阅读说明：本技术 包括可运动夹具匣的夹具施放器 (Clip applier including movable clip magazine ) 是由 F·E·谢尔顿四世 D·J·穆莫 J·L·哈里斯 G·J·巴克斯 于 2018-10-29 设计创作，主要内容包括：本发明公开了一种用于夹持组织的外科装置。该外科装置包括壳体,从壳体延伸的轴,从轴延伸的端部执行器,马达,被构造成能够响应于马达而旋转的旋转输入件,以及具有多个夹具的夹具匣。轴限定轴轴线。夹具匣可操作地连接到旋转输入件。夹具匣能够响应于旋转输入件的旋转而沿第一方向运动通过夹具进给冲程。夹具匣能够响应于旋转输入件的旋转而沿第二方向运动。第二方向横向于第一方向。(A surgical device for clamping tissue is disclosed. The surgical device includes a housing, a shaft extending from the housing, an end effector extending from the shaft, a motor, a rotary input configured to rotate in response to the motor, and a clip cartridge having a plurality of clips. The shaft defines a shaft axis. The gripper box is operatively connected to the rotary input. The clip magazine is movable in a first direction through a clip feed stroke in response to rotation of the rotary input. The gripper cartridge is movable in a second direction in response to rotation of the rotary input. The second direction is transverse to the first direction.)

1. A surgical device for clamping tissue, comprising:

a housing;

a shaft extending from the housing, wherein the shaft defines a shaft axis;

an end effector extending from the shaft;

a motor;

a rotational input configured to rotate in response to the motor; and

a gripper magazine comprising a plurality of grippers, wherein the gripper magazine is operably connected to the rotary input, wherein the gripper magazine is movable in a first direction through a gripper feed stroke in response to rotation of the rotary input, wherein the gripper magazine is movable in a second direction in response to rotation of the rotary input, and wherein the second direction is transverse to the first direction.

2. The surgical device of claim 1, wherein the first direction is translation along the shaft axis, and wherein the second direction is rotation about the shaft axis.

3. The surgical device of claim 2, wherein the end effector comprises:

a loading portion configured to receive a clip from the clip magazine;

a receiving section; and

a firing drive configured to advance the clip from the loading portion into the receiving portion.

4. The surgical device of claim 3, wherein the plurality of clips are biased outwardly relative to the shaft axis, and wherein as the clip magazine rotates about the shaft axis, the clips are biased into the loading portion when the clips and the loading portion are aligned.

5. The surgical device of claim 4, wherein the clip cartridge is prevented from rotating when the clip is positioned in the loading portion.

6. The surgical device of claim 5, wherein after the clips in the loading portion are advanced into the receiving portion, the clip magazine is rotatable by the rotational input to align another of the clips with the loading portion to bias the other clip into the loading portion.

7. The surgical device of claim 1, wherein the clip magazine comprises at least two storage locations for the plurality of clips, and wherein each storage location comprises at least two clips in a clip stack.

8. The surgical device of claim 1, wherein a first amount of rotation of the rotational input moves the clip magazine in the first direction, and wherein a second amount of rotation of the rotational input moves the clip magazine in the second direction.

9. A surgical device for clamping tissue, comprising:

a housing including a motor;

a shaft extending from the housing, wherein the shaft defines a shaft axis and includes a loading portion;

an end effector extending from the shaft;

a rotational input configured to rotate in response to the motor, wherein the rotational input comprises a first cam lobe; and

a gripper box comprising a plurality of grippers and a second cam lobe, wherein the first cam lobe is configured to engage the second cam lobe to translate the gripper box from a fully retracted position to a fully advanced position in response to rotation of the rotary input in a first direction, and wherein a first of the grippers from the gripper box is aligned with the loaded portion of the shaft when the gripper box is in the fully advanced position.

10. The surgical device of claim 9, wherein the first clip is stripped from the clip magazine into the loading portion upon retraction of the clip magazine from the fully advanced position to the fully retracted position in response to rotation of the rotational input in a second direction opposite the first direction.

11. The surgical device of claim 10, wherein the clip magazine is biased toward the rotational input via a biasing member, and wherein the biasing member retracts the clip magazine toward the fully retracted position when the rotational input is rotated in the second direction.

12. The surgical device of claim 9, wherein the rotary input further comprises a notch at a distal end of the first cam lobe, wherein the clip cartridge further comprises a protrusion extending proximally from the second cam lobe, and wherein the protrusion is configured to engage the notch when the clip cartridge is in the fully advanced position.

13. The surgical device of claim 12, wherein the rotational input and the clip cartridge rotate together when the protrusion of the clip cartridge engages the notch of the rotational input and the rotational input rotates in the first direction.

14. The surgical device of claim 13, wherein when the protrusion of the clip cartridge is engaged with the notch of the rotational input, the clip cartridge is rotatable relative to the shaft axis to align the other clip with the loading portion of the end effector.

15. The surgical device of claim 9, wherein the clip magazine comprises at least two storage locations for the plurality of clips, and wherein each storage location comprises at least two clips stacked on top of each other.

16. The surgical device of claim 9, further comprising an articulation joint configured to allow articulation of the end effector relative to the shaft.

17. A surgical device for clamping tissue, comprising:

a housing including a motor configured to output rotational motion;

a shaft extending from the housing, wherein the shaft defines a shaft axis;

an end effector extending from the shaft; and

a magazine comprising a plurality of clamps, wherein the magazine is movable in a first direction in response to the rotational movement, wherein the magazine is movable in a second direction in response to the rotational movement, and wherein the second direction is transverse to the first direction.

18. The surgical device of claim 17, wherein the first direction is translation along the shaft axis, and wherein the second direction is rotation about the shaft axis.

19. The surgical device of claim 18, further comprising a rotational input operably responsive to the rotational motion, wherein the rotational input is configured to transmit the rotational motion from the motor to the cartridge to move the cartridge in the first and second directions.

20. The surgical device of claim 19, wherein a first amount of rotation of the rotational input moves the cartridge in the first direction, and wherein a second amount of rotation of the rotational input moves the cartridge in the second direction.

Background

A variety of fasteners can be used to treat, clamp, fasten, secure, and/or hold tissue. The clamp can be positioned relative to tissue located within a surgical site of a patient and subsequently deformed to, for example, apply a clamping force to the tissue.

Drawings

The features and advantages of the present invention and the manner of attaining them will become more apparent and the invention itself will be better understood by reference to the following description of exemplary embodiments of the invention taken in conjunction with the accompanying drawings, wherein:

FIG. 1 is a partial perspective view of a clip applier;

FIG. 2 is a cross-sectional view of an end effector of the clip applier of FIG. 1, including a removable clip cartridge, a reciprocating firing drive for sequentially advancing clips, a receiver for receiving a clip, and a crimp drive for deforming a clip;

FIG. 3 is a partial cross-sectional view of the clip applier of FIG. 1 in an open configuration;

FIG. 4 is a partial cross-sectional view of the clip applier of FIG. 1 in a closed configuration;

FIG. 5 is a cross-sectional view of the end effector of FIG. 2 in an unfired state;

FIG. 6 is a cross-sectional view of the end effector of FIG. 2, showing the firing drive in a partially fired state, wherein a firing member of the firing drive has advanced a clip into the receiver;

FIG. 7 is a cross-sectional view of the end effector of FIG. 2 showing a firing drive engaged with a crimping drive;

FIG. 8 is a cross-sectional view of the end effector of FIG. 2 showing a crimping drive in at least a partially fired state;

FIG. 9 is a cross-sectional view of the end effector of FIG. 2 showing the firing drive disengaged from the firing member;

FIG. 10 is a cross-sectional view of the end effector of FIG. 2 showing the crimping drive in its fully fired state;

FIG. 11 is a cross-sectional view of the firing drive of the end effector of FIG. 2 in a partially retracted position with the firing drive reengaged with the firing member;

FIG. 12 is a cross-sectional view of the firing drive of the end effector of FIG. 2 disengaged from the crimping drive;

FIG. 13 is a perspective view of the clamp shown in FIGS. 2-12;

FIG. 14 is a front view of the cartridge shown in FIGS. 1-12 including a plurality of clips, with portions of the cartridge removed to show the clips stored in the cartridge;

FIG. 15 is a side view of the cartridge of FIG. 14, shown with portions removed to show clips stored within the cartridge;

FIG. 16 shows a cross-sectional plan view of the cartridge of FIG. 14 taken along line 16-16 in FIG. 15;

FIG. 17 is a side view of an alternative cartridge that may be used in conjunction with the clip applier of FIGS. 1-12, or any other suitable clip applier, where the cartridge is shown partially removed to illustrate a biasing member and a push plate positioned intermediate the biasing member and a clip contained therein;

FIG. 18 is a side view of a cartridge according to at least one alternative embodiment, shown with portions removed to illustrate a biasing member and a lockout plate positioned intermediate the biasing member and a clamp contained therein;

FIG. 19 is a cross-sectional plan view of the cartridge of FIG. 18, taken along line 19-19 in FIG. 18;

FIG. 20 is a side view of an additional alternative cartridge that may be used in conjunction with the clip applier of FIGS. 1-12, or any other suitable clip applier, wherein the cartridge may include a housing shown partially removed to illustrate a lockout plate including a guide that is configured to cooperate with a guide defined in the cartridge housing;

FIG. 21 is a cross-sectional plan view of the cartridge of FIG. 20 taken along line 21-21 in FIG. 20;

FIG. 22 is a front view of a firing drive according to at least one embodiment including a rotary input, a rotary output, a firing nut engaged with the rotary output, and a transmission in a firing configuration;

FIG. 23 is a perspective view of the firing drive of FIG. 22 showing the firing nut in an unfired position;

FIG. 24 is a perspective view of the firing drive of FIG. 22 showing a firing nut advanced along the rotary output and a cam extending from the firing nut;

FIG. 25 is a perspective view of the firing drive of FIG. 22 showing the cam of the firing nut engaged with the transmission of the firing drive and the transmission in a reverse configuration;

FIG. 26 is a perspective view of the firing drive of FIG. 22 showing the firing nut in a retracted position and a second cam extending from the firing nut that engages the transmission to transition the transmission from its reverse configuration to its fired configuration;

FIG. 27 is a perspective view of an automated surgical instrument system that operably supports a plurality of surgical tools that may be used with the clip applier of FIGS. 2-12 or any other suitable clip applier;

FIG. 28 is a perspective view of a surgical tool including an actuator module, a shaft extending from the actuator module, and an alternative end effector;

FIG. 29 is a perspective view of a handle actuator that may be used with the clip applier of FIGS. 2-12, or any other suitable clip applier;

FIG. 30 is a cross-sectional view of the articulation joint shown in FIG. 2;

FIG. 31 is a rear perspective view of an alternative actuator module that may be used in place of the actuator module of FIG. 28, with at least a portion of its housing removed;

FIG. 32 is an exploded view of a portion of the actuator module of FIG. 31;

FIG. 33 is a partial cross-sectional view of the actuator module of FIG. 31;

FIG. 34 is a cross-sectional view of an articulation actuator of the actuator module of FIG. 31;

FIG. 35A is a partial cross-sectional view of an end effector of a clip applier in a closed configuration;

FIG. 35B is a partial cross-sectional view of the end effector of FIG. 35A in an open configuration;

FIG. 35C is a cross-sectional view of the end effector of FIG. 35A in an open configuration;

FIG. 36 is a partial cross-sectional view of the end effector of FIG. 35A showing the position of the stored jaws when the crimp drive of the end effector is in a fully fired position;

FIG. 37 is a partial cross-sectional view of the end effector of FIG. 35A showing the position of the stored jaws when the crimp drive is in the starting position;

FIG. 38 is a partial cross-sectional view of the end effector of FIG. 35A showing the position of the stored jaws when the crimp drive is in a fully retracted position;

FIG. 39 is a partial cross-sectional view of a clip applier including a clip cartridge containing clips of a first size;

FIG. 40 is a partial cross-sectional view of the clip applier of FIG. 39 including a different clip cartridge containing clips of a second size;

FIG. 41 is a partial cross-sectional view of a stacked arrangement of multiple layers of clips;

FIG. 42A is a perspective view of a clip applier including an attachment mechanism;

FIG. 42B is a cross-sectional view of the clip applier of FIG. 42A;

FIG. 43A is a perspective view of a clip applier including a clip magazine;

FIG. 43B is a perspective view of a clip used with the clip applier of FIG. 43A;

FIG. 44 is a perspective view of a clip reloader for use with a clip applier that includes a clip magazine;

FIG. 45 is a perspective view of the clip reload;

FIG. 46 is a cross-sectional view of the clip reloader of FIG. 45;

FIG. 47 is a cross-sectional view of the end effector of the clip reloader and clip applier of FIG. 45;

FIG. 48 is a plan view, partially in section, of a clip applier;

FIG. 49 is a side view, partially in section, of the clip applier of FIG. 48;

FIG. 50 is a perspective view of the clip applier of FIG. 48;

FIG. 51A is a perspective view of a fixture including a flexible base;

FIG. 51B is a side view of the clamp of FIG. 51A in various configurations;

FIG. 51C is a perspective view of a clip used with the clip applier;

FIG. 51D is a side view of the clamp of FIG. 51C in a storage configuration;

FIG. 51E is a side view of the clamp of FIG. 51C in a pre-firing configuration;

FIG. 51F is a side view of the clamp of FIG. 51C in a post-fired configuration;

FIG. 52 is a perspective view of a clip applier including a rotatable clip magazine;

FIG. 53 is a partial cross-sectional view of the clip applier of FIG. 52, showing the closure tube of the clip applier in a fully retracted position;

FIG. 54A is a partial cross-sectional view of the clip applier of FIG. 52, showing the closure tube in a starting position;

FIG. 54B is a perspective view of a ground portion including a timing portion of the clip applier of FIG. 52;

FIG. 55 is a partial cross-sectional view of the clip applier of FIG. 52, showing clips stored in the rotatable clip magazine, shown with some components removed, prior to advancement;

FIG. 56 is a partial cross-sectional view of the clip applier of FIG. 52 showing a clip advanced from the rotatable magazine by the feeder member of the clip applier;

FIG. 57 is a partial cross-sectional view of the clip applier of FIG. 52, showing the feeder member retracted;

FIG. 58 is a partial cross-sectional view of the clip applier of FIG. 52, showing the closure tube of the clip applier in a fully retracted position;

FIG. 59 is a partial cross-sectional view of the clip applier of FIG. 52, showing the closure tube in a starting position and the firing member advancing the clip, shown with some components removed;

FIG. 60 is a partial cross-sectional view of the clip applier of FIG. 53, showing the firing member retracted and the closure tube in a fully advanced position, shown with some components removed;

FIG. 61 is a partial cross-sectional view of a clip applier including a replaceable cartridge;

FIG. 62A is a cross-sectional end view of a rotatable gripper cartridge;

FIG. 62B is a plan view of a clip used with the rotatable clip magazine of FIG. 62A;

FIG. 63A is a perspective view of a releasable clip cartridge including an articulation joint;

FIG. 63B is a partial cross-sectional view of the releasable clip cartridge and articulation joint of FIG. 63A;

FIG. 64 is a perspective view of a clip applier including an articulation joint;

FIG. 65 is a partial cross-sectional view of a jaw assembly of a clip applier;

FIG. 66A is a partial cross-sectional view of a clip applier jaw assembly including an offset support leg;

FIG. 66B is a partial cross-sectional view of the jaw assembly of the clip applier of FIG. 66A;

FIG. 67 is a plan view, partially in section, of the jaw assembly of the clip applier of FIG. 65;

FIG. 68 is a plan view, partially in section, of the jaw assembly of the clip applier of FIG. 66A;

FIG. 69 is a graphical depiction of the movement of the cam member and feeder shoe of the clip applier throughout its operation;

FIG. 70 is a graph depicting displacement of a cam member and feeder shoe of the clip applier of FIG. 52 as a function of time;

FIG. 71 depicts a first graph showing force of a clip advancing a clip applier as a function of displacement and a second graph showing voltage of a motor of the clip applier as a function of time;

FIG. 72 depicts a graph of force applied to a pair of jaws of a clip applier versus time;

fig. 73 relates to an alternative embodiment;

FIG. 74 relates to an alternative embodiment;

FIG. 75 is a perspective view of a clip applier including a rotating clip magazine, magnets, and Hall effect sensors;

FIG. 76 is a graphical depiction of the clip applier of FIG. 75, showing voltage of the Hall effect sensor as a function of magnet position over time;

FIG. 77 is a partial cross-sectional view of a clip applier including resistance sensing circuitry;

FIG. 78A is a partial cross-sectional view of a clip applier including a variable resistance meter;

FIG. 78B is a partial cross-sectional view of the clip applier of FIG. 78A in a partially crimped configuration;

FIG. 79 is a perspective view of a clip applier jaw including a strain gauge;

FIG. 80 is a graphical depiction of the clip applier jaws of FIG. 79, showing voltage of the strain gauge as a function of time;

FIG. 81A is a partial cross-sectional view of a clip applier including a sensor array and a magnet;

FIG. 81B is a partial cross-sectional view of the clip applier of FIG. 81A;

FIG. 82 is a perspective view of a clip applier system utilizing a trocar;

FIG. 83 is a perspective view of the clip applier system of FIG. 82;

FIG. 84A is a partial side elevational view of the clip applier system of FIG. 82, depicting jaw wings of a clip applier of the clip applier system positioned distal to a loading arm of a clip magazine of the clip applier system;

FIG. 84B is a partial side elevational view of the clip applier system of FIG. 82, depicting jaw wings of the clip applier positioned proximal to a loading arm of the clip magazine;

FIG. 84C is a partial side elevational view of the clip applier system of FIG. 82, depicting jaw wings of the clip applier positioned proximal to a loading arm of the clip magazine;

FIG. 85A is a partial perspective view of the clip applier system of FIG. 82;

FIG. 85B is a cut-away perspective view of the clip applier system of FIG. 82;

FIG. 86A is a plan view of the clip applier system of FIG. 82, depicting the jaw wings of the clip applier in an expanded configuration;

FIG. 86B is a plan view of the clip applier system of FIG. 82, depicting the jaw wings of the clip applier in a retracted configuration;

FIG. 87A is a perspective view of a clip applier and a clip cartridge for use with the clip applier;

FIG. 87B is a perspective view of a clip magazine seated into the clip applier of FIG. 87A;

FIG. 87C is a perspective view of the clip applier and clip magazine of FIG. 87A in a loaded configuration;

FIG. 87D is a cross-sectional view of the clip applier and clip magazine of FIG. 87A in the loaded configuration of FIG. 87C;

FIG. 88A is a perspective view of an empty clip magazine removed from the clip applier of FIG. 87A;

FIG. 88B is a plan view of an empty clip magazine seated into the clip applier of FIG. 87A;

FIG. 88C is a cross-sectional plan view of the clip applier and clip magazine of FIG. 87A;

FIG. 88D is a cross-sectional plan view of the clip applier and clip magazine of FIG. 87A in an almost empty configuration; and

FIG. 89 is a side elevational view of a clip applier utilizing interchangeable clip magazines;

FIG. 90A is a side elevational view of the distal head releasably attached to the shaft of the clip applier;

FIG. 90B is a front elevational view of the distal head and shaft of FIG. 90A;

FIG. 91A is a side elevational view of the distal head releasably attached to the shaft of the clip applier;

FIG. 91B is a front elevational view of the distal head and shaft of FIG. 91A;

FIG. 92A is a side elevational view of the distal head releasably attached to the shaft of the clip applier;

FIG. 92B is a front elevational view of the distal head and shaft of FIG. 92A;

FIG. 93A is an exploded perspective view of a clip applier system including an interchangeable distal head releasably attachable to a clip applier;

FIG. 93B is a cross-sectional view of a quick disconnect configured for use between a shaft and a distal head of a clip applier;

FIG. 93C is a cross-sectional view of the quick disconnect of FIG. 93B;

FIG. 93D is a front elevational view in cross-section of the quick disconnect of FIG. 93B;

FIG. 94 is a cross-sectional view of a clip magazine including clips stacked in an offset manner;

FIG. 95A is a cross-sectional view of a clip magazine including an opening for an internal drive mechanism of a clip applier;

FIG. 95B is a cross-sectional view of a clip magazine including an angled clip channel and an opening for an internal drive mechanism of a clip applier;

FIG. 95C is a cross-sectional view of a clip cartridge used with a clip applier;

FIG. 95D is a cross-sectional view of a clip cartridge used with a clip applier;

FIG. 95E is a cross-sectional view of a gripper magazine including grippers stacked in a non-concentric radial array;

FIG. 96 is a perspective view of a clip magazine including angled clip storage channels;

FIG. 97A is a cross-sectional view of a clip magazine including a plurality of clips and latches, shown with the clip magazine in a fired position;

FIG. 97B is a cross-sectional side elevational view of the clip magazine of FIG. 97A;

FIG. 98 is a cross-sectional view of the clamp cartridge of FIG. 97A, which has been rotated counterclockwise approximately 30 degrees from the firing position of FIG. 97A toward the clamp loading position;

FIG. 99 is a cross-sectional view of the clamp cartridge of FIG. 97A, which has been rotated counterclockwise approximately 60 degrees from the firing position of FIG. 97A toward the clamp loading position;

FIG. 100 is a cross-sectional view of the clip magazine of FIG. 97A in a clip loading position, wherein a clip is positioned in the loading slot;

FIG. 101 is a cross-sectional view of the clip magazine of FIG. 97A in a clip loading position with a locking clip positioned in the loading slot;

FIG. 102 is a perspective view of a clip applier including a clip magazine and a rotary input, shown with the clip magazine in a proximal position;

FIG. 103 is a perspective view of the clip applier of FIG. 102, shown with the clip magazine in a distal position;

FIG. 104 is a perspective view of the clip applier of FIG. 102, shown with the clip magazine in a distal position and rotated approximately 120 degrees;

FIG. 105 is a perspective view of the clip applier of FIG. 102 including a feeder shoe, a crimp drive, and a shaft having a loading slot with clips from a clip magazine stored therein;

FIG. 106 is an exploded perspective view of the clip applier of FIG. 105;

FIG. 107 is a cross-sectional view of a rotary input and clip magazine for use with a clip applier, wherein the rotary input is a multi-directional rotary input;

FIG. 108 is a cross-sectional side view of the rotary input and clip magazine used with the clip applier, wherein the rotary input is a multi-directional rotary input;

FIG. 109 is a cross-sectional front view of the rotary input and gripper cartridge of FIG. 108;

FIG. 110 is a cross-sectional view of a rotary input and a clip magazine used with a clip applier, wherein the rotary input is a unidirectional rotary input;

FIG. 111 is a cross-sectional view of a rotary input, a clip magazine, and a loading slot for use with a clip applier, wherein the rotary input is a unidirectional rotary input;

FIG. 112 is a perspective view of a rotary input and a clip magazine for use with a clip applier, wherein the clip magazine includes a clamshell configuration;

FIG. 113 is a cross-sectional front view of the clip magazine of FIG. 112;

FIG. 114 is an exploded perspective view of a clip applier including a clip magazine and magazine driver, wherein the clip magazine and magazine driver include camming surfaces;

FIG. 115A is a side elevational view of the clip applier of FIG. 114, shown with the clip magazine in a proximal position;

FIG. 115B is a side elevational view of the rotatable clip magazine of FIG. 114, wherein the cam advancer has advanced the rotatable clip magazine from a proximal position to a distal position;

FIG. 115C is a side elevational view of the rotatable gripper magazine of FIG. 114 in a ready timing position with respect to the cam pusher of FIG. 114;

FIG. 116 is a graphical depiction of the absolute rotational position of the cartridge driver of the clip applier of FIG. 114 during a sequence of operations;

FIG. 117 is a cross-sectional view of a clip applier including an end effector, a clip magazine, a clip carriage, and a clip former configured to form a clip from the clip magazine;

FIG. 118A is a cross-sectional view of the clip applier of FIG. 117, depicting the clip carrier holding a clip, with portions of the clip applier removed for illustrative purposes;

FIG. 118B is a cross-sectional view of the clip applier of FIG. 117, depicting the clip carriage advancing clips to a staging position with portions of the clip applier removed for illustrative purposes;

FIG. 118C is a cross-sectional view of the clip applier of FIG. 117, depicting the clip carriage retracted and the clips in a staged position with portions of the clip applier removed for illustrative purposes;

FIG. 118D is a cross-sectional view of the clip applier of FIG. 117, depicting the clip carriage advancing clips in a staged position into the end effector, with portions of the clip applier removed for illustrative purposes;

FIG. 119A is a cross-sectional view of the clip applier of FIG. 117, depicting the clip carriage retracting the clips to a forming position with the anvil positioned over the clips;

FIG. 119B is a cross-sectional view of the clip applier of FIG. 117, depicting the clip carriage retracting the clip to a forming position with the anvil positioned between the first and second legs of the clip;

FIG. 120A is a plan view of the clip carriage and anvil of the clip applier of FIG. 117, with a clip having been positioned around the anvil, and with the clip in an unformed state;

FIG. 120B is a plan view of the clip carriage and anvil of the clip applier of FIG. 117, with a clip having been positioned around the anvil, and with the clip in a formed condition;

FIG. 121 is a cross-sectional view of the clip applier of FIG. 117;

FIG. 122 is a perspective view of a clip applier including an end effector, a clip magazine, and a coaxial rotary input comprised of a double-woven cable;

FIG. 123 is a perspective view of a clip applier including an end effector, a clip magazine, and a coaxial rotary input of wire tubing;

FIG. 124 is a perspective view of a rotary input for use with a clip applier, wherein the rotary input includes layers of helical springs wound in opposite directions;

FIG. 125 is a perspective view of a clip applier including a shaft, a clip magazine, and a clip advancer configured to advance clips from the clip magazine into a loading slot, then into a staging position, and then into a clip track of the clip applier, with a first clip shown in the clip magazine;

FIG. 126 is a perspective view of the clip applier of FIG. 125, depicting a first clip being advanced into a loading slot of the clip applier as the clip magazine moves distally;

FIG. 127 is a perspective view of the clip applier of FIG. 125, depicting a first clip being peeled from the clip magazine as the clip magazine rotates and retracts through the loading slot of the clip applier;

FIG. 128 is a perspective view of the clip applier of FIG. 125, depicting a first clip in the loading slot as the clip magazine is further rotated and retracted;

FIG. 129 is a perspective view of the clip applier of FIG. 125, depicting a first clip in the loading slot with the clip magazine fully retracted, thereby placing the first clip in a position to be advanced through the loading slot;

FIG. 130 is a perspective view of the clip applier of FIG. 125, depicting a first clip in the loading slot as the clip magazine is advanced to engage the clip advancer with the back side of the first clip;

FIG. 131 is a perspective view of the clip applier of FIG. 125, depicting a first clip after it has been advanced through the loading slot by a clip pusher;

FIG. 132 is a perspective view of the clip applier of FIG. 125, depicting a first clip after it has been pushed out of the loading slot into the staging position by the clip pusher;

FIG. 133 is a perspective view of the clip applier of FIG. 125, depicting a first clip positioned in a staging position and a clip pusher and clip magazine retracted;

FIG. 134 is a perspective view of the clip applier of FIG. 125, depicting the clip magazine and clip advancer advancing and abutting against a first clip in a staging position;

FIG. 135 is a perspective view of the clip applier of FIG. 125, depicting a first clip after it has been advanced by a clip advancer from a staging position into a clip track;

FIG. 136 is a perspective view of the clip applier of FIG. 125, depicting a first clip after it has been fully advanced into the clip track by the clip advancer;

FIG. 137 is a perspective view of the clip applier of FIG. 125, depicting a first clip after it has been advanced through the load slot, with a second clip positioned in the load slot and a third clip positioned in the clip magazine;

FIG. 138 is a perspective view of the clip applier of FIG. 125, depicting a first clip in the clip track, a second clip in the staging position, and a third clip in the loading slot;

FIG. 139 is a perspective view of the clip applier of FIG. 125, depicting a first clip in the clip track, a second clip in the staging position, a third clip in the loading slot, and a fourth clip in the clip magazine;

FIG. 140 is a perspective view of the clip applier of FIG. 125, depicting a first clip in the clip track, a second clip in the clip track, a third clip in the staging position, and a fourth clip in the loading slot;

FIG. 141A is a perspective view of the clip applier of FIG. 125, depicting the end effector extending from a shaft of the clip applier with a first clip in the clip track, a second clip in the clip track, a third clip in the staging position, a fourth clip in the loading slot, and a fifth clip in the clip magazine.

FIG. 141B is a perspective view of the clip applier of FIG. 125, wherein a first clip, a second clip, a third clip, a fourth clip, and a fifth clip have been advanced toward the end effector.

FIG. 141C is a perspective view of the clip applier of FIG. 125, with a first clip having been advanced into the end effector.

FIG. 142 is a perspective view of the clip applier of FIG. 125, depicting the jaw cam and feeder shoe mounted to the end effector.

FIG. 143 is a perspective view of the clip applier of FIG. 125, depicting the feeder shoe engaged with a backside of a first clip and the jaw cam in a proximal position.

FIG. 144A is a perspective view of an alternative embodiment of a jaw cam for use with the end effector of the clip applier of FIG. 125, shown with the jaw cam in a proximal position;

fig. 144B is a perspective view of the alternative embodiment of fig. 144A, shown with the jaw cam in a distal position.

FIG. 144C is a perspective view of the alternative embodiment of FIG. 144B, shown with the jaw cam in a closed position;

FIG. 145 is a perspective view of a clip applier including a translatable clip magazine and translatable and rotatable clip advancers configured to advance a clip;

FIG. 146 is a plan view of the clip applier of FIG. 145, showing the clip magazine and clip advancer in a proximal position;

FIG. 147 is a plan view of the clip applier of FIG. 145, showing the clip magazine and clip advancer moved distally from their proximal positions to advance a clip;

FIG. 148 is a plan view of the clip applier of FIG. 145, showing the clip magazine and clip advancer moved to their distal-most positions to fully advance a clip;

FIG. 149 is a plan view of the clip applier of FIG. 145, showing the clip magazine and clip advancer partially retracted from their distal-most position toward their proximal positions;

FIG. 150 is a plan view of the clip applier of FIG. 145, showing the clip magazine and clip advancer in their proximal positions;

FIG. 151A is a side view of the clip applier of FIG. 145, showing the clip magazine and clip advancer in their proximal positions, with clips ready to be advanced;

FIG. 151B is a side view of the clip applier of FIG. 145, showing the clip magazine and clip advancer in their distal-most positions after advancing a clip;

FIG. 152 is a perspective view of a clip applier including an end effector spanning two different planes, a clip cartridge, and a rotary input extending through the clip cartridge;

FIG. 153 is a cross-sectional view of the clip applier of FIG. 152, depicting the end effector and a portion of the rotary input extending through the clip magazine;

FIG. 154 is a cross-sectional view of the clip applier of FIG. 152, depicting an anchor of the end effector partially extending through the clip magazine;

FIG. 155 is a cross-sectional view of the clip applier of FIG. 152, depicting the end effector and a portion of the rotary input extending through a clip magazine including a clip retainer;

FIG. 156 is a perspective view of a clip applier including an end effector extending from a shaft and a clip cartridge, wherein the end effector spans two different planes;

FIG. 157 is a side view of the clip applier of FIG. 156;

FIG. 158 is a perspective view of the clip applier of FIG. 156, depicting the collar of the clip applier being mounted to the end effector;

FIG. 159 is a perspective view of the clip applier of FIG. 156, showing the collar of the clip applier mounted to the end effector;

FIG. 160 is a perspective view of an alternative embodiment end effector;

FIG. 161 is a side view of a clip applier including a drive screw having two different thread pitches configured to move a cam member and a feeder shoe in opposite directions to advance and crimp a clip, showing the cam member in a proximal position and the feeder shoe in a distal position;

FIG. 162 is a side view of the clip applier of FIG. 161, showing the cam member in a distal position and the feeder shoe in a proximal position;

FIG. 163 is a plan view of a clip applier including an end effector including jaws configured to close parallel to one another in response to rotation of a drive screw, the jaws shown in an open position;

FIG. 164 is a plan view of the clip applier of FIG. 163, showing the jaws in a closed position;

FIG. 165 is a plan view of a clip applier including an end effector including jaws configured to provide for the start of a tip closure in response to rotation of a drive screw, the jaws shown in an open position;

FIG. 166 is a plan view of the clip applier of FIG. 165, showing the jaws in a closed position;

FIG. 167A is a side elevational view of a clip applier including a jaw cam and a clip advancer, wherein the clip applier is configured to advance a clip and approach a pair of jaws in response to the same rotational input, showing the jaw cam in a distal position and the jaws in a closed configuration;

FIG. 167B is a side elevational view of the clip applier of FIG. 167A, showing the pair of jaws in an open configuration and the jaw cams retracted to a proximal position;

FIG. 167C is a side elevational view of the clip applier of FIG. 167A, showing the pair of jaws in an open configuration and the jaw cams retracted to a fully retracted position to release the clip advancer and advance a clip into the pair of jaws;

FIG. 167D is a side elevational view of the clip applier of FIG. 167A, with the deck retrieval latch of the jaw cam operably engaged with the clip advancer when the jaw cam is again advanced to the distal position;

FIG. 168 is a perspective view of a jaw cam and track retrieval latch of the clip applier of FIG. 167A;

FIG. 169 is a perspective view of a jaw cam and track retrieval latch of the clip applier of FIG. 167A, engaging a feeder track of a clip advancer;

FIG. 170 is a perspective view of a clip applier including a cam member and a clip advancer threadably engaged with the rotary input and configured to advance a clip and approximate a pair of opposing jaws, wherein the cam member and clip advancer are in a proximal position and the pair of jaws are closed;

FIG. 171 is a perspective view of the clip applier of FIG. 170, with the cam member and clip advancer in an intermediate position and the pair of jaws open;

FIG. 172 is a perspective view of the clip applier of FIG. 170, with the cam member and clip advancer in a distal position, the pair of jaws open, and a clip having been advanced into the pair of jaws;

FIG. 173 is a cross-sectional side view of the clip applier of FIG. 170, with the cam member and clip advancer in a proximal position and the pair of jaws closed;

FIG. 174 is a cross-sectional side view of the clip applier of FIG. 170, with the cam member and clip advancer in an intermediate position and the pair of jaws open;

FIG. 175 is a cross-sectional side view of the clip applier of FIG. 170, with the cam member and clip advancer in a distal position, with the pair of jaws open, and a clip having been advanced into the pair of jaws;

FIG. 176 is a graphical depiction of a clip applier showing the position of a crimp drive of the clip applier over time and including a set point indicating clip formation; and

FIG. 177 is a schematic view of a control system for use with any of the surgical instruments disclosed herein.

Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.

Detailed Description

The applicant of the present application owns the following U.S. patent applications filed on 26.10.2018 and each incorporated herein by reference in its entirety:

-U.S. patent application Ser. No. 16/172,130 entitled "CLIP APPLIER COMPRISING INTERCHANGEABLE CLIP RELOADS";

-U.S. patent application serial No. 16/172,078 entitled "CLIP APPLIER comprisinga rotable CLIP MAGAZINE";

-U.S. patent application serial No. 16/172,087 entitled "CLIP APPLIER COMPRISING CLIP ADVANCING SYSTEMS";

-U.S. patent application serial No. 16/172,094 entitled "CLIP APPLIER COMPRISING A CLIP CRIMPING SYSTEM";

-U.S. patent application Ser. No. 16/172,128 entitled "CLIP APPLIER COMPRISING A RECIPROCATING CLIP ADVANCINGMEMBER";

-U.S. patent application Ser. No. 16/172,168 entitled "CLIP APPLIER COMPRISING A MOTOR CONTROL"; and

U.S. patent application Ser. No. 16/172,164 entitled "SURGICAL SYSTEM COMPRISING A SURGICAL TOOL AND A SURGICAL BUB".

The applicant of the present application owns the following U.S. patent applications filed 2018, 8, 24, each incorporated herein by reference in its entirety:

-U.S. patent application Ser. No. 16/112,129 entitled "SURGICAL SUTURING INSTRUMENTS CONGURED TO MANIPULATE TISSUESING MECHANICAL AND ELECTRICAL POWER";

-U.S. patent application Ser. No. 16/112,155 entitled "SURGICAL SUTURING INSTRUMENTS COMPLEMENTING A CAPTURE WIDTH WHICHIS LARGER THAN TROCAR DIAMETER";

U.S. patent application Ser. No. 16/112,168 entitled "SURGICAL SUTURING INSTRUMENTS COMPRISING A NON-CIRCULARNEEDLE";

-U.S. patent application serial No. 16/112,180 entitled "ELECTRICAL POWER OUTPUT CONTROL BASED ON MECHANICAL FORCES";

-U.S. patent application serial No. 16/112,193 entitled "REACTIVE ALGORITHM FOR minor SYSTEM";

-U.S. patent application serial No. 16/112,099 entitled "SURGICAL INSTRUMENT COMPRISING AN ADAPTIVE ELECTRICAL SYSTEM";

-U.S. patent application Ser. No. 16/112,112 entitled "CONTROL SYSTEM ARRANGEMENTS FOR A MODULAR SURGICALINSTRUCOMENT";

U.S. patent application Ser. No. 16/112,119 entitled "ADAPTIVE CONTROL program FOR A SURGICAL SYSTEM COMPRISING COMPUTER THAN ONE TYPE OF CARTRIDGE";

U.S. patent application Ser. No. 16/112,097 entitled "SURGICAL INSTRUMENT SYSTEM COMPLEMENTS BATTERY ARRANGEMENTS";

-U.S. patent application Ser. No. 16/112,109 entitled "SURGICAL INSTRUMENT SYSTEMS COMPRISING HANDLE ARRANGEMENTS";

U.S. patent application Ser. No. 16/112,114 entitled "SURGICAL INSTRUMENT SYSTEM COMPLEMENTS FEEDBACK MECHANISMS";

-U.S. patent application Ser. No. 16/112,117 entitled "SURGICAL INSTRUMENT SYSTEM COMPLISING LOCKOUT MECHANISMS";

-U.S. patent application serial No. 16/112,095 entitled "minor ingredients combining a locked END effector socket";

-U.S. patent application serial No. 16/112,121 entitled "SURGICAL INSTRUMENTS COMPRISING A SHIFTING MECHANISM";

U.S. patent application Ser. No. 16/112,151 entitled "SURGICAL INSTRUMENTS COMPRISTING A SYSTEM FOR ARTICULATION AND DROTATION COMPENSATION";

-U.S. patent application Ser. No. 16/112,154 entitled "SURGICAL INSTRUMENTS COMPRISING A BIASED SHIFTING MECHANISM";

U.S. patent application Ser. No. 16/112,226 entitled "SURGICAL INSTRUMENTS COMPRISING AN ARTICULATION DRIVE THATPROVIDES FOR HIGH ARTICULATION ANGLES";

-U.S. patent application serial No. 16/112,062 entitled "SURGICAL DISSECTORS AND MANUFACTURING TECHNIQUES";

-U.S. patent application serial No. 16/112,098 entitled "SURGICAL DISSECTORS CONFIGURED TO APPLY MECHANICAL ANDELECTRICAL ENERGY";

-U.S. patent application Ser. No. 16/112,237 entitled "SURGICAL CLIP APPLIER CONFIGURED TO STORE CLIPS IN A STOREDSTATE";

-U.S. patent application serial No. 16/112,245 entitled "SURGICAL CLIP APPLIER COMPRISING AN EMPTY CLIP CARTRIDGELOCKOUT";

-U.S. patent application serial No. 16/112,249 entitled "SURGICAL CLIP APPLIER COMPRISING AN AUTOMATIC CLIP FEEDINGSYSTEM";

-U.S. patent application serial No. 16/112,253 entitled "SURGICAL CLIP APPLIER COMPRISING ADAPTIVE FIRING CONTROL"; and

U.S. patent application Ser. No. 16/112,257 entitled "SURGICAL CLIP APPLIER COMPRISING ADAPTIVE CONTROL IN RESPONSETO A STRAIN GAUGE CICUIT".

The applicants of the present application own the following U.S. patent applications filed on 1/5/2018 and each incorporated herein by reference in its entirety:

-U.S. provisional patent application serial No. 62/665,129 entitled "SURGICAL SUTURING SYSTEMS";

U.S. provisional patent application serial No. 62/665,139 entitled "SURGICAL INSTRUMENTS COMPRISING CONTROL SYSTEMS";

-U.S. provisional patent application serial No. 62/665,177 entitled "SURGICAL INSTRUMENTS COMPRISING HANDLE ARRANGEMENTS";

U.S. provisional patent application serial No. 62/665,128 entitled "MODULAR SURGICAL INSTRUMENTS";

-U.S. provisional patent application serial No. 62/665,192 entitled "SURGICAL DISSECTORS"; and

U.S. provisional patent application serial No. 62/665,134 entitled "SURGICAL CLIP APPLIER".

The applicant of the present application owns the following U.S. patent applications filed 2018 on 28/2 and each incorporated herein by reference in its entirety:

-U.S. patent application serial No. 15/908,021 entitled "minor entering WITH removal RELEASE";

-U.S. patent application Ser. No. 15/908,012 entitled "SURGICAL INSTRUMENT WITH CUTTING DUAL ROTATABLE MEMBERS TO EFFECTDIFFERENT TYPES OF END EFFECTOR MOVEMENT";

-U.S. patent application Ser. No. 15/908,040 entitled "SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTIONATING MULTIPLE END EFFECTOR FUNCTIONS";

-U.S. patent application Ser. No. 15/908,057 entitled "SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTIONATING MULTIPLE END EFFECTOR FUNCTIONS";

-U.S. patent application serial No. 15/908,058 entitled "SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES"; and

U.S. patent application Ser. No. 15/908,143 entitled "SURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS".

The applicant of the present application owns the following U.S. patent applications filed 2017 on 30/10 and each incorporated herein by reference in its entirety:

-U.S. provisional patent application serial No. 62/578,793 entitled "minor entering WITH removal RELEASE";

U.S. provisional patent application Ser. No. 62/578,804 entitled "SURGICAL INSTRUMENT WITH CUTTING DUAL ROTATABLE MEMBERS TO EFFECTDIFFERENT TYPES OF END EFFECTOR MOVEMENT";

U.S. provisional patent application Ser. No. 62/578,817 entitled "SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTIONATING MULTIPLE END EFFECTOR FUNCTIONS";

U.S. provisional patent application Ser. No. 62/578,835 entitled "SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTIONATING MULTIPLE END EFFECTOR FUNCTIONS";

-U.S. provisional patent application serial No. 62/578,844 entitled "minor incorporation WITH MODULAR POWER source" and; and

U.S. provisional patent application Ser. No. 62/578,855 entitled "SURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS".

