Endoscopic multiple ligating clip applier

Abstract

An endoscopic clip applying system as described which contains a venting system and a clip applying support system which prevents closure of the mechanism before firing. Also, the system ensures proper loading of the clips and prevents them from falling out during loading. Further, the system describes an easily manufacturable, positively opening system which has minimized size requirements. Furthermore, a lock-out mechanism is provided so that the mechanism may not be inadvertently fired. The shaft resists excessive torque as well as holds the clip in place during firing. There are provisions for sealant and non back-up of the clips, as well as features which make the clip properly placed for closure.

We claim: 
     
       1. An endoscopic mechanism comprising: an actuation mechanism;   an endoscopic portion for insertion inside a body cavity having a proximal end and a distal end, said endoscopic portion including:   a support tube with a tubular cross section, said support tube having an open distal end into which may pass fluids from said body cavity;   a driving mechanism contained in said support tube and connected to said actuation mechanism at said endoscopic portion proximal end;   a plurality of surgical fasteners in said support tube capable of being fastened to body tissue by said driving mechanism at said endoscopic portion distal end: and   a venting mechanism including a passageway through the tubular cross section of said support tube proximally from the open distal end thereof providing communication between the interior of said support tube and the exterior thereof for venting body fluids which may have passed into said support tube through the open distal end thereof.   
     
     
       2. The mechanism of claim 1 wherein said passageway comprises a vent hole in said tubular cross-section and a channel between said vent hole and said distal end, wherein said channel provides a conduit between said vent hole and said distal end. 
     
     
       3. The mechanism of claim 2 further comprising a sealing mechanism at the proximal end of said endoscopic portion and said actuation mechanism and said driving mechanism extending through the sealing mechanism so that different ambient pressures may be maintained within said endoscopic portion and said actuation mechanism. 
     
     
       4. The mechanism of claim 3 wherein said sealing mechanism comprises a resilient sealant fitting within the tubular cross section of said endoscopic portion at its proximal end, with a plurality of chambers surrounded therein, said chamber providing communication between said actuation mechanism and said driving mechanism. 
     
     
       5. The mechanism of claim 1 comprising ligating clip applier wherein said surgical fasteners comprise a plurality of ligating clips each said clip having a pair of legs; and wherein said applier contains: a pair of jaws for closing one of said ligating clips, said jaws forming a pan of said driving mechanism, and actuable by said actuation mechanism and a camming channel surrounding said jaws. 
     
     
       6. The applier of claim 5 including a feed bar containing a support mechanism for maintaining said clip on said jaws, said support mechanism including a pair of outer edges which contact said jaws, and a pair of angled protrusions which contact the legs of said clip. 
     
     
       7. The applier of claim 6 wherein said support mechanism operates in conjunction with a clip returning floor, said floor having a tab which remains in the plane of said clip throughout motion of said jaws, and said tab preventing proximal migration of said clip along said jaws. 
     
     
       8. The applier of claim 6 wherein said support mechanism maintains said jaws in a spaced-apart relationship with said clip between said jaws. 
     
     
       9. The applier of claim 5 wherein said camming channel has a camming surface which corresponds to a camming surface on each of said jaws such that the contact between said camming surfaces causes closure of said jaws. 
     
     
       10. The applier of claim 9 further including a tab within said camming channel which causes said jaws to open when said camming channel is caused to retract in said instrument by said actuation mechanism. 
     
     
       11. The applier of claim 9 further comprising each of said jaws having a distal end within which is held a said clip, and each of said jaw distal ends characterized by a point of contact with the distal end of said opposite jaw, and each said jaw containing an anti-torque post on said jaw, such that said clip may be held on said jaws between each of said jaw distal ends and each of said jaw anti-torque posts. 
     
     
       12. The applier of claim 11 further including a heel on each of said jaws spaced proximally from the corresponding jaw anti-torque post, each of said heels providing an additional point of contact between said jaws. 
     
     
       13. The applier of claim 11 wherein said jaws are held within a shroud, and said shroud having a distal surface in which to hold a blood vessel to be ligated. 
     
