GB1560282A - Surgical ligating instrument and method - Google Patents

Surgical ligating instrument and method Download PDF

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Publication number
GB1560282A
GB1560282A GB1610077A GB1610077A GB1560282A GB 1560282 A GB1560282 A GB 1560282A GB 1610077 A GB1610077 A GB 1610077A GB 1610077 A GB1610077 A GB 1610077A GB 1560282 A GB1560282 A GB 1560282A
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United Kingdom
Prior art keywords
tube
instrument according
inner tube
instrument
inner member
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Expired
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GB1610077A
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KLI Inc
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KLI Inc
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Priority to GB1610077A priority Critical patent/GB1560282A/en
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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F6/00Contraceptive devices; Pessaries; Applicators therefor
    • A61F6/20Vas deferens occluders; Fallopian occluders
    • A61F6/202Means specially adapted for ligaturing, compressing or clamping of oviduct or vas deferens
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30Surgical pincettes without pivotal connections
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B2017/12018Elastic band ligators

Description

(54) SURGICAL LIGATING INSTRUMENT AND METHOD (71) We, KLI, INC., a corporation organised and existing under the laws of the State of Pennsylvania, United States of America, of 65 Industrial Drive, Ivyland, Pennsylvania 18974, United States of America, do hereby declare the invention for which we pray that a Patent may be granted to us and the method by which it is to be performed to be particularly described in and by the following statement: This invention relates to a surgical ligating instrument for tubal ligation within the human and/or animal body, by the application of at least one elastic ring to an anatomical structure. Although this invention relates particularly to female sterilization procedures involving the Fallopian tubes, the instrument and method of this invention may be applied to the vas in the human male, and to any other anatomical structural member.
The surgical ligating instrument in accordance with this invention may be used ideally in combination with a laparoscopy system of the type described in our issued U.S. Patent No. 3,834,392. The instrument in accordance with this invention is relatively simple and inexpensive in construction, and requires a minimum of maintenance. Of greater importance, however, is the fact that it is extremely convenient and effective for the surgeon to handle, particularly in allowing the surgeon to perform the most delicate and critical steps of the procedure smoothly and continuously and, if desired, with the use of only one hand.
As will further become apparent hereinafter, the instrument and method in accordance with this invention are of particular advantage in that the surgeon performs one step of the method against a minimum of frictional or other opposition, and is automatically notified of the transition to a further step of the procedure by encountering a considerably increased resistance while continuing his hand motion in a continuous manner and in the same direction.
Surgical ligating instruments have heretofore been used for a wide variety of pur poses.
In our prior U.S. Patent No. 3,834,392 granted September 10, 1974, we disclose a laparoscopy system for female sterilization whereby a single unit contains the power source to provide illumination, oscillatory electrical power and CO, for a laparoscopy.
CO2 gas, under pressure, is first passed into the body through a needle into the peritoneal cavity. A trocar and cannula are inserted into the gas filled abdominal cavity.
A telescope connected to a source of illumination, is inserted into the body cavity through the cannula. The Fallopian tubes are then identified through the laparoscope.
A flexible forceps is, thereafter, inserted through the laprascope into the body cavity.
The forceps is manipulated to successively close the passage through each Fallopian tube either by means of sending electrical oscillations through the forceps to simultaneously cut, seal and cauterize each tube in turn, or by means of a specific clamp which clamps the passage shut.
A typical clamp for that purpose is described in the U.S. Patent to Davis No.
3,856,016, granted December 24, 1974.
Still another clamping means utilized in tubal ligation, having the form of an elastic cord or ring, is shown and described in the U.S. Patent to Van Hoorn No.
3,760,810, granted September 25, 1973. The Van Hoorn patent shows a surgical instrument for ligating internal structures of a cavity in the human body, by means of at least one elastic cord. Two tubes are mounted for relative sliding movement one inside the other, the inner tube protruding at the front of the outer tube. An elastic cord or band is stretched upon the outer sur face of the protruding portion of the inner tube, and after the tube to be ligated is drawn into the inner tube of the surgical ligating instrument, relative displacement of the outer tube forwardly relative to the inner tube ejects the elastic band and tightens it about the tube to be ligated. Thus, a stretchable or elastic cord or ring is used in the manner of the clamp of the Davis patent, for tubal ligation of blood vessels in the treatment of rectosigmoidal lesions, and in the treatment of internal structures of the human body.
