Abstract: An endoscopic biopsy forceps has a detachable proximal handle portion and a distal portion which includes a pair of jaws mounted at the distal end of a flexible conduit. At least one pull wire extends through the conduit and is coupled to the jaws so that movement of the pull wire(s) through the conduit causes the jaws to open and close. The proximal end of the pull wire(s) is provided with a mating tip and the proximal end of the conduit is provided with a mating sleeve. The handle portion includes a shaft and a spool. The conduit is detachably attached to the shaft, while the pull wire(s) is detachably attached to the spool. Attachment is effected by spring biased coupling devices which engage the mating tip of the pull wire(s) and the mating sleeve of the conduit.

Abstract: An apparatus for counting the number of times a temperature cycle occurs includes an indicator having sequential indicia and a temperature responsive member for indicating a next one of the indicia. Mechanical, fluid mechanical and electronic versions of the invention are disclosed. In the mechanical version, the indicator can be a ratchet member having teeth, a pawl and a display surface containing indicia. A temperature responsive element such as a bimetallic member engages the teeth of the ratchet and advances the ratchet each time the apparatus is subjected to a preset temperature cycle. A housing with a window masks the display to indicate one of the indicia as advanced by the temperature responsive element. Preferred embodiments of the mechanical version include a ring-like ratchet member with interior teeth and an exterior display surface.

Abstract: A Jacobs type curved clamping or dissector element for a disposable laparoscopic instrument is provided. The Jacobs' type end effectors generally comprises first and second pivotally mounted elongate, opposed clamp members each of which has a straight base portion, an intermediate portion extending away from the axis of the base portion and a curved distal portion which angles 70 to 90 degrees relative to the intermediate portion and which extends back toward and slightly beyond the longitudinal projection of the base portion. The clamp members note when pivotally rotated to a closed-clamp position.

Abstract: An endoscopic electrosurgical suction-irrigation instrument with insertable probes and attachments is disclosed. The instrument has a fluid chamber sealed at its proximal end with a slit valve for receiving the probes and connected at its distal end to a cannula through which the inserted probes extend. The fluid chamber is selectively provided with suction and/or irrigation and includes an electrical contact for supplying voltage to an inserted electrosurgical probe. Depending on the probe configuration suction and/or irrigation is provided in an annular space between the probe and the cannula or through the probe. Valves, connectors and switches for use with the instrument are also disclosed.

Abstract: An endoscopic instrument with suction/irrigation end effectors includes a tube, a push rod which extends through the tube, an actuator engaging the tube and the push rod, and end effectors coupled to the tube and push rod, where the end effectors include or define a bore which acts as a lumen for suction/irrigation. A fluid conduit in the tube communicates with the bore in the end effectors and is coupled to a suction or irrigation source. In one embodiment, a pair of end effectors are each coupled to a separate irrigation/suction conduit which is fed through the tube. The proximal ends of the conduits are coupled to one or separate fluid couplings at the proximal end of the instrument for connection with suction/irrigation sources. In another embodiment, a stationary end effector is provided with a fluid bore which is coupled to a fluid conduit integral with the tube.

Abstract: A non-metallic end effector for use in an endoscopic surgical tool includes a metallic core for strength and for providing a selected electrode surface on the end effector. Selectively conductive end effectors are manufactured by insert molding a plastic or ceramic or other non-conductive body around a metallic or otherwise conductive core. The conductive core is exposed on a selected portion of the working surface of the end effector and extends through the non-conductive body of the end effector for coupling to an electrical source. Selectively conductive end effectors of this type can also be manufactured by coating a cast end effector member with a non-conductive polymer or by metallically plating a non-conductive ceramic end effector member. By extending the conductive core of a selectively conductive end effector member to the pivot hole of the member, electrical coupling can be made through the clevis and tube of an endoscopic instrument.

Abstract: A pericardial endoscopic scissors is provided and generally comprises a hollow tube with a clevis coupled thereto, first and second scissor blades laterally offset from each other and both having elongate straight blade edges angled at about 45 degrees relative to the hollow tube, with the first scissor blade pivotally engaging the clevis so that its blade can angle about 90 degrees relative to the hollow tube in an open position, a rod extending through the hollow tube and coupled to the pivoting first scissor blade, and an actuator engaging the rod and imparting reciprocal motion thereto, which reciprocal motion is translated to pivotal motion of the first scissor blade. The fixed second scissor blade is provided at its distal end with an integral probe element which is laterally offset relative to and indented from the straight blade edge.

