US2011169A - Forcipated surgical electrode - Google Patents

Forcipated surgical electrode Download PDF

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US2011169A
US2011169A US60493532A US2011169A US 2011169 A US2011169 A US 2011169A US 60493532 A US60493532 A US 60493532A US 2011169 A US2011169 A US 2011169A
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jaws
jaw
stem
end
electrode
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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
    • 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
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00184Moving parts
    • A61B2018/00196Moving parts reciprocating lengthwise
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/007Aspiration
    • A61B2218/008Aspiration for smoke evacuation

Description

Aug. 13, 1935. R Q WAPPLER 2,011,169

FORCIPATED SURGICAL ELECTRODE Filed April 15, 1932 3 Sheets-Sheet 1 INVENTOR Aug. 13, 1935. F. c. WAPPLER 2,011,169

. FORCIPATED SURGICAL ELECTRODE Filed April 13, 1952 5 Sheets-Sheet 2 Aug. 13, 1935. F. c. WAPPYLER 2,011,169

FORCIPATED SURGICAL ELECTRODE Filed April 15, 1932 ,5 Sheets-Sheet 3 INVENTOR Patented Aug. 13, 1935 PATENT OFFIQ E- EORCIPA EED SURGICAL. ELEQTRODE Frederick Charles Nappler, New Yrli, N. YL Application Aprill3, 1932,8eriallNo; 604,935

13 Glaims. (Cl. 174-89) My present invention relatesgenerally to surgical instruments and-has-par-ticularreference to surgical" instruments of thetype which are designed toapply electrical currents tothe human body;

' Although I have herein illustrated and shall hereinafter describe aparticular type- 0f surgical instrument wherein the operative electrode is in v the former 'a pair of complementaryjaws, never:

thelessit will beunderstood that the' broader phases of my invention arenot' restricted to an instrument having anys-pecific character of elec-- trode or electrodes. 7

The instruments to whichmy invention relates "are of the'type-wherebyhigh frequency alternating current may be applied to the part of the humanbody' to be-treated-by means of an electro-dearranged'usuallyat the forwardend of an sort" of manually-graspable control device.

J So

elongated stem orthe like, this electrode member-- being adapted for insertion into andthrough a fenestrated endoscopic tube whereby the electrode operates throughthe fenestrab The electrode member usually carries a binding post at its rear end and is provided with electrode-operat mechanism which extendsrear-Wardly along or through the stem'i'nto association with some The current which flows through the" body from the electrode isreturned to a. suitable source ofourrent by way ofarelatively large'indifferent elecrelatively bulky and cumbersome, especially WhEl'Glb is in the form of quartz or similar vitreone material. Furthermore, only the simplest. types of mechanical movements could be provided for with any'degree of economical success be cause of the obvious difiiculties involved in proper ly insulating the-electrodeand the binding post irc-mtheoperating mechanism; These diflicul ties have been especially difiicult to obviate in connection with forcipated instruments wherein a pair of cooperativewrcomplementary jaws of necessarily-great strengtha have been sought to be used as=operative electrodesiof the present character.

Myprcsent invention is. predicated UIJOIDthCi discovery that the useof a: proper type of high 5; frequency current, especially where. theroscillations are properly and. effectively-sustained ata maintained comparatively lowvoltage, permits: insulation to be dispensed with entirely: This remarkable phenomenon, due primarily, if not. solely, tothe present rapidz development inthe relatively new art of: employing; high. frequency: current for surgical purposes, has tremendously far-reaching effects in connection. with the art of instrumentmanuiacture andvdesignn Not only; 151 may electrode instruments be providediinigreat- 1y. sinplified forms, but instruments with. en'.-- tirely new characteristics 0f operation andlstructure may: be. manufactured economically and:

with feasibility and; safety. For example, my present. invention has enabled: me. tov desigm an entirely new type of electrode instrumenttof; forcipated character, audit is this general type of instrument whichhas been'illustrated and. Willi hereafter be described tolexemplify. thegeneral nature of my presentinvention;

It may thus-bestated-to be a more particular: object of: my. inventionto provide anew; and improved type of forcipatedssurgicahelectrode char;-- acterized by greatlsimplicity,remarkable strength, compactness and: full: opportunity for complete: illuminated visibility.

