Ligating instrument with multiple loop ligature supply and methods therefor

• US 5,693,059 A
• Filed: 09/15/1995
• Issued: 12/02/1997
• Est. Priority Date: 09/15/1995
• Status: Expired due to Fees

• Current Assignee: Inbae Yoon
• Original Assignee: Inbae Yoon
• Inventors: Yoon, InBae
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): PHAM, THUY D
• Application Number:
  US08/531,153
• Time in Patent Office: 809 Days
• Field of Search: 606/139, 606/146, 606/102, 606/113, 606/144, 606/148
• US Class Current: 606/139
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 2017/0454 the anchor being crimped or clamped on the suture
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2090/062 penetration depth

Abstract

A ligating instrument for forming ligatures at an internal operative site in the body includes an instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between the distal and proximal ends. A ligature supply including a plurality of preformed, contractible ligature loops of filamentous ligature material is disposed in the lumen. Each of the ligature loops has a fixed knotting element and a movement permitting knotting element permitting movement of the ligature material relative thereto to reduce the size of the ligature loops around anatomical structure. The ligature supply is movable distally relative to the instrument body to move a ligature loop through the distal end to deploy the ligature loop externally of the instrument body for positioning around anatomical structure. An operating member carried by the instrument body is operable to move the ligature material proximally relative to the instrument body to reduce the size of the ligature loop around the anatomical structure to form a ligature while the movement permitting knotting element of the ligature loop is maintained externally of the instrument body. A method of forming ligatures includes the steps of withdrawing a ligature loop of filamentous material through a distal end of an instrument body, positioning the ligature loop around anatomical structure, moving an operating member to move the filamentous material proximally relative to the instrument body to reduce the size of the ligature loop around the anatomical structure to form a ligature and withdrawing another ligature loop of the ligature supply through the distal end of the instrument body to form another ligature.

Claims

1. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate instrument body having a distal end for being introduced at the operative site, a proximal end for being disposed externally of the body and a lumen between said distal and proximal ends;

a ligature supply received within said lumen, said ligature supply being defined by lengths of filamentous ligature material carrying a plurality of fixed knotting elements and a plurality of movement permitting knotting elements arranged thereon in spaced, alternating sequence to define a plurality of ligature loops, each of said ligature loops being defined by a fixed knotting element, a movement permitting knotting element spaced from said fixed knotting element and segments of said lengths of ligature material extending between said fixed knotting element and said movement permitting knotting element, said fixed knotting elements being fixedly secured to said lengths of ligature material, said movement permitting knotting elements being slidably carried by said lengths of ligature material to permit the space between a fixed knotting element and a movement permitting knotting element of a ligature loop to be reduced in size to contract the ligature loop, said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and being contractible around anatomical structure to form ligatures; and

an operating member carried by said instrument body and operable from said proximal end of said instrument body for contracting said ligature loops around anatomical structure to form ligatures.

2. A ligating instrument as recited in claim 1 wherein said operating member includes means for moving said lengths of ligature material proximally relative to said instrument body and relative to said movement permitting knotting element of a withdrawn ligature loop.

3. A ligating instrument as recited in claim 2 wherein said instrument body includes jaws at said distal end for maintaining said movement permitting knotting element of a withdrawn ligature loop externally of said instrument body when said lengths of ligature material are moved proximally by said operating member to contract the withdrawn ligature loop around anatomical structure to form a ligature.

4. A ligating instrument as recited in claim 2 wherein said operating member includes means for moving said ligature supply distally relative to said instrument body to permit withdrawal of said ligature loops through said distal end of said instrument body.

5. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate instrument body having a distal end for being introduced at the operative site, a proximal end for being disposed externally of the body and a lumen between said distal and proximal ends;

a plurality of preformed, variable size ligature loops of filamentous ligature material received within said lumen, said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and being reducible in size around anatomical structure to form ligatures;

an operating member carried by said instrument body and operable from said proximal end of said instrument body for reducing the size of said ligature loops around anatomical structure to form ligatures, said operating member including means for moving said ligature material proximally relative to said instrument body;

jaws at said distal end of said instrument body for maintaining said ligature loops externally of said instrument body when said ligature material is moved proximally by said operating member to reduce the size of said ligature loops around anatomical structure to form ligatures; and

a cutter carried by said instrument body for cutting said ligature material proximally of ligatures formed with said ligature loops.

6. A ligating instrument as recited in claim 5 wherein said cutter is disposed within said lumen.

7. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate instrument body having a distal end for being introduced at the operative site, a proximal end for being disposed externally of the body and a lumen between said distal and proximal ends;

a plurality of preformed, variable size ligature loops of filamentous ligature material received within said lumen, said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and being reducible in size around anatomical structure to form ligatures; and

an operating member carried by said instrument body and operable from said proximal end of said instrument body for reducing the size of said ligature loops around anatomical structure to form ligatures, said operating member including means for moving said ligature material proximally and distally relative to said instrument body, said operating member including a spool rotatable to wind and unwind said ligature material thereon.

8. A ligating instrument as recited in claim 7 and further including a handle mounting said proximal end of said instrument body and wherein said spool is mounted on said instrument body to be rotated by a hand grasping said handle.

