US2880728A - Ligature inserter - Google Patents

Description

c. s; RIGHTS LIGATURE INSERTER April 7, 1959 2 Sheets-Sheet 1 Filed Feb. 5, 1958 I.INVENT0R. CLYDE s. RIGHTS W i BY 46 I 16mm & 14m:

C. S. RIGHTS LIGATURE INSERTER April 7, 1959 2 Sheets-Sheet 2 Filed Feb. 3, 1958 IN VEN TOR.

CLYDE S. RIGHTS United States Patent .LIGATURE INSERTER Clyde s. Rights, Mission Beach, Calif. Application February a, 1958, Serial No. 712,854

11 Claims. Cl. 128-326) The present invention relates generally to surgical instruments and more particularly to a ligature inserter.

The primary object of this invention is to providea ligature inserter which will make a figure 8 stitch in one complete cycle of operation involving closing, opening and withdrawal of the instrument, and to make this opera.- tion possible using only one hand.

Another object of this invention is to provide a ligature inserter which holds a ligature satisfactorily in preliminary position on the needles for forming the stitch and has means for retaining the ends of the ligature until the stitch is completed.

Another object of this invention is to provide a ligature inserter having easily replaceable needles and other portions to facilitate servicing and cleaning.

Still another object of this invention is to provide a ligature inserter which may be used for surgery in deep body cavities and in restricted places without fear of injury to surrounding organs.

Finally, it is an object to provide a ligature inserter of the aforementionedcharacter which is simple, safe and convenient to use and which will give generally efficient and durable service.

With these and other objects definitely in view, this invention consists in the novel construction, combination and arrangement of elements and portions, as will be hereinafter fully described in the specification, particularly pointed out in the claims, and illustrated in the drawings which form a material part of this disclosure, and in which:

Figure 1 is a top plan view of the ligature inserter;

Figure 2 is an enlarged fragmentary side elevation view taken in the direction of arrows 2-2 of Figure 1;

Figure 3 is an enlarged, fragmentary perspective view of one tip of the device;

Figure 4 is an enlarged, fragmentary, exploded view, in perspective, of the other tip of the device;

Figure 5 is an enlarged, fragmentary side elevation view taken in the direction of arrows 5-5 in Figure 1;

Figure 6 is a fragmentary top plan view of the inserter with a ligature in place, the organ to be stitched being indicated sectionally in broken line between the tips;

Figure 7 is a view similar to Figure 6, but with the inserter fully closed and the needles penetrating the organ;

Figure 8 is a view similar to Figure 6, with the inserter reopened and the stitch formed;

Figure 9 is an enlarged, fragmentary sectional view taken on the line 9-9 of Figure 7, with rubber sleeves added; and

Figure 10 is a sectional view, in'broken line, of the organ with the figure 8 stitch completed and loosely tied.

Similar characters of reference indicate similar or identical elements and portions throughout the specification and throughout the views of the drawings.

Referring now to the drawings in detail, the inserter comprises a pair of pivoted levers 10 with portions 'there- 2,880,728 Patented Apr. 7, 1959 "ice 2 of'constituting a pair of arms 12 provided with finger grips 14, and a pair of legs 16 and 18 having slightly inwardly bent tip portions 20 and 22, respectively. The cross sectional shapev of the legs and tips is shown as substantially square for convenience, but may be changed according to requirements.

The tip 20 has a generally rounded end 24 having a transverse slot 26, the open side of which constitutes'a reduced width throat 28, and adjacent the outer face of said tip a blind socket 30 extends from said slot longitudinally into the tip. The upper portion of the tip 20 has a notch 32 spaced slightly from the end 24 and extending substantially half the thickness of thetip, as shown in Figures 4 and S, the notch having a sloping wall' 34 furthermost from said end. The tip. 20 has a removable clamp portion 36, comprising a block '38 shaped to fit closely in the notch 32 and having a resilient plate or tongue 40 extending longitudinally from one side thereof to lie fiat on the upper surface of said tip when said block is seated in the notch- 32. The upper surface of the tip 20 has an upwardly projecting, longitudinally elongated post 42 integral therewith, said post having an overhanging flange 44. The tongue 40 is provided with an elongated slot 46 of sufficient width at one end to pass over the flange 44 while the other end, is reduced in width to fit the post 42, so that the tongue can be snapped into place over the post to hold the clamp portion'36 in place with the block 38 firmly seated in the notch 32. This post and slot construction is similar to that used to attach certain types of scalpel blades to their handles and merely illustrates one type of easily releasable fastening for the clamp portion 36. Extending from the other end of the block 38 is a .small resilient leaf 50 which bears on the upper face of the end 24. The lowerface of the block 38 and the upper face of the notch 32, which are contacting surfaces, each have a plurality of longitudinal serrations 52, which are preferably arranged as in Figure 9 with the ridges of the serrations opposed, although the serrationsrnay intermesh if desired. The inner wall of the tip 20 at the interface of the block 38 and notch 32 is provided with a generally conical entry socket 54 leading into the serrations 52.

