JP2023041714A - Endoscopic instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enhance operability of an instrument for operating a basket type device for capturing an object removed from a body of an animal.

SOLUTION: There is provided an instrument used by a surgeon for operating a basket type device for capturing an object removed from a body of an animal. The instrument includes a first control device and a second control device. The first control device combines with the basket type device to selectively control the basket type device, and move the basket type device between a first closed position and a second open position. The first control device includes a handle that combines with a plunger to operate a relative position of the plunger with respect to a cylinder of a plunger/cylinder mechanism. The second control device is disposed adjacent to the first control device, and combines with the basket type device to selectively and independently control rotation for the first control device.

SELECTED DRAWING: Figure 8

COPYRIGHT: (C)2023,JPO&INPIT

Description

TECHNICAL FIELD Exemplary and non-limiting embodiments relate generally to endoscopes and, more particularly, to devices for use with endoscopes.

US Pat. No. 6,764,499 discloses a medical device with a basket. US Pat. No. 8,211,115 discloses retrieval baskets of various sizes.

U.S. Pat. No. 6,764,499 U.S. Pat. No. 8,211,115

The following summary is intended to be exemplary only. This summary is not intended to limit the scope of the claims.

According to one aspect, an exemplary embodiment can be provided in an instrument for use by a surgeon to manipulate a basket-type device for capturing objects removed from an animal's body, The instrument is adapted to couple to the basket-shaped device for selectively controlling the basket-shaped device and for moving the basket-shaped device between a first closed position and a second open position. a handle coupled to the plunger for manipulating the relative position of the plunger with respect to the cylinder of the plunger/cylinder mechanism; and positioned adjacent to the first controller and adapted to couple to the basket-shaped device for selectively controlling rotation of the basket-shaped device independently of the first controller; a second controller;

According to another aspect, exemplary embodiments can be provided in an instrument for use by a surgeon to manipulate a basket-type device for capturing an object removed from an animal's body. , the instrument has a longitudinal axis and includes a housing including a passageway, a first portion located in the passageway of the housing, and a second portion extending from the housing. , a first controller adapted to be coupled to the basket-shaped device for selectively controlling the basket-shaped device, the first controller being adapted to move between a first closed position and a second open position; axially moveable in the passageway of the housing to move the basket-shaped device in the second open position, and rotatable into the passageway of the housing to rotate the basket-shaped device when in the second open position. and an end surface coupled to a second portion of the first controller for axially moving with the first controller to move the first controller to an end surface that rotates and moves independently of the first controller so that it can assume a fixed and rotated state while the controller rotates.

The foregoing aspects and further features are employed and described in the following description in conjunction with the accompanying drawings.

It is a side view of an endoscope. 1 is a side view of the distal end of an endoscopic instrument; FIG. 3 is a side view from the distal end of the endoscope shown in FIG. 1 illustrating the expansion of the instrument shown in FIG. 2; FIG. 4 is a perspective view of the proximal end of the endoscopic instrument shown in FIGS. 2-3; FIG. 5 is a schematic diagram illustrating the assembly shown in FIG. 4 coupled with a sheath and basket-type device; FIG. Figure 5 is an exploded perspective view of the assembly shown in Figure 4; Figure 7 is a cross-sectional view of the outer sleeve of the assembly shown in Figures 4 and 6; Figure 7 is a cross-sectional view of the assembly shown in Figures 4 and 6; 9 is a partial cross-sectional view of the upper button and plunger shown in FIG. 8; FIG. Figure 9 is a perspective view of the plunger shown in Figures 4, 6 and 8; Figure 11 is a cross-sectional view of the plunger shown in Figure 10; Figure 9 is a perspective view of an alternative embodiment of the connector shown in Figures 4 and 8; Figure 13 is an exploded perspective view of the connector shown in Figure 12;

Referring to FIG. 1, a side view of an example device 10 is shown. Apparatus 10 in this example is an endoscopic medical device that is configured to be partially inserted into a patient's body, such as through the patient's urethra, for example. Endoscope 10 generally includes a control portion 12 and a flexible or semi-flexible shaft 14 connected to control portion 12 . In this example, the control portion 12 forms a handle for the device. Shaft 14 includes a passive deflection section 16 and an active deflection section (bending section) 18 at the distal end of shaft 14 . A control system 22 for controlling the active bending portion 18 extends from the control portion 12 to the active bending portion 18 . Control system 22 generally includes flexible control wires, wire sheaths and actuators 28 . The wire is connected at one end to the actuator 28 and at a second end to the active deflection portion 18 .

