MXPA06004253A - Surgical clip advancement and alignment mechanism - Google Patents

Abstract

A surgical clip applier and methods for applying surgical clips to a vessel, duct, shunt, etc., during a surgical procedure are provided. In one exemplary embodiment, a surgical clip applier is provided having a housing with a trigger movably coupled thereto and an elongate shaft extending therefrom with opposed jaws formed on a distal end thereof. The trigger is adapted to advance a clip to position the clip between the jaws, and to move the jaws from an open position to a closed position to crimp the clip positioned therebetween.

Description

MECHANISM OF ADVANCE AND ALIGNMENT OF A SURGICAL CLAMP FIELD OF THE INVENTION The present invention is widely related to surgical devices, and in particular to methods and devices for applying surgical forceps for conduits, vessels, shunts, effe.

BACKGROUND OF THE INVENTION In recent years, surgery has progressed very markedly to the performance of laparoscopic and endoscopic procedures, such as cholecysectomy, gastrosyomies, appendemphomies and hernia repair. These procedures are achieved through a trocar assembly, which is a surgical instrument used to pierce a body cavity. The trocar contains, typically, a puncture of the sharp oblurator and a tube or cannula of the iron. The cannula is inserted into the skin to gain access to the body cavity, using the puncture of the obturator to penetrate the skin. After penetration, the obturator is removed and the trocar cannula remains in the body. It is through this cannula that the surgical instruments are placed. A surgical instrument that is commonly used with an Ibar cannula is an applicator of surgical tweezers to ligate a vessel blood, a chord, a shunt, or a portion of the body's fluid during surgery. Most clip applicators typically have a handle with an elongate body that has a pair of opposed moving jaws formed at one end thereof to hold and form a clip between them. The jaws are placed around the vessel or conduit, and the clamp is pressed or formed in the vessel by closing the jaws. In many of the prior art grippers applicators, the feeding and forming mechanisms require precise timing and coordinated movement for the components to operate. This need for precise timing and control has resulted in the need for complex mechanical designs, thereby increasing the cost of the gripper applicators. Many prior art grippers applicators also use a spring-loaded clip advance assembly to advance one or more clips through the body of the device. As a result, the jaws must contain a mechanism to prevent the accidental projection of the gripper of the amphibious device from which the clip is formed. You will hear dislodges from the gripper applicators. They include the inability to handle an overload applied to the jaws by the gibberish under a variety of conditions. Many disposiíivos require the total closing of the jaws, which results in an overload in the jaws when the glass or conduit placed eníre them is too much.

Large to allow complete closure, or when a foreign object is placed between the jaws. Accordingly, there remains a need for improved methods and devices for applying surgical clamps to vessels, conduits, shunts, etc.

BRIEF DESCRIPTION OF THE INVENTION The present invention provides a method and devices to apply a surgical clamp to a vessel, conduction, derivation, etc. In an exemplary embodiment, a surgical clip applier is provided having a housing with a trigger movably coupled thereto, and an elongate body extending therefrom, with opposing jaws formed at a distal end thereof. The trigger is adapted to advance a clamp to place the clamp between the jaws, and to move the clamps from an open position to a closed position to fold the clamp placed between them. The surgical clamp applicator can have a variety of configurations, and can include a variety of features to facilitate the advancement and formation of a surgical clamp. In one embodiment, the surgical clip applier may include a feeding shoe which is slidably positioned within the elongate body and which is adapted to actuate at least one surgical clip through the body. elongate. In an exemplary embodiment, the feed shoe may be adapted to move only in a distal direction, so that the proximal movement of the feed shoe was substantially avoided. The elongated body may also include a footplate of the clamp placed therein, and adapted to grasp at least one surgical clamp. The allmenlation shoe can be placed in a deselzable manner in the grip of the gripper. A variety of techniques can be used to facilitate the dissimilar movement and prevent the proximal movement of the food jet. In an exemplary embodiment, the feeding shoe may include an adaptive pin for coupling the gripper foot to prevent proximal movement of the feed shoe in the gripper footplate, but allows for the differential motion of the feed shoe. deníro of the grip of the clamp. The plunger footplate may include several apertures formed therein to receive the pin, to prevent proximal movement of the feed shoe in the gripper track. In yet another exemplary embodiment, the feeding shoe may include a pin and the feed bar may include several detents formed therein and adapted to engage the pin to move the feed shoe disily when the feed bar moves discordantly. In another embodiment, the elongate body may include a feed bar slidably disposed therein and coupled to the jack, so that movement of the jack to a closed position is Adapla to advance the feed bar disiálmenie, advancing the lanzada feeding power distally. By way of non-limiting example, the feed bar can be coupled to the trigger by a trigger insert which coincides with the trigger, and by a connection extending between the trigger insert and the proximal end of the feed bar. The proximal end of the feed bar may include a coupler that is adapted to receive a portion of the connection. The feed bar may also include a distal end having an impeller that is adapted to engage the most dis- tal clamp and drive the clamp further distally towards the jaws. In certain exemplary embodiments, the feed bar may be adapted to engage and initiate advancement of a more distal clamp in the jaws, to initiate feed advancement of the feed shoe. In another embodiment, a clamp advancing mona is provided to advance a clamp through a surgical clamp applicator. The clamp advancing monia can be used with a variety of surgical clamp applicators, including those known in the art. In an exemplary embodiment, the feed assembly of the clip may include a plunger foot that is adapted to grip at least one clip, and a feed shoe that is adapted to slideably match the grip of the clip and to move in a dissimilar direction at least one clamp positioned in the distal direction of the grip of the clamp. The feeding shoe may include, in an exemplary embodiment, a pin that is adapted to engage the track of the clip to prevent proximal movement of the feeder shoe within the track of the clip, and which is adapted to allow distal movement of the feeder shoe within the track of the clip. pin. The track of the clip may include a plurality of openings formed therein for receiving the pin, to prevent proximal movement of the feeder shoe within the track of the clip. The feed assembly of the clamp also includes a feed bar that is adapted to engage a movable trigger formed in a housing of a surgical clamp applicator, and which is adapted to move slidably distally when the trigger is closed to advance the . Feeding shoe and at least one clip placed inside the gripper track. The power bar can have a variety of configurations, and in an exemplary embodiment, the distal end of the feed bar may include an impeller that is adapted to engage the distalmost clip to drive the most distal clip of the clip track in the jaws formed at a distal end of a surgical clamp applicator. In another exemplary embodiment, the feed shoe may include a spike, and the feed bar may include a plurality of detents formed therein, which are adapted to engage the spike to move the spreading feed shoe, when the bar of food moves dissidently. In use, the proximal end of the disc bar may include a coupler that is adapted to receive a connection for coupling the feed bar to a gaíillo of a surgical forceps applicator. An exemplary method for advancing a surgical tweezers through an elongated body of a surgical tweezers applicator is also provided. In one embodiment, the feeding bar may be advanced distally within the elongate body of a surgical clip applier, to distally move a feeding shoe positioned within the elongated body and thereby advance at least one clip distally. The feeding bar can be advanced distally, for example, by actuating a barrel coupled to a housing, which coincides with a proximal exfrequency of the elongate body. In an exemplary embodiment, when the feeding bar is advanced distally, an impeller of the distal end of the feed bar may engage a more distal clip and advance the clip between opposing jaws formed at a distal end of the elongate body. The method may also include proximally retracting the feed bar within the elongate body, while the feed shoe is held in a substantially fixed position. In another exemplary embodiment, a method for applying a surgical clip is provided and includes moving a trigger coupled to a housing, a first distance to a closed position, to actuate the forward assembly of the clip, positioned within the housing, advancing through thus a clamp in a jaw assembly formed at a distal end of the elongated body, and further moving the trigger, a second distance to the closed position to actuate a mounting that forms the clamp, placed inside the housing, thereby forming the clamp placed within the jaw assembly. The trigger is preferably flexible in relation to the advancing assembly of the clamp during the actuation of the assembly forming the clamp. The assembly that forms the clamp can also be flexible in relation to the assembly of the clamps during the actuation thereof. In other aspects, an overload mechanism is provided to be used with a surgical device. In an exemplary embodiment, the overload mechanism may include a member that receives a force rotatably and slidable in a housing, and that has a surface with a first exile and a second opposing eximeum, and a deviating moni accommodation and adapted to resist the movement of the member receiving the force. In an exemplary embodiment, resistance increases from the first end to the second end. The member receiving the force may have a variety of configurations, but in one embodiment, the surface receiving the force formed therein is placed in an aperture in the housing. The surface receiving the force may include a first portion that is adapted to receive a force to rotationally move the member receiving the force within the housing, and a second portion that is adapted to receive a force to move in a slidable manner. the member who receives the force inside the lodge. The deviation monía also it may have a variety of configurations, but in an exemplary embodiment, the diverting assembly may include a spring positioned around a post with springs, and a plunger slidably positioned relative to the post with springs and having a head formed therein. same, and adapted to compress the spring after the sliding movement of the plunger towards the post with springs. In another embodiment, the housing may include a rotatable monorail that is coupled between the member receiving the force and the deviating mona, so that the rotatable monaia is adapted to transfer a force applied to the limb that receives the force to the deviating moniage. , to overcome the resistance. In an exemplary mode, the rotatable monorail may include an articulated connection that is rotatably connected to the member receiving the force, and a pivot connection that is rotatably coupled to the articulated connection and that is adapted to apply a force to the rear deviation assembly. the revolving movement of the same. In another embodiment, a surgical tweezers applicator having an overload mechanism is provided to prevent overload of a clamping force applied to the applicator jaws of tweezers. In an exemplary embodiment, the surgical tweezer applicator may include a housing that is a gaily, movably coupled thereto, an elongate body that is ex- tended from the housing with opposing jaws formed in a distal ex- treme thereof, and which is move between a position open and a closed position, and a moniaje of cams placed deníro of the lodging and the elongated body and coupled to the gaíillo. The cam follower can be adapted to apply a closing force to the jaws, upon actuation of the trigger to move the jaws from the open position to the closed position. The cam assembly may also be adapted to transfer the closing force to an overload mechanism positioned within the housing, when the closing force is greater than a resistance of the overload mechanism that is applied to the cam assembly. In an exemplary embodiment, the resistance of the overload mechanism is correlated with a force required to move the jaws from the open position to the closed position. Although various techniques can be used to couple the cam assembly to the overload mechanism, in an exemplary embodiment, the cam assembly moves relative to a surface that receives the force of the overload mechanism, so that the clamping force of the assembly of cams is applied across the surface that receives the force of the overload mechanism, as the trigger is actuated to cause the cam assembly to move the jaws from the open position to the closed position. The surface that receives the force of the overload mechanism can be adapted to resist movement in a proximal direction and the resistance can be increased as the trigger is actuated to cause the cam assembly to move relative to the surface receiving the force, and move the jaws from the open position to the closed position.

