US2898915A - Implement for tying blood vessels - Google Patents

Description

4 Sheets-Sheet 1 ASINHP K. KAMMER IMPLEMENT FOR. TYING BLOOD VESSELS Aug. 11, 1959 Filed April l0, 1956 Aug'. M, 1959 K. KAMMER IMPLEMENT FOR TYING BLOOD VESSELS 4 Sheets-Sheet 2 Filed April l0, 1956 Aug.. 1l, 1959 K. KAMMx-:R

IMPLEMENT FOR TYING BLOOD VESSELS 4 Sheets-Sheet 3 Filed April 10, 1956 K. KAMMER IMPLEMENT FOR TYING BLOOD` VESSELS Aug. 11, 1959 4 Sheets-Sheet 4 Filed April 10, 1956 2,898,915 IMPLEMENT FOR TYING BLOOD VESSELS Karl Kammer, Lahr, Germany Application April 10, 1956, Serial No. 577,339

Claims priority, application Germany April 14, 1955 17 claims. (Cl. 12s- 326) The present invention relates to an instrument for )gripping and tying oft the open ends of lexible tubular elel.

ments, and particularly for tying off open blood vessels and the like astringently.

It is the primary object of the present invention to provide an improved instrument of the type as described which comprises a forcepslike clamp for Igripping an open blood vessel or the like, and means for applying and tying a thread thereon 'and knotting the same at least twice, and then cutting off the ends of such thread which, prior to such tying and knotting operation, had been held on the head of the instrument in the form of prelooped open knots.

An instrument of this type known prior to this invention contained a spring-operated drive which was released by the operation of a handleand was further controlled by such handle so as to be released in several stages in such a manner that first the head of the instrument together with the tying thread thereon was moved from the rear toward and in front,v of the forcepslike clamp and thus over the blood Vessel to be tied olfg-that the first knot was then tightened on the thread and thereafter the second knot was applied thereover and likewise tightened, whereupon finally the ends of the thread were cut off near the knots, f

It is another object of the present invention to provide certain new and valuable improvements in an instrument of the type as described above which permit the instrument to be manipulated much more easily and to operate much more accurately and reliably than the instruments Apreviously known for this purpose.

A further object of the invention is to provide an in- :strument of the type as described in which each indi- 'vidual function thereof within a definite sequence of :steplike operations is separately safeguardedand completed before the next function can take place.

A further object of the invention is to provide an in- ;strument of this type which is designed so as to permitit ito be cleaned very easily, quickly, and thoroughly, and to abe taken apart for such purpose and then to be reassem- `bled more easily than this was possible in previous in- :struments of this type, and without requiring the individual element-s of the instrument to be ldisassembled for :such cleaning purpose.

It is another object of the invention to provide a new and improved mechanism for operating the instrument and controlling the individual ffunctions thereof, and especially for operating the cutting knives of such instrument.

A further object of the invention is to provide such instrument with a new mechanism which permits the ends of the tying thread after being cut off near the tightened knots to be safely held and retained on its supporting plate by means of which the thread is applied to the instrument, so that these severed ends may be safely removed together with this plate after the entire operation is completed. f

Still another object of the invention is to provide an in- StatesPatent i Azinsen? Patented Aug. 11, 1959 strument of this type in which the operating handle and thevvarious elements, the function of which is mechanically controlled by such handle, are designed so as to permit the individual successive operating steps to be carried .out merely by pressing and then releasing the handle, and -while the handle carries out either suchy pressing or releasing movements.

