US 1612697 A
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4 g l s s l l H. L. CECIL INSTRUMENT FOR REMOVING URETERAL CALCUL-I Filed March 29, 1926 Dec. 28 1926.
ATTORNEY narran` stares rareurorriea HONABD L. CECL, 0F DALLAS, TEXAS.
INSTRUMENT FOR REMOVING RETERAL CALCULI.`
Application led March 29, 1926. Serial No. 98,239.
This invention relates to 'improvements in instruments for removing uretcral ealculi, and in such relates more particularly to the rangement and construction of thereof.
and crushing Connection it novel arthe parts `For a number of years ureteral calculi have been removed by cystoscopic manipulation, but it has been only withi n the last decade that such methods have gained'recognition. The cystoscopic removal of ureteral calculi at the present time consists in dilating the ureter to a suiiicient size to permit the passage of the stone or to render the passage quicker and less painful. ln conjuncection of a local to render the intion with dilatiomthe .j anesthetic is done in order sertion' of instruments less painful dilation is effected,
relax the ureter. AAfter and to oil is frequently injected above the stone to bring' about easier passage thereof. One other method in common use'by the orologist is toenlarge the ureteral meatus by cutting it, either with scissors or by high electric. current.
frequency The' above methods are objectionabley for reasons best known to those of the medical and surgical profession, and being ly impressed with the need of an i thoroughnstrument which-win @mais the above difficulties, ai@ instrument herein described is presented.
A particular obj ect of the invention is that it can be passed by a stone in the as much ease as a catheter of like size,
ureter with the jaws of the instrument being vertically arranged thereby enabling it to grasp a stone with greater ease and facility than with instruments having forceps j aws.
Another objectof the invention is when traction' is made.y the force from above the .stone directly d that exerted is ownward and again when a stone is grasped'the diameter occupied by the stone and instrument 1s very little, if any, greater thanthe stone itself.
A further particular obiect of the invention is that it will crush a stone or remove it A from the ureter land has ample strength to perform this operation.
lVith the above and other and further objects in view, the invention will and more fully understood fro n a be vbetter perusal of the following description, talren in connection with the accompanying drawings and wherein: 1 l
Figure l 1s an elevational v1 ew of the assembled instrument comprising the invention. shown partly in section.
1ligure 2 is an enlarged detailed sectional view of a wing nut for crushing and holding the stone, also illustrating the upper party of the handle of the instrument.
Figure 3 is also an enlarged detailed sec-- tional view of the two jaws of the instrument Vand illustrating the manner of grasping and holding a stone. K
Figure e is a cross-sectional view along line lf-4 of Figure 3 and illustrating the means employed to lock the wire in the instrument jaws. l f
Figure 5 is a cross-sectional view on line 5-5 of Figure l, the view being enlarged.
Figure 6 is a cross-sectional view on line 6-5 of Figure 2.
Figure 7 is a detailed sectional view of a modified form of the device for manipulating the jaws; andA Figure 8 illustrates an enlarged detailed view of the two jaws of the instrument showing their position when moved apart to `grasp a stone, and also indicating amodiication of the instrument.
Proceeding in accordance with the drawings and-wherein numerals are employed .to designate the various parts of the invention, a sleeve is shown at l provided with rings 2 throughwhich the index and middle fingers of the hand areA inserted and forming one portion of the handle. To the lower end of the sleeve l is secureda exible tubing 3. This tubing is made of wound steel wire such as is used lin cysto-scopic forceps, etc. The upper part of the handle 5 is so constructed and arranged las to move within t-he sleeve l, clearly illustrated in Figure l. This portionof the handle has alsoa ring 6 adapted for engagement with the thumb of the 'hand in manipulating the jaws. lt will beV observed that one side of the handle or shaft 5 is flattened and provides a scale to ascertain how far the aws are separated and also to prevent its turning'in the sleeve l. lt is self-evident that when a stone is grasped between the spaced parts of the wire it is vvery important that some means be provided to ascertain the distance the jaws are to be moved apart, the size of the stone having been previously determined. lf one portionY of the handle is allowed to rotate within the other the parts of the instrument may become unscrewe'd. While this is not so apt to occur, such possible turning of one porl varied, and other suitable means employed to prevent telescoping.
The jaw 8, as will be observed in Figure 3, has a partially hollow interior, and after entering the jaw the wires 7 are spaced apart by a spacer element 10. The terminal jaw 11 is also hollowed and has a lug 12 around which the wires are passed, or the wires separated and attached thereto, to hold them inthe outer jaw. These two jaws are opened and closed by manipulation of the sleeve 1, this being accomplished by means of the steel wires 7, traversing' the instrument. These wires, after being passed over the lug or attached thereto are secured firmly at their opposite upper ends to the upper end of the shaft 5 by a set screw 5a.
Referring to Figure 3, it will be noticed that there is afxed to the terminal jaw 11 a guide member 14, constructed of the same material and of the same formation as the tubing 3. This flexible guide serves the purpose of guiding the instrument by the stone 16, and also prevents the terminal jaw 11 from turning sideways or at too great an angle, at the time of crushing the stone. The guide 14 has also a shoulder 13a.
