Clip applier

Abstract

To provide a clip applier that may be configured to apply a surgical clip.SOLUTION: A clip applier may include a first jaw member and a second jaw member, where the first jaw member is configured to pivot between an open configuration and a closed configuration. The clip applier may also include a first leaf spring configured to bias the first jaw member into the open configuration, and a tubular member configured to advance over the first jaw member to cam the first jaw member into a closed configuration against the bias of the first leaf spring. The clip applier may further include a second leaf spring configured to bias the second jaw member into an open configuration, and a tubular member configured to advance over the second jaw member to cam the second jaw member into a closed configuration against the bias of the second leaf spring.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] [Priority] This application claims the benefit of priority to U.S. Provisional Patent Application No. 62 / 906,585 (filed September 26, 2019), the disclosure of which is incorporated herein by reference in its entirety.

[0002] The present disclosure relates generally to clip appliers, and more particularly, to clip appliers having improved actuation mechanisms and / or stabilizing members configured to stabilize a surgical clip. [Background technology]

[0003] Ligation of tissue (e.g., blood vessels, lymph nodes, nerves, fallopian tubes, and cardiac tissue) is a common task across many surgical procedures. This can be performed by closing the vessel with a surgical clip or by suturing the vessel with a surgical thread. The use of surgical thread requires a combined manipulation of needle and surgical thread to form the knot required to secure the vessel. Such combined manipulation is time consuming and difficult to perform, especially in endoscopic procedures characterized by limited space and / or visibility. In contrast, surgical clips are relatively quick and easy to apply. Thus, the use of surgical clips in endoscopic and open procedures has expanded exponentially. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] U.S. Patent No. 6,880,699 [Patent Document 2] U.S. Pat. No. 4,834,096 Summary of the Invention [Problem to be solved by the invention]

[0005] The present inventors have recognized that a need exists for improving one or more features of clip appliers, such as the stability of a surgical clip within the clip applier and / or the ease of actuation. Surgical clips are often applied by clip appliers having a pair of opposing jaws. Currently available clip appliers often secure the clip using two contact points, for example, the opposing jaws can engage a boss on a distal end of the surgical clip. However, the two contact points do not provide sufficient stability to the surgical clip, which may cause the surgical clip to become misaligned or even fall off the clip applier during a surgical procedure. Furthermore, existing clip appliers often do not provide sufficient closing force and / or reliable opening of the jaws. The disclosed methods and systems are directed to alleviating or overcoming one or more of the above-listed problems and / or other problems of the prior art. [Means for solving the problem]

[0006] A first aspect of the invention is directed to a clip applier configured to apply a surgical clip. The clip applier can include a first jaw member and a second jaw member. The first jaw member can include a first inner surface and a first stabilizing member extending from the first inner surface and can be configured to engage a distal portion of a first leg member of a surgical clip. The second jaw member can include a second inner surface and a second stabilizing member extending from the first inner surface. The second jaw member can be configured to engage a distal portion of a second leg member of a surgical clip. The first and second stabilizing members can be configured to be positioned laterally of a proximal portion of a surgical clip to reduce lateral movement of the surgical clip.

[0007] A second aspect of the invention is directed to an assembly including a surgical clip having a first leg member and a second leg member and a clip applier. The clip applier can include a first jaw member and a second jaw member. The first jaw member can include a first inner surface and a first stabilizing member extending from the first inner surface and can be configured to engage a distal portion of the first leg member of the surgical clip. The second jaw member can include a second inner surface and a second stabilizing member extending from the first inner surface. The second jaw member can be configured to engage a distal portion of the second leg member of the surgical clip. The first stabilizing member and the second stabilizing member can be configured to be positioned laterally of a proximal portion of the surgical clip to reduce lateral movement of the surgical clip.

