US2382109A - Diagnostic and electrosurgical appliance - Google Patents

Description

Aug. 14, 1945.

A. L. SHEIFFELE DIAGNOSTIC AND ELECTRO-SURGIQAL APPLIANCE 2 Sheets-sheet 1 Filed Aug. 6, 1945` (viti INVENTOR. ARTHUR LHElFFELE Aug. 14, 1945. A. L sHc-:IFFELE `Dfmlosfrc AND ELECTRO-SURGICAL APPLIANCE Filed Aug. 6, 1943 2 Sheets-Sheet 2 RYL imode, to straightensaid Patented Aug. 14, 1945 DIGNos'ric ANDELECTRUSURGIGAL i Sheiele,

\ Chicago, ll., asslignor to William `J. Cameron, Chicago, Il 1 l Application August 6, 1943, Serial No.y 197;639

' s claims. (c1. 12844) My present invention relates geifiei'iailly to surgical appliances. Although this'de'vice is adapted to be used for a variety ot purposes, it has been especially devised for examination, treatiiint and surgical procedure at the signioid flexurevor region of the colon'in the human body, and Vit preferably employs aradio high-frequency eur'- rent which maybe readily controlled by the oper'- ator at al1 times."

The appliance which I have invented comprises a tubular body having 'a suitable -guideway that is adapted to receive an elongated semi-rigid conductor which carries electrode at its distal end, said electrodetbeing connected-tothe conductor by means of a readily eiible extension of conductive material which renders lit capable of universal movement or adjustment Within certain limits.- This pe'i'inits th ltiod, when it is projected beyond the distal end of the tubular body, to be controlled lto such extent thatv yit may be placed in proximity to the tissues come prised with a relatively large area within the colon. Means also arefpiovide'd in Connection with my surgical appliance lwhereby' the area be ing examined or treated may billuminatedfor observation by the operatord 1' I-h e electrode is adapted, among other things, tosar c'rrftldaguL late the tissue ina relatively short period of time and sterilize the same, and this' the Wall of the colon is in distefded position and under observation by thel operator who has f'll vision oi' the area underI treo;tfnerit.Y Provision is made whereby vapors, which are frequently cre# ated during treatment or operations 'of this char-Y acter, may lie-vented tromvthe cavitythr'oughthe medium of a suction'passag'e ayand'- thus avoid any fogging of the walls of -tlieappl'iance or of the lenses in an observation latter is employed in ance.

One of the special faturesboi this appliance is the electrode and its associated elements. This embodies a. normally curved, flexible conductor member extending from the distal end` of .the semi-rigid conductor member, which latter inem` connection with this amsn-4 ber constitutes the major.y portion of an elongated structure. Both of thes'e members `are hollow, and there is a small r'od. that is moved longitudinally Within the conductors and is adptaiwhile it is moving in the :flexible conductor towards the ele'ccurvedf' distal conductor, thereby adjusting theA eieetrode into af variety of operating positions;` it wiii be' seen that the eiectrodehas arniiversai adjust ent certain lmis S that i'i'.'I'tl'la'ylbrditld ih posi-2" is perferniedwniie telescope' when the kinddescribed herein that is Vdependable parts' that vare capable of withstandtion about the axis ci the Senn-'rigid and straight maior portion of the conductor structure.

onev of the aims 'cf improvements is te provide a surgical appliance of a novel character, and which is adapted to perform its required functions in an eii'ctive marmer, Anctiierobiect or aim is to provide a surgical appliance of the made ofsturuy and iii-g heavy duty and 'which may be readily sterili'z'ed by boiling `or byotheir methods. The im'- provements which I .naive described herein are of compact arrangement; they are convenient to operate and adjust to the desired posit-ions; and

lthe appliance is economical toproduce so that it maybe manufactured and sold at a 'competitive retail price to the user. t yThe before-'mentioned and other objects,

and advantages of myl improvements will be'ob.-

vious to persons who .are skilled in the art after the construction and operation of this .appliance is understood from the vwithin description. t It is preferred to practice my invention in substantially the manner hereinafter fully described and as more particularly enumerated in the ,appended claims, and for a. better understanding. of my `said improvement,` referenceis, now made ,tothe ac,- comp'anying drawings that form apart ot this speciicaton. f c l.

