US 1453975 A
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Description (OCR text may contain errors)
May 1, 1923. 1,453,975
G. GREENBERG ET AL URET HROS COPE Filed Oct. 18 1919 4 Sheets-Sheet l wvemmo 663/24 4268]? 551; 9%11 lie M172 6] May 1, 1923. 1,453,975
G. GREENBERG ET AL URETHROSCOPE Filed Oct. 18, 1919 4 Sheets-Sheet 2 may 1", 1923. 11,453,975
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G. GREENBERG ET AL URETHROSCOPE Filed Oct. 13, 1919 4 Sheets-Sheet 4 um-M 504,
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GEZA GREENBERG, OF NEW YORK. N. Y., AND WILLIAM A. WINTER, OF EAST ORANGE,
' NEW JERSEY.
Application filed October 18, 1919.
To all whom it may concern Be it known that we, GEzA GREENBERG and WILLIAM A. VINTER, both citizens of the United States, the former a resident of New York, county and State of New York, the latter of East Orange, county of Essex, State of New Jersey, have invented certain new and useful Improvements in Urethroscopes, set forth in the following specification.
This invention relates most particularly to urethroscopes, although many of its novel features are broadly applicable to a surgical instrument adapted to facilitate the examination of an internal body cavity through a natural openin and to such instruments broadly for facllitating surgical operations within a body. cavity. It is therefore to be understood that no claim caption is to limit the claim structure specifically to a urethroscope because it is well understood that the same may be applicable in the examination of the alimentary canal from either of its natural openings.
As is well known in connection with the bladder and urethra, dilation is naturally responsive to liquid pressure, whereas for the most part heretofore urethroscopes have effected dilatation by means of mechanically movable or expanding parts, the contact of which with mucous membrane has a decided injurious effect. An object of the present invention is to dilate the cavity under examination or operation in a natural manner by fluid under pressure while, at the same time, providing for the maintenance of the dilatation and the manipulation of operatin implements while also a clear vision 0 the parts under observation is maintained.
A further object of the invention is to make possib'e urethroscopic examination and operation with the manipulation of any one of a variety of interchangeable instruments while a single urethral external tube is of necessity inserted but once and maintained in position. It is a still further object of the invention to make possible the employment of the single urethral tube necessitating but a single insertion and, at the same time, provide alternatively for either air or liquid dilatation of the cavity under treatment and at the same time provide uniform illumination of the arts and the production under both conditions of a Serial No. 331,550.
satisfactory magnified image of the parts.
A further ob ect of the invention is to provide a urethroscope comprising an internal illuminating electric lamp, an external urethral tube, and lens means for observation urposes, the various parts of which comp ete instrument are readily operable and assembleable, so that individual sterilization may be effected, it being particularly desirable that the parts contactable with the mucous membrane be capable of individual heat sterilization as by boiling in water.
It is a further object of the invention in carrying out the above objects to provide a concentric field of the parts under examina tion.
The important object of the invention is to facilitate the use of surgical instruments through an open-ended tube by so arranging the magnifying lens that, although its focus is at the locality of the part to be operated on near the distal end of the tube, nevertheless the shank of the operating tool or other manipulating part extends through the vision field of the lens greatly to aid the relative positioning of the surgical instrument by the surgeon. To make this object c earer, it may be suggested that there is an analogy between the manner in which a person manipulates a piece of chalk on a blackboard directly in his eye vision fie d and actually obscuring a part of the board as he manipulates the chalk to the manner in which it is desired for the surgeon to be able to manipulate an instrument through the vision field of the lens or lens portion provided with our obturator. In this connection it is to be understood that lens port-ion refers to the entire lens structure employed, either a complete disk or a fraction thereof and that focal diameter means the actual diameter of the complete disk of which the lens portion employed is a part.
Inasmuch as the practice of urethral examination and operation necessitates the use of the same instrument upon each of many patients, it is of supremeimportance that every precaution be taken against contagion by transmittal. To this end the heat steri lizability of all the mucous membrane contacting parts of each urethroscope is of advantage. It is, however, a further object to make possible and convenient the conducting of nearly all examinations and operations under the protection of an active or POSltlVP, ermicide by providing for the introduct on into the urethra and about all the operating parts of the instrument of a suitable germicidal liquid as, for example, a water solutlon, one to five-thousand, of oxycyanid of morcury which, in addition to its germicidal properties and capability of dilating the parts under examination or operation, 18 also light refracting, and we propose to cause this liquid itself to form the magnifying lens at the proximal end of each instrument.
