Endoscopic grasping instrument with scissors

A multifunctional endoscopic instrument for use in performing endoscopic procedures within an anatomical cavity includes a handle and an elongate tubular member having a proximal end coupled with the handle for being disposed externally of the anatomical cavity and a distal end for being disposed within the anatomical cavity and carrying a pair of opposed, relatively movable jaws. The jaws are operable by manipulation of the handle to grasp objects, such as needles, and to cut tissue. In addition, the elongate tubular member defines a channel permitting fluids and other instruments to be communicated at the operative site without the need of having to remove the endoscopic instrument from the body.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
The present invention relates generally to medical procedures and 
instruments and, more particularly, to a multifunctional endoscopic 
grasping instrument with scissors. 
2. Discussion of the Related Art 
Endoscopic and minimally invasive medical procedures, such as laparoscopy, 
have become widely accepted for surgery and diagnosis due to the 
associated advantages relating to reduced trauma and hospitalization time. 
The performance of an endoscopic procedure typically involves creation of 
one or more puncture sites through a wall of an anatomical cavity using a 
penetrating instrument including an obturator, such as a trocar, disposed 
within a portal sleeve. After the penetrating instrument has penetrated 
into the anatomical cavity, the obturator is withdrawn leaving the sleeve 
in place to form a portal in the cavity wall for the introduction of 
instruments such as endoscopes, ligating appliers, forceps, cauteries and 
the like into the anatomical cavity. 
Endoscopic procedures commonly involve performing a number of individual 
acts or functions within the anatomical cavity including grasping, 
cutting, coagulating, irrigating, aspirating, puncturing, injecting, 
dissecting, cauterizing, ligating, suturing, illuminating, visualizing 
and/or collecting specimens for biopsy. However, most endoscopic 
instruments are designed to perform only one of the above functions, 
requiring several incisions for placement of multiple portal sleeves to 
accommodate a suitable number of endoscopic instruments for performing the 
required functions or necessitating frequent withdrawal and replacement of 
individual endoscopic instruments through a single incision. While it is 
generally desirable to minimize the number of incisions created for 
performing a particular endoscopic procedure, substitution of instruments 
through a single incision can be time consuming, depending on the 
efficiency of the medical facility and staff, increasing the period of 
anesthetization for the patient. Additionally, internal bleeding can 
develop during the substitution of instruments thereby obscuring the field 
of view and requiring time consuming clean-up procedures to be performed. 
A disadvantage of endoscopic instruments having articulated jaws, in 
particular, is that the jaws are typically mounted on pivots at the distal 
end of relatively long shafts requiring complicated and space-consuming 
linkages for converting the user's proximal movements into motion of the 
jaws increasing the risk of fluid leaking through poorly sealed pivotal 
mounts. 
SUMMARY OF THE INVENTION 
Accordingly, it is a primary object of the present invention to overcome 
the above-mentioned disadvantages of the prior art with an endoscopic 
instrument capable of performing multiple functions. 
Another object of the present invention is to permit multiple functions to 
be performed with a single endoscopic instrument while defining a channel 
through the instrument for other instruments and/or fluids to be 
introduced at the operative site so that other functions can be performed 
without the need of having to remove the endoscopic instrument from the 
body. 
Some of the advantages of the present invention over the prior art are that 
the endoscopic instrument can perform multiple functions through a single 
incision thereby minimizing the number of incisions required to perform an 
endoscopic procedure, that the frequency of substitution of instruments 
through a single incision can be reduced, that visualization of tissue 
through an operating channel formed through the instrument permits 
grasping and cutting operations to be performed with greater precision, 
that conventional handle structures can be used to provide users with a 
familiar feel and to decrease adaptation time, that the instrument can be 
fabricated at low cost using simple mechanisms without complicated 
linkages, and that the instrument can be sterilized for reuse or 
disposable for single patient use as desired. 
These and other objects, advantages and benefits are realized with the 
present invention as generally characterized in an endoscopic instrument 
including a handle and an elongate tubular member having a proximal end 
coupled with the handle for being disposed externally of the anatomical 
cavity and a distal end for being disposed within the anatomical cavity 
and carrying a pair of opposed, relatively movable jaws. The jaws are 
operable by manipulation of the handle to perform multiple functions such 
as, for example, grasping objects such as needles and cutting tissue. In 
addition, the elongate tubular member defines a channel providing access 
to the operative site from outside the anatomical cavity without the need 
of having to remove the instrument from the cavity. 
