US2041521A - Surgical instrument - Google Patents

Description

May l9, 1936. s. J. BLUMENTHAL 2,041,521

SURGICAL INSTRUMENT Filed Oct. 3l, 1955 INvr-:NroR I 54m/EL J Bami/WML ATTORNE? Patented May 19, 1936 UNITED YSTATES PATENT OFFICE 19 Claims.

This invention relates to surgical instruments, and particularly to what are known as tonsillotomes used in the removal of tonsils; and the object of the invention is to provide an instrument of the class described which is so constructed as to more eiciently remove a tonsil from the standpoint, rst, the simplicity of applying the instrument and secondly, in supporting the pillars of the tonsil fossae to prevent injury thereto 1o and to avoid unnecessary throat mutilation and still further, to produce a substantially hemostatic action which will materially reduce the degree of bleeding and obviate hemorrhages; a further object being to provide an instrument of the class described which will more efciently remove what is termed the root of the tonsils; a further object being to provide an instrument of the class described involving a movable blade including spaced jaw ends with means for supporting a wire between the spaced jawends when in operative position to act as a blade in severing or removing a tonsil; a further object being to provide means for supporting the shearing or cutting wire in the. holder or frame of the instrument so as not to interfere With the passage of the tonsil to be severed through an opening formed in the end of the instrument adjacent said spaced edges; a further object being to provide a simple means of attaching a wire to the instrument and for securing and retaining the same in connection therewith; a stili further object being to provide an instrument of the class described wherein the jaw end thereof includes a relatively thin frame with the movable jaw members and shearing wire disposed within the boundaries of said frame; and with these and other objects in view, the invention consists in an instrument of the class and for the purpose specified, which is simple in construction, efficient in use and which is constructed as hereinafter described and claimed.

Fig. l is a side. View of an instrument made according to my invention.

Fig. 2 is a plan view of the instrument shown in Fig. l with parts of the construction broken away.

Fig. 3 is a longitudinal, sectional view through one end of the instrument shown in Figs. 1 and 2 on an enlarged scale.

4 is a View similar to Fig. 3 showing the jaws of the instrument partially advanced.

Fig. 5 is a View similar to Fig. 2 showing only a part of the construction onv an enlarged scale and with parts broken away and in section, the

section being on the line 5 5 of Fig. 1.

(Cl. 12S-309) method of engaging and supporting the tonsils 10y in the instrument as well as due to the manner of severing the tonsils and it has been further experienced that with known instruments, it has been extremely diicult, if not impossible, to remove the root of the tonsils. It is the purpose of 15,

my invention to provide an instrument which will overcome these objectionable features and perform the operation in the simplest and most foolproof manner, and further to provide an instrument of practical design which will facilitate assemblage and separation of the various operative parts for cleaning, sterilization and other purposes.

In the accompanying drawing, I have shown one form of instrument for carrying my invention into effect, and in which ID represents the main stock or body of the tool which is in the form of an elongated and substantially rectangular bar, terminating at one end in a relatively thin and wide head or frame I I, the bottom wall of which terminates short cf the end of said frame to provide a large opening I3 therein. The frame II is bounded by an upstanding flange I4 which as viewed in plan, note Fig. 2 of the drawing, is U-shaped in form, or'in other words, extends over the iront crosshead I5 of said frame, the latter being preferably curved or arc-shaped in form to provide a suitable end to the instrument. The inner surface of the flange I4 is grooved as seen at I6 to receive a shearing wire or strand II, the 40 side members I la of which extend longitudinally of the side flanges of the frame, whereas the crosshead I'Ib is normally disposed within the groove "of the crosshead end I5 of the frame, as is seenA in Fig. 5 of the drawing. 45

The body HI has inwardly of the other end thereof a downwardly and angularly disposed handle I8 which may be of any preferred design and construction to provide a suitable hand grip,

the side surfaces of the handle member being 50 free to pass in attachment and detachment with respect to the tool and in placing the same upon the body I0 and within a passage or guide channel I9b in the enlargement I9. A winged screw 2| is mounted in the top of the enlargement I9 and cooperates with the plunger 20 to secure the same in diierent positions, and especially in its operative position as later described.

