US2898916A - Devices for the gripping and ligaturing of the ends of tubular vessels - Google Patents

Description

Aug. ll, 1959 K. KAMMER 2,898,916

DEvIcEs FOR THE GRIPPING AND LIGATURING oF l THE ENDS 0E TUBULAE vEssELs Filed Jan. 5, 1954 3 Sheets-Sheet 1 Qmc 3 Sheets-Sheet 2 2 5 a0 M H 5 3 2 .www 1 n 2 AJ f 1|. W .0u H W 4 A v O Y .r J 2W 7\ a .i 3 w M 5 4 M M .n H 3 l Allg' 11, 1959 K. KAMMER DEVICES FOR THE GRIPPING AND LIGATURING OF THE ENDS OF TUBULAR VESSELS Filed Jan. 5. 3954 K. KAMMER DEVICES FOR THE GRIPPING AND LIGATURING OF' Aug. ll,` 1959 THE ENDS OF TUBULAR VESSELS 5 Sheets-Sheet 5 Filed Jan. 5, 1954 arent n Q 2,898,915 Patented Aug. l1, 1959 DEVICES FOR THE GRIPPIN G AND LIGATURING F THE ENDS 0F TUBULAR VESSELS The present application is a continuation-in-part application of my copending application Serial No. 347,336 and now abandoned and concerns a device for gripping and ligaturing the ends of tubular vessels such as are used in blood staunching in surgical operations.

With the device as claimed in said patent application, it is important that the knotting of the thread should be effected rapidly, independently of the force of the power of the manual operation of the device, and as smoothly as possible in order to ensure absolutely reliable operation. An object of the present invention is to improve this device both from a purely structural and also a functional point of view. This is effected firstly by tting with its own drive which is only released by hand so that it correctly executes successive operations. The surgeon operating the device has only to see that the ligaturing point is correctly gripped.

The separate drive of the appliance may be electrically, magnetically, pneumatically or hydraulically operated. The construction can be effected very simply especially when a spring motor is used. It is yalso an important factor that the head of the device is constructed with a very smooth surface without projecting parts so that catching in the area of the wound is impossible. It is of special importance that the blades which automatically sever the ligaturing thread upon the completion of the knot, should be completely retractable into the head of the device.

Another object of the invention is a construction, in which the ligaturing thread disposed on the device with its prepared loops, does not come into contact with the surface of the wound. This is achieved by a cover plate which is used as a carrier for the ligaturing thread. A final object of the invention is an auxiliary thread magiazine which keeps ligaturing threads ready in prepared loops so that the individual thread with its carrier and assembly plate is quickly available.

The invention will be described further, by way of example, with reference to the accompanying drawings, in which:

Fig. 1 is a side view, partly in section, of a device in accordance with the invention;

Fig. 2 is a front elevation of the face of the head of this device;

Fig. 3 is a longitudinal section through the device on the line lll-III in Fig. 2;

Fig. 3a is a cross section on the line Illa-Illa of Fig. 3;

Fig. 4 is a longitudinal sectional View on the line lV-IV of Fig. 6, with la View of the thread tensioning slide;

Fig. 5 is another sectional view on the line V-V of Fig. 6 with a View of the cutting device;

Fig. 6 is a side elevation of the device with the housing cut away;

Fig. 7 is a plan View of the thread magazine used on the device as shown in Figs. l to 6 as an auxiliary device, opened without a cover;

Fig. 8 is this magazine in a longitudinal section on line VIII--VIII of Fig. 7; and

Fig. 9 is a front view of the thread carrier plate.

In the device shown in Figs. l to 6, the outer casing 1 is a straight handle lying comfortably in ones hand. This casing 1 which also has a series of part-circumfer entially extending ilute 2, contains all the essential parts of the device protectively enclosed with the exception of the operating lever 3 which is hinged to the rear end of the device by a pivot pin 4. A leaf spring 5, which normally keeps the lever 3 in the position shown in Fig. l, acts on this operating lever 3. O11 the front end, the operating lever 3 also has an impact catch lever 7 hinged on the pin 6 and which has an inward angular bend 8 at the front end. This lever 7 is under the action of a small spring 9 which keeps the lever 7 in its normal position at an obtuse angle to the operating lever 3. Only upon pressing the lever 3 against the casing 1, the catch lever 7 moves to a straightened position shown in Fig. 3 when its pointed end 10 encounters resistance.

A small slide 11 with a head pin 12 retained in a slot 13 is disposed on the operating lever 3. A stirrup 15 drawn back by a spring 14 is disposed on this slide 11. By pressing the slide 11 forwards by the thumb of the hand holding the device, the stirrup 15 slides on to an inclined member 16 which is mounted on the leaf spring 5, and presses the leaf spring 5 somewhat further away from the lever 3, so that a member 17 secured to the lower side of the spring 5 presses a pin 18 inwards which normally projects somewhat out of the sleeve 1 under the action of a spring 19. The shoulder 17 engages in a slot 20 in the sleeve 1. In this way the appliance is disengaged. It can then operate automatically as described below.

