Drawings
Fig. 1 is a schematic structural view of a clip applier provided in an embodiment of the disclosure.
Fig. 2A-2B are schematic structural views of a cartridge provided by an embodiment of the present disclosure.
Fig. 3 is a schematic structural view of a clip provided in an embodiment of the present disclosure.
Fig. 4 is a cross-sectional view of a clip applier provided by an embodiment of the disclosure, with a jaw assembly in an open state.
Fig. 4A is a schematic structural diagram of the switching mechanism in fig. 4.
Fig. 4B is a schematic structural view of the coupling mechanism in fig. 4.
Fig. 5A is a schematic cross-sectional view of a portion of a clip applier provided in an embodiment of the disclosure, at the perspective of M-M of fig. 5B, wherein the clip feeding assembly is not in abutment with the clip.
Fig. 5B is a schematic cross-sectional view of a portion of the clip applier provided in an embodiment of the disclosure, at the view L-L of fig. 5A, wherein the clip feeding assembly is not in abutment with the clip.
Fig. 6A is a schematic cross-sectional view of a portion of the clip applier provided in an embodiment of the disclosure, at the perspective M-M of fig. 6B, with the clip feeding assembly abutting the clip and pushing the clip into the jaw assembly.
Fig. 6B is a schematic cross-sectional view of a portion of the clip applier provided in an embodiment of the disclosure, taken at the perspective L-L of fig. 6A, wherein the clip feeding assembly abuts the clip and pushes the clip into the jaw assembly.
Fig. 6C is a schematic cross-sectional view of a portion of a clip applier provided by an embodiment of the application, at the perspective M-M of fig. 6D, with the jaw assembly closed.
Fig. 6D is a schematic cross-sectional view of a portion of a clip applier provided by an embodiment of the application, at the view L-L of fig. 6C, with the jaw assembly closed.
Fig. 7 is a schematic view of the structure of the clip applier provided by the disclosed embodiments, wherein the wrench is in an open position and a portion of the handle housing of the clip applier is removed.
Fig. 8 is a schematic view of the structure of the clip applier provided by the disclosed embodiments, wherein the wrench is in an intermediate position and a portion of the handle housing of the clip applier is removed.
Fig. 9 is a schematic view of the structure of the clip applier provided by the disclosed embodiments, wherein the wrench is in a closed position and a portion of the handle housing of the clip applier is removed.
Fig. 10 is a schematic structural view of a guide pivot provided in an embodiment of the present disclosure.
Fig. 11 is another angular structural schematic view of a guide pivot provided in an embodiment of the present disclosure.
Fig. 12 is a schematic structural view of a guide channel according to an embodiment of the present disclosure.
Fig. 13 is a schematic structural view of a clip applier provided with an auxiliary drive mechanism, according to another embodiment of the disclosure, with portions of the handle housing of the clip applier removed, and the jaw assembly in an initial open state.
Fig. 14 is an enlarged view at a in fig. 13.
Fig. 15 is a schematic view of a slider in a clip applier according to another embodiment of the disclosure.
Fig. 16 is an exploded view of the slider shown in fig. 15.
Fig. 16A is a schematic view of another angle of the slider shown in fig. 15.
Fig. 16B is a schematic view of another angle of the slider shown in fig. 15.
Fig. 17 is a schematic view of a slide in mating relationship with a handle housing with a jaw assembly in an initial open state according to another embodiment of the present disclosure.
Fig. 18 is an enlarged view at B in fig. 17.
Fig. 19 is a schematic view of a slide in mating relationship with a wrench when a jaw assembly is in an initial open state, in accordance with another embodiment of the present disclosure.
Fig. 20 is a schematic structural view of a clip applier of another embodiment of the disclosure, with the jaw assembly in a partially closed condition.
Fig. 21 is an enlarged view of a portion C in fig. 20.
Fig. 22 is a schematic view of a slide in mating relationship with a wrench when the jaw assembly is in a partially closed condition, in accordance with another embodiment of the present disclosure.
Fig. 23 is a schematic structural view of a clip applier of another embodiment of the disclosure, with the handles reset to bring the jaw assembly into a reopened condition.
Fig. 24 is an enlarged view of D in fig. 23.
Fig. 25 is a schematic view of a slide in mating relationship with a wrench when the handles are reset to place the jaw assembly in a re-open state in accordance with another embodiment of the present disclosure.
Fig. 26 is a schematic view of a structure of a clip applier provided with an auxiliary drive mechanism, with portions of the handle housing of the clip applier removed, and with the jaw assembly in an initial open state, in accordance with yet another embodiment of the disclosure.
Fig. 27 is an enlarged view at E in fig. 26.
Fig. 28 is a schematic view of a slider in a clip applier according to yet another embodiment of the disclosure.
Fig. 29 is an exploded view of the slider shown in fig. 28.
Fig. 30 is a schematic view of a slide in mating relationship with a handle housing with a jaw assembly in an initial open state according to yet another embodiment of the present disclosure.
Fig. 31 is a schematic structural view of a clip applier of a further embodiment of the present disclosure, with a jaw assembly of the clip applier about to begin partially closing.
Fig. 32 is an enlarged view of F in fig. 31.
FIG. 33 is a schematic view of the slide and wrench engagement relationship of the clip applier jaw assembly as it is about to begin partial closure
Fig. 34 is a schematic structural view of a clip applier of a further embodiment of the disclosure, with the jaw assembly in a partially closed condition.
Fig. 35 is an enlarged view at G in fig. 34.
Fig. 36 is a schematic view of the slider in engagement with the wrench when the jaw assembly is in a partially closed condition.
Fig. 37 is a schematic view of a clip applier of a further embodiment of the disclosure, with the handles reset to bring the jaw assembly into a re-open condition.
Fig. 38 is an enlarged view at H in fig. 37.
FIG. 39 is a schematic view of the slider in mating relationship with the wrench when the jaw assembly is in a re-opened condition.
Reference numerals of the above drawings:
1-a handle assembly; 2-a head handle housing; 3-a handle housing; 4-wrench, 401-first drive, 402-second drive, 5-shaft assembly, 6-cartridge, 7-bottom, 8-first side, 9-second side, 10-entry, 11-first lateral barb, 12-second lateral barb, 13-inclined end, 14-jaw assembly, 15-first jaw, 16-second jaw, 22-clip, 23-first jaw, 25-first ear, 26-connection, 27-second jaw, 29-second ear, 30-engagement, 31-push grip block, 32-jaw drive tube, 33-bead, 34-shoe, 35-sleeve, 351-protrusion, 36-first return, 37-base, 38-guide slot, 39-guide face, 40-feed grip lever, 41-resilient bar, 42-feed grip block, 43-feed grip drive tube, 44-recess, 45-third return, 46-shoe, 62-seat, 63-first clutch member, 64-second guide pin, 68-guide face, 74-guide face, and 78-guide face, 82-third swivel arm, 83-guide wall, 84-blocking wall, 85-pivot end, 86-guide channel, 87-main channel, 88-opening, 89-secondary channel, 9-auxiliary drive mechanism, 91-slider, 911-abutment, 912-guide surface, 913-mounting cavity, 914-limit slot, 915-guide slot, 92-abutment, 921-swivel axis, 922-abutment plane, 923-ramp portion, 93-torsion spring, 94-platen, 95-guide pin, 951-first pin, 952-second pin, 96-spring, 97-connecting pin.
Detailed Description
In order to make the objects, technical solutions and advantages of the present disclosure more apparent, the present disclosure will be further described in detail with reference to the accompanying drawings and examples. It should be understood that the specific embodiments described herein are for purposes of illustration only and are not intended to limit the present disclosure. Based on the embodiments in this disclosure, all other embodiments that a person of ordinary skill in the art would obtain without making any inventive effort are within the scope of protection of this disclosure.
It is to be understood that the terms "proximal", "posterior" and "distal" and "anterior" are used herein with respect to a clinician manipulating the handles of the clip applier. The terms "proximal", "posterior" and "anterior" refer to the portion proximal to the clinician, and the terms "distal" and "anterior" refer to the portion distal to the clinician. I.e., the handle assembly is proximal and the jaw assembly is distal, e.g., the proximal end of a component represents an end relatively close to the handle assembly and the distal end represents an end relatively close to the jaw assembly.