Other objects and advantages of the present invention will become apparent 
from the following description of the preferred embodiments taken in 
conjunction with the accompanying drawings, wherein like parts in each of 
the several figures are identified by the same reference numerals or by 
reference numerals having the same last two digits.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
The endoscopic instrument of the present invention can be utilized in any 
type of anatomical cavity; and, accordingly, while the instrument is 
described hereinafter for use with a portal sleeve in endoscopic 
procedures, such as laparoscopy, the instrument can be used with catheters 
and other small or large diameter tubular or hollow, cylindrical members 
providing access to small cavities, such as veins and arteries as well as 
large cavities, such as the abdomen. 
An endoscopic instrument 10 in accordance with the present invention, as 
illustrated in FIGS. 1 and 2, includes a housing 12, an outer tubular 
member 14 extending distally from the housing 12, an inner tubular member 
16 telescopically fitted within the outer tubular member and terminating 
distally in a pair of opposed jaws 18 and 20, and a handle portion formed 
of a fixed handle 24 and a movable handle 26. 
Housing 12 includes longitudinally spaced front and rear walls 28 and 30 
oriented perpendicular to a longitudinal axis of the instrument, a top 
wall 32 substantially parallel to the longitudinal axis and a bottom wall 
34 having a concave forward portion 36 curving downwardly from the front 
wall to connect with an upper end of fixed handle 24 and a rearward 
portion 38 extending proximally at an angle relative to the longitudinal 
axis of the instrument from an upper end of the handle 24 to rear wall 30. 
A lower end of the fixed handle is configured as an elongate finger loop 
40 to accommodate one or more fingers of a user. Movable handle 26 is 
pivotally mounted on a pin 42 proximally spaced from fixed handle 24 and 
secured internally to a wall or walls of the housing. A lower end of the 
handle 26 is configured as a finger loop 44 to accommodate one or more 
fingers of the user, and a pair of arcuate mating protrusions, shown by 
broken lines at 46 and 48 in FIG. 2, can optionally be carried in opposed 
relation on finger loops 40 and 44 for ratcheting engagement during 
operational use. Movable handle 26 includes an arcuate end portion 50 
disposed within housing 12 and defining a plurality of gear teeth 52 on a 
side of pin 42 opposite finger loop 44. 
Outer tubular member 14 is open at both ends and extends distally from 
housing 12 through an opening in the front wall 28 of the housing. Distal 
end 54 of outer tubular member 14 can be blunt as shown, tapered, beveled, 
slotted or chamfered as desired or have any other suitable distal 
configuration. Preferably, outer tubular member 14 is made of a 
cylindrical length of a substantially rigid material, such as stainless 
steel or other medically acceptable metal or plastic materials. The 
proximal end 56 of the outer tubular member is movably disposed within the 
housing and carries a rack 58 in spaced relation to the toothed end 
portion 50 of handle 26. A pinion gear 60 engages the rack 58 and is 
mounted on the same shaft as a reduction gear 62 which meshingly engages 
toothed end portion 50 of the handle to convert relatively small rotary or 
pivotal movement of the handle into significantly larger linear movement 
of the rack. Looking at FIGS. 2 and 3, it will be appreciated that 
counterclockwise rotation of handle 26 about pin 42 results in proximal 
movement of outer tubular member 14 relative to housing 12 and that 
clockwise rotation of handle 26 about pin 42 results in distal movement of 
outer tubular member 14 relative to housing 12. In a preferred embodiment, 
movable handle 26 is biased in a clockwise direction toward fixed handle 
24, for example by use of a torsion spring (not shown) coiled around pin 
42 and connected between the movable handle and the fixed handle and/or 
the housing. 
