GB2324966A - Ligating apparatus - Google Patents
Ligating apparatus Download PDFInfo
- Publication number
- GB2324966A GB2324966A GB9709473A GB9709473A GB2324966A GB 2324966 A GB2324966 A GB 2324966A GB 9709473 A GB9709473 A GB 9709473A GB 9709473 A GB9709473 A GB 9709473A GB 2324966 A GB2324966 A GB 2324966A
- Authority
- GB
- United Kingdom
- Prior art keywords
- filament
- loop
- vessel
- free end
- transfer
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B17/12013—Implements 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
Abstract
Ligating apparatus for use in surgery comprises upper and lower jaw members (11, 10) which can be closed around the vessel to be ligated (not shown), the upper jaw member carrying a length of filament (not shown) having its free end releasably secured in a holder (22) and a filament transfer rod (12) which is arranged to transfer a portion of the filament around the vessel to a keyhole-shaped slot (17) wherein the filament is grabbed by a filament grabber (20). The filament transfer rod (12) carries transversely-extending cylindrical loop-forming members which form loops in the filament which are received in respective loop-holders (18, 19). An inner drive cylinder (8) lowers transfer rod (12) by means of a cam (27) and subsequently rotates the loops in the filament by means of a rack and pinion drive acting on the loop holders. This rotation enables the filament grabber (20) to advance through the loop holders, grab the filament, and retract through the loop holders to form a knot in the filament, which is then tightened to form the ligature.
Description
Ligating apparatus
The present invention relates to ligating apparatus. Such apparatus is useful for forming ligatures around veins, arteries, ducts and other vessels in surgical procedures carried out on the human or animal body.
Surgical procedures for forming ligatures around eg blood vessels currently take about 3 to 4 minutes per ligature and require a number of different instruments.
There is a need for a ligating instrument which can speed up this procedure and which can preferably be used to form a ligature around a vessel which is only accessible by the surgeon from one side.
The invention provides ligating apparatus for forming a ligature around a body vessel from a ligating filament extending across the vessel from a first side of the vessel to a second side of the vessel opposite the first side, the filament having a free end at the second side of the vessel, the apparatus comprising movable filamentholding means arranged to hold the free end of the filament, the filament-holding means being arranged to pass the free end region of the filament further around the vessel to encircle the vessel, and means for securing the free end region of the filament to the region of the filament extending across the vessel to form a ligature.
Preferably the free end region of the filament is secured to the region of the filament extending across the vessel by forming a knot.
Preferably the apparatus further comprises loop-forming means arranged to form a loop in a portion of the filament adjacent the first side of the vessel and loopclosing means arranged to close the neck of the loop, the filament-holding means being arranged to thread the free end of the filament through the loop to encircle the vessel, and the securing means being arranged to secure the threaded portion of the filament to the loop region of the filament to form the ligature. Preferably the loopclosing means comprises means for twisting the loop so as to cross over the lengths of filament forming its neck portion.
Preferably the loop is twisted and the free end of the filament is threaded through the loop to form a knot. Preferably two loops are formed and twisted and the free end of the filament is passed through both twisted loops to form a common knot.
Preferably the loop-forming means is arranged to twist the loop by from one to one and a half turns. In a preferred embodiment the loop further from the vessel is twisted by one and a quarter turns in order to orient the loop at a right angle to the filament, so that the filament can be easily passed through the loop.
Preferably the movable filament-holding means is arranged to extend through the loop(s), grasp the free end of the filament and then retract through the loop(s) to form a knot.
Preferably the apparatus comprises comprising means for releasably securing the free end region of the filament in a first position at the second side (which is preferably the distal side) of the vessel. Preferably the filament-holding means comprises filament transfer means arranged to transfer the free end region of the filament transversely from said first position to a second position further around the vessel, the second position being aligned with the path of travel of filament-grabbing means, the filament-grabbing means being arranged to grab said free end region from said second position and move said free end region in a direction to substantially complete the encirclement of the vessel.
