US2004559A - Method and instrument for electrosurgical treatment of tissue - Google Patents

Method and instrument for electrosurgical treatment of tissue Download PDF

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US2004559A
US2004559A US64384632A US2004559A US 2004559 A US2004559 A US 2004559A US 64384632 A US64384632 A US 64384632A US 2004559 A US2004559 A US 2004559A
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electrode
member
stem
instrument
end
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Wappler Frederick Charles
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Wappler Frederick Charles
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B18/1442Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00Medical syringes, e.g. enemata; Irrigators
    • A61M3/02Enemata; Irrigators
    • A61M3/0279Cannula; Nozzles; Tips; their connection means

Description

June 11, 1935. WAPP E ET AL 2,004,559

METHOD AND INSTRUMENT FOR ELECTROSURGICAL TREATMENT OF TISSUE' Filed Nov. 22, 1932 2 Sheets-Sheet 1 June 11, 1935. R. H. WAPPLER ET AL 2,004,559

METHOD AND INSTRUMENT FOR ELECTROSURGICAL TREATMENT OF TISSUE Filed Nov. 22, 1932 2 Sheets-Sheet? 1& 5

INVENTORJ ReiufiaIdE W :144,

Patented June 11, 1935 UNITED STATES METHOD AND INSTRUMENT FOR ELECTRO- SURGIC'AL TREATMENT OF TISSUE- Reinhold H. Wappler, Yonkers, and Frederick Charles Wappler, New York, N. IL; said Frederick C. Wappler administrator hold H. Wappler, deceased of said Rein- Application November 22, 1932, Serial no. 643,846

20 Claims.

Our present invention relates generally to electro-surgery, and has particular reference to an improved type o f'electrodic instrument, and, coordinately, to an improved method of treating 5 tissue.

It is a general object of our present invention to provide an improved electro-surgical instrument of the character in which means are provided for conducting or directing high-frequency electric current to interior portions of the human body for the purpose of subjecting tissue to the unique actions of such current, Our present instrument provides a novel and improved assem- .bly of operative parts whereby an electrode, or electrodes may be more efficiently and controllably manipulated for the purpose of effecting certain desired treatments of tissue.

A more particular object of our invention lies in providing an improved instrument for ef- 'fecting coagulation, cutting, or other destruction, shrinkage, or treatment of tissue in rela tively inaccessible places; also for permitting improved and more controllable coagulation and/or cutting and/or treatment of neoplastic growths in general; also for efiecting removal or severance of growths and adhesions in an improved and expeditious manner. I

It is vitally important, in the treatment of most interior growths, adhesions, and the like, that assured hemostasis be effected, for the reason, among others, that interior hemorrhage is all too frequently disastrous. In the cutting of adhesions or growths, for examplait is extremely important that the resultant stumps be retained under proper and visible control until after the surgeon or operator has made certain that complete hemostasis has been achieved.

It is a feature of our present instrument to provide a unitary, compact electrodic instrument which permits a wide variety of electro-surgical procedures and/or treatments to be carried out with great facility and with an improved simplicity of control and manipulation. Our instrument permits operations to be performed under conditions which enable the operatcr'to proceed in an unhurried and careful manner, with maximum safety and provision for thorough visibility, examination, and treatment, and with a minimum of danger, especially so far as uncontrollable hemorrhage is concerned.

A particular feature of our invention lies in providing an instrument in which a single control mechanism may be employed to effect a va-. riety of movements and manipulations of one or more electrode elements. Briefly, our invention (01. 174-89) embodies the usual elongated stem insertable through an endoscopic tube, a movablemember pivotally associated with the forward end of the stem, a mechanism for controlling the move-' ments of such member, and an electrode articulated to the stem and to the movable member in such a manner that movements of the pivoted, member will compel corresponding and responsive movements of the electrode.

