CN101664331A - Endoscope operation applicator with a fastener - Google Patents

Abstract

An apparatus for application of surgical clips to body tissue is provided and includes a handle assembly; a shaft assembly including a housing extending distally from the handle assembly and defininga longitudinal axis; a plurality of surgical clips disposed within the shaft assembly; a jaw mounted adjacent a distal end portion of the shaft assembly, the jaw being movable between an open spaced-apart condition and a closed approximated condition; and a pusher bar reciprocally disposed within the housing of the shaft assembly and being detachably connectable to the housing of the shaft assembly, the pusher bar being configured to load a distal-most surgical clip into the jaws during distal movement and remain connected to the housing of the shaft assembly and in a distally advanced position during an approximation of the jaws. The invention relates to an endoscope operation applicator with a fastener.

Description

Endoscope operation applicator with dead lock

Quoting of related application

[0001] to require in the serial number that on August 29th, 2008 submitted to be the rights and interests and the priority of 61/092,806 U.S. Provisional Application to the application, and the full content of this provisional application is incorporated herein by reference.

Technical field

[0002] disclosure relates to operation applicator, especially relates to a kind of novel endoscope operation applicator.

Background technology

[0003] endoscopic staplers is known in the art with applicator and is used for many different and useful operative procedure.Under the situation of laparoscopic surgical procedure, by inserting the passage that narrow pipe that enters otch for a short time in the skin or sleeve pipe acquire abdominal part inside.And Wicresoft's program that carry out at other position on health is generally known as endoscopic procedure usually.Typically, pipe or casing bit stretch in the patient's body by entering otch, so that provide access.This kind inlet allows the surgeon to utilize the trocar to insert a plurality of different operating theater instruments and is used for carrying out operative procedure in the place away from otch.

[0004] in most these programs, the surgeon often must stop blood or another kind of liquid flowing by one or more vascular.In program, the surgeon is applied on blood vessel or the another kind of conduit through regular meeting's clip of will performing the operation, and crosses these conduits to prevent body fluid flow.Endoscope's applicator is used for applying single clip when entering body cavity, this is known in the art.Typically, such single applicator make by biocompatible materials and usually by compress on vascular.In case be applied on the vascular, this has just been stopped liquid flowing by conduit by the clip of compress.

[0005] transfers the 5th of Green people such as (Green) total, 084,057 and 5,100, described endoscope's applicator that can apply a plurality of clips when entering in the body cavity separately in endoscope or laparoscopic procedure in No. 420 United States Patent (USP)s, the full content of above-mentioned two patents is incorporated herein by reference.Disclose another kind of compound endoscope applicator in total the 5th, 607, No. 436 United States Patent (USP)s that transfer Bu Lade people such as (Pratt), the full content of this patent is incorporated herein by reference equally.These devices typically are used in the single operative procedure, but this not necessarily.At serial number is 08/515,341 U.S. Patent application, promptly authorizes now in the 5th, 695, No. 502 United States Patent (USP)s to Pi Aier people such as (Pier) and discloses a kind of operation applicator of disinfectant again, and the content disclosed in this patent is incorporated herein by reference.This applicator advances and forms a plurality of clips when inserting in the body cavity separately.But the applicator of described repeated disinfection is configured to hold and with tradable cartridge clip cooperation so that when entering body cavity separately, advance and form a plurality of clips.An important design object is that the clip of will performing the operation under the situation of clip from load module not being carried out any compression is contained between the jaw.These of clip in loading process are crooked or reverse and often have many beyond thought consequences.This compression when loading may slightly change the aligning of clip between jaw.This can make the surgeon with clip from removing between the jaw so that abandon clip.In addition, this pre-load compression slightly compression clip some part and change its how much.This can make the surgeon with clip from removing between the jaw so that abandon clip.

[0006] carries out endoscope or laparoscopic procedure through being everlasting away from the place of otch.Therefore, for the user who is positioned at the device near-end, the reducing of the visual field or tactile feedback may make applying of clip complicated.Therefore wish to improve the operation of apparatus by the indication of the indication that provides single clip to be launched to the user, the loss that is included in the clip in the load units or any other surgical event.It would also be desirable to provide a kind of like this operation applicator: the jaw that it has promoted the successful load of clip and has separated this operation applicator, then clip is contained between the jaw preventing any damage or the excess compression of clip, and prevents that before emission jaw is pressed on the clip.

Summary of the invention

[0007] disclosure relates to novel endoscope operation applicator.

[0008], provide a kind of being used for that the operation clip is applied to device in the soma according to a scheme of the present disclosure.This device comprises: Handleset; Shaft assembly, it distad extends from Handleset, and defines the longitudinal axis; Be arranged in a plurality of operation clips in the shaft assembly; Jaw, the distal portion of its adjacent shafts assembly is installed, and this jaw can move between open mode that separates and approaching closure state; And push rod, it can be arranged in the shaft assembly with moving back and forth, this push rod clip that is configured to when jaw is in open mode farthest side performed the operation is packed in the jaw, and jaw near during the time keep in touch with the clip that is loaded into.

[0009] push rod can comprise the pusher that is formed on its far-end.Pusher can have the operation stitching nail that narrow profile is loaded into contact on single position.Pusher can limit the plane cardinal principle plane orthogonal with the operation stitching nail that is loaded into.

[0010] described device can further comprise the connecting plate that can be arranged in the shaft assembly with moving back and forth.Connecting plate can be connected on the push rod.In use, during the initial distal movement of connecting plate, push rod can advance towards the distally, and during the further distal movement of connecting plate, connecting plate can be thrown off from push rod.

[0011] push rod can comprise support first spring clip thereon, and this first spring clip is used for being in when advancing the position optionally part bonding with shaft assembly at push rod, optionally push rod is remained on this propelling position.Push rod can further comprise support second spring clip thereon, and second spring clip is used for optionally first part bonding with connecting plate.After the initial distal movement of connecting plate, first parts of connecting plate can optionally break away from from second spring clip.

[0012] described device can further comprise the pushing plate that can be arranged in the shaft assembly with moving back and forth.Pushing plate can comprise at least one fin that can optionally be engaged by the shoulder of push rod.In use, during the distally and proximal movement of push rod, the shoulder of push rod can engage with at least one fin of pushing plate, with one in the distally of realizing pushing plate and the proximal movement.

[0013] described device can further comprise the clip follower that is supported on slidably in the shaft assembly, and the clip follower is used for distal direction and promotes a plurality of operation clips.The clip follower comprises from outstanding first projection of its first surface and from the second outstanding projection of its second surface.In use, along with the pushing plate distal motion, first projection of clip follower can engage with pushing plate, thereby make this clip follower distal motion to advance a plurality of operation clips, and wherein, along with the pushing plate proximal motion, second projection of clip follower can engage with fixed part, thereby the clip follower is maintained fixed.

[0014] described device can further comprise the clip carrier that is arranged in the shaft assembly, wherein, this clip carrier is configured to keep a plurality of operation clips and clip follower, and wherein, second projection of clip follower can with the part bonding that is formed in the clip carrier.

[0015] can progressively advance the clip follower to pass through shaft assembly.The clip follower can comprise the window catch (catch) that stretches out from its surface, and wherein, after in the end an operation clip was launched, this window catch can engage with push rod and can prevent the motion of throw-out lever proximal direction.

[0016] described device can further comprise the ratchet assembly that is arranged in the Handleset.When push rod does not turn back to proximal position, can prevent that this ratchet assembly from resetting.

[0017] described device can further comprise the enumerator that is supported in the housing unit.After the operation clip had been launched, this enumerator can provide indication.

[0018] described device can further comprise the indicator that is supported in the housing unit.When at least one operation clip was loaded in the jaw, the operation clip is launched and described device is reset, indicator can provide at least one in audition and the sense of touch indication.

[0019] described device can further comprise the clapboard that can be arranged in the shaft assembly with moving back and forth.Clapboard can not move between the position in described jaw at position and its far-end that its far-end is arranged in the jaw.Clapboard can comprise further that support is used for optionally the 3rd spring clip with second part bonding of connecting plate thereon, and wherein, after the initial distal movement of connecting plate, second parts of connecting plate optionally break away from from the 3rd spring clip.

[0020] described device can further comprise the drive rod that is activated and be connected to connecting plate by Handleset, and drive rod is used to realize the motion of connecting plate.Described device can further comprise the driving passage that can be arranged in the shaft assembly with moving back and forth, wherein, drive rod optionally with drive channel engagement to realize the translation of this driving passage.When driving passage and distad advance, its far-end can with the surface engagement of jaw, to realize the approaching of jaw.

[0021] thus driving passage actuatable wedge-lock releasing device when it distad advances and allows to drive passage near jaw so that the clapboard proximal motion makes the near-end of clapboard return from jaw.

[0022] shaft assembly can be with respect to Handleset around longitudinal axis rotation.Shaft assembly can comprise support protector within it.Wherein, this protector can prevent that the 3rd spring clip from outwards opening during by this protector in the 3rd spring clip translation.

[0023] clapboard and/or driving passage can be biased to proximal position.

[0024], provide a kind of being used for that the operation clip is applied to device in the soma according to another scheme of the present disclosure.This device comprises: Handleset; Shaft assembly, it distad extends from Handleset, and defines the longitudinal axis; Be arranged in a plurality of operation clips in the shaft assembly; Jaw, the distal portion of its adjacent shafts assembly is installed, and this jaw can move between open mode that separates and approaching closure state; And the clip follower, it is supported in the shaft assembly slidably, is used for distad promoting a plurality of operation clips.This clip follower comprises from outstanding first projection of its first surface and from the second outstanding projection of its second surface.Along with pushing plate distad advances, first projection of clip follower engages with pushing plate, thereby make this clip follower distal motion to advance a plurality of operation clips, and, along with the pushing plate proximal motion, second projection of clip follower engages with fixed part, thereby the clip follower is maintained fixed.

