U.S. patent number 3,687,138 [Application Number 05/064,161] was granted by the patent office on 1972-08-29 for repeating ligature gun.
Invention is credited to Robert K. Jarvik.
United States Patent |
3,687,138 |
Jarvik |
August 29, 1972 |
**Please see images for:
( Certificate of Correction ) ** |
REPEATING LIGATURE GUN
Abstract
A preformed ligature comprises a loop, loop forming closure and
an extension which may be pulled to close the loop about a bleeder.
One preformed ligature according to the invention is formed of a
continuous loop of gut or synthetic suture material tied into a
slip knot to form the closure and the extension is the second loop
thus formed therein which may be pulled by means of a hook. Another
preformed dual loop ligature is formed of a continuous loop of
suture material and a narrow enveloping closure. The loop
preferably has a ratchet-like surface and the closure a cooperating
pawl-like surface to provide a ligature loop that may only slip one
way. Repeating ligature guns for applying a plurality of such
preformed ligatures comprise a tubular cartridge on which a
plurality of the ligatures are preformed; the cartridge comprising
a helical loop engaged track for advancing the ligatures toward the
end thereof. During a surgical procedure, successive cartridges may
be mounted on the instrument provided by the invention. The
instrument comprises clamping jaws coaxial with the mounted
cartridge for pulling a clamped bleeder into the end of the tubular
cartridge and means for rotating the cartridge one revolution to
advance a ligature off the end of its helical track. The cartridge
preferably comprises a bar about which the second loops of the
preferred forms of preformed ligatures are formed for preventing
rotation of the ligatures as they are advanced by the helical track
and for pushing against the slip knot or closure when the ligature
is being tightened. A trigger on the ligature gun controls closure
of the jaws and withdrawing of the bleeder into the end of the
cartridge while rotating the cartridge one revolution by means of a
cam mechanism to release a ligature. The cam track may be part of
the cartridge or part of the instrument. The instrument is provided
with a hook for engaging the second loop of the pretied ligature
and for pulling the same to tighten the ligature about a bleeder.
The hook may be actuated by the first trigger or by a second hook
trigger. In one embodiment of the invention, a cutter is provided
for cutting the extended loop of the pretied ligature.
Inventors: |
Jarvik; Robert K. (Stamford,
CT) |
Family
ID: |
22053975 |
Appl.
No.: |
05/064,161 |
Filed: |
August 17, 1970 |
Current U.S.
Class: |
606/139 |
Current CPC
Class: |
A61B
17/12013 (20130101) |
Current International
Class: |
A61B
17/12 (20060101); A61b 017/12 () |
Field of
Search: |
;128/322,326 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Pace; Channing L.
Claims
Having described my invention, what I claim as new and desire to
secure by Letters Patent is:
1. A unitary repeating ligature gun comprising:
A. a ligature carrier adapted to carry a plurality of ligatures
each comprising an elongated piece of material formed into a closed
loop and an extended portion which when pulled reduces the size of
the loop, said carrier being hollow at at least one end thereof and
having a plurality of ligatures surrounding the carrier adjacent
said hollow end, the ligature closest to said hollow end being the
foremost;
B. grasping means for grasping the material to be ligated;
C. grasping actuator means for causing said grasping means to grasp
material to be ligated and to position the same axially within the
hollow end of said carrier;
D. means for pulling the extended portion of the foremost ligature
to constrict the loop portion thereof about the material to be
ligated;
E. mounting means to which said ligature carrier, said grasping
means, said grasping actuator means, and said pulling means are
mounted; and,
F. further means mounted on said mounting means and operatively
associated with said ligature carrier, said grasping actuator
means, and said pulling means, and for causing said grasping means
first to grasp the material to be ligated, second to position the
same within the hollow end of said carrier, third to release said
foremost ligature, fourth to pull the extended portion of the
ligature to ligate the material to be ligated, and to advance the
next foremost ligature to the foremost position on said
carrier.
2. A ligating instrument comprising:
A. grasping means for grasping material to be ligated;
B. a hollow ligature carrier adapted to carry a plurality of
ligatures axially aligned about the hollow portion of said ligature
carrier;
C. means for causing said grasping means to grasp material to be
ligated;
D. means for reciprocating said grasping means axially with respect
to said carrier to position the foremost of said ligatures while
still on said hollow ligature carrier about the material to be
ligated while the material is grasped by said grasping means;
E. means for advancing said ligatures on said carrier one at a time
for each reciprocation of said carrier means and actuation of said
grasping means; and
F. means for causing the foremost of said ligatures to engage and
ligate said material to be ligated for each reciprocation of said
carrier means with respect to said grasping means.
3. A ligating instrument as defined in claim 2 wherein said
advancing means comprises an exterior helical track on said
ligature carrier and means for rotating said carrier one revolution
for each said reciprocation.
