Abstract:
The present disclosure relates to a ligating instrument and end effector assemblies for use in laparoscopic tubal ligation procedures. The ligating instrument includes an integral grasping assembly and an integral end effector actuator and is configured to perform a ligating procedure by operation of a single hand of a user. The ligating instrument includes an integral grasper assembly for grasping a tubular tissue section and removable end effector or suture deployment mechanism for holding open a suture to be positioned about the tubular section. The grasper is configured to draw the tubular section into the open loop of suture material and cinch the suture material about the tubular tissue section. A rotator knob may be provided to orient grasper members associated with the grasper assembly relative to the tissue section. An alternative end effector is provided to removably mount on the distal end of the ligating instrument and to cut that part of the tubular tissue section which needs to be removed after the tubular tissue section has been ligated. A relatively soft over mold section may be provided to at least partially enclose the handle of the ligating instrument in order to provide comfort and facilitate a surer grip of the instrument.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS  
       [0001]    The present disclosure claims priority to U.S. Provisional Application Serial No. 60/248,436, filed Nov. 14, 2000, and entitled, “Device for Laparoscopic Tubal Ligation”. 
     
    
     
       BACKGROUND  
         [0002]    1. Field of the Invention  
           [0003]    The present invention relates to surgical devices and methods and, more particularly, to devices and methods for grasping a tissue segment and delivering a loop of suture material to the tissue segment with a single, one hand operable ligating instrument for the purpose of ligation.  
           [0004]    2. Description of Related Art  
           [0005]    Modern surgical techniques often entail the use of endosurgery, wherein large incisions are avoided, and, instead, elongated instruments are inserted into and manipulated through trocars. Typically the surgical site, such as the peritoneum, is viewed remotely, and the surgeon works while watching a monitor.  
           [0006]    Endoscopic applications of preknotted suture loops include the ligation of protruding pieces of tissue such as polyps or ends of blood vessels. Several devices are known in the art that deliver such suture loops to a site generally remote from the surgeon&#39;s hand and are remotely manipulable.  
           [0007]    The tonsillotome of Longino (U.S. Pat. No. 1,468,599) contains a shank having a lumen wherein a suture loop resides and from which the loop is manipulable around a piece of tissue. Previously disclosed devices include those of Neivert (U.S. Pat. No. 1,833,687), who discloses a surgical snare comprising a fixed and a movable member capable of relative movement for tightening the snare loop that has been housed in the bore of the movable member.  
           [0008]    The ligating loop device of Bueina (U.S. Pat. No. 5,242,459) has a shaft with a suture loop at its distal end, the loop having a slip knot. In addition, the device has a cutting element for severing the loop once it has been tightened. As with the device of Neivert, relative movement between two cylindrical members causes a tightening of the knot.  
           [0009]    Noda et al. (U.S. Pat. No. 5,320,629) also contains relatively slidable members, one of which carries a suture with a slip knot at the end.  
           [0010]    The endoscopic loop applying instrument of Kinet et al. (U.S. Pat. No. 5,405,351) both delivers the loop and cuts the free end of suture material.  
           [0011]    The ligating instrument of Yoon (U.S. Pat. No. 5,486,186) also delivers a loop of suture material, the material extending through the lumen of an elongated device for being operated upon to tighten the loop around a piece of tissue. A cutter is also disclosed that is positioned within the lumen and is externally operable.  
           [0012]    An exemplary device for ligating tissue is disclosed in U.S. Pat. No. 6,152,936 to Christy et al.(the entire disclosure of which is incorporated by reference herein) which discloses a novel suture management device including legs to hold a loop of suture material open to position around tissue.  
           [0013]    A problem shared by the above devices is the need for multiple instruments and, more importantly, the need to use two hands to operate the instruments to grasp and ligate the tissue structure.  
