US1798902A - Surgical instrument - Google Patents

Description

March 31, 1931. E. M. RANEY 1,798,902

SURGICAL INSTRUMENT Filed Nov. 5, 1928 50g/ij@- I .ZYJ'fi/fffflffi-Yqqef{9L-merecen PRG P12/E TOR Patented Mar. 31, 1931 EDWIN ivi. nanny, or sT. Louis, Missonnr SURGICAL INSTRUMENT Application led November This invention relates generally to surgical instruments and, more particularly, to`

a certain new and useful improvement in surgical instruments of the type known as s tonsillotomes.

In tonsillotomy, a hemorrhage concoini` tant with the excision generally occurs when using an ordinary tonsillotonie having the form of a. pair of blunt edged shears, the ap io plication of a suitable astringent in the forni preferably of a styptic'medicine being re-` quired to contract the soft the flow of blood. i Ordinary tonsillotomes perform the eXcitissues and check between the blunt edges of the shears to masticate the tissue along the line of cleavage and thus leave the root of the tonsil in a condition favorable to the rapid coagulation of the blood and to the suppression of the hemorrhage. Nevertheless, the flow of blood may not altogether be permanently sup@ pressed, especially in patients suffering from hemorraghicdiathesis or the like, so that the *operation may be, andL often is, followed by a lesion difficult to correct.

I have found" that the hemorrhage may be suppressed and morbid conditions averted by a form of diatherinic tonsillotome having its exciding members each connected to one of the opposite terminals of a source of elec` trical energy preferably furnishing an alternating current of `a frequency of not less than five hundred liilocycles per second, coininonly referred to as aliigh frequency current.

My present invention has hence for its prime object the provision of a tonsillotome 4,0 for diathermically eifecting `separation and removal of the. tonsil.

My present invention has for further objects the provision of a tonsillotome ofthe type stated which may be readily manufactured, which may be conveniently manipusion of the tonsil by compressing the same L y 5, 192s. seriai n lated, and which is eiicient in ance of its int the performended functions.

And with the above and other objects in view, my invention resides in the novel features -of form and combination of parts `hereinafterdescribed and po construction, arrangement,

inted out in the claims.

In the accompanying drawing,-`-

Figure 1 is a sectional view of the pharyni geal region of sented therein a human being, illustrating a tonsillotome `of my invention orally `pre- .for a tonsillar operation;

Figure 2 isa longitudinally sectional view through the tonsillotome,`

Figure 3 is lotome; and

Figure 4 is a sectional view, of the tonsillotome, along t Referring now more in d ence characters to the dra trates a preferred embodiment of my invention,` the instrument a top `plan view of the tonsilhe line 4-4, Figure 2.

etail and by refer- Wing,`which illusincludes a suitably elongated, relatively strip-like rigid member or so-called frame A of at l,at its forward end iiected or conj end, is a prete lation handle spatulate contour, as ,and suitably conoinedto frame A` at its rear rably obliquelydisposed insu- 2. The frame A is approxi` mately flat and smooth upon its upper face,

, forpurposes presently appearing, and in its spatulate or head-end 1 is provided with a tonsillar fenestra or aperture l 3.

Integrally or otherwise xed upon `and extending continuously along` the margin of the spatulate or head-end l of frame A ure 3, is anundercut or as best seen in Fig-` recessed wall 4 providing a guide-way for the correspondingly spatulate head rigid co-operati fully described,` flat face and at sai for slidable `or relatively to th -endi of a likewise elongated ng member B, presently more y and smooth on its under d face disposed longitudinally shiftable` movement upon and e frame A. The members A and B are'preferably of reduced sectional area through t heir middle or oral portion,as

best seen in Figure 3, for both reducing the weight of the instrument and facilitating its use, the frame A being provided longitudinally upon its opposite side margins at and adjacent its rear end with undercut or passing downwardly through and Yout of handle 2, is one lead 9 of a conducting cable 1() for electrically connecting .the frame A with a source (not shown) of alternating electrical energy having a frequency of at least five hundred kilocycles per second, a conveniently operable switch or other suitable make-and-break device, as at 1 1, being incorporated in the lead 9, as seen in Figure .1. In such manner, the stationary excidingmember 7 is connected or included' electrically in, and may be described` as the terminal of one side of, the circuit.

