US1097132A - Hemostatic tonsillotome. - Google Patents

Description

B. 1). LA FORGE. HEMOSTATIG TONSI-LLOTOMB. APPLICATION I ILED DBO. 29, 1913.

1 7 1 32 Patented May 19, 1914.

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i mw B. 1). LA FOROE.' HEMOSTATIGI TONSILLOTOME. APPLICATION FILED D30. 29, 1913.

LQQ'ZJ 3 2, Patented May 19, 1914.

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. To all whom it may concern:

BURDEITE DUDLEY LA FORCE, 0E OT'LUiiIWA, IOWA.

HEIVIQSTATIG TQNSILLO$OME Specification of Letters latent.

Patented May 19, rate.

Application filed December 29, 1913. Serial N 0. 809,212.

. Be it known that I, Bunnn'r'rn DUDLEY LA FORCE, citizen of the United States, residing at Ottumwa, in the county of VVapello and State of Iowa, have invented certain new and useful Improvements in I-Iemostatic Tonsillotomes, of which the following is a specification.

This invention relates to improvements in surgical instruments of the type called tonsillotomes, the primary purpose of which is to effect the removal of tonsils, adenoid growths, and other more or less inaccessible members or tissues.

While the instrument hereinafter de-' scribed is especially designed for removing the faucial tonsils, the principles entering into its construction and operation are such that it may be effectively used for other surgical operations which requires ligation,

' hemostasia and amputation, in rapid se quence, for their successful completion.

The-especial object of the improvements which form the subject matter of this application, is to provide an instrument of the type stated, in which a ligator, hemostat and knife are so combined that they may be con veniently and effectively operated in rapid sequence, as compared with separate instruments, thus requiring the patient to be under anesthesia for the bricfest possible period, and by which a bloodless operation may be performed.

A further object of my innprovcmcnts is to so combine the several instrumentalities which make up the complete device, that each will complement the other in effecting a the various steps required in a complete op- Fig. 3 is an enlarged sectional view of the eration upon the part removed.

A still further object of my improvements is to provide an instrument having its members of strong and simple construction, so assembled that they may be readily disassembled for cleaning, and in which there will be no inaccessible joints or crevices. I

Havin the aforegoing special objects, and others o general utility in mind, I have invented and designed the instrument herein shown, described and claimed in a preferred form, as follows c- In the accompanying drawing :Figure 1 is a sideelevation, in full size, of a faucial hemostatic tonsillotome constructed according tomy invention; Fig. 2 is a to) plan View of the instrument shown in *ig. 1;

tonsil engaging terminals of the ligator,

hemostat and knife of my improved instrument; Fig. it is an enlarged plan view of the rear portion of the main frame of my improved to-nsillotome; Fig. 5 is a top plan view of the knife member; Fig. 6 is a plan view of the hcmostat; Fig. 7 is a plan View of the ligator; Fig. 8 is a fragmental view showing in elevation the upper portions of the handle members of my invention, and- Fig. 9 is a detail of a spring catch which forms a feature of my invention.

Referring to the details of the drawing,

the reference character 10 represents the handle member of my improved instrument, and it is made up of the following parts A rearward grasping portion 10, a forward grasping portion 10 to the'inner opposed faces of which ,are secured springs 10 adapted to force said grasping portions apart, as shown in Fig. 1. The handles are pivoted together at 10*, and above their pivoted points are formed with integral extensions 10 10 respectively, the former serving as a lever adapted to operate certain other members of the instrument, and the latter or-part 10*, which is bifurcated having rectangular portions 10 at its upper end, one of which is adapted to fit a correspond ing notch 11 in the main frame of the instrument, to be hereinafter described. The terminals 10 have a threaded hole l0 formed therein, and the lever 10 has a curved notch 1O formed in its inner edge as shown in Fig, 8. The member 10 is split, as indicated by dotted lines in Fig. 8, to receive the member 10 when the latter is in its closed position, so that while one of the parts 10 engages the notch 11 in the frame 11, the other portion 10*, passes througha suitable slot 11 at the other side of the frame, as shown in Fig. 2. A thumb screw 10 has a threaded engagement with the holes 10 in the portions 10 and by tightening said nut the two terminals 10 of the fork 10 are removably but firmly clamped upon the frame of the instrument. The notch 1O in the inner edge of the member 10 provides for the screw 10 when the two members 10, 10, are in their closed position.

