U.S. patent number 3,783,873 [Application Number 05/181,040] was granted by the patent office on 1974-01-08 for weighted surgical clamp having foldable prop.
Invention is credited to Harvey Barry Jacobs.
United States Patent |
3,783,873 |
Jacobs |
January 8, 1974 |
WEIGHTED SURGICAL CLAMP HAVING FOLDABLE PROP
Abstract
Weighted clamp for surgical retracting use in the operating
room. In one form, a clamp is fitted with weights in one or both
handles which may be detachable and will vary in accordance with
the surgical procedure. For gall bladder or hernia operations in
adults the weights may vary from about 1/2 pounds to about 5
pounds. In infants the weights are smaller, e.g., from 1/4 to 2
pounds. For venous or arterial surgery the weights may vary from 2
to 6 ounces for light veins up to 1-2 pounds for larger arteries.
For use in stabilizing fractures the weights vary from 2 pounds up
to 50 pounds. The weighted units may be screwed on, clipped on,
pushed on or magnetically attached to or taken off of the handle. A
pivoted folding prop is attached to each leg of the clamp. The arms
of the prop are swung outwardly to stabilize the weighted clamp in,
outside or on the body. A modified form of weighted clamp is fitted
with a suction pad in the jaw portion for atraumatically holding
hollow organs, such as bowel, heart or lung or solid organs such as
spleen, liver, or kidney and the handles with pad may be separated
by unbolting at the scissors pivot.
Inventors: |
Jacobs; Harvey Barry (Reston,
VA) |
Family
ID: |
22662653 |
Appl.
No.: |
05/181,040 |
Filed: |
September 16, 1971 |
Current U.S.
Class: |
606/151; 606/208;
606/205 |
Current CPC
Class: |
A61B
17/2812 (20130101); A61B 17/04 (20130101); A61B
17/0206 (20130101); A61B 2017/2837 (20130101); A61B
2017/306 (20130101); A61B 2017/1125 (20130101) |
Current International
Class: |
A61B
17/28 (20060101); A61B 17/02 (20060101); A61B
17/04 (20060101); A61B 17/11 (20060101); A61B
17/30 (20060101); A61B 17/03 (20060101); A61b
017/02 (); A61b 017/08 (); A61b 017/28 () |
Field of
Search: |
;7/4 ;81/5.1,415,418
;128/17,20,69,75,84B,84C,84R,297,299,321,325,346,33R |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
"Progress in Surgery," In Am. Jour. Surg. 28 : 52-55.
1914..
|
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Saffitz; Abraham A.
Claims
What is claimed is:
1. A weighted clamp adapted to thoracic surgery, cardio-vascular
surgery, eye surgery and other surgical procedures wherein a low
profile is presented in the operating field, and which eliminates
the need for an assistant to hold the retracted clamp during
surgery comprising:
a. a pair of shaft members with handles at one end and terminating
in jaw portions at other ends thereof;
b. pivot means for opening and closing said shaft members;
c. latch and unlatch means to hold the jaws in latched position for
retraction and to unlatch the jaws when the clamp is to be
opened;
d. attachment means at the end of the handles of said shaft handle
members; and
e. separably attachable weights adapted to be attached to either
one or both of said attachment means of said shaft handles.
2. A weighted clamp which eliminates the need for an assistant to
hold the retracted clamp during surgery, comprising:
a. a pair of shaft members with handles at one end and terminating
in jaw portions at opposite ends thereof;
b. pivot means for opening and closing said shaft members;
c. latch and unlatch means to hold the jaws in latched position for
retraction and to unlatch the jaws when the clamp is to be
opened;
d. attachment means at the end of each of said shaft handles;
e. separably attachable weights adapted to be attached to either
one or both of said attachment means of said shaft handles; and
f. monopod means foldably and pivotally attached to at least one of
said shaft handles between the pivot means and handle, said monopod
being foldable to lie flush against the shaft when not in use and
being pivotably foldable at 90.degree. to an erected position for
supporting said weighted clamp.
Description
This invention relates to a weighted locking clamp for surgical
retracting use which facilitates delicate surgical operations under
conditions wherein the jaws of the clamp are attached directly to
the anatomical structure or to a drain structure placed around the
anatomical structure subject to surgery and wherein one or both
handles of clamp at the most remote point from the jaws are
provided with weights, preferably detachable weights, to assist in
stabilizing the clamp in latched position and thereby free the
surgeon or his assistant for other tasks during the surgical
procedure.
