Surgical clamps

Abstract

Surgical devices and related methods are disclosed. An example end effector of a surgical device may include a first jaw, a second jaw, and an articulation mechanism operable to move the first jaw between an open position, an intermediate position, and a closed position. The example articulation mechanism may include a first jaw mount coupled to the first jaw such that movement of the first jaw mount along a path causes rotation and translation of the first jaw mount and the first jaw. A pivotally mounted crank may operably couple an actuator linkage to the first jaw mount such that moving the actuator linkage rotates the crank, and rotation of the crank may cause the first jaw mount to move along the path.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims the benefit of U.S. Provisional Application No. 62 / 790,938 filed on January 10, 2019, U.S. Provisional Application No. 62 / 796,998 filed on January 25, 2019, U.S. Provisional Application No. 62 / 874,150 filed on July 15, 2019, and U.S. Provisional Application No. 62 / 947,573 filed on December 13, 2019, all of which are incorporated herein by reference.

[0003] Introduction of the invention. Technical Field

[0004] The present disclosure relates to medical instruments and devices and related methods, and more particularly, to surgical devices and related methods for clamping and ablating tissue. Summary of the invention

[0005] The present disclosure contemplates that atrial fibrillation is a common arrhythmia that affects millions of people in the United States alone. Ablation of cardiac tissue is a common procedure for treating arrhythmias, the purpose of which is to create scar tissue, thereby causing interruption of erroneous electrical impulse paths in cardiac tissue. Ablation has been achieved or suggested using a variety of techniques, such as freezing via a cryogenic probe, heating via radiofrequency (RF) energy, surgical cutting, and other techniques. As used herein, "ablation" may refer to the removal or destruction of a function of a body part (e.g., cardiac tissue), regardless of the device or process used to perform the ablation. In addition, "transmural" as used herein may refer to passing through a wall or thickness, such as through the wall or thickness of a hollow organ or blood vessel. Typically, ablation of cardiac tissue may be performed in an open surgical procedure, in which the sternum is separated and the surgeon may approach the heart directly, or by a minimally invasive approach, such as between the ribs or via a catheter introduced through a vein and into the heart.

[0006] The present disclosure contemplates that although clip-type ablation devices are designed for use concurrently with coronary artery bypass grafting, only a small percentage of atrial fibrillation patients who undergo coronary artery bypass grafting are being treated for atrial fibrillation.

[0007] The present disclosure contemplates that problems encountered in cardiac ablation procedures may include difficulties in accurately locating target tissue and difficulties associated with tissue ablation. For example, in some cases, it may be difficult to position an ablation device at a specific desired location on the heart due to the structure of the heart. As an example, some ablation procedures involve isolating the pulmonary veins. Because the pulmonary veins are located on the posterior side of the heart, it may be difficult to position an ablation device to achieve the desired ablation. As another example, in some cases, it may be difficult to create a continuous, sufficiently deep (e.g., transmural) line of ablated tissue, which may be necessary to electrically isolate a portion of the heart. Such difficulties may be particularly relevant when the ablation procedure involves sequentially creating a series of shorter lesions at different locations that, taken together, are intended to form a continuous lesion.

[0008] Although known devices have been safely and effectively used to clamp and ablate tissue (e.g., cardiac tissue), improvements in the construction and operation of surgical devices for clamping and ablating tissue may be beneficial to users (e.g., surgeons) and patients. The present disclosure includes various improvements that may improve the construction, operation, and use of surgical devices for clamping and ablating tissue (e.g., cardiac tissue).

[0009] A first aspect of the present disclosure is to provide an end effector for a surgical device, comprising: a first jaw; a second jaw; and an articulation mechanism operable to move the first jaw between an open position, an intermediate position, and a closed position, wherein the first jaw and the second jaw are separated and substantially non-parallel, the first jaw and the second jaw are separated and substantially parallel, and the first jaw and the second jaw are substantially adjacent and substantially parallel in the closed position. The articulation mechanism may include: a first jaw mount coupled to the first jaw, the first jaw mount being movable along a path, wherein movement of the first jaw mount along the path causes rotation and translation of the first jaw mount and the first jaw, thereby moving the first jaw between the open position, the intermediate position, and the closed position; and a pivotally mounted crank, the crank operably coupling an actuator linkage to the first jaw mount, such that moving the actuator linkage rotates the crank, wherein rotation of the crank moves the first jaw mount along the path.

[0010] In a more detailed embodiment of the first aspect, the path may include at least one straight portion and at least one curved portion. The path may be at least partially defined by a slot. The first pin may be movably disposed in the slot to move along the path. The first jaw mount may include a first pin. Movement of the first jaw mount along the path may include movement of the first pin along the slot. The first jaw mount may include a second pin, the second pin being movably disposed in the slot to move along the path.

[0011] In a more detailed embodiment of the first aspect, the end effector can include a connecting linkage having a proximal end and a distal end, the connecting linkage being operatively interposed between the actuator linkage and the crank. The proximal end of the connecting linkage can be pivotally coupled to the actuator linkage, and / or the distal end of the connecting linkage can be pivotally coupled to the crank. The proximal end of the connecting linkage can include a guide slidably disposed in a guide slot. The guide slot can be generally linear and / or can be oriented to be generally in line with the actuator linkage.

[0012] In a more detailed embodiment of the first aspect, the crank may include a first arm and a second arm. The first arm of the crank may be operably coupled to the actuator linkage, and / or the second arm of the crank may be slidably and / or pivotably coupled to the first jaw mounting member. The second arm of the crank may include a crank slot and / or the first jaw mounting member may include a pin. As the crank rotates and the first jaw mounting member moves along the path, the pin may move along the crank slot. The crank slot may be substantially straight and / or the crank slot may be oriented substantially radially relative to the axis of rotation of the crank.

[0013] In a more detailed embodiment of the first aspect, each of the first jaw and the second jaw may include a first end proximal to the hinge mechanism and a second end substantially distal to the hinge mechanism, each second end terminating in a respective tip.

[0014] In a more detailed embodiment of the first aspect, the surgical device may include: a shaft; an end effector as described above disposed at a distal end of the shaft; and a handle disposed at a proximal end of the shaft. The handle may include an actuator operatively coupled to an actuator linkage, and / or the actuator linkage may extend longitudinally through the shaft to the end effector. The end effector may include a head at least partially containing an articulation mechanism, the first jaw and / or the second jaw may be generally disposed distally on the head, and / or the first jaw and the second jaw may be generally oriented laterally from the head.

[0015] In a more detailed embodiment of the first aspect, in the open position, the end of the first jaw and / or the end of the second jaw can be spaced apart and / or at least partially define an open mouth. Each of the end of the first jaw and / or the end of the second jaw can be configured to releasably couple with at least one of the first end and / or the second end of the flexible guide. The end of the first jaw can be configured to magnetically releasably couple with the first end of the flexible guide, and / or the end of the second jaw can be configured to magnetically releasably couple with the second end of the flexible guide.

[0016] In a more detailed embodiment of the first aspect, each of the first jaw and / or the second jaw may include a plurality of substantially straight portions interspersed with curved portions. At least one of the first jaw and / or the second jaw may be configured to ablate tissue clamped therebetween. Each of the first jaw and / or the second jaw may include a pair of elongated, spaced-apart electrodes operatively coupled to a source of radiofrequency energy for ablating tissue clamped between the first jaw and the second jaw. The electrodes in each pair of electrodes may be spaced apart by approximately 0.1 mm to approximately 3.0 mm.

[0017] A second aspect of the present disclosure is to provide a surgical device, comprising: a distal handle, the distal handle comprising an actuator; a shaft extending distally from the handle, the shaft comprising an actuator linkage extending therethrough, the actuator linkage operatively coupled to the actuator; and / or an end effector disposed at the distal end of the shaft. The end effector may include a head, a first jaw disposed distally on the head, a second jaw disposed distally on the head, and / or an articulation mechanism. The articulated mechanism may include: a connecting linkage including a proximal end and / or a distal end, the proximal end of the connecting linkage being pivotally connected to the distal end of an actuator linkage; a pivotally mounted crank including a first arm and a second arm, the first arm being pivotally connected to the distal end of the connecting linkage; and / or a first jaw mounting rigidly attached to the first jaw, the first jaw mounting being pivotally and slidably connected to the second arm of the crank; wherein moving the actuator on the handle is operable to move the first jaw from an open position to a closed position, in the open position, the first jaw and the second jaw are separated and substantially non-parallel, and in the closed position, the first jaw and the second jaw are substantially adjacent and substantially parallel.

[0018] In a more detailed embodiment of the second aspect, the first jaw mount may be movable along a path. Movement of the first jaw mount along the path may result in rotation and / or translation of the first jaw mount and the first jaw, thereby moving the first jaw from an open position to a closed position. Rotation of the crank may cause the first jaw mount to move along the path. The first jaw and / or the second jaw may extend generally transversely relative to the axis. Moving the actuator on the handle may be operable to move the first jaw between an open position, an intermediate position, and / or a closed position, in which the first jaw and the second jaw are separated and substantially parallel. The second arm of the crank may include a crank slot and / or the first jaw mount may include a pin. As the crank rotates, the pin may move along the crank slot. The proximal end of the connecting linkage may include a guide slidably disposed in a guide slot. The guide slot may be generally linear and / or may be oriented to be generally in line with the actuator linkage. The actuator may include a plunger that is depressed distally to move the first jaw from an open position to a closed position. The shaft may be substantially rigid. At least a portion of the shaft may be flexible. The shaft may be substantially straight. Each of the first jaw and / or the second jaw may terminate at a respective end. In the open position, the ends of the first jaw and / or the ends of the second jaw may be spaced apart and / or at least partially define an open mouth. The ends of the first jaw and / or the ends of the second jaw may be configured to be releasably coupled to respective ends of an elongated flexible guide. Each of the first jaw and / or the second jaw may include a plurality of substantially straight portions interposed with curved portions. Each of the first jaw and / or the second jaw may include at least one electrode operatively coupled to a source of radiofrequency energy for ablating tissue clamped between the first jaw and / or the second jaw.

