referring now to the drawings by reference character and , in particular , to fig1 - 4 thereof , a preferred embodiment of the surgical device 10 is shown , configured to apply either an elastic ring or stretchable clip onto a tubular , anatomical structure . surgical device 10 includes an inner tubular member 12 which is slidably , telescopically received within a middle , tubular member 14 which , in turn , is telescopically , slidably received within an outer , tubular member 16 . each tubular member 12 , 14 and 16 has a distal end 18 , 20 and 22 and a proximal end 24 , 26 and 28 , respectively . inner tubular member 12 has a forceps 30 of any desired construction extending from its distal end 18 . the inner tubular member 12 may be of unitary construction or may be of two - piece telescoping construction to prevent the proximal end thereof from extending out of the proximal end of the device 10 in certain application . forceps 30 are extended from and retracted into distal end 20 of middle tubular member 14 by sliding inner tubular member 12 within middle tubular member 14 . this is accomplished by moving a surrounding handle 32 which engages a peg 34 which depends from a mesial portion of inner tubular member 12 , as is best illustrated in fig4 . the term &# 34 ; forceps &# 34 ; in the present application is intended to cover any type of gripping or holding means including suction means or the like , the forceps shown in fig4 having concave portions 30a at the distal ends of the forceps members and a hole 30b in the end of the lower forceps member . the structure of handle 32 is best shown in fig6 . a slot 36 is formed at the forward end 38 of handle 32 , and peg 34 is trapped therein by a cap 40 threaded onto end 38 . referring to fig3 middle tubular member 14 has an elongated slot 42 formed in the bottom thereof and outer tubular member 16 has a similar slot 44 formed in the bottom thereof . slots 42 and 44 have , generally , the same dimensions and peg 34 extends through slots 42 , 44 as can be appreciated from fig1 . thus , movement of handle 32 back and forth effects extension and retraction of forceps 30 from distal end 30 of middle tube 14 . in order to accomplish an electrical cauterization procedure , peg 34 may also be a bipolar or unipolar electrical connector . inner tubular member 12 may include an additional electrical connector 46 which is shown at the upper right hand portion of fig1 . connector 46 may be a unipolar or bipolar electrical connector . proximal end 24 of member 12 may be threaded to receive an additional tubular segment 48 which may be provided with a stop cock 50 and a port 52 . port 52 may be connected , for example , to a pressurized supply of an inert gas such as carbon dioxide ( not shown ). obviously , the gas will pass through the tubular member 12 to the surgical field . after the gas is introduced , stop cock 50 is closed to prevent the escape of the gas . turning now to fig5 an instrument is illustrated which may be inserted through proximal end 24 of inner tubular member 12 , into the surgical field . this instrument may be in the form of an elongated needle or cannula 54 , housed within a protective shield 56 forming insulation when the needle conducts electricity or a shield when the needle is used as a laser delivery device or probe . this instrument may be provided to effect electrical cauterization . for example , end 58 of the instrument may be provided with a unipolar electrical connector 60 . this instrument might also be used for the injection of anesthesia , application of an inert gas such as carbon dioxide into the surgical field , application of laser energy to the surgical field , or for other , known purposes . with further reference to fig1 a rotatable , threaded connector member 62 is located on outer tubular member 16 between distal end 22 and the handle 32 for the purpose of releasably securing the device 10 to a laparoscope ( not shown ) or the like . referring now to fig1 right hand portion , and fig7 a handle structure is shown which is employed to eject a stretchable ligature from the distal end 20 of middle tubular member 14 . a generally u - shaped handle 64 is provided which may be in one piece or may be centrally bifurcated at 66 into a first handle member 68 and a second handle member 70 . handle members 68 and 70 may be pivotally connected at the bifurcation point 66 and a spring 72 may be provided to urge members 68 and 70 apart . with reference to fig3 proximal end 26 of middle tubular member 14 includes a depending , threaded post 74 . the upper end of handle member 68 is provided with an internally threaded member 76 for securing post 74 to the handle member 68 . of course , post 74 extends downwardly through the elongated slot 44 of outer tubular member 16 . the upper end of second handle member 70 includes a capture ring 78 through which proximal end 28 of outer tubular member 16 is inserted . the proximal end 28 of tubular member 16 is externally threaded at 80 to receive an internally threaded capture cap 82 . thus , as handles 68 and 70 are squeezed together , distal end 22 of outer tubular member 16 moves towards and slides over the distal end 20 of middle tubular member 14 , thus to eject a stretchable ligature mounted on distal end 20 . the methodology for accomplishing this is well disclosed in my prior u . s . pat . no . 3 , 989 , 049 . this patent discloses the ejecting of one or more elastic rings , such as is shown at 84 in fig1 . if multiple stretchable ligatures , plugs or caps are mounted on distal end 20 , a gauge 86 may be provided which controls the movement of the outer tubular member 16 to eject the ligatures one at a time and to indicate the number of ligatures being ejected . the gauge may be mounted on either handle member 68 ( fig7 ) or handle member 70 ( fig1 ). the gauge may be pivotally mounted as is shown at 87 so that it may be swung out of the way if it is not to be used and may be used as a locking or control device for various occluding ligatures or devices . for further security of structure , proximal end 26 of middle tubular member 14 may be provided with a second , upstanding vertical post 88 having a head 90 . proximal end 28 of outer tubular member 16 would be provided with an upper , elongate slot 92 within which post 88 rides as outer tubular member 16 is moved axially relative to middle tubular member 14 , to eject a stretchable ligature in the manner just described . with reference to fig8 a and 8b , a forceps structure is shown for taking a biopsy . an interchangeable inner tubular member 12 is provided with forceps 94 having cooperating , biopsy box members 96 and 98 . retraction of forceps 94 in the manner described above causes the forceps to close and grasp tissue at the ends while the biopsy box members 96 and 98 cut and enclose a piece of tissue . with reference to fig9 the instrument 10 of fig1 is shown in combination with a laparoscope 100 . outer tubular member 16 is received with main body 102 of laparoscope 100 . a light source is provided at 104 . laparoscope 100 includes an offset portion 104 having an eyepiece 106 . conveniently , offset portion 104 is connected to main body 102 by a swivel connection 108 . swivel connection 108 permits the offset portion 104 to be moved to a more comfortable position for the surgeon . more specifically , the surgeon need not stand directly behind the laparoscope but may more comfortably , view the surgical field from the side of the instrument . fig1 illustrates another forceps instrument for taking a biopsy including cooperating cutting members 110 and 112 disposed on opposite sides of instruments 54 . the cutting portions 110 and 112 of the forceps members are concave to cut and capture tissue therebetween , and pointed portions extend distally from the cutting portions for use in grasping the tissue prior to cutting for biopsy purposes . as briefly discussed above and disclosed in extended detail in , for example , my prior u . s . pat . nos . 3 , 911 , 923 and 3 , 989 , 049 , one method of applying a stretchable ligature to an anatomical tubular structure includes extending forceps 30 about the tube , withdrawing forceps 30 into proximal end 20 of middle tubular member 14 so as to crimp the tube and form a loop therein ( e . g ., as shown here in fig2 and 23 ) and then moving outer tubular member over middle tubular member 14 to eject a stretchable ligature ( such as elastic member 84 ) onto and over the looped , anatomical tubular structure . when the distal end 20 of middle tubular member 14 is completely closed , difficulty has been found in withdrawing an adequate amount of anatomical tubular structure into the device so as to assure effective occlusion of tissue upon placement of the stretchable ligature therearound . with reference to fig1 , a distal end 20 of middle tubular member 14 is illustrated having a tissue receiving slot 114 formed therein . excess tissue may be located within the slot during the procedure so that an adequate amount of tubular structure is withdrawn into the middle tubular member 14 . also , the slot 114 allows the middle tubular member to expand somewhat to facilitate the entry of the tubular structure therein . as shown in fig1 , a pair of tissue receiving slots 114 , 116 are provided which have generally similar dimensions . this structure permits application of a stretchable ligature laterally across an anatomical tubular structure and thus eliminates the need for forming a loop in the tube being ligated . depending on the type of ligating device and the distal configuration of the forceps being utilized , the tissue may or may not be moved into the slots of the middle tubular member . for example , where forceps with kissing ends are used with a ligating device as shown in fig1 a , the tissue is moved to the distal end of the middle tubular member and the ligature is applied thereto without entry of the tissue into the slots . when forceps with overlapping ends are used with a stretchable ring device , the tissue may be moved into the slots before the ring is applied thereto . the slots 114 and 116 also provide increased space to accommodate tissue to be engaged , such as tubes to be ligated which have a size so as not to be easily received in middle member 14 when forceps 30 draw the tube into the middle member to form a loop in the tube . that is , in a manner similar to that described above with respect to the single slot embodiment of fig1 , slots 114 and 116 accommodate excess tissue to permit positioning of the tissue at the distal end of member 14 and also allow the distal end of the middle member to expand to accommodate a greater tissue volume . to this end , opposed slots 114 and 116 are disposed between the opposed members of forceps 30 , as shown in fig1 ; and , preferably , a plane passing centrally through slots 114 and 116 is substantially transverse to a plane passing centrally through the opposed forceps members . accordingly , the slots are disposed in the distal end of the middle member at positions not angularly aligned with the forceps members ; and , preferably , the slots 114 and 116 are aligned with the plane of the loop of a tube to be ligated such that the slots provide maximum accommodation for excess tube tissue . a first embodiment of a stretchable ligature of this invention is illustrated in fig1 a . this ligature includes a one - piece clip 118 , formed of any non - tissue reactive , medical grade material that is suitable for implantation in the human body , having base portions 120 , 122 and pairs of cooperating legs 124 , 126 . at least the base portions 120 , 122 are made of a material having a sufficient elastic memory to force the pairs of legs 124 , 126 , with or without engaging teeth , closed after placement of the clip 118 over an anatomical tubular structure . clip 118 is opened and forced over distal end 20 of middle tubular member 14 in a manner to be described below . this is shown in fig1 . forceps 30 are then manipulated to grasp an anatomical tube and pull the same within the slots 114 , 116 . outer tubular member 16 is then pushed over tubular member 14 to eject both clip 118 and the anatomical tubular tissue from the instrument . when ejected , the legs 124 , 126 grasp and occlude the anatomical tubular structure under the urging of the base 120 , 122 . the result is illustrated in fig1 b . when conducting a sterilization procedure and in order to assure a permanent sterilization , the section of tubular tissue between the legs 124 , 126 may be severed and removed . this is illustrated in fig1 . after placement of clip 118 as described above , inner tubular member 12 may be replaced with another instrument having spring - loaded blades 128 , 130 at the proximal end 18 of the member 12 similar to the structure shown in fig1 . the blades are brought together by retracting the member 12 within the intermediate tubular member 14 , thus to sever a section 132 from the anatomical tubular structure , it being appreciated that the concave portions serve to cut and capture the tissue 132 while the pointed distally extending portions service to hold the tissue . thereafter , an instrument 54 ( fig5 ) can be inserted within the inner tubular member 12 , the instrument 54 being connected to a source of suction ( not shown ). instrument 54 is then extended into the surgical field and suction is applied to remove the excised piece 132 . fig1 illustrates a package 134 including a pair of clips 118 , a pair of elastic rings 119 , a loading device 136 and a pushing device 138 . in order to load a clip 118 onto distal end 20 of intermediate tubular member 14 , end 140 of loading device 136 is inserted into the distal end 20 . clip 118 is slipped onto the narrowed end 142 of loading device 136 . pushing device 138 has a central aperture 144 and spring ends 146 , 148 . pushing device 138 is inserted onto loading device 136 with end of 142 of loading device inserted through central aperture 144 of pushing device 138 . the clip is then slid up the conical - shaped loading device 136 and pushed onto distal end 20 of intermediate tubular member 14 . the result is illustrated in fig1 . similar structure for loading an elastic ligature is disclosed in my prior u . s . pat . nos . 