US1303135A - Reinhold h - Google Patents

Description

R. H. WAPPLER. SURGICAL INSTRUMENT. APPLICATION FILED OCT. 17, 1911.

Patented May 6, 1919. 2 SHEETS-SHEET l- R. H. WAPPLER. SURGICAL INSTRUMENT. APPLICATION HLED OCT, 17. I917.

Patented May 6, 1919.

2 SHEETSSHEET 2 11v Vb TOR fim'zz/zold/f Wag?! 2m A TTORNE Y ed for use while the REINHOLD H. WAPPLEB, OF NEW YORK,

COMPANY,

N. Y., ASSIGNOR '10 WAPPLEB, ELECTRIC me, A oonronnrron or new YORK.

SURGICAL INSTRUMENT.

Specification of Letters Patent.

Patented May 6, 1919.

Application filed October 17, 1917. Serial No. 196,995.

To all whom it may concern:

Be it known that I, REINHOLD H. WAF- PLER, a citizen of the United $tates, residing in the city of New York, in the county and State of New York, have invented certain new and useful Improvements in Surgical Instruments, of which the following is a full, clear, and exact description.

vMy invention relates'to surgical instruments of the kind associated with explorations of internal portions of the body, and performance of operations upon such portions while the same are subject to the actual view of the operator.

More particularly stated, I seek to provide a surgical instrument in which are effectively combined a cystoscope or its equivalent for enabling the operator to view directly various internal portions of the body, for instance the bladder, and guiding mechanism to be'connected to the cystoscope, and adaptcystoscope is in action,

for facilitating the introduction of exploring devices, and operating instruments, so

as to enable the operator to employ the same, and also to observe every stage of his work. While my invention is adapted for general use upon various internal portions of the body, it is of special service in connection with diseases of nary organs.

In the surgical treatment of such diseases, there are in general three distinct steps to be performed. First, the bladder and, parts adj abent to it must be inspected, y"-1neans of a systoscope or its equivalent. econd, one or more catheters mustbe inserted and actuated after insertion, in order tuienable the operator, by aid of the'cystoscope; to locate the precise seat of the disease or obstruction sought, and also in some instances'to fa; cilitate thedischarge of urine from the bladder. Third, an operating instrument, of a character dependent upon conditions, must in some instances be inserted and used in accordance with the surgical work found necessary.

Heretofore separate instruments have customarily been used for performing the three steps above enumerated This has rendered the mechanism complicated and expensive, and has prevented the reduction to a minimum the length of time required for an operation.

By my invention I employ a single cystothe bladder and other ur1- scope for enabling the operator to make all necessary examinations and observations, the cystoscope being provided with mechanical means for holding and guiding, in succession and if need be while the cystoscope is in active use, first one or more catheters, and second an operating instrument of suitable form.

In other words I provide a eystoscope with means for enabling other instruments to be connected to it, these other instruments being interchangeable relatively to each other and thus employed.

Reference is made to the accompanying drawing forming a part of this specification, and in which like letters indicate like parts through all of the views.

Figure 1 is a fragmentary plan of my device, showing the cystoscope and parts accompanying the same as used with two flexible catheters.

Fig. 2 is a fragmentary side elevation of the mechanism shown in Fig. 1.

Fig. 3-is a fragmentary plan showingthe cystoscope as carrying two catheters and a ide for the catheters, and also aclamp for holding these parts together.

Fig. 4 is a section on the line 4-4: of Fig. 2, looking in the direction indicated by the arrows.

Fig. 5 is a section on the line 5-5 of Fig. 3, looking in the direction indicated by the arrows.

Fig. 6 is a perspective of the guide, exhibited alone.

Fig. 7 is aside view of my device, partly in elevation and partly broken away, showing how the operating instrument is inserted and guided without interference with the cystoscope. Fig. 8 is a fragmentary side elevation showing the device as used when the cystoscope and the operating instrument, are in active use at the same instant.

Fig. 9 is a section on the line 9--9 of Fig. 3,.looking in the direction indicated by the arrows. I

- A metallic sheath is shown at 9, and has a general tubular form, being provided with an axially disposed bore- 10 having an elliptical cross-section, as shown more particularly in Fig. 4.

The shea h 9 is provided end portion 11, carrying a lamp 12.

with an upturned tuny incandescent A cap 13, earned by th upturned end portion of the sheath, is detachable in order to facilitate the removal and replace ment of the lamp. This cap 13 also constitutes a tip for the end of the sheath, and for this purpose is rounded.

