US1731069A - Surgical instrument - Google Patents

Description

Oct. 8, 1929. HERMAN 1,731,069

SURGICAL INSTRUMENT Filed Jan. 16 1928 3 Sheets-Sheet 1 IN VEN TOR.

FBHerman A TTORNE Y Oct. 8, 1929. F. P. HERMAN SURGICAL INSTRUMENT Filed Jan. 16, 1928 3 Sheets-Sheet 2 INVENTOR. EBHerman ATTORNEYJ Oct. 8, 1929. F. P. HERMAN SURGICAL INSTRUMENT Filed Jan. 16, 1928 3 Sheets-Sheet INVENTOR. ERIIerman AITORNEYS l iiiretaral y i'rfthe form of a. t:

Patented Oct. 8, 1929 UNITED STATES FLORENTINE PETER HERMAN, OF WEST PALM BEACH, FLORIDA SURGICAL INSTRUMENT Apphcation filed January 16, 1928.

10 The current may be an undamped current of high frequency, for example about 1,000,000 cycles, or a spark gap current of a sutliciently high spark frequency to resemble an undamped current of a suiiiciently high fre- 15 quency to have the property of cutting. In

the older instrument the active terminal of the source of current was connected to a metallic snare and inactive terminal thereof to a large sheet such as lead foil to be applied to any part of the body, the snare being so insulated that only the cutting port-ion thereof was exposed.

In the new instrument according to the present application the sheet of lead foil is done away with and the inactive terminal of the generator is connected to a member which is adapted to engage the tissue which is to be removed. This member may be either mounted directly on the snare supporting member or it may be a separate instrument, the latter arrangement being more desirable for certain purposes. The new instrument has a number of advantages over the older one, the principal advantage being that the current passes only through the tissue which is to be removed and not through the body. As a result of this feature the scar tissue is very slight and it is possible to positively cook the tissue which is to be removed without affecting the underlying tissue. During the operation the snare wire remains cold, the cutting action being the result of the electric current itself and not of a heated snare. A further advantage of the instrument in which the member to which the inactive terminal is connected is mounted on the snare su' port is that only a single application of t e instrument to the us to be re moved is required. The ibe r i}s whim-Hi Serial No. 247,202.

serves not only to form an electric contact therewith, but also to grasp the tissue so that no other forceps are needed. This feature is of particular importance in tonsillotomy because of the limited space within which the surgeon has to operate.

The separate tissue engaging member which is preferably in a form of a forceps may also be connected to the active electrode of the generator and used to grasp a gauze sponge which is dipped into a saline solu tion and applied to bleeding parts after the operation. In this case the inactive electrode is applied to a portion of the body adjacent the wound, for example on the neck directly opposite the tonsil externally and the current passes through the dampened sponge and seeks the avenue of least resistance which is naturally that point from which the blood is flowing, namely, the artery or vein which is bleeding or oozing. This brings about a direct application of coagulating current down the terminus of the artery or vein needing the same. The invention is applicable to instruments for many different kinds of operations, but the nature of the invention will be suiiiciently understood from the accompanying drawing and specification in which I have shown and described two embodiments of the invention suitable for tonsillotomy.

Fig. 1 shows in side elevation an instrument of the type having a forceps mounted on the snare support itself. A wiring diagram is also shown in this figure,

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

Fig. 3 is a longitudinal section on theline 33 of Fig. 2,

Fig. 4 is a section on the line l& of Fig. 2,

Fig. 5 is a section on the line 55 of Fig. 2,

Fig. 6 is a section on the line 6-6 of Fig. 2,

Fig. 7 is an elevation of a separate forceps,

Fig 8 is a longitudinal section thereof on the line 8-8 of Fig. 7 and Fig. 9 shows the manner in which the separate forceps is used in combination with an open snare.

""iii first to Figs. 1 to 6 21 provided with a lock anddrag member 3 which cooperates with depressions 4: in thebar 2 to control the motion of the finger grip or to lock the same. One end of thebar 2 is provided with athumb grip 5 and the other end with. asleeve 6 adapted to receive 'the shank 7 of a supportingmember 8 having a bore 9 in which is slidab y received the stem of ametallic snare 10. The rear end of the snare is secured inmetallic tube 11. in an aperture in the finger grip 1 by means of a set screw 12 having a knurledhead 13 of insulating mat rial. Themember 8 is made of insulating material and the bore 9 is preferably lined with a metallic tube 14 for reinforcement. At its outer end themember 8 has aloop 15 of insulatin material the inner circumference of which is grooved to receive the loop of the snare 9 when in its expanded position.

Themember 8 is provided with a secondlongitudinal bore 16 which is likewise lined with ametallic tube 17 within which is slidably mounted a metallic forceps composed of a bar 18, afinger grip 19 at one end there of, and a pair ofjaws 20 at the other end thereof. Thejaws 20 are preferably two curved spring steel members secured at one end in a slot 21 in the rod 18. Theaws 20 are curved so as to normally spread apart and lie in substantial alinement with the sides of theloop 15. The sides of theloop 15 are provided withguards 22 which extend over thejaws 20 and cover all but the ends thereof. Thejaws 20 have stops 20 which abut against the end oftube 17 and limit the motion of the jaws into the tube, l Vhen the jaws are drawn into thebore 16 by pulling onfinger grip 19 they are closed together in an obvious manner.

