Endoscopic clip applier for robotic-assisted surgery

Abstract

Disclosed are devices, systems and methods for assisting endoscopic robotic surgery. In some aspects, an endoscopic multi-load clip applier device includes a housing structured to include a compartment operable to store and distribute one or more clips; a flexible end coupled to the housing; and at least two grip components coupled to the housing and operable to compress and release upon control by robotic forceps of a robotic-assisted surgery system, wherein the at least two grip components are configured for the robotic forceps to grab and manipulate to place one or more clips at a surgical site directed by a surgeon using the device.

Description

PCT ApplicationAttorney Docket No.: 009062.8570.WO00ENDOSCOPIC CLIP APPLIER FOR ROBOTIC-ASSISTED SURGERYCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This patent document claims priority to and benefits of U.S. Provisional Patent Application No. 63 / 730,893, titled “ENDOSCOPIC CLIP APPLIER FOR ROBOTIC- ASSISTED SURGERY” and filed December 11, 2024. The entire contents of the aforementioned patent application are incorporated by reference as part of the disclosure of this patent document.TECHNICAL FIELD

[0002] This patent document generally relates to instrumentation and techniques for robotic - assisted surgery and, more particularly, to endoscopic clip appliers used for vessel ligation.BACKGROUND

[0003] Robotic-assisted surgery, also referred to as robotic surgery, encompasses various types of medical surgical procedures that are, at least partially, performed by a robotic system. Generally, the robotic instrumentation enables the operation of miniaturized tools that enable the surgery to be performed with high precision. This can result in a variety of advantages, such as requiring only small incisions for the patient, decreased blood loss during surgery, less pain, and a quicker recovery time. Robotic surgery has been considered successful in overcoming limitations with current minimally-invasive surgical procedures and enhancing the capabilities of surgeons, allowing surgeons to perform more complex, open surgeries.SUMMARY

[0004] Disclosed are devices, systems and methods for assisting endoscopic robotic surgery.

[0005] In some embodiments in accordance with the present technology, an endoscopic multi-load clip applier device includes a housing structured to include a compartment operable to store and distribute one or more clips; a flexible end coupled to the housing; and at least two grip components coupled to the housing and operable to compress and release upon control by robotic forceps of a robotic-assisted surgery system, wherein the at least two grip components are configured for the robotic forceps to grab and manipulate to place one or more clips at a surgical site directed by a surgeon using the device.184643849.3 1PCT ApplicationAttorney Docket No.: 009062.8570.WO00

[0006] In some embodiments in accordance with the present technology, an endoscopic multi-load clip applier can be configured to be disposable and can be used in conjunction with a variety of robotic surgical systems. In some embodiments, an example endoscopic multi-load clip applier is configured to be introduced into an operative field (e.g., a surgical cavity) via a bedside assistant port (e.g., via a trocar). Once the instrument is in the field, a surgeon is able to pick up an end of the example endoscopic multi-load clip applier (e.g., using robotic forceps) and then place the clip (e.g., titanium clip) wherever indicated. The end of the instrument can be configured to be flexible to allow for ease of maneuvering inside the cavity, and to carry multiple clips that can automatically reload after deploying.

[0007] The disclosed endoscopic multi-load clip applier can provide several advantages, including but not limited to affordability, as it is cheaper than current technology on the market. Importantly, example embodiments of the endoscopic multi-load clip applier in accordance with the disclosed technology can be configured in a manner that gives control back to the surgeon during robotic-assisted surgical operations.

[0008] Example embodiments of clips used with an example endoscopic multi-load clip applier can be made of titanium, can be one or multiple sizes, and / or can be configured to be more flat on the outside edge with a lip to ensure that the grasping forceps have secure and firm grip on the clip, which can thereby prevent dislodging and slipping while applying force into the clip to close it and ligate the desired tubular structure and / or blood vessel.

[0009] The subject matter described in this patent document can be implemented in specific ways that provide one or more of the following features.BRIEF DESCRIPTION OF THE DRAWINGS

[0010] FIG. 1 shows a diagram of an example embodiment of an endoscopic multi-load clip applier device in accordance with the present technology.

[0011] FIG. 2 illustrates an example multi-load clip provider device, in accordance with the present technology.

[0012] FIG. 3 is an exploded diagram illustrating example components of the example multiload clip provider device, in accordance with the present technology.

[0013] FIG. 4 is a diagram illustrating example components of an example clip storage module, in accordance with the present technology.184643849.3 2PCT ApplicationAttorney Docket No.: 009062.8570.WO00

[0014] FIG. 5 is a diagram illustrating example components of an example clip dispensing module, in accordance with the present technology.

[0015] FIG. 6 is a diagram illustrating a combination of an example clip storage module and example clip dispensing module, in accordance with the present technology.

[0016] FIG. 7 is a diagram illustrating an example cable system for providing clips from a clip storage module, in accordance with the present technology.

[0017] FIGS. 8 A and 8B are diagrams illustrating an example forceps handle of an example multi-load clip provider device, in accordance with the present technology.

[0018] FIG. 9 is a flow diagram for an example method of providing a multi-load clip provider device, in accordance with the present technology.

[0019] FIG. 10 is a flow diagram for an example method of providing a plurality of clips at a surgical site for a robotic-assisted surgery, in accordance with the present technology.DETAILED DESCRIPTION

[0020] Currently, during surgery, there are multiple methods for vessel ligation. Example methods include using titanium clips (such as example clips 102, e.g., of various sizes, as shown in box 199 of FIG. 1) that permanently clamp down on a vessel to restrict blood flow through the vessel and stop or prevent bleeding, and using high-energy devices that clamp down and use cautery to seal the vessel together (such as a harmonic device or ‘vessel sealer’ device). For robotic-assisted surgery, surgeons may use the high-energy clamping devices or a combination of stapling and clips to achieve the same result. For example, surgeons may use a harmonic device or a robotic instrument to place a metal titanium clip where indicated.

[0021] Current vessel ligation systems face multiple limitations to their use in the surgical field. For example, certain endoscopic devices used to apply clips are single-load devices, requiring the device to be extracted from the surgical site and manually reloaded with a new clip after every use. This requires extra time during the surgery and limits the device’s efficiency. Additionally, certain devices (such as high-energy sources) are prohibitively costly. For example, endoscopic staplers, such as robotic staplers, induce a high financial cost for each staple load; have a limited number of uses (e.g., 12 uses) before the surgeon must use an additional stapler; are time-consuming, as they can require the device to be removed and manually reloaded between each staple application; and are bulky, using a large apparatus (e.g., a 45 mm hand184643849.3 3PCT ApplicationAttorney Docket No.: 009062.8570.WO00 piece) which is larger than the typical vessel requiring ligation (e.g., 7 mm), restricting its use in many surgical operations. Furthermore, such devices result in a lack of control by the surgeon. That is, an endoscopic assist device can take control from the surgeon during surgery, forcing the surgeon to rely on a surgical assistant to perform important tasks on behalf of the surgeon.

[0022] When searching for solutions to these challenges, it can be appreciated that titanium vessel clips are the reliable standard of vessel ligation. What is needed is a clip applier that can handle multiple loads and be used by the robotic instruments to increase the speed of use, reduce the cost and waste of present vessel ligation approaches, and provide the surgeon with direct control of the instrument to increase maneuverability.