In this disclosure, unless explicitly stated or limited otherwise, terms such as "connected," "coupled," and the like, are to be construed broadly, and may be, for example, fixedly connected, detachably connected, movably connected, or integrally formed, directly connected, indirectly connected via an intermediate medium, or in communication with each other between two elements or in an interaction relationship such as abutment. The specific meaning of the terms in this disclosure will be understood by those of ordinary skill in the art as the case may be. It should be noted that, when the terms "connected" and "connected" are used in the meanings defined by the corresponding terms, they are used in the excluding of the obvious cases, and not excluding other possible cases.
The term "axial" as used herein refers to the length of the sleeve 35.
The clips of the clip applier are arranged in the clip magazine in a pre-compressed state in which the clips are partially compressed to reduce the space occupied thereby, and are urged by the clip feed drive mechanism to enter the jaw assembly and open to an expanded state in the jaw assembly. Because the clip can creep after being compressed in the clip bin for a long time, elasticity is reduced, tension may be insufficient when the clip enters the jaw assembly, if the jaw opening angle is large, the clip cannot be well opened against the jaw (the clip is slow to open and the opening angle is small), and the clip is easy to fall off from the jaw, so that the use of the instrument is affected.
The utility model provides a clip applier can solve the tension insufficiency and lead to the unstable technical problem of clip when the clip gets into the jaw subassembly. The technical idea of the present disclosure is described in detail below with reference to the accompanying drawings.
Referring to fig. 1 to 4, fig. 1 is a schematic structural diagram of a clip applier according to an embodiment of the disclosure. Fig. 2A-2B are schematic structural views of a cartridge provided by an embodiment of the present disclosure. The cartridge 6 houses a plurality of clips 22. Fig. 3 is a schematic structural view of a clip provided in an embodiment of the present disclosure. Fig. 4 is a cross-sectional view of a clip applier provided by an embodiment of the disclosure, with a jaw assembly in an open state.
Referring to fig. 1, the present embodiment provides a clip applier, such as a continuous clip applier, for applying clip 22 to tissue or blood vessels. In general positional relationship, the clip applier includes an operating assembly 1, a shaft assembly 5 extending from the operating assembly 1, a transmission mechanism, a clip cartridge 6, and a jaw assembly 14 disposed at a distal end of the shaft assembly 5.
The operating assembly 1 comprises a body and a wrench 4. The body comprises a housing to which the wrench 4 is movably connected. The housing is divided into a head housing 2 and a handle housing 3 extending from the underside of the head housing 2 in a positional relationship, and the handle housing 3 and the wrench 4 constitute a handle assembly. The user can grasp the handle housing 3 with one hand and pull the wrench 4 with a finger so that the wrench 4 moves relative to the body, thereby driving the transmission mechanism to move.
In this embodiment, the wrench 4 has a forward movement and a reverse movement, and the direction of the forward movement and the direction of the reverse movement are opposite. The wrench 4 has an open position (the position of the wrench 4 shown in fig. 1), an intermediate position (the position of the wrench 4 shown in fig. 8) and a closed position (the position of the wrench 4 shown in fig. 9). After the wrench 4 moves forward from the open position under the action of external force, the free end of the wrench 4 can stay at the intermediate position close to the handle shell 3, and the wrench 4 is continuously pressed, so that the wrench 4 moves forward from the intermediate position to the closed position. When the wrench 4 is released in a state in which the wrench 4 is in the closed position, the wrench 4 is reversely moved from the closed position to the open position.
Referring to fig. 2A-2B, a cartridge 6 is provided to the shaft assembly 5. The proximal end of the cartridge 6 is connected to the body of the operating assembly 1 and the distal end of the cartridge 6 is connected to the jaw assembly 14. Before clamping, the clips 22 are placed in the clip magazine 6. Referring to fig. 2A, the cartridge 6 houses a plurality of clips 22, the plurality of clips 22 being sequentially arranged from the distal end to the proximal end of the cartridge 6, respectively a first clip, a second clip to an nth clip. The first clip is closest to the distal end of the cartridge 6 and is first fed into the jaw assembly 14. The clips 22 other than the first clip in the clip magazine 6 are defined as other clips. The clamp bin 6 comprises M stations, wherein the M stations are arranged from the far end to the near end of the clamp bin 6 and are respectively a first station, a second station and an M station, the first clamp is located at the first station of the forefront end, and the second clamp is arranged at the second station to the N station in sequence corresponding to the N clamp. M is more than or equal to 2, and M is more than or equal to N.
Referring to fig. 3, the clip 22 includes a first clip arm 23, a second clip arm 27, and a connecting portion 26 between the first clip arm 23 and the second clip arm 27. The connection 26 is flexible so that the first clamp arm 23 and the second clamp arm 27 can pivot relative to each other. One end of the first clamping arm 23 is connected with the connecting part 26, and the other end is provided with two first lugs 25, one first lug 25 is arranged on one side of the first clamping arm 23, and the other first lug 25 is arranged on the opposite side of the first clamping arm 23. One end of the second clip arm 27 is connected to the connecting portion 26, and the other end is provided with an engaging portion 30, and specifically, the engaging portion 30 is a curved C-shaped hook portion. The second clamping arm 27 is provided with two second lugs 29 near the clamping part 30, one second lug 29 is arranged on one side of the second clamping arm 27, and the other second lug 29 is arranged on the other opposite side of the second clamping arm 27.
The size of the engaging portion 30 is larger than the distance between the two first ear portions 25, and the two first ear portions 25 have a certain elasticity and can be deformed. Thus, the first clamping arm 23 and the second clamping arm 27 are close to each other under the driving of the external force, the clamping portion 30 moves between the two first ear portions 25, the two first ear portions 25 deform under the action of the clamping portion 30 to clamp the clamping portion 30 between the two first ear portions 25, the first clamping arm 23 and the second clamping arm 27 are fully clamped, the clamp 22 is in a closed state, and blood vessels or tissues placed between the first clamping arm 23 and the second clamping arm 27 can be effectively clamped and stopped.
Referring to fig. 2A-2B, the cartridge 6 includes an axially extending bottom portion 7 and opposed first and second side portions 8, 9. When the clip 22 is installed in the clip cartridge 6, the clip 22 is compressed, limited by the size and interior space of the clip cartridge 6. Specifically, the first arm 23 of the clip 22 abuts the first side 8 and the second arm 27 abuts the second side 9, so that the clip 22 is in a pre-compressed state, and the two arms are compressed but not compressed to a closed state, i.e. the two arms of the clip 22 are close to each other but not engaged.
The bottom 7 of the cartridge 6 is formed with a plurality of abutment assemblies along its length, one at each station. Referring to fig. 2A, each abutment assembly comprises a first transverse barb 11 and a second transverse barb 12. The first transverse barbs 11 are arranged in a row, the second transverse barbs 12 are arranged in a row, the first transverse barbs 11 and the second transverse barbs 12 are arranged on the bottom 7 in two rows, the first transverse barbs 11 are arranged close to the first side part 8, the second transverse barbs 12 are arranged close to the second side part 9, and the transverse barbs on each row are arranged at equal intervals along the axial direction. Each transverse barb is inclined from the bottom 7 of the cartridge 6 towards the distal end of the cartridge 6 and towards the interior of the cartridge 6, i.e. the proximal end of each transverse barb is connected to the bottom 7, the distal end being movable, in this embodiment the transverse barb is a distally lifted resilient tab. The distal end of each transverse barb is a beveled tip 13.
The first transverse barb 11 of each abutment assembly abuts against a first ear 25 of a clip 22 from behind the first ear 25 and the second transverse barb 12 abuts against a second ear 29 of the same clip 22 from behind the second ear 29. Specifically, when the angled end 13 of the first transverse barb 11 engages a first ear 25, the angled end 13 of the second transverse barb 12 engages a second ear 29 on the same side of the first ear 25. Thus, each abutment assembly is capable of preventing the clip 22 from entering an adjacent proximal station from the current station in the cartridge 6.
As the clip 22 moves axially forward, the clip 22 slidably contacts the forward transverse barb to press the transverse barb against the base 7 so that the clip 22 can pass smoothly over the transverse barb to allow the clip 22 to enter an adjacent distal station from the current station. Specifically, as the clip 22 moves axially forward, the first arm 23 of the clip 22 slides past the first transverse barb 11 in front of it, while the second arm 27 of the clip 22 slides past the second transverse barb 12 in front of it, causing both the first transverse barb 11 and the second transverse barb 12 to flex toward the base 7, so that the clip 22 passes smoothly over the first transverse barb 11 and the second transverse barb 12 to enter the adjacent distal station.
