Ligating instrument with multiple loop ligature supply and methods therefor

Claim 2

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for being introduced at the operative site, a proximal end for being disposed externally of the body and a lumen between said distal and proximal ends; a ligature supply received within said lumen, said ligature supply being defined by lengths of filamentous ligature material carrying a plurality of fixed knotting elements and a plurality of movement permitting knotting elements arranged thereon in spaced, alternating sequence to define a plurality of ligature loops, each of said ligature loops being defined by a fixed knotting element, a movement permitting knotting element spaced from said fixed knotting element and segments of said lengths of ligature material extending between said fixed knotting element and said movement permitting knotting element, said fixed knotting elements being fixedly secured to said lengths of ligature material, said movement permitting knotting elements being slidably carried by said lengths of ligature material to permit the space between a fixed knotting element and a movement permitting knotting element of a ligature loop to be reduced in size to contract the ligature loop, said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and being contractible around anatomical structure to form ligatures; and an operating member carried by said instrument body and operable from said proximal end of said instrument body for contracting said ligature loops around anatomical structure to form ligatures.

Claim 3

A ligating instrument as recited in claim 1 wherein said operating member includes means for moving said lengths of ligature material proximally relative to said instrument body and relative to said movement permitting knotting element of a withdrawn ligature loop.

Claim 4

A ligating instrument as recited in claim 2 wherein said instrument body includes jaws at said distal end for maintaining said movement permitting knotting element of a withdrawn ligature loop externally of said instrument body when said lengths of ligature material are moved proximally by said operating member to contract the withdrawn ligature loop around anatomical structure to form a ligature.

Claim 5

A ligating instrument as recited in claim 2 wherein said operating member includes means for moving said ligature supply distally relative to said instrument body to permit withdrawal of said ligature loops through said distal end of said instrument body.

Claim 6

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for being introduced at the operative site, a proximal end for being disposed externally of the body and a lumen between said distal and proximal ends; a plurality of preformed, variable size ligature loops of filamentous ligature material received within said lumen, said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and being reducible in size around anatomical structure to form ligatures; an operating member carried by said instrument body and operable from said proximal end of said instrument body for reducing the size of said ligature loops around anatomical structure to form ligatures, said operating member including means for moving said ligature material proximally relative to said instrument body; jaws at said distal end of said instrument body for maintaining said ligature loops externally of said instrument body when said ligature material is moved proximally by said operating member to reduce the size of said ligature loops around anatomical structure to form ligatures; and a cutter carried by said instrument body for cutting said ligature material proximally of ligatures formed with said ligature loops.

Claim 7

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for being introduced at the operative site, a proximal end for being disposed externally of the body and a lumen between said distal and proximal ends; a plurality of preformed, variable size ligature loops of filamentous ligature material received within said lumen, said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and being reducible in size around anatomical structure to form ligatures; an operating member carried by said instrument body and operable from said proximal end of said instrument body for reducing the size of said ligature loops around anatomical structure to form ligatures, said operating member including means for moving said ligature material proximally relative to said instrument body; jaws at said distal end of said instrument body for maintaining said ligature loops externally of said instrument body when said ligature material is moved proximally by said operating member to reduce the size of said ligature loops around anatomical structure to form ligatures; and a cutter carried by said instrument body for cutting said ligature material proximally of ligatures formed with said ligature loops.

Claim 8

A ligating instrument as recited in claim 5 wherein said cutter is disposed within said lumen.

Claim 9

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for being introduced at the operative site, a proximal end for being disposed externally of the body and a lumen between said distal and proximal ends; a plurality of preformed, variable size ligature loops of filamentous ligature material received within said lumen, said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and being reducible in size around anatomical structure to form ligatures; and an operating member carried by said instrument body and operable from said proximal end of said instrument body for reducing the size of said ligature loops around anatomical structure to form ligatures, said operating member including means for moving said ligature material proximally and distally relative to said instrument body, said operating member including a spool rotatable to wind and unwind said ligature material thereon.

Claim 10

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for being introduced at the operative site, a proximal end for being disposed externally of the body and a lumen between said distal and proximal ends; a plurality of preformed, variable size ligature loops of filamentous ligature material received within said lumen, said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and being reducible in size around anatomical structure to form ligatures; and an operating member carried by said instrument body and operable from said proximal end of said instrument body for reducing the size of said ligature loops around anatomical structure to form ligatures, said operating member including means for moving said ligature material proximally and distally relative to said instrument body, said operating member including a spool rotatable to wind and unwind said ligature material thereon.