[0025] described device can further comprise the pushing plate that can be arranged in the shaft assembly with moving back and forth.Pushing plate can limit a plurality of windows that form along its length.In use, along with pushing plate moves back and forth, first projection of clip follower can optionally engage with a window in a plurality of windows.

[0026] described device can further comprise the push rod that can be arranged in the shaft assembly with moving back and forth.This push rod clip that is configured to can be when jaw is in open mode farthest side be performed the operation is packed in the jaw, and jaw near during keep in touch with the operation clip that is loaded into.

[0027] pushing plate can comprise at least one fin that can optionally engage with the shoulder of push rod.During the distally and proximal movement of push rod, the shoulder of push rod can engage with at least one fin of pushing plate, with one in the distally of realizing pushing plate and the proximal movement.

[0028] push rod can comprise the pusher that is formed on its far-end, and wherein, pusher has the operation stitching nail that narrow profile is packed into contact on single position.Pusher can limit the plane cardinal principle plane orthogonal with the operation stitching nail that is loaded into.

[0029] described device can further comprise the connecting plate that can be arranged in the shaft assembly with moving back and forth.Connecting plate can optionally be connected on the push rod.In use, during the initial distal movement of connecting plate, push rod can distad advance, and during the further distal movement of connecting plate, this connecting plate can be thrown off from push rod.

[0030] push rod can comprise support first spring clip thereon, and this first spring clip is used for being detachably connected to the parts of shaft assembly when push rod is in the propelling position, thereby push rod is remained on this propelling position.Push rod can further comprise support second spring clip thereon, and second spring clip is used to be detachably connected to first parts of connecting plate, and wherein, after the initial distal movement of connecting plate, first parts of connecting plate are thrown off from second spring clip.

[0031] described device can further comprise the clip carrier that is arranged in the shaft assembly.The clip carrier can be configured to keep a plurality of operation clips and clip follower.Second projection of clip follower can with the part bonding that is formed in the clip carrier.Can progressively advance the clip follower to pass through shaft assembly.The clip follower can comprise the window catch that stretches out from its surface.After in the end an operation clip was launched, window catch can engage with push rod, and can prevent the motion of throw-out lever proximal direction.

[0032] described device can further comprise and is arranged in ratchet assembly in the Handleset.When push rod does not turn back to proximal position, can prevent that this ratchet assembly from resetting.

[0033] described device can further comprise the enumerator that is supported in the housing unit, and wherein, after the operation clip had been loaded into or has launched, this enumerator can provide indication.Described device can further comprise the indicator that is supported in the housing unit, and wherein, when at least one operation clip was loaded in the jaw, the operation clip is launched and described device is reset, this indicator can provide at least one in audition and the sense of touch indication.

[0034] described device can further comprise the clapboard that can be arranged in the shaft assembly with moving back and forth.Clapboard can not move between the position in described jaw at position and its far-end that its far-end is arranged in the jaw.This jaw can comprise further that support is used for the 3rd spring clip that optionally engages with second parts of connecting plate thereon, and wherein, after the initial distal movement of connecting plate, second parts of connecting plate can optionally break away from from the 3rd spring clip.

[0035] described device can further comprise drive rod, and drive rod activates and be connected to the motion that is used to realize connecting plate on the connecting plate by Handleset.Described device can further comprise the driving passage that can be arranged in the shaft assembly with moving back and forth, wherein, drive rod can with engage to realize the translation of this driving passage with driving channel selecting, and wherein, when driving passage and distad advance, its far-end can with the surface engagement of jaw to realize the approaching of jaw.Driving passage actuatable wedge shape jam plate when it distad advances and can allow to drive passage near jaw so that thereby the clapboard proximal motion makes the far-end of clapboard return from jaw.

[0036] shaft assembly can be with respect to Handleset around longitudinal axis rotation.Shaft assembly can comprise support cuff (cuff) within it, and wherein, this cuff can prevent that when the 3rd spring clip translation strides across this cuff the 3rd spring clip from outwards opening.

[0037] clapboard and/or driving passage can be biased to proximal position.

[0038] according to another scheme of the present disclosure, provide a kind of being used for that the operation clip is applied to device in the soma, wherein, described device comprises Handleset and the shaft assembly that distad extends and define the longitudinal axis from this Handleset.Handleset comprises trigger and drive rod, and this drive rod can pass through the reciprocal translation of trigger when trigger-acted.Shaft assembly comprises: housing; Be arranged in a plurality of operation clips in the housing; Jaw, distal portion of its contiguous housing is installed, and this jaw can move between open mode that separates and approaching closure state; Can be arranged in the push rod in the housing, this push rod clip that is configured to when jaw is in open mode farthest side performed the operation is packed in the jaw with moving back and forth, and jaw near during keep in touch with the operation clip that is loaded into; Contiguous push rod can be arranged in the pushing plate in the housing with moving back and forth, pushing plate comprises at least one fin that optionally engages with the shoulder of push rod, wherein, during the distally and proximal movement of push rod, the shoulder of push rod engages with at least one fin of pushing plate, with one in the distally of realizing pushing plate and the proximal movement; Contiguous pushing plate is arranged in the clip carrier in the housing, and wherein, this clip carrier is configured to keep a plurality of operation clips; The clip follower, it is supported on the proximal position of the most a plurality of surgical clips in the clip carrier slidably, this clip follower is configured to distal direction and promotes a plurality of operation clips, this clip follower comprises from outstanding first projection of its first surface and from the second outstanding projection of its second surface, wherein, along with the pushing plate distal motion, first projection of clip follower engages with pushing plate, thereby make this clip follower distal motion to advance a plurality of operation clips, and wherein, along with the pushing plate proximal motion, second projection of clip follower engages with the clip carrier, thereby the clip follower is maintained fixed; Contiguous clip carrier can be arranged in the driving passage in the housing with moving back and forth, wherein, drive rod with engage to realize the translation of this driving passage, wherein with driving channel selecting, when the driving passage distad advanced, the surface engagement of its far-end and jaw was to realize the approaching of jaw; And the contiguous passage that drives can be arranged in clapboard in the housing with moving back and forth, and this clapboard does not move between the position in described jaw at position and its far-end that its far-end is arranged in the jaw.

[0039] push rod can comprise the pusher that is formed on its far-end.Pusher can have the operation stitching nail that narrow profile is loaded into contact on single position.Pusher can limit the plane cardinal principle plane orthogonal with the operation stitching nail that is loaded into.Push rod can comprise support first spring clip thereon, and this first spring clip can be in when advancing the position with the parts of the housing of shaft assembly at push rod and optionally engage, optionally push rod is remained on this propelling position.Push rod can further comprise support second spring clip thereon, second spring clip is used for optionally engaging with first parts of connecting plate, wherein, after the initial distal movement of connecting plate, first parts of connecting plate optionally break away from from second spring clip.

[0040] can progressively advance the clip follower to pass through shaft assembly.The clip follower can comprise the window catch that stretches out from its surface.In use, after in the end an operation clip was launched, window catch can engage with push rod, and can prevent the motion of throw-out lever proximal direction.

[0041] Handleset can further comprise the ratchet assembly that is arranged in it.In use, when push rod does not turn back to proximal position, can prevent that this ratchet assembly from resetting.Handleset can further comprise the enumerator that is supported in the housing unit, and wherein, after the operation clip had been launched, this enumerator can provide indication.Further, Handleset can comprise support indicator within it.Indicator can provide the audition of indication incident and at least one in the sense of touch indication.For example, described incident can be that at least one operation clip is loaded in the jaw, the operation clip is launched and described device is reset.

[0042] clapboard can comprise further that support is used for the 3rd spring clip that optionally engages with second parts of connecting plate thereon.In use, after the initial distal movement of connecting plate, second parts of connecting plate can optionally break away from from the 3rd spring clip.

[0043] shaft assembly can comprise the clapboard lock.In use, can distad advance the back to activate the clapboard lock at it thereby drive passage, and allow to drive passage near jaw so that the clapboard proximal motion makes the far-end of clapboard return from jaw.

[0044] shaft assembly can be with respect to Handleset around longitudinal axis rotation.Shaft assembly can comprise and be supported on the intravital cuff of shell that wherein, this cuff prevents that when the 3rd spring clip translation strides across this cuff the 3rd spring clip from outwards opening.

[0045] clapboard and/or driving passage can be biased to proximal position.