         SUMMARY  
         [0014]    There is disclosed a ligating instrument configured for single handed operation which includes integral grasping assembly to grasp a tissue section along with suture management assembly to hold open a loop of suture material such that the grasped tissue can be drawn through the material. The ligating instrument generally includes a handle assembly, an elongate tubular member extending distally from the handle assembly and an end effector mounted on a distal end of the elongate tubular member and operable to hold open a loop of material. A grasping member is extendable from a distal end of the elongate tubular member and a grasp actuator, integral with the handle assembly is provided such that actuation of the grasp actuator moves the grasping member relative to the distal end of the elongate tubular member.  
           [0015]    The grasper assembly includes a grasper pusher which is configured to extend a pair of flexible legs beyond the distal end of an elongated tubular member of the ligating instrument in order to grasp tissue. Springs are provided to bias the grasper members in a retracted position within the elongated tubular member. Preferably a thumbwheel is provided at the proximal end of the instrument to rotate and orient the grasper legs relative to the tissue to be grasped.  
           [0016]    The above described interval suture ligating mechanism including a lever configured to draw a suture held by an end effector about a tubular tissue section and cut the suture. A first end effector is provided for removable mounting on a distal end of the elongate tubular member of the ligating instrument and generally includes pivotal legs having fingers at their distal end for holding a section of suture in an open loop configuration. Preferably the legs have ramps formed on them such that upon advancement of the grasper members the legs are cammed open to hold the suture in an open condition. A cutter may be provided on the first end effector to cut the length of suture material upon actuation of the device.  
           [0017]    A second end effector is provided and is removably mountable on the distal end of the elongate tubular member. The second end effector is configured such that upon actuation of the ligating instrument a continuous loop of suture material draws the tubular tissue section to be excised against a cutting blade associated with the second end effector. Preferably, the second end effector includes a single arm having a similar ramp which engages the grasper and maintains the loop in an open configuration.  
           [0018]    A resilient or flexible material may be formed as an over mold over at least a portion of the handle of the ligating instrument in order to provide comfort to the user and ensure a firmer grip. 
       
    
    
     DESCRIPTION OF THE DRAWINGS  
       [0019]    Various embodiments are described herein with reference to the drawings wherein:  
         [0020]    [0020]FIG. 1 is a perspective view of one embodiment of the disclosed ligating instrument with half of the handle body removed;  
         [0021]    [0021]FIG. 2 is a perspective view of a first handle body half;  
         [0022]    [0022]FIG. 3 is a perspective view of a second handle body half;  
         [0023]    [0023]FIG. 4 is a perspective view of the assembled first and second handle body halves;  
         [0024]    [0024]FIG. 5 is a perspective view of a handle subassembly of a grasper assembly;  
         [0025]    [0025]FIG. 6 is a sectional view of the handle assembly;  
         [0026]    [0026]FIG. 7 is a partial enlarged sectional view showing the area of detail A of FIG. 6;  
         [0027]    [0027]FIG. 8 is a partial enlarged sectional view showing the area of detail B of FIG. 6;  
         [0028]    [0028]FIG. 9 is a perspective view of a grasper subassembly of the grasp assembly;  
         [0029]    [0029]FIG. 10 is a perspective view of a handle subassembly of the handle assembly;  
         [0030]    [0030]FIG. 11 is a sectional view of the distal end of the ligating instrument;  
         [0031]    [0031]FIG. 12 is a side view of a cutter tube;  
         [0032]    [0032]FIG. 13 is a perspective view of the cutter tube;  
         [0033]    [0033]FIG. 14 is a side view of a pull tube;  
         [0034]    [0034]FIG. 15 is a perspective view of the pull tube;  
         [0035]    [0035]FIG. 16 is a side view, partly shown in section, of a grasp tube;  
         [0036]    [0036]FIG. 17 is a perspective view of an outer tube;  
         [0037]    [0037]FIG. 18 is a perspective view of a ligation squid assembly;  
         [0038]    [0038]FIG. 19 is a side view, in section, of a stiff deflecting leg;  
         [0039]    [0039]FIG. 20 is a side view of a pinned leg;  
         [0040]    [0040]FIG. 21 is a side view of a middle leg;  
         [0041]    [0041]FIG. 22 is a perspective view of the cutting blade of the ligation squid assembly;  
         [0042]    [0042]FIG. 23 is a perspective view of the suture spool of the ligation squid assembly;  
         [0043]    [0043]FIGS. 24 and 25 are perspective views of an alternative embodiment of a suture management squid device for use with a ligation squid assembly similar to that shown in FIG. 18;  
         [0044]    [0044]FIG. 26 is a perspective view of a transecting squid assembly for use with the disclosed ligating instrument;  
         [0045]    [0045]FIGS. 27 and 28 are perspective views of the squid body of FIG. 26;  
         [0046]    [0046]FIG. 29 is a perspective view, with parts separated, of the spool assembly of FIG. 26; and  
         [0047]    FIGS.  30 - 32  are perspective views of an over molded handle for use with the disclosed ligating instrument. 