Further objects of the invention are to 1mprove in general an instrument of th1s type.
The novel features of the invention are set forth in the following claims which are directed merely for purposes of illustration and explanation to the embodiments of the invention set forth in the following specification in connection with the accompanying drawings, which form a part hereof, and in which like characters designate corresponding parts in the several figures.
lln the drawings- Fig. 1 is a fractional vertical section through the human body showing the urethral passage and particularly bringing out the advantage of our obturator during the insertion of the urethroscope;
Fig. 2 is a view similar to Fig. 1 showing the obturator with its tip moved into position for the removal of the obturator from the urethroscope;
Fig. 3 is a longitudinal section, with parts shown in elevation, of the urethroscope adapted for observation under liquid dilatation;
Fig. 4 is a view similar to Fig. 3 showing the urethroscope modified for observation under air dilatation Fig. 5 is a view similar to Figs. 3 and 4 showing theurethroscope adapted for liquid dilatation and providing for small instrument manipulation during observation;
Fig. 6 shows a modification of the window structure providing for the manipulation of larger instruments;
Fig. 7 is an end view of the structure both as it appears in Fig. 3 and in Fig. 4;
Fig. 8 is a detail view showing various configurations of the external tube;
Fig. 9 shows in longitudinal section with parts in elevation a form of the urethroscope adapted for single duct catheterizing under liquid dilatation;
Fig. 10 is a section through line X-X of Fig. 9;
Fig. 11 is a cross section through line XT-XI of Fig. 10;
Fig. 12 is a longitudinal section showing the detail construction of the hinged tip obturator;
Fig. 13 is a detail of the manipulating Fig. 16 is a perspective view of the distal I end of the mechanism shown in Fig. 15 and drawn to an enlarged scale;
Fig. 17 is a cross section through the external tube showing the structure of Fig. 15 in position;
Fig. 18 shows a modification in which the external tube is curved better to accommodate curved passages;
Fig. 19 illustrates a typical image of the natural urethra made by the instrument in the field of .the' veru-montana.
Fig. 2-0 illustrates the catheterizing of an ejaculatory duct; and
Fig. 21 illustrates the contemporaneous catheterizing of the two ureters.
In the drawings A is a right cylindrical metal tube preferably of polished, nickel or polished nickel plated brass of an external diameter approximating the minimum average internal surgical diameter of the duct in which it is to be inserted, for example, the urethra. Its length to the socket 1 at its proximal end should equal the maximum length of the parts to be operated upon. As shown in Fig. 8, the distal end 2 of the tube A may have a right blunt nose 2', a 45 blunt nose 2", a 30 blunt nose 2", or any other desired configuration, those illustrated being most satisfactory.
The socket 1 has a flange 3 providing a tapered mounting at the mouth 4:. The socket also is preferably provided with one or more, preferably two, stopcocks 5 and 6,
the ducts 7 of which communicate with the duct 8 of the tube A and which. are preferably located radially at 90 with each other so that one duct such as 6 may communicate with means such as the tube 9 for supplying fluid, either liquid or air, under pressure. The cock 5 is primarily useful as a vent for the escape of air when liquid is employed, although it is to} be understood that the two cocks may be employed as inlet and exit ducts when irrigation is being practiced.
The tapered seat 4. provides for the interchangeable mounting of various interchangeable tools, each provided with a tapered plug connector 10 such as that illustrated for the mounting B, which carries a metallic stem 11 preferably of nickel to extend elementally internally of the tube A where it is screw threaded at its distal end, as indicated by 12 to form a socket for the incandescent lamp 13. The stem 11 is provided with a central insulated lead 14 which,
together with thestem, completes the circuit for the lamp l3, whichis extended through the connector 14?, the conducting elements of which are indicated by 15 and 16 capable of cooperating in an obvious manner with the complementary socket connector. It is preferred that the length of the stem 11 be such that the electric lamp 13 terminates in a protected position within the distal end 2 of the tube A so that it. cannot contact with the parts under examination or operation. 1
In the structure shown in Figs. 3, 4, 5, 6 and 7 the lamp carrying mounting B is itself provided with a tapered seat 17 similar to the seat 4 of the socket 1. This seat 17 serves to mount the quickly attached and detached lens cap 0, C, C", C', the tapered plug ring portion 18 of each of which caps engages in the seat 17. Y
The cap C is provided preferably with a con cavo-convex window 19, the curvature of both surfaces of which is such as to form a lens of the liquid filling the interior cavity 20 of such refractory power that its focal length approximates the distal end 2 of the tube A, the focus rays being indicated by 21. The cap C of Fig. 4, for use with air dilatation or merely air without dilatation is preferably a plano-convex lens 19', the convex curvature of which is such also as to make its focal point correspond in location approximately with the distal end 2 of-t'he tube A.