In the drawings: Y c

Figure 1 is a viewin longitudinalside elevation of the surgical appliance which is shown. with suitable instrumentalities in cooperation there with.;q t v Figure 2 is a longitudinal sidee'elevation ofthe `obturator device which is used in connection with this surgical appliance, the device being, removed from the tubular body of the appliance.` n

, Figure 3 is an end view of the obturatorfhe'ad looking at the same on the transverse `plane of IineS-f-LFl-gure 2. f t Figure 4 is a transverse ,section ot: thermain tubular-.body member of the appliance, the view being on the plane 0! lineA 4M, Figure 1, with the several parte omitted. fr

Figui-e v6 is' a longitudinal side elevatioiiqot ineens for providing illumination at the distal end cf tir-appiiance. Y

rieure 7 is a icngitfcirfai side eievetin of the away to simplify the showing. y l r The surgical appliance which haslbeenshow'n" stoodI asbeingmore orl purpose .of illustrating@J ,typical ,or. preferred Figure 11 is a fragmentary vertical section:

taken on the plane of the brolgerr line .I ITI I iri Figure 9, portions of the head at the proximal,

end of the electrode and its carrier being broken herein is especially designed;.or,l examination,l

` treatment and surgical procedure in cavities of., the human body, particularly in the intestinalr tract., and. this applianers .adapted .to ...illuminate the areapin ,11,J. e s,t ion.W Itfvvillbe Iunderstood that this isbut one of. a number .of Auses .tdwhichthe ,appliance maybe ,nutyfithcut modification or its general structureand assembly.V l

The Aace.cmpariying drawings are less schematicV for.; the

embodiment ,of .my improved .surgical appliance andits .various parts, `andin said,.draWings ,the ysamereference characters are .employed for the ypurpose-of identifying. the same .parts wherever Isuch parts appear 4in .the .different views thereof.

Mysurgical appliance-.as shovvn inthe accompanying .drawingsfcomprisesan elongated .body

.Ill inthe form'ofvfatube thatfis@providedatits proximal end with an annularffiaredflange: II

that may--be utili-Zedfor detachably mounting a` suitable handle, or telescope, Vor other accessory :Whichris `not shown.- The lower segmentof this tubular. body is.- providedtwith a pair oflongitudinally extending -pipes I 2 and I3 that are preferably `disposedalongside. each other with their axes Vparallel to each other.-v .These pipes. I2 and diameter but slightly less than the inside diameter of the tube I0, and it is carried upon the end of an elongated rod I6, While the other end of this rod, which is long enough to protrude beyond the proximal end of the tube, is provided with a knurled handle I1 for easy manipulation. At the proper location on the rod there is a stopper or plug I8 that vvill enter the proximal end of, the tubular body andV hasA an annular bead or iiange I9 that is adapted'to' abut the end of the tube or its flange II to maintain the obturator in a proper position with its conical end projectedbeyond-the end of said tube.

Parallel concave grooves 20 and 2| are made in the circumference of the head I5 to permit the latter 4to'move inthe tubular body and escape or acvcommodate itself to the portions of the pipes I2 ,and I3 where the latter project into the tube I0. It ywill be understood, that after the appliance has been inserted to the desired location, the obturator is Withdrawn from they tubular body .I0 Whichvwill leave the latter freel for the operatorto inspect and voperatefuponfor treat the tissue in the cavity when the latter has been illuminated.

I3 areof .different diameters and constitute guides to .receive certain instrumentalitiesthat are constituent parts of thev appliancej and are adapted forA cooperativefuse as vvill--la`.terbev explained herein. The axes of these guide pipesuarenot parallel with the axis of the'tubularfbodybut they. are oblique thereto `and. f are y convergent in a direction towards thedistal-end ofthe body so that at the proximal portion-oi the body the pipes I2 and I3 are disposed outside the circumference of i the-body while l atY the v@distal portion `said pipes .are .inside orvvithinfthe tubular body as shownfrespectively in Figures 5 *and-4.: Inv order to take Careof4 thisparticular arrangement, `the tubular bodyis provided -witha graduallytapering longitudinal enlargement or` channel ..I4 exs tending outwardly from its circumference toV pro'- vide a-convenient ,seat/in. which the pipes- I 2 and I3 are placed side, by sideand brazed or soldered intheir. respective permanent. positions. L. ,L

