Background

In cardiothoracic (heart and lung) surgery, robotic-assisted systems like the da Vinci Xi enhance precision and control. One critical tool used is the endoscopic clip applier, which places titanium clips on blood vessels to stop bleeding. However, the current clip applier holds only one clip at a time, requiring repeated:

1. Instrument removal from the patient

2. Manual reloading by a surgical technician

3. Reinsertion into the patient

This process slows surgery, disrupts workflow, and increases reliance on assistants. 

While handheld clip appliers, such as Johnson & Johnson’s Ligamax, offer preloaded cartridges that allow for multiple firings in a single procedure, no equivalent multi-load clip applier exists for robotic surgery. This creates a major inefficiency in robotic-assisted surgeries, especially in urgent cases where multiple clips must be applied quickly. Key issues with manual clip appliers include:

• Limited motion control with stiff instrument arm

• Increased reliance on surgical assistants for manual clip replacement

These limitations highlight the urgent need for an integrated multi-load clip applier that enhances surgical efficiency without compromising precision.