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Claims  |
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What is claimed is:
1. A method of occluding a reproductive tubular member to effect at least
temporary sterilization which comprises selecting a site in the wall of
the abdominal cavity near said reproductive tubular member, surgically
penetrating the wall of the abdominal cavity to provide an entry therein,
inserting an elastic ring applicator device containing at least one
elastic ring through said entry to the location area of said reproductive
tubular member, reproductive said repproductive tubular member while
viewing said area and withdrawing said reproductive tubular member
sufficiently to form a bend therein and to block the same, effecting
release of said elastic ring onto and around said bend in the reproductive
tubular member in the bent position, releasing said reproductive tubular
member from the ring applicator device to free the bent portion, and
withdrawing said ring applicator device from the abdominal cavity thereby
leaving an occluded reproductive tubular member therein.
2. The method of occluding a reproductive tubular member to effect at least
temporary sterilization according to claim 1, wherein the elastic ring
applicator device comprises an inner cylinder and an outer cylinder, said
inner cylinder being coaxially and slidably disposed within said outer
cylinder, the proximal end portion of said inner cylinder extending
beyond the proximal end portion of the outer cylinder and containing at
least one elastic ring disposed thereon and forceps means slidably
disposed within said inner cylinder, and wherein the forceps means are
displaced from the proximal end portion of the ring applicator device, a
segment of the reproductive tubular member is grasped by said forceps
means and pulled inside of the inner cylinder of the elastic ring
applicator device a predetermined distance sufficient to form a bend in
said reproductive tubular member, and the elastic ring is then displaced
from the end of the inner cylinder to a position around the segment of the
reproductive tubular member held by the forceps means thereof by axially
moving the outer cylinder and the inner cylinder relative to each other,
thereby forming a loop in said reproductive tubular member.
3. The method of claim 2, wherein a closed loop is formed in said
reproductive tubular member, the ingress and egress to and from said loop
being cut off by the elastic power of the elastic ring.
4. The method of occluding a reproductive tubular member to effect at
leaast temporary sterilization according to claim 1, wherein the elastic
ring applicator device comprises an inner cylinder and an outer cylinder,
said inner cylinder being coaxially disposed within and in engaging
relationship with said outer cylinder, the proximal end portion of said
inner cylinder extending beyond the proximal end portion of the outer
cylinder and containing at least one elastic ring disposed thereon,
forceps means slidably disposed within said inner cylinder and means for
rotating said outer and inner cylinders in the axial direction, and
wherein the forceps means are displaced from the proximal end portion of
the ring applicator device, a segment of the reproductive tubular member
is grasped by said forceps means and pulled inside of the inner cylinder
of the elastic ring applicator device a predetermined distance sufficient
to form a bend in said reproductive tubular member and the elastic ring is
then displaced from the end of the inner cylinder to a position around the
segment of the reproductive tubular member held by the forceps means
thereof by axially moving the outer cylinder and the inner cylinder
relative to each other, thereby forming a loop in said reproductive
tubular member.
5. The method of claim 4, wherein a closed loop is formed in said
reproductive tubular member, the ingress and egress to and from said loop
being cut off by the elastic power of the elastic ring.
6. The method of claim 1, wherein the reproductive tubular member is a
Fallopian tube.
7. The method of claim 1, wherein the reproductibe tubular member is a vas
deferens.
8. The method of claim 1, wherein the location area is inflated to obtain
manipulation room.
9. The method of claim 1, wherein the reproductive tubular member is
grasped at some intermediate point.
10. The method of claim 1, wherein optical viewing means and illuminating
means are attached to the ring applicator device and a single incision is
made in the abdominal wall to provide said entry into the abdominal
cavity.
11. The method of claim 1, wherein optical viewing means and illuminating
means are separate from the ring applicator device and an incision is made
in the wall of the abdominal cavity for the optical viewing portion of
said inner cylinder extending beyond the proximal end portion of the outer
cylinder and containing at least one elastic ring disposed thereon and
forceps means slidably disposed within said inner cylinder, and wherein
the forceps means are displaced from the proximal end portion of the ring
applicator device, a segment of the reproductive tubular member is grasped
by said forceps means and pulled inside of the inner cylinder of the
elastic ring applicator device a predetermined distance sufficient to form
a bend in said reproductive tubular member, and the elastic ring is then
displaced from the end of the inner cylinder to a position around the
segment of the reproductive tubular member held by the forceps means
thereof by axially moving the outer cylinder and the inner cylinder
relative to each other, thereby forming a loop in said reproductive
tubular member.