The use of this appliance, in thepolon requires that. its; .distal ,end be inserted. through; theanus and rectum and inwardlytothesigmoid iiexure Where. .1211 Surg9a1-pl'9cdll1f *cakes 131266,2111 this' 'ifisrtigfi seguid. 1P@ readily aszqmplished Without-injury to the membrane/vor 1tissuepast whicnitis moved. rTo accomplish thiathe ,distal end. f tii'tubulalfbody is.giQSlsdbY-a1i-0bturat9t Whi'chucomprises a head I 5lLliayving,l an lacorn-l Shaped' apical end, 5a :Sadziieaghas Westside l that is reinforced by a I have shown, in Figure, one of severalmeans which may be. employed .for-illuminating the tissue or membrane thatis contiguous the distal yend* of the appliance, but it will be understood that other similar devices maybe used for this purpose, suchfor examplev asl a lamp which may be'mountedupon the flared flange II on the main `tube I0. This illuminatordevceconsists ofha pipe 22 havingfa laterally bent., end portion 23 web. .24, saidy bent. portion terminating `,ina cylindrical belleshaped end 25 that is open at its outer endwhere it houses a pair of electric terminals 2 6., 26, which are separated from eachother by insulation andare connected to the ends of small electric conductor Wires 21, 2 1.- At the otherV end ofthe pipe 22,-a sleeve, 28` of insulatingl materiali projects axially therefrom and envelops a small electric socket'29 innwhich aminiatureelectrio lightv lamp 30 is mounted. The terrninalsofI the socket are electrically connected tothe ,conductorsxZ'L 21, and thevlatter are maintained .in spaced. relation to each otherwithin the tube `22 by means of suitable insulation.v seen. in Figure 6the lamp 30 preferably projects outofand beyond the insulation sleeve and when the tube 22 is .inserted its distance into theV larger guide I2 saidvlamp will bevdisposeda slight distance insidethe distal end of the tubular body I0 of the appliance yas shown in Figure jl, andthe rays'of light from the lamp will be emitted from thebodyzto illuminate the membrane or tissue adjacent. thereto. @It will be understood that the lateral tendzportion l23.of the tube 2 2 [affords a' convenient'- handleto 'be grasped in inserting the lamp andiitsmounting into the guide I2 and for removing the lamp therefrom, and italsowill benoted that the leading or free edge of the'rweb 24 constitutes` a stop that limits the inward'movementof' the lamp to positionrthe latter atv its desired locationwithin they tultaularbodywli).`v s

The guide pipe I 3 is adaptedtoreceive' and hold an instrument 'or accessory that"V u'pplied ,'With anqelectric current of the hig'l'i-freduency. radio instrument' by' a suitable feed. co

tails thereof yare shown in enlarged formin Figures 8, 9,.etc. H I. .1. -f -v i.

The device which is-shown comprises an'f'elo'ngated tube 3| of insulation suchas hardf'rubber, Bakelite (a resinous or phenolic condensation product), or any other suitable material that may be adapted for thepurposedesired. The .diameter of the tube 3| issuch that said tube maybe readily inserted intothe guidel pipe"|3, and it is of such length that its ends. will protrude beyond the ends of .the'tubular body l0 preferablyin the manner shown in the.` drawings "(Figure 1), wherein the protrudingportion of the proximal end is considerably longer than `.at .the distal end so that. said proximal portion may be. provided with instrumentalitiesfor manipulatingtthe instrument. i .i i As shown in enlarged detailin Figure 8, :the hard rubber or Bakelite tube telescopes upon and envelops an elongated tube32 of suitable conductive material, or metal, andfits end (to the left in Figures '7 and 8), carries a flexible member 33 that is adaptedvto. be moved or adjusted.into a variety of positions relative to and about the axis of the instrument. This member 33 is preferably a wire of ne `or small gauge that is wound-in' a spiral to form a flexible. hollow cylinder. The Wire is preferably.v spring' metal. and prior'to being tempered, and. after the spiralA has been formed, the member is shaped into an arcuate or curved form which will become permanentafter the temperingprocess has been completed, with the result :that said member :has .a normally curved axis such as suggested in dotted linesiin Figure 8 of the drawings. t f Y. M

