US20120265220A1 - Articulating Steerable Clip Applier for Laparoscopic Procedures - Google Patents

Abstract

A long articulating steerable clip applier affixed to a user-operated handle. A surgical jaw assembly is attached to the other end of the clip applier. The clip applier is composed of articulating phalanges that are connected end to end by pivoting links and capable of angulations relative to one another when subjected to a tensile force. Each phalange has opposing s-shaped exterior grooves that form two continuous spiral-shaped channels for holding tension wires once the phalanges are assembled. Multiple tension wires are attached to opposite ends of adjacent phalanges. When each wire is pulled, this tensile force causes the phalanges to pivot at equivalent angles with each other. As each individual phalange pivots by an equivalent angle, the sum of these angles causes the free end of the clip applier to pivot by a large angle or a cascading actuation effect.

Description

CROSS REFERENCE TO RELATED APPLICATION
• This application claims the benefit of U.S. Provisional Patent Application No. 61/321,233 filed on Apr. 6, 2010, the contents of which are incorporated herein by reference.
FIELD OF THE INVENTION
• This invention relates to a novel articulating steerable clip applier for laparoscopic or endoscopic procedures.
BACKGROUND OF INVENTION
• Laparoscopic and endoscopic procedures are conducted through a small incision in the skin or natural body orifices.
• In order to operate on a given tissue or a blood vessel, surgeons must ligate or occlude blood vessels to prevent patient blood loss. Surgical clip appliers are used in these surgeries for the application of hemostatic clips to ligate vessels. Clip appliers hold a surgical clip in an open position in a pair of specially adapted jaws. Once these jaws, containing clips, are positioned over a vessel, the clip is manually released over the vessel to ligate it. Inaccuracies in movement or failure to securely occlude the clip to the vessel can result damage to vessels or tissues, internal bleeding, lethal drops in blood pressure, infections, or longer recovery periods
• These instruments need to provide precise and accurate movement in order to ligate vessels within the body that are difficult to access. Instruments are needed that are narrow enough to be inserted through a small opening (such as an incision, trocar or natural body orifice), long enough to reach the desired internal tissues, and flexible enough to provide a wide range of motion to navigate the distal end of a clip applier with jaws containing loaded clips around body tissues to advance towards the internal operation site.
• Accordingly, the subject invention discloses an improved steerable articulating surgical clip applier. It contains a long, narrow, distal articulating disposable portion that is inserted into a patient during surgery. This distal articulating portion is removably attached to a proximal non-disposable control unit for moving the long disposable portion within the patient and operating actuators to control the articulation and ligation of the clip applier.
• By separating these two components, the risk of cross contamination between separate patients or separate tissues on the same patient is reduced. The non-disposable control unit does not enter the patient and the contaminated long and narrow component is simply disposed after each surgical procedure is completed. In addition, costs are saved since medical providers only need to replace the disposable component between surgical procedures.
SUMMARY OF THE INVENTION
• There are additional features of the invention that will be described hereinafter and which will form the subject matter of the claims appended hereto. In this respect, before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and to the arrangements of the components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments and of being practiced and carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein are for the purpose of the description and should not be regarded as limiting.
• The subject invention discloses an endoscopic surgical tool having a handle and a shaft member coupled to the handle and extending along a shaft axis from a proximal end to a distal end, wherein the distal end of the shaft member is adapted to receive an end effector, comprising: A. a linear array of n phalanx sections, where n is an integer greater than 2, wherein the linear array includes a sequentially aligned proximal phalanx section, n−2 intermediate phalanx sections, and a distal phalanx section, wherein the ith phalanx section, wherein i is greater than or equal to 1 and less than or equal to n, extends along an associated central axis CAi between a proximal end PEi and a distal end DEL and includes: a tubular member TMi defining a. a central void region CVRi extending along the central axis CAi between the proximal end PEi and the distal end DEL and b. an exterior surface ESi disposed about the central void region CVRi and extending along the central axis CAi from the proximal end PEi to the distal end DEL wherein the n phalanx sections are aligned whereby the central axis CAi of each phalanx section intersects with the central axis of phalanx sections adjacent thereto in the linear array, B. an end effector coupler EEC disposed at the distal end of the distal phalanx section and adapted for coupling the distal end to an end effector, C. a base coupling assembly BC disposed at the proximal end of the proximal phalanx section and adapted to couple to the proximal end of the proximal phalanx section to the distal end of the shaft member, whereby the shaft axis intersects the central axis of the proximal phalanx section and whereby the proximal phalanx section is movable with respect