     
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS  
       [0048]    Referring to FIG. 1, a ligating instrument is shown which is configured to grasp and ligate a tubular structure with a single instrument while being operated by a single hand of the user. The disclosed ligating instrument  10  generally includes a handle assembly  12  and an elongated outer tube  14  extending distally from handle assembly  12 . Various removable end assemblies or single use loading units “SLLU&#39;s”  16  are removably mounted on a distal end of outer tube  14 . As used herein, the term “proximal” means the end of a component or part thereof closer to the operator while the term “distal” refers to that component or part thereof further from the operator. A grasper pusher  18  is movably mounted with respect to handle assembly  12  and functions along with a grasp subassembly  20  to extend and retract tissue grasp legs (described below) from the distal end of outer tube  14 . A handle thumbwheel  22  is rotatably mounted on a proximal end of handle assembly  12  and  13  provided to rotate tissue grasp legs relative to outer tube  14  to orient the grasp legs relative to tissue. A handle lever  24  is pivotably mounted to handle assembly  12  and functions with a handle subassembly  26  to actuate various SULU&#39;s  16 . Preferably, ligating instrument  10  is formed of steel, however, other biocompatible materials such as titanium, metals, plastics or ceramics can be used.  
         [0049]    Ligating instrument  10  is particularly designed to be used in a single-handed fashion and includes an ergonomically curved depending leg  28  to facilitate one-handed use of ligating instrument  10 . Preferably, handle assembly  12  includes a first handle body half  30  (FIG. 2) and a second handle body half  32  (FIG. 3). First and second handle body halves  30  and  32 , respectively, are mirror images, i.e. complimentary components which combine to form a handle body  34  (FIG. 4). Referring for the moment to FIGS. 2, 3 and  12 , outer tube  14  includes a proximal flange  106  which fits in channels  108  in first and second handle body halves  30 ,  32 . Outer tube  14  also has a bayonet type slot  110  at the distal end for receipt of various end assemblies.  
         [0050]    As shown in FIGS.  2 - 4 , handle body  34  defines a transverse pusher slot  36  and a pair of longitudinal pusher slots  38  and  40  radially spaced apart and extending distally from transverse pusher slot  36 . By moving grasper pusher  18  through transverse pusher slot  36 , grasper pusher can be aligned with either of longitudinal pusher slots  38  or  40  to facilitate right or left handed use. Handle body  34  also defines an opening  42  for handle lever  24 .  
         [0051]    Referring now to FIGS.  5 - 9 , grasp subassembly  20  will now be described. Referring initially to FIG. 5, a grasp handle subassembly  44  of grasper assembly  20  includes a grasp spring tube  46  having a rotatable plug  48  at a distal end of spring tube  46 . A grasper subassembly  50  of grasper assembly  20  extends through grasp handle subassembly  44  and extends distally therefrom through outer tube  14 . A grasper plug  52  is provided at a proximal end of grasp handle subassembly  44  to connect thumbwheel  22  to grasp subassembly  20  and thereby allow grasp subassembly  20  to rotate about the longitudinal axis of ligating instrument  10  in order to orient grasper legs with respect to the tissue to be ligated.  
