US 2484059 A
Description (Le texte OCR peut contenir des erreurs.)
Oct. 11, 1949. F. J. WALLACE ELECTROSURGICAL RESECTING INSTRUMENT 2 Sheets-Sheet l Filed July 10, 1945 Y. u ummm. [.Illlw Oct. 11, 1949. F. J. WALLACE ELECTROSURGICAL RESECTING INSTRUMENT Filed July 1o, 1945` 2 Sheets-Sheet 2 Patented Oct. 11, 1949 INST - RUMENI.`
Frederick. J. Wallace, New York, N. Y., assignor to American ystoscope MakersLInc., New York, N. Y., a corporation of New York Application July 10, 1945, Serial No. 604,220 9`C1ams. (C1. 12s-303.15)
This invention relates to a surgicalinstrument, and more particularly to such an instrument adapted, among other things, to remove protrusions, tissue growths and the like by resection with the aid of a highfrequency electric current.
The instrument of this invention has wide application in the leld of surgery and is capable of readily resecting protrusions on. the exterior of a body and protrusions, tumorous growths or -other masses of body tissue in body passages and cavities. For example, the presentinventionm-ay be readily employed for the resection of protrusions in the urethra and. bladder neck, and for the excision of undesirable growths on theV prosltate gland and other internal organs.
As will be apparent to a person skilled in the art from the detailed. description that' follows, the instrument may be inserted in a. body passage or cavity to the region of the protrus'ion or the like which is to be removed', whereupon the protiusion or the like may be resected by a high frequency cutting electrode under conditions of illuminated vision. One of the features of the invention resides in the provision of a cutting electrodeY that is adapted to be rotated:A continuously and automatically, to the end that the protr-u'sion ortissue growth may be quickly amr readily resected with a minimum of effort and strain on the surgeon operating the instrument, and with correspond*- ing reduction in discomfort and ifm-general 13h-Ys'- ical and nervous effect on the patient-a In present day high frequency elfectrosurgical instruments, the cutting electrodes have to be manually actuated by thel surgeon to cut away a piece of a protrusion` ati-a timer procedure involves the cutting off of a relatively small portion of the protrusion with each manual actu-- ation of the cutting" electrode. This is objet; tionable for several reasons. First, the resection or excision of a large mass of tissue by taking small individual cuts is a. tedious and vtimely operation. Also;A asurge'o'n perf-ornngtlie rcsection in this man-'ner is under consid'era-blel physical strain and nervous tension asf heisl obliged to manually actuate the electrode. for each- `individual cut in pruning away a--mass of tissue. Moreover, .the patient may also bev under cone sid'erable strain` during theoperationan-d is quite often subjected to pain yand discomfort due to the presence of the instrument'in: his` body and as a consequence of the operationof the instru-- ment.
The present invention eliminates these objections as it contemplates the employment-of an Velectrode having a cengurationandso arranged .to the Vrotary shaft andthe. electrode.
, Z as tobe continuously operated :at the will of the surgeon Vand expeditiously resect protrusions without undue discomfort to the patient and with a diminution of elort and strain on the :part of the surgeon.l The instrument may in'- clude an endoscopic tube having a lateral fenestra and provided with a removable telescope having Aa source of illuminati-on opposite the fenestra. A rotary shaft is mounted inthe endoscopic tube and. has secured thereto a cuttingV electrode,y disposed. in the region of the fenestra and rotatable with the shaft. One preferred form of cutting electrode is substantially helical in configuration and attains a screw-like movement in the course of its actuation. by the rot-ary shaft; The endoscopic tube, telescope, and rotary shaft are `mounted at their rearward ends on a supporting device having a hollow handle in the form of a pistol grip. Preferably within the supporting devicev is `a prime mover andcooperating speed-reducing gearing for imparting continuous rotation The prime mover may comprise a suitable small electric motor or fluid actuated unit, as desired. Provision. is made in the instrument for transmitting and/or withdrawing uidthrough the instrument into and fromv a body cavity. The various parts may be readily assembled into the unitary structure and dismantled for repair and other purposes, as will be apparent from. the detailed dev seriptionthat fo11ows.-
It is the primary object of this invention to provide a surgical instrument for more readily and expeditiously resecting a protrusion or the like than has been possible heretofore.