to the distal end of the shaft member substantially only in rotational motion about a transverse axis TA0 perpendicular to the central axis of the proximal phalanx section, D. n−1 phalanx section coupling assemblies PC, wherein each phalanx section coupling assembly is associated with an intermediate phalanx section and wherein the coupling assembly PCi associated with the ith phalanx section couples a distal end of the ith phalanx section to the proximal end of the adjacent i+1th phalanx section whereby the proximal end of the i+1th phalanx section is movable with respect to the distal end of the ith phalanx section substantially only in rotational motion about a transverse axis TAi perpendicular to the central axis of the ith phalanx section, wherein TAi and TA0 are mutually parallel, and wherein each of the base coupling assembly and the n−1 phalanx coupling assemblies are operative whereby a torque applied to the proximal end of the proximal phalanx section about an axis parallel to transverse axis TA0, effects a same-direction angular rotational displacement of each of the ith phalanx sections with respect to the adjacent phalanx sections about the respective transverse axes TAi.
• In a further embodiment of the subject invention, the base coupling assembly BC may be adapted to detachably couple the proximal end of the proximal phalanx section to the distal end of the shaft member.
• In another embodiment of the subject invention, the end effector coupling assembly EEC may be adapted to detachably couple the end effector to the distal end of the distal phalanx section.
• In an additional embodiments of the subject invention, the ith phalanx section coupling assembly Ci may include: i. a coupling cam surface CCSi disposed about a cam central axis CCAi affixed to the distal end of the ith phalanx section, wherein the cam central axis CCAi is substantially coaxial with the transverse axis TAi, a substantially non-stretchable link coupling a point on the coupling cam surface of the ith phalanx section CCSPi with a point EPi+2 on the proximal end of the i+2th phalanx section, wherein point CCSPi and point EPi are disposed in a plane including CAi+1 and perpendicular to the transverse axes TAi and TAi+2 and on opposite sides central axis of the i+1 phalanx section CAi+1.
• In a further embodiment of the subject invention, the link of coupling assembly Ci may be a cable extending between point CCSPi and point EPi+2.
• In another embodiment of the subject invention, the cable extends in a helical path about the central axis CAi+1 between point CCSPi and point EPi+2.
• In an additional embodiment of the subject invention, the exterior surface ESi includes an open-faced helical channel HCi+1 disposed about the central axis CAi+1, and the cable of coupling assembly Ci extends through the helical channel HCi+1.
• In a further embodiment of the subject invention, the same-direction angular rotational displacement of each of the ith phalanx sections with respect to the adjacent phalanx sections are equi-angle.
• In another embodiment of the subject invention, the tubular members TMi may be characterized by the same distance between the proximal end PEi and the distal end Dei.
• In a further embodiment of the subject invention, at least two of the tubular members TMi may be characterized by different distances between their respective proximal ends PEi and distal ends Dei.
• In an additional embodiment of the subject invention, the cam surfaces CCSi may be circular segments.
• The subject invention also discloses an endoscopic surgical apparatus comprising: a handle having a front end and defining a longitudinal axis; an actuation member associated with the handle; an elongated articulating section comprising a plurality of interconnected pivotable vertebrae extending distally from the front end of said handle, wherein the plurality of pivotable vertebrae comprises an exterior surface, further wherein the plurality of pivotable vertebrae comprises an interior surface that defines a channel extending distally from the front end of said handle to a distal end to permit passage of surgical clips; and a tensioning system selectively operable from the actuation member to apply tensioning force to the plurality of interconnected pivotable vertebrae such that the proximal end of each interconnected pivotable vertebrae pivots at a substantially equivalent angle.
• Another embodiment of the subject invention is an endoscopic surgical apparatus comprising: a handle having a front end and defining a longitudinal axis; an actuation member associated with the handle; an elongated articulating section comprising a plurality of interconnected pivotable vertebrae extending distally from the front end of said handle, wherein the plurality of pivotable vertebrae comprises an exterior surface, wherein each pivotable vertebrae comprises a set of opposing spiral-shaped grooves on the exterior surface such that the elongated articulating section has contiguous set of opposing spiral-shaped grooves, further wherein the plurality of pivotable vertebrae comprises an interior surface that defines a channel extending distally from the front end of said handle to a distal end to permit passage of surgical clips; and a plurality of tension wires inserted into the contiguous spiral-shaped grooves, wherein the plurality of tension wire are selectively operable from the actuation member to apply tensioning force to the plurality of interconnected pivotable vertebrae such that the proximal end of each interconnected pivotable vertebrae pivots at a substantially equivalent angle.
