CA2131973C - Apparatus for applying surgical clips - Google Patents
Apparatus for applying surgical clips Download PDFInfo
- Publication number
- CA2131973C CA2131973C CA002131973A CA2131973A CA2131973C CA 2131973 C CA2131973 C CA 2131973C CA 002131973 A CA002131973 A CA 002131973A CA 2131973 A CA2131973 A CA 2131973A CA 2131973 C CA2131973 C CA 2131973C
- Authority
- CA
- Canada
- Prior art keywords
- clip
- jaw
- handle portion
- jaw members
- handle
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Classifications
-
- 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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S227/00—Elongated-member-driving apparatus
- Y10S227/901—Surgical clip appliers
Abstract
An apparatus is provided for applying surgical clips which includes provisions for applying a partially closed clip to ducts or shunts during a surgical procedure such as cholecystectomy procedures. The apparatus includes means for effecting a partial closing stroke of the handle mechanism to correspond to a partial closure of the jaw members, and permits a partial opening stroke to release the partially closed clip in the jaw mechanism. Other features of the invention include means for preventing over advancement of a clip to the jaw mechanism, means for cradling the clip as it is advanced from the clip supply to the jaw mechanism, means for preventing splaying of the jaws in the event of a clip-over-clip application, and a novel rotation collar. The instrument of the present invention provides the surgeon with visual, audible, and tactile indication of the positioning of the jaw members to effect the application of a partially closed clip.
Description
1537 (203-1268) APPARATUS FOR APPhYING SURGICAL CLIPS
BACKGROUND OF THE INVENTION
1. Field of the Invention This invention relates to an apparatus for applying surgical clips to body tissue during laparoscopic or endoscopic procedures, and more particularly, to a surgical clip applier adapted to apply fully crimped clips as well as a partially formed clip during surgical procedures.
BACKGROUND OF THE INVENTION
1. Field of the Invention This invention relates to an apparatus for applying surgical clips to body tissue during laparoscopic or endoscopic procedures, and more particularly, to a surgical clip applier adapted to apply fully crimped clips as well as a partially formed clip during surgical procedures.
2. ~?escrivtion of Related Art In laparoscopic and endoscopic surgical procedures, a small incision is made in the patient's body to provide access for a tube or cannula device. Once extended into the patient's body, the cannula provides an access port which allows insertion of various surgical instruments through the cannula for acting on organs, blood vessels, ducts, or body tissue far removed from the incision. Often during these procedures, it is necessary to apply hemostatic clips to blood vessels or various ducts to prevent the flow of body Fluids therethrough during the procedure. Many times, the surgical procedure may necessitate the temporary implantation of shunts or tubes into ducts or vessels. Such procedures, such as gall bladder surgery, often require the placement of a shunt into the ducts during excision of the organ. To secure the shunt, a clip must be applied which is partially closed so as to avoid occluding the shunt. While instruments for performing surgical clip application are known in the art, none provide indication of the successful application of a partially crimped clip, such as is necessary to secure the shunt. Fully crimping a clip over a shunt will obviously occlude the shunt and defeat its purpose.
One clip applier known well in the art is described in U.S. Patent No. 5,084,057. This instrument includes a mechanism for sequentially advancing a plurality of surgical clips towards a pair of distal jaw members.
Through actuation of handle structure, the jaw members are closed to advantageously crimp the clip. The instrument does not provide an indication of the spacing between the jaws during the closing of the jaw members, other than through visual examination of the jaw members through an endoscope. Thus, when attempting to detachably secure a shunt to tissue, e.g., for cholangiography, it can be difficult to ascertain whether the jaw members have closed to an appropriate gap for securing the shunt.
Furthermore, many instruments now incorporate ratchet mechanisms to prevent inadvertent opening of the handles and jaws until the clip is fully crimped, requiring a full closing stroke. Thus, the instruments are not designed to deliver a partially crimped clip.
It has been common for clip appliers to rely on friction to capture a clip between the jaw members following advancement of the clip from the clip supply.
Accordingly, the jaw members are constructed so as to have a gap between the crimping surface of each jaw member which is slightly less than the distance between the legs of a clip, so that the clip is slightly pinched between the jaws to hold the clip therein.
Another method of maintaining the clip within the jaws is to machine the crimping surfaces of the jaw members to have a clip accepting slot. However, this increases cost ~ i J
One clip applier known well in the art is described in U.S. Patent No. 5,084,057. This instrument includes a mechanism for sequentially advancing a plurality of surgical clips towards a pair of distal jaw members.
Through actuation of handle structure, the jaw members are closed to advantageously crimp the clip. The instrument does not provide an indication of the spacing between the jaws during the closing of the jaw members, other than through visual examination of the jaw members through an endoscope. Thus, when attempting to detachably secure a shunt to tissue, e.g., for cholangiography, it can be difficult to ascertain whether the jaw members have closed to an appropriate gap for securing the shunt.
Furthermore, many instruments now incorporate ratchet mechanisms to prevent inadvertent opening of the handles and jaws until the clip is fully crimped, requiring a full closing stroke. Thus, the instruments are not designed to deliver a partially crimped clip.
It has been common for clip appliers to rely on friction to capture a clip between the jaw members following advancement of the clip from the clip supply.
Accordingly, the jaw members are constructed so as to have a gap between the crimping surface of each jaw member which is slightly less than the distance between the legs of a clip, so that the clip is slightly pinched between the jaws to hold the clip therein.
Another method of maintaining the clip within the jaws is to machine the crimping surfaces of the jaw members to have a clip accepting slot. However, this increases cost ~ i J
and requires precision during the machining process to provide the proper dimensions for end use. The jaw members are typically a costly item since they are machined from a single piece to form the crimping surfaces.
In view of this, it has been known to fabricate the jaw members separately, and then to assemble the jaw mechanism in the clip applying instrument. However, in instruments such as those disclosed in U.S. Patent Nos.
5,047,038: 4,246,903 and 4,228,895, the jaws are hinged at a pivot point and do not provide reliable securements and accurate caroming.
Should the jaw members be improperly gapped or aligned, the clip tends to fall out of the jaws, and potentially, into the patient's body. In addition, the clip advancement mechanism may not properly orient the clip if the jaws are not properly spaced. While some instruments may provide some clip alignment feature or clip stop mechanism, these are typically internal mechanisms which operate in conjunction with the clip supply, not the jaw mechanisms, such as disclosed in U.S. Patent Nos.
5,192,288 and 4,616,650. Finally, should the clip become dislodged, or slightly deviate otE-line, there is no provision in the prior art for holding or guiding the clip into the jaws. While some instruments may provide tabs to align the clip at the clip supply, such as disclosed in U.S. Patent No. 4,492,262, there is no provision to support the clip outside the instrument at the jaws.
It is also common, due to the restricted space at the surgical site in which the clip appliers are used, that at times a clip may be applied which is interfered with by a clip that has previously been applied, leading to a splaying of the jaws beyond the original gap between the '~~?~.~' jaw members. Depending on the strength of the jaw members, this may lead to an improper feeding of a subsequent clip to the jaws, resulting in potential instrument malfunction.
It has been long known to provide instruments having a means for rotating the instrument with respect to its longitudinal orientation, typically through the provision of a rotation collar positioned at the juncture between the handle and elongated body portions of the instrument. Despite the multitude of prior art rotatable surgical instruments, a need exists to optimize the rotation collar to provide for more facile rotation capabilities.
Those skilled in the surgical arts have recognized the need for a clip applicator which may be used in endoscopic or laparoscopic procedures such as gall bladder operations which is configured to partially close and release a clip to secure shunts during the procedure.
In addition, a need exists for a clip applier which accurately advances and holds a clip in the jaw mechanism and which prevents splaying of the jaws in the event of a clip over clip application. An instrument is also needed which provides a visual indication of the position of the jaw mechanism, and may also provide an audible arid tactile indication. An instrument is also needed which prevents feeding of a clip in the event the jaws are not fully _ opened, as well as an instrument which provides for facile rotation of the instrument's body portion.
~_3UMMARY OF TBE INVENTION
A novel clip applier of the present invention obviates the disadvantages encountered in the prior art and provides a cost-effective instrument which ensures accurate ~~ ~~~~ i~ J
and efficient application of clips during a surgical procedure. The clip applier of the present invention provides an instrument which allows the surgeon to apply partially closed clips during a gall bladder operation to permit securement of shunts in organs without occluding the shunt, and provides visual, audible and/or tactile indication of when the jaws are in a predetermined position to permit the surgeon to release pressure on the handles to release the partially closed clip. The instrument of the present invention substantially reduces the possibility of clips inadvertently falling out of the jaws, and prevents splaying of the jaws beyond the initial clip-receiving gap between the crimping surfaces in the event a clip is applied over a previously applied clip. The instrument also prevents a clip from being fed to the jaws in the event the jaws are not fully opened, and includes a clip holding feature associated with the clip advancing mechanism to hold a clip to ensure correct positioning between the jaw members. The~instrument also permits facile rotation of body portion with respect to its longitudinal orientation through the provision of a novel rotation collar.
In accordance with the present invention, an apparatus is disclosed for applying surgical clips to vessels and ducts in a patient which comprises a handle _ portion, a body portion which extends distally from. the handle portion, a clip supply for storing a plurality of surgical clips in a position for sequential advancement towards a distal end of the body portion, a jaw mechanism disposed at the distal end of the body portion which is movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of the handle portion, means for advancing a clip from the clip supply to the jaw mechanism and means which will affect a partial closure of a clip positioned in the jaw mechanism. The closing mechanism provides a means for affecting a closing stroke of the jaw mechanism from the open position to the closed position and includes means for permitting at least a partial opening stroke of the jaw mechanism after at least a partial closing stroke is completed. The instrument provides the surgeon with a means for crimping a clip partially and then opening the jaws a sufficient distance to release the partially closed clip. The closing mechanism of the instrument requires a full closing stroke of the handle mechanism prior to feeding a subsequent clip to the jaw mechanism. The present invention provides the surgeon with an apparatus which will allow him to apply surgical clips to ducts within the body and further provides a means for the temporary implantation of shunts or tubes in ducts by allowing partial closure of a clip without fully forming the clip to prevent occlusion of the duct or implanted shunt.
The instrument provides a tactile indication of the position of the jaw mechanism so that the surgeon knows when the jaw mechanism has closed a sufficient distance to place the jaws in a predetermined zone or position in which the clip is partially closed for application to the duct or shunt at the surgical site. The instrument may further provide audible indication of the position of the jaws in the predetermined zone, and further may include visual indication means which will give the surgeon a visual indication of when the jaws are in the predetermined zone.
The instrument allows the surgeon to partially open the ~~v~~i~. J
handle mechanism to release pressure on the partially closed clip to allow the clip to be removed or released from the jaw mechanism. Upon release of the partially closed clip, the surgeon continues the closing stroke to reset the instrument to place it in a position for a subsequent use.
The tactile and audible indicators essentially comprise a ratchet mechanism positioned within the handle portion of the clip applying instrument of the present invention. The ratchet mechanism includes a rack member positioned within the handle portion and a pawl member which is preferably positioned on the pivoting handle of the handle portion. The pawl member engages the rack member upon commencement of the closing stroke of the handle portion. Once the pawl member engages the rack, the movable handle is permitted to move in a closing direction towards the stationary hand grip, but is prevented from moving in an opening stroke away from the stationary hand grip. When the movable handle has travelled a sufficient distance, and the jaw mechanism has closed a corresponding sufficient distance so that a clip positioned between the jaw members is partially closed, the pawl member is released from the rack member, which allows the surgeon to effect a partial opening stroke of the movable handle, which provides a corresponding partial opening stroke of the jaw mechanism, and the partially closed clip is released from the jaw mechanism. The partial opening stroke of the handle portion will terminate when the pawl member re-engages the rack member and in order to reuse the instrument, the surgeon must complete the closing stroke of the movable handle of the handle portion.
_g_ ~~c~~~~i J
The rack and pawl assembly provides an audible indication of when the jaw members are in the proper zone to effect release of the partially closed clip. As the pawl travels over the rack, an audible clicking sound may be heard as the pawl passes over the teeth of the rack member. When the jaw members are in the proper position, i.e., the jaws are partially closed to partially close a clip position therebetween, the pawl member leaves the teeth of the rack member so that the clicking sound has ceased. Upon this audible indication, the surgeon will know that a partial opening stroke may be affected to release the clip positioned between the jaws. The pawl will then re-engage the rack member to terminate the opening stroke, and the surgeon knows that he must complete the closing stroke to reload the instrument. The pawl and rack mechanism also provides the surgeon with a tactile indication by allowing him to "feel" the instrument when it is in the predetermined zone for partial closure of a clip.
As the surgeon moves the movable handle towards the stationary hand grip and the pawl passes over the teeth of the rack, the surgeon can feel the clicking of the pawl over the teeth of the rack. When the pawl leaves the rack, and the surgeon no longer feels the pawl passing over the teeth of the rack, he will know that the jaws are in the predetermined zone for partially closing a clip, and can release the force on the movable handle to effect a partial opening stroke of the movable handle and allow the partially closed clip to be released from the jaw mechanism.
The ratchet mechanism disclosed in the handle portion preferably comprises a rack member having a plurality of teeth over a first distance and a plurality of _g_ s-/ -~ r~ ~ ~-~ X~.s .:~
S r h3v c :! J
teeth over a second distance which is separated by a space having no teeth. When the pawl member travels to the space having no teeth, the surgeon will know that the jaw mechanism is positioned within the predetermined zone for releasing the partially closed clip. Alternatively, the rack member may comprise a pair of rack members positioned in a series relationship which is separated by a distance.
As the pawl member travels the distance between the two rack members, the surgeon will know that the jaw members are in the predetermined zone to release the partially closed clip. As a further alternative embodiment, the rack member may include teeth over a distance corresponding to a partial closing stroke so that once the pawl member passes the rack member, the surgeon will know that the jaw members are in the predetermined zone for releasing a partially closed clip. The rack member will ensure that the partial opening stroke which will release the partially closed clip will be terminated once the pawl member re-engages the rack member. The surgeon must then fully close the handle portion to reset the instrument to position a subsequent clip in the jaw mechanism for the next use.
It is also contemplated that the ratchet mechanism include a pair or rack members positioned in parallel relationship, where the first rack includes teeth over at least a partial closing distance and does not provide teeth for a portion of the closing stroke which will allow the surgeon to partially open the handle portion to release a partially closed clip positioned in the jaw mechanism. The second rack member, positioned next to the first rack member will include teeth over the distance in which the first rack member is devoid of teeth. Preferably, the teeth of the second rack member are spaced differently ~~._'~s from the teeth of the first rack member so that the surgeon knows from the audible indication of the change in rack members that the jaw mechanism is in the predetermined zone for effecting a partial opening stroke of the handle portion to release the clip which is partially closed in the jaw mechanism. In this embodiment, one or two pawl members may be provided, or when a single pawl member is provided, a portion of the movable handle may engage the second rack member to provide the audible indication of the predetermined zone of the jaw mechanism.
The present invention also contemplates the provision of a visual indication for the surgeon, outside the patient's body, of the position of the jaw members, particularly when the jaw members are in the predetermined position or zone for partially closing a clip positioned between the jaw members. The visual indication may be provided on an instrument having the ratchet mechanism inside the handle. Moreover, the instrument may provide visible, audible and tactile indications of the position of the jaw mechanism. Within the handle portion, a first transmission means is provided for a linearly transferring motion from the movable handle to the clip advancing means, and a second transmission means for linearly transferring motion from the movable handle to the jaw closing means.
The first transmission means which operates the clip _ advancement means comprises a pusher tube which is operatively connected to a pusher bar which extends the length of the instrument to push clips from the clip supply to the jaw mechanism. The second transmission means'which operates the jaw closing means comprises a channel tube which is operatively connected to a sliding channel which extends the length of the body portion to effect opening i~
v z and closing of the jaw members. In the preferred embodiment, an indicator or flag is provided on the channel tube which is visible through an aperture or window in the handle portion. When the instrument is at rest, such that the jaw members are fully opened to receive a clip therebetween, the flag on the channel tube is positioned within the handle away from the window or aperture. As the movable handle is moved through its closing stroke, the channel tube moves forward to urge the sliding channel forward to commence closing of the jaws and closure of a clip therebetween. Once the jaws have been closed a sufficient distance to effect a partial closure of the clip, the flag will appear in the aperture or window to indicate to the surgeon that a partial closure of the clip has been completed. At this point, the surgeon may commence a partial opening stroke of the handle portion to partially open the jaw mechanism to release the clip from between the jaw members. The visual indication may be used in conjunction with the ratchet mechanism described above, such that When the pawl member disengages from the rack member the flag will appear in the window to give the surgeon a visual, audible and tactile indication of the position of the jaw mechanism.
In a further embodiment of the present invention, a clutch mechanism may be provided on the handle portion, _ in particular on the movable handle, which may be manually set to provide the surgeon with the jaw positioning feature. Preferably, a pivotable clutch block may be provided on the movable handle which is positionable between an armed and a disarmed position. In the disarmed position, the clutch block is hidden within the structure of the movable handle, and may be pivoted to the armed ~~.~~.~'~' position when the surgeon desires to utilize the jaw positioning feature. Once pivoted to the armed position, the clutch block protrudes from the movable handle towards the stationary hand grip. As the surgeon begins the closing stroke, the movable handle moves towards the stationary hand grip and the jaw mechanism begins to close.
Once the clutch block engages the stationary hand grip, the surgeon will no longer be able to close the two handles.
At this point, the surgeon will know that the jaw members are positioned a distance corresponding to a partial closure of a clip positioned therebetween, and he will know that in order to release the clip from the jaw mechanism he must ease up on the force for closing the movable handle.
As the surgeon eases the force, and a partial opening , stroke is commenced, the clip is released from the jaw mechanism and the clutch block will automatically move from the armed position to the disarmed position, thus allowing the surgeon to complete the closing stroke. As stated with the embodiments described above, this clutch block feature may be utilized with the internal ratchet mechanism within the handle and/or the flag mechanism associated with the channel tube. Accordingly, the surgeon may have a visual, audible and/or tactile indication of the position of the jaw members during the surgical procedure.
In an additional embodiment, an audible indicator _ in the form of a beeper may be provided to indicate the positioning of the jaw members with respect to the predetermined zone for partially crimping a clip. The stationary hand grip houses a small power cell such as a battery and the beeper itself. In addition, a small switch having a spring metal contact arm is provided to close the circuit and activate the beeper. As the pivoting handle is ~~i~.~l~
moved in the closing stroke, the beeper will sound when the jaws have been closed a sufficient distance to partially close the clip. The partial opening stroke will be completed when the beeper shuts off, indicating to the surgeon that the partially closed clip has been released and the complete closing stroke may be effected. It is also contemplated that a light or LED be provided in place of the beeper, although both the light and beeper may be provided together, providing the surgeon with the visible and audible indication of the jaw position.
An additional feature of the present invention is the provision of a novel rotation collar which allows for facile rotation of the body portion and jaw mechanism during use of the instrument. As the surgeon grips the handle portion of the instrument, he may rotate the body portion using his index finger to move the rotation collar which couples the body portion to the handle portion. The rotation collar of the present invention includes an external surface having a plurality of scalloped portions into which the fingertip of the surgeon's index finger may comfortably fit. In particular, the scalloped portions are dimensioned and configured to accept the volar surface, or fingerprint portion, of the distalmost phalange of the surgeon's index finger. The raised walls of the individual scalloped portions provide comfortable seating for the tip of the finger of the surgeon to prevent slipping during rotation of the collar.
The instrument of the present invention also includes a number of novel features which are associated with the jaw mechanism of the instrument. In particular, typical jaw mechanisms for surgical clip appliers provide a pair of jaw members which are machined from a single sheet .~ i~ ral of material and then secured to the distal end of the body portion of the instrument so that the jaw members may be flexed toward one another during closure of the instrument.
The present invention provides a novel construction for the jaw mechanism in which the jaw members are constructed separately in mirror image so that the jaw members each include a clip crimping region and a mounting region. At the mounting region, there is provided a dovetail connection assembly to join the two jaw members together and a mounting means is also provided which includes a spacing between several of the dovetail joints which provides for mounting to the body portion of the instrument. Construction of the jaw members in accordance with this dovetail mounting feature allows the jaw members to be fabricated in simpler, more cost efficient manners, which eliminates the expensive machining process and increases the precision with which these jaw members are fabricated.
The present invention also provides, adjacent the jaw mechanism, a tissue stop which will contact a vessel or duct in the event the clip is not positioned in the jaw mechanism. The tissue stop of the present invention also includes a clip stop provision which will arrest the forward advancement of the clip into the jaw mechanism by the clip advancement means to prevent a clip from being pushed too far into and through the jaw mechanism. The clip stop means may comprise a tab member which extends upwardly to engage an inside surface of the clip, or may also comprise, in an alternate embodiment, a raised wall which engages at least the inside surface of the clip member as it is inserted into the jaws.
The present invention also provides a means for preventing splaying or over-opening of the jaw members, e.g., in the event that a clip is applied over a previously applied clip at the surgical site. The present invention provides a jaw stop mechanism which prevents the jaws from opening further than the at rest gap between the jaw members prior to the receipt of a clip. The jaw stop may comprise a bracket which surrounds the jaw members, or preferably, comprises a bracket having a pair of upstanding tabs which extend from the tissue stop member and engage into recesses provided in the jaw members to prevent the unwanted outward splaying of the jaws.
The jaw members of the present invention also include a clip blocking means which prevents the advancement of a clip into the jaw mechanism in the event the jaws are not fully opened in the clip receiving position. The present invention provides the crimping region with a blocking wall which prevents advancement of a clip by engaging the leg portions of the clip in the event the jaws are not opened to their clip receiving position.
The present invention also provides a means for accurately guiding a clip into the jaw mechanism from the clip supply. The clip advancing means in the present invention comprises a pusher bar which includes a cradling mechanism for holding and guiding a clip as it moves from the clip supply to the jaw mechanism. The cradling means engages at least an outside surface of the bight portion of the clip, which is the portion of the clip between the two legs. In one embodiment, the cradling means comprises a notch in the pusher bar whereby the pusher bar rides over the clip until the bight portion of the clip is engaged in the notch. Preferably, the notch includes a ramped forward -16- ~ ~ 3 :~ zJ
portion which allows the pusher bar to move rearwardly off the clip so that the clip remains in the jaws after the pusher bar is retracted. In a second embodiment, the distalmost end of the pusher bar is provided with clip engaging fingers which may be integral with the pusher bar or which may be provided as a snap-on piece which will grasp and hold the clip as it is guided from the clip supply to the jaw mechanism. In a further embodiment, a single finger may pass over the bight portion of the clip, and since it is attached to or integral with the distalmost end of the pusher bar, guide the clip from the clip supply to the jaw mechanism.
~RIEB DESCRIPTION OF THE DRAWINGS
The foregoing features and further features of the present invention will become more readily apparent and may be understood by referring to the following detailed description of an illustrative embodiment of the clip applying instrument, taken in conjunction with the accompanying drawings, in which:
Fig. 1 illustrates a perspective view of the clip applying instrument of the present invention;
Fig. 2a illustrates an exploded perspective view of the handle portion of the instrument of Fig. 1:
Fig. 2b illustrates an exploded perspective view of the body portion and jaw mechanism of the instrument of Fig. 1;
Fig. 3 illustrates a side plan view in partial cutaway of the handle of the instrument of Fig. 1 in its initial, or at-rest, position:
~-~~~.~~:a Fig. 4 illustrates a side plan view in partial cutaway of the handle of Fig. 3 in a position in which a clip is loaded into the jaw mechanism;
Fig. 5 illustrates a side plan view in partial cutaway of the handle of the instrument of Fig. 1 in the clip crimping position;
Fig. 6 illustrates a side plan view in partial cutaway of the handle of the instrument of Fig. 1 in the at-rest position after crimping of a clip and prior to subsequent feeding of a successive clip;
Fig. 7 illustrates a side plan view in partial cutaway of the handle of the instrument of Fig. 1 in which the jaw mechanism is in a predetermined position indicative of a partial closing stroke to partially crimp a clip positioned in the jaws;
Fig. 8 illustrates a top plan view of the handle of the instrument of Fig. 1 showing the visual indication of the predetermined position of the jaw mechanism of the embodiment of Fig. 7:
Fig. 9 illustrates the ratchet mechanism of the present invention during a closing stroke of the handle mechanism;
Fig. 10 illustrates the ratchet mechanism of the present invention during an opening stroke of the handle mechanism:
Figs. 11a-11d illustrate the rack member of the ratchet mechanism of the present invention;
Figs. 12a and 12b illustrate the jaw mechanism of the present invention;
Figs. 13a-13c illustrate a first embodiment of the tissue stop of the present invention having a clip stop member and a jaw stop member positioned thereon;
_ _18_ V ~ ~ ri O
Figs. 14a-14c illustrate another embodiment of the tissue stop of the present invention having a clip stop positioned thereon;
Figs. 15a-15c illustrate another embodiment of the tissue stop of the present invention having a clip stop positioned thereon;
Figs. 16a-16c illustrate a further embodiment of the tissue stop of the present invention having a clip stop positioned thereon:
Figs. 17a-17c illustrate a further embodiment of the tissue stop of the present invention having a clip stop positioned thereon;-Fig. 18 illustrates the jaw mechanism of the present invention having a clip blocking member according to the present invention;
Fig. 19 illustrates a first embodiment of the pusher bar of the present invention having a clip cradling means positioned thereon;
Fig. 20 illustrates the pusher bar of the present invention having an alternate embodiment of the clip cradling means;
Fig. 21 illustrates a further embodiment of the pusher bar having a clip cradling meanss Fig. 22 illustrates the pusher bar of the present imrention having a further embodiment of the clip cradling means positioned thereon:
Figs. 23a and 23b illustrate the jaw stop mechanism of the present invention;
Fig. 24 illustrates a plan view of the handle block mechanism;
Figs. 25a and 25b illustrate a side plan view in partial cutaway of the movable handle of the present invention employing the handle block member of Fig. 24;
Figs. 26a-26c illustrate the components of the rotation collar of the present invention;
Fig. 27 illustrates a side cross-sectional view of the rotation collar of the present invention as it is positioned at the junction of the body portion and the handle portion;
Fig. 28 illustrates a side plan view in cutaway of the handle mechanism of the present invention employing an audible indicator of the position of the jaw members in relation to a predetermined position; and Fig. 29 illustrates a side plan view in cutaway of the handle of the present invention employing a visual indication of the position of the jaw members in relation to a predetermined position.
r~m~srr.~rn npar:uT~TrnN Og Tgg pRggERRED EMBODIMENTS
Referring now in specific detail to the drawings, in which like reference numerals identify similar or identical elements throughout the views, Fig. 1 illustrates the clip applying instrument 10 of the present invention.
Clip applying instrument 10 includes a handle portion 12 having a movable handle 14 and a stationary hand grip 16, which serves to operate a jaw mechanism 20 through the provision of an elongated body portion 18. The junction at which body portion 18 is joined to handle portion 12 includes a rotation collar 22 for varying the orientation of the jaw mechanism at the surgical site. Handle portion 12 further includes an aperture or window 24 which provides a visual indication of at least one position of the jaw 20 .'~~g~~~ ~~~ J
members during a closing stroke of the handle portion.
