US2442966A - Electrosurgical resecting instrument - Google Patents

Description

June 8, 1948.

F. J. WALLACE ELEGTROSURGICAL RESEC'I'I NG INSTRUMENT 3 Sheets-Sheet 1 Filed Sept. '7, 1946 R um g @Ua Q R INVENTOR. FEEDER/6W] MAL/10E ATTORNEY June 1948.

F. J. WALLACE ELECTROSURGICAL RESECTING INSTRUMENT '3 Sheets-Sheet 2 Filed Sept. 7, 1946 INVENTOR. JVVALLAOE A TTORNE'Y &

FFTEDER/CK a Q N in G 5% m wx \Wwk m m Q IMLINS m \S v i f mi June 1948. F. J. WALLACE ELECTROSURGICAL RESECTING INSTRUMENT Filed Sept. 7, 1946 '3 Sheets-Sheet 3 JIIIIIII NNT LQN III JNVENTOR. FPEDER/C/r J VWILLAOE 4 7 k ATTORZSEY Patented June 8, 1948 ELECTROSURGICAL RESECTING INSTRUMENT Frederick J. Wallace, New York, N. Y., assignor to American Cystoscope Makers, Inc., New York, N. Y., a corporation of New York Application September 7, 1946, Serial No. 695,513

14 Claims. (01. 128-30315) This invention relates generally to electrosurigery and has particular reference to an electrosurgical resecting instrument adapted to be advantageously employed for the removal of protrusions, tissue growths and the like with the aid of pable of readily removing protrusions, tumorous growths or other masses of body tissue that may be on the exterior of a body or within body passages or cavities. In this connection, the present invention is well suited for the speedy resection of protrusions in the urethra and bladder neck and for the excision of undesirable growths on the prostate gland and other internal organs.

An instrument constructed in accordance with this invention may be inserted in a body passage or cavity to the region of a protrusion or the like' which is to be removed, whereupon the protrusion may be resected by a high frequency reciprocatory cutting electrode under conditions of illuminated vision. One of the features of the invention resides in the provision of acutting electrode adapted to be reciprocated continuously and automatically to the end that the protrusion or tissue growth may be quickly and readily resected with a minimum of effort and strain on the part of the operating surgeon and with cor-' responding reduction in discomfort and nervous efiect on the patient.

In present-day high frequency electrosurgical instruments employing a reciprocable cutting electrode, the cutting electrode is manually operated by the surgeon to thereby cut away a piece of a protrusion on each movement of the electrode. This procedure is objectionable for a number of reasons. For one thing, the resection or excision of a large mass of tissue by making small individual cuts is both tedious and time-consuming. Also, the operating surgeon is under a considerable physical strain and nervous tension, as he is obliged to manually actuate the electrode for each individual cut in pruning away a mass of tissue growth. Additionally, the patient is generally under considerable strain during an operation of this character and is often subjected to great pain and discomfort due to the presence of with instruments of thisgeneral character.

the instrument in hisbody and as, a consequence of the operationof the instrument...

Several: worthwhile .developments have been made in comparativelytrecentyears in connection For example, F. C. Wappler-Eatents 2,038,393, granted April 21, 1936, and.2,090,923,.granted August 24,

1937, both disclose endoscopic instruments that are provided with reciprocable,cuttingelectrodes. In accordance with the teachings of these patents, it has been the general practice heretofore to manually actuate the cutting electrode ,by imparting movement, thereto through the medium of arackand .pinion'device; Instruments of this type require that the operating surgeon employ one hand to hold and control; the instrument as a unit and his other hand forthe actuation of the cutting electrode. Both of the operating surgeons hands are thus occupied with thehandling of the instrument, and the surgeon is thereby unable to conveniently use his hands for other purposes, such as for the palpation of the prostate gland, as may be necessary in many instances.

My present invention ,obviates the diificulties experienced heretofore, as will be apparent from the detailed; description further along herein.