12. The method of claim 10, wherein the making an incision is made in the
umbilicus.
13. The method of claim 11, wherein entry is obtained for the ring
applicator device by making an incision in the umbilicus.
14. The method of claim 1, wherein the reproductive tubular member is
withdrawn into the ring applicator device to form said bend therein.
15. The method of claim 14, wherein the elastic ring is disposed on the
proximal end of the ring applicator device and is displaced therefrom
around the bent portion of the reproductive.
16. The method of claim 2, wherein the location area is inflated with air
or carbon dioxide gas to obtain manipulation room.
17. The method of claim 2, wherein the forceps means is provided with sharp
edges and the loop in said reproductive tubular member is cut by said
forceps means.
18. The method of claim 16, wherein a cannula having a trocar disposed
therein is inserted into said entry and after the trocar is removed, the
ring applicator is inserted into the space vacated by said trocar.
19. The method of claim 16, wherein a cannula housing two trocars is
inserted into said entry and after the trocars are removed, the ring
applicator device and an optical viewing means and illuminating are
inserted into the spaces vacated by said trocars.
20. The method of claim 4, wherein the inner and outer cylinders are in
screw engagement with each other and by rotating the outer cylinder the
elastic ring is pushed from the proximal end portion of the inner cylinder
to a position around the bent reproductive tubular member.
21. The method of claim 4, comprising a ring applicator, the proximal end
of the inner cylinder having means thereon to selectively retain on its
outer end surface at least two elastic occluding rings and said outer
cylinder having an expandable end portion, wherein by axially moving the
outer and inner cylinders relative to each other said expandable end
portion cooperates with said proximal end portion of the inner cylinder
for sequentially ejecting the elastic occluding rings from the inner
cylinder after axially displacing the outer and inner cylinders relative
to each other to position said expandable end portions behind a ring.
22. The method of claim 1, wherein said occluding method effects permanent
sterilization.
23. A method of occluding a reproductive tubular member to effect at least
temporary sterilization which comprises selecting a site in the wall of
the abdominal cavity near said reproductive tubular member, surgically
penetrating the wall of the abdominal cavity to provide an entry therein,
inserting an elastic ring applicator device containing at least one
elastic ring through said entry to the location area of said reproductive
tubular member, grasping said reproductive tubular member while viewing
said area and withdrawing said reproductive tubular member sufficiently to
form a bend therein, effecting release of said elastic ring onto and
around said bend in the reproductive tubular member to hold said tubular
member in the bent position and to block the same, releasing said
reproductive tubular member from the ring applicator device to free the
bent portion, and withdrawing said ring applicator device from the
abdominal cavity, thereby leaving an occluded reproductive tubular member
therein. |
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Claims |
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Description |
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BACKGROUND OF THE INVENTION
The present invention relates to an occlusion ring and the method and
device for applying said ring to an anatomical tubular structure. More
particularly, the present invention is directed to a ring applicator
device, combinations of said device with other instruments and a technique
and method for carrying out tubal ligation of the human female in order to
effect permanent or temporary sterilization. The device of the present
invention can also be effectively used to sterilize the human male.
In many areas of the world, the question of population control has become a
central issue. Since birth control devices are not always used faithfully
or fail to work in some instances, various procedures have been proposed
for effecting the sterilization of women as well as men. However, many of
these techniques are unpopular because of the resulting complications, the
high expense and because of the general unacceptability among the populace
of effecting a sterilization which is permanent and cannot be reversed.
Nevertheless, sterilization is obviously an effective means for solving
various problems of population explosion and of voluntarily limiting the
size of the family where desired on the part of the parent. Accordingly,
research into finding various techniques and instruments has continued
both under private and government support.