• An additional embodiment of the subject invention is an endoscopic surgical apparatus comprising: a handle having a front end and defining a longitudinal axis; an actuation member associated with the handle; an elongated articulating section comprising a plurality of interconnected pivotable vertebrae extending distally from the front end of said handle, wherein the plurality of pivotable vertebrae comprises an exterior surface, wherein each pivotable vertebrae comprises a set of opposing spiral-shaped grooves on the exterior surface such that the elongated articulating section has contiguous set of opposing spiral-shaped grooves, further wherein the plurality of pivotable vertebrae comprises an interior surface that defines a channel extending distally from the front end of said handle to a distal end to permit passage of surgical clips; and a plurality of tension wires inserted into the contiguous spiral-shaped grooves, wherein the plurality of tension wire are selectively operable from the actuation member to apply tensioning force to the plurality of interconnected pivotable vertebrae such that the proximal end of each interconnected pivotable vertebrae pivots at a substantially equivalent angle.
• A further embodiment of the subject invention discloses an endoscopic surgical apparatus comprising: a handle having a front end and defining a longitudinal axis; an actuation member associated with the handle; an elongated articulating section comprising a plurality of interconnected pivotable vertebrae extending distally from the front end of said handle, wherein the plurality of pivotable vertebrae comprises an exterior surface, further wherein the plurality of pivotable vertebrae comprises an interior surface that defines a channel extending distally from the front end of said handle to a distal end to permit passage of surgical clips; and a plurality of semi-circular ligaments placed over the plurality of pivotable vertebrae, wherein the plurality of semi-circular ligaments are selectively operable from the actuation member to apply tensioning force to the plurality of interconnected pivotable vertebrae such that the proximal end of each interconnected pivotable vertebrae pivots at a substantially equivalent angle.
• Another embodiment of the subject invention is an endoscopic surgical apparatus comprising: a handle having a front end and defining a longitudinal axis; an actuation member coupled with the handle; an elongated articulating shaft coupled to the handle with a base coupling assembly and extending distally from the front end of said handle from a proximal end to a distal end, wherein the distal end of the articulating shaft is adapted to receive an end effector, the articulating shaft comprising a linear array of phalanx sections, wherein the linear array includes a sequentially aligned proximal phalanx section coupled on a distal end to the base coupling assembly, intermediate phalanx sections, and a distal phalanx section adapted to receive the end effector on the distal end, wherein each phalanx section comprises i) a proximal end and a distal end; ii) a central cavity extending along a central axis between the proximal end and the distal end; iii) an exterior surface; and iv) a set of opposing substantially spiral-shaped grooves on the exterior surface that extend along each phalanx from the proximal end to the distal end, wherein each the distal end of each phalanx section couples the proximal end of the adjacent phalanx section, whereby the proximal end of the phalanx section is movable with respect to the distal end of the phalanx section in rotational motion , and a plurality of tension wires inserted into the spiral-shaped grooves, wherein the plurality of tension wire are operable from the actuation member to apply tensioning force to the linear array of phalanx sections such that the proximal end of each phalanx section pivots at a substantially equivalent angle.
• Another embodiment of the subject invention is an endoscopic surgical apparatus comprising: a handle having a front end and defining a longitudinal axis; an actuation member coupled with the handle; an elongated articulating shaft coupled to the handle with a base coupling assembly and extending distally from the front end of said handle from a proximal end to a distal end, wherein the distal end of the articulating shaft is adapted to receive an end effector, the articulating shaft comprising a linear array of phalanx sections, wherein the linear array includes a sequentially aligned proximal phalanx section coupled on a distal end to the base coupling assembly, intermediate phalanx sections, and a distal phalanx section adapted to receive the end effector on the distal end, wherein each phalanx section comprises i) a proximal end and a distal end; ii) a central cavity extending along a central axis between the proximal end and the distal end; iii) an exterior surface; wherein each the distal end of each phalanx section couples the proximal end of the adjacent phalanx section, whereby the proximal end of the phalanx section is movable with respect to the distal end of the phalanx section in rotational motion, and a plurality of semi-cylindrical ligaments placed over the plurality of phalanx sections, wherein the plurality of semi-cylindrical ligaments are selectively operable from the actuation member to apply tensioning force to the plurality of phalanx sections such that the proximal end of each phalanx section pivots at a substantially equivalent angle.
• In embodiments of the subject invention, each phalanx or pivotable vertebrae may comprise a substantially cylindrical configuration.
• In other embodiments of the subject invention, each phalanx or pivotable vertebrae may comprise a single piece.
• In further embodiments of the subject invention, each phalanx or pivotable vertebrae may comprise two substantially half-cylindrical pieces.