9. A ligating instrument as recited in claim 7 and further including a rotational control mechanism for locking said spool in incremental rotational positions, said rotational control mechanism including a plurality of locking teeth carried by said spool and a pawl member carried by said instrument body for engaging said locking teeth.

10. A ligating instrument as recited in claim 9 wherein said pawl member is mounted on said instrument body in a position permitting said spool to rotate in a single direction.

11. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends;

a ligature supply including a plurality of ligature loops disposed in said lumen, said ligature loops being connected to one another in series, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a fixed knotting element and a movement permitting knotting element carried by segments of filamentous ligature material, said fixed knotting element being fixedly secured to said segments and said movement permitting knotting element being slidably carried by said segments in a manner permitting movement of said segments of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure;

an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said segments of said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures; and

a fixating member at said distal end of said instrument body for structurally deforming said movement permitting knotting elements to fixedly secure said movement permitting knotting elements to said segments of said ligature material in a manner preventing untightening of the ligatures.

12. A ligating instrument as recited in claim 11 wherein said movement permitting knotting elements are compressible and said fixating member includes jaws movable between open and closed positions to receive said movement permitting knotting elements between said jaws in said open position and to compress said movement permitting knotting elements between said jaws in said closed position such that said movement permitting knotting elements grip said segments of said ligature material.

13. A ligating instrument as recited in claim 12 wherein said movement permitting knotting elements are made of plastically deformable material and said jaws plastically deform said movement permitting knotting elements between said jaws in said closed position.

14. A ligating instrument as recited in claim 11 wherein said segments of said ligature material are movable by said operating member relative to said movement permitting knotting elements in a first direction to tighten said ligature loops and said movement permitting knotting elements each include structure preventing movement of said segments of said ligature material relative to said movement permitting knotting elements in a second direction, opposite said first direction, to prevent untightening of the ligatures formed with said ligature loops.

15. A ligating instrument as recited in claim 11 wherein each of said ligature loops includes two segments of said filamentous ligature material extending between a movement permitting knotting element and a fixed knotting element, said movement permitting knotting element connecting said two segments of ligature material to one another at a proximal end of said ligature loop and said fixed knotting element connecting said two segments of ligature material to one another at a distal end of said ligature loop.

16. A ligating instrument as recited in claim 11 wherein said ligature supply is removably disposed in said lumen of said instrument body.

17. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends;

a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material in a manner permitting movement of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure, said movement permitting knotting elements each including opposed legs spaced from one another, said movement permitting knotting elements being compressible to move said legs toward one another;

an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures; and

a fixating member at said distal end of said instrument body for fixing said movement permitting knotting elements to said ligature material in a manner preventing untightening of the ligatures, said fixating member including jaws movable from an open position for receiving said movement permitting knotting elements to a closed position for compressing said movement permitting knotting elements to move said legs toward one another to grip said ligature material therebetween.

18. A ligating instrument as recited in claim 17 wherein said movement permitting knotting elements are made of plastically deformable material and said jaws plastically deform said knotting elements to grip said ligature material when moved from said open position to said closed position.

19. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends;

a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material, said movement permitting knotting elements each including opposed legs spring biased to be normally disposed in a closed position wherein said legs are substantially in contact with one another to grip said ligature material therebetween and prevent movement of said movement permitting knotting elements relative to said ligature material, said legs being movable away from one another against said bias to an open position permitting movement of said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure;

an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements in said open position to tighten said ligature loops around anatomical structure to form ligatures; and

jaws at said distal end of said instrument body movable between a jaws closed position and a jaws open position, said jaws in said jaws open position receiving said movement permitting knotting elements therebetween, said jaws in said jaws closed position engaging said legs of said movement permitting knotting elements therebetween, said jaws being movable from said jaws closed position to said jaws open position for moving said legs of said movement permitting knotting elements therebetween away from one another to permit movement of said ligature material relative to said movement permitting knotting elements between said jaws to form ligatures and being movable from said jaws open position to said jaws closed position for releasing said legs of said movement permitting knotting elements therebetween for movement to said normally closed position to grip said ligature material between said legs and prevent untightening of the ligatures.

20. A ligating instrument as recited in claim 19 wherein said knotting elements are made of plastically deformable material and said jaws plastically deform said knotting elements to grip said ligature material when moved from said jaws open position to said jaws closed position.

21. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body, a lumen between said distal and proximal ends and a handle at said proximal end;

a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material in a manner permitting movement of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure;

an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures;

a fixating member at said distal end of said instrument body for fixing said movement permitting knotting elements to said ligature material in a manner preventing untightening of the ligatures; and

a cutter carried by said instrument body for cutting said ligature material proximally of a ligature formed with one of said ligature loops, said fixating member and said cutter being coupled with said handle, said handle being operable to actuate said fixating member and said cutter simultaneously to fix one of said movement permitting knotting elements and to cut said ligature material proximally of said one movement permitting knotting element simultaneously.

22. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body;

jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening;

a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position;

a plurality of preformed, contractible ligature loops of filamentous ligature material connected to one another in series and slidably disposed in said tubular member, each of said ligature loops having a knotting element of plastically deformable material attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first size opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws; and

means disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being adapted to receive said knotting element of said at least one ligature loop between said jaws in said open position and to crush said knotting element of said at least one ligature loop between said jaws when said jaws are moved to said closed position to prevent expansion of the ligature.

23. A ligating instrument as recited in claim 22 wherein said jaws are biased toward said open position and further including an outer member disposed around said tubular member and coupled with said handle, said outer member being movable by said handle to constrain said jaws in said closed position and to release said jaws from constraint by said outer member for movement to said open position.

24. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body;

jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening, said jaws being biased toward said open position;

a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position;

an outer member disposed around said tubular member and coupled with said handle, said outer member being movable by said handle to constrain said jaws in said closed position and to release said jaws from constraint by said outer member for movement to said open position, said outer member having an external surface and a scale along said external surface for taking measurements in the body;

a plurality of preformed, contractible ligature loops of filamentous ligature material slidably disposed in said tubular member, each of said ligature loops having a knotting element attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first size opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws; and

an operating member disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being operable by said handle to change said configuration of said knotting element of said at least one ligature loop to prevent expansion of the ligature.

25. A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising

an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body;

jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening;

a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position;

a plurality of preformed, contractible ligature loops of filamentous ligature material slidably disposed in said tubular member, each of said ligature loops having a knotting element attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws;

an operating member disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being operable by said handle to change said configuration of said knotting element of said at least one ligature loop to prevent expansion of the ligature; and

a cutter disposed around said ligature material and having a cutting blade movable from a non-cutting position to a cutting position to cut said ligature material proximally of a ligature formed with one of said ligature loops.

26. A ligating instrument as recited in claim 25 wherein said cutter has a proximal end coupled with said handle, said handle being operable to move said cutter between said non-cutting position and said cutting position.

27. A method of forming ligatures in anatomical structure at an internal operative site in the body comprising the steps of

providing a ligating instrument including an elongate instrument body having a distal end, a proximal end and a lumen between the distal and proximal ends, a ligature supply disposed within the lumen and an operating member disposed at the proximal end of the instrument body and connected to the ligature supply for moving the ligature supply relative to the instrument body, the ligature supply including lengths of filamentous ligature material carrying a plurality of fixed knotting elements and a plurality of movement permitting knotting elements arranged thereon in spaced, alternating sequence to define a plurality of ligature loops, each ligature loop including a fixed knotting element, a movement permitting knotting element spaced from the fixed knotting element and segments of the lengths of ligature material extending between the fixed knotting element and the movement permitting knotting element, the fixed knotting elements being fixedly secured to the lengths of ligature material, the movement permitting knotting elements being movably carried by the lengths of ligature material to permit movement of the ligature material relative thereto to reduce the size of the ligature loops when the ligature supply is moved proximally relative to the instrument body;

introducing the distal end of the instrument body at the internal operative site;

withdrawing a ligature loop from the distal end of the instrument body to position the ligature loop, including the knotting elements therefor, externally of the instrument body;

positioning the ligature loop around anatomical structure;

moving the operating member to move the ligature supply proximally relative to the instrument body while the movement permitting knotting element of the ligature loop is held externally of the instrument body to reduce the size of the ligature loop around the anatomical structure to form a ligature; and

withdrawing another ligature loop from the distal end of the instrument body to form another ligature at the operative site without withdrawing the ligating instrument from the body.

28. A method of forming ligatures as recited in claim 27 and further including, prior to said step of withdrawing another ligature loop, fixedly securing the movement permitting knotting element of the ligature loop to the ligature material to secure the ligature.

29. A method of forming ligatures as recited in claim 28 and further including, subsequent to said step of fixedly securing, cutting the ligature material proximally of the ligature.

30. A method of forming ligatures in anatomical structure at an internal operative site in the body comprising the steps of

providing a ligating instrument including an elongate instrument body having a distal end, a proximal end and a lumen between the distal and proximal ends, a ligature supply including a plurality of preformed ligature loops of filamentous ligature material disposed within the lumen and an operating member disposed at the proximal end of the instrument body and connected to the ligature material for moving the ligature material relative to the instrument body, each ligature loop including a knotting element permitting movement of the ligature material relative thereto to reduce the size of the ligature loop when the ligature material is moved proximally relative to the instrument body;

introducing the distal end of the instrument body at the internal operative site;

withdrawing a ligature loop from the distal end of the instrument body to position the ligature;

loop, including the knotting element therefor, externally of the instrument body;

positioning the ligature loop around anatomical structure;

moving the operating member to move the ligature material relative to the instrument body while the knotting element of the ligature loop is held externally of the instrument body to reduce the size of the ligature loop around the anatomical structure to form a ligature;

fixing the knotting element of the ligature loop to the ligature material to secure the ligature and, simultaneously with said step of fixing, cutting the ligature material proximally of the ligature; and

withdrawing another ligature loop from the distal end of the instrument body to form another ligature at the operative site without withdrawing the ligating instrument from the body.