[0008] In some embodiments, an inner portion of the first stabilizing member is spaced apart from the second jaw member in the open configuration and an inner portion of the second stabilizing member is spaced apart from the first jaw member in the open configuration. In some embodiments, the first jaw member has a first channel on a first inner surface and the second jaw member has a second channel on a second inner surface, the first channel does not receive the second stabilizing member in the open configuration, the first channel receives the second stabilizing member in the closed configuration, the second channel does not receive the first stabilizing member in the open configuration and the second channel receives the first stabilizing member in the closed configuration. In some embodiments, the first channel has a widened proximal portion configured to receive the second stabilizing member and the second channel has a widened proximal portion configured to receive the first stabilizing member. In some embodiments, the first stabilizing member includes a first wall extending longitudinally along the first inner surface, and the second stabilizing member includes a second wall extending longitudinally along the second inner surface, the first wall and the second wall being disposed laterally of a longitudinal axis of the clip applier. In some embodiments, the first stabilizing member and the second stabilizing member each have at least one substantially flat outer side surface. In some embodiments, the first stabilizing member and the second stabilizing member extend substantially parallel in the open configuration and the closed configuration. In some embodiments, the first stabilizing member and the second stabilizing member overlap laterally in the closed configuration. In some embodiments, the first stabilizing member and the second stabilizing member do not overlap laterally in the open configuration. In some embodiments, the first stabilizing member and the second stabilizing member each have an inner portion defining an apex extending distally in the open configuration. In some embodiments, the first inner surface has at least one first recess on a distal portion configured to receive a first boss on a first leg member of the surgical clip, and the second inner surface has at least one second recess on a distal portion configured to receive a second boss on a second leg member of the surgical clip. In some embodiments, the first stabilizing member is integral with the first jaw member and the second stabilizing member is integral with the second jaw member. In some embodiments, the first stabilizing member and the second stabilizing member are configured to not be in proximal contact with the proximal end of the surgical clip in the open configuration.

[0009] A third aspect of the invention is directed to a clip applier configured to apply a surgical clip. The clip applier can include a first jaw member and a second jaw member, the first jaw member configured to pivot between an open configuration and a closed configuration. The clip applier can also include a leaf spring configured to bias the first jaw member to the open configuration and a tubular member configured to advance over the first jaw member to cam the first jaw member to the closed configuration against the bias of the leaf spring.

[0010] In some embodiments, the clip applier has a second leaf spring configured to bias the second jaw member to an open configuration, the second jaw member configured to pivot between an open configuration and a closed configuration, and the tubular member configured to advance over the second jaw member to cam the second jaw member to the closed configuration against the bias of the second leaf spring. In some embodiments, the leaf spring overlaps a proximal portion of the first jaw member to bias the first jaw member to the open configuration, and the second leaf spring overlaps a proximal portion of the second jaw member to bias the second jaw member to the open configuration. In some embodiments, the proximal portion of each of the first and second jaw members includes a proximal extension that is angled relative to a longitudinal axis of the clip applier. In some embodiments, the proximal extension extends from only one lateral side of each of the first and second jaw members. In some embodiments, each of the first and second jaw members has a proximal portion and a distal portion, the proximal portion having a width less than the distal portion and configured to be received in the tubular member. In some embodiments, the clip applier has a connector disposed on the tubular member, and the leaf spring and the second leaf spring are disposed on opposite lateral sides of the connector. In some embodiments, the proximal portion of the leaf spring and the proximal portion of the second leaf spring are secured to the connector. In some embodiments, at least one of the first and second jaw members is pivotally coupled to the connector. In some embodiments, the first jaw member is pivotally coupled to the connector at a first pivot pin, and the second jaw member is pivotally coupled to the connector at a second pivot pin. In some embodiments, the proximal portion of at least one of the first and second jaw members straddles a distal portion of the connector. In some embodiments, the tubular member includes a distal portion and a proximal portion, the distal portion having a larger diameter than the proximal portion, the distal portion configured to cam the first and second jaw members into the closed configuration. In some embodiments, the connector has a pin and the tubular member has an elongated slot, the pin progressing through the elongated slot as the tubular member is advanced. In some embodiments, the pin of the connector is secured to a shaft that receives the tubular member.In some embodiments, the clip applier includes a shaft, a handle assembly on a proximal end of the shaft, and an actuator extending through the shaft and actuated by the handle assembly, the actuator configured to advance through the shaft to advance a tubular member over the first and second jaw members.

