US 2104029 A
Description (OCR text may contain errors)
c 5r a blood vessel.
Y A. Patented Jan. 4, 19738 Y l l Y Y :UNIT-ED'STAT-ES PTENFOFFIICEY t 2,104,029" y HEMos'rA'r' v Louis. A... Eshman, Los AngclesrCalif. .Application May 13,. 1936, Serii1-.1\i ..y '19;512 iifclaims., (calza-326) `My invention relates to a'hemostatoffantypeeto Another` object` and feature of my invention prevent bleedingfby forming a-ligature` around an.A as it relates to the implement is in using a crossA artery, vein, arteriole, venule orotherblood vessel. handled .tool pVOted irl themfrmer 4Of Surgical orthe'like, forConvenience'designatedherein as. shears a-ndhaving one stem with clampingorV Y gripping jaws for the freeend of the gut and Invarioussurgical.operations it is thepresent the -otherstem'y having anger for feeding-thepractice to Aligate blood vessels'with'hand [operendl-into the-gripping jaws. The gut'isprefer-f ated instrumentsor byl handusi-ngjfcatgut in ably'fsupplied-from ay spoollmountedfon one of` Vwhichreach individual ligaturejmade must be done the handles which passes through guide eyes,r one 0y by-either hand operation' or by hand manipulation being-adjacent the pivotand theiother adjacent Yoiya `tool land Vusually'tlie blood' vessel must'be thestemhavingwthe finger, the gut beingvheld clampedV prior' to or. at Vthe time of vapplying the under tension; Withthis device afeatureinthe catgut ligature. In some operations allargefnumoperation is pressing a strand of the gut held beber 'of-ligatures-of blood vessels must beemade" tween the clamping. jaw and the.r iingerwhen and asthetimeior performing the operation is spread apartf against Ythe flesh wherev a blood usually morev Vor less s limited, a. considerable vessel is imbedded in the surface and thensqueezamountof'time available is consumed in'makirigr ingA thefhandlestogether which causes the .jaw these various'ligaturesfofjthe bloodvessels., and the fingers. to again engage. Atv the vsame An objectl and feature. of this present inventime the blood vessel issqueezed betweeny com-..
2Q' tion is a combination hemostatand catgutapply-V Vplementa-ryv devices ontheend of the *sternV in` f ingsor ligatingV device whichfunctions to :wrapthel Vcludingaiz. pinfand a pressure device. These.
' `gut-,around a bloo'dfvessel while it is'stillimbedded' bringthelstretchedfgut into thetightengagement in a surface portion of the Vflesh to V.effect theirm withthey blood vessel; a knifelike'.device-formed attachment or11igating`f of the ends; of,v thegut` preferably on. the ljawportion .of the tool then 25f- WrappedY varound the blood. vesseland to out*y 0r operates to sever thef ends,'.at the same timethe j sever the' ends.` leaving a finished ligature iniI end. portions ofA thezgutA after being wrapped which 511810100011r VeSSel hasfbeen Compressed; the` around thebloodvessel areclamped and' squashed gut ligature `llas been Wrapped aroundithe blOOd' together forming thefadheslveftype of ligature.
Vessel, th ligature SeVeIBdiaind hpOTOIIO the. My invention.alsoromprehends the manner. 0r
391 OflOOd Vessel Slightly Separated fromftheL-Sllrllllld--l rx'iethod offsurgically-ligating a member such as :a ing fleSh- Ilmak'll-Se 0f the' property 0f Surgical: blood Vesselv or the like, in which a strand of' gut that When' portrnllsral@A squeezed, squashed stretched gut is looped around the member, the or pressed together andat the.sametimefcrimped;y Vtwo .portions of 'the strand are; formedinto Ya that .adhesive.characteristics.are developed- Which bightwiththeporon's. of the Strandl jnvcontact;
" twofparts of the gut.
