US20090018572A1 - Device for grasping and/or severing - Google Patents

Abstract

A surgical device (101) for grasping and severing body tissue comprises a housing (140) which defines a proximal end (102) and a distal end (104), a user operating handle (160) at the proximal end (102), and two blade elements (110, 120) at the distal end (104). The user operating handle (160) may be activated to pivot the blade elements (110, 120) about two parallel grasping pivot axes to grasp a piece of body tissue which is located between the blade elements (110, 120). The user operating handle (160) may also be activated to pivot the blade elements (110, 120) about a severing pivot axis to sever a piece of body tissue which is located between the blade elements (110, 120).

Description

• This application is a divisional of application Ser. No. 10/870,943, filed on Jun. 21, 2004, which claims priority from Irish application serial no. 2003/0460 filed on Jun. 20, 2003. The entire contents of each of these applications are incorporated herein by reference.
INTRODUCTION
• This invention relates to a device for grasping and/or severing.
• During a surgical procedure when body tissue is to be removed from a body cavity, it is often required that the body tissue be securely held, so that the body tissue can be severed. It is known for a surgeon carrying out such a surgical procedure to use one instrument for grasping and securely holding the body tissue, and to use a second separate instrument to sever the body tissue. However such an approach requires a great deal of skill on the part of the surgeon to operate the two separate instruments simultaneously, often in addition to operating other instruments, such as an endoscope. Furthermore the use of two instruments generally requires a greater working space in the body cavity and a larger incision to accommodate the two different surgical instruments.
• In U.S. Pat. No. 6,391,043 a surgical device for use in grasping and severing body tissue is described.
• This invention is aimed at providing an improved device for grasping and/or severing.
STATEMENTS OF INVENTION
• According to the invention there is provided a device for grasping and/or severing, the device comprising:
• • a first operative element and a second operative element;
  • at least one of the operative elements being pivotable about a grasping pivot axis for grasping an object located between the operative elements; and
  • at least one of the operative elements being pivotable about a severing pivot axis for severing an object located between the operative elements;
  • the grasping pivot axis intersecting the severing pivot axis.
• The device of the invention provides a particularly simple mechanism to enable an object, such as a piece of body tissue, to be grasped and to be severed.
• By arranging the pivot axes such that the grasping pivot axis intersects the severing pivot axis, the overall size of the device is minimised. This space-saving aspect of the invention may be particularly important when the device is used during a surgical procedure, in which case the working space available within a body cavity to perform the grasping and severing actions may be limited.
• In one embodiment of the invention the point of intersection of the grasping pivot axis with the severing pivot axis is in the region of the proximal end of each operative element.
• In a preferred case the device comprises a housing defining a proximal end and a distal end, and the first operative element and the second operative element are provided at the distal end of the housing. Ideally the operative element is pivotable relative to the housing about the grasping pivot axis. Most preferably the operative element is pivotable relative to the housing about the severing pivot axis. The first operative element may be pivotable relative to the housing about a first grasping pivot axis, and the first operative element is pivotable relative to the housing about a first severing pivot axis. The second operative element may be pivotable relative to the housing about a second grasping pivot axis, and the second operative element is pivotable relative to the housing about a second severing pivot axis. Preferably the first grasping pivot axis is parallel to the second grasping pivot axis. Ideally the first grasping pivot axis is spaced apart from the second grasping pivot axis. Preferably the first severing pivot axis is parallel to the second severing pivot axis. Ideally the first severing pivot axis is co-axial with the second severing pivot axis.
• In another embodiment the device may comprise at least one actuating element for controlling pivoting of the operative element from a proximal end of the device. The actuating elements provide the user with a degree of control from the proximal end of the device over the grasping and severing actions of the operative elements. In this manner the device may be used to grasp and sever in a difficult-to-access location, for example in a body cavity having a narrow access opening. Preferably the actuating element is translatable to control pivoting of the operative element. The device may comprise a first actuating element connected to the operative element for controlling pivoting of the operative element relative to the housing about the grasping pivot axis. Ideally the first actuating element is connected to the first operative element for controlling pivoting of the first operative element relative to the housing about the first grasping pivot axis, and the first actuating element is connected to the second operative element for controlling pivoting of the second operative element relative to the housing