[0019] The third aspect of the present disclosure is to provide a surgical device, the surgical device includes a shaft and / or an end effector disposed at the distal end of the shaft, the end effector includes a head, the head includes an articulation mechanism, the articulation mechanism is operable to move a first jaw between an open position and a closed position, in which the first jaw and the second jaw are separated and substantially non-parallel, and in the closed position, the first jaw and the second jaw are substantially adjacent and substantially parallel. Each of the first jaw and / or the second jaw may include a first substantially straight portion near the head, a second substantially straight portion, a third substantially straight portion away from the head, a first curved portion between the first substantially straight portion and the second substantially straight portion, and / or a second curved portion between the second substantially straight portion and the third substantially straight portion. Each of the first jaw and / or the second jaw may terminate at a respective end near the third substantially straight portion. In the open position, the end of the first jaw and / or the end of the second jaw may be spaced apart and / or at least partially define an open mouth.

[0020] In a more detailed embodiment of the third aspect, the articulation mechanism can be operable to rotate and / or translate the first jaw between an open position, an intermediate position, and / or a closed position, in which the first jaw and the second jaw are separated and / or substantially parallel. The first substantially straight portion, the second substantially straight portion, and / or the third substantially straight portion of the first jaw can be oriented obliquely relative to each other. The first substantially straight portion, the second substantially straight portion, and / or the third substantially straight portion of the second jaw can be oriented obliquely relative to each other. The first substantially straight portion, the second substantially straight portion, and / or the third substantially straight portion of the first jaw can be substantially coplanar. The first substantially straight portion, the second substantially straight portion, and / or the third substantially straight portion of the second jaw can be substantially coplanar. The first substantially straight portion, the second substantially straight portion, and / or the third substantially straight portion of the second jaw can be substantially coplanar with the axis.

[0021] In a more detailed embodiment of the third aspect, the second substantially straight portion of the first jaw can be longer than at least one of the first substantially straight portion of the first jaw and / or the second substantially straight portion of the first jaw. The second substantially straight portion of the first jaw can be longer than both the first substantially straight portion of the first jaw and / or the second substantially straight portion of the first jaw.

[0022] In a more detailed embodiment of the third aspect, the first jaw and / or the second jaw can be disposed substantially distally on the head. The first jaw and / or the second jaw can be oriented substantially laterally from the head. In the closed position, the second substantially straight portion of the first jaw can be oriented approximately perpendicular to the axis.

[0023] In a more detailed embodiment of the third aspect, in the closed position, the first substantially straight portion of the first jaw can extend distally and / or laterally substantially diagonally away from the head. The third substantially straight portion of the first jaw can extend proximally and laterally substantially diagonally away from the second curved portion. The second jaw can be rigidly arranged relative to the axis. The first substantially straight portion, the second substantially straight portion, and / or the third substantially straight portion of the second jaw can be substantially coplanar with the axis.

[0024] In a more detailed embodiment of the third aspect, the device may include a handle disposed proximally on the shaft, and the handle may include an actuator operatively connected to the articulation mechanism. The end of the first jaw and / or the end of the second jaw may be configured to be releasably coupled to the respective ends of the elongated flexible guide. Each of the first jaw and / or the second jaw may include at least one electrode operatively coupled to a source of radiofrequency energy for ablating tissue clamped between the first jaw and / or the second jaw. The articulation mechanism may include: a first jaw mount coupled to the first jaw, the first jaw mount being movable along a path, wherein movement of the first jaw mount along the path causes rotation and / or translation of the first jaw mount and the first jaw, thereby moving the first jaw between an open position and a closed position; and / or a pivotally mounted crank that operatively couples an actuator linkage to the first jaw mount, such that moving the actuator linkage rotates the crank, wherein rotation of the crank moves the first jaw mount along the path.

[0025] A fourth aspect of the present disclosure is to provide a guide for a surgical device, the guide comprising: an elongated flexible guide body, the guide body comprising a first end and a second end; a first guide connector disposed on the first end; and / or a second guide connector disposed on the second end. The first guide connector can be selectively releasably connected to at least one of the second guide connector and / or the first end of the first jaw of the surgical device and / or the second end of the second jaw of the surgical device. The second guide connector can be selectively releasably connected to at least one of the first guide connector and / or the first end and / or the second end. When the first guide connector is connected to the second guide connector, the guide can form a closed loop.

[0026] In a more detailed embodiment of the fourth aspect, the first guide connector may include a first permanent magnet. The second guide connector may include a second permanent magnet. The first permanent magnet and / or the second permanent magnet may be oriented so that opposite magnetic poles face away from the guide body, thereby allowing the first guide connector and the second guide connector to be magnetically coupled to each other to form a closed loop with the guide. The first guide connector may include a covering configured to receive the first permanent magnet therein. The first permanent magnet may be securely contained in the covering of the first guide connector. The second guide connector may include a covering configured to receive the second permanent magnet therein. The second permanent magnet may be securely contained in the covering of the second guide connector.

[0027] In a more detailed embodiment of the fourth aspect, the guide body can be generally tubular.

[0028] In a more detailed embodiment of the fourth aspect, the surgical apparatus may include: a surgical device comprising a handle, an axis extending distally from the handle and / or an end actuator disposed near the distal end of the axis, the end actuator comprising a first jaw and a second jaw; and / or a guide as described above.

[0029] A fifth aspect of the present disclosure is to provide a method for using a surgical device, the method comprising positioning an elongated flexible guide near the heart so that the guide extends from a first end of the guide, passes through the transverse sinus from right to left, passes through the oblique sinus from left to right, and extends to a second end of the guide; connecting the first end of the guide to the end of a first clamp of a clamp; connecting the second end of the guide to the end of a second clamp of the clamp; positioning the first clamp and the second clamp near the left atrium by pulling the guide generally from right to left and forward; and / or clamping a portion of the left atrium between the first clamp and the second clamp.

[0030] In a more detailed embodiment of the fifth aspect, the method may include, after clamping the portion of the left atrium, at least partially ablating the portion of the left atrium between the first clamp and the second clamp. Ablating the portion of the left atrium between the first clamp and the second clamp may include applying bipolar radiofrequency energy to the portion of the left atrium between the first clamp and the second clamp using a first electrode and a second electrode arranged substantially in parallel on the first clamp and a third electrode and a fourth electrode arranged substantially in parallel on the second clamp.

[0031] In a more detailed embodiment of the fifth aspect, positioning the elongated flexible guide proximate the heart may include positioning the guide proximate the heart so that the guide extends from a first end of the guide, through the oblique sinus from left to right, proximate the right pulmonary vein above, through the transverse sinus from right to left, and to a second end of the guide; releasably coupling the first end to the second end to form a closed loop with the guide; moving the guide so that the guide extends from the releasably coupled first and second ends, through the transverse sinus from right to left, proximate the left pulmonary vein below, through the oblique sinus from left to right, and to the releasably coupled first and second ends; and / or separating the first end from the second end. Releasably coupling the first end to the second end may include releasably magnetically coupling a first permanent magnet disposed at the first end of the guide with a second permanent magnet disposed at the second end of the guide.

[0032] In a more detailed embodiment of the fifth aspect, the clamp may include a handle, a shaft extending distally from the handle, and an end effector disposed at a distal end of the shaft, the end effector including a first clamp and a second clamp. Positioning the first clamp and the second clamp proximate the left atrium may include positioning the first clamp at least halfway through the transverse sinus and positioning the second clamp at least halfway through the oblique sinus. Clamping a portion of the left atrium between the first clamp and the second clamp may include clamping a portion of the left atrium surrounding the right pulmonary vein. The method may include ablating a portion of the left atrium surrounding the right pulmonary vein between the first clamp and the second clamp. The method may include clamping a portion of the left atrium surrounding the left pulmonary vein between the first clamp and the second clamp and / or ablating a portion of the left atrium surrounding the left pulmonary vein between the first clamp and the second clamp. The portion of the left atrium surrounding the right pulmonary vein and / or the portion of the left atrium surrounding the left pulmonary vein may not overlap and / or the corresponding ablation operations may form spaced-apart pulmonary vein isolation lesions. The portion of the left atrium surrounding the right pulmonary vein and / or the portion of the left atrium surrounding the left pulmonary vein may overlap between the right pulmonary vein and / or the left pulmonary vein, and / or the corresponding ablation operation may form a lesion in a figure-of-eight pattern.

[0033] In a more detailed embodiment of the fifth aspect, clamping a portion of the left atrium between the first clamp and the second clamp may include clamping the left atrium so that the portion of the left atrium between the first clamp and the second clamp simultaneously surrounds the right pulmonary vein and the left pulmonary vein. The method may include, after clamping the portion of the left atrium, at least partially ablating the portion of the left atrium between the first clamp and the second clamp. Ablating the portion of the left atrium between the first clamp and the second clamp may include forming a complete box-shaped lesion around the right pulmonary vein and the left pulmonary vein in a single ablation operation without repositioning the first clamp and / or the second clamp.

[0034] In a more detailed embodiment of the fifth aspect, coupling the first end of the guide to the end of the first jaw of the clamp may include releasably coupling the first end of the guide to the end of the first jaw of the clamp. Coupling the second end of the guide to the end of the second jaw of the clamp may include releasably coupling the second end of the guide to the end of the second jaw of the clamp.