In the exemplary embodiment shown, the control portion 12 has a slide or lever (control lever) 30 that is operated by the user. Lever 30 is connected to actuator 28 . Actuator 28 is adapted to pull and loosen wires of control system 22 . Actuator 28 moves when lever 30 is moved by the user. Actuator 28 may be, for example, a drum or may be connected by a pulley so as to be rotatable to control portion 12 while pulling one wire and simultaneously loosening another wire. In alternate embodiments, the actuator may be any suitable type of device, such as a rocker arm, adapted to pull and loosen wires of control system 22 . In another alternative embodiment, where the control system can have more than one pair of control wires, the control portion includes additional actuators and corresponding actuators for driving the additional pairs of bending control wires. have control over In yet another alternative embodiment, the control portion may comprise a handle with controls for a rack and pinion mechanism or other suitable user operated control system.

A shaft 14 protrudes from the control portion 12 at one end. Flexible shaft 14 includes flexible control wires, fiber optic image bundles, fiber optic illumination bundles and working channels of control system 22 . A port 60 for inserting instruments into the working channel 24 of the shaft is located on the control portion 12 . Control portion 12 also has a light source post 62 for connecting a light source (not shown) to the illumination bundle. Additionally, the control portion 12 has an eyepiece 63 for the user to view the images propagated by the image bundle from the front end 20 . In alternate embodiments, the flexible shaft can be housed within a different system. Shaft 14 generally includes frame 26 , cover 32 and objective head 34 .

Referring also to FIGS. 2-3, the distal end of endoscopic instrument 36 is shown. Instrument 36 is attached to device 10 and is configured to extend from distal end 20 of shaft 14 from working channel 24 . Instrument 36 is, in this example, a Surgeon Controlled Basket Device (SCBD). Instrument 36 includes assembly 33 with basket-type device 50 and sheath 56 . The basket-type device 50 includes a basket portion 52 at its distal end and a shaft portion 54 extending from a sheath 56 to the proximal end of instrument 36 . Shaft portion 54 functions as a control wire for moving basket portion 52 . Sheath 56 and basket-shaped device 50 are longitudinally movable relative to each other to move basket-shaped device 50 between forward and rearward positions relative to sheath 56 . FIGS. 2 and 3 show that the shaft portion (control wire) 54 moves forward relative to the sheath 56 so that the basket portion 52 is positioned outside the gap 66 at the front end of the sheath 56. . In a position forward of sheath 56 on basket-type device 50 , basket portion 52 is positioned inside sheath 56 . Basket portion 52 is collapsed by sheath 56 into a smaller shape to fit inside sheath 56 .

With further reference to FIGS. 4-5, instrument 36 in this example includes control assembly 70 . A control assembly 70 is coupled to the proximal end of basket device 50 and sheath 56 . Control assembly 70 is attached to control portion 12 at port 60 and is configured to enter working channel 24 . Although this feature is described with reference to the exemplary embodiment of the control assembly shown in the drawings, it should be understood that this feature can be embodied in many alternative forms of embodiment. . In addition, any suitable size, shape or type of elements or materials could be used.

In this example, control assembly 70 includes outer sleeve 72 , connector 74 and plunger 76 . Connector 74 is configured to connect control assembly 70 to control portion 12 at port 60 . Outer sleeve 72 is slidably connected to connector 74 as indicated by arrow A in FIG. In this example, the proximal end of sheath 56 is attached to outer sleeve 72 to move sheath 56 longitudinally when outer sleeve 72 is moved. Plunger 76 is movably mounted on outer sleeve 72 as indicated by arrow A and also slides. FIG. 4 shows plunger 76 in an outer home position with respect to outer sleeve 72 . From this outer home position, the plunger 76 can be pushed down into the outer sleeve 72 as indicated by arrow B. The proximal end of the shaft portion 54 of the basket-shaped device 50 is attached to a plunger 76 that longitudinally moves the shaft portion 54 of the basket-shaped device 50 as the plunger 76 moves longitudinally. can be moved. Thus, when plunger 76 is depressed against outer sleeve 72 , the distal end of basket-shaped device 50 extends from front end gap 66 of sheath 56 . When plunger 76 is not depressed, distal end 52 of basket device 50 is retracted toward front end gap 66 of sheath 56 .