First, the blood vessel which is intended to be ligatured to stop bleeding, is to be gripped with a clamping eifect. For this purpose a gripping member disposed on the head of the device is used. The gripping member is formed by a stationary arm 21 and by an arm 23 moving against this arm around a hinge axis 22, the arm 23 automatically opening by means of an intermedi-ate spring not shown and closing against this spring as soon as the blood vessel to be ligatured is gripped thereby. This is eifected by pressing the operating lever 3 against the sleeve 1. The tip 10 of the lever 7 passes through a slot 24 in the sleeve 1 into the interior of the device and presses with a closing elect lagainst the movable clamping arm 23 which is provided with a notch 25 assuring a good hold for the tip 10 of the catch (see Fig. 3).

The blood vessel which has been closed in this manner must then be immediately ligatured. For this purpose, the ligaturing device disposed on the head of the appliance is used. This co-operates with four parts guided on a core member 26 rigidly secured to casing on the sleeve 1 and at the same time serves as a handle for the gripping members 21, 23. A sleeve-like ligature head 28 is slidably mounted on the core 26. This slide is engaged at the rear by a strong helical compression spring 29 which is also mounted on the core member 26. This spring 29 is accordingly compressed and tends to press the slide 28 to the front. This is prevented however iirst by the above-mentioned pin 18 which does not release the slide 28 until the small slide 11 on the `operating lever is moved to the front in accordance with the gripping of the vessel, whereby the pin 18 is pressed out of the slot 20 and the slide 28 can thus move forward under the pressure of the spring 29. The ligature head 28 has a face 30 on which the surgical ligaturing thread 31 ready looped for a double knot and consisting of catgut, for example, has been placed. The sliding head 28 must, therefore, iirst move so far to the front that the face 30 stops exactly where the gripping means 21, 23A

ends at the front and provides the desired ligaturing point for the held vessel. The ligaturing device is correctly retained at this point since the ligature head 28 with its face 30 runs against the curve 8 of the impact catch lever 7 and is thereby stopped in its forward movement.

Fig. 3 shows in dotted lines the position. of the surface 30 of the ligature head shortly before the latter has arrived at the free ends of members 21, 22. When this is the case, the first ligaturing loop of the thread 31 must immediately be pulled tight. This is effected by means of a ligature holding member 33 which is also displaceably disposed on the core 26. The ligaturing thread 31 with its first ligaturing thread portion 34 is wound round the sleeve-shaped member 33 surrounding the members 21, 23 and having oval cross section. When ligature holding member 33 is retracted behind the face 30, the thread loop 34 tensioned round it, disposed on the face 30 slides off and can be tightened rapidly for achieving ligaturing with the first knot if the ends of the thread are subjected to a corresponding pull as will be described below.

The return of the sleeve 33 is effected as follows. When the slide 28 moves forward, the sleeve 33 is arrested shortly before reaching the ligaturing point. This is effected by a control screw 35 disposed in the sleeve 1 engaging a slot 36 in the sleeve 33 when run against the rear edge 37 of this slot and thereby stops the sleeve 33 which is thus located behind the face 30 in the desired position relative to the slide 28.

When the first ligatur'ing of the blood vessel is terminated, a further safety knot must be effected above it. This knot is also already prepared in a ready wound loop 38 on the face 30 wound round the pins 39 and 40, which also at first project from the face 30 and then are withdrawn at a suitable moment behind the face 30 so that this second knot loop also slides over them and can be pulled tight to form a second knot by a pull on the ends of the thread. The pins 39 and 40, which project through holes in the face 30, form the front end of a third slide member 41 which rests on the ligature head slide 28 and at first is jointly moved with this slide until the first ligaturing knot is completed. When this has happened the operating lever 3 is released. By coming out of the slot 24 it releases the slide 28 again so that the latter can move further to the front under the force of the spring 29. However, the slide member 41 is also retained now relative to this forward motion by the control screw 35 because the latter engages in a slot 42 of the slide member 41, then engages the rear edge 43 of the slot and retains the slide member 41 with its pins 39 and 40 holding the second knotted loop. The consequence of this is that the said pins are stationary whilst the face 30 advances with a second threaded loop 38 as far as these pins 39 and 40 and slips this loop over the pins so that the second knot also can be effected by a pull and be disposed over the first knot. j It may be an advantage if the slide 28 is moved to the frontpnot only by the push spring 29, but also by an additional control. For this purpose the slide 28 can be moved as desired further to the front by renewed pressing on the operating lever 3. The point of the catch lever can then engage in a notch 44 on Vthe slide 28 which has already moved further to the front to the position shown in dotted lines in Fig. 3. The impact catch lever 7 reaches its stretched position as soon as it meets resistance in the notch 44. By this means, its effective length is extended and the slide 28 advances in this case just so far that the second thread knot falls off as the face 30, as already mentioned, advances as far as the pins 39 and 40 s'o that the second thread loop can slide over them.