about the second grasping pivot axis. The device may comprise a second actuating element connected to the operative element for controlling pivoting of the operative element relative to the housing about the severing pivot axis. Ideally the second actuating element is connected to the first operative element for controlling pivoting of the first operative element relative to the housing about the first severing pivot axis, and the second actuating element is connected to the second operative element for controlling pivoting of the second operative element relative to the housing about the second severing pivot axis. The device may comprise a third actuating element connected to the operative element for controlling pivoting of the operative element relative to the housing about the severing pivot axis. Ideally the third actuating element is connected to the first operative element for controlling pivoting of the first operative element relative to the housing about the first severing pivot axis, and the third actuating element is connected to the second operative element for controlling pivoting of the second operative element relative to the housing about the second severing pivot axis.
• In one case one of the operative element or the actuating element comprises at least one male projection configured to be received in at least one corresponding female recess in the other of the actuating element or the operative element to connect the actuating element to the operative element. Preferably the operative element comprises the at least one male projection and the actuating element comprises the at least one corresponding female recess. Ideally the male projection is rotatably received in the corresponding female recess. Most preferably pivot axis extends through the male projection. The co-operating male projection and female recess provide a means of connecting the operative element to the actuating element, and also provide a means by which the operative element may pivot relative to the housing.
• The actuating element may comprise a generally cylindrical part extending distally from a proximal end of the housing. Preferably the actuating element comprises one or more arms extending distally from a distal end of the cylindrical part to the distal end of the housing. Ideally the or each actuating element comprises two diametrically opposed arms. Most preferably the actuating element is connected to the operative element at the one or more arms. The one or more arms of the first actuating element and the one or more arms of the second actuating element and the one or more arms of the third actuating element may be configured to facilitate connection of each of the actuating elements to both the first operative element and the second operative element. Preferably the one or more arms of the actuating elements are staggered radially around the circumference of the operative elements. The arms of the cylindrical actuating elements enable all three actuating elements to be connected to both operative elements.
• In one embodiment the device comprises two or more actuating elements and the actuating elements extend co-axially. Preferably the first actuating element is located radially outwardly of the second actuating element. Preferably the second actuating element is located radially outwardly of the third actuating element.
• The or each actuating element may comprise a user control element at the proximal end of the device. Preferably the user control element comprises a handle.
• In a preferred case the housing comprises the first actuating element and the second actuating element and the third actuating element.
• The operative element may comprise a support element pivotably connected to the distal end of the housing. Preferably the support element of the first operative element contacts the support element of the second operative element. Ideally the support element of the first operative element contacts the support element of the second operative element along a plane substantially parallel to the grasping pivot axis. Most preferably the first operative element is pivotable relative to the housing about the first grasping pivot axis between a closed configuration and an open configuration for grasping an object:
• • in the closed configuration, the support element of the first operative element contacting the support element of the second operative element along a first base surface of the support element of the first operative element;
  • in the open configuration, the support element of the first operative element contacting the support element of the second operative element along a second base surface of the support element of the first operative element.
• The plane of the or each base surface may be substantially parallel to the grasping pivot axis. Preferably the angle defined between the first base surface and the second base surface is less than 180 degrees. Ideally the angle defined between the first base surface and the second base surface is greater than 90 degrees. Because the first base surface is arranged at an angle to the second base surface, this enables the support element to pivot between the closed configuration and the open configuration. The support element may comprise the first base surface, the second base surface and a curved surface. In one case the support element is substantially hemi-spherical in shape.
• The support element may comprise an apex projection projecting from an apex of the support element, a first side projection projecting from a first side of the support element, and a second side projection projecting from a second side of the support element. Preferably a first side projection and the second side projection protrude in opposite directions from an external surface of the support element.