The use of an elastic band or ring in tubal ligation of the Fallopian tubes in the human female, or the vas in the human male, using the system of our aforesaid U.S. Patent No. 3,834,392 is shown in the U.S. Patent to Yoon No. 3,870,048, granted March 11, 1975. In the Yoon device, as well as in our aforesaid patent, the procedure is preferably used in conjunction with a viewing device such as a laparoscope or a culdoscope. rhe placement of the elastic ring on the tubes eliminates the need for time-consuming procedures which are discomforting to the patient and the use of bulky and expensive equipment. Moreover, depending upon the size and elastic power of the rings, the sterilization can be made permanently or reversibly, as desired. The device and method are also applicable to the sterilisation of the human male by the ligature of the vas. Further, the device of the Yoon patent includes an outer tube having an expandable end portion which permits the device to be "loaded" with two or more rings at the same time, and to discharge separate rings at different times and in succession to one another, so that both fallopian tubes may be successively ligated without removing the ring applicator device from the peritoneal cavity of the patient.
The devices of the prior art, as discussed herein, tend to be rather complicated for the surgeon to operate. The ejection of the multiple rings in succession, for example, as in the Yoon patent, requires a considerable number of successive manipulations in order to grasp the falopian tube, draw it into the inner tube of the instrument, and discharge each elastic ring to its desired position surrounding each fallopian tube.
Also, substantial gas pressure losses are encountered, requiring monitoring and replacement of gas escaping from the peritoneal or other cavity, as provided for in our aforementioned U.S. patent.
According to one aspect of the present invention we provide a surgical ligating instrument for tubal ligation by the application of an elastic ring to an anatomical tube comprising an elongate inner member having grasping means as a forward end thereof for grasping an anatomical tube to be ligated, a tube arranged to be a close sliding fit over said inner member, said tube havigg a surface adjacent its forward end over which an elastic ring is adapted to fit in a tensioned condition, manually engageable actuating means operatively connected to said member to slide it rearwardly within said tube, means operative to actuate said grasping means to grasp the anatomical tube to be ligated and to draw it into said tube means in response to retraction of said member relative to said tube, ejecting means operable upon further retraction of said member relative to said tube to eject said elastic ring whilst said anatomical tube to be ligated extends into said tube thereby positioning said elastic ring surrounding said anatomical tube and effecting ligation thereof.
Referring to the accompanying drawings: Fig. 1 is a view in perspective showing a surgical ligating instrument embodying features of this invention, combined with a laparoscope; Fig. 1(a) is a front view; Fig. 2 is an exploded view in perspective, showing various components of the surgical ligating instrument of Fig. 1, all separated from each other, and also separated from the laparoscope which also appears in this figure. A cleaning brush is also shown; Figure 3 is a schematic view illustrating a typical view that is obtained by the surgeon in the course of the ligating procedure, upon viewing through the laparoscope; Fig. 4 is a view in side elevation showing one embodiment of surgical ligating instrument in accordance with this invention, with certain parts broken away and others shown in section in order to more clearly reveal important details. In Fig. 4 the instrument is shown with the forceps in a forward position inserted through the operating laparoscope; Fig. 5 is a view similar to Fig. 4, showing the forceps somewhat withdrawn and in engagement with an anatomical structural member such as a Fallopian tube, for example.
Fig. 6 is a view similar to Fig. 5, showing the instrument further retracted rearwardly and showing an elastic occluding ring after it has been ejected and elastically secured upon the anatomical tube. Fig. 6 (a) is an enlarged sectional view of the area VI (a) appearing in Fig. 6; and Fig. 7 is a view in side elevation of a ligating instrument in a form ideally suited for second incision use.
Referring now in detail to the figures of the drawings, wherein similar reference characters refer to similar parts, and turning particularly to Fig. 1, the number 20 designates a laparoscope and the number 11 designates a ligating instrument in accor dance with this invention, shown as being inserted into the bore of the laparoscope 10, and with only its rearward end clearly visible in Fig. 1. Protruding from the forward end of the laparoscope 10, however, are certain components of the ligating instrument 11 in accordance with this invention, particularly the forceps 12, and the inner tube 14, all of which will be described in greater detail hereinafter.
The laparoscope includes a tubular housing 15 having a neck portion 16, a side arm 17 and an optical viewing portion 20 which includes an eyepiece 21.
As in known in the art, an extension 22 is provided which contains a bundle of fiberoptic strands, and this extension 22 is adapted to be connected to a light-transmitting cable (not shown) which also comprises a bundle of fiberoptic strands encased in a flexible sheathing, for example, adapted to be connected to an illuminator in the manner fully shown and described in our aforementioned U.S. Patent No. 3,834, 392. As shown in the aforesaid patent, the laparoscope 10 has a continuous bore for the insertion of the ligating instrument 11, and also has another bore which comprises an optical passageway connected to the eyepiece 21, which latter bore is parallel to and adjacent to the bore through which the instrument 11 is inserted into the laparoscope.
As stated in our aforesaid U.S. patent, the interior of the tubular housing 15 is filled with fiberoptic material around the two tubular passageways, and the fiberoptic material is connected into the fiberoptic material which fills this interior portion of housing 15.