Further objects, features, and advantages of the present invention will appear from the following detailed description thereof, as well as from the accompanying drawings Aof one preferred embodiment, in which- Fig, 1 shows a side view of the instrument in the tensioned position ready for use, in which, however, just as in Figs. 2 to 7, the thread supporting plate, which is to beplaced upon the front surface of the tying head and which applies the thread to the instrument so as to kbe ready for tying, has been omitted so that the invention may be more easily understood;

y Fig. 2 shows a central longitudinal cross section through the instrument in the same position as shown in Fig. l;

Fig. 3 shows another cross-sectional View similar to Fig. 2, but with the instrument in the position upon the completion of the first operating step in which the operating handle is depressed to its first stage for closing the forcepslikepclamp;

Fig. 4 shows a similar cross-sectional view which illustrates the position of the instrument in the second stage ofits operation when the Ioperating handle is further depressed for quickly advancing the tying head which carries lthe thread supporting plate so as to feed the thread to the place or blood vessel to be tied;

. Fig., 5 shows a further similar cross-sectional view of the yinstrument Vin the third stage of its operation, that is, in the position which it assumes Iwhen the first knot has been applied and the thread ytensioner has partly retracted;

Fig. 6 shows a vertical cross section taken along line VI-VI of Fig. 5, with the instrument in the same operating position as shown in Fig. 5;

Fig. 7 shows another cross-sectional View similar to Figa 5, illustrating, however, the final operating position of the instrument, in which the thread tensioner has completely retracted and has also tightened the second knot which had previously been applied, and in which the ends ofthe thread which are secured to the thread supporting plate have also already been cut;

Fig. 8 shows an enlarged view of the front end of the instrument together with the tying head and the thread supporting plate thereon in the position as illustrated in Fig. 7;

Fig. 9 shows a plan view of a thread supporting plate i with a thread applied thereto in a position ready for use;

Fig. 10 shows an exploded perspective View of the assembly of a thread supporting plate prior to its applicationqto the head of the instrument and consisting of two telescoping parts; while Fig. l1 shows a partial plan view of the thread supporting plate with the ends of the thread secured thereto so as not to be detachable therefrom of their own accord.

Referring to the drawings, the new instrument essentially consists of an outer tubular casing 1 which is partly enclosed at one side by an elongated cap member 2 which carries at its upper end a nut 3 in which a shaft 4 is threadedly secured which extends at its lower end into the stationary prong 5 of a forcepslike clamp, the other prong 6 of which is pivotally secured thereto and normally held in the open position by a spring. For

. member 2 is slightly depressed, whereby a roller 8 which is mounted on handle 7 acts by lever action upon the pivotal arm 6. A compression spring 9 is mounted on shaft 4 and acts at one end upon a bearing member 10 and at the other end upon a ring 11 which is slidable on shaft 4. Ring 11, in turn, is slidable within a main tubular slide member 13 until it engages a screw 12 which thus serves as a stop member. The main slide member 13 has further rigidly secured thereto a ring 14 for supporting a second compression spring 15 which surrounds the rear or upper end of member 13, while the lower or front end of slide member 13 carries a tying head 16, the front surface of which is adapted to hold the thread supporting plate 57, as shown in Fig. 8, which is clamped between a nose 18 and a leaf spring 17 on the head 16. In order to hold the main slide member 13 in the rear tensioned position, a pawl 22 is mounted on a pin 20 in eyes 19 extending from casing 1 so as tol be pivotable relative to casing 1 against the action of a spring 21. Its detent 23 engages behind a catch 24 on the main slide member 13 and retains the same in the rear tensioned position. For releasing pawl 22, the operating handle 7 is depressed toward casing 1 so that a' cam portion on its rear inner end engages a roller 25 and turns the same so as to pivot pawl 22 in the direction of the arrow, as shown in Fig. 3, thereby disengaging the detent 23 from the catch 24. The end of pawl 22 which carries roller 25 has also pivotally mounted thereon a second lever 26 which together with pawl 22 forms a bell crank,` which is pivotable outwardly from its end position as shown in Figs. 2 and 3, and the function of which will be subsequently described. Lever 26 has a central longitudinal slot 27 in which another lever` 2y8 engages which is pivotally mounted on the operating handle 7 on a pin 29. Closely adjacent to its pivot 29,` lever 28 carries a roller 30 which, when the apparatus is in the position as shown in Fig. 5, is designed to depress the retarding lever 31, which is likewise mounted on the main slide member 13, so as to retard the return movement of member 13 as subsequently described.