When the double knotted ligature for the gripped blood vessel has been effected in the manner described, it is necessary to cut off the ends of the thread which have become superfluous. This is also automatically carried out by the present device. For this purpose it has, cutter blades 45 which are disposed on both sides of the slide 2,8. These blades are mounted o n a pin 46 on the slide 28 pivotable relative to the longitudinal axis of the device in parallel planes. A chamfered edge 47 of the cutter blades slidably engages a complementarily chamfered cam 48 which is mounted on the slide member 41. This slide member 41, on the front of which the pins 39 and 40 are disposed, is stopped in a certain position by the control screw 35. The slide 28 on the other hand can be moved somewhat further to the front until it engages with its cap 49 the rear of the slide member 41 which is blocked by the screw 35. Movement of the slide 28 to the front can also be effected by the push spring 29 alone, if it is sufficiently strong. On the other hand, forward motion ofthe slide can be effected by actuating the operating lever 3 again. It then engages with the point 10 of its impact catch lever 7 in a second notch 50 on the slide 28 and presses the latter further to the front. The chamfer 47 runs against the cam 48 and thereby allows the blades 45 to carry out the necessary lateral pivotal motion so that the ends of the thread disposed in front of blade 51 are pressed againstl a stationary counter blade (not shown) and are severed with a scissors motion behind the second thread knot. If then the blades 45 return againmwhen the slide 28 is pushed back against the spring 29, the cam 48 is again located in "the cutter gap 52. The blades 45 can then return to the position shown in Fig. 5 under the pressure of spring means 53 and are ready for the next cutting operation. It is essential that the` blades 45 should not project from the face 30 of the device, but should be disposed behind the face and thereby be safely prevented to come into contact with the surface of the wound.

Reference has already been made to the automatic tightening of the ligature of thread 31 and the knotting thereof by a powerful pull is exerted on the end of the thread, as it slides with its prepared loops 34 and 38 first over the sleeve 33 and in the second stage over the pins 39 and 4t). For this purpose the two ends of the ligaturing thread, after the latter has been applied to the device with a single movement in the manner to be described below, are made fast to the two side buttons 54 and 55, by winding around, for example. These buttons 54 and 55 are disposed 'on a forward slide member which will be referred to as a thread tensioning means 56. This thread tensioning means movably supported at the rear by a bush 57 on the core 26. A powerful pressure spring 58 which is supported at the front on the slide 28 acts on bearing bush 57. This spring 58 is compressed when the device has the slide 28 in the position as shown in Figs. l to 6.

If the device is released so that the slide 28 can move forwards, the ends of the thread tied to the buttons 54 and 55 carry with them the thread tensioner 56 to the front, at first with its bush 57, whilst maintaining the pressure tension of the spring 58. But as soon as the first ligature loop 34 of the thread 31 slides off 4the knot sleeve 33 which is returned behind the face 30, the ends v of the thread are lengthened and allow the thread tensioning bush 57 to slide back on the core 26 under the pres# sure of the springs 58. A strong automatic ligature of the vessel gripped by the gripping members is thereby produced with a rapid operation. Immediately afterwards, as explained above, the pins 39 and 40 are drawn in and the ends of the thread secured to the buttons 54 and 55 are further extended. The bush 57 of the thread tensioner 56 can move back further under the effect of the springs 58 and thus secures the second thread knot above the first. When this is effected the cutting of the superiiuous ends of the thread is finally performed in the manner described above.

As will be apparent from the above description and particularly from Fig. 3, the pressure springs 29 and 58 mounted in series has an accumulating effect. These springs could be replaced by a common spring if required or, with a suitable choice of construction, by a different elrive of electric, pneumatic, hydraulic type or the like. It is also possible, however, to divide the springs 29 or 58 into `a stronger and a weakerspring which are then disposed in series so that the stronger spring first completely compresses the weaker spring and the latter only becomes effective during a clearly dilerent working stage when the more powerful spring is completely released. By this means it is possible to avoid a single specially powerful spring which would be ditlicult to operate at first in order to obtain a satisfactory operation at the end.

It should also be mentioned that the nose projection 59 on the shoulder 17 which is used for pushing in the releasing pin 18, slides along the chamfer 60 when the slide sleeve 28 springs forward under the powerful pressure of the helical spring 29. This has a braking effect as desired which can be somewhat further influenced by pressing down the operating lever 3. As soon as this operating lever 3 is again free of pressure, which happens as soon as the first ligature is completed in the above described manner, the gripping members 21, 23 immediately release again the gripped vessel and open automatically. This action automatically prevents the possibility of the vessel being drawn into the head of the device while being held in the clip.