Alternatively, the proximal end of sheath 56 may be connected to plunger 76 and the proximal end of shaft portion 54 of basket-type device 50 may be connected to outer sleeve 72 . In this alternative, the plunger 76 can be depressed from its extended home position to its depressed position on the outer sleeve 72 to move the sheath 56 across the basket portion 52 and the plunger can move from its depressed position. Loosened to its extended home position, the sheath 56 can be moved away from the basket portion 52 .

Referring also to FIG. 6, an exploded view of control assembly 70 is shown. In the example shown, control assembly 70 includes two springs 78, 79 and top button 80. As shown in FIG. Referring also to FIG. 7, top spring 78 is located at region 82 of outer sleeve 72 and bottom spring 79 is located at region 83 of outer sleeve 72 . Also shown in FIG. 8, a slightly different button 80' is used. Upper spring 78 is compressed between surface 92 shown in FIG. 7 and bottom end 90 of plunger 76 to extend its extension relative to outer sleeve 72 as shown in FIGS. In the home position, plunger 76 is biased. A top member 88 is connected to the top end of outer sleeve 72 to maintain bottom end 90 of plunger 76 within region 82 .

Bottom spring 79 biases outer sleeve 72 away from connector 74 . However, bottom member 84 is connected to the bottom end of outer sleeve 72 . A bottom member 84 is adjustably positioned over the connector 74 . The bottom member 84 engages a recess 86 in the connector 74 at one of a plurality of different longitudinal positions of the connector 74 to adjustably secure the longitudinal position of the outer sleeve 72 on the connector 74. It has a protrusion configured to: In the example shown, the outer sleeve 72 can rotate axially with the bottom member 84 away from the recess 86 . Outer sleeve 72 can then be slid longitudinally along connector 74 to a new longitudinal position. Outer sleeve 72 can then be rotated axially in a direction opposite bottom member 84 to re-engage a new pair of indentations 86 . This can be used to act as a fine adjustment to apparatus 10 for both basket device 50 and sheath 56 to move together.

A top button 80 is attached to the top of the plunger 76 . An upper button 80 is mounted on top of the plunger 76 for axial rotation. Figures 4 and 6 show the top button 80 covering less than half of the top side of the plunger. Figures 8 and 9 show a top button 80' covering most of the top surface. However, both top buttons 80, 80' function in the same way. In particular, the upper buttons 80, 80' provide an upper surface for the user's fingers to press again, while still allowing the plunger 76 to rotate easily axially on the outer sleeve 72. is.

As seen in FIGS. 9-11, plunger 76 has an upper end 94 . The upper end 94 has finger grooves 96 to provide good frictional contact with the user's fingers. Upper end 94 has hole 98 . Top buttons 80 , 80 ′ have protrusions 100 extending into holes 98 . Buttons 80, 80' are rotatably mounted to plunger 76 at this projection/hole interface. The proximal end of shaft portion 54 of basket-type device 50 is fixedly connected to plunger 76 in a channel providing hole 98 . However, shaft portion 54 of basket-type device 50 is not directly connected to buttons 80, 80'. Thus, when the user rests his finger on the button 80, 80', the user can rotate the plunger while keeping the button 80, 80' and his finger on the button from rotating axially. By rotating 76 axially, the basket device 50 can be axially rotated. This provides a more comfortable feel to the user's fingers and is less likely to cause the user's fingers to slip away from the button/plunger assembly while the plunger is rotating. Become.

The example embodiments identified above provide an instrument with a first controller and a second controller. A first control is formed by a plunger/cylinder mechanism with button 80 and outer sleeve 72 . This first controller is adapted to move the basket device linearly. A second control is formed by a plunger 76 and adapted to rotate the basket-shaped device 50 independently of the first control of the linear movement or position of the basket-shaped device 50 . In the above example, plunger 76 connects button 80 to the cylinder formed by basket-shaped device 50 and outer sleeve 72 .