In another exemplary embodiment, the overload mechanism may include a housing having a profile connection slidably and rotatably therein, and having the surface receiving the force formed therein and positioned adjacent an aperture formed therein. accommodation. The surface receiving the force may include a first portion that is adapted to receive a force to rotationally move the force-receiving member within the housing, and a second portion that is adapted to receive a force to move the member slidably. that receives the force inside the housing. The overload mechanism may also include a deflection assembly that is adapted to apply a resistance to the profile connection. In an exemplary embodiment, the deflection assembly may be coupled to the profile connection by a rotary assembly, which is adapted to rotate the rotational movement of the profile connection, and which is adapted to slide in the sliding motion of the connection of the profile. profile to apply a force to the deflection assembly, to overcome the resistance. Methods for applying a surgical clamp applicator, which has an overload mechanism, are also provided. In an exemplary embodiment, a closing force can be applied to a pair of opposed jaws formed in a surgical clip applier. The closing force may be effective to move the opposing jaws from an open position to a closed position. When the closing force is greater than a threshold force of an overload mechanism, the closing force is transferred to the Overload mechanism placed inside the surgical clamp applicator. In an exemplary embodiment, the threshold force of the overload mechanism increases as the jaws move from an open position to the closed position. Although the overload mechanism may have a variety of configurations, in one embodiment, the overload mechanism may include an element that receives the force, which is adapted to receive the clamping force, and a deviating monia that is adapted to resist the clamping force. movement of the element that receives the force, in response to the closing force. The surgical clip applier may include a cam assembly that is adapted to apply the clamping force to the jaws, and which includes a roller member that rolls through the element receiving the force as the closing force is applied to the jaws. The threshold force of the overload mechanism may be increased as the roller member rolls through the element receiving the force. In particular, when the roller member rolls through a first portion of the element receiving the force, the elements receiving the force can rotate if the closing force is greater than the threshold force, and when the roller member rolls Through a second portion of the element receiving the force, the element receiving the force can slip if the closing force is greater than the threshold force. In an exemplary embodiment, the threshold force required to rotate the element receiving the force is less than the threshold force required to slide the element that receives the force. In other aspects, a surgical tweezers applicator is provided and may include a clamp advance assembly coupled to a trigger and adapted to advance at least one surgical tweezers through an elongate body extending from a housing, and a moniage forming the clamp coupled to a gaíillo and adapted to drive a jaw assembly formed at a distal end of the elongated body, to form a surgical clamp. The trigger can be coupled to the housing and adapted to actuate the advancement of the clamp and the moniage that forms the clamp. In an exemplary embodiment, the trigger has two sequential drive stages. The trigger may be effective to actuate the advance assembly of the clamp during the first stage of actuation, and may be effective to actuate the assembly that forms the clamp during the second stage of operation, while being flexible in relation to the advance assembly. of the clamp.

BRIEF DESCRIPTION OF THE DRAWINGS The invention will be understood more fully from the following detailed description taken in conjunction with the accompanying drawings, in which: Figure 1A is a side view of an exemplary embodiment of a surgical clip applier; Figure 1 B is an exploded view of the surgical tweezers applicator shown in Figure 1A; Figure 2A is a top view of a clamp assembly of the jaws of the mosirado surgical clamp applicator in Figure 1A; Figure 2B is a lower visia of the clamp mounting of the jaws shown in Figure 2A; Figure 2C is a side view of the jaw clamping jaw shown in Figure 2B; Figure 2D is a cross-sectional view of the fastener assembly of the jaws shown in Figure 2C, taken along the line D-D; Figure 3A is a top view of a supply shoe for use with the clamp mounting of the jaws shown in Figures 2A-2D; Figure 3B is a bottom view of the mosírada food jet in Figure 3A; Figure 4A is a perspective view of a feed bar that is configured to advance the feed shoe of Figures 3A and 3B through the jaw clamp assembly shown in Figures 2A-2D; Figure 4B is a side view of the proximal end of the feed bar shown in Figure 4A and the proximal end of the jaw holder body shown in Figures 2A and 2B, which shows the allmenage bar in a more proximal position; Figure 4C is a side view of the feed bar and the clamping body of the jaws in Figure 4B, which shows the feed bar in a more disial position; FIG. 4D is a side view of another embodiment of a proximal end of a mold feeding rod in relation to the proximal end of the clamping body of the jaws in the teeth.

Figures 2A and 2B, which shows the feeding bar in the most proximal position; FIG. 4E is a lateral view of the feed bar and fastener body of the jaws shown in FIG. 4D, showing the feed bar in a more distal position; Figure 4F is a side view of yet another embodiment of a proximal end of a feed bar, shown in relation to the proximal end of the fastener body of the jaws shown in FIGS.

Figures 2A and 2B, which shows the feed bar in the most proximal position; Figure 4G is a side view of the feed bar and the clamp body shown in Figure 4F, showing the feed bar in an intermediate position; Figure 4H is a side view of the feed bar and fastener body of the jaws shown in Figure 4F, showing the feed bar in a more distal position; Figure 5A is a side perspective view of an impeller that is configured to engage a distal end of the feed bar shown in Figure 4A; Figure 5B is a side perspective view of another embodiment of an impeller, which is configured to be coupled to a disilike extrusion of the feed bar shown in Figure 4A; Figure 6A is a cross-sectional view of a clamp advancement assembly, including the clamp mounting of the clamps shown in Figures 2A-2D, the power sampler shown in Figures 3A-3B, and the clamp bar. feed shown in Figure 4A, showing the feed bar in an initial position, proximal, relative to the gripper track of the clamp assembly of the jaws; Figure 6B is a cross-sectional view of the advance assembly of the nose clip in Figure 6A, showing the feed bar moved in a distal direction; Figure 6C is a cross-sectional view of the advancing clamp assembly shown in Figure 6B, which shows the most discretely moved feed bar, thereby moving the feed shoe and the clamp feeder distally of the shoe. of feeding in a distal direction; Figure 6D is a cross-sectional view of the advancing apex of the mosirado clip in Figure 6C, which shows the feed bar returned to the initial, proximal position, shown in the Figure 6A, while the feeding shoe and the gripper supply remain in the advanced position shown in Figure 6C; Figure 6E is a bottom perspective view of the mosdyred impeller in Figure 5A, placed in the middle of the gripper clamp of the jaw clamp, shown in Figures 2A-2D, showing the impeller in a more proximal position; Figure 6F is a bottom perspective view of the impeller shown in Figure 6E, showing the impeller at a more distal position after advancing the clamp in the jaws of the surgical clamp applicator; Figure 7 is a side perspective view of a pair of jaws of the surgical clip applier shown in Figure 1A; Figure 8 is a perspective view of a cam for use with the jaws shown in Figure 7; Figure 9 is a top perspective view of a push rod that is adapted to engage the mosdy cam in Figure 8, to move the cam relative to the mosíradas jaws in Figure 7; FIG. 10A is a top view of the cam shown in FIG. 8, coupled to the jaws shown in FIG. 7, showing the cam in an initial position and the jaws open; Figure 10B is a top view of the mossy cam in Figure 8, coupled to the mosdyred jaws in Figure 7, which show the cam in advance over the jaws and the jaws in a closed position; Figure 11 is a top perspective view of a tissue latch that is adapted to engage a distal end of the clamp track of the clamp mounting of the mosdyred jaws in Figures 2A-2D; Fig. 12 is a top view of a distal eximetre of the surgical clip applier shown in Fig. 1A, showing the tissue lock shown in Fig. 11 positioned between the jaws shown in Fig. 7; Figure 13 is a partially cross-sectional, side view of a handle portion of the surgical tweezers applicator shown in Figure 1A; Figure 14 is a perspective view of a surgical insert of the surgical tweezers applicator shown in Figure 1A; Figure 15A is a side perspective view of a half of the feed bar coupler of the mosirado surgical tweezers applicator bar in Figure 1A; Figure 15B is a view in perspective view of the other side of the feed bar coupler shown in Figure 15A; Figure 16 is a top perspective view of a flexible connection forming part of an advancing assembly of the forceps of the surgical forceps applicator shown in Figure 1A; Figure 17A is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 1A, showing an advance assembly of the clip in an initial position; Figure 17B is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 17A, showing the advancing apex of the partially driven clip; FIG. 17C is a partially cross-sectional, lateral view of a portion of the handle of the surgical clip applier shown in FIG. 17B, showing the advance assembly of the fully driven clip; Figure 17D is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 17A, showing a mounting that forms the driven clip; Figure 18 is a side view of a roller of the closure connection forming part of a mounting that forms the clamp of the surgical clamp applicator shown in Figure 1A; Figure 19 is a top perspective view of a closure connection that is coupled to the roller of the closure connection shown in Figure 18, to form part of a monaus forming the clamp of the surgical clamp applicator shown in Figure 1A; Figure 20A is a top perspective view of a coupler of the closure connection that engages the closure connection shown in Figure 19, and that is also part of the mounting that forms the clip of the surgical clip applier shown in FIG. Figure 1A; Figure 20B is a bottom view of the closure connection shown in Figure 20A, coupled to the push rod of Figure 9, and having one embodiment of a diverting element positioned therein; Figure 20C is a bottom view of the closure connection shown in Figure 20A, coupled to the push rod of Figure 9, and having another embodiment of a diverting element positioned therein; Figure 21A is an enlarged lateral perspective view of an antirelome mechanism of the surgical tweezers applicator shown in Figure 1A; Figure 21B is a perspective view of an organism mechanism of the mosírado amphérrenoid mechanism in Figure 21A; Figure 22A is a partially cross-sectional, side view of a portion of the hand handle of the surgical tweezers plunger in Figure 1A, which shows the ani- retretome mechanism in an initial position; Figure 22B is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 22A, showing the anti-return mechanism in a partially actuated position; Figure 22C is a partially cross-sectional, side view of a portion of the handle of the surgical gripper plunger shown in Figure 22B, showing the aniirrehire mechanism in a fully actuated position; Figure 22D is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 22C, showing the non-return mechanism returning to an initial position; FIG. 22E is a partially cross-sectional, side view of a portion of the handle of the surgical tweezer applicator shown in FIG. 22D, showing the aniirreorhino mechanism returned to the initial position; Figure 23A is an exploded visia of an overload mechanism of the mosirado surgical tweezers applicator in Figure 1A; FIG. 23B is a cross-sectional view partially of the overload mechanism shown in FIG. 23A, which shows the roller of the closing connection that first turns in conjunction with the connection of the profile; Figure 23C is a partially cross-sectional view of the overload mechanism shown in Figure 23B, showing the roller of the closure connection applying a force to the profile connection, causing the profile connection to rotate; Figure 23D is a perspective view of another embodiment of an overload mechanism to be used with a surgical clip applier; Figure 24A is a perspective view of a wheel indicating the canis of the clamps of the surgical clamp jaw puller in Figure 1A; Figure 24B is a visual view of a wheel indicating the caníidad of pinzas mosírada in Figure 24A; Figure 25 is a top perspective view of an actuator of the number of pliers for use with the indicator wheel of the number of pliers shown in Figure 24; Figure 26A is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 1A, showing the movement of the clip-type actuator of Figure 25 and the indicator wheel of FIG. the clamp canity of Figure 24; and Figure 26B is a partially cross-sectional, side view of a portion of the handle of the surgical clip applier shown in Figure 26A, showing the additional movement of the the gripper actuator of FIG. 25 and the indicator wheel of the number of grippers of FIG. 24.

