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[54] CRYOSURGICAL INSTRUMENT 14 Claims, 8 Drawing Figs.

[52] U.S.C1 128/303.1

[51] Int. CI A61b 17/36

[50] Field of Search 128/303,

303.1,400—402

[56] References Cited

UNITED STATES PATENTS

2,645,097 7/1953 Posch 128/400X

2,672,032 3/1954 Towse 128/303.1

2,982,112 5/1961 Reyes 128/303. IX

3,272,203 9/1966 Chato 128/303.1

3,451,395 6/1969 Thyberg 128/303.1

3,289,424 12/1966 Shepherd 128/303.1

3,369,549 2/1968 Armao 128/303.1

3,393,679 7/1968 Crump etal 128/303.1

3,398,738 8/1968 Lamb etal 128/303.1

Primary Examiner— Anton O. Oechsle
Assistant Examiner— Richard J. Apley
Attorney—Marechal, Biebel, French & Bugg

ABSTRACT: An instrument system for performing surgery using very cold temperatures which includes a pencil-like instrument adapted to have a liquefied gas evaporated near the tip of a probe to reduce substantially the temperature thereof. In order to increase the cooling effect, a vacuum is applied to the exhaust to increase the rate of evaporation. In one embodiment, the liquefied gas in the liquid state is used to raise the temperature of the probe, and the entire operation of the instrument is controlled from a single manual valve which may be mounted on the instrument or be a foot pedal.

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1

CRYOSURGICAL INSTRUMENT

RELATED APPLICATIONS

Reference is made to my copending applications Ser. No. 447,124, filed April 12, 1965 and now U.S. Pat. No. 3,439,680 and Ser. No. 596,705, filed November 23, 1966 and now U.S. Pat. No. 3,434,477, both assigned to the assignee of this application.

BACKGROUND OF THE INVENTION

Very cold temperatures have come into acceptance for many surgical operations and treatment, both on humans and animals. For example, cryosurgery is being used for treating brain tumors, for removing cataracts from the eyes, as well as for repairing detached retinas.. Much of the equipment designed heretofore has been very complex, bulky and heavy. It is difficult for the surgeon to master the operation of the apparatus without complete understanding of the technical details thereof, thus impeding the acceptance of these instruments. The hand piece utilized to apply the cold temperatures frequently has a large diameter in order to provide the proper insulation so that the cold temperatures are not transmitted to the surgeon's hand, and this makes the instrument difficult to maneuver during surgery.

Accordingly, there is a substantial need for an instrument of very simplified design which can be easily transported by the surgeon and which provides a maximum amount of cooling at the end of the probe. Moreover, it is desirable that these devices have means for heating the probe in order to raise the temperature thereof as required during the surgery.

SUMMARY OF THE INVENTION

A cryosurgical system having a pencil-like hand piece which supplies liquid gas through a very small tube which sprays it adjacent the tip, and having an exhaust system connected to a vacuum pump so that the gas is quickly evaporated and removed from the probe. This permits maximum heat to be extracted through the tip to insure that no prolonged contact with a portion of the human body cannot increase the temperature of the tip. When desired, the temperature of the tip can be elevated by flooding the probe with the liquid gas which is still a relatively low temperature but warmer than the temperature produced by the evaporating liquid. In one embodiment, the flow of liquid gas is controlled from a foot switch while in another it is controlled from a small valve in the pencil-like hand piece. In a third embodiment, a U-shaped probe is utilized and no valve is provided.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a sectional view taken centrally through a preferred embodiment of the invention and showing the associated controls schematically;

FIG. 2 is a sectional view similar to FIG. J showing another embodiment of the invention;

FIG. 3 is a sectional view of the valve showing it in its alternate position and taken along the line 3—3 of FIG. 4;

FIG. 4 is another sectional view taken along the line 4—4 of FIG. 6;

FIG. 5 is a plan view of the probe utilized in the instrument shown in FIG. 2;

FIG. 6 is a plan view of the valve actuator;