These elements will be described in detail below.
Fig. 2a illustrates the components of the handle portion 12 of instrument l0 of Fig. 1. The handle portion 12 includes a housing 12a and 12b within which the components of the handle portion are positioned. Rotation collar 22 includes a rotation ratchet mechanism 26 which provides for incremental rotation of rotation collar 22. A
biasing spring 28 and a washer assembly 30 are provided to apply pressure to the ratchet mechanism 26. Rotation collar 22 is further described in detail with respect to the preferred embodiment of the rotation collar 22 as illustrated in Figs. 26 and 27 below.
Movable handle 14 is secured to the housing halves by a pin 31 which permits rotation of movable handle 14 with respect to stationary hand grip 16. A handle spring 32 is provided to bias movable handle 14 to the open position, and movable handle 14 is connected through a series of linkages to effect loading of a clip into the jaw mechanism as well as crimping of a clip as will be described below. A pusher tube 52 and a channel tube 50 are provided in nested arrangement and are operatively connected to the movable handle 14 through channel tube links 34 and pusher tube links 36. A spring member 54 secures pusher tube 52 and channel tube 50 to each other, - which are held in place by a C-clamp 56.
Movable handle 14 further includes a pawl member 40 which is secured with a pawl spring 42 to the pawl housing 38 which is part of movable handle 14. As will be described below, pawl member 40 engages rack member 48 to provide for incremental closure of the movable handle 14, which in turn effects incremental closure of the jaw mechanism at the distal end of the instrument. A lever 44 is provided along with a latch plate 46 to coordinate the movements of pusher tube 52 and channel tube 50 with respect to the movable handle 14.
As will be described below, channel tube 50 is operatively connected to a caroming mechanism which includes a slidable channel to effect caroming or closing of the jaw members to crimp a clip therebetween. Pusher tube 52 is operatively connected to a pusher bar mechanism which serves as the clip advancement means to advance a clip from the clip supply to the jaw mechanism. The operation of the handle mechanism with respect to the jaw mechanism will be discussed below.
Fig. 2b illustrates the body portion 18 and jaw mechanism 20 of the instrument 10 of Fig. 1. Body portion 18 includes an upper housing half 58 and a lower housing half 86, within which are enclosed the operative elements of the body portion for advancing a clip to the jaw mechanism and for caroming the jaw members closed to crimp a clip positioned therebetween. A pusher bar 60 is provided which is operatively connected at handle engagement means 85 to the pusher tube 52 illustrated in Fig. 2a. A clip feed spring 62 is provided for urging individual clips from the clip supply 70 through the provision of pin holder 66 _ and clip follower 68. A seal block 69 is provided toward the proximal end of upper housing half 58 and lower housing half 86 to obstruct the passage of gaseous media therethrough. Sealing block 69 preferably receives a sealing material, e.g., silicone grease, to improve its sealing function: As is known in the art, when all the clips have been delivered, clip follower 68 prevents -22- c c further advancement of pusher bar 60 to give an indication to the surgeon that the instrument is no longer operative and has been emptied of its clips: A cover plate 72 is a?.so provided to overlay the jaw mechanism 20 when the instrument is assembled to. facilitate crimping of a clip positioned between the jaws.
Jaw mechanism 20, which will be described in detail below, includes the jaw members 75, a tissue stop 78, a channel slide plate 80, and a caroming channel 82 Which is operatively connected at the handle engagement means 84 to the channel tube 50 discussed above with respect to Fig. 2a. A crimping bracket 76 is spot welded to the distal end of caroming channel 82 to assist the caroming of the jaw members 75 towards each other to crimp a clip positioned therebetween. The entire body portion is secured together with the assistance of c-clamp 88.
Turning now to Fig. 3, the operation of the handle mechanism of the instrument 10 will be described.
Fig. 3 shows the instrument 10 in its initial position prior to the advancement of a clip to the jaw mechanism 20.
As can be seen in Fig. 3, the jaw mechanism is in its initial at-rest position in which the jaw members 75 are separated an initial distance D1 where the jaw members 75 are in their clip receiving position. Pusher bar 60 is in its retracted position out of the vicinity of the jaw members 75, and behind a clip in anticipation of feeding the clip to the jaw mechanism 20. As can be seen in Fig.
3, pusher tube 52 is in its fully retracted position awaiting slight movement of movable handle 14 to feed a clip to the jaw mechanism 20. Pusher tube 52 is held in the position shown in Fig. 3 by pusher tube lever 44 which is engaged in a slot 53 in pusher tube 52. 7~ever 44 is maintained in this position until movable handle 14 is moved slightly in the direction of stationary hand grip 16 so that detent 90 on lever 44 engages a corresponding detent on an end of handle 14 to effect a slight pivoting motion of lever 44 out of slot 53, to permit advancement of pusher tube 52 under the influence of pusher tube spring 54 to the position shown in Fig. 4. As seen in Fig. 4, movable handle 14 is still substantially in the at-rest position, and in fact handle pawl member 4o has not yet engaged rack member 48. In this position, pusher tube 52 is fully advanced, thus moving the pusher bar 60 in a distal direction to advance a clip 144 to the jaw mechanism 20.
As seen in Fig. 5, as a full closing stroke of movable handle 14 is effected towards stationary hand grip 16, channel tube 50 is advanced through the provision of channel tube link 34, while pusher tube link 36 simultaneously moves pusher tube 52 in the direction towards the proximal end of the handle portion 12. In the position shown in Fig. 5, channel tube 50 is fully advanced, thus moving caroming channel 82 fully forward to cam the jaw members 75 closed to crimp clip 144 positioned therebetween. Since pusher tube 52 is moved to its proximalmost position, it has consequently wfthdrawn pusher bar 60 out of the jaw mechanism to the clip supply 70 to be in position to feed a subsequent clip to the jaw mechanism 20. However, as pusher tube 52 is moved to the position shown in Fig. 5, lever 44 is pivoted back into slot 53 to maintain pusher tube 52 in the position shown in Fig. 5.
As the movable handle 14 returns to its fully open position, as seen in Fig. 6, channel tube 50 returns to its initial position under the influence of channel tube link ,~ y-y c 34, while pusher tube 52 is maintained in a proximal position due to lever 44. In this position, as seen in Fig. 6, the pusher bar 60 has not yet been advanced so that the jaws 75 are empty, awaiting a slight closing stroke of movable handle 14 to feed the next clip to the jaw mechanism 20.
Having thus described the operation of the internal components of the handle portion 12, reference will be made to Figs. 7 and 8 which illustrate the partial crimping feature of the present invention. As discussed previously, it is often times desirable to provide a means for applying a partially closed clip during certain surgical procedures, in particular during a cholecystectomy procedure, more commonly known as gall bladder surgery. In such a procedure, it is sometimes necessary to place a shunt or tube into a duct to introduce media to the duct, while at the same time maintaining the shunt in place.
Accordingly, it becomes necessary to secure the shunt in place through the application of a clip, but it is necessary to prevent occlusion of the shunt through the provision of a partially closed clip. Furthermore, since the cholecystectomy procedure has now gained increased popularity as an endoscopic procedure, the surgeon s reliance on the endoscope to determine when a clip has been partially crimped introduces additional challenges.
Although the surgical site is viewed on a video monitor, the field is somewhat distorted and it may be difficult to accurately determine when the clip is partially crimped about the duct or shunt. In addition, the closing mechanism for the instrument must ensure that the partially closed clip does not disengage from the instrument prior to securement on the duct or shunt.
~e~i~~~e[~J
Turning now to Fig. 7, and with particular reference to Figs. 9 and 10, there is illustrated the mechanism of the present invention which provides for a partial closure of a clip for application to tissue, in particular a duct within the body to secure the duct or to place a shunt in the duct during the surgical procedure.
The mechanism of the present invention allows the surgeon to know when the jaw members are at a predetermined position indicating a partial closure of the clip for proper securement on the shunt and/or duct. Reference is also made to Figs. 3-6 disclosed above. After a clip has been fed to the jaw mechanism, the instrument is in the position as shown in Fig. 4 above. In this position, the jaw members 75 are separated by an initial distance D1 which indicates the clip receiving position of the jaw mechanism 20. As the movable handle 14 is moved towards the stationary hand grip 16, the pawl member 40 engages rack member 48 to provide for incremental closure of the handle mechanism, and consequently the jaw mechanism 20 as the surgeon continuously moves handle member 14 towards stationary hand grip 16. As seen in Fig. 9, the rack member allows for a closing stroke as pawl member 40 passes over teeth 100 of rack member 48. The teeth 100 prevent movement of the handle in the opening direction, or away from stationary hand grip 16. As the pawl member 40 is moved over teeth 100 in the direction of arrow A, the jaw mechanism slowly closes to crimp the clip 144 that is positioned between jaw members. As pawl member 40 passes over teeth 100, the surgeon is provided with a tactile indication of the position of the jaw mechanism by feeling the clicks of the pawl member 40 over the teeth 100. The c s -~ r., J
clicking also provides an audible indication of the position of the jaw members as they begin the crimping of the clip.
Once the pawl member 40 reaches the position shown in Fig. 7, such that the pawl member 40 is positioned over the space 104 between the first teeth 100 and the second teeth 102, the surgeon will know through the tactile indication of the cessation of the clicking of the pawl member 40 over the teeth 100, as well as the cessation of the audible clicking sound, that the jaw members are in the predetermined position having the distance D2 between them corresponding to a partial crimping of the clip. When the pawl member 40 is positioned over space 104, the surgeon may effect a partial opening stroke of the handle member which will permit the clip 144 to be disengaged from the jaw mechanism 20. The opening stroke will of course be regulated by the distance of the space 104, since once the pawl member 40 re-engages the teeth 100, the opening stroke will no longer be permitted. After the clip has been released from the jaw mechanism in a partially closed manner over the duct, or the shunt that is positioned in the duct, the instrument must be reset to allow subsequent clip applications by completing the closing stroke so that the pawl member 40 passes through the space 104 and completely over the second set of teeth 102.
Once the closing stroke.is completed, teeth I02 still prevent pawl member 40 from traveling in a direction opposite arrow A, thus preventing an opening stroke of the movable handle 14. Accordingly, upon fully closing movable handle 14 to stationary hand grip 16, pawl member 40 engages blocking wall 106, which.causes pawl member 40 to rotate in a clockwise direction with respect to Fig. 9.
~~u ~~~ d Rotation in the clockwise direction moves pawl detent 110 over handle detent 112 to the position shown in Fig. 10.
When pawl detent 110 is in the position shown in Fig. 10 with respect to handle detent 112, the pawl member 40 is held in a position that fully disengages pawl member 40 from rack member 48. This allows an opening stroke of the handle mechanism so that the handle may return to the position shown in Fig. 6 to await feeding and application of the next clip. Referring once again to Fig. 10, as the handle mechanism fully opens, boot portion 108 of pawl member 40 will engage the wall of stationary hand grip 16, which causes pawl member 40 to rotate in a counter-clockwise direction with respect to Fig. 10, thus moving the pawl detent 110 back over handle detent 112 to return the pawl member 40 to the position shown in Fig. 9. The handle is once again ready to be used to apply a subsequent clip.
Having described the audible and tactile indicators which allow the surgeon to determine when the jaw mechanism is in the predetermined position D2 for the application of a partially closed clip, reference is once again made to Fig. ?, along with Fig. 8, so that the visual indicator may now be described. As seen in Figs. ? and 8, the present invention provides a window 24, preferably on either side of handle portion 12, which provides for a _ visual indication of the spacing between the jaws so the surgeon knows when the jaw members are in the predetermined position D2 for the application of a partially closed clip.
As can be seen in Fig. ?, channel tube 50 includes a shroud portion 92 upon which is positioned a flag 94. As the handle member 14 is moved towards stationary hand grip 16, _28_ ~-s a~~,~y~;~
t~
as described above, channel tube 50 moves in the direction towards the distal end of the instrument through the provision of channel tube link 34. As the handle is closed, channel tube 50 moves forward with flag 94 appearing in the window 24 of the handle 12. Once the flag 94 is visible in the indicator window 24, the surgeon knows that jaw members 75 have been sufficiently closed to partially crimp a clip 144 positioned therebetween. It is contemplated that the visual indicator flag 94 may be utilized with the audible and tactile indicators comprising the ratchet mechanism in the handle 12 described above.
Once the surgeon sees the flag 94 in the window 24, he will know that the jaws are in the predetermined position D2 and a partial opening stroke may be effected to release the partially closed clip 144 from the jaw mechanism 20. After the partially closed clip is released, the handle is fully closed to reset the instrument as described above. Of course, it is also contemplated that the visual indicator may be used by itself to provide the surgeon with a purely visual indication of the position of the jaw members.
Fig. 24 and Figs. 25a-25b illustrate a further mechanism for providing indication to the surgeon of the predetermined distance D2 for the application of a partially closed clip. In Fig. 24, there is shown a handle block member 180 for positioning in movable handle 14 as seen in Fig. 25a. Block 180 includes a flexible notch lock 182 and a handle engagement notch 184. A pivot pin 186 is provided, along with an eccentric pin slot 188. The entire mechanism is biased by a spring member 190. Turning to Fig. 25a, the block 180 is stored in a recess 200 of handle member 14. Spring 190 maintains block 180 in the recess 200 29 ~~~~~~';'>
v until the surgeon desires to move the block 180 into an armed position. To do so, the surgeon moves block 180 through the provision of finger notch 191 in the direction of arrow B to an armed position where notch lock 182 engages pin 202. As the movable handle 14 is moved toward stationary hand grip 16, the handle engagement notch 184 contacts stationary hand grip 16 as shown in Fig. 25b. In this position, the handle has closed a sufficient distance to close the jaw mechanism to the predetermined position so that the distance between the jaw members is equal to D2.
In this position, the clip has been crimped sufficiently to partially close the clip about a duct or shunt. When the handle block 180 is in the position shown in Fig. 25b, it can be seen that pin slot 188 has shifted with respect to pin 186, and in order to release handle block 180, the surgeon partially opens the handle mechanism so that a partial opening stroke of handle 14 is commenced. In this position, spring 190 returns block 180 into the,recess 200 so that the block 180 is in the position shown in Fig. 25a.
The handle may then be fully closed to reset the instrument for application of a subsequent clip. As discussed above with the various indicator means, the handle block 180 may be utilized with the visual, audible, and tactile indicators as addressed above, or may be used by itself.
Turning now to Figs. 28 and 29, alternate - embodiments of the indicators are disclosed. In Fig. 28, an audible indicator comprising a small speaker or beeper 250 is provided in the stationary hand grip 16 and is associated with a battery pack 252 and a switch 254 having a spring contact arm 256 which is actuated by a shoulder 258 on the movable handle 14. As the handle is closed, and the jaw members reach the predetermined position D2 indicative of a partially closed clip, the shoulder 258 on the movable handle 14 will have traveled to the position of engagement with the spring arm 256 of the switch 252 to close the switch contacts and create an audible sound through the beeper 250. When the surgeon hears the beeper, the jaw members 75 will be in the predetermined position D2 and the surgeon will know to begin the partial opening stroke to release the partially closed clip. The partial opening stroke will be terminated when the beeper shuts off. The partially closed clip is then released, and the full closing stroke may be completed to reset the instrument. It is contemplated that activation means, e.g., a toggle switch, may be associated with handle portion 12 to allow the surgeon to activate the electronic mechanism when it is desired to benefit from the audible indicator provided thereby.
With reference to Fig. 29, a similar arrangement is provided as that disclosed in Fig. 28. However, instead of a beeper 250, a small light bulb or LED 260 is provided within the handle 16 which will provide a visible indication of the position of the jaw mechanism with respect to the predeteratined position D2. Tn this embodiment, movement of the movable handle 14 towards the stationary handgrip 16 a sufficient distance will close the ' contacts of the switch 254 as the shoulder 258 of the movable handle 14 contacts the spring arm 256 of the switch 254. Once the contacts are closed, the light 260 will be illuminated, through the provision of the battery 252, and the surgeon will have a visual indication that the jaw mechanism is now in the predetermined position D2 and that l~ ~?1~' the partial opening stroke may be commenced to release the partially closed clip from the jaw mechanism. Of course, it is contemplated that the embodiment of Fig. 29 may be utilized by itself, or in combination with the embodiment of Fig. 28, or any of the other position indicator embodiments described above.
Figs. lla-lld illustrate various embodiments of the rack member 48. Since it is desirable to ensure a partial closing stroke prior to the partial opening stroke to release the partially crimped clip, the first set of teeth 100 are provided to ensure the partial closing stroke as the pawl member 40 moves across rack member 48. As seen in Fig. lla, the embodiment disclosed above, once the partial closing stroke is completed as the pawl member 40 passes over teeth 100, the space 104 provides a means for effecting the partial opening stroke to allow the partially closed clip to be released from the jaw mechanism. After release of the clip, teeth 100 prevent further opening of the handle mechanism, and requires the surgeon to fully close the instrument by ensuring that the pawl member 40 passes over second set of teeth 102. Fig. 11b illustrates an alternate embodiment of the rack member 48, and illustrates rack member 48a which includes teeth 100 and an elongate space 104. After the pawl member 40 passes over teeth 100, the opening stroke may be effected anywhere _ within space 104. After the clip that is partially closed has been released from the jaw mechanism 20, the surgeon fully completes the closing stroke as the pawl member 40 passes over the space 104. Teeth 100 prevent a full' opening stroke without the full closing stroke. Fig. iic illustrates a further embodiment of rack member 48b where two rack members are positioned in series relation with respect to each other and the space 104 is actually the area between the two separate rack members 114 and 116.
Rack 114 includes the first set of teeth 100 and rack 116 includes the second set of teeth 102. Once the partial closing stroke is completed as the pawl member 40 passes over teeth 100, the surgeon may effect the partial opening stroke as the pawl member 40 is positioned at the location of the space 104 between the two rack members. The partial opening stroke will be completed when the pawl member 40 re-engages teeth 100, and the surgeon must fully close the handle by passing pawl member 40 over teeth 102 to return the instrument to the set position for further use. Fig.
lld illustrates a further embodiment of the rack mechanism of the present invention. Rack member 48 is provided with a parallel rack 118 which is positioned in parallel relationship. Rack member 118 includes a plurality of teeth 124 which are positioned adjacent space 104. It is contemplated in this arrangement that parallel rack 118 includes spring arm 120 which provides for flexible movement of parallel rack 118 at its connection point 123 with rack 48. As the handle mechanism is moved in a closing stroke, pawl member 40 passes over teeth 100 to ensure the partial closing stroke. As pawl member 40 passes into space 104, a shoulder portion of the movable handle 14 (not shown), or a second pawl member (not shown) may engage teeth 124 to provide the surgeon with a tactile or audible indication that the jaw mechanism is in the predetermined position D2. It is contemplated that the teeth 124 provide a different feel and different sound than that associated with the teeth 100 and 102 of rack 48. In addition, the flexibility of parallel rack 118 due to the spring arm 120 will provide the surgeon with a different feel to indicate that the jaw mechanism 20 is in the predetermined position D2.
Turning now to Fig. 12, there is illustrated the novel jaw mechanism of the present invention. Typically, jaw mechanisms are constructed from a single sheet of material in which the jaw structure is machined in an expensive and time-consuming process to form the individual jaw members 75. The present invention provides a pair of jaw members 126 and 128 which are constructed in mirror image and include a crimping region 130 and a mounting region 134. The individual jaw members 126 and 128 are secured together by a dovetail connection arrangement 132 which secures the two jaw members together and provide a mounting means 136 through the provision of spaces between the dove-tail portions. The present invention.provides a simple and cost efficient means for constructing the jaw mechanism which is assembled prior to assembly on the instrument itself.
Turning now to Fig. 13, there is illustrated the novel tissue stop 78 of the present invention. Figs. 13-17 illustrate various embodiments of the tissue stop, which includes a vessel contacting region 138 which will contact a vessel, duct, or tissue in the event a clip is not positioned in the jaw mechanism. In Fig. 13a-13c, there is illustrated tissue stop 78 having clip stop 140 which provides a means for arresting the advancement of a clip from the clip advancing means to prevent the clip from being over-advanced to the jaw mechanism and insures the proper alignment of the clip once it is positioned in the jaws. Clip stop 140 includes a raised portion which will engage an inside surface of the clip, preferably at the :~ y~ "~~ :3 bight portion, to properly align the clip within the jaws and prevent its over-advancement through the jaw mechanism.
The tissue stop 78 of Fig. 13 also includes a jaw stop, which comprises a pair of raised arms which engage recesses in the underside of the jaw members 75 to prevent splaying of the jaw members, as will be described below with reference to Fig. 23.
Figs. 14a-14c disclose an alternate embodiment of the tissue stop 78 which includes an upstanding hook member 150 which comprises the clip stop for arresting the advancement of the clip into the jaw mechanism. Clip member 150 engages at least an inside surface of the clip at the bight portion to prevent over-advancement of the clip into the jaw mechanism and properly align the clip with respect to the jaw members.
Figs. 15a-15c illustrate a further embodiment of the clip stop assembly positioned on the tissue stop 78.
In this embodiment, a pair of detents 146 are provided which engage an inside surface of the clip in the region of the bight portion to arrest its advancement into the jaw mechanism.
Figs. 16a-16c show a further embodiment of the clip stop positioned on the tissue stop 78, in which a pair of upstanding walls are provided for engaging at least the inside surface of the legs of the clip as it is advanced into the jaw mechanism. A further embodiment is disclosed in Figs. 17a-17c in which a contoured surface 152 is provided to properly align the clip in the jaw mechanism. A
notch 153 is provided to engage the clip on the inside surface of the bight portion to slow the clip as it is advancing to the jaws.
lriv,LrJ,.i :) Turning now to Fig. 18, there is illustrated the clip blocking mechanism associated with the jaw members 75 which prevents advancement of a clip into the jaws unless the jaws are fully opened in the clip receiving position, having a gap between them at a distance D1 which is indicative of the clip receiving position. As seen in Fig.
18, the jaw mechanism is shown in phantom in the fully opened, clip receiving position. A clip block member 156 is provided on each jaw member 75 which will engage the forward portion of the clip legs as the clip 144 is inserted into the partially closed jaws. As indicated in Fig. 18, distance D3 is less than distance D1 which indicates the clip receiving position.
Fig. 19 illustrates the clip engaging feature of the pusher bar 60 of the present invention. In order to prevent improper insertion of a clip into the jaw mechanism, it is desirable to provide a cradling mechanism to engage the clip and keep it in proper alignment as it is inserted into the jaws. As seen in Fig. 19, clip 144 is cradled by pusher bar 60 at the cradle notch 158 as it is inserted into jaw mechanism 20. Cradle notch 158 includes a tamped forward portion 159 which facilitates removal of the pusher bar from the jaw assembly without pulling the clip 144 out of the jaw assembly 20. An alternate embodiment of the cradling means is illustrated in Figs.
20, 21 and 22. In Fig. 20, clip engaging fingers 162 are pivotally secured to pusher 60 at pivot pin 160. This permits some play in the clip engaging fingers 162 to insure proper alignment of the clip 144 in the jaw mechanism 20. Preferably, fingers 162 are constructed of a flexible plastic material which permits retraction of the _36_ pusher bar and fingers without dislodging the clip from the jaw mechanism. Fig. 21 illustrates a further cradling mechanism 164 which is secured to pusher bar-60 at clasp 166. It is contemplated that this embodiment can also be constructed of a flexible plastic material or a springy metal material, and may be permanently secured to pusher bar 60 or as a snap on feature when such a cradling mechanism 164 is desired. Fig. 22 shows a further embodiment of the cradling means 168, and is preferably constructed of a spring metal material which is spot welded at weld 170 and includes a flexible notch portion 172 which cradles the clip 144 but permits retraction of the pusher bar 60 without dislodging the clip 144 from the jaw mechanism 20.
Figs. 23a and 23b illustrate the jaw stop mechanism of the present invention. In certain surgical procedures utilizing surgical clip appliers, due to the cramped spacing inside the body during the endoscopic procedure, coupled with the sometimes distorted field of view through an endoscope or fiber optic system, application of a clip over a previously applied clip is sometimes unavoidable. When this occurs, many times the jaw mechanism may be damaged in that the individual jaw members 75 splay outwardly a distance further than the initial clip receiving distance D1. When this occurs, a subsequently fed clip to the jaw mechanism may become disoriented or dislodged due to the overspacing between the jaws. In order to prevent this possibility, the instrument of the present invention provides a jaw stop mechanism which includes jaw stop bracket 174 as seen in Fig. 23a, which is part of tissue stop 78. This embodiment is similar to that shown above with respect to Figs. 13a-13c. The bracket _; -.3 engages recesses 176 in the underside of the jaw members, and prevents splaying of the jaws to a distance that is greater than Dl. Fig. 23b illustrates a similar embodiment, in which bracket 178 is spot welded to tissue stop 78 instead of being integrally formed.
Figs. 26 and 27 illustrate the rotation collar of the present invention. Rotation collar 22 includes the collar 22, inner sleeve 194, and outer sleeve 196. As can be seen in Fig. 27, inner sleeve 194 is positioned against body portion i8 and surrounded by outer sleeve 196, both of which are nested inside rotation collar 22. The plurality of planar surfaces which make up inner sleeve 194 cooperate with the plurality of planar surfaces 198 about the.
circumference of body portion 18 to provide for incremental rotation of the collar 22, and consequently the body portion 18, about a longitudinal axis of the instrument.
Collar 22 includes a plurality of indentations 192 which have a scalloped cross-section and are dimensioned and configured to accommodate the finger tip of the surgeon. The scalloped walls 193 have a sufficient height to substantially enclose the volar surface, or the finger grint portion of the distal most phalange of the index finger of the surgeon. By substantially enclosing the volar surface of the finger tip of the surgeon, slippage is substantially reduced and for all practical purposes eliminated, so that single finger rotation of the body portion, and consequently the jaw mechanism is provided for the surgeon.
The surgical clip applying instrument of the present invention provides a number of novel features which enhance the performance of the instrument during laparoscopic or endoscopic surgical procedures. Each of c r-~~~~~;.J
the features of the present invention simplify the operation of the instrument and substantially eliminates inadvertent misapplication of clips during the surgical procedure. The instrument provides a visible, audible, and tactile indication of the position of the jaw members during application of a clip, particularly during application of clips during such surgical procedures as gall bladder operations.
While the invention has been particularly shown and described with reference to the preferred embodiments, it will be understood by those skilled in the art that various modifications and changes in form and detail may be made therein without departing from the scope and spirit of the invention.. Accordingly, modifications such as those suggested above, but not limited thereto, are to be considered within the scope of the invention.
In view of this, it has been known to fabricate the jaw members separately, and then to assemble the jaw mechanism in the clip applying instrument. However, in instruments such as those disclosed in U.S. Patent Nos.
5,047,038: 4,246,903 and 4,228,895, the jaws are hinged at a pivot point and do not provide reliable securements and accurate caroming.
