Occlusion ring and method and device for its application

Abstract

A ring applicator device for use in applying an elastic occluding ring to an anatomical tubular structure which comprises an inner cylinder slidably disposed within an outer cylinder, forceps means slidably disposed within said inner cylinder, means for moving said forceps means into and out of the inner cylinder and means for ejecting an elastic ring from the end of said inner cylinder by axially displacing said outer and inner cylinders relative to each other.

Description

BACKGROUND OF THE INVENTION

The present invention relates to an occlusion ring and the method and device for applying said ring to an anatomical tubular structure. More particularly, the present invention is directed to a ring applicator device, combinations of said device with other instruments and a technique and method for carrying out tubal ligation of the human female in order to effect permanent or temporary sterilization. The device of the present invention can also be effectively used to sterilize the human male.

In many areas of the world, the question of population control has become a central issue. Since birth control devices are not always used faithfully or fail to work in some instances, various procedures have been proposed for effecting the sterilization of women as well as men. However, many of these techniques are unpopular because of the resulting complications, the high expense and because of the general unacceptability among the populace of effecting a sterilization which is permanent and cannot be reversed. Nevertheless, sterilization is obviously an effective means for solving various problems of population explosion and of voluntarily limiting the size of the family where desired on the part of the parent. Accordingly, research into finding various techniques and instruments has continued both under private and government support.

Tubal ligation has commonly been used to effect sterilization in women. The common practice is to cut and tie the Fallopian tubes in order to prevent fertilization of the egg. More recently, the use of clips for closing the tubes has been suggested. Another recent procedure involves cauterization of the tubes by electrical means. However, each of these procedures involves much discomfort to the patient and highly skilled personnel to successfully complete the operation. Also, in the procedure requiring the use of clips, in some instances the clips have fallen off thereby rendering the sterilization ineffective. With respect to cauterization by means of electricity, there remains the ever present dangers of inadvertently burning certain organs of the body and, for example, accidentally rupturing the bowel.

In copending application Ser. No. 383,475, filed July 30, 1973, the applicant discloses a simplified instrument and technique for applying an elastic ring to an anatomical tubular structure, e.g., the Fallopian tube, thereby effecting permanent or temporary sterilization of the human female. In said copending application, the ligature is performed in conjunction with a laparoscope which is an instrument well known in the mechanical field for viewing the internal portions of the body. The ligation device of said copending application is a ring applicator which is used to quickly and effectively slip a small elastic or rubbery ring or band around the Fallopian tubes of the female in order to permanently or temporarily block said tubes. As thoroughly disclosed in said copending application, the sterilizing device or instrument includes a grasping means which is used to pull a portion of the Fallopian tube of the female into the device and slidable or rotatable tubular means for slipping or pushing the elastic or stretchable ring over the bent portion of the Fallopian tube held in the device, thereby effecting the ligature. In operation, the entire device is inserted through the abdominal wall or through the vaginal cavity, the grasping means is pushed forward to engage a segment of the Fallopian tube, the grasping means is then retracted into the inner tube of the applicator device, and finally, the device is manipulated so as to release the elastic ring from the end of the applicator, thereby placing it around the segment of the Fallopian tube contained in the inner tube of the applicator device. The Fallopian tube which is now held in a crimped or bent position by the elastic ring can then be released from the applicator device.

In one of the embodiments of the device set forth in the applicant's copending application, a laparoscope was physically combined with the applicator device to, in effect, produce a single instrument requiring only a single incision to be made in the patient. This is to be compared with one of the prior art techniques wherein the sterilizing device and the laparoscope were used as two separate instruments requiring two separate incisions to be made in the patient. In the applicant's copending application wherein the laparoscope is physically combined with the applicator device, the location of the laparoscope relative to the grasping means made it difficult, in some instances, to see the elastic ring and the Fallopian tube at all times, particularly before the application of the elastic ring onto the Fallopian tube and also it was difficult to verify whether or not the elastic ring had been effectively applied. Thus, in said copending application, once the Fallopian tube had been grasped by the grasping means (forceps means) and pulled into the inner tube for the application of the elastic ring, the physician conducting the operation lost his view of the subsequent steps of the operation, that is, the application of the elastic ring to the Fallopian tube and the determination of whether or not the elastic ring had been correctly applied.