FIG. 7 is a sectional view similar to FIG. 1 showing another embodiment of the invention; and

FIG. 8 is an enlarged view partially broken away and illustrating the U-shaped probe.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The surgical apparatus shown in FIG. 1 includes a pencillike instrument 10 which can be held in the hand of a surgeon in substantially the same manneer as a pen or pencil. The instrument 10 includes an elongated hand piece 11 of a plastic

2

material, for example, polytetrafluoroethylene, which is a good insulator and protects the surgeon's hand from the temperature of the cold liquid and gases flowing therethrough. The hand piece has the parallel inlet, bypass and exhaust

5 passages 12, 13 and 14 therethrough all of which communicate with the space 15 formed by the base of the internally threaded bore 16. Thus, the bypass passage 13 has the short unrestricted passage 17 connecting to this bore, the inlet passage 12 has an elongated restricted passage 21 which connects centrally with this bore, and the exhaust passage 14 has a shorter restricted passage 22 in communication with the bore.

The probe 25 is removably secured in the left-hand end of the hand piece 11, as shown in FIG. 1, and includes a

I g frustoconical body 26 having the closed outer tube 27 secured in the central bore 28 and extending to the curved end portion 30 thereof with the tip 31 on the end thereof. The other end of the tube 27 extends beyond the body 26 and has the threaded bushing 32 thereon adapted to threadediy engage the bore 16

20 to secure the probe on the hand piece 11. The O-ring seal 33 in the annular groove in the end surface 34 of the hand piece 11 seals against the body 26 and prohibits the escape of gas or liquids therebetween. A small diameter tube 35 is supported within the outer tube

25 27 by the brackets 36, and the right-hand end thereof extends beyond the outer tube 27 so that it is received in the left-hand end of the restricted passage 21. The O-ring seal 37 in the hand piece adjacent the end of the passage 21 seals against the end of the tube 35 so that the liquid flows from the passage 21

30 directly into the needle-like tube 35 which conducts it to its outlet 38 adjacent the tip 31. A plastic cover insulator 39 may be provided around the outer tube 27 of the probe to prohibit the escape of heat through this outer tube except in the area of

^ the tip 31.

The refrigerant control system for the surgical instrument includes a source of liquid gas. for example, liquid nitrogen, in the form of a cylinder 40 having a manual valve 42 thereon. This cylinder is connected by the conduit 43 having the filter

40 44 therein to a three-way valve 45 which is operated by a foot pedal 46 and the spring 47. The valve 45 is connected to the inlet and bypass passages 12 and 13 in the hand piece 11 by the flexible conduits 48 and 49. In addition, the valve is connected to a vacuum pump 50 through the flexible conduit 51

45 having the one-way check valve 52 therein, and this pump is also connected to the vent passage 14 in the hand piece 11 through the flexible conduit 53, Each of the conduits 48, 49 and 53 is connected to the hand piece 11 by a suitable coupling 55 which may be permanent or detachable without

50 departing from the scope of the invention.

The operation of the valve will now be described in connection with the operation of the entire instrument system. Accordingly, the instrument 10 is ready for use when the various conduits are properly attached, the cylinder 40 of refrigerant

^ is connected to the conduit 43 and the valve 42 opened, and the source of power for the vacuum pump 50 is connected thereto. The spring 47 normally positions the valve 45 in the Off position (FIG. 1) wherein flow of refrigerant from the conduit 43 is blocked and not permitted into the conduits 48, 49 or 51.

When it is desirable to reduce the temperature of the tip 31 to perform the surgical operation, the surgeon depresses the foot pedal 46 so that the valve passage 57 interconnects the

55 conduits 43 and 48 thereby feeding the liquid gas into the inlet passage 12 and into the needle-like tube 35 which conducts the liquid gas to a position adjacent the tip 31. The gas is then sprayed from the end of this tube and, because the vacuum pump 50 is applying a suction through the conduit 53 and the

70 exhaust passage 14, the liquid is quickly evaporated and withdrawn from the space 58 around the outside of the inner tube 36. There is little or no unevaporated liquid in this space because of the quick removal thereof, so that the tip 31 is quickly cooled and remains cooled even when placed in con

75 tact with a heated portion of the body.

