US 2012776 A
Description (OCR text may contain errors)
935. H. A. ROEDER 2,012,776
LIGATOR Filed May 20, 1932 2 Sheets-Sheet l J 21672i07f Aug. 7, 1935. H. A. ROEDER 2,012,776
LIGAI'OR Filed May 20, 1932 2 Sheets Sheet 2 777W i i9;
Patented Aug. 27, 1935 In tying arteries and' tissues during operations or bringing together the lips. of a wound when stitching the practice has hithertobeen to place a gut filament around the artery clipped with clamp forcepsor around the tissue parts and to' loop it to a surgical, knot, 'and; when stitching Wounds, todraw a gut filament or the like by! means of ain'eedle through the! lips of the wound; to bring' the lips together and then toknot the gutji V V Appliances have also already been-proposed for facilitating the forming of the knotf' These appliances fhave, however, not been generally adopted in practiceas they are not only'complicated but are diflicult-to manipulate. In addition'the second loop required for making the knot hashad to be formed with the fin'gers.
' Accordihgfto' the inventionthe gut isfprepared for tying. u nr stitching by :a'preliininaryknot being formed in it. The loop need t'hen only be 7 drawn tight for tying-up an artery'orfor bringing the lips of a wound together." I I V For manipulating the gutthe invention providesan appliance,the -object of which 'is t bring the loop to the desired place; i I
1 he appliance' forming the subjectmatterof the invention is thereforeaninstmiment into whicha prepared gut filament having' a loop is inserted. a I A constructional example of the instrument according tov the invention is illustrated in the accompanying drawings in which Fig. 1 showsdiagrammatically a surgical filament with a slip knot according .to'the invention. Figs. 2 and 3 show a similar knot to that of Fig. 1, diagrammatically and-in perspective,
Fig. 4 is'a diagrammatic view of another way of forming the slip knot,
Fig. 5 is a, similar'knot to that of Fig. 4,: 7
Fig. 6 shows another'way, of forming the slip knot, Fig. 7 is aslip knot according to Fig. 2 shown diagrammatically, formed. on a separate surgical filament,
Fig. 8 is the slip knot according to Fig. 7' shown in perspective, I
Fig. 9 shows'a gut according to Fig. 1, which is looped around a pin, and'how a needle may be introduced through the hollow pin, 7
Fig; 10 shows in elevation a constructional form of an instrument for carrying out the invention having rigid finger rings, I
Fig.- 11 a constructionalfor'rn with slidablefingerv rings,
Fig. 12 is a section on line XIIXII of Fig. 11,
' b'y' pullihg the' end l in the directiongof-the rrow i? ulling Fig; s somewhat 'niodifiedform partly brokenaway, Fig. 14 aside-view of 'the'upper part of Eig'lO d.,. .J;
. Fig. 15 another'form of the instrument to an" F k whemthe slip knotl isiheld fasti- Fig; 2:shows anotherway of forming knot. The loop 3'-i's' i this 'case" also-contracted 5'-is the part-of lthe filament wrapped around the middle part thereof.
1 Fig'. 3 shows the knot-illustrated diagrammath cally in Fig. 2 drawn together. [It is not possible o--"eiilarge the ofo' by pulling in the "direction of the arrow B V *Inthe case o the filamen showninFiga the knot is tightened "by. nippingthe 'passed through end after-the loop'has'bee'n'draw'n tight. .c. According to F 6, on the loop being-pulle I f the' knetare laid -tightly Y the outer filament'iend hipped 1 ii. a
by way of example. It is not essential, that .the f knot shall, be formed as described above and 1 other forms. of knot maybe used, as' the gut.
swells owing to the moisture of the-body, .causing the knot'to tighten up on the middle part of the filament, thus tying off the artery, as experiments have proved.
Accordingto Fig. 7 aslip knot, as shown in. 1
portion of tissue or two'lips of a wound which 4 7' are to be drawn together haye been pierced, being knotted with the loop 1, by pulling at the filament 8 in the direction-C, the lips of the wound may be brought together and at the same time the; loop formed by the filaments I and 8 7 may be contracted without .any danger of the loop becoming loose again..;Instead of: forming a loop or eye I. with'the filament 6, it is of course also possible to knot, the end of the filament 8 5'5 the slip a 5 "rue forms of k-not 'illustrated are only give ri 3e which has been inserted. in the needle with the free end of the filament 6.