The sheath 9 is providedwith a slot 14 merging laterally into the bore 10, and with an opening 14 which is merely one extremity of the bore 10, as may be understood rom Fig. 2;

The sheath 9 16. The sheath is further provided with a short tubular portion 17, detachable .from the main or' body portion of the'sheath, and carrying valves The sheath is further provided with a collar 20, and with insulating members 21, 22

whereby this collar is insulated from other parts of the sheath. Electrical connections are shown at'23, 24 and are provided with contact portions 25, 26, the latter engaging respectively the portions 15 and 20 of the sheath and being movable relatively thereto. The electrical connections may be turned bodily around on the axis of the sheath as a center,'- this purpose being facilitated if need be by use of the milled ring 16, which is fixed relatively to the sheath. An insulated conductor 27 is connected to the collar and therefrom extends through asmall passage 28 to the incandescent lamp 12, for the purpose of causing the same to be illuminated. he parts are so proportioned, shaped and arranged that when the sheath is empty its bore is totally free from any obstructionfrom end to end.

The barrel ofthe cystoscope is shown at 29..and carries a lens mounting 30, containing a spheroidal lens or other lens of the i kind usually employed as the object lens of a cystoscope.

The barrel 29 is mounted upon a tubular stock 30, carrying a head 31 and milled rim 32, through which passes the axis of'the cystoscope barrel, this axis being the line of sight of the operator as he looks through the cystoscope. Thetubular stock 30 extends through a closure plug 33, as shown more particularly in Figs. 2 and 3, the axis of the stock not being exactly in the center of the plug, but a little eccentric thereto, so that when the closure plug is fitted into the tubular ortion 17 the barrel of the cystoscope is in t e upperportion of the sheath. This is indicated in Figs. 2, 4. 7 and 8.

The closure plug 33 .is provided with a head 34 of substantially annular form, this head being eccentric to the axis of the stock 30 and therefore parallel to the optical axis of the cystoscope.

Extending from the head 34 is a middle tube 35 and two side tubes 36, 37. Each of these three tubes leads into a single passage is furtherprovided with an enlarged portion 15 and with a milled ring 18, 19 for discharging urine.

catheters are each of tubular form 33 (see Fig. 9) with which the closure plug 33 is provided. The passage 33* is of cylindrical form, so located that when the closure plug is inserted into the tubular member 17, as indicated in Figs. 1, 2 and 8, the passage 33 merges into the bore of. the sheath, that is, into the lower portion of the bore when the sheath is in its normal position. An obturator is shown at 38, and.,is simply a rubber cap for closing the outer or free end of the tube 35 when this tube is not inuse. The obturator closes the tube watertight'and air-tight. Another obturator 39, similar in form but of smaller size, is used for closing either of the smaller tubes 36, 37 Two catheters are shown at 40, 41. These and flexible. As here shown they are unlike in color so as to be readily distinguishable by sight. This is not essential and they may if desired be exactly alike.

For the purpose of holding the closure plug 33 I member 17 I provide the head 34 with a form 42 carrying a pin 43, and upon the top of the tubular member 17 I mount a revoluble locking member'44, provided with a handle 45; The locking member 44 is actuated by the handle 45 for the purpose of gripping and releasing the pin 43. Thus the parts 42, 43, 44 and 45, together, constitute a clutch, for holding the closure plug 33 in a predetermined normal fixed position relatively to the sheath and parts carried thereby. I I 1 A guide 46, shown in its entirety in Fig.= 6 and. in this instance made of sheetmetal, is adapted for attachment to the cystoscope barrel. A central rib 47 is provided with a pair of laterally extending wings 48, integral with it. The wings 48 are each curved in cross-section, as may be understood from. Figs. 4 and 5. Preferably a single strip of sheet metal is bent .back upon itself to form the rib, the edges of the strip being then bent outwardly from each other, slightly curved, to form the wings. The rib is also provided with a notch 49, and with a clip 50 disposed adjacent this notch and soldered upon the upper surface of the wings. The clip has the form of a split cylinder, and may be sprung slightly so as to grip the barrel of the cystoscope.

he guide 46 also carries a fin 51, which is merely a thin blade extending from one end of the rib 47, as shown in Fig, 6.

and is so formed and arranged as to extend nto the passage 33" Whenever the guide 46 is mounted upon the cystoscope barrel as in proper relation to the tubular -fin is virtually a continuation of the rib 47,

shown fonlnstanc'e in Figs. 1 and 3. The

manner in whichjthe passage 33 is, divided or cloven by thefin is shown more particularly in Flg. 9. The purpose of this ar til they protrude from I 9, then pulls scope barrel .scope in place rangement is to facilitate the insertion of the flexible catheters 40, 41 through the tubes 36, 37 and to direct each catheter into proper sliding engagement with the guide 46. The rounded surfaces bf this guide, due to curvature of the wings 48 as shown in Fig. 4, still further facilitates the free movements of the catheters, as a semi-rounde passage is thus provided for each of the two catheters.