Further referring to Fig. 1, the ligating instrument 11 also includes a knurled, threaded sleeve 23 attaching the ligating instrument 11 to the laparoscope 10, and the instrument 11 further includes an outer tube 24 having a slot 25, for a purpose which will be further explained hereinafter.
The outer tube 24 has a rearwardly located stop member 26 and is secured at the rearward end to a handle 27 having a large circular opening 30 adapted to accommodate the thumb of the surgeon, and having a flat rearward surface 31 which is substantially perpendicular to the axis of the ligating instrument 11 for ease of loading the elastic ring, for example, providing stability in the vertical loading position.
Accordingly, it will be appreciated from an inspection of Fig. 1 that the combined laparoscope and ligating instrument there shown may be utilized in the performance of a surgical procedure of the type referred to in our aforementioned U.S. Patent No.
3,834,392. In that procedure, a gas such as carbon dioxide or air is caused to flow into the abdominal cavity in order to increase the available working area, and the combination of a trocar and cannula is then inserted into the gas-filled abdominal cavity. Both the laparoscope and the ligating instrument 11, combined as in Fig. 1, are inserted through the cannula into the abdominal cavity, providing both a medical viewing means and a surgical instrument for performing the tubal ligation.
After properly positioning the instrument within the abdominal cavity, the surgeon captures the anatomical tube (such as a Fallopian tube) within the forceps 12, gently draws the Fallopian tube within the inner tube 14 of the ligating instrument, and discharges an elastic band, previously stretched over the inner tube 14, causing it to contract around the Fallopian tube to accomplish the ligation. The ligated Fallopian tube is then expelled from within the inner tube 14, the forceps 12 are opened, and the ligated tube is released.
The entire combination of laparoscope 10 and ligating instrument 11 may then be removed from the cannula, care being taken to maintain the gas pressure within the abdominal cavity, a fresh ring may be stretched upon the forward end of the inner tube 14, the combined laparoscope and ligating instrument may be reinserted into the abdominal cavity, and the other Fallopian tube may similarly be ligated.
Fig. 2 shows more specific details of the apparatus in accordance with this invention, and shows the ligating instrument separated into three parts.
As stated, the number 13 designates a rod which is substantially cylindrical, and which includes a pair of forceps 12 at its forward end. As shown, the forceps 12 are made of springy metal, and are normally separated as shown in Fig. 2. They are, however, springy enough to be closed with respect to each other when they are squeezed together. A cylindrical bore 32 which is unthreaded, extends through the rod 13 at its rearward end.
The number 14 designates an inner tube which is straight, hollow, and which has an inner diameter that closely approximates the outer diameter of the rod 13 so that they have freedom to move slidably back and forth with respect to each other, but are so closely fitting that the space between them is substantially gas tight. A slot 33 extends through the tubing 14 near its rearward end. Extending from the rearward end of inner tube 14, and fixedly secured thereto, is a compression spring 34 which, at its own rearward end is secured to a threaded nut 35. The number 27, as heretofore stated, designates a handle member having a hole 30 adapted for the insertion of the surgeon's thurnb, and also having a flat rearward end 31. The compression spring 34 is quite flexible, and is shown in Fig. 2 as being slightly curved longitudinally, as under the infuence of gravity, for example.
However, it is normally maintained in a straight condition during the operation of the ligating instrument in acordance with this invention.
The number 24, as heretofore stated, designates the outer tube, which is shown in Fig. 2 in conjunction with the inner tube 14. It will be observed from Fig. 2 that the inner tube 14 projects a slight distance forwardly of the forward end of the outer tube 24. This provides a forward outer surface portion on the tube 14, over which an elastic ring or band may be stretched. Desirably the inner tube projects beyond the outer tube by a distance greater than the axial thickness of the occluding ring. Such a stretching operation may be accomplished by any desired external device, such as a tapered member of the type appearing in the U.S. Patent to Scott No. 3,726,278, issued April 10, 1973. The elastic ring is not shown in Fig. 2, in order more clearly to show the forward surface of the inner tube 14.
Further referring to Fig. 2, the number 36 designates a manual actuator having a cylindrical bore through which the outer tube 24 extends. The actuator 36 has a pair of flanges 37, 37' and a concavely rounded finger grip portion 40 adapted to accommodate the index finger and the forefinger of the surgeon in performing the manipulative steps of the tubal ligation procedure. At its rearward end, the actuator 36 has a threaded bore 41 adapted to receive a connector 42 which has a knurled knob 43, a threaded portion 44 adjacent to the knob 43, and an extension stud 45 extending from the threaded portion 44. As previously stated, the outer tube 24 is provided with a slot 25 and the inner tube 14 is provided with a slot 33, both of which are aligned with each other, and through which the extension stud 45 of the connector 42 extends. The threads 44 mate with the threads in the threaded bore 41 of the manual actuator 36, and the extension stud 45 seats within the bore 32 which is located at the rearward end of the rod 13. Thus, movement of the actuator 36 longitudinally back and forth, in the area of the slots 25, 33, moves the rod 13 and its attached forceps 12, back and forth independently of the inner and outer tubes.
