Abstract:
A multifunctional forceps set which integrates two important surgical procedures of incision and ligation into a continuous working procedure. The forceps set is co-used with two loop ligatures formed of braided sutures and transfigured from a surgeon&#39;s knot. In use, the loop ligatures are side by side loaded in the forceps mouth of the forceps and controlled by the forceps to minify the size of the loop and accomplish ligation function. The forceps set is developed from consolidation of surgical scalpel, forceps and device simulating finger&#39;s functions. Also, the forceps set can rapidly perform the procedures of double grasping, incision between grasping, proper ligating divided pedicles and cutting residual sutures of post-ligation. The forceps set enables surgeons to use familiar technique in a challenging operative field such as endoscopic surgery.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     The present invention is related to an operation instrument, and more particularly to a multifunctional forceps set which is designed from the key concept of integrating surgical procedures of double grasping, incision and ligation into a continuous working procedure to facilitate progress of operation. The forceps set of the present invention can be easily solely operated by an operator.  
         [0002]     Surgeon uses surgical scalpel for excision, hemostatic forceps for bleeding control, suture for ligation bleeding vessels or vascular pedicles in his or her routine surgical procedures. However, it&#39;s hard to do it in a confined operation field like endoscopic surgery. To accomplish these important and necessary operative procedures, it has to depend on alternative devices such as metallic clips, stapler, Roeder loop ligature and equipment using special energy sources such as electro-surgery units, laser or harmonic scalpel, etc. All of these instruments or devices are extremely expensive and have their inherent limitations in real practice. The laser or harmonic scalpel can coagulate small vessels only (diameter less than 4 mm). The bipolar electro-surgery device that is extensively used in current endoscopic surgery can provide better coagulation for large vessels, but may cause more peripheral thermal tissue injury. Ligasure™, a new bipolar electro-surgery unit has the features of high ampere, low voltage and low thermal injury can coagulate larger vessels with diameter up to 7 mm. However, a common silk suture can ligate a vessel with diameter up to 10 mm easily. Metallic clips and staplers can clip vessels or seal vascular tissue, but will cause permanent foreign body retention effect on tissue. Roeder loop ligature is not convenient to use and has no enough tensile strength in bulky ligation. In addition, it will cost a learner much time to learn the use of the above instruments or devices. Furthermore, in case these instruments are incorrectly used, a seriously dangerous result may occur. The limited performance of those alternative instruments or devices points to the urgent need for the better and safer instrument in real practice.  
       SUMMARY OF THE INVENTION  
       [0003]     It is therefore a primary object of the present invention to provide a multifunctional forceps set, the multifunctional forceps set can be very easily and safely operated, enabling surgeons to perform surgery in confined and challenging operation field.  
         [0004]     The present invention can be best understood through the following description and accompanying drawings wherein: 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0005]      FIG. 1  is a perspective view showing the structure of a standard surgeon&#39;s knot;  
         [0006]      FIG. 2  shows that the standard surgeon&#39;s knot is converted into the loop ligature of the present invention;  
         [0007]      FIG. 3  shows the structure of the loop ligature of the present invention;  
         [0008]      FIG. 4  shows that the loop of the loop ligature of the present invention is adjustable in size;  
         [0009]      FIG. 5  shows that the loop ligature of the present invention is converted into a secure knot;  
         [0010]      FIG. 6  is an enlarged view of circled area of  FIG. 5 ;  
         [0011]      FIG. 7  is a perspective assembled view of a preferred embodiment of the forceps set of the present invention;  
         [0012]      FIG. 8  is a general perspective exploded view of the preferred embodiment of the forceps set of the present invention according to  FIG. 7 ;  
         [0013]      FIG. 9  is a perspective view of a front section of  FIG. 7 ;  
         [0014]      FIG. 10  is a perspective view of a rear section of the forceps set of the present invention;  
         [0015]      FIG. 11  shows the structure of front end of the lower jaw of the forceps set of the present invention;  
         [0016]      FIG. 12  shows the structure of rear end of the lower jaw of the forceps set of the present invention;  
         [0017]      FIG. 13  is a view according to  FIG. 12 , showing that the small blade is mounted at rear end of the lower jaw;  
         [0018]      FIG. 14  shows that the locating member is co-used with the loop ligature of the present invention;  
         [0019]      FIG. 15  is a perspective view of a part of the present invention, showing the relative position of the pull member;  
         [0020]      FIG. 16  shows that the loop ligature is loaded in the forceps mouth;  
         [0021]      FIG. 17  shows that the forceps of the present invention is operated to clamp a tissue;  
         [0022]      FIG. 18  shows that the forceps of the present invention is operated to incise a tissue;  
         [0023]      FIGS. 19 and 20  show the divided pedicles are ligated by the loop ligatures;  
         [0024]      FIG. 21  shows that the trigger is pulled to track the second tracking member;  
         [0025]      FIG. 22  shows that the third tracking member is drivingly tracked;  
         [0026]      FIG. 23  shows that the residual sutures of post-ligation are cut off; and  
         [0027]      FIG. 24  shows the continuous operations of the present invention, that is, grasping→incision→looping→ligation→securely knotting→cutting residual sutures of post-ligation. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0028]      FIG. 7  shows a preferred embodiment of the multifunctional forceps set of the present invention which includes a forceps and two loop ligatures disposed on the forceps.  
