US 3035582 A
Description (OCR text may contain errors)
H. W. SEIGER MULTIPLE FORCEPS TISSUE HOLDING INSTRUMENT Filed Oct. 16, 1959 May 22, 1962 3 Sheets-Sheet l INVENTOR. [La/9m WJE/GEH May 22, 1962 H. w. SEIGER MULTIPLE FORCEPS TISSUE HOLDING INSTRUMENT Filed Oct. 16, 1959 5 Sheets-Sheet 2 W \N Q a: 1 i w Q Q \N INVENTOR. HARRY PM 15/650 ATTORNEY y 2, 1962 H. w. SEIGER 3,035,582
MULTIPLE FORCEPS TISSUE HOLDING INSTRUMENT Filed Oct. 16, 1959 5 Sheets-Sheet 3 INVENTOR. H400) WJE/GEH Arm/war United States Patent Office 3,035,582 Patented May 22, 1962 3,035,582 MULTIPLE FORCEPS TISSUE HOLDING INSTRUMENT Harry Wright Seiger, 520 Arizona Ave., Santa Monica, Calif. Filed Oct. 16, 1959, Ser. No. 847,012 3 Claims. (Cl. 128-321) This application is in part a continuation of my pending application Serial No. 712,939 filed February 3, 1958, for Holder for Tenacula, now Patent No. 2,977,958.
This invention relates broadly to surgical holding instruments and more particularly to a holding device for securing at least two forceps in a predetermined orientation with respect to each other to enable manipulation of of the forceps simultaneously with one hand, and which will be self-retaining when required. The invention contemplates the use of ring forceps, tenacula or other types of forceps.
Many types of surgical operations require the use of forceps for holding tissue or organs in a convenient position during the surgery. For example, in cold coning of the cervix, two or three single pronged tenacula are circum-ferentially imbedded in the cervix about the cervical s and the cervix itself pulled outwardly and sufiiciently stretched to enable the surgeon to efiect the cold coning. For an operation of this type, the manipulation of the tenacula requires the presence of the surgeon and one nurse or assistant.
Bearing the above in mind, it is a primary object of the present invention to provide a mechanical holding device which will enable the manipulation of more than one forceps by the use of only one hand whereby the surgeon himself may properly stretch and position the cervix or other tissue or organ upon which surgery is to take place and the need for one nurse or assistant is eliminated.
More particularly, it is an object to provide a holding device of the above type which will properly orient and position two or more forceps at a desired relative spatial position with respect to each other to facilitate a cold coning or other operation in the uterine cervical region.
Still another object is to provide a holding device for forceps which will enable each of the forceps to be relatively free for attachment to the tissue to be held and yet which will also permit the simultaneous manipulation of the forceps with one hand, and when necessary will be selfretaining so that both hands are free for the surgery.
Another object is to provide a holder for forceps which may be adjusted and secured in different positions so that the forceps may be accommodated to different sized organs and for different types of operations. For example, in vaginal hysterectomy or plastic surgery such as cystocele repair of urethrocele repair, or tubal etc., one tenaculum will frequently tear through the tissue or hold the cervix at an undesirable angle whereas two or more tenacula will act to self-retain their hold on the cervix and at the same time hold the cervix in line for necessary surgery. Also, ring forceps will be self-retaining and will hold the post partum cervix for necessary suturing.
These and many other objects and advantages of this invention are attained, briefly, by providing a pair of holding arms coupled together at first adjacent ends and terminating at their other ends in diverging portions connected to suitable forceps. The coupling means at the first pair of adjacent ends may comprise a pivot pin for pivotally connecting the arms for movemet about an axis normal to a plane including the arms.
An adjustable connector is spaced from the pivot coupling the holder arms and extends transversely of the arms to secure them at any predetermined position apart. The forceps themselves may comprise simple hooks or single pronged scissor types. They may be secured to the ends of the diverging portions of the arms through a suitable coupling such as a pivot for rotative movement about an axis transverse to the arm-coupled pivot. By this arrangement, the forceps may be easily manipulated for initial insertion or imbedding in the tissue, and for spreading the tissue after attachment of the forceps there- The invention is particularly characterized by the com bination of a holder with a pair of opposed forceps having jaws adapted to be clamped against opposed areas of tissue in a manner to provide a fixed, or non-slipping (i.e. non-releasing or non-extensible) attachment between the ends of the forceps and the tissue, which becomes effective to spread the opposed tissue areas apart as the forceps are manipulated by the holder to effect a spreading action between the forceps.