F'L frolm 'lm. `and COIltllllOllS attachment 0fY the and a'lhgnment, then these portions are squashed Y, u
or` pressed to form a binding union ofthe A:twof
With my I'IVEIOI'J. .I .115622121161 Stel'led Catgut` portions. of. the strand! In. addition, thestrandr;
such as received directly' from the sterile con-V is crimped and, finally Severed; Thisprodure tainers in which cas-ethegut. is ksoft and flexible l 1eaVes.as;the,na1 result the membersuch as. a. wl andlha's practically no springiness as is. thelcalsebloodv vessel; with Vth-egut-looped thereaboutland of the dnedf' gut' Therefore the' gut.ls"rea'dl1y two portions of ,a strand secured'together byjbeingV wrapped .around .the blood vessel andwhen the, squashed and crmpedunt, the-y adhere overlapping end portions, are ,clamped together M Y. nto i l illustrated ,in con .th they adhere without'the-,necessity offorming ak y y1 Ve 1 n s d h, E@ lon W1 f V45'.` knot. This action is therefore quickly ,performedy thepaccomphanyng' fav/1n?" ln W 1C and whenfthe two ends'adjacent theparts of the Flgure 1 1S a 51d? elea'tlon'taken m the dlr-01- gut adhering together are sever-ed, it leaves a1 tlm@ of we arrow'l of Fgme 2' complete ligature .due tothe adhesive properties Flgure 2 1S an edge @lef/anon taken 1n the dlrec'f of the -gut'when two parts arefrmly presseclfvory OHLO-'tllea'OW vofFlgllIe 1- f of squeezed'together.'v A feature of my 'invention`r Figure 3'iSadetall0r1gtU-dinal Sectionon thetherefore relates notV only to theimplement but line 3-'3 of Figure- 2 in` the directionof theL to the manner of making theiligature in which arrowsthrough-the-jaw on'.Y the right hand stem,
the end portions of thegut after 'wrapping around: having the ffeeding Yiingerfanditheseries of sockets a. blood. vessel arev compressed and in effect orl recesses.,
squashedfon'e onto theothentozrmly, adhere'. Figure 4;' is aY front elevationL of. thefl'awl 01,2,
Figure 3 taken in the direction of the arrow 4 of Figure 1 or 3.
Figure 5 is a detail longitudinal section on the line 5 5 of FigureV 6, of the jaw on the left hand stem showing the resilient gripping jaws, the knife blade, the squashing implement and the guide pin.
Figure 6 is a front elevation of the jaw of Figure 5 taken in the direction of the arrow E of Figure 1 or 5.
Figure 7 is a transverse section on the line 'I-'I of Figure 5 in ther direction ofthe arrows.
Figure 8 is a partial elevation of the jaws showing the first step in gripping the freeV end of the catgut by the resilient jaws on the left hand stem.
Figure 9 is an elevation similarto Figure 8 showing however the gut stretched between the left hand clamping jaw and the right hand jaw and indicating the manner in which the gut is pressed by the jaws around a blood vessel or the like.
Figure 10 is an elevation similar to Figures 8 and 9 illustrating however the final action involving squashing the blood vessel between the jaws squashing the soft catgut on one side of the bloodvessel and severing or cutting the free ends of the gut to make the crimped ligature.
Figure 11 is a cross section through a blood vessel with the catgut looped therearound and1 crimped to form the ligature, such section being taken in the direction of the' arrow II of Figure 12.
Figure 12 is an elevation of the ligature of Figure 11 taken in the direction of the arrow I2 of Figure 11.
In my invention I employ a scissorlike device I I in which there are two handles I2 and I3, each having a finger loop. One of the handles is provided with a ratchet bar I4 extending therefrom and the 'other with a gripping tooth I5 to engage'therewith as is common in surgical shears. The left handle is illustrated as having a slot I6 therethrough and through this extends the right hand handle, there being a pivot of a known type. Thus, there are two stems, a right stem I1 and a left stem I8 Vproviding at their ends a right hand jaw I9 and a left hand jaw 2D.
