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Numéro de publicationUS3893454 A
Type de publicationOctroi
Date de publication8 juil. 1975
Date de dépôt6 févr. 1974
Date de priorité4 déc. 1973
Numéro de publicationUS 3893454 A, US 3893454A, US-A-3893454, US3893454 A, US3893454A
InventeursHagelin Karl Wilhelm
Cessionnaire d'origineStille Werner Ab
Exporter la citationBiBTeX, EndNote, RefMan
Liens externes: USPTO, Cession USPTO, Espacenet
Instrument for use in coniotomy
US 3893454 A
Résumé
A coniotomy instrument comprising a speculum portion and a knife unit the knife of which passes through the speculum portion and is adapted on application of the instrument to be advanced in such a manner that the knife point protrudes from the fore end of the speculum portion to facilitate penetration and which, after application of the instrument, is retractable to leave a free passage for air flow through the speculum portion. The speculum portion comprises two separable specula blades, each at a fore end of two tongs legs, and the knife unit comprises a U-shaped portion with two resilient U-shaped legs which slidably engage over the speculum portion and a knife blade which is centrally located between the U-shaped legs and extends through the speculum portion.
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Description  (Le texte OCR peut contenir des erreurs.)

[ 1] 3,893,454 July 8, 1975 INSTRUMENT FOR USE IN CONIOTOMY [75] Inventor: Karl Wilhelm Hagelin, Backvagen,

Sweden [73] Assignee: Aktiebolaget Stille-Werner,

Stockholm, Sweden [22] Filed: Feb. 6, 1974 [21] Appl. No.: 440,121

OTHER PUBLlCATlONS Salvatore, J. 15 A New Rapid Tracheotomy Instrument", in J.A.M.A. 16516: 20772078, 1957.

Primary ExaminerChanning L. Pace Attorney, Agent, or Firm-l-lill, Gross, Simpson, Van Santen, Steadman, Chiara & Simpson 5 7] ABSTRACT A coniotomy instrument comprising a speculum portion and a knife unit the knife of which passes through the speculum portion and is adapted on application of the instrument to be advanced in such a manner that the knife point protrudes from the fore end of the speculum portion to facilitate penetration and which, after application of the instrument, is retractable to leave a free passage for air flow through the speculum portion. The speculum portion comprises two separable specula blades, each at a fore end of two tongs legs, and the knife unit comprises a U-shaped portion with two resilient U-shaped legs which slidably engage over the speculum portion and a knife blade which is centrally located between the U-shaped legs and extends through the speculum portion.

8 Claims, 7 Drawing Figures PATHJTEDHL 8 1975 ,893,454

sum 2 dMQHYFDJUL mars SHEET 1 INSTRUMENT FOR USE IN CONIOTOMY BACKGROUND OF THE INVENTION Tracheotomy and coniotomy are steps which can be taken in order to release an obstruction in the airpassages of vertebrates, e.g. steps which can be taken to relieve situations of such a complicated nature as to render it insufficient merely to arrange the patient in a position to permit draining of the obstruction through the patients mouth, to cleanse the mouth cavity of the patient and to move the patients tongue forward, and with which it is impossible to effect endotracheal intubation, which involves the insertion of a pharynx tube and an endotracheal tube through the mouth.

Tracheotomy is a surgical remedy, in which an opening is made through the wall of the trachea and the soft portions of the larynx at a position located a few cartilages beneath the thyroid cartilage. This form of surgery is to be preferred when the opening is to remain for more than I or 2 days; the opening may in fact be left for many years, for example in the respiratory treatment of patients suffering from poliomyelities(sic) or in the treatment of patients who have been operated upon for cancer of the throat. Such surgery requires trained operators, assistants, special instruments, and should not be carried out when pressed for time.

