US3809093A

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Publication number: US3809093A
Application number: US00244143A
Authority: US
Inventors: S Abraham
Original assignee: Individual
Current assignee: Individual
Priority date: 1972-04-14
Filing date: 1972-04-14
Publication date: 1974-05-07
Anticipated expiration: 1991-05-07
Also published as: IT983317B

Abstract

The probe of a hand held surgical tool includes a surgical tip at the end of a rod which swings through a limited arc in one plane only at a rate of less than about 100 cycles per second. One or more stationary tubes supply fluid to and/or suction fluid from the region of the tip. For eye surgery, the probe may use a globular tip about 1 millimeter in diameter having a small (0.1 mm) lateral or forward cutting projection and/or an abrasive surface. The tool facilitates cataract removal through a small limbal opening, and is useful for other surgical procedures of the eye and other body areas.

Description

[451 May 7,1974

[ SURGICAL TOOL [76] Inventor: Samuel V. Abraham, 16026 Royal Oak Rd., Encino, Calif. 91316 [22] Filed: Apr. 14, 1972 [21] App]. No.: 244,143

[52] U.S. Cl. 128/305 [51] Int. Cl. A6lb 17/32, A61f 9/00 [58] Field of Search 128/24 A, 41, 48, 276, 128/303' R, 304, 305

[5 6] References Cited UNITED STATES PATENTS 1,658,278 2/1928 Bardach et'al 128/41 UX 2,514,665 7/1950 Myller 128/304 X 2,874,470 2/1959 Richards... 128/24 A X 2,990,616 7/1961 Balamuth et a] 32/26 3,076,904 2/1963 Kleesattel et al. 128/24 A X FOREIGN PATENTS OR APPLICATIONS.

97,760 9/1924 Austria 128/41 Primary Examiner-Channing L. Pace Attorney, Agent, or Firm-Flam &Flam 57 ABSTRACT The probe of a hand held surgical tool includes a surgical tip at the end of a rod which swings through a limited arc in one plane only at a rate of less than about 100 cycles per second. One or more stationary tubes supply fluid to and/or suction fluid from the region of the tip. For eye surgery, the probe may use a globular tip about 1 millimeter in diameter having a small (0.1 mm) lateral orforward cutting projection and/or an abrasive surface. The tool facilitates cataract removal through a small limbal opening, and is useful for other surgical procedures of the eye and other body areas.

18 Claims, 14 Drawing Figures POW! QUPPLY 57 2l 6 7g 2 57 56 e 27 F 363 a5 was a? J i "I 5/ /8 "/A4 I. I 56 57 PUMP 52 4/ PATENTEUHAY. mm 38091093 sum 1 OF 2 v Powzn SUPPLY FLUID SUPPLY SURGICAL TOOL BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical tool having a globular cutting and/or abrasive tip at the end of a rod driven through a limited arc in a single plane.

2. Description of the Prior Art r Cataract surgery is necessitated when the lens of an eye becomes so occluded or opaque as to prevent light entering throughthe cornea to reach the retina. In conventional intracapsu lar extraction, a semicircular 150 to 180) incision is made along the limbus where the cornea joins the opaque sclera of the eye. The entire lens is removed intact through this opening. Alternatively, in extracapsular extraction, a knife and forceps inserted through the large opening are used to sever and remove the anterior lens capsule, the lens material itself, and possibly the posterior capsule. The incision is closed with multiple sutures.

Although a high success rate is associated with such cataract removal procedures, certain complications are not uncommon. Considerable traumais experienced, and a hospital stay of ,4 or more daysfollowing the. operation is typical. The relatively large knife and forceps may create some difficulty. in completely removing all minute lens particles. Fluid loss through the opening may be so great as to cause collapse of the cornea or a flat anterior chamber.