The main slide`member 13 further carries a second slide member 32, the front end of which carries a pair of pinlike projections 33 which are adapted to pass through corresponding bores 34 inthe `tying lhead 16. Slide member 32 is slidably mounted on the main slide member 13 and is acted upon by a strong third compression spring 35, one end of which acts upon an inner flange 36 at the upper end of slide member 32, while the other end acts upon a guide -pin 37 on the main slide 13'. Spring 15 in the upper, tubular part of the mainslide member 13 acts upon a further slide member 38 which surrounds the main slide member 13 and serves as a thread tensioner. This thread tensioner 38 carries on each side a draw bar 39 which has a hook 40 on its front end for catching and tensioning the thread. These hooks 40 are shaped so as to permit the thread to slide along therein when the knots are being tightened. ANear their rear end, each of draw Vbars 39 further has pivotally mounted thereon a lock pawl 41. AThese lock pawls are both urged outward by a single leaf spring 42 so that, in the tensioned position as shown in Figs. 2, 3, and 4, their detents 45 will engage with lateral shoulders 43 of a T-shaped member 44, as shown particularly in Fig. 6, which, in turn, is secured to the main slide mem-y ber 13.

Two lateral knives 46 are provided for cutting off the ends of the thread after the knots have been tied. Each of the knives carries two guide pins 47 and 48 which are received in guide slots 49 and 50, respectively, formed in the main slide member 13. The slot 49 extends in axial direction whereas the slot 50 is curved downwardly and outwardly. Each knife 46 also carries or is formed with a projection 51 which is received in a notch 52 formed in slide member 32, as is best shown in Fig. 5. By virtue of this arrangement, the knives will, after a certain movement of slide 32, be moved in axial direction and simultaneously pivot about a transverse axis so that the front portions of the knives, which are the poras shown in Fig. 3, to close the forceps.

tions formed 'with cutting edges, will move toward the thread, thereby executing a slicing movement so as cleanly to cut the thread.

The operation of the instrument as above described is as follows:

Proceeding from the position of the instrument when under tension, as shown in Figs. l and 2, the blood vessel which is to be tied off is first gripped by the toothed endsS and 6 .of the forceps by pressing upon the operating handle 7 with the same hand which holds the apparatus by its casing 1 and the cap member 2. By such movement 4of handle 7, roller 8 forces the pivotable prong 6 of the forceps against the stationary prong 5, Since the person using the instrument should clearly feel in his hand the different operating stages thereof, lever 28 which is mounted on the operating handle 7 is provided with a detent 53 with which the free end of lever 26 engages which is mounted on pawl 22 so as to be pivotable outwardly thereto from its endnposition as shown in Figs. 2 and 3. Thus, lwhen handlel 7 is first being depressed, this free end of lever 26 abuts upon detent 53 and prevents the two levers 22 and 26 from spreading apart.

f This opposing pressure which is clearly felt by the hand,

indicates .that theforceps is fully closed and that the rst operating stage is completed. i

When the operating handle 7 is then further depressed, the cam surface on its inside pushes'roller 25 down? wardly so that 4levers 22 and 26 move from Vthe position shown -in Fig. 3 to that shown in Fig. 4, in which lever 26 slides off the detent 53 of lever 28, and the detent 23 on lever 22 slides off the catch 24, thereby releasing the latter -so that -the main slide member 13 under the A action of spring 9 will slide quickly forward, and the tying head -16 will move over the two prongs 5 and 6 o'f the forceps and its front surface will even extend slightly beyond the tip thereof, that is, over the end of the blood -vessel .to be tied off. At such quick advance of the main slide member 13, catch 24 thereof slightly engages and pushes back lever 28 so that its detent 53 Vslides olf the end of lever 26 and, when handle 7 is then further depressed, permits lever 26 to carry out its pivotal movement to the lower end position as shown in Fig. v5, in -which its front end acts upon detents 54 on slide member 32. Y