Abstract: An endoscopic bipolar electrocautery instrument includes a proximal actuator coupled by a tube and push rod to a pair of distal graspers. The tube is covered with an insulating shrink wrap from its distal end up to an uncovered proximal portion. A stationary jaw with an integral clevis is mounted inside the distal end of the tube and electrically contacts the inner surface thereof. The clevis holds a pair of ceramic insulators between which a movable jaw is mounted on an insulated bushing with an axle pin. The movable jaw is electrically and mechanically coupled to the push rod which is covered with an insulating shrink wrap from a point just proximal of its connection with the movable jaw to a point near its proximal end. The uninsulated proximal end of the tube is mounted in a conductive bushing which rotates within a nonconductive handle. The proximal end of the push rod extends beyond the conductive bushing and a rubber insulator is fitted between the bushing and the push rod.

Abstract: An endoscopic scissors includes a clevis having a relatively large diameter bore in its first arm and relatively smaller diameter bore in its second arm. A pair of scissor elements having mounting/pivot holes are mounted between the clevis arms. Either the small diameter bore in the second clevis arm or the mounting/pivot hole in the scissor element closest to the second clevis arm is threaded. A stepped diameter axle pin having a threaded portion is inserted with its smaller end entering the larger diameter bore of the first clevis arm. The threaded portion of the axle pin threadably engages either the threaded bore in the second clevis arm or the threaded mounting/pivot hole of the scissor element closest to the second clevis arm. In one embodiment, the bore in the second clevis arm is not threaded and the threaded portion of the axle pin engages only the threaded threaded mounting/pivot hole of the scissor element closest to the second clevis arm.

Abstract: An apparatus for counting the number of times a medical instrument has been sterilized includes an indicator having sequential indicia and a heat responsive member for indicating a next one of the indicia. Mechanical, fluid mechanical and electronic versions of the invention are disclosed. In the mechanical version, the indicator can be a ratchet member having teeth, a pawl and a display surface containing indicia. A heat responsive element such as a bimetallic member engages the teeth of the ratchet and advances the ratchet each time the apparatus is subjected to the heat of sterilization. A housing with a window masks the display to indicate one of the indicia as advanced by the heat responsive element. Preferred embodiments of the mechanical version include a ring-like ratchet member with interior teeth and an exterior display surface. The number of teeth is preferably one or more less than the number of indicia so that upon advancing the ratchet member to the last indicia, it can be advanced no further.

Abstract: An actuator for a laparoscopic surgical instrument imparts reciprocal motion to a push rod surrounded by a hollow tube. The actuator includes a plastic housing which fixedly engages the hollow tube, and a lever which fixedly engages the push rod and pivotally engages the housing. The housing also preferably includes an integral handle. When the handle and lever are manipulated by the user such as by pivotal movement of the lever, reciprocal motion is imparted to the push rod relative to the hollow tube. The lever also includes an external unevenly surfaced portion which when frictionally engaged by a digit of a human hand will impart pivotal motion to the lever, and hence reciprocal motion to the push rod.

Abstract: Various embodiments of flexible plastic tubing are disclosed for connection to an endoscopic instrument having suction, irrigation and electrocautery capabilities, with the electrocautery capability requiring connection to an electrical wire. Generally, the tubing is an integral, extruded flexible plastic tube having a first suction portion with a first interior cylindrical passageway, a second irrigation portion with a second interior cylindrical passageway, and a third portion with a third passageway for the electrical wire. The third portion joins the other portions. The third portion has a substantially cylindrical interior passageway with first and second flexible lips defining a peripheral opening which is narrower than the electrical wire such that the electrical wire is inserted past the lips and held in the passageway and is removable from the passageway.