To apply the plurality of clips 22 in succession, the clip applier needs to perform three actions, a clip feeding action by the clip feeding driving mechanism, a jaw closing action (clip applying action) by the jaw driving mechanism, and a clip pushing action by the clip pushing driving mechanism.
Referring to fig. 1 and 4 in combination, the transmission mechanism includes a clip feed drive mechanism, a jaw drive mechanism, and a push clip drive mechanism. In response to movement of the wrench 4 from the open position to the intermediate position, the clip feed drive mechanism drives the first clip from the clip magazine 6 into the jaw assembly 14. In response to movement of the wrench from the intermediate position to the closed position, the jaw drive mechanism drives the jaw assembly closed to close the clips 22 in the jaw assembly, with the wrench 4 in the closed position, each push block being located on a rear side of the second clip through the nth clip, respectively. In response to movement of the wrench 4 from the closed position to the open position, the plurality of push clips 31 are advanced to drive the second clip to the nth clip, respectively, forward.
It should be noted that the descriptions of the specific structure of the clip feeding driving mechanism and the specific structure of the jaw driving mechanism and the specific structure of the push clip driving mechanism in the following embodiments are only exemplary, and are intended to be used for explaining the present disclosure, and are not to be construed as limiting the present disclosure.
The clip feed drive mechanism is used to drive clips 22 into the jaw assembly 14 (clip feed action), the push clip drive mechanism is used to drive other clips in the clip magazine 6 forward one station (push clip action), and the jaw drive mechanism is used to drive the jaw assembly 14 in motion. The wrench 4 drives the transmission mechanism to move, thereby driving the clip feeding driving mechanism, the clip pushing driving mechanism and the jaw driving mechanism to move, so that the clip feeding driving mechanism performs a clip feeding action, the clip pushing driving mechanism performs a clip pushing action, and the jaw driving mechanism performs a jaw closing action (clip applying action).
Referring to fig. 4, the jaw drive mechanism includes a jaw drive tube 32 and a sleeve 35. The jaw drive tube 32 is housed within the housing of the operating assembly 1. The sleeve 35 is fitted over the outside of the clip housing 6, and the sleeve 35 also forms part of the shaft assembly 5. The proximal end of the sleeve 35 is coupled to the jaw drive tube 32, and the distal end of the sleeve 35 mates with the jaw assembly 14, and in response to forward movement of the wrench 4 from the neutral position to the closed position, the jaw drive tube 32 moves distally to drive the sleeve 35 distally to thereby drive the jaw assembly 14 closed.
The jaw drive mechanism also includes a first reset member 36. The first reset member 36 is disposed within the head housing 2 of the clip applier and is disposed over the jaw drive tube 32. The proximal end of the first return member 36 abuts the stop 34 on the outer surface of the jaw drive tube 32 and the distal end abuts the inner wall of the head housing 2. The first return member 36 is configured to store energy as the jaw drive mechanism advances, and the first return member 36 returns to deformation to release the energy and thereby power the return of the jaw drive mechanism. For example, the first return member 36 is a spring.
Jaw assembly 14 includes a first jaw arm 15 and a second jaw arm 16, each pivotally connected to a distal end of cartridge 6. A second return member, for example a spring, is provided between the first 15 and second 16 jawarms for opening the jaws. As the jaw drive tube 32 drives the sleeve 35 distally, the jaw assembly 14 can be at least partially received within the sleeve 35 from the distal end of the sleeve 35 such that the jaw assembly 14 is closed, with the second return member between the two jawarms being compressed, while the first return member 36 is also compressed. When crimping is complete, sleeve 35 is moved proximally by first reset member 36, and jaw assembly 14 can be extended from the distal end of sleeve 35, and the second reset member can release energy to open jaw assembly 14.
Referring to fig. 5A-5B, the shaft assembly 5 further includes a base 37, the base 37 having a relatively high rigidity, the base 37 being disposed partially within the sleeve 35 and partially within the head housing 2. The base 37 is mounted on the outside of the bottom 7 of the cartridge 6. The clip 22, the first side 8 of the cartridge 6 and the second side 9 of the cartridge 6 are all located on the inside of the bottom 7, the inside and outside referring to the sides of the plane in which the bottom 7 lies.
Referring to fig. 4, 5A-5B, and 6A-6B, the pinch drive mechanism includes a pinch assembly and a pinch drive tube 43. The feed clip drive tube 43 is partially located within the jaw drive tube 32 and is axially movable within the jaw drive tube 32. The proximal end of the clip feed assembly is connected to a clip feed drive tube 43, which tube 43 moves distally to drive the clip feed assembly distally in response to forward movement of the wrench 4 from the open position such that the clip feed assembly drives the clip 22 from the clip magazine 6 into the jaw assembly 14. The guiding groove 38 is arranged on the base 37, the guiding groove 38 accommodates the clip feeding assembly and moves axially, the distal end of the guiding groove 38 is provided with a guiding surface 39, the guiding surface 39 is an inclined surface, the guiding surface 39 is arranged at an angle with the axial direction, and the guiding surface 39 is inclined from the proximal end to the distal end towards the direction approaching the clip bin 6. The bottom 7 of the cartridge 6 is provided with an inlet 10 corresponding to the guide surface 39.
The pinch drive mechanism further comprises a third return member 45, for example, the third return member 45 is a spring. Referring to fig. 4, the inner wall of the jaw drive tube 32 is provided with ribs 33. The distal end of the third restoring member 45 abuts against the rib 33 of the jaw drive tube 32, and the proximal end abuts against the distal end surface of the clip feeding drive tube 43. The third reset piece 45 is used for storing energy when the clip feeding driving mechanism advances, and the third reset piece 45 recovers deformation to release the energy so as to provide power for the reset and back of the clip feeding driving mechanism.
Referring to fig. 5A-5B, 6A-6B, the clip feed assembly includes a clip feed bar 40, an elastic bar 41, and a clip feed block 42. The proximal end of the pinch rod 40 is connected to a pinch drive tube 43, the distal end of the pinch rod 40 is connected to the proximal end of the elastic rod 41, and the distal end of the elastic rod 41 is connected to a pinch block 42. The clip feed lever 40 is rigid and does not deform easily, avoiding blocking of the clip feed assembly due to bending during axial movement in the guide slot 38.
Referring to fig. 5A-5B and fig. 6A-6B, the clip feed driving tube 43 drives the clip feed lever 40 to move distally, so that the elastic lever 41 and the clip feed block 42 also move distally, and the third restoring member 45 is deformed. When the resilient bar 41 moves distally to the point where the feed block 42 abuts the guide surface 39, the resilient bar 41 begins to flex and the feed block 42 is advanced obliquely along the guide surface 39 from the entrance 10 of the cartridge 6 between the first clip and the second clip within the cartridge 6 and abuts the first clip at the rear end of the first clip to advance into the jaw assembly 14.
After the clip 22 is clamped in the jaw assembly 14, the feed block 42 at the distal end of the resilient bar 41 continues to abut the clip 22 from the rear end of the clip 22 to prevent proximal (i.e., rearward) movement of the clip 22 during clamping. Closing jaw assembly 14 closes clip 22 and reopens jaw assembly 14 to disengage clip 22 from jaw assembly 14, i.e., complete application of the clip. After the jaw assembly 14 is closed, the clip feed assembly is reset by the third reset member 45, and in particular, the clip feed rod 40 moves axially proximally in the guide slot 38, driving the resilient rod 41 and the clip feed block 42 back from the inlet 10 into the guide slot 38 along the guide surface 39.
Referring to fig. 4, 5B and 6B, the push clip drive mechanism includes a push clip seat 46. The proximal end of the push holder 46 is located within the clip feed drive tube 43, and the other portion of the push holder 46 extends distally and is disposed within the sleeve 35, with the base 37 mounted on one side of the cartridge 6 and the push holder 46 disposed on the opposite side of the cartridge 6. The push holder 46 is axially movable in the feed gripper driving tube 43.
