Note: Descriptions are shown in the official language in which they were submitted.
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FORCEPS
BACKGROUND OF THE INVENTION
1. FIELD OF THE INVENTION
The present invention relates generally to surgical
implements for gripping tissue, and more particularly
to alternative embodiments of forceps used to grasp
the vas deferens of the scrotum and vagus nerve while
conducting surgical interventions in the lower
esophagus or stomach.
2. DESCRIPTION OF RELATED ART
Voluntary surgical contraception, also called
contraceptive sterilization, has become the most
widely used method of family planning in the world.
It is also one of the safest and most economical
contraceptive methods. The health benefits of
contraceptive sterilization are especially evident in
developing countries where temporary contraceptive
methods may be periodically in short supply or used
ineffectively, and where unwanted pregnancies carry a
high risk of maternal death. Contraceptive
sterilization may be performed on either the female
(tubal ligation), or the male (vasectomy). Although
both procedures are equally effective as contraceptive
methods, vasectomy is simpler, safer, and less
expensive than tubal ligation.
Vasectomies can be accomplished by cutting or
clipping the vas deferens. Because of the relatively
high failure rate of the clipping method, cutting is
preferred. In the cutting method, a forceps is used
during the vasectomy procedure to grasp and elevate
the vas deferens, the duct which transports sperm and
semen from the testicles to the penis. The vas
deferens is elevated and exposed so that it may be cut
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and ligated, thus completely preventing the flow of
sperm in the vasectomized male. In a standard
vasectomy, the vas deferens is isolated, the grasping
tips of forceps are clamped behind it, and the duct is
elevated. Once having elevated the vas deferens, the
surgeon rotates it, thus exposing its surrounding
sheath, which is then dissected to uncover the duct.
A commonly used instrument in performing in
performing surgical interventions is a standard
forceps, such as Allis forceps. The standard forceps
comprises a scissor-like construction that includes a
locking mechanism for the two arms at the handle end.
The grasping tips, at the ends of the arms opposite
the handles, have mating sawtooth extensions, which
meet in a line perpendicular to the lengthwise
extension of the instrument and are used to clamp onto
tissue.
Because of the large, flattened area defined by the
tips of standard forceps, additional tissue is often
grasped during a surgical operation and elevated along
with the target tissue, such as the vas deferens or
vagus nerve, to be grasped. For example, the vagus
- nerve, like many other nerves, lies in close proximity
to vascular tissue such as veins and arteries, and is,
along with such other tissues, cloaked in mesenteric
tissue. Moreover, a nerve, although having moderate
resilience to stretching thereby allowing an
instrument to be placed loosely beneath the nerve to
retract it from a surgical site, is particularly
vulnerable to crushing, the consequence of which may
include faulty neurological transmission due to an
interruption of electrical conduction caused by
irreparably crushing of cells. Because the vagus
nerve has a large diameter, exceeding 4 mm in places,
to pull it up and out of an incision area with the
larger, flattened areas of the tips of the closed jaws
of the a standard forceps would likely cause crushing,
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and at best pinching as a result of the nerve bending
over the edged surface of the jaws. Thus, the large
ends and clamping structure defined by the standard
forceps is particulary unsuited for use to grasp and
retract the vagus nerve.
Moreover, particularly in the case of the vas
deferens, due to the open ends of the grasping tips,
tissue often slips out of the grasp of the instrument
when the nerve is lifted clear. The large end
structure defined by the standard forceps frequently
permits the vas deferens to escape the surgeon's grasp
as he pulls it up and out of the incision. Finally,
due to the large open ends of the grasping tips, the
vas deferens often slips out of the grasp of the
instrument when the duct is rotated to expose the
surrounding sheath. In each case, the surgeon is
required to recapture the duct, and recommence this
part of the procedure. Such imprecision and slippage
renders the procedure longer, and more difficult to
conduct than if a forceps with a design more specific
to the procedure were used. In each case, the surgeon
is required to recapture the tissue, and recommence
this part of the procedure. Such imprecision and
slippage renders the procedure longer, and more
difficult to conduct than if a forceps with a design
more specific to the procedure were used.
