Abstract:
Co-axial actuated scissors for slidable positioning along a nerve for cutting the nerve or other anatomical surgical structure in a plane normal to the longitudinal axis of the scissors and away from the surgery site without harming adjacent tissues includes a first scissor portion having an offset handle attached to a slotted cylinder and a second scissor portion having an offset handle attached to an inner cylindrical member with the inner member telescoped within the slotted cylinder for concentric rotation therewith and the slotted cylinder and rotating member defining the longitudinal axis such that the cylinder and the rotating member include a loop end comprising a pair of cutting jaws whose cutting action is normal to the longitudinal axis and which are movable from an open position to a gripping position to a fully closed position for cutting the nerve through rotatable concentric actuation of the rotating member relative to the slotted cylinder and with detents positioned on an arcuate arm of the first scissor portion successively engaging a receiving notch located on the handle of the second scissor portion for holding the cutting jaws in each position as needed in order to effectuate the surgical operation.

Description:
FIELD OF THE INVENTION 
     The present invention pertains to surgical cutting instruments, and more particularly pertains to surgical scissors having cutting blades that cut at an orientation normal to the primary axis through which the handles travel for the co-axial actuation of the cutting blades. 
     BACKGROUND OF THE INVENTION 
     In cutting or severing a nerve or other anatomical structure a number of critical factors and circumstances must be taken into consideration for achievement of a successful surgical procedure. The actual cutting action, for example, must be accomplished without cutting any adjacent structure, and such cutting action often doesn&#39;t require direct visualization of the structure being cut. Indeed, with certain types of surgical procedures, non-visualization is often preferred. Moreover, there are other procedures, such as common digital neuroma excision in the foot, where severance of the nerve as far away from the main site of surgical dissection is preferred. By severing the anatomical structure as far as possible from the main surgical site as is surgically prudent, postoperative complications such as recurrent nerve entrapment are minimized. In addition, the positioning of the scissors in proximity to and then over the structure to be cut, and then the further movement of the scissors along the structure as far from the surgical site as determined to be prudent by the surgeon, and to the exclusion of any surrounding structure, must be carefully and unobtrusively accomplished. Thus, the proper use of surgical cutting instruments must provide for the optimal severance of the anatomical structure as far away from the main surgical site as is practical and clinically indicated in order to decrease the chances for post-operative complications such as symptomatic soft tissue structure entrapment within the area that defines the most concentrated operative scarring. 
     Thus, the prior art discloses a number of surgical cutting instruments, prominent among them are the Steinberg et al. patent (U.S. Pat. No. 5,746,748) that discloses a circumcision instrument that includes pivotally interconnected cross members that includes handles with finger loops at a proximal end jaws at a distal end with the jaws having surfaces that contact and clamp tissue therebetween for severing. 
     The Wales patent (U.S. Pat. No. 5,800,449) discloses a knife shield for surgical instruments that includes a handle from which a tube extends and which encloses therein a tissue stop for protecting tissue engaged by the jaws of the forceps until the surgeon desires to cut the tissue. 
     The Eubanks, Jr. et al. patent (U.S. Pat. No. 5,593,420) discloses a miniature endoscopic surgical instrument assembly and method of use that includes a securing mechanism for securing a miniature medical implement member to a support sheath so that the support sheath strengthens the implement member and prevents the implement member from breaking during an endoscopic medical procedure. 
     Nonetheless, despite the ingenuity of the above devices, there remains a need for a surgical cutting instrument having ergonomic handles that are offset from the main working axis of the instrument and which includes various operational handle positions and cutting jaws that cut in a plane normal to the main axis of the instrument and which are movable concomitant with the movement of the handles to the various positions for properly orienting and aligning the instrument with respect to the anatomical structure before cutting the structure. 
     SUMMARY OF THE INVENTION 
     The present invention comprehends co-axial actuated scissors for cutting anatomical structures, such as nerves, in a plane that is normal (at 90 degrees) to the primary working or operational axis of the scissors, with the working or operational axis extending from the base of the manually operable scissor handles and through rotatable cylindrical members to the cutting jaws wherein the concentric rotation of the cylindrical members relative to each other actuates the cutting action of the cutting jaws. 
     Thus, the co-axial actuated scissors include a first scissor portion slidably and telescopically securable to a second scissor portion. The first scissor portion includes an offset handle attached to a stem with an inner cylindrical rotatable member connected to the lower end of the stem. The inner cylindrical rotatable member defines a distal or loop end that includes an arcuate cutting blade or jaw. Formed on the stem is a receiving notch that opens rearwardly or away from the distal end that defines the location of the cutting jaw. 