[0023] Disclosed herein are devices, systems, and methods for assisting endoscopic robotic surgery. In some embodiments in accordance with the present technology, an endoscopic multiload clip provider is disclosed, which can be configured to be disposable and can be used in conjunction with a variety of robotic surgical systems, including more than the current market-leading system. Such an endoscopic multi-load clip provider device can include a storage module for storing multiple titanium clips, which can be dispensed from the device at the surgical site for retrieval by robotic forceps and / or application to a vessel. The disclosed technology can allow the surgeon to have more power over when and how clips are provided at the surgical site, and thus give control back to the surgeon. Additionally, solutions disclosed herein are envisioned to decrease the cost from $300 per use for conventional techniques to less than $300 per operative case.Example Embodiments of Endoscopic Multi-load Clip Applier Devices

[0024] FIG. 1 shows a diagram of an example embodiment of an endoscopic multi-load clip applier device 100, in accordance with the present technology. The example endoscopic multiload clip applier device 100 (“clip applier device 100”) includes a multi-load clip housing structure 110 that stores multiple clips. For instance, in some embodiments, the housing structure 110 includes a storage compartment (not shown, also referred to as a storage member) within the housing structure 110 that is operable to store the multiple clips and distribute therefrom. The housing structure 110 is coupled to a flexible end 112 extending away from the housing structure 110. The flexible end 112 can be configured to allow for maneuverability inside the cavity at the surgical site. For example, a surgical site or cavity of the surgical site can refer to a small region in or around an anatomic structure that has a dimension in a millimeter regime, e.g., 10 mm,184643849.3 4PCT ApplicationAttorney Docket No.: 009062.8570.WO0012 mm, or 15 mm. Examples of surgical cavities include anatomical cavities (e.g., thoracic cavity, mediastinum, opened potential space, and / or abdominal thoracic space) and instrument cavities (e.g., an endoscopic shaft, such as a trocar), which can be inserted into and / or disposed inside of an anatomical cavity. Such example surgical cavities can vary in size (e.g., between patients). The clip applier device 100 includes at least two grip components 114 for applying and / or providing clips 116. e.g., dispensing a clip at the surgical site via control by the robotic surgical instrument. The at least two grip components 114 are connected to the housing structure 110 and operatively coupled to the storage compartment to receive (e.g., repeatedly receive) a clip from the storage member and subsequently provide the clip (e.g., apply the clip to a blood vessel and thus restrict blood flow through the blood vessel). The grip components 114 can hold a clip 116 (e.g., a titanium clip like the titanium clips 102) and can be configured to be grabbed and / or manipulated by forceps. The surgeon can use the forceps to manipulate the grips 114 to use the clip applier device to place one or more clips at a surgical site.

[0025] In some embodiments, the clip applier device 100 can be introduced into the operative field (also herein called a surgical site) via an assistant port at a patient’s bedside during a surgical operation. For example, an assistant can insert the clip applier device 100 into a surgical cavity of the surgical site. With the clip applier device 100 in the field, the surgeon is able to pick up (e.g., using forceps) the clip applier device 100 (e.g., by grasping the housing structure 110, the flexible end 112, and / or the grip components 114) and then place the clip 116 wherever indicated. In some embodiments, the clip applier device 100 can be configured to be disposable (e.g., for single-patient use only). In some embodiments, the clip applier device 100 is configured for multiple uses (e.g.. configured to be sterilized and / or re-sterilized after use). In some embodiments, the clip applier device is configured to fit through a trocar with a size (e.g., diameter) of 12 mm or 10 mm.

[0026] In some embodiments, the clip applier device 100 can carry multiple clips 116 (e.g., small, medium, or large clips) that automatically reload after deploying. For example, the clip 116 can be automatically positioned into the grips 114 from the housing structure 110 after a previous clip 116 has been applied by the clip applier device 100 and / or removed from the clip applier device 100 (e.g., by forceps). In some embodiments, a firing action is disposed at the back of the clip applier device 100 for a surgical assistant to operate. For example, the clip applier device 100 can have, attached to the flexible end 112 and opposite the housing structure184643849.3 5PCT ApplicationAttorney Docket No.: 009062.8570.WO00110, an operating member (not shown in FIG. 1 ) for reloading the clip applier device 100. The operating member can be configured to cause the clip applier device 100 to provide and / or apply a clip (e.g.. cause a clip to be positioned by a dispensing member such that the clip is accessible by forceps) and / or cause the clip applier device 100 to reload a clip (e.g., to cause a clip to be transferred from a clip storage member to a dispensing member). For example, the operating member can be a handle attached to the flexible end 112, which can “open” the device (e.g., provide the clip, such as by revealing a clip ready to be picked up by the surgeon using forceps) when turned clockwise, and can reload the device (e.g., reveal a new clip for the surgeon’s use).

[0027] In some embodiments of the clip applier device 100, there is a pair of pads (not shown) on the front end of the instrument (e.g., on and / or near the grips 114) for the forceps to grab the titanium clip and place it where directed. The pads can be configured for use in addition to and / or alternatively to the firing action disposed at the back of the clip applier device 100 (e.g., the pads can be configured to actuate the clip applier device 100 to provide and / or apply the clip). In some implementations, the grips 114 and / or the pads are composed of plastic and / or a composite material.

[0028] In some embodiments, the clip applier device 100 can be preloaded with up to 20 clips 116. Each clip can be configured to be applied to an anatomical structure. For example, each clip can be configured to be applied to a blood vessel and restrict blood flow through the blood vessel, and / or can be configured to be applied to an anatomical structure containing a blood vessel (e.g., the thymus, a fat pad, such as the mesentery fat pad, etc.) and thus restrict blood flow. Each clip 116 can be a titanium clip and / or can include grooves configured to “lock” the clip 116 into place and prevent it from dislodging. In some embodiments, the clips 116 can be configured to be relatively flat on the outside edge with a lip to insure the grasping forceps have a secure and firm grip on the clip 116, preventing dislodging and slipping while applying force to close the clip 116 and ligate the desired tubular structure and / or blood vessel. Additionally, the clip applier device 100 can be configured to store and / or dispense such clips 116 (e.g., can contain a storage member configured to store clips 116 that are configured to prevent slipping during application).

[0029] In some embodiments of the device, the clip applier device 100 is configured to be used in conjunction with robotic-assisted surgery. For example, in some embodiments, the clip applier device 100 can be brought into the surgical site by the surgical assistant (e.g., through184643849.3 6PCT ApplicationAttorney Docket No.: 009062.8570.WO00 appropriately sized trocars) and opened up inside the surgical cavity, where the surgeon can use robotic forceps to pick up the clip 116 from the clip applier device 100 and place said clip 116 where indicated. The clip applier device 100 can be configured as a long endoscopic device that is a sterile, single-patient use item (i.e., disposable) and / or is configured for multiple uses (e.g., can be sterilized and / or re-sterilized). The described example clip applier device 100 differs from current models on the market by way of its structure designed for integration with a variety of robotic-assisted surgical systems. Additionally, individual clips are configured to work with existing robotic surgical instruments, allowing the disclosed technology to be implemented with robotic-assisted surgical systems without requiring excessive exchanges of arms and preventing time delays associated with loading a new clip.Further Embodiments of the Multi-load Clip Applier Devices

[0030] FIG. 2 illustrates an example embodiment of the clip applier device 100, referred to as a multi-load clip provider device 200 (also referred to as the “clip provider device 200”), in accordance with the present technology. The structure and function of the clip provider device 200 can be generally similar to and / or an embodiment of the endoscopic multi-load clip applier device 100 described in detail with respect to FIG. 1. The clip provider device 200 can be configured to be inserted at a surgical site and to provide one or more surgical clips for use in vessel ligation. The clip provider device 200 can be configured as a single-use item (e.g., not configured to be re-sterilized after use) or can be configured as a multi-use item (e.g., configured to be re-sterilized after use).

