Abstract:
The present invention provides a surgical device having a tissue engaging portion, a shaft member, and a handle assembly. The tissue engaging portion includes first and second opposed jaws for grasping, securing, and occluding body tissue and conduits. The shaft member is operatively coupled to the tissue engaging portion and is capable of being placed in different curvatures. The handle assembly is operatively coupled to both the shaft member and to the tissue engaging portion. The shaft member of the present invention allows the surgeon to bend and adjust the shape of the surgical device to minimize its intrusion and to allow for proper positioning in predetermined body locations. In a preferred embodiment, a portion of the device is disposable.

Description:
FIELD OF THE INVENTION  
         [0001]    This invention relates generally to surgical devices and more specifically to a surgical device with a malleable shaft for use in grasping, securing, and occluding body tissue and conduits.  
         BACKGROUND OF THE INVENTION  
         [0002]    Surgical devices generally include, but are not limited to, clamps, scissors, forceps, dissectors, and retractors. Typically, such surgical devices consist of three elements: a handle, tissue engaging means, and a member extending between the handle and the tissue engaging means. The handle opens and closes the jaws of the tissue engaging means and often has a locking mechanism to hold the jaws closed. The jaws of the tissue engaging means vary extensively in configuration, length, angle, and delicacy depending upon the function of the device and the tissue being engaged. There are many variations of the member provided between the handle and the tissue engaging means. Such members have been provided in a large number of lengths, bends, and angles in order to allow the surgeon to place the jaws in a large number of locations in a wide variety of human body shapes and sizes.  
           [0003]    Traditionally, surgeries have been quite invasive to the patient&#39;s body, often involving large open incisions. Such surgeries result in great trauma to the patients and require long periods of recovery time. Because these surgeries often involve large incisions, there has not been a strong need for providing surgical devices of a size and detail appropriate for a limited work area. In addition, in order to provide surgeons with a number of choices, surgical devices of various shapes have been provided.  
           [0004]    In the recent past, minimally-invasive surgery (MIS) has grown in popularity as an alternative to traditional, large incision surgery. The term MIS refers to performing surgery in smaller incisions in order to reduce the trauma experienced by the patient, increase the speed of healing, and reduce the recovery time. For the patient, this ultimately equates to less time in the hospital which adds to the cost effectiveness of these procedures.  
           [0005]    Understandably, it is very challenging for surgeons to perform surgical tasks in small, MIS incisions. The normal concerns of surgery are compounded with the unique problems brought about by MIS procedures. For example, since the objectives of open surgeries and MIS surgeries are often the same, the occluding of body conduits is still of concern. However, surgical devices of the past were designed for occluding of body conduits during open surgery wherein the size of the surgical device was not constrained by narrow diameters of small, MIS incisions. Thus, such surgical devices, which are necessary in most all procedures, protrude out of the MIS incision and have the potential to interfere with the surgeons&#39; hands as they try to visualize, cut, dissect or suture within the incision. Additionally, in the area of non-minimally invasive surgery, the use of instruments has increased as the surgery techniques have become more and more complex.  
           [0006]    Thus, it would be advantageous to have a surgical device which minimizes the degree to which it potentially interferes with the surgeon during any surgery, thereby allowing the surgeon to perform more efficient surgery. It would be further advantageous to have a surgical device that allows proper positioning to predetermined body locations within the small incisions.  
         BRIEF DESCRIPTIONS OF THE INVENTION  
         [0007]    The present invention provides a surgical device which minimizes the degree which it potentially interferes with the surgeon during surgery, particularly but not limited to, MIS. The present invention also provides a surgical device that allows proper positioning to predetermined body locations. The present invention achieves these objectives by utilizing a surgical device with a malleable shaft which allows the surgeon to bend and adjust the shape of the device to minimize its intrusion and to allow for proper positioning in predetermined body locations. The surgical device of the present invention is further provided with tissue engaging means and a handle portion. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0008]    [0008]FIG. 1 is a side view of a preferred embodiment made in accordance with the principles of the present invention.  