     The co-axial actuated scissors also include a second scissor portion that includes an offset handle attached to a stem with the stem being attached at its lower end to a primary cylinder. The area where the stems of the handles for both the first and second scissor portions attach, respectively, to the inner rotatable member and the primary cylinder, is designated as the handle base. The primary cylinder includes a bore that is coequal in length with the primary cylinder and a longitudinal slot that is substantially coequal in length with the primary cylinder. An angulated or curved groove is located at the rear of the primary cylinder and in the area where the stem attaches to the primary cylinder, and, furthermore, the angulated groove registers with the longitudinal slot but is oriented transverse to the longitudinal slot. The primary jaw also defines a distal, cutting or loop end that includes an arcuate cutting blade or jaw that cooperates with the cutting blade mounted to the distal end of the inner cylindrical rotatable member for holding and severing the anatomical structure such as the nerve. Thus, more particularly, the position of the cooperating cutting jaws is denoted as the loop end of the scissors. 
     In addition, the second scissor portion includes an arcuate arm that extends from the stem toward, and depending upon the handle positions during use of the device, past the stem of the first scissor portion. The arcuate arm includes at least two spaced-apart detents that face the loop end of the scissors, and the detents are dimensioned to seat within the receiving notch concomitant with the surgeon moving the handles to the various operative surgical positions. Thus, the detents are spaced on the arm of the second scissor portion to provide for three discrete scissor positions (which also corresponds to the positions of the cutting jaws): a full open position, a surgical structure gripping position, and a cutting or severing position. 
     In assembling the co-axial actuated scissors the inner cylindrical rotating member of the first scissor portion is telescoped within the bore of the primary cylinder of the second scissor portion so that the inner member is rotatable within the bore and concentric thereto, and the cutting jaws are disposed in opposed cutting relationship at the loop end. The lower end of the stem of the first scissor portion seats within the angulated groove at the rear of the primary cylinder and travels within—and is delimited by—the length of the angulated groove during manipulation of the co-axial actuated scissors during the positioning, gripping and cutting of the anatomical structure. The inner member and the primary cylinder are disposed concentric relative to each other and define a longitudinal axis extending through the scissors from the handle end to the loop end. Furthermore, the cutting plane of the jaws—and thus the cutting action of the jaws—is normal (at 90 degrees) to the longitudinal axis and thus the axis of rotation of the inner member and the primary cylinder. In addition, the concentric rotatable disposition of the inner rotating member within the primary cylinder defines an axial length or portion that extends, in effect, from the handle end to the loop end, and the inner member and the primary cylinder rotate with respect to each other along this axial length. The stem of the second scissor portion is aligned with the receiving notch formed on the stem of the first scissor portion and moves through the receiving notch simultaneous with the manual movement of the offset handles to the various surgical positions. In addition, as the stem moves through the receiving notch the detents successively engage a cavity formed within the receiving notch thereby allowing the cutting jaws to be held and maintained in the full open position and the gripping position as long as desired by the surgeon. Completely closing the offset handles together causes the cutting jaws to sever the anatomical structure. The handles, and more specifically the finger holes of the handles, are disposed offset or non co-planar to the longitudinal axis and the disposition and cutting action of the jaws. Moreover, the offset finger holes of the handles enhance both the ease of use and the ergonomic functioning of the scissors. 
     There are several alternative embodiments that provide for the concentric rotation of the inner member relative to the primary member, but employ different structural elements to hold the cutting jaws in the various operational positions. In one alternative embodiment a protrusion extends from the surface of the inner cylinder at the rear thereof. Formed on the inner annular surface of the primary cylinder, and in alignment with the protrusion, is a plurality (preferably three) of spaced-apart notches each of which is sized to receive the protrusion. The notches are spaced on the inner annular surface of the primary cylinder in an arcuate arrangement so as to define the various surgical operative positions for the scissors, i.e., the fully open position, the anatomical structure gripping position and the cutting position. Thus, as the surgeon manipulates and opens and closes the handles, the inner member and the primary cylinder rotate relative to each other concomitant with the protrusion seating in the notch with each notch corresponding to a discrete surgical position. The surgical positions correspond to the surgeon first positioning the scissors adjacent the structure to be cut, then gripping the structure at the loop end and sliding the scissors along the structure for positioning and placing the loop end at the desired orientation, and as far from the surgical site as determined to be prudent by the surgeon, and then closing the cutting jaws for severing the anatomical structure such as the nerve. 