One of the outstanding features of this invention resides in theprovision of an instrument of the character indicated having the parts so constructed and arrangedthat the operating surgeon can handlethe instrument and control movement of the cutting electrode by using only one hand, the surgeon's other hand being free for manual palpation orfor other purposes, as required. To this end the instrument includes a rotary driving unit and suitable means for translating rotation of the driving unit into reciprocation of the cutting electrode, alliarranged'within the instrument grip or handle and under the control of the operating surgeon at all times; and therefore capable of being readily placed into and out of service at will. Iv I s It isanimportant object of this invention to provide an improved electrosurgical resecting instrument of the type having a reciprocable cutting electrode.

Another object'of the invention is to provide an instrument of thecharacter indicated wherein a reciprocatory cutting'electrode is actuated by a. driving unit carried by the instrument and adapted to be placed into and out of active service at the will of the operating surgeon.

Another object .of the invention is to provide a high frequency electrosurgical instrument having parts constructed. and arranged so that the op- 1.10 by apair of screws 3! and is provided with a vision of an instrument of the character indicated,

including a reciprocatory cutting electrode that is adapted to be actuated through the mediumot.

a rotary driving means.

A still further object of the inventionis'toprovide an electrosurgical instrument of-the type indicated that is simple and attractive in design; staunch in construction and dependable in operation.

With the above andiother objectsinsview, the invention comprises the .devices, :combmations and arrangements oftparts set' forth in; the following detailed description and. illustrated in the annexed drawings of preferred embodiments .of the invention, from which theseveral. features of the inventionptogether *with:the=:advantages attainable thereby, will be readily imderstood by persons skilled inthe art.

In the drawings, wherein like referencenumerals denote corresponding parts-throughout the several views:

Figure 1 isasideelevatiorr view of one embodimentof an instrument constructcd -in accordance with this invention, with parts "broken'awaytfor better illustration;

Figure 2 is a top plan view of theinstrument illustrated in Figure l;

Figure 3 isan enlarged cross-sectional view taken along line 3-3 of Figure 5;

Figure 4 is across-sectionalview'taken along line 4-4 of Figure 6;

Figure 5 is an enlarged longitudinal-cross sectionalview of the instrument shown in Figure 1;

Figures 6, 7 and -8"'-al:8-61'0SS'-SCtlOIlBl views taken along lines '66,'11 and 8- 8,"respectivcly, of Figure 5; a

Figure 9 is an enlarged fragmentary crosssectional view taken along line-9'-9-of"I-igure- 1;

Figures 10 and 11- are cross-sectional views taken along lines iU--l 0 and I ll I, respectively, of Figure 5;

Figure 12 is illustrative-of a-second'iembodiment of an instrument constructed'inaccordance with this invention and corresponds generally t Figure 5; and

Figures 13 and 14 arefragmentary cross-sectional views taken along lines l3-43and M--H, respectively, of Figure12.

Referring now to the drawings andmore-particularly to Figures-l, 3, 5 and 6 thereoi, a hollow instrument handle or support of the-pistol grip type is generally indicated by numeral l5 and is preferably madeof a suitable electrically insulating plastic material. Handle =15 consists of a molded body I6, having a removable'side cover plate I! that is-maintained. in position by screws 1 8, and a horizontal partition i9; integral with andextending-part way across body. As is'bestshown in Figure 5;partition1i-9 divides the! interior of handle l5into' a driveucompartment 2 0, an instrument compartment 2|, andalpa'ssage 22; establishing communication betweencompartments and; 2]. The lowersendrofxbody tiilis hollowed out to form a plug: receiving -compart-- menthandle.

.of electrical terminal posts 41. in Figure 5, plug 46 and terminal posts 41 are (Figures 1 and 8).

ment 23 that merges with drive compartment 20.