Referring to fig. 5A-5B and fig. 6A-6B, corresponding to M stations of the clamping magazine 6, M side cavities are provided on the push clamping seat 46 at intervals, and a push clamping block 31 is provided in each side cavity. Each push clamp block 31 is connected with the push clamp seat 46 through a spring 72. The spring 72 provides a force to the push clamp block 31 that rotates toward the outside of the side cavity, specifically tilting the distal end of the push clamp block 31 out of the side cavity toward the clip 22. In response to the push clips 46 being axially advanced distally, the distal end of each push clip block 31 abuts and pushes one clip 22 forward, respectively, such that the clip 22 moves axially distally and the clip 22 passes smoothly over the first transverse barb 11 and the second transverse barb 12, whereby the clip 22 enters the adjacent distal end station from the current station. Thereby, the pushing holder 46 pushes the other clips (clips 22 other than the first clip) in the clip magazine 6 forward by one station. When the push clip seat 46 retreats axially, the clip 22 cannot retreat under the action of the first transverse barb 11 and the second transverse barb 12, so that the push clip block 31 abuts against the clip and is extruded by the clip 22 to rotate into the side cavity, the push clip block 31 retreats proximally along the side surface of the clip 22, the clip 22 is avoided, and the push clip block 31 is prevented from retreating with the clip 22 during retreating.
As described above, the clip applier includes the transmission mechanism, and the wrench 4 drives the transmission mechanism to move, so that the clip feeding driving mechanism performs the clip feeding action, the jaw driving mechanism performs the clip applying action, and the clip pushing driving mechanism performs the clip pushing action.
Specifically, the transmission mechanism further comprises a switching mechanism and a matching mechanism. The structure and principle of the switching mechanism will be described in more detail below with reference to the placement direction and angle of the clip applier in fig. 4:
Referring to fig. 4, 4A and 4B, and fig. 7 to 9, the switching mechanism includes a housing 62, a first clutch 63, a clutch switching mechanism, and a second clutch 64. The seat 62 has a first kidney-shaped hole and a second kidney-shaped hole that are disposed opposite each other in a direction perpendicular to the paper surface (with reference to the placement angle of the clip applier in fig. 7). The first clutch member 63 is accommodated in the base 62, and the second clutch member 64 is a distal end surface of the base 62.
The clip feeding driving tube 43 is sleeved outside the clip pushing seat 46. The feed clip drive tube 43 is partially located within the jaw drive tube 32 and is axially movable within the jaw drive tube 32. The proximal end of the clip feed drive tube 43 is provided with circumferentially extending grooves 44. In the initial state, the seat 62 is sleeved outside the clamp driving tube 43, the bottom end of the first clutch member 63 is inserted into the groove 44, and the upper end of the first clutch member 63 is connected with the clutch switching mechanism.
The clutch switching mechanism includes a guide post 65 and a guide rail. The upper end of the first clutch 63 is connected to a guide post 65. The guide rail is provided in the head housing 2, and the guide post 65 is movable on the guide rail. The head housing 2 of the clip applier includes a first head housing and a second head housing (not numbered) disposed in a radial direction of the sleeve 35. The guide rails are symmetrically arranged on the inner walls of the first head housing and the second head housing 2. That is, the inner wall of the first head housing is provided with a guide rail, and the inner wall of the second head housing is also provided with a guide rail.
The guide post 65 is accommodated in the seat 62, and the guide post 65 has a first guide end and a second guide end. The first guide end of the guide post 65 is located on and movable on the guide rail of the inner wall of the first head housing after protruding from the first kidney-shaped hole, and the second guide end of the guide post 65 is located on and movable on the guide rail of the inner wall of the second head housing after protruding from the second kidney-shaped hole. Each kidney-shaped hole extends in the up-down direction, and the guide post 65 is movable in the up-down direction. The guide rail includes a first guide surface 66 and a second guide surface 67, the second guide surface 67 being higher than the first guide surface 66.
The wrench 4 pushes the base 62 to move the base 62 distally, and the first clutch 63 advances forward to drive the clip feeding driving mechanism to move distally to perform the clip feeding operation. The guide post 65 is capable of following the movement of the first clutch 63 to move on the guide rail. The first clutch 63 is kept engaged with the clip feed driving tube 43 while the guide post 65 moves on the first guide surface 66. Since the second guide surface 67 is higher than the first guide surface 66, when the guide post 65 moves onto the second guide surface 67 of the guide rail, the first clutch member 63 is driven to move upward, so that the first clutch member 63 is separated from the groove 44 of the clip feeding driving tube 43 and separated from the clip feeding driving tube 43.
During distal movement of the clip feeding drive mechanism by the wrench 4, the second clutch member 64 (distal end face of the housing 62) is gradually brought closer to the proximal end face of the jaw drive tube 32. In response to the first clutch member 63 being disengaged from the clip feed drive tube 43, the second clutch member 64 abuts the proximal end face of the jaw drive tube 32 to urge the jaw drive tube 32 to move, thereby driving the jaw drive mechanism to move to perform a jaw closing action.
One of the mating mechanisms is connected to the housing 62 and the other is connected to the proximal end of the push holder 46, with a distance between one of the mating mechanisms and the other. When the clip feeding driving mechanism advances, the clip pushing driving mechanism retreats to store energy, and the clip feeding action executed by the clip feeding driving mechanism is asynchronous with the clip pushing action executed by the clip pushing driving mechanism.
Referring to fig. 4, 7-9, the mating mechanism includes an upper rack 69, an intermediate member 71, and a lower rack 70, the intermediate member 71 including a first gear and a second gear. The upper rack 69 is engaged with a first gear, and the lower rack 70 is engaged with a second gear, and the first gear and the second gear are coaxially arranged and synchronously rotate. The clip feed drive tube is drivingly connected to the upper rack 69 and the clip feed drive tube is movable in the same direction as the upper rack 69, for example, as previously described, the housing 62 is drivingly connected to the clip feed drive tube, the housing 62 is connected to the upper rack 69, and the push holder 46 is connected to the lower rack 70. The upper rack 69 and the lower rack 70 move in opposite directions, and when the upper rack 69 moves distally, the lower rack 70 moves proximally. The upper rack 69 and the lower rack 70 are each disposed in the axial direction, and the first gear and the second gear are disposed between the upper rack 69 and the lower rack 70. The push-grip drive mechanism also includes a fourth reset member 68, one end of the fourth reset member 68 being connected to the handle housing and the other end being connected to the proximal end of a lower rack 70. For example, the fourth restoring member 68 is a spring.
The clip applier further includes a retaining mechanism that can abut against the clip feeding driving mechanism to prevent the clip feeding driving mechanism from backing when the first clutch 63 of the switching mechanism is separated from the clip feeding driving mechanism. When the wrench 4 is in the intermediate position, the user releases the wrench 4, and the stop mechanism still abuts against the clip feeding driving mechanism to prevent the clip feeding driving mechanism from retreating, as will be described later.
Referring to fig. 4 and 10 to 12, the backstop mechanism includes a guide pivot 73 and a biasing spring 74. The guide pivot member 73 has a pivot portion 76. The pivot 76 is pivotally connected to the handle housing by a first pivot axis such that the guide pivot 73 rotates relative to the handle housing about the first pivot axis. The biasing spring 74 gives a pushing force to the guide pivot member 73 so that the guide pivot member 73 tends to rotate clockwise. The guide pivot member 73 is provided with a stopper 79. The wrench 4 is relatively movably connected with the guide pivot 73. During movement of the wrench 4 from the open position to the intermediate position, the biasing spring 74 urges the guide pivot member 73 to rotate such that the stopper 79 approaches and abuts against the clip feed drive tube 43 to prevent rearward movement.
The guide pivot member 73 further has a force receiving portion 77, a guide portion 78, a first rotating arm 80 extending proximally from the pivot portion 76, and a second rotating arm 81 extending distally from the pivot portion 76. The guide pivot member 73 further includes a third arm 82 extending obliquely upward from the pivot 76, the third arm 82 making an obtuse angle with the first arm 80. The first arm 80 has a force receiving portion 77 at its distal end, the second arm 81 has a guide portion 78 at its distal end, and the third arm 82 has a retreating portion 79 at its distal end.
One end of the biasing spring 74 abuts the force receiving portion 77, and the other end abuts the handle housing. The first rotating arm 80 and the second rotating arm 81 form a lever with the first rotation axis of the pivoting portion 76 as a fulcrum, the biasing spring 74 and the guide portion 78 are located at two ends of the lever, and when the biasing spring 74 is in a compressed state, the biasing spring 74 applies a pushing force to the force receiving portion 77, so that the guide pivoting member 73 has a tendency to rotate clockwise, that is, the retaining portion 79 and the guide portion 78 also have a tendency to rotate clockwise (referring to the placement angle of the clip applier in fig. 4).