Inner member 16 includes a tubular portion 64 telescopically fitted within 
outer tubular member 14 and defining a lumen or channel 66 through the 
instrument. The proximal end of the inner member extends through the rear 
wall of housing 12 and terminates at a coupling 68, for example a Luer 
lock, for connection with sources of fluid or suction, other medical 
instruments and operating units such as those shown and described in my 
pending application Ser. No. 08/376,186, the disclosure of which has been 
incorporated herein by reference. A hollow, spherically-shaped valve 
housing 70 is distally spaced from the coupling within the housing, and a 
spherical valve member 72 having a cylindrical aperture or passage 74 
formed therethrough is rotatably disposed within the valve housing and 
connected with a knob 78 extending upwardly through an opening in the top 
wall of the housing to permit manual operation of the valve from outside 
the housing. The inner member is fixed relative to the housing with a 
flange 76 mounted between the coupling and the valve and received within a 
slotted recess formed in rear wall 30. The distal end of tubular portion 
64 is bifurcated or split longitudinally to form integral one-piece jaws 
18 and 20 in opposed relation, the jaws being normally biased apart as 
shown in FIGS. 3 and 4. Referring to FIG. 4, in particular, jaws 18 and 20 
cooperate to define a grasping portion at a distal end having opposed 
inner surfaces 80 and 82 formed with conventional diamond-shaped 
protrusions or teeth 84 for securely holding a suture needle, anatomical 
tissue or any other useful object when closed and a cutting portion 
proximally spaced from the grasping portion and including a pair of 
cutting members or blades 86 and 88 carried by the jaws in opposed 
relation. As best seen in FIGS. 4 and 5, blades 86 and 88 are proximally 
spaced from grasping surfaces 80 and 82 and are mounted to project 
inwardly along a central longitudinal axis of each jaw in generally 
opposed relation so that sharp tissue cutting edges 90 and 92 of the 
blades slidingly engage one another like a scissors when the jaws are 
moved between the closed position or condition shown in FIG. 2 and the 
open position or condition shown in FIG. 3. The blades are shown oriented 
parallel to a longitudinal axis of the inner tubular member but can be 
oriented at any angle relative to the longitudinal axis dependent upon 
procedural use. Wedge-like cams 93 and 94 protrude outwardly from 
respective outer surfaces 95 and 96 of jaws 18 and 20 and taper inwardly 
in the proximal direction to present an angled cam surface against which 
the distal end of outer tubular member 14 can act to force the jaws 
together. 
Tubular body 64 of the intermediate member is preferably formed with jaws 
18 and 20 as a single unitary part using a resilient medically-acceptable 
material such as, for example, a spring steel or a plastic material having 
suitable elastic properties for normally biasing the upper and lower jaws 
apart while permitting the jaws to be moved toward one another in response 
to forces acting on the outer jaw surfaces and/or cams as a result of 
relative axial movement between the outer tubular member and the inner 
member. Blades 86 and 88 can be formed integrally with the jaws as a 
one-piece unit or formed separately of the jaws and connected thereto in 
any suitable manner such as, for example, by adhesive bonding, welding or 
mechanical attachment. Preferably, the blades are formed of a medical 
grade metal material such as stainless steel or titanium. 
An insulated connector 98 can optionally be mounted on housing 12 opposite 
the handle portion or anywhere else on the instrument to connect with 
electrically conductive elements of the instrument for performing unipolar 
or bipolar electric coagulation, for example using one or both of the 
blades as conductive elements. 
In use, instrument 10 is grasped using finger loops 40 and 44 and is guided 
to the operative site via a portal sleeve positioned in the wall of an 
anatomical cavity. The portal sleeve can be positioned in the anatomical 
cavity wall using any suitable penetrating technique, including those 
creating puncture sites by means of removable obturators such as trocars, 
and can include a valve housing, if desired, to prevent loss of 
pneumoperitoneum during insertion and withdrawal of the instrument. 
Visualization of the endoscopic procedure can be accomplished using a 
conventional endoscope incorporated into the instrument, for example 
within the central channel 66 defined by tubular shaft 64, or separately 
positioned within the anatomical cavity through a second portal sleeve 
located at another puncture site. 
Instrument 10 is advanced distally through the portal sleeve until jaws 18 
and 20 emerge into the anatomical cavity. At this point, the instrument 
can be manipulated externally of the body to position the jaws at the 
operative site. Various grasping and cutting functions can be performed at 
the operative site using different portions of the jaws and by operating 
the handles of the instrument to open and close the jaws as required. 
Since inner member 16 is fixed relative to housing 12, actuation of the 
jaws to open or close is controlled by moving outer tubular member 14 
relative to the inner member. If closed, jaws 18 and 20 can be opened by 
moving outer tubular member 14 proximally relative to inner member 16. 
Movement of the outer tubular member over the inner member is controlled 
by operation of movable handle 26. Counterclockwise rotation of handle 26 
about pin 42 results in clockwise rotation of reduction gear 62 which, in 
turn, causes an equal angular rotation of pinion 60. Pinion 60 is of 
greater diameter than reduction gear 62 so that, for equal angles of 
rotation, pinion 60 will produce greater circumferential displacement. 
