a  of the trip switch  112 ) until an angled distal surface of a distal bearing ring  108  engages the second end  112   b  of the trip switch to pivot the trip switch clockwise (when viewed in  FIG. 1 ), which disengages the first abutment surface  102   d  from the first end  112   a  of the trip switch  112 , thereby allowing the shaft spring  106  to proximally urge the visual slider  102 . The visual slider is proximally urged until the first end  112   a  of the trip switch  112  engages a second abutment surface  102   d  of the visual slider  102  to stop proximal movement of the visual slider and exposing the indicator region  102   b  through the window  111  (indicating the cholangio zone to the surgeon), as shown in  FIGS. 12 and 44 .  
         [0124]     When the trigger is squeezed from the cholangio zone to the generally fully squeezed position (and thus the distal bearing continues to move distally to cause the jaws  56  to generally fully crimp the clip  52   a ,  52   b ), the outer circumference of the distal bearing ring  108  further engages the second end  112   b  of the trip switch  112  to further pivot the trip switch clockwise, which disengages the second abutment surface  102   d  from the first end  112   a  of the trip switch  112 , thereby allowing the shaft spring  106  to further proximally urge the visual slider  102  until the slider reaches its limit of proximal travel along the indicator shaft  104 , thereby exposing the indicator region  102   c  through the window  111  (indicating the generally fully squeezed position to the surgeon), as shown in  FIG. 45 .  
         [0125]     When the trigger  64  is released (and the distal bearing begins to move proximally due to the biasing force of the compression spring  78 ), a proximal face of the distal bearing ring  108  engages an indicator finger  102   d  to proximally move the visual slider  102  so that the first abutment surface  102   d  of the visual slider  102  again abuts against a first end  112   a  of the trip switch  112  to reset the visual slider in its distalmost position (thereby again exposing the indicator region  102   a  through the window  111 ), as shown in  FIG. 1 .  
         [0126]     It is noted that, in alternative embodiments, one skilled in the art would readily appreciate that the present invention may be provided with only one indicator region  120   a ,  120   b ,  120   c , only two indicator regions  120   a ,  120   b ,  120   c  (rather then three as shown in the figures), or more than three indicator regions, to indicate any combination of (a) that the clip-applying device  50  is unsqueezed, (b) that the clip applying device is in the cholangio or other mid-squeeze zone, and (c) that the clip applying device is generally fully squeezed.  
         [0127]     The clip applying device  50  of the present invention may also include an audible and/or tactile indicating arrangement. Specifically, in the event the surgeon is too focused on the surgery at hand to look at the viewing window  111 , the indicating arrangement may audibly and/or tactilely indicate to the surgeon when the clip applying device is in the cholangio zone and/or when the trigger is generally fully squeezed. Additionally, the tactile indicating arrangement of the present invention may assist the surgeon in the event that the surgeon is hearing-impaired.  
         [0128]     As shown in  FIGS. 12 and 45 , an upper (first) ratchet  120  and a lower (second) ratchet  122  are affixed to and move with the trigger  64 , which pivots about the trigger pivot shaft  64 P. Additionally, an upper (first) pawl  124  and a lower (second) pawl  126  are pivotably affixed about a proximal paddle shaft  25 P, about which the proximal paddle  25  is also affixed. Additionally, the upper pawl  124  is biased to pivot counterclockwise (when viewed in  FIG. 12 ) by an upper spring  128 , and lower pawl  126  is biased to pivot counterclockwise by a lower spring  130 , the upper spring having a stronger spring force than the lower spring.  
         [0129]     When the trigger is squeezed from the unsqueezed position toward the cholangio zone, lower spring  130  biases the lower pawl  126  to engage the lower ratchet  122  to create a ratcheting sound as the trigger is squeezed toward the cholangio zone and the upper and lower ratchets pivot counterclockwise about trigger pivot  64 P (when viewed in  FIG. 12 ), while indicator region  102   a  is displayed in the window  111 . Once the cholangio zone is entered (and at substantially the same time the window  111  displays indicator region  102   b ), the upper ratchet  120  and lower ratchet  122  continue to pivot counterclockwise so that the upper ratchet engages the upper pawl  124 . Specifically, when the cholangio zone is entered, the upper pawl  124  (due to the biasing force of the upper spring  128 ) engages the first tooth of the upper ratchet  120  to enter a first channel (cholangio channel)  120   a  of the upper ratchet to emit a distinct sound and transmit a distinct tactile sensation. The sound and feel of the upper pawl  124  entering the first channel  120   a  is significantly different than the sound and feel of ratcheting of the lower pawl  126  ratcheting with the lower ratchet  122 , due to the spring force of the upper spring being greater than that of the lower spring. Additionally or alternatively, differing the dimensions and/or materials between the upper ratchet  120  and the lower ratchet  122  and/or differing the dimensions and/or materials between the upper pawl  124  and the lower pawl  126  may contribute to the differing sounds and feels when the trigger  64  is squeezed.  
         [0130]     When the trigger  64  moves from the cholangio zone to the generally fully squeezed position (and at substantially the same time the window  111  displays indicator region  102   c ), the upper ratchet  120  and lower ratchet  122  continue to pivot counterclockwise such that the upper pawl moves from the cholangio channel  120   a  to a generally fully squeezed channel  120   b , to emit the distinct sound and transmit the distinct tactile sensation. It is noted that the two distinct sounds and sensations (i.e., of the upper pawl  124  engaging the upper ratchet  120 ) can be made different by differing the dimensions and/or material of the cholangio channel  120   a  and the generally fully squeezed channel  120   b . It is further noted that in alternative embodiments, the generally fully squeezed channel  120   b  may be eliminated, thereby alerting the surgeon only to when the clip applying device  50  is in the cholangio zone.  
         [0131]     When the trigger  64  is released, the trigger moves to the unsqueezed position to disengage the upper pawl  124  from the upper ratchet  120 , thereby resetting the clip applying device  50 . The upper ratchet  120 /upper pawl  124  and the lower ratchet  122 /lower pawl  126  lie in different X-Y planes (different sagittal planes) so that the upper ratchet does not ever engage the lower pawl and so that the lower ratchet does not ever engage the upper pawl.  
         [0132]     It is noted that while many of the figures show the indicating arrangement of the present invention being used in a clip applying device  50  that can accept more than one type of clip supply cartridge  68   a ,  68   b , it should be readily understood by those skilled in the art that the indicating arrangement of present invention may be used in a clip applying device that can accept only a single type of cartridge, or alternatively, may be used in a clip applying device having clips pre-installed therein.  
         [0133]     It is further noted that the foregoing examples have been provided merely for the purpose of explanation and are in no way to be construed as limiting of the present invention. While the present invention has been described with reference to a preferred embodiment, it is understood that the words which have been used herein are words of description and illustration, rather than words of limitation. Changes may be made, within the purview of the appended claims, as presently stated and as amended, without departing from the scope and spirit of the present invention in its aspects. Although the present invention has been described herein with reference to particular means, materials and embodiments, the present invention is not intended to be limited to the particulars disclosed herein; rather, the present invention extends to all functionally equivalent structures, methods and uses, such as are within the scope of the appended claims.

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