US20200315629A1 - Endoscopic surgical clip applier - Google Patents
Endoscopic surgical clip applier Download PDFInfo
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- US20200315629A1 US20200315629A1 US16/905,974 US202016905974A US2020315629A1 US 20200315629 A1 US20200315629 A1 US 20200315629A1 US 202016905974 A US202016905974 A US 202016905974A US 2020315629 A1 US2020315629 A1 US 2020315629A1
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- assembly
- inner shaft
- endoscopic
- proximal
- fired position
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00407—Ratchet means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2902—Details of shaft characterized by features of the actuating rod
Definitions
- the present disclosure relates to surgical clip appliers. More particularly, the present disclosure relates to endoscopic surgical clip appliers having handle assemblies configured for use with various different endoscopic assemblies.
- Endoscopic surgical staplers and surgical clip appliers are known in the art and are used for a number of distinct and useful surgical procedures.
- access to the interior of an abdomen is achieved through narrow tubes or cannulas inserted through a small entrance incision in the skin.
- Minimally invasive procedures performed elsewhere in the body are often generally referred to as endoscopic procedures.
- a tube or cannula device is extended into the patient's body through the entrance incision to provide an access port. The port allows the surgeon to insert a number of different surgical instruments therethrough using a trocar and for performing surgical procedures far removed from the incision.
- surgeon must often terminate the flow of blood or another fluid through one or more vessels.
- the surgeon will often use a particular endoscopic surgical clip applier to apply a surgical clip to a blood vessel or another duct to prevent the flow of body fluids therethrough during the procedure.
- Endoscopic surgical clip appliers having various sizes (e.g., diameters), that are configured to apply a variety of diverse surgical clips, are known in the art, and which are capable of applying a single or multiple surgical clips during an entry to the body cavity.
- Such surgical clips are typically fabricated from a biocompatible material and are usually compressed over a vessel. Once applied to the vessel, the compressed surgical clip terminates the flow of fluid therethrough.
- Endoscopic surgical clip appliers that are able to apply multiple clips in endoscopic or laparoscopic procedures during a single entry into the body cavity are described in commonly-assigned U.S. Pat. Nos. 5,084,057 and 5,100,420 to Green et al., which are both incorporated by reference in their entirety.
- Another multiple endoscopic surgical clip applier is disclosed in commonly-assigned U.S. Pat. No. 5,607,436 by Pratt et al., the contents of which is also hereby incorporated by reference herein in its entirety. These devices are typically, though not necessarily, used during a single surgical procedure.
- endoscopic or laparoscopic procedures it may be desirable and/or necessary to use different size surgical clips or different configured surgical clips depending on the underlying tissue or vessels to be ligated.
- a single endoscopic surgical clip applier it is desirable for a single endoscopic surgical clip applier to be loadable with and capable of firing different size surgical clips as needed.
- endoscopic surgical clip appliers that include handle assemblies configured for use with various different endoscopic assemblies having different clips loaded therein and/or configured for performing various different surgical tasks.
- proximal refers to the end of the apparatus or component thereof which is closer to the user and the term “distal” refers to the end of the apparatus or component thereof which is further away from the user.
- distal refers to the end of the apparatus or component thereof which is further away from the user.
- a reposable surgical instrument including a handle assembly and a first endoscopic assembly.
- the handle assembly includes a housing, a drive bar slidably supported within the housing, a trigger pivotably connected to the housing and operably coupled to the drive bar such that movement of the trigger relative to the housing from an un-actuated position to an actuated position translates the drive bar from a proximal position to a distal position, a ratchet pawl pivotably supported on the drive bar, and a receiver assembly extending from the housing and configured to releasably engage an endoscopic assembly therein.
- the first endoscopic assembly is configured for ratcheting use and includes a proximal hub, an elongated shaft, an end effector assembly, and a drive assembly.
- the proximal hub is insertable into and releasably engagable within the receiver assembly and includes a ratchet rack disposed therein.
- the ratchet rack defines a plurality of ratchet teeth.
- the elongated shaft extends distally from the proximal hub.
- the end effector assembly is supported at a distal end of the elongated shaft.
- the drive assembly includes an inner shaft slidably disposed within the proximal hub and the elongated shaft and defining proximal and distal ends.
- the distal end of the inner shaft is operably coupled to the end effector assembly such that movement of the inner shaft from an un-fired position to a fired position effects manipulation of the end effector assembly.
- initial translation of the drive bar from the proximal position towards the distal position moves the ratchet pawl into engagement with the ratchet rack and the drive bar into abutment with the drive assembly such that further distal translation of the drive bar towards the distal position incrementally urges the inner shaft from the un-fired position towards the fired position as the ratchet pawl is incrementally advanced along the ratchet rack in successive engagement with the ratchet teeth thereof.
- the drive bar prior to engagement of the ratchet pawl with the ratchet rack, the drive bar is permitted to return proximally, thereby returning the inner shaft towards the un-fired position.
- the drive bar is inhibited from return proximally, thereby inhibiting the inner shaft from returning towards the un-fired position.
- the ratchet pawl clears the ratchet rack and is disengaged therefrom. Further, with the ratchet pawl cleared and disengaged from the ratchet rack, the drive bar is permitted to return proximally, thereby returning the inner shaft towards the un-fired position.
- the drive assembly of the first endoscopic assembly further includes a plunger operably engaged with the proximal end of the inner shaft.
- the drive bar is configured to abut the plunger and urge the plunger distally to thereby urge the inner shaft from the un-fired position towards the fired position.
- the plunger may further be configured to translate together with the inner shaft from the un-fired position to the fired position, and to translate distally independently of the inner shaft and relative thereto from the fired position to an end position.
- the drive assembly of the first endoscopic assembly includes first and second springs.
- the second spring defines a spring constant greater than that of the first spring such that the first spring is compressed upon translation of the plunger together with the inner shaft from the un-fired position to the fired position, and such that the second spring is compressed upon translation of the plunger distally independently of the inner shaft and relative thereto from the fired position to the end position.
- translation of the drive bar from the proximal position to the distal position defines an actuation stroke length of the handle assembly and translation of the inner shaft from the un-fired position to the fired position defines a firing stroke length of the first endoscopic assembly that is smaller than the actuation stroke length of the handle assembly.
- the end effector assembly of the first endoscopic assembly includes first and second jaw members.
- movement of the inner shaft of the drive assembly of the first endoscopic assembly from the un-fired position to the fired position moves the first and second jaw members from an open position to a closed position.
- the first and second jaw members may be configured to receive a surgical clip therebetween such that moving the first and second jaw members from the open position to the closed position forms the surgical clip.
- the reposable surgical instrument further includes a second endoscopic assembly.
- the second endoscopic assembly is configured for non-ratcheting use and includes a proximal hub insertable into and releasably engagable within the receiver assembly, an elongated shaft extending distally from the proximal hub, an end effector assembly supported at a distal end of the elongated shaft, and a drive assembly.
- the drive assembly includes an inner shaft slidably disposed within the proximal hub and the elongated shaft and defining proximal and distal ends.
- the distal end of the inner shaft is operably coupled to the end effector assembly such that movement of the inner shaft from an un-fired position to a fired position effects manipulation of the end effector assembly.
- the proximal hub of the second endoscopic assembly With the proximal hub of the second endoscopic assembly releasably engaged within the receiver assembly, translation of the drive bar from the proximal position to the distal position moves the drive bar into abutment with the drive assembly to thereby continuously urge the inner shaft from the un-fired position towards the fired position.
- the ratchet pawl remains idle during translation of the drive bar between the proximal and distal positions.
- the drive bar is permitted to return proximally, thereby returning the inner shaft towards the un-fired position at any point during distal translation of the drive bar.
- the second endoscopic assembly may further include any or all of the features detailed above with respect to the first endoscopic assembly.
- FIG. 1 is a perspective view of the proximal portion of an endoscopic surgical clip applier provided in accordance with the present disclosure including a handle assembly having an endoscopic assembly engaged therewith;
- FIG. 2 is perspective view of the clip applier of FIG. 1 with the endoscopic assembly removed from the handle assembly;
- FIG. 3 is an enlarged, perspective view of the area of detail indicated as “ 3 ” in FIG. 2 ;
- FIG. 4 is a transverse, cross-sectional view taken across section line 4 - 4 in FIG. 3 ;
- FIG. 5 is a transverse, cross-sectional view taken across section line 5 - 5 in FIG. 3 ;
- FIG. 6 is a longitudinal, cross-sectional view of the receiver assembly of the handle assembly of FIG. 1 ;
- FIG. 7 is a transverse, cross-sectional view of the receiver assembly of FIG. 6 including the endoscopic assembly of FIG. 1 , absent the internal components thereof, operably engaged within the receiver assembly;
- FIG. 8 is a longitudinal, cross-sectional view taken across section line 8 - 8 in FIG. 7 ;
- FIG. 9 is a longitudinal, cross-sectional view of a portion of the handle assembly of FIG. 1 including the endoscopic assembly of FIG. 1 operably engaged therein;
- FIG. 10A is an enlarged, longitudinal, cross-sectional view of the area of detail indicated as “ 10 A” in FIG. 9 , illustrating the handle assembly of FIG. 1 disposed in an un-actuated position;
- FIG. 10B is an enlarged, longitudinal, cross-sectional view of the area of detail indicated as “ 10 A” in FIG. 9 , illustrating the handle assembly of FIG. 1 transitioning from the un-actuated position to an actuated position;
- FIG. 10C is an enlarged, longitudinal, cross-sectional view of the area of detail indicated as “ 10 A” in FIG. 9 , illustrating the handle assembly of FIG. 1 disposed in the actuated position;
- FIG. 10D is an enlarged, longitudinal, cross-sectional view of the area of detail indicated as “ 10 A” in FIG. 9 , illustrating the handle assembly of FIG. 1 transitioning from the actuated position back to the un-actuated position;
- FIG. 11A is a perspective view of another endoscopic assembly configured for use with the handle assembly of FIG. 1 ;
- FIG. 11B is an enlarged, perspective view of the distal portion of the endoscopic assembly of FIG. 11A ;
- FIG. 11C is a longitudinal, cross-sectional view of the endoscopic assembly of FIG. 11A ;
- FIG. 11D is an enlarged, longitudinal, cross-sectional view of the proximal portion of the endoscopic assembly of FIG. 11A ;
- FIG. 12A is a perspective view of another endoscopic assembly configured for use with the handle assembly of FIG. 1 ;
- FIG. 12B is an enlarged, perspective view of the distal portion of the endoscopic assembly of FIG. 12A ;
- FIG. 12C is a longitudinal, cross-sectional view of the endoscopic assembly of FIG. 12A ;
- FIG. 12D is an enlarged, longitudinal, cross-sectional view of the proximal portion of the endoscopic assembly of FIG. 12A ;
- FIG. 13 is an exploded, perspective view of the proximal end of another endoscopic assembly configured for use with the handle assembly of FIG. 1 ;
- FIG. 14 is an exploded, perspective view of the proximal end of another endoscopic assembly configured for use with the handle assembly of FIG. 1 ;
- FIG. 15 is a perspective view of the proximal end of another endoscopic assembly configured for use with the handle assembly of FIG. 1 .
- Clip applier 10 generally includes a handle assembly 100 and a plurality of endoscopic assemblies, e.g., endoscopic assembly 200 , selectively connectable to and extendable distally from handle assembly 100 .
- Handle assembly 100 is advantageously configured to operate each of the plurality of endoscopic assemblies, upon connection thereto, and may be configured as a sterilizable, reusable component such that handle assembly 100 may be repeatedly used with different and/or additional endoscopic assemblies during the course of one or more surgical procedures.
- the endoscopic assemblies may be configured as single-use disposable components, limited-use disposable components, or reusable components, depending upon a particular purpose and/or the configuration of the particular endoscopic assembly. In either configuration, the need for multiple handle assemblies 100 is obviated and, instead, the surgeon need only select an appropriate endoscopic assembly and connect that endoscopic assembly to handle assembly 100 in preparation for use.