Positioned within handle [5 and secured to the side wall thereof by screws 24 (Figure 6) is a rotary driving means 25 that will now be described. Driving means 25 includes a casing 26 and a cover plate 21. A worm gear 28, rotatably mounted on a stationary shaft 29, carried by casing 26, is disposed within the casing and projects through and beyond cover 21. A crank arm 30 is attached to the outer end of worm gear 28 peripherally grooved crank pin 32 proximate one end. Also within casing 26 and meshing with worm-gear 28 is a worm 35 having an integral rotary shafttfi that projects beyond casing 26 andthat is restrained against downward axial movement .by a collar 31. Shaft 36 extends downwardly and into a hollow connector sleeve assembly 38, wherein it is coupled to the upper end of a flexible shaftv 39 that is rotatable in a flexible conduit 40.

Rotation is imparted to flexibleshaft 39, shaft '36, worm 35', worm gear 28, crank arm 30 and "crankpin. 32, in the order named, throughthe medium of a suitable electric motor (notshown). Such a motor isnusually located remotely: from the instrument handle andis placed into and out ofuactive service by an. electric circuit, partially shownin Figure 5 and including aswitch 43 car- 'rie eby handle l5 and conveniently arranged to permita spring'pressed'puslibutton 44, for actuating the switch, to -be readily depressed and released by the index finger of the. hand used by the operating surgeon in. gripping'the instru- A pair of electric leads-45, wholly within. compartment '20, connects switch 43 with anelectric plug 45 that is provided. with a pair As is illustrated containedin plug compartment, 23 of the handle and are maintained therein by a set screw 48 (Figures land 6). a

i A forwardly tapered frustro-cbnical collar 50 has an integral ring flange 5| that accommodates theupper forwardend of handle [5 and that is aflixed to the handle by a series of screws 52 Projecting forwardly of flange 5| is a pairof spacedparallel lingers 53 (Figurefi2), either or both of which carries an upstanding locking pin 54 (Figure 1). A telescopeguide tube 55 extends through and is attached to collar 50 in the usual manner.

A second, collar 51 is flared at itsforward end and is bored centrally at its rear end to obtain a forwardly and. inwardly, tapered recess-58 that isadaptedto receive the forward end of collar 50 and form a snug, fluid-tight connection therewith. An upright post 59 is mounted on collar 51:.and carriesa locking attachment 60. When the parts are in the relative position. shown in Figures 1. and 2, post 59 is located between fingers 53 and locking attachmentfill engageslock pin '54 so as to lock collars 50"and 51 together. The

flared end'of collar 51 is internally threaded to engage with. corresponding external threads material and that is provided with the usual fenestra' 62. An irrigating liquid discharge conduit-53 is connected-to collar"?! and communicates'with the interior of endoscopic tube iil,

. A plate-55 is disposed within instrument compartment' 2 l and. abuts the rear end of collar 50.

:Plateafi5isprovided witha. through keyhole aper- 'ture=56. (Figure 8), for theiree passage of telescope guide tube '55 and an electrode rod shaft to be described, andwith a pair of spaced blind bores 61 (Figure 3), for the reception and retention of the forward end of each of a pair of parallel guide tubes 68. As is depicted in Figures 5 and 9, each guide tube 68 has a longitudinal slot 69 and. is insertable through a corresponding passage in a stationary block I that is attached to handle I by screws II. A plate I2, fastened to block I0 by screws i3, serves as a closure for the rear end of both guide tubes 68 and also as an abutment for helical compression springs I5 that are housed within these tubes. A pin I8 mounted in block 10 freely supports a rotary pulley I9.

A slide block 80 of an electrical insulating material is disposed in instrument compartment 2i intermediate plate 65 and stationary block I0.

Block 80 carries a pair of bearing sleeves 8| that are concentric with and permit reciprocation of this block with respect to and along guide tubes 68. Each sleeve 8| has a lateral extension 82 that projects into a corresponding slot 69 of guide tubes 68 (Figure 3) and that bears against the forward end portion of a corresponding comstranded cable, a strip of catgut or the like, is.

secured at one end to coupling member 03, passes over pulley I9, and is provided with a loop at its other end for engagement with crank 32 (Figure 5).

