US20020046961A1 - Surgical clip holder and method therefor - Google Patents

Abstract

The surgical clip holder retains a plurality of surgical clips which are removed by clip carrying jaws of a clip appliance. The holder includes a pedestal base which defines clip retaining depressions between intervening lands. A superstructure with a plurality of flexible guide ribs is mounted on the pedestal base. In one embodiment, finger tabs from a rim of the superstructure retain lower clip leg segments. At least one of the tabs has an aperture for receiving a lower leg segment of the clip. The aperture helps ensure consistent placement of the clip within the depressions to facilitate alignment and registration of the clip with the jaws of the clip appliance.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• This application is a continuation-in-part of application Ser. No. 09/692,022, filed Oct. 19, 2000, the entire content of which is hereby incorporated by reference.[0001]
FIELD OF THE INVENTION
• The present invention relates to a surgical clip holder and a method therefor.[0002]
BACKGROUND OF THE INVENTION
• Surgical clips are sometimes utilized by physicians and other medical personnel to clamp blood vessels and other organic bodies, biological systems and structures. The surgical clips are typically quite small and are generally V-shaped or U-shaped. The height of these clips sometimes is 5 mm and the span of the clips is on the order of 2-3 mm. Surgeons or other medical professionals close these clips with clip appliances. The clip appliances typically include clip carrying jaws.[0003]
• A single clip appliance can be utilized to dispense many surgical clips if the clips are readily accessible during the surgical procedure. Typically, a plurality of surgical clips are retained in a clip holder.[0004]
• U.S. Pat. No. 4,936,447 to Peiffer discloses a clip holder wherein each clip is loosely supported on a pedestal base. The pedestal base has clip carrying depressions thereon and intervening raised lands. In one embodiment, the Peiffer '447 clip holder includes centering protrusions extending laterally from the side walls of the raised lands. When the clip is retained in the depression, the centering protrusions grasp the surgical clip on either side of the clip. In another embodiment, the Peiffer '447 clip holder loosely retains the clips on a pedestal and a pair of opposing fingers grasp opposing legs of the clip. The opposing fingers have a downward angle which ensures that the clip carrying jaws of the clip applicator meet minimal resistance from the fingers as the clip jaws are placed over the clips. The down angle of the fingers also enables the clip jaws to grasp the clip below an intermediate bend in the legs of the surgical clip. The down angle further ensures that the clip is always in positive contact with either the fingers or the applicator clip jaws. The jaws of the clip applicator contact the surgical clip before the fingers are pushed out of the way. The clips loosely rests on the pedestal in that there is no frictional contact between the clip and the pedestal. See also U.S. Pat. No. 4,972,949 to Peiffer.[0005]
• U.S. Pat. No. 4,294,355 to Jewusiak discloses a surgical clip holder wherein the surgical clips are loosely held on a vertical post from a pedestal base and finger springs extend from base side walls to stabilize the loosely hanging surgical clip. The clip also has a spacer shaped leg and that leg of the clip rests on a small ledge rising above the pedestal base.[0006]
• U.S. Pat. No. 3,713,533 to Reimels discloses a surgical clip holder wherein the clip is spring loaded in the holder between a base pedestal and opposing side walls or ledges. To remove the Reimels surgical clip, clip carrying jaws collapse the surgical clip about the pedestal.[0007]
• U.S. Pat. No. 4,146,130 to Samuels discloses a surgical clip holder wherein the clips are maintained in tension between a pedestal base and side walls of the clip holder. The tension is released when the clip carrying jaws of the clip applicator bend the clip legs downward about the pedestal base stand.[0008]
• U.S. Pat. No. 4,361,229 to Mericle discloses a clip holder which retains the clip with fingers extending from the side walls of the retainer. The clips are loosely hung on a vertical post or pedestal. The clip jaws first move the fingers away from the surgical clip and then lock onto special protruding side tabs from the clip legs.[0009]
• U.S. Pat. No. 3,631,707 to Miller discloses a clip holder wherein the clips are closely mounted by an interference fit on a pedestal stand in the clip holder.[0010]
• U.S. Pat. No. 4,076,120 to Carroll discloses a clip holder wherein the clips are loosely held on a pedestal stand by side wall protrusions. The side walls which define the clip retaining cavities, flex laterally outward upon insertion of the clip carrying jaws of the clip applicator.[0011]
• U.S. Pat. No. 4,344,531 to Giersch discloses a clip holder which retains clips somewhat like a common stapler, i.e., loaded on a pedestal base with a biased clip pusher wall.[0012]