     
       14. The applier of claim 11 further including a feed bar forming a part of said driving mechanism, and operable along a path, wherein said clips are held in a stack and the first of said clips is moved from said clip stack to a position between said jaws due to retraction of said feed bar, and further including a lever which moves into the path of said feed bar after the last of said clips has been moved from said clip stack, thereby preventing operation of said feed bar. 
     
     
       15. The applier of claim 14 further including a spring-loaded feeder mechanism having a spring, wherein said lever is pivotably attached to said spring-loaded feeder mechanism, such that said lever is spring-loaded to be held out of the path of said feed bar by said feeder mechanism, such that when said feeder mechanism has moved the last of said clips on a clip stack, said feeder mechanism is inoperative to hold said spring of said feeder mechanism, thereby pivoting said lever into said feed bar path. 
     
     
       16. The endoscopic mechanism of claim 1 wherein said support tube is formed from torque resisting material which prevents deflection of said endoscopic mechanism along said tube during operation of said driving mechanism. 
     
     
       17. The endoscopic mechanism of claim 1 comprising a clip applier such that said fasteners are a plurality of clips on a clip stack and including: a pair of jaws for closing a said clip by operation of said driving mechanism; a transfer mechanism for moving a said clip from said clip stack a feed bar movable between said jaws and said clip stack, and a retaining member on said clip stack to hold said clips within said clip stack, such that said retaining member enables only one of said clips at a time to interact with said transfer mechanism. 
     
     
       18. The applier of claim 17 including a camming surface on said transfer mechanism, wherein said retaining member is moved into a retaining position by said camming surface, such that said retaining member prevents movement of said clips as said transfer mechanism returns to said clip stack in order to retrieve a said clip. 
     
     
       19. The applier of claim 17 further including a timing mechanism on said applier which causes loading of a clip onto said jaws when said jaws are opened to a maximum width, said timing mechanism comprising a blocking component attached to said transfer mechanism and said driving mechanism, such that said blocking component prevents operation of said transfer mechanism during operation of said driving mechanism to close said jaws. 
     
     
       20. The applier of claim 19 further including said timing mechanism interacting with said driving mechanism such that said driving mechanism is moved to a forwardmost position in order to close said jaws, and said driving mechanism prevented from reversing motion until said jaws have been closed on a said clip. 
     
     
       21. The applier of claim 17 wherein said clip stack is a unitary member of said clip applier. 
     
     
       22. A device for applying a plurality of surgical clips seriatim, said device comprising: an elongated shaft assembly containing a jaw member having a pair of spaced apart jaws for receiving a surgical clip therebetween, a clip feed mechanism for storing an array of surgical clips and delivering a clip between said jaws, and a jaw closure mechanism for closing a surgical clip positioned between said jaws; and a handle assembly connected to said shaft assembly containing a single trigger means for actuating said jaw closure mechanism to close a clip positioned in said jaws and for actuating said clip feed mechanism to deliver a clip between said jaws;   said clip feed mechanism including A) an elongated clip track for housing said array of surgical clips in an end-to-end relationship in a first path extending through a first plane, B) spring means for shifting the distal-most clip in said first path out of the plane of said first path and into a second path extending through a second plane generally parallel to the plane of the first path, C) a feed bar member mounted for reciprocating movement in said shaft assembly in said second plane for (a) enabling said spring means to shift the distal-most clip in said first path from said first path into said second path upon proximal movement of said feed bar, and (b) contacting the distal-most clip and advancing same distally into a position between said jaws upon distal movement of said feed bar, and D) said clip: track having an escapement member integral with said clip track that is movable between (a) a tint position extending into said first path so as to engage the leading clip from the array and maintain the array of clips stationary within said first path as the distal-most clip is directed into said jaws, and (b) a second position wherein said escapement member is removed from said first path to allow distal movement of said array of clips.   
     
     
       23. The device as defined in claim 22 wherein the clip track is formed of an integral member having a rectangular cross-section defining a floor, lateral side walls, and a top overlying at least the legs of the clips. 
     