When handle 7 is then further depressed in the next operating stage, the projecting lugs 55 on the free edge of the lateral walls thereof act against the detents 45 on pawls 41 so as to release them'from their'engagement with shoulders 43 and'thereby disengage the thread tensioning slide 38 from the main slide member 13. These lugs 55, instead of being provided on the operating handle 7, may also be provided -in a corresponding lateral posii tion on pawl 22. When handle 7 is fully depressed and I' action of spring 15, so that the hooks 40 on draw bars 39.

which in their downward movement had passed behind the thread 56 will pick up the thread as shown in Fig. 8 and thereby tighten the first knot which had been -lying ready prepared on the thread supporting plate 57. During the further retraction of the thread tensioner 33, hooks 40 will then also engage and tighten the thread for the second 'knot which had 'been prelooped about the pointed projections 33 on the front end of slide member 32. In this connection it should be noted that, when the knots are thus'tightened, the endslof the thread 56 will be retained in a pair ofl slots 60 in supporting plate 57., as shown in Figs. 9 and l0, and that thread;V 56 will slide along hooks 40. This permits the length of thread 56 it assures that` the ends of the thread when subsequently cut off will remain attached to plate 57 so that they can be removed together with the plate without requiring any additional operation. l I In order to give the draw bars 39 adequate time to tighten the knots, which are applied in quick succession, one above the other, before the ends of the thread which are still hooked on the supporting plate 57 are cutl off, a suitable retarding device is provided which prevents slide member 32 from retracting completely to its released position. This device, as shown in Figs. 5 and 7, consists of a retarding lever 31 which -is pivotably mounted on the main slide member 13, and a wedge-shaped stop member58 on the other slide member 32. When slide member 32 retracts'through the action of spring 35, this stop member 58 will be engaged andV retained by a cam 59 on the retarding lever 31 until the pressure upon the operating handle 7 is released.` When this occurs, the pressure of roller 30 on lever 28 upon retarding lever 31 is also released, and the latter'can escape'outwardly to the position showngin dot-and-dash lines in Fig. 7. Cam 59 will then release the stop 58on slide member 32 and permit the same to pass under the action of spring 35.

An important object of the invention is to assure that the ends of the'thread will not be cutfofIr until theA two knotsrhave been applied one after the other 'andf each of them has been separately tightened. yIn order to prevent the second knot from being applied prematurely, the front end of lever 26 will engage with the'detentr54 and thus prevent slide member 32 from snapping back too soon. This can therefore not occur until operating handle 7 has been suiciently released in the outward direction. Axial movement` of slide member 32 produces a similar movement of knives 46 which are retracted at the return movement of member 32 by the projecting lugs 51 en' gaging in the notches 52 in vmer'nber'32. Due to the curved shape of slot 50, the blades of'knives 46 will at the same time carry out a lateralmove'ment in the direction toward the thread, and thereby cut on the thread with aclean drawing cut.

f The front end of casing'l further carries a smallpivotal arm 61 which normally is turned inwardly as shown in the drawings, but may be'pivoted outwardly about a pin 62. When in such position, the instrument maybe' easily taken apart for cleaningwithout requiring any of its individual parts to be disassembled. If arm 61 is thus pivoted outwardly, the main slide member 13 with all the parts thereon may be easily pulled out of casing 1 toward the front, and be similarly reinserted. Also, after removing the main slide member 13 and screw 3,

the entire shaft 4 of the forceps may also be easily with-y drawn from the casing 1 either for cleaning the same or for exchanging it for one with different forceps prongs or tips.

Fig. l0 once more illustrates the thread supporting plate 57 separately from the instrument and together with its applicator plate 63 lwhich, is inserted from below into and against plate 57 so that its projecting vparts 64 and 65 pass through the corresponding apertures 66 and 67 in plate 57 and hold thethread 56 in a pre-looped condition lfor the two knots as shown in Fig. 9. The aplicator plate 63 will be pushed out of plate 57 when the latter is attached to the head 16 of the apparatus between the clamps 17 and 18, at which time the prongs 5 and 6 of the forceps and the pinlike projections 33 on slide member 32 will take over the function of the projections 64 and 65, respectively, of the applicator plate 63.

