HK1193014A - Surgical device - Google Patents

Description

Surgical device

Cross Reference to Related Applications

This application claims the benefit of U.S. provisional patent application serial No.61/523,805 entitled "laproscoppicdevice" filed on 15/8/2011, the disclosure of which is incorporated herein by reference.

Technical Field

The present invention relates to surgical devices, and more particularly, to surgical devices that may be used in minimally invasive procedures. The present disclosure also relates to surgical devices that facilitate the positioning and deployment of atrial appendage occlusion devices. Further, the present disclosure relates to a surgical device adapted to receive or cooperate with a flexible endoscope.

Background

Exemplary embodiments disclosed herein include one or more active or passive repositioning mechanisms. As will be discussed in greater detail below, active repositioning mechanisms provide infinite adjustment because the user physically manipulates controls to directly manipulate the repositioning of the end effector. In contrast, a passive repositioning mechanism may be considered to operate similar to an optical switch (off or on). In this manner, the passive repositioning mechanism allows or disallows repositioning of the end effector, but is not responsible for actively manipulating the position of the end effector. In other words, the passive repositioning system allows free movement of the end effector within the end effector's range of motion when the mechanism is in the "on" position, but locks the end effector's movement within the end effector's range of motion when the mechanism is in the "off" position. In an exemplary form, the laparoscopic device may incorporate an active repositioning mechanism and a passive repositioning mechanism to control movement in different directions, such as pitch and yaw.

Exemplary embodiments also include an active repositioning mechanism that provides a specific motion translation. In other words, a ninety degree change in the controller position will result in a forty-five degree change in the end effector position. As disclosed herein, certain parameters may be modified to provide different motion transformations depending on the end application and user preferences.

Disclosure of Invention

A first aspect of the present invention provides a medical device comprising: (a) a first joint comprising a first member and a second member, the first member configured to be repositionable in an X-Y plane relative to the second member; (b) a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable relative to the fourth member in a Y-Z plane perpendicular to the X-Y plane; and (c) a controller operatively coupled to the first joint and the second joint, the controller including a first control configured to direct repositioning of at least one of the first member and the second member and a second control configured to direct repositioning of at least one of the third member and the fourth member.

In a more specific embodiment of the first aspect, the first control comprises a passive control configured to be repositionable between a first position that allows free movement between the first member and the second member in an X-Y plane and a second position that prevents movement between the first member and the second member in the X-Y plane; and the second control portion includes an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the third member relative to the fourth member at a different position within the Y-Z plane. In yet a more particular embodiment, the passive control portion includes a lever repositionably mounted to the housing of the controller, the lever being coupled to the passive control wire; and the passive control wire is further coupled to a repositionable fastener configured to engage at least one of the first and second members to inhibit movement of the first and second members within the X-Y plane. In yet another embodiment, a spring is used to bias the repositionable fastener to prevent movement between the first member and the second member in the X-Y plane; and the lever is configured to be repositionable to tension the passive control wire to overcome the bias of the spring to allow movement between the first member and the second member in the X-Y plane. In another specific embodiment, the instrument further comprises a longitudinal conduit extending between the controller and the first connector, wherein at least a portion of the passive control wire extends through the longitudinal conduit. In a more specific embodiment, the instrument further includes a longitudinal conduit extending between the controller and the first fitting, wherein the first member is mounted to the controller and the second member is repositionably mounted to the first member. In a more specific embodiment, the first member is elongate and includes an internal cavity that at least partially receives a repositionable fastener to resist movement between the first member and the second member in an X-Y plane; and at least one of the first member and the longitudinal conduit houses a spring that biases the repositionable fastener to resist movement between the first member and the second member in an X-Y plane. In another more particular embodiment, at least one of the first member and the second member includes a protrusion, at least one of the first member and the second member includes a cavity configured to receive the protrusion; the cavity is at least partially defined by the support surface; and the projection is configured to contact the bearing surface when movement occurs between the first member and the second member in the X-Y plane. In yet a more particular embodiment, the first member includes a cavity and the second member includes a protrusion; the repositionable fastener includes at least one tooth and the second member includes at least one tooth, the tooth of the second member being configured to engage the at least one tooth of the repositionable fastener to prevent movement between the first member and the second member in the X-Y plane. In yet a more particular embodiment, the cavity comprises a first cavity and a second cavity spaced apart from and facing each other; the projections comprise a first projection and a second projection spaced apart from and facing away from each other; the first cavity is configured to receive the first protrusion; and the second cavity is configured to receive the second protrusion.

In yet a more particular embodiment of the first aspect, the first member comprises a clevis; and the second member comprises a basin-shaped structure. In yet a more particular embodiment, the first control comprises a passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within an X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; the clevis includes an inner cavity that at least partially receives a repositionable fastener and a biasing spring; the repositionable fastener includes a portion of the first control portion; the first control portion further includes an actuator repositionably mounted to the controller; and the first control portion further comprises a tether coupled to both the actuator and the repositionable fastener. In yet another embodiment, the basin includes a first basin half and a second basin half; and the first and second tub-shaped structure halves are identical. In another specific embodiment, the active control portion includes an actuator repositionably mounted to a housing of the controller, the actuator operatively coupled to the active control line; and an active control line coupled to at least one of the third member and the fourth member to control movement between the third member and the fourth member within the Y-Z plane. In a more specific embodiment, the actuator includes a wheel and a linkage plate; the wheel comprises a helical cavity; and the linkage plate includes a protrusion configured to be received within the helical cavity of the wheel. In a more specific embodiment, the actuator includes a wheel and a linkage plate; the chain plate comprises a spiral cavity; and the wheel linkage plate includes a protrusion configured to be received within the helical cavity of the linkage plate. In another more specific embodiment, the actuator includes a wheel and a linkage plate; the linkage plate comprises a cavity; and the wheel includes a helical projection configured to be received within the cavity of the linkage plate. In yet a more particular embodiment, the actuator includes a wheel and a linkage plate; the wheel includes a cavity; and the linkage plate includes a helical projection configured to be received within the cavity of the wheel.

In a more specific embodiment of the first aspect, the second control portion comprises an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the third member in a different position within the Y-Z plane relative to the fourth member, the second member being mounted to the third member; and the third member is repositionably mounted to the fourth member. In yet a more particular embodiment, the fourth member is elongate and includes an inner cavity that at least partially houses the repositionable pull link; and the fourth member includes a channel configured to receive at least a portion of an active control line. In yet another embodiment, the channel includes a first arcuate section and a second arcuate section; the active control lines include a first active control line and a second active control line; the first arcuate segment is configured to receive a first active control line; the second arcuate section is configured to receive a second active control line; at least a portion of the first active control line is secured to the fourth member; and at least a portion of the second active control line is fixed to the fourth member. In another particular embodiment, at least one of the third member and the fourth member includes a protrusion; at least one of the third member and the fourth member includes a cavity configured to receive the protrusion; the cavity is at least partially defined by the support surface; and the projection is configured to contact the bearing surface when movement occurs between the third member and the fourth member in the Y-Z plane. In a more specific embodiment, the fourth member includes a cavity; and the third member includes a projection. In a more specific embodiment, the cavities include a first cavity and a second cavity spaced apart from and facing away from each other; the projections comprise a first projection and a second projection spaced apart from and facing each other; the first cavity is configured to receive the first protrusion; and the second cavity is configured to receive the second protrusion. In another more specific embodiment, the second control portion comprises an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the third member in a different position within the Y-Z plane relative to the fourth member, the third member comprising a basin-shaped structure; and the fourth member comprises a yoke. In yet a more particular embodiment, the active control portion includes an actuator repositionably mounted to a housing of the controller, the actuator operatively coupled to the first active control line and the second active control line; the yoke comprises an inner cavity which at least partially receives a repositionable pull link; the yoke comprises a first channel configured to receive at least a portion of a first active control line and a second channel configured to receive at least a portion of a second active control line; and at least a portion of the first active control line and the second active control line are secured to the yoke. In yet another more specific embodiment, the second member and the third member are mounted to each other; and the second and third members cooperate to form a basin-shaped structure.

In yet a more particular embodiment of the first aspect, the actuator includes a first wheel, a first linkage plate, a second wheel, and a second linkage plate; the first and second wheels each comprise a helical cavity; the first and second linkage plates each include a protrusion configured to be received within respective helical cavities of the first and second wheels; a first active control line is coupled to the first linkage plate; and a second active control line is coupled to the second linkage plate. In yet another more specific embodiment, the first wheel is a mirror image of the second wheel. In yet another specific embodiment, the helical cavity of each of the first and second wheels comprises arcuate walls defining the helical cavity; and the protrusion of each of the first and second linkage plates includes a curved surface configured to contact the arcuate wall of the respective helical cavity. In another specific embodiment, the first control comprises a first passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within an X-Y plane and a second position that inhibits movement between the first member and the second member within the X-Y plane; and the second control portion comprises a second passive control portion configured to be repositionable between a first position that allows free movement between the third member and the fourth member in the Y-Z plane and a second position that inhibits movement between the third member and the fourth member in the Y-Z plane. In a more specific embodiment, the first passive control section includes an actuator repositionably mounted to a housing of the controller, the actuator coupled to the first passive control line; and the first passive control wire is further coupled to at least one of the first member and the second member to prevent movement between the first member and the second member in the X-Y plane. In a more specific embodiment, the actuator is configured to be repositionable to allow movement between the first member and the second member within an X-Y plane. In yet a more particular embodiment, the first member is elongate and includes an internal cavity that at least partially receives a repositionable fastener to resist movement between the first member and the second member in an X-Y plane; and at least one of the first member and the longitudinal conduit houses a spring that biases the repositionable fastener to resist movement between the first member and the second member in an X-Y plane.

In a more specific embodiment of the first aspect, at least one of the first member and the second member includes a protrusion; at least one of the first member and the second member includes a cavity configured to receive the protrusion; the cavity is at least partially defined by the support surface; and the projection is configured to contact the bearing surface when movement occurs between the first member and the second member in the X-Y plane. In yet another more specific embodiment, the first member includes a cavity; the second member includes a projection; the repositionable fastener includes at least one tooth; and the second member includes at least one tooth configured to engage the at least one tooth of the repositionable fastener to prevent movement between the first member and the second member in the X-Y plane. In yet another specific embodiment, the cavity comprises a first cavity and a second cavity spaced apart from and facing each other; the projections comprise a first projection and a second projection spaced apart from and facing away from each other; the first cavity is configured to receive the first protrusion; and the second cavity is configured to receive the second protrusion. In another particular embodiment, the first member comprises a clevis; and the second member comprises a basin-shaped structure. In a more specific embodiment, the clevis includes an internal cavity that at least partially receives the repositionable fastener and the biasing spring; the repositionable fastener includes a portion of the first control portion; the first control portion further includes an actuator repositionably mounted to the controller; and the first control portion further includes a tether coupled to both the actuator and the repositionable fastener. In a more specific embodiment, the basin includes a first basin half and a second basin half; and the first and second tub-shaped structure halves are identical. In another more specific embodiment, the second control portion includes an actuator repositionably mounted to a housing of the controller, the actuator operatively coupled to the passive control line; and a passive control wire is coupled to at least one of the third member and the fourth member to control movement between the third member and the fourth member within the Y-Z plane. In yet a more particular embodiment, the actuator includes a depressible button extending through the housing of the controller configured to engage the receiver; the actuator comprises at least one tooth; and the receiver includes at least one tooth configured to selectively engage the at least one tooth of the actuator. In yet a more particular embodiment, an actuator is repositionably mounted to a housing of a controller, the actuator including a portion of a first control portion and a portion of a second control portion; the first passive control includes a first receiver repositionably mounted to a housing of the controller, the first receiver operatively coupled to a first wire mounted to at least one of the first and second components; and the second passive control includes a second receiver repositionably mounted to the housing of the controller, the second receiver operatively coupled to a second wire mounted to at least one of the third member and the fourth member.

In yet a more particular embodiment of the first aspect, the actuator comprises a depressible button biased by a spring, the actuator being configured to be repositionable between a first position and a second position, the first position allowing free movement between the first member and the second member in the X-Y plane and allowing free movement between the third member and the fourth member in the Y-Z plane, the second position preventing free movement between the first member and the second member in the X-Y plane and preventing free movement between the third member and the fourth member in the Y-Z plane, the actuator being lockable in the first position; the actuator does not engage the first receiver or the second receiver in the first position; and the actuator engages the first and second receivers in the second position. In yet a more particular embodiment, the actuator includes a depressible button biased by a spring to engage the first and second receivers; the first and second receivers are rotationally repositionable along a common spool that extends internally in the controller when not engaged by the depressible button, and are non-rotationally repositionable along the common spool when engaged by the depressible button. In yet another specific embodiment, the instrument further comprises an end effector operatively coupled to the first joint and the second joint. In another particular embodiment, the end effector comprises at least one of: a surgical dissector, an ablation pen, a sealing clip applier, surgical forceps, surgical jaws, a linear cutter, an ablation clamp, and an ablation rail. In a more specific embodiment, the controller includes a third control portion operatively coupled to the end effector. In a more specific embodiment, the end effector comprises a clip deployment device; and the third control portion includes a link that extends from the controller to the end effector to control repositioning of at least a portion of the clip deploying device. In another more specific embodiment, the clip deployment device includes opposing jaws removably coupled to the occlusion clip; and the linkage is configured to be repositioned to remove the occlusion clip coupled to the opposing jaw. In yet a more particular embodiment, the opposing jaws each include an aperture through which the tether extends; a tether coupled to the occlusion clip; and the linkage is removably coupled to the tether.

In yet a more particular embodiment of the first aspect, the tether comprises a suture loop; and a linkage is interposed between the suture loop and the occlusion clip. In yet another aspect of the invention, an end effector comprises a clip deployment device; and the third control portion comprises a pull link extending from the controller to the end effector to control repositioning of at least a portion of the clip deploying device. Further, in yet another embodiment, the second joint includes a channel along which the pull link is configured to traverse; a pull link operatively coupled to the third control and the clip deployment device; and the deployment device includes at least two ganged clips operatively coupled to the pull link, each of the at least two ganged clips having a non-circular cam that rides on a cam drive surface of at least one of the two jaws, the at least two ganged clips being configured to pivot relative to the two jaws until interaction between the cam and the cam drive surface inhibits further pivoting.

A second aspect of the present invention provides a medical device comprising: (a) a controller that at least partially houses a plurality of controls; (b) an elongated conduit operatively coupling the controller to the first joint and the second joint; (c) a first joint comprising a first member and a second member, the first member being configured to be repositionable in an X-Y plane relative to the second member; (d) a second joint operatively coupled to the first joint, the second joint including a third member and a fourth member, the third member configured to be repositionable relative to the fourth member in a Y-Z plane perpendicular to the X-Y plane; and (e) an end effector operatively coupled to the first joint and the second joint, wherein the control comprises: a first control operatively coupled to the first joint to control movement of the first member relative to the second member in the X-Y plane; a second control operatively coupled to the second joint to control movement of the third member relative to the fourth member in the Y-Z plane; a third control operatively coupled to the end effector for controlling movement of at least a portion of the end effector.

In a more specific embodiment of the second aspect, the instrument further comprises an occlusion clip removably mounted to the end effector, wherein the plurality of controls includes a fourth control for detaching the occlusion clip from the end effector. In yet a more particular embodiment, the first control comprises a passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within an X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and the second control portion includes an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the third member relative to the fourth member at a different position within the Y-Z plane. In yet another specific embodiment, the third control portion comprises a second active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions orients the end effector in a different position. In another specific embodiment, the instrument further comprises an occlusion clip removably mounted to the end effector, wherein the plurality of controls includes a fourth control for detaching the occlusion clip from the end effector, wherein the fourth control includes a passive control configured to detach or retain the connection between the end effector and the occlusion clip. In a more specific embodiment, the first control comprises a first passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within an X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and the second control comprises a second control configured to be repositionable between a first position that allows free movement between the third member and the fourth member in the Y-Z plane and a second position that prevents movement between the third member and the fourth member in the Y-Z plane. In a more specific embodiment, the third control portion comprises an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions orients the end effector in a different position.