In a preferred embodiment of our invention, the-movable member is constructed in the formofa' two-armed jaw adapted to cooperate with a similar complementary jaw of stationary charaoter. we arrange a means for articulating the free forward end of a wireelectrode which is in pivotal association with the stem at the rear of the jaw. In accordance with this arrangement of parts, a single control means will swing the movable jaw toward and away from the stationary Between the arms of the-movable jaw jaw, and will simultaneously constrain the wire electrodeto move in a similar and corresponding manner. The uses to which these severalelements may be put are quite varied, as will be pointed out hereinafter, andpermit a variety of operative procedures to be carried out with enhanced facility, reliability, an'dyease. For example, where the electrode wire is provided with a portion extending forwardly through the 'arms of the movable jaw, the instrument is admirably suited for effectinga novel type of severance of an adhesion or growth, under conditions which automatically couple acutting procedure with a clamping action, which engages the resultant stump or stumps, thereby holding the latterfor, examination and possible further treatment be-' fore the operation is entirely completed. This, precedure constitutes by itself an important and independent object of our invention. In a preferred form of instrument, the stationary jaw hereinbefore referred to is constructed and arranged to serve as a second electrode,

insulated from the movable wire electrode hereinbefore referred to, whereby the instrument is readily adapted for a further variety of useful purposes and modes of procedure."

A further feature of our invention lies in constructing the instrument in such a manner that a variety of wire electrodes may be removably" and selectively associated therewith, thereby combining a wide number ofcapabilities in a means suitable-manner with theclamping arrangement- 24, and is also provided-with an electric binding 1 of Figure 1 1;

1 ing an adjusted relationship further'procedure; The endoscopictribeZB-terminates at its rear} end-in thefiange ZI'and-in-the attachment sleeve I or=- neck 22-1 The neck 22 carries the irrigation outlet 23 and also suitable' mechahismsuchj as the clamp M for facilitating association, with the embodying the features of our'present invention;

Figure 2 is an enlarged llon'gitudinal cross section through the instrument of Figure l, withcertain-portions omitted. for .the sake of clearness;

Figure 3 is a plan View, partly insection, taken. substantially along the line 3-3 of Figure 2, with certain parts omitted for the sake of clearness; Figure 4 is an enlarged" cross sectionalview taken substantially along the line l- -flhof Fig.-

ure,

. "'Figure 5 is-across sectional viewtaken sub'-' stantiallyalongithe line 5-5 of Figure 2;

Figure 16 is"a'-longitudinal side view similar to thel'eft end of Figure-2, showing a modified type of electrode in association with the instrument;

' Figure-7 is aside view of the electrodeof Figures1'-5, shown by itself; l

Figure 8' is a-view similar to gFigure '7, illustrating the electrode-of- Figure 6 by itself;

Figure-9 is a side view of the forward end of theinstrument of Figure 1, showing-astep in one mode of use;

Figure 1 0 is a diagrammatic cross-sectional view taken" substantially along the line Hli0 of-Figure 9;

Figurell is a similar to Figure 9, showing a subsequentstep in; the procedure;

Figure 12' isa diagrammatic cross sectional vi'ewtaken-substantially along the 'line l2l2 Figure 13 is a sideview-of the forward end of the instrument of Figure 6, showing one man-;

nerof-use'; and: V I

Figure 14 is-a view similar to Figure 13; showtube 20, of the interior removable 'assembly.

The operative assembly consists of theusual plug- 2-5 whose forward portion (not "shown in Figures-2' and 3). is slightly tapered andis adapted tofit'snugly into the neck 22. The "plug carries a forked "member adapted to engage'in a post 26 which is mounted'in uninsulat'ed relationship so that all o1- the parts not specifically insulated-from the binding post 26 or the plug 25-- are in electrical contact therewith.

* -Extending rear-wardly from the plug 25is the supporting arm 21 terminatingin its rear end in a bearing 28 and asuitable clamp 29,-the bearing 28: and clamp 29*being adapted to engage and secure'the rearend of a suitable telescopi'c device The-latter is-preferably of the character illustrated and described in United States Letters Patent No. 1,680,491, and' consists of an eyepiece 3|; suitable terminal bands 32 for establishing electrical connection with the forward illuminating: lampi33', and an objective lens 34 arranged of parts during'a behind the lamp 33 and commanding an obliquely forward field of vision.

