Patent GB-750525-A (GB)
Title: Improvements in or relating to devices for the gripping and ligaturing of the ends of tubular vessels
IPC: A61B17/12
Filed: 1953-12-07
Abstract: 750,525. A ligaturing device. KAMMER, K. Dec. 7, 1953 [April 10, 1953], No. 33905/53 Addition to 747,617. Class 81(2). In a ligaturing device as claimed in the parent Specification the successive movements necessary for ligaturing with a double or 'granny' knot are performed under the action of drive means which only need to be released and controlled by hand. The device described consists essentially of nine parts-a casing 1, an integral core and vessel gripper 26, 21, 23, a spring 29, sliding members 28, 33 and 41, cutting blades 45, thread tensioner 56, 57, 58, and operating lever 3-the operation of the device being as follows. Initially the device is as shown in Fig. 1 whereupon to grip the end of a severed blood vessel the surgeon presses the lever 3 inwards and pushes the slide 11 downwards. The device has previously been 'cocked' all the sliding members around the core 26 being held against the spring 29 by a spring loaded catch 18 protruding through the casing wall and locking the sliding member 28. Movement of the lever 3 causes its tip 10 to engage a notch 25 on the vessel gripper thus closing the latter against a spring. At the same time movement of the slide 11 causes the catch 18 to disengage thus allowing the slide 28 to move downwards. In this movement the slide carries members 33 and 41 with it until a screw 35 engaging in slots 36, 42 in the members ensures that first one and then the other member is stopped. The slide 28 is provided with a face 30 upon which a carrier plate 61 carrying a ligaturing thread 31 is disposed the thread being formed in two loops 34, 38. In the ' cocked ' position of Fig. 1, the loop 34 is disposed around the end of slide member 33 which protrudes from the face 30 whilst the loop 38 is disposed around pins 39, 40 which are carried by the slide member 41 and also protrude from the face 30. When the member 33 is arrested by screw 35 the slide 28 moves until the protruding part of 33 is behind the face 30 when the first knot will become tied. At this point the slide 28 is arrested itself by the surface 32 abutting the lower end of lever 3. The lever is then released this causing the grip on the vessel to be released and also enabling the spring pressed slide 28 to move once again until the member 41, with its pins 39, 40, is arrested and finally overtaken by the slide such that the thread loop 38 may be tightly knotted around the vessel. In this final movement of the slide 28, blades 45 which are pivotally disposed each side of the slide-which is U-shaped-are caused to move against the thread ends by engagement of chamfers 47 on the blades and cam surfaces 48 on the member 41 (see Fig. 5) and thus sever the thread. When the carrier plate with its thread is fitted to the face 30 of the device the ends of the thread are tied to buttons 54, 55 which are connected through members 56 with a collar 57 disposed around the core 26 at the rear end of the device. A compressed spring 58 is arranged between slide 28 and collar such that on downward movement of the slide the buttons, members 56, collar 57 and spring 58 are forced to follow keeping their relative positions this movement providing a space between collar 57 and cap 27 of the device into which the spring 58 (and collar 57) may expand on any lengthening of thread between its point of application on the vessel and its holding buttons 54, 55. Such lengthening occurs twice i.e. on formation of each knot. The expansion of spring 58 therefore ensures instant tightening of the knots. In an alternative method of using the device the spring 29 is not made strong enough to move the slide 28 after the member 41 has been arrested. In this case the lever 3 is pressed inwards once again to engage a notch 44 on the slide 28, further pressing of the lever causing the slide to pass over the pins 39, 40 and thus effect the second knot. If the lever is again withdrawn and then pressed inwards it will engage a notch 50 on the slide continued pressure thus causing relative movement of blades 45 and member 41 to effect severance of thread. Downward movement of slide 28 is limited by the abutment of a collar 49 on the slide with the arrested member 41. For charging the device with carrier plates 61 already threaded a device as shown in Fig. 8 is used. This comprises an upper compartment 70 with pillars 71, 72, 73, which correspond to the holes 63, 64, 65, Fig. 9, in each plate. The compartment has a false bottom 74 which is resiliently mounted by springs 75 disposed around pillars 76, 77, 78, 79, which pass through the bottom. Thread loaded plates 61 are stacked upon the pillars 71, 72, 73, in the compartment 70 and when a ligaturing device is to be loaded it is pressed down upon the top plate such that said plate is held against the face 30 by spring catches 67, 68. The movable false bottom ensures that a plate 61 is always available at the top of the compartment as the pillars 76, 78, 79 push the plates upwards. The pillars 71, 72, 73, in the compartment 70 together with a base plate 80 may form an interchangeable insertion member which may be sterilised, filled with new threads and hermetically sealed until required for use. The springs 29, 58 in the ligaturing device comprising the drive means may be replaced by a single spring or the drive means of the device may be electric, magnetic, pneumatic or hydraulic.