DETAILED DESCRIPTION OF THE INVENTION The present invention generally provides a surgical tweezers applicator and methods for using a surgical tweezers applicator to apply surgical tweezers to a vessel, conduit, shunt, efe, during a surgical procedure. An exemplary surgical clip applier may include a variety of features to facilitate the application of a surgical clip, as described herein and illustrated in the drawings. However, a person skilled in the art will appreciate that the surgical tweezers applicator may include only a few of the characteristic scaffolds and / or may include a variety of other features known in the art. The surgical tweezers applicator described herein is intended simply to represent certain exemplary embodiments. Figure 1A illustrates an exemplary surgical clip applier. As shown, the clip applier 10 generally includes a housing 12 having a stationary handle 14 and a movable handle or trigger 16 which is rotatably coupled to the housing 12. An elongated body 18 extends from the housing 12 and includes a pair of opposed jaws 20 formed at a distal end thereof for folding a surgical clip. The elongate body 18 may be rotatably coupled to the housing 12, and may include a rotation knob 22 for rotating the body 18 relative to the housing 12. Figure 1 B illustrates an exploded visia of the surgical clamp applicator 10 shown in Figure 1A, and the various components will be described in more detail below. Figures 2A-12 illustrate exemplary embodiments of the various components of the body 18 of the surgical clip applier 10. In general, referring to Figure 1 B, the body 18 includes an outer tube 24 housing the body components, which may include a fastener assembly of the jaws 26 having a clamping body 28 with a gripper track 30 and a push rod channel 32 formed therein. The jaws 20 can be configured to coincide with a distal end of the gripper of the clip 30. The body assembly 18 can also include a clip advance assembly, which, in an exemplary embodiment, can include a feed shoe. 34 which is adapted to be slidably placed in the grip of the clip 30 to advance a series of clips 36 placed thereon, and a feed bar 38 which is adapted to drive the food jet 34 through the Clamp track 30. The feed bar 38 may include an impeller assembly 40 that is adapted to match a distal eximere thereof to advance a distal clamp in the jaws 20. The body assembly 18 may also include a mount for forming or driving with cam the clip, which, in an exemplary embodiment, may include a cam 42 which is adapted to slidably match the jaws 20, and a push rod 44 that can engage the cam 42 to move the cam 42 relative to the jaws 20. The body assembly may also include a tissue lock 46 that may coincide with a distal seal of the footplate. of the clip 30, to facilitate the positioning of the jaws 20 in relation to a surgical site. The various components of an exemplary clamp advancing monaage are shown in more detail in Figures 2A-5. Referring first to Figures 2A-2D, the clamp assembly of the jaws 26 is shielded and includes an elongate clamped body 28, substantially flat, having a proximal eximeum 28a, which coincides with the outer tube 24, and one end distal 28b which is adapted to match the jaws 20. Although a variety of techniques can be used to match the proximal end 28a of the clamping body of the jaws 28 with the outer tube 24, in the illustrated embodiment, the proximal eximere 28a includes teeth 31 formed on opposite sides thereof, which are adapted to be received within the corresponding holes (or not openings) formed in the outer tube 24, and a cut 29 formed in the same, which allows the opposite sides of the proximal eximeum 28a to flex or form a spring. In particular, the cut 29 allows opposite sides of the proximal eximere 28a of the clamping body of the jaws 28 to be compressed towards each other when the clamping body of the jaws 28 is inserted into the external tube 24. Once the teeth 31 they are aligned with the corresponding openings in the exoerous tube 24, the proximal end 28a of clamp body 28 will return to its original, uncompressed configuration, thereby causing teeth 31 to extend into corresponding openings to engage outer tube 24. As will be discussed in more detail below with respect to to Figure 4A, the device may also include a feature to prevent compression of the opposite sides of the proximal end 28a of the clamp body 28 during use of the device, to prevent accidental uncoupling of the teeth 31 from the outer tube 24 A variety of techniques can also be used to match the distal end 28b of the clamping body of the jaws 28 with the jaws 20, however, in the illustrated embodiment, the distal end 28b of the clamping body of the jaws 28 includes several cuts. or teeth 78 formed therein to coincide with the corresponding protuberances or teeth 94 formed s in the jaws 20, which will be discussed in more detail with reference to Figure 7. The teeth 78 allow a proximal portion of the jaws 20 to be substantially coplanar with the clamping body of the jaws 28. The fastener assembly of the jaws jaws 26 may also include a channel of the push rod 32 formed therein, to slidably receive the push rod 44, which is used to advance the cam 42 over the jaws 20, as will be discussed in more detail a coníninuación. The push rod channel 32 can be formed using a variety of techniques, and can have any shape and size depending on the shape and size of the push rod 44. As shown in Figure 2D, the channel of the push rod 32 is fixedly attached, for example, by welding, to an upper surface of the body of the fastener 28, and has a substantially rectangular shape, and defines a path 32a that is exfined to irevés. The channel of the push rod 32 may also extend along the length of the body or only a portion of the body of the fastener 28. A person skilled in the art will appreciate that the clamping arm of the jaws 26 need not include a channel of the rod. of push 32 to facilitate movement of the push rod 44 of the elongated body 18 of the surgical clip applier 10. As further shown in Figures 2A-2D, the clamp assembly of the jaws 26 may also include a track of the clamp 30, which coincides in it or formed in it. The track of the clip 30 is shown as coinciding with a lower surface of the clamping body of the jaws 28, and is extended distally beyond the distal end 28b of the clamping body of the jaws 28 to allow a disilike eximere 30b of the track of the clip 30 is substantially aligned with the jaws 20. In use, the gripper of the clip 30 is configured to grip at least one, and preferably a series of clips therein. Accordingly, the track of the clip 30 may include opposite side rails 80a, 80b that are adapted to seat opposite ends of one or more clips therein, so that the tips of the clips are aligned axially with one another. In an exemplary mode, the clip track can be configured to seat approximately twenty clamps that are pre-positioned within the track of the clamp 30 during fabrication. A person skilled in the art will appreciate that the shape, size and configuration of the clip track 30 may vary depending on the shape, size and configuration of the clips, or other locking devices such as clips, adapted to be received in the same In addition, a variety of other techniques may be used, instead of a track of the clamp 30, to maintain a supply of clamps with the elongate body 18. The piste of the clamp 30 may also include several openings 30c formed therein., to receive a spigot 82a formed on a feed shoe 34 adapted to be placed in the footwell of the clip 30, as will be discussed in more detail below. In an exemplary embodiment, the grip of the clip 30 includes a number of openings 30c corresponding to at least the number of clips adapted to be pre-positioned within the device 10 and applied during use. The openings 30c are preferably equidistant from one another to ensure that the pin 82a on the feed shoe 34 engages with an opening 30c each time the feed shoe 34 is advanced. Although not shown, the grip of the clip 30 may include detents, rather than apertures 30c, or may include features that allow the clip track 30 to engage with the supply shoe 34 and prevent distal movement, but allows proximal movement of the feed shoe 34. The track of the clip 30 may also include a tang of the secure 118 formed therein, as shown in Figure 2B, which is to be effectively engaged with the corresponding latch pin formed in the feed shoe 34, to prevent movement of the feed shoe 34 beyond a more distal position, as will be discussed below. The pin of the latch 118 may have a variety of configurations, but in an exemplary embodiment it is in the form of two adjacent tabs extending towards each other to enclose a portion of the clamp of the clamp, thereby allowing the clamps to pass through. through. An exemplary feed shoe 34 is shown in more detail in Figures 3A and 3B, and can be adapted to directly drive the pliers across the gripper foot 30. Although the feed shoe 34 may have a variety of configurations, and a variety of other techniques can be used to drive the clamps through the clip track 30, in an exemplary embodiment, the feeder shoe 34 has a generally elongated shape with proximal and distal exuda 34a, 34b. The distal end 34b may be adapted to accommodate the most proximal gripper on the track of the clip 30 to push the clips through the track of the clip 30. In the illustrated exemplary embodiment, the distal end 34b is substantially v-shaped to Set a v-shaped bend portion of a clamp. The distal end 34b also includes a rectangular shaped notch 34c formed therein to allow the impeller 40 to engage the distalmost clamp and advance it towards the jaws 20, as will be discussed in more detail below. The distal end 34b can, for of course, vary depending on the configuration of the clamp, or other closure mechanism, that is being used with the device 10. In another exemplary embodiment, the feeding shoe 34 may also include features to facilitate distal movement of the feeding shoe 34 within the track of the clip 30, and to substantially prevent proximal movement of the feed shoe 34 within the track of the clip 30. Such a configuration will ensure the advancement and proper placement of the clips in the track of the clip. clamp 30, thus allowing a more dislodged clamp to be advanced between the jaws 20, with each action of the gaíillo 16, as will be discussed with more detail below. In the exemplary embodiment illustrated, the feed shoe 34 includes a spigot 82a formed in the upper surface 34s thereof, and angled proximally to engage one of the openings 30c formed in the footwell of the clip 30. In use, the angle of the pin 82a allows the feed shoe 34 to slide effectively into the track of the clip 30. Each time the feed shoe 34 is advanced, the pin 82a will move in a distal direction from one opening 30c to the next opening 30c in the grip of the clip 30. The engagement of the pin 82a with the opening 30c in the track of the clip 30, will prevent the feed shoe 34 from moving proximally to return to the previous position, as will be described with more come to conclusion. In order to facilitate the proximal movement of the feed shoe 34 within the track of the clip 30, the feed shoe 34 it may also include a tang 82b formed in the bottom surface 34i thereof, as shown in Figure 3B, to allow the feed shoe 34 to engage the feed bar 38 (Figure 4A) according to the feed bar 38 It moves distally. The lower pin 82b is similar to the upper pin 82a in that it can be angled proximally. In use, each time the feed bar 38 moves distally, a retainer 84 formed in the feed bar 38 can engage the lower pin 82b and move the feed shoe 34 disily, a predetermined distance within the track of the clip. 30. The feed bar 38 can then be moved proximally to return to its initial position, and the angle of the lower peg 82b will allow the peg 82b to slide towards the next retainer 84 formed in the feed bar 38. As previously indicated, a variety of different characteristic features can be used to the pegs 82a, 82b and the pegs. apertures 30c or detents 84 to control the movement of the feed shoe 34 in the track of clip 30. As mentioned previously, the feed shoe 34 may also include a lock formed therein, which is adapted to stop the movement of the feeding shoe 34 when the feed shoe 34 is in the most distal position and there are no clips remaining in the device 10. Although the safety can have a variety of configurations, Figures 3A and 3B illustrate a spindle earthen 82c formed in the food jet 34 and extending in a lower direction for coupling the locking pin 118 (Figure 2B), formed in the track of the clip 30. The third pin 82c is positioned so as to engage the locking pin 118 in the grip of the clip 30 when the supply shoe 34 is in a more distal position, avoiding at the same time the movement of the feed shoe 34 and the feed bar 38 when the supply of grippers is terminated. Figure 4A illustrates an exemplary embodiment bar 38 for operating the supply jet 34 through the gripper foot 30 of the classembly 26. As shown, the allmeation rod 38 has a generally elongated shape with ends proximal and distal 38a, 38b. The proximal end 38a of the feed bar 38a can be adapted to match a feed bar coupler 50 (Figure 1B), which will be discussed in more detail below. The feed bar coupler 50 may coincide with a feed connection 52 which is effective, upon actuation of the trigger 16, to slidably move the feed bar 38 in a disial direction of the elongated body 18. The differential end 38b of the feed bar 38b can be adapted to coincide with an impeller 40, 40 ', the exemplary embodiments of which are shown in Figures 5A and 5B, which is effective to drive a more disal pincer positioned in the grip of the gripper 30 in the jaws 20, which will be discussed with more details below.

