US1707736A - Tonsil enucleator - Google Patents

Description

TONS IL ENUCLEATOR Filed May 18, 1927 2 Sheets-Sheet '1 April 2, 1929. B. D. LAJoRcE 1,707,736

TONS IL ENUCLEATOR Filed May 18, 1927 2 Sheets-Sheet 2 Cal Cal

Patented Apr. 2, 1929.

PATENT OFFICE.

BURDETTE D. LA FORCE, OF GTTUMWA, IOWA.

TONSIL ENUCLEATOR.

Application filed May 18,

My invention pertains to a tonsil enucleator and is a type of surgical instrument in the class of tonsilcctomcs or tonsil snares, the primary purpose of which is to effect a removal oi the itaucial tonsils or other more or less inaccessible tissues.

A general object of my invention is a surgical instrument suitable for the above purposes and other operations in \\"l1lCl] lJUOillO- sta nd amputation in rapid succession are necessary for their successful completion.

A further object of my invention is the construction of a tonsil enucleator or similar siu. 'ical instrument having a blade of the character of a hcmostat lade with a metal loop operating therewith, the loop tunctioning somewhat as a snare and pressing the tonsils or other tissues to be removed against the hemostat blade, thereby crushing the tissues before the severing an d thereby perl'iernn ing a substantially bloodless operation.

Another object of my invention is the construction of a tonsil enucleator or similar surgical instrument having the hemostat blade and the wire loop or snare associated, whereby the snare can be slid lengthwise and manipulatcd independently of the blade to engage and grip the tonsh or the like and by means of a trigger the snare may be operated to press the tissues between the blade and such snare and this pressure may be increased by a. screw threaded device, pressing the tis sues between the blade and the snare, and then when desired the blade and the snare may be slid longitudinally, severing the tensils or other tissues.

lily invention will be more readily understood from the following description and drawings, in which Figure 1. is a side elevation of my tonsil cnmrleator.

Figure 2 is a longitudinal section on the line 2-2 of Fig. in the direction. of the arrows. v

Figure 3 is a plan view taken in the direction oi the arrow 3 of Fig. 1.

Figure is a front end view taken. in the direction oi the arrow l of Fig. 1.

Figure 5 is a rear elevation taken in the direction of the arrow 5 of Fig. 1.

Figure (3 is a plan view similar to Fig. 1 showing the parts of the implement in a ditlerent position, as when crushing the tissues prior to their severance.

1927. Serial No. 192,271.

Figure 7 is a plan view of the instrument showing the position after severing the tensils and moving the hemostat blade and the loop.

Figure 8 is a section on the line 88 of Fig. 7 in the direction of the arrows.

Figure 9 is an enlarged detail section on the line 9-9 of Fig. 6 in the direction of the arrows.

Figure 10 is a plan view of the loop or snare.

Figure 11 is a transverse sectional detail on the line 1111 of Fig. 7, showing the posi tious of the catch.

The fixed structure of my device is formed substantially as follows:

It includes a main supporting arm 11, which forms a slidway, this arm having an operating end 12 with a longitudinal slot 13 through such end. Such end has opposite projecting sides 14, the slot being sufliciently wide to pass through said projecting sides. The supporting arm has a longitudinal groove 15 positioned substantially centrally.

and has an abutment end 16 with an opening 17 therein. A handle 18 extends downwardly from the end of the supporting arm adjacent the abutment end and is provided with a brace 19 which is adapted to fit over the top ofthe hand between the thumb and the lirst finger.

A sliding bar 20 is mounted on the arm 11 having a pair of pins 21 or the like extending into the groove 15. This bar is flat and has serrations 22 at its rear end extending outwardly beyond the body of the bar. The distal end of the bar forms a hemostat blade section 23, this extending through the slot 13 "from the rear end 24 which stops the bar by a ridge 25 transversely on such bar, and the forward end of the hemostat blade preterably has vertical corrugations 26 and a slightly convexed edge 27 as indicated most clearly in. Fig. 7, and a deep concave groove 27 (Fig. 9).

On top of the slidable bar, having the hemostat blade, is positioned an operating bar 28 which is held in position by means of a slide clamp 29, this having a base 30 which fits underneath. thesupporting arm 11 and has a. longitudinal ridge 31 engaging one side of such supporting arm. The vertical side 32 ot the slide clamp extends upwardly along the sides of the supporting arm 11 and the slidable bar 20 and is secured to the edge of the ope 'atinp; bar 28 by screws 32:3 or the like. A trigger ill is rigidly secured to the base 2-50 of the slide clamp.