Another common instrument known is the rod clamp
used with a threaded rod in orthopedic surgery. The
clamp has a blunt, widened tip, defining an aperture
for passage and clamping of the rod. Whereas the
aperture may allow passage of any tubular item, the
blunt, wide tip and short jaws prevent the rod clamp
from use for fine manipulations in a wound site, such
as finding a nerve in an already occluded area. The
short, wide, blunt jaws would act to block the view of
the wound site. Moreover, because the end of the jaws
are very near the pivot stud joining the two arms of
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the clamp to allow a scissoring action of the clamp,
the arms must be widely spread apart for open the jaws
to open sufficiently at the opposite end to accept the
vagus nerve. This would require a surgeon to have a
very large hand span in order to operate with
difficulty at best.
Several attempts have been made to overcome the
problems associated with the use of standard forceps
in procedures requiring manipulation of stranded or
tubular tissues. U.S. Patent No. 2,397,823, issued to
Carl W. Walter, on April 2, 1946, discloses a forceps
intended to be capable of grasping a wide variety of
objects. This forceps has a elongated "pistol-grip"
handle. It is oriented at an angle of at least 45
degrees relative to a gripping portion of the device.
The forceps of Manuel V. Santos shown in U.S. Pat. No.
3,828,791 issued August, 13, 1974 utilizes a similar
functional design. Consequently, minute manipulations
of tissue during a surgical procedure would be
cumbersome at best, and dangerous at worst.
Moreover, the Walter forceps is shown to have
serrations on the very tip. Such serrations, while
providing additional gripping friction, would
necessarily cause destruction of surrounding tissue.
Also, the presence of these serrations clearly
indicate that this forceps has a clamping hole
substantially recessed from the end of the device, in
stark contrast with applicant's own invention. Use of
such a device in a retraction of the vagus nerve or
vas deferens would require a larger incision than
necessary to pass the device into the wound site
sufficiently far for the clamping hole to engage the
vas deferens (requiring an extraordinarily large
incision in the scrotum for insertion of the device,
leading to increased likelihood of infection), or,
similarly, the vagus nerve. Moreover, it would cause
tissue damage when the device is closed and clamped
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around the nerve. It would also make the lifting of
the vagus nerve and, during the vasectomy procedure,
lifting and turning of the vas deferens impossible
without substantial destruction of surrounding,
additional tissue caught in the large extension of the
forceps' tips beyond the clamping hole, in turn
resulting in additional, unwarranted procedure length,
trauma, and danger.
Both the Santos and Walters devices fail to have a
beveled rim around the edge of the hole nearer its
grasping end to provide effective gripping for lifting
stranded tissue such as the vagus nerve. Instead, the
Walters device has "arcs of different curvature"
disposed around the rims of recesses in the jaws,
which are described as including an "almost blade-like
inner edge." Such bladed arcs would tend to cut
tissue held, making holding of tissue impractical and
dangerous. In fact, the forceps is intended for use
with objects other than tissue, such as needles and
swabs. Importantly, the literature describing the use
of this device does not even mention its use for vagus
retraction and lifting or vasectomies.
U.S. Patent No. 2,642,871, issued to Joseph Theurig,
on June 23, 1953, discloses a forceps suitable for
grasping tubular objects, such as syringes. The
forceps has a clamping aperture described and depicted
as comprising "transverse inverted obtuse angular
meeting faces." The difficulty concomitant of using
such a device in lifting the vagus nerve and vas
deferens is substantial. Because the aperture is not
curved to the shape of a tubular or stranded tissue,
such as the vas deferens or vagus nerve, the tissue
would tend to both slide laterally and rotate within
the aperture, if not be pinched during full closure
with the tips contacting one another. Such sliding
during vasectomies would make performance of the
procedure impossible because the appropriate cutting
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and knotting of the duct would be unfeasible. Making
the device smaller, so that the device would immovably
hold the vas deferens or vagus, would result in
failure of the device to close completely, as shown in
Fig. 4 of the Theurig patent. Without complete
closure, the device would tend to allow undesired
release of the vas deferens and vagus during required
lifting or rotation. The Theurig forceps also lacks
a beveled rim around the edge of the hole nearer its
grasping end to provide effective gripping of tubular
tissue. Notably, the literature referring to the use
of this device does not even mention use for
retracting the vagus nerve or for vasectomies.
