Laraposcopic surgical grasper having an attachable strap

• US 5,613,973 A
• Filed: 03/10/1995
• Issued: 03/25/1997
• Est. Priority Date: 03/10/1995
• Status: Expired due to Fees

• Current Assignee: Fertility Acoustics Inc.
• Original Assignee: Wilson Greatbatch Technologies, Inc.
• Inventors: Belstadt, Jack A., Jackson, Robert C., Klementowski, Thomas W.
• Primary Examiner(s): Hafer, Robert A.
• Assistant Examiner(s): YU, JUSTINE ROMANG
• Application Number:
  US08/402,344
• Time in Patent Office: 746 Days
• Field of Search: 606/113, 606/114, 606/106-110, 606/127, 606/128, 119/803, 119/804, 119/802
• US Class Current: 606/113
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/30 Surgical pincettes without pivotal connectionsfor holding suture needles or materials A61B17/0483; wound clamps A61B17/08 ; hand-held gripping tools without pivotal connections in general B25B9/02
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• CPC Class Codes: A61B 17/50 Instruments, other than pincettes or toothpicks, for removing foreign bodies from the human body locating otherwise A61B5/06; locating by radiation A61B6/00; removing calculi A61B17/22; from the eyes A61F9/00709
• CPC Class Codes: A61B 2017/00469 for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop

Abstract

A medical grasper device (10) that is useful for holding and manipulating a body organ is described. The grasper device is partially inserted into a body cavity and comprises a flexible strap (14) having a distal section (18) that is deployed from a tube (12) to form a partial closed loop (2). A terminal end of the strap has an aperture (42) that is manipulated by a separate forceps-type device to mate with a connection means (56) provided on the grasper device to complete the loop. The closed loop is then adjustable in size to provide for positioning the loop at a desired location around the target body organ to hold and manipulate the body organ. At such time as the grasper device is no longer needed in the surgical procedure, the strap is either removed from the connection means with the aforementioned forceps-type device or is cut by a separate cutting means to release the loop from the body organ and the grasper device is removed from the body cavity.

Claims

1. A medical device that is insertable into a body cavity during a surgical procedure to hold and manipulate a body organ from a remote location outside the cavity, which comprises:

a) elongated conduit means having a surrounding sidewall providing an inside passage and extending to proximal and distal portions having respective spaced apart open ends, wherein the proximal portion of the conduit means provides a handle means for inserting the distal portion into the body cavity and for manipulating the distal portion from the remote location;

b) flexible strap means having a width and a thickness so as to be in a movable relationship in the inside passage of the conduit means, and at least a portion of the strap means is extendable out through the distal open end of the conduit means wherein the strap means has a first section and a second section; and

c) manipulative means operatively associated with the strap means and manipulatable from the remote location to move the strap means along the inside passage of the conduit means to extend at least the second section of the strap means out through the distal open end of the conduit means, wherein the strap means is provided with an attachment means which upon extension of the second section of the strap means out through the distal open end of the conduit means is either initially in an unattached state and attachable to a strap connection means provided by the medical device or first detachable from the strap connection means and then reattachable thereto such that the attachment means is removably mated to the strap connection means with either the attachment means surrounding the strap connection means or strap connection means surrounding the attachment means to thereby define a loop encircling the body organ and having relative rigidity in a plane normal to the loop, and wherein upon formation of the loop, the handle means and the manipulative means are manipulatable from the remote location to position and tighten the defined loop around the body organ.

2. The medical device of claim 1 wherein the second section of the strap means is provided with memory-curved characteristics that cause the second section to curve back toward itself with the attachment means unattached from the connection means and upon extension of the second section of the strap means out through the distal open end of the conduit means.

3. The medical device of claim 1 wherein the first section of the strap means extends along and through the conduit means and outwardly of the conduit means adjacent to the proximal portion of the conduit means to provide the manipulative means for moving the strap means along the inside passage of the conduit means.

4. The medical device of claim 1 wherein the manipulative means comprises drive rod means provided inside the conduit means and in a movable relationship with the inside passage thereof, the drive rod means having a proximal portion positioned near the proximal portion of the conduit means and wherein the first section of the strap means is connected to a distal portion of the drive rod means so that the drive rod means is manipulatable from the remote location to move the strap means along the inside passage of the conduit means.