4. A ligating instrument as defined in claim 3 wherein said
ligature carrier is removable from said ligating instrument.
5. A ligating instrument as defined in claim 3 wherein said means
for rotating said ligature carrier comprises a helical cam track
and a reciprocating cam actuator, said cam actuator being
reciprocated simultaneously with actuation of said grasping
means.
6. A ligating instrument as defined in claim 2 wherein said
grasping means extends through and is mounted for axial motion
within said ligature carrier.
7. A ligating instrument as defined in claim 6 and trigger means
for actuating said means for causing, said reciprocating means,
said advancing means, and said last-named means.
8. A unitary ligature gun as defined in claim 1 wherein the
ligatures each comprise a first and a second loop having at least
one common loop forming portion, each of said first loops being
mounted about said ligature carrier, and:
G. a rod spaced from and extending parallel to said carrier means
about which each of of said second loops are engaged.
9. A unitary ligature gun as defined in claim 8 wherein said
ligature carrier comprises an exterior helical track, and:
H. means for rotating said carrier one revolution each time said
grasping means positions material within the hollow end of said
carrier.
10. A unitary ligature gun as defined in claim 8 and:
H. hook means for engaging the second of said loops of the foremost
ligature which is about said rod after the first loop thereof has
been disengaged from said helical track, said hook means being
adapted to pull said second loop to tighten said first loop of said
ligature.
11. A unitary ligature gun as defined in claim 10 wherein the
ligatures each comprise closure means medial thereof; and said hook
means and said rod are formed such that said closure means is
maintained in engagement with said rod as the ligature is
tightened.
12. A repeating ligating instrument comprising:
A. jaws for grasping material to be ligated;
B. actuator means to which said grasping jaws are mounted;
C. mounting means for mounting a hollow ligature carrier about said
actuator means;
D. a hollow ligature carrier for mounting to said mounting means,
said carrier adapted to carry a plurality of ligatures which when
said carrier is mounted to said mounting means are aligned axially
about said actuator means;
E. ligature presentation means for causing said ligature carrier to
present at least one of said ligatures at a time for ligation;
F. manually operable means mounted to said mounting means and
operatively associated with said actuator means and said ligature
presentation means for:
a. first causing said jaws to close and grasp material to be
ligated,
b. second for reciprocating said jaws with respect to said carrier
while the jaws are grasping material to be ligated,
c. third for fastening at least one of said ligatures to the
material to be ligated, and
d. for causing said ligature presentation means to present at least
another ligature for ligation before said jaws are again
reciprocated with respect to said carrier.
Description
SUMMARY OF THE INVENTION
This invention relates to repeating ligature guns, multi-ligature
cartridges, and preformed ligatures therefor. More particularly, it
relates to the rapid and repeated ligation of so-called bleeders in
surgical procedures.
After a surgeon has made an incision, it is necessary to clamp the
tissue wherever blood is being lost due to the cutting of blood
vessels. The usual technique is to clamp each so-called bleeder
with a hemostat (locking dog nosed pliers) as soon after the vessel
is severed as possible. This controls the loss of blood until a
ligature can be tied around the vessel. As many as twenty or more
bleeders may be clamped by as many hemostats in common surgical
procedures before they are tied. Thus, a single operation often
requires the use of a large number of hemostats. These are handed
to the surgeon and his assistants, one at a time, by the scrub
nurse.
The surgical field often becomes cluttered with hemostats, which
interfere with the surgeon's view and hinder the convenient
application of additional hemostats. However, good surgical
practice requires the application of hemostats to all bleeders
before any are tied.
The tying process requires one hand to hold the hemostat and two
hands to pass the suture material around the hemostat and to form
the ligature by tying a knot. This procedure thus requires two
people. In addition, the ligatures must be cut and the excess
suture material removed from the incision. The used hemostats must
be handed to the scrub nurse and be readied for reuse. Thus, this
entire technique for the achievement of hemostasis requires the
coordination and teamwork of at least three people. The speed with
which the bleeders may be tied off is often the determining factor
in the time required for the opening stages of many surgical
operations.
Many instruments have been disclosed in the prior art for ligating
bleeders. However, none of these have come into general use, due to
inherent deficiencies. Instruments such as disclosed in U.S. Pats.
Nos. 3,033,204, 3,040,747, and 3,169,526, issued to E. C. Wood; No.
2,268,755, issued to S. F. Li; and No. 1,625,602, issued to H. G.
Gould et al, have been designed for aiding the surgeon in applying
a single pretied length of suture material to a bleeder. Other
instruments, such as that disclosed in U.S. Pat. No. 2,371,082,
issued to F. Vistreich are designed to apply a single collar of
resilient material to a deep bleeder. However, these instruments,
since they apply only one ligature at a time after which another
preformed ligature must be affixed to the instrument before it can
then be applied to the next bleeder, do not materially reduce the
amount of time or effort required in a surgical procedure. Other
more complex instruments, such as disclosed in U.S. Pat. Nos.