U.S. Patent No. 5,067,958, issued to Jeffrey J.
Sandhaus, on November 26, 1991, demonstrates a
complicated apparatus intended to be used in
procedures for implanting locking clips for clamping
and occluding tubular vessels, such as the vas
deferens during a vasectomy. In addition to the
ancillary concerns about cost, ease of construction
and maintenance, this device has several practical
shortcomings in regard to use and teaching in relation
to vasectomy forceps and vasectomy procedures. One
problem is that it relies on clamping of the vas
deferens, rather than cutting it; consequently, the
desired sterilization cannot be completely ensured by
the use of this device. Another problem is that its
complicated operation requires special training for
use, and requires additional pre-surgical preparation
time. Whereas the device includes a curved clamping
hole appropriate for immovably holding a tublar vessel
with the tips contacting one another, the clamping
hole is relatively far removed (in comparison with
applicant's own invention) from the end of the
apparatus, as shown in Fig. 45 of the Sandhaus patent.
Use of such a device in a vasectomy or vagus lifting
procedure would cause tissue damage while the device
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is passed sufficiently far into the wound site for the
clamping hole to engage the vas deferens or vagus;
cause tissue damage when the device is closed and
clamped around the vagus nerve; and, make the
procedure's lifting of the vagus impossible without
substantial destruction of surrounding tissue, because
of additional tissue caught in the large extension of
the forceps' tips beyond the clamping hole. The
Sandaus forceps also fails to provide a beveled rim
around the edge of the hole nearer its grasping end to
provide effective grasping during lifting or rotation
of a tubular tissue to prevent lateral slippage of the
instrument along the tubular tissue.
British Patent No. 2,227,200, issued to Malcolm
Charles Holbrook, on July 25, 1990, discloses a
forceps used for holding a catheter or organ duct
during the course of a surgical procedure. This
forceps has a three-millimeter clamping hole centered
five millimeters from the end of the forceps, a
relatively large distance (many times as large as the
applicant's own invention) that makes the device
unusable for the vagus retracting procedure. This
forceps was designed for its invisibility to X-rays
used during a surgical procedure, and not for use in
vagus retractions.
The Holbrook forceps also lacks a beveled rim around
the edge of the hole nearer its grasping end to
provide effective gripping a vagus nerve. The large
end design of the Holbrook patent has a clasping,
rather than grasping function, and is unsuitable for
use with nerve tissue due to the risk of crushing.
Other inventions have similar disadvantages. UK
Patent Application No. 2 210 574 to James Richard
Smith describes a forceps with triangular head,
including a bridge defining an aperture for gripping
a suture needle. None of the devices shown therein
can grasp a vagus nerve without clamping down upon it,
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causing crushing. This disadvantage is likewise true
of the surgical forceps with notches for accommodating
suture needles as shown in U.S. Pat. No. 4,226,241
issued October 7, 1980 to William E. Walker, Jr. USSR
Patent No. 145,976 shows a pair of forceps, having
serated teeth provided along a substantial portion of
the tip before an aperture is provided. Like the
previously mentioned devices, the serated tip
increases the risk of crushing and increased trauma
due to insertion of the tip into surrounding tissue.
USSR Patent No. 1321409 shows a pair of forceps,
having semi-circular jaws with intermittant sets of
serated teeth. USSR Patent No. 219095 shows a pair of
forceps, having open-ended tipped jaws moulded to the
same shape as a prosthesis for the long branch of the
anvil in the ear; the open-ended tips are unsuitable
for retracting a tubular tissue, allowing it to slip
from the open-ends.
Finally, European Patent Application by applicant
Fritz Lolagne published January 25, 1995, contemplates
forceps generally sized to closely conform to the
cross-sectional shape of the vas deferens and vagus
nerve, providing preferred diameters of the enclosing
aperture at the tip of the forceps to be 0.40
centimeters in length and 0.30 centimeters in width.
The application fails to disclose the crested ridge or
the hourglass profile of the present invention.
None of the above inventions and patents, taken
either singularly or in combination, is seen to
describe the instant invention as claimed. Thus, a
forceps solving the aforementioned problems is
desired.