[0035] In a more detailed embodiment of the fifth aspect, the clamp may include a shaft, a handle disposed proximally on the shaft, and / or an end effector disposed distally on the shaft, the end effector including a first jaw and / or a second jaw. Positioning the first jaw and / or the second jaw proximal to the left atrium may include positioning the shaft in a generally front-to-back direction along the right side of the heart. The clamp may include a shaft, a handle disposed proximally on the shaft, and / or an end effector disposed distally on the shaft, the end effector including a first jaw and / or a second jaw. The portion of the left atrium clamped between the first jaw and the second jaw may include an actuator on the operating handle that is operatively connected to move the first jaw from an open position to a closed position. BRIEF DESCRIPTION OF THE DRAWINGS

[0036] Example embodiments are described with reference to the accompanying drawings, in which:

[0037] Figure 1 is a perspective view of an example surgical apparatus;

[0038] Figure 2 is a detailed perspective view of an example end effector;

[0039] Figure 3 is a side view of an example end effector with jaws in an open position;

[0040] Figure 4 is a side view of an example end effector with the jaws in a neutral position;

[0041] Figure 5 is a side view of an example end effector with jaws in a closed position;

[0042] Figure 6 and 7 is a perspective cutaway view of an example hinge mechanism;

[0043] Figure 8 is an exploded perspective view of an example end effector including an example articulation mechanism;

[0044] Fig. 9 and 10 is a detailed internal perspective view of an example head shell portion;

[0045] Fig.11 is an interior side view of an example handle;

[0046] Fig.12 is a detailed view of an inwardly facing (e.g., tissue gripping) surface of an example first jaw;

[0047] Fig.13 is a detailed view of an inwardly facing (e.g., tissue gripping) surface of an example second jaw;

[0048] Fig.14 is a cross-sectional view of an example first jaw;

[0049] Fig.15 is a perspective view of an example guide;

[0050] Fig.16 is a perspective view of an example guide attached to the end of the jaws of a clamp;

[0051] Fig.17 is a detailed exploded perspective view of an example guide connector;

[0052] Figure 18-24 is a simplified posterior perspective view of a heart showing an example operation using a guide and / or clamp;

[0053] Fig.25 is a simplified upper perspective view of a heart showing an example clamp;

[0054] Fig.26 is a schematic posterior view of the left atrium of the heart showing an example box lesion;

[0055] Fig. 27 is a schematic posterior view of the left atrium of the heart showing an example pulmonary vein isolation injury; and

[0056] Fig.28 is a schematic posterior view of the left atrium of a heart showing an example figure-eight lesion; all in accordance with at least some aspects of the present disclosure. DETAILED DESCRIPTION

[0057] Example embodiments according to the present disclosure are described and illustrated below to cover devices, methods, and techniques related to medical surgery. Of course, it will be apparent to those of ordinary skill in the art that the embodiments discussed below are examples and may be reconfigured without departing from the scope and spirit of the present disclosure. It should also be understood that variations of the example embodiments considered by those of ordinary skill in the art will simultaneously constitute a part of the present disclosure. However, for clarity and precision, the example embodiments discussed below may include optional steps, methods, and features, and those of ordinary skill should recognize that these are not necessary conditions to fall within the scope of the present disclosure.

[0058] The present disclosure includes, among other things, medical devices and apparatus and related methods, and more particularly, surgical devices and related methods for clamping and ablating tissue. Some example embodiments according to at least some aspects of the present disclosure may be particularly useful for ablation of cardiac tissue, such as for treating arrhythmias such as atrial fibrillation, for reasons discussed above in the introduction and in the patent references incorporated herein by reference.

[0059] Figure 1is a perspective view of an example surgical device, such as a surgical clamp 100, according to at least some aspects of the present disclosure. In some example embodiments, the surgical clamp 100 may include a handle 200 disposed at a proximal end 302 of a generally elongated shaft 300. An end effector 400 may be disposed at a distal end 304 of the shaft 300. The end effector 400 may include one or more jaws, such as a first jaw 502 and / or a second jaw 504, which are generally disposed distally on the head 402. The handle 200 may include an actuator, such as a plunger 202, which is operable to move the first jaw 502 and / or the second jaw 504 relative to the head 402, such as to close (e.g., clamp) on the target tissue 102.

[0060] As used herein, “proximal” may generally refer to a direction toward the handle 200 end of the surgical clip 100 . As used herein, “distal” may generally refer to a direction toward the end effector 400 end of the surgical clip 100 .

[0061] Figure 2 4 is a detailed perspective view of an example end effector 400 according to at least some aspects of the present disclosure. Each of the first jaw 502 and the second jaw 504 may include a respective first end 506, 508 proximal to the head 402 and a respective second end 510, 512 substantially distal to the head 402. Each of the second ends 510, 512 may terminate in a respective tip 514, 516. Figure 2 In the open position, the jaws 502 , 504 may define an open mouth 518 between the spaced apart ends 514 , 516 .

[0062] Figure 3 is a side view of an example end effector 400 with jaws 502, 504 in an open position, Figure 4 is a side view of an example end effector 400 with jaws 502, 504 in an intermediate position, Figure 5 is a side view of an example end effector 400 with jaws 502 , 504 in a closed position, all in accordance with at least some aspects of the present disclosure.

[0063] refer to Figure 1-3 In the open position, the first jaw 502 and the second jaw 504 may be separated and may not be substantially parallel. Figure 4 In the intermediate position, the first jaw 502 and the second jaw 504 may be separated and may be substantially parallel. Figure 5In the closed position, the first jaw 502 and the second jaw 504 can be substantially adjacent and can be substantially parallel. As used herein with reference to the jaws 502, 504 in the closed position, "substantially adjacent" can include a small gap between the jaws 502, 504, such as due to the target tissue 102 ( Figure 1 ), the target tissue 102 can be clamped between the clamps 502, 504.

[0064] refer to Figure 3-5 , the first jaw 502 is moved from the open position ( Figure 3 ) to the middle position ( Figure 4 ) may include a significant angular change (eg, pivoting or rotating) relative to the head 402, such as about an axis of rotation that is substantially perpendicular to the shaft 300. The first jaw 502 is moved from the neutral position ( Figure 4 ) to the closed position ( Figure 5 ) may include substantial translation relative to the head 402, such as while the first jaw 502 and the second jaw 504 remain substantially parallel.

[0065] In some example embodiments, the first jaw 502 may be movable relative to the head 402, while the second jaw 504 may be fixed (e.g., rigid) relative to the head 402. In some cases, having a rigid jaw 504 may be advantageous because it may be used to position the fixture 100 ( Figure 1 ) to provide a fixed, known reference point for the surgeon when moving the first jaw 502 and the second jaw 504. In other example embodiments, both the first jaw 502 and the second jaw 504 can be moved relative to the head 402. For purposes of clarity and brevity, the description herein focuses on the movement of the first jaw 502 and the associated components that facilitate such movement. However, those skilled in the art will appreciate that substantially similar components can be used to facilitate the movement of the second jaw 504, thereby providing an alternative example embodiment in which both the first jaw 502 and the second jaw 504 can be moved relative to the head 402 between an open position, an intermediate position, and a closed position, and such an embodiment is within the scope of the present disclosure.

[0066] In some example embodiments, the shaft 300 can be substantially rigid. In other example embodiments, at least a portion of the shaft 300 can be bendable or ductile (e.g., plastically deformable), which can allow a user to configure the shaft 300 to accommodate a particular anatomical structure of a patient. In some example embodiments, the shaft can be substantially straight (e.g., linear). In other example embodiments, the shaft 300 can include at least one curved portion. For example, the shaft 300 can be generally C-shaped (e.g., one curved portion) or S-shaped (e.g., two curved portions in opposite directions).

[0067] Figure 6 and 7 is a perspective cross-sectional view of an example hinge mechanism 600 ( Figure 6 and 7 are different side perspective views of the same example device), Figure 8 is an exploded perspective view of an example end effector 400 including an example articulation mechanism 600, Fig. 9 and 10 404, 406, all in accordance with at least some aspects of the present disclosure. Figure 1 ), the hinge mechanism 600 is operable to move the first jaw 502 between the open position, the intermediate position, and the closed position. In embodiments including a movable second jaw 504, a similar hinge mechanism can be used in conjunction with the second jaw 504.

[0068] refer to Figure 6-10 , the example articulation mechanism 600 may include a first jaw mount 602 that may be coupled (e.g., rigidly attached) to the first jaw 502. In some example embodiments, the first jaw mount 602 may be integrally formed with at least a portion of the first jaw 502, e.g., Figure 8 In other embodiments, the first jaw 502 may be attached to a separate component including the first jaw mount 602 .

[0069] In some example embodiments, the first jaw mount 602 may be positioned relative to the head 402 along a path 604 ( Fig. 9 and 10 ) movement, which may cause the first jaw mount 602 and the first jaw 502 to rotate and / or translate between an open position, an intermediate position, and / or a closed position. For example, the first jaw 502 may rotate approximately 45 degrees between the open position and the intermediate position, and / or the first jaw may translate approximately 10 millimeters between the intermediate position and the closed position. For example, the first jaw mount 602 may include a first pin 606 and / or a second pin 608 that may be slidably and / or rotatably movable along a path 604, and the path 604 may be at least partially defined by one or more slots. For example, the path 604 may be at least partially defined by a slot 610 on an inner surface of the shell portion 404 of the head 402, and / or the path 604 may be at least partially defined by a slot 612 on an inner surface of the shell portion 406 of the head 402. Although the illustrated embodiment utilizes pins 606, 608 movable within slots 610, 612 to facilitate movement of the first jaw mount 602 along path 604, utilizing other components and / or mechanisms, such as rails, rollers, sliders, etc. to facilitate movement of the first jaw mount 602 along path 604 is also within the scope of the present disclosure.