Furthermore, because of the arrangement of the sliding ring handle means, that is, the variable distance the grasping means could be extended and retracted, by operating the sliding ring handle a considerable amount of expertise was required for the physician utilizing the device to determine whether or not the Fallopian tube was in a proper position inside the inner tube of the device for the successful application of the elastic ring. Thus, for example, if the Fallopian tube was somewhat larger than normal, the resistance felt by the physician by attempting to pull the Fallopian tube into the inner tube of the device for the application of the elastic ring might mislead the physician into prematurely applying the elastic band. This situation is further complicated by the location of the laparoscope with respect to the ring applicator, that is, in a position where it is not possible to completely view all stages of the sterilization procedure.

Furthermore, although the combination of the laparoscope with the ring applicator device has been found to be particularly effective for the sterilization of humans using the single incision method, because of the location of the laparoscope relative to the sliding ring handle means for operating the grasping means, there exists the possibility that the hand of the physician may become contaminated by inadvertently touching himself in the facial area.

SUMMARY OF THE INVENTION

One of the objects of the present invention is to provide a simplified instrument and method for applying an occlusion ring to an anatomical tubular structure.

Another object of the present invention is to provide a simplified instrument and method for effecting permanent or temporary sterilization of the human female.

A further object of the present invention is to provide a novel technique and instrument for accomplishing tubal ligation which may be employed by physicians with many degrees of skill and without the need for expensive or bulky equipment.

A still further object of the present invention is to provide a portable instrument for mechanically effecting tubal ligation wherein a sliding ring handle which is operatively connected to a grasping means is so disposed as to indicate to the physician the precise time when the elastic ring should be applied to the crimped Fallopian tube.

An additional further object of the present invention is to provide an applicator device which is physically combined with a laparoscope system in such a way as to enable the physician operating the device to view the entire ligation operation.

Yet another object of the present invention is to provide a laparoscope which is combined with a ring applicator device in such a manner as to substantially eliminate the contamination of the instrument or the physicians hand.

Still another object of the present invention is to provide an instrument which can also be used for the sterilization of the human male.

Other objects and further scope of applicability of the present invention will become apparent from the detailed description given hereinafter; it should be understood, however, that the detailed description and specific examples, while indicating preferred embodiments of the invention, are given by way of illustration only, since various changes and modifications within the spirit and scope of the invention will become apparent to those skilled in the art from this detailed description.

Pursuant to the present invention, the above-mentioned disadvantages may be eliminated and an improved ligature method and ring applicator device as well as a combination of said device with a laparoscopic system may be obtained by following the teachings of the ring applicator device of the present invention, keeping in mind the disclosure of the applicant's copending application Ser. No. 383,475, filed July 30, 1973, the subject matter of which is hereby incorporated by reference.

In accordance with the present invention, the sterilization of the human female or human male may be attained by the use of elastic rings for effecting the ligature of the Fallopian tubes. Advantageously, the ligature is performed in conjunction with a laparoscope which is an instrument well known in the medical field for viewing the internal portions of the body. The instrument of the present invention is a ring applicator which is used to quickly and effectively slip a small elastic or rubbery ring around the Fallopian tubes of the female in order to permanently or temporarily block the same. Basically, the instrument of the present invention, shown in detail in the attached drawings, includes a grasping means which is used to pull a portion of the Fallopian tube of the female into the device and slidable or rotatable tubular means for slipping or pushing the elastic or stretchable ring over the portion of the Fallopian tube held in the device, thereby effecting the ligature. In operation, the entire device is inserted through the abdominal wall or by means of the vaginal route, the grasping means is pushed forward to engage a segment of the Fallopian tube, the grasping means is then retracted into the inner tube of the applicator device, and finally the device is manipulated so as to release the elastic ring from the end of the applicator and place it around the segment of the Fallopian tube contained therein. Thereafter, the loop held by the elastic ring can be cut by the grasping means for permanent sterilization, if desired, or the loop can be left as is with the elastic ring holding the Fallopian tube in a crimped position thereby permanently or temporarily effecting sterilization. Temporary sterilization is contemplated by cutting the elastic band in a subsequent operative procedure.