[0031] The clip provider device 200 can include a housing structure 210 configured to be inserted at a surgical site of a patient (e.g., into a surgical cavity). The housing structure 210 can be configured to pass through a trocar (e.g., a shaft) with a diameter of 15 mm or less (e.g., 12 mm or 10 mm). The housing structure 210 can contain (e.g., partially contain) a clip storage member 220 (also referred to herein as a storage module 220) configured to store a plurality of clips 202. The housing structure 210 can contain (e.g., partially contain) a clip dispensing member 260 (also referred to herein as a dispensing module 260) configured to provide and / or apply one or more clips 202. The dispensing module 260 can be contained in the housing structure 210 while being partially exposed (as shown in FIG. 2) to provide and / or apply the one or more clips 202. As described in more detail below, the clip provider device 200 can be configured to transfer a clip 202 from the storage module 220 to the dispensing module 260,184643849.3 7PCT ApplicationAttorney Docket No.: 009062.8570.WO00 where the dispensing module 260 can provide the clip 202 (e.g., allow the clip 202 to be retrieved by forceps from the dispensing module 260). In some embodiments, the dispensing module 260 can be configured to allow the clip 202 to be applied (e.g., directly from the dispensing module 260), such as by allowing the clip 202 to be clamped onto a vessel while being held by the dispensing module 260. For example, the dispensing module 260 can include a pair of articulate grips (e.g., connected together by a hinge) that allow forceps to press the grips together to clamp the clip 202.

[0032] In some embodiments, the clip provider device 200 includes a cable 204 used to operate the clip provider device 200. For example, the cable can cause the clip provider device 200 to transfer a clip 202 from the storage module 220 to the dispensing module 260 (e.g., effected by pulling the cable in a first direction) and / or cause the clip provider device 200 to apply and / or eject a clip 202 (e.g., effected by pulling the cable in a second direction).

[0033] In some embodiments, the clip provider device 200 is configured to be an endoscopic device (e.g., to be placed in a surgical site via a trocar or other endoscopic device). The clip provider device 200 can be configured to fit through a shaft with a diameter of 15 mm or less (e.g., 12 mm or 10 mm).

[0034] FIG. 3 is an exploded diagram illustrating example components of the example multiload clip provider device 200, in accordance with the present technology. The diagram features the embodiment of the clip provider device 200 in the center, and its components exploded peripherally around the center. The clip provider device 200 can include a storage module 220 and a dispensing module 260 at least partially surrounded by an outer wall, served by the housing structure 210. The storage module 220 and / or dispensing module 260 can be connected and / or operatively coupled to the housing structure 210. The clip provider device 200 can additionally include a forceps handle 280 for use in positioning the clip provider device 200 in the surgical site.

[0035] The storage module 220 can include a clip cartridge 224, a clip cartridge top plate 222, a clip cartridge platform 226, and a clip transfer plate 228. As described in more detail with respect to FIG. 4, the clip cartridge 224 can hold multiple clips, which are placed against the clip cartridge top plate 222 by the clip cartridge platform 226 and pushed by the clip transfer plate 228 from the clip cartridge 224 into the dispensing module 260.

[0036] The dispensing module 260 can include a pair of grips 262 and a grip closer plate184643849.3 8PCT ApplicationAttorney Docket No.: 009062.8570.WO00264. As described in more detail with respect to FIG. 5, the pair of grips 262 can be configured to hold clips that are received from the storage module 220, and the grip closer plate 264 can be configured to cause the pair of grips 262 to close, thus applying and / or ejecting the held clip.

[0037] FIG. 4 is a diagram illustrating example components of the example clip storage module 220, in accordance with the present technology. As shown in FIG. 4, the storage module 220 includes a clip cartridge 224, a clip cartridge top plate 222, a clip cartridge platform 226. and a clip transfer plate 228. When assembled, a lower surface 232 of the clip cartridge top plate 222 can contact (e.g., be coupled to) an upper surface 234 of the clip cartridge 224; the clip cartridge platform 226 can be disposed inside of a cavity of the clip cartridge 224; and an inward surface 236 of the clip transfer plate 228 can contact an outward surface 238 of the clip cartridge 224.

[0038] The clips can be pushed by the clip cartridge platform 226 (e.g., via one or more springs, not shown in FIG. 4) towards the top plate 222. The clips can then be pushed by the clip transfer plate 228 and transferred from the storage module 220 into the dispensing module 260. In particular, a flexible transfer tab 240 of the clip transfer plate 228 can enter the clip cartridge 224 via a rear channel (disposed above a rear upper surface 242) and push the clip through a forward channel (disposed above a forward upper surface 244).

[0039] The clip cartridge 224 includes a cavity extending from an upper surface 234 of the clip cartridge 224 and extending partially through the clip cartridge 224 (e.g., the cavity does not have an opening on the side of the clip cartridge 224 opposite the upper surface 234). The cavity is configured to hold the clip cartridge platform 226 and can include a clip storage space configured to contain multiple clips. When the storage module 220 is assembled, the clip storage space is bounded by the inner walls of the clip cartridge 224, the lower surface 232 of the clip cartridge top plate 222, and the upper surface 246 of the clip cartridge platform 226. The clips stored in the cavity of the clip cartridge 224 can be pushed by the clip cartridge platform 226 (e.g., via one or more springs, not shown in FIG. 4) towards the top plate 222. The clips can be pushed by the clip cartridge platform 226 along a storage direction (vertically upward in FIG. 4), where the clips are stacked along the storage direction. The clips can be stored at an angle with respect to the storage direction. That is, as described in more detail with respect to FIG. 6, the components of the storage module 220 (e.g., the upper surface 246 of the clip cartridge platform 226, the upper surface 234, rear upper surface 242, and forward upper surface 244 of the clip cartridge 224, and the lower surface 232 of the clip cartridge top plate 222) can be configured184643849.3 9PCT ApplicationAttorney Docket No.: 009062.8570.WO00 such that the clips are stored at an angle (e.g., a 45° angle) with respect to the clip storage direction, to facilitate the transfer of the clip from the clip chamber 224 to the dispensing module 260. Additionally, the cavity and / or the clip cartridge platform 226 (e.g., the upper surface 246 of the clip cartridge platform 226) can be configured to match a shape of the clips, such as a shape of the clips when stored at an angle with respect to the clip storage direction.

[0040] The clip cartridge 224 includes a forward channel and a rear channel for use in transferring clips from the clip cartridge 224. When the storage module 220 is assembled, the forward channel is bounded by a forward upper surface 244 and the lower surface 232 of the clip cartridge top plate 222. The forward upper surface 244 is parallel to the upper surface 234 and offset from the upper surface 234 such that a clip can pass between the forward upper surface 244 and the lower surface 232 (e.g., can pass through the forward channel). When the storage module 220 is assembled, the rear channel is bounded by a rear upper surface 242 and the lower surface 232 of the clip cartridge top plate 222. The rear upper surface 242 is parallel to the upper surface 234 and offset from the upper surface 234 such that a portion of the clip transfer plate 228 (e.g., a flexible transfer tab 240 of the clip transfer plate 228) can pass between the rear upper surface 242 and the lower surface 232 (e.g., can pass through the rear channel). The rear channel is configured to receive the clip transfer plate 228 (e.g., the flexible transfer tab 240 of the clip transfer plate 228), which pushes a clip through the forward channel, where the clip then exits the storage module 220.