Whereas the art of bloodlessly cutting; or." punching;diseaseditissue, orxthe like;.by means." of. jaw electrodes has heretofore been:. highly une- 355. satisfactory and often utterly incapable? of: feasible accomplishment, my present invention permits suitably visualized:andilluminatedzforcepi jaws to be employed withigreat" ease: andlefiiciencys as electrodes of the character called: ion by 403 modern electro-surgery: present. invention] further permits instruments of this: type. and ofl othen widely varying. types,.to:- bevregularly em'-.-- ployed with safety in routlne;operatiyeipractice..

From-its broader aspect: my invention. consists 411s briefly inthe provisionof a new type ofoperative; electrode member which iscomposed of." an". 81011: gated stem; a conductive electrodeatf its forward; end, a binding post andcontrolideviceatr its rear: end; and electrodemperating mechanismlbetween; saidelectlrode and 'controlldevice, thesentire memt-- her" being insertable as aiunit into an. endoscopic tube and" the several parts thereof: being: assembled in mutually: uninsulated relationship:. The; endoscopio tube into which the electrodezisain-r 58:

serted is composed almost entirely of insulating material so that the path of current travel through the patient is restricted to one which emanates from the operative electrode or electrodes.

Where my invention is applied to a forcipated surgical electrode, I am enabled to provide a peculiarly eihcient and practical device which consists essentially of an elongated metallic stem and a pair of complementary conductive jaws mounted at the forward end of the stem, a binding post and control device for the jaws at the rear end of the stem, and jaw-operating mechanism extending rearwardly from the jaws to the control device, all of the parts thus entering into the instrument being arranged and assembled in uninsulated relationship which permits me to achieve not only great strength and compactness, but also remarkable and efficient illumination and visibility of the operative jaws.

I attain the foregoing objects and such other objects'and advantages as may hereinafter appear, or be pointed out, in the manner illustratively shown in the accompanying drawings, wherein Figure l is a perspective view of a surgical instrument of the present character;

- Figure 2 is a fragmentary side view of the forward portion of Figure 1, shown partly in section;

Figure 3 is an enlarged front end view of Figure 1;

Figure 4 is a side view of the electrode member and associated parts shown by itself, the jaws being open;

Figure 5 is an enlarged bottom view of the forward portion of Figure 4, the jaws being closed,

Figure 6 is an enlarged perspective view of the forward portion of Figure 4, with the jaws closed;

Figure '7 is a cross-sectional view taken substantially on the line of l'l of Figure 4;

Figure 8 is a view similar to Figure 4 showing a modified type of instrument, the jaws being open;

Figure 9 is a view similar to Figure 5 showing the jaws of Figure 8 from underneath;

Figure 10 is a front-end view of Figure 8; and

Figure 11 is a cross-sectional view taken substantially on the line i l of Figure 8.

In Figures 1-3, I have shown an electrode member of the present character associated with an endoscopic tube 20 having a forward lateral fenestra 2|. The tube 20 is composed of insulating material, such as hard rubber, or bakelite, and is preferably provided at its rear end with the insulating flange 22 and a connecting sleeve 23.

The sleeve 23 need not necessarily be of insulating material.

Carried by the sleeve 23 is the pet-cock 24 which communicates with the interior of the tube 20, and permits steam or fumes to be withdrawn from the latter during operations. The sleeve 23 is also provided with a connecting member or mechanism 25 which is adapted to facilitate the security with which the inner electrode member is held in association with the tube 20.

The electrode member is shown by itself in Figures 4-7 and consists of an elongated metallic stem having a relatively large tubular portion 26, and two relatively small tubes 2'! and 28, arranged along opposite sidesof the tube 26. At its rear end, the stem merges with the relatively enlarged plug portion 29, having bores which form continuations of the tubes 23, 27!, and 28. The

rear portion of the plug 29 carries the electrical binding post 38, the connector member 3! (adapted to cooperate with the device 25), and a fixed handle 32 of the manually-graspable control device. The plug 29 is also provided with a continuation 33 of the tube 25 terminating in a clamp device 34, which is adapted to facilitate the secure accommodation of a telescopic tube.

While any type of illuminating device or telescope may be used, I prefer to employ a telescope such as is described in U. S. Patent No. 1,680,491. This device is provided with the usual eye-piece 35, and the conductive sleeves 36. The latter are adapted to receive electrical connectors which supply the current for a miniature lamp 37 mounted at the forward tip of the telescope. Behind the lamp 3?, the telescope St is provided with a lens 39 which commands an obliquelyforward field of vision.