The applicant of the present patent application owns the following U.S. provisional patent applications filed on 28.12.2017, the disclosures of which are incorporated herein by reference in their entirety:

-U.S. provisional patent application serial No. 62/611,341 entitled "INTERACTIVE SURGICAL PLATFORM";

-U.S. provisional patent application serial No. 62/611,340 entitled "CLOUD-BASED MEDICAL ANALYTICS"; and

U.S. provisional patent application serial No. 62/611,339 entitled "rolling ASSISTED minor PLATFORM".

The applicant of the present patent application owns the following U.S. provisional patent applications filed on 28/3/2018, each of which is incorporated herein by reference in its entirety:

-U.S. provisional patent application serial No. 62/649,302 entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED communica capabilities";

-U.S. provisional patent application serial No. 62/649,294 entitled "DATA STRIPPING METHOD TO interface patent RECORD and issue electronically sized RECORD";

U.S. provisional patent application serial No. 62/649,300 entitled "SURGICAL HUB SITUATIONAL AWARENESS";

U.S. provisional patent application serial No. 62/649,309 entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEEATER";

-U.S. provisional patent application serial No. 62/649,310 entitled "compass IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS";

U.S. provisional patent application serial No. 62/649,291 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE color TO detection OF particles OF BACK SCATTERED LIGHT";

U.S. provisional patent application serial No. 62/649,296 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR basic DEVICES";

-U.S. provisional patent application serial No. 62/649,333 entitled "closed-BASED MEDICAL ANALYTICS FOR custom coatings and polymers TO a USER";

U.S. provisional patent application serial No. 62/649,327 entitled "closed-BASED MEDICAL ANALYTICS FOR SECURITY AND authentication methods AND REACTIVE MEASURES";

-U.S. provisional patent application serial No. 62/649,315 entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICSNETWORK";

-U.S. provisional patent application serial No. 62/649,313 entitled "closed INTERFACE FOR coated minor DEVICES";

-U.S. provisional patent application serial No. 62/649,320 entitled "DRIVE ARRANGEMENTS FOR ROBOT-associated minor component platformes";

-U.S. provisional patent application serial No. 62/649,307 entitled "AUTOMATIC TOOL advanced FOR roll-ASSISTED surgery FOR" and; and

U.S. provisional patent application Ser. No. 62/649,323 entitled "SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS".

The applicant of the present patent application owns the following U.S. patent applications filed on 29/3/2018, each of which is incorporated herein by reference in its entirety:

-U.S. patent application serial No. 15/940,641 entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED communica capabilities";

-U.S. patent application serial No. 15/940,648 entitled "INTERACTIVE SURGICAL SYSTEMS WITH CONDITION manual officings AND DATA CAPABILITIES";

U.S. patent application Ser. No. 15/940,656 entitled "SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPTIONING ROOM DEVICES";

-U.S. patent application Ser. No. 15/940,666 entitled "SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS";

-U.S. patent application Ser. No. 15/940,670 entitled "COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY METHOD INTELLIGENT SURGICAL HUBS";

-U.S. patent application serial No. 15/940,677 entitled "SURGICAL HUB CONTROL ARRANGEMENTS";

-U.S. patent application Ser. No. 15/940,632 entitled "DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND DCREATE ANONYMIZED RECORD";

U.S. patent application Ser. No. 15/940,640 entitled "COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERSAND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICSSYSTEMS";

-U.S. patent application serial No. 15/940,645 entitled "SELF description DATA PACKETS GENERATED AT AN issuingintenstrenent";

-U.S. patent application serial No. 15/940,649 entitled "DATA PAIRING TO interconnected DEVICE MEASURED PARAMETER WITHAN OUTCOME";

U.S. patent application serial No. 15/940,654 entitled "SURGICAL HUB SITUATIONAL AWARENESS";

-U.S. patent application serial No. 15/940,663 entitled "SURGICAL SYSTEM DISTRIBUTED PROCESSING";

U.S. patent application Ser. No. 15/940,668 entitled "AGGREGAGATION AND REPORTING OF SURGICAL HUB DATA";

U.S. patent application Ser. No. 15/940,671 entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEEATER";

-U.S. patent application serial No. 15/940,686 entitled "DISPLAY OF align OF STAPLE CARTRIDGE TO PRIOR LINEARSTAPLE LINE";

-U.S. patent application serial No. 15/940,700 entitled "STERILE FIELD INTERACTIVE CONTROL DISPLAYS";

-U.S. patent application serial No. 15/940,629 entitled "compass IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS";

-U.S. patent application Ser. No. 15/940,704 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPONEPERIES OF BACK SCATTERED LIGHT";

-U.S. patent application Ser. No. 15/940,722 entitled "CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OFMONO-CHROMATIC LIGHT REFRACTIVITY"; and

U.S. patent application Ser. No. 15/940,742 entitled "DUAL CMOS ARRAY IMAGING".

The applicant of the present patent application owns the following U.S. patent applications filed on 29/3/2018, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/940,636 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR minor DEVICES";

U.S. patent application Ser. No. 15/940,653 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS";

-U.S. patent application serial No. 15/940,660 entitled "closed-BASED MEDICAL ANALYTICS FOR custom mixing and polymers TO a USER";

-U.S. patent application Ser. No. 15/940,679 entitled "CLOOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGETRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET";

U.S. patent application Ser. No. 15/940,694 entitled "CLOOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED DIVIDIONIZATION OF INSTRUMENTS FUNCTION";

U.S. patent application Ser. No. 15/940,634 entitled "CLOOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION RENDS AND REACTIVE MEASURES";

-U.S. patent application serial No. 15/940,706 entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICSNETWORK"; and

U.S. patent application Ser. No. 15/940,675 entitled "CLOOUD INTERFACE FOR COUPLED SURGICAL DEVICES".

The applicant of the present patent application owns the following U.S. patent applications filed on 29/3/2018, each of which is incorporated herein by reference in its entirety:

-U.S. patent application Ser. No. 15/940,627 entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";

-U.S. patent application serial No. 15/940,637 entitled "structural and geographic FOR ROBOT-associated surveyed surgiclatforms";

-U.S. patent application Ser. No. 15/940,642 entitled "CONTROL FOR ROBOT-ASSISTED SURGICAL PLATFORMS";

-U.S. patent application Ser. No. 15/940,676 entitled "AUTOMATIC TOOL ADJUSTMENT FOR ROBOT-ASSISTED SURGICATALLATOMS";

-U.S. patent application Ser. No. 15/940,680 entitled "CONTROL FOR ROBOT-ASSISTED SURGICAL PLATFORMS";

-U.S. patent application serial No. 15/940,683 entitled "passenger activity FOR ROBOT-associated passenger" and;

-U.S. patent application Ser. No. 15/940,690 entitled "DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; and

U.S. patent application Ser. No. 15/940,711 entitled "SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS".

The applicant of the present patent application owns the following U.S. provisional patent applications filed on 30/3/2018, each of which is incorporated herein by reference in its entirety:

-U.S. provisional patent application serial No. 62/650,887 entitled "SURGICAL SYSTEMS WITH OPTIMIZED sizing capturing CAPABILITIES";

U.S. provisional patent application serial No. 62/650,877 entitled "SURGICAL SMOKE EVACUTION SENSING AND CONTROL";

-U.S. provisional patent application serial No. 62/650,882 entitled "SMOKE evacution MODULE FOR INTERACTIVE television program"; and

U.S. provisional patent application serial No. 62/650,898 entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH seperable armayementes".

The applicant of the present patent application owns the following U.S. provisional patent applications filed on 2018, 4/19, which are incorporated herein by reference in their entirety:

U.S. provisional patent application serial No. 62/659,900 entitled "METHOD OF HUB COMMUNICATION".

Numerous specific details are set forth herein to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments described in the specification and illustrated in the accompanying drawings. Well-known operations, components and elements have not been described in detail so as not to obscure the embodiments described in the specification. The reader will understand that the embodiments described and illustrated herein are non-limiting examples and that specific structural and functional details disclosed herein are representative and illustrative. Variations and changes may be made to these embodiments without departing from the scope of the claims.

The term "comprises" (and any form comprising (comprises) ", such as" comprises "and" comprising) "," has "(and any form having (has), such as" has "and" has) "," contains "(and any form containing (includes), such as" comprises "and" contains) ", and" contains "(and any form containing (contains)," such as "contains" and "contains" are open-ended verbs. Thus, a surgical system, device, or apparatus that "comprises," "has," "contains," or "contains" one or more elements possesses those one or more elements, but is not limited to possessing only those one or more elements. Likewise, an element of a system, apparatus, or device that "comprises," "has," "includes," or "contains" one or more features possesses those one or more features, but is not limited to possessing only those one or more features.

The terms "proximal" and "distal" are used herein with respect to a clinician manipulating a handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion located away from the clinician. It will be further appreciated that for simplicity and clarity, spatial terms such as "vertical," "horizontal," "up," and "down" may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily appreciate that the various methods and devices disclosed herein may be used in a variety of surgical procedures and applications, including, for example, in conjunction with open surgical procedures. With continued reference to this detailed description, the reader will further appreciate that the various instruments disclosed herein can be inserted into the body in any manner, such as through a natural orifice, through an incision or puncture formed in tissue, and the like. The working portion or end effector portion of the instrument may be inserted directly into a patient or may be inserted through an access device having a working channel through which the end effector and elongate shaft of the surgical instrument may be advanced.

During various surgical procedures, a surgeon or other clinician may apply clips to a patient's tissue to achieve various effects and/or treatment results. Referring to FIG. 1, a surgical instrument, such as clip applier 100, for example, can be configured to apply one or more clips to tissue located within a surgical site of a patient. Referring now to FIG. 13, in general, the clip applier 100 can be structured and arranged to position the clip 140 relative to tissue in order to compress the tissue within the clip 140. The clip applier 100 can be configured to deform a clip 140, for example, as shown in fig. 3 and 4, and as described in more detail further below. Each clamp 140 may include a base 142 and opposing legs 144 extending from the base 142. For example, the base 142 and the legs 144 may include any suitable shape, and may define a substantially U-shaped configuration and/or a substantially V-shaped configuration. The base 142 may include angled portions 141 that are connected together by a joint 143. In use, the legs 144 of the clip 140 can be positioned on opposite sides of tissue, wherein the legs 144 can be urged toward one another, thereby compressing the tissue positioned between the legs 144. The joint 143 can allow the angled portion 141 of the base 142 and the legs 144 extending therefrom to deform inwardly. In various circumstances, when the clamp 140 is sufficiently compressed, the clamp 140 may be configured to yield or plastically deform, although a certain amount of elastic deformation or rebound may occur within the deformed clamp 140.

Referring now to fig. 1 and 2, a clip applier 100 can include a shaft 110, an end effector 120, and a replaceable clip cartridge or magazine 130. Referring to fig. 14-16, the clip cartridge 130 can include a housing 132 and a plurality of clips 140 positioned within the housing 132. The housing 132 may define a storage chamber 134 in which the clips 140 may be stacked. The storage chamber 134 may include a sidewall that extends around, or at least substantially around, the perimeter of the clamp 140. Referring again to fig. 13, each clamp 140 may include opposing faces, such as a top face 145 and a bottom face 146 located on opposing sides of the clamp 140, wherein the top face 145 of a clamp 140 may be positioned against the bottom face 146 of an adjacent clamp 140 when the clamps 140 are stacked in the housing 132, and wherein the bottom face 146 of a clamp 140 may be positioned against the top face 145 of another adjacent clamp 140. In various circumstances, the bottom surface 146 of the clamp 140 can face downward toward one or more support shelves or platforms 135 defined in the housing 132, while the top surface 145 of the clamp 140 can face upward away from the support shelves 135. In some cases, the top surface 145 and the bottom surface 146 of the clip 140 can be the same, or at least substantially the same, while in other cases, the top surface 145 and the bottom surface 146 can be different. For example, the stack of clips 140 shown in fig. 14-16 includes five clips 140; however, other embodiments are contemplated wherein the stack of clamps 140 can include more than five clamps 140 or less than five clamps 140. In any event, the clip cartridge 130 can further include at least one biasing member, such as biasing member 136, positioned, for example, intermediate the top clip 140 in the stack of the cases 132 and clips 140. As described in greater detail below, the biasing member 136 can be configured to bias a bottom clip 140, or more particularly a bottom surface 146 of the bottom clip 140, in the stack of clips 140 against a support shelf 135 defined in the casing 132. The biasing member 136 may comprise a spring, and/or any suitable compressive resilient element, for example, which may be configured to apply a biasing force to the clamp 140, or at least to the top clamp 140, which is transmitted downward through the stack of clamps 140.

When the clamp 140 is positioned against the support bracket 135 as described above, the clamp 140 can be supported in a firing position in which the clamp 140 can be advanced and ejected from the cartridge 130. In various instances, the support bracket 135 can define at least a portion of a firing chamber 149 wherein the clips 140 can be sequentially positioned in a firing position. In some cases, the firing chamber 149 can be defined entirely within the cartridge 130, or in other cases, the firing chamber 149 can be defined within the shaft 110 and the cartridge 130 and/or between the shaft 110 and the cartridge 130. In any event, as described in further detail below, the clip applier 100 can include a firing drive that can advance a firing member into the cartridge 130 and push a clip 140 from a fired position where it is positioned against the support bracket 135 to a fired position where it is received within the end effector 120 of the clip applier 100. Referring primarily to fig. 14-16, the housing 132 of the cartridge 130 can include a proximal opening or window 133 that can be aligned, or at least substantially aligned, with the support shelf 135 such that a firing member can enter the cartridge 130 through the proximal opening 133 and push the clips 140 distally out of the cartridge 130. In at least one such embodiment, for example, the housing 132 can further include a distal or discharge opening or window 137, which can also be aligned with the support bracket 135 such that the clip 140 can be advanced or fired distally along a firing axis 139 that extends through the proximal opening 133, the firing chamber 149, and the distal opening 137.

To advance the clip 140 out of the cartridge 130, further to the above, the firing member of the firing drive can be advanced into the cartridge housing 132 and, in various circumstances, into the firing chamber 149. As disclosed in further detail below, the firing member can pass completely through the cartridge 130 in order to advance the clip 140 into its fired position within the end effector 120. After a clip 140 positioned in the firing chamber 149 has been advanced distally by the firing member, as described above, the firing member can be retracted sufficiently that the biasing member 136 can position another clip 140 against the support bracket 135. In various circumstances, the biasing member 136 can bias the clamp 140 against the firing member while the firing member is positioned within the housing 132. Such grippers 140 may be referred to as queued (queued) grippers. After the firing member has been fully retracted and has slid out from under the queueing clamp 140, the biasing member 136 may bias the clamp 140 against the support bracket 135, in which case the next stroke of the reciprocating firing member is staged. Referring primarily to fig. 2 and 14-16, for example, the cartridge 130 can be configured to supply the clip 140 to the firing chamber 149 along a predetermined path, such as the supply axis 138. The supply axis 138 can be transverse to the firing axis 139 such that the clip 140 is advanced into the firing chamber 149 in a different direction than the direction of advancement of the firing member through the firing chamber 149. In at least one such embodiment, for example, the supply axis 138 can be perpendicular, or at least substantially perpendicular, to the firing axis 139.

Referring again to fig. 2, for example, the shaft 110 can include a cartridge aperture or pocket 131 that can be sized and configured to receive the clip cartridge 130 therein. The cartridge aperture 131 may be sized and configured such that the housing 132 of the cartridge 130 is closely received within the cartridge aperture 131. The sidewalls defining the cartridge aperture 131 can limit, or at least substantially limit, lateral movement of the cartridge 130 relative to the shaft 110. The shaft 110 and or the cartridge 130 may also include one or more locks that can releasably retain the cartridge 130 in the cartridge aperture 131. As shown in fig. 2, the cartridge 130 can be loaded into the cartridge bore 131 along an axis that is parallel to or collinear with the supply axis 138 in at least one embodiment. As also shown in fig. 2, the shaft 110 can further include a pad or base 118 extending from the sidewall 111 of the shaft 110, wherein the pad 118 can be received within and/or engaged with the housing 132 of the cartridge 130. The pad 118 may be sized and configured to be closely received within a groove 148 defined in the cartridge housing such that the pad 118 may limit, or at least substantially limit, lateral movement of the cartridge 130 relative to the shaft 110. The pad 118 may be sized and configured to align the cartridge 130 within the shaft 110 and/or support the cartridge housing 132.

Once the clip cartridge 130 has been positioned and seated within the shaft aperture 131, referring now to fig. 5 and 6, the firing drive 160 of the clip applier 100 can be actuated to advance the clip 140 from the clip cartridge 130 as described above. The firing drive 160 may include, for example, a rotary drive input such as a drive screw 161, and a replaceable firing nut 163 operably engaged with the drive screw 161. The drive screw 161 may include at least one drive thread 162 that may be threadably engaged with a threaded bore extending through the firing nut 163. In various embodiments, the clip applier 100 can further include, for example, an electric motor operably coupled with the drive screw 161. In various examples, the drive screw 161 is operably coupled with a motor of a surgical instrument system including a hand-held instrument or robotic arm, for example. In any event, movement of the firing nut 163 within the shaft 110 can be constrained such that when the motor rotates the drive screw 161 about the longitudinal axis 164, the firing nut 163 moves along the longitudinal axis 164. For example, when the motor rotates the drive screw 161 in a first direction, the drive screw 161 can advance the firing nut 163 distally toward the end effector 120, as shown in fig. 6. When the motor rotates the drive screw 161 in a direction opposite the first direction, the drive screw 161 may retract the firing nut 163 proximally away from the end effector 120. The shaft 110 may include one or more bearings configured to rotatably support the drive screw 161. For example, the bearing 159 can rotatably support the distal end of the drive screw 161, for example, as shown in fig. 5 and 6.

The firing drive 160 can also include a firing member 165 extending from the firing nut 163 that can be advanced distally and retracted proximally by the firing nut 163, as described in further detail below. In comparing fig. 5 and 6, the reader will note that the firing nut 163 and firing member 165 have been advanced from a proximal, unfired position shown in fig. 5 to a distal, fired position shown in fig. 6, wherein the firing member 165 has advanced the clips 140 from the clip cartridge 130 into the end effector 120. Referring primarily to fig. 5, the clip cartridge 130 is shown to include a plurality of clips 140 stored therein, with one of the clips 140 positioned in the firing position, as described above. As shown in fig. 5 and 6, the firing member 165 can include a distal portion 166 that can be advanced into the staple cartridge 130 along a firing axis 167 and engage the clip 140 positioned in the firing position as the firing member 165 and the firing nut 163 are advanced distally. In some cases, the firing member 165 can comprise a linear member, while in other cases, for example, the distal end 166 of the firing member 165 can extend upward from the firing member 165. Further to the above, the firing member 165 can advance the clip 140 distally out of the clip cartridge 130 along the firing axis 167 and into the receiving cavity 122 defined in the end effector 120.

In various instances, the firing member 165 can be attached to the firing nut 163 and extend distally from the firing nut 163, while in other instances, the firing member 165 and the firing nut 163 can be operably connected to one another by a firing actuator 168. The firing actuator 168 may be pivotally mounted to the firing member 165 at a pivot 169 and may include a distal arm 170a and a proximal arm 170b that may engage the longitudinal slot 113 defined in the housing 112 of the shaft 110. In at least one such embodiment, each of the arms 170a,170b can include a projection such as projections 171a and 171b, respectively, extending therefrom that can slide within the longitudinal slot 113. Further to the above, the firing nut 163 can further include a firing pin 172 extending therefrom configured to engage the distal arm 170a to advance the actuator 168 and firing member 165 distally, as described above. In use, referring again to the progression illustrated in fig. 5 and 6, the firing nut 163 may be advanced distally by the drive screw 161, wherein a firing pin 172 positioned intermediate the distal arm 170a and the proximal arm 170b may contact the distal arm 170a and drive the actuator 168 and firing member 165 distally. As actuator 168 is advanced distally, actuator 168 may be prevented from rotating about pivot pin 169 until actuator 168 reaches the position shown in fig. 6, as one or both of protrusions 171a and 171b, which may be prevented from sliding in shaft slot 113, are moved laterally relative to longitudinal shaft slot 113.

When actuator 168 has reached the position shown in fig. 6, distal protrusion 171a may enter distal slot portion 114 of longitudinal slot 113, which can pivot actuator 168 downward, or allow actuator 168 to pivot downward, as shown in fig. 9. In at least one such embodiment, the distal protrusion 171a can come into contact with a sidewall of the distal slot portion 114 that can guide the distal protrusion 171a downward and pivot the actuator 168 about the pivot axis 169 as the actuator 168 is advanced forward by the firing nut 163. In this pivoted position, the firing pin 172 extending from the firing nut 163 may no longer be engaged with the distal arm 170a of the actuator 168, wherein the firing nut 163 may then be moved distally independently of the actuator 168, leaving behind the actuator 168 and firing member 165. In other words, the distal end 114 of the longitudinal shaft slot 113 can deactivate the firing member 165, wherein the position of the firing member 165 at this time can represent a fully fired or distal most position of the firing member 165. In this position, the clamp 140 has been fully advanced into the receiving cavity or receptacle 122. Further, in this position, the next clip 140 to be advanced into the receiving cavity 122 can be biased against the top surface of the firing member 165, as described further above.

Further to the above, for example, once the clamp 140 is positioned within the receiving cavity 122, the crimp drive 180 may deform the clamp 140. Referring now to fig. 3 and 4, the end effector 120 of the clip applier 100 can further comprise a first jaw 123a and a second jaw 123b, wherein the first jaw 123a and the second jaw 123b can at least partially define the receiving chamber 122. As shown in fig. 3 and 4, the first jaw 123a can include a first channel 124a and the second jaw 123b can include a second channel 124b that are each configured to receive and support at least a portion of a clip 140 therein. The first jaw 123a may be pivotably coupled to the frame 111 of the shaft 110 by a pin 125a, and the second jaw 123b may be pivotably coupled to the frame 111 by a pin 125 b. In use, the crimping drive 180 can be configured to rotate the first jaw 123a toward the second jaw 123b, and/or the second jaw 123b toward the first jaw 123a, so as to compress a clip 140 positioned therebetween. In at least one such embodiment, the crimping drive 180 can include a cam actuator 181 configured to engage a first cam surface 126a defined on the first jaw 123a with a second cam surface 126b on the second jaw 123b in order to pivot the first jaw 123a and the second jaw 123b toward one another. The cam actuator 181 can include a collar that at least partially surrounds the first jaw 123a and the second jaw 123 b. In at least one such embodiment, the collar can include an inner cam surface 182 that can be contoured to contact the cam surfaces 126a,126b of the jaws 123a,123b and drive them inward toward one another. In various circumstances, a clamp 140 positioned within a receiving chamber 122 defined in the end effector 120 can be positioned relative to tissue prior to actuation of the crimp drive 180. In some cases, the crimp drive 180 can be at least partially actuated prior to positioning the clip 140 relative to the tissue to at least partially compress the clip 140. In certain examples, the clamp 140 and receiving chamber 122 can be sized and configured such that the clamp 140 can be biased or bent inwardly when the end effector 120 is in its unactuated state, as shown in fig. 3. In various examples, the crimped first jaw 123a and second jaw 123b can be actuated to resiliently crimp and/or permanently crimp a clip 140 positioned therebetween.

Further to the above, firing nut 163 is configured to actuate crimping drive 180. More specifically, referring now to fig. 7, the crimping drive 180 can comprise a crimping actuator 188 operably coupled with the cam actuator 181, wherein the crimping actuator 188 can be selectively engaged by the firing nut 163 as the firing nut 163 is advanced distally as described above. In at least one such embodiment, the firing nut 163 can further include a second firing pin, such as firing pin 184 extending therefrom, which can be configured to engage the crimping actuator 188 as the firing nut 163 advances the firing actuator 168. Referring again to fig. 7, the crimping actuator 188 is positioned in the unactuated position and, when the firing nut 163 is advanced sufficiently to engage the distal arm 190a of the crimping actuator 188, the firing nut 163 can rotate the crimping actuator 188 upwardly into the actuated position as shown in fig. 8. As also shown in fig. 8, for example, the distal arm 190a and the proximal arm 190b may each include a projection, such as projections 191a and 191b, respectively, extending therefrom that may be positioned within a second longitudinal slot, such as slot 115, defined in the shaft 110. As the crimping actuator 188 rotates upwardly about the pivot 189 from its unactuated position, the projections 191a and 191b may move from the proximal curved end 116 of the longitudinal slot 115 into a portion of the substantially linear longitudinal slot 115. Similar to the above, the sidewalls of the longitudinal slot 115 can constrain the movement of the crimp actuator 188 along the longitudinal path and can limit or prevent rotation of the crimp actuator 188 once the crimp actuator 188 has been rotated upward into the at least partially actuated position, as described above. As the reader will appreciate, the firing pin 172 of the firing drive 160 and the firing pin 184 of the crimping drive 180 both extend from the firing nut 163. For ease of illustration, firing pin 172 and firing pin 184 are shown extending from the same side of firing nut 163; however, it is contemplated that the firing pin 172 may extend from a first lateral side of the firing nut 163, while the firing pin 184 may extend from other lateral sides of the firing nut 163. In such instances, the firing actuator 168 may be positioned alongside a first lateral side of the drive screw 161, and the crimping actuator 188 may be positioned alongside an opposite lateral side of the drive screw 161. Accordingly, longitudinal slot 113 may be defined in a first lateral side of shaft housing 112, while longitudinal slot 115 may be defined in an opposite lateral side of shaft housing 112.

Further to the above, cam actuator 181 can be operably coupled with crimp actuator 188 such that when crimp actuator 188 is advanced distally by firing nut 163, cam actuator 181 can be advanced distally, as shown in fig. 8 and 10, until distal protrusion 191a extending from distal arm 190a reaches distal end 117 of longitudinal slot 115. In such a distal position, the cam actuator 181 may be in a fully advanced position and the clip 140 positioned within the receiving chamber 122 may be in a fully deformed or crimped configuration. The cam actuator 181 can then be retracted and the end effector 120 can be opened again. More specifically, the drive screw 161 can be rotated in the opposite direction to move the firing nut 163 proximally and retract the cam actuator 181, wherein, in certain instances, the end effector 120 can further comprise a biasing member configured to bias the first jaw 123 and the second jaw 123b from the closed or fired position shown in fig. 4 into the open or unfired position shown in fig. 3. As the firing nut 163 is retracted from its position shown in fig. 10, a firing pin 184 extending from the firing nut 163 may engage the proximal arm 190b of the crimping actuator 188 and move the crimping actuator 188 and the cam actuator 181 extending therefrom proximally as shown in fig. 12. Similar to the above, a proximal protrusion 191b extending from a proximal arm 190b of the crimp actuator 188 can contact a sidewall of the curved proximal end 116, wherein the sidewall can guide the crimp actuator 188 downward and rotate the crimp actuator 188 about the pivot 189. At this point, the firing pin 184 can no longer engage the crimp actuator 188, the cam actuator 181 can be fully retracted, and the firing nut 163 can continue to be retracted proximally relative to the crimp actuator 188.

Further to the above, referring now to fig. 11, as the firing nut 163 is retracted proximally, the firing nut 163 can reengage the firing actuator 168. As described above, when the firing actuator 168 reaches the distal end 114 of the longitudinal slot 113, the firing actuator 168 is rotated downward, and, thus, the firing actuator 168 may still be in its downward rotated position when the firing nut 163 is retracted proximally to reengage the firing actuator 168. As shown in fig. 11, a firing pin 172 extending from firing nut 163 can engage a proximal arm 170b of firing actuator 168, and as firing nut 163 is further retracted, firing nut 163 can rotate firing actuator 168 upward such that projections 171a and 171b extending from arms 170a and 170b, respectively, can re-enter a longitudinal portion of longitudinal slot 113. The firing nut 163 may then be retracted until the firing actuator 168 and firing member 165 extending therefrom have returned to their starting or unfired position shown in FIG. 5. In such instances, as the firing nut 163 retracts the firing member 165 proximally, the firing member 165 can be withdrawn from the clamp cartridge 130 such that a new clamp 140 can be biased into the firing chamber of the clamp cartridge 130 by the biasing member 136. Once the firing member 165 and firing actuator 168 have been retracted to their starting positions and the next clip 140 has been positioned within the firing chamber, the firing drive 160 can be actuated again to move the firing nut 163 and firing member 165 distally to advance the next clip 140 into the end effector 120. Likewise, as the firing nut 163 is moved distally again, the firing nut 163 may re-actuate the crimping drive 180 to deform the next clip 140. The firing nut 163 may then be retracted to again reset the crimping drive 180 and the firing drive 160. This process can be repeated until a sufficient number of clips 140 have been applied to the target tissue and/or until the clips 140 contained in the clip cartridge 130 are exhausted. In the event additional clamps 140 are required, the emptied clamp cartridge 130 can be removed from the shaft 110 and an alternate clamp cartridge 130 containing the additional clamps 140 can be inserted into the shaft 110. In some cases, for example, an at least partially depleted clip cartridge 130 can be replaced with the same, or at least nearly the same, replacement clip cartridge 130, while in other cases, the clip cartridge 130 can be replaced with a clip cartridge that contains more or less than five clips 140 therein and/or a clip cartridge that contains clips other than clips 140 therein.

Referring again to fig. 6-9, the firing nut 163 of the illustrated embodiment can be configured to disengage the firing actuator 168 while the firing nut 163 is engaged with the crimping actuator 188. In other words, the firing drive 160 may be deactivated at the same time as the crimping drive 180 is activated. In various circumstances, such timing can be achieved, for example, when the distal end 114 of the longitudinal slot 113 is aligned, or at least substantially aligned, with the proximal end 116 of the second longitudinal slot 115. In the illustrated embodiment and/or any other suitable embodiment, there may be a delay between deactivation of the firing drive 160 and activation of the crimping drive 180. In some instances, such a delay between the end of the firing stroke of firing member 165 and the beginning of the firing stroke of cam actuator 181 may occur to ensure that clip 140 has been positioned in its fully seated position within receiving chamber 122 before clip 140 is deformed by cam actuator 181. In various circumstances, such a delay may be created, for example, when the distal end 114 of the longitudinal slot 113 is positioned proximally relative to the proximal end 116 of the second longitudinal slot 115. In the illustrated embodiment and/or any other suitable embodiment, deactivation of the firing drive 160 can occur after activation of the crimp drive 180. In some cases, for example, such overlap between the end of the firing stroke of the firing member 165 and the beginning of the firing stroke of the cam actuator 181 can be created so as to apply at least some inward pressure to the clip 140 as it moves to its fully seated position within the receiving chamber 122, thereby reducing or eliminating relative movement between the clip 140 and the receiving chamber 122 sidewall. In various circumstances, such overlap can occur, for example, when the distal end 114 of the longitudinal slot 113 is positioned distally relative to the proximal end 116 of the second longitudinal slot 115.

In the illustrated embodiment of fig. 1 and/or any other suitable embodiment, turning now to fig. 17, a clip cartridge, such as clip cartridge 230, for example, can include a push plate 248 positioned intermediate the biasing member 136 and the topmost clip 140 stacked within the clip cartridge 230. The push plate 248 can be rigid, or at least substantially rigid, and can include a first bearing surface against which the biasing member 136 can apply a biasing force. The push plate 248 can also include a second bearing surface that can transfer the biasing force to the top surface 145 of the topmost clamp 140. For example, the push plate 248 can be constructed from a sheet of stainless steel material, but the push plate 248 can have any suitable shape and can be constructed from any suitable material. In some instances, the push plate 248 may not be attached to the biasing member 136, while in other instances, the push plate 248 may be attached to the biasing member 136 such that the push plate 248 does not fall out of the cartridge housing 132. In various circumstances, the push plate 248 can be sized and configured such that it cannot pass through the proximal opening 133 and/or the distal opening 137 defined in the cartridge housing 132.

In the illustrated embodiment of fig. 1 and/or any other suitable embodiment, turning now to fig. 18 and 19, a clip cartridge, such as a clip cartridge 330, for example, can comprise a lockout member that can be positioned within the firing chamber 149 of the clip cartridge 330 after all of the clips 140 contained within the clip cartridge 330 have been ejected from the cartridge 330. The lockout member may include a lockout plate 348 positionable intermediate the biasing member 136 and the top surface 145 of the topmost clip 140 contained within the clip magazine 330. In use, further to the above, the clips 140 can be sequentially positioned in the firing chamber 149 of the clip cartridge 130 and then pushed distally out of the clip housing 132, wherein the biasing member 136 can bias the lockout plate 348 against the shelf 135 after the last clip 140 has been pushed out of the clip housing 132 and the firing member 165 has been withdrawn from the clip cartridge 130. In this position, the lockout plate 348 may be aligned with the proximal opening 133 and the distal opening 137 such that the firing member 165 cannot enter, or at least substantially cannot enter, the clip cartridge 130. In such instances, the lockout plate 348 can block the firing member 165 from entering and passing through the housing 132, and thus, can prevent accidental firing of the clip applier 100 after the clip cartridge 130 has run out of clips. In the event that an operator of the clip applier 100 were to actuate the firing drive 160 and attempt to advance the firing member 165 into an empty clip cartridge 130, the firing member 165 would contact and abut the lockout plate 348, wherein, in such instances, a compressive load may be generated within the firing member 165. The clip applier 100 can further include a clutch configured to slip and operatively disconnect the motor from the drive screw 161 when a compression load generated within the firing member 165 exceeds a certain amount or a predetermined amount. In addition to or in lieu of a clutch, the motor and/or motor controller of the clip applier 100 operating the firing drive 160 can, for example, include a load sensor configured to detect a load generated within the firing member 165 and can shut off and/or reduce the voltage and/or current supplied to the motor when the load generated within the firing member 165 exceeds a certain or predetermined amount. In any event, lockout plate 348 may be sized and configured such that when firing member 165 contacts lockout plate 348, lockout plate 348 does not fall out through distal opening 137 and/or proximal opening 133. To reuse the clip applier 100, an operator of the clip applier 100 can remove the empty cartridge 330 from the shaft 110 and insert, for example, a new clip cartridge 330 into the shaft 110. At this point, the clip 140 can be positioned within the firing chamber 149 of the new clip cartridge 330 and the firing member 165 can be advanced distally into the new clip cartridge 330 to deploy the clip 140 as described above.

In the illustrated embodiment of fig. 1 and/or any other suitable embodiment, referring now to fig. 20 and 21, a clip cartridge, such as clip cartridge 430, for example, can comprise a guide that can limit or constrain movement of a lockout member within clip cartridge 430. Similar to the above, the latch member can include a latch plate 448, for example, which can be positioned intermediate the biasing member 136 and the top surface 145 of the topmost clip 140 contained within the housing 432 of the clip cartridge 430. In use, similar to the above, as the clips 140 are sequentially ejected from the clip cartridge 430, the lockout plate 448 can be gradually pushed downward into the firing chamber 149. The latch plate 448 may be sized and configured such that it is closely received within the cartridge housing 432 and such that relative lateral movement between the latch plate 448 and the housing 432 may be limited in order to reduce or prevent the possibility of misalignment of the latch plate 448 within the clamp cartridge 430. For example, in the event that lockout plate 448 will become misaligned within clamp cartridge 430, lockout plate 448 may be incorporated within housing 432 and prevent biasing member 136 from applying an appropriate biasing force to the stack of clamps 140. As shown in fig. 20 and 21, the latch plate 438 can further include a guide member 447 extending therefrom, the guide member 447 can be received within a guide slot 446 defined in the cartridge housing 432. The guide member 447 and the guide slot 446 may be sized and configured such that the guide member 447 is closely received within the guide slot 446 and such that relative lateral movement between the lockout plate 438 and the cartridge housing 432 may be limited. Each of the guide slots 446 may be defined by opposing side walls 445 that may define a spacing therebetween equal to or slightly greater than the width of the guide member 447 positioned therein such that the guide member 447 may slide between the opposing side walls 445 with the side walls 445 between the top 443 and bottom 444 of the guide slots 446. Thus, while the guide members 447 and guide slots 446 can limit lateral movement therebetween as described above, for example, the guide members 447 and guide slots 446 can allow relative movement between the lockout plate 438 and the cartridge housing 432 along a predetermined path that is parallel or collinear with the supply axis 138. When the lockout plate 438 is pushed into the firing chamber 149 by the biasing member 136, as described above, the lockout plate 438 may inhibit advancement of the firing member 165 and operation of the clip applier 100 until the emptied clip cartridge 430 is replaced with another suitable clip cartridge.

In the illustrated embodiment of fig. 1 and/or any other suitable embodiment, as described above, the drive screw 161 can be rotated in a first direction to advance the firing nut 163 distally and can be rotated in a second or opposite direction to retract the firing nut 163 proximally. To rotate the drive screw 161 in the first and second directions, an electric motor operatively coupled to the drive screw 161 may be operated in the respective first and second directions. In the illustrated embodiment of FIG. 1 and/or any other suitable embodiment, a clip applier can employ a motor that operates in only a first direction, wherein rotation of the motor in this single direction can be used to advance the firing nut distally and retract the firing nut proximally. Turning now to fig. 22-26, the output of the electric motor may be transmitted to a drive system 560 through a transmission 550. The transmission system 550 may include an input shaft 552 that operates in a single direction, wherein the transmission system 550 may be switched or transitioned between a first state or configuration in which the transmission system 550 rotates the drive screw 561 of the drive system 560 in a first direction and a second state or configuration in which the transmission system 550 rotates the drive screw 561 in a second or opposite direction. A first state of the transmission system 550 is shown in fig. 22-24, and a second state of the transmission system 550 is shown in fig. 25 and 26.

Referring again to fig. 22-24, the input shaft 552 can include an input gear 551 mounted thereon that is operatively coupled or meshingly engaged with the shifter gear 553 such that rotation of the input shaft 552 is transmitted to the shifter gear 553. As with all of the gears described above, the gears operatively coupled or meshingly engaged with each other may include, for example, any suitable arrangement of teeth that may transfer rotation of one gear to another. When the input shaft 552 rotates in a first direction, the shifter gear 553 rotates in a second or opposite direction. In a first state of the transmission system, the shifter gear 553 is in a first position in which the shifter gear 553 is operatively coupled with the intermediate gear 554, wherein the intermediate gear 554 rotates in a first direction when the input gear 551 rotates the shifter gear 553 in a second direction as described above. Although not shown, for example, the idler gear 554 may be rotatably supported within the shaft 110 of the clip applier 100. The intermediate gear 554 can also be operably coupled with an output gear 555 mounted to the drive screw 561 such that rotation of the intermediate gear 554 can be transmitted to the output gear 555. As described above, when the intermediate gear 554 is driven in the first direction by the shifter gear 553, the intermediate gear 554 may drive the output gear 555 and the drive screw 561 in the second direction. Similar to the above, firing nut 563 may be operably coupled with drive screw 561 and suitably constrained within shaft 110 such that when drive screw 561 is rotated in a second direction, firing nut 563 is advanced distally, as indicated by arrow D.

Similar to the above, the firing nut 563 can be advanced to its distal-most position shown in FIG. 24 in order to advance the clip 140 from the clip cartridge 130 into the end effector 120 and crimp the clip 140, as described above. As seen in fig. 23 and 24, the firing nut 563 may further include a cam rod 569 extending therefrom that is configured to transition the transmission 550 from its first state to its second state. By comparing fig. 24 and 25, the reader will note that shifter gear 553 is movable between a first position in which drive system 550 is in its first state and a second position in which drive system 550 is in its second state. More specifically, the shifter gear 553 is mounted to a shifter 556 that is rotatable about the input shaft 552 such that the shifter gear 553 is rotatable from its first position in which the shifter gear 553 is operably engaged with the input gear 551 and the intermediate gear 554, and its second position in which the shifter gear 553 is operably disengaged from the intermediate gear 554. Although the shifter gear 553 is operably disengaged from the intermediate gear 554 when the shifter gear 553 is in its second position, the shifter gear 553 can be operably coupled with the input gear 551 and the output gear 555 to transfer rotational motion from the input shaft 552 to the drive screw 561. As shown in fig. 24 and 25, the shifter 556 may include a central aperture through which the input shaft 552 may extend; however, the shifter 556 may not be operably engaged with the input shaft 552 such that rotation of the input shaft 552 does not rotate the shifter 556 and, likewise, rotation of the shifter 556 does not rotate the input shaft 552. In any event, the shifter 556 can further include a cam follower 558 extending therefrom, the cam follower 558 can be engaged by a cam 568 defined on the cam rod 569 as the firing nut 563 is advanced distally. When cam 568 engages cam follower 558, cam 568 may rotate shifter 556 and shifter gear 553 between its first and second positions, as described above.

When the shifter gear 553 is in its second position and the transmission system 550 is in its second state, both the input shaft 552 and the drive screw 561 may be rotated in a first direction, as described above. More specifically, when the input shaft 552 rotates in a first direction, it can rotate the input gear 551 in the first direction, and as the shifter gear 553 directly engages the input gear 551, the shifter gear 553 will rotate in a second direction. The reader will note that when the transmission system 550 is in its second state, the shifter gear 553 rotates in a second direction, in contrast to when the transmission system 550 is in its first state, the shifter gear 553 rotates in a first or opposite direction. Further to the above by comparing fig. 24 and 25, the reader will appreciate that when the transmission 550 is in its second state, the intermediate gear 554 is no longer operably positioned intermediate the input gear 551 and the shifter gear 553, resulting in a different rotational direction. Because the shifter gear 553 is operably engaged with the input gear 551 and the output gear 555 when the shifter gear 553 is in its second position, the shifter gear 553 may rotate the output gear 555 and the drive screw 561 coupled to the output gear 555 in a first direction. When the drive screw 561 is rotated in a first direction, as shown in fig. 25 and 26, the firing nut 563 can be retracted proximally to allow the end effector 120 to reopen and retract the firing member 165. Referring primarily to FIG. 26, the firing nut 563 may further include a second cam bar 567 extending therefrom that includes a cam 566 configured to contact a cam follower 558 of the shifter 556 as the firing nut 563 is proximally retracted to its fully retracted position. In such a case, the cam 566 may push the shifter 556 back to its first position and operably engage the intermediate gear 554 such that the transmission system 550 may be reset to its first state and the clip applier 100 may be actuated again.

