Abstract:
A banding apparatus and method. One embodiment is a unitary or integrated hemorrhoidal single hand-held and single hand-operated ligator, which can, in some embodiments, enable direct visualization and release of multiple bands. The ligator has a gun-shaped handle extending from a vacuum generating trigger tube, with a fixed band bearing barrel extending from the vacuum generating trigger tube. A vacuum generating tube extends through the band bearing barrel from the rear of the gun ligator to the band bearing barrel end of the ligator gun, and is in air movement communication with the vacuum generating tube and band bearing barrel end of the ligator gun. A band actuating barrel is threadably mounted to surround a portion of the band bearing barrel, and rotation of the barrel cause the barrel to move laterally and force one or more ligating bands along and off of the band bearing barrel end. A light source can be included to illuminate the band bearing barrel end. Most components are made of nearly transparent. durable, lightweight, recyclable plastic, such as polypropylene; and with such components the operator can see through the gun components and observe the material, such as a hemorrhoid, to be ligated.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    The present nonprovisional application claims priority through Applicant&#39;s prior provisional patent application of the same title, Ser. No. 61/603,839, filed Feb. 27, 2012, which prior provisional patent application is hereby incorporated by reference in its entirety. In the event of any inconsistency between such prior provisional patent application and the present nonprovisional application, the present nonprovisional application shall prevail. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure is directed to a banding apparatus and method of banding, and in one particular embodiment, to a hemorrhoid ligator and method of hemorrhoidal ligation. 
       BACKGROUND 
       [0003]    The process of ligation of internal hemorrhoids is decades old. The principal of ligation is strangulation of redundant hemorrhoidal tissue. This is achieved by placing a rubber band (a “ligature”) over hemorrhoidal tissue that is pinched or suctioned into an open tube. 
         [0004]    One such prior art ligator is used with an endoscope. This type of ligator is attached to the tip of the endoscope, introduced into the rectum, and retroflexed toward one or more hemorrhoids to be ligated. The one or more hemorrhoids are suctioned into the ligator, and the ligator then applies ligating bands to each such hemorrhoid. This endoscope-based procedure allows the operator to directly visualize the hemorrhoid before and during the ligation process; but this endoscopic process is complex, requires extensive training, and requires use of an expensive endoscope in an endoscopy unit or operating room setting. 
         [0005]    Similar and other ligators have been in use for many years to treat symptomatic internal hemorrhoids in outpatient ambulatory gastroenterology (GI) or surgical practices. These devices include the CRH O&#39;Reagon Disposible Ligator made by CRH Medical, the Short-Shot Saeed Hemorrhoidal Multi-Band Ligator by made by Wilson Cook Medical, and the Haemoband made by Haemoband Surgical Ltd. 
         [0006]    The CRH O&#39;Regan procedure includes use of an anoscope to identify the location of internal hemorrhoids. If hemorrhoids are found, the anoscope is removed and a single band is loaded onto the tip of the ligator. The ligator is blindly inserted into the rectum. The tip of the ligator is then directed toward the location of a previously identified hemorrhoidal column. While holding the ligator with one hand, suction is applied with the other hand and tissue is pulled into the ligator, and the ligating band is deployed by sliding an overtube over the end of the ligator. If more banding is needed, then the ligator must be removed and re-loaded with another band. While this CRH technique allows for hand-applied suctioning and lower cost than endoscope-based techniques, this technique requires repeated instrumentation of the anus, blind ligation, application of only a single band during a given insertion of the ligator, and difficult reloading of bands on the tip of the device. 
         [0007]    The Short-Shot Ligator is a hand-held instrument with capacity for up to four preloaded bands. After insertion of an anoscope, and identification of hemorrhoids, the anoscope is left in place and the ligator is pushed through the anoscope. The tip of the ligator is then approximated to the tissue, which is suctioned into the ligator using an external suctioning system. The bands are then deployed by using a string mechanism manipulated by the thumb. While this technique allows deployment of multiple, preloaded bands in a single insertion of the ligator, it requires use of an external suctioning system not available outside of an endoscopic or surgical setting. This procedure also provides only semi-direct visualization. While the anoscope is in place, target hemorrhoidal tissue can be seen only until the ligator is introduced into the anoscope. At that point, direct visualization is lost and the ligation procedure requires that the practitioner approximate the tip of the ligator to the target hemorrhoid blindly (meaning that the practitioner tries to put the tip where the practitioner remembers the hemorrhoids to be in the prior inspection). This approximation may be inaccurate and does not allow direct visualization of the amount of suctioned hemorrhoidal tissue. This may lead to suctioning of a small amount of hemorrhoidal tissue leading to limited success of the procedure. 