• In additional embodiments of the subject invention, the elongated articulating section may further comprise a distally attached surgical jaws assembly. In another embodiment the subject invention, the end effector may comprise a distally attached surgical jaws assembly.
• In other embodiments of the subject invention, each pivotable vertebrae may project a first pivot member from the proximal end and project a second pivot member from the distal end, wherein the first pivot member of each pivotable vertebrae pivotably couples about a rotational axis to the second pivot member of a proximally adjacent pivotable vertebrae.
• In further embodiments of the subject invention, the first pivot member may comprise a substantially cylindrical protrusion and the second pivot member may comprise a substantially cylindrical bore adapted for receiving the substantially cylindrical protrusion.
• In other embodiments of the subject invention, each pivotable vertebrae may project a plurality of first pivot members from the proximal end and project a plurality of second pivot members from the distal end, wherein the plurality of first pivot members of each pivotable vertebrae pivotably couples about a rotational axis to the plurality of second pivot members of proximally adjacent pivotable vertebrae.
• In additional embodiments of the subject invention, each phalanx section or pivotable vertebrae may be composed of injected-molded plastic.
• In embodiments of the subject invention, the plurality of pivotable vertebrae fits within 3 mm to 10 mm envelope of MIS instrumentation.
• In other embodiments of the subject invention, the plurality of tension wire may comprise a material selected from the group consisting of nickel titanium alloy, braided stainless steel, a single stainless steel wire, Kevlar, a high tensile strength monofilament thread, or combinations thereof.
• In further embodiments of the subject invention, each tension wire attaches on a proximal end to a pivotable vertebrae proximate to the handle, extends through the spiral shaped grooves on a first subsequent adjacent distal pivotable vertebrae, and attaches on a distal end to a second subsequent adjacent distal pivotable vertebrae.
• In additional embodiments of the subject invention, each tension wire proximally attaches on one side of the elongated articulating section to a pivotable vertebrae proximate to the handle, extends through the spiral shaped grooves on a subsequent adjacent distal pivotable vertebrae, and distally attaches on the opposing side of elongated articulating section to an opposing side of second subsequent adjacent distal pivotable vertebrae.
• In other embodiments of the subject invention, applying force in the proximal direction to the proximal end of each tension wire rotates the second subsequent adjacent distal pivotable vertebrae, further wherein the direction of rotation is away from the side on the elongated articulating section that attaches to the proximal end of the tension wire.
• In embodiments of the subject invention, applying force in the proximal direction to the proximal end of each tension wire rotates the second subsequent adjacent distal pivotable vertebrae, further wherein the direction of rotation is toward the side on the elongated articulating section that attaches to the distal end of the tension wire.
• There has thus been outlined, rather broadly, the more important features of the invention in order that the detailed description thereof that follows may be better understood, and in order that the present contribution to the art may be better appreciated. There are additional features of the invention that will be described hereinafter and which will form the subject matter of the claims appended hereto.
• These together with other objects of the invention, along with the various features of novelty, which characterize the invention, are pointed out with particularity in the claims annexed to and forming a part of this disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
• Advantages of the present invention will be apparent from the following detailed description of embodiments thereof, which description should be considered in conjunction with the accompanying drawings, in which:
• FIG. 1 illustrates a top view of the articulating steerable clip applier showing the separate angles of movement by different phalanges with covers.
• FIG. 2 illustrates a side view of the articulating steerable clip applier showing the separate angles of movement by different phalanges within a cover.
• FIG. 3 illustrates a cross-sectional top view of the articulating steerable clip applier along theline8 ofFIG. 2.
• FIG. 4 illustrates an enlarged cross-sectional top view ofline15 ofFIG. 3 showing the pivotable connection between two phalanges on the articulating steerable clip applier.
• FIG. 5 illustrates another top view of the articulating steerable clip applier showing the separate angles of movement by individual phalanges guided by tension wires connected from a first phalange traversing through opposing spiraled grooves on the next distal phalange to attach to a second distal phalange.
• FIG. 6 illustrates another top view of the articulating steerable clip applier showing the separate angles of movement by individual phalanges with opposing spiraled grooves for holding the tension wires.
• FIG. 7 illustrates a top view of connected adjacent phalanges of the articulating steerable clip applier without covers showing the separate angles of movement by different adjacent phalanges by flexible tension wires.
• FIG. 8 illustrates the attachments of separate flexible tension wires on the separate phalanges of the articulating steerable clip applier, wherein each tension wire connects on its proximal end to one side of a first phalange, traverses through opposing spiraled grooves on the next distal phalange and attaches on its distal end to the opposing side of a second distal phalange.