Referring to fig. 9, the wrench 4 is provided with a pivoting end 85 pivotally connected to the handle housing, and the wrench 4 rotates about the pivoting end 85. The wrench 4 also has a guide channel 86. Referring to fig. 10 and 11, the retaining mechanism of the present embodiment further includes a guide member 75, and the guide member 75 is disposed at a guide portion 78 of the guide pivot member 73. At least a portion of the guide 75 is received in the guide channel 86. When the wrench 4 is rotated about its pivoting end 85, the guide channel 86 rotates therewith, and the guide 75 rotates about the first rotation axis 76 of the pivot 76 under the influence of the biasing spring 74. Guide channel 86 is a circumferentially enclosed channel, and guide 75 is restrained from moving circumferentially within guide channel 86 and cannot leave guide channel 86, so that guide 75 cannot be disengaged from wrench 4 in this embodiment.
Referring to fig. 12, the guide channel 86 includes a start point a, a stop point b, and an end point c. The distance from the start point a to the pivoting end 85 of the wrench 4 and the distance from the end point c to the pivoting end 85 of the wrench 4 are smaller than the distance from the stop point b to the pivoting end 85 of the wrench 4. That is, the position of the stop point b is higher than the start point a and the end point c.
The guide passage 86 includes a main passage 87 and only one sub-passage 89 extending from an opening portion 88 of the main passage 87, the opening portion 88 being located between both ends of the main passage 87. The secondary channel 89 extends from the opening 88 of the primary channel 87 in a direction away from the pivoting end 85 of the wrench 4, i.e. the distance between the secondary channel 89 and the pivoting end 85 is greater than the distance between the primary channel 87 and the pivoting end 85. The main channel 87 has a start point a and an end point c at both ends, respectively. The stop point b is located in the secondary channel 89. The biasing spring 74 applies a force to the guide pivot member 73 such that the guide member 75 can disengage from the primary channel 87 into the secondary channel 89.
When the wrench 4 is in the open position, the guide 75 is located at the starting point a. The movement of the wrench 4 from the open position to the intermediate position causes the wrench 4 to drive the guide 75 to rotate clockwise from the start point a under the action of the biasing spring 74 to lift up into the passage 89 and move from the passage 89 to the stop point b. From the intermediate position, the wrench 4 moves to the closed position, and the wrench 4 moves the guide 75 from the stop point b in the channel 89 down to the end point c of the main channel 87. When the guide member 75 enters the slave passage 89, the guide pivot member 73 is rotated upward, so that the stopper 79 of the guide pivot member 73 moves upward.
Referring to fig. 12, the secondary channel 89 includes a blocking wall 84. The main channel 87 comprises a first wall extending from the starting point a to the connection with the blocking wall 84, the first wall and the blocking wall 84 being at right or acute angles. Thus, by a simple angular design of the guide channel 86, it is ensured that the blocking wall 84 effectively prevents the guide 75 from retracting from the stop point b to the starting point a, so that the wrench 4 can stay in the intermediate position.
To enable the guide 75 to move from the stop point b to the end point c, the secondary channel 89 further includes a guide wall 83. The main channel 87 further comprises a second wall extending from the end point c to be connected to the guide wall 83, the second wall making an obtuse angle with the guide wall 83. The simple angular design of the guide channel thus ensures that the guide 75 can move from the stop point b to the end point c.
Referring to fig. 11 and 12, when the user presses the wrench 4 to move the wrench 4 from the open position to the intermediate position, the guide 75 moves from the start point a to the stop point b, the guide 75 enters the slave passage 89 from the master passage 87, the guide pivot member 73 is lifted up by rotating upward, at this time, the first clutch member 63 is separated from the clip feeding drive tube 43, the second clutch member 64 abuts against the jaw drive tube 32, at this time, the clip applier is in the clip feeding completed state, the clip 22 is in the ready position, and the stop portion 79 moves up to abut against the clip feeding drive tube 43 to prevent the clip from moving backward.
The user continues to press the wrench 4, and the wrench 4 moves from the intermediate position to move the guide member 75 from the stop point b to the end point c, the guide member 75 continues to move in the channel 89, the guide pivot member 73 does not move downward, and the stop portion 79 keeps abutting against the clip feeding driving tube 43 to avoid the clip feeding driving tube 43 from retreating, so that the clip feeding block 42 abuts against the clip 22 at the proximal end of the clip 22, and the clip 22 does not retreat during clip application, thereby ensuring clip application stability. In this process, the second clutch member 64 abuts the jaw drive tube 32 and the switching mechanism drives the jaw drive mechanism to move distally to perform a jaw closing action (pinching action).
When the user continues to press the wrench 4 and the wrench 4 reaches the closed position and moves the guide 75 from the stop point b to the end point c in the main passage 87 along the secondary passage 89, the stop 79 moves below the clip feed drive tube 43, the stop 79 is separated from the clip feed drive tube 43, and the clip feed drive tube 43 is retracted by the third restoring member 45. When guide 75 reaches terminus c, the clip applier is in the clip applier-completed state and clip 22 held in jaw assembly 14 is compressed to the closed state. The wrench 4 is loosened, the jaw driving mechanism is reset under the action of the first reset piece 36, the switching mechanism is reset under the action of the fourth reset piece 68, and the wrench 4 is reset under the drive of the switching mechanism.
The working process of the transmission mechanism of the clip applier to execute the clip feeding action, the clip applier action and the clip pushing action is described in detail below:
When the wrench 4 is in the open position, the plurality of push clips 31 are located on the front sides of the second clip to the nth clip, respectively. The user presses the wrench 4 to move the wrench 4 from the open position toward the intermediate position, the wrench 4 pushes against the base 62 of the switching mechanism to move the switching mechanism distally, the guide post 65 moves on the first guide surface 66, the first clutch 63 advances with the switching mechanism and drives the clip feeding driving mechanism to move distally to perform the clip feeding action, and the upper rack 69 moves distally. In the process of moving the upper rack 69 distally, the upper rack 69 drives the lower rack 70 to retreat through the intermediate piece 71, and the lower rack 70 is connected with the pushing clamp seat 46 to further drive the pushing clamp seat 46 to retreat, so that the fourth reset piece 68 stores energy, and the pushing clamp blocks 31 respectively move proximally.
When the wrench 4 reaches the intermediate position, the guide post 65 of the switching mechanism moves onto the second guide surface 67 of the guide rail, the first clutch member 63 is separated from the clip feeding drive tube 43, the clip feeding drive mechanism is finished (the clip feeding action is completed), the clip 22 enters the jaw assembly 14, and the second clutch member 64 abuts against the proximal end surface of the jaw drive tube 32 to push the jaw drive tube 32 to move. The guide 75 of the retaining mechanism enters the secondary channel 89 from the main channel 87 of the guide channel 86, and the guide pivot 73 is lifted up in a rotating manner, which gives a click to the user, the wrench 4 is released when the wrench has reached the intermediate position, and the wrench 4 can stay in the intermediate position due to the blocking wall 84 of the guide channel 86. The clip feed block 42 of the clip feed drive mechanism continues to abut the clip 22 from the rear end of the clip 22 by the stop mechanism, retaining the clip 22 in the jaw assembly 14. As shown in fig. 6A and 6B, each push block 31 moves to one side of the second clip to the nth clip in the radial direction of the clip magazine 6, respectively. For example, taking the push block 31 located on the front side of the second clip when the wrench 4 is located at the open position as the distal-most push block 31 in fig. 5A and 5B, the push block 31 moves proximally to one side of the second clip in the radial direction of the clip magazine 6, and the two overlap in the radial direction of the clip magazine 6, as shown in fig. 6A and 6B, the push block 31 has not moved to the rear side of the second clip. The radial direction of the cartridge 6 is perpendicular to the axial direction of the cartridge 6, which is along the width direction of the cartridge. Taking fig. 6A as an example, the radial direction of the cartridge 6 is a direction perpendicular to the drawing plane.