- Handle assembly 100 is initially detailed for use in connection with a generic endoscopic assembly 200 that includes features common to any endoscopic assembly usable with handle assembly 100 .
- Exemplary embodiments of particular endoscopic assemblies e.g., endoscopic assembly 300 ( FIGS. 11A-11D ) and endoscopic assembly 400 ( FIGS. 12A-12D ), are thereafter detailed below.
- endoscopic assembly 200 is configured to selectively connect to and extend distally from handle assembly 100 .
- Endoscopic assembly 200 includes a proximal hub 210 configured for insertion into and releasable engagement within handle assembly 100 , an elongated shaft 220 extending distally from proximal hub 210 , an end effector assembly (not shown) disposed at the distal end of elongated shaft 220 , and an internal drive assembly 230 ( FIG. 9 ) including an inner drive shaft 232 ( FIG.
- Proximal hub 210 of endoscopic assembly 200 defines a generally tubular configuration and includes a longitudinally-extending slot 212 defined therein and an annular groove 214 defined therein. Longitudinally-extending slot 212 defines an open proximal end. Annular groove 214 extends circumferentially about proximal hub 210 and intersects longitudinally-extending slot 212 , although other non-intersecting configurations are also contemplated.
- endoscopic assembly 200 may further include a ratchet rack 215 ( FIG. 9 ) mounted within and disposed towards the proximal end of proximal hub 210 .
- ratchet rack 215 FIG. 9
- ratchet rack 215 is omitted.
- handle assembly 100 includes a receiver assembly 170 configured to receive proximal hub 210 of endoscopic assembly 200 and enable releasable engagement of endoscopic assembly 200 with handle assembly 100 .
- Receiver assembly 170 includes an outer collar 172 and an inner tubular member 174 .
- Inner tubular member 174 defines an interior diameter slightly larger than an exterior diameter of proximal hub 210 of endoscopic assembly 200 to enable slidable insertion of proximal hub 210 into inner tubular member 174 without significant play or gaps therebetween.
- Inner tubular member 174 further includes a plurality of apertures 176 defined therethrough and positioned circumferentially about inner tubular member 174 .
- a ball bearing 178 ( FIG.
- apertures 176 are configured to inhibit ball bearings 178 ( FIG. 8 ) from passing entirely therethrough and into inner tubular member 174 .
- Outer collar 172 is positioned so as to block the outwardly-facing ends of apertures 176 , thereby retaining ball bearings 178 within apertures 176 between outer collar 172 and inner tubular member 174 (except for the portions of ball bearings 178 ( FIG. 8 ) extending into inner tubular member 174 ).
- a pin 180 extends through a pin aperture 182 defined within inner tubular member 174 and at least partially through a pin slot 184 ( FIGS. 5 and 6 ) defined within outer collar 172 .
- Pin 180 extends at least partially into the interior of inner tubular member 174 and, as detailed below, is configured to facilitate alignment of endoscopic assembly 200 upon insertion of endoscopic assembly 200 into handle assembly 100 .
- Pin 180 is further configured to retain outer collar 172 and inner tubular member 174 in fixed rotational orientation relative to one another.
- Outer collar 172 is engaged with rotation knob 190 of handle assembly 100 in fixed rotational orientation such that, with pin 180 rotatably coupling outer collar 172 and inner tubular member 174 , rotation of rotation knob 190 can be effected to similarly rotate receiver assembly 170 .
- Rotation knob 190 includes an alignment indicator 192 disposed thereon that is aligned with pin 180 to enable alignment of endoscopic assembly 200 with receiver assembly 170 without the need to directly view the position of pin 180 .
- endoscopic assembly 200 is oriented such that longitudinally-extending slot 212 thereof is aligned with pin 180 of receiver assembly 170 .
- alignment of longitudinally-extending slot 212 and pin 180 can be achieved via aligning longitudinally-extending slot 212 with alignment indicator 192 of rotation knob 190 of handle assembly 100 .
- proximal hub 210 of endoscopic assembly 200 is slid proximally into inner tubular member 174 of receiver assembly 170 . Alignment of longitudinally-extending slot 212 and pin 180 ensures that, upon proximal sliding of proximal hub 210 into inner tubular member 174 , pin 180 is translated through longitudinally-extending slot 212 .
- proximal hub 210 As proximal hub 210 is slid proximally into inner tubular member 174 , ball bearings 178 apply radially-inward force on the exterior of proximal hub 210 causing proximal hub 210 , outer collar 172 , inner tubular member 174 , and/or ball bearings 178 to move or flex to accommodate proximal hub 210 between ball bearings 178 .
- Ball bearings 178 are permitted to rotate within apertures 176 as proximal hub 210 is slid proximally into inner tubular member 174 , reducing friction and permitting relatively easy sliding of proximal hub 210 into inner tubular member 174 .
- proximal hub 210 Upon full insertion of proximal hub 210 into inner tubular member 174 , e.g., upon pin 180 reaching the closed, distal end of longitudinally-extending slot 212 , ball bearings 178 are moved into position about annular groove 214 . As a result of the radially-inward force imparted by ball bearings 178 and/or the other components of receiver assembly 170 and endoscopic assembly 200 , once the fully inserted position has been achieved, ball bearings 178 are urged, under bias, into annular groove 214 to thereby releasably lock proximal hub 210 of endoscopic assembly 200 in engagement within receiver assembly 170 of handle assembly 100 .
- endoscopic assembly 200 is pulled distally relative to handle assembly 100 under sufficient urging so as to dislodge ball bearings 178 from annular groove 214 , thus permitting proximal hub 210 of endoscopic assembly 200 to be slid distally out of receiver assembly 170 of handle assembly 100 .
- handle assembly 100 generally includes a housing 110 , a trigger assembly 120 pivotably coupled to housing 110 , a ratcheting drive assembly 130 operably coupled to trigger assembly 120 , the receiver assembly 170 which extends distally from housing 110 , and the rotation knob 190 which is operably disposed about receiver assembly 170 .
- Housing 110 is configured to house the internal working components of handle assembly 100 and defines a body portion 111 and a fixed handle portion 112 extending downwardly from body portion 111 .
- Body portion 111 defines an annular slot 115 on the interior thereof.
- Body portion 111 of housing 110 further includes an internal pivot post 116 extending transversely within body portion 111 .
- Receiver assembly 170 of handle assembly 100 includes a retention clip 186 disposed about the proximal end of inner tubular member 174 thereof.
- Retention clip 186 is captured within annular slot 115 of housing 110 to rotatably engage receiver assembly 170 with housing 110 .
- Rotation knob 190 of handle assembly 100 is operably engaged about receiver assembly 170 in fixed rotational orientation relative thereto such that rotation of rotation knob 190 relative to housing 110 effects similar rotation of receiver assembly 170 relative to housing 110 .
- rotation knob 190 may be rotated relative to housing 110 to similarly rotate endoscopic assembly 200 relative to housing 110 .
- Fixed handle portion 112 of housing 110 is configured to facilitate grasping of handle assembly 100 and manipulation thereof and is monolithically formed with body portion 111 , although other configurations are also contemplated.
- Trigger assembly 120 generally includes a trigger 122 , a biasing member 127 , and a linkage 128 .
- Trigger 122 includes a grasping portion 123 , an intermediate pivot portion 124 , and a proximal extension portion 125 .
- Grasping portion 123 of trigger 122 extend downwardly from body portion 111 of housing 110 in opposed relation relative to fixed handle portion 112 of housing 110 .
- Grasping portion 123 is configured to facilitate grasping and manipulation of trigger 122 .
- Intermediate pivot portion 124 of trigger 122 is at least partially disposed within housing 110 and is configured to receive pivot post 116 of housing 110 so as to enable pivoting of trigger 122 about pivot post 116 and relative to housing 110 , e.g., between an un-actuated position, wherein grasping portion 123 of trigger 122 is spaced-apart relative to fixed handle portion 112 , and an actuated position, wherein grasping portion 123 of trigger 122 is approximated relative to fixed handle portion 112 .
- Proximal extension portion 125 of trigger 122 of trigger assembly 120 is disposed on an opposite side of intermediate pivot portion 124 and, thus, pivot post 116 , as compared to grasping portion 123 of trigger 122 . As such, pivoting of grasping portion 123 proximally, e.g., towards the actuated position, urges proximal extension portion 125 distally.
- Proximal extension portion 125 of trigger 122 is further configured to receive a first pin 129 a for pivotably coupling the proximal end of linkage 128 and proximal extension portion 125 of trigger 122 with each other.
- Biasing member 127 is engaged between proximal extension portion 125 and fixed handle portion 112 of housing 110 and is disposed in an at-rest condition in the un-actuated position of grasping portion 123 of trigger 122 . Pivoting of grasping portion 123 towards the actuated position elongates biasing member 127 storing energy therein such that, upon release of grasping portion 123 , grasping portion 123 is returned towards the un-actuated position under the bias of biasing member 127 .
- biasing member 127 may define any suitable configuration for biasing grasping portion 123 of trigger 122 towards the un-actuated position.
- linkage 128 is coupled at its proximal end to proximal extension portion 125 of trigger 122 via first pin 129 a .
- Linkage 128 is also pivotably coupled, at its distal end, to proximal block 134 of drive bar 132 of ratcheting drive assembly 130 via a second pin 129 b .
- ratcheting drive assembly 130 of handle assembly 100 generally includes a drive bar 132 and a pawl assembly 140 .
- Drive bar 132 includes a body portion 133 , a proximal block 134 engaged to body portion 133 at the proximal end thereof, and a distal block 136 engaged to body portion 133 at the distal end thereof.
- Proximal block 134 includes a proximally-extending finger 135 that is received within a track 118 defined within body portion 111 of housing 110 so as to guide translation of drive bar 132 through body portion 111 of housing 110 .
- Proximal block 134 is coupled with linkage 128 via second pin 129 b such that, upon pivoting of grasping portion 123 of trigger 122 towards the actuated position, drive bar 132 is translated distally through body portion 111 of housing 110 .
- distal block 136 is advanced into inner tubular member 174 of receiver assembly 170 and into contact with the proximal end of inner drive shaft 232 of inner drive assembly 230 of endoscopic assembly 200 to thereby urge inner drive shaft 232 distally.
- distal translation of inner drive shaft 232 through and relative to proximal hub 210 and elongated shaft 220 effects manipulation of the end effector assembly (not shown) of endoscopic assembly 200 , e.g., to perform the one or more surgical tasks of the endoscopic assembly 200 .
- Pawl assembly 140 of ratcheting drive assembly 130 is mounted within distal block 136 and includes a ratchet pawl 142 , a pawl pin 144 , and a pawl biasing member 146 .
- Ratchet pawl 142 is pivotably coupled to and within distal block 136 by pawl pin 144 so as to enable pivoting of ratchet pawl 142 relative to distal block 136 .
- Pawl biasing member 146 of pawl assembly 140 is coupled at one end to ratchet pawl 142 and at the other end to distal bock 136 so as to bias ratchet pawl 142 towards an operable orientation.
- ratchet pawl 142 is configured to successively engage the ratchet teeth of ratchet rack 215 during actuation of handle assembly 100 so as to enable incremental advancement of inner drive shaft 232 to manipulate the end effector assembly (not shown) of endoscopic assembly 200 .
- ratchet pawl 142 is simply advanced through proximal hub 210 of endoscopic assembly 200 upon actuation of handle assembly 100 without interfering with the advancement of inner drive shaft 232 to manipulate the end effector assembly (not shown) of endoscopic assembly 200 .
- endoscopic assembly 200 is engaged with handle assembly 100 , as detailed above. Once endoscopic assembly 200 and handle assembly 100 are engaged, handle assembly 100 and endoscopic assembly 200 are together ready for use.
- trigger 122 is initially disposed in the un-actuated position under the bias of biasing member 127 .
- drive bar 132 is disposed in its respective proximal-most position, spaced-apart from endoscopic assembly 200 .
- inner drive shaft 232 of inner drive assembly 230 of endoscopic assembly 200 is disposed in a proximal-most position such that the end effector assembly (not shown) of endoscopic assembly 200 is disposed in its initial position.