In practice it is sometimes convenient to attach the catheters to the guide 46 so as to facilitate the insertion of both the guide and the catheters, as practically a unit, into the sheath. For this purpose I employ a clamp 52, shown more particularly in Figs. 3 and 5. This clamp is made of spring sheet metal, and isprovided with jaws 53, '54. The jaw 53 is fashioned to fit upon the barrel 29 and clip 50, the jaw 54 being of proper fo m to fit against the under side of the two catheters 40, 41 while the latter ment with the guide 46. With the parts 1n this position the jaw 54 extends through the notch 49 and is thus ping or moving along theguide 46.;

With the parts thus arranged the operator can thrust the free end ofthe cystoand the adjacent ends ofthe guide 46 me those of the two catheters into the sheath 9, and then by removing the clamp 52 he can push the cystoscope barrel, accompanied by the guide and catheters, unthe distant end 0 the sheath, as indicated in Figs. 1 and 2 Thus the closure plug 33 is brought to fit into the tubular member 17 and thus locked by means of the clutch, as above described. In order to remove the catheters and guide, the operator withdraws them, to-

ether with the cystoscope, from the sheath the catheters out cystoscope barrel.

- The cystoscope alone, catheters and guide, may be thrust through the sheath 9 a'sjindicated' in Fig. 7 and in such event the barrel of the cystoscope assumes a definiteposition within the upper half of the bore 10, the bottom half of this bore being unobstructed. With the cystothe barrel 29 always occupies this exact-position, whether the catheters and guide be present or not. This may be understood from Figs. 4 and 7.

With the parts arranged as indicated in Fig. 7, an operating ble that is, without the instrument of suita form can be thrust throughthe tube 35 and thus guided inserted farther until its free end from the opening 14.

One form of operating instrument, suitable for this purpose and known as forceps, is shown in Figs. 7 and 3. This instrument protrudes comprises a flexible body portion 55 and handle 56, both of tubular Any other i I, For purposes of catheteriz ation are 'arran ed as above described with referare in engageprevented from sl1pgagement with different physiological the operatin of the tubes 36, 37, and disconnects the clip 50 from the V the free end of the sheath.

into the bore 10,.and then gently form. Through the body portion and handle extends an actuating wire 57 to which is connected a pair of jaws 58. For securing the wire and tightening it there is a thread 59 and nut 60. form of operating instrument, however, may be used, provided only that.

I it will admit of insertion through the tube 35 and bore 10. y The operationof my device is as follows: the parts ence to igs. 1 and 2. The operator now grasps the ends of the catheters protruding from the tubes 36, 37, and by pulling the catheters he moves them slightly endwise, so that their opposite ends are housed within the adjacent end of the sheath. The instrument is next inserted throu h theurethra and into'the bladder. Next the incandescent lamp is caused to glow, electric current through the electrical connections which are in' turn energized from any suitable source of current. I r

The operator now looks through the cystoscope and by manipulation of the catheters he inserts them into the ureters or into enparts in which the existence of disease is suspected. He thus makes a thorough exploration. He may use one or both catheters, as he may see proper, and he has a direct view of the parts as pressed open or otherwise ma nipulated by the catheter or, catheters,-