     It is an object of the present invention to provide co-axial actuated scissors that include indicia or markings that are calibrated for measuring the distance from the surgical site at which the cut is being made to the base of the handles of the scissors. 
     It is another object of the present invention to provide co-axial actuated scissors that can capture and sever structures that can vary by site and application. 
     It is yet another object of the present invention to provide co-axial actuated scissors wherein the cutting is accomplished at an orientation that is normal to the longitudinal axis of the scissors. 
     It is still yet another object of the present invention to provide co-axial actuated scissors that allow a surgeon to move along a nerve or other structure to be severed to a surgically optimum position into the operative wound while continuously maintaining contact with the nerve or other structure. 
     It is still yet a further object of the present invention to provide co-axial actuated scissors wherein the cutting blades of the scissors produce a clean and complete cut without fraying of the anatomic surgical structure. 
     A further object of the present invention is to provide co-axial actuated scissors that include cutting blades that are inwardly bent toward each other thereby increasing the binding forces of the blades in order to produce a clean severance of the anatomical surgical structure. 
     A still further object of the present invention is to provide co-axial actuated scissors that achieve the cutting of the anatomical surgical structure without cutting any adjacent structure and without direct visualization of the particular anatomical surgical structure that is being cut. 
     Still another object of the present invention is to provide co-axial actuated scissors that allow the surgeon to cut the nerve or other structure as far as possible from the main surgical site thereby minimizing post-operative complications. 
     Still yet another object of the present invention is to provide co-axial actuated scissors wherein all dimensions, including the shapes of the handles, can be variable depending upon different applications and surgical sites. 
     Still yet a further object of the present invention is to provide co-axial actuated scissors wherein the attachment and detachment of the handle portions is by a slidable telescoping action that doesn&#39;t require screws or other fixation devices and which allows for easy reprocessing and sterilization of the instrument after usage. 
     Yet another object of the present invention is to provide co-axial actuated scissors that are manufactured from a medical-grade stainless steel or other premium alloy. 
     Yet still another object of the present invention is to provide co-axial actuated scissors that are capable of being used in the sectioning or freeing of tendons during amputations or tendon transfer procedures. 
     Yet still a further object of the present invention is to provide co-axial actuated scissors wherein the cutting blades form a capturing loop that captures the anatomical surgical structure and allows the scissors to slide proximally and distally along the anatomical structure until the desired position is obtained at which time the handles can be completely closed thereby closing the cutting blades and causing the anatomical surgical structure to be cut and severed. 
     These and other objects, features and advantages will become apparent to those skilled in the art upon a perusal of the following detailed description read in conjunction with the accompanying drawing figures and appended claims. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of the co-axial actuated scissors of the present invention illustrating the disposition of the co-axial actuated scissors for cutting an anatomical structure in the foot of the individual; 
         FIG. 2  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the disposition of the scissors as the scissors are slid along the structure to achieve the proper orientation and position before the severing of the anatomical structure; 
         FIG. 3A  is a perspective view of the co-axial actuated scissors of the present invention illustrating the engagement of one handle with a detent for holding the scissors at the gripping position resulting in the capturing of the anatomical structure by the loop end of the scissors; 
         FIG. 3   b  is a perspective view of the co-axial actuated scissors of the present invention illustrating the closing of the handles and the concomitant axial rotation of the scissors thereby bringing the jaws together to sever the anatomical structure; 
         FIG. 4   a  is a perspective view of the co-axial actuated scissors of the present invention illustrating the engagement of the handles with the detent for maintaining the scissors at the gripping position and the cutting jaws oriented for holding the anatomical structure; 
         FIG. 4   b  is a perspective view of the co-axial actuated scissors of the present invention illustrating the disposition of the scissors at the gripping position, the movement of the stem of the handle of the first scissor portion within the angulated groove of the second scissor portion, and the aperture formed by the abutment of the cutting jaws for holding the anatomical structure; 
         FIG. 5  is a perspective view of the co-axial actuated scissors of the present invention illustrating the disassembly of the scissors and the structural elements that comprise the first scissor portion and the second scissor portion; 
         FIG. 6  is a top plan view of the co-axial actuated scissors of the present invention illustrating the first scissor portion disassembled from the second scissor portion; 
         FIG. 7   a  is a top plan view of the co-axial actuated scissors of the present invention illustrating the location of the handles when the scissors are disposed to the gripping position for sliding along and holding the anatomical structure; 
         FIG. 7   b  is a sectioned side elevational view of the co-axial actuated scissors of the present invention taken along lines  7   b - 7   b  of  FIG. 7   a  illustrating the engagement of the detent on the arm of the second scissor portion with the receiving notch of the stem of the first scissor portion; 