         [0052]    Grasp handle subassembly  44  further includes a grasp collar  54  which is longitudinally slidable over grasp spring tube  46 .  
         [0053]    As shown, grasper pusher  18  includes a thumbshaft  56  which is attached to a grasp clevis  58 . Grasp clevis  58  is rotatably mounted about grasp collar  54  so as to allow grasper pusher  18  and thumbshaft  56  to move through transverse pusher slot  36  in handle body  34 . This allows switching from right to left hand operation and visa versa. A distal edge of grasp clevis  58  abuts a flange  60  on grasp collar  54  to drive grasp collar  54  longitudinally in response to longitudinal movement of grasper pusher  18  and thumbshaft  56  through one of longitudinal pusher slots  38  or  40  in handle body  34 .  
         [0054]    Grasp handle subassembly  44  also includes a spring  62  positioned inside spring tube  46  which biases grasp collar  54  and thus grasper pusher  18  proximally. Grasp collar  54  is connected to grasper subassembly  50  of grasper subassembly  20  as described below.  
         [0055]    Referring now to FIG. 9, grasper subassembly  50  of grasp subassembly  20  will now be described. As noted above, grasper subassembly  50  extends through outer tube  14  and handle subassembly  44 . A proximal end of grasper subassembly is connected to grasp collar  54 . Grasper assembly  50  generally includes a grasp tube  64  movably mounted within grasp spring tube  46 . A grasp tube extension  66  extends distally from grasp tube  46  and through outer tube  14  to a distal end thereof. (See also, FIG. 16)  
         [0056]    A return spring driver assembly  68  extends through grasp tube  64  and grasp tube extension  66 . A pair of flexible grasper legs  70  are mounted on a distal end of return spring driver assembly by means of an end piece  72  and pins  74 . When return spring driver assembly is in a proximal position relative to handle body  34 , grasper legs  70  are drawn into grasp tube extension  66  and assume a generally flat configuration. A second spring  76  is positioned within grasp tube  64 .  
         [0057]    A first driver plate  78  is affixed to a proximal end of return spring driver assembly  68  by means of a pin  80 . A second driver plate  82  is movably mounted over driver assembly  68  and contacts second spring  76  and a proximal end of grasp tube  64 .  
         [0058]    In operation, a first movement or throw of grasper pusher  18  within one of longitudinal pusher slots  38 ,  40 , drives grasper subassembly  50  distally within grasp spring tube  46  against the bias of first spring  62 . This extends the distal end of grasp tube extension  66  out of the distal end of outer tube  14 . Further distal movement of grasper pusher  18  moves return spring driver assembly  68  distally against the further bias of second spring  76  to thereby extend grasper legs  70  out of and beyond the distal end of grasp tube extension  66  and thus beyond the distal end of outer tube  14  and allows the legs  70  to spring open to grasp tissue.  
         [0059]    Referring now to FIGS.  6 - 8  and  10 - 11  there will now be described handle subassembly  26 . Referring initially to FIG. 10, handle subassembly  26  includes handle lever  24 , which has a drive bracket  84  pivotally mounted to handle body  34  by pins (not shown) which extend from first and second handle body halves  30  and  32  and into corresponding holes  86  in drive bracket  84 . Handle subassembly  26  also includes a cutter tube  88  having a mounting bracket  90  at its proximal end. Mounting bracket  90  is pinned to drive bracket  84  by pins  92 . Mounting bracket  90  includes a pair of lips  94  which are longitudinally guided by slots  96  in first and second handle body halves  30  and  32  (FIGS. 2 and 3). Thus, movement of handle lever  24  towards handle body  34  drives cutter tube  88  distally, while movement of handle lever  24  away from handle body  34  retracts cutter tube  88  in the proximal direction. Referring for the moment to FIGS. 12 and 13, cutter tube has projections  112  on the distal end to cam a cutting blade on an end assembly to cut suture material.  