The left hand jaw 20 illustrated particularly in Figures 5, 6, and '7 has an oiset end piece 2I with a flat end 22. A resilient gripping jaw 23 has an end piece 24 with a roughened under surface indicated at 25 and an edge notch 26. This jaw has a resilient spring arm 21 extending-along the stem I8 to whichit is secured by a bolt 28 using an elongated washer 29 under the head of the bolt. VIntegrally connected to the spring arm 21 is a guide pin 3E, this being as shown as at tached by a riveted head 3l and such pin extends through a perforation 32 in the offset part 2I of the jaw. The pin has a notch 33 on the end which extends through the perforation 32.
Located on the jaw 25 is a transverse knife blade 35. This extends between the side edges of the offset end of the stem I8 and it has a notch 36 in the end. This knife blade has a slightly rounded outer edge 3l' so that it is not a sharp edged implement.
A pressing or squashing stud 40 is secured to the face of the offset portion 2l of the jaw 20.
This has parallel sides 4! and a central transverse notch 42. This squashing stud is positioned between the blade 31 and the guide pin 3D and is centrally located as regards these elements, beingV in alignment with the notches 26, 36 and 33.
Tris squashing stud is narrower than the guide pin and is substantially equal in width to the notch 33 formed in the end of this pin.
The right hand jaw I9 has a threading perforation 45 on the back extending from the lower end 46 to the outer end 4l and at this outer end there is an inwardly extending nger 48, the upper surface of the finger being in alignment with the outer end 41 of the jaw. This finger terminates in a slightly rounded outer edge 49 and has a longitudinal notch 5I] positioned centrally therein.
Below the finger 4S there is a transverse blade receiving slot 5I. This extends from side to side of the jaw IS on the stem I'I and is of suicient Width to allow the knife blade 35 to have a working fit therein and is of suiicient depth so that when the jaws are squeezed as tight together as possible, that the blade is slightly spaced from the bottom or base 52 of this slot 5I.
Located below the slot 5I there are two rectangular recesses 53 and 54, these being separated by a narrow iin 55. These recesses are to receive the Vprojecting portions of the squashing stud 40, the
fin 55 engaging in the transverse notch 42 of this stud and thus forming a limit to the inward movement of the jaws I9 and 20 towards each other. Located below the recesses 53 and 54 there is a cylindrical socket 56, this being positioned to receive the end of the'guide pin 30. The base 51 of this socket is adapted to be engaged by the end of the guide pin. On account of this pin being resiliently mounted when the jaws are fully clamped together, the pin 30 pushes outwardly on the spring arm 2'I and thus gives a slight movement to the resilient jaw end 24. It will be noted that the recesses 53V and 54 are centrally located as regards the sides of the jaw i9 and these are onlyV of sufficient width to allow the proper fit of the narrow squashing stud 4B. They are thus of less width considered transversely than the cylindrical socket 56 to receive the guide pin 30.
The feed of the gut thread is by using a spool or reel 60 which is shown as mounted on the arm I3 by a collar 6I or the like. The reel has an outer flange 62 and an inner flange 63, this latter having a toothed edge 54 engaged by the free end of the spring 65, the fixed end 66 being secured to the handle I3 Vby a screw 6'! or thelike. A winding of gut 68 is illustrated as being wound on the spool and has a lead 69 along the handle I3, then through an elongated eye 'FEI substantially'in alignment with the pivot pin of the handle, thence there is a lead II to the threading perforation 45 from which an end Section I2 of the gut thread leads over the end of the finger 43 engaging in the notch 55 and having a slight downturned end 13. On account of the gut being soft and flexible but without substantial springiness or resilient action the gut is readily bent over the end of the finger, and remains in this position with the portions 'H and 69 sufficiently tight to retain the gut in the proper position.