[0041] The clip transfer plate 228 includes a clip transfer base plate 248 and a flexible transfer tab 240. The flexible transfer tab 240 can include a notch 250 configured to push clips through the forward channel of the clip cartridge 224. For example, the notch 250 can match a shape of the clips contained in the clip cartridge 224. The flexible transfer tab 240 can be configured to enter the clip cartridge 224 through the rear channel to push a clip contained in the clip cartridge 224. That is, the clip transfer plate 228 can be configured such that, when the clip transfer base plate 248 is moved towards the clip cartridge top plate 222, the flexible transfer tab 240 contacts the lower surface 232 of the clip cartridge top plate 222 and bends into the rear channel. The flexible transfer tab 240 can then move between the rear upper surface 242 and the lower surface 232 until the notch 250 makes contact with the clip. As the clip transfer base plate 248 continues to move toward the clip cartridge top plate 222, a top portion of the flexible transfer tab 240 can move through the clip cartridge 224, parallel to the lower surface 232 of the184643849.3 10PCT ApplicationAttorney Docket No.: 009062.8570.WO00 clip cartridge top plate 222, and push the clip through the forward channel (e.g., between the forward upper surface 244 and the lower surface 232) until the clip has exited the clip cartridge 224. The flexible transfer tab 240 can then be removed from the clip cartridge 224 by moving the clip transfer base plate 248 away from the clip cartridge top plate 222. Once the flexible transfer tab 240 has been removed, the clip cartridge platform 226 can push the remaining clips stored in the clip cartridge 224 such that a subsequent clip becomes pressed against the lower surface 232 of the clip cartridge top plate 222, and is in position to be transferred from the storage module 220.

[0042] In some embodiments, the clip transfer base plate 248 contains one or more cable channels 252. As described in more detail with respect to FIG. 7, the cable channels 252 can be used to couple one or more cables to the clip transfer base plate 248. The cables can be used to actuate the clip transfer plate 228 (e.g., to move the clip transfer base plate 248 towards and / or away from the clip cartridge top plate 222).

[0043] FIG. 5 is a diagram illustrating example components of the example clip dispensing module 260, in accordance with the present technology. The dispensing module 260 includes a pair of grips 262 and a grip closer plate 264. The pair of grips 262 is configured to receive a clip supplied by the storage module 220, and hold the clip between the grips. The pair of grips 262 can provide the clip (e.g., allow the clip to be retrieved by a surgeon using forceps, and subsequently applied to a vessel by the surgeon) and / or apply the clip (e.g.. by causing the pair of grips 262 to be pressed together, deforming the clip between the grips and applying the clip to a vessel).

[0044] The pair of grips 264 includes two articulating grip components 266a and 266b. The articulating grip components 266 are connected together by a hinge 268 (e.g., a torsion spring) which allows the articulating grip components 266 to articulate by being pressed together. The articulating grip components 266 can be pressed together externally (e.g., by forceps) and / or by the grip closer plate 264. The articulating grip components 266 can include structures to assist in externally closing the pair of grips 264. For example, the articulating grip components 266 can have teeth (not shown in FIG. 5) disposed on an outer surface of the articulating grip components 266 (e.g., an outer surface 272) that assists in allowing forceps to grip and manipulate the pair of grips 264.

[0045] Each articulating grip component 266 can include a channel 270 used to hold a clip.184643849.3 11PCT ApplicationAttorney Docket No.: 009062.8570.WO00That is, when the clip is held in the pair of grips 262, the clip can be positioned at least partially within each channel 270 of the articulating grip components 266 to assist in preventing the clip from moving from between the articulating grip components 266.

[0046] The grip closer plate 264 can be configured to close the pair of grips 262 to apply and / or eject a held clip. The grip closer plate 264 includes a notch 274 configured to close the pair of grips 262. When the grip closer plate 264 is moved towards the pair of grips 262, the hinge 268 enters the notch 274, and the sides of the notch 274 contact the outer edge of each articulating grip component 266. As the grip closer plate 264 continues to move towards the pair of grips 262, the sides of the notch 274 force the articulating grip components 266 together, closing the pair of grips 262. In some embodiments, the closing of the pair of grips 262 causes the clip to be ejected from the dispensing module 260 (e.g., from the pair of grips 262). For example, if a held clip has been applied to a vessel (e.g., by a surgeon using forceps to close the pair of grips 262 to apply the clip), then actuating the grip closer plate 264 to close the pair of grips 262 can cause the clip to be pushed away from the dispensing module 260, allowing a subsequent clip to be dispensed.

[0047] In some embodiments, the grip closer plate 264 contains one or more cable channels 276. As described in more detail with respect to FIG. 7, the cable channels 276 can be used to couple one or more cables to the grip closer plate 264. The cables can be used to actuate the grip closer plate 264 (e.g., to move the grip closer plate 264 towards and / or away from the pair of grips 262).

[0048] FIG. 6 illustrates a cross-sectional view of an example combination 600 of an example clip storage module and an example clip dispensing module, in accordance with the present technology. Included in the combination 600 are components of the example storage module 220, including a clip cartridge top plate 222, clip cartridge 224, a clip cartridge platform 226, and a flexible transfer tab 240 of a clip transfer plate 228. Included in the combination 600 are components of the example dispensing module, including an actuating grip component 266 and hinge 268 (e.g., a torsion spring). As shown in FIG. 6. the dispensing module 260 is coupled to the storage module 220 (e.g., by the housing structure 210) such that the articulating grip components 266 are in contact with an inward surface 610 of the clip cartridge 224, and the hinge 268 is coupled to a pin 612 coupled to and / or integral with the clip cartridge 224 (e.g., having a torsion spring wrapped around the pin 612).184643849.3 12PCT ApplicationAttorney Docket No.: 009062.8570.WO00

[0049] As shown in FTG. 6, the clip cartridge platform 226 is disposed inside of a cavity in the clip cartridge 224. When the storage module 220 is loaded with one or more clips (not shown in FIG. 6), the clips will be disposed inside the cavity between the upper surface 246 of the clip cartridge platform and the lower surface 232 of the clip cartridge top plate 222, and stacked along a storage direction (vertically upward in FIG. 6). As shown in FIG. 6, a platform spring 602 is disposed between the clip cartridge platform 226 and the clip cartridge 224. The platform spring 602 is configured to push the clip cartridge platform 226 along the storage direction towards the clip cartridge top plate 222. The platform spring 602 causes the clip cartridge platform 226 to push the stored clips against the lower surface 232 of the clip cartridge top plate 222.

[0050] When a clip is to be transferred from the storage module 220 to the dispensing module 260, the clip transfer plate 228 can be moved in the storage direction (e.g., such that the flexible transfer tab 240 is moved towards the clip cartridge top plate 222) and the flexible transfer tab 240 can contact the lower surface 232 of the clip cartridge top plate 222 and bend towards the clip cartridge 224. A top portion of the flexible transfer tab 240 can move along the lower surface 232 and enter the clip cartridge 224 between the rear upper surface 242 and the lower surface 232, where it can contact a clip (e.g., the clip in contact with the lower surface 232) and push the clip towards the articulating grip component 266 (e.g., push the clip between the forward upper surface 244 and the lower surface 232). The clip can then be pushed, by the flexible transfer tab 240, from the clip cartridge 224 into the articulating grip components 266 (e.g., into the respective channels 270 of the articulating grip components 266). The clip transfer plate 228 can then be moved in the opposite direction, removing the flexible transfer tab 240 from the clip cartridge 224, and allowing the clip cartridge platform to push the remaining stored clips towards the lower surface 232. This process can be repeated and clips can be transferred until no clips remain in the cavity of the clip chamber 224. In some embodiments, the flexible transfer tab 240 is configured to remain partially inserted into the clip chamber 224 between clip transfers (e.g., such that a portion of the flexible transfer tab 240 remains disposed between the rear upper surface 242 and the lower surface 232, and / or such that a portion of the flexible transfer tab 240 remains bent).