SUl!~ARY OF THE INVENTION
The forceps of the present invention includes a
first embodiment and modified second embodiment to
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resolve the problems inherent in the prior art. Each
embodiment includes a small end structure, comprising
an oval-shaped, closed loop, the second embodiment
further having an hourglass shape when viewed in
profile. The closed loop of both is defined by the
ends of beveled grasping tips attached to a pair of
jaws of locking forceps in a closed position, a series
of mating serrations on the jaws ending proximate the
loop.
In the first embodiment, the preferred aperture
opening is defined by the loop having a 2.5 mm
transverse inner diameter and 4 mm longitudinal inner
diameter. The shape and size of this closed loop
permits the surgeon to firmly grasp the vas deferens
and surrounding sheath, to elevate it up and out of
the incision, and to rotate it all in one movement,
thus exposing the surrounding sheath in order to
facilitate its dissection. Once the duct is thus
exposed by the invention, it can be easily cut and
ligated. The mating serrations, which form a line
following the lengthwise extension of the instrument,
provide a continuous, firmly closed line behind the
loop. As compared to a vasectomy as performed with
the standard forceps design, the surgeon using the
present invention need not create an excessively large
scrotal incision to grasp the vas deferens, elevate it
out of the incision, and rotate it to expose the
outside sheath for dissection. Moreover, the standard
forceps cause additional tissue to be grasped and
damaged, and the vas deferens slips with such
frequency that effective cutting and ligation of the
vas deferens is difficult and time-consuming. In
contrast, the minute, beveled, curved loop of the
present invention allows for a smaller incision with
more accurate grasping, reduces slippage during this
part of the procedure, and assures that no tissue
other than the vas deferens is grasped. In fact, the
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applicant has found in his own medical practice that
the present forceps are easier, faster, safer and
generally much preferable to use in the course of
performing vasectomies, as compared to use of standard
forceps.
In the second embodiment, the loop is approximately
0.60 centimeters in longitudinal outer diameter (from
distalmost tip to first serration) and 0.40
centimeters in transverse outer diameter (from outside
surface to outside surface). The forceps also reduces
slippage of the vagus by a raised bevelled ridge on
the closed loop facing inward towards the aperture.
The oval-shaped and hourglass profiled aperture
defined by the closed loop is shaped and sized to
permit a surgeon to firmly grasp the vagus nerve, and
to elevate it up and out of the incision area, in
order to facilitate the remaining procedure. The
preferred aperture opening is defined by the loop
having a 3 mm transverse inner diameter and 4 mm
longitudinal inner diameter. The hourglass profile
allows the vagus nerve to rest in a transverse groove
of the tip, defining the constriction found in the
hourglass profile. The mating serrations, which form
a line following the lengthwise extension of the
instrument, provide a continuous, firmly closed line
behind the loop and define the longitudinal axis of
the forceps. The arms of the forceps are
approximately 11 centimeters long, thereby providing
additional reach necessary in surgical interventions
in the lower esophagus and stomach where the vagus
resides.
Thus, the present invention provides numerous
advantages over the standard forceps design used in
conducting vasectomies and vagus nerve retractions,
including but not limited to:
(1) reducing the risk of slippage of the vas
deferens or vagus nerve due to the oval-shaped
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grasping opening, thereby reducing the time needed to
conduct the procedure so the operation can be
accomplished more safely and with less discomfort to
the patient;
(2) a smaller incision than that necessary with the
standard forceps due to a decreased tip size, thereby
reducing risk of infection or hemorrhage following a
vasectomy or vagus resection procedure, respectively,
and providing an added cosmetic benefit to the patient
in the case of a vasectomy; and,
(3) specifically with regard to the second
embodiment, minimizing the risk of pinching the vagus
nerve due to the properly dimensioned opening and the
hourglass profile, which allows the nerve to lie
across the jaws on a more gentle arc.
Specifically with regard to the first embodiment, a
vasectomy can be accomplished using the first
embodiment in approximately six to eight minutes, as
compared with more than fifteen to twenty minutes
using the standard forceps design. This reduction is
achieved without changing the technique used for the
procedure. Since most vasectomies are performed using
local anesthesia, a reduction in the time necessary to
conduct the procedure means the operation can be
accomplished more safely and with less discomfort to
the patient.