'lhe slide bar has a yolae 3:35 at its outer end, this yoke having a loop 37 is secured in such yoke, the-loop torn'iing a snare. This loop has two parallel sides 35% and a base end 35.), the end being; llattoned, as indicated in the cross section oil .llhg. 2, so that it may be entered Qtltfjch'lstl in the slot 36 ot the yoke 135 and when turned in the lwrizoutal position the loop is prevented from being d awn out of such slot. The distal end -Ztt) ol? the loop is prefer; lily corrugated on the inside surface, indi 'ated at ll, forming part ol t snare to cooperate with the hemostat blade.

Extending rearwardly from the operating bar is a screw el-Q, this screw extending through a catch l3 which is loosely mounted on the screw and is adapted to tit between the abutment end lb of the supporting arm and the end istoi the slidable bar 20 having the heniostat blade. lower sm'l ace sothlit arm he sawing by the handle 46 from a position 'wlthfithelnindle inclined dmvnwardly and between the abutment 1G and the end l l, or when swung upwardly into the position showlrin ll igsi 8 and 11 the catch allows the upper surface oi the slid'able bar 2 to slide underneath, as is indicated by the relative position of such catch in Figs. 1 and 7.

The screw 42 slides tln'oauh the open' 17 in the abutment ltland has a knob ll" at its end to allow pressure ther on. ihnut lb is threaded oh the sere w and has radial spokes ll) to allow ready pressure thereon in screw m the nut tight against the abutment 16 The mechanical manipulation of mylenu cleator is substantially as 'l'ollouns:

The slide bar 20 may be moved longitudp nally oi thesupporting arm 11 by grippingthe ser 'atioi'is ZZ when thehaiulle is in a vertical. pesitionan d when this bar thrust out\ 'ard into the'piisition shown in Fig. 2 so that the ridge eng a the r tar part fZ l oi the operatuni; ondoit thodevice, such bar 15 in v I u 1 its extreme position. In oroer to hold the hen'iostat blade in this position the handle l6 of the catch is dropped to one side or the other so that, the catch tits between tl e abutment end it; of the support'ii'iti; arm and the end. ll o l the slidable bar ill). 'lhis, therel'ore, reslraius the rearvmrd moven'ient ot the hemostat blade. manipulated by first screwing the clai'nping screw 4.8 tinvards the knob ll oi the operating bar and by means of the trigger 3-]: thrusting the loop outwardly through. the sides of the slot 1&5, the sides 355 of such loop pass' g' on the outside oil the hemostat blade, as 1llustrated in Fin". 7.

To draw back this blade he first finger of the hand may pull on the trigger 3a which a slot 36 therethrough, and

loop engages the end ot the heinostat bia This catch is llat on the The loop or snare may be gradually pulls the snare inwardly, the operating bar hlltlillg on the slidable bar :20 which, as above mentioned, is told stationary, being so held by the catch 4:3. The iii-n gger may be d awn inwardly until the distal end of the le. Then to give increased pressure, the not i}; is jammed tight against the abutment end 16 ot the supporting arm ll, the operator utilizing thespoluasii) in turning this. Then, when desired, the :atch may be released troni thebael: ol' the sliidal'ile bar 20 by shitting same to the upper position and the hemostat blade with the loop ill-.te snare may then. be drawn rezu'wardly jt'rcely by the tri 1;; Bl, these moving together or, if d sired, by further jamming thenut -l8 against the abutment.

In manipulatingtheenuclcator in a surgical operation, for instance toreniore the tonsils, the laucial tonsil is engaged by the metal loop by'pressing the distal end elf such loop when in its outer position against the posterior pillar of the throat and the iaucial tonsil; lBressure is made in a direction to "force the loop in back'ojt the tonsil and by manipulation of the instrun'ient thetonsil is made to bulge the anterior pillar of the throat "forward. W hen the anterior pillar is seen to bulge forward, it is pressed upon by thelirst linger of the unoccupied hand or the operator to cause the tonsil to slip through the'loop oi the snare. l Vhen it is dete mined that this has been ZLCCOll'lPllSllBtl, the trigger is pulled, which brings the loop tightly against the tissue oi the tonsil and compresses this tissue between the hemostat blade and the distal end of the loop. Considerable pres sure may be brought to bear by pulling on the trigger but, as this usually is not soilicient to thoroughly crush the tissue, the nut it; is operated as above explained and when the tissue has been thoroughly crushed the tonsil may be grasped by forceps. The catch which holds the ope 'ating bar and the hemostat blade in place is released and either the trigger ispulled by the linger or the nut is is tin'ned, which procedure severs the tonsil from the tissues that have, been held in the hemostat. 'lhese seve 'al operations may be performed with my instrument to ell'ect the complete enucleation oi? the tonsil without hemorrhage.

llt will be noted that the grooves through the operating end 12 and the projecting ends l/l oi the supporting, arm give a pport to the loop or share and considerably stilien the wire so that this wire has a relatively long longitudinal support.

in my invention a hen'iostat may be conside ed as formed by a itenestra in which one part, that is a relatively stationary part, is tormedby'the hemostat blade 23 and the other by the loop or snare, this forming, a fenest a or window when open. Thus the tonsil may lit) be introduced in this fenestra when the win- (low structure is open and the tissues squeezed by closing such window structure, and finally amputated by a complete pressure between the heinostat blade and the end of the loop, and by the retraction of the hemostat blade in such a manner that the wire forming the loop will break through the weakened tissues when it is further retracted through the slotted part of the frame.