In a particularly preferred embodiment the weighted clamp of the
invention is provided with folding arms pivotally attached to each
leg of the clamp which are swingable outward to form a foldable
prop support adapting the weighted clamp to be positioned in
substantially any location on or in the body during surgical
procedure to thereby eliminate the usual type of obstruction which
conventional locking clamps have provided. This usual obstruction
requires the service of a special surgical assistant to hold and
manipulate the conventional clamp under the surgeon's
direction.
In a modified form of the invention, a weighted clamp is fitted
with a suction cup in the jaw portion for holding organs such as
heart, lung, spleen, bowel, liver or kidney.
A preferred form of the invention comprises a weighted clamp whose
weight is either evenly distributed between the two handles or
located mainly in one handle depending upon the area of the
operation.
Although in most surgical applications, there will be sufficient
lateral width or space for movement about the handle portion of the
weighted clamp there are instances where the space is very limited,
as for example in neck or thyroid surgery, or in pediatric surgery
wherein the surgical field is very limited and the placement of the
weight in one handle permits a delicate balance for stabilizing the
clamp at the handle end. This is simply done by using a single
weight at the handle which rests on the part of the patient most
remote from the surgical field. In this manner, there is a minimum
amount of space occupied by the surgical apparatus.
Weights of varying sizes are described below in terms of surgical
procedures and provision is made for additional weights to be
screwed on, clipped on, pushed on or attached by magnet means to
increase the clamp's weight without having to remove it and to use
a second one in its place. The gripping jaws of the clamp may be
smooth, or tooth-like, or slightly roughened and the ends of the
jaw may have a ring or locking end, or pointed teeth ends,
depending upon the type of tissues or materials which are worked
upon as a primary retractor.
The weighted clamp of the invention is uniquely adapted to be used
in all fields of surgery as illustrative examples below indicate
and the weights are tailored to the uses in specific surgical
procedures but the illustrative examples are not limited
exclusively to these weights or these procedures.
For example, retracting around the spermatic cord when the
spermatic cord is elevated in a surgical procedure generally
employs a soft rubber drain placed around the cord and a clamp
attached to the drain for the surgeon's assistant to hold and
retract. This conventional clamp can be replaced by the weighted
clamp of the present invention in which the unit of weight in an
adult is between 1 to 3 pounds and in a child from 1/2 to 11/2
pounds with the result that the assistant is freed for other tasks.
In addition, for retraction around delicate arteries and veins, the
weights can run from 2 ounces to 11/2 pounds, depending upon the
size of the vessels, and for such delicate work, has a great
advantage for the surgeon to be free from having to work with an
untrained assistant. Also, around intestines, weights run from 6
ounces to 3 pounds, around nerve structures from 2 ounces to 11/2
pounds and around tendons from 4 ounces to 4 pounds.
It is particularly advantageous to use the weighted retractor of
the invention in combination with suction means and special
elastomeric suction pads which are operative individually or
together to gently grasp by suction forces relatively large areas
of hollow or solid tissue without any danger of ripping, tearing,
or crushing, the suction holding forces being controlled by a
simple adjustment of line vacuum. In this embodiment of weighted
clamp with suction pads, a single clamp handle may be separated
pivot-bolt to permit each handle (scissor's leg) to be separately
used as a weighted suction lever. Used in this manner, delicate
emergency intestinal anastomosis may be performed by one surgeon
under the most difficult circumstances without the need for any
additional skilled surgical assistants. This model may be used with
unique benefits in manipulating lung, heart, spleen, liver and
kidney under secure atraumatic control.
In its use in rectal surgery, weights of 2 to 8 pounds are used. To
hold sutures in anastomostic areas as counter traction, from 2
ounces to 4 pounds are employed as weight. In its use in orthopedic
surgery to help maintain the stabilization portion of fractures,
prior to its permanent fixation, a metal ring or a band is placed
around the fractured portion and the orthopedic clamp is used with
detachable weights from 6 ounces to 50 pounds, depending upon the
kind of bone fracture and the location of the fracture.