2,898,915 and 2,898,916, issued to K. Kammer, have been devised for
automatically tying a successive plurality of ligatures from a
spool of suture material. However, these instruments are complex,
are difficult to load with the suture material, and, being
complicated, are hard to disassemble and sterilize. None of the
above prior art instruments have come into general use.
What is needed is an instrument which will rapidly and repeatedly
clamp and ligate bleeders; an instrument that can be operated with
one hand; an instrument which does not leave any excess material,
such as cut ends in the incision; an instrument which may be
reloaded by means of a cartridge with a plurality of pretied
ligatures repeatedly during an operation; and an instrument which
is easy to disassemble and sterilize.
OBJECTS OF THE INVENTION
It is therefore an object of the invention to improve the art of
surgery.
Another object of the invention is to provide for rapid ligation of
a plurality of bleeders.
Still another object of the invention is to provide pretied
ligatures for facilitating the above objects.
A further object of the invention is to provide an instrument for
applying a plurality of ligatures of the above character.
Another object of the invention is to provide an instrument of the
above character which may be operated by one hand.
A further object of the invention is to provide an instrument of
the above character which leaves no excess material or cut ends on
the sutures in the body which have to be removed by the
surgeon.
Still another object of the invention is to provide an instrument
of the above character which is convenient to sterilize.
Yet another object of the invention is to provide an instrument of
the above character which does not require lubrication.
Still another object of the invention is to provide an instrument
of the above character employing a replaceable cartridge or carrier
for a plurality of pretied ligatures of the above character.
A further object of the invention is to provide a cartridge of the
above character which is disposable.
A still further object of the invention is to provide an instrument
of the above character which can affix ligatures to bleeders with
varying tension according to the size of the vessel and type of
tissue in which it occurs.
Still another object of the invention is to provide an instrument,
cartridge and preformed ligatures of the above character which may
be mass produced at low cost, are convenient to use and require
little or no servicing.
Other objects of the invention will in part be obvious and will in
part appear hereinafter.
The invention accordingly comprises articles of manufacture
possessing the features, properties and the relations of elements
which will be exemplified in the articles hereinafter described,
and apparatus comprising the features of construction, combinations
of elements and arrangements of parts which will be exemplified in
the constructions hereinafter set forth. The scope of the invention
is indicated in the claims.
The DRAWINGS
For a fuller understanding of the nature and objects of the
invention, reference should be had to the following detailed
description taken in connection with the accompanying drawings in
which:
FIG. 1 is a side view, partially in cross section, of a repeating
ligature gun according to the invention;
FIG. 2 is an enlarged fragmentary side view, partially in cross
section, of the disposable multiple ligature-bearing cartridge of
the repeating ligature gun of FIG. 1;
FIG. 3 is a cross sectional view taken along the lines 3--3 of FIG.
2;
FIG. 4 is a cross sectional view taken along the lines 4--4 of FIG.
2;
FIG. 5 is an enlarged fragmentary perspective view of the
cartridge-engaging portion of the ligature gun of FIG. 1;
FIG. 6 is a top view of a continuous loop of suture material which
may be formed into a pretied ligature according to the
invention.
FIGS. 6A, 6B, 6C, 6D, and 6E illustrate the manner in which the
continuous loop suture of FIG. 6 may be formed into a pretied
ligature according to the invention;
FIG. 7 is a side view, partially cut away and partially in cross
section and similar to FIG. 1, of the repeating ligature gun of
FIG. 1;
FIG. 8 is an enlarged perspective view of a cam in the ligature gun
of FIG. 1;
FIG. 9 is an enlarged cross sectional view taken along the lines
9--9 of FIG. 7;
FIG. 10 is an enlarged cross sectional view taken along the lines
10--10 of FIG. 7;
FIGS. 11, 12 and 13 are enlarged fragmentary side views of the
tissue engaging end of the repeating ligature gun of FIG. 1,
illustrating the application of a ligature as shown in FIG. 6 to a
bleeder;
FIG. 14 is a front view taken along the lines 14--14 of FIG. 11
with the bleeder removed;
FIG. 15 is a side view of the elements of the repeating ligature
gun of FIG. 1 disassembled for cleaning and sterilization;
FIG. 16 is a perspective view of another embodiment of the
repeating ligature gun of the present invention;
FIG. 17 is a side view of the repeating ligature gun of FIG.