• U.S. Pat. No. 4,696,396 to Samuels discloses a surgical holder wherein the clips are closely mounted on a pedestal base and are retained in place by side wall protrusions from side walls defining clip cavities.[0013]
• U.S. Pat. No. 4,212,930 to Raczkowski discloses a wound clip rack. U.S. Pat. No. 4,685,564 to Hills discloses a blade holder magazine.[0014]
OBJECTS OF THE INVENTION
• It is an object of the present invention to provide a surgical clip holder which retains the clips with an interference fit on a base pedestal.[0015]
• It is an additional object of the present invention to provide a surgical clip holder wherein the clip carrying jaws of a clip appliance are guided through a flexible rib cage to the clips aligned with rib defined gaps in the rib cage.[0016]
• It is an additional object of the present invention to provide a clip holder which loosely compresses or holds the top of the surgical clip in a clip retaining depression on the base pedestal.[0017]
• It is another object of the present invention to provide a method of retaining and retrieving surgical clips wherein the flexible rib cage acts as an arcuate guide and the rib cage flexes laterally upon insertion of the clip carrying jaws.[0018]
SUMMARY OF THE INVENTION
• The surgical clip holder retains a plurality of surgical clips therein. The surgical clips are adapted to be removed from the clip holder by clip carrying jaws of a clip appliance. The holder includes a pedestal base which defines clip retaining depressions separated by intervening lands. Each depression is adapted to retain a corresponding clip therein. A superstructure, including a base and a plurality of flexible ribs, is mounted on and over the pedestal base. The ribs have a height exceeding the height of the pedestal. Each pair of ribs forms a guide towards a corresponding clip retaining depression on the pedestal. The ribs act as a guide for clip carrying jaws of a clip appliance and flex apart during insertion of the jaws and retrieval of the clip from the clip retaining depression. In a further refinement of the invention, the ribs are arcuate elements, each having an apex and each carrying a depending finger at its apex. The depending finger is adapted to rest atop the clip retained in the respective depression. Preferably, the depending finger is L-shaped with the vertical portion of the L element disposed in a plane defined by the rib and the horizontal L element extending into the interspace between adjacent ribs. The lower depending surface of the L-shaped finger gently rests atop the apex of the surgical clip. When the clip carrying jaws are inserted through the guide plane defined by the pair of ribs, the ribs flex laterally apart (since the interspace between the ribs is smaller than the lateral span of the clip carrying jaws), the L-shaped finger moves away from the top of the clip, the clip carrying jaws grasp the clip and retrieve the clip. The clip, when withdrawn from the pedestal base, is far removed from the pedestal by the time the rib guides flex back to original, parallel plane positions and the finger tip moves back into the interspace.[0019]
• In a further embodiment, finger tabs from a rim of the superstructure retain lower clip leg segments. At least one of the finger tabs has an aperture for receiving one clip leg to facilitate registration of the jaws of the clip appliance with the clip. The aperture is shaped to receive at least a portion of one of the legs of a clip disposed in a corresponding clip depression. Examples of suitable shapes include round, rectangular, and keyhole. If the finger tab is bifurcated, the aperture is formed between the forked end. Alternatively, the aperture can be located at some distance from the end of the finger tab. A slit can extend from the end to the aperture to allow the aperture to flex open.[0020]
• The method of retaining and retrieving the surgical clips includes supporting and retaining the clips with an interference fit about substantially the entirety of the underside of the clip. The method includes providing a flexible rib cage acting as arcuate guides. Apertures for receiving at least one of the legs of the clip are also provided. Clip carrying jaws of the clip appliance are guided through adjacent rib guides towards the clip while the rib guides flex laterally outboard. The aperture on the finger tabs facilitates alignment of the jaws with the clip. The clip is gripped by the clip retaining jaws of the clip appliance and the clip is withdrawn from the pedestal's interference fit thereby permitting the adjacent rib guides to return to an initial, parallel plane position. In preferred embodiment, the method includes a step of gently compressing or holding the top end of the clip when the clip is retained with the interference fit.[0021]
BRIEF DESCRIPTION OF THE DRAWINGS
• Further objects and advantages of the present invention can be found in the detailed description of the preferred embodiments when taken in conjunction with the accompanying drawings in which:[0022]