Description of drawings

[0046] following detailed description in conjunction with the drawings, this applicator will more fully be familiar with and be become better understood, in the accompanying drawings:

[0047] Fig. 1 is the front perspective view according to the operation applicator of an embodiment of the present disclosure;

[0048] Fig. 2 is the rear perspective view of applicator shown in Figure 1, illustrates the rotation of its shaft assembly;

[0049] Fig. 3 is the front perspective view of far-end of the shaft assembly of applicator illustrated in figures 1 and 2;

[0050] Fig. 4 is the vertical view of applicator illustrated in figures 1 and 2;

[0051] Fig. 5 is the lateral elevational view of applicator illustrated in figures 1 and 2;

[0052] Fig. 6 is the axonometric chart of Fig. 1 to the Handleset of applicator shown in Figure 5, illustrates left half housing by the situation from wherein removing;

[0053] Fig. 7 is the axonometric chart of Fig. 1 to the Handleset of applicator shown in Figure 5, illustrates right half housing by the situation from wherein removing;

[0054] Fig. 8 is the axonometric chart of Fig. 1 to the parts decomposition of the Handleset of applicator shown in Figure 5;

[0055] Fig. 8 A is Fig. 6 to Handleset shown in Figure 8 at trigger by the axonometric chart under situation about wherein removing;

[0056] Fig. 8 B is the axonometric chart of Fig. 6 to the feedback means of Handleset shown in Figure 8;

[0057] Fig. 9 is the axonometric chart of Fig. 1 to the parts decomposition of the shaft assembly of applicator shown in Figure 5;

[0058] Figure 10 is the right side front perspective view of shaft assembly shown in Figure 9, shows the situation of assembling;

[0059] Figure 11 is that the details that shows among Figure 10 is represented regional zoomed-in view;

[0060] Figure 12 is the right side front view of Fig. 9 to shaft assembly shown in Figure 11, shows upper shell by the situation from wherein removing;

[0061] Figure 13 is that the details that shows among Figure 12 is represented regional zoomed-in view;

[0062] Figure 14 is that the details that shows among Figure 12 is represented regional zoomed-in view;

[0063] Figure 15 is that the details that shows among Figure 12 is represented regional zoomed-in view;

[0064] Figure 16 is the axonometric chart that the parts of the near-end of push rod of the shaft assembly shown in Fig. 9 to 15 and spring clip (snap clip) decompose;

[0065] Figure 17 is Fig. 9 to the upward view of shaft assembly shown in Figure 15, illustrates the near-end of push rod and is arranged in spring clip in the upper shell;

[0066] Figure 18 is the right side front perspective view of Fig. 9 to shaft assembly shown in Figure 17, shows upper shell and push rod by the situation from wherein removing;

[0067] Figure 19 is that the details that shows among Figure 18 is represented regional zoomed-in view;

[0068] Figure 20 is that the details that shows among Figure 18 is represented regional zoomed-in view;

[0069] Figure 21 is the right side front perspective view of Fig. 9 to shaft assembly shown in Figure 20, shows upper shell, push rod and pushing plate by the situation from wherein removing;

[0070] Figure 22 is that the details that shows among Figure 21 is represented regional zoomed-in view;

[0071] Figure 23 is the axonometric chart of the parts decomposition of clip follower and latch plate;

[0072] Figure 23 A is the top perspective view after clip follower shown in Figure 23 and latch plate assembling finish;

[0073] Figure 24 is the face upwarding stereogram of clip follower shown in Figure 23;

[0074] Figure 25 is the right side front perspective view of Fig. 9 to the far-end of shaft assembly shown in Figure 23, shows upper shell, push rod, pushing plate and clip carrier by the situation from wherein removing;

[0075] Figure 26 is the right side front perspective view of the far-end of shaft assembly shown in Figure 25, shows upper shell, push rod, pushing plate, clip carrier and drives passage by the situation from wherein removing;

[0076] Figure 27 is the left side front perspective view of Fig. 9 to shaft assembly shown in Figure 26, shows upper shell, push rod, pushing plate, clip carrier, driving passage and clapboard by the situation from wherein removing;

[0077] Figure 28 is that the details that shows among Figure 27 is represented regional zoomed-in view;

[0078] Figure 29 is that the details that shows among Figure 27 is represented regional zoomed-in view;

[0079] Figure 30 is the left side front perspective view of the lower house of the shaft assembly shown in Fig. 9 to 29;

[0080] Figure 31 is that the details that shows among Figure 30 is represented regional zoomed-in view;

[0081] Figure 31 A is that the details that shows among Figure 30 is represented regional zoomed-in view;

[0082] Figure 32 is the longitdinal cross-section diagram of the applicator shown in Fig. 1 to 31A, illustrates the applicator that is under the actuating state not;

[0083] Figure 33 is that the details that shows among Figure 32 is represented regional zoomed-in view;

[0084] Figure 34 is the longitdinal cross-section diagram of far-end of the shaft assembly of the applicator shown in Fig. 1 to Figure 31 A;

[0085] Figure 35 is the sectional view along the intercepting of the 35-35 among Figure 34;

[0086] Figure 36 is that the details that shows among Figure 34 is represented regional zoomed-in view;

[0087] Figure 37 is the sectional view along the intercepting of the 37-37 among Figure 36;

[0088] Figure 38 is that the details that shows among Figure 34 is represented regional zoomed-in view;

[0089] Figure 39 is the sectional view along the intercepting of the 39-39 among Figure 38;

[0090] Figure 40 is that the details that shows among Figure 34 is represented regional zoomed-in view;

[0091] Figure 41 is the sectional view along the intercepting of the 41-41 among Figure 40;

[0092] Figure 42 is that the details that shows among Figure 34 is represented regional zoomed-in view;

[0093] Figure 43 is the sectional view along the intercepting of the 43-43 line among Figure 42;

[0094] Figure 44 is the longitdinal cross-section diagram of the applicator shown in Fig. 1 to 43 during initial activation;

[0095] Figure 45 is that the details that shows among Figure 44 is represented regional zoomed-in view;

[0096] Figure 46 is that the details that shows among Figure 34 is represented regional 36 the zoomed-in view during the initial activation of applicator;

[0097] Figure 47 is that the details that shows among Figure 34 is represented regional 40 the zoomed-in view during the initial activation of applicator;

[0098] Figure 47 A is the vertical view of push rod, illustrates the motion of push rod during the initial activation of applicator;

[0099] Figure 47 B and Figure 47 C all are longitdinal cross-section diagrams of shaft assembly, illustrate the motion of clapboard during the initial activation of applicator;

[00100] Figure 48 and Figure 49 be during the initial driving of applicator shaft assembly along the zoomed-in view in the cross section of 41-41 intercepting among Figure 40;

[00101] Figure 50 is that the details that shows among Figure 34 during the initial activation of applicator is represented regional 42 zoomed-in view;

[00102] Figure 51 is the left side face upwarding stereogram of the far-end of shaft assembly during the initial activation of applicator;

[00103] Figure 52 to Figure 54 all is longitdinal cross-section diagrams of shaft assembly, illustrate the further motion of clapboard during the initial activation of applicator, and the bar of connecting plate is from the disengaging of the spring clip of clapboard;

[00104] Figure 55 is the longitdinal cross-section diagram of the applicator shown in Fig. 1 to Figure 54, illustrates the applicator between further period of energization;

[00105] Figure 56 is that the details that shows among Figure 55 is represented regional zoomed-in view;

[00106] Figure 56 A is a right parallax stereogram of removing the shaft assembly of upper shell, illustrates the motion of push rod between the further period of energization of applicator;

[00107] Figure 56 B and Figure 56 C all are upward views of pushing plate, illustrate the motion of pushing plate between the further period of energization of applicator;

[00108] Figure 57 is that the details that shows among Figure 34 between the further period of energization of applicator is represented regional 36 zoomed-in view;

[00109] Figure 58 is the zoomed-in view that the details that shows among Figure 34 between the further period of energization of applicator is represented regional 40 applicators;

[00110] Figure 59 and Figure 60 are the longitdinal cross-section diagrams of shaft assembly, being connected of boss that illustrates the motion of push rod between the further period of energization of applicator and be supported on clip and upper shell on the push rod;

[00111] Figure 61 is that the details that shows among Figure 34 between the further period of energization of applicator is represented regional 40 zoomed-in view;

[00112] Figure 62 is that the details that shows among Figure 34 between the further period of energization of applicator is represented regional 42 zoomed-in view;

[00113] Figure 63 is the longitdinal cross-section diagram of shaft assembly, illustrates the motion of drive rod between the further period of energization of applicator;

[00114] Figure 64 and Figure 65 be between the further period of energization of applicator shaft assembly along the zoomed-in view in the cross section of 41-41 intercepting among Figure 40;

[00115] Figure 66 be shaft assembly between the further period of energization of applicator far-end overlook the left side axonometric chart;

[00116] Figure 67 to Figure 69 is the longitdinal cross-section diagram of shaft assembly, illustrates the motion of connecting plate between the further period of energization of applicator;

[00117] Figure 67 A to Figure 69 A is the longitdinal cross-section diagram according to the shaft assembly of another optional embodiment of the present disclosure, illustrates the motion of connecting plate between the further period of energization of applicator;

[00118] Figure 70 is the longitdinal cross-section diagram of the applicator shown in Fig. 1 to Figure 69 between last period of energization;

[00119] Figure 71 is that the details that shows among Figure 70 is represented regional zoomed-in view;

[00120] Figure 72 is that the details that shows among Figure 34 between the last period of energization of applicator is represented regional 42 zoomed-in view;

[00121] Figure 73 and Figure 74 are the front perspective view of the far-end of shaft assembly, illustrate the actuating of jaw between the last period of energization of applicator;

[00122] Figure 75 is the axonometric chart that illustrates the operation clip that is applied on the vascular;

[00123] Figure 76 is that the details that shows among Figure 70 when the trigger of applicator is released is represented regional 71 zoomed-in view;

[00124] Figure 76 A is the lateral elevational view of Handleset when trigger unclamps after it activates fully;

[00125] Figure 77 is the longitdinal cross-section diagram of shaft assembly, illustrates the motion of connecting plate during trigger unclamps;

[00126] Figure 78 is the longitdinal cross-section diagram of shaft assembly, illustrates the motion of push rod during the unclamping of trigger and is supported on clip on the push rod from the disengagement of the boss of upper shell;

[00127] Figure 79 is a right parallax stereogram of removing the shaft assembly of upper shell, illustrates the motion of push rod during the unclamping of trigger;

[00128] Figure 80 is that the details that shows among Figure 34 during trigger unclamps is represented regional 40 zoomed-in view;

[00129] Figure 81 is the longitdinal cross-section diagram of shaft assembly, and the bar that illustrates connecting plate during trigger unclamps is connected on the spring clip of push rod once more;

[00130] Figure 82 to Figure 83 all is longitdinal cross-section diagrams of shaft assembly, engaging once more on the bar that illustrates the further motion of clapboard during trigger unclamps and connecting plate and the spring clip of clapboard;

[00131] Figure 84 is the front perspective view of the far-end of shaft assembly when applicator is in blocking;

[00132] Figure 85 is that the details that Figure 34 shows when applicator is in blocking is represented regional 42 zoomed-in view; And

[00133] Figure 86 is that the details that Figure 70 shows when applicator is in blocking is represented regional 71 zoomed-in view.