Preferably the loop(s) are formed on the proximal side of the vessel and preferably the ligating filament crosses over the upper surface of the vessel and its free end is passed beneath the vessel to encircle the vessel. However in another embodiment the loop(s) could be formed on the distal side of the vessel and the free end of the ligating filament could be passed over the top of the vessel to encircle the vessel.
Other preferred features of the invention are defined in the dependent claims.
A preferred embodiment is described below by way of example only with reference to Figures 1 to 9 of the accompanying drawings, wherein:
Figure 1 shows the stages in the configuration of the ligating filament as it is used to form a ligature using an instrument in accordance with the invention;
Figure 2 is a sketch perspective view of the instrument of the invention in its initial configuration prior to forming a ligature;
Figure 3 is a diagrammatic longitudinal cross-section of the instrument showing the filament transfer and loop fonnation illustrated in Figure 1A;
Figure 4 is a diagrammatic longitudinal cross-section of the instrument showing the loop twisting as shown in Figure 1B;
Figure 5 is a diagrammatic longitudinal cross-section of the instrument showing the filament grabbing operation as shown in Figures 1B and 1C; Figure 6 is a diagrammatic longitudinal cross-section of the instrument showing the further filament transfer and withdrawal of the filament grabber to tighten the knot as shown in Figure 1D;
Figure 7 is a diagrammatic longitudinal cross-section of the instrument showing the completion of the further filament transfer operation and the release of the free end of the filament by the filament grabber as shown in figures 1E and 1F;
Figure 8 is a plan view showing a detail of the releasable securing arrangement and the further transfer rod, and
Figure 9 is a sketch perspective view of the releasable securing arrangement and the further transfer rod as a new portion of filament is transferred to the releasable securing arrangement, thereby restoring the apparatus to its initial condition as shown in Figure 2.
Referring to Figure 1A, the filament 2 is shown extending across a blood vessel 1 from the right to the left and has two loops 3 and 4 formed to the right of the vessel.
It is assumed that the right hand side in the drawing is the "first" (proximal) side and the left hand side is the "second" (distal) side. The free end region of the filament 2 is lowered from its initial (first) position 2' to a second position to begin the encirclement of the blood vessel.
Referring to Figure 1B, loop 3 is twisted clockwise by approximately 270 degrees and the loop 4 is twisted clockwise by one and a quarter turns. In this condition both loops lie transverse to the plane of the drawing (in which the plane of the remainder of the filament lies) and lie in the return path of the filament as shown by the dashed line.
Referring to Figure 1C, the free end region of the filament 2 is drawn through both loops as indicated by arrow A.
Referring to Figure 1D, the filament is then pushed in region 6 as indicated by arrow
B while its free end is pulled in the opposite direction as indicated by arrow A, thereby tightening a knot around vessel 1. The tightening in the opposite directions balances the forces acting on the blood vessel and prevents the blood vessel from being dragged forwardly or backwardly.
This knot is indicated by reference numeral 7 in Figure 1E and Figure lF. The latter
Figure shows the cutting of the filament at the distal end, resulting in a length of filament 2 and a ligature closing the vessel 1.
It should be noted that the number of twists applied to the loops 3 and 4 can be varied and the direction of twisting can be anti-clockwise instead of clockwise. In principle the loops could be preformed in the length of filament 2 and the threaded portion of the filament could be attached to the interior of the loops by means other than knotting.
Referring now to Figure 2, the instrument for carrying out the above operations comprises an outer cylinder 9 (shown cut away at 26 to reveal the interior of the instrument) carrying a hollow lower jaw 10 and a hollow upper jaw 11. These jaws oppose one another and are hinged at their proximal ends so that they can be closed around the vessel to be ligated.
The upper jaw 11 has a keyhole-shaped longitudinal slot 24 in its lower wall and the lower jaw 10 has a similar facing slot 17 in its upper wall. A filament transfer rod 12 having a bifurcated distal end 23 is pivotally supported in upper jaw 11 and can be swung downwardly through slots 17 and 24 to transfer the free end region of the filament from a first position within a filament-securing clip 22 to a filament receiver 29 (Figure 3) where the free end lies in a second position in the path of a filament grabber 20. Filament grabber 20 is movable longitudinally to grab the free end of the filament and withdraw it through twisted loops formed in the filament and held by rotatable loop receivers 18 and 19.
