US2275167A - Electrosurgical instrument - Google Patents

Description

March 3, 1942. w. BIERMAN ELECTROSURGICAL INSTRUMENT Filed April 26, 1939 To GQQUND OR CURRENT INVENTOR WML/AM B/ERMAN BY ATTORNEY Patented Mar. 3, 1942 UNITED STATES PATENT leprice 9 Claims.

This application relates to surgical devices. More particularly, my invention relates to an improved construction for electro-surgical instruments adapted for the removal of human tissue by means of an electrical current.

One of the objects of my invention is to provide an electro-surgical instrument of the character described which shall be so designed that new growths or diseased tissue in the human body' may be removed with such accuracy that only the desired portion is destroyed while the adjacent healthy tissue is left completely intact.

Another object of my invention is to provide an electro-surgical instrument of the character described in which the volume of the tissue to be destroyed at one time is precisely limited to a predetermined amount.

Still another object of my invention is to provide an electro-surgical instrument of the character described having means for forcing the tissue to assume a polypoid shape, i. e., one in which there is a narrow constricted stem region and an enlarged region above the constricted stem region to facilitate the tissue destruction.

A still further object of my invention is to provide an electro-surgical instrument of the character described which shall comprise relatively few and simple parts, which shall be easy to assemble and relatively inexpensive to manufacture and which, at the same time, shall operate with a high degree of eiciency.

Other objects of this invention will in part be obvious and in part hereinafter pointed out.

The invention accordingly consists in the features of construction, combinations of elements, and arrangement of parts which will be exemplified in the construction hereinafter described, and of which the .scope of application will be indicated in the claims.

In the accompanying drawing, in which is shown one of the various possible embodiments of this invention,

Fig. l is a cross-sectional View of an electrosurgical instrument constructed in accordance with my invention;

. Fig. 2 is an enlarged sectional view of a portion of the device shown in Fig. l.

Fig. 3 is a cross-sectional view taken substantially on the line 3-If of Fig. 2;

Fig. 4 is a View similar to Fig. 2 but showing a modied form of my invention;

Fig. 5 is a wiring `f iiagrmn showing the use of an indicating light in connection. with my invention; and

(Cl. 12S- 363.17)

Fig. 6 is a cross-sectional view taken substantially on theline 5 5 of Fig. l..

As is well known, the surgical technique employed for the removal of human tissue such as, for example, tonsllar tissue, consists in the use of high frequency currents which are applied by means of needle electrodes to the tissue to be removed. "lr's technique is` known as electrosurgery and its use is recognized by the medical profession as having denite advantages over the prior surgical techniques which involved cutting with sharp-edged instruments.

In the type of electro-surgical devices heretofore employed, certain inherent disadvantages were apparent. One such disadvantage was to be found in the fact that it was extremely difficult to localize the destructive action of the electric current. This was `due to the fact that when the needle electrodes were applied to the tissue to be destroyed, any slight movement of the patent ment of high eiciency. The electro-surgical instrument of my invention comprises an elongated main stem ID being of hollow construction for the major portion thereof with the exception of the portion Ita adjacent one end thereof which is of substantially solid construction. Rotatably mounted on a portion of the Amain stem I0 adjacent the opposite end thereof from the end I0a is a hollow bushing ll having an interior chamber Ii.' communicating with theinterior of the main stem lil by means of an aperture I4 in the wall of said main stem. The bushing Il is prevented from lateral displacement by means of a collar I5 which may be integral with the stem Ill, anda collared plug I6 threadedly received in the open end of the stem HJ and abutting the bushing Il as shown.. The bushing Il is open at the bottom end thereof. A portion of the outer wall of said bushing ll adjacent said open end is threaded and is adapted to have threadedly attached thereto a housing I8 containing a chamber I9 communicating with the chamber I2 of the bushing Il, The bushing ll and the housing I8 are preferably made of electrically insulating material such as, for example, Bakelite or the like. Threadedly attached to the housing I8 is a stem 2i) which may also be of Bakelite and which is provided with a longitudinal through opening 2 I. The housing I8 andstem 20 serve as a handle for gripping the instrument. Attached to the bottom end of the stem 2li is aflexible tubing 22 in which the opening 23 therein communicates with the opening 2l. An aperture 2li is provided in the housing I8 which communicates at one end thereof with the stem opening 2I and at the other end thereof with the chamber I9. The solid portion Illa. of the stem is provided with alongitudinal aperture 25 which communicates at one end thereof with the hollow opening of the main stern and at the other end thereof with the surrounding atmosphere through the open end Ib of the stem. The stem ornozzle 20 is adapted to be connected to any suitable source of suction supply (not shown), by any suitable means such as, for example, theflexible tubing 22.

