US2691370A - Instrument for heart surgery - Google Patents

Description

Oct. 12, 1954 F. J. WALLACE INSTRUMENT FOR HEART SURGERY 2 Shee ts-Sheet l Filud March 27, 1952 INVENTOR.

ATTORNEY Oct. 12, 1954 F. J. WALLACE INSTRUMENT FOR HEART SURGERY 2 Sheets-$heet 2 Filed March 27, 1952 IN V EN TOR. FREDERICK J. WALLACE ATTORNEY Patented Oct. 12, 1954 metric INSTRUMENT FOR HEART SURGERY Frederick Joseph Wallace, New York, N. Y., as-

Cystoscope Makers, Inc.,

signor to American New York, N. Y.., a c

orporation of New York Application March 27, 1952, Serial No. 278,834

This invention relates to a surgical instrument and, more particularly, to such an instrument that is adapted to be employed advantageously in operating on the living human heart under conditions of illuminated vision.

Statistics indicate that heart failure is the leading present-day cause of death in this country. One Of the principal conditions that contributes to heart failure is stenosis of a heart passage in the region of the mitral, aortic or pulmonary valves. Such stenosis is often a consequence of the thickening of one or another of these valves due to rheumatic fever or other degenerative processes. Heart valves that have thus become thickened, or hardened or calcified for any reason, cease to function normally and, as a result, cause changes in the rate of flow of blood from one chamber of the heart to another with attendant ill effects on the health of an individual.

Several surgical procedures have been attempted with the view of alleviatin these conditions. These procedures have contemplated providing an opening through the wall of the heart, inserting a small knife through the opening and slitting the valve under consideration with the aid of the knife. These procedures have been limited in their application and have not proven to be satisfactory for the principal reason that they are necessarily blind procedures, and as a consequence the operating surgeon is unable to view the heart valve that is being operated on and isv unable to observe the actual cutting step of the procedure.

The surgical instrument of this invention successfully overcomes the objections experienced in earlier procedures as it permits or the cutting of portions of a heart valve under conditions of illuminated and adequate vision. In this connection, the operating surgeon may, by the use of my instrument, properly view the section of the heart valve to be operated on and simultaneously sever a portion of such valve in a manner as to permit normal functioning of the valve after the operation is completed.

A preferred and recommended surgical instrument constructed in accordance with this invention includes a support that carries a plurality of parallel forwardly extending tubes that comprise a telescope-receiving first tube, a rod-receivin second tube, a lamp-carrier third tube, and a fluid-transmitting fourth tube. A surgical telescope is positioned within the first tube and dc: fines therewith an annular space that communicates with a conduit which is also carried by the 12 Claims. ((11. 128- 6) support. A second conduit carried by the support communicates with the fourth tube. These conduits and the corresponding tubes permit the introduction and withdrawal of suitable liquids into and from selected regions within the heart. The instrument is provided with a scissors type tissuesevering means comprising a stationary blade disposed forwardly of and in spaced relation to the distal end of the first tube and the telescope, and a movable blade pivoted at its opposite ends to the stationary blade and to a rod which is slidable in the second tube. The blades are so arranged as to be viewed through the telescope. The rod is reciprocable through the medium of a means that will be described in detail further along herein, whereby to impart corresponding pivotal movement to the movable blade relative to the stationary blade.

The primary object of the invention is to provide a surgical instrument that is adapted to be used advantageously in internal surgical procedures and especially those concerned with the interior of the human heart.

Another object of the invention is to provide an improved surgical instrument capable of being inserted into a living human heart by way of a previously formed incision and thereupon operated under conditions of illuminated vision to sever heart tissue, such as tissue that forms part of the mitral, aortic or pulmonary valves.

A further object of the invention is to provide an instrument of the character indicated that is simple and compact in construction, reasonable in manufacturin and upkeep costs, and capable of performing its intended functions in a satisfactory manner.

The foregoing objects, as well asv additional objects, and the advantages obtainable by the use of the instrument of this invention will be readily apparent to persons skilled in the art upon reference to the following detailed description taken in conjunction with the annexed drawings which respectively describe and illustrate a preferred embodiment of the invention.

In the drawings:

, Figure l is a top plan view, partly in longitudinal cross section, of an instrument constructed in accordance with this invention;

Figure 2' is a side elevational view of the instrument shown in Figure 1, partly in longitudinal cross section, certain of the parts being broken away for better illustration;

Figure 3 is a fragmentary view taken along line 3-3 of Figure 1;

Figure 4 is a View corresponding to Figure 2, a

number of the parts being omitted, other parts being shown in another relative position, and certain parts being shown in cross section;

Figure 5 is an enlarged, cross-sectional view taken along line 5-5 of Figure 4;

Figure 6 is a view in enlargement takenalong line 6-6 in Figure 2;

Figure '7 is a view in enlargement taken along line 1-1 of Figure 2;

Figure 8 is a view in enlargement taken along line 8-8 of Figure 2; and

Figure 9 is an enlarged view taken from the left of Figure 2.