     
       24. The device as defined in claim 22, wherein said escapement member includes an escapement portion that is biased out of said first path toward said second position and is directed into said first path into said first position when said feed bar member contacts said end portion as it moves proximally. 
     
     
       25. The device as defined in claim 24 wherein said escapement portion is bent so as to extend distally and in a direction towards said first path so as to prevent distal movement of the array of clips in said first path. 
     
     
       26. The device as defined in claim 22 wherein said spring means includes a proximal end portion that is secured in said shaft assembly so as to preclude distal or proximal movement thereof and an intermediate portion that is movable between a first position extending into said second path to direct the distal clip thereinto and a second position located out of said second path, said intermediate portion of said spring means being biased toward its first position, said intermediate portion being movable into said second position in response to distal movement of said feed bar member. 
     
     
       27. The device as defined in claim 22 wherein the outer edge portions at the distal end of the feed bar are spaced by a dimension corresponding to the dimension between said spaced jaws and adapted to bear against said jaws as the distal-most clip is advanced between said jaws to prevent said jaws from closing until said feed bar member is withdrawn from between said jaws. 
     
     
       28. The device as defined in claim 27 wherein a distal end portion of said feed bar member contacts said clip positioned between said jaws and prevents proximal movement thereof. 
     
     
       29. A device for applying a plurality of surgical clips seriatim, said device comprising: an elongated shaft assembly containing a jaw member having a pair of spaced apart jaws for receiving a surgical clip therebetween a clip feed mechanism for storing an array of surgical clips and delivering a clip between said jaws, and a jaw closure mechanism for contacting said jaws and closing a surgical clip positioned between said jaws; and   a handle assembly connected to said shaft assembly containing a single trigger means for actuating said jaw closure mechanism to close a clip positioned in said jaws and for actuating said clip feed mechanism to deliver a clip between said jaws;   said jaw member includes a pair of spaced apart arms that define said jaws at a distal end portion thereof, each of said jaws having a distal portion and a proximal portion, said distal portions include a channel for receipt of a portion of a surgical clip therein, said channels having an end wall at the distal end thereof to thereby close said channels, said channels being in a generally parallel facing relationship to one another, said distal and proximal portions of said jaws having outer surfaces, said outer surfaces of said proximal portions defining outer cam surfaces that extend proximally and inwardly, said jaw closure mechanism including means for contacting said cam surfaces of said proximal portions as said jaw closure mechanism moves distally to cause said jaws to move towards one another and close a surgical clip positioned therebetween, said end walls of said channels have inner surfaces that contact one another as said jaws close the surgical clip, and said proximal portions have inner surfaces adjacent the proximal end of said cam surfaces that contact one another as said jaws close the surgical clip.   
     
     
       30. The device as defined in claim 24 in which said elongated shaft assembly has a substantially uniform external diameter throughout its length, and wherein the maximum width between the outer surfaces of said jaws in their open position is relatively the same as the external diameter of said elongated shaft assembly. 
     
     
       31. The device as defined in claim 24 wherein said elongated shaft assembly includes, an outer tubular non-resilient member to provide resistance to bending. 
     
     
       32. The device as defined in claim 24 in which said jaw closure mechanism includes a cam channel having an integral jaw engaging mechanism, said jaw engaging mechanism forming a box-shaped element having a pair of lateral sides, a top and a bottom, said lateral sides capable of engaging said cam surfaces, and having folded members to complete said box, said folded members being joined by a dovetail joint. 
     
     
       33. The device as defined in claim 24 wherein each of said jaws includes inwardly extending projections located adjacent the distal end of said cam surfaces, said inwardly extending projections contact one another as the jaws close the surgical clip. 
     
     
       34. An instrument adapted for use in an insufflated body cavity comprising: an elongated tubular member having a distal working end containing an operating means adapted to be inserted into the body cavity and a proximal end adapted to be manipulated by a surgeon; at least one actuating element connecting said operating means and said proximal end mounted for movement within said tubular member: means within said tubular member for sealing said tubular member against loss of gas from said insufflated body cavity, said sealing means including a housing within said tubular member between the distal and proximal ends thereof and disposed in sealed relationship with said tubular member and said actuating element; said housing including a sidewall, end walls, and divider walls which cooperate to define a central chamber and end chambers at opposite sides of said central chamber, said end and divider walls including clearance openings accommodating said actuating element, and means in said sidewalls for permitting sealant material to be inserted into said central chamber. 
     