At its rearward end, the outer tube 24 includes a tapered collar 46 which is adapted to mate with a corresponding taper (not shown in Fig. 2) within the threaded nut 35 which is secured at the rearward end of the inner tube 14. The free end 47 of the outer tube 24 also fits within the bore within the threaded nut 35 of inner tube 14.
The outer tube 24 also includes a fixed flange 50 which is adapted to butt against the rearward end of the screw threaded flange 51 at the rearward end of the laparoscope 10. The entire ligating instrument 11 may be inserted into the bore 52 of the laparoscope by sliding the rod 13 rearwardly, compressing the forceps together within the inner tube 14, and then inserting the combination of the inner tube, the outer tube and the rod lengthwise in a forward direction into and through the tubular bore 52, and by then securing the threaded sleeve 23 to the correspondingly threaded flange 51.
Figs. 4, 5 and 6 show the combined laparoscope 10 and ligating instrument 11, with the optical viewing portion 20 and the eyepiece 21 removed for clarity of illustration.
In Fig. 4 it will be apparent that the rod 13 is concentrically mounted within the inner tube 14 which in turn is concentrically mounted within the outer tube 24. It will also be clear that the connector 42 has its extension rod portion 45 extending into and nearly completely through the bore 32 which is located at the rearward end of the rod 13. Further, the slots 25, 33 of the outer and inner tubes 24, 14 are lined up with each other, providing a substantially frictionless path for the reciprocating movement of the connector 42 back and forth within the length of the slots. However, the slot 25 in outer tube 24 extends somewhat farther to the rear than the slot 33 in the inner tube 14. Thus, with the rearward movement of the manual actuator 36, as shown in Fig. 5, the extension stud 45 of the connector 42 also moves rearwardly, until the extension stud 45 contacts the forward end of the spring plug 48 in inner tube 14. This provides a means for limiting the further rearward movement of the rod 13 and its associated forceps 12, independently of the inner tube 14. Accordingly, further rearward movement of the manual actuator 36 engages the inner tube 14 and causes it to move together with the rod 13, in a rearward direction, as shown in dot dash lines in Fig. 6.
In view of the fact that the compression spring 34 is secured to the rearward end of the inner tube 14, such further rearward movement of the manual actuator 36 causes the spring 34 to compress, thus providing a clearly noticeable resistance to such further movement and signaling to the surgeon that he has reached the stage where he is about to discharge the streched occlusion ring from the forward end of the ligating instrument 11.
It will be appreciated that, as shown in Fig. 4, the occlusion ring 53 has been stretched over and completely on the forward end of the inner tube 14, forward of the forward edge of the outer tube 24, as shown in Fig. 4. As shown at the forward end of the apparatus appearing in Fig. 5, the forceps 12 are squeezed together and capture the Fallopian tube T, bending it back upon itself and drawing it rearwardly within the inner tube 14. As shown in Fig. 6, further rearward movement of the actuator 36, against the resistance of the compression spring 34, moves the inner tube 13 rear wardly with respect to the outer tube 24 and causes the forward leading edge of the outer tube 24 to restrain the occlusion ring 53 against rearward movement together with the inner tube 14, whereupon the occlusion ring 53 is discharged from the for ward end of the inner tube 14, affixing it self by tension around the doubled Fal lopian tube T.
The actuator 36 and the handle 27 co operate with each other and are spaced in a manner to allow the surgeon to insert his thumb into the hole 30 of the handle 27 and to use his index finger and forefin ger within the rounded finger grip 40 between the flanges 37 on manual actuator 36. In this manner the surgeon can easily, and without encountering any substantial resistance, draw the forceps 12 and the associated Fallopian tube T rearwardly until the Fallopian tube at least partially enters within the confines of the forward end of the inner tube 14, and after the complete withdrawal of the forceps 12 within the inner tube 14, the surgeon encounters the resistance of the compression spring 34, occasioned by contact between the extension rod 45 of the connector 42 and the forward end of the spring plug 48 in inner tube 14. The surgeon may then conveintly utilize a sqeezing action, drawing his fingers and thumb toward one another, compressing the spring 34 and discharging the occlusion ring 53 from the forward end of the inner tube 14 as shown in Fig. 6(a).
