US1625602A - Surgical appliance - Google Patents

Surgical appliance Download PDF

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Publication number
US1625602A
US1625602A US10013126A US1625602A US 1625602 A US1625602 A US 1625602A US 10013126 A US10013126 A US 10013126A US 1625602 A US1625602 A US 1625602A
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Prior art keywords
barrel
ligature
means
jaws
knot
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Harold G Gould
Obenshain Kyle Dirias
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Harold G Gould
Obenshain Kyle Dirias
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    • 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0474Knot pushers

Description

April 19, 192?.

H. G. GOULD ET AL SURGICAL APPLIANCE Filed April 6. 1926 3 Sheets-Sheet 1 INVENTORS y. 022e 7am-T0 ZM M ATTORNEYS WITNEssaS 1 l 625 602 Alm! 19 927 H. G. GouLD ET AL SURGICAL APPLIANCE Filed April 6, 1926 3 Sheets-Sheet 2 WITNEssEs j INVENToRs ATTORNEYS l H. G. GOULD ET AL SURGICAL APPLINCE Filed April 6. 1926 3 Sheets-Sheet 5 5% ill'll l/VVNTURS HG. Gould KAP. Oberuscvff/ ATTORN EYS Patente'd Vpr. 4 19,1927.

UNITED STATES PATENT OFFICE.-

' SURGICAL APPLIANCE.

Application led April 6,

This invention relates` to surgical appliances for placing liga-tures on blood vessels.

It is common )ractice in surgery to grasp the bleeding points .with a pair of artery forceps, pass a ligature around the grasped tissues, and then tie said llgature wlth a sur.- geohs knot. This operation requlreslthe use of both hands of the-surgeon and .frequently an assistant is necessary to aid 1n holdlng the artery forceps. n

An object of the present invention 1s the provision of a device for not only holdmg the tissues of a wound, but for tylng a liga'- ture on the bleeding tissues, the operatlon being performed with one hand.

A further object of the inventlon is the provision of a device for holding tissues and tying a ligature about said tlssues and in which a conically shaped hollow barrel 1s mounted for sliding movement against the tension of a'spring, said spring being adapted to operate the barrel for forcing a pair of jaws into clamping relation with tlssue,

' 25 while a pair of knot carriers are employed in conjunction with -a second spring that draws the. knots ti llt when the loop of `ligature is forced o the end of the conical barrel and placed around the tissues, a knife being employed to sever the ligature when the operation is complete.

Thls invention will be best understood from a consideration of the following detailed description, in View of the aecompanying drawings forming a part of the specification; nevertheless it is to be understood that the invention is not confined to the disclosure, being susceptible of such changes and modifications which shall define no material departure from the salient features` of the invention as expressed in the appended claims.

In the drawings:

Figure 1 is a longitudinal side view of a device constructed inaccordance with the principles of my invention. Figure 2 is a longitudinal vertical section ,of the same.

Figure 3 is a plan view.

Figure 4 is a plan View of the device show- 1926. seriai No. 100,131.

ing the ligature in operative position on the tying device.

Figure 5 is a plan view showin the dev1ce 1n operation when the knotte loop has been forced olf of the tying device.

Figure 6 shows a plan view of the device 1n o erative position after the second knot has een forced up taut.

Figure 7 shows the position of the device after the ligature has been severed and the knot tied.

Figure Sis a fragment-ary view in perspective of the knot tying device with a llgature in position to be tied.

Figure 9 shows a longitudinal `view of a modified form of the invention.

v- Flgure 10 is a view. in perspective of the same. a

Flgure 11 1s a rspective vieur of the shears used in conJunction with the device for cutting the ligatures after the knot has been tied.

Figure 12 is an end view of the device shown in Fig. 9. v

Referring more particularly to the drawings, 10 designates a handle to which is securedI at ri ht angles a rod 11 havin a reduced portlon 12 which is embrace bya `coil spring 13. One end of the coil spring abuts a shoulder 14 on the lrod 11 while the 80 other end abuts a shoulder 15 on a barrel 16 slidably mounted on the rod 11.