Tubal ligation has commonly been used to effect sterilization in women. The
common practice is to cut and tie the Fallopian tubes in order to prevent
fertilization of the egg. More recently the use of clips for closing the
tubes has been suggested. Another recent procedure involves cauterization
of the tubes by electrical means. However, each of these procedures
involves much discomfort to the patient and highly skilled personnel to
successfully complete the operation. Also, in the procedure requiring the
use of clips, in some instances the clips have fallen off thereby
rendering the sterilization ineffective. With respect to cauterization by
means of electricity, there remains the ever present dangers of
inadvertently burning certain organs of the body and, for example,
accidentally rupturing the bowel.
SUMMARY OF THE INVENTION
One of the objects of the present invention is to provide a simplified
instrument and method for applying an occlusion ring to an anatomical
tubular structure.
Another object of the present invention is to provide a simplified
instrument and method for effecting permanent or temporary sterilization
of the human female.
A further object of the present invention is to provide a novel technique
and instrument for accomplishing tubal ligation which may be employed by
physicians with many degrees of skill and without the need for expensive
or bulky equipment.
A still further object of the present invention is to provide a portable
instrument for mechanically effecting tubal ligation wherein a sliding
ring handle which is operatively connected to a grasping means is so
disposed as to indicate to the physician the precise time when the elastic
ring should be applied to the crimped Fallopian tube.
An additional further object of the present invention is to provide an
applicator device which is physically combined with a laparoscope system
in such a way as to enable the physician operating the device to view the
entire ligation operation.
An additional further object of the present invention is to provide an
applicator device which is physically combined with a laparoscope system
in such a way as to enable the physician operating the device to view the
entire ligation operation.
Yet another object of the present invention is to provide a laparoscope
which is combined with a ring applicator device in such a manner as to
substantially eliminate the contamination of the instrument or the
physician's hand.
Still another object of the present invention is to provide an instrument
which can also be used for the sterilization of the human male.
Other objects and further scope of applicability of the present invention
will become apparent from the detailed description given hereinafter; it
should be understood, however, that the detailed description and specific
examples, while indicating preferred embodiments of the invention, are
given by way of illustration only, since various changes and modifications
within the spirit and scope of the invention will become apparent to those
skilled in the art from this detailed description.
Pursuant to the present invention, the above-mentioned disadvantages may be
eliminated and an improved ligature method and ring applicator device as
well as a combination of said device with a laparoscopic system may be
obtained by following the teachings of the ring applicator device of the
present invention.
In accordance with the present invention, the sterilization of the human
female or human male may be attained by the use of elastic rings for
effecting the ligature of the Fallopian tubes. Advantageously, the
ligature is performed in conjunction with a laparoscope which is an
instrument well known in the medical field for viewing the internal
portions of the body. The instrument of the present invention is a ring
applicator which is used to quickly and effectively slip a small elastic
or rubbery ring around the Fallopian tubes of the female in order to
permanently or temporarily block the same. Basically, the instrument of
the present invention, shown in detail in the attached drawings, includes
a grasping means which is used to pull a portion of the Fallopian tube of
the female into the device and slidable or rotatable tubular means for
slipping or pushing the elastic or stretchable ring over the portion of
the Fallopian tube held in the device, thereby effecting the ligature. In
operation, the entire device is inserted through the abdominal wall or by
means of the vaginal route, the grasping means is pushed forward to engage
a sigment of the Fallopian tube, the grasping means is then retracted into
the inner tube of the applicator device, and finally the device is
manipulated so as to release the elastic ring from the end of the
applicator and place it around the segment of the Fallopian tube contained
therein. Thereafter, the loop held by the elastic ring can be cut by the
grasping means for permanent sterilization, if desired, or the loop can be
left as is with the elastic ring holding the Fallopian tube in a crimped
position thereby permanently or temporarily effecting sterilization.
Temporary sterilization is contemplated by cutting the elastic band in a
subsequent operative procedure.
When the applicator device is used in conjunction with a laparoscope, a
very small incision may be made when using either the abdominal or vaginal
approach because the light associated with the laparoscope facilitates the
location of the Fallopian tubes. However, when the ring applicator device
is used without the aid of a laparoscope, a slightly larger incision is
required in order for the physician to locate the Fallopian tubes.