A further object of the invention is to provide a surgical instrument embodying a holder having spreading arms and a pair of forceps pivotally attached to the spread ends of the arms in a relationship such that the forceps may extend from their pivot points diagonally with respect to the plane of the arms and toward one another at a relatively fiat angle to a vertex point where they may be attached to an organ or a piece of tissue to be spread. The invention provides for a primary spreading action upon the tissue, accomplished by adjusting the relative spacing of the holder arms.
A characteristic of the arrangement of parts in my instrument, which provides an unintended or incidental characteristic of operation, is one wherein the relationship between the plane of the holder arms, the axes of the pivots attaching the forceps to the ends of the arms, the normal spacing of the pivot points, and the length of the forceps with relation thereto, is such that by shifting the holder after the forceps have been attached to the tissue, a minor amount of additional spreading action will be exerted between the jaws of the forceps. The present invention minimizes this incidental characteristic by arranging for a spreading diver ence between the pivots.
joining the forceps to the holder, in the normal range of adjustment of the holder arms. In this connection, a general object of the invention is to provide an instrument which can be manipulated to either side of a median operative field or area without detaching the forceps from the tissue or changing the adjustment of the holder arms, and with only a minimum variation in the degree of spread being exerted against the tissue.
Further objects are to provide, in a surgical instrument of the type outlined above, improvements in means for securing the holder arms in various positions of spreading adjustment; improvements in the arrangement and construction of pivots connecting the tenacula to the holder arms, and other improvements which will be more fully identified in the ensuing specifications.
Gther objects and advantages will become apparent in the ensuing specification and appended drawing in which:
FIG. 1 is a plan view of a surgical instrument embodying my invention;
FIG. 2 is a fragmentary end view of the joint between the holder arms thereof;
FIG. 3 is a detail sectional view of the arm adjustment lock, taken on the line 33 of FIG. 1;
FIG. 4 is a fragmentary detail sectional view of a modified form of the arm adjustment lock;
FIG. 5 is a sectional view of the modified form shown in FIG. 4 taken on the line 5-5 of FIG. 4;
FIG. 6 is a front end View of the instrument shown in FIG. 1;
FIG. 7 is a fragmentary plan view of a surgical instrument embodying another form of the invention;
FIG. 8 is a fragmentary front end view of the same;
I 3 FIG. 9 is a fragmentary plan view of an instrument embodying a further modified form of the invention;
FIG. 10 is a fragmentary front end view of the same; and
FIG. 11 is a fragmentary plan view of another modified form of the invention.
General Description of Invention as Embodied in FIG. 1
Referring now to the drawings in detail, and in particular to FIGS. 1, 2 and 6, I have shown therein, as an example of one form in which the invention may be embodied, a surgical instrument embodying, in general, a holder A and a pair of forceps B pivotally attached to the holder A for manipulation in spreading a body organ such as a cervix, or opposed tissues such as the sides of an incision, etc. The forceps B in themselves may be of a known type having jaws 19 formed as extensions of arms 11 which are pivoted together at 12 and may terminate in loop handles 13, 13 and be provided with ratchet toothed coupling fingers 14 for holding the jaws 10 in clamped attachment to respective areas of tissue. The jaws 10 may be of the tenaculum (pointed) type as shown in FIG. 1, or may be of the loop or alligator-jaw types hereinafter described in other embodiments of the invention. Each of the forceps has one of its handles 13' attached by means of a pivot 15 to a boss 16 on the end of a respective one of two spreading terminal arms 17 of the holder A.
The holder A further includes a pair of handle arms 18, 19 which are hinged to one another at one end of the instrument by means of a clevis type hinge 20 shown in detail in FIG. 2. Thus the spacing between the forceps pivots 15 at the ends of terminal arms 17 may be varied. Adjustable connector means is provided for securing the arms in the selected spacing. Such means may take various form, such as the means shown in my earlier pending application referred to above, or may embody an arcuate sector 21 having one end attached to handle arm 18 by a pivot 22 in a slot 23 in an enlargement portion 24 of arm 18. The sector 21 has its other end portion provided with teeth 25 along one margin thereof, and this end portion is extended through a slot 26 in an enlargement 27 of arm 19. A lock screw 28 is threaded through one cheek of the enlargement 27,
and has a conical point 29. adapted to be pressure-engaged in a notch between any selected pair of teeth 25 to securely lock the arms of the holder A in any selected position of spreading adjustment.