• FIG. 9 illustrates a side view of the articulating steerable clip applier showing the opposing spiraled grooves which contain the tension wires.
• FIG. 10 illustrates a vertical cross-sectional view of an individual phalange atline18 ofFIG. 9 which contains a lumen that allows actuators, surgical clips, surgical clip carrying assemblies and other functional elements to pass through and operate to control clip movement, clip ligation or phalange articulation.
• FIG. 11 illustrates a perspective view of the articulating steerable clip applier showing an individual phalange separated into the top and bottom half-phalanges.
• FIG. 12 illustrates a perspective view of a top half-phalange and a bottom half phalange of the articulating steerable clip applier.
• FIG. 13 illustrates a perspective view of a phalange comprising assembled top half and bottom half phalanges of the articulating steerable clip applier.
• FIG. 14 illustrates a side view of a top and bottom semi-circular connecting ligaments of an individual phalange.
• FIG. 15 illustrates a front view of a top and bottom semi-circular connecting ligaments of an individual phalange.
• FIG. 16 illustrates a side view of a top semi-circular connecting ligament of an individual phalange.
• FIG. 17 illustrates a side view of a substantially circular elongate tubing that covers each individual phalange.
• FIG. 18 illustrates a front view of a substantially circular elongate tubing that covers each individual phalange.
• FIG. 19 illustrates a side view of an articulating steerable clip applier operatively attached on the proximal end to a user-operated handle.
DETAILED DESCRIPTION OF THE EMBODIMENTS
• While several variations of the present invention have been illustrated by way of example in particular embodiments, it is apparent that further embodiments could be developed within the spirit and scope of the present invention, or the inventive concept thereof. However, it is to be expressly understood that such modifications and adaptations are within the spirit and scope of the present invention, and are inclusive, but not limited to the following appended claims as set forth.
• FIGS. 1-3,5,6 and11 illustrate adistal end2 of the articulatingsteerable clip applier1. Theclip applier1 is a long, narrow structure with a freedistal end2 adapted for coupling to an end effector, such as asurgical jaw assembly3, and a proximal end101 operatively coupled to a user-operated handle100 (as shown inFIG. 19). Theclip applier1 is composed of a plurality of relatively short articulating members orphalanges4 that are connected end to end by pivotinglinks5 and capable of angulations6 relative to one another when subjected to a tensile force.FIG. 3 illustrates a cross-sectional top view of the articulating steerable clip applier along theline8 ofFIG. 2.FIG. 4 illustrates an enlarged cross-sectional top view ofpivoting point5 showing the pivotable connection between twophalanges4 on the articulatingsteerable clip applier1 fromline15 ofFIG. 3.
• A sheath ofelongate tubing7 covers eachindividual phalange4 such that the flexible joints of thephalange4 are exposed. In one embodiment of the subject invention, thistubing7 is composed of flexible materials. In another embodiment of the subject invention, thistubing7 is composed of inflexible materials. Accordingly, the plurality ofphalanges4 is covered with a plurality oftubings7. One embodiment of thetubing7 is shown inFIGS. 17 and 18. A single flexible tubing (not shown) may cover the entire plurality of phalanges of theclip applier1.
• Thedistal end2 of the articulatingsteerable clip applier1 contains afinal phalange9. Thefinal phalange9 has adistal end10 adapted for coupling to an end effector, such as asurgical jaw assembly3, and aproximal end11 that is attached to an adjacentproximal phalange12. Thedistal tip13 of thejaw assembly3 is a surgical clip applicator for applying a surgical clip to a blood vessel (not shown).
• The proximal end of the articulatingsteerable clip applier1 contains aninitial phalange14. Theinitial phalange14 has a proximal end101 operatively coupled to a user-operatedhandle100 and adistal end16 that is attached to an adjacent firstdistal phalange17.
• FIGS. 11-13 illustrateindividual phalanges4 spaced apart, but thephalanges4 are disposed in the articulatingclip applier1 so that the distal end of eachproximal phalange4 co-acts with the proximal end of the adjacentdistal phalange4.
• Eachphalange4 has a generally cylindrical configuration and is symmetrical about a longitudinal axis. Eachphalange4 has anexterior surface18, described more fully below, and aninterior surface19 that defines alumen20 extending between theproximal end21 anddistal end22.FIG. 10 illustrates a vertical cross-sectional view of anindividual phalange4 atline18 ofFIG. 9. The plurality oflumens20 of eachphalange4 forms an internallongitudinal passage23 in the articulatingclip applier1.Longitudinal passage23 permits actuators, surgical clips, surgical clip carrying assemblies and other functional elements to pass throughclip applier1 and to control the operation of clip movement, clip ligation or phalange articulation. Eachphalange4 is composed of twohalf phalanges24. As shown inFIG. 12, eachhalf phalange24 has the same structure: acurved exterior surface18 and a generally planarinterior surface19. Eachhalf phalange24 has a substantially half-round or half-elliptical cross-sectional configuration so that an assembledphalange4 has a substantially cylindrical configuration. Theinterior surface19 of eachhalf phalange24 contains alongitudinal channel27.