When the applicator device is used in conjunction with a laparoscope, a very small incision may be made when using either the abdominal or vaginal approach because the light associated with the laparoscope facilitates the location of the Fallopian tubes. However, when the ring applicator device is used without the aid of a laparoscope, a slightly larger incision is required in order for the physician to locate the Fallopian tubes.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from the detailed description given hereinbelow and the accompanying drawings which are given by way of illustration only, and thus are not limitative of the present invention and wherein,

FIG. 1 shows one embodiment of the ring applicator device of the present invention in combination with a laparoscope;

FIGS. 2a, 2b and 2c show the loading device which can be inserted into the front end of the ring applicator device for loading the elastic rings onto the end of said ring applicator device;

FIG. 3 shows, in greater detail, the front end portion of the ring applicator device and the positioning of the laparoscope relative to the grasping means of the ring applicator device of the present invention;

FIG. 4 shows the pusher device which is utilized to push the ring from the loading device onto the end of the ring applicator device;

FIG. 5 shows another embodiment of the present invention wherein a portion of the laparoscope is offset with respect to the ring applicator device;

FIG. 6 shows another embodiment of the present invention wherein a trigger means is utilized for applying the elastic ring to the Fallopian tube;

FIG. 7 shows another embodiment of the present invention wherein an improved ring applicator device is used not in combination with a laparoscope;

FIG. 8 shows a top view of a lever and the guide slot used by said lever in pushing the inside cylinder of the ring applicator of FIG. 7 to the forward position;

FIG. 9 shows the bottom view of the sliding handle ring which slides back and forth in a slot to expel and retract the grasping means;

FIGS. 10a, 10b, 10c and 10d show in sequential steps, the abdominal method of performing the ligation of the Fallopian tube using the ring applicator device of the present invention in combination with the laparoscope wherein the device is inserted through the abdominal wall by a single incision made in the navel area;

FIG. 11 shows the abdominal method using the two hole technique wherein the culdoscope (light source) and the ring applicator are inserted through the abdominal wall through two separate incisions;

FIG. 12 shows the vaginal method of performing the ligation of the Fallopian tube wherein the ring applicator device and the culdoscope (light source) are used as two separate instruments; and

FIG. 13 shows the vaginal method similar to FIG. 11 wherein the laparoscope and ring applicator are combined into a single instrument.

DETAILED DESCRIPTION OF THE DRAWINGS

In the following description of the Figures, like elements are used throughout the various views to indicate like parts. One embodiment of the ring applicator of the present invention is shown in FIG. 1. The device comprises an inner cylinder 2 disposed within an outer cylinder 1 said inner cylinder being slidably engaged with said outer cylinder. Thus, the outer cylinder 1 can be axially moved relative to the inner cylinder 2. The outer cylinder is provided with a ring pusher 4 which is in sliding relationship with hollow cylinder 5. The inner cylinder 2 houses a laparoscope 6, a light source 7, for example fiber optics, disposed on both sides of the laparoscope and cylinder 5 which is adapted to house the grasping means 8. In operation, the outer cylinder 1 is pushed in the backward direction against the action of the spring 9 and locked in the position shown in FIG. 1 by the screw lock 10. The ring applicator device is now ready to be loaded with the elastic band 12. Referring now to FIGS. 2a, 2b and 2c, the elastic ring is inserted with the fingers onto the end of the loading device 13. The loading device is then inserted into the end of cylinder 5 and with the aid of the expandable pushing device 14, the ring 12 is pushed along the surface of the loading device 13 until it is loaded onto the outer surface of the cylinder 5. In this connection, it should be noted that the pushing device 14 is segmented and made of an expandable material, for example spring metal or an expandable plastic material which is capable of expanding as the ring is pushed along the ever increasing diameter of the loading device 13. Once the ring 12 has been loaded on the cylinder 5, the pusher device 14 is retracted and the loading device 13 is removed from the end of cylinder 5.

The loaded ring applicator device is now inserted into a cannula which had been previously inserted into the patient in a well known manner. By looking through the eye piece 15 of the laparoscope 6 and through the use of the light source 7 introduced into the applicator device the physician can readily see the pelvic cavity. When the Fallopian tube is discovered by the physician, the grasping forceps 8 are pushed forward utilizing the fixed ring 16 as leverage and pushing the slidable ring 18 forward until its forward movement is limited by the end of the slot 2a. The grasping forceps 8 now extend from the end of the cylinder 5. The forceps 8 are then used to grab the Fallopian tube and pull it inside of cylinder 5. This is accomplished by pulling the sliding ring 18 rearward until it strikes the rear end of the slot 20. The Fallopian tube is now in a proper crimped position within the cylinder 5. Then the locking device 10 is unscrewed thereby enabling the spring 9 to force the outer cylinder 1 in the forward direction, the nose 4 of said outer cylinder pushing the elastic band around the Fallopian tube inside of cylinder 5. Then the ring 18 is then pushed in the forward direction thereby expelling the Fallopian tube crimped by the elastic ring from the end of the ring applicator device. The above process is repeated in order to apply the same technique to the second Fallopian tube in the same manner. The ring applicator device can then be removed from the cannula and after the cannula is removed from the patient the incision can be closed in a well known manner.