The specific embodiment

[00134] the existing embodiment that describes in detail with reference to the accompanying drawings according to operation applicator of the present disclosure, similar Reference numeral is represented similar or identical parts in the accompanying drawing.It is described in the whole text to reach following description as shown in the figure, according to tradition, and during relative position on relating to operating theater instruments, the close user's of term " nearside " finger device a end, the end away from the user of term " distally " finger device.

[00135], refers to 100 generally according to the operation applicator of an embodiment of the present disclosure referring now to Fig. 1 to Fig. 5.Applicator 100 comprises Handleset 102 and endoscopic portion, and this endoscopic portion comprises the shaft assembly 104 that distad extends from Handleset 102.

[00136] shaft assembly 104 has the external diameter of about 10mm.The purposes that depends on expectation is performed the operation such as obesity, and shaft assembly 104 can have length various elongations or that shorten.

[00137] extremely shown in Figure 5 as Fig. 1, operation applicator 100 comprises far-end that is installed in shaft assembly 104 and a pair of jaw 106 that can be activated by the trigger 108 of Handleset 102.A pair of jaw 106 is made by suitable biocompatible material such as rustless steel or titanium, and this a pair of jaw defines and is used for operation clip " C " is contained in wherein path 10 6a between it.Relative to each other open or during non-approaching state, record the external diameter of the width of a pair of jaw 106 when a pair of jaw 106 is in greater than shaft assembly 104.

[00138] a pair of jaw 106 is installed on the far-end of shaft assembly 104 so that their relative this places are vertically fixing.Knob 110 can be rotatably installed in the far-end of Handleset 102, and is connected in shaft assembly 104 with to 106 transmission of shaft assembly 104 and a pair of jaw and/or 360 ° of rotations (referring to Fig. 2) around its longitudinal axis are provided.

[00139], shows the Handleset 102 of operation applicator 100 referring now to Fig. 1 to Fig. 8.Handleset 102 comprises housing 103, and this housing has first or right side half 103a of and second or left side half 103b of.Handleset 102 comprises the trigger 108 that is supported on pivotly between right side half 103a of and left side half 103b of.As will be discussed in more detail, Handleset 102 defines and is formed at being used in the housing 103 and supports and show the window 103c of counting mechanism.The housing 103 of Handleset 102 can be made by suitable plastic.

[00140] housing 103 is supported on driven unit 120 between right side half 103a of and left side half 103b of.Driven unit 120 comprises forked link 122, and this forked link has first end and second end that is pivotally connected in crankshaft cheek 124 that is pivotally connected in trigger 108.As Fig. 6 to shown in Figure 9, driven unit 120 further comprise the driving adapter 134 that rotatably is connected in crankshaft cheek 124, with drive adapter 134 interconnective plungers 135 and be supported on the spring 136 that drives on the adapter 134.Plunger 135 defines vertical slit 135a, and this vertical slot arrangements becomes and is suitable for the near-end of drive rod 140 is contained in wherein.

[00141] drive rod 140 is connected in plunger 135 (referring to Fig. 9) by unitary pin 135b.Be provided with medicated cap 144, plunger 135 runs through this medicated cap.Sealing member (seal) (not shown) is set sets up airtight sealing between plunger 135 and the outer tube 150.

[00142] as Fig. 6 to shown in Figure 8, Handleset 102 further comprise be formed in the crankshaft cheek 124/on tooth bar 124a so that tooth bar 124a can be with crankshaft cheek 124 motions.Tooth bar 124a comprises and places distal recesses 124b that crankshaft cheek 124 limits and a plurality of teeth between the proximal flutes 124c.Groove 124b and 124c are set to allow ratchet 224 upsets and when crankshaft cheek 124 changes, to be promoted on the tooth of tooth bar 124a between nearside and distal movement.

[00143] Handleset 102 further comprises ratchet 224, and in the position that engages that ratchet 224 and the tooth bar 124a of crankshaft cheek 124 operate substantially, ratchet 224 is pivotally connected in housing 103 by detent pin 226.Ratchet 224 comprises pawl teeth 224a, this pawl teeth selectively with the indented joint of the tooth bar 124a of crankshaft cheek 124.Pawl teeth 224a can engage with restriction tooth bar 124a with rack tooth and in turn limit the lengthwise movement of crankshaft cheek 124 in Handleset 102.Pawl spring 228 is set so that ratchet 224 is gone into partially to engaging of operating with the tooth bar 124a of crankshaft cheek 124.

[00144] extremely shown in Figure 8 as Fig. 6, crankshaft cheek 124 is connected in forked link 122 pivotly by pin 123.Crankshaft cheek 124 defines a series of hook tooth 124a of being formed at wherein with engaging of selecting with ratchet 224.

[00145] shown in Fig. 8, Fig. 8 A and Fig. 8 B, Handleset 102 further comprises audition/tactile feedback member 126, and this feedback means is operatively relevant with trigger 108 so that therewith rotate and rotate around common axle when trigger 108 activates.Feedback means 126 defines raceway 126a, and raceway 126a defines a plurality of hook tooths or step 126b.Be provided with deflectable arm 127, this deflectable arm comprises the connection of operation or is arranged among the raceway 126a of feedback element 126 and first end that contacts with step 126b and be connected in second end of housing 103.In operation, when actuated triggers 108, arm 127 by and/or move along the raceway 126a that is formed in the feedback means 126.As will be discussed in more detail, along with arm 127 moves on the step 126b of feedback means 126, arm 127 bullets pin step 126b, and produce sound/click and/or the appreciable vibration that can hear.

[00146] audition/tactile feedback member 126 comprise enough step 126b in case clip be completely enclosed back in the jaw of operation applicator 100, the clip of packing into formed the back by operation applicator 100 jaws and when operation applicator 100 is reset to original position and prepares launch/to form another clip generation audition/sense of touch indicate.

[00147] shown in Fig. 6, Fig. 7, Fig. 8 and Fig. 8 A, the Handleset 102 of operation applicator 100 further comprises and is supported in the housing 103 and by being limited to the visible counting mechanism 132 of window 103c in the housing 103.Counting mechanism 132 comprises the energy (not shown) of forms such as display 132a, processor 132b and use battery.

[00148] display 132a can be that any device known in the art is to provide the indication of incident.Incident can relate to the program or the operation of applicator 100.Display 132a is liquid crystal display (LCD).

[00149] display 132a shows one or more operating parameters of applicator 100 to the surgeon.The operating parameter that is shown by display 132a comprises number, location parameter, the operating time of use or any other parameter of program of the quantity (amount) of remaining clip or number (number), already used clip.

[00150] arrange mylar (Mylar) or another polymerization insulant between the contact of battery or the energy and processor 132b, this material prevents that the battery or the energy are depleted in storing process.Projection is stretched out to allow projection to be easy to remove therefrom from the housing 103 of operation applicator 100.In case projection is removed, the contact of the battery or the energy and processor 132b electrically contacts, and makes display 132a energising.

[00151] shown in Fig. 6, Fig. 7, Fig. 8 and Fig. 8 A, the Handleset 102 of operation applicator 100 further comprises count actuation mechanism, and this mechanism comprises the count actuation lever 130 that has being configured to and be suitable for operatively, optionally engaging the processor 132b of counting mechanism 132.Count actuation lever 130 further comprises the second arm 130b, and this arm is configured to and is suitable for engaging the slit 128a that is formed in the actuation plate 128 operatively, slidably, and actuation plate 128 is supported in the housing 103 slidably.

[00152] in operation, will be described in more detail as following, along with trigger 108 is extruded, trigger 108 makes forked link 122 distad advance, and makes crankshaft cheek 124 distad advance.When the arm 124d of crankshaft cheek 124 advances preset distance, the finger 128b of arm 124d joint or contact activated plate 128.Along with crankshaft cheek 124 further distad advances, crankshaft cheek 124 distal direction promote or pulling trigger board 128, thereby activate count actuation lever 130 to activate counting mechanism 132.

[00153] especially, when actuation plate 128 distal motion enough apart from the time, in its slit 128b with the second arm 130b of cam driven count actuation lever 130 and make 130 rotations of count actuation lever cause the first arm 130a rotation.When actuation plate 128 proximal motion enough apart from the time, the second arm 130b reposition of count actuation lever 130 causes the first arm 130a of count actuation lever 130 to break away from counting mechanism 132.

