US2002559A - Means for surgical resection - Google Patents

Description

May 28; 1935.

F. c 'WAPPLER I 2,002,559

MEANS FOR SURGIGfXL RESECTION Filed April 15, 1932 {IQ/9'1 a 26 a?! INVENTOR Patented May 28, 1935 I MEANS FOR SURGICAL RESECTION Frederick Charles Wappler, New York, N, Y. Application April 13, 1932,"Se! 'i2tl N0. 604,934-

5Claims. (ohm-4,9);

My present invention relates generally to surgeryand has particular reference to anew and improved type-of instrument of unique characteristics and-capabilities to be used for alleviating 5 obstructing protrusions of body cavities.

' Although my invention is directed primarily towards the alleviation: of ailments due to protrusions, neverthelessit will be understood that from its broadest aspects my invention is useful generally for avariety of types of resection or coagulation of tissue by means of suitably generated high frequency electric current. vention is useful for the alleviation of tumor massesor the like constrictions in general; A typical Thus, my inor treatment and of neoplasms and example of the uses to which my present method and instru mentare particularly adapted lies in the alleviatlon ofprotrusions inthe deep urethra or bladder neck-caused for example by enlargement or ailmentsof the prostate gland.

A general object of my invention is to provide a novel method and. instrument for permitting disorders of the character mentioned by -means of a comparatively capable of performance under vlated or treated simple operation, I only local anaesthesia, practically h character, and of short duration.

My invention 1510f leviate protrusions and resecting a sort of channel or groove protrnsionor constriction; and it is feature of my invention to accomplish this ob-- jective inasimplified manner which involves the to be. alleemost'atic in the type which seeks to althe like by electrically through the a particular mere provision of a slit through the cavity wall portion which is under. treatment.

it is an object of my In general, provide a method of treatment and invention to a particular type-of surgical instrument which is not only simple and reliabl'ejbut which is highly efficacious in fulfilling its contemplated functions, and

is suitably provided with means-for ing suitable irrig which accomplishation and permitting; complete illuminated visibility of the site Eof operation; and

wherein the ihstiulnefit is a compact and workmanlike' mechanism capable of manufacture in a practical and commercial manner adapted to be expeditiously constructed, assembled, adjusted,

and manipulated.

One of the characterizing features of a preferred embodiment of means for protruding the electrode my invention lies the provision; of a fenestrated endoscopic tubean'dj a wire electrode normally in a retracted position within the confines of 'tnetube, together with a.

of the 'fene'stra' and "substantially parallel to itself ment embodying the features of present 'invention.

FigureB is aview taken from the bottoi'n' of Figure 2, and v Figure 4 is an end view taken from the left of Figure 2. p

In Figure 1 I have Shown arear portion ID of a suitable. endoscopic tube which is provided at its forward end with a substantially laterai'rerlestra II. "The tube It terminates in sleeve-'12 'ahcl flange 13, thesleeve I2 being adapted to facilitate the removameassociation with the tube In or an interior operative member presently to be described. 'I'he'sleve I2 is also preferably 'pirovided with the pet cock- 14 forming a part of the irrigation Q i 1 The. interior member may consist of any Silitable arrangement or su pc tingpa'rts, and Ihfave ltyand i1 new in unitary reiauonship by eans or the rorward sleeve l8,- the latter having a forward extension ,ltwhich fits snugly against the walls of the tube HI adjacentto thefenestra-l I. When the interior member isposition, the ex- 5 tension l 9 formsvirtually a part of the endoscopic when. J

The tube [5 is adaptedtoaocommodate a suitable telescopezfl' "hich is prefr'ablyof the charaCter described and illustrated in U. 5. Patent N9. 4 1,680,491, 'afil lfiimlhatihg lamp?! being mounted at'thejeiitreirie forward tip of the telescope, and the objective lens 22 arranged slightly to the rear of the lamp 21 and commanding an obliquely forwar'dfieldo-f vision. Atthe rear, the telescope 2 D is provided with the; usual eye-piece 23, the elecme termina rings 24,and suc other mechanism, such aspin' 25 forfacilitating the manner in which thetelescope is held in proper position.