After completion of the ligation procedure, the surgeon may simply relax the squeezing pressure thus obtained, whereby the compression spring 34 urges the inner tube forwardly with respect to the outer tube, following which the surgeon can simply shift the manual actuator 36 forwardly to release the forceps 12 from the inner tube 14, whereupon the forceps 12 automatically open because of their inherent springiness, thus releasing the ligated Fallopian tube T with the occlusion ring 53 tensioned around the Fallopian tube T.
It wil be apparent that the ligating instrument 11 is a ring applicator which may be utilized independently of the laparoscope 10. For example, a two-incision procedure may be used, wherein the laparoscope may be inserted through an independent incision in order to view the internal cavity during the operation, while the ligating instrument 11 may be introduced through a separate cavity in order to perform the tubal ligation procedure. It is also possible to utilize the ligating instrument 11 in conjunction with a culdoscope when entry is made through the vaginal cavity. It is also possible to put a bend or curve in the instrument to work through the culdesac, for example. It is also possible to eliminate members 50 and 23 if a locking mechanism is not desirable, as on a second incision instrument of the type appearing in Fig. 7.
It will also be appreciated that; however used, and whether used in conjunction with a laparoscope or not, the operation of the ligating instrument 11 is extremely simple, even in the hands of a surgeon who is relatively inexperienced in this ligation procedure. The movements of his thumb, index finger and forefinger may be readily correlated into a single squeezing type of action, and the surgeon is automatically informed at the stage when the forceps 12 have been withdrawn completely into the inner tube 14, and when the ligating instrument is ready to discharge the occlusion ring 53.
For example, any sort of stop means may be provided, instead of the stop means provided at the rearward end of the slot 33, and any resistance-supplying means may be substituted for the compression spring 34. Further, although the actuating means shown and described herein serves to move both the rod 13 and the inner tube 14 against the action of the resistance means, it is sufficient at this stage of the procedure to move the inner tube 14.
It is of course not necessary to provide a first stage operation in which there is no resistance to the movement of the surgeon's fingers, and to provide a second stage operation in which a very high resistance is encountered. The important fact is that the amount of resistance changes and thus signals to the surgeon the fact that the forceps 12 have been withdrawn completely into the inner tube 14, and that the procedure has reached the stage where the occlusion ring 53 should be discharged.
It will be apparent that a wide variety of other ejecting means may be used other than the outer tube 24. However, it is important in accordance with this invention that the ejection of the occlusion ring 53 should be preceded by notification to the surgeon, either by the development of a resistance to the movement of the surgeon's hand, which resistance is of such magnitude that it can be easily sensed by the surgeon, or by any other notification means, such as a ball detent or the like.
It is important in accordance with this invention that a close sliding fit be maintained along the rod 13, the inner tube 14 and the outer tube 24. As has been noted, the ligation procedure is frequently performed while maintaining a certain required gas pressure inside the abdominal cavity of the patient. While loss of gas pressure can readily be made up, and is indeed normally made up in the course of the usual tubal ligation procedure, it is highly preferred to maintain such close clearances that, although they do not interfere with relative sliding movement, they do very substantially reduce the escape of gas between the relatively sliding surfaces. In this connection, it is also highly desirable to provide the laparoscope with a carefully controlled inner diameter of the bore 52, in order to accommodate closely the outer surface of the outer tube 24 of the ligating instrument 11.
It will now be apparent that the instrument in accordance with this invention is very easy to disassemble, clean, sterilize and reassemble. As viewed in Fig. 2, the separate parts contain only open and easily accessible surfaces, all of which can readily be cleaned with a brush B shown in Fig. 2.
This brush may also be used to clean the internal bore 52 of the laparoscope 10.
Although it is preferred to clean and sterilize the parts separately, they can be cleaned separately, then reassembled and sterilized. Difficulty in sterilization has been a serious drawback in instruments of the prior art.
In disassembling the ligating instrument 11 in accordance with a preferred procedure, the thumb should be inserted into the hole 30 of the handle 27, and the force and index fingers should be placed into the rounded finger grip 40 in the manual actuator 36. The forceps 12 should be extended fully forwardly, in the open position. The connector 42 is then removed by unscrewing it from the manual actuator 36. Holding the outer tube 24 in one hand, the other hand is used to pull gently on the forceps 12 to remove the rod 13 completely from the inner tube 14. Holding the handle 27 with one hand, the other hand loosens the knurled nut at the rearward end of the outer tube 24. Still holding the handle 27 with one hand and the outer tube 24 with the other, the inner tube is gently pulled axially away from the outer tube until all of the compression spring 34 and a small portion of the inner tube 14 are clear. Then, with the hand that had been holding the handle 27, the inner tube 14 is carefully grasped and pulled out completely. This simple procedure presents the ligating instrument in a proper condition for cleaning.
It is highly recommended that the applicator should be cleaned immediately after use.