In yet a more particular embodiment of the second aspect, the first control comprises a first passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within at least 90 ° of an X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and the second control comprises a second control configured to be repositionable between a first position and a second position, the first position allowing free movement between the third member and the fourth member within at least 90 ° of the Y-Z plane, and the second position preventing movement between the third member and the fourth member within the Y-Z plane. In yet a more particular embodiment, the first control comprises a passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within at least 90 ° of an X-Y plane, and a second position that prevents free movement between the first member and the second member within the X-Y plane; and the second control portion includes an active control portion configured to be repositionable among an infinite number of positions within at least ninety degrees in the Y-Z plane, wherein each of the infinite number of positions the third member relative to the fourth member at a different position within the Y-Z plane. In yet another embodiment, the active control portion includes a first wheel having a first spiral cavity formed therein and a second wheel having a second spiral cavity formed therein, the first and second spiral cavities being mirror images of each other; the active control portion further includes a first linkage plate coupled to the first link line and a second linkage plate coupled to the second link line; the first linkage plate includes a first protrusion configured to be received within the first helical cavity; the second linkage plate includes a second protrusion configured to be received within the second helical cavity; the first and second wheels are coupled to each other such that rotation of one wheel results in corresponding rotation of the other wheel, wherein rotation in a first direction results in tension on the first link but not the second link; and rotation in a second direction causes tension on the second link but not on the first link; and tension on the first link line causes movement in a positive X direction in a Y-Z plane, and tension on the second link line causes movement in a negative X direction in the Y-Z plane. In another particular embodiment, the end effector comprises at least one of: a surgical dissector, an ablation pen, a sealing clip applier, surgical forceps, surgical jaws, a linear cutter, an ablation clamp, and an ablation rail.

Drawings

FIG. 1 is a top perspective view of an exemplary laparoscopic device according to the present disclosure.

FIG. 2 is an exploded view of the proximal end of the exemplary laparoscopic device of FIG. 1.

FIG. 3 is a top perspective view of the proximal end of the exemplary laparoscopic device of FIG. 2, without the left side housing.

FIG. 4 is a top perspective view of the proximal end of the exemplary laparoscopic device of FIG. 2, without the right side housing.

Fig. 5 is a top perspective view of the right and left side housings mounted to each other.

Fig. 6 is a bottom perspective view of the right and left side housings mounted to each other.

FIG. 7 is a top perspective view of an exemplary wheel of the exemplary laparoscopic device of FIG. 1.

Fig. 8 is a side view of the exemplary wheel of fig. 7.

Figure 9 is a bottom perspective view of the exemplary wheel of figure 7,

fig. 10 is a bottom view of the exemplary wheel of fig. 7.

FIG. 11 is a top perspective view from the right side of an exemplary linkage plate of the exemplary laparoscopic device of FIG. 1.

FIG. 12 is a top perspective view from the left side of the example linkage plate of FIG. 11.

FIG. 13 is a top perspective view from the front of the example linkage plate of FIG. 11.

FIG. 14 is an enlarged side view with the right side housing removed showing the interaction between the wheels and the linkage plate in the first position.

FIG. 15 is an enlarged side view with the right side housing removed showing the interaction between the wheels and the linkage plate in the second position.

Fig. 16 is an enlarged side view of the wheel and linkage plate with the right side housing removed, showing the interaction between the wheel and linkage plate in a third position,

FIG. 17A is a side view showing three vertical positions of an end effector implemented using an active positioning mechanism.

Fig. 17B is a top view showing three horizontal positions of the end effector (showing the change in position relative to the end effector using the semi-rigid tube) achieved using a passive repositioning mechanism.

FIG. 18 is an enlarged side view with the right side housing removed showing the angle θ between the catch and the groove.

FIG. 19 is a top perspective view of the outside of the right side housing of the exemplary laparoscopic device of FIG. 1.

FIG. 20 is a top perspective view of the inside of the right side housing of the exemplary laparoscopic device of FIG. 1.

FIG. 21 is a top perspective view of the outside of an exemplary rod of the exemplary laparoscopic device of FIG. 1.

Fig. 22 is a side view of the exemplary lever of fig. 21.

Fig. 23 is a top perspective view of the inside of the exemplary lever of fig. 21.

FIG. 24 is a top perspective view of the outside of the left side housing of the exemplary laparoscopic device of FIG. 1.

FIG. 25 is a top perspective view of the inside of the right side housing of the exemplary laparoscopic device of FIG. 1.

FIG. 26 is an enlarged side view of the interior of the proximal portion of the exemplary controller of the laparoscopic device of FIG. 1, with the left side housing removed.

Fig. 27 is an enlarged side view of the interior of the proximal portion of the example controller of fig. 1 with the right side housing removed.

FIG. 28 is a top perspective view of an exemplary handle mechanism of the laparoscopic device of FIG. 1.

Fig. 29 is a bottom perspective view of the exemplary handle mechanism of fig. 28.

FIG. 30 is a top perspective view of the interior of the exemplary controller of FIG. 1 and the proximal end of the conduit of the exemplary laparoscopic device with the left side housing removed.

FIG. 31 is a top perspective view of the interior of the exemplary controller of FIG. 1 and the proximal end of the conduit of the exemplary laparoscopic device with the right side housing removed and the exemplary cap installed.

FIG. 32 is a top perspective view of the interior of the exemplary controller of FIG. 1 and the proximal end of the conduit of the exemplary laparoscopic device with the right side housing removed and the exemplary cap removed.

FIG. 33 is a longitudinal cross-sectional view of an alternative exemplary tube for use with the laparoscopic device of FIG. 1.

FIG. 34 is an exploded view of the distal end of the exemplary laparoscopic device of FIG. 1.

FIG. 35 is a top perspective view of an exemplary clevis of the exemplary laparoscopic device of FIG. 1.

Fig. 36 is a top perspective view of the example clevis of fig. 35 without the top housing.

Fig. 37 is a top view of the example clevis of fig. 36.

Fig. 38 is a top perspective view of a bottom housing of the example clevis of fig. 35.

FIG. 39 is a top perspective view of an exemplary tooth receiver of the exemplary laparoscopic device of FIG. 1.

Figure 40 is a front side view of the example tooth receiver of figure 39.

Figure 41 is a rear side view of the example tooth receiver of figure 39.

Fig. 42 is a top perspective view of the exemplary clevis of fig. 35 without the top housing but with a pair of tooth plates and a single basin structure half.

Fig. 43 is a top perspective view of the exemplary clevis of fig. 35 without the top housing but with a single tooth plate and a single basin structure half.

Figure 44 is a top perspective view of an exemplary toothed plate of the exemplary laparoscopic device of figure 1.

FIG. 45 is an external side view of an exemplary basin half of the exemplary laparoscopic device of FIG. 1.

FIG. 46 is a front side view showing the assembled basin half of FIG. 42.

FIG. 47 is a top view of the basin half of FIG. 46.

FIG. 48 is an inside top perspective view of an exemplary basin half of the exemplary laparoscopic device of FIG. 1.

Figure 49 is a top perspective view of an exemplary repositionable jaw assembly of the exemplary laparoscopic device of figure 1,

FIG. 50 is a top perspective view of an exemplary yoke and pull link of the exemplary laparoscopic device of FIG. 1.

Fig. 51 is a top perspective view from the proximal end of the exemplary yoke of fig. 50.

Fig. 52 is a horizontal cross-sectional view of the exemplary yoke and pull link of fig. 50.

Fig. 53 is a horizontal cross-sectional view of the exemplary yoke of fig. 50.

Fig. 54 is a top perspective view of the pull link of fig. 50.

Fig. 55 is a horizontal cross-sectional view of an exemplary yoke and pull link coupled to an exemplary linkage plate and linkage clamp.

FIG. 56 is a top perspective view of an exemplary pull link coupled to an exemplary linkage plate and linkage clip.

Fig. 57 is a top perspective view of an example linkage plate coupled to the example linkage clip of fig. 56.

FIG. 58 is an external perspective view of an exemplary left side jaw of the exemplary laparoscopic device of FIG. 1.

Fig. 59 is an interior perspective view of the exemplary left-hand jaw of fig. 58.

FIG. 60 is a top view of the jaws and various other distal components of the exemplary laparoscopic device of FIG. 1 in the most compact width orientation.

Figure 61 is an enlarged top view of the jaws and gang clamp of figure 60.

FIG. 62 is a top view showing the position of the jaws and various other distal components of the exemplary laparoscopic device of FIG. 1 when the pull link is initially displaced proximally.

Figure 63 is an enlarged top view of the jaws and links of figure 62.

FIG. 64 is a top view showing the position of the jaws and various other distal components of the exemplary laparoscopic device of FIG. 1 when the pull link is moved proximally further than in FIG. 62.

FIG. 65 is an enlarged top view of the jaws and the unification clip of FIG. 64.

Figure 66 is a top view showing the position of the jaws and various other distal components of the exemplary laparoscopic device of figure 1 when the pull link is moved to its most proximal position to fully open the jaws.

FIG. 67 is a top view illustrating the position of the jaws and various other distal components if the exemplary laparoscopic device of FIG. 1 does not include a pivot point between the jaws and the linkage clip.

FIG. 68 is a perspective view of an exemplary clamp in an open position that can be used with the exemplary laparoscopic device of FIG. 1.

Fig. 69 is a perspective view of the example clamp of fig. 68 in a closed position.

Fig. 70 is a cross-sectional view of the example clamp of fig. 68 in its open configuration, showing a wire member, a rigid tube member, and a biasing member.

FIG. 71 is a cross-sectional view of the example clamp of FIG. 69 in its closed configuration, showing a wire member, a rigid tube member, and a biasing member.

Fig. 72 is a perspective view of the exemplary clamp of fig. 68-71 and illustrates the ability to close in a non-parallel manner.

Fig. 73 is a perspective view of a first stage of assembly of an alternative embodiment of the clamp, showing a wire member surrounded by a rigid tubular member.

FIG. 74 is a perspective view of a second stage of assembly of the clamp of FIG. 73, with a pressure plate added over the rigid tubular member.

FIG. 75 is a perspective view of the clip of FIGS. 73 and 74 after the outer fabric covering has been disposed over the entire surface of the clip.

FIG. 76 is a top perspective view of an alternative exemplary controller that can be used with the laparoscopic device of FIG. 1.

FIG. 77 is a top perspective view of the alternative example controller of FIG. 76, shown without the left side housing.

Fig. 78 is an enlarged perspective view of the interior of the distal end portion of the alternative control of fig. 76.

FIG. 79 is a side view of the structure shown in FIG. 78, with the button shown in its highest vertical position.

Fig. 80 is a side view of the structure shown in fig. 78, with the button shown in its lowest vertical position.

FIG. 81 is an enlarged perspective view of the interior of the distal end portion of the alternative exemplary controller of FIG. 76, shown without the button and first tooth assembly.

FIG. 82 is an enlarged perspective view of the interior of the distal end portion of the alternative exemplary controller of FIG. 76, shown without the button.

Detailed Description

Exemplary embodiments of the present disclosure are described and illustrated below as including surgical devices, and more particularly surgical devices that may be used in minimally invasive procedures. The present disclosure also relates to surgical devices that facilitate the positioning and deployment of atrial appendage occlusion devices. Further, the present disclosure relates to surgical devices adapted to receive or be used in coordination with a flexible endoscope. Of course, it will be apparent to those skilled in the art that the embodiments discussed below are exemplary in nature and may be reconfigured without departing from the scope and spirit of the present disclosure. However, for the sake of clarity and accuracy, the exemplary embodiments as discussed below may include optional steps, methods and features that those skilled in the art would consider as not essential within the scope of the present disclosure.

Referring to fig. 1-6, the exemplary laparoscopic device 100 includes a controller 110, the controller 110 being mounted to the proximal end of a relatively linear semi-rigid conduit 112. The controller 110 includes various controls for manipulating the repositionable mechanism 116, the repositionable mechanism 116 being operatively coupled to an end effector 118, wherein the repositionable mechanism 116 is mounted to the distal end of the tube 112. In this exemplary embodiment, the repositionable mechanism 116 is coupled to an end effector that includes a clip deployment device 118. However, as will be discussed in the embodiments below, the end effector 118 may include any number of devices, such as, but not limited to, forceps, an ablation rail, jaws, a linear cutter, an ablation pen, an ablation clamp, an illuminated dissector, and a non-illuminated dissector.

The exemplary repositionable mechanism 116 incorporates both active and passive mechanisms. It should be noted that the active mechanism operates to control the pitch (i.e., up and down) of the end effector 118, while the passive mechanism operates to control the yaw (i.e., side-to-side) of the end effector. However, as will be apparent from the disclosure below, in alternative exemplary embodiments, repositionable mechanism 116 may include only active or passive mechanisms. Conversely, in another alternative exemplary embodiment, the repositioning mechanism 116 may utilize a passive mechanism to control the pitch (i.e., up and down) of the end effector 118, while an active mechanism operates to control the yaw (i.e., from side to side) of the end effector. Those skilled in the art will appreciate that the following description is but one configuration of a variety of configurations that incorporate active and passive mechanisms for controlling the motion of the end effector 118 in two planes.

The controller 110 includes a right side housing 130 and a left side housing 132, the right side housing 130 and the left side housing 132 cooperatively defining an interior cavity and corresponding opening to accommodate passage of some controls. The first of these openings is a back opening 134 that accommodates the passage of a pair of wheels 136, 138 that are rotatably repositioned along a transverse axis.

Referring to fig. 7-10, each wheel 136, 138 includes a contact surface 140, the contact surface 140 adapted to be contacted by a user to rotate the wheel. The contact surface 140 includes a series of circumferentially distributed depressions 142 interposed between a series of knurls 144 to facilitate gripping between a user and the wheels 136, 138. Each knurl 144 is sloped to match the profile of the wheels 136, 138, which decreases from a maximum where the contact surface 140 abuts the inner face 146. A planar ring surface 148 is radially inset from the recess 142 and the knurls 144, the planar ring surface 148 circumferentially bounding the outer boundary of an annular outer cavity 152. A pair of inclined surfaces 154, 156 are inset from the ring surface 148 and are axially spaced from one another to narrow the diameter of the cavity 152 as it moves axially deeper into the cavity. The cavity 152 is also defined in part by a hollow axle 158 extending from each wheel 136, 138. This hub 158 is circumferentially surrounded at its base by a circular boss 162, wherein the hub and platform cooperate to progressively increase the radial dimension of the annular cavity 152. The interior of the axle 158 defines a cylindrical cavity 166, and the cylindrical cavity 166 continues this cylindrical shape until an interior midpoint is reached, at which point the cavity assumes a semi-circular shape that extends to the inner surface 146. A semi-circular protrusion 170 adjacent to the cavity 166 extends generally perpendicularly away from the inner surface 146. The inner surface 146 also includes a helical groove 172, the helical groove 172 being distributed about 220 degrees around the protrusion 170. In this way, the radial distance between the groove 172 and the projection 170 gradually changes until the maximum and minimum of the groove ends are reached.