As previously mentioned, the proximal end 38a of the feed bar 38 may include a feature to prevent compression of the opposite sides of the proximal end 28a of the clbody 28 (Figures 2A and 2B) during use of the device, to prevent accidental uncoupling of the legs 31 of the outer tube 24. In an exemplary embodiment, shown in Figures 4A-4C, the proximal blade 38a of the feeding rod 38 may include a protrusion 39 formed therein, which is adapted to extend into the opening 29 formed in the proximal eximeum 28a of the clng body of the jaws 28. When the feed bar 38 is in a more proximal position (i.e., when the gaillard 16 is in an open position), the protuberance 39 it will be placed at the proximal end of the opening 29, as shown in Figure 4B, allowing the proximal end 28a of the body to hold the teeth. Aces 28 is compressed to allow the body 28 to slide in the outer tube 24. When the feed bar 38 is in a more distal position (ie, when the barrel 16 is in an at least partially closed position), the profusion 39 will be placed in an intermediate location adjacent to the teeth 31, as shown in Figure 4C, to avoid compression of the proximal end 28a of the clng body of the jaws 28. This is particularly advantageous during the use of the device, since the The protrusion 39 will prevent accidental uncoupling of the fastener body from the jaws 28 of the exoerus tube 24 during use of the device. Although Figures 4A-4C illustrate a prognostic 39 that has a rectangular cross-sectional shape with rounded edges, the proverbial 39 may have a variety of other shapes and sizes. For exe, as shown in Figures 4D and 4E, the protrusion 39 'has a cross-sectional shape that is somewhat triangular with a tapered end that is adapted to extend between the teeth 31 to further ensure that the proximal end 28a of the body Jaw cl28, can not be compressed during the use of the device. You can also use more than one bulge. For exe, Figures 4F-4H illustrate another embodiment, in which the proximal end 38a 'of the feed bar 38 includes two protuberances 39a, 39b formed therein, and spaced apart from one another. The two protuberances 39a, 39b will prevent compression of the proximal eximere 28a of the clamping body 28 of the jaws when the feeding bar 38 is in a more proximal position, as shown in Figure 4F, and when the feeding bar 38 is in a more distal position , as shown in Figure 4H. Compression of the proximal end 28a of the clamping body of the jaws 28 can occur only when the feed bar 38 is in an intermediate position, so that the teeth 31 are positioned between the projections 40a, 39b, as shown in Figure 4G . As also mentioned previously, the feed bar 38 may include one or more detents 84 formed therein, for engaging the lower peg 82b formed in the feed shoe 34. The number of detents 84 may vary, but in an exemplary embodiment , the The feed bar 38 has a number of detents 84 that correspond to, or is larger than, an amount of grippers adapted to be supplied by the device 10, and more preferably, it has a retainer 84 more than the number of grippers adapted to be provided by the device 10. By way of non-limiting example, the feed bar 38 may include eighteen detents 84 formed therein, for supplying seventeen clamps that are pre-positioned within the track of the clip 30. Such configuration allows the feed bar 38 advance the feed shoe 34 seventeen times, thus advancing seventeen clamps to the jaws 20 for the application. The detents 84 are also preferably, equidistant from each other, to ensure that the feed shoe 34 is engaged and advanced by the feed bar 38 each time the feed bar 38 is advanced. The feed bar 38 may also include a feature to control the movement rate of the feed bar 38, relative to the track of the clip 30. Such a configuration will ensure that the feed shoe 34 is advanced a predetermined distance each time. that the jack 16 is actuated, thus advancing a single clamp towards the jaws 20. Although a variety of techniques can be used to control the distal movement of the feed bar 38, in an exemplary embodiment, the feed bar 38 can include a protuberance 86 formed therein, which is adapted to be slidably received within a corresponding groove 88 (Figure 2B), formed in the clamping body of the jaws 28. The length of the groove 88 is effective to limit the movement of the protrusion 86 therein, thus limiting movement of the feed bar 38. Accordingly, in use, the feed bar 38 can slide between a fixed proximal position and a fixed distal position with respect to the track of the clip 30, thereby allowing the feeding bar 38 advance the feed shoe 34 a predetermined distance, with each advance of the feed bar 38. Figure 5A illustrates an exemplary embodiment of an impeller 40, which is adapted to coincide with the distal end 38b of the feed bar 38 and which is effective to drive a clamp further distal from the track of the clip 30 towards the jaws 20. A variety of techniques can be used to match the Impeller 4 0 with the feed bar 38, but in the illustrated embodiment, the proximal end 40a of the impeller 40 is in the form of a female connector that is adapted to receive the male connector formed at the distal end 38b of the feed bar 38. The impeller 40 preferably matches, in a fixed manner with the feed bar 38, however, it can optionally be formed integrally with the feed bar 38. The distal end 40b of the feed bar 38 is adapted in a manner that Preferred for advancing a clamp towards the jaws 20 and therefore, the distal exorder 40b of the impeller 40 may include, for example, a member that pushes the clamp 90 formed in it. The member that pushes the clip 90 may have a variety of shapes and sizes, but in an exemplary embodiment, it has an elongated shape with a recess 92 formed in the dlstal end thereof, for seating the bend portion of a clip. The shape of the recess 92 may vary depending on the particular configuration of the clamp. The member that pushes the clamp 90 can also extend at an angle in a superior direction with respect to a longitudinal axis A of the impeller 40. Such a configuration allows the member that pushes the clamp 90 to be expelled toward the track of the clamp 30 for coupling a clamp, while the rest of the impeller 40 extends substantially parallel to the track of the clamp 30. Figure 5B illustrates another exemplary embodiment of a member that pushes the clamp 90 'of an impeller 40'. In this modality, the member that pushes the pin 90 'is slightly narrower and has a small recess 92' formed at the most distal end thereof. In use, the impeller 40 can engage and advance only the most dislodged clamp positioned in the gripper 30 of the clamp 30 in the jaws 20. This is due to the positioning of the feed bar 38, which moves in a slidable manner. confront the proximal and distal fixed positions, as previously discussed. Figures 6A-6G illustrate the advance assembly of the clamp in use, and in particular Figures 6A-6D illustrate the movement of the feed bar 38 in the footwell of the clamp 30 to advance the food jet 34 and the supply of clamps 36, and Figures 6E-6F illustrate the movement of the impeller 40 to advance a clamp further distal toward the jaws 20. The components in the housing 12 that are used to drive the clamp advance monia will be discussed in more detail below. As shown in Figure 6A, in the rest position, the feed bar 38 is in a more proximal position so that the pro -ube 86 is positioned proximally within the elongated slot 88 in the clamping body of the jaws 28. The feed shoe 34 is positioned within the track of clip 30 and, assuming that device 10 has not been used yet, feed shoe 34 is in a more proximal position, so that upper pin 82a in the shoe of feed 34, is coupled with the first opening or the most proximal 30c-? formed in the track of the clip 30, to prevent proximal movement of the feed shoe 34, and the lower pin 82b in the feed shoe 34, is placed between the first detent 84-? and the second detent 842 on the feed bar 38, so that the lower spindle 82b is deflected in a higher direction by the feed bar 38. The detents 84 on the feed bar are sequentially marked as 84- ?, 842 , etc., and the openings 30c in the track of the clip 30 are sequentially marked as 30c- ?, 30c2, etc. As shown further in Figure 6A, a series of clips 36, sequentially marked as 36 ?, 362,. . . 36x, with 36x being the most distal clamp, is placed within the track of the clamp 30 distal to the supply shoe 34.

Upon actuation of the trigger 16, the feed bar 38 is advanced distally, causing the protrusion 86 to slide distally from the slot 88. As the feed bar 38 moves distally, the lower pin 82b of the feed shoe 34, will it slide on the first retainer 84-? in the feed bar 38. The additional distal movement of the feed bar 38 will cause the first detent 84? is coupled with the lower pin 82b, as shown in Figure 6B, and which moves the feed shoe 34 and the clip supply 36- ?, 362, efe, in a disial direction. As shown in Figure 6C, when the protrusion 86 comes into engagement with the distal eximere of the elongated slot 88 in the clamping body of the jaws 28, the feed bar 38 is prevented from moving distally in a further manner. In this position, the feed shoe 34 has advanced a predetermined distance to advance the supply of grippers 36 ?, 362, ... 36, away from the track of the gripper 30 a predetermined distance. The upper pin 82a of the feed shoe 34 has been advanced towards the second opening 30c2 in the footwell of the clip 30 to prevent the proximal movement of the feed shoe 34, and the lower pin 82b of the food shoe 34 still coupled by the first detent 84-? in the feed bar 38. The movement of the feed bar 38 from the most proximal, initial position, shown in Figure 6A, to the most distal, end position, shown in Figure 6C, will also advance the most distal clip 36x, towards the jaws 20. In particular, as shown in Figure 6E, the distal movement of the feed bar 38 will cause the pushing member 90 of the impeller 40, which is attached to the distal end of the feed bar 38, to engage with the most dissimilar 36x clamp positioned in the footwell of the clamp 30 and advance the clamp 36x towards the jaws 20, as shown in Figure 6F. In an exemplary embodiment, the impeller 40 will engage and initiate the advance of the most dissimilar clamp 36x before engaging and starting feed of the feed shoe 34. As a result, the more dissimilar 36x clamp will advance a distance that is greater than a distance displaced by the feed shoe 34. Such a configuration allows only the most distal clip 36x to advance towards the jaws 20, without accidentally advancing an additional clamp towards the jaws 20. Once the clamp 36x has been partially or completely formed, the trigger 16 can be released to release the formed clamp 36x. the release of the trigger 16 will retract the feed bar 38 in a proximal direction, until the protrusion 86 returns to the initial most proximal position within the elongated slot 88, as shown in Figure 6D. As the feed bar 38 is recirculated proximally, the feed shoe 34 will not move proximally as the upper pin 82a will engage the second opening 30c2 in the footwell of the clip 30. The lower pin 82b will not interfere with the proximal movement of the pin. feed bar 38, and once the feed bar 38 is in the most proximal, initial position, as shown, the lower pin 82b will be placed between the second detent 842 and the third detent 843 in the feed bar 38.

