US 2708437 A
Description (OCR text may contain errors)
May 17, 1955 s, P. R. HUTCHINS SURGICAL INSTRUMENT 4 Sheets-Sheet 1 Filed March 31, 1952 Je/wyn ER. Hutch/rm INVENTOR BY/ j wl/ A TTORNE Y6 S. P. R. HUTCHINS SURGICAL INSTRUMENT May 17, 1955 4 Sheets-Sheet 2 Filed March 31, 1952 y 7, 1955 s. P. R. HUTCHINS 2,708,437
SURGICAL INSTRUMENT Filed March 31, 1952.
4 Sheets-Sheet 3 Je/Wyr/ F. R. //u ch/rm IN V EN TOR.
sylg g Z W ATTORNEYS M y 7, 1955 s. P. R. HUTCHINS SURGICAL INSTRUMENT 4 Sheets-Sheet 4 Filed March 31, 1952 SURGICAL IN STRUIVIENT Selwyn P. R. Hutchins, Houston, Tex., assignor to Elizabeth Painter Hutchins, Houston, Tex.
Application March 31, 1952, Serial No. 279,605 13 Claims. (Ci. 128-7) This invention relates to endoscopic surgical instruments used for examination and surgery within cavities of the human body. While the preferred form of the instrument described and shown in this application is designed primarily for transurethral prostatic surgery, it is readily adaptable to other uses and is not limited to that specific purpose.
It is an object of this invention to provide an endoscopic surgical instrument of the cold punch type which provides a more positive cutting action and which is easier to employ than similar instruments now in use.
Another object of this invention is to provide an instrument of this type which will cut, as distinguished from shear, substantially all of a tissue protruding through a fenestra in the instrument.
Another object is to provide an instrument of this type wherein resection of the desired tissue is effected by a rotating knife moving across a fenestra through which said tissue protrudes, such resection leaving an even bed of tissue facilitating more effective hemostasis and reducing the amount of prying to keep tissue engaged between the fenestra periphery and the knife.
Another object is to provide a surgical instrument of this type which can readily be manipulated with one hand leaving the other free, as for example in prostatic surgery, for rectal palpation and third dimensional perception.
Another object is to provide an improved instrument of this type wherein irrigating fluid is introduced close to the eyepiece in order to reduce the time for removal of bloody fluid from the region of the eyepiece after draining the biadder or other body cavity of irrigating fiuid and resected tissue.
Another object is to provide an improved instrument of this type which is adapted to be rotated so as to position the fenestra opposite any selected portion of the lateral circumference of a passage into which the instrument is inserted, the instrument being so constructed and arranged to permit such rotation without necessitating a change in the stance or operating grasp of the doctor manipulating the instrument.
Another object of this invention is to provide an in strument of this type so constructed and arranged as to permit rapid assembly and disassembly for cleaning purposes or for interchange of parts and one which can be assembled without use of tools.
Other objects, advantages and features of this invention will be apparent to one skilled in the art upon the consideration of the written specification, the appended claims, and the attached drawings wherein:
Fig. 1 is a general perspective view of a preferred embodiment of the instrument of this invention showing it assembled;
Figs. 2 and 3 are isometric views, partially in section, illustrating the mode of actuation of the cutting blade of this instrument;
Figs. 4 and 4a illustrate the positioning of the parts of the instrument after the blade has been retracted and just before a resection is made;
Figs. 5 and 5a are similar to Figs. 4 and 4a respectively except they show the cutting blade in the advanced position it occupies while an observation is made therethrough;
23%,437 Patented May 17, 1955 Fig. 6 is a view taken on line 6-6 of Fig. 5;
Fig. 7 is a view taken on line 7-7 of Fig. 5;
Fig. 8 is a view taken on line 3-8 of Fig. 5; and
Fig. 9 illustrates a type of wrench useful for changing the cutting blade of the instrument of this invention.