FIG. 5 shows the embodiment of the present invention wherein the laparoscope is offset from the device to permit freedom of movement of the sliding ring 18 while at the same time avoiding possible contamination by contact of the hand operating the sliding ring with the face of the physician.

FIG. 6 shows another embodiment of the present invention wherein the movement of the outer cylinder 1 with respect to the inner cylinder 2 can be accomplished by trigger action utilizing trigger means 17. In this embodiment, while the trigger 17 is depressed, the outside cylinder 1 is pushed in the rearward direction and then the trigger is released locking the outside cylinder in said position. Now the front end of the ring applicator device is ready for loading. After the elastic ring has been loaded onto the front end of the ring applicator device and the Fallopian tube has been pulled into the cylinder 5, the elastic band can be applied to or shot onto the crimped Fallopian tube by pulling the trigger 17. The obvious advantages of the use of the trigger device reside in simplifying the overall operation of the ring applicator for the benefit of the physician. FIG. 6 also shows the use of a single sliding ring means 16 wherein the distance the grasping means is extended from or retracted into the ring applicator is variable depending on the physician operating the device.

FIG. 7 shows one of the features of the present invention wherein the ring applicator device is shown not in combination with a laparoscope system. The use of the ring applicator device as shown in FIG. 7 without the assistance of a laparoscope requires a slightly larger incision so that the operating physician can locate the Fallopian tubes without the aid of a light source. The ring applicator device of FIG. 7 comprises an inner cylinder tube 2 coaxially and slidably disposed within an outer cylinder 1. The outer cylinder 1 is provided with a handle means 22 to aid the physician in stabilizing the instrument during the operative procedure. The inner tube 2 is associated with a spring 9 such that when the lever 19 is pushed in the forward direction along slot 20 and locked in section 21 of slot 20, the inner cylinder 2 is pushed forward and extends beyond the front end of the outer cylinder 1 as shown in FIG. 7. Now the front end of the ring applicator device can be loaded with the elastic band 12 in the manner described above. With the ring applicator in the loaded state it is inserted into the patient through a cannula in a known manner and upon the location of the Fallopian tube the ring 18 which is attached to forceps 8 disposed inside of the cylinder 2 is pushed forward in slot 20 until said forceps extend beyond the front portion of cylinder 2. The extent to which the ring 8 is pushed in the forward direction is limited by the length of the slot 20 shown in FIG. 9. Upon grasping the Fallopian tube with the forceps 8, the ring 18 is pulled in the reversed direction drawing the Fallopian tube in a crimped position inside of cylinder 2. Because the ring 16 is fixed, when the ring 18 is pulled into contact with ring 16, which is also at the end of the slot 20, the physician knows that the Fallopian tube has, in fact, been pulled into the inner cylinder 2. This advantageous feature adds an element of control to the ring applicator device in that the physician does not have to rely upon his judgment to determine whether or not the Fallopian tube is in the proper position for the application of the elastic band thereto. Once the ring 18 is in contact with the ring 16, which indicates that the Fallopian tube is in a proper position within cylinder 2, the lever 19 which is locked in position 21 of the slot 20 is released enabling spring 9 which has been in an extended position to pull the inner cylinder 2 in the rearward direction. In so doing, the elastic band 12 disposed on the end of the inner cylinder 2 is pushed from said tube onto the Fallopian tube by the outer cylinder 1. Now the ring 18 is pushed in the forward direction, thereby releasing the Fallopian tube containing the elastic band securely attached thereto. Of course, the above procedure is repeated with respect to the second Fallopian tube.

It can be readily understood that the use of a fixed and sliding ring in conjunction with the ring applicator device as shown in FIG. 7 is the same as that utilized in FIGS. 1 and 6 of the present application.