3,536,075

3 4

When it is desirable to raise the temperature of the tip 31 connection with FIG. 1. Similarly, the probe assembly 78 is

from this very cold temperature, the surgeon merely depresses secured to the left-hand end of the hand piece 1 la in the same

the valve 45 to align the valve passages 61 and 62 with the manner as described above.

conduits 43—49 and 48—51 so that the liquid refrigerant The bypass passages 74 and 76 in the hand piece and the flows through the conduits 43 and 49 and into the bypass 5 body 77 of the probe assembly communicate through a tube passage 13, and into the space 15 at the right end of the tube 101 to a point in the hollow circular tip 98 opposite the junc27 and the space 58 around the needle-like tube 35. Because ture 102 with the outer tube 97 so that flow from the passages of the restricted passage 22 in the exhaust passage 14 and the 74 and 76 enters the interior space 103 of the tip 98 at the pressurization of the liquid, the entire space 58 is quickly filled farthest point from the aforesaid juncture 102. A tank 40a of with liquid so that the temperature of the tip is raised to the ^ liquid gas is connected to the inlet passage 70 through the flextemperature of the liquid gas, which may be cold but always ible conduit 104 having the filter 44a therein, whereas the exmuch warmer than temperature present during evaporation of haust passage 71 is connected by the flexible conduit 106 to the gas. The restricted passage 22 prohibits the gas from being the vacuum pump 50a which may be of any conventional drawn directly into the exhaust passage 14 although the .„ design. ■ , vacuum continues at all times to remove a portion of this In operation of this embodiment, after the tank 40a of liquid which will be at least partially evaporated. The exhaust refrigerant and the vacuum pump 50a are connected to the gas, whether liquid or gas, is then drawn through the conduit hand piece 11a by the conduits 104 and 106, the valve 42a of 48, the valve passage 62, and the conduit 51 having the check the tank 40a is opened so that the pressure therein forces valve 52 therein. 20 uciuid refrigerant into the inlet passage 70 in the hand piece.

If the surgeon again requires a low temperature at the tip The surgeon will have moved the valve 73 to the closed posi31, he merely removes pressure from the foot pedal 46 and al- tion so that the body 81 blocks the restricted passage 72 and lows the spring 47 to return the valve 45 to the position the refrigerant will flow no further than the valve. When it is wherein the valve passage 57 again connects the conduits 43 desired to cool the circular tip 98 of the probe assembly 78, and 49 at which time the operation described above is recom- 2<i the valve 73 is moved to the open position wherein the menced. The vacuum is sufficient to evacuate quickly the refrigerant flows through the valve passage 88, the restricted space 58 once the supply through the passage 13 is ter- passage 72, and into the needle-like tube 100 from where it is minated. When the surgeon is finished with the instrument, sprayed into the space 103 in the interior of the annular tip 98 the spring 47 returns the valve to the Off position wherein the to reduce the temperature thereof. The evaporation is very conduits 48, 49, and 51 are blocked and further flow of 30 fast and efficient due to the vacuum being applied to the exrefrigerant is not permitted. However, the vacuum continues haust passage 71 in the space by the vacuum pump 50, as to withdraw all of the refrigerant of the instrument through the described above. The gases quickly evaporate and are exhaust passage 14. withdrawn through the passage 71.