Referring now to the drawings wherein like reference numerals denote corresponding parts throughout the several views, the surgical instrument illustrated therein includes a tubular sheath l9 that is slightly flared atits forward end It and that is externally threaded at itsrearward end 12 for engagement with corresponding threads in atubular support member 13. Sheath I is provided with acircular flange 14 immediately adjacent its threadedend portion 12 for abutting the forward end of support member l3 Secured to and forming a fluid-tight fit withsupport member 13 is a cluster of parallel forwardly projecting tubes, namely, a combined fluid-transmitting and telescope-receiving tube IS, a light-carrier tube l6 and a fluid-transmitting tube ll Support member l3 carries afirst conduit 20 having apetcock 21. This conduit is adapted to be connected to a source of fluid supply (not shown) and transmit such fluid into tube is by way of apassage 22 in member $23 (Figure 6) and an opening 23 in the wall oftube 15. Memher [3 also carries asecond conduit 24 having apetcock 25.Conduit 24 is adapted to be connected to a partial vacuum (not shown) for effecting withdrawal of fluid from tube IT by way of apassage 25 in the tubular member and an opening 27 in the wall of tube ll.

Tubes I5, l and l! are maintained in the illustrated relative position with the aid of holding elements 28 (Figure 8), each of which has arod passage 29. Thesepassages 29 are aligned and parallel to the axes of tubes l5, l5 and H. Holders 23 may be considered astubes defining passages 29 As shown in Figures '7 and 8, tubes orholders 28 are positioned below tube I5, while tubes l6 and ii are located to opposite sides of a plane common to the axes of tubes l5 and 28. Further, the axes of tubes It and I? lie intermediate the axes of tubes t5 and 28. This results in a compact tube assemblage that con tributes materially to the utility of the instrument as a whole and to the benefits obtainable by the use thereof in practice.

An electric contact terminal 3b is adapted to be connected to a suitable source of electric current supply. An electric conductor, comprising a wire 3| imbedded in a suitableinsulating sheath 32, is secured at one end to terminal es, extends through a passage 33 in tubular member i3, and then extends through the interior of light-carrier tube 16. Wire 3! makes electrical contact with aminiature lamp 34 that is carried at the forward end of tube l6 (Figures 3 and 9).

As is best shown in Figures 1, 2 and 9, telescope tube I5 is provided with a plurality of angularly spaced internal projections or teats 35 slightly rearward of its forward end. Thestem 35 of a surgical telescope 3? is adapted to be inserted in tube l5 by way of a through passage inmember 13. The telescope stem is supported at its forward end by teats 3E and at its rearward end by member !3 in a manner that it forms in annular space i5 with the interior of tube IS. The telescope has a suitable lens system. including an objective lens 38 (Figure 9), and aneyepiece 39. The lens system is such as to provide an adequate forward field of vision, the necessary illumination being supplied bylamp 34 when the instrument is in active use.

The instrument is provided with a scissors type tissue-severing means that will now be described. In this connection, there is secured to the distal end of tube iii a member 4i; having a bent forward extension 4! that terminates in a stationary orfixed blade 42. This blade has a cutting edge '33 that is inclined in downward and forward direction as best shown in Figure 4. A movable blade M is pivoted at its upper end to the stationary blade as indicated. at 35. The movable blade is pivoted at its lower end, as indicated at it. to the forward end of an actuating rod 4'! that is slidable inpassages 22!.Blades 42 and 44 are so constructed and arranged with respect to other parts to lie in the field of vision of telescope 3'5.

The instrument is provided with a forceps type control unit Ell for imparting reciprocation to rod ll and corresponding pivotal movement of movable blade id with respect to thestationary blade 42. The control unit includes a support body 5! having anintegral saddle 52. As is best shown in Figures 2, 4 and 6, member l3 rests onsaddle 52 and is secured thereto by a pair ofscrews 53. Also integral with body 5! is a bandle e4 having a thumb-receivingloop 55. Body 5% is provided with a vertical through slot and a horizontal groove 5?, best shown in Figures 4 and 5. A slide block til is connected to the rearward end of rod 4? and has an integral depending rail 61 that rides in groove The slide block is slotted as indicated at 62.