[00154] now go to Fig. 9 to Figure 31 A, the shaft assembly 104 of operation applicator 100 is illustrated and is described hereinafter.Shaft assembly 104 and assembly thereof can be made by suitable biocompatible material such as rustless steel, titanium, plastics etc.Shaft assembly 104 comprises outer tube 150, and outer tube 150 has and is supported on near-end 150a, the far-end 150b in the housing 103 and runs through wherein inner chamber 150c.Outer tube 150 is by being fixed in the housing 103 from the outstanding flange of its outer surface.Shaft assembly 104 further comprises upper shell 152a and the lower house 152b in the inner chamber 150c that is arranged in outer tube 150.Rear portion upper shell 154 is arranged in the outer tube 150 and the nearside of upper shell 152a.

[00155] as Fig. 9, Figure 12 and shown in Figure 13, shaft assembly 104 further comprises the push rod 156 that is arranged in slidably in upper shell 152a and the rear portion upper shell 154.Push rod 156 comprises the far-end 156a that defines narrow shape pusher 156c, pusher 156c is configured to and be suitable for optionally engaging/moves the clamp " C1 " of the farthest side of (promptly distad advancing) a pile clip " C ", and keeps in touch with the clamp " C1 " of farthest side during its initial formation.Push rod 156 further comprises near-end 156b.Push rod 156 defines distal window 156d with window catch 156e, be positioned at the nearside of distal window 156d and be formed on its every lateral edges a pair of groove 156f, be positioned at side groove 156f nearside elongated slot 156g and be positioned at the nearest side window mouth 156h of the nearside of slit 156g.

[00156] as Fig. 9 and shown in Figure 14, the upper surface along push rod 156 supports the first spring clip 157a to push rod 156 at the distal position place of side groove 156f.The first spring clip 157a disposes by this way: its tip is outstanding or a certain amount of at interval with the upper surface of push rod 156.

[00157] as Fig. 9 and shown in Figure 15, the lower surface along push rod 156 supports the second spring clip 157b to push rod 156 at the proximal position place of its nearest side window mouth 156h.The second spring clip 157b locatees by this way: its tip is outstanding to be enough to be pressed in amount on the nearest side window mouth 156h of push rod 156.The tip of the second spring clip 157b separates each other a certain amount of, and this amount is less than the width of the nearest side window mouth 156h of push rod 156.

[00158] extremely shown in Figure 20 as Fig. 9 and Figure 16, shaft assembly 104 further comprises the pushing plate 162 that can be supported on push rod 156 belows with moving back and forth.As Figure 16 and shown in Figure 17, the 4th spring clip 157d is supported on the near-end of pushing plate 162.Spring clip 157d comprises a pair of tip, and this tip removably is connected in the nearside that is formed among the upper shell 152a and keeps groove 152m and distally to keep groove 152n.Like this, in use, spring clip 157d removably engages and keeps groove 152m and distally to keep groove 152n so that pushing plate 162 remains on nearside or distal position.When pushing plate 162 distad advances, inwardly drive the tip of spring clip 157d and make pushing plate 162 continue distal motion with cam.

[00159] as Figure 18 to shown in Figure 20, pushing plate 162 comprises a series of window 162a that are formed at wherein and extend along its length.As shown in figure 19, each window 162a defines proximal, and this edge extends so that limit antelabium or lug 162c in the lower face of pushing plate 162.Pushing plate 162 further comprises a pair of flank sheet 162b, and this flank sheet is extending towards the direction of upper shell 152a from its lateral edges.As shown in figure 15, a pair of flank sheet 162b is arranged among the side groove 156f of push rod 156 slidably.

[00160] extremely shown in Figure 22 as Fig. 9 and Figure 21, shaft assembly 104 further comprises the clip carrier 164 that is arranged among the upper shell 152a and is positioned at pushing plate 162 belows.Clip carrier 164 generally is to have upper wall, pair of sidewalls and the qualification box like structure by the lower wall of its passage.Clip carrier 164 comprises and being formed in the lower wall and along a plurality of window 164a (referring to Fig. 9) that separate of its length longitudinal extension.Clip carrier 164 comprises and being formed in the upper wall and along the elongated window of its length longitudinal extension.

[00161] as Fig. 9 and shown in Figure 21, a pile operation clip " C " is by so that pack into and/or remain in the passage of clip carrier 164 therein and/or along the mode of its slip.The configuration of the passage of clip carrier 164 also is sized to head the mode of tail is kept a pile or a plurality of operation clip " C " slidably.

[00162] as shown in figure 19, the far-end of clip carrier 164 comprises a pair of resilient tangs 164b that separates.Tang 164b be configured to and be suitable for removably engaging the farthest side that remains on these heaps operation clips " C " in the clip carrier 164 perform the operation clip " C1 " after stride portion (backspan).

[00163] extremely shown in Figure 24 as Fig. 9 and Figure 21, the shaft assembly 104 of applicator 100 further comprises the clip follower 166 in the passage that is arranged in clip carrier 164 slidably.To be described in more detail as following, clip follower 166 is positioned at the rear of this heap operation clip " C " and is set to promote forward this heap clip " C " between the period of energization of applicator 100.As will be hereinafter described in more detail, clip follower 166 activates by moving back and forth forward and backward of pushing plate 162.

[00164] as Figure 23, Figure 23 A and shown in Figure 24, clip follower 166 comprises main part 166a, substantially from main part 166a upwards and the distally that extends back projection 166b, and substantially from main part 166a and the nearside that extends back projection 166c downwards.

[00165] projection 166b in the distally of clip follower 166 disposes and is sized to the lug 162c of the window 162a that optionally engages pushing plate 162.In use, along with pushing plate 162 distal direction advance or motion, the distally projection 166b of clip follower 166 makes clip follower 166 progressively advance or advance towards distal direction towards the joint of the lug 162c of the window 162a of pushing plate 162.

[00166] nearside projection 166c disposes and is sized to and optionally engages the window 164a that is formed in the clip carrier 164.In use, the joint of the nearside of clip follower 166 projection 166c in the window 164a that forms clip carrier 164 prevents that clip follower 166 proximal direction from advancing or moving.

[00167] clip follower 166 comprises that support or selectively integrally formed with it latch plate 165 thereon.Latch plate 165 comprises that with from the main part 166a of clip follower 166 upwards and the flexible tail 165a that extends from latch plate 165 of direction backward, this flexible tail defines window 165b.

[00168] as Fig. 9, Figure 25 and shown in Figure 38, the position that shaft assembly 104 further is included in clip carrier 164 belows can be supported on the driving passage 168 in the channel components 104 with moving back and forth.Drive passage 168 and be the passage of U-shaped substantially, this passage comprises from striding the 168c of portion thereafter and is leaving clip carrier 164 and the upwardly extending a pair of sidewall 168b that separates towards the side of lower house 152b.Drive passage 168 further be included in slit 168a nearside the position from after stride the 168c of portion outstanding and in the side of sidewall 168b upwardly extending protruding 168d.As shown in figure 41, drive passage 168 and define slit in the sidewall that is formed among the sidewall 168b or window 168e optionally to hold the tooth 194c of clapboard releasing device 194.

[00169] as Fig. 9 and shown in Figure 25, the shaft assembly 104 of applicator 100 comprises the driving passage strap 167 that is fixed on the driving passage 168.Strap 167 is fixed to the sidewall 168b that drives passage 168 and goes up so that across the sidewall 168b horizontal expansion that drives passage 168.Strap 167 is fixed at the distal position place of elongated slot 168a and drives on the passage 168.Strap 167 is fixed to and drives on the passage 168 so that clapboard 172 is striden extension between 168c of portion and the jaw 106 behind driving passage 168.

[00170] as Fig. 9, Figure 26 and shown in Figure 27, applicator 100 comprises and is installed on the shaft assembly 104 or is installed in the far-end of shaft assembly 104 and a pair of jaw 106 that can be activated by trigger 108.Jaw 106 is formed by suitable biocompatible materials such as rustless steel or titanium.

[00171] by be formed among the lower house 152b be formed at jaw 106 in hold the boss that slit engages, jaw 106 is installed in the contiguous far-end that drives passage 168, so that jaw 106 is maintained fixed with respect to driving passage 168.As shown in figure 25, jaw 106 defines and is used for operation clip " C " is contained in wherein path 10 6a between it.

[00172] as Fig. 9, Figure 25 and shown in Figure 26, the shaft assembly 104 of applicator 100 further comprises clapboard 172, and clapboard 172 has the near-end that places the far-end between driving passage 168 and the jaw 106 and run through shaft assembly 104.Clapboard 172 comprises that the far-end 172a of taper substantially is with the optionally insertion of operation between jaw 106.As shown in figure 26, clapboard 172 defines from its lower surface outstanding fin or protruding 172b.As shown in figure 22, clapboard 172 defines the farthest side slit 172c that is formed on wherein and is slidably received within wherein with the second bar 174c with connecting plate 174.

[00173] as shown in figure 22, the 3rd spring clip 157c is supported on the proximal end of clapboard 172.The 3rd spring clip 157c locatees by this way: the outstanding amount that is enough to be pressed on the nearest side window mouth 172c that is formed in the clapboard 172 of its tip.The tip of the 3rd spring clip 157c separates each other a certain amount of, and this amount is less than the width of the nearest side window mouth 172c of clapboard 172.

[00174] as Fig. 9, Figure 18, Figure 20 and shown in Figure 36, the shaft assembly 104 of applicator 100 further comprises connecting plate 174, and connecting plate 174 places between push rod 156 and the clapboard 172 slidably and removably can be connected in each of push rod 156 and clapboard 172.Connecting plate 174 comprises first bar 174b of tapered distal end 174a, surface extension from it and the second bar 174c that extends from its lower surface.Among bar 174b, the 174c each all has the profile of tear-drop shaped substantially, and the far-end of each among its king-rod 174b, the 174c is all greater than its near-end.

