U.S. patent number 3,856,018 [Application Number 05/477,269] was granted by the patent office on 1974-12-24 for process for ligating sectioned blood vessels.
Invention is credited to Andre Robert Chancholle, Jean Maurice Francois Perisse, Pierre Perisse.
United States Patent |
3,856,018 |
Perisse , et al. |
December 24, 1974 |
PROCESS FOR LIGATING SECTIONED BLOOD VESSELS
Abstract
A process for ligating sectioned blood vessels comprising
applying a cylindrical body adapted for removable attachment to a
suction source against the end of a sectioned vessel and the tissue
zone theresurrounding to effect simultaneously the elimination of
blood and the formation within the cylindrical body of a tissue bud
containing the end of the vessel, and thereafter applying a
ligature member to the tissue bud at the base thereof, while still
applying the suction force, to close the vessel end. The closure
member can be a loop of ligature thread which is supported at the
open end of the cylindrical body and which is applied to the tissue
bud by acting on an external actuator. The closure member can also
be a metal clip which is initially supported within the cylindrical
body and is deformed and clamped at the base of the bud by acting
on an external actuator.
Inventors: |
Perisse; Pierre (Rieumes,
FR), Perisse; Jean Maurice Francois (Rieumes,
FR), Chancholle; Andre Robert (Toulouse,
FR) |
Family
ID: |
26989876 |
Appl.
No.: |
05/477,269 |
Filed: |
June 7, 1974 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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335758 |
Feb 26, 1973 |
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Current U.S.
Class: |
606/139; 606/158;
606/143 |
Current CPC
Class: |
A61B
17/12009 (20130101); A61B 17/128 (20130101); A61B
17/122 (20130101) |
Current International
Class: |
A61B
17/122 (20060101); A61B 17/12 (20060101); A61B
17/128 (20060101); A61b 017/12 () |
Field of
Search: |
;128/325,326,327,334R,320,33A,305 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Laudenslager; Lucie H.
Attorney, Agent or Firm: Waters, Roditi, Schwartz &
Nissen
Parent Case Text
CROSS RELATED APPLICATION
This application is a division of application Ser. No. 335,758,
filed Feb. 26, 1973.
Claims
We claim:
1. A process for ligating sectioned blood vessels comprising
applying suction force to the end of a sectioned vessel, as well as
the tissue zone surrounding it to effect simultaneously the
elimination of blood and the formation of a tissue bud containing
the end of the vessel, and contracting the tissue bud at the base
thereof, while still applying the suction to close said vessel
end.
2. A process as claimed in claim 1 wherein said contraction of the
tissue bud is effected from a location remote from said bud.
3. A process as claimed in claim 1 wherein the tissue bud is formed
within a channel which is subjected to the suction force, and the
tissue bud is contracted by applying a closure member thereto when
the bud is in said channel.
Description
BRIEF SUMMARY OF THE INVENTION
This invention relates to a process and apparatus for ligating
sectioned blood vessels.
Hemostasis is a phase of a surgical operation where procedures are
carried out for preventing or stopping the spread of blood in the
operating area.
Hemostasis may arise in two ways:
In one situation the blood vessel is localized before sectioning.
Two hemostatic clamps are placed on the vessel and the vessel may
then be sectioned between the clamping points, without causing any
blood flow, a ligature then being applied to each of the ends of
the sectioned vessel.
In another situation, which is most frequent, the blood vessel is
sectioned before the hemostatic clamps are applied. The blood
flowing from the vessel is then absorbed either by swabbing or,
more frequently, by use of a suction apparatus. The end of the
sectioned vessel may then be correctly localized and a hemostatic
clamp placed thereon. Finally, the end of the vessel is tied.
In both procedures described above, the ligation of the sectioned
vessel is always delicate and may even be difficult to perform when
the vessel is located at the bottom of a deep cut or in an area
which is anatomically difficult to reach. The difficulty of the
operation due to the slenderness of the vessels and to the
inconvenient access is further aggravated by the fact that the
hemostatic clamp most frequently conceals from the operator the
portion of the vessel where the ligature is to be placed. It thus
happens that the ligature thread squeezes the end of the clamp
itself, thereby causing the breaking of the thread when the clamp
is removed.
A further deficiency of the known procedure is that the placement
of the hemostatic clamps has a traumatic effect on the
peri-arterial tissues which are always clamped at the same time as
the vessel and are thus crushed.