Accordingly, it is a principal object of the
invention to reduce the risk of slippage of the vagus
during retraction and vas deferens during vasectomies
by providing an oval-shaped grasping aperture sized to
the diameter of the vagus nerve and vas deferens,
which allows a user to grasp and lift the vagus nerve
or vas deferens more easily and securely than does the
standard design.
It is another object of the invention to reduce the
time needed to conduct a procedure by reducing the
lost time due to slippage of a tubular or stranded
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tissue during a procedure, as compared to using the
standard forceps design, by providing a surgical clamp
having a closed ended loop.
It is a further object of the invention to reduce
damage to surrounding tissue by having a very short
tip which encloses the tubular or stranded tissue
without unduly grasping or otherwise disturbing
surrounding connective and other tissue.
Still another object of the invention is to provide
a tip which allows the vagus nerve to rest in a groove
during lifting of the vagus nerve.
An additional object ~f the invention is to provide
a forceps suited for excellent characteristics for use
in operations involving the vagus nerve by virtue of
added length to the forceps handle.
A still further object of the invention to provide
a forceps having a grasping opening, as opposed to a
clamping opening, of a size and shape which prevents
crushing of the vagus nerve during interventions in
the lower esophagus or stomach.
Still another object of the invention is to allow
for a smaller incision to be made during a vasectomy
procedure than that necessary with standard forceps by
providing a smaller end structure, thereby leading to
reduced risk of infection following the procedure and
producing less cosmetic damage.
It is an object of the invention to provide improved
elements and arrangements thereof in an apparatus for
the purposes described which is inexpensive,
dependable and fully effective in accomplishing its
intended purposes.
These and other objects of the present invention
will become readily apparent upon further review of
the following specification and drawings.
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BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is an enviromental, perspective view of the
invention showing the forceps of the first
embodiment.
Fig. 2 is a plan view of the first embodiment of the
forceps of the present invention, in a closed
position, featuring the oval-shaped opening of the
grasping tip and showing a bevelled ridge as a greatly
enlarged feature for clarity of illustration.
Fig. 3 is a plan view of the first embodiment of the
forceps of the present invention, in a pre-grasping or
open position.
Fig. 4 is an enlarged, close-up view of the grasping
tips of the first embodiment, depicting the thin,
pincer-like grasping tips and the beveled bottom
portion of the clamping loop.
Fig. 5 is a cross-sectional view of the grasping end
of the first embodiment.
Fig. 6 is an environmental, perspective view of a
second embodiment of the forceps according to the
present invention.
Fig. 7A is an top plan view of the second embodiment
of the forceps in a closed state according to the
present invention.
Fig. 7B is a side view of a partial profile of the
forceps according to the second embodiment of the
present invention, featuring the hourglass profile of
the closed tip.
Fig. 8 is a top plan view of the second embodiment
of the forceps in an open state according to the
present invention.
Fig. 9 is a greatly enlarged, perspective view of a
detail of the second embodiment of the forceps
according to the present invention, featuring the open
tip.
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Fig. 10 is a side view, partially fragmented of the
second embodiment of the forceps according to the
present invention, featuring the hourglass profile of
the grasping tip.
Fig. 11 is a top cross-sectional view of the second
embodiment of the forceps according to the present
invention, environmentally representing the vagus
nerve enclosed in the grasping tips, as drawn along
line 11--11 of Fig. 7A.
Similar reference characters denote corresponding
features consistently throughout the attached
drawings.
DETATT.T~'n DESCRIPTION OF THE PREFERRED EMBODIMENT
The present invention is a surgical instrument in
two embodiments for grasping, elevating, and
retracting stranded or tubular tissue, particularly
the vas deferens and the vagus nerve.
Describing first the first embodiment, the forceps
10 includes arms 12, 14, each having handle sections
16, 18 at a first end 17. The handle sections 16, 18
have sawtooth extensions 20, 22 projecting inward from
the handle sections 16, 18. The sawtooth extensions
20, 22 engage one another when the forceps 10 is in a
closed position, as shown in Fig. 2.
The arms 12, 14 also have pivoting sections 24, 26
next to the handle sections 16, 18. Along these
pivoting sections 24, 26, the arms 12, 14 cross one
another and are connected at their crossing by a
cross-over stud 28, as shown in Fig. 1. The preferred
length between stud 28 and first end 17 is
approximately 10.5 centimeters.
