Surgical clip application assembly

Abstract

An apparatus for the transoral invagination and fundoplication of the stomach to the esophagus includes a clip applier having sharp toothed jaws for grasping and damaging the fundus prior to applying the clip. The clip applier has an overall diameter of less than 7 mm. The clip applier jaws are coupled to a pull wire via a linkage which increases the mechanical advantage and thus permits greater grasping force. A plurality of clip designs are also provided.

1 . A surgical clip application assembly, comprising:
 a surgical clip; and   a surgical clip applier having:
 a hollow member having a proximal end and a distal end; 
 a clevis coupled to said distal end of said hollow member; 
 a first jaw rotatably coupled to said clevis; 
 a second jaw rotatably coupled to said clevis in opposed relation to said first jaw, said first and second jaws adapted to apply said surgical clip to a location; 
 at least one pull/push wire coupled to said first and second jaws and extending through said hollow member to said proximal end of said hollow member; and 
 actuation means coupled to said proximal end of said hollow member and to said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first and second jaws about said clevis from an open to a closed position, wherein at least one of said jaws is provided with a plurality of teeth arranged to puncture and damage tissue adjacent to said surgical clip at said location. 
   
   
   
       2 . A surgical clip applier according to  claim 1 , wherein both of said jaws are provided with a plurality of teeth arranged to puncture and damage tissue adjacent two sides of the surgical clip. 
   
   
       3 . A surgical clip applier according to  claim 1 , wherein:
 at least one of said first and second jaws has:
 a clip guiding channel shaped to fit a surgical clip; and 
 a hook shaped anvil at an end of said channel; and 
   said first and second jaws apply the surgical clip with said channel.   
   
   
       4 . A surgical clip applier according to  claim 1 , wherein:
 each of said first and second jaws have:
 a clip guiding channel shaped to fit a surgical clip; and 
 a hook shaped anvil at the end of said channel; 
   said first and second jaws apply the surgical clip with said channel.   
   
   
       5 . A surgical clip applier according to  claim 4 , wherein each of said anvils has a helical surface. 
   
   
       6 . A surgical clip applier according to  claim 4 , wherein each of said anvils has a curved surface. 
   
   
       7 . A surgical clip applier according to  claim 6 , wherein said surface is curved about a single axis. 
   
   
       8 . A surgical clip applier according to  claim 4 , wherein:
 each of said jaws has a longitudinal axis and a vertical axis perpendicular to the longitudinal axis, and   each of said channels is arranged at an angle relative to said vertical axis.   
   
   
       9 . A surgical clip applier according to  claim 8 , wherein said angle is approximately 22 degrees. 
   
   
       10 . A surgical clip application assembly, comprising:
 a surgical clip; and   a surgical clip applier having:
 a hollow member having a proximal end and a distal end; 
 a clevis coupled to said distal end of said hollow member; 
 a first jaw rotatably coupled to said clevis; 
 a second jaw rotatably coupled to said clevis in opposed relation to said first jaw, said first and second jaws adapted to apply said surgical clip to a location; 
 at least one pull/push wire coupled to said first and second jaws and extending through said hollow member to said proximal end of said hollow member; and 
 an actuator coupled to said proximal end of said hollow member and to said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first and second jaws about said clevis from an open to a closed position, wherein at least one of said jaws is provided with a plurality of teeth arranged to puncture and damage tissue adjacent to said surgical clip at said location. 
   
   
   
       11 . A surgical clip application assembly, comprising:
 a surgical clip; and   a surgical clip applier having:
 a hollow member having a proximal end and a distal end; 
 a clevis coupled to said distal end of said hollow member; 
 a first jaw rotatably coupled to said clevis, said first jaw having a first clip guiding channel terminating in a first anvil; 
 a second jaw rotatably coupled to said clevis in opposed relation to said first jaw, said second jaw having a second clip guiding channel terminating in a second anvil, said first clip guiding channel and said second clip guiding channel guiding said surgical clip when disposed therebetween; 
 at least one pull/push wire coupled to said first and second jaws and extending through said hollow member to said proximal end of said hollow member; and 
 actuation means coupled to said proximal end of said hollow member and to said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first and second jaws about said clevis from an open to a closed position. 
   
   
   
       12 . A surgical clip application assembly, comprising:
 a surgical clip; and   a surgical clip applier having:
 a hollow member having a proximal end and a distal end; 
 a clevis coupled to said distal end of said hollow member; 
 a first jaw rotatably coupled to said clevis, said first jaw having a first clip guiding channel terminating in a first anvil; 
 a second jaw rotatably coupled to said clevis in opposed relation to said first jaw, said second jaw having a second clip guiding channel terminating in a second anvil, said first clip guiding channel and said second clip guiding channel guiding said surgical clip when disposed therebetween; 
 at least one pull/push wire coupled to said first and second jaws and extending through said hollow member to said proximal end of said hollow member; and 
 an actuator coupled to said proximal end of said hollow member and to said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first and second jaws about said clevis from an open to a closed position. 
   
   
   
       13 . A surgical clip applier according to  claim 12 , wherein both of said jaws are provided with a plurality of teeth arranged to puncture and damage tissue adjacent two sides of the surgical clip. 
   
   
       14 . A surgical clip applier according to  claim 12 , wherein:
 at least one of said first and second jaws has:
 a clip guiding channel shaped to fit a surgical clip; and 
 a hook shaped anvil at an end of said channel; 
   said first and second jaws apply the surgical clip with said clip guiding channel.   
   
   
       15 . A surgical clip applier according to  claim 12 , wherein:
 each of said first and second jaws have:
 a clip guiding channel shaped to fit a surgical clip; 
 a hook shaped anvil at the end of said channel; 
   said first and second jaws apply the surgical clip with said channel.   
   
   
       16 . A surgical clip applier according to  claim 15 , wherein each of said anvils has a helical surface. 
   
   
       17 . A surgical clip applier according to  claim 15 , wherein each of said anvils has a curved surface. 
   
   
       18 . A surgical clip applier according to  claim 17 , wherein said surface is curved about a single axis. 
   
   
       19 . A surgical clip applier according to  claim 15 , wherein:
 each of said jaws has a longitudinal axis and a vertical axis perpendicular to the longitudinal axis, and   each of said channels is arranged at an angle relative to said vertical axis.   
   
   
       20 . A surgical clip applier according to  claim 19 , wherein said angle is approximately 22 degrees.