The body I0 is provided with a longitudinal channel Illa which opens through the inner end of said body and extends to and opens into a transverse opening Ib adjacent the enlarged end II and mounted in the channel is a rod 22, the rear end portion of which is threaded to receive a feed member 23. The member 23 is provided with laterally extending arms 23a forming nger pieces, by means of which said member may be rotated, the inner end 23h of said member engaging the end of the body I0 in the operation of drawing the wire I1 or the crosshead I'Ib thereof toward the handle member I8 in the operation of shearing a tonsil.

The outer end of the rod 22 is provided with a head or button 22a by means of which the rod may be moved forwardly t0 advance the wire I'I or the crosshead IIb thereof into the groove I6 in the crosshead I5 of the frame. The inner end portion of the rod 22 has a transverse aperture 22h, preferably of the cross sectional form seen in Figs. 3 and 4 of the drawing, and which opens into a recess 22o on the lower face of said rod. The purpose of this construction is to automatically bend and couple the ends of the wire with the rod 22, which result is accomplished by advancing the rod 22 forwardly to a point where it will register with the opening IIlb. The ends of the wire I'I are then passed through the aperture 22b and extended to a slight degree, and by drawing the rod 22 outwardly or in the direction of the knob 22a, the protruding ends IIc are bent over in the manner illustrated in Fig. 3 of the drawing. It will thus be apparent that no tools are required to make the attachment of the wire to the rod 22.

In the above operation, the plunger or bar 20 has a transverse aperture 20a therein disposed in transverse alinement with the aperture 22h. The end 20h of the plunger 20 tapers to a comparatively thin plateforming one jaw of the instrument and another jaw plate 24 has its side edges attached to the plate 2Db and both plates operate in the grooves I6 in the side members of the frame I I, the plates 20h and 24 being spaced apart as indicated at'25, note Figs. 3, 4 and '7, to provide for the passage of the side members I'Ia of the wire therethrough as well as the crosshead IIb in the operation of severing a tonsil, it being understood that the chamber or space 25 between said plates opens through the front and rear ends of the plate 24 as clearly illustrated in Figs. 3 and 4 of the drawing. As seen in Figs. 2 and 5 of the drawing, the crosshead I5 is arc-shaped in form, and the forward jaw ends of the plates 20h, 24 are of corresponding form so as to seat snugly upon the crosshead I5 for purposes later described.

The other end of the plunger bar 20 is provided with lateraly extending wings or nger pieces 26, by means of which said plunger may be moved longitudinally of the stock or body I0 in the movement of the jaw plates toward and from the crosshead I5. Adjacent the finger pieces 26, the plunger 20 is provided with a yoke 21, note Fig.I 9,

, which surrounds the body I0 and serves to guide the plunger in its movement on said body. It

is also preferred that the upper surface of the plunger be milled or roughened as indicated at 28, where the thumb screw 2| cooperates therewith so as to insure positive locking of the plunger with respect to the body I0 when the jaw plates 5 are in operative position and in the operation of moving the crosshead I'Ib of the wire backwardly or in the direction of the handle I8 in severing a tonsil.

Pivoted to one side of the body IU as seen at 10 29 is a spring pawl or catch device 30, the olfset end 3l of which is adapted to cooperate with a recess 32 foimed in the plunger to limit the backward movement of the plunger. The pawl also includes laterally extending anges 33 disposed l5 upon the upper surface of the plunger 20 and the lower surface of the body I0, note Fig. 8, to aid in retaining the plunger on and guiding its movement relatively to the body I0.