BRIEF DESCRIPTION OF THE DRAWINGS
The present invention will become more fully understood from the detailed
description given hereinbelow and the accompanying drawings which are
given by way of illustration only, and thus are not limitative of the
present invention and wherein,
FIG. 1-4 show the operation of one embodiment of the ring applicator of the
present invention;
FIG. 5 discloses a needle like instrument for introducing a gas into the
body cavity;
FIG. 6 shows a cannula with a trocar associated therewith to facilitate
entry of the ring applicator into the body cavity; m
FIG. 7 shows the ring applicator of FIGS. 1 to 4 used in combination with a
laparoscope;
FIG. 8 shows another embodiment of the ring applicator of the present
invention;
FIG. 9 shows another embodiment of the front end portion of the ring
applicator which is used to eject the elastic rings from the end of said
applicator;
FIG. 10 discloses an embodiment in which a cannula, a laparoscope and the
ring applicator can be used in an effective combination;
FIG. 11 shows another embodiment of the ring applicator of the present
invention in combination with a laparoscope;
FIG. 12 shows the front end portion of the combination shown in FIG. 11;
FIG. 13 shows how the front end portions of FIG. 11 slide with respect to
each other to mount the elastic ring on the tube;
FIG. 14 shows a device for loading the elastic rings onto the end portion
of a ring applicator;
FIGS. 15 and 16 show the front and rear end portions, respectively, of a
device for introducing a gas into the body cavity;
FIGS. 17 and 18 disclose a further view of the rear end portion of the
device of FIG. 16 where the gas cylinder is shown in the loaded and
unloaded position;
FIGS. 19, 20 and 21, show enlarged views of stainless steel type rings
which can be used in place of the elastic rings with the device;
FIG. 22 shows another embodiment of the ring applicator device of the
present invention in combination with a laparoscope;
FIGS. 23a, 23b and 23c show the loading device which can be inserted into
the front end of the ring applicator device for loading the elastic rings
onto the end of said ring applicator device;
FIG. 24 shows, in greater detail, the front end portion of the ring
applicator device and the positioning of the laparoscope relative to the
grasping means of the ring applicator device of FIG. 22;
FIG. 25 shows the pusher device which is utilized to push the ring from the
loading device onto the end of the ring applicator device;
FIG. 26 shows another embodiment of the present invention wherein a portion
of the laparoscope is offset with respect to the ring applicator device;
FIG. 27 shows another embodiment of the present invention wherein a trigger
means is utilized for applying the elastic ring to the Fallopian tube;
FIG. 28 shows another embodiment of the present invention wherein an
improved ring applicator device is used not in combination with a
laparoscope;
FIG. 29 shows a top view of a lever and the guide slot used by said lever
in pushing the inside cylinder of the ring applicator of FIG. 28 to the
forward position;
FIG. 30 shows the bottom view of the sliding handle ring which slides back
and forth in a slot to expel and retract the grasping means;
FIGS. 31a, 31b, 31c and 31d show in sequential steps, the abdominal method
of performing the ligation of the Fallopian tube using the ring applicator
device of the present invention in combination with the laparoscope
wherein the device is inserted through the abdominal wall by a single
incision made in the navel area;
FIG. 32 shows the abdominal method using the two hole technique wherein the
culdoscope (light source) and the ring applicator are inserted through the
abdominal wall through two separate incisions;
FIG. 33 shows the vaginal method of performing the ligation of the
Fallopian tube wherein the ring applicator device and the culdoscope
(light source) are used as two separate instruments; and
FIG. 34 shows the vaginal method similar to FIG. 32 wherein the laparoscope
and ring applicator are combined into a single instrument.