The tip 22 has the upper end portion removed to form a generally flat shoulder 56 while the underside of the tip is tapered so that the end constitutes a wedge portion 58. At the junction of the shoulder 56 and the upwardly extending end wall 60 of the cut-away portion is a further transverse slot 26 having a reduced throat 28, While adjacent the outer surface of the tip 22 is a blind socket 30 extending from said slot longitudinally into the tip, in the same manner as the end structure of the tip 20. Fitted over the wedge portion 58 is a removable clamp portion 62 comprising a block 64 which rests on the face of the'shoulder 56 and a tapered portion 66 which bears on the tapered under surface of said wedge portion, said block'and said tapered portion being interconnected by a relatively thin bight portion 68. Extending longitudinally from the tapered portion 66 is a tongue 40, with which the clamp portion 62 is secured to the tip 22 by means of the slot and post structure shown on the tip 20. Extending from the block 64 is,a resilient leaf 70 which rests on the upper surface of the tip 22 adjacent the end wall 60, as shown in Figures 2 and 3. The upper face of the shoulder 56 and the lower face of the block 64 have longitudinal serrations 71, as in Figure 9, and the inner wall of the tip 22 at the interface of said shoulder and block has a generally conical entry socket 73 leading into said serrations.

The tip 20 is provided with an inwardly projecting needle 72 having a stem 74 which is preferably elliptical in cross section, having its maximum thickness in the direction longitudinal of the tip, and is a close fit in he slot 26, one end of said stem having a shank 76 turned at right angles thereto to fit into the blind socket 30. The throat 28 is slightly narrower than the thickness of the stem 74 so that the needle must be snapped into place and is thus firmly yet removably held. The protruding end of the stem 74 is cut at an angle to provide a sharp point 73 and the point has an open notch 80 cut across the minimum thickness of said stem and extending longitudinally into the stem. The tip 22 is fitted with a needle 82 similar in all respects to the needle 72 and held in the slot 26 at the inner end of the shoulder 56. The needles 72 and 82 are positioned so that, when the tips and 22 are brought together, the needle 72 enters the entry socket 73 of the tip 22 and the needle 82 enters the entry socket 54 of the tip 20. Thus the needle 72 separates the block 64 from the shoulder 56, the bight portion 68 being sufficiently resilient to allow limited movement, and the needle is gripped tightly by the serrations 71. Similarly, the needle 82 lifts the block 38 from the notch 32, since the tongue is resilient, and is gripped firmly by the serrations 52.

The legs 16 and 18 are normally held apart by a curved leaf spring 84, one end of which is fixed to the inner face of the wedge portion 58 by screws 86 or the like, the other end of the spring having a longitudinal slot 88 which receives a pin 90 fixed in 'the inner face of the leg '16. The portion of the leaf spring 84 adjacent the leg 18 is shaped to extend outwardly around the needle 82 and is cut away, as shown in Figure 3, to clear the needle.