[0051] The storage module 220 and / or the dispensing module 260 can be configured to facilitate clip transfer. For example, the clips can be stored at a storage angle 604 with respect to184643849.3 13PCT ApplicationAttorney Docket No.: 009062.8570.WO00 the storage direction (e.g., a 45° angle). Additionally, or alternatively, the clips can be transferred at a transfer angle 608 between the storage angle 604 and the direction of the channel 270 (e.g., an angle between the stored clip and a provided clip held between the articulating grip components 266) can be configured to minimize the change in direction of the clip as it is transferred from the storage module 220 to the dispensing module 260. For example, the transfer angle 608 can be less than 45° (e.g., 25°).

[0052] FIG. 7 is a diagram illustrating an example cable system 700 for providing clips (e.g., actuating dispensing of clips) from a clip storage module, in accordance with the present technology. As shown in FIG. 7, a clip transfer plate, including a clip transfer base plate 248 and a flexible transfer tab 240, is coupled to a grip closer plate 264 via a cable 702. The cable 702 is coupled to the clip transfer base plate 248 through a cable channel 252, and is coupled to the grip closer plate 264 through a cable channel 276. The cable 702 is connected over an arm 282 of a forceps handle (not shown in FIG. 7), as described in more detail with respect to FIG. 8A.

[0053] The cable 702 extends through the respective cable channels and forms two cable loops 704a and 704b. The cable loops 704 can be used (e.g., pulled by forceps operated by a surgeon) to actuate the clip transfer plate to transfer a clip and / or the grip closer plate 264 to apply and / or eject a held clip. For example, when the cable loop 704a is pulled, the grip closer plate 264 moves away from the pair of grips (not shown in FIG. 7), allowing the pair of grips to open, while simultaneously moving the clip transfer base plate 248 towards the clip cartridge top plate 222, causing a clip to be transferred to the pair of grips. Additionally, or alternatively, when the cable loop 704b is pulled, the clip transfer base plate 248 is pulled away from the clip cartridge top plate 222, pulling back the flexible transfer tab 240 and allowing another clip to be readied for transfer, while simultaneously moving the grip closer plate 264 to move towards the pair of grips, causing the pair of grips to apply and / or eject a held clip.

[0054] FIG. 8A is a diagram illustrating an example forceps handle 280, in accordance with the present technology. As shown in FIG. 8A, the forceps handle 280 includes a pair of arms 282 and a handle portion 284. As shown and described in FIG. 7, when the clip provider device 200 is assembled, the arms 282 are disposed on either side of the clip cartridge 224. In some embodiments, the arms 282 are configured to contact and / or redirect a cable (e.g., cable 702 of FIG. 7) used to actuate the clip transfer base plate 248 and / or the grip closer plate 264. In some embodiments, the arms 282 are configured to couple to the housing structure 210 of the clip184643849.3 14PCT ApplicationAttorney Docket No.: 009062.8570.WO00 provider device 200 (e.g., in order to couple the forceps handle 280 to the housing structure 210).

[0055] The handle portion 284 is configured to allow forceps to grab the forceps handle 280 to manipulate the clip provider device 200. The handle portion 284 can include teeth 286 configured to improve the ability of forceps to grip the forceps handle 280. The teeth 286 can be configured to match teeth present on the forceps (e.g., configured for a particular type or model of forceps).

[0056] FIG. 8B illustrates forceps 800 gripping a forceps handle 280 of a multi-load clip provider device 200. In some embodiments, the forceps handle 280 is configured to be oriented along a direction of the dispensing module 260. For example, the forceps handle 280 can be oriented such that the forceps 800, when grasping the forceps handle 280, are in an orientation compatible with the dispensing module 260 (e.g., are in an orientation that allows the forceps 800 to retrieve a clip held by the dispensing module 260 and / or apply a clip held by the dispensing module 260).

[0057] While the example multi-load clip provider device 200 has been described in detail above, other embodiments have been considered by the inventors. For example, the clip provider device 200 can include a flexible end extending from the housing structure 210. The flexible end can extend from the housing structure 210, located at a surgical site, to location that is external to the patient. In some embodiments, the flexible end can include an operating member (e.g., disposed opposite the housing structure 210) that enables an assistant to operate the clip provider device 200. For example, the operating member can allow the assistant to transfer clips from the storage member 220 to the dispensing member 260 and / or to actuate the dispensing member 260 to apply and / or eject clips held by the dispensing member 260. The operating member can be configured as an alternative and / or addition to, or replacement for, the cable 702 as a means of operating the clip provider device 200.

[0058] In some embodiments, the clip provider device 200 is configured to be coupled to and / or integrated with a robotic-assisted surgery system. For example, the housing structure 210, storage module 220, and dispensing module 260 can be disposed on the end of a robotic arm (e.g., function as an end effector for a robotic manipulator). The robotic arm can be used to position the device without the need for external manipulation by forceps. Additionally, the robotic-assisted surgery system (e.g., the robotic arm) can be used to operate the clip provider device 200 to provide clips (e.g., to actuate dispensing of clips), apply clips, and / or eject clips.184643849.3 15PCT ApplicationAttorney Docket No.: 009062.8570.WO00The robotic arm can be configured as an alternative and / or addition to, or replacement for, the cable 702 as a means of operating the clip provider device 200.Manufacturing flow

[0059] FIG. 9 is a flow diagram for an example method 900 of providing a multi-load clip provider device, in accordance with the present technology. The multi-use clip provider device can use one or more components described with respect to FIGS. 1-8. including the clip applier device 100, housing structure 110, the clip provider device 200, storage member 220, and / or dispensing member 260.

[0060] The method 900 can include, at operation 910, providing a clip storage member. The clip storage member can be configured to store a plurality of clips and can include a mechanism for supplying stored clips. In some embodiments, the storage member is configured to hold at least 20 clips. The clips can be titanium clips, and / or can include grooves that allow for improved grip by an applied clip on a vessel.

[0061] As an illustrative example of providing the storage member, the method can include, at operation 912, providing a clip cartridge. The clip cartridge can include a cavity configured to store multiple clips. The method 900 can include, at operation 914, inserting a clip cartridge platform into the cavity of the clip cartridge. Operation 914 can include inserting a spring into the cavity, where the spring is disposed between the clip cartridge platform and a bottom surface of the cavity, and where the spring is configured to push the clip cartridge platform away from the bottom surface and towards an opening of the cavity. The method 900 can include, at operation 916, inserting one or more clips into the clip cartridge cavity. The one or more clips can be disposed above the clip cartridge platform. The method 900 can include, at operation 918, attaching a clip cartridge top plate to the clip cartridge. The clip cartridge top plate can be attached above the one or more clips, such that the one or more clips are disposed between the clip cartridge platform and the clip cartridge top plate. The clip cartridge can be configured to include a rear channel and a forward channel disposed under the clip cartridge top plate. The forward channel can be configured to be large enough to allow clips to pass through and exit the clip cartridge. The method 900 can include, at operation 920, coupling a clip transfer plate to the clip cartridge. The clip transfer plate can include a clip transfer base plate and a flexible transfer tab. Coupling the clip transfer plate can include bringing the clip transfer plate into contact with the clip cartridge and / or partially inserting the flexible transfer tab into the rear channel of the184643849.3 16PCT ApplicationAttorney Docket No.: 009062.8570.WO00 clip cartridge.