When the wrench 4 is located at the middle position, the wrench 4 is pressed to enable the wrench 4 to move from the middle position towards the closed position, the stopping mechanism is gradually separated from the clip feeding driving tube 43, the switching mechanism continues to push the jaw driving mechanism and the upper rack 69 to advance under the action of the wrench 4, meanwhile, the upper rack 69 continues to drive the lower rack 70 to retreat through the middle piece 71, the lower rack 70 is connected with the pushing clamp 46, the pushing clamp 46 continues to retreat, and when the pushing clamp 46 retreats, the fourth reset piece 68 continues to store energy, and the jaw driving tube 32 drives the sleeve 35 to advance to close the jaw assembly 14. When the wrench 4 reaches the closed position, the jaw assembly 14 is closed (the clamping action is completed), the energy storage of the fourth reset member 68 is completed, the backstop mechanism is completely separated from the clamp feeding driving tube 43, and the clamp feeding driving tube 43 is reset under the action of the third reset member 45. As shown in fig. 6C and 6D, each push block 31 is moved proximally to the rear side of the second clip to the N-th clip, respectively, taking the push block 31 located on the front side of the second clip when the wrench 4 is located at the open position as an example, the push block 31 moves to the rear side of the second clip. Releasing the wrench 4, the jaw drive mechanism is reset by the first reset member 36 and the push grip block 46 is advanced by the fourth reset member 68 to advance the other clips in the cartridge 6 one station (push grip action completed).
Because the clip will creep after being compressed in the clip bin for a long time, the elasticity is reduced, and the tension may be insufficient when entering the jaw assembly, if the jaw opening angle is larger, the clip cannot be well opened against the jaw, and the movement of the clip in the jaw assembly is unstable, the clip may be distorted, or even may fall off from the jaw assembly, and the use of the clip applier is affected.
To solve the above-described problem, referring to fig. 13 to 21, the clip applier of another embodiment of the present disclosure further includes an auxiliary driving mechanism 9. In response to movement of wrench 4 from the open position to the intermediate position, the clip feeding drive mechanism drives clip 22 from clip cartridge 6 into jaw assembly 14, and auxiliary drive mechanism 9 pushes sleeve 35 distally to partially close jaw assembly 14 while clip 22 is in jaw assembly 14.
That is, the auxiliary drive mechanism 9 is configured such that the wrench 4, upon completion of the clip feeding action, simultaneously moves the sleeve 35 distally through the auxiliary drive mechanism 9 to partially close the jaw assembly 14. So that the clip 22 is secured against the jaw assembly 14 during entry into the jaw assembly 14, i.e., the first and second arms 23, 27 of the clip 22 abut the first and second jawarms 15, 16, respectively, and move along the first and second jawarms 15, 16, such that the clip is able to move steadily forward in the jaw assembly even when the width of the clip is small.
A detailed description is provided below in connection with a specific embodiment of the auxiliary drive mechanism 9. It should be noted that the description of the specific structure of the auxiliary drive mechanism 9 in the following embodiments is merely exemplary, and is intended to be illustrative of the present disclosure and not to be construed as limiting the present disclosure.
Referring to fig. 13 to 16, the auxiliary drive mechanism 9 includes a slider 91 and an abutment 92, the abutment 92 being movably connected with the slider 91. The slider 91 is movably provided to the handle housing 3.
Distal movement of the slider 91 may cause distal movement of the cannula 35, for example, with the distal end of the slider 91 provided with an abutment 911. The abutment 911 is for axially abutting the sleeve 35, thereby pushing the sleeve 35 to move distally in the axial direction of the sleeve 35. The abutment 911 is configured to be able to abut against a protrusion 351 on the outer wall of the sleeve 35, for example.
Referring to fig. 19, wrench 4 includes a first drive portion 401, with first drive portion 401 being configured to drive auxiliary drive mechanism 9 such that wrench 4, upon completion of a pinching motion, simultaneously moves sleeve 35 distally through auxiliary drive mechanism 9 to partially close jaw assembly 14. The wrench 4 further includes a second driving portion 402, where the second driving portion 402 is configured to abut against the seat body 62, and then sequentially drive the clip feeding driving mechanism to perform a clip feeding action, the jaw driving mechanism to perform a jaw closing action, and the clip pushing driving mechanism to perform a clip pushing action.
In the embodiment of the disclosure, when the wrench 4 is in the open position, in response to applying a force to the wrench 4 to move the wrench 4 from the open position to the intermediate position, the first driving portion 401 pushes the abutment 92 to move distally, which in turn drives the slider 91 to move distally and abut the sleeve 35, such that the slider 91 pushes the sleeve 35 to move distally, enabling the sleeve 35 to simultaneously partially close the jaw assembly when the clip 22 enters the jaw assembly 14 from the clip magazine 6.
During movement of the wrench 4 from the open position to the closed position, the first drive portion 401 is moved distally by the proximal abutment 92 in response to rotation of the wrench 4 such that the slide 91 pushes the sleeve 35 distally to partially close the jaw assembly, and the first drive portion 401 moves over the abutment 92 distally of the abutment 92 in response to continued rotation of the wrench 4, the first drive portion 401 is disengaged from the abutment 92.
The following is a specific explanation. Referring to fig. 13, 14, 17-19, with the wrench 4 in the open position, the jaw assembly 14 is in the open state. The open state is defined herein as an initial open state. As will be appreciated in connection with the foregoing, the forward most clip in cartridge 6 has not yet been pushed into jaw assembly 14. The first driving portion 401 is located on the proximal side of the abutment 92, but has not yet abutted to the abutment 92.
Referring to fig. 20-22, in response to a force applied to the wrench 4, the wrench 4 is moved from the open position to the intermediate position, and the first driving portion 401 gradually moves to abut against the proximal side of the abutment 92 during rotation of the wrench 4 by the first driving portion 401, which in turn pushes the abutment 92 to move distally. When the abutment 92 moves distally, the slider 91 is moved distally. As slider 91 is moved distally, abutment 911 at the distal end of slider 91 urges sleeve 35 distally, thereby partially closing jaw assembly 14, as shown in fig. 20, with jaw assembly 14 in a partially closed condition.
During movement of the wrench 4 from the open position to the intermediate position, the second drive 402 acts on the clip feed drive mechanism such that the clip feed drive mechanism pushes the forward-most clip 22 in the cartridge 6 into the jaw assembly 14. For example, the second driving unit 402 is brought into contact with the housing 62 to realize driving connection with the clip feeding driving mechanism.
In the present disclosure, the partially closed state of the jaw assembly 14 is one state intermediate between the initial open state and the closed state. In the partially closed state, the space in the jaw assembly 14 is reduced compared to the initial open state, thereby allowing the clip 22 to move steadily within the jaw assembly.
In the clip applier of the present disclosure, the wrench 4, upon completion of the clip feeding action, also moves the sleeve 35 via the auxiliary drive mechanism 9 to partially close the jaw assembly 14. In this case, in the process of completing the clip feeding operation, the first driving portion 401 abuts against the proximal end of the abutment 92, and the second driving portion 402 acts on the clip feeding driving mechanism, and both the operations are synchronized. The wrench 4 is rotated from the opening position to the middle position to realize the partial closing of the jaw assembly 14 and the entering of the clip into the jaw assembly 14, and the synchronization and stability of the two actions of the partial closing of the jaw assembly 14 and the entering of the clip 22 into the jaw assembly 14 are better.
In other embodiments of the present disclosure, in the process of completing the clip feeding operation, the first driving portion 401 abuts against the proximal end of the abutment 92, and the second driving portion 402 acts on the clip feeding driving mechanism, for example, the first driving portion 401 abuts against the proximal end of the abutment 92, and then the second driving portion 402 acts on the clip feeding driving mechanism, for example, when the device is specifically set, different abutment sequences can be achieved by adjusting the rotation radii of the first driving portion 401 and the second driving portion 402 according to the specific situation of the initial positions of the abutment 92 and the seat 62.
Referring to fig. 20-22, after wrench 4 has completed partially closing jaw assembly 14, and continued rotation of wrench 4, first drive portion 401 will slide along the proximal end of abutment 92 and beyond abutment 92 to the distal side of abutment 92. At this time, the first driving portion 401 is separated from the abutment 92.
The sleeve 35 is reset proximally to its initial position by the first reset member 36. After the cannula 35 is reset, the jaw assembly 14 is in a re-open state. In the reopened condition, the jaw assembly 14 has a clip 22 therein. Facilitating the physician to place the blood vessel in the jaw assembly 14 and adjust it to the proper position for the next clamping action. During the resetting of the sleeve 35, the sleeve 35 pushes the slider 91 proximally, thereby resetting the auxiliary drive mechanism 9 to the initial position.