The process can be repeated to advance another clamp towards the jaws 20. With each actuation of the gaíillo 16, the lower pin 82b will be coupled by the next detent, that is to say, the retainer 842 formed in the feed bar 38, the upper pin 82a in the feed shoe 34, it will move distally towards the next opening, that is, the opening 30c3 in the track of the clip 30, and the most distal clip will be advanced towards the jaws 20 and released. Where the device 10 includes a predetermined number of pliers, for example seventeen pliers, the trigger 16 can be operated seventeen times. Once the last clamp has been applied, the latch, for example, the third spigot 82c in the supply shoe 34, can engage the latch pin 118 in the track of the clamp 30, to prevent further distal movement of the clamp. Feeding shoe 34. Figures 7-9 illustrate several exemplary components of a mount that forms the gripper. Referring first to Figure 7, an exemplary embodiment of the jaws 20 is shown. As mentioned previously, the jaws 20 may include a proximal portion 20a having teeth 94 to match the corresponding teeth 78 formed in the clamp body of the jaws. 28. However, other techniques can be used to match the jaws 20 with the clamping body of the jaws 28. For example, a dovetail connection, a male-female connection can be used. Alternatively, the jaws 20 can be formed integrally with the retaining body 28. The distal portion 20b of the jaws 20 can be adapted to receive a clip therebetween, and thus the distal portion 20b may include first and second opposites jaw members 96a, 96b that move one relative to the ofro. In an exemplary embodiment, the jaw members 96a, 96b are biased to an open position, and a force is required to move the jaw members 96a, 96b one toward the ear. The jaw members 96a, 96b may each include a slit (only a slit 97 is shown), formed therein on the opposing internal surfaces thereof, to receive the tips of a clip in alignment with the jaw members. 96a, 96b. The jaw members 96a, 96b may also include a cam track 98a, 98b formed therein, to allow the cam 42 to engage the jaw members 96a, 96b and move the jaw members 96a, 96b one toward the other. In an exemplary embodiment, the cam track 98a, 98b is formed on an upper surface of the jaw members 96a, 96b. Figure 8 illustrates an exemplary cam 42 to slidably match, and engage the jaw members 96, 96b. The cam 42 may have a variety of configurations, but in the illustrated embodiment, it includes a proximal end 42a which is adapted to coincide with a push rod 44, discussed in more detail below, and a dissimilar excerpt 42b which is adapted. for coupling the jaw members 96a, 96b. A variety of techniques can be used to match the cam 42 with the push rod 44, but in the illustrated exemplary embodiment, the cam 42 includes a female or wedged cut 100 formed therein and adapted to receive a male or wedge member 102 formed in the distal end 44b of the push rod 44. The male member 102 is shown with more develle in Figure 9, which illustrates the push rod 44. As shown, the male member 102 has a shape corresponding to the shape of the cut 100 to allow the two members 42, 44 to coincide. A person skilled in the art will appreciate that the cam 42 and the push rod 44 can optionally be formed integrally with one another. The proximal end 44a of the push rod 44 can be adapted to coincide with a closure connection assembly, discussed with more detail below., to move the push rod 44 and the cam 42 relative to the jaws 20. As further illustrated in Figure 8, the cam 42 may also include a protrusion 42c formed therein, which is adapted to be slidably received. It is provided with an elongated slot 20c formed in the jaws 20. In use, the pro-bulge 42c and the slot 20c can function to form a proximal lock for the mounting that forms the clip. Referring again to Figure 8, the distal end 42b of the cam 42 can be adapted to engage the jaw members 96a, 96b. Although a variety of techniques can be used, in the exemplary exemplary embodiment, the distal end 42b includes a cam channel or tapered recess 104 formed therein, to slidably receive the cam tracks 98a, 98b from the jaw members 96a 96b. In use, as shown in Figures 10A and 10B, the cam 42 can be advanced from a position proximal, in which the jaw members 96a, 96b are spaced apart from one another, towards a distal position, in which the jaw members 96a, 96b are positioned adjacent to each other and in a closed position. As the cam 42 is advanced over the jaw members 96a, 96b, the tapered recess 104 will push the jaw members 96a, 96b toward each other, thereby folding a clip placed therebetween. As previously mentioned, the surgical tweezers applicator 10 may also include a tissue lock 46 to facilitate placement of the tissue in the surgical site within the jaws 20. Figure 11 shows an exemplary embodiment of a tissue lock 46 having a proximal end and distal ends 46a, 46b. The proximal end piece 46a may be adapted to coincide with a distal end of the clip track 30 to place the idler lock 46 adjacent the jaws 20. However, the tissue lock 46 may be integrally formed with the footplate of the clip 30. , or it may be adapted to match or be integrally formed with a variety of other body components 18. The distal seal 46b of the latch 46 may have a shape that is adapted to seat a vessel, conduit, bypass, etc., between the same. , to position and align the jaws 20 relative to the target site. Shown in Figure 11, the distal end 46b of the tissue lock 46 substantially has a v-shape. The distal end 46b may also have a curved configuration to facilitate placement of the device through a trocar or other access tube. The distal end 46b of the tissue lock 46 may also optionally include other features to facilitate movement of the clip thereon. For example, as shown in Figure 11, the tissue latch 46 includes a ramp 47 formed in a middle portion of the distal end 46b to hold a collet in alignment with the tip of the impeller assembly 40. In particular, the ramp 47 can allowing the tip of a clamp to be mounted lengthwise, thereby preventing the clamp from being misaligned relative to the drive assembly 40, that is, by pushing the clamp in a disial direction. A person skilled in the art will appreciate that the safety of the device 46 can have a variety of other configurations, and can include a variety of other features to facilitate the advancement of a clamp throughout. Figure 12 illustrates the tissue lock 46 in use. As shown, the tissue latch 46 is placed just below the jaws 20 and in a location that allows a vessel, conduit, shunt, etc., to be received between the jaws 20. As shown further, a surgical clip 36 the jaws 20 are positioned so that the bend portion 36a of the clip 36 aligns with the idle lock 46. This will allow the excrements 36b of the clip 36 to be completely placed around the vessel, lead, bypass, or I heard objeíivo siíio. Figures 13-26B illustrate several exemplary infernal components of housing 12 to control the advancement and formation of the clamp. As previously described, the surgical forceps applicator 10 it may include some or all of the features described herein, and may include a variety of other features known in the art. In certain exemplary embodiments, the infernal components of the gripper applicator 10 may include an advance assembly of the clip, which engages the advancing assembly of the body clip 18, to advance at least one clip through the elongate body 18, to place the clamp in front of the jaws 20, and a moniage forming the clamp, which engages the moniage forming the body clamp 18, to close the jaws 20 to form a clamp partially or completely closed. You will hear exemplary features include a non-return mechanism to control the movement of the trigger 16, an overload mechanism to prevent overload of the force applied to the jaws 20 by the monaus forming the clamp, and an indicator of the amount of clamps to indicate a number of clamps remaining in the device 10. Figures 13-16D illustrate an exemplary embodiment of an advancement of the accommodation clamp 12 to effect the movement of the feeding bar 38 of the body 18. In general, the advancement assembly of the clamp may include an insert of the gaíillo 48 which is coupled to the trigger 16, a coupler of the feed bar 50 which can coincide with a proximal end 38a of the feed bar 38, and a feed connection 52 which is adapted to be expelled between the insert of the gaíillo 48 and the coupler of the bar of feed 50, to transfer the movement of the insert of gaíillo 48 to the coupler of the feed bar 50.

Figure 14 illustrates the insert of gaíillo 48 with more deilla. The shape of the gaíillo insert 48 may vary depending on the other components of the housing 12, but in the illusory embodiment, the gaíillo insert 48 includes a central portion 48a which is adapted to rotationally coincide with the housing 12, and a portion elongated 48b which is adapted to extend indent and coincide with the gaíillo 16. The central portion 48a can include a hole 106 that extends through to receive a body to rotatably match the insert of the trigger 48 with the housing 12. The center portion 48a may also include a first recess 108 formed in the edge of the upper side to receive a portion of the feed connection 52. The first recess 108 preferably has a size and shape that allow a portion of the connection 52 is extended therein, so that the power connection 52, will be driven to rotate when the i The neck of the gaíillo 48 rotates due to the movement of the cape 16. As shown in Figure 14, the first recess 108 is substantially elongated and includes a substantially circular portion formed therein, to seat a body formed at a proximal end of the connection. of feed 52, as will be discussed in more detail with respect to Figure 16. The insert of gaíillo 48 can also include a second recess 110 formed in the edge of the rear side to receive a roller of closing connection 54, which is coupled with the push bar 44 for moving the cam 42, for closing the jaws 20, and ratchet teeth 112 formed on the edge of the bottom side thereof, to coincide with a figure of 60 to control the movement of the trigger 16, as will be discussed in more detail below. The exemplary feed bar coupler 50 is shown with more dimensions in Figures 15A and 15B, and can be adapted to couple the proximal end of the feed bar 38 with the distal end of the feed connection 52. Although they can be used a variety of techniques for matching the feed bar coupler 50 to the proximal end 38a of the feed bar 38, in an exemplary embodiment, the feed bar coupler 50 is formed from two separate halves 50a, 50b, which coincide together to maintain the proximal eximere 38a of the feed bar 38 therebetween. When they coincide, the two halves 50a, 50b together define a central body 50c having substantially circular ridges 50d, 50e formed at opposite ends thereof, and defining a recess 50f therebetween for seating a distal portion of the connection feed 52. The center body 50c defines an opening 50g through to receive the proximal end 38a of the feed bar 38 and to lock the feed bar 38 in a relatively fixed position, relative to the coupler of the feed bar 50. The coupler of the feed bar 50 may, however, be integrally formed with the feed bar 38, and may have a variety of other shapes and sizes to facilitate matching with the feed connection 52.