Pinion 60 engages the gear teeth of rack 58 to cause proximal movement of 
the outer tubular member 14 relative to jaws 18 and 20 thereby permitting 
the jaws to move resiliently to the open position shown in FIG. 3. In the 
open position, jaws 18 and 20 are biased apart such that inner surfaces 80 
and 82 of the jaws and cutting edges 90 and 92 of the blades are angularly 
spaced from one another allowing objects to be positioned between 
different portions of the jaws. Conversely, clockwise rotation of the 
handle 26 about pin 42 results in counterclockwise rotation of reduction 
gear 62 and pinion 60 causing distal movement of rack 58 and outer tubular 
member 14 relative to the jaws so that distal end 54 of the outer tubular 
member will slide over the jaws in an axial direction causing the jaws to 
be cammed inwardly from the open position to the closed position. As the 
jaws move from the open position to the closed position, inner surfaces 80 
and 82 will rotate toward another to grasp objects, such as needles or 
tissue, disposed therebetween, and cutting edges 90 and 92 of the blades 
will slidingly engage one another like a scissors to cut objects, such as 
tissue or unsecured lengths of suture material, placed between the blades 
when the jaws are in the open position. 
Movable handle 26 is preferably proximally spaced from fixed handle 24 as 
shown so that the user can maintain one or more fingers on the stationary 
handle 24 while operating the movable handle 26 with the thumb and/or 
other fingers of the hand. Movable handle 26 is preferably biased in a 
clockwise direction, looking at FIG. 3, toward stationary handle 24 so 
that, when the movable handle is released, outer tubular member 14 will be 
automatically moved over jaws 18 and 20 to close the jaws together, for 
example to hold a suture needle between the jaws during complicated 
maneuvers requiring free hand movement. 
In addition to performing various grasping and cutting functions, the 
endoscopic instrument 10 permits access to the operative site from outside 
the body through channel 66 formed through the instrument between proximal 
and distal ends of the inner tubular member. The channel can, for example, 
be used to introduce lengths of suture material (with or without knotting 
elements attached thereto) as well as any other medical devices or 
instruments, such as endoscopes or probes, or to perform irrigation or 
aspiration at the operative site, for example by attaching a source of 
fluid or suction to the coupling at the proximal end of the inner member, 
or to administer medicaments as desired. 
FIGS. 6 and 7 illustrate a modification of the jaws of the endoscopic 
instrument according to the present invention wherein the modified upper 
jaw 118 carries a blade 186 with a cutting edge 190 and the modified lower 
jaw 120 defines a concave recess or pocket 102 for receiving the blade. 
Blade 186 extends perpendicularly from a proximal end of inner surface 180 
of the needle holding portion of the upper jaw and is centrally located 
along the longitudinal axis of the inner member in opposed relation to the 
pocket, which is formed in the proximal end of inner surface 182 of the 
needle holding portion of the lower jaw. Cutting edge 190 of the blade is 
angularly spaced from the lower jaw when the jaws are in the open position 
as shown in FIG. 6, permitting anatomical tissue and other objects to be 
positioned between the blade and the pocket. When jaws 118 and 120 are 
closed, blade 186 moves toward pocket 102 and is received therein to cut 
any object held between the cutting portion of the jaws. As seen in FIG. 
7, jaws 118 and 120 can be closed completely when blade 186 is disposed 
within pocket 102 and can thus compress or flatten the tissue or object 
held therebetween if desired. 
The modified jaws 218 and 220 shown in FIGS. 8 and 9 are similar to the 
jaws described above but carry a pair of blades 286 and 288 disposed 
proximally of inner grasping surfaces 280 and 282 in opposed relation 
along lateral edges of the jaws. Blades 286 and 288 depend perpendicularly 
from opposed lateral edges of the jaws and have opposed cutting edges 290 
and 292 spaced apart when jaws 218 and 220 are open to permit positioning 
of anatomical tissue and other objects between the blades. When jaws 218 
and 220 are closed, cutting edges 290 and 292 of the blades move towards 
one another and into sliding contact to cut any tissue or objects held 
between the jaws. As best seen in FIG. 9, the off-axis or eccentric 
position of the blades also facilitates visualization of the procedure 
through an endoscopic instrument positioned within channel 266. 