• FIGS.[0023]1-4B diagrammatically illustrate the pedestal base wherein FIG. 1 is a side elevational view, FIG. 2 is a top view, FIG. 3 is a cross-sectional view from the perspective ofsection line3′-3″ in FIG. 2, FIG. 4A is a cross-sectional view fromsection line4A′-4A″ in FIG. 2 and FIG. 4B is a diagrammatic view of the pedestal base with a clip mounted thereon;
• FIGS.[0024]5-8B diagrammatically illustrate one embodiment of the superstructure of the surgical clip holder wherein FIG. 5 is a diagrammatic, side elevational view, FIG. 6 is a top view, FIG. 7 is a cross-sectional view fromsection line7′-7″ in FIG. 6, FIG. 8A is a cross-sectional view from the perspective ofsection line8A′-8A″ and FIG. 8B is a front elevational view;
• FIG. 9 diagrammatically illustrates the surgical clip holder with four (4) surgical clips retained by the holder and two (2) empty clip retaining depressions;[0025]
• FIG. 10 is a detailed, partial, cross-sectional view of the L-shaped finger depending from the apex of a rib guide;[0026]
• FIGS.[0027]11-13 diagrammatically illustrate mounting the surgical clip on the pedestal base, mounting the rib guide superstructure on the pedestal base and a cross-sectional view of the clip holder with a retained clip generally from the perspective ofsection line8A′-8A″ in FIG. 6, respectively;
• FIGS.[0028]14A-14D diagrammatically illustrate a clip carrying jaw of a clip appliance capturing and grabbing the clip while the guide ribs flex laterally apart;
• FIGS. 15 and 16 diagrammatically illustrate a side elevational view and a cross-sectional view of the surgical clip holder with jaw bumpers on the rib guides;[0029]
• FIG. 17 is a partial, cross-sectional, detail view of one type of rib guide and the depending L-shaped finger;[0030]
• FIG. 18 diagrammatically illustrates a jaw bumper placed at an arcuate position on the rib guide such that as the clip carrying jaws move from open span position A to open span position B, the rib guides flex further laterally outboard (FIG. 14D) due to the presence of a larger, lateral bumper at position B as compared the lateral size of the bumper at position A;[0031]
• FIGS.[0032]19A-19C diagrammatically illustrate the clip carrying jaws moving from initial position A to initial position B and the greater lateral outboard movement (FIG. 14D) caused by a specially positioned jaw bumper;
• FIGS.[0033]20-23B diagrammatically illustrate another embodiment of the clip holder wherein FIG. 20 is a side elevational view, FIG. 21 is a top view, FIG. 22 is a cross-sectional view fromsection line22′-22″, FIG. 23A is a cross-sectional view fromsection line23A′-23A″ and FIG. 23B is a front elevational view;
• FIGS.[0034]24-27 diagrammatically illustrate mounting the surgical clip on the pedestal base, mounting the superstructure on the pedestal base wherein the superstructure includes finger tabs, a diagrammatic cross-sectional view of the assembled clip holder and a detail view of the finger tab effecting the lower distal end of the surgical clip;
• FIGS.[0035]28A-28D diagrammatically illustrate grasping and retrieving the surgical clip, the flexing of the guide ribs and the depression of the finger tab upon full insertion of the clip jaws in the clip holder;
• FIG. 29 diagrammatically illustrates a portion of another embodiment of the finger tabs in which the finger tabs have an aperture for receiving one leg of the clip;[0036]
• FIGS.[0037]30A-30D are top views of different embodiments of the finger tabs having an aperture; and
• FIG. 31 diagrammatically illustrates a clip carrying jaw of a clip appliance capturing and grabbing the clip.[0038]
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The present invention relates to a surgical clip holder and a method therefor.[0039]
• FIGS.[0040]1-4B diagrammatically illustrate the base pedestal utilized in connection with the certain rib guide superstructures one of which is shown in FIGS.5-8B and the other of which is shown in FIGS.20-23B. Although the embodiments may be combined, the combination is currently not the preferred clip holder structure. Similar numerals designate similar items throughout the drawings.
• FIG. 1 diagrammatically illustrates a side elevational view of[0041]pedestal base10. FIG. 5 diagrammatically illustrates a side elevational view ofsuperstructure12. FIG. 15 shows a modified version ofsuperstructure12 and FIG. 20 shows another embodiment of the superstructure.
• FIGS.[0042]1-2 are discussed concurrently herein.Pedestal base10 includes a central pedestal stand14 defining, at laterally spaced apart positions, clip retaining depressions, two of which are identified asclip retaining depressions16 and18. Although a plurality ofclip retaining depressions16,18 are defined between interveninglands17,19, the clip retaining depression will be referenced with asingle numeral18 hereinafter.Lands19,21 will be identified as necessary in the drawings. There is no substantial difference between the plurality of clip depressions and intervening lands other than the depressions are laterally spaced apart along upright stand14 as are the intervening lands. Each clip depression is adapted to retain a surgical clip therein.Surgical clip20 is shown in FIG. 4B.