The terminal arms 17 are formed as integral extensions of handie arms 18, 19 and are joined thereto by elbow bends 30 and, in a normal position of spreading adjustment of the holder A, as shown for example in FIG. 1, will project almost directly away from one another, while the handle arms 18, 19 are in sufficiently Lclosely spaced relation to one another to be used by the surgeon conjointly as a handle for manipulating the instrument.
Referring now to FIGS. 1 and 6, which show the ini strument adjusted to the same degree of spread and with the same angle of pivotal inclination of the forceps B about'their pivots 15 with respect to the plane of holder A, it will be apparent that at this adjustment of spread, the opposing jaws 10 of the respective forceps ;B, swinging in the paths indicated by the arrows 31,
can be brought nearly together in the planeof holder A and, when inclined at the relatively fiat angle 32 subtended between them as indicated at 32 in FIG. 6, they will be at approximately the correct spacing for engaging the Sides of a normal cervix. The angle 32 is very nearly the maximum angle (most fiat) at which the instrument can be used most satisfactorily. By adjusting handle arms 18, 19 to closer spacing the forceps, when positioned with their jaw ends 10 in adjacency for initial attachment to tissues to be spread, will subtend between themanangle 32 that is more acute than the angle 32 of FIG. 6. The position of adjustment shown in FIG.
6 accordingly represents one satisfactory position of adjustment of the arms 17 toward one another in preparation for a surgical operation wherein the instrument is to be utilized for spreading opposed tissues that are initially closely spaced, as in an incision. In this and more widely spread positions of spreading adjustment, the axes of forceps pivots 15, indicated at 33 in FIG. 1, instead of being parallel to one another, are disposed at an acute angle diverging away from the hinged end 20 of bolder A.
The median longitudinal axes of the respective forceps B, indicated by axis lines 34 of FIG. 1, instead of being in alignment, are inclined at a broad obtuse angle toward the median perpendicular plane 35 of holder A (normal to the common plane of arms 1719) in the direction away from the hinged end 20 of the holder, so that the jaw ends 10 of the forceps constitute, in effect, the protruding working extremity of the instrument, for most convenient attachment thereof to the organ or other tissue to be engaged and spread.
Operation of Instrument of FIG. 1
Referring again to FIG. 6 and to the paths of movement of jaws 10 as indicated by arrows 31, it will be apparent that as the forceps B are swung in the direction indicated by arrows 31, increasing the acute angles 49 which they subtend to the plane 36 of holder A, that the distance between the jaw ends of forceps B will increase to some extent. If the forceps B are now visualized as being attached to an organ or the sides of an incision in approximately the relative positions shown in FIG. 6 (eg at the attachment point indicated at 38) it will be apparent that upon shifting the holder A so as to shift the attachment pivots 15 of forceps E away from the points of attachment 38 to an organ or the like, the handle ends of the forceps being thus pulled away from the points of attachment in the direction indicated by arrows 39', that the forceps B will thereby be drawn to positions of increased angular divergence 49 from the plane 36 of holder A, the holder plane 36 moving away from jaws 10 so that the relative movement of the latter is as indicated by arrows 31 of FIG. 6. As previously pointed out, such a movement of the jaws 10 away from the holder plane 36 is accompanied by a small increase in the spacing between the jaws 10. By a reverse shifting action, in which the plane 36 of holder A, opposite the forceps B, is shifted toward the points of attachment 38 of the forceps to the tissue, the jaw ends ofthe forceps will be moved toward one another to decrease the spacing between attachment points 38.