As described above, the firing drive of the clip applier 100 can be operated by a surgical instrument system that includes an electric motor. The robotic surgical instrument system 20 is shown in fig. 27 and may include a plurality of moveable arms 30. Each arm 30 may include an actuator module 32 that includes an electric motor configured to provide rotational motion to a shaft 110 of the clip applier 100 and/or any other suitable surgical instrument. Referring now to fig. 28, an end effector 620 can be selectively engaged and disengaged with the actuator shaft 610 of the clip applier, wherein the end effector 620 can include a proximal end 621 that can be coupled to a distal end 611 of the shaft 610. The proximal end 621 of the end effector 620 may include an outer housing 629, a frame extending through the outer housing 629, an outer drive shaft extending through the frame, and an inner drive shaft extending through the outer drive shaft. Similarly, the distal end 611 of the shaft 610 may include an outer housing 619, a frame 663 extending through the outer housing 619, an outer drive shaft 662 extending through the frame 663, and an inner drive shaft 661 extending through the outer drive shaft 662. With respect to the distal end 611 of the shaft 610, the frame 663, the outer drive shaft 662, and the inner drive shaft 661 can each include a portion of a tongue connector 613 extending therefrom and a portion of a connector groove 612 defined therein, wherein the tongue connector 613 can be received within a tongue groove 623 defined in the proximal end 621 of the end effector 620, and wherein the tongue groove 612 can receive a tongue connector 622 extending from the proximal end 621 of the end effector 620. Similar to the tongue connector 613 extending across the frame 663, the outer drive shaft 662, and the inner drive shaft 661 of the distal shaft end 611, the tongue connector 622 may extend across the frame, the outer drive shaft, and the inner drive shaft of the proximal end 621 of the end effector 620. Additionally, similar to the tongue groove 612 extending across the frame 663, the outer drive shaft 662, and the inner drive shaft 661 of the distal shaft end 611, the tongue groove 623 may extend across the frame, the outer drive shaft, and the inner drive shaft of the proximal end 621 of the end effector 620. In the configuration shown in fig. 28, tongue connector 622 of end effector 620 can slide laterally into tongue groove 612 of shaft 610 while tongue connector 613 of shaft 610 slides laterally into tongue groove 623 of end effector 620. As a result of such assembly, the frame of the end effector 620 can be securely coupled to the frame 663 of the shaft 610, the outer drive shaft of the end effector 620 can be operably coupled to the outer drive shaft 662 of the shaft 110, and the inner drive shaft of the end effector 620 can be operably coupled to the inner drive shaft 661 of the shaft 110. The reader will note that when assembling end effector 620 to shaft 610, portions of tongue connector 612 are aligned with each other, portions of tongue groove 613 are aligned with each other, portions of tongue groove 622 are aligned with each other, and portions of tongue connector 623 are aligned with each other. When assembled, the outer drive shaft 662 of the shaft 110 may rotate the outer drive shaft of the end effector 620, and the inner drive shaft 661 of the shaft 610 may rotate the inner drive shaft of the end effector 620. When the outer drive shaft 662 and/or the inner drive shaft 661 are rotated, portions of the tongue connector 612, the tongue groove 613, the tongue groove 622, and the tongue connector 623 may no longer be aligned. To remove the end effector 620 from the shaft 610, the inner drive shaft 661 and/or the outer drive shaft 662 can be rotated to one or more positions where the tongue connectors 612 and 623 and tongue grooves 613 and 622 are sufficiently aligned.

Referring again to fig. 28, the outer housing 619 of the shaft 610 can further include a stop 614 configured to limit lateral movement of the end effector 620 as the end effector 620 slides laterally onto the distal end 611 of the shaft 610. The stop 614 may provide a reference by which the inner drive shaft of the end effector 620 and the inner drive shaft 661 of the shaft 610 are aligned along the longitudinal axis 615, the outer drive shaft of the end effector 620 and the other drive shaft 662 of the shaft 610 are aligned along the longitudinal axis 615, and/or the frame of the end effector 620 and the frame 663 of the shaft 610 are aligned along the longitudinal axis 615. Further to the above, the inner drive shaft 661 may extend into an actuator module 632, which may include an electric motor and/or a gear train 664 operably coupled with the inner drive shaft 661, which is capable of rotating the inner drive shaft 661. In addition, the actuator module 632 may include a second electric motor and gear train operably engaged with the second drive shaft 662, which may be configured to drive the second drive shaft 662. As described in more detail below, a second electric motor may be used to articulate the end effector 620. Additionally, as further described above, the outer housing 619 of the shaft 610 and/or the frame 663 may further include a gear 617 mounted thereon that is operably engaged with the electric motor and gear train 618 that is capable of rotating the shaft 610 and the end effector 620 about the longitudinal axis 615. For example, if the electric motor and gear train 618 is operated in a first direction, the shaft 610 and end effector 620 may rotate in a clockwise direction about the axis 615, while if the electric motor and gear train 618 is operated in a second direction, the shaft 610 and end effector 620 may rotate in a counterclockwise direction about the axis 615 for positioning and orienting the end effector 620.

As described above, the end effector 620 can be selectively attached to and detached from the shaft 610. The reader will note that the principles discussed in connection with the end effector 620 and shaft 610 are equally applicable to the end effector 120 and shaft 110, etc. of the embodiment disclosed in fig. 1.

That is, referring again to FIG. 27, one of the robotic arms 30 can be selectively engaged with the end effector 120 of the clip applier or, alternatively, with any other suitable end effector, such as an end effector of a surgical stapler. In such cases, the end effector 120 may be selectively interchangeable with another end effector, and thus, a single robotic arm 30 may be used to perform more than one function. In other words, the clip applier 100 can include a replaceable loading unit that can be replaced with, or interchanged with, another clip applier loading unit and/or any other suitable replaceable loading unit. Referring now to FIG. 29, the end effector 120 and shaft 110 of the clip applier 100 can be used with a surgical instrument system that includes a handle 700. The handle 700 may include an actuator 701 that may be run or pressed toward the clamp 702 to impart rotational motion to the drive screw 161, as described above. In some cases, rotation of the actuator 701 may be mechanically transferred to the drive screw 161, while in other cases, the actuator 701 may run a motor operatively coupled to the drive screw 161.

Further to the above, the end effector 120 and the shaft 110 of the clip applier 100 can be aligned along a longitudinal axis of the clip applier 100. Turning now to FIG. 30, the end effector 120 and/or the shaft 110 can further include an articulation joint 101 configured to allow articulation of the end effector 120 relative to the longitudinal axis of the clip applier 100. The shaft 110 may include an outer housing or frame portion 119, which may include the proximal end 102 and may include the distal portion of the articulation joint 101. The proximal end 102 may comprise a spherical or at least substantially spherical end 102, e.g., which may be received within a spherical or at least substantially spherical cavity 104 defined in an articulation joint member 103. The articulation joint member 103 may also include a spherical or at least substantially spherical end 105, which may be received within a spherical or at least substantially spherical cavity 107 defined in the shaft frame portion 106, for example. The proximal end 102 of the shaft 110 may be at least partially captured within the lumen 104 such that the proximal end 102 cannot be easily removed from the lumen 104. That is, proximal end 102 and lumen 104 may be sized and configured to allow proximal end 102 to rotate in any suitable direction within lumen 104. As also shown in FIG. 30, the clip applier 100 can further include articulation control devices 108a and 108b, which can extend through the articulation joint 101 and can include distal ends that fit within mounting holes 109a and 109b, respectively, where the mounting holes 109a and 109b are defined within the proximal end 102 of the shaft housing 119, for example. In use, the articulation control devices 108a and 108b may be pushed and/or pulled to move the proximal end 102 within the lumen 104. Further to the above, the end 105 of the articulation joint member 103 may be at least partially captured within a cavity 107 defined in the shaft frame portion 106 such that the end 105 cannot be easily removed from the cavity 107. That is, end 105 and cavity 107 may be sized and configured to allow end 105 to rotate in any suitable direction within cavity 107 when shaft end 102 is pushed and/or pulled by actuators 108a and 108b as described above.

Further to the above, referring again to fig. 30, for example, screw 161 may be rotationally driven by an input shaft (such as input shaft 152). The input shaft 152 may extend through apertures 156 defined in the shaft frame portion 106, the articulation joint member 103, and the proximal end 102 of the shaft housing 119. The input shaft 152 can include an input gear 151 mounted to a distal end thereof that can be operably coupled with an output gear 155 mounted to a proximal end of a drive screw 161. In use, as described above, the input shaft 152 may be rotated by an electric motor, wherein the input shaft 152 may rotate the drive screw 161. As described above, the articulation joint 101 can be configured to allow the end effector 120 and at least a portion of the shaft 110 to articulate relative to a longitudinal axis defined by the clip applier 100. To accommodate such movement, at least a portion of the input shaft 152 extending through the articulation joint 101 may be sufficiently flexible.

Referring now to fig. 31-34, for example, the articulation actuators 108a and 108b may be operated by an actuator module (such as module 832). Referring primarily to fig. 31, the actuator module 832 may include a rotatable articulation driver 833 that is capable of pushing and pulling the articulation actuators 108a and 108 b. The articulation drive 833 may comprise a cylindrical or at least substantially cylindrical collar 835 comprising a bore 837 configured to receive at least a portion of the shaft frame 106 therein so as to rotatably support the collar 835. The articulation drive 833 may also include an input gear portion 834 that may be operably coupled with the gear train 831 of the electric motor and module 832, wherein the articulation drive 833 may be caused to rotate about the axle frame 106 when the electric motor and gear train 831 is actuated. Referring primarily to fig. 32 and 34, the articulation driver 833 may also include two cam slots defined in the sidewalls of the collar bore 837, but the reader will note that only one cam slot 835a is shown in the views provided. The cam slot 835a is configured to receive a cam follower 838a extending from the articulation driver 108a, wherein the cam follower 838a is configured to slide within the cam slot 835 a. As the articulation driver 833 rotates, for example, the helical profile of the cam slot 835a can be configured to push the cam follower 838a distally or pull the cam follower 838a proximally, depending on the direction of rotation of the articulation driver 833. Due to the proximal or distal movement of cam follower 838a, cam actuator 108a may move proximally or distally, respectively. Although not shown, the articulation driver 108b may include a cam follower, similar to cam follower 838a, that is capable of sliding within the other cam slots described above. Other cam slots may be configured such that when the articulation actuator 108a is driven distally by the articulation driver 833 as the articulation driver 833 rotates in a first direction, the articulation actuator 108b may be pulled proximally. Similarly, other cam slots may be configured such that when articulation actuator 108a is pulled proximally by articulation driver 833 as articulation driver 833 rotates in a second direction, articulation actuator 108b may be driven distally. Referring primarily to fig. 32, the shaft frame portion 106 may include a clearance slot 839 defined therein through which the cam follower may extend. Although the above-described features are discussed in connection with the actuator module 832, such features may be used in connection with other actuator modules disclosed herein.

Fig. 35A, 35B, and 35C depict a clip applier 70100 according to at least one embodiment. The clip applier 70100 is similar in many respects to clip applier 100, and for the sake of brevity, most of these aspects will not be repeated here. Similar to the clip applier 100, the clip applier 70100 includes an end effector 70120, a shaft, a clip cartridge, and a firing member 70165. The clip cartridge includes a plurality of clips 70140 removably stored therein. The end effector 70120 comprises a first jaw 70123a and a second jaw 70123b, wherein the first jaw 70123a and the second jaw 70123b at least partially define a receiving chamber 70122. In addition, the first jaw 70123a and the second jaw 70123B are pivotally coupled to the shaft by pins 70125 such that the first jaw 70123a and the second jaw 70123B are movable relative to each other between an open position (fig. 35B) and a closed position (fig. 35A). The first jaw 70123a and the second jaw 70123b can be moved between an open position and a closed position by a crimp drive 70180 (see fig. 36-38). Other embodiments are contemplated wherein the first jaw 70123a and the second jaw 70123b are pivotably coupled to the shaft with at least one pin similar to the first jaw 125a and the second jaw 125b depicted in fig. 1. The first jaw 70123a and the second jaw 70123b include pre-forming features, such as protrusions 70126a and 70126b, discussed in further detail below.

In use, the firing member 70165 advances the clips 70140 from the clip cartridge onto the protrusions 70126a and 70126b, as shown in fig. 35A. In this position, the clamp 70140 is in a preformed configuration. The width of the clip 70140 in the preformed configuration may preferably be 0.080 ". When the first and second jaws 70123a, 70123B are moved from the closed position to the open position, the protrusions 70126a, 70126B cause the clip 70140 to deploy to a deployed configuration, as depicted in fig. 35B. The width of clip 70140 in the deployed configuration may preferably be 0.210 ". During the transition of the clip 70140 from the pre-shaped configuration to the deployed configuration, the firing member 70165 supports the back side of the clip 70140. More specifically, the firing member 70165 includes angled surfaces 70165a and 70165b that provide support to the back side of the clamp 70140 as the clamp 70140 is deployed. Additionally, as the clip 70140 is deployed, the firing member 70165 can be advanced to allow the angled surfaces 70165a and 70165b to continue to remain in contact against the back side of the clip 70140 as the clip 70140 is deployed. Once in the deployed configuration, the clip 70140 is advanced into the receiving chamber 70122 by the firing member 70165. The protrusions 70126a and 70126b include angled portions that allow the clip 70140 to slide over the protrusions 70126a and 70126b as the clip 70140 is advanced by the firing member 70165. After the clip 70140 has been advanced into the receiving chamber 70122, the firing member 70165 is retracted and the crimp drive 70180 is actuated to transition the first jaw 70123a and the second jaw 70123b to the closed position depicted in fig. 35A to crimp the clip 70140 positioned in the receiving chamber 70122. After the clip 70140 is crimped, another clip 70140 can be advanced by the firing member 70165 over the protrusions 70126a and 70126 b. When the first and second jaws 70123a, 70123b are moved from the closed position to the open position by the crimp drive 70180, the clip 70140 that has been crimped in the receiving chamber 70122 will be released from the receiving chamber 70122 and the clip 70140 that is advanced over the projections 70126a, 70126b will be deployed into the deployed configuration by the projections 70126a, 70126b of the first and second jaws 70123a, 70123 b. The interaction between the crimp drive 70180 and the first and second jaws 70123a, 70123b is discussed in further detail below.

36-38 depict the clip applier 70100 as described above. Additionally, fig. 36-38 further depict the interaction between the crimp drive 70180 and the first jaw 70123a and the second jaw 70123 b. The crimp drive device 70180 includes a first crimp drive pin 70180a and a second crimp drive pin 70180b projecting therefrom. The first jaw 70123a includes a first jaw cam 70124a extending therefrom and the second jaw 70123b includes a second jaw cam 70124b extending therefrom. In use, the crimp drive 70180 can be moved between a fully retracted position (fig. 38), a starting position (fig. 37), and a fully fired position (fig. 36). The fully fired position may preferably be 0.300 "distal of the starting position. The fully retracted position may preferably be 0.050 "proximal of the starting position. Other embodiments having different distances between the starting, fully retracted, and fully fired positions are contemplated. The crimp drive 70180 cammingly engages the outer surfaces of the first jaw 70123a and the second jaw 70123b to transition the first jaw 70123a and the second jaw 70123b to the closed position as the crimp drive 70180 is moved into the fully fired position (fig. 36), similar to the interaction between the crimp drive 180 and the first jaw 123a and the second jaw 123b described above. In the starting position (fig. 37), the first and second crimp drive pins 70180a and 70180b engage the first and second jaw cams 70124a and 70124b, respectively, such that the first and second jaws 70123a and 70123b move toward the open position to release the crimp clamp 70140 from the first and second jaws 70123a and 70123 b. When the crimp driver 70180 is in the starting position, another clip 70140 may be advanced over the protrusions 70126a and 70126b as described above. In addition, as the crimp drive device 70180 is moved from the starting position (fig. 37) to the fully retracted position (fig. 38), the first and second crimp drive pins 70180a, 70180b transition the first and second jaws 70123a, 70123b toward the open position and, as a result, the clips 70140 positioned about the projections 70126a, 70126b are deployed into the deployed configuration, as described above. An alternative embodiment is contemplated wherein the crimp clip 70140 is released from the first jaw 70123a and the second jaw 70123b and, at the same time, the other clip 70140 positioned on the projections 70126a and 70126b is at least partially deployed as the crimp drive device is moved from the closed position to the starting position.

Fig. 39 and 40 depict a clip applier 70150 according to at least one embodiment. The clip applier 70150 includes a frame 70155, a firing member 70160, a first jaw 70170a, and a second jaw 70170 a. The first jaw 70170a and the second jaw 70170b are pivotably coupled to the frame 70155 such that the first jaw 70170a and the second jaw 70170b are movable relative to each other. The clip applier 70150 is configured to receive, for example, various types of clip cartridges, such as the clip cartridge 70130 depicted in FIG. 39. The clip cartridge 70130 comprises a cartridge body 70132 comprising a first cartridge jaw 70132a and a second cartridge jaw 70132b which oppose one another. When the clip cartridge 70130 is attached to the frame 70155 of the clip applier 70150, the first cartridge jaw 70132a biases the first jaw 70170a toward the second jaw 70170b, and the second cartridge jaw 70132b biases the second jaw 70170b toward the first jaw 70170 a. Thus, when the clip cartridge 70130 is attached to the clip applier 70150, the first jaw 70170a and the second jaw 70170b are approximated to form the receiving chamber 70175. The clip cartridge 70130 also includes a plurality of clips 70136 that are removably stored in a clip housing 70134. The clip cartridge 70130 also comprises, for example, a biasing member, such as a spring 70138, configured to bias the clip 70136 from the clip housing 70134 into the receiving chamber 70175. Once in the receiving chamber 70175, the clip 70136 can be advanced by the firing member 70160 into a crimping chamber in the distal ends of the first and second jaws 70170a, 70170 b. The clip 70136 positioned in the crimping chamber can then be crimped as the first jaw 70170a and the second jaw 70170b are moved toward each other.

FIG. 40 depicts a different clip cartridge 70130' positioned in a clip applier 70150. The clip cartridge 70130' is similar to the clip cartridge 70130 described above, except for the differences described below. Clip cartridge 70130 'is configured to store clips 70136' that are smaller than clips 70136. Other embodiments are contemplated in which the clip cartridge 70130' is configured to store clips that are larger than the clips 70136. In any event, clip cartridge 70136 'includes one, a clip housing 70134' that stores clips 70136 ', and two, biasing members, such as springs 70138', that bias stored clips 70136 'into receiving chamber 70175', for example. In addition, the clip cartridge 70130 ' comprises a cartridge body 70132 ', a first cartridge jaw 70132a ', and a second cartridge jaw 70132b ' opposite the first cartridge jaw 70132a '. The first cartridge jaw 70132a 'and the second cartridge jaw 70132 b' extend further inward toward one another than the first cartridge jaw 70132a and the second cartridge jaw 70132b of the clip cartridge 70130. In other words, the gap between the first cartridge jaw 70132a 'and the second cartridge jaw 70132 b' is less than the gap between the first cartridge jaw 70132a and the second cartridge jaw 70132 b. When the clip cartridge 70130 'is attached to the clip applier 70150, the receiving chamber 70175' defined between the first jaw 70170a and the second jaw 70170b will be smaller than the receiving chamber 70175. By varying the distance between the first and second cartridge jaws of the clip cartridges 70130 and 70130', receiving chambers of various sizes can be created. Thus, the clip cartridges 70130 and 70130' can be modified to access the first jaw 70170a and the second jaw 70170b of the clip applier 70150 to receive any suitable clip size.

FIG. 41 depicts a clip applier 70200 according to at least one embodiment. The clip applier includes a shaft 70210 extending from the housing, an end effector 70220 extending from the shaft 70210, a feeder member 70230 configured to move through the clip applier 70200 in response to rotational movement generated in the housing, and a clip cartridge 70240. The end effector includes a pair of jaws 70225 configured to move relative to one another between an open position and a closed position. Clip magazine 70240 is not removable from clip applier 70200; however, other embodiments are contemplated in which clip magazine 70240 is removable and/or replaceable. Clip magazine 70240 includes a first layer 70246 of clips 70244 and a second layer 70248 of clips 70244 stored within clip magazine 70240. The first layer 70246 of clips 70244 is in a feed position from which clips can be ejected from the clip magazine 70240. The second tier 70248 of clips 70244 is stored above the first tier 70246 of clips 70244 in a storage position from which clips cannot be ejected from the clip magazine 70240. Each of the first layer 70246 and the second layer 70248 includes three clips 70244, however, other embodiments having more or less than three clips are contemplated. The first layer 70246 and the second layer 70248 are separated by a dividing member, such as a dividing plate 70249. The clip magazine 70240 also includes a top plate 70243 and a biasing member 70242. The top panel 70243 rests on top of the second layer 70248 of clip 70244. The biasing member 70242 biases the top plate 70243 toward the top of the second tier 70248 of the clip 70244, and thus biases the second tier 70248 of the clip 70244 toward the divider plate 70249. The divider panel 70249 rests on top of the first layer 70246 of the clip 70244 and the distal protrusion 70232 of the feeder member 70230. The distal protrusion 70232 extends above the feeder member 70230. The operation of the clip applier 70200 is discussed in further detail below.

In use, the feeder member 70230 is translated distally to push the first layer 70246 of clips 70244 out of the clip magazine 70240 toward the end effector 70220. As the first layer 70246 of clips 70244 is being advanced from the clip magazine 70240, the dividing plate 70249 is supported by either the distal projections 70232 of the feeder member 70230 or the clips 70244 that have not yet been fully ejected from the clip magazine 70240. Once the feeder member 70230 has pushed all of the clips 70244 in the first layer 70246 out of the clip magazine 70240, the dividing plate 70249 is biased by the biasing member 70242 into the recess 70233 in the feeder member 70230. The groove 70233 is defined between the distal protrusion 70232 of the feeder member 70230 and a proximal protrusion 70234 of the feeder member 70230 that extends upwardly from a proximal end of the feeder member 70230. Once the separation plate 70249 is seated in the groove 70233, the feeder member 70230 and the separation plate 70249 can be retracted proximally out of the clip magazine 70240 together. After the feeder member 70230 and the dividing plate 70249 are fully retracted out of the clip magazine 70240, the second tier 70248 of clips 70244 is biased by the biasing member 70242 to the feed position (i.e., the position where the first tier 70246 of clips 70244 was). The feeder member 70230 and the dividing plate 70249 can be advanced together toward the end effector to eject the second tier 70248 of clips 70244 from the clip magazine 70240. The reader will appreciate that all of the clips 70244 in the first layer 70246 and/or the second layer 70248 are not fired at the same time, but rather are fired one at a time to allow each clip 70244 to be crimped sequentially by a pair of jaws 70255 of the end effector 70220. As noted above, other embodiments are contemplated in which more than one clip 70244 may be ejected at a time.

Fig. 42A depicts a clip applier 70250 according to at least one embodiment. The clip applier 70250 includes an elongate shaft 70260 extending from the housing, a clip cartridge 70270 extending from the elongate shaft 70260, and an end effector 70280 extending from the clip cartridge 70270. The elongate shaft 70260 and the clip cartridge 70270 define a shaft axis SA. The elongate shaft 70260 includes a first inwardly extending pawl 70264a and a second inwardly extending pawl 70264b opposite the first inwardly extending pawl 70264 a. The first and second inwardly extending pawls 70264a, 70264b extend inwardly toward the shaft axis SA and are deflectable outwardly away from the shaft axis SA when a force is applied thereto. The elongate shaft 70260 also includes a top notch 70262a and a bottom notch 70262b opposite the top notch 70262 a. The top notch 70262a and the bottom notch 70262b are located in a distal end of the elongate shaft 70260. The clip cartridge 70270 can be releasably attached to the distal end of the elongate shaft 70260, as discussed in further detail below.

Clip cartridge 70270 includes a top protrusion 70272a and a bottom protrusion 70272b opposite top protrusion 70272 a. The top protrusion 70272a and the bottom protrusion 70272b extend from the clip cartridge 70270 away from the axis SA. The clip cartridge 70270 also includes first and second slots 70274b in the proximal end of the clip cartridge 70270. The first and second slots 70274b are opposite each other. The clip cartridge 70270 is configured to slide into the inner diameter of the elongate shaft 70260 such that the top protrusion 70272a slides into the top notch 70262a, the bottom protrusion 70272b slides into the bottom notch 70262b, the first inwardly extending pawl 70264a engages the first slot of the clip cartridge 70270, and the second inwardly extending pawl 70264b engages the second slot 70274b of the clip cartridge 70270 to attach the clip cartridge 70220 to the elongate shaft 70260. After the clip cartridge 70270 is attached to the elongate shaft 70260, the elongate shaft 70260 and the clip cartridge 70270 are fixedly coupled such that they can rotate together about the shaft axis SA. In addition, when the clinician applies a distal force to the clip cartridge 70270 to disengage the first and second inwardly extending pawls 70264a, 70264b of the elongate shaft 70260 from the first and second slots 70274b of the clip cartridge 70270, the clinician can separate the clip cartridge 70270 from the elongate shaft 70260.

Referring primarily to fig. 42A and 42B, the end effector 70280 includes a first jaw 70280a and a second jaw 70280B configured to move relative to each other between an open position (fig. 42A) and a closed position (fig. 42B). To this end, the first jaw 70280a and the second jaw 70280b include an opening at their proximal ends that is configured to receive a pin 70290. The pin 70290 is rotatably captured within an opening 70276 in the clip cartridge 70270. The pin 70290 defines a pin axis PA that is orthogonal to the shaft axis SA. The first jaw 70280a and the second jaw 70280b are rotatable relative to each other about a pin axis PA. When the first and second jaws 70280a, 70280b are in an open position (fig. 42A), a clip can be positioned between the first and second jaws 70280a, 70280 b. As the first and second jaws 70280a, 70280B move toward the closed position (fig. 42B), a clip is crimped between the first and second jaws 70280a, 70280B. The first jaw 70280a and the second jaw 70280b are moved from an open position to a closed position by a closure tube that cammingly engages the outer surfaces of the first jaw 70280a and the second jaw 70280b as the closure tube is moved distally. When the closure tube is retracted, the first jaw 70280a and the second jaw 70280b are returned to the open position by a biasing member or spring that biases the first jaw 70280a and the second jaw 70280b into the open position. Other embodiments are contemplated in which the first jaw 70280a and the second jaw 70280b are movable from a closed position to an open position by jaw cams (similar to the jaw cams 70124a and 70124b depicted in, for example, fig. 36-38) on the first jaw 70280a and the second jaw 70280b that interact with a closure tube.

Fig. 43A depicts a clip applier 70300 according to at least one embodiment. The clip applier 70300 includes a shaft 70310, an end effector 70320 extending from the shaft 70310, a firing drive, and a clip cartridge 70306. The clip cartridge 70306 is built into the shaft 70310 of the clip applier 70300, as depicted in FIG. 43A. However, other embodiments are contemplated in which the clip cartridge 70306 can be releasably attached to the clip applicator 70300. The shaft 70310 includes openings 70308 on either side of the shaft 70310 that allow a user of the clip applier 70300 to access the clip cartridge 70306. Other embodiments having only one opening in the shaft 70310 of the clip applier are contemplated. The clip applier 70300 also includes an outer tube 70302 that is slidable along the shaft 70310 of the clip applier 70300. The outer tube 70302 is configured to slide along the shaft 70310 to cover the opening 70308 in the shaft 70310. The clip magazine 70306 is configured to store a plurality of clips, such as the clip 70304, therein. When the outer tube 70302 does not block the opening 70308, the clamp 70304 can be inserted into the clamp cassette 70306 through the opening 70308, as depicted in fig. 43A. Once positioned in the clamp cartridge 70306, the clamp 70304 can be advanced by a firing member from the clamp cartridge 70306 into the end effector 70320. In at least one embodiment, the clips 70304 can be advanced sequentially from the clip magazine 70306 into the end effector 70320. When the outer tube 70302 covers the opening 70308, access to the clip cartridge 70306 is prevented, and if a clip 70304 has been inserted into the clip cartridge 70306, the outer tube 70302 prevents the clip 70304 from exiting the clip cartridge 70306 through the opening 70308. Once all of the clips 70304 within the clip cartridge 70306 have been advanced into the end effector 70320, the outer tube 70302 can be retracted to allow a new set of clips to be inserted into the clip cartridge 70306. Further to the above, the outer tube 70302 can be operably engaged with a firing member of the clip applier 70300 such that the firing member cannot be actuated when the outer tube 70302 is retracted, or at least partially retracted, as depicted in fig. 43A.

Fig. 44 depicts a clip applier 70300'. The clip applier 70300' is similar in many respects to the clip applier 70300. The clip applier 70300 ' includes an elongate shaft 70315 extending from a housing, an articulation joint 70314 extending from the elongate shaft 70315, a shaft assembly 70310 ' extending from the articulation joint 70314, an end effector 70320 extending from the shaft assembly 70310 ', and an outer tube 70302 ' positioned about the shaft assembly 70310 '. An articulation joint 70314 couples elongate shaft 70315 to shaft assembly 70310 'such that shaft assembly 70310' can articulate relative to elongate shaft 70315. The shaft assembly 70310' includes a proximal shaft portion 70311 extending from an articulation joint 70314, a distal shaft portion 70312 extending from the proximal shaft portion 70311, and a hinge 70307. The distal shaft portion 70312 also includes a clip pocket 70306'. Other embodiments are contemplated wherein the proximal shaft portion 70311 comprises a clip magazine 70306'. The hinge 70307 allows the distal shaft portion 70312 to rotate away from the proximal shaft portion 70311. When the proximal shaft portion 70311 and the distal shaft portion 70312 are aligned, the outer tube 70302 'is configured to slide along the shaft assembly 70310' between a locked position and an unlocked position. More specifically, when the proximal shaft portion 70311 and the distal shaft portion 70312 are aligned and the outer tube 70302' is in the locked position, the distal shaft portion 70312 is prevented from rotating about the hinge 70307 away from the proximal shaft portion 70311. The distal shaft portion 70312 can be rotated about the hinge 70307 away from the proximal shaft portion 70311 when the outer tube 70302' is in the unlocked position. As further described above, as the distal shaft portion 70312 is rotated away from the proximal shaft portion 70311, the opening 70308 'in the clip cassette 70306' is exposed. The opening 70308 ' allows the clip 70304 ' to be inserted into the clip pocket 70306 '.

Further to the above, a clip reloader 70350 can be utilized to insert a clip 70304 'into a clip applier 70300', as depicted in FIG. 44. The clip reload includes a housing 70352, a trigger 70354 movable relative to the housing 70352, a feeder bar operably engaged with the trigger 70354, an elongate shaft 70356 extending from the housing 70352, and a docking station 70360 extending from the elongate shaft 70356. A plurality of clips 70304' are removably stored in the elongate shaft 70356. In one embodiment, the elongate shaft 70356 stores 20 clips within a six inch span of the elongate shaft 70356. Other embodiments, for example, having different numbers of clamps and spans are contemplated. As the trigger 70354 is moved toward the housing 70352, the clip 70304' is advanced from the elongate shaft 70356 into the docking station 70360 by the feeder lever. The docking station 70360 includes a cavity 70358 configured to dock with the shaft assembly 70310 'of the clip applier 70300' as the distal shaft portion 70312 is rotated away from the proximal shaft portion 70311. When the docking station 70360 is docked with the shaft assembly 70310 'of the clip applier 70300', the clips 70304 'can be advanced from the elongate shaft 70356 into the clip cartridge 70306' of the clip applier.

Fig. 45-47 depict different clip reloaders 70400. The clip reloader 70400 is similar in many respects to clip reloader 70350. The clip reload 70400 includes a housing 70410, a plurality of clips 70404 stored within the housing 70410, and a plunger 70402. The plunger 70402 extends into the housing 70410 and is movable relative thereto. In the embodiment shown in fig. 45 and 46, the clips 70404 are stacked vertically; however, other embodiments are contemplated in which the clips are stacked horizontally. The feeder block 70406 extends from the plunger 70402 and is slidably engaged with the interior of the housing 70410. Feeder block 70406 includes an angled portion that supports the back side of the topmost clamp in the stack of clamps, as depicted in fig. 45. Housing 70410 includes a boss 70408 extending from the bottom of housing 70410 and a flexible ramp 70409 extending from the bottom of boss 70408. Housing 70410 also includes a cutout region 70411. Interfacing the clip reloader 70400 with a clip applier is discussed in further detail below.

In various instances, the clip reloader 70400 is configured to insert a clip 70404 into a clip applier (such as clip applier 70450), for example. The clip applier 70450 includes a shaft 70460, an end effector 70480 extending distally from the shaft 70460, and an articulation joint 70470 extending proximally from the shaft 70460. To align the clip reload 70400 with the clip applier 70450, the boss 70408 interfaces with an opening 70464 in the shaft 70460 of the clip applier 70450, the cut-out region 70411 mates with the exterior of the shaft 70460, and the flexible ramp 70409 extends into the clip slot 70462 of the clip applier 70450, as depicted in fig. 47. The opening 70464 opens into a clip slot 70462 that includes an angled portion that receives the boss 70408 and flexible ramp 70409 of the clip reload 70400. The clip slot 70462 also includes a flat portion that facilitates advancement of a clip 70404 into the end effector 70480 of the clip applier 70450. The operation of the clip reloader 70400 in conjunction with the clip applier 70450 is discussed in further detail below.

In use, after the clip reload 70400 is docked with the clip applier 70450, the plunger 70402 is moved toward the clip applier 70450 to advance the clips 70404 from the housing 70410 into the angled portions of the clip slots 70462. The ramp 70409 supports and guides the clip 70404 from the angled portion of the clip slot 70462 into the flat portion of the clip slot 70462. As shown in fig. 47, when the clip reload 70400 is docked with the clip applier 70450, the housing 70410 of the clip reload 70400 is positioned at an angle relative to the longitudinal axis of the clip applier 70450. Other embodiments are contemplated wherein housing 70410 is orthogonal, or at least substantially orthogonal, to clip applier 70450 when docked. Referring primarily to FIG. 47, the clip applier 70450 further includes a flexible firing member 70465 positioned within the firing slot 70466 proximal of the clip slot 70462. After the clip reload 70400 is undocked from the clip applier 70450, the flexible firing member 70465 can be moved from the firing slot 70466 into the clip slot 70462 to advance the clips 70404 into the end effector 70480. Once at least one or all of the clips 70404 have been advanced into the end effector 70480, the flexible firing member 70465 can be retracted from the clip slot 70462 into the firing slot 70466, and additional clips 70404 can be loaded into the clip slot 70462 by the clip reloader 70400.

Fig. 48-50 depict a clip applier 70500. The clip applier 70500 includes an elongate shaft 70570 extending from the housing (see fig. 50), a shaft 70510 attachable to the elongate shaft 70570, an end effector 70520 extending from the shaft 70510, and a clip cartridge 70530. The attachable shaft 70510 includes an upper pivot link 70512 and a lower pivot link 70514 extending distally therefrom. The end effector 70520 includes a first jaw 70521a and a second jaw 70521b that are movable relative to each other about a pivot pin 70511 between an open position and a closed position. The pivot pin 70511 is constrained within openings in the upper and lower pivotal links 70512, 70514 of the shaft 70510. The clip magazine 70530 is removably positioned within the attachable shaft 70510 and includes a plurality of clips 70532. The clip applier 70500 further includes a closure system 70540 and a firing system 70550. The closure system 70540 and the firing system 70550 are discussed in more detail below.

The closure system 70540 includes a proximal closure driver 70542 having a threaded portion 70543, a distal closure driver 70566 having a closure nut 70544, an upper closure hinge 70545a, and a lower closure hinge 70545 b. The proximal closure drive 70542 is configured to rotate in response to rotational movement generated within the housing of the clip applier. The closure drive 70542 imparts rotational motion to a threaded portion 70543 that is threadably received in the closure nut 70544. The closure drive 70542 may include a flexible portion to facilitate the transfer of rotational motion to the closure nut 70544. The closure nut 70544 is rotatably constrained within the shaft 70510 such that rotation of the threaded portion 70543 in a first direction will cause the nut 70544 to translate distally and rotation of the threaded portion 70543 in a second direction opposite the first direction will cause the nut 70544 to translate proximally. A distal closure driver 70566 extends from closure nut 70544 and is attached to upper closure hinge 70545a and lower closure hinge 70545b via closure pin 70547. The closure pin 70547 allows the upper closure hinge 70545a and the lower closure hinge 70545b to translate distally and proximally with the distal closure driver 70566 while still being rotatable about the closure pin 70547. Further to the above, the upper closure hinge 70545a is rotatably engaged with the proximal portion 70523a of the first jaw 70521a and the lower closure hinge 70545b is rotatably engaged with the proximal portion 70523b of the second jaw 70521 b. As shown in fig. 48, the first jaw 70521a and the second jaw 70521b cross each other about the pivot pin 70511 in a scissor-like fashion. Such an arrangement allows the first jaw 70521a and the second jaw 70521b to move toward an open position when the upper closure hinge 70545a and the lower closure hinge 70545b are translated distally by the closure system 70540 and allows the first jaw 70521a and the second jaw 70521b to move toward a closed position when the upper closure hinge 70545a and the lower closure hinge 70545b are translated proximally by the closure system 70540.

The clip applier 70500 also includes a firing system 70550 having a firing member 70560. The firing member 70560 translates through the end effector between an unfired position and a fired position in response to a rotational motion that drives the closure system 70540. Other embodiments are contemplated in which the closure system 70540 and the firing system 70550 are operated by, for example, two separate motors within the housing of the clip applier. The firing member 70560 is configured to advance a clip 70532 from the clip cartridge 70530 into the first jaw 70521a and the second jaw 70521b of the clip applier 70500. As shown in fig. 49, the clip magazine 70530 is at least partially supported by the closure system 70540. More specifically, a biasing member (such as a leaf spring 70546), for example, biases the clip 70532 toward the firing member 70560 and holds the clip cartridge 70530 in place. Other embodiments are contemplated wherein the closure system 70540 can align and/or guide and/or lock the clip magazine 70530 into place within the shaft 70510. The embodiment depicted in fig. 48 and 49 shows a closure system 70540 disposed around the clip magazine 70530 to allow more space within the shaft 70510 for the clip magazine 70530 and the clip 70532; however, the closure system may have any suitable arrangement. The closure system 70540 is discussed in further detail below.

The threaded portion 70543 and the closure nut 70544 of the closure system 70540 allow the first jaw 70521a and the second jaw 70521b to be actuated more precisely when moving between the open and closed positions as compared to previous clip applier arrangements that utilized a translating closure tube or camming member. Rotary encoders and/or other sensors can be used in conjunction with the closure system 70540 to provide even greater accuracy in determining the position of the first jaw 70521a and the second jaw 70521 b.

Turning now to fig. 50, the clip applier 70500 further includes protrusions 70513 and 70516 extending from the proximal end of the shaft 70510. Protrusions 70513 and 70516 may have the same shape or different shapes. The protrusions 70513 and 70516 are configured to lockingly engage slots 70572a and 70572b in the elongate shaft 70570 of the clip applier 70500 to form a bayonet connection therebetween. The slots 70572a and 70572b include L-shaped portions that lock the protrusions 70513 and 70516 in place when the shaft 70510 is inserted into the elongate shaft 70570 and then rotated relative thereto. Fig. 50 further depicts a clip 70532 positioned within the first jaw 70521a and the second jaw 70521 b. The clip 70532 and other embodiments of clips for use with clip appliers, such as the clip applier 70500, are discussed in further detail below.

Turning now to fig. 51A and 51B, the clamp 70532 includes a base portion 70534, a first leg 70534a extending from the base portion 70534, and a second leg 70534B extending from the base portion 70534 and opposite the first leg 70534 a. Base portion 70534 may include a flexible material (such as plastic and/or any other suitable flexible material) to allow clip 70532 to flex between multiple positions without breaking or plastically deforming in an undesirable manner. For example, the clip 70532 can be moved between a cartridge storage configuration, a pre-fired configuration, and a post-fired configuration, as depicted in fig. 51B. The first leg 70534a includes a reinforced region having a ridge 70535a and the second leg 70534b includes a reinforced region having a ridge 70535 b. The ridges 70535a and 70535b extend along at least a portion of the first and second legs 70534a and 70534b, respectively. The ridges 70535a and 70535b act as a rigid backbone to prevent or at least substantially reduce deformation of the first and second legs 70534a and 70534b during crimping. Other embodiments are contemplated in which only one of the first and second legs 70534a, 70534b includes a ridge. The ridges 70535a and/or 70535b can be constructed of a rigid material, such as fiberglass-filled and/or particle-filled plastic, for example, to prevent or at least reduce deflection of the first leg 70534a and/or the second leg 70534b when the clip 70532 is crimped. The clip 70532 also includes a locking portion, such as a tooth 70536, extending from a portion of the first leg 70534 a. When the clip 70532 is crimped (see the post-fired configuration in fig. 51B), the teeth 70536 lockingly engage the edges of the openings or windows 70537 in the second leg 70534B. Such an arrangement allows clip 70532 to remain in a crimped state after clip 70532 has been released from the jaws of a clip applier. In addition, the clip 70532 includes a gripping feature, such as a protrusion 70538, extending from the inner surface of the first and second legs 70534a, 70534 b. When the clip 70532 is crimped, the protrusion 70538 engages tissue clamped between the first and second legs 70534a, 70534 b. Protrusions 70538 prevent or at least substantially reduce movement of tissue relative to clip 70532 after clip 70532 is crimped about the tissue. For example, the protrusion 70538 may be any number of shapes and sizes, such as a pyramid shape, a conical shape, a frustoconical shape, and/or any other suitable shape.