The arm 21 also carries the insulated terminal block 35, secured by the stud 36 and provided with the insulated binding post 3?.

Secured to the plug 25 and projecting forwardly. therefrom is the elongated stem.33 pro- .videdwith the upper guidejchannel' ortube 39, the lower guidechannel or tube 40, and the lateral guide tubes ll. The telescope 38 is adapted to be accommodated in the upper channel or tube 3S, and it will be understood that the plug 25 "and the blockare provided with suitable bores through which this telescope may slidably extend. At the forwardend of the stem 38 we mount the stationary. jaw 62 which consists preferably of two spaced parallel arms substantially aligned with'the axis of the stem 38. These arms pref- .erablyjoin at the forward end so that the jaw is substantially U-shaped zontal plane: 7

Pivote d to the rear of the fixed ja'w'42', as at when viewed ina horithe pivot points" ltgis'a similarly constructed two-arnied movable jaw 35; This jaw is adapted,

to be rocked or pivoted from the open full-line positionof Figure l into theclosed full-line 'posi-.. tion of Figure'Z, and thisis accomplished by a.

pair of controlrods d5 which are slidably accommodated in the guidetubcs. ll and are pivoted at their forward ends to the rear of the movable, jaw M, as at the pivot pointsdfi, These rods, extend rearwardlythrough' the tubes 4i, thence. throughsuitablyprepared bores in' th'e plug '25,;

and are secured at,their rear ends to a member 47 which'isunder the control of the scissors-like.

control mechanism 38.

The fixed handle, ofthe latter mechanism is rigidly secured, as at 49, to the plug 25; and-the movable handle is pivoted, as at SKI/to the fixed handle and has its'free end pivotally articulated. as at"5l,to the member 41. When the handles; 38 are drawn toward each'other, the member 47- is advanced forwardly, .and this advances the;

control rods '65 and forces the movable jaw 44 into its'close'd position. When the handles 48 are sep'arated by a slightdegree, the rods are correspondingly retracted, and the movable jaw is opened into the dot-and-dash position of Figure .2.

Thel'ele ctrode member shown in association: withthe instrument of Figures 1-5 is illustrated; most; clearly in Figure 7, and comprises the elongated conductive member 52v and the elec-.'

The latter ispivoted, as at 54,-tQ' the forward. end of the conductive member 52;. and ism-electrical connectionwith themember:

trode wire 53.

52; The latter is provided with a sheath of insulation 55 terminating short of the. pivot point vi 5 l-and short of therear end of the member 525;." and the insulation 55:15 in turn ensheathed ina:

metallic outer sheath '56.

The electrode wire 53 is, in the form of Figure '7, provided with the ofiset portion 5'1 which 2; doubles-back upon itself at its'forward end to provide the journal piece 58 arranged substantially along a line passing through the pivot point Whentheelectrode ofFigure 7' is associatedwith the instrumentof Figure l, itis-slidrearwardly'throi'igh the guide tube orchannel ii its rear'end' is suitably clamped so-a's to bring the; unin'sulat'ed 'rearend of 1 the conductive member her 52 inelectrical connection with the binding' post 31, and the forward journal piece 58 is suitably articulated .tothe movable jaw 44.

The articulation of the journal piece58 with the jaw .44 may be accomplished in the manner 5-5 illustrated most clearly in Figures' l and 2, and preferably consists in providing a longitudinal bearing 59 between the arms of the jaw 44, so that the 'journal piece 58' may be slidablyinserted' rearwardly into the-bearing 59, as illus- 1 o; trated most clearly in FigureZ. This bearing is provided with an insulating lining 60 so that the electrode wire 53 is insulated from the jaw 44 and from the other portions of the instrumentwhich are in electrical connection with the jaw sufiiciently to release them from the rear por-tion of 'the'electrode member.

