Ligature clips, such as the Teleflex Hemolockā¢ locking polymer clip, are used in various minimally-invasive procedures to ligate tissue in a simple, controlled way. However, currently these clips must be individually loaded into a clip applier apparatus and reloaded after each clip. In some procedures, the use of multiple clips is common, e.g., in a Cholecystectomy, 3 clips are routinely used. While multi-fire mechanisms exist for metal ligating clips, no such device exists for polymer locking clips due in part to their complexity.
The disclosed multi-fire clip applier is best understood with reference to the sequence of drawings labeled
Attached to the outer tube is are the clipping jaws 18. Opening and closing of the jaws is effected using a mechanism proximal to the applier, either through linear actuation (e.g., a bowden cable) or through rotary cams driven through a sleeve over the tube. In use, the user actuates the spring coil 14 to advance the distalmost clip C until it engages with or seats against capture features within the clipping jaws. The instrument is then moved into position with the jaws over the tissue to be ligated. The jaws are then closed, locking the clip C using the clipping features of the jaws. Clipping features for clip applier jaws are known to those skilled in the art and typically are specific to the type of clip to be used.
Guides, tracks, or other alignment/capture features in the jaws 18 allow the clip to advance to the clipping features without sliding out of the device. For example, lateral side walls 19 define tracks to prevent the clips from sliding laterally out of the jaws. These tracks could be configured as shown, or could be formed to fully enclose the bosses.
To apply an additional clip, the user actuates the spring to cause the next clip to advance to the jaws. As shown in
The pitch of the spring 14 should equal the horizontal distance between the clip actuation bosses when the clip is oriented such that it has the smallest profile when seen from a distal viewing orientation. This will allow it to be advanced by the coil without binding.
Each clip assists in pushing the distally adjacent clip along its path. The last clip is pushed along by a disk 20 which remains within the assembly.
The device could be configured as a reloadable, reusable device into which the user preloads several clips, or alternatively as a single, pre-loaded disposable device that would lock onto a reusable handle. The apparatus as described could having a longer shaft to hold more clips, and could possibly also be slightly flexible through the use of compliant materials in the outer sleeve and orientation prongs.