• In a further embodiment the operative element comprises a blade element for grasping and/or severing an object. Preferably the blade element is formed integrally with the support element.
• The grasping pivot axis is preferably arranged substantially perpendicular to the severing pivot axis.
• The invention also provides in another aspect a device for grasping and/or severing, the device comprising:
• • a housing defining a proximal end and a distal end; and
  • a first operative element and a second operative element at the distal end of the housing;
  • at least one of the operative elements being pivotable relative to the housing about a grasping pivot axis for grasping an object located between the operative elements; and
  • at least one of the operative elements being pivotable relative to the housing about a severing pivot axis for severing an object located between the operative elements;
  • the housing comprising a first actuating element, a second actuating element and a third actuating element;
  • the first actuating element being connected to the operative element, the severing pivot axis being defined by the connection of the first actuating element to the operative element; and
  • the second actuating element being connected to the operative element and the third actuating element being connected to the operative element, the grasping pivot axis being defined by the connections of the second actuating element and the third actuating element to the operative element.
• The connection of the actuating element to the operative element also provides the means by which the operative element may pivot relative to the housing, and in this manner the overall size of the device is minimised.
• In one embodiment the actuating element is connected to the operative element by a pivot member. Preferably the operative element comprises a male projecting pivot member configured to be received in a corresponding female recess in the actuating element. Ideally the pivot axis extends through the pivot member.
• In a further aspect the invention provides a device for grasping and/or severing, the device comprising:
• • a housing defining a proximal end and a distal end; and
  • a first operative element and a second operative element at the distal end of the housing;
  • each operative element comprising a support block connected to the housing, and an elongate blade element extending distally from the support block;
  • at least one of the blade elements being movable relative to the housing in a grasping action to grasp an object located between the operative elements; and
  • at least one of the blade elements being movable relative to the housing in a severing action to sever an object located between the operative elements.
• The device according to the invention has been found to provide the user with enhanced control over the motion of the operative elements. In particular the positions of the operative elements may be more precisely controlled during both the severing action and the grasping action to enable the user to achieve a more effective severing or grasping.
• In one case the support block of the first operative element contacts the support block of the second operative element.
• The housing may define an inner lumen, and the two support blocks may be at least partially located within the inner lumen in a snug fit. Preferably the two support blocks together have a combined cross-sectional area substantially equal to the cross sectional area of the inner lumen.
• In one case the support block is substantially hemi-spherical in shape.
• The surgical device of the invention may be employed for grasping and/or severing an object during a surgical procedure.
• The invention provides in a further aspect a surgical device comprising a first distal blade element and a second distal blade element for severing and/or grasping, and a proximal user operating part;
• • wherein the first blade element and the second blade element are movable relative to each other in a first direction in a grasping action, and in a second direction in a severing action;
  • wherein the first blade element extends from a first support element, and the second blade element extends from a second support element; and
  • wherein the support elements are movably coupled, and axes, about which said support elements are movable, intersect substantially at a centroid of a coupling defined by the support elements.
• In yet another aspect of the invention, there is provided a surgical device comprising first and second distal operable elements and a proximal user operating part,
• • wherein the operable elements extend from first and second support elements;
  • wherein the operable elements are movable relative to each other in a plurality of directions; and
  • wherein the support elements are movably coupled, and axes, about which the support elements are movable, intersect substantially at a centroid of a coupling defined by the support elements.
• The invention also provides in another aspect a coupling comprising first and second support elements, which are movable relative to one another in a first direction in a grasping action and in a second direction in a severing action, and axes, about which the support elements are movable, intersect substantially at a centroid of the coupling.
• The coupling may be generally spherical. Preferably each support element is generally hemispherical.
• In another aspect of the invention, there is provided a method of grasping and/or severing, the method comprising the steps of:
• • providing a first operative element and a second operative element;
  • providing a first actuating element, a second actuating element and a third actuating element;
  • moving the first actuating element relative to the second actuating element and the third actuating element to pivot at least one of the operative elements to grasp an object Located between the operative elements; and
  • moving the second actuating element relative to the first actuating element in a first direction and moving the third actuating element relative to the first actuating element in a second direction opposite to the first direction to pivot at least one of the operative elements to sever an object located between the operative elements.
• Preferably moving the first actuating element relative to the second actuating element and the third actuating element pivots the first operative element and the second operative element in opposite directions to grasp an object located between the operative elements.
• Desirably moving the second actuating element relative to the first actuating element in the first direction and moving the third actuating element relative to the first actuating element in the second direction pivots the first operative element and the second operative element in opposite directions to sever an object located between the operative elements.
• The actuating element may be moved by translating the actuating element.
• The surgical method of the invention may be employed for grasping and/or severing an object during a surgical procedure.
BRIEF DESCRIPTION OF THE DRAWINGS
• The invention will be more clearly understood from the following description of some embodiments thereof, given by way of example only, with reference to the accompanying drawings, in which:—
• FIG. 1 is a side view of a proximal end of a device for grasping and/or severing according to the invention;
• FIG. 2 is a partially cross-sectional, side view of a distal end of the device ofFIG. 1 in a closed configuration;
• FIG. 3 is a partially cross-sectional, plan view from above of the distal end of the device ofFIG. 1 in the closed configuration;
• FIG. 4 is a partially cross-sectional, side view of the distal end of the device ofFIG. 1 in an open grasping configuration;
• FIG. 5 is a partially cross-sectional, plan view from above of the distal end of the device ofFIG. 1 in an open severing configuration;
• FIG. 6 is a plan view from above of an operative element of the device ofFIG. 1;
• FIG. 7 is a side view of the operative element ofFIG. 6;
• FIG. 8 is an end view of the operative element ofFIG. 6;
• FIG. 9 is a perspective view of another device for grasping and/or severing according to the invention;
• FIG. 10 is an enlarged, perspective view of a distal end of the device ofFIG. 9 in an open grasping configuration;
• FIG. 11 is a plan view from above of the distal end of the device ofFIG. 9 in the open grasping configuration;
• FIG. 12 is an enlarged, perspective view of the distal end of the device ofFIG. 9 in an open severing configuration; and
• FIG. 13 is a side view of the distal end of the device ofFIG. 9 in the open severing configuration.
DETAILED DESCRIPTION
• Referring to the drawings, in particularFIGS. 1,2 and3, thedevice1 comprises aproximal end2, anintermediate portion3, and adistal end4. Afirst blade element10 and asecond blade20 extend from the intermediate portion of thedevice1 at thedistal end4. User operating means60 are provided near theproximal end2. Theintermediate portion3 of the device comprises an actuating means and ahousing40.
• Referring toFIGS. 1,2,6,7 and8, theblade elements10,20 are elongated and comprisedistal tips32,42, cuttingedges30,40, and backs31,41 respectively. Theblade elements10,20 extend from block-shapedsupport elements11,21 respectively.
• While theblade elements10,20 and thesupport elements11,21 are substantially similar, for purposes of clarity, similar features of the elements have been indicated by different numerals respectively in the drawings and description.
• Thesupport elements11,21 are generally hemispherical in form and comprise external curved surfaces13,23 and substantially flat faces12,22 respectively. Thesupport elements11,21 are partially cut-away, with a secondplanar base portion18,28 of each face being arranged at an angle0 to a firstplanar base portion17,27 thereof (FIG. 7). The angle0 is less than 180° to enable pivoting of thesupport elements11,21 to an open grasping configuration (FIG. 4). Theplanar base portions18,28,17,27 are arranged parallel to the Z-axis.
• Thesupport elements11,21 are mounted in thedevice housing40 so that theelement21 which supports theblade element20 is inverted relative to theelement11 which supports theblade element10.
• Thesupport elements11,21 are mounted near the distal end of thehousing40 partially within thehousing40 in a snug fit. Theblade elements10,20 are formed integrally with the front curved portions of thesupport elements11,21 and extend therefrom in the distal direction. Thesupport elements11,21 which are contained within thehousing40 are distinct and independent of one another, and are not inter-linked or connected to one another. When mounted in thehousing40 they are held in proximity to each other substantially about a centroid. The coupling defined by thesupport elements11,21 is generally spherical in form (FIG. 2). The faces12,22 of the two coupledelements11,21 are aligned.
• In the closed configuration, theblade elements10,20 of thedevice1 substantially abut each other (FIG. 2). Thesupport elements11,21 are also substantially abutting with the firstplanar portions17,27 being held in contact (FIG. 2).
