US1344227A - hauman - Google Patents

Description

A. W. HAUMAN.

INSTRUMENT FOR THE REMOVAL OF HEM'ORRHOIDS AND RESECTION 0F. PROLAPSUS RECTI.

APPLICATl ON nuzn APR. 30. 1919.

1,344,227, Patented June 22, 1920.

3 SHEETS-SHEET I.

W v i 4 I Hi A. W. HAUMAN. I INSTRUMENT FOR THE REMOVAL OF HEMORRHOIDS AND RESECTION 0F PROLAPSUS REST].

APPLICATION FILED K30. 1919.

Patented June 22, 1920.

3 SHEETSSHEEI 2- me/nloz fllexander walkerfiauman A. W. HAUMAN. INSTRUMENT FOR THE REMOVAL OF HEMORRHOIDS AND RESECTION 0F PROLAPSUS RECTI.

APPLICATION FILED APR. 30. 1919.

3 SHEETS-Shh?! 3.

1,344,227. PatentedJune 22,1920.

awuem to c aleacanderwalkerflauman W #M/Ludu UNITED STATES PATENT OFFICE.

ALEXANDER WALKER HAUMAN,

or CAPE TOWN, SOUTH AFRICA.

INSTRUMENT FOR THE REMOVAL OF HEMOR RI-I OIDS AND RESECTION OF PROLAPSUS RECTI.

A lication filed April so,

strument entitled Instrument for. the Re-- moval of Hemorrhoids and Resection of Prolapsus Recti, (Prolapse of the Rectum,) of which the following is a specification.

In performing the surgical operation for the removal of hemorrhoids (or piles) and the resection of prolapsus recti (prolapse of the rectum) the operator has in the past been greatly handicapped by two difiiculties, namely the heavy flow of blood necessitating constant swabbing and the insertion of each stitch required without any guide as to the position thereof, making the operation both a lengthy and difficult one.

I have invented an instrument (which may be styled a hemorrhoid or bowel circumciser) the use of which renders the operation almost bloodless and greatly simplifies the same and shortens the duration thereof.

With this specification will be found explanatory drawings on which:

Figure 1 is a perspective view of the in strument.

Fig. 2 is a longitudinal section of the same.

Fig. 3 is a face or front view of the instrument fixed by three fixing needles passing through tissues and holes.

Fig. 4: is another face or front viewof the instrument in use showing the ligature being tied around tissues inthe groove D.

Fig. 5 shows the tissue being cut away.

Fig. 6 is another front view showing the stitching and tying of the interrupted stitches.

Fig. 7 shows the double-length ligatures being put through the three fixing needles to complete the operation- I Fig. 8 shows the operation completed with the instrument still in position. v

Fig. 9 shows the rectum with the stitches after removal of the instrument.

Fig. 10 is a part section showing the mirror.

On the various figures the different parts are lettered as follows: r

F. (Figs. 1 and 2) the face or front end of the instrument, and P the point or back handling same. I the instrument is about 11} to 2. inches but Specification of Letters Patent. Pate t d J n 22 1920 1919. Serial No. 293,886.

end. R the body. the slits. o the holes.

D the groove in the collar. fixing needles. T rubber points of the needles. W tissues to be cut away. L the circular ligature. L the extra ligature. M cut margin of tissues. S the stitching needle. L the double length ligatures threaded through the three fixing needles. B is the mirror.

' The instrument is cylindrical in shape and may be made of any hard metal, or metal enameled, or of orcelain, although metal is more suitable. ame is described in connection with the accompanying drawings. One end P, the point (which is regarded as the back end), is cut on theslant or cone-shaped so as to be easily inserted into the rectum. It may either be closed as shown or may be open. If open a swab may be introduced to prevent any contents from the bowel passing through. This end need not necessarily be cut on the slant. It may be cut straight or it may be made to come to a'point. The other end, the face of the instrument, is circular. Around this end is a collar A around which runs a deep circular groove D. The width and thickness of this collar vary in different sized instruments. A good average width is about %ths inch and a good average thickness about ths inch. It is wise to have the groove D fairly deep. Through this collar and the end of the body of the instrument, a series of slits, E, are made at regular intervals be solid instead of hollow, save as to the front portion which should be hollow. A

cross-bar H placed in the instrument about half an inch from the face or front is for A convenient length for it may be shorter or longer. A useful circumference for adults is about 41} inches with a collar of about 5 inches. For children a smaller size will be necessary.