Certain improvements in surgical procedures and tools have been suggested. Two-way syringe-like devices are known wherein eye fluid, possibly containing particles of lens material, is removed through one tube while a sterile isotonic fluid is supplied through a second tube. This maintains the necessary pressure in the anterior aqueous chamber to prevent corneal collapse. Amanual tool has been suggested in which such tubes are concentric, the inner tube containing a knife blade rotated within the outer tube to cut lens material extruded or suctionedinto the tubes through lateral opening s. Such a device, while effective for the removal of relatively soft lens material, is not useful forincising the lenscapsule, andmaybe ineffective in the removal of senile cataracts.

An ultrasonic emulsifier for cataract surgery is described in the US. Pat. No. 3,589,363 to Banko and Kelman. That instrument uses a knife-tipped probe reciprocated longitudinally at an ultrasonic rate, typically from 1,000 to 100,000cycles per second, to break up lens material. Use of the emulsifier is described in Highlights of Ophthalmology, Volume XIII, No. 1 beginning atpage 38. A small limbal incision first is made, and a cystotome, iris forceps and scissors are used to remove aV-shaped section of the anterior capsule; The ultrasonically vibrated knife probe is inserted throughthis opening into the lens. The rapid reciprocation acts like a miniature jack hammer to break up and emulsify lenscortex and nucleus material, which is suctionedout by a tube surrounding the tip. A second tube supplies fluid to replace that removed and maintain the necessary chamber pressure.

An object of thepresent invention is to provide an improved cataract removal tool requiring a single small openingto the eye, which facilitates the cutting and removal of both capsule and lens material, and which may be used without the traumatic effects associated 2 with prior art large opening and ultrasonic emulsificav tion techniques. Inaddition to cataract removal, the inventive tool is useful for other surgical procedures both of the eye and of other body areas.

SUMMARY OF INVENTION The foregoing and other objectives are achieved by providing a hand held surgical tool having a probe which is driven back and forth through a limited arc in a single plane at a selectable rate of between 0 and about cycles per second. For eye surgery, the probe may comprise a rod having a diameter of O.5 millimeter and a globular tipabout l millimeter in diameter. The tip may include a lateral or forward cutting projection extending about 0.1 millimeter 'from the globe, which itself may be smooth or abrasive. The probe may include one or more tubes for communicating fluid to and/or suctioning fluid from the region of the tip. In other embodiments, the tool may include a freezing or heating tip, a fiber optic light guide, and/or a forceps tip. r

with reference to the accompanying drawings wherein like numerals designate corresponding elements in the several figures. i r

FIG; 1 is a pictorial view of the inventive surgical tool with the probe operatively positioned in the anterior aqueous chamber of an eye (shown in section).

FIG. 2 is a longitudinal sectional view of the surgical tool, as seen alongtheline 2 2 of FIG. 1.

FIG. 3 is a longitudinal sectional view of the same surgical tool in a plane perpendicular to FIG. 2, as viewed along the line 3-3 thereof.

FIGS. 4 and 5 are transverse sectional views of the surgical tool, as viewed along the lines 4-4 and 5-5 of FIGS. 2 and 3 respectively. FIG. 5 showing the fluid distribution control.

FIG. 6 is a sectional view of the: surgical tool probe extending through a corneal opening, as seen along the line 6-6 of FIG. 1. r 1 l FIGS. 7 through 10 are greatly enlarged perspective views of alternative probe tips for the tool of F IG. 1.

FIG. 11 is a greatly enlarged perspective view of a surgical tool embodiment wherein the probe rod extends through afluid communicating tube.

FIGS. 12, 13 and Marc fragmentary perspective views, partly in section, of surgical tool embodiments incorporating respectively a fiber optic light guide, a freezing tip and a forceps.

DESCRIPTION OF THE PREFERRED EMBODIMENTS .T he following detailed description is of the bestpresently contemplated modes of carrying out the invention. This description is not to be taken in a limiting sense, but is made merely for the purpose of illustrating the general principles of the invention since the scope of the invention best is defined by the appended claims.