Embedded in the block' 35 is a conductive cle- 302'm'ent '64," andthis element is provided with a longitudinal bore adapted to receive the rear uninsulated end of the conductive member 52. The interior portion 65 of the binding post 31 is in electrical connection with the element 64.

' By virtue of the insulated nature of the block 35, the exterior of the binding post 31, and the sheath 55, it is obvious that by inserting the electrode -member in the manner hereinbefore described the operative portion '51 of the elec- 40; tro'de wire 53 is brought into electrical connection with the interior portion of the binding post 31, and is atthe same time thoroughly and completely insulated 'from all portions of the instrument. a

When the electrode member is clamped into association with the instrument, as described, the electrode wire 53 is effectually mounted in pivotal association, at its rear end, with the stem 38; This efiect is most clearly shown in Figure 2, 501. where it will be noted that the electrode wire 53 is adapted to pivot around the point 54 from the full-line position into the dot-and-d'ash-line position.

The member -41 is provided with a suitable 555 channel in its upper portion to permit passage of the telescope '30, and with a similar suitable opening in its lower portion to permit passage of the electrode member of Figure-'7.' The'plug 25 is also provided with a suitable bore to permit the 6&2: electrode member to pass therethroughQ -The capabilities of the instrument, so far as adjustability and movability of parts is concerned, will be clear'from the description given. "The movable jaw 44 constitutes a movable member wire 53; and during anypivotal'mo vement ofthischaracter the operative'portion 51' of the 'elec-- trode wire will remain in substantially parallel relationship with the jaw clearlyin' Figure'fi. i

j It is to be noted --that-the type-of electrode illustrated in Figure '1' is one'in which the else-- trode wire has a portion (51) projecting forward-- ly through the arms of the movablejaw mem-"f' her-44. I

One manner-ofutilizing the instrument is' illustrated in Figures 9-42.; The procedure illustrated in these figures consists in electro- 44, as indicated most surgically coagulating and'cuttingthrougna growth,-such as an adhesion band 66. Theband is firstengaged as illustrated in Figures 9 and 10, at the area at which the severance is to take place. The engagement is effected between the fixed jaw 42 and the electrode wire 51'. may be accomplished under illuminated vision,- as will be readily understood. The engaged orclamped area isthen subjected to electric"'co'ag-- ulation by passing a suitable high-frequency coagulating current through the engaged body 66 from the electrodev 53-to the electrode jaw 42. One way of accomplishingthisuisatoestablisht an electricalconnection at the'ibinding postlfi' with one terminal of a sourceof suitable high frequency coagulating current,' and by estab lishing another-connection at the bindingpos't 31 with the other terminal 'of' such --current" The actual cutting throughor severanceofthe body 66 is accomplished by then utilizing the electrode wire 53 as a cutting electrode, -This' is easily accomplished by connecting the 'a'ctive terminal of a suitable cutting current'with" the binding post 31, and connecting the other in difierent terminal of the current with the binding post 26. Obviously, the connections 'previously established for coagulating purposesmay j be retained, and suitable alterations or adjustments made in the source of, -high-' frequency current. v

With the passage of a' cutting current from the relatively 'attenuatedelectrode 51 to fthe blunter indifi'erent electrode 42, a cutting effect will be achieved and the electrode 51 may 'be ad'-"- Vancedthrough the body 66 asthe cutting pro: ceeds. During this advance, and during the out} ting procedure itself,-the movable jaw '44 enters;

into a clamping relationship with'respect to the fixed jaw 42, as illustrated most clearly inFi'g"-" ures 1 1 and 12, as a result of which the two 'fre-f sultant stumps are held in firm engagement be tween the oppositepairs'of jaw-arms. "After the out has beenaccomplished, the parts willrbein the relationship of Figure 12, and it is to be'noted that the opposed stumps are as'yet unreleased-1' by the instrument and are, therefore, still avail-' able for careful unhurried inspection by the operator. Should-he"find"that'they*are not fully" hemostat'i'c, he -may proceed when them-ac cordingly so that he may be fully 's ati sfied that nohemorrhage of any character is likely't'o;

follow after they are'finally released."