In the event of acute air-passage obstruction when prevailing conditions do not permit endotracheal intubation or tracheotomy, coniotomy is performed instead, this operation being effected between the thyroid cartilage and the cricoid cartilage lying immediately therebeneath. From a technical point of view, this operation is much simpler to effect than tracheotomy and can also be carried out quickly by relatively untrained personnel, and hence it is recommended for use under conditions of war where the possibility of effecting endotracheal intubation or tracheolaryngotomy do not exist. A person versed in surgery will be able to perform the operation under primitive conditions in a short period of time, with the aid of a knife or even a sliver of glass. Once the situation has been temporarily remedied, the patient can be moved to a hospital where he, or she may be tracheotomized in the relative peace and quiet of the hospital environment, whereafter the coniotomy opening can be closed.

In the case of personnel unacustomed to surgery, and particularly in the case of relatively poorely educated personnel, the performance of coniotomy can present difficulties. A plurality of comparatively complicated instruments have been proposed, for the purpose of overcoming these difficulties, and certain instruction in the use of such instruments is given by the Swedish national defence forces, for example. It can be said in general that the simpler the instruments the greater the surgical expertise is required to use the instrument. On the other hand, the more complicated the instrument is the greater is the number of manipulating sequences required, with attendant loss in time, while at the same time the more complicated instrument is heavier and more expensive than less complicated instruments.

BRIEF SUMMARY OF THE INVENTION The object of the present invention is to circumvent the drawbacks of the coniotomy instruments as known hitherto by providing an inexpensive coniotomy instrument of simple design which enables coniotomy to be performed rapidly and reliably by persons only relatively briefly instructed in the use of said instrument, thereby enabling the instrument to be used not only by medical personnel but also by ambulance drivers, nurses etc.

Basically, the coniotomy instrument according to the invention comprises a speculum portion which is adapted to be introduced into the trachea of the patient, and a knife unit the knife of which passes through the speculum portion and is adapted on application of the instrument to be advanced in such a manner that the knife point protrudes from the fore end of the speculum portion to facilitate penetration, and which, after application of the instrument, is retractable to leave a free passage for air flow through the speculum portion.

In one embodiment of the coniotomy instrument according to the invention the speculum portion comprises two separable specula blades, each at a fore end of two tongs legs, and the knife unit comprises a U- shaped portion with two resilient legs which slidably engage over the speculum portion and a knife blade which is centrally located between the legs and extends through the speculum portion.

Preferably, the resilient yoke legs are provided with abutment means to limit the depth of introduction of the instrument with the knife unit in its foremost position on the specula blades, and preferably the length of the knife should be such that with the instrument introduced to a maximum amount the point of the knife is situated essentially centrally of the trachea of a normal patient.

BRIEF DESCRIPTION OF THE DRAWINGS In the drawings wherein like reference characters indicate like or corresponding parts:

FIG. 1 shows in perspective a speculum portion of the coniotomy instrument of the present invention;

FIG. 2 shows in perspective a knife unit of the coniotomy instrument according to the invention;

FIGS. 3-5 illustrate diagrammatically how the coniotomy instrument shown in FIGS. 1 and 2 is used;

FIG. 6 shows in perspective a greatly simplified version of a two-part speculum portion of a coniotomy instrument according to the invention; and

FIG. 7 shows in perspective a knife unit which is slightly modified in relation to the knife unit shown in FIG. 2 and which is intended for use together with the speculum portion shown in FIG. 6.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS OF THE INVENTION The coniotomy instrument shown in FIGS. 1-2 comprises a speculum portion, generally shown at 10, and a knife unit, generally shown at II. The speculum portion 10 has two frustoconical specula blades l2, 13, with an opening 14 formed therebetween. The specula blades l2, 13 are formed on the front ends of two tongs legs l5, l6 capable of being moved towards and away from each other,'said legs with the illustrated embodiment being pivotally connected together at pivot point 17. The legs 15, 16 are spring biassed for movement towards each other by means of a suitable spring 18. The construction of the legs l5, 16, the pivot bearing 17 therebetween and the construction of the spring means actuating said legs, can be varied within wide limits. Further, the spring means may be omitted, if desirable. The speculum portion 10 can also be made from a wide variety of materials, even though hitherto the most suitable material is considered to be that normally used in the manufacture of conventional hospital and nursing instruments.