Referring now to the drawings, thesurgical tool 15 includes a generallycylindrical handle 16 having a conical end 17. Projecting from the end 17 is aprobe 18 which, in the embodiment of FIGS. .1 through 6, includes arod 19 having a generally globularsurgical tip 20, and a pair of

fluid communicating tubes

21, 22. Contained within thehandle 16 is amechanism 23, described below, for imparting an arcuate or swinging motion to therod 19 andtip 20 in a plane (see thearrows 24 in FIGS. 2 and 6) not including thetubes 21,

22. The extent of arcuate motion is limited, as by anadjustable stop 26. Each

stationary tube

21, 22 may deliver fluid from asupply 27 or may suction fluid from the region of thetip 20 in cooperation with a pump 28. Adistributor 29 on thehandle 16 controls such fluid delivery and suction.

For eye surgery therod 19 may have a length of about 18 millimeter and adiameter of about 0.5 millimeters. Thesurgical tip 20 may be elipsoidal or spherical with a maximum dimension of about 1 millimeter. In the embodiment of FIG. 7, useful for cutting the anterior lens capsule, thetip 20a is generally elipsoidal and has a pointed or knife edgedprojection 30 extending laterally about 0.1 millimeters. The globular tip 20b may have an abrasive surface with no cutting projection (FIG. 8) or alateral cutting projection 30 may be combined with an abrasive surface as in the tip 200 of FIG. 9. In FIG. 10, a generally crescent shaped cuttingprojection 31 extends from the forward end of thesurgical tip 20d. Therod 19 may be situated within a fluid flow tube 21 (FIG. 11) having a diameter sufficient for therod 19 to swing through a desired arc.

Use of thesurgical tool 15 for cataract removal is illustrated in FIG. 1. Initially a small limbal opening 35 (typically less than 3 millimeters diameter) is made in theeye 36 where thecornea 37 joins thesclera 38. Theprobe 18 is inserted through theopening 35 in a plane generally parallel to the iris 39. Themechanism 23 is energized to swing theprobe 19 back and forth through an arc of less than about 3 millimeters, preferably at a selected rate of from to about 100 cycles per second.

Using thesurgical tip 20a (FIG. 7), multiple small incisions are made in theanterior capsule 40 of the lens 41. Alternatively, the roughenedtip 20b or 20c may be used to macerate thecapsule 40. Thedistributor 29 is adjusted to suction fluid from the region of thetip 20 via one of the

tubes

21, 22 and to supply an appropriate sterile isotonic fluid to the same region via the

other tube

21, 22. As small particles of thecapsule 40 material are cut away or macerate, they are suctioned or aspirated from theeye 36 via thetool 15. The supplied fluid replaces that removed, insuring a substantially constant pressure within theanterior chamber 42 to prevent collapse of thecornea 37.

With part of thecapsule 40 cut away, theprobe 18 is inserted within the lens and used to break up and remove occluded cortex 41 and/or nucleus 41a material. The tool then may be used to cut and remove the posterior lens capsule 43. Particles, if any, too large to be suctioned through the

tube

21 or 22 may escape or be withdrawn through theopening 35. If a different surgical tip is desired, theprobe 18 may be removed from theeye 36, a new tip substituted, and the instrument reinserted to continue the operation. When all lens material has been removed, theprobe 18 is withdrawn and a single suture used to close theopening 35.

An entire senile cataract can be removed with thesurgical tool 15 in less than about 15 minutes. There is little trauma and a very short recovery period.

Thesurgical tool 15 is useful for other types of eye surgery. Thus an iridotomy may be perfonned using any of the

surgical tips

20a, 20b, 206 or 20d to form small holes in the iris 39. The iridotomy may be combined with a cataract procedure making a separate iridectomy unnecessary. Using thesurgical tool 15 for iridencleisis, the probe l8 is used to make small openings through the sclera 38 from inside the iris angle (trabecular meshwork) to permit material of the iris 39 to escape. Such procedures are useful to drain or relieve ex- 'cess internal pressure in the treatment of congenital or acquired glaucoma. Thetool 15 may be used for vitreous surgery and for treatment of flat chambers. Since thetips 20a 20d are dull and rounded, the chance of inadvertent damage to eye tissue is minimal.