The spring 13 is lcompressed by drawing the barrel 16 rearwardly and towards the handle 10 by means of the finger piece 17 secured to the barrel. .A trigger 18 pivoted at 19 on the finger piece 17 has a pm 20 normally engaging a recess 21 in the rod 11 for retaining-'t e barrel in a predetermined position as will be presently explained. A spring 22 secured at one end to the finger piece presses against the trigger so that the pin 20 will be maintained in a perforation 23 in the sleeve 16 and against the rod 11 in order that the pin may drop into the 05 recess 21 when the pin alines with said recess.

The sleeve 16 has a conically shaped end 24 which normally receives the tying loofp 25 of a ligature 26. The outer free end o the 100 rod 11 has a pair of resilient clamping jaws 27 secured at 28 to the rod. These jaws are adapted to expand and spread apart when the sleeve 16 is moved towards the handle l0 and the jaws are projected from the conical end 24 of the sleeve.

A devicefor tying the first knot 29 of the ligature is slidably mounted on the sleeve 16 and comprises a flat rod 30 rovided with lugs 31 and 32 forming a for or U-shaped member at the free and forward end of the bar. The rear end of the bar has a de nending arm 33 to which is connected a linger ring 34. The lugs 31 and 32 have s lots 35 adapted to receive the Strands of the ligature which are located between the knots 29 and 86. The rod 30 is guided ou the sleeve 16 by means of spaced lugs 37 depending from a spring casing 38. The lugs embrace opposits side edges of the sliding rod 3() and a sliding rod 39.

The sliding rod 39 carries the second knot tying device which consists of a pair of lugs 40 and 41. At the ends of said lugs are provided upstanding ears 42 having pas* Sages 43 to receive the strands of the ligature. The strands are threaded into the passages 43 through transverse slots 44 which extend through the tops of the ears 42 and into the passages 43. The other end ot' rod 39 extends to the rear of the sleeve 16 and beyond the arm 33 and spring casing 38 andis provided with a depending arm 45 having a linger ring 46.

A coil spring 47 is located in the casing 38 and has one end connected to a rod 48 equipped with a button or clamp 49 to which is adapted to be secured the free ends ot the ligature 26. The rod 48 is slidable in a passage at the front end of the casing 38. The rear end of casing has a passage through which is mounted a tensioning bar 5() provided with teeth 51 adapted to engage the edge of the material of the casing surrounding the opening through which the bar is assed. A finger piece 52 on the end of the ar 5.0 is used for actuating said bar to tension the spring 47 and likewise the ligature 26. The casing 38 is secured to the sleeve 16 by means of straps 53.

The arm has a lateral extension 33 While arm 45 has a lateral extension 45 whereby said arms will be sufiiciently projected from the side of the barrel or sleeve 16 so that the linger pieces carried bv said arms may be readily engaged by the fingers of the o erator and whereby the arm 46 may easi y clear the handle 1() when the barrel is moved rearwardly into engagement with said handle.

In the modified form shown in Figures 9 to 12 inclusive the sleeve or barrel 16 has a conically shaped portion 24 and the ljavvs 27 are slidably mounted Within the barrel and operated in a manner similar to the construction shown in Figures 1 to 8 inclusive. The diii'crence in the two devices consists in the lower semi-cylindrical slidably mounted member or bar which has lugs 61 at its end provided with slots 62 through which is threaded the ligature 63. This ligature has two knots 64 and 65.

A second member or bar 66 which is semicylindrical in shape is slidably mounted on the barrel above the member 6() and has slots 67 through which the ends of the ligature are inserted and slots 68 cut through the' side of the barrel are provided to permit the ligaturcs passing from the slots 67 to the exterior of the member 66 so that the ends may be connected to the button 49 as has been previously described. The bars or members 60 and 66 partially embrace opposite sides of the barrel 16a.

