U.S. patent number 3,805,787 [Application Number 05/263,448] was granted by the patent office on 1974-04-23 for ultrasonic surgical instrument.
This patent grant is currently assigned to Surgical Design Corp.. Invention is credited to Anton Banko.
United States Patent |
3,805,787 |
Banko |
April 23, 1974 |
ULTRASONIC SURGICAL INSTRUMENT
Abstract
Surgical instrument using ultrasonic energy which are to operate
upon tissue including arrangements for shielding ultrasonic
transducer probe to prevent energy from being radiated into
unwanted areas which also include provisions for applying
irrigation fluid and/or suction pressure to desired locations
within the operating field.
Inventors: |
Banko; Anton (Bronx, NY) |
Assignee: |
Surgical Design Corp. (Long
Island, NY)
|
Family
ID: |
23001817 |
Appl.
No.: |
05/263,448 |
Filed: |
June 16, 1972 |
Current U.S.
Class: |
604/22; 604/43;
606/169; 606/171; 601/2 |
Current CPC
Class: |
A61M
1/85 (20210501); A61F 9/00745 (20130101); A61B
2017/320084 (20130101) |
Current International
Class: |
A61F
9/007 (20060101); A61M 1/00 (20060101); A61B
17/32 (20060101); A61m 001/00 () |
Field of
Search: |
;128/24A,303,276,278 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Trapp; Lawrence W.
Attorney, Agent or Firm: Darby & Darby
Claims
What is claimed is:
1. An ultrasonic energy instrument comprising ultrasonic transducer
means including elongated probe means for converting electrical
energy into vibratory energy along the length of the probe means to
produce movement at the free tip end of said probe means, shield
means of substantially rigid metallic material, and means for
mounting said shield means around and in spaced relationship to
said probe means over a substantial portion without any mechanical
connection between the probe means and the shield means of the
length thereof to confine the vibrating energy.
2. An instrument as in claim 1 wherein said shield means extends
beyond the tip of the probe means.
3. An instrument as in claim 2 wherein said shield means extends
completely around the probe for its entire length.
4. Apparatus as in claim 2 wherein said shield means is partially
open at the portion which extends beyond the probe tip.
5. An instrument as in claim 1 wherein said means for mounting said
shield means to said transducer means comprises first coupling
means on said transducer means and mating demountable second
coupling means to which said shield means are mounted.
6. An ultrasonic energy instrument comprising ultrasonic transducer
means including elongated probe means for converting electrical
energy into vibratory energy along the length of the probe to
produce movement at the free tip end of said probe means, first
coupling means on said transducer means adjacent the attached end
of said probe means, second coupling means, an elongated tubular
shield means attached to said second coupling means, said coupling
means when connected to said first coupling means holding said
shield means around and in spaced relationship to said probe means
over a substantial portion of the length of said probe means to
confine the vibratory energy and leaving a space between said probe
means and said shield means and an exit from said space to the
exterior of the instrument, and means on said second coupling means
for supplying fluid to said space between said probe means and said
shield means, said fluid leaving said space from said exit.
7. Apparatus as in claim 6 wherein said fluid is a liquid which
flows around the probe means to cool the same.
8. Apparatus as in claim 6 wherein said fluid is a gas.
9. An ultrasonic energy instrument comprising an ultrasonic
transducer means including an elongated probe means for converting
electrical energy into vibratory energy along the length of the
probe means to produce movement at the free tip end of said probe
means.
a. first and second tubular sleeve means,
b. means for mounting said first and second tubular sleeve means to
said transducer means to hold said first tubular sleeve means in
spaced relationship with said probe means over at least a
substantial portion of the length thereof to define a first
passageway between said probe means and said first tubular sleeve
means and to hold said first and second tubular sleeve means in a
spaced relationship to define a second passageway therebetween,
c. means for supplying fluid to said first and second passageways,
and
d. means for permitting the fluid in each of said passageways to
exit therefrom.
10. An instrument as in claim 9 further comprising means for
sealing the exit of the second passageway at the tip end of the
probe, said second sleeve being formed with an opening in the wall
thereof through which the second fluid can exit from the second
passageway.
11. An instrument as in claim 10 further comprising means for
shielding a substantial portion of the tip of the probe means to
hold it out of contact with an object with which the instrument is
to be used.
12. An instrument as in claim 9 further comprising means for
sealing the exit of the second passageway at the tip end of the
probe, said first sleeve being formed with an opening in a wall
thereof to provide communication between said first and said second
passageways for the second fluid.
13. An instrument as in claim 9 further comprising means for
sealing the exit of said first passageway at the tip end of the
probe, said first sleeve formed with an opening in the wall thereof
to direct the first fluid out of said first passageway at an angle
lying off the longitudinal axis of the probe.