11 represents generally the main frame of my improved instrument upon which the operating members are slidably mounted. This frame throughout the greater part of its length is substantially a fiat bar of steel, but at its rear portion is bent at right angles 'wardly from the rear end of the bar.

to provide a post 11, the end of which is perforated to provide spaced threaded: eyes 11 The bar is also bent at 11 so that the portions 11 11,and the connecting portion of the bar, form an open rectangular yoke, as clearly shown inFig. 1. One edge of the bar adjacent the bond 11 is cut away to provide the rectangular notch 11. The bar is further provided with a small diamond shaped slot 11 a slot 11 near the edge, opposite the notch 11, and an elongated slot 11 extending longitudinally of the bar between the slot,11 and the notch 11. The forward end of the bar is formed into a rectangular yoke 11 in the inner walls of which are slidcways 11, 11 and the cross bar at the end of the yokeis slit to provide a passageway 11 (see Fig. 3) for the knife 12. l p

The reference character 12 represents the knife member of my improved instrument, the same consisting of a thin steel bar,-fiat throughout the greater part of its length as shown in Fig. 5, but provided at its rear end with a lug 12 at right angles to the bar, through which lug is an opening 12*. The bar is also provided with two slots 12, 12 extending longitudinally thereof, and at its forward end the bar is widened'and provided with a beveled cutting edge 12. The knife rests upon the frame 11 and is mounted to slide in the groove 11 in said frame.

As best shown in Fig. 6,the hemostat member, 13, of my improved instrument consists of a flat bar of steel except for the threaded stem 13, which extends rear- There are two longitudinal slots 13, 13, in said bar, and along one edge are ratchet teeth 13 Near the forward end of the bar, and on the upper surface, are small guide lugs 13*, and the forward end portion of the bar is widened and provided on its edges with flanges 13. adapted to engage the groovesor slideway 11 in the frame 1.1. The forward end of the hemostatic bar is provided with serrations or teeth 13 which are adapted to cooperate with similar teeth formed on the opposed edge of the yoke 11 in the gripping or crushing of the tonsil.

The ligator member, 14, or ligature carrier, of my improved instrument is shown in plan view in Fig. 7 and same consists of a thin flat bar throughout the greater portion'of its length, but at its rear portion is provided with a triangular shaped lug 14, which serves as a suitable finger-engaging portion of this member, its surface being preferably roughened to prevent slippage of the fingers of the operator. This member 11, is also provided with an elongated slot 14, and its forward end is made tapering and somewhat i thinner than the body of the member, and 3 is rounded as at 11. and in the extreme end 3 isadapted to receive the ligature 1 1 the ends of which are held by the spring clip one end of which is a post 15 which terminates at its free end in a transverse tongue 15. The opposite end of the latch is formed with spreading angular extensions 15 which are adapted to embrace the lower edge and sides of the bar 11 when the latch is in operative position, and when in this position, the post or stem 15 will pass through the slots 11, 12, and 13, and the diamond shaped end 15 of the stern will extend crosswise of the diamond shaped slot 11 ,"VVhen itis desired to discharge the catch, the end 15 is forced downwardly against the tension exerted by the opposite end and the catch is given a quarter turn, thus bringing the end 15 into registry with are slot 11, so that it can be drawn through the-slot. As best shown in Fig. 2, a thumb screw 16, has a threaded engagement with the eyes 11 at the rear end of the frame 11, and serves to guide the stem 13" which passes below saidsscrew.

Mounted upon the threaded stem 13, is a wheel 17 which, when screwed by turning to the left to the point shown in Fig. 1, in which it impingesagainst the end of the arm 11, serves as a lock-nut against the longitudinal mbvement of said stemwhen the forward end of the hemostat is in its most forward position, but when a longitudinal movement of the heme-static member or bar of'which said threaded stem is an extension independently of the handle is desired, such movement is effected by the rotation of said nut 17 to the left and it also forces forward the knife. by reason of the, connection between the rear end of the knife and stem 13, which is effected by the hub extension 18 on the nut 18. When it is desiredto move the knife independently of the hemostat and the handle lever, the nut 18 is turned to the right or left, depending upon whether it is desired to feed the knife forward or backward.