It is thus seen from the above described construction that when thev suction device is ren-- dered effective, air will be drawn from the open end IIlb of the stem I through theaperture 25, the hdllow tubular portion of the stem, the aperture I4, the chambers I2 and It, the aperture 2d and theopenings 2| and 23. A pair of washers I3 are interposed between the bushing I I and the collar I5 at one side and between the bushing II and the plug to prevent air leakage.

, At the free end of the main stem there is provided asuction cup 21 which is formed 'by providing asleeve 28 having the inner wall thereof threaded and adapted to be threadedly received on the externally threadedportion 29 of the solid stern portion Ia. By rotating thesleeve 28, it is possible to adjust the depth of' the suction cup 2l, the purpose of which will be explained as the description proceeds.

Mounted within the main stem is a central electrode 3d having one end Sila thereof connected to a source of current supply in the manner to be described, the other electrode end tb being permanently held in position within an opening in the solid stem portion Ida. A portion 3| of the electrode 3i! adjacent the end del; is externally threaded as shown. Threadedly received on this portion 3| is a central electrode tip $2. This electrode tip 32 (the active electrode) is designed to contactively engage the tissue to be destroyed and may be adjustablv moved in axial direction by merely rotating the same. The electric circuit may be completed as follows: A wire 5b is connected to one terminal of the current source and is in electrical continuity withthe central electrode 3d in a manner to be subsequently described, and terminates as thecentral electrode tip 32 which, when in contact with tissue to be coagulated, serves as the active electrode. The larger dispersive electrode which is generally applied to any other suitable part of the body is connected to the other terminal of the current source. An alternative circuit may be employed wherein the active electrode remains asl above described but in which the return Vsupply is effected by grounding through the means of ametal collar 36 disposed adjacent the open end I 0b of the stem and attached to awire 35 which is grounded.

A still further alternative circuit which may loe-'employed is to use the active electrode described above but to effect the return supply I6 on the other side through the metal collar 33 attached to thewire 35 and thence connected to the other terminal of the current source instead of being grounded.

It is thus seen that when the openend I0b of the stern iii is disposed at the point where it is desired to remove the tissue and the current is rendered effective through any of the above described means,'the circuit will be completed by the tissue and the current will effect the destruction of said tissue.

As hereinbefore explained, it is of extreme importance that the only tissue destroyed shall be the diseased tissue which it is desired to destroy and, therefore, once the instrument has been properly located with respect to the tissue to be destroyed, if the source of suction is rendered effective, the said tissue will be drawn into the suction cup 2l yand will thus be held in gripped position with respect to the electrode so that when the current is applied, only that tissue which it is desired to be destroyed will be destroyed and adjacent healthy tissue will not be harmed.

An exact delimitation of the area of tissue being destroyed is caused by the employment of the suction cup 2l around theelectrode tip 32, since the pressure exerted on the tissue by the edgeof the cup greatly restricts and substantially stops the flow of blood to and from the area to be destroyed Without affecting blood circulation in the surrounding area not then to be destroyed. This abrupt change in blood circulation causes the region which is destroyed by heat due to coagulation by a high frequency current to be definitely limited, since tissue with an active circulation loses heat much more rapidly than tissue in which the circulation of blood has been substantially out off.

When the suction cup 2l is applied to a pedunculated growth, said growth will be gripped and may be held with its body away from the tissue toi which it is attached to maintain pedunculation and consequent freedom from contact with adjacent tissue during the period in which the high frequency current is applied. By this technique the coagulation occurs in the stem of the pedunculated growth, although said stem spaced from the immediate region which the electrode touches. The destructive action of the current is thus automatically limited to the region where the pedunculated growth is smallest, i. e. at its base where pedicle or stem joins the supporting surface. Hitherto where no suction means had been used in conjunction with a coagulating electrode, it had been necessary to press he electrode against the surface to be destroyed and when this technique waspracticed upon pedunculated growths such growths would be transformed into sessile shapes because of their intimate contact with the tissue from which they arose before coagulation and thus the advantage cf coagulating the said growth at its stem would be lost.