DETAILED DESCRIPTION OF THE DRAWINGS
One embodiment of the ring applicator of the present invention is shown in
FIGS. 1 to 4. The device comprises an inner tube 2 disposed within an
outer tube 1, said inner tube being provided with a cutting edge 3 at its
front end. The outer tube is in engaging relationship with the inner tube
so that by rotating the outer tube using gripping means 4 said outer tube
is moved axially in the direction of the cutting edge 3. Grasping means 5
which is provided at one end with forceps 6 and at the other end with a
sliding ring 7 is slidably disposed within the inner tube 2. By manually
moving the sliding ring 7 the forceps 6 can be moved into and out of the
inner tube 2. For example, by moving sliding ring 7 in the direction
indicated in FIG. 1 along groove 8, relating to the stationary ring 9, the
forceps 6 which is compressed within tube 2, as shown in FIG. 1, is pushed
out of the end portion of said tube to a position shown in FIG. 2, the
arms of said forceps springing apart because of their inherent resiliency
or spring-like property. If desired, the forceps means can be provided
with cutting edges 10. The stationary ring 9 is provided to facilitate
grasping the ring applicator and sliding the ring 7. The front end portion
of tube 2 is provided with a plurality of grooves 11 which are adapted to
receive elastic rings 12.
FIG. 3 shows the position of the ring applicator at a time when, for
example, the tube 13 of the female is grasped by the forceps 6 and pulled
inside tube 2. By turning the outer tube 1 about the external thread 14
provided on inner tube 2, the end portion 15, which can be made, for
example, of spring metal, pushes the end elastic ring from the tube 2 to a
position around the crimped tube 13. Then by reversing the direction of
the grasping means 5, the forceps is pushed from the tube 2 which causes
it to spring open, releasing the tube 13 held in a crimped condition by
the elastic ring. By reversing the direction of the outer tube 1 using
gripping means 4, the spring nature of the end portion 15 of said outer
tube causes said portion to enlarge around the end elastic ring 12 and
position itself therebehind. The device is now loaded again and in a
position to discharge a second elastic ring. It is to be understood that a
plurality of elastic rings may be provided in the grooves 11 of tube 2 so
that one ring at a time can be used, as desired by the physician. The end
portion 15 of the outer tube 1 can be attached to tube 1 by screw means
16.
FIG. 4 indicates one location in which screw threads 14 can be utilized to
effect the movement of tube 1 relative to tube 2. The screw threads may,
of course, be provided at any convenient location between said tubes.
Also, the gripping means 4 can be provided at any convenient location.
FIG. 5 illustrates a needle instrument which is used to puncture the body
cavity as the first step in the operational procedure. This instrument
comprises a thin cylinder 17 which acts as a needle to puncture the skin.
The needle surrounds blunted stylet 18 which functions to introduce a gas,
e.g., carbon dioxide, from container 19 into the abdominal cavity.
Gripping means 20 is used to rotate cylinder 17 with respect to stylet 18,
said stylet being provided with external threads 21. Thus, the gas is
introduced into the body through the end hole in stylet 18 as it protrudes
beyond the end of cylinder-needle 17.
After inflating the body cavity with carbon dioxide gas, a trocar 22, shown
in FIG. 6, with a cannula 23 is introduced into the body by umbilical
incision. The trocar has a pointed end 24, thereby permitting easy entry
through the skin. The trocar is removed and the cannula is left in
position to hold the ring applicator and/or laparoscope for use as
discussed below. As can be noted in FIG. 6, the cannula is provided with a
valve, e.g., a trumpet valve 25, to prevent the carbon dioxide gas from
escaping.
Laparoscopy is a well known and widely accepted technique in the medical
field at the present time. The ring applicator of the present invention
can be used in conjunction with a laparoscope as is schematically shown in
FIG. 7, or it can be used as part of a two-hole technique using the
cannula-trocar arrangement shown in FIG. 10. In FIG. 7, the ring
applicator of the invention, for example, the instrument of FIG. 1, is
attached to laparoscope 26. Laparoscope 26 is used to view the internal
cavity during the operation by viewing through lenses 27 and 28. Light
source 29 introduces a light into channel 30 to the instrument to
facilitate viewing. The two instruments need not be attached, and a trocar
containing two holes, as shown in FIG. 10, can be used to permit entry of
the ring applicator and the laparoscope into the abdominal cavity.
