US 3196876 A
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Description (OCR text may contain errors)
M. M. MILLER July 27, 1965 DILATOR 2 Sheets-Sheet 1 Filed May 10. 1961 INVENTOR ATTORNEY July 27, 1965 M M. MILLER 2 Sheets-Sheet 2 Filed May 10. 1961 R m m V m M4U/9/CE M 44/4156 ATTORNEY United States Patent 3,196,876 DILATOR Maurice M. Miller, 207 Medical Towers, Norfolk, Va. Filed May 10, 1961, Ser. No. 109,075 1 (Jlaim. (Cl. 128-343) The present invention relates to the class of surgical instruments and more particularly to a dilator for exploration of the common duct and dilatation of the Sphincter of Oddi.
On many occasions, the common duct is opened to search for and remove stones. Certain indications for exploration of the common duct have been devised and whenever one or more of these indications are present, the duct is most often explored. Some of the common indications are: when a stone is palpable in the common duct; when the common duct is dilated; when there are small stones present in the gallbladder; when jaundice of the obstructive variety is present and various others. After the common duct has been opened and explored for stones, it is necessary to dilate the Sphincter of Oddi. This is done to encourage and facilitate passage of residual stones or debris left in the common duct. The Sphincter is also dilated to make sure that there is no stricture of the Sphincter of Oddi or stone present in the ampulla.
The usual procedure in this type of operation has been to make a longitudinal incision in the anterior surface of the common duct just distal to the entrance of the cystic duct for the entrance of the probe. The usual probe used for this purpose comprised a malleable metal rod approximately fifteen inches in length and having a portion approximately twice the length of the probe portion and an enlarged portion at the end of the probe portion. The probe is passed through the incision with the probe shaped to fit the curve of the common duct and its enlarged tip forced through the Sphincter of Oddi into the duodenum, thereby dilating the Sphincter of Oddi. To increase the dilation it has been customary to provide a plurality of probes, each having an increasingly larger tip, and successively inserting and removing the various probes.
The preceding steps not only increase the time of the probing operation due to the fact that each probe must be separately shaped to fit the curve of the common duct, but the insertion of the various probes increases the danger of tearing the common duct or pushing a hole in a portion of the common duct in an area not visible to the operator.
The primary object of the present invention is to provide a dilator which is much more rapid in its operation and which lessens the chances of tearing the common duct.
The present invention contemplates the use of a single probe or dilator which is similar in design to the first probe described above but having a substantially rigid handle portion approximately ten inches long and a malleable probe portion about five inches long and terminating in an enlarged oval tip. The handle portion is squared to permit easy handling and firm control of the instrument. In addition, there is a plurality of sleeve dilators made of a very malleable material. The sleeve dilators are hollow and the diameter of the hollow opening is slightly larger than the diameter of the probe and slightly smaller than the diameter of the enlarged oval tip whereby the sleeve may be pushed down over the entire length of the probe until its tip reaches and is stopped by the enlarged oval tip of the probe. The tip end of each sleeve is also oval shaped and slightly enlarged with the diameter of the tip of the first sleeve about 1 mm. larger than the diameter of the probe tip 3,196,876 Patented July 27, 1965 which is approximately 3 mm. in diameter. The diameter of the tip of the second sleeve is 5 mm., the diameter of the tip of the third sleeve 6 mm. and so on whereby each succeeding sleeve presents a slightly larger dilator.
Thus, the primary object of the invention is to provide a combined probe and dilator in the form of a probe having a dilating tip and a plurality of sleeve like dilators wherein the probe serves as a guide for the sleeve dilators.