         [0008]    The Haemoband Ligator is similar to the Short Shot but differs in that it can deploy multiple preloaded bands by a hand-trigger mechanism. This ligator is used in conjunction with a lighted anoscope. Use of the anoscope and approximation of the tip of the ligator is identical to the Short-Shot Ligator, resulting in the same issues described above for the Short-Shot Ligator. 
       BRIEF SUMMARY OF CERTAIN ASPECTS OF THIS SPECIFICATION 
       [0009]    The applicant has invented a banding apparatus and banding method having a substantial number of aspects. In one banding method aspect, the operator can grip the actuator with one hand and while holding the actuator with the one hand: with the one hand actuate the ligator to remove air from a vacuum generating portion of the ligator; insert one end of the ligator into a cavity of a human or other living entity; observe target material, such as target flesh, through the ligator during the ligation process; with the one hand actuate the ligator to generate a vacuum and suck the target material into the ligator with the vacuum; and with the same hand actuate the ligator to release a ligating band around the sucked-in material. 
         [0010]    In another aspect, the operator observes the target material through the material sucking structure. In yet another aspect, the operator can use an additional structure, such as an anoscope for example, to first locate the target material, and the operator can then insert the sucking portion of the ligator through the additional locating structure about material to be ligated. In a further aspect, the target material is a hemorrhoid, and in yet another, the ligator can carry and release multiple ligating bands during one instrument penetration of the applicable cavity. 
         [0011]    In another aspect, the one hand can actuate the ligator to generate a vacuum with a trigger on the ligator. In a still further aspect, the one hand can actuate the ligator to release the ligating band with a finger rotating an actuation tab on the ligator. 
         [0012]    In another aspect, during a single penetration of the cavity, the ligator can be moved one or more times to allow the operator to observe through the ligator, and apply a ligating band, to other target material, such as a target hemorrhoid as an example. In a further aspect, the ligator can be used only one time and then thrown away. In yet another aspect, the ligator can be sterilized and reused. 
         [0013]    Certain embodiments of the ligator apparatus include a vacuum drawing barrel, a narrower vacuum drawing tube or section within the barrel, and a band actuating barrel surrounding the vacuum drawing barrel. Some embodiments include an enlarged vacuum drawing section in air transport communication with the narrower vacuum drawing tube or section. In certain instances, the internal volume of the enlarged vacuum drawing tube or section is substantially larger than the combined volume of narrower vacuum drawing tube or section and any additional vacuum drawing portions of the ligator. 
         [0014]    Some embodiments of the enlarged vacuum drawing tube or section include a sealed trigger penetrating the tube or section, and in certain instances, the sealed trigger is biased towards a decompressed or unactuated position. 
         [0015]    In some ligators, the band actuating barrel surrounds the vacuum drawing barrel. The band actuating barrel can be actuated to slide and eject one ore more ligating bands mounted about the band ligating end of the vacuum drawing barrel. The band actuating barrel of some embodiments is threadably mounted to the vacuum drawing barrel and is finger rotatable to move the band actuating barrel to eject one or more ligating bands. 
         [0016]    In certain instances, the vacuum drawing barrel is somewhat transparent or translucent. Some instances include a somewhat transparent or translucent band actuating barrel and vacuum drawing tube or section within the interior of at least a portion of the vacuum drawing barrel. 
         [0017]    One embodiment of the ligator is hand holdable and includes a vacuum actuating trigger activatable with the one hand and a band actuating barrel actuatable with the same hand. Some embodiments provide a unitary, hand-held ligator including a vacuum drawing barrel, a band actuating barrel, an enlarged vacuum drawing section in vacuum drawing communication with the vacuum drawing barrel, and a vacuum drawing trigger. In some embodiments, the unitary ligator includes a hand-actuatable structure to actuate the band actuating barrel. In some instances, the band ejection end of the ligator is insertable into a cavity, and the vacuum-drawing trigger and hand-actuatable structure are activatable by a finger. 
         [0018]    In some ligator embodiments, the hand-actuatable structure can include inwardly extending tabs on the band actuating barrel and outwardly extending tabs of the vacuum drawing barrel. These tabs can interact as the band actuating barrel moves, limiting movement of the band actuating barrel until sufficient force is applied to overcome resistance to barrel movement provided by the interacting tabs. 