The degree of change in spacing, however, is minimized by a number of characteristics of proportioning and arrangement of parts of the instrument. The length of the forceps from their pivot axes 33 to median plane 35 along their longitudinal axes 34, is considerably more than the Width of the organ or incision to be spread. Thus with the jaws 10 attached to the sides of an organ or incision in relatively close adjacency with respect to the relatively extensive spread between the pivots 15, and with the longitudinal forceps axes 34 subtending with one another a fairly shallow angle 32 (FIG. 6), considerable shifting of holder A toward or away from the points of attachment 38 can be effected with only a minimum amount of spreading of the organ or tissue. At the same time, the manipulation of the holder can be utilized to apply a direct pull against a cervix along 'its axis,'tending to draw it toward the surgeon while simultaneously spreading it. In fact,the holder can be shifted to one side or the other with respect to the field of operation (e.g. above or below the level of the cervix to which the forceps are attached) without any undesirable change in the degree of spread applied to the tissue. The arms of holder A can be adrelation to the average spacing between the tissue engaging positions of the jaws 10 during a spreading operation, while simultaneously providing for sufiiciently close spacing of handles 18, 19 to accommodate One-handed gripping thereof, the outwardly bent terminal arms 17 are provided, and they are bent away from the extended axes of handle arms 18, 19 at a very substantial acute angle 41 (FIG. 1) preferably greater than 45 although substantially less than 90".
In normal positions of usage of the instrument, the pivot axes 33 will have the diverging relation shown in FIG. 1. Consequently, the paths of swinging movement of longitudinal axes 34 of the forceps, instead of being disposed in a common transverse plane at right angles to the median longitudinal plane 35 of the holder, will define acute angles to the plane 35, thus beginning an approach toward a parallel condition in the planes of the paths of swinging movement of the jaws 10. Consequently, the degree of spreading action of jaws 10 incidental to the swinging movement about pivots 15 away from or toward the holder plane 36, will be reduced in proportion to the degree of divergence between the pivot axes 33. Also, the angle 42 defined between each pivot axis 33 and the longitudinal median axis 34 of the respective tenaculum, instead of being a 90 angle, may be an obtuse angle as shown, thus increasing the forward projection of jaws 10 with respect to the remainder of the instrument.
Modified FormFlGS. 4 and 5 In lieu of the clamp screw 28 of FIGS. 1, 3, a spring latch 43 of thin, stamped spring sheet material may be secured, as by rivets 44, to one cheek of enlargement 27, and may have, as an integral extension of one side thereof, and bent at right angles to its plane, a dog 45 engageable in a selected notch between adjacent teeth 25 of sector 21 to lock the arm 19 thereto in any selected position of spreading adjustment of arms 18, 19. Normally spring biased to a locking position lying fiating against the surface of enlargement 27, with the dog 45 in locking engagement with teeth 25, the latch may be retracted by means of an actuator screw 46, similar to a set screw, threaded through the opposite cheek of enlargement 27, extending through both cheeks and bearing against the inner face of latch 43 to flex the same outwardly to an unlatching position indicated in dotted lines in FIG. 5, wherein dog 45 is shifted laterally out of engagement with teeth 25.
Modified Forms--FIGS. 7 and 8 As previously indicated, any of the several conventional types of forceps-jaw construction may be utilized. For example, instead of the tenacula jaws 10 of FIG. 1, the jaws 10a may be of the ring type shown at B1 in FIG. 7.
Alternatively, the forceps may be of the type shown at B2 in FIG. 8, embodying toothed alligator jaws 18b.
Instead of attaching the pivots to handle loops 13' as in FIG. 1, each pivot 15 may be attached to a lever arm 11 of the corresponding tenacula, as shown in FIGS. 7 and 8. In this case, the spread between the pivot axes 33a (for forceps of the same length) may be somewhat less than the spread existing in FIG; 1.
Modified Forms-FIGS. 911
In lieu of the single pivot 15 connecting each forceps to the holder, a pivot joint may be utilized as shown in FIGS. 9 and 10. In such an arrangement, pivots 15c, attached to handle loops 13 in the same manner as in FIG. 1, instead of being fixed in the terminal bosses 16c of the holder arms 17, are mounted in knuckles 48 having respective trunnions 49 pivotally mounted in the terminal bosses 160. Thus the forceps, in addition to executing the swinging movement about their pivots 15c, indicated by arrow 310 in FIG. 10 (corresponding to the swinging movement similarly indicated in FIG. 6) may execute an additional swinging movement about the axes of trunnions 49 (e.g. to positions dropped downwardly as indicated at B" in FIG. 10 for one of the tenacula) wherein the approximately common plane of the pivots may tilt about an approximately common transverse axis indicated at 49 in FIG. 9, so as to subtend varying dihedral angles with respect to the plane 36 of the holder A.