This invention has for another object the provision of a high frequency electrosurgical instrument wherein the cutting electrode may be actuated continuously at the will of the operator.
It is another object of the invention to provide an instrument of. the character indicated, including a rotary cutting .electrode that is adapted to be continuously operated'through the mediumfof a driving unit, such as ran electric motor or a uuid actuated prime mover.
A further object of the invention. is to provide an electrosurgicalinstrument of the character described ythat is relatively simple and compact design, reasonable in manufacturing and upkeep costs, and capable of performing its intended functions in an. elective and trouble-free manner.
Theseobjects, las well as other objects, together withthe advantages obtainable by the practice ofv this invention, willy be readily apparent to persons skilled in the art by reference to the following detailed description taken in conjunction with the :annexed drawings which respectively describe and illustrate preferred embodiments of the invention.
In the drawings:
Figure 1 is a side elevational view of an instrument embodying the devices of the inv-ention, partly in vertical cross section` and with parts broken away for better illustration;
Figure 2 is a cross-sectional view taken `along line 2--2 of Figure 1;
Figure 3 is a cross-sectional view taken along line 3-3 of Figure 1;
Figure 4 is an enlarged cross-sectional View taken along line 4-4 of Figure l;
Figure 5 is an enlarged cross-sectional view taken along line 5-5 of Figure 1;
Figure 6 is an enlarged perspective view of a device employed with this invention;
Figure '1 is an enlarged view, partly in vertical cross section, of the cutting electrode and associated devices shown in Figure 1;
Figures 8-11, inclusive, are views similar to Figure 7 and illustrating modifications of the cutting electrode.
Referring now to the drawings wherein like reference characters denote corresponding parts throughout the several views, and more particularly to Figure 1, there is shown an outer endoscopic tubular member I5 provided at its forward end with a curved beak or nosepiece I8, having an aperture I1 that is substantially parallel with the axis of the tubular member, and provided with a lateral fenestra I8. The rearward end of tubular member I5 is preferably threaded externally for engagement with corresponding internal threads in a ared collar I9 to form an effective fluid-tight connection therewith. The rearward end of collar I9 is provided with a forwardly and inwardly tapered recess 20 and a passage'ZI in fluid communication with the interior of tubular member I5 and a conduit 22.
In Figure 6 there is depicted in enlargement a device 23 that is adapted to be inserted into and removed from tubular member I5 at will. Device 23 includes a unitary bundle of tubes 24, 25, V26 and 21, tube 24 being adapted to accommodate a telescope, tubes 25 and 26 being adapted to respectively introduce and withdraw an irrigating fluid through the instrument, and tube 21, having a longitudinal slot 28, being adapted to support an electrode shaft, all as more fully described further along herein. A depending support 29 is spaced from the forward end of tubes 25, 26 and 21, forming an opening 30 therebetween and having an aperture 3l that is axially coincident with tube 21 and aperture I 1 when the parts are in assembled relation, as shown in Figure 1. Secured in sealed relation to the rearward end portion of the bundle of tubes is a frustro conical collar 32 adapted to be received in recess 20 and form a snug iiuid-tight connection with collar I9. Collar 32 carries a flange 33 having a series of circumferentially spaced tapped openings 34, 35 and 36. As will be observed in Figure 3, tapped openings 35 are provided with petcocks 31 and 38, that respectively communicate through ducts 39 and 40 with corresponding tubes 25 and 26.
Collar 32 and associated parts are mounted on a supporting device that will now be described, and that includes a hollow handle 415 of the pistol grip type having a top wall 46. The upper forward portion of wall 46 is in the nature of a,
saddle 41 wherein ange 33 of collar 32 is seated and is attached by set screws 48 that engage with tapped openings 36 (Figure 3). A bore 49, closed at its rearward end by a screw plug 50, constitutes a compartment within which a prime mover, hereinafter described, is housed. Directly above this compartment is a block of insulating material 5I that may be composed of hard rubber. A bridge 152 is attached to block 5I by set screws 53 and to flange 33 of collar 32 by set screws 54. The forward end portion 55 of the bridge is bifurcated longitudinally to receive a post 56 that projects upwardly of collar I9. Post 59 carries a locking attachment 51 for effecting coupling,r engagement between the post and bridge 52. Preferably integral with bridge 52 at its rearward end is a 'depending arm 58 having a first opening 59 coaxial with a bore 68 in block 5I and with tube 24, and a relatively smaller second opening 6I vthat is parallel with opening 59.