The cap C is provided with a window 19" similar to the window 19 but having a perforation 21' preferably central provided with a packing washer or bushing 22 completing an air-tight seal about the shank 23 of the universal tool holder 24. suitable for the manipulation of any suitable operating tool such as the urethrotomy knife 25.
In the cap C' only a fractional lens window 19" is provided, the remainder of the opening in the cap being employed for the manipulation of larger tools such as scissors, pliers. snares and the'like. It is to be understood that the part 19" may be either the concavo-convex window of Fig. 3 or the plano-convex lens of Fig. 4. It is likewise to be understood that a flexible gasket or diaphragm may complete the hydraulic enclosure otherwise provided by the opening 21" of the structure in Fig. 6.
Figs. 9. 10 and 11 illustrate the tube and socket A, 1, structure with a mountingstructure combining within itself the lens means and is particularly an instrument for catheterizing a single duct as, for example, catheterizing an ejaculatory duct, as indicated in Fig. 20. The mounting D comprises the usual tapered flange 10, butthe closure opposite the nd of the duct 8 is only partly transparent, that is, a fractional window 30 is employed, which may be of the type indi-- cated in Figs. 9 and 10 for employment with a liquid medium to complete the lens or which may be of the type in Fig. 6, if desired, where only air is em loyed within the cavity 31. The mounting B mounts a tubular stem 32 extending elementally internally of the tube A and at its proximal end-preferably has a knob 32 to mount a sealing rubber nipple 33 having fluid sealing sliding engagement with the catheter 34, which may be manually pushed through the bore of the stem 32. The distal end of the stem 32 is provided with a hinged trowel-like lip 35 connected by a pair of.eccentrically connecting rods 36 with a rack carriage '37, which meshes with a pinion 38 carried by the stem 39 and operable by the knurled fin ger wheel 40, which may be provided with a position marker 41. A rotation of the wheel 40 controls the position of the lip 35, which in turn, through the resilience of the catheter 34, changes the angular direction of its distal tip 42. An axial manipulation of the tube A bodily moves the tip 42, its rotation gives it a lateral angular adjustment, and the manipulation of the wheel 40 changes its angular direction relatively to the axis of the tube A. It is thus apparent that the tip 42 may readily be manipulated to enter an ejaculatory duct (see Fig. 20) 43, into which it may be thrust the desired distance by pushing in the proximal end of the catheter. It is preferable that the catheter stem 32 run alongside of and be secured to the electric lamp stem 11, which is the same as that described in connection with Fig. 3, etc. It is preferred, however, that the connector 14 for the lamp leads extend out at right angles to the structure instead of at the inclination illustrated in Fig. 3. It is also preferable that-each connecting rod 36 extend through the tube A in a protecting duct 45.
Figs. 15 and 16 and 17 illustrate a. modification of the catheter structure, otherwise like that of Figs. 9, 10 and 11, except that twin catheter ducts 32' and 32" are provided and that the hinged lip simultaneously guiding and deflecting two catheter tips 50 and 51 is of approximately figure 3 contour in cross section. A single connecting rod 52 and the-guide duct 53 connects with the rack carriage operable by the finger wheel 40, the same as in the structure of Figs. 9 and 10. In this structure the electric lamp stem 11 is likewise preferably combined in a similar manner. This structure has the ad.-
vantage of providing for the simultaneouscatheterizing of two ducts such as the two ureters so that simultaneous samples of the its "insertion. The feature of this obturator (ill &
-is that its tip may be swung and fixed in different angular positions by a manipulation f the proximal end of the tube A. A lateral angular position of the tip 60 such as that indicated in Fig. 1 is particularly desirable when an observation or treatment of the prostatic portion of the urethra or the bladder'itsclf is to be had. By this inclination the veru-montana 61 and other natural obstructing parts may he escaped with ease. After the complete insertion of the instrument, as indicated in Fig. 2, the tip 60 may be straightened out so that the entire obturator is readily removable.