16;
FIG. 18 is an enlarged fragmentary side view, partially in cross
section, of the repeating ligature gun of FIG. 16;
FIG. 19 is a fragmentary enlarged cross sectional view taken along
the lines 19--19 of FIG. 17;
FIG. 20 is a fragmentary cross sectional view taken along the lines
20--20 of FIG. 18;
FIGS. 21 and 22 are enlarged fragmentary side views of the tissue
engaging end of the repeating ligature gun of FIG. 17, illustrating
the application of a ligature as shown in FIG. 24;
FIG. 23 is a fragmentary side view, partially in cross section of a
modification of the repeating ligature gun of FIG. 15;
FIG. 24 is a top view of a preformed ligature according to the
invention;
FIG. 24A is a top view of a portion of the ligature of FIG. 24;
FIG. 24B is a cross sectional view taken along the lines 24B--24B
of FIG. 24; and
FIG. 24C is a cross sectional view taken along the lines 24C--24C
of FIG. 24B.
The same reference characters refer to the same elements throughout
the several view of the drawings.
GENERAL DESCRIPTION
In general, preformed ligatures according to the invention comprise
a continuous loop of suture material, that has been tied into a
slip knot as illustrated in FIG. 6D or which is provided with a
tight-fitting collar as illustrated in FIG. 24 to form the pretied
ligature into two loops, one of which may be expanded to contract
the other, the contracting loop becoming the actual ligature.
A plurality of such ligatures are mounted on a ligature carrier
cartridge, as illustrated in FIGS. 2 and 16 The barrel of the
carrier is provided with a helical track about one turn of which
one of the loops of each of the preformed ligatures is engaged. The
other loop of each ligature is engaged about an elongated pin
slightly displaced from and parallel to the helical track.
A cam is provided for rotating the helical track with respect to
the elongated pin. The cam may be a portion of the ligature gun, as
illustrated in FIGS. 7 and 8, or may be a portion of the cartridge,
as illustrated in FIG. 16.
The cartridge has an axial bore through which, when the cartridge
is mounted on the ligature gun, gripper jaws may be retracted to
pull a bleeder into the end of the cartridge.
The repeating ligature guns of the invention are provided with
means for rotating the helical track one revolution each time the
jaws are retraced into the end of the cartridge. Preferably a
single trigger causes the jaws to grip the bleeder, draw the
bleeder into the cartridge, and to rotate the helical track to
allow the ligature to engage the bleeder. Another trigger is
provided which operates a hook, which thereafter engages the second
loop of the preformed ligature and pulls the same such that the
slip knot or collar thereof is caused to move towards the bleeder
and the loop about the bleeder to close therearound, forming the
ligature.
In one embodiment of the invention, the open loop not engaging the
bleeder is then cut to release it from the gun. In another
embodiment of the invention, it is not cut.
All embodiments of the invention provide for the application of a
large plurality of ligatures before it is necessary to reload the
instrument and also provide for convenient reloading of the
instrument so a single instrument may be used throughout the course
of a single operation.
SPECIFIC DESCRIPTION
More particularly, referring to FIG. 1, a repeating ligature gun 12
according to the invention comprises an elongated outer barrel 14;
a handle 16; tissue-gripping jaws, generally indicated at 18; a
ligature cartridge, generally indicated at 20; a cam assembly,
generally indicated at 22, for rotating the ligature cartridge 20;
a trigger 24 for closing the jaws 18, for causing the jaws to
retract within the cartridge 20, and for rotating the cartridge 20
by means of the cam mechanism 22; a hook mechanism, generally
indicated at 26; a trigger 28 for operating the same; a cutter 30;
and a trigger 32 for operating the cutter.
As illustrated in FIGS. 1, 7, and 15, the handle 16 is provided
with a bore 34 for engaging the barrel 14. The handle 16 is clamped
onto the barrel 14 between a circumferential annular stop 36 and an
end cap 38 threaded onto the barrel 14 at threads 40. The lowermost
portion of the barrel 14 is slotted as at 65 and is engaged by a
key 44 formed on the handle 16 to prevent relative rotation of the
barrel 14 with respect to the handle 16 and to provide a stop for
the stroke of extension 64 described below.
Referring to FIG. 1, the upper jaw 46 of the gripping jaws 18 is
integrally formed on an elongated rod 48 which passes through the
entire length of the instrument. A bore 50 is formed in the end cap
to support one end of the rod 48, another position being supported
by pin 62 as described below. The lower jaw 52 is pivoted to rod 48
at pivot 54. The forward end of rod 48 is half round so that a
second half round rod 56 can actuate lower jaw 52 by means of its
attachment at pivot 58.
Still referring to FIG. 1, the elongated upper jaw rod 48 is
mounted to an inner barrel assembly 60 at pin 62.
Referring to FIGS. 1, 7, and 10, inner barrel assembly 60 is
provided with an extension 64 which passes through slot 65 provided
in outer barrel 14. Extension 64 is provided with a pair of
depending extensions arms 66 and 68 best seen in FIG. 10. Trigger
24 is mounted for pivotal rotation about a pivot 70, extending
between extension arms 66 and 68. Trigger 24 is provided with a
pair of wishbone-like extensions 67--67 which engage slots 69-69 in
the lower half-round jaw actuating rod 56.
