US1971024A - Instrument for electrosurgical resection - Google Patents

Description

Aug. 21,1934.

F. C. WAPPLER.

INSTRUMENT FOR ELECTROSURGICAL RESECTION File d Jan. 25, 1932 2 Sheets-:Sheet l IN V EN TOR,

A TTORfiY 1934- F. c. WAPPLER 1,971,024

INSTRUMENT FOR ELECTROSURGICAL RESECTION Filed Jan. 25, 1932 2 Sheets-Sheet 2 Patented Aug. 21, 1 934 OFFICE iNs'rRUMENT 'Foit ELECTROSURGICAL EsE T ON Frederick Charles Wappler, New York,-N; Y.

Application January 25,

1932, Serial No. 588,602

- Mypresent invention relates generally to surgery, and hasparticular reference toa surgical unique characteristics lo the deep urethra or bladder neck, caused, for

' an instrument by means'of which internal protrusions or the like may be subjected to treatments which result in their elimination, more especially by a resection orexcision accomplished by electrical means; the treatmentbeingaccom- '25 plished under illuminated vision and ma highly expeditious and simplified manner.

One of the features of my invention'lies'in the provision of an instrument whereby an excision may be effected in a direction substantially transverse to the axis of the cavity in which the protrusion exists. It is a specific feature of myinvention to provide an operative electrode whose construction and arrangement are such that after the protrusion, or any part thereof, hasbeen engaged, as, for example, within the fenestra of an endoscopic tube, the engaged mass may .be cut or excised from the cavity wall by a transverse movement, of the electrode. e

One of the main objects of my present improved 40 instrument lies in the provision of means-for resecting masses which: are larger thanthose which have heretofore been capable of excision by an instrument of thesame size.

A particular feature of my invention lies in an arrangement whereby an operative electrode wire or the like is normally adapted to be positioned yvithin'the confines of the instrument, but isfso constructed and mounted that during its movement it will be caused to emerge from the instrument.

with 'means for sweeping the electrode wire through a transverse are which extends out of the-fenestra. The-instrument is so constructed that the total sweep ofthe electrode wire is approximately'270, and during its movement the wire emerges from the fenestraat one lateral edge thereof and-reenters the fenestra adjacent to the opposite lateral edge.

\ onset the features of construction whereby this desirable effect'is achieved liesin the provision of a longitudinal spindle whichis journaled in the tube along an axis-"which is offset with respect to the electrode wire. The spindle is mounted in spindle bearings which are arranged. forwardly and rearwardly of the 'fenestra, respectively, and the'electrode wire is connectedat "its forward and rearward ends, by means of crank portions, with'thespindle proper. v

f Another feature of'construction lies in an improved means for efficiently and conveniently effecting the desired'rotation of the spindle, preferablybymeans of pinions or the like arranged. at the rear endofthe instrument. r A further feature lies in the provision of an arrangement whereby the position 'of the operative electrode wirefwith respect to the tube fenestra, isconstantly indicated on the exterior, -and preferably, at tlie 'rear, of the instrument,

Another feature lies in the manner whereby 'theuninsulated, operative electrode wire is adapted'to' be' electrically connected, in an insulated 'mannerfwithan electric terminal arranged at'the rear portion of the instrument, this being necessarily accomplished in a way which does not interferewith the contemplated rotative' movements of the spindle hereinbefore referred tol'f" 1 v y g Preferably, the spindle is constructed as a hollow member; and the electrode wire isforme d 'anintegral portion of a longitudinal conducting 'member which extends rearwardly through the'hollow' spindle and is ensheathed in insulationc a Other featuresof my invention lie in the association with an electrode tube of the foregoing general character of means for irrigating the area under treatment, together with means for arranging and mounting a telescope to permit a fulland efficient view of the operative procedures. r 1 z Ni In general, itisan object of my invention to provide an instrument which is not only "simple and reliablebut: which is highly efficacious in fulfilling its-contemplated function; to? provide a compact and workmanlike mechanism capable Figure 1 is a longitudinal view of an assembled instrument of the present character, taken from the fenestrated side of the tube;

Figure 2 is a similar view takeri substantialli along the line 2-2 of Figure 1, with parts shown in section and other parts-omitted. fo1',,the sake of clearness;