         [0019]    Some embodiments of the ligator can be made of lightweight yet rigid material, such as a rigid plastic, for many of the components. 
         [0020]    Some embodiments have a unitary gun-shape, with a handle and trigger extending a nearly transparent or translucent rigid vacuum-generating and ligature-delivery tube. This and other ligator embodiments can be particularly durable, easy to use with one hand, and economical, and have a long shelf-life. They can be made of dominantly recyclable materials as well, such as steel and recyclable plastic. 
         [0021]    There are other aspects and advantages of the present apparatus and methods disclosed by the present specification. They will become apparent as the specification proceeds. In this regard, it is to be understood that the Background and this Brief Summary are not intended to be limiting, and thus the scope of the invention is to be determined by the claims as issued and not whether given subject matter addresses an issue noted in the Background or includes subject matter recited in this Brief Summary. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0022]    The applicant&#39;s preferred and other embodiments are further disclosed in association with the accompanying drawings, in which: 
           [0023]      FIG. 1  is a perspective view of a unitary, hand-held banding ligator; 
           [0024]      FIG. 2  is a right side elevational view of the banding ligator of  FIG. 1 ; 
           [0025]      FIG. 3  is a left side elevational view of the banding ligator of  FIG. 1 ; 
           [0026]      FIG. 4  is a front side elevational view of the banding ligator of  FIG. 1 ; 
           [0027]      FIG. 5  is a back side elevational view of the banding ligator of  FIG. 1 ; 
           [0028]      FIG. 6  is a top plan view of the banding ligator of  FIG. 1 ; 
           [0029]      FIG. 7  is a bottom plan view of the banding ligator of  FIG. 1 ; 
           [0030]      FIG. 8  is an exploded perspective view of the banding ligator of  FIG. 1  having a main ligator body, a outer band ejection tube, a vacuum tube end plug, a trigger, a rubber plunger, and a spring; 
           [0031]      FIG. 9  is perspective view of the outer band ejection tube of  FIG. 8 ; 
           [0032]      FIG. 10  is front elevational view of the outer band ejection tube of  FIG. 8 ; 
           [0033]      FIG. 11  is a rear elevational view of the plug of  FIG. 8 ; 
           [0034]      FIG. 12  is a left side elevational view of the plug of  FIG. 8 ; 
           [0035]      FIG. 13  is a right side elevational view of the plug of  FIG. 8 ; 
           [0036]      FIG. 14  is a top plan view of the plug of  FIG. 8 ; 
           [0037]      FIG. 15  is a bottom plan view of the plug of  FIG. 8 ; 
           [0038]      FIG. 16  is a left side elevational view of the trigger of  FIG. 8 ; 
           [0039]      FIG. 17  is a left side elevational view of the trigger of  FIG. 8  with the rubber plunger mounted on the back end of the trigger; 
           [0040]      FIG. 18  is a back side elevational view of the trigger and plunger of  FIG. 18 ; 
           [0041]      FIG. 19  is a front side elevational view of the trigger and plunger of  FIG. 18 ; 
           [0042]      FIG. 20  is a bottom plan view of the trigger and plunger of  FIG. 18 ; 
           [0043]      FIG. 21  is a top plan view of the trigger and plunger of  FIG. 18 ; 
           [0044]      FIG. 22  is a cross-sectional view of the ligator of  FIG. 1  taken through section line  22 - 22  of  FIG. 4 ; 
           [0045]      FIG. 23  is a cross-sectional view of the ligator of  FIG. 1  taken along section line  23 - 23  of  FIG. 2 ; and 
           [0046]      FIG. 24  is a partial cross-sectional view of a ligator embodiment, taken along section line  24 - 24  of  FIG. 5 , having a removable battery and battery powered LED light source within the ligator to provide light at the ligating end of the ligator. 
       
    
    
       [0047]    It is to be understood that spacially-orienting terms, such as top, bottom, front, back, upwardly, or downwardly are used to explain relative orientation of structures as shown in the Figures and as the structures might be used. They are not to be construed, however, to require such an orientation in space. 
       DETAILED DESCRIPTION 
       [0048]      FIGS. 1-24  depict a ligator that can be utilized to ligate flesh such as one or more hemorrhoids. This ligator and the associated ligator components and methods can be used to ligate other material, human or otherwise. 