Referring to FIG. 1, inner barrel assembly 60 is biased forward by
means of a compression spring 72 until extension arms 66 and 68
come to rest against the forward end 74 of slot 65. In this relaxed
position, the forward edge 76 of trigger 24 also comes into contact
with the slot edge 74 and the trigger is biased clockwise to open
jaws 18.
When the trigger 24 is initially pulled towards the handle 16, its
initial counterclockwise rotation pushes lower jaw actuating rod 56
forward, rotating lower jaw 52 clockwise as seen in FIG. 1, thus,
closing the jaws 18. Further pulling of the trigger 24 causes the
inner barrel assembly 60 to move rearwardly against the action of
spring 72. Thus, as illustrated in FIG. 11, the jaws 18 first clamp
the tissue 78, and thereafter draw the same within the ends of the
cartridge assembly 20.
The cartridge assembly 20 is mounted to the forward end of the
outer barrel 14. As best seen in FIGS. 1 and 2, the cartridge
assembly 20 is provided with an outer barrel 80 having a
circumferential outwardly extending annular stop 82 (see also FIG.
15) which is engaged with the forward end 84 of the barrel 14. An
extended key-shaped section 86 fits into a key slot 88, best seen
in FIG. 5, formed in the end of barrel 14. Barrel 14 is provided
with a spring hook 90 formed as an extension of a ring 92 for
holding the annular stop 82 against the end of 84 of the barrel 14.
The ring 92 is held from forward motion by means of a tab 94
extending into a hole 96 formed in the barrel 14.
Again referring to FIG. 2, the carrier or cartridge 20 is provided
with an elongated hollow cylinder portion 98, which is free to
rotate within the outer cylinder 80, but is prevented from lateral
motion by means of a circumferential inwardly depending groove 100
in the cylinder 98 and one or more bosses or ridges 102 inwardly
depending from the outer cylinder 80. The inner cylinder 98 is
further provided with a pair of jaw extensions 104, 106 which
engage the cam mechanism 22.
A plurality of pretied sutures 108, according to the invention, are
mounted in a continuous helical groove 110 formed in the outer
circumference of the forward end of cylinder 98. As best seen in
FIG. 3, one of the loops 112 of the pretied suture 108 is engaged
about one turn of the helix, while the other loop 114 thereof is
engaged about an elongated pin 116 press fit within extension 86 of
the outer cylinder 80. Thus, rotation of the inner cylinder 98 by
means of the extension 104 and 106 in the clockwise direction, as
seen in FIG. 3, will cause the sutures 108 to advance along the
cartridge 20 and for each rotation one will be released from the
end thereof.
For this purpose, a cam 118, best illustrated in FIG. 8, is
provided. The cam is hollow to provide for the jaw rods 48 and 56.
One end thereof is provided with a slot 120 for receiving the
extension arms 104 and 106 of the cartridge 20. As shown in FIGS. 1
and 7, the cam is mounted within the outer barrel 14. The outwardly
extending collar 122 of the cam 118 engages the inwardly extending
collar 124 within the barrel 14 and prevents rearward motion of the
cam 118. Forward motion is prevented by engagement against the
cartridge 20. Cam 118, as best shown in FIG. 8, is provided with a
continuous circumferential cam track 126, comprising a helical
curved portion 128 encompassing approximately a 360.degree.
traverse of the cam 118 and a straight portion 130 connecting the
two ends of the helical portion 128. The cam track 128 is engaged
by a cam pin 132 mounted to inner barrel assembly 60. Thus, when
trigger 24 is drawn back towards handle 16, pin 132 rides in the
curved portion 128 of cam 118, causing cam 118 to turn clockwise,
as seen in FIG. 8, one revolution, thus releasing the pretied
suture 108' (FIG. 2) at the forward end of the cartridge 20, as
best seen in FIG. 11. When the trigger 24 is released, cam pin 132
traverses the straight portion 130 of the cam track 126, readying
the cam mechanism 22 for the next suture tying operation.
As best seen in FIGS. 11 through 13, pin 116 is provided with an
end slot 134. Slot 134 receives hook 136 integral with hook arm 137
which is mounted to cutter arm 138 (FIGS. 1 and 7) at pivot pin
140. The entire cutter and hook operating assembly, generally
indicated at 142, is mounted between brackets 144, and 145 which
are integral with and extend below barrel 14. Pivot arms 146 and
148 are pivoted between brackets 144 and 145 at pivots 150 and 152.
Cutter arm 138 is pivoted to pivot arms 146 and 148 at pivot pins
154 and 156 respectively. Cutter arm 138 is provided with slots
153, 155 and 157 for receiving hook arm 137, and pivot arms 146 and
148 which are of reduced thickness near pivots 140, 154 and 156.