This is done by placing the disassembled applicator parts and cleaning brush in warm water with a mild, not abrasive detergent.
The brush B is utilized to clean the insides of the tubes, and it is preferably pushed into the tubes using a rotating motion. When cleaning the outer tube 24, the brush can be pushed through until the bristle portion projects from the tube.
After cleaning, the outsides of the tubes are simply wiped off with a soft cloth and the parts are rinsed thoroughly with clean water and excess liquid is shaken off, then all parts are air dried.
In accordance with the assembly procedure after cleaning and sterilization, the inner tube 14 together with its compression spring 34 and handle 27, is inserted into the outer tube 24. The slots 33, 25 are aligned with each other, and the knurled nut 55 is engaged but not tightened to threaded nut 35. The rod 13 together with its forceps 12 is the inserted into the inner tube 14 and the bore 32 at the rearward end of the rod is lined up with the slots in the inner and outer tubes. The tongs of the forceps 12 are, of course, permanently aligned with respect to the bore in the rod 13 and if the forceps 12 are vertically aligned, the bore 32 will also be vertical. With the single incision device to operate through a laparoscope the forceps tongs should be angularly displaced relative to the axis of the bore to bring them into view of the optic, as shown in Figs. l(a) and 3.
As a further step in the assembly procedure, the manual actuator is slid over the outer tube and its threaded opening 42 is aligned with the bore 32. Then the long extension stud 45 of connector 42 is inserted through the slots and into the bore 32, and the connector 42 is then threaded to the manual actuator by turning the knurled knob 43. It is significant that no thread damage can occur to with this invention the angle of the forceps 12 is in constant orientation with respect to the location of the connector 42. In this manner, the forceps may be angled toward the optical passage in the laparoscope 10, as previously described and as clearly illustrated in Fig. 3 of the drawings.
It is advantageous to provide the sleeve 26, which provides a clearly visible mechanical stop, and which visually informs the surgeon that the occlusion ring 53 has been discharged.
It is important in accordance with this invention that the apparatus is completely free of Wrings or washers which, with packing, tend to wear. We have found surprisingly that by providing proper clearance between the rod 13, the inner tube 14 and the outer tube 24, that only minimal amounts of gas can escape from the peritoneal cavity, because of the close sliding fit - all without interfering with the smoothness and ease of operation of the ligating instrument 11.
The provision of a compression spring 34, or any other equivalent resisting device, such as an air or gas cylinder, bellows or the like, is of considerable importance in that it assures the surgeon that the ligating instrument cannot discharge the occlusion ring 53 prematurely. It is normal in the operation of the ligating instrument 11 for the surgeon to feel the increased resistance at the time that the forceps 12 have been completely withdrawn within the inner tube 14, and the surgeon must deliberately draw the manual actuator 36 rearwardly against this known resistance in order to cause the release of the occlusion ring 53.
WHAT WE CLAIM IS: 1. A surgical ligating instrument for tubal ligation by the application of an elastic ring to an anatomical tube comprising an elongate inner member having grasping means at a forward end thereof for grasping an anatomical tube to be ligated, a tube arranged to be a close sliding fit over said inner member, said tube having a surface adjacent its forward end over which an elastic ring is adapted to fit in a tensioned condition, manually engageable actuating mean operatively connected to said inner member to slide it rearwardly within said tube, means operative to actuate said grasping means to grasp the anatomical tube to be ligated and to draw it into said tube means in response to retraction of said in ner member relative to said tube, ejecting means operable upon further retraction of said inner member relative to said tube to eject said elastic ring whilst said anatomical tube to be ligated extends into said tube thereby positioning said elastic ring surrounding said anatomical tube and effect ing ligation thereof.
2. An instrument according to Claim 1 including means for determining further re traction of said inner member, said means comprising resistance means operatively as sociated with said manually engageable actuating means and arranged to impose a manually detectable increase in resistance to said further retraction of said inner member relative to said tube.
3. An instrument according to Claim 1 or 2 wherein said manually engageable actuating means is also operatively connected to said inner member to slide it rearwardly within said tube during said further retraction.
4. An instrument according to any of Claims 1 to 3 wherein stop means is provided to prevent excessive retraction of said member after said elastic ring has been ejected in response to said further retraction of said inner member.
5. An instrument according to any of Claims 1 to 4 wherein said tube is an inner tube of an ejector means comprising an outer ejecting tube within which said inner tube is slidably arranged.
6. An instrument according to Claim 5 wherein a positioning means is provided for positioning the forward end of said outer ejecting tube rearwardly of the forward end of said inner tube.
7. An instrument according to any of Claims 2 to 6 wherein said resistance means includes a mechanical spring.
8. An instrument according to Claim 7 wherein said spring is substantially helical and is attached to said inner tube and wherein said further retraction compresses said spring.