Referring to fig. 11-13, the wheels 136, 138 are operatively coupled to the repositionable mechanism 116 and operate to control the pitch of the repositionable mechanism. To control the pitch of the repositionable mechanism 116, each wheel 136, 138 is coupled to a linkage plate 180, the linkage plate 180 converting the rotational motion of the wheel to longitudinal motion along a longitudinal axis extending along the length of the pipe 112. In particular, each linkage plate 180 includes a key shape having a planar section 182 and a plurality of stamped openings 184, 186, 188. A first of these stamped openings 184 has a horseshoe shape that forms a protrusion extending into the opening. The tab is then deformed by bending the tab ninety degrees appropriately to form a catch 190 extending perpendicularly away from planar segment 180. The second opening 186 has a generally oval shape with rounded ends and is configured to reduce the weight of the linkage plate 180 and provide a complementary opening for the semi-circular protrusion 170 of the corresponding wheel 136, 138 (see fig. 8-10). The third opening 188 has a width dimension that is significantly shorter than the vertical dimension to form an elongated, generally rectangular opening with rounded corners. Such a third opening 188 is used to pass the connection line 199 therethrough and cooperates with the half-ring 196 to secure the connection line to the linkage plate 180. In particular, the ends of the planar segment 182 are deformed to form the half-ring 19, wherein the connecting wire 194 passes on the interior of the half-ring (i.e., the concave aspect of the half-ring) and extends through the third opening 188. In this exemplary embodiment, the connection line 194 includes a cylindrical sleeve 198, the cylindrical sleeve 198 being secured to the line such that no lateral movement between the sleeve and the line occurs. The sleeve 198 is sized to allow the sleeve and the connection line 194 to pass through the third opening 188. In particular, after the sleeve 198 and the connecting wire 194 pass through the third opening 188, the sleeve 198 is longitudinally positioned against the linkage plate 180 and abuts the half ring 196. Specifically, the sleeve 198 is sized such that it does not pass through the half ring 196 when longitudinally positioned against the linkage plate 180. In this manner, repositioning of attachment wire 194 may be accomplished by repositioning linkage plate 180 to tension attachment wire 194. Each linkage plate 180 also includes a spacer flange 200 that extends over the second opening 186. The spacer flange 200 includes a longitudinal S-shaped bend applied to the key top. Such flanges 200 cooperate with mating flanges 200 of another linkage plate 180 to ensure proper spacing between adjacent linkage plates.

Referring to fig. 2, 3 and 7 to 17, the assembly of the wheels 136, 138 and linkage plate 180 provides the means to: the repositionable mechanism 116 is repositioned upward or downward simply by rotating the wheel in a clockwise or counterclockwise direction. In particular, the linkage plates 180 are assembled back-to-back with one of the linkage plates 180 inverted so that the flanges 200 face inwardly toward each other. In this way, flange 200 of first linkage plate 180 abuts planar surface 182, while second linkage plate flange 200 abuts planar surface 18 of the first linkage plate. In this orientation, the fasteners 10 of each linkage plate 180 extend outwardly away from each other. More specifically, the fasteners 190 (and a portion of the linkage plate 180 itself) are sandwiched between the inner faces 146 of the wheels 136, 138 and are received within the respective helical grooves 172 of adjacent wheels 136, 138. At the same time, when the inner faces 146 are brought closer together, the semi-circular projections 170 of the wheels 136, 138 are aligned such that the planar surfaces of the projections abut each other, thereby forming cylindrical projections that extend through the two second openings 186 of the linkage plate 180.

With particular reference to fig. 14-17A, the consistent rotation of the wheels 136, 138 operatively changes the vertical orientation of the repositionable mechanism 116. For example, starting at position a as shown in fig. 17A, rotation of the top-moving, distal and downward wheels 136, 138 operatively pulls the first linkage plate 180 proximally while pushing the second linkage plate distally. In other words, the rotational motion of the wheels 136, 138 via the interface between the helical groove 172 and the catch 190 is translated into horizontal motion of the linkage plate 180. More specifically, the catch 190 of the first linkage plate 180 abuts an end of the helical groove 172 of the first wheel 136, the end of the helical groove 172 of the first wheel 136 limiting the vertical travel of the repositionable mechanism 116. In this exemplary embodiment, the vertical travel is limited such that the maximum deflection angle is minus sixty degrees from horizontal. To move the repositionable mechanism 116 upward, the wheels 136, 138 are rotated clockwise, thereby changing the position of the helical groove 172 relative to the catch 190. In the exemplary form, the fastener 190 runs within the helical groove 172 and is maintained in a constant horizontal orientation relative to the groove as the tension of the connecting wire 194 pulls the linkage plate 180 proximally. But as the wheels 136, 138 are rotated clockwise from position a, the distance from the centre of the wheels to the helical groove 172 occupied by the catch 190 decreases, thereby repositioning the first linkage plate 180 proximally relative to the wheels. Continued clockwise rotation (about 1/2 revolutions) of the wheels 136, 138 operatively raises the repositionable mechanism 116 upward to position B (see fig. 17A), wherein the repositionable mechanism is at an angle of zero relative to horizontal. Further clockwise rotation of the wheels 136, 138 clockwise (about 1/2 revolutions) operatively brings the repositionable mechanism 116 up to position C (see fig. 17A), where the repositionable mechanism is at a sixty degree angle relative to horizontal. Conversely, rotation of wheels 136, 138 moving proximally and downwardly from the top is operative to push first linkage plate 180 distally while pulling on the second linkage plate, thereby lowering repositionable mechanism 116 through attachment wires 194.

The rotation of the wheels 136, 138 is proportional to the pivotal movement of the repositionable mechanism 116. It should be noted that position C corresponds to the opposite end of the catch 190 adjacent the helical groove 172, which is operative to set the vertical travel limit at sixty degrees relative to horizontal. Briefly, the repositionable mechanism is operatively advanced 120 degrees by rotating the wheels 136, 138 approximately 360 degrees. Thus, the wheels 136, 138 are operative to convert three degrees of rotational motion to one degree of pivotal motion. And the shape of the helical groove 172 may be modified to increase or decrease the translation between the rotational movement of the wheels 136, 138 and the pivotal movement of the repositionable mechanism 116. For example, the pitch of the helical groove 172 may be set such that two full rotations of the wheels 136, 138 are required to move from one end point of the groove to the opposite end point. In this example, the transition would be a six degree rotational motion to a one degree pivotal motion (assuming a maximum pivotal range of 120 degrees). In other words, movement of the repositioning mechanism 116 between the pivot end points will require two full rotations of the wheels 136, 138. Instead, the pitch of the helix may be arranged to extend around one third of the wheels 136, 138 so that the transition will be one-to-one (i.e. one degree of rotational movement to one degree of pivotal movement).

The helical groove 172 may also be configured to have a variable rate of speed as the wheels 136, 138 rotate. In other words, the change in distance from the center of the wheels 136, 138 to the groove 172 is not constant along the entire 360 degrees. For example, the middle section of the channel 172 may have a slope within ± 20 degrees from horizontal (i.e., zero degrees) associated with a two degree rotation being converted into a one degree pivoting motion of the repositionable mechanism 116. But beyond this point the groove 172 decreases in slope so that a final 40 degree travel (between 20 to 60 degrees and-60 to-20 degrees) is achieved by rotating the wheel three degrees for a one degree pivoting motion. Those skilled in the art will appreciate that various combinations may be achieved by varying the slope of the grooves 172 and including one or more grooves having a different slope.

Referring to fig. 18, the slope of the helical groove 172 (i.e., the angle θ) also affects whether the repositioning mechanism 116 is self-locking. In the context of the present disclosure, self-locking refers to automatically inhibiting movement. In an exemplary form, as the angle θ of the helical groove 172 increases (and the degree of rotation to pivot conversion decreases), the resistance to movement of the catch 190 within the groove 172 decreases. In an exemplary form, the resistance is greatest when the angle θ between the fastener and the groove is ninety degrees. In contrast, when the angle θ between the catch and the groove is zero, the resistance is minimal. At some angle θ between zero and ninety degrees, the resistance is large enough to provide a self-locking feature. In other words, to achieve a self-locking feature, the resistance to movement of the catch 190 within the groove 172 must be greater than the tension T on the connecting wire 194. The more spiral turns that make up the grooves 172, the greater the angle θ. The fewer helical turns that make up the groove 172, the smaller the angle θ, and the greater the chance that back loading will cause the wheels 136, 138 to rotate. In an exemplary form, the helical groove 172 has an angle of about 80-85 degrees. This angle is sufficient to provide a self-locking feature, but the back load (the force transmitted along connection line 194 that is applied directly to the repositioning mechanism 116) is not operable to rotate the wheels 136, 138, thereby inhibiting pivotal movement of the repositioning mechanism. However, it may be desirable to avoid the self-locking feature, at which point the shape of the catch 190 and the groove 172 may be altered to reduce friction therebetween, including reducing the number of turns of the helix to reduce the angle θ.

As discussed above, the wheels 136, 138 rotate and act as cams to reposition the linkage plate 180, which also repositions the attachment wire 194. As will be discussed in greater detail below, the attachment wire 194 is mounted to the yoke 614, and the yoke 614 rotates relative to the tub structure halves 594, 596 to provide an infinite number of positions within the range of motion imparted by the helical grooves 172 of the wheels 136, 138. For the purposes of this disclosure, this mechanism is referred to as an active repositioning mechanism because the positive (positive) rotation of the wheel directly causes a proportional movement of the yoke 614 relative to the tub-shaped structure halves 594, 596. In addition, the user of the wheels 136, 138 operates to lock the position of the end effector 118 by stopping the rotation of the wheels. In the exemplary form, the resistance to rotation of the wheels 136, 138 is a result of the angle between the boundary of the groove 172 and the catch 190 of the linkage plate 180. Based on the configuration of this mechanism, the user of the wheels 136, 138 actively controls the position of the end effector 118.

In an alternative exemplary embodiment, the active mechanism may be remotely controlled so that the user does not physically touch the wheels 136, 138, but instead operates a controller that is remote from the wheels. The controller is communicatively coupled to a motor or actuator that is operated to drive the wheel in a desired direction, allowing the wheel to be remotely controlled.

In another exemplary embodiment, the active mechanism is removed from the controller 110 and repositioned distally near the end effector 118 at the distal end of the tube 112. In this embodiment, the active mechanism is exposed and available for manipulation by the robotic attachment to locally reposition the end effector (relative to the controller 110). More specifically, the wheel will be rotated by the robotic attachment in order to reposition the end effector 118.

As will be discussed in greater detail below, such active mechanisms have "on" and "off" functionality that allows a particular movement of the end effector 118 or does not allow such same movement, as compared to passive mechanisms. Such a mechanism is referred to herein as passive, since it does not affirmatively allow control of incremental movement of the end effector 118, but rather operates only to allow or disallow movement.

Referring back to fig. 1, 5 and 19-23, the right side housing 130 of the controller 110 also includes an exterior recess 230 and a pair of through openings 232, 234 to receive a repositionable lever 236, the repositionable lever 236 being part of a passive mechanism. As will be discussed in greater detail below, the repositionable lever 236 can be manipulated to lock or unlock the repositionable mechanism 116 in order to provide or restrict lateral adjustability of the end effector 118. The first through opening 232 is defined by a cylindrical bearing 238 extending perpendicularly away from the housing 130. The bearing 238 includes an outer circular bearing surface 240 and an inner circular bearing surface 242 sandwiched by the rods 236. In this way, the lever 236 rotates about the outer bearing surface 240 and rotates within the inner bearing surface 242. Stem 236 includes a conical appendage 248 integrally formed with a cup-shaped cover 250. The interior of cup-shaped cover 250 is hollowed out to define an interior cavity 252 bounded by a peripheral wall 254, peripheral wall 254 having a generally circular shape at one end and an arcuate (but not rounded) shape at the other end. A cylindrical upstanding tab 256 extends perpendicularly away from the interior of cup-shaped cover 250 and is spaced generally equidistant from the circular portion of peripheral wall 254, but extends above the height of the peripheral wall. A second cylindrical upstanding protrusion 258 is formed at the corner of the arcuate end of the peripheral wall 254. This second cylindrical projection 258 extends perpendicularly away from the interior of the cup-shaped cover 250 (and parallel to the first cylindrical projection 256) and extends above the height of the first cylindrical projection 256. The first cylindrical projection 256 is received within the first through opening 232 of the cylindrical bearing 238, while the second cylindrical projection 258 is received within the second through opening 234. The circular cross-sections of the first cylindrical protrusion 256 and the first through opening 232 and the dimensions of each allow the first cylindrical protrusion to rotate within the first through opening without significant radial play that would otherwise cause the lever 236 to not rotate in unison about a single axis of rotation. Conversely, the second through opening 234 is elongated and presents an arcuate path that follows the movement of the second cylindrical projection 258. More specifically, the second through opening 234 includes a rounded end that substantially matches the curvature and size of the second protrusion 258, but allows for play between the bounds of the opening and the protrusion so the protrusion can move within the opening. At the same time, the height of the second through opening 234 is slightly greater than the diameter of the second protrusion 258, and the arcuate path of the through opening follows the position of the second protrusion as the lever 236 is rotated about the housing 130. The limits or endpoints of the openings set limits on the rotational repositioning of the lever 236. As will be discussed in greater detail below, the limits provide locked and unlocked positions that correspond to locked or free lateral adjustability of the end effector 118. More specifically, the lever 236 is coupled to the connection wire 21 by wrapping the connection wire around the first cylindrical protrusion 256. The remaining outer surface 260 of the right side housing 130 is convex and includes a number of additional features.

With particular reference to fig. 2, 19 and 20, additional features include an enlarged section 264 proximate the distal end 262, the distal end 262 being rounded at its bottom side. Such enlarged section 264 tapers proximally and distally to transition into a proximal neck 266 and a distal flange 268. The distal flange 268 is interposed between the enlarged section 264 and the semicircular adapter 270. As will be discussed in greater detail below, the adapter 270 includes a pair of detents 272, the detents 272 engaging the semi-rigid tube 112 to inhibit longitudinal movement of the tube relative to the controller 110. The two locking pins 272 extend parallel to each other and from an inner circumferential surface 278 of the adapter 270, which inner circumferential surface 278 communicates with the semi-rigid conduit 112. The exterior of the adapter 270 is smooth and semi-circular to receive a cylindrical cap 282, the cylindrical cap 282 surrounding the exterior of the adapter 270.

Referring to fig. 5 and 6, the outer surface 260 of the right outer shell 130 also includes a sloped back surface 284 (sloping downward from the distal end to the proximal end) that transitions in an arc into a carved recess 286 and an arcuate inner side surface 288, both the carved recess 286 and the arcuate inner side surface 288 transitioning into a relatively planar ventral surface 290. As will be discussed in greater detail below, the ventral surface 290 of the right side housing 130 cooperates with a corresponding ventral surface 294 of the left side housing 132 to partially define a handle mechanism port 296 and a handle retention port 298. The two ports 296 and 298 are open to the interior of the respective housings 130, 130. The surfaces 284, 288, 290 converge proximally to partially define a proximal port 300, the proximal port 300 also being open to the interior of the housing 130.

Referring back to fig. 20, the interior of the right hand housing includes a series of hollow cylinders 304, the hollow cylinders 304 extending generally perpendicularly from the interior surface and generally parallel to each other. Each cylinder 304 is sized to receive a threaded fastener to mount the respective housings 130, 132 to one another. In the exemplary form, two of the hollow cylinders 304 are spaced apart from one another with a cross member 306 having a semi-circular cut-out. Extending proximally from the hollow cylinders 304 are a pair of stiffening ribs 308, with a correspondingly shaped protrusion 310 partially interposed between the pair of stiffening ribs 308, the corresponding shape of the protrusion 310 defining the outer recess 230. Another pair of hollow cylinders 304 are provided at the proximal end of the projection 310. These hollow cylinders 304 are followed by another pair of stiffening ribs 308, with the third set of hollow cylinders 304 interposed between the pair of stiffening ribs 308. The pair of hollow cylinders 304 that make up the third set are spaced apart from each other by a cross member 312, the cross member 312 including an oblong projection 314 extending from the proximal end to the distal end. As will be discussed below, the oblong projection 314 is hollowed out and includes a corresponding cavity 316, the corresponding cavity 316 receiving a portion of a handle mechanism 320 (see fig. 26). Finally, proximal stiffening ribs 308 are interposed between the third set of cylinders and the proximal single cylinder 304. A portion of the perimeter of the inner surface of the right side shell 130 includes a recessed ledge 322, the recessed ledge 322 being received within a corresponding channel 324 (see fig. 25) of the left side shell 132 to align the shells 130, 132. And the interior of the right side housing also includes a detent 326, detent 326 extending into handle retention port 298 and serving to retain the handle mechanism in a set position.