Trigger 28 is formed as an extension of hook arm 138.
Because the forward pivot arm 146 is longer than the rear pivot arm
148, when the trigger 28 is drawn rearwardly, the forward end of
arm 138 will swing in a greater arc downward and rearward, carrying
the hook 136 along with it. The hook engages the lower loop 114 of
the pretied suture, 108', as best seen in FIG. 12, and draws the
ligature tight about the tissue 78. The hook 136 remains biased
upwardly with respect to the forward end of cutter arm 138 through
the action of downwardly biasing leaf spring 158, mounted to and
between brackets 144 and 145, spring 158 biases a cutter trigger
portion 160 of hook arm 137 clockwise about pivot 140. When the
trigger 160 is pushed upwardly, hook 136 is caused to be drawn down
into a slot 162 formed in the end of cutter arm 138, as best seen
in FIG. 14. Slot 162 and hook 136 are provided with cooperating
scissors-like sharp edges 164 and 166, which cut the lower loop 114
of the pretied suture 108, as best seen in FIG. 13. Hook arm 138 is
biased upwardly by means of leaf spring 168.
It should be noted as best seen in FIGS. 11 through 13 that when
loop 114 is pulled downwardly and rearwardly by hook 136, the
forward end 170 of pin 116 which is curved upwards retains the knot
portion 172 of the ligature 108 and pushes the same towards the
bleeder tissue 78. Thus the ligature is tightened not only by
pulling the loop 114 through the knot portion 172 but by actually
pushing the knot portion against the bleeder 78.
Now referring to FIG. 6, each of the ligatures 108 is formed of a
continuous loop of suture material 174 which may be gut or manmade
absorbable material such as polyhydroxyacetic ester as disclosed in
U.S. Pat. Nos. 3,225,766 and 3,297,033. The material 174 is
preferably, but not necessarily, round in cross section. It is
formed into a preformed suture as shown in FIG. 6D by first
twisting it into the double loop configuration shown in FIG. 6A and
then pulling a portion of the upper loop through the lower loop
thus formed as shown in FIGS. 6B and 6C. The resulting pretied
ligature 108 has two stable positions, those shown in FIGS. 6D and
6E. It is preferred that the sutures be mounted about the cartridge
cylinder 98 and pin 116 as shown in FIG. 6D rather than as shown in
FIG. 6E. It has been found that when it is mounted as shown in FIG.
6D the slip knot portion 172 thereof remains open as shown in FIG.
6D against the pin 116 of the cartridge 20 (FIG. 2) until the
bleeder 78 begins resisting closure of the loop 112 when the
ligature is nearly tight. This allows portion 176 of the ligature
108 to be drawn easily through the slip knot 172 until the final
tightening. If the ligature is mounted as illustrated in FIG. 6E
the portion 176 tends to interfere with the portion 178 during
tightening and the knot 172 tends to become tight prematurely.
The repeating suture gun illustrated FIGS. 1 through 13 is
preferably manufactured of stainless steel which can be given a
smooth surface so that all parts will operate easily without
lubrication and can be conveniently sterilized. The cartridge 20 of
FIG. 2 is preferably formed of Delrin or other plastic material
which also can be sterilized. The pin 116 is stainless steel.
Summarizing the operation of the ligature gun, cartridge and
ligatures illustrated in FIGS. 1 through 14 the surgeon holds the
gun 12 in one hand by placing his thumb, third and fourth fingers
about the handle 16. The middle finger operates the main trigger 24
and the index finger operates the hook trigger 28 and the cutter
trigger 32.
When the surgeon pulls the trigger 24 towards the handle 16 with
his middle finger, jaws 18 clamp about the bleeder and pull it
inwardly into the hollow interior of cylinder 98 of cartridge 20.
At the same time, pin 132 moving in helical cam track 128 rotates
the cartridge one revolution, releasing the end pretied ligature
108' as seen in FIG. 11. The surgeon then pulls trigger 28 with his
index finger drawing the hook 136 and cutter arm 138 downward and
rearward as seen in FIG. 12. This pulls portion 176 of pretied
ligature 108 as seen in FIG. 6D through slip knot portion 172. At
the same time, pin 116 holds knot portion 172 open and in effect
pushes it against bleeder 78 (FIG. 12) and the slip knot 172 is
drawn tight. The amount of tightness is controlled by the surgeon
in accordance with the amount of force applied to trigger 28. The
surgeon then pushes his index finger slightly upward, engaging
cutter trigger 32 which causes hook 136 to pass through opening 162
in cutter bar 138, thus cutting loop 114. When trigger 24 is
released jaws 18 move forward and open, releasing the ligatured
bleeder 78.