The manner in which the ligaturing 'rh-read is applied to the device described will now be further explained. For this purpose a carrier plate 61, as shown in Fig. 9 as a separate part, is used. In Fig. l this plate 61 is disposed on the head of the appliance. This plate 61 has a depression 62 in which the thread loops 34 and 38 can be safely accommodated. In addition the plate 61 hasV three perforations. The center-perforation 63 is the largest and oval in shape for fitting over sleeve 33 so that the plate 61 with hole 63 can be placed over this sleeve which has to hold the first thread loop 34, while the two other perforations 64 and 65 lit over the pins 39 and 40 which hold the second thread loop 38. The thread carrier plate 61 is mounted with the thread 31 held by a boss bounding in its depression 62 in such a manner on the face 30 of the appliance that the ligaturing thread 31 is safely disposed behind these faces 30 and 61. The carrier plate 61 is safely retained on the head of the device between the resilient holding means 67 and 68; The ends of the thread project from under the side of the plate 61. As already described above they are secured to the side buttons 54 and 55 so that the ends of the thread suitably arrive in front of the cutting blade 51. Lateral depressions 69 are provided on the parts over which the ends of the thread slide.

It should be further observed that, when using the described device, parts 23, 33 and 41 which are moved to the front telescopically, can be pressed inwards together by the lingers of the free hand to be ready for the next use of the instrument. The pin 18 catches lwith a locking effect in the slot 20 on the sleeve. The next ligature thread can now be applied to the head of the device in a manner described and the device is immediately ready for use again for the next ligature after the ends of the thread have been secured to the buttons 54 and 55.

l ,The disposal of the new ligaturing thread can be effected by hand by means of the thread carrier plate 6l. This operation may, however, be executed completely mechanically by means of the auxiliary device shown in Figs. 7 and 8. This device is a magazine in which a fairly large number of ligaturing threads 31 are kept readily available in stacked carrier plates 61. Carrier plates 61 are disposed in the upper parts 76 of the magazine on three posts 71, 72 and 73 which correspond to the parts 33, 39 and 40 of the device and also fit into the appropriate holes 63, 64 and 65 on the carrier plates 61. The ligaturing device as described can be accordingly so inserted head first directly into this thread maga- Zine that the closed gripping means 21, 23 pass in the pillar 71 which is constructed with its front part hollow for this purpose. The top thread; carrier plate 61 is automatically attached to the vhead of the device by-re-v silient members 67 and 68- and can be immediately taken from the magazine, correctly disposed on the device, as the carrier plates 61 keep the ligaturing thread 31 prepared ready wound in the two loops 34 and 38, as clearly shown in Fig. 7.y The ends of the thread return under the plate on the opposite side and are retained by the plate disposed below so that it is impossible for the thread loops to become loose and, onv the other hand, the ends of the thread may be easily obtained when the ligaturing thread is disposed on the device.

The thread magazine can be completely emptied and the remainingl threads keep arriving at the top with their carrier plates on the posts 71, 72 and 73 holding them. An intermediate base or false bottom 74 of the magazine is so mounted on springs 75 held by four pins 76 to 79 that these pins can pass upwards through the base 74. When the ligaturing device is therefore mounted as described, pressure can be exerted from above on the posts 71, 72 and 73, and the intermediate base is lowered against the pressure of the springs 75, while the pins 76 to 79 move upwards and press the carrier plates 61 stacked in the magazine against the ligaturing device so that `the top plate is attached to on the head of the device without ligaturing thread having to be touched at all by the iinygers. It has not been hitherto possible to achieve this result in any device of the described type. As the threads are drawn tightly wound around the posts 71, 72, 73 on their carrier plates, they do not slip down with their carrier plate 61 on these columns, even when the magazine is gradually emptied.

The posts 71, 72 and 73 holding the carrier plates can be constructed with an interchangeable base plate 80, and can then be sterilised, filled withnew ligaturing threads, hermetically sealed, delivered and used.

What I claim is:

l. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing having a front end; a blood Vessel gripping member having a lgripping portion and mounted on said casing, said gripping member having a relative projecting position wherein said gripping member projects with its gripping portion beyond said front end of said casing, at least one ligature holding member having a holding portion, mounted on said casing and movable between a projecting position lwherein said holding member projects with its holding portion beyond said front end of said casing and is adapted to support the outer loop of a prospective knot of a ligature to be tied abouta blood vessel, the inner loop of which knot is located about said gripping portion of said gripping member while said gripping member and said casing are in said ,relative projecting position thereof, and a retracted position wherein said holdin-g member is located substantially within said casing, releasing said outer loop; tensioning means on said casing for tensioning a ligature while the outer loop of the prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping portion of said gripping member, and while the ligature when tied is located about a blood vessel; and manually operable actuating means for engaging and shifting an inner ligature loop located about said gripping portion of said gripping member to slide off said gripping member about a blood vessel held thereby and then moving said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under actionof said tensioning means.

2. A surgical :instrument for tieing ligatures comprising, in combination, an elongated casing having a front end; a blood vessel gripping member having a gripping portion and mounted on said casting, said gripping member and said Vcasing having a relative projecting position wherein ysaid gripping member projects its gripping portion beyond said front end of said casing; at least one ligature holding member having a holding portion, mounted on said casing and movable between a projecting position wherein said holding member projects with its holding portion beyond said front end of said casing and is adapted to support the outer loop of a prospective knot of a ligature to be tied yabout a blood vessel, the inner loop of which knot is located about said gripping portion of said gripping member while said gripping member alud said casing are in said relative projecting position thereof, and a retracted position wherein said holding member is located substantially within said casing, releasing said outer loop; tensioning means on said casing for tensioning a ligature while the outer loop of the prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping portion of said gripping member, and while the ligature when tied is located about a blood vessel; manually operable actuating means for engaging and shifting an inner ligature loop located aboutsaid gripping portion of said gripping member to slide off said gripping member about a blood vessel held thereby and then moving said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means; and cutting means for cutting off the ends of a ligature tensioned by said tensioning means after the ligature has been tied about the blood vessel.

3. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing having a front end; a blood vessel gripping member having a gripping portion and mounted on said casing, said gripping member and said casing having a relative projecting position wherein said gripping member projects with its gripping portion beyond said front end of said casing; at least one ligature holding member having a holding portion, mounted on said casing and movable between a projecting position wherein said holding member projects with its holding portion beyond said front end of said casing and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping portion of said gripping member while said gripping member and said casing are in said relative projecting position thereof, and a retracted position wherein said holding member is located substantially within said casing, releasing said outer loop; tensioning means on said casing for tensioning a ligature while the outer loop of the prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping portion of said gripping member, and while the ligature when tied is located about a blood vessel; at least one cutting member having a cutting edge, mounted on said casing and movable between a cutting position wherein said cutting edge engages the free end portions of a ligature tensioned by said tensioning means and a retracted position spaced therefrom; and manually operable actuating means for engaging and shifting an inner ligature loop located about said gripping portion of said gripping member to slide oif said gripping member about a blood vessel held thereby, then moving said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means, and then moving said cutting member from its retracted position into its cutting position, resulting in cutting oif the end portions of the ligature tied about the blood vessel.

4. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing having a front end; a blood vessel gripping member having a gripping portion and mounted on said casing, said gripping member and said casing having a relative projecting posi-- tion wherein said gripping member projects with its gripping portion beyond said front end of said casing, said gripping member including two cooperating gripping elements pivotally movable relative to each other and adapted to grip a blood vessel therebetween; at least one ligature holding member having a holding portion, mounted on said casing and movable between a. projecting position wherein said holding member projects with its holding portion beyond said front end of said casing and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping portion of said gripping member while said gripping member and said casing are in said relative projecting position thereof, and a retracted position wherein said holding member is located substantially within said casing, releasing said outer loop, tensioning means on said casing for tensioning a ligature while the outer loop of the prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping portion of said gripping member, and while the ligature when tied is located about a blood vessel; and manually operable actuating means for pivoting said gripping elements relative to each other and for engaging and shifting an inner ligature loop located about said gripping portion of said gripping member to slide of said gripping member about a blood vessel held thereby and then moving said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means.

5. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing having a front end face; a blood vessel gripping member having a gripping portion and mounted on said casing, said gripping member and said casing having a relative projecting position wherein said gripping member projects with its gripping portion beyond said front end face of said casing; two ligature holding members each having a holding portion, mounted on said casing and movable between a projecting position wherein said holding members project with their holding portions beyond said front end face of said casing and are adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping portion of said gripping member while said gripping member and said casing are in said relative projecting position thereof, and a retracted position wherein said holding members are located substantially within said casing, releasing said outer loop; tensioning means on said casing for tensioning a ligature while the outer loop of the prospective knot thereof is held by said holding members, while the inner loop thereof is located about said gripping portion of said gripping member, and while the ligature when tied is located about a blood vessel; and manually operable actuating means for engaging and shifting an inner ligature loop located about said gripping portion of said gripping member to slide off said gripping member about a blood vessel held thereby and then moving said holding members from their projecting position into their retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means.

6. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing having a front end face; a blood vessel gripping member having a gripping portion and mounted on said casing, said gripping member and said casing having a relative projecting position wherein said gripping member Projects with its gripping portion beyond said front end face of said casing; two ligature holding members each having a holding portion, mounted on said casing and movable between a projecting position wherein said holding members project with their holding portions beyond said front end face of said casing and are adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping portion of said gripping member while said gripping member and said casing are in said relative projecting position thereof, and a retracted position wherein said holding members are located substantially within said casing, releasing said outer loop; tensioning means on said casing for tensioning a ligature while the outer loop of the prospective knot thereof is held by said holding members, while the inner loop thereof is located about said gripping portion of said gripping member, and while the ligature when tied is located about a blood vessel; two cutting members each having a cutting edge, mounted on said casing and movable between a cutting position wherein said cutting edges engage the free end portions of a ligature tensioned by said tensioning means and a retracted position spaced therefrom; and manually operable actuating means for engaging and shifting an inner ligature loop located about said gripping portion of said gripping member to slide off said gripping member about a blood vessel held thereby, then moving said holding members from their projecting position into their retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means, and then moving said cutting members from their retracted position into their cutting position, resulting in cutting olf the end portions of the ligature tied about the blood vessel.

7. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing having a front end; a blood vessel gripping member having a gripping portion and mounted on said casing, said gripping member and said casing having a relative projecting position wherein said gripping member projects Wi-th its gripping portion beyond said front end of said casing; at least one ligature holding member having a holding portion, mounted on said casing and movable between a projecting position wherein said holding member projects with its holding portion beyond said front end of said casing and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping portion of said gripping member while said gripping member and said casing are in said relative projecting position thereof, and a retracted position wherein said holding member is located substantially within said casing, releasing said outer loop; tensioning means on said casing for tensioning a ligature while the outer loop of the prospective knot thereof is held yby said holding member, while the inner loop thereof is located about said gripping portion of said gripping member, and while the ligature when tied is located about a blood vessel, said tensioning means including spring means arranged within said casing; and manually operable actuating means for engaging and shifting an inner ligature loop located about Asaid gripping portion of said gripping member to slide oi said gripping member about a blood vessel held thereby ,and -then moving said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops ,about the blood vessel held by said gripping member under action of said tensioninaY means 8. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing; an elongated blood vessel gripping member mounted on said casing and extending outwardly therefrom through one end thereof, said gripping member having a gripping portion spaced from said one end of said casing; a ligaturing head having a free end face and mounted on said cati-i ing for sliding movement relative thereto between 'a forward position wherein said free end face of said head is in front of said gripping portion of said gripping member and a retracted position wherein said free end face of said head is behind said gripping portion .of said gripping member; at least one ligature holding member having a holding portion, mounted on said casing and slidable relative thereto and to said head between a projecting position wherein said holding portion projects in front of said free end face of said head and is adapted to support the outer loop of Va prospective knot of a ligature to be tied about a blood vessel, the inner loop of Which knot is located about said gripping member While said head is in its retracted position, and a retracted position wherein said holding portion is located behind sad free end face of said head, releasing said outer loop; tensioning means for tensioning a ligature while the outer loop of a prospective knot thereof is held by said holding member, while the inner `loop thereof is located about said gripping member, and while the ligature when tied is located about a blood vessel; and moving means for first sliding said head from its retracted position to its forward position permitting the inner ligature loop located about said gripping portion of said gripping member to slide oif said gripping member about a blood vessel held thereby and then sliding said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means.

9. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing; an elongated blood vessel gripping member mounted on said casing and extending outwardly therefrom through one end thereof, said gripping member having a gripping portion spaced from said one end of said casing; a ligaturing head having a free end face and mounted on said casing for sliding movement relative thereto between a forward position wherein said free end face of said head is in front of said gripping portion of said gripping member and a retracted position wherein said free end face of said head is behind said gripping portion of said gripping member; at least one ligature holding member having a holding portion, mounted on said casing and slidable relative thereto and to said head between a projecting position wherein said holding portion projects in front of said free end face of said head and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping member While said head is in its retracted position, and a retracted position wherein said holding portion is located behind said free end face of said head, releasing said outer loop; tensioning means for tensioning a ligature while the outer loop of a prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping member, and while the ligature when tied is located about a blood vessel; moving means for iirst sliding said head from its retracted position to its forward position permitting the inner ligature loop located about `said gripping portion of said gripping member to slide off said gripping member about a blood vessel held thereby and then sliding said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means; and cutting means for cutting olf the ends of a ligature tensioned by said tensioning means after the ligature is tied about the blood vessel.

t 10. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing; an elongated blood vessel gripping member mounted on'said casing and extending outwardly therefrom through one end thereof, said gripping member having a gripping portion spaced from said one end of Said casing; a ligaturing head having a free end face and mounted on said casing for sliding movement relative thereto between a forward position wherein said free end face of said head is in front of said gripping portion of said gripping member and a retracted position wherein said free end face of said head is behind said gripping portion of said gripping member; at least one ligature holding member having a holding portion, mounted on said casing and slidable relative thereto and to said head between a projecting position wherein said holding portion projects in front of said free end face of said head and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping member while said head is in its retracted position, and a retracted position wherein said holding portion is located behind said free end face of said head, releasing said outer loop; tensioning means for tensioning a ligature while the outer loop of a prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping member, and while the ligature when tied is located about a blood vessel; cutting means mounted on said head for movement therewith relative to 4said casing, said cutting means being movable relative to said head between a cutting position wherein said cutting means engages the free end portions of a ligature tensioned by said tensioning means and a retracted position spaced therefrom; and moving means for first sliding said head from its retracted position to its forward position permitting the inner ligature loop located about said gripping portion of said gripping member to slide off said gripping member about a blood vessel held thereby, then sliding said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means, and then moving said cutting means from its retracted position into its cutting position, resulting in cutting off the end portions of the ligature tied about the blood vessel.