Anelectric contact 23 is mounted on the member 18 at the rear end ofbore 16. This contact consists of an insulated metallic tube 24 adapted to receive acontact point 25 and connected at its inner end to themetallic lining 17 ofbore 16. An electric contact is also provided on the finger grip 1 consisting of ametallic tube 26 adapted to receive a contact point 27 and connected at its upper end by awire 28 to themetallic tube 11 in which the end of the snare is secured. A high.

frequency generator 2-9 capable of producing a cutting current is sup-plied with current from alight socket 20 bywires 31 and 32 in one of which is inserted afoot switch 33. The inactive terminal 34 of the generator is connected to thecontact point 25 inserted incontact 23. Theactive terminal 36 is connected to contact point 27 inserted incontact 26.

The operation of the instrument is as follows:

Thefoot switch 33 being off and the snare and forceps being in expanded position the tonsil is worked through theloop 15 and the jaws of the forceps are then drawn in by pulling onfinger grip 19 which causes them to grasp the tonsil and form a good electric connection therewith. Simultaneously the snare is drawn up taut and the foot switch is then turned on sending an electric current from the snare through the tonsil to the forceps. This current is of a cutting nature as set forth above and the snare is easily drawn through the base of the tonsil. There is practically no penetration of the underlying tonsil fossa by the current and the resulting scar tissue is therefore very slight.

In Figs. 7 to 9 l have shown a separate forceps adapted to be used in connection with an open snare for cases in which all of the tonsil cannot be removed by the first operation with the covered snare. This forceps consists of a tubular body 40 of insuhd'ingmaterial lined with a metallic forceps consisting of a rod 42 having secured to one end a pair ofresilient jaws 43 as in the instrument previously described. Thetubes 4*.0 and 41 are provided with a slot 41 1 through which extends thestem 15 of a finger grip 116, which stem is screwed into a threaded hole near the end of the rod 12. Athumb grip 17 is mounted on thetube 10 adjacent the rear end thereof. The rear end of thetube 11 is open and is adapted to receive a contact point 18.

In using this forceps in connection with an open snare the electrical connections are the same with the first described instrument; that is to say, the inactive terminal of the generator 29 is connected to the forceps and the active terminal is connected to the snare. On the other hand, when using the forceps with a gauze sponge above described, the active terminal of the generator is connected to the forceps and the inactive terminal is connected to an electrode which is applied to the external surface of the body adjacent the part being treated.

Having described my invention, 1 claim:

1. In a device of the class described, an in sulated metallic snare, an insulateo metallic forceps, a source of cutting electric current, means for connecting one terminal of said source of current to said snare, and means for connecting the other terminal thereof to said forceps.

'2. In a device of the class described for ren'ioving undesirable tissue, a tube of insulating material, a l'netallic snare slidably mounted in said tube, means for drawing said snare into said tube, an insulated n'letallic member adapted to engage the undesirable tissue, a. source of cutting electric current, means for connecting one terminal of said source of current to said snare, and means for connecting the other terminal thereof to said memlmr.

3. In a device of the class des ihed, an insulated metallic snare, a tube of insulating material, a pair of relatively movable jaws connected together at one end and ifQSllliffllllly held apart, the connected ends of said jaws being inserted in said tube, means for drawing said jaws into said tube to close them together, a source of cutting electric current, means for connecting one terminal of said source of current to said snare, and means for connecting the other terminal thereof to said forceps.

t. In a surgical instrument, a snare, a forceps comprising a pair of relatively movable jaws connected together at one end and resiliently held apart, a supporting body having a bore in which said snare is slid ably mounted and asecond bore into which the connected ends of said jaws are inserted, the loop of said snare and the jaws of said forceps being located at one end of said body adjacent one another, means for drawing said snare into said first mentioned bore, means for drawing the jaws of said forceps into said second bore to close them together, a source of cutting electric current, means for connecting one terminal of said source of current to said snare, and means for connecting the other ter minal thereof to said forceps.

5. In a surgical instrument, a snare, a forceps comprising a pair of relatively movable jaws connected together at one end and resiliently held apart, a supporting body haw ing a bore in which said snare is slidably mounted and a second bore into which the connected ends of said jaws are inserted, the loop of said snare and the jaws of said forceps being located at one end of said body adjacent one another, said body having a grooved loop of insulating material at the end of said first mentioned bore adapted to receive the loop of said snare in its expanded position, means for drawing said snare into said first mentioned bore, means for drawing the aws of said forceps into said second bore to close them together, a source of cutting electric current, means for connecting one terminal of said source of current to said snare, and means for connecting the other terminal thereof to said forceps.

6. In a surgical instrument, a snare, a forceps comprising a pair of relatively movable jaws connected together at one end and resiliently held apart, a supporting body having a bore in which said snare is slidably mounted and a second bore into which the connected ends of said jaws are inserted, the loop of said snare and the jaws of said forceps being located at one end of said body adjacent one another, said body having a grooved loop of insulating material at the end of said first mentioned bore adapted to receive the loop of said snare in its expanded position, guards of insulating material projecting laterally from said loop of insulating material and partially covering the jaws of said forceps, means for drawing said snare into said first mentioned bore, means for drawing the awe of said forceps into second here to close them together, a source of cutting electric current, means for connecting one terminal of said source of current to said snare, and means for connecting the other terminal thereof to said forceps.

7. In a surgical instrument, a snare, a forceps comprising a pair of relatively movable jaws connected together at one end and resiliently held apart, a supporting body having a bore in which said snare is slidably mounted and a second bore into which the connected ends of said jaws are inserted, the loop of said snare and the jaws of said forceps being located at one end of said body adjacent one another, means for drawing said snare into said first mentioned bore, means for drawing the jaws of said forceps into said second bore to close them together, a stop on said forceps adapted to en age the end of said body to limit the motion of said forceps, a source of cutting electric current, means for connecting one terminal of said source of current to said snare, and means for connecting the other terminal thereof to said forceps.

FLORENTINE PETER HEBli EAN.

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