US1609238A - Vacuum tonsillectome - Google Patents

Description

Nov. 30, 1926.

A F. A fEcK VACUUM TONSILLECTOME 4 sheets-sheet 1 Filed Feb. 19, 1.925

, \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\IIIII Nov. 30', 1926.4

F. A. BECK VACUUM ToNsILLEcToME Filed Feb. 19,

1925 4 Sheets-Sheet 3 Nov. 3o, v 1926.

F. A. l-:CK

VACUUM TONSILLECTOIB Filed Feb. 19 "1925 4 Sheets-.Sheb` I i' if' I n 1 Patented Nov. 30, 1926.

PATENT OFFICE.

FOSTER A. BECK, OF ALLENTOVVN,l PENNSYLVANIA.

VACU'M fronsirtncmons.

Application filed February 19, 1925. Serial No. 10,227.

My invention relates to new and useful improvements in a vacuum tonsillectome. and has 'for its primary object to provide an e'iiective device of this character which will enable a surgeon or other qualified person to enucleate' a patients tonsils safely and completely with the capsule intact, without unnecessary injury to the patient and without damage to the instrument during the time the patient is under either local or general anesthesia.

Another object of the invention is to provide an instrument of this character which will be well balanced and handy, thus giving a maXi-mumefficiency with a minimum oi? weight and which will include means for regulating the needle and steel wire snare.

A further object of my invention is to provide a structure which will permit of a gradual enucleation when desired.'

A further object of the invention is to provide such an instrument with a removable cannula which may be removed or replaced without affecting the operating parts of the instrument and which 'may be adjusted to dii'i'erent positions to the convenience of the operator permitting use of the instrument in either hand.

A still further object of my invention is to provide a tonsil receiving cup for detachable connection to the outer en-d of the cannula; to provide means for producing a vacuum in said tonsil receiving cup; and to provide means for regulating the amount of vacuum so produced in said cup.

Other objects of the invention are, to provide means for locking or holding the instrument in diiierent positions; to provide means for controlling said locking or holdingl means; to provide means for demount-r. ably connecting the different elements; and to provide means for collecting the blood or secretions which may pass through the conduit leading from the tonsil receiving cup.

lith these ends in view, this invention consists in the details of construction and combination of elements hereinafter' set forth and then specifically designated by the claims.

In order that those skilled in the art to which this invention appertains, may understand how to make and use the Same, I will describe its construction in detail, referring by numerals to the accompanying drawings forming a part of this application. in which 1*- l Fig. l, is a side elevation of a vacuum tonsillectome embodying my improvements with portions broken away and shown in section to illustrate certain details of construction. .Fig 2, is an enlarged fragmentary sectional view of the outer end of the cannula showing the manner of attaching the tonsil receiving cup thereto which, with other porions of the instrument, are shown in elevaion.

Fig. 3, is a side elevation of the instrument in the position assumed when the 'parts are operated to force the needle outward and illustrating the adjustable portion of the cannula in a slightly different position with the outer end thereof broken away and a portion shown in section.

i Fig. 4, is a broken or foreshortened perspective View of the needle on a larger scale.

Fig. 5, is a side elevation of the instrument looking at the side opposite to that shown in Fig. l.

Fig. 6, is a detail edge view of the fulcrum pin for the instrument handles.

Fig. 7 is an inner face View thereof.

Fig. 8, is a longitudinal sectional elevation of the cannula, the needle therein and the tonsil receiving cup.

Fig. 9, is a plan view of the instrument, as shown in Fig. 1.`

Fig. l0, is a section at the line 10i-l0 of Fig. l with the vacuum apparatus removed.

Fig. ll, is a side elevation of the receptacle to receive the blood secretions and the like passing through the vacuum conduit and its connection with the vacuum controlling valve, the latter being shown in secion.

Fig. 12, is a side elevation of the vacuum controlling valve.

Fig. 13, is a face or plan View of the adjustable clamp for holding the tonsil receiving cup on the cannula.