1l. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing; an elongated blood vessel gripping member mounted on said casing and extending outwardly therefrom through one end thereof, said gripping member having a gripping portion spaced from said one end of said casing; a ligaturing head having a free end face and mounted on said casing for sliding movement relative thereto between a forward position wherein said free end face of said head is in front of said gripping portion of said gripping member and a retracted position wherein said free end face of said head is behind said gripping portion of said gripping member; at least one ligature holding member having a holding portion, mounted on said casing and slidable relative thereto and to said head between a projecting position wherein said holding portion projects in front of said free end face of said head and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping member while said head is in its retracted position, and a retracted position wherein said holding portion is located behind said free end face of said head, releasing said outer loop; a sleeve member encompassing said gripping member, mounted on said casing and slidable relative thereto and to said head between a projecting position wherein said sleeve member projects in front of said free end face of said head and is adapted to support the inner loop of a prospective knot of a ligature to be tied about a blood vessel and located about said gripping member, a'nd a retracted position wherein said sleeve member is located behind said free end face of said head, releasing said inner loop; tensioning means for tensioning a ligature while the outer loop of a prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping member and supported by said sleeve member, and while the ligature when tied is located about a blood vessel; and moving means for first sliding said head'from its retracted position `to its forward position, then sliding said sleeve member from its projecting posi-1 tion into its retracted position permitting the inner ligature loop located about said gripping portion of said gripping member and supported by said sleeve member to slide olf said sleeve member about a blood vessel held by said gripping member, and then sliding said holding member from its projecting position into its retracted positien, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means.

12. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing; an elongated blood Vessel gripping member mounted on said casing and extending outwardly therefrom through one end thereof, said gripping member including two cooperating gripping elements each having a gripping portion spaced from said one end of said casing, said gripping elements being movable relative to each other and adapted to grip a blood vessel between said gripping portions thereof; a ligature head having a free end face and mounted on said casing for sliding movement relative thereto between a forward position wherein said free end face of said head is in front of said gripping portions of said gripping elements and a retracted position wherein said free end face of said head is behind said gripping portions of said gripping elements; at least one ligature holding member having a holding portion, mounted in said casing and slidable relative thereto and to said head between a projecting position wherein said holding portion projects in front of said free end face of said head and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping elements while said head is in its retracted position, and a retracted position wherein said holding portion is located behind said free end face of said head, releasing said outer loop; tensioning means for tensioning a ligature while the outer loop of a prospective knot thereof is held by said holding member and while the inner loop thereof is located about said gripping elements; and moving means for first sliding said head from its retracted position to its forward position permitting the inner ligature loop located about said gripping elements to slide off said gripping elements about a blood vessel held thereby and then sliding said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means.

13. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing; an elongated blood vessel gripping member mounted on said casing and extending outwardly therefrom through one end thereof, said gripping member having a gripping portion spaced from said one end of said casing; a ligaturing head having a free end face and mounted on said casing for sliding movement relative thereto between a forward position wherein said free end face of said head is in front of said gripping portion of said gripping member and a retracted position wherein said free end face of said head is behind said gripping portion of said gripping member; at least one ligature holding member having a holding portion, mounted on said casing and slidable relative thereto and to said head between a projecting position wherein said holding portion projects in front of said free end face of said head and is adapted to support the asfissia outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping member while said head is in its retracted position, and a retracted position wherein said holding portion is located behind said free end face of said head, releasing said outer loop; tensioning means for tensioning a ligature while the outer loop of a prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping member, and while the ligature when tied is located about a blood vessel; and moving means for first sliding said head from its retracted position to its forward position permitting the inner ligature loop located about said ygripping portion of said gripping member to slide ofIr said gripping member about a blood vessel held thereby and then sliding said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means, said moving means including biasing means for urging said head to its forward position, releasable detent means for maintaining said head in its retracted position when the same' has been moved thereto against the action of said biasing means, and manually operable means for releasing 4said detent means thereby permitting said biasing means to move said head to its forward position.

14. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing; an elangated blood vessel gripping member mounted on said casing and extending outwardly therefrom through one end thereof, said gripping member having a gripping portion spaced from said one end of said casing; a ligature head having a free end face and mounted on said casing for sliding movement relative thereto between a forward position wherein said free end face of said head is a predetermined distance in front of said -gripping portion of said gripping member and a retracted position wherein said free end face of said head is behind said gripping portion of said gripping member; at least one ligature holding member having a holding portion, mounted on said casing and slidable relative thereto and to said head between a projecting position wherein said holding portion projects in front of said free end face of said head and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping member while said head is in its retracted position, and a retracted position wherein said holding portion is located behind said free end face of said head, releasing said outer loop; tensioning means for tensioning a ligature while the outer loop of a prospective knot lthereof is held by said holding member, while the inner loop thereof is located about said gripping member, and while the ligature when tied is located about a blood vessel; and moving means for first sliding said head from its retracted position to its forward position permitting the inner ligature loop located about said gripping portion of said gripping member to slide ofI said gripping member about a blood vessel held thereby and then sliding said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formaton of -a knot by both loops about the blood vessel held by said gripping member under action of said tensioning means, said moving means including biasing means for urging said head to its forward position, irst stop means on said casing adapted to be engaged by said head for preventing forward movement thereof beyond said forward position thereof, releasable detent means for maintaining said head in its retracted position when the same has been moved thereto against the action of said biasing means, manually operable means for releasing said detent means thereby permitting said biasing means to move said head to its forward position, and second stop means on said casing adapted to be engaged by said holding member when the same 'slides together with said head toward said forward position thereof after said free end face of said head has `moved in front of said gripping portion of said gripping member but before said free end face is spaced said predetermined distance from said gripping portion of said vgripping member thereby preventing further sliding movement of said holding member relative to said casing but permitting sliding movement of said head relative to said casing `and consequently relative to said holding member so that said holding member moves into its retracted position when said biasing means continues to move said head toward said forward position thereof.

