US2197055A - Tonsillotome - Google Patents

Description

J. T. MOORE TONSILLOTOME April 16, 1940.

Filed Feb. 25, 1937 .-l TTURA'EY Patented Apr. 16, 1940 7' *PAT ENT OFFICE TONSILLOTOME John Terrell Moore, Tampa, Fla. Application February 25, 1937, Serial No. 127,705

4 Claims.

Thisinvention relates to instruments of the surgical snare type especially adapted for removing tonsils.

The primary object of the invention is to provide a device in which the tonsil hook lies within the loop of the snare and cooperates with the a member that carries the snare to maintain it in operative position during the preliminary dissection freeing the tonsil from the anterior pillar. Another object of the invention is the provision of a device which is easy to operate, light in weight, smooth and efficient in operation, and not likely to get out of order. A further object of the invention is the provision of a small number :of parts which are readily detachable to permit easy and thorough cleaning and sterilization.

In the drawing, Figure 1 is a plan view of the entire device assembled; Fig. 2 is a similar plan view of the tonsil hook with the snare bar and.

the counterpressure bar removed; Fig. 3 is a side elevation with parts in section of the assembled device with the elements in the same relative positions'as in Fig. 1; Fig. 4 is a plan view of the opposite face of the counterpressure bar from that shown in Fig. 1; Fig. -5 is a plan view of the snare bar; Fig. 6 is a plan view of the snare; and Fig. 7 is an end view of the retention clip.

A counterpressure bar I has a thumb loop 2 at one end and an inclined guide portion 3 at the other endprovided with a passageway therethrough indicated in broken lines at 4 in Fig. 4 for the reception of a snare 5 shown in plan in Fig. 6 and in side elevation in Fig. 3. The snare has a longitudinal slot near one end and an aperture 1 near the other end, shown in Fig. 6 as circular and concentric with a curved front end i B. The material of the snare willpreferably be of an alloy such as stainless steel which will be strong, light, resilient, durable, and easily sterilized.

A snare bar 9 has at one end 2. lug l0 having in its front end a notch H to receive the portion of the snare at the front end of the slot 6, this notch ll being deep enough to permit the snare to slide rearward to a point at which the rear end of the slot will clear the rear end of the lug to permit the snare to be bent down behind the rear end 12 of the'lug which has a notch 13 into which the snare can be slid forward until the V-shaped notch 14 in its rear end can move down. in front of the front end l5 of the snare bar. The rear notch I3 is not as deep as the front notch ll and the snare cannot slide forward enough to disengage from the lug at its front end. Its resiliency will retain it in the twonotches and it cannot slide backward while the notch I4 is in contact with the V-shaped front end l'5 of the snare bar. This form of engagement also serves to prevent angular lateral movement of the snare on the lug l0. I

The snare bar has two finger loops "5 and I! which project laterally, one on each side of the bar.

The counterpressure bar'l has two longitudinal slots l8 and I9, and the snare bar has a relatively short slot 20 which lies opposite the slot I8 to receive the head 2| of a T-shaped lug 22 on a. retention clip 23 shown in end view in Fig. 7. With the clip held at right angles to the bars I and 9, the'head 2| can be passed through the slots l8 and 20 and then turned to bring the body of the c1ip p-aralle1 with the bars with the ends of the head 2| at each side of the slot 20 where it may be held in position by .a screw 24 passed through a hole in the clip and secured in a threaded socket '25 formed in the bar 9. The bars I and 9 will be held together by the clip 23 with its lug 22 and screw 24 free to slide longitudinally of the slots l8 and 19 in the bar I, the ends of the slots acting as stops to limit sliding movement of the snare bar on the counterpressure bar in both forward and rearward directions.

The snare bar, at its limit of forward movement, does not reach the guide portion 3 of the counterpressure bar, but the snare 5 will be of the proper length to cause the entire aperture 1 to project beyond the front end of the portion 3 at its limit 'of forward movement, and the slots 18 and I9 will be of such lengththat the entire aperture 1 will be withdrawn into the guide por tion 3 through the'opening 4 at the rearward limit of sliding movement of the snare bar.

The tonsil' hook member 26 has hooks 2! formed on its front end, and atits rear or handle end, it has two flanges 28 and 29 spaced far enough apart to receive the body portions of the bars I and 9 and of a length to extend from the rear ends of the finger loops l6 and I! to the front end of the thumb loop 2 when the bar 9 is bar I if the front ends of the flanges should become disengaged from the finger loops.