[0070] refer to Fig. 9 and 10 In some example embodiments, the path 604 (and / or slots 610, 612) may include at least one generally straight portion 614 and / or at least one generally curvilinear portion 616. In some embodiments including two pins 606, 608 that move along the path 604 defined by the slots 610, 612, the generally curvilinear portion 616 may be operable to cause the first jaw mount 602 (and the attached first jaw 502) to generally pivot or rotate relative to the head 402. The length, orientation, and / or curvature of the generally curvilinear portion 616 may establish a range of angular rotation of the first jaw mount 602 and / or an amount of translation of the first jaw mount 602 relative to the head 402. Similarly, in some embodiments including two pins 606, 608 that move along a path 604 defined by slots 610, 612, a substantially straight portion 616 may be operable to translate the first jaw mount 602 (and the attached first jaw 502) relative to the head 402 without substantially changing the angle of the first jaw mount 602 relative to the head 402. The length and / or orientation of the substantially straight portion 614 may establish the range of translation of the first jaw mount 602 relative to the head 402. It is also within the scope of the present disclosure to utilize any combination of substantially curved portions 616 and / or substantially straight portions 614 to provide a desired path 604 to obtain the desired movement of the first jaw mount 602 (and the attached first jaw 502). For example, an alternative path may include a continuous curve with a varying curvature over its length. Or, for example, an alternative path may include two substantially straight portions 614 interspersed with curved portions 616.

[0071] refer to Figure 6-10 In some example embodiments, the articulation mechanism 600 can include a crank 618 pivotally mounted relative to the head 402. For example, the crank 618 can be pivotally disposed within the head 402, such as by a pivot pin 620 received in the pivot holes 408, 410 of the shell portions 404, 406, respectively. The crank 618 can be operably coupled to the first jaw mount 602 to move the first jaw mount 602 along the path 604. For example, rotation of the crank 618 can cause the first jaw mount 602 to move along the path 604.

[0072] In some example embodiments, the crank 618 may include a first arm 622 that may be operably coupled to the actuator linkage 306 and / or a second arm 624 that may be operably coupled to the first jaw mount 602. Figure 1) can be operably coupled to the actuator linkage 306, which can extend generally longitudinally through the shaft 300. Some example embodiments can include a connecting linkage 626 interposed between the actuator linkage 306 and the crank 618. The articulation mechanism 600 can be configured such that movement of the actuator 202 causes rotation of the crank 618 (e.g., via the actuator linkage 306 and / or the connecting linkage 626). As the crank 618 rotates, the second arm 624 can move the first jaw mount 602 along the path 604 to move the first jaw 502 between the open position, the intermediate position, and / or the closed position.

[0073] Although the crank 618 of the illustrated embodiment includes two arms 622, 624 that extend substantially separately, it is also within the scope of the present disclosure to utilize a crank having arms that are not substantially separately formed. For example, such a crank can be substantially a circular sector of approximately 120 degrees, wherein the area between the arms is at least partially continuous. In some example embodiments, connecting the arms 622, 624 together at a position radially away from the axis of rotation can increase the strength of the crank 618, thereby increasing the maximum allowable torque and / or force for a given material and thickness. In some example embodiments, changing the effective length of the arms 622, 624 (e.g., the radial distance between the pivot pin 620 and the first pin 606 and / or the pivot pin 620 and the pivotable connection 632 (described below)) can help change the maximum allowable torque and / or force.

[0074] In some example embodiments, the distance between the pivot axis of the crank 618 (e.g., the pivot pin 620) and the path 604 (along which the first pin 606 moves) can vary over the length of the path 604. Thus, the second arm 624 of the crank 618 can be slidably and / or pivotally coupled to the first jaw mount 602. For example, the second arm 624 of the crank 618 can include a crank slot 628 that slidably and / or pivotably receives the first pin 606 of the first jaw mount 602 such that as the first jaw mount 602 moves along the path 604, the first pin 606 moves along the crank slot 628. In some example embodiments, the crank slot 628 can be substantially straight and / or can be oriented substantially radially relative to the rotational axis of the crank 618 (e.g., the pivot pin 620).

[0075] In some example embodiments including a connecting linkage 626, a proximal end of the connecting linkage 626 may be coupled to a distal end of the actuator linkage 306 via a pivotable connection 630. The distal end of the connecting linkage 626 may be coupled to the first arm 622 of the crank via a pivotable connection 632. The pivotable connection 630 between the distal end of the actuator linkage 306 and the proximal end of the connecting linkage 626 may include one or more guides 634, 636 that may be slidable within corresponding guide slots 638, 640 on the inner surface of the shell portions 404, 406 of the head 402. In some example embodiments, the guide slots 638, 640 may be generally linear and / or may be generally axially positioned relative to the shaft 300 such that the actuator linkage 306 moves proximally and distally generally along a straight line (e.g., generally in line with the actuator linkage 306).

[0076] Fig.11 2 is an internal side view of an example handle 200 according to at least some aspects of the present disclosure. Generally, the handle 200 can be constructed and / or operated as described in U.S. Patent No. 8,876,820, which is incorporated herein by reference. The handle 200 can include grips 204, 206, 208. The handle 200 can include a port 210 through which wires 212 or tubes can extend from the interior of the handle 200 to the exterior. For example, wires 212 for ablation electrodes or sensors on the jaws 502, 504 can be guided through the shaft 300, into the handle 200, and out through the port 210.

[0077] In some example embodiments, the handle 200 may house an actuator mechanism 214. In this example embodiment, the plunger 202 may be used to articulate one or more of the jaws 502, 504. The plunger 202 may be generally aligned with the shaft 300. When the plunger 202 is in a fully retracted or proximal position, the first jaw 502 may be in an open position ( Figure 3 When the plunger 202 is depressed in the distal direction, the first jaw 502 can be moved from the open position ( Figure 3 ) moves to the middle position ( Figure 4 ). Further depression of the plunger 202 can move the first jaw 502 from the middle position ( Figure 4 ) moves to the closed position ( Figure 5 ).

[0078] In some exemplary embodiments, the actuator mechanism 214 may include a locking mechanism. For example, the plunger 202 may include a generally longitudinal slot 216 with a widened proximal opening 218. When the jaws 502, 504 are in the closed position, the opening 218 may be aligned with the locking button 220, which may be spring biased to drive the locking button 220 into the opening 218, thereby preventing the plunger 202 from moving proximally and maintaining the jaws 502, 504 in the closed position. Depressing the locking button 220 may disengage the locking button 220 from the opening 218, thereby releasing the plunger 202 and allowing it to move proximally to open the jaws 502, 504.

[0079] In some example embodiments, the actuator mechanism 214 can be configured to control and / or limit the amount of force that can be applied by the jaws 502, 504 when the plunger 202 is depressed. For example, the actuator mechanism 214 can include a release rod 222 and a force limiting spring 224. The release rod 222 can be slidable relative to the actuator linkage 306, and the force limiting spring 224 can be arranged to apply a distal force to the actuator linkage 306. When the plunger 202 is depressed, the force limiting spring 224 can be compressed between a step 226 on the plunger 202 and the actuator linkage 306. Thus, depressing the actuator 202 applies a load on the force limiting spring 224, which is transferred to the actuator linkage 306, which moves the actuator linkage 306 distally. If the jaw clamping load exceeds the desired maximum value while the plunger 202 continues to be depressed, the force limiting spring 224 is further compressed and the release rod 222 moves distally without moving the actuator linkage 306. Thus, the force limiting spring 224 substantially limits the maximum jaw clamping load. One of ordinary skill in the art will recognize that the tissue clamping pressure can be a function of the jaw clamping force and the area of ​​tissue being clamped. The actuator mechanism 214 may include a return spring 228 that is operable to move the actuator linkage 306 proximally when the actuator 202 is released.

[0080] Fig.12 is a detailed view of an inwardly facing (eg, tissue clamping) surface of an example first jaw 502, Fig.13 is a detailed view of an inwardly facing (eg, tissue clamping) surface of an example second jaw 504, and Fig.14 is a cross-sectional view of an example first jaw 502, all of which are in accordance with at least some aspects of the present disclosure. Fig.14 Certain components and dimensions associated with the first jaw 502 are shown, but the second jaw 504 may include similar components with similar dimensions unless specifically indicated otherwise.

[0081] refer to Figure 2 , 812-14, in some example embodiments, the first jaw 502 can include a substantially rigid jaw beam 520 extending generally from the proximal portion 506 (e.g., near the first jaw mount 602) to the distal portion 510 (e.g., near the end 514). Similarly, the second jaw 504 can include a substantially rigid jaw beam 522 extending generally from the proximal portion 508 to the distal portion 512 (e.g., near the end 516). The jaw beams 520, 522 can be constructed of, for example, stainless steel, which can provide desired bending strength, as well as act as a heat sink during some surgical procedures involving ablation. Other biocompatible materials that provide suitable mechanical and thermal properties, such as other metals (e.g., aluminum), can be used for alternative jaw beams.

[0082] In some exemplary embodiments, insulators 524, 526 may be disposed on each respective jaw, such as on the inwardly facing surface of each respective jaw beam 520, 522. Insulators 524, 526 may be constructed of a non-conductive material such as molded plastic. Other biocompatible materials that provide suitable insulating and thermal properties may be used in place of the insulators.