Referring to fig. 5, 6, 24 and 25, the left side housing 132 is similar to the right side housing 130 and includes a convex outer surface 340 and a concave inner surface 342. The inner surface 340 and the outer surface 32 converge to partially define the back-side opening 134, the handle mechanism port 296, the handle retention port 298, and the proximal port 300.

The left side housing 132 of the controller 110 includes an enlarged section 354 near the distal end 352, the enlarged section 354 being rounded on its bottom side. Such enlarged section 354 tapers proximally and distally to transition into a proximal neck 356 and a distal flange 358. The distal flange 358 is interposed between the enlarged section 354 and the semicircular adapter 360. The exterior of the adapter 360 is smooth and semi-circular to receive the cylindrical cap 282, the cylindrical cap 282 surrounding the exterior of the adapter 360.

The outer surface 340 of the left side housing 132 also includes an angled back face 364 (sloping downward from the distal end to the proximal end), the angled back face 364 transitioning in an arc to a sculpted recess 366 and an arcuate lateral surface 368, both the sculpted recess 366 and the arcuate lateral surface 368 transitioning to the opposite planar ventral surface 294. The arcuate lateral surface 368 includes a plurality of through-holes 370, the through-holes 370 being partially bounded by corresponding hollow cylinders 372 that extend into the interior of the left side housing 132. These cylinders 372 are adapted to align with the hollow cylinders 304 of the right side housing 130 and receive corresponding fasteners (not shown) to mount the housings to one another. In addition, the ventral surfaces 290, 294 of the housings 130, 132 cooperate to define a handle mechanism port 296 and a handle retention port 294. The surfaces 364, 368, 294 converge proximally to partially define a proximal port 300, the proximal port 300 also being open to the interior of the housing 132.

The interior of the left side housing 132 includes a number of hollow cylinders 372, the hollow cylinders 372 extending generally perpendicularly from the inner surface 342 and being generally parallel to one another. In the exemplary form, two of the hollow cylinders 372 closest to the distal end are spaced apart from each other and have substantially the same height. A pair of stiffening ribs 378 run proximally from the hollow cylinders 372, with a cylindrical protrusion 380 partially interposed between the pair of stiffening ribs 378, the cylindrical protrusion 380 having a hollow interior cavity 382 and a longitudinal height approximating the rib height. Proceeding proximally from the stiffening rib 378 are a pair of hollow cylinders 372, the hollow cylinders 372 being spaced apart from each other by an L-shaped cross member 383. It should also be noted that the dorsal column 372 has a height that is relatively the same as the height of the high portion of the cross member, while the ventral column has a height that is relatively the same as the height of the lower portion of the cross member. Proceeding proximally from the L-shaped cross member 383, the larger hollow cylinder 384 intersects the stiffening rib 379, and the stiffening rib 379 has a notched cutout that resembles the L-shaped cross member. Proceeding further proximally from the larger cylinder 384 is an L-shaped cross member 385 followed by a pair of hollow cylinders 372, the pair of hollow cylinders 372 comprising a third set spaced apart from one another by a cross member 386, the cross member 386 comprising an oblong protrusion 388 extending proximally to distally. As will be discussed below, the oblong projection 388 is hollowed out and includes a corresponding cavity 390 to receive a portion of the handle mechanism 320. Finally, a proximal stiffening rib 392 is interposed between the third set of cylinders and the proximal single cylinder 394. A portion of the perimeter of the inner surface 340 of the left side shell 132 includes a channel 324, the channel 324 receiving the recessed ledge 322 of the right side shell 130.

Referring to fig. 2 and 26-29, the handle mechanism 320 includes a repositionable handle 400, a drive link 402, a return spring 404, and a draw plate 406. As will be discussed in greater detail below, the pull plate 406 is coupled to a pull wire 408, the pull wire 408 operatively coupled to the clip deployment device 118 to selectively open and close an occlusion clip 1160 (see fig. 75), such as in an atrial appendage occlusion clip deployment surgical procedure. The following is a more detailed explanation of the corresponding components of the handle mechanism 320.

Repositionable handle 400 includes an arcuate, ventral gripping surface 414, the arcuate, ventral gripping surface 414 having a longitudinally spaced series of projections 416 to facilitate gripping by a user. At the same time, the ventral gripping surface 414 tapers from a maximum value in the medial to lateral direction between the proximal and distal ends. Opposite the ventral gripping surface 414 is a corresponding inner surface 418, from which a pair of spaced, parallel, vertical walls 420, 422 extend. The vertical walls 420, 422 are also connected to each other via a plurality of transverse walls 424. The proximal transverse wall is also connected to an upstanding ring 428, the upstanding ring 428 being provided with a through opening 430 in the medial to lateral direction. Extending distally from the ring 428, the walls 420, 422 gradually increase in height and extend distally beyond the ventral gripping surface 414. In particular, the distal-most portions of the walls 420, 422 each include a rounded, dorsal end having a circular opening 434 extending in a medial-to-lateral direction. The distal wall 436 spans proximally between the walls 420, 422 and transitions to the ventral gripping surface 414. The circular openings 434 of the walls 420, 422 are laterally aligned, as are two pairs of additional circular openings 440, 442 extending through the walls in the medial-to-lateral direction. Two pairs of openings 440, 442 are smaller in diameter than distal opening 434 and are each adapted to receive a pin 444 to repositionably mount drive link 402 to handle 400. While only one of the pair of openings 440, 442 is occupied by the pin 444, the other pair of openings that is not occupied may be used depending on the spring rate of the return spring 404 and the device (e.g., the clip deployment device 118) that includes the end effector 118.

The exemplary drive link 402 includes a U-shaped, longitudinally extending plate sized to fit between the walls 420, 422 of the handle 400. The distal end of the plate 402 includes a U-shaped bend and a pair of through openings (extending in the medial-to-lateral direction) that receive the pins 444. The proximal ends of the plates 402 include respective legs that are parallel to each other and each have a through opening. Each of the plate 402 legs is biased by a coil return spring 404, the coil return spring 404 contacting a rounded end of each leg. In this exemplary embodiment, return spring 404 is not rigidly coupled to drive link 402, but is biased against the drive link and held in place by the bias of the return spring itself pushing against the respective stiffening ribs of housings 130, 132 and the proximal end of plate 402. A through opening in the leg receives a second pin 450, which second pin 450 is also simultaneously received within cavity 390 of oblong projection 388 and within cavity 316 of oblong projection 314, which couples drive link 402 to drawer plate 406.

The pull plate 406 comprises a substantially straight and flat base plate with three openings 460, 462, 464 extending in the medial to lateral direction. The first opening 460 receives the second pin 450 to mount the drive link to the drawer plate 406. The second opening 462 comprises a rectangular opening with rounded corners, while the third opening 464 comprises a smaller rectangular opening with rounded corners having a proximal-to-distal dimension that is less than the dorsal-to-ventral dimension. The strips of the drawing plate 406 are inserted between the openings 462, 464 and deformed to form lateral half-rings 468, which are concave laterally and convex medially. The second strip of the drawing plate 406 at the distal end is also deformed to form a medial half-ring 470, which is convex laterally and concave medially. It should be noted that the lateral half ring 468 is deeper than the medial half ring 470 because the lateral half ring 468 is sized to receive the sleeve 474, which sleeve 474 surrounds the proximal end of the withdrawal wire 408. This sleeve 474 is not easily repositioned longitudinally along the withdrawal string 408. Thus, repositioning of the sleeve 474 correspondingly causes the withdrawal wire to reposition when the withdrawal wire 408 is tensioned.

Repositionable handle 400 is adapted to be grasped by a user and repositioned from a retained position to a free position. In the holding position (see fig. 26), the ring 428 of the handle 400 engages the detent 326 of the right side housing 130 to hold the handle adjacent the housings 130, 132. When the user wishes to disengage handle 400 from latch 326, the user slides the handle laterally away from the latch and out of engagement with the latch. The bias of the spring 404 then operatively pushes against the drive link 402, and the drive link 402 itself pushes against the handle 400 to force the handle away from the housings 130, 132. At the same time, the drawer plate 406 is also repositioned. When the handle 400 engages the detent 326, the drawer plate is fully retracted to the proximal-most position. As will be discussed in more detail below, the proximal-most position of the pull plate 406 causes the pull wire 408 (which is also mounted to the pull link 764) to be pulled proximally to open the occlusion clip 1160. Conversely, when the handle 400 is disengaged from the detent 326 and moved away from the housings 130, 132, the pull plate is repositioned in the distal direction. Finally, if the handle 400 is repositioned to the maximum travel away from the housings 130, 132, the drawer plate 406 is positioned in the distal most position. As will be discussed in more detail below, the distal-most position of the pull plate 406 causes the pull wire 408 to reposition distally to close the occlusion clip 1160.

Referring to fig. 2-4, the controller 110 further includes a removable handle 490, the removable handle 490 seated within the proximal port 300 of the housing 130, 132. The removable handle 490 is coupled to one or more clip release wires 492 (in this case, two clip release wires), the clip release wires 492 being used to disconnect the occluding clip from the clip deployment device 118. In this way, the handle can be removed from the proximal end of the controller 110, pulling the release wire(s) proximally and disconnecting the 2 occlusion clips from the clip deployment device 118. In this exemplary embodiment, the handle 490 is secured within the proximal port 300 via a friction fit that can be overcome by a user applying pressure to the handle to move it proximally relative to the controller 110. It is within the scope of the present disclosure to use a locking pin or other positive (positive) release mechanism to release the handle 490 from the controller 110.

Referring again to fig. 2-32, assembly of the controller 110 includes mounting the wheels 136, 138 to one another such that the inner faces 146 of the wheels sandwich the linkage plate 180 therebetween. A more detailed description of the assembly of the wheels 136, 138 and linkage plate 180 has been given and will not be repeated for the sake of brevity. The wheels 136, 138 are then oriented such that the axle 158 faces in opposite directions and are received within the cylindrical projection 380 of the left housing 132 and the circular bearing surface 242 of the right housing 130, respectively. Likewise, the drive link 402 is mounted to the right and left side housings 130, 132 by pins 450, the pins 450 being simultaneously received within the cavities 31, 390 of the oblong projections 314, 388. In the exemplary form, drive link 402 and right side housing 130 sandwich drawer plate 406 therebetween. At the same time, drive link 402 is mounted to handle 400, and the circular opening 434 of the handle receives cylinder 304 of right side housing 130 to rotatably mount the handle to the housing. Further, spring 404 is inserted into right side housing 130 such that the spring is interposed between proximal stiffening rib 308 and drive link 402. Finally, a removable handle 490 is interposed between the housings 130, 132, and then the housings 130, 132 are mounted to one another to close the controller. At this time, the pull wire 408, the clip release wire 492, the connection wire 194, and the connection wire 261 all extend through the distal end 262 of the housing 130, 132.

Referring to fig. 20 and 30-32, the controller 110 is mounted to a semi-rigid tube 112, the semi-rigid tube 112 being relatively linear and having a relatively constant circular cross-section. In this exemplary embodiment, the conduit 112 is made of stainless steel and includes a proximal circular opening and a distal circular opening. The proximal circular opening provides access between the interior of the conduit 112 and the interior of the controller 110. More specifically, the hollow interior of conduit 112 accommodates the passage of pull wire 408, connection wire 194, and connection wire 261. Conduit 112 includes a proximal end segment having a pair of rectangular, arcuate cutouts 500. These cutouts 500 provide corresponding openings for the latches 272 of the adapter 270 to stuff the tubing 112 and mount the tubing 112 to the housings 130, 132.

Further, as shown in fig. 33, the semi-rigid conduit 112 may be relatively linear, but include two additional apertures 504, 506, the two apertures 504, 506 housing a separate conduit 508 adapted to provide a separate pathway for a probe tool 510. Exemplary probing tools for use with the present semi-rigid tubing include, but are not limited to, forceps, ablation rails, jaws, linear cutters, ablation pens, ablation clamps, illuminated dissectors, and non-illuminated dissectors. The example probe tool 510 may be used in combination with an end effector that is manipulated by the repositionable mechanism 116.

Referring to fig. 34-38, the distal end of the example repositionable mechanism 116 includes a clevis 514, and the clevis 514 includes a ventral clevis housing 516 and a dorsal clevis housing 518. Each housing 516, 518 mirrors the other and includes a convex semi-cylindrical proximal section 522 with a partially closed semi-circular proximal end 524 (except for a notch 526). Extending longitudinally in the distal direction, the outer surface of the semi-cylindrical proximal section 522 includes a pair of through holes 530 that extend into the housing interior, the pair of through holes 530 being generally longitudinally aligned and positioned to lie along the apex of the cylindrical proximal section 522. Extending longitudinally beyond the through bore 530 in a distal direction is a semi-cylindrical collar 532, the collar 532 operatively increasing the diameter of the housings 516, 518 as compared to a cylindrical proximal section 522 having a substantially constant diameter. Extending distally from collar 532 is an overhang 536. The overhang 536 includes a generally planar outer surface 538 that transitions into a sloped peripheral surface 540, the sloped peripheral surface 540 being embodied as parallel sides having a rounded proximal end 542. The peripheral surface abuts a substantially planar inner surface 544 that is substantially parallel to the planar outer surface 538. The inner surface 544 includes a circular recess 546 and includes a circular circumferential surface 548 extending between the inner surface and a bottom planar surface 550 of the recess. The inner surface also includes a portion of a rectangular depression 552 that continues distally into a concave, semi-cylindrical inner surface 554 of collar 532. It should be noted that semi-cylindrical inner surface 554 of collar 532 exhibits the same dimensions as the semi-cylindrical inner surface of cylindrical proximal section 522. The semi-cylindrical inner surface 554 of the cylindrical proximal section 522 includes a distal rib 558, the distal rib 558 having substantially the same shape as the partially closed semi-circular distal end 524. Similar to the semi-circular distal end 524, the distal rib 558 further includes a notch 560, the notch 560 being longitudinally aligned with another notch 526 such that the notches are substantially the same size. When the housings 516, 518 are brought together, the distal ribs 558 are aligned over one another such that the notches 560, 526 cooperate to provide a pair of through openings. At the same time, the distal end 524 of the housing is also aligned to form an internal cavity that houses the biasing spring 564 and the tooth receiver 566 as part of the clevis 514.

Referring to fig. 36, 37 and 39-41, tooth receiver 566 comprises a proximal cylindrical portion 568, proximal cylindrical portion 568 has a uniform circular cross-section and extends substantially linearly. The uniform circular cross-section is sized to be received within the bias spring 564 when assembled. Proximal cylindrical portion 568 is hollow and includes a circular proximal end wall 570 having a pair of circular openings 572, each of the pair of circular openings 572 adapted to accommodate passage of a patch cord 194 therethrough. A larger oblong opening 574 is interposed between the circular openings 572 and is adapted to accommodate passage of the pull wire 408 and the clip release wire 492. Extending distally from cylindrical portion 568 is a tooth receiving head 576, with medial M and lateral L sections extending medially and laterally from cylindrical portion 576. A cylindrical cavity 577 is interposed between the medial and lateral segments, the cylindrical cavity 577 being aligned with the hollow cavity of the proximal cylindrical portion 568. Each section of tooth-receiving head 576 includes a generally rectangular cross-section, but for a series of distal teeth 578. Specifically, the teeth 578 have a sawtooth pattern and are formed to extend in a medial-to-lateral direction (perpendicular to a longitudinal axis extending through the cylindrical section 568). In this exemplary embodiment, the teeth 578 are sized to receive corresponding teeth 580 from a pair of tooth plates 582.