Reference is next had to Figures 5 and 11 for details of construction of a high frequency electrode forming part of this invention and including a tubular shaft 99 that is axially reciprocable through collar 50 and keyhole aperture 66 in plate 05. Imbedded in a sheath of fine insulating material 81 and concentric and reciprocable with tubular shaft 86 is an electrically conductive rod 88 which merges at its forward end with a cutting loop electrode 89 that is free of insulatin material and that may be the same as or similar to the loop electrode disclosed in aforementioned Wappler Patent 2,038,393. The rear portion of tubular shaft 86 is anchored in slide block 80 while the exposed rearward extremity of conductive rod 83 projects through and beyond the rear end of block 80 and contacts the top portion of spring element 84.

A plate of insulating material 90 is affixed to the top of handle I5 by screws 9| and 92 (Figure 2) and carries an integral lateral socket body 93. Imbedded in socket body 93 is an electrically conductive element 94, which is best shown in Figure 6 and which has an outer blind bore 95 and an inner blind bore 99. Acompression spring 91 establishes electrical contact between lement 94 and a vertical conductive rod 98 in handle body I0. A horizontal conductive rod 99 also in body I6 is in intimate electrical contact with rod 98 and. is maintained in electrical engagement with a conductive bar I00 by a screw I9I. Bar I00 is disposed in a groove formed in the upper surface of partition I9 and is connected thereto by screws l0I. Also bar I00 is parallel to the path of travel of slide block 80 and is at all times incontact with spring element 84. An electric Depending from and attached to.

plug I02 includes a terminal I03 that is adapted to be snugly received in blind bore 95 and thus make suitable electricalcontact with element 94. Plug I02 is adapted to be connected to an appropriate source of high frequency electric current (not shown) so as to'electrically energize cuttin loop electrode 89, through the medium of element 94, compression spring 91, vertical rod 98, horizontal rod 99, bar I00, spring contact element 89, and electrode rod 88, in the order set forth.

A telescope, generally denoted by numeral I05, includes a tubular body I09 of relatively small diameter adapted to be inserted successively through stationary block I0 and guide tube 55 so that a miniature electric lamp I01, carried at its forward end and energized in the usual manner, may be positioned directly opposite fenestra 92 for providing illumination therethrough. At the rear end of the telescope is a conventional eyepiece I00. The telescope forms a fluid-tight seal with stationary block I0 and is provided with a recessed aligning element I09 that is adapted to be engaged by a spring extension IIO integral with a plate III that is clamped between body I6 and plate and retained in position by screws 92. The telescope lens system (not shown) may be of any suitable type, such as, for example, the lens system for commanding an obliquely forward field of vision disclosed in R. H. Wappler Patent 1,680,490, granted August 14, 1928.

Irrigating liquid may be transmitted into a body cavity by the instrument of this invention by a system of interconnecting devices and passages that will now be described, having particular reference to Figures 1, 9, 10 and 11. The irrigating liquid obtained from a convenient source of supply, not shown, is introduced into the instrument by way of a petcock I I2 that is mounted on the side of and is in communication with a passage H3 in body l6. Passage H3 is in alignment with a longitudinal passage H4 in collar 50, the latter passage intersecting with a generally radially bored passage II5 which in turn connects with a tube Il6 that is parallel and connected to tube 55 and terminates slightly rearwardly of fenestra 62 when the instrument is assembled.

For the purpose of briefly outlining the mode of operation of the above described instrument, let us first assume that the instrument is fully assembled; that endoscopic tube 6| has been inserted in a body passage so that fenestra 62 is in the region of the tissue growth to be resected; and that telescope lamp I01 is connected to a suitable source of electric current, plug I02 is connected to an appropriate source of high frequency current, and plug 49 and flexibleshaft 39 are connected electrically and mechanically, respectively, to an electric motor. A quantity of an irrigating liquid may be transmitted into the body cavity by way of petcock II2, the passages communicating therewith, and endoscopic tube ill, and subsequently withdrawn through the endoscopic tube and conduit 63.