         FIG. 7   c  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the position of the handles and the cutting jaws when the scissors are disposed to the anatomical structure gripping position; 
         FIG. 7   d  is a side elevational view of the co-axial actuated scissors of the present invention illustrating the offset orientation of the handles relative to the longitudinal main axis of the scissors and the projection of the cutting jaws normal to the longitudinal axis; 
         FIG. 8   a  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the engagement of the first detent with the receiving notch on the stem of the first scissor portion for maintaining the scissors in the fully open disposition; 
         FIG. 8   b  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the engagement of the second detent with the receiving notch of the stem of the first scissor portion and the formation of an aperture by the cutting jaws for holding the anatomical structure and maintaining the scissors in the gripping position; 
         FIG. 8   c  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the closing of the handles upon each other and the concomitant movement of the cutting jaws to the maximum cutting position for severing the anatomical structure; 
         FIG. 9  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the engagement of the first detent with the stem and the disposition of the handles and the cutting jaws when the scissors are disposed to the open position; 
         FIG. 10  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the engagement of the second detent with the stem and the disposition of the handles and the cutting jaws when the scissors are disposed to the anatomical structure gripping position; 
         FIG. 11  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the closing of the handles and the concomitant closing of the cutting jaws for cutting and severing the anatomical structure such as the nerve; 
         FIG. 12  is a side elevational view of the co-axial actuated scissors of the present invention illustrating the orientation of the offset handles relative to the cutting jaws that are normal to the main longitudinal axis of the scissors; 
         FIG. 13  is a perspective view of the co-axial actuated scissors of the present invention illustrating the closing together of the handles and the concomitant closing of the cutting jaws; 
         FIG. 14  is a perspective view of the co-axial actuated scissors of the present invention illustrating the engagement of the second detent with the stem and the disposition of the jaws at the anatomical structure gripping position; 
         FIG. 15  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the disposition of the handles and the cutting jaws when the scissors are at the fully open position; 
         FIG. 16  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the disposition of the handles and the cutting jaws when the scissors are at the anatomical structure gripping position; 
         FIG. 17  is a front elevational view of the co-axial actuated scissors of the present invention illustrating the disposition of the handles and the cutting jaws when the scissors are closed for cutting and severing the anatomical structure; 
         FIG. 18  is a side elevational view of the co-axial actuated scissors of the present invention illustrating the disposition of the handles and the jaws as being normal to the longitudinal main axis of the scissors; 
         FIG. 19  is a top plan view of a first alternative preferred embodiment of the co-axial actuated scissors of the present invention; 
         FIG. 20  is an enlarged front elevational view of the first alternative preferred embodiment of the co-axial actuated scissors of the present invention first shown in  FIG. 19 ; 
         FIG. 21  is a front elevational view of the first alternative preferred embodiment of the co-axial actuated scissors of the present invention first shown in  FIG. 19 ; 
         FIG. 22  is a side elevational view of the first alternative preferred embodiment of the co-axial actuated scissors of the present invention first shown in  FIG. 19 ; 
         FIG. 23  is a top plan view of a second alternative preferred embodiment of the co-axial actuated scissors of the present invention; 
         FIG. 24  is a sectioned elevational view taken along lines  24 - 24  of  FIG. 23  of the co-axial actuated scissors of the present invention first shown in  FIG. 23 ; 
         FIG. 25  is a front elevational view of the second alternative preferred embodiment of the co-axial actuated scissors first shown in  FIG. 23  illustrating the disposition of the handles and the cutting jaws when the scissors are disposed to the anatomical structure gripping position; 
         FIG. 26  is a side elevational of the second alternative preferred embodiment of the co-axial actuated scissors of the present invention; 
         FIG. 27  is a top plan view of third preferred alternative embodiment of the co-axial actuated scissors of the present invention; and, 
         FIG. 28  is an enlarged sectional view of the third preferred alternative embodiment of the co-axial actuated scissors of the present invention first shown in  FIG. 27 . 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     Illustrated in  FIGS. 1 through 28  are several embodiments for co-axial actuated scissors whose primary working action is through two concentric members that rotate with respect to each other along a main longitudinal axis that extends from an operating hand position to a distal, loop or cutting end. Moreover, the capturing, holding and cutting of an anatomical structure, such as a nerve, is done normal (perpendicular or at 90 degrees) to the main longitudinal axis. In addition, the operation of the scissors is such that the handles can be squeezed for reaching an initial operational position so that the cutting end of the scissors can be appropriately positioned proximally or distally relative to the anatomical structure, with the handles then being closed for cutting and severing the anatomical structure. 