         [0009]    [0009]FIG. 2 is a side view of an alternate embodiment of the handle and ratchet assembly of the present invention.  
         [0010]    [0010]FIG. 2 a  is a side view of the ratcheting means shown in the assembly of FIG. 2.  
         [0011]    [0011]FIG. 3 is a side view of an alternate embodiment made in accordance with the principles of the present invention.  
         [0012]    [0012]FIG. 3 a  is a side view of the tissue engaging means of the embodiment of FIG. 3, the tissue engaging means being in the closed position.  
         [0013]    [0013]FIG. 3 b  is a side view of the tissue engaging means of the embodiment of FIG. 3, the tissue engaging means being in the open position.  
         [0014]    [0014]FIG. 3 c  is a cross sectional view of the tissue engaging means of the embodiment of FIG. 3.  
         [0015]    [0015]FIG. 4 is a cross-sectional view of the mechanism which enables handle to shaft rotation.  
         [0016]    [0016]FIG. 5 is a cross-sectional view of a malleable embodiment of the shaft member made in accordance with the principles of the present invention.  
         [0017]    [0017]FIGS. 6 a - 6   c  are side views of an alternate embodiment of the jaw actuating mechanism made in accordance with the principles of the present invention.  
         [0018]    [0018]FIG. 7 is a side view of a wound tubing embodiment of the shaft member made in accordance with the principles of the present invention.  
         [0019]    [0019]FIG. 7 a  is a cross-sectional view of the wound tubing embodiment of the shaft member shown in FIG. 7.  
         [0020]    [0020]FIG. 7 b  is a cross-sectional view of the wound tubing embodiment of the shaft member shown in FIG. 7, placed in a bent shape.  
         [0021]    [0021]FIG. 7 c  is a side view of a ball and socket embodiment of the shaft member made in accordance with the principles of the present invention.  
         [0022]    [0022]FIG. 7 d  is a cross-sectional view of the ball and socket embodiment of the shaft member shown in FIG. 7 c.    
         [0023]    [0023]FIG. 7 e  is a cross-sectional view of the ball and socket embodiment of the shaft member shown in FIG. 7 c , placed in a bent shape.  
         [0024]    [0024]FIG. 8 is a top view of an alternate embodiment of the jaw actuating mechanism made in accordance with the principles of the present invention.  
         [0025]    [0025]FIG. 8 a  is a cross-sectional view of the jaw actuating mechanism shown in FIG. 8, taken along the plane of line  8   a - 8   a.    
         [0026]    [0026]FIG. 8 b  is a top view of the jaw actuating mechanism shown in FIG. 8, in the closed position.  
         [0027]    [0027]FIG. 8 c  is a top view of the jaw actuating mechanism shown in FIG. 8, shown with alternate jaws.  
         [0028]    [0028]FIG. 9 is a perspective view of an alternate preferred embodiment made in accordance with the principles of the present invention.  
         [0029]    [0029]FIG. 9 a  is a detail view of the ball and socket arrangement used in the embodiment of FIG. 9.  
         [0030]    [0030]FIG. 10 is a perspective view of a disposable embodiment made in accordance with the principles of the present invention.  
         [0031]    [0031]FIGS. 11 and 12 are cross-sectional views of the coupling arrangement between the jaw actuating means and the tissue engaging means of the embodiment of FIG. 10.  
         [0032]    [0032]FIGS. 13 and 14 are cross-sectional views of the coupling arrangement between the jaw actuating means and the handle assembly of the embodiment of FIG. 10.  
         [0033]    [0033]FIG. 15 a  is a cross-sectional view of the coupling arrangement of FIGS. 11 and 12, in the locked position.  
         [0034]    [0034]FIG. 15 b  is a cross-sectional view taken along the plane of line  15   a - 15   a  of FIG. 15 a.    