FIGS. 10a, 10b, 10c and 10d show, in sequence, the application of an elastic ring to a Fallopian tube using the single incision abdominal approach and utilizing the device shown in FIG. 1. In said Figures, 23 is the uterus, 24 is the pelvic bone, 25 is a round ligament, 26 is a fimbrea and 27 is the Fallopian tube. In FIG. 10a, the Fallopian tube has been grasped by the grasping means 8. In FIG. 10b the Fallopian tube has been pulled inside of cylinder 5. FIG. 10c shows the elastic ring in position on the Fallopian tube and FIG. 10d shows the removal of the crimped Fallopian tube from the end of the ring applicator device. Because of the recessed position of the laparoscope, the physician can view the entire operative procedure.

FIG. 11 shows the double incision abdominal approach wherein the culdoscope and the ring applicator are inserted through separate incisions made in the abdominal wall.

FIG. 12 shows the vaginal approach utilized in the present invention wherein the ring applicator 34 which is used to grasp the Fallopian tube 27 is not physically combined with the culdoscope 33 (light source). The retractor 36 and the forceps 35 are utilized to assist the physician in performing the tubal ligation. In FIG. 12, 28 represents the spine of the patient, 29 is the rectum, 27 is the Fallopian tube, 23 is the uterus and 30 is the bladder.

FIG. 13 is similar to FIG. 12 with the exception that the ring applicator device is physically combined with the laparoscope as shown in FIG. 1.

The sterilization operation utilizing the ring applicator device as defined by the present invention renders sterilization so simple that only about 5 to 10 minutes are required to perform the operation and accordingly, an out-patient procedure may be employed where permitted. This is particularly important in developing countries where hospital facilities are not abundant and may not even be available.

A particular advantage of the present invention is that the blockage of the tubes can be made permanent or temporary, as desired. This particular feature of the invention depends upon the size and the elastic power of the rings employed. If the rings are very small and have a strong elastic power, they will so tightly grip the Fallopian tubes that the blood supply in this part of the tube will be completely blocked, thereby resulting in a sluffing off of the tubes to effect a permanent sterilization, analogous to the well known method of cutting and tieing the Fallopian tubes. However, if the elastic bands are of a larger size and have a smaller elastic power, it is possible to effect a temporary or reversible sterilization since, although the elastic band will serve to prevent the ovum passage to the uterus, the holding power thereof will not be so strong as to shut off the blood supply through the tubes. Accordingly, if the woman should desire to return to a normal situation at a later time, it would be possible for the Fallopian tubes to be restored to their natural function. Hence, the results of permanent or temporary sterilization are dependent upon the size of the rings used and the elastic power thereof.

The rings used for application to the Fallopian tubes are made of government-approved, non-tissue reactive material which have a strong enough elastic power to perform the function described herein. Various rubbery materials may, of course, be used. The preferred material is silicone rubber, for example, the material commercially available under the name "Silastic". Colagen or any other absorbable or nonabsorbable synthetic elastic material which is not harmful to human tissue may be employed, for example, latex rubber or Teflon (tetrafluoroethylene). As pointed out above, the size of the rings may be varied wherein smaller rings are used for permanent tubal ligation, and larger rings are used in connection with effecting a temporary sterilization. Spring-like metal rings, preferably made of stainless steel, can also be used, as discussed above.

The device of the present invention can be made of medically-approved materials, including many different types of metals, preferably stainless steel, plastics and the like and, hence, is relatively inexpensive because of its simple nature. It can also be made as a disposable instrument, for example, from a synthetic resin such as polyethylene, polypropylene, polycarbonate, polystyrene, polyamide, polyacetates, or acrylic resin. In this embodiment, the wall of the ring applicator can itself act as a laparoscope for transmitting the light from a light source to the internal cavity, and a tube can be disposed around the inner tube (which would have a needle-like point) to push an elastic ring over the salpinx portion of the Fallopian tube when it is slid or otherwise moved with respect to said inner tube. This embodiment of the invention would be espcially attractive where inexpensive instruments are a necessity. Moreover, the ring applicator device of the present invention has a wide range of applicability since it can be used in conjunction with the regular abdominal laparoscopic technique, as discussed above, or in connection with the known vaginal culdascopic procedure. The use of the device eliminates the need for large, bulky equipment which is normally used with the electrical procedures employed in the prior art as well as the complicated carbon dioxide supply systems used with other techniques. A very simple and relatively small carbon dioxide supply system can be used together with the instrument, or a squeeze bulb may even be used to provide the necessary gas and to maintain the required gas pressure inside the abdominal cavity while the operation is being performed. The elimination of complicated electrical and gas supply systems makes it possible to save time in setting up for the procedure. In addition, as pointed out above, the operation may be carried out quite quickly in less than ten minutes.