[00175] in operation, the first bar 174b of connecting plate 174 configuration and be sized to be fixed to push rod 156 on second spring clip 157b is dismountable is connected, the second bar 174c configuration of connecting plate 174 and be sized to be fixed to clapboard 172 on the 3rd spring clip 157c is dismountable is connected.

[00176] as Figure 22, Figure 36 and shown in Figure 37, the second bar 174c of connecting plate 174 extends among the window 140b that is limited to drive rod 140.Like this, along with drive rod 140 moves back and forth, connecting plate 174 is with its reciprocating motion.

[00177] shown in Figure 31 A, protector 198 is supported among the lower house 152b position of the relative distance between the tip of being convenient to keep the 3rd spring clip 157c during its initial distally advances.Like this, the second bar 174b of connecting plate 174 can not break away from the 3rd spring clip 157c prematurely and crossed protector 198 up to the 3rd spring clip 157c.

[00178] as Fig. 9, Figure 27, Figure 29 and shown in Figure 41, the shaft assembly 104 of applicator 100 further comprises the slip joint 180 in the passage that is supported on lower house 152b slidably.Slip joint 180 comprises main part 182 and from the bar 184 of its extension.When in the passage that is properly positioned on lower house 152b, the bar 184 of slip joint 180 extends on the direction in cardinal principle distally.The bar 184 of slip joint 180 is the minor axis 152d (referring to Figure 29) by being formed among the lower house 152b and extending from the passage of lower house 152b slidably.Shaft assembly 104 further comprises biasing member 186, this biasing element be supported on the bar 184 with the form of compression spring and place the minor axis 152d of lower house 152b and the main part 182 of slip joint 180 between.

[00179] main part 182 of slip joint 180 comprises boss 182a, and this boss forms near the near-end of main part 182, and is configured to and is suitable for slidably engaging (referring to Figure 29) in the elongated slot 140a of drive rod 140.The main part 182 of slip joint 180 further comprises nest eye 182b, and this nest eye forms near the far-end of main part 182, and is configured to and the protruding 168d that is suitable for driving passage 168 is contained in wherein (referring to Figure 38 and Figure 39).

[00180] as Fig. 9, Figure 27 and shown in Figure 28, the shaft assembly 104 of applicator 100 further comprises in the passage that is supported on lower house 152b slidably locks 190 with the clapboard that drives in the passage 168.The bar 190b that clapboard lock 190 comprises main part 190a, distad extend from main part 190a, the afterbody 190c that extends from main part 190a proximad, be formed at main part 190a upper surface nest eye 190d and bar or the tooth 190e that extends from afterbody 190c.Shaft assembly 104 further comprises biasing member 192, and this biasing member is supported on bar 190b with the form of compressing spring and goes up and place between the main part 190a of lower house 152b and clapboard lock 190.

[00181] shaft assembly 104 of applicator 100 further comprises the clapboard releasing device 194 in the passage that rotatably is supported on lower house 152b.Clapboard releasing device 194 comprises bar 194a, and the tooth 190e that this bar is configured to extend with the afterbody 190c that locks 190 from clapboard engages; Mallet 194b, this mallet is stretching out from bar 194a on the direction of the afterbody 190c of clapboard lock 190; And tooth 194c, this tooth stretches out from bar 194a on the direction of the afterbody 190c that leaves clapboard lock 190.

[00182] now to operation applicator 100 to form around such as the destination organization of vascular or the operation clip that curls is described.With reference to Figure 32 to Figure 43, be illustrated in any operation or use operation applicator 100 before.As Figure 32 and shown in Figure 33, before using or launching applicator 100, trigger 108 generally is in non-pressure-bearing or non-actuated condition.Like this, the crankshaft cheek 124 of driven unit 120 is in the position of withdrawal or nearside, and therefore, plunger 135 and drive rod 140 also are in retracted position.When crankshaft cheek 124 was in retracted position, ratchet 224 was arranged among the distal recesses 124b that is limited in the crankshaft cheek 124.

[00183] as Figure 35 to shown in Figure 37, when driven unit 120 and drive rod 140 were in retracted position, connecting plate 174 was positioned at withdrawal or side position recently.When connecting plate 174 is positioned at withdrawal or nearest side position, push rod 156 also is in withdrawal or nearest side position, the first tear-drop shaped bar 174b of connecting plate 174 be arranged in push rod 156 nearest side window mouth 156h near-end and keep and the engaging of the tip snap fit of the second spring clip 157b.And, when connecting plate 174 is positioned at withdrawal or nearest side position, clapboard 172 also is positioned at withdrawal or nearest side position, and the second tear-drop shaped bar 174c of connecting plate 174 is arranged in the near-end of the nearest side window mouth 172c of clapboard 172, and keeps and the engaging of the tip snap fit of the 3rd spring clip 157c.

[00184] as Figure 36 and shown in Figure 37, when driven unit 120 and drive rod 140 were in retracted position, the protruding 182a of slip joint 182 was arranged in the farthest side position of the elongated slot 140a of drive rod 140.

[00185] as Figure 38 and shown in Figure 39, when driven unit 120 and drive rod 140 are in retracted position, clip follower 166 is positioned at the most proximal end of the passage of clip carrier 164, wherein projection 166b in the distally of clip follower 166 operatively is arranged among the nearest side window mouth 162a of pushing plate 162, and nearside projection 166c operatively is arranged among the nearest side window mouth 164a of clip carrier 164.

[00186] continues with reference to Figure 38 and Figure 39, when driven unit 120 and drive rod 140 are in retracted position, slip joint 180 is positioned at nearest side position, and be arranged among the nest eye 182b of slip joint 180 because drive the protruding 168d of passage 168, also be positioned at nearest side position so drive passage 168.As Figure 38 and shown in Figure 39, slip joint 180 is near the physics backstop 152e (referring to Figure 30) that gives prominence to from lower house 152b.

[00187] as Figure 40 and shown in Figure 41, when driven unit 120 and drive rod 140 were in retracted position, clapboard lock 190 is arranged in nearest side position so that the tooth 190e that extends from its afterbody 190c is arranged in the nearside (referring to Figure 30 and Figure 31) of the inclination lug 152f that is formed at lower house 152b.As shown in figure 41, clapboard lock 190 is near the physics backstop 152g that gives prominence to from lower house 152b.Equally as shown in figure 41, clapboard releasing device 194 is arranged in primary importance and sentences just its tooth 194c and protrude among the window 168e that is formed among the sidewall 168b that drives passage 168.

[00188] as Figure 42 and shown in Figure 43, when driven unit 120 and drive rod 140 are in retracted position, the pusher 156c of push rod 156 be arranged in the farthest side clip " C " that remains in the clip carrier 164 after stride the nearside of portion.Farthest side clip " C " remains in the passage of clip carrier 164 by its tang 164b.And as mentioned above, in this position, clapboard 172 is positioned at nearest side position so that its far-end 172a is positioned at the nearside of jaw 106.

[00189] as shown in figure 43, when driving passage 168 was positioned at nearest side position, its far-end broke away from from the proximal cam surface 106b of jaw 106.

[00190] now forwards Figure 44 to Figure 54 to, in the phase I of initial stroke, along with trigger 108 is extruded or activates from initial position, trigger 108 makes forked link 122 towards distal direction motion crankshaft cheek 124, and this will make and drive adapter 134 and plunger 135 distal motion and make drive rod 140 distal motion.When along with plunger 135 distal motion, spring 136 is compressed primary quantity.

[00191] meanwhile, along with crankshaft cheek 124 distal motion, the tooth of tooth bar 124a engages with the tooth 224a of ratchet 224, and ratchet 224 shifts out or rotate the distal recesses 124a of crankshaft cheek 124.Like this, under the situation of not finishing complete distally stroke, crankshaft cheek 124 can not be got back to nearest side position.

[00192] as shown in figure 44, along with trigger 108 is extruded primary quantity, arm 127 beginning translations are by the raceway 126a of feedback means 126.

[00193] as shown in figure 46, along with drive rod 140 moves towards distal direction, drive rod 140 promotes connecting plate 174 towards distal direction.Because push rod 156 optionally is connected in connecting plate 174 by the second spring clip 157b, push rod 156 is advanced or pulling towards distal direction.And because clapboard 172 optionally is connected in connecting plate 174 by the 3rd spring clip 157c, clapboard 172 is also advanced or is dragged towards distal direction.

[00194] along with drive rod 140 towards distal direction motion, its elongated slot 140a also towards the distal direction motion so that the protruding 182a of slip joint 182 translation on respect to its proximal direction.

[00195] extremely shown in Figure 49 as Figure 47, along with clapboard 172 moves towards distal direction, because the protruding 172b of clapboard 172 remains among the nest eye 190d of clapboard lock 190, clapboard lock 190 is moved towards distal direction or is dragged, this makes the tooth 190e of its afterbody 190c be crossed the inclination lug 152f that is formed among the lower house 152b with cam driven, thereby moves to the distal position of inclination lug 152f from the proximal position of inclination lug 152f.Along with clapboard lock 190 moves towards distal direction, biasing member 192 is compressed primary quantity.As shown in figure 49, clapboard lock 190 locks 190 near the physics backstop that is formed among the lower house 152b towards the distal direction motion until clapboard.