Referring to fig. 42-44, the tooth plates 582 are also part of the clevis 514, and each tooth plate 582 comprises a circular, generally flat plate. About 225 ° of the plate has a circular circumferential surface 584. But the remaining 135 degrees of the circumferential surface are formed to include a series of teeth 580. As discussed above, teeth 580 are sized to be received between teeth 578 of tooth receiver 566. Centered within the mid-portion of each tooth plate 582 is a through opening 586, the through opening 586 being defined by parallel linear sides 588 and arcuate ends 590. These through openings 586 are adapted to receive respective basin half 594 in order to allow or limit lateral movement of the basin half.

Referring back to fig. 35-37, assembling clevis 514 includes inserting proximal cylindrical portion 568 of tooth receiver 566 within a cylindrical cavity formed by the helical shape of biasing spring 564. Assembling the clevis 514 also includes aligning the ventral clevis housing 516 with the dorsal clevis housing 518 such that the edges where the outer and inner surfaces meet mate and overlie one another. The edges may be welded or adhered together using conventional techniques. The structure formed by assembling the shells 516, 518 forms a distal cylindrical cavity 598 and a proximal cylindrical cavity 600, with a circular wall having a through opening interposed between the distal cylindrical cavity 598 and the proximal cylindrical cavity 600. As previously discussed, the circular wall is formed by joining distal ribs 558 of the housings 516, 518, while the opening is formed by joining the notches 560. The distal cylindrical cavity 598 is sized to receive a tooth receiver 566 inserted within the biasing spring 564 such that the end of the biasing spring opposite the tooth receiver contacts the circular wall to provide a stop against which the spring may compress. At the same time, the distal end 524 is closed except for the opening formed by the adjoining notch 526. As mentioned above, the connection line 261 is operatively coupled to the rod 236. This wire 261 also extends through the semi-rigid conduit 112 and through the opening until reaching the castellated receiver 566, where it is installed to the castellated receiver to facilitate the castellated receiver repositioning.

Referring to fig. 35-48, clevis 514 is coupled to universal joint 610. This universal joint 610 includes a first basin structure half 594 coupled to a second basin structure half 596. To provide lateral repositioning, basin structure halves 594, 596 are coupled to clevis 514. In particular, the basin shaped structure halves 594, 596 are identical to each other, and therefore a detailed explanation of only one of the basin shaped structure halves is provided for greater clarity.

Each basin half 594, 896 includes a distal paddle 624 having a substantially planar inner surface 626 surrounding an upstanding rim 628. Opening 630 extends through rim 628 and through paddle 624, but is partially covered by an outer protruding cap 634 integrally formed with the paddle. The cap 634 includes a V-shaped recess 636 that projects into the opening 630 on one side and a passage 638 that projects into the opening from the other side. The channel 638 extends proximally beyond the cap 634 and follows an arcuate path partially around the proximal end 640 of the basin structure half and terminates adjacent an integral plateau 642 having a circular profile. The semi-circular inner surface 646 of the platform 642 is substantially planar and includes a radial groove 648 with arcuate sidewalls and rounded ends extending to the center of the platform. The arcuate sidewalls operate to increase the width of groove 648 as the distance from inner surface 646 increases. The radial groove 648 also extends outwardly through the circular circumferential surface 650. The circumferential surface 650 defines an outer limit of an annular flat outer surface 652 surrounding the upstanding projections 656. This upstanding projection 656 extends through an opening 586 of the corresponding tooth plate 582 to mount the tooth plate to the yoke half 620 (see fig. 42). In the exemplary form, the upstanding projections 656 extend perpendicularly away from the annular surface 652 and include a pair of parallel straight sides 658 with a pair of arcuate sides 660 interposed between the pair of parallel straight sides 658, the straight sides 658 and the arcuate sides 660 together defining a boss top 662.

In an exemplary form, the distal paddle 624 includes a circular circumferential surface 664 connected to the neck 666 to connect the distal paddle 624 to the integrated platform 642. The neck 666 also includes an arcuate wall 668, the arcuate wall 668 being adapted to match the contour of the circular peripheral surface 650 of the opposed tub-shaped structure halves 594, 596. Neck 666 also includes a centering block 672, and centering block 672 has a planar surface 674 that is parallel to inner surface 646 of platform 642. The planar surface 674 has in part a raised peninsula 678, the raised peninsula 678 having arcuate sidewalls and an exposed rounded end. The arcuate sidewall operates to decrease the width of the peninsula 678 as the distance from the planar surface 674 increases. As will be discussed in more detail below, the peninsula 678 is generally the same size as the radial groove 648, such that the peninsula of the first basin structure half 594, 596 is received within the radial groove of the second basin structure half to align the basin structure halves when assembled. Block 672 also includes a portion of channel 63 on one side, while it also includes a channel 682 having a semi-circular cross-section and extending substantially in a straight line (except for a proximal slope). The channel 682 is generally central and extends radially toward the inner surface 626 of the distal paddle 624. In the exemplary form, linear channel 682 is interposed between carry-over 678 and radial groove 648, with peninsula 678 and radial groove 648 being substantially parallel to one another and in a horizontally offset position.

Referring to fig. 42, 43, and 45-48, assembly of the universal joint 610 includes orienting the basin structure halves 594, 596 such that the inner surfaces 626 of the paddles 624 face each other. Likewise, the neck portions 666 of the tub-shaped structure halves 594, 596 are positioned adjacent to each other such that the peninsula 678 of the first tub-shaped structure half 594 is received within the radial groove 648 of the second tub-shaped structure half 596, so the inner surface 646 of the platform 642 of the second tub-shaped structure half contacts the planar surface of the first tub-shaped structure half. In this orientation, the tub shaped structure halves 594, 596 are moved against each other (see fig. 46) to define a circumferentially-bounded through opening 688. After the basin structure halves 594, 596 are mounted to each other in the aforementioned orientation, a respective tooth plate 582 is mounted to each of the basin structure halves. In an exemplary embodiment, each tooth plate 582 is positioned such that the openings 586 are aligned with the upstanding projections 656. Specifically, the parallel side 658 of the upstanding projections 656 are aligned and inset relative to the parallel side 588, defining openings 586, while the arcuate side 660 of the upstanding projections are aligned and inset relative to the arcuate end 590, defining openings. Thereafter, the ventral and dorsal clevis housings 516, 518 are repositioned to sandwich the basin-shaped structure halves 594, 596 therebetween. Specifically, the circular recess 546 of each housing receives the respective upstanding projections 656 of the basin-shaped structure halves 594, 596. The diameter of the circular boundary of the recess 546 is slightly larger than the distance between the arcuate sides 660 of the protrusion, allowing the protrusion to rotate within the recess. It should be noted that the curvature of the side 660 may be more pronounced than the curvature of the wall 546 defining the protrusion, but not so pronounced that there is a large play. While the basin shaped structure halves 594, 596 are sandwiched by the ventral and dorsal clevis housings, the two tooth plates 582 are positioned such that at least one tooth 580 is received within the gap between the teeth 578 of the tooth receiver 566. Rotational movement (angular change in horizontal plane) of the basin-shaped structure halves 594, 596 relative to the ventral and dorsal clevis housings 516, 518 is inhibited when the teeth 580 of the tooth plate 582 engage the teeth 578 of the tooth receiver 566. Conversely, the basin shaped structure halves 594, 596 are able to rotate relative to the ventral and dorsal clevis housings 516, 518 when the teeth 580 of the tooth plate 582 are not engaged with the teeth 578 of the tooth receiver 566. The default position of the tooth receiver 566 creates engagement between the respective teeth 578, 580 based on the bias exerted on the tooth receiver by the spring 564. But this bias can be overcome by pulling the tooth receiver 566 proximally using the connecting wire 261 that is coupled to both the tooth receiver and the repositionable lever 236. In particular, to lock the angular position of the basin structure halves 594, 596 relative to the ventral and dorsal clevis housings 516, 518, the lever 236 is rotated distally to allow the spring 564 to bias to push the tooth receiver 566 into engagement with the tooth plate 582. To unlock the basin pattern halves 594, 596 relative to the ventral and dorsal clevis housings 516, 518, the lever 236 is rotated proximally to overcome the bias of the spring 564, compressing the spring and pulling the tooth receiver 566 out of engagement with the tooth plate 582. When this occurs, the basin structure halves 594, 596 can generally change their angular horizontal orientation relative to the ventral and dorsal clevis housings 516, 518, and have an angular adjustment range of 160 degrees. This angular adjustment and corresponding angular orientation passes from the tub shaped structure halves 594, 596 to the yoke 614.

In an exemplary form, the clevis 514 (housing 516, 518, spring 564 and tooth receiver 566), tooth plate 582 and basin half 594, 596 cooperate to form a distal portion of the passive structure. This passive configuration allows or inhibits yaw (i.e., side-to-side) of the end effector 118 depending on whether the tooth receiver 566 is biased distally into engagement with the tooth plate 582 by the spring 564. The mechanism is considered passive because the tooth receiver 564 is engaged or disengaged with respect to the tooth plate 582. In other words, unlike the active mechanisms previously discussed, such passive mechanisms do not operate to reposition the end effector from side to side. Rather, such a passive mechanism provides full freedom to move laterally within a particular range of motion between the clevis 514 and the basin shaped structure halves 594, 596 when the tooth receiver 566 is not engaging the tooth plate 582. In an exemplary form, it is contemplated that the robotic instrument (not shown) or anatomical feature (i.e., the heart itself) cooperates with the pressure applied to the distal end of the semi-rigid tube 112 to laterally reposition the end effector (such as shown by the three positions depicted in fig. 17B in an exemplary form) after manipulating the controller 110 (and in particular, the lever 236) to disengage the tooth receivers 566 from the toothed plates 582. The end effector 118 can be repositioned (i.e., not locked in position laterally) as long as the tooth receivers 566 are disengaged from the tooth plates 582. But inhibits lateral repositioning of the end effector 118 when the lever 236 is actuated such that the spring 564 is forced and the tooth receiver 566 engages the tooth plate 582.

Referring to fig. 49-52, the yoke 614 includes a cylindrical proximal end 690 integrally coupled to a bottom surface 692 and a top surface 694, and an identically shaped top surface 694. More specifically, as will be discussed in greater detail below, the cylindrical proximal end 690 includes a through cavity 696 that extends into the open space 698 between the bottom surface 692 and the top surface 694 through the cavity 696 so as to accommodate certain portions of the repositionable mechanism 116.

In an exemplary form, the cylindrical proximal end 690 includes a circumferential groove 702, the circumferential groove 702 dividing the cylindrical proximal end into a pair of discs 704. Each disk 704 is a mirror image of the other and includes a rounded circumferential surface 706, the rounded circumferential surface 706 having a substantially constant width and defining an outer limit of a substantially planar lateral surface 708, the substantially planar lateral surface 708 being substantially perpendicular with respect to the circumferential surface. This lateral surface 708 is generally annular to define a cylindrical recess 710, the cylindrical recess 710 not extending completely through the disc 704 and being equally circumferentially spaced relative to the edge of the circumferential surface 706. In the exemplary form, cylindrical recess 710 is defined by a top beveled ring 714, followed by a constant diameter ring 716, followed by a second beveled ring 718, second beveled ring 718 abutting a substantially planar bottom surface 720 parallel to lateral surface 708.

The circumferential grooves 702 between the disks 704 extend in a semicircular path and intersect the through-holes 722 extending through the bottom surface 692 and the top surface 694. Proximal to the recess 702, as opposed to the through-hole 722, a V-shaped opening is formed that is part of the through-cavity 696, wherein the distal tip of the opening is defined by a rectangular boundary 724, the rectangular boundary 724 being adjacent to a circular wall 726, the circular wall 726 defining a cylindrical portion of the through-cavity. The ventral and dorsal sections of the groove 702 receive respective connection wires 194, wherein pulling a first one of the connection wires causes the yoke 614 to move upwardly (i.e., ventrally) and pulling a second one of the connection wires causes the yoke to move downwardly (i.e., dorsally). More specifically, the attachment wire 194 partially encircles the yoke 614 by being located within a portion of the groove 702 and terminates in the cavity, wherein the attachment wire 194 is secured in place.

A top surface 694 and a bottom surface 692 extend distally from the disk 704. The top surface 694 and the bottom surface 692 include rounded overhangs having opposing planar outer surfaces 732 that transition to an inclined circumferential surface 734, the inclined axial surface 734 itself transitioning to a vertical circumferential surface 736 that is perpendicular to the outer surfaces. It should be noted that the vertical thickness of top surface 694 is greater than the vertical thickness of bottom surface 692, but apart from this difference in thickness, the top and bottom surfaces are the same. The vertical peripheral surface 736 defines an outer boundary of the multi-layered inner surface 738. In particular, the inner surface 738 is partially defined by a raised boss 740, the raised boss 740 having an opposing planar end surface 742 that abuts an opposing planar vertical sidewall 744, the opposing planar vertical sidewall 744 being offset relative to a centerline of the yoke 614. Contiguous with the side wall 744 is a relatively planar horizontal wall 746, which in turn, the relatively planar horizontal wall 746 is contiguous with a block U-shaped groove 748. The boss 740, side wall 744, horizontal wall 746, and U-shaped groove 748 cooperate to form a stepped cross-section. The U-shaped groove does not extend proximally as far as side wall 744 and horizontal wall 746 because the U-shaped groove terminates at proximal end wall 752 distal to the ends of the side and horizontal walls (which terminate at rear wall 754). Proximate the rear wall 754, the top 694 and bottom 692 include a pair of vertical through openings that align with their mating through openings and receive a pair of dowels 758. As discussed in more detail below, the dowels mount to both the top 694 and bottom 692 surfaces, as well as to the repositionable jaw assembly 760.

Referring to fig. 49, 50, and 52-54, repositionable jaw assembly 760 includes a pull link 764 operatively coupled at its proximal end to connection wire 194 and at its distal end to both right linkage plate 766 and left linkage plate 768. In this exemplary embodiment, the pull link 764 comprises a hollow cylinder 770 mounted to a mini-clevis 772. In particular, hollow cylinder 770 is mounted to extend perpendicularly away from clevis 772 and is adapted to receive attachment wire 194 therein. More specifically, the connecting wire 194 is glued to the interior of the hollow cylinder 770 such that tensioning the connecting wire 764 in the proximal direction operatively repositions the pull link 764 proximally. This proximal repositioning is also operative to reposition the ends of linkage plates 766, 768 mounted to clevis 772. In the exemplary form, clevis 772 includes a pair of spaced apart upstanding arms 774 having a constant width and height along a longitudinal length thereof 774. Each upstanding arm 774 terminates in a hollow loop 776 that has a height that is substantially the same as the height of the upstanding arm, but has a width that is greater than the width of the upstanding arm. The two loops 776 are substantially the same width and are sized to fit between the corresponding upright walls 744 of the bottom and top surfaces 692 and 694 to ensure that the movement of the clevis 772 relative to the yoke 614 is linear.