Obviously, the procedure of Figures 9-12 I may be carried out without necessarilyaccomplishing" manner described. -Whether"this preliminary co- 4% e lllation -isrefieotediortnotethedesirable-o1amp-: ing-.;of the opposed: stumps: simultaneouslwwithl the procedureof the cutting;operationuis: ao-- c,omplish ed-.= i -Where the preliminary coagulatinggproeedure iszxnoti-employed,- =-the" jawsAZ-Aand :44 {need not necessanilst beiemployed as? the; inuifierentr elect trode fon the;cutting.current-; and. the more cone ventionalltype-ofsremotevindifferentelectro de may; ll): be used, if desired. In such an event, thejawsi 42 and 4,4-ser;ve the purely ;mechanical function ofiengaging-the opposedxesultantgstumps; as;- the; cuttings-is accomplished, It: is preferable; however; tor employ; 1 these; Jaws as the-=indifierent, l5: eleotrodei inasmuch as themode. of procedureeis greatlmsimplified and renderedrmoreefficient-ibyi -i 1 fa-I: I 1' f l .L I It ,Will be; understood thattthemodepf pro-r cedure illustratedr-in Figures.:912; whileit conestltutes by itselfza-an: important objective;- and phase of our present invention, andeonsists oi: a.nevel'andimproyed methodof severing through-i aQ massofi tissue with. a maximum: of safetyr and! reiiability, nevertheless the instrument of); Fig, ures 1-5-isnotnecessarily,restricted in 1138911565 toayprocedure of this specific-:characteia; llfl-I' strui nentw may for, example; be; used J01? purely; coagulation;;:-purposes. On it may-.1 be; used for; cutting through a neoplasm onggrowthwwhich-is: notrin thefQI{Il 20f an: adhesion. In the latter eventuality, the resultant. stump; of the. rowth; willbeengaged by one pairof opposediaw arms,- while the excised mass, will be engaged by the: opposite-painof; opposed jawarms: Byzslightl-yi releasing, the; jaws, etherstumpI-imay bereleased; without at the same time releasing the-excised; mass; and after the stump, has-,-been.-re1eased1the: jaws, may be clamp.ed-.-together' again-to; obtain a firm grasp of. the excised massgwhereupon; 9 the latter-may be withdrawn'iromthe-interior of,,the,body by means of these two ljaws, thelat-j ten serving; merely as meoheznicat forceps during: this step .l I a simi lar-way the instrumentrmay beouSedH- 45 fona variety; of similar purposes, andthe jaws? maybe employem; wherever necessar-y or desired; are 1 purely, mechanical -forceps- -to engages-or" grasp t such excised. masseson r pieces ofltissue as 1' may be necessaryto accomplish any specificches jective sdependingupon circumstances;

, In Figure 8,.we-have illustrated a modifiedvtype; of. electrode whichnmay be- -assoeiated withfi the instrument im-place of: the electrodeillustrated; inl Eigure Thisfelectrode consist-sect; a, cone 5 5 ductive: eloneated,- member 10,1 'ensheathed .incat. 'tubeof insulation TH,- and an;outer;metallic; sheath 12. '11'h e;;r-ear-andforward; ends of: the member: lnlLare esposed;asbeiore and a tgthe;

forward. end is at-{pivot- 13 to which the rean 0f:.' 60 1, an, electrode is pivotallyn attached-. elec trode. is, in this lease, constructed zin; a mannerz whereby-it willalways lie to itherear oft-the mov ablevmembernflg and with; thi'srobjeetiineview thew electrode.- is provided with) theoff et forward-i- 65,sm ne s1 s;

'I,'his-:electrode is inserted: into: the:- instrument: in the same-manner as ;thepreviouslwdescribede electrode, being snugly accommodated within the. guide tube :lfl and havingyits ISEI HdPTOdIix6186?? 70 v tricaltcontaet with; the conductive element 64:.