In the rst action to properly thread the gut, the handles are squeezed together a suicient amount to bring the jaws I9 and 2D substantially into the relation shown in Figure 8. This causes the finger 48 to become inserted underneath the upper portion 24 of the flexible jaw 23 mounted on the end of the spring 21 slightly upwardly inserting a fold or reverse bend 74 adjacent the end of the gut thread between the end 22 of the offset jaw portion EI and the reoleada? hetweenthe neisibleiaw :24 and the end .silient .24- llhe .gut is engaged by .the
Ateeth lo or roughened surfaoe on the nderside of. this resilient jaw a4 so .that the handles .are
frhowed apart. thus separating theiaws t9 and .2.0,
theiolded end of -thegut isheldl by the J'aw .20
vbetween 'its end portion 22 and the flexible jaw 24- f'lhisoauses .the guttohave atightly strotohed strand-:horden .l5 illustrated full lines ih* Figure y9 between'the soaoedaoart jaws..4
48 on the' jaw lll there isa downward oiiset 1.851 with a shear- Immediately belowV` the ,finger ing edge 8o and a .hat surface ilv therebelow eonheeting with the rhainiloody .of .the jaw above Vjaw 24 leavihgvsufiioieht space for the aotion .of :the shear-lng edge B6 operating .with the surface 2t' 'to shear Athe.strands oitlie'gut. This thus vsei/ers the gut- 'the aetion and-the'rnannerof operating .the :devioe is ihdioated mainly vin Figures 8 through lZiin which in Figure 9a blood'vessel is rindicated by the. numeral l5. .in its first position in full lirios- Thishoweyerlih ligatingrooerations is ernloedded ihlthe `ilesh- The Airholesieht pressed somewhat ololiquely so that the laws straoldle the lolood vessel and ioree this with .a oertain arnouht. oi the .ilesh sornewhat into the Position shown lor. l-'.,:ih .Figure i?,- oauses a nartolbight indieated at l5. to be formed `in the strand 15, this beingV indicatedA in dotted liheslis the laws are pressed inwardly the eight 1e' of .the strano is Vtroneo downwardly somewhat into the oosition of Figure lo and the. longitudinal notch 33 of the guide pin ,30 functions to align the two strands of the gut in oontact 'with each other and lining up-with the axis of the pin il?l therefore suon guide sin, when its end is'forced into the-cylindrical socket 56 orv the iaw le, positively. holds the two parts of the strand of gut closely contiguous to the blood vessel and. .a certain amountoi the flesh adhering thereto, somewhat as shown in Figure 10. operation. and `funotioning of the squashing stud 40 which has Athev (zentralA transverse Vnotch `42 isv to Apress orsquash the two aligned parts of the gut, the two parts of the studrnay force the gut slightly into Vthe recesses 53 `and 54 on the jaw l9,'thef1n 55 registering with the hetoh 421 forrns hart of. the kink .shown in the gutinFigure Ll. y n f 35 which as above mehr,
The knifelike blade Vtioned, has a rounded edge with a notch .35 therein, pressesy the two strands of gutforcing these l slightly rinto Vthe transverse slot .5I in the jaw I9 a-nd-rrrnly holding these two strands while being severed asabove, mentioned, by the shearingl edge $6 operating `irl conjunction with: the surface 2 2 of the ond 2l of the opposite jaw V2li when the two main' jaws are forced tightly together.' action squashes the soft guttogether and iorrns a series of kinks in the bight -22 oi the. onset rigid-portion o f-ftheiawd-.pis
ready .for another operation. l This vaotion :usually leaves aY shortseetion of the drst usediportionen-i. the gut oaught inthe iaw 2a butthls isl not. the way. and ymay be'lef't witnoutremoval or may be removed by a sharp instrumente or by the ngers, however, Vthe operation of .clamp-. ing `laws together frees any small end of t the gut Loaugntin 4.the jawel! between its flexible portion` and lits rigid-portion. Thus as soon-,as
.one blood yessel has .been squeezedand ligated These twostrandsareparallel. .The type of ligaV ture Ais indicated bythe `assembly'numeralf'l in which on one side there is a hump 'I9 and on thev other sidey a, depressionrll. The endportions severedlby .the shearing'edge are indicated at 8l, the immediate loop around thelblood vessel being indicated lat 82. It-is' to Lbe understood, ho-Wever, that 'the two portions -of the gut are so pressed and .squeezed together-that in reality they merge or adhere together. The crimp's and kinksformed inthe soluashedgut aldi in the ad- `hesionof the. two portions of thegut strand.'