Figure 3 is an enlarged, -transverse view; taken 1 substantially along the line 33 of Figure 1 Figure 4 is an enlarged, cross-sectional view; taken substantially along the. line i t of Fig: ure k eu efi i er at yce l reed f agmen a y, longitudinal section, takenin. -the same direction a i u .1- .2 a; F re. .6 is a g e -e a ed; fra mentar lon itudin l,- sec ion. ta en ubs antia rthe direction of Figure 2; :,J l F gur s :71. 8.; a d ;;a :e-,.. arsed, cr ss-5. ti na v ws, ,.-ta n bs nti ll al n lth lin 8,. o igurefi, andshow n th operat v al abi ie of-r thep ent n t umn tan 1 Figure l0; is a cross-sectional view, taken subntia y al nefth -1 ne;.-. 1. i red 1 h r e .i m nt ncl des a puberta- .dos op tub 20, 1pr erably-b :in ul n mater .rial such as. ba elit a d-prov ded a t orward end with, a substantially. lateral fenestr a 21;, At its rearaend, this tube is attached, as, by screw threads, with agcgllar 22;, vided-.with h r ar flange 3.1. 1 a QBQJH QF .vid d with. a p oc Zil' hTQUShWhiC a tiviatine qui may p ss Th flan -@31 8 i f-Q lv d with an pe n 2.5 apted t re e ve forwardly projecting p n ZGearried by those parts of .the instrumentwhich areto be inserted into the tube20 v Th pi is u ted on x n t hi h. a a td to fi s u y and n m otativly thint tube 20. This unit comprises a: collar 2f7; adapt ed to abut against the rearsurfaceof the flange 23 a d p o ded t .th at l;b0$ .2 h Qh carries the pin 26, and also with the lateral boss 29 whichcarries the: meshing pinions 30; and 31. F wa f he co a 7 is a por i n .32 ad p ed ,tofit snugly into the rear of the borevof; t he collar 22. Projecting forwardly from; the.portion 32 is a bundle of three tubes 33,34, and 35. Thetube 33-is adapted toaccornmodate atelescope presently to be described} 'I'hetube 3 5 is adapted to accommodate, and. serves as one of the bearings of, thelongitudinal spindle herein,- after to be described in greater detail. ,The tube 34 is somewhat smaller. thanthe others .and is an irrigation tube, communicating iatiits rear'end with a second petcock 36 mounted upon the portion 2'7. a

It will be understood thatthe portionszzfl and 32 are provided with bores whdchcommunicate with the tubes 33 and 35.

Projecting rearwardlylfrom the portion 2'1 is the send-circular:guide '37 which .is aligned with the tube 33 and is'a'dapted-to encompasst-he telescope. The guide 37 connects-at its rear end with the insulating block 38 which-carries the-electric terminal 39. Attached to the rear of the block 38, preferably by means of a stud 40, is the clamp bearing 41 for the telescope.

The telescope which I employ is preferably of the type illustrated and described in United States Letters Patent No. 1,680,491, being provided with an illuminating lamp 42 at its forward end and an objectivelens 43. which commands a forwardly obliquefieldof vvvision. The,tubular -bocly portion of the telescope is designated by the reference "nu'inerai 44 and extends longitudinally through -'-,.the tube 33, through the portions 32 and 2'7,

through the guide 3'], the block 38, and the clamp jand'terminatesat its rear end with the usual eyepiece 45 and with the terminal members 46 to which;suitableelectrical connection may be rnade, as at 47, for operating the lamp 42.

-- The tubes-=33;34-;and 35 terminate at their forwardends, at substantially the same point, viz.,

slightly behind the fenestra 21. At this forward nd, -th ,tu s: .33 anlfifx are smereediinto inte ral asso iation Wi h. a :sle v-e ..:4.8: which: fi s nu ly .within the confines; -of the outer endoscopic: tube 20. This sleeve is integrally associated at its fore ward end-with, the portion ,49 which lies. adjacent;

52 me e 311 8 mila c an p t onrfitwhicb conne ts with-theql n itudin .3 nd qti meme b rfidar ansed in a ial a nm nt with,- ube 535: andextendin rea w rd1y th ou h halatten. ..'l enductiv mem r 5.5 is e sh a h d. i th insu ation fi md;the at e is .e c s dw hi an a r or e; 5.7 0 .me. a t1 be 5. s snugly yet rotatably mounted within the bearing; .tube .35 and; xtendsi thr u h-the. lat er, th ou :the o tions; 32 a d 27,. and. then e reanward y :in