• Theproximal end21 of theexterior surface18 of eachhalf phalange24 contains anextension29. Theextension29 may have angledsides30 that form acurved end31. Thetop surface32 of eachextension29 has a curvature that is substantially the same as the curvature of theexterior surface18. The bottom33 of eachextension29 has a substantially flatplanar surface34. The bottom34 of eachextension29 further has a substantiallycylindrical protrusion35.
• Thedistal end22 of eachhalf phalange24 contains a substantially flatplanar surface37 that is lowered from thecurved exterior surface18. The substantially flatplanar surface37 has a substantially circularinternal bore38 with a diameter that is generally larger than the diameter of thecylindrical protrusion35.
• Aphalange4 is assembled by attaching theinterior surfaces19 of twohalf phalanges24 to one another so that the twolongitudinal channels27 on eachinterior surface19 of eachhalf phalange24 form thelumen20. An assembledphalange4 will have twoextensions29 on theproximal end21, with their respective substantiallycylindrical protrusions35 facing each other. The substantially flatplanar surfaces37 of thedistal end22 will be on opposing sides of the assembledphalange4.
• In one embodiment of the subject invention, thephalanges4 are composed of injected-molded plastic.
• As shown inFIGS. 3 and 11, the plurality ofphalanges4 is connected end to end by pivotinglinks5 in the following manner:
• Theinitial phalange14 has a proximal end101 attached to a user-operated handle100 (shown inFIG. 19). Thedistal end16 of theinitial phalange14 has substantially flatplanar surfaces39 on the top and bottom of theexterior surface18. The substantially flatplanar surfaces39 each have a substantially circular internal bore41 with a diameter that is generally larger than the diameter of thecylindrical protrusion35.
• Theclip applier1 is assembled by placing the two substantiallycylindrical protrusions35 on theproximal end21 of the firstdistal phalange17 into the internal bores41 on opposing sides on thedistal end16 of theinitial phalange14. This pivotinglink5 attaches the firstdistal phalange17 to theinitial phalange14.
• Theproximal end21 of the firstdistal phalange17 may pivot with respect to theinitial phalange14. The two substantiallycylindrical protrusions35 may rotate within the internal bores41. The substantially flatplanar surfaces34 of eachextension29 rotate freely on the substantially flatplanar surfaces39 on opposing sides of theinitial phalange14.
• Second, third and subsequentdistal phalanges4, as desired, are added to the firstdistal phalange17 as follows: the two substantiallycylindrical protrusions35 on theproximal end21 of asubsequent phalange4 are placed into theinternal bores38 on opposing sides on thedistal end22 of the precedingproximal phalange4.
• As shown inFIGS. 1,3,5,6 and7, the proximal ends21 of all subsequentdistal phalanges4 may pivot with respect todistal ends22 of their respective adjacentproximal phalanges4. Theprotrusions35 on theproximal end21 of each subsequentdistal phalange4 may rotate within theinternal bores38 on thedistal end22 of the adjacentproximal phalange4. The substantially flatplanar surfaces34 of eachextension29 rotate freely on the substantially flatplanar surfaces37 of the adjacentproximal phalange4.
• As shown inFIGS. 9,12 and13, theexterior surface18 of eachhalf phalange24 contains at least one axially extending s-shapedgroove42 or channel. The curve of the s-shapedgroove42 traverses the width and length of theexterior surface18 of thehalf phalange24. The s-shapedgroove42 begins on one side of theexterior surface18 at theproximal end21 of thehalf phalange24, axially extends and curves over theexterior surface18 to the opposing side of the exterior surface on thedistal end22 of thehalf phalange24.
• Once aphalange4 is assembled, it has twogrooves42 on bothexterior surfaces18 that axially extend in thephalange4 in opposing s-shaped curves. Once the plurality ofphalanges4 is assembled, the two s-shapedgrooves42 form two continuous axially extending spiral shapedchannels43 that curve in opposing directions from each other.
• A tension cable or wire is inserted into each spiral shapedchannel43, to provide steering control for the plurality ofphalanges4. Tension wire is preferably made from a superelastic material, e.g., nickel titanium alloy, braided stainless steel, a single stainless steel wire, Kevlar, a high tensile strength monofilament thread, or combinations thereof.
• As shown inFIGS. 5,7 and8 a first set of twowires45aand45bare connected on their respective proximal ends46aand46bto theinitial phalange14 and connected on their respective distal ends47aand47bto theproximal end21 of the adjacent firstdistal phalange17. Theproximal end46aofwire45ais attached to oneside14aof theinitial phalange14 and thedistal end47aofwire45ais attached to theside17aof the firstdistal phalange17 on itsproximal end21. Theproximal end46bofwire45bis attached to the opposingside14bof theinitial phalange14 and thedistal end47bofwire45bis attached to theside17bof the firstdistal phalange17 on itsproximal end21. Whenwire45ais pulled, this tensile force causes the firstdistal phalange17 to pivot back and forth at itsproximal end21 towardsside17a,away fromside14b.Whenwire45bis pulled, this tensile force causes the firstdistal phalange17 to pivot back and forth at itsproximal end21 towardsside17b,away fromside14a.Furthermore, each subsequently attachedphalange4 is moved by the same pivoted angle above, when eitherwire45aor45bis pulled.
