US 3606878 A
Description (OCR text may contain errors)
p 21, 1971 H. "B. Ki-t tLoss, JR 3,505,873
NEEDLE INSTRUMENT FOR EXTRACTING BIOPSY SECTIONS Filed Oct. 4, 1968 Mada/r02 //dn A,?D A. (611445.56
8 M W n Mu United States Patent 3,606,878 NEEDLE INSTRUMENT FOR EXTRACTING BIOPSY SECTIONS Howard B. Kellogg, Jr., 3843 92nd NE., Bellevue, Wash. 98004 Filed Oct. 4, 1968, Ser. No. 765,161 Int. Cl. A611) /00 US. Cl. 128-2B 2 Claims ABSTRACT OF THE DISCLOSURE Specimen tissue drawn by suction into a specially formed side port adjacent the hollow penetrating needle tip is severed by forward motion of a tubular cutter slidable in the needle passage through prehensile application of thumb pressure on the outer end of an actuator rod. Suction is applied to the needle passage behind the cutter and reaches the port through passage in the cutter itself so as to help retain the specimen in the cutter cup. The cutter is removable to facilitate dislodging of the specimen and to sharpen and clean the cutter.
DESCRIPTION This invention relates to improvements in surgical instruments for extracting biopsy sections and more particularly concerns a trocar or needle instrument of this nature which may be used for the nonincisional penetration of intervening tissues so as to reach internal organs, membranes and tissues requiring examination. The invention is herein illustratively described by reference to the presently preferred embodiment; however, it will be recognized that certain modifications and changes therein with respect to details may be made without departing from the essential features involved.
A principal application for this invention is to provide an improved instrument with which to extract biopsy specimens from any of various parts and regions otherwise ditlicult to examine nonoperatively, examples being lung tissue, pericardial tissues and peritoneal tissues. With this invention exploratory examination of dilferent regions of a patients lung, chest cavity liner, heart sac or other internal organs and membranes may be achieved quickly and without major trauma or shock to the patient and with reliable results flowing from the positional precision and controllability of the instrument for taking the specimen. The instrument is relatively simple in construction and easily operated by a physician with a minimum of attendant equipment or help. The instrument is broadly intended for use both in clinical office examinations and in operating room procedures and is generally compatible to all conventional auxiliary requirements for surgical in struments such as ease of cleaning and sterilization, producability in a form which is safely and reliably useable and similar qualities.
An object of this invention therefore is to devise an instrument of the described nature which facilitates early safe examination of patients in body cavity regions otherwise difficult to reach for biopsy studies by conventional techniques and instruments. A related object is to devise an instrument which is relatively versatile in that it may be used for extracting biopsy sections in any of various parts of the body and in particular of doing so in the critical and diificult areas within the chest cavity which "ice are areas in which early and detailed knowledge of conditions are most essential to proper and timely diagnosis of a variety of diseases and disorders.
In accordance with this invention an elongated bluntly-pointed hollow needle instrument has a main passage extending lengthwise therein and opening near the tip of the instrument through a side wall or port into which a knuckle or bulge of tissue may be drawn by suction applied to the opposite end of the passage when the port is pressed against the tissue surface. A cutter plunger preferably of cylindrical form slidably received in the passage is operated by an actuator rod extending slidably through the sealed opposite end of the passage. The cutting edge is the forward edge of the cutter. Suction applied to the needle passage behind the cutter is communicated through the cutter to the needle passage forward of the cutter. Thus a specimen of indrawn tissue severed by the cutter on its forward traversal of the side port in the needle is received and held in the cutter interior. The suction helps hold the specimen reliably within the cup or cavity of the cutter for subsequent removal after the needle is withdrawn from the patient.
These and other features, objects and advantages of the invention will become more fully evident from the following description thereof by reference to the accompanying drawings.
FIG. 1 is an isometric view of the improved instrument.
FIG. 2 is an enlarged isometric view of the cutter and adjacent end portion of the control rod which actuates the cutter, with these elements separated for purposes of illustration.
FIG. 3 is a side view of the instrument appearing in FIG. 1.
FIG. 4 is an enlarged longitudinal sectional view of the instrument from the aspect shown in FIG. 3, with the plunger retracted.
