US 2277139 A
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March 24, 1942. F, Q NIEMAND 2,277,139
SURGICAL INSTRUMENT Y Filed Dec.' 15. 1959 Illllllllllrllllllllllll 58 Y "il" f;
VENTOA a Tramway Patented Mar. 24, 1942 UNITED STATES SURGICAL INSTRUMENT Frederick G. Niemand, San Francisco. Calif'. Y Application December 15, 1939, Serial No. 309,583`
Claims. :(.Clt l--llg-I)V The present invention relates to surgical instruments and particularly to instruments for handling and applying metallic ligatures.
In surgery, metallic ligatures have, to a great extent replaced the ordinary suture for closing wounds. These ligatures, which consist of small metal clip-like members with flesh-engaging barbs, are bent to assume a position with the barbs engaging the flesh on opposite sides of a wound to draw and hold the edges of the wound in contact with each other to facilitate healing. It isfnecessary that the clips, and any instrument employed in their application, be sterile, and it is desirable that the clipsl be handled in a manner to admit of accurate and rapid placement so as not to prolong unnecessarily the time of applying the ligatures.
It is the object of the present invention to provide an instrument for holding and applying metallic ligatures in which they may conveniently be sterilized and by whichl they may be applied to a wound quickly and conveniently.
A further object is the provisionl of such an instrument with a pistol-like shape in which the ligatures are contained in a magazine and presented one at a time to a clamping mechanism at the distal end of the instrument, and in which the said clamping mechanism is actuated by a trigger-like member under pressure of one nger of the hand which holds the instrument.
It is also an object of the invention to provide a device of this characterv of relatively simple construction and in which a supply of metallic ligatures may readily be placed for automatic feeding toward the distal end, andv for automatic and positive application.
Further objects and .advantages of the invention are made apparent in the following specification, wherein reference is made in detail to the accompanying drawing, in which` one form of the invention is illustrated.
In the drawing- Fig. l is a side elevation of a surgical instrument embodying the present invention;
Fig. 2 is a rea-r end View of the same;
Fig. 3 is a section taken on line III- III of Fig. 1;
Fig. 4 is a section taken on line IV-IV of Fig. 1;
Fig. 54 is a, plan view of the instrument shown in Fig. 1;
Fig. 6 is a section taken on the line VI-VI of Fig. 5;
Fig. 7e is aipl'anrview similarftoFigQ- butw-ith the parts illustrated in their ligature-closing position;
Fig.` S is a perspective view of a conventional metallic ligature of a type that may be used in the instrument of thisfinvention; `and f Fig. 9 is a perspective view of the same ligature in its closed position. I
Referring to the drawing ink detail, the instru'- ment is shown as comprising a handle I9 of the pistol-grip type,V adapted to be held in the hand with the index nger free to exert pressure on a trigger I I inthe same manner that thetrigger of a gun is actuated. The handle l0 supports a forwardly projecting plateA I2 on the upper surface of which a magazine I3 is -supported yfor longitudinal sliding` movement. The magazine I3 is connected with the trigger Il by means `of screws such as indicated at I5, which screws pass through a pair of slots I6 in the plate I2 and serve with said 'slots to guide the trigger and magazine for longitudinal sliding movement relative to the plate. A spring I1 engages between the trigger II and'handle IIJ normally to urge themagazine and trigger forwardly, and this spring embraces a pin I8 by which it is guided and which is fixed to the rear edge of 'the trigger. and slidable into a hole I9 bored in the handle II), as best illustrated in Fig. 6. The magazine I3 consists chiey of a metal bar, generally rectangular in cross section, and having a slot 20 milled in its upper edge toslidably receive a supply of ligatures.
The manner in which the ligatures are received by the mechanism may best be understood upon reference to Figs. 3 and 8. In Fig. 8 a
conventional ligature is shown as being formed. of a metal strip 2| bent upon itself to'iorm` rounded ends 22 from which barbs 23 project to engage the flesh and drawv together the opposite sides of a wound` when the ligature is bent to the position indicated in Fig. 9. The ends of the metal strip 2| terminatecentrally of the back of the ligature and are bent outwardly to form ay pair of Wings 24. These wings 24 serve,' when the ligature has been bent to the position illusguide the ligature in the magazine, and for this purpose are placed in the slot 20 of the magazine bar I3. When a plurality of ligatures have been placed side by side in the magazine in the position illustrated in Fig. 3, a retaining bar 25, which is pivoted by a pin 26 at the rear end of the magazine, is brought down to overlie the clips, as shown in Fig. 3, and prevents their removal from the magazine while permitting them freely to slide longitudinally thereof. The retaining bar 25 is locked in its closed position by a pin 21 inserted in registering perforations in the bar itself and in one side of the magazine in which the bar is pivoted. This locking pin 21 is carried by a plate 28 fixed to one end of a plunger 29 which slides through the magazine and has an enlarged head 30 at its opposite end. A spring 3I interposed between the head 30 and the magazine I3 normally urges the plunger outwardly, but when it is pressed inwardly against the tension of the spring 3I it effects withdrawal of the locking pin 21, to permit the retaining bar 25 to swing around its pivot 26 to the position illustrated in dotted lines at 25a in Fig. 1.
