Surgical clip application assembly
View Patent ↗An apparatus for the transoral invagination and fundoplication of the stomach to the esophagus includes a clip applier having sharp toothed jaws for grasping and damaging the fundus prior to applying the clip. The clip applier has an overall diameter of less than 7 mm. The clip applier jaws are coupled to a pull wire via a linkage which increases the mechanical advantage and thus permits greater grasping force. A plurality of clip designs are also provided.
1. A surgical clip applier, comprising:
a) a hollow member having a proximal end and a distal end;
b) a clevis coupled to said distal end of said hollow member;
c) a first jaw rotatably coupled to said clevis;
d) a second jaw rotatably coupled to said clevis in opposed relation to said first jaw, said first and second jaws adapted to apply a surgical clip;
e) at least one pull/push wire coupled to said first and second jaws and extending through said hollow member to said proximal end of said hollow member; and
f) actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first and second jaws about said clevis from an open to a closed position, wherein:
at least one of said jaws is provided with a plurality of teeth arranged to puncture and damage tissue adjacent to the surgical clip;
each of said jaws has a clip guiding channel and a hook shaped anvil at the end of said channel; and
each of said anvils has a helical surface.
2. A surgical clip applier according to claim 1 , wherein:
each of said anvils has a curved surface.
3. A surgical clip applier according to claim 2 , wherein:
said surface is curved about a single axis.
4. A surgical clip applier according to claim 1 , wherein:
each of said jaws has a longitudinal axis and a vertical axis perpendicular to the longitudinal axis, and
each of said channels is arranged at an angle relative to said vertical axis.
5. A surgical clip applier according to claim 4 , wherein:
said angle is approximately 22 degrees.
6. A surgical clip applier, comprising:
a) a hollow member having a proximal end and a distal end;
b) a clevis coupled to said distal end of said hollow member;
c) a first jaw rotatably coupled to said clevis, said first jaw having a first clip guiding channel terminating in a first anvil;
d) a second jaw rotatably coupled to said clevis in opposed relation to said first jaw, said second jaw having a second clip guiding channel terminating in a second anvil;
e) at least one pull/push wire coupled to said first and second jaws and extending through said hollow member to said proximal end of said hollow member; and
f) actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first and second jaws about said clevis from an open to a closed position, wherein:
each of said anvils has a helical surface.
7. A surgical clip applier according to claim 6 , wherein:
each of said jaws has a longitudinal axis and a vertical axis perpendicular to the longitudinal axis, and
each of said channels is arranged at an angle relative to said vertical axis.
8. A surgical clip applier according to claim 7 , wherein:
said angle is approximately 22 degrees.
9. An endoscopic surgical instrument, comprising:
a) a hollow member having a proximal end and a distal end;
b) a clevis coupled to said distal end of said hollow member;
c) a first end effector rotatably coupled to said clevis;
d) a first pull/push wire extending through said hollow member to said proximal end of said hollow member;
e) a first linkage including a first rotating element rotatably coupled to said clevis and coupled to said first push/pull wire, and a second element rotatably coupled to said first element and rotatably coupled to said first end effector; and
f) actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first end effector about said clevis.
g) a second end effector rotatably coupled to said clevis and in opposed relation to said first end effector;
h) a second pull/push wire extending through said hollow member to said proximal end of said hollow member; and
i) a second linkage including third and fourth elements, said third element rotatably coupled to said clevis and coupled to said second push/pull wire, and said fourth element rotatably coupled to said third element and rotatably coupled to said second end effector,
wherein said actuation means is coupled to said second push/pull wire for moving said second push/pull wire through said hollow member to cause a rotation of said second end effector about said clevis.
10. An endoscopic surgical instrument according to claim 9 , wherein:
said first and third elements each comprise a substantially L-shaped member having an elbow rotatably coupled to said clevis.
11. An endoscopic surgical instrument according to claim 10 , wherein:
each substantially L-shaped member has a first arm of a first length to which said first and second push/pull wires are respectively coupled and a second arm of a second length to which said second and fourth elements are respectively coupled, said first length being longer than said second length.
12. An endoscopic surgical instrument according to claim 11 , wherein:
said second element has a third length, said third length being shorter than said first length.
13. An endoscopic surgical instrument, comprising:
a) a hollow member having a proximal end and a distal end;
b) a clevis coupled to said distal end of said hollow member;
c) a first end effector rotatably coupled to said clevis;
d) a first pull/push wire extending through said hollow member to said proximal end of said hollow member;
e) a first linkage including a first rotating element rotatably coupled to said clevis and coupled to said first push/pull wire, and a second element rotatably coupled to said first element and rotatably coupled to said first end effector; and
f) actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first end effector about said clevis, wherein:
said first element is a substantially L-shaped member having an elbow rotatably coupled to said clevis.
14. An endoscopic surgical instrument according to claim 13 , wherein:
said substantially L-shaped member has a first arm of a first length to which said first push/pull wire is coupled and a second arm of a second length to which said second element is coupled, said first length being longer than said second length.
15. An endoscopic surgical instrument according to claim 14 , wherein:
said second element has a third length, said third length being shorter than said first length.