     
       35. An instrument as defined in claim 34 in which said actuating element is mounted for reciprocating movement within said tubular member, and wherein the openings in said end walls and divider walls are aligned with one another to accommodate said actuating element. .[.36. In combination: a surgical trocar including a tubular cannula having a given internal diameter: and   an endoscopic multiple clip applier comprising, an elongated shaft assembly including a jaw member having a pair of spaced apart jaws for receiving a surgical clip therebetween, said jaws extending outwardly from the distal end of said shaft assembly, said shaft assembly being generally cylindrical throughout its length and having an external diameter which permits said shaft assembly to be inserted into, and withdrawn from, said trocar cannula a clip feed mechanism for storing an array of surgical clips within said elongated shaft assembly and for delivering a clip between said jaws, a jaw closure mechanism for moving said jaws from an open clip holding position to a closed clip closing position to apply a clip to body tissue, said jaws having a maximum width dimension between the outer surfaces in the open position that is no greater than the internal diameter of said trocar cannula and relatively the same as the outer diameter of said shaft assembly so that said shaft assembly with a clip positioned between said jaws can be inserted into, and withdrawn from, said trocar cannula without closing said jaws, and a handle assembly connected to said shaft assembly and containing a single trigger means operable to first actuate said jaw closure mechanism and close a clip positioned between said jaws and to thereafter automatically actuate said clip feeding mechanism to feed and position between said jaws the next   
     
     
        clip from said array of clips..].37. A device for applying a plurality of surgical clips seriatim, said device comprising: a) an elongated shaft assembly having an outer diameter including: (i) a jaw member having at its distal portion a pair of spaced apart jaws for receiving a surgical clip between said jaws, said jaws being narrowly configured so that the greatest distance between the outer surfaces of said jaws at their fully open position is relatively the same as the outer diameter of said elongated shaft assembly, said jaws having channels in a generally parallel relationship for the receipt of a surgical clip therein, and said jaw member including a pair of proximally extending spaced apart jaw arms, said jaw arms each having a primary heel located proximally of said jaws that is defined as an inner surface in each jaw arm which contacts the corresponding inner surface in the opposite jaw am as the jaws close a surgical clip;   (ii) a clip feed mechanism for storing an array of surgical clips and delivering a clip between said jaws, said clip feed mechanism including: (A) an elongated clip track for housing said array of surgical clips in a first path extending through a first plane with said dips arranged end-to-end with their legs facing the distal end of the device, (B) spring means for shifting the distal-most clip in said first path out of the plane of said first path and into a second path extending through a second plane generally parallel to the plane of the first path, (C) a feed bar member positioned in said second plane such that proximal movement of said feed bar member enables said spring means to shift said distal-most clip in said first path from said first path into said second path and such that distal movement of said feed bar member advances said distal-most clip into a position between said jaws, (D) an escapement member associated with said dip track which is movable between (1) a first position extending into said first path so as to maintain the array of clips stationary within said first path, and (2) a second position wherein said escapement member is removed from said first path to allow distal movement of said array of clips;   (iii) a jaw closure mechanism for closing a surgical clip positioned between .said jaws including a cam channel having an integral jaw engaging mechanism, said cam channel including a box-shaped element with a pair of lateral sides, a top and a bottom, said lateral sides capable of engaging the outer surfaces of the proximal portions of said jaws and said top having a folded member to complete said box, said folded member being formed as a dovetail joint;   (iv) a gaseous sealing structure comprising a housing which includes a sidewall, endwalls and divider walls which cooperate to define a central chamber, and end chambers at opposite ends of said central chamber, said end and divider walls including clearance openings for accommodating movement of said clip feed mechanism and said jaw closure mechanism, said sidewall having apertures for permitting sealant material to be inserted into said central chamber; and     (b) a handle assembly connected to said shaft assembly containing a single trigger means for actuating said jaw cam channel to close a clip positioned in said jaws and for actuating the distal and proximal movements of said feed bar member to deliver a clip between said jaws.   
     