It is an object of the present invention to remedy these
deficiencies by providing an apparatus whereby the easy and precise
placement of ligatures on the extremities of sectioned vessels may
be affected even in areas of difficult access, without causing the
collapse of the peri-arterial tissues.
The invention further provides a process according to which the end
of the sectioned vessel, together with the tissue area surrounding
it are subjected to the action of a suction apparatus, such suction
producing, simultaneously with the elimination of blood, the
formation in the interior of the suction apparatus of a tissue
cone. At the base of this cone there is then placed a preformed
loop which is preset and detachably secured around the orifice of
the tube at the end of the suction apparatus. The free portions of
the thread which constitute the loop are then moved, by any
suitable means, in a direction perpenticular to the plane of the
loop. The closure of this loop and the contraction of the vessel
may thus be controlled from a point remote from the operating area
by pulling manually or by any other means, upon the ends of the
said free portions of the thread.
The apparatus provided by the invention comprises essentially a
cylindrical member provided at one of its ends with means for
removably securing the suction nozzle of a known suction apparatus
and provided at its other end with a preformed loop of ligature
thread, arranged around the circumference of the orifice of said
cylindrical member, the loop being held detachably in place by any
suitable means. The free portions of the loop are guided along
external walls of the member and their ends are secured to a
control member capable of being moved manually or otherwise along a
generatrix of the cylindrical member.
According to another feature of the invention, the preformed
ligature loop is detachably held in place by reason of the thread
of the loop being embedded, substantially halfway in the thickness
of the plastic material constituting the cylindrical member, this
resulting from the molding of the member on the preformed loop.
The invention further comprises an apparatus for practising the
process, which apparatus is characterized essentially by the fact
that the contraction means consists of a metal clip suitably
positioned within the body of the suction apparatus and the
clamping action of which around the base of the tissue cone is
controlled, by any suitable means, from a point remote from the
area where the operation is performed.
In accordance with a preferred embodiment of the invention, the
body of the suction apparatus constitutes a storage space for a
plurality of clips arranged one behind the other, the first clip
being located against a stop formed at the opening of the suction
apparatus in which the tissue cone is formed. The clamping of the
clip on the base of the cone is effected by closure of the jaws on
the body of the apparatus, resilient means being provided for the
placing against said stop of a succeeding clip after the first clip
has been used.
Other features of the invention will become clear from the
following description in conjunction with the accompanying drawings
in which:
FIG. 1 is a view in longitudinal section of the apparatus of the
present invention in place over a sectioned vessel;
FIG. 2 is a view similar to FIG. 1 after the application of suction
which forms the tissue cone;
FIG. 3 shows the apparatus of FIG. 2 after the closure of the
preformed loop around the tissue cone;
FIG. 4 is a perspective view showing the device removed after
interruption of the suction;
FIG. 5 is a section along the line C-D of FIG. 1;
FIG. 6 is a section along the line A-B of FIG. 1;
FIGS. 7-10 are enlarged photographs of the cylindrical body
carrying the preformed loop;
FIGS. 11, 12 and 13 show one embodiment of a clip seen in plan, in
section and in perspective, respectively;
FIG. 14 is a view in longitudinal section of another embodiment of
the apparatus according to the invention;
FIG. 15 is a view in front elevation view of the apparatus shown in
FIG. 14;
FIG. 16 is a view in longitudinal section of the apparatus showing
the tissue cone formed in the interior of the body of the
apparatus;
FIG. 17 is a view in cross section along line a-b of FIG. 16;
FIG. 18 is a view in longitudinal section of the apparatus showing
the jaws and the clip placed between them applied to the base of
the tissue cone; and
FIG. 19 is a perspective view of a clip collapsed by the jaws.
DETAILED DESCRIPTION
With reference to FIGS. 1 to 10, the apparatus of the invention
commprises a cylindrical body 1, adapted to be secured to a suction
apparatus (not shown) by any suitable means, for example by means
of a reduced portion 2 adapted to engage in the suction nozzle of
the suction apparatus.
At the end of the body 1 opposite the end which is connected to the
suction apparatus, there is provided a preformed ligature thread
loop 3. This loop is positioned around the opening of the
cylindrical body 1 and is removably held in that position on a
shoulder in the body by being embedded to substantially
half-thickness of the thread within the plastic material of which
the body 1 is made (FIGS. 7-10). The loop illustrated in the
drawings and in the photographs forms, after clamping, a knot,
called a "surgeon's knot". It will be understood that any other
type of preformed loop may be used.