the; block-38in the manner most;clearly illustrated-. n-F s IQa w tw e the block. 3 a dthecollar .7 ther is arranged a rotatable sleeve 58, through which the .tube 57zpasses-and towhich it is secured -.by means 10f the set screw 59. The screw 59:and the sleeve :58 rotate alongwith' the tubeo'r spindle-57-.: At-its forward 'en'dpthe sleeve-'58 is provid'ed with the teeth 60, these teeth forminga pinion which is adapted to mesh-with t hef'gear wheel or 'pi i jaLl i.- :2. r I One "of the features-of invention liesinatranging the set screw 59 in alignment with"the electrode wire 52 whereby: the screw will s rve afviSib l'ej external indicatmn; gr pofsition ofth' ,Wire' '52. 1111 Figure 1.v or examplethe screw/ ests directedfdownwa'rdly, and thisfindi sates 'thatfthe: 'eIF tIOde wire 52 r is also'fdirecte'd gd nw f H In the V bigggtendsgbut whereas the. tube 3'7 .termi'natesas a la he in u at ete s. isx e d ree for i-a slig ht-ly greater extent, and the conductive member 55 extends rearwardlyifor,afurther ex; t t in w o a n i h; a-eqnslue irefbi s ie block38 is a bore 61 into theiube iii.

:or the like '63 which is electrically connected with the electricterminal 39. 1 v

It-will thus-be seen that there is a continuous electrical connection between the terminal 39 and the electrode wire. 52, this .being: accomplished through the intermediary of the longitudinal conductive member- 55. When the member 55 rotates,- along with the insulation '56, the tube 57, and thesleeve 58, this electrical connection remains unimpaired. 1 7 3 .rAtits forward end, the insulation 56 is caused to extend for a substantial distance along the crank portion 54, as indicated in Figure 6. This is an important feature of construction because it prevents the conductive member 55 from independently rotating with-in the insulation tube 56.1 When the instrument is used, the-outer endoscopic tube is first inserted into the body cavity with the aid of an obturator. The telescope is then. arranged in association with the unit which is tobe inserted into the tube 20. (The electrode wire and its associated parts are permanently connected with this unit.) The obturator having been removed, this entire-assembly is inserted forwardly through the tube 20and is properly positioned with respect to the latter by means of the engagement of the pin26 with the flange 23. During this insertion, the. control wheelz'30 is manipulatedsoas to position the .electrodewire .52 in one or the other of its normal positions within the confines of the in} strument, for example, the position of Figure 7.01- .that of Figure '9; The necessary electrical connections are then made, it being understood that the terminal 39 is connected with one terminal of a suitable source of high-frequency current, while the patient is either grounded or suitably connected with the other terminal of the high-frequency source. After the necessary electrical connections have been made and the desired irrigation, if any, has beenefiected, and after the protusion has been accommodated within the fenestra in readiness for the excision, all this being accomplished under illuminated vision by virtue of the telescope arrangement, the Wheel is rotated by the operator. This effects a rotation of the spindle constituted of the tube 57 and the insulation tube 56, and this rotation of the spindle causes a corresponding rotation of the conductive member and of the electrode wire 52.

By virtue of my present construction and arrangement of parts, the foregoing manipulation causes the electrode wire 52 to sweep through a transverse are which extends out of the fenestra 21. The approximate sweep of the electrode wire is indicated most clearly in Figures 7-9 by the dot-and-dash lines 64. It is to be noted that the wire sweeps through approximately 270; that it emerges from the confines of the instrument at a point closely adjacent to one lateral edge of the fenestra 21; that it reaches its maximum emergence in the position of Figures 6 and 8; and that it reenters the instrument adjacent to the opposite lateral edge of the fenestra 21.

This sweep of the electrode wire causes a re- 5 section or excision of a mass larger than any which has been heretofore possible of accomplishment by an instrument of the same general character and size. The present instrument has been successfully employed in the excision of masses having a length of the order of an inch and a thickness of over five-sixteenths inch. These masses are removed by withdrawing the entire assembly rearwardly through the tube 20. To facilitate this withdrawal, the forward en- .'Ihe;-procedure;..may be repeated with: equal 3 facility 'after the excised mass has been removed;

and during each operation the functioning ofthe instrument is characterized by the remarkable rigidity-of the rotatingaelectrodewire and by the exceptionally: smooth. out; which it effects.