• [0043]Pedestal base10 includes abase platform22 and keyway defining feet24. FIG. 4B showsfeet24 defining akey way25. Pedestal stand14 is sometimes referred to herein as “pedestal14.”
• FIG. 3 shows[0044]pedestal base10 including a pair ofinterlocks26,28.Interlocks26,28 co-act with complementary interlocks on the rib guide superstructure. Other interlock designs may be utilized. The interlocks clip the base10 to the superstructure.
• FIG. 4A shows[0045]pedestal14 with an outer body surface which is generally complementary tosurgical clip20. This complementary shape enables an interference fit betweenpedestal14 andclip20. FIG. 4B diagrammatically showsclip20 mounted with an interference fit in a clip retaining depression. In other words, the user can invertpedestal base10 when theclip20 is retained on the pedestal and the clip will not fall frompedestal14. Since the surgical clips typically are titanium or other strong, high quality metal or other biocompatible material, the ridges or grooves on the inboard surface of the surgical clip typically are not adversely affected by the interference fit withpedestal14. The “pedestal base” is sometimes referred to as “base10” herein.
• FIGS.[0046]5-8B diagrammatically illustrate a preferred embodiment of theclip holder superstructure12. FIG. 5 is a side elevational view showing laterally spaced apartflexible ribs30,32,34 and36. Hereinafter, theribs30,32 will be utilized to generally designate all adjacent, spaced apart guide ribs.Superstructure12 includesend panels37,39. The end panels have interlock elements (not shown) which mate and lock ontointerlock elements26,28 in FIG. 3.
• FIG. 7 diagrammatically illustrates that each[0047]rib30 includes a depending finger, one of which is identified as dependingfinger40. Dependingfinger40 is L-shaped in the currently preferred embodiment as shown in FIG. 10 or, in another configuration, may be a horizontal flexible, finger extending intointerspace33 betweenadjacent ribs30,32. In a preferred embodiment, the lateral extension of depending finger40 (a horizontal L element or simply a horizontal element) extends intointerspace33 approximately one-half the lateral span ofinterspace33.Interspace33 is defined byadjacent ribs30,32.
• [0048]Rib36 adjacent toside wall37 includes a right hand extending finger40aand a lefthand extending finger40b.The dependingfingers40 may be right hand extensions or may be left hand extensions.
• FIG. 8A shows[0049]rib30 being an arcuate element rising abovesuperstructure base41.Superstructure base41, as shown in FIG. 8A, includes a basekey way43 that coacts with a base key and base key way inpedestal base22,foot element24 and pedestal basekey way25 shown in FIG. 4B. The respective base key ways and co-acting keys provide positional registration between the rib guide superstructure and the pedestal base.
• FIG. 9 diagrammatically illustrates[0050]surgical clip holder8 whereinsuperstructure12 is mounted atoppedestal base10. This mounting procedure is discussed in connection with FIG. 12. In FIG. 9,surgical clip20 is retained in a clip retaining depression.Flexible ribs30,32 are disposed in parallel planes on either side ofclip20 and the underlying clip depression. The interspace betweenribs30,32 is aligned with the clip and associated clip depression and acts as a guide for the clip jaws.Finger40 extends part way into interspace33 (see detail in FIG. 10), such that thelower surface44 offinger40 gently rests atop the apex ofclip20. Careful registration and alignment of superstructure12 (FIG. 5) over pedestal base10 (FIG. 1) is accomplished by the keys and key ways in therespective bases22,41. As discussed later, the parallel positioning ofribs30,32 andclip retaining depression18 is important because the flexible ribs act as guide for the clip carrying jaws of a clip appliance. In FIG. 9, depressions18a,18bdo not carry clips.
• FIGS.[0051]11-13 diagrammatically show the assembly process for the surgical clip holder.
• FIG. 11 diagrammatically shows[0052]surgical clip20 having an apex7 and clip legs defining a firstangular leg configuration5,6 and alower leg segment3,4 with a different angular configuration.Pedestal14 rises abovebase10 and has a similar outer body shape which is complementary to the inner body shape ofsurgical clip20.Arrows51,53 show thatclip20 is mounted ontopedestal14.
• In FIG. 12 the[0053]rib carrying superstructure12 is mounted atoppedestal base10 as shown byarrows55,57.Superstructure12 is placed atoppedestal base10 after the clips are loaded onto pedestal14 (FIG. 11). Interlocking mechanism hold theclip holder unit10,12 together.