FIG. 5 is a view similar to FIG. 4 with the plunger thrust forward to sever a biopsy specimen.
Referring to the drawings, the instrument resembles a trocar-type instrument, which in this case comprises an elongated tubular stylet or hollow needle body 10 having a bluntly-pointed tip 12. The body 10 comprises a straight tube the longitudinal bore of passage in which 10a extends throughout its length and is closed at its forward or distal end by the tip fitting 12' exteriorly bluntly pointed and of round cross section. The tip fitting has a base 12a plugged into the end of the needle body. At location A near the rearward or proximal end of the needle it is provided with a short branch or elbow comprising tube 14 extending at an angle to the tube 10. The branch section 14 has an end fitting 14a for connecting it to a suction hose 16 or syringe shown in bro-ken lines. Beyond the branch 14 the main tube 10 terminates in an internally threaded coupling head 10" into which a plug 18 is threaded tightly so as to compress a gasket 20 against a seat in the base of the head 10. The plug 18 has a knurled ring 18a by which it may be tightened and removed through application of finger pressure. The plug is centrally aperturedso as to pass a slide rod 22. Leakage of air past the rod is prevented by lateral expansion of the seal 20 under pressure from tightening of the plug 18. Rod 22 is connected to a hollow cylindrical cutter knife 24 slidably received in the central passage of the tube 10. This knife is of tubular form and has a sharp cutting tip 24a formed by beveling its distal end outwardly from its inner to its outer peripheral surface. At its inner or proximal end the cutter 24 is internally threaded to receive a connector fitting 26 which is welded or otherwise secured at 28 to the actuation rod 22. The connector fitting 26 has a central passage 26a. leading into the interior of cutter 24 and branching passages 2612 leading to the exterior of the fitting, which itself has an external diameter slightly smaller than the passage diameter of needle tube 10. As a result, the hollow interior of cutter 24 hence the needle tube passage ahead of the cutter are in direct communication through the passages 26a and 26b with the passage a behind the cutter, hence with the section branch 14.
Near its tip 12 the tubular needle body 10 has a side aperture or port 10b which may be traversed longitudinally by the cutting edge 24a through advancement of the actuator rod 22. The length of the cutter 24 somewhat exceeds the length of the aperture 10b, so that with the cutter in its forwardmost position as shown in FIG. 5, the cutter closes off the aperture 10b. This forwardmost position of the cutter is established by contact between the base of the thumbstall 30 on the end of rod 22 and the outer face of the plug fitting 18, in which position the cutting edge 24a stops just short of contact with the fitting 12 forming the tip or point of the trocar. In this manner the cutting edge is protected against dulling contact with a metallic surface. Port 10b is preferably formed as the intersection of the tubular form of needle body 10 with the convex side of another cylinder transverse to it, which cutter cylinder side has a progressively decreasing radius in the direction from the base to the tip end of needle 10.
It will also be seen that various handle arrangements may be provided with the instrument, that shown being similar to a conventional trocar handle in which the body portion is provided with two fingerstalls 32 and 34 on opposite sides thereof near the base or proximal end of the instrument. Thus the surgeon may conveniently hold the instrument by placing two fingers in the respective stalls 32 and 34 and his thumb in the thumbstall 30.
In use suction is applied through the hose 16 or syringe to the branch 14 and thereby to the internal passages within the tubular body 10 of the instrument. This suction extends through the passages 26a and 26b to the interior of the cutter 24 and from there to the port or aperture 10b. When the instrument is to be inserted for taking a biopsy specimen, such as in the chest cavity for example, the surgeon typically makes a very short incision in the skin of the patient and then punches the instrument through the fascia and muscle. With the fascia and muscle penetrated, the surgeon then tilts and revolves the instrument, with appropriate awareness and control of the relative position of the aperture 10b,to the region sought, until the aperture is pressed against the pleura surface of the chest cavity, against the lung, or the heart sac, depending upon the material to be excerpted. With the cutter 24 then retracted, the applied suction draws a knuckle or bunch of the tissue T into the entrance of the port 10b and thereby into the path of the cutter 24. At this point the bulge of tissue drawn by suction into the instrument appears as in FIG. 4. The surgeon then applies forward thrust to the cutter through advancement of the rod 22' so as to advance the cutter to the position shown in FIG. 5 and in so doing shears off the knuckle of tissue. The described shape of the aperture as an anvil or reaction edge for the tissue during cutting helps gather the material into a shape during increase of cutting pressure from the blade in which pulling and tearing will be minimized, and at the same time closes off the aperture 1012 against further application of suction to the tissue surface T and against loss of the cut specimen in subsequently retracting the instrument. Preferably suction continues to be applied during withdrawal so that the severed specimen of tissue held within. the cup of cutter 24 will be reliably retained even though accidentally the cutter might be retracted and the port partially reopened.
