Laparoscopic instrument and related surgical method

Abstract

A medical instrument insertable through a cannula, the instrument comprising an elongate shaft; and an operative tip having a first jaw and a second jaw movable with respect to the first jaw. The operative tip disposed at a distal end of said elongate shaft and being disposed on said shaft for rotation relative to at least a distal end portion of said shaft about a longitudinal axis of said distal end portion.

1 . A medical instrument insertable through a cannula, said instrument comprising:
 an elongate shaft; and   an operative tip having a first jaw and a second jaw movable with respect to the first jaw, the operative tip disposed distally of a distal end of said shaft, said operative tip being disposed for rotation relative to at least a distal end portion of said shaft about a longitudinal axis of said distal end portion.   
     
     
         2 . The instrument defined in  claim 1  wherein said shaft includes a tubular sheath, further comprising a cable or rod member extending longitudinally through said sheath, said cable or rod member being operatively connected to said operative tip for moving the jaws between open and closed positions and for rotating said jaws about the axis of said distal end portion of said shaft. 
     
     
         3 . The instrument defined in  claim 2 , further comprising a handle, said tubular sheath being connected to said handle and rotatable relative to said handle about a longitudinal axis of a proximal portion of said shaft, said cable or rod member being longitudinally shiftable and rotatable relative to said sheath. 
     
     
         4 . The instrument defined in  claim 3  wherein said cable or rod member is linked to said jaws for pivoting said jaws. 
     
     
         5 . The instrument defined in  claim 3  wherein said handle includes a rotary actuator knob operatively linked to said sheath, said handle carrying a pair of annular toothed members spring loaded into toothed engagement to provide said rotary knob and said sheath with a plurality of angular rest positions. 
     
     
         6 . The instrument defined in  claim 1 , further comprising a handle, said shaft being connected to said handle, said handle including a ratchet member releasably locking said operative tip in a plurality of different operative configurations. 
     
     
         7 . The instrument defined in  claim 6  wherein said handle includes two first finger grips or handle parts pivotably coupled to one another, said ratchet member being pivotably mounted to one of said finger grips or handle parts and provided with teeth cooperating with a stop on the other of said finger grips or handle parts. 
     
     
         8 . The instrument defined in  claim 6  wherein said handle includes a trigger cooperating with said ratchet member for releasing said ratchet member from each of a plurality of locked positions each corresponding to a respective one of said operative configurations of said operative tip. 
     
     
         9 . The instrument defined in  claim 6  wherein said handle includes a movable member cooperating with said ratchet member for deactivating said ratchet member. 
     
     
         10 . The instrument defined in  claim 1  wherein said shaft includes said distal end portion and a proximal shaft portion, said distal end portion extending at an acute angle relative to said proximal shaft portion, said proximal shaft portion being rotatable relative to a handle about a longitudinal axis of said proximal shaft portion. 
     
     
         11 . The instrument defined in  claim 1 , wherein a distal portion of the shaft is angled with respect to a proximal portion of the shaft. 
     
     
         12 . A medical instrument insertable through a cannula, said instrument comprising:
 a handle;   an elongate shaft having at least two portions including a proximal shaft portion and a distal shaft portion, said proximal shaft portion being attached at a proximal end at least indirectly to said handle, said proximal shaft portion being rotatable relative to said handle about an axis of said proximal shaft portion, said distal shaft portion extending at an angle relative to an axis of said proximal shaft portion; and   an operative tip rotatable relative to the distal shaft portion about an axis of said distal shaft portion.   
     
     
         13 . The instrument defined in  claim 12  wherein said shaft includes a tubular sheath, further comprising a cable or rod member extending longitudinally through said sheath, said cable or rod member being operatively connected to said operative tip for actuating said operative tip and for rotating said operative tip about the axis of said distal shaft portion. 
     
     
         14 . The instrument defined in  claim 13  wherein said operative tip includes a first jaw and a second jaw, at least the first jaw being movable with respect to the second jaw, and said cable or rod member being linked to at least the first jaw for pivoting said first jaw. 
     
     
         15 . The instrument defined in  claim 14  wherein said first jaw and said second jaw are mounted between prongs or legs of a clevis, said clevis being rotatably attached to a distal end of said sheath. 
     
     
         16 . The instrument defined in  claim 13  wherein said handle includes a rotary actuator knob operatively linked to said sheath, said handle carrying a pair of annular toothed members spring loaded into toothed engagement to provide said rotary knob and said sheath with a plurality of angular rest positions. 
     
     
         17 . The instrument defined in  claim 14  wherein said handle includes a ratchet member releasably locking at least said first jaw in a plurality of positions. 
     
     
         18 . The instrument defined in  claim 17  wherein said handle includes two first finger grips or handle parts pivotably coupled to one another, said ratchet member being pivotably mounted to one of said finger grips or handle parts and provided with teeth cooperating with a stop on the other of said finger grips or handle parts. 
     
     
         19 . The instrument defined in  claim 17  wherein said handle includes a trigger cooperating with said ratchet member for releasing said ratchet member from each of a plurality of locked positions each corresponding to a respective one of said positions of the first jaw. 
     
     
         20 . The instrument defined in  claim 17  wherein said handle includes a movable member cooperating with said ratchet member for deactivating said ratchet member. 
     
     
         21 - 33 . (canceled)