9. An instrument according to Claim 8 wherein the forward end of said spring is attached to the rearward end of said inner tube and wherein a handle is attached to the rearward portion of said spring, and wherein said manually engageable actuating means is attached to said inner member, and engageable upon said tube whereby said spring may be compressed by relative movement between said handle and said actuating means.
10. An instrument according to Claim 9 wherein said handle includes a curved hole adapted for operation by insertion of the surgeon's thumb.
11. An instrument according to Claim 9 or 10 wherein said handle has a substantially flat rearward surface.
12. An instrument according to any of Claims 7 to 11 wherein said resistance means is connected to said inner tube and is movable together with said inner tube relative to said inner member.
13. An instrument according to any of Claims 1 to 12 wherein said inner member
**WARNING** end of DESC field may overlap start of CLMS **.

Claims (29)

**WARNING** start of CLMS field may overlap end of DESC **. with this invention the angle of the forceps 12 is in constant orientation with respect to the location of the connector 42. In this manner, the forceps may be angled toward the optical passage in the laparoscope 10, as previously described and as clearly illustrated in Fig. 3 of the drawings. It is advantageous to provide the sleeve 26, which provides a clearly visible mechanical stop, and which visually informs the surgeon that the occlusion ring 53 has been discharged. It is important in accordance with this invention that the apparatus is completely free of Wrings or washers which, with packing, tend to wear. We have found surprisingly that by providing proper clearance between the rod 13, the inner tube 14 and the outer tube 24, that only minimal amounts of gas can escape from the peritoneal cavity, because of the close sliding fit - all without interfering with the smoothness and ease of operation of the ligating instrument 11. The provision of a compression spring 34, or any other equivalent resisting device, such as an air or gas cylinder, bellows or the like, is of considerable importance in that it assures the surgeon that the ligating instrument cannot discharge the occlusion ring 53 prematurely. It is normal in the operation of the ligating instrument 11 for the surgeon to feel the increased resistance at the time that the forceps 12 have been completely withdrawn within the inner tube 14, and the surgeon must deliberately draw the manual actuator 36 rearwardly against this known resistance in order to cause the release of the occlusion ring 53. WHAT WE CLAIM IS:
1. A surgical ligating instrument for tubal ligation by the application of an elastic ring to an anatomical tube comprising an elongate inner member having grasping means at a forward end thereof for grasping an anatomical tube to be ligated, a tube arranged to be a close sliding fit over said inner member, said tube having a surface adjacent its forward end over which an elastic ring is adapted to fit in a tensioned condition, manually engageable actuating mean operatively connected to said inner member to slide it rearwardly within said tube, means operative to actuate said grasping means to grasp the anatomical tube to be ligated and to draw it into said tube means in response to retraction of said in ner member relative to said tube, ejecting means operable upon further retraction of said inner member relative to said tube to eject said elastic ring whilst said anatomical tube to be ligated extends into said tube thereby positioning said elastic ring surrounding said anatomical tube and effect ing ligation thereof.
2. An instrument according to Claim 1 including means for determining further re traction of said inner member, said means comprising resistance means operatively as sociated with said manually engageable actuating means and arranged to impose a manually detectable increase in resistance to said further retraction of said inner member relative to said tube.
3. An instrument according to Claim 1 or 2 wherein said manually engageable actuating means is also operatively connected to said inner member to slide it rearwardly within said tube during said further retraction.
4. An instrument according to any of Claims 1 to 3 wherein stop means is provided to prevent excessive retraction of said member after said elastic ring has been ejected in response to said further retraction of said inner member.
5. An instrument according to any of Claims 1 to 4 wherein said tube is an inner tube of an ejector means comprising an outer ejecting tube within which said inner tube is slidably arranged.
6. An instrument according to Claim 5 wherein a positioning means is provided for positioning the forward end of said outer ejecting tube rearwardly of the forward end of said inner tube.
7. An instrument according to any of Claims 2 to 6 wherein said resistance means includes a mechanical spring.
8. An instrument according to Claim 7 wherein said spring is substantially helical and is attached to said inner tube and wherein said further retraction compresses said spring.
9. An instrument according to Claim 8 wherein the forward end of said spring is attached to the rearward end of said inner tube and wherein a handle is attached to the rearward portion of said spring, and wherein said manually engageable actuating means is attached to said inner member, and engageable upon said tube whereby said spring may be compressed by relative movement between said handle and said actuating means.
10. An instrument according to Claim 9 wherein said handle includes a curved hole adapted for operation by insertion of the surgeon's thumb.
11. An instrument according to Claim 9 or 10 wherein said handle has a substantially flat rearward surface.
12. An instrument according to any of Claims 7 to 11 wherein said resistance means is connected to said inner tube and is movable together with said inner tube relative to said inner member.
