US1627941A - Surgical instrument - Google Patents

Description

May lo 1927' R. H. WAPPLER SURGICAL INSTRUMENT Filed oct. 16, v`1924 2 sheets-sheet 1 Muy 1o, 1927.

R. H. WAPPLER SURGICAL INSTRUMENT Filed oct. 1e, 1924' 2 shuts-sheet 2 ATTORNEY Patented May 10, 1927.

UNITED' STATES REINI-IOLD H. WAtLER, OF YONKERS, NEW YORK.

SURGICAL NSTRU'MENT.

Application filed October 16, 1924.

My invention relates to surgical instruments oi' the type in which an operating device such as a pair ot' forceps is connected, detachably or otherwise, with an optical instrument such a cystoscope or endoscope and usually embodying a small instrument known in this art as a telescope, all for the purposes ot enabling the surgeon to look closely into various cavities, channels and ducts ot' the human body, and Vto remove therefrom foreign substances such as gall stones, missiles and supertluous growths.

More particularly stated, my invention vcompreheiuls a. surgical instrument ot the general character just mentioned, and provided with a pair of jaws and with an endoscope, these parts being each adapted relatively to the other so that, with the instrument as a unit inserted into a cavity ot the body, the jaws of the forceps being open and the operator making his observations through the endoscope, his lield of vision has the form of a cone extending out directly through the opening between the jaws, or in other words the jaws may be considered as a pair oi. shutters between which 'the operator looks out from the instrument. and thus the operator sees straight ahead ot' the open jaws.

My invention turther contemplates the employment, Vin an instrument ot this general character, of jaws curved or bent and thus adapted to grasp objects located a little to one side trom the iront or distal end ot the apparatus` in connection with an endoscope so arranged that its lield oit vision e1;- tends laterally and coincides as tar as practicable with the opening etween the jaws, as above stated. By this arrangement, notwithstanding the unfavorable position ot the object to be seen through the endoscope and grasped by the jaws, the operator can still easily see it through the endoscope and readily lgrasp it between the jaws, and as a rule as soon as he can see it all he can grasp it by simply closing the jaws.

li'ly invention further contemplates iniproved nnifchanism connected with the jaws o' the forceps and with a pair oi handles tor actuating the same so as to enable the operator to shift said handles angularly around into an infinite number oit different positions, thereby facilitating the convenience ot the operator in manipulating the jaws while holdinggj the handles in any ot said positions, the jaws being also as unit Serial No. 743,856.

movable angularly into an infinite number oi? different positions, independently of the positions ot the handles. l 1

My invention further comprehends various improvements in -endoscopes and surgical forceps adapted for use therewith, and also improvements upon various combinations of these parts with others as incorporated in a surgical instrument.

Reference is made to the accompanying drawing forming a part of this speciiication and in which like reference characters indicate like parts throughout the several figures.

Figure l is a side elevation of one forni of my improved surgical instrument, in which the torceps jaws are curved, the jaws being here shown as closed.

Figure 2 is a fragmentary longitudinal cross section through the mechanism shown in Figure l. i.

Figure 3 is partly a side elevation and partly a longitudinal section ol' the mechanism shown in Figure 1, various movable parts being shown as they appear when the jaws are open.

Figure 4 is a section on the line 4-4 of .Figure 2, looking in the direction indicated by the arrows.

Figur-e is a fragmentary inverted plan showing another form of my device, in which the forceps jaws are straight, the jaws being here shown as closed.

Figure 6 is a side elevation ot the mechanism appearing in Figure 5.

Figure T is a side elevation of the mechanism shown in Figures and 6, but with the jaws open.