15. A surgical instrument for tieing ligatures comprising, in combination, an elongated casing; an elongated blood vessel gripping member mounted on said casing and extending outwardly therefrom through one end thereof, said gripping member having a gripping portion spaced from said one end of said casing; a ligaturing head having a free end face and mounted on said casing for sliding movement relative thereto between a forward position wherein said free end face of said head is a predetermined distance in front of lsaid gripping portion of said gripping member and a retracted position wherein said yfree end face of said head is behind said gripping portion of said gripping member; at least one ligature holding member having a holding portion, mounted on said casing and slidable relative thereto and to said head between 'a projecting position wherein said holding portion projects in front of said free end face of said head and is ladapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping member while said head is inits retracted position and a retracted position wherein said holding portion is located behind said free end face of said head, releasing said outer loop; tensioning means for tensioning a ligature while the outer loop of a prospective knot thereof is held by said holding member, while the inner loop thereof is located about said gripping member, and while `the ligature when tied is located about a blood vessel; cutting means mounted on said head for movement therewith relative to said casing, said cutting means being movable relative to said head between a cutting position wherein said cutting means engages the free end portions of a ligature tensioned by said tensioning means and ta retracted position spaced therefrom; and moving means for first sliding said head from its retracted position to its forward position permitting the inner ligature loop located about said gripping portion of said gripping member to slide olf said gripping member about a blood vessel held thereby, then sliding said holding member from its projecting position into its retracted position, resulting in freeing of the outer loop and formation of la knot by both loops about the blood Vessel held by said gripping member under action of said tensioning means, and then moving said cutting means from its retracted position into its cutting position, resulting in cutting olf the end portions of the ligature tied about the blood vessel, said moving means including biasing means for urging said head to its forward position, first stop means on said casing adapted to be engaged by said head for preventing forward movement thereof beyond said forward position thereof, releasable detent means for maintaining said head in its retracted position when the same has been moved thereto against the action of said biasing means, manually operable means for releasing said detent means thereby permitting said biasing means to move said head to its forward position, second stop means on said casing adapted to be engaged by said holding member when the same slides together with said head toward said forward position thereof after said free end face of said head has moved in front of said gripping portion of said gripping member but before said free end face is spaced said predetermined distance from said gripping portion of said gripping member thereby preventing further sliding movement of said holding member relative to said casing but permitting sliding movement of said head relative to said casing and consequently relative to said holding member so that said holding member moves into its retracted position when said biasing means continues to move said head toward said forward position thereof, and means on said holding member for moving said cutting means from its retracted position into its cutting position after lsaid holding member has moved into its retracted position.

16. A surgical instrument for tieing lgatures comprising, in combination, an elongated casing; an elongated blood vessel gripping member mounted on said casing and extending outwardly therefrom through one end thereof, said gripping member having a gripping portion spaced from said one end of said casing; a ligaturing head having a free end face and mounted on said casing for sliding movement relative thereto between a forward position wherein said free end face of said -head is in front of said gripping portion of said gripping member and a retracted position wherein said free end face of said head is behind said gripping portion of said gripping member; at least one ligature holding member having a holding portion, mounted on said casing and slidable relative thereto and to said head between a projecting position wherein said holding portion projects in front of said free end face of said head and is adapted to support the outer loop of a prospective knot of a ligature to be tied about a blood vessel, the inner loop of which knot is located about said gripping member while said head is in its re'- tracted position, and a retracted position wherein said holding portion is located behind said free end face of said head, releasing said outer loop; tensioning means for -tensioning a ligature while the outer loop of a prospective knot thereof is held by said holding member, While the inner loop thereof is located about said gripping member, and while the ligature when tied is located about a blood Vessel; moving means for first sliding said head from its retracted position to its forward position permitting the inner ligature loop located about said gripping portion of said gripping member to slide olf said gripping mem'- ber about a blood vessel held thereby, then sliding said holding member from its projecting position into its reL tracted position, resulting in freeing of the outer loop and formation of a knot by both loops and about the blood vessel held by said gripping member under action of said tensioning means; a carrier plate having a first annular boss portion adapted to be surrounded by the inner loop of a prospective ligature knot, at least one second boss portion adapted yto be surrounded by the outer loop of the respective ligature knot, and retaining portions for retaining the free ends of the ligature while exposing end portions thereof; and means on said casing for detachably holding said carrier plate in a position in which said rst annular boss portion encompasses said holding member, and said tensioning means engages said exposed end portions of the ligature whereby the inner and outer loops of a prospective ligature knot are supplied to said gripping member and said holding member.

References Cited in the tile of this patent UNITED STATES PATENTS

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