An Ergonomic Flexible Multi-Fire Clip Applier With Multiple Degrees-of-Freedom for Minimally Invasive Surgery to Improve Hemostatic Efficiency

Hemorrhage can lead to shock and even death of patients, making one of the main risks in surgical procedures. Most traditional clip appliers are rigid, have limited flexibility, and can only fire a single clip within each insertion, which cannot meet the needs of surgeons to efficiently and flexibly control bleeding vessels. In this study, a novel hand-held Hem-o-lok clip applier is proposed, which is designed to have a high flexibility and allow multiple fires of clips. The wrist at the end effector consists of discrete joints and a flexible shaft, allowing bending in two directions. The tong head at the end effector enables multiple fires of hemostats and can be delivered to different positions for clamping blood vessels and human tissues. It also can be driven to rotate by the flexible shaft. Additionally, an ergonomic handle is designed to control the multiple degrees-of-freedom (DOFs) movements of the instrument tip. Finally, the effectiveness of the entire system is evaluated through performance experiments. The bending angle of end effector was about ±70 deg in both directions (yaw and pitch), and the rotation angle was ±160 deg. The measured gripping forces of the applier ranged from 16.70 N to 24.93 N, and the average time to complete three consecutive clamping was 8.67 s. The proposed clip applier could improve the hemostatic efficiency and allow an intuitive and flexible operation in the meantime.