Turning now to fig. 51C-51F, a different clip 70580 is depicted for use with a clip applier. Clamp 70580 is similar in many respects to clamp 70532. That is, the base 70534 of the clamp 70580 includes a stress relief notch 70588 on a side of the base 70534 opposite the first and second legs 70534a, 70534 b. In use, the stress relief notch 70588 allows the first and second legs 70534a, 70534b to flex inward and then outward multiple times without plastically deforming in an undesirable manner. In various instances, however, clamp 70580 may be configured to yield or plastically deform when clamp 70580 is sufficiently compressed. In various circumstances, such designed or controlled yielding may assist in folding of clip 70580 into a desired shape.

Fig. 52-60 depict a clip applier 70600. Turning now to fig. 53, the clip applier 70600 includes a shaft 70610 extending from the housing, an end effector 70605 extending from the shaft 70610, and a rotatable clip cartridge 70650. The end effector 70605 includes first and second jaws that are movable relative to one another between open and closed positions, similar to the first and second jaws 70123a, 70123b of the clip applier 70100, described above. The rotatable clip cartridge 70650 is rotatably and slidably supported within the clip applier 70600. More specifically, the rotatable clip magazine 70650 is rotatable about the shaft axis SA and translatable along the shaft axis SA. The shaft axis SA is defined by the shaft 70610. Additional details regarding how the clip magazine 70650 is supported within the clip applier 70600 are provided below.

Referring to fig. 52, the rotatable clip magazine 70650 includes a body portion 70652 that includes five sides, each side including a clip channel 70656 configured to removably store clips 70654 therein. Body portion 70652 also includes an opening 70653 extending through body portion 70652. In the illustrated embodiment, the body portion 70652 is shaped, for example, as a pentagon; however, other embodiments are contemplated in which the opening 70653 includes different shapes to allow more or less than five clip channels 70656, and thus more or less than five clips 70654, to be stored in the rotatable clip magazine 70650. In at least one embodiment, the clamp 70654 has a clamp width of, for example, 0.080", a clamp thickness of 0.03", and a clamp length of 0.310 "(for limax 5 clamps) or 0.315" (for ER320 clamps); however, clamps having any suitable dimensions may be used. Further, it is contemplated that the clips stored in clip magazines 70650 will have the same, or at least substantially the same, dimensions; however, alternative embodiments are contemplated wherein clips having different sizes may be stored in the same clip magazine. Additionally, in at least one embodiment, the overall diameter of the entire rotatable clamp magazine 70650 is, for example, 0.996 "; however, the clip cartridge 70650 can have any suitable diameter, including a diameter that can allow the clip cartridge 70650 to be inserted through a trocar. The rotatable clip magazine 70650 also includes timing portions, such as teeth 70658, for example, extending proximally from the clip magazine 70650. The clip applier 70600 includes a number of drives and drivers that define a sequence of motions and/or operations of the clip applier 70600, as described in further detail below.

Referring again to fig. 53, the clip applier 70600 also includes a closure tube 70620, a feeder member 70630, and a firing member 70640. Closure tube 70620 includes a closure drive 70625 extending proximally from a closure tube 70620. The closure drive 70625 extends through an opening 70653 in the clip cassette 70650 and is operably engaged with an actuator within the housing of the clip applier 70600. Clip magazine 70650 is supported on at least a portion of closure drive 70625. The closure tube 70620 is at least partially supported and aligned within a groove in the shaft 70610. The closure tube 70620 is movable between a plurality of positions, such as a fully retracted position, a starting position, and a fully advanced position (see fig. 53 and 54A). Similar to the crimp drive device 70180 of the clip applier 70100, the closure tube 70620 is configured to move the first and second jaws of the end effector 70605 toward and away from one another. As the closure tube 70620 is moved distally, the closure tube 70620 cammingly engages the first and second jaws to move them to a closed position, and as the closure tube 70620 is moved proximally, the closure tube 70620 engages jaw cams on each of the first and second jaws to move them to an open position. That is, any suitable jaw opening and closing arrangement may be used.

The feeder member 70630 is aligned with one of the clip channels 70656 of the rotatable clip cartridge 70650 and is configured to push the clips 70654 out of the clip channel 70656 that is aligned with the feeder member 70630 toward the end effector 70605. The feeder member 70630 can be linearly translated through the clip applier 70600 by a feeder gear 70638 and a feeder drive device 70635 that is operably engaged with the rack portion of the feeder member 70630. The feeder drive device 70635 includes a pinion gear 70637 at a distal end thereof that is operably engaged with the feeder gear 70638 such that the feeder member 70630 linearly translates through the clip applier 70600 as the feeder drive device 70635 rotates. The feeder drive device 70635 is operably engaged with a first motor within the housing of the clip applier 70600. The first motor transmits rotational motion to the feeder drive device 70635. Similar to the operation of the feeder member 70630, the firing member 70640 can be linearly translated through the clip applier by a firing gear 70648 and a firing drive 70645 that are operably engaged with a rack portion of the firing member 70640. The firing drive 70645 includes a pinion 70647 on a distal end thereof that is engaged with the firing gear 70648 such that as the firing drive 70645 rotates, the firing member 70640 linearly translates through the clip applier 70600. In addition, the firing drive 70645 is operably engaged with a second motor within the housing of the clip applier 70600. The second motor transmits rotational motion to the firing drive 70645. Other embodiments are contemplated wherein feeder drive 70635 and firing drive 70645 can be rotated by the same motor using a transmission. Additionally, other embodiments are contemplated and are further described below wherein the feeder member 70630 and the firing member 70640 translate together through the clip applier 70600. Operation of the feeder member 70630 and firing member 70640 is also described in more detail below.

Referring primarily to fig. 53, the firing member 70640 includes a distal portion 70640a extending therefrom that is configured to advance a clip 70654 into an end effector. The shaft 70610 also includes a ground portion 70612 that is mounted to the shaft 70610 and aligned with the clip pocket 70650. Ground portion 70612 is mounted to shaft 70610 such that ground portion 70612 is not movable, translatable, and/or rotatable relative to shaft 70610. Ground portion 70612 includes, for example, a timing portion extending distally therefrom, such as teeth 70614, as shown in fig. 54B. The teeth 70614 of the ground portion 70612 are aligned, or at least substantially aligned, with the teeth 70658 of the rotatable gripper box 70650. In addition, the ground portion 70612 supports a biasing member, such as a spring 70616, thereon. The spring 70616 biases the clip cartridge 70650 distally toward the closure tube 70620 and end effector 70605, as shown in fig. 54A. Other embodiments are contemplated wherein the spring comprises a leaf spring and the clip applier 70600 further comprises a track, and the leaf spring can be configured to index the clip magazine 70650 and prevent the clip magazine 70650 from counter-rotating. In any event, rotation of clip pocket 70650 about shaft axis SA and translation of clip pocket 70650 along shaft axis SA are described in further detail below.

Referring primarily to fig. 52, the closure tube 70620 includes a timing channel 70622 positioned radially around the closure drive 70625. The closure drive 70625 rotatably and slidably supports the rotatable clip magazine 70650 thereon, as described above. The timing channel 70622 engages with a protrusion within the opening 70653 of the clip magazine 70650 to rotationally lock the clip magazine 70650 in place relative to the closure tube 70620 when the closure tube is in the starting or fully advanced position. When the closure tube 70620 is moved to the fully retracted position, as shown in FIG. 53, the spring 70616 moves/biases the clip magazine 70650 toward the closure tube 70620, causing the timing channel 70622 to disengage from the projections within the opening 70653 of the clip magazine 70650. Thus, the clip magazine 70650 is free to rotate about the shaft axis SA. Additionally, as closure tube 70620 is moved to the fully retracted position, teeth 70658 of clip magazine 70650 engage teeth 70614 of ground portion 70612 to rotate (i.e., cycle) clip magazine 70650. More specifically, teeth 70658 and teeth 70614 are configured to rotate clip magazine 70650 a predefined amount of degrees about axis SA based on the spacing and angle of teeth 70658 relative to teeth 70614. The reader will appreciate that the spacing and angle of teeth 70658 relative to teeth 70614 can be designed to produce a suitable degree of rotation of clip cassette 70650 about axis SA. In the embodiment shown in fig. 52-54A, the teeth 70658 and the teeth 70614 are spaced apart and aligned such that when they are engaged, the clip magazine 70650 is rotated 72 degrees to align adjacent clips 70654 with the feeder member 70630. After cycling of clip cassette 70650, closure tube 70620 can be moved distally from the fully retracted position to the starting position (fig. 54A), causing timing channel 70622 to engage a protrusion in opening 70653 of clip cassette 70650 to lock rotation of clip cassette 70650, as described above. The use of the clip applier 70600 to advance, form, and fire the clip 70654 is described in further detail below.

As described above, feeder member 70630 and firing member 70640 can translate together. For simplicity, fig. 55-60 illustrate the function of the clip applier 70600 wherein the feeder member 70630 and the firing member 70640 move together to feed and fire the clips 70654 from the rotatable clip cartridge 70650. Turning now to fig. 55 and 56, the clips 70654 are advanced from the rotatable clip magazine 70650 into engagement with a biasing member, such as a leaf spring 70624, for example, a closure tube 70620 by the feeder member 70630. The leaf spring 70624 biases and guides the clamp 70654 onto the top of the firing member 70640 as shown in fig. 56. When the firing member 70640 and the feeder member 70630 are retracted, the clip 70654 is moved further downward by the leaf spring 70624 and seats around a pre-forming feature (such as the protrusion 70608) depicted in, for example, fig. 57. The protrusion 70608 may be similar to the protrusions 70126a and 70126B described above (see fig. 35A and 35B). One protrusion 70608 is located on one jaw of the end effector 70605 and the other protrusion 70608 is located on the other jaw of the end effector 70605.

When the closure tube 70620 is in a fully retracted position, referring to fig. 58, the jaws of the clip applier 70600 are in an open position and the protrusions 70608 deploy the clips 70654 from a stored configuration to a fired configuration, similar to the deployment of the clips 70140 described above in connection with fig. 35A and 35B. When the closure tube 70620 is moved to the fully retracted position, the rotatable clip magazine 70650 is rotated (i.e., cycled) about the shaft axis SA to position another clip 70654 in alignment with the feeder member 70630, as described above. Turning to fig. 59, the firing member 70640 can be moved toward the end effector 70605 to advance the clip 70654 over the protrusions 70608 and into the end effector 70605. As described above in connection with the protrusions 70126a and 70126b, the protrusions 70608 can include an angled portion that allows the clip 70654 to slide over the protrusions 70608 as it is advanced distally by the firing member 70640. Once the clip 70654 is positioned in the end effector 70605, the closure tube 70620 can be moved to a fully advanced position (fig. 60) to move the jaws from an open position to a closed position to crimp the clip 70654 positioned between the jaws.

Further to the above, because the feeder member 70630 translates with the firing member 70640, as described above, when the firing member 70640 advances a clip 70654 into the end effector 70605, the feeder member 70630 advances another clip 70654 (i.e., a clip that rotates into position when the closure tube 70620 is fully retracted) from the clip cartridge 70650 downward onto the firing member 70654 by way of the leaf spring 70624. Likewise, the firing member 70640 and the feeder member 70630 can be retracted to allow the new clip 70654 to be biased downward by the leaf spring 70624 and seated around the protrusion 70608. As the clip cartridge 70650 is cycled, the new clip 70654 can then be deployed to a firing configuration, and the new clip 70654 can then be advanced into the end effector 70605 for crimping, as described above. The process can be repeated until the clip magazine 70650 has been exhausted. The reader will appreciate that the closure tube 70620 can be moved between a starting position (fig. 56 and 57) and a fully advanced position (fig. 60) to crimp and release the clip 70654 within the end effector 70605 without cycling the clip magazine 70650. This allows the jaws of the end effector 70605 to move between the open and closed positions without cycling the clip cassette 70650 and/or ejecting another clip from the clip cassette 70650.

FIG. 61 depicts a clip applier 70700 according to at least one embodiment. The clip applier 70700 includes a shaft 70710 extending from the housing, an end effector 70705 extending from the shaft 70710, and a clip cartridge 70720 releasably attachable to the clip applier 70700. The end effector 70705 comprises first and second jaws that are movable relative to each other, similar to the first and second jaws 70123a, 70123b described above. The clip applier 70700 further includes a firing system 70730 that includes a rotatable drive 70732 that is operably responsive to a motor within the housing of the clip applier 70700. The rotatable drive 70732 includes a threaded portion. The firing system 70730 also includes a firing member 70736 and a firing nut 70734. The firing nut 70734 is threadably received on the threaded portion of the rotatable drive 70732. The firing nut 70734 is rotatably constrained within the clip applier 70700 such that rotation of the rotatable drive 70732 translates the firing nut 70734 through the clip applier 70700. The firing member 70736 is engaged with the firing nut 70734 and translates into the first and second jaws of the end effector 70705 in response to translation of the firing nut 70734 by the rotatable drive 70732. The attachment of the clip cartridge 70720 to the clip applier 70700 is described in more detail below.

The clip applier 70700 also includes a docking region or groove 70714 in the distal end of the clip applier 70700, as shown in fig. 61. The clip cartridge 70720 includes a body portion 70722 that is slidably received in the groove 70714 of the clip applier 70700. The locking feature 70728 extends proximally from the clip cartridge 70720. Locking feature 70728 includes an angled surface 70728a at its proximal end and a downwardly extending detent 70728b, although locking feature 70728 may include any suitable arrangement. When the clip cartridge 70720 is docked within the groove 70714, the locking feature 70728 engages the protrusion 70712 of the shaft 70710. More specifically, the angled surface 70728a slides over the protrusion 70712 and the downwardly extending detents 70728b lock into place proximal to the protrusion 70712, locking the clip cartridge 70720 to the clip applier 70700. In such instances, as angled surface 70728a slides over protrusion 70712, locking feature 70728 deflects and then resiliently returns to or at least toward its undeflected configuration when pawl 70728b locks into place. Sufficient distal pulling motion can cause the locking feature 70728 to deflect and release the clip cartridge 70720 from the clip applier 70700. The operation of the clip applier 70700 is described in further detail below.

The clip cartridge 70720 further includes, for example, a ramp portion 70721, a plurality of clips 70724 positioned in a stack, and a biasing member (such as a spring 70726). The clamp 70724 is biased toward the ramp portion 70721 by a spring 70726. In fact, the top clip 70724 in the clip stack is biased into the ramp portion 70712 by a spring 70726. When the clip cartridge 70720 is docked with the clip applier 70700, the ramp portion 70721 is aligned with the feeder drive device 70740 of the clip applier 70700, as described above. The feeder drive device 70740 is operably responsive to an actuator within the housing of the clip applier 70700. The feeder drive device 70740 is configured to be reciprocally actuated into the ramp portion 70721. To accommodate the angled portion within the ramp portion 70721, the feeder drive device 70740 can be flexible. The feeder drive device 70740 feeds the top clamp 70724 in the stack of clamps through the ramp portion 70721 and into the end effector 70720. Once in the end effector 70705, the clip 70724 can be advanced further distally into the first and second jaws of the end effector 70705 by translation of the firing member 70736, as described above. Once in the first and second jaws, the clip 70724 can be crimped by the crimp drive device. The feeder drive device 70740 can be retracted to allow the other clamp 70724 to be biased into the ramp portion 70721. The feeder drive device 70740 can advance a new clip 70724 through the ramp portion 70721 and into the first and second jaws of the end effector 70705, as described above. The above process can be repeated until all of the clips 70724 in the clip cartridge 70720 have been depleted, and/or until the appropriate number of clips have been applied to the tissue.

Fig. 62A depicts a clip applier system 70750, according to at least one embodiment. The clip applier system 70750 includes a shaft 70760 extending from the housing, a clip applier 70250 depicted in fig. 42 positioned at least partially within the shaft 70760, and a rotatable clip cartridge 70650 depicted in fig. 52-60 positioned within the shaft 70760. The feeder member is configured to advance the clips 70654 from the rotatable clip magazine 70650, one at a time, into the first jaw 70280a and the second jaw 70280b of the clip applier 70250. Once positioned within the first jaw 70280a and the second jaw 70280B, the clip 70654 can be crimped as discussed above with respect to fig. 42A and 42B. Once the clip 70654 is crimped, the rotatable clip magazine 70650 can be cycled (i.e., rotated) to position another clip 70654 for advancement by the feeder member into the first jaw 70280a and the second jaw 70280b of the clip applier 70250. The process may continue until all of the clips 70654 in the rotatable clip magazine 70650 have been exhausted. After all of the clips 70654 have been exhausted, the rotatable clip magazine 70650 can be replaced with another rotatable clip magazine 70650 containing a complete complement of clips 70650. Other embodiments are contemplated in which an emptied rotatable clip magazine 70650 may be separated from the clip applicator system 70750, reloaded with clips 70650, and then reattached to the clip applicator system 70750 for further use.

Turning now to fig. 63A and 63B, an articulation joint 70800 for use with a clip applier is shown. The articulation joint 70800 releasably couples the clip cartridge 70820 to the shaft 70810 of the clip applier. The shaft 70810 includes an articulation pivot or pivot pin 70814 that extends from the interior of the shaft 70810. The pivot pin 70814 includes a base portion 70817, a first leg 70814a extending from the base portion 70817, and a second leg 70814b extending from the base portion 70817 and opposite the first leg 70814 a. The first leg 70814a and the second leg 70814b extend away from each other. The first leg 70814a includes a first detent or shoulder 70816a extending outwardly from the first leg 70814a, and the second leg 70814b includes a second detent or shoulder 70816b extending outwardly from the second leg 70814 b. The clip cartridge 70820 includes a first opening 70822 and a second opening 70824 positioned adjacent and lateral to the first opening 70822. The first opening 70822 is centered in the clip cartridge 70820 and rotatably receives the pivot pin 70814 when the clip cartridge 70820 is attached to the shaft 70810. As the first opening 70822 slides onto the pivot pin 70814 due to the angled surfaces at the ends of each of the first leg 70814a and the second leg 70814B, the first leg 70814a and the second leg 70814B flex toward each other (see fig. 63B). As the first and second legs 70814a, 70814B flex toward each other, the pivot pin 70814 can slide through the first opening 70822 until the first and second pawls 70816a, 70816B clear the first opening 70822, as shown in fig. 63B. Once the first and second pawls 70816a, 70816b clear the first opening 70822, the first and second legs 70814a, 70814b can be deployed to lock the clip cartridge 70820 to the pivot pin 70814. More specifically, the bottom surfaces of the first pawl 70816a and the second pawl 70816b rest on the outer surface 70826 of the clip cartridge 70822, thereby preventing the clip cartridge 70820 from separating from the pivot pin 70814 unless a sufficient force is applied that exceeds a predetermined or designed force threshold. The reader will appreciate that a user of the clip applier can forcibly attach the clip cartridge 70820 to the shaft 70810 and detach the clip cartridge 70820 from the shaft 70810. Articulation of the clip cartridge about the pivot pin 70814 is described in further detail below.

The clip applier depicted in fig. 63A and 63B further includes a rotatable output 70830 that is operably responsive to a motor located within the housing of the clip applier. The rotatable output 70830 is threadably engaged with the threaded portion 70834 of the articulation rod 70832. Rotation of the rotatable output 70830 in a first direction translates the articulation rod 70832 distally, and rotation of the rotatable output 70830 in a second or opposite direction translates the articulation rod 70832 proximally. The articulation rod 70832 includes a downwardly extending protrusion 70836 that is slidably received within a slot 70812 defined in the shaft 70810. The protrusion 70836 and the slot 70812 guide the articulation rod 70832 as the articulation rod 70832 translates and limits relative lateral movement between the articulation rod 70832 and the shaft 70810. The articulation rod 70832 also includes an upwardly extending protrusion 70838 that is received in the second opening 70824 of the clip cartridge 70820 when the clip cartridge 70820 is attached to the shaft 70810. In use, distal translation of the articulation rod 70832 will cause the clip cartridge 70820 to rotate in a first direction about the pivot pin 70814, and proximal translation of the articulation rod 70832 will cause the clip cartridge 70820 to rotate in a second or opposite direction about the pivot pin 70814. The articulation rod 70832 may be flexible to allow the articulation rod 70832 to flex as needed as the clamp cartridge 70820 is articulated about the pivot pin 70814.

FIG. 64 depicts a clip applier 70900 according to at least one embodiment. The clip applier 70900 includes an elongate shaft 70910, an articulation joint 70920, and a distal head 70930. An articulation joint 70920 extends from the elongate shaft 70910, and a distal head 70930 extends from the articulation joint 70920. The distal head 70930 includes a distal shaft 70932 attached to an articulation joint 70920, an end effector 70936 including a first jaw 70936a and a second jaw 70936b, and a clip cartridge 70934. The first jaw 70936a and the second jaw 70936b can be moved relative to each other between an open position and a closed position by, for example, any suitable drive system, such as the drive systems disclosed herein. The clip cartridge 70934 stores a plurality of clips that can be advanced into the end effector 70936 and crimped by the first jaw 70936a and the second jaw 70936 b. The clip cartridge 70934 is removably attachable to the distal shaft 70932 via a keying arrangement 70938. Other embodiments are contemplated wherein the clip cartridge 70934 is not removably attachable to the distal shaft 70932. Elongated shaft 70910 defines a first roll axis RA₁And distal head 70930 defines a second roll axis RA₂. The elongate shaft 70910 and the distal head 70930 can articulate relative to each other about an articulation axis AA via an articulation joint 70920. For example, the arrangement depicted in fig. 64 may be attached to multiple clip applier handle types, such as standard handles (i.e., stick grips) and/or pistol grip handles via the elongate shaft 70910. Depending on the type of handle attached to the elongate shaft 70910Different actuations of or within the shank may be about the first roll axis RA₁A second roll axis RA₂And articulation axis AA perform different actuations of the arrangement depicted in fig. 64. These actuations are described in further detail below.

If the elongate shaft 70910 is attached to a standard handle (i.e., a stick handle), still referring to fig. 64, the elongate shaft 70910, articulation joint 70920, and distal head 70930 can all be rotated about the first roll axis RA by the clinician rotating the stick handle₁And (4) rotating. Additionally, a rotation knob on the wand handle is operably engaged with the elongate shaft 70910, such as by an electric motor and/or control system, such that manually rotating the rotation knob will cause the distal head 70930 to rotate about the second roll axis RA₂And (4) rotating. In addition, articulation of the distal head 70930 relative to the elongate shaft 70910 about the articulation axis AA is driven by an articulation driver operably engaged with, for example, a motor housed within the wand handle. If the elongate shaft 70910 is attached to, for example, a pistol grip handle (such as the handle 700 described above), the elongate shaft 70910, articulation joint 70920, and distal head 70930 may all be rotated about the first roll axis RA, e.g., by a rotation knob₁And (4) rotating. Additionally, the distal head 70930 is rotated about the second roll axis RA by a dedicated motor within the pistol grip handle₂And (4) rotating. Still further, articulation of the distal head 70930 relative to the elongate shaft 70910 about the articulation axis AA is caused by an articulation driver operably engaged with a motor housed within the pistol grip handle. The reader should appreciate that the elongate shaft 70910 surrounds the first roll axis RA depending on the type of handle attached to the arrangement depicted in fig. 64₁Can be achieved by manually rotating the entire handle, rotation of a rotation knob engaged with the elongate shaft, and/or by a dedicated motor within the handle. In addition, distal head 70930 is centered about second roll axis RA₂Can be achieved by rotation of a rotation knob engaged within the elongate shaft 70910 or by a dedicated motor within the handle.

The clip applier jaw assembly 70950, or one half of the jaw assembly 70950, and the clip legs 70954 of a clip are shown in fig. 65. As seen in fig. 65, the clip applier jaw assembly 70950 includes a first jaw 70950a that includes a base 70952, a first leg 70952a extending from the base 70952, and a second leg 70952b extending from the base 70952. The first leg 70952a and the second leg 70952b oppose each other and define a receiving area 70953 therebetween. Clip legs 70954 are received in receiving region 70953, but it is noted that a portion of the cross-section of clip legs 70954 are not positioned within receiving region 70953. Thus, only a portion of the clip leg 70954 cross-section is supported by the first jaw 70950 a. Other arrangements exist in which the receiving region 70953 is substantially the same depth and width as the clip legs 70954 of the clip, such that all, or at least substantially all, of the cross-section of the clip legs 70954 are positioned within the receiving region 70953 and supported by the first jaw 70950 a.

A clip applier jaw assembly 70960 is depicted in FIG. 66A. The clip applier jaw assembly 70960 includes a first jaw 70960a that includes a base 70962, a first leg 70962a, a second leg 70962b, and a receiving area 70963 that receives a first clip leg 70964 of a clip. When the first clip leg 70964 is seated in the receiving region 70963, the first leg 70962a of the first jaw 70960a extends from the base portion 70962 beyond the first clip leg 70964. The second leg 70962b of the first jaw 70960a extends from the base portion 70962 and terminates before the end of the first clip leg 70964 such that only a portion of the first clip leg 70964 is supported by the second leg 70962b of the first jaw 70960 a.

The clip applier jaw assembly 70960 further includes a second jaw 70960b positioned opposite or opposing the first jaw 70960 a. The second jaw 70960b includes a base 70962 ', a first leg 70962a ', a second leg 70962b ', and a receiving region 70963 ' that receives the second clip leg 70964 ' of the clip. The second jaw 70960b is opposite the first jaw 70960a such that the first leg 70962a of the first jaw 70960a is aligned with the first leg 70962a 'of the second jaw 70960b and the second leg 70962b of the first jaw 70960a is aligned with the second leg 70962 b' of the second jaw 70960 b. When the second clip leg 70964 ' is seated in the receiving region 70963 ', the second leg 70962b ' of the second jaw 70960b extends from the base portion 70962 ' beyond the second clip leg 70964 ' of the clip. In addition, the first leg 70962a ' of the second jaw 70960b extends from the base portion 70962 ' and terminates prior to the end of the second clip leg 70964 ' such that only a portion of the second clip leg 70964 ' is supported by the first leg 70962a ' of the second jaw 70960 b.

When the first jaw 70962a and the second jaw 70962B of the clip applier jaw assembly 70960 are in the closed configuration, as depicted in fig. 66B, the first leg 70962a of the first jaw 70960a supports the entire first clip leg 70964 of a clip and also supports a portion of the second clip leg 70964' of the clip. In addition, the second leg 70962b 'of the second jaw 70960b supports the entire second clip leg 70964' of the clip and also supports a portion of the first clip leg 70964 of the clip. Because the first leg 70962a of the first jaw 70960a and the second leg 70962b 'of the second jaw 70960b are opposite one another, the cross-section of the first and second clip legs 70964, 70964' is supported along at least a portion of the leg length by both the first and second jaws 70960a, 70960 b. Such an arrangement prevents or at least inhibits twisting of the clip when the clip is crimped.

Referring to fig. 67, the clip legs 70954 are seated within the first clip jaw 70950a of the clip applier jaw assembly 70950, but are not prevented from sliding longitudinally within the clip applier jaw assembly 70950. In accordance with at least one embodiment, such as the clip applier jaw assembly 70960, for example, the first jaw 70960a and/or the second jaw 70960b include a clip ejection prevention feature, such as a distal stop 70966. The distal stop 70966 prevents the clip 70964 from sliding out of the distal end of the first jaw 70950a and/or the second jaw 70950b of the clip applier jaw assembly 70960. Other clip applier jaw shapes and guide features configured to control the position of a clip and/or prevent the clip from inadvertently falling and/or shooting from a clip applier are discussed in more detail below.

As described above, the jaws of a clip applier, or "clip jaws," are used to deform a clip. The reader will appreciate that the clip jaws themselves are subject to stress and strain, and in some cases, may plastically deform. For example, a clip jaw designed to resist plastic deformation during use can include a clip jaw that varies in thickness, width, and/or clip path depth along the length of the clip jaw in order to improve stiffness in a snap clip applier. Additionally, a proximal portion of one of the clip applier jaws can include a protruding rod (i.e., a tongue portion) and a proximal portion of the other clip applier jaw can include a groove (i.e., a groove portion) such that the protruding rod sits in the groove when the clip applier jaws are closed. Such an arrangement provides excellent jaw resilience to vertical tilting and/or twisting of the jaws of the clip applier relative to one another during crimping of the clip. The improved clip retention structure is discussed in further detail below.

In at least one embodiment, the clip applier jaw can include a clip retention channel or groove to allow clips to be advanced into the clip applier jaw from below via the feeder member. The feeder member includes a flexible drive plate that retracts and extends into a distal end of the clip applier jaws to hold a clip in a distal position until the clip applier jaws are actuated (i.e., moved from an open position to a closed position). In addition, the feed member prevents any additional clips from being accidentally advanced into the clip applier jaws until the feeder member is retracted to retrieve and advance the next clip. Clip applier jaws that include a distal retention feature are discussed in more detail below.

In at least one embodiment, the clip applier jaws each include a distal retention feature, such as a flange, that extends over a guide slot in the clip applier jaws, for example. The guide slot may include a retention feature, such as a groove, for example, on a distal end thereof that cooperates with a protrusion on the clip to allow the clip to remain in a distal position within the clip applier jaw without being held in place by the firing member and/or the feeder member. The construction and manufacture of certain clip applier jaws is discussed in more detail below.

In various embodiments, the clip applier jaw is manufactured using a two-part process, wherein at least a distal portion of the clip applier jaw is Metal Injection Molded (MIM) within an injection mold. In some cases, the injection mold includes two sides that are translatable toward and away from each other along a parting line axis, and the interface between the two mold halves is generally planar or at least substantially planar, and is commonly referred to as a "parting plane". In at least one such instance, the parting plane is perpendicular to an axis of a clip groove of a clip applier jaw formed in the injection mold. Such an arrangement allows, for example, rigid features such as rails to be designed onto the back side of the clip applier jaws, friction or retention features within the clip channel, and/or the distal retention features described above. For example, using the MIM process may often require machining, grinding, and/or polishing of the clip applicator jaws after removal from the injection mold. The clip applier jaws can then be pivotally pressed together and/or pivotally welded to a connection feature of the end effector. By using MIM to produce certain portions of the jaws, the cost of producing the jaws can be reduced because a low cost manufacturing method can be used for the connection features as opposed to using MIM to produce the entire clip applier jaw. Additionally, the clip applier jaws can be separately manufactured using MIM and then welded to the spring-based interconnect clip. In addition, the separately manufactured clip applier jaws, which are subsequently assembled together, allow the clip applier jaws to have a metal clip guide track to be built into the laterally inward facing portion of the clip applier jaws. Clip applier jaws that are independently manufactured using MIM can also include distal clip retention features, such as flanges, that prevent accidental ejection of clips from the distal end of the clip applier jaw. As a result of these MIM processes, such distal clip retention features can extend over a major face of a clip applier jaw.

As described above, and as described in greater detail below, certain clip appliers are configured to be insertable into a patient through a passageway defined in a trocar. That is, many clip appliers have clip jaws that are wider than the trocar passageway when in their open configuration. The following describes various systems that may be incorporated into a clip applier to facilitate insertion of the clip applier through a trocar passageway.

Referring to fig. 69, the graph 71000 depicts the movement of a cam member and a feeder/firing member of, for example, a clip applier (such as the clip applier 70100). The cam member is similar to the cam member 70180 and the feeder shoe is similar to the firing member 70165 illustrated in, for example, fig. 35A-38. To configure the clip applier 70100 in a trocar insertion configuration, the camming member is moved to a fully advanced position to close the jaws of the clip applier and the feeder shoe is moved to a fully retracted position. In various instances, the clip applier can include a control system that includes a button that, when depressed, places the clip applier in its trocar insertion configuration. In at least one instance, the control system operates one or more electric motors of the clip applier to configure the drive system, as described above. At this point, the clip applier is ready for insertion into the patient through the trocar. Once inserted into the patient, the button can be depressed again, and in response, the control system will retract the cam member to the fully retracted position and open the jaws of the clip applier. The button can be depressed repeatedly as needed to switch the configuration of the clip applier. Such an arrangement may also be used to remove the clip applier from the patient through a trocar. The reader should appreciate that opening and closing the jaws via the buttons will not affect other functions of the clip applier, such as advancing clips, forming clips, and/or ejecting clips from a clip magazine.

As further described above, once the clip applier has been inserted through the trocar and the button has been actuated a second time (i.e., the jaws are open), the firing button can be depressed, causing the feeder shoe to advance to the fully advanced position. For example, the clip will be advanced with the feeder shoe, as described above with respect to the clip applier 70100 (fig. 35A-38). The feeder shoe can then be retracted to a fully retracted position, and the cam member can be advanced to a fully advanced position to form a clamp around the tissue of the patient, as also described above. The cam member can then be retracted to a fully retracted position to release the clip and tissue. Once all of the clips have been applied, or at least a sufficient number of clips have been applied, the button can be actuated again to close the jaws, allowing the clip applier to be removed through the trocar. Such an arrangement enables a user of the clip applier to close the jaws without releasing a loose clip into the patient.

Further to the above, embodiments are contemplated in which the clip applier includes a motor and a motor controller. The motor controller may be configured to control the motor via the processor and the memory. The motor controller can implement a motor control algorithm to configure the jaws to open and close a clip and to advance the clip into the jaws. For example, as described above, after the jaws have been inserted through the trocar, a motor control algorithm can be implemented to allow the jaws to advance a clip into a crimping and/or forming position. By not feeding clips into the jaws until after the clip applier has been introduced into the patient, the jaws can be moved into a very compact arrangement when inserted through a trocar, as described above.

Turning now to fig. 70, a graph 71100 depicts movement of a cam member and a feeder shoe of a clip applier, such as the clip applier 70600, that includes, for example, a rotating clip magazine (i.e., a cylindrical magazine). The operation of the clip applier depicted in FIG. 70 is similar in many respects to the operation of the clip applier 70600. For example, the cam member is similar to closure tube 70620, the feeder shoe is similar to feeder member 70630, and the barrel magazine is similar to rotatable gripper magazine 70650 shown in fig. 52-60. The clip applier is placed into the patient through the trocar with the jaws closed and a clip positioned in the jaws and another clip aligned with the feeder shoe for deployment from the magazine. With the feeder shoe in the starting position (i.e., zero displacement), the cam member can be advanced from the starting position to a fully advanced position to crimp a clamp already disposed within the jaw. In at least one instance, the distance between the starting position and the fully advanced position is, for example, 0.3 ". The cam member is then retracted to a partially advanced position just proximal of the fully advanced position to reduce the force applied to the clip by the jaws. The cam member is again advanced to the fully advanced position to again crimp the clamp. By applying a force, reducing the force, and then again applying the same or another force, the elasticity within the clip may be reduced so that a fully plastic deformation may occur to properly crimp the clip to the patient tissue. The partially advanced position depends on the type of clip being used with the clip applier. For example, for a clip having a clip opening of 0.210", the partially advanced position is preferably 0.2" distal of the starting position, and for a clip having a clip opening of 0.180", the partially advanced position is preferably 0.23" distal of the starting position, for example. The appropriate threshold may be set by the user depending on the type of clip in the magazine being used with the clip applier. Other embodiments having different clip sizes and positional arrangements for the partially retracted position and the fully advanced position are contemplated.

In any event, as the feeder shoe advances the clip distally from the magazine into the preform position toward the jaws of the clip applier (e.g., when the feeder shoe is 0.08 "distal from the starting position), the cam member is then retracted proximally toward the starting position after the clip has been properly compressed. The jaws may be partially opened by retracting the cam member slightly beyond the starting position when the clip is in the pre-forming position, i.e., the cam member interacts with the jaws of the clip applier to open the jaws when the cam member is retracted proximally of the starting position, as described above. Such an arrangement allows the clip to be deployed through the preformed features (i.e., protrusions 70608) on each of the jaws, as described above. The feeder shoe then distally advances the clip further into a crimping position, such as 0.3 "distal from the starting position. Once the feeder shoe is advanced beyond the barrel magazine (i.e., to the pre-forming position), the barrel magazine may be cycled (i.e., rotated) to position another clamp for advancement into the jaws. The barrel magazine is cycled by retracting the cam member to a fully retracted position, e.g., 0.05 "proximal to the starting position. The circulating gripper will be biased against the feeder shoe, which prevents the gripper from being ejected completely from the magazine. Once the feeder shoe is retracted to the start position, the cycled clamp can be displayed (i.e., because the feeder shoe has been retracted and no longer blocks such movement, the biasing member in the magazine can now position the cycled clamp in alignment with the feeder shoe). At this point, the already preformed clip is positioned in the jaws and another clip is aligned with the feeder shoe for deployment from the magazine into the clip applier jaws as when the clip applier is first inserted into the patient. The same operations described above can be performed until all the grippers in the magazine are exhausted.

For example, a graph 71200 of a firing member of a clip applier (such as any of the clip appliers described herein) is shown in FIG. 71. Graph 71200 illustrates the relationship between force and displacement required to advance a clip within a clip applier (i.e., via a firing member). With further reference to FIG. 71, a graph 71300 of the same clip applier is shown illustrating the voltage applied to a motor that drives a firing member of the clip applier versus time. The motor controller of the clip applier can monitor the current drawn by the motor and/or the force applied to the firing member by the motor to detect a clip feed jam or irregular force within the clip applier and then prevent further advancement of the firing member by effecting a change in the voltage applied to the electric motor, as shown in graph 71300. In other words, if the monitored force exceeds a threshold value, and/or the monitored motor current exceeds a threshold value, the motor controller may, during the clip feeding step, first, reduce the magnitude of the voltage potential applied to the motor over a period of time, and, second, further evaluate the force within the firing system and/or further evaluate the current drawn by the motor. If the force and/or motor current continues to increase as the voltage continues to be applied to the motor, the motor control system may stop the motor and/or reverse the direction of the motor shaft to shorten the firing member back to the stroke distance, thereby clearing the stuck clamp. Once the stuck clip is cleared, the clip applier can return to its normal operation and be ready for the next clip to be advanced according to the clip applier's normal sequence of operation.

Other embodiments are contemplated in which clearing of a stuck clip is accomplished by interrupting the normal sequence of end effector jaw operation. More specifically, once a clip occlusion is detected, the control system (i.e., motor controller, processor, and memory) of the clip applier can request that the clinician initiate occlusion removal actuation. Prior to another attempt to re-advance the clip, the occlusion removal actuation causes the jaws of the clip applier to open more than normal. During an attempt to re-advance the clip, the acceptable load threshold (i.e., current threshold and/or force threshold) can be raised above the normal threshold previously described to ensure ejection of the clip from the jaws. Once the stuck clip has been ejected, the clip applier can return to its normal operation and be ready for the next clip to be advanced according to the clip applier's normal sequence of operation.

As described above, some clip appliers may be loaded with clips having a first size and/or a second size. The relative dimensions of the clip may be measured using, for example, any suitable dimension, such as the leg-to-leg width of the clip. A first clip having a first width may be wider than a second clip having a second width. In various instances, the clip applier can be loaded with only the first clip, only the second clip, or both the first clip and the second clip. In any event, clips having different dimensions can deform differently for a given closing stroke of the clip jaws. Thus, for example, a first closing stroke of the jaws of a clip can be more preferably used with a first clip, while a second closing stroke of the jaws of the clip can be more preferably used with a second clip. Many of the clip appliers disclosed herein are capable of selectively applying more than one closing stroke to the jaws of a clip; however, in order to apply the correct closing stroke to the clip, the clip applier needs to be able to assess which size clip is positioned within the clip jaws. In some cases, such information may be manually entered into the control system of the clip applier by a clinician. Such an arrangement is convenient when the clips in the clip applier are all the same size. In various instances, a clip cartridge attached to a clip applier includes, for example, a marker, such as a microchip, that can be evaluated by, for example, a control system and/or a sensor circuit in communication with the control system. Such an arrangement is convenient when the clips in the clip magazine are all of the same size.

In various instances, further to the above, the clip applier can be configured to evaluate a clip positioned between the clip jaws of the clip applier to evaluate a size of the clip. Once a clip is loaded between the jaws of the clip, the control system can partially operate the jaw closure drive and observe the force within the jaw closure drive and/or the current drawn by the electric motor of the jaw closure drive. The control system is configured to compare the measured data to data stored in the memory device, for example, to assess whether a clip between the jaws of the clip is a first clip or a second clip or any other clip. For example, if the measured force and/or motor current follows a first curve, the control system will determine that the clamp is a first clamp, and then apply a first closing stroke. Similarly, if the measured force and/or motor current follows a second profile for a second clamp, the control system will apply a second closing stroke. Thus, the control system may use the jaw closure drive to apply a short evaluation closure stroke to evaluate the clip size, and then optionally complete the full closure stroke. In at least one instance, the control system can reset the jaw closure drive after performing the short evaluation closure stroke, and then optionally complete the full closure stroke. In various instances, it is contemplated that a short evaluation closing stroke will not plastically deform, or at least substantially plastically deform, the clamp.

Referring to FIG. 72, a graph 71400 of force applied to a pair of jaws of a clip applier versus time is shown. The control system of the clip applier can monitor the force within the crimp drive and/or the current drawn by the motor to determine the amount of force required to crimp a clip positioned within the jaws of the clip applier. For the first portion of the closing stroke of the jaws, the feedback force is initially dependent upon the size and/or type of clip within the jaws. Once the size/type of clip is determined, the force applied to the jaws of the clip applier can be adjusted for the remainder of the jaw closing stroke to crimp the clip with an appropriate amount of force. Such an arrangement is convenient when more than one size clip has been loaded into the clip applier. Other embodiments are contemplated in which the adaptive control process change is initiated by the cartridge recognizing itself to the clip applier upon insertion into the clip applier. This allows the clip applier to update alternative control programs and thresholds (i.e., the force applied to the jaws) for the size/type of clip loaded into the clip applier. In addition, an alternative form of cartridge identification may be to detect the load required to complete the first operation of the clip applier, which may be advancing clips from the cartridge or preforming clips within the jaws, as described above. The first job of the clip applier may have a significantly higher load threshold required to complete the operation, and exceeding or not exceeding the threshold will then determine subsequent operations of the clip applier and the threshold limits for each operation.