Claim 11

A ligating instrument as recited in claim 7 and further including a handle mounting said proximal end of said instrument body and wherein said spool is mounted on said instrument body to be rotated by a hand grasping said handle.

Claim 12

A ligating instrument as recited in claim 7 and further including a rotational control mechanism for locking said spool in incremental rotational positions, said rotational control mechanism including a plurality of locking teeth carried by said spool and a pawl member carried by said instrument body for engaging said locking teeth.

Claim 13

A ligating instrument as recited in claim 9 wherein said pawl member is mounted on said instrument body in a position permitting said spool to rotate in a single direction.

Claim 14

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends; a ligature supply including a plurality of ligature loops disposed in said lumen, said ligature loops being connected to one another in series, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a fixed knotting element and a movement permitting knotting element carried by segments of filamentous ligature material, said fixed knotting element being fixedly secured to said segments and said movement permitting knotting element being slidably carried by said segments in a manner permitting movement of said segments of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure; an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said segments of said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures; and a fixating member at said distal end of said instrument body for structurally deforming said movement permitting knotting elements to fixedly secure said movement permitting knotting elements to said segments of said ligature material in a manner preventing untightening of the ligatures.

Claim 15

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends; a ligature supply including a plurality of ligature loops disposed in said lumen, said ligature loops being connected to one another in series, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a fixed knotting element and a movement permitting knotting element carried by segments of filamentous ligature material, said fixed knotting element being fixedly secured to said segments and said movement permitting knotting element being slidably carried by said segments in a manner permitting movement of said segments of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure; an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said segments of said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures; and a fixating member at said distal end of said instrument body for structurally deforming said movement permitting knotting elements to fixedly secure said movement permitting knotting elements to said segments of said ligature material in a manner preventing untightening of the ligatures.

Claim 16

A ligating instrument as recited in claim 11 wherein said movement permitting knotting elements are compressible and said fixating member includes jaws movable between open and closed positions to receive said movement permitting knotting elements between said jaws in said open position and to compress said movement permitting knotting elements between said jaws in said closed position such that said movement permitting knotting elements grip said segments of said ligature material.

Claim 17

A ligating instrument as recited in claim 12 wherein said movement permitting knotting elements are made of plastically deformable material and said jaws plastically deform said movement permitting knotting elements between said jaws in said closed position.

Claim 18

A ligating instrument as recited in claim 11 wherein said segments of said ligature material are movable by said operating member relative to said movement permitting knotting elements in a first direction to tighten said ligature loops and said movement permitting knotting elements each include structure preventing movement of said segments of said ligature material relative to said movement permitting knotting elements in a second direction, opposite said first direction, to prevent untightening of the ligatures formed with said ligature loops.

Claim 19

A ligating instrument as recited in claim 11 wherein each of said ligature loops includes two segments of said filamentous ligature material extending between a movement permitting knotting element and a fixed knotting element, said movement permitting knotting element connecting said two segments of ligature material to one another at a proximal end of said ligature loop and said fixed knotting element connecting said two segments of ligature material to one another at a distal end of said ligature loop.

Claim 20

A ligating instrument as recited in claim 11 wherein said ligature supply is removably disposed in said lumen of said instrument body.

Claim 21

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends; a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material in a manner permitting movement of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure, said movement permitting knotting elements each including opposed legs spaced from one another, said movement permitting knotting elements being compressible to move said legs toward one another; an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures; and a fixating member at said distal end of said instrument body for fixing said movement permitting knotting elements to said ligature material in a manner preventing untightening of the ligatures, said fixating member including jaws movable from an open position for receiving said movement permitting knotting elements to a closed position for compressing said movement permitting knotting elements to move said legs toward one another to grip said ligature material therebetween.

Claim 22

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends; a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material in a manner permitting movement of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure, said movement permitting knotting elements each including opposed legs spaced from one another, said movement permitting knotting elements being compressible to move said legs toward one another; an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures; and a fixating member at said distal end of said instrument body for fixing said movement permitting knotting elements to said ligature material in a manner preventing untightening of the ligatures, said fixating member including jaws movable from an open position for receiving said movement permitting knotting elements to a closed position for compressing said movement permitting knotting elements to move said legs toward one another to grip said ligature material therebetween.

Claim 23

A ligating instrument as recited in claim 17 wherein said movement permitting knotting elements are made of plastically deformable material and said jaws plastically deform said knotting elements to grip said ligature material when moved from said open position to said closed position.