The knife unit 11 is preferably made of steel and is designed to straddle the specula blades 12, 13. The knife 11 has a knife blade 19 located centrally between two resilient legs 20, 21 of a U-shaped member. The legs 20, 21 are formed integrally with a bight portion 22, also referred to herein as a back plate or web member of said U-shaped member. The web member and the legs are bent from a strip-shaped blank in a manner to form wing-like grip portions 23, 24 at the junction between the web 22 and the rear ends of the legs 20, 21. In the process of manufacturing the knife unit by bending the aforementioned strip-shaped blank, abutment plates 25, 26 are formed on the front ends of the legs 20, 21, said plates 25, 26 projecting laterally outwards on respective sides of the knife blade 19. Prefer ably the knife unit 1 1 is provided with appropriate locking means which enable the knife unit 11 to be held on the specula blades 12, 12 in a predetermined position, in which the point of the knife is located inwardly of the fore ends of the specula blades 12, 13, Le. inwardly of the front end 13a of the specula blades 13 (FIG. I), for example, thereby obviating the need of providing means to protect the knife edge. One example of such locking means is illustrated in FIG. 2 in the form of a small groove 27 on the inside of the leg 20, said groove being intended to snap over the edge 28 of the rear end of the specula blade 12 when the knife unit 1 1 is mounted to the speculum portion 10. Many different types of locking arrangements suitable for the purpose envisaged are conceivable.

The manner in which the eoniotomy instrument shown in FIGS. 1 and 2 is used will now be described with reference to FIGS. 3-5: The shoulders of the patient are supported so that the patients neck is arched rearwardly. If time permits, the region where the incision is to be made is cleansed and a local anesthetic applied. The instrument is held in one hand with the thumb resting on the back plate 22 of the knife unit 11. In order not to unnecessarily obstruct vision of the knife unit in FIG. 3, the thumb is purposely shown wrongly positioned. The knife unit 11 is affixed to the speculum portion so that, as the instrument is gripped, the knife point 19 is located behind the front ends of the specula blades 12, 13, Le. in an inwardly withdrawn position. Subsequent to gripping the instrument, the thumb is pressed against the back plate 22 of the knife unit 11 to move the knife unit forwardly on the specula blades 12, 13 unit] the back plate 22 engages the rear ends of the specula blades 12, 13. The point of the knife 19 then projects a predetermined distance beyond the fore ends of the specula blades 12, 13.

The place where the incision is to be made is then localized with the index finger of the other hand and the instrument is placed at right angles to the trachea with the point of the knife 19 located as close as possible to the center line thereof. Then the knife is caused to pass through the soft portions of the throat and into the lumen of the trachea, essentially by exerting pressure with the thumb, until the abutment plates 25, 26 of the knife unit 11 engage the throat. The wing members or abutment plates 25, 26 are, of course, intended to prevent the knife blade 19 from penetrating too far into the lumen of the trachea; it will be perceived that for this reason the instrument should be so dimensioned that with the abutment plates 25, 26 abutting the throat, the point of the knife 19, with a normal" patient, should reach to the center of the trachea and that tolerances should be provided for ensuring reliable function of the instrument and safety of use with respect to adult patients whose dimensions deviate from normal.

Subsequent to the knife blade's 19 having been inserted in the aforedescribed manner, the thumb of said one hand is removed from the back plate 22 of the knife unit 11, whereafter the knife unit 11 is grasped between the thumb and index finger of the other hand and fully withdrawn (FIG. 4) while the speculum portion is retained in position. The speculum portion 10 is then widened, to enable air to pass through. In the case of emergency, the patient may be transported in this state, optionally subsequent to pivoting the speculum portion 10 so that thetongs legs lie parallel with the longitudinal direction of the trachea.

As illustrated in FIG. 5, however, it is to advantage to insert a tracheal cannula provided with a cuff, a shown generally by the reference 28A in FIG. 5. The cannula comprises in principle a bent pipe having an inflatable cuff at its inner end. If such a cannula is used, the speculum portion may be removed, of course. Subsequent to placing the cannula in position and inflating the cuff, respiration can be given to the patient, either by means of an oxygen treatment apparatus of the like or by blowing in air.