Filament-securing clip 22 is supported at the mouth of an aperture in the lower edge of a supporting plate 21 and co-operates with a further filament transfer rod (not shown in Figure 2) as will subsequently be described in more detail.
Upper jaw 11 is shown cut away at 25 to reveal loop-forming cylinders 13 and 14 which are carried on an intermediate portion of the filament transfer rod 12 and pass through apertures 15 and 16 in the lower wall of the upper jaw to engage the filament and form two loops therein. These loops and the cylinders 13 and 14 are carried into the loop receivers 18 and 19 as the filament transfer rod 12 swings further downwards.
Both the bifurcated end region 23 of the filament transfer rod 12 and the front end of filament grabber 20 have suitable jaw or clip arrangements for grasping the filament.
The filament transfer rod 12 is driven by a cam 27 which engages the forward edge of a longitudinally slidable control cylinder 8 as shown more clearly in Figure 3.
The control cylinder 8 is driven in conjunction with a further thread transfer rod 30 and in conjunction with the opening and closing of the jaws 10 and 11 by any suitable means (eg mechanical or electromechanical) to perform the required sequence of operations in the required sequence. The control cylinder 8 has an aperture 81 adjacent cam 27(as best seen in Figure 3) and depresses the thread transfer rod assembly twice in each cycle as first the front edge of the cylinder and then the rear edge of aperture 81 ride over cam 27.
The control cylinder 8 also rotates the loop receivers about their vertical axes by means of a toothed rack 40 on its inner surface which engages respective pinions 41 and 42 on the loop receivers. Since the pinion 42 is engaged by the advancing rack before the pinion 41, it rotates more than pinion 41 so that the desired degree of twist is imparted to each loop.
A continuous supply of filament (not shown) is housed in the distal portion of the instrument.
Referring to Figure 3, the first stage in the operation of the instrument involves the closure of the jaws 10 and 11 around the vessel 1 and the lowering of the thread transfer rod 12 which transfers the free end of the ligating filament 2 to filament receiver 29. Simultaneously, the loop-forming cylinders 13 and 14 form loops in the filament which are received in the loop receivers. In this position the thread transfer rod 12 extends substantially horizontally from its supporting pivot 36 and is biased upwardly (ie clockwise about pivot 36) by spring means (not shown) against the action of the forward region of cylinder 8 acting on the tip of cam 27.
Further advancement of the control cylinder 8 brings aperture 81 over the cam 27 and allows the filament transfer rod 12 to swing upwardly, whilst the loop receivers are rotated by engagement of their pinions with the rack on the interior of the control cylinder, as shown in Figure 4.
Referring to Figure 5, the next stage involves advancing a further thread transfer rod 30 which engages a transverse pusher member 38 on filament grabber 31. Filament grabber 31 is slidably supported on a fixed support member 43 and is biased rearwardly against the action of the thread transfer rod 30 by a compression spring 35. When the thread transfer rod reaches the free end region of the filament 2 in the holder 29 it grabs the filament between its jaws 20 (which may be resiliently biased towards the closed configuration and forced over the filament or could be closed mechanically or electromechanically) and the transverse pusher member 38 is released from the further thread transfer rod (eg by sliding over a fixed camming surface or guide slot (not shown) which rotates it about thread transfer rod 30), allowing the further thread transfer rod 30 to retract the free end region of the filament through the loops 3 and 4 as shown in Figure 6. The further thread transfer rod 30 simultaneously advances further and engages the length of filament extending rearwardly from rearward loop and tightens the knot around the vessel 1 in conjunction with thread grabber 31. This process involves some anti-clockwise rotation of the ligature around the vessel 1. As shown in Figure 6, the further thread transfer rod 30 carries an annular member 44 which is acted on by a compression spring 33 to provide a spring return action when the actuator of the further thread transfer rod (not shown) is released.