Referring to fig. 55-57, the yoke 614 also mounts a pair of right and left linkage clamps 780, 782, the pair of right and left linkage clamps 780, 782 being simultaneously mounted to the linkage plates 766, 68. In the exemplary form, the right and left linkage clips 780, 782 are mirror images of each other and each include a proximal through hole 786, the proximal through holes 786 receiving the dowels 758 of the yoke 614 to pivotally mount the right and left linkage clips to the yoke. Also, right and left linkage clips 780, 782 include second through-holes 788 distal to proximal holes 786 that receive dowels 790 then received through openings 792 at the ends of linkage plates 766, 768. The diameter of opening 792 at the ends of linkage plates 766, 768 is larger than the diameter of dowel 790 so that the linkage plates can be pivotally repositioned about the dowel. In contrast, second through-hole 788 generally has a diameter that is the same as the diameter of dowel 790, thereby securing the dowel within the second through-hole via a friction fit. Opposite the ends of the linkage plates 766, 768 are inner through holes 794 having a larger diameter than the dowels 796 frictionally received within the loops 776 of the clevis 772. In this manner, linkage plates 766, 768 can be pivotally repositioned relative to dowel 796 and clevis 772. The distal end of each of the right and left linkages 780, 782 is a rounded, flat head 798 that surrounds a distal opening 800 having a three quarter moon shape. In particular, the distal head and 798 are sized so that the width of the head is greater than the width of the remainder of the linkage clip 780, 782. More specifically, distal head 798 is rounded to extend toward the interior of repositionable jaw assembly 760. As will be discussed in greater detail below, the rounded profile of the distal head matches the cylindrical profile of the corresponding jaws 806, 808.

When assembled, a hollowed out loop 776 of clevis 772 sandwiches the ends of linkage plates 766, 768 between them. Opposite ends of the linkage plates 766, 768 are interposed between respective right and left linkage clamps 780, 782. Thus, the left linkage clip 782 directly overlies the other and is spaced from the other by the thickness of the left linkage plate 768 and an associated gap that operates to provide movement between the left linkage plate and the left linkage clip. Likewise, the right linkage clamp 780 overlies the other directly and is spaced by the thickness of the right linkage plate 766 and an associated gap that operates to provide movement between the right linkage plate and the right linkage clamp. At the same time, near boss 740 on the right side, the distance between top surface 694 and bottom surface 692 is slightly greater than the cumulative thickness of right linkage clip 780 and right linkage plate 766. Similarly, near left boss 740, the distance between top surface 694 and bottom surface 692 is slightly greater than the cumulative thickness of left link clip 782 and left link plate 768. When assembled, the linkage plates 766, 768 are rotationally repositionable relative to the clevis 772 and the right and left linkage clamps 780, 782, while the right and left linkage clamps are rotationally repositionable relative to the linkage plates and relative to the dowels 758 of the yoke 614. As will be discussed in greater detail below, the clevis 772 retracts proximally within the yoke 614 (see fig. 49) to operatively widen the gap between the right and left linkage clamps 780, 782 at the rounded end 798 thereof. Conversely, positioning the clevis 772 distally relative to the yoke 614 operatively reduces the gap between the rounded ends 798 of the right and left linkage clamps 780, 782. In this manner, repositioning of clevis 772 is indirectly operative to reposition right jaw 806 and left jaw 808.

Referring to fig. 49, 58 and 59, the right jaw 806 and the left jaw 808 are mirror images of each other and are mounted to the right linkage clamp 780 and the left linkage clamp 782, respectively. Thus, for the sake of greater brevity, the left-hand jaw will be shown and discussed only with respect to fig. 58 and 59. Each jaw 806, 808 includes a proximal clevis 810, proximal clevis 810 including a top rounded shelf 814, top rounded shelf 814 being spaced apart from bottom rounded shelf 816. Each shelf 812, 814 includes a through opening 818, the through opening 818 operable to receive a half-moon shaped cylindrical dowel 820. This dowel 820, while received in the through opening 818 of the brackets 812, 814, is also received in the distal opening 800 of the respective pair of linkage clips 780, 782. In the exemplary form, dowel 820 frictionally fits within through opening 818 such that the dowel cannot be rotationally repositioned within the through opening. In contrast, the half-moon shape of dowel 820 does not occupy the full area of the three-quarter moon shape of distal opening 800. In this manner, there is play between the walls defining the distal opening and the dowel 820 so that the dowel can be rotationally repositioned relative to the respective linkage clamp 780, 782. To further stabilize the connection between the respective jaws 806, 808 and the respective linkage clips 780, 782, each jaw includes a protrusion 824, the protrusion 824 extending proximally from a vertical wall 826, the vertical wall 826 connecting the shelves 812, 814 at their respective distal ends. This tab 824 has a thickness that approximates the gap between the respective overlying linkage clips 780, 782 to inhibit the distal ends 798 of the linkage clips from compressing against each other. Conversely, compression is reduced due to the tabs 824, and to the extent compression occurs, the overlying gang clips 780, 782 compress against the tabs rather than against each other.

Extending distally from proximal clevis 810 is an elongated guide 830, elongated guide 830 having a convex outer longitudinal profile and a concave inner longitudinal profile. The elongated guide 830 has a significant longitudinal dimension and a vertical dimension that approximates and extends beyond the thickness of the clamping portions 1162, 1164 (see fig. 75). In the exemplary form, the distal end 832 of the guide 830 is rounded. A pair of lateral through-holes 836, 838 are interposed between distal end 832 and proximal clevis 810, the pair of lateral through-holes 836, 838 receiving sutures 840 to mount jaws 806, 808 to respective clamping portions 1162, 1164. The outer side 844 of the guide 830 includes a longitudinal channel 846 extending from the distal end 832, intersecting each of the through-holes 836, 838, passing proximally through the vertical wall 826 and terminating adjacent the tab 824. This channel 846 receives a corresponding clip release wire 492, the clip release wire 492 being coupled to a removable handle 490 of the controller 110. In an exemplary form, the suture 840 is wrapped (to form a loop) around both the clip release wire 492 and the respective clip segments. In this manner, when the clip is ready to be deployed, the removable handle 490 is proximally repositioned relative to the remainder of the controller 110, thereby pulling the clip release wire 492 proximally. Initially, the end of the wire-releasing clip 492 is passed completely through the distal suture 840, and then completely through the proximal suture 840, thereby releasing the clip from the guide 830 and the rest of the laparoscopic device 100.

Referring to fig. 44, 60 and 61, the repositionable jaw assembly 760 is manipulated to be linearly aligned to fit through a trocar for anatomical deployment. Initially, as shown in FIGS. 60 and 61, the repositionable pawl assembly 760 is linearly aligned and in a compact lateral position. In this position, the first face 850 of each dowel 820 of the two jaws 806, 808 contacts the first face 852 defining a portion of the three-quarter moon shaped opening 800.

Referring to fig. 44 and 62-66, to open the jaws 806, 808, the pull link 764 is pulled proximally via the connection line 194. Proximal movement of the pull link 764 causes the ends of right and left linkage plates 766 and 768 coupled to the pull link to be proximally repositioned by pivoting about dowel 796 extending through the pull link. Since the opposite ends of the linkage plates 766, 768 are pivotally coupled to the right and left linkage clamps 780, 782 via the dowels 790, the movement of the pull links operatively spreads the distal ends of the linkage clamps away from each other. As previously discussed, the three-quarter moon shaped opening 800 allows for limited pivotal movement of the dowel 820 of the respective jaws 806, 808 relative to the linkage clamps 780, 782. In this manner, pivotal movement between the linkage clamps 780, 782 and the jaws 806, 808 causes the distal ends of the jaws 806, 808 to initially move closer to one another, while the proximal ends of the jaws move away from one another, as shown in FIG. 62. While the linkage plates 766, 768 pivot relative to the linkage clamps 780, 782, the linkage clamps are also operative to pivot relative to the jaws 806, 808 as represented by the first face 850 of the dowel 820 moving away from the first face 852 of the linkage clamp, as shown in fig. 63. Continued proximal movement of the pull link 764 causes the distal ends of the linkage clamps 780, 782 to move even further away from each other as shown in fig. 64. When in this position, as shown in fig. 65, further pivotal movement between the jaws 806, 808 and the unification clips 780, 782 is inhibited by the second face 854 of the dowel 820 contacting the second face 856 of the unification clip (which defines a portion of the three-quarter moon shaped opening 800). In other words, the faces 852, 856 of the gang clips 780, 782 provide a range of boundaries for the movement of the dowel 820 therebetween. When the second faces are in contact with each other, a maximum angle between the linkage clamps 780, 782 and the clamping jaws 806, 808 is achieved. Thereafter, continued proximal movement of the pull link 764 to the maximum proximal point (i.e., travel limit) causes the distal ends of the linkage clamps 780, 782 to reach the maximum separation, which corresponds to the distal ends of the jaws 806, 808 moving apart from one another, as shown in fig. 66. In an exemplary form, when the pull link 764 reaches the point of maximum proximity, the jaws 806, 808 reach a parallel position. This parallel position would not otherwise be available without some pivotal movement between the clamping jaws 806, 808 and the unification clips 780, 782. As shown in fig. 67, without pivotal movement between the linkage clamps 780, 782 and the clamping jaws 806, 808, the clamping jaws will occupy the angular orientation of the linkage clamps and never reach the parallel position spaced from each other when the pull link 764 reaches its proximal point.

Fig. 68 and 70 show an embodiment of the left atrial appendage occlusion clamp 110 in an open position with spaced apart rigid clamping portions 1102, 1104 and resilient or elastic biasing members 1106, 1108 at opposite ends of each clamping portion 1102, 1104. The clamping portions 1102, 1104 may be tubular, and the clamping portions 1102, 1104 are at least substantially parallel to each other when stopped (i.e., when they cannot be used to clamp tissue). The clamping portions 1102, 1104 may also have substantially equal lengths or different lengths, and each may have a larger outer diameter than the wire used to form each of the biasing members. In this regard, the wires forming the pusher members 1106, 1108 may extend through the hollow interiors of the clamp portions 1102, 1104. In this alternative example, the pushing members 1106, 1108 are each formed as a ring. The planes defined by the looped configuration of the pusher members 1106, 1108 may be substantially parallel to each other, and thus substantially perpendicular to each of the clamping portions 1102, 1104. Of course, other angled configurations are possible.

Fig. 69-71 show the same clamp 1110 of fig. 68 and 70, with the clamping portions 1102, 1104 in a position in which they are normally biased together. Contact between the clamping portions 1102, 1104 may initially occur along their entire parallel lengths, as shown. Of course, when the clamping portions 1102, 1104 are covered in fabric or other material (as described below), contact between the fabric and the other material may instead occur. In fig. 68-71, only the structure and relative positions of the rigid members 1102, 1104 and the biasing members 1106, 1108 are shown. The final assembly is depicted in fig. 72-74, which, while describing slightly different embodiments, show the general steps of each embodiment configuration. The clamping portions 1102, 1104 may be made of rigid tubes 1112, 1114 of a rigid metal, such as titanium, disposed on a wire member 1116. In this embodiment, titanium is used for its compatibility with MRI imaging, its biocompatibility, and its galvanic compatibility with the wire member 116 (when the wire member 1116 is formed of a superelastic material such as nitinol). This and other embodiments disclosed herein may use a superelastic material, such as nitinol, to form the pusher members 1106, 1108. The superelasticity will allow the material to significantly extend to open the clamping portions 1106, 1108 of the clamp 1110 without permanently deforming the material. These superelastic materials are also compatible with MRI imaging and are easily tolerated as implant materials in the body. The rigid tubular members 1112, 1114 of this embodiment are mechanically fastened to the underlying wire member 1116, preferably by mechanically swaging the titanium tubes 1112, 1114 into the wire member 1116. Although a single continuous wire member is shown being directed through both clamping portions 1102, 1104 and pushing members 1106, 1108, the clamp 1110 of this embodiment may be made of two or more wires, or have any other suitable components.

As shown in fig. 72, the clamp 1110 can also apply force to the anatomical structure in a non-parallel clamping manner in order to close the tissue or anatomical structure in a parallel manner. This allows the clamp 1110 to accommodate non-uniform tissue thickness over the length of the clamping portions 1102, 1104. Further, with separate biasing members 1106, 1108 at opposite ends of the clamping portions 1102, 1104, non-parallel clamping may result from either side of the clamp 1110. The non-parallel gripping feature of this embodiment allows the clamp 1110 to accommodate a wide range of hollow anatomical structures of different wall thicknesses over its length and breadth. For example, certain anatomical structures such as atrial appendages have an internal structure known as trabecular bone, which is non-uniform and often results in a variable thickness in one or more of its dimensions. For this or other reasons, uneven clamping may therefore be detrimental to such applications.

Fig. 73 shows an alternative embodiment of a clamp 1160, the clamp 1160 including two biasing members 1166, 1168, the two biasing members 1166, 1168 being shaped like a letter "U" instead of the more nearly circular ring configuration of fig. 68-71. As in the case of the first clamp 110, the U-shaped urging members 1166, 1168 of the clamp 1160 may also lie in planes that are generally parallel to each other and perpendicular to the axes of the clamping portions 1162, 1164. A potential use of the embodiment of fig. 73 may be that the U-shaped biasing members 1166, 1167 exert less force on the clamping portions 1162, 1164 than do the annular biasing members 1106, 1108 of the clamp 1110 of fig. 68-71, making it more suitable for clamping anatomical structures that do not require a relatively high clamping force. The U-shaped configuration of biasing members 1166, 1168 generally requires less space in a direction perpendicular to the axis of clamping portions 1162, 1164. Fig. 73 illustrates a first stage of assembly of the clamp 1160, wherein the rigid tubular members 1163, 1165 are joined with the superelastic wire member 1164. In this embodiment, mechanical swaging may be used to join tubular members 1163, 1165 to wire 1161. However, adhesives or laser welding or other attachment methods may be readily used. Likewise, it should be appreciated that the rigid tubular members 1163, 1167 may not need to be bonded to the wire member 1161 at all. The rigid tubular members 1163, 1165 may be relied upon to design their inner diameters to simply fit tightly over the wire 1161. Further, the rigid tubular members 1163, 1165 may assume a number of different cross-sectional shapes. Cross-sectional shapes such as oval, triangular or rectangular with rounded edges, etc. may be preferred, and may preclude the addition of load spreading platens 1167, 1169 shown in fig. 74, as these alternative shapes may provide a larger contact area with the anatomy to which clamp 1150 will engage. Since different anatomical structures vary significantly from subject to subject, it is advantageous to employ a manufacturing method in which the length 1171 of the clamp 1160 may be easily varied. By cutting the rigid members 1163, 1165 to various lengths, differently sized assemblies may be constructed.

Fig. 74 shows the next step of assembling the jig. Load spreading platens 1167, 1169 made of plastic or other biocompatible material (such as urethane) may be slipped over the titanium or other suitable material tubing forming rigid tubular members 1163, 1165 to provide a resilient surface 1173 such that the load is spread over a larger surface area, thereby preventing point source loading of tissue that might otherwise result from cutting the tissue before the tissue has had a chance to become internally fused. Platens 1167, 1169 may be assembled and applied to rigid tubular members 1163, 1165 prior to the swaging step, or platens 1167, 1169 may alternatively be manufactured with a longitudinal split that allows the material to be opened and forced to fit onto rigid tubular members 1163, 1165.

Fig. 75 shows clamp 1160 after a fabric covering material 1174 made of a material such as polyester is stitched around clamp portions 1162, 1164 and biasing members 1166, 1168. It should be understood that this material, or any other similar material, may be used as a full or partial covering in any of the disclosed embodiments. Such materials are preferably adapted to engage tissue of the clamped anatomical structure and tissue of the surrounding area. Preferably, material 1174 is a circular warp knit tube, having a diameter of about 4 to 5mm, and made of a combination of 1/100, 2/100, and 1/100 polyester (textured polyester). Material 1174 may also be subjected to a heat treatment to cause a velvet effect. The fabric or other material 1174 is also stitched or otherwise applied to the biasing members 1166, 1168. In addition, fabric tabs 1177 may be attached to opposite respective ends of the clamping portions 1162, 1164 to prevent any portion of the engaged anatomical structure from coming out of the annular occluded area of the clamping portions 1162, 1164. In other words, the fabric piece 1177 acts as a tissue stop member or dam at the opposite end of the clip. This or other tissue-blocking features may also be implemented in any of the other embodiments. This is desirable because it minimizes the likelihood of accidentally leaving any portion of the engaged anatomy unimpeded. Material 1177, like material 1174, may also promote tissue ingrowth.