Figure 16 illustrates an exemplary power connection 52, which may extend between the galena insert 48 and the feed bar coupler 52. In general, the feed connection 52 may have a substantially flat elongated shape with proximal and distal ends. 52a, 52b. The proximal end 52a is adapted to be rotatably seated within the first recess 108 of the trigger insert 48 and thus, as previously discussed, may include a body 53 (Figure 1 B), which is exposed to an iris. The body 53 can be adapted to rotate within the first recess 108 of the gaillard insert 48, thereby permeating the insert of the gaillard 48 to rotate the feed connection 52. The distal end 52b of the allmeation connection 52, can be adapted to be coupled to the feed bar coupler 50 and thus, in an exemplary embodiment, includes opposing arms 114a, 114b formed therein, and defining an aperture 116 therefrom, to seat the central body 50a of the coupler of the feed bar 50. The arms 114a, 114b are effective for coupling and moving the coupler 50 as the feed connection 52 rotates about a pivot axis X. The pivot axis X can be defined by the location in which the connection 52 is engaged with the housing 12, and can be placed anywhere on the power connection 52, but in the illusive embodiment, it is positioned adjacent the proximal eximeum 52a of the power connection 52. In an exemplary embodiment, the connection 52 can be flexible to eliminate the need to calibrate the advance assembly of the clamp and the moniage that forms the clamp. In particular, the feed connection 52 allows the galet 16 to continue moving to a closed position, even after the feed bar 38 and the feed bar coupler 50 are in a more distal position, and provides some freedom to the moniajes that form the clamp and advance the clamp. In other words, the gaíillo 16 is flexible in relation to the feed bar 38 during the closing of the gaíillo. The stiffness and particular resistance of the feed connection 52 may vary depending on the configuration of the feed clamp assembly and the clamp assembly, but in an exemplary embodiment, the feed connection 52 has a rigidity that is find it from 1339.34 to 1964.37 kilograms per second (75 to 110 pounds per inch), and most preferably it is approximately 1660.79 kilograms per meter (93 pounds per inch) (as measured in the interface between connection 52 and the coupler of the feed bar 50), and has a strength that is in the range of 11.35 kilograms and 22.7 kilograms (25 pounds and 50 pounds), and most preferably is about 15.89 kilograms (35 pounds). The feed connection 52 can also be formed from a variety of materials, including a variety of polymers, metals, etc. An exemplary material is polyetherimide reinforced with glass, but a number of reinforced thermoplastics can be used, including glass-reinforced liquid chrysalum polymers, glass-reinforced nylon and carbon-fiber reinforced versions of these fermoplastics and the like. The polymers Fiber-reinforced thermosetting materials such as thermosetting polyesters can also be used. The power connection 52 can also be made of metal, such as spring steel, to achieve the desired combination of limited flexibility and spiral resistance. Figures 17A-17D illustrate the advance assembly of the exemplary gripper in use. Figure 17A shows an initial position, where the trigger 16 is resting in an open position, the coupler of the feed bar 50 and the feed bar 38 are in the most proximal position, and the feed connection 52 is exhausted in the opposite direction. the insert of the gaíillo 48 and the coupler of the feeding bar 50. As previously discussed, in the initial open position, the prouberance 86 in the feed bar 38 is placed at the proximal end of the elongated slot 88 in the fastener body. of the jaws 28. A first biasing member, e.g., a spring 120, is coupled to the insert of the trigger 48 and the housing 12, to maintain the Insert of the gaíillo 48 and the gaíillo 16 in the open position, and a second member of deviation, for example, the spring 122, extends between the coupling of the body 124, which rotatably matches the body 18 with the housing 12, and the coupler of the feed bar 50 for maintaining the coupler of the feed bar 50 and the feed bar 38 in the most proximal position. When the winch 16 is driven and moved to the closed position, that is, towards the stationary handle 14, to overcome the deflection forces applied by the springs 120, 122, the insert of the hood 48 it starts to rotate in a counter clockwise direction, as shown in Figure 17B. As a result, the feed connection 52 is driven to rotate in a counterclockwise direction, by moving the coupler of the feed bar 50 and the feed bar 38 in a different direction. The projection 86 on the feed bar 38 thus moves distally against the elongated slot 88 in the clamping body of the jaws 28, thereby advancing the feed shoe 34 and the clamps 36 placed within the grip of the clamp. . The spring 120 is expelled between the housing and the insert of the gaíillo 48, and the spring 122 is compressed between the coupler of the feed bar 50 and the coupler of the body 124. As the trigger 16 is further actuated and the galette insert 48 continues to rotate, the coupler of the feed bar 50 and the bar 38, will finally reach a more distal position. In this position, the protuberance 86 in the feed bar 38 will be placed in the distal groove of the groove 88 in the clamping body of the jaws 28 and the clamp will be placed between the jaws 20, as previously discussed. The spring 122 will be fully compressed between the body coupler 124 and the feed bar coupler 50, and the feed connection 52 will flex, as shown in Figures 17C and 17D. As the feed connection 52 flexes, and more preferably, once the feed connection 52 is fully flexed, the monaus forming the gripper will be driven to close the jaws 20. The connection of The feed 52 will remain flexed during the actuation of the clip forming assembly, for example, the second drive step, so that the trigger insert 48 is flexible relative to the feed assembly of the gripper, and in particular with the feed bar. feed 38. A moniage forming the exemplary collet of housing 12 is shown in more detail in Figures 18-20. In general, the mounting that forms the clamp is placed inside the housing 12 and is effective to move the push rod 44 and the cam 42 relative to the jaws 20, to move the jaws 20 to a closed position and to fold the same. a clip placed between them. Although the moniae forming the clamp may have a variety of configurations, the assembly that forms the illustrated exemplary collet includes a roller of the closure connection 54, which is slidably coupled to the trigger insert 48, a closure connection 56. which is adapted to be coupled to the roller of the closing connection 54, and a closing coupler 58 which is adapted to be coupled to the closing connection 56 and to the push rod 44. Figure 18 illustrates the roller of the closing connection 54 in more detail, and as shown, the roller of the closure connection 54 includes a central body 54a having substantially circular ridges 54b, 54c, formed adjacent the opposite end ends thereof. The central body 54a can be adapted to settle within the second recess 110 in the gauche insert 48, so that the shoulders 54b, 54c are received on the opposite sides of the trigger insert 48. The central body 54a it may also be adapted to match the opposite arms 126a, 126b of the closure connection 56 to place the arms on opposite sides of the hood insert 48. An exemplary embodiment of a lock connection 56 is shown in more detail in Figure 19 , and as shown, it has opposing arms 126a, 126b that are separated a distance one from the other. Each arm 126a, 126b includes a proximal end 128a, 128b which is adapted to engage the central body 54a of the roller of the closing connection 54, and a distal extrude 130a, 130b which is adapted to match a closing coupler 58 for coupling the roller of the closing connection 54 and the closing connection 56 to the push rod 44. In an exemplary embodiment, the proximal end 128a, 128b of each arm 126a, 126b is adapted to rotatably match the roller of the closure connection 54, and thus, arms 126a, 126b may include, for example, hook-shaped members 132a, 132b formed therein, for coupling central body 54a. The hook-shaped members 132a, 132b extend in opposite directions to facilitate coupling between the closure connection 56 and the roller of the closure connection 54. The distal eximera 130a, 130b of the arms 126a, 126b may coincide with one another. the other, and may include an aperture 134 which is broken open to receive a body that is adapted to rotationally match the closure connection 56 with the closure coupler 58. A person skilled in the art will appreciate that it can a variety of other techniques are used to match the closure connection 56 with the roller of the closure connection 54 and the closure coupler 58. An exemplary closure coupler 58 is shown in more detail in Figure 20A, and as shown in FIG. The sample includes a proximal portion 58a having two arms 136a, 136b with openings 138a, 138b extending through and adapted to align with the opening 134 in the closure connection 56 to receive a body to match the two components. The closure coupler 58 may also include a distal portion 58b that is adapted to coincide with the proximal end 44a of the push rod 44 (Figure 9). In an exemplary embodiment, the closure coupler 58 includes a cut-out 59 (Figures 20B and 20C) formed therein and having a shape that is adapted to seat the proximal end 44a of the push rod 44. The distal portion 58b of the Closing coupler 58 can also be configured to receive a portion of the coupler of the feed bar 50 when the trigger 16 is in the open position. A person skilled in the art will appreciate that a variety of other matching techniques can be used, to match the lock coupler 58 with the push rod 44, and that the lock coupler 58 and the push rod 44 may optionally be formed integrally with one another. In other exemplary embodiments, shown in Figures 20B and 20C, a biasing member may be positioned within the cutout 59 to bias the push rod 44 in a distal direction. Such configuration will prevent the accidental release of a clamp from the jaws, particularly during the initial steps of the closure, if the user releases the winch 16. In particular, although the anirremorphism mechanism, discussed in more detail below, can be adapted to prevent the trigger 16 from opening until the trigger 16 reaches a predetermined position, the antirewire mechanism may allow some minor movement of the trigger 16. Thus, in the event that a user releases the trigger 16 and a smaller opening of the trigger 16 occurs, the biasing member will deflect the push rod 44 in a distal direction, maintaining therefore the push rod 44 in a substantially fixed position. Although a variety of biasing members may be used, in the embodiment shown in Figure 20B, the biasing member is a cantilevered beam 61 that is positioned between the proximal end 44a of the push rod 44 and the rear wall of the recess 59 to deflect the push rod 44 distally. The cantilevered beam 61 may be formed of a shape memory material, such as Nitinol, which allows the beam 61 to flex or flatten when a proximally directed force is applied to it. The beam 61 may also be formed from a variety of other materials, such as spring steel or reinforced polymers, and more than one beam may be used. Figure 20C illustrates another embodiment of a biasing member that is in the form of a spiral or spring lipo 63. As shown, the spring 63 is positioned between the proximal end 44a of the push rod 44 and the rear wall. of the recess 59 to deflect the push rod 44 distally. The spring 63 is adapted to be compressed when a directed force is applied to it proximally A person skilled in the art will appreciate that a variety of other biasing members, including elastomeric compression members, can be used. In use, referring again to Figures 17A-17D, as the trigger 16 initially moves from the open position to the closed position, the roller of the closure connection 54 will roll from the recess 110 in the insert of the barrel 48. Once that the feed bar 38 and the feed bar coupler 50 are in the most distal position, as shown in Figure 17C, the further actuation of the trigger 16 will cause the recess 110 in the trigger insert 48 to engage the roller of the closure connection 54, forcing it to rotate with the insert of the hood 48, as shown in Figure 17D. As a result, the closure coupler 58 will move distally, thereby causing the push rod 44 to move distally. As the push rod 44 advances distally, the cam 42 is advanced over the jaws 20 to close the jaws 20 and to fold the clip placed therebetween. The trigger 16 can optionally be partially closed to only partially close the jaws 20 and thereby fold, partially a clamp placed between them. Exemplary techniques to facilitate complete and partial selective clamping of the clamp will be discussed in more detail below. Once the clip is applied, the clip 16 can be released, allowing then the spring 120 to pull the insert of the clip 48 back to its initial position, and allowing the spring 122 to drive the coupler of the feed bar 50 and the bar from feed 38 back to the proximal position. As the insert of the trigger 48 returns to its initial position, the roller of the closing connection 54 moves back to its initial position as well, thus pulling the closing connection 56, the closing coupler 58, and the push rod 44 proximally. The surgical tweezers applicator 10 may also include a variety of characteristic features to facilitate the use of the device 10. In an exemplary embodiment, the surgical tweezer applicator 10 may include an anti-retraction mechanism to control the movement of the trigger 16. In particular, the anti-return mechanism can prevent the trigger 16 from opening during a partial closing run. However, once the trigger reaches a predetermined position, at which point the clamp placed between the jaws can be partially folded, the anti-recess mechanism can release the gaíillo, allowing the trigger to open and release the clamp or to close for Completely fold the clamp, as desired by the user. Figures 21 A and 21 B illustrate an exemplary embodiment of a non-return mechanism in the form of a ratchet. As shown, the ratchet includes a set of teeth 112 formed in the trigger insert 48, and a pawl 60 that is adapted to be rotatably positioned within the housing 12 and positioned adjacent the trigger insert 48, so that the closure of the hood 16 and the rotational movement of the trigger insert 48 will cause the ratchet 60 to engage the teeth 112. The teeth 112 can be configured to prevent rotation of the ratchet 60 until the Ratchet 60 reaches a predetermined position, at which point the ratchet 60 is free to rotate, thus allowing the winch 16 to open or close. The predetermined position preferably corresponds to a position in which the jaws 20 are partially closed. In an exemplary embodiment, as shown, the teeth 112 include a first set of teeth for example, ten teeth, which have a size that prevents rotation of the pawl 60 relative thereto, thus preventing the gaíillo 16 from opening when the fringe 60 is coupled with the first set 112a of teeth 112. The teeth 112 may also include a final or terminal tooth, referred to as a "tock" tooth having a size that allows the ratchet 60 to rotate relative thereto when the ratchet 60 is coupled with the "fock" tooth 112b. In particular, the "tock" tooth 112b preferably has a size that is substantially greater than the size of the first set of teeth 112a, so that a large relative groove 140 is formed between the first set of teeth 112a and the tooth "tock" 112b. The notch 140 has a size that allows the pawl 60 to rotate therein, thereby allowing the pawl 60 to move selectively beyond the tock tooth 112b or back toward the first set of teeth 112a. A person skilled in the art will appreciate that the "iock" tooth 112b may be the same size or smaller in size as the first ten teeth 112a, while a groove 140 formed therebetween that allows the insertion of a turn is still provided. in the same.