Having thus determined the seat of the disease, the operator may concludeto use I instrument. For this purpose he actuates t e clutch in order to release the closure plug 33 and then withdraws this closure plug, together with the cystoscope barrel and parts carried thereby. He next for this purpose being supplied disconnects the guide and catheters, and y then replaces the closure plug, together with the cystoscope barrel carried by it, and actuates the clutch so as to again lock the closure plug in position. This leaves the apparatus in the condition indicated at the right of Fig. 7, the cystoscope barrel occupying the upper half of the bore 10. The operator now inserts instrument. If'this happens ceps above described, he inserts the jaws 58 through the tube 35 and by feeding the body portion 55 into this tube a suilicient distance, he brings the jaws 58 out toward Next the operator inserts the sheath and its accompanying parts through the urethra and into the bladder. The incandescent lamp is next caused to glow, and as the operator looks through the cystoscope be actuates the operating instrm'nent. Suppose he sees in the bladder or in one of the uterers a gall stone. He so aet'uates the operating instrument as to the operating to be the forcause the jaws 58 to clasp "the stone, which gagement with said longitudinal guide, of a thereupon is easy to dislodge by simply pair of flexible catheters. pulling upon the operating instrument. 5. In a device of the character described This done, the entire apparatus is removed the combination of a sheath carrying a lamp bodily, the gall stone-coming out with the and provided-with a bore, a cystoscope for forceps. extending through said bore, means for guid- Other operating instruments of different ing into said bore a pair of flexible catheters, kinds may be thus used for different pur and a guide removably housed Within said poses, as for instance treatment of lesions by bore in order to facilitate the travel of means of an electric. spark or by local apflexible exploring members through said 7 plication of medicines. bore, said guide being for this purpose pro- I donot limit myself to the precise mechvided with a partition and with rounded anism here shown, as variation therein may portions extending from said partition. be made without departing from the spirit 6. In a device of the character described of my invention. the combination of a sheath provided with a claim v bore, a closure plug detachably-engaging 1. The combination, with a sheath carrysaid sheath and provided with a passage for ing a lamp and provided with a bore, of a communicating with said bore whenever said cystoscope detachably supported by said closure plug is in fitting engagement with sheath and provided with a barrel portion said'sheath, said closure plug being also proextending through said bore, aguide detachvided with a guiding tube communicating ably secured to said barrel portion of said with said passage in order to facilitate the cystoscope and provided with a partitioning introduction of an I operating instrument member, and a plurality of flexible operatthrough said passage and into said bore, ing members to be thrust through said bore said closure plug being further provided and guided by said partitioning member. with a plurality of additional guiding tubes 2. The combination, with a sheath carrycommunicating with said passage to faciliing a lamp and provided With a bore, of a tate the introduction of flexible exploring cystoscope mounted upon said sheath for enmembers through said passage and into said abling the operator to see through said bore, bore while said operating member is not in and a guide detachably mounted upon said said bore, and a guide to be fitted into said cystoscope and located within said bore, said bore while said operating instrument is abguide having a rib and a pair of wings for sent from said bore, said guide having a the purpose of partitioning off differ'entporpartition for-demarking the respective paths tions of said bore. of travel of said flexible exploring members,

3. Ina device of the character described and also having a fin for extending into said the combination, with a sheath carrying a passage and serving therein as a partition lamp and provided with a longitudinal bore, for guiding said flexible exploring members of aclosure plug for fitting-into said bore, through said passage. 7 and a cystoscope supported by said closure 7. The combination, with a sheath carryplug for enabling the operator to see through ing a lamp and provided with a bore, of a 7 said bore, said closure plug being provided closure plug engaging said sheath, a cystowith means for enabling flexible operating s ope carried by said plug and extending members to be thrust through it and into through said bore, and a guide provided said bore, and guiding mechanism located. with means for detachably holding it upon within said bore for guiding said flexible said cystoscope, for the purpose of guiding operating members therein. transient exploring members when thrust 4 In a device of the character described int aid bore. the combination, with a sheath carrying a 8. In a device of the character described lamp and provided with a bore, of a closure the combination, with a sheath carrying a plug detachably engaging said sheath, a lamp and provided with a longitudinal bore, cystoscope carried by said closure plug and of a closure plug for fitting into said longiextending through said bore whenever said tudinal bore,a cystoscope extending through closure plug is in fitting engagement with said closure plug and supported thereby, a said sheath, a guiding tube carried by said guide separate from sald cystoscope and de closure plug for directing an operating 1ntachably mounted thereupon for extend ng strument into the bore of said sheath, a loninto said bore, and a plurality of guiding gitudinal guide provided with means for detubes carried by said closure plug and protachably securing it upon said cystoscope in vided with a plurality of passages merging order to facilitate the introduction of said together for the purpose of guidingtransient guide along with said cystoscope into said members into said bore when said closure bore when-said operating instrument is not plug is fitted into said bore. in use, and a pair of guiding tubes carried 9. In a device of the character described bv said closure plug to facilitate the introthe combination, with a sheath carrying a dhction into said bore, and into sliding enlamp and provided with a longitudinal bore,

' with a central passage and with means of a closure plug for fitting into said bore and a cystoscope supportedby said closure plug for enabling the operator to see through said bore, said closure plug being providfed or guiding flexible operating members through said central passage and into said bore, and a guide detaohably mounted upon said oysto-- scope for extending therewith into said bore when said bore, said guide having a fin closure plug is fitted into said 10 for extending into said central opening of said closure plug in order to hers.

guide the flexible operating mem- REINHOLD H. WAPPLER.

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