Again referring to Figure 1, the shaft 5 is threaded from end to end as indicated at 17, with the exception of the flat portion comprising the scale, previously mentioned. This is for the purpose of enabling a wing nut 18 to be advanced along the shaft to hold a stone after it has been grasped and to provide for fine adjustments. The wing nut is also for the purpose of crushing a stone after it has been engaged.
In Figures 7 and 8 are shown modifications of the instrument. In this instance there is provided a second wire 19 fastened to a lever 20, )ivoted adjacent the upper ring 6. This second wire traverses the instrument in the same manner as the single or divided wirev 7 and is securely fastened to the terminal jaw 11, passing through the lug` 10. Thus movement of the lever 20 downward will pull wire. 19 upward and cause the strands of wire 7 to assume the position shown by dotted lines in Figure 8, thus spreading them to receive a stone.
In the operation of the instrument, in the removal of a stone, the instrument (closed) is passed through a cystoscope, into the ureter and above the stone. After the instrument is above the stone the jaws are opened and the instrument moved outwardly until the proximal jaw is felt to pass the stone. The stone then lies between the two jaws. The jaws are closed, engaging the stone. This is accurately determined by the scale on the handle of the instrument. Traction is again made on tie instrument to remove the stone. lf this is found impossible, the stone is crushed with the wing tap on the handle. The instrument is then removed. The fragments of the crushed stone will easily pass later.
From the foregoing it will be evident that traction on a stone can be exerted equal to the strength of the steel wire traversing t-he entire length of the instrument. t is also apparent that such a force would never be necessary to extract a stone from Vthe ureter. To crush a stone a compression force can be exerted equal to the weakest point from the proximal jaw to the sleeve handle; or a tensile force equal to pull the steel lug from the terminal jaw, to pull the wire from the set screw, or to breal; the wires. i
It is obvious that further modifications and changes may be made in the invention in keeping with and within the scope and meaning of the following claims:
1. An instrument for removing ureteral calculi, comprising' a handle including a shaft and a tubular element, a flexible tube secured to the tubular element, a proximal jaw and a terminal jaw secured to the outer end of the flexible tube, Hexible wires traversing the tubular element and flexible tube, the outer ends of the wires being attached to said terminal jaw of the instrument, means for moving the jaws to and from each other to spread the wires apart between the jaws in grasping the object to be removed, means for adjusting and holding the jaws in a'djustable position, and a guide on the terminal jaw said proximal jaw including a spacer element for moving the wires apart or movement of the jaws.
2. An instrument for removing and crushing ureteral calculi, said instrument having a handle including a shaft and a tubular element, a flexible, metallic, elongated tube secured to one end of the tubular element, and flexible wires traversing said flexible tube; a terminal jaw, a. proximal jaw secured to the outer end of the flexible tube, said wires traversing said jaw, and secured to the ter-,120 minal jaw a flexible guide attached to the terminal jaw; said jaws adapted to be moved to and from each other by manipulation of said handle, to spread the wires apart between the jaws, the object to be removed being caught between the wires in their spread position between the jaws said proximal jaw including a spacer element for moving the wires apart on movement of the jaws.
8. An instrument for removing and crush- 139 ing ureteral calculi, which comprises a 'flexible, elongated, metallic tube having ilexible wires passed through the tube; a handle, including` a threaded shaft having a scale, with a linger-engaging member, an element movable on said shaft to hold the jaws in set position, a tubular element, including a finger-engaging element and through which the shaft reciprocates; said flexible tube connected at one end to the lower portion of said tubular element, a proximal jaw secured to the outer end of said `flexible tube and a terminal jaw fastened to said wires; said wires, on reciprocation of the handle and shaft in the tubular element being spread apart between the jaws to grasp the Object between the wires said proximal jaw including a spaced element for moving the wires apart on movement of the jaws.
4. An 'instrument of the character described in claim 1, and wherein said shaft has a wing nut adapted to be advanced upon the shaft to hold the jaws and grasped stone in position between said parts of the wires and for crushing said stone.
5. An instrument as set forth in claim l, and wherein the ends of the wires are secured to the upper end of said shaft and wherein said proximal j aw, and said tubular element have means for preventing said flexible tube from telescoping into said element t0 prevent jamming and catching of the parts.
6. AAn instrument Yfor removing ureteral calculi which comprises a handle, including a threaded shaft and a tubular element, a flexible metallic tube secured to said tubular element, a plurality oi' wires traversing the handle and tube, a proximal jaw secured to the tube and a terminal jaw secured to the wires, a lever adjacent the handle for pulling the terminal jaw towards the proximal jaw to spread the wires apar. to engage a stone; means for fastening the wires to the handle, and a wing nut adapted to be advanced upon tlie threaded shaft to bring the wires together to crush a stone, and a iiexible `guide secured to the terminal jaw said proximal jaw including a spacer element for moving the wires apart on movement of the jaws.
In testimony whereot1 I atyix my signature.
HOVARD L. CECIL.