The reference character 19. represents a pawl pivotally mounted on apin 20 in the frame 11, and adapted to have its point 19 held in operative engagement with the teeth 11 of the hemostat by the expansive action of a spring 21, when said hemostat is in position that will bring said point in the path of said teeth. The handle extension arm or lever 10 engages the slots 11*. 12 13", and 11 and serves to push forwardly the knife and hemostat a certain distance when the handle members 10*, 10", are brought close 65 of the rounded portion is a groove 14 which 1 together by the operator. lVhen thus operated the pawl 19, by engaging the teeth 13 will hold the parts in such position. until the pawl is manually released.

The method of procedure in the use of the hemostatic tonsillotome is as follows :The faucial tonsil is engaged into the fenestrum of the instrument by placing the yolte 11 around it and all of the tissues immediately in. apposition to. the capsule of the tonsil are thoroughly crushed by pressing the handles of the instrument tightly together, thus bringing the hemostat in close engagement with the tissues immediately back of the capsule, in which position it is held by the engagement of the pivotal pawl with the teeth provided therefor on the edge of the rear ,portion of the hemostat bar. Thenext step to further crush the tissues and clamp them effectively in the hemostat yoke, is accomplished by turning the wheel 1'? to the left, so that it will impinge against the end 11 of the main frame. After the tissues are thoroughly crushed, the ligator or ligature carrier, with a ligature looped over the end Li, and in the groove 14:, and held under tension by the spring catch li is pushed forwardly, piercing the tissues clamped by the hemostat. Whereupon the ligature is slaclrened by disengaging it from the catch, the ligator retracted, thus leaving the loop end of the ligature on the farther side of the tissues, where it may be grasped by suitable instruments, the loop brought around the rear end of the instrument and the ligation completed by tying the ligature down tightly against the tissues under compression. This'ligation operation may be repeated in as many places as the size of the member operated upon may require. After these operations are performed, the operating nut 18 is turned to the right thereby sliding the knife tl irough the groove provided therefor in the frame, and severing the tonsil or part operated uponiinmediately adjacent the heinostat. The hemostat then released by turning the nut 17 to the right and releasing the pawl 19, thereby allowing the springs {10C to expand the handles, and retracting the knife and hemostat. The several operations described effect the complete enuoleation of the tonsil without hemorrhage;

1. A surgical instrument comprising a fixed frame having a fenestruni at its forward end, a pair of handles detachably connected. wit-l said' frame, one of said handles being pivotally connected with the other and'having an arm extending through said frame, 'a hemostat bar slidably arranged on said frame, a knife slidable on said frame, and a ligator slldahle on said hemostat bar, said bar and knife adapted to be operated by said arm and to enter said yoke.

2. A surgical instrument comprising a fixed frame having a fenestrum at its forward end, a pair of handles detachahly conneoted with said frame, one of said handles being pivotally connected with the other and having an arm extending through said frame, a hemostat bar slidably arranged on said frame, a, knife slidable on, said frame adjacent said bar, a ligator slidable on said hemostat bar, vsaid loar and lrnife adapted to be operated by said arm and to enter said yoke, and means for locking said bar in operative position.

3. A surgical instrument comprising a fixed frame having a fenestrum at its forward end, apair of handles connected with said frame, one of said handles being pivoted to the other and having an arm extending through said frame, a hemostat bar slidably mounted on said frame and having a slot operatively engaged by said arm,

a knife slidably mounted on said frame and having a slot o-peratively engaged by said arm, means for locking said bar in operative position, and means for detachably connecting said bar and knife with said frame.

4 A surgical instrument comprising a frame having a fenestrum at its forward end, a pair of handles connected with said frame, a heniostat bar slidably mounted on said frame, and adapted to enter said fenestruni, a knife slidably mounted on said frame, means for operating said bar and knife, means for locking said bar in operative position, and means for detachably connecting said bar and knife with said frame.

5. A'surgical instrument, a frame having a fenestrum at its forward end, a pair of handles connected with said frame, a hemostat oar slidably mounted on said frame, and adapted to enter said fenestrum, means for operating'said bar from said handles to be operated on, a ligator slidable on said hemostat, means for operating said ligator, means for holding a ligature under tension on said ligator, means for operating said hemostat, and means for locking said hemostat in operative position:

8, In a surgical instrument, a supporting m mber, a hemostet, a ligator and a knife, In testimony whereof I aflix my signature shdably arranged 111 superposed relatlon on m the presence of two w1tnesses. said frame, lndependent means for operat- BURDETTE DUDLEY LA FORCE- ing szud hemostat, hgator and knlfe, and Vitnesses:

a means for locking the hemostat in oper- J. A. HULL,

ative position. ELMER J. LAMBERT.

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