[0011] In order that the present disclosure may be readily understood, aspects of the disclosure are shown by way of example in the accompanying drawings. [Brief description of the drawings]

[0012] [Figure 1] 1A-1D illustrate an exemplary embodiment of a clip applier of the present disclosure. [Diagram 2] FIG. 2 is a perspective view of a distal end effector of the clip applier of FIG. 1 . [Diagram 3] FIG. 3 is a front view of the distal end effector of FIG. 2. [Figure 4] FIG. 4 is a side view of the distal end effector of FIGS. 2-3 with an exemplary surgical clip attached. [Diagram 5] FIG. 5 is a perspective view of the distal end effector of FIGS. 2-4 with an exemplary surgical clip attached. [Figure 6] FIG. 6 is a side view of the clip applier of FIGS. 1-5 in an open configuration. [Figure 7] FIG. 7 is a side view of the clip applier of FIGS. 1-6 in a closed configuration. [Figure 8] FIG. 8 is a top view of the clip applier of FIGS. 1-7 in a closed configuration with the overtube removed. [Figure 9] FIG. 9 is a side view of the clip applier of FIGS. 1-8 in a closed configuration with the shaft removed.

[0013] The same or similar reference numbers are used in the drawings and the following detailed description to refer to the same or similar parts. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0014] The invention will now be described below with reference to the figures in which like reference numbers refer to like parts throughout. By conventional convention, as used herein and unless otherwise indicated herein, the term "proximal" refers to the relative positioning of the clip applier or component generally closer to the user or medical personnel handling or manipulating the device with which it is intended to be used, and the term "distal" refers to the relative positioning of the clip applier or component further from the user or medical personnel handling or manipulating the device with which it is intended to be used. The term "vertical" refers to the relative orientation of the clip applier parallel to or along a plane that extends uniformly through both jaw members to the component. The term "longitudinal" refers to the relative orientation along the longitudinal axis or length of the clip applier or component. The term "lateral" refers to the relative orientation parallel to or along a plane that extends vertically between the first and second jaw members to the component with which it is intended to be used.

[0015] FIG. 1 illustrates an exemplary clip applier 100 having a jaw assembly 102, a shaft 104, and a handle assembly 106. The jaw assembly 102 can include a first jaw member 110 and a second jaw member 112 pivotally coupled at a distal portion of the shaft 104 and actuable by longitudinal movement of an overtube or tubular member 114. Movement of the tubular member 114 can be caused by relative movement of a first handle member 116 and a second handle member 118. For example, the first handle member 116 can be fixed and the second handle member 118 can be pivotally movable on a pivot pin such that pivotal rotation of the second handle member 118 relative to the first handle member 116 can cause longitudinal advancement of the tubular member 114. The tubular member 114 can include a camming surface at a distal end of the tubular member 114 that cams the first and second jaw members 110, 112 into a closed configuration. The clip applier 100 may be a manual clip applier in which a user or medical personnel front-loads the surgical clips 50 from a clip cartridge into the jaw assembly 102 and individually applies each of the surgical clips 50 to tissue after each load. Further disclosure of the manual loading of the clip applier 100 may be found in U.S. Patent No. 6,880,699, the entire disclosure of which is hereby incorporated by reference in its entirety.

[0016] FIG. 2 illustrates a first perspective view of an exemplary embodiment of the jaw assembly 102 of the clip applier 100, and FIG. 3 illustrates a front view of the jaw assembly 102. FIG. 4 illustrates a side view of the jaw assembly 102 with a surgical clip 50 loaded thereon, and FIG. 5 illustrates a perspective view of the jaw assembly 102 with a surgical clip 50 loaded thereon. FIG. 6 illustrates a side view of the clip applier 100 in an open configuration, and FIG. 7 illustrates a side view of the clip applier 100 in a closed configuration. FIG. 8 illustrates a top view of the clip applier 100 in a closed configuration with the tubular member 114 removed for clarity purposes. FIG. 9 illustrates a side view of the clip applier 100 in a closed configuration with the shaft 104 removed for clarity purposes.