The coniotomy instrument illustrated in FIGS. 6 and 7 is a simplified embodiment of the aforedescribed instrument. The instrument shown in FIGS. 6 and 7 comprises two specula blades 29, 30 which are slightly bent and pivoted relative to each other either in the form of a fixed pivot connection (eventhough said parts are shown separated) or in the form of a loose pivot connection comprising a pivot cup and a pivot head at each edge of the specula blades 29, 30. Each of the specula blades 29, 30 has at its rear end two grip wings 31, 32 and 33, 34, respectively. The instrument shown in FIGS. 6 and 7 also has a knife unit 35, the two legs 36, 37 of which converge towards each other in a direction toward the point of the interlying knife blade 38. The dimensions of the instrument area such that the rear edges of the specula blades 29, 30, when the knife is inserted, engage in recesses 39 in the legs 36, 37. The front ends of the specula blades then lie close together, abutting the sides of the knife blade 38. Subsequent to inserting the instrument, the knife unit can be retracted until the edges of the specula blades snap into recesses or grooves 40 in the yoke legs. The yoke legs then move the rear portions of the specula blades together by pivoting around the pivot points of the specula blades, so that the opening between the front ends of the specula blades is widened to permit air to enter the trachea. The wings 31, 32, 33 and 34 can be used as holding means when the knife unit is retracted.

Having thus described my invention it will be apparent that various immaterial modifications in the same way may be made without departing from the spirit and scope of my invention.

What I claim is:

1. An instrument for use in coniotomy, comprising:

a. a speculum portion including blades jointly defining an air flow passage extending between an outer and an inner end thereof; and

b. a knife unit having a blade movably introducible through said air flow passage and so advanceable that the point of the blade can protrude from said inner end of said speculum portion;

whereby said speculum portion provides guidance for said knife unit, and whereby said air-flow passage becomes unrestricted in response to retraction of said knife unit.

2. A coniotomy instrument according to claim I in which said speculum portion comprises complemental hollow semicylindrical blades.

3. A coniotomy instrument as claimed in claim 1, wherein the knife unit is generally Ushaped and comprises a bight portion which forms a finger grip portion and two resilient legs extending from said bight portion, mutually spaced from each other, said legs being adapted to straddle said speculum portion to slidably and removably hold the knife unit thereon and between which said knife blade is centrally located.

4. A coniotomy instrument as claimed in claim 3, wherein said knife unit has latch means for holding said knife unit in a predetermined position on the speculum portion.

5. A coniotomy instrument according to claim 4 in which said latch means comprises at least one groove in one of said legs.

6. A coniotomy instrument as claimed in claim 3 wherein said resilient legs have abutment means for limiting the depth of introduction of the knife blade when the knife unit is in its most advanced position on the speculum portion, and wherein the length of the knife blade is such that the point of the knife blade will extend to substantially the center of a trachea.

7. A coniotomy instrument as claimed in claim 2 wherein the knife unit is generally U-shaped and comprises a bight portion which forms a finger grip portion and two resilient legs extending from said bight portion, mutually spaced from each other, said legs being adapted to straddle the specula blades to slidably and removably hold the knife unit thereon and between which said knife blade is centrally located.

8. A coniotomy instrument as claimed in claim 4, wherein said resilient legs have abutment means for limiting the depth of introduction of the knife blade when the knife unit is in its most advanced position on the speculum portion, and wherein the length of the knife blade is such that the point of the knife blade will extend to substantially the center of the trachea.