It is to be understood that various specific mechanical embodiments may be employed to perform the various functions described herein. Basically, the invention comprises an instrument for puncturing and entering into the body cavity, grasping the Fallopian tubes, slipping an elastic ring thereover, and optionally cutting the tubes, if desired. The associated equipment represents technical modifications and adds to this basic idea, and a particularly preferred embodiment is the use of the ring applicator of the invention together with the laparoscope or a similar viewing instrument.

In an analogous manner, the method and device of the present invention may be used to effect the sterilization of the human male. In this case the appropriate incision is made and one or more elastic rings are applied to the vas to effect the ligature thereof and block the passage of the sperm. The elastic or stretchable rings used in this connection must, of course, be small enough to ligate the small diameter of the vas.

It is readily apparent that the device of the present invention can be used to occlude any anatomical tubular structure for any purpose.

The invention being thus described, it will be obvious that the same may be varied in many ways. Such variations are not to be regarded as a departure from the spirit and scope of the invention, and all such modifications as would be obvious to one skilled in the art are intended to be included within the scope of the following claims.

Claims

What is claimed is:

1. A ring applicator device for use in applying an elastic occluding ring to an anatomical tubular structure which comprises an inner cylinder slidable disposed within an outer cylinder, forceps means slidably disposed within said inner cylinder, said forceps means being spring loaded so that they spring open when they are displaced from the end of the inner cylinder, means for moving said forceps means into and out of the inner cylinder and means for ejecting an elastic ring from the end of said inner cylinder by axially displacing said outer and inner cylinders relative to each other.

2. The device of claim 1, wherein the inner cylinder is associated with a spring means such that in the loaded state the front end portion of the inner cylinder extends beyond the front end portion of the outer cylinder.

3. The device of claim 2, wherein means are provided for locking and unlocking the inner cylinder relative to the outer cylinder.

4. The device of claim 1, wherein the forceps means are slidably disposed within the inner cylinder.

5. The device of claim 4, wherein handle means are attached to the opposite end portion of the forceps means, said handle means being adapted to slide a fixed distance in the axial direction of the ring applicator to expose the forceps means from the end of the inner cylinder and retract said forceps means into the inner cylinder.

6. The device of claim 1, wherein an optical viewing means and an illuminating means are combined with the ring applicator.

7. The device of claim 6, wherein the optical viewing means and illuminating means is a laparoscope.

8. The device of claim 1, wherein a culdoscope is combined with the ring applicator, said culdoscope and ring applicator being in justaposition with respect to each other.

9. The device of claim 1, wherein the optical viewing means and illuminating means are recessed from the end portion of the inner cylinder so that the physician has full vision of said end portion and the extension and retraction of the forceps means therefrom.

10. A ring applicator device for use in applying an elastic occluding ring to an anatomical tubular structure which comprises an outer cylinder having a cut-away front portion and slidably disposed about an inner cylinder, said inner cylinder housing optical viewing means, illuminating means and a hollow cylinder, said hollow cylinder extending a distance in front of the optical viewing means and illuminating means and housing forceps means slidably disposed therein, said cut-away portion of the outer cylinder terminating in a ring pusher which is coaxially disposed about said hollow cylinder and slidably disposed with respect thereto, means for moving said forceps means into and out of the hollow cylinder, and means for removing an elastic ring from the end of the hollow cylinder by axially displacing said outer and hollow cylinders relative to each other.

11. The device of claim 10, wherein handle means are attached to the opposite end portion of the forceps means, said handle means being adapted to slide a fixed distance in the axial direction of the ring applicator to expose the forceps means from the end of the hollow cylinder and retract said forceps means into the hollow cylinder.

12. The device of claim 11, wherein the opposite, rear end portions of the optical viewing means is off-set with respect to the ring applicator.

13. The device of claim 10, wherein the outer and inner cylinders are provided with a spring locking device.

14. The device of claim 13, wherein the spring locking device is provided with a screw lock.

15. The device of claim 13, wherein the spring locking device is provided with a trigger means.

16. The ring applicator device of claim 1, wherein in the loaded state, the front end of the inner cylinder protrudes beyond the outer cylinder.