[00196] shown in Figure 47 A, along with push rod 156 moves towards distal direction, the fin 162b of pushing plate 162 is the translation preset distance in the side groove 156f of push rod 156, contacts or engage the near-end of the side groove 156f of push rod 156 up to fin 162b.

[00197] shown in Figure 47 B and Figure 47 C; along with clapboard 172 moves towards distal direction; because second bar 174c of connecting plate 174 and being connected of the 3rd spring clip 157c have prevented that by protector the second bar 174c of connecting plate 174 breaks away from from the 3rd clamp 157c prematurely.Especially, along with connecting plate 174 towards distal direction motion, the tip of tip that protector 198 acts on the 3rd spring clip 157c to prevent tip because the power that the distally power that the second bar 174c is produced is applied to it and outwards opening.

[00198] as shown in figure 50, along with push rod 156 towards distal direction motion, its pusher 156c engage farthest side clip " C " after stride portion and begin and promote farthest side clip " C " towards the distally mode.Along with push rod 156 towards distal direction moved farthest side clip " C ", farthest side clip " C " breaks away from and begins to enter into the path 10 6a of jaw 106 from the rear of the tang 164b of clip carrier 164.

[00199] shown in Figure 51, along with clapboard 172 moves towards distal direction, its far-end 172a enters between the jaw 106, makes jaw 106 outwards open.

[00200] shown in Figure 52 to Figure 54,, clapboard lock 190 further moves towards distal direction in case, then having prevented clapboard 172 near the physics backstop that is formed among the lower house 152b.Yet drive rod 140 continues towards distal direction motion connecting plate 174.Because connecting plate 174 is continued distad to promote; so in case the most advanced and sophisticated distal motion of the tip of the 3rd spring clip 157c is to surpassing protector 198; the power on the second bar 174c of then acting on enough makes the tip of the 3rd spring clip 157c outwards open and makes the second bar 174c from throwing off therebetween, thereby makes connecting plate 174 continue to move towards distal direction.

[00201] now forwards Figure 55 to Figure 69 to, along with trigger 108 is further pushed or activate second stage by initial stroke from the phase I of initial stroke, trigger 108 makes forked link 122 further towards distal direction motion crankshaft cheek 124, and this make to drive adapter 134 and make plunger 135 further distal motion and further towards distal movement drive rod 140 subsequently.Along with plunger 135 distal motion, spring 136 is compressed further amount.

[00202] meanwhile, along with crankshaft cheek 124 towards distal movement, the tooth of its tooth bar 124a with respect to the tooth 224a of ratchet 224 further towards proximal movement.Like this, under the situation of not finishing complete distally stroke, crankshaft cheek 124 still can not turn back to nearest side position.

[00203] shown in Figure 55, along with crankshaft cheek 124 after the distal movement preset distance, its arm 124d engages or the finger 128b of contact activated plate 128.Along with crankshaft cheek 124 further advances towards the distally, crankshaft cheek 124 promotes or pulling actuation plate 128 towards distal direction, thereby activates count actuation lever 130 to activate counting mechanism 132.

[00204] especially, when actuation plate 128 towards distal movement enough apart from the time, in its groove 128b with the second arm 130b of cam driven count actuation lever 130 and impel its rotation, cause the first arm 130a of count actuation lever 130 to engage counting mechanism 132, thereby realize the variation in its display.Especially, the display that shows the number of remaining clip in the operation applicator 100 will reduce one.Selectively, the clip counting mechanism will increase by one or produce some other variation.

When [00205] further being pushed along with trigger 108, arm 127 continues the raceway 126a of translation by feedback means 126.In this, in the extruding of trigger 108, the operation clip is loaded in the jaw 106.Correspondingly, arm 127 will interact with the step 126b among the raceway 126a that is formed at feedback means 126 and produce and inform that user's clip has been loaded into the audition/sense of touch indication in the jaw.

[00206] shown in Figure 57, along with drive rod 140 further moves towards distal direction, drive rod 140 continues to promote connecting plate 174 towards distal direction.Because push rod 156 still optionally is connected in machine plate 174 by the second spring clip 157b, so push rod 156 is further advanced or drags towards distal direction.Yet, because the 3rd spring clip 157c of clapboard 172 is broken away from by the second bar 174c from connecting plate 174, so clapboard 172 is not further advanced or drag towards distal direction.

[00207] shown in Figure 56 A to Figure 56 C, along with push rod 156 continues motion towards distal direction, the near-end of the side groove 156f of push rod 156 engages a pair of fin 162b of pushing plate 162, and push rod 156 advances or drag pushing plate 162 towards distal direction.

[00208] shown in Figure 56 B and Figure 56 C, along with slurcam 162 advances towards the distally, spring clip 157d breaks away from nearside and keeps groove 152m and engage the distally that is formed among the upper shell 152a keeping groove 152n.

[00209] shown in Figure 57, drive rod 140 is towards distal direction motion, optionally moves to nearest side position among the elongated slot 140a of drive rod 140 up to the protruding 182a of slip joint 182.

[00210] along with push rod 156 continues towards the distal direction motion, push rod 156 continues to promote pushing plate 162 towards distal direction by fin 162b.Shown in Figure 58, along with pushing plate 162 moves towards distal direction, the proximal of window 162a that the distally of clip follower 166 projection 166b is received the distally projection 166b of clip follower 166 engages so that promote clip follower 166 with respect to clip carrier 164 towards distal direction, thereby makes the amount that this stack gripper " C " advances to be increased.Along with clip follower 166 towards distal direction motion, make the relative distal window 164a of its nearside projection 166c distad advance a window 164a from the relative proximal window 164a of clip carrier 164 to clip carrier 164.

[00211] shown in Figure 58 to Figure 60, along with push rod 156 towards distal direction motion, the first spring clip 157a bullet that is supported on the push rod 156 is locked on the boss 152h of upper shell 152a, thereby push rod 156 is remained on forward position.

[00212] in addition, shown in Figure 61, along with push rod 156 continues to make this stack gripper " C " move towards distal direction towards the distal direction motion.

[00213] shown in Figure 62, along with push rod 156 moves towards distal direction, its pusher 156c continues to enter into fully up to farthest side clip " C1 " towards distal direction moved farthest side clip " C1 " the path 10 6a of jaw 106.In operation, the pusher 156c of push rod 156 during the formation of described clip " C " with the clip " C " of packing into after the portion of striding keep in touch so that stability is provided and holds it in suitable position for it.

[00214] shown in Figure 63, along with drive rod 140 further moves towards distal direction, its shoulder 140c contact drives the most proximal end of passage 168.Like this, along with drive rod 140 further moves towards distal direction, drive rod 140 is towards the distal direction motion or promote to drive passage 168.

[00215] shown in Figure 64, along with driving passage 168, be formed at the tooth 194c of the proximal contact clapboard releasing device 194 of the window 168e among the sidewall 168b that drives passage 168 towards the distal direction motion, make clapboard releasing device 194 rotate.Along with clapboard releasing device 194 rotation, the tooth 190e of its mallet 194b extruding clapboard lock 190 is to release tooth 190e or knocking-on from the rear of inclination lug 152f.In this case, shown in Figure 65, allow biasing member 192 decompressions, thereby towards proximal direction motion clapboard lock 190.Shown in Figure 66, along with clapboard lock 190 moves towards proximal direction, because clapboard 172 is connected on the clapboard lock 190, so clapboard 172 moves so that its far-end 172a is disengaged from withdrawing from jaw 106 towards proximal direction.

[00216] shown in Figure 58 and Figure 67 to Figure 69, because push rod 156 remains on distal position by the first spring clip 157a with being connected of boss 152h, so along with drive rod 140 further moves towards distal direction, the power that acts on connecting plate 174 makes the second spring clip 157b break away from from the first bar 174b of connecting plate 174, thereby allows connecting plate 174 to continue to move towards distal direction.

[00217] shown in Figure 67 A to Figure 69 A, in one embodiment, the tip of the tip of the second spring clip 157b can be configured to outwards outstanding so that engage the surface (referring to Fig. 9) of upper back housing 154, thereby prevents the too early disengaging of the second spring clip 157b from the first bar 174b of connecting plate 174.In this embodiment, groove can be formed in the surface of rear portion upper shell 154, with the outside open position consistency of tip possibility of the second spring clip 157b, thereby allows the first bar 174b disengaging and the continuation of connecting plate 174 to move towards distal direction.

[00218] shown in Figure 70 to Figure 75, activated the final stage that enters initial stroke along with trigger 108, trigger 108 makes forked link 122 further towards distal direction motion crankshaft cheek 124, and this makes driving adapter 134 and plunger 135 further towards distal movement and further towards distal movement drive rod 140.Along with driving adapter 134 towards distal movement, spring 136 is compressed further amount.

[00219] meanwhile, along with crankshaft cheek 124 towards distal movement, the tooth of its tooth bar 124a with respect to the tooth 224a of ratchet 224 further towards proximal movement to such position: in this position, enter the proximal flutes 124c of crankshaft cheek 124 along with the tooth 224a of ratchet 224, the tooth of tooth bar 124a breaks away from from the tooth 224a of ratchet 224, itself resets thereby make.Like this, when trigger 108 unclamped, crankshaft cheek 124 can be back to nearest side position.

[00220] shown in Figure 72 to Figure 74, during the final stage of the initial stroke of trigger 108, driving passage 168 and strap 167 moves towards distal direction with respect to jaw 106, so that drive the cam face 106b that the distal side edge of passage 168 engages jaw 106, make jaw 106 close and form therebetween clamp " C1 ".Shown in Figure 74, the pusher 156c of push rod 156 remains on the distal position place, is contacting with the portion of striding behind the described clip " C " during the formation of described clip " C ".