Referring also to Figures 12 and 13, an alternative connector is shown. In this example embodiment, connector 102 is configured to replace connector 74 . Connector 102 generally comprises an extension shaft 104 and an internal insert 106, a plunger shaft 108 and two buttons 110. As shown in FIG. A front end 112 of plunger shaft 108 is adapted to reside within working channel 24 at port 60 . An internally facing projection of the bottom member 84 on the outer sleeve 72 is located in the groove 114 . The bottom spring 79 biases the outer sleeve 72 away from the extension shaft 104 while the internal protrusions on the bottom member 84 located in the grooves 114 maintain the connection of the outer sleeve 72 to the extension shaft 104. . Bottom spring 79 can be compressed to move outer sleeve 72 downward over the exterior of extension shaft 104 . This allows sheath 56 and basket-type device 50 to move together relative to connector 102 and apparatus 10 . Outer sleeve 72 and attached bottom member 84 rotate axially on extension shaft 104 to move the inner projections on bottom member 84 to rotate within region 116 and over connector 102 in the forward position. , the longitudinal position of the outer sleeve 72 may be fixed.

The plunger shaft 108 includes a lateral slot 118 and a tooth pocket 120 opposite the slot 118 . Slot 118 permits relative movement of button 110 along the longitudinal length of plunger shaft 108 . Tooth pocket 120 allows teeth 122 to engage and secure the button 110 to the plunger shaft 108 in an adjustable position. Button 110 passes through slot 118 through buttonhole 124 in inner insert 106 . Button 110 can be biased outwardly by a spring (not shown). button 110 is depressed inwardly to move tooth 122 out of tooth pocket 120 to longitudinally extend extension shaft 104 (with attached internal insert 106) along the direction of plunger shaft 108; or can be retracted. This feature may allow the use of different endoscope-equipped instruments with working channels of varying lengths. The length of connector 102 can be adjusted to accommodate working channels of varying lengths. Therefore, the instrument can be used with various types of endoscopes.

For example, the features described herein provide an endoscopic instrument having a spin plate, such as plunger 76, for axially rotating another member, such as a basket-type device. can. The features described herein are not necessarily limited to Surgeon Controlled Basket Devices (SCBDs). The features described herein may be used to integrate the plunger mechanism with the pivot mechanism into a single simplified design.

A conventional surgeon-controlled basket-type device (SCBD) device allows the operator of a plunger-style basket to hold the basket open and, if desired to rotate the basket, rotate the plunger. , it is difficult to maintain a steady finger position and pressure on the plunger.

Features described herein allow a finger to maintain pressure on the plunger while rotating the plunger without imposing rotation on the operator's finger used to maintain the pressure. A mechanism can be provided to allow The top surface rotates independently with respect to the plunger. This allows the plunger to rotate freely without having to be adjusted by the finger used to apply downward pressure. For example, a top surface such as button 80 or 80' can be attached to the plunger in a manner that holds the top surface stable against the plunger in the direction of movement that results in basket orientation (axial), but There is no link between the radial position of the top surface and the radial position or movement of the plunger mechanism. This allows the two components to rotate independently of each other while still maintaining a linear relationship.

In one type of exemplary embodiment, an instrument for use by a surgeon to manipulate a basket-type device for capturing an object to be removed from an animal's body can be provided, the instrument comprising: , adapted to couple to the basket-shaped device to selectively control the basket-shaped device and to move the basket-shaped device between the first closed position and the second open position; 1 controller comprising a plunger/cylinder mechanism and a handle coupled to the plunger for manipulating the relative position of the plunger with respect to the cylinder; , positioned adjacent to the first controller and adapted to couple to the basket-shaped device for selectively controlling rotation of the basket-shaped device independently of the first controller; 2 controllers.

The instrument may further comprise a sheath having a first end and a second end, the sheath adapted to receive the basket-shaped device and to close the basket-shaped device in the first closed position therewith. The sheath is longitudinally slidable between an open position and a second open position, and the sheath is coupled to a first controller for translational movement relative to the basket-type device. , the basket-type device is coupled to a second controller for rotational movement with respect to the first controller. The instrument may further comprise a first operatively disposed biasing mechanism for biasing the plunger relative to the cylinder to move the basket device toward the first closed position. The instrument may further comprise a locking mechanism coupled to the first controller for locking the plunger in the second open position. The second controller can remain operational when the locking mechanism locks the first controller. The second controller can keep the basket device rotating while the first controller is fixed. The instrument may further comprise a second biasing mechanism for biasing the basket device toward the first closed position relative to the handle and sheath, the basket device being securely attached to the second controller. is coupled to rotate with A second biasing mechanism may be coupled to the second controller for biasing the plunger 76 in a direction that moves the basket to the first closed position. The instrument may further comprise a luer coupler such as connector 74, for example, to selectively couple the instrument to an endoscope.