Should the jaw members be improperly gapped or aligned, the clip tends to fall out of the jaws, and potentially, into the patient's body. In addition, the clip advancement mechanism may not properly orient the clip if the jaws are not properly spaced. While some instruments may provide some clip alignment feature or clip stop mechanism, these are typically internal mechanisms which operate in conjunction with the clip supply, not the jaw mechanisms, such as disclosed in U.S. Patent Nos.
5,192,288 and 4,616,650. Finally, should the clip become dislodged, or slightly deviate otE-line, there is no provision in the prior art for holding or guiding the clip into the jaws. While some instruments may provide tabs to align the clip at the clip supply, such as disclosed in U.S. Patent No. 4,492,262, there is no provision to support the clip outside the instrument at the jaws.
It is also common, due to the restricted space at the surgical site in which the clip appliers are used, that at times a clip may be applied which is interfered with by a clip that has previously been applied, leading to a splaying of the jaws beyond the original gap between the '~~?~.~' jaw members. Depending on the strength of the jaw members, this may lead to an improper feeding of a subsequent clip to the jaws, resulting in potential instrument malfunction.
It has been long known to provide instruments having a means for rotating the instrument with respect to its longitudinal orientation, typically through the provision of a rotation collar positioned at the juncture between the handle and elongated body portions of the instrument. Despite the multitude of prior art rotatable surgical instruments, a need exists to optimize the rotation collar to provide for more facile rotation capabilities.
Those skilled in the surgical arts have recognized the need for a clip applicator which may be used in endoscopic or laparoscopic procedures such as gall bladder operations which is configured to partially close and release a clip to secure shunts during the procedure.
In addition, a need exists for a clip applier which accurately advances and holds a clip in the jaw mechanism and which prevents splaying of the jaws in the event of a clip over clip application. An instrument is also needed which provides a visual indication of the position of the jaw mechanism, and may also provide an audible arid tactile indication. An instrument is also needed which prevents feeding of a clip in the event the jaws are not fully _ opened, as well as an instrument which provides for facile rotation of the instrument's body portion.
~_3UMMARY OF TBE INVENTION
A novel clip applier of the present invention obviates the disadvantages encountered in the prior art and provides a cost-effective instrument which ensures accurate ~~ ~~~~ i~ J
and efficient application of clips during a surgical procedure. The clip applier of the present invention provides an instrument which allows the surgeon to apply partially closed clips during a gall bladder operation to permit securement of shunts in organs without occluding the shunt, and provides visual, audible and/or tactile indication of when the jaws are in a predetermined position to permit the surgeon to release pressure on the handles to release the partially closed clip. The instrument of the present invention substantially reduces the possibility of clips inadvertently falling out of the jaws, and prevents splaying of the jaws beyond the initial clip-receiving gap between the crimping surfaces in the event a clip is applied over a previously applied clip. The instrument also prevents a clip from being fed to the jaws in the event the jaws are not fully opened, and includes a clip holding feature associated with the clip advancing mechanism to hold a clip to ensure correct positioning between the jaw members. The~instrument also permits facile rotation of body portion with respect to its longitudinal orientation through the provision of a novel rotation collar.
In accordance with the present invention, an apparatus is disclosed for applying surgical clips to vessels and ducts in a patient which comprises a handle _ portion, a body portion which extends distally from. the handle portion, a clip supply for storing a plurality of surgical clips in a position for sequential advancement towards a distal end of the body portion, a jaw mechanism disposed at the distal end of the body portion which is movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of the handle portion, means for advancing a clip from the clip supply to the jaw mechanism and means which will affect a partial closure of a clip positioned in the jaw mechanism. The closing mechanism provides a means for affecting a closing stroke of the jaw mechanism from the open position to the closed position and includes means for permitting at least a partial opening stroke of the jaw mechanism after at least a partial closing stroke is completed. The instrument provides the surgeon with a means for crimping a clip partially and then opening the jaws a sufficient distance to release the partially closed clip. The closing mechanism of the instrument requires a full closing stroke of the handle mechanism prior to feeding a subsequent clip to the jaw mechanism. The present invention provides the surgeon with an apparatus which will allow him to apply surgical clips to ducts within the body and further provides a means for the temporary implantation of shunts or tubes in ducts by allowing partial closure of a clip without fully forming the clip to prevent occlusion of the duct or implanted shunt.
The instrument provides a tactile indication of the position of the jaw mechanism so that the surgeon knows when the jaw mechanism has closed a sufficient distance to place the jaws in a predetermined zone or position in which the clip is partially closed for application to the duct or shunt at the surgical site. The instrument may further provide audible indication of the position of the jaws in the predetermined zone, and further may include visual indication means which will give the surgeon a visual indication of when the jaws are in the predetermined zone.
The instrument allows the surgeon to partially open the ~~v~~i~. J
handle mechanism to release pressure on the partially closed clip to allow the clip to be removed or released from the jaw mechanism. Upon release of the partially closed clip, the surgeon continues the closing stroke to reset the instrument to place it in a position for a subsequent use.
The tactile and audible indicators essentially comprise a ratchet mechanism positioned within the handle portion of the clip applying instrument of the present invention. The ratchet mechanism includes a rack member positioned within the handle portion and a pawl member which is preferably positioned on the pivoting handle of the handle portion. The pawl member engages the rack member upon commencement of the closing stroke of the handle portion. Once the pawl member engages the rack, the movable handle is permitted to move in a closing direction towards the stationary hand grip, but is prevented from moving in an opening stroke away from the stationary hand grip. When the movable handle has travelled a sufficient distance, and the jaw mechanism has closed a corresponding sufficient distance so that a clip positioned between the jaw members is partially closed, the pawl member is released from the rack member, which allows the surgeon to effect a partial opening stroke of the movable handle, which provides a corresponding partial opening stroke of the jaw mechanism, and the partially closed clip is released from the jaw mechanism. The partial opening stroke of the handle portion will terminate when the pawl member re-engages the rack member and in order to reuse the instrument, the surgeon must complete the closing stroke of the movable handle of the handle portion.
_g_ ~~c~~~~i J
The rack and pawl assembly provides an audible indication of when the jaw members are in the proper zone to effect release of the partially closed clip. As the pawl travels over the rack, an audible clicking sound may be heard as the pawl passes over the teeth of the rack member. When the jaw members are in the proper position, i.e., the jaws are partially closed to partially close a clip position therebetween, the pawl member leaves the teeth of the rack member so that the clicking sound has ceased. Upon this audible indication, the surgeon will know that a partial opening stroke may be affected to release the clip positioned between the jaws. The pawl will then re-engage the rack member to terminate the opening stroke, and the surgeon knows that he must complete the closing stroke to reload the instrument. The pawl and rack mechanism also provides the surgeon with a tactile indication by allowing him to "feel" the instrument when it is in the predetermined zone for partial closure of a clip.
As the surgeon moves the movable handle towards the stationary hand grip and the pawl passes over the teeth of the rack, the surgeon can feel the clicking of the pawl over the teeth of the rack. When the pawl leaves the rack, and the surgeon no longer feels the pawl passing over the teeth of the rack, he will know that the jaws are in the predetermined zone for partially closing a clip, and can release the force on the movable handle to effect a partial opening stroke of the movable handle and allow the partially closed clip to be released from the jaw mechanism.
The ratchet mechanism disclosed in the handle portion preferably comprises a rack member having a plurality of teeth over a first distance and a plurality of _g_ s-/ -~ r~ ~ ~-~ X~.s .:~
S r h3v c :! J
teeth over a second distance which is separated by a space having no teeth. When the pawl member travels to the space having no teeth, the surgeon will know that the jaw mechanism is positioned within the predetermined zone for releasing the partially closed clip. Alternatively, the rack member may comprise a pair of rack members positioned in a series relationship which is separated by a distance.
As the pawl member travels the distance between the two rack members, the surgeon will know that the jaw members are in the predetermined zone to release the partially closed clip. As a further alternative embodiment, the rack member may include teeth over a distance corresponding to a partial closing stroke so that once the pawl member passes the rack member, the surgeon will know that the jaw members are in the predetermined zone for releasing a partially closed clip. The rack member will ensure that the partial opening stroke which will release the partially closed clip will be terminated once the pawl member re-engages the rack member. The surgeon must then fully close the handle portion to reset the instrument to position a subsequent clip in the jaw mechanism for the next use.
It is also contemplated that the ratchet mechanism include a pair or rack members positioned in parallel relationship, where the first rack includes teeth over at least a partial closing distance and does not provide teeth for a portion of the closing stroke which will allow the surgeon to partially open the handle portion to release a partially closed clip positioned in the jaw mechanism. The second rack member, positioned next to the first rack member will include teeth over the distance in which the first rack member is devoid of teeth. Preferably, the teeth of the second rack member are spaced differently ~~._'~s from the teeth of the first rack member so that the surgeon knows from the audible indication of the change in rack members that the jaw mechanism is in the predetermined zone for effecting a partial opening stroke of the handle portion to release the clip which is partially closed in the jaw mechanism. In this embodiment, one or two pawl members may be provided, or when a single pawl member is provided, a portion of the movable handle may engage the second rack member to provide the audible indication of the predetermined zone of the jaw mechanism.
The present invention also contemplates the provision of a visual indication for the surgeon, outside the patient's body, of the position of the jaw members, particularly when the jaw members are in the predetermined position or zone for partially closing a clip positioned between the jaw members. The visual indication may be provided on an instrument having the ratchet mechanism inside the handle. Moreover, the instrument may provide visible, audible and tactile indications of the position of the jaw mechanism. Within the handle portion, a first transmission means is provided for a linearly transferring motion from the movable handle to the clip advancing means, and a second transmission means for linearly transferring motion from the movable handle to the jaw closing means.
The first transmission means which operates the clip _ advancement means comprises a pusher tube which is operatively connected to a pusher bar which extends the length of the instrument to push clips from the clip supply to the jaw mechanism. The second transmission means'which operates the jaw closing means comprises a channel tube which is operatively connected to a sliding channel which extends the length of the body portion to effect opening i~
v z and closing of the jaw members. In the preferred embodiment, an indicator or flag is provided on the channel tube which is visible through an aperture or window in the handle portion. When the instrument is at rest, such that the jaw members are fully opened to receive a clip therebetween, the flag on the channel tube is positioned within the handle away from the window or aperture. As the movable handle is moved through its closing stroke, the channel tube moves forward to urge the sliding channel forward to commence closing of the jaws and closure of a clip therebetween. Once the jaws have been closed a sufficient distance to effect a partial closure of the clip, the flag will appear in the aperture or window to indicate to the surgeon that a partial closure of the clip has been completed. At this point, the surgeon may commence a partial opening stroke of the handle portion to partially open the jaw mechanism to release the clip from between the jaw members. The visual indication may be used in conjunction with the ratchet mechanism described above, such that When the pawl member disengages from the rack member the flag will appear in the window to give the surgeon a visual, audible and tactile indication of the position of the jaw mechanism.
In a further embodiment of the present invention, a clutch mechanism may be provided on the handle portion, _ in particular on the movable handle, which may be manually set to provide the surgeon with the jaw positioning feature. Preferably, a pivotable clutch block may be provided on the movable handle which is positionable between an armed and a disarmed position. In the disarmed position, the clutch block is hidden within the structure of the movable handle, and may be pivoted to the armed ~~.~~.~'~' position when the surgeon desires to utilize the jaw positioning feature. Once pivoted to the armed position, the clutch block protrudes from the movable handle towards the stationary hand grip. As the surgeon begins the closing stroke, the movable handle moves towards the stationary hand grip and the jaw mechanism begins to close.
Once the clutch block engages the stationary hand grip, the surgeon will no longer be able to close the two handles.
At this point, the surgeon will know that the jaw members are positioned a distance corresponding to a partial closure of a clip positioned therebetween, and he will know that in order to release the clip from the jaw mechanism he must ease up on the force for closing the movable handle.
As the surgeon eases the force, and a partial opening , stroke is commenced, the clip is released from the jaw mechanism and the clutch block will automatically move from the armed position to the disarmed position, thus allowing the surgeon to complete the closing stroke. As stated with the embodiments described above, this clutch block feature may be utilized with the internal ratchet mechanism within the handle and/or the flag mechanism associated with the channel tube. Accordingly, the surgeon may have a visual, audible and/or tactile indication of the position of the jaw members during the surgical procedure.
In an additional embodiment, an audible indicator _ in the form of a beeper may be provided to indicate the positioning of the jaw members with respect to the predetermined zone for partially crimping a clip. The stationary hand grip houses a small power cell such as a battery and the beeper itself. In addition, a small switch having a spring metal contact arm is provided to close the circuit and activate the beeper. As the pivoting handle is ~~i~.~l~
moved in the closing stroke, the beeper will sound when the jaws have been closed a sufficient distance to partially close the clip. The partial opening stroke will be completed when the beeper shuts off, indicating to the surgeon that the partially closed clip has been released and the complete closing stroke may be effected. It is also contemplated that a light or LED be provided in place of the beeper, although both the light and beeper may be provided together, providing the surgeon with the visible and audible indication of the jaw position.
An additional feature of the present invention is the provision of a novel rotation collar which allows for facile rotation of the body portion and jaw mechanism during use of the instrument. As the surgeon grips the handle portion of the instrument, he may rotate the body portion using his index finger to move the rotation collar which couples the body portion to the handle portion. The rotation collar of the present invention includes an external surface having a plurality of scalloped portions into which the fingertip of the surgeon's index finger may comfortably fit. In particular, the scalloped portions are dimensioned and configured to accept the volar surface, or fingerprint portion, of the distalmost phalange of the surgeon's index finger. The raised walls of the individual scalloped portions provide comfortable seating for the tip of the finger of the surgeon to prevent slipping during rotation of the collar.
The instrument of the present invention also includes a number of novel features which are associated with the jaw mechanism of the instrument. In particular, typical jaw mechanisms for surgical clip appliers provide a pair of jaw members which are machined from a single sheet .~ i~ ral of material and then secured to the distal end of the body portion of the instrument so that the jaw members may be flexed toward one another during closure of the instrument.
The present invention provides a novel construction for the jaw mechanism in which the jaw members are constructed separately in mirror image so that the jaw members each include a clip crimping region and a mounting region. At the mounting region, there is provided a dovetail connection assembly to join the two jaw members together and a mounting means is also provided which includes a spacing between several of the dovetail joints which provides for mounting to the body portion of the instrument. Construction of the jaw members in accordance with this dovetail mounting feature allows the jaw members to be fabricated in simpler, more cost efficient manners, which eliminates the expensive machining process and increases the precision with which these jaw members are fabricated.
The present invention also provides, adjacent the jaw mechanism, a tissue stop which will contact a vessel or duct in the event the clip is not positioned in the jaw mechanism. The tissue stop of the present invention also includes a clip stop provision which will arrest the forward advancement of the clip into the jaw mechanism by the clip advancement means to prevent a clip from being pushed too far into and through the jaw mechanism. The clip stop means may comprise a tab member which extends upwardly to engage an inside surface of the clip, or may also comprise, in an alternate embodiment, a raised wall which engages at least the inside surface of the clip member as it is inserted into the jaws.
The present invention also provides a means for preventing splaying or over-opening of the jaw members, e.g., in the event that a clip is applied over a previously applied clip at the surgical site. The present invention provides a jaw stop mechanism which prevents the jaws from opening further than the at rest gap between the jaw members prior to the receipt of a clip. The jaw stop may comprise a bracket which surrounds the jaw members, or preferably, comprises a bracket having a pair of upstanding tabs which extend from the tissue stop member and engage into recesses provided in the jaw members to prevent the unwanted outward splaying of the jaws.
The jaw members of the present invention also include a clip blocking means which prevents the advancement of a clip into the jaw mechanism in the event the jaws are not fully opened in the clip receiving position. The present invention provides the crimping region with a blocking wall which prevents advancement of a clip by engaging the leg portions of the clip in the event the jaws are not opened to their clip receiving position.
The present invention also provides a means for accurately guiding a clip into the jaw mechanism from the clip supply. The clip advancing means in the present invention comprises a pusher bar which includes a cradling mechanism for holding and guiding a clip as it moves from the clip supply to the jaw mechanism. The cradling means engages at least an outside surface of the bight portion of the clip, which is the portion of the clip between the two legs. In one embodiment, the cradling means comprises a notch in the pusher bar whereby the pusher bar rides over the clip until the bight portion of the clip is engaged in the notch. Preferably, the notch includes a ramped forward -16- ~ ~ 3 :~ zJ
portion which allows the pusher bar to move rearwardly off the clip so that the clip remains in the jaws after the pusher bar is retracted. In a second embodiment, the distalmost end of the pusher bar is provided with clip engaging fingers which may be integral with the pusher bar or which may be provided as a snap-on piece which will grasp and hold the clip as it is guided from the clip supply to the jaw mechanism. In a further embodiment, a single finger may pass over the bight portion of the clip, and since it is attached to or integral with the distalmost end of the pusher bar, guide the clip from the clip supply to the jaw mechanism.
~RIEB DESCRIPTION OF THE DRAWINGS
The foregoing features and further features of the present invention will become more readily apparent and may be understood by referring to the following detailed description of an illustrative embodiment of the clip applying instrument, taken in conjunction with the accompanying drawings, in which:
Fig. 1 illustrates a perspective view of the clip applying instrument of the present invention;
Fig. 2a illustrates an exploded perspective view of the handle portion of the instrument of Fig. 1:
Fig. 2b illustrates an exploded perspective view of the body portion and jaw mechanism of the instrument of Fig. 1;
Fig. 3 illustrates a side plan view in partial cutaway of the handle of the instrument of Fig. 1 in its initial, or at-rest, position:
~-~~~.~~:a Fig. 4 illustrates a side plan view in partial cutaway of the handle of Fig. 3 in a position in which a clip is loaded into the jaw mechanism;
Fig. 5 illustrates a side plan view in partial cutaway of the handle of the instrument of Fig. 1 in the clip crimping position;
Fig. 6 illustrates a side plan view in partial cutaway of the handle of the instrument of Fig. 1 in the at-rest position after crimping of a clip and prior to subsequent feeding of a successive clip;
Fig. 7 illustrates a side plan view in partial cutaway of the handle of the instrument of Fig. 1 in which the jaw mechanism is in a predetermined position indicative of a partial closing stroke to partially crimp a clip positioned in the jaws;
Fig. 8 illustrates a top plan view of the handle of the instrument of Fig. 1 showing the visual indication of the predetermined position of the jaw mechanism of the embodiment of Fig. 7:
Fig. 9 illustrates the ratchet mechanism of the present invention during a closing stroke of the handle mechanism;
Fig. 10 illustrates the ratchet mechanism of the present invention during an opening stroke of the handle mechanism:
Figs. 11a-11d illustrate the rack member of the ratchet mechanism of the present invention;
Figs. 12a and 12b illustrate the jaw mechanism of the present invention;
Figs. 13a-13c illustrate a first embodiment of the tissue stop of the present invention having a clip stop member and a jaw stop member positioned thereon;
_ _18_ V ~ ~ ri O
Figs. 14a-14c illustrate another embodiment of the tissue stop of the present invention having a clip stop positioned thereon;
Figs. 15a-15c illustrate another embodiment of the tissue stop of the present invention having a clip stop positioned thereon;
Figs. 16a-16c illustrate a further embodiment of the tissue stop of the present invention having a clip stop positioned thereon:
Figs. 17a-17c illustrate a further embodiment of the tissue stop of the present invention having a clip stop positioned thereon;-Fig. 18 illustrates the jaw mechanism of the present invention having a clip blocking member according to the present invention;
Fig. 19 illustrates a first embodiment of the pusher bar of the present invention having a clip cradling means positioned thereon;
Fig. 20 illustrates the pusher bar of the present invention having an alternate embodiment of the clip cradling means;
Fig. 21 illustrates a further embodiment of the pusher bar having a clip cradling meanss Fig. 22 illustrates the pusher bar of the present imrention having a further embodiment of the clip cradling means positioned thereon:
Figs. 23a and 23b illustrate the jaw stop mechanism of the present invention;
Fig. 24 illustrates a plan view of the handle block mechanism;
Figs. 25a and 25b illustrate a side plan view in partial cutaway of the movable handle of the present invention employing the handle block member of Fig. 24;
Figs. 26a-26c illustrate the components of the rotation collar of the present invention;
Fig. 27 illustrates a side cross-sectional view of the rotation collar of the present invention as it is positioned at the junction of the body portion and the handle portion;
Fig. 28 illustrates a side plan view in cutaway of the handle mechanism of the present invention employing an audible indicator of the position of the jaw members in relation to a predetermined position; and Fig. 29 illustrates a side plan view in cutaway of the handle of the present invention employing a visual indication of the position of the jaw members in relation to a predetermined position.
r~m~srr.~rn npar:uT~TrnN Og Tgg pRggERRED EMBODIMENTS
Referring now in specific detail to the drawings, in which like reference numerals identify similar or identical elements throughout the views, Fig. 1 illustrates the clip applying instrument 10 of the present invention.
Clip applying instrument 10 includes a handle portion 12 having a movable handle 14 and a stationary hand grip 16, which serves to operate a jaw mechanism 20 through the provision of an elongated body portion 18. The junction at which body portion 18 is joined to handle portion 12 includes a rotation collar 22 for varying the orientation of the jaw mechanism at the surgical site. Handle portion 12 further includes an aperture or window 24 which provides a visual indication of at least one position of the jaw 20 .'~~g~~~ ~~~ J
members during a closing stroke of the handle portion.
These elements will be described in detail below.
Fig. 2a illustrates the components of the handle portion 12 of instrument l0 of Fig. 1. The handle portion 12 includes a housing 12a and 12b within which the components of the handle portion are positioned. Rotation collar 22 includes a rotation ratchet mechanism 26 which provides for incremental rotation of rotation collar 22. A
biasing spring 28 and a washer assembly 30 are provided to apply pressure to the ratchet mechanism 26. Rotation collar 22 is further described in detail with respect to the preferred embodiment of the rotation collar 22 as illustrated in Figs. 26 and 27 below.
Movable handle 14 is secured to the housing halves by a pin 31 which permits rotation of movable handle 14 with respect to stationary hand grip 16. A handle spring 32 is provided to bias movable handle 14 to the open position, and movable handle 14 is connected through a series of linkages to effect loading of a clip into the jaw mechanism as well as crimping of a clip as will be described below. A pusher tube 52 and a channel tube 50 are provided in nested arrangement and are operatively connected to the movable handle 14 through channel tube links 34 and pusher tube links 36. A spring member 54 secures pusher tube 52 and channel tube 50 to each other, - which are held in place by a C-clamp 56.
Movable handle 14 further includes a pawl member 40 which is secured with a pawl spring 42 to the pawl housing 38 which is part of movable handle 14. As will be described below, pawl member 40 engages rack member 48 to provide for incremental closure of the movable handle 14, which in turn effects incremental closure of the jaw mechanism at the distal end of the instrument. A lever 44 is provided along with a latch plate 46 to coordinate the movements of pusher tube 52 and channel tube 50 with respect to the movable handle 14.
As will be described below, channel tube 50 is operatively connected to a caroming mechanism which includes a slidable channel to effect caroming or closing of the jaw members to crimp a clip therebetween. Pusher tube 52 is operatively connected to a pusher bar mechanism which serves as the clip advancement means to advance a clip from the clip supply to the jaw mechanism. The operation of the handle mechanism with respect to the jaw mechanism will be discussed below.
Fig. 2b illustrates the body portion 18 and jaw mechanism 20 of the instrument 10 of Fig. 1. Body portion 18 includes an upper housing half 58 and a lower housing half 86, within which are enclosed the operative elements of the body portion for advancing a clip to the jaw mechanism and for caroming the jaw members closed to crimp a clip positioned therebetween. A pusher bar 60 is provided which is operatively connected at handle engagement means 85 to the pusher tube 52 illustrated in Fig. 2a. A clip feed spring 62 is provided for urging individual clips from the clip supply 70 through the provision of pin holder 66 _ and clip follower 68. A seal block 69 is provided toward the proximal end of upper housing half 58 and lower housing half 86 to obstruct the passage of gaseous media therethrough. Sealing block 69 preferably receives a sealing material, e.g., silicone grease, to improve its sealing function: As is known in the art, when all the clips have been delivered, clip follower 68 prevents -22- c c further advancement of pusher bar 60 to give an indication to the surgeon that the instrument is no longer operative and has been emptied of its clips: A cover plate 72 is a?.so provided to overlay the jaw mechanism 20 when the instrument is assembled to. facilitate crimping of a clip positioned between the jaws.
Jaw mechanism 20, which will be described in detail below, includes the jaw members 75, a tissue stop 78, a channel slide plate 80, and a caroming channel 82 Which is operatively connected at the handle engagement means 84 to the channel tube 50 discussed above with respect to Fig. 2a. A crimping bracket 76 is spot welded to the distal end of caroming channel 82 to assist the caroming of the jaw members 75 towards each other to crimp a clip positioned therebetween. The entire body portion is secured together with the assistance of c-clamp 88.
Turning now to Fig. 3, the operation of the handle mechanism of the instrument 10 will be described.
Fig. 3 shows the instrument 10 in its initial position prior to the advancement of a clip to the jaw mechanism 20.
As can be seen in Fig. 3, the jaw mechanism is in its initial at-rest position in which the jaw members 75 are separated an initial distance D1 where the jaw members 75 are in their clip receiving position. Pusher bar 60 is in its retracted position out of the vicinity of the jaw members 75, and behind a clip in anticipation of feeding the clip to the jaw mechanism 20. As can be seen in Fig.
3, pusher tube 52 is in its fully retracted position awaiting slight movement of movable handle 14 to feed a clip to the jaw mechanism 20. Pusher tube 52 is held in the position shown in Fig. 3 by pusher tube lever 44 which is engaged in a slot 53 in pusher tube 52. 7~ever 44 is maintained in this position until movable handle 14 is moved slightly in the direction of stationary hand grip 16 so that detent 90 on lever 44 engages a corresponding detent on an end of handle 14 to effect a slight pivoting motion of lever 44 out of slot 53, to permit advancement of pusher tube 52 under the influence of pusher tube spring 54 to the position shown in Fig. 4. As seen in Fig. 4, movable handle 14 is still substantially in the at-rest position, and in fact handle pawl member 4o has not yet engaged rack member 48. In this position, pusher tube 52 is fully advanced, thus moving the pusher bar 60 in a distal direction to advance a clip 144 to the jaw mechanism 20.
As seen in Fig. 5, as a full closing stroke of movable handle 14 is effected towards stationary hand grip 16, channel tube 50 is advanced through the provision of channel tube link 34, while pusher tube link 36 simultaneously moves pusher tube 52 in the direction towards the proximal end of the handle portion 12. In the position shown in Fig. 5, channel tube 50 is fully advanced, thus moving caroming channel 82 fully forward to cam the jaw members 75 closed to crimp clip 144 positioned therebetween. Since pusher tube 52 is moved to its proximalmost position, it has consequently wfthdrawn pusher bar 60 out of the jaw mechanism to the clip supply 70 to be in position to feed a subsequent clip to the jaw mechanism 20. However, as pusher tube 52 is moved to the position shown in Fig. 5, lever 44 is pivoted back into slot 53 to maintain pusher tube 52 in the position shown in Fig. 5.
