US2273686A - Surgical instrument - Google Patents

Description

lF'eb. 17, 1942. s. `1.'E:|.UMEr\r|-HA| SURGICAL INSTRUMENT Filed March 26, 1940 EN MN ATTOR EY Patented Feb. 17, 1942 l UNITED STATES SURGICAL INSTRUMENT samuel J. Blumenthal, Brooklyn, N. Y. l Application March 26, 1940, Serial No. 325,943

6 Claims.

This invention relates to surgical instruments designed primarily for use in the removal of tonsils or "in performing what is commonly termed tonsillectomy- Iby instruments termed tonsilletorne's; and the object ofthe invention is topro- 5 `videan instrument of the character described employing a comparatively thinftonsil receiving ring-'with two supporting or engaging blades having, outer surfaces flush with the surfaces of the ring and with means for applying equalized pres'- 10 sure to both bladesn firmlyengaging the tissue intermediate the tonsil and throat and in supporting the tissue in a manner facilitating cutting thereof by a knifemovably disposed between 'said' blades; al further object being to provide'an 15 instrument of the character described wherein* the outer extremity ofthe rigis provided centrally thereof with a recess receiving the pointed end only of a knfejand further in the provision of a pointed cutter edge' on the knife `to rst puncture and then shear cut the tautly supported tissue, thereby simplifying lthe severing 'operation' and insuring positive cutting ofthe entire tissuein removal of the tonsil; a still further objeot being to provide means for keyingv kaninstrument of the class and for the .purpose specified, which is simple in construction, eilicient in use, and which is constructed as hereinafter described and claimed. 1

The invention" is fully disclosed in the following specification, of which the accompanying drawing forms va part, in which the separate parts` of my improvement are designated by suit- "1( able referencecharacters in each of the views, and in which: Fig. lis a plan View of an instrument made according to my invention with part of the construction broken away'. p

Fig. 2 is a longitudinal sectional view on the line 2-2 of Fig. 1.

` Fig. 3 `is a view similar to Fig. 2 showing only a part ofthe construction with parts in a different position.

Figs. 4, 5 and 6 are views similar toFig. 3 showing theA parts 'in other`r positions; and

Fig.'-7 is an exploded view of a part 'of one end portion of the instrument illustrating the several blade members in their related position. 55

(Cl. 12S-309) `My present invention forms a continuation in part of the structure disclosed in my prior application, Ser. No. 208,988y led May 20, 1938. In the present application, certain features which were disclosed in. said prior application are in,- corporated but modified to adapt the same to the new structural features of the present instru-'- ment. I f j In tonsillectomy, many difficulties have been experienced at the crucial moment, namely the moment of performing the severing operation of the tonsil, which resultsin the incomplete severance cf the'tonsil causing inconvenience 'and annoyance to the physicianand sometimes serious trouble to the patient. In other instances, unnecessary injury to the throat tissue isexperienced by reason of slippage of the tissue during the cuttingl operation or removal of the tonsil. Further, unnecessary injury to the/tissue or pillars is experienced by usingtonsillotomes having unnecessarily thick or heavy ring ends. It is the purpose of"my invention to obviate these and other objectionable features to 'instruments lof this'type and kind', while at they Same time producing 'an instrument which is substantially foolproof inv operation in the manipulation of the several blades including the cutter blade or knife, asv will more fully hereinafter appear. Still further, it is an object'of` my invention to provide an instrument of the character described employing parts of simple and easily cleanable construction with the means for quickly and easily attaching and detaching they several parts for cleaning and sterilization.

In Figs. 1 and 2l of the drawing I have shown at I0 the elongated shank or body of the instrument which includes a protrudinghandle portion II, only part of which isshown in Fig. 2 of the drawing. Above the handle portion, thebody is yoke-shaped in form to provide upwardly extending side plates IZ having bayonet apertures I3 toA receive the lock plate I4 pivoted to one kof the plates I2 `as seen at I5. yThe forward end of the body I0 terminates in what is commonly termed a ring Itv having a groove I1 extending from the outer'end I8 of the ring along the sides' `of the rectangular" blade guiding portion I9 disposed inwardly of said ring. The outer end I8 of the ring I6 is also apertured as seen at 20'centrally of said end and in alinement with the groove I1 to receive the pointed and sharpened end of the blade as will later appear. The blade guiding portion I9 of the body I`0 is composed'of va top plate 2l, and the forward extension of the body I0 as at 22, and threeblades 23, 24 and 25 are movably disposed between the parts 2| and 22 as will be apparent.