An exemplary embodiment can be provided in an instrument for use by a surgeon to manipulate a basket-type device for capturing objects removed from an animal's body, the instrument having a longitudinal axis and including a housing including a passageway; a first portion located in the passageway of the housing; and a second portion extending from the housing. a basket-shaped device adapted to be coupled to the basket-shaped device for selectively controlling the basket-shaped device to move the basket-shaped device between a first closed position and a second open position; , axially movable in the passageway of the housing and rotatably movable in the passageway of the housing to rotate the basket-shaped device when in the second open position; and an end surface coupled to the second portion of the first control device for axial movement with the first control device while the first control device rotates and an end surface that rotates and moves independently of the first controller so that it can assume a fixed and rotated state.

The instrument may further comprise a sheath having a first end and a second end, the sheath adapted to receive the basket-shaped device and to close the basket-shaped device in the first closed position therewith. adapted to slide longitudinally between an open position and a second open position, the basket-type device being coupled to a first controller for translational movement relative to the sheath; A sheath is coupled to the housing. The instrument further comprises an operationally disposed first biasing mechanism for biasing the first controller with respect to the passageway within the housing to move the basket device toward the first closed position. be able to. The instrument may further comprise a locking mechanism coupled to the housing for locking the first controller in the second open position. The first controller can continue to take rotational action when the locking mechanism locks the first controller in the second open position. The instrument may further comprise a luer coupler for selectively coupling the instrument to the endoscope.

It should be understood that the foregoing description is exemplary only. Various alternatives and modifications can be devised by those skilled in the art. For example, the features recited in the various dependent claims may be combined with each other in any suitable combination. Moreover, features from the various embodiments described above can be selectively combined into new embodiments. Accordingly, this description is intended to embrace all such alternatives, modifications and variations that fall within the scope of the appended claims.

[Section 1]
An instrument for use by a surgeon for manipulating a basket-type device for capturing objects removed from the human or animal body, comprising:
adapted to couple to the basket-shaped device for selectively controlling the basket-shaped device and for moving the basket-shaped device between a first closed position and a second open position; A first controller comprising
a plunger/cylinder mechanism;
a handle coupled to the plunger of the plunger/cylinder mechanism for manipulating the position of the plunger relative to the cylinder of the plunger/cylinder mechanism;
a second controller positioned adjacent to the first controller for selectively controlling rotation of the basket-shaped device independently of the first controller for controlling rotation of the basket; a second controller adapted to couple to the mold device;
Equipment that has.
[Section 2]
A sheath having a first end and a second end for containing the basket-shaped device and for moving the basket-shaped device between the first closed position and the second open position. and a sheath adapted to slide longitudinally of said basket-shaped device,
The sheath is coupled to the first controller for translational movement relative to the basket-shaped device, and the basket-shaped device is coupled to the first controller for rotational movement relative to the first controller. 10. The instrument of paragraph 1, further comprising a sheath coupled to the second controller.
[Section 3]
Clause 1 or, further comprising a first biasing mechanism operatively arranged to bias said plunger relative to said cylinder to move said basket-shaped device toward said first closed position; A device according to paragraph 2.
[Section 4]
4. The instrument of any one of paragraphs 1-3, further comprising a locking mechanism coupled to the first controller for locking the plunger in the second open position.
[Section 5]
5. The instrument of clause 4, wherein the second control device is operable when the locking mechanism locks the first control device.
[Section 6]
further comprising a second biasing mechanism for biasing the basket-shaped device toward the first closed position relative to the handle and the sheath, wherein the basket-shaped device is controlled by the second controller; A device according to any one of paragraphs 1-5, which is rigidly rotationally coupled.
[Section 7]
7. The device of any one of paragraphs 1-6, further comprising a luer coupler for selectively coupling the device to an endoscope.
[Section 8]
An instrument for use by a surgeon for manipulating a basket-type device for capturing objects removed from the human or animal body, comprising:
a housing having a longitudinal axis and including a passage;
a first controller comprising a first portion located in the passageway of the housing and a second portion extending from the housing for selectively controlling the basket device; a shaft in the passageway of the housing adapted to be coupled to the basket-shaped device for control and to move the basket-shaped device between a first closed position and a second open position; a first controller movable in a direction and rotatably movable into the passageway of the housing to rotate the basket device when in the second open position; ,
an end surface coupled to the second portion of the first controller configured to move axially with the first controller, the first controller rotating; an end surface configured to rotatably move independently of said first controller of said end surface to remain rotatably fixed for a period of time;
Equipment that has.
[Section 9]
adapted to accommodate the basket-shaped device and to slide the basket-shaped device longitudinally between the first closed position and the second open position; a sheath having a first end and a second end, wherein the basket-shaped device is coupled to the first controller for translational movement relative to the sheath; 9. The instrument of clause 8, further comprising a sheath coupled to the housing.
[Section 10]
a first biasing mechanism arranged for operation to bias the first controller against the passageway in the housing to move the basket device toward the first closed position; 10. The device of paragraphs 8 or 9, further comprising:
[Section 11]
11. The instrument of any one of clauses 8-10, further comprising a locking mechanism coupled to the housing for locking the first controller in the second open position.
[Section 12]
12. The instrument of clause 11, wherein the first controller continues to take rotational operation when the locking mechanism locks the first controller in the second open position.
[Section 13]
13. The instrument of any one of clauses 8-12, further comprising a luer coupler for selectively coupling said instrument to an endoscope.