The tube [6 connec' et cock 2'6 and orms part of the irrigating ts at its rear end with the a retracted position 7 terminal of the high its rear end, the rod 21 may be provided with a rack 28 adapted to be engaged by a. pinion 29 operated by means of a control wheel 30 or the like. This mechanism is merely typical of a variety of possible arrangements for enabling the operator to move the rod 27 longitudinally in accordance with the desired operation or functioning of the operative electrode. The rod 27 is also preferably caused to convey the electric current to the electrode at its forward end, and I have therefore illustratively shown the electric terminal or binding post 3! at the rear end of the rod 27.

In accordance with my present invention an electrode wire 32 is arranged at the forward end of the endoscopic tube adjacent to the fenestra I I. This wire is normally in the position designated by the dotted line 33, whereby it lies normally in tube It. The wire 32, is, in the illustrated embodiment, arranged longitudinally with respect .tothe instrument as a whole.

My present invention contemplates a bodily movement ofthe electrode wire 32 out of and back into the fenestra H as indicated most clearly in FigureZ, the'extreme outer position being approximately designated by the dotted line 34. To accomplish this contemplated movement of the electrode, I articulate it with a suitable parallel motion mechanism which is controlled by longitudinal reciprocations of the rod 27. I prefer to provide the construction herein illustrated, whereby the opposite ends 35 and 36 of the wire 32 are pivoted to the two links 31 and 33 respectively, these links being substantially parallel to each other; and having their rear ends pivoted to extension l9 forming virtually a part of the endoscopic tube IE3; The forward end of the rod 2'! is pivoted as at 39 to the rear link 38 so that axial movements of the rod 21 will rock the link 38 within the range approximately indicated by the dotted positions Hand 34. Obviously the rod 27 is resiliently flexible, especially at its forward end, so as to permit it to function in the manner de-' scribed.

Upon referring to Figures 3 and shit will be observed that each of the links'3'l and 38 is bifurcated at its rear end so that the pivotal mountings 40 and, are arranged along opposite sides.

of the endoscopic tube. This construction not only enhances the visibility afforded by the telescope 20 but it permits the instrument to be constructed in a compact and workmanlike manner whereby the links 3'! and 38 are caused to straddle or extend around the telescope 20 as indicated most clearly in Figure 4.

In practicing my present invention, it will be understood that an electric connection is'established between one terminal of a suitable source of resecting current and an indiiferent electrode contacting with the patient at some suitable point. Under certain circumstances the endoscopic tube I 0 may itself serve as the indifferent electrode. In this way, one terminal of the current source is connected electrically with the cavity wallor protrusion which is to be treated. The other frequency source of current is connected with active electrode 32, for example by means of the binding post 3! Where the tube I0 is used as the indifferent electrode, the active electrode 32 is suitably insulated from it, as by forming extension i9 of insulatingmaterial and properly insulating the control rod 27. Where the relatively remote indifferent electrode is employed, the tube It is preferably composed of insulatingmater 'al, and insuch an event, the use within the confines of the of a proper type of alternating current will not necessarily require that the electrode 32 be mounted in insulated relationship to the extension I9, the control device 353, or other portions of the interior member.

It will also be understood that proper connections to the pet cocks will be made, where desired or necessary, so as to submerge the portion to be treated under a suitable liquid such as water.

All of the foregoing procedure as well as the subsequentoperative procedures may be carried out under well illuminated full vision.

After the protrusion or similar cavity wall portion or constriction has been properly exposed within the illuminated vision of the telescope and in the range of action of the electrode, the con trol device 39 is manipulated to withdraw the rod 2? rearwardly, thus serving to rock the link 38 and causing the electrode 32 to protrude laterally out of the fenestra in a direction substantially transverse to its own axis. This movement causes the electrode to move substantially parallel to itself whereby an entirely novel and highly efficient result is accomplished by virtue of the fact that the electrode wire 32 encounters the protrusion or cavity wall in a broadside manner. This encounter permits the electrode wire 32 to be advanced bodily against and into the exposed cavity wall portion, whereby a single operation results in cutting a longitudinal slit through the obstruction or constriction. The type of current employed renders this operation entirely hemostatic and accomplishes this in a rapid and simple manner which requires only local anmsthesia. The electrode is immediately withdrawn into its normal retracted position after the desired slit, has been cut, whereupon theinstrument may be withdrawn and the operation is complete. The formation of 7 obstruction, inasmuch as a longitudinal channel or groove has thereby been formed in the obstruction. This alleviation is accomplished, as will be understood, without any necessity for actually excising any of the tissue, although obviously the protruding movement of the electrode may be accompanied by a lateral movement or movements (by rotation of the entire instrument) to accomplish such particular objects as may be found necessary under particular circumstances.