Like characters of reference are used throughout the several views to designate like parts.
A particular feature of this invention lies in the provision of an instrument having an outer fenestrated tube in association with an annular knife which, in operation, has its cutting edge moved both longitudinally and laterally across the fenestra. To accomplish this purpose, there is provided a novel means for moving the knife rotatively simultaneous with longitudinal movement thereof. As an additional feature of this invention, an improved means is provided for supplying irrigating fluid to the instrument so that such fluid will wash the instrument free from bloody material tending to obstruct vision along the entire path of vision through the instrument.
Referring now to the drawings, the instrument comprises an outer tube 10 having a smooth outer surface so that it is adapted to be inserted into the body passage in which the resection is to be made. The outer tube has a fenestra 11 situated near one end thereof. Disposed within passage 12 in the outer tube and adjacent fenestra 11 is an annular knife 13 having a circular cutting edge 14. Preferably, annular knife 13 is of such outer diameter that it provides a snug fit in passage 12 and cutting edge 14 is disposed along the outer periphery of the knife so that as the knife edge passes the fenestra, the tissue protruding into the fenestra will be cut away even with the inner surface of passage 12. Knife 13 is carried at one end of an inner tube 15 and preferably has a threaded connection 16 therewith as illustrated in Fig. 9. Such connection permits rapid and easy changing of the knives on tube 15. For this purpose, as illustrated in Fig. 9, a short section of rubber tubing 17 can be slid over the knife and grasped by a spring type Wrench 18 having a semi-circular portion 19 and handles extending therefrom permitting the Wrench to tightly grasp rubber tube 17 and thereby turn the knife from tube 15 without injury of the knife.
Outer tube 10 has a driving element 20 mounted for reciprocation with respect thereto for a purpose to be made more apparent hereinafter. Driving element 20 can be mounted upon an annular tubular part 21 which is connected to tube 10 by thread 22 and can be considered a part of tube 10. Tubular part 21 has a smooth surface portion 23 extending past thread 22 toward tube 10 and having a close fit within the latter to increase the rigidity of the connection between part 21 and tube 10. Tubular part 21 has an increased diameter portion 24 formed with longitudinal grooves 25 and 26 adapted to slidably receive inturned keys 27 and 28 carried by driving element 20. In this manner, there are provided slide and guide parts between driving element 20 and tubular part 21. Thence, upon longitudinal movement of driving element 20 with respect to tube 10, the driving element is not permitted to rotate with respect to the tube but can only move in a longitudinal direction.
An actuating means is provided for simultaneously rotating knife 13 and moving it along fenestra 11 in a longitudinal direction. Such means includes not only driving element 20 but also a means connecting this element with the knife for translating movement of the driving element into simultaneous rotative and longitudinal movement of the knife. Such connecting means can comprise an elongate member 29 fixed with respect to inner tube 15 and having a spirally shaped portion such as spiral grooves 30 disposed along its length. A pin member 31 is carried by tubular part 21, and hence by tube 10, in such a manner as to extend into groove 30 and engage the same so that upon movement of tube and elongate member 29 past the pin in a longitudinal direction, tube 15 and knife 13 are rotated about their axes. To provide for longitudinal driving of the tube 35 and knife 13, a driving bar 32 is carried by and as a part of driving element and has a connection with tube 15 to pull it forwardly with forward movement of the driving element. The driving bar extends through tubular part 21 by means of slots 33 and 34. Its connection with tube 15 can comprise suitable anti-friction elements such as roller bearing assembly 35 abutting against elongate member 29. The normal functioning of this bearing assembly 35 is that the race abutting the driving bar 32 receives driving force from the bar but does not rotate with respect thereto. The race abutting the elongate member 29 normally