In setting upon surgical fractures seriously limited surgical
fields are encountered and heavy weights and forces must be applied
in precise locations to facilitate accuracy in mating and joining
broken bone surfaces. The orthopedic model of weighted clamp of the
invention provides a unique means for the orthopedic surgeon to
supply these forces and weights by himself, and without further
injury to muscle tissue, nerve, ligament, etc., by applying the
minimum weights to accomplish retraction and thereafter changing
the weights (adding or subtracting) as required to aid alignment
and healing. In this connection, the orthopedic model provides the
unique advantage of permitting weight substitution in cooperation
with band substitution (one or more bands being usable), the band
width in the jaw portion (see FIG. 6) being adapted for the handle
weight and bone area requirements. Heretofore, these have been very
difficult adjustments to make by the surgeon working alone.
In eye surgery to hold suture material weights can run from 1/2
ounce to 8 ounces. In head and neck surgery for pulling flaps of
tissue away or to mobilize portions of specimens, from 4 ounces to
4 pounds and unbalanced weights are preferred. Also, in
cardio-vascular surgery for holding suture material or holding
major blood vessels, 2 ounces to 2 pounds is employed. In
urological procedures, to hold the ureter weights can be from 2
ounces to one pound. These are only but a few of the numerous uses
of this clamp.
The following table illustrates preferred detachable weights for
surgery:
Procedure Retracted Area Optimum Range Bones Bone-shaft 8 lbs 2-50
lbs Tendons Tendon 3 lbs 1-6 lbs Hysterectomy Uterus 3 lbs 2-8 lbs
Celiotomy Fascia and peritoneum 3 lbs 2-4 lbs Cholycystectomy
Fundus of gall bladder 2 lbs 2-8 lbs Hemorrhoidectomy Anal skin 2
lbs 1-6 lbs Adult hernorrhaphy Spermatic cord 2 lbs 1-3 lbs
Esophagectomy (adult) Esophagus 2 lbs 1-4 lbs Ureteral surgery
Ureter 1 lb 1/2-2 lbs Pediatric hernior- raphy Spermatic cord 1 lb
1/2-11/2 lbs Esophagectomy (pediatric) Esophagus 1 lb 1/2-2 lbs
Arterial surgery (large) Artery 1 lb 1 -2 lbs Venous dissection
Vein 1/2 small 1/2-1 1/2 lbs Intestinal anastom- Intestinal holding
osis suture or clamp 12 oz 1/2-3 lbs Large nerve dissec- tion Large
nerve 10 oz 1/2-1 lb Smaller arteries Artery 10 oz 6-14 oz and
nerves Nerve 4 oz 2 -14 oz
When the clamp is applied, and if additional weighting is deemed
necessary, these can be screwed, clipped, attached by magnets or
hooks to the previous weighted unit without having to remove this
unit or it can be interchanged with one of a heavier design.
The gripping end of the clamp can be also made in such a manner
that it can be detached and a more preferred type of gripping unit
for that procedure applied by either screwing or insertion via
clipping type of connection to the shaft end. A foldable prop
structure can be built into the gripping portion of the clamp as an
optional feature to allow the tip to be elevated above the weighted
portion to retract the tissue away from other portions of the
surgical field.
In gall bladder surgery the weighted clamp may be used without the
foldable prop structure and a recommended procedure is to start the
dissection with an 8 lb weight locked onto the top of the gall
bladder to tension the bladder, duct and associated artery. After
surgical removal of the gall bladder from attachment to the liver,
the weight is dropped to 1 -2 pounds to reduce the tension which is
now placed on the delicate artery and the duct. Accidental ripping
of the artery or duct is thereby minimized.
In hernia surgery the tripod structure raises the clamped area,
stabilizes the retractor unit, and effectively expands the surgical
space by utilizing the height dimension without any obstruction by
a surgical assistant or the need for his services for this
function. There is no benefit in changing weights in this hernia
procedure.
In hysterectomy procedures, the surgical phase for ovarian
dissection requires retraction of delicate processes, and the
weighted clamp with foldable prop can provide significant
advantages especially since the procedure starts with a relatively
light weight of 1 -2 pounds and the weight must be increased to
about 6 -9 pounds when the dissection of the uterus begins,
following completion of the ovarian procedure. Particularly with
obese patients, there is need to expose the ovarian structure and
the foldable prop is invaluable for this purpose.