The operating surgeon is now ready to remove the tissue growth. He grips handle I5 with one hand, placing the forefinger of that hand lightly against switch button 44; and, sighting through eyepiece I08, he manipulates the instrument until the tissue growth is accommodated in fenestra 62. His other hand is free for manual palpation of the prostate gland, or for other purposes, as may be required. .The surgeon then presses switch button 44 inwardly with his forefinger and thus completes the electric circuit to with, a block secured to the rearward end portion of said rod and reciprocably mounted to said support, rotary driving means carried by said support, means for imparting continuous rotation to said driving means, and means associated with said driving means nd said block for translating rotational movement of said driving means into reciprocatory movement of said block and said rod, said last mentioned means comprising spring means for moving said block in one direction with respect to said support and means connected to said block and said driving means for moving said block in the opposite direction against the action of said spring means during a predetermined portion of each cycle of rotation of said driving means.

6. In a surgical instrument of the character described, a support, an endoscopic tube carried by said support, an electrode rod movable longitudinally in said tube, a cutting electrode at the forward end portion of said rod and movable therewith, a block secured to the rearward end portion of said rod and reciprocably mounted to said support, rotary driving means carried by said support, means for imparting continuous rotation to said driving means, and means associated with said driving means and said block for translating rotational movement of said driving means into reciprocatory movement of said block and said rod, said last mentioned means comprising spring means for moving said block in one direction with respect to said support and flexible connector means secured to said block and said driving means for moving said block in the opposite direction against the action of said spring means during a predetermined portion of each cycle of rotation of said driving means.

7. In a surgical instrument of the character described, a support, an endoscopic tube carried by said support, an electrode rod movable longitudinally in said tube, a cutting electrode at the forward end portion of said rod and movable therewith, a block secured to the rearward end portion of said rod and reciprocably mounted to said support, rotary driving means carried by said support including a worm gear, means for imparting continuous rotation to said driving means including a rotary shaft and a worm meshing with said worm gear and rotatable with said shaft, spring means for moving said block in one direction with respect to said support, and flexible connector means secured to said block and said worm gear for moving said block in the opposite direction against the action of said spring means during a predetermined portion of each cycle of rotation of said worm gear.

8. In a, surgical instrument of the character described, a hollow handle, an endoscopic tube carried .by said handle, an electrode rod movable longitudinally in said tube, a cutting electrode at the forward end portion of said rod and movable therewith, a block reciprocably arranged Wholly within said handle and connected to the rearward end portion of said rod, rotary driving means wholly within said handle, means at least partially within said handle for imparting continuous rotation to said driving means, and spring means within said handle for moving said block in one direction with respect to said handle, and flexible connector means within said handle and secured to said block and said rotary driving means for moving said block in the opposite direction against the action of said spring means during a predetermined portion of each cycle of rotation of said driving means.

9. In a surgical instrument of the character described, a hollow handle, an endoscopic tube carried by said handle, an electrode rod movable longitudinally in said tube, a cutting electrode at the forward end portion of said rod and movable therewith, a block reciprocably arranged wholly within said handle and connected to the rearward end portion of said rod, rotary driving means wholly within said handle including a worm gear, means for imparting continuous rotation to said driving means including a rotary shaft and a worm meshing with said worm gear and rotatable with said shaft, and spring means within said handle for moving said block in one direction with respect to said handle, and flexible connector means within said handle and secured to said block and said rotary driving means for moving said block in the opposite direction against the action of said spring means during a predetermined portion of each cycle of rotation of said driving means.

10. In a surgical instrument of the character described, a hollow handle, an endoscopic tube carried by said handle, an electrode rod movable longitudinally in said tube, a cutting electrode at the forward end portion of said rod and movable therewith, at least one guide tube within said handle, a block within said handle and reciprocable along said guide tube, said block being rigidly attached to the rearward end portion of said rod, rotary driving means wholly within said handle including a worm gear and a crank rotatable in response to rotation of-said worm gear, means for imparting continuous rotation to said driving means including a rotary shaft and a worm within said handle and meshing with said worm gear, and a compression spring concentric with said guide tube for moving said block in one direction along said guide tube, and flexible connector means within said handle and secured to said block and said crank for moving said block in the opposite direction along said guide tube against the action of said spring during a predetermined portion of each cycle of rotation of said crank.