Theblades 23 and 24 may be said to be tissue engaging blades, whereas theblade 25 may properly be termed the cutter blade or knife. rl'his knife is'disposed intermediate theblades 23 and 24. The body I has a rectangular extension I Da rearwardly of the handle II which terminates in a long threaded rod 2S preferably having what is termed a double thread to provide quick and free movement of a largeknurled nut 21 longitudinally of thescrew 26. At the end of this screw is a stop nut 2B limiting outward movement of the nut 2'1. In this way thenut 21 may be quickly and easily spun by the physician in moving the same into operativeand inoperative positions, and is sufficiently large in diameter to exert the required pressure on theblades 23, 24 in applying equalized pressure thereto as later described.

The upper surface IUb of the body I9 is straight and smooth throughout the entire length thereof from thepart 22 to the part Ita to provide free sliding movement of theblade 24 thereon and in like manner the free sliding movement of theother blades 25, 23 which are disposed upon theblade 24. All of the blades are of suflicient width adjacent the yoke-shaped portion defined by the plates I2 to be guided in their sliding movement by these plates. The outer end portions of theblades 23 and 24 are enlarged to t snugly but freely in the hollow frame I9, whereas the blade orknife 25 is slightly wider than theblades 23 and 24`to be guided in the groove II where it vextendsalong the sides of the frame I9.

' Theblade 23 is enlarged in thickness inwardly -of the wide end thereof as seen at 23a. This ythickened portion terminates at its inner end in a heavy yoke-shaped part 29 which nts over and is movable longitudinally of thescrew 26. Theblade 23 also has forwardly of theyoke 29 laterally extendingwings 30 forming nger or thumb pieces facilitating sliding movement of said blade.

`The blade`23 also has an elongated aperture 3l, `the side walls of the forward end of which has inwardly extendingcleats 32 which form keys for guiding a slidingkey block 33 with respect to the blade' 23. The upper portion of theblock 33 is of such width as to pass freely but snugly through the aperture 3l when the forward end .f

of the block clears the cleats orflanges 32. Opposite sides of theblock 33 are grooved as seen at Y34 to receive the cleats orflanges 32 when theblock 33 is moved forwardly.

The lower portion of theblock 33 is also pro- 'vided with outwardly projectinganges 35 which extend beyond 'the side walls of the aperture 3I.

vThus theblock 33 is keyed against tilting movement on the blade23 when in aposition similar to* that shown in Fig. 2 of the drawing. The `purpose of' this construction is to facilitate the handling ofthe blades in the assemblage thereof,

`while at the same time making it possible to detach thekey block 33 from theblade 23 upon removal'of anoperating lever 36 from said block.

`Thelever 36 has a yoked: end 3? spanning an -upward extension on theblock 33 and is pivoted thereto by ascrew 38. To thelever 36 is pivoted The coupling adjustment of thepivots 39 and 43 in changing the location of theblock 33 as will be apparent.

It will be understood that the rear portion of the aperture 3|, or in other words, that portion thereof rearwardly of the cleats orflanges 32, will be of a length equal to or slightly greater than the length of theblock 33 to facilitate the passage of theblock 33 upwardly through the aperture 3l. However, in the normal position of the block with respect to theblade 23, it will assume a position wherein the cleats orfianges 32 are in engagement with thegrooves 34 of said V block. Thelever 33 is of course coupled with .to the blade the block after it has been arranged in the aperture 3I. The yoked end of the lever 3? prevents the rear end of theblock 33 from dropping through the aperture. With this construction the lower end of the block including the flanges are maintained in substantially parallel relationship to the lower surface of theblade 23 at all times. `This enlarged end forms a keyway snugly but freely fitting withinapertures 44 and 45 formed in theblades 24 and 25 respectively, thus maintaining alinement of the rear end portions of all of the blades ,while at the same time placing theblade 25 in direct operative engagement with theblock 33 to facilitate manipulation of the blade orknife 25 by thelever 36. In other words, the length of theaperture 45 is such as to freely receive the lower portion of theblock 33, and by swinging thelever 36 to the right from the position shown in Fig. 2, the blade will be moved forwardly in the direction of the end I8 of the ring I5, whereas movement of the lever into the position shown in Fig. 2, withdraws the 'blade from the outer end of the ring.

`linger pieces facilitating manual movement of theblade 24 and the support of this blade in operative positions. Beyond thewings 46, the blade has a protruding reducedextension 47 which is adapted to pass through theyoked end 29 of theblade 23 so that in the use of the instrument, thenut 21 will operate upon the extension 4l to advance theblade 24 to a point where the end of theextension 47 is ush with the end of theyoke 29. At this point bothblades 23, 24 may be simultaneously moved forward to apply an equalized pressure upon the tissue, thus preventing uneven or unbalanced application of pressures by these blades and preventing severance or cutting of the tissue by the rounded ends of these blades which seat upon therounded surfaces 48 of the ring I6 above and below the groove I'I. The thicknesses of the blade edges are equal to the thicknesses of thesurfaces 48 at the outer end portion I8 of the ring so that these blades present smooth upper and lower surfaces at the end portion I8 of the ring. It will be understood that the application of equalized pressure on theblades 23, 24 operates in a manner that one blade physician will soon realize the amount of pressure required upon thenut 23 to insure a firm engagement with the tissue without danger of severing the tissue and yet insuring the firm support of the tissue between the blade edges and the surfaces 4'8.