Referring to fig. 76-82, an alternative exemplary controller 1210 may be used in place of the previous controller 110 with the exemplary laparoscopic device 100. Similar to the first controller 110, this alternative example controller 1210 may be coupled to the semi-rigid tube 112 in order to manipulate a repositionable mechanism (not shown) that is operatively coupled to the end effector 118. However, as will be discussed in greater detail below, this example controller 1210 incorporates dual passive mechanisms in order to control the pitch (i.e., up and down) and yaw (i.e., side-to-side) of the end effector. In exemplary form, unlike the first exemplary controller 110, this alternative exemplary controller 1210 does not include an active mechanism to manipulate the pitch of the end effector 118, but instead utilizes a passive system that operates to lock the end effector in a predetermined plurality of pitch positions.

Controller 1210 includes a right side housing 1230 and a left side housing 1321 that cooperate to define an interior cavity and corresponding opening to accommodate passage of a particular control. The first of these openings is a back opening 1234, the back opening 1234 accommodating the passage of a vertically repositionable button 1236. As will be discussed in greater detail below, the repositionable button 1236 may be vertically manipulated to lock and unlock the repositionable mechanism 116 in order to provide or constrain the lateral and vertical adjustability of the end effector 118.

Repositionable button 1236 includes an arcuate top 1238 from proximal to distal end that includes a tab and a proximal ridge to accommodate the thumb of a user positioned on top of the button. The medial to lateral width of the curved top 1238 is substantially constant and overlaps with a vertical, planar appendage 1242 extending from the bottom side of the curved top. The vertical appendages 1242 have a relatively constant and minimum medial-to-lateral dimension, but include a proximal-to-lateral dimension that gradually decreases from a maximum where the appendage extends from the top of the arc to a minimum where the appendage terminates. At the end of the attachment 1242, a pair of tooth receivers 1246 extend outwardly in medial and lateral directions from opposite sides of the attachment. The tooth receivers 1246 each include a series of longitudinal pyramid shapes 1248, the series of longitudinal pyramid shapes 1248 being parallel and radially arranged to define a series of corresponding longitudinal pyramid cavities 1250. At the medial end of the middle tooth receiver 1246 and at the lateral end of the longitudinal tooth receiver 1246 is a cylindrical protrusion 1252, which cylindrical protrusion 1252 is received within a corresponding vertical, oblong groove 1254 on the interior of the housings 1230, 1232. These notches 1254 inhibit significant medial-to-lateral and proximal-to-distal travel of the tooth receiver 1246 when the tooth receiver is vertically repositioned. In other words, when button 1236 is pressed vertically, toothed receiver 1246 is repositioned in a corresponding vertical manner. In this manner, when the toothed receptacle is indirectly mounted to the button via the accessory 1242, movement of the toothed receptacle 1246 may directly cause the button 1236 to move.

The button 1236 is vertically biased to its highest vertical position shown in fig. 79. To achieve this biasing, housings 1230, 1232 include parallel walls 1258, with parallel walls 1258 cooperating to form a medial-to-lateral groove into which at least one spring 1260 is seated. The spring 1260 is rated for a sufficient spring force to overcome the weight of the button 1236, the attachment 1242, the tooth receiver 1246 and the cylindrical protrusion 1252 to force the button to its highest vertical position. But the spring force is not so great that too much force from the user's thumb is required to press the button 1236 and overcome the bias of the spring 1260.

The axle 1264 extends in a medial to lateral direction within the interior cavity cooperatively defined by the housings 1230, 1232. This hub 1264 is cylindrical and includes a constant longitudinal diameter, thereby giving the hub a circular circumference. In the exemplary form, the medial and lateral ends of the axle 1264 are received within corresponding cylindrical cavities (not shown) on the interior of the housing. The depth of these cavities is also not so great as to cover most of the axle 1264. The exposed cylindrical portion of the axle 1264 operatively receives a pair of tooth assemblies 1268, 1270 that sandwich the accessory 1242 therebetween, the accessory 1242 itself including a vertical, oblong aperture (not shown) to accommodate passage of the axle and vertical travel of the accessory relative to the axle having a fixed orientation. In the exemplary form, the tooth assemblies 1268, 1270 include a through cylindrical bore 1272 that allows the assemblies to rotate outside of the axle.

Each of the tooth assemblies 1268, 1270 are identical to each other. Therefore, the redundant description of the second rack assembly is omitted for greater clarity. The tooth assemblies 1268, 1270 include wheels 1276, the wheels 1276 having circumferentially distributed teeth 1278, the circumferentially distributed teeth 1278 being sized to engage a respective tooth receiver 1246 and be received within the longitudinal pyramid cavity 1250 when the tooth receiver is in the raised upright position (see fig. 79). The wheel 1276 has a substantially uniform width if the pair of extensions 1280, 1282 are not considered. The first projection 1280 is generally radially centered relative to the wheel and partially defines a through aperture 1272, the through aperture 1272 receiving the axle 1264. This first extension 1280 is semi-circular in shape, extends medially from the wheel 1276, and includes corresponding top and bottom arcuate surfaces 1284, 1286, the top and bottom arcuate surfaces 1284, 1286 being radially inset relative to the wheel. These arcuate surfaces 1284, 1286 act as cam drive surfaces for respective connecting lines 1288, 1290 extending from the second filament 1282. The first extrusion 1280 further includes a pair of vertical flanges 1294 extending from the arcuate surfaces 1284, 1286 and cooperating with the circumferential ends of the wheel to provide medial and lateral guides for the connecting line 1288, 1290 such that the connecting line is left therebetween. The second filament 1282 is oriented proximally with respect to the first filament 1280 and includes a rectangular profile having a pair of L-shaped walls 1292 and a floor 1296 that cooperate to define an interior cavity. An opening (not shown) extends through the bottom surface into the cavity. This opening receives a fastener (such as a screw) 1300, around which the connecting wire 1288, 1290 is wrapped and secured in place. Fastener 1300 is also recessed into the cavity such that L-shaped wall 1292 extends laterally beyond the end of the fastener. Thus, the connecting wires 1288, 1290 extending from the fastener pass through the gap between the L-shaped walls 1292 with one wire passing over the top arcuate surface 1284 and the second wire passing under the bottom arcuate surface 1282. The wires 1288, 1290 then extend distally and taper to extend through the respective eyelet opening at the proximal end of the conduit 112.

Each of the tooth assemblies 1268, 1270 is independently rotatably repositionable relative to each other. The first tooth assembly 1268 operates to provide part of a passive repositionable mechanism to control the pitch (i.e., up and down) of the end effector 118, while the second tooth assembly 1270 operates to provide part of a passive repositionable mechanism to control the yaw (i.e., side-to-side) of the end effector. In an exemplary form, when the button 1236 is not pressed, the spring 1260 operatively biases the tooth receiver 1246 into engagement with the teeth 1278 of the tooth assemblies 1268, 1270, thereby inhibiting rotation of the tooth assemblies about the axle 1264. When the tooth assemblies 1268, 1279 are locked in place (see fig. 79), the end effector 118 cannot be repositioned in the vertical direction (i.e., to affect pitch) or in the medial-to-lateral direction (i.e., to affect yaw). Thus, when the tooth assemblies 1268, 1279 are locked in place (see fig. 79), the end effector 1128 is also locked in place.

To change the vertical or medial-to-lateral position of the end effector 118, the user presses the button 1236. By pressing the button 1236, the toothed receiver 1246 is operative to further compress the spring 1260 and disengage the toothed assemblies 1268, 1270. More specifically, the longitudinal pyramid shape 1248 and corresponding longitudinal pyramid cavity 1250 no longer engage the teeth 1278 of the tooth assemblies 1268, 1270, thereby allowing the tooth assemblies to rotate about the axle 1264. By allowing free rotation of the tooth assemblies 1268, 1270 about the axle 1264, the connection lines 1288, 1290 linking the end effector 118 with the tooth assemblies can be repositioned, which allows the end effector to be freely repositioned in a vertical direction (i.e., to affect trim) or a medial-to-lateral direction (i.e., to affect list). Upon reaching the respective vertical and medial-to-lateral positions of the end effector 118, the user will discontinue pressing the button 1236 to lock in the relative vertical and medial-to-lateral positions. To lock in place, the spring 1260 forces the tooth receiver 1246 up and into engagement with the tooth assemblies 1268, 1270. Since the tooth assemblies 1268, 1270 include teeth 1278 that engage the longitudinal pyramid shape 1248 of the tooth receiver 1246, the spring 1260 will guide the tooth receiver upward and cause the tooth assemblies to possibly rotate slightly about the axle 1264 so that the teeth are fully received within the longitudinal pyramid cavity 1250. If the end effector 118 is positioned such that the teeth 1278 are aligned with the longitudinal pyramid cavity 1250, the vertical and medial-to-lateral position will be accurately maintained due to the tension on the connecting lines 1288, 1290. However, if the position of the end effector 118 is such that the teeth 1278 are slightly misaligned with the longitudinal pyramid cavity 1250, then the vertical and medial-to-lateral positions will change as the tooth assemblies 1268, 1270 are rotated slightly about the axle 1264 such that the teeth are fully received within the longitudinal pyramid cavity 1250. After the teeth 1278 are aligned and received within the longitudinal pyramid cavity 1250, the vertical and medial to lateral positions will be precisely maintained due to the tension on the connecting lines 1288, 1290.

To maintain the orientation of the semi-rigid tubing (which carries the connection lines 1288, 1290) relative to the outer housings 1230, 1232, the distal end of the right outer housing 1230 includes a pair of latches 1302 that engage the semi-rigid tubing 112. The latches 1302 inhibit the tubing 112 from moving longitudinally relative to the controller 1210. The two lock pins 1302 extend parallel to each other and extend from the inner circumferential surface of the right side case 1230.

The right side outer housing 1230 and the left side outer housing 1232 cooperate to define a handle mechanism port 1310 and a proximal port 1312 that are open to the interior of the respective outer housings. The handle mechanism port 1310 accommodates passage of a portion of the handle mechanism 1318, including the repositionable handle 1320, the drive plate 1322, the return spring 1324, and the wire holder 1326. As will be discussed in greater detail below, the wire holder is coupled to both the pull wire 1328 and the drive plate 1322 such that movement of the handle 1320 operatively opens and closes the occlusion clip 1160 (see fig. 75), such as during an atrial appendage occlusion clip deployment surgical procedure. The following is a more detailed explanation of the corresponding components of the handle mechanism 1318.

Repositionable handle 1320 includes an arcuate, ventral gripping surface, which may include a series of projections spaced longitudinally to facilitate gripping by a user. Opposite the ventral gripping surface is a corresponding inner surface from which a pair of spaced apart parallel vertical walls 1330, 1332 extend. The vertical walls 1330, 1332 are also connected to each other via a plurality of transverse walls 1334. The vertical walls 1330, 1332 each include a distal upstanding ring 1338, the ring 1338 providing a through opening in a medial to lateral direction to receive an axle 1340 extending from the right side housing 1230, the handle 1320 rotating about the axle 1340. Extending distally from ring 1338, walls 1330, 1332 include circular openings extending in a medial-to-lateral direction that receive pins 1344 to repositionably mount drive plate 1322 to handle 1320.

The example drive plate 1322 comprises an arcuate, flat plate sized to fit between the walls 1330, 1332 of the handle 1320. The distal end of plate 1322 includes an opening adapted to receive pin 1344. Extending proximally from the opening is an elongated, arcuate opening 1346, the opening 1346 being adapted to receive a dowel 1348 extending from the interior of the right side housing 1230. In this manner, as handle 1324 repositions drive plate 1322, dowel 1348 is repositioned relative to opening 1230. In the exemplary form, the opening is partially defined by a lip 1350, lip 1350 serving to hold dowel 1348 in a static position after handle 1320 is fully closed. Meanwhile, the proximal end of the drive plate 1322 includes an aperture 1352, the aperture 1352 receiving a portion of the spring 1324 for biasing the handle 1320 to the open position shown in fig. 77. The opposite end of the spring 1324 is mounted to a dowel 1354, the dowel 1354 extending from the interior of the right side housing 1320.

The controller 1210 further includes a removable handle 1360, the removable handle 1360 being seated within the proximal port 1312 of the outer housings 1230, 1232. The removable handle 1360 is coupled to one or more clip release wires 492 (in this case, two clip release wires), the clip release wires 492 serving to disconnect the occluding clip from the clip deployment device 118. In this manner, the handle 1360 may be removed from the proximal end of the controller 1210, thereby drawing the release wire(s) proximally and disconnecting the occlusion clip from the clip deployment device 118. In this exemplary embodiment, the stem 1360 is secured within the proximal port 1312 via a friction fit that is overcome by pressure applied to the stem by a user to displace it distally relative to the controller 1210. It is within the scope of the present disclosure to use a latch or other positive release mechanism to release the handle 1360 from the controller 1210.

From the above description and summary, it will be apparent to those skilled in the art that, while the methods and apparatus described herein constitute exemplary embodiments of the invention, the invention is not limited to the foregoing, and that changes may be made to these embodiments without departing from the scope of the invention as defined in the appended claims. Furthermore, it is to be understood that the invention is defined by the appended claims, and that any limitations or elements describing the exemplary embodiments set forth herein are not intended to be incorporated into the interpretation of any claim element unless such limitation or element is explicitly set forth. Likewise, it is to be understood that any and all of the identified advantages or objects of the invention disclosed herein need not be met to fall within the scope of any claims, since the invention is defined by the claims, and since inherent and/or unforeseen advantages of the present invention may exist, even though they may not have been explicitly discussed herein.

Claims (67)

1. A medical device, comprising:

a first joint comprising a first member and a second member, the first member configured to be repositionable in an X-Y plane relative to the second member;

a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a Y-Z plane perpendicular to the X-Y plane; and

a controller operatively coupled to the first joint and the second joint, the controller including a first control configured to direct repositioning of at least one of the first member and the second member and a second control configured to direct repositioning of at least one of the third member and the fourth member.

2. The medical instrument of claim 1, wherein:

the first control comprises a passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within the X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and

the second control portion includes an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the third member relative to the fourth member at different positions within the Y-Z plane.

3. The medical instrument of claim 2, wherein:

the passive control section includes a lever repositionably mounted to a housing of the controller, the lever being coupled to a passive control wire; and

the passive control wire is also coupled to a repositionable fastener configured to engage at least one of the first member and the second member to prevent movement between the first member and the second member within the X-Y plane.

4. The medical instrument of claim 3, wherein:

biasing the repositionable fastener with a spring to resist movement between the first member and the second member within the X-Y plane; and

the lever is configured to be repositionable to tension the passive control wire against the bias of the spring to allow movement between the first member and the second member within the X-Y plane.

5. The medical instrument of claim 4, further comprising a longitudinal conduit extending between the controller and the first fitting, wherein at least a portion of the passive control wire extends through the longitudinal conduit.

6. The medical instrument of claim 1, further comprising a longitudinal conduit extending between the controller and the first joint, wherein:

the first member is mounted to the controller; and

the second member is repositionably mounted to the first member.

7. The medical instrument of claim 6, wherein:

the first member is elongate and includes an internal cavity that at least partially receives a repositionable fastener to resist movement between the first member and the second member within the X-Y plane; and

at least one of the first member and the longitudinal conduit houses a spring that biases the repositionable fastener to resist movement between the first member and the second member within the X-Y plane.

8. The medical instrument of claim 7, wherein:

at least one of the first member and the second member comprises a protrusion;

at least one of the first member and the second member includes a cavity configured to receive the protrusion;

the cavity is at least partially defined by a support surface; and

the projection is configured to contact the bearing surface when movement occurs between the first member and the second member in the X-Y plane.

9. The medical instrument of claim 8, wherein:

the first member comprises the cavity;

the second member comprises the projection;

the repositionable fastener includes at least one tooth; and

the second member includes at least one tooth, the at least one tooth of the second member being configured to engage the at least one tooth of the repositionable fastener to prevent movement between the first member and the second member within the X-Y plane.