It is also noted from the above described construction that the amount of tissue to be destroyed at one time may be precisely regulated the relative distance between the open ends of thesleeve 28 and the end of the solid stem portion Illa. Anut 31 is provided which is threadedly received on the stem portion Illa for locking thesleeve 28 in any desired position ln accordance with my invention, I have so designed the instrument that the electric current will not be rendered effective until the suction means has rst been rendered effective to draw the tissue Within thesuction cup 21. By such construction I am able to avoid the possibility of coagulating any tissue which it is not desired to destroy. The means by which this is accomvplished will now be described. Apoppet valve 40 is provided which serves as a closure for the chamber l2. Thepoppet valve 40 is attached to a`stem 4| by any suitable attaching means such as the nuts 42. A portion of the stem is slidably received in anopening 43 in the housing I8, the saidopening 43 communicating with anenlarged opening 44 which, in turn, communicates with theopening 2| of thenozzle 20. Thepoppet valve 40 is normally kept in closed position by means of acoil compression spring 45. Thestem 4| is of electrically conductive material and is interconnected to the central electrode 3i! by means of aconductor wire 46 passing through the aperture I4 in the wall of the stem H). At the lower end ofthe housing |8 and disposed in the path of movement of thestem 4| is a thinflat spring 48 of electrically conductive material which is attachedly held in such position by means of ascrew 49 passing through thespring 48 and contactively engaging a metallicv sleeve embedded in the material of the housing I8, the saidscrew 49 and sleeve being also of electrically conductive material. Aconductor wire 50 leading to the source of current supply has one baredend 50a thereof frictionally received in an electrically conductive sleeve embedded in the housing |8 and designed to contactvely engage the first named sleeve holding thescrew 49. It is thus seen that when thestem 4| is caused to slidably move downwardly against the action of thespring 45, the free end ofstem 4| contactively engages thespring 48 to complete an electric circuit between thecentral electrode 30 and theconductor wire 50 thrcugh thespring 48 andscrew 49. The only manner .in which thestem 4| may be caused to move downwardly to make the circuit just described is by rendering the suction means through theflexible tube 22 effective. This will cause the poppet valve to open in the manner hereinbefore described.

Thevalve 4|) will open and remain open for a short time to complete the electric circuit which energizes theelectrode 32. It will be noted that in order to practice my invention thevalve 40 need not be maintained open for more than a few seconds as within this period coagulation is fully completed.

It is thus seen from the above described construction that the current cannot be rendered effective until the suction means has first been rendered effective, thereby preventing the coagulating of any tissue until the same has been drawn into thesuction cup 21. Atubular member 55 is provided having one end 55a thereof opening to the surrounding atmosphere and the other end thereof communicating with theopening 2| in thenozzle 20. Saidmember 55 may be forced into the bore provided in the stern 2c after the latter has been screwed upon the housing IB. Also, if desired, thetube 55 may be cut off flush with the stern 20. By means of thistubular member 55, it is possible to start the vacuum pump in operation Without causing the downward movement of thestem 4| and consequently without rendering the electric circuit effective. In operating the instrument, the vacuum pump may rst be started in operation,

which will draw air from the surrounding atmosphere through the tubular member and down through theopenings 2| and 23. When the instrument is properly positioned with respect to the tissue to be destroyed, the end 55a of thetubular member 55 exposed to the surrounding atmosphere may be covered in any suitable manner such as, for example, by placing a finger of the operator thereover in which case the air will be drawn from the chamber I9 through theopening 24 to cause thepoppet valve 40 to withdraw from its normal closed position and at the same time to supply suction to thesuction cup 2 to draw the tissue therein. Simultaneously with the above operation, the circuit of the electric current is rendered eiective to destroy the tissue within the suction cup through contacting of thestem 4| andmember 48.

While in the drawing I have illustrated a method of suction control by means of the nger, it is understood that a similar control may be employed for operation by foot.