Citations de brevets
Brevet cité Date de dépôt Date de publication Déposant Titre
US831592 *21 mars 190625 sept. 1906Joseph H BallardGynecological appliance.
US2406647 *10 août 194427 août 1946 Caponizing instrument
US3182663 *8 mars 196111 mai 1965Louis AbelsonCricothyrotomy needle
US3476113 *24 août 19674 nov. 1969John J TarsitanoPocket-sized crico-thyrotomy set
Référencé par
Brevet citant Date de dépôt Date de publication Déposant Titre
US5186168 *6 juin 199016 févr. 1993Spofford Bryan TTranstracheal catheter system and method
US5297546 *4 sept. 199029 mars 1994Bryan T. SpoffordTranstracheal catheter system and method
US5407427 *10 mars 199318 avr. 1995Loma Linda University Medical CenterTrocar facilitator for endoscopic surgery
US5443484 *14 mars 199422 août 1995Loma Linda University Medical CenterTrocar and method for endoscopic surgery
US5569300 *12 avr. 199529 oct. 1996Redmon; Henry A.Dilating surgical forceps having illumination means on blade inner surface
US5577993 *13 janv. 199526 nov. 1996Loma Linda University Medical CenterTrocar facilitator for endoscopic surgery and method of using the same
US5899854 *20 avr. 19984 mai 1999University Of New MexicoSpeculum and method for inserting an elongated instrument into an animal's body
US5951466 *13 avr. 199814 sept. 1999Viamedics, LlcSelf-seating surgical access device and method of gaining surgical access to a body cavity
US5967143 *27 août 199819 oct. 1999Klappenberger; JurgenSurgical instrument for emergency medicine
US5988168 *16 mai 199723 nov. 1999Bair; Aaron E.Method and apparatus for establishing a surgical airway
US621760229 juil. 199617 avr. 2001Henry A. RedmonMethod of performing illuminated subcutaneous surgery
US6302842 *11 janv. 200116 oct. 2001Innovative Surgical Design LlcEpisiotomy retractor
US630934910 avr. 199730 oct. 2001Endoscopic Technologies, Inc.Surgical retractor and stabilizing device and method for use
US63123777 août 20006 nov. 2001Viamedics, LlcSoft tissue compression shield and method of retracting tissue
US64886202 oct. 19983 déc. 2002Viamedics, LlcSelf-seating surgical access device
US674639613 avr. 19998 juin 2004Viamedics, LlcSelf-seating surgical access device and method of use
US68903421 août 200110 mai 2005Loma Linda UniversityMethod and apparatus for closing vascular puncture using hemostatic material
US720799230 sept. 200224 avr. 2007Stephen RitlandConnection rod for screw or hook polyaxial system and method of use
US745563916 sept. 200525 nov. 2008Stephen RitlandOpposing parallel bladed retractor and method of use
US748176613 août 200427 janv. 2009Synthes (U.S.A.)Multiple-blade retractor
US76550251 mars 20052 févr. 2010Stephen RitlandAdjustable rod and connector device and method of use
US76823758 mai 200323 mars 2010Stephen RitlandDynamic fixation device and method of use
US769549830 janv. 200713 avr. 2010Stephen RitlandConnection rod for screw or hook polyaxial system and method of use
US775393910 févr. 200413 juil. 2010Stephen RitlandPolyaxial connection device and method
US776304720 févr. 200327 juil. 2010Stephen RitlandPedicle screw connector apparatus and method
US778069916 juin 200324 août 2010Loma Linda University Medical CenterVascular wound closure device and method
US79595649 juil. 200714 juin 2011Stephen RitlandPedicle seeker and retractor, and methods of use
US798524518 nov. 200526 juil. 2011Stephen RitlandConnection rod for screw or hook polyaxial system and method of use
US801216716 août 20046 sept. 2011Loma Linda University Medical CenterVascular wound closure device and method
US802139919 juil. 200620 sept. 2011Stephen RitlandRod extension for extending fusion construct
US806221728 janv. 200822 nov. 2011Theken Spine, LlcSurgical retractor with removable blades and method of use
US819246328 avr. 20085 juin 2012Mcloughlin JosephSurgical retractor and related methods
US822145926 juil. 201017 juil. 2012Stephen RitlandPedicle screw connector apparatus and method
US8262571 *24 mai 200411 sept. 2012Stephen RitlandIntermuscular guide for retractor insertion and method of use
US8356598 *6 mars 200822 janv. 2013Pyng Medical Corp.Apparatus and related method for providing a passage into the body