. @It will thusb'e seen that I have provided an instrument of relativesimplicity; whose operative ,characteristics ;are of an, efficient and desirable-character; and which is reliable and highly efficacious in fulfilling its. contemplated fun i ns.. u .In general,.,it will-be obvious that changes in the details". herein describedand illustrated for the purpose of explaining the nature of my invention may-be :made bythose skilled in the art without departing from the spirit; and scope of the inventionas expressedinathe appended claims. Itis therefore intended that these details be interpreted as illustrative, and not in a limiting 6 :1 ;--Having thus described my invention, and illustrated its use,w hat I claimas new and-desire to secure by Letters Patent ;i s-- ;,;1. In an instrument .of the character. described, atube having a lateral fenestra, a longitudinal electrode wire normal-1y within the confines of the tube adjacent-to said fenestra, and means for, sweeping said wire through a transverse are extending .out of the ifenestra and beyond the confines of the tube. a

2. In an instrument of the character described, a tube having a lateral fenestra, a longitudinal electrode wire normally within the confines of the tube adjacent to said fenestra, and means for sweeping said wire through a transverse arc extending out of the fenestra and beyond the confines of the tube; said means comprising a longitudinal spindle journaled in the tube along an axis ofiset with respect to said electrode wire, and a crank portion between said spindle and said electrode wire.

3. In an instrument of the character described, a tube having a lateral fenestra, a longitudinal electrode wire normally within the confines of the tube adjacent to said fenestra, and means for sweeping said wire through a transverse are extending out of the fenestra and beyond the confines of the tube; said means comprising a longitudinal spindle journaled in the tube along an axis offset with respect to said electrode wire, spindle bearings arranged forwardly and rearwardly of the fenestra, respectively, and a crank portion between the rear end of said electrode wire and said spindle.

4. In an instrument of the character described, a tube having a lateral fenestra, a longitudinal electrode wire normally within the confines of the tube adjacent to said fenestra, and means for sweeping said wire through a transverse are extending out of the fenestra and beyond the confines of the tube; said means comprising a longitudinal spindle journaled in the tube along an axis offset with respect to said electrode wire, spindle bearings arranged forwardly and rearwardly of the fenestra, respectively, a crank por- 1 5. In an instrument of the character described, i

a tube having:v a; laterali fenestra, a "longitudinal electrode wire nnrmally' mthin, Ethel-confines of the tube adjacent: to said fenestrmandl meansifor sweeping said wire outwardly beyond ti'ie confines of the tube through atran-sverse are which emergesrfrom the fenestrabat; one lafieratxedge thereof and reenters the fenestraat' the 011130;- site lateral edge; said means comprising a longitudinal spindle journaled i'm'the tube along: an axis ofiset with respect toe" said electrode: wire and substantially equidistant from the lateral edges of said fenestra-and a crank portion beitw-eensaid spindle and said electrode: wire.

6. In an instrument of the character described, a tube having a lateralfenestra; ar-longitudinal, uninsulated electrode wire normally within the confines of the tube ad-Jfacent tosaid fenestrm'an electric terminal at the rear of said tube; means for sweeping said wire. outwardly-beyond the confines of the tube through atransverse arcfextending out of said fenestra; said "means compris ing' a longitudinal, hollow spindle journaled in the tube along an axisoff'set with respect to said electrode wire-and acrank portion between said spindle and said electrode wire; and means 'ex tending throughsaid spindle for establishing an insulated electrical -connection between said terminal and said wire-. 7 l

' '7.- Inani-ns'trument ofthe character described, a tube having alateral fenestra; a longitudinal, uninsula-ted electrode wire normally with'in the confines of the tube adjacent tosai'd fenestra, means for sweeping said'wire through a transverse are, said means comprising a longitudinal,

nneres hot-law spindle vjienrhealed.- in the tube. along: an axis oilset with respect tdsaidel'ectrode; wire and crank-connected; ta'the latter; an electric: terminal at the rear of the; tubev and providediwithaa conductive. hearing alignediowith said spindle, and means. extending through, said spindle. and journaletd'; in: said'bea-ring for establishing an-irrsula-ted electrical connection. between; said terminal and said wire. 4 I I 8. In an instrument of the character described, a tube having a lateral fenestra, a longitudinal conductive; member journaled in the tubeand provided witlran integral, oflset electrode: portiorr arranged tdlie adjacent" td said fenestra, and-means fer rotating, said conductive meniber to' sweep said. electrode portion: through a transverse arc across said fenestra; said elec.* trode; portion being; so constructed. and. arranged as-to lie normally within the confines, of the tube and to sweep out of the. fenestraand beyond 7 the confines: of the tube duringrotation of said conductive member. 1 1 a 9.. In an instrument of the. character dc scrihech a; tube: having: a lateral. fenestra,. alongitudi-nal member journaled in the tube. and provided with an, offset electrode portion arranged torlie normally within the confines of: the; tube adjacent. to said fenestra, and means for rotating said: member to sweep said electrodeportion .througha. transverse arc, saidelectrode. portion being so. "constructed and arranged. that. it. will move through; the fenestra and outof the; confines-of the tube during rotation of said member.

.' FREDERICK-CHARLES -WAPPLER.

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