The length of theaperture 44 in theblade 24 is such as to provide free movement of theblock 33 therein so that in the rearward or withdrawal movement of the blade, no movement is applied 24, thereby assuring the gripping of trally of the blade.

the severed tonsil in the instrument in the manner illustrated in Fig. 6 of the drawing.

The blade is shorter than both of theblades 23 and 24, and the forward wide end thereof terminates in a pointed or prong-like end 25a cen- The blade is beveled on both upper and lower surfaces in sharpening or grinding the same, as will appear in Figs. 3` to 6, inclusive, and these sharpened ends extend to the side edges of the blade so as to insure the cutting of all of the tissue engaged between the ends of theblades 23, 24 and the outer end lporl tion I8 of the ring I6. In the forward movement of the knife orblade 25, thepronged end 25a thereof will extend into theaperture 20, but not suiiiciently to protrude beyond the outer end of the ring.

In the use of the-instrument, all of the blades will be drawn backwardly substantially into the position shown in Fig. 2 to expose the ring IB. With the tool in this position, the ring end of the instrumentv is insertedinto the throat and the tonsil is passed through thering inthe usual manner. When held in this position, the thumb of the hand is applied to one of the wings to advance theblade 23 manually in the direction of the end of the ring to engage the tissue in the the manner clearly seen in Fig. 4 of the drawing.

In this position, thetissu'e is supported firmly between the ends of theblades 23, 24, andis securely and positively held in this position, eliminating any further care or attention on the part of the physician and preventing any possible loosening of the tissue which has been experi- 'enced by slackening manual pressure upon the blades as heretofore experienced.

The physician then moves thelever 36 rearwardly which advances the knife orblade 25 forwardly, and the pointed orpronged end 25a will rst pierce or puncture the rmly supported tissue and then pass through the tissue in shearlike action, producing a clean cutting or severing of the rmly supported tissue. After this, the thumb of the hand supporting the instrument is moved into engagement with one of the wings 4G to apply slight pressure thereon. Thereafter, thenut 21 is loosened to free theblade 23, the lever is then moved forwardly to withdraw theblade 25, and theblade 23 is moved rearwardly out of engagement with the ring end I8, thus freeing the tissue adjacent the throat. The instrument may then be removed and will have the removed or severed tonsil supported in connection with it by theblade 24, upon which the slight manual pressure has been applied by engagement of one of thewings 46. The purposev of this latter engagement is to avoid opening movement of theblade 24 by its frictional engagement with theblade 25, but very slight pressure will be required to resist this frictional engagement.

It will of course be understood that whenthe instrument has been removed from the patients throat, the tonsil may be dropped frorn` the instrument bysimply manually sliding the blade `semble and disassemble the parts.

`24 rearwardly. In order to insure the application of synchronized pressure of theblades 23,

24 upon thetissue engaged thereby, it is essential that the length of these two blades with respect to the forward rounded ends thereof and the inner surface of theyoke 29 and the end of the extension 41 be the same; that is to say, assuming that the twosurfaces 48 engaged by the blades are in common vertical alinement.

In the above described cycle of operation and in moving thelever 36 forwardly to withdraw the knife, theblock 33 may engage theblade 23 to move the same rearwardly to a slight extent. This movement is of course not objectionable, and in fact would be desirable in that it will eliminate the separate operation of manually retracting theblade 23. It is desirable to provide sufiicient clearance in the length of theaperture 44 to prevent the aforesaid movement of theblock 33 from contributing any movment to theblade 24, the result of which would free the tonsil from the instrument before the instrument has been removed from the throat.

In assembling and disassembling the parts, it will be `apparent that thescrew 21 is moved into a position adjacent thestop nut 28. The threeblades 23, 24 and 25 arranged one upon the other in the manner illustrated are then placed upon the top of the body rearwardly of the enlargement and between the plates I2', and are then moved forwardly. The pin 4I is then coupled with the plates I2 and the lock or retaining plate I4 is moved into operative position. To detach the parts, the above operation is reversed.

By reason of the simplicity of the construction, it is only a matter of a few seconds to as- In this way, cleaning or the sterilization of the instrument may be effected, thus maintaining long life and durability of the instrument.