     Thus, shown in  FIGS. 1 through 18  is a preferred embodiment for co-axial actuated scissors  10  for cutting anatomical structures, such as a nerve  12 , extending through the foot  14  of an individual with the cutting of nerve  12  occurring away from the surgical site  16  and without harming adjacent tissue or the need for making a second incision. Scissors  10  of  FIGS. 1 through 18  includes a pair of coacting scissor portions; more specifically denoted a first scissor portion  18  and a second scissor portion  20 . As will be hereinafter further described, first scissor portion  18  is slidably and telescopically disposed in second scissor portion  20  so that both scissor portions  18  and  20  can concentrically rotate relative to each other for effecting the holding and then the cutting of nerve  12 . First scissor portion  18  includes a first offset handle  22  and a finger hole  24  defined by circular offset handle  22 . A stem  26  is integrally attached to the lower portion of offset handle  22 , and stem  26  includes a rearwardly formed rectangular-shaped receiving notch  28 . Moreover, as shown most clearly in  FIG. 7   b , receiving notch  28  is further defined by a detent cavity  30  that is smaller than receiving notch  28  and generally centrally located thereon. 
     As shown in  FIGS. 1 through 18 , stem  26  includes a lower end  32 , and lower end  32  of stem  26  is integrally connected to an elongated inner first concentric member or cylindrical rotating member  34 . Inner cylindrical rotating member  34  preferably is a solid structure or piece, and the area where lower end  32  of stem  26  attaches to inner rotating member  34  is defined as the rear or handle end  36  of first scissor portion  18 . This area can also be referred to as the proximal end  38  of first scissor portion  18  and, by extension, scissors  10 . Opposite of handle end  36  is a distal end  40  of first scissor portion  18 , and located at distal end  40  is an arcuate cutting blade or jaw  42  terminating with a jaw or blade tip  44 . 
     Coacting with and slidably and telescopically engaged to first scissor portion  18  is second scissor portion  20  as shown in  FIGS. 1 through 18 . Second scissor portion  20  includes a second offset handle  46 , and cylindrical offset handle  46  defines a finger hole  48 . A stem  50  is attached to the lower portion of offset handle  46 , and laterally extending from stem  50  is an arcuate arm  52  that is appropriately sized to pass through receiving notch  28  on first scissor portion  18  during operation of scissors  10 . Arm  52  includes a detent means that includes a plurality of stops or detents forwardly facing for determining the various surgical operational positions of the handle by their successive and discrete engagement and seating within cavity  30  of receiving notch  28 . As shown in  FIGS. 1 through 18 , the preferred embodiment of the invention includes at least two detents  54  denoted the initial or first detent and the second detent, and the successive and discrete engagement of each detent  54  with receiving notch  28  denotes a specific scissor position or configuration as will be hereinafter further explained. 