When the instrument is withdrawn from the patient the surgeon unscrews the plug fitting 18 and withdraws the cutter out of the open base end of the needle instrument whereby the specimen of tissue may be removed from the cutter cup for examination purposes. Should it not drop out of the cutter cup readily, the cup may be unscrewed from the fitting 26 in order to press the specimen out of the cutter.
In its various applications to biopsy specimen removal the instrument is in each instance intended to perforate intervening body tissues with a minimum of injury and laceration of adjoining tissues. It may be applied to pericardial examinations, peritoneal examinations and various others. Only the tissue surface from which the biopsy section is taken is affected by the instrument during the process of penetration and removal. A clean cut is made in the removal process so as to avoid laceration and tearing of adjoining tissues. The facility with which the instrument may be disassembled for cleaning, for specimen removal, and for sharpening of the cutter if necessary are further advantages.
Unlike prior suction type invention instruments for specimen removal, the prehensile grip and actuation arrangement of the present instrument comprising fingerstalls and thumbstall, and the forward direction of motion of the cutter on its cutting stroke effected by closing movement of the thumbstall toward the fingerstalls is an important feature facilitating holding of the instrument and applying maximum force to the cutter with steadiness during the cutting stroke. This is particularly important in the cutting of tough tissues or in cases wherein delicately precise positioning of the inserted instrument are critical.
These and other aspects of the invention will be evident to those skilled in the art based on an understanding of the foregoing disclosure of the preferred embodiment thereof.
What is claimed is:
1. A biopsy specimen-taking trocar instrument for use by puncturing it into the human chest cavity and similar applications, comprising an elongated hollow needle of rigid tubular form pointed at one end adapting it to pierce through hard chest cage tissues and having a longitudinal passage therein terminating at the point, the pointed end being of symmetrically round cross section tapering smoothly from the tubular exterior on a longitudinal convex curvature which decreases in radius toward the tip extremity to a smoothly rounded tip adapted to slide over soft internal tissues without lacerating them, said needle having a side opening closely adjacent the point so as to admit a knuckle of specimen tissue into the passage, said opening being formed substantially as the intersection of the needles exterior with a cylindrical surface at right angles to the needle, a cutter received in said passage for longitudinal movement and having a forward cutting edge transversely contoured to the passage wall in a sliding fit therewith adapting it to sever the admitted tissue by traversing said opening toward the point, handle means fixedly mounted on the needle back from the pointed end including finger stalls on opposite sides of the needle in predetermined positional relationship to the side opening, means comprising a fitting connected with the needle back from the pointed end thereof at a location for applying suction to the needle passage behind the cutter in a position of the cutter retracted behind said opening, said cutter comprising means forming a passage for communicating the applied suction past the cutter and to said passage forwardly of the cutter, actuator means connected with the cutter and extending exteriorly of the needle to permit manually moving the cutter longitudinally in said passage, said cutter comprising a tubular memher having a sharpened forward cutting edge surrounding a tissue-receiving receptacle in the path of communication of suction applied from behind the cutter, said actuator means comprising a longitudinally extending rod having a thumbstall on the exterior end thereof, a removable closure fitting on the end of the needle opposite the point through which the rod passes slidably, means forming a seal closing the needle passage against entry of air around the rod, and a fitting on the interior end of the rod, said fitting and said tubular cutter member being detachably interconnected.
2. The instrument defined in claim 1 wherein the side opening is formed as the intersection of the needle exterior with another cylinder with progressively decreasing radius in the direction forward of the needle.
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