- trigger 122 is urged from the un-actuated position to the actuated position. More specifically, grasping portion 123 of trigger 122 is pivoted towards fixed handle portion 112 of housing 110 to urge linkage 128 distally which, in turn, urges drive bar 132 distally. As drive bar 132 is urged distally, distal block 136 and, thus, ratchet pawl 142 are translated distally.
- distal block 136 Upon sufficient distal translation of drive bar 132 , distal block 136 eventually extends into receiver assembly 170 and proximal hub 210 of endoscopic assembly 200 , wherein distal block 136 abuts the proximal end of inner drive shaft 232 of drive assembly 230 of endoscopic assembly 200 . As shown in FIG. 10B , upon further distal translation of distal block 136 , distal block 136 urges inner drive shaft 232 distally through proximal hub 210 of endoscopic assembly 200 to begin to manipulate the end effector assembly (not shown) thereof. At or near the same time drive shaft 232 is urged distally, ratchet pawl 142 of handle assembly 100 is moved into position to operably engage ratchet rack 215 of endoscopic assembly 200 .
- trigger 122 may be released to return drive bar 132 proximally, thereby allowing inner drive assembly 230 and the end effector assembly (not shown) of endoscopic assembly 200 to return to their respective initial positions.
- ratchet pawl 142 is engaged with ratchet rack 215 , only further distal advancement of drive bar 132 is permitted until ratchet pawl 142 has cleared ratchet rack 215 , at the end of the firing stroke.
- ratchet rack 215 may be positioned further proximally or more distally to ensure engagement at the desired point during actuation and firing.
- ratchet pawl 142 With ratchet pawl 142 engaged with ratchet rack 215 , incremental advancement of drive bar 132 and, correspondingly, inner drive assembly 230 , to incrementally fire endoscopic assembly 200 can be achieved by moving trigger 122 further towards the actuated position. During such incremental advancement, tactile feedback by way of ratchet pawl 142 engaging successive teeth of ratchet rack 215 can be felt by the surgeon.
- drive bar 132 Upon sufficient actuation of trigger 122 to fully fire endoscopic assembly 200 , drive bar 132 is sufficiently-distally positioned such that ratchet pawl 142 has cleared ratchet rack 215 , thus disengaging ratchet pawl 142 from ratchet rack 215 , as shown in FIG. 10C .
- the length of ratchet rack 215 is thus configured so as to enable ratchet pawl 142 to clear ratchet rack 215 and disengage from ratchet rack 215 only after endoscopic assembly 200 has been fully fired.
- ratchet rack 215 may define a longer or shorter length to ensure full firing before disengagement of ratchet pawl 142 from ratchet rack 215 .
- trigger 122 may be released or returned to the un-actuated position such that, as shown in FIG. 10 D, drive bar 132 is permitted to return proximally, while ratchet pawl 142 slides proximally over ratchet rack 215 .
- Proximal return of drive bar 132 allows inner drive assembly 230 and the end effector assembly (not shown) of endoscopic assembly 200 to return proximally to the respective initial positions thereof.
- FIGS. 11A-11D and 12A-12D two different endoscopic assemblies 300 and 400 , respectively, provided in accordance with the present disclosure and configured for use with handle assembly 100 ( FIG. 1 ) are shown, although it is envisioned that various other different endoscopic assemblies may be provided for use with handle assembly 100 ( FIG. 1 ).
- Endoscopic assembly 300 is configured to grasp and/or manipulate tissue, retrieve a surgical clip, and to close, fire, or form the surgical clip about tissue. It is contemplated that endoscopic assembly 300 be configured to close, fire or form surgical clips similar to those shown and described in U.S. Pat. No. 4,834,096, the entire contents of which are incorporated herein by reference.
- Endoscopic assembly 400 is configured to close, fire, or form one or more surgical clips about tissue.
- endoscopic assembly 400 may be configured to close, fire or form surgical clips similar to those shown and described in U.S. Pat. Nos. 7,819,886 or 7,905,890, the entire contents of each of which are incorporated herein by reference.
- endoscopic assembly 300 is configured for non-ratcheting use and generally includes a proximal hub 310 , an inner drive assembly 320 disposed within and extending through proximal hub 310 , an elongated shaft 340 extending distally from proximal hub 310 , and an end effector assembly 350 including a pair of jaw members 360 a , 360 b disposed at the distal end of elongated shaft 340 .
- proximal hub 310 of endoscopic assembly 300 defines a generally tubular configuration and an exterior diameter slightly smaller than that of inner tubular member 174 of receiver assembly 170 of handle assembly 100 to enable slidable insertion of proximal hub 310 into inner tubular member 174 without significant play or gaps therebetween.
- Proximal hub 310 includes features similar to those detailed above with respect to endoscopic assembly 200 ( FIG. 2 ) so as to enable engagement of proximal hub 310 within receiver assembly 170 of handle assembly 100 in a similar fashion.
- proximal hub 310 includes a longitudinally-extending slot 311 configured to receive pin 180 of receiver assembly 170 to ensure proper alignment of endoscopic assembly 300 relative to handle assembly 100 , and an annular groove 312 configured to receive at least a portion of each ball bearing 178 to releasably lock proximal hub 310 of endoscopic assembly 300 in engagement within receiver assembly 170 of handle assembly 100 .
- proximal hub 310 does not include a ratchet rack disposed therein.
- Proximal hub 310 of endoscopic assembly 300 further defines an internal bore 313 having an open proximal end 314 and a reduced-diameter distal opening as compared to the diameter of bore 313 so as to define a shoulder 315 therebetween.
- inner drive assembly 320 of endoscopic assembly 300 includes an inner shaft 322 slidably disposed within both proximal hub 310 and elongated shaft 340 of endoscopic assembly 300 .
- Inner shaft 322 includes a proximal end 323 supporting a transverse pin 324 disposed within bore 313 of proximal hub 310 , and a distal end 325 supporting a cam pin 326 disposed towards the distal end 344 of elongated shaft 340 .
- cam pin 326 is disposed within cam slots (not shown) of jaw members 360 a , 360 b of end effector assembly 350 to enable pivoting of jaw members 360 a , 360 b between open and closed positions in response to translation of inner shaft 322 through elongated shaft 340 .
- Inner drive assembly 320 further includes a plunger 328 and first and second biasing members 330 , 332 , respectively.
- Plunger 328 is slidably disposed within bore 313 of proximal hub 310 and defines an internal cavity 329 within which transverse pin 324 of proximal end 323 of inner shaft 322 is slidably confined.
- First biasing member 330 of inner drive assembly 320 is disposed within internal bore 313 of proximal hub 310 and interposed between shoulder 315 of proximal hub 310 and transverse pin 324 of inner shaft 322 .
- First biasing member 330 has a first spring constant “K 1 ” which is less than a second spring constant “K 2 ” of second biasing member 332 , the purpose of which is detailed below.
- Second biasing member 332 is disposed within cavity 329 of plunger 328 and is interdisposed between transverse pin 324 of inner shaft 322 and the proximal end of plunger 328 .
- first and second biasing members 330 , 332 respectively, facilitate appropriate translation of inner shaft 322 through proximal hub 310 and elongated shaft 340 to open and close jaw members 340 a , 340 b , and to enable full actuation of trigger 122 ( FIG. 1 ), as detailed below.
- Elongated shaft 340 of endoscopic assembly 300 defines a generally tubular configuration and extends between and interconnects proximal hub 310 and end effector assembly 350 . More specifically, the proximal end 342 of elongated shaft 340 is secured to proximal hub 310 , while the distal end 344 of elongated shaft 340 supports a clevis 346 configured to pivotably engage jaw members 360 a , 360 b of end effector assembly 350 at distal end 344 of elongated shaft 340 via a pivot pin 352 .
- End effector assembly 350 includes first and second jaw members 360 a , 360 b .
- Jaw members 360 a , 360 b are pivotably engaged to one another and clevis 346 via pivot pin 352 so as to permit pivoting of jaw members 360 a , 360 b relative to one another and elongated shaft 340 between an open position and a closed position.
- the proximal end of each jaw member 360 a , 360 b defines the cam slots (not shown) that are configured to receive cam pin 326 of inner shaft 322 such that translation of inner shaft 322 pivots jaw members 360 a , 360 b between the open and closed positions.
- jaw members 360 a , 360 b are configured to receive and close, fire or form a surgical clip, e.g., a surgical clip similar to those shown and described in U.S. Pat. No. 4,834,096, previously incorporated herein by reference.
- Endoscopic assembly 300 is first engaged with handle assembly 100 , similarly as detailed above with respect to endoscopic assembly 200 ( FIGS. 7 and 8 ).
- trigger 122 is disposed in the un-actuated position under the bias of biasing member 127 .
- drive bar 132 is disposed in a proximal-most position.
- inner shaft 322 of inner drive assembly 320 of endoscopic assembly 300 is disposed in a proximal-most position under the bias of first and second biasing members 330 , 332 .
- jaw members 360 a , 360 b initially, are disposed in the open position. With jaw members 360 a , 360 b disposed in the open position, a new, unformed or open surgical clip (not shown) may be located or loaded within jaw members 360 a , 360 b . Jaw members 360 a , 360 b of end effector assembly 350 may be used to retrieve or pick-up a surgical clip from a clip holder (not shown), the surgical clip may be manually loaded by the user, end effector assembly 350 may be pre-loaded by the manufacturer, or the surgical clip may be placed between jaw members 360 a , 360 b in any other suitable fashion.
- trigger 122 is urged from the un-actuated position to the actuated position to urge linkage 128 distally which, in turn, urges drive bar 132 distally through housing 110 such that distal block 136 is urged through receiver assembly 170 and into bore 313 of proximal hub 310 of endoscopic assembly 300 .
- linkage 128 urges drive bar 132 distally through housing 110 such that distal block 136 is urged through receiver assembly 170 and into bore 313 of proximal hub 310 of endoscopic assembly 300 .
- distal block 136 eventually contacts plunger 328 of drive assembly 320 of endoscopic assembly 300 .
- first spring constant “K 1 ” of first biasing member 330 being less than second spring constant “K 2 ” of second biasing member 332 , as distal block 136 is initially urged into plunger 328 , plunger 328 and inner shaft 322 translate together distally such that first biasing member 330 is compressed while second biasing member 332 remains substantially un-compressed.
- cam pin 326 is translated through the cam slots of jaw members 360 a , 360 b to pivot jaw members 360 a , 360 b towards the closed position to close and/or form the surgical clip (not shown) loaded within end effector assembly 350 .
- Cam pin 326 is advanced distally until cam pin 326 reaches an end of the cam slots of jaw members 360 a , 360 b and/or until jaw members 360 a , 360 b are fully approximated against one another or fully closed on the surgical clip.
- the required travel distance of inner shaft 322 to fully form the surgical clip may vary. As the distance of travel for trigger 122 between the un-actuated and actuated positions does not vary, it is endoscopic assembly 300 that accounts for this variation while allowing the surgeon to effect a full actuation stroke of trigger 122 , as detailed below.
- trigger 122 may be released and allowed to return under bias to the un-actuated position, thereby pulling drive bar 132 and distal block 136 back to their respective proximal-most positions and allowing jaw members 360 a , 360 b to return to the open position. Thereafter, the above-detailed use may be repeated to close, fire, or form additional surgical clips. Additionally or alternatively, jaw members 360 a , 360 b of end effector assembly 350 may be used to grasp and/or manipulate tissue as desired prior to or after formation of one or more surgical clips. As endoscopic assembly 300 is configured for non-ratcheting use, ratchet assembly 140 remains idle during the above-detailed operation, without interfering with the firing of endoscopic assembly 300 . Further, in such a non-ratcheting use configuration, actuation of trigger 122 and, thus, firing of endoscopic assembly 300 may be aborted at any point during the actuation and/or firing process.
- endoscopic assembly 400 generally includes a proximal hub 410 , an elongated shaft 420 extending distally from proximal hub 410 , a drive assembly 430 disposed within proximal hub 410 and elongated shaft 420 , and a pair of jaw members 460 a , 460 b supported at the distal end of elongated shaft 420 .