         [0060]    Handle subassembly  26  further includes a pull tube  98  having a fire clevis  100  affixed to a proximal end of pull tube  98 . As shown in FIGS. 14 and 15, pull tube  98  has a flange  114  at its proximal end which held in notches  116  in fire clevis  100  (FIG. 10). Pull tube  98  has projections  118  at a distal end to engage a corresponding suture spool on an end assembly to cinch a suture. Referring to FIGS. 2, 3 and  10 , fire clevis  100  has lips  120  which are longitudinally guided in slots  122  in first and second handle body halves  30 ,  32 .  
         [0061]    Handle lever  24  has a handle link  102  pivotally mounted at a first end near the proximal end of handle lever  24 . A two part linkage  104  connects a second end of handle link  102  to fire clevis  100 . When handle lever  24  is moved toward handle body  34 , fire clevis  100 , and thus pull tube  98 , are drawn proximally within handle body  34 . Similarly when handle lever  24  is pivoted away from handle body  34 , pull tube  98  is moved distally within outer tube  14 .  
         [0062]    Referring now to FIG. 18, there is disclosed an end effector or SULU particularly adapted to be used with ligating instrument  10 . Ligating squid assembly  124  generally includes a squid body  126  having a squid to  128  extending proximally from squid body  126 . A plurality of suture supporting legs are pivotally mounted to squid body  126  and extend distally therefrom. Specifically, a stiff leg  130  extends distally from squid body  126  and is configured to retain a segment of suture material and a slip knot at the end of stiff leg  130 . Squid body  126  also includes a pair of pinned legs  132  which are pivotally connected to squid body  126  and a middle leg  134  which is also pivotally connected to squid body  126 . Referring for the moment to FIG. 19, stiff leg  130  generally includes a guide slot  138  running partially along the length thereof as well as a suture hole formed in the distal end of stiff leg  130 . A length of suture (not shown) is threaded through suture hole  136  into guide slot  138  and the guide tube  140  connects guide slot  138  with suture hole  136 . A partial ramp  140  is formed on the underside of stiff leg  130  to partially flex stiff leg  130  away from the center line of the instrument as grasper legs  70  are extended past stiff leg  130 .  
         [0063]    Referring to FIG. 20, there is illustrated one of a pair of pinned legs  132  which include fingers  142  at a distal end thereof to support a portion of a suture loop. Similarly, referring to FIG. 21, middle leg  134  also has fingers  142  to assist in maintaining an open suture loop.  
         [0064]    Referring back to FIG. 14, ligation squid assembly  124  further includes a guide tube  146  in alignment with guide slot  138  of stiff leg  130  to receive a length of suture therethrough. A cutting blade  148  is positioned adjacent to guide tube  146  and is flexible in response to engagement with projections  112  of cutting tube  88  so as to cam the cutting blade into engagement with the suture and sever it.  
         [0065]    A ligating squid assembly  124  further includes a suture spool  150  slidably mounted about squid body  126 . Suture spool  150  is configured to retain a free end of a length of suture and, upon proximal movement of suture spool  150 , cinch a suture around tissue positioned within the loop of suture held by the squid arms. Arms  152  extend from a proximal end of suture spool  150  and are configured to engage projections  118  on pull tube  98  such that when pull tube  98  is retracted proximally it draws suture spool  150  and thus the length of suture proximally. As shown in FIGS. 20 and 21, pinned legs  132  and middle leg  134  include ramps  154  and  156 , respectively. Ramps  154  and  156  deflect legs  132  and middle leg  134  upon engagement with grasper legs  70  as grasper legs  70  are extended out the distal end of ligating instrument  10 .  