Fig. 1l linally shows a partial vview of a modification of plate 57 in which the end portions 68 of thread 56 may also be secured to plate 57 by being wrapped around a pair of lugs 69 which may be bent over and pressed together, so that after these ends have been cut oli? the thread 56, they will remain securely attached to plate 57 and 'be removed together with this plate.

Although my inventionv has been illustrated AandL described with reference to.` the preferred embodiments-- 6 thereof, I wish to have it understood that it is in no way limited to the details of such embodiments, but is capable of numerous modifications within fthe scope of the appended claims. v v f Having thus fully disclosed my invention, what I claim is: y

l. An instrument for gripping and tying olf the open ends of flexible tubular'elements and particularly blood vessels comprising a casing having an opening at one end, a forcepslike clamp mounted on said kcasing and normally held in an open position, an operating handle pivotably mounted on said casing and adapted to be pivotally depressed in several stages toward said casing and when initially depressed to close said clamp Vto grip said tubular element, thread holding means slidably mounted on said casing and extending through said opening for holding at least one thread =with at least two prelooped open knots and for moving said thread holding means so as to move said knots over said clamp and superimposed on veach other upon said tubular element when said handle is further depressed, tightening means for tightening said knots one after the other when said handle is finally depressed, spring means Withinsaid casing and controlled by the different stages of depression of said handle for carrying out the different movements of all of said means in successive order, and cutting means also operated bysaid spring means during the following releasing movement of said handle for cutting olf the thread near said tightened knots by a sudden stroke.

2. An instrument for gripping and tying off the open ends of flexible tubular elements and particularly blood vessels comprising a casing having an opening at one end, a forcepslike clamp mounted on said casing and normally'held in an open position, an operating handle: pivotally mounted at its lower end on said casing' and adapted to be pivotally depressed in several successive stages toward said casing, the lower end of said handle forming a lever, said lever being adapted to `close said clamp to grip said tubular element when said handle is initially depressed, control means `comprising a bell crank having a pair of arms disposed underneath said'handle and connected so as to be pivotable relative to each other from an acute angular end position, and one of said arms being pivotally mounted near the free end thereof on said casing, the inner surface of said handle when being further depressed acting upon the fulcrum of said arms, means slidably mounted in said casing and extending through said opening for holding at least one thread with at least two prelooped open knots, means for moving said thread holding means so as to move said knotsv over said clamp and superimposed on each other upon said tubular element when said handle is further depressed against said lbell crank and the two yarms of the' latter are thereby partly spread apart, means for tightening said knots one after the other when Asaid handle is iinally depressed and said arms of said bell crank are' fully spread apart, spring means within said casing adapt` ed to be acted upon-by said bell crank and controlled by the successive increased pressure of said handle upon said bell crank and the different angular positions of the two arms thereof for carrying out the different movements of all of said means in successive order, and cutting-means also operated by said spring means .during the following releasing movement of said handle and aV sudden automatic disengagement of one of the arms of said 4bell crank from said spring means for cutting oft the thread near said tightened knots by a sudden stroke.