         [0029]      FIG. 3  shows the configuration of the loop ligature  20 . The loop ligature  20  is transfigured from a standard surgeon&#39;s knot.  FIG. 1  shows a standard surgeon&#39;s knot  10  for ligating a tissue such as a vessel. The surgeon&#39;s knot is braided from a surgical braided and coated suture. (In this embodiment, USP “0” braided and coated polyglactin  910  is chosen as standard reference.) The standard surgeon&#39;s knot  10  includes a twice matted section  12 , a first once matted section  14  on outer side and a second once matted section  16  on outermost side. When the segment A of the surgeon&#39;s knot  10  is pulled to straighten the two once matted sections  14 ,  16 , a state as shown in  FIG. 2  is formed. Then the segment A of the surgeon&#39;s knot  10  is pulled to straighten the twice matted section  12 , whereby the loop ligature  20  transfigured from the surgeon&#39;s knot is formed as shown in  FIG. 3 . The loop ligature  20  includes a loop  21  and a knotted section  22 . The knotted section  22  has multiple circle sections formed by winding segment B around the segment A. The segment B is first wound around the segment A from one side of the loop  21  to form a first circle  23 . Then the segment B is wound around the segment A from one side of the first circle section  23  near the loop  21  to form a second circle section  24 . A first bridge section  25  extending from the second circle section  24  is bridged over the first circle section  23 . Then a third circle section  26  is formed on the other side of the first circle section  23 . Then a fourth circle section  27  is formed on a free side of the third circle section  26 . A second bridge section  28  is bridged between the third and fourth circle sections  26 ,  27 .  
         [0030]     The use of the loop ligature is different from the use of the common standard surgeon&#39;s knot. With respect to the standard surgeon&#39;s knot, two ends of the suture (the ends A and B shown in  FIG. 1 ) are tracked to convert the matted sections  12 ,  14 ,  16  into a secure knot. In comparison with the standard surgeon&#39;s knot, the loop ligature of the present invention has two characteristics as follows: 
        1. The loop ligature  20  is not a secure knot. Instead, the loop ligature  20  is a slippery knot. With the knotted section  22  located, for example, when the knotted section  22  is pinched by fingers or when the loop ligature is fitted through a body having an opening (such as the ring body  18  shown in FIGS.  4  to  6 ) and the knotted section  22  is stopped and located, by means of tracking the movable end A, the diameter of the loop  21  can be changed.     2. After the loop  21  is adjusted to a suitable diameter, as shown in  FIG. 5 , the fixed end B is forcedly tracked to straighten the fourth circle section  27  of the knotted section  22 , whereby the segment A is forcedly formed with a knotted section  29  tightly binding the segment B as shown in  FIG. 5 . Accordingly, the loop ligature  20  forms a firm secure knot. Therefore, the loop  21  cannot be expanded to achieve a binding effect. It is found through tests that the secure knot has a tensile strength of ligation as the standard surgeon&#39;s knot.        
 
         [0033]     It should be noted that in the figures, the knotted section  22  is enlarged for illustration. In fact, the knotted section  22  is a tight state.  
         [0034]     Referring to FIGS. 7 and 8, the forceps set  30  of the present invention includes the following elements.  
         [0035]     A forceps body  32  has a fixed handle  33  and a movable handle  36 . A forward extending barrel  34  is disposed on upper side of the fixed handle  33 . A finger hole  35  is formed on upper side of the barrel  34 . A top end of the movable handle  36  is pivotally connected with a top end of the fixed handle  33  and positioned on rear side of the fixed handle  33 . The movable handle  36  can be opened from the fixed handle  33  or closed to the fixed handle  33 . The movable handle  36  is formed with a through hole  361  aligned with a rear end of the barrel  34 . A pair of slots  37  are axially formed on the circumference of a middle section of the barrel  34 . A pair of splits  38  are axially formed on two sides of front end of the barrel  34 .  