• A second set of twowires48aand48bare connected on their respective proximal ends49aand49bto theinitial phalange14 and connected on their respective distal ends50aand50bto theproximal end51 of the seconddistal phalange52, which is adjacent tophalange17. Thewires48aand48bare inserted into the two spiral shapedchannels43 that curve in opposing directions. Theproximal end49aofwire48ais attached to oneside14aof theinitial phalange14 and thedistal end50aofwire48ais attached to the opposingside52bof the seconddistal phalange52 on itsproximal end51. Theproximal end49bofwire48bis attached to the opposingside14bof theinitial phalange14 and thedistal end50bofwire48bis attached to the opposingside52aof the seconddistal phalange52 on itsproximal end51. Whenwire48ais pulled, this tensile force causes the seconddistal phalange52 to pivot back and forth at itsproximal end51 towardsside52b,away fromside14a. Whenwire48bis pulled, this tensile force causes the seconddistal phalange52 to pivot back and forth at itsproximal end51 towardsside52a,away fromside14b. Furthermore, each subsequently attachedphalange4 is moved by the same pivoted angle above, when eitherwire48aor48bis pulled. Since the proximal end and the distal end of eachwire48aor48bis attached to opposing sides of theinitial phalange14 and the seconddistal phalange52, pulling eitherwire48aor48bcauses the seconddistal phalange52 to pivot in the direction of the distal end of the wire and away from the proximal end of the wire.
• A third set of twowires53aand53bare connected on their respective proximal ends54aand54bto the firstdistal phalange17 and connected on their respective distal ends55aand55bto theproximal end56 of the thirddistal phalange57, which is adjacent to seconddistal phalange52. Thewires53aand53bare inserted into the two spiral shapedchannels43 that curve in opposing directions. Theproximal end54aofwire53ais attached to oneside17aof the firstdistal phalange17 and thedistal end55aofwire53ais attached to the opposingside57bof the thirddistal phalange57 on itsproximal end56. Theproximal end54bofwire53bis attached to the opposingside17bof the firstdistal phalange17 and thedistal end55bofwire53bis attached to the opposingside57aof the thirddistal phalange57 on itsproximal end56. Whenwire53ais pulled, this tensile force causes the thirddistal phalange57 to pivot back and forth at itsproximal end56 towardsside57b, away fromside17a.Whenwire53bis pulled, this tensile force causes the thirddistal phalange57 to pivot back and forth at itsproximal end56 towardsside57a, away fromside17b.Furthermore, each subsequently attachedphalange4 is moved by the same pivoted angle above, when eitherwire53aor53bis pulled. Since the proximal end and the distal end of eachwire53aor53bis attached to opposing sides of the firstdistal phalange17 and the thirddistal phalange57, pulling eitherwire53aor53bcauses the thirddistal phalange57 to pivot in the direction of the distal end of the wire and away from the proximal end of the wire.
• Additional sets of two wires may be connected on their proximal ends to a proximal phalange and connected on their distal end to the proximal end of phalange that is two phalanges distal from the proximal phalange. The wires are inserted into the two spiral shapedchannels43 that curve in opposing directions. The proximal end of each wire is attached to one side of the proximal phalange. The distal end of each wire is attached to the opposing side of the phalange that is two phalanges distal from the proximal phalange. When each wire is pulled, this tensile force causes the phalange that is two phalanges distal from the proximal phalange to pivot back and forth at its proximal end. The direction of this pivoting is towards the distal end attachment of each wire and away from the proximal end attachment of each wire.
• A user may actuate the wires above to pivot all the remainingphalanges4 such that theangle6 between the distal end of a preceding phalange and the proximal end of the subsequent phalange in the clip applier is substantially equivalent.FIGS. 1 and 2 illustrate the separate, but identical, angles ofmovement6 byindividual phalanges4.
• As eachindividual phalange4 pivots by anequivalent angle6, the sum of theseangles6 causes thedistal end2 of theclip applier1 to pivot by a large angle or a cascading actuation effect, as shown inFIG. 1.
• In another embodiment of the subject invention, as shown inFIGS. 14-16, the tension wires above may be replaced by semi-circular connectingligaments61. Eachindividual phalange4 may be substantially covered with two semi-circular connectingligaments61.FIGS. 14 and 15 illustrate two semi-circular connectingligaments61 in an opposing top-bottom configuration61ato cover an individual phalange (not shown).
• Each semi-circular connectingligament61 has aflexible tip62 on its proximal end and aflexible tip63 on its distal end. Furthermore,flexible tips62 and63 are on opposing sides of each semi-circular connectingligament61.
• In the opposing top-bottom configuration61a,flexible tips62 are attached to the distal end of a proximal phalange on opposing sides, an adjacent distal phalange is substantially covered by the two opposing semi-circular connectingligaments61, andflexible tips63 are attached to the proximal end of a second distal phalange on opposing sides.
• Eachflexible tip62 is attached to one side of the proximal phalange and eachflexible tip63 is attached to the opposing side of the second distal phalange. When aflexible tip62 is pulled, this force causes the second distal phalange to pivot at its proximal end. The direction of this pivoting is away from theflexible tip62 that is pulled.
• A user may actuate theflexible tips62 above to pivot all the remainingphalanges4 such that theangle6 between the distal end of a preceding phalange and the proximal end of the subsequent phalange in the clip applier is substantially equivalent.FIGS. 1 and 2 illustrate the separate, but identical, angles ofmovement6 byindividual phalanges4.
• In one embodiment of the subject invention, the narrow plurality ofphalanges4 may easily fit within respective envelopes of 10 mm and 3 mm MIS instrumentation, while retaining flexible movements within a patient.