It will be understood that if at any time it 20 is found desirable to remove the wire I'I, the same may be readily withdrawn from between the plates 20h and 24, and by bringing the aperture 22h in alinement with the apertures Ib and 20a, the ends of the wire attached to the plunger25 22 may be forcibly withdrawn. If found necessary, a screw driver may be inserted between the ends of the wire to free them from the recess 22c, and a new wire may be replaced in the manner heretofore set forth. 30

In the use of my improved instrument for removing tonsils, the tonsil including the capsule is forced by hand or the ngers of a hand through the opening I3, when the jaw plates 2Gb and 24 are in the position shown in Figs. 35 2, 3 and 5 of the drawing. The tonsil is held in this position, preferably with pressure applied to the end of the jaw 24, and the instrument is then operated to either draw the body I 0 or crosshead I5 thereof forwardly into engagement 40 with the jaws 24, 20h, or the latter may be moved in the direction of said crosshead.

At the completion of this operation, the edges of the two pillars, that is to say, the anterior pillar and the posterior pillar are securely 45 pinched or held between the jaw ends and the crosshead I5, or at least, between one of said jaw ends and said crosshead, after which the thumb screw 2| is tightened to retain the plunger 20 and body I0 against relative movement. 50`

The m'ember 23 is now rotated to draw the crosshead IIb of the wire from the groove in the crosshead I5 into the chamber or space 25 between the jaw plates 2Gb, 24, which operation severs the tonsil, and this operation, by reason of the manner of supporting the pillars in the instrument, is performed without tearing or otherwise mutilating the throat or the muscular tissue. Further, it will appear that my improved instrument will provide, by virtue of the manner 60 of engaging the pillar structure, a substantially hemostatic action, eliminating excessive bleeding, and obviating to a major degree the possibility of hemorrhages. After severing the ton-- sil, the thumb screw 2| will be loosened and the 55 jaws separated from the crosshead I5 a slight degree, sufficient to remove the instrument from the throat, but not suicient to permit displacement of the severed tonsil from the instrument.

It will be understood that while I have shown 70 certain details of construction for carrying my invention into effect, I am not necessarily limited to these details, nor am I necessarily limited to the specific use of the instrument herein described, and various other changes in and modi- 75 fications of the construction' herein disclosed m'ay be made within the scope of the appended claims, Without departing from the spirit of my invention or sacrificing its advantages.

Having fully described my invention, what I claim as new and desire to secure by Letters Patent, is:

1. In an instrument of the class described, a yoke-shaped frame including channeled side rails and a grooved crosshead, a relatively large opening in the frame adjacent and in alinement with the crosshead thereof, a wire fashioned to form a crosshead seating in the groove of said first named crosshead and including side members disposed in the channel of the side rails of said frame, means for moving the crosshead of said wire toward and from the crosshead of said frame, and a jaw member slidably engaging the frame and movable toward and from said crosshead, said member including a surface seating on the crosshead of the frame at one side of the groove therein.

2. In an instrument of the class described, a yoke-shaped fram'e including channeled side raiis and a grooved crosshead, a relatively large opening in the frame adjacent and in alinement with the crosshead thereof, a wire fashioned to form a crosshead seating in the groove of said first named crosshead and including side members disposed in the channel of the side rails of said frame, means for moving the crosshead of said wire toward and from the crosshead of said frame, a jaw member slidably engaging the frame and movable toward and from said crosshead, said member including a surface seating on the crosshead of the frame at one side of the groove therein, and another jaw member slidably engaging the frame and seating on said crosshead at the opposite side of said groove.

3. In an instrument of the class described, a yoke-shaped frame including channeled side rails and a grooved crosshead, a relatively large opening in the frame adjacent and in alinement with the crosshead thereof, a wire fashioned to form a crosshead seating in the groove of said first named crosshead and including side menrbers disposed in the channel of the side rails of said frame, means for moving the crosshead of said wire toward and from the crosshead of said frame, a jaw member slidably engaging the frame and including a surface seatingon the crosshead of the frame at one side of the groove therein, another jaw member slidably engaging the frame and seating on said crosshead at the opposite side of said groove, and one of said jaw m'embers constituting an integral part of a plunger having at one end a finger piece by means of which the same may be moved forwardly and backwardly in said frame.