Another embodiment of the invention is shown in FIG. 2 When it is desirable to quickly raise the temperature of the

which also includes a pencil-like hand piece 11a which also 35 tip 98, the surgeon moves the knob 95 to the bypass position

can be easily held in the hand of a surgeon. This hand piece in- wherein the liquid refrigerant flows through the valve passage

eludes an elongated body of plastic material having parallel 88 and into the bypass passages 74 and 76, through the tube

inlet and exhaust passages 70 and 71 therein. In the restricted 101, and into the space 103 in the interior of the annular tip

portion 72 of the passage 70 a small valve 73 is provided for 98 and the outer tube 97. Since the liquid floods the tip, no

diverting the flow of liquid into a bypass passage 74 formed in 4() evaporation occurs, and the tip 98 is raised to the temperature

the hand piece 11a, and leading to a complementary passage of the liquid which is much warmer than that created by the

76 in the body 77 of the probe assembly 78. evaporation of the liquid. The vacuum continues to withdraw

As shown in FIGS. 3 and 4, the valve 73 includes a cylindri- the liquid and any gas which may be created into the vent

cal body 81 mounted in a complementary bore 82 in the hand passage 71 through the restricted passage 22 which limits the

piece 11a and held therein by the annular retainer 83 which 45 rate Qf withdrawal so that the flooding can take place. When

surrounds the upstanding stem 84 on the body 81 and engages the valve 73 is moved to the open position again, the tip is

the complementary threads 85 on the outer end of the bore. A again cooled as the vacuum draws the flooded refrigerant

suitable washer 86 is provided between the shoulder 87 on the therefrom. Moreover, if the valve 73 is turned to the Off posi

body of the retainer for frictionless rotation of the latter. The tion the vacuum will continue to exhaust all refrigerant from

O-ring seals 89 are interposed between the body 81 and the the bypass system.

hand piece 11a to block the escape of gas or liquids therefrom. Another embodiment of the invention is shown in FIGS. 7

A passageway 88 is provided centrally through the body and 8, including the hand piece 1 lb having parallel inlet and

adapted to communicate with the opposite ends 90 and 91 of vent passages 120 and 121 therein. The probe 123 has its body

the restricted passage 72. The right-hand end 93 of this valve ^ 124 threadedly secured in the recessed end 125 of the hand

passage 88 is is enlarged so that it remains in communication piece lib and the O-ring seal 126 insures that the refrigerant

with the right-hand end 90 of the passage 72 as the valve 73 is will not escape through the threaded connection. The tip 127

rotated to a position wherein the left-hand end is in communi- includes an elongated U-shaped outer tube 128 which com

cation with the bypass passage 74, as shown in FIG. 3. A suita- municates with the passage 130 and 131 in the body of the

ble knob 95 is provided on the stem 84 for turning the valve 73 probe which in turn are aligned with the inlet and vent

between an Off positon wherein the passage 88 is not aligned passages 120 and 121. The needle-like inner tube 132 is

with either of the passage 72 or 74, the straight through posi- mounted in the passage 130 for conducting the liquid

tion as shown in FIG. 2 wherein the valve passage 88 connects refrigerant to the end portion 134 of the tip. As shown in FIG.

the passages 70 and 72, and the bypass position as shown in 8, the end portion of the tip is filled with a porous plastic

FIG. 3 wherein it connects the passages 70 and 74. A pointer 65 material 135 having maximum amount of surface area, such as

96 is provided on the knob 95 for indicating the position of the Zitex, which insures that the liquid will be spread over the sur

valve 73. faces thereof and quickly evaporated.

The probe assembly 78 in this embodiment includes the In operation, the tank 40b of refrigerant is connected to the

elongated outer tube 97 having a circular shaped tip 98 on the inlet passage through the flexible conduit 137 and the filter end thereof, as shown in FIG. 5. The outer tube 97 and the tip 70 44b, and when the valve 41fc on the tank is opened, the

98 are hollow and the needle-like inner tube 100 extends refrigerant flows through the inlet passage 120, and into the

through the outer tube and approximately one-half way inner tube 132 and then is sprayed from the end thereof into

around the circular tip 98. This inner tube is held in the outer the end portion 134 of the tip. Much of the evaporation occurs

tube 97 by the brackets 99, and is adapted to engage the as the refrigerant is sprayed from the tube 132, but any

restricted passage in the same manner as described above in 75 remaining liquid quickly spreads on the surfaces of the porous

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