The arms 12, 14 additionally have grasping sections
30, 32 at a second end 19. The length from stud 28 to
second end 19 is approximately 3 centimeters. The
grasping sections 30, 32 comprise grasping tips 34, 36
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which define and semi-enclose open, grasping regions
38, 40. As may be seen, from Fig. 3 particularly, the
juxtaposition of such grasping regions 38, 40 upon
placement of the forceps 10 in a closed orientation,
forms an oval opening 42, somewhat elongated along an
axis parallel to a long axis of the forceps. Sample
dimensions for the opening are 0.25 centimeters in
width and 0.40 centimeters in length. The grasping
sections 30, 32 also have mating serrations 44, 46,
which lie farther from the second end than the
grasping tips 34, 36 and grasping regions 38, 40, and
immediately adjacent to said tips 34, 36 and said
regions 38, 40.
The grasping tips 34, 36 have a v-shape formed by
inverted v-shaped beveled surfaces extending away from
arms 12, 14 into oval opening 42. The v-shaped
surfaces or ridges 44a, 46a (best viewed in Fig. 4)
are disposed circumferentially around inner edges or
facing surfaces of the grasping tips 34, 36. The v-
shaped surfaces 44a, 46a may extend along the entire
facing surfaces of grasping tips 34, 36 or may extend
only partially along the facing surfaces, preferably
along the lower half of the facing surfaces closer to
the first end 17. The v-shaped ridges project at a
greater height at an end of the grasping tips 34, 36
farther from the second end 19 than at an end of the
grasping tips 34, 36 nearer to the second end 19. The
v-shaped ridges 44a, 46a culminate in crest tips. The
crest tips may be sharp or may be rounded, preferably
with a radius of curvature of about 500 micrometers.
The v-shaped surfaces faciliate the grasping function
of the forceps 10 by slightly circumferentially
depressing the vas deferens and preventing lateral
sliding of the forceps.
In use of the forceps during a vasectomy procedure,
a user first creates an incision 48 in the scrotum 50.
Because of the compact and efficient shape of the
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present forceps 10, such an incision 48 can be smaller
than an incision (not shown) provided using forceps of
the prior art (not shown). More specifically, the
grasping tips 34, 36 are extraordinarily narrow, as
viewed from any perspective, Figs. 1 and 5.
Additionally, the grasping regions 38, 40 are
positioned at a most extreme portion of the second end
19, so that there is essentially no distance between
the grasping regions 38, 40 and the most extreme
portion of the second end 19, as shown in Fig. 3. As
will be appreciated, limitations on the character of
submitted drawings make it necessary to depict even
very thin objects with with some distance between
edges; however, it must be understood that the
locations of the grasping regions 38, 40 are as close
to the most extreme portion of the second end 19 as is
physically and practically possible. This positioning
of the grasping regions 38, 40 comprises a crux of the
innovation of this invention, insofar as this
positioning enables the user to grasp tubular tissue
such as the vas deferens 52 without contacting or
grasping tissue beyond the location of the tubular
tissue sought to be grasped, and without making a
large incision.
With more particularity, the dimensions of the
generally oval shaped opening 42 are about 0.40
centimeters in length and 0.25 centimeters in width,
and the distance between the most extreme portion of
the second end 19 of arms 12, 14, and the end of the
opening nearest said tip is less than 1 millimeter.
These dimensions are depicted approximately in Figs.
2 and 3, within the constraints of limitations on
submitted drawings. It may be seen particularly from
Fig. 3, that the small overall grasping sections' 30,
32 size, the closed loop 42, and the proximity of this
loop 42 to the distal extremity of the forcep arms 12,
14 that enables the use and advantages of the present
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forceps 10. Moreover, the small size and extreme
location of the grasping sections 30, 32 and the
closed loop 42, as well as the proximity of this end
loop to the distal extremity of the forcep arms 12,
14, enable the user to efficiently tip up or rotate
the vas deferens 52 to be out of the incision 48
during a vasectomy so that its covering sheath (not
shown) can be dissected. The overall procedure, as
previously described herein, is thereby enabled with
a greatly shortened time for the surgery, and with
more precision in lifting, rotating and initially
locating the vas deferens. In other words, the shape
and size of the grasping sections 30, 32 permit the
user to firmly grasp the vas deferens 52, to lift it
up and out of the incision 48, and to rotate it all in
one motion, thus exposing the surrounding sheath for
dissection. Once the duct 52 is exposed, it can be
easily cut and ligated. Significantly, the risk of
slippage of the vas deferens 52, when it is rotated
during the vasectomy procedure, is greatly reduced.