11. In a surgical instrument of the character described, a support, an endoscopic tube carried by said support, an electrode rod movable longitudinally in said tube, a cutting electrode at the forward end portion of said rod and movable therewith, a block secured to the rearward end portion of said rod and reciprocably mounted to said support, rotary driving means carried by said support, means for imparting continuous rotation to said driving means, and means associated with said driving means and said block for translating rotational movement of said driving means into reciprocatory movement of said block and said rod, said last mentioned means comprising a member rotatable in response to rotation of said driving means and having a continuous peripheral groove formed therein and an element aflixed to said block and registering with said groove.

12. In a surgical instrument of the character described, a support, an endoscopic tube carried by said support, an electrode rod movable longitudinally in said tube, a cutting electrode at the forward end portion of said rod and movable therewith, a block secured to the rearward end portion of said rod and reciprocably mounted to said support, rotary driving means carried by said support including a worm gear, means for imparting continuous rotation to said driving means including a rotary shaft and a worm meshing with said worm gear and rotatable with said shaft, and means associated with. said means and block ior'translating-rotational movementof saidairiving means dntoirecipmoatorymovement of said block1and .'said rod, :said lastmentionsed means minimisingv a membervrotatable in response to rotation-ofzsaid driving means and having a continuons rperipheral groove formed therein and an element :afflxed lto said biockand registering with said groove.

13. In --a-surgiea1 instnm1mt:of the-character described, a'hoilow handle, an endoscopic tube carried by said'hamdla an electrode rod'movabie longitudinally in said 'tube,'a cutting electrode at the Iorwairden'cl portion of :saidrod and movab'le therewith, a block reoipro'cably arranged flwho y withinsaid handle and connected to the rearward end portion of sa'id rod, rotary driving means wholly within said handle including-"a worm gear, means for imparting continuous-rotation to said driving'means i-ncludingra rotary shaft and a worm mesifing iwith' said'wormgear and rotatable-Mill saidshaft, and-means within said handle andassociated with said driving means and block for translating rotational movement of *said driving means into rediprocatory movement of said block and said rod, said last mentioned means comprising .a member rotatable irresponse "to rotation of said driving means and having acontimions peri-pheralgroove formed -therein and an element'a-flixed-to said block and registering with said groove.

14. Ina surgical instrument of the 1 character described, a hollow handle, an endoscopic ca'rried oy said handle, an electrode "rod movable longtiudina'lly *in 'said'tube, a cutting electrode at 12 the forward-end portion of said rod and movable therewith, :at least one guide rod within said handle; ablock within said handle and reciprocable along said guide rod, said block being rigidly attached tor-the rearward end portion oisaid electrode rod, rotary driving "means wholly within said handle including a worm gear, means for imparting continuous rotation to said driving means including a rotmy shaft and a worm wholly within said; handle and meshing with said wormgeanandmeans wholly within said handle and-connected to said :driving means and said block for translating rotational movement of said driving means into reciprocatory movement of said 'block and said rod, said last' mentioned means including a shaft rotatable with saidworm gear-and havinga continuous peripheral groove of generally-helical configuration formed therein andia member projecting-from said block vand registei ingwith said groove.

FREDERICK J. WALLACE.

REFERENCES CITED The' toiiowingmefierences are of record "in the file'o'f this'patent:

UNITED. STATES PATENTS Number Name Date 1;6794950 :Stem Aug. 77,1928 1,963,633 Wappl-er June 19,1934 2,090,923 'Wappler Aug. '24, 1937 FOREIGN PATENTS Number Country Date 373 112 italy July 19, 1939

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