I will first describe the form of my device appearing' in Figures l to 1l inclusive.

r'i barrel S has a general tubular form, and is provided with a portion 9 curved to iiorm a jaw. Another jaw lO, also curved but separate from the barrel, is mounted thereupon by means of a pair of journal necks l1 which extend into a pair of sockets l2, serving as bearings, and shown more particularly in Figure Ll. Thus while the jaw 9 is rigid relatively to the barrel 8 and preferably integral therewith, the jaw l0 is adapted to move relatively to the jaw 9. lThe jaw l0 carries-a. cross pin 13, extending through a slotI ligas indicated in Figure Ll, and encircling this cross pinis an annular bearing l5, provided with an extending port-ion 16. This extending portion is by means of :tas-

tenings 17 secured upon an operating tube 18.

The operating tube is movable back and Aforth in the general direction oi: its own length, and is used tor actuatingthe inovable jaw 10.

Secured rigidly upon the operatingY tube 18 and thus inovable therewith is an operating` sleeve 18', which extends telescopically into an annular head 19 and also into the adjacent end portion of the barrel 8 which is fitted into this annular head, as inay be understood troni Figure 2. The operating` sleeve 18d is provided with a slot 20a. A screw Q extends through the wall o'lt the cylindrical head 19 and the adjacent portion oi' the barrel, and into the slot 20', so as to act as a spline pin. this arrangement the operating sleeve 181L is rendered slidable in the direction ot its length but is unable to turn upon its axis owing to the sere-w 2O litting into the slot QOi.

fin annular head 21 is provided with an annular' portion 23 ot reduced diameter, the annular head 19 beingv similarly provided with an annular portion ot the saine dianiete-r as the portion 28. .ll-i swivel collar 2d encircles the two reduced portions 22 and Q8, and abuts neatly against the adjacent body portions ot the two heads 19 and 21.

The swivel collar Qel carries a handle Aintegral with it, this handle havin` a portion 26 formed into a finger link, as inay he understood more particularly 'troni Figure 1. Another handle 2T, having a portion 28 lorined into linger linli, is n'iounted upon the swivel collar 2d by ineans of a journal pin 29, as shown more particularly in Figures 2 and 8.

rl'he operatingl sleeve 18 is provided with an annular bearin` 80, and the handle 2T is provided with a ball portion 81 fitting neatly into the annularI bearing 30. By this arrangement the handle Q7 inay be .rnoved back and 'lorth upon the journal pin as a center, and when so nioved it causes the operating sleeve 18, carrying,` the operating` tube 18, to be thrust back and lorth in the general direction ot the length oi? the barrel 8.

Since the operating sleeve 18(L is unable to turn because held by the screw acting as a spline pin, and since the swivel collar 24 carrying the vtwo handles Q5 and 27 is free to turn, it follows that these handles an together be rotated around into any required angular position. For ,this prpoee the ball portion 31, ot' the handle 27 inerely glides around in the annular bearing 80, and this is done without disturbing' the position ot the operating tube 18.

The operating sleeve 18, and the adjacent end portion et the operating,Y sleeve 18 cured tixedly thereto as above described, are together provided with a spline slot 82, as indicated incre particularlyv in Figure. 2.

A screw 33 extends through a portion ol the annular head 21 and into this slot and thus serving as a spline pin. By this arrangement the annular head 21 is prevented troni turning, and is maintained always in registry with the annular head 9.

A pair of: connecting pins 84 and 85 eX- tend tangentially into the swivel collar 9.4-, and engage the respective reduced portions 28 and 22 of the annular heads Q1 and 19. For this purpose the reduced portions 23 and 2d are provided respectively with annular bearings 84e and 8o, so arranged that the connectingv pins extend through theni tangentially may be understood troni Fig ures 1 and 2. By this arrangen'ient the swivel collar 2d serves as a coupling between the annular heads 19 and 21 and holds these heads spaced apart by a detinite distance which never varies and yet the swivel collar and parts carried thereby can turn freely, as above described. The connecting pin il is provided with a niilled head 31S and the connecting pin is similarly `provided with a inilled head 3T. Vllhis is t'or the purpose ot facilitating the reinoval, replacement and adjustment ot the connectingI pins.