A semi-cylindrical cutter 69 is slidably mounted on the member 66 and is provided with a slot 7 0 through which projects a pin 71. The slot is inclined at an acute angle to a vertical plane passing through the axis o't` the barrel 16` so that when the cutter 69 is moved outwardly by the linger piece 72 the cutter will be given a slight rotary mo tion over the member 66 so that when the knives 7 3 are moved across the slots 68 they will cut the ends of the ligature 63 in a shearing action after the members 60 and 66 have been moved outwardly forcing the loop 74 ofi ot' the conically shaped portion 24 of the barrel 16 and after the knots 64 and 65 have been tightened.

The operation of our device is as follows:

The loop 25 of the ligature is placed around the conical end 24 ot' the barrel and held against slippage while threading by a spring 54 secured to the barrel. A single knot 29 is then formed and the strands of the ligature placed in the slots 35 of thelugs 31 and 62. A second loose knot 36 is then i'ormed and the strands ot the ligature are inserted through the transverse slots 43 into the passages 43 of the ears 42 on the ends of the lugs 40 and 41 oi the second knot. tying device. The free ends ot the ligature are clamped or secured to the button 49. The bar 50 is then adjusted to place the proper tension on the ligature through the spring 47. rilhe device is now ready for use by a surgeon.

rl`he handle 10 is now grasped and the trigger 18 is actuated to release the pin 2O from the recess 2l in the rod when a rearward pull is exerted on the finger piece 17. The barrel 16 is moved rearwardly on the rod il. until the rear end ot' said barrel ahuts the handle 10.

At this time` the resilient jaws 27 have been i'orccd outwardly from the front end ot the barrel and because ot their resiliency they will be forced apart and in open position. The jaws are then placed in embracing relation with a tissue to be tiedand the finger piece 17 is then released, The spring having been compressed forces the barrel 16 outwardly until a point is reached where the pin 20 slips into the recess 21 when the barrel will be locked against further forward movement. 'llie outer end of the barrel riding over the jaws 27 forces them together in clamping relation on the tissue. rlhe outer ends ot' the jaws at this time are substantiallyv alined with the outer end of the barrel 16. A finger of the operator is inserted through ring 34 and the ring and l1kewise the bar 30 and lugs 31 and 32 are pushed forwardly. By reason of the spreading of said arms and the forward movement, the loop is forced 'olf the conical end 24 of the barrel 16 and the knot- 29 is drawn up tight upon the tissue. The bar through the ring 34is drawn rearwardly whence the strands of the ligature are released from the slots 36-of the lugs 31 and 32. The spring 47 maintains the ligature under tension during the first tying operation. l

The second ring is engaged by a finger and moved forwardly, forcing the bar 39 along the barrel and lugs 40 and-41 to the end of the barrel, whereby the secondknot vr36 is drawn up tight on the first knot.

It will be appreciated that all the various velements of the device are so positioned and coordinated that they are adapted for operation by fingers of one hand of the surgeon 'so that the other hand is free for other purposes.

lVe claim: j.

1. A surgical appliance for tying ligatures, comprising a barrel, means slidably mounted in the barrel for clamping aztissue, means for holding a loose slip knot in embracing relation with the clamping means, means for removing the slip knot from the -holding means and in embracing relation with the tissue, and means for drawing the knot up tight on said tissue.

2. A surgical appliance for tying. ligatures, comprising means for clamping a tissue, means for holding a loose slip knot in embracing relation with the clamping means, means for removing the slip mot from the holding means and in embracing relation with the tissue. and means for drawing the knot up tight on said tissue, and means associated with the remoi-'ing means for cutting the ligature after the knot has been drawn tight.