The final stage of travel of the further thread transfer rod 30 is shown in Figures 7, 8 and 9. As best seen in Figures 8, the thread transfer rod 30 passes between opposed inwardly biased resilient leaf members 22A and 22B which are supported at their rear (right hand) ends, so that filament 2 is captured within a longitudinal slot running along the upper surface of the further thread transfer rod (as best seen in
Figure 9). As the further thread transfer rod advances further, a transverse cut-out 32 in its upper tip portion registers with downward extensions of the leaf members 22A and 22B and enables the leaf members to spring back to a closed position in which they grasp the filament 2. Finally the filament transfer rod 12 is lowered by advancing control cylinder 8 to cut the filament 2 on a cutting blade 28 (Figure 7) whose cutting edge faces rearwardly. Alternatively the forward motion of the further filament transfer rod 30 may be arranged to force the filament against the cutting edge to achieve the required cutting action. Opening of the jaws completes the cycle and returns the instrument to the original configuration shown in Figure 2.
Claims (24)
1. Ligating apparatus for forming a ligature around a body vessel from a ligating filament extending across the vessel from a first side of the vessel to a second side of the vessel opposite the first side, the filament having a free end at the second side of the vessel, the apparatus comprising movable filament-holding means arranged to hold the free end of the filament, the filament-holding means being arranged to pass the free end region of the filament further around the vessel to encircle the vessel, and means for securing the free end region of the filament to the region of the filament extending across the vessel to form a ligature.
2. Ligating apparatus according to claim 1, further comprising loop-forming means arranged to form a loop in a portion of the filament adjacent the first side of the vessel and loop-closing means arranged to close the neck of the loop, wherein the filament-holding means is arranged to thread the free end of the filament through the loop to encircle the vessel, and the securing means is arranged to secure the threaded portion of the filament to the loop region of the filament to form the ligature.
3. Apparatus according to claim 2 wherein the loopclosing means comprises means for twisting the loop so as to cross over the lengths of filament forming its neck portion.
4. Apparatus according to claim 3 wherein said loop-forming means is arranged to twist the loop by from one to one and a half turns.
5. Apparatus according to claim 2 or claim 3 or claim 4 wherein the movable filament-holding means is arranged to extend through said loop, grasp the free end of the filament and then retract through said loop to form a knot.
6. Apparatus according to any of claims 2 to 5 wherein the loop-forming means is arranged to form a further loop further from the vessel than the first-mentioned loop and to twist the further loop so as to cross over the lengths of filament forming its neck portion and the filament-holding means is arranged to thread the free end of the filament through both loops to form at least one knot.
7. Apparatus according to claim 6 wherein the loop-forming means is arranged to twist the further loop more than the first-mentioned loop.
8. Apparatus according to any preceding claim, further comprising means for tightening the ligature.
9. Apparatus according to any preceding claim, further comprising cutting means arranged to cut the filament after the filament has encircled the vessel.
10. Apparatus according to any preceding claim, further comprising means for releasably securing the free end region of the filament in a first position at the second side of the vessel.
11. Apparatus according to claim 10 wherein said filament-holding means comprises filament transfer means arranged to transfer the free end region of the filament transversely from said first position to a second position further around the vessel, the second position being aligned with the path of travel of filament-grabbing means, the filament-grabbing means being arranged to grab said free end region from said second position and move said free end region in a direction to substantially complete the encirclement of the vessel.
12. Apparatus according to claim 11 as dependent on claim 2 or any claim dependent on claim 2 wherein the filament transfer means comprises an arm which in use extends towards the vessel and is pivoted at its proximal end, the distal end of the arm being arranged to engage the free end portion of the vessel and the intermediate portion of the arm carrying transversely projecting means for forming at least one loop in the filament.
13. Apparatus according to claim 12, further comprising linear drive means and camming means coupled between the linear drive means and said pivoted arm and arranged to pivot the arm in response to rectilinear motion of the linear drive means.
14. Apparatus according to claim 2 or any of claims 3 to 13 as dependent on claim 2, further comprising loop-holding means aligned with the loop-forming means and arranged to hold the or each loop in position.
15. Apparatus according to claim 14, further comprising means for rotating said loop-holding means about an axis of symmetry of the loop therein.