I AIn the operation of my hemostat of course a surgeon willbe guidedjby his prior experience and by the sizeof the blood've'ssel `or other tissue to .be ligated. For instance, should thebl'ood vessel .be 'quite small and readily picked up, the vjaws should only be spread apart a suilicient amount to properly engage the blooduvessel and to form the crimp and squashing of the gut. -If
the blood vessel and tissue to be engaged fby the gut islarger, manifestly the jaws would be spread Wider apart in order to provide a longer strand section such as illustrated at in Figure 9. The
- minimum distance'of spreading the jawsto pro'- Y.v idea suflieient length of strand such as Vl5 be'- `tween the -jaws is such that the two sides of the Vforceps and brought to a position toy engage the Also it is not ystrand of gut between the jaws. necessary to force the' ends .of the jaws deeply into the flesh vas the instrument can be held at an acute angle to the surface having the Yblood yessel. tov loe ligated. The illustration of. Figure 9 is intended to show the relativeposition taken by the blood vessel at -lB and. l5. as the jaws are inet/ed togetherin various .stages of the same oheration to .bringthe blood vessel and the .bight ofthe strand. of. gut into somewhat the position shownin Figurellh lf: there is anyY flesh surrounding the blood vessel this mayY heremoved from the -iaws which squash .thegut and therefore thereewoulol loe no injury to: suon flesh. vWith rny instrument of oourse it is manifest that the .surgeen would require his Askill the operation of the. device to. make. good ligatures anoto operate quickly, but with my instrument and manner of procedure, a series of members can be much more rapidly ligated than is the present practice.
Various changes may be made in the details of the construction without departing from the spirit or scopeA of the invention as defined by the appended claims.
1. A hemostat comprising an instrument having stems pivotally connected, each with a jaw thereon, a feeding device for gut mounted on one of the jaws,.a resilient jaw connected to the second jaw and adapted to retain the end of the gut on bringing the jaws together so that on separation of the jaws a strand of gut extends between said jaws whereby such strand may be looped around a member to be surgically ligated, means on the said jaws to align the end portions of the gut extending from the member surrounded by the gut and means to compress the end portions of the gut to secure same together whereby the gut may be securely attached to the member surrounded by the gut.
2. A hemostat as claimed in claim 1, one of the jaws having means to sever or cut the strands f the gut spaced from the portions of the gut secured by pressing together.
3. A hemostat comprising in combination an instrument having handles with stems pivotally connected together, one of the stems having a jaw with a gut feeding nger, the other stem having a second jaw with a resilient secondary jaw connected thereto whereby when the jaws are moved together the said nger is adapted to engage an end of a thread of gut in the secondary jaw so that on opening of the jaws a strand of gut stretches between the two jaws, the jaws being operative to form a loop in the gut around a member to be surgically ligated forming a bight in the strand, complementary means on the two main jaws to align the strand portions of the gut forming the bight, means to compress or squash together the said strand portions forming the bight and complementary means on the two main jaws to sever the two strand portions forming the bight spaced from the article to be ligated, the said severing means being operative when the two main jaws are brought together.
4. A hemostat as claimed in claim 3, means to feed the thread of gut to the said finger whereby on closing the jaws to loop the strand around the member to be ligated and in securing the bight of the loop together, a new strand becomes attached to the secondary jaw.
5. A hemostat comprising an instrument having stems pivotally connected together, each with a jaw thereon, means to grip one end of a thread of gut by one jaw, the other jaw having means to stretch a strand of gut from the holding jaw,
the said jaws when brought together being adapted to form a bight on the strand around a blood vessel to be ligated, a guide means on one of the jaws having a notch to align the two portions of the strand of the bight one in contact with the other and a squashing means cooperative between the two jaws to squash the two portions of the strand forming the bight whereby the gut may form a ligature around the blood vessel.
6. A hemostat as claimed in claim 5, a severing means operative between the two jaws when firmly pressed together to sever the two portions of the strand forming the bight, the point of severance being displaced from the portion of the strand squashed together.