Figures 22A-22D illustrate the mechanism of the ratchet in use. When the trigger 16 initially moves to a closed position, as shown in Figure 22A, the pawl 60 will engage the first set of teeth 112a thereby preventing the trigger 16 from opening. Additional actuation of the winch 16 will cause the pawl 60 to advance beyond the first set of teeth 112a until the pawl 60 reaches the groove 140 next to the tock tooth 112b. Once the ratchet 60 reaches the "tock" tooth 112b, at which point the jaws 20 are partially closed due to the partial distal movement of the cam 42 on the jaws 20, the ratchet 60 is free to rotate, thereby allowing that the trigger 16 be opened or closed, as desired by the user. The. FIG. 22C illustrates the trigger 16 in a completely closed position, and FIGS. 22D and 22E will show the winch 16 returning to the open position. The ratchet mechanism may also be configured to emit an audible sound indicating the position of the jaws 20. For example, a first sound may be emitted when the ratchet 60 engages the first set of teeth 112a, and a second sound, different, by For example, a stronger sound can be emitted when the ratchet 60 engages the "Ick" tooth 112b. As a result, when the barrel 16 reaches the predetermined position in which the syringe 60 is coupled with the tock tooth 112b, the sound indicates to the user that the jaws 20 are in a partially closed position. The user can thus release the louver 16 to release a clamp partially closed, or can completely close the trigger 16 to completely close the clamp. In another exemplary embodiment, the surgical clip applier 10 may include an overload mechanism that is adapted to prevent overloading of a force applied to the jaws 20 by the trigger 16. Typically, during the application of a surgical clip, a some force to close the jaws 20 and to fold the clip around the tissue placed between them. As the forming process proceeds and the clip is at least partially closed, the force required to continue closing the jaws 20 around the clip increases significantly. In consecuense, in an exemplary embodiment, the overload mechanism can have a resistance that correlates with the force required to close the jaws 20. In other words, the resistance of the overload mechanism can be increased as the force required to close the jaws 20 is increased . The resistance is, however, preferably slightly greater than the force required to close the jaws 20 to prevent accidental actuation of the overload mechanism. As a result, if the jaws 20 are prevented from closing when the trigger 16 is initially actuated, the force required to overcome the resistance of the overload mechanism is relatively low. This is particularly advantageous since the jaws 20 are more susceptible to deform when they are open or only partially closed. The overload mechanism will be activated more easily in the initial stages of forming the clamp to prevent deformation of the jaws. Conversely, when the jaws 20 are substantially closed, the resistance is relatively high, so that the overload mechanism can only be actuated upon application of a significant force applied to the jaws 20. FIG. 23A illustrates an exemplary embodiment of an overload mechanism 62, which shows an exploded view. In general, the overload mechanism may include an overload housing 64 formed of two halves 64a, 64b and containing a profile connection 66, an articulated connection 68, a pivot connection 70, and a deviation assembly 72. The Deviation assembly 72 may include a spring post 150 which is engaged with the housing 64 and which includes a bore extending through, to receive a plunger 154. A spring 152 is placed around the spring posed 150, and the plunger 154 is expelled through the springs 150 and includes a head 154a formed therein which is adapted to abut against the spring 152. The pivot connection 70 may be generally L-shaped and may be coupled to the housing 64 by means of a pivot pin 156 which is exposed to idle. A proximal groove 70a of the pivot connection 70 may be contacted with the head 154a of the plunger 154, and a dislodging groove 70b of the pivot connection 70 may be rotatably coupled with the hinged connection 68 by means of a pivot bolt 166. The articulated connection 68, in turn, can be coupled with the profile connection 66, which can be slidably and rotatably positioned within the housing 64, adjacent an opening 64d formed in the housing. The rotational movement of the connection of the profile 66 within the housing 64 can be achieved by, for example, a pivot pin 158 extending through the connection of the profile 66 and being positioned within a first slot 160a (only one is shown). slot) formed in each half 64a, 64b of the housing 64, and the sliding movement of the profile connection 66 within the housing 64 can be achieved by, for example, opposing protuberances 168a, 168b formed in the profile connection 66, which are received Within a second slot 160b (only one groove is shown) formed in each half 64a, 64b of the housing 64. In use, the connection of the profile 66 can be adapted to receive a force of the mounting that forms the clip and conrol the force with the resistance of the deflection assembly 72. In particular, the overload mechanism 62 uses the spring 152 junction with the hinged connection 68 and the pivot connection 70 to deflect the cone. of the profile 66 to rotate about the pivot pin 158 or to slide against the housing 64. For the rotational aspect, the force exerted by the compressed spring 152 is transferred through the hinged connection 68 and the pivot connection 70, so that a rotational moment is applied to the connection of the profile 66 against the housing 64. Thus, this monaage causes the connection of the profile 66 to resist rotation with respect to the housing 64. If the moment generated by a radial load of the roller of the connection of closure 54 against the connection of the profile 66 exceeds the moment of the pivot connection 70 and the articulated connection 68, the connection of the profile 66 starts to rotate, deforming the articulated connection 68 and causing the pivot connection 70 to further compress the spring 152. For the sliding aspect, the Pivot connection 70, the articulated connection 68 and the connection of the profile 66 are aligned so that the sliding force (resistance to sliding) is the force required to deform the hinged connection 68 and the pivoie connection 70. If the radial load of the roller of the closing connection 54 with the connection of the profile 66 exceeds the deformation force of the connections, then the pivot connection 70 further compresses the spring 152 as the connection of the profile 66 slides proximally. This is shown in more detail in Figures 23B-23C, and as shown, the opening 64d in the housing 64 allows the roller of the closure connection 54 of the clip forming assembly to roll with the connection of the profile 66. As As a result, when the hood 16 is actuated and moved to the closed position, the roller of the closing connection 54 applies a force to the connection of the profile 66. The resistance of the spring of the overload 152, however, will maintain the connection of the profile 66 in a substantially fixed position unless the force applied by the roller of the closing connection 54 is increased to a force that is greater than the resistance, for example, a threshold force. This can be caused, for example, by a foreign object placed between the jaws 20 or when the jaws 20 are completely closed and with the clamp and the clamp 20. glass, conduit, derivation, etc., between them. When the jaws 20 can no longer be closed, the force applied to the roller of the closing connection 54 of the closure movement of the hood 16 will be transferred to the connection of the profile 66, which will then rotate and slide inside the housing 64, thus causing the pin connection 70 to rotate, which urges the plunger 154 to compress the spring of the overload 152. As previously indicated, the force required to drive the overload mechanism can be correlated with the force required to close the jaws 20, which increases as the louver 16 moves to the closed position. This can be achieved due to the configuration of the connection of the profile 66. In particular, when the roller of the closing connection 54 first enters into contaction with the connection of the profile 66 and is therefore in a lower position, the connection of the Profile 66 can rotate inside housing 64, as shown in Figure 23B. As the roller of the closing connection 54 moves upwards together with the connection of the profile 66, the force required to overcome the resistance of the overload mechanism increases, because the connection of the profile 66 must slide within the housing 64, as shown in Figure 23C. The force required to rotate the connection of the profile 66 may be less than the force required to slide the connection of the profile 66. Accordingly, if the jaws 20 are prevented from closing, for example, by a foreign object, as the trigger is initially act, a minimum force will be required to cause the roller of the latch connection 54 to transfer the force to the lower portion of the connection of the profile 66, causing the connection of the profile 66 to rotate. When the jaws 20 are substantially closed and the louver 16 is almost completely driven, a significant amount of force is required to cause the roller of the locking connection 54 to transfer the force to the upper portion of the connection of the profile 66, causing the connection of the profile 66 slides inside the housing 64 to overcome the resistance of the spring of the overload 152. Although the amount of force required to drive the overload mechanism may be greater than and may be increased in relation to the amount of force required to closing the jaws 20, the force is preferably only slightly greater than the force required to close the jaws 20 to prevent deformation or other damage to the jaws 20. A person skilled in the art will appreciate that the strength can be adjusted based on the force required to close the jaws 20. The connection of the profile 66, and in particular its The distal 66s of the profile 66 connection may also have a shape that facilitates the correlation between the force required to drive the overload mechanism and the force required to close the jaws 20. For example, where the force required to close the jaws 20 is increased to a linear proportion, the distal surface 66s of the connection of the profile 66 can be planar, to prevent the connection of the profile 66 from interfering with the movement of the roller of the closure connection 54 above, and to allow a linear force is applied to the trigger 16 to close the jaws 20. Conversely, when the force required to close the jaws 20 is not linear, as the louver 16 moves to the closed position, the connection of the profile 66 may have a non-linear force corresponding to the non-linear force. Such a configuration will prevent the forces required to close the cam 42 (Figure 8) from becoming too aliased. By way of non-limiting example, the force required to close the jaws 20 may be non-linear due to the force of the recess 104 in the cam 42, which is adapted to push the jaw members 96a, 96b towards each other. As shown in Figure 8, the recess 104 may have a curved configuration so that the force will vary as the cam 42 passes over the jaw members 96a, 96b. The connection of the profile 66 can, therefore, have a corresponding curved distal surface, so that the force will also vary as the roller of the closing connection 54 passes over. As shown in Figures 23A and 23B, the connection of the profile 66 is curved, so that the lower portion of the connection of the profile 66 is substantially convex and the upper portion of the connection of the profile 66 is substantially concave. A person skilled in the art will appreciate that the connection of the profile 66 can take a variety of other forms, and that a variety of technical features can be used to opfimize the force necessary to close the jaws 20 and the force necessary to operate the mechanism of overload. A person skilled in the art will also appreciate that the overload mechanism can have a variety of other configurations. By way of non-limiting example, Figure 23D illustrates an overload mechanism that is in the form of a cantilevered beam 170 to receive a force applied by the roller of the closure connection 54. The beam 170 may have a substantially curved member 172 with a clamp 174 coupled to one end thereof. The curved member 172 may have a bending moment, which when deformed with a force greater than the bending moment, deforms, to adopt a condition of low stiffness. The clamp 174 can provide more rigidity to the curved member 172, so that the bending moment increases adjacent to the clamp 174. In use, the beam 170 can be loaded into the housing 12 of the gripper applicator 10, so that the roller of the closing connection 54 comes into contact with the concave surface, and the beam 170 can be positioned at an angle so that the roller of the closing connection 54 is further away from the beam when the trigger 16 is actuated initially, and the The roller of the closing connection 54 is closer to the beam as the trigger 16 moves to the closed position. As a result, the resistance to deformation will increase as the roller of the closure connection 54 moves therefrom and the louver 16 of the gripper applicator moves towards the closed position. Although not shown, multiple beams could optionally be used in a stacked manner and the terminal or free end of the beams could be contoured to conform to the strain load at a particular point along the beam.