Abstract: Surgical instruments for insertion through trocar tubes are disclosed. The instruments broadly include: a hollow tube; a clevis which is formed separately from the tube with the distal end of the hollow tube crimped around the proximal end of the clevis, and with the clevis including a pivot pin; at least one end effector element having a pivot hole through which the pivot pin of the clevis is pivotally engaged, and another through-hole; a push rod extending at least partially through the hollow tube and mechanically coupled to the end effector element; and a plastic actuator engaging the proximal end of the push rod and for imparting reciprocal motion to the push rod relative to the tube, where the reciprocal motion is translated at the clevis into pivotal motion of the end effector element. Preferably, staple-like connectors are used to mechanically couple the end effector element to the push rod, especially for double acting instruments.

Abstract: An endoscopic surgical scissors instrument is provided with end effectors having arcuate cammed surfaces proximal their pivot points. The instrument includes a pair of scissor blades coupled to a pivot post such that at least one blade is pivotally movable with respect to the other from an open position to a closed position. The blades have inside cutting edges which engage each other in bearing contact as the blades are moved from the open to the closed position. In addition, each blade is bowed so as to effect a biasing of the cutting edges together in positions near the closed position. The arcuate cammed surface on the blades are located behind the pivot post, and the cammed surfaces push the blades apart behind the pivot post, thereby urging the cutting edges in front of the pivot post together in the open position of the blades.

Abstract: An endoscopic electrosurgical suction-irrigation instrument with insertable probes and attachments is disclosed. The instrument has a fluid chamber sealed at its proximal end with a slit valve for receiving the probes and connected at its distal end to a cannula through which the inserted probes extend. The fluid chamber is selectively provided with suction and/or irrigation and includes an electrical contact for supplying voltage to an inserted electrosurgical probe. Depending on the probe configuration suction and/or irrigation is provided in an annular space between the probe and the cannula or through the probe. Valves, connectors and switches for use with the instrument are also disclosed.

Abstract: An improved use counter for endoscopic instruments is mounted in the ferrule of the distal portion of an endoscopic instrument having separable proximal and distal portions. The counter includes a ratchet wheel having inner and outer teeth and a bimetallic coil having a fixed end and a free end. The fixed end of the bimetallic coil is attached to a hub portion of the ferrule and the free end of the bimetallic coil engages the inner teeth of the ratchet wheel. An inwardly extending tooth in the ferrule engages the outer teeth of the ratchet wheel to prevent backward movement of the ratchet wheel. The outer surface of the ratchet wheel is also provided with incremental indicia viewable through a window in the ferrule. As the bimetallic coil is heated and cooled when the instrument is sterilized, the free end of the coil engages and advances one tooth of the ratchet wheel. Movement of the free end is preferably limited by stops.

Abstract: Methods of endoscopic surgery are disclosed. The methods utilize a suction/irrigation endoscopic instrument and a second endoscopic instrument. The suction/irrigation endoscopic instrument has a cannula, a fluid chamber in communication with the cannula, and an automatic valve at the proximal end of the fluid chamber. The second endoscopic instrument has end effectors and actuating means, and the end effectors of the second endoscopic instrument is inserted through the automatic valve, through the fluid chamber, and through the cannula. The methods involve inserting the suction/irrigation instrument through a trocar tube, and then inserting the second endoscopic instrument therethrough. The automatic valve insures that there is no leakage when the second instrument is inserted. The second endoscopic instrument may rotated inside, or may be partially withdrawn into the suction/irrigation instrument.

Abstract: Medical instruments are provided having end effectors and end effector actuator apparatus which are rotatable relative to the end effectors. The instruments generally include a tube which is typically coupled to the end effectors via a clevis around which the end effectors pivot, a push rod extending through the tube and coupled to the end effectors, and an actuator apparatus engaging the tube and the push rod with the actuator apparatus including a handle which surrounds and rotatably engages the proximal end of the tube, and a lever arm which pivotally engages the handle and is coupled to the push rod such that pivotal movement of the lever arm relative to the handle effects axial movement of the push rod relative to the tube and pivotal movement of the end effectors.

Abstract: A Verres-type needle which has a sharpened outer needle and allows passage of a blunt inner needle within the outer needle. The Verress needle also contains a position indicator to indicate the position of the inner needle within the outer needle, so that the user knows whether the inner needle is in a protective or non-protective position. Further, a liquid level indicator demonstrates the path of liquid flow within the Verress-type needle. Finally, there is an acoustical enhancment mechanism, which allows the user to know whether the blunt inner needle has sprung forward within the abdominal cavity, to its most forward, protective position.