rEhe barrel 8 carries a hand valve 38, and connect-ed with the lat-ter is a rubber pipe 39, lor supplying water into vthe barrel 8. Siniilarly, a hand valve -lO is inounted upon the annular head Q1 tor facilitating the discharge or '\vatei. l provide the barrel 8 with a pair oi? educts 'a5-1 disposed adjacent the jaws 9 and 10, to facilitate 'the tlow ot water ifroin the barrel 8. lilhen the instru nient is inserted into any cavity ot the body and water is adniitted through the pipe 39 and hand valve 88 into the barrel 8. the water can usually inalte its escape quite Yfreely between the jaws 9 and. 1l); but it the jaws happen to be closed, or so disposed relatively to the adjacent tissues of the body that the water cannot readily uralte .its es cape, it can easily pass through the educts d1. iftlter the water 'tullils its inission, such tor instance as "ashing out vthe cavity, it llows baclnvardiy through the operating tube 18, and thence out through the hand valve d0.

An endosrope extends through the o perating tube 18, and is approriin'iately concentric to the same. rlhis endoscope is ot the kind described in Iny pending` application liled June 25, 1928. Serial Elo. eilig- 239. lt is provided with a prisinoid L13 and a lens 14, the latter serving as a window, and so (zo-operating' with prisinoid that the opera tors field of vision, outwardly 'troni the lens 414i, has the proximate torni olf a cone, the anis ot which is oblique relatively to the 2general longitudinal axis oi' the endoscope.

A miniature lainp e5 is carried upon the distal end of the endoscope, and projects out into the fixed jaw 9. vided with an enlarged tubular portion l?,

r1`he endoscope is proitl Il t) and with a wire 48, the latter being connected with the lamp 45 tor energizing the same. The wire 4-8 is connected with a metallic collar t9, insulated :trom other portions and used for n'ialiing electrical connections.

The endoscope contains lenses, a pair ot which are shown at 50. lhese lenses, the parts 48 and 4.-.9, and the wire #i8 and Aits connectors, are here shown conventionally, as constituting no essential'parts ot' my present invention.

Detachabl y niounted uponthe tubular portion 4-7 is an annular head 5l, carrying a dowel piu 52. An annular head 53, encircling the tubular port-ion l?, is provided with a dowel hole 'i-il: into which the dowel pin tits detachablj.

Engaging the annular head 522 is a coupling link 55, having a threaded engagement with the annular head 2l. l`heannular head 53 carries dowel pins 56., which tits into dowel holes 5T. gasket 555. made preferably ot rubber, eucircles the tubular portion el? and is located between the annu lar heads 2l and 523. *ly removingl the couplingring the annular head 533 and gasket 58 can be removed.

Vlxnrated upon opposite sides ot the metal lic ring ett) are a pair ot rings 59 and (30 ot insulating material, preferably hard rubber. tu annular head (il carried by the tubular portion 4T, and detachably connected ith this annular head. (il is another annular head tti, carrying an indicator knob (33, used as hereinatter described.

Two lenses are shown at (if-t and (S53. the lens 65 serving as an eye piece.

T he parts 51., 532. and wiriousI other parts to the right thereof according to Figure 2, serve collectively the purpose ot a handle tor the endoscope, and enable it to be withdrawn and replaced bodily and as a unit.

With the handle in such position that the dowel pin 52 tits into the dowel hole 54, as indicated in Figure 2, the iiulicator knob G3 always extends in the same plane as that in which the jaws 9 and l() are curved. 'llheretoie liiynoting the position ot the knob :'33 the operator can determine the angular direction in which the jaws extend.

The operators tield o't vision, when loolfg ing through the endoscope and out lthrough the lens 44 at the distal end thereof. is practically in the iorm ot a cone, with its apex iin the lens et and its axis extending oblique ly downward and to the lett according to Figures 1 to 3 inclusive.