The hook member is curved inward at 34 adjacent to the portion 8 of the snare in its forward position and the curvature of the inclined end portion 3 holds the snare outward beyond the curved portion of the hook whenthe bars I and 9 lie within the flanges 28 and 29. In the normal operation of the device, the hook will extend only a little distance beyond the front end of the snare loop, but the shaft of the hook will be surrounded by the loop.

The snare 5 will first be engaged with the lug- I!) of the snare bar and then will be slid through the passageway 4 in the guide portion 3 "of the counterpressure bar. When the two bars I and 9 are placed together with either face of the bar 9 lying in contact with the bar I, the lug 22 of the retention clip will be passed through the slots It and 20 and the clip will then be turned to bring the head 2 I at right angles to the slots, with the ends of the head engaging the bar at the opposite-sides of the slot I8. The screw 24 will then be passed through slot I 9 into the socket 25, and the two bars are then ready for relative sliding movement. With theend of the bar I held with the inclined portion 3 turned toward the hooks 21, the member 26 will be inserted through the aperture I and the flanges will then be placed in positionbetween the thumb and finger loops as shown in Fig. 1.

, The operator willgrasp the handle of the hook member in one hand, thus holding the bars I and 8 in the recess between the flanges, and will take hold of the tonsil toberemoved with the hooks. While held by the hooks, the tonsil is dissected loose from the anterior pillar with a scalpel until the snarecan be slid oif the hook around the tonsil. The flanges 28 and 29 will then be removed from between the thumb loop 2 and the finger loops l6 and I1 to permit relative movement of these loops toward each other. When the snare has been moved into position around the tonsil, the operator inserts fingers and thumb in the loops and draws the snare into the guide member, severing the remaining attachments of the tonsil by crushing them off against the blunt blade formed by the end of the guide portion 3. The inside of the loop portion 8 of the snare is preferably rounded so that it will crush the tissues instead of cutting them, to minimize the danger of hemorrhage.

It will be understood by those skilled in the art that the structures illustrated may be modified inimany details without departure from the spir it of the invention as claimed;

I claim:

1. A surgical-instrument comprising a counterpressure bar having a passageway formed therein, a snare bar slidably mounted upon the counterpressure bar and having a snare thereon projecting through said passageway, finger loops upon one bar and a thumb loop upon the other bar, and a hook member having flanges adapted to receive the said bars and to engage the said loops to prevent sliding movement of either bar upon the other.

2. A surgical instrument comprising a counterpressure bar having a guide member at its forward end formed with a passageway to guide the sliding movement of a snare, a snare bar and a snare attached thereto for sliding movement within the said passageway and having a loop projecting beyond the said passageway, and

means for guiding and limiting the sliding move- I ment of the snare bar upon the counterpressure bar, and ahook member adapted to engage the said bars to prevent their relative sliding movement 'and'having a hook portionadapted to extend through the loop-of the snarewhile in en gagement with said bars.

3. A surgical instrument comprising accounterpressure bar and a snare bar :connected for relative sliding movement, thecounterpressure bar having its forward end inclined at an angle to its longitudinal axis and provided with a pas-' sageway for a snare, a flexible snare having a loop'and detachably connected with the snare bar I for sliding movement through. the inclined passageway, and a .hookmember: provided with a hook at its forward end-and curved to pass through the loop of the snare and having its bandle portion adapted -for engagement with the snare bar and the counterpressure bar toprevent sliding movement of either upon the other.-

4. A surgical instrument comprising a thin flexible .element having a 'longitudinalslot within its length and a notch at one end,"and a-support-for said element having a lug toreceive said element,

the lug being provided with a'notch in its for-- ward end of suficient depth to permit the-por tionof the flexible element in front of theslot' willextend beyond the rearend of the 'lug'to' permit the lug to enter theslot, and the lug. be-

to be lslid rearward until the rear end of the slot ing provided :with a notch for the reception of the :flexibleelement in its rear end of less depth than the front slot whereby the flexible element may slide forward on the lug while engaged with both notchesand thesupport for the flexible ele-'- ment'having a-detent portion behind the rear notch in the lug of greaterheight than the rear notch and at a distance from the lug to permit the rear end of the flexible element to spring down between the lug and the detent portion;

' JOHN TERRELL MOORE)

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