         [0035]    [0035]FIG. 16 a  is a cross-sectional view of the coupling arrangement of FIGS. 11 and 12, in the unlocked position.  
         [0036]    [0036]FIG. 16 b  is a cross-sectional view taken along the plane of line  16   a - 16   a  of FIG. 16 a.    
         [0037]    [0037]FIG. 17 is a cross-sectional view of an alternate embodiment of the jaw actuating mechanism made in accordance with the principles of the present invention.  
         [0038]    [0038]FIG. 17 a  is a top view of the jaw actuating mechanism shown in FIG. 17.  
         [0039]    [0039]FIG. 17 b  is a cross-sectional view of the jaw actuating mechanism shown in FIG. 17, in the closed position.  
         [0040]    [0040]FIGS. 18 and 19 are cross-sectional views of an alternate embodiment of the coupling arrangement between the jaw actuating means and the handle assembly made in accordance with the principles of the present invention.  
         [0041]    [0041]FIG. 18 a  is an enlarged view of the coupling arrangement of FIG. 18.  
         [0042]    [0042]FIG. 19 a  is an enlarged view of the coupling arrangement of FIG. 19. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0043]    Referring first to FIG. 1, a surgical device  10  made in accordance with the principles of the present invention is shown. The surgical device  10  generally includes a handle portion  12 , a shaft member  14 , and tissue engaging means  16 . Although the figures depict a clamping device, it should be understood that the principles of the present invention are not limited to clamping devices and can be applied to other surgical devices such as, for example, scissors, forceps, dissectors, and retractors.  
         [0044]    The handle portion  12  functions to move the tissue engaging means  16  between open and closed positions. The handle portion  12  comprises a ratchet handle assembly  19  having an angled handle. It should be understood that alternate handle assemblies having different orientations or ratchet designs could also be employed. The handle assembly  19  of the present invention includes a pair of elongate legs  21 ,  23  which terminate at distal ends with finger grips and which are pivotably connected together at an intermediate location along the lengths thereof at a pivot element  26 . A shaft support element  28  for the shaft member  14  is mounted to the proximal end of leg  21 . While leg  21  remains stationary with respect to the shaft support element  28 , leg  23  moves with respect to leg  21  about the pivot element  26 . Additionally, the proximal end of leg  23  is operatively connected to an actuating means  31  which extends axially through the shaft member  14  and is operatively coupled to the tissue engaging means  16 . In the preferred embodiment, the actuating means  31  comprises a cable. However, other alternate equivalent actuating means could also be employed.  
         [0045]    The handle assembly  19  is further provided with a ratcheting mechanism  35  which is mounted on one of the legs and which interacts with the other leg to hold the tissue engaging means in the closed position. To move the tissue engaging means to the open position, lever  36  is depressed to release leg  23  and the tissue engaging means from the closed position. To move the tissue engaging means from the open position to the closed position, leg  23  is pushed toward leg  21 , the proximal end of leg  23  pulling back on the actuating means  31  and thereby actuating the tissue engaging means. Actuation of the tissue engaging means will be discussed in more detail below.  
         [0046]    An alternate handle assembly and ratcheting mechanism that could be used with the present invention is shown in FIG. 2. The handle assembly  19  includes two elongate legs  22 ,  24  operatively coupled together at one end. The legs terminate at distal ends with finger grips. Each of the legs is also provided with a lateral extension  25 ,  27  carrying ratcheting means  29 . The ratcheting means  29 .cooperate in the manner shown in FIG. 2 a . As the legs are moved relative to one another, the ratcheting means cooperate to set the tissue engaging means of the device in the desired position.  
         [0047]    In an alternate embodiment of the handle assembly, shown in FIG. 3, leg  123  can be mounted on a shaft support element  128  for shaft member  114  while leg  121  moves about the pivot element  126 . The proximal end of leg  121  is operatively connected to piston  130  which reciprocates axially within shaft support element  128 . When leg  121  is moved toward leg  123 , leg  121  acts upon piston  130  which in turn pushes on the actuating means  131 . The actuating means  131  in turn acts on the tissue engaging means  116 .  