The slits E are slightly wider at the face or front of the instrument gradually narrowing down until just where they run into the holes C behind the collar. The diameter of the holes is greater than the width of the slits, so that a needle fitting the holes or able to just pass through same will not be able to slip forward through the slits. The portions of the instrument between the slits may be in a straight line with the body of the instrument but it is better to have them slightly bent or sloped backward or outward from the center as this exposes the inside of the holes better to view when the operator is looking at the face or front of the instrument. The groove D may be of different depths (about or of an inch is a convenient size for adults). It may be narrow or broader depending on the size of the instrument (a width of 5 or -1- of an inch for adult size is convenient).

A detachable mirror 13 may be inserted in front of the cross-bar to enable the operator to get a better view of all the holes. It is not essential but may be of assistance, 6. 9. it enables him to view the uppermost holes without stooping.

Having described the instrument I now give a description of its use in the operation above referred to.

The rectum is dilated and the instrument introduced with the point P inward. The parts being on the stretch an incision is carried around the skin and mucous membrane junction, and the cut skin surface is pushed well back with a wet swab as in -Whiteheads operation, or this portion of the operation may first be completed before the instrument is introduced. The instrument is next pushed well into the rectum by the crossbar H and disappears from view. It is then drawn forward again and the hemorrhoids come well out and cover the face of the instrument in extensive cases, or are pulled forward over the face of the instrument with Lane forceps, while the fixing needles hereafter referred to are be ing introduced. Three fixing needles are now introduced. The first needle passes through the skin a little beyond the cut surface, then through the hemorrhoids and mucous membrane, then enters any hole (C) in the front end F of the instrument. It then passes through the center of the instrument and enters a hole diametrically opposite passing outthrough inucous membrane, pile area and catches the cut skin edge on the opposite side. If it is remembered that the holes are just behind the collar there will be no difliculty in getting the needle to enter one. The next needle is then passed in the same way some spaces away from the first so as to cross it and form the letter X. The third fixing needle is passed in the same way midway between the first two, and as its point crosses the center of the cylinder it must be passed between the first two needles at the point where these first two cross, 2'. e. in front of the one and behind the other. In this way it separates the first two needles at that point, and will easily find its own corresponding hole on the opposite side. This" procedure simultaneously fixes all three needles firmly. Fig. 3 shows the three needles G G G in position looking at the face of the instrument and with their points capped with pieces T of rubber. The pile area should be well drawn forward with Lane forceps at the points where the fixing needles enter and pass through. The points of the fixing needles will lie well against the skin of the perineum and will not injure the operator. Ordinary straight cutting needles are used as fixing needles, but they must be of such a size that they will fit through the holes 0 but will not be able to slip through the slits (E) or else the instrument would slip into the rectum. In other words the instrument is so constructed thatthe needle which just fits the holes will not be able to slip through the slits. Too thin a needle must therefore not be used. Needles must be sufficiently long so that the eye of the needle will remain free.

The operators assistant now pulls on the cross-bar while the operator ties a silk ligature around the mass of piles. This ligature if kept close to the front aspect of the needles will fall into the groove, D, and the operator ties the mass securely in the groove, leaving the ends of the ligature long and kept out of the way with an artery forceps clamped on. This is useful when the silk ligature is afterward removed. The silk ligature is easily tied if it is first fixed about its middle to the lowest needle point (or any needle point, and as will later be seen preferably to the one farthest back) by an extra loop of silk also left long. This gives a fixed point to start from. The tying of the ligature in the groove D is illustrated in Fig. it. If the needles are properly fixed and the ligature securely tied then the whole mass of piles can now be cut away in one sweep flush with the face of the instrument, or the operator may cut away in sections as he chooses. The operation is almost bloodless. The cutting away is shown in Fig. 5. Interrupted catgut sutures are now inserted through all the vacant holes always passing the needle from within the cylinder of the instrument where the hole can be distinctly seen. A small weld curved needle S is used and one which will pass throu h the holes C and not through the slits The operator should not rise from his stool while introducing these sutures once he has attained the method. The needles are handed on a holder. The first stitch goes through a hole to the right (back hand) which the assistant ties and the next to the left which the operator ties, and so on. As the needle emerges on the outer surface, the operator pulls the cut skin edge over its point with toothed forceps. The ligature slips through the slits and the knots are all tied on top of the groove. Fig. 6 illustrates the stitching and tying of the stitches.