Alternatively, the ring applicator device of the invention can be used in
conjunction with a culdoscope when entry is made through the vaginal
cavity.
FIG. 8 shows another embodiment of the present invention wherein tubes 1
and 2 are slidably disposed with respect to each other and thus tube 2 is
slid into and out of tube 1 by sliding ring 7 along groove 8. This is to
be compared with the embodiment of FIG. 1 wherein screw threads are
provided to enable the movement of tubes 1 and 2 with respect to each
other. Also in this embodiment, ring 31 is utilized to slide grasping
means 5 into and out of inner tube 2. In one feature of the present
invention, a locking device 32 may be provided to lock the inner and outer
tubes with respect to each other. The specific location of the locking
device, as shown, facilitates locking tubes 1 and 2 together with the
physician's same hand. Alternatively, a locking device in the form of a
ratchet means 33 can also be used not only as an equivalent type locking
device, but also to enable the axial movement of the tubes, relative to
each other, in predetermined increments.
FIG. 9 shows another embodiment of the front end portion 15 of the outer
tube 1. Thus, said front end portion 15 can be provided with a plurality
of spring-loaded sections 34 which are forced open by the elastic ring
disposed on the inner tube 2 when the inner tube 2 is pulled inside the
outer tube 1. Thus, for example, when the ring applicator is ready for
use, the grooves 11 are loaded with elastic rings 12 and the front end
portion 15 of the outer tube 1 extends over all of the elastic rings
except the end ring which is to be first used during the operational
procedure. By sliding inner tube 2 into outer tube 1, the elastic ring is
pushed from the end of the applicator onto the crimped female tube. Then
by sliding tube 2 out of tube 1, the enlarged diameter of the elastic ring
disposed around the inner tube forces the spring loaded sections 34 open
until said sections have reached a position between adjacent elastic
rings, at which point section 34 springs closed, leaving an exposed
elastic ring for next use and housing the remaining elastic rings.
FIG. 10 is similar to FIG. 6 with the exception that two trocars 22 are
utilized so that multiple instruments can be used simultaneously. Also
FIG. 10 shows the use of a screw-type surface 35 on the outer surface of
the cannula to facilitate the introduction of the cannula into the body
cavity and to prevent accidental rupturing.
FIGS. 11, 12 and 13 illustrate still another embodiment of the present
invention showing a laparoscope and a ring applicator device used in
combination. Also a means (not shown) can be provided for introducing a
gas into the body cavity between concentric tubes. In said FIGS., an inner
tube 37 is slidably disposed within an outer tube 36, both of said tubes
having a cut-away portion 38, so that the front and rear portions of tubes
36 and 37 are connected by saddle portions 39 and 40. Portions of tubes 36
and 37 are cutaway to provide the physician with a better overall view
when looking axially through the laparoscope. An additional tube or
conduit 41 is cradled in the bottom portion of the inner tube 37, said
tube housing the grasping means 5 which can be moved into and out of said
tube. Squeeze handles 42 operate to open and close the forceps 6. In this
embodiment, one of the forceps arms is rigid and the other one is hinged
with respect thereto so that the forceps can be opened and closed by the
operation of said squeeze handles. Also squeeze handles 43 are associated
with tubes 36 and 37 so that said tubes can be moved relative to each
other, said movement pushing the elastic ring 12 from the end of tube 37
by tube 36. The embodiment of FIGS. 11, 12 and 13 is also provided with a
light source 29 for the laparoscope and an air bulb or carbon dioxide
source (not shown) can be introduced between concentric tubes into the
body cavity.
FIG. 14 shows a cone-shaped ring applicator 44 for applying the elastic
rings to the end of the tubes.
FIGS. 15 and 16 show cutaway views of the front and rear end portions
respectively of a needle instrument for injecting a gas into the body
cavity. The front portion shows a cutting edge 45 and a hollow rod 46 with
a hole 47. The hollow rod 46 which is spring loaded by spring 48 provides
communication between the body cavity and a carbon dioxide cannister 49.