[0062] The method 900 can include, at operation 930, providing a clip dispensing member. The clip dispensing member can be configured to repeatedly receive a clip from the storage member (e.g., as supplied through the forward channel of the clip cartridge) and provide the clip. The dispensing member can be configured to provide the clip by holding the clip such that the clip can be retrieved (e.g., by a surgeon using forceps, such as robotic forceps). In some embodiments, the dispensing member is configured to apply the clip. The dispensing member can be configured to apply the clip by allowing the clip to be clamped while held in the dispensing member (e.g., the dispensing member can be articulate to clamp the clip while being held).

[0063] As an illustrative example of providing the dispensing member, the method 900 can include, at operation 932, attaching two articulating grip components together to form a pair of grip components. The pair of grip components can be configured to provide a clip by holding the clip between the two grip components. The grip components can be attached by a hinge (e.g., a torsion spring). In some embodiments, the pair of grip components is configured to apply a clip by allowing the grip components to be pressed together and / or closed (e.g., by rotating about the hinge) and thus compress a clip held between the grip components. In some embodiments, the pair of grip components is configured to eject a clip held by the pair of grip components (e.g., by causing the grip components to be pressed together and / or closed). The grip components can be pressed together by an internal force (e.g., servos or mechanisms inside the device, such as a grip closer plate) and / or an external force (e.g., forceps, such as robotic forceps, operating to close the pair of grips). In some embodiments, the grip components include a set of teeth (e.g.. disposed on an outward-facing surface, on a face of a grip component that is opposite the additional grip component). The set of teeth can allow for improved grip and / or manipulation by forceps (e.g., robotic forceps). In some embodiments, each grip component includes a channel configured to partially surround a clip held in the pair of grips and thus facilitate in holding the held clip.

[0064] Continuing this illustrative example, the method 900 can include, at operation 934, coupling the articulating grip components (e.g., the pair of grip components) to the clip cartridge. For example, the clip cartridge can have a peg coupled to and / or integral with the clip cartridge, configured to couple to the hinge of the pair of grip components (e.g.. the peg can extend through a torsion spring connecting the grip components). The dispensing member can thus become184643849.3 17PCT ApplicationAttorney Docket No.: 009062.8570.WO00 coupled to the storage member. In some embodiments, the dispensing member (e.g., the pair of grips) is configured such that a clip held by the dispensing member is at a particular angle with respect to a clip held in the storage member (and thus require a clip to be rotated by the particular angle when transferred from the storage member to the dispensing member). For example, the dispensing member can be configured such that a first clip stored in the storage member is at an angle of 45° or less with respect to a second clip held by the dispensing member (e.g., held by the pair of grip components).

[0065] The method 900 can include, at operation 936, coupling a grip closer plate to the articulating grip components (e.g., the pair of grip components). The grip closer plate can be configured to close the pair of grips to apply and / or eject a clip held by the pair of grip components.

[0066] The method 900 can include, at operation 940, attaching a cable between the clip transfer plate and the grip closer plate. The cable can be configured to enable (e.g., cause) the storage member to supply a clip while the dispensing member receives and provides the clip (e.g., the cable can be configured to actuate the dispensing of clips), and to alternatively enable the dispensing member to apply and / or eject the clip. For example, the cable can be configured to, when pulled in a first direction, lower the grip closer plate to open the pair of grip components while raising the clip transfer plate to transfer a clip from the storage member (e.g., from the clip cartridge) to the dispensing member (e.g., to the pair of grips). The cable can be configured to, when pulled in a second direction opposite the first direction, lower the clip transfer plate and raise the grip closer plate to close the pair of grips (e.g., to apply and / or eject a clip held by the pair of grips).

[0067] The method 900 can include, at operation 942, attaching a forceps handle to the clip cartridge. The forceps handle can be configured to facilitate grabbing and manipulating the clip applier device by forceps (e.g.. robotic forceps). In some embodiments, the forceps handle includes a set of teeth configured to improve the grip of the forceps on the forceps handle. In some embodiments, the forceps handle is configured such that forceps grasping the forceps handle will be placed in an orientation that is compatible with the clips provided by the dispensing member (e.g., the forceps will be in an orientation that allows the forceps to retrieve the clips).

[0068] The method 900 can include, at operation 944, coupling the storage member and the184643849.3 18PCT ApplicationAttorney Docket No.: 009062.8570.WO00 dispensing member to a housing structure. The storage member and dispensing member can be disposed inside (e.g., partially disposed inside) of the housing structure. The housing structure can be configured to be inserted into a surgical site of a patient. For example, the housing structure (and thus the clip provider device) can be configured to pass through a shaft with a diameter of 15 mm or less (e.g., 12 mm or 10 mm). This can allow the clip provider device to be inserted into the surgical site through a trocar.Usage flow

[0069] FIG. 10 is a flow diagram for an example method 1000 of operating a robotic-assisted surgery system to apply clamps to an anatomic structure or structures (e.g., one or more blood vessels) at a surgical site, in accordance with the present technology.

[0070] The method 1000 can include, at operation 1002, placing a multi-load clip provider device at the surgical site. The multi-use clip provider device can use one or more components described with respect to FIGS. 1-8, including the clip applier device 100, housing structure 110, the clip provider device 200, storage member 220, and / or dispensing member 260. The multiload clip provider device can be configured to store a plurality of clips which can be provided (e.g., one at a time) and applied to anatomic structure(s) (e.g., vessel(s)) at the surgical site. In some embodiments, the multi-load clip provider device can be an independent device that is placed completely inside a surgical cavity of the surgical site. In some embodiments, the multiload clip provider device includes a flexible end configured to extend outside of the surgical site. The flexible end can include an operating member configured to be used by an assistant to provide the clips. In some embodiments, the multi-load clip provider device includes a robotic arm which can be used to position the multi-load clip provider device inside of the surgical site. The multi-load clip provider device can thus be a component of the robotic-assisted surgery system.

[0071] The method 1000 can include, at operation 1004, placing robotic forceps of the robotic-assisted surgery system at the surgical site.

[0072] The method 1000 can include, at operation 1006, retrieving a first clip of the plurality of clips by the robotic forceps from the multi-load clip provider device. The clip can be retrieved by directly grasping the clip by the robotic forceps.

[0073] The method 1000 can include, at operation 1008. applying the first clip by the robotic forceps to a first anatomic structure (e.g., first vessel). Applying the first clip can include184643849.3 19PCT ApplicationAttorney Docket No.: 009062.8570.WO00 clamping the first clip by the robotic forceps onto the first vessel, thus ligating the vessel.

[0074] In some embodiments, applying the first clip to the first vessel includes the robotic forceps grasping one or more grip members of the multi-load clip provider device, and manipulating the one or more grip members to apply the first clip to the first vessel. For example, the grip members can be articulate and allow the clip to be clamped onto the first vessel while still being held by the multi-load clip provider device. In some embodiments, using the grip members to apply the first clip is performed as an alternative to retrieving the first clip at operation 1006.

[0075] The method 1000 can include, at operation 1010, operating the multi-load clip provider device to provide (e.g., by the multi-load clip provider device) a second clip of the plurality of clips. In some embodiments, operating the multi-load clip provider device to provide the second clip includes manipulating the multi-load clip provider device using the robotic forceps. For example, the robotic forceps can be used to actuate one or more grip members of the multi-load clip provider device, which can lead to providing the second clip. Alternatively, or additionally, the robotic forceps can be used to actuate a cable of the multi-load clip provider device, which can lead to providing the second clip. In some embodiments, operating the multiload clip provider device to provide the second clip includes activating an operating member attached to a flexible end of the multi-load clip provider device. In some embodiments, operating the multi-load clip provider device to provide the second clip includes operating the multi-load clip provider device by the robotic-assisted surgery system through a robotic arm attached to and / or included in the multi-load clip provider device.

