title: A reverse-action clip applier for aneurysm surgery.
abstract: BACKGROUND
  Clipping is an important technique for cerebral aneurysm surgery. Although clip mechanisms and features have been refined, little attention has been paid to clip appliers. Clip closure is traditionally achieved by opening the grip of the clip applier. We reconsidered this motion and identified an important drawback, namely that the standard applier holding power decreased at the moment of clip release, which could lead to unstable clip application.
  
  
  OBJECTIVE
  To develop a forceps to address this clip applier design flaw.
  
  
  METHODS
  The new clip applier has a non--cross-type fulcrum that is closed at the time of clip release, with an action similar to that of a bipolar forceps or scissors. Thus, a surgeon can steadily apply the clip from various angles.
  
  
  RESULTS
  We successfully used our clip applier to treat 103 aneurysms. Although training was required to ensure smooth applier use, no difficulties associated with applier use were noted.
  
  
  CONCLUSIONS
  This clip applier can improve clipping surgery safety because it offers additional stability during clip release.
authors.affiliation: *Division of Neurosurgery, Ina Central Hospital, Ina, Japan; ‡Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sato
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Koyama
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hanaoka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
mesh_terms: D004867:Equipment Design; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D013525:Surgical Instruments; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods