A surgical clip applier and methods for applying surgical clips to a vessel, duct, shunt, etc., during a surgical procedure are provided. In one embodiment, a surgical clip applier is provided and can include a shaft having a proximal end and a distal end with opposed jaws thereon, a guide member disposed within the shaft and configured to guide a clip into the opposed jaws, the guide member having a channel formed in a surface thereof, and an advancer movably disposed within the shaft and configured to advance a clip over the guide member and into the opposed jaws, the advancer having a distal tip that slidably engages the channel for maintaining contact with a surgical clip as it is advanced into the opposed jaws. In other embodiments, the guide member can also include a proximal channel formed in a superior surface thereof. The advancer can be configured to deflect downward into the proximal channel to move proximally beneath an inferior surface of the apex of the clip to position itself proximally to the clip to advance the clip into the opposed jaws.
IMPROVED CLIP ADVANCER FIELD OF THE INVENTION 10001] The present invention relates broadly to surgical devices, and in particular to methods and devices for applying surgical clips to ducts, vessels, shunts, etc. 5 BACKGROUND OF THE INVENTION 10002] Surgical clip appliers are commonly used for ligating blood vessels, ducts, shunts, or a portion of body tissue during surgery. Most clip appliers typically have a handle with an elongate shaft having a pair of movable opposed jaws formed on an end thereof for holding and forming a ligation clip therebetween. The jaws are positioned around the vessel or duct, and the clip is crushed 10 or formed on the vessel by the closing of the jaws.  Clip appliers that are configured to deliver multiple clips typically include an advancer mechanism that sequentially advances the clips into the jaws of the clip applier. Many clip appliers have jaws that are angled with respect to the shaft for better visibility. The angled jaws require that a clip being fed into the jaws change orientation. This change in orientation can lead to misalignment 15 between the advancer mechanism and the clip, which can result in the clip being improperly fed into the jaws, further resulting in a malformed clip being delivered to the tissue. Problems can also arise as the advancer mechanism retracts behind the next clip and fails to engage the clip to advance it into the jaws.  Accordingly, there remains a need for improved methods and devices for applying 20 surgical clips to vessels, ducts, shunts, etc. [0004A] Reference to any prior art in the specification is not, and should not be taken as, an acknowledgment, or any form of suggestion, that this prior art forms part of the common general knowledge in Australia or any other jurisdiction or that this prior art could reasonably be expected to be ascertained, understood and regarded as relevant by a person skilled in the art. 25 [0004B] As used herein, except where the context requires otherwise, the term "comprise" and variations of the term, such as "comprising", "comprises" and "comprised", are not intended to exclude other additives, components, integers or steps. SUMMARY OF THE INVENTION 1 [00051 The present invention provides method and devices for applying a surgical clip to a vessel, duct, shunt, etc. In one aspect of the invention there is provided a surgical clip applier, comprising: a shaft having a proximal end and a distal end with opposed jaws thereon; a guide member disposed within the shaft and configured to guide a clip into the opposed jaws, the guide 5 member having a channel formed in a surface thereof; and an advancer movably disposed within the shaft and configured to advance a clip over the guide member and into the opposed jaws, the advancer having a distal tip that slidably engages the channel for maintaining contact with a surgical clip as it is advanced into the opposed jaws; wherein a proximal portion of the channel has a ramped surface formed thereon and configured to abut against a proximal portion of the distal tip to cause a 10 distal portion of the distal tip to deflect away from the guide member during proximal movement of the advancer.  In one embodiment, the distal tip can have a distal-facing surface that is configured to abut an apex of a surgical clip to advance the surgical clip into the opposed jaws. The distal- facing surface of the distal tip can have a height that is greater than a depth of the channel. In one 15 embodiment, the channel of the guide member can be in the form of an opening formed through the guide member. A distal portion of the channel can also have a ramped surface formed thereon and configured to abut against a distal portion of the distal tip to cause the distal portion of the distal tip to deflect away from the guide member during distal movement of the advancer. The guide member can also include a longitudinally-extending groove formed therein and configured to substantially 20 prevent lateral movement of the distal tip relative to opposed lateral sidewalls of the guide member. [00071 The device can also include at least one clip disposed within the shaft. In one embodiment, the clip can have a maximum height measured in a direction transverse to a longitudinal axis of the shaft, and the distal tip can have a maximum height measured in a direction transverse to a longitudinal axis of the shaft that is greater than the height of the at least one clip. In 25 other aspects, the guide member can be in the form of or can include a tissue stop having a distal end with a recess formed therein for receiving tissue. The opposed jaws can be configured to engage opposed legs of a surgical clip such that an apex of the surgical clip is maintained a distance above the guide member during advancement of the surgical clip into the opposed jaws.  In another aspect of the invention, a surgical clip applier is provided and includes a 30 shaft having opposed jaws on a distal end thereof. The opposed jaws can be movable between open and closed positions for applying a clip to tissue. A clip advancer can be movably disposed within the shaft and it can have a distal tip configured to advance at least one clip into the opposed jaws.