[0076] The method 1000 can include, at operation 1012, retrieving, by the robotic forceps, the second clip from the multi-load clip provider device.

[0077] The method 1000 can include, at operation 1014, applying the second clip to a second anatomic structure (e.g.. a second vessel). In some implementations, the second vessel can be the same vessel as the first vessel or can be a different vessel.Examples

[0078] In some embodiments in accordance with the disclosed technology (example Al), an endoscopic multi-load clip applier device includes a housing structured to include a compartment operable to store and distribute one or more clips; a flexible end coupled to the housing; and at least two grip components coupled to the housing and operable to compress and release upon184643849.3 20PCT ApplicationAttorney Docket No.: 009062.8570.WO00 control by robotic forceps of a robotic-assisted surgery system, wherein the at least two grip components are configured for the robotic forceps to grab and manipulate to place one or more clips at a surgical site directed by a surgeon using the device.

[0079] Example A2 includes the device of example Al or any of examples A1-A5, wherein the one or more clips include titanium clips.

[0080] Example A3 includes the device of example Al or any of examples A1-A5, wherein the flexible is operable to allow for maneuverability of the device inside a surgical cavity.

[0081] Example A4 includes the device of example Al or any of examples A1-A5, wherein the housing is configured a plurality of the one or more clips and to automatically reload a second clip after deploying a first clip of the plurality of clips as directed by the surgeon using the device.

[0082] Example A5 includes the device of example Al or any of examples A1-A5, wherein the device is configured to provide direct and complete control of the device to the surgeon using the robotic-assisted surgery system.

[0083] In some embodiments in accordance with the disclosed technology (example Bl), an endoscopic multi-load clip provider device includes a housing structure configured to be inserted inside a surgical cavity ; a flexible member coupled to the housing structure and extending away from the housing structure; a storage member disposed within the housing structure and configured to store a plurality of clips, wherein each clip is configured to be applied to a blood vessel an anatomical structure; and thus restrict blood flow through the blood vessel; and a dispensing member connected to the housing structure and operatively coupled to the storage member, wherein the dispensing member is configured to repeatedly receive a clip from the storage member and provide the clip.

[0084] Example B2 includes the device of example Bl or any of examples B1-B12, wherein each clip is configured to be applied to a blood vessel and thus restrict blood flow through the blood vessel.

[0085] Example B3 includes the device of example Bl or any of examples B1-B12, wherein the flexible member is configured to allow for maneuverability of the device inside the surgical cavity.

[0086] Example B4 includes the device of example Bl or any of examples B1-B12, wherein the dispensing member is configured to allow retrieval of a provided clip by robotic forceps of a184643849.3 21PCT ApplicationAttorney Docket No.: 009062.8570.WO00 robotic-assisted surgery system.

[0087] Example B5 includes the device of example Bl or any of examples B1-B12, including an operating member coupled to the flexible member and disposed opposite the housing structure, wherein the operating member is configured to enable operation of the dispensing member to receive a clip from the storage member and provide the clip.

[0088] Example B6 includes the device of example Bl or any of examples B1-B12, where the dispensing member comprises a pair of grip components, wherein the pair of grip components is configured to be manipulated by robotic forceps of a robotic-assisted surgery system, wherein manipulating the pair of grip components enables operation of the dispensing member to receive a clip from the storage member and provide the clip.

[0089] Example B7 includes the device of example B6 or any of examples B1-B12, wherein the pair of grip components is configured to allow the forceps to apply a provided clip by manipulating the grips.

[0090] Example B8 includes the device of example B7 or any of examples B1-B12, wherein the dispensing member is configured to automatically receive a clip from the storage member after the provided clip is applied.

[0091] Example B9 includes the device of example Bl or any of examples B1-B12, wherein the storage member is configured to hold at least 20 clips.

[0092] Example B10 includes the device of example Bl or any of examples B1-B12, wherein the plurality of clips comprise titanium clips.

[0093] Example Bl l includes the device of example Bl or any of examples B1-B12, wherein the clip provider device is configured to be sterilized after use.

[0094] Example B12 includes the device of example Bl or any of examples B1-B12, wherein the clip provider device is configured to pass through a shaft with a diameter of 12 mm.

[0095] In some embodiments in accordance with the disclosed technology (example Cl), a multi-load clip provider device includes a housing configured to be inserted into a surgical site of a patient; a storage member disposed within the housing and configured to store a plurality of clips; and a dispensing member disposed within the housing and configured to repeatedly receive a clip from the storage member and provide the clip.

[0096] Example C2 includes the device of example Cl or any of examples C1-C17, including a cable coupled to the dispensing member, wherein the cable is configured to enable184643849.3 22PCT ApplicationAttorney Docket No.: 009062.8570.WO00 operation of the dispensing member to receive a clip from the storage member and provide the clip.

[0097] Example C3 includes the device of example Cl or any of examples C1-C17, wherein the dispensing member comprises a pair of articulating grip components, wherein the pair of grip components is configured to hold a clip between the grip components, and wherein the grip components are configured to enable a held clip to be applied by allowing the grip components to be pressed together.

[0098] Example C4 includes the device of example Cl or any of examples C1-C17, wherein each grip component of the pair of grip components comprises a set of teeth configured to improve manipulation of the pair of grip components by robotic forceps of a robotic-assisted surgery system.

[0099] Example C5 includes the device of example Cl or any of examples C1-C17, wherein each grip component of the pair of grip components comprises a channel configured to hold a clip that is held between the grip components.

[0100] Example C6 includes the device of example Cl or any of examples C1-C17, wherein the pair of grip components is configured such that an angle between a first clip stored in the storage member and a second clip held in the pair of grip components is less than 45 degrees.

[0101] Example C7 includes the device of example Cl or any of examples C1-C17, including a forceps handle, wherein the forceps handle is configured to allow robotic forceps of a robotic-assisted surgical system to grasp and position the clip provider device.

[0102] Example C8 includes the device of example C7 or any of examples C1-C17, wherein the forceps handle is configured to be oriented along a direction of the dispensing member such that the robotic forceps, when grasping the forceps handle, will be in an orientation that allows the robotic forceps to apply a clip provided by the dispensing member.

[0103] Example C9 includes the device of example C7 or any of examples C1-C17, where the forceps handle comprises a set of teeth configured to improve grip of the forceps handle by the robotic forceps.

[0104] Example CIO includes the device of example Cl or any of examples C1-C17, including a flexible member coupled to the housing and extending away from the housing.

[0105] Example Cl l includes the device of example Cl or any of examples C1-C17, wherein the clip provider device is configured to be sterilized after use.184643849.3 23PCT ApplicationAttorney Docket No.: 009062.8570.WO00

[0106] Example Cl 2 includes the device of example Cl or any of examples Cl -Cl 7, wherein the storage member is configured to store at least 20 clips.

[0107] Example C13 includes the device of example Cl or any of examples C1-C17, wherein the plurality of clips comprises titanium clips.

[0108] Example C14 includes the device of example Cl or any of examples C1-C17, wherein the clip provider device is configured to pass through a shaft with a diameter of 12 mm.

[0109] Example C15 includes the device of example Cl or any of examples C1-C17, including a robotically articulate member coupled to the housing, wherein the robotically articulate member is configured to position the housing within the surgical site of the patient.

[0110] Example C16 includes the device of example C15 or any of examples C1-C17, wherein the robotically articulate member is configured to enable operation of the dispensing member to receive a clip from the storage member and provide the clip.