As the movable handle 14 returns to its fully open position, as seen in Fig. 6, channel tube 50 returns to its initial position under the influence of channel tube link ,~ y-y c 34, while pusher tube 52 is maintained in a proximal position due to lever 44. In this position, as seen in Fig. 6, the pusher bar 60 has not yet been advanced so that the jaws 75 are empty, awaiting a slight closing stroke of movable handle 14 to feed the next clip to the jaw mechanism 20.
Having thus described the operation of the internal components of the handle portion 12, reference will be made to Figs. 7 and 8 which illustrate the partial crimping feature of the present invention. As discussed previously, it is often times desirable to provide a means for applying a partially closed clip during certain surgical procedures, in particular during a cholecystectomy procedure, more commonly known as gall bladder surgery. In such a procedure, it is sometimes necessary to place a shunt or tube into a duct to introduce media to the duct, while at the same time maintaining the shunt in place.
Accordingly, it becomes necessary to secure the shunt in place through the application of a clip, but it is necessary to prevent occlusion of the shunt through the provision of a partially closed clip. Furthermore, since the cholecystectomy procedure has now gained increased popularity as an endoscopic procedure, the surgeon s reliance on the endoscope to determine when a clip has been partially crimped introduces additional challenges.
Although the surgical site is viewed on a video monitor, the field is somewhat distorted and it may be difficult to accurately determine when the clip is partially crimped about the duct or shunt. In addition, the closing mechanism for the instrument must ensure that the partially closed clip does not disengage from the instrument prior to securement on the duct or shunt.
~e~i~~~e[~J
Turning now to Fig. 7, and with particular reference to Figs. 9 and 10, there is illustrated the mechanism of the present invention which provides for a partial closure of a clip for application to tissue, in particular a duct within the body to secure the duct or to place a shunt in the duct during the surgical procedure.
The mechanism of the present invention allows the surgeon to know when the jaw members are at a predetermined position indicating a partial closure of the clip for proper securement on the shunt and/or duct. Reference is also made to Figs. 3-6 disclosed above. After a clip has been fed to the jaw mechanism, the instrument is in the position as shown in Fig. 4 above. In this position, the jaw members 75 are separated by an initial distance D1 which indicates the clip receiving position of the jaw mechanism 20. As the movable handle 14 is moved towards the stationary hand grip 16, the pawl member 40 engages rack member 48 to provide for incremental closure of the handle mechanism, and consequently the jaw mechanism 20 as the surgeon continuously moves handle member 14 towards stationary hand grip 16. As seen in Fig. 9, the rack member allows for a closing stroke as pawl member 40 passes over teeth 100 of rack member 48. The teeth 100 prevent movement of the handle in the opening direction, or away from stationary hand grip 16. As the pawl member 40 is moved over teeth 100 in the direction of arrow A, the jaw mechanism slowly closes to crimp the clip 144 that is positioned between jaw members. As pawl member 40 passes over teeth 100, the surgeon is provided with a tactile indication of the position of the jaw mechanism by feeling the clicks of the pawl member 40 over the teeth 100. The c s -~ r., J
clicking also provides an audible indication of the position of the jaw members as they begin the crimping of the clip.
Once the pawl member 40 reaches the position shown in Fig. 7, such that the pawl member 40 is positioned over the space 104 between the first teeth 100 and the second teeth 102, the surgeon will know through the tactile indication of the cessation of the clicking of the pawl member 40 over the teeth 100, as well as the cessation of the audible clicking sound, that the jaw members are in the predetermined position having the distance D2 between them corresponding to a partial crimping of the clip. When the pawl member 40 is positioned over space 104, the surgeon may effect a partial opening stroke of the handle member which will permit the clip 144 to be disengaged from the jaw mechanism 20. The opening stroke will of course be regulated by the distance of the space 104, since once the pawl member 40 re-engages the teeth 100, the opening stroke will no longer be permitted. After the clip has been released from the jaw mechanism in a partially closed manner over the duct, or the shunt that is positioned in the duct, the instrument must be reset to allow subsequent clip applications by completing the closing stroke so that the pawl member 40 passes through the space 104 and completely over the second set of teeth 102.
Once the closing stroke.is completed, teeth I02 still prevent pawl member 40 from traveling in a direction opposite arrow A, thus preventing an opening stroke of the movable handle 14. Accordingly, upon fully closing movable handle 14 to stationary hand grip 16, pawl member 40 engages blocking wall 106, which.causes pawl member 40 to rotate in a clockwise direction with respect to Fig. 9.
~~u ~~~ d Rotation in the clockwise direction moves pawl detent 110 over handle detent 112 to the position shown in Fig. 10.
When pawl detent 110 is in the position shown in Fig. 10 with respect to handle detent 112, the pawl member 40 is held in a position that fully disengages pawl member 40 from rack member 48. This allows an opening stroke of the handle mechanism so that the handle may return to the position shown in Fig. 6 to await feeding and application of the next clip. Referring once again to Fig. 10, as the handle mechanism fully opens, boot portion 108 of pawl member 40 will engage the wall of stationary hand grip 16, which causes pawl member 40 to rotate in a counter-clockwise direction with respect to Fig. 10, thus moving the pawl detent 110 back over handle detent 112 to return the pawl member 40 to the position shown in Fig. 9. The handle is once again ready to be used to apply a subsequent clip.
Having described the audible and tactile indicators which allow the surgeon to determine when the jaw mechanism is in the predetermined position D2 for the application of a partially closed clip, reference is once again made to Fig. ?, along with Fig. 8, so that the visual indicator may now be described. As seen in Figs. ? and 8, the present invention provides a window 24, preferably on either side of handle portion 12, which provides for a _ visual indication of the spacing between the jaws so the surgeon knows when the jaw members are in the predetermined position D2 for the application of a partially closed clip.
As can be seen in Fig. ?, channel tube 50 includes a shroud portion 92 upon which is positioned a flag 94. As the handle member 14 is moved towards stationary hand grip 16, _28_ ~-s a~~,~y~;~
t~
as described above, channel tube 50 moves in the direction towards the distal end of the instrument through the provision of channel tube link 34. As the handle is closed, channel tube 50 moves forward with flag 94 appearing in the window 24 of the handle 12. Once the flag 94 is visible in the indicator window 24, the surgeon knows that jaw members 75 have been sufficiently closed to partially crimp a clip 144 positioned therebetween. It is contemplated that the visual indicator flag 94 may be utilized with the audible and tactile indicators comprising the ratchet mechanism in the handle 12 described above.
Once the surgeon sees the flag 94 in the window 24, he will know that the jaws are in the predetermined position D2 and a partial opening stroke may be effected to release the partially closed clip 144 from the jaw mechanism 20. After the partially closed clip is released, the handle is fully closed to reset the instrument as described above. Of course, it is also contemplated that the visual indicator may be used by itself to provide the surgeon with a purely visual indication of the position of the jaw members.
Fig. 24 and Figs. 25a-25b illustrate a further mechanism for providing indication to the surgeon of the predetermined distance D2 for the application of a partially closed clip. In Fig. 24, there is shown a handle block member 180 for positioning in movable handle 14 as seen in Fig. 25a. Block 180 includes a flexible notch lock 182 and a handle engagement notch 184. A pivot pin 186 is provided, along with an eccentric pin slot 188. The entire mechanism is biased by a spring member 190. Turning to Fig. 25a, the block 180 is stored in a recess 200 of handle member 14. Spring 190 maintains block 180 in the recess 200 29 ~~~~~~';'>
v until the surgeon desires to move the block 180 into an armed position. To do so, the surgeon moves block 180 through the provision of finger notch 191 in the direction of arrow B to an armed position where notch lock 182 engages pin 202. As the movable handle 14 is moved toward stationary hand grip 16, the handle engagement notch 184 contacts stationary hand grip 16 as shown in Fig. 25b. In this position, the handle has closed a sufficient distance to close the jaw mechanism to the predetermined position so that the distance between the jaw members is equal to D2.
In this position, the clip has been crimped sufficiently to partially close the clip about a duct or shunt. When the handle block 180 is in the position shown in Fig. 25b, it can be seen that pin slot 188 has shifted with respect to pin 186, and in order to release handle block 180, the surgeon partially opens the handle mechanism so that a partial opening stroke of handle 14 is commenced. In this position, spring 190 returns block 180 into the,recess 200 so that the block 180 is in the position shown in Fig. 25a.
The handle may then be fully closed to reset the instrument for application of a subsequent clip. As discussed above with the various indicator means, the handle block 180 may be utilized with the visual, audible, and tactile indicators as addressed above, or may be used by itself.
Turning now to Figs. 28 and 29, alternate - embodiments of the indicators are disclosed. In Fig. 28, an audible indicator comprising a small speaker or beeper 250 is provided in the stationary hand grip 16 and is associated with a battery pack 252 and a switch 254 having a spring contact arm 256 which is actuated by a shoulder 258 on the movable handle 14. As the handle is closed, and the jaw members reach the predetermined position D2 indicative of a partially closed clip, the shoulder 258 on the movable handle 14 will have traveled to the position of engagement with the spring arm 256 of the switch 252 to close the switch contacts and create an audible sound through the beeper 250. When the surgeon hears the beeper, the jaw members 75 will be in the predetermined position D2 and the surgeon will know to begin the partial opening stroke to release the partially closed clip. The partial opening stroke will be terminated when the beeper shuts off. The partially closed clip is then released, and the full closing stroke may be completed to reset the instrument. It is contemplated that activation means, e.g., a toggle switch, may be associated with handle portion 12 to allow the surgeon to activate the electronic mechanism when it is desired to benefit from the audible indicator provided thereby.
With reference to Fig. 29, a similar arrangement is provided as that disclosed in Fig. 28. However, instead of a beeper 250, a small light bulb or LED 260 is provided within the handle 16 which will provide a visible indication of the position of the jaw mechanism with respect to the predeteratined position D2. Tn this embodiment, movement of the movable handle 14 towards the stationary handgrip 16 a sufficient distance will close the ' contacts of the switch 254 as the shoulder 258 of the movable handle 14 contacts the spring arm 256 of the switch 254. Once the contacts are closed, the light 260 will be illuminated, through the provision of the battery 252, and the surgeon will have a visual indication that the jaw mechanism is now in the predetermined position D2 and that l~ ~?1~' the partial opening stroke may be commenced to release the partially closed clip from the jaw mechanism. Of course, it is contemplated that the embodiment of Fig. 29 may be utilized by itself, or in combination with the embodiment of Fig. 28, or any of the other position indicator embodiments described above.
Figs. lla-lld illustrate various embodiments of the rack member 48. Since it is desirable to ensure a partial closing stroke prior to the partial opening stroke to release the partially crimped clip, the first set of teeth 100 are provided to ensure the partial closing stroke as the pawl member 40 moves across rack member 48. As seen in Fig. lla, the embodiment disclosed above, once the partial closing stroke is completed as the pawl member 40 passes over teeth 100, the space 104 provides a means for effecting the partial opening stroke to allow the partially closed clip to be released from the jaw mechanism. After release of the clip, teeth 100 prevent further opening of the handle mechanism, and requires the surgeon to fully close the instrument by ensuring that the pawl member 40 passes over second set of teeth 102. Fig. 11b illustrates an alternate embodiment of the rack member 48, and illustrates rack member 48a which includes teeth 100 and an elongate space 104. After the pawl member 40 passes over teeth 100, the opening stroke may be effected anywhere _ within space 104. After the clip that is partially closed has been released from the jaw mechanism 20, the surgeon fully completes the closing stroke as the pawl member 40 passes over the space 104. Teeth 100 prevent a full' opening stroke without the full closing stroke. Fig. iic illustrates a further embodiment of rack member 48b where two rack members are positioned in series relation with respect to each other and the space 104 is actually the area between the two separate rack members 114 and 116.
Rack 114 includes the first set of teeth 100 and rack 116 includes the second set of teeth 102. Once the partial closing stroke is completed as the pawl member 40 passes over teeth 100, the surgeon may effect the partial opening stroke as the pawl member 40 is positioned at the location of the space 104 between the two rack members. The partial opening stroke will be completed when the pawl member 40 re-engages teeth 100, and the surgeon must fully close the handle by passing pawl member 40 over teeth 102 to return the instrument to the set position for further use. Fig.
lld illustrates a further embodiment of the rack mechanism of the present invention. Rack member 48 is provided with a parallel rack 118 which is positioned in parallel relationship. Rack member 118 includes a plurality of teeth 124 which are positioned adjacent space 104. It is contemplated in this arrangement that parallel rack 118 includes spring arm 120 which provides for flexible movement of parallel rack 118 at its connection point 123 with rack 48. As the handle mechanism is moved in a closing stroke, pawl member 40 passes over teeth 100 to ensure the partial closing stroke. As pawl member 40 passes into space 104, a shoulder portion of the movable handle 14 (not shown), or a second pawl member (not shown) may engage teeth 124 to provide the surgeon with a tactile or audible indication that the jaw mechanism is in the predetermined position D2. It is contemplated that the teeth 124 provide a different feel and different sound than that associated with the teeth 100 and 102 of rack 48. In addition, the flexibility of parallel rack 118 due to the spring arm 120 will provide the surgeon with a different feel to indicate that the jaw mechanism 20 is in the predetermined position D2.
Turning now to Fig. 12, there is illustrated the novel jaw mechanism of the present invention. Typically, jaw mechanisms are constructed from a single sheet of material in which the jaw structure is machined in an expensive and time-consuming process to form the individual jaw members 75. The present invention provides a pair of jaw members 126 and 128 which are constructed in mirror image and include a crimping region 130 and a mounting region 134. The individual jaw members 126 and 128 are secured together by a dovetail connection arrangement 132 which secures the two jaw members together and provide a mounting means 136 through the provision of spaces between the dove-tail portions. The present invention.provides a simple and cost efficient means for constructing the jaw mechanism which is assembled prior to assembly on the instrument itself.
Turning now to Fig. 13, there is illustrated the novel tissue stop 78 of the present invention. Figs. 13-17 illustrate various embodiments of the tissue stop, which includes a vessel contacting region 138 which will contact a vessel, duct, or tissue in the event a clip is not positioned in the jaw mechanism. In Fig. 13a-13c, there is illustrated tissue stop 78 having clip stop 140 which provides a means for arresting the advancement of a clip from the clip advancing means to prevent the clip from being over-advanced to the jaw mechanism and insures the proper alignment of the clip once it is positioned in the jaws. Clip stop 140 includes a raised portion which will engage an inside surface of the clip, preferably at the :~ y~ "~~ :3 bight portion, to properly align the clip within the jaws and prevent its over-advancement through the jaw mechanism.
The tissue stop 78 of Fig. 13 also includes a jaw stop, which comprises a pair of raised arms which engage recesses in the underside of the jaw members 75 to prevent splaying of the jaw members, as will be described below with reference to Fig. 23.
Figs. 14a-14c disclose an alternate embodiment of the tissue stop 78 which includes an upstanding hook member 150 which comprises the clip stop for arresting the advancement of the clip into the jaw mechanism. Clip member 150 engages at least an inside surface of the clip at the bight portion to prevent over-advancement of the clip into the jaw mechanism and properly align the clip with respect to the jaw members.
Figs. 15a-15c illustrate a further embodiment of the clip stop assembly positioned on the tissue stop 78.
In this embodiment, a pair of detents 146 are provided which engage an inside surface of the clip in the region of the bight portion to arrest its advancement into the jaw mechanism.
Figs. 16a-16c show a further embodiment of the clip stop positioned on the tissue stop 78, in which a pair of upstanding walls are provided for engaging at least the inside surface of the legs of the clip as it is advanced into the jaw mechanism. A further embodiment is disclosed in Figs. 17a-17c in which a contoured surface 152 is provided to properly align the clip in the jaw mechanism. A
notch 153 is provided to engage the clip on the inside surface of the bight portion to slow the clip as it is advancing to the jaws.
lriv,LrJ,.i :) Turning now to Fig. 18, there is illustrated the clip blocking mechanism associated with the jaw members 75 which prevents advancement of a clip into the jaws unless the jaws are fully opened in the clip receiving position, having a gap between them at a distance D1 which is indicative of the clip receiving position. As seen in Fig.
18, the jaw mechanism is shown in phantom in the fully opened, clip receiving position. A clip block member 156 is provided on each jaw member 75 which will engage the forward portion of the clip legs as the clip 144 is inserted into the partially closed jaws. As indicated in Fig. 18, distance D3 is less than distance D1 which indicates the clip receiving position.
Fig. 19 illustrates the clip engaging feature of the pusher bar 60 of the present invention. In order to prevent improper insertion of a clip into the jaw mechanism, it is desirable to provide a cradling mechanism to engage the clip and keep it in proper alignment as it is inserted into the jaws. As seen in Fig. 19, clip 144 is cradled by pusher bar 60 at the cradle notch 158 as it is inserted into jaw mechanism 20. Cradle notch 158 includes a tamped forward portion 159 which facilitates removal of the pusher bar from the jaw assembly without pulling the clip 144 out of the jaw assembly 20. An alternate embodiment of the cradling means is illustrated in Figs.
20, 21 and 22. In Fig. 20, clip engaging fingers 162 are pivotally secured to pusher 60 at pivot pin 160. This permits some play in the clip engaging fingers 162 to insure proper alignment of the clip 144 in the jaw mechanism 20. Preferably, fingers 162 are constructed of a flexible plastic material which permits retraction of the _36_ pusher bar and fingers without dislodging the clip from the jaw mechanism. Fig. 21 illustrates a further cradling mechanism 164 which is secured to pusher bar-60 at clasp 166. It is contemplated that this embodiment can also be constructed of a flexible plastic material or a springy metal material, and may be permanently secured to pusher bar 60 or as a snap on feature when such a cradling mechanism 164 is desired. Fig. 22 shows a further embodiment of the cradling means 168, and is preferably constructed of a spring metal material which is spot welded at weld 170 and includes a flexible notch portion 172 which cradles the clip 144 but permits retraction of the pusher bar 60 without dislodging the clip 144 from the jaw mechanism 20.
Figs. 23a and 23b illustrate the jaw stop mechanism of the present invention. In certain surgical procedures utilizing surgical clip appliers, due to the cramped spacing inside the body during the endoscopic procedure, coupled with the sometimes distorted field of view through an endoscope or fiber optic system, application of a clip over a previously applied clip is sometimes unavoidable. When this occurs, many times the jaw mechanism may be damaged in that the individual jaw members 75 splay outwardly a distance further than the initial clip receiving distance D1. When this occurs, a subsequently fed clip to the jaw mechanism may become disoriented or dislodged due to the overspacing between the jaws. In order to prevent this possibility, the instrument of the present invention provides a jaw stop mechanism which includes jaw stop bracket 174 as seen in Fig. 23a, which is part of tissue stop 78. This embodiment is similar to that shown above with respect to Figs. 13a-13c. The bracket _; -.3 engages recesses 176 in the underside of the jaw members, and prevents splaying of the jaws to a distance that is greater than Dl. Fig. 23b illustrates a similar embodiment, in which bracket 178 is spot welded to tissue stop 78 instead of being integrally formed.
Figs. 26 and 27 illustrate the rotation collar of the present invention. Rotation collar 22 includes the collar 22, inner sleeve 194, and outer sleeve 196. As can be seen in Fig. 27, inner sleeve 194 is positioned against body portion i8 and surrounded by outer sleeve 196, both of which are nested inside rotation collar 22. The plurality of planar surfaces which make up inner sleeve 194 cooperate with the plurality of planar surfaces 198 about the.
circumference of body portion 18 to provide for incremental rotation of the collar 22, and consequently the body portion 18, about a longitudinal axis of the instrument.
Collar 22 includes a plurality of indentations 192 which have a scalloped cross-section and are dimensioned and configured to accommodate the finger tip of the surgeon. The scalloped walls 193 have a sufficient height to substantially enclose the volar surface, or the finger grint portion of the distal most phalange of the index finger of the surgeon. By substantially enclosing the volar surface of the finger tip of the surgeon, slippage is substantially reduced and for all practical purposes eliminated, so that single finger rotation of the body portion, and consequently the jaw mechanism is provided for the surgeon.
The surgical clip applying instrument of the present invention provides a number of novel features which enhance the performance of the instrument during laparoscopic or endoscopic surgical procedures. Each of c r-~~~~~;.J
the features of the present invention simplify the operation of the instrument and substantially eliminates inadvertent misapplication of clips during the surgical procedure. The instrument provides a visible, audible, and tactile indication of the position of the jaw members during application of a clip, particularly during application of clips during such surgical procedures as gall bladder operations.
While the invention has been particularly shown and described with reference to the preferred embodiments, it will be understood by those skilled in the art that various modifications and changes in form and detail may be made therein without departing from the scope and spirit of the invention.. Accordingly, modifications such as those suggested above, but not limited thereto, are to be considered within the scope of the invention.
Claims (73)
1. An apparatus for applying surgical clips comprising:
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, such movement from the open to the closed position defining a closing stroke of the jaw mechanism;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw mechanism; and means for ensuring completion of the closing stroke of said handle portion and said jaw mechanism, said means for ensuring completion of the closing stroke including means for permitting a partial opening stroke of said jaw mechanism after at least a partial closing stroke is effected to permit release of a partially formed clip from said jaw mechanism.
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, such movement from the open to the closed position defining a closing stroke of the jaw mechanism;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw mechanism; and means for ensuring completion of the closing stroke of said handle portion and said jaw mechanism, said means for ensuring completion of the closing stroke including means for permitting a partial opening stroke of said jaw mechanism after at least a partial closing stroke is effected to permit release of a partially formed clip from said jaw mechanism.
2. An apparatus according to Claim 1, wherein said means for ensuring completion of a closing stroke includes a ratchet mechanism disposed within said handle portion, said ratchet mechanism including at least one rack member and at least one pawl member.
3. An apparatus according to Claim 2, wherein said rack member has a length which corresponds to a partial closing stroke of said jaw mechanism.
4. An apparatus according to Claim 1, wherein said means for effecting a closing stroke includes a ratchet mechanism disposed within said handle portion, said ratchet mechanism including at least two rack members and at least one pawl member.
5. An apparatus according to Claim 4, wherein said rack members are arranged in a series relation having a space therebetween, such that said pawl member engages and traverses a first rack member, said space, and a second rack member in sequence during the closing stroke.
6. An apparatus according to Claim 5, wherein said means for permitting a partial opening stroke comprises said space between said rack members.
7. An apparatus according to Claim 1, further comprising means for camming said jaw mechanism from said open position to said closed position in response to movement of said handle portion.
8. An apparatus according to Claim 7, wherein said means for ensuring completion of the closing stroke includes a ratchet mechanism disposed within said handle portion, said ratchet mechanism including at least two rack members arranged in a series relation having a space therebetween and at least one pawl member, such that said pawl member engages and traverses a first rack member, said space, and a second rack member in sequence during a closing stroke of said handle portion.
9. An apparatus according to Claim 7, further comprising visual indicator means associated with said camming means for providing indication of a predetermined position of said jaw mechanism being between said open position and said closed position.
10. An apparatus according to Claim 8, further comprising visual indicator means associated with said camming means corresponding to said pawl member being in position at said space between said rack members, said indicator means further providing indication of a predetermined position of said jaw mechanism being between said open position and said closed position.
11. An apparatus according to Claim 1, wherein said jaw mechanism comprises a pair of jaw members, said jaw members defining a gap therebetween when said jaw mechanism is in said open position.
12. An apparatus according to Claim 11, further comprising means for engaging said jaw members to prevent said jaw members from being spaced apart from each other a distance which is greater than said gap defined by said jaw members in said open position.
13. An apparatus according to Claim 12, wherein said engaging means comprises a bracket including a pair of tab members for engaging a portion of said jaw members to restrict splaying of said jaw members away from each other a distance greater than said gap.
14. An apparatus according to Claim 12, further comprising tissue stop means disposed adjacent said jaw members for aligning said jaw members with respect to a vessel, said tissue stop means contacting said vessel only when said jaw members are devoid of a clip.
15. An apparatus according to Claim 14, wherein said engaging means is integrated with said tissue stop means.
16. An apparatus according to Claim 11, further comprising means associated with said jaw members for blocking advancement of a clip into said jaw members unless said jaw members are in said open position.
17. An apparatus according to Claim 14, further comprising means disposed on said tissue stop means for arresting advancement of a clip into said jaw members, said arresting means engaging at least an inside surface of said clip during advancement to said jaw members to arrest advancement and align said clip between said jaw members.
18. An apparatus according to Claim 11, further comprising tissue stop means disposed adjacent said jaw members for aligning said jaw members with respect to a vessel when said jaw members are devoid of a clip, said tissue stop means including clip stop means for arresting advancement of a clip into said jaw members.
19. An apparatus according to Claim 18, wherein said clip stop means engages at least an inside surface of a clip to arrest advancement of said clip.
20. An apparatus according to Claim 1, further comprising cradling means associated with said advancing means for engaging at least an outside surface of a clip during advancement of said clip to said jaw mechanism.
21. An apparatus according to Claim 1, wherein said advancing means includes a pusher bar assembly for pushing a clip from said clip supply to said jaw mechanism.
22. An apparatus according to Claim 21, further comprising means associated with said pusher bar for cradling at least an outside surface of said clip during advancement of said clip to said jaw mechanism.
23. An apparatus according to Claim 22, wherein said cradling means comprises a notch in a distal end of said pusher bar, said notch being dimensioned and configured to overlay and engage at least a bight portion of said clip during advancement of said clip.
24. An apparatus according to Claim 22 wherein said cradling means comprises clip engaging fingers depending from a distal end of said pusher bar, said fingers being dimensioned and configured to grasp at least a bight portion of said clip during advancement of said clip.
25. An apparatus for applying surgical clips comprising:
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw mechanism; and a ratchet mechanism disposed within said handle portion, the ratchet mechanism retaining said jaw mechanism at incremental stages of closure over at least a partial closing stroke, said ratchet mechanism including means for permitting at least a partial opening stroke during said closing stroke to permit release of a partially formed clip from said jaw mechanism.
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw mechanism; and a ratchet mechanism disposed within said handle portion, the ratchet mechanism retaining said jaw mechanism at incremental stages of closure over at least a partial closing stroke, said ratchet mechanism including means for permitting at least a partial opening stroke during said closing stroke to permit release of a partially formed clip from said jaw mechanism.
26. An apparatus according to Claim 25, wherein said ratchet mechanism comprises a rack member and a pawl member, said pawl member being positioned on a movable handle of said handle portion, and being engageable with said rack member during said closing stroke.
27. An apparatus according to Claim 26, wherein said rack member includes a plurality of teeth over a portion of a length of said rack member, a remaining portion of said length of said rack member being devoid of teeth, such that said plurality of teeth permit incremental closure and said remaining portion of said rack member permits said partial opening stroke during said closing stroke.
28. An apparatus according to Claim 26, wherein said rack member includes at least two portions each having a plurality of teeth along a length thereof, said two portions being separated by a portion of said rack member being devoid of teeth, such that said teeth permit incremental closure and said devoid portion permits said partial opening stroke during said closing stroke.