The portion of the stem IU adjacent the suction cup end may be angularly bent in any desired manner so that areas of tissue diicult of access may be reached with facility. Also the rotatable mounting of the bushing and the attachednozzle 25 facilitates this action. A

Means are provided to limit the amount of relative rotational movement between the bushing il with thenozzle 2|) and the stem I0 to prevent strain and possible breaking of thewires 35 or 46 due to twisting. As shown in Fig. 6 of the drawing, the collar |5 is provided with a projecting lug |5a which is adapted to abut a pin lib fixed to the bushing after a predetermined amount of relative rotation.

The shape of the suction cup may take any desirable form .such as, for example, that shown in Figs. 1 and 2 or, if desired, thesuction cup 21 may be pear-shaped as shown in Fig. 4 of the drawing. In this shape of suction cup, when theL tissue is drawn up into the space within the cup, it takes the form of a pedunculated mass, i. e., a mass having an enlarged portion attached to a constricted portion or stem. When the current is applied at the expanded end through theelectrode tip 32, the generated current becomes concentrated at the oonstricted end, thereby causing coagulation of only a very small area relative to the amount of tissue removed. By such construction of the suction cup, the possibility of primary or reactionary hemorrhage is minimized and for the same reason, the resulting scar tissue is relatively small.

In accordance with my invention the stem |0 may be constructed of a material which will possess suilicient resilience so as to permit of manually reforming the shape thereof to more readily gain access to otherwise inaccessiblev parts.

It is also noted that theactive electrode tip 32 may be of any other desired shape from that shown, such as, for example, one having a sharp needle point.

v If desired, in connection with my electro-surgical instrument, a pilot or indicating light may he provided which may be connected as shown in 5 of the drawing. Thepilot light 5|) will thus be rendered effective when the circuit is closed by means of thestem 4|, to dim theiight 60.

It is to be noted that my invention may be satisfactorily practiced with a high frequency current using a biterminal or uniterminal technique. The metal collar may either be connected to the ground which will further assist in exact delimitation of tissue to be destroyed, or the metal collar itself may be connected directly to the other terminal of the current source.

It will thus be seen that there is provided a device in which the several objects of this invention are achieved, and which is well adapted to meet the conditions of practical use.

As various possible embodiments might be made of the above invention, and as various changes might be made in the embodiments above set forth, it is to be understood that all matter herein set forth or shown in the accompanying drawing is to be interpreted as illustrative and not in a limiting sense.

Having thus described my invention, I claim as new and desire to secure by Letters Patent:

l. An electro-surgical instrument for removing human tissue, comprising a hollow stem of insulating material open at one end and adapted to be connected to a vacuum device for creating a suction at said open end to draw in and hold said tissue, said open end being adapted to be stoppered by said drawn-in tissue, an electrode in said stem having a portion thereof disposed adjacent said open end so as to intimately contact said drawn-in tissue, means for connecting said electrode to a source of current supply, and means for preventing the effective energization of said electrode without first rendering said vacuum device effective for drawing in said tissue.

2. An electro-surgical instrument for removing human tissue, comprising a hollow stem of insulating material open at one end and adapted to be connected to a vacuum device for creating a suction at said open end to draw in and hold said tissue, said open end being adapted to be stoppered by said drawn-in tissue, an'electrodei in said stem having a portion thereof disposed adjacent said open end so as to intimately contact said drawn-in tissue, means for connecting said electrode to a source of current supply, and means for normally rendering ineffective the suction action for drawing in said tissue while said vacuum device is in operation.

3. An electro-surgical instrument for removing human tissue, comprising a hollow stem of insulating material open at one end and adapted to be connected to a Vacuum device for creating a suction at said open end to draw in and hold said tissue, an electrode in said stem having a portion thereof disposed adjacent said open end so as to intimately contact said drawn-in tissue, means for connecting said electrode to a source of current supply, and means for limiting the amount of tissue to be suctionally drawn into said open end, said last named means comprising a sleeve mounted on said stem adjacent the open end thereof, said sleeve being movable axially to project beyond the said open end of said stem to form a suction cup area.

4. An electro-surgical instrument for removing human tissue, comprising a hollow stem of insulating material open at one end and adapted to be connected to a vacuum device for creating a suction at said open end to draw in and hold said tissue, an electrode in said stem having a portion thereof disposed adjacent said open end so as to intimately contact said drawn-in tissue, means for connecting said electrode to a source of current supply, and means for limiting the amount of tissue to be suctionally drawn into said open end, said last named means comprising a' sleeve mounted on said stem adjacent the open end thereof, said sleeve vbeing movable axially to project beyond the said open end of said stem to form a suction cup area, said projecting portion of said sleeve terminating in a constricted opening to cause said drawn-in tissue to assume a shape having an enlarged outermost portion adjacent to a constricted portion.