At its forward end, the tube 26 is provided with the substantially semi-circular extension flit which carries the complementary conductive electrode jaws. Both of these jaws are substantially U- shaped, and they are preferably constructed in a manner whereby one of them is adapted to nest within the other when the jaws are closed, as shown in Figures 5 and 6. In the form illustrated, the outer U-shaped jaw ll is integrally formed at the forward end of extension it, and it is preferably provided with teeth 12 along its rear edge. The inner movable jaw 43 is preferably provided with teeth M on its forward edge, and is pivoted as at 65 to the outer jaw ll. The jaw 63 is also provided with rearwardly extending cars 46' in which a crossbar ll is articulated. At its opposite ends the bar 47 is provided with two spaced control arms 48 and ie, which extend rearwardly through the tubes 2'1 and 28, respectively. At the rear ends of the arms 48 and it, they connect with a member 58 slidaoly mounted on the tubular extension 33 and engaged by the end 5! of the movable handle 52: of the control device. The handle 52 is pivoted to the handle 32, as at 53.

The manner in which the control device governs the cooperative movements of the jaws will be obvious from the description given. When the operator grasps the handles 32 and 52 of Figure 4, and moves the handle towards the handle 32, the member 50 is shifted towards the left, thus shifting the control arms 48 and 4% and moving the jaw 43 from the open position of Figure 4 into the closed positions of Figures 5 and 6. By manipulating the control device in reverse manner, the jaws are caused to open relatively to each other.

It is to be noted that the control arms 48 and 49 are arranged in sufiiciently spaced relationship to permit the lens 39 to command an unusually complete field of vision, amply illuminated by lamp Bl, through the space between arms t8 and 49. The jaws are thus maintained under constant illuminated vision, and the U-shaped configuration of the jaws prevents the rearward jaw from impeding equally efiicient visibility of the relatively forward jaw.

I am enabled to construct the jaws in the U- shaped manner shown without any sacrifice of strength or rigidity by virtue of the fact that the jaw portion of the device is entirely devoid of any insulating material. The integral association of the outer jaw with extension 40 lends strength and rigidity to it, and to the entire structure, and the mounting of the inner jaw, together with the rigid and staunch association therewith of the operating mechanism, constituted by the arms 68 and 49, provides an assembly of remarkable strength and ruggedness.

Notionly is the forward portion of the device devoid of insulation, but also. the rear portion, which includes the binding post 30': and the control device. Accordingly the entire assembly is unusually simple and: compact, and the. several.

parts; may. be manufactured and associated expeditiously within. a minimum space and with a minimum amount of material, yet with a maximum. or s rength and rigidity- Strange as; it may seem, the efficiency with which the device may be, used: is not in. the least impaired, by the uninsulated relationship of the several parts. The; operator may grasp. the controldevice with his bare hands-if. he wishes, and hemameven, place himself. in. parallel with. the circuit by touching, the patient with the: other hand. Not onlydoes the operator remain unaffected by any passage of current, but the functioning of the; jaws asoperative electrode conductors of the current is not in: the least mitigated. Accordingly all the advantages of modern highfrequency surgery are capable of enjoyment, together with, the obvious advantages of a forcipated instrument. Diseased tissue, tumors, adhesions, and the like, may be operated upon, resected, coagulated, cooked, or treated in any corresponding manner with remarkable efficiency and safety. Since any contactof the-electrode jaws with the tissue rendered completel hemostatic before the jaws are completely closed. The constriction of blood vessels and lymph'channels extends somewhat beyond the area or line-of contact, and the jaws, or forceps, are thus in eifectcapable of excising coagulated and bloodless masses. They may be further employed as pincers to remove dead tissue, and, in thisway, a wide variety of operative procedures may be effected. Should any blood vessel accidentally open, a brief passage of, current therethrough by contacting either of the jaws thereto renders it hemostatic.

InFigures 8-11, I have illustrated a slightly modified construction inwhichthe. elongated metallic stem of the electrode. member consists of the-tube 66 arranged alongside of a channel memher 6!. The stem is provided at, its rear end with a: plug portion 82, which carries, as in the embodimentalready described, an electrical binding post a connecting member 64, a fixed handle 65- of the control device, andthe extensionv 66 of the channel member 61.