     
            The device as defined in claim 37 wherein said elongated shaft assembly includes an outer non-resilient tube to provide resistance to 
     
     
        bending. 39. The device as defined in claim 37 wherein the distal end of said feed bar member is dimensioned such that the width of said feed bar 
     
     
        member is approximately the same as the width of said clips. 40. The device as defined in claim 37 wherein the distal end of said feed bar member is configured to contact the distal-most clip at the outer edges of 
     
     
        said clip. 41. The device as defined in claim 37 wherein the outer surfaces of the distal end of said feed bar member bear against the inner surfaces of said jaws to prevent said jaws from closing when a clip is 
     
     
        positioned in said jaws. 42. The device as defined in claim 37 wherein said clip track is comprised of a one-piece channel having a generally rectilinear cross-section dimensioned to prevent misalignment of surgical 
     
     
        clips in said array of surgical clips. 43. The device as defined in claim 37 wherein said elongated shaft assembly contains openings distal to said gaseous sealing structure to allow the passage of fluids into and out of 
     
     
        the elongated shaft. 44. The device as defined in claim 37 wherein each of said channels having an end wall at a distal end thereof to close said channels, said end walls having inner surfaces that contact one another as 
     
     
        the jaws close a surgical clip. .Iadd.45.  In combination: a surgical trocar including a tubular cannula having a given internal diameter; and   an endoscopic multiple clip applier comprising, an elongated shaft assembly including a jaw member having a pair of spaced apart jaws for receiving a surgical clip therebetween, said surgical clip having spaced apart legs having outer surfaces, the width dimension of said outer surfaces of said legs of said clip being approximately one-half the maximum width dimension of the outer surfaces of said spaced apart jaws, said jaws extending outwardly from the distal end of said shaft assembly, said shaft assembly being generally cylindrical throughout its length and having an external diameter which permits said shaft assembly to be inserted into, and withdrawn from, said trocar cannula, a clip feed mechanism for storing an array of said surgical clips within said elongated shaft assembly and for delivering a clip between said jaws, a jaw closure mechanism for moving said jaws from an open clip holding position to a closed clip closing position to apply one of said clips to body tissue, said jaws having a maximum width dimension between the outer surfaces in the open position that is no greater than the internal diameter of said trocar cannula and relatively the same as the outer diameter of said shaft assembly so that said shaft assembly with one of said clips positioned between said jaws can be inserted into, and withdrawn from, said trocar cannula without closing said jaws, and a handle assembly connected to said shaft assembly and containing a single trigger operable to first actuate said jaw closure mechanism and close the clip positioned between said jaws and to thereafter automatically actuate said clip feeding mechanism to feed and position between said jaws the next of said clips from said array of clips..Iaddend..Iadd.46. The combination of claim 45 wherein said external diameter of said shaft assembly of said endoscopic multiple clip applier is in close fitting relationship with the internal diameter of said trocar cannula..Iaddend..Iadd.47. The combination of claim 45 wherein said clip feed mechanism comprises a clip track disposed within said elongated shaft assembly having said array of surgical clips stored therein in an end-to-end relationship, and a feed bar disposed within said elongated shaft assembly for reciprocating movement between a first position wherein said feed bar is engageable with a distal clip in said array of surgical clips and a second position wherein said feed bar is adjacent said jaws and said distal clip is separated from said array and is positioned between said jaws..Iaddend..Iadd.48. The combination of claim 47 wherein said jaw member comprises a proximal portion having outer surfaces that define outer cam surfaces that extend proximally and inwardly, and said jaw closure mechanism includes a member that contacts said outer cam surfaces as said jaw closure mechanism moves distally to cause said jaws to move towards one another and close a surgical clip positioned therebetween. .Iadd.49. In combination:   a surgical trocar including a tubular cannula having a given internal diameter; and   an endoscopic multiple clip applier comprising, an elongated shaft assembly including a jaw member having a pair of spaced apart jaws for receiving a surgical clip therebetween, said jaws extending outwardly from the distal end of said shaft assembly, said shaft assembly being generally cylindrical throughout its length and having an external diameter which permits said shaft assembly to be inserted into, and withdrawn from, said trocar cannula, a clip feed mechanism for storing an array of surgical clips within said elongated shaft assembly and for delivering a clip between said jaws, a jaw closure mechanism for moving said jaws from an open clip holding position to a closed clip closing position to apply a clip to body tissue, said jaws having a maximum width dimension between the outer surfaces in the open position that is no greater than the internal diameter of said trocar cannula and relatively the same as the outer diameter of said shaft assembly so that said shaft assembly with a clip positioned between said jaws can be inserted into, and withdrawn from, said trocar cannula without closing said jaws, said jaw member including a pair of proximally extending spaced apart arms each having an inner surface located proximally of said jaws which initially contacts the corresponding inner surface of the opposite jaw arm prior to final closure of a surgical clip by said jaws, and a handle assembly connected to said shaft assembly and containing a single trigger operable to first actuate said jaw closure mechanism and close a clip positioned between said jaws and to thereafter automatically actuate said clip feeding mechanism to feed and position between said jaws the next clip from said array of   
     