16. Apparatus according to claim 11 or any claim dependent on claim 11, further comprising further filament transfer means arranged to transfer a length of said filament extending between the second position and the vessel to said releasable securing means.
17. Apparatus according to claim 16 as dependent on claim 11 or as dependent upon any claim dependent on claim 11 wherein said further filament transfer means is coupled to said filament-grabbing means and is arranged to advance the filamentgrabbing means towards the filament, to release the filament-grabbing means after the latter has grabbed the filament to enable retraction of the filament-grabbing means, and then to transfer a length of filament extending between the second position and the vessel to the releasable securing means.
18. Apparatus according to claim 17 as dependent on claim 11 or any claim dependent on claim 11 wherein said filament transfer means is arranged to act transversely on the region of the filament lying between the free ends and the other ends of the jaw members to release the filament from the securing means.
19. Apparatus according to claim 17 or claim 18 wherein the further filament transfer means and filament-grabbing means are arranged to move a part simultaneously so as to tighten the ligature around the vessel.
20. Apparatus according to claim 19 wherein the further filament transfer means and filament-grabbing means are spring loaded and are arranged to move apart under spring action.
21. Apparatus according to claim 10 or any claim dependent on claim 10 wherein the releasable securing means comprises two cooperating jaw members having free ends biased inwardly towards each other and supported in a spaced apart configuration at their other ends whereby in use, the tree end region of the filament can be passed between said other ends towards said free ends and gripped by said free ends.
22. Ligating apparatus as claimed in any preceding claim, comprising first and second jaw members which can be closed around the vessel, the first jaw member being arranged to support a length of filament over the vessel and housing filament transfer means arranged to transfer a free end region of the filament to the second jaw member, the second jaw member housing said filament-holding means.
23. Ligating apparatus as claimed in any preceding claim, further comprising means for feeding a continuous length of filament to the second side of the vessel.
24. Apparatus for forming a ligature around a vessel in the human or animal body, substantially as described hereinabove with reference to Figures 1 to 9 of the accompanying drawings.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| GB9709473A GB2324966A (en) | 1997-05-09 | 1997-05-09 | Ligating apparatus |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| GB9709473A GB2324966A (en) | 1997-05-09 | 1997-05-09 | Ligating apparatus |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| GB9709473D0 GB9709473D0 (en) | 1997-07-02 |
| GB2324966A true GB2324966A (en) | 1998-11-11 |
Family
ID=10812088
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| GB9709473A Withdrawn GB2324966A (en) | 1997-05-09 | 1997-05-09 | Ligating apparatus |
Country Status (1)
| Country | Link |
|---|---|
| GB (1) | GB2324966A (en) |
Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5312423A (en) * | 1992-10-01 | 1994-05-17 | Advanced Surgical Intervention, Inc. | Apparatus and method for laparaoscopic ligation |
| WO1994017737A1 (en) * | 1993-02-09 | 1994-08-18 | Laparomed Corporation | Dual ligating and dividing apparatus |
| US5417700A (en) * | 1992-03-30 | 1995-05-23 | Thomas D. Egan | Automatic suturing and ligating device |
| EP0537955B1 (en) * | 1991-10-12 | 1996-12-11 | Ethicon, Inc. | Laparoscopic instrument for the application of endoligatures |
-
1997
- 1997-05-09 GB GB9709473A patent/GB2324966A/en not_active Withdrawn
Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP0537955B1 (en) * | 1991-10-12 | 1996-12-11 | Ethicon, Inc. | Laparoscopic instrument for the application of endoligatures |
| US5417700A (en) * | 1992-03-30 | 1995-05-23 | Thomas D. Egan | Automatic suturing and ligating device |
| US5312423A (en) * | 1992-10-01 | 1994-05-17 | Advanced Surgical Intervention, Inc. | Apparatus and method for laparaoscopic ligation |
| WO1994017737A1 (en) * | 1993-02-09 | 1994-08-18 | Laparomed Corporation | Dual ligating and dividing apparatus |
Also Published As
| Publication number | Publication date |
|---|---|
| GB9709473D0 (en) | 1997-07-02 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| WAP | Application withdrawn, taken to be withdrawn or refused ** after publication under section 16(1) |