I am aware of the fact that the protrusion of an electrode laterally out of the fenestra of an endoscopic tube is not broadly new; and I wish to point out that the characterizing feature of my present construction lies in the fact that the electrode wire is arranged ina plane that may be said to be substantially parallel to the plane of the fenestra. In this way,-a lateral movement of the wire, parallel to itself, permits the wire to be applied broadside against the cavity wall which it encounters.

It will be understood that the arrangement of the electrode wire in the longitudinal relationship shown is not necessarily the only arrangement whichfalls within the purview of my pres-. entinvention, the essential characteristic lying in the fact that the electrode wire is moved bodily and in a substantially lateral direction out of the fenestra so as to encounter the exposed cavity wall portion in a broadside manner.

In general, it will be understood that the details of construction, such as the particular shape and arrangement of the electrode, and the particular manner of controlling the movements of the same, may be modified in a variety of ways the slit results in alleviating the by those skilled in the art, without departing from the spirit and scope of the invention as expressed in the appended claims.

Having thus described my invention and illustrated its use, what I claim as new anddesire to secure by Letters Patent is 1. In an instrument of the character described, a fenestrated endoscopic tube insertable into a body cavity, a wire electrode substantially parallel to the tube axis and arranged adjacent to said fenestra in normally retracted position within the confines of said tube, and means for moving said electrode laterally out of said fenestra; said means comprising apair of parallel links pivoted to opposite ends of the electrode respectively, the other ends of said links being pivoted to the tube, and control means extending rearwardly along the tube and adapted to rock at least one of said links.

2. In an instrument of the character described,

a fenestrated endoscopic tube insertable into a body cavity, a wire electrode substantially parallel to the tube axis and arranged adjacent to said fenestra in normally retracted position within the confines of said tube, a telescope within said tube behind said electrode and commanding a view of the fenestra, and means for moving said electrode laterally out 'of said fenestra, said means comprising a pair of parallel links pivoted to opposite ends of the electrode respectively, the other ends of said links being bifurcated to straddle said telescope and being pivoted to the tube, and control means extending rearwardly along the tube and adapted to rock at least one of said links.

3. In an instrument of the character described, a laterally fenestrated endoscopic tube insertable into a body cavity, a wire electrode adjacent to the fenestra and normally in retracted position within the confines of said tube, said wire being arranged in a plane substantially parallel to the plane of the fenestra, an electric binding post at the rear of said tube, means for conducting a high-frequency current to said wire from said binding post, and means for moving said wire, substantially parallel to itself, laterally out of the fenestra and back again.

4. In an instrument of the character described, a laterally fenestrated' endoscopic tube insertable into a body cavity, a wire electrode adjacent to the fenestra and normally in retracted position within the confines of said tube, said wire being arranged in a plane substantially parallel to the plane of the fenestra, an electric binding post at the rear of said tube, means for conducting a high-frequency current to said wire from said binding post, and means ior moving said wire,

substantially parallel to itself, laterally out of the fenestra and back again; said means comprising aparallel-motion mechanism articulated to said wire, and control means extending rearwardly along the tube. V

5. In an instrument of the character described, a laterally fenestrated endoscpoic tube insertable into a body cavity, a wire electrode adjacent to the fenestra and normally in retracted position within the confines of said tube, said wire being arranged substantially parallel to the tube axis, an electric binding post at the rear of said tube, means for conducting a high-frequency current to said Wire from said binding post, and means for moving said wire, substantially parallel to itself, laterally out of the fenestra and back again.

FREDERICK CHARLES WAPPLER.

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