[0017] As shown in Figures 2-3, the first jaw member 110 can include a first inner surface 120 having a first longitudinal channel 122, one or more recesses 124 on a distal portion, and a stabilizing member 126 on a proximal portion. The second jaw member 112 can include a second inner surface 130 having a second longitudinal channel 132, one or more recesses 134 on a distal portion, and a stabilizing member 136 on a proximal portion. The recesses 124, 134 can be substantially semicircular channels at the distal portions of the jaw members 110, 112. The stabilizing members 126, 136 can be integral with the respective jaw members 110, 112. The stabilizing members 126, 136 can be substantially rigid and extend substantially parallel to the longitudinal axes of the jaw members 110, 112 in the open and closed configurations to create a longitudinal space therebetween. The first stabilizing member 126 can include a first wall projecting from and extending longitudinally along the first inner surface 120, and the second stabilizing member 136 can include a second wall projecting from and extending along the second inner surface 130. The first and second walls 126, 136 can be fin-shaped including a concave and / or angled distal surface and a convex and / or angled proximal surface, each relative to the inner surfaces 120, 130, such that the inner portions 128, 138 define a distally facing apex. The inner portions 128, 138 can extend distally in an open configuration, as shown in FIG. 4. The first and second jaw members 110, 112 can be rotationally symmetrical such that the first and second stabilizing members 126, 136 can be positioned laterally of a longitudinal axis of the clip applier. The surgical clip 50 can be received along the longitudinal axis of the clip applier, ie, the stabilizing members 126 , 136 can be positioned on either side of a proximal portion of the surgical clip 50 .

[0018] The stabilizing members 126, 136 may or may not laterally overlap one another in an open configuration (e.g., FIGS. 1-6), and the stabilizing members 126, 136 can laterally overlap one another in a closed configuration (e.g., FIG. 7). The first inner portion 128 can be spaced apart from the second jaw member 112 and not received in the second longitudinal channel 132 in the open configuration (e.g., FIGS. 2-6). The first inner portion 128 can be received in the second longitudinal channel 132 in the closed configuration (e.g., FIG. 7). Similarly, the second inner portion 138 can be spaced apart from the first jaw member 110 and not received in the first longitudinal channel 122 in the open configuration (e.g., FIGS. 2-6). The second inner portion 138 can be received in the first longitudinal channel 122 in a closed configuration, and the second inner portion 138 can be received in the first longitudinal channel 122 in a closed configuration (e.g., FIG. 7). For example, as further shown in FIG. 3, the first longitudinal channel 122 can include a widened proximal portion 123 configured to receive the second stabilizing member 136, and the second longitudinal channel 132 can include a widened proximal portion 133 to receive the first stabilizing member 126. The widened proximal portions 123, 133 can be off-axis, transverse to the longitudinal axis of the clip applier 100, such that the longitudinal channels are asymmetrical about the longitudinal axis. Each of the stabilizing members 126, 136 can include at least one transverse flat surface to facilitate insertion into the respective longitudinal channel 122, 132 and / or provide transverse stability of the surgical clip 50. For example, each of the stabilizing members 126, 136 can include a flat lateral outer surface that slides along the flat inner side of the widened proximal portion 123, 133. The first longitudinal channel 122 and / or the second longitudinal channel 132 can also receive a portion of a surgical clip 50 in an open configuration (as shown in FIG. 4 ) and / or a closed configuration.