The. parts are so proportioned and arranged that when the jaws 9 Aand l() are wide open. as indicated in Figure 3, the operators tield ot vision is at its maximum; or in other words. the hase ot the cone of vision coincides substantially with the opening between the jaws 9 and l0 according to Figure 3. Such being the case, the jaws are for this purpose analogous to a pair ot shutters through which the 'operator cannot see when they are closed, and through which he can see to the extent that they may be opened. The result ot this arrangement is that the operator sees in the same proximate direction in which the jaws extend. The optical eli'ect is about the same as i't-the operators eye were to occupy the position ot the lens del, and the axis ot his field of vision were to extend thence obliquely downward to the lettaccording to Figure 3, so that he could look out between the jaws.

lt t'ol'lows from this arrangement that with the instrument as a unit inserted` into a cavity ot the body and the-operator lool;- ing through the endoscope, any object which he can see plainly is of necessity located directl y in trout ot the jaws and between them, and thencey in favorable position -to be grasped by the jaws. It also follows practically as a matter of course that the operator, in order to gra-sp the object between the jaws, need do little or nothing except close the jaws. Either before or after closing the jaws the operator can determine the location ot the object mentioned, at least relatively to the distal end of the instrument, by merely noting the position of the indicating linob 3, as above described.

It the cavity contains blood, mucous, dirt or other substance tending to obscure the operators vision, he can wash out the objectionable material by the flow ot' water through the instrument as above described.

In the torni ot my device shown in Figures 5 to 7 inclusive the barrel appears at (SU, and integral with it is a straight stationary jaw (lo-acting with this stationary jaw is a. movable jaw G8, also straight. 'lVith this torni oit my device, or even with the other form already described, the water connections may be discarded it' this be desired.

lilith either form of my device the two jaws, itl polished internally, act to some extent as refiectors and thus increase lthe et'- ciency ot the illumination. In the forms shown in Figures l to 4C inclusive, the torni ot jaw 9 is especially favorable .tor this purpose.

The operation ot my device is as t'ollows:

The \f'arious parts being constructed and assembled as shown in the drawing and above described, the instrument is ready for use.

' The barrel 8 being thrust into a cavity of the body, the operator swings the handle 27 into the position indicated for it in Figure thereby causing the jaw l() to assume the position indicated tor it in this figure. `The operator now looks through the endoscope, and by aid lof light from thelamp 45, can see iis-above described.

Having located an object to be removed,

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and if need be having shifted the position ot the instrument slightly in order to bring the jaws into a more 'favorable position, the operator actuates the handle 2T and thus closes the jaws upon the object to be removed. rlhis donev` the operator now carefully removes the instrument trom the cavity, and in so doing brings out the object now held between the jaws.

lit 'for any reason the operator wishes to shift the general position ot' the two handles 27 and 25, he merely swings them around bodily tor this purpose as above indicated, thereby turning the swivel collar 2st as described. There is no danger ot displacing either ot the handles relative to the other, and the handles as a pair can be etlfectively operated in any angular position into which they can thus be turned.

I do not limit mysel't to the precise mechanism here shown and described as variations may be made therein without departing 'l'rom my invention, the scope ot which is coininensurate with my claims.

l claim:

l. ln a surgical instrument the condi-ination oitI a barrel, a pair ot hollow jaws .mounted upon one end ot said barrel and arranger to open and shut, and by so doing to open andiclose said end ot said barrel, means controllable by the operator t'or actuating said jaws, and an optical instrument extending through said barrel and having a tield of vision substantially in the torni o't' a cone outwardly between said aws, in such direction that the axis ot the cone coincides substantially with the plane ot' movement of the jaws.