14. An instrument as in claim 13 further comprising means for
sealing the exit of the second passageway at the tip end of the
probe, said first sleeve being formed with an opening in a wall
thereof to provide communication between said first and said second
passageways for the second fluid.
15. An instrument as in claim 13 further comprising a third sleeve
means which is slidable over said second sleeve means to close off
the opening in the wall of said first sleeve means.
16. An instrument as in claim 15 further comprising means for
sealing the exit of the second passageway at the tip end of the
probe, said first sleeve being formed with an opening in a wall
thereof to provide communication between said first and said second
passageways for the second fluid.
17. An instrument as in claim 16 further comprising means for
shielding a substantial portion of the tip of the probe means to
hold it out of contact with an object with which the instrument is
to be used.
18. An instrument as in claim 13 further comprising means for
shielding a substantial portion of the tip of the probe means to
hold it out of contact with an object with which the instrument is
to be used.
19. The instrument of claim 6 wherein said shield means is of
metal.
20. An instrument as in claim 9 wherein said means for mounting
said first and second sleeve means comprises a holder to which said
sleeve means are attached and mating coupling means on said holder
and said transducer means, said means for supplying fluid to said
first and second passages including means on said holder for
accepting first and second fluids from respective sources.
Description
This invention relates to surgical instruments and more
particularly to surgical instruments using ultrasonic energy which
are designed for operating on tissue, for example, to remove pieces
of tissue from a larger mass. In prior U.S. Pat. No. 3,589,363,
which I am one of the co-inventors, instruments of this general
type are disclosed in which the probe end of an ultrasonic
transducer is designed to be inserted through an incision into an
operating field. The tip of the probe is to come in direct contact
with tissue in the operating field and the ultrasonic energy
radiated from the probe tip acts to remove particles of tissue from
a larger tissue mass and to withdraw these particles from the
operating field by means of a suction system. The removal of the
tissue particles from the mass is generally accomplished by the
ultrasonic energy which acts to emulsify the tissue, that is, to
act upon a portion of the tissue to heat it by ultrasonic energy so
that the tissue particles will break away from the larger body.
In the instruments disclosed in the aforesaid patent, a shield of a
silicone composition is provided around a portion of the transducer
probe to provide a passage for fluid to be introduced in the
proximity of the operating field and to prevent the vibrator from
rubbing against the walls of the incision or other parts of the
body being operated upon. In the instruments of the patent, an
arrangement is also provided for conveying suction pressure through
the center of the transducer probe and irrigation fluid in a
passage between the outer surface of the probe and the inner
surface of the silicone shield. Since the suction pressure is
applied directly through the center of the probe and the irrigation
fluid also exits through the probe tip, this limits the usefulness
of the instrument in the sense that the probe must be aimed
directly at the tissue for the suction pressure and irrigation
fluid to be effective. In many cases, this is neither desirable nor
possible. In accordance with the teachings of the aforesaid patent,
the tissue to be removed is to be brought directly into contact
with the tip of the transducer probe. Here again, this has been
found to be undesirable in many cases since portions of the tissue
directly adjacent those in contact with the tip of the probe can
become heated and possibly damaged.
The present invention relates to an improved ultrasonic surgical
instrument. In accordance with the invention, a number of
attachments are provided for use with an ultrasonic transducer,
each attachment having an arrangement such that a shield of
metallic material can be placed around the probe and held in
concentric relationship therewith. This provides an effective
shield against unwanted radiation of the ultrasonic energy. In
addition, the attachements are such so as to be able to provide
irrigation fluid or suction pressure, either individually or in
combination, at desired points within the operating field, not
necessarily in front of the probe. The attachments are also capable
of providing suction pressure to draw the tissue to be removed
adjacent the tip of the probe but hold it out of direct contact. In
addition, an arrangement is provided for efficiently removing from
the operating field those particles which have been cut from the
tissue mass by a combined suction and pressure flow.
It is therefore an object of the present invention to provide
ultrasonic instruments for removal of tissue in which unwanted
radiation of ultrasonic energy can be controlled.
An additional object is to provide ultrasonic instruments in which
the energy can be applied to a given localized area with the
selective application of irrigation fluid and/or suction pressure
at any desired portion within the operating field.