[0019] As shown in FIGS. 4-5, the jaw assembly 102 can be configured to hold the surgical clip 50 at at least three contact points. The surgical clip 50 can include a first leg member 52 and a second leg member 54 having proximal ends pivotally joined at a hinge portion 56. The surgical clip 50 can include one or more bosses 58 at a distal portion of each of the first and second leg members 52, 54. The bosses 58 can be circular corresponding to the recesses 124, 134 and can be releasably received in the recesses 124, 134 to secure the distal portion of the surgical clip 50. Additionally, a proximal portion of the surgical clip 50 (e.g., the hinge portion 56) can be received between the stabilizing members 126, 136 to reduce lateral movement or sway of the surgical clip 50. Each of the inner portions (e.g., distally facing apexes) 128, 138 of the stabilizing members 126, 136 can laterally overlap the hinge portion 56 to reduce lateral movement or sway of the surgical clip 50 (as shown in FIG. 4). The first leg member 52 of the surgical clip 50 can have a concave inner surface, a convex outer surface, and a hook member on a distal portion. The second leg member 54 can include a convex inner surface, a concave inner surface, and a tip member on a distal portion. When the surgical clip 50 closes, the hook on the first leg member 52 can deflect around the tip member on the second leg member to secure the surgical clip 50 in a latched configuration. Due to the curvature, the first and / or second leg members 52, 54 can straighten and / or elongate during the closing and / or latching process. The clip applier 100 and / or stabilizing members 126, 136 cannot proximally abut the surgical clip 50 to allow the surgical clip to straighten and / or extend during the closing and / or latching process.

[0020] The surgical clip 50 can be manufactured in any suitable size and can be applied to any number of tissues, such as blood vessels, lymph nodes, nerves, fallopian tubes, or cardiac tissue. The surgical clip 50 can be manufactured from any suitable biocompatible material, such as metals and polymers. In some embodiments, the surgical clip 50 is comprised of a one-piece integral polymer body formed of a suitable strong biocompatible engineered plastic, such as the types commonly used for surgical implants. Exemplary materials include homopolymer or copolymer polyacetal, polyethylene terephthalate (PET), polybutylene terephthalate (PBT), polyoxymethylene, or other thermoplastic materials with similar properties that can be injection molded, extruded, or otherwise processed into similar articles. Exemplary embodiments and features of the surgical clip 50 are further disclosed in U.S. Pat. No. 4,834,096, the disclosure of which is incorporated herein by reference in its entirety.

[0021] As shown in FIGS. 6-9, the pivotal rotation of the jaw assembly 102 is biased to an open configuration by at least one leaf spring 140 and can be actuated by longitudinal movement of the tubular member 114. The at least one leaf spring 140 can have a distal end that overlaps at least one of the jaw members 110, 112. For example, the at least one leaf spring 140 can include a pair of leaf springs 140 on either side of a vertical beam or connector 142, and the proximal ends of the leaf springs 140 can be secured (e.g., welded) to the connector 142 in a cantilever configuration. The leaf springs 140 can be on either vertical side of a longitudinal axis of the clip applier 100. Each of the jaw members 110, 112 can have a proximal portion that includes a pair of proximal members 144. The proximal member 144 of each jaw member 110, 112 may include a pair of legs separated from one another and straddling a distal portion of the connector 142 for pivotal stability. The proximal member 144 may be pivotally secured to the connector 142 using at least one pivot pin 146. Thus, the first jaw member 110 may be secured to the connector 142 using at least one pivot pin 146 and the second jaw member 112 may be secured to the connector 142 using at least one pivot pin 146. The first and second pivot pins 146 of the jaw members 110, 112 may be on opposite perpendicular sides of a longitudinal axis of the connector 142. The connector 142 may be fixedly secured to the lumen 108 of the shaft 104 and extend distally from the tubular member 114. The proximal member 144 can have a width that is less than the distal length of the jaw members 110, 112 such that the proximal member 144 fits inside the tubular member 144 and is cammed into the closed configuration. The tubular member 144 also prevents the jaw members 110, 112 from bending in the closed configuration.