5. The medical device of claim 1 wherein the first section of the strap means extends along and through the inside passage and outwardly of the conduit means adjacent to the proximal portion thereof to provide the manipulative means for moving the strap means along the inside passage of the conduit means, and wherein a second manipulative means comprises an attachment rod means provided inside the conduit means and in a movable relationship with the inside passage thereof, the attachment rod means having a proximal portion positioned near the proximal portion of the conduit means and wherein the attachment means of the strap means is releasibly attachable to a distal portion of the attachment rod means sewing as the strap connection means to thereby define the loop.

6. The medical device of claim 1 wherein the manipulative means comprises drive rod means provided inside the conduit means and in a movable relationship with the inside passage thereof, the drive rod means having a proximal portion positioned near the proximal portion of the conduit means, and wherein the first section of the strap means is connected to a distal portion of the drive rod means with the attachment means of the strap means releasibly attachable to a distal portion of the drive rod means serving as the strap connection means to define the loop so that the proximal portion of the drive rod means is manipulatable from the remote location to move the strap means along the inside passage of the conduit means to adjust a size of the loop extending from the distal open end of the conduit means.

7. The medical device of claim 1 wherein the manipulative means comprises drive rod means provided inside the conduit means and in a movable relationship with the inside passage thereof, the drive rod means having a proximal portion positioned near the proximal portion of the conduit means with the first section of the strap means connected to a distal portion of the drive rod means, a collar means surrounding a locking portion of the conduit means and in a movable relationship therewith, and a joining means for joining the collar means to the proximal portion of the drive rod means and in a manner allowing axial movement of the collar means along the proximal portion of the conduit means to move the drive rod means and associated strap means along the inside passage of the conduit means.

8. The medical device of claim 7 wherein the joining means comprises elongated connector means extending through the drive rod means and in a direction substantially normal to a first longitudinal axis of the drive rod means and wherein opposed ends of the connector means engage the collar means, the connector means being movable axially along a pair of diametrically opposed slots extending longitudinally along the proximal portion of the conduit means.

9. The medical device of claim 7 wherein the joining means further provides for rotational movement of the collar means and the drive rod means as a unit relative to the conduit means, the collar means supporting a locking means that can releasably contact the locking portion of the conduit means at an infinite number of annular locations around a second longitudinal axis of the conduct means to provide for locking and unlocking the drive rod means for preventing and allowing, respectively, movement of the strap means along the conduit means.

10. The medical device of claim 9 wherein the joining means comprises elongated connector means extending through the drive rod means in a direction substantially normal to a first longitudinal axis of the drive rod means and wherein opposed ends of the connector means are rotatably received in an inner annular groove provided on an inner wall of the collar means, the annular groove being concentric with the first longitudinal axis.

11. The medical device of claim 1 wherein the strap means has a second longitudinal axis and further comprising guide means provided on the conduit means for holding and directing movement of the strap means through the conduit means while preventing the strap means from rotating about the second longitudinal axis thereof relative to the inside passage of the conduit means.

12. The medical device of claim 11 wherein the guide means is provided at the distal portion of the conduit means and comprises a guide body having inner and outer end faces and a guide passage extending through the body between the end faces, and wherein the guide passage is elongated in a direction parallel to a plane of the width of the strap means and the guide passage is dimensioned and disposed so as to prevent the strap means from rotating about the second longitudinal axis thereof.

13. The medical device of claim 11 wherein the guide means comprises a guide body having an outer wall, and wherein the conduit means is provided with at least one inwardly projecting conduit protrusion that is removably receivable in a channel provided in the outer wall of the guide means to removably mount the guide means at the distal portion of the conduit means when the conduit protrusion is received in the channel.

14. The medical device of claim 13 wherein a pivotable tang portion of the guide means extends into the channel at a position spaced from a terminus portion thereof to lock the guide means to the conduit means at such time as the guide means has been manipulated to receive the conduit protrusion in the terminus portion of the channel of the guide means.