         [0036]     A first link  40  and a second link  45  are axially slidably fitted in the barrel  34 . The front ends of the two links protrude from the front end of the barrel. The rear end of the first link  40  is pivotally connected in the through hole  361  of the movable handle  36 . The rear end of the second link  45  extends through the through hole  361  and rearward protrudes from the movable handle. A first resilient member  46  is fitted on the second link  45 . One end of the first resilient member  46  abuts against the rear end of the second link, while the other end of the first resilient member  46  abuts against the movable handle, whereby when no external force is applied to the second link, the second link keeps in a rearward position. A fissure  42  is axially formed on the first link  40  and inward extends from front end thereof. A blade  48  is fixed at front end of the second link  45 . The second link  45  is placed on top face of the first link  40  with the blade  48  snugly positioned in the fissure  42  as shown in  FIG. 9 .  
         [0037]     A press unit  50 , in this embodiment, includes a trigger  51  and a lever  60 .  
         [0038]     The trigger  51  has a disc-shaped body section  52  and a pull arm  55  connected with the circumference of the body section. A cam section  53  is formed on the circumference of the body section. The body section of the trigger  51  is pivotally disposed on the forceps body, whereby the trigger  51  can be rotated. The pull arm  55  forward projects from front edge of the forceps body for manually shifting.  
         [0039]     A secure pin  56  is angularly displaceably pivotally disposed on the forceps body. One end of the secure pin  56  has a hook section  57 . When the secure pin is positioned in a latching position, the hook section hooks a notch  54  of the trigger to prevent the trigger from rotating.  
         [0040]     The bottom end of the lever  60  is pivotally disposed on the fixed handle  33  behind the trigger  51 , whereby the lever  60  can be swung. A second resilient member  65  is connected between the trigger and the lever. When no external force is applied to the lever, the second resilient member  65  on one hand resiliently keeps the lever in a forward leaning state and on the other hand keeps the trigger in a not pulled position. The lever  60  is formed with a protuberance  62  in contact with the body section  52  of the trigger. When pulling the trigger, the cam section  53  can drive the protuberance  62  of the lever  60  to make the free end of the lever swing forward. It should be noted that the configuration of the trigger is not limited to the conformation shown in the figures. Alternatively, a trigger can be back and forth slidably mounted on the forceps body. By means of rearward pressing the trigger, the rear end of the trigger can also push the lever to move backward.  
         [0041]     A pull ring  70  has a ring body  72  and two ring sections  74  respectively fixedly connected with top and bottom end of the ring body. The ring body  72  is slidably fitted around the barrel  34 .  
         [0042]     Two first tracking members  75 , two second tracking members  76  and a third tracking member  78  as shown in  FIGS. 9 and 10 . The tracking members are preferably steel strings and back and forth slidably disposed in the barrel  34 . The two first and second tracking members  75 ,  76  are respectively positioned on two sides of the barrel. The third tracking member  78  is positioned on bottom side of the barrel. It should be noted that the portions of the wall of the barrel where the tracking members  75 ,  76 ,  78  and the second link  45  are disposed can be thickened. The thickened portions can be formed with fine tunnels through which the above members are passed.  
         [0043]     The rear ends of the two first tracking members  75  are respectively fixedly disposed on two sides of the ring body  72  of the pull ring as shown in  FIG. 10 , whereby the first tracking members  75  can be pulled by the pull ring. The rear ends of the two second tracking members  76  are connected with the free end of the lever  60  to be pulled by the lever. The front ends of the first and second tracking members  75 ,  76  are exposed to outer side through the splits  38  of the barrel  34  as shown in  FIGS. 7 and 9 . The bottom of the barrel  34  is formed with an orifice  341  near the forceps body  32 . The rear end of the third tracking member  78  is threaded through the orifice  341  and conducted out to connect with a connecting button  79  disposed on the forceps body. The connecting button  79  is up and down movably disposed on the fixed handle  33 . In this embodiment, the front edge of the fixed handle is formed with a guide rail  331  the cross-section of which is T-shaped as shown in  FIG. 8 . The connecting button  79  is a U-shaped member up and down movably inlaid in the guide rail. However, the up and down moving measure of the connecting button is not limited to this embodiment. The present invention further includes a third connecting member  791 . Referring to  FIGS. 8 and 10 , one end of the third resilient member  791  is connected with the connecting button  79 , while the other end of the third resilient member  791  is connected with a connecting section  58 . The connecting section  58  is a part of the secure pin  56  and is synchronously movable along with the secure pin  56 . The third resilient member  791  resiliently keeps the secure pin in the latching position and keeps the connecting button  79  in an upper dead end of its travel. When the connecting button  79  is positioned in the upper dead end, the connecting button is right positioned under the pull arm  55  of the trigger.  