Claim 24

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends; a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material, said movement permitting knotting elements each including opposed legs spring biased to be normally disposed in a closed position wherein said legs are substantially in contact with one another to grip said ligature material therebetween and prevent movement of said movement permitting knotting elements relative to said ligature material, said legs being movable away from one another against said bias to an open position permitting movement of said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure; an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements in said open position to tighten said ligature loops around anatomical structure to form ligatures; and jaws at said distal end of said instrument body movable between a jaws closed position and a jaws open position, said jaws in said jaws open position receiving said movement permitting knotting elements therebetween, said jaws in said jaws closed position engaging said legs of said movement permitting knotting elements therebetween, said jaws being movable from said jaws closed position to said jaws open position for moving said legs of said movement permitting knotting elements therebetween away from one another to permit movement of said ligature material relative to said movement permitting knotting elements between said jaws to form ligatures and being movable from said jaws open position to said jaws closed position for releasing said legs of said movement permitting knotting elements therebetween for movement to said normally closed position to grip said ligature material between said legs and prevent untightening of the ligatures.

Claim 25

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between said distal and proximal ends; a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material, said movement permitting knotting elements each including opposed legs spring biased to be normally disposed in a closed position wherein said legs are substantially in contact with one another to grip said ligature material therebetween and prevent movement of said movement permitting knotting elements relative to said ligature material, said legs being movable away from one another against said bias to an open position permitting movement of said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure; an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements in said open position to tighten said ligature loops around anatomical structure to form ligatures; and jaws at said distal end of said instrument body movable between a jaws closed position and a jaws open position, said jaws in said jaws open position receiving said movement permitting knotting elements therebetween, said jaws in said jaws closed position engaging said legs of said movement permitting knotting elements therebetween, said jaws being movable from said jaws closed position to said jaws open position for moving said legs of said movement permitting knotting elements therebetween away from one another to permit movement of said ligature material relative to said movement permitting knotting elements between said jaws to form ligatures and being movable from said jaws open position to said jaws closed position for releasing said legs of said movement permitting knotting elements therebetween for movement to said normally closed position to grip said ligature material between said legs and prevent untightening of the ligatures.

Claim 26

A ligating instrument as recited in claim 19 wherein said knotting elements are made of plastically deformable material and said jaws plastically deform said knotting elements to grip said ligature material when moved from said jaws open position to said jaws closed position.

Claim 27

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body, a lumen between said distal and proximal ends and a handle at said proximal end; a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material in a manner permitting movement of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure; an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures; a fixating member at said distal end of said instrument body for fixing said movement permitting knotting elements to said ligature material in a manner preventing untightening of the ligatures; and a cutter carried by said instrument body for cutting said ligature material proximally of a ligature formed with one of said ligature loops, said fixating member and said cutter being coupled with said handle, said handle being operable to actuate said fixating member and said cutter simultaneously to fix one of said movement permitting knotting elements and to cut said ligature material proximally of said one movement permitting knotting element simultaneously.

Claim 28

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body, a lumen between said distal and proximal ends and a handle at said proximal end; a ligature supply including a plurality of ligature loops of filamentous ligature material disposed in said lumen, each of said ligature loops being withdrawable through said distal end of said instrument body for positioning around anatomical structure and including a movement permitting knotting element carried by said ligature material in a manner permitting movement of said ligature material relative to said movement permitting knotting element to tighten the ligature loop around anatomical structure; an operating member carried by said instrument body and operable from said proximal end of said instrument body for moving said ligature material relative to said movement permitting knotting elements to tighten said ligature loops around anatomical structure to form ligatures; a fixating member at said distal end of said instrument body for fixing said movement permitting knotting elements to said ligature material in a manner preventing untightening of the ligatures; and a cutter carried by said instrument body for cutting said ligature material proximally of a ligature formed with one of said ligature loops, said fixating member and said cutter being coupled with said handle, said handle being operable to actuate said fixating member and said cutter simultaneously to fix one of said movement permitting knotting elements and to cut said ligature material proximally of said one movement permitting knotting element simultaneously.

Claim 29

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body; jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening; a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position; a plurality of preformed, contractible ligature loops of filamentous ligature material connected to one another in series and slidably disposed in said tubular member, each of said ligature loops having a knotting element of plastically deformable material attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first size opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws; and means disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being adapted to receive said knotting element of said at least one ligature loop between said jaws in said open position and to crush said knotting element of said at least one ligature loop between said jaws when said jaws are moved to said closed position to prevent expansion of the ligature.