[0083] In some example embodiments, such as example embodiments configured for radio frequency (RF) ablation, the jaws 502, 504 may include one or more electrodes that may be disposed on (e.g., at least partially mounted within) the insulators 524, 526. For example, the electrodes may be bonded to or overmolded into the insulators 524, 526. The first jaw may include one or more elongated, spaced electrodes: a first electrode 528 and / or a second electrode 530. Similarly, the second jaw may include one or more elongated, spaced electrodes: a third electrode 532 and / or a fourth electrode 534. In some example embodiments, the electrodes 528, 530, 532, 534 may be configured to perform bipolar radio frequency ablation of the target tissue 102 clamped between the jaws 502, 504. Each electrode 528, 530, 532, 534 may have a width 536, which may be the width of the tissue-facing surface in a direction generally perpendicular to the local elongated direction of the electrode. In embodiments where each jaw 502, 504 includes more than one electrode 528, 530, 532, 534, the electrodes 528, 530, 532, 534 may be spaced apart by an electrode spacing 538. Each electrode 528, 530, 532, 534 may extend beyond a surface protrusion height 540 of the insulator 524, 526. Each electrode 528, 530, 532, 534 may be spaced apart from its corresponding jaw beam 520, 522 by an insulation depth 542. Each electrode 528, 530, 532, 534 may have an electrode height 572.

[0084] In some example embodiments, the electrode width 536 may be about 0.1 mm to about 2.0 mm. In some example embodiments, the electrode width 536 may be about 0.2 mm to about 0.4 mm. Figure 12-14 In the example embodiment shown, the electrode width 536 may be approximately 0.30 millimeters. In some example embodiments, each electrode 528, 530, 532, 534 may have substantially the same width 536, which may be substantially constant over the length of each electrode 528, 530, 532, 534. In other embodiments, the width 536 may vary over the length of the electrode 528, 530, 532, 534 and / or may differ from electrode 528, 530, 532, 534 to electrode 528, 530, 532, 534.

[0085] In some example embodiments, the electrode spacing 538 may be about 0.1 mm to about 3.0 mm. In some example embodiments, the electrode spacing 538 may be about 0.3 mm to about 0.6 mm. Figure 12-14 In the example embodiment shown, the electrode spacing 538 can be approximately 0.43 millimeters. In some example embodiments, the electrode spacing 538 can be substantially constant over the length of the plurality of electrodes 528, 530, 532, 534, so that the electrodes 528, 530, 532, 534 are substantially parallel in any local area. In other embodiments, the electrode spacing 538 can vary over the length of the plurality of electrodes 528, 530, 532, 534, so that the electrodes 528, 530, 532, 534 can be closer together in some areas and / or farther apart in other areas.

[0086] In some example embodiments, the protrusion height 540 may be about 0.0 mm (e.g., flush) to about 0.5 mm. In some example embodiments, the protrusion height 540 may be about 0.1 mm to about 0.2 mm. Figure 12-14 In the example embodiment shown, the protrusion height 540 may be approximately 0.15 millimeters. In some example embodiments, the protrusion height 540 may be substantially constant over the length of a particular electrode 528, 530, 532, 534 and / or may be substantially the same for two or more electrodes 528, 530, 532, 534. In other embodiments, the protrusion height 540 may vary over the length of an electrode 528, 530, 532, 534 and / or from electrode 528, 530, 532, 534 to electrode 528, 530, 532, 534.

[0087] In some example embodiments, the insulation depth 542 may be about 0.1 mm to about 5.0 mm. In some example embodiments, the insulation depth 542 may be about 0.8 mm to about 1.6 mm. Figure 12-14 In the example embodiment shown, the insulation depth 542 may be approximately 1.25 millimeters. In some example embodiments, the insulation depth 542 may be substantially constant over the length of a particular electrode 528, 530, 532, 534, and / or may be substantially the same for two or more electrodes 528, 530, 532, 534. In other embodiments, the insulation depth 542 may vary over the length of an electrode 528, 530, 532, 534 and / or from electrode 528, 530, 532, 534 to electrode 528, 530, 532, 534.

[0088] In some example embodiments, the electrode height 572 may be about 0.25 mm to about 3.0 mm. In some example embodiments, the electrode height 572 may be about 0.3 mm to about 0.7 mm. Figure 12-14 In the example embodiment shown, the electrode height 572 may be approximately 0.5 millimeters. In some example embodiments, the electrode height 572 may be substantially constant over the length of a particular electrode 528, 530, 532, 534 and / or may be substantially the same for two or more electrodes 528, 530, 532, 534. In other embodiments, the electrode height 572 may vary over the length of an electrode 528, 530, 532, 534 and / or from electrode 528, 530, 532, 534 to electrode 528, 530, 532, 534.

[0089] In some exemplary embodiments, the electrodes 528, 520, 532, 534 may extend substantially the entire length of the jaws 502, 504 between the head 402 and the tips 514, 516. Figure 2 , 12 13, the electrodes 528, 520, 532, 534 may be approximately 105 mm long. In an alternative exemplary embodiment having a shorter jaw, the electrodes 528, 520, 532, 534 may be approximately 86 mm long.

[0090] U.S. Patent No. 9,924,998, entitled “Ablation System, Clamp and Method of Use”, issued on March 27, 2018, is incorporated herein by reference and describes various devices and methods related to tissue ablation using radiofrequency energy, some of which may be used in conjunction with some example embodiments according to at least some aspects of the present disclosure. In general, reducing the electrode spacing 538 can result in narrower lesions and / or faster ablation. In general, increasing the insulation depth 542 can result in narrower lesions, faster ablation, and / or lower energy per unit volume.

[0091] In some example embodiments according to at least some aspects of the present disclosure, the jaws 502, 504 of the clamp 100 can be configured to facilitate positioning near and engaging with a particular target tissue 102 in a desired manner. For example, the shape of the clamp 502 between the first end 506, 508 near the head 402 and the ends 514, 516 can be selected based on the target tissue 102 and / or the location of the target tissue 102 relative to other anatomical structures. As described in detail below, some example clamps 100 can be used to create lesions around the pulmonary veins, which are generally located on the posterior portion of the heart. When approaching the heart via a median sternotomy, creating lesions around the pulmonary veins may require positioning the clamp 100 at least partially around the posterior portion of the heart while engaging the left atrium and avoiding nearby structures that will not be ablated.

[0092] refer to Fig.12 and 13 In some example embodiments, the jaws 502, 504 may be formed of one or more substantially straight (e.g., substantially linear) portions 544, 546, 548, 550, 552, 554, which may be interspersed with one or more substantially curved or bent portions 556, 558, 560, 562. For example, in the first jaw 502, a first substantially straight portion 544 may extend from the first end 506 to the first curved portion 556. A second substantially straight portion 546 may extend from the first curved portion 556 to the second curved portion 558. A third substantially straight portion 548 may extend from the second curved portion 558 to the second end 510. In some example embodiments, each of the substantially straight portions 544, 546, 548 may be oriented obliquely (e.g., non-parallel and non-perpendicular) relative to each of the other substantially straight portions 544, 546, 548. For example, the angle 564 between the first substantially straight portion 544 and the second substantially straight portion 546 may be about 110 degrees to about 150 degrees, and / or the angle 566 between the second substantially straight portion 546 and the third substantially straight portion 548 may be about 110 degrees to about 150 degrees. Fig.12 In the example embodiment shown, portion 544 may have a length of approximately 2.9 centimeters, portion 546 may have a length of approximately 5.0 centimeters, portion 548 may have a length of approximately 2.8 centimeters, angle 564 may be approximately 128 degrees and / or angle 566 may be approximately 133 degrees.

[0093] Similarly, in the second jaw 504, a first substantially straight portion 550 may extend from the first end 508 to a first curved portion 560. A second substantially straight portion 552 may extend from the first curved portion 560 to the second curved portion 562. A third substantially straight portion 554 may extend from the second curved portion 562 to the second end 512. In some example embodiments, each of the substantially straight portions 550, 552, 554 may be oriented obliquely (e.g., non-parallel and non-perpendicular) relative to each of the other substantially straight portions 550, 552, 554. For example, an angle 568 between the first substantially straight portion 550 and the second substantially straight portion 552 may be approximately 110 degrees to approximately 150 degrees, and / or an angle 570 between the second substantially straight portion 552 and the third substantially straight portion 554 may be approximately 110 degrees to approximately 150 degrees. In Fig.13 In the example embodiment shown, portion 550 may have a length of approximately 2.9 centimeters, portion 552 may have a length of approximately 5.0 centimeters, portion 554 may have a length of approximately 2.8 centimeters, angle 568 may be approximately 128 degrees and / or angle 570 may be approximately 133 degrees.

[0094] In an alternative example embodiment having a shorter jaw, portion 544 may have a length of less than about 2.9 centimeters, portion 546 may have a length of less than about 5.0 centimeters, portion 548 may have a length of less than about 2.8 centimeters, angle 564 may be about 128 degrees and / or angle 566 may be about 133 degrees. Similarly, portion 550 may have a length of less than about 2.9 centimeters, portion 552 may have a length of less than about 5.0 centimeters, portion 554 may have a length of less than about 2.8 centimeters, angle 568 may be about 128 degrees and / or angle 570 may be about 133 degrees.

[0095] In some example embodiments, first jaw 502 and second jaw 504 may be shaped generally as mirror images of each other, which may facilitate clamping target tissue 102 between jaws 502, 504 over any portion of the length of jaws 502, 504. In other embodiments, first jaw 502 and second jaw 504 may have different sizes.