29. An apparatus according to Claim 25, wherein said ratchet mechanism comprises a pair of rack members and a pawl member, said pawl member being positioned on a movable handle of said handle portion, and being engageable with said rack members during said closing stroke.
30. An apparatus according to Claim 29, wherein said rack members include a plurality of teeth and are positioned in a series relationship with a space therebetween, such that said teeth permit incremental closure and said space permits said partial opening stroke during said closing stroke.
31. An apparatus according to Claim 29, wherein said rack members include a plurality of teeth and are positioned in a parallel relationship, a first rack member having teeth over a portion of its length and a remaining portion of said length being devoid of teeth, and a second rack member having teeth over its length.
32. An apparatus according to Claim 31, wherein said first rack member is engaged by said pawl member, and said second rack member is engaged by a portion of said movable handle member.
33. An apparatus according to Claim 26, wherein said pawl member includes means for maintaining said pawl member out of engagement with said rack member subsequent to a complete closing stroke to permit a complete opening stroke.
34. An apparatus according to Claim 27, further comprising camming means responsive to movement of said handle portion for moving said jaw mechanism from said open position to said closed position, said camming means including visual indication means indicative of said pawl member being positioned on said rack at said remaining portion devoid of teeth and indicative of said camming means moving said jaw mechanism to a predetermined position between said open position and said closed position.
35. An apparatus according to Claim 28, further comprising camming means responsive to movement of said handle portion for moving said jaw mechanism from said open position to said closed position, said camming means including visual indication means indicative of said pawl member being positioned on said rack at said portion devoid of teeth and indicative of said camming means moving said jaw mechanism to a predetermined position between said open position and said closed position.
36. An apparatus according to Claim 27, wherein said jaw mechanism is positioned at a predetermined position between said open position and said closed position when said pawl member is located at said remaining portion devoid of teeth of said rack member during said closing stroke.
37. An apparatus according to Claim 28, wherein said jaw mechanism is positioned at a predetermined position between said open position and said closed position when said pawl member is located at said portion devoid of teeth of said rack member during said closing stroke.
38. An apparatus for applying surgical clips comprising:
a handle portion;
a body portion extending from said handle portion;
a pair of jaw members extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, said open position defining a gap between said jaw members;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw members;
means for camming said jaw members from said open position to said closed position;
a bracket positioned distally of said camming means to engage said jaw members to prevent said jaw members from being spaced a distance which is greater than said gap defined by said jaw members in said open position; and tissue stop means disposed adjacent said jaw members for contacting a vessel when said jaw members are devoid of a clip, said bracket being positioned on said tissue stop means.
a handle portion;
a body portion extending from said handle portion;
a pair of jaw members extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, said open position defining a gap between said jaw members;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw members;
means for camming said jaw members from said open position to said closed position;
a bracket positioned distally of said camming means to engage said jaw members to prevent said jaw members from being spaced a distance which is greater than said gap defined by said jaw members in said open position; and tissue stop means disposed adjacent said jaw members for contacting a vessel when said jaw members are devoid of a clip, said bracket being positioned on said tissue stop means.
39. An apparatus according to claim 38, further comprising means associated with said jaw members for blocking advancement of a clip into said jaw members unless said jaw members are in said open position.
40. An apparatus according to Claim 39, further comprising a clip stop means for arresting advancement of a clip into said jaw members, said clip stop means engaging at least an inside surface of said clip.
41. An apparatus according to Claim 39, further comprising cradling means associated with said advancing means for engaging at least an outside surface of said clip during advancement of said clip to said jaw members.
42. In an apparatus for applying surgical clips, said apparatus including a handle portion, a body portion extending from said handle portion and defining a longitudinal axis, a clip supply disposed in said body portion, and means for advancing a clip from said clip supply to a jaw mechanism; the improvement which comprises:
said jaw mechanism disposed at an end of said body portion opposite said handle portion and operable to close clips positioned therein in response to movement of said handle portion, said jaw mechanism including a pair of jaw members each having a clip crimping region in opposed relation and a mounting region for mounting to said body portion, said mounting region including means for coupling said pair of jaw members to each other, said coupling means providing an interdigitating connection between said jaw members.
said jaw mechanism disposed at an end of said body portion opposite said handle portion and operable to close clips positioned therein in response to movement of said handle portion, said jaw mechanism including a pair of jaw members each having a clip crimping region in opposed relation and a mounting region for mounting to said body portion, said mounting region including means for coupling said pair of jaw members to each other, said coupling means providing an interdigitating connection between said jaw members.
43. An apparatus according to Claim 42, further comprising means for blocking advancement of a clip to said jaw members when said jaw members are spaced a distance which is less than a distance defined by a gap between said jaw members when said jaw members are in said open position, said blocking means being disposed adjacent said crimping region.
44. An apparatus according to Claim 42, wherein said coupling means comprises a dovetail assembly providing a plurality of cooperating sections between said jaw members.
45. An apparatus according to Claim 44, wherein said dovetail assembly includes a plurality of spaces for facilitating mounting of said jaw mechanism to said body portion.
46. An apparatus according to Claim 44, further comprising bracket means for preventing said jaw members from being spaced a distance which is greater than a distance defined by a gap between said jaw members when said jaw members are in said open position.
47. An apparatus for applying surgical clips comprising:
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion, each clip in said clip supply having a pair of legs depending from a bight portion extending therebetween, said bight portion having a polygonal cross-section defining a perimeter of the clip including a top portion, a bottom portion and at least one side portion;
means for advancing a clip from said clip supply to said jaw mechanism; and means associated with said advancing means for cradling said clip at said bight portion upon advancing said clip to said jaw mechanism for guiding said clip into said jaw mechanism, said cradling means engaging said side portion and at least one of said top portion and said bottom portion of said clip.
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion, each clip in said clip supply having a pair of legs depending from a bight portion extending therebetween, said bight portion having a polygonal cross-section defining a perimeter of the clip including a top portion, a bottom portion and at least one side portion;
means for advancing a clip from said clip supply to said jaw mechanism; and means associated with said advancing means for cradling said clip at said bight portion upon advancing said clip to said jaw mechanism for guiding said clip into said jaw mechanism, said cradling means engaging said side portion and at least one of said top portion and said bottom portion of said clip.
48. An apparatus according to Claim 47, wherein said advancing means includes a pusher bar for advancing said clip, said pusher bar having said cradling means disposed thereon.
49. An apparatus according to Claim 48, wherein said cradling means comprises a notch in a distal end of said pusher bar for overlaying at least a bight portion of said clip.
50. An apparatus according to Claim 49, wherein said notch includes at least one ramped surface to facilitate disengagement of said pusher bar from said clip subsequent to advancement of said clip to said jaw mechanism.
51. An apparatus according to Claim 48, wherein said cradling means comprises at least one clip engaging finger for overlaying at least a bight portion of said clip.
52. An apparatus far applying surgical clips comprising:
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion;
means for advancing a distalmost clip from said clip supply to said jaw mechanism; and means for engaging at least an inside surface of said distalmost clip subsequent to advancing said distalmost clip to a position substantially within said jaw mechanism to align said clip between jaw members of said jaw mechanism.
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion;
means for advancing a distalmost clip from said clip supply to said jaw mechanism; and means for engaging at least an inside surface of said distalmost clip subsequent to advancing said distalmost clip to a position substantially within said jaw mechanism to align said clip between jaw members of said jaw mechanism.
53. An apparatus according to Claim 52, further comprising tissue stop means for contacting a vessel when said jaw mechanism is devoid of a clip, said tissue stop means having said clip engaging means disposed thereon.
54. An apparatus according to Claim 53, wherein said clip engaging means comprises a raised wall surface on said tissue stop means, said wall surface engaging at least an inside surface of said clip.
55. An apparatus according to Claim 53, wherein said clip engaging means comprises a tab member on said tissue stop means for engaging at least an inside surface of said clip.
56. An apparatus according to Claim 52, wherein said clip engaging means comprises a tab member disposed on a distal end of said body portion for engaging at least an inside surface of said clip.
57. An apparatus according to Claim 52, further comprising a clip stop means disposed on said jaw mechanism for preventing advancement of a clip to said jaw mechanism when said jaw mechanism is not in said open position.
58. An apparatus according to Claim 53, wherein said jaw mechanism comprises a pair of jaw members, said jaw members being spaced apart in said open position and defining a clip receiving gap therebetween, said jaw members further including means for preventing splaying of said jaw members to a distance greater than said gap.
59. An apparatus according to claim 58, wherein said splaying preventing means comprises a bracket disposed on said tissue stop means, said bracket comprising a pair of tab members which engage recesses in said jaw members.
60. An apparatus for applying surgical clips comprising:
a handle portion;
a body portion extending from said handle portion;
a pair of jaw members extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, said open position defining a gap between said jaw members:
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw members means for camming said jaw members from said open position to said closed position in response to movement of said handle portion; and an indicator member operably associated with said camming means, said indicator member indicating at least one distance between said jaw members which is greater than a distance defined by said closed position and less than said gap of said open position;
wherein said camming means comprises a slidable channel disposed in said body portion and an advancement tube disposed in said handle portion for sliding said channel to cam said jaw members from said open position to said closed position in response to movement of said handle portion; and wherein said indicator member comprises a flag disposed on said advancement tube, and an aperture in said handle portion for displaying said flag when said jaw members are spaced said predetermined distance.
a handle portion;
a body portion extending from said handle portion;
a pair of jaw members extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, said open position defining a gap between said jaw members:
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw members means for camming said jaw members from said open position to said closed position in response to movement of said handle portion; and an indicator member operably associated with said camming means, said indicator member indicating at least one distance between said jaw members which is greater than a distance defined by said closed position and less than said gap of said open position;
wherein said camming means comprises a slidable channel disposed in said body portion and an advancement tube disposed in said handle portion for sliding said channel to cam said jaw members from said open position to said closed position in response to movement of said handle portion; and wherein said indicator member comprises a flag disposed on said advancement tube, and an aperture in said handle portion for displaying said flag when said jaw members are spaced said predetermined distance.
61. An apparatus according to Claim 60, further comprising a rack and pawl mechanism disposed in said handle portion, said pawl being engaged with said rack during at least a partial closing stroke of said handle portion, said pawl being disengaged when said flag is positioned in said aperture to permit at least a partial opening stroke of said handle portion.
62. An apparatus for applying surgical clips comprising:
a handle portion including a pivoting handle and a stationary handle;
a body portion extending from said handle portion;
a pair of jaw members extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, said open position defining a gap between said jaw members;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw members;
means for camming paid jaw members in response to movement of said handle portion from said open position to said closed position; and an indicator operably associated with said housing of said handle portion, said indicator indicating at least one distance between said jaw members which is greater than a distance defined by said closed position and less than said gap of said open position;
wherein said indicator comprises a clutch mechanism disposed on said pivoting handle for engaging said housing during a portion of pivoting movement, said clutch mechanism providing tactile indication of said jaw members being spaced said predetermined distance.
a handle portion including a pivoting handle and a stationary handle;
a body portion extending from said handle portion;
a pair of jaw members extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion, said open position defining a gap between said jaw members;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw members;
means for camming paid jaw members in response to movement of said handle portion from said open position to said closed position; and an indicator operably associated with said housing of said handle portion, said indicator indicating at least one distance between said jaw members which is greater than a distance defined by said closed position and less than said gap of said open position;
wherein said indicator comprises a clutch mechanism disposed on said pivoting handle for engaging said housing during a portion of pivoting movement, said clutch mechanism providing tactile indication of said jaw members being spaced said predetermined distance.
63. An apparatus according to Claim 62, wherein said clutch mechanism includes a block member extending from said pivoting handle towards said stationary handle, said block member contacting said stationary handle when said jaw members are spaced said predetermined distance.
64. An apparatus according to Claim 63, wherein said block member is movable between an armed position and a disarmed position, said block member including means for automatically moving said block member from said armed position to said disarmed position.
65. An apparatus according to Claim 64, wherein said automatic means disarms said block member upon release of a force on said block member corresponding to said block member contacting said stationary handle.
66. An apparatus for applying surgical clips comprising:
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw mechanism;
means for camming said jaw mechanism from said open position to said closed position in response to movement of said handle portion; and a visual indicator on said housing, the visual indicator providing visual indication of a predetermined position of said jaw mechanism between said open position and said closed position; and audible indication means associated with said handle portion for providing audio indication of said predetermined position of said jaw mechanism between said open position and said closed position.
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw mechanism;
means for camming said jaw mechanism from said open position to said closed position in response to movement of said handle portion; and a visual indicator on said housing, the visual indicator providing visual indication of a predetermined position of said jaw mechanism between said open position and said closed position; and audible indication means associated with said handle portion for providing audio indication of said predetermined position of said jaw mechanism between said open position and said closed position.
67. An apparatus according to Claim 66, wherein said visual indication means comprises an aperture on said handle portion for displaying a flag disposed on said camming means, said flag being disposed in said aperture when said jaw mechanism is in said predetermined position.
68. An apparatus according to Claim 66, wherein said audible indication means comprises a rack and pawl mechanism disposed within said handle, said pawl being engaged with said rack when said jaw mechanism is out of said predetermined position, and said pawl being disengaged from said rack when said jaw mechanism is in said predetermined position.
69. An apparatus according to Claim 68, wherein said rack includes a plurality of teeth, at least a portion of said rack being devoid of teeth, such that when said pawl is in a position on said rack corresponding to said portion devoid of teeth, said jaw mechanism is in said predetermined position.
70. An apparatus according to Claim 66, wherein said visual indication means comprises a light indicator positioned on said handle portion and including a power source, said light indicator being actuated by switch means engaged by movement of said handle portion when said jaw mechanism is in said predetermined position.
71. An apparatus according to Claim 66, wherein said audible indication means comprises a sound generator positioned in said handle portion and including a power source, said sound generator being actuated by switch means engaged by movement of said handle portion when said jaw mechanism is in said predetermined position.
72. An apparatus for applying surgical clips comprising:
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw mechanism;
means for camming said jaw mechanism from said open position to said closed position in response to movement of said handle portion; and audible indication means associated with said handle portion for providing audio indication of a predetermined position of said jaw mechanism between said open position and said closed position.
a handle portion;
a body portion extending from said handle portion;
a jaw mechanism extending from said body portion at an end opposite said handle portion and movable between an open position for receiving a clip and a closed position for forming a clip in response to movement of said handle portion;
a clip supply disposed within said body portion;
means for advancing a clip from said clip supply to said jaw mechanism;
means for camming said jaw mechanism from said open position to said closed position in response to movement of said handle portion; and audible indication means associated with said handle portion for providing audio indication of a predetermined position of said jaw mechanism between said open position and said closed position.
73. An apparatus according to Claim 72, wherein said audible indication means comprises a sound generator positioned in said handle portion and including a power source, said sound generator being actuated by switch means engaged by movement of said handle portion when said jaw mechanism is in said predetermined position.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/134,347 | 1993-10-08 | ||
US08/134,347 US5607436A (en) | 1993-10-08 | 1993-10-08 | Apparatus for applying surgical clips |
Publications (2)
Publication Number | Publication Date |
---|---|
CA2131973A1 CA2131973A1 (en) | 1995-04-09 |
CA2131973C true CA2131973C (en) | 2005-05-24 |
Family
ID=22462944
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002131973A Expired - Lifetime CA2131973C (en) | 1993-10-08 | 1994-09-13 | Apparatus for applying surgical clips |
Country Status (5)
Country | Link |
---|---|
US (3) | US5607436A (en) |
EP (1) | EP0656190B1 (en) |
CA (1) | CA2131973C (en) |
DE (1) | DE69425417T2 (en) |
ES (1) | ES2148263T3 (en) |
Families Citing this family (827)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5582616A (en) * | 1994-08-05 | 1996-12-10 | Origin Medsystems, Inc. | Surgical helical fastener with applicator |
US5803089A (en) | 1994-09-15 | 1998-09-08 | Visualization Technology, Inc. | Position tracking and imaging system for use in medical applications |
US5700271A (en) | 1995-10-20 | 1997-12-23 | United States Surgical Corporation | Apparatus for applying surgical clips |
DE29616632U1 (en) * | 1996-09-24 | 1996-11-28 | Aesculap Ag | Surgical application device for U-shaped clips |
US5833696A (en) * | 1996-10-03 | 1998-11-10 | United States Surgical Corporation | Apparatus for applying surgical clips |
EP1006886B1 (en) * | 1997-02-13 | 2003-07-09 | Boston Scientific Limited | Dilator for minimally invasive pelvic surgery |
US6551328B2 (en) * | 1997-11-03 | 2003-04-22 | Symbiosis Corporation | Surgical instrument for invagination and fundoplication |
US6660010B2 (en) * | 1998-01-27 | 2003-12-09 | Scimed Life Systems, Inc. | Bone anchor placement device with recessed anchor mount |
US5976160A (en) * | 1998-03-31 | 1999-11-02 | Design Standards Corporation | Handle mechanism with two distinct pivot points |
AU733868B2 (en) | 1998-05-12 | 2001-05-31 | Boston Scientific Limited | Manual bone anchor placement devices |
US6228098B1 (en) | 1998-07-10 | 2001-05-08 | General Surgical Innovations, Inc. | Apparatus and method for surgical fastening |
US7364577B2 (en) | 2002-02-11 | 2008-04-29 | Sherwood Services Ag | Vessel sealing system |
US6193732B1 (en) | 1999-01-08 | 2001-02-27 | Cardiothoracic System | Surgical clips and apparatus and method for clip placement |
US8758400B2 (en) | 2000-01-05 | 2014-06-24 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
US6391048B1 (en) | 2000-01-05 | 2002-05-21 | Integrated Vascular Systems, Inc. | Integrated vascular device with puncture site closure component and sealant and methods of use |
US7842068B2 (en) | 2000-12-07 | 2010-11-30 | Integrated Vascular Systems, Inc. | Apparatus and methods for providing tactile feedback while delivering a closure device |
US9579091B2 (en) | 2000-01-05 | 2017-02-28 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
US6461364B1 (en) | 2000-01-05 | 2002-10-08 | Integrated Vascular Systems, Inc. | Vascular sheath with bioabsorbable puncture site closure apparatus and methods of use |
CN1302754C (en) | 2000-02-04 | 2007-03-07 | 康曼德公司 | Surgical clip applier |
US6840945B2 (en) * | 2001-02-28 | 2005-01-11 | Microline, Inc. | Medical clip applier safety arrangement |
US7141056B2 (en) * | 2000-02-15 | 2006-11-28 | Microline Pentax Inc. | Multiplier extension arrangement |
US6569171B2 (en) * | 2001-02-28 | 2003-05-27 | Microline, Inc. | Safety locking mechanism for a medical clip device |
IL135571A0 (en) * | 2000-04-10 | 2001-05-20 | Doron Adler | Minimal invasive surgery imaging system |
AU2001288006A1 (en) | 2000-09-08 | 2002-03-22 | Thomas Anthony | Device for locating a puncture hole in a liquid-carrying vessel |
US6626918B1 (en) | 2000-10-06 | 2003-09-30 | Medical Technology Group | Apparatus and methods for positioning a vascular sheath |
US6599298B1 (en) | 2000-10-23 | 2003-07-29 | Vitalitec International, S.A. | Automatic surgical clip applier |
US8062314B2 (en) * | 2000-12-06 | 2011-11-22 | Ethicon Endo-Surgery, Inc. | Methods for the endoluminal treatment of gastroesophageal reflux disease (GERD) |
US20020138086A1 (en) * | 2000-12-06 | 2002-09-26 | Robert Sixto | Surgical clips particularly useful in the endoluminal treatment of gastroesophageal reflux disease (GERD) |
US20020068945A1 (en) * | 2000-12-06 | 2002-06-06 | Robert Sixto | Surgical clips particularly useful in the endoluminal treatment of gastroesophageal reflux disease (GERD) |
US7727246B2 (en) * | 2000-12-06 | 2010-06-01 | Ethicon Endo-Surgery, Inc. | Methods for endoluminal treatment |
US6716226B2 (en) * | 2001-06-25 | 2004-04-06 | Inscope Development, Llc | Surgical clip |
US7232445B2 (en) * | 2000-12-06 | 2007-06-19 | Id, Llc | Apparatus for the endoluminal treatment of gastroesophageal reflux disease (GERD) |
US8690910B2 (en) | 2000-12-07 | 2014-04-08 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US6695867B2 (en) | 2002-02-21 | 2004-02-24 | Integrated Vascular Systems, Inc. | Plunger apparatus and methods for delivering a closure device |
US7806904B2 (en) | 2000-12-07 | 2010-10-05 | Integrated Vascular Systems, Inc. | Closure device |