Many of the clip appliers described herein have been discussed in the context of squeezing the clip jaws of the clip applier to compress the clip into its proper size. Other embodiments are contemplated in which the clips are elastically or resiliently stretched and then released once the target tissue has been positioned within the stretched clips. Such an arrangement may be particularly useful, for example, when clamping or clipping a blood vessel. In such cases, the clamp may be released to elastically return to or at least towards its unstretched position and clamp the blood vessel in an atraumatic or nearly atraumatic manner. All clip appliers disclosed herein may be adapted to apply such stretch and release clips. Further to the above, the clip applier disclosed herein can be configured to apply both a clamp to a compression clip and a stretch and release clip. Similar to the above, clip appliers will need to be able to identify the type of clips received therein in order to properly apply them to patient tissue. The identification chip in the cartridge can be used for such purposes, for example.

Fig. 75 depicts a clip applier system 71500, according to at least one embodiment. The clip applier system 71500 includes the clip applier 70600 described above. The clip applier system 71500 also includes a magnet that is aligned with one of the clips 70654 of the rotatable clip cartridge 70650. The clip applier system 71500 also includes a sensor, such as a hall effect sensor 71502, for example, fixedly positioned within the ground portion 70612 of the clip applier 70600. The magnets may be sensed by the hall effect sensor 71502, and based on the voltage potential generated by the hall effect sensor, the control system of the clip applier 71500 can determine the radial position and orientation of the magnets, and thus the radial position and orientation of the clip cartridge 70650. When the magnets are in the first position 71504, referring to fig. 76, the rotatable clip magazine 70650 is loaded with a complete complement of clips 70654, and one of the clips 70654 can be advanced from the rotatable clip magazine 70650 into the end effector 70605. The rotatable gripper bin 70650 may then be cycled (e.g., rotated) as described above, moving the magnets between the first position 71504 and the second position 71506. Another clip 70654 may be pushed out of the rotatable clip magazine 70650 and the rotatable clip magazine 70650 may be cycled again to move the magnets to the third position 71508. The other clip 70654 may be pushed out of the rotatable clip magazine 70650 and the rotatable clip magazine 70650 may be cycled again to move the magnet to the fourth position 71510. Additionally, another clamp 70654 may be pushed out of the rotatable clamp magazine 70650 and the rotatable clamp magazine 70650 may be cycled again to move the magnets to the fifth position 71512. In the fifth position 71512, the last clip 70654 in the rotatable clip magazine 70650 can be pushed out of the rotatable clip magazine 70650. Thus, clip applier system 71500 can determine the status of clip magazine 70650 (i.e., the number of clips remaining) based on the position of the magnet relative to hall effect sensor 71502. Further to the above, fig. 76 depicts the voltage potential generated by the hall effect sensor 71502 as a function of the position of the magnet.

In at least one alternative embodiment of the clip applier system 71500, the clip magazine 70650 further comprises an extension member or rod that extends proximally from the clip magazine 70650 once all of the clips 70654 have been ejected from the clip magazine 70650. The extension member is sensed by the hall effect sensor 71502 and/or another electrical sensor within the clip applier 70600. When the clip applier system 71500 detects an extending member, the mechanical systems of the clip applier 70600 (i.e., the feeder member 70630, the firing member 70640, and the drive tube 70620) can be locked to prevent further actuation.

FIG. 77 depicts a clip applier 71600. The clip applier 71600 includes a first jaw 71610a and a second jaw 71610b that are movable relative to one another between an open position and a closed position. The clip applier 71600 is configured to receive a clip 71604 that is crimped by the first jaw 71610a and the second jaw 71610b as the first jaw 71610a and the second jaw 71610b are moved toward the closed position. The clip applier 71600 includes a resistance sensing circuit configured to determine the position of the clip 71604 within the clip applier 71600. The resistance sensing circuit includes a supply voltage source 71602 that supplies current through a first lead 71620a, a first jaw 71610a, a clamp 71604, a second jaw 71610b, and a resistor 71620b, and returns to a loop 71606 where the current can be measured. When clip 71604 is moved distally through the clip applier, such as to the position shown by clip 71604', the path through which the current flows is larger (i.e., larger than the path of clip 71604) and the resistance within the path is larger, and therefore the current measured at loop 71606 will be smaller. Thus, the current measured at loop 71606 is proportional to the position of clip 71604 within clip applier 71600. The control system of the clip applier is configured to use the magnitude of the current in the sensing circuit to evaluate the position of the clip 71604' within the jaws 71610a and 71610 b. A higher current value indicates that clip 71604 ' is more proximal, and a lower current value indicates that clip 71604 ' is more distal, while a middle current value indicates that clip 71604 ' is positioned in the middle of jaws 71610a and 71610 b.

Still referring to fig. 77, the clip applier 71600 also includes a second resistance sensing circuit configured to determine when the first jaw 71610a and the second jaw 71610b are in the closed position. More specifically, the supply voltage supplies a current that flows through a first lead 71630a connected to the first jaw 71610 a. The first lead 71630a is insulated from the first jaw 71610a, i.e., it does not allow current to flow into the first jaw 71610 a. When the first jaw 71610a and the second jaw 71610b are in the closed position, the first lead 71630a contacts the second lead 71630b connected to the second jaw 71610b, which allows current to flow into the resistor 71630c and into the loop 71606 where the current can be measured. The second lead 71630b is also insulated from the second jaw 71610 b. Thus, when the first jaw 71610a and the second jaw 71610b are in the closed position, the control system will sense, via a loop, a current determined by the second resistance through the resistor 71630c that indicates that the first jaw 71610a and the second jaw 71610b are in the closed position. The control system may also simultaneously sense the resistance through resistor 71620b, which indicates the position of the clip 71604 within the clip applier 71600. Other embodiments are contemplated in which only one of the resistance sensing circuits described above is used with the clip applier 71600.

Fig. 78A and 78B depict a variable resistance system for use with a clip applier 71650 that is configured to collect information (i.e., data) regarding the position of the clip jaws and the formation of a clip during a crimp stroke. The clip applier 71650 is similar in many respects to the clip applier 71600, for example. The clip applier 71650 includes a first jaw 71650a and a second jaw 71650B that are movable relative to one another between an open position (fig. 78A), a partially closed position (fig. 78B), and a closed position. The clip applier 71650 is configured to receive a clip 71654 that is crimped by the first jaw 71650a and the second jaw 71650b as the first jaw 71650a and the second jaw 71650b are moved toward the closed position. The legs of the clip 71654 positioned within the first and second jaws 71650a, 71650b extend outwardly into engagement with the first and second jaws 71650a, 71650b to ensure that the clip 71654 is properly seated therebetween (i.e., so that there is no tilt or play between the clip 71654 and the first and second jaws 71650a, 71650 b). In each case, as a clip is fed into the first jaw 71650a and the second jaw 71650b, the legs of the clip deflect slightly inward. The variable resistance system of clip applier 71650 is described in further detail below.

The variable resistance system includes three return paths through which current can flow and be sensed by the control system of the clip applier to determine the position of the first jaw 71650a and the second jaw 71650b relative to each other and to sense the formation of the clip 71654. The first return path 71660 includes a second jaw 71650 b. The second return path 71670 includes a variable resistor configured to determine the position of the first jaw 71650a and the second jaw 71650b relative to each other. More specifically, as the first jaw 71650a and the second jaw 71650b move from the open position (fig. 78A) toward the closed position, the resistance in the variable resistor will change. The third return path 71680 includes another variable resistor at the distal end of the second jaw 71650b that is insulated from the second jaw 71650 b. When the first and second jaws 71650a, 71650b are in the open position (fig. 78A), the clip 71654 is in contact with the first and third return paths 71660, 71680. When the first and second jaws 71650a, 71650n are in a partially closed position (fig. 78B), the clips 71654 are only in contact with the first return path 71660. When the first and second jaws 71650a, 71650b are in the closed position, the clip 71654 has been fully crimped and is again in contact with the first return path 71660 and the third path 71680. Throughout the movement of the first jaw 71650a and the second jaw 71650b between the open position, the partially closed position, and the closed position, the second return path 71670 determines the position of the first jaw 71650a relative to the second jaw 71650 b. Thus, the variable resistance system can determine jaw position and sense clip formation throughout the clip formation process by determining the resistance through each of the three paths.

FIG. 79 depicts a clip applier jaw 71700, according to at least one embodiment. The clip applier jaw 71700 is configured to move toward and away from another clip applier jaw, and is further configured to crimp a clip as described above with respect to the various embodiments disclosed herein. The clip applier includes a proximal strain gauge 71720 and a distal strain gauge 71730, and/or any number of suitable strain gauges. A proximal strain gauge 71720 and a distal strain gauge 71730 are positioned on a face 71710 of the clip applier jaw 71700. Other embodiments are contemplated in which more than two strain gauges are spaced apart along any suitable face of the clip applier jaw 71700 and/or are built into the clip applier jaw 71710 itself. The proximal strain gauge 71720 is part of a proximal strain gauge circuit and generates a voltage signal indicative of strain within the clip applier jaw 71700 in a first position, and the distal strain gauge 71730 is part of a distal strain gauge circuit and generates a voltage signal indicative of strain within the clip applier jaw 71700 in a second position. The proximal and distal strain gauge circuits are in communication with the control system of the clip applier, and as a clip is formed between the clip applier jaw 71700 and the other clip applier jaw, the control system will detect different levels of strain at the first and second positions.

Referring to fig. 80, a graph 71800 of the strain (measured in volts, but may be more conveniently shown in mV) within the proximal and distal strain gauges 71720, 71730 at various stages of clip formation is depicted. Upon initial placement of a clip between the jaws of a clip applier, the clip legs of some clips are biased outwardly into engagement with the jaws, as described above. In such cases, a greater strain may be measured in the proximal strain gauge 71720 than in the distal strain gauge 71730. At this stage, the voltage difference within the strain gauges 71720, 71730 is a voltage a, as depicted in fig. 80. As the jaws of the clip applier begin to form a clip, the reading from the proximal strain gauge 71720 will exceed the pre-formed strain threshold T_PFWhile the reading from the distal strain gauge 71730 remains below the preformed strain threshold T_PF. This may indicate that the clip is formed only at or near the proximal strain gauge 71720. At this stage, the voltage difference between the readings of the strain gauges 71720, 71730 is measured as a'. As the jaws of the clip applier further form a clip, the reading from the distal strain gauge 71730 will eventually exceed the pre-formed strain threshold T_PFAnd the reading from the proximal strain gauge 71720 will eventually exceed the fully formed strain threshold T_FF. This may indicate that the clip has been fully formed at or near the proximal strain gauge 71720, and has begun to be distally addressed The deformation at or near the gauge 71730. When the readings from the proximal strain gauge 71720 and the distal strain gauge 71730 are both measured as exceeding the full forming threshold T, respectively_FFAnd a pre-forming threshold T_PFThe difference in strain gauge readings is measured as a ", as depicted in fig. 80. In addition, as the jaws of the clip applier further form a clip, the reading from the distal strain gauge 71730 will eventually exceed the fully formed strain threshold T_FFAnd the reading from the proximal strain gauge 71720 will continue to increase above the fully formed strain threshold T_FF. When the readings from the proximal strain gauge 71720 and the distal strain gauge 71730 are both measured to exceed the full forming threshold T_FFThe difference in strain gauge readings was measured as a' ", as depicted in fig. 80.

Further to the above, the status of the clip can be determined by measuring the difference between the readings of the proximal strain gauge 71720 and the distal strain gauge 71730 throughout the formation of the clip. More specifically, a difference in the voltage measurements A indicates that the clip is about to deform. The difference in the voltage measurements a' indicates that only the proximal portion of the clip has been deformed. The difference in voltage measurements a "indicates that the proximal portion of the clip has been fully formed and the distal portion of the clip has begun to deform. And finally, the difference in the voltage measurements a' "indicates that both the proximal and distal portions of the clip have been fully formed.

As described above, clip appliers are typically inserted into a patient through a trocar. Thus, the diameter of the passageway through the trocar determines a number of design considerations for the clip applier, and particularly for the portion of the clip applier that is inserted through and/or into the trocar passageway. That is, there is often an incentive to make the trocar as narrow as possible to reduce the size of the incision in the patient, among other reasons. Thus, narrow trocars and narrow trocar passageways present significant design constraints and often limit the width of clips that can be used. In view of this, a clip applier is disclosed herein that is configured to store a clip in a small configuration and enlarge it once on the other side of the trocar. Such an arrangement may allow the use of a clamp that, in its enlarged state, exceeds the diameter of the trocar through which it is inserted.

Fig. 81A and 81B depict a clip applier 71900 according to at least one embodiment. The clip applier 71900 includes a first jaw 71910a and a second jaw 71910B that are movable relative to one another about a pivot pin 71912 between a closed position, a starting position (fig. 81A), and an open position (fig. 81B). The clip applier 71900 further includes a cam member 71920 configured to move the first jaw 71910a and the second jaw 71910b between a closed position, a starting position, and an open position. More specifically, when the cam member 71920 is moved to the fully retracted position (fig. 81B) due to the cam member 71920 engaging the first jaw cam 71914a on the first jaw 71910a and the second jaw cam 71914B on the second jaw 71910B, the cam member 71920 moves the first jaw 71910a and the second jaw 71910B to the open position. Further, when the cam member 71920 is moved distally to the starting position depicted in fig. 81A (i.e., the cam member 71920 no longer engages the first jaw cam 71914a and the second jaw cam 71914b, allowing the first jaw 71910a and the second jaw 71910b to assume the starting position), the cam member 71920 moves the first jaw 71910a and the second jaw 71910b to the starting position. Further, when cam member 71920 is moved distally to the fully advanced position due to cam member 71920 cammingly engaging the outer surfaces of first jaw 71910a and second jaw 71910b, cam member 71920 moves first jaw 71910a and second jaw 71910b to the closed position. The first jaw 71910a and the second jaw 71910b are configured to receive a clip 71904 therein that will be deployed during a preforming operation and crimped during a crimping operation. Fig. 81A depicts the clip 71904 in a storage configuration when the first jaw 71910a and the second jaw 71910b are in a starting position. The clip 71904 may be, for example, a 5mm clip in a storage configuration. The deployment of the clamp 71904 during the preforming operation and the crimping of the clamp 71904 during the crimping operation are described in further detail below.

The first jaw 71910a and the second jaw 71910b include pre-forming features or protrusions 71930a and 71930b similar to the protrusions 70126a and 70126b described above. The protrusions 71930a and 71930B engage an inner surface of the clip 71904 and deploy the clip 71904 from a stored configuration (fig. 81A) to a fired configuration (fig. 81B) when the first jaw 71910a and the second jaw 71910B are moved to the open position. For example, the clip 71904 deploys from a storage configuration in which the clip 71904 has a width of about 5mm to a fired configuration in which the clip 71904 has a width of about 10 mm. That is, the clip may have any suitable stored width and any suitable deployed width. After the clip 71904 has been deployed to the fired configuration, the firing member advances the clip over the protrusions 71930a, 71930b into a crimped position within the first jaw 71910a and the second jaw 71910 b. The protrusions 71930a and 71930b include angled portions that allow the clip 71904 to slide over the protrusions 71930a and 71930b when advanced by the firing member. Once the clip is in the crimping position, the cam member 71920 is advanced distally to the fully advanced position during the crimping stroke to move the first jaw 71910a and the second jaw 71910b to the closed position to crimp the clip 71904 within the crimping chamber.

Further to the above, the clip applier 71900 also includes a sensor array 71940 that detects a magnet 71950 included in one of the first jaw 71910a and the second jaw 71910 b. The sensor array 71940 senses the position of the magnet 71950 relative to the sensor array 71940 in order to determine the position of the first jaw 71910a and the second jaw 71910b relative to one another during operation of the clip applier 71900.

As described herein, clip appliers are loaded with clips in a variety of ways. For example, clips can be loaded into a clip applier via a clip magazine. Such a clip magazine may include, for example, clips stacked along a longitudinal axis. Such clip magazines may also include clips stacked along an axis transverse to the longitudinal axis of the clip applier. Some of the bins are stored in a circumferential configuration, as described above. That is, some clip appliers may be configured to hold only one clip at a time. The teachings provided herein are applicable to such clip appliers. In at least one instance, for example, a single clip applier can be used with a docking station that includes a plurality of clips stored therein. In such cases, the clinician may use the docking station to re-supply clips to the single clip applier after each use of the clip applier. In some cases, the docking station may be positioned within the patient, which prevents the need to remove the clip applier from the patient so that the clip applier can be reloaded. In at least one instance, as described below, the docking station may be attached to a trocar, for example, that is inserted into a patient. As already mentioned above, the concept of a docking station positioned within the patient's body may also be used with a multi-clip applier. In such cases, one or more clips from the docking station may be loaded into the multi-clip applier without having to remove the clip applier from the patient.

Turning to fig. 82 and 83, a clip applier system 72000 is depicted. The clip applier system includes trocar 72010, clip cartridge 72050, and clip applier 72020. The clip applier 72020 includes an elongate shaft 72011 extending from the housing, an articulation joint 72022 extending from the elongate shaft 72011, and an end effector 72024 extending from the articulation joint 72022. The end effector 72024 includes a first jaw 72024a and a second jaw 72024b that are movable relative to each other between an open position and a closed position. The end effector 72024 is articulatable relative to the elongate shaft 72011 about an articulation joint 72022. The clip magazine 72050 includes an opening 72051 through the clip magazine 72050 (see fig. 82). Prior to insertion of the clip applier 72020 through the trocar 72010, the clip cartridge 72050 is positioned within the patient and attached to the distal end of the trocar 72010. The opening 72051 allows the clip cartridge 72050 to be received and attached to the distal end of the trocar 72010 as depicted in fig. 83. The clip cartridge 72050 can be attached to the distal end of the trocar 72010, such as by threading. The clip applier 72020 is then inserted through the openings 72051 of trocar 72010 and clip cassette 72050 until the end effector 72024 of clip applier 72020 is positioned distal of clip cassette 72050. As clip applier 72020 is retracted toward clip magazine 72050, clip applier 72020 engages clip magazine 72050 to eject clips from clip magazine 72050 into an end effector of clip applier 72020, as discussed in more detail below.

Turning to fig. 85A and 85B, clip magazine 72050 further includes a leaf spring 72052, a plurality of clips 72054 removably stored in clip magazine 72050, a spring 72059, a slide 72058, and a loading arm 72056. Leaf spring 72052 prevents clip 72054 from inadvertently falling out of clip magazine 72050. A spring 72059 biases the slide 72058 distally to bias the clip 72054 toward the loading arm 72056. The loading arms 72056 grasp the clip 72054 and hold it in place until acted upon by the clip applier 72020. To do so, as the clip applier 72020 is retracted toward the clip cassette 72050 (i.e., proximally), the loading arms 72056 engage the jaw wings 72026 of the clip applier 72020. When the jaw wings 72026 are engaged by the loading arm 72056, the jaw wings 72026 move proximally and the loading arm 72056 rotates toward the end effector 72024 to load clips 72054 from the clip magazine 72050 into the end effector 72024 of the clip applier 72020. Fig. 84A-84C depict the movement of the jaw wings 72024 and loading arms 72056 as the clip applier 72020 retracts toward the clip cassette 72050. After the clips 72054 have been loaded into the end effector 72024, the clip applier 72024 can be moved distally to a desired position within the patient to crimp the clips 72054 around the patient tissue. After the clips 72054 are crimped and released, the clip applier 72020 can be retracted toward the clip cassette 72050 (i.e., proximally) to engage the jaw wings 72026 with the loading arms 72056 of the clip cassette 72050 to load another clip into the clip applier 72020. This process may be repeated until all of clips 72054 have been depleted from clip magazine 72050, and/or until the appropriate number of clips have been applied.

Turning now to fig. 86A and 86B, the relationship between the jaw wings 72026 and the first and second jaws 72024a and 72024B of the clip applier 72020 is depicted. The jaw wings 72026 are operably engaged with the first jaw 72024a and the second jaw 72024B such that the jaw wings 72026 are retracted when the first jaw 72024a and the second jaw 72024B are in a closed position (fig. 86B). To this end, the clip applier 72020 can be inserted through the clip magazine 72050 without the jaw wings 72026 engaging the loading arms 72056 of the clip magazine 72050. Other embodiments are contemplated in which clip applier 72020 engages clip magazine 72050 to load clips 72054 into end effector 72024 when clip applier 72020 moves from a proximal position behind clip magazine 72050 to a distal position beyond clip magazine 72050.

Clip applier 73000 is depicted in fig. 87A-87D. The clip applier 73000 includes an elongate shaft 73010 extending from the housing, an articulation joint 73020 extending from the elongate shaft 73010, a cartridge housing 73030 extending from the articulation joint 73020, and an end effector 73040 extending from the cartridge housing 73030. The end effector 73040 includes a first jaw 73040a and a second jaw 73040b that are movable relative to each other between an open position and a closed position. The cartridge case 73030 includes a bottom case 73030b and a top case 73030 a. The top housing 73030a is movable relative to the bottom housing 73030b about a pivot pin 73032 attached to an articulation joint 73020 between an open position (fig. 87A) and a closed position (fig. 87C). The cartridge housing 73030 can receive a clamp cartridge 73050 that includes a plurality of clamps 73054 stored therein. Clip 73054 is loaded into clip magazine 73030 and locked in place by a biasing member or leaf spring 73056. Leaf spring 73056 prevents clip 73054 from ejecting from clip magazine 73050 until clip magazine 73050 is seated in magazine housing 73030, as discussed in more detail below.

The clip magazine 73050 also includes notches 73058 on either side of the clip magazine 73050. To properly seat clip magazine 73050 in magazine housing 73030, notch 73058 of clip magazine 73050 aligns with protrusion 73034 of magazine housing 73030 to seat and align clip magazine 73050 in magazine housing 73030, as depicted in fig. 87B. Once clip magazine 73050 is installed into magazine housing 73030, top housing 73030a can be moved to the closed position, as depicted in fig. 87C. Top housing 73030a includes a latch release or protrusion 73032 that engages leaf spring 73056 of clip magazine 73050 when clip magazine 73050 is installed in magazine housing 73030 and top housing 73030a is in the closed position, as depicted in fig. 87D. When the leaf spring 73056 is depressed by the protrusion 73032, the clip 73054 is no longer locked into place within the clip cartridge 73050 and can be ejected from the clip cartridge 73050 into the end effector 73040 by the firing member.

Turning now to fig. 88A-88D, after all of the clips 73054 have been ejected from clip magazine 73050, clip magazine 73050 can lock when removed from magazine housing 73030 to prevent clip magazine 73050 from being reinstalled into magazine housing 73030 until at least one new clip 73054 is reloaded. More specifically, clip nest 73030 includes a slide 73052 that moves through clip nest 73030 as clip 73054 is ejected. Slide 73052 includes a spring-loaded detent 73059 that aligns with a notch 73058 in clip magazine 73050 when the last clip 73054 has been ejected from clip magazine 73050. When the clip magazine 73050 is installed in the magazine housing 73030 and the clip magazine 73050 has been exhausted, the spring-loaded detents 73059 are biased against the protrusions 73034, as depicted in fig. 88B and 88D. After clip magazine 73050 is removed from magazine housing 73030, spring-loaded pawls 73059 protrude through notches 73058 to lock slide 73052 in place, as depicted in fig. 88A. An empty clip magazine 73050 cannot be reinstalled into magazine housing 73030 unless at least one clip 73054 is loaded into clip magazine 73050. More specifically, until the slide 73052 is retracted to disengage the spring-loaded detent 73059 from the notch 73058 (i.e., to install at least one clip 73054), the clip magazine 73050 cannot be installed into the magazine housing 73030 because the spring-loaded detent 73059 occupies the notch 73058 and will not allow the notch 73058 to properly align and seat with the projection 73034 of the magazine housing 73030.

Other embodiments are contemplated wherein the clip applier system includes a clip applier, a trocar, and a sensing system. The clip applier of the clip applier system is similar in many respects to clip applier 72020, and the trocar is similar in many respects to trocar 72010. The trocar may include a sensor, such as a hall effect sensor, for example, attached to or near the distal end of the trocar. The clip applier can also include a detectable element, such as a magnet, positioned in the end effector of the clip applier, for example. A magnet in the end effector of the clip applier and a hall effect sensor on the distal end of the trocar are included in the sensing system. The sensing system is in signal communication with the control system of the clip applier via a wireless signal transmitter in the trocar and a wireless signal receiver in the clip applier. The control system of the clip applier is configured to automatically control opening and closing of the jaws of the end effector based on the position of the magnet relative to the hall effect sensor. More specifically, when the magnet in the jaws is positioned a predetermined distance distal to the Hall effect sensor of the trocar (which indicates that the jaws have passed through the trocar), the clip jaws are automatically moved to the open position by the control system of the clip applier. In addition, the control system of the clip applier can automatically load clips into the open jaws. Such an arrangement reduces the time required to load the clip applier after it is inserted into the patient. In addition, when the magnet in the jaws approaches the hall effect sensor of the trocar from a distal position (i.e., the clip applier is retracted proximally toward the trocar), the control system automatically moves the jaws to a closed position to allow the clip applier to be retracted through the trocar.

FIG. 89 depicts a clip applier 74000 according to at least one embodiment. The clip applier 74000 includes an elongate shaft 74010 extending from a housing, a clip reloading device 74020 including a plurality of clips, a distal head 74030 rotatable relative to the housing, an end effector 74040 extending from the distal head 74030, and an articulation joint 74050 rotatably connecting the distal head 74030 and the elongate shaft 74010. The distal head 74030 can be articulated relative to the elongate shaft 74010 by an articulation rod 74052 that is operably responsive to a motor within the housing of the clip applier 74000. Additionally, the clip reloading device 74020 can be releasably attached to the distal head 74030 via an opening 74032 in the distal head 74030 and a protrusion 74022 on the clip reloading device 74020. The protrusion 74022 extends outward and is captured by the opening 74032 to releasably attach the clip reload device 74020 to the distal head 74030. The clip reload device 74020 may be interchangeable with other clip reload devices, for example, the clip reload device 74020 may be interchangeable with a clip reload device containing clips smaller or larger than the clips of the clip reload device 74020. This arrangement allows different sized clip reloading devices to be attached to the same distal head, such as distal head 74030, for example.

Fig. 90A and 90B depict a distal head 74100 releasably attached to a shaft 74120 of a clip applier in accordance with at least one embodiment. The distal head 74100 has an eight millimeter diameter and is used with a limaxx 5 clamp from Ethicon inc, and the shaft 74120 has an eight millimeter diameter shaft, for example. The distal head 74100 can be releasably attached to the shaft 74120 by a pawl 74105. Other embodiments with different attachment mechanisms are contemplated. The distal head 74100 includes a proximal portion 74110 that extends proximally from the distal head 74100 and includes a pawl 74105 thereon. The proximal portion 74110 is configured to fit inside and align with the shaft 74120 of the clip applier to facilitate proper attachment of the distal head 74100 to the shaft 74120.

Fig. 91A and 91B depict a distal head 74200 releasably attached to a shaft 74220 of a clip applier in accordance with at least one embodiment. The distal head 74200 has a nine millimeter diameter and is used with an ER320 clip from Ethicon inc, and the shaft 74220 has an eight millimeter shaft diameter. The distal head 74200 can be releasably attached to the shaft 74220 by a pawl 74205. The distal head 74200 includes a proximal portion 74210 that extends proximally from the distal head 74200 and includes a pawl 74205 thereon. The proximal portion 74210 is configured to fit inside and align with the shaft 74220 of the clip applier to facilitate proper attachment of the distal head 74200 to the shaft 74220.

Fig. 92A and 92B depict a distal head 74300 releasably attached to a shaft 74320 of a clip applier in accordance with at least one embodiment. The distal head 74300 is an eleven millimeter distal clip applier head for use with an ER420 clip, and the shaft 74320 is an eight millimeter shaft, for example. The distal head 74300 can be releasably attached to the shaft 74320 by a pawl 74305. The distal head 74300 includes a proximal portion 74310 that extends proximally from the distal head 74300 and includes a pawl 74305 thereon. The proximal portion 74310 is configured to fit inside and align with the shaft 74320 of a clip applier to facilitate proper attachment of the distal head 74300 to the shaft 74320.

The distal heads 74100, 74200, and 74300 have different sizes as described above, however, the distal heads 74100, 74200, and 74300 can be releasably attached to shafts of the same size (e.g., eight millimeter shafts).

Fig. 93A depicts a clip applier system 74400, according to at least one embodiment. The clip applier system 74400 includes a clip applier shaft 74410 extending from a housing of the clip applier system 74400. Clip applier shaft 74410 is configured to be selectively receivable, for example, in various distal heads, such as distal head 74450, or in alternative distal head 74460. The clip applier shaft 74410 includes a proximal shaft 74412 extending from the housing of the clip applier, a distal shaft 74420 including an opening 74422, and an articulation joint 74415 connecting the proximal shaft 74412 and the distal shaft 74420. The openings 74422 are configured to receive the protrusions 74452, 74462 of the distal heads 74450 and 74460, respectively, depending on which distal head is attached to the clip applier shaft 74410. In at least one embodiment, the distal heads 74450 and 74460 are of different sizes (e.g., in diameter and/or length) and are configured to store, for example, different sized clips. In addition, the distal head 74450 includes an end effector 74454 extending therefrom, and the distal head 74460 includes an end effector 74464 extending therefrom that is of different sizes and can form clips of different sizes. In view of the above, the clip applier system 74400 includes a clip applier shaft 74410 that is configured to interchangeably connect different sized distal heads with different sized end effectors to the same sized clip applier shaft 74410.

Fig. 93B depicts a clip applier system 74470, according to at least one embodiment. The clip applier system 74470 includes a distal head 74472 configured to releasably attach to a shaft 74478 including a rotary input 74479. The shaft 74478 extends from the housing of the clip applier system 74470 and is operable in response to rotational movement generated by a motor within the housing. The distal head includes a bracket 74474 and a drive screw 74477 in threaded engagement with the bracket 74474. The carriage 74474 is configured to translate relative to the distal head 74472 when the distal head 74472 is attached to the shaft 74478. More specifically, drive screw 74477 is threadably engaged with collar 74476 of bracket 74474 and bracket 74474 is rotatably constrained within distal head 74472 such that as drive screw 74477 rotates, bracket 74474 will translate through distal head 74472. When the distal head 74472 and the shaft 74478 are brought together, the rotation input 74479 is configured to be connected to the drive screw 74477 via a quick disconnect 74475 on the distal end of the rotation input 74479. Thus, the rotation input 74479 may rotate the drive screw 74477 when it is attached. In at least one embodiment, the proximal end of the drive screw 74477 includes a square shape (see fig. 93D) and the distal end of the rotation input 74479 includes a square opening configured to receive the square shape of the drive screw 74477 to allow rotational motion to be transmitted from the rotation input 74479 to the drive screw 74477. Other embodiments are contemplated having different types of mechanical connections between rotational input 74479 and drive screw 74477 to allow distal head 74472 and shaft 74478 to be releasably attached and rotate together.

Once the distal head 74472 is attached to the shaft 74478, the rotary input 74479 may be rotated to translate the carriage 74474 between a proximal position and a distal position within the distal head 74472. The pitch of the drive screw 74477 may be selected to effect translation of the carriage 74474 through a stroke of predetermined length. The predetermined length may be based on, for example, the distal head function being performed by the translation of the carriage 74474, such as feeding a clip through the distal head into the end effector or crimping the clip within the end effector. In addition, the predetermined length may be selected based on the size (e.g., diameter or length) of the distal head and/or the size of the clip to be advanced and/or formed.

Fig. 93C depicts a clip applier system 74480, according to at least one embodiment. The clip applier system 74480 is similar in many respects to the clip applier system 74470. The distal head 74482 includes a bracket 74484 rotatably constrained within the distal head 74482, and the bracket 74484 includes a collar 74486 configured to capture a drive screw 74487 of the distal head 74482. The drive screw 74487 can be releasably attached to the rotational input 74479 of the shaft 74478 of the clip applier system 74470, similar to above. As shown in fig. 93C, the distal head 74482 is larger than the distal head 74472; however, the bracket 74484 of the distal head 74482 is sized such that when the distal head 74482 is attached to the shaft 74478, the drive screw 74487 and the rotation input 74489 are aligned. Thus, the quick disconnect 74475 of the clip applier system 74470 is compatible with the drive screw 74487 of the clip applier system 74480. Similar to drive screw 74477 of clip applier system 74470, the pitch of drive screw 74487 may be selected to achieve translation of carriage 74484 through a stroke of a predetermined length. The predetermined length can be based on, for example, the distal head function being performed by translation of the carriage 74484, such as feeding a clip through the distal head 74482 into the end effector or crimping a clip within the end effector. In addition, the predetermined length may be selected based on the size (e.g., diameter and/or length) of the distal head and/or the size of the clip to be advanced or formed.

FIG. 94 depicts a clip magazine 74500 of a clip applier in accordance with at least one embodiment. The gripper cartridge 74500 is rotatable about the cartridge axis MA. For example, the clip magazine 74500 is configured to removably store, for example, a plurality of clips, such as internal clips 74501, 74503, 74505 and external clips 74502, 74504, 74506. The clip magazine 74500 includes an outer housing 74510 having a plurality of clips removably stored therein. The grippers are arranged in a radial array and spaced about 120 degrees apart about the cassette axis MA. Additionally, the outer clamps 74502, 74504, and 74506 are closest to the outer housing 74510, and the inner clamps 74501, 74503, 74505 are closest to the cartridge axis MA. Each outer clip 74502, 74504, and 74506 is laterally offset from and stacked on top of a respective inner clip 74501, 74503, and 74505. Each outer clip 74502, 74504, 74506 is centered on a clip axis CA that is spaced about 120 degrees apart, and each inner clip 74501, 74503, 74505 is offset from its respective clip axis CA. For example, the outer clamp 74502 is stacked on top of the inner clamp 74501, and the edge of the outer clamp 74502 is offset from the edge of the inner clamp 74501 (the outer clamp 7502 is centered on the clamp axis CA, while the inner clamp 74501 is not centered on the clamp axis CA). When the arrangement is repeated with a clip stack at each 120 degree position, as shown in fig. 94, the outer casing 74510 is, for example, smaller than a clip arrangement in which the clip stack is not offset (such as in fig. 95A). In other words, if the clips are stacked on top of each other without lateral offset, the radial footprint of the clips will be larger without regard to other factors. Other embodiments of the clip arrangement within the clip magazine are contemplated and described below.

Fig. 95A depicts a clip cassette 74550 according to at least one embodiment. Clip magazine 74550 is configured to be attached to and/or fit within clip applier shaft 74552, and is rotatable relative to clip applier shaft 74552. The clip magazine 74550 includes, for example, a plurality of clips 74554 arranged in a stack and stored in a clip magazine 74550 at storage locations 74556 radially spaced apart by about 120 degrees. The storage position 74556 is sized to keep the edges of the clips 74554 aligned with each other. An opening 74558 in clip magazine 74550 allows the internal drive to pass through clip magazine 74550. The internal drive device can push clips 74554 out of the clip magazine 74550 into the clip applier's end effector and/or crimp clips 74554 positioned in the clip applier's end effector. Other embodiments are contemplated in which more than one internal drive extends through, for example, opening 74558. The clamps 74554 are the same size; however, in at least one alternative embodiment, the size of the clips 74554, e.g., positioned at each storage location 74556, is different. Additionally, in at least one alternative embodiment, the clip dimensions may vary, for example, between storage locations 74556. Clip applier shaft 74552 includes a loading slot 74559 configured to receive clip 74554 when one of storage positions 74556 is aligned with loading slot 74559. In at least one embodiment, the biasing member 74557 is configured to bias the clip 74554 from the clip magazine 74550 into the loading slot 74559.

Fig. 95B depicts a clip cassette 74560 according to at least one embodiment. Clip magazine 74560 is configured to be attached to and/or fit within clip applier shaft 74562, and is rotatable relative to clip applier shaft 74562. The clip magazine 74560 includes a plurality of clips 74564 arranged in a stack and stored in a clip magazine 74560 at storage locations 74566 radially spaced about 120 degrees apart. The storage locations 74566 are angled to offset the edges of the clips 74564, and each storage location 74566 stores a plurality of clips 74564. An opening 74568 in clip magazine 74560 allows the internal drive of the clip applier to pass through clip magazine 74560. The internal drive device may push clips 74564 out of clip magazines 74560 into the clip applier's end effector and/or crimp clips 74564 positioned in the end effector. Other embodiments are contemplated in which more than one internal drive extends through opening 74568. The clamps 74564 are the same size; however, in at least one alternative embodiment, the size of the clips 74564 positioned at each storage location 74566 is different. In at least one alternative embodiment, the clip dimensions can vary, for example, between storage locations 74566. Clip applier shaft 74562 includes a loading slot 74569 configured to receive clip 74564 when one of storage positions 74566 is aligned with loading slot 74569. The biasing member 74567 is configured to bias the clip 74564 from the clip magazine 74560 into the loading slot 74569.

Fig. 95C depicts a clip cassette 74570 according to at least one embodiment. Clip magazine 74570 is configured to be attachable to and/or fit within clip applier shaft 74572, and is rotatable relative to clip applier shaft 74572 about magazine axis MA. The clip applier shaft 74572 defines a shaft axis SA. In addition, the clip magazine 74570 includes a plurality of clips 74574 arranged in a stack and stored in the clip magazine 74570 at storage locations 74576 radially spaced about 120 degrees apart. Storage location 74576 is sized to keep the edges of clips 74574 aligned, and each storage location 74576 stores a plurality of clips 74574. The cartridge axis MA is offset from the shaft axis SA; thus, the diameter of clip magazine 74570 is reduced (compared to clip magazine 74550) to provide adequate storage for clips 74574. Thus, in at least one embodiment, the storage position 74576 is closer together than the storage position 74556 of the clip magazine 74550. Clip magazine 74570 works in conjunction with an external driver configured to push clips 74574 out of clip magazine 74570 and/or crimp clips 74574 positioned in an end effector of a clip applier. In at least one embodiment, the size of the clamp 74574 positioned at each storage location 74576 is different. In at least one alternative embodiment, the clip size may vary between storage locations 74576. Clip applier shaft 74572 includes a loading slot 74579 configured to receive clip 74574 when one of storage positions 74576 is aligned with loading slot 74579. The biasing member 74577 is configured to bias the clip 74574 from the clip magazine 74570 into the loading slot 74579.

Fig. 95D depicts a clip cassette 74580 according to at least one embodiment. Clip magazine 74580 is configured to be attachable to and/or fit within clip applier shaft 74582, and is rotatable relative to clip applier shaft 74582 about magazine axis MA. The clip applier shaft 74852 defines a shaft axis SA. The clip magazine 74580 includes a plurality of clips 74584 arranged in a stack and stored in a clip magazine 74580 at storage locations 74586 radially spaced about 120 degrees apart. Storage location 74586 is sized to keep the edges of clips 74584 aligned, and each storage location 74586 stores a plurality of clips 74584. The cartridge axis MA is offset from the shaft axis SA; thus, the diameter of clip magazine 74580 is reduced (compared to clip magazine 74550) to provide adequate storage for clips 74574. Thus, in at least one embodiment, for example, the storage position 74586 is closer together than the storage position 74556 of the clip magazine 74550. Clip magazine 74580 works in conjunction with an external drive device configured to push clips 74584 out of clip magazine 74580. In addition, clip magazine 74580 is configured to protrude through an opening 74589 in clip applier shaft 74582, which provides additional space for clip magazine 74580 relative to clip applier shaft 74582. In at least one embodiment, the size of the clamp 74584 positioned at each storage location 74586 is different. In at least one alternative embodiment, the clip dimensions can vary between storage locations 74586. Clip applier shaft 74582 includes a loading slot 74581 configured to receive clip 74584 when one of storage positions 74586 is aligned with loading slot 74581. Biasing member 74587 is configured to bias clip 74584 from clip magazine 74580 into loading slot 74581.

Fig. 95E depicts a clip cassette 74590 according to at least one embodiment. Clip magazine 74590 is configured to be attached to and/or fit within clip applier shaft 74592, and is rotatable relative to clip applier shaft 74592. The clip magazine 74590 includes a plurality of clips 74594 arranged in a stack and stored in a clip magazine 74590 at storage locations 74596 radially spaced apart by about 90 degrees. Storage location 74596 is sized to, for example, keep the edges of clip 74594 aligned and multiple clips can be stored in each location. The clamps 74594 are the same size; however, in at least one alternative embodiment, the size of the clips 74594 positioned at each storage location 74596 is different. In at least one alternative embodiment, the clip dimensions can vary between storage locations 74596. The clip magazine 74590 is rotated using a gear and tooth arrangement 74591. More specifically, clip magazine 74590 also includes a circumferential rack of teeth 74593 extending between storage positions 74596. The circumferential rack of teeth 74593 is operably engaged with the rotatable drive shaft 74599 of the clip applier. The rotatable drive shaft 74599 includes a gear 74598 affixed thereto that engages a circumferential rack of teeth 74593. Thus, as the rotatable drive shaft 74599 rotates, clip magazine 74590 rotates relative to clip applier shaft 74592. The clip applier shaft 74592 includes a loading slot 74595 configured to receive a clip 74594 when one of the storage positions 74596 is aligned with the loading slot 74595. The biasing member 74597 is configured to bias the clip 74594 from the clip magazine 74590 into the loading slot 74595.

Fig. 96 depicts a clip magazine 74600 in accordance with at least one embodiment. The clip cassette 74600 is configured for use with a clip applier and the clip cassette 74600 is configured to store a plurality of clips 74610. Clips 74610 are arranged in clip magazines 74600 in a clip stack and are held in clip magazines 74600 by clip channels 74620 that are angled laterally relative to the radius of clip magazines 74600. The clip channel 74620 partially mimics the shape of the clip 74610 in a clip stack in order to retain the clip 74610 into the clip magazine 74600. More particularly, the clip channel 74620 provides space for the clip 74610 to slide relative to the clip channel 74620 at discrete positions, and at other discrete positions the clip channel 74620 releasably holds the clip 74610 in place. For example, the clip channel 74620 may include discrete holding positions 74630 and 74640 to hold the clip 74610 in place. The discrete holding locations 74630, 74640 provide a tighter fit between the clip 74610 and the clip channel 74620 than the rest of the clip channel 74620. The discrete holding positions 74630, 74640, along with the angled clip channel 74620, hold the clip 74610 in the clip magazine 74600 until the clip 74610 is ejected.