• As illustrated, and for the purposes of this description, the Y-axis of thedevice1 is defined as running from theproximal end2 to thedistal end4, and is the longitudinal axis of thedevice1. The X-axis is taken as running through a centroid of the coupling defined by thesupport elements11,21 at right angles to the Y-axis (FIG. 2).
• Theblade elements10,20 andsupport elements11,21 are movable about two distinct axes. Firstly, they are movable about the X-axis in the directions A, −A (FIG. 5). Secondly, since the faces12 and22 of thesupport elements11,21 are partially cut-away, thesupport elements11,21 may be tilted or rotated with respect to each other in directions B, −B about axes parallel to the Z-axis (FIG. 4). Thus thesupport elements11,21 and the attachedblade elements10,20 are movable about two different axes. The axes about which they are movable intersect substantially at a centroid of the coupledsupport elements11,21.
• The coupling defined by thesupport elements11,21 and the associatedhousing40 comprise means to facilitate controlled movement of thesupport elements11,21 relative to thehousing40. In effect, the actuating means for moving theblade elements10,20 comprises thesupport elements11,21 arranged to interact with thehousing40. Thehousing40 comprises threemovable sleeves34,35,36, which are connected to the user operating means60. Thesleeves34,35,36 act as actuating elements to enable a user to control the pivoting of theblade elements10,20 relative to thehousing40 from theproximal end2.
• Referring toFIGS. 6,7 and8, thesupport elements11,21 comprise a series of pins protruding from the curved external surfaces13,23 thereof. Thesupport element11 comprises side pins14 and15 and atop pin16 protruding from the top surface thereof. Similarly thesupport element21 comprises side pins24 and25 and atop pin26.
• Referring toFIGS. 2,3,4 and5, the pins co-operate with recesses or slots on the internal surfaces of thesleeves34,35,36. Thehousing40 comprises anouter sleeve34, anintermediate sleeve35 and aninner sleeve36. Theouter sleeve34 has a radius sufficient to accommodate theother sleeves35,36 and thesupport elements11,21. As illustrated inFIG. 2 when thedevice1 is in the closed configuration, theouter sleeve34 extends beyond the top pins16,26 and the centroid of the coupledsupport elements11,21 towards thedistal end4 of thedevice1. Thesleeves34,35,36 are substantially cylindrical in form and arranged in a co-axial manner with theintermediate sleeve35 located within theouter sleeve34, and with theinner sleeve36 located within theintermediate sleeve35.
• Referring toFIGS. 2,3,4 and5, thesleeves34,35,36 each comprise arms which extend to the protruding pins of thesupport elements11,21. With thedevice1 in the closed configuration (as illustrated inFIGS. 2 and 3) the ends of the arms of the sleeves are in alignment. In the closed configuration, thedistal end4 ofhousing40 has a cylindrical form and surrounds thesupport elements11,21. The cylindrical form is comprised of the six separate arms extending from thesleeves34,35,36. Thesleeve34 comprisesarms43,44, thesleeve35 comprisesarms45,47 and thesleeve36 comprisesarms46,48. The arms are of equal width and are curved in shape. The arms are radially staggered around the circumference of thehousing40 so that when aligned in the closed configuration together the arms form a continuation of the cylindrical form of theouter sleeve34 which extends to thesupport elements11,21. Thearms43,44 are a continuation of thesleeve34. Thearms45,47 are necessarily arranged at an angle to theintermediate sleeve35 for purposes of alignment with theouter sleeve34 and thearms43,44 of theouter sleeve43. The arms of each individual sleeve are located on opposite sides of the sleeve. Recessed slots for receiving the protruding pins are provided on the internal surfaces of the arms of the sleeves.
• Theexternal sleeve34 comprises recessedslots51,52 for receivingtop pins16,26 respectively. Similarly, theintermediate sleeve35 comprises recessed slots (not shown) for receivingpins14,24 respectively, and theinner sleeve36 comprises recessed slots (not shown) for receivingpins15,25. When thedevice1 is assembled for use thepins14,24 are on opposite sides of thedevice1 respectively as are thepins15,25.
• Thesleeves34,36 are movable in the distal and proximal directions by translation.
• User operating means60 are provided near theproximal end2 of thedevice1. The actuating means of thedevice1 comprises thesleeves34,35,36, which are moved in response to user operation of the operating means60 to affect pivoting of thesupport elements11,21.
• Movement of thesupport elements11,21 results in the movement of theintegral blade elements10,20 in a severing or a grasping action. The effect of movement of thesleeves34,35,36 is to exert forces on thesupport elements11,21 by means of the pins co-operating with the recesses on the internal surfaces of thesleeves34,35,36. Depending on the required action i.e. a severing or grasping action, the relative positions of the components of thedevice1 and their movement relative to each other is as follows:
• Device at rest: (FIGS. 2 and 3)
• Theblade elements10,20 are closed and substantially abut each other. Thefirst face portions17,27 of thesupport elements11,21 are also substantially abutting and their perimeter edges are aligned. Thesleeves34,35 and36 are in the rest configuration.
Grasping Action (FIGS. 2 and 4):