In another exemplary embodiment, the surgical clip applier 10 may include an indicator of the number of clips to indicate the number of clips remaining in the device 10. Although several techniques may be used to indicate the number of remaining clips, FIGS. 24A- 25 illustrate an exemplary embodiment of a pinion pointer indicator that has an indicator wheel 74 and an indicator actuator 76. The indicator wheel 74 is shown in detail in Figures 24A and 24B, and as shown, has a generally circular or cylindrical defining a central axis Y around which the wheel 74 is adapted to rotate. The wheel 74 includes teeth 142 formed around and adapted to be coupled by the Indicator 76 actuator, and an indicator member 144. The indicator member 144 can have a variety of configurations, but in an exemplary embodiment, the indicator member 144 is in the form of a contrasting color pad having a color, eg, orange, red, etc., which differs from the rest of the indicator wheel 74. Figure 25 illustrates the exemplary flag actuator 76 in more detail. The actuator 76 is adapted to be slidably positioned within the housing 12 and to engage the coupler of the feed connection 50 and to move as the coupler of the feed bar 50 and the feed bar 38 move. Accordingly, the indicator actuator 76 may include a protrusion 146, only a portion of which is shown, formed on a lower surface thereof, to extend into the recess 50f formed between the circular flanges 50d, 50e in the coupler of the feed bar 50. The protrusion 146 allows the actuator of the indicator 76 to be engaged by the coupler of the feed bar 50 and moves with the same. The indicator actuator 76 may also include a coupling mechanism 148 formed therein, and adapted to engage the bosses 142 formed on the indicator wheel 74. As shown in FIG. 25, the coupling mechanism 148 on the indicator actuator 148. 76 is in the form of an arm having a tongue formed at the end thereof for engaging the teeth 142. In use, the indicator wheel 74 is rotatably positioned within the housing 12, as shown in Figures 26A-26B, and the indicator accordion 76 is slidably positioned in the housing 12, so that the coupling mechanism 148 is positioned adjacent to the indicator wheel 74 and the projection 146 extends towards the coupler of the feed bar 50. housing 12 includes a window 12a formed therein, to provide visual access to indicator wheel 144. As the window 16 moves to the closed position and the coupler of the feed bar 50 moves distally, the flag actuator 76 will move dis- tally with the feed bar 38 and the coupler of the feed bar 50. As a result, the coupling mechanism 148 on the indicator actuator 76, will engage the teeth 142 on the indicator wheel 74, thereby causing that the wheel 74 rotates as the clamp is advanced towards the jaws 20. Each time the trigger 16 is actuated to advance a clamp 20 towards the jaws 20, the actuator of the Indicator 74 rotates the indicator wheel 76. When the supply of If the gripper has two or three grippers, the color pad 144 will start appearing on the indicator wheel 74 in the window 12a formed in the housing 12, thus indicating to the user that only a few grippers remain. The colored color pad 144 can be adapted to occupy all of the window 12a when the grip supply is exhausted. In an exemplary embodiment, the indicator wheel 74 may include an antirewire mechanism that is adapted to prevent the indicator wheel 74 from rotating in a reverse direction, eg, a counterclockwise direction, after advancing. Although the anilirretomo mechanism can have a variety of configurations, in the modality shown in Figure 24B, the indicator wheel 74 includes opposite arms 73a, 73b, which extend substantially parallel to the axis Y. Each arm 73a, 73b has a pawl 75a, 75b formed at the most distal end thereof, which is adapted to engage the corresponding dieses formed in the housing 12. Although not shown, the corresponding dieses may be formed within a circular protrusion formed in an inner portion of the housing 12 adjacent to the housing. window 12a. When the Indicator wheel 74 is placed in the housing 12, the arms 73a, 73b extend towards the projection circular formed around the circumference formed by it. As a clamp is applied and the indicator wheel 74 rotates, the arms 73a, 73b can flex on the teeth in the housing to move to the next position. When the indicator actuator 76 slides proximally to return to its initial position, the arms 73a, 73b will engage the teeth in the housing to prevent the indicator wheel 74 from rotating in a reverse direction, i.e., returning to the previous position. A person skilled in the art will appreciate that a variety of other techniques can be used to prevent the return of the indicator wheel 74. As previously mentioned, the surgical clip applier 10 can be used to apply a partial or completely closed clip to a site. surgical, such as a glass, lead, derivation, ele. In laparoscopic and endoscopic surgery, a small incision is made in the patient's body to provide access to the surgical site. Typically, an access port or cannula is used to define a working channel that extends from the Incision in the skin to the surgical site. Frequently, during surgical procedures, it is necessary to stop the flow of blood through vessels or other conduits, and some procedures may require the use of a shunt. A surgical clamp can then be used to fold the vessel or to ensure bypass to the vessel. Accordingly, a surgical clamp applicator, such as the clamp applicator 10, can be inserted through the cannula or otherwise introduced into the surgical site to place the clamps 20. around the vessel, bypass or other driving. The tissue lock 46 can facilitate the placement of the jaws 20 around the target site. The louver 16 can then be operated to cause a clamp to advance between the jaws and to be placed around the target site, and to cause the jaws 20 to close to fold the clamp. Depending on the intended use of the clamp, the trigger 16 may be partially actuated, as indicated by the audible sound of the pawl 60 upon reaching the tock tooth 112b, or it may be actuated completely. The gaffle 16 is then released to release the clamp partially or completely closed, and the procedure can be repeated if necessary to apply additional tweezers. One of skill in the art will appreciate the advantages and additional features of the invention, based on the modalities described above. rdingly, the invention is not limited by what has been particularly disclosed and described, except as indicated by the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety.

Claims (25)

NOVELTY OF THE INVENTION CLAIMS

1. - A surgical tweezers applicator, comprising: a housing of a handle that has a hook attached thereto; an elongate body extending from the handle housing and having opposed jaws formed in a distal groove thereof and moving in an open position and a closed position; an advance assembly of the clamp placed on the elongate body to advance at least one clamp through the elongate body to place a clamp between the opposing jaws; and a flexible connection positioned within the handle housing and adapted to transfer movement of the hood to the feed assembly of the clamp, to cause the feed assembly of the clamp to advance at least one clamp, in response to the movement of the trigger .

2. The surgical tweezers applicator according to claim 1, further characterized in that the flexible connection is placed rotatably within the housing and extends the forward monaje of the clip and an insert of the barrel that is coupled to the trigger .

3. The surgical tweezers applicator according to claim 2, further characterized in that the advance assembly of the clip includes a feed bar extending through the elongate body and having a distal end adapted to advance at least one clip through the elongate body distally, and a proximal end coupled to a feed bar coupler for receiving a portion of the flexible connection.

4. The surgical tweezers applicator according to claim 3, further characterized in that the flexible connection includes a first end adapted to be received within a recess formed inside the coupler of the feeding bar, and a second end adapted for to be received inside a recess formed in the insert of the gaffle.

5. The surgical tweezers applicator according to claim 4, further characterized in that the flexible connection is adapted to rotate about a transverse axis, located between the first and second ends and extending substantially perpendicular to a longitudinal axis that is extends between the first and second ends.

6. The surgical tweezers applicator according to claim 1, further characterized in that the flexible connection is adapted to flex when the trigger moves to a closed position.

7. The surgical tweezers applicator according to claim 1, further characterized in that the flexible connection is formed of a polymer.

8. - The surgical tweezers applicator according to claim 1, further characterized in that the flexible connection is formed of a metal.

9. A forward assembly of the clamp, for use with a surgical clamp applicator, comprising: a clamping body, adapted to be placed within an elongated body of a surgical clamp applicator, and to advance the clamp minus a surgical clamp after distal movement thereof; a shroud insert adapted to be placed within a housing of a surgical clip applier and to engage a trigger that moves relative to the housing, so that the movement of the trigger is effective to move the shroud insert; and a flexible connection adapted to be rotatably positioned within the housing and to extend between the galette insert and the advancer body of the clamp, so that the movement of the gaff insert is effective to make the flexible connection rotate and make therefore, the advancing body of the clamp moves distally.

10. The advancement assembly of the clamp according to claim 9, further characterized in that the advancing body of the clamp comprises a feed bar having a proximal end adapted to be coupled to the flexible connection.

11. The advance assembly of the clamp according to claim 10, further characterized in that the proximal end of the feed bar includes a coupler for coupling the flexible connection.

12. - The advance assembly of the clamp according to claim 11, further characterized in that the coupler comprises opposite annular rims defining an annular groove between them, to seat a portion of the flexible connection.

13. The advance assembly of the clamp according to claim 12, further characterized in that the flexible connection includes opposing arms that are adapted to be received within the annular groove.

14. The advance assembly of the clamp according to claim 9, further characterized in that the trigger insert includes a recess formed therein to receive a portion of the flexible connection.

15. The advance assembly of the clamp according to claim 9, further characterized in that the flexible connection is adapted to rotate about a transverse axis located between the first and second opposite ends, and that extends substantially perpendicular to an axis longitudinal extending between the first and second ends.

16. The advancement assembly of the clamp according to claim 15, further characterized in that the first end is adapted to be coupled to the advancing body of the clamp, and the second end is adapted to be coupled to the trigger insert, and wherein the transverse axis is located substantially adjacent to the second end.

17. - A surgical clamp applicator, comprising: a clamp advance assembly coupled to a trigger and adapted to advance at least one surgical clamp through an elongate body extending from a housing; a clip-forming assembly coupled to a trigger and adapted to drive a jaw assembly formed at a distal end of the elongated body to form a surgical clip; and a trigger coupled to the housing and adapted to actuate the advancing assembly of the clamp and the assembly forming the clamp, wherein the trigger has two sequential stages of operation, the gaíillo is effective for driving the advance assembly of the clamp during the first actuating member, and the trigger is effective to actuate the assembly that forms the gripper and is flexible in relation to the advancing assembly of the gripper during the second actuating step.

18. The surgical tweezers applicator according to claim 17, further characterized in that the trigger and the advance assembly of the clip are coupled by a flexible connection.

19. The surgical tweezers applicator according to claim 18, further characterized in that it additionally comprises a hook insert coupled between the hood and the flexible connection, the trigger insert is adapted to rotate with the trigger during the first and second stages. of action.

20. The surgical tweezers applicator according to claim 19, further characterized in that the insert of the gaffle is adapted to make the flexible connection rotate and flex during the first actuation step, and wherein the trigger insert is adapted to maintain the flexible connection in a flexed position during the second actuation step.

21. A method for advancing a surgical clamp on a surgical clamp picker, comprising: moving a trigger coupled to a housing to a closed position, to make a flexible connection placed within the housing rotate and disially advance a mounting of advancing the clamp placed within an elongated body that extends from the housing, to initiate at least one advancement of the clamp toward the opposing jaws formed at a distal end of the elongated body; further moving the trigger to the closed position to cause the flexible connection to flex, so that the advancement of the clamp advancement is maintained in a substantially fixed position while the clamp forming assembly is advanced distally to make the opposing jaws formed at a distal end of the elongate body are thus closed and closed, the clamp placed between them.

22. The method according to claim 21, further characterized in that it further comprises releasing the hood to an open position to cause the flexible connection to rotate in an opposite direction and proximally retract the advancing assembly of the clamp.

23. - The method according to claim 21, further characterized in that the flexible connection extends between an insert of the trigger coupled to the trigger and the advance assembly of the gripper.

24. The method according to claim 23, further characterized in that the movement of the trigger causes the trigger insert to rotate, thereby causing the flexible connection to rotate.

25. The method according to claim 23, further characterized in that the advancing clamp assembly comprises a feed bar that has a coupling member formed at a proximal end thereof and coupled to the supply connection.