Fig. 97A and 97B depict a clip magazine 74700 according to at least one embodiment. Clip magazine 74700 is configured to be attached to and/or fit within a shaft 74720 of a clip applier, for example. The shaft 74720 defines a shaft axis SA. The clip cassette 74700 includes a tray 74710 that includes a plurality of clip holders 74712 configured to store a plurality of clips 74714. The clip retainer 74712 extends from the driven portion of the bracket 74710 such that the plurality of clips 74714 are positioned distal of the bracket 74710. The clip cartridge 74700 is configured to rotate relative to the shaft 74720 about the shaft axis SA between a plurality of clip firing positions (fig. 97A) and a plurality of clip loading positions (fig. 100). Clip magazine 74700 is rotatable via a rotary input 74726 that is operably responsive to a motor of a clip applier. As clip magazine 74700 rotates, clip 74714 is configured to be biased into clip track 74716 of shaft 74720 when clip magazine 74700 is in the loaded position, as shown in fig. 100. A clip 74714 positioned in the clip track 74716 is configured to be advanced by the feeder shoe 74724 into the end effector of the clip applier when the clip cassette 74700 is in the firing position, as shown in fig. 97A. Other embodiments are contemplated in which the clip track 74716 is part of the clip magazine 74700 and is aligned with another clip track in the shaft 74720 to facilitate, for example, stripping and advancing of the clip 74714 from the clip magazine 74700.

Further to the above, each clip retainer 74712 stores two clips 74714. Other embodiments are contemplated in which each clip retainer 74712 stores one clip or more than two clips 74714. Each clip retainer 74712 includes a biasing member 74713 (see fig. 101) configured to bias the clip 74714 away from the shaft axis SA. The clip rails 74716 are configured to receive the clips 74714 when one of the clips 74714 is biased into the clip rail 74716 (e.g., when the clip magazine 74700 is in a loaded position). Additionally, when the clip magazine 74700 is initially loaded into the clip applier, one of the clips 74714 may have been loaded into the clip track 74716, as shown in fig. 97A. Clip magazine 74700 also includes a latch or lockout clip 74718 configured to prevent further rotation of clip magazine 74700 after all clips 74714 have been spent. As shown in fig. 97B, the lockout clip 74718 extends proximally further than the clip 74714 to allow the lockout clip 74718 to interfere with the bracket 74710 when the clip cartridge 74700 is empty. The operation of clip magazine 74700 is described in more detail below.

In the orientation shown in fig. 97A, the clip cartridge 74700 is in a fired position. After the clip magazine 74700 is initially loaded into the clip applier, the clips 74714 have been loaded into the clip tracks 74716 by the biasing members 74713, as described above. An initially loaded clip 74714 can be advanced into an end effector of a clip applier by a feeder shoe 74724 of the clip applier. Feeder shoe 74724 extends on one side of bracket 74710 to engage clips 74714 without interfering with clip magazine 74700. Once the feeder shoe 74724 is retracted, the next clamp 74714 is rotated into position, as described in more detail below.

Referring now to fig. 98, after initial clamp 74714 is advanced by feeder shoe 74724 and feeder shoe 74724 is retracted, clamp magazine 74700 is rotated toward the loaded position (see fig. 100). As the clip magazine 74700 is rotated toward the loaded position, the leading edge of the next clip 74714 drops into the recessed portion 74719 of the clip track 74716 (see fig. 98). As the clip magazine 74700 is rotated further toward the loaded position, the clip 74714 begins to seat in the clip track 74716 (see fig. 99). Referring now to fig. 100, when the clip 74714 and the clip track 74716 are fully aligned, the clip 74714 is fully biased into the clip track 74716 by the biasing member 74713. Clamp 74714 is now in the loaded position. Additional operations of clip magazine 74700 are discussed in more detail below.

As the clip cassette 74700 is rotated from the loaded position shown in fig. 100 to another firing position, the remaining clips 74714 remain in their respective clip retainers 74712. More specifically, referring to fig. 100, when the clip magazine 74700 is in the loaded position, another clip 74714 sits on top of the clip 74714 in the clip track 74716. As the carriage 74710 rotates, the clamp 74714 will continue to rotate with the carriage 74710 because there is no room for the clamp 74714 to move toward the clamp rail 74716 because the clamp rail 74716 is already occupied by the clamp 74714. Once the clip cassette 74700 is rotated into the firing position, clips 74714 positioned in the clip track 74716 are advanced into the end effector by the feeder shoe 74724, as described above. As the clip magazine 74700 is rotated toward the other loading position, the other clip 74714 is peeled away (i.e., biased into the clip track 74716), as described above. This sequence continues until all of the clips 74714 have been stripped from the clip magazine 74700 and advanced into the end effector. The external clip 74714 (i.e., clips 2, 3, and 4) is first peeled from the clip magazine 74700 based on the arrangement described above. Once all of the outer clips 74714 are peeled away, the inner clip 74714 (i.e., clips 5, 6 and lockout clip 74718) can be peeled away of clip cassette 74700. The latching clip 74718 of clip magazine 74700 is described in more detail below.

Referring now to fig. 101, after all clips 74714 have been stripped from clip magazine 74700, when clip magazine 74700 is rotated into a final loaded position, locking clip 74718 is biased into clip track 74716. As described above, the locking clip 74718 extends proximally further toward the bracket 74710 than the clip 74714 (see fig. 97B). Thus, when the lockout clip 74718 is positioned in the clip track 74716, the lockout clip 74718 will interfere with the carriage 74710 as the clip cassette 74700 rotates from the loaded position to the fired position. More specifically, the bracket 74710 of the clip magazine 74700 will engage the top of the lockout clip 74718, which prevents further rotation of the clip magazine 74700. The biasing member 74713 pushes the locking clip 74718 into the clip track 74716 and holds the locking clip 74718 in place. Alternatively, the biasing member 74713 in the last clip retainer 74712 position may be configured to extend into the clip track 74716 to prevent further rotation of the clip cassette 74700 after all clips have been exhausted.

As a way to minimize rotational binding of the clip 74714 as the clip magazine 74700 rotates, the clip magazine 74700 may vary the amount of force that the biasing member 74713 applies to the clip 74714 depending on, for example, the orientation of the clip magazine 74700. In at least one embodiment, the clip cartridge 74700 can reduce the amount of force that the biasing member 74713 applies to the clip 74714 when the clip cartridge 74700 is in the firing position. Alternatively, the clip magazine 74700 may increase the amount of force that the biasing member 74713 applies to the clip 74714 to urge the clip 74714 above the clip track 74716 into the clip track 74716 when the clip magazine 74700 is in the loaded position. Other embodiments are contemplated wherein the clip magazine 74700 may relieve the spring bias of the biasing member 74713 just prior to the alignment of the clip 74714 with the clip track 74716 (see fig. 98 and 99) and increase the spring bias when the clip 7471 is aligned with the clip track 74716 (see fig. 100) to cause the clip 74714 to eject from the clip retainer 74712 only when the clip 74714 is aligned with the clip track 74716. To reduce the spring bias in the unloaded position (i.e., fired position), the inner diameter 74722 of the clip cartridge 74700 can be eccentric relative to the travel path of the cartridge 74710. In such cases, the inner diameter 74722 of clip magazine 74700 may be shaped such that when clip magazine 74700 is in the loaded position, biasing member 74713 is compressed, providing a greater force to clip 74714. Additionally, the inner diameter 74722 may provide space for the biasing member 74713 to extend when the clip cassette 74700 is in the fired position and/or moved from the fired position to the loaded position, thereby providing less force to the clips 74714.

As further described above, as another way to minimize rotational binding of clamp 74714 as clamp magazine 74700 rotates, inner diameter 74722 of clamp magazine 74700 may be polished to reduce friction between bracket 74710 and inner diameter 74722. Other embodiments are contemplated in which inner diameter 74722 is polished only in certain areas to reduce rotational friction, for example, as bracket 74710 rotates through certain radial positions. In such cases, high friction may hold the clip cartridge 74700 in place while firing.

102-106 depict a clip applier 74800 according to at least one embodiment. Clip applier 74800 includes a clip magazine 74810 having a plurality of clips, a rotational input 74820, a shaft 74830 extending from housing, a feeder shoe 74840, and a crimp drive 74850. The shaft 74830 defines a shaft axis SA, and the clamp magazine 74810 is translatable along and rotatable about the shaft axis SA. The plurality of clips includes a first set of clips 74806 stored on a first side 74812 of clip magazine 74810, a second set of clips 74807 stored on a second side 74814 of clip magazine 74810, and a third set of clips 74808 stored on a third side 74816 of clip magazine 74810. The first side 74812, second side 74814, and third side 74816 are positioned about 120 degrees apart about the shaft axis SA. Each of the first clip set 74806, the second clip set 74807, and the third clip set 74808 is biased radially outward relative to the clip magazine 74810 by a biasing member 74809 (see fig. 104). The first clip set 74806, the second clip set 74807, and the third clip set 74808 are stored in the clip slots 74804 of the clip magazine 74810. The rotational input 74820 is configured to rotate in response to rotational motion generated by a motor positioned in the housing of the clip applier 74800. The rotary input 74820 is threadably engaged with the clamp magazine 74810. The operation of the clip applier 74800 is discussed in more detail below.

To peel the first clip set 74806 from the clip magazine 74810, the clip magazine 74810 is translated distally by rotating the input 74820 until the first clip set 74806 is aligned with the loading slot 74832 in the bottom of the shaft 74830 of the clip applier 74800. The first clip set 74806 includes a first clip 74806a and a second clip 74806b (see fig. 106). The clip magazine 74810 is rotatably constrained within a shaft 74830 of the clip applier 74800 by the first clip set 74806 and the biasing member 74809 such that the clip magazine 74810 can translate between a proximal position (fig. 102) and a distal position (fig. 103) when the rotary input 74820 is rotated in the direction D1.

The clip magazine 74810 can then be retracted from the distal position (fig. 103) to the proximal position (fig. 102) to peel the first clip 74806a from the clip magazine 74810 by rotating the rotary input 74820 in the opposite direction D2. Notably, when the clip magazine 74810 is in the distal position, the second clip 74806b of the first clip set 74806 is positioned on top of the first clip 74806a in the loading slot 74832, and thus, the clip magazine 74810 is still rotatably constrained via the biasing member 74809. Thus, clip magazine 74810 will translate proximally in response to rotation of rotational input 74820 in direction D2 (fig. 102). Once the clip magazine 74810 is retracted to the proximal position, the feeder shoe 74840 can advance the first clip 74806a in the loading slot 74832 into the end effector of the clip applier 74800. The clip magazine 74810 can then be translated from a proximal position to a distal position to place the second clip 74806b into the loading slot 74832. At this point, clip magazine 74810 is still rotatably constrained by biasing member 74809, which remains engaged with second clip 74806b as it is seated in loading slot 74832. Thus, when the rotary input 74820 is rotated in the second direction D2, rotation of the rotary input 74820 will translate the clip magazine 74810 proximally. In addition, when the biasing member 74809 is retracted proximally beyond the loading slot 74832, the biasing member 74809 still applies a force to the shaft 74830 of the clip applier 74800 and thus continues to rotatably constrain the clip cartridge 74810. Once the clip magazine 74810 is in the proximal position, the second clip 74860b in the loading slot 74832 can be advanced by the feeder shoe 74840 into the end effector of the clip applier 74800. At this point, the clip magazine 74810 no longer has clips remaining on the first side 74812 of the clip magazine 74810. Then, as the biasing member 74809 rotatably constrains the clip magazine 74810 against the shaft 74830, the clip magazine 74810 can translate from a proximal position (fig. 102) to a distal position (fig. 103), as described above. Once in the distal position (fig. 103), the clip magazine 74810 will no longer be rotationally constrained because the biasing member 74809 no longer has clips in the loading slot 74832 to press against; and, as a result, biasing member 74809 no longer rotatably constrains clip cartridge 74810. More specifically, the biasing member 74809 only extends downward far enough to engage the shaft 74830 of the clip applier 74800 and not into the loading slot 74832. Thus, if a clip is not positioned in load slot 74832, clip magazine 74810 will rotate in response to rotation of rotary input 74820. At this point, rotation of the rotary input 74820 rotates the gripper cartridge 74810.

As further described above, when load slot 74832 is empty and rotary input 74820 rotates, clip magazine 74810 will rotate until second set of clips 74807 are aligned with and biased toward load slot 74832. The first clip of the second set of clips 74807 will occupy loading slot 74832, and thus clip cassette 74810 will again be rotatably constrained, as described above. The clip magazine 74810 can now be translated between a distal position (fig. 103) and a proximal position (fig. 102) to peel the first and second clips of the second clip set 74807 from the clip magazine 74810. Once the first and second clips of the second clip set 74807 are peeled apart and advanced, the clip magazine 74810 can be rotated to align the third clip set 74808 with the loading slot 74832. The third clip set 74808 may follow the same firing and advancement sequence as the first clip set 74806 and the second clip set 74807. Other embodiments are contemplated wherein the clip magazine 74810 includes more or less than three sides including clips, for example.

As clip magazine 74810 translates from the proximal position (see fig. 102) to the distal position (see fig. 103), further to the above, clip magazine 74810 engages a distal stop 74860 extending downward from a shaft 74830 of clip applier 74800. Distal stop 74860 prevents further distal translation of clip cassette 74810 and properly aligns clip cassette 74810 with loading slot 74832. In addition, rotation input 74820 includes a proximal stop 74862 that prevents further proximal translation of clip cartridge 74810. As described above, the rotary input 74820 is threadably engaged with the clamp magazine 74810. Other embodiments having different rotational inputs to the clip magazine connection are contemplated, as discussed in more detail below.

Fig. 107 depicts a rotary input 74920 and a clip magazine 74910 in accordance with at least one embodiment. The rotary input 74920 and clip magazine 74910 are similar in many respects to the rotary input 74820 and clip magazine 74810 of clip applier 74800 (see fig. 102-106). For example, rotational input 74920 is threadably engaged with clip magazine 74910, and rotational input 74820 is configured to advance, retract, and rotate clip magazine 74910. The rotation input 74920 includes a protrusion 74922 extending from a distal end of the rotation input 74920. The protrusion 74922 engages the internal threads 74912 of the clip cartridge 74910. As the rotary input 74920 rotates and the clip magazine 74910 is rotatably constrained, the clip magazine 74910 will translate. In such instances, the protrusion 74922 of the rotary input 74920 engages the internal threads 74912 of the clip magazine 74910 to linearly advance and retract the clip magazine 74910. The rotational input 74920 is configured to rotate in a first direction to distally translate the clip magazine 74910 and, correspondingly, rotate in a second direction opposite the first direction to proximally translate the clip magazine 74910. In use, the rotary input 74920 rotates clockwise and counterclockwise to achieve a desired range of motion of the clip magazine 74910, such as to translate the clip magazine 74910 back and forth between, for example, a proximal position and a distal position.

Fig. 108 and 109 depict a rotary input 74940 and a clamp magazine 74930, in accordance with at least one embodiment. Rotational input member 74940 and clip magazine 74930 are similar in many respects to rotational input member 74820 and clip magazine 74810 of clip applier 74800 (see fig. 102-106). For example, the rotary input 74940 is threadably engaged with the clip magazine 74930, and the rotary input 74940 is configured to advance, retract, and rotate the clip magazine 74930. The clip magazine 74930 includes a plurality of clips 74934 and a biasing member 74936 for biasing the clips 74934 out of the clip magazine 74930. The rotary input 74940 includes external threads 74942 that engage bushings 74932 in the clip cartridge 74930. The collar 74932 engages the external threads 74942 at the base of the external threads 74942 and is configured to ride along the external threads 74942 of the rotation input 74940 to translate the clamp magazine 74930 as the rotation input 74940 rotates. The rotary input 74940 is a multi-directional rotary drive for the clip magazine 74930 that advances and retracts the clip magazine 74930 to strip clips from the clip magazine 74930. The rotary input 74940 is configured to rotate in a first direction to distally advance the clip cassette 74930 and, correspondingly, rotate in a second direction opposite the first direction to proximally advance the clip cassette 74930. In use, the rotational input 74940 is rotated, e.g., clockwise and counterclockwise, to achieve a desired range of motion of the clip magazine 74930, such as translating the clip magazine 74930 back and forth between the proximal and distal positions.

Fig. 110 depicts a rotary input 74960 and a clamp box 74950, in accordance with at least one embodiment. Rotational input member 74960 and clip magazine 74950 are similar in many respects to rotational input member 74820 and clip magazine 74810 of clip applier 74800 (see fig. 102-106). For example, the rotary input 74960 is threadably engaged with the clip cassette 74950 and is configured to advance, retract, and rotate the clip cassette 74950. The rotational input 74960 includes a protrusion 74962 extending from the rotational input. The protrusion 74962 engages the internal threads 74952 of the clip cartridge 74950. The internal threads 74952 are one-way threads; thus, as the rotary input 74960 rotates and the clip magazine 74950 is rotatably constrained, the clip magazine 74950 translates between the proximal and distal positions. Once the clip magazine 74950 has reached the distal position, the protrusion 74962 moves through the distal end 74954 of the internal threads 74952, which switches the direction of translation of the clip magazine 74950 while the rotational input 74960 rotates in the same direction. The internal threads 74952 include left-hand and right-hand threaded portions that are connected at their distal ends such that the left-hand and right-hand threaded portions include one continuous thread groove. Thus, the rotary input 74960 need only be rotated in one direction to achieve the desired range of motion of the clip cassette 74950, i.e., to translate the clip cassette 74950 back and forth between the proximal and distal positions.

Fig. 111 depicts a rotary input 74980 and a clamp box 74970, in accordance with at least one embodiment. The rotary input 74980 and clamp cassette 74970 are similar in many respects to the rotary input 74820 and clamp cassette 74810. For example, the rotary input 74980 is threadably engaged with the clip magazine 74970, and the rotary input 74880 is configured to advance, retract, and rotate the clip magazine 74970. The rotation input 74980 includes a threaded groove 74982 defined on the outside of the rotation input 74980 that engages a bushing 74972 in the clip cartridge 74970. Collar 74972 engages threaded groove 74982 at the base of threaded groove 74982. The threaded groove 74982 is a one-way thread, and thus, as the rotary input 74980 is rotated and the clip magazine 74970 is rotatably constrained, the clip magazine 74970 translates back and forth between a proximal position and a distal position. Once the clip magazine 74970 has reached the distal position, collar 74972 will move through distal end 74984 of threaded channel 74982, which switches the direction of translation of clip magazine 74970 while rotational input 74980 rotates in the same direction. The thread groove 74982 includes left-hand and right-hand thread portions that are connected at their distal ends such that the left-hand and right-hand thread portions include one continuous thread groove. Thus, the rotary input 74980 need only be rotated in one direction to achieve the desired range of motion of the clip cassette 74970, i.e., to translate the clip cassette 74970 back and forth between the proximal and distal positions.

Fig. 112 depicts a rotary input 74990 and a clamp box 74995, in accordance with at least one embodiment. Rotational input member 74990 and clip magazine 74995 are similar in many respects to rotational input member 74820 and clip magazine 74810 of clip applier 74800 (see fig. 102-106). For example, the rotary input 74990 is threadably engaged with the clip magazine 74995, and the rotary input 74980 and clip magazine 74995 are configured to advance, retract, and rotate the clip magazine 74995. The clip cassette 74995 includes an upper portion 74995a and a lower portion 74995b that are assembled together using alignment pins 74999 and coupling collars 74997. The clip magazine 74995 also includes a cutout region 74996 configured to receive the coupling collar 74997 when the upper portion 74995a and the lower portion 74995b are positioned together. Coupling collar 74997 and alignment pin 74999 are configured to hold upper portion 74995a and lower portion 74995b together.

Further to the above, clip pocket 74995 includes internal threads 74991 that can be molded and/or machined into the inner diameter of clip pocket 74995. The upper portion 74995a and the lower portion 74995b may be assembled around the rotation input 74990 such that the protrusion 74992 extending from the rotation input 74990 engages the internal threads 74991. The internal threads 74991 may be molded and/or machined into any of the types of internal threads described herein. The rotational input 74990 may be a one-way drive and/or a multi-way drive, as described herein, depending on the internal threads utilized. Additionally, the crimp drive 74993 may be placed through an opening in the rotational input 74990 such that the crimp drive 74993 and the rotational input 74990 are coaxial. The crimp drive 74993 is configured to actuate jaws of an end effector of a clip applier to crimp a clip positioned between the jaws.

For example, a cross-sectional view of clip magazine 74995 positioned within shaft 74994 of a clip applier is shown in FIG. 113. To achieve the clamshell configuration described above (e.g., splicing together the upper portion 74995a and the lower portion 74995b of the clip magazine 74995), the clip magazine 74995 can be split such that only one clip storage location 74998 is cut in half. This allows for easy assembly and alignment of upper portion 74995a and lower portion 74995 b.

FIG. 114 depicts a clip applier 76000 according to at least one embodiment. The clip applier 76000 includes a rotational input 76022, a cartridge driver 76020 extending from the rotational input 76022, a clip cartridge 76010, a firing drive 76030, and a biasing member 76040. The rotational input 76022 includes a flexible rotational drive to flex and/or bend about an articulation joint of a clip applier. The cartridge driver 76020 includes a first camming surface 76024 that includes a notch 76026 at its distal end. The clip cassette 76010 includes a second cam surface 76014 that includes a protrusion 76016 extending from a proximal end thereof. The clip applier 76000 is shown in an exploded view in fig. 114 with the clip cartridge 76010 separated from the cartridge driver 76020 to illustrate the biasing member 76040.

Further to the above, the clip cartridge 76010 is configured to translate relative to the cartridge driver 76020 between a proximal position (fig. 115A) and a distal position (fig. 115B) as the cartridge driver 76020 rotates. The biasing member 76040 is configured to bias the clip cartridge 76010 toward the proximal position and against the cartridge driver 76020. The first and second cam surfaces 76024, 76014 include complementary shapes and the first and second cam surfaces 76024, 76014 are aligned when the clip cassette 76010 is in the proximal position (fig. 115A). The second cam surface 76014 includes a raised shoulder and the first cam surface 76024 is supported by the body 76003 of the clip cartridge 76010 when the clip cartridge 76010 and the cartridge driver 76020 are engaged. Clip magazine 76010 also includes a first clip storage position 76001, a second clip storage position 76002, and a third clip storage position configured to store a clip 76004 for clipping tissue. In the embodiment shown in fig. 114, there are three clip storage positions, each of which is configured to be able to store two clips 76004. Other embodiments having more or less than three clip storage positions are contemplated, wherein each clip storage position stores, for example, more or less than two clips 76004. The rotational input 76022 is configured to rotate the cartridge driver 76020 to translate and rotate the clip cartridge 76010, as described in more detail below.

Referring now to fig. 115A, the clip cartridge 76010 is in its proximal position relative to the cartridge driver 76020. With the rotary input 76022 in the first direction D₁Upon rotation, first camming surface 76024 of cartridge driver 76020 engages second camming surface 76014 of clip cartridge 76010 to translate clip cartridge 76010 to its distal position (fig. 115B). In the distal position, the first clip storage position 76001 is located above a loading slot of a clip applier, similar to the loading slot 74832 described with respect to the clip applier 74800, for example. In at least one embodiment, when the first clip storage position 76001 is aligned with the loading slot, the clip 76004 is ejected from the first clip storage position 76001 into the loading slot by the biasing member 76006. The rotary input 76022 is then oriented in a second direction D₂Rotate to move the cartridge driver 76020 from a distal position to a proximal positionThe clip 76004 is peeled away from the clip magazine 76010. Notably, the biasing member 76040 pulls the clip cartridge 76010 toward the cartridge driver 76020 such that it follows the cartridge driver 76020 in the second direction D₂Rotating, the second cam surface 76014 and the first cam surface 76024 are continuously engaged. After the first clip in the first clip storage position 76001 has been stripped, the clip magazine 76010 can be advanced from a proximal position to a distal position, as described above, to align the second clip in the first clip storage position 76001 with the loading slot. To strip the second clip, clip magazine 76010 is rotated to align second clip storage location 76002 with the loading slot, as discussed in more detail below.

With the second clip of the first clip storage position 76001 in the loading slot and the clip cartridge 76010 positioned in its distal position, the cartridge driver 76020 is in the first direction D₁Further rotation of (a) will rotate the clip magazine 76010 to strip the second clip from the first clip storage position 76001. In such cases, rotation of the input 76022 will rotate the cartridge driver 76020 to engage the notch 76026 of the cartridge driver 76020 with the protrusion 76016 of the clamp cartridge 76010. Once notch 76026 and protrusion 76016 are engaged, as input 76022 is rotated in direction D₁Rotating, the clip cartridge 76010 will rotate with the cartridge driver 76020. The clip magazine 76010 is oriented in a first direction D₁Rotate 120 degrees to align the second clip storage position 76002 with the loading slot as shown in figure 115C. The first clip 76004 in the second clip storage position 76002 is peeled away from the clip magazine 76010 by translating the clip magazine 76010 from its distal position to its proximal position via the magazine driver 76020 and the biasing member 76040, as described above. After the first clip 76004 in the second clip storage location 76002 has been stripped, the clip cartridge 76010 can be moved by the cartridge driver 76020 in the first direction D₁Another 120 degrees rotation is made to strip the second clip in the second clip storage position 76002 and align the third clip storage position with the loading slot. The first clip in the third clip storage position can be peeled away via retraction of the clip magazine 76010 between its distal and proximal positions, as described above. The second clip in the third clip storage position may also pass through the clip magazine 76010 are peeled back upon retraction between their distal and proximal positions, as described above. Additionally, the second clip in the third clip storage position may also be in the first direction D via the clip magazine 76010 when the clip magazine is in its distal position₁Is peeled off as described above.

Further to the above, alternative embodiments are contemplated wherein the clip cartridge 76010 includes a notch at the proximal end of the second camming surface 76014 and the cartridge driver 76020 includes a protrusion at the distal end of the first camming surface 76024. The notches and protrusions can perform the same function as notches 76026 and protrusions 76016 described above (i.e., for example, engaging cartridge driver 76020 with clip cartridge 76010 in its distal position to rotate clip cartridge 76010).

Figure 116 is a graphical depiction of rotational position versus time of a cartridge driver 76020 for a clip applier 76000. When the cartridge driver 76020 is at position 76110, the clip cartridge 76010 is in its proximal position shown in fig. 115A. As the cartridge driver 76020 is rotated from zero to 90 degrees, the clip cartridge 76010 moves to its distal position shown in fig. 115B and the first clip 76004 from the first clip storage position 76001 is biased into the loading slot. The cartridge driver 76020 can then be rotated back to 0 degrees at position 76120 to peel the first clamp 76004 from the first clamp storage position 76001 as described above. The cartridge driver 76020 can then be rotated 90 degrees from zero to place the second clamp from the first clamp storage position 76001 into the loading slot at position 76130. The second clip from the first clip storage location 76001 is then peeled away as the cartridge driver 76020 rotates from zero to 210 degrees at location 76140. The second clip storage position 76002 is now aligned with the loading slot and the first clip from the second clip storage position 76002 is biased into the loading slot at position 76140. As the cartridge driver 76020 rotates back to 90 degrees from zero at position 76150, the first clamp from the second clamp storage position 76002 is peeled away. As the cartridge driver 76020 rotates from zero to 210 degrees, the second clamp from the second clamp storage position 76002 aligns with and is biased into the loading slot at position 76160. The cartridge driver is then rotated from zero to 330 degrees to strip the second clip from the second clip storage position 76002 and align the first clip from the third clip storage position with the loading slot at position 76170. When the cartridge driver 76020 rotates from zero back to 210 degrees at position 76180, the first clip from the third clip storage position can be peeled away. The second clip in the third clip storage position is then aligned with and biased into the loading slot as the cartridge driver 76020 rotates from zero to 330 degrees. The second clip in the third clip storage location can be peeled from the clip magazine 70610 by rotating the magazine driver 76020 from zero back to 90 to 210 degrees at position 76194 to retract the clip magazine 70610 to the proximal position, or by rotating the magazine driver 76020 from zero back to 120 to 90 degrees at position 76192 to rotate the clip magazine 70610 and peel the clip.

FIG. 117 depicts a clip applier 76200 according to at least one embodiment. The clip applier 76200 includes a distal head 76220 extending from the elongate shaft, a clip magazine 76210, an end effector 76230 extending through and from the distal head 76220, a clip carriage 76260, and a clip former 76242. The distal head 76220 is articulatable relative to the elongate shaft. The end effector 76230 includes a pair of opposing jaws that are movable between an open position and a closed position by a jaw cam 76232, as described herein. The jaw cam 76232 is operably engaged with the jaw cam driver 76250. As the jaw cam driver 76250 rotates, the jaw cam 76232 translates between a proximal position and a distal position to move the jaws of the end effector 72630 between an open position and a closed position. The jaw cam driver 76250 can rotate in response to rotational movement generated by a motor in the housing of the clip applier 76200.

Further to the above, the jaw cam driver 76250 passes through an opening in the clip magazine 76210 and through an opening in the magazine driver 76202 that extends proximally from the clip magazine 76210. The cartridge driver 76202 is configured to rotate the clip cartridge 76210 in response to rotational movement generated by a motor in the housing of the clip applier 76200. The cartridge driver 76202 and the jaw cam driver 76250 are configured to rotate about the same axis (see fig. 121). The clip magazine 76210 includes a plurality of clips 76204 stored in a plurality of clip storage locations. Each clip storage location includes, for example, a pair of clips 76204 stacked on top of each other. The clip 76204 can be biased out of the clip storage position, e.g., into the loading slot 76262 of the clip holder 76260, by a biasing member, such as a leaf spring, as described in further detail below. Other embodiments are contemplated in which the clip magazine 76210 stores one clip or more than two clips 76204 in each clip storage location.

The gripper cartridge 76210 is configured to be rotatable between a plurality of storage positions and a plurality of ejection positions. In the storage position of the clip 76210, the clip 76204 cannot be ejected from the clip pocket 76010. In the ejection position of the gripper magazine 76210, one of the gripper storage positions is aligned with the loading slot 76262 of the gripper bracket 76260 and one of the grippers 76204 is biased into the loading slot 76262 from the gripper magazine 76210. As shown in fig. 118A, after the clamp 76204 is positioned in the loading slot 76262, the clamp 76204 can be advanced distally to the staging position 76224 or retracted proximally to the forming position 76228 by the clamp bracket 76260, as described in more detail below.

The clamp carriage 76260 is configured to translate proximally and distally in response to rotation of the carriage driver 76264. The carriage driver 76264 is configured to rotate in response to rotational movement generated by a motor in the housing of the clip applier 76200. To advance the clamp 76204 into the staging position 76224, the carriage driver 76264 rotates in a first direction. After the clip bracket 76260 advances the clip 76204 to the staging position 76224 (see fig. 118B), the clip bracket 76260 may be retracted proximally as the biasing member or leaf spring 76226 engages the back side of the clip 76204 to hold the clip 76204 in the staging position 76224 (see fig. 118C). As the carriage driver 76264 rotates in a second direction opposite the first direction, the clamp carriage 76260 retracts via the carriage driver 76264. After the clamp 76204 is placed in the staging position 76224 and the clamp bracket 76260 is retracted, the clamp bracket 76260 can be advanced to engage the distal end 76266 of the clamp bracket 72260 with the clamp 76204 to advance the clamp 76204 into the end effector (see fig. 118C and 118D).

Further to the above, after the clamp 76204 is positioned in the loading slot 76262 from the clamp magazine 76210, as shown in fig. 118A, the clamp carriage 76260 is retracted to the forming position 76228 by rotating the carriage driver 76264 in the second direction. Once in the forming position 76228 (see fig. 119A and 119B), the clamp former or anvil 76242 is lowered between the opposed legs 76204a and 76204B of the clamp 76204 by the anvil driver 76240 (see fig. 120A and 120B). Anvil driver 76240 is configured to translate in response to rotational movement produced by a motor of clip applier 76200 or another motor of clip applier 76200 such that as anvil 76240 translates, anvil 76242 is configured to translate closer to and further from loading slot 76262 of clip carriage 76260, depending on the direction of translation of anvil driver 76240.

Notably, the anvil driver 76240 includes a pair of laterally extending pins 76244 that engage a pair of angled slots 76246 in the anvil 76242. As anvil driver 76240 translates distally, the anvil moves toward loading slot 76262. As anvil driver 76240 translates proximally, anvil 76242 moves away from loading slot 76262. The formation of the clamp 76204 positioned in the loading slot 76262 is described in more detail below.

After the anvil 76242 is lowered between the legs 76204a and 76204B of the clamp 76204, the clamp bracket 76260 is advanced distally, as described above, such that the legs 76204a and 76204B of the clamp 76204 are deployed away from each other by the anvil 76242 (see fig. 120B). The clamp 76204 includes an angled portion 76206 connecting the legs 76204a and 76204B of the clamp 76204 that is engaged by the anvil 76242 as the clamp bracket 76260 is advanced such that the angled portion 76206 is deformed from a closed orientation (see fig. 120A) to an open orientation (see fig. 120B). After the clamp 76204 has been deployed, the anvil driver 76240 may move the anvil 76242 away from the loading slot 76262 such that the clamp bracket 76260 may advance the clamp 76204 into the staging position 76224, as described above. Once in the staging position 76224, the clamp 76204 can be advanced into the end effector 76230, as described above.

As further described above, staging position 76224 is configured to store a single clip 76204. However, other embodiments are contemplated wherein staging position 76224 is configured to enable, for example, storage of a plurality of grippers 76204 in a gripper stack. The plurality of clips in the stack of clips in the staging position 76224 can be formed or unformed, as described above, and can be stacked in the staging position 76224 until they are sequentially advanced into the end effector by the clip carrier 76260 in the manner described above.

As described above, the jaw cam driver 76250, the cartridge driver 76202, the carriage driver 76264, and the anvil driver 76240 are configured to rotate in response to rotational movement produced by the same motor of the clip applier 76200 or different motors of the clip applier 76200 in order to perform a particular distal head function. The motor of the clip applier 76200 also includes a motor controller configured to control the jaw cam driver 76250, the cartridge driver 76202, the carriage driver 76264, and the anvil driver 76240. The jaw cam driver 76250, the cartridge driver 76202, the carriage driver 76264, and the anvil driver 76240 may be actuated by a motor controller to synchronize and/or interrupt one or more of the drivers in order to perform a more distal head function than a dedicated driver.

FIG. 122 depicts a clip applier 76300, according to at least one embodiment. The clip applier 76300 includes an outer tube 76305 extending from the housing, a clip cartridge 76307 attachable to the outer tube 76305, and an end effector 76309. The outer tube 76305 includes a proximal tube segment 76380, an articulation tube segment 76350 extending from the proximal tube segment 76380, and a distal tube segment 76340 extending from the articulation tube segment 76350. The end effector 76309 includes a first jaw 76310 that is movable between an open position and a closed position relative to a second jaw 76320. The second jaw 76320 extends from the distal tube segment 73640, and the first jaw 76310 is rotatable relative to the second jaw about a pivot pin 76315. The first jaw 76310 is actuatable between an open position and a closed position via a jaw driver 76360 that is configured to rotate relative to the outer tube 76305 in response to rotational movement generated within a housing of the clip applier 76300. Other embodiments are contemplated in which both the first jaw 76310 and the second jaw 76320 are rotatable, e.g., relative to each other, between an open position and a closed position.

Further to the above, clip magazine 76307 includes a plurality of clips removably stored therein. Each of the clips can be translated into the end effector 76309 by a clip advancer of the clip applier 76300 that is operably responsive to the clip driver 76370. Clip driver 76370 is configured to rotate relative to outer tube 76305 in response to rotational movement generated by a motor within the housing of clip applier 76300. The clamp driver 76370 is received within an opening in the jaw driver 76360 such that the clamp driver 76370 and the jaw driver 76360 are coaxial. In other words, the clamp driver 76370 and the jaw driver 76360 comprise nested rotational drive trains. Additionally, the clip driver 76370 and the jaw driver 76360 can each be operated independently of one another via the motor of the clip applier 76300. The articulation tube portion 76350, the jaw driver 76360, and the clamp driver 76370 are configured to articulate in bending and/or flexing with the outer tube 76305. The jaw driver 76360 and the clamp driver 76370 can be constructed of a double-woven cable that provides torsional force regardless of the direction in which the jaw driver 76360 and the clamp driver 76370 are rotated. In various circumstances, the jaw driver 76360 and the clamp driver 76370 can provide, for example, equal torque regardless of the direction in which they are rotated.

Fig. 123 depicts a clip applier 76300' according to at least one embodiment. Clip applier 76300' is similar in many respects to clip applier 76300. For example, the clip applier 76300 ' includes a jaw driver 76360' and a clip driver 76370', which perform the same end effector functions as the jaw driver 76360' and the clip driver 76370', respectively. However, the jaw driver 76360 'and the clamp driver 76370' can be constructed of wire tubing that provides different torsional forces depending, for example, on the direction in which the jaw driver 76360 'and the clamp driver 76370' are rotated. Other embodiments are contemplated wherein the jaw drivers 76360 and 76360 'and/or the clamp drivers 76370 and 76370' are comprised of a double-woven cable and/or wire tubing and combinations thereof. In other words, the configuration of the tube or shaft (e.g., the jaw drivers 76360, 76360 'or the clamp drivers 76370, 76370') can be selected based on, for example, the amount of torque required to perform a particular end effector function, such as feeding a clamp or crimping a clamp. Notably, a dual weave cable may be more compatible with higher loads in both directions, and a wire tube (i.e., such as a coil spring) may be better suited to transmit torsional loads in one direction than in the other. More specifically, the wire tube is wound in a specific direction; thus, rotating the wire tube in the direction of the windings requires less force than rotating the wire tube in the opposite direction to the windings. Additionally, the dual weave cable may include windings woven together in opposite directions; thus, for example, if the windings are balanced, the same amount of force would be required to rotate the bi-woven cable in either direction.

Figure 124 depicts a rotational input 76400 according to at least one embodiment. The rotational input 76400 can be used to drive the distal head function of any of the clip appliers discussed herein. The rotary input 76400 includes an outer hollow tube 76410 and an inner hollow tube 76420 that rotate together. The inner hollow tube 76420 is housed within the outer hollow tube 76410. The outer hollow tube 76410 includes a plurality of coil springs 76412 wound in a first direction. The inner hollow tube 76420 includes a plurality of coil springs 76422 wound in a second direction opposite the first direction. The plurality of coil springs 76412 interlock with the plurality of coil springs 76422. More specifically, each of the coil springs 76422 in the inner hollow tube 76420 flank the pair of coil springs 76412 of the outer hollow tube 76410 such that each of the coil springs in the inner hollow tube 76420 is intermediate the pair of coil springs 76412 of the outer hollow tube 76410 such that torque is transmitted therebetween.

In at least one alternative embodiment, the clip applier can include a rotary input comprising a solid-walled tube that is laser cut to create an interlocking pattern. The interlocking pattern provides a preferred direction of rotation for the rotational input. In addition, such a rotational input is relatively flexible to facilitate articulation of the end effector about the articulation joint, as described in further detail in U.S. patent application 13/536,232 filed 6-28 2012, which is incorporated by reference in its entirety.

Fig. 125 depicts a clip applier 77000 according to at least one embodiment. The clip applier 77000 includes a shaft 77010 extending from the housing, an end effector 77050 (see fig. 141A) extending from the shaft 77010, a clip magazine 77020, and a clip pusher 77030. The clip magazine 77020 and clip pusher 77030 are contained within the shaft 77010. The clamp magazine 77020 is configured to translate and rotate relative to the shaft 77010 in response to translational motion transmitted from the housing. While the clamp advancer 77030 is translatably coupled to the clamp magazine 77020, the clamp advancer 77030 is configured to translate relative to the shaft 77010 as the clamp magazine 77020 translates. The clamp magazine 77020 is configured to store a plurality of clamps 77004 in a plurality of clamp slots 77022 positioned radially around the clamp magazine 77020. Each clamp slot 77022 includes a clamp spring 77025 configured to bias a clamp 77004 out of the clamp magazine 77020.

The clip advancer 77030 includes a slot 77036, a proximal feeder spring 77032, and a distal feeder spring 77034. As described below, the proximal and distal feeder springs 77032, 77034 advance and hold the clips in place as they are advanced into the end effector 77050. The shaft 77010 includes a retaining spring 77018 that extends into a loading slot 77015 of the shaft 77010. The loading slot 77015 is configured to temporarily store a clip 77004 before it is advanced into the end effector 77050 of the clip applier 77000. The shaft 77010 includes a channel 77012 that includes a translating portion 77014 and a rotating portion 77016. The clamp magazine 77020 includes a pin 77024 configured to ride within the groove 77012 in order to translate and rotate the clamp magazine 77020, as described in more detail below.

When the clip magazine 77020 is in the proximal position, referring again to fig. 125, the pin 77024 of the clip magazine 77020 is located in the proximal portion of the translating portion 77014 of the channel 77012. As the clamp magazine 77020 translates distally to a distal position, as shown in fig. 126, the clamp magazine 77020 and the clamp advancer 77030 translate distally together and the pin 77024 rides within the translating portion 77014 of the groove 77012. As the clamp magazine 77020 translates to the distal position (fig. 126), the clamp slot 77022 of the clamp magazine 77020 will align with the loading slot 77015 of the shaft 77010, and the clamp spring 77025 will bias the clamp 77004 into the loading slot 77015, as shown in fig. 126. When the clip magazine 77020 is retracted from the distal position toward the proximal position, as shown in fig. 127, the pin 77024 of the clip magazine 77020 is configured to ride within the rotating portion 77016 of the channel 77012 to rotate the clip magazine 77020 relative to the shaft 77010 and retract the clip magazine 77020 to the proximal position. As the clamp magazine 77020 rotates and translates proximally, the clamp 77004 in the loading slot 77015 remains in the loading slot 77015 as shown in fig. 128. At this point, the clamp 77004 can be advanced into the end effector 77050.