US7905900B2 (en) | 2003-01-30 | 2011-03-15 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US6623510B2 (en) | 2000-12-07 | 2003-09-23 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US7211101B2 (en) | 2000-12-07 | 2007-05-01 | Abbott Vascular Devices | Methods for manufacturing a clip and clip |
EP1913896B1 (en) * | 2001-03-09 | 2012-12-26 | Boston Scientific Limited | Method for making a medical sling |
AU2001249933B2 (en) | 2001-04-06 | 2006-06-08 | Covidien Ag | Vessel sealer and divider with non-conductive stop members |
US6808491B2 (en) * | 2001-05-21 | 2004-10-26 | Syntheon, Llc | Methods and apparatus for on-endoscope instruments having end effectors and combinations of on-endoscope and through-endoscope instruments |
IES20010547A2 (en) | 2001-06-07 | 2002-12-11 | Christy Cummins | Surgical Staple |
US11229472B2 (en) | 2001-06-12 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with multiple magnetic position sensors |
US6824547B2 (en) * | 2001-07-13 | 2004-11-30 | Pilling Weck Incorporated | Endoscopic clip applier and method |
US7179265B2 (en) * | 2001-08-21 | 2007-02-20 | Microline Pentax, Inc. | Reduced diameter clip applying arrangement |
US7464847B2 (en) | 2005-06-03 | 2008-12-16 | Tyco Healthcare Group Lp | Surgical stapler with timer and feedback display |
US10285694B2 (en) | 2001-10-20 | 2019-05-14 | Covidien Lp | Surgical stapler with timer and feedback display |
WO2003088815A2 (en) * | 2002-04-17 | 2003-10-30 | Tyco Healthcare Group, Lp | Tacking tool and tack |
AU2003231752A1 (en) | 2002-04-22 | 2003-11-03 | Tyco Healthcare Group, Lp | Tack and tack applier |
AU2003225257A1 (en) * | 2002-04-29 | 2003-11-17 | Tyco Healthcare Group, Lp | Ligation clip applier and method |
US8194121B2 (en) * | 2002-05-16 | 2012-06-05 | C2Cure, Inc. | Miniature camera head |
JP4508866B2 (en) | 2002-06-04 | 2010-07-21 | アボット ヴァスキュラー デヴァイシス | Vascular closure clip and delivery device |
US7931649B2 (en) | 2002-10-04 | 2011-04-26 | Tyco Healthcare Group Lp | Vessel sealing instrument with electrical cutting mechanism |
US7105004B2 (en) * | 2002-10-21 | 2006-09-12 | Start Llc | One-hand locking and releasing handheld medical instrument |
US7799026B2 (en) | 2002-11-14 | 2010-09-21 | Covidien Ag | Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion |
US7211092B2 (en) * | 2002-11-19 | 2007-05-01 | Pilling Weck Incorporated | Automated-feed surgical clip applier and related methods |
US8758398B2 (en) | 2006-09-08 | 2014-06-24 | Integrated Vascular Systems, Inc. | Apparatus and method for delivering a closure element |
US8905937B2 (en) | 2009-02-26 | 2014-12-09 | Integrated Vascular Systems, Inc. | Methods and apparatus for locating a surface of a body lumen |
US8398656B2 (en) | 2003-01-30 | 2013-03-19 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US7857828B2 (en) | 2003-01-30 | 2010-12-28 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US8202293B2 (en) | 2003-01-30 | 2012-06-19 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US8821534B2 (en) | 2010-12-06 | 2014-09-02 | Integrated Vascular Systems, Inc. | Clip applier having improved hemostasis and methods of use |
US20040193213A1 (en) * | 2003-03-11 | 2004-09-30 | Ernest Aranyi | Clip applying apparatus with curved jaws, and clip |
ES2616695T3 (en) * | 2003-03-11 | 2017-06-14 | Covidien Lp | Staple application device with inclined jaw |
WO2004098383A2 (en) | 2003-05-01 | 2004-11-18 | Sherwood Services Ag | Electrosurgical instrument which reduces thermal damage to adjacent tissue |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US7875040B2 (en) * | 2003-10-15 | 2011-01-25 | Femcare Limited | Visual indication of a trigger intermediate position on an applicator |
WO2005039422A2 (en) * | 2003-10-15 | 2005-05-06 | Femcare Limited | Applicator |
US9848938B2 (en) | 2003-11-13 | 2017-12-26 | Covidien Ag | Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion |
US7367976B2 (en) | 2003-11-17 | 2008-05-06 | Sherwood Services Ag | Bipolar forceps having monopolar extension |
US7131970B2 (en) | 2003-11-19 | 2006-11-07 | Sherwood Services Ag | Open vessel sealing instrument with cutting mechanism |
US7585304B2 (en) * | 2004-02-02 | 2009-09-08 | Teleflex Medical Incorporated | Endoscopic clip applying apparatus with improved aperture for clip release and related method |
US8182501B2 (en) | 2004-02-27 | 2012-05-22 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical shears and method for sealing a blood vessel using same |
US7780662B2 (en) | 2004-03-02 | 2010-08-24 | Covidien Ag | Vessel sealing system using capacitive RF dielectric heating |
US8517921B2 (en) * | 2004-04-16 | 2013-08-27 | Gyrus Acmi, Inc. | Endoscopic instrument having reduced diameter flexible shaft |
US7621926B2 (en) * | 2004-04-16 | 2009-11-24 | Applied Medical Resources Corporation | Multi-fire surgical clip applier |
IES20040368A2 (en) | 2004-05-25 | 2005-11-30 | James E Coleman | Surgical stapler |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US11890012B2 (en) | 2004-07-28 | 2024-02-06 | Cilag Gmbh International | Staple cartridge comprising cartridge body and attached support |
EP1799120B1 (en) | 2004-09-23 | 2017-11-01 | Covidien LP | Clip applying apparatus and ligation clip |
ES2388673T3 (en) | 2004-10-08 | 2012-10-17 | Tyco Healthcare Group Lp | An endoscopic clip or surgical clip applier |
BRPI0518171B8 (en) * | 2004-10-08 | 2021-06-22 | Ethicon Endo Surgery Inc | ultrasonic forceps coagulator apparatus |
WO2006042110A2 (en) * | 2004-10-08 | 2006-04-20 | Tyco Healthcare Group, Lp | Apparatus for applying surgical clips |
US7819886B2 (en) * | 2004-10-08 | 2010-10-26 | Tyco Healthcare Group Lp | Endoscopic surgical clip applier |
US8409222B2 (en) | 2004-10-08 | 2013-04-02 | Covidien Lp | Endoscopic surgical clip applier |
US9763668B2 (en) | 2004-10-08 | 2017-09-19 | Covidien Lp | Endoscopic surgical clip applier |
NO322695B1 (en) * | 2004-12-29 | 2006-11-27 | Surgitech Norway As | Instrument especially for use in laparoscopic surgical procedure |
NO322694B1 (en) * | 2004-12-29 | 2006-11-27 | Surgitech Norway As | Apparatus, especially for use in laparoscopic surgery |
US7909823B2 (en) | 2005-01-14 | 2011-03-22 | Covidien Ag | Open vessel sealing instrument |
US7686804B2 (en) | 2005-01-14 | 2010-03-30 | Covidien Ag | Vessel sealer and divider with rotating sealer and cutter |
US20060184191A1 (en) | 2005-02-11 | 2006-08-17 | Boston Scientific Scimed, Inc. | Cutting balloon catheter having increased flexibility regions |
US8038686B2 (en) * | 2005-04-14 | 2011-10-18 | Ethicon Endo-Surgery, Inc. | Clip applier configured to prevent clip fallout |
US7288098B2 (en) * | 2005-04-14 | 2007-10-30 | Ethicon Endo-Surgery, Inc. | Force limiting mechanism for medical instrument |
US20090014002A1 (en) * | 2005-04-14 | 2009-01-15 | Honeywell International Inc. | Air filter assembly |
US7740641B2 (en) * | 2005-04-14 | 2010-06-22 | Ethicon Endo-Surgery, Inc. | Clip applier with migrational resistance features |
US7699860B2 (en) * | 2005-04-14 | 2010-04-20 | Ethicon Endo-Surgery, Inc. | Surgical clip |
US7261724B2 (en) | 2005-04-14 | 2007-08-28 | Ethicon Endo-Surgery, Inc. | Surgical clip advancement mechanism |
US8523882B2 (en) * | 2005-04-14 | 2013-09-03 | Ethicon Endo-Surgery, Inc. | Clip advancer mechanism with alignment features |
US7297149B2 (en) | 2005-04-14 | 2007-11-20 | Ethicon Endo-Surgery, Inc. | Surgical clip applier methods |
US7686820B2 (en) * | 2005-04-14 | 2010-03-30 | Ethicon Endo-Surgery, Inc. | Surgical clip applier ratchet mechanism |
US7731724B2 (en) * | 2005-04-14 | 2010-06-08 | Ethicon Endo-Surgery, Inc. | Surgical clip advancement and alignment mechanism |
US8025668B2 (en) * | 2005-04-28 | 2011-09-27 | C. R. Bard, Inc. | Medical device removal system |
CA2609970C (en) | 2005-06-03 | 2014-08-12 | Tyco Healthcare Group Lp | Battery powered surgical instrument |
US11291443B2 (en) | 2005-06-03 | 2022-04-05 | Covidien Lp | Surgical stapler with timer and feedback display |
US8926633B2 (en) | 2005-06-24 | 2015-01-06 | Abbott Laboratories | Apparatus and method for delivering a closure element |
US8313497B2 (en) | 2005-07-01 | 2012-11-20 | Abbott Laboratories | Clip applier and methods of use |
US8025621B2 (en) * | 2005-07-26 | 2011-09-27 | Microline Surgical, Inc. | Medical device with adjustable inner shaft movement |
US20070060895A1 (en) | 2005-08-24 | 2007-03-15 | Sibbitt Wilmer L Jr | Vascular closure methods and apparatuses |
US8920442B2 (en) | 2005-08-24 | 2014-12-30 | Abbott Vascular Inc. | Vascular opening edge eversion methods and apparatuses |
US9456811B2 (en) | 2005-08-24 | 2016-10-04 | Abbott Vascular Inc. | Vascular closure methods and apparatuses |
US7419495B2 (en) * | 2005-08-25 | 2008-09-02 | Microline Pentax Inc. | Trigger lockout device for clip applying instrument |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
WO2007041132A1 (en) * | 2005-09-29 | 2007-04-12 | Applied Medical Resources Corporation | Manually actuated surgical clip applier |
CA2561034C (en) | 2005-09-30 | 2014-12-09 | Sherwood Services Ag | Flexible endoscopic catheter with an end effector for coagulating and transfecting tissue |
US7879035B2 (en) | 2005-09-30 | 2011-02-01 | Covidien Ag | Insulating boot for electrosurgical forceps |
CA2561638C (en) | 2005-09-30 | 2015-06-30 | Sherwood Services Ag | Insulating boot for electrosurgical forceps |
US7922953B2 (en) | 2005-09-30 | 2011-04-12 | Covidien Ag | Method for manufacturing an end effector assembly |
US7722607B2 (en) | 2005-09-30 | 2010-05-25 | Covidien Ag | In-line vessel sealer and divider |
US20070191713A1 (en) | 2005-10-14 | 2007-08-16 | Eichmann Stephen E | Ultrasonic device for cutting and coagulating |
US20070089433A1 (en) * | 2005-10-20 | 2007-04-26 | Smurfit-Stone Container Enterprises, Inc. | Methods and systems for monitoring a shelf life of a product stored within a container |
US7738401B2 (en) * | 2005-10-20 | 2010-06-15 | At&T Intellectual Property I, L.P. | System and method for overlaying a hierarchical network design on a full mesh network |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US20070162030A1 (en) * | 2006-01-06 | 2007-07-12 | Ernest Aranyi | Multi-pronged compressive absorbable tack |
US7621930B2 (en) | 2006-01-20 | 2009-11-24 | Ethicon Endo-Surgery, Inc. | Ultrasound medical instrument having a medical ultrasonic blade |
US20070173866A1 (en) * | 2006-01-23 | 2007-07-26 | Tyco Healthcare Group, Lp | Surgical hemostatic clip |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US20110290856A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument with force-feedback capabilities |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
DE102006007107B4 (en) * | 2006-02-16 | 2007-10-18 | Peter Lazic Gmbh | Pipe tongs with power transmission |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
USD629101S1 (en) | 2006-03-24 | 2010-12-14 | Tyco Healthcare Group Lp | Surgical clip applier |
USD625009S1 (en) | 2006-03-24 | 2010-10-05 | Tyco Healthcare Group Lp | Surgical clip applier |
US8808310B2 (en) * | 2006-04-20 | 2014-08-19 | Integrated Vascular Systems, Inc. | Resettable clip applier and reset tools |
JP5148598B2 (en) | 2006-05-03 | 2013-02-20 | ラプトール リッジ, エルエルシー | Tissue closure system and method |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US8556930B2 (en) | 2006-06-28 | 2013-10-15 | Abbott Laboratories | Vessel closure device |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
EP2314232B1 (en) | 2006-10-17 | 2015-03-25 | Covidien LP | Apparatus for applying surgical clips |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US20080169332A1 (en) | 2007-01-11 | 2008-07-17 | Shelton Frederick E | Surgical stapling device with a curved cutting member |
JP2008192187A (en) * | 2007-01-31 | 2008-08-21 | Fujitsu Ltd | Head controller, memory device, and contact detection method |
US7473258B2 (en) * | 2007-03-08 | 2009-01-06 | Cardica, Inc. | Surgical stapler |
US7533790B1 (en) | 2007-03-08 | 2009-05-19 | Cardica, Inc. | Surgical stapler |
US20090001130A1 (en) | 2007-03-15 | 2009-01-01 | Hess Christopher J | Surgical procedure using a cutting and stapling instrument having releasable staple-forming pockets |
US7431188B1 (en) | 2007-03-15 | 2008-10-07 | Tyco Healthcare Group Lp | Surgical stapling apparatus with powered articulation |
US8226675B2 (en) | 2007-03-22 | 2012-07-24 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8911460B2 (en) | 2007-03-22 | 2014-12-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8057498B2 (en) | 2007-11-30 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument blades |
US20080234709A1 (en) * | 2007-03-22 | 2008-09-25 | Houser Kevin L | Ultrasonic surgical instrument and cartilage and bone shaping blades therefor |
US8142461B2 (en) | 2007-03-22 | 2012-03-27 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
CN101641051B (en) | 2007-03-26 | 2011-11-23 | Tyco医疗健康集团 | Endoscopic surgical clip applier |
EP2671519B1 (en) | 2007-04-11 | 2014-12-17 | Covidien LP | Surgical clip applier |
US8800837B2 (en) | 2007-04-13 | 2014-08-12 | Covidien Lp | Powered surgical instrument |
US11259801B2 (en) | 2007-04-13 | 2022-03-01 | Covidien Lp | Powered surgical instrument |
US20080255413A1 (en) | 2007-04-13 | 2008-10-16 | Michael Zemlok | Powered surgical instrument |
US7950560B2 (en) | 2007-04-13 | 2011-05-31 | Tyco Healthcare Group Lp | Powered surgical instrument |
US7823760B2 (en) | 2007-05-01 | 2010-11-02 | Tyco Healthcare Group Lp | Powered surgical stapling device platform |
US20080277445A1 (en) * | 2007-05-07 | 2008-11-13 | Zergiebel Earl M | Single fire tacker instrument |
US7931660B2 (en) * | 2007-05-10 | 2011-04-26 | Tyco Healthcare Group Lp | Powered tacker instrument |
US11857181B2 (en) | 2007-06-04 | 2024-01-02 | Cilag Gmbh International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US20080312649A1 (en) * | 2007-06-18 | 2008-12-18 | Paul Guerra | Illuminated instrument buttons |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US8226681B2 (en) | 2007-06-25 | 2012-07-24 | Abbott Laboratories | Methods, devices, and apparatus for managing access through tissue |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
JP2009045428A (en) * | 2007-07-25 | 2009-03-05 | Terumo Corp | Operating mechanism, medical manipulator and surgical robot system |
US8348967B2 (en) * | 2007-07-27 | 2013-01-08 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8882791B2 (en) * | 2007-07-27 | 2014-11-11 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8523889B2 (en) | 2007-07-27 | 2013-09-03 | Ethicon Endo-Surgery, Inc. | Ultrasonic end effectors with increased active length |
US8808319B2 (en) | 2007-07-27 | 2014-08-19 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8257377B2 (en) * | 2007-07-27 | 2012-09-04 | Ethicon Endo-Surgery, Inc. | Multiple end effectors ultrasonic surgical instruments |
US8252012B2 (en) * | 2007-07-31 | 2012-08-28 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with modulator |
US8512365B2 (en) | 2007-07-31 | 2013-08-20 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US9044261B2 (en) | 2007-07-31 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Temperature controlled ultrasonic surgical instruments |
US8430898B2 (en) | 2007-07-31 | 2013-04-30 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
EP2796102B1 (en) | 2007-10-05 | 2018-03-14 | Ethicon LLC | Ergonomic surgical instruments |
USD594983S1 (en) | 2007-10-05 | 2009-06-23 | Ethicon Endo-Surgery, Inc. | Handle assembly for surgical instrument |
US7922063B2 (en) | 2007-10-31 | 2011-04-12 | Tyco Healthcare Group, Lp | Powered surgical instrument |
US7901423B2 (en) | 2007-11-30 | 2011-03-08 | Ethicon Endo-Surgery, Inc. | Folded ultrasonic end effectors with increased active length |
US10010339B2 (en) | 2007-11-30 | 2018-07-03 | Ethicon Llc | Ultrasonic surgical blades |
US20090157101A1 (en) | 2007-12-17 | 2009-06-18 | Abbott Laboratories | Tissue closure system and methods of use |
US8893947B2 (en) | 2007-12-17 | 2014-11-25 | Abbott Laboratories | Clip applier and methods of use |
US7841502B2 (en) | 2007-12-18 | 2010-11-30 | Abbott Laboratories | Modular clip applier |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
JP5410110B2 (en) | 2008-02-14 | 2014-02-05 | エシコン・エンド−サージェリィ・インコーポレイテッド | Surgical cutting / fixing instrument with RF electrode |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US9770245B2 (en) | 2008-02-15 | 2017-09-26 | Ethicon Llc | Layer arrangements for surgical staple cartridges |
US8733611B2 (en) * | 2008-03-12 | 2014-05-27 | Covidien Lp | Ratcheting mechanism for surgical stapling device |
US8021375B2 (en) * | 2008-04-21 | 2011-09-20 | Conmed Corporation | Surgical clip applicator |
US9282965B2 (en) | 2008-05-16 | 2016-03-15 | Abbott Laboratories | Apparatus and methods for engaging tissue |
US8058771B2 (en) | 2008-08-06 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic device for cutting and coagulating with stepped output |
US9089360B2 (en) | 2008-08-06 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US20110208212A1 (en) | 2010-02-19 | 2011-08-25 | Zergiebel Earl M | Surgical clip applier |
US8056565B2 (en) | 2008-08-25 | 2011-11-15 | Tyco Healthcare Group Lp | Surgical clip applier and method of assembly |
US8465502B2 (en) | 2008-08-25 | 2013-06-18 | Covidien Lp | Surgical clip applier and method of assembly |
EP2543324B1 (en) | 2008-08-29 | 2015-10-21 | Covidien LP | Endoscopic clip applier |
US8585717B2 (en) | 2008-08-29 | 2013-11-19 | Covidien Lp | Single stroke endoscopic surgical clip applier |
US9358015B2 (en) | 2008-08-29 | 2016-06-07 | Covidien Lp | Endoscopic surgical clip applier with wedge plate |
US8267944B2 (en) | 2008-08-29 | 2012-09-18 | Tyco Healthcare Group Lp | Endoscopic surgical clip applier with lock out |
US8409223B2 (en) | 2008-08-29 | 2013-04-02 | Covidien Lp | Endoscopic surgical clip applier with clip retention |
US20100051668A1 (en) | 2008-09-03 | 2010-03-04 | Milliman Keith L | Surgical instrument with indicator |
US8113405B2 (en) | 2008-09-03 | 2012-02-14 | Tyco Healthcare Group, Lp | Surgical instrument with indicator |
US20100057118A1 (en) * | 2008-09-03 | 2010-03-04 | Dietz Timothy G | Ultrasonic surgical blade |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US8142473B2 (en) | 2008-10-03 | 2012-03-27 | Tyco Healthcare Group Lp | Method of transferring rotational motion in an articulating surgical instrument |
US8016827B2 (en) | 2008-10-09 | 2011-09-13 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US8398676B2 (en) | 2008-10-30 | 2013-03-19 | Abbott Vascular Inc. | Closure device |
US9795442B2 (en) | 2008-11-11 | 2017-10-24 | Shifamed Holdings, Llc | Ablation catheters |
DE102008058207A1 (en) * | 2008-11-19 | 2010-05-20 | Dannoritzer Medizintechnik Gmbh & Co. Kg | Handle device |
US20100137845A1 (en) * | 2008-12-03 | 2010-06-03 | Immersion Corporation | Tool Having Multiple Feedback Devices |
US8858594B2 (en) | 2008-12-22 | 2014-10-14 | Abbott Laboratories | Curved closure device |
US8323312B2 (en) | 2008-12-22 | 2012-12-04 | Abbott Laboratories | Closure device |
US9089311B2 (en) | 2009-01-09 | 2015-07-28 | Abbott Vascular Inc. | Vessel closure devices and methods |
US9414820B2 (en) | 2009-01-09 | 2016-08-16 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US20100179589A1 (en) | 2009-01-09 | 2010-07-15 | Abbott Vascular Inc. | Rapidly eroding anchor |
US9486191B2 (en) | 2009-01-09 | 2016-11-08 | Abbott Vascular, Inc. | Closure devices |
US9173644B2 (en) | 2009-01-09 | 2015-11-03 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US8114122B2 (en) | 2009-01-13 | 2012-02-14 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US20100185234A1 (en) | 2009-01-16 | 2010-07-22 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
CN102341048A (en) | 2009-02-06 | 2012-02-01 | 伊西康内外科公司 | Driven surgical stapler improvements |
JP2012525215A (en) * | 2009-04-30 | 2012-10-22 | クック メディカル テクノロジーズ エルエルシー | System and method for deploying fiducials |
US8187273B2 (en) | 2009-05-07 | 2012-05-29 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8728099B2 (en) * | 2009-05-12 | 2014-05-20 | Ethicon, Inc. | Surgical fasteners, applicator instruments, and methods for deploying surgical fasteners |
US8579920B2 (en) | 2009-05-12 | 2013-11-12 | Ethicon, Inc. | Surgical fasteners, applicator instruments, and methods for deploying surgical fasteners |
USD698021S1 (en) | 2009-05-12 | 2014-01-21 | Ethicon, Inc. | Surgical fastener |
US8728098B2 (en) * | 2009-05-12 | 2014-05-20 | Ethicon, Inc. | Surgical fasteners, applicator instruments, and methods for deploying surgical fasteners |
US8920439B2 (en) * | 2009-05-12 | 2014-12-30 | Ethicon, Inc. | Applicator instruments having curved and articulating shafts for deploying surgical fasteners and methods therefor |
US9055945B2 (en) | 2009-05-12 | 2015-06-16 | Ethicon, Inc. | Surgical fasteners having articulating joints and deflectable tips |
US8894669B2 (en) * | 2009-05-12 | 2014-11-25 | Ethicon, Inc. | Surgical fasteners, applicator instruments, and methods for deploying surgical fasteners |
USD744646S1 (en) | 2009-05-12 | 2015-12-01 | Ethicon, Inc. | Surgical fastener |
US20100298743A1 (en) * | 2009-05-20 | 2010-11-25 | Ethicon Endo-Surgery, Inc. | Thermally-activated coupling arrangements and methods for attaching tools to ultrasonic surgical instruments |
US9700339B2 (en) * | 2009-05-20 | 2017-07-11 | Ethicon Endo-Surgery, Inc. | Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments |
WO2010138538A1 (en) | 2009-05-26 | 2010-12-02 | Zimmer, Inc. | Handheld tool for driving a bone pin into a fractured bone |
US8821514B2 (en) | 2009-06-08 | 2014-09-02 | Covidien Lp | Powered tack applier |
US8334635B2 (en) | 2009-06-24 | 2012-12-18 | Ethicon Endo-Surgery, Inc. | Transducer arrangements for ultrasonic surgical instruments |
US8246618B2 (en) | 2009-07-08 | 2012-08-21 | Tyco Healthcare Group Lp | Electrosurgical jaws with offset knife |
US8663220B2 (en) * | 2009-07-15 | 2014-03-04 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US9017326B2 (en) * | 2009-07-15 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Impedance monitoring apparatus, system, and method for ultrasonic surgical instruments |
US8461744B2 (en) * | 2009-07-15 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Rotating transducer mount for ultrasonic surgical instruments |
US8342378B2 (en) | 2009-08-17 | 2013-01-01 | Covidien Lp | One handed stapler |
US20110054492A1 (en) | 2009-08-26 | 2011-03-03 | Abbott Laboratories | Medical device for repairing a fistula |
US8133254B2 (en) | 2009-09-18 | 2012-03-13 | Tyco Healthcare Group Lp | In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor |
US8112871B2 (en) | 2009-09-28 | 2012-02-14 | Tyco Healthcare Group Lp | Method for manufacturing electrosurgical seal plates |
US8430892B2 (en) | 2009-10-06 | 2013-04-30 | Covidien Lp | Surgical clip applier having a wireless clip counter |
US8267945B2 (en) * | 2009-10-09 | 2012-09-18 | Ethicon Endo-Surgery, Inc. | Clip advancer with lockout mechanism |
US9168054B2 (en) | 2009-10-09 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US8262679B2 (en) * | 2009-10-09 | 2012-09-11 | Ethicon Endo-Surgery, Inc. | Clip advancer |
USRE47996E1 (en) | 2009-10-09 | 2020-05-19 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US8986302B2 (en) | 2009-10-09 | 2015-03-24 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US10441345B2 (en) | 2009-10-09 | 2019-10-15 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US10172669B2 (en) | 2009-10-09 | 2019-01-08 | Ethicon Llc | Surgical instrument comprising an energy trigger lockout |
US11090104B2 (en) | 2009-10-09 | 2021-08-17 | Cilag Gmbh International | Surgical generator for ultrasonic and electrosurgical devices |
US8734469B2 (en) * | 2009-10-13 | 2014-05-27 | Covidien Lp | Suture clip applier |
US9186136B2 (en) | 2009-12-09 | 2015-11-17 | Covidien Lp | Surgical clip applier |
US8545486B2 (en) | 2009-12-15 | 2013-10-01 | Covidien Lp | Surgical clip applier |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8561871B2 (en) | 2009-12-31 | 2013-10-22 | Covidien Lp | Indicators for surgical staplers |
US8714430B2 (en) | 2009-12-31 | 2014-05-06 | Covidien Lp | Indicator for surgical stapler |
US8469981B2 (en) | 2010-02-11 | 2013-06-25 | Ethicon Endo-Surgery, Inc. | Rotatable cutting implement arrangements for ultrasonic surgical instruments |
US8579928B2 (en) | 2010-02-11 | 2013-11-12 | Ethicon Endo-Surgery, Inc. | Outer sheath and blade arrangements for ultrasonic surgical instruments |
US8961547B2 (en) * | 2010-02-11 | 2015-02-24 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with moving cutting implement |
US8486096B2 (en) * | 2010-02-11 | 2013-07-16 | Ethicon Endo-Surgery, Inc. | Dual purpose surgical instrument for cutting and coagulating tissue |
US9259234B2 (en) | 2010-02-11 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with rotatable blade and hollow sheath arrangements |
US8382782B2 (en) * | 2010-02-11 | 2013-02-26 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with partially rotating blade and fixed pad arrangement |
US8531064B2 (en) * | 2010-02-11 | 2013-09-10 | Ethicon Endo-Surgery, Inc. | Ultrasonically powered surgical instruments with rotating cutting implement |
US8323302B2 (en) * | 2010-02-11 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Methods of using ultrasonically powered surgical instruments with rotatable cutting implements |
US8419759B2 (en) * | 2010-02-11 | 2013-04-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with comb-like tissue trimming device |
US8951272B2 (en) | 2010-02-11 | 2015-02-10 | Ethicon Endo-Surgery, Inc. | Seal arrangements for ultrasonically powered surgical instruments |
US8683895B2 (en) * | 2010-02-23 | 2014-04-01 | Kensey Nash Corporation | Single revolution snap action drive for surgical fasteners |
US8403945B2 (en) | 2010-02-25 | 2013-03-26 | Covidien Lp | Articulating endoscopic surgical clip applier |
US10136898B2 (en) | 2010-03-09 | 2018-11-27 | Teleflex Medical Incorporated | Narrow profile surgical ligation clip |
WO2011112877A1 (en) | 2010-03-10 | 2011-09-15 | Menn Pavel | Surgical clips for laparoscopic procedures |
US8303624B2 (en) | 2010-03-15 | 2012-11-06 | Abbott Cardiovascular Systems, Inc. | Bioabsorbable plug |
US20120265220A1 (en) | 2010-04-06 | 2012-10-18 | Pavel Menn | Articulating Steerable Clip Applier for Laparoscopic Procedures |
WO2011143468A2 (en) | 2010-05-12 | 2011-11-17 | Shifamed, Llc | Low profile electrode assembly |
US9655677B2 (en) | 2010-05-12 | 2017-05-23 | Shifamed Holdings, Llc | Ablation catheters including a balloon and electrodes |
GB2480498A (en) | 2010-05-21 | 2011-11-23 | Ethicon Endo Surgery Inc | Medical device comprising RF circuitry |
US8795327B2 (en) | 2010-07-22 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with separate closure and cutting members |
US9192431B2 (en) | 2010-07-23 | 2015-11-24 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8403946B2 (en) | 2010-07-28 | 2013-03-26 | Covidien Lp | Articulating clip applier cartridge |