         [0048]    The present invention can also be provided with a mechanism that enables the handle assembly  19  to rotate freely relative to the shaft member  14  to allow the handle to lie flat on the operating table and out of the surgeon&#39;s way. FIG. 4 shows the detailed view of this mechanism. As knob  39  is loosened from its attachment with the support element  28  of the handle assembly, the force applied by the knob  39  against bearing  40  and gasket  41  is removed. Consequently, the shaft member  14  can then rotate freely with respect to the support element  28 . To set the handle assembly in the desired position with respect to the shaft member, the knob  39  is tightened against the support element  28 , thereby acting against the gasket. The gasket  41  thereby functions as a brake, preventing the shaft member to be rotated with respect to the handle assembly after tightening.  
         [0049]    The surgical device is further provided with a shaft member  14  which connects the handle assembly  12  to the tissue engaging means  16 . As seen in FIG. 1, one end of the shaft member  14  is operatively coupled to the shaft support element  28  of the handle assembly  19  while the opposite end of the shaft member  14  is operatively coupled to the tissue engaging means  16 . In the present invention, the shape of the shaft member  14  can be reconfigured in order to enable proper positioning of the tissue engaging means to predetermined body locations. The shaft member  14  can be manipulated to the desired shape to avoid obstructions in an area of work or placed out of the way of the surgeon. It can take a number of forms to accomplish its function.  
         [0050]    The shaft member can take a malleable form. Due to its malleable nature, the shaft can be placed in various arrangements to reach desired body locations. In such an embodiment of the present invention, the shaft member comprises a malleable tube with the actuating means extending axially there through. One end of the actuating means is operatively connected to the tissue engaging means while the other end is operatively coupled to the handle assembly. In one embodiment of the present invention, the ends of the actuating means can be coupled to the tissue engaging means and to the handle assembly via a ball and socket coupling. Each end of the actuating means is provided with a member in the shape of a ball which mates with a socket carried by the tissue engaging means and the handle assembly. FIG. 9 a  is a detailed view of the ball and socket coupling arrangement between the actuating means and the tissue engaging means. However, alternate equivalent coupling means could also be utilized.  
         [0051]    The malleable tube of the shaft member could comprise tubing made of soft metal such as, for example, annealed stainless steel, brass, or aluminum, or wound tubing made of steel that is bendable and that can be placed in different shapes. Such a wound tubing embodiment of the shaft member  14  is depicted in FIGS.  7 - 7   b . For a soft metal tube, the bending moment required to create a permanent set in the shaft in the range of approximately 0.5 in-lbs to 8 in-lbs, and preferably approximately 2 in-lbs. Alternately, the shaft member  414  could comprise a dual-channeled tube  416  having the actuating means extending through one channel  419  and a malleable rod  422  extending through the other channel  425  along the length of the tube. The channel  419  housing the jaw actuating means (not shown) preferably extends through the center of the tube  416 , with the channel  425  housing the malleable rod  422  extending off-center, as shown in FIG. 5. Alternately, the malleable rod  422  can be positioned in other locations in the tube  416  with respect to its center. Due to the presence of the malleable rod  422 , the tube  416  can be placed in various shapes. In a further alternate embodiment, a plurality of malleable rods, rather than a single malleable rod, can be employed to keep the tube in the desired shape.  