         [0049]    With reference now to  FIG. 1 , one embodiment of the present ligator, generally  10 , is gun-shaped, having a handle  12 , a vacuum drawing trigger  14  slidably penetrating a vacuum drawing tube  16  extending from the upper end  18  of the handle  12 , and a fixed banding barrel  20  extending transversely from the upper side  22  of the vacuum drawing tube  16 . An external banding barrel  24  slidably surrounds the central external periphery (not shown in  FIG. 1 ) of the fixed banding barrel  20 ; and a band bearing tubular end  25  of the fixed banding barrel  20  extends outwardly from the tubular band ejecting end  27  of the external banding barrel  24 . The external banding barrel  24  thus surrounds, and is coaxial with, the fixed banding barrel  20 . 
         [0050]    With reference now to  FIG. 2 , the handle  12  has a generally planer bottom end  26  extending transversely from the lower end  28  of the back side  30  of the handle  12 . The front side  32  of the handle  12  has three concave finger grip channels  34 ,  36 ,  38  extending along the front side  32  of the handle  12  from the bottom end  26  to the top end  40  of the handle  12 . 
         [0051]    The front side  44  of the vacuum drawing trigger  14  provides a somewhat contract finger trigger channel with a vacuum drawing tube plunger section  46  extending from the trigger channel  44  to penetrate the vacuum drawing tube  16 . The top side  48  of the trigger channel  44  and the plunger section  46  extend angularly downwardly from a taller or deeper portion  50  of the tube plunger section  46 . The relatively shallower section  52  of the tube plunger section  46  thus provides a free area  54  above the trigger  14  through which finger actuatable tabs, e.g.,  56 ,  58 , extending radially outwardly from the external banding barrel  24 , can rotate with respect to the fixed banding barrel  20 . 
         [0052]    In this embodiment, the band bearing end  25  of the fixed banding barrel  20  has three ligation rubber bands  60 ,  62 ,  64  mounted in mating concave rubber band mounting channels (not shown) in the outer periphery band bearing end  25  (note that there is room  66  for a fourth band to be mounted at the periphery band bearing end  25  as shown in  FIG. 2 ). Differing numbers of bands and mating mounting channels may be utilized; and concave mounting channels (or ribs) may also be eliminated if desired. 
         [0053]    With reference now to  FIGS. 3 and 8 , the handle  12  also includes rectangular channels or passages, e.g.,  68 ,  70 ,  72 , passing through the handle  12  for the handle left side  74  to the handle right side  76 . The resulting rectangular framing  73  extends from the handle left side  74  to the handle right side  76  to provide a rigid grippable handle surface on theses sides  74 ,  76  while reducing the amount of material in the handle  12 . 
         [0054]    With reference now to  FIG. 4 , the fixed banding barrel  20  includes an interior vacuum drawing barrel  78 . With reference to  FIGS. 5 and 6 , this vacuum drawing barrel  78  extends to the back end  80  of the ligator gun  10 . 
         [0055]    With reference now to  FIG. 8 , the fixed banding barrel  20  includes an exterior threaded section  82  intermediate the back end  84  and front end  86  of the banding barrel  20 . The forward end  88  of the threaded section  82  terminates in a narrowing conical neck,  90 , which in turn terminates is a less steeply angled conical front barrel section  92 . The conical front barrel section  92  in turn terminates in a banding tubular section  94 , on which banding bands can be mounted. The external banding barrel has an interior periphery (not shown in  FIG. 8 ) that generally mates with the external periphery of the fixed banding barrel  20 . 
         [0056]    The vacuum drawing trigger  14  has a rubber vacuum sealing plunger cap  96  that mounts on the cap mounting end  98  of the trigger  14  opposite its finger channel  44 . The diametral width of the sealing cap  96  is slightly wider than the interior diameter of the vacuum drawing tube  16 . A stainless steel spring  100  mounts within the interior of vacuum drawing tube  16  coaxially with the tube  16 . The sealing cap  96  and trigger  14  mount with the sealing cap  96  friction fit within the interior of the vacuum drawing tube  16  to abut a forward end  102  of the spring  100 . A sealing cap or plug  120  mounts within a mating plug mounting slot (see  119  in  FIG. 1 ) in the back end  121  of the fixed banding barrel  20 . 