A telescope, generally indicated by reference numeral 65, includes a tubular body 66 of relatively small diameter adapted to be inserted through opening 59, bore 69 and tube 24 so that an electric lamp 51 at its forward end may be positioned opposite fenestra I8 for providing illumination therethrough. The telescope is preferably constructed with a portion of enlarged diameter 83 that forms a snug frictional t with opening 59 in arm 58 and carries an aligning pin 89 that registers with opening 6I. At the rearward end of the telescope is an eyepiece 10. The telescope lens system (not shown) may be of any suitable type, such as, for example, the lens system disclosed in the patent to R. H. Wappler 1,680,490, granted August 14, 1928. The telescope is provided with the usual terminal members 1I, electrical plug 12 for lconnection to a convenient source of electricity (not shown), and a pair of contact arms 13.
A`rotary hollow shaft 15 is disposed within tube 21. Coaxially arranged within and spaced from the inner surface of hollow shaft 15 by a sheath of insulating material 16 is an electrically conductive rod 11. As will be noted from an examination of Figures 1 and '7, both end portions of rod 11 extend beyond the confines of hollow shaft 15, the rearward end portion of the rod being free of the insulating material.
A preferred form of the cutting electrode is shown in Figures 1, 5 and '7 and consists of a pair of electrically conductive wires 18, each of which is bent intermediate its ends to assume the generally helical illustrated configuration. The rear--4 ward end of each wire 18 is imbedded in the forward end portion of rod 11, while the forward end of each of these wires is imbedded in a shaftlike element of electrical insulating material 19 that is accommodated in aperture 3| of support 29 and aperture I1 of beak I6 for rotation therein when the parts are in assembled relation, as shown in Figure 1. A collar 8U is mounted on rod 11 and is spaced rearwardly of hollow shaft and insulating sheath 16. The extreme end portion 8l of rod 11 extends into an electrically conductive bearing 32 that is maintained in a cavity in block 5I by a screw plug 83 of electrical insulating material. Rod portion 8l is in close contact with block `82, which, in turn, is in electrical communication with an electrode terminal 84 that is adapted to be connected with a suitable source of high frequency electric current (not shown).
As is best shown in Figure 1, one end face of arraigado rodi- I2-Fandholiowfshart 'lili against rearward movement; Rod 'IT and hollow` shari; 155i are restrained against forward movement through theraid'f of 'a deter-it' means that will now be descrited,V having particu-lar reference' to'fFigures lia-nd?. Thisrrcludes ahollow plugiir threadedl'y mounted in one* side` ofblo'ckl 5i! and having a'vpin or detent @t reciprocable therein andextending therethrough; Detent tcarries a` lia-nge 811 and is norma-Hy and yielounglv1 urged toward the rig-ht, as viewed in Figure 2, through the coaction of iiang'fe sT and a coaxiali compression spring 88, to the endfthat anextremitv of decent this received in anopeningi? inthe block. The outer end'of detent 8E carriesA ai knob S- for manually moving t'he d'et'ent towardS ther left, as viewed in Figure 2`; againstthe` action of: compressionv spring 881 Etv W'lT be Observed' that deteilt 81E, when in' pr'O- tracted position, extendsV beneath rod 'H and fltearsY against theforward end face' ofcoll'ar 80 to` thereby restrain rod TT and shaft 15 against forwardtmovement.