[0096] refer to Figure 3-5, 12 and 13, in some example embodiments, the respective substantially straight portions 544, 546, 548 associated with the first jaw 502 may be substantially coplanar (e.g., they may be substantially located in the same plane). Similarly, the respective substantially straight portions 550, 552, 554 associated with the second jaw 504 may be substantially coplanar. In other example embodiments, at least one of the substantially straight portions 544, 546, 548, 550, 552, 554 associated with a particular jaw 502, 504 may be substantially non-coplanar relative to another substantially straight portion 544, 546, 548, 550, 552, 554 associated with the particular jaw 502, 504.

[0097] In some example embodiments, the first and third substantially straight portions 544, 548, 550, 554 of each jaw 502, 504 can help position the clamp 100 at a desired location on the patient's anatomy. For example, the first and third substantially straight portions 544, 548, 550, 554 of each jaw 502, 504 can help position the clamp 100 on the posterior side of the heart (e.g., on the left atrium) because they can be pointed slightly anteriorly. The more convex anterior orientation of the first and third substantially straight portions 544, 548, 550, 554 can improve positioning of the clamp 100 around the heart from an anterior surgical entry location (e.g., a median sternotomy) compared to a fully curved jaw.

[0098] In some example embodiments, the second substantially straight portion 546, 552 of each jaw 502, 504 can facilitate the desired engagement of the clamp 100 with the target tissue. For example, the second substantially straight portion 546, 552 of each jaw 502, 504 can facilitate engagement of the clamp 100 with the left atrium (e.g., generally around the pulmonary veins). Compared to some fully curved clamps, the second substantially straight portion 546, 552 can engage the left atrium in a straight manner generally between the right and left pulmonary veins, which can position the clamping (and ablation) location on the left atrium generally anteriorly and / or can facilitate formation of an effective transmural lesion. In addition, compared to some fully curved clamps, the second substantially straight portion 546, 552 is less likely to slip off the back of the left atrium.

[0099] refer to Figure 1-5 , 12 and 13, in some example embodiments, the jaws 502, 504 may be generally disposed distally on the head 402 and / or may be generally oriented laterally from the head 402 (e.g., generally from the first end 506, 508 to the second end 510, 512). For example, the second substantially straight portion 546, 552 of each jaw 502, 504 may be oriented approximately perpendicular to the axis 300. Figure 1-5, 12, and 13, in the closed position, the second substantially straight portions 546, 552 can be oriented at an angle of approximately 98 degrees relative to the shaft 300. In alternative example embodiments including shorter jaws, in the closed position, the second substantially straight portions 546, 552 can be oriented at an angle of approximately 98 degrees relative to the shaft 300. In some other embodiments, in the closed position, the second substantially straight portions 546, 552 can be oriented at an angle of approximately 45 degrees to approximately 135 degrees relative to the shaft 300. In other example embodiments, the jaws 502, 504 can be oriented at other angles relative to the shaft 300, such as being generally in line with the shaft 300 (e.g., extending generally directly distally).

[0100] Fig.15 is a perspective view of an example guide 700, Fig.16 is a perspective view of an example guide 700 attached to the ends 514, 516 of the jaws 502, 504 of the clamp 100, and Fig.17 is a detailed exploded perspective view of an example guide connector 708, all of which are in accordance with at least some aspects of the present disclosure. Fig.17 Certain components associated with the guide connector 708 associated with the first end 704 of the guide 700 are shown, but the guide connector 710 associated with the second end 706 may include similar components unless specifically indicated otherwise.

[0101] refer to Figure 15-17 In some example embodiments, the guide 700 may include an elongated flexible guide body 702 extending between a first end 704 and a second end 706. In some example embodiments, the guide body 702 may be generally tubular. In some example embodiments, the guide body 702 may have a diameter of about 2.0 mm to about 10.0 mm. In some example embodiments, the guide body 702 may have a length of about 30 cm to about 180 cm. Figure 15-17 In the illustrated embodiment, the guide body 702 can have a diameter of about 5 millimeters and / or can have a length of about 80 centimeters. The guide body 702 can be made of a thermoplastic elastic polymer such as a thermoplastic vulcanizate (TPV) (e.g., SANTOPRENE). Other potentially suitable materials for the guide body 702 include biocompatible materials having appropriate strength, flexibility, and anti-kink properties.

[0102] In some example embodiments, one or more of the ends 704, 706 may have a corresponding guide connector 708, 710 disposed thereon. In some example embodiments, the guide connectors 708, 710 may be configured to releasably couple to each other, thereby forming the guide 700 into a closed loop. In some example embodiments, the guide connectors 708, 710 may be configured to releasably couple to the ends 514, 516 of the jaws 502, 504 of the clamp 100 (see Fig.16 ).

[0103] refer to Fig.17 , the example guide connector 708 can include a permanent magnet 712, which can be contained between a coupler 714 and a cover 716. For example, the cover 716 can be in the form of a generally hollow cylinder having a closed distal end and sized to receive the magnet 712 therein. A proximal surface 718 of the cover 716 can be permanently attached to a distal surface 720 of the coupler 714, such as by welding, which can securely contain the magnet 712 within the cover 716. A proximal portion 722 of the coupler 714 can be permanently fixed within a cavity 724 at the first end 704 of the guide body 702.

[0104] In some example guides 700 that utilize magnets 712 in the guide connectors 708, 710 of the guide, the magnets can be oriented so that the guide connectors 708, 710 will magnetically couple to each other, thereby allowing the guide 700 to form a complete closed loop. For example, the magnet 712 in the guide connector 708 at the first end 704 can be oriented so that its north pole faces distally (e.g., away from the guide body 702). The magnet 712 in the guide connector 710 at the second end 706 can be oriented so that its south pole faces distally (e.g., away from the guide body 702). Therefore, the farthest ends of the magnets 712 will attract each other, rather than repel each other.

[0105] In some example embodiments, the guide connectors 708, 710 can be configured to magnetically releasably couple to the ends 514, 516 of the jaws 502, 504 of the clamp 100. For example, at least a portion of the jaws 502, 504 can be comprised of a ferromagnetic material that is attracted to the magnets 712 in the guide connectors 708, 710. In some example embodiments, the guide connectors 708, 710 can be configured to mechanically releasably couple to the ends 514, 516 of the jaws 502, 504 of the clamp 100, such as by frictional engagement, an engagement latch, a snap feature, etc. Additionally, some embodiments can utilize both mechanical and magnetic couplings. For example, referring to Figure 8 and 15-17, the ends 514, 516 may include an open-ended hollow portion that may receive at least a portion of the cover 716 of the guide connector 708, 710 therein. The ends 514, 516 may mechanically prevent lateral movement of the guide connector 708, 710, and the guide connectors may be magnetically retained within the ends 514, 516 by their attraction to the metal of the clamp beams 520, 522.

[0106] Figure 18-24 is a simplified rear perspective view of a heart 800 illustrating example operations using a guide 700 and / or a clamp 100, all in accordance with at least some aspects of the present disclosure. While the following description focuses on using a guide 700 to help position a clamp 100 to form a "box lesion" around all four pulmonary veins in a single clamp and ablation operation as only one example, one skilled in the art will recognize that the various steps and methods described below can be used in conjunction with a guide 700 and / or a clamp 100 for other clamp and / or ablation operations.

[0107] refer to Fig.18 In one example method, the first end 704 of the guide 700 can be introduced behind the heart 800, for example generally through the oblique sinus 802 between the inferior vena cava 804 and the right pulmonary vein 806. This can include dissecting through the pericardial reflection between the right pulmonary vein 806 and the inferior vena cava 804.

[0108] refer to Fig.19 In one example method, the second end 706 of the guide 700 may be guided to the rear of the heart 800, such as midway through the transverse sinus 808 between the right pulmonary vein 806 and the superior vena cava 810. This may include dissecting through the pericardial reflection between the right pulmonary vein 806 and the superior vena cava 810. The second end 706 may then be guided generally anteriorly between the superior vena cava 810 and the aorta 812.

[0109] refer to Fig. 20 In an example method, the second end 706 of the guide 700 may be directed through the remainder of the transverse sinus 808 generally between the aorta 812 and the left pulmonary vein 814 .

[0110] refer to Fig.21 In one example method, the first end 704 and the second end 706 can be releasably coupled so that the guide 700 generally forms a complete loop around the pulmonary veins 806, 814. For example, the guide connectors 708, 710 ( Fig.15 and 17 ) can be releasably connected to each other (e.g., magnetically connected).

[0111] refer to Fig. 22 In one example method, the guide 700 (e.g., as a complete loop) can be pulled generally toward the patient's right side and / or can be rotated such that the guide 700 extends forward from the posterior portion of the heart 800 with the releasably coupled ends 704, 706 extending generally to the patient's right side.

[0112] refer to Fig.23 In an example method, the releasably coupled ends 704, 706 of the guide 700 can be disconnected from each other. The first end 704 of the guide can be releasably connected to the end 514 of the first jaw 502 of the clamp 100. The second end 706 of the guide 700 can be releasably connected to the end 516 of the second jaw 504 of the clamp 100.

[0113] refer to Fig.24 In one example method, the guide 700 may be pulled generally toward the left side of the patient, which may pull the jaws 502, 504 of the clamp 100 to a position near the pulmonary veins 806, 814 and / or the left atrium 816. The clamp 100 may be inserted generally from the anterior right side of the patient's heart 800. The handle 200 may be generally located anteriorly, and the shaft 300 may extend generally posteriorly along the right side of the heart 800. The head 402 may be located on the right posterior side of the heart 800, generally to the right side of the right pulmonary vein 806. The tips 514, 516 of the clamps 502, 504 may generally reach the left side of the left pulmonary vein 814. The first clamp 502 may extend generally from right to left, generally in front of and above the pulmonary veins 806, 814, and to the rear of the superior vena cava 810 and the aorta 812 (e.g., generally through the transverse sinus 808). The second clamp 504 can extend generally from right to left, generally in front of and below the pulmonary veins 806, 814, and above the inferior vena cava 804 (eg, generally through the oblique sinus 802).