         [0057]    With reference now to  FIG. 9 , the exterior banding barrel  24  has an internal thread section  104  that threadably mates with, as shown in  FIG. 8 , the exterior threaded section  82  on the fixed banding barrel  20 . Referring back to  FIG. 9 , the back end  106  of the interior threaded section  104  terminates in a generally tubular back end  108  of the exterior banding barrel  24 . The tubular back end  108  has radially inwardly extending adjuster tabs, e.g.,  110 ,  112 , coaxial with the axis of the exterior banding barrel  24 . These inwardly extending tabs, e.g.,  110 ,  112 , are sized to abut, as shown in  FIG. 8 , a portion of the side walls of similarly sized radially outwardly extending adjuster tabs, e.g.,  114 ,  116 , on the fixed banding barrel  14  adjacent the back end  118  of the threaded section  82  on the barrel  14 . 
         [0058]    With reference now to  FIGS. 11 ,  12 ,  13 ,  14 , and  15 , the sealing plug  120  has an arced base  122 , a sealing wall  124  extending upwardly from the arced base  122 , and a tube sealing cap  126  extending from upper end  128  of the sealing wall  124  opposite the arced base  122 . 
         [0059]    Referring next to  FIG. 16 , the back or plunging end  123  of the trigger  14  has a narrowed neck  123  intermediate a diametrally wider sealing cap base  125  and diametrally wider cap retainer/ram  127 . With reference now to  FIG. 22 , the vacuum sealing cap  96  is somewhat C shaped to matingly surround and grip the cap retainer/ram  96  of the trigger  14 . With reference to  FIGS. 17-21 , prior to being mounted to penetrate the vacuum drawing tube  16  as shown in  FIG. 1 , the vacuum sealing cap  96  is slightly wider than the width of the vacuum drawing tube  16 . The sealing cap  96  thus provides a friction fit of the cap  96  within the vacuum drawing tube  16  and will sufficiently seal to allow drawing of a vacuum within the vacuum drawing tube  16  when the ligator, generally  10 , as explained below. 
         [0060]    With reference now to  FIG. 22 , the external banding barrel  24  is mounted on the fixed banding barrel  20  by threading the internal threaded section  104  of the external banding barrel  20  to mate with the external threaded section  82  on the fixed mounting barrel  20 . An exemplary external threaded section is 20 mm wide, providing  6  fine threads, approximately 2 mm deep, along the length of fixed mounting barrel  20 . The interior vacuum drawing barrel  78  extends from the back end  80  of the fixed banding barrel  20  to penetrate the diametrally wider band bearing tubular section or end  25  of the fixed banding barrel  20 . The band bearing tubular section or end  25  has vacuum sealing wall  154  extending from around the periphery of the interior vacuum drawing barrel  78  to sealingly abut the surrounding interior periphery  152  of the fixed banding barrel  20 . In some embodiments, the interior diameter of the band bearing tubular end  25  may be down to 1.50 inches. In some instances, the maximum interior diameter of forwardly tapering (i.e., somewhat conical, reducing in diameter from back to front end) vacuum drawing barrel  78  may be up to 1.30 inches. 
         [0061]    The trigger  14  mounts within vacuum drawing tube  16  so that the vacuum sealing cap  96  is coaxial with both the axis of the vacuum drawing tube  16  and the axis of the spring  100 . The spring  100  is intermediate, and respectively abuts at its opposing ends  130 ,  132 , the vacuum sealing cap  96  and the concave rear wall  134  of the vacuum drawing tube  16 . The concave rear wall  134  and slightly V-shaped or arced cross-section  136  of the vacuum sealing cap  96  cooperatively support the spring in position within the vacuum drawing tube  16 . 
         [0062]    As shown in  FIGS. 22 and 23 , the sealing plug  120  is mounted in the plug mounting slot  119  spaced from air pathway channel  138  that extends upwardly from the back end  146  of the vacuum drawing tube  16  to the back end  140  of the vacuum drawing barrel  78 . The sealing plug  120  and air pathway channel  138  thus cooperatively provide a sealed (vacuum drawing) air pathway  148  from the vacuum drawing tube  16  to the vacuum drawing barrel  78  and vice versa. With the trigger  14  in the uncompressed position (prior to compression of the spring  100 ), the volume V 1  of the interior of the vacuum drawing tube  16  is 1.5 to 3 or more times the total volume V 2 +V 3 +V 4  collectively provided by the air pathway  148 , the vacuum drawing tube  16 , and the vacuum drawing end  150  in the vacuum drawing barrel  20 . 