15. The medical device of claim 13 wherein the guide means further includes a guide passage that is elongated in a direction parallel to a plane of the width of the strap means and that is dimensioned and disposed so as to prevent the strap means from rotating about the second longitudinal axis thereof and wherein there are at least two sets of mating conduit protrusions and associated channels spaced along the sidewall of the conduit means and the outer wall of the guide means such that when the guide means is removably mounted at the distal portion of the conduit means, the elongated guide passage extending through the guide body is aligned along a predetermined plane with respect to a third longitudinal axis of the conduit means.

16. The medical device of claim 1 wherein the attachment means of the strap means comprises a strap opening extending through the thickness of the strap means with the strap connection means being associated with the conduit means and comprising a first post member extending from the conduit means, the first post member sized to mate with the strap opening to close the defined loop.

17. The medical device of claim 16 wherein the strap connection means includes a guard means that prevents the strap opening from releasing from its mated relationship with the first post member.

18. The medical device of claim 17 wherein the first post member comprising the strap connection means has a length between spaced apart first and second ends, the first end connected to the conduit means and the second end extending from the conduit means and spaced therefrom, and wherein the guard means comprises a second post member having a length between spaced apart ends, one end of the second post member connected to the conduit means with the other end thereof in an overlapping relationship with the second end of the first post member, wherein the second post member is in a resilient relationship with the first post member such that the post members are movable to a spaced relationship with respect to each other when the strap opening at the second section of the strap means is moved over the second end of the first post member, and wherein the strap opening is movable along the length of the first post member towards the first end thereof such that when the strap opening is clear of the second end of the first post member and the other end of the second post member, the resilient relationship between the first and second post members returns them to their overlapping relationship to attach the strap means to the strap connection means to close the defined loop with the guard means provided by the second post member preventing the strap means from releasing from the first post member.

19. The medical device of claim 1 wherein a locking means is provided on the conduit means, the locking means being accessible from the remote location and being movable to an enabled position to prevent movement of the strap means along the conduit means and wherein the locking means is movable to a disabled position to enable movement of the strap means along the inside passage of the conduit means.

20. The medical device of claim 19 wherein the locking means comprises a threaded member that is received in a threaded opening provided in the surrounding sidewall of the conduit means, the threaded member being rotatable in a first direction to contact either the manipulative means or the strap means inside the conduit means and thereby provide the enabled position for the locking means and wherein the threaded member is rotatable in a second direction to be removed from contact with either the manipulative means or the strap means inside the conduit means to thereby provide the disabled position for the locking means.

21. The medical device of claim 1 including a sealing means that seals between the inside of the conduit means and either the strap means or the manipulative means to prevent fluids present inside the body cavity from moving through the conduit means and past the sealing means when the distal portion of the conduit means is inserted into the body cavity, the sealing means allowing movement of the strap means and the manipulative means along the inside passage of the conduit means.

22. The medical device of claim 1 wherein the thickness of the strap means at the second section, spaced toward the first section from the attachment means, extends between a continuous inner surface and an outer surface with at least one recessed formation formed into the thickness from the inner surface and extending towards the outer surface to a depth through the thickness at least intermediate the inner and outer surfaces so that when the attachment means at the second section of the strap means is attached to the strap connection means to define the loop, the manipulative means is manipulatable to tighten the loop around the body organ and the recessed formation prevents the tightened loop from releasing from the body organ as the device is used to manipulate the body organ.

23. The medical device of claim 22 wherein the recessed formation comprises a plurality of openings extending through the thickness of the strap means and positioned at spaced locations along the loop to thereby prevent the tightened loop from releasing from the body organ.

24. The medical device of claim 23 wherein the openings providing the recessed formations are beveled.

25. The medical device of claim 24 wherein the beveled openings have a narrow opening portion facing inwardly of the loop.

26. The medical device of claim 1 wherein the conduit means, the strap means and the manipulative means comprise a kit for providing the medical device and wherein at least some of them are disposable.

27. The medical device of claim 26 wherein the strap means has a longitudinal axis and the kit further comprises a guide means positionable on the conduit means for preventing the strap means from rotating about the longitudinal axis thereof relative to the inside passage of the conduit means and wherein the guide means is disposable.

28. The medical device of claim 26 further comprising a sealing means that seals between the inside of the conduit means and either the strap means or the manipulative means to prevent fluids present inside the body cavity from moving through the conduit means to the proximal open end thereof when the distal portion of the conduit means is inserted into the body cavity, the sealing means allowing movement of the strap means and the manipulative means along the inside passage of the conduit means and wherein the sealing means is disposable.