An object of the invention is to provide a weighted, clamp for use
in surgical retracting operations in the emergency room or in the
operating room which frees the surgeon's assistant to assist in
other and usually more delicate parts of the operative procedures.
A further object of the invention is to provide a combination of
handled-weighted surgical clamp means with detachable and varying
weights in the handle while the jaws are in the locked position,
with folding prop support means adjacent to the pivot tongs of the
clamp, these support means being adapted to stabilize fully
retracted clamp in locked position on, outside, or in the body
during surgery, and to elevate the jaws above the weighted handle
level.
The invention will be better understood and additional objects will
become apparent from the following detailed description of certain
preferred embodiments illustrated in the accompanying drawings.
Various changes may be made, however, in the details of
construction and arrangement of parts and certain features may be
used without others. All such modifications within the scope of the
appended claims are included within the invention.
While the invention is described with particular reference to
hernia, gall bladder, arterial and surgical fracture traction
operations, it is to be understood that certain features of the
invention are also applicable to the variably weighted clamping
and/or retracting of arteries, veins, nerves, fascia, muscles, etc.
and to the support of the weighted clamp.
The invention as described below will be better understood from the
appended drawings, in which:
FIG. 1 is a perspective view of a weighted clamp in accordance with
the invention which is adapted to receive screwed-on weights of
various sizes in the handle portion.
FIG. 2 is a side elevational view of the clamp of FIG. 1.
FIG. 3 is a fragmentary view partly in section and partly in
elevation showing a modification of magnetic detachable handle
weight useful in vein and nerve surgery.
FIG. 4 is a fragmentary view partly in section and partly in
perspective showing the screw-on handle weight especially useful
for hernia, gall bladder and rectal surgery.
FIG. 5 is a fragmentary view partly in section and partly in
perspective showing orthopedic hook and eye detachable handle
weight.
FIG. 6 is a perspective view of an orthopedic weighted clamp in
accordance with the invention.
FIG. 6A is a fragmentary view of a modification of hook and eye
clamp like that in FIG. 6 but useful for holding fascia.
FIG. 7 is a side elevational view of the orthopedic weighted clamp
of FIG. 6 with the flexible band holding onto bone.
FIG. 8 is a fragmentary perspective view of a preferred lateral
pivot and 90.degree. hinge foldable prop joint.
FIG. 9 is a perspective view of a weighted clamp having removable
jaw sections and a removable scissors pivot bolt, this embodiment
being adapted for separation of each handle.
FIG. 10 is a perspective view of a separated handle with a suction
pad in the jaw portion in place of the removed serrated jaw
sections, and shows the handle after removal of the scissors pivot
bolt, this embodiment being adapted for atraumatic manipulation of
hollow or solid organs, e.g., bowel, lung, spleen, liver or
kidney.
FIG. 11 is a cross-sectional view of the handle of FIG. 10 along
line 11--11 of FIG. 10.
FIG. 12 shows a fragmentary portion of the pad end illustrating
flexibility of the distal suction end of the pad conduit which is
made of flexible plastic.
FIG. 13 shows diagrammatically the magnetic attachment of a weight
to the handle bottom which is provided with a suction conduit for
attachment to a vacuum line.
FIG. 14 shows a diagrammatic fashion a screw fitted attachment for
the handle bottom of the type in FIG. 13.
FIG. 15 shows a sectional view of the suction pad with multiple
perforations adapted to diffuse the suction over the entire pad
area.
A preferred embodiment having various types of modified weighted
handle members and jaw members is shown in FIGS. 1-8 wherein the
clamp 1 comprises a pair of similar metal jaws, a pivot for the
handle jaws, and foldable props. In FIGS. 1 and 2, the jaws 11 and
12 are hinged together at pivot 13 for movement toward and away
from each other. A sliding movement rather than a pivotal movement
may be provided by modifying the pivot arrangement if desired. The
jaw 11 in FIGS. 1 and 2 is integral with a handle portion 15 to
provide a scissors action for opening and closing the jaws. The
jaws may be bent at 17 to a considerable angle relative to the
pivotal and handle portions as shown in these FIGS. The handles 15
and 16 have locking lugs 18 equipped with interengaging ratchet
teeth 19 to lock the jaws in closed or partially closed
positions.