Claim 30

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body; jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening; a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position; a plurality of preformed, contractible ligature loops of filamentous ligature material connected to one another in series and slidably disposed in said tubular member, each of said ligature loops having a knotting element of plastically deformable material attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first size opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws; and means disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being adapted to receive said knotting element of said at least one ligature loop between said jaws in said open position and to crush said knotting element of said at least one ligature loop between said jaws when said jaws are moved to said closed position to prevent expansion of the ligature.

Claim 31

A ligating instrument as recited in claim 22 wherein said jaws are biased toward said open position and further including an outer member disposed around said tubular member and coupled with said handle, said outer member being movable by said handle to constrain said jaws in said closed position and to release said jaws from constraint by said outer member for movement to said open position.

Claim 32

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body; jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening, said jaws being biased toward said open position; a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position; an outer member disposed around said tubular member and coupled with said handle, said outer member being movable by said handle to constrain said jaws in said closed position and to release said jaws from constraint by said outer member for movement to said open position, said outer member having an external surface and a scale along said external surface for taking measurements in the body; a plurality of preformed, contractible ligature loops of filamentous ligature material slidably disposed in said tubular member, each of said ligature loops having a knotting element attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first size opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws; and an operating member disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being operable by said handle to change said configuration of said knotting element of said at least one ligature loop to prevent expansion of the ligature.

Claim 33

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body; jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening, said jaws being biased toward said open position; a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position; an outer member disposed around said tubular member and coupled with said handle, said outer member being movable by said handle to constrain said jaws in said closed position and to release said jaws from constraint by said outer member for movement to said open position, said outer member having an external surface and a scale along said external surface for taking measurements in the body; a plurality of preformed, contractible ligature loops of filamentous ligature material slidably disposed in said tubular member, each of said ligature loops having a knotting element attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first size opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws; and an operating member disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being operable by said handle to change said configuration of said knotting element of said at least one ligature loop to prevent expansion of the ligature.

Claim 34

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body; jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening; a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position; a plurality of preformed, contractible ligature loops of filamentous ligature material slidably disposed in said tubular member, each of said ligature loops having a knotting element attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws; an operating member disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being operable by said handle to change said configuration of said knotting element of said at least one ligature loop to prevent expansion of the ligature; and a cutter disposed around said ligature material and having a cutting blade movable from a non-cutting position to a cutting position to cut said ligature material proximally of a ligature formed with one of said ligature loops.

Claim 35

A ligating instrument for forming ligatures in anatomical structure at an internal operative site in the body comprising an elongate tubular member having a distal end for being disposed at an internal operative site and a proximal end for being disposed externally of the body; jaws at said distal end of said tubular member for being moved from a closed position wherein said jaws define a first size opening to an open position wherein said jaws define a second, greater size opening; a handle coupled with said proximal end of said tubular member for moving said jaws between said closed position and said open position; a plurality of preformed, contractible ligature loops of filamentous ligature material slidably disposed in said tubular member, each of said ligature loops having a knotting element attached to said ligature material, said knotting elements having a configuration to prevent passage of said knotting elements through said first opening and to permit passage of said knotting elements through said second size opening, said ligature material being movable distally relative to said tubular member to permit movement of at least one of said ligature loops, including said knotting element thereof, distally through said second size opening with said jaws in said open position to deploy said at least one ligature loop externally of said jaws; an operating member disposed at said proximal end of said tubular member for moving said ligature material proximally relative to said tubular member with said jaws in said closed position to contract said at least one ligature loop around anatomical structure to form a ligature, said jaws being operable by said handle to change said configuration of said knotting element of said at least one ligature loop to prevent expansion of the ligature; and a cutter disposed around said ligature material and having a cutting blade movable from a non-cutting position to a cutting position to cut said ligature material proximally of a ligature formed with one of said ligature loops.

Claim 36

A ligating instrument as recited in claim 25 wherein said cutter has a proximal end coupled with said handle, said handle being operable to move said cutter between said non-cutting position and said cutting position.

Claim 39

A method of forming ligatures as recited in claim 27 and further including, prior to said step of withdrawing another ligature loop, fixedly securing the movement permitting knotting element of the ligature loop to the ligature material to secure the ligature.

Claim 40

A method of forming ligatures as recited in claim 28 and further including, subsequent to said step of fixedly securing, cutting the ligature material proximally of the ligature.