[0022] One of the proximal members 144 of each of the jaw members 110, 112 may further include a proximal extension 148 proximal to the pivot pin 146 and angled relative to the longitudinal axis of the clip applier 100. The proximal extension 148 may be a leg extension extending from one proximal member 144 further proximally than the opposing proximal member 144 of the same jaw member 110, 112. The proximal extensions 148 of the first and second jaw members 110, 112 may cross each other laterally at the longitudinal axis of the clip applier 100. Only one of the proximal members 144 of each jaw member 110, 112 may have a proximal extension 148 to allow pivoting by the respective leaf spring 140 and to prevent interference by the opposing jaw member 110, 112. The proximal extensions 148 may extend from only one lateral side of each of the first and second jaw members 110, 112. Thus, the proximal extensions 148 of the jaw members 110, 112 may extend on both lateral sides of the connector 142. The proximal extensions 148 may include an upper surface 149 that is inclined relative to the longitudinal axis. The leaf springs 140 may overlap or be radially symmetrically placed on the inclined surfaces of each of the proximal extensions 148 of the jaw members 110, 112 in both the open configuration ( FIG. 6 ) and the closed configuration ( FIG. 7 ) to bias the jaw assembly 102 in the open configuration. Thus, the leaf springs 140 may be biased (straight) or slightly biased in the open configuration due to the relative angles of the jaw members 110, 112, and may be biased or further biased in the closed configuration. The bias of the leaf spring 140 can urge the extensions 148 of each of the jaw members 110, 112 symmetrically in opposite directions relative to the longitudinal axis of the clip applier 100 to bias the jaw assembly 102 toward the open configuration. The jaw members 110, 112 can contact one another (e.g., at the proximal extensions 148 as shown in FIG. 6 ) to prevent further pivotal rotation and to provide a stop in the open configuration.

[0023] The tubular member 114 can be actuated by longitudinal movement of an actuator 150. The actuator 150 can be an actuation shaft extending through the lumen 108 of the shaft 104 and connected to the handle assembly 106. Squeezing or compression of the second handle member 118 relative to the first handle member 116 can cause longitudinal advancement of the actuator 150 which causes longitudinal advancement of the tubular member 114 against the bias of the leaf spring 140 to cam the proximal member 144 of the jaw assembly 102 into a closed configuration. Releasing the second handle member 118 releases the distal force applied to the tubular member 114 such that the bias of the leaf spring 140 opens the jaw members 110, 112 and longitudinally retracts the tubular member 114. The tubular member 114 can have a distal portion 152 and a proximal portion 154, the distal portion 152 having a larger diameter than the proximal portion 154. The distal portion 152 can extend distally from the shaft 104 and can have a diameter substantially the same as that of the shaft 104. That is, a proximal end of the distal portion 152 can abut a distal portion of the shaft 104 when the jaw assembly 102 is in an open configuration (as shown in FIG. 6 ). The distal portion 152 can be configured to cam the first and second jaw members 110, 112 to receive the proximal portion 144 and close the jaw assembly 102. That is, the leaf spring 140 can bias the jaw assembly open by radially covering the proximal extensions 148, 102 proximal to the hinge pin 146, and the tubular member 114 can close the jaw assembly 102 by camming a portion of the jaw members 110, 112 distal to the hinge pin 146.

[0024] A proximal portion 154 of the tubular member 114 can be slidably received in the lumen 108 of the shaft 104. The proximal portion 154 can be secured to the actuator 150 by receiving the actuator 150 in a lumen of the proximal portion 154 and / or by mating one or more radial protrusions of the actuator 150 with one or more proximal slots in or on the proximal portion 154. The proximal portion 154 can include an elongated slot 160 that receives a proximal end of the connector 142 in a distal opening and receives a pin 162 on the connector 142 along its length. Longitudinal movement of the tubular member 114 relative to the connector 142 can slide the pin 162 longitudinally through the elongated slot 160. The pin 162 can be fixedly secured (e.g., welded) to the shaft 104 to stabilize the connector 142. For example, the pin 162 may extend through and be welded into an elongated slot 164 of the shaft 104 that overlaps with the elongated slot 160 of the tubular member 114. The overlap of the elongated slots 160, 164 may allow visibility of the relative longitudinal position and / or movement of the tubular member 114 during actuation of the jaw assembly 102.