After all the free holes are thus done there remain only the three fixing needles to deal with. These are threaded with double length catgut, for preference the foremost one first, (see Fig. 7). Seize the point of this needle and draw it right through the instrument, cut the suture in the center of the instrument and this will give two sutures in situ. The other two needles are similarly treated. When the two last sutures are tied the instrument will then be loose and is withdrawn.

In introducing the fixing needles it will be most convenient to first introduce the needle G next the needle G to lie in front of the first, and then the third needle G to pass between the other two. This leaves the first needle G farthest back. The extra silk thread which served originally to fix the circular silk ligature should be tied around the point of the first needle G. This enables the operator to knot his silk ligature just in front of the eye of the needle G and the ends with forceps clamped will lie on the patient. The suture at the point of needle G will be the last one to'be tied and just before tying pull on the extra silk loop and this will bring the circular ligature into view out of the groove and it is then cut. The extra silk thread is also then removed before tying. By drawing on the knotted end of the circular silk ligature it will come away and does not cause any slacking of the interrupted sutures. A circular catgut ligature may be used instead of silk and left in situ, but it is not so secure as a strong silk one. The operator should wear cotton gloves so as to tie the catgut sutures very firmly and they should be tied with three knots and cut short.

The operation is practically bloodless and can be completed in about 15 minutes. The more extensive the case the better will the instrument be suitable. Fig. 8 illustrates a front view of the rectum with the operation complete.

Cases of prolapsed rectum requiring resec tion are admirably suited by the instrument. The stitching can be done very rapidly and it is well to have several needles threaded before commencing.

I claim:

1. A surgical instrument comprising a hollow member having a front part provided with an external circumferential groove intersected by longitudinal slits communicatpassage of fixing and surgical instrument comprising a hollow member having an external circumferential groove in which the tissue may be bound during the operation and having a series of holes for the reception of fixing and stitching needles and slits in communication with such holes, the width of said slits being such as to permit the passage of the stitching medium and prevent the passage of the needles.

4. A surgical instrument comprising a hollow member having an external groove in which the tissue may be bound and having a series of holes for the reception of fixing and stitching needles, and a cross bar for use in handling the instrument during the operation.

5. A surgical instrument comprising a hollow body provided with a closed rear end and an open front end and a cross bar near the front to serve as a handle, the front end having a series of holes for the reception of fixing and stitching needles, and slots communicating with the said holes and having a width less than the diameter of the said needles.

6. A surgical instrument comprising a substantially cylindrical body part having an open front end and a collar on said front end formed with a series of slits opening into holes for the passage of fixing and stitching needles, said slits having a width less than the diameter of said holes.

7. A surgical instrument comprising a cylindrical body part having a closed rear end and a flared open front end, a cross-bar near the front end, and an enlargement at the front end having an external groove in which the tissue may be temporarily bound and having holes for the fixing and stitch ing needles and a series of slits for the pas sage of the stitching medium.

8. A surgical instrument comprising a body part having an open front end, a crossbartherein, and a mirror adapted to be mounted on the cross-bar, the front end having a circumferential groove intersected by longitudinal slits opening into holes for fixing and stitching needles.

In testimony whereof I have hereunto affixed my signature in the presence of two witnesses.

A. WALKER HAUMAN. Witnesses:

A. E. PHILLIPS, FRANK U. CLIFF.

Images