The arrangement of the locking pin and plunger is such that the head 30 on the plunger is arranged on the right side of the instrument, in a position where it may conveniently be depressed by the thumb of the right hand holding the instrument while the left hand is employed to raise the retaining bar 25 and insert a supply of clips to the magazine.
In order to facilitate feeding of the clips toward the distal end of the magazine, a weight 34 is slidably mounted on the retainer bar 25, and is provided with a trailing spring finger 35 adapted to engage the teeth of a rack 36 cut in the upper edge of the bar 25. The spring is secured to the weight adjacent its rear end, so that it may be lifted out of engagement with the rack 36 when it is desired to move it rearwardly of the bar 25. The tendency of the weight during use of the instrument is to gravitate forwardly, as the instrument is usually held with-its distal end in a lowered position. This forward movement of the weight 34 urges the ligatures forwardly, so that the foremost one will always be presented to that portion of the instrument from which it is discharged.
At the extreme forward end of the retainer bar 25 a spring 3S is xed to extend forwardly and curve downwardly over the rounded forward end of the magazine I3, and thus to guide the ligatures one at a time to a position between the ends of a pair of levers 40, where they are supported and aligned by a plate 4I which is secured to and extends forwardly from the magazine. As the foremost ligature in the magazine passes around the forward curved end thereof, and comes to rest against the plate 4I, its outer ends lie between the ou-ter ends of the levers-4U, in the position illustrated in Fig. 5, so that upon being brought together theselevers will cause a compression of the clip to its flesh-engaging position, which is illustrated in Fig. 9.
'I'he levers 4I) are pivoted as by screws 42 to the plate I2, and are provided with tails 43 having opposed inwardly-converging cam surfaces 44. A cam 45, shown as circular in shape, is fixed ina suitable recess in the lower surface of the magazine I3, so that when the magazine is retracted with respect to the plate I2 by pressure on the trigger II, the cam 45 engages the surfaces 44 on the tails of the levers and moves the forward ends of the levers together, to bend the (i Il ligature into its flesh-engaging position. This same movement of the trigger II serves to retract the plate 4I which is supported by the end of the magazine, and thus removes the plate from the position where it supports the ligature, which is then supported entirely by the ends of the levers 40, without obstruction during its bending and application to the wound. The retraction of the magazine also causes the end of the spring 38 to snap over the ligature held between the ends of the levers 40. While the magazine is retracted, the ligatures in it are free to move forwardly under inuence of the weight 34, so that the next one will be positioned between the ends of the levers 40 when the magazine is released.
The outer ends of the levers 40 are normally urged apart by a pair of springs 46 (see Fig. '1) which engage their inner ends and are wound on pins 41 and anchored in holes 48 in the plate I2. Y
With lthe construction described above, the instrumentmay be held and operated with the right hand while the left hand is free for use in connection with properly positioning the flesh for reception of the ligatures. Furthermore, the ligatures, which are contained in large number in the magazine of the instrument, may be applied as rapidly as desired, and with thev necessity only of imparting pressure to the trigger II with the index finger. The shape of the entire instrument is such that it is convenient to handle, and the ligatures may be applied in exactly the position desired and with a rapidity that facilitates the entire operation.
While certain features of the invention have been described in detail for purposes of illustration, it is to be understood that various changes may be resorted to in the construction and arrangement of the several parts, all within the scope of the appended claims.
Having thus described and illustrated my invention, what I claim and desire to secure by Letters Patent is l. An instrument for applying surgical ligatures comprising a pair of levers pivotable to engage and bend a ligature, a magazine to contain a plurality of ligatures and present them one at a time to a position between said levers, a pistol-grip handle supporting said levers and magazine, a trigger, and means operable upon compression of the trigger to retract the magazine and pivot said levers. i
2. An instrument for applying surgical ligatures comprising a pistol-grip handle, a' plate extending fowardly therefrom, a pair of ligaturebending levers pivotally mounted on said plate, a magazine for supplying ligatures to said levers, retractably mounted on said plate, a trigger positioned for compression by the index finger of the hand holding said handle, and means whereby compression of the trigger will effect retraction of said magazine and bending of a ligature between said levers.
3. In an instrument for applying surgical ligaof ligature bending levers arranged to receive ligatures from one end of the magazine, a handle disposed substantially at right angles to the magazine at its opposite end and adapted to be gripped by one hand, and means operable by the gripping hand to retract the magazine and pivot the levers.
5. In an instrument for applying surgical ligatures, a handle, a plate supported thereby and extending forwardly therefrom when the handle is gripped in the manner of a pistol, means for supplying ligatures one at a timeito and bending them at the forward end of said plate, and means operable by the hand gripping the handle for actuating the supplying and bending means.
FREDERICK G. NIEMAND.