In carrying out my invention as here embodied, 10 and 11 represent two handles produced from suitable material such assteel or bronze and nickel plated or otherwise suit ably finished and these handles are pivoted together by means of a fulcrum pin 12, Figs. 6 and 7, which passes through suitable bearings provided on said handles intermediate their ends and said fulcrum pin carries a resilient leaf 13 on one portion of which is a stud let to enter the hole 15, Fig. 5, formed in one face 0f the handle 11 and When the stud 1st is in the hole 15 an end of the leafI 13 will underlie the head of a screvv' 16, or its equivalent, carried by one of the handles, thereby holding the fulcrum pin 12 in place until it is desirable or necessary to demount the handles at which time the outer free end of the leaf 13 may be flexed until the stud la is disengaged from the hole 15 and then by rotating said leaf its opposite end will be disengaged from the screw 16 permitting the fulcrum pin 12 to be Withdrawn. By constructing the operating portion of the instrument in this manner the handles may be actuated so as to move them relative to each other after the manner of shears or the like.

The handle 10 includes a loop-like grip 17 from the upper portion of Which projects the bifurcated extension 13 forming bearings 19 for a purpose to be later described, and this handle also includes a neck 2O through which is formed a slot 21 and one of the end Walls 22 of this slot is so fashioned as to provide a Wedge or click 23 and on this neck is formed the bifurcated head 2e in the bifurcations of which are formed circular openings 25 to act as bearings for parts to be described and with these openings coniinunicate the open ended slots 2t.

The other handle 11 includes a hand hold portion or grip 27 provided with a horn 23 which will rest inthe crotch between the thrust and index linger of the operators hand and prevent slipping the handle in one direction. This handle 11 also includes a neck 29 provided With an aperture 30 and from this neck extends the bifurcated head 31, the bifurcations of which are provided with notches 32 to form the horns 33.

The reference numeral denotes the cannula which is made in two parts and for convenience of description one of these Will be designated the stationary cannula section 35 and the othe'r, the adjustable cannula section 36. The stationary cannula section 35 has a hole 3? therethrough which is rectangular in cross section, preferably square, as shown in Fig. 10, and for convenience of manufacture it is preferred that this section of the cannula be of the same shape, or in other Words that the shape of this section of the cannula Will provide the shape of hole desired. At one end of the stationary cannula section 35 are located the oppositely projecting trunnions 33 having opposite fiat sides Which Will permit the passage of said trunnions through the slots 26 when the cannula is swung to the proper position and also has two opposite arcuate sides to provide bearing surfaces in the holes 25, While at the other end is pivoted a catch 39, the bifureated nose i0 of which is normally Lacasse forced into engagement with the adjustable cannula section 36 by means of the spring 111 carried by the catch 39 and engaging a surface of the cannula section 35. The catch 39 when in engagement with the adjustable cannula section 36 coacts With the bead 42 to prevent Withdrawal of the adjustable cannula section which is provided with a terminal a3 to lit the hole in the stationary cannula section.

'lhe adjustable cannula section has bore lil therethrough and at its outer end is formed the oval ring 4:5 having an internal groove i6 ruiming entirely around the saine in the same plane as and in communication with the bore lill.

A tonsil receiving cup il? of any desirable construction but preferably formed of glass is detachably connected to the ring l5 of the cannula by means of a liz-ed clamp A18 Which engages one part of the flange at the mouth of the tonsil receiving cup, in connection with the adjustable clamp t9 which engages the cup below the flange about its mouth opposite the clamp 4 3 and said adjust-able "l clamp 49 is of such shape that it can straddle the cap and is provided With a slot 50, Fig. 13, for registration with the threaded stud 51 .carried by the adjustable cannula section and on which is threadet the nut 52 to draw the adjustable clamp toward the cannula and When the outer end of said clamp is in engagenient with the lug 53 also formed on said cannula the central portion of the adjustable clamp will be slighmy flexed and thus maintain a tension on the tonsil receiving cup to hold it firmly in relation to the cannula ring and in order to more securely seal the mouth of the cup a packing ringl or Washer 511 is interposed between the mouth of the cup and the cannula ring. F or eonvenienee of illustration the fixed clamp 13 is shown as secured to the cannula ring by means of a screw The tonsillectome needle includes the spring 57, a bod)v 53, rectangular in cross section to lit the hole 3l of the stationary cannula section, and a shank 59 externally threaded as indicated at GO. in the outer extremity of the needle prong are fornied holes (i1, Fig. 2, said holes preferably being two in number so that the ends of a snare wire 52 may be threaded in said holes after said snare Wire has been formed into a loop which *will rest Within the groove lli in the cannula ring. The needle shank, when the parts are in op'r-irative positions, passes through the bifurcated head 3l and has threaded thereon a nut 03 of suitable formation to permit of its ready manipulation and j'novide an annular bead for coaction with the hooks or for projection Within the notches 32 in the head 31 whereby said nut and head Will move in unison and in order to maintain said bead to the neck 2921s at 66, lthe said latch having a lip 67V which may be swung under the bead 64.

