DEVICE FOR LIGATION OF HEMORRHOIDS Background of the invention : Everyone has veins (low pressure blood vessels that return blood to the heart) around the anal opening. When these veins become abnormally enlarged or dilated, they are called hemorrhoids. The typical American diet is relatively high in refined and processed food and low in grain and bulk forming foods. Stools that have less bulk are harder to pass and lead to constipation. This in turn, causes an increased pressure in the veins around the anal canal. The veins thereby become dilated and enlarged, resulting in hemorrhoids. The common name for hemorrhoids (haemorrhoids in U. K.) is"piles. " Hemorrhoids are one of the most common ailments for men and women alike affecting more than half the population at some point in their lives. Onset commonly occurs after the age of 30, but hemorrhoids are reported in people of all ages. More than 525,000 patients in the United States are treated annually for symptomatic hemorrhoids.

Hemorrhoids are classified into internal and external hemorrhoids.

There is a line (the dentate line) in the anal canal which separates two different types of anal skin. Whereas the skin above the dentate line is not sensitive to pain, the skin below this line is quite sensitive to pain.

Internal hemorrhoids occur above the dentate line and are, therefore, usually painless. They can cause bleeding or they may push out of the anal opening (prolapse) when they become quite large.

External hemorrhoids occur below the dentate line and are generally painful. They are sometimes called skin tags, or can be seen or felt as extra skin around the anus. External hemorrhoids can become very distressing when the blood in the external hemorrhoid clots and inflammation irritates the nearby, pain-sensitive skin. This condition is called a thrombosed external hemorrhoid and is quite painful.

Prior Art: Hemorrhoids that bleed are most often internal hemorrhoids. These can be treated by various methods, including injection sclerotherapy, infrared coagulation, surgical hemorrhoidectomy or rubber band ligation.

Infrared coagulation uses a infrared light source to coagulate the dilated veins of the hemorrhoid. This causes the hemorrhoids to shrink since blood does not flow through the coagulated blood vessels. This is an office procedure and is pain free. It may take more treatment sessions to eliminate the hemorrhoid group when compared to rubber band ligation.

Injection sclerotherapy of hemorrhoids involves injecting an irritating chemical into the hemorrhoid which causes inflammation and closure of the veins, thereby shrinking the hemorrhoid.

A hemorrhoidectomy involves surgically excising (removing) the hemorrhoid groups in the anal canal. This can be done with a scalpel, cautery device or a laser. There is evidence to suggest that laser hemorrhoidectomy has an advantage of less pain in the recovery period than non-laser hemorrhoidectomy. This surgery is generally done as an outpatient and hospitalization is usually unnecessary. The operation can be done under a general, spinal, or local anesthetic. The choice as to which is most appropriate varies from patient to patient and is best left to the judgment of the surgeon. Complete healing from this operation can take two to four weeks. However, after one week most patients are able to return to their usual activities with minimal or no discomfort.

The newest procedure for treating hemorrhoids is called the procedure for prolapse and hemorrhoids (PPH). PPH shuts off the blood vessels that form the hemorrhoids and causes them to return up into the anal canal. It is used for internal and external hemorrhoids of moderate or greater severity. During PPH, a circular stapling device is inserted into

the rectum, pushing the hemorrhoids and the tissue surrounding them up into the anal canal. The stapler then is fired, stapling the hemorrhoids and surrounding tissue to tissue higher up in the anal canal. Early reports on the use of PPH are excellent though careful comparisons with other techniques have not been done. Pain following the procedure is much less than after surgery. It remains to be seen what the long-term results of treatment will be.

Rubber band ligation is an office procedure in which a small rubber band is placed at the base of the internal hemorrhoid with a special applicator. The rubber band cuts off the blood supply to the hemorrhoid and the hemorrhoid falls off in about four to five days. There is generally minimal or no discomfort associated with this procedure.

U. S. Pat. No. 3,760, 810 to Van Hoorn discloses an endoscope-equipped instrument comprising a device with two tubes mounted one inside the other, with the inner tube protruding at the front of the outer tube.

Means are included to move the outer tube forwardly relative to the inner tube and cause an elastic cord to be dislodged and placed about the tissue to be ligated.

In U. S. Pat. No. 4, 257, 419, there is disclosed an instrument for ligating hemorrhoids, wherein a suction tube fitted inside a proctoscope provides means for sucking the hemorrhoid into a suction cavity where a ligating ring is applied. Both of these instruments are rigid devices suited for treating lesions close to the external regions, and both are equipped with only a single elastic ring for treating a single lesion.

In U. S. Pat. Nos. 4,257, 420 and 4,471, 766, there is disclosed an instruments which equipped with a single elastic band and utilize forceps to position the tissue for ring ligation.