     Lower end  56  of stem  50  of second scissor portion  20  attaches to an elongated second outer concentric member or primary cylinder  58  that is slightly longer than inner rotating member  34  of first scissor portion  18 . Primary cylinder  58  includes an annular external surface  60  and an inner annular surface  62 . Primary cylinder  58  includes a bore  64  coequal in length with primary cylinder  58  and a longitudinal slot or groove  66  that extends through the surface of primary cylinder  58  and which substantially extends along the length of primary cylinder  58 . Located at the rear or handle end  68  of second scissor portion  20  is an angulated or proximal groove  70 . Angulated groove  70  extends transverse to longitudinal slot  66  but opens and joins to longitudinal slot  66 ; and thus slot  66  and angulated groove  70  form, in effect, a continuous opening on primary cylinder  58 . In addition, the width of longitudinal slot  66  is slightly greater than stem  26  of first scissor portion  18  for facilitating the assembly of first scissor portion  18  to second scissor portion  20  as will be hereinafter explained. Thus, body  72  of scissors  10  comprises both inner rotating member  34  and primary cylinder  58  when they are assembled together for concentric rotation relative to each other during the operation of scissors  10 . It should also be noted that body  72  of scissors  10  defines a main longitudinal axis  74  extending therethrough (through inner rotating member  34  and primary cylinder  58 ), and this axis  74  is indicated in  FIGS. 5 and 7   d . Handles  22  and  46  are thus offset or angled from axis  74  at an angle that is between 0 degrees and 90 degrees as shown in  FIG. 7   d  (handles  22  and  46  are offset at approximately 45 degrees in  FIG. 7   d ), and this offset enhances the ease and use of scissors  10  during the surgical procedure. The rotation of inner rotating member  34  and primary cylinder  58  is about this main longitudinal axis  74 . As with inner rotating member  34 , opposite of handle end  68  of second scissor portion  20  is a distal end  76 , and, more specifically, located at distal end  76  and integrally formed on and extending from primary cylinder  58  is an arcuate cutting jaw or blade  78 . Cutting blade  78  includes a blade tip  80 , and cutting blade  78  of second scissor portion  20  is inwardly curved relative to cutting blade  42  of first scissor portion  18  to achieve maximum shearing force for cleanly and quickly severing the anatomical structure when cutting jaws  42  and  78  are closed upon each other as shown, for example, in  FIGS. 8   c ,  11 , and  13 . The distal end  76  of body  72  of scissors  10  is also denoted the cutting or loop end  82 , and this denotes to the configuration cutting jaws  42  and  78  take during the use of scissors  10 , especially when cutting jaws  42  and  78  are disposed to a particular detent position to be hereinafter further explained. 
     With reference to  FIGS. 5 through 14 , cutting jaws  42  and  78  extend from body  72  of scissors  10  and are disposed normal to main longitudinal axis  74  of scissors  10  while handles  22  and  46  are offset or angled with regard to main longitudinal axis  74  and the extension of cutting jaws  42  and  78 . Handles  22  and  46  define an operating hand position  84  and cutting jaws  42  and  78  define a cutting position  86  with inner rotating member  34  and primary cylinder  58  (body  72  of scissors  10 ) rotating relative to each other and about main longitudinal axis  74 . The co-operative pivotal movement and cutting action of cutting jaws  42  and  78  occurs concomitant with the rotation of concentrically disposed rotating member  34  and primary cylinder  58  and in a plane normal to their concurrent concentric rotation. Cutting position  86  may be fully open position  94 , gripping position  96 , or surgical cutting position  100 , as more fully described herein. 
     As shown in  FIG. 5 , the upper part of external surface  60  of primary cylinder  58  is calibrated with regularly spaced indicia or markings  88  for measuring and determining the distance from surgical site  16  at which the anatomical structure is being cut to the point, place or depth of insertion of body  72  of scissors  10 . Thus, as shown in  FIGS. 1 and 2 , body  72  of scissors  10  has been inserted beneath upper layers  90  of skin  92  of foot  14  and into foot  14  for positioning and holding the anatomical structure. Regularly spaced indicia  88  allows the surgeon to determine how far into foot  14  body  72  of scissors  10  extends without the need for direct visualization and without the need for lifting up the various layers  90  of skin  92 , muscle and tissue surrounding surgical site  16 . 