[0114] Fig.25 800, showing an example clamp 100 according to at least some aspects of the present disclosure. The clamp 100 can be positioned so that the left atrium 816 ( Fig.24 ) is clamped between the clamps 502, 504, while the clamps 502, 504 do not engage the right atrium. The ends 514, 516 of the clamps 502, 504 can be generally located in front of the left pulmonary vein 814. The clamps 502, 504 can be generally behind the left atrial appendage 818.

[0115] Fig.26 is a schematic posterior view of the left atrium 816 of the heart 800 showing an example box lesion 820, Fig. 27is a schematic posterior view of the left atrium 816 of the heart 800 showing example pulmonary vein isolation lesions 822, 824, and Fig.28 is a schematic posterior view of the left atrium 816 of the heart 800, showing an example figure-of-eight lesion 826 (e.g., including overlapping lesions 828, 830), all of which are in accordance with at least some aspects of the present disclosure. Figure 18-25 The described surgery can be used to produce Fig.26 box-shaped lesion 820, for example in a single clamping and ablation step. Alternatively, a similar procedure can be used to create Fig. 27 Pulmonary vein isolation injury 822, 824 and / or Fig.28 Figure 8 injury 826. Typically, these alternative procedures may include two or more clamping and ablation steps, such as one from a left approach and one from a right approach, wherein only a portion of the left atrium 816 is clamped and ablated at a time. In some such procedures, the clamp 100 may be extended partially around the heart posteriorly so that the ends 514, 516 of the clamps 502, 504 are located between the left pulmonary vein 814 and the right pulmonary vein 806.

[0116] Some example devices according to at least some aspects of the present disclosure may incorporate an end bias to account for the effect of tissue on the angular relationship of the jaws. For example, closing the jaws of an example clamp on tissue may cause the jaws to flex apart due to bending stresses. As a result, the angular position of the jaws when closed on tissue may be different from the angular position of the jaws when empty and closed. Some example embodiments may account for this difference by, for example, constructing an end effector so that the jaws are slightly non-parallel in the closed position when the jaws are empty. For example, when empty, the ends of the jaws may be offset inwardly from parallel by approximately 0.020 inches in the closed position, which may result in the jaws being substantially parallel in the closed position when tissue is between the jaws. More generally, in some example embodiments, the design of the end effector and jaws may be such that the jaws are substantially parallel when actuated on tissue.

[0117] From the above description and summary of the invention, it will be apparent to one of ordinary skill in the art that, while the methods and apparatus described herein constitute example embodiments according to the present disclosure, it should be understood that the scope of the disclosure contained herein is not limited to the precise embodiments above and may be varied without departing from the scope defined by the following claims. Likewise, it should be understood that it is not necessary to satisfy any or all of the identified advantages or purposes disclosed herein in order to fall within the scope of the claims, as inherent and / or unforeseeable advantages may exist even though they may not be explicitly discussed herein.

[0118] The claims are as follows.

Claims

1. An end effector for a surgical device, the end effector comprising: First clamp; Second clamp; as well as an articulation mechanism operable to move the first jaw between an open position, wherein the first jaw and the second jaw are separated and substantially non-parallel, an intermediate position, wherein the first jaw and the second jaw are separated and substantially parallel, and a closed position, wherein the first jaw and the second jaw are substantially adjacent and substantially parallel; The hinge mechanism comprises a first jaw mount coupled to the first jaw, the first jaw mount being movable along a path, wherein movement of the first jaw mount along the path causes rotation and translation of the first jaw mount and the first jaw to move the first jaw between the open position, the intermediate position, and the closed position, a pivotally mounted crank, the crank comprising a first arm and a second arm, the second arm of the crank being slidably and pivotably coupled to the first jaw mount, the crank operably coupling an actuator linkage to the first jaw mount such that moving the actuator linkage rotates the crank, wherein rotation of the crank moves the first jaw mount along the path; as well as a connecting linkage having a proximal end and a distal end, the proximal end of the connecting linkage being pivotally coupled to the distal end of the actuator linkage and the distal end of the connecting linkage being pivotally coupled to the first arm of the crank, the proximal end of the connecting linkage including a guide slidably disposed in a guide slot, the guide slot being generally linear and oriented generally in line with the actuator linkage; wherein distally / forwardly repositioning the actuator linkage is operable to reduce a spacing between the first jaw and the second jaw; and Wherein, repositioning the actuator linkage proximally / posteriorly is operable to increase the spacing between the first jaw and the second jaw.

2. The end effector according to claim 1, wherein: The path includes at least one straight portion and at least one curved portion.

3. The end effector according to claim 1, wherein the path is at least partially defined by a slot; and The first pin is movably disposed in the slot to move along the path.

4. The end effector according to claim 3, wherein said first jaw mounting member comprises said first pin; and Wherein movement of the first jaw mount along the path includes movement of the first pin along the slot.

5. The end effector according to claim 4, wherein: The first jaw mount also includes a second pin movably disposed in the slot to move along the path.

6. The end effector according to claim 1, wherein the crank comprises a first arm and a second arm; wherein the first arm of the crank is operatively coupled to the actuator linkage; and Wherein the second arm of the crank is slidably and pivotably coupled to the first jaw mount.

7. The end effector according to claim 6, in, The second arm of the crank includes a crank slot and the first jaw mount includes a pin; and Wherein as the crank rotates, the pin moves along the crank slot and the first jaw mount moves along the path.

8. The end effector according to claim 7, wherein the crank slot is substantially straight; and Wherein the crank slot is oriented substantially radially relative to the rotational axis of the crank.

9. The end effector according to claim 1, wherein: Each of the first jaw and the second jaw includes a first end proximal to the hinge mechanism and a second end generally distal to the hinge mechanism, each second end terminating in a respective terminal end.

10. The end effector according to claim 9, wherein: In the open position, the distal end of the first jaw and the distal end of the second jaw are spaced apart and at least partially define an open mouth.

11. The end effector according to claim 9, wherein: Each of the distal ends of the first jaw and the second jaw is configured to releasably couple with at least one of the first end and the second end of the flexible guide.

12. The end effector according to claim 11, wherein: A distal end of the first jaw is configured to magnetically releasably couple with a first end of the flexible guide, and a distal end of the second jaw is configured to magnetically releasably couple with a second end of the flexible guide.

13. The end effector according to claim 1, wherein: Each of the first jaw and the second jaw includes a plurality of substantially straight portions interspersed with curved portions.

14. The end effector of claim 1, wherein: At least one of the first jaw and the second jaw is configured to ablate tissue clamped therebetween.

15. The end effector according to claim 14, wherein: Each of the first jaw and the second jaw includes a pair of elongated, spaced-apart electrodes operatively coupled to a source of radiofrequency energy for ablating tissue clamped between the first jaw and the second jaw.

16. The end effector according to claim 15, wherein: The electrodes in each pair of electrodes are spaced 0.1 mm to 3.0 mm apart.

17. The end effector of claim 1, further comprising a flexible guide, the flexible guide comprising: an elongated guide body including a first end and a second end; a first guide connector disposed on the first end; and a second guide connector disposed on the second end; wherein the first guide connector is selectively releasably connectable to the first jaw; and Wherein the second guide connector is selectively releasably connectable to the second jaw.

18. The end effector according to claim 17, in, The first guide connector includes a first permanent magnet; and The second guiding connector includes a second permanent magnet.

19. The end effector according to claim 18, in, the first guide connector comprising a cover configured to receive the first permanent magnet therein; and Wherein the first permanent magnet is securely contained within a covering of the first guide connector.

20. The end effector according to claim 19, in, the second guide connector comprising a cover configured to receive the second permanent magnet therein; and Wherein the second permanent magnet is securely contained within the cover of the second guide connector.

21. The end effector of claim 17, wherein: The first guide connector is selectively releasably connectable to the first end of the first jaw; and The second guide connector is selectively releasably connectable to the second end of the second jaw.

22. The end effector of claim 17, wherein: The first guide connector is selectively releasably connectable to the second guide connector to form a closed loop.

23. The end effector of claim 18, wherein: The first and second permanent magnets are oriented with opposing poles facing away from the guide body, thereby allowing the first and second guide connectors to magnetically couple to each other to form a closed loop.

24. A surgical device comprising: axis; The end effector according to claim 9, which is disposed at the distal end of the shaft; and a handle disposed at the proximal end of the shaft; wherein the handle includes an actuator operatively coupled to an actuator linkage; and Wherein the actuator linkage extends longitudinally through the shaft to the end effector.

25. The surgical device according to claim 24, wherein the end effector comprises a head portion at least partially containing the articulation mechanism; wherein the first jaw and the second jaw are disposed generally distally on the head; and Wherein the first jaw and the second jaw are oriented generally laterally from the head.