In U. S. Pat. No. 3,870, 048, there is disclosed a ring applicator device having forceps slidably mounted in a cylinder for grasping the fallopian tube and including means for displacing an elastic ring to effect a ligation of tissue. While this device can be equipped with a plurality of

elastic rings, its rigidity precludes its use with a flexible endoscope for treating the deeper regions of an internal organ, such as the alimentary tract.

In U. S. Pat. Nos. 6,149, 659 and 6,685713, there is disclosed a flexible endoscopic instrument is provided with a plurality of elastic ligating bands mounted on a barrel of an endoscopic ligator affixed in coaxial relation to the insertion end of an endoscope. The bands are adapted to be dislodged therefrom in sequence at selectively controlled times for treating multiple lesions during a single insertion of the endoscope into a body organ. While this device can be equipped with a plurality of elastic bands, its mode of action depends mainly on pulling a trip wire.

SUMMARY OF THE INVENTION The present invention relates to new device for ligation of hemorrhoids using a new mechanism that overcome the disadvantages found in presently available devices. Most of devices available in prior art either dispence one rubber band a time or in case of multi ligation, depend on a trip wire. The present invention directed to new device which can effectively dispense multi ligation using a new mechanism.

In one embodiment of the invention, the device is loaded with several rubber bands that can be used in one operation. The number of the rubber bands may vary from 3-6 rubber band. In other embodiment of the invention, rubber band can be loaded as a disposable cartridge which is loaded on use.

Another object of the invention is to provide a simple and efficient device to load the rubber bands and endoscopic ligator. Other objects and particular benefits of the present invention can be readily discerned from the following description and accompanying figures.

BRIEF DESCRIPTION OF THE DRAWINGS Fig 1 is schematic drawings of the new device according to the present invention.

Fig 2 longitdal section of part A shown in Fig 1.

Fig 3 longitdal section of part B shown in Fig 1 Fig 4 schematic drawings showing the loading of rubber bands.

DESCRIPTION OF THE PREFERRED EMBODIMENTS For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiment illustrated in the drawings. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, and any alterations or modifications in the illustrated device, and any further applications of the principles of the invention as illustrated therein are contemplated as would normally occur to one skilled in the art to which the invention relates.

The present invention contemplates an endoscopic ligating device as depicted in fig 1, that is capable of discharging a plurality of ligating rubber bands without having to remove, load and reinsert the device.

For better use and control of the new device, it was made in the shape of pistol that can be easily carried and controlled.

Reverting to Fig 1, a new device is illustrated. The said device consists mainly of three parts. The first part (front part or ligation part) which responsible for rubber ligation bands consists of fixed part (A) and movable part (B). In the first embodiment of the present invention the fixed part which is better shown in Fig 2, consists of threaded cylinder ( 10). The circumference of the threaded cylinder is decreased gradually towards the nozzle of the said cylinder. Dimensions of all threads are otherwise identical. The outer threaded surface having three elongated passageways extending from the base of the cylinder up to the tip of the

nozzle. The said three passageways are identical in all respect ( dimensions) with equal distance in between the three passageways.

This part display an important role during use of the device. This part prevent ligation rubber band from moving backward after dispensing and in the mean time is connected to the long tube responsible for the pulling veins of the hemorrhoid inside the device. For frequent use of the device, this part may be manufactured from stainless steel, however, for more easy and single use, it may also be made from suitable plastic material.

Accordingly in another embodiment of the device, fixed part may be made either from stainless steel, for use several times; or from plastic material, for single use (disposable).

In another embodiment of the device, the fixed part which made of metal is loaded with ligation rubber bands for every new use, whereas loaded plastic movable part can only be inserted in the device for every new use.

The movable part (B) which is better shown in Fig 3 consists of a cylinder with three threaded, identical, equally interspaced arms. threads conform in all respect with the threads of the fixed part (A).

This part is connected to cylinder based on a spring and surrounding the pulling tube but shorter in length. This part is responsible for triggering the ligation rubber band.

The main second part of the device consists of triggering cylinder 6 which can move forward and backward to act on pushing the movable part (A) and effect triggering action.

The main third part 3 (rear part or mechanical part) consisting of cylinders and handle for holding the device. The cylinder is connected from the far end (4) to pulling mechanism which act on pulling the veins of the hemorrhoid inside the device. The opening 7 control the process of pulling the veins. Triggering means are enclosed in the

cylinder (5). Parallel to this cylinder, there is an illumination means that facilitate orientation of the instrument in the body organ.

On the other hand a special hollow cone is used to be fitted on the nozzle of the device to load ligation rubber bands.

The device of the present invention characterized in that it has an easy and simple mechanism for triggering and ligates the vein. In use the physician will hold the device using the handle and orient the device to the veins of the hemorrhoid and trigger, once the physician press the triggering handle 2, cylinder 6 will move forward towards the vain and pull it inside the device by the effect of suction made through 4. in the meantime, ligation rubber band is released and pushed around the vain which still inside the device. Once the rubber band is released and ligation is made the vain is released and the process completed.