The mating serrations, forming a line matching the
lengthwise extension of the instrument, closes firmly
behind the opening 10a, 12a.
A method of use of the apparatus 10 would include
the steps of: lowering grasping sections 22 of arms
12, 14 of a forceps instrument 10 according to the
invention into the incision 48; causing grasping
regions 38, 40 located at an extreme end of the
forceps 10 to surround and encompass the vas deferens
52; closing the instrument 10, with serrations 44, 46
in mating position and engaging sawtooth projections
together so the device 10 is locked closed, as shown
in Fig. 2; lifting the vas deferens 52 out of the
incision 48; and rotating it to facilitate dissection
of the surrounding sheath (not depicted).
Subsequently, the vas deferens is severed and
resulting cut ends (not shown) are ligated closed.
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Alternately, the ligations (not shown) may be placed
first, and the vas deferens 52 cut between the
ligations. The forceps 10 is released, and standard
surgical procedures follow.
Turning now to the description of the second
embodiment and referring to Figures 6-11, forceps 110
includes structural elements common to both
embodiments, namely arms 112, 114, each having handle
sections 116, 118 at a first end 117. The handle
sections 116, 118 have sawtooth extensions 120, 122
projecting inward from the handle sections 116, 118.
The sawtooth extensions 120, 122 engage one another
when the forceps 110 is in a closed position, as shown
in Fig. 7A.
The arms 112, 114 also have pivoting sections 124,
126 next to the handle sections 116, 118. Along these
pivoting sections 124, 126j the arms 112, 114 cross
one another and are connected at their crossing by a
cross-over stud 128, as shown in Fig. 6. The
preferred length between stud 128 and first end 117 is
approximately 14.5 centimeters. The length from stud
128 to a second end 119 is approximately 8
centimeters. The arms 112,114 of the forceps 110
approximate eleven centimeters from stud 128. An
overall length of the forceps 110 of approximately
22.5 centimeters is thereby attained, providing
additional reach necessary in surgical interventions
in the lower esophagus and stomach where the vagus is
present.
The arms 112, 114 additionally have grasping
sections 130, 132 at a second end 119. These grasping
sections 130, 132 comprise grasping tips 134, 136
which define and semi-enclose open, grasping regions
138, 140. As may be seen, from Fig. 7A particularly,
the juxtaposition of such grasping regions 138j 140
upon placement of the forceps 110 in a closed
orientation, forms a substantially oval opening 142,
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19
somewhat elongated along an axis parallel to a long
axis of the forceps. Sample dimensions for the
opening are 0.3 centimeters in width and 0.4
centimeters in length (or 3 mm transverse inner
diameter and 4 mm longitudinal inner diameter).
In profile, grasping tips 134,136 are both formed as
identical hourglass configurations, which provide
opposing, transverse grooves 137,139, as most clearly
seen in Fig 7B. As shown in Fig. 6, the hourglass
profile allows the vagus nerve V to rest in a
transverse groove 137 of a grasping tip 134, providing
a seat mimimizing pinching and crushing of the nerve
when stretched during retraction. As can be
appreciated from Fig. 11, the vagus nerve V is shown
closely entrapped by the grasping tips 134,136, and
grooves 137,139 of tip 136 permit a gradual bend in
the vagus nerve without pinching, unlike a cylindrical
channel formed by an edge over which the vagus nerve
could be pinched. As a further result of the
hourglass configuration, the leading edges 149,151
(Figs. 8 and 9) appear as bar-like edges, having a
nominal width and a length substantially the same as
the thickness of the instrument. The nominal width
minimizes the surface area capable of inadvertantly
grasping surrounding tissue but still allows edges
49,51 to completely enclose the vagus nerve.