From Fig. 8 is will be clearly seen how the filaneedlel l. After thetissues have been pierced, this end can be passed throughthepin 9:in the direction of the arrow D. After the pin has been 7 withdrawn from the slip knot the parts of the tissue aretied ofi in the manner described. 4
. As shown in Fig. 10 the appliance for bringing" the filament into position consists of a barshaped part I I which is provided at one end with a some-' what thicker handle part and jat the'other'end with a slightlytapered carrier part. The handle, as shown in the drawings, is provided with rings I2, 13, M which are'rarranged in a knownmanner so that .they can be grasped with the thumb and v the first and second finger of the hand; The carrier part is tubular, has a channel l5 and is preferably bent over at an angle of to the part I l as'willlbe seen from Fig. 14. The free end 16 or the carrier partis ball-shaped, so as to avoid injury when the instrument is in use. s
Whenthe instrument is-to be used, a gutfilament I'Lwhich is provi-dedi with, a loop as dee scribed above, but which is not shown, is intro duced at l B, so that itprojects with .the not illustratedloop at the other'endof the channel I5 and; ,thefloop. of. the" gut filament: is passed over the handle of, the clamp forcepsfwhich have-been applied. Withgthe instrument the loop of: the
I gutfilament is brought overthe place to=be tied off and drawn completely tight, thefingers of one hand. gripping the rings 2 l3, and I 4. and ,the other hand drawing the loop of the gut filament tight... r v; p
r As shown in Fig l1 the rings' f o r the middle and first finger may also be slidable onfa non-circular, for instance a four-cornered, part] f the handle up .to the-pointwhere they strikejagainst the.
stop l9. In this extreme position they are held by a leaf-spring 2 0.
- Asshow'n in Fig; l l the left'- hand ring [2 may.
be pivoted on a pin, .2 I. which is screwedinto a guide part. 22 which is slidable on the part 18,.
The; inner end of] the ring; part l2 is eccentric,
as will be seen, from the figure, so that the gut filament I! can be gripped between the righthandring l3-and the left-hand ring [2. The ring 12 is held in this position by a spring 23.
When a gut filament is introduced into the 5 tubular'part and is clamped between the rings l2 and I3, the loop of the filament is first reduced in size by moving the rings l.2 and I3 in the direction of the arrow A, .and; oil-the pull continuing-is-drawn completely tight-g1 After the 10 artery has been tied off the gut filament I1 is freed from the clamped position by swinging over the ring l2 in the direction of the arrow E.
The-constructional form shown in Fig. 13 difiers from that ofFig. 11 only in this, that the two 15 case .be-twined round the rings. By moving the rings downwards the loop is contracted or drawn .In thecons'tructional form shown in Fig. 15 the ball-shaped part I6 is arranged to be slipped ,on
The bent over The gut ,tothe free end of the part H"; end 241s not bored butvhas a, groove 25.
filament IT can therefore be threaded into the 2 ball-shapedpart-lt and the connection between the instrument and the .gut filament is effected by slipping the ball-shapedpart l6 ontothe part 24. The bore-26. of the ball-shapedpart-is for this purpose made slightly conical, widening to Q9 wards the apart 24, and the part-.24 is made with a corresponding taper. Y.
The endof thecarrier partmay lie in any plane with respectto the plane of the rings, accordingto the purpose forwhich the instrument 1 3 is to beused. f 7 r A ligator comprising inycombinationga barshaped carrier member for the. surgical filament and a non-circular handle part, the carrier mem- 4Q ber'being, bent over at the ,free end and having a channel in'the bend,;the handle part having a fingerring atthe free endandcarrying a sleevelike member guided thereon, anda spring brake for the sleeve-like member, finger; rings being se- 4,5 cure-d on opposite sides'to the said;;sleevelike member, one of the said finger rings being mov-