10. The medical instrument of claim 9, wherein:

the cavity comprises a first cavity and a second cavity spaced apart from and facing each other;

the projections comprise a first projection and a second projection spaced apart from and facing away from each other;

the first cavity is configured to receive the first protrusion; and

the second cavity is configured to receive the second protrusion.

11. The medical instrument of claim 6, wherein:

the first member comprises a clevis; and

the second member includes a basin structure.

12. The medical instrument of claim 11, wherein:

the first control comprises a passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within the X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and

the clevis includes an internal cavity that at least partially receives a repositionable fastener and a biasing spring;

the repositionable fastener includes a portion of the first control portion;

the first control portion further comprises an actuator repositionably mounted to the controller; and

the first control portion further includes a tether coupled to both the actuator and the repositionable fastener.

13. The medical instrument of claim 11, wherein:

the basin-shaped structure comprises a first basin-shaped structure half part and a second basin-shaped structure half part; and

the first basin half and the second basin half are identical.

14. The medical instrument of claim 2, wherein:

the active control portion includes an actuator repositionably mounted to a housing of the controller, the actuator operatively coupled to an active control line; and

the active control line is coupled to at least one of the third member and the fourth member to control movement between the third member and the fourth member within the Y-Z plane.

15. The medical instrument of claim 14, wherein:

the actuator comprises a wheel and a linkage plate;

the wheel comprises a helical cavity; and

the linkage plate includes a protrusion configured to be received within the helical cavity of the wheel.

16. The medical instrument of claim 14, wherein:

the actuator comprises a wheel and a linkage plate;

the linkage plate comprises a spiral cavity; and

the wheel includes a protrusion configured to be received within the helical cavity of the linkage plate.

17. The medical instrument of claim 14, wherein:

the actuator comprises a wheel and a linkage plate;

the linkage plate comprises a cavity; and

the wheel includes a helical projection configured to be received within the cavity of the linkage plate.

18. The medical instrument of claim 14, wherein:

the actuator comprises a wheel and a linkage plate;

the wheel includes a cavity; and

the linkage plate includes a helical protrusion configured to be received within the cavity of the linkage plate.

19. The medical instrument of claim 1, wherein:

the second control portion comprises an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the third member relative to the fourth member at different positions within the Y-Z plane;

the second member is mounted to the third member; and

the third member is repositionably mounted to the fourth member.

20. The medical instrument of claim 1, wherein:

the fourth member is elongated and includes an inner cavity at least partially housing a repositionable pull link; and

the fourth member includes a channel configured to receive at least a portion of the active control line.

21. The medical instrument of claim 19, wherein:

the channel comprises a first arcuate segment and a second arcuate segment;

the active control lines comprise a first active control line and a second active control line;

the first arcuate segment is configured to receive the first active control line;

the second arcuate segment is configured to receive the second active control line;

at least a portion of the first active control line is secured to the fourth member; and

at least a portion of the second active control line is secured to the fourth member.

22. The medical instrument of claim 19, wherein:

at least one of the third member and the fourth member comprises a protrusion;

at least one of the third member and the fourth member includes a cavity configured to receive the protrusion;

the cavity is at least partially defined by a support surface; and

the projection is configured to contact the bearing surface when movement occurs between the third member and the fourth member in the Y-Z plane.

23. The medical instrument of claim 22, wherein:

the fourth member comprises the cavity; and

the third member includes the projection.

24. The medical instrument of claim 23, wherein:

the cavity comprises a first cavity and a second cavity spaced apart from each other and facing away from each other;

the projections comprise a first projection and a second projection spaced apart from and facing each other;

the first cavity is configured to receive the first protrusion; and

the second cavity is configured to receive the second protrusion.

26. The medical instrument of claim 1, wherein:

the second control portion comprises an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the third member relative to the fourth member at different positions within the Y-Z plane;

the third member comprises a basin-shaped structure; and

the fourth member comprises a yoke.

27. The medical instrument of claim 26, wherein:

the active control portion includes an actuator repositionably mounted to a housing of the controller, the actuator operatively coupled to a first active control line and a second active control line;

the yoke comprises an inner cavity that at least partially receives a repositionable pull link;

the yoke comprises a first channel configured to receive at least a portion of the first active control line and a second channel configured to receive at least a portion of the second active control line; and

at least a portion of the first active control line and the second active control line are secured to the yoke.

28. The medical instrument of claim 26, wherein:

the second member and the third member are mounted to each other; and

the second and third members cooperate to form a basin-shaped structure.

29. The medical instrument of claim 27, wherein:

the actuator comprises a first wheel, a first linkage plate, a second wheel and a second linkage plate;

the first and second wheels each comprise a helical cavity;

the first and second linkage plates each include a protrusion configured to be received within respective helical cavities of the first and second wheels;

the first active control line is coupled to the first linkage plate; and

the second active control line is coupled to the second linkage plate.

30. The medical instrument of claim 29, wherein: the first wheel is a mirror image of the second wheel.

31. The medical instrument of claim 29, wherein:

the helical cavity of each of the first and second wheels comprises an arcuate wall defining the helical cavity; and

the protrusion of each of the first and second linkage plates includes a curved surface configured to contact the arcuate wall of the respective helical cavity.

32. The medical instrument of claim 1, wherein:

the first control portion comprises a first passive control portion configured to be repositionable between a first position that allows free movement between the first member and the second member within the X-Y plane and a second position that inhibits movement between the first member and the second member within the X-Y plane; and

the second control portion includes a second passive control portion configured to be repositionable between a first position that allows free movement between the third member and the fourth member within the Y-Z plane and a second position that inhibits movement between the third member and the fourth member within the Y-Z plane.

33. The medical instrument of claim 32, wherein:

the first passive control section includes an actuator repositionably mounted to a housing of the controller, the actuator coupled to a first passive control line; and

the first passive control wire is also coupled to at least one of the first member and the second member to prevent movement between the first member and the second member within the X-Y plane.

34. The medical instrument of claim 33, wherein: the actuator is configured to be repositionable to allow movement between the first member and the second member within the X-Y plane.

35. The medical instrument of claim 34, further comprising a longitudinal conduit extending between the controller and the first fitting, wherein at least a portion of the first passive control wire extends through the longitudinal conduit.

36. The medical instrument of claim 32, further comprising a longitudinal conduit extending between the controller and the first fitting, wherein:

the first member is mounted to the controller; and

the second member is repositionably mounted to the first member.

37. The medical instrument of claim 36, wherein:

the first member is elongate and includes an internal cavity that at least partially receives a repositionable fastener to resist movement between the first member and the second member within the X-Y plane; and

at least one of the first member and the longitudinal conduit houses a spring that biases the repositionable fastener to resist movement between the first member and the second member within the X-Y plane.

38. The medical instrument of claim 37,

at least one of the first member and the second member comprises a protrusion;

at least one of the first member and the second member includes a cavity configured to receive the protrusion;

the cavity is at least partially defined by a support surface; and

the projection is configured to contact the bearing surface when movement occurs between the first member and the second member in the X-Y plane.

39. The medical instrument of claim 38, wherein:

the first member comprises the cavity;

the second member comprises the projection;

the repositionable fastener includes at least one tooth; and

the second member includes at least one tooth configured to engage the at least one tooth of the repositionable fastener to prevent movement between the first member and the second member within the X-Y plane.

40. The medical instrument of claim 39, wherein:

the cavity comprises a first cavity and a second cavity spaced apart from and facing each other;

the projections comprise a first projection and a second projection spaced apart from and facing away from each other;

the first cavity is configured to receive the first protrusion; and

the second cavity is configured to receive the second protrusion.

41. The medical instrument of claim 35, wherein:

the first member comprises a clevis; and

the second member includes a basin structure.

42. The medical instrument of claim 41, wherein:

the clevis includes an internal cavity that at least partially receives a repositionable fastener and a biasing spring;

the repositionable fastener includes a portion of the first control portion;

the first control portion further comprises an actuator repositionably mounted to the controller; and

the first control portion further includes a tether coupled to both the actuator and the repositionable fastener.

43. The medical instrument of claim 41, wherein:

the basin-shaped structure comprises a first basin-shaped structure half part and a second basin-shaped structure half part; and

the first basin half and the second basin half are identical.

44. The medical instrument of claim 32, wherein:

the second control portion includes an actuator repositionably mounted to a housing of the controller, the actuator operatively coupled to a passive control line; and

the passive control wire is coupled to at least one of the third member and the fourth member to control movement between the third member and the fourth member within the Y-Z plane.

45. The medical instrument of claim 44, wherein:

the actuator includes a depressible button extending through a housing of the controller and configured to engage a receiver;

the actuator comprises at least one tooth; and

the receiver includes at least one tooth configured to selectively engage the at least one tooth of the actuator.

46. The medical instrument of claim 32, wherein:

an actuator repositionably mounted to a housing of the controller, the actuator including a portion of the first control portion and a portion of the second control portion;

the first passive control includes a first receiver repositionably mounted to the housing of the controller, the first receiver operatively coupled to a first wire mounted on at least one of the first and second members; and

the second passive control includes a second receiver repositionably mounted to the housing of the controller, the second receiver operatively coupled to a second wire mounted on at least one of the third member and the fourth member.

47. The medical instrument of claim 46, wherein:

the actuator comprising a depressible button biased by a spring, the actuator being configured to be repositionable between a first position and a second position, the first position allowing free movement between the first and second members in the X-Y plane and allowing free movement between the third and fourth members in the Y-Z plane, the second position preventing free movement between the first and second members in the X-Y plane and preventing free movement between the third and fourth members in the Y-Z plane;

the actuator is lockable in the first position;

the actuator does not engage the first receiver or the second receiver in the first position; and

the actuator engages the first and second receivers in the second position.

48. The medical instrument of claim 46,

the actuator includes a depressible button biased by a spring to engage the first and second receivers;

the first and second receivers being rotationally repositionable along a common spool that extends internally within the controller when not engaged by the depressible button,

the first and second receivers are not rotationally repositionable along the common spool when engaged by the depressible button.

49. The medical instrument of claim 1, further comprising an end effector operatively coupled to the first and second joints.

50. The medical instrument of claim 49, wherein the end effector comprises at least one of: a surgical dissector, an ablation pen, a sealing clip applier, surgical forceps, surgical jaws, a linear cutter, an ablation clamp, and an ablation rail.

51. The medical instrument of claim 49, wherein: the controller includes a third control portion operatively coupled to the end effector.

52. The medical instrument of claim 51, wherein:

the end effector comprises a clip deployment device; and

the third control portion includes a link extending from the controller to the end effector to control repositioning of at least a portion of the clip deployment device.

53. The medical instrument of claim 52, wherein:

the clip deployment device includes opposing jaws removably coupled to an occlusion clip; and

the linkage is configured to be repositioned to remove the occlusion clip coupled to the opposing jaw.

54. The medical instrument of claim 53, wherein:

the opposing jaws each include an aperture through which a tether extends;

the tether is coupled to the occlusion clip; and

the link is removably coupled to the tether.

55. The medical instrument of claim 54, wherein:

the tether comprises a suture loop; and

the connecting rod is arranged between the suture ring and the plugging clamp.

52. The medical instrument of claim 51, wherein:

the end effector comprises a clip deployment device; and

the third control portion includes a link extending from the controller to the end effector to control repositioning of at least a portion of the clip deployment device.

56. The medical instrument of claim 52, wherein:

the second joint includes a channel along which the pull link is configured to traverse;

the pull link is operatively coupled to the third control and the clip deployment device; and

the deployment device includes at least two ganged clips operatively coupled to the pull link, each of the at least two ganged clips having a non-circular cam that rides on a camming surface of at least one of the two jaws, the at least two ganged clips configured to pivot relative to the two jaws until interaction between the cam and camming surface inhibits further pivoting.

57. A medical device, comprising:

a controller at least partially housing a plurality of controls;

an elongated conduit operatively coupling the controller to the first and second joints;

a first joint comprising a first member and a second member, the first member configured to be repositionable in an X-Y plane relative to the second member;

a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a Y-Z plane perpendicular to the X-Y plane; and

an end effector operatively coupled to the first and second joints;

wherein the plurality of control sections include: a first control operatively coupled to the first joint to control movement of the first member relative to the second member in the X-Y plane; a second control operatively coupled to the second joint to control movement of the third member relative to the fourth member in the Y-Z plane; a third control operatively coupled to the end effector to control movement of at least a portion of the end effector.

58. The medical instrument of claim 57, further comprising an occlusion clip removably mounted to the end effector, wherein the plurality of controls includes a fourth control that detaches the occlusion clip from the end effector.

59. The medical instrument of claim 57, wherein:

the first control comprises a passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within the X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and

the second control portion includes an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the third member relative to the fourth member at different positions within the Y-Z plane.

60. The medical instrument of claim 59, wherein: the third control portion includes a second active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the end effector at a different position.

61. The medical instrument of claim 60, further comprising an occlusion clip removably mounted to the end effector, wherein the plurality of controls includes a fourth control for detaching the occlusion clip from the end effector, wherein the fourth control includes a passive control configured to detach or retain a connection between the end effector and the occlusion clip.

62. The medical instrument of claim 57, wherein:

the first control portion comprises a first passive control portion configured to be repositionable between a first position that allows free movement between the first member and the second member within the X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and

the second control includes a second control configured to be repositionable between a first position that allows free movement between the third member and the fourth member within the Y-Z plane and a second position that prevents movement between the third member and the fourth member within the Y-Z plane.

63. The medical instrument of claim 62, wherein: the third control portion comprises an active control portion configured to be repositionable among an infinite number of positions, wherein each of the infinite number of positions the end effector at a different position.

64. The medical instrument of claim 63, further comprising an occlusion clip removably mounted to the end effector, wherein the plurality of controls includes a fourth control for detaching the occlusion clip from the end effector, wherein the fourth control includes a passive control configured to detach or retain a connection between the end effector and the occlusion clip.

65. The medical instrument of claim 57,

the first control comprises a first passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within at least 90 ° of the X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and

the second control comprises a second control configured to be repositionable between a first position that allows free movement between the third member and the fourth member within at least 90 ° of the Y-Z plane and a second position that prevents movement between the third member and the fourth member within the Y-Z plane.

66. The medical instrument of claim 57, wherein:

the first control comprises a passive control configured to be repositionable between a first position that allows free movement between the first member and the second member within at least 90 ° of the X-Y plane and a second position that prevents movement between the first member and the second member within the X-Y plane; and

the second control includes an active control configured to be repositionable among an infinite number of positions within at least ninety degrees in the Y-Z plane, wherein each of the infinite number of positions the third member relative to the fourth member at a different position within the Y-Z plane.

67. The medical instrument of claim 66,

the active control part comprises a first wheel and a second wheel, wherein a first spiral cavity is formed in the first wheel, a second spiral cavity is formed in the second wheel, and the first spiral cavity and the second spiral cavity are mirror images of each other;

the active control portion further includes a first linkage plate coupled to the first link line and a second linkage plate coupled to the second link line;

the first linkage plate comprises a first protrusion configured to be received within the first helical cavity;

the second linkage plate includes a second protrusion configured to be received within the second helical cavity;

the first and second wheels being coupled to each other such that rotation of one wheel results in a corresponding rotation of the other wheel, wherein rotation in a first direction results in tension on the first link but not on the second link, but rotation in a second direction opposite the first direction results in tension on the second link but not on the first link; and

tension on the first link causes movement in a positive X direction in the Y-Z plane, and tension on the second link causes movement in a negative X direction in the Y-Z plane.

68. The medical instrument of claim 57, wherein the end effector comprises at least one of: a surgical dissector, an ablation pen, a sealing clip applier, surgical forceps, surgical jaws, a linear cutter, an ablation clamp, and an ablation rail.