13. An instrument according to any of Claims 1 to 12 wherein said inner member
comprises a straight, elongated rod having grasping means in the form of forceps at its forward end.
14. An instrument according to any of Claims 5 to 13 wherein said outer ejecting tube includes a stop positioned for limiting relative' rearward movement of said inner tube.
15. An instrument according to Claim 14 wherein said outer ejecting tube includes a stop limiting rearward movement of said tube relative to said outer ejecting tube, and wherein said outer tube stop is spaced rearwardly of said inner tube stop, whereby in a single rearward movement of said manually operable means said rod moves rearwardly of both tubes and, then the rod and inner tube move rearwardly in unison, and then said motion in unison is stopped.
16. An instrument according to any of Claims 13 to 15 including means for disassembling said rod and said tubes each from each other for separate cleaning and sterilisation.
17. An instrument according to any of Claims 13 to 16 wherein said manually operable means is located outside said outer tube and wherein both said inner tube and said outer tube are provided with openings to allow independent movement, and wherein said connection extends through said openings.
18. An instrument according to Claim 17 wherein said openings are slotted openings.
19. An instrument according to Claim 18 wherein said resistance means, which connects said outer tube to said inner tube, also predetermines the spacing of said slotted openings, and wherein the slotted opening in said outer tube extends rearwardly of the slotted opening of said inner tube, whereby the slotted opening of said inner tube provides a stop which is contacted by said connection.
20. An instrument according to any of Claims 5 to 19 wherein said outer tube includes connection means for connection to an optial viewing device having a viewing bore substantially parallel to said inner member.
21. An instrument according to Claim 20 wherein said instrument is combined with and connected to an optical viewing device and wherein said optical viewing device includes a bore which has an inner diameter which forms a close sliding fit with the outer diameter of said outer tube.
22. An instrument according to any of Claims 5 to 21 wherein said forward end of said inner tube projects forwardly of the front end of said outer tube by a distance greater than the axial thickness of said elastic occluding ring.
23. An instrument according to any of Claims 20 to 22 wherein said optical viewing device includes an optical passageway extending parallel to and adjacent to the said bore in said optical viewing device, and wherein said manually operable means is secured to said inner member in a manner to prevent rotation of said inner member within said inner tube, and wherein said grasping means are angularly arranged in a direction from the axis of said bore toward the axis of said optical passageway.
24. Ah instrument according to Claims 17 to 23 wherein said connection is threaded to said manually operable means.
25. An instrument according to Claim 24 wherein said connection includes a projection which extends into a cavity formed in said rod.
26. An instrument according to Claim 25 wherein said projection has a cylindrical outer surface and said cavity is correspondingly shaped.
27. A surgical ligating instrument substantially as herein described with reference to, and as shown in, the accompanying drawings.
28. A method of assembling a surgical ligating instrument as claimed in any of claims 5 to 27 which includes the steps of inserting said inner tube into said outer tube, substantially aligning said openings, inserting said rod into said inner tube, substantially aligning with said openings the point at which the actuating means are operatively connected to said inner member, and inserting said connecting means through both said openings and securing it to said point on said rod.
29. A method of assembling a surgical ligating instrument substantially as herein described;with reference to the accompanying drawings.
Reference has been directed in pursuance of section 9, subsection (1) of the Patents Act 1949, to patent No. 1 497 799.
GB1610077A 1977-04-19 1977-04-19 Surgical ligating instrument and method Expired GB1560282A (en)

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GB1610077A GB1560282A (en) 1977-04-19 1977-04-19 Surgical ligating instrument and method

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Application Number Priority Date Filing Date Title
GB1610077A GB1560282A (en) 1977-04-19 1977-04-19 Surgical ligating instrument and method

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GB1560282A true GB1560282A (en) 1980-02-06

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999023953A1 (en) * 1997-11-12 1999-05-20 Boston Scientific Limited Gastrointestinal compression clips
US6387114B2 (en) 2000-04-28 2002-05-14 Scimed Life Systems, Inc. Gastrointestinal compression clips

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999023953A1 (en) * 1997-11-12 1999-05-20 Boston Scientific Limited Gastrointestinal compression clips
US6099552A (en) * 1997-11-12 2000-08-08 Boston Scientific Corporation Gastrointestinal copression clips
US6241748B1 (en) 1997-11-12 2001-06-05 Boston Scientific Corporation Gastrointestinal compression clips
US6387114B2 (en) 2000-04-28 2002-05-14 Scimed Life Systems, Inc. Gastrointestinal compression clips

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Legal Events

Date Code Title Description
PS Patent sealed
732 Registration of transactions, instruments or events in the register (sect. 32/1977)
PE20 Patent expired after termination of 20 years

Effective date: 19970418