7. A hemostat as claimed in claim 5, the squashing means including a squashing stud having a transverse notch on one jaw, the opposite jaw having recesses with a fin, the iin being adapted to interfit with the said notch to thereby form a crimp in the two portions of the strand forming the bight.
8. A hemostat as claimed in claim 5, one of the jaws having a transverse knife blade with a longitudinal notch in alignment with the notch of the guide means, the notch of the knife being adapted to engage the two parts of the strand forming the bight, the opposite jaw having a transverse slot to receive the said knife and thereby retain a firm grip on the two portions of the strand during the squashing of the said portions of the strand.
9. A hemostat comprising in combination an instrument having stems, each with a jaw thereon and means to mount said stems to bring the jaws into operativev engagement, a first jaw having a fixed jaw element and a resilient element engaging the end thereof, the second jaw having a projecting finger with means to guide a thread of gut over the finger whereby on initially engaging the finger with the jaw elements of the first jaw, the end of a strand of gut may be gripped by the said jaw elements, the spreading apart of the jaws being adapted to form a strand of gut extending from the rst to the second jaws adapted to form a loop with a bight of the strand around a member to be ligated, the said jaws having means to align the two portions of the strand forming the bight and means to squash the aligned portions of the strand, the second jaw having a shearing edge cooperative with the fixed jaw element of the first jaw and thereby sever the two portions of the strand forming the loop and bight on completion of the ligature.
10. A hemostat as claimed in claim 9, the means to align the two portions of the strand comprising a guide pin resiliently mounted on the first jaw and having a notch therein, the second jaw having a socket to receive the end of the guide pin.
11. A hemostat as claimed in claim 9, the means to squash the gut comprising a transverse knifelike device on the first jaw having a longitudinal notch to engage the portions of the strand of the gut, the second jaw having a transverse slot to receive the knife and a squashing stud on the rst jaw cooperating with the second jaw to squash the gu 12. A hemostat as claimed in claim 9, the second jaw having a device for guiding the gut, a means for supplying the thread of gut and maintaining a desired tension on the strand whereby the nger on the second jaw co-acts with the first fixed and resilient jaw elements when the shearing edge cooperates with the fixed element of the first jaw to shear the first strand of gut to insert the end of a second strand of the gut thread into gripping engagement between the resilient and fixed elements of the rst jaw.
13. A hemostat comprising in combination pivotally connected handle members, each having a stem, one stern having a, first jaw and the other a second jaw on the ends, a reel for gut mounted on one of the handles, the second jaw having a guiding perforation for the gut and a finger on the end facing towards the first jaw, said finger having a central notch, the nger being transverse to the jaw, the first jaw having a fixed end portion and a resilient gripping jaw with serrations whereby on moving the jaws together the said ngerinserts the endof a thread of gut between the fixed end and the resilient jaws and whereby on separating the jaws a taut strand of gut is stretched between the first and second jawsY whereby said strand may form a loop around a member to be ligated, the rst jaw having a guide pin connected to part of the resilient jaw, the guide pin having a notch to engage the two portions of the strand of gut which form a bight around the member, Athe Y second jaw having a socket to engage the said pin, a knifelike device on the first jaw having a notch to engage the gut, a transverse slot on the second jaw to receive ther knifelike device, a squashing means on the rst'jaw cooperating with a complementary squashing means on the second jaw to squash, press together and crimp thetwo portions of the strand between the pin and the said knifelike device and a severing means on the said jaws operative when the jaws are forced tightly together to sever the two portions of the strand spaced from the knife-like device.
14. A hemostat as claimed in claim 13, the said severing means havinga shearing edge mounted onthe second jaw immediately adjacent the said nger, said edge being operative with the xed end of the first' jaw, the said finger being adapted to space the resilient jaw from the said xed end of theV first jaw y'and insert the end of a second strand of the thread of gut between the xed jaws apart.
Y end and the resilient jawon'again spacing they LOUIS A. Eem/IAN. 15