In FIGS. 1 and 2 the jaws 11 and 12 have ridges 9 incorporated on
their adjacent touching surfaces and these ridges hold the clamped
object without slipping. For heavy duty surgery the adjacent edges
may be of the tooth 8 in socket 7 variety as shown in FIGS. 6 and
7, this tooth and socket being used to hold the band 6 in FIGS. 6
and 7 by locking the eyelets 5 together. This band is used in
orthopedic surgery where the band is passed around a bone and heavy
weighted units are used as shown in the Table herein.
The handles 15 and 16 in FIGS. 1 and 2 have weights 3 and 4
respectively incorporated in their structure and projecting
proximally. The weights may be evenly distributed or may be mostly
distributed in one member. The shapes can be cylindrical, oval,
rectangular, dish-like or triangular but must be so shaped to allow
complete locking of the ratchet teeth 19. They are preferably made
of sterilizable stainless steel coverings 1 and 2 and the inside of
these coverings can be filled with heavy material such as lead 20
and 21.
Shafts 22 and 23 have foldable prop members 24 and 25 attached by
the pivot bending hinges 26 and 27. The hinge joint (see FIG. 8) 28
allows full extension to 90.degree. and pivot joint 29 allows
lateral extension of foldable proper members 24 and 25. At the end
of foldable prop members 24 and 25 is the stand members 30 and 31.
These elevate the jaw end of the clamp in relation to the surgical
field and the handle. This may be of the concave semi-circular form
depicted or sharp needle or tooth-like end as well as pincer-like
holding ends.
The end of the weights have provision for the attachments of
additional weights as deemed necessary by the surgeon. These
weights come in different sizes and shapes to suit the particular
operation. There are screw-like threads 34 and 35 (not shown)
incorporated in weights 3 and 4 into which screw in weight 38 via
screw 36. There is provision for additional weights to be added via
screw threaded holes 40 without the necessity for removing the
clamp (see FIG. 4).
The weight attachment device (see FIG. 3) may be of the magnetic
variety 42 and 43 with lateral stabilization members 44 and 45.
With heavy orthopedic like weights (see FIG. 5) a hook and eye
arrangement, 46 and 47, may be conveniently used.
Foldable prop units 24 and 25 are stored parallel and stabilized
against shafts 22 and 23 by securing or holding units 32 and 33,
when not in use.
In the embodiments shown in FIGS. 1-8 if only jaw 15 is weighted
then the corresponding foldable prop 25 may be used in a narrow
surgical space as in pediatric surgery or in neck surgery, for
example, and this is of great advantage in providing all of the
weight on one side of the clamp.
In other surgical uses, of the clamp in FIGS. 1-8, both foldable
props are folded back, for example, in thoracic surgery where it is
necessary that the jaws must be below the patient's outer chest to
eliminate any hazards in snagging and to permit full movement.
Thus, in this application, the weighted clamp is used without a
foldable prop.
Although the weighted orthopedic clamp embodiment shown in FIG. 6
is shown in combination with a band, it is contemplated that the
clamp may be used without a band and that the straight hook portion
8 may be elongated and provided with a sharpened point for form
fascia hook 8a, shown in FIG. 6A, which fits into the straight
elongated eye portion 72; and this modified jaw structure can be
used with great advantage in holding delicate fascia without
crushing. It is believed that this novel jaw has not heretofore
been provided or used in any clamp, surgical or otherwise, and
certainly has not been provided in a weighted clamp. In this latter
embodiment, the weighting of the clamp permits atraumatic holding
of the fascia without the need for a surgical assistant.
In the embodiments of FIGS. 9-15, a modification of weighted clamp
is provided with a soft suction cup in the jaw which, when suction
means is applied, serves to hold soft organs such as bowel, liver
or spleen, heart or lung, without any danger of tearing or ripping.
In this suction form of weighted clamp, it is possible to use the
foldable prop with only one of the weights, as shown in FIG. 9.
It is also contemplated that both of the foldable props may be
folded back for thoracic surgery, or that one foldable prop may be
folded back for periatric or neck surgery with the embodiments of
FIGS. 1-8.
However, the suction embodiments of FIGS. 9-15 all preferably
employ a removable scissors pivot bolt 56 which effects separation
of each handle to permit atraumatic manipulation of the soft or
hollow organ by a single handle part or which, without disassembly,
permits suction to be applied to both jaws.