1t may be more readily understood how the hemostasis takes place in such an operation by those not es1 ccially familiar with such operations by knowing that when a blood. vessel is thoroughly crushed and its lumen is closed and. more or less glued together by pressure that the blood in the lumen of the vessel at the place where the crushing is produced and adjacent thereto becomes coagulated and blocks the flow of blood in the vessel. thus preventing bleeding.

In reviewing some of the important features of my invention it will be observed that a mechanism is provided whereby the tissues to be severed are crushed directly in the place where they are linally completely severed which it is believed is accomplished in a unique manner.

Another very important feature of my im proved instrument is the very simple manipulation necessary to accomplish the op eratien above described.

l vl'ien it is understood that many very badly diseased tonsils are very deeply imbedded in the tissues, and which fact makes their removal more difficult, it will be readily appreciated by operators to have an instrument whereby such tonsils may be removed in a simple and bloodless manner.

Cl. he simple manner of the removal of the tonsil with my improved instrument is especially due to the provision of a mechanism whereby the engagement of the tonsil is el liected by lassoing it with a wire or the like loop which is held and supported in an open manner. By being held and thus supported the wire or the like loop will stand the pressure necessary to press it down around the tonsil. Having the tonsil once engaged in the provided lasso the other unique features are provided in a very simple manner of manipulation to thoroughly crush the tissues about the tonsil and to sever them where they have been crushed and in thisway perforn'iing a blood less operation.

A special feature of my. invention is that the heavy wire loop is supported at the sides where it passes through the guide slots in such a manner that this cannot collapse. This distinguishes from the type of flexible snare in which a wire is contracted, squeezing the tonsil and eventually cutting the same. With my construction I have the benefit ol the snare-like loop in that my wire loop may be readily titted behind the tonsil.

Another characteristic feature oil my invention is that the snare-like rigid loop is contracted around the tonsil, crushing the tissue ot' the tonsil between the wire ot" the loop and the dull ed go of the hemostat blade. Therefore, by this construction and the manner of retracting the loop, the tissue may be thorou hly crushed a ainst this stat blade, and after suflieientcrushing, the tissues are cut in the exact place in which they have been crushed. This, to a great extent, prevents a hemorrhage.

Another characteristic feature of my invention is that the heinostat blade and the loop, when the tissues are crushed therebetween, may be retracted .into the guide structure at the end of the instrument, thus entirely clearing the loop from the severed tonsil.

My invention also distinguishes from the tonsilloton'ies in which the tonsil is severed by a moving, knife-like construction having a sharp blade, and in some of these, the tonsil is held in a rigid position by a holding device that the blade may press the tonsil against this holding structure, but in this case there is no el'l'cctive crushing oil? the tonsil. at the very place at which it is subsequently severed.

\Vhile the description of the instrument herein shown, described and claimed, in a preferred form, is especially designed to enucleate the faucial tonsil in a bloodless man ner, it will be easily understood that instruments embodying the unique features herein described may be provided in instruments made smaller or larger to be adapted to such )arts as the nasal cavities, the rectum, or al domina l. cavity, and the like, for the removal or tissues and abnormal growths in a bloodloss manner.

Various changes may be madein the principles of my invention without departing from the spirit thereof, as set forth in the description, drawings and claims.

I claim:

1. A surgical instrument having a dull liemostat blade and a non-collapsible snare like wire loop, means to move said blade and loop relatively to each other to crush tissue between the end of the blade and the wire loop, and to sever such tissue.

2. A surgical instrument having a dull homostat blade and a non-collapsible snare like wire loop, slidably mounted one relative to the other to engage and crush tissue between the end of the blade and the wire loop, and means to slide the hemostat blade and the loop together with tissue compres l therobetween.

3. A surgical instrument having a sup porting structure with a dull hemostat blade slidably mounted thereon, a wire loop like non-collapsible snare also slidably mounted on the supporting structure to slide relative to the hemostat blade to crush tissue between iii the end of the hlad and the end, oi the snare, and means to hold. the hemostat blade ritationary during the sliding ot the si'iare.

i. A surgical instrument having a Supporting structure with a sliding her having a (lull lIQD'IOSl HlJ blade and a slidable operating her having a non-collapsible snare like wire loop, mains to latch the slitlable bar with the hcmostat blade in one position, and meane to slide the one o with the .llQiiiOStttl) blade latched to compress tissue between the end oi the blade and, the snare.