3. A surgical appliance for tying ligatures, comprising a barrel, means slidably mounted in the barrel for clamping a tissue, means' for holding a plurality of loose slip knotshin embracing relation with the clamping means, means for removing the slip knots from the holding 'means and in embracing relation with the tissue, and means cooperating with the removing .means for drawing the knots up tight on said tissue. 4. A surgical`appliance for tying ligat-ui'es, comprising a hollow barrel, clamping jaws slidably mounted in the barrel, said jaws adapted to be disposed normally within the barrel, said barrel 'adapted to carry a loop of the ligature having a loose knot. means on the barrel for forcing the loo i ofligature off the barrel 4and for drawing the knot up tight. 5. A surgical appliance for tying ligatui'es, comprising clan'iping jaws, a hollow barrel slidably mountedon the jaws, said jaws adapted to be disposed normally within the barrel, said barrel adapted to carry a loop of the ligature having a plurality of loose knots, means on the barrel for forc-l ing the loop of ligature olf the barrel .and for drawing the knots up tight.

6. A surgical appliance for tying ligatures, comprising clamping jaws, a hollow barrel slidably mountedvon the jaws, said jaws adapted to be disposednormally with-` in the barrel, said barrel adapted to carry' a loop of the ligature having a plurality of looe knots, means on the barrel for forcing the loop of ligature ofi the barrel and for drawing the knots up tight, a knife, and means for operating the knife to sever the ligature after the last knot has been ldrawn up tight.'

7. A surgical appliance for tying ligatures, comprising a barrel, a clamping means operated by the barrel, said barrel being adapted to hold a loosely knotted loop of the ligature` and knot tying means, said means consisting of a plurality of rods slidably mounted on the barrel and provided with lugs. said lugs havingineans for holding the ligature.

8. A surgical appliance for tying ligatures, comprising a barrel, .i clamping means operated by the barrel, said barrel being adapted to hold a loosely knotted loop of the ligature, and knot tying means, said means consisting of a plurality of rods slidal'ily mounted on the barrel and provided with lugs, said lugs having means for holding the ligature, tensioning means for the ligature.

9. A surgical appliance for tying ligatures, comprising a barrel, a clamping means operated by the barrel, said barrel being adapted to hold a loosely knotted loop of the ligature, and knot tying means, said means consisting 'of a plurality of rods slidalily mounted on the barrel and provided with lugs. ,said lugs having meansl for holding the. ligature` tensioning means for the ligature, means for-adjusting the tensioning means.

10. A surgical appliance for tying ligatures. comprising a barrel. a clamping means operated by the barrel, said barrel being adapted to hold a loosely knotted loop of lli the ligature. and knot tying means, Said means consisting of a plurality of rods slidably mounted on the barrel and provided with lugs, the lugs on one of the rods havingr slots to receive the strands of the ligature, said rod when operated forcing the loop otl' the barrel around a tissue adapted to be tied and causingthe knot to be drawn taut.

11. A surgical appliance for tying ligaturcs, comprising a barrel, a clamping means operated b v the barrel, said barrel being adapted to hold a loosely knotted loop of the ligature, and knot tying means. said means consisting of a plurality of rods slidablv mounted on the barrel and provided with lugs` said lugs having means for holding the ligature, a spring for operating the barrel to actuate the clamping means.

'12. A surgical appliance for tying ligatures` comprising a barrel, a clamping means operated by thc barrel, said barrel being adapted to hold a loosely knotted 'loop of the ligature` and knot tying means, said means consisting of a plurality of rods slid- *ablv mounted on the barrel and provided with lugs` said lugs having means for holding the ligature, a spring for operating theV barrel to actuate the clamping means. a ten- `sioning means for the ligature on the barrel.

153. A surgical appliance for tying ligatures` comprising a handle, a rod secured to the handle, resilient clampingjaws on im end of the rod normall)Y spread apart` a barrel slidable on the, rod and having a conical end to receive a loosely knotted loop of the ligature, said barrel adapted to be moved into telescoping relation with the jaws for forcing said jaws into clamping action, a spring for ope ating the barrel to actuate the jaws. means for releasably retaining the barrel against the tension of the spring, and means on the barrel for forcing the loop of ligature oli' the barrel and for drawing the knot up tight.