In some embodiments, in response to rotation of the wrench 4 from the open position to the intermediate position, the first driving portion 401 first pushes the abutment 92 to move so that the abutment 92 drives the slider 91 to move distally along the axial direction of the sleeve 35 to effect the jaw portion to close, the wrench 4 continues to rotate, the first driving portion 401 is located distally of the abutment 92 and is separated from the abutment 92, the sleeve 35 is reset proximally by the first reset member 36 to effect the jaw to open again, for example, when the wrench 4 moves to the intermediate position, the first driving portion 401 of the wrench 4 is separated from the abutment 92 so that the sleeve 35 is reset proximally by the first reset member to open the jaw, at which time the wrench 4 may stay in the intermediate position, as described above, to facilitate the doctor to place a blood vessel in the jaw assembly 14 and adjust to a proper position for the next clamping action.
In response to movement of the wrench 4 from the intermediate position to the closed position, referring to fig. 8, the second drive portion 402 is still in abutment with the housing 62, and the second clutch member 64 is in abutment with the proximal end face of the jaw drive tube 32 to urge the jaw drive tube 32 to move, and the jaw drive tube 32 urges the sleeve 35 to move, such that the jaw assembly 14 is fully closed, completing the clamping action. This operation is described above, and will not be repeated here.
In some embodiments, the first driving portion 401 of the wrench 4 has also been axially separated from the auxiliary driving mechanism 9 at the same time as the gripping action of the wrench 4 is completed, i.e. the first driving portion 401 has passed beyond the abutment 92 to the distal side of the abutment 92. For example, the first driving portion 401 of the wrench 4 and the abutment 92 may be separated slightly before the clamping operation is completed, or the wrench 4 and the auxiliary driving mechanism 9 may be separated axially and the clamping operation of the wrench 4 may be completed simultaneously.
In some embodiments, when the wrench 4 is in the closed position, the wrench 4 moves from the closed position to the open position in response to withdrawing the force applied to the wrench 4, and the auxiliary drive mechanism 9 evades the wrench 4 to enable the wrench 4 to be reset toward the open position.
Referring to fig. 9, 23-25, after the clamping action is completed, the wrench 4 is in the closed position and the first drive portion 401 is distal of the abutment 92. Releasing the wrench 4, the first drive portion 401 will move proximally, the first drive portion 401 pushing the abutment 92 of the auxiliary drive mechanism 9 against the slide 91, thereby moving the abutment 92 to the unseated position to unseat the first drive portion 401, allowing the wrench 4 to be reset to the open position. The escape position is not a fixed position, but when the abutment 92 moves relative to the slider 91 to reach the fixed position, the abutment 92 is no longer on the movement path of the first driving portion 401, and the movement of the first driving portion 401 is not blocked, so that the wrench 4 can be smoothly reset.
For example, in the process of resetting the wrench 4 from the closed position to the open position, the first driving portion 401 abuts against the distal side of the abutment 92, the abutment 92 receives a force in the axial direction of the sleeve 35 and in the proximal direction, and the abutment 92 moves relative to the slider 91, so that the first driving portion 401 passes over the abutment 92 to the proximal side of the abutment 92, and the wrench 4 can be reset to the open position to perform the next clamping operation.
In some embodiments, the wrench 4 is rotatably coupled to the handle housing 3, and the slider 91 is linearly movable relative to the handle housing 3 in the axial direction of the sleeve 35. By translating the rotation of the wrench 4 into a linear movement of the auxiliary jaw drive mechanism 9 such that the direction of movement of the slider 91 is the same as the direction of movement of the sleeve, the sleeve 35 can be pushed more stably, which in turn effects a partial closure of the jaw assembly 14.
Referring to fig. 15 to 18, the clip applier further includes a pressing plate 94, and a guide pin 95, the guide pin 95 connecting the pressing plate 94 with the inner wall of the handle housing 3. The slider 91 is disposed between the pressing plate 94 and the inner wall of the handle housing 3, and the slider 91 is relatively slidably fitted with the guide pin 95 to guide the slider 91 to move linearly in the axial direction. The slider 91 is thus provided to the handle housing 3 so as to be movable relative to each other, and the presser plate 94 prevents the slider 91 from moving in the radial direction of the sleeve 35.
The guide pin 95 includes a first pin 951 and a second pin 952, wherein the first pin 951 and the second pin 952 are located at both sides of the slider 91, and a guide passage is formed between the first pin 951 and the second pin 952. One side of the slider 91 is also provided with a guide surface 912 that slidingly engages the first pin 951.
In some embodiments, the abutment 92 is rotatably coupled to the slide 91 such that the first drive portion 401 pushes the abutment 92 proximally in response to movement of the wrench 4 from the open position toward the closed position, thereby causing the slide 91 to push the sleeve 35 distally to partially close the jaw assembly, and such that the first drive portion 401 pushes the abutment 92 distally in response to movement of the wrench 4 from the closed position toward the open position, the abutment 92 rotates relative to the slide 91 to the retracted position, and the abutment 92 retracts the first drive portion 401, thereby resetting the wrench 4 to the open position.
In response to the application of force to the wrench 4 to move the wrench 4 from the open position to the closed position, e.g., during movement of the wrench 4 from the open position to the intermediate position, the first drive portion 401 pushes the abutment 92 proximally, the abutment 92 is subjected to a force in the axial direction of the sleeve 35 and distally, and the abutment 92 abuts the proximal end of the slider 91, thereby pushing the slider 91 distally;
In response to the withdrawal of the force applied to the wrench 4 to move the wrench from the closed position to the open position, the first driving portion 401 pushes the abutment 92 from the distal side, and when the abutment 92 receives the force in the axial direction of the sleeve 35 and in the proximal direction, the abutment 92 rotates relative to the slider 91 to the retracted position, so that the first driving portion 401 can go beyond the abutment 92 to the proximal side of the abutment, and the wrench 4 can be reset to the open position to perform the next clamping operation.
The auxiliary drive mechanism 9 further includes a biasing member that biases the abutment 92 toward the slider 91 so that the abutment 92 abuts against the slider 91. For example, the biasing member is a torsion spring 93, the torsion spring 93 being disposed between the abutment 92 and the slider 91, the torsion spring 93 urging the abutment 92 toward the proximal end of the slider 91. The abutment member 92 is rotatably mounted at the proximal end of the slider 91, for example, by a rotation shaft 921. The torsion spring 93 is fitted over the rotation shaft 921 of the abutment 92.
In some embodiments, the first driving portion 401 is a cylinder. The outer wall of the cylinder is an arc surface, and when the first driving part 401 pushes against the abutting piece 92 and slides on the abutting piece 92, the first driving part 401 is separated from the abutting piece 92 by the arrangement of the arc surface.
The operation of the clip applier is described below in connection with one embodiment.
Referring to fig. 13, 14, 18 and 19, with the wrench 4 in the open position, the jaw assembly 14 is in the open state. The first driving portion 401 is located on the proximal side of the abutment 92, but has not yet abutted to the abutment 92.
Referring to fig. 20 to 22, the wrench 4 moves from the open position toward the intermediate position. During rotation of the first drive portion 401 following the wrench 4, the first drive portion 401 gradually moves against the proximal end of the abutment 92, which in turn pushes the abutment 92 to move distally and the first drive portion 401 slides on the proximal end of the abutment 92 as the wrench rotates. When the abutment 92 moves distally, the slider 91 is moved distally. As slider 91 moves distally, abutment 911 at the distal end of slider 91 pushes sleeve 35 distally, thereby partially closing jaw assembly 14. At the same time, the second drive 402 drives the clip feed drive mechanism in motion, pushing the clip 22 into the jaw assembly 14.
When the wrench 4 is in the intermediate position, the first driving part 401 has passed over the abutment 92 and separated from the abutment 92, and the first driving part 401 moves to the distal side of the abutment 92, the sleeve 35 is reset to its initial position by the first reset member 36, the jaw assembly 14 is opened again, and the doctor can place the blood vessel in the jaw assembly 14 and adjust it to a proper position for the next action.
Referring to fig. 4, 8-9, continued rotation of the wrench 4 moves the wrench from the neutral position toward the closed position, and the second drive portion 402 of the wrench 4 drives the housing 62, the housing 62 drives the jaw drive tube 32 distally, and the jaw drive tube 32 pushes the sleeve 35 and closes the jaw assembly 14, thereby completing the crimping action.