3. An instrument for lgripping and tying off the open ends of exible tubular elements and particularlyblood' vessels comprising a casing having an opening at one end, a forcepslike clamp mounted on said casing and normally held in an open position, an operating handle pivotally: mounted at itsv lower end on said casing and adapted" tovbe pivotallydepressed in several successive stages to-L ward Said casing, the lower end otsaid handle tannins a lever adapted to @lese said slamp to Ygrip said. tabular element when said handle is initially depressed, .control means comprising a bell crank havinga pair oi arms dis- Possa underneath Said handle and eonneted so .as t be pivotable relative to each other from au acute angular @11d Position, 011s 0f Said arms being Pit/@tally mpunted near the f ree `end thereof on said casing, the inner surface of said handle when being further depressed acting upon the fulcrum of said arms, means for locking said two arms in a fixed angular position relative to each other until an increased pressure upon said handle and said fulcrum automatieally releases suchl locking action and permits the free ends of said arms to pivot away from each other, means s lidably mounted in said casing and extending through said opening for holding at least one thread with at least two prelooped open knots, means for moving said thread holding means so as to move saidknots over said clamp and superimposed on each other upon said tubular element when said handle is further depressed against said bell crank and the two arms of the latter are thereby partly spread apart, means for tightening` said knots one afterthe other when said n andle is finally depressed and said arms of said bell crankV are fully spread apart, spring means within said casing adapted to be acted upon by said bell crank and controlled by the successive increased pressure of said handle upon said bell crank and the different angular positions of the two arms thereofv for carrying out the different movements of all of said means in successive order, and cutting means also operated by said spring means during the following releasing movement of said handle and a. sudden automatic disengagement of one of the arms of said bell crank from said spring-meansy for cutting off the thread near said tightened knots by a sudden stroke.

4` An instrument for gripping and tying ofi the open-` ends of flexible tubular elements and particularly bloody vessels comprising a casing having an opening at one end, a forcepslike clamp` mounted onV said casing and normally held in anopen position, anV operating handle pivotally mounted at its lower end on said casing and adapted to be pivotally depressedl in several successive stages toward said casing, the lower end of said handle forming a lever adapted to close said clamp4 to grip` said tubular element when said handle is initially depressed, thread holding means comprising aY pair ofi thread holding slide members withinsaid casing and ex- .tending through said opening and each adapted to hold a thread with ay preloopedopen knot on its outer end, means within saidtcasing for moving both of said threadholding slide members so as to move said knotsA over said clamp and superimposed on eachother upon said-` tubular element when said handle is` further depressed, means for tightening said knots one after the other when said handle is finally depressed and then released,- safety, means for preventing the second knot frombeing applied and tightened as long as Ithe first knothas not been applied and tightened, saidsafety means being released automatically Iwhen said handleisbeing released, cutting means operatively associated with one of said ,thread holding slide members for cutting off the thread near` said tightened knots when said handle` is` further released,V and spring means within said casing` and controlled by,

the successive pressing and releasing movements of said handle for carrying out the difrferent movements o f all' of said means in ,successive order.

5. Aninstrument as` defined in claim` 1, wherein ,said-,-

cutting means comprise a pair of knife blades, and further comprising means for guidingl said bladesin-,thein retracting'cutting stroke. so -as to move generally in anaxial direction butlsimultaneouslyto carry outiagpiw.

otal I slicingl stroke.

of said thread holding slide members from retracting completely during the releasing movement of said handle and after the second knot has been tightened until said handle has been released 4to a certain point.

7. An instrument as defined in claim 4 wherein said cutting vmeans are connected with the second thread holding means., and further comprising locking means for preventing the other of said thread holding slide memlbers from retracting completely during the releasing movement of said handle until the second knot has been tightened and said handle has been released to a certain point, and a strong spring acting upon said second thread holding member so that, when said ylocking means are released, said second thread holding member will snap back suddenly to its end position and thereby take along said cutting means in a sudden, jerky movement thereof.

8. An instrument as defined in claim 1, further comprising a locking member mounted at the front end of said casing so as to be pivotable from one position, in which it is directed toward the inside of said casing and holds the various elements in their respective position within.y said casing, toward another position in which it is turned toward the outside of said casing and in which the essential elements within said casing may be easily withdrawn therefrom through said opening.

9. An instrument asl defined in claim 1, wherein said tightening means comprise a pair of hooks, said hooks being shaped and disposed` so as automatically to engage withy the thread when moving in the direction thereto, andto permit the thread to slide within said hooks when said thread is being tightened.

10. An instrument as defined in claim 1, wherein said 11. An instnument as defined in claim 1, wherein said tightening means comprise a pair of hooks, said thread holding means including a plate designed so as to hold the thread in a prelooped open knot and having on each side a pair of Ilugs forming an intermediate, substantially Uashaped opening through which said hooks are adapted to pass so asl -to engage the thread, and means on one of'each of said pairs of lugs for securing the ends of the thread so as to remain safely connected to said plate lwhile said threadvis being tensioned and cut.