[0025] The many features and advantages of the present invention are apparent from the detailed specification, and it is the intention of the appended claims to cover all such features and advantages of the present invention that fall within the true spirit and scope of the invention. Moreover, since numerous modifications and variations will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation illustrated and described, and therefore, all suitable modifications and equivalents may be resorted to as falling within the scope of the present invention.

Claims

1. 1. A clip applier configured to apply a surgical clip, comprising: a handle assembly including a first handle member and a second handle member; a shaft extending from the handle assembly; a connector having a proximal portion disposed in the lumen of the shaft; a jaw assembly including a first jaw member and a second jaw member, the first jaw member comprising a first proximal member pivotally secured to a distal portion of the connector by a first pivot pin, the second jaw member comprising a second proximal member pivotally secured to the edge portion of the connector by a second pivot pin, the first proximal member comprising a first proximal extension proximal to the first pivot pin and angled relative to a longitudinal axis of the connector, and the second proximal member comprising a second proximal extension proximal to the second pivot pin and angled relative to a longitudinal axis of the connector, the first jaw member and the second jaw member configured to pivot between an open configuration and a closed configuration; a tubular member configured to move longitudinally on the first and second proximal members, the tubular member including a distal portion configured to cam the first and second jaw members into the closed configuration; a first leaf spring having a proximal end secured to the connector in a cantilever configuration and a distal end overlapping the first proximal extension of the first jaw member to bias the first jaw member into the open configuration; a second leaf spring having a proximal end secured to the connector in a cantilever configuration and a distal end overlapping the second proximal extension of the second jaw member to bias the second jaw member into the open configuration; A clip applier comprising:

2. 2. The clip applier of claim 1, wherein the first and second proximal members are configured to fit inside the tubular member when the first and second jaw members are cammed into the closed configuration.

3. 3. The clip applier of claim 1 or 2, wherein a distal end of the tubular member includes a camming surface for camming the first and second jaw members into the closed configuration against the bias of the leaf spring.

4. The clip applier of claim 1 , wherein the first proximal extension and the second proximal extension straddle the distal portion of the connector.

5. 5. The clip applier of claim 1, wherein the first pivot pin and the second pivot pin are disposed on opposite sides of the longitudinal axis of the connector.

6. 6. The clip applier of claim 1, wherein the connector is fixedly secured to the shaft.

7. 7. The clip applier of claim 1, wherein the first proximal member and the second proximal member each have a width that is less than a distal length of the first jaw member and the second jaw member, respectively.

8. 8. The clip applier of claim 1, wherein the first and second leaf springs contact respective inclined surfaces of the first and second proximal extensions in both the open and closed configurations to bias the jaw assembly toward the open configuration.

9. 9. The clip applier of claim 1, wherein a diameter of the distal portion of the tubular member is greater than a diameter of a proximal portion of the tubular member, the distal portion of the tubular member extends distally of the shaft, and a proximal end of the distal portion of the tubular member is configured to abut the distal portion of the shaft when the jaw assembly is in the open configuration.

10. The clip applier of claim 9 , wherein the lumen of the shaft is configured to slidably receive the proximal portion of the tubular member.

11. 11. The clip applier of claim 1, further comprising an actuator configured to actuate movement of the tubular member, the actuator comprising an actuation shaft extending through the shaft lumen and connected to the handle assembly.

12. The proximal portion of the tubular member is configured to receive a portion of an actuator and / or mate one or more radial protrusions of the actuator with one or more proximal slots in or on the proximal portion of the tubular member. The clip applier of claim 11.

13. 13. The clip applier of any one of claims 1 to 12, wherein the first handle member is fixed and the second handle member is pivotally moveable on a pivot pin such that pivoting the second handle member relative to the first handle member causes longitudinal movement of the tubular member.

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