Other objects and advantages of the present invention will become
more apparent upon reference to the following specification and
annexed drawings, in which:
FIG. 1 is a plan view, taken partially in cross-section of a
transducer useful with the present invention and a partial block
diagram showing of the auxiliary equipment;
FIG. 2 is a fragmentary view of the front of the transducer,
partially cut away and partially in cross-section showing a shield
in accordance with the invention;
FIGS. 2A and 2B are fragmentary views shown partly broken away, of
modifications of the transducer tip and shield;
FIG. 3 is a fragmentary view of the front of the transducer
partially cut away and partially in cross-section showing a
transducer modified for receiving irrigation fluid or suction
pressure;
FIG. 4 is a fragmentary view of a portion of a transducer partly
cut away and partly in cross-section showing another embodiment of
the invention for using both irrigation fluid and suction
pressure;
FIG. 4A is an enlarged fragmentary view of the end portion of the
tip of the instrument of FIG. 4 showing a modification thereof;
FIG. 5 is a fragmentary view, taken partly in cross-section and
partly broken away, of a further modification of the invention
showing an external irrigation;
FIG. 5A is an enlarged fragmentary view of the tip of the
instrument shown in FIG. 5 and showing a further modification
thereof;
FIG. 6 is a fragmentary view, taken partly in cross-section,
showing the tip of an instrument incorporating a further
modification of the invention having internal irrigation;
FIG. 7 is a plan view of a further embodiment of the invention
shown partly broken away and partly in cross-section; and
FIG. 7A is an enlarged view of the front portion of the tip of the
instrument of FIG. 7.
Referring to FIG. 1, a typical transducer 10 for use with the
subject invention is shown. While a magnetostructure type
transducer is described, it should be understood that a
piezoelectric type also may be utilized. The transducer includes
the usual stack of laminations 12 of magnetostrictive material
which are fastened together, such as by brazing, at one end 11. The
stack 12 is to have coil of wire (not shown) placed in proximity
thereto in a conventional manner to supply excitation energy of a
suitable frequency, preferably in the ultrasonic range, from a
source 14 over leads 16. Any suitable ultrasonic source may be
utilized. The term "ultrasonic energy" is used herein in the broad
sense and encompasses energy within the range from 1,000 Hz up to
100,000 Hz. Typical ultrasonic frequencies which are utilized are
in the range between 25,000 Hz. 50,000 Hz. The ultrasonic source 14
is shown as having a variable control 15 for setting the frequency
and/or the amplitude of power to be supplied to the transducer 10
over the leads 16. If desired, a suitable source of cooling fluid
also can be used to cool the laminations 12 and the coil. This
would be applied to a housing covering the stack and the coil. Such
constructions are conventional in the art and are not further
described.
The transducer 10 also includes an acoustic transformer 18 one of
whose ends is threaded onto a stud 19 which is attached to the
lamination stack 12. The transformer 18 has another set of threads
20 at an intermediate point to which is threaded the housing
containing the coil for the stack 12 and the cooling fluid
connections. Threads 20 are usually located at a nodal point of
transformer 18.
The acoustic transformer 18 is tapered in a manner to achieve a
desired impedance transformation between the end of stack 12 and a
probe 24. A structure generally designated as 26 is provided
between the threads 20 and end of transformer 18 adjacent the probe
24 to act as a mode suppressor and also as a resonator to tune the
transformer 18 so that the desired longitudinal vibrations are
produced at the free end (tip) of probe 24. Mode suppressor
structure 26 has a thread 28 thereon to accept and hold a number of
different types of shielding structures to be described below.
Threads 28 are preferably located at or near a mode (null) point of
the mode suppressor 26.
FIG. 1 also shows a source 30 of irrigation or treatment fluid,
which can be of any desired composition, for example a saline
solution, to be supplied to the area to be operated on and also a
source 32 of suction pressure 32. The respective output conduits
30a and 32a are shown for these two sources. One or both conduits,
as is described below, can be connected to the instrument to supply
irrigation fluid and/or suction pressure to the area being operated
upon.
The two sources 30 and 32 are shown under the control of a
switching circuit 34. The switching circuit is operated by the
person using the instrument. Any suitable switching circuit can be
used, for example, a relay actuated circuit. One or both of the
sources 30 and/or 32 can be actuated at a given time as desired.
Such circuits are also conventional and no further description
thereof is necessary.
As explained in my prior patent, the probe 24 is to be inserted
into the tissue area to be operated upon. Where the tissue area is
within the eye, a suitable incision is made and the probe inserted
through the incision. The ultrasonic energy produced by the
transducer 10 is converted into motion at the tip of the probe 24.
Some of the energy also is radiated. The combination of the motion
and the energy produce the desired effect on the tissue to change
its state to a less solid form. This process is generally called
emulsification. It has been found that the energy from the probe 24
preferably should be confined to the tip end so that only a
predetermined portion of tissue adjacent the tip end will be
effected by the instrument. To accomplish this, a shielding
arrangement is used for the probe.