rotates with the member 29, he balls of assembly 35 allowing substantially frictionless relative rotation between the bearing races. Means for biasing tube 15 and knife 13 in a direction away from fenestra 11 can comprise a spring 36 having one end abutting suitable anti-friction elements such as roller bearing assembly 37 and the other end abutting an inturned shoulder 35 on tubular part Zll. The roller bearing assembly 37 normally functions in substantially the same manner as bearing assembly 35, the race abutting the elongate member 29 rotating therewith and the race abutting the spring 36 remaining substantially fixed with respect to the spring 36 which normally does not rotate. An annular part 39 can be carried by tube 15 on the side of driving bar 32 opposite from elongate element 29 to permit tube 15 to be manually retracted away from the fenestra should spring 36 fail to function as desired. Annular part 39 can be maintained in proper relationship with the driving bar by a small snap ring 39a situated in groove 3%. It will be noted sufiicient space is left between annular part 39 and driving bar 32 to permit the annular part to be slid toward the driving bar for removal of the snap ring. It will also be noted that annular part 39 has an endwise facing shoulder extending over the snap ring and having a snug fit therewith to prevent dislocation of the snap ring from its shallow groove upon the application of manual force to the driving element to pull tube 15 away from the fenestra. In this manner, an easily removable, locked-in-place shoulder is provided on tube 15 for abutment with driving element 20 to retract knife 13.
With the apparatus as thus far described, it will be apparent that spring 36 will bias knife 13 to one side of fenestra 11 as shown in Fig. 4a when driving element 20 is released. However, upon movement of driving element 20 towards fenestra 11, driving bar 32 will engage roller bearing assembly 35 and urge tube 15 and knife 13 toward the fenestra. Simultaneously elongate element 29 will be rotated, thereby causing rotation of tube 15 and knife 13, by spiral groove 39 moving along fixed pin 31. In this manner, knife 13 is moved longitudinally across fenestra 11 and simultaneously is rotated so that any tissue protruding into tube It through the fenestra is actually cut, as distinguished from sheared, by knife edge 14.
Tube 10 can be provided with a hand held in the form of an annular outwardly extending flange 4t) and driving element 20 can be provided with a similar flange 41 thereby permitting the surgeon to grasp these flanges in one hand, if desired, and move driving element 21 with respect to tube It). These flanges also permit the surgeon to readily rotate the instrument without changing his stance or altering the manner in which he grips the instrument.
An extension 42 of tube 19 is connected by means of thread 43 to tubular part 21 to which it can be locked by screw 43a and has a passage 44 extending therethrough into which tube 15 can be received and reciprocated. Extension 42 is provided with an internal endwise boss 45 fitting snugly around tube 15 and having a packing cap 46 with a packing 47 disposed therein adapted to form a seal with the outer periphery of tube 15. In this manner, a sliding seal is provided between extension 42 and tube 15 permitting the passage of fluid from passage 44 and extension 42 through tube 15 and then on out through tube It}, or vice versa, as will be more fully described hereinafter. A spacer 46a is clamped between the end of part 21 and extension 42 and has outwardly extending legs b adapted to prevent driving bar 32, part 39 or ring 39a from striking cap 46.
An eyepiece 48 is connected to extension 42 by means of a bayonet joint including groove 49 in extension 42 and a pin 50 carried by the eyepiece. Eyepiece 48 has a passage 51 therethrough coinciding with passage 44 and having its outer end closed off by suitable lens 52. Disposed immediately adjacent to and outwardly from the lens is an annular passage 53 having communication through inlet 54 with passage 51. Inlet 54 is positioned so as to be in the upper portion of the eyepiece and passage 51 when the instrument is in its normal operating position. In this manner, any air which may be entrapped adjacent lens 52 will flow out of passage 51 into annular passage 53 and be removed from the instrument thereby greatly facilitating the observation through the instrument.