         [0063]    Referring back to  FIG. 8 , the fixed banding barrel  20 , the interior vacuum drawing barrel  78 , the vacuum drawing tube  16 , and the handle  12  can be injection molded to form a one piece structure made of nearly transparent, rigid plastic, such as for example FDA-approved polyprophylene. This one piece structure can also be injection molded in two or more sections, which can then be formed into one piece by gluing or sonic welding the sections together. The trigger body  138 , the sealing plug  120 , and the external banding barrel  24  are also injection molded of nearly transparent plastic, such as FDA-approved polyethylene. 
         [0064]    When assembled, the axis of each of the fixed banding barrel  20 , the interior vacuum drawing barrel  78 , and the vacuum drawing tube  16  are parallel and coplanar. In addition, the center axis of each of the fixed banding barrel  20  and the external banding barrel  24  are coaxial. 
         [0065]    Referring back to  FIG. 3 , the resulting ligator can have the following dimensions shown in the Figures. Such a ligator can be extremely strong, economical, durable, and lightweight, weighing only 0.23 ounces when the components are made of polyethylene, rubber, and stainless steal as described above. The dimensions can and weight vary by anywhere from up to plus or minus 50%, or to as small or as large as may be needed for a given application. 
         [0066]    Referring to the Figures generally, the ligator  10  can be used to attach a ligature or ligating band to human or other types of tissues. The ligator  10  can thus be used to place a ligating band on one or more hemorrhoids as follows:
   1. Place one or more ligating bands on the band bearing tubular end  25  of the ligator  10 .   2. Lubricate and place an anoscope, such as an off-the-shelf Anospec anooscope made by OBP Medical, Inc., of Lawrence, MA, into the anus to detect hemorrhoidal tissue. This particular anoscope includes a minauture light source that directs light through the anoscope, including through its open smaller, penetrating end, providing the operator with the ability to observe an illuminated hemorrhoid and other tissue visible through that smaller end as well as through the nearly transparent anoscope side walls.   3. Grasp the ligator  10  as if it were a gun, placing the index finger on or adjacent the trigger  14  and the three other fingers in the mating finger grip channels  34 ,  36 ,  38 .   4. While continuing to grasp the ligator with one hand:
       A. with the index finger, squeeze the trigger  14  so that it penetrates the vacuum drawing tube  16 , forcing air out of the vacuum drawing tube  16 , through the air pathway  148 , through the vacuum drawing barrel  78 , and out the tubular end  25  of the ligator  10 ;   B. insert the band bearing tubular end  25  through the anoscope toward the hemorrhoid;   C. look through the interior of the fixed banding tube  20  to observe the hemorrhoid and, while doing so, (i) position the band bearing tubular end  25  to surround the hemorrhoid and (ii) release squezzing pressure on the trigger  14  so that the stainless steel spring urges the trigger  14  outwardly from the vacuum drawing tube  16 , drawing a vacuum in the tubular end  25  and sucking the entire hemorrhoid and possibly some supporting tissue into the tubular end  25 ;   D. observe the hemorrhoid pulled by the resulting vacuum pressure within the band bearing tubular end  25  so that the end  25  surrounds the hemorrhoid;   E. place the tip of the index finger on a finger tab near to top side of the ligator  10 , e.g.,  56 ; and   F. with the tip of the index finger, if the finger tip is the right hand index finger tip, apply downwardly rotating pressure on the finger tab  56  (if the left hand finger tip, apply upwardly rotating pressure on the finger tab), causing the external banding barrel  24  to controllably rotate and thereby move toward and over the band bearing end  25 , forcing a ligature over the band bearing end  25  to compress around the base of the hemorroid and any other tissue within the band bearing end  25 . In the disclosed embodiment, the external banding barrel rotation is controlled by the interaction of inwardly extending adjuster tabs, e.g.,  110 ,  112 , and mating outwardly extending adjuster tabs, e.g.,  114 ,  116 . When these differing inwardly and outwardly extending adjuster tabs collide, they resist further rotation of the external banding barrel  24  with respect to the fixed vacuum drawing barrel  20  until the operator applies sufficient additional force to a finger tab  56 , resulting in a clicking sound and feel to the operator as two interacting tabs separate and the barrel  24  rotates to the next tab stop brought about by interaction of a differing pair of mating such inwardly and outwardly extending adjuster tabs. The operator thus can carefully control the degree of rotation, and resulting lateral movement, of the external banding barrel  25  and, in turn, ligature movement along and off of the external banding barrel  25 .   