As the clip magazine 77020 and clip advancer 77030 translate distally from a proximal position to a distal position, the proximal feeder spring 77032 will engage the clips 77004 in the loading slot 77015 and translate the clips 77004 distally into the staging position 77017 within the shaft 77010 of the clip applier 77000, as shown in fig. 129-131. As the proximal feeder spring 77032 pushes the clamp 77004 distally, see fig. 132, the clamp 77004 engages the securement spring 77018, which biases the clamp 77004 from the loading slot 77015 into the staging position 77017. As the clip advancer 77030 and clip magazine 77020 retract, the clip 77004 will remain in the staging position 77017 as shown in fig. 133. Staging position 77017 includes a slot, or any suitable means of holding clamp 77004.

Referring now to fig. 134-136, after clip 77004 is positioned in staging position 77017, clip magazine 77020 can again be translated to a distal position to advance clip 77004 into clip track 77052 (see fig. 141A). More specifically, as the clip magazine 77020 moves toward the distal position, the distal feeder spring 77034 of the clip advancer 77030 will engage the clip 77004 and advance the clip 77004 from the staging position 77017 (see fig. 134) into the clip track 77052 (see fig. 136).

As described above, the clip magazine 77020 is configured to hold a plurality of clips 77004. However, only one clamp 77004 is shown in fig. 125-136 to illustrate how the clamp 77004 is advanced by clamp advancers 77030 and clamp magazines 77020. Referring primarily to fig. 137, with each retraction of the clip magazine 77020 from the distal position to the proximal position, the clip magazine 77020 will rotate, as described above. Thus, when the clamp 77004 is advanced into the loading slot 77015 and the clamp advancer 77030 and clamp magazine 77020 are retracted, the clamp magazine 77020 will rotate relative to the clamp advancer 77030 to align the second clamp 77005 with the slot 77036 of the clamp advancer 77030. Thereafter, the clip advancer 77030 advances a second clip 77005 into the loading slot 77015, while the proximal feeder spring 77032 advances the clip 77004 into the staging position 77017 as described above. The clip advancer 77030 and clip magazine 77020 can then be retracted again, leaving the clip 77004 in the staging position 77017 and the second clip 77005 in the loading slot 77015. When the clip magazine 77020 is retracted again, it will rotate again and, as a result, the third clip 77006 can be aligned with the slot 77036 of the clip advancer 77030. Then, as the clip magazine 77020 is moved toward the distal position, the clip advancer 77030 can advance the third clip 77006 toward the loading slot 77015.

Referring now to fig. 138, as the third clip 77006 is advanced into the loading slot 77015, the proximal feeder spring 77032 of the clip advancer 77030 will advance the second clip 77005 from the loading slot 77015 into the staging position 77017. In addition, the clip 77004 positioned in the staging position 77017 will be advanced into the clip track 77052 by the distal feeder spring 77034. Referring now to fig. 139, when the clip magazine 77020 is subsequently retracted to the proximal position, it will rotate the fourth clip 77007 and align it with the slot 77036 of the clip advancer 77030. Then, the fourth clamp 77007 may be advanced into the loading slot 77015 while the third clamp 77006 in the loading slot 77015 is advanced into the staging position 77017 (see fig. 140). Additionally, as the fourth clamp 77007 is advanced toward the loading slot 77015, the clamps 77004, 77005 are advanced distally by the distal feeder spring 77034 (see fig. 140). More specifically, the distal feeder spring 77034 engages the second clip 77005 and advances the second clip 77005 from the staging position 77017 into the clip track 77052. The second clamp 77005 engages the back side of the clamp 77004 so that the second clamp 77005 advances the clamp 77004.

As further described above, the clip magazines 77020 can be retracted to rotate the clip magazines again, which will align the fifth clip 77008 (see fig. 141A) with the slot 77036 of the clip pusher 77030. The fifth clamp 77008 may then be advanced into the loading slot 77015, while the fourth clamp 77007 is advanced into the staging position 77017 and the third clamp 77006 is advanced into the clamp rail 77052. The third clamp 77006 engages the back side of the second clamp 77005 and thus advances the second clamp 77005 and the first clamp 77004 through the clamp rail 77052. The strokes of the clip pusher 77030 and clip magazine 77020 cause the clips to be advanced one clip length at a time through the clip track 77052. Other embodiments having different stroke of the clamp pusher 77030 and clamp magazine 77020 are contemplated, among other things. Additional operations of clip applier 77000 are discussed in more detail below.

141A-141C, the clip applier 77000 further includes a jaw cam 77060 configured to actuate the end effector 77050. The end effector 77050 includes first and second jaws 77054, 77056 that at least partially define a receiving chamber 77055 therein and are movable relative to one another between an open position and a closed position. The end effector 77050 also includes a proximal portion 77058 that extends proximally from the first and second jaws 77054, 77056. The proximal portion 77058 is attached to the shaft 77010 via a laterally extending pin secured within the distal end of the shaft 77010 such that the end effector 77050 is mounted to the shaft 77010. The jaw cam 77060 is configured to translate along a proximal portion 77058 of the end effector 77050 between a proximal position (see fig. 141A) and a distal position (see fig. 141C). The jaw cam 77060 is threadably engaged with the rotary input such that rotation of the rotary input will translate the jaw cam 77060. The rotary input is operable in response to rotary motion generated within the housing of the clip applier 77000. The jaw cam 77060 is rotatably constrained by a proximal portion 77058 of the end effector 77050 such that when the rotary input is rotated, the jaw cam 77060 translates. The first jaw 77054 and the second jaw 77056 remain in an open position as the jaw cam 77060 moves between the proximal position and the distal position; however, jaw cam 77060 is movable beyond the distal position to cammingly engage first jaw 77054 and second jaw 77056 to move first jaw 77054 and second jaw 77056 toward the closed position, as described in more detail below.

Jaw cam 77060 is slidably coupled to a feeder shoe 77062 extending distally from jaw cam 77060. The jaw cam 77060 and feeder shoe 77062 are configured to advance a clip from the clip track 77052 (if a clip is present in the clip track) into the receiving chamber 77055 of the end effector 77050. The jaw cam 77060 includes a pin 77065 (see fig. 142) that extends into a slot 77064 of the feeder shoe 77062. The feeder shoe 77062 further includes a biasing member (e.g., a spring 77061) extending proximally from, for example, the distal end of the slot 77064, which engages the pin 77065 of the jaw cam 77060 such that the feeder shoe 77062 is biased distally by the spring 77061. In other words, the spring 77061 acts to keep the pin 77065 positioned in the proximal end of the slot 77064.

Further to the above, the feeder shoe 77062 advances a clip (if present in clip track 77052) into the receiving chamber 77055 of the end effector 77050 as the jaw cam 77060 moves from the proximal position to the distal position. More specifically, as jaw cam 77060 translates distally, the distal end of feeder shoe 77062 engages the back side of a clip in clip track 77052 to advance the clip (see fig. 143). The biasing force of the spring 77061 is not overcome by translating the clip into the end effector 77050; thus, as jaw cam 77060 translates to a distal position, feeder shoe 77062 moves with jaw cam 77060. When the jaw cam 77060 moves to the distal position, the feeder shoe 77062 is stopped from being further advanced by a distal stop 77057 protruding from the clip track 77052. More specifically, the feeder shoe 77062 includes a protrusion 77063 extending toward the clamp rail 77052 that engages the distal stop 77057 to prevent further distal translation of the feeder shoe 77062. The jaw cam 77060 can then be further translated beyond the distal position to cammingly engage the first jaw 77054 and the second jaw 77056 of the end effector 77050 to crimp a clip positioned in the receiving chamber 77055. In other words, when jaw cam 77060 translates beyond the distal position, feeder shoe 77062 will not translate with jaw cam 77060. As the rotational input continues to drive the jaw cam 77060 distally, the biasing force of the spring 77061 is overcome and the pin 77065 of the jaw cam 77060 will translate distally through the slot 77064 of the feeder shoe 77062 because the feeder shoe 77062 is prevented from translating distally via the distal stop 77057. In such instances, the spring 77061 is compressed to allow the jaw cam 77060 to translate distally without further advancing the feeder shoe 77062.

Further to the above, as the jaw cam 77060 is retracted from the over-distal position to the distal position, the spring 77061 will bias the feeder shoe 77062 proximally such that the pin 77065 is again positioned in the proximal end of the slot 77064. Additionally, the first jaw 77054 and the second jaw 77056 will move from the closed position to the open position to release the crimped clip from the end effector 77050. As the jaw cam 77060 retracts from the distal position to the proximal position due to the biasing force of the spring 77061, the pin 77065 will remain in the proximal end of the slot 77064, as described above. Thus, jaw cam 77060 and feeder shoe 77062 can retract together to position feeder shoe 77062 behind another clamp in clamp track 77052. More specifically, the distal end of the feeder shoe 77062 includes an angled portion 77067 that allows the feeder shoe 77062 to slide upward and over the next clip positioned in the clip track 77052. In addition, the clamp rail 77052 includes a proximal stop 77053 at its proximal end that prevents further proximal translation of the feeder shoe 77062, i.e., via the protrusions 77063 on the feeder shoe 77062. The proximal stop 77053 ensures that the distal end of the feeder shoe 77062 is aligned with the back side of the next clamp in the clamp rail 77052.

The clip advancer 77030 and the jaw cam 77060 can be independently sequenced, i.e., intermittently actuated by the motor, to move the first jaw 77054 and the second jaw 77056 between the open position and the closed position without advancing a clip into the end effector 77050. In such cases, the clip advancer 77030 can be prevented from being actuated when the jaw cam 77060 is actuated. Thus, the jaw cam 77060 can open and/or close the first jaw 77054 and the second jaw 77056 without a clip positioned between the first jaw 77054 and the second jaw 77056 until the clip advancer 77030 has been actuated. In at least one instance, the jaw cam 77060 can be configured to open and/or close the first jaw 77054 and the second jaw 77056 a predetermined number of times before the clip advancer 77030 is actuated to feed clips. In some instances, after advancing a clip (or clips) into the end effector 77050 for crimping between the first jaw 77054 and the second jaw 77056, the sequence between the jaw cam 77060 and the clip advancer 77030 can be interrupted so as not to advance another clip into the clip track 77052. Jaw cam 77060 and feeder shoe 77062 can advance and crimp one or more clips held in clip track 77052 until clip track 77052 is empty. With clip track 77052 empty, jaw cam 77060 can be moved between the proximal and distal positions as needed without feeder shoe 77062 engaging a clip. The clamp advancer 77030 may then be actuated again to advance more clamps into the clamp track 77052 to engage the feeder shoe 77062. In other words, the clip applier 77000 can intermittently advance clips into the end effector 77050 such that the first and second jaws 77054, 77056 can be actuated with or without clips present, even after clips have been advanced and crimped.

144A-144C depict a clip applier 77000' according to at least one embodiment. The clip applier 77000' is similar in many respects to the clip applier 77000. More specifically, the clip applier 77000 'includes a jaw cam 77060' configured to move the first jaw 77054 and the second jaw 77056 of the end effector 77050 between the open position and the closed position, as described above. The jaw cam 77060 'includes a body portion 77062' configured to threadably engage a rotary input 77070 ', which is operatively responsive to rotary motion generated within the housing of the clip applier 77000'. As the rotary input 77070 'rotates, the jaw cam 77060' will translate to move the first jaw 77054 and the second jaw 77056 between the open position and the closed position.

Further to the above, the body portion 77062 'includes a protrusion 77066' extending laterally therefrom. The protrusion 77066 ' is configured to extend into a proximal opening 77069 ' of the clip advancer 77064 ' to releasably engage the body portion 77062 ' with the clip advancer 77064 '. Other embodiments are contemplated in which the clamp pusher 77064 'and the body portion 77062' can be releasably attached with, for example, a spring clamp or any other suitable device. In any case, the clamp pusher 77064 'includes a feeder shoe 77067' extending distally therefrom. The feeder shoe 77067 'is configured to advance a clip (e.g., one of clips 77004, 77005, 77006, 77007, 77008) from the clip track 77052 into the receiving chamber 77055 of the end effector 77050 as the body portion 77062' is moved from the proximal position (fig. 144A) to the distal position (fig. 144B). During translation of the body portion 77062' between the proximal and distal positions, the first and second jaws 77054, 77056 are not approximated (i.e., they remain open).

Further to the above, the body portion 77062 'can be advanced beyond the distal position (fig. 144B) to the closed position (see fig. 144C) in response to further rotation of the rotational input 77070'. As the body portion 77062' moves toward the closed position, it will cammingly engage the outer surfaces of the first and second jaws 77054, 77056 to move the first and second jaws 77054, 77056 toward the closed position. Once the clip 77004 has been advanced into the receiving chamber 77055, a distal end of the feeder shoe 77067 ' of the clip advancer 77064 ' abuts against the clip 77004, and the clip 77004 abuts against the distal stop 77059, thereby preventing further distal advancement of the clip advancer 77064 '. A distal stop 77059 is positioned at the distal end of both the first jaw 77054 and the second jaw 77056 and prevents the clip 77004 from translating distally out of the end effector 77050. Thus, as the body portion 77062 ' of the jaw cam 77060 ' is advanced beyond the distal position (fig. 144B) to the closed position (fig. 144C), the protrusion 77066 ' of the body portion 77062 ' moves from the proximal opening 77069 ' of the clip advancer 77064 ' into the distal opening 77068 ' of the clip advancer 77064 ' because the clip advancer 77064 ' is no longer able to translate distally, as described above. In other words, as the body portion 77062 'is advanced from the distal position (fig. 144B) toward the closed position (fig. 144C), the retention force between the proximal opening 77069' and the protrusion 77066 'is overcome by the body portion 77062'. Thus, the body portion 77062 'and the clip advancer 77064' may be translated together to advance a clip into the end effector 77050, and then the body portion 77062 'may be further advanced distally to move the first and second jaws 77054, 77056 into a closed position without further advancing the clip advancer 77064'.

145-150 depict a clip applier 77100 according to at least one embodiment. The clip applier 77100 includes a shaft 77120, a clip magazine 77110, a clip pusher 77130, and a feeder shoe 77140. The shaft 77120 extends from the housing of the clip applier 77100 and defines a shaft axis SA. The clip magazine 77110 is configured to translate relative to the shaft 77120 between a proximal position (see fig. 146 and 150) and a distal position (see fig. 148) in response to a rotational output of a motor within the housing of the clip applier 77100. Similar to the above, the clip magazine 77110 is also configured to be able to store multiple clips 77104 in multiple clip storage locations 77112. The clip pocket 77110 also includes a boss 77114 extending from a distal end thereof. The clip advancer 77130 is rotatably mounted on the boss 77114 of the clip magazine 77110 so that the clip advancer 77130 can rotate relative to the clip magazine 77110 and can translate with the clip magazine 77110. Clip pusher 77130 is configured to translate clip 77104 through clip track 77106 in response to translation of clip pocket 77110, as described in more detail below.

The shaft 77120 of the clip applier 77100 includes an annular groove 77124 on the inner diameter 77122 of the shaft 77120. The annular groove 77124 is configured to slidably receive the protrusion 77138 extending from the cam member 77132 of the clip pusher 77130. An annular groove 77124 is defined in the inner diameter 77122 of the shaft 77120 to provide a helical path of travel for the projection 77138 of the cam member 77132. The helical travel path of the annular groove 77124 is in a first direction. The cam member 77132 extends laterally from the body portion 77131 of the clip pusher 77130 relative to the shaft axis SA. The cam member 77132 includes an annular slot 77134 that is configured to slidably receive a protrusion 77141 extending from the proximal end of the feeder shoe 77140. An annular slot 77134 is formed in the cam member 77132 to provide a helical travel path for the protrusion 77141 extending from the feeder shoe 77140. The helical travel path of the annular groove 77124 of the shaft 77120 and the helical travel path of the annular slot 77134 of the cam member 77132 are in opposite directions.

The clip pusher also includes a groove 77136 between the cam member 77132 and the body portion 77131. The groove 77136 provides clearance for the feeder shoe 77140 to translate relative to the clamp pusher 77130. More specifically, when the projection 77141 of the feeder shoe 77140 is captured in the annular slot 77134 of the cam member 77132, the feeder shoe 77140 is positioned within the groove 77136.

Further to the above, the feeder shoe 77140 includes a dovetail portion 77144 extending from a distal end of the feeder shoe 77140. The dovetail portion 77144 is captured in a longitudinal groove 77126 defined in the inner diameter 77122 of the shaft 77120. The longitudinal groove 77123 includes a complementary shape to the dovetail portion 77144 so that the dovetail portion 77144 is retained within and slidable along the longitudinal groove 77123. The feeder shoe 77140 also includes a clip feeder 77146 extending downward from its proximal end. The clip feeder 77146 is configured to feed clips 77104 through the clip track 77106 of the clip applier 77100 as the clip cartridge 77110 translates distally, as discussed in more detail below.

See again fig. 146-150. When the clamp pocket 77110 is atIn translation between its proximal position and its distal position, the projection 77138 extending from the cam member 77132 is configured to travel through the annular groove 77124 of the shaft 77120, and the projection 77141 of the feeder shoe 77140 is configured to travel through the annular slot 77134 of the cam member 77132. Referring primarily to fig. 146, the clip magazine 77110 is in a proximal position and the clips 77104 are abutted against the clip feeder 77146 of the feeder shoe 77140. As the clip magazine 77110 translates distally (see fig. 147), the clip advancer 77130 will rotate as the projections 77138 are constrained within the annular groove 77124 of the shaft 77120. As described above, the feeder shoe 77140 is constrained to move longitudinally by the longitudinal groove 77126 and the dovetail portion 77144 of the feeder shoe 77140. Thus, as the clip advancer 77130 is rotated, the clip advancer 77130 will translate the feeder shoe 77140 distally as a result of the side walls of the annular slot 77134 engaging the projections 77141 of the feeder shoe 77140 as the annular slot 77134 rotates. As the feeder shoe 77140 translates distally, the feeder shoe 77140 will translate the clip 77104 distally via the clip feeder 77146. In addition, as the gripper magazine moves from the proximal position to the distal position, it moves through a stroke length SL₁And the feeder shoe 77140 moves through the stroke length SL₂(see fig. 151A and 151B). The stroke length SL of the feeder shoe 77140₂Is the stroke length SL of the gripper stock 77110₁Twice as much. Other embodiments are contemplated wherein the stroke length SL₂For example specific stroke length SL₁Twice as large or as small. In various instances, the pitch of annular groove 77124 and annular slot 77134 may be configured to modify, for example, stroke length SL₁And SL₂。

Further to the above, as the clip magazine 77110 translates into the distal position (fig. 148), the above-described rotation of the clip advancer 77130 will continue until the protrusion 77138 of the clip advancer 77130 reaches the end of the annular groove 77124, thereby preventing further rotation of the clip advancer 77130. In addition, distal translation of the feeder shoe 77140 will continue until the protrusion 77141 reaches the end of the annular slot 77134 of the clip advancer 77130, thereby preventing further distal translation of the feeder shoe 77140. Accordingly, the clip magazine 77110 can be translated proximally toward a proximal position (see fig. 149) to partially retract the feeder shoe 77140. Further proximal translation of the clip magazine 77110 to a proximal position (see fig. 150) will fully retract the feeder shoe 77140.

Fig. 152 and 153 depict a clip applier 77200 according to at least one embodiment. The clip applier 77200 includes a shaft 77220 extending from a housing of the clip applier 77200, a clip magazine 77210 extending from the shaft 77220, a clip pusher 77230 extending from the clip magazine 77210, a firing drive 77250, and an end effector 77240. Clamp magazine 77210 defines a magazine axis MA. The clip magazine 77210 is configured to be rotatable about a magazine axis MA. The firing drive 77250 is also aligned with the cartridge axis MA and is rotatable about the cartridge axis MA in response to rotational movement generated by a motor within the housing of the clip applier 77200. The clip magazine 77210 includes clip holders 77212 positioned about 120 degrees apart circumferentially about the magazine axis MA. The clip holder 77212 is configured to store a plurality of clips for gripping tissue. Each of the clip holders 77212 is configured to align with the clip track 77232 of the clip advancer 77230 as the clip magazine 77210 is rotated about the magazine axis MA between the plurality of ejection positions. For example, one of the ejection positions is shown in fig. 153, i.e., the clamp holder 77212 is aligned with the clamp rail 77232. When the clip magazine 77210 is in the eject position, the clip magazine 77210 is configured to bias clips from the clip magazine 77210 into the clip track 77232. Once the clamp is positioned in the clamp track 77232, it can be advanced into the end effector 77240 by the feeder shoe 77270. The feeder shoe 77270 can translate relative to the shaft 77220 through the clip track 77232 in response to rotational movement generated within the housing of the clip applier 77200.

Further to the above, the end effector 77240 includes a proximal portion 77245 that is configured to extend through a first opening 77234 in the clip advancer 77230 and a second opening 77216 in the clip magazine 77210. The proximal portion 77245 includes a first arm 77246 and a second arm 77248 that extend through a first opening 77234 in the clip advancer 77230 and a second opening 77216 in the clip magazine 77210. The end effector 77240 also includes a proximal anchor 77249 that extends through a first opening 77234 in the clip advancer 77230 and through the slot 77214 of the clip magazine 77210. Slots 77214 are disposed radially about cartridge axis MA within clip cartridge 77210 at about 120 degrees spacing. The slot 77214 extends away from the second opening 77216 to provide clearance for a proximal anchor 77249 of the end effector 77240. Additionally, the first and second arms 77246, 77248 are chamfered to provide clearance for the firing drive 77250.

Further to the above, the end effector 77240 also includes a first jaw 77242 extending distally from the first arm 77246 of the proximal portion 77245, and a second jaw 77244 extending distally from the second arm 77248 of the proximal portion 77245. The first and second arms 77246, 77248 of the proximal portion 77245 are coupled together via a collar 77260. The first and second arms 77246, 77248 extend away from each other at least partially due to their connection via the proximal anchor 77249. The collar 77260 can be advanced from a proximal position to a distal position to move the first and second arms 77246, 77248 together or toward each other. In such instances, the first jaw 77242 and the second jaw 77244 can move between an open position (as shown in fig. 152) and a closed position in response to distal movement of the collar 77260. In addition, the first and second jaws 77242, 77244 extend downward from the central plane CP (see fig. 155) of the proximal portion 77245 such that the firing drive 77250, the first and second arms 77246, 77248 of the proximal portion 77245, and the first and second jaws 77242, 77244 are positioned on different planes of the clip applier 77200. The first jaw 77242 and the second jaw 77244 at least partially define a receiving chamber 77241 configured to receive a clip from the clip magazine 77210.

The above arrangement allows clips to be fed into the jaws of the end effector 77240 along a plane that is offset from the cassette axis MA. The jaws of the end effector are angled toward the cartridge axis MA at their distal ends, as shown in fig. 152, to allow a clip positioned therein to be crimped in a plane that is closer to the cartridge axis MA than the plane through which the clip is fed into the end effector 77240. This allows a different input other than a feeder shoe, such as the firing drive 77250, to extend through the clip magazine 77210 while crimping the clips in a plane that is coincident or nearly coincident with the magazine axis MA.

Fig. 156 and 157 depict a clip applier 77300, according to at least one embodiment. The clip applier includes an elongate tube 77320 extending from a housing of the clip applier 77300, a clip cartridge 77310 housed within the elongate tube 77320, and an end effector 77340. The clamp magazine 77310 includes a central opening 77316 that defines a magazine axis MA. The clamp cassette 77310 is configured to translate along and rotate about the cassette axis MA. The clamp magazine 77310 also includes clamp slots 77312 radially disposed about 120 degrees apart about the magazine axis MA. The clamp slot 77312 is configured to store a plurality of clamps that are biased out of the clamp magazine 77310. The clips can be biased out of the clip magazine 77310 by any suitable biasing member, including, for example, the biasing members described herein. The elongated tube 77320 also includes an opening 77322 that provides clearance for clips from the clip cartridge 77310 to bias from the clip cartridge 77310 onto the clip track when one of the clip slots 77312 is aligned with the opening 77322. The clamp may be advanced by the feeder shoe through the clamp track into the end effector, as described herein.

Referring now primarily to fig. 156, the end effector 77340 includes a first jaw 77342, a second jaw 77344, and a proximal portion 77345 extending proximally from the first jaw 77342 and the second jaw 77344. The first jaw 77342 and the second jaw 77344 at least partially define a receiver 77341 configured to receive a clip from the clip track as the clip is advanced by the feeder shoe, as described above. The proximal portion 77345 is configured to attach the end effector 77340 to the elongate tube 77320. The proximal portion 77345 includes a first support 77346 extending proximally from the first jaw 77342 and the second jaw 77344. The first support 77346 is located below the cartridge axis MA, as discussed in more detail below.

The proximal portion 77345 also includes a second support 77348 located between the cartridge axis MA and the first support 77346. Other embodiments are contemplated in which the second support 77348 is located, for example, at and/or above the cartridge axis MA. In any case, the proximal portion 77345 includes a U-shaped portion connecting the first support 77346 and the second support 77348 at their proximal ends. The elongate tube 77320 also includes a lateral rod 77324 positioned at a distal end of the elongate tube 77320 and spanning the inner diameter 77326 of the elongate tube 77320. The U-shaped portion 77347 is configured to receive the lateral rod 77324 to connect the proximal portion 77345 of the end effector 77340 to the elongate tube 77320.

Further to the above, and with reference to fig. 158 and 159, the clip applier 77300 further includes a collar 77360 mounted about the first support 77346 of the proximal portion 77345 of the end effector 77340. After the proximal portion 77345 of the end effector 77340 is attached to the elongate tube 77320, a collar 77360 is formed around the first support 77346, as described above. More specifically, the collar 77360 includes a first bendable side 77364 and a second bendable side 77365. The first bendable side 77364 includes a groove 77366 and the second bendable side 77365 includes a protrusion 77367. The first and second bendable sides 77364 and 77365 bend around the first support 77346 and attach together under the first support 77346. More specifically, the protrusion 77367 engages the groove 77366 to slidably secure the collar 77360 to the proximal portion 77345 of the end effector 77340. In at least one alternative embodiment, the assembled collar 77360 is attached to the end effector 77340 prior to attaching the end effector 77340 to the elongate tube 77320. More specifically, collar 77360, after being assembled in the manner described above, slides onto proximal portion 77345 of end effector 77340 before second support 77348 bends relative to first support 77346. Once the collar 77360 is attached to the proximal portion 77345, the second support 77348 can be bent relative to the first support 77346 to form a U-shaped portion 77347. The end effector 77340 is then attached to the elongate tube 77320 in the manner described above. The operation of collar 77360 is discussed in more detail below.

The collar 77360 is configured to cammingly engage the first jaw 77342 and the second jaw 77344 as the collar 77360 moves from a proximal position to a distal position. In such instances, the first jaw 77342 and the second jaw 77344 can move relative to one another between an open position and a closed position as the collar 77360 moves from a proximal position to a distal position. Collar 77360 includes a projection 77362 extending toward the cartridge axis MA. The projection 77362 includes a threaded hole 77343 that is threadedly engaged with the gasket driver (see fig. 158). The collar driver is configured to move the collar 77360 between the proximal and distal positions in response to rotational movement generated within the housing of the clip applier 77300. The projection 77362 extends within an opening 77349 in the second support member 77348. In fact, the opening 77349 extends into the U-shaped portion 77347 to provide clearance for the gasket driver to extend proximally through the central opening 77316 of the clamp cassette 77310. This arrangement allows the clip magazine 77310 to rotate about the magazine axis MA while the collar 77360 translates along an axis parallel to but offset from the magazine axis MA. As shown in fig. 157, the jaws of the end effector 77340 are angled toward the cartridge axis MA at their distal ends to allow clips positioned therein to be crimped in a plane that is closer to the cartridge axis MA than the plane through which the clips are fed into the end effector 77340. This allows a different input (such as a liner driver) other than the feeder shoe to extend through the clamp magazine 77310 while still allowing the clamps to be crimped in a plane that is coincident or substantially coincident with the magazine axis MA.

Referring now to fig. 160, an alternative end effector 77340' for use with a clip applier 77300 is depicted. The end effector 77340' is similar in many respects to the end effector 77340. The end effector 77340' includes a first protrusion 77342a extending from the first jaw 77342 and a second protrusion 77344b extending from the second jaw 77344. The first and second protrusions 77342a, 77344b are angled relative to each other such that their proximal ends are closer together than their distal ends. The end effector 77340' is configured to be used with a cam member 77370 that includes a first slot 77372 oriented transversely with respect to the first protrusion 77342a and a second slot 77374 oriented transversely with respect to the second protrusion 77344 b. The cam member 77370 is movable between a proximal position and a distal position by a cam member driver in response to rotational movement generated within a housing of the clip applier 77300. More specifically, the cam member driver is threadably engaged with the cam member 77370 via a threaded aperture 77376 defined in the cam member 77370 such that as the cam member driver rotates, the cam member 77370 translates. As the cam member 77370 moves from the proximal position to the distal position, the side walls of the first slot 77372 and the second slot 77374 will engage the protrusions 77342a, 77344 b. Because the projections 77342a, 77344b are angled relative to the slots 77372, 77374, as the cam member 77370 is moved from the proximal position to the distal position, the cam member 77370 will bias the first jaw 77342 and the second jaw 77344 toward the closed position. Additionally, as cam member 77370 is moved from the distal position to the proximal position, cam member 77370 will bias first jaw 77342 and second jaw 77344 toward the open position.

Fig. 161 and 162 depict a clip applier 77400 according to at least one embodiment. Clip applier 77400 can include, for example, a clip applier head or end effector 77420 extending from a shaft. The end effector 77420 includes a top portion 77422, a bottom portion 77424, and an intermediate portion 77426 connecting the top portion 77422 and the bottom portion 77424. Top portion 77422 and bottom portion 77424 lie in two different parallel or at least substantially parallel planes. The bottom portion 77424 includes a pair of opposed jaws 77421 extending distally therefrom. The pair of opposing jaws 77421 at least partially define a receiving chamber 77428 therein. The opposing jaw 77421 is movable between an open position and a closed position via a cam member 77440 that is slidably attached to the bottom portion 77424 of the end effector 77420. Cam member 77440 is rotatably constrained by base portion 77424 and is in threaded engagement with drive screw 77430. Drive screw 77430 includes a distal threaded portion 77434, a proximal threaded portion 77432, and an intermediate portion 77436 connecting distal threaded portion 77434 and proximal threaded portion 77432.

Further to the above, intermediate portion 77436 of drive screw 77430 is rotatably supported by, but not threadedly engaged with, an opening in intermediate portion 77426 of end effector 77420. Distal threaded portion 77434 is threadably engaged with cam member 77440 such that rotation of drive screw 77430 in a first direction will translate cam member 77440 distally. Additionally, proximal threaded portion 77432 is threadably engaged with feeder shoe 77450 such that rotation of drive screw 77430 in a first direction will translate feeder shoe 77450 proximally. In other words, the distal threaded portion 77434 and the proximal threaded portion 77432 are threaded in opposite directions. In addition, the distal threaded portion 77434 has a smaller pitch than the proximal threaded portion 77432. Thus, for a given rotation of drive screw 77430, cam member 77440 will translate less than, for example, feeder shoe 77450. As drive screw 77430 is rotated in a first direction, cam member 77440 will translate from a proximal position (see fig. 161) to a distal position (see fig. 162), and feeder shoe 77450 will translate from a distal position (see fig. 161) to a proximal position (see fig. 162). As cam member 77440 moves toward the distal position, it will cammingly engage the pair of opposing jaws 77421 and move jaws 77421 to the closed position. Accordingly, as drive screw 77430 is rotated in a second direction opposite the first direction, cam member 77440 will translate from the distal position (see fig. 162) to the proximal position (see fig. 161), and feeder shoe 77450 will translate from the proximal position (see fig. 162) to the distal position (see fig. 161). As the cam member 77440 moves toward the proximal position, the pair of opposing jaws 77421 will move to the open position.

Further to the above, clip applier 77400 further comprises a clip track 77410 configured to store a first clip 77404, a second clip 77405, and a third clip 77406. In at least one embodiment, the first clamp 77404, the second clamp 77405, and the third clamp 77406 can be fed by a clamp magazine into the clamp track 77410. Clips 77404, 77405, 77406 are biased distally by feeder block 77412 and feeder spring 77413. The feeder shoe 77450 also includes a feeder rod 77452 extending distally therefrom. The feeder bar 77452 includes a first clip notch 77454 at a distal end thereof, and a second clip notch 77456 proximal of the first clip notch 77454. Operation of clip applier 77400 is described in more detail below.

When the clip applier 77400 is initially loaded into a surgical site through, for example, a trocar or cannula (see primarily FIG. 161), the opposing jaws 77421 can already have a first clip 77404 positioned therein. In such instances, the second clip 77405 and the third clip 77406 are positioned in the clip track 77410 and are biased distally by the feeder spring 77413. The second clip 77405 and the third clip 77406 are held in place by the second clip notch 77456 of the feeder rod 77452. With the springs in the deployed position, the biasing force from the feeder spring 77413 in this position is insufficient to force the second clip 77405 out of the second clip notch 77456. As drive screw 77430 is rotated in a first direction, opposing jaw 77421 will move toward a closed position and feeder shoe 77450 will move toward a proximal position, as described above. As the feeder shoe 77450 moves toward the proximal position, the first clamp 77404 will be crimped and the feeder shoe 77450 will proximally retract the second clamp 77405 and the third clamp 77406, compressing the feeder spring 77413. The second clip 77405 and the third clip 77406 will retract proximally until the biasing force from the feeder spring 77413 overcomes the retaining force between the second clip 77405 and the second clip notch 77456. At this time, the second clip 77405 will be slid by the second clip notch 77456. However, first clamp notch 77454 will catch second clamp 77405. Further, the third clip 77406 will follow the second clip 77405 through the second clip notch 77456 such that the feeder spring 77413 pushes the second clip 77405 via the third clip 77406.

After the first clamp 77404 has been crimped, it may be released from the receiving chamber 77428 by rotating the drive screw 77430 in a second direction. As described above, when the drive screw 77430 is rotated in the second direction, the opposing jaws 77421 of the end effector 77420 will move to the open position and the feeder shoe 77450 will move toward the distal position. As the feeder shoe 77450 moves toward the distal position, the feeder rod 77452 will carry the second clip 77405 and the third clip 77406 distally. Second clip 77405 and third clip 77406 will remain biased into first clip recess 77454 by feeder spring 77413 until the distal end of feeder shoe 77450 approaches receiving chamber 77428 of end effector 77420. The distal end of the feeder shoe 77450 is configured to bend or flex upward as it approaches the receiving chamber 77428 of the end effector 77420, thus releasing the second clip 77405 from the first clip notch 77454. Once the second clip 77405 is released, the feeder spring 77413 biases the second clip 77405 into the receiving chamber 77428 of the end effector 77420. At the same time, third clip 77406 is biased distally by feeder spring 77413, but cannot enter receiving chamber 77428 because the receiver is occupied by second clip 77405. In such cases, the third clip 77406 is staged for the next actuation of the clip applier as described below.

Further to the above, drive screw 77430 may now be rotated in a first direction to crimp second clamp 77405 positioned in receiving chamber 77428 and retract feeder rod 77452 via feeder shoe 77450, as described above. As the feeder rod 77452 is retracted, the first clip notch 77454 will engage the third clip 77406 and proximally retract the third clip 77406 (see fig. 162). At this stage, the feeder shoe 77450 is again in the proximal position, the cam member 77440 is again in the distal position, the second clip 77405 has been crimped against the jaws 77421, and the third clip 77406 has been retracted. The drive screw 77430 can now be rotated in a first direction to release the second clip 77405 from the opposing jaw 77421 of the end effector 77420 and advance the third clip 77406 into the opposing jaw 77421 via the feeder bar 77452 in the manner discussed above in connection with the second clip 77405. The third clip 77406 can then be crimped by rotating the drive screw 77430 in the second direction, and the crimped third clip 77406 can then be released from the opposing jaw 77421 by rotating the drive screw 77430 in the first direction.

The above-described embodiments of fig. 161 and 162 include a system for automatically loading a plurality of clips into an end effector after a first clip has been crimped and released. The clips loaded into the end effector are then sequentially crimped and released.

Fig. 163 and 164 depict a clip applier 77500 according to at least one embodiment. The clip applier includes an end effector 77520, an actuator 77510, and a drive screw 77530 extending proximally from the actuator 77510. The actuator 77510 includes a drive bar 77511 and a threaded nut 77514 at the proximal end of the drive bar 77511. The drive rod 77511 includes internal threads 77512 that are configured to receive the external threads 77532 of the drive screw 77530. The actuator 77510 is rotatably constrained within the shaft of the clip applier 77500 by a threaded nut 77514, and thus, the drive screw 77530 can be rotated to translate the actuator 77510 between a proximal position (fig. 163) and a distal position (fig. 164). The drive screw 77530 may rotate about a drive axis DA in response to rotational motion generated by a motor of the clip applier 77500. The drive screw 77530 includes a pair of laterally extending pins 77516 that extend away from the drive bar 77511 of the actuator. The end effector 77520 includes a first jaw 77522 and a second jaw 77524 that are movable relative to each other between an open position (fig. 163) and a closed position (fig. 164). The first jaw 77522 and the second jaw 77524 at least partially define a receiving chamber 77521 between an inner surface 77518 of the first jaw 77522 and an inner surface 77519 of the second jaw 77524. The first jaw 77522 and the second jaw 77524 are discussed in more detail below.

The first jaw 77522 includes a first cam member 77526. The second jaw 77524 includes a second cam member 77528. The first cam member 77526 includes a first pair of parallel slots 77527 that are angled transverse to the drive axis DA. The second cam member 77528 includes a second pair of parallel slots 77529 that are angled transverse to the drive axis DA. The first pair of parallel slots 77527 is transverse to the second pair of parallel slots 77529. The laterally extending pins 77516 of the actuator 77510 are received in the first pair of parallel slots 77527 and the second pair of parallel slots 77529. In addition, the first cam member 77526 includes a lateral slot 77523 at the proximal end of the first cam member 77526. The second cam member 77528 includes a protrusion or pin 77525 that extends into the lateral slot 77523 of the first cam member 77526. The operation of the clip applier 77500 is discussed in more detail below.

As described above, the rotational-translational actuator 77510 of the screw 77530 is driven. As the actuator 77510 translates from the proximal position to the distal position, the laterally extending pins 77516 will engage the sidewalls of the first pair of slots 77527 and the second pair of slots 77529 to move the end effector from its open position to its closed position. Notably, the first jaw 77522 and the second jaw 77524 are closed in a parallel manner. In other words, the first jaw 77522 and the second jaw 77524 translate closed without rotating closed. This movement is controlled by the arrangement of laterally extending pin 77516 and pin 77525.

Fig. 165 and 166 depict a clip applier 77600 according to at least one embodiment. The clip applier includes a shaft 77640 extending from a housing of the clip applier 77600. The shaft 77640 defines a shaft axis SA. The clip applier 77600 further includes an end effector 77620, an actuator 77650, and a drive screw 77660 extending proximally from the actuator 77650. The actuator 77650 may include a boss 77658 at its proximal end. The boss 77658 comprises internal threads configured to receive a drive screw 77660; thus, the drive screw 77660 is threadably engaged with the actuator 77650. The actuator 77650 is rotatably constrained within the shaft 77640 such that when the drive screw 77660 is rotated, the actuator 77650 translates between a distal position (fig. 165) and a proximal position (fig. 166). The drive screw 77660 is rotatable about the shaft axis SA in response to rotational movement generated by a motor of the clip applier 77600.

Further to the above, the end effector 77620 comprises a first jaw 77622 and a second jaw 77632 that are movable relative to each other between an open position (fig. 165) and a closed position (fig. 166). The first and second jaws 77622, 77632 at least partially define a receiving chamber 77621 between the inner surface 77623 of the first jaw 77622 and the inner surface 77633 of the second jaw 77632. The first jaw 77622 includes a first cam member 77624 extending proximally from the first jaw 77622. The second jaw 77632 includes a second camming member 77634 that extends proximally from the second jaw 77632. The first cam member 77624 includes a first slot 77626 that is angled transverse to the shaft axis SA. More specifically, the first slot 77626 includes a distal portion that extends in one direction and a proximal portion that extends in another direction. The second cam member 77634 includes a second slot 77636 that is transverse to the shaft axis SA. More specifically, the second slot 77636 includes a distal portion that extends in one direction and a proximal portion that extends in another direction. The first and second slots overlap to form an X-shape, as shown in fig. 165.

The actuator 77650 comprises a distal slot 77654, a proximal slot 77656, and a distal projection 77652. The distal slot 77654 is transverse to the shaft axis SA in a first direction and the proximal slot 77656 is transverse to the shaft axis SA in a second direction opposite the first direction. The distal projection 77652 of the actuator 77650 is configured to be slidably received in the first slot 77626 and the second slot 77636. In addition, the first cam member 77624 includes a first cam protrusion 77628 located at a proximal end of the first cam member 77624. The second cam member 77634 includes a second cam projection 77638 located at a proximal end of the second cam member 77634. The first cam protrusion 77628 is located proximal to the second cam protrusion 77638. The first cam projection 77628 is configured to be slidably received in the proximal slot 77656 of the actuator 77650 and the second cam projection 77638 is configured to be slidably received in the distal slot 77654 of the actuator 77650. The operation of the clip applier 77600 is discussed in more detail below.

As described above, rotation of the drive screw 77660 results in translation of the actuator 77650. As the actuator 77650 translates from the distal position (fig. 165) to the proximal position (fig. 166), the distal projection 77652 of the actuator 77650 will move proximally the distance D1. As the distal projection 77652 moves proximally, the distal projection 77652 engages the sidewalls of the first and second slots 77626, 77636 that move toward each other. Additionally, as the actuator 77650 moves proximally, the distal slot 77654 and the proximal slot 77656 will move proximally, causing the second cam protrusion 77638 and the first cam protrusion 77628 to move in opposite directions transverse to the shaft axis SA. More specifically, the first cam protrusion 77628 will move distally along the shaft axis SA and transverse to the shaft axis SA in the first direction FD. Additionally, the second cam tab 77638 will move distally along the shaft axis SA and transverse to the shaft axis SA in the second direction SD. As the first cam protrusion 77628 moves in the first direction FD and the second cam protrusion 77638 moves in the second direction SD, the first and second jaws 77622, 77632 will move toward the closed position shown in fig. 166. More specifically, the distal end of the inner surface 77623 of the first jaw 77622 and the distal end of the inner surface 77633 of the second jaw 77632 will move toward each other. Thus, when the first and second jaws 77622, 77632 are in the closed position, the inner surface 77623 of the first jaw 77622 and the inner surface 77633 of the second jaw 77632 are not parallel. In other words, the end effector 77620 begins to close with the tip of the jaws as compared to the parallel closed end effector 77520 with the jaws.