[0111] Example C17 includes the device of example C15 or any of examples C1-C17, wherein the robotically articulate member is configured to enable the dispensing member to apply a clip provided by the dispensing member.

[0112] In some embodiments in accordance with the disclosed technology (example DI), a method of operating a robotic-assisted surgery system to apply a clamps to an anatomic structure at a surgical site includes placing, at the surgical site, a multi-load clip provider device, wherein the multi-load clip provider device comprises a plurality of clips; placing, at the surgical site, robotic forceps of the robotic-assisted surgery system; retrieving, by the robotic forceps and from the multi-load clip provider device, a first clip of the plurality of clips; applying, by the robotic forceps, the first clip to a first anatomic structure; operating the multi-load clip provider device to provide, by the multi-load clip provider device, a second clip of the plurality of clips; retrieving, by the robotic forceps and from the multi-load clip provider device, a second clip; and applying the second clip to a second anatomic structure.

[0113] Example D2 includes the method of example DI or any of examples D1-D4, wherein at least one of the first anatomic structure or the second anatomic structure is a blood vessel.

[0114] Example D3 includes the method of example DI, the method of example D2, or any of examples D1-D4, wherein the second anatomic structure is the first anatomic structure.

[0115] Example D4 includes the method of example DI or any of examples D1-D4, wherein operating the multi-load clip provider device to provide the second clip comprises operating the184643849.3 24PCT ApplicationAttorney Docket No.: 009062.8570.WO00 multi-load clip provider device with the robotic forceps.

[0116] Some embodiments in accordance with the disclosed technology (example El) include an endoscopic multi-load clip applier device or method as disclosed in this patent document.

[0117] Some embodiments in accordance with the disclosed technology (example Fl) include a robotic-assisted surgery system comprising or operable to use an endoscopic multi-load clip applier device as disclosed in this patent document, including the devices of any of examples A1-A5, B1-B12, C1-C17, or El.Conclusion

[0118] While this patent document contains many specifics, these should not be construed as limitations on the scope of any invention or of what may be claimed, but rather as descriptions of features that may be specific to particular embodiments of particular inventions. Certain features that are described in this patent document in the context of separate embodiments can also be implemented in combination in a single embodiment. Conversely, various features that are described in the context of a single embodiment can also be implemented in multiple embodiments separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a subcombination or variation of a subcombination.

[0119] Similarly, while operations are depicted in the drawings in a particular order, this should not be understood as requiring that such operations be performed in the particular order shown or in sequential order, or that all illustrated operations be performed, to achieve desirable results. Moreover, the separation of various system components in the embodiments described in this patent document should not be understood as requiring such separation in all embodiments.

[0120] Only a few implementations and examples are described and other implementations, enhancements and variations can be made based on what is described and illustrated in this patent document.184643849.3 25

Claims

PCT ApplicationAttorney Docket No.: 009062.8570.WO00CLAIMSWhat is claimed is:

1. An endoscopic multi-load clip provider device comprising: a housing structure configured to be inserted inside a surgical cavity; a flexible member coupled to the housing structure and extending away from the housing structure: a storage member disposed within the housing structure and configured to store a plurality of clips, wherein each clip is configured to be applied to an anatomical structure; and a dispensing member connected to the housing structure and operatively coupled to the storage member, wherein the dispensing member is configured to repeatedly receive a clip from the storage member and provide the clip.

2. The clip provider device of claim 1, wherein each clip is configured to be applied to a blood vessel and thus restrict blood flow through the blood vessel.

3. The clip provider device of claim 1, wherein the flexible member is configured to allow for maneuverability of the device inside the surgical cavity.

4. The clip provider device of claim 1, wherein the dispensing member is configured to allow retrieval of a provided clip by robotic forceps of a robotic-assisted surgery system.

5. The clip provider device of claim 1, comprising: an operating member coupled to the flexible member and disposed opposite the housing structure, wherein the operating member is configured to enable operation of the dispensing member to receive a clip from the storage member and provide the clip.184643849.3 26PCT ApplicationAttorney Docket No.: 009062.8570.WO006. The clip provider device of claim 1 , where the dispensing member comprises a pair of grip components, wherein the pair of grip components is configured to be manipulated by robotic forceps of a robotic-assisted surgery system, wherein manipulating the pair of grip components enables operation of the dispensing member to receive a clip from the storage member and provide the clip.

7. The clip provider device of claim 6, wherein the pair of grip components is configured to allow the forceps to apply a provided clip by manipulating the grips.

8. The clip provider device of claim 7, wherein the dispensing member is configured to automatically receive a clip from the storage member after the provided clip is applied.

9. The clip provider device of claim 1, wherein the storage member is configured to hold at least 20 clips.

10. The clip provider device of claim 1, wherein the plurality of clips comprise titanium clips.

11. The clip provider device of claim 1, wherein the clip provider device is configured to be sterilized after use.

12. The clip provider device of claim 1, wherein the clip provider device is configured to pass through a shaft with a diameter of 12 mm.

13. A multi-load clip provider device, comprising: a housing configured to be inserted into a surgical site of a patient; a storage member disposed within the housing and configured to store a plurality of clips; and a dispensing member disposed within the housing and configured to repeatedly receive a clip from the storage member and provide the clip.184643849.3 27PCT ApplicationAttorney Docket No.: 009062.8570.WO0014. The clip provider device of claim 13, wherein the dispensing member comprises a pair of articulating grip components, wherein the pair of grip components is configured to hold a clip between the grip components, and wherein the grip components are configured to enable a held clip to be applied by allowing the grip components to be pressed together.

15. The clip provider device of claim 13, comprising a flexible member coupled to the housing and extending away from the housing.

16. The clip provider device of claim 13, wherein the clip provider device is configured to be sterilized after use.

17. The clip provider device of claim 13, wherein the storage member is configured to store at least 20 clips.

18. The clip provider device of claim 13, wherein the plurality of clips comprises titanium clips.

19. The clip provider device of claim 13, wherein the clip provider device is configured to pass through a shaft with a diameter of 12 mm.

20. The clip provider device of claim 13, comprising: a robotically articulate member coupled to the housing, wherein the robotically articulate member is configured to position the housing within the surgical site of the patient.

21. The clip provider device of claim 20, wherein the robotically articulate member is configured to enable operation of the dispensing member to receive a clip from the storage member and provide the clip.

22. The clip provider device of claim 20, wherein the robotically articulate member is configured to enable the dispensing member to apply a clip provided by the dispensing member.184643849.3 28PCT ApplicationAttorney Docket No.: 009062.8570.WO0023. A method of operating a robotic-assisted surgery system to apply clamps to an anatomic structure at a surgical site, comprising: placing, at the surgical site, a multi-load clip provider device, wherein the multi-load clip provider device comprises a plurality of clips; placing, at the surgical site, robotic forceps of the robotic-assisted surgery system; retrieving, by the robotic forceps and from the multi-load clip provider device, a first clip of the plurality of clips; applying, by the robotic forceps, the first clip to a first anatomic structure; operating the multi-load clip provider device to provide, by the multi-load clip provider device, a second clip of the plurality of clips; retrieving, by the robotic forceps and from the multi-load clip provider device, a second clip; and applying the second clip to a second anatomic structure.

24. The method of claim 23, wherein at least one of the first anatomic structure or the second anatomic structure is a blood vessel.

25. The method of claim 23 or claim 24, wherein the second anatomic structure is the first anatomic structure.

26. The method of claim 23, wherein operating the multi-load clip provider device to provide the second clip comprises operating the multi-load clip provider device with the robotic forceps.184643849.3 29

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