       5. Either (i) move the anoscope to surround another hemorrhoid within the patient and repeat step 4; or (ii) remove the anoscope and ligator  10  from the patient.   6. Repeat step 5 as needed.
 
Each ligated tissue thereby loses its blood supply, dies, and is naturally excreted out of the patient, along with the ligature, typically within 5-7 days. In addition, in the event that steps 4C and 4D above result in an undesired amount of tissue being sucked into the band bearing tubular end, the position of the anoscope and/or ligator can be adjusted as desired and steps 4C and 4D repeated thereby acquiring the proper amount of hemorrhoidal tissue to be ligated. The ability to view suctioned material without an endoscope is a unique aspect of this device. Applicant believes that in all other devices, if an insufficient amount of tissue is suctioned and banded, it can be difficult to take corrective action.
   
 
         [0079]    The procedure described above is easy and quick, while being less intimidating to users and patients, less intrusive, and less risky than many prior art devices and techniques. This procedure typically requires 1-2 minutes to complete. The amount of patient discomfort is correspondingly reduced. In addition, this type of ligator and procedure can readily be used in an ambulatory setting because no external suctioning system is necessary in the embodiments shown in the Figures. The ligator&#39;s incorporated light source eliminates the need for a separate light system, such as a headlamp, thus reducing possible bacterial contamination of the separate light source. 
         [0080]    The ligator  10  can be very economical to make, assemble, package, and ship. It can be disposed of after a single use, or it can be sanitized and re-used, particularly if it is made of metal, if desired. Further, the ligator  10  is dominantly made of recyclable polypropylene and steel, so the ligator  10  has minimal negative environmental impact when recycled or reused, depending on the material used. 
         [0081]    The ligator  10  may also be made and supplied to users without ligating bands preloaded on the ligator  10 ; and in this fashion users can load conventional, off-the-shelf hemorrhoidal rubber bands on the ligator  10  with a conventional hemorrhoidal band loader. This can dramatically increase the shelf life of the ligator by three years or more. 
         [0082]    With reference to  FIG. 24 , the ligator  10  can include an associated light source, such as a small battery and battery powered LED light source  170  mounted laterally to the side of, and abutting laterally, the back end  172  of the interior vacuum drawing barrel  78 . The battery powered LED source  170  can be made removable by including a removable cover (not shown) covering and securing the battery and LED light source within the interior periphery of the fixed banding barrel  16 . An exemplary such battery and LED source is a Zweibruder TT7830CP Micro Light. Alternatively, a light source can include use of (i) an optical cable to deliver light to a portion of the ligator  10 , such as the band bearing end  25  or (ii) one or more flourescent light sources mounted to direct light toward the band bearing end  25 . 
         [0083]    An embodiment of the ligator can include a magnifying lens in the viewing path of the user of the ligator. With reference to  FIG. 14  for example, the sealing plug  120  can include a magnifying lens in or mounted to the sealing cap portion  126  of the sealing plug  120 . 
         [0084]    Referring now to  FIG. 8 , an embodiment of the ligator can utilize a hand squeezable balloon-like device in place of, or as an addition to, the vacuum drawing tube  12 . In addition, other spring or trigger biasing mechanisms can be used in the place of, or in addition to, the stainless steel spring  100 ; and the trigger biasing mechanism can be deleted altogether, relying on the user to move the spring outwardly of the vacuum drawing tube  16 . 
         [0085]    Alternatively, a separate vacuum drawing structure could be use in addition to, or in place of, the vacuum drawing tube  16 , trigger  14 , and spring  100 . For example, a vacuum drawing tube from a separate vacuum drawing device could be made connectable to the internal vacuum drawing barrel  78 . 
         [0086]    The trigger and handle can be made in variety of differing shapes other than those described above. For example, both the trigger and handle could utilize less material by being constructed differently, such as with thinner or less wide or deep portions. 
         [0087]    Alternative uses of the present ligators or aspects of one or more of them include:
       banding of esophageal varices;   laparoscopic surgery;   veterinary use for animal sterilization, castration, and other procedures; and   industrial or other uses for compression or other band deployment.       
 
         [0092]    This description is not to be construed as limiting. Further, various components of embodiments disclosed herein may be mixed and matched with each other to yield further arrangements of the features disclosed herein.