US1741461A - Surgical instrument - Google Patents

Description

Dec. 3l, 1929. F. P. HERMAN SURGICAL INSTRUMENT Filed June 29, 1927 2 sheets-sheet INI/ENTOR. /rman A TToRNE Ys Dec. 31, 1,929. F. PQHERMAN SURGICAL INSTRUMENT 2 Sheets-Sheet Filed June 29 1927 INVENTOR. lf'lsrman ........iiiaii f n l nw ATTORNEYS Patented Dec. 31, 1929 UNITED ySTATES PATENT ori-ics SURGICAL INSTRUMENT Application filed .Tune 29,

This invention relates to surgical instruments and has for its obj ect to provide an in-V strument for severing tissue which will cut, crush, and coagulate the tissue and thereby make possible a bloodless operation.

My instrument is of the type in which a Wire snare is used for the cutting and the invention consists in the application to the snare of a high frequency cutting and coag- 0 ulating current of electricity, one pole of the source of current being connected to the snare and the other pole to a dispersing electrode of large surface which is placed in intimate contact with the body of the patient. When the 3 5 tissue to be severed is properly engaged in the snare the current is turned on and the snare drawn through the tissue at a fairly rapid rate, which is accomplished with considerable ease, as the current itself is of the cutting type- The character of the current used 1s of great importance. It should be of a frequency of about 1,000,000 oscillations per second and should be of 200 to 400 milliamperes at a high voltage. This current is midway between cutting current rand a coagulating current and produces the most satisfactory results. The coagulation of the surface tissue brings about a bloodless post operative condition and destroys any microscopical cells which are frequently left and result in new growths. Furthermore, by the sealing of the blood and lymph vessels, any local infection of the wound and also the production :sa of blood stream infections or metastatic complications are prevented. The selection of the proper type of current is of particular importance for regulating the depth of coagulation. The depth should be suflicient to effectually prevent bleeding and perform the other functions above mentioned, but should not be so deep as to cause undue sloughing which might result in hemorrhage.

My invention is particularly applicable to tonsillotomes and similar instruments and in the accompanying drawing I have shown several forms of tonsillotomes embodying the invention.

Fig. 1 isan organization View of a tonsillotome and the electrical apparatus used in 1927. Serial No. 202,345.

connection therewith in accordance with my invention,

Fig. 2 is a plan view of the tonsillotome shown in Fig.. 1,

Fig. 3 is a vertical longitudinal section thereof, Fig. 4 is a cross section on the line 4 4 of Fig. 3, FF ig. 5 is a cross sectionv on the line 5 5 of 1g. 3, i Fig. 6 is an elevation of another form of 60 supporting member for the snare,

Fig. 7 is a horizontal section on the line 7-7 of Fig. 6,

Fig. 8 is a cross section on the line 8-8 ofV Fig c t5' 7 Fig. 9 is a cross section on the line 9-.9 of Fig. 6, n

Fig. 10 is a longitudinal section of another form of supporting member, and 0 Fig. 11 is a bottom view of a block forming part of an adjustable stop.

. In the drawing I have illustrated my invention as applied to an instrument of the Beck-Schenck type comprising a handle member 1, a carriage 2 slidably mounted on the handle member, a wire snare 3 secured to the carriage, and a detachable supporting member 4 for the snare. The handle member 1 is channel shaped and has a threaded shaft- 5 rotatably mounted within its channel. A` handle 6 is provided on the end of shaft 5 for rotating the same. A clutch 7 is mounted on a spring 8 and is adapted to be thrown into engagement with the threads of shaft 5 by a 5 yoke 9 pivoted on the carriage at 10. The carriage can be moved freely on the handle member whenl the clutch 7 is thrown out and can be locked in any position by throwing in the clutch or be then moved slowly and with greater force by rotating handle 6. This construction is well known and is not claimed as a part of my invention.