12. An instrument for gripping and tying otf the open ends of flexible tubular elements and particularly blood vessels comprising anelongated outer casing having a lateral opening and anopening at one end thereof, an operating handle pivotally mounted on said casing and partly extending into said casing through said lateral opening, a forcepslike clamp having a shaft mounted within said casing in axial direction thereof and a. pair of prongs at one end of said shaft and projecting through said end opening, one of said prongs 'being stationary andelement, va slide member within said casing and extendingy through said end opening and having a head portion around said prongs, means adapted to hold a thread with a preloopedlopen knot thereon, means for connecting said thread holding means to said head portion, a spring acting-upon said slide member tending `to move the same forwardly, control means mounted on said casing and adapted toY be engaged by said` handle for holding said slide member in a rear. tensioned position against the action of said springand fon-releasing said slide member when saidfhandleisfurther depressed so as to move J Saidathread; holding4 means. forward" along said prongs.

andslghtly beyond the tip thereof and upon said tubular element, a second slide member within said casing and movable relative to said rst slide member, gripping hooks on thefront end of said second slide member, a second spring acting upon said second slide member, means for releasably connecting said first and second slide members so that when said rst slide memlber moves forward,fittakes along said second slide member and gripping hooks, a third slide member within said casing and having a pair of prongs projecting through said end opening and adapted to slide relative to said r'st slide member and to hold a thread with a second prelooped open knot thereon, a third spring acting upon said third slide member and tending to retract the same relative to said first slide member, said control means further engaging said third slide member when said handle is further depressed so as to move said third slide member forwardly against the action of said third spring and then to hold the same in a tensioned condition, means for acting upon said connecting means to release said second slide member from said rst slide member when said handle is still further depressed so that said second spring will then pull back said gripping hooks and the latter will rst engage and tighten the thread on said thread holding means so as to tighten the rst knot, and will thereafter also engage and tighten the thread on said projecting prongs of said third slide member so as to tighten the second knot above said rst knot, and a fourth slide member having a pair of knife blades yat the front end thereof, means for operatively connecting said third and fourth slide members so that, when said third slide member was previously moved forwardly, it also moved said knife blades toward and along said theads, said handle when subsequently released also releasing said control means and suddenly disengaging the same from said third slide member to permit the latter suddenly to retract from said tensioned condition and thereby to take along said fourth slide member, so that the knife blades thereon will then cut olf the thread near said tightened knots by a sudden drawing stroke.

13. A surgical instrument for tying ligatures comprising, in lcombination, a casing; a clamp for clamping a blood vessel or the like; tying means for tying a ligature about a blood vessel or the like while the same is clamped by said clamp; cutting means for cutting the ends of the ligature after the same has been tied about the blood vessel or the like; and a common operating member mounted on said casing in such a manner as to be capable of being pressed and released, said member being operatively connected to said clamp, tying means Iand butting means in such a manner that during progressive depressing and release of said member, said clamp is moved from open position to closed position so that a blood vessel or the like may be clamped, said tying means thereafter tie a ligature about the blood vessel or the like clamped by said clamp, and lsaid Icutting means thereafter cut the ends of the ligature tied about the blood vessel or the like.

14. A surgical instrument for tying ligatures comprising, in combination, ya casing; a clamp for clamping a blood vessel or the like; tying means for tying a ligature about a blood vessel or the like while the same is clamped by said clamp; cutting means for cutting the ends of the ligature after the same has been tied about the blood Vessel or the like; and a common operating member mounted on said casing in such a manner as to be capable of being pressed and released, said member being operatively connected to said clamp, tying means and cutting means in such a manner that during progressive depressing of said member, said clamp is moved from open position to closed position so that a blood vessel or the like may be clamped and said tying means thereafter tie a ligature about the blood vessel or the like clamped by said clamp, and that upon release of said common operating member said cutting means cut the .l0 ends of the ligature tied -about the blood vessel or the like.