From the above portion of the description it is `believed that it will be obvious to any one skilled in this art that the adjustable cannula section 36 may be withdrawn at pleasure from the stationary cannula section 35 and then replaced in any one of four positions or so that the tonsil receiving cup may depend as shown in Fig. 1, or it may project to either side or above the instrument and when the parts are ready for use the movement of the handles from the positions shown in Fig. 3 to the positions illustrated in Figs. 1 and 5 will draw the tonsillectome needle through the cannula and gradually decrease the loop of the snare as the latter is drawn into the cannula which action will encucleate a tonsil over which the cannula ring has been placed.

The tonsil receiving cup is of the general formation of a retort such as used by chemists and the neck 68 thereof has a bulbous formation G9 on its outer free end to assist in retaining the conduit 70 in connection with said tonsil receiving cup and this conduit 7() is preferably a flexible tube so that the end opposite the tonsil receiving cup may be connected with a suction or air rarefying device whereby the'vacuum or rarelication of air may be produced in the tonsil receiv` ing cup and as the suction apparatus may be of any well known or usual construction it will not be shown or described in detail.

This conduit may be supported by a hook 71 and one of the handles of the instrument, as on the neck portion of the handle 10, to eliminate or reduce to a minimum the possibility of said conduit interfering with the operations of the device.

In order to control the rarelication of the air in the tonsil receiving cup I prefer to insert a vacuum controlling valve 72 inthe line A.between the tonsil receiving cup and` the vacuum apparatus and therefore have shown the conduit 70 as connected with one of the arms 73 of the valve body which is of the S-way type and therefore provided with two other arms 74 and 75. The arm 74 may have another conduit 76 connected therewith leading to another tonsil receiving cup or it may lead directly to the at mosphere while the other arm 75 is connected with a conduit 77 which may connect with the vacuum producing apparatus. In the valve body is 'the rotatable valve plug 78 having three communicating ducts 79, 8O and 81 while said valve plug has a peripheral groove 82 of sufficient length to form a communication between the arms 7 3 and 7 4 and the duct 79 when` the valve plug is positioned so ,that said duct 79 is midway between the arms 7 3 :and 7 4, as shown. The valve plug is provided with a suit-able knob 83 for actuating it and said knob-has a pointer 84 positioned `relative to the duct 79 so that the operator may readily ascertain the location of said duct.

From the above it will be seen 'that when the apparatus is in operation if the valve is set so that the duct 79 aligns with the open-V ing through the ar1n73 the duct 80 will align with the opening through the arm 75.

so that the suction action will be taking place through the conduit 70 but if the valve is set until the duct 79 aligns with the opening through the arm 74 the duct 81 will be moved into alignment with the opening through the arm 7 5 and the suction action will take place through the conduit 76 but when the valve is set as shown in Fig. l1, the-suction action has been shut off but the peripheral groove 82 is in communication with the openings through the arms 73 and 74 and the one not in use will permit atmospheric air to flow into the oneV which has been in use and thus break the vacuum.