     
        clips..Iaddend..Iadd.50.  The combination of claim 49 wherein the external diameter of said shaft assembly of said endoscopic multiple clip applier is in close fitting relationship with the internal diameter of said trocar cannula..Iaddend..Iadd.51. The combination of claim 49 wherein said clip feed mechanism comprises a clip track disposed within said elongated shaft assembly having an array of surgical clips stored therein in an end-to-end relationship, and a feed bar disposed within said elongated shaft for reciprocating movement between a first position wherein said feed bar is engageable with a distal clip in said array of surgical clips and a second position wherein said feed bar is adjacent said jaws and said distal clip is separated from said array and is positioned between said jaws..Iaddend..Iadd.52. The combination of claim 51 wherein said jaw closure mechanism comprises a proximal portion having outer surfaces that define outer cam surfaces that extend proximally ad inwardly, and said jaw closure mechanism includes a member that contacts said cam surfaces as said jaw closure mechanism moves distally to cause said jaws to move towards one another and close a surgical clip positioned 
     
     
        therebetween..Iaddend..Iadd.53.  In combination: a surgical trocar including a tubular cannula having a given internal diameter; and   an endoscopic multiple clip applier comprising, an elongated shaft assembly including a jaw member having a pair of spaced apart jaws for receiving a surgical clip therebetween, said surgical clip having spaced apart legs having outer surfaces, the width dimension of said outer surfaces of said legs of said clip being approximately one-half the maximum width dimension of the outer surfaces of said spaced apart jaws, said jaws extending outwardly from the distal end of said shaft assembly, said shaft assembly being generally cylindrical throughout its length and having an external diameter which permits said shaft assembly to be inserted into, and withdrawn from, said trocar cannula, the external diameter of said shaft assembly being in close fitting relationship with the internal diameter of said trocar cannula, a clip feed mechanism for storing an array of said surgical clips within said elongated shaft assembly and for delivering a clip between said jaws, a jaw closure mechanism for moving said jaws from an open clip holding position to a closed clip closing position to apply one of said clips to body tissue, said jaws having a maximum width dimension between the outer surfaces in the open position that is no greater than the internal diameter of said trocar cannula and relatively the same as the outer diameter of said shaft assembly so that said shaft assembly with one of said clips positioned between said jaws can be inserted into, and withdrawn from, said trocar cannula without closing said jaws, said jaw member including a pair of proximally extending spaced apart arms each having an inner surface located proximally of said jaws which initially contacts the corresponding inner surface of the opposite jaw arm prior to final closure of a surgical clip by said jaws, and a handle assembly connected to said shaft assembly and containing a single trigger operable to first actuate said jaw closure mechanism and close the clip positioned between said jaws and to hereinafter automatically actuate said clip feeding mechanism to feed and position between said jaws the next of said clips from said array of clips..Iaddend.