The blade orknife 25 is of one thickness and balanced contour and may be inserted in position vwith either side of the blade upward, by reason of the double grinding of the cutter edge thereof. Having fully described my invention, what I claim as new and desire to secure by Letters Patent, is:

l. In a tonsillotome vof the class described, an elongated body portion terminating at one end in a thin ring grooved and recessed on its inner surface, two tissuev engaging blades slidably mounted on said body and having rounded ends movable `toward and from the inner surface of said ring to engage tissue above and below the grooved and recessed portion `of the ring, a knife arranged between said blades and having a sharpened end movable into the grooved and recessed portion of said ring, said sharpened end of the knife being pointed centrally whereby the tissue supported between said blades will be rst pierced by said pointed end in advancing the knife in the direction of said grooved ring, said blades andsaid knife all having vertically alined apertures in the shank portions thereof, a key block arranged in said apertures, means on said block and on the apertured portion of one of said blades for keying said blades and knife in coupled relationship, means on saidblock and one of said blades for retaining the blade against accidental displacement from said block, and a lever pivotally coupled with said body and with said block for moving the block longitudinally of said body in advancing and retracting said knife.

2. In a tonsillotome of the class described, an elongated body portion terminating at one end in a thin ring grooved and recessed on its inner surface, two tissue engaging blades slidably mounted on said body and having rounded ends movable toward and from the inner surface of said ring to engage tissue above and below the grooved and recessed portion of the ring, a knife arranged between said blades and having a sharpened end movable into the grooved and recessed portion of said ring, said sharpened end of the knife being pointed centrally whereby the tissue supported between said blades will be rst pierced by said pointed end in advancing the knife in the direction of said grooved ring, said blades and said knife all having vertically alined apertures in the shank portions thereof, a key block arranged in said apertures, means on said block and on the apertured portion of one of said blades for keying said blades and knife in coupled relationship, means on said block and one of said blades for retaining the blade against accidental displacement from said block, a lever pivotally coupled with said body and with said block for moving the block longitudinally of said body in advancing and retracting said knife, and means in threaded engagement with said body for simultaneously advancing both of said blades in the direction of said ring independent of said knife.

3. An instrument -of the class described comprising an elongated body, the outer end of said body terminating in a relatively thin ring, three elongated blades disposed one upon the other on said body and independently movable longitudinally thereof, the upper and lower blades comprising tissue engaging members cooperating with said ring, the intermediate blade compris- :y

ing a knife adapted for severing the tissue engaged by said members, said blades having registering elongated apertures at end portions thereof remote from said ring, a longitudinally movable key block extending through said apertures maintaining the alinement of said blades, means movable longitudinally of said body for uniformly supporting said members in tissue engaging position, and said key block closely engaging the aperture of said knife blade thereby u.

forming means for positively supporting and moving said knife blade independently of said members.

4. An instrument of the class described comprising an elongated body, the outer end of said body terminating in a relatively thin ring, three elongated blades disposed one upon the other on said body and independently movable longitudinally thereof, the upper and lower blades comprising tissue engaging members cooperating with said ring, the intermediate blade comprising a knife adapted for severing the tissue engaged by said members, said blades having registering elongated apertures at end portions thereof remote from said ring, a longitudinally movable key block extending through said apertures maintaining' the alinement of said blades, means movable longitudinally of said body for uniformly supporting said members in tissue engaging position, said key block closely engaging the aperture of said knife blade thereby forming means for positively supporting and moving said knife blade independently of said members, and means pivoted to said block and linked to said body forming an actuating lever for said knife blade.

5. In an instrument of the class described comprising an elongated body terminating at one end in a relatively thin ring, three superimposed blades independently movable toward and from said ring, the top and bottom blades forming means for clamping tissue against said ring, the intermediate blade comprising a knife adapted to sever the tissue between said first named blades, independent means for moving said blades, a key member movable longitudinally of said body, cooperating means on said key member and blades for maintaining vertical alinement of said blades, and said key member slidably engaging said top and bottom blades and closely engaging said intermediate knife blade thereby forming means for positively advancing and retracting said knife blade wtih respect to the top and bottom blades.

6. In an instrument of the class described comprising an elongated body terminating at one end in a relatively thin ring, three superimposed blades independently movable toward and from said ring, the top and bottom blades forming means for clamping tissue against said ring, the intermediate blade comprising a knife adapted to sever the tissue between said first named blades, independent means for moving said blades, a key member movable longitudinally of said body, cooperating means on said key member and blades for maintaining vertical alinement of said blades, said key member slidably engaging said top and bottom blades and closely engaging said intermediate knife blade thereby forming means for positively advancing and retracting said knife blade with respect t0 the top and bottom blades, and other means movable longitudinally of said body for uniformly supporting said top and bottom blades in clamping position.

SAMUEL J. BLUMENTHAL.

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