The grasping sections 130, 132 also have mating
serrations 144, 146, which lie farther from the second
end than the grasping tips 134,136 and grasping
regions 138,140, and immediately adjacent to said tips
134, 136 and said regions 138, 140. These serrations
144, 146 faciliate the grasping function of the
forceps 110 by forming a line following the lengthwise
extension of the instrument as shown in Fig 6 and 7A,
to provide a continuous, firmly closed line behind the
grasping tips 134,136, which line defines in part the
longitudinal axis of the forceps 110.
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The grasping tips 134,136 also have a v-shape formed
by inverted v-shaped beveled surfaces extending away
from arms 112, 114 into oval opening 142. The v-
shaped surfaces or ridges 144a, 146a (best viewed in
Fig. 9) are disposed circumferentially around inner
edges or facing surfaces of the grasping tips 134,136.
The v-shaped surfaces 144a, 146a may extend along the
entire facing surfaces of grasping tips 134,136 or may
extend only partially along the facing surfaces,
preferably along the lower half of the facing surfaces
closer to the first end 117. The v-shaped ridges
project at a greater height at an end of the grasping
tips 134,136 farther from the second end 119 than at
an end of the grasping tips 134, 136 nearer to the
second end 119. The v-shaped ridges 144a, 146a
culminate in crest tips. The crest tips may be sharp
or may be rounded, preferably with a radius of
curvature of about 500 micrometers. Again referring
to Fig. 11, the v-shaped surfaces facilitate the
grasping function of the forceps 110 by slightly
circumferentially depressing the vagus nerve without
crushing, and thereby preventing lateral sliding of
the forceps.
Because of the compact and efficient shape of the
present forceps 110, an incision 148 of surrounding
connective tissue can be smaller than an incision (not
shown) provided using forceps of the prior art (not
shown). More specifically, the grasping tips 134,136
are extraordinarily narrow. Additionally, the
grasping regions 138, 140 are positioned at a most
extreme portion of the second end 119, so that there
is essentially no distance between the grasping
regions 138, 140 and the most extreme portion of the
second end 119, as exemplified in Fig. 9 by the narrow
width of the leading edge 49. As will be appreciated,
limitations on the character of submitted drawings
make it necessary to depict even very thin objects
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with with some distance between edges; however, it
must be understood that the locations of the grasping
regions 38, 40 are as close to the most extreme
portion of the second end 19 as is physically and
practically possible. This positioning of the
grasping regions 38, 40 comprises a crux of the
innovation of this invention, insofar as this
positioning enables the user to grasp stranded or
tubular tissue such as the vagus nerve V without
contacting or grasping tissue beyond the location of
the tubular tissue sought to be grasped, and without
making a large incision.
With more particularity, the dimensions of the
generally oval shaped opening 142 are about 0.40
centimeters in length and 0.30 centimeters in width,
and the distance between the most extreme portion of
the second end 119 of arms 112, 114, and the end of
the opening nearest the tip is less than 1 millimeter.
These dimensions are depicted approximately in Figs.
7A and 8, within the constraints of limitations on
submitted drawings. It may be seen particularly from
Fig. 7A, that the size of the elongated overall
grasping sections 130,132, the closed loop or oval
opening 142, and the proximity of this loop 142 to the
distal extremity of the forcep arms 112, 114 enables
the use and advantages of the present forceps 110 with
the procedures retracting the vagus nerve. Moreover,
the small size and extreme location of the grasping
sections 130, 132 and the closed loop 142, as well as
the proximity of this end loop to the distal extremity
of the forcep arms 112, 114, enable the user to
efficiently tip up or lift the vagus nerve V to be out
of the incision 148, i.e. retraction. The overall
procedure is thereby enabled with a greatly shortened
time for the surgery, and with more precision in
lifting and initially locating the vagus nerve. In
other words, the shape and size of the grasping
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sections 130, 132 permit the user to firmly grasp the
vagus nerve V, to lift it up and out of the incision
148, and thus expose the surrounding area for further
manipulation. Significantly, the risk of slippage of
the vagus V, when it is held by the forceps 110 is
greatly reduced. The mating serrations, forming a
line matching the lengthwise extension of the
instrument, closes firmly behind the opening.
It is to be understood that the present invention is
not limited to the embodiments described above, but
encompasses any and all embodiments within the scope
of the following claims.