14. A surgical appliance for tying ligaturcs. comprising a handle, a rod secured to the handle. resilient clan'iping jaws on an end of the rod normally spread apart, a barrel slidable on the rod and having a conical end to receive a loosely knotted loop ot. the ligature` said barrel adapted to he moved into telcscoping relation with the jaws for forcing said jaws into clamping action, a spring 'l'or operating the barrel to actuate the jaws, n1 `ans tor releasably retaining the barrel against the tension of the spring. a rod slidablc on the barrel, and a fork on the rod, means on the lugs tor holding the ligature. said last named rod when operated folcing the loop of ligature ot'f the barrel and drawing the knot up tight.

15. A surgical appliance for tying liga- `turcs, comprising a handle, a rod secured t0 the handle, resilient clamping jaws onan end of the rod normally spread apart, a ligature having a plurality of loosely knotted loops, a barrel slidable on the rod and having a conical end to receive a loosely knotted loop of the ligature, said barrel adapted to be moved into telescoping relation with the jaws for forcing said jaws into clamping action, a spring for operating,r the barrel to actuate the jaws, means for releasably retaining the barrel against the tension of the spring, a plurality of rods slidable on the barrel, each of the rods havingr a fork adjacent the conical end of the barrel, means on the lugs for holdingr the ligature between the knotted portions ot the loops of ligature, said rods adapted to be operated for successively forcing the loop ott the end of the barrel and for drawing the knot up tight.

1G. A surgical appliance for tying ligatures, comprising a hollow barrel, clamping jaws slidably mounted in the barrel, means for causing said jaws'to move into clamping relation, a member partially embracing the barrel and slidably mounted on the barrel and having slotted lugs adapted to receive the ends ot' a ligature, a Second member partially embracing the barrel and slidablv mounted on the barrel and provided with slots to receive other portions of the ligature, said barrel having a conically shaped member adapted to receive a loop of the ligature, means for moving the barrel embracing members outwardly of the barrel for forcing the loop troni said barrel.

17. A surgical appliance for tying ligatures, comprising a hollow barrel, clamping jaws slidably mounted in the barrel, means for causing said jaws to move into clan'iping relation, a member partially embracing the barrel and slidablv mounted ou the barrel and having slotted lugs adapted to receive the ends of a ligature. a second member partially enlbracing the barrel and slidably mounted on the barrel and provided with slots to receive other portions ot the ligature, said barrel having a conically shaped member adapted to receive a loop of the ligature, means for moving the. barrel embracing members outwardly of the barrel -for forcing the loop from said barrel. a cutter slidably mounted on one of the barrel embracing members and provided with knives adapted to move over the ligature receiving slots for shearing the ends of the ligature.

18. A surgical appliance for tying ligatures, comprising a hollow barrel. clamping jaws slidably mounted in tbe barrel. means for causing said jaws to move into clamping relation. a member partiall \r embracing the barrel and slidably mounted on the barrel and having slotted lugs adapted to receive the ends of a ligature, a second member partially embracing the barrel and slidably mounted on the barrel and provided with slots to receive other portions of the ligature,

Iuu

Leemans B said barrel having a. conically shaped memto move over the ligature receiving slots for ber adapted to receive a loop of the ligature,` shearing the ends of the ligature and means means for moving the barrel embracing for causing the cutter to have a slight rotary 10 members outwardly of the barrel for forcing motion to produce a shearing action of the 5 the loop from said barrel, a cutter slidably knives.

mounted on one of the barrel embracing HAROLD G. GOULD. members and provided with knives adapted KYLE DIR-IAS OBENSHAIN.

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Cited By (120)

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