     As shown in  FIGS. 8   a  through  8   c ,  9  through  11  and  15  through  17 , scissors  10  have three distinct operational detent positions wherein the manual movement of handles  22  and  46  causes the successive engagement of detents  54  with receiving notch  28  and the concomitant rotation of rotating member  34  and primary cylinder  58  causing the pivotal movement of cutting jaws  42  and  78 . Fully open position  94  is shown in  FIGS. 8   a ,  9  and  15 , and in fully open position  94 , detent  54  denoted first detent has engaged receiving notch  28  and the end of arm  52  of second scissor portion  20  projects slightly past receiving notch  28  and stem  26  of first scissor portion  18 . Cutting jaws  42  and  78  of scissors  10  are fully open to allow the surgeon to initially orient and dispose scissors  10  with respect to surgical site  16  and the anatomical structure to be cut. Anatomical structure gripping position  96  is shown in  FIGS. 8   b ,  10  and  16 , and to obtain this position, handles  22  and  46  are closed upon each other thereby causing the concurrent concentric rotation of rotating member  34  and primary cylinder  58  and bringing cutting tips  44  and  80  of jaws  42  ad  78  into engagement. Arm  52  of second scissor portion  20  slides within receiving notch  28  of first scissor portion  18  until detent  54  denoted the second detent is encountered, and upon encountering this second detent, a slight resistance to further movement results and this detent seats within receiving notch  28  thereby maintaining the anatomical structure gripping position. With tips  44  and  80  of cutting jaws  42  and  78  touching each other, an arcuate shape for jaws  42  and  78  forms, in effect, the loop configuration that defines loop end  82 , and the loop configuration includes an aperture  98  that encompasses and holds the anatomical structure, such as nerve  12  therein and between cutting jaws  42  and  78  prior to the cutting action. Scissors  10  can now be slid or pushed proximally or distally with nerve  12  contained and held within aperture  98  as far from surgical site  16  as determined prudent by the surgeon. Once satisfied with the placement and orientation of scissors  10 —and particularly the placement of cutting jaws  42  and  78 —the next detent position is obtained. Thus,  FIGS. 8   c ,  11  and  17  illustrate the detent or surgical cutting position  100  produced by handles  22  and  46  coming together at the limit of the rotational ability of inner rotating member  34  and primary cylinder  58 . This limit also defines the pivotal range of motion of jaws  42  and  78 . Simultaneous with the closure of handles  22  and  46  detent  54  denoted the second detent is disengaged from receiving notch  28  thereby allowing arm  52  to continue sliding through receiving notch  28 . Concomitant with this action cutting blades  42  and  78  close upon and sever nerve  12 . In severing nerve  12 , which is shown most distinctly in  FIG. 3   b , cutting tips  44  and  80  of cutting blades  42  and  78  move past each other concomitant with the closure of handles  22  and  46  and the rotation of rotating member  34  concentric and relative to primary cylinder  58  for cleanly severing, and without fraying, the anatomical structure such as nerve  12 . Angulated groove  70  delimits the rotation of first scissor portion  18  with respect to second scissor portion  20  and thus the movement of handle  22  and cutting blade  42  of first scissor portion  18  with respect to second scissor portion  20 . After nerve  12  has been severed the surgeon would open scissors  10  by pivoting handles  22  and  46  away from each other, and thus the above described actions would all be repeated but in the reverse order. 
     With reference to  FIGS. 1 through 18 , a representative clinical use or application of scissors  10  would commence with both scissor portions  18  and  20  initially being placed on the surgical tray in an unassembled configuration. As shown in  FIG. 5 , in order to assemble first scissor portion  18  to second scissor portion  20 , stem  26  of first scissor portion  18  is aligned with longitudinal slot  66  of primary cylinder  58  so that inner rotating member  34  can be telescopically slid within bore  64  of primary cylinder  58 . Stem  26  of first scissor portion  18  would be received within angulated groove  70  of primary cylinder  58  for pivotal movement therein. Accompanying this placement would be the disposition of the tip of arm  52  of second scissor portion  20  within receiving notch  28  of first scissor portion  18 . Handles  22  and  46  would be manually squeezed and moved toward each other so that detent  54  denoted the first detent would engage receiving notch  28  thereby disposing scissors  10  to fully open position  94 . When passed to the surgeon, scissors  10  would be placed into proximity with and then over surgical site  16  and the structure, such as nerve  12  as shown in  FIGS. 1 through 3   b , that is to be severed. The surgeon would then manually squeeze and move handles  22  and  46  further toward each other so that detent  54  denoted the second detent encounters receiving notch  28  thereby simultaneously pivoting cutting jaws  42  and  78  toward each other for grasping, capturing and holding nerve  12  between cutting jaws  42  and  78 . Upon obtaining anatomical structure gripping position  96  scissors  10  can then be pushed or slid proximally or distally along the anatomical structure, such as nerve  12 , with jaws  42  and  78  encompassing nerve  12  and nerve  12  enclosed within aperture  98  to a position as far from surgical site  16  as determined to be prudent by the surgeon. The slidable movement of jaws  42  and  78  and body  72  of scissors  10 , as shown in  FIGS. 1 and 2 , would be to the exclusion of any other surrounding structure. When the surgeon is satisfied with the orientation and placement of scissors  10 —and crucially the position of cutting jaws  42  and  78 —handles  22  and  46  are completely closed upon each other thereby causing the simultaneous disengagement of detent  54  denoted the second detent from receiving notch  28  and cavity  30 , and the movement of jaws  42  and  78  toward each other for severing nerve  12  with cutting tips  44  and  80  of jaws  42  and  78  actually passing by each other as shown in  FIGS. 3   b  and  8   c  as the cut is completed. Scissors  10  are then withdrawn from surgical site  16  along with the specimen generally with handles  22  and  46  reoriented so that detent  54  denoted the second detent is brought back into engagement with receiving notch  28 . Scissors  10  can then be returned back to the surgical tray for reprocessing and sterilization in central supply. 