US8968337B2 (en) | 2010-07-28 | 2015-03-03 | Covidien Lp | Articulating clip applier |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US8758399B2 (en) | 2010-08-02 | 2014-06-24 | Abbott Cardiovascular Systems, Inc. | Expandable bioabsorbable plug apparatus and method |
US8603116B2 (en) | 2010-08-04 | 2013-12-10 | Abbott Cardiovascular Systems, Inc. | Closure device with long tines |
US11925354B2 (en) | 2010-09-30 | 2024-03-12 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US8777004B2 (en) | 2010-09-30 | 2014-07-15 | Ethicon Endo-Surgery, Inc. | Compressible staple cartridge comprising alignment members |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US9788834B2 (en) | 2010-09-30 | 2017-10-17 | Ethicon Llc | Layer comprising deployable attachment members |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US9241714B2 (en) | 2011-04-29 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator and method for making the same |
US8979890B2 (en) | 2010-10-01 | 2015-03-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument with jaw member |
US8888809B2 (en) | 2010-10-01 | 2014-11-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with jaw member |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
US8568425B2 (en) | 2010-11-01 | 2013-10-29 | Covidien Lp | Wire spool for passing of wire through a rotational coupling |
US9011464B2 (en) | 2010-11-02 | 2015-04-21 | Covidien Lp | Self-centering clip and jaw |
US9113940B2 (en) | 2011-01-14 | 2015-08-25 | Covidien Lp | Trigger lockout and kickback mechanism for surgical instruments |
US9186153B2 (en) | 2011-01-31 | 2015-11-17 | Covidien Lp | Locking cam driver and jaw assembly for clip applier |
US8496157B2 (en) | 2011-02-18 | 2013-07-30 | Covidien Lp | Tilting anvil for annular surgical stapler |
US9149276B2 (en) | 2011-03-21 | 2015-10-06 | Abbott Cardiovascular Systems, Inc. | Clip and deployment apparatus for tissue closure |
DE102011001706A1 (en) | 2011-03-31 | 2012-10-04 | Aesculap Ag | Surgical clip applicator |
US8968293B2 (en) | 2011-04-12 | 2015-03-03 | Covidien Lp | Systems and methods for calibrating power measurements in an electrosurgical generator |
BR112013027794B1 (en) | 2011-04-29 | 2020-12-15 | Ethicon Endo-Surgery, Inc | CLAMP CARTRIDGE SET |
US9775623B2 (en) * | 2011-04-29 | 2017-10-03 | Covidien Lp | Surgical clip applier including clip relief feature |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
US8702749B2 (en) | 2011-06-09 | 2014-04-22 | Covidien Lp | Lever latch assemblies for vessel sealer and divider |
US20120330326A1 (en) | 2011-06-22 | 2012-12-27 | Tyco Healthcare Group Lp | Surgical clip applier including atraumatic jaw feature |
US8838208B2 (en) | 2011-06-28 | 2014-09-16 | Cook Medical Technologies Llc | Fiducial deployment needle system |
US8917084B2 (en) * | 2011-07-01 | 2014-12-23 | Synergistic Technology Solutions, Inc. | High voltage sensing mechanism with integrated on-off switch |
US9259265B2 (en) | 2011-07-22 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Surgical instruments for tensioning tissue |
USD700967S1 (en) | 2011-08-23 | 2014-03-11 | Covidien Ag | Handle for portable surgical device |
JP5848827B2 (en) | 2011-09-15 | 2016-01-27 | テレフレックス メディカル インコーポレイテッドTeleflex Medical Incorporated | Manual surgical ligation clip applier |
EP2755576B1 (en) | 2011-09-15 | 2019-05-22 | Teleflex Medical Incorporated | Automatic surgical ligation clip applier |
EP2768418B1 (en) | 2011-10-19 | 2017-07-19 | Ethicon Endo-Surgery, Inc. | Clip applier adapted for use with a surgical robot |
US9333025B2 (en) | 2011-10-24 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Battery initialization clip |
USD687549S1 (en) | 2011-10-24 | 2013-08-06 | Ethicon Endo-Surgery, Inc. | Surgical instrument |
US20130131697A1 (en) | 2011-11-21 | 2013-05-23 | Covidien Lp | Surgical clip applier |
US9332976B2 (en) | 2011-11-30 | 2016-05-10 | Abbott Cardiovascular Systems, Inc. | Tissue closure device |
US9364239B2 (en) | 2011-12-19 | 2016-06-14 | Covidien Lp | Jaw closure mechanism for a surgical clip applier |
US9364216B2 (en) | 2011-12-29 | 2016-06-14 | Covidien Lp | Surgical clip applier with integrated clip counter |
USD680220S1 (en) | 2012-01-12 | 2013-04-16 | Coviden IP | Slider handle for laparoscopic device |
EP2811932B1 (en) | 2012-02-10 | 2019-06-26 | Ethicon LLC | Robotically controlled surgical instrument |
MX353040B (en) | 2012-03-28 | 2017-12-18 | Ethicon Endo Surgery Inc | Retainer assembly including a tissue thickness compensator. |
RU2014143258A (en) | 2012-03-28 | 2016-05-20 | Этикон Эндо-Серджери, Инк. | FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS |
CN104334098B (en) | 2012-03-28 | 2017-03-22 | 伊西康内外科公司 | Tissue thickness compensator comprising capsules defining a low pressure environment |
US9439668B2 (en) | 2012-04-09 | 2016-09-13 | Ethicon Endo-Surgery, Llc | Switch arrangements for ultrasonic surgical instruments |
US9237921B2 (en) | 2012-04-09 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US9241731B2 (en) | 2012-04-09 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Rotatable electrical connection for ultrasonic surgical instruments |
US9226766B2 (en) | 2012-04-09 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Serial communication protocol for medical device |
US9724118B2 (en) | 2012-04-09 | 2017-08-08 | Ethicon Endo-Surgery, Llc | Techniques for cutting and coagulating tissue for ultrasonic surgical instruments |
US9408610B2 (en) | 2012-05-04 | 2016-08-09 | Covidien Lp | Surgical clip applier with dissector |
US9364228B2 (en) | 2012-05-11 | 2016-06-14 | Ethicon, Llc | Applicator instruments having distal end caps for facilitating the accurate placement of surgical fasteners during open repair procedures |
US8518055B1 (en) | 2012-05-11 | 2013-08-27 | Ethicon, Inc. | Applicator instruments for dispensing surgical fasteners during open repair procedures |
US10575716B2 (en) | 2012-05-11 | 2020-03-03 | Ethicon Llc | Applicator instruments with imaging systems for dispensing surgical fasteners during open repair procedures |
US8679140B2 (en) | 2012-05-30 | 2014-03-25 | Covidien Lp | Surgical clamping device with ratcheting grip lock |
US9532787B2 (en) | 2012-05-31 | 2017-01-03 | Covidien Lp | Endoscopic clip applier |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US11202631B2 (en) | 2012-06-28 | 2021-12-21 | Cilag Gmbh International | Stapling assembly comprising a firing lockout |
US9408606B2 (en) | 2012-06-28 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Robotically powered surgical device with manually-actuatable reversing system |
US9282974B2 (en) | 2012-06-28 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Empty clip cartridge lockout |
US20140005705A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulating shafts |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
JP6290201B2 (en) | 2012-06-28 | 2018-03-07 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Lockout for empty clip cartridge |
US20140005702A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with distally positioned transducers |
US9326788B2 (en) | 2012-06-29 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Lockout mechanism for use with robotic electrosurgical device |
US9198714B2 (en) | 2012-06-29 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Haptic feedback devices for surgical robot |
US9820768B2 (en) | 2012-06-29 | 2017-11-21 | Ethicon Llc | Ultrasonic surgical instruments with control mechanisms |
US9351754B2 (en) | 2012-06-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with distally positioned jaw assemblies |
US9393037B2 (en) | 2012-06-29 | 2016-07-19 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9283045B2 (en) | 2012-06-29 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Surgical instruments with fluid management system |
US9226767B2 (en) | 2012-06-29 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Closed feedback control for electrosurgical device |
US9408622B2 (en) | 2012-06-29 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9987067B2 (en) | 2012-07-11 | 2018-06-05 | Zimmer, Inc. | Bone fixation tool |
US9700310B2 (en) * | 2013-08-23 | 2017-07-11 | Ethicon Llc | Firing member retraction devices for powered surgical instruments |
US9492224B2 (en) | 2012-09-28 | 2016-11-15 | EthiconEndo-Surgery, LLC | Multi-function bi-polar forceps |
US9095367B2 (en) | 2012-10-22 | 2015-08-04 | Ethicon Endo-Surgery, Inc. | Flexible harmonic waveguides/blades for surgical instruments |
US10201365B2 (en) | 2012-10-22 | 2019-02-12 | Ethicon Llc | Surgeon feedback sensing and display methods |
US20140135804A1 (en) | 2012-11-15 | 2014-05-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic and electrosurgical devices |
US9364209B2 (en) | 2012-12-21 | 2016-06-14 | Abbott Cardiovascular Systems, Inc. | Articulating suturing device |
US9968362B2 (en) | 2013-01-08 | 2018-05-15 | Covidien Lp | Surgical clip applier |
US9113892B2 (en) | 2013-01-08 | 2015-08-25 | Covidien Lp | Surgical clip applier |
US9750500B2 (en) | 2013-01-18 | 2017-09-05 | Covidien Lp | Surgical clip applier |
EP2967642B1 (en) | 2013-02-26 | 2017-02-01 | Cook Medical Technologies LLC | Ratchet-slide handle and system for fiducial deployment |
JP6345707B2 (en) | 2013-03-01 | 2018-06-20 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Surgical instrument with soft stop |
JP6382235B2 (en) | 2013-03-01 | 2018-08-29 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Articulatable surgical instrument with a conductive path for signal communication |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US10226273B2 (en) | 2013-03-14 | 2019-03-12 | Ethicon Llc | Mechanical fasteners for use with surgical energy devices |
US9241728B2 (en) | 2013-03-15 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument with multiple clamping mechanisms |
US10098694B2 (en) | 2013-04-08 | 2018-10-16 | Apama Medical, Inc. | Tissue ablation and monitoring thereof |
CN110141177B (en) | 2013-04-08 | 2021-11-23 | 阿帕玛医疗公司 | Ablation catheter |
US10349824B2 (en) | 2013-04-08 | 2019-07-16 | Apama Medical, Inc. | Tissue mapping and visualization systems |
US9649110B2 (en) | 2013-04-16 | 2017-05-16 | Ethicon Llc | Surgical instrument comprising a closing drive and a firing drive operated from the same rotatable output |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
US9351728B2 (en) * | 2013-06-28 | 2016-05-31 | Covidien Lp | Articulating apparatus for endoscopic procedures |
US10085746B2 (en) | 2013-06-28 | 2018-10-02 | Covidien Lp | Surgical instrument including rotating end effector and rotation-limiting structure |
US9358004B2 (en) | 2013-06-28 | 2016-06-07 | Covidien Lp | Articulating apparatus for endoscopic procedures |
US9257763B2 (en) | 2013-07-02 | 2016-02-09 | Gyrus Acmi, Inc. | Hybrid interconnect |
US9510739B2 (en) | 2013-07-12 | 2016-12-06 | Gyrus Acmi, Inc. | Endoscope small imaging system |
MX369362B (en) | 2013-08-23 | 2019-11-06 | Ethicon Endo Surgery Llc | Firing member retraction devices for powered surgical instruments. |
US9775624B2 (en) | 2013-08-27 | 2017-10-03 | Covidien Lp | Surgical clip applier |
US9814514B2 (en) | 2013-09-13 | 2017-11-14 | Ethicon Llc | Electrosurgical (RF) medical instruments for cutting and coagulating tissue |
CN103536324B (en) * | 2013-09-29 | 2017-02-15 | 北京派尔特医疗科技股份有限公司 | Anastomat and indicating device of anastomat |
US9265926B2 (en) | 2013-11-08 | 2016-02-23 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
US10779838B1 (en) | 2013-11-13 | 2020-09-22 | Joseph W Blake, III | Instrument for serially applying clips to a surgical site |
US10485545B2 (en) | 2013-11-19 | 2019-11-26 | Datascope Corp. | Fastener applicator with interlock |
GB2521228A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
GB2521229A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
US9795436B2 (en) | 2014-01-07 | 2017-10-24 | Ethicon Llc | Harvesting energy from a surgical generator |
KR102412395B1 (en) * | 2014-01-10 | 2022-06-22 | 콘메드 코포레이션 | Devices for applying surgical clips |
US9707005B2 (en) | 2014-02-14 | 2017-07-18 | Ethicon Llc | Lockout mechanisms for surgical devices |
US9554854B2 (en) | 2014-03-18 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Detecting short circuits in electrosurgical medical devices |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
US10013049B2 (en) | 2014-03-26 | 2018-07-03 | Ethicon Llc | Power management through sleep options of segmented circuit and wake up control |
US10463421B2 (en) | 2014-03-27 | 2019-11-05 | Ethicon Llc | Two stage trigger, clamp and cut bipolar vessel sealer |
US10092310B2 (en) | 2014-03-27 | 2018-10-09 | Ethicon Llc | Electrosurgical devices |
US9737355B2 (en) | 2014-03-31 | 2017-08-22 | Ethicon Llc | Controlling impedance rise in electrosurgical medical devices |
CA2944654C (en) | 2014-04-03 | 2020-07-14 | Zimmer, Inc. | Orthopedic tool for bone fixation |
US9913680B2 (en) | 2014-04-15 | 2018-03-13 | Ethicon Llc | Software algorithms for electrosurgical instruments |
CN106456158B (en) | 2014-04-16 | 2019-02-05 | 伊西康内外科有限责任公司 | Fastener cartridge including non-uniform fastener |
JP6636452B2 (en) | 2014-04-16 | 2020-01-29 | エシコン エルエルシーEthicon LLC | Fastener cartridge including extension having different configurations |
BR112016023807B1 (en) | 2014-04-16 | 2022-07-12 | Ethicon Endo-Surgery, Llc | CARTRIDGE SET OF FASTENERS FOR USE WITH A SURGICAL INSTRUMENT |
US20150297223A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
WO2015191223A1 (en) | 2014-06-09 | 2015-12-17 | Cook Medical Technologies Llc | Screw-driven handles and systems for fiducial deployment |
WO2015195232A1 (en) | 2014-06-16 | 2015-12-23 | Cook Medical Technologies Llc | Plunger-driven collet handle and system for fiducial deployment |
US9700333B2 (en) | 2014-06-30 | 2017-07-11 | Ethicon Llc | Surgical instrument with variable tissue compression |
US10285724B2 (en) | 2014-07-31 | 2019-05-14 | Ethicon Llc | Actuation mechanisms and load adjustment assemblies for surgical instruments |
US10098641B1 (en) | 2014-08-21 | 2018-10-16 | Joseph W Blake, III | Jaws and cams for clip applying instruments |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US10111679B2 (en) | 2014-09-05 | 2018-10-30 | Ethicon Llc | Circuitry and sensors for powered medical device |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
MX2017003960A (en) | 2014-09-26 | 2017-12-04 | Ethicon Llc | Surgical stapling buttresses and adjunct materials. |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US9968363B2 (en) | 2014-10-20 | 2018-05-15 | Joseph W. Blake, III | Multi-clip applier |
US20160113655A1 (en) | 2014-10-24 | 2016-04-28 | Covidien Lp | Reposable multiplatform endoscopic surgical clip applier |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10702278B2 (en) | 2014-12-02 | 2020-07-07 | Covidien Lp | Laparoscopic surgical ligation clip applier |
EP3226786B1 (en) | 2014-12-03 | 2022-05-25 | Cook Medical Technologies LLC | Endoscopic ultrasound fiducial needle stylet handle assembly |
US10639092B2 (en) | 2014-12-08 | 2020-05-05 | Ethicon Llc | Electrode configurations for surgical instruments |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
BR112017012996B1 (en) | 2014-12-18 | 2022-11-08 | Ethicon Llc | SURGICAL INSTRUMENT WITH AN ANvil WHICH IS SELECTIVELY MOVABLE ABOUT AN IMMOVABLE GEOMETRIC AXIS DIFFERENT FROM A STAPLE CARTRIDGE |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US9943309B2 (en) | 2014-12-18 | 2018-04-17 | Ethicon Llc | Surgical instruments with articulatable end effectors and movable firing beam support arrangements |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US10159524B2 (en) | 2014-12-22 | 2018-12-25 | Ethicon Llc | High power battery powered RF amplifier topology |
US9931124B2 (en) | 2015-01-07 | 2018-04-03 | Covidien Lp | Reposable clip applier |
WO2016112509A1 (en) | 2015-01-15 | 2016-07-21 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10292712B2 (en) | 2015-01-28 | 2019-05-21 | Covidien Lp | Surgical clip applier with integrated cutter |
US10245095B2 (en) | 2015-02-06 | 2019-04-02 | Ethicon Llc | Electrosurgical instrument with rotation and articulation mechanisms |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10548504B2 (en) | 2015-03-06 | 2020-02-04 | Ethicon Llc | Overlaid multi sensor radio frequency (RF) electrode system to measure tissue compression |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US10159491B2 (en) * | 2015-03-10 | 2018-12-25 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10321950B2 (en) | 2015-03-17 | 2019-06-18 | Ethicon Llc | Managing tissue treatment |
US10342602B2 (en) | 2015-03-17 | 2019-07-09 | Ethicon Llc | Managing tissue treatment |
US10595929B2 (en) | 2015-03-24 | 2020-03-24 | Ethicon Llc | Surgical instruments with firing system overload protection mechanisms |
US10213201B2 (en) | 2015-03-31 | 2019-02-26 | Ethicon Llc | Stapling end effector configured to compensate for an uneven gap between a first jaw and a second jaw |
US10314638B2 (en) | 2015-04-07 | 2019-06-11 | Ethicon Llc | Articulating radio frequency (RF) tissue seal with articulating state sensing |
US10034684B2 (en) | 2015-06-15 | 2018-07-31 | Ethicon Llc | Apparatus and method for dissecting and coagulating tissue |
US11020140B2 (en) | 2015-06-17 | 2021-06-01 | Cilag Gmbh International | Ultrasonic surgical blade for use with ultrasonic surgical instruments |
US11051873B2 (en) | 2015-06-30 | 2021-07-06 | Cilag Gmbh International | Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters |
US11141213B2 (en) | 2015-06-30 | 2021-10-12 | Cilag Gmbh International | Surgical instrument with user adaptable techniques |
US10357303B2 (en) | 2015-06-30 | 2019-07-23 | Ethicon Llc | Translatable outer tube for sealing using shielded lap chole dissector |
US10034704B2 (en) | 2015-06-30 | 2018-07-31 | Ethicon Llc | Surgical instrument with user adaptable algorithms |
US10898256B2 (en) | 2015-06-30 | 2021-01-26 | Ethicon Llc | Surgical system with user adaptable techniques based on tissue impedance |
US11129669B2 (en) | 2015-06-30 | 2021-09-28 | Cilag Gmbh International | Surgical system with user adaptable techniques based on tissue type |
US10154852B2 (en) | 2015-07-01 | 2018-12-18 | Ethicon Llc | Ultrasonic surgical blade with improved cutting and coagulation features |
US10987159B2 (en) | 2015-08-26 | 2021-04-27 | Covidien Lp | Electrosurgical end effector assemblies and electrosurgical forceps configured to reduce thermal spread |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10478188B2 (en) | 2015-09-30 | 2019-11-19 | Ethicon Llc | Implantable layer comprising a constricted configuration |
US10751108B2 (en) | 2015-09-30 | 2020-08-25 | Ethicon Llc | Protection techniques for generator for digitally generating electrosurgical and ultrasonic electrical signal waveforms |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10736633B2 (en) | 2015-09-30 | 2020-08-11 | Ethicon Llc | Compressible adjunct with looping members |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
CA2997936A1 (en) | 2015-10-10 | 2017-04-13 | Covidien Lp | Endoscopic surgical clip applier |
US10959771B2 (en) | 2015-10-16 | 2021-03-30 | Ethicon Llc | Suction and irrigation sealing grasper |
US10595930B2 (en) | 2015-10-16 | 2020-03-24 | Ethicon Llc | Electrode wiping surgical device |
US10702279B2 (en) | 2015-11-03 | 2020-07-07 | Covidien Lp | Endoscopic surgical clip applier |
US10213250B2 (en) | 2015-11-05 | 2019-02-26 | Covidien Lp | Deployment and safety mechanisms for surgical instruments |
WO2017079895A1 (en) | 2015-11-10 | 2017-05-18 | Covidien Lp | Endoscopic reposable surgical clip applier |
EP3373826A4 (en) | 2015-11-10 | 2019-11-06 | Covidien LP | Endoscopic reposable surgical clip applier |
US10390831B2 (en) | 2015-11-10 | 2019-08-27 | Covidien Lp | Endoscopic reposable surgical clip applier |
WO2017087549A1 (en) | 2015-11-16 | 2017-05-26 | Apama Medical, Inc. | Energy delivery devices |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US10959806B2 (en) | 2015-12-30 | 2021-03-30 | Ethicon Llc | Energized medical device with reusable handle |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10179022B2 (en) | 2015-12-30 | 2019-01-15 | Ethicon Llc | Jaw position impedance limiter for electrosurgical instrument |
US10575892B2 (en) | 2015-12-31 | 2020-03-03 | Ethicon Llc | Adapter for electrical surgical instruments |
CN108430350B (en) * | 2016-01-11 | 2021-06-08 | 捷锐士阿希迈公司(以奥林巴斯美国外科技术名义) | Forceps with tissue stop |
EP3402417A4 (en) | 2016-01-11 | 2019-12-04 | Covidien LP | Endoscopic reposable surgical clip applier |
US11229471B2 (en) | 2016-01-15 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization |
US10716615B2 (en) | 2016-01-15 | 2020-07-21 | Ethicon Llc | Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade |
US10537351B2 (en) | 2016-01-15 | 2020-01-21 | Ethicon Llc | Modular battery powered handheld surgical instrument with variable motor control limits |
US11129670B2 (en) | 2016-01-15 | 2021-09-28 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization |
CA3011262A1 (en) | 2016-01-18 | 2017-07-27 | Covidien Lp | Endoscopic surgical clip applier |
JP6911054B2 (en) | 2016-02-09 | 2021-07-28 | エシコン エルエルシーEthicon LLC | Surgical instruments with asymmetric joint composition |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10555769B2 (en) | 2016-02-22 | 2020-02-11 | Ethicon Llc | Flexible circuits for electrosurgical instrument |
CA2958160A1 (en) | 2016-02-24 | 2017-08-24 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
US10433840B2 (en) | 2016-04-18 | 2019-10-08 | Ethicon Llc | Surgical instrument comprising a replaceable cartridge jaw |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
CA3021683A1 (en) | 2016-04-21 | 2017-10-26 | Applied Medical Resources Corporation | Laparoscopic clip applier |
US10987156B2 (en) | 2016-04-29 | 2021-04-27 | Ethicon Llc | Electrosurgical instrument with electrically conductive gap setting member and electrically insulative tissue engaging members |
US10485607B2 (en) | 2016-04-29 | 2019-11-26 | Ethicon Llc | Jaw structure with distal closure for electrosurgical instruments |
US10702329B2 (en) | 2016-04-29 | 2020-07-07 | Ethicon Llc | Jaw structure with distal post for electrosurgical instruments |
US10646269B2 (en) | 2016-04-29 | 2020-05-12 | Ethicon Llc | Non-linear jaw gap for electrosurgical instruments |
US10856934B2 (en) | 2016-04-29 | 2020-12-08 | Ethicon Llc | Electrosurgical instrument with electrically conductive gap setting and tissue engaging members |
US10456193B2 (en) | 2016-05-03 | 2019-10-29 | Ethicon Llc | Medical device with a bilateral jaw configuration for nerve stimulation |
US20170340325A1 (en) | 2016-05-31 | 2017-11-30 | Covidien Lp | Endoscopic reposable surgical clip applier |
US20180008277A1 (en) | 2016-07-11 | 2018-01-11 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10245064B2 (en) | 2016-07-12 | 2019-04-02 | Ethicon Llc | Ultrasonic surgical instrument with piezoelectric central lumen transducer |
US10893883B2 (en) | 2016-07-13 | 2021-01-19 | Ethicon Llc | Ultrasonic assembly for use with ultrasonic surgical instruments |
US10842522B2 (en) | 2016-07-15 | 2020-11-24 | Ethicon Llc | Ultrasonic surgical instruments having offset blades |
US10376305B2 (en) | 2016-08-05 | 2019-08-13 | Ethicon Llc | Methods and systems for advanced harmonic energy |
US10285723B2 (en) | 2016-08-09 | 2019-05-14 | Ethicon Llc | Ultrasonic surgical blade with improved heel portion |
WO2018027788A1 (en) | 2016-08-11 | 2018-02-15 | Covidien Lp | Endoscopic surgical clip applier and clip applying systems |
USD847990S1 (en) | 2016-08-16 | 2019-05-07 | Ethicon Llc | Surgical instrument |
US10828056B2 (en) | 2016-08-25 | 2020-11-10 | Ethicon Llc | Ultrasonic transducer to waveguide acoustic coupling, connections, and configurations |
AU2016420481A1 (en) | 2016-08-25 | 2019-01-17 | Covidien Lp | Endoscopic surgical clip applier and clip applying systems |
US10952759B2 (en) | 2016-08-25 | 2021-03-23 | Ethicon Llc | Tissue loading of a surgical instrument |
US10751117B2 (en) | 2016-09-23 | 2020-08-25 | Ethicon Llc | Electrosurgical instrument with fluid diverter |
CN106361396B (en) * | 2016-09-27 | 2018-11-23 | 熊力 | A kind of liver vessel folder closes device |
US10617409B2 (en) | 2016-10-21 | 2020-04-14 | Covidien Lp | Surgical end effectors |
US10743859B2 (en) | 2016-10-21 | 2020-08-18 | Covidien Lp | Surgical end effectors |
US11298123B2 (en) | 2016-10-21 | 2022-04-12 | Covidien Lp | Surgical end effectors |
US10639044B2 (en) | 2016-10-31 | 2020-05-05 | Covidien Lp | Ligation clip module and clip applier |
US10660651B2 (en) | 2016-10-31 | 2020-05-26 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10492795B2 (en) | 2016-11-01 | 2019-12-03 | Covidien Lp | Endoscopic surgical clip applier |
US10426489B2 (en) | 2016-11-01 | 2019-10-01 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10610236B2 (en) | 2016-11-01 | 2020-04-07 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10966704B2 (en) | 2016-11-09 | 2021-04-06 | Biomet Sports Medicine, Llc | Methods and systems for stitching soft tissue to bone |
US10603064B2 (en) | 2016-11-28 | 2020-03-31 | Ethicon Llc | Ultrasonic transducer |
US11266430B2 (en) | 2016-11-29 | 2022-03-08 | Cilag Gmbh International | End effector control and calibration |
JP6983893B2 (en) | 2016-12-21 | 2021-12-17 | エシコン エルエルシーEthicon LLC | Lockout configuration for surgical end effectors and replaceable tool assemblies |
US10588632B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical end effectors and firing members thereof |
US10675025B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Shaft assembly comprising separately actuatable and retractable systems |
US10588631B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical instruments with positive jaw opening features |
US10675026B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Methods of stapling tissue |
JP2020501779A (en) | 2016-12-21 | 2020-01-23 | エシコン エルエルシーEthicon LLC | Surgical stapling system |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
US10980536B2 (en) | 2016-12-21 | 2021-04-20 | Ethicon Llc | No-cartridge and spent cartridge lockout arrangements for surgical staplers |
US10524789B2 (en) | 2016-12-21 | 2020-01-07 | Ethicon Llc | Laterally actuatable articulation lock arrangements for locking an end effector of a surgical instrument in an articulated configuration |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US10888309B2 (en) | 2017-01-31 | 2021-01-12 | Covidien Lp | Surgical fastener devices with geometric tubes |
US10709455B2 (en) | 2017-02-02 | 2020-07-14 | Covidien Lp | Endoscopic surgical clip applier |
US10758244B2 (en) * | 2017-02-06 | 2020-09-01 | Covidien Lp | Endoscopic surgical clip applier |
WO2018141110A1 (en) | 2017-02-06 | 2018-08-09 | Covidien Lp | Surgical clip applier with user feedback feature |
US10660725B2 (en) | 2017-02-14 | 2020-05-26 | Covidien Lp | Endoscopic surgical clip applier including counter assembly |