- Endoscopic assembly 400 is configured to close, fire, or form one or more surgical clips about tissue, such as those shown and described in U.S. Pat. Nos. 7,819,886 or 7,905,890, previously incorporated herein by reference.
- proximal hub 410 further includes features similar to those detailed above with respect to endoscopic assembly 200 ( FIG. 2 ) so as to enable engagement of proximal hub 410 within receiver assembly 170 of handle assembly 100 in a similar fashion. More specifically, proximal hub 410 includes a longitudinally-extending slot 411 configured to receive pin 180 of receiver assembly 170 to ensure proper alignment of endoscopic assembly 400 relative to handle assembly 100 , and an annular groove 412 configured to receive at least a portion of each ball bearing 178 to releasably lock proximal hub 410 of endoscopic assembly 400 in engagement within receiver assembly 170 of handle assembly 100 .
- endoscopic assembly 400 is configured for ratcheting use and, thus, proximal hub 410 of endoscopic assembly 400 further includes a ratchet rack 415 mounted therein and disposed towards the proximal end thereof.
- pawl assembly 140 ( FIG. 9 ) is configured to operably engage ratchet rack 415 to enable ratcheting use of endoscopic assembly 400 .
- Drive assembly 430 of endoscopic assembly 400 includes an inner shaft 431 slidably supported within the interior of elongated shaft 420 and proximal hub 410 .
- Inner shaft 431 includes a proximal end 433 and a distal end 434 .
- the proximal end 433 of inner shaft 431 extends into internal bore 413 of proximal hub 410 and is operably coupled to plunger 435 of drive assembly 430 via receipt of transverse pin 436 of inner shaft 431 within longitudinal slots 437 of plunger 435 .
- Distal end 434 of inner shaft 431 is operably coupled to the firing components disposed within the distal end of elongated shaft 420 which, in turn, are coupled to jaw members 460 a , 460 b such that jaw members 460 a , 460 b are moved from an open position to a closed position to form a surgical clip (not shown) that has been loaded into first and second jaw members 460 a , 460 b in response to distal translation of inner shaft 431 through elongated shaft 420 .
- Drive assembly 430 further includes a stop ring 438 and first and second biasing members 439 a , 439 b , each of which is disposed about inner shaft 431 .
- Stop ring 438 is fixedly engaged about inner shaft 431 and disposed within internal bore 413 of proximal hub 410 .
- First biasing member 439 a is positioned distally of stop ring 438 and is retained between stop ring 438 and the distal end of proximal hub 410 .
- Second biasing member 439 b is positioned proximally of stop ring 438 and is retained between stop ring 438 and the distal end of plunger 435 .
- First biasing member 439 a has a first spring constant “KK 1 ” which is less than a second spring constant “KK 2 ” of second biasing member 439 b , the purpose of which is detailed below.
- endoscopic assembly 400 is first engaged with handle assembly 100 , similarly as detailed above with respect to endoscopic assembly 200 ( FIGS. 7 and 8 ).
- trigger 122 is disposed in the un-actuated position under the bias of biasing member 127 .
- drive bar 132 is disposed in a proximal-most position and, thus, inner shaft 431 of drive assembly 430 is disposed in a proximal-most position under the bias of first and second biasing members 439 a , 439 b , respectively.
- jaw members 460 a , 460 b initially, are disposed in the open position.
- a new, unformed or open surgical clip (not shown) may be located or loaded within jaw members 460 a , 460 b , or may be otherwise operably positioned (manually or automatically) for insertion therebetween for formation or closure about tissue upon closure of jaw members 460 a , 460 b .
- a surgical clip is first advanced from elongated shaft 420 between jaw members 460 a , 460 b and, thereafter, jaw members 460 a , 460 b are closed to form the surgical clip.
- a series of surgical clips may be loaded within elongated shaft 420 for sequential firing in a similar manner.
- other suitable surgical clips and/or configurations for firing thereof are also contemplated.
- trigger 122 is urged from the un-actuated position to the actuated position. More specifically, grasping portion 123 of trigger 122 is pivoted towards fixed handle portion 112 of housing 110 to urge linkage 128 distally which, in turn, urges drive bar 132 distally. As drive bar 132 is urged distally, distal block 136 and ratchet pawl 142 are likewise translated distally. Upon sufficient actuation of trigger 122 , ratchet pawl 142 is moved into engagement with ratchet rack 415 of endoscopic assembly 400 . Similarly as detailed above with respect to endoscopic assembly 200 ( FIGS.
- trigger 122 may not return towards the un-actuated position and, thus, drive bar 132 may not return proximally until endoscopic assembly 400 has been fully fired.
- distal block 136 As drive bar 132 is translated distally, distal block 136 is advanced through housing 110 , receiver assembly 170 , and into bore 413 of proximal hub 410 of endoscopic assembly 400 . Eventually, distal block 136 of handle assembly 100 contacts plunger 435 of drive assembly 430 of endoscopic assembly 400 . Due to first spring constant “KK 1 ” of first biasing member 439 a being less than second spring constant “KK 2 ” of second biasing member 439 b , as distal block 136 is initially urged into plunger 435 , plunger 435 and inner shaft 431 translate together distally such that first biasing member 439 a is compressed while second biasing member 439 b remains substantially un-compressed.
- a surgical clip is first loaded between first and second jaw members 460 a , 460 b and, thereafter, first and second jaw members 460 a , 460 b are transitioned from the open position to the closed position to form the surgical clip about tissue, although other configurations are also contemplated.
- ratchet pawl 142 is incrementally engaged with successive ratchet teeth of ratchet rack 415 of endoscopic assembly 400 , similarly as detailed above with respect to endoscopic assembly 200 ( FIGS. 9 and 10A-10D ).
- endoscopic assembly 400 As noted above with respect to endoscopic assembly 300 ( FIGS. 11A-11D ), depending upon the particular endoscopic assembly used, the configuration of the surgical clip being formed, and/or other factors, the required travel distance of the drive assembly of the endoscopic assembly to fully form the surgical clip may vary. Thus, in order to ensure that trigger 122 may be actuated through the full actuation stroke thereof, e.g., from the un-actuated position to the actuated position, endoscopic assembly 400 allows for further travel of drive bar 132 beyond the fully-fired position of endoscopic assembly 400 , as detailed below.
- plunger 435 is continued to be driven distally.
- second biasing member 439 b is compressed, thus allowing plunger 435 to translate distally independently of inner shaft 431 . That is, the compression of second biasing member 439 b enables inner shaft 431 to remain in position while the full actuation stroke of trigger 122 is completed.
- Ratchet rack 415 of endoscopic assembly 400 is configured such that, upon full actuation of handle assembly 100 and/or full firing of endoscopic assembly 400 , ratchet pawl 142 has cleared ratchet rack 415 and is disengaged therefrom. More specifically, ratchet rack 415 defines a length suitable for enabling ratcheted, incremental transition jaw members 460 a , 460 b from the open position towards the closed position and such that, upon reaching the fully closed position of jaw members 460 a , 460 b , the fully actuated position of handle assembly 100 , and/or the distal-most position of plunger 435 , ratchet pawl 142 has cleared ratchet rack 415 .
- trigger 122 may be released or returned to the un-actuated position to thereby return drive bar 132 and inner shaft 431 to their initial positions, thus returning first and second jaw members 460 a , 460 b to the open position. Thereafter, the above-detailed use may be repeated to close, fire, or form additional surgical clips.
- FIGS. 13-15 the proximal ends of various other endoscopic assemblies 500 , 600 , 700 , respectively, configured for use with handle assembly 100 are shown.
- Endoscopic assemblies 500 , 600 ( FIGS. 13 and 14 , respectively) are configured for ratcheting use and, thus, proximal hubs 510 , 610 include ratchet racks 515 , 615 configured to be mounted therein and disposed towards the proximal end thereof.
- ratchet rack 415 of endoscopic assembly 400 FIGS.
- ratchet racks 515 , 615 define lengths suitable for enabling ratcheted advancement of the inner drive assemblies 530 , 630 thereof for manipulating the end effector assemblies (not shown) thereof and for enabling full return of the inner drive assemblies 530 , 630 after a full actuation and/or firing stroke.
- ratchet racks 415 ( FIG. 12 ), 515 , and 615 define different lengths corresponding to the different firing stroke requirements of respective endoscopic assemblies 500 , 600 .
- ratchet racks of various other configurations are also contemplated, depending upon the firing stroke requirements of the particular endoscopic assembly for which the ratchet rack is provided.
- the ratchet rack need not be disposed at the proximal end of the proximal hub of the endoscopic assembly but, rather, can be distally-spaced therefrom to delay ratcheting engagement until further into the firing stroke.
- Endoscopic assembly 700 FIG. 15
- proximal hub 710 does not include a ratchet rack.
- endoscopic assemblies including a pair of jaws having a unique and diverse firing stroke length thereof, may be provided for use with handle assembly 100 ( FIG. 1 ) for ratcheting use or non-ratcheting use.
- handle assembly 100 FIG. 1
- Such a configuration accommodates various different endoscopic assemblies having different configurations and/or different firing stroke lengths while providing a constant actuation stroke length.
- various endoscopic assemblies, constructed in accordance with the principles of the present disclosure may be provided which are also capable of firing or forming or closing surgical clips of various sizes, materials, and configurations, across multiple platforms for multiple different manufactures.
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Abstract
Description
- The present application is a Continuation application claiming the benefit of and priority to U.S. patent application Ser. No. 15/751,240, filed on Feb. 8, 2018, now U.S. Pat. No. 10,702,279, which is a National Stage Application of PCT/CN2015/093626, filed Nov. 3, 2015, under 35 USC § 371 (a), the disclosure of each of the above-identified applications being hereby incorporated by reference in its entirety.
- The present disclosure relates to surgical clip appliers. More particularly, the present disclosure relates to endoscopic surgical clip appliers having handle assemblies configured for use with various different endoscopic assemblies.
- Endoscopic surgical staplers and surgical clip appliers are known in the art and are used for a number of distinct and useful surgical procedures. In the case of a laparoscopic surgical procedure, access to the interior of an abdomen is achieved through narrow tubes or cannulas inserted through a small entrance incision in the skin. Minimally invasive procedures performed elsewhere in the body are often generally referred to as endoscopic procedures. Typically, a tube or cannula device is extended into the patient's body through the entrance incision to provide an access port. The port allows the surgeon to insert a number of different surgical instruments therethrough using a trocar and for performing surgical procedures far removed from the incision.
- During a majority of these procedures, the surgeon must often terminate the flow of blood or another fluid through one or more vessels. The surgeon will often use a particular endoscopic surgical clip applier to apply a surgical clip to a blood vessel or another duct to prevent the flow of body fluids therethrough during the procedure.
- Endoscopic surgical clip appliers having various sizes (e.g., diameters), that are configured to apply a variety of diverse surgical clips, are known in the art, and which are capable of applying a single or multiple surgical clips during an entry to the body cavity. Such surgical clips are typically fabricated from a biocompatible material and are usually compressed over a vessel. Once applied to the vessel, the compressed surgical clip terminates the flow of fluid therethrough.
- Endoscopic surgical clip appliers that are able to apply multiple clips in endoscopic or laparoscopic procedures during a single entry into the body cavity are described in commonly-assigned U.S. Pat. Nos. 5,084,057 and 5,100,420 to Green et al., which are both incorporated by reference in their entirety. Another multiple endoscopic surgical clip applier is disclosed in commonly-assigned U.S. Pat. No. 5,607,436 by Pratt et al., the contents of which is also hereby incorporated by reference herein in its entirety. These devices are typically, though not necessarily, used during a single surgical procedure. U.S. Pat. No. 5,695,502 to Pier et al., the disclosure of which is hereby incorporated by reference herein, discloses a resterilizable endoscopic surgical clip applier. The endoscopic surgical clip applier advances and forms multiple clips during a single insertion into the body cavity. This resterilizable endoscopic surgical clip applier is configured to receive and cooperate with an interchangeable clip magazine so as to advance and form multiple clips during a single entry into a body cavity.