         [0052]    The shaft member can also take a form that is both flexible and rigid. This form has the ability to be flexible so that the surgeon can form a predetermined shape to fit into a particular body opening and pathway. The state of the shaft can be changed from rigid to flexible and vice versa. Such an embodiment of the present invention is shown in FIG. 1 and in detail in FIGS. 7 c - 7   e . The shaft member  14  comprises a series of interconnected ball and socket segments  38  through which the actuating cable  31  passes. FIGS. 7 d - 7   e  show the cross-section of a typical ball and socket segment, while FIG. 7 e  shows the interaction between adjacent segments when the shaft member is placed in a desired shape. Referring back to FIG. 1, a tightening knob  42  is also provided adjacent the shaft support element  28  which can be actuated in order to exert axial compression on the segments  38 . This compression allows the ball and socket segments  38  of the shaft member  14  to be locked in any shape selected by the surgeon or other user of the surgical device.  
         [0053]    Alternately, the shaft member comprises a flexible tube with the actuating cable extending axially there through. A second applier instrument that is malleable grasps the shaft member and together the two are inserted into the incision. Once the tissue engaging means are in the closed position, the applier instrument is released and removed.  
         [0054]    The surgical device is further provided with a tissue engaging means  16  which functions to grasp, secure, and occlude body tissue and conduits. The tissue engaging means  16  includes a pair of jaws  46 ,  48 , the jaws being connected at one end by a hinge  50 . The jaws are moveable by various mechanisms between an open position and a closed position. The tissue engaging means can also be provided with a compression return spring  53  to assist the jaws in returning to the open position.  
         [0055]    Since it is important to surgeons to reduce the size and bulk of the hinge of the jaws in order to increase visualization and to minimize the space the tissue engaging means occupies, in one embodiment of the present invention, the jaws are coaxial with the longitudinal axis of the shaft member. This orientation, which is shown in FIGS. 3, 6,  8  and  9 , reduces the size and bulk of the hinge while still maintaining the strength required by the jaws. However, the tissue engaging means can be placed in alternate arrangements with respect to the shaft member. For example, in FIG. 1, the tissue engaging means is arranged at approximately a 90° angle with respect to the shaft member.  
         [0056]    In one embodiment of the invention, the shaft member is separable from the tissue engaging means. In use, the shaft member is utilized to place the tissue engaging means in the location desired. The shaft member is then released from the tissue engaging means and removed from the patient&#39;s body, leaving the tissue engaging means within the body. The tissue engaging means has a suture or tether attached to it, which extends out of the incision. When the tissue engaging means is to be removed, the shaft member is inserted back into the incision and is guided to the tissue engaging means by the suture or tether. The shaft member then is coupled to the tissue engaging means and the entire device is removed.  
         [0057]    The jaws can be actuated by a number of different mechanisms, as shown in FIGS. 3, 6,  8 ,  9 , and  10 . Despite the use of a non-rigid shaft member, the present invention is capable of exerting a force on the tissue engaging means in the range of approximately 10-20 lbs. In the embodiment of FIG. 3, the hinged end of each jaw is provided with a reduced thickness portion  154 ,  155 . In the open position of the tissue engaging means, shown in FIG. 3 b , a jaw actuating member  156  mates with the reduced thickness portions of the jaws. In use, the handle assembly  112  is actuated, thereby pushing the actuating means  131  forward. The actuating means  131  in turn pushes the actuating member  156 , thereby causing it to slide forward and out of the reduced thickness portions, as shown in FIG. 3 a . This motion squeezes the jaws  146 ,  148  to the closed position while the reverse motion separates the jaws  146 ,  148  to the open position.  
         [0058]    In the alternate embodiment of FIGS. 6 a  to  6   c , the hinged end of each jaw is provided with a hole  259  which interacts with a hook  261  provided at the end of the actuating cable  231 . Spring  253  is provided to maintain the jaws  246 ,  248  in the open position, as shown in FIG. 6 a . To place the jaws  246 ,  248  in the closed position, the handle assembly is actuated, thereby pulling the cable  231  and hook  261  back through the shaft member  214 . As the cable  231  is pulled back, the jaws  246 ,  248  are actuated to the closed position by their interaction with a conical end member  264  provided on the shaft member  214 .  