1. A surgical clip applier, comprising: a shaft having a proximal end and a distal end with opposed jaws thereon; a guide member disposed within the shaft and configured to guide a clip into the opposed 5 jaws, the guide member having a channel formed in a surface thereof; and an advancer movably disposed within the shaft and configured to advance a clip over the guide member and into the opposed jaws, the advancer having a distal tip that slidably engages the channel for maintaining contact with a surgical clip as it is advanced into the opposed jaws; wherein a proximal portion of the channel has a ramped surface formed thereon and 10 configured to abut against a proximal portion of the distal tip to cause a distal portion of the distal tip to deflect away from the guide member during proximal movement of the advancer.
2. The surgical clip applier of claim 1, wherein the distal tip has a distal-facing surface that is configured to abut an apex of a surgical clip to advance the surgical clip into the opposed jaws.
3. The surgical clip applier of claim 2, wherein the distal-facing surface of the distal tip has a 15 height that is greater than a depth of the channel.
4. The surgical clip applier of any one of the preceding claims, wherein the channel of the guide member comprises an opening formed through the guide member.
5. The surgical clip applier of any one of the preceding claims, wherein a distal portion of the channel has a ramped surface formed thereon and configured to abut against a distal portion of the 20 distal tip to cause the distal portion of the distal tip to deflect away from the guide member during distal movement of the advancer.
7. The surgical clip applier of any one of the preceding claims, further comprising at least one clip disposed within the shaft, the clip having a maximum height measured in a direction transverse to a longitudinal axis of the shaft, and wherein the distal tip has a maximum height measured in a direction transverse to a longitudinal axis of the shaft that is greater than the height of the at least one clip.
8. The surgical clip applier of any one of the preceding claims, wherein the guide member comprises a tissue stop having a distal end with a recess formed therein for receiving tissue.
9. The surgical clip applier of any one of the preceding claims, wherein the opposed jaws are configured to engage opposed legs of a surgical clip such that an apex of the surgical clip is 5 maintained a distance above the guide member during advancement of the surgical clip into the opposed jaws.
10. A surgical clip applier, comprising: a shaft having opposed jaws on a distal end thereof, the opposed jaws being movable between open and closed positions for applying a clip to tissue; 10 a clip advancer movably disposed within the shaft and having a distal tip configured to advance at least one clip into the opposed jaws; and an advancer guide disposed within the elongate shaft, the advancer guide having a ramped surface formed thereon and configured to cause a distal portion of the distal tip to deflect away from the guide member during proximal movement of the advancer to position the distal tip behind an 15 apex of a surgical clip disposed within the shaft.
11. The surgical clip applier of claim 10, wherein the advancer guide includes a channel formed therein, and the ramped surface is formed adjacent to a proximal end of the channel.
12. The surgical clip applier of claim 10 or 11, wherein the ramped surface comprises a proximal ramped surface, and the guide member includes a distal ramped surface configured to 20 cause the distal portion of the distal tip to deflect in a direction away from the guide member during distal movement of the advancer.
13. The surgical clip applier of claim 12, wherein the advancer guide includes a channel formed therein, and the distal ramped surface is formed adjacent to a distal end of the channel.
14. The surgical clip applier of any one of claims 10 to 13, wherein the ramped surface is 25 formed adjacent to a channel formed in the advancer guide, the channel being configured to receive the distal tip of the advancer therein.
16. The surgical clip applier of claim 14 or 15, wherein the advancer guide includes a distal longitudinally-extending channel formed therein and configured to slidably receive the distal tip of the advancer guide.
17. A method for advancing a clip into opposed jaws of a clip applier, comprising: 5 actuating a trigger to cause an advancer to move distally through a shaft and to contact and advance a surgical clip distally along a superior surface of a guide member and into opposed jaws of the clip applier, the advancer having a distal tip with a distal-facing surface that allows an apex of the surgical clip to move in superior and inferior directions while still maintaining contact with the apex of the surgical clip; and 10 releasing the rigger to move the advancer proximally, the distal tip of the advancer deflecting in an inferior direction beneath a inferior surface of a second surgical clip during proximal movement of the advancer.
18. The method of claim 17, wherein, as the advancer moves proximally, the guide member causes the distal tip of the advancer to deflect in a superior direction to position the distal tip of the 15 advancer at a location proximal to a second surgical clip.
19. The method of claim 17 or 18, wherein the guide member includes a longitudinally extending groove formed therein that maintains the distal tip of the advancer in alignment with a longitudinal axis of the guide member.
20. The method of any one of claims 17 to 19, wherein the advancer tip maintains contact with 20 an apex of the clip as the opposed jaws are closed to close the clip.
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