To use the device a ligature 92 is threaded in place by passing one end of the ligature through the notch 80 of the needle 72, wrapping the ligature around itself and around the stem 74 and securing the end 94 of the ligature under the leaf 50. The other end of the ligature 92 is passed through the notch 80 of the needle 82, wrapped around itself and around the stem 74 and the end 96 is secured under the leaf 70, a slack loop 98 of ligature being left between the two needles. The instrument is then inserted into the area of surgery and moved so that the tissue, represented by the numeral 100, to be stitched is positioned between the tips 20 and 22, as in Figure 6. Since the leaf spring 84 extends beyond the needle 82, the point of that needle is protected and only the needle 72 must be maneuvered to avoid damage to other portions of the body organs. When satisfactorily positioned, the finger grips 14 are brought together to bring the tips 20 and 22 together so that the needles 72 and 82 pierce the tissue 100 from opposite sides. The slight inward bend of the tips 20 and 22 ensures that the needles will enter their respective entry sockets substantially axially thereof to prevent breakage. The spacing between the needles is on the order of half an inch, which is a satisfactory dimension for the figure 8 type of stitch, although the spacing may be altered as required. As the needle 72 pierces the tissue 100, the point 78 enters the entry socket 73 of the tip 22 and passes between the serrations 71, as in Figure 9, so that the suture which is held in the notch 80 is gripped firmly by the serrations. Similarly, the needle 82 enters the entry socket 54 of the tip 20 and corresponding portion of the suture is gripped by the serrations 52. The disposition of the notches 80 causes the ligature to extend above and below the needle, so that some portion of the ligature is in a position to be gripped by the serrations S2 and 71. In certain cases, where necessary, sleeves 104 and 106 of rubber or the like may be fitted over each of the tips 20 and 22, as indicated in Figure 9, to assist in removing the ligature from the needles. The needles actually pierce the sleeves 104 and the resilient material of the sleeves holds the ligature by friction when the needles are withdrawn. The sleeves 104 and 106 may be short lengths of rubber tubing merely long enough to extend over the entry sockets 54 and 73. The action of the sleeves 104 and 106 when used, is supplemental to the action of the serrations 52 and 71. The action of the needles entering the entry sockets causes the leaf 50 and the leaf 70 to be lifted, so releasing the ligature ends 94 and 96 respectively, as indicated in Figure 7. Conventional ligature material has a reasonable amount of natural resiliency and so the ends tend to straighten out and become free when the retaining leaves are lifted. The finger grips are then opened, assisted by the spring 84, to withdraw the needles 72 and 82 from the tissue 100, as in Figure 8, and, in doing so, leave the ligature ends 94 and 96 now gripped in the tips 22 and 20, respectively, and the ligature 92 is now threaded through the tissue in a figure 8 stitch. The ends 94 and 96 are then manually released from the tips 22 and 20 and are tied in a suitable knot 102, as in Figure 10 to complete the figure 8 stitch.

This type of stitch is used a great deal in surgery for operations such as hysterectomy in which severed tissue must be properly stitched to ensure hemostasis. Normally the stitch is applied manually with a curved needle held in a needle clamp or the like, and it is diflicult to handel the needle inside body cavities to avoid piercing or otherwise damaging surrounding organs. Furthermore, in the conventional, prior art method, two actions were necessary to apply the stitch correctly. The device described herein enables a surgeon to apply a proper figure 8 stitch in a single action and in very restricted areas, without fear of injury of surrounding organs by the needles. To facilitate use in specific surgical procedures, the legs 16 and 18 may be bent or curved to any degree of offset without departing from the invention as disclosed herein and further, the legs may be interconnected by a resilient bight jportion rather than the pivotal connection shown.

The operation of this invention will be clearly comprehended from a consideration of the foregoing description of the mechanical details thereof, taken in connection with the drawings and the above recited objects. It will be obvious that all said objects are amply achieved by this invention.

It is understood that minor variations from the form of the invention disclosed herein may be made without departure from the spirit and scope of the invention, and that the specification and drawings are to be considered as merely illustrative rather than limiting.

I claim:

1. A ligature inserter instrument comprising: a pair of levers having a pivotal interconnection; the free end of each lever having a needle extending toward the free end of the other lever; said needles being unequally spaced from said pivotal interconnection; and gripping means on each lever to receive a portion of a ligature transferred from the needle on the other 'lever when the free ends are brought together.

2. A ligature inserter instrument comprising: a pair of levers having a pivotal interconnection; the free end of each. lever having a needle extending toward the free end of the other lever; said needles being unequally spaced from said pivotal interconnection; gripping .means on each lever to receive a portion of a ligature transferred from the needle on the other 'lever when the free ends are brought together; ligature end holding means on each of said levers for holding the ends of the ligature before said free ends of the levers are brought together; and means to release said ligature end holding means when said free ends are brought together.

3. An instrument according to claim 2 wherein each of the last mentioned means is released by the needle of the other lever.

4. A ligature inserter instrument comprising: .a pair of elongated legs hinged together at one end; the free ends of said legs each having an inwardly projecting needle secured thereto; each of said legs having a needle receiving portion positioned to receive the needle of the opposed leg; said needles having pointed ends shaped to hold and temporarily retain portions of a ligature; said needle receiving portions having gripping means to grip portion of ligature transferred thereto from the needle of the opposing leg, said gripping means being adapted to retain said transferred portions when the needles are withdrawn; whereby a figure eight stitch is occomplished and the transferred portions of the ligature can be pulled in the proper direction to tighten said stitch as the instrument is withdrawn.

5. A ligature inserter instrument comprising: a pair of elongated legs hinged together at one end; the free ends of said legs each having an inwardly projecting needle secured thereto; each of said legs having a needle receiving portion positioned to receive the needle of the opposed leg; said needles having pointed ends shaped to hold and temporarily retain portions of a ligature; said needle receiving portions having gripping means to grip portion of ligature transferred thereto from the needle of the opposing leg, said gripping means being adapted to retain said transferred portions when the needles are withdrawn; whereby a figure eight stitch is accomplished and the transferred portions of the ligature can be pulled in the proper direction to tighten said stitch as the instrument is withdrawn; a leaf spring fixed at one end to one of said legs adjacent the needle and slidably connected to the other of said legs to hold the legs apart, the fixed end of said leaf spring being shaped to extend around and substantially shield the point of the adjacent needle when the legs are separated.