         [0059]    [0059]FIG. 8 depicts a further alternate embodiment of the jaw actuating mechanism. The mechanism includes a cylindrical clevis  520  having two longitudinal slots  522 ,  524  along its length, the slots located opposite of one another. The clevis  520  further includes a longitudinal cut-out  527  along its length. The jaws  546 ,  548  are disposed at one end of the clevis  520 . The opposite end of the clevis  520  is provided with a cylindrical extension  529  through which the jaw actuating mechanism extends. In this embodiment, the jaw actuating mechanism comprises a wire driver  531  which extends through the cylindrical extension  529  and is operatively connected to one end of the jaws.  
         [0060]    The jaws  546 ,  548  of this embodiment are provided with a diagonal slot  567 ,  569  at one end. As shown in FIG. 8 b , the slotted ends of the jaws are disposed within the cut-out  527  of the clevis when the jaws are in the closed position. The jaws are attached along their median portion to the clevis by a screw  572  extending transversely across the longitudinal cut-out  527 . The remainder of the jaws, the tissue engaging ends, extend from the clevis  520 .  
         [0061]    The end of the wire driver  531  which is coupled to the jaws  546 ,  548  is provided with a hook  561 . As seen in FIG. 8 a , a portion of the hook  561  is accommodated within each of the longitudinal slots. The remaining portion of the hook is coupled to the slots  567 ,  569  of the jaws. To actuate the jaws to an open position, the driver  531  is pushed toward the jaws. This motion causes the hook  561  to travel to one end of each of the slots  567 ,  569 , thereby causing the jaws  546 ,  548  to pivot about the screw and move to the open position. As shown in FIG. 8, the slotted ends of the jaws extended outwardly from the longitudinal cut-out  527  when the jaws are in the open position. To return the jaws back to the closed position, the driver  531  is moved in the direction away from the jaws, thereby causing the driver to move to the opposite end of the slots  567 ,  569 . The jaws again move about the screw to the closed position. In the closed position, the slotted ends of the jaws are within the cut-out  527 . As can be seen by referring to FIGS. 8 and 8 c , this type of actuating mechanism can be used with different tissue engaging means.  
         [0062]    A further preferred alternate embodiment of the present invention is depicted in FIG. 9. The surgical device  510  generally includes a handle assembly  512  comprising shaft support  528  and legs  521 ,  523 , a shaft member  514  with an actuating cable  531  extending therethrough, and tissue engaging means  516  including jaws  646 ,  648 . The actuating cable  531  is coupled to the leg  523  and to jaw  646  by a ball and socket arrangement, as mentioned above and as shown in detail in FIG. 9 a . When leg  523  of the handle assembly is moved toward leg  521 , this movement pulls on the actuating cable  531 . The actuating cable  531  in turn pulls jaw  646 , causing it to move toward jaw  648  and to the closed position. When it is desired to return the jaws to the opened position, leg  523  is released, thereby releasing the force on the cable and returning the jaws to the open position.  
         [0063]    In the embodiment of FIG. 9, the shaft member  514  can take one of two forms. The shaft member  514  can comprise the dual-channeled tube, as discussed above and shown in FIG. 5. Alternately, the shaft member can be comprised of tubing made of soft metal such as, for example, annealed stainless steel, brass or aluminum that is bendable and that can be placed in different shapes. In either instance, the shaft member is of a malleable type so that it can be placed in various arrangements to reach desired body locations.  
         [0064]    In order to save the time and costs involved in sterilizing the surgical device and to reduce the cost and waste involved with fully disposable devices, the surgical device of the present invention can be made in part of disposable material so that the remainder of the surgical device is reusable. In one embodiment of the present invention, the tissue engaging means and the shaft member are made of disposable material, and a handle portion is made of re-useable material such as stainless steel. Alternately, only the tissue engaging means is made of disposable material, and the shaft member and the handle portion of re-useable material.  