5. An electro-surgical instrument for removing human tissue, comprising a hollow stem of insulating material open at one end and adapted to be connected to a Vacuum device for creating a suction at said open end to draw in and hold said tissue, said open end being adapted to be stoppered by said drawn-in tissue, an electrode in said stem having a portion thereof disposed adjacent said open end so as to intimately contact said drawn-in tissue, means for connecting said electrode to a source of current supply, and meansfor preventing the energization of said electrode without first rendering said vacuum device effective for drawing in said tissue, said last named means comprising an insulated handle member attached to said stem, said handle member having an air passageway connected to said vacuum device and communicating with the interior of said hollow stern, and a valve member normally interrupting the passage of air through said passageway.

6. An electro-surgical instrument for removing human tissue, comprising a hollow stem of insulating material open at one end and adapted to be connected to a vacuum device for creating a suction at said open end to draw in and hold said tissue, said open end being adapted to be stoppered by said drawn-in tissue, an electrode in said stem having a portion thereof disposed adjacent said open end so as to intimately contact said drawn-in tissue, means for connecting said electrode to a source of current supply, and means for preventing the energization of said electrode without first rendering said vacuum device effective for drawing in said tissue, said last named means comprising an insulated handle member attached to said stem, said handle member having an air passageway connected to said vacuum device and communicating with the interior of said hollow stem, and a valve member normally interrupting the passage of air through said passageway, said valve member being so disposed that the effective operation of said suction device will cause it to be moved to open position.

7. An electro-surgical instrument for removing human tissue, comprising a hollow stem of insulating material open at one end and adapted to be connected to a vacuum device for creating a suction at said open end to draw in and hold said tissue, said open end being adapted to be stoppered by said drawn-in tissue, an electrode in said stem having a portion thereof disposed jacent said open end so as to intimately contact said drawn-in tissue, means for connecting said electrode to a source of current supply, means for preventing the energization of said electrode with out rst rendering said vacuum device effective for drawing in said tissue, said last named means comprising an insulated handle member attached to said stem, said handle member having an air passageway connected to said vacuum device and communicating with the interior of said hollow stem, a valve member normally interrupting the passage of air through said passageway, said valve being so disposed that the effective operation of said suction device will cause it to be moved to open position, and means for completing an elec tric circuit between said electrode and said source of current supply upon such movement of said valve.

8. An electro-surgical instrument for removing human tissue, comprising a hollow stem of insulating material open at one end and adapted to be connected to a vacuum device for creating a suction at said open and to draw in and hold said tissue, said open end being adapted to be stoppered by said drawn-in tissue, an electrode in said stem having a portion thereof disposed adjacent said open end so as to intimately contact said drawn-in tissue, means for connecting said electrode to a source of current supply, means for preventing the energization of said electrode without first rendering said vacuum device effective for drawing in said tissue, said last named means comprising an insulated handle member attached to said stem, said handle member having an air passageway connected to said vacuum device and communicating with the interior of said hollow stem, a valve member normally interrupting the passage of air through said passageway, said valve being so disposed that the eiective operation of said suction device will cause it to be moved to open position, and means for completing an electric circuit between said electrode and said source of current supply upon such movement of said valve, said hollow stem material being manually bendable whereby to cause the same to assume shape designed to facilitate access to otherwise inaccessible tissue parts. v

9. An electro-surgical instrument for removing human tissue by coagulation, comprising a hollow stem of insulating material open at one end and adapted to be connected to a Vacuum device for creating a suction at said open end to draw in and hold said tissue, an electrode in said stem having a tip member so disposed with respect to said open end that the said suctionally drawn-in tissue will be brought into intimate contact with said tip member, said tip member being axially movable with respect to said electrode, and means for connecting said electrode to a source of current supply, said hollow stem material being manually bendable whereby to cause the same to assume a shape designed to facilitate access to otherwise inaccessible tissue parts.

WILLIAM BIERMAN.

Images