The telescope 6! is adapted to be accommodated within the members GI and 66, the latter terminating in a clamp 68 of a character hereinbefore described. The telescope is of the type which has an illuminating lamp at its forward end and an objective lens 18 slightly to the rear, commanding an obliquely forward field of vision.

Mounted in the tube 60 is a control rod H, articulatedat its rear end 12 to the end of the movable handle 730i the control device. The handles 13,-and65 are pivoted, as at 14. I

The tube 60 is-provided at its forward end with an extension 15, the latter in turn provided with spaced guide-rods 16 and H. These rods terminate at their forward ends in the integrallyiormed U-shaped jaw l8, arranged as in the previous embodiment in a, substantially transverse planewith respect to the instrument as a whole.

The complementary movable; jaw I S-is slightly smaller than the jaw 18 so as to nest therewith when the'jaws are closednandlthe jaw 1:9 is provided at its end with the rearwardly-extending control arms 80 and 8|, these arms being in this embodiment provided with: sleeves 82'" and 83 which are adapted to engage slidably with the guide-rods l6: and H, respectively. At the rear, the arms 80sand Sl are-connected with the crosspiece 84 which ismounted on the forward end of the controlirod'. H

By manipulating the handles 55 and 131 of: the control device; the operator is enabled toadvance, or retract, the rod H, whereby the jaw T9 is correspondingly advanced, or retracted with respect to-the jaw 18. At all times, the telescope 61 commandsa full and complete visibility through the space-betweenthe arms Stand 21 of the'two jaws T18. and I9 and: the U-shaped configuration. of the jaws facilitates the eflicient illumination and visibility of the entire operative procedure. In many respects, the structure of FiguresS-Il is preferable because theabsence of any pivot between the jaws dispenses with. any necessity for closing; or joining, the free ends of the jaws even to the slight extent necessitated by the pivot arrangement 45 of Figure 6;

It isto be noted that all ofthe parts of thedevice ,are completely uninsulated from one another. The construction is thereby extremely simplified and capableof embodying, the requisite strength ina minimum space and with a minimum amount of material and manufacturing. ex,-

pense.

It will be understood that. the forcipated instrurnents herein described'are merely illustrative of a wide variety of instruments which, may be constructed in accordance with my present invention, and, they have-beenchosen by me as exemplifications of the broader phases, of my invention for. the reason that. they are typical of the types of instruments-which'have heretofore proven themselves to be unfeasible for use as conductors or applicators of highfrequency currents. Therefore, I do not intend to-limit my. invention to instruments having jaws, except in so far. as the same may be specifically referred to in the appended claims. Also, the details of construction have been shown and described merely by way of illustration. Any suitable control device other than the scissors-like handles might, for example, be employed. The stems of the electrode members may be constructedin a variety'of ways. 7 In general, it will be understood that the details herein described and illustrated may, in many respects, be alteredby those skilledin the art withoutdeparting from thespirit and scope of my invention as expressed in the appended claims. Having thusdescribedmy invention and illustrated its use, what I claim as new and desire to secure by Letters Patent is- 1. In a. forcipated surgical electrode, an elongated stem, a pair of complementary, conductive, mutually uninsulated, U-shaped-jawsmounted at the forward end of said stem, means for conducting high-frequency current through said stem to said jaws, and means for opening and closing said jaws, said means comprising a pair of spaced control arms extending rearwardly stem; to said, jaws, means for: opening, and. closing;

said jaws, said means comprising a pair of spaced control arms extending rearwardly from one of said jaws, and means carried by said stem for commanding an illuminated vision of said jaws through the space between said control arms.

3. In a forcipated surgical electrode, an elongated stem, a pair of complementary, conductive, mutually uninsulated U-shaped jaws mounted at the forward end of said stem, means for conducting high-frequency current through said stem to said jaws, means for opening and closing said jaws, said means comprising a pair of spaced control arms extending rearwardly from one of said jaws, and a telescope carried by said stem and having its objective arranged slightly to the rear of said jaws to command a field of vision through the space between said arms.

4. In a forcipated surgical electrode, an elongated stem, a pair of complementary, conductive, mutually uninsulated, U-shaped jaws mounted at the forward end of said stem and arranged substantially transverse to the latter, means for conducting high-frequency current through said stem to said jaws, a pair of spaced control arms extending rearwardly from one of said jaws for controlling its movements toward and away from the other jaw, and a telescope carried by said stem and commanding an obliquely forward visibility of said jaws through the space between said arms.

