US 2400251 A
Description (OCR text may contain errors)
May 14, 1946. c. E. NAGEL 2,400,251
'GYNECOLOGICAL INSTRUMENT Filed July 29, 1943 2 Sheets-Sheet 2' Eli ll; [80 ge ail-ii I fla /2s ZI/a 'wazyram ax ATTOR N EYS Patented May 14, 1946 UNITED STATES PATENT OFFICE 6 Claims.
My invention relates to the art of surgery, and has among its object and advantages the provision of an improved gynecological instrument facilitating procedures such as; for example, oiiphorectomy, salpingectomy, hysterectomy, supravaginal, total, and radical with upper third of the vaginal vault.
In the accompanying drawings:
Figure 1 is an elevational view illustrating one mode of procedure in the application of my instrument.
Figure 2 is a face view of the operating plat form.
Figure 3 is a sectional view taken along the line 3-3 of Figure 2.
Figure 4 is a sectional view of one of the uterine stems.
. Figure 5 is a fragmentary View of the instrument handle.
' Figure 6 is an end view of the handle of Figure 5.
Figure '7 is a sectionalview of one type of connection between coacting parts of the instrument.
Figure 8 is a sectional view of another type of connection.
Figure 9 is a plan view of a stand employed for supporting the instrument in accordance with the illustration of Figure 1.
Figure 10 is a sectional view taken along the line Ill-l0 of Figure 9.
Figure 11 is a sectional view of one of the operating platforms showing its detachable connection with the stem structure of the instrument, and
Figure 12 is a sectional view of another form of uterine stern.
In the embodiment selected to illustrate the invention, I make use of an operating platform or cervical cup I4 having a stem 16 provided with a bore l8, as illustrated in Figures 1 and 3., The operating platform [4 is cup-shaped, with its concavity 2|] contoured to fit the cervix"22. At least three different sizes of operating platforms are provided, so that the small normal cervix may be served, as well as those enlargedby various and sundry pathology also. Obviously a large polyp or fibroid of the cervix and extending intra-vaginally must first be removed before the operating platform may be employed.
In the wall 24' of the operating platform is provided a groove 26, the posterior wall 28 of which is somewhat higher than the anterior wall 30, since the posterior cervico-vaginal reflection is higher than the anterior reflection. Also, the
posterior wall 28 is higher than the anterior wall 38 which defines the larger circumference of the concavity 20.
Into the threaded bore 32 of the operating platform is threaded the shank 34 of a uterine stem 36, see Figures 1 and 4. i'his stem is hol- -low and provided with perforations 38, and is fashioned with anannular bead 40 receivable in the counterb-ore 42 in the operating platform. Th bead 4!] acts as a stop for the uterine stem 36 when its shank 34 is threaded into the bore 32, but the counterbore brings the bead flush with the bottom face area of the concavity 2B.
Figure 4 illustrates the uterine stem 35 as having its hollow extending through the shank 3% for communication with the bore [8 in the stem IE, but the other end of the uterine stem is closed and tapers gently to a small rounded point. The uterine stem may be made of several lengths and diameters, all interchangeable with the operating platform.
Figure 1 illustrates the uterine stem 36 in position in the uterus 46. When in position, the uterine stem tends to give fixation to the uterus, and likewise tends to permit the assistant to move the uterus from side to side and otherwise to manipulate same at the direction of the operator. Because of its hollow and perforate design, the uterine stem serves as a suction element, tending in this manner to aspirate the uterine cavity.
According to Figurev l, the stem I6 is connected with a handle 48 through the medium of an elbow 59 bent through an arc of less than a right-angle. Both the handle 48 and the elbow 50 are bored at 52 as a continuation of the bore IS in the stem [6. An adaptor 54 is fashioned at the free end of the handle 48 for connection with suction apparatus (not shown).
One end of the elbow 59 is provided with a threaded. bore 56 into which the threaded shank 58 on the stem [6 is screwed. A similar connection is provided between the other end of the elbow 59 and the handle 58, the threaded shank 60 being fashioned on the elbow for insertion in the threaded bore 62 in the handle, as shown in Figures 1 and 5. Manipulation of the instrument is made easier by a pistol grip 64 on the handle 48.
While no instrument yet made can supplant the ability, ingenuity and intelligence of the man using it, this instrument has for it purpose an or a Byford uterine elevator, and its construction provides the added function of aspiration. Its operating platform I 4 and contained stem 36 gives fixation and relatively easy manipulation of the uterus.
The long handle and curvature of the instrument assures upward pressure tending to elevate the uterus, thus fixing it without the use of intrapelvic instrumentation and giving freedom of action to the operator. It can perform the functions of an intrapelvic uterine elevator without crowding the wound with instruments. In each procedure, the method of hemostasis by ligature, rather than by hemostats is the method of choice.