The other lead 12 of the conducting-cable passesfthrough a tube V13 forming substantially apart of frame A and depending therefrom through the handle 2,- the latter being .2 preferablysplit in the plane of the rtube 13 p and secured therearound by suitable fasten-r ing elements 14, as seen in Figure 2.

Disposed in a recess 15 in the upper farce of the frame A preferably intermediate the guide-walls 6, is an insulating member 16 having a cup-like chamber 17 depending into the upper end of the tube 13'. Springset by a spring 18 for normal endwise presentation through the insulation 16 for yielding engagement with the shiftable member B, is a reciprocable contact-plunger 19Y flexibly connected electrically with the lead. 12 through a suitable aperture as at 20, lin the bottom wall of the chamber 17, as best seen in Figure 2.

The member B is likewise constructed of' suitable metallic material, and disposed in and along the kcenter line of member B and extending from adjacent the rear end thereof to and through its head-end v5, is a strip of insulating material 21, which is laterally extended over themargin'of the head-end 5 in an arcuate or horn-like shape to form an eX- ciding member-support 22. Mounted on,

^ and insulated by the support 22 from, the

shiftable member B, is'the shiftable metallic exciding member 23, whose exciding edge is formed complementary to, and adapted to engage the groove of, the stationary metallic exciding member 7. A conductor'24 is embedded in the insulating strip 21 and leads from the exciding member 23 to a contactbutton 25 disposed in the rear end portion of the member B and terminating flush with the under face thereof for exposure to and contact with the plunger 19 on predetermined movement of the shiftable member B in operating direction, that is to say, in a direction to move the shiftableV eXciding member 23 over the tonsillar aperture 3, both of the eXciding members being electrically energized in opposition when the button 25 engages with the contact plunger 19. In such manner also, the shiftable eXciding member 23 is adapted for inclusion in, and to provide terminal of the opposite side of, the circuit.

v A trigger 26 is pivotally supported, as at 27, upon the frame A in gripping relation with the handle 2, the latter being preferably provided with finger notches 28 in the usual manner. Extending from the trigger 26 into a slot 29 in the frame A, is a dog 30 adapted to swingably pass into and out of a slot 31 in the shiftable member B for engagement with an end wall thereof to move the member B in operating direction on the trigger 26 being pressed or pulled towards the handle 2. On the trigger 26 being actuated away from the handle 2, the dog may be entirely disengaged from the shiftable member slot 31,

land the member B then shifted rearwardly upon the frame-A until the end portion thereof is disengaged from the guide-walls 6 and the head-end 5 disengaged from the guidewall 4, whereupon, since the intermediate por,- tion of member B is narrower than the dis'- tance between vthe walls'6,'the member B may be lifted from `the frame A.

The point at which the button 25 contacts 'f the plunger 19 is selected, so that the tonsil tissue willbe firmly grasped between the exciding members 7 and 23 whenA the current is kapplied therebetween. This position is most easily attained by the operator pressing the shiftable member B with his thumb while grasping the handle 2, a thumb-piece 32 being provided on the member B for the purpose. Thereafter the movable eXciding member 23 is gently and firmly moved by means of the trigger 26V kerf-like through the tonsil tissue as it isseparated by the diathermic action of the high-frequency current 'occurring concomitantly. The diathermic effect increases as the distance between the exciding members is decreased, hence it is not necessary that the current be supplied during the entire travel of the exciding member 23 across the aperture 3. For this reason, the'dimensions of the contact-button 25 are chosen to insure the passage of the current'through thetonsil tissue where wanted and'cut off the 'supply of current before the completion of the ezciding movement of the member B,as well as also to prevent a short circuit when the movable exciding member 23 touches the stationary eX- ciding member 7 In prac-tice, asshoivn in Figure l, the tonsillotome is orally presented into the pharynx of the patient and manipulated to pass the lobe of the tonsil through the tonsillary aperture 3. The location of the excision having been determined, the operator grasps the tonsil between the exciding members 7 and 23 and proceeds with the `operation as hereinbefore set forth, whereupon the operation is completed, the eect of the high frequency current being to close the Wound, through coagulation of the tissues, after the diathermy, thereby preventing hemorrhagic lesions, the result of the operation being to effect a neat and complete and substantially bloodless severance of the tonsil.