• Theouter sleeve34 is moved towards theproximal end2 of thedevice1 relative to thesleeves35,36, which remain stationary. This has the effect of exerting forces on the top pins16,26 in the proximal direction to pivot thesupport elements11,21 about grasping pivot axes which are parallel to Z-axis of thedevice1 so that theblade elements10,20 are separated in the direction B, −B. Thesupport element11 turns in the direction B pivoting about thepins14,15 and thesupport element21 turns in the direction −B pivoting about thepins24,25.
• The grasping pivot axis for thesupport element11 is provided by an axis which extends through the twopins14,15, and the grasping pivot axis for thesupport element21 is provided by an axis which extends through the twopins24,25. These two pivot axes are parallel, and are spaced-apart by the distance between the side pins14,15 of onesupport element11 and the side pins24,25 of theother support element21.
• Thedevice1 is thus opened to the open grasping configuration. Movement of thesleeve34 in the opposite direction results in theblade elements10,20 being closed in a grasping action.
Severing Action (FIGS. 3 and 5):
• Theinner sleeve36 is moved relative to theintermediate sleeve35, and theouter sleeve34 is held stationary. In the illustrated embodiment, theinner sleeve36 is moved proximally and theintermediate sleeve35 is moved distally. This has the effect of exerting a force on theside pin14 in the distal direction and a force on theside pin15 in the proximal direction to pivot thesupport element11 in the direction −A, and has the effect of exerting a force on theside pin24 in the distal direction and a force on theside pin25 in the proximal direction to pivot thesupport element21 in the direction A in the Y-Z plane of thedevice1 pivoting about the X-axis, which acts as the severing pivot axis for bothsupport elements11,21.
• Thesupport element11 turns in the direction −A pivoting about thepin16, and thesupport element21 turns in the direction A pivoting about thepin26. Thedevice1 is thus opened to the open severing configuration.
• Movement of theinner sleeve36 distally and theintermediate sleeve35 proximally results in theblades10,20 being closed in a severing configuration.
• The severing pivot axis through the X-axis is perpendicular, in this case, to the grasping pivot axes which are parallel to the Z-axis.
• Referring toFIG. 1, the user operating means60 compriseshandles61,63 and acentral support62. Thecentral support62 is attached to theintermediate sleeve35, thehandle61 is attached to theouter sleeve34 and thehandle63 is attached to theinner sleeve36. A user operates thedevice1 by means of operating the user operating means60 to cause movement of thesleeves34,35,36 as required. In the grasping action, thehandle61 is operated to move theouter sleeve34 relative to the other twosleeves35,36. In the severing action, thehandle63 and thecentral support62 are operated to move theinner sleeve36 and theintermediate sleeve35.
• While in the present embodiment a user operating means60 comprising handles is used to selectively actuate the actuating means, it will be appreciated that any other suitable arrangement may also be used.
• Referring toFIGS. 9 to 13 asurgical device101 according to an alternative embodiment of the invention comprises adistal end104, aproximal end102, and ahousing140. First andsecond blade elements110,120 extend from thehousing140 at thedistal end104 of thedevice101. User operating means160 are provided near theproximal end102. As described previously in relation to the first embodiment, theblade elements110,120 extend from a coupling defined bysupport elements111,121. Theblade elements110,120 and supportelements111,121 are movable in two directions in a grasping action and a severing action. Thehousing140 comprises anouter sleeve134 comprisingarms143,144 which extend to thesupport elements111,121. Thearms143,144 of theouter sleeve134 comprise recessed slots for receiving pins protruding from the apexes of thesupport elements111,121.
• The invention provides a surgical device with the advantage that it may be used for both grasping and severing tissue. The actuating means and support means for the blades are substantially enclosed within the body of the apparatus. The grasping and severing actions are achieved by a actuating mechanism which provides for movement about two different axes. It is not necessary to provide separate actuating means to achieve each distinct movement.
• Furthermore the severing pivot axis and the grasping pivot axis, about which each support element moves intersect each other. As a result the device is compact.
• Furthermore since the actuating means are contained substantially within or integral with the housing of the device, the device does not present any protruding parts which may move to interfere with the surgical procedure at hand.
• It will be appreciated that the form of the blade elements is not limited to those illustrated For example, curved blade elements or blade elements of any other suitable form could also be used.
• The coupling of the invention may also be used in other suitable applications, for example in gardening tools, shelving support systems and the like.
• Operable elements other than blade elements may be provided extending from the support elements. The operable elements may be corresponding elements which co-operate to perform a particular action. Operable elements for any application may be provided for example surgical devices, gardening tools, shelving support systems and the like.
• While in the present embodiment the actuating means comprises sleeves substantially of cylindrical form it will be appreciated that any other suitable means may also be used.
• The invention is not limited to the embodiments hereinbefore described, with reference to the accompanying drawings, which may be varied in construction and detail.