5. fr surgical instrument, as claimed in claim et, meann to unlatch the :lidable bar and to allow sliding of said ha ancl hemostat blade and the snare, with tissue prcsneil between the bind: and the snare.

(3. A. surgical instrument having a eupporting structure with an ope 'atin g end having a slot, at slidahlc bar having;- a dull hemoetat blade fitting in said slot, a noncollapeihle wire loop like snare slidablc through the said slot, and ncans to slide the snare to compress tiesue bot-ween same and the end ol the hemosl'at blade.

7. A surgical instrument having a oupporting structure with an operating end having a slot, a slidable her having a (lull hemostaiblailc h tting in said slot, at non-collapsible wire loop like snare elidzible through the said slot, means to'siide the snare to compresis tissue between some and the end of the hemontat blade, and means to latch the Sikh able bar with the heinoistat blade in the slot, said means being l'UlQtLSEllJlQ to allow movement ot' the bar and the blade with the anarc, having tissue crushed. between the blade and the snare.

8. A surgical Illihtl'llllltl'll) having, a supporting Structure, an operating end having a hint, a sliilable bar having a hemoslat blade lilting in said slot, a non-colla1 )eible snare lihe wire loop extending; through the slot in Htlltl operating); end, 111103.115; actuated by a lie- ;ger to slide the snare relative to the said blade to crush tieisue between the blade and. the nnare, and manually operztcd means independent oil? the linger opera ted device to incr aisle the pressure of the snare against the blade.

9. A. surgical instrument, as claime: claim 8, a latch mounted in the supporting structure positioned to engage the slidablc bar and to hold same with the blade in the slot, said latch being relezinahle to allow elitiingg' oi the said bar under said latch.

10. A Surgical instrument having a supporting; arm with an abutment at one end and an operating end having a slot, a slidublc bar having a hen'iostat blade mounted. on the hupporting arm, the blade fitting); in the said slot, with means; to limit the forward, movement Ojii said, blade in the slot, or operai ing l ar rilidahly mounted on the supporting bar, a wire loop like non-collapsible snare connected to the operating bar and extending through th i said silot, means to latch the slidable blade with the slidahle her with the hemostat blade in. the slot, and a trigger device connected to the operatic bar to slide same relative to the :aliclahle bar to compress tissue between the hen'iostat blade and the end of the snare.

ll. 1, surgical instrument, as claimed in claim it), and a Screw threaded niecln'inisim operatively com meted. to the operating bar and causing an increz eed tension on the loop lihe snare, the said latch being releasable from the elitlable bar to allm :-1iinultaneous movement oft the l'ieli'iostat blade and the snare.

12. A surgical instrument comprising; in combination a f-iupporting arm having an operating end. with a slot thercthrougli, a slidable bar mounted thereon, having a hcinoetat blade titling in the said slot, an llpel'tlllll'lg' bur Slidable on the slidable bar and lowing); a yohe at its; outer end with a slot therethrough, a loop 'l'ormingg' a snare, having;- one part littii'ig in said yoke and ineertahle through the said slot in the yoke, the loop extending through the slot in. the operating curl oi? the supporting arm, and mean: to slitle the r-slidahle bar o COHlPYEF-lS tissue between. the loop and the hcmostat liilade.

13. in a surgical instrinnent a ni| )porting arm having an ope 'ating end with a slot thcret irougih, a oiiilable bar having a homostat bl roe tilting in the said slot, an operating bar 141 dine; on the slidable ha and. having a yoke at its outer and, with a slot ii said yoke, a loop forming a entire having a flattcued end, the said flattened. end being inner-table through the slot in the yoke, two sides of the loop extending through the slot in. the operatio end, and. the distal end of the loop having internal corrugations.

let. in a surgical ins-:irument a heinorstat blade, lnivine means to support 541M110, a snare l'ke loop elidahle in. relation to the said blade,

I the blade having an wine with a concave groove, meai'n; to draw the distal end of the loop into the said groove.

15. A, surgical. instrument comprising in combination a supporting arm having a pistol gri p, on operating end on said arm having a slot theretlnrougrh, an almtment extending upvardly at the other end, a slidable bar mountecl on the supporting arm, interacting means to guide the elidahle her, said bar having a hen'iostat blade fitting in the said slot, an operating bar s-sliclahle oi. the elirlable bar and having a loop like snare connected thereto, the snare extending through the said slot, a screw extend pig rearwardiy from the operating bar throi i the abutment, a catch having sides; partly encircling the mid screw and loosely fitting thereon, the said catch in one position fitting; between the eml of the sli=1lable bar and. the abutment and in another

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