29. The medical device of claim 26 further including a locking means that is positionable on the conduit means, the locking means being accessible from the remote 16cation and being movable to an enabled position to prevent movement of the strap means along the conduit means and wherein the locking means is movable to a disabled position to enable movement of the strap means along the inside passage of the conduit means and wherein the locking means is disposable.

30. A medical device that is insertable into a body cavity to hold and manipulate a body organ located therein from a remote location outside the cavity during a surgical procedure, which comprises:

a) elongated conduit means having surrounding sidewall providing an inside passage extending to proximal and distal portions having respective spaced apart open ends, wherein the proximal portion of the conduit means provides a handle means for inserting the distal portion into the body cavity and for manipulating the distal portion from the remote location;

b) flexible strap means having a width and a thickness so as to be in a movable relationship in the inside passage of the conduit means, wherein at least a portion of the strap means is extendable out through the distal open end of the conduit means, the strap means provided with an attachment means and having a first section and a second section and wherein the thickness of the strap means at the second section extends between a continuous inner surface and an outer surface with at least one recessed formation formed into the thickness from the inner surface and extending towards the outer surface to a depth through the thickness at least intermediate the inner and outer surfaces; and

c) manipulative means operatively associated with the strap means and manipulatable from the remote location to move the strap means along the inside passage of the conduit means so that upon extension of at least the second section of the strap means out through the distal open end of the conduit means the attachment means is either initially in an unattached state and attachable to a strap connection means provided by the medical device or first detachable from the strap connection means and then reattachable thereto such that the attachment means is removably mated to the strap connection means with either the attachment means surrounding the strap connection means or the strap connection means surrounding the attachment means to thereby define a loop, and wherein the manipulative means is manipulatable to tighten the loop around the body organ and the recessed formation prevents the tightened loop from releasing from around the body organ as the device is used to manipulate the body organ.

31. The medical device of claim 30 wherein the manipulative means comprises a drive rod means provided inside the conduit means and in a movable relationship with the inside passage thereof, the drive rod means having a proximal portion positioned near the proximal portion of the conduit means and wherein the first section of the strap means is connected to a distal portion of the drive rod means so that the proximal portion of the drive rod means is manipulatable from the remote location to move the strap means along the inside passage of the conduit means, and wherein a second manipulative means comprises an attachment rod means provided inside the conduit means and in a movable relationship with the inside passage thereof, the attachment rod means having a second, proximal portion positioned near the proximal portion of the conduit means and wherein the attachment means of the strap means is releasibly attachable to a distal portion of the attachment rod means serving as the strap connection means to thereby define the loop.

32. The medical device of claim 30 wherein the strap means has a longitudinal axis and further comprising guide means provided on the conduit means for holding and directing movement of the strap means along and through the conduit means while preventing the strap means from rotating about the longitudinal axis thereof relative to the inside passage of the conduit means.

33. The medical device of claim 30 wherein a locking means is provided on the conduit means, the locking means being accessible from the remote location and being movable to an enabled position to prevent movement of the strap means along and through the conduit means and wherein the locking means is movable to a disabled position to enable movement of the strap means along the inside passage of the conduit means.

34. The medical device of claim 30 including a sealing means that seals between the inside of the conduit means and either the strap means or the manipulative means to prevent fluids present inside the body cavity from moving through the conduit means and past the sealing means when the distal portion of the conduit means is inserted into the body cavity, the sealing means allowing movement of the strap means and the manipulative means along the inside passage of the conduit means.