l5. A surgical instrument for tying ligatures comprising, in combination, a casing; a clamp for clamping a blood vessel or the like; tying means for tying an at least doubly-knotted ligature about a blood vessel or the like while the same is clamped by said clamp; cutting means for cutting the ends of the ligature after the same has been tied about the blood vessel or the like; and acommon operating member mounted on said casing in such a manner as to be capable of being pressed and released, said member being operatively connected to said clamp, tying means and cutting means in such a manner that during progressive depressing of said member, said clamp is moved from open position to closed position so that a blood vessel or the like may be clamped and said tying means thereafter tie one knot of an at least doublyknotted ligature about the blood vessel or the like clamped by said clamp, and that upon release of said common operating member, said tying means tie the second knot of the ligature and said cutting means thereafter cut the ends of the ligature tied about the blood vessel or the like.

16. A surgical instrument for tying ligatures comprising, in combination, an elongated casing having a front end; an elongated clamp carried by said casing and extending beyond said front end thereof, said clamp being movable between open and closed positions; a ligature carrier carried by said casing for movement relative thereto between a retracted position wherein said carrier is near said front end of said casing and an extended position wherein said carrier is located beyond said front end a distance which is approximately equal to the distance which said clamp extends beyond said front end; tying means associated with said ligature carrier for removing therefrom, while said carrier is in its extended position, a ligature carried thereby, placing such ligature about a blood vessel or the like clamped by said clamp, and tying such ligature about the blood vessel or the like; cutting means associated with said ligature carrier for cutting the ends of a ligature previously carried by said carrier and thereafter tied about the blood vessel or the like; and a common operating member mounted on said casing in such a manner as to be lcapable of being pressed and released, said member being operatively connected to said clamp, ligature carrier, tying means and cutting means in such a manner that during progressive depressing and release of said member, said clamp is moved from its open to its closed position, said ligature carrier is thereafter moved from its retracted to its extended position, said tying means thereafter remove from said ligature carrier a ligature carried thereby, place such ligature about a blood vessel or the like clamped by said clamp, and tie su'ch ligature about the blood vessel or the like, and said cutting means thereafter cut the ends of the ligature tied about the blood vessel or the like.

17. A surgical instrument for tying ligatures comprising, in combination, -an elongated casing having a front end; an elongated clamp carried by said casing and extending beyond said front end thereof, said clamp being movable between open and closed positions; a ligature carrier carried by said casing for movement relative thereto between a retracted position wherein said carrier is near said front end of said casing and an extended position wherein said 'carrier is located beyond said front end a distance which is approximately equal to the distance which said clamp extends beyond said front end; tying means associated with said ligature carrier for removing therefrom, while said carrier is in its extended position, a ligature carried thereby, placing such ligature about a blood vessel or the like clamped by said clamp, and tying such ligature about the blood vessel or the like; cutting means associated with said ligature carrier for cutting the ends of a ligature previously lcarried by said carrier and thereafter tied about the blood vessel or the like; and

' Il a common operating member mounted onV said casing in such a manner as to be capable of being pressed and released, said member being operativelyA connected to said clamp, ligature carrier, tying means and cutting means in such a manner that during progressive depressing of said member, said clamp is moved from its open to its closed position, said ligature carrier is thereafter moved from its retracted to its extended position, and said tying means thereafter remove from said ligature carrier a ligature carried thereby, place such ligature about a blood vessel or the like 'clamped by said clamp, and tie such ligature about the blood vessel or the like, and that upon -release of said common operating member said cutting References Cited in the file of this patient UNITED STATES PATENTS 1,625,602 Gould et al. Apr. 19, 1927 1,691,386 Fisher Nov. 13, 1928 2,316,297 Southerland et al. Apr. 13, 1943 FOREIGN PATENTS 419,087 Great Britain Nov. 6, 1934 1,078,682 France May 12, 1954

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