• FIG. 13 shows that[0054]rib30 ofsuperstructure12 rises abovepedestal14 such that the height of the rib is greater or exceeds the height of the pedestal and the opening span d is greater than the clip span or the pedestal span e. In other words, the plurality of flexible ribs on the superstructure are spaced apart from the pedestal base which defines the plurality of clip retaining depressions both in height and in depth. The term “depth” refers to the opening span d as compared with opening span e. As discussed later with respect to FIG. 14A, opening span e is generally similar to the opening span of the clip carrying jaw of the clip appliance.
• FIGS.[0055]14A-14B diagrammatically illustrate the insertion of the clip appliance, the capture of the clip and the removal of the clip from the surgical clip holder.
• In FIG. 13,[0056]finger40 is shown as “flying” or disconnected from adjacent structures becausefinger40 extends fromrib32 which is not shown in FIG. 13. See FIG. 14B. The depending finger fromrib30 is omitted in FIGS. 14A and 14C in order to show the gentle depression or compression offinger40 onclip20.Finger40 is shown onrib32 in FIG. 14B.
• The clip appliance includes[0057]clip carrying jaws50,52.Clip jaw52 is shown in cross section such thatinner jaw rib54 is visible. An opposing rib, not shown onjaw52 in FIG. 14A, grips the other side ofsurgical clip20. In FIGS. 14A and 14B,clip jaw52 is inserted and guided byflexible ribs30,32 towardsclip20 retained in the corresponding depression. Since the lateral span f ofclip jaw52 is greater than the interspace33 (FIG. 10), when theclip jaw52 is inserted betweenflexible ribs30,32, the ribs move laterally outboard and away fromclip20. This flexing shown in FIGS. 14B and 14D permits the clip holder to retain a plurality of clips in a smaller space.
• Further, when[0058]flexible guide rib32 moves laterally to the left in FIG. 14B, dependingfinger40 is withdrawn from the apex ofsurgical clip20. FIGS. 14C and 14D diagrammatically show the complete insertion ofclip carrying jaws50,52 into the surgical clip holder formed bypedestal base10 andsuperstructure12. In this position,tab40 of the depending finger has been completely withdrawn away from the apex of clip20 (see FIG. 14D) and theclip retaining jaws50,52 have clamped ontoclip20. Thereafter, theclip carrying jaws50,52 are withdrawn vertically from the surgical clip holder consisting ofpedestal base10 andsuperstructure12, andribs30,32 flex back to their original or initial position.Base10 may be weighed down by an additional weight (not shown).
• In this manner,[0059]ribs30,32 form arcuate guides spaced entirely apart from the retained clips and the underlyingpedestal base substructure10.Ribs30,32 ofsuperstructure12 guide the clip carrying jaws of the appliance and flex laterally outboard while the clip carrying jaws grip the clip.
• FIGS. 15 and 16 diagrammatically show a variation of the system shown in FIGS.[0060]5-8B. Theflexible guide ribs30,32 include dependingfingers40 but also include jaw bumpers, one of which isjaw bumper60. In the one embodiment,jaw bumper60 has aleading edge slope62 as shown in FIG. 17. Thejaw bumper60 moves the associated rib guide32 an additional lateral distance when the clip carrying jaws are inserted intointerspace33.
• FIGS.[0061]18-19C diagrammatically show that in certain situations, the placement ofjaw bumper60 can control the lateral displacement ofrib32 dependent upon the opening span of the clip carrying jaw. In some instances, the clip appliance and particularly theclip carrying jaws50,52 (FIG. 14A), are not completely open when the appliance is inserted between the rib guides30,32. In other words, the initial position of one of the clip carrying jaws, e.g.,jaw52, falls within plane A shown in FIG. 18. As the clip appliance is moved vertically downward thepedestal14 and theclip20 causes theclip carrying jaw52 to further open its opening span from vertical position A to vertical B. In some situations, this may be beneficial since the clip is maintained in the clip depression onpedestal14 with an interference fit and to cleanly remove the clip frompedestal14, a tight fit between theclip carrying jaws50,52 andclip20 must be obtained by tight spring action betweenjaws50,52 andclip20. This tight spring action and clip compression is achieved by forcingjaws50,52 further open from position A to B. This further opening is noted by jaw movement from A to B in FIG. 18.
• In any event, when the[0062]clip carrying jaw52 is inserted at position A and moved to position B as shown in FIG. 18, ajaw bumper60, which is strategically located at a position outboard location A onrib32, is activated to move or further nudgeflexible rib32 in a lateral direction. See FIG. 14B. The jaw bumper is located behindrib32 in FIG. 18 as is the clip applier jaw moving from position A to position B.