Aside from this double-pivotal connection between the forceps and the holder arms, the instrument of FIGS. 9 and 10 may be the same as that shown in FIG. 1, and accordingly, corresponding reference numerals are utilized to designate the similar parts. Alternatively, in lieu of the piercing jaws 10, the forceps may have the ring jaws 10a of FIG. 7. Also, in lieu of attaching the pivots to the sides of handle loops 13a they may be attached to forceps lever arms 11d, as shown in FIG. 11. The knuckles 48 with their trunnions 49 connecting them to terminal bosses 16c, are the same as in FIG. 9.
Operation of Instrument of FIGS. 911
The operation of the instrument of FIGS. 91 1, with the double jointed connections of the forceps to the hold er, is substantially the same as that of the instrument shown in FIGS. 1 and 6, but differs in that the planes of the respective forceps, in addition to tilting about the axis of pivots 150 to vary the angle 32 subtended between them, may also tilt about the transverse axes of trunnions 49 so as to effect approximately a tilting movement about a common axis 49', thereby to remain oriented in positions which do not vary with respect to the tissue (e.g. avoid twisting action against the tissue) except for the spreading action applied thereto.
It will be understood that in lieu of the gimbal type universally pivotal joint between holder arms and forceps shown in FIGS. 911, the invention may utilize the well known ball and socket type pivot for attaching the two pairs of forceps to the holder arms.
What is claimed is:
1. In a multiple-forceps tissue-spreading surgical instrument, in combination: a holder comprising a pair of arms and adjustable connector means connecting said arms for adjustable spacing thereof on respective sides of a longitudinal median axis; a pair of forceps units having respective jaw extremities adapted to be attached to respective elements of tissue in adjacent spaced relation to said median axis and having handles at their opposite ends; and respective pivots attaching said handles to the spaced ends of said holder arms on axes diverging in the direction away from said connector means and subtending small acute angles with respect to said median axis, whereby the extent of said resultant change in jaw spacing is reduced below the extent of change that would exist under the condition of full parallelism of said pivot axes, said arms being hinged together at their ends remote from said pivots, and said connector means comprising a marginally toothed sector bar pivoted to one of said arms and extending through a slot in the other arm, and a clamp screw threaded in said other arm and having a point engageable between marginal teeth of said sector bar.
2. In a multiple-forceps tissue-spreading surgical instrument, in combination: a holder comprising a pair of arms; adjustable connector means connecting said arms for adjustable spacing thereof on respective sides of a longitudinal median axis; a pair of forceps units having respective jaw extremities adapted to be attached to respective elements of tissue in adjacent spaced relation to said median axis and having handles at their opposite ends; and respective pivots attaching said handles to the spaced ends of said holder arms on axes diverging in the direction away from said connector means and subtending small acute angles with respect to said median axis, whereby the extent of said resultant change in jaw spacing is reduced below the extent of change that would exist under the condition of full parallelism of said pivot axes; said arms being hinged together at their ends remote from said pivots; and said connector means comprising a marginally toothed sector bar pivoted to one of said arms and extending slidably through a slot in the other arm, and a spring latch secured to said other arm and having a locking finger engageable between marginal teeth of said sector bar.
3. In a multiple-forceps tissue-spreading surgical instrument, in combination: a holder comprising a pair of arms; adjustable connector means connecting said arms for adjustabie spacing thereof on respective sides of a longitudinal median axis; a pair of forceps units having respective jaw extremities adapted to be attached to respective elements of tissue in adjacent spaced relation to said median axis and having handles at their opposite ends; and respective pivots attaching said handles to the spaced ends of the said holder arms on axes diverging in the direction away from said connector means and subtending small acute angles with respect to said median axis, whereby the extent of said resultant change in jaw spacing is reduced below the extent of change that would exist References Cited in the file of this patent UNITED STATES PATENTS 459,641 Mendelson Sept. 15, 189]. 476,754 Mendelson June 7, 1892 574,529 Elliott Jan. 5, 1897 2,702,540 Debeh Feb. 22, 1955 OTHER REFERENCES General Catalogue, Copyright 1938, page 313 (Mueller). (Copy in Division 55.)