         [0065]    One such disposable device is shown in FIG. 10. The device  710  includes a disposable shaft member  714  operatively coupled to the tissue engaging means  716  and to the handle assembly  712 , both made of re-useable material. The shaft member  714  is comprised of a malleable tube, preferably of a soft metal such as, for example, annealed stainless steel, brass or aluminum, having a plastic covering for cosmetic purposes. Alternately, the shaft member  714  is comprised of a malleable plastic tube, preferably of polyethylene or some other suitable plastic extrusion.  
         [0066]    A jaw actuating means  731 , comprising either a flexible cable or rod, extends through the tube  715 , the actuating means  731  being capable of sliding freely within the tube. Each end of the actuating means  731  extends from a respective end of the malleable tube  715  and is provided with a spherical ball  720 ,  722  at its tip. As shown in FIGS.  11 - 14 , both the tissue engaging means  716  and the handle assembly  712  are provided with a mating socket  724 ,  726  for the spherical ball  720 ,  722 . As discussed below, the malleable tube  715  is coupled to the tissue engaging means  716  and to the handle assembly  712  by the mating of the spherical balls  720 ,  722  with the sockets  724 ,  726 .  
         [0067]    Referring to FIGS. 11 and 12, one of the jaws  748  of the tissue engaging means  716  is provided at one end with a cylinder  733 . The other jaw  746  of the tissue engaging means  716  is provided with a bolt  737 . The bolt  737  includes a cut-out portion  739  in which one end of jaw  746  pivots. The bolt  737  then extends away from jaw  746  through the cylinder  733  to mate with the jaw actuating means  731 . As mentioned above, the bolt  737  is provided with the socket  724  which mates with the spherical ball  720  of the jaw actuating means  731 . The cylinder  733  is also provided with a spring  741  which biases the bolt  737  and in turn the jaw  746  to the open position. To actuate the jaws of the tissue engaging means from the open position shown in FIG. 11 to a closed position, the handle assembly  712  is actuated to pull one end of the jaw actuating means  731  in the direction away from the tissue engaging means  716 . Due to the ball and socket coupling, the bolt  737  is also pulled away from the tissue engaging means  716 . This action causes the bolt  737  to act on jaw  746  via the cut-out portion  739 , the jaw  746  pivoting to the closed position shown in FIG. 12. Since the jaws are spring biased to the open position, upon release of the pressure on the legs of the handle assembly, the jaws are returned to the open position.  
         [0068]    As shown in FIGS. 13 and 14, a similar ball and socket coupling is employed to couple the jaw actuating means  731  to the handle assembly  712 . One of the legs of the handle assembly  712  is provided at one end with a cylinder  735  while the other leg  723  is provided with a bolt  739 . The bolt  739  includes a cut-out portion  743  in which the end of leg  723  pivots. The bolt  739  then extends away from the leg  723  through the cylinder  735  to mate with the jaw actuating means  731 . To mate with the spherical ball  722  of the jaw actuating means  731 , the bolt  739  is provided with a socket  726 . In order to actuate the tissue engaging means  716  to the closed position, the legs  721 ,  723  of the handle assembly  712  are moved from the position shown in FIG. 13, in which the legs are apart from one another, to the position shown in FIG. 14, in which the legs are brought together. With this action, leg  723  acts on the bolt  739  pulling it in a direction away from the tissue engaging means  716 . The bolt  739  in turn acts on the jaw actuating means  731 , pulling it in a direction away from the tissue engaging means  716 . As discussed above, this action causes the opposite end of the jaw actuating means  731  to act on jaw  746  of the tissue engaging means  716 , thereby bringing the jaws together to the closed position, as shown in FIG. 12.  
         [0069]    To enable the shaft member  714  to be separated from the handle assembly  712  and the tissue engaging means  716  and thus disposable, locking clips  751 ,  753  are provided at each ball and socket coupling. As seen from FIGS. 15 b  and  16   b , each clip is provided with an opening  755  generally in the shape of the numeral “8.” To lock the ball  720  of the jaw actuating means  731  to the socket  724  of the bolt  737 , the locking clip  751  is placed in the position shown in FIG. 15 b . To unlock the ball  720  of the jaw actuating means  731  from the socket  724  of the bolt  737  and thus allow the shaft member  714  to be separated and disposed, the locking clip  751  is placed in the position shown in FIG. 16 b.    