Reference numeral 11 indicates an electrical apparatus for producing a cutting electric current wires 12, 13, 14, and 15 being pro-l vided for connecting the apparatus to an electric light socket 16. The current is controlled by a foot switch 17 in wire 13. One terminal of apparatus 11 is connected by wire CTX 18 to a metal sheet 19 of large surface adapted to be placed in intimate contact with a portion of the patients body. The other terminal is connected by wire 20 to the snare 3. The snare is completely insulated from the metal portions of the carriage 2 and handle member l. I have shown the carriage constructed partly of metal and partly of insulating material, but it may equally Well be made entirely of insulating material. The metallic portion of the carriage shown is in general fork shaped and receives between its two arms 2l and 22 a block 23 of insulating material such as hard rubber, fiber, glass or other suitable composition. The block 23 is held in place by screws 24. A hole 24 is bored through the block 23 and through an eXtension 25 thereof which hts into a hole 26 in the metallic` fork. The hole 24 receives the stem of the snare 3 and a clamp 27 is provided for clamping the stein in the block 23. The clamp 27 consists of a pin extending through a transverse hole 28 in the block 23 and having a slot 29 through which the stern of snare 3 projects. T he end of the pin is threaded to receive a wing nut 30 by which the pin is drawn to one side to clamp the stem against the side of the hole 24. A screw 31 extending through slot 29 prevents the pin 27 from slipping out of hole 24 when the snare is removed. A hole is bored in the end of pin 27 to receive the contact point 32 of wire 20, the end of the pin 27 being splitlongitudinally to permit slight expansion. rlhe threaded portion of pin 27 is tapered so that when the wing nut 30 is screwed down the split end of the pin is clamped upon contact point 32.

rlhe supporting member 4 for the snare is made of insulating material, preferably glass, and consists of a cup 33, a supporting and snare guiding tube 34, and a suction tube 35. The tube 34 lits tightly into a metallic mounting tube 36, the ends of tubes 34 and 36 being reduced to such a size that they will lit into the standard sleeve 37 of handle member l. Tube 36 is recessed at 38 to receive a spring pressed locking collar 39 by which it is secured in position. An apertured lug 40 depending from tube 36 receives the end of tube 35 and holds the supporting member against rotation in tube 36. rl"ube 34 is lined with a metal tube 4l to give it greater strength. The cup 33 is grooved at 42 to receive the loop of the snare in its fully expanded position. A ledge 43 projects above the mouth of tube 35 to prevent a portion of a tonsil from being drawn against the mouth of the tube and shutting olf the suction from the cup. A nipple 44 is plugged into the end of tube 35 to provide a connection for a suction pipe 45 leading to an electric suction pump 46. A receptacle 47 is inserted in pipe 45 to catch any pus or other debris drawn out of the suction cup 33. The motor of pump 46 is connected to line wires 1.4 and 15 by wires 48 and 49, in one of which is placed a foot switch 50.

The operation is as follows: The carriage 2 is moved forward far enough to expand the loop of snare 3 into groove 42 and is locked in that position by clutch 7. The tonsil is then worked into cup 33 by the fingers and by the application of suction as desired under the control of foot switch 50. When the snare is as close to the base of the tonsil as possible clutch 7 is thrown out and the snare drawn back until the tonsil is firmly clenched. The current is then turned on by foot switch 17 and the snare drawn through the base of the tonsil at a fairly rapid rate. Because of the cutting action of the current it is not necessary to use the worm 5 for drawing the snare through; in fact the cutting operation should be performed more quickly than would be possible with the worm 5. The clutch and worm therefore serve merely as a locking leans for the carriage. Any other means for holding the carriage against sliding movement on the handle member would serve equally well.

ln order to prevent a spark at the end 0f the cutting operation l provide an adjustable stop 5l for limiting the movement of the carriage. rlhe handle member 1 is slotted at 52 to receive a flat square headed screw 53. A block 54 slips freely over screw 53 and is clamped against handle member l byr a knurled nut 55. The bottom surface of block 54 and the top surface of handle member l are notched so that they will not slip when clamped together. The screw 53 has a flat side 56 which cooperates with a similar flat side 57 of block 54 to prevent the block from rotating. Before an operation is begun the carriage 2 is moved to such a position that the loop of the snare is almost completely drawn within tube 34 and stop 5l is brought into abutting relation with the carriage and clamped. In the course of the operation the carriage is stopped just before the severing is completed and the current is turned off. The stop is then unclamped and the severing completed without the application of electricity.

Figs. 6 to 9 showl another form of supporting member for the snare. A tube 60 of insulating material has a loop 6l formed on one end and its other end reduced to lit into' a metal shank 62 of the standard size for mounting the supporting member in sleeve 37 of the handle member l. The metal shank 62 has an extension 63 which covers substantially one half of tube 60 and loop 6l. rl"he loop 6l is grooved at 64 to receive the loop of the snare. rllhis supporting member can be conveniently made by molding a hand rubber tube into the metal shell.