Thus the excision is performed by my tonsillotome Without incising or masticating the tissue of the tonsil, the separation being effected by diathermy and hemorrhage prevented by the coagulation produced by the high frequency of the current in passing' from one exciding member of the tonsillotome to the other through the tissue of the tonsil along the desired line of separation. Hence it Will be seen that my new tonsillotome, When used in combination With a source of highfrequency alternating current, is an eiiicient instrument for the surgical purposes intended; it is of simple construction, light in Weight, relatively inexpensive to manufacture, and effective in operation.

While I have shown and described herein the preferred form of my invention, it Will be understood that changes and modifications in the form, construction, arrangement, and combination of the several parts of the instrument may be made and substituted for those herein shown and described Without departing from the nature and principle of my invention.

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

l. In a tonsillotome, the combination with a. source of high frequency alternating electrical current having a frequency not less than live hundred kilocycles per second, of a frame adapted for oral presentation, the tonsillar end of the frame having an aperture for the reception of the lobe of the tonsil, the end Wall of the aperture forming a stationary exciding member, a co-operating exciding member shiftable on the frame across said aperture, said stationary eXciding member being connected With one terminal of said source of current, and means for connecting the other terminal of said source of current to `the shiftable exciding member on movement thereof to a predetermined position.

2. In a tonsillotome, the combination with a source of high frequency alternating electrical current having ay frequency not less than-five hundred kilocycles per'second, of a frame adapted for oral presentatiomithe tonsillar endy of the frame having an aperture ing member shiftable on the framefacross said aperture, said stationaryexciding member being connected with one terminal of said source of currentyand means for con-` necting theother terminal of "said source of current to the shiftable exciding member on movement thereof to a predetermined position. said last mentioned means also disconnecting said source of current from the shiftable exciding member prior to the termination of the exciding movement thereof.

3. In a tonsillotome, a frame adapted for oral presentation, the tonsillar end of the frame having an aperture for the reception ofthe lobe of the tonsil, a metallic stationary exciding member mounted on the end Wall of the aperture, a shiftable member mounted on the frame for movement relatively to said aperture, a metallic eXciding member insulatably mounted on said shiftable member for passage across said aperture, a contact-member insulatably mounted on the frame for slidably contacting the shiftable member, a conductor mounted on said shiftable member `for engagement with said contact-member on movement of the shiftable member to a predetermined position,`said conductor having electrical connection With the movablel eXciding member, means for connecting the contact-member with one terminal of va source of electrical energy,`and means for connecting the other terminal of said source with the stationary exciding member. y

4. In a tonsillotome, a metallic frame adapted for oral presentation, `the tonsillar end of the frame having an aperture for the reception of the lobe of the tonsil,` the end Wall of the aperture forming a stationary exciding member, ashiftable'member slidably mounted on the frame for movement relatively to said aperture, an insulating' strip longitudinallymounted `in the shiftable member and slidably contacting a surface of the frame, a spring set `contact-member normally bearing against said insulating strip, a conductor embedded in said insulating strip having one terminal exposed for selective engagement With said contactmember, a movable exciding member mounted on said insulating strip for carried movement across said aperture, the other terminal of said conductor being connected to the movable exciding member, means for connecting said contact-member With one terminal of a source of electrical energy, and means for connecting the other terminal of said source of energy With said frame.

ico

5. In a surgical instrument for diathermie tonsillotomy, means comprising Veo-operating excidmg members, one of which 1s slidably sliiftable .relatively to the other,A for holding the Vtonsil in operative position, means operable conjointly'by and with said first mentioned means for passing a Current of electricity from one to the other of said members through the interposed tonsil tissue,

Vand lmeans in connection With said last-mentioned means for automatically regulating the duration of the passage of the current.

VIn testimony whereof, I have signed my name to this specification.

Y EDWIN M.- RANEY.

Images