3 , 911 , 923 and 3 , 989 , 049 . other embodiments of the ligatures of this invention are illustrated in fig1 - 20 inclusive . in fig1 a , a clip 150 is shown including an elastic memory base 152 and a clamp portion in the form of a single pair of cooperating legs 154 , 156 . an opening 158 is formed in base 152 so that the clip 150 may be inserted onto proximal end 20 of intermediate tubular member 14 in the manner just discussed . fig1 b illustrates clip 150 after installation . fig1 a shows a clip 160 having an elastic memory base 162 and opposed legs 164 , 166 . base 160 may extend the full length of legs 164 , 166 ( not shown ). clip 160 is illustrated in place , ligating an anatomical tubular structure , in fig1 b . another clip 168 is illustrated in fig2 a , including a pair of elastic memory bases 170 , 172 joined by opposed legs 174 , 176 . fig2 b shows the clip 168 ligating an anatomical tubular structure . if desired , the facing surfaces of the legs of each of the clips just discussed may be serrated as is shown at 177 in order to assure that the clip is securely locked onto the anatomical tubular structure being ligated . fig2 - 23 illustrates yet another stretchable ligature embodiment of this invention and two methods of placements of the ligature over and about an anatomical tubular structure . a clip 178 includes a pair of elastic memory bases 180 , 182 which assume a quadrilateral configuration when forced open , as shown in fig2 . bases 180 , 182 are joined by a pair of legs 184 , 186 . the facing surfaces of legs may be provided with mating engaging structures . for example , pins 188 extend inwardly from leg 186 to be received in holes 189 in leg 184 and lock the legs together to enhance locking of the clip 178 onto the tissue being occluded . as shown in fig2 , a large loop 190 is formed in the tissue being occluded and the clip 178 is applied well below the upper end of the loop 190 . in fig2 , the clip is applied over the loop 190 with only the base 180 performing the occluding function . the term &# 34 ; ligature &# 34 ; as generally used in this application is intended to cover members such as rings , clips , plugs or caps for anatomical tubular structures within the scope of the present invention . different types of forceps for mounting on the distal ends of the interchangeable inner tubular members 12 are shown in fig2 through 39 . in accordance with the principles of the present invention , these modified forceps are mounted on inner tubular members which can be readily interchanged with the tubular member 12 shown in fig4 depending on the specific surgical application for the device 10 of the present invention . as illustrative examples , the forceps of fig2 has overlapping end portions when they are closed and are suitable for use with occluding rings , while the forceps of fig2 and 27 have &# 34 ; kissing &# 34 ; or abutting end portions when closed and are suitable for use with stretchable clips . the forceps of fig2 has a stationary hook - like member and a movable member while the forceps of fig2 has a single hook - like member . the forceps of fig2 and 30 are provided with recessed or concave areas for holding a tubular structure or the like ; the forceps of fig3 has four members ; the forceps of fig3 and 35 are provided with portions for cutting and holding a biopsy specimen ; and the forceps of fig3 , 34 , 36 , 37 , 38 and 39 are provided with additional members to combine needle - holding cutting and biopsy functions along with clamping and scissor and knife cutting . referring to fig4 and 41 , the distal end of the inner tubular member 212 may be open at its end portion 213 ( fig4 ) or at a side portion 215 ( fig4 ) for the purpose of applying suction to hold and move delicate tissue to produce a suction forceps function . as shown in fig4 through 47 , the surgical device 10 of the present invention may be utilized to