Thus, after the body cavity is cut or punctured by the cutting edge 45,
the spring 48 pushes the hollow rod 46 into the body cavity thereby
exposing hole 47 to said cavity. Then by pushing the cutting edge 50 into
the carbon dioxide cannister 49, the gas is conveyed under a positive
pressure from the cannister through the hole 47 into said body cavity. The
cutting edge 50 can be provided with a gauge handle 51 which enables the
operator to insert or retract the cutting edge in a controlled manner,
thereby controlling the introduction of carbon dioxide into the body
cavity.
The needle in FIG. 15 is also shown as containing a sleeve 52 which is
internally threaded to receive external threads 53 provided on needle body
45'. The sleeve, which does not enter the body cavity but rather abuts
against the outside of the body, e.g., the abdomen, functions to prevent
the needle from being pushed into the body in an uncontrolled fashion.
Thus the rod can be screwed into the body in increments in a controlled
manner. This advantageous feature avoids the undesired penetration of
other organs. It is apparent that such a screw arrangement can be adopted
to the introduction of any instrument into the body.
FIGS. 17 and 18 show how the gas in the cannister 49 is maintained under
pressure. In FIG. 17, a collapsible type baffle arrangement 54 pushes
forward to assist the movement of the gas from the cannister into the
needle instrument. FIG. 18 shows a cannister loaded with a gas inasmuch as
the baffle means 54 is compressed against the rear portion of the
cannister. Hence, a positive pressure is then present in cannister 49. The
cannister can also be provided with a gauge 55 for visually determining
the amount of gas which has been removed from the cannister. The cannister
49 can be made to be rechargeable by providing a valve (not shown) for
reintroducing the gas therein.
FIGS. 19 and 20 show a spring stainless steel metal ring which can be used
in place of the elastic rings. In FIG. 20 the ring is shown as it would
appear on the ring applicator in an extended condition and FIG. 19 shows
how it would appear when coiled around the female tube.
FIG. 21 shows another embodiment wherein a coiled spring 57 is used in
place of the elastic ring.
In practice, the operation of the present invention is conducted as
follows. First, a needle-like instrument of the type described above is
inserted into the navel area in order to permit the flow of carbon dioxide
or air into the abdominal cavity so as to provide more space within which
to work inside the cavity. After the appropriate amount of gas has been
introduced, the needle-like instrument is removed and is replaced by the
trocar-cannula combination. If the operation is being performed with the
ring applicator of the invention being separate from the laparoscope, the
single trocar is removed and replaced with said ring applicator. A
laparoscope is inserted into the abdominal cavity for viewing purposes at
a different location. In the case where two-hole laparoscopy is being
employed, a cannula containing two trocars is employed, and the ring
applicator of the invention is placed into one of these holes and the
laparoscope into the other of these holes. In this case, the ring
applicator and the laparoscope can both be operated by the same physician.
After positioning the instruments properly within the body with the aid of
the view provided by the laparoscope, the physician engages the Fallopian
tube in the forceps means, pulls the tube inside of the ring applicator
instrument and then slips the elastic band over the tube. The forceps
means is then ejected from the instrument and the tube disengaged
therefrom. If desired, two or more rings may be placed upon either or both
of the tubes. The instruments are then removed, the cannula is removed and
appropriate measures are used to insure that the incision or small hole in
the skin area is properly cared for.
Another embodiment of the ring applicator of the present invention is shown
in FIG. 22. The device comprises an inner cylinder 2' disposed within an
outer cylinder 1' said inner cylinder being slidably engaged with said
outer cylinder. Thus, the outer cylinder 1' can be axially moved relative
to the inner cylinder 2'. The outer cylinder is provided with a ring
pusher 4' which is in sliding relationship with hollow cylinder 5'. The
inner cylinder 2' houses a laproscope 6', a light source 7', for example
fiber optics, disposed on both sides of the laparoscope and cylinder
5'which is adapted to house the grasping means 8'. In operation, the outer
cylinder 1' is pushed in the backward direction against the action of the
spring 9' and locked in the position shown in FIG. 22 by the screw lock
10'. The ring applicator device is now ready to be loaded with the elastic
band 12'. Referring now to FIGS. 23a, 23b and 23c, the elastic ring is
inserted with the fingers onto the end of the loading device 13' . The
loading device is then inserted into the end of cylinder 5' and with the
aid of the expandable pushing device 14', the ring 12' is pushed along the
surfce of the loading device 13' until it is loaded onto the outer surface
of the cylinder 5'. In this connection, it should be noted that the
pushing device 14' is segmented and made of an expandable material, for
example, spring metal or an expandable plastic material which is capable
of expanding as the ring is pushed along the ever increasing diameter of
the loading device 13'. Once the ring 12' has been loaded on the cylinder
5', the pusher device 14' is retracted and the loading device 13' is
removed from the end of cylinder 5'.