Other forms of theprobe 18 increase the versatility of thesurgical tool 15. For example (FIG. 11) a fiber opticlight guide 44 may be used to illuminate the operative area at thesurgical tip 20. A freezing probe 45 (FIG. 13) may be incorporated either instead of or in addition to therod 19. Such a freezing probe 45 may comprise ametal rod 46 having aninsulative sheathing 47 and communicating between a freezing tip 48 and areservoir 49 containing freon or other liquid at an appropriate cryogenic temperature. The probe 45 is useful for freezing tumors or cysts. Tumors of the iris 39 or ciliary body 51 (FIG. 1) may be reached interiorly of theeye 36, via theanterior chamber 42 or the posterior chamber 52, to be frozen bythe tip 48. The freezing tip 48 or a heating tip (not shown) may be used to affect the ciliary body production of aqueous in the treatment or control of glaucoma by direct application from inside theanterior chamber 42.

Alternatively, the freezing tip 48 or heating tip may be used to cauterize blood vessels, as in the zonular region 53. A forceps tip 55 (FIG. 14) is useful for removing sections of eye tissue too large to be aspirated via the

tube

21 or 22. 9

Details of thefluid distributor control 29 are shown in FIGS. 2 and 5. The

tubes

21, 22 extend through thehandle 16 to

terminations

21a, 22a opening into thedistributor 29. Thefluid supply 27 and the pump 28 respectively are connected to thehandle 16 via a pair of

flexible tubes

56, 57 leading to

distributor openings

56a, 57a. Thedistributor control 29 is rotatable relative to thehandle 16 and has five sets of channels for selectively connecting the

With thedistributor 29 set to theposition 29a (FIG. 5), the tube .21 communicates via thetermination 21a, thechannel 58 and theopening 56a to thesupply tube 56. Similarly, thetube 22 is connected via thedistributor channel 59 to thesuction tube 57. Accordingly,

fluid from thesupply 27 is supplied to the region of thetip 18 via thetube 21, and fluid is suctioned via thetube 22 to the pump 28.

In the position 29b, thedistributor 29 interchanges the supply and suction lines so that fluid is supplied via thetube 22 and pumped via thetube 21. In the

positions

29c, 29d and 29e thepump 29 is connected to neither

tube

21, 22 so that no suctioning takes place. However, fluid is delivered respectively via thetube 21, thetube 22, or both

tubes

21 and 22. Anappropriate detent 60 maintains thedistributor control 29 at the selected position.

In the embodiment ofFlGS. 2 through 4, a simpleelectromagnetic vibrator 23 imparts swinging motion to therod 19. Thus themechanism 23 includes an electromagnet 61 mounted within thehandle 16 by asupport 62 ofplastic or like insulating material. Oneleg 63a of a generally Ll-shapedflat metal strip 63 also is mounted to thesupport 62. Theother leg 63!) is spaced from thepole pieces 61a so as to be attracted by the electromagnet 61. Thefree end 63c of thestrip 63 is situated along the longitudinal axis .of thehandle 16 and terminates at a fitting 64 which releasably retains therod 19. The strip section 630 extends between the are limitingstops 26.

. Theelectromagnet 35 is energized by a signal from apower supply 65 supplied via acable 66. The signal may comprise voltage pulses supplied at a rate adjusted by acontrol 67 in thehandle 16. Each pulse-energizes the magnet 61 so as to attract themetal section 63b and cause therod 19 to move upward as viewed in FIG. 2. When the pulse terminates, the magnet 61 is deenergized and the resiliency of themember 63 causes thesection 63b to swing away from thepole pieces 61a, carrying therod 19 downward (FIG. 2). The stops 26 limit the extent of arcuate travel of thetip 20. Typically, the pulse rate may be selected so that therod 19 swings back and forth at a rate in the range of from 0 to about 100 cycles per second.