In Fig. 10 I have shown still another form of supporting member consisting of a straight tube of insulating material lined with a strengthening metal tube 71. In this case the end of the insulating tube itself is formed as a standard shank 72 adapted to fit into the sleeve 37 of handle member l.

It will be noted that in all the modifications the snare and the clamp 27 are the only parts of the instrument which are electrified. This is of great importance in that it eliminates the danger of sparking which would occur, if the whole instrument except the supporting member were electrified, whenever the surgeon touched the patent.

I-Iaving described my invention, I claim:

l. In a surgical instrument, a metallic Snare, a non-conducting supporting member therefor, means for sliding said snare relative to said supporting member, a source of cutting electric current, means connecting one pole of said source of current to said snare, and means whereby the other pole of said source of current can be connected to the body of the patient.

2. In a surgical instrument, a metallic snare, an insulated supporting member therefor, means for sliding said snare relative to said supporting member, a source of cutting electric current, means connecting one pole of said source of current to said snare, and means whereby the other pole of said source of current can be connected to the body of the patient.

3. In a surgical instrument, a metallic snare, a tubular supporting member within which said snare is slidably mounted, means for drawing said snare through said tube, a source of cutting electric current, means connecting one pole of said source of current to said snare, and means whereby the other pole of said source of current canbe connected to the body of the patient.

4. A surgical instrument comprising a handle member, an insulated supporting member mounted thereon, a metallic snare slidable with relation to said supporting member, a carriage slidably mounted on said handle member, said carriage consisting at least in part of insulating material, means for securing the end of said snare in said insulating material, a source of cutting electric current, means connecting one pole of said source of current to said snare, and means whereby the other pole of said source of current can be connected to the body of the patient.

5. A surgical instrument comprising a handle member, an insulated supporting member mounted thereon, a metallic snare slidable with relation to said supporting member, a carriage slidably mounted on said handle member, said carriage consisting at least in part of insulating material, a metallic clamp for securing the end of said snare in said insulating material, a source of cutting electric current, means connecting one pole of said source of current to said clamp, and means whereby the other pole of said source of current can be connected to the body of the patient.

6. A surgical instrument comprising a cup formed of insulating material, a suction tube communicating with said cup, a second tube communicating with said cup, a metallic snare having a stem slidable in said second tube and a loop adapted to be drawn across the mouth of said cup, means for sliding saidl snare relative to said cup, a source of cutting electric current, means connecting one pole of said source of current to said snare, and means whereby the other pole of said source of current can be connected to the body of the patient.

7. A surgical instrument comprising a cup formed of insulating material, a suction tube communicating with said cup, a second tube communicating with said cup, a metallic snare having a stem slidable in said second tube and a loop adapted to be drawn across the mouth of said cup, a handle member, a metallic tube on said handle member adapted to receive said second tube of said cup for mounting the snare on said handle member, means for sliding said snare relative to said cup, a source of cutting electric current, means connecting one pole of said source of current to said snare, and means whereby the other pole of said source of current ycan be connected to the body of the patient.

8. A surgical instrument in accordance with claim 6 in which said metallic tube is provided with an apertured lug adapted to receive said suction tube.

9. A surgical instrument comprising a handle member, an electrically non-conductive supporting member mounted thereon, a metallic snare adapted to slide relative to said supporting member, a carriage slidable on said handle member, means for securing said snare to said carriage, an adjustable stop on said handle member for limiting the movement of said carriage, a source of cutting electric current, means for connecting one pole of said source of current to said snare, and means whereby the other pole of said source of current can be connected to the body of the patient.

10. A surgical instrument comprising a tube of insulating material terminating in a loop, a metallic casing covering one side of said tube and loop, a metallic snare having a stem slidable in said tube and a loop adapted to lit within said loop of insulating material, means for relatively sliding said snare and tube, a source of cutting electric current, means for connecting one pole of said source of current to said snare, and means whereby the other pole of said source of current can be connected to the body of the patient.

The foregoing specification signed at Vest Paln Beach, Florida, this SOthday of May, 192

FLORENTINE PETER HERMAN.

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