Completing the endoscopic tube is an upturned portion 55 on the end of tube 10. Portion 55 contains a light source such as bulb 56 which is connected to a source of el ctric current through post 57 and wires 58 which, it will be understood, extend to the light bulb. In this manner, a surgeon can insert the instrument into a body cavity and then, after turning on light bulb 56, observe the cavity by looking through lens 52 down through passages 51, 54 and through tube 15 into passage 12. It will be noted that the end of tube 10 is mitered as at 59 to facilitate placement of tissue for this observation.
Means are provided for introducing irrigating fluid into the instrument in order to wash out bloody fluid or pieces of tissue from its interior. Such means can comprise a fluid inlet conduit 60 situated adjacent eyepiece 48 and between the eyepiece and the driving element so as to have communication with passage 44 and tube 15. A major portion of fluid flowing inwardly through this inlet conduit will flow through tube 15 and cut through passage 12 and a minor portion will pass in an opposite direction through passage 51, inlet 54 and annular passage 53 to clear the eyepiece of bloody fluid and the like. The fluid passing out of the eyepiece can be drained from annular passage 53 by a suitable iluid outlet connection 61 having a valve 62 therein.
A fluid outlet is provided from the instrument to be employed to drain the bladder and remove tissue pieces therefrom. Such outlet can comprise a fluid outlet conduit 63 having a valve 54 therein. The junction between conduit 63 and extension 42 is enlarged by providing a sloping wall connection 65 on the side of the conduit adjacent the fenestra. With such construction, any tissue being removed through the instrument will not be likely to become lodged within the instrument since a considerably larger area is provided through which the tissue can fall into conduit 63 than would be the case were wall 65 vertical.
To complete the instrument, a fulgurating electrode connection 66 is provided permitting an electrode 67 to be pushed through passage 63 in tube 10 and thence outwardly through mitered end 59 into contact with the bed of raw tissue for facilitating hemostasis.
In the operation of this instrument, a fluid supply tube 69, containing a suitable flow control valve if demaking connection between a suitable electric source and bulb 56, the instrument can be inserted into the body passage where the resection is to be made, such insertion being with driving element 2% advancedto its Figs. 5-5A position. The tissue which it is desired to remove can be located by observing through lens 52, passages 51 and 44, tube 15 and passage 12 to locate the tissue immediately in front of tube at the miter-ed end thereof. After the tissue has been located and the instrument oriented both longitudinally and rotatively, the instrir ment can be then advanced sufficientiy so that the ob served tissue is positioned opposite fenesira 11 (the knife still in its Figs. 5-5A position). Then, the surgeon permits spring 36 to push element 29 and knife 14 to the Pigs. 4'4A position thereby opening the fenestra to permit tissue to protrude into it. After the tissue has been positioned within the fenestrn driving element 20 is pulled towards flange 4'3 and tube li causing driving bar 32 to move tube longitudinally while pin 31 coacts with elongate element 2? to cause simultaneous rotation of the tube. This simultaneous longitudinal movement and rotation moves knife edge 14 of knife 13 longitudinally along fenestra 11 and rotates it thereby. As a result, substantially all tissue protruding into passage 12 through fenestra 11 is cut away and very little if any will be pushed out of passage 1'2. through fenestra 11 back into the bed of tissue being resected. This permits very accurate resections to be made, and it is ordinarily not necessary to operate knife 13 several times in order to be sure to cut away all the tissue which originally extended through fenestra 11. When the tissue has been severed, fluid flows through conduit 60, passage 44-, tube 15 and out through passage 12 to remove any blood or tissue from within tube 15 and passage 12. Further observations can then be taken. After a new cut has been positioned opposite the fenestra as above described, release of driving element permits spring 36 to move the driving element, tube 15 and the connecting parts therebetween to the rear of the instrument.
After the resection has been completed, electrode 67 can be pushed through passage 68 and out into contact with the bed of cut tissue remaining in the body passage to provide an effective hemostasis in a manner well known to those skilled in the art.
From the foregoing it will be seen that this invention is one well adapted to retain all of the ends and objects hereinabove set forth, together with other advantages which are obvious and which are inherent to the structure.