4. In an instrument of the class described, a yoke-shaped frame including channeled side rails and a grooved crosshead, a relatively large opening in the frame adjacent and in alinement with the crosshead thereof, a wire fashioned to form a crosshead seating in the groove of said rst named crosshead and including side members disposed in the channel of the side rails of said frame, means for moving the crosshead of said wire toward and from the crosshead of said frame, a jaw member slidably engaging the frame and including a surface seating on the crosshead of the frame at one side of the groove therein, another jaw member slidably engaging the frame and seating on said crosshead at the opposite side of said groove, one of said jaw members constituting an integral part of a plungerhaving at one end a finger piece by means of which the same may be moved forwardly and backwardly in said frame, and said means including a rod with which the ends of said wire are coupled.

5. In an instrument of the class described, a yoke-shapedframe including channeled side rails and a grooved crosshead, a relatively large opening in the frame adjacent and in alinement with the crosshead thereof, a wire fashioned to form a crosshead seating in the groove of said rst named crosshead and including side members disposed in the channel of the side rails of said frame, means for moving the crosshead of said wire toward and from the crosshead of said frame, a jaw member slidably engaging the frame and including a surface seating on the crosshead of the frame at one side of the groove therein, another jaw member slidably engaging the frame and seating on said crosshead at the opposite side of said groove, one of said jaw members constituting an integral part of a plunger having at one end a nger piece by means of which the same may be moved forwardly and backwardly in said frame, said means including a rod with which the ends of said wire are coupled, and means for retaining said plunger against movement relatively to the frame.

6. In an instrument ofthe class described, a yoke-shaped frame including channeled side rails and a grooved crosshead, a relatively large opening in the frame adjacent and in alinement with the crosshead thereof, a wire fashioned to form a crosshead seating in the groove of said first named crosshead and including side members disposed in the channel of the side rails of said frame, means for moving the crosshead of said Wire toward and from the crosshead of said frame, a jaw member slidably engaging the frame and including a surface seating on the crosshead of the frame at one side of the groove therein, another jaw member slidably engaging the frame and seating on said crosshead at the opposite side of said groove, one of said jaw members constituting an integral part of a plunger having at one end a finger piece by means of which the same may be moved forwardly and backwardly in said frame, said means including a rod with which the ends of said wire are coupled, means for retaining said plunger against movement relatively to the frame, and manually operated means for moving said rod longitudinally with respect to said plunger.

7. In an instrument of the class described comprising an elongated body, one end portion of which is provided with an angularly extending handle, the other end of said body being relatively thin and terminating in a substantially U-shaped frame consisting of side channels and an outer crosshead having a groove in the inner surface thereof, said frame having a relatively large opening at the outer end thereof and in alinement with said crosshead, two members slide ably engaging said body, one of said members including a jaw portion adapted to move toward and from said crosshead transversely of the opening in said frame and to form in conjunction with said crosshead cooperating jaws for securing an element or body therebetween, and the other of said first named members including a part normally seating in the groove of said crosshead and adapted to transverse the opening in said frame to form a shearing element.

8. In an instrument of the class described comprising an velongated body, one end portion of which is provided with an angularly extending handle, the other end of said body being relatively thin and terminating in a substantially U' shaped frame consisting of side channels and an outer crosshead having-a groove in the inner surface thereof, said frame having a relatively large opening at the outer end thereof and in alinement with said crosshead, two members slidably engaging said body, one of said members including a jaw portion adapted to move toward and from said crosshead transversely or" the opening in said frame and to form in conjunction with said crosshead cooperating jaws for securing an element or body therebetween, the other of said rst named members including a part normally seating in the groove of said crosshead and adapted to transverse the opening in said frame to form a shearing element, and means for supporting and guiding said shearing element upon the jaw portion of the first named member.