2 plunger shaft 10 device (endoscope)
12 Control portion 14 Shaft 16 Passive deflection portion 18 Active deflection portion 20 Distal end 22 Control system 24 Working channel 26 Frame 28 Actuator 30 Lever 32 Cover 33 Assembly 36 Instrument 50 Basket-type device 52 Basket portion 54 Shaft portion 56 Sheath 60 port 76 plunger 78 spring 79 spring 80 button 80' button 96 finger groove 114 groove 116 area 118 slot 122 tooth

Claims (15)

An instrument for use by a surgeon to manipulate an assembly of a sheath and basket-type device for capturing an object removed from the human or animal body, comprising:
an outer sleeve having a first cylinder at a first end and a second cylinder at an opposite second end, the sheath and basket device assembly connected to the outer sleeve; an outer sleeve configured with a sheath;
a connector slidably connected to the outer sleeve within the first cylinder at a first end of the outer sleeve and configured to connect the instrument to a port of an endoscope; ,
a plunger slidably connected to said outer sleeve within said second cylinder at a second end opposite said outer sleeve, said sheath and basket-type device assembly connected to said plunger; a plunger configured to have a distal end of a basket-shaped device of
comprising
the plunger is configured to slide longitudinally within the second cylinder and rotate axially relative to the outer sleeve;
the outer sleeve is configured to move longitudinally over the connector as the connector slides longitudinally within the first cylinder;
configured such that movement of the outer sleeve relative to the connector moves the sheath and the basket-type device relative to the connector;
An instrument, wherein movement of the plunger relative to the outer sleeve is configured to move the basket device relative to the sheath. 2. The device of claim 1, further comprising a first biasing member biasing said outer sleeve away from said connector. 3. The instrument of claim 2, wherein said first biasing member comprises a first spring. 4. The instrument of claim 2 or 3, further comprising a second biasing member biasing the plunger outwardly relative to the outer sleeve. 5. The instrument of claim 4, wherein said second biasing member comprises a second spring. wherein the plunger is configured to axially rotate the basket-shaped device relative to the sheath and longitudinally slide the basket-shaped device relative to the sheath; 10. The device of Claim 1. 2. The instrument of claim 1, wherein said outer sleeve forms a handle for moving said outer sleeve towards said connector. 8. The device of Claim 7, wherein the plunger forms a button adapted to be pushed into the outer sleeve. 9. The device of claim 8, wherein said button is rotatable relative to said outer sleeve. A device according to any one of the preceding claims, characterized in that said connector comprises a luer coupler. said plunger having a shaft extending between a first enlarged end and a second enlarged end, said first enlarged end being disposed within said second cylinder; A device according to any one of claims 1 to 10, characterized in that 12. The method of claim 11, wherein said first enlarged end of said plunger is retained within said second cylinder by a retaining member connected to said second end of said outer sleeve. instrument. 13. The instrument of claims 11 or 12, wherein said plunger further comprises a button connected to said second enlarged end. 14. The instrument of claim 13, wherein said button includes a projection that extends into a hole formed in said second enlarged end. 15. A device as claimed in any one of the preceding claims, characterized in that the connector includes a plurality of indentations for adjustably securing the longitudinal position of the outer sleeve on the connector. .

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