As it is desirable to .collect the blood and secretions which may be drawn from the. tonsil receiving cup before they reach the vacuum producing apparatus I have shown a waste receptacle 85 having an inlet 86 to which one end of the conduit 77 is connected while the outlet 87 has a conduit 88 connected therewith leading directly to the vacuum producing apparatus. As will be noted the inlet and outlet of the waste receptacle 85 are in the form of tubes and the inlet tube projects into the receptacle within close proximity of its bottom while. the outlet tube projects just inside the closure so that as the blood and secretions are drawn through the several conduits they will finally deposit in the waste receptacle 85 'from which they cannot be withdrawn by the vacuum pro,

ducing apparatus unless the waste receptacle was to become filled or nearly so.

In order that the instrument may have a gradual operating movement that will fill the requirements of all cases in which the instrument might be used a sector 89 is pivoted at 90 to the handle 11, and more particularly within the aperture 30 in the neck 29 yof said handle while the other end projects through the opening 21 in the neck 2O of the handle 10 and this sector is controlled through 'the vmedium of a connecting rod. 91 slidably connected with the sector by a pin 92 passing through the arcuate slot 93 formed lengthwise of the sector and sai-d` connecting rod 91 is movable longitudinally of itself because ofthe slot 94 formed therein and through which the screw 95, or its equivalent, passes for connection to the handle 10 thereby holding said connecting rod in place. The end of the connecting rod opposite the one attached to the sector is pivoted as at 96 to the trigger 97 which latter is pivoted as at 98 between the bifurcations of the extension 18. This trigger has a nose 99 for coaction with the spring 100 fixed to the handle 10 by a fastening device 101 and as plainly shown this spring projects into the space between the bifurcations of the extension 18 and the leaf of the spring is provided with an indent 102 for coaction with the nose 99 of the trigger for a purpose to be presently described.

The upper or convex edge of the sector is provided with serrations or ratchet teeth 103 for coaction with the wedge or click 23 under certain conditions while. in the lower or concaved edge of the sector is formed a notch 104 adjacent the pivoted end of said sector which under certain conditions will register with the pin 105 in the opening 21 formed in the neck of the handle 10.-

rlhe operation of the last described por-- tion of the invention is as follows Then the trigger 97 is positioned so that its nose 99 enters the indent 102 in th-e spring 100 the 'free end of the sector 89 will be lowered sufficiently to allow the handle 10 to pass freely back and forth without any of the parts thereof engaging any portion of the sector. By actuating the trigger until its nose is disengaged from the indent 102 in the spring 100 and said nose assumes a position toward the outer terminus or free end of the spring leaf, as shown in Fig. 3, the sector 89 will be drawn down farther until its lower concaved edge engages the pin 105 and since the 'action of the spring is then applied to the trigger nos-e to one Side of an imaginary line through the trigger fulcrum and the spring indent the tendency will be to force the finger or tail piece trigger outward thus pulling the sector downward into Contact with the pin 105 under tension of the spring 100. Then by separating the grips of the handles the parts will be moved to some position such as shown in Fig. 3 which will bring the notch 104: in the sector into alignment with the pin 105 and the spring 100 will cause said notch and pin to register and thereby'prevent any movement of the parts.

To release the sector and place the instrument in condition for operation the trigger 97 is pulled down so that the nose of said trigger will be moved to the other side of the imaginary line through the spring indent and trigger fulcrum at which time said spring will act to force the sector 89 upward so that its teeth 103 will coact with the wedge or click 23 and said sector is held in such position under tension of the spring 100 as will be obvious, thereby permitting the teeth to click passed the wedge or click 23 in one direction while preventing any retrogression of the handles.

When the movements of the parts have been completed so that the handles assume.'

vhave been drawn into the cannula and the tonsil enucleated by the snare. Ars soon as the enucleation of the tonsil has been accomplished the suction within the tonsil receiving cup 47 will Cause said tonsil to enter th-e cup where it will remain during the removal of the instrument. As before stated, during lthe operation the blood and secretions of the patient accumulating will be drawn into the tonsil receivinOr cup and deposited in the waste receptacle.

rEhe use of an instrument such as herein described will expedite operations of this character and eliminate a good deal of the suffering of a patient while enhancing the chances of success in a more sanitary manner.