         [0066]    Referring now to FIGS. 24 and 25, there is disclosed an integrally molded squid device for use with a ligation squid assembly similar to that of ligation squid assembly  124 . Molded squid device  170  is an integral structure, preferably formed of a plastic material. Squid device  170  generally includes a base  172  having a stiff leg  174  extending distally therefrom. Stiff leg  174  includes a channel  176  and a bore  178  for receipt of a length of suture. Squid device  170  further includes a pair of side legs  180  which have ramps  182  for engagement with a grasper device to bias legs  180  outwardly in a manner similar to that described hereinabove. Said legs  180  also have fingers  184  to releasably retain a section of suture and maintain it in an open loop configuration.  
         [0067]    Molded squid device  170  further includes a bottom leg  186  having a ramp  188  for engagement with a grasper device. Bottom leg  186  also includes a fingers  190  to releasably retain a section of the suture material. Stiff leg  174 , side legs  180  and bottom leg  186  are connected to base  174  by living hinges  192 ,  194 , and  196 , respectively. Base  172  also includes a socket  198  for mounting squid device to a modified ligating squid assembly.  
         [0068]    It should be noted that by integrally molding squid device  170  as a unitary structure, squid device  170  takes advantage of the inherent flexibility characteristics of a living hinge to retain the legs in a generally collapsed configuration.  
         [0069]    Referring now to FIG. 26, there is illustrated a unique transecting squid assembly for use with the disclosed ligating instrument  10  to cut the loop of tissue remaining after being ligated with the suture of ligating squid assembly  124 . Transecting squid assembly  200  is configured to be reusable and releasably mountable in the distal end of outer tube  14 . Transecting squid assembly  200  is provided to grasp and cut a previously ligated tissue section.  
         [0070]    Transecting squid assembly  200  generally includes a squid body  202  having a middle leg  204  pivotally mounted on squid body  202  as shown. Middle leg  204  includes fingers  206  at its distal end to hold a portion of a continuous loop of wire in an open loop configuration. A squid tube  208  extends proximally from squid body  202  and is insertable within outer tube  14 . Transection squid assembly  200  further includes a spool assembly  210  slidably mounted on squid tube  208  and configured to secure a portion of a the loop of material. A pair of cutting blades  212  extend from the distal most tip of squid body  202 . Blades  212  are provided to cut anatomical tissue drawn against blades  212  by contraction of the closed loop of wire material.  
         [0071]    Referring for the moment to FIGS. 27 and 28, an underside of squid body  202  includes a longitudinally extending wire channel  214  which is configured to retain and guide a segment of a continuous wire loop.  
         [0072]    Referring now to FIG. 29, the spool assembly  210 , which is slidably mounted on squid tube  208  generally includes four subsections  216 ,  218 ,  220  and  222  which are welded together. A portion of a closed wire loop is secured within channels  224  in part  216 .  
         [0073]    The above disclosed ligating instrument is particularly suitable for ligating anatomical tubular structures, such as, for example Fallopian tubes. The operation of ligating instrument  10  to ligate a Fallopian tube in the manner of an endoscopic, Pomeroy type procedure will now be described. Initially, a ligating squid assembly  124  is inserted and affixed to a distal end of ligating instrument  10 . As noted above, ligating squid assembly  124  includes a bayonet type fitting which engages the distal end of outer tube  14 . Prior to insertion in the body, the legs of ligation squid assembly  124  are in a collapsed configuration generally in alignment with the longitudinal axis of outer tube  14 . Handle lever  24  is in an open position and grasp pusher  18  is in a proximal most position. As noted hereinabove, the instrument is specifically designed to be operated with a single hand, i.e., a one hand use instrument. In grasping the instrument, the pinky and ring finger of the operable hand rest upon depending leg  28  while the middle finger and index finger rest upon handle lever  24 . The thumb is positioned adjacent grasp pusher  18 . As further noted hereinabove, by initially moving grasper pusher  18  through transverse slot  36  in handle body  34 , the ligating instrument  10  can be configured for case of use with either hand.  