insert a plug or the like in the utero - tubal junction in a reversible sterilization procedure . in a preferred embodiment , the plug 220 comprises a generally cylindrical base portion 222 and a plurality of flexible and resilient fingers 224 that are tapered to a pointed end portion and are normally closed , as shown in fig4 . in accordance with the operation of the surgical device 10 hereinbefore described , the plug 220 is mounted on the end portion of the middle tubular member 14 by being pushed thereon with a pusher device 226 of any desired construction . in this manner , the fingers 224 of the plug 220 are opened such that it is slidable over the middle tubular member 14 and is frictionally retained thereon , as shown in fig4 . thereafter , the plug 220 may be inserted in the utero - tubal junction in a hysteroscopic procedure ( fig4 ) or a laparoscopic procedure ( fig4 ) by movement of the outer tubular member 16 into engagement with the base portion of the plug to push it off the middle tubular member 14 in a manner previously described herein . if desired , a needle 228 ( fig4 ) may be inserted through the middle tubular member 14 for the purpose of applying an anesthetic or the like during or before insertion of the plug 220 into the utero - tubal junction . referring to fig4 through 55 , the surgical device 10 of the present invention can also be utilized to position a cap 230 over the fimbria 232 of the fallopian tubes 234 in a reversible sterilization procedure . in a preferred embodiment , the cap 230 comprises an elongated , generally cylindrical body portion 236 with an elongated slit 238 therethrough so that the plug can be expanded for mounting on the end portion of the middle tubular member 14 in the manner shown in fig5 . the cap 230 has an enlarged head portion 240 comprising a plurality of normally closed fingers 242 that are defined by transversed slots 244 in the head portion . the plug 230 is made of any suitable flexible and resilient material , such as a suitable plastic material so that the body portion 236 and head portion 240 thereof are normally closed in the manner shown in fig4 , 49 and 51 . in operation , the body portion 236 and head portion 250 of the plugs 230 are opened in any suitable manner to an extent such that the plug can be slidably and frictionally mounted on the distal end of the middle tubular member 14 of the surgical device 10 in the manner shown in fig5 . through the use of suitable forceps 250 on the distal end of the inner tubular member 12 , the tube 234 is grasped and then the plug 230 is positioned over the fimbria thereof , as shown in fig5 , by moving the outer cylinder 16 of the surgical device 10 into engagement with the head portion 240 of the plug 230 and pushing it off the middle tubular portion 14 in the manner previously described herein . it will be understood that the edges of the elongated slit 238 in the body portion 236 of the plug 230 may be serrated or otherwise constructed to increase the gripping power of the plug when it is positioned over the tube 234 by the surgical device 10 . the invention may be embodied in other specific forms without departing from the spirit or essential characteristics thereof . the present embodiments are therefore to be considered in all respects as illustrative and not restrictive , the scope of the invention being indicated by the appended claims rather than by the foregoing description and all changes which come from within the meaning and range of equivalency of the claims are therefore intended to be embraced therein .
a multi - functional surgical device useful , for example , for male and female sterilization procedures . the device can be used for applying an elastic occluding ring onto an anatomical tubular structure , for cutting and cauterizing the cut ends of such a structure , for introducing a gas and / or anesthesia into the surgical field , for a biopsy procedure , for illuminating and viewing the surgical field , for applying a conventional clip to an anatomical tubular structure , and / or for applying a flexible and resilient ligature . an applicator device for applying a flexible and resilient ligature , plug or cap onto an anatomical tubular structure including tissue grasping forceps moved into and out of the distal end of a tubular member which has one or two anatomical tubular structure receiving slots . a flexible and resilient ligature , plug or cap having legs and a base having sufficient elastic memory to close the legs and occlude an anatomical tubular structure .