It will be understood that certain features and subcornbinations are of utility and may be employed Without reference to other features and subcombinations. This is contemplated by and is within the scope of the claims.
As many possible embodiments may be made of tlr: invention without departing from the scope thereof, it is to be understood that all matter herein set forth or shown in the accompanying drawings is to be interpreted as illustrative and not in a limiting sense.
The invention having been described, what is claimed is:
1. In a surgical instrument, a tube having a lateral fenestra, an annular knife arranged for rotary and longitudinal movement within said tube, and actuating means for simultaneously rotating said knife and moving it longitudinally along said fenestra.
2. The instrument of claim 1 wherein said actuating means includes a second tube disposed within the firstnamed tube, said knife being carried at the end of said second tube.
3. The instrument of claim 1 wherein said actuating means includes a driving element movable relative to said tube and means connecting said element with said knife and said tube with said knife for translating movement of said element with respect to said tube into 6 simultaneous rotative and longitudinal movement of said knife.
4. In a surgical instrument, a first tube having 3. lateral fenestra, a second tube rotatable and reciprocal within said first tube, an annular knife carried by said second tube adjacent said fcnestra, a driving element mounted for longitudinal movement relative to said first tube, and means connecting said driving element, first tube, and second tube for rotation and longitudinal movement of the second tube upon longitudinal movement of the driving clement whereby said knife can be rotated while moving longitudinally across said fenestra.
5. The instrument of claim 4 wherein said connecting means comprises an elongate member having a spirally shaped portion and a pin member engaging said portion, said elongate member and said pin member being carried by said first and second tubes, and a connection between said driving element and said second tube limiting longitudinal movement but permitting rotation therebetween.
6. The instrument of claim 4 in combination with means for introducing an irrigating fluid into said instrument for passage internally of said first tube, and an eyepiece carried by an extension of said first tube to permit observation through said second tube in the direction of said fenestra, said means for introducing fluid comprising a fluid conduit adjacent said eyepiece and connected to introduce fluid into said second tube and into said eyepiece.
7. The instrument of claim 5 in combination with means biasing said second tube away from said fenestra to retract said knife after it has been moved across said fenestra.
8. The instrument of claim 7 in combination with slide and guide parts connecting said driving element and said first tube to prevent relative rotation therebetween.
9. In a surgical instrument, a first tube having :1 lateral fenestra, a second tube arranged for rotary and longitudinal movement within said first tube, an annular knife carried at the end of said second tube adjacent said fenestra, a driving element reciprocal with respect to said first tube, an elongate member carried by said second tube and having a spirally arranged element thereon, a pin member carried by said first tube and extending to engage said spiral element, a driving bar connecting between the driving elcrnent and said second tube to move the latter longitudinally with the driving element and means biasing said second tube away from said fenestra, whereby upon movement of said driving element toward said fenestra the second tube will simultaneously rotate and longitudinally move said knife across said fenestra.
10. The instrument of claim 9 in combination with slide and guide parts between the driving element and said first tube preventing relative rotation therebetween.
11. The instrument of claim 9 in combination with an eyepiece carried by an extension of said first tube to permit observation through said second tube in the direction of said fencstra, and a fluid inlet conduit adjacent said eyepiece and connected to introduce fluid into said second tube and into said eyepiece.
12. The instrument of claim 11 in combination with a fluid outlet conduit adjacent said eyepiece and connected to receive flow from said second tube.
13. The instrument of claim 12 wherein said eyepiece has an opening immediately adjacent a lens in said eyepiece, said opening being situated in the upper portion of the eyepiece when the latter is in its normal operating position.
References (Iitcd in the file of this patent UNITED STATES PATENTS 1,677,209 Rose July 17, 1928 2,279,714 Meyerhof Apr. 14, 1942 2,312,933 Seiders Mar. 2, 1943 2,484,059 Wallace Oct. 11, 1949