6. A ligature inserter instrument comprising: a pair of elongated legs having a pivotal connection at one end; the tips of said legs at the ends thereof remote from said pivotal connection each having an inwardly projecting needle removably held therein and said needles being longitudinally spaced apart; each tip having a clamp element resiliently mounted thereon, said clamp element having a gripping surface in firm contact with a portion of the tip and said gripping surface constituting a needle receiving portion and being aligned with the needle of the opposite tip; said needles having means to hold portions of a ligature during entry into the respective needle receiving portions, whereby said gripping surfaces hold and retain said portions of the ligature when said needles are withdrawn.

7. A ligature inserter instrument comprising: a pair of elongated legs having a pivotal connection at one end; the tips of said legs at the ends thereof remote from said pivotal connection each having an inwardly projecting needle removably held therein and said needles being longitudinally spaced apart; each tip having a clamp element resiliently mounted thereon, said clamp element having a gripping surface in firm contact with a portion of the tip and said gripping surface constituting a needle receiving portion and being aligned with the needle of the opposite tip; said needles having means to hold portions of a ligature during entry into the respective needle receiving portions, whereby said gripping surfaces hold and retain said portions of the ligature when said needles are withdrawn; spring means attached to said legs to hold the legs normally apart, said spring means being shaped to shield one of said needles when the legs are apart.

8. A ligature inserter instrument comprising: a pair of elongated legs having a pivotal connection at one end; the tips of said legs at the ends thereof remote from said pivotal connection each having an inwardly projecting needle removably held therein and said needles being longitudinally spaced apart; each tip having a clamp element resiliently mounted thereon and bearing on a portion of the tip, the contacting faces of said clamp element and said tip having gripping surfaces, and a tapered entry socket shaped to guide a needle between said gripping surfaces, said entry sockets each being aligned with the needle of the opposite tip; said needles having notched pointed ends for releasably holding portions of a ligature during insertion between said gripping surfaces, whereby the ligature portions are gripped and retained when said needles are withdrawn.

9. A ligature inserter instrument comprising: a pair of elongated legs having a pivotal connection at one end; the tips of said legs at the ends thereof remote from said pivotal connection each having an inwardly projecting needle removably held therein and said needles being longitudinally spaced apart; each tip having a clamp element resiliently mounted thereon and bearing on a portion of the tip, the contacting faces of said clamp element and said tip having gripping surfaces, and a tapered entry socket shaped to guide a needle between said gripping surfaces, said entry sockets each being aligned with the needle of the opposite tip; said needles having notched pointed ends for releasably holding portions of a ligature during insertion between said gripping surfaces, whereby the ligature portions are gripped and retained when said needles are withdrawn; and ligature end retaining portions mounted on said clamp elements and movable therewith to hold the ends of a ligature and to release the ends when the clamp elements are moved by insertion of the needles between said gripping surfaces.

10. A ligature inserter instrument comprising: a pair of elongated legs having a pivotal connection at one end; the tips of said legs at the ends thereof remote from said pivotal connection each having an inwardly projecting needle removably held therein and said needles being longitudinally spaced apart; each tip having a clamp element resiliently mounted thereon and bearing on a portion of the tip, the contacting faces of said clamp element and said tip having gripping surfaces, and a tapered entry socket shaped to guide a needle between said gripping surfaces, said entry sockets each being aligned with the needle of the opposite tip; said needles having notched pointed ends for releasably holding portions of a ligature during insertion between said gripping surfaces, whereby the ligature portions are gripped and retained when said needles are withdrawn; and ligature end retaining portions mounted on said clamp elements and movable therewith to hold the ends of a ligature and to release the ends when the clamp elements are moved by insertion of the needles between said gripping surfaces; a leaf spring fixed at one end to one of said legs adjacent the needle and slidably connected to the other of said legs to hold the legs apart, the fixed end of said leaf spring being shaped to protect and substantially enclose the adjacent needle when said legs are apart.

11. A ligature inserter instrument according to claim 2 and including a resilient sleeve element removably fitted on each of said levers and positioned so as to be pierced by the needle of the other lever and to frictionally grip the ligature carried by this needle.

References Cited in the file of this patent UNITED STATES PATENTS 1,656,467 Blake Ian. 17, 1928

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