Now referring to FIG. 15, the entire mechanism may be conveniently
disassembled for cleaning, as shown. Note that the cam 118 may be
removed from the outer barrel 14 through the front of barrel 14 and
that the inner barrel assembly 60 is removed by pulling it out of
the rear of barrel 14 after barrel 14 has been disassembled from
handle 16. The cartridge 20 is preferably supplied with pretied
ligatures and the cartridge assembly sterilized. Thus, a plurality
of cartridges may be made available for use in a single
operation.
An alternative embodiment of the invention is illustrated in FIGS.
16 through 22. In this embodiment, the ligature cartridge 200 has
an integral cam 202. This allows the repeating ligature gun,
generally indicated at 204, to be cleaned without disassembly.
Furthermore, the cam 202 being of plastic material provides a
smoother action when it is being rotated by pin 206.
As seen in FIG. 17 in its unactuated position hook 208 is spaced
from the end of cartridge pin 210. When the hook trigger 212 is
operated, hook 208 is recessed in an opening 214 in the end of pin
210 to engage the lower loop 216 of preformed ligature 218. The
ligature 218 is then drawn tight against pin 210 as shown in FIG.
21, and when trigger 212 is released the lower loop 216 of the
ligature 218 is allowed to escape through the opening between the
end of the hook 208 and the pin 210. Thus, the lower loop 216 need
not be cut.
Another advantage of the embodiment shown in FIGS. 16 through 22 is
that the hook trigger 212 is recessed within the jaws trigger 220.
Note particularly and referring to FIGS. 16 and 17, that the
repeating ligature gun 204 is provided with a handle 222 to which
are mounted a pair of elongated support bars 224 and 226. Upper
gripper jaw 228 is formed integrally on the end of an elongated
shaft 230 which is half round at its forward end, and of circular
cross section at its rearward end. This rod-like portion extends
through opening 232 in handle 222, and is fixed to a trigger
assembly 234 by pin 236 (FIG. 18).
Trigger assembly 234 is slidably mounted on bars 224 and 226 and is
forwardly biased by springs 238 and 240. Arm 242 integral with
trigger assembly 234 mounts pin 206 which engages cam track 244 of
cam 202 as illustrated in FIG. 17. Cam track 244 is the same shape
as cam track 126 illustrated in FIG. 8. Trigger 220 is pivotally
mounted to trigger assembly 234 at pin 248, as best seen in FIG.
19. Slot 250 is formed in trigger 220 to receive hook trigger 212
as also seen in FIG. 19. Trigger 220 is normally biased in the
clockwise direction about pin 248 due to springs 238-240 and the
engagement of the forward upper edge 252 thereof with the end of
cam 202. This causes a wishbone connection, generally indicated at
254, to a push lower jaw operating half round bar 256 rearwardly to
open a lower jaw 258 which is pivoted to upper jaw actuating bar
230 at pivot 260 and to lower jaw actuating bar 256 at pivot
262.
A barrel assembly 264 is mounted to the forward end of support rods
224 and 226. Barrel assembly 264 comprises an inwardly depending
annular stop 266 (best seen in FIG. 18) and a spring-like retaining
clip 268. Clip 268 fits into a recess 270 in outer cylinder portion
272 of cartridge 200 and prevents rotation or forward motion
thereof when it is inserted in barrel assembly 264.
As best seen in FIG. 16, cartridge 200 comprises a hollow
cylindrical portion 274 having a helical track 276 and a rearward
extension forcing cam 202. Outwardly extending annular collar 278
of portion 274 fits between stop 266 and outer cylinder 272 when
the cartridge is mounted in barrel assembly 264 to prevent forward
or rearward motion thereof. Outer cylinder 272 is provided with an
integrally depending detent projection 280 which cooperates with
inwardly depending annular depression 282 in cylinder 274 to keep
the cartridge assembled. Metal rod 210 is press fit within outer
cylinder 272 which preferably is of Delrin or other sterilizable
plastic material as is inner cylinder 274.
The pretied or preformed ligatures 218 are mounted on the cartridge
200 in the manner described with reference to previous embodiments.
That is, they may be the preformed sutures shown in FIG. 24 and as
illustrated in FIG. 17 through 22 or they may be the form
illustrated in FIG. 6D.
Hook 208 is mounted on elongated hook rod 284 and is slidable
within strap 286 formed on hook guide arm 290. The rearward end 291
of hook guide arm 290 is pivotally mounted within recess 293 in
handle extension 294 on pivot pin 292, as best seen in FIG. 20.
Abutment 295 formed on handle extension 294, as best seen in FIG.
18, acts as a stop to rearward travel of trigger assembly 234.
The end of hook rod 284 is formed into a T-shaped extension 296
which is retained in spring 298 mounted to the lower end of handle
extension 294 (FIGS. 18 and 20). Spring 298 biases hook 208
forwardly, as best seen in FIG. 17.