One end of the-flexible member 33 is `inserted into the bore of the metal tube 32 .and is brazed, soldered or otherwisepermanently attachedl so that the hollow interior of thecoil forms a continuation ofthe bore ofthe metal tube 32, the other or free end of the ilexible member has'an electrode 34 anchored to it in any suitable'manner to close the outer free end and also to be in electrical connection with the metal coil33 'that forms the flexible member, so that-the electric current is transmitted from the metal tube 32 to the electrode 34. As illustrated in the drawings, the electrode 34 is spherical or globular in shape, but it will be appreciated .that other shapes may be used if it should be dictated for a particular type of use. 'I'he high-frequency radio current which is transmitted along the metal tube 32 and through the flexible extension (coil) 33 to the electrode 34, heats the latter to the desired temperature for the surgical procedure for which the instrument has been designed, and when said electrode is placed in contact with or close to the tissue it will cause a desiccation or coagulation thereof. In order to protect and insulate the coiled Wire extension 33, it is preferably surrounded by a jacket or sleeve 35 of relatively'fsoft or elastic rubber between the terminal electrode 34 and the end edge of the hard-rubber or Bakelite tube 3| so that said sleeve will readily conform to the shape of said flexible extension 33 and move with it when the latter is adjusted.

The normally curved or arcuate extension or iiexible member 33 which carries the electrode 34 at its end is adapted to be adjusted, by a, Warping action, into a variety of positions around the axis of the instrument and it is therefore capa- Ible of universal movement within certain limits. This adjustment or warping is accomplished by inserting a straight element longitudinally through the metal tube 32 and into the hollow flexible extension which will' progressively straighten the ourveor arc of said 'extension be' ginning at its anchored endnear the distalend of the inner-.metal tube 32 of the instrument and lmoving towards lthe electrode carried at the end lof f the iiexible member ,33. will move the electrode 34towardsfthe axis lof: the .instrument untilit has been alignedtherewith.. i.

The element which I prefer to employ-for per--V forming the function of warping theflexible ex.` tension 33 is an elongated wire or small rod- 36 that is of less diameter than. the inside diame. ter of thetube 32, and it is of such length that it will. extend fromy the free end portion of 4the iiexibleextension `33 and project from the-prox# imal end of said 4tube 32 whereit is provided with. an enlargement 31 of suitable insulating. material which constitutes A`a linger-grip by which the rod is manipulated. ..--An elongated,

tubular `gasket 38 surrounds the portion of. the rod 36 adjacent theinger-grip enlargement 3l, which .gasket .is of pliable material ,of a diame-` ter toV snugly vit within ythe proximal. end portion of. the tube 32. and thereby closey thel latter but at the same time permit the rodjto be in serted into the tube .and to be adjusted long i tudinally therein while itis performing; its func,-V tion of -warping the flexible'extension-.33'.4

`The end of the instrument opposite the elec.

'trede is inserted longitudinally through and anchored in the lateral horizontally .disposed arm 38 of a substantially Lg-shaped holder orvhandle.

- formed of hard-rubber or Bakelite, the other or longer arm 39 of said holder being disposed` oblique to the arm 38 and being provided with a longitudinal atial bore 40 that extends to near the top thereof. The lower open end of said bore 46 has an electric terminal connector 4| inserted and anchored in it with a portion projecting axially therefrom. s There is a .laterally disposed vent stub. 42 integral with the arm 33 of the L-shaped holder, which said stub has a rela-V tively small vborew43uthat communicates athits., inner portion with the bore 40 of the holder arm 38, and the tube 44 of a suction-bulb 45.,.isy adapted to be engaged over said ,stub .llthe purpose of which will later bev explainedmherein.