     Illustrated in  FIGS. 19 through 28  are several alternative embodiments for scissors  10  shown in  FIGS. 1 through 18 . The alternative embodiments primarily disclose alternative detent structures for reaching, setting and maintaining the various surgical positions  94 ,  96  and  100  that result from the closing—or opening—of handles  22  and  46  and the simultaneous concentric rotations of inner rotating member  34  and primary cylinder  58 . 
     Thus,  FIGS. 19 through 22  disclose a first preferred alternative embodiment for scissors  10  wherein a protrusion  102  projects outwardly from the external surface of inner rotating member  34 . Protrusion  102  is located at the proximal or handle end  36  of the body of scissors  10 . Formed on inner annular surface  62  of primary cylinder  58  are a plurality—three as shown in FIGS.  20  and  21 —of spaced-apart generally square-shaped recesses  104  sized to receive and maintain therein protrusion  102  as a function of the movement of handles  22  and  46  to the various surgical detent positions. Thus, recess  104  located at the lowermost position corresponds to fully open position  94 , and when protrusion  102  is seated within recess  104  scissors  10  are maintained in fully open position  94  as shown in  FIGS. 8   a  and  15 . Recess  104  that is located at the middle position or the nine o&#39;clock position corresponds to anatomical structure gripping position  96  wherein cutting blades  42  and  78  form an aperture  98  for capturing and holding the anatomical structure so that scissors  10  can be properly positioned and oriented prior to cutting the structure.  FIG. 20  shows protrusion  102  seated within middle recess  104 . Recess  104  located at the uppermost position corresponds to detent fully closed position  100  and when protrusion  102  seats within recess  104  as a result of the closure of handles  22  and  46  and the rotation of inner rotating member  34  relative to primary cylinder  58  cutting jaws  42  and  78  are pivoted toward and past each other for cutting the anatomical structure as shown in  FIGS. 8   c  and  17 . 
     Illustrated in  FIGS. 23 through 26  is a second preferred alternative embodiment for the co-axial actuated scissors shown in  FIGS. 1 through 18 . The alternative embodiment of  FIGS. 23 through 26  includes a plurality—at least three—of spaced-apart recesses  106  formed at handle end  68  of second scissor portion  20 , and, more specifically, recesses  106  are formed on the portion at handle end  68  of primary cylinder  58  that forms and defines rear face  108  of angulated groove  70 . Located at the lowermost position of stem  26  of handle  22  of first scissor portion  18  is a protrusion  110  adapted for successive mating engagement and seating within recesses  106  concomitant with the movement of handles  22  and  46  to various detent positions  94 ,  96  and  100 . The location of each recess  104  on rear face  108  that defines angulated groove  70  corresponds to the three surgical operational positions, i.e., fully open position  94 , anatomical structure gripping position  96 , and detent fully closed and cutting position  100 . 
       FIGS. 27 and 28  illustrate a third preferred alternative embodiment for scissors  10  first shown in  FIGS. 1 through 18 . In  FIGS. 27 and 28  three spaced-apart recesses  112  are formed at the lower portion of the handle end, and adjacent lower end  32  of stem  26 , of first scissor portion  18 . The spacing of recesses  112  corresponds, respectively, to fully open position  94 , anatomical structure gripping position  96 , and fully closed cutting position  100 . A protrusion or nubbin  114  on rear face  108  of the slot that the defines angulated groove  70 , and which is located at handle end  68  of primary cylinder  58  is adapted for successive seating engagement within recesses  112  concomitant with the opening and closing of handles  22  and  46  and the rotation of inner rotating member  34  and primary cylinder  58 . 
     The above-described preferred and alternative embodiments are intended, by way of example, to illustrate the principles of the invention but not in any way to limit the scope of the claims. Thus, numerous other alterations, variations, and modifications can be made by those skilled in the art without departing from the spirit of the invention or the scope of the appended claims.