Claims (11)

1. An endoscopic surgical tool having a handle and a shaft member coupled to the handle and extending along a shaft axis from a proximal end to a distal end, wherein the distal end of the shaft member is adapted to receive an end effector, comprising:

A. a linear array of n phalanx sections, where n is an integer greater than2, wherein the linear array includes a sequentially aligned proximal phalanx section, n−2 intermediate phalanx sections, and a distal phalanx section, wherein the ith phalanx section, wherein i is greater than or equal to 1 and less than or equal to n, extends along an associated central axis CAi between a proximal end PEi and a distal end DEL and includes:

a tubular member TMi defining

a. a central void region CVRi extending along the central axis CAi between the proximal end PEi and the distal end DEi,

b. an exterior surface ESi disposed about the central void region CVRi and extending along the central axis CAi from the proximal end PEi to the distal end DEi,

wherein the n phalanx sections are aligned whereby the central axis CAi of each phalanx section intersects with the central axis of phalanx sections adjacent thereto in the linear array,

B. an end effector coupler EEC disposed at the distal end of the distal phalanx section and adapted for coupling the distal end to an end effector,

C. a base coupling assembly BC disposed at the proximal end of the proximal phalanx section and adapted to couple to the proximal end of the proximal phalanx section to the distal end of the shaft member, whereby the shaft axis intersects the central axis of the proximal phalanx section and whereby the proximal phalanx section is movable with respect to the distal end of the shaft member substantially only in rotational motion about a transverse axis TA0 perpendicular to the central axis of the proximal phalanx section,

D. n−1 phalanx section coupling assemblies PC, wherein each phalanx section coupling assembly is associated with an intermediate phalanx section and wherein the coupling assembly PCi associated with the ith phalanx section couples a distal end of the ith phalanx section to the proximal end of the adjacent i+1th phalanx section whereby the proximal end of the i+1th phalanx section is movable with respect to the distal end of the ith phalanx section substantially only in rotational motion about a transverse axis TAi perpendicular to the central axis of the ith phalanx section, wherein TAi and TA0 are mutually parallel, and

wherein each of the base coupling assembly and the n−1 phalanx coupling assemblies are operative whereby a torque applied to the proximal end of the proximal phalanx section about an axis parallel to transverse axis TA0, effects a same-direction angular rotational displacement of each of the ith phalanx sections with respect to the adjacent phalanx sections about the respective transverse axes TAi.

2. An endoscopic surgical tool according toclaim 1, wherein the base coupling assembly BC is adapted to detachably couple the proximal end of the proximal phalanx section to the distal end of the shaft member.

3. An endoscopic surgical tool according toclaim 1, wherein the end effector coupling assembly EEC is adapted to detachably couple the end effector to the distal end of the distal phalanx section.

4. An endoscopic surgical tool according toclaim 1, wherein at least the ith phalanx section coupling assembly Ci includes:

i. a coupling cam surface CCSi disposed about a cam central axis CCAi affixed to the distal end of the ith phalanx section, wherein the cam central axis CCAi is substantially coaxial with the transverse axis TAi,

ii. a substantially non-stretchable link coupling a point on the coupling cam surface of the ith phalanx section CCSPi with a point EPi+2 on the proximal end of the i+2th phalanx section, wherein point CCSPi and point EPi are disposed in a plane including CAi+1 and perpendicular to the transverse axes TAi and TAi+2 and on opposite sides central axis of the i+1 phalanx section CAi+1.

5. An endoscopic surgical tool according toclaim 4, wherein the link of coupling assembly Ci is a cable extending between point CCSPi and point EPi+2.

6. An endoscopic surgical tool according toclaim 5, wherein the cable extends in a helical path about the central axis CAi+1 between point CCSPi and point EPi+2.

7. An endoscope surgical tool according toclaim 6, wherein the exterior surface ESi includes an open-faced helical channel HCi+1 disposed about the central axis CAi+1, and the cable of coupling assembly Ci extends through the helical channel HCi+1.

8. An endoscope surgical tool according toclaim 1, wherein the same-direction angular rotational displacement of each of the ith phalanx sections with respect to the adjacent phalanx sections are equi-angle.

9. An endoscope surgical tool according toclaim 1, wherein the tubular members TMi are characterized by the same distance between the proximal end PEi and the distal end Dei.

10. An endoscope surgical tool according toclaim 1, wherein at least two of the tubular members TMi are characterized by different distances between their respective proximal ends PEi and distal ends Dei.

11. An endoscope surgical tool according toclaim 1, wherein the cam surfaces CCSi are circular segments.

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