As shown in FIG. 9, suction is transmitted via flexible plastic
tubing 48 and flexible plastic conduits 49a and 49b to hollow
connectors 59a and 59b and to lumens 50a and 50b in the handle
shafts 23 and 22, respectively. Lumens 50a and 50b pass around the
pivot bolt 56 and terminate at a hollow screw opening in the
connectors 55a and 55b, respectively. The handles 22 and 23 can be
easily separated at bolt 56 (see FIG. 10) and the flexible
elastomeric suction pad 51 is screwed in at the hollow threaded
opening 55a. Suction is then applied through lumen 50a, screw joint
(see FIG. 11), and hollow suction pad shaft 54 so as to grip the
organ through multiple openings 52 and the hollow suction diffusing
pad 51. This suction pad structure is shown in cross section in
FIG. 15. A flexible plastic tubular handle 57 (see FIG. 12) may be
used instead of the solid metal handle 23 or instead of the
threaded metal and plastic assembly of interfitting tubes 23 and 53
in FIG. 10. The additional weights 43 may be attached by magnetic
means and are stabilized by lateral plug in members 45 and 44 as
shown in FIG. 13. Alternatively, the additional weights 38 may be
added by means of the screw-in connector 36 (see FIG. 14) whereby
the screw 36 fits into socket joint 34.
In the light of the foregoing description of the weighted clamps
with soft suction cup and separable shaft features in FIGS. 9-15
and in the light of the locking-type clamps in FIGS. 1-8 which may
utilize one or both tripods, it is seen that the various
embodiments illustrated herein provide a weighted clamp adapted for
broad utility in surgery to eliminate the need for an assistant to
hold and retract the clamp and to permit the necessary manipulation
of the shaft handles by the surgeon who is acting alone. The
surgeon may lock or unlock the jaws relying upon the lock and
unlock means; he may disengage the pivot means (see FIG. 9) to use
a single suction pad for holding soft tissue (see FIG. 10); and he
may readily add or subtract weights in units varying from 1/2 ounce
for eye surgery up to about 50 pounds for orthopedic surgery.
The versatility of the embodiment of the invention set forth in
FIGS. 9-15 can be better appreciated in terms of the separability
of the shaft handle fitted with elastomeric suction pad means if
one considers the uses the surgeon makes of the separated shaft
handles in emergency situations. For example, in pediatrics where
the flexible plastic distal portion of the conduit 57 (see FIG. 12)
is lengthened relative to the receiving handle portion as shown in
FIG. 10, the resultant suction handle shaft embodiment has unique
utility to pick up and remove foreign objects for the windpipe and
trachea of a child who has swallowed a foreign object.
Obviously, the dimensions of the pad may be varied to accommodate
specific holding tasks in pediatric emergency procedures and
different pad sizes and shapes are contemplated for working with
large or small organs or foreign objects.
Additional versatility in the utilization of the separated suction
shaft handle and pad assembly of FIGS. 10 and 12 is had by reason
of the selection of the material which makes up the hollow suction
pad shaft portion, this material being a rigid metal or rigid
plastic in FIG. 10 (see reference numeral 54) and being a flexible
plastic in FIG. 12. Suitable rigid materials are aluminum,
stainless steel, magnesium aluminum alloy, acrylonitrile --
butadiene-styrene copolymer plastic, phenol formaldehyde resin or
impact-resistant polystyrene. Suitable flexible plastics are
polyethylene, nylon, cellulose acetate, vinyl chloride polymers and
copolymers, and soft acrylic polymers and copolymers such as are
based upon copolymerization of ethyl or butyl acrylate,
acrylonitrile and styrene.
The detachable pad 51 is formed of a soft elastomer which is
readily sterilized, such as polyurethane elastomer,
polyether-polyurethane elastomer, vulcanized gum rubber,
butadiene-acrylonitrile rubber, polyvinyl chloride plastisol,
ethylene-propylene rubber and the like, and which is not toxic or
irritating to animal tissue.
If the surgical use is to be carried out in tissue areas where
blood clotting occurs because of the introduction of the plastic,
then Dacron, Teflon and silicone plastics, which are known to be
non-pyrogenic, may be employed.
* * * * *