US11033325B2 (en) | 2017-02-16 | 2021-06-15 | Cilag Gmbh International | Electrosurgical instrument with telescoping suction port and debris cleaner |
US10603038B2 (en) | 2017-02-22 | 2020-03-31 | Covidien Lp | Surgical clip applier including inserts for jaw assembly |
US10548602B2 (en) | 2017-02-23 | 2020-02-04 | Covidien Lp | Endoscopic surgical clip applier |
US11583291B2 (en) | 2017-02-23 | 2023-02-21 | Covidien Lp | Endoscopic surgical clip applier |
US10799284B2 (en) | 2017-03-15 | 2020-10-13 | Ethicon Llc | Electrosurgical instrument with textured jaws |
US11160559B2 (en) * | 2017-03-21 | 2021-11-02 | Teleflex Medical Incorporated | Clip applier with stabilizing member |
JP6876821B2 (en) | 2017-03-21 | 2021-05-26 | テレフレックス メディカル インコーポレイテッド | Clip applier with replaceable tip |
CN116784923A (en) | 2017-03-21 | 2023-09-22 | 泰利福医疗公司 | Clip applier with stabilizing member |
EP3600083A4 (en) | 2017-03-21 | 2021-03-31 | Teleflex Medical Incorporated | Flexible stabilizing member for a clip applier |
WO2018175610A1 (en) | 2017-03-21 | 2018-09-27 | Teleflex Medical Incorporated | Surgical clip and clip applier |
US20180271526A1 (en) | 2017-03-22 | 2018-09-27 | Covidien Lp | Endoscopic surgical clip applier |
US11497546B2 (en) | 2017-03-31 | 2022-11-15 | Cilag Gmbh International | Area ratios of patterned coatings on RF electrodes to reduce sticking |
US10675043B2 (en) | 2017-05-04 | 2020-06-09 | Covidien Lp | Reposable multi-fire surgical clip applier |
US10722235B2 (en) | 2017-05-11 | 2020-07-28 | Covidien Lp | Spring-release surgical clip |
US11311295B2 (en) | 2017-05-15 | 2022-04-26 | Covidien Lp | Adaptive powered stapling algorithm with calibration factor |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US11141154B2 (en) | 2017-06-27 | 2021-10-12 | Cilag Gmbh International | Surgical end effectors and anvils |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US20190000461A1 (en) | 2017-06-28 | 2019-01-03 | Ethicon Llc | Surgical cutting and fastening devices with pivotable anvil with a tissue locating arrangement in close proximity to an anvil pivot axis |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
US11058424B2 (en) | 2017-06-28 | 2021-07-13 | Cilag Gmbh International | Surgical instrument comprising an offset articulation joint |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
US10603117B2 (en) | 2017-06-28 | 2020-03-31 | Ethicon Llc | Articulation state detection mechanisms |
EP4070740A1 (en) | 2017-06-28 | 2022-10-12 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US10660723B2 (en) | 2017-06-30 | 2020-05-26 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10639032B2 (en) | 2017-06-30 | 2020-05-05 | Covidien Lp | Endoscopic surgical clip applier including counter assembly |
US10820920B2 (en) | 2017-07-05 | 2020-11-03 | Ethicon Llc | Reusable ultrasonic medical devices and methods of their use |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US10675112B2 (en) | 2017-08-07 | 2020-06-09 | Covidien Lp | Endoscopic surgical clip applier including counter assembly |
US10932790B2 (en) | 2017-08-08 | 2021-03-02 | Covidien Lp | Geared actuation mechanism and surgical clip applier including the same |
US10863992B2 (en) | 2017-08-08 | 2020-12-15 | Covidien Lp | Endoscopic surgical clip applier |
US10786262B2 (en) | 2017-08-09 | 2020-09-29 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10786263B2 (en) | 2017-08-15 | 2020-09-29 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10835341B2 (en) | 2017-09-12 | 2020-11-17 | Covidien Lp | Endoscopic surgical clip applier and handle assemblies for use therewith |
US10835260B2 (en) | 2017-09-13 | 2020-11-17 | Covidien Lp | Endoscopic surgical clip applier and handle assemblies for use therewith |
US10758245B2 (en) | 2017-09-13 | 2020-09-01 | Covidien Lp | Clip counting mechanism for surgical clip applier |
US10653429B2 (en) | 2017-09-13 | 2020-05-19 | Covidien Lp | Endoscopic surgical clip applier |
US11490951B2 (en) | 2017-09-29 | 2022-11-08 | Cilag Gmbh International | Saline contact with electrodes |
US11033323B2 (en) | 2017-09-29 | 2021-06-15 | Cilag Gmbh International | Systems and methods for managing fluid and suction in electrosurgical systems |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
US11484358B2 (en) | 2017-09-29 | 2022-11-01 | Cilag Gmbh International | Flexible electrosurgical instrument |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US20190125320A1 (en) | 2017-10-30 | 2019-05-02 | Ethicon Llc | Control system arrangements for a modular surgical instrument |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US11207066B2 (en) | 2017-10-30 | 2021-12-28 | Covidien Lp | Apparatus for endoscopic procedures |
CN111526810A (en) * | 2017-10-30 | 2020-08-11 | 爱惜康有限责任公司 | Surgical instrument system including lockout mechanism |
US10987104B2 (en) | 2017-10-30 | 2021-04-27 | Covidien Lp | Apparatus for endoscopic procedures |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US10945734B2 (en) | 2017-11-03 | 2021-03-16 | Covidien Lp | Rotation knob assemblies and surgical instruments including the same |
US11376015B2 (en) * | 2017-11-03 | 2022-07-05 | Covidien Lp | Endoscopic surgical clip applier and handle assemblies for use therewith |
US10828036B2 (en) * | 2017-11-03 | 2020-11-10 | Covidien Lp | Endoscopic surgical clip applier and handle assemblies for use therewith |
US11116513B2 (en) | 2017-11-03 | 2021-09-14 | Covidien Lp | Modular surgical clip cartridge |
US10932791B2 (en) | 2017-11-03 | 2021-03-02 | Covidien Lp | Reposable multi-fire surgical clip applier |
US10722236B2 (en) | 2017-12-12 | 2020-07-28 | Covidien Lp | Endoscopic reposable surgical clip applier |
US10849630B2 (en) | 2017-12-13 | 2020-12-01 | Covidien Lp | Reposable multi-fire surgical clip applier |
US10743887B2 (en) | 2017-12-13 | 2020-08-18 | Covidien Lp | Reposable multi-fire surgical clip applier |
US10959737B2 (en) | 2017-12-13 | 2021-03-30 | Covidien Lp | Reposable multi-fire surgical clip applier |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US10682134B2 (en) | 2017-12-21 | 2020-06-16 | Ethicon Llc | Continuous use self-propelled stapling instrument |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US11864728B2 (en) | 2017-12-28 | 2024-01-09 | Cilag Gmbh International | Characterization of tissue irregularities through the use of mono-chromatic light refractivity |
US11672605B2 (en) | 2017-12-28 | 2023-06-13 | Cilag Gmbh International | Sterile field interactive control displays |
US11903601B2 (en) | 2017-12-28 | 2024-02-20 | Cilag Gmbh International | Surgical instrument comprising a plurality of drive systems |
US11013563B2 (en) | 2017-12-28 | 2021-05-25 | Ethicon Llc | Drive arrangements for robot-assisted surgical platforms |
US11896322B2 (en) | 2017-12-28 | 2024-02-13 | Cilag Gmbh International | Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub |
US11051827B2 (en) | 2018-01-16 | 2021-07-06 | Covidien Lp | Endoscopic surgical instrument and handle assemblies for use therewith |
CN108420506B (en) * | 2018-03-21 | 2023-11-24 | 汕头大学 | But washing attracts and quick replacement catheter's abdominal cavity pincers |
WO2019191271A1 (en) | 2018-03-28 | 2019-10-03 | Datascope Corp. | Device for atrial appendage exclusion |
US10993721B2 (en) | 2018-04-25 | 2021-05-04 | Covidien Lp | Surgical clip applier |
US11298126B2 (en) | 2018-05-02 | 2022-04-12 | Covidien Lp | Shipping wedge for end effector installation onto surgical devices |
US11116500B2 (en) | 2018-06-28 | 2021-09-14 | Covidien Lp | Surgical fastener applying device, kits and methods for endoscopic procedures |
US11497490B2 (en) | 2018-07-09 | 2022-11-15 | Covidien Lp | Powered surgical devices including predictive motor control |
US10786273B2 (en) | 2018-07-13 | 2020-09-29 | Covidien Lp | Rotation knob assemblies for handle assemblies |
US11259887B2 (en) | 2018-08-10 | 2022-03-01 | Covidien Lp | Feedback mechanisms for handle assemblies |
US11219463B2 (en) | 2018-08-13 | 2022-01-11 | Covidien Lp | Bilateral spring for surgical instruments and surgical instruments including the same |
US11278267B2 (en) | 2018-08-13 | 2022-03-22 | Covidien Lp | Latch assemblies and surgical instruments including the same |
US11051828B2 (en) | 2018-08-13 | 2021-07-06 | Covidien Lp | Rotation knob assemblies and surgical instruments including same |
US11033256B2 (en) | 2018-08-13 | 2021-06-15 | Covidien Lp | Linkage assembly for reusable surgical handle assemblies |
US11344316B2 (en) | 2018-08-13 | 2022-05-31 | Covidien Lp | Elongated assemblies for surgical clip appliers and surgical clip appliers incorporating the same |
US11253267B2 (en) | 2018-08-13 | 2022-02-22 | Covidien Lp | Friction reduction mechanisms for handle assemblies |
US11246601B2 (en) | 2018-08-13 | 2022-02-15 | Covidien Lp | Elongated assemblies for surgical clip appliers and surgical clip appliers incorporating the same |
WO2020034130A1 (en) * | 2018-08-16 | 2020-02-20 | 台湾先进手术医疗器材股份有限公司 | Driving device of vascular clip applier |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US11147566B2 (en) | 2018-10-01 | 2021-10-19 | Covidien Lp | Endoscopic surgical clip applier |
US11197734B2 (en) | 2018-10-30 | 2021-12-14 | Covidien Lp | Load sensing devices for use in surgical instruments |
US11369372B2 (en) | 2018-11-28 | 2022-06-28 | Covidien Lp | Surgical stapler adapter with flexible cable assembly, flexible fingers, and contact clips |
CN109674500A (en) * | 2018-12-25 | 2019-04-26 | 上海逸思医疗科技有限公司 | A kind of safety device of surgical instruments |
US11141777B2 (en) | 2018-12-31 | 2021-10-12 | Cilag Gmbh International | Multi-piece jaw assembly for surgical clip applier |
US11202635B2 (en) | 2019-02-04 | 2021-12-21 | Covidien Lp | Programmable distal tilt position of end effector for powered surgical devices |
US11376006B2 (en) | 2019-02-06 | 2022-07-05 | Covidien Lp | End effector force measurement with digital drive circuit |
US11259807B2 (en) | 2019-02-19 | 2022-03-01 | Cilag Gmbh International | Staple cartridges with cam surfaces configured to engage primary and secondary portions of a lockout of a surgical stapling device |
US11219461B2 (en) | 2019-03-08 | 2022-01-11 | Covidien Lp | Strain gauge stabilization in a surgical device |
US11524398B2 (en) | 2019-03-19 | 2022-12-13 | Covidien Lp | Gear drive mechanisms for surgical instruments |
US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11523817B2 (en) | 2019-06-27 | 2022-12-13 | Covidien Lp | Endoluminal pursestring device |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11853835B2 (en) | 2019-06-28 | 2023-12-26 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11241235B2 (en) | 2019-06-28 | 2022-02-08 | Cilag Gmbh International | Method of using multiple RFID chips with a surgical assembly |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11298132B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Inlernational | Staple cartridge including a honeycomb extension |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
USD944984S1 (en) | 2019-12-19 | 2022-03-01 | Covidien Lp | Tubular positioning guide |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
USD944985S1 (en) | 2019-12-19 | 2022-03-01 | Covidien Lp | Positioning guide cuff |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11197675B2 (en) | 2019-12-19 | 2021-12-14 | Covidien Lp | Positioning guide for surgical instruments and surgical instrument systems |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US11684412B2 (en) | 2019-12-30 | 2023-06-27 | Cilag Gmbh International | Surgical instrument with rotatable and articulatable surgical end effector |
US20210196359A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instruments with electrodes having energy focusing features |
US11723716B2 (en) | 2019-12-30 | 2023-08-15 | Cilag Gmbh International | Electrosurgical instrument with variable control mechanisms |
US11779387B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Clamp arm jaw to minimize tissue sticking and improve tissue control |
US11812957B2 (en) | 2019-12-30 | 2023-11-14 | Cilag Gmbh International | Surgical instrument comprising a signal interference resolution system |
US11786291B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Deflectable support of RF energy electrode with respect to opposing ultrasonic blade |
US11911063B2 (en) | 2019-12-30 | 2024-02-27 | Cilag Gmbh International | Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade |
US11696776B2 (en) | 2019-12-30 | 2023-07-11 | Cilag Gmbh International | Articulatable surgical instrument |
US11660089B2 (en) | 2019-12-30 | 2023-05-30 | Cilag Gmbh International | Surgical instrument comprising a sensing system |
US11759251B2 (en) | 2019-12-30 | 2023-09-19 | Cilag Gmbh International | Control program adaptation based on device status and user input |
US11779329B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a flex circuit including a sensor system |
US11452525B2 (en) | 2019-12-30 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising an adjustment system |
US11779340B2 (en) | 2020-01-02 | 2023-10-10 | Covidien Lp | Ligation clip loading device |
US11723669B2 (en) | 2020-01-08 | 2023-08-15 | Covidien Lp | Clip applier with clip cartridge interface |
US11458244B2 (en) | 2020-02-07 | 2022-10-04 | Covidien Lp | Irrigating surgical apparatus with positive pressure fluid |
US11553913B2 (en) | 2020-02-11 | 2023-01-17 | Covidien Lp | Electrically-determining tissue cut with surgical stapling apparatus |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
US11622768B2 (en) | 2020-07-13 | 2023-04-11 | Covidien Lp | Methods and structure for confirming proper assembly of powered surgical stapling systems |
US20220031351A1 (en) | 2020-07-28 | 2022-02-03 | Cilag Gmbh International | Surgical instruments with differential articulation joint arrangements for accommodating flexible actuators |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
US11717289B2 (en) | 2020-10-29 | 2023-08-08 | Cilag Gmbh International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
US11617577B2 (en) | 2020-10-29 | 2023-04-04 | Cilag Gmbh International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
US11653919B2 (en) | 2020-11-24 | 2023-05-23 | Covidien Lp | Stapler line reinforcement continuity |
US11744580B2 (en) | 2020-11-24 | 2023-09-05 | Covidien Lp | Long stapler reloads with continuous cartridge |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11655792B2 (en) | 2021-04-30 | 2023-05-23 | Trillium Worldwide, Inc. | Voltage sensing mechanism |
US20220378424A1 (en) | 2021-05-28 | 2022-12-01 | Cilag Gmbh International | Stapling instrument comprising a firing lockout |
US11684362B2 (en) | 2021-06-07 | 2023-06-27 | Covidien Lp | Handheld electromechanical surgical system |
US11771432B2 (en) | 2021-06-29 | 2023-10-03 | Covidien Lp | Stapling and cutting to default values in the event of strain gauge data integrity loss |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11832823B2 (en) | 2022-02-08 | 2023-12-05 | Covidien Lp | Determination of anvil release during anastomosis |
Family Cites Families (79)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2968041A (en) * | 1958-09-25 | 1961-01-17 | John F Skold | Applicator for surgical clamps |
US3777538A (en) * | 1972-03-15 | 1973-12-11 | Weck & Co Edward | Surgical clip applicator |
US3780416A (en) * | 1972-07-10 | 1973-12-25 | G Rider | Surgical tubing clip clenching tool |
US4027510A (en) * | 1974-05-15 | 1977-06-07 | Siegfried Hiltebrandt | Forceps |
US3955581A (en) * | 1974-10-18 | 1976-05-11 | United States Surgical Corporation | Three-stage surgical instrument |
US4412539A (en) * | 1976-10-08 | 1983-11-01 | United States Surgical Corporation | Repeating hemostatic clip applying instruments and multi-clip cartridges therefor |
US4226242A (en) * | 1977-09-13 | 1980-10-07 | United States Surgical Corporation | Repeating hemostatic clip applying instruments and multi-clip cartridges therefor |
US4166466A (en) * | 1976-10-08 | 1979-09-04 | Jarvik Robert K | Repeating hemostatic clip applying instruments and multi-clip cartridges therefor |
US4188953A (en) * | 1977-08-05 | 1980-02-19 | Charles H. Klieman, M.D. | Hemostatic clip |
CA1082552A (en) * | 1977-08-05 | 1980-07-29 | Charles H. Klieman | Hemostatic clip applicator |
US4452376A (en) * | 1977-08-05 | 1984-06-05 | Charles H. Klieman | Hemostatic clip applicator |
US4611595A (en) * | 1977-08-05 | 1986-09-16 | Charles H. Klieman | Spring activated hemostatic clip applicator |
US4316468A (en) * | 1977-08-05 | 1982-02-23 | Charles H. Klieman | Surgical stapler |
US4242902A (en) * | 1978-05-11 | 1981-01-06 | United States Surgical Corporation | Surgical clip applicator |
US4152920A (en) * | 1977-10-17 | 1979-05-08 | United States Surgical Corporation | System for applying surgical clips |
US4196836A (en) * | 1978-02-14 | 1980-04-08 | Senco Products Inc. | Surgical stapling instrument |
US4185762A (en) * | 1978-03-27 | 1980-01-29 | Minnesota Mining And Manufacturing Company | Medical stapling device |
US4228895A (en) * | 1979-04-02 | 1980-10-21 | American Cyanamid Company | Magazine tape containing a plurality of hemostatic clips |
US4246903A (en) * | 1979-04-02 | 1981-01-27 | American Cyanamid Company | Surgical instrument to apply a hemostatic clip to a vessel and method of using the same |
US4299224A (en) * | 1979-06-06 | 1981-11-10 | United States Surgical Corporation | Disposable clip applier |
US4372316A (en) * | 1979-08-02 | 1983-02-08 | Blake Joseph W Iii | Surgical device |
US4296751A (en) * | 1979-08-02 | 1981-10-27 | Blake Joseph W Iii | Surgical device |
US4532925A (en) * | 1979-08-02 | 1985-08-06 | Joseph W. Blake, III | Ligator device |
US4452357A (en) * | 1980-07-22 | 1984-06-05 | Charles H. Klieman | Surgical stapler |
US4430997A (en) * | 1980-11-19 | 1984-02-14 | Ethicon, Inc. | Multiple clip applier |
US4522207A (en) * | 1981-02-06 | 1985-06-11 | Charles H. Klieman | Spring activated hemostatic clip applicator |
US4646740A (en) * | 1981-02-23 | 1987-03-03 | Edward Weck & Co., Inc. | Automatic hemoclip applier |
US4394864A (en) * | 1981-04-15 | 1983-07-26 | Jeffrey Sandhaus | Apparatus and method for effecting occlusion of the vas deferens |
US4662373A (en) * | 1981-06-29 | 1987-05-05 | American Cyanamid Company | Surgical ligating instrument |
US4576166A (en) * | 1981-06-29 | 1986-03-18 | American Cyanamid Company | Surgical ligating instrument |
AR230173A1 (en) * | 1981-06-29 | 1984-03-01 | American Cyanamid Co | INSTRUMENT FOR SURGICAL LINKS |
US4471780A (en) * | 1982-02-05 | 1984-09-18 | Ethicon, Inc. | Multiple ligating clip applier instrument |
US4480641A (en) * | 1982-02-05 | 1984-11-06 | Ethicon, Inc. | Tip configuration for a ligating clip applier |
US4509518A (en) * | 1982-02-17 | 1985-04-09 | United States Surgical Corporation | Apparatus for applying surgical clips |
US4425915A (en) * | 1982-02-26 | 1984-01-17 | Ethicon, Inc. | Surgical clip applier with in-line cartridge and interruptable biased feeder |
US4450839A (en) * | 1982-02-26 | 1984-05-29 | Ethicon, Inc. | Surgical clip applier with serpentine spring clip feeder |
US4512345A (en) * | 1982-09-30 | 1985-04-23 | United States Surgical Corporation | Surgical clip applying apparatus, and clips and clip train for use therein |
US4492232A (en) * | 1982-09-30 | 1985-01-08 | United States Surgical Corporation | Surgical clip applying apparatus having fixed jaws |
US4674504A (en) * | 1982-10-06 | 1987-06-23 | Klieman Charles H | Spring activated hemostatic clip applicator |
US4534351A (en) * | 1982-10-20 | 1985-08-13 | Senmed, Inc. | Ligator |
US4556058A (en) * | 1983-08-17 | 1985-12-03 | United States Surgical Corporation | Apparatus for ligation and division with fixed jaws |
US4944443A (en) * | 1988-04-22 | 1990-07-31 | Innovative Surgical Devices, Inc. | Surgical suturing instrument and method |
US4549544A (en) * | 1983-10-31 | 1985-10-29 | Senmed, Inc. | Clip stop for a surgical ligating instrument |
US4557263A (en) * | 1984-01-23 | 1985-12-10 | United States Surgical Corporation | Apparatus for applying surgical clips |
US4616650A (en) * | 1984-07-27 | 1986-10-14 | United States Surgical Corporation | Apparatus for applying surgical clips |
US4598711A (en) * | 1984-08-09 | 1986-07-08 | American Cyanamid Company | Surgical instrument |
US4572183A (en) * | 1984-11-26 | 1986-02-25 | Senmed, Inc. | Positive feed system for a surgical ligating instrument |
US5047038A (en) * | 1985-07-01 | 1991-09-10 | Edward Weck Incorporated | Automatic hemostatic clip applier |
US4712549A (en) * | 1985-07-01 | 1987-12-15 | Edward Weck & Co. | Automatic hemostatic clip applier |
US4967949A (en) * | 1986-07-11 | 1990-11-06 | Vastech Medical Products Inc. | Apparatus for effecting occlusion of the vas deferens |
US5067958A (en) * | 1986-07-11 | 1991-11-26 | The Population Counsil, Inc. | Apparatus for effecting occlusion of target vessels or tissue |
US4850355A (en) * | 1987-04-06 | 1989-07-25 | Richard-Allan Medical Industries, Inc. | Hemostatic clip applicator for applying multiple hemostatic clips |
US5100418A (en) * | 1987-05-14 | 1992-03-31 | Inbae Yoon | Suture tie device system and applicator therefor |
US5084057A (en) * | 1989-07-18 | 1992-01-28 | United States Surgical Corporation | Apparatus and method for applying surgical clips in laparoscopic or endoscopic procedures |
US5100420A (en) * | 1989-07-18 | 1992-03-31 | United States Surgical Corporation | Apparatus and method for applying surgical clips in laparoscopic or endoscopic procedures |
US5030226A (en) * | 1988-01-15 | 1991-07-09 | United States Surgical Corporation | Surgical clip applicator |
US5049152A (en) * | 1989-03-07 | 1991-09-17 | Richard-Allan Medical Industries | Hemostatic clip applicator |
US5104395A (en) * | 1989-07-03 | 1992-04-14 | Edward Weck Incorporated | Automatic hemostatic clip applicator |
CA2018472A1 (en) * | 1989-07-03 | 1991-01-03 | Curtis W. Thornton | Automatic hemostatic clip applicator |
US5282807A (en) * | 1990-11-05 | 1994-02-01 | Knoepfler Dennis J | Automatic stapler for laparoscopic procedure with selective cutter, nontraumatic jaws and suction irrigator |
US5104394A (en) * | 1990-11-05 | 1992-04-14 | Knoepfler Dennis J | Automatic stapler for laparoscopic procedure with selective cutter and suction irrigator |
CA2060281A1 (en) * | 1991-02-20 | 1992-08-21 | John C. Phillips | Hemostatic clip applier |
US5176702A (en) * | 1991-04-04 | 1993-01-05 | Symbiosis Corporation | Ratchet locking mechanism for surgical instruments |
US5171247A (en) * | 1991-04-04 | 1992-12-15 | Ethicon, Inc. | Endoscopic multiple ligating clip applier with rotating shaft |
US5246156A (en) * | 1991-09-12 | 1993-09-21 | Ethicon, Inc. | Multiple fire endoscopic stapling mechanism |
US5171249A (en) * | 1991-04-04 | 1992-12-15 | Ethicon, Inc. | Endoscopic multiple ligating clip applier |
US5112343A (en) * | 1991-04-05 | 1992-05-12 | Edward Weck Incorporated | Endoscopic clip appliers |
FR2679763B1 (en) * | 1991-07-31 | 1994-02-04 | Vitacorp | SURGICAL PLIERS FOR POSITIONING SUTURE CLIPS. |
US5356064A (en) * | 1991-10-18 | 1994-10-18 | United States Surgical Corporation | Apparatus and method for applying surgical staples to attach an object to body tissue |
US5199566A (en) * | 1991-10-18 | 1993-04-06 | Ethicon, Inc. | Surgical clip applier |
US5289963A (en) * | 1991-10-18 | 1994-03-01 | United States Surgical Corporation | Apparatus and method for applying surgical staples to attach an object to body tissue |
US5163945A (en) * | 1991-10-18 | 1992-11-17 | Ethicon, Inc. | Surgical clip applier |
US5207691A (en) * | 1991-11-01 | 1993-05-04 | Medical Scientific, Inc. | Electrosurgical clip applicator |
US5290299A (en) * | 1991-12-11 | 1994-03-01 | Ventritex, Inc. | Double jaw apparatus for attaching implanted materials to body tissue |
US5171251A (en) * | 1992-03-02 | 1992-12-15 | Ethicon, Inc. | Surgical clip having hole therein and method of anchoring suture |
US5246450A (en) * | 1992-03-10 | 1993-09-21 | Edward Weck Incorporated | High capacity medical clip feeding and dispensing mechanism |
GR1002336B (en) * | 1992-05-06 | 1996-05-21 | Ethicon Inc. | Endoscopic surgical apparatus capable of ligation and division. |
US5258007A (en) * | 1992-05-14 | 1993-11-02 | Robert F. Spetzler | Powered surgical instrument |
US5192288A (en) * | 1992-05-26 | 1993-03-09 | Origin Medsystems, Inc. | Surgical clip applier |
-
1993
- 1993-10-08 US US08/134,347 patent/US5607436A/en not_active Expired - Lifetime
-
1994
- 1994-09-13 CA CA002131973A patent/CA2131973C/en not_active Expired - Lifetime
- 1994-10-05 ES ES94115677T patent/ES2148263T3/en not_active Expired - Lifetime
- 1994-10-05 EP EP94115677A patent/EP0656190B1/en not_active Expired - Lifetime
- 1994-10-05 DE DE69425417T patent/DE69425417T2/en not_active Expired - Lifetime
-
1995
- 1995-06-07 US US08/476,607 patent/US5792150A/en not_active Expired - Lifetime
-
1996
- 1996-08-01 US US08/691,887 patent/US5755726A/en not_active Expired - Lifetime
Also Published As
Publication number | Publication date |
---|---|
US5792150A (en) | 1998-08-11 |
US5755726A (en) | 1998-05-26 |
EP0656190A3 (en) | 1995-12-13 |
US5607436A (en) | 1997-03-04 |
CA2131973A1 (en) | 1995-04-09 |
DE69425417T2 (en) | 2001-01-25 |
EP0656190B1 (en) | 2000-08-02 |
EP0656190A2 (en) | 1995-06-07 |
DE69425417D1 (en) | 2000-09-07 |
ES2148263T3 (en) | 2000-10-16 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CA2131973C (en) | Apparatus for applying surgical clips | |
US5383881A (en) | Safety device for use with endoscopic instrumentation | |
CA2102346C (en) | Rotatable articulating endoscopic fastening instrument | |
US5300081A (en) | Surgical clip applier having clip advancement control | |
EP0656191B1 (en) | Surgical clip applier | |
CA2157746C (en) | Surgical clip applicator | |
US5340360A (en) | Ligating clip applier | |
US6059799A (en) | Apparatus for applying surgical clips | |
US5437645A (en) | Surgical instrument positioning device | |
CA2107970C (en) | Endoscopic surgical stapling instrument with pivotable and rotatable staple cartridge | |
CA2197152C (en) | Apparatus for applying surgical clips | |
EP0539124B1 (en) | Surgical clip cartridge | |
US5382253A (en) | Clip applier tool | |
US7866526B2 (en) | Apparatus for applying surgical fasteners to body tissue | |
US5382254A (en) | Actuating handle for surgical instruments | |
US5257713A (en) | Surgical fastening device | |
US20030014060A1 (en) | Endoscopic clip applier and method | |
EP0755655A2 (en) | Surgical instrument actuating member and system for connecting different types of instruments | |
JPH0592006A (en) | Device for mounting endoscopic surgical clip | |
JPH06315486A (en) | Operating device method for surgical staples to attach objective to somatic tissue | |
AU700452B2 (en) | Surgical clip magazine |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
EEER | Examination request | ||
MKEX | Expiry |
Effective date: 20140915 |
|
MKEX | Expiry |
Effective date: 20140915 |