35. A medical device that is insertable into a body cavity during a surgical procedure to hold and manipulate a body organ from a remote location outside the body cavity, which comprises:

a) elongated conduit means having a surrounding sidewall providing an inside passage and extending to proximal and distal portions having respective spaced apart open ends, wherein the proximal portion of the conduit means provides a handle means for inserting the distal portion into the body cavity and for manipulating the distal portion from the remote location;

b) flexible strap means having a width so as to be in a movable relationship in the inside passage of the conduit means, and at least a portion of the strap means is extendable out through the distal open end of the conduit means, wherein the strap means includes a first section and a second section;

c) first manipulative means provided by the first section of the strap means which extends along and through the inside passage and outwardly of the conduit means adjacent to the proximal portion thereof and being manipulatable from the remote location to move the strap means along the inside passage of the conduit means to extend at least the second section of the strap means out through the distal open end of the conduit means; and

d) a second manipulative means comprising attachment rod means provided inside the conduit means and in a movable relationship with the inside passage thereof, the attachment rod means having a proximal portion positioned near the proximal portion of the conduit means and wherein the strap means is provided with an attachment means which upon extension of the second section of the strap means out through the distal open end of the conduit means is either initially in an unattached state and attachable to a strap connection means provided by a distal portion of the attachment rod means or first detachable from the strap connection means and then reattachable thereto such that the attachment means is removably mated to the strap connection means with either the attachment means surrounding the strap connection means or the strap connection means surrounding the attachment means to thereby define a loop comprising the strap means.

36. The medical device of claim 35 wherein the second section of the strap means is provided with memory-curved characteristics that cause the second section to curve back toward itself with the attachment means unattached from the connection means and upon extension of the second section of the strap means out through the distal open and of the conduit means.

37. The medical device of claim 36 wherein the thickness of the strap means at the second section, spaced toward the first section from the attachment means, extends between an inner surface and an outer surface with at least one recessed formation formed into the thickness from the inner surface and extending towards the outer face to a depth through the thickness at least intermediate the inner and outer surfaces so that when the attachment means of the strap means is attached to the strap connection means provided on the attachment rod means to define the loop, the first manipulative means is manipulatable to tighten the loop around the body organ and the recessed formation prevents the tightened loop from releasing from the body organ as the device is used to manipulate the body organ.

38. The medical device of claim 35 including a guide means provided on the conduit means for holding and directing movement of the strap means while preventing the strap means from rotating about a longitudinal axis of the strap means.

39. The medical device of claim 38 wherein the guide means is provided at the distal portion of the conduit means and comprises a guide body having inner and outer end faces and a guide passage extending through the body between the end faces, and wherein the guide passage is elongated in a direction parallel to the plane of the width of the strap means and is dimensioned and disposed so as to prevent the strap means from rotating about the longitudinal axis of the strap means.

40. The medical device of claim 35 wherein a locking means for the strap means is provided on the conduit means, the locking means being accessible from the remote location and being movable to an enabled position to prevent movement of the strap means along the conduit means and wherein the Locking means is movable to a disabled position to enable movement of the strap means along the inside passage of the conduit means.

41. The medical device of claim 35 including a sealing means that seals between the inside of the conduit means and at least one of the group consisting of the strap means, the first manipulative means and the second manipulative means to prevent fluids present inside the body cavity from moving through the conduit means and past the sealing means when the distal portion of the conduit means is inserted into the body cavity, the sealing means allowing movement of the strap means, the first manipulative means and the second manipulative means along the inside passage of the conduit means.

42. A medical device that is insertable into a body cavity during a surgical procedure to hold and manipulate a body organ from a remote location outside the body cavity, which comprises:

a) elongated conduit means having a surrounding sidewall providing an inside passage extending to proximal and distal portions having respective spaced apart open ends, wherein the proximal portion of the conduit means provides a handle means for inserting the distal portion into the body cavity and for manipulating the distal portion from the remote location;

b) flexible holding means in a movable relationship in the inside passage of the conduit means, and at least a portion of the holding means is extendable out through the distal open end of the conduit means, wherein the holding means has a first section and a second section;

c) manipulative means operatively associated with the holding means and manipulatable from the remote location to move the holding means along the inside passage through the conduit meads to extend at least the second section of the holding means out through the distal open end of the conduit means, wherein the holding means is provided with an attachment means which upon extension of the second section of the holding means out through the distal open end of the conduit means is either initially in an unattached state and attachable to a holding connection means provided by the medical device or first detachable from the holding connection means and then reattachable thereto such that the attachment means is removably mated to the strap connection means with either the attachment means surrounding the strap connection means or the strap connection means surrounding the attachment means to thereby define a loop encircling the body organ and having relative rigidity in a plane normal to the loop; and

d) sealing means provided inside the conduit means to seal between the inside of the conduit means and either the holding means or the manipulative means to thereby prevent fluids present inside the body cavity from moving through the conduit means and past the sealing means when the distal portion of the conduit means is inserted into the body cavity, the sealing means allowing movement of the holding means and the manipulative means along the conduit means.