- During endoscopic or laparoscopic procedures, it may be desirable and/or necessary to use different size surgical clips or different configured surgical clips depending on the underlying tissue or vessels to be ligated. In order to reduce overall costs of an endoscopic surgical clip applier, it is desirable for a single endoscopic surgical clip applier to be loadable with and capable of firing different size surgical clips as needed.
- Accordingly, a need exists for endoscopic surgical clip appliers that include handle assemblies configured for use with various different endoscopic assemblies having different clips loaded therein and/or configured for performing various different surgical tasks.
- As detailed herein and shown in the drawing figures, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end of the apparatus or component thereof which is closer to the user and the term “distal” refers to the end of the apparatus or component thereof which is further away from the user. Further, to the extent consistent, any or all of the aspects and features detailed herein may be used in conjunction with any or all of the other aspects and features detailed herein.
- Provided in accordance with aspects of the present disclosure is a reposable surgical instrument including a handle assembly and a first endoscopic assembly. The handle assembly includes a housing, a drive bar slidably supported within the housing, a trigger pivotably connected to the housing and operably coupled to the drive bar such that movement of the trigger relative to the housing from an un-actuated position to an actuated position translates the drive bar from a proximal position to a distal position, a ratchet pawl pivotably supported on the drive bar, and a receiver assembly extending from the housing and configured to releasably engage an endoscopic assembly therein. The first endoscopic assembly is configured for ratcheting use and includes a proximal hub, an elongated shaft, an end effector assembly, and a drive assembly. The proximal hub is insertable into and releasably engagable within the receiver assembly and includes a ratchet rack disposed therein. The ratchet rack defines a plurality of ratchet teeth. The elongated shaft extends distally from the proximal hub. The end effector assembly is supported at a distal end of the elongated shaft. The drive assembly includes an inner shaft slidably disposed within the proximal hub and the elongated shaft and defining proximal and distal ends. The distal end of the inner shaft is operably coupled to the end effector assembly such that movement of the inner shaft from an un-fired position to a fired position effects manipulation of the end effector assembly. With the proximal hub releasably engaged within the receiver assembly, initial translation of the drive bar from the proximal position towards the distal position moves the ratchet pawl into engagement with the ratchet rack and the drive bar into abutment with the drive assembly such that further distal translation of the drive bar towards the distal position incrementally urges the inner shaft from the un-fired position towards the fired position as the ratchet pawl is incrementally advanced along the ratchet rack in successive engagement with the ratchet teeth thereof.
- In aspects of the present disclosure, prior to engagement of the ratchet pawl with the ratchet rack, the drive bar is permitted to return proximally, thereby returning the inner shaft towards the un-fired position. On the other hand, with the ratchet pawl engaged with the ratchet rack, the drive bar is inhibited from return proximally, thereby inhibiting the inner shaft from returning towards the un-fired position.
- In aspects of the present disclosure, once the inner shaft reaches the fired position, the ratchet pawl clears the ratchet rack and is disengaged therefrom. Further, with the ratchet pawl cleared and disengaged from the ratchet rack, the drive bar is permitted to return proximally, thereby returning the inner shaft towards the un-fired position.
- In aspects of the present disclosure, the drive assembly of the first endoscopic assembly further includes a plunger operably engaged with the proximal end of the inner shaft. The drive bar is configured to abut the plunger and urge the plunger distally to thereby urge the inner shaft from the un-fired position towards the fired position. The plunger may further be configured to translate together with the inner shaft from the un-fired position to the fired position, and to translate distally independently of the inner shaft and relative thereto from the fired position to an end position.
- In aspects of the present disclosure, the drive assembly of the first endoscopic assembly includes first and second springs. The second spring defines a spring constant greater than that of the first spring such that the first spring is compressed upon translation of the plunger together with the inner shaft from the un-fired position to the fired position, and such that the second spring is compressed upon translation of the plunger distally independently of the inner shaft and relative thereto from the fired position to the end position.
- In aspects of the present disclosure, translation of the drive bar from the proximal position to the distal position defines an actuation stroke length of the handle assembly and translation of the inner shaft from the un-fired position to the fired position defines a firing stroke length of the first endoscopic assembly that is smaller than the actuation stroke length of the handle assembly. As such, translation of the plunger from the fired position to the end position enables completion of the actuation stroke of the handle assembly after completion of the firing stroke of the first endoscopic assembly.
- In aspects of the present disclosure, the end effector assembly of the first endoscopic assembly includes first and second jaw members. In such aspects, movement of the inner shaft of the drive assembly of the first endoscopic assembly from the un-fired position to the fired position moves the first and second jaw members from an open position to a closed position. Further, the first and second jaw members may be configured to receive a surgical clip therebetween such that moving the first and second jaw members from the open position to the closed position forms the surgical clip.
- In aspects of the present disclosure, the reposable surgical instrument further includes a second endoscopic assembly. The second endoscopic assembly is configured for non-ratcheting use and includes a proximal hub insertable into and releasably engagable within the receiver assembly, an elongated shaft extending distally from the proximal hub, an end effector assembly supported at a distal end of the elongated shaft, and a drive assembly. The drive assembly includes an inner shaft slidably disposed within the proximal hub and the elongated shaft and defining proximal and distal ends. The distal end of the inner shaft is operably coupled to the end effector assembly such that movement of the inner shaft from an un-fired position to a fired position effects manipulation of the end effector assembly. With the proximal hub of the second endoscopic assembly releasably engaged within the receiver assembly, translation of the drive bar from the proximal position to the distal position moves the drive bar into abutment with the drive assembly to thereby continuously urge the inner shaft from the un-fired position towards the fired position.
- In aspects of the present disclosure, with the proximal hub of the second endoscopic assembly releasably engaged within the receiver assembly, the ratchet pawl remains idle during translation of the drive bar between the proximal and distal positions.
- In aspects of the present disclosure, with the proximal hub of the second endoscopic assembly releasably engaged within the receiver assembly, the drive bar is permitted to return proximally, thereby returning the inner shaft towards the un-fired position at any point during distal translation of the drive bar.
- In aspects of the present disclosure, the second endoscopic assembly may further include any or all of the features detailed above with respect to the first endoscopic assembly.
- Aspects and features of the presently-disclosed endoscopic surgical clip applier are described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements and:
-
FIG. 1 is a perspective view of the proximal portion of an endoscopic surgical clip applier provided in accordance with the present disclosure including a handle assembly having an endoscopic assembly engaged therewith; -
FIG. 2 is perspective view of the clip applier ofFIG. 1 with the endoscopic assembly removed from the handle assembly; -
FIG. 3 is an enlarged, perspective view of the area of detail indicated as “3” inFIG. 2 ; -
FIG. 4 is a transverse, cross-sectional view taken across section line 4-4 inFIG. 3 ; -
FIG. 5 is a transverse, cross-sectional view taken across section line 5-5 inFIG. 3 ; -
FIG. 6 is a longitudinal, cross-sectional view of the receiver assembly of the handle assembly ofFIG. 1 ; -
FIG. 7 is a transverse, cross-sectional view of the receiver assembly ofFIG. 6 including the endoscopic assembly ofFIG. 1 , absent the internal components thereof, operably engaged within the receiver assembly; -
FIG. 8 is a longitudinal, cross-sectional view taken across section line 8-8 inFIG. 7 ; -
FIG. 9 is a longitudinal, cross-sectional view of a portion of the handle assembly ofFIG. 1 including the endoscopic assembly ofFIG. 1 operably engaged therein; -
FIG. 10A is an enlarged, longitudinal, cross-sectional view of the area of detail indicated as “10A” inFIG. 9 , illustrating the handle assembly ofFIG. 1 disposed in an un-actuated position; -
FIG. 10B is an enlarged, longitudinal, cross-sectional view of the area of detail indicated as “10A” inFIG. 9 , illustrating the handle assembly ofFIG. 1 transitioning from the un-actuated position to an actuated position; -
FIG. 10C is an enlarged, longitudinal, cross-sectional view of the area of detail indicated as “10A” inFIG. 9 , illustrating the handle assembly ofFIG. 1 disposed in the actuated position; -
FIG. 10D is an enlarged, longitudinal, cross-sectional view of the area of detail indicated as “10A” inFIG. 9 , illustrating the handle assembly ofFIG. 1 transitioning from the actuated position back to the un-actuated position; -
FIG. 11A is a perspective view of another endoscopic assembly configured for use with the handle assembly ofFIG. 1 ; -
FIG. 11B is an enlarged, perspective view of the distal portion of the endoscopic assembly ofFIG. 11A ; -
FIG. 11C is a longitudinal, cross-sectional view of the endoscopic assembly ofFIG. 11A ; -
FIG. 11D is an enlarged, longitudinal, cross-sectional view of the proximal portion of the endoscopic assembly ofFIG. 11A ; -
FIG. 12A is a perspective view of another endoscopic assembly configured for use with the handle assembly ofFIG. 1 ; -
FIG. 12B is an enlarged, perspective view of the distal portion of the endoscopic assembly ofFIG. 12A ; -
FIG. 12C is a longitudinal, cross-sectional view of the endoscopic assembly ofFIG. 12A ; -
FIG. 12D is an enlarged, longitudinal, cross-sectional view of the proximal portion of the endoscopic assembly ofFIG. 12A ; -
FIG. 13 is an exploded, perspective view of the proximal end of another endoscopic assembly configured for use with the handle assembly ofFIG. 1 ; -
FIG. 14 is an exploded, perspective view of the proximal end of another endoscopic assembly configured for use with the handle assembly ofFIG. 1 ; and -
FIG. 15 is a perspective view of the proximal end of another endoscopic assembly configured for use with the handle assembly ofFIG. 1 . - Turning to
FIGS. 1 and 2 , an endoscopic surgical clip applier provided in accordance with the present disclosure is identified byreference numeral 10.Clip applier 10 generally includes ahandle assembly 100 and a plurality of endoscopic assemblies, e.g.,endoscopic assembly 200, selectively connectable to and extendable distally fromhandle assembly 100.Handle assembly 100 is advantageously configured to operate each of the plurality of endoscopic assemblies, upon connection thereto, and may be configured as a sterilizable, reusable component such that handleassembly 100 may be repeatedly used with different and/or additional endoscopic assemblies during the course of one or more surgical procedures. The endoscopic assemblies may be configured as single-use disposable components, limited-use disposable components, or reusable components, depending upon a particular purpose and/or the configuration of the particular endoscopic assembly. In either configuration, the need formultiple handle assemblies 100 is obviated and, instead, the surgeon need only select an appropriate endoscopic assembly and connect that endoscopic assembly to handleassembly 100 in preparation for use. -