Of course I do not wish to be limited to the exact details of construction as herein shown as these may loe varied within the limits of the appended claims without departing from the spirit of my invention.

l-lainng thus fully described my invention, what I claim as new and useful is 1. A surgical instrument including pivoted handles, one of which has a head provided with holes with which open ended slots con'nnunicate, a cannula, trunnions on said cannula fashioned vto permit passage through the slots when the cannula is in a position at substantially right angles to its working position, the head of the other handle having notches, a needle slidably mounted in the cannula, a nut having threaded connection with said needle, means on said nut registering with the notches in the head of said other handle, and means to normally maintain the means on the nut in registration with the notches.

2. A tonsillectome including a pair of handles, means to detachably pivot said handles to each other, one of said handles including a loop-like grip, a neck and bifurcated head, the bifurcation of said head having slots leading to holes, the other of said handles including a straight grip with a horn at one portion thereof, a neck and bi furcated head, the bifurcations of said head being notched to provide downwardly projecting forks, a cannula, trunnions at one end of said cannula` for registration with the slots and holes in the head of the first mentioned handle, a needle slidably mounted in said cannula, and a nut having threaded connection with the needle with a portion in registration with the notches in the head `of the other handle whereby the operations of the handles will reciprocate the needle in the cannula.

3. A tonsillectome including a pair of handles, means to detachably pivot said handles to each other, one of said handles including a loop-like grip, a neck and bifurcated head, the bifurcation of said head having slots leading to holes, the other of said handles including a straight grip with a horn at one portion thereof, a neck and bifurcated head, the bifurcations of said head being notched to provide downwardly projecting forks, a cannula, trunnions at one end of said cannula for registration with the slots and holes in the head of the irst mentioned handle, a needle slidably mounted in said cannula, a nut having threaded connection with the needle with a portion in registration with the notches in the head of the other handle whereby the operations of the handles will reciprocate the needle in the cannula, and a controlling mechanism connected with the handles whereby the parts may be held in a set position, released and placed in operative condition while preventing retrogression.

4. A tonsillectome including a pair of handles, means to detachably pivot said handles to each other, one of said handles including a loop-like grip, a neck and bifurcated head, the bifurcations of said head having slots leading to holes, the other of said handles including a straight grip with ahorn at one portion thereof, a neck and bifur, cated head, the bifurcations of said head being notched to provide downwardly projectk ing forks, a cannula, trunnions at one end of said cannula for registration with the slots and holes in the head of the first mentioned handle, a needle slidablymounted in said cannula, a nut having threaded connection with the needle with a portion in registran tion with the notches in the head of the other handle whereby the operations of the handles will reciprocate the needle in the cannula, a sector pivoted at one end of the neck of one of the handles and having a longitudinal slot provided with ratchet teeth along its convex edge, and a notch in its concave edge adjacent the pivoted end, a wedge or click on the other handle for coaction with the sector teeth under certain conditions, a pin on said other handle for coaction with the notch in the sector under other conditions, a connecting rod longitudinally slidably mounted Von said other handle and carrying means for registration with the sector slot whereby the sector may slide relative to the connecting rod or be actuated by said connecting rod, a trigger pivoted to said `other handle and having pivotal connection with the connecting rod, and means to maintain said trigger under spring tension in a position which will cause the teeth of the sector to engage the wedge or click, another position which will permit the sector to engage the pin, or an intermediate position.

5. A vacuum tonsillectome including a cannula, a ring at' the outer end of said cannula, a needle slidably mounted in the cannula, pivoted handles one of which is connected with the cannula and the other with the needle Vwhereby the latter may be reciprocated in the former, a tonsil receiving cup detachably connected with the ring of the cannula, a conduit having one end connected to an outlet from said cup, a 3- way valve for connection with said conduit, and another conduit leading to a vacuum producing apparatus, and another conduit leading to the atmosphere, said valve including a valve plug provided with three communicating ducts and a peripheral groove communicating with the outer ends of two of said ducts, and a waste receiving receptacle interposed in the connecting line between the valve and vacuum producing apparatus.

In testimony whereof, I aiiixed my signature.

FOSTER A. BECK, M. D.

have hereunto

Images