43. The medical device of claim 42 wherein the second section of the holding means is provided with memory-curved characteristics that cause the second section to curve back toward itself with the attachment means unattached from the holding connection means and upon extension of the second section of the holding means out through the distal open end of the conduit means.

44. The medical device of claim 42 wherein the first section of the holding means extends along and through the inside passage and outwardly of the conduit means adjacent to the proximal portion thereof to provide the manipulative means for moving the holding means along the inside passage of the conduit means.

45. The medical device of claim 42 wherein a locking means for the holding means is provided on the conduit means, the locking means being accessible from the remote location and being movable to an enabled position to prevent movement of the holding means along the conduit means and wherein the locking means is movable to a disabled position to enable movement of the holding means along the inside passage of the conduit means.

46. A medical device that is insertable into a body cavity during a surgical procedure to hold and manipulate a body organ from a remote location outside the cavity, which comprises:

a) elongated conduit means having a surrounding sidewall providing an inside passage and extending to proximal and distal portions having respective spaced apart open ends, wherein the proximal portion of the conduit means provides a handle means for inserting the distal portion into the body cavity and for manipulating the distal portion from the remote location;

b) flexible strap means having a width and a thickness so as to be in a movable relationship in the inside passage of the conduit means, wherein at least a portion of the strap means is extendable out through the distal open end of the conduit means, the strap means having a first section and a second section;

c) manipulative means operatively associated with the strap means and manipulatable from the remote location to move the strap means along the inside passage of the conduit means to extend at least the second section of the strap means out through the distal open end of the conduit means, wherein the strap means is provided with an attachment means which upon extension of the second section of the strap means out through the distal open end of the conduit means is either initially in an unattached state and attachable to a connection means provided by the medical device or first detachable from the strap connection means and then reattachable thereto such that the attachment means is removably mated to the strap connection means with either the attachment means surrounding the strap connection means or the strap connection means surrounding the attachment means to thereby define a loop encircling the body organ and having relative rigidity in a plane normal to the loop; and

d) sealing means provided inside the conduit means and in a sealing relationship therewith, wherein the sealing means meals between the inside of the conduit means and either the strap means or the manipulative means to prevent fluids present inside the body cavity from moving through the conduit means to the proximal open end thereof when the distal portion of the conduit means is inserted into the body cavity, and wherein upon formation of the loop, the handle means and the manipulative means are manipulatable from the remote location to position and tighten the defined loop around the body organ with the sealing means allowing movement of the strap means and the manipulative means along the conduit means.

47. The medical device of claim 46 wherein the second section of the strap means is provided with memory-curved characteristics that cause the second section to curve back toward itself with the attachment means unattached from the connector means and upon extension of the of the second section of the strap means out through the distal open end of the conduit means.

48. The medical device of claim 46 wherein the thickness of the strap means at the second section, spaced toward the first section from the attachment means, extends between a continuous inner surface and an outer surface with at least one recessed formation formed into the thickness from the inner surface and extending towards the outer surface to a depth through the thickness at least intermediate the inner and outer surfaces so that with the attachment means at the second section of the strap means attached to the strap connection means provided by the medical device to define the loop, the manipulative means is manipulatable to tighten the loop around the body organ and the recessed formation prevents the tightened loop from releasing from around the body organ as the device is used to manipulate the body organ.

49. The medical device of claim 46 wherein the first section of the strap means extends along and through the inside passage and outwardly of the conduit means adjacent to the proximal portion of the conduit means to provide the manipulative means for moving the strap means along the inside passage of the conduit means.

50. The medical device of claim 46 wherein the strap means has a longitudinal axis and further comprising guide means provided on the conduit means for preventing the strap means from rotating about the longitudinal axis thereof relative to the inside passage of the conduit means.

51. The medical device of claim 46 wherein a locking means for the strap means is provided on the conduit means, the locking means being accessible from the remote location and being movable to an enabled position to prevent movement of the strap means along the conduit means and wherein the locking means is movable to a disabled position to enable movement of the strap means along the inside passage of the conduit means.