9. In an instrument of the class described comprising an elongated body, one end portion of which is provided with an angularly extending handle, the other end of said body being relatively thin and terminating in a substantially U- shaped frame consisting of side channels and an outer crosshead having a groove in the inner surface thereof, Said frame having a relatively large opening at the outer end thereof and in alinement with said crosshead, two members slidably engaging said body, one of said members including a jaw portion adapted to move toward and from said crosshead transversely of the opening in said frame and to form in conjunction with said crosshead cooperating jaws for securing an element or body therebetween, the other of said first named members including a part normally seating in the groove of said crosshead and adapted to transverse the opening in said frame to form a shearing element, means for supporting and guiding said shearing element, upon the jaw portion of the first named member, and means for retaining the first named member against movement with resp-ect to said body in the movement of said second named member.

10. In an instrument of the class described comprising an elongated body, one end portion of which is provided with an angularly extending handle, the other end of said body being relatively thin and terminating in a substantially U- shaped frame consisting of side channelsand an outer crosshead having a groove in the inner surface thereof, said frame having a relatively large opening at the outer end thereof and in alinement with said crosshead, two members slidably engaging said body, one of said members including a jaw portion adapted to move toward and from said crosshead transversely of the opening in said frame and to form in conjunction with said crosshead cooperating jaws for securing an element or body therebetween, the other of said first named members including a part normally seating in the groove of said crosshead and adapted to transverse the opening in said frame to form a shearing element, means for supporting and guiding said shearing element upon the jaw portion of the rst named member, means for retaining the first named member against movement with respect to said body in the movement of said second named member, and a pawl cooperating with the first named member to limit the movement thereof in one direction.

11. In an instrument of the class described comprising an elongated body, one end portion of which is provided with an angularly extending handle, the other end of said body being relatively thin and terminating in a substantially U- shaped frame consisting of side channels and an outer crosshead having a groove in the inner surface thereof, said frame having a relatively large opening at the outer end thereof and in alinement with said crosshead, two members slidably engaging said body, one of said members including a jaw portion adapted to move toward and from said crosshead transversely of the opening in said frame and to form in conjunction with said crosshead cooperating jaws for securing an element or body therebetween, the other of said first named members including a part normally seating in the groove of said crosshead and adapted to transverse the opening in said frame to form a shearing element, means for supporting and guiding said shearing element upon the jaw portion of the rst named member, means for retaining the rst named member against movement with respect to said body in the movement of said second named member, a pawl cooperating with the first named member to limit the movement thereof in one direction, and the means for actuating said second named member including a manually actuated part in threaded engagement with said member and cooperating with said body,

12. A tonsillotome comprising a body portion having a transverse opening in the end thereof bounded by a crosshead forming a xed jaw part, two jaw plates movable on said body toward and from the fixed jaw part, said jaw plates engaging the fixed jaw part at spaced intervals, a shearing element supported within the boundaries of the xed jaw part intermediate said jaw plates, and means for actuating said shearing element to move the same from said fixed jaw part between said jaw plates in a severing operation of the instrument.

13. A surgical instrument comprising an elongated body including a handle member, one end of the body being fashioned to form a frame having a relatively large opening transversing said end thereof and forming an outer crosshead wall joining side wall portions, a plunger slidabiy mounted on said body and frame and including a jaw portion, the free edge of the jaw portion being normally disposed inwardly of the opening and being movable transversely of said opening toward the outer crosshead of said frame, a severing strand normally supported in the crosshead and side walls of the frame and movable inwardly and transversely of said opening and relatively to and in contact with the jaw portion of said plunger.

14. A surgical instrument comprising an elongated body including a handle member, one end of the body being fashioned to form a frame having a relatively large opening transversing said end thereof and forming an outer crosshead wall joining said side wall portions, a plunger slidably mounted on said body and frame and including a jaw portion adapted to transverse said opening, the free edge of the jaw portion being normally disposed inwardly of the opening and being movable toward the outer crosshead of said frame, a severing strand normally supported in the crosshead and side walls of the frame and movable inwardly and transversely of said opening and relatively to the jaw portion of said plunger, said jaw portion including spaced jaw plates, and said severing strand being movable between said plates..