The free portion 4 of the loop, guided in two groves 5 formed on
the flange of the body 1 are bent down along the exterior sides of
the body and are secured to a button 6 provided with a fastener 7
which is slidable along a guideway 8 formed in the side of the
body.
The operation of the apparatus is as follows:
The end of the body 1, provided with the preformed loop, is applied
to the orifice of a sectioned vessel 9 (FIG. 1). The suction
apparatus, to which the device is connected, is then set in
operation. The suction thus created in the interior of the axial
cavity of the body 1, forms a small tissue cone or bud 10 in the
center of which the section end of the vessel is located. It is
then sufficient for the operator to move the slidable button 6 in
the direction of the arrow f (FIGS. 2 and 3) to cause, by pulling
on the loop ends 4, the closure of the loop 3 and the contraction
of the vessel (FIG. 3).
It will be observed that the preformed loop which, as previously
stated, has been embedded up to half the thickness of the thread
within the plastic material of the body 1, will be easily removed
by a pull on the loop ends 4.
At the end of the stroke of the button 6, the slide 7 leaves the
guideway 8. The interruption of the suction, under the control of
the operator, causes the tissue bud to be released. The body 1 may
then be removed from the tissue and the loop ends 4 are cut to the
desired length. The body 1 is then detached from the suction
apparatus and is thrown away along with the slide button and the
ends of the loop attached to it. At each hemostatic operation, a
new cylindrical body, provided with a preformed loop, is used, as
previously stated.
It is within the scope of the present invention to employ other
means than those previously described. Thus for example, the
preformed loop of thread may be secured to the end of the body by
any suitable adhesive. Also the movement of the slide button may be
effected by mechanical means, for example by a return spring, or by
pneumatic means. In the latter case, the slide button may be made
integral with a plunger movable within a cylinder molded into the
sides of the body, the suction created by the suction apparatus to
which the body is connected being utilized for causing movement of
the plunger after the cylinder has been operatively connected to
the suction source of the suction apparatus.
A different embodiment of the invention is illustrated in FIGS. 11
through 18. In this embodiment, the apparatus comprises a hollow
body 11 (FIG. 14) having an end portion adapted to be connected to
a source of suction and having at its other end a shoulder 13
extending inwardly of the body 11. In the interior of the body 11
are a plurality of clips 14 pressed by a guide 15 slidable within
the body 11. The guide in turn is urged by a spring 16 engaging the
bottom of the body 11.
Jaws 17, in the form of semi-circular sectors, are pivotally
mounted on a pin 18 carried by the body 11. The jaws are arranged
in such manner that their ends which are directed toward the
interior of the device engage the clip which abuts the shoulder
13.
The apparatus just described operates in the following manner:
The apparatus is placed opposite the zone where the operation is
being performed (FIG. 14), and it sucks blood spread in the
immediate vicinity of the sectioned vessel, thereby permitting the
operator to locate the orifice (not shown) with precision. The end
of the apparatus is then applied to this orifice (see FIG. 16)
whereby the stopping of the bleeding by suction has the effect of
closing the lips of the sectioned vessel. At the same time the
suction causes the forming of a tissue bud 19 at the center of
which is located the end of the sectioned vessel. The bud is formed
in the interior of the body of the apparatus and hence in the
interior of the clips located at the end of the apparatus.
It is thereafter sufficient for the operator to act upon the jaw 17
by any suitable mechanical or pneumatic means to cause the jaws to
close in the direction of the arrows F (FIG. 18), thereby causing
the bending of the clip which is situated against the shoulder 13
around opposite sides of the base of the bud, which results in the
contraction of the bud and hence the hemostasis of the vessel.
The removal of the jaws, together with the interruption of the
suction then permits removal of the apparatus from contact with the
tissues.
The clips 14 are then pressed by the guide 15 against the end of
the body of the apparatus until the next succeeding clip comes into
engagement with the shoulder 13. The apparatus is then ready for a
new operation.
It will be understood that various modifications of the invention
may be made without departing from the scope of the invention, for
example the shape of the clips, as well as the means utilized for
causing the clamping of the clips into position on the base of the
bud.
With the aid of the apparatus described herein, each hemostasis
operation on a vessel may be performed rapidly, accurately and with
ease, even under the least favorable operating conditions. Further,
a large number of successive hemostasis operations may be performed
upon numerous vessels which are sectioned in the course of an
operation, without any preparation being necessary between
operations.
* * * * *