• FIGS.[0063]19A-19C show that clipjaw52 moves further to the right as the clip jaw is inserted vertically downward onpedestal14. In FIG. 19C,jaw bumper60 has a slope change orgradient change65 such that when the clip passes to the right of that gradient orslope change65 onjaw bumper60,rib32 moves further in a lateral direction. In FIG. 19A,rib32 is moved laterally due to the lateral span ofclip jaw52. See FIG. 14D. Bumper has not affected the lateral movement ofrib32 in FIG. 19A. In FIG. 19B,jaw bumper60 causes additional lateral movement ofrib32. In FIG. 14C, a maximum lateral movement ofrib32 is achieved due to thejaw bumper60 and the slope change or gradient atbumper line65. A slope for thejaw bumper60 is shown in connection with leadingslope edge62 in FIG. 17. The thickness or lateral dimension ofbumper60 is greater to the right ofgradient65 than the left of the gradient.
• FIGS.[0064]20-23B diagrammatically illustrate another embodiment of the present invention whereinclip superstructure12 includesfinger tabs70,72 which extend toward the distal end of the clips and also extend towards the distal ends ofclip retaining depressions16,18 inpedestal base14. See FIG. 1.Flexible guide ribs30,32 are also part of the embodiment shown in FIGS.20-23B.
• FIG. 23A shows finger ribs or[0065]tabs70,72 protruding inboard towards a location defined thepedestal base14. FIG. 23B showsside wall37.
• FIG. 24 diagrammatically shows clip[0066]20 being mounted onpedestal14 ofbase10. FIG. 25 showsrib guide superstructure12 being mounted onbase10 after the clip mounting step such thatfinger tabs70,72 mate with and extend over the distal ends69,71 ofclip20.
• FIG. 26 diagrammatically shows[0067]finger tabs70,72 coacting withdistal ends69,71 ofclip20.
• FIG. 27 shows that[0068]distal end69 ofclip20 is gently urged inboard towardpedestal14. The terminal ends of each clip leg are urged towards the pedestal.
• FIG. 28A diagrammatically shows[0069]clip jaws50,52 being inserted between flexible rib guides30,32. FIG. 28B shows lateral flexion of the ribs. In FIGS. 28C and 28D, clipjaws50,52 have been fully inserted into the clip holder, theflexible guide ribs30,32 reach their maximum flexion distance and the distal end ofjaws50,52 depressfinger tabs70,72. The depression offinger tabs70,72 enable the complete release ofclip20 frompedestal14.
• As shown with respect to FIG. 28A, the opening span e of[0070]clip20 and the length oflower clip leg3,4 is such thatclip jaws50,52 touch and engageclip20 prior to the distal ends80,81 ofclip jaws50,52striking finger tabs72,70. The angle of the finger tabs is not important. The opening span of the clip jaws and the span e ofpedestal14 and the length of theclip legs3,4 determine whenjaws50,52 strike orimpact legs3,4. In this embodiment, clipjaws50,52 fully engagesurgical clip20 well before engagement and physical contact withfinger tabs70,72.
• After[0071]clip jaws50,52 are withdrawn from the position illustrated in FIG. 28C,finger tabs70,72 spring upward to their initial, horizontal position.
• As shown in FIG. 28B,[0072]finger tabs70,70acoact with the distal ends of eachclip20,20a.Hence, eachclip retaining depression16,18 (FIG. 2) has a pair of opposingfinger tabs70,72.
• As shown in FIG. 29,[0073]finger tabs70,72 can be provided with anaperture90 configured and dimensioned to receive one oflower leg segments3,4 ofsurgical clip20.Aperture90 helps ensure thatclip20 is centered withinclip depression18, thereby facilitating alignment ofclip jaws50,52 withclip20. In an exemplary embodiment, only one of the pair offinger tabs70,72 hasaperture90. Alternatively, eachfinger tab70,72 hasaperture90.
• [0074]Aperture90 can have any shape appropriate for receivinglower leg segments3,4 ofclip20. Examples of suitable shapes include rectangular (FIG. 30A), keyhole (FIG. 30B), and round or substantially round (FIGS. 30C and 30D). As shown in FIGS. 30A and 30B, the end offinger tab70 can be bifurcated intotips92,94 so that the end is forked withaperture90 defined betweentips92,94. The bifurcation can reduce the amount of depression offinger tabs70,72 that is needed to allowlower leg segments3,4 to disengage fromfinger tabs70,72. FIG. 30C showsfinger tab70 with aslit96 extending toaperture90.Slit96 allowsaperture90 to flex open, thereby releasinglower leg segments3,4 fromfinger tabs70,72.
• As with the previously described embodiments, the clip holder of FIG. 29 is loaded with clips by first mounting a plurality of[0075]clips20 onto pedestal14 (FIG. 11) and then mountingrib carrying superstructure12 atop pedestal base10 (FIG. 12). The mounting occurs so thatlower leg segments3,4 ofclips20 are received in arespective aperture90 offinger tabs70,72. In use, clipjaws50,52 of a clip appliance are inserted between flexible rib guides30,32 of the clip holder so thatclip jaws50,52 engageclip20.Finger tabs70,72 flex down asclip jaws50,52 are further inserted. This bending disengages lowerclip leg segments3,4 fromaperture90 offinger tabs70,72 and allows complete release ofclip20 frompedestal14. By providing a consistent placement oflower leg segments3,4 withinclip retaining depression18,aperture90 enables registration and alignment ofclip20 with the clip appliance.
• The claims appended hereto are meant to cover modifications and changes within the scope and spirit of the present invention.[0076]