Handle assembly 100 is initially detailed for use in connection with a genericendoscopic assembly 200 that includes features common to any endoscopic assembly usable withhandle assembly 100. Exemplary embodiments of particular endoscopic assemblies, e.g., endoscopic assembly 300 (FIGS. 11A-11D ) and endoscopic assembly 400 (FIGS. 12A-12D ), are thereafter detailed below. - Continuing with reference to
FIGS. 1 and 2 , as noted above,endoscopic assembly 200 is configured to selectively connect to and extend distally fromhandle assembly 100.Endoscopic assembly 200 includes aproximal hub 210 configured for insertion into and releasable engagement withinhandle assembly 100, anelongated shaft 220 extending distally fromproximal hub 210, an end effector assembly (not shown) disposed at the distal end ofelongated shaft 220, and an internal drive assembly 230 (FIG. 9 ) including an inner drive shaft 232 (FIG. 9 ) extending throughproximal hub 210 andelongated shaft 220 and operably coupled to the end effector assembly (not shown) at the distal end of inner drive shaft 232 (FIG. 9 ). As detailed below, upon engagement ofendoscopic assembly 200 withhandle assembly 100, actuation ofhandle assembly 100 effects distal translation of inner drive shaft 232 (FIG. 9 ) ofendoscopic assembly 200 throughproximal hub 210 andelongated shaft 220 to manipulate the end effector assembly (not shown) ofendoscopic assembly 200, e.g., to perform the one or more surgical tasks of theendoscopic assembly 200. -
Proximal hub 210 ofendoscopic assembly 200 defines a generally tubular configuration and includes a longitudinally-extendingslot 212 defined therein and anannular groove 214 defined therein. Longitudinally-extendingslot 212 defines an open proximal end.Annular groove 214 extends circumferentially aboutproximal hub 210 and intersects longitudinally-extendingslot 212, although other non-intersecting configurations are also contemplated. In embodiments whereendoscopic assembly 200 is configured for ratcheting use,endoscopic assembly 200 may further include a ratchet rack 215 (FIG. 9 ) mounted within and disposed towards the proximal end ofproximal hub 210. In embodiments whereendoscopic assembly 200 is configured for non-ratcheting use, ratchet rack 215 (FIG. 9 ) is omitted. - Referring additionally to
FIGS. 3-6 , handleassembly 100 includes areceiver assembly 170 configured to receiveproximal hub 210 ofendoscopic assembly 200 and enable releasable engagement ofendoscopic assembly 200 withhandle assembly 100.Receiver assembly 170 includes anouter collar 172 and an innertubular member 174. Innertubular member 174 defines an interior diameter slightly larger than an exterior diameter ofproximal hub 210 ofendoscopic assembly 200 to enable slidable insertion ofproximal hub 210 into innertubular member 174 without significant play or gaps therebetween. Innertubular member 174 further includes a plurality ofapertures 176 defined therethrough and positioned circumferentially about innertubular member 174. A ball bearing 178 (FIG. 8 ) is captured within each of theapertures 176 such that a portion of each ball bearing 178 (FIG. 8 ) protrudes inwardly into innertubular member 174. However,apertures 176 are configured to inhibit ball bearings 178 (FIG. 8 ) from passing entirely therethrough and into innertubular member 174.Outer collar 172, on the other hand, is positioned so as to block the outwardly-facing ends ofapertures 176, thereby retainingball bearings 178 withinapertures 176 betweenouter collar 172 and inner tubular member 174 (except for the portions of ball bearings 178 (FIG. 8 ) extending into inner tubular member 174). - A
pin 180 extends through apin aperture 182 defined within innertubular member 174 and at least partially through a pin slot 184 (FIGS. 5 and 6 ) defined withinouter collar 172.Pin 180 extends at least partially into the interior of innertubular member 174 and, as detailed below, is configured to facilitate alignment ofendoscopic assembly 200 upon insertion ofendoscopic assembly 200 intohandle assembly 100.Pin 180 is further configured to retainouter collar 172 and innertubular member 174 in fixed rotational orientation relative to one another.Outer collar 172 is engaged withrotation knob 190 ofhandle assembly 100 in fixed rotational orientation such that, withpin 180 rotatably couplingouter collar 172 and innertubular member 174, rotation ofrotation knob 190 can be effected to similarly rotatereceiver assembly 170.Rotation knob 190 includes analignment indicator 192 disposed thereon that is aligned withpin 180 to enable alignment ofendoscopic assembly 200 withreceiver assembly 170 without the need to directly view the position ofpin 180. - With reference to
FIGS. 1, 2, 7 and 8 , in order to engageendoscopic assembly 200 withhandle assembly 100,endoscopic assembly 200 is oriented such that longitudinally-extendingslot 212 thereof is aligned withpin 180 ofreceiver assembly 170. As noted above, rather than having to alignpin 180 directly, alignment of longitudinally-extendingslot 212 and pin 180 can be achieved via aligning longitudinally-extendingslot 212 withalignment indicator 192 ofrotation knob 190 ofhandle assembly 100. Once alignment has been achieved,proximal hub 210 ofendoscopic assembly 200 is slid proximally into innertubular member 174 ofreceiver assembly 170. Alignment of longitudinally-extendingslot 212 andpin 180 ensures that, upon proximal sliding ofproximal hub 210 into innertubular member 174,pin 180 is translated through longitudinally-extendingslot 212. - As
proximal hub 210 is slid proximally into innertubular member 174,ball bearings 178 apply radially-inward force on the exterior ofproximal hub 210 causingproximal hub 210,outer collar 172, innertubular member 174, and/orball bearings 178 to move or flex to accommodateproximal hub 210 betweenball bearings 178.Ball bearings 178 are permitted to rotate withinapertures 176 asproximal hub 210 is slid proximally into innertubular member 174, reducing friction and permitting relatively easy sliding ofproximal hub 210 into innertubular member 174. Upon full insertion ofproximal hub 210 into innertubular member 174, e.g., uponpin 180 reaching the closed, distal end of longitudinally-extendingslot 212,ball bearings 178 are moved into position aboutannular groove 214. As a result of the radially-inward force imparted byball bearings 178 and/or the other components ofreceiver assembly 170 andendoscopic assembly 200, once the fully inserted position has been achieved,ball bearings 178 are urged, under bias, intoannular groove 214 to thereby releasably lockproximal hub 210 ofendoscopic assembly 200 in engagement withinreceiver assembly 170 ofhandle assembly 100. - In order to remove
endoscopic assembly 200 fromhandle assembly 100,endoscopic assembly 200 is pulled distally relative to handleassembly 100 under sufficient urging so as to dislodgeball bearings 178 fromannular groove 214, thus permittingproximal hub 210 ofendoscopic assembly 200 to be slid distally out ofreceiver assembly 170 ofhandle assembly 100. - Turning now to
FIGS. 1, 2, and 9 , handleassembly 100 generally includes ahousing 110, atrigger assembly 120 pivotably coupled tohousing 110, a ratchetingdrive assembly 130 operably coupled to triggerassembly 120, thereceiver assembly 170 which extends distally fromhousing 110, and therotation knob 190 which is operably disposed aboutreceiver assembly 170. -
Housing 110 is configured to house the internal working components ofhandle assembly 100 and defines abody portion 111 and a fixedhandle portion 112 extending downwardly frombody portion 111.Body portion 111 defines anannular slot 115 on the interior thereof.Body portion 111 ofhousing 110 further includes aninternal pivot post 116 extending transversely withinbody portion 111. -
Receiver assembly 170 ofhandle assembly 100 includes aretention clip 186 disposed about the proximal end of innertubular member 174 thereof.Retention clip 186 is captured withinannular slot 115 ofhousing 110 to rotatably engagereceiver assembly 170 withhousing 110.Rotation knob 190 ofhandle assembly 100 is operably engaged aboutreceiver assembly 170 in fixed rotational orientation relative thereto such that rotation ofrotation knob 190 relative tohousing 110 effects similar rotation ofreceiver assembly 170 relative tohousing 110. Thus, withendoscopic assembly 200 engaged withinreceiver assembly 170,rotation knob 190 may be rotated relative tohousing 110 to similarly rotateendoscopic assembly 200 relative tohousing 110. - Fixed
handle portion 112 ofhousing 110 is configured to facilitate grasping ofhandle assembly 100 and manipulation thereof and is monolithically formed withbody portion 111, although other configurations are also contemplated. -
Trigger assembly 120 generally includes atrigger 122, a biasingmember 127, and alinkage 128.Trigger 122 includes a graspingportion 123, anintermediate pivot portion 124, and aproximal extension portion 125. Graspingportion 123 oftrigger 122 extend downwardly frombody portion 111 ofhousing 110 in opposed relation relative to fixedhandle portion 112 ofhousing 110. Graspingportion 123 is configured to facilitate grasping and manipulation oftrigger 122.Intermediate pivot portion 124 oftrigger 122 is at least partially disposed withinhousing 110 and is configured to receivepivot post 116 ofhousing 110 so as to enable pivoting oftrigger 122 aboutpivot post 116 and relative tohousing 110, e.g., between an un-actuated position, wherein graspingportion 123 oftrigger 122 is spaced-apart relative to fixedhandle portion 112, and an actuated position, wherein graspingportion 123 oftrigger 122 is approximated relative to fixedhandle portion 112. -
Proximal extension portion 125 oftrigger 122 oftrigger assembly 120 is disposed on an opposite side ofintermediate pivot portion 124 and, thus,pivot post 116, as compared to graspingportion 123 oftrigger 122. As such, pivoting of graspingportion 123 proximally, e.g., towards the actuated position, urgesproximal extension portion 125 distally.Proximal extension portion 125 oftrigger 122 is further configured to receive afirst pin 129 a for pivotably coupling the proximal end oflinkage 128 andproximal extension portion 125 oftrigger 122 with each other.Biasing member 127 is engaged betweenproximal extension portion 125 and fixedhandle portion 112 ofhousing 110 and is disposed in an at-rest condition in the un-actuated position of graspingportion 123 oftrigger 122. Pivoting of graspingportion 123 towards the actuated position elongates biasingmember 127 storing energy therein such that, upon release of graspingportion 123, graspingportion 123 is returned towards the un-actuated position under the bias of biasingmember 127. Although illustrated as an extension coil spring, biasingmember 127 may define any suitable configuration for biasinggrasping portion 123 oftrigger 122 towards the un-actuated position. - As noted above,
linkage 128 is coupled at its proximal end toproximal extension portion 125 oftrigger 122 viafirst pin 129 a.Linkage 128 is also pivotably coupled, at its distal end, toproximal block 134 ofdrive bar 132 of ratchetingdrive assembly 130 via asecond pin 129 b. As a result of this configuration, pivoting of graspingportion 123 towards the actuated position urgesproximal extension portion 125 distally which, in turn, urgeslinkage 128 distally to thereby urgedrive bar 132 distally. - Continuing with reference to
FIGS. 1, 2, and 9 , ratchetingdrive assembly 130 ofhandle assembly 100 generally includes adrive bar 132 and apawl assembly 140.Drive bar 132 includes abody portion 133, aproximal block 134 engaged tobody portion 133 at the proximal end thereof, and adistal block 136 engaged tobody portion 133 at the distal end thereof.Proximal block 134 includes a proximally-extendingfinger 135 that is received within atrack 118 defined withinbody portion 111 ofhousing 110 so as to guide translation ofdrive bar 132 throughbody portion 111 ofhousing 110.Proximal block 134, as noted above, is coupled withlinkage 128 viasecond pin 129 b such that, upon pivoting of graspingportion 123 oftrigger 122 towards the actuated position, drivebar 132 is translated distally throughbody portion 111 ofhousing 110. Upon sufficient distal translation ofdrive bar 132,distal block 136 is advanced into innertubular member 174 ofreceiver assembly 170 and into contact with the proximal end ofinner drive shaft 232 ofinner drive assembly 230 ofendoscopic assembly 200 to thereby urgeinner drive shaft 232 distally. As noted above, distal translation ofinner drive shaft 232 through and relative toproximal hub 210 andelongated shaft 220 effects manipulation of the end effector assembly (not shown) ofendoscopic assembly 200, e.g., to perform the one or more surgical tasks of theendoscopic assembly 200. -
Pawl assembly 140 of ratchetingdrive assembly 130 is mounted withindistal block 136 and includes aratchet pawl 142, apawl pin 144, and apawl biasing member 146.Ratchet pawl 142 is pivotably coupled to and withindistal block 136 bypawl pin 144 so as to enable pivoting ofratchet pawl 142 relative todistal block 136.Pawl biasing member 146 ofpawl assembly 140 is coupled at one end to ratchetpawl 142 and at the other end todistal bock 136 so as to biasratchet pawl 142 towards an operable orientation. - As detailed below, in embodiments where