The forward journal; piece-Jj5-:is-rnounted?inslid-1 able-awociation-with therbearinge 59, but; in: this case: the J'wrna-lt: piece: projects forwardly-1 into the bearing, .while in. the previous case-rthefj ournal; 75; 'pieemfikproiectedrearwardly into thebearing; q

- The relationships-ct parts, iwhenrthisi. assembly has been eff ected; is shownimost clearlydn'rF-lgures: 6,1313, andnjlgandg it; will! be observed thatspivotal movements of the'men ben into vaziediposltioniv. of,;obliquity will compel? similar and responsive? movements,of:theeleetrodetwire14: i I 1- The. ease with; which the part'sj:=may3thus-.=be adjusted; iI'ltO any desired. obliqueszpositiorr mits;theinstrument;to-be used for awide variety: of purposes, one ofwhich, is-,shown,.- merelyibw way of, illustration, in 1 Figures; anda 1425111 116. ref erence numeral 16; applied: to, a probnusionl at the, interior'endaof; a ;body canal 1:1 ,and, it wilL- be pbsenvedzthatwhen the instrument: is adjusted into the position of Figure 13 the electrode wire; M1 is admirably situatedrfor, performing: :1an :1 desired act of electro -surgica1-: treatment ,uponl' ther remotewallyof the protrusion? H5; This: remote: wall is, usually difrcultofi access;, but thewpresenti n trument nermit e w il toib brought into! 201: efficient cont act therewith, I If. therprotrusiomisi toe-betreated further, as,:for examplegalongithez upper edge orarea thereof ,,it' is ,a -relatively sim-. ple matter to-adjust the eleotrodewireik inbDI'thE! position of- Figure :14; nwhiohevent funtherfdeev s: sired contact maybeestablished at any required area-v I 1 .551; The actual procedure whichlit-may.be desiredi to cam-y out in any (given-Teasetwilli-dependxgtof courseupon the circumstanceszof that: casepihutr we will mention, inpassinggthat. the procedure: illustrated in Figures l3;and-i14"may-,- fonexampleb be: one of-;-1: u:cecoagulation of tissue; orppiwothetj' diathermic treatment, shrinkage; or destructioni of I tissue. The adjustability. of the partspermlts the instrument to be: used with great ease under? avariety of specializediconditionsn u 1 h The-electrode: l4- mayalsoibe; usedi-foreouttingi purposes; and we have-found that the-instrument, of Figures, 6 13; and v 14; is; admirably suited :for' 40 r effecting-excision pf growths onmasses that are: inconvenient-1y located in: placeswhich would? 7 otherwise be difiicult-gof accessgzWheneven acutl-w ting is accomplished with this electrode, the mow-:2 able memben A 4; serves as, a convenientlfstophor 4-5 a abutmentwhichlimits-the-depth ofiicuttingzfm-w- When the electrode 14" is .used as-;,-acutting; electrode-- a suitable connection :must gbe-made to} an indifferent electrode; and,rifedesiredctheiendoei scopicr-tube .20-, if composed ofi-metal; may he'use'clr 503 for: this purpose,- thereby permitting the-binding; post 2fi to be employed as a convenientpoint Foil connection for the indifferent terminal. V Ni The: forcep jaws 42-; and; 44 are: obviously available, 1 before, for purposes Qfil grasping, any; excised ,V-masses .or the like aiter any particular; cutting operation hasbeemconsummateds.

