Design of a Hand-held Multi-fire Clip Applier with Multiple Dofs for Minimally Invasive Surgery

Hemorrhage can lead to shock and even death of patients, making one of the main risks in surgical procedures. With the increasing complexity of bleeding during surgical procedures, there is a growing demand for the clip appliers with more functions. However, 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. And it also can be driven to rotate by the flexible shaft. Additionally, an ergonomic handle is designed to control the multi-degree-of-freedom movements of the instrument tip. Finally, the effectiveness of the entire system is evaluated through performance experiments. The design method of this paper can also provide theoretical guidance for other hand-held surgical instruments.