The control unit also includes amovable handle 63 having a finger-receiving loop E i and an upper extension 65 that registers withslot 56 in support body 5! and projects into slot 62 in slide block (38. Handle 83 is pivotally connected to support body 5! by a pivot screw 66. A pin S'i carried by slide block 6i; extends across slot 62 and registers with a slot 88 in the upper end portion of extension 85. It will be apparent from an examination of Figures 2 and 4 that pivotal movement ofhandle 53 in one direction effects corresponding movement of block 69 androd 47 and pivotal movement of movable blade M with respect tostationary blade 52. i

For the purpose of briefly outlining the mode of operation of the above described embodiment of the invention, it is assumed that the instrument is to be used to operate on a living human heart for the purpose of severing portions of the tissue of the mitral valve. The heart is exposed and a purse string suture is placed in the heart. An incision is made in the left ventrical and the forward end portion of the instrument is inserted through the incision. The suture is then drawn around sheath in to minimize loss of blood. The instrument is next advanced in the heart to the mitral valve. The parts of the instrument are.

in the relative position shown in Figure 2 andlamp 34 is energized during the time the instrument is inserted through the incision and advanced into the heart. An isotonic saline solution from a suitable source and under appropriate pressure is then forced into the heart by way ofconduit 20,passage 22, opening 23 and annular space 'l'5'-. The solution is thus discharged from the instrument in the region adjacent to objective lens -38 of the telescope and moves the blood in the immediate vicinity of the objective lens but of the way, thereby permitting clear visualization of the parts of the heart directly forward of the objective .lens. Simultaneously with the foregoing, a vacuum isiapplied toconduit 24. With petcock '25 open, the vacuum withdraws from the heart, by way of tube 11, opening 21,passage 26 and conduit 2-4, anamount of the solution, or a mixture of the solution and blood, equal to the amount introduced into the heart, whereby to maintaina proper balance. Selected portions of the mitral valve are then severed under conditions of illuminated vision by operating handle :63 of the control unit and correspondingly actuating movable blade 4-4 with respect to stationary blade 42-. Upon completion of the tissue-cutting operation, the instrument is withdrawn from the heart :and necessary steps are taken to prevent loss of blood through the previously formed incision.

When the instrument is used to operate on the aortic valve, it (is inserted into the heart by way of the carotid artery and the procedure followed is similar to that outlined above with respect to operating on the mitral valve.

From the foregoing, it is believed that the construction, operation and advantages of my present invention will be readily comprehended by persons skilled in the art. It is to be clearly understood, however, that various changes in the apparatus set forth may be made without departing from the scope of the invention, it being intended that all matter contained in the description or shown in the drawings shall be interpreted as illustrative only and not in a limiting sense.

I claim:

1, in a surgical instrument of the character described, a support, a tube secured to and extending forwardly of the support, tissue-severing means comprising a stationary blade disposed forwardly of and in spaced relation to the forward end of the tube and a movable blade pivoted at one end to the stationary blade, said blades being adapted to be viewed through a telescope upon insertion thereof in the tube, a rod pivotally connected at one end to the other end of the movable blade, and means carried by the support and connected to the other end of the rod for imparting reciprocation to the rod and corresponding pivotal movement to the movable blade with respect to the stationary blade.

2. In a surgical instrument of the character described, a support, a tube secured to and extending forwardly of the support, a member secured to and projecting beyond the forward end of the tube, tissue-severing means comprising a stationary blade afiixed to the member and disposed forwardly of and in spaced relation to the forward end of the tube and a movable blade pivoted at one end to the stationary blade, said blades being adapted to be viewed through a telescope upon insertion thereof in the tube, a rod reciprocable along a path substantially parallel to the axis of the tube, said rod being pivotally connected at its forward end to the other end of the movable blade, and means carried by the support and connected to the rear end of the rod for imparting reciprocation to the rod and corresponding pivotal movement to the movable blade with respect to the stationary blade.

3. In a surgical instrument of the character atone end to the stationary blade, said blades bemg adapted to 'b'e'vi'ewed through a telescope upon insertion thereof in the tube, a rod reciprocable along a path substantially parallel to the axis of the tube, said rod being pivotally connected at its forward end to the other end of the movable blade, and means carried by the support and connected to the rear end of the .rod for imparting reciprocation to the rod and corresponding pivotal movement to the movable blade with respect to the stationary blade, said .last mentioned means comprising a block mounted on and slidable with respect to the support, a .handle pivotally connected to the support, and means for translating pivotal movement of the handle into sliding movement of the block.

4. A surgical instrument in accordance with claim 3, wherein the last mentioned means comprises a pin carried by the block and registering with a slot in the handle.