         [0074]    Ligating instrument  10  is then inserted into the body such that ligating squid assembly  124  is positioned adjacent a Fallopian tube. Thereafter, the thumb can be pushed against grasper pusher  18  driving grasper pusher  18  distally to initially extend grasp tube extension  66  towards the distal end of outer tube  14 . Further pressure through a second throw or distal distance of grasper pusher  18  extends grasper legs  70  out the distal end of outer tube  14 . As grasper legs  70  extend beyond the distal end of outer tube  14 , grasper legs  70  engage ramps  154  and  156  on pinned legs  132  and  134  camming legs  132  and  134  into an open position. Grasper legs  70  extend beyond the ends of legs  132  and middle leg  134  and are positioned about the tubular structure. It should be noted that as grasper legs extend out the distal end of outer tube  14  they extend through the open suture loop held by stiff leg  130 , pinned leg  132  and middle leg  134 .  
         [0075]    Upon slow release of grasper pusher  18  against the bias of the return springs, grasper legs  70  grasp the anatomical tubular structure and draw a tubular structure through the open loop of suture material. Once grasper pusher  18  is returned to a fully proximal most position the fingers may be operated to actuate handle lever  24 . As handle lever  24  is moved toward handle body  34 , pull tube  98 , which is attached at its distal end to spool  150  draws spool  150  and thus the attached section of suture material proximally thereby contracting the loop of suture material about the Fallopian tube and pulling the suture material free of the associated legs. It should be noted that the proximal movement of pull tube  98  is a fairly long throw relative to the forward movement of cutter tube  88  which also happens in response to depression of lever  24 . As cutter tube  88  is advanced it cams cutting blade  148  against the suture material at a point adjacent guide tube  146  to thereby sever the suture material. Grasper pusher  18  can then be advanced to release the now sutured and ligated Fallopian tube structure.  
         [0076]    Ligating instrument  10  is then withdrawn from the body and ligating squid assembly  124  is removed from ligating instrument  10 .  
         [0077]    In order to cut the now ligated loop section of tubular tissue structure, transecting squid assembly  200  is assembled onto the distal end of ligating instrument  10  and ligating instrument  10  is reinserted into the body adjacent the ligated Fallopian tube. Advancement of grasper pusher  18  again advances grasper legs  70  towards the anatomical tubular structure camming open the middle squid leg  204  of transecting squid assembly  200 . Grasper pusher  18  is again operated to regrasp the tissue with grasper leg  70  and draw it into the continuous wire loop of material supported by transacting squid assembly  200 . Handle lever  24  is then again actuated to draw spool assembly  210  proximally thereby drawing the ligated loop of tissue section adjacent and against cutting blade  212  which thereby severs the tissue section. The dissected tissue section remains grasped by grasper leg  70  and the instrument is removed leaving the free ends of the Fallopian tube ligated together by the loop of suture material.  
         [0078]    The ligating instrument  10  is preferably provided as an instrument assembly containing one or more ligation squid assemblies  124  and a reusable transecting squib assembly  200 . Thus, a new ligating assembly  124  can be attached to ligation instrument  10  and the opposite Fallopian tube ligated in similar manner.  
         [0079]    Referring to FIGS.  30 - 32 , there is disclosed an over molded part  226  for use with at least part of handle body  34 . Overmold  226  is formed of a relatively resilient material to increase the comfort in holding ligating instrument  10  and provide a better grip on ligating instrument  10 . Over mold  226  can be formed of various materials, such as, plastics, foams, etc.  
         [0080]    It will be understood that various modifications can be made to the embodiments disclosed herein. For example, other SULU&#39;s having different functions may be used with the disclosed one handled instrument having an integral grasper. Therefore, the above description should not be construed as limiting but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.