In its construction this preferred obturator comprises a tube 63 of a size to fit within the tube A. The hinge 6-1 swingingly mounts the tip 60 which is operated by the connecting rod 65 having pivotal connection 66 with the tip 60. The rod 65 is normally spring pressed outwardly by the compression spring 67 within the socket 68 of the head 69, which presses against the latching thumb piece 70. The thumb piece 70 has a neck 71 adapted to pass into the channel 68 and is provided with a circumferential latching groove 72 into which the flange 7 3 of the catch 74 tends to snap under the tension of the spring 75.
When the catch 74 is released, the spring 67 holds the tip and is capable of forcing the tip into the axially aligned position shown in full lines in Fig. 12. Thumb pressure 9n the thumb piece 70 tilts the tip 60 into the position shown in dotted lines in Fig. 12 and it is there held until released by the catch 74, as indicated in Fig. 13. It is of course to be understood that for less extensive examination and treatment of the urethra, a simple form of obturator may be employed if desired, although of course the obturator described is serviceable for all purposes.
In Fig. 18 there is illustrated a modified urethroscope similar to that of Figs. 3, 4, 5, 6, 7 and 8. except that the tube A is bent better to conform to the natural longitudi nal configuration of the duct in which it is to be employed and its internal walls are reflecting so that the image rays E21 are reflected for purposes of observation by the inner walls of the tube itself.
What we claim and desire to secure by United States Letters Patent is 1. A surgical instrument'for Viewing and operating upon an interior cavity of the body through a natural opening comprising an open-ended tube for insertion through said opening; an incandescent light near the distal endof said tube; magnifying means mountable on the proximal end of said tube and having its focal point located approximately at the distal end of said tube and having its focal axis corresponding with the middle of said tube and completing a closure for the said proximal end of said tube;
means for forcing a transparent fluid adapted to distend said cavity into said tube; and a surgical tool movable at the distal end of said tube within the vision-range of the focus of said lens and having a manipulating part operable outside and at the proximal end of said tube and having a fluid-tight exit connection with said tube but permitting the manipulation of said surgical tool.
2. An instrument for viewing the interior of a body cavity comprising an open-ended tube; an incandescent electric light at the distal end of said tube; means completing an optically curved transparent closure at the proximal end of said tube; and means for filling said tube with a refracting transparent liquid under pressure for distention upon the body part at the distal end of said tube and to cooperate with said closure to complete a liquid lens the focal end of which is located at the distal end of said tube.
3. A urethroscope comprising an openended tube for entering the urethra in combination with a removable obturator itself comprising a shank adapted to pass through and extend out of the distal end of said openended tube and having a tapered, blunt-nosed tip of a cross-section approximating the full inner cross-section of said open-ended tube and having a lateral hinge connection with said shank and adapted to swing into and out of axial alignment therewith: a thrust rod having a hinge connection with said tip and operable from the proximal end of said obturator 'to change and fix the angular position of said tip; and means on said obturator for fixing the longitudinal position of said thrustrod.
4;. An obturator comprising an elongated shank serving as a hinging member; a smooth, tapered, blunt-nosed cylindrical obturator tip having a hinge connection on one side at its rear end with said shank; an adjusting thrust rod having a pivot connection with said obturator tip at its rear end laterally at a distance from said hinge connec tion; and catch mechanism for fixing the longitudinal position of said thrust rod relatively to said shank.
5. In a urethroscope in combination, a separate external tube for entering the urethra, having a socket at its proximal end; a ring member to be mounted in said socket and carrying an electric light stem for traversing said tube so that a light may be mounted on said stem at the distal end of said tube; and lens completing means adapted to be mounted at the proximal end of said tube. whereby said tube may be heat sterilized separately from said stem and whereby said stem may be assembled in fixed relation to said tube after said tube is in position within the urethra.
6. A urethroscope comprising an open ended tube; a lens closure for the proximal lOU end of said tube having an optical curvature such that when said tube is filled with a suitable liquid in inner contact with said lens, the focus of said lens will approximate the distal end of said tube.
7 A urethroscope comprising an open ended tube; a lens completing means for the proximal end of said tube, the focal axis of which corresponds at least approximately -with the axis of said tube, in combination names to this specification, this 11t day of J5 September, 1919.
GEZA'GREENBERG, M. D. WM. A. WINTER.