Surgical tool

Abstract

A medical instrument comprising: (a) a first joint comprising a first member and a second member, the first member configured to be repositionable with respect to the second member in a first degree of freedom; (b) a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a second degree of freedom; (c) a pair of repositionable jaws operatively coupled to the first joint and the second joint; (d) an open-ended occlusion clip detachably mounted to the pair of repositionable jaws; and, (e) a controller operatively coupled to the first joint, the second joint, and the pair of repositionable jaws, the controller including a first control configured to direct repositioning of at least one of the first member and the second member, and a second control configured to direct repositioning of at least one of the third member and the fourth member, and a third control configured to direct repositioning of the pair of repositionable jaws, the third control including a line operatively coupled to the first and second jaws in at least a gun tackle pulley configuration

What is claimed is: 
     
         1 - 33 . (canceled) 
     
     
         34 . A method of controlling an end effector of a medical instrument that includes a first jaw and a second jaw, the medical instrument including a hand-held device operatively coupled to the end effector, comprising:
 providing a first control of the hand-held device configured to direct repositioning of at least one of a first member and a second member of a first joint of the end effector, the first member and second member being repositionable with respect to one another in a first degree of freedom;   providing a second control of the hand-held device configured to direct repositioning of at least one of a third member and a fourth member of a second joint of the end effector, the third member and fourth member being repositionable with respect to one another, in a second degree of freedom different from the first degree of freedom; and,   providing a third control of the hand-held device configured to direct repositioning of the first jaw with respect to the second jaw, wherein the third control includes a line operatively coupled to the first and second jaws in at least a gun tackle pulley configuration.   
     
     
         35 . The method of  claim 34 , further including providing a fourth control of the hand-held device configured to selectively disengage an open-ended occlusion clip operatively coupled to the first and second jaws. 
     
     
         36 . The method of  claim 34 , wherein:
 the first control includes a first wheel having a first line partially wound therearound, where the first line is also operatively coupled to at least one of the first member and the second member of the first joint of the end effector; and,   the second control includes a second wheel having a second line partially wound therearound, where the second line is also operatively coupled to at least one of the third member and the fourth member of the second joint of the end effector.   
     
     
         37 . The method of  claim 34 , wherein the third control includes a repositionable handle operatively coupled to the hand-held device, the repositionable handle operatively coupled to the line to reposition the first and second jaws between an open non-parallel position and a closed parallel position. 
     
     
         38 - 50 . (canceled) 
     
     
         51 . A method of deploying an occlusion clip comprising:
 inserting an open-ended occlusion clip removably mounted to an end effector deployment device having repositionable jaws through at least one of an incision and a trocar, the occlusion clip and the end effector deployment device mounted to one another when inserted into and through at least one of the incision and the trocar;   repositioning the end effector deployment device to reposition the occlusion clip so an open end of the open-ended occlusion clip is interposed by a portion of a left atrial appendage interposing a base and a tip of the left atrial appendage without passing a tip of the left atrial appendage between opposing clamping surfaces of the occlusion clip and without piercing the left atrial appendage between the occlusion clip;   clamping the left atrial appendage with the open-ended occlusion clip to occlude the left atrial appendage;   disengaging the open-ended occlusion clip from the end effector deployment device; and,   withdrawing the end effector deployment device through at least one of the incision and the trocar.   
     
     
         52 . The method of  claim 51 , wherein the inserting step occurs during at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach. 
     
     
         53 . The method of  claim 51 , further comprising insufflating a thoracic space prior to the inserting step. 
     
     
         54 . The method of  claim 51 , further comprising:
 making an incision as part of a procedure comprising at least one of an open sternotomy, a left thoracotomy, a right thoracotomy, a left port procedure, a right port procedure, a subxiphoid approach, and a transdiaphragmatic approach; and,   introducing a trocar through the incision.   
     
     
         55 . The method of  claim 51 , wherein:
 the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device; and,   repositioning the end effector deployment device step includes actuating at least one of a first control and a second control associated with the hand-held device to actively reposition the end effector within at least one of an X-Y plane and a Y-Z plane with respect to the hand-held device.   
     
     
         56 . The method of  claim 51 , wherein the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, the method further comprising repositioning the open-ended occlusion clip from a compressed position to an expanded position prior to interposing a portion of the left atrial appendage between the opposing clamping surfaces. 
     
     
         57 . The method of  claim 56 , further comprising actuating a handle associated with the hand-held device to direct repositioning of the open-ended occlusion clip between the compressed position and the expanded position. 
     
     
         58 . The method of  claim 57 , wherein:
 actuating the handle causes a pair of jaws associated with the end effector to reposition with respect to one another; and,   the pair of jaws is mounted to the open-ended occlusion clip.   
     
     
         59 . The method of  claim 51 , wherein the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device, the method further comprising rotationally repositioning the open-ended occlusion clip with respect to the left atrial appendage by rotating the hand-held device. 
     
     
         60 . The method of  claim 51 , further comprising grasping the left atrial appendage concurrent with repositioning the end effector deployment device to reposition the occlusion clip so the open end of the open-ended occlusion clip is interposed by the portion of the left atrial appendage. 
     
     
         61 . The method of  claim 51 , further comprising repeating the repositioning and clamping steps prior to the disengaging step. 
     
     
         62 . The method of  claim 51 , further comprising confirming a clamping position of the open-ended occlusion clip is operative to occlude the left atrial appendage using at least one of visualization and a transesophageal echocardiogram. 
     
     
         63 . The method of  claim 51 , wherein:
 the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device; and,   disengaging the open-ended occlusion clip from the end effector deployment device includes actuating a control associated with the hand-held device.   
     
     
         64 . The method of  claim 63 , wherein:
 the control comprises a repositionable tab operatively coupled to a wire, which is operative coupled the end effector and the open-ended occlusion clip; and,   removing the repositionable tab from the hand-held device repositions the wire with respect to at least one loop encompassing at least one of the open-ended occlusion clip and the end effector deployment device in order to disengage the open-ended occlusion clip from the end effector deployment device.   
     
     
         65 . The method of  claim 51 , wherein:
 the inserting step includes inserting the open-ended occlusion clip and the end effector deployment device through the trocar;   the withdrawing step includes withdrawing the end effector deployment device through the trocar; and,   the trocar comprises a twelve millimeter or less diameter orifice.   
     
     
         66 . The method of  claim 51 , wherein:
 the end effector deployment device is mounted to a longitudinal conduit, which is mounted to a hand-held device; and,   the step of repositioning the end effector deployment device to reposition the occlusion clip includes locking a position of the end effect deployment device in at least one of an X-Y plane and a Y-Z plane with respect to the hand-held device.   
     
     
         67 - 97 . (canceled) 
     
     
         98 . A method of deploying an occlusion clip comprising:
 inserting an open-ended occlusion clip removably mounted to an end effector deployment device, having repositionable jaws, through at least one of an incision and a trocar, the open-ended occlusion clip biased to a clamping position;   repositioning the end effector deployment device to counteract a bias of the open-ended occlusion clip and reposition the open-ended occlusion clip to a tissue insertion position where the full bias of the open-ended occlusion clip is not applied to a left atrial appendage tissue;   repositioning the end effector deployment device to reposition the open-ended occlusion clip in the tissue insertion position so a portion of a left atrial appendage between a base and a tip of the left atrial appendage interposes the open-ended occlusion clip without ever having a tip of the left atrial appendage interpose the open-ended occlusion clip; and,   repositioning the open-ended occlusion clip to apply the full bias to the left atrial appendage.   
     
     
         99 - 113 . (canceled)