Claims (19)

1-64. (canceled)

65. A surgical method of grasping and/or severing body tissue, the method comprising the steps of:

a) providing a first operative element and a second operative element;

b) providing a first actuating element, and a second actuating element coaxially positioned with respect to one another;

c) moving the first actuating element relative to the second actuating element to pivot at least one of the operative elements in a first orientation to grasp body tissue located between the operative elements; and

d) moving the second actuating element relative to the first actuating element to pivot at least one of the operative elements in a second orientation to sever body tissue.

66. A method as claimed inclaim 65 wherein the step of moving the first actuating element relative to the second actuating element pivots the first operative element and the second operative element in opposite directions to grasp tissue between the operative elements.

67. A method as claimed inclaim 65 wherein the step of moving the second actuating element relative to the first actuating element pivots the first operative element and the second operative element in opposite directions to sever tissue.

68. A method as claimed inclaim 65 wherein the actuating element is moved by axially translating the actuating element.

69. (canceled)

70. A method as claimed inclaim 67 further comprising the step of moving a third actuating element relative to the second actuating element in a direction different than the direction of movement of the second actuating element.

71. A surgical method of grasping and/or severing body tissue, the method comprising the steps of:

a) providing a surgical instrument having a first operative element, a second operative element, a first actuating element and a second actuating element;

b) moving one of the first and second actuating elements to pivot the first operative element in a first direction; and

c) moving the other of the first and second actuating elements to pivot the first operative element in a second direction transverse to the first direction, the first actuating element being slidably disposed within the second actuating element.

72. A method as claimed inclaim 71 wherein the step of moving one of the actuating elements to pivot the first operative element in a first direction comprises pivoting a handle to effect axial translation.

73. A method as claimed inclaim 72 wherein the step of moving one of the actuating elements to pivot the first operative element in a second direction comprises pivoting a handle.

74. A method as claimed inclaim 71 wherein the first operative element and the first actuating element interact for movement by a stationary pin-recess arrangement.

75. A method as claimed inclaim 71 wherein the first operative element and the second actuating element interact for movement by a stationary pin-recess arrangement.

76. A method as claimed inclaim 75 wherein the first operative element and the first actuating element interact for movement by a stationary pin-recess arrangement.

77. A method as claimed inclaim 70 wherein the operative elements have curved proximal surfaces which move into abutment when the first and second operative elements are moved to a closed position.

78. A surgical method of grasping and/or severing body tissue, the method comprising the steps of:

a) providing a surgical instrument having a first operative element, a second operative element, a first sleeve and a second sleeve, the first and second sleeves engagable with a portion of the operative elements;

b) moving the first sleeve in an axial direction to pivot at least one of the operative elements between an open and closed position in a first orientation; and

c) moving the second sleeve in an axial direction to pivot at least one of the operative elements between an open and closed position in a second orientation different than the first orientation.

79. The method ofclaim 78 wherein the step of moving the first sleeve comprises moving the first sleeve within the second sleeve.

80. The method ofclaim 78 wherein the first sleeve has a recess to receive a first projecting portion of the first operative element, and wherein the step of moving the first sleeve applies a force to the first projecting portion of the first operative element to effect pivoting of the first operative element in the first orientation.

81. The method ofclaim 78 wherein the second sleeve has a recess to receive a second projecting portion of the first operative element, and wherein the step of moving the second sleeve applies a force to the second projecting portion of the first operative element to effect pivoting of the first operative element in the second orientation.

82. The method ofclaim 80 wherein the second sleeve has a recess to receive a second projecting portion of the first operative element, and wherein the step of moving the second sleeve applies a force to the second projecting portion of the first operative element to effect pivoting of the first operative element in the second orientation.

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