endoscopic assembly 200 includes aratchet rack 215 to enable ratcheting use, ratchetpawl 142 is configured to successively engage the ratchet teeth ofratchet rack 215 during actuation ofhandle assembly 100 so as to enable incremental advancement ofinner drive shaft 232 to manipulate the end effector assembly (not shown) ofendoscopic assembly 200. In embodiments whereendoscopic assembly 200 is configured for non-ratcheting use and, thus, does not include aratchet rack 215, ratchetpawl 142 is simply advanced throughproximal hub 210 ofendoscopic assembly 200 upon actuation ofhandle assembly 100 without interfering with the advancement ofinner drive shaft 232 to manipulate the end effector assembly (not shown) ofendoscopic assembly 200. - Referring to
FIGS. 1, 9, and 10A-10D , the use ofhandle assembly 100 in conjunction withendoscopic assembly 200, whereinendoscopic assembly 200 includesratchet rack 215 to enable ratcheting use (as illustrated), is now detailed. Initially,endoscopic assembly 200 is engaged withhandle assembly 100, as detailed above. Onceendoscopic assembly 200 and handleassembly 100 are engaged,handle assembly 100 andendoscopic assembly 200 are together ready for use. In use,trigger 122 is initially disposed in the un-actuated position under the bias of biasingmember 127. As shown inFIGS. 9 and 10A , withtrigger 122 disposed in the un-actuated position, drivebar 132 is disposed in its respective proximal-most position, spaced-apart fromendoscopic assembly 200. As a result,inner drive shaft 232 ofinner drive assembly 230 ofendoscopic assembly 200 is disposed in a proximal-most position such that the end effector assembly (not shown) ofendoscopic assembly 200 is disposed in its initial position. - In order to manipulate the end effector assembly (not shown) of
endoscopic assembly 200, e.g., to perform the one or more surgical tasks of theendoscopic assembly 200,trigger 122 is urged from the un-actuated position to the actuated position. More specifically, graspingportion 123 oftrigger 122 is pivoted towards fixedhandle portion 112 ofhousing 110 to urgelinkage 128 distally which, in turn, urges drivebar 132 distally. Asdrive bar 132 is urged distally,distal block 136 and, thus, ratchetpawl 142 are translated distally. Upon sufficient distal translation ofdrive bar 132,distal block 136 eventually extends intoreceiver assembly 170 andproximal hub 210 ofendoscopic assembly 200, whereindistal block 136 abuts the proximal end ofinner drive shaft 232 ofdrive assembly 230 ofendoscopic assembly 200. As shown inFIG. 10B , upon further distal translation ofdistal block 136,distal block 136 urgesinner drive shaft 232 distally throughproximal hub 210 ofendoscopic assembly 200 to begin to manipulate the end effector assembly (not shown) thereof. At or near the sametime drive shaft 232 is urged distally, ratchetpawl 142 ofhandle assembly 100 is moved into position to operably engageratchet rack 215 ofendoscopic assembly 200. - As can be appreciated, prior to engagement of
ratchet pawl 142 withratchet rack 215,trigger 122 may be released to returndrive bar 132 proximally, thereby allowinginner drive assembly 230 and the end effector assembly (not shown) ofendoscopic assembly 200 to return to their respective initial positions. However, onceratchet pawl 142 is engaged withratchet rack 215, only further distal advancement ofdrive bar 132 is permitted untilratchet pawl 142 has clearedratchet rack 215, at the end of the firing stroke. Thus, the point during actuation ofhandle assembly 100 and firing ofendoscopic assembly 200 at whichratchet pawl 142 is positioned to engageratchet rack 215 is determinant of many events in the actuation ofclip applier 10. Accordingly, depending upon the particular firing requirements ofendoscopic assembly 200 relative to the actuation stroke ofhandle assembly 100,ratchet rack 215 may be positioned further proximally or more distally to ensure engagement at the desired point during actuation and firing. - With
ratchet pawl 142 engaged withratchet rack 215, incremental advancement ofdrive bar 132 and, correspondingly,inner drive assembly 230, to incrementally fireendoscopic assembly 200 can be achieved by movingtrigger 122 further towards the actuated position. During such incremental advancement, tactile feedback by way ofratchet pawl 142 engaging successive teeth ofratchet rack 215 can be felt by the surgeon. - Upon sufficient actuation of
trigger 122 to fully fireendoscopic assembly 200,drive bar 132 is sufficiently-distally positioned such thatratchet pawl 142 has clearedratchet rack 215, thus disengagingratchet pawl 142 fromratchet rack 215, as shown inFIG. 10C . As can be appreciated, the length ofratchet rack 215 is thus configured so as to enableratchet pawl 142 toclear ratchet rack 215 and disengage fromratchet rack 215 only afterendoscopic assembly 200 has been fully fired. Accordingly, depending upon the particular firing requirements ofendoscopic assembly 200 relative to the actuation stroke ofhandle assembly 100,ratchet rack 215 may define a longer or shorter length to ensure full firing before disengagement ofratchet pawl 142 fromratchet rack 215. - Once
ratchet pawl 142 clearsratchet rack 215 and is disengaged therefrom, trigger 122 may be released or returned to the un-actuated position such that, as shown in FIG. 10D,drive bar 132 is permitted to return proximally, whileratchet pawl 142 slides proximally overratchet rack 215. Proximal return ofdrive bar 132 allowsinner drive assembly 230 and the end effector assembly (not shown) ofendoscopic assembly 200 to return proximally to the respective initial positions thereof. - Turning to
FIGS. 11A-11D and 12A-12D , two differentendoscopic assemblies FIG. 1 ) are shown, although it is envisioned that various other different endoscopic assemblies may be provided for use with handle assembly 100 (FIG. 1 ).Endoscopic assembly 300 is configured to grasp and/or manipulate tissue, retrieve a surgical clip, and to close, fire, or form the surgical clip about tissue. It is contemplated thatendoscopic assembly 300 be configured to close, fire or form surgical clips similar to those shown and described in U.S. Pat. No. 4,834,096, the entire contents of which are incorporated herein by reference.Endoscopic assembly 400 is configured to close, fire, or form one or more surgical clips about tissue. More specifically, it is contemplated thatendoscopic assembly 400 may be configured to close, fire or form surgical clips similar to those shown and described in U.S. Pat. Nos. 7,819,886 or 7,905,890, the entire contents of each of which are incorporated herein by reference. - Referring to
FIGS. 11A-11D ,endoscopic assembly 300 is configured for non-ratcheting use and generally includes aproximal hub 310, aninner drive assembly 320 disposed within and extending throughproximal hub 310, anelongated shaft 340 extending distally fromproximal hub 310, and anend effector assembly 350 including a pair ofjaw members elongated shaft 340. - Referring to
FIGS. 1-3 , in addition toFIGS. 11A-11D ,proximal hub 310 ofendoscopic assembly 300 defines a generally tubular configuration and an exterior diameter slightly smaller than that of innertubular member 174 ofreceiver assembly 170 ofhandle assembly 100 to enable slidable insertion ofproximal hub 310 into innertubular member 174 without significant play or gaps therebetween.Proximal hub 310 includes features similar to those detailed above with respect to endoscopic assembly 200 (FIG. 2 ) so as to enable engagement ofproximal hub 310 withinreceiver assembly 170 ofhandle assembly 100 in a similar fashion. More specifically,proximal hub 310 includes a longitudinally-extendingslot 311 configured to receivepin 180 ofreceiver assembly 170 to ensure proper alignment ofendoscopic assembly 300 relative to handleassembly 100, and anannular groove 312 configured to receive at least a portion of eachball bearing 178 to releasably lockproximal hub 310 ofendoscopic assembly 300 in engagement withinreceiver assembly 170 ofhandle assembly 100. Asendoscopic assembly 300 is configured for non-ratcheting use,proximal hub 310 does not include a ratchet rack disposed therein.Proximal hub 310 ofendoscopic assembly 300 further defines aninternal bore 313 having an openproximal end 314 and a reduced-diameter distal opening as compared to the diameter ofbore 313 so as to define ashoulder 315 therebetween. - Referring again to
FIGS. 11A-11D ,inner drive assembly 320 ofendoscopic assembly 300 includes aninner shaft 322 slidably disposed within bothproximal hub 310 andelongated shaft 340 ofendoscopic assembly 300.Inner shaft 322 includes aproximal end 323 supporting atransverse pin 324 disposed withinbore 313 ofproximal hub 310, and adistal end 325 supporting acam pin 326 disposed towards thedistal end 344 ofelongated shaft 340. As detailed below,cam pin 326 is disposed within cam slots (not shown) ofjaw members end effector assembly 350 to enable pivoting ofjaw members inner shaft 322 throughelongated shaft 340. -
Inner drive assembly 320 further includes aplunger 328 and first andsecond biasing members Plunger 328 is slidably disposed withinbore 313 ofproximal hub 310 and defines aninternal cavity 329 within whichtransverse pin 324 ofproximal end 323 ofinner shaft 322 is slidably confined. - First biasing
member 330 ofinner drive assembly 320 is disposed withininternal bore 313 ofproximal hub 310 and interposed betweenshoulder 315 ofproximal hub 310 andtransverse pin 324 ofinner shaft 322. First biasingmember 330 has a first spring constant “K1” which is less than a second spring constant “K2” ofsecond biasing member 332, the purpose of which is detailed below. Second biasingmember 332 is disposed withincavity 329 ofplunger 328 and is interdisposed betweentransverse pin 324 ofinner shaft 322 and the proximal end ofplunger 328. As detailed below, first andsecond biasing members inner shaft 322 throughproximal hub 310 andelongated shaft 340 to open and close jaw members 340 a, 340 b, and to enable full actuation of trigger 122 (FIG. 1 ), as detailed below. -
Elongated shaft 340 ofendoscopic assembly 300 defines a generally tubular configuration and extends between and interconnectsproximal hub 310 and endeffector assembly 350. More specifically, theproximal end 342 ofelongated shaft 340 is secured toproximal hub 310, while thedistal end 344 ofelongated shaft 340 supports aclevis 346 configured to pivotably engagejaw members end effector assembly 350 atdistal end 344 ofelongated shaft 340 via apivot pin 352. -
End effector assembly 350, as noted above, includes first andsecond jaw members Jaw members clevis 346 viapivot pin 352 so as to permit pivoting ofjaw members elongated shaft 340 between an open position and a closed position. The proximal end of eachjaw member cam pin 326 ofinner shaft 322 such that translation ofinner shaft 322 pivotsjaw members jaw members - The use of
handle assembly 100 in conjunction withendoscopic assembly 300 is now detailed with reference toFIGS. 1, 9, and 11A-11D .Endoscopic assembly 300 is first engaged withhandle assembly 100, similarly as detailed above with respect to endoscopic assembly 200 (FIGS. 7 and 8 ). At this point, trigger 122 is disposed in the un-actuated position under the bias of biasingmember 127. Withtrigger 122 disposed in the un-actuated position, drivebar 132 is disposed in a proximal-most position. Further,inner shaft 322 ofinner drive assembly 320 ofendoscopic assembly 300 is disposed in a proximal-most position under the bias of first andsecond biasing members jaw members jaw members jaw members Jaw members end effector assembly 350 may be used to retrieve or pick-up a surgical clip from a clip holder (not shown), the surgical clip may be manually loaded by the user,end effector assembly 350 may be pre-loaded by the manufacturer, or the surgical clip may be placed betweenjaw members - In or to close, fire, or form the surgical clip loaded between
jaw members trigger 122 is urged from the un-actuated position to the actuated position to urgelinkage 128 distally which, in turn, urges drivebar 132 distally throughhousing 110 such thatdistal block 136 is urged throughreceiver assembly 170 and intobore 313 ofproximal hub 310 ofendoscopic assembly 300. Astrigger 122 is pivoted further towards the actuated position,distal block 136 eventually contacts plunger 328 ofdrive assembly 320 ofendoscopic assembly 300. Due to first spring constant “K1” of first biasingmember 330 being less than second spring constant “K2” ofsecond biasing member 332, asdistal block 136 is initially urged intoplunger 328,plunger 328 andinner shaft 322 translate together distally such that first biasingmember 330 is compressed while second biasingmember 332 remains substantially un-compressed. - As
inner shaft 322 is translated distally,cam pin 326 is translated through the cam slots ofjaw members jaw members end effector assembly 350.Cam pin 326 is advanced distally untilcam pin 326 reaches an end of the cam slots ofjaw members jaw members inner shaft 322 to fully form the surgical clip may vary. As the distance of travel fortrigger 122 between the un-actuated and actuated positions does not vary, it isendoscopic assembly 300 that accounts for this variation while allowing the surgeon to effect a full actuation stroke oftrigger 122, as detailed below. - Once