Continuous rotation is imparted to hollow shaftY T5 and thence to`v the cutting electrode through the'rnediuin of driving devices shown` in Figure 1. These devices preferably include a prunenlover' or motor, denoted by reference character P', that is housed within compartment 49. The prime mover iii-ay :be Veither an electric motor or' a Huid; actuated unit of suitable ksize 'and` having requisite characteristics. A conduit Q2' extending through the .interior 'of4 hollow handle' 45" connectsat its upper' end with prime mover' P andv at. its lower end' with a coupling element 93 in the' bottom wall olf theV handle. If the prime mover is an electric moto'n, a cable havirig electric conductdrs is `passed upwardly through conduit 9'? to the motor and is connected to' an! appropriate source of electrical supply for f1.
energizing themotor. Should prime nio-verl? be a fluid actuated unit, the actuating uid is transmitted iront a convenient' source (not shown) to coupling element 93 through conduit 92, and
thence to the uniti prime mover may be *Y placed inand out of service-by a suitableiootoperated control (not shown). order that the surgeons hands may be free to handle the instrument andiperforhfi the operation. Integral with prime mover P is a speed-reducing device- R; that may consist ofen appropriate train of gears and that has .an-. aligning. pin- 94 registering with a blindv bore 95 in wall 4t.. Actuation of Aprime mover P and speed-reducing ldevice R imparts rotation to a drive gear $6 that meshes with an idler gear 9i which in turn engages a gear 98 formed'in the rear end of hollow shaft 'l-whereby continuous rotation is imparted to? cutting electrode 18.
The cutting electrode illustrated in Figure 8 consists essentially of a central longitudinal .portion that is parallel with the aXis of hollow shaft 15, a forward crank portion IDI that is imbedded in shaftlike element 19 and a rearward crank portion |02 that is imbedded in rod 11.
In Figures 9, and 11, there are illustrated three helical cutting electrode arrangements. Referring rst to Figure 9, the cutting electrode shown therein is in the form of a helical wire interposed between and imbedded at its opposite ends in element 'I9 and rod 17, respectively.
The helical wire cutting electrode l B4 of Figure 10 is coaxial and rotatable with a member |015 that constitutes an extension of rod 71, and that is welded or otherwise secured to the end portions 6 -l-an'd ISM? of? the cutting electrodm- Itwillabe noted-L' that.v with this type.I of constructicm. the forwardendfo'f member |115 is imbedded in element 19';
The cutting. electrode arrangement shownV in Figure. 11. contemplates a transparent core member [ed made-of an electrical insulating material', such as glass, and. having a rounded forward end portion Hill` adapted to be rotatably positioned in aperture 3! of depending member' Z9 arid'aper'- ture 1111 in the curvedf beak. 'll'ie rearward end portion Hill isrecessed vtonon-rotataloly-V engage the forwardy end of' rod-Tlf. Core2 member HI81L is fashionedwith an inner helical groove t'l I' andi a second helical' groove H2?, the-latter carrying' a helical cutting electrode wire H31 that its rearward" end portion IM arranged' in electrical contact with rod 11.
For the purpose ofy briefly outlining the'operation of the instrument of' this invention,V let us assume' that it is' to be used for the resection of a prostate growth.' The parts within endoscopic tubular member l5 are Yremoved andz anobturator is placed therein. The tubular member i5 is then inserted, beak endfirst, through the urethra until ren-estre i8i arrivesy at the proximate location of the prostate growth. The body iluidsy are withdrawn through the'sheath' and'conduit 2`2 and the obturator is withdrawn. Thev various other devices are then assembled in the' relative. positions shown Figure 1. Electrical"V connection with lamp 6-7- of telescope 65 is' made through plug l l. Electrode terminal 823' connected with one terminal of the source ofl high frequency electric' current; the patient being grounded or suitably connectedwith the Vother'"terminaliof" the high frequency current source. An'ir'rigating. liquid may be transmitted through petcocl: 31, duct 39 and tube 2,5 and`A withdrawn through tube. 2t, passage ,4'0 and the other :petc'ocll: 3l. The 'surgeen grips. handle' 4'5 in one hand and` sights through'the telescope to locate `the exact region where it is desired to carry outthe cutting operation;v He may manipulate the instrument tobring it to the proper region. within Vthe body. vrThe growth that isv to' be cut is accommodated within fenestra' I8, the high frequencyA circuit is com.-
pl'eted, and the prime mover placed in service. Y
At such time, the prime mover P, cooperating with speed reducer Rg, imparts rotation toy hollow shaft 't5' and" thence to cutting electrode 'la through meshing, gears Q5, Si? and 93.; It will be. readily apparent to persons skilled in the art that the instrument of this invention is so 'constructed and arranged' as to facilitate and expedite thev resection of the growth..