         [0044]     A forceps mouth  80  has two side by side arranged lower jaws  82  and two side by side arranged upper jaws  84 . In this embodiment, the two lower jaws  82  are integrally formed at front end of a bar member  81 . The two lower jaws define therebetween a gap  821 . The bar member  81  is fixedly fitted in the barrel from front end thereof with the two lower jaws  82  positioned at front end of the barrel. The bar member  81  is positioned under the first link  40 . The rear end of each of the two upper jaws  84  has two pivot points c, d. The lower pivot point c serves as a fulcrum for pivotally connecting the upper jaw with the bar member  81 . The upper pivot point d is for pivotally connecting the upper jaw with the front end of the first link  40 . Accordingly, the upper jaws are pivotally connected with the two lower jaws on upper side thereof. When the first link is displaced to drivingly move the upper jaws  84 , the upper jaws can be opened from the lower jaws or closed thereto. In addition, the front ends of the upper jaws can be fixed together by a staple  87  so as to ensure that the upper jaws be harmonically opened and closed. The upper jaws define a gap  841  therebetween. The gaps  821 ,  841  and the fissure  42  of the first link are in the same axial direction.  
         [0045]     In addition, the periphery of each upper jaw  84  is formed with a circumferential groove  842 . Referring to  FIG. 11 , the top edge of the front end of each lower jaw  82  is formed with a funnel-shaped recess  821  which is slightly larger than the volume of the knotted section  22  of the loop ligature  20 . In addition, the front edge of outer side of each lower jaw is formed with a small groove  822  near the recess  821 . The small groove  822  is slightly larger than the diameter of the suture. Two steel plates  85  are respectively fixedly disposed at front ends of the two lower jaws  82 . Each steel plate  85  has a through hole  851  corresponding to the recess  821 . Referring to  FIG. 12 , the outer side of rear end of each lower jaw  82  is formed with an inward extending small fissure  823  near the pivot joint. The bottom face of the rear end of the lower jaw is formed with a guide channel  824  behind the small fissure  823 .  
         [0046]     The present invention further includes two small blades  95 . As shown in  FIGS. 12 and 13 , the blade sections of the small blades face upward. The two small blades are respectively replaceably plugged in the two small fissures  823 . A protective jacket  951  is disposed at outer end of each small blade.  
         [0047]     The present invention further includes a locating member  100 . Referring to  FIG. 14 , the locating member  100  is like a slender rod formed of a copper filament coated by a plastic skin. Two ends of the copper filament protrude from the plastic skin to form two deformable hook sections  102 .  
         [0048]     The present invention further includes a pull member  105 . Referring to  FIG. 15 , in this embodiment, the pull member  105  is a loop. A middle section of the pull member  105  is hooked with the hook section  781  of the front end of the third tracking member  78 . Two ends of the pull member  105  are respectively conducted through the guide channels  824  of the bottom faces of the lower jaws and reversely upward folded for tracking the suture.  
         [0049]     The loop ligature  20  is mounted in the upper and lower jaws  82 ,  84 . Referring to  FIG. 14 , the loop  21  is first adjusted to a size adapted to the size of the jaws. Then the hook sections  102  of the locating member  100  are hooked with two sides of the loop. Then, as shown in  FIG. 16 , the upper edge of the loop  21  is inlaid in the grooves  842  of the upper jaws  84  and the locating member  100  is inlaid in an insertion dent  825  formed on rear end of top face of the lower jaw. Then the two ends A, B of the loop ligature  20  are threaded through the through hole  851  of the steel plate  85 . The movable end A is conducted rearward through the small groove  822 . The fixed end B is conducted through the recess  821 . The knotted section  22  of the loop ligature  20  is located in the through hole  851  of the steel plate and the recess  821 . The lower edge of the loop  21  is wound along the circumference of the lower jaw  82 . The periphery of front end of the lower jaw (or steel plate) can be formed with notch  852  for locating the lower edge of the loop. Accordingly, two loop ligatures  20  can be respectively located on the two pairs of jaws  82 ,  84 .  
         [0050]     Then, the two ends A, B of the loop ligature  20  are conducted through one end of the pull member  105  as shown in  FIG. 15 . The hook section  751  of the first tracking member  75  is hooked with a secure knot of the movable end A of the loop ligature  20  as shown in  FIG. 16 . The hook section  761  of the second tracking member  76  is hooked with the secure knot of the fixed end B. At this time, the loading of the loop ligature on the forceps of the present invention is completed.  