jaw members cam pin 326 has reached the end of the cam slots ofjaw members inner shaft 322 is no longer permitted to travel further distally. Thus, if circumstances arise, wherein further distal urging ofdistal block 136 is necessary, e.g., to complete the actuation stroke oftrigger 122,plunger 328 is advanced distally independently ofinner shaft 322 to compresssecond biasing member 332. Thus, the compression ofsecond biasing member 332 enablesinner shaft 322 to remain in position while the full actuation stroke oftrigger 122 is completed. - Once the surgical clip has been fully formed,
trigger 122 may be released and allowed to return under bias to the un-actuated position, thereby pullingdrive bar 132 anddistal block 136 back to their respective proximal-most positions and allowingjaw members jaw members end effector assembly 350 may be used to grasp and/or manipulate tissue as desired prior to or after formation of one or more surgical clips. Asendoscopic assembly 300 is configured for non-ratcheting use, ratchetassembly 140 remains idle during the above-detailed operation, without interfering with the firing ofendoscopic assembly 300. Further, in such a non-ratcheting use configuration, actuation oftrigger 122 and, thus, firing ofendoscopic assembly 300 may be aborted at any point during the actuation and/or firing process. - Referring to
FIGS. 12A-12D ,endoscopic assembly 400 generally includes aproximal hub 410, anelongated shaft 420 extending distally fromproximal hub 410, adrive assembly 430 disposed withinproximal hub 410 andelongated shaft 420, and a pair ofjaw members elongated shaft 420.Endoscopic assembly 400 is configured to close, fire, or form one or more surgical clips about tissue, such as those shown and described in U.S. Pat. Nos. 7,819,886 or 7,905,890, previously incorporated herein by reference. - With additional reference to
FIGS. 3-6 ,proximal hub 410 further includes features similar to those detailed above with respect to endoscopic assembly 200 (FIG. 2 ) so as to enable engagement ofproximal hub 410 withinreceiver assembly 170 ofhandle assembly 100 in a similar fashion. More specifically,proximal hub 410 includes a longitudinally-extendingslot 411 configured to receivepin 180 ofreceiver assembly 170 to ensure proper alignment ofendoscopic assembly 400 relative to handleassembly 100, and anannular groove 412 configured to receive at least a portion of eachball bearing 178 to releasably lockproximal hub 410 ofendoscopic assembly 400 in engagement withinreceiver assembly 170 ofhandle assembly 100. - Referring again the
FIGS. 12A-12D ,endoscopic assembly 400 is configured for ratcheting use and, thus,proximal hub 410 ofendoscopic assembly 400 further includes aratchet rack 415 mounted therein and disposed towards the proximal end thereof. As detailed below, during actuation ofhandle assembly 100 and firing ofendoscopic assembly 400, pawl assembly 140 (FIG. 9 ) is configured to operably engageratchet rack 415 to enable ratcheting use ofendoscopic assembly 400. - Drive assembly 430 of
endoscopic assembly 400 includes aninner shaft 431 slidably supported within the interior ofelongated shaft 420 andproximal hub 410.Inner shaft 431 includes aproximal end 433 and adistal end 434. Theproximal end 433 ofinner shaft 431 extends intointernal bore 413 ofproximal hub 410 and is operably coupled toplunger 435 ofdrive assembly 430 via receipt oftransverse pin 436 ofinner shaft 431 withinlongitudinal slots 437 ofplunger 435.Distal end 434 ofinner shaft 431 is operably coupled to the firing components disposed within the distal end ofelongated shaft 420 which, in turn, are coupled tojaw members jaw members second jaw members inner shaft 431 throughelongated shaft 420. -
Drive assembly 430 further includes astop ring 438 and first andsecond biasing members inner shaft 431.Stop ring 438 is fixedly engaged aboutinner shaft 431 and disposed withininternal bore 413 ofproximal hub 410. First biasingmember 439 a is positioned distally ofstop ring 438 and is retained betweenstop ring 438 and the distal end ofproximal hub 410. Second biasingmember 439 b is positioned proximally ofstop ring 438 and is retained betweenstop ring 438 and the distal end ofplunger 435. First biasingmember 439 a has a first spring constant “KK1” which is less than a second spring constant “KK2” ofsecond biasing member 439 b, the purpose of which is detailed below. - The use of
handle assembly 100 in conjunction withendoscopic assembly 400 is now detailed with reference toFIGS. 1, 9, and 12A-12D .Endoscopic assembly 400 is first engaged withhandle assembly 100, similarly as detailed above with respect to endoscopic assembly 200 (FIGS. 7 and 8 ). At this point, trigger 122 is disposed in the un-actuated position under the bias of biasingmember 127. Withtrigger 122 disposed in the un-actuated position, drivebar 132 is disposed in a proximal-most position and, thus,inner shaft 431 ofdrive assembly 430 is disposed in a proximal-most position under the bias of first andsecond biasing members jaw members jaw members jaw members jaw members elongated shaft 420 betweenjaw members jaw members elongated shaft 420 for sequential firing in a similar manner. However, other suitable surgical clips and/or configurations for firing thereof are also contemplated. - In order to close, fire, or form the surgical clip loaded between
jaw members trigger 122 is urged from the un-actuated position to the actuated position. More specifically, graspingportion 123 oftrigger 122 is pivoted towards fixedhandle portion 112 ofhousing 110 to urgelinkage 128 distally which, in turn, urges drivebar 132 distally. Asdrive bar 132 is urged distally,distal block 136 and ratchetpawl 142 are likewise translated distally. Upon sufficient actuation oftrigger 122, ratchetpawl 142 is moved into engagement withratchet rack 415 ofendoscopic assembly 400. Similarly as detailed above with respect to endoscopic assembly 200 (FIGS. 9 and 10A-10D ), once ratchetpawl 142 is engaged withratchet rack 415,trigger 122 may not return towards the un-actuated position and, thus, drivebar 132 may not return proximally untilendoscopic assembly 400 has been fully fired. - As
drive bar 132 is translated distally,distal block 136 is advanced throughhousing 110,receiver assembly 170, and intobore 413 ofproximal hub 410 ofendoscopic assembly 400. Eventually,distal block 136 ofhandle assembly 100 contacts plunger 435 ofdrive assembly 430 ofendoscopic assembly 400. Due to first spring constant “KK1” of first biasingmember 439 a being less than second spring constant “KK2” ofsecond biasing member 439 b, asdistal block 136 is initially urged intoplunger 435,plunger 435 andinner shaft 431 translate together distally such that first biasingmember 439 a is compressed while second biasingmember 439 b remains substantially un-compressed. Asinner shaft 431 is translated distally, a surgical clip is first loaded between first andsecond jaw members second jaw members handle assembly 100 and firing ofendoscopic assembly 400, ratchetpawl 142 is incrementally engaged with successive ratchet teeth ofratchet rack 415 ofendoscopic assembly 400, similarly as detailed above with respect to endoscopic assembly 200 (FIGS. 9 and 10A-10D ). - As noted above with respect to endoscopic assembly 300 (
FIGS. 11A-11D ), depending upon the particular endoscopic assembly used, the configuration of the surgical clip being formed, and/or other factors, the required travel distance of the drive assembly of the endoscopic assembly to fully form the surgical clip may vary. Thus, in order to ensure thattrigger 122 may be actuated through the full actuation stroke thereof, e.g., from the un-actuated position to the actuated position,endoscopic assembly 400 allows for further travel ofdrive bar 132 beyond the fully-fired position ofendoscopic assembly 400, as detailed below. - As
trigger 122 is further actuated to complete the full actuation stroke thereof,plunger 435 is continued to be driven distally. However, sinceinner shaft 431 cannot travel further distally beyond its distal-most position, second biasingmember 439 b is compressed, thus allowingplunger 435 to translate distally independently ofinner shaft 431. That is, the compression ofsecond biasing member 439 b enablesinner shaft 431 to remain in position while the full actuation stroke oftrigger 122 is completed. -
Ratchet rack 415 ofendoscopic assembly 400 is configured such that, upon full actuation ofhandle assembly 100 and/or full firing ofendoscopic assembly 400, ratchetpawl 142 has clearedratchet rack 415 and is disengaged therefrom. More specifically,ratchet rack 415 defines a length suitable for enabling ratcheted, incrementaltransition jaw members jaw members handle assembly 100, and/or the distal-most position ofplunger 435, ratchetpawl 142 has clearedratchet rack 415. Onceratchet pawl 142 has clearedratchet rack 415 and been disengaged therefrom, trigger 122 may be released or returned to the un-actuated position to thereby returndrive bar 132 andinner shaft 431 to their initial positions, thus returning first andsecond jaw members - Turning to
FIGS. 13-15 , the proximal ends of various otherendoscopic assemblies handle assembly 100 are shown.Endoscopic assemblies 500, 600 (FIGS. 13 and 14 , respectively) are configured for ratcheting use and, thus,proximal hubs ratchet racks ratchet rack 415 of endoscopic assembly 400 (FIGS. 12A-12D ), ratchetracks FIG. 12 ), 515, and 615 define different lengths corresponding to the different firing stroke requirements of respectiveendoscopic assemblies FIG. 15 ), like endoscopic assembly 300 (FIGS. 11A-11D ) is configured for non-ratcheting use and, thus,proximal hub 710 does not include a ratchet rack. - In addition to the above exemplary embodiments it is contemplated, and within the scope of the present disclosure, that other endoscopic assemblies, including a pair of jaws having a unique and diverse firing stroke length thereof, may be provided for use with handle assembly 100 (
FIG. 1 ) for ratcheting use or non-ratcheting use. Such a configuration accommodates various different endoscopic assemblies having different configurations and/or different firing stroke lengths while providing a constant actuation stroke length. Accordingly, various endoscopic assemblies, constructed in accordance with the principles of the present disclosure, may be provided which are also capable of firing or forming or closing surgical clips of various sizes, materials, and configurations, across multiple platforms for multiple different manufactures. - It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure.
Claims (21)
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US16/905,974 US20200315629A1 (en) | 2015-11-03 | 2020-06-19 | Endoscopic surgical clip applier |
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US201815751240A | 2018-02-08 | 2018-02-08 | |
US16/905,974 US20200315629A1 (en) | 2015-11-03 | 2020-06-19 | Endoscopic surgical clip applier |
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PCT/CN2015/093626 Continuation WO2017075752A1 (en) | 2015-11-03 | 2015-11-03 | Endoscopic surgical clip applier |
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US16/905,974 Abandoned US20200315629A1 (en) | 2015-11-03 | 2020-06-19 | Endoscopic surgical clip applier |
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US15/751,240 Active 2036-10-05 US10702279B2 (en) | 2015-11-03 | 2015-11-03 | Endoscopic surgical clip applier |
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EP (1) | EP3370625B1 (en) |
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CN (1) | CN108348259B (en) |
AU (1) | AU2015413639A1 (en) |
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-
2015
- 2015-11-03 AU AU2015413639A patent/AU2015413639A1/en not_active Abandoned
- 2015-11-03 CN CN201580084311.3A patent/CN108348259B/en active Active
- 2015-11-03 WO PCT/CN2015/093626 patent/WO2017075752A1/en active Application Filing
- 2015-11-03 JP JP2018521252A patent/JP6626197B2/en active Active
- 2015-11-03 EP EP15907594.4A patent/EP3370625B1/en active Active
- 2015-11-03 US US15/751,240 patent/US10702279B2/en active Active
- 2015-11-03 CA CA2998890A patent/CA2998890A1/en not_active Abandoned
-
2020
- 2020-06-19 US US16/905,974 patent/US20200315629A1/en not_active Abandoned
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Also Published As
Publication number | Publication date |
---|---|
JP2018534055A (en) | 2018-11-22 |
AU2015413639A1 (en) | 2018-04-05 |
CA2998890A1 (en) | 2017-05-11 |
EP3370625B1 (en) | 2020-07-01 |
US10702279B2 (en) | 2020-07-07 |
WO2017075752A1 (en) | 2017-05-11 |
CN108348259B (en) | 2020-12-11 |
CN108348259A (en) | 2018-07-31 |
US20180235637A1 (en) | 2018-08-23 |
EP3370625A1 (en) | 2018-09-12 |
JP6626197B2 (en) | 2019-12-25 |
EP3370625A4 (en) | 2019-09-25 |
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