FIGS. 10 and 11 illustrate a further modification of the endoscopic 
instrument wherein the upper jaw 318 carries an off-axis or eccentric 
blade 386 with cutting edge 390 and the lower jaw 320 defines a concave 
pocket 302 for receiving the blade. Blade 386 extends perpendicularly from 
a proximal end of inner grasping surface 380 of the needle holding portion 
of the upper jaw and is laterally spaced from the central longitudinal 
axis of the inner member to be disposed along an outer peripheral edge of 
the jaw in opposed relation to pocket 302. Cutting edge 390 of the blade 
is angularly spaced from pocket 302 in lower jaw 320 when the jaws are 
open permitting anatomical tissue and other objects to be positioned 
between the blade and the pocket. When jaws 318 and 320 are closed, blade 
386 moves toward pocket 302 and is received therein to cut any tissue or 
object held between the jaws. 
The grasping portion of the instrument jaws can be suitably configured to 
grasp any type of object during an endoscopic procedure. As described 
above, the grasping portion can be configured to include opposed surfaces 
which are caused to meet or come very close to one another to clamp 
objects such as needles positioned between the jaws by exerting a 
compressive force on the objects as the jaws are moved toward one another. 
Under certain circumstances, however, medical personnel may wish to hold 
an object without deforming or compressing the object, for example when 
moving or manipulating certain tubular organs. FIGS. 12-17 illustrate 
modifications of the endoscopic instrument wherein the jaws are provided 
with concave holding portions between which objects may be held without 
being deformed or compressed. In FIG. 12, the modified upper and lower 
jaws 418 and 420 include grasping surfaces 480 and 482 disposed distally 
of cutting members 486 and 488, respectively, and concave portions 404 and 
406 of arcuate configuration disposed between the grasping surfaces and 
the cutting members and facing one another in opposed relation to define a 
circular or other suitably shaped opening therebetween when the jaws are 
closed, the opening having a size and shape to surround selected objects, 
such as tubular vessels and organs, without substantially traumatically 
compressing the objects. The modified instrument jaws 518 and 520 shown in 
FIG. 13 are similar to those shown in FIG. 12 but with concave portions 
504 and 506 disposed proximally of grasping surfaces 580 and 582, and 
cutting members 586 and 588 disposed between the concave portions and the 
grasping surfaces. Another modification of the instrument jaws is shown in 
FIG. 14 wherein upper and lower jaws 618 and 620 are similar to those 
described above but with concave portions 604 and 606 disposed distally of 
cutting members 686 and 688, and grasping surfaces 680 and 682 disposed 
between the concave portions and the cutting members. In the modification 
of the instrument jaws shown in FIG. 15, upper and lower jaws 718 and 720 
are similar to those described above but with grasping surfaces 780 and 
782 disposed proximally of cutting members 786 and 788, and concave 
portions 704 and 706 disposed between the grasping surfaces and the 
cutting members. The modified instrument jaws 818 and 820 shown in FIG. 16 
are similar to those described above but with concave portions 804 and 806 
disposed distally of grasping surfaces 880 and 882, and cutting members 
886 and 888 disposed between the concave portions and the grasping 
surfaces. Yet another modification of the instrument jaws is shown in FIG. 
17 wherein upper and lower jaws 918 and 920 are similar to those described 
above but with concave portions 904 and 906 disposed proximally of cutting 
members 986 and 988, and grasping surfaces 980 and 982 disposed between 
the concave portions and the cutting members. 
From the above, it will be appreciated that the endoscopic instrument 
according to the present invention permits multiple grasping and cutting 
functions to be performed with a single instrument while defining a 
channel for fluids and other medical instruments and probes to be 
introduced at the operative site without the need of having to remove the 
endoscopic needle-holding instrument from the body. 
The jaws making up the jaw portion of the endoscopic instrument can be 
formed as an integral one-piece unit or assembled from separate pieces; 
and, depending on procedural use, one of the jaws can be fixed and the 
other movable, both jaws can be movable, the jaws can be linked by pivots 
or formed at the end of a tubular member or formed at the end of a pair of 
pivotally connected arms. The jaws, including any of the grasping or 
cutting portions thereof, can be straight, curved and/or angled as 
desired. Any of the jaws shown or described herein can be formed with 
opposed inner surfaces formed of repeated patterns of diamond-shaped 
protrusions, lateral and/or longitudinal ribs and/or other types of 
structural features suitable for holding needles and other types of 
objects during an endoscopic procedure. The jaws can have any shape in 
transverse cross-section when closed including, but not limited to, 
circular, elliptical, rectangular and polygonal configurations, and can 
have opposed arcuate or concave portions for holding objects, such as 
tubular organs, without traumatically compressing the objects. The jaws 
can also be of varying width in the longitudinal direction such that, for 
example, relatively thin cutting members or blades can be formed along a 
first longitudinal portion of the jaws and grasping portions of greater 
width than the cutting members can be formed at longitudinally spaced 
locations relative to the cutting members. 