5. In a surgical instrument of the character described, a support, a plurality of parallel tubes secured to and extending forwardly of the support and comprising a first tube for receiving a telescope, a second tube for carrying a lamp, and a third tube for transmitting a fluid, tissuesevering means comprising a stationary blade 'disposed forwardly of and in spaced relation to the forward end 'of the first tube and a movable blade pivoted at one end of the stationary blade, said blades being adapted to be viewed through a telescope upon insertion thereof in the first tube, a rod reciprocable along a path parallel to the axes :of said tubes, said rod being pivotally connected at its forward end to the other end of the movable blade, and means carried by the support and connected to the other end of the rod for imparting reciprocation to the rod and corresponding pivotal movement to the movable blade withrespec-t to the stationary blade.

6. In a surgical instrument of the character described, a support, a plurality of parallel tubes secured to and extending forwardly of the support and comprising a first tube for receiving a telescope, a second tube for carrying a lamp, and a third tube for transmitting a fluid, a conduit carried by the support and communicating with the first tube, a conduit carried by the support and communicating with the third tube, tissue-severing means comprising a stationary blade disposed forwardly of and in spaced rela tion to the forward end of the first tube and a movable blade pivoted at one end to the stationary blade, said blades being adapted to be viewed through a telescope upon insertion thereof in the first tube, a rod reciprocable along a path parallel to the axes of said tubes, said rod being pivotally connected at its forward end to the other end of the movable blade, and means carried by the support and connected to the other end of the rod for imparting reciprocation to the rod and corresponding pivotal movement to the movable blade with respect to the stationary blade.

7. In a surgical instrument of the character described, a support, a plurality of parallel tubes secured to and extending forwardly of the support and comprising a first tube for receiving a telescope, a second tube for receiving a rod, a third tube for carrying a lamp, and a fourth tube for transmitting a fluid, the axes of the third and fourth tubes being disposed to oppositesides of a plane common to the axes of the first and second tubes and intermediate the axes of the first and second tubes, tissue-severing means comprising a stationary blade disposed forwardly of and in spaced relation to the forward end of the first tube and a movable blade pivoted at one end of the stationary blade, said blades being adapted to be viewed through a telescope upon insertion thereof in the first tube, a rod reciprocable in the second tube and pivotally connected at its forward end to the other end of the movable blade, and means carried by the support and connected to the other end of the rod for imparting reciprocation to the rod and corresponding pivotal movement to the movable blade with respect to the stationary blade.

8. In a surgical instrument of the character described, a support, a plurality of parallel tubes secured to and extending forwardly of the support and comprising a first tube for receiving a telescope, a second tube for receiving a rod, a third tube for carrying a lamp, and a fourth tube for transmitting a fluid, the axes of the third and fourth tubes being disposed to opposite sides of a plane common to the axes of the first and second tubes and intermediate the axes of the first and second tubes, a conduit carried by the support and communicating with the first tube, a conduit carried by the support and communicating with the fourth tube, tissue-severing means comprising a stationary blade disposed forwardly of and in spaced relation to the forward end of the first tube and a movable blade pivoted at one end of the stationary blade, said blades being adapted to be Viewed through a tele scope upon insertion thereof in the first tube, a rod reciprocable in the second tube and pivotally connected at its forward end to the other end of the movable blade, and means carried by the support and connected to the other end of the rod for imparting reciprocation to the rod and corresponding pivotal movement to the movable blade with respect to the stationary blade.

9. In a surgical instrument of the character described, a support, a plurality of parallel tubes secured to and extending forwardly of the support and comprising a first tube for receiving a telescope, a second tube for receiving a rod, a third tube for carrying a lamp, and a fourth tube for transmitting a fluid, a telescope in the first tube and defining an annular space with the interior thereof, a conduit carried by the support and communicating with said annular space, a rod reciprooable in the second tube, a lamp secured to the forward end of the third tube, a conduit carried by the support and communicating with the fourth tube, tissue-severing means comprising a stationary blade disposed forwardly of and in spaced relation to the forward end of the first tube and a movable blade pivoted at its opposite ends to the stationary blade and the rod, said blades being adapted to be viewed through the telescope, and means carried by the support and connected to the other end of the rod for imparting reciprocation to the rod and corresponding pivotal movement to the movable blade with respect to the stationary blade.

10. A surgical instrument in accordance with claim 9, wherein the axes of the third and fourth tubes are disposed to opposite sides of a plane common to the axes of the first and second tubes and lie intermediate the axes of the first and second tubes.

11. A surgical instrument in accordance with claim 9, wherein said last mentioned means comprises a block mounted on and slidable with respect to the support, a handle pivotally connected to the support, and means for translating pivotal movement of the handle into sliding movement of the block.

12. A surgical instrument in accordance with claim 11, wherein the last mentioned means comprises a pin carried by the block and registering with a slot in the handle.

References Cited in the file of this patent UNITED STATES PATENTS Number Name Date 1,127,948 Wappler Feb. 9, 1915 1,627,941 Wappler May 10, 1927 2.011.,169 Wappler Aug. 13, 1935

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