         [0051]     The operation of the present invention in surgery is described as follows:  
         [0052]     First, the fixed handle  33  and movable handle  36  of the forceps  30  are held with one hand (such as right hand) to open out the movable handle  36 . At this time, the first link  40  is pulled backward to upward open the two upper jaws  84 .  
         [0053]     The opened forceps mouth  80  is aimed at the tissue to be ligated. Then the movable handle  36  is closed forward as shown in  FIG. 17 . At this time, the first link  40  drives the upper jaws  84  to close and clamp the tissue in the forceps mouth  80 . The bottom of the movable handle  36  has a projection  361  formed with ratchets. The rear end of the fixed handle  33  is formed with ratchets  332 . The ratchets can be engaged with each other to keep the handles of the forceps closed.  
         [0054]     Then, the second link  45  is forward pushed with the other hand (such as left hand) as shown in  FIG. 18 . At this time, the blade  48  is moved into the gaps  821 ,  841  between the two pairs of jaws in front of the front end of the forceps mouth for incising the tissue. In addition, as shown in  FIG. 7 , a locating member  49  can be disposed on the second link  45  for abutting against back face of the movable handle  36 , serving as a front dead end of the travel of the second link. After the second link is released from the pressing force, the first resilient member  46  resiliently pushes back the second link  45 , whereby the blade  48  is restored into the fissure  42 .  
         [0055]     Then, as shown in  FIGS. 19 and 20 , the thumb of left hand of an operator extends into the finger hole  35  of the forceps body  32  and the index finger and middle finger are respectively extend into the two ring sections  74  of the pull ring  70  to pull the pull ring  70  rearward. Via the two first tracking members  75 , the movable ends A of the two loop ligatures  20  are synchronously pulled backward to minify the loops  21  of the loop ligatures. At this time, the hook sections  102  of the locating members  100  are forcedly deformed, whereby the loops are released from the hooked state and separated from the locating members. When the loops are tracked and minified, the loops are separated from the forceps mouth and contracted toward the outer sides of the front ends of the two lower jaws. In addition, when the operator contracts the loops, the loops respectively loop the divided pedicles. Then, as shown in  FIG. 20 , the operator gradually opens the movable handle  36  with right hand, while continuously pulling the pull ring  70  with left hand so as to ligate the pedicles to a sufficient tensile strength.  
         [0056]     After the above operation is completed, the secure pin  56  is shifted to an unlatched position as shown in  FIG. 21 . At this time, the secure pin  56  is detached from the notch  54  of the trigger  51 . The operator pulls the trigger with index finger of right hand to rotate the body sect ion  52 . At this time, the cam sect ion  53  rearward pushes the lever  60 , whereby the two second tracking members  76  are synchronously pulled backward by the lever to track the fixed ends B of the two loop ligatures. Accordingly, the loop ligatures are converted into secure knots as shown in  FIG. 5  to keep the tensile strength of ligation.  
         [0057]     When the trigger  51  is further pressed downward, the connecting button  79  is triggered as shown in  FIG. 22 . At this time, the third tracking member  78  and the pull member  105  are pulled. When the pull member  105  is pulled, two ends thereof respectively downward pull the segments A, B of the loop ligatures  20  as shown in  FIG. 23 . At this time, the segments A, B are cut off the small blades  95 . Accordingly, the residual sutures of post-ligation are smoothly cut off and the forceps set can be removed.  
         [0058]     When re-using the forceps set, the operator only needs to load two new loop ligatures onto the forceps mouth.  
         [0059]     The forceps set of the present invention can be easily solely operated by an operator. The forceps set of the present invention can rapidly perform the procedures of incision, ligating divided pedicles and cutting residual sutures of post-ligation. In a confined operation field, the forceps set of the present invention can ligate larger and thicker tissue than the existent expensive endoscope instruments. Moreover, the present invention is developed from consolidation of surgical scalpel, forceps and device simulating finger&#39;s functions. The present invention enables surgeons to use familiar technique in a challenging operative field such as endoscopic surgery. It will not cost long time for surgeons to learn the operation skill of the forceps set of the present invention. Furthermore, the forceps set of the present invention is a mechanical design without using any special energy so that the surgery can be performed more safely and the operation time is shortened. Therefore, better recovery is achievable.  
         [0060]     The above embodiments are only used to illustrate the present invention, not intended to limit the scope thereof. Many modifications of the above embodiments can be made without departing from the spirit of the present invention.