Itwillfbeobvious"that-otherelectrodes, OfvVEIy-F? ingconfigurations, depending; upon theipa-rticuw l e o chth ra e to-ib t; mayvbevso employed with; the presentt instrument; and-that the, electrodes of Figures; and -8 have-;been-,illustreated merely byway of. exampl and -forrthe -pui'-,;-r pose ofexplaining the general: nature; and Ecjapaa:

bilities lof our present-instrument. The:essentialr characteristics 'of any electrode of; the-present; character are that it consistrof an: elongated; con-s ductive 5 member adapted to be? clampedvatz-theta rear, in association? withv the terminal bloclsuiiri together-with amelectrode wire orthe-like pivotal?- 1y connected-torthe forwardend of-therconductive? member.- The'electrode wire-mustzembodyfaij-oum nal piece which may be slidably" engaged? with; the 'bearingtfiw:1 All-- of the -'fore'goinge;proeedures% are; ofs courses capable ofaccomplishment under illuminated vision, as will be obvious from the arrangement and construction of the telescope illustratively shownin the present drawings. The formation of the jaws 42 and 4 3 with two spaced parallel arms permits unimpeded vision of the electrode wire and of the area which is the subject of treatment or engagement. "The irrigation outlet 23 maybe conveniently :employed as an aspirating outlet for drawing fumes rearwardly through the instrument and .hence out of the path'of the objective of the telescope. Under certain circumstances, we contemplate eliminating one of the control arms 45 (since one alone would be sufficient to effect the desired movements of the jaw 44), and utilizing the empty guide'tube M for purposes of irrigation, either liquid or gaseous.

It .will be observed that from certain aspects the stationary jaw is not always essential. That is, in so far as the movability and adjustability of the electrode wire is concerned, the movable jaw 44 is in itself a sufficient instrumentality for effecting the desired pivotal movements.

From another aspect, it will be obvious, from the descriptions given, that the jaws need not necessarily be employed as electrode jaws, but that their use as an electrode is highly desir ableia'nd advantageous under many conditions, as hereinbefore described. It will also be understood that the uses to which the instrument may be put are of a varied character, and we'do not intend to limit the instrument 'to the specific uses hereinbefore described by way of illustration. It may be stated, briefly, that the instrument has proven to be highly satisfactory in-the treatment and severance of adhesions generally, both pulmonary and abdominal; in the treatment and removal of growths and protrusions in the rectum, lower bowels, trachea, bronchi, and oesophagus; and in the general treatment, cutting, and excision of a variety of neoplastic'and papillomatous growths and masses. In general; it will be understood that changes in the details herein described and illustrated for the purpose of explaining the nature of our invention may be made by those skilled in the art, without departing from the spirit and scope of the invention as expressed in the appended claims. It is therefore intended that these details be interpreted as illustrative, and not in a limiting sense.

Having thus described our invention, and illustrated itsuse, what we claim as new and desire 'to secure byLetters Patent isl. In an instrument of the character described, an elongated stem, a member pivotallymounted atits-rear'end to the forward portion of the stem so as tobe movable, from a longitudinal position intopositions of varying obliquity with respect to the stem axis, a longitudinal electrode whose: rear end is pivotally associated with the .stem rearwardly of said member, and means articulating saidmember and electrode for constraining thei. electrode to move with and substantially-parallel to said member.

2; In an instrument of the character described, an elongated .stem, a memberpivotally mounted at its reari end to the forward portion of the stem so as to be movable from a longitudinal position into positions of varying obliquity with "respect to the stem axis, a longitudinal electrode whose rear end is pivotally associated with the stem rearwardly of said member, and means at the forward end of said electrode and carried by said member and articulated to -the forwardportion of said electrode for compelling the latter to respondinitspivotal'movementsto thepivotal movementsof said member." r

3. man instrument of the character described, A

an elongated stem, a member pivotally mounted at its rear end to the forward portion 'ofthe stem so as to be movablefrom alongitudinal position into positions *of varying obliquity with respect to the stem axis, a longitudinal electrode whose rear end is pivotally associated withthe stem rearwardly of said member, and meansslid ably articulating the forward? portions of-said member and electrode so that pivotalmovements of said member will effect corresponding; pivotal movements ofsaidelectrode. I