[00221] shown in Figure 55, along with trigger 108 is extruded last amount, arm 127 continues the raceway 126a of translation by feedback means 126.In this, in the extruding of trigger 108, operation clip " C1 " is completed into by jaw 106.Correspondingly, arm 127 will interact with another step 126b among the raceway 126a that is formed at feedback means 126, and produce and inform that the audition/sense of touch of performing the operation the user clip " C1 " having formed by jaw 106 indicates.

[00222] shown in Figure 75, operation clip " C1 " can form or be crimped onto in vascular " V " or any other biological tissue.

[00223] now forwards Figure 76 to Figure 84 to, the operation of the applicator 100 when expression is back to not extruding or unactuated position along with trigger 108.Shown in Figure 76, along with trigger turns back to not extrusion position, spring is allowed to remove compression, thereby throw crank plate 124 moves towards proximal direction, and this makes plunger towards proximal movement and towards the proximal movement drive rod.Because ratchet 224 has resetted, now allow crankshaft cheek 124 proximal motion to enter the distal recesses of crankshaft cheek 124 once more up to the tooth 224a of ratchet 224.

[00224] shown in Figure 76 A, along with crankshaft cheek 124 towards proximal movement, its arm 124d breaks away from the finger 128b of actuation plate 128, makes actuation plate 128 move towards proximal direction.Along with actuation plate 128 towards proximal movement, in its groove 128b,, and impel second arm 130b rotation with the second arm 130b of cam driven count actuation lever 130, cause the first arm 130a of count actuation lever 130 to break away from from counting mechanism 132.

[00225] shown in Figure 77, along with drive rod 140 moves towards proximal direction, drive rod 140 is by first bar 174b pulling connecting plate 174.Along with connecting plate 174 moves towards proximal direction, the first bar 174b engages with the tip of the second spring clip 157b and promotes push rod 156 by the second spring clip 157b towards proximal direction.

[00226] shown in Figure 78, along with masterpiece is used on the push rod 156 with towards proximal direction motion push rod 156, described retentivity of making every effort to overcome the boss 152h that has obeyed the first spring clip 157a and upper shell 152a, thus discharge the first spring clip 157a and make push rod 156 move from boss 152h towards proximal direction.

[00227] shown in Figure 79, along with push rod 156 continues towards the proximal direction motion, the fin 162b of the distal engagement pushing plate 162 of its side groove 156f also makes pushing plate 162 move towards proximal direction.Along with push rod 156 moves towards proximal direction, push rod nose 156c stings at the rear of the farthest side clip of this remaining heap clip " C ", thereby becomes new farthest side clip " C1 ".

[00228] shown in Figure 80, along with pushing plate 162 moves towards proximal direction, the proximal of the window 164a of the nearside projection 166c engaging clip carrier 164 of clip follower 166 is so that keep the relative position of clip follower 166 in clip carrier 164.When pushing plate 162 towards proximal direction motion, make the relative distal window 162a of its distally projection 166b distad advance a window 162a from the relative proximal window 162a of pushing plate 162 to pushing plate 162.

[00229] shown in Figure 81, when push rod 156 stops its proximal movement, when it engages with the boss of giving prominence to from the inner surface of upper half-shell 152a, the proximal movement that continues of connecting plate 174 will make the bar 174b that wins engage once more with the second spring clip 157b.Along with the proximal movement of push rod 156 stops, the proximal movement that continues of connecting plate 174 will make the bar 174b that wins engage once more with the second spring clip 157b.

[00230] shown in Figure 82 and Figure 83, along with connecting plate 174 moves towards proximal direction, because the proximal movement of drive rod 140, the second bar 174c engages with the tip of the 3rd spring clip 157c and promotes clapboard 172 by the 3rd spring clip 157c towards proximal direction.Along with clapboard 172 moves towards proximal direction, clapboard lock 190 is towards the physics backstops of proximal direction motion in clapboard lock 190 contact housing lower half 152b, thus the proximal movement of prevention clapboard 172.In case the tip of the tip of the 3rd spring clip 157c surpasses protector 198 towards distal movement, then when clapboard 172 stops its proximal movement, the proximal movement that continues of connecting plate 174 will make the second bar 174c engage once more with the 3rd spring clip 157c.

[00231] when trigger 108 is back to the unactuated position, arm 127 with translation by feedback means 126 raceway 126a and interact with another step 126b among the raceway 126a that is formed at feedback means 126, and produce audition/sense of touch indication of informing user's operation applicator 100 and being reset and having prepared to launch once more.

[00232] now forward Figure 84 to Figure 85 to, the structure of expression operation applicator 100 is thereafter the application of last operation clip " C ".Shown in Figure 84 and Figure 85, when last operation clip has been pushed into and has formed, push rod 156 still is in and advances or distal position, clip follower 166 is progressively advanced enough amounts by graduated disc 158, its latch plate 165 is passed through the window 162a of pushing plate 162 to upper offset, and enters into the distal window 156d of push rod 156.The location of latch plate 165 in the distal window 156d of push rod 156 makes the window catch 156e of proximal window 156d enter the also window 165b of engage latch plate 165.Like this, because clip follower 166 remains on distal position by its distally projection 166c that engages in the distal window 164a of clip carrier 164, latch plate 165 engages the window catch 156e of push rods 156, thereby and anti-throw-out lever 156 turn back to nearest side position ratchet 224 resetted.

[00233] shown in Figure 86,, makes and itself reset thereby the tooth bar 124a of ratchet 224 and crankshaft cheek 124 keeps engaging and be not allowed to enter proximal flutes 124c because push rod 156 can not or be prevented from moving to its complete proximal position.Because can not making, ratchet 224 itself resets, so crankshaft cheek 124 is lockable or distad stops or proximal movement.

Should be appreciated that [00234] more than describing only is explanation of the present disclosure.Those skilled in the art can make various replacements and improvement not deviating under the situation of the present disclosure.Correspondingly, the disclosure is intended to comprise all these replacements, improvement and variation.With reference to the described embodiment of accompanying drawing only for proving that some example of the present disclosure occurs.There are not other element, step, method and the technology that are different in essence within the scope of the present disclosure with above-mentioned and/or claims yet.

Claims (11)

1, a kind of being used for is applied to device in the soma with the operation clip, and described device comprises:

Handleset, it comprises trigger and drive rod, described drive rod passes through the reciprocal translation of trigger when trigger-acted;

Shaft assembly, it distad extends and defines the longitudinal axis from described Handleset, and described shaft assembly comprises:

Housing;

Be arranged in the intravital a plurality of operation clips of described shell;

Jaw, distal portion of its contiguous described housing is installed, and described jaw can move between open mode that separates and approaching closure state;

Push rod, it can be arranged in the housing of described shaft assembly with moving back and forth, the described push rod described jaw that is configured to when distal movement the operation clip of farthest side packed into;

The clip follower, it is slidably supported and is used for distal direction promotes a plurality of operation clips in described shaft assembly; And

The clip carrier, it is arranged in the described shaft assembly, and wherein said clip bearer configuration becomes to keep a plurality of operation clips and clip follower;

Wherein said clip follower comprises the window catch that extends from its surface, and wherein after launching last operation clip, described window catch engages described push rod and prevents described push rod proximal direction motion.

2, device according to claim 1, wherein said push rod comprises the pusher that is formed on its far-end, wherein said pusher has narrow profile and is used for the operation stitching nail that contact is loaded on single position.

3, device according to claim 2, wherein said pusher define the basic plane orthogonal in plane of the operation stitching nail of orientating as and being loaded into.

4, device according to claim 1, further comprise the connecting plate that can be arranged in the described shaft assembly with moving back and forth, wherein said connecting plate is detachably connected on the described push rod, wherein described push rod distad advances during the initial distal movement of described connecting plate, and during the further distal movement of described connecting plate, described connecting plate is thrown off from described push rod.

5, device according to claim 4, wherein said push rod further comprises first spring clip that is supported on the described push rod, described first spring clip is used for being connected to the fixed part of the housing that is arranged on described shaft assembly when described push rod is in the propelling position, described push rod is remained on described propelling position.

6, device according to claim 1, wherein said push rod further comprises and is supported in second spring clip that is used on the described push rod with first part bonding of described connecting plate, wherein after the initial distal movement of described connecting plate, first parts of described connecting plate break away from from described second spring clip.

7, device according to claim 4, further comprise the pushing plate that can be arranged in the described shaft assembly with moving back and forth, described pushing plate comprises at least one fin of the shoulder that is detachably connected to described push rod, wherein during the distal movement and proximal movement of described push rod, the shoulder of described push rod engages with at least one fin of described pushing plate, with one in the distal movement that realizes pushing plate and the proximal movement.

8, device according to claim 7, wherein said clip follower comprises from outstanding first projection of the first surface of described clip follower with from the second outstanding projection of the second surface of described clip follower, wherein along with described pushing plate distal motion, first projection of described clip follower engages with described pushing plate, thereby make described clip follower distal motion to advance described a plurality of operation clip, and wherein, along with described pushing plate proximal motion, second projection and the part bonding of described clip follower, thus described clip follower is maintained fixed.

9, device according to claim 8, second projection and the part bonding that is formed in the clip carrier of wherein said clip follower.

10, device according to claim 8 wherein progressively advances described clip follower by described shaft assembly.

11, device according to claim 1 further comprises the ratchet assembly that is arranged in the described Handleset, wherein when described push rod does not turn back to proximal position, prevents that described ratchet assembly from resetting.

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