Claims (37)

What is claimed is:

1. A surgical clip holder for retaining a plurality of surgical clips, each clip having a pair of clip legs and adapted to be removed from the clip holder with clip carrying jaws of a clip appliance, the surgical clip holder comprising:

a pedestal base defining clip retaining depressions and intervening lands, each said depression adapted to retain a corresponding clip of said plurality of clips; and

a superstructure including a base mounted onto said pedestal;

a plurality of flexible ribs rising above the superstructure base and spaced apart from said pedestal, said ribs having a height exceeding a height of said pedestal and forming a guide towards a corresponding clip retaining depression; and

a plurality of finger tabs extending substantially inboard toward said pedestal from said superstructure base, a respective pair of finger tabs disposed toward opposing ends of a corresponding clip depression, each said finger tab having a length sufficient to engage an adjacent end of a clip adapted to be disposed in said corresponding clip retaining depression,

wherein said ribs are adapted to act as a guide for said clip carrying jaws and to flex apart upon insertion of said jaws of said clip appliance; and

at least one in said respective pair of finger tabs has an aperture adapted to receive one leg of a clip disposed in said corresponding clip depression.

2. A clip holder as claimed inclaim 1 wherein said ribs are entirely spaced apart from said pedestal.

3. A clip holder as claimed inclaim 1 wherein said pedestal includes a platform, said platform defining at least one interlock, said superstructure base including at least one complementary interlock adapted to mate with said at least one interlock on said platform.

4. A clip holder as claimed inclaim 1 wherein said clip carrying jaws have an opening span and a lateral span, said lateral span begin substantially normal to said opening span, said ribs on said superstructure being spaced apart a distance which is less than said lateral span of said clip carrying jaws, said pedestal having a width which is equal to or less than said opening span of said clip carrying jaws.

5. A clip holder as claimed inclaim 1 wherein said ribs are arcuate elements rising above said superstructure base, each said rib having an apex, each rib carrying at its apex a depending finger adapted to rest atop said clip adapted to be retained in the respective depression.

6. A clip holder as claimed inclaim 5 wherein said finger is substantially L-shaped and a vertical L-element of said finger is disposed in a plane defined by the rib carrying said finger and a horizontal L-element of said finger extends into an interspace between adjacent ribs.

7. A clip holder as claimed inclaim 6 wherein each said horizontal L-element of said fingers extend less than one-half the interspace between adjacent ribs.

8. A clip holder as claimed inclaim 5 wherein each rib includes a jaw bumper adapted to displace the finger carrying rib further from said interspace upon insertion of said clip carrying jaws.

9. A clip holder as claimed inclaim 8 wherein each finger carrying rib includes two jaw bumpers which are disposed on opposing arcuate segments of the respective rib.

10. A clip holder as claimed inclaim 8 wherein said jaw bumper has a leading edge slope which varies the displacement of said finger carrying rib dependent upon a position of said clip carrying jaw adapted to be inserted into said interspace between adjacent ribs.

11. A clip holder as claimed inclaim 1 wherein each finger tab is disposed substantially in a horizontal plane.

12. A clip holder as claimed inclaim 1 wherein each finger tab has an aperture.

13. A clip holder as claimed inclaim 1 wherein the at least one finger tab has a forked end with the aperture defined therebetween.

14. A clip holder as claimed inclaim 13 wherein the aperture has a rectangular shape.

15. A clip holder as claimed inclaim 13 wherein the aperture has a keyhole shape.

16. A clip holder as claimed inclaim 1 wherein the aperture is round.

17. A clip holder as claimed inclaim 1 wherein an end of the at least one finger tab has a slit extending to the aperture allowing the aperture to flex open.