An electrical contact (not shown) may be provided in circuit with the magnet 61 to be opened and closed as the member'63b vibrates. Themember 63b thus may interrupt a dc voltage supplied via theline 66 to the magnet 61. The magnitude of the voltage could be ad justed by the control 67to affect the swing rate of therod 19. In other embodiments (not shown), themechanism 23 might be replaced by a spring wound vibrator, by a small motor powered by batteries within thehandle 16 itself, or by other well known devices for imparting arcuate motion.

Themember 62 may slide longitudinally within a slot 68 (FIG. 2) in thehandle 16. Since themember 62 carries thestrip 63, longitudinal movement ofthe'member 62 will adjust the position of the leg 630 relative to thestops 26, and thereby control the arc of therod 19. Alternatively, thestops 26 may be positionable separately by means of afinger control member 69. The

tubes

21, 22 might be coiled around themechanism 23 so that the fluid flowing through the tubes will cool the mechanism. Foot controls (not shown) may be provided to control therod 19 swing rate and/or adjust the fluid flow and suction rates through thestationary tubes 21 v and 22.

.The tool is by no means limited to use in eye surgery, but is equally useful in other applications where tissue is to be sectioned, incised, frozen or cauterized in any accessible body cavity or subcutaneous location.

Thetool 15 is useful for biopsies and eviscerations, and

6 tions, the probe dimensionsmay differ from those described above for ophthalmological surgery.

Intending to claim all novel, useful and unobvious features shown or described, I make the following claims:

1. A surgical tool for prising:

an elongated tubular handpiece,

a probe extending from one end of said handpiece, said probe having a globular surgical tip with a maximum diameter of less than about l.5 millime- ICXS,

means mounted in said handpiece for imparting only swinging motion to said probe through a limited arc in one plane only, at a rate of swinging of less than about cycles per second, and

at least one fluid flow tube extending from said handpiece end genernally parallel to said probe but spaced from said plane for communicating fluid to or from the region of said tip.

2. A surgical tool according to claim 1 wherein said surgical tip includes a lateral cutting projection which protrudes less than about 0.2 millimeter.

3. A surgical tool according to claim 1 wherein said globular tip includes a forward cutting projection which protrudes less than about 0.2 millimeter.

4. A surgical tool according to claim 1 wherein said probe extends from said handpiece less than about 25 millimeters, wherein said probe diameter is less than about 1 millimeter, wherein said tube is less than about 2 millimeters in diametenand wherein said are is limited to a maximum tip excursion of less than about 3 millimeters.

5. A surgical tool according toclaim 4 further comprising means, in said handpiece, for selectively adjusting the limits of said arc.

opthalmological surgery com- 6.. A surgical tool according to claim 1 and having two fluid flow tubes extending from said handpiece, together withmeans 'for selectively supplying fluid via one or both or said tubes and means for suctioning fluid from the region of said tip via one of said tubes.

'7. A surgical tool according toclaim 6 together with control means for selectively interconnecting said tubes and said means for supplying and suctioning.

8. A surgical tool according to claim 1 wherein said tube surrounds said probe and is of sufficient diameter to permit said probe to swing through said limited are within said surrounding tube.

9. A surgical tool according to claim 1 wherein said probe is detachable from said means for imparting said swinging motion.

10. A surgical tool according to claim 1 together with fiber optic means for guiding light to the region of said tip.

11. A surgical tool according to claim 1 wherein said means for imparting said swinging motion comprises:

a lever arm extending through a portion of said,

handpiece and electromagnetic means for periodically attracting said arm toward one side of said handpiece, said arm thereafter resiliently returning toward the.

other side of said handpiece, such action imparting said swinging motion to said probe. 12. A hand held tool for opthalmological surgery comprising:

a handpiece,

probe means extending from an end of said handpiece and consisting of a probe having a surgical tip,

means mounted in said handpiece for swinging said probe through a limited are at a rate less than about 100 cycles per second, the probe being prevented from longitudinal motion in a direction parallel to the handpiece, the surgical tip of said probe being globular and having a maximum diameter of less than about 1.5 millimeters, said probe extending from said handpiece less than about 25 millimeters and having a diameter less than about 1 millimeter, said are being limited to a maximum tip excursion of less than about 3 millimeters, and

means, in said handpiece, for selectively adjusting the limits of said arc.