When trigger 220 is drawn rearward, as best seen in FIGS. 16 and
18, to cause the jaws 228 and 258 to grip the bleeder 78 and to
pull it within the end of cartridge 200, the rearward upper edge
300 of trigger 220 pushes the T-shaped portion 296 of hook rod 284
rearward, causing the hook end to recess within the recess 214 in
cartridge bar 210, as shown in FIG. 18. Simultaneously, pin 206 has
traversed the helical portion of cam track 244 to rotate cam 202
(and thus helix 276) one revolution releasing the forwardmost
preformed ligature 218, as shown in FIG. 18.
Hook trigger 212 is integrally formed on hook guide 290. Hook guide
290 has an opening 306 in the end therein for guiding hook 208 in
its forward and rearward motion into and out of engagement with the
recess 214 in pin 210 of cartridge 200. Hook guide 290 is biased
clockwise about is mounting pivot 292 by means of leaf spring 308
mounted to barrel assembly 264 at yoke 310. When trigger 212 is
pulled, hook 208 and hook guide 290 move together counterclockwise
about mounting pin 292 to tighten the ligature 218 about the
bleeder 78. Hook 208 pulls the lower loop 216 and pin 210 holds the
closure portion 312, as best seen in FIG. 21. As previously stated,
when trigger 220 is released, the ligature may be disengaged from
the gun without cutting, as illustrated in FIG. 22.
Now referring to FIG. 23, in a modified suture gun according to the
invention the hook actuating trigger 316 is mounted forward of the
jaws actuating trigger 220 and is slidably engaged about hook guide
bar 318 by means of yokes 320 and 322 integral therewith. Guide bar
318 is biased clockwise about pivot 292 (FIG. 16) by means of leaf
spring 324 mounted to modified yoke 326 integral with barrel
assembly 264. Trigger 316 is normally biased forward by trigger 220
pushing against stop 328 mounted on trigger 316. Trigger 316 is
pulled after trigger 220 has already been pulled, as previously
described. Trigger 316 slides until a stop abutment 328 contacts
trigger 220. Guide bar 318 is drawn counterclockwise about pivot
292 through the contact of inclined plane portion 327 of trigger
slide assembly 316 with pin 325. Guide bar 318 brings hook rod 284
along with it since the hook bar is held within yoke 330. This
modification provides increased leverage on the hook bar 284
through the action of the forwardly mounted sliding trigger
316.
The ligature gun illustrated in FIGS. 16 through 23 is preferably
formed of stainless steel for the reasons stated with reference to
the earlier described embodiment of the invention.
Now referring to FIGS. 24 and 24A and 24C, an alternative form of
preformed ligature 218 according to the invention (also illustrated
in FIGS. 17, 18, 21 and 22) comprises an endless loop of suture
material 400 which may be collagen (gut) or the previously
described synthetic material. Two pluralities of ratchet-like
ridges 402 and 404 are formed on opposite sides of loop 400. An
enveloping collar-like closure 312 is provided with cooperating
pawl-like teeth 408 and 410 formed therein so that the collar 312
may be pushed towards the upper loop 412 or the upper loop 412
constricted by pulling on the lower loop 314. The closure 312 may
have a pair of slits 412 and 414 formed therein to add to its
resilience when traversing the ratchet teeth 402 and 404.
It will be apparent that it is absolutely necessary for the pin 210
of the cartridge 200 to engage the closure portion 312 and hold the
same while the hook 208 engages the lower loop 216 (as shown in
FIG. 21), since otherwise there would be no force between the loop
400 of suture material and closure 312. However, it is possible to
make a closure which would act exactly like the loop of suture
material formed into a double loop with a slipknot therebetween, as
illustrated in FIG. 6D. This can be done by forming the continuous
loop 400 and the closure 312 as an integral unit and providing only
one side of the loop 400 with ratchet teeth which side can then be
pulled through the closure 312 while the closure is held fixed to
the other side of the continuous loop 400 about the bleeder. Other
forms of molded plastic fasteners having integral closures such as
now used to affix tags, tie bundles, wires and the like and sold
under the Trademark "Secur-A-Tie" by Dennison Manufacturing Company
may also be employed without departing from the scope of the
invention.
I have thus provided repeating ligature guns, multi-ligature
cartridges, and preformed ligatures therefor which may be employed
to tie any number of bleeders during an operating procedure merely
by changing presterilized cartridges of preformed ligatures.
It will thus be seen that the objects set forth above, among those
made apparent from the preceding description, are efficiently
attained and since certain changes may be made in the above
articles and constructions without departing from the scope of the
invention, it is intended that all matter contained in the above
description or shown in the accompanying drawings shall be
interpreted as illustrative and not in a limiting sense.
It is also to be understood that the following claims are intended
to cover all of the generic and specific features of the invention
herein described, and all statements of the scope of the invention
which, as a matter of language, might be said to fall
therebetween.
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