18. A clip holder as claimed inclaim 17 wherein the aperture is one of a round, square or keyhole strapped aperture.

19. A surgical clip holder for retaining a plurality of surgical clips, each clip having a pair of clip legs and adapted to be removed from the clip holder with clip carrying jaws of a clip appliance, the surgical clip holder comprising:

a pedestal base defining a plurality of clip retaining depressions and intervening lands, each said depression adapted to retain a corresponding clip of said plurality of clips; and

a superstructure including a superstructure base mounted onto said pedestal;

a plurality of flexible ribs rising above said superstructure base and spaced apart from said pedestal, said ribs having a height exceeding a height of said pedestal and forming a guide toward a corresponding clip retaining depression; and

a plurality of finger tabs extending substantially inboard toward said pedestal from said superstructure base, said plurality of finger tabs paired off with said plurality of clip retaining depressions and each respective pair of finger tabs disposed toward opposing ends of a corresponding clip depression, each said finger tab having a length sufficient to engage an adjacent end of a clip adapted to be disposed in said corresponding clip retaining depression,

wherein said ribs are adapted to act as a guide for said clip carrying jaws and to flex apart upon insertion of said jaws of said clip appliance; and

each finger tab has an aperture adapted to receive one leg of a clip disposed in said corresponding clip depression.

20. A clip holder as claimed inclaim 19 wherein said ribs are entirely spaced apart from said pedestal.

21. A clip holder as claimed inclaim 19 wherein said pedestal includes a platform, said platform defining at least one interlock, said superstructure base including at least one complementary interlock adapted to mate with said at least one interlock on said platform.

22. A clip holder as claimed inclaim 19 wherein said clip carrying jaws have an opening span and a lateral span, said lateral span begin substantially normal to said opening span, said ribs on said superstructure being spaced apart a distance which is less than said lateral span of said clip carrying jaws, said pedestal having a width which is equal to or less than said opening span of said clip carrying jaws.

23. A clip holder as claimed inclaim 19 wherein said ribs are arcuate elements rising above said pedestal base, each said rib having an apex, each rib carrying at its apex a depending finger adapted to rest atop said clip adapted to be retained in the respective depression.

24. A clip holder as claimed inclaim 23 wherein said finger is substantially L-shaped and a vertical L-element of said finger is disposed in a plane defined by the rib carrying said finger and a horizontal L-element of said finger extends into an interspace between adjacent ribs.

25. A clip holder as claimed inclaim 24 wherein each said horizontal L-element of said fingers extend less than one-half the interspace between adjacent ribs.

26. A clip holder as claimed inclaim 23 wherein each rib includes a jaw bumper adapted to displace the finger carrying rib further from said interspace upon insertion of said clip carrying jaws.

27. A clip holder as claimed inclaim 26 wherein each finger carrying rib includes two jaw bumpers which are disposed on opposing arcuate segments of the respective rib.

28. A clip holder as claimed inclaim 26 wherein said jaw bumper has a leading edge slope which varies the displacement of said finger carrying rib dependent upon a position of said clip carrying jaw adapted to be inserted into said interspace between adjacent ribs.

29. A clip holder as claimed inclaim 19 wherein each finger tab is disposed substantially in a horizontal plane.

30. A clip holder as claimed inclaim 19 wherein each finger tab has a forked end with the aperture defined therebetween.

31. A clip holder as claimed inclaim 30 wherein the aperture has a rectangular shape.

32. A clip holder as claimed inclaim 30 wherein the aperture has a keyhole shape.

33. A clip holder as claimed inclaim 19 wherein the aperture is round.

34. A clip holder as claimed inclaim 19 wherein an end of the at least one finger tab has a slit extending to the aperture allowing the aperture to flex open.

35. A clip holder as claimed inclaim 34 wherein the aperture is round.

36. A method of retaining surgical clips and retrieving said surgical clips with clip carrying jaws of a clip appliance comprising the steps of:

supporting and retaining said clips with an interference fit about substantially the entirety of underside of said clip;

providing a flexible rib cage acting as arcuate guides spaced entirely apart from said retained clips;

providing an aperture on a finger tab for receiving a portion of a leg of each of said clips;

guiding said clip carrying jaws of said clip appliance through adjacent rib guides towards said clip while flexing said adjacent rib guides laterally outboard;

flexing the finger tabs with the clip carrying jaws to thereby remove the leg from the aperture;

gripping a clip with said clip carrying jaws and withdrawing said clip from said interference fit and then permitting said adjacent rib guides to return to an initial position.

37. A method as claimed inclaim 36 including the step of gently compressing a top end of said clip when said clip is retained with said interference fit and including the step of laterally withdrawing the compression of the clip end upon flexion of said adjacent rib guides.

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