The tubular portion of this instrument, which' comprises the telescoped outer insulating tube 3|-` i and the inner metal tube 32, is of a length sol that, when the instrument has been inserted into its guide-pipe I3 until the holder arm 38 abuts the ilange on the obturator cylinder ID, the opposite ends of said tubes 3| and 32 will project out of the guide-pipe I3 and protrude slightly beyond the adjacent end of the obtura.- tor cylinder |0. There is a suitable clearance between the rod 36 and the inner metal tube 32, so that a. passageway 46 is provided within the elongated portion of the instrument which said passageway 46 is utilized to effectively vent the vapor, smoke, and the like, which may be created in performing the surgical procedure within the cavity. In order that this passageway 46 may communicate with the cavity, the tubes 3| and 32 are provided with one or more transversely disposed bores 41 at a location beyond the end of the guide-pipe |3. The opposite or outer end portions of the tubes are provided with a. discharge port 48 through which the vapor, etc., is emitted into the bore 40 of the arm 39 of the holder, and from thence said vapor is Withdrawn through the hollow vent stub 42 by the manipulation of the suction bulb.

This warping A recess or slot 49 is formed longitudinally in the insulating outer tube 3l, which said slot ex-Y tends with the holder arm'38 and the latter covers said slot. A conductor wire 50 is placed in said slot in contact with and is anchored to -the porconductor wire 50, the interior of `the holder,

alongside the-tubular members 3| and 32 of the l instrument, is channeled or grooved as at I to providefor thedisposition of the said wire 50. In this arrangement the electric current received bythe terminal plug 4I passes'through. successive portions of the instrument, such as the wire 5U,

the metal inner pipe 32, and the flexible iconductor 33, to the electrode 34.

Communication between the passageway 4E and the bore 40 of the arm 39 Yof the proximal head is established by forming a long longitudinal slot 52 in the conductor tube 32, which slot registers at one end with the small discharge port 48 in the insulating tube which leads into bore 40 of the head. At its other end said slot 52 extends beyond the inner end of the tubular gasket so that the vapor or the like will be by-passed alongside said gasket to the port 42.

What I claim as new is:

l. In a surgical appliance, ya flexible ductor of normally arcuate form; al hollow rigid conductor anchored `at`one end of said arcuate conductor in tangent relation thereto, said rigid conductor having vent ports at its distal portion; an electrode at the free end of said arcuate' conductor and normally eccentric to the axis of said rigid conductor; a rod movable longitudinally in said conductors, said rod during movement in said flexible conductor adapted to straighten the latter to move said electrode towards the axis of said rigid conductor, said rod having less diameter than the bore of said rigid conductor to provide an air-passageway therebetween com# municating with said vent ports; and suction means communicating with said air-passageway at the proximal portion of said -rigid conductor, said means adapted to exhaust vapor and the like from said air-passageway.

hollowr conf2; A'surgical 'applianceembodying a cylindrical body normally open at its ends; guideways within said body; a flexible hollow. conductor normally of arcuate form; a hollow rigid conductor anchored at one end to said arcuate conductor and `extending'tangent thereto; insulation enveloping said conductors and providing a unit removably inserted in one of said guideways; vent;ports in said unit adjacent the distal portion of said cylindrical body; an exposed electr'ode'at the free end of said arcuate conductor and normally concentric to the axis of said rigid conductor; a rod movable longitudinally in said conductors and in spaced relation to said rigid conductor` V to provide a passageway therebetween, said .rod-,during movement in said exible conductor adapted to straighten the latter to thereby move said electrode towards the axis of said rigid conductor; suctionv means communicating with said passageway at the proximal portion of said unit, said means adapted to exhaust vapor and the like from said passageway; and a light unit removably inserted in the other guideway, said light unit embodying an insulating tube; an electric lampat the distal end of said tube; and electric conductors within said insulating tube and in circuit` with said lamp.

:3. A surgical appliance comprising a cylindrical 'body normally open at its ends; a tubular guidewayin said body; a bowed hollow conductor of flexible material; a tubular conductor anchored at vone end to said bowed conductor; insulation enveloping said conductors for effecting a'unit removably inserted'in said guideway to project the flexible conductor out of the distal end of said body; means venting said unit adjacent said' il'exible bowed conductor; an electrode at the outer end of said bowed conductor; a, rod

' in said conductors, there being a passageway between said rod and said tubular conductor, said rodiadapted for movement into said bowed conductor to effect a radial movement of said elec` trode towards the axis of said unit; means for evacuating said passageway through the'proximal portion of said unit; and means removably inserted in said body for providing illumination adjacent the distal end thereof.

i.. SVHEIFFELE.

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