.4. In an instrumentof the character described,

an elongated stem, .a memberapivotally mounted at its rear end "to the'forward portion: of the L stem. so as tobe movable from a longitudinal position into positions of varying obliquity' fwith respect to the stem axis, a longitudinal bearing carried-by said member, a longitudinalf'elec'trode whose'rear endis pivotally associated 'With'the stem rearwardly of said member, and 'a journ'al piece at the forward end of said electrode and slidably accommodated in said bearing. I

'5. In an instrument'of the character described,

an elongated stem, a member'cornpris'ing parallel arms and pivotally mounted at the rear'ends-of said arms to the forward portion of: said-stem,

mechanism for pivoting said member from a longitudinal-position into positions of varying obliquity with respect 'to the stem -aXis', 'a'-longi'- said arms to theforwardportion of 'said stem,

mechanism for'pivoting said member from awn-- 'gitudinal position into positions of =v'aryin'g obli'q uitywith'respe'ct to the'stem axis', a longitudinal electrode lying in a plane between said armsand having its rear end-pivotally associated withthe stem rearwardly of said member, and-means lying between said arms and slidably articulating the latter to the forward portion 'of said electrode so that pivotal movements of said member will effect corresponding pivotal movements "of said'-' -electrode in said plane. 3 Y g T:

7. In an instrument of the character described, an elongated stem, a member comprising parallel arms and pivotally mounted at'the rear ends of said arms to the forward portionof'said stem, mechanism for pivoting said member from a lon gitudinal position into positions of varying obliquity with respect to the stem'axis, a longitudinal trode lying in a planebetween said armsand having its'rear end pivotally associated with the stem bearing carried by said member between the forward portions of said arms, a longitudinal elec rearwardly of said member, and a journal piece slidably accommodated in said-bearing.

8. In an instrument of the character'described an elongated stem, a member comprising parallel",

arms .and pivotally mounted at the rear en'ds of said arms to the forward portion of said stem, mechanism for pivoting said member 'from alongitudinal position into positions of varying obnqan elongated stem, a member pivotally mounted at its rear end to the forward portion of the stem so as to be movable into positions of varying obliquity with respect to the stem axis, a longitudinal electrode wire having its rear end pivotally-associated with the stem and its forward end slidably articulated to said member, and means for removably mounting said electrode wire in association with said stem and member.

18. In an instrument of the character described, an elongated stem, a member pivotally mounted at its rear end to the forward portion of the stem so as to be movable into positions of varying obliquity with respect to the stem axis, a longitudinal electrode wire having its rear end pivotally associated with the stem and its forward end slidably articulated to said member, and means for removably mounting said electrode wire in association with said stem and member; said means comprising a clamp at the rear of said stem, and a conductive body pivotally connected to the rear end of said wire and removably engaged at its rear end by said clamp.

19. In an instrument of the character described, an elongated stem, a member pivotally mounted at its rear end to the forward portion of the stem so as to be movable into positions of varying obliquity with respect to the stem axis, a binding post mounted ininsulated relation at the rear end of said stem, a conductive body arranged in insulated relation along said stem, an electrode wire pivoted to the forward end of said body, means for removably securing the rear end of said body in electrical connection with said binding post, and means for removablyarticulating the electrode wire in insulated relation at its forward end to said member. i

20. As a new article of manufacture, an electrode device for removable association with an instrument of the character described, comprise ing an elongated conductive body, a sheath of insulation around said body and terminating short of its rear end so that the latter may be removably clamped into electrical connection with a binding post, an'uninsulated electrode wire pivoted to the forward end of'said body, and a journal piece at the forward end of said electrode wire for slidable articulation with a bearing member.

REINHOLD H. WAPPLER. FREDERICK CHARLES WAPPLER.

US2004559A 1932-11-22 1932-11-22 Method and instrument for electrosurgical treatment of tissue Expired - Lifetime US2004559A (en)

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