2. ln a surgical instrun'ient the combination oi a barrel, a pair ot jaws mounted upon one end ot' said barrel, mechanism connected with said jaws and controllalfile by the operator for the purpose ot causing said jaws to grip and in so doingI to close said end ot said barrell` an endoscope separate troni said barrel and extending lengthwise therethrough, said endoscope having a lield ot vision extendingl obliquely `troni the general axis ot the endoscope, said tield ot vision being in the form ot a cone so located that its axis coincides substantially with the plane ot' relative movement ot' said jaws in closing.

il. In a surgical instrument the combination ot' a barrel, a pair ot' jaws mounted upon one end ot' said barrel, mechanism connected with said jaws and controllable by the operator tor causing said jaws to grip and thus to close said `end ot said barrel, an endoscope extending lengthwise through said barrel and having a tield of vision extending obliquely outward trom said open end thereof and between. said jaws when open, said Vtield of vision having the form ot a cone with its axis entirely within the general plane in which said jaws are to be closed.

4;. In a surgical instrument of the character described the combina-tion ot a barrel of substantially tubular form, a jaw rigidly mounted upon said barrel and curved so as to extend sidewise therefrom, said jaw being hollow, another jaw journaled upon said barrel and also curved so as to extend sidewise therefrom, said second mentioned jaw being hollow and movable relatively to said iirst mentioned jaw, operating mechanism connected with said movable jaw and extending through said barrel tor enabling the operator to actuate said movable jaw, and an endoscope extending through said barrel and havingv a tield of vision in the 'torni oiI a cone with its axis oblique to the general longitudinal axis ot said barrel, said endoscope being so positioned relatively to said barrel and to said jaws that said lield ot vision ot said endoscope is bounded by said jaws when open.

5. ln a surgical instrument of the character described the combination of a barrel, a pair ot jaws supported thereby and an endoscope extending axially through said barrel and into proximity to said jaws, an operatingl tube connected with one ot said jaws for actuating it relatively to the other jaw, said operating tube being concentric to said barrel and to said endoscope, and mechanism connected with said operating tube for moving itl bodily bacl-z and torth in order to actuate said ii'iovable jaw.

(i. ln a surgical instrunient ot the character described a barrel ot substantially cylind rical torni, a pair of jaws supported by said barrel, an operating tube extending through said barrel and connected with said jaws, said operating tube beingl movable in the direction et its length tor caiising said jaws to open and close, an operating sleewe mountc-d upon said operating tube and having a portion serving as a bearing and provided 'with an annular groove, a slip collar encircling said operating sleeve, mechanism coacting with said slip collar and connected with said operating` sleeve for supporting said operating sleeve, a movable handle journaled upon said slip collar and provided with a portion extending into said annular groove, so that when said handle is moved back and forth said slip collar communicates motion to said operating tube and causes one of said jaws to be actuated, and another handle mounted upon said slip collar and coacting with said tirst mentioned handle.

'i'. In a surgical instrument ot' the character described the con'ibination ot a barrel, a pair of jaws supported by said barrel, an operating tube connected with one of said jaws and extending through said barrel for operating said jaw, an operating sleeve carried by said operating tube and provided with a bearingl ot annular form, a slip collar encircling said operating sleeve and revoluble relatively thereto, a handle journaled upon said slip Collar and provided With a portion engaging said bearing for causing movements of said ha-ndle to attuate said operating sleeve, and mechanism connected with said slip collar for supporting said operat iing sleeve.

8. In a surgical instrument the combination of a barrel of substantially cylindrical form, a pair of jaws supported by said barrel, an operating tube connected with said jaws for actuating said barrel, an annular head encircling said barrel and secured rgidly thereto, another annular head encircling said barrel and loose relatively thereto, an operating sleeve mounted rigidly upon said operating tube and having spline connections lto said first mentioned annular head and to said second mentioned annular head in order to prevent each annular head from turning relatively to the other or to said operating sleeve, a slip collar engaging said operating sleeve and portions ol said annular heads, said slip collar being revoluble relative-v ly to said operating sleeve and to said annular heads, and a pair of handles carried by said slip collar, one mounted upon said slip eollar and other journaled upon said slip collar and movable relatively thereto, said last mentioned handle being connected with said operating Sleeve and movable for the purpose of actuating theflatter.

Signed at New York, in the county of and tate of N. Y., this 14 day of October, 1924.'

REINHOLD H.y VVAPPLER.

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