         [0070]    Another preferred alternate embodiment of the present invention is depicted in FIGS.  17 - 19 . The device  810  includes a tissue engaging means  816  with jaws  846 ,  848 , a shaft member  814 , and a handle assembly  812  with handles  821 ,  823 . The shaft member  814  is comprised of a malleable tube, preferably of a soft metal such as, for example, annealed stainless steel, brass or aluminum. Each end of the shaft member is provided with a terminal member  840 ,  841 . As shown in the figures, a jaw actuating means  831  comprising a cable extends through the shaft member  814 . The jaw actuating means is provided at each end with a terminal member  818 ,  819 , each terminal member having a spherical ball  820 ,  822  associated therewith.  
         [0071]    Referring to FIGS.  17 - 17   b , the tissue engaging means  816  is carried by a housing  824 . Within the housing  824 , a bolt member  837  moves, the bolt member being provided with a pin  832  and a socket  838  which cooperates with the spherical ball  820  of the jaw actuating means  831 . Jaw  846  of the tissue engaging means is provided with a slot  825  which is operatively coupled to a bolt member  837  via pin  832 . The shaft member  814  is coupled to the housing  824  by the cooperation between terminal member  840  and cap  833 . To couple the shaft member with the housing, terminal member  840  is abutted against the housing  840  and the cap  833  is then attached to housing  824  via a suitable means such as screw threads.  
         [0072]    To actuate the tissue engaging means from its open position, shown in FIG. 17, to its closed position, shown in FIG. 17 b , the jaw actuating means is pulled in a direction away from the tissue engaging means. This movement in turn causes the bolt member  837  to move away from the tissue engaging means. As the bolt member moves away, the pin  832  travels from one end of the slot to the other, thereby causing the jaw to pivot about the fulcrum  850  to its closed position. The coupling arrangement between the jaw actuating means and the tissue engaging means allows the force required to remain relatively low, particularly when taking into consideration the long, thin configuration of the shaft member. Once the jaw actuating means is released, it moves back towards the jaw actuating means and the jaw  846  returns to its open position.  
         [0073]    Referring to FIGS.  18 - 19 , handle  821  of the handle assembly is provided at one end with a housing  852 . Within the housing  852 , a bolt member  839  moves, the bolt member  839  being provided with a socket  855  for coupling with the jaw actuating means and a cut-out portion  843  in which the end of leg  823  pivots. The shaft member  814  is coupled to the housing  852  by the cooperation between terminal member  841  and cap  834 . To couple the shaft member  814  with the housing  852 , terminal member  841  is abutted against the housing  852  and the cap  834  is then attached to housing  852  via a suitable means such as screw threads.  
         [0074]    In order to actuate the tissue engaging means  816  to the closed position, the legs  821 ,  823  of the handle assembly  812  are moved from the position shown in FIG. 18, in which the legs are apart from one another, to the position shown in FIG. 19, in which the legs are brought together. With this action, leg  823  acts on the bolt member  839  pulling it in a direction away from the tissue engaging means  816 . The bolt member  839  in turn acts on the jaw actuating means  831 , pulling it in a direction away from the tissue engaging means  816 . As discussed above, this action causes the opposite end of the jaw actuating means  831  to act on jaw  846  of the tissue engaging means  816 , thereby bringing the jaws together to the closed position, as shown in FIG. 17 b.    
         [0075]    It should be understood that various changes in modifications to the preferred embodiment described herein will be apparent to those skilled in the art. Such changes and modifications can be made without departing from the spirit and scope of the present invention and without diminishing its attendant advantages. It is therefore intended that such changes and modifications be within the scope of the claims.