Other objects and advantages of the present invention will be readily apparent from the following detailed description taken inconjunction with the accompanying drawings wherein:
FIGURE 1 is an elevational view of the probe members;
FIGURE 2 is a similar view of one of the sleeve dilators;
FIGURE 3 is a similar view showing the dilator of FIGURE 2 mounted on the probe shown in FIGURE 1;
FIGURE 4 is an enlarged detail view of the device shown in FIGURE 3 with the sleeve dilator shown in section;
FIGURE 5 is a sectional view taken on line 55 of FIGURE 4;
FIGURE 6 is a sectional view taken on line 66 of FIGURE 4;
FIGURE 7 is a sectional view taken on line 77 of FIGURE 4;
FIGURE 8 is a view similar to FIGURE 7, but showing a sleeve dilator with a slightly enlarged tip;
FIGURE 9 is a view of the duct system showing the probe inserted;
FIGURE 10 is a similar view showing the probe with a sleeve dilator mounted thereon.
Referring to the drawings in detail, and particularly to FIGURES 9 and 10, showing the duct system, numeral 12 denotes the common duct, numeral 13 indicates the hepatic ducts, numeral 14 denotes the duodenum and numeral 15 denotes the Sphincter of Oddi. The incision in the common duct is denoted by numeral 16, held apart by silk threads 17 to permit entrance of the probe member 18.
The probe member 18, shown in FIGURE 1, is approximately fifteen inches in length, consisting of a substantially rigid handle portion 19 ten inches in length and a malleable probe portion 20 five inches in length. The malleable probe portion terminates in an enlarged, oval-shaped tip portion 21 having a cross-sectional diameter of 3 mm. The probe portion 20 has a diameter of approximately 2 mm. and the handle portion 19 is squared to permit easy handling and firm control of the instrument. The probe is made of any suitable metal commonly used for surgical instruments.
The sleeve dilator, indicated by numeral 22, comprises a hollow sleeve formed of malleable material having an internal diameter slightly larger than the diameter of the probe but slightly smaller than the diameter of the probe tip 21 whereby the sleeve may encompass the probe and slide along the probe until stopped by the bulbous tip of the probe. The sleeve shown in FIGURE 2 has an enlarged oval-shaped tip 23 having an outside cross-sectional diameter of approximately 4 mm. As previously described, a plurality of sleeves are provided wherein the tip is made of a larger diameter than the previous sleeve and FIGURE 8 shows such a sleeve wherein the tip 23 has an outside diameter of 5 mm. It will be understood that the hollow inner diameter of each sleeve is constant but the dilator or top portion increases in diameter in increments of 1 mm. each.
The instrument of the present invention is used in the following manner:
On most occasions, the common duct is opened to search for and remove stones. The probe 18 is inserted into the common duct 12 through incision 16. The malleable portion 20 may be easily shaped to fit the contour of the common duct. The probe is then further manipulated whereby the tip end of the probe passes through the Sphincter of Oddi to dilate same. Once the guide probe has been successfully inserted through the common duct into the duodenum, it remains in position and serves as a guide for further dilation of the Sphincter of Oddi, by threading the sleeve dilators over the guide probe as shown in FIGURE 10. The bulbous tip of the guide probe is easily felt through the wall of theduodenum, and the sleeve dilator also, since its tip is stopped by the tip of the guide probe.
It will thus be seen that the instrument described above is well adapted to accomplish the advantages and objects set forth.
While I have described a preferred form of probe and dilator, it is to be understood that various changes and modifications may be made herein without departing from the spirit of the invention as defined in the appended claim.
Having thus described the invention, what is claimed A dilator comprising an elongated rod having a handle portion and a malleable probe portion of substantially constant diameter throughout, said probe portion having an enlarged tip portion at its end opposite the handle portion, and a removable malleable sleeve slidably mounted on said rod, said sleeve having an internal diameter slightly larger than the diameter of the rod but smaller than the tip portion whereby said tip portion forms a stop for said sleeve, said sleeve having an enlarged portion on the end thereof adjacent the enlarged tip portion.
References Cited by the Examiner UNITED STATES PATENTS 672,377 4/01 Kearns 128341 2,106,707 2/38 Greth 128341 2,221,138 11/40 Hendrickson 12834l FOREIGN PATENTS 439,133 11/35 Great Britain.
1,878,671 9/32 Cantor.
RICHARD A. GAUDET, Primary Examiner.
JORDAN FRANKLIN. Examiner.