US84255524 avr. 200523 avr. 2013Loma Linda University Medical CenterApparatus for closing vascular puncture
US848611122 juin 200616 juil. 2013Stephen RitlandDynamic fixation device and method of use
US849162824 août 201023 juil. 2013Loma Linda University Medical CenterVascular wound closure device and method
US85237702 mai 20123 sept. 2013Joseph McLoughlinSurgical retractor and related methods
US858573923 mars 201019 nov. 2013Stephen RitlandDynamic fixation device and method of use
US8652036 *25 oct. 201018 févr. 2014Beaver-Visitec International (Us), Inc.Speculum
US868506223 mars 20101 avr. 2014Stephen RitlandDynamic fixation device and method of use
US86909221 mars 20108 avr. 2014Stephen RitlandDynamic fixation device and method of use
US870275022 mars 201322 avr. 2014Loma Linda UniversityApparatus for closing vascular puncture
US8795165 *8 janv. 20075 août 2014Medical Components, Inc.Pivoting dilator
US87953262 oct. 20085 août 2014Covidien LpExpanding seal anchor for single incision surgery
US884569419 sept. 201130 sept. 2014Warsaw Orthopedic, Inc.Rod extension for extending fusion construct
US89323349 sept. 200513 janv. 2015Stephen RitlandDynamic fixation device and method of use
US910173120 juin 201311 août 2015Loma Linda University Medical CenterVascular wound closure device and method
US92329677 avr. 201412 janv. 2016Stephen RitlandDynamic fixation device and method of use
US932050528 févr. 201426 avr. 2016Loma Linda UniversityApparatus for closing vascular puncture
US947451820 juin 201425 oct. 2016Covidien LpExpanding seal anchor for single incision surgery
US962279029 sept. 201418 avr. 2017Warsaw Orthopedic, Inc.Rod extension for extending fusion construct
US20010053922 *13 août 200120 déc. 2001Zhu Yong HuaTissue opening locator and everter and method
US20040002708 *8 mai 20031 janv. 2004Stephen RitlandDynamic fixation device and method of use
US20040054346 *16 juin 200318 mars 2004Zhu Yong HuaVascular wound closure device and method
US20050080320 *13 août 200414 avr. 2005Lee Andrew MaxMultiple-blade retractor
US20050149023 *1 mars 20057 juil. 2005Stephen RitlandAdjustable rod and connector device and method of use
US20050209637 *4 avr. 200522 sept. 2005Zhu Yong HApparatus for closing vascular puncture
US20050234497 *16 juin 200520 oct. 2005David HungExternally positioned medical dilator
US20060009768 *9 sept. 200512 janv. 2006Stephen RitlandDynamic fixation device and method of use
US20060079899 *18 nov. 200513 avr. 2006Stephen RitlandConnection rod for screw or hook polyaxial system and method of use
US20070189968 *20 mars 200716 août 2007Annette BianchiGel composition for filling a breast milk duct prior to surgical excision of the duct or other breast tissue
US20070250100 *8 janv. 200725 oct. 2007Medical Components, Inc.Pivoting dilator
US20080257359 *6 mars 200823 oct. 2008Royce RumseyApparatus And Related Method For Providing A Passage Into The Body
US20100160969 *1 mars 201024 juin 2010Stephen RitlandDynamic Fixation Device and Method of Use
US20100174318 *23 mars 20108 juil. 2010Stephen RitlandDynamic Fixation Device and Method of Use
US20100179596 *23 mars 201015 juil. 2010Stephen RitlandDynamic Fixation Device and Method of Use
US20110022094 *26 juil. 201027 janv. 2011Stephen RitlandPedicle Screw Connector Apparatus and Method
US20110046664 *24 août 201024 févr. 2011Loma Linda University Medical CenterVascular wound closure device and method
US20110098538 *25 oct. 201028 avr. 2011Beaver-Visitec International (Us), Inc.Speculum
US20110200695 *25 avr. 201118 août 2011Annette BianchiGel composition for filling a breast milk duct prior to surgical excision of the duct or other breast tissue
WO1997037596A1 *10 avr. 199716 oct. 1997Endoscopic Technologies, Inc.Surgical retractor and stabilizing device
WO2002054961A1 *8 janv. 200218 juil. 2002Innovative Surgical Design LlcEpisiotomy retractor
Classifications
Classification aux États-Unis600/219, 600/225, 128/207.29, 600/235
Classification internationaleA61M16/04
Classification coopérativeA61M16/0472
Classification européenneA61M16/04E8