Referring still to fig. 23 to 25, after the clamping operation is completed, the wrench 4 is released, the wrench 4 moves from the closed position toward the open position, the first driving portion 401 moves toward the proximal side, the first driving portion 401 pushes the abutment 92 from the distal side, and when the abutment 92 receives a force acting in the axial direction of the sleeve 35 and toward the proximal side, the abutment 92 rotates relative to the slider 91 against the elastic force of the torsion spring 93, so that the first driving portion 401 can reach the proximal side of the abutment beyond the abutment 92, and the wrench 4 can be reset to the open position, so that the next clamping operation can be performed.
As described above, with the clip applier of the presently disclosed embodiments, by providing the auxiliary drive mechanism 9, it is possible to achieve partial closure of the jaw assembly 14 while the clip 22 is being pushed into the jaw assembly 14, so that the clip 22 can be stably moved in the jaw assembly 14, preventing the clip from falling off.
Referring to fig. 26-29, another implementation of the auxiliary drive mechanism 9 is provided in a clip applier of a further embodiment of the present disclosure.
In some embodiments of the present disclosure, the abutment 92 moves linearly relative to the slide 91, the abutment 92 has an abutment plane 922 proximal and a ramp 923 distal, the first drive 401 moves the abutment 92 distally from the proximal abutment plane 922 in response to movement of the wrench 4 from the open position toward the closed position, the abutment 92 moves the slide 91 distally to move the sleeve 35 distally to partially close the jaw assembly, and the first drive 401 moves the abutment linearly relative to the slide 91 from the distal abutment ramp 923 to the dodged position in response to movement of the wrench 4 from the closed position toward the open position.
The abutment 92 abuts against the first driving portion 401 in the axial direction of the socket 35 during movement of the wrench 4 from the open position toward the closed position, and the abutment 92 is retracted from the first driving portion 401 of the wrench 4 during resetting of the wrench 4 from the closed position to the open position.
As described in detail below.
Referring to fig. 26-30, with the wrench 4 in the open position, the jaw assembly 14 is in an initial open state. The forward most clip 22 in the cartridge 6 has not yet been pushed into the jaw assembly 14. At this time, the first driving portion 401 is located proximal to the abutment 92, but has not yet abutted against the abutment plane 922 of the abutment 92.
In some embodiments of the present disclosure, referring to fig. 31-33, in response to applying a force to the wrench 4 to move the wrench 4 from the open position to the intermediate position, the first drive portion 401 will follow the wrench 4 and gradually approach the abutment plane 922. The first driving part 401 pushes against the abutment 92, the abutment 92 drives the slider 91 to move distally, and the slider 91 pushes the sleeve to move distally, so that the jaw assembly 14 is partially closed, during which the first driving part 401 always abuts against the abutment plane 922 and slides along the abutment plane 922 in response to the rotation of the handle 4. Referring to fig. 33, the first drive portion 401 is shown abutting against the abutment plane 922 when the jaw assembly 14 is in a partially closed condition.
In response to continued wrench rotation, the first drive portion 401 gradually moves away from the abutment plane 922, and with reference to fig. 34-36, the first drive portion 401 is about to disengage from the abutment plane 922 of the abutment 92. When the first drive portion 401 of the wrench 4 moves to disengage from the abutment 92, i.e., the first drive portion 401 is axially separated from the abutment 92 by the sleeve 35, the sleeve 35 is reset by the first resilient member 36, the jaw assembly 14 is in a reopened condition in which the clip 22 has entered the jaw assembly 14, facilitating the clinician to place a blood vessel in the jaw assembly 14 and adjust it to a proper position for a next clamping action, e.g., when the wrench 4 is in an intermediate position, and the wrench 4 may remain in an intermediate position as previously described.
When clamping is completed, the wrench 4 is in the closed position, with the first drive portion 401 distal to the abutment 92. At this time, in response to the withdrawal of the force to the wrench 4, the first driving portion 401 moves proximally and abuts against the slope portion 923. The first driving portion 40 moves the abutment 92 relative to the slider 91, so that the first driving portion 401 moves along the ramp portion and passes over the abutment 92, resetting the wrench 4 to the open position.
In the clip applier according to the embodiment of the disclosure, the wrench 4 moves the sleeve 35 to partially close the jaw assembly 14 through the auxiliary driving mechanism 9 in the process of completing the clip feeding action, so that the jaw assembly 14 is partially closed while the clip 22 is pushed into the jaw assembly 14, and the clip 22 can be stably abutted to the jaw assembly 14 without falling off.
In some embodiments, referring to fig. 27-29, the slider 91 moves linearly relative to the handle housing 3 in the axial direction of the cannula 35, and the abutment 92 moves relative to the slider 91 in a direction that is at an angle to the cannula axis, including 90 degrees. For example, the abutment plane 922 is perpendicular to the axial direction, and the bevel portion 923 is inclined with respect to the axial direction of the cannula 35, and the bevel portion 923 is inclined from the proximal end to the distal end in a direction approaching the axial direction of the cannula.
The abutment plane 922 is perpendicular to the axial direction of the sleeve 35, and provides a stable force bearing surface when the first driving portion 401 abuts against the abutment plane 922. The inclined surface portion 923 is inclined with respect to the axial direction of the sleeve 35, so that after the clamping action is completed and the wrench 4 is released, the inclined surface portion 923 plays a role of guiding the movement of the first driving portion 401, so that the first driving portion 401 smoothly passes over the abutment 92 and moves to the proximal side.
The slider 91 has a guide groove 915 along the axial direction of the sleeve 95. The clip applier further comprises a pressing plate 94 and a guide pin 95, wherein the guide pin 95 connects the pressing plate 94 with the handle housing 3 and penetrates through the guide groove 915, so that the sliding piece 91 is movably arranged on the handle housing 35 along the axial direction of the sleeve 35.
In some embodiments, referring to fig. 27-29, the slider is provided with a mounting cavity 913. The abutment 92 is partially housed within the mounting cavity 913. The auxiliary driving mechanism 9 further includes an elastic member 96, where the elastic member 96 is located in the mounting cavity and is disposed between the abutment member 92 and the slider 91, and in response to the first driving portion 401 pushing against the inclined surface portion 923, the abutment member 92 moves relative to the mounting cavity 913 of the slider 91 against the elastic force of the elastic member 96, so that the first driving portion 401 passes over the abutment member 91 to achieve a reset. The elastic member 96 is, for example, a spring.
The auxiliary driving mechanism 9 further includes a limiting slot 914 and a connecting pin 97, for example, the limiting slot 914 is disposed in the mounting cavity 913, and the connecting pin 97 is connected to the abutment 92 and slidably engaged with the limiting slot 914. The limiting groove 914 extends along the moving direction of the abutting piece 91, and the connecting pin 97 extends into the limiting groove 914. When the abutment 92 moves relative to the slider 91, the connecting pin 97 is slidably engaged with the limiting groove 914 to restrict the movement track of the abutment 92. In addition, the abutment 92 is partially accommodated in the mounting cavity 913, and when the abutment 92 moves relative to the slider 91, the abutment 91 slidably engages with the inner wall of the mounting cavity 913, so that the movement of the abutment 92 is smoother.
Of course, the manner in which the abutment 92 is movably connected to the slider 91 is not limited to the above. In other embodiments, the abutment 92 may be directly connected to the slider 91 by the elastic member 96, for example, by connecting one end of the elastic member 96 to the abutment 92 and the other end of the elastic member 96 to the slider 91, the connection between the abutment 92 and the slider 91 may be achieved.
In summary, by providing the auxiliary drive mechanism 9, the wrench 4, upon completion of the pinching motion, moves the sleeve 35 distally by the auxiliary drive mechanism 9 to partially close the jaw assembly 14. The clip 22 is thus able to ensure abutment against the jaw assembly 14 during entry into the jaw assembly 14, i.e. the first and second arms 23, 27 of the clip 22 abut the first and second jawarms 15, 16 respectively and move along the first and second jawarms 15, 16, so that the clip is able to move steadily forward in the jaw assembly even at small opening amplitudes, avoiding twisting or falling out of the jaws.
It should be understood that although the present disclosure describes embodiments, not every embodiment is provided with a separate embodiment, and that this description is for clarity only, and that the skilled artisan should recognize that the embodiments may be combined as appropriate to form other embodiments that will be understood by those skilled in the art.
The above list of detailed descriptions is only specific to practical embodiments of the present disclosure, they are not intended to limit the scope of the present disclosure, and all equivalent embodiments or modifications that do not depart from the spirit of the present disclosure should be included in the scope of the present disclosure.