The operating platform I4 tends to give the less skillful in hysterectomies a guide and artificial landmark, since the outer edge 28 of the platform is easily felt with the guiding finger. It also tends to roll the ureters away from the uterine body and also aids in making both ureters and the uterine arteries more easily palpable to the less skilled operator. In fact in the complete or total hysterectomy, one may with impunity place the knife in the groove after fixing the vaginal wall with guide sutures, and remove the structure with little fear of injuring either the bladder, the rectum, or the ureters.
In the elimination of hemostatic clamps, uterine elevators and retractors, good vision is assured for the operator. It requires only reasonable skill to use and with the patient in Trendelenberg, with the legs properly flexed over the edge of the table, and the viscera carefully packed off from the pelvic structures, the operator is assured of an almost textbook picture of his structures. The assistant manipulates the handle and may thus elevate the uterus and its adnexa into the wound, or positionally change it by various motions of the hand.
For the surgeon who prefers to do pelvic work with the patient not in Trendelenberg position and to assure efficient functioning of the instrument, a light stand 64 is provided, which is placed between the thighs and upon which the elbow 50 of the instrument rests. This stand assures the operator of a fulcrum rest, permitting both leverage and stability.
More specifically, the stand $4 comprises a base $5 having an upstanding post 08 provided with a threaded bore 10 into which a rod 12 is threaded. At the upper end of the rod 12 is provided a ball 14 fitting inside a socket I6 on a curved rest I8 into which the elbow 50 is positioned, as in Figure 1. A loose fit is provided betweenthe ball .14 and the socket I6, so that the rest 18 has universal pivotal connection with the ball, thus providing positional flexibility which permits all necessary manipulation of the instrument.
Figure 12 illustrates a modified uterine stem 80, which is hollow and perforated in the manner of the stem 36, the difference residing in its uniform diameter and unthreaded shank 82. The operating platform 84 of Figure 11 is identical with the platform I4 with the exception of its stem 86, and the shank 82 has a friction fit in the bore 68. A counterbore 90 is provided for the bead 92 on the stem 80.
The stem 86 has a taper 94 frictionally fitting a socket 96 at one end of a stem 98. The other end of the stem 98 is tapered at I00 to frictionally fit a socket I02 at one end of an elbow I04 corresponding to the elbow 50. A taper I06 is formed at the other end of the elbow I04 to be frictionally fitted into a socket of similar taper in a handle (not shown) which otherwise corresponds to the handle 48. All handles and stems are bored in the same manner as the instrument of Figure 1.
Figure 7 illustrates a stem connection wherein the part I08 has a tapered shank II 0 fitting a tapered bore I I2 in the part I I4.
Figure 8 illustrates a stem part IIB having a shank II8 of uniform diameter fitting in a uniform diameter bore I20 in a stem part I22.
The bores in the respective platforms I4 and 84 are such as to permit passage of either a 24F catheter or an operating direct cystoscope of such s1ze.
Without further elaboration, the foregoing will so fully illustrate my invention that others may, by applying current knowledge, readily adapt the same for use under various conditions of service.
1. A gynecological instrument comprising an actuating stem, an operating platform at one end of the stem and having a concavity constituting a cervical cup, a uterine stem attached to the operating platform within the perimeter of said concavity, a detachable connection between said uterine stem and said operating platform, said actuating stem being provided with a grip part, and a bend in said actuating stem between said grip part and said operating platform.
2. The invention described in claim 1 wherein said actuating stem is made up of detachable sections and provided with a connection for suction apparatus.
3. A gynecological instrument, comprising an actuating stem, an operating platform at one end of the stem and having a concavity constituting a cervical cup, a uterine stem attached to the operating platform within the perimeter of said concavity, said actuating stem provided with an axial bore, and said uterine stem having a hollow and perforate construction and having coaxial communication with said bore.
4. A gynecological instrument, comprising an actuating stem, an operating platform at one end of the stem and having a concavity constituting a cervical cup, a uterine stem attached to the operating platform within the perimeter of said concavity, a supporting stand for said stem, and a universal pivotal connection between said stand and said actuating stem.
5. A gynecological instrument, comprising an actuating stem, an operating platform at one end of the stem and having a concavity constituting a cervical cup, a uterine stem attached to the operating platform within the perimeter of said concavity, said actuating stem provided with a bend, and a supporting stand engageable with said bend and having a joint for pivotally supporting the actuating stem.
6. A gynecological instrument, comprising an actuating stem, an operating platform at one end of the stem and having a concavity constituting a cervical cup, a uterine stem attached to the operating platform within the perimeter of said concavity, said actuating stem provided with a bore, and said uterine stem comprising a hollow, perforate structure coaxial with said bore adjacent the operating platform and communicating therewith.
CHARLES E. NAGEL.