The loaded ring applicator device is now inserted into a cannula which had
been previously inserted into the patient in a well known manner. By
looking through the eye piece 15' of the laparoscope 6' and through the
use of the light source 7' introduced into the applicator device the
physician can readily see the pelvic cavity. When the Fallopian tube is
discovered by the physician, the grasping forceps 8' are pushed forward
utilizing the fixed ring 16' as leverage and pushing the slidable ring 18'
forward until its forward movement is limited by the end of the slot 22".
The grasping forceps 8' now extend from the end of the cylinder 5'. The
forceps 8' are then used to grab the Fallopian tube and pull it inside of
cylinder 5'. This is accomplished by pulling the sliding ring 18' rearward
until it strikes the rear end of the slot 20'. The Fallopian tube is now
in a proper crimped position within the cylinder 5'. Then the locking
device 10' is unscrewed thereby enabling the spring 9' to force the outer
cylinder 1' in the forward direction, the nose 4' of said outer cylinder
pushing the elastic band around the Fallopian tube inside of cylinder 5'.
Then the ring 18' is then pushed in the forward direction thereby
expelling the Fallopian tube crimped by the elastic ring from the end of
the ring applicator device. The above process is repeated in order to
apply the same technique to the second Fallopian tube in the same manner.
The ring applicator device can then be removed from the cannula and after
the cannula is removed from the patient the incision can be closed in a
well known manner.
FIG. 26 shows the embodiment of the present invention wherein the
laparoscope is offset from the device to permit freedom of movement of the
sliding ring 18' while at the same time avoiding possible contamination by
contact of the hand operating the sliding ring with the face of the
physician.
FIG. 27 shows another embodiment of the present invention wherein the
movement of the outer cylinder 1' with respect to the inner cylinder 2'
can be accomplished by trigger action utilizing trigger means 17'. In this
embodiment, while the trigger 17'is depressed, the outside cylinder 1 is
pushed in the rearward direction and then the trigger is released locking
the outside cylinder in said position. Now the front end of the ring
applicator device is ready for loading. After the elastic ring has been
loaded onto the front end of the ring applicator device and the Fallopian
tube has been pulled into the cylinder 5', the elastic band can be applied
to or shot onto the crimped Fallopian tube by pulling the trigger 17'. The
obvious advantages of the use of the trigger device reside in simplifying
the overall operation of the ring applicator for the benefit of the
physician. FIG. 27 also shows the use of a single sliding ring means 16'
wherein the distance the grasping means is extended from or retracted into
the ring applicator is variable depending on the physician operating the
device.
FIG. 28 shows one of the features of the present invention wherein the ring
applicator device is shown not in combination with a laparoscope system.
The use of the ring applicator device as shown in FIG. 28 without the
assistance of a laparoscope requires a slightly larger incision so that
the operating physician can locate the Fallopian tubes without the aid of
a light source. The ring applicator device of FIG. 28 comprises an inner
cylinder tube 2' coaxially and slidably disposed within an outer cylinder
1'. The outer cylinder 1' is provided with a handle means 22'to aid the
physician in stabilizing the instrument during the operative procedure.
The inner tube 2' is associated with a spring 9' such that when the lever
19' is pushed in the forward direction along slot 20 and locked in section
21' of slot 20', the inner cylinder 2' is pushed forward and extends
beyond the front end of the outer cylinder 1' as shown in FIG. 7'. Now the
front end of the ring applicator device can be loaded with the elastic
band 12' in the manner described above. With the ring applicator in the
loaded state it is inserted into | | |