Fig. 167A-167D depict a clip applier 77700, according to at least one embodiment. The clip applier 77700 includes an end effector 77720, a clip cassette 77710, a clip feed system 77730, and a jaw cam assembly 77740. The end effector 77720 includes a pair of opposed jaws 77721 configured to move between an open position and a closed position, as described herein. The clip magazine 77710 and the jaw cam assembly 77740 can be actuated via two separate rotational inputs. Clip magazine 77710 is similar to clip magazine 76010 of clip applier 76000 (see FIG. 114). Clip magazine 77710 includes a plurality of clips 77714 stored in a plurality of clip holders 77718. The clamp magazine 77710 is rotatable and translatable via a magazine driver 77716 that is operably responsive to the first rotational input 77712. The first rotational input 77712 is operably responsive to rotational movement generated within the housing of the clip applier 77700. In any event, the clip magazine 77710 is configured to be advanced and retracted to strip the clips 77714 from the clip magazine 77710 into a loading slot (such as loading slot 77722 of the end effector 77720).

The jaw cam assembly 77740 includes a jaw cam 77742 that is threadably engaged with a second rotational input 77744. The second rotary input 77744 is operable to respond to rotary motion generated within the housing of the clip applier 77700. The second rotational input 77744 is configured to translate the jaw cam 77742 between a fully advanced position (fig. 167D), a retracted position (fig. 167B), and a fully retracted position (fig. 167C). The jaw cam 77742 is configured to interact with an opposing jaw 77721 of the end effector 77720 to move the opposing jaw 77721 between an open position and a closed position. More specifically, jaw cam 77742 includes a cam window 77743 (see fig. 168) configured to be received over proximal portion 77723 of opposing jaw 77721. The first rotational input 77712 and the second rotational input 77744 can be operated independently of each other by the motor control system of the clip applier 777000.

When the jaw cam 77742 is in its fully advanced position (fig. 167D), the opposing jaw 77721 of the end effector 77720 is in its closed position. More specifically, as jaw cam 77742 moves toward the fully advanced position, cam window 77743 of jaw cam 77742 will cammingly engage the exterior of opposing jaw 77721 to move opposing jaw 77721 to the closed position. When the jaw cam 77742 is in its retracted position (fig. 167B) or fully retracted position (fig. 167C), the opposing jaw 77721 is in its open position. When jaw cam 77742 is not holding opposed jaws 77721 together, opposed jaws 77721 are biased away from each jaw, allowing opposed jaws 77721 to move to the open position. The counter jaw 77721 can be moved between an open position and a closed position without performing a clip feed or clip magazine function.

As mentioned above, the jaw cam 77742 can also be used to release the clip feed system 77730 such that clips can be fed into the end effector 77720. As described below, the jaw cam 77742 retracts from its retracted position to its fully retracted position to release the feeder shoe 77732, which is pushed distally by the feeder spring 77734.

Referring now to fig. 168 and 169, the jaw cam 77742 also includes a track release latch 77746 positioned thereon. The track release latch 77746 is biased toward the jaw cam 77742 by a biasing member 77748. The track release latch 77746 includes a projection 77747 on a distal end thereof that extends through a top opening 77745 in the jaw cam 77742 and down into the cam window 77743 of the jaw cam 77742. The protrusion 77747 includes a chamfered portion 77747a on the distal end of the track plate release latch 77746. The track release latch 77746 also includes a chamfered portion 77749 on its proximal end.

Further to the above, the clip feed system 77730 includes a feeder shoe 77732, a release latch 77731, and a feeder spring 77734. In its stored position, the feeder shoe 77732 is biased away from the proximal stop 77750 of the clip applier 77700 by the feeder spring 77734, but is held in place by the release latch 77731 (see fig. 167A).

When the clip applier 77700 is in an initial position (e.g., when the clip applier 777000 is placed into a surgical site), the opposed jaws 77721 of the end effector 77720 can be in a closed position (see fig. 167A). In such instances, the feeder shoe 77732 remains in its storage position or cocked position, as described above.

When the jaw cam 77742 is retracted to a retracted position (fig. 167B) to open the opposing jaws 77721, the loading slot 77722 can receive one of the clips 77714 from the clip magazine 77710. The jaw cam 77742 can then be retracted to a fully retracted position (fig. 167C) to release the feeder shoe 77732 and advance the clip 77714 into the opposing jaw 77721 of the end effector 77720. More specifically, as the jaw cam 77742 retracts to the fully retracted position (fig. 167C), the jaw cam 77742 engages the front side 77738 of the release latch 77731 to rotate the release latch 77731 away from the feeder shoe 77732. Additionally, as the jaw cam 77742 is moved to the fully retracted position, the track release latch 77746 engages a proximal stop 77750 that moves the track release latch 77746 in an upward direction UD (see fig. 169) providing clearance for the feeder track 77732 to advance toward the end effector 77720.

After the clip 77714 has been advanced into the end effector 77720, the jaw cam 77742 is moved to its fully advanced position (see fig. 167D) to move the opposing jaws 77721 of the end effector 77720 to their closed position to crimp the clip 77714 positioned in the end effector 77720. Notably, the jaw cam 77742 carries the track release latch 77746 distally to again engage the feeder track 77732. More specifically, as the jaw cam 77742 is moved toward the fully advanced position, a chamfered portion 77747a on a distal end of the track release latch 77746 engages a proximal end of the feeder track 77732 such that the track release latch 77746 is biased in an upward direction UD. When the jaw cam 77742 is in the fully advanced position, the track release latch 77746 is moved downward toward the feeder track 77732 by the biasing member 77748. In other words, as the jaw cam 77742 is moved toward the fully advanced position, the track release latch 77746 can move upward and over the feeder track 77732 to engage the distal side of the feeder track 77732.

The jaw cam 77742 can now be used to retract the feeder shoe 77732. When the jaw cam 77742 reaches its retracted position (fig. 167B), the feeder shoe 77732 reengages the release latch 77731.

When the feeder shoe 77732 is engaged with the release latch 77731, the jaw cam 77742 is free to translate between the retracted position of fig. 167A and the fully advanced position (fig. 167D) to actuate the opposing jaw 77721 of the end effector 77720, as described herein. The opposing jaws 77721 can be opened and closed without having to feed and/or crimp the clip. Such opening and closing is often required to position the end effector of the clip applier within the patient. This is possible in part due to the fact that the clip feed system is not triggered during the closing stroke of the jaw cam system. Rather, as described above, the clip feed system can only be actuated when the jaw cam is fully retracted, i.e., retracted proximally after the position of the jaw cam associated with the fully open position of the opposed jaws. Once the jaw cam 77742 is moved to the retracted position (fig. 167B), another clip 77714 can be positioned from the clip magazine 77710 in the loading slot 77722, and the clip 77714 can be advanced into the end effector 77720 by the feeder shoe 77732 and crimped against the jaws 77721, as described above. This process may continue until all of clips 77714 have been exhausted from clip magazine 77710.

Fig. 170-175 depict a clip applier 77800 according to at least one embodiment. The clip applier 77800 includes an end effector 77820, a clip track 77840, a cam member 77850, a clip pusher 77860, and a rotary input 77870. The rotary input 77870 defines an axis of rotation RA and is rotatable about the axis of rotation RA in response to rotational motion generated by a motor within the housing of the clip applier 77800. The rotation input 77870 includes a proximal threaded portion 77872 and a distal threaded portion 77874 extending from the proximal threaded portion 77872. Proximal threaded portion 77872 has a greater pitch than distal threaded portion 77874; however, any suitable pitch may be used.

The end effector 77820 extends distally from the clip track 77840 and is mounted to the clip track 77840 via a mounting member 77830. The mounting member 77830 extends above the clip track 77840 and between the first jaw 77822 and the second jaw 77824 of the end effector 77820. The first jaw 77822 and the second jaw 77824 move relative to each other between an open position (fig. 172 and 175) and a closed position (fig. 170 and 173). The first jaw 77822 and the second jaw 77824 at least partially define a receiving chamber 77826 therebetween. In addition, the mounting member 77830 includes a pair of laterally extending pins 77832. Each of the first jaw 77822 and the second jaw 77824 includes a hole 77829 configured to slidably receive the pair of laterally extending pins 77832 of the mounting member 77830. Thus, the first jaw 77822 and the second jaw 77824 can move laterally relative to each other along the laterally extending pin 77832.

The first jaw 77822 includes a first pin 77827 extending upwardly intermediate the holes 77829 in the first jaw 77822. In addition, the second jaw 77824 includes a second pin 77828 extending upwardly intermediate the holes 77829 in the second jaw 77824. The first pin 77827 is slidably received in the first slot 77852 of the cam member 77850, and the second pin 77828 is slidably received in the second slot 77854 of the cam member 77850. The first slot 77852 includes a longitudinal portion 77856 and a transverse portion 77857. The longitudinal portion 77856 is parallel to the rotational axis RA of the rotational input 77870 and the transverse portion 77857 is transverse to the rotational axis RA of the rotational input 77870. Similarly, the second slot 77854 includes a longitudinal portion 77858 and a transverse portion 77859. The longitudinal portion 77858 is parallel to the rotational axis RA of the rotational input 77870 and the transverse portion 77859 is transverse to the rotational axis RA of the rotational input 77870. Lateral portions 77857 and 77859 extend from longitudinal portions 77856 and 77858 toward axis of rotation RA.

Further to the above, the cam member 77850 also includes a protrusion 77851 extending upwardly from a proximal end thereof. The protrusion 77851 includes internal threads 77853 (see fig. 175) that threadably engage the distal threaded portion 77874 of the rotary input 77870. Similarly, clip pusher 77860 includes a protrusion 77862 extending upwardly from a proximal end thereof. The protrusion 77862 includes internal threads 77864 that threadably engage the proximal threaded portion 77872 of the rotation input 77870. The protrusion 77851 of the cam member 77850 and the protrusion 77862 of the clip advancer 77860 are both rotatably constrained within the slot 77882 of the top housing 77880 of the clip applier 77800. As the rotary input 77870 rotates about the axis of rotation RA, the slot 77882 allows the cam member 77850 and the clip pusher 77860 to translate along the axis of rotation RA. As described above, the proximal threaded portion 77872 of the rotation input 77870 has a greater pitch than the distal threaded portion 77874 of the rotation input 77870. Thus, rotation of the rotary input 77870 will translate the clip advancer 77860 through a clip advancement stroke and will translate the cam member 77850 through a jaw closing stroke that is less than the clip advancement stroke. In other words, rotation of the rotary input 77870 will translate the clip advancer 77860 a greater distance than it translates the cam member 77850. Clip pusher 77860 also includes a feeder shoe 77866 extending downward from clip pusher 77860. The feeder shoe 77866 is configured to translate through the loading slot 77842 of the clip track 77840 as the clip advancer 77860 translates via the rotational input 77870. The loading slots 77842 are configured to store a plurality of clips 77804 in longitudinal rows for sequential advancement into the receiving chamber 77826 of the end effector 77820. The operation of the clip applier 77800 is discussed in more detail below.

In the initial position, the first jaw 77822 and the second jaw 77824 are in a closed position with no clip 77804 disposed therebetween, as can occur when the clip applier 77800 is first loaded into a surgical site. Also in such instances, both the clip advancer 77860 and the cam member 77850 are in, for example, their proximal positions (see fig. 170 and 173). As the rotary input 77870 is rotated in the first direction FD, the clip advancer 77860 and cam member 77850 translate distally to an intermediate position to move the first and second jaws 77822, 77824 to an open position and advance a clip 77804 through the clip track 77840 to a position just proximal of the receiving chamber 77826 of the end effector 77820. As the cam member 77850 translates distally from its proximal position to this intermediate position (fig. 171 and 174), as described above, the lateral portions 77857 and 77859 of the first and second slots 77852 and 77854 of the cam member 77850 engage the first and second pins 77827 and 77828 of the first and second jaws 77822 and 77824 and move the first and second pins 77827 and 77828 away from each other until the first and second pins 77827 and 77828 move into the longitudinal portions 77856 and 77858 of the first and second slots 77852 and 77854 (see fig. 171).

As described above, the first and second pins 77827, 77828 extend upwardly from the first and second jaws 77822, 77824, and the first and second jaws 77822, 77824 are slidable relative to each other along a pair of laterally extending pins 77832 of the mounting member 77830. Thus, as the cam member 77850 is moved distally from its proximal position to this intermediate position, the first jaw 77822 and the second jaw 77824 are moved to their open positions. In addition, when the clip advancer 77860 is moved from its proximal position (fig. 173) to this intermediate position (fig. 174), the feeder shoe 77866 of the clip advancer 77860 advances the first clip 77804 to a position just proximal of the receiving chamber 77826. In other words, the rotational input 77870 can be rotated in the first direction FD to move the first jaw 77822 and the second jaw 77824 to the open position without advancing the clip 77804 into the end effector 77820.

When the clip advancer 77860 and cam member 77850 are in their intermediate positions (fig. 171 and 174), the rotary input 77870 can be further rotated in the first direction FD to further distally translate the clip advancer 77860 and cam member 77850 to advance the first clip 77804 into the receiving chamber 77826 of the end effector 77820. More specifically, the cam member 77850 can be moved from an intermediate position (fig. 171) to a distal position (fig. 172), and the clip advancer 77860 can be moved from an intermediate position (fig. 171) to a distal position (fig. 172). As the cam member 77850 moves toward the distal position, the first and second pins 77827, 77828 of the first and second jaws 77822, 77824 will move through the longitudinal portions 77856, 77858 of the first and second slots 77852, 77854 of the cam member 77850 and the first and second jaws 77822, 77824 are not driven laterally. As the clip advancer 77860 is moved toward the distal position, the feeder shoe 77866 of the clip advancer 77860 advances the first clip 77804 into a receiving chamber 77826 defined between the first jaw 77822 and the second jaw 77824. The feeder shoe 77866 is angled such that it will also advance the second clip 77804 distally to a position just proximal of the receiving chamber 77826.

Once the first clip 77804 has been advanced into the receiving chamber 77826, the rotary input 77870 may be rotated in a second direction to retract the clip advancer 77860 and the cam member 77850 to their neutral positions. When the clip advancer 77860 and the cam member 77850 are moved into their intermediate positions, the first jaw 77822 and the second jaw 77824 will remain in the open position and the feeder shoe 77866 of the clip advancer 77860 is retracted proximally beyond the receiving chamber 77826. Thus, the feeder shoe 77866 will not interfere with the crimping of the first clamp 77804 positioned in the receiving chamber 77826.

Further to the above, the rotary input 77870 can also be further rotated in the second direction to retract the clip advancer 77860 and cam member 77850 from their neutral positions to their proximal positions. As the clip advancer 77860 and the cam member 77850 move toward their proximal positions, the first jaw 77822 and the second jaw 77824 move to a closed position to crimp the first clip 77804 positioned therebetween. In addition, the clip advancer 77860 is moved proximally such that the feeder shoe 77866 is moved proximally beyond a second clip 77804 positioned in the clip track 77840 just proximal of the receiving chamber 77826. The distal end of the feeder shoe 77866 is angled such that the feeder shoe 77866 can move upward and over the second clamp 77804 into a position behind the second clamp 77804. The first and second jaws 77822, 77824 can then be moved to an open position to release the first clip 77804 from the first and second jaws 77822, 77824 while advancing the second clip 77804 into the receiving chamber 77826. Then, when the third clip 77804 is advanced into the receiving chamber 77826, the second clip 77804 can be crimped and released, and so on.

Referring to fig. 176, a graph 78000 of the displacement of the crimp drive of the clip applier system at various set points over time is depicted. The crimping drive is configured to crimp a clip 78004 positioned between the jaws of the end effector, as described herein. The crimp drive is operably responsive to a motor of the clip applier system configured to generate rotational motion. Additionally, the motor may be controlled by a motor controller that includes a processor and a memory in signal communication with the processor. The motor controller is configured to detect a current draw of the motor, compare the detected current to a predetermined range of currents stored in a memory of the motor controller, and then adjust a speed and/or force of the crimp drive based on the detected current. The predetermined range of current stored in the memory may be based on an expected amount of current consumed on the motor by the various clamp formations. This information may be programmed into the motor controller as it is manufactured and/or from the surgical hub, as described in more detail below.

Following the crimping drive₀Distance of movement_AStill referring to fig. 176, a clip 78004 positioned in the end effector is configured to be crimped by the crimp drive such that distal ends of the legs of the clip contact at a set point 78010. This type of formation is referred to as a tip start, however other types of formation may be used. Following the crimping drive_ADistance of movement_BThe clamp is further formed at set point 78020. Following the crimping drive_BDistance of movement_CThe clamp is fully formed at set point 78030. The motor controller may detect each orientation of the clamp 78004 at the set points 78010, 78020, and 78030 based on the current draw of the motor and/or any other performance characteristic of the motor. Using this data, the motor controller can adjust the operation of the motor to achieve the desired result. For example, when the ends of the legs of the clamp 78004 contact (e.g., at set point 78010), the motor controller will likely detect an increase in the current draw of the motor due to the force required to form the clamp exceeding the configuration shown at set point 78010. As the clamp 78004 advancesFurther formed into the orientation shown at set point 78020, current consumption will likely increase further because the force required to crimp clip 78004 will increase further due to the resistance of the tissue and the additional deformation of clip 78004. As clip 78004 is fully formed (e.g., at point 78030), the current consumption of the motor will increase significantly because clip 78004 cannot be formed further. The current drawn on the motor at each of these set points 78010, 78020, 78030 can be compared to a predetermined range of current stored in the memory of the motor controller to determine how the motor controller proceeds, as described in more detail below.

Further to the above, at set point 78010, the motor controller may instruct the motor to continue to drive the crimp drive from a distance_AAdvance to distance_BOr distance_CTo further form the clip. Additionally, the motor controller may instruct the motor to dwell at the set point 78010 for a set period of time (e.g., from t)_ATo t_x) Then the crimping drive device is driven from the distance_ARetracted to a distance₀To release clamp 78004 or to distance a crimping drive_AAdvance to distance_BOr distance_CTo further crimp clamp 78004. The motor controller may instruct the motor to perform a similar function at each set point 78010, 78020, and 78030. For example, at set point 78020, the motor controller may instruct the motor to continue to move the crimp drive from the distance_BAdvance to distance_cTo further form the clip. Additionally, at set point 78020, the motor controller may instruct the motor to dwell for a set period of time (e.g., from t)_bTo t_D) Then the crimping drive device is driven from the distance_BRetracted to a distance₀To release clamp 78004 or to distance a crimping drive_BAdvance to distance_CFor example, to fully crimp clamp 78004.

The current draw expected at each of the set points 78010, 78020, 78030 can be preprogrammed into the memory of the motor controller so that the motor controller will automatically stop the motor when the current draw on the motor indicates one of the set points 78010, 78020, 78030. The motor controller may then require manual input from the user of the clip applier system in order to proceed. Thus, a user of the clip applier system can selectively determine the extent to which the clip 78004 is deformed and when to release the clip 78004, such that different ranges of clip formation are possible according to the preprogrammed set points 78010, 78020, 78030. Additionally, the motor controller may be configured to slow, pause, or speed up the motor at each set point based on manual input from a user. More specifically, once the set points 78010, 78020, 78030 are reached, the motor will pause and/or stop, the user may select a slow motion button (e.g., some form of actuator) to direct the motor controller to slowly advance the crimp drive from one set point to another, or the user may select a fast motion button or actuator to direct the motor controller to advance the crimp drive more quickly.

In previous devices, the opening and closing of the jaws of a clip applier caused the clips to automatically cycle, i.e., feed into the jaws and then crimp. In many cases, such an arrangement is suitable; however, there may be many instances where cycling the clamp causes the clamp to fall into the patient or otherwise be wasted. For example, when the jaws are closed to insert a clip applier through the trocar and then reopened within the patient, the clip is crimped and then dropped into the patient when the jaws are opened. In many of the embodiments described herein, the clip feed system and the jaw drive system of the clip applier are operated by separate and distinct drive systems. In such embodiments, the clip feed system can be deactivated while the jaw drive system is circulating. Such an arrangement allows the jaws of the clip applier to be opened and closed as many times as necessary to position the clip applier within the patient without circulating the clip. Once the clip applier is properly positioned within the patient, the clip feed system can be reactivated such that the clip feed system and the jaw drive system can be used to cooperatively apply a clip to patient tissue. In various embodiments, the clip applier includes an actuator and/or control in communication with a control system of the clip applier, which when actuated, deactivates the clip feed system. In certain embodiments, the actuator is reactivated to reactivate the clip feed system, or the clip applier includes a separate actuator to reactivate the clip applier.

As further described above, the jaws of the clip applier can grasp and/or dissect tissue of a patient. In such cases, the jaws may be repeatedly opened and closed. As described above, deactivating the clip feed system may facilitate use of the end effector in this manner. In addition to or in lieu of the above, the clip applier can have a grasping and/or dissection mode. In such one or more modes, the controller of the clip applier can move the jaws out of their normal closing and opening strokes. For example, in the grasping mode, the jaws can be moved closer together than they are in a fully crimped or fully fired position. In such a position, the jaws may be used to grasp, for example, very small objects, such as suture needles. For example, in an anatomical mode, a jaw may move farther than its open or cocked position. In such a position, the jaws may be used to deploy an incision in the tissue of a patient. Similar to the above, the clip applier can include one or more actuators and/or controls that can be used to place the clip applier in one or more grasping and/or anatomical modes by the clinician.

It is noted that, as further described above, for example, the load or force experienced by the jaws of the clip applier and/or the pattern of force experienced by the jaws of the clip applier can be detected as being different by one or more strain gauges and/or pressure sensors. For example, when a clip is not positioned between the jaws and the jaws are being used for grasping, the jaws of the clip applier can experience very little load during the entire closing stroke of the jaws, or at least until the end of the closing stroke. The controller of the clip applier may recognize such a force mode and automatically enter a grasping mode. A similar pattern can occur when the jaws of a clip applier are used to dissect tissue, except that the force increases abruptly as the jaws open. The controller of the clip applier may recognize such a force pattern and automatically enter the dissection mode. The clip applier can have an override feature that, when actuated by the clinician, can place the clip applier back in its clip firing mode.

As described above, the control system of the clip applier is preprogrammed or programmed to move the jaws of the clip applier to a predetermined position prior to use by a clinician. In various instances, the control system includes an interface configured to allow a clinician to set or program the position of the jaws. Such an interface may include, for example, a control screen and/or actuators in communication with the clip applier control system. The control system includes, for example, a memory, such as a solid state memory, configured to store the settings such that the jaws may be automatically moved to the positions when the clinician instructs the jaws to be automatically moved to the positions. In at least one instance, the clip applier includes a first position control and a second position control, but can include any suitable number of position controls. For each position control, the clinician can program a particular position or configuration of the jaws when the position control is actuated. Such positions may include, for example, less than a fully open position and less than a fully closed position.

As further described above, an initial test of a clip applier on a production line generates an expected load profile required to fire a clip in that particular clip applier. The load profile may be used to form, for example, a set of thresholds, such as the set points described above, within which the device is expected to operate. The motor current is measured as an indicator of load when the jaws are closed, while the motor voltage is an indicator of motor speed. If the load on the motor exceeds an expected threshold (e.g., indicating a higher load and/or thicker tissue) during use, the closed-loop nature of the system allows a control algorithm stored in the memory of the motor controller to adjust the current supplied to the motor. However, these changes are dynamic changes. They do not evaluate the loads experienced during other firings in the instrument or other instruments. That is, such data may be used to adjust the control program of the applicator. Such adjustments may include, for example, adjusting the motor voltage to slow the rate of advancement of the crimp drive and/or changing the final stroke position of the crimp drive.

Situational awareness can be used to adjust the operation of the clip applier. Situational awareness is the ability of a surgical system to determine or infer information related to a surgical procedure from data received from a database and/or instruments. The information may include the type of surgery being performed, the type of tissue being operated on, or the body cavity being the subject of the surgery. Using the contextual information related to the surgical procedure, the surgical system may, for example, improve the way it controls the instrument and provides recommendations to the surgeon during the surgical procedure. In various instances, the control of the surgical instrument may be adjusted without requiring input from a user of the surgical instrument.

When used in conjunction with a surgical hub and situational awareness module as described herein and/or incorporated by reference, the clip applier described herein can be used to detect diseased tissue and/or detect tissue quality. For example, the clip applier disclosed herein can detect atherosclerosis (e.g., arteriosclerosis) or an aneurysm (e.g., weak arterial walls), as well as the presence of another clip, staple, or artifact trapped between the jaws of the clip applier.

More specifically, the surgical hub or system may detect a potential risk of atherosclerosis (arteriosclerosis) by investigating contextual cues (e.g., predetermined patient information and/or patient information collected by the surgical system during surgery) stored at the surgical hub that are indicative of conditions such as hypertension, high cholesterol (especially LDL cholesterol), and co-morbidities (e.g., obesity and diabetes). If such a condition is detected, the surgical hub may direct the clip applier that is being used to respond in a particular manner. The first action prompted for the situation may include, for example, slowing the rate of jaw actuation, reducing the maximum torque and clamp load thresholds for unfired operations (e.g., opening and closing jaws of a clamp applier in the absence of a clamp), and/or reducing the maximum stroke of a camming member or crimp drive for forming a clamp. The surgical system may monitor additional contextual cues, and the surgical system may take a second action in response to the monitored contextual cues, as discussed in more detail below.

As further described above, the surgical system may monitor contextual cues, such as the force required to crimp a clamp. For example, the surgical system may detect an irregular force peak outside of the expected forming event and associated slope, and the surgical system may direct the clip applier to perform a second action. More specifically, when an irregular force peak is detected, the motor may be stopped and the force on the jaws may be monitored to monitor tissue creep. Furthermore, if the tissue does not relax (e.g., tissue creep abnormalities), irregularities may exist between the jaws. The surgical system can then indicate a fault condition and request feedback from the user to open the jaws of the clip applier to prevent inadvertent clamping of the unknown object. Further, if tissue relaxation (e.g., tissue creep) is detected but outside of a predefined expected range, the surgical system may adjust the rate of advancement of the crimp/closure drive with additional set stop points for further monitoring and moving the jaws at a slower crimp rate. In other words, the surgical system may pause the closing of the jaws to monitor tissue creep and then determine how to proceed based on the detected tissue creep, for example.

Further to the above, the surgical system may monitor, for example, contextual cues, such as the load on the crimp drive shaft of the clip applier. The crimp drive shaft may be equipped with a strain gauge to determine the force within the crimp drive shaft when the clip applier crimps the clip. Thus, the strain gauge can be used to determine the force applied to the tissue by the clip applier jaws. The clip applier can be used in conjunction with a surgical system (e.g., including a surgical grasper), as described above. The surgical grasper is used to hold the target tissue and may stretch or relax the tissue in response to a detected load within the crimp drive shaft. For example, if the loading of the crimp drive shaft approaches a threshold value, indicating that the tissue being grasped or clamped is too thick to crimp the clamp around the tissue, the grasper of the surgical system will automatically move in an attempt to relieve the force on the crimp drive shaft. More particularly, the grasper may be moved to stretch the tissue to thin the tissue between the jaws of the clip applier so that the clip can be properly crimped, for example, around the tissue. If the automatic mitigation effort fails to mitigate the load, actuation of the jaws of the clip applier (e.g., via the crimp drive shaft) can be slowed or stopped by the surgical system.

As further described above, the surgical hub may detect an aneurysm (weak arterial wall strength) by investigating contextual cues stored in the surgical hub indicative of such conditions (e.g., predetermined patient information and/or patient information acquired by the surgical system during a procedure). For example, a vision system of a surgical system including one or more cameras may detect a bulge or change in artery thickness in a clamped position relative to adjacent regions. In addition to or instead of the above, the impedance of the tissue may be monitored to determine whether fat deposits are present within the arterial wall, which may be indicative of a weak arterial wall. Additionally, clip applier jaw loading can be monitored to determine if tissue is present indicating sudden compliance of a weak artery wall. In such cases, the force required to crimp the clip around the tissue is less than desired. Actions may be taken in response to the monitored parameters that are contextual cues, which may include, for example, slowing the rate of jaw actuation, lowering the maximum torque and clamp load thresholds for unfired operation, and/or reducing the maximum stroke of a cam member or crimp drive that drives clip formation.

As further described above, for a list of known causes of an aneurysm that a patient may exhibit before or during a surgical procedure, the surgical system may initiate a query to the surgical hub database. The surgical system may use this information to determine whether the cause of the irregularity during tissue clamping requires a greater/different response. For example, known causes of surgical system interrogation may include hypertension, smoking, obesity, a family history of atherosclerosis, bacterial activity, and/or polyarteritis nodosa (e.g., inflammation of the arterioles and middle arteries), which if present, may cause the controller of the hub to assume the presence of an aneurysm.

As further described above, the surgical system may monitor contextual cues to identify potential problems, such as weakening an artery wall, for example. The clip applier can automatically slow the crimp rate of the clips if the surgeon pauses the examination of the surgical site after the detected weakness is presented to the user. In other words, the surgical system assumes that the surgeon's pause indicates that the surgeon is cautious due to the contextual cues presented; thus, if there is actually an arterial wall weakness, the surgical system automatically responds by slowing the crimp rate of the clip to prevent accidental tissue damage.

As further described above, the surgical hub can detect the presence of another clip, staple, or object within the jaws of the clip applier by investigating contextual cues stored in the surgical hub that indicate such a condition.

For example, if a previous procedure used a clip in the associated body cavity, the controller may assume that the high force stress and/or strain was the result of the previous clip being captured in the end effector. Contextual cues to monitor to determine whether an undesirable object is present between the jaws when clamped may include forces on the clamp during clamp formation. If the force depicts a spike with a high magnitude and a very steep slope during clip formation, time after tip contact, or during leg formation, this may be indicative of an irregular object within the jaws of the clip applier. Further, visual cues from the visual system described herein may indicate that an irregular object, such as a staple or a clip, that has been positioned in a surgical site may be used between the jaws of a clip applier. This information can be fed back directly to the surgical hub and/or the clip applier to direct the clip applier to perform a particular action in response to the detected information. For example, the clip applier jaws can be stopped and a visual alert can be provided to the clinician, the final stroke distance to form the clip can be shortened such that the final crimped clip is not fully crimped to avoid shearing the irregular object, and/or the jaws can be closed at a very slow rate to minimize damage to the irregular object and surrounding tissue.

FIG. 177 is a logic diagram of a control system 75000 for use with any of the various clip appliers described herein. Control system 75000 includes control circuitry. The control circuit includes a microcontroller 75040 that includes a processor 75020 and a memory 75030. One or more sensors (such as sensor 75080, sensor 75090, sensor 71502, and sensor array 71940), for example, provide real-time feedback to processor 75020. The control system 75000 also includes, for example, a motor driver 75050 configured to control the electric motor 75010 and a tracking system 75060 configured to determine a position of one or more longitudinally movable components in the clip applier, such as a firing member 70165 (fig. 35A), a crimp drive 70180 (fig. 36), a feeder member 70630 (fig. 53), a firing member 70640 (fig. 53), and a closure tube 70620 (fig. 53). The tracking system 75060 is also configured to determine the position of, for example, one or more rotating components, such as a rotatable clip magazine 70650 (FIG. 52), within the clip applier. The tracking system 75060 provides position information to the processor 75020, which can be programmed or configured to, among other things, determine the position of the rotatable clip magazine 70650 (fig. 52), determine the position of the firing member, feeder member, closure tube, and/or crimp drive, and determine the orientation of the jaws of the clip applier. The motor driver 75050 can be, for example, a3941 available from Allegro Microsystems, Inc; however, other motor drives could readily be substituted for use in the tracking system 75060. A detailed description of an absolute positioning system is described in U.S. patent application publication 2017/0296213, entitled "SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING NSTRUMENT," the entire disclosure of which is hereby incorporated by reference.

Microcontroller 75040 can be, for example, any single-core or multi-core processor, such as those provided by Texas Instruments under the tradename ARM Cortex. In at least one case, microcontroller 75040 can be, for example, an LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments, which includes, for example: 256KB of single cycle flash or other non-volatile memory (up to 40MHz) on-chip memory, prefetch buffers to improve performance beyond 40MHz, 32KB of single cycle Serial Random Access Memory (SRAM), loadIs provided withInternal Read Only Memory (ROM) for software, Electrically Erasable Programmable Read Only Memory (EEPROM) for 2KB, one or more Pulse Width Modulation (PWM) and/or Frequency Modulation (FM) modules, one or more Quadrature Encoder Input (QEI) analog, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, the details of which can be found in the product data sheet.

In each case, microcontroller 75040 comprises a safety controller that includes two series based controllers, such as TMS570 and RM4x, also available from Texas Instruments under the trade name Hercules ARM Cortex R4. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, etc., to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options.

The microcontroller 75040 is programmed to perform various functions, such as precisely controlling the speed and/or position of the firing member, feeder member, crimp drive, or closure tube of any of the clip appliers disclosed herein, for example. The microcontroller 75040 is also programmed to precisely control the rotational speed and position of the clip applier end effector and the articulation speed and position of the clip applier end effector. In each case, microcontroller 75040 calculates the response in the software of microcontroller 75040. The calculated response is compared to the measured response of the actual system to obtain an "observed" response, which is used for the actual feedback decision. The observed response is a favorable tuning value that equalizes the smooth continuous nature of the simulated response with the measured response, which can sense external influences on the system.

The motor 75010 is controlled by a motor driver 75050. In various forms, the motor 75010 is a DC brushed driving motor, for example, having a maximum rotational speed of about 25,000 RPM. In other arrangements, the motor 75010 includes a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor driver 75050 can include, for example, an H-bridge driver that includes Field Effect Transistors (FETs). The motor driver 75050 can be, for example, a3941 available from AllegroMicrosystems, Inc. A3941 motor driver 75050 is a full bridge controller for use with an external N-channel power Metal Oxide Semiconductor Field Effect Transistor (MOSFET) specifically designed for inductive loads, such as brushed DC motors. In each case, the motor driver 75050 includes a unique charge pump regulator that provides full (>10V) gate drive for battery voltages as low as 7V and allows the a3941 motor driver 75050 to operate at reduced gate drive as low as 5.5V. A bootstrap capacitor may be employed to provide the aforementioned battery supply voltage required for the N-channel MOSFET. The internal charge pump of the high-side drive allows for direct current (100% duty cycle) operation. The full bridge may be driven in fast decay mode or slow decay mode using diodes or synchronous rectification. In slow decay mode, current recirculation can pass through either the high-side or low-side FETs. The power FET is protected from breakdown by a resistor adjustable dead time. The overall diagnostics indicate undervoltage, overheating, and power bridge faults, and may be configured to protect the power MOSFETs in most short circuit situations. Other motor drives can be readily substituted.

The tracking system 75060 includes, for example, a controlled motor drive circuit arrangement that includes one or more position sensors, such as sensor 75080, sensor 75090, sensor 71502, and sensor array 71940. A position sensor for an absolute positioning system provides a unique position signal corresponding to the position of a displacement member. As used herein, the term displacement member is used generally to refer to any movable member of any of the clip appliers disclosed herein. In various instances, the displacement member may be coupled to any position sensor suitable for measuring linear or rotational displacement. The linear displacement sensor may comprise a contact displacement sensor or a non-contact displacement sensor. The linear displacement sensor may comprise a Linear Variable Differential Transformer (LVDT), a Differential Variable Reluctance Transducer (DVRT), a sliding potentiometer, a magnetic sensing system comprising a movable magnet and a series of linearly arranged hall effect sensors similar to the arrangement shown in fig. 75, a magnetic sensing system comprising a fixed magnet and a series of movable linearly arranged hall effect sensors similar to the arrangement shown in fig. 81A and 81B, an optical sensing system comprising a movable light source and a series of linearly arranged photodiodes or photodetectors, or an optical sensing system comprising a fixed light source and a series of movable linearly arranged photodiodes or photodetectors, or any combination thereof.

The position sensors 75080, 75090, 71502, and 71940 may include, for example, any number of magnetic sensing elements, such as magnetic sensors that are classified according to whether they measure the total or vector component of the magnetic field. The techniques for producing the two types of magnetic sensors described above encompass a number of aspects of physics and electronics. Technologies for magnetic field sensing include detection coils, flux gates, optical pumps, nuclear spins, superconducting quantum interferometers (SQUIDs), hall effects, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedances, magnetostrictive/piezoelectric composites, magnetodiodes, magnetotransistors, optical fibers, magneto-optical, and magnetic sensors based on micro-electromechanical systems, among others.

In various instances, one or more of the position sensors of the tracking system 75060 include a magnetic rotary absolute positioning system. Such a position sensor can be implemented AS an AS5055EQFT single-chip magnetic rotary position sensor available from australia Microsystems, AG, and can be engaged with the controller 75040 to provide an absolute positioning system. In some cases, the position sensor includes low voltage and low power components, and includes four hall effect elements located in a region of the position sensor near the magnet. A high resolution ADC and an intelligent power management controller are also provided on the chip. CORDIC processors (for coordinate rotation digital computers), also known as bitwise and Volder algorithms, are provided to implement simple and efficient algorithms to compute hyperbolic and trigonometric functions, which require only addition, subtraction, bit-shift and table-lookup operations. The angular position, alarm bits, and magnetic field information are transmitted to the controller 75040 over a standard serial communication interface such as an SPI interface. The position sensor may provide, for example, 12 or 14 bit resolution. The position sensor may be, for example, an AS5055 chip provided in a small QFN 16-pin 4 × 4 × 0.85mm package.

The tracking system 75060 may include and/or be programmed to implement feedback controllers such as PID, state feedback, and adaptive controllers. The power supply converts the signal from the feedback controller into a physical input, in this case a voltage, to the system. Other examples include Pulse Width Modulation (PWM) and/or Frequency Modulation (FM) of voltage, current, and force. Other sensors may be provided to measure physical parameters of the physical system other than location. In various instances, other sensors may include sensor arrangements, such as those described in the following patents: U.S. patent 9,345,481 entitled "STAPLE CARTRIDGE TISSUE thicssensor SYSTEM," which is hereby incorporated by reference in its entirety; U.S. patent application publication 2014/0263552 entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," which is hereby incorporated by reference in its entirety; and U.S. patent application Ser. No. 15/628,175 entitled "TECHNIQES FOR ADAPTIVE VECONTROL OF A SURGICAL STAPLING AND CUTTING INSTRUMENT," which is hereby incorporated by reference in its entirety. In a digital signal processing system, an absolute positioning system is coupled to a digital data acquisition system, wherein the output of the absolute positioning system will have a limited resolution and sampling frequency. The absolute positioning system may include comparison and combination circuitry to combine the calculated response with the measured response using an algorithm (such as a weighted average and a theoretical control loop) that drives the calculated response toward the measured response. The calculated response of the physical system takes into account characteristics such as mass, inertia, viscous friction, inductive resistance to predict the state and output of the physical system by knowing the inputs.

Thus, the absolute positioning system provides an absolute position of the displacement member upon power-up of the instrument, and does not retract or advance the displacement member to a reset (clear or start) position as may be required by conventional rotary encoders that simply count the number of forward or backward steps taken by the motor 75010 to infer the position of the device actuator, firing member, feeder drive, crimp drive, closure tube, etc.

The sensor 75080, which includes a strain gauge or a micro-strain gauge, for example, is configured to measure one or more parameters of the end effector of the clip applier, such as the strain experienced by the jaws during the crimping operation. In one embodiment, the sensor 75080 may include strain gauges 71720 and 71730 (fig. 79), for example, as described in more detail above. The measured strain is converted to a digital signal and provided to a processor 75020. In addition to or in lieu of sensor 75080, a sensor 75090 including a load sensor, for example, can measure the closing force applied to the jaws of the clip applier by the closure drive system. In various instances, a current sensor 75070 may be employed to measure the current drawn by the motor 75010. The force required to clamp the first and second jaws to crimp the clip can correspond to, for example, the current consumed by the motor 75010. The measured force is converted to a digital signal and provided to the processor 75020. A magnetic field sensor may be employed to measure the thickness of the trapped tissue. The measurements of the magnetic field sensors may also be converted to digital signals and provided to the processor 75020.

The controller 75040 can use measurements of tissue compression, tissue thickness, and/or force required to close the end effector and crimp a clamp around the tissue measured by the sensors to characterize the position and/or velocity of the tracked movable member. In at least one instance, the memory 75030 can store techniques, formulas, and/or look-up tables that can be employed by the controller 75040 in the evaluation. In various circumstances, the controller 75040 can provide the user of the clip applier with a choice as to the manner in which the clip applier should operate. To this end, the display 75044 may display various operating conditions of the clip applier and may include touch screen functionality for data entry. Further, the information displayed on display 75044 may overlap with images acquired via the imaging modules of one or more endoscopes and/or one or more additional surgical instruments used during the surgical procedure.

As mentioned above, the clip applier disclosed herein can include a control system. Each of the control systems may include a circuit board having one or more processors and/or memory devices. The control system is configured to, among other things, store sensor data, for example. They are also configured to store data identifying, for example, the type of clip applier attached to a handle or housing, such as handle 700 (fig. 29). More specifically, when attached to the handle or housing by a sensor, the type of clip applier can be identified, and the sensor data can be stored in the control system. In addition, they are also configured to store data including whether the clip applier has been previously used and/or how many clips have been ejected from a clip magazine or clip cartridge of the clip applier during operation. For example, this information may be obtained by the control system, for example, to assess whether the clip applier is suitable for use and/or has been used less than a predetermined number of times.

The surgical instrument systems described herein are actuated by an electric motor; the surgical instrument systems described herein may be actuated in any suitable manner. In certain examples, the motors disclosed herein may comprise a portion or portions of a robotic control system. For example, U.S. patent application serial No. 13/118,241 (now U.S. patent 9,072,535), entitled "SURGICAL INSTRUMENTS WITH robotic SURGICAL INSTRUMENTS," the entire disclosure of which is incorporated herein by reference, discloses several examples of robotic SURGICAL instrument systems in greater detail.