13. A surgical tool according to claim 12 further comprising:

a pair of tubes extending from said handpiece generally parallel to said probe, together with means for supplying fluid, means for suctioning fluid, and distributor control means in said handpiece for selectively interconnecting said tubes and said means for supplying and suctioning.

14. A surgical tool according to claim 12 further comprising a light guide extending beside said probe from said handpiece to the vicinity of said surgical tip.

15. A surgical tool according to claim 12 wherein said surgical tip is globular and includes a lateral cutting projection.

16. A surgical tool according to claim 12 wherein said surgical tip is globular, at least a portion of the surface of said globular surgical tip being abrasive.

17. A surgical tool according to claim 12 wherein said surgical tip is globular and includes a forward cutting projection.

18. A surgical tool according to claim 1 wherein said globular surgical tip includes an abrasive surface region.

Claims

1. A surgical tool for opthalmological surgery comprising: an elongated tubular handpiece, a probe extending from one end of said handpiece, said probe having a globular surgical tip with a maximum diameter of less than about 1.5 millimeters, means mounted in said handpiece for imparting only swinging motion to said probe through a limited arc in one plane only, at a rate of swinging of less than about 100 cycles per second, and at least one fluid flow tube extending from said handpiece end genernally parallel to said probe but spaced from said plane for communicating fluid to or from the region of said tip.

4. A surgical tool according to claim 1 wherein said probe extends from said handpiece less than about 25 millimeters, wherein said probe diameter is less than about 1 millimeter, wherein said tube is less than about 2 millimeters in diameter, and wherein said arc is limited to a maximum tip excursion of less than about 3 millimeters.

5. A surgical tool according to claim 4 further comprisIng means, in said handpiece, for selectively adjusting the limits of said arc.

6. A surgical tool according to claim 1 and having two fluid flow tubes extending from said handpiece, together with means for selectively supplying fluid via one or both or said tubes and means for suctioning fluid from the region of said tip via one of said tubes.

7. A surgical tool according to claim 6 together with control means for selectively interconnecting said tubes and said means for supplying and suctioning.

8. A surgical tool according to claim 1 wherein said tube surrounds said probe and is of sufficient diameter to permit said probe to swing through said limited arc within said surrounding tube.

11. A surgical tool according to claim 1 wherein said means for imparting said swinging motion comprises: a lever arm extending through a portion of said, handpiece and electromagnetic means for periodically attracting said arm toward one side of said handpiece, said arm thereafter resiliently returning toward the other side of said handpiece, such action imparting said swinging motion to said probe.

12. A hand held tool for opthalmological surgery comprising: a handpiece, probe means extending from an end of said handpiece and consisting of a probe having a surgical tip, means mounted in said handpiece for swinging said probe through a limited arc at a rate less than about 100 cycles per second, the probe being prevented from longitudinal motion in a direction parallel to the handpiece, the surgical tip of said probe being globular and having a maximum diameter of less than about 1.5 millimeters, said probe extending from said handpiece less than about 25 millimeters and having a diameter less than about 1 millimeter, said arc being limited to a maximum tip excursion of less than about 3 millimeters, and means, in said handpiece, for selectively adjusting the limits of said arc.

13. A surgical tool according to claim 12 further comprising: a pair of tubes extending from said handpiece generally parallel to said probe, together with means for supplying fluid, means for suctioning fluid, and distributor control means in said handpiece for selectively interconnecting said tubes and said means for supplying and suctioning.