15. A surgical instrument comprising an elongated body including a handle member, one end of the body being fashioned to form a frame having a relatively large opening transversing said end thereof and forming an outer crosshead wall joining said side wall portions, a plunger slidably mounted on said body and frame and including a jaw portion adapted to transverse said opening, the free edge of the jaw portion being normally disposed inwardly of the opening and being movable toward the outer crosshead of said frame, a severing strand normally supported in the crosshead and side walls of the frame and movable inwardly and transversely of said opening and relatively to the jaw portion of said plunger, said jaw portion including spaced jaw plates and said severing strand being movable between said plates, and a rod movable longitudinally of said body and with which said severing strand is coupled and by means of which said strand is operated.

16. A surgical instrument comprising an elongated body including a handle member, one end of the body being fashioned to form a frame having a relatively large opening transversing said end thereof and forming an outer crosshead wall joining said side wall portions, a plunger slidably mounted on said body and frame and including a jaw portion adapted to transverse said opening,

the free edge of the jaw portion being normally disposed inwardly of the opening and being movable toward the outer crosshead of said frame, a severing strand normally supported in the crosshead and side walls of the frame and movable inwardly and transversely of said opening and relatively to the jaw portion of said plunger, said jaw portion including spaced jaw plates and said severing strand being movable between said plates, a rod movable longitudinally of said body and With which said severing strand is coupled and by means of which said strand is operated, and means comprising a member in threaded engagement with said rod for moving the same and said strand in one direction.

17. A surgical instrument comprising an elongated body including a handle member, one end of the body being fashioned to form a frame having a relatively large opening transversing said end thereof and forming an outer crosshead Wall joining said side wall portions, a plunger slidably mounted on said body `and frame and including a jaW portion adapted to transverse said opening, the free edge of the jaw portion being normally disposed inwardly of the opening and being movable toward the outer crosshead of said frame, a severing strand normally supported in the crosshead and side walls of the frame and movable inwardly and transversely of said opening and relatively to the jaw portion of said plunger, said jaw portion including spaced jaw plates and said severing strand being movable between said plates, a rod movable longitudinally of said body and with which said severing strand is coupled and by means of which said strand is operated, means comprising a member in threaded engagement with said rod for moving the same and said strand in one direction, and manually operated means for retaining the plunger against movement relatively to said body.

18. A surgical instrument comprising an elongated body including a handle member, one end of the body being fashioned to form a frame having a relatively large opening transversing said end thereof and forming an outer crosshead wall joining said side Wall portions, a plunger slidably mounted on said body and frame and including a jaw portion adapted to transverse said opening, the free edge of the jaw portion being normally disposed inwardly of the opening and being movable toward the outer crosshead of said frame, a severing strand normally supported in the crosshead and side Walls of the frame and movable inwardly and transversely of said opening and relatively to the jaw portion of said plunger, said jaw portion including spaced jaw plates and said severing strand being movable between said plates, a rod movable longitudinally of said body and with which said severing strand is coupled and by means of which said strand is operated, means comprising a member in threaded engagement with said rod for moving the same and said strand in one direction, manually operated means for retaining the plunger against movement relatively to said body, and one end of the plunger extending to form a finger piece facilitating the operation thereof.

19. A surgical instrument comprising an elongated body including a handle member, o-ne end of the body being fashioned to form a frame having a relatively large opening transversing said end thereof and forming an outer crosshead wall joining said side Wall portions, a plunger slidably mounted on said body and frame and including a jaw portion adapted to transverse said opening, the free edge of the jaw portion being normally disposed inwardly of the opening and being movable toward the outer crosshead of said frame, a severing strand normally supported in the crosshead and side walls of the frame and movable inwardly and transversely of said, opening and relatively to the jaw portion of said plunger, said jaw portion including spaced jaw plates and said severing strand being movable between said plates, a rod movable longitudinally of said body and with which said severing strand is coupled and by means of which said strand is operated, means comprising a member in threaded engagement with said rod for moving the same and said strand in one direction, manually operated means for retaining the plunger against movement relatively to said body, one end of the plunger extending to form a finger piece facilitating the operation thereof, and a pull on said body cooperating with said plunger to limit the movement of said plunger in one direction.

SAMUEL J. BLUMENTHAL.

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