26. A surgical device comprising: a distal handle including an actuator; a shaft extending distally from the handle, the shaft including an actuator linkage extending therethrough, the actuator linkage operatively coupled to the actuator; and An end effector is disposed at the distal end of the shaft, the end effector comprising: head, a first jaw disposed distally on the head, a second jaw disposed distally on the head, and Articulated mechanism, comprising: a connecting linkage including a proximal end and a distal end, the proximal end of the connecting linkage being pivotally coupled to the distal end of the actuator linkage, the proximal end of the connecting linkage including a connecting guide slidably disposed in a guide slot, the guide slot being generally linear and oriented to be generally in line with the actuator linkage, a crank comprising a first arm and a second arm, the first arm being pivotally coupled to the distal end of the connecting linkage, and a first jaw mount rigidly attached to the first jaw, the first jaw mount being pivotably and slidably coupled to the second arm of the crank; Wherein moving the actuator distally on the handle is operable to move the actuator linkage distally and move the first jaw from an open position to a closed position, wherein the first jaw and the second jaw are separated and substantially non-parallel, and wherein the first jaw and the second jaw are substantially adjacent and substantially parallel.

27. The surgical device of claim 26, wherein: The first jaw mount is movable along a path, wherein movement of the first jaw mount along the path causes rotation and translation of the first jaw mount and the first jaw to move the first jaw from the open position to the closed position.

28. The surgical device of claim 27, wherein: Rotation of the crank moves the first jaw mount along the path.

29. The surgical device of claim 26, wherein: The first jaw and the second jaw extend generally transversely relative to the shaft.

30. The surgical device according to claim 26, in, The second arm of the crank includes a crank slot and the first jaw mount includes a pin; and As the crank rotates, the pin moves along the crank slot.

31. The surgical device of claim 26, wherein: An actuator includes a plunger that is depressed distally to move the first jaw from the open position to the closed position.

32. The surgical device of claim 26, wherein: The shaft is substantially rigid.

33. The surgical device of claim 26, wherein: At least a portion of the shaft is bendable.

34. The surgical device of claim 26, wherein: The axis is substantially straight.

35. The surgical device of claim 26, wherein each of the first jaw and the second jaw terminates in a respective distal end; and in, In the open position, the distal end of the first jaw and the distal end of the second jaw are spaced apart and at least partially define an open mouth.

36. The surgical device of claim 35, wherein: The distal end of the first jaw and the distal end of the second jaw are configured to releasably couple to respective ends of an elongated flexible guide.

37. The surgical device of claim 26, wherein: Each of the first jaw and the second jaw includes a plurality of substantially straight portions interspersed with curved portions.

38. The surgical device of claim 26, wherein each of the first jaw and the second jaw comprises at least one electrode operatively coupled to a source of radio frequency energy for ablating tissue clamped between the first jaw and the second jaw.

39. The surgical device of claim 26, further comprising a flexible guide, the flexible guide comprising: an elongated guide body including a first end and a second end; a first guide connector disposed on the first end; and a second guide connector disposed on the second end; wherein the first guide connector is selectively releasably connectable to the first jaw; and Wherein the second guide connector is selectively releasably connectable to the second jaw.

40. The surgical device according to claim 39, in, The first guide connector includes a first permanent magnet; and The second guiding connector includes a second permanent magnet.

41. The surgical device according to claim 40, in, the first guide connector comprising a cover configured to receive the first permanent magnet therein; and Wherein the first permanent magnet is securely contained within a covering of the first guide connector.

42. The surgical device according to claim 41, in, the second guide connector comprising a cover configured to receive the second permanent magnet therein; and Wherein the second permanent magnet is securely contained within the cover of the second guide connector.

43. The surgical device of claim 39, wherein: The first guide connector is selectively releasably connectable to the first end of the first jaw; and The second guide connector is selectively releasably connectable to the second end of the second jaw.

44. The surgical device of claim 39, wherein: The first guide connector is selectively releasably connectable to the second guide connector to form a closed loop.

45. The surgical device of claim 40, wherein: The first and second permanent magnets are oriented with opposing poles facing away from the guide body, thereby allowing the first and second guide connectors to magnetically couple to each other to form the guide into a closed loop.

46. ​​A surgical device comprising: a shaft including an actuator linkage extending therethrough, the actuator linkage being operatively coupled to the actuator; and an end effector disposed at a distal end of the shaft, the end effector including a head, the head including an articulation mechanism operable to distally move the actuator linkage and the first jaw from an open position in which the first jaw and the second jaw are separated and substantially non-parallel to a closed position in which the first jaw and the second jaw are substantially adjacent and substantially parallel; wherein each of the first jaw and the second jaw includes a first substantially straight portion proximal to the head, a second substantially straight portion, a third substantially straight portion distal to the head, a first curved portion between the first substantially straight portion and the second substantially straight portion, and a second curved portion between the second substantially straight portion and the third substantially straight portion; wherein each of the first jaw and the second jaw terminates proximate a respective end of the third substantially straight portion; and wherein, in the open position, the distal end of the first jaw and the distal end of the second jaw are spaced apart and at least partially define an open mouth; Wherein, the articulated mechanism comprises: a connecting linkage having a proximal end and a distal end, the proximal end of the connecting linkage being pivotally coupled to the distal end of the actuator linkage, the proximal end of the connecting linkage comprising a connecting guide slidably disposed in a guide slot, the guide slot being generally linear and oriented to be generally in line with the actuator linkage, a pivotably mounted crank comprising a first arm and a second arm, the first arm being pivotally coupled to the distal end of the connecting linkage, and A first jaw mount is rigidly attached to the first jaw, the first jaw mount being pivotably and slidably connected to the second arm of the crank.

47. The surgical device of claim 46, wherein the articulation mechanism is operable to rotate and translate the first jaw between the open position, an intermediate position, and the closed position, wherein the first jaw and the second jaw are separated and substantially parallel.

48. The surgical device of claim 46, wherein: The first substantially straight portion, the second substantially straight portion, and the third substantially straight portion of the first jaw are oriented obliquely relative to each other.

49. The surgical device of claim 46, wherein: The first substantially straight portion, the second substantially straight portion, and the third substantially straight portion of the second jaw are oriented obliquely relative to each other.

50. The surgical device of claim 46, wherein: The first substantially straight portion, the second substantially straight portion, and the third substantially straight portion of the first jaw are substantially coplanar.

51. The surgical device of claim 46, wherein: The first substantially straight portion, the second substantially straight portion, and the third substantially straight portion of the second jaw are substantially coplanar.

52. The surgical device of claim 51, wherein: The first substantially straight portion, the second substantially straight portion, and the third substantially straight portion of the second jaw are substantially coplanar with the axis.

53. The surgical device of claim 46, wherein: The second substantially straight portion of the first jaw is longer than at least one of the first substantially straight portion of the first jaw and the second substantially straight portion of the first jaw.

54. The surgical device of claim 53, wherein: The second substantially straight portion of the first jaw is longer than both the first substantially straight portion of the first jaw and the second substantially straight portion of the first jaw.

55. The surgical device of claim 46, wherein the first jaw and the second jaw are generally disposed distally on the head; and Wherein the first jaw and the second jaw are oriented generally laterally from the head.

56. The surgical device of claim 55, wherein: In the closed position, the second substantially straight portion of the first jaw is oriented approximately perpendicular to the axis.

57. The surgical device of claim 46, wherein: In the closed position, the first substantially straight portion of the first jaw extends distally and laterally generally diagonally away from the head.

58. The surgical device of claim 46, wherein: A third substantially straight portion of the first jaw extends generally diagonally proximally and laterally away from the second curvilinear portion.

59. The surgical device of claim 46, wherein: The second jaw is rigidly disposed relative to the shaft.

60. The surgical device of claim 59, wherein: The first substantially straight portion, the second substantially straight portion, and the third substantially straight portion of the second jaw are substantially coplanar with the axis.

61. The surgical device of claim 46, further comprising a handle disposed proximally on the shaft, the handle comprising the actuator operatively connected to the articulation mechanism.

62. The surgical device of claim 46, wherein: The distal end of the first jaw and the distal end of the second jaw are configured to releasably couple to respective ends of an elongated flexible guide.

63. The surgical device of claim 46, wherein: Each of the first jaw and the second jaw includes at least one electrode operatively coupled to a source of radio frequency energy for ablating tissue clamped between the first jaw and the second jaw.

64. The surgical device of claim 46, wherein: the first jaw mount being movable along a path, wherein movement of the first jaw mount along the path causes rotation and translation of the first jaw mount and the first jaw to move the first jaw between the open position and the closed position; and The crank operably couples an actuator linkage to the first jaw mount such that moving the actuator linkage rotates the crank, wherein rotation of the crank moves the first jaw mount along the path.

65. The surgical device of claim 46, further comprising a flexible guide, the flexible guide comprising: an elongated guide body including a first end and a second end; a first guide connector disposed on the first end; and a second guide connector disposed on the second end; wherein the first guide connector is selectively releasably connectable to the first jaw; and Wherein the second guide connector is selectively releasably connectable to the second jaw.

66. The surgical device according to claim 65, in, The first guide connector includes a first permanent magnet; and The second guiding connector includes a second permanent magnet.

67. The surgical device according to claim 66, in, the first guide connector comprising a cover configured to receive the first permanent magnet therein; and Wherein the first permanent magnet is securely contained within a covering of the first guide connector.

68. The surgical device according to claim 67, in, the second guide connector comprising a cover configured to receive the second permanent magnet therein; and Wherein the second permanent magnet is securely contained within the cover of the second guide connector.

69. The surgical device of claim 65, wherein: The first guide connector is selectively releasably connectable to the first end of the first jaw; and The second guide connector is selectively releasably connectable to the second end of the second jaw.

70. The surgical device of claim 65, wherein: The first guide connector is selectively releasably connectable to the second guide connector to form a closed loop.

71. The surgical device of claim 66, wherein: The first and second permanent magnets are oriented with opposing poles facing away from the guide body, thereby allowing the first and second guide connectors to magnetically couple to each other to form a closed loop.

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