The cutting members or blades can be carried by one or both jaws and 
centrally located for cutting anatomical tissue, unsecured lengths of 
suture material or any other objects normally cut during a surgical 
procedure, or the blades can be offset laterally from the central 
longitudinal axis of the jaws to permit better visualization and to allow 
the formation of longitudinal grooves or openings through the jaws when 
closed. If a single blade is carried by one jaw, the other jaw can carry 
an opposed blade in a manner to permit sliding contact with scissor-like 
cutting, direct abutment of cutting edges to produce a chopping cut, 
and/or can form a pocket for receiving the cutting edge of the opposed 
blade to permit partial or complete closure of the jaws together. 
Furthermore, the blades can have straight, curved or angled cutting edges 
and can be oriented at any angle relative to a longitudinal axis of the 
jaws. 
The handle portion of the endoscopic instrument shown and described herein 
is exemplary of the types of conventional handle mechanisms suitable for 
performing the function of actuating the jaws; accordingly, the handles 
can have any configuration to actuate the jaws including, but not limited 
to, configurations employing a pair of pivotally connected arms, one fixed 
and one pivoted arm, a pistol grip with a movable trigger, or resilient 
U-shaped handle members. Further, the handle portion of the instrument can 
be configured to rotate relative to a pivot axis oriented perpendicular to 
the longitudinal axis of the instrument so that, for example, in one 
position the handles will extend laterally from the instrument or at a 
substantially perpendicular angle relative to the longitudinal axis; 
while, in another position, the handles will extend proximally from the 
instrument like scissor handles. 
It will be appreciated that the handle portion and jaw portion of the 
endoscopic instrument can be integrally formed as a one-piece unit or 
formed as separate components and coupled together, for example, by use of 
pivots, linkages, rods, cables, telescoping members, brackets and other 
mechanical and/or electrical couplings. 
When the instrument is formed of telescoping members, it will also be 
appreciated that individual tubular members, such as the inner member can 
be made rotatable about a longitudinal axis of the instrument either alone 
or in combination with other telescoping members. Moreover, when the 
instrument is coupled with a source of fluid or suction, an operating unit 
or other medical device, the instrument housing can have any configuration 
for being releasably coupled including, but not limited to threaded or 
telescoping portions, detents, latches or any other suitable connections. 
Furthermore, the housing can be cylindrical or rectangular or have any 
other useful or convenient configuration in cross-section. 
The inner member can define one channel as shown or multiple channels of 
similar or different cross-sectional configuration. Any of the channels 
defined by the inner member can be coaxially disposed or offset from the 
central longitudinal axis of the inner member and can have any suitable 
configuration in cross-section dependent upon procedural use including, 
but not limited to, circular, elliptical and polygonal cross-sectional 
configurations. 
The outer tubular member can have any suitable configuration in 
cross-section to fit through a portal formed in the wall of an anatomical 
cavity and to receive the inner member for sliding movement therein. The 
distal end of the outer tubular member can be blunt, tapered, beveled or 
chamfered, and can also be provided with longitudinal slots or interior 
grooves for receiving protrusions or cams carried on the outer surfaces of 
the jaws to assist in maintaining proper alignment of the jaw blades when 
cutting tough materials. Alternatively, protrusions can be carried on an 
interior surface of the outer tubular member in alignment with slots or 
grooves formed in the jaws to maintain alignment during operational use. 
The components of the endoscopic instrument of the present invention can be 
made of any suitable, medical grade materials to permit sterilization for 
reuse or disposal for single patient use. The components can be made of 
multiple parts of various configurations and materials to reduce cost 
and/or simplify fabrication. The instrument can have various valves, stop 
cocks and seals in the housing and/or inner member to control fluid flow 
therethrough. 
The features of the various embodiments described above can be combined in 
any manner desired dependent upon the operational requirements of the 
procedure to be performed and the complexity of the endoscopic instrument. 
Inasmuch as the present invention is subject to many variations, 
modifications and changes to detail it is intended that all subject matter 
discussed above or shown in the accompanying drawings be interpreted as 
illustrative only and not be taken in a limiting sense.