5. In a forcipated surgical electrode, an elongated stem, a pair of complementary, conductive, mutually uninsulated, U-shaped jaws mounted at the forward end of said stem, means for opening and closing said jaws, said means comprising a pair of spaced control arms extending rearwardly from one of said jaws, whereby the functioning of said jaws may be observed from the rear through the space between said control arms, and electric binding post at the rear portion of the stem and in electrical connection with said jaws, said binding post being adapted to establish an electrical connection with a source of high-frequency current so that the latter will be conducted through thestem to said jaws.

6. In a forcipated surgical electrode, an elongated stem having a substantially transverse, d-shaped, conductive jaw at its forward end, a complementary, U-shaped, conductive jaw pivoted at its rear end to the rear end of the first-named jaw and uninsulated from the latter, means for conducting high-frequency current through said stem to said jaws, a laterally disposed control arm extending rearwardly from the pivoted jaw, and means at the rear portion of the stem for axially reciprocating said arm to open and close said jaws relative to each other.

'7. In a forcipated surgical electrode, an elongated stem having a substantially transverse, U-snaped, conductive jaw at its forward end, a complementary, U-shaped, conductive jaw pivoted at its rear end to the rear end of the firstnamed jaw, a pair of spaced control arms extending rearwardly from the pivoted jaw and uninsulated from the latter, means for conducting high-frequency current through said stem to said jaws, and means at the rear portion of the stem for axially reciprocating said arms to move said jaw into and out of operative registry with the other jaw.

8. In a forcipated surgical electrode, an elongated stem having a substantially transverse, U-shaped, conductive jaw at its forward end, a complementary, U-shaped, conductive jaw pivoted at its rear end to the rear end of the firstnamed jaw and uninsulated from the latter, means for conducting high-frequency current through said stem to said jaws, a pair of spaced control arms extending rearwardly from the pivoted jaw, means for axially reciprocating said arms to actuate the jaws, and a telescope arranged to command visibility of said jaws through the space between said arms.

9. In a forcipated surgical electrode, an elongated stem having a substantially transverse, U-shaped, conductive jaw at its forward end, a pair of spaced conductive guide rods extending rearwardly from the free ends of said U, a complementary, conductive, U-shaped jaw slidably mounted on said guide rods, said jaws and guide rods being associated in mutually uninsulated relationship, means for conducting high-frequency current through said stem to said jaws, and means for sliding said complementary jaw along said rods to advance it and withdraw it from the other jaw.

10. In a forcipated surgical electrode, an elongated stem having a substantially transverse, U- shaped, conductive jaw at its forward end, a pair of spaced, conductive guide rods extending rearwardly from the free ends of said U, a complementary, conductive, U-shaped jaw, a pair of spaced, conductive control arms extending rearwardly from said complementary jaw and in slidable engagement with said guide rods, respectively, said jaws and guide rods being associated in mutually uninsulated relationship, means for conducting high-frequency current through said stem to said jaws, and means for axially reciproeating said arms to move said jaws into and out of operative registry.

11. In a forcipated surgical electrode, an elongated stem having a substantially transverse, U- shaped, conductive jaw at its forward end, a pair of spaced, conductive guide rods extending rearwardly from the free ends of said U, a complementary, conductive, U-shaped jaw, a pair of spaced, conductive control arms extending rearwardly from said complementary jaw and in slidable engagement with said guide rods, respectively, said jaws and guide rods being associated in mutually uninsulated relationship, means for conducting high-frequency current through said stem to said jaws, means for moving said control arms to actuate said jaws, and a telescope arranged to command visibility of said jaws through the space between said arms.

12. In a forcipated instrument of the character described, a stem, a U-shaped jaw at the forward end of the stem and provided at its ends with a pair of rearwardly extending guide rods, and a complementary, U-shaped jaw provided at its ends with a pair of rearwardly extending control arms in slidable engagement, respectively, with said guide rods.

13. In a forcipated instrument of the character described, a stem, a U-shaped jaw at the forward end of the stem and provided at its ends with a pair of rearwardly extending guide rods, a complementary, U-shaped jaw provided at its ends with a pair of rearwardly extending control arms in slidable engagement, respectively, with said guide rods, and a telescope arranged with its objective slightly behind said first-named jaw and commanding visibility of said jaws through the space betwen said control arms.

FREDERICK CHARLES WAPPLER

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