From the foregoing, itis believed that the construction,` operation and advantages of my pres'- ent invention will be readily comprehended 4by persons skilled in the art. It is to be clearly understood, however, that various changes in the apparatus may b-e resorted to without departing from the spirit of the invention, as defined by the appended claims.
l. In a surgical instrument of the character described, a tubular member having a fenestra formed therein, at least one electrode wire r0- tatably supported within the tubular member and positioned at least in part within the fenestra, a portion of the electrode wire intermediate its ends being substantially helical in configuration, and means comprising a motor for imparting continuous rotation to the electrode wire.
2. In a surgical instrument of the character described, a tubular member having a fenestra formed therein, al rotary shaft disposed in the tubular member, aV substantially helical cutting electrode positioned at least in part within the fenestra, said cutting electrode being substantially coaxial with the shaft and having one end secured thereto for rotation therewith, and means comprising a motor for imparting continuous rtation to the shaft.
.3, In a surgical instrument of the character described, a tubular member having a fenestra formed therein, a rotary shaft disposed in the tubular member, a substantially helical cutting electrode positioned at least in part within the fenestra,A said cutting electrode being substantially coaxial with the shaft and having its end portions afxed to the shaft for rotation therewith, and means comprising a motor for imparting continuous rotation to the shaft.
4. In a surgical instrument of the character described, a tubular member having a fenestra formed therein, a rotary shaft disposed in the tubular member, a transparent electrically nonconductive element substantially coaxial with the shaft and rotatable therewith, said element carrying a substantially helical cutting electrode p0- sitioned at least in part within the fenestra, and means comprising a motor for imparting continuous rotation to the shaft.
5. In a surgical instrument of the character described, a tubular member having a lateral fenestra, a supporting device removably secured to the tubular member, a rotary shaft journaled in the tubular member and the supporting device, a cutting electrode positioned at least in part within the fenestra and connected to the shaft for rotation therewith, means including an electric motor carried by the supporting device for imparting continuous rotation to the shaft, and means comprising a spring pressed detent for maintaining the shaft in operative engagement with the last mentioned means.
6. In a surgical instrument of the character described, a tubular member having a lateral fenestra, a supporting device removably secured to the tubular member, a rotary shaft journaled in the tubular member and the supporting device, a cutting electrode positioned at least in part within the fenestra and connected to the shaft for rotation therewith, means including a fluid actuated motor carried by the supporting device for imparting continuous rotation to the shaft, and means comprising a spring pressed detent for maintaining the shaft in operative engagement with the last mentioned means.
'7. In a surgical instrument of the character described, a tubular member having a lateral fenestra, a hollow supporting device removably secured to the tubular member, a rotary shaft journaled in the tubular member and the supe porting device, a substantially helical cutting electrode positioned at least in part within the fenestra, said cutting electrode being substantially coaxial with the shaft and having one end secured thereto for rotation therewith, an electric motor mounted in the hollow supporting device for imparting continuous rotation to the shaft and means comprising a detentfor maintaining the shaft in operative engagement with the electric motor.
8, In a surgical instrument of the character described, a tubular member having a lateral fenestra, a hollow supporting device removably secured to the tubular member, a rotary shaft journaled in the tubular member and the supporting device, a substantially helical cutting electrode positioned at least in part within the fenestra, said cutting electrode being substantially coaxial with the shaft and having its end portions afxed to the shaft for rotation therewith, an electric motor mounted in the hollow supporting device for imparting continuous rotation to the shaft and means comprising a detent for maintaining the shaft in operative engagement with the electric motor.
9. In a surgical instrument of the character described, a tubular member having a lateral fenestra, a hollow supporting device removably secured to the tubular member, a rotary shaft journaled in the tubular member and the supporting device, a transparent electrically nonconductive element substantially coaxial with the shaft and rotatable therewith, said element carrying a substantially helical cutting electrode positioned atleast in part within the fenestra, an electric motor mounted in the hollow supporting device for imparting continuous rotation to the shaft and means comprising a detent for maintaining the shaft in operative engagement with the electric motor.
FREDERICK J. WALLACE.
REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS It/aly Apr. 24, 1939
Citations de brevets