FIG. 2 shows a structure for confining the bulk of the ultrasonic
energy within the length of probe 24. As shown, a hollow cap 40 is
fastened to the threads 28 on the end of resonator 26. An O-ring is
located between the inner face of cap 40 and a shoulder in front of
threads 28 to provide a fluid-seal. A tubular sleeve 46 is fastened
within the front end of cap 40 in the area 47 by an suitable
arrangement which is compatible with the materials of both the cap
40 and the sleeve 46. In a preferred embodiment of the invention,
both the cap 40 and the sleeve 46 are of stainless steel.
Therefore, the construction to mate the two together can be either
by welding or some other suitable technique. As should be apparent,
the surface area 47 in which the joining of members 40 and 46 takes
place provides a high degree of stability for the sleeve 46 so that
it can be kept coaxial and concentric with the probe 24.
As seen in FIG. 2, only a small portion 24a of the probe extends
beyond the free end of the sleeve 46. The material of shield 46
reflects the radiated ultrasonic energy from the probe 24. Because
of this arrangement, ultrasonic energy will only be radiated from
this unshielded tip portion 24a of the probe. Therefore, the area
of the operational field which come in contact with the shield 46
will experience little or no deleterious effects. It should be
noted that the length of the free end 24a beyond the shield 46 can
be controlled somewhat by threading or unthreading in the cap 40 to
move shield 46 forward or backward.
The shield-probe tip structure of FIG. 2 will have a relatively
open pattern of ultrasonic energy radiation in the area beyond
shield 46. Also, the tip 24a of the probe can come into contact
with the tissue in the operational field. FIG. 2A shows a further
arrangement in which a curved portion 47 of shield 46 extends over
the front of the probe tip 24a. The extending portion 47 is
designed preferably to cover only a portion of the total angle of
the tip 24. That is, for example, the included angle of the
extending piece 47 can be in the order from 30.degree. to about
27.degree..
Extending shield piece 47 serves two purposes. First of all, spaces
the tip 24a of the probe away from the tissue being operated upon.
That is, the tip 24a is kept substantially or entirely out of
contact with the tissue by piece 47. Secondly, piece 47 confines
the radiation of ultrasonic energy only to the open area of tip
24a. That is, little or no energy will be radiated into tissue in
the area of the extension piece 47.
FIG. 2B shows another embodiment of the invention in which the
shield 46 extends fully over the free end of the tip 24. This
arrangement serves to further narrow down the beam of the
ultrasonic energy radiated from the tip of probe 24. In addition,
it completely prevents the tip 24 from coming into contact with the
tissue. This provides an additional safety feature.
The shield structures of FIGS. 2A and 2B can be utilized with the
instrument structure of FIG. 2.
FIG. 3 shows another embodiment of the invention which is similar
to that as shown in FIG. 2. Here, the cap 40 is modified to have a
bore 50 therein which accepts one of the conduits 30a or 32a from
the irrigation or suction sources. Bore 50 communicates with an
annular chamber 41 defined between the inner surface of cap 40 and
the front end of the resonator 26. Irrigation fluid or suction
pressure from conduit 30a or 32a passes from chamber 41 through the
space, or passage, 25 between probe 24 and sleeve 46. Where
irrigation fluid is used, the fluid exits passage 25 adjacent the
tip 24a of the probe. This is shown by the arrow. Where suction
pressure is used, the tissue to be operated upon will be drawn in
towards the passage 25 to the active end 24a of probe 24. Here
again, the shield 46 prevents a substantial portion of the
ultrasonic energy from radiating into an undesired area.
It should be understood that the structures of FIGS. 2A and 2B can
be used with the instrument of FIG. 3 to space the tip 24a from the
tissue and/or to confine the radiation of the energy from the tip.
In the embodiment of FIG. 3, the shield 46 is also held in spaced
relationship from the probe 24 by the mounting arrangement. Where
treatment fluid is supplied through the passage 25, the fluid also
serves to cool the probe 24 and the shield 46. Both of these
elements are heated to an extent by the ultrasonic energy.
FIG. 4 shows a further embodiment of the invention in which the
instrument is provided with the capability of handling suction
pressure and irrigation fluid at the same time. In the embodiment
of FIG. 4 a second bore 54 is formed in the cap 40 and the cap is
also formed with an annular space 57 near the front end thereof
which communicates with bore 54. The sleeve 46 is attached to cap
40 as in the embodiments of FIGS. 2 and 3 so that the passage 25
between probe 24 and shield 46 is in communication with the annular
chamber 41 which in turn is in communication with bore 50. Shield
46 is held in spaced relationship with probe 24.
A second sleeve 59 is attached to the front end of the cap 40 and
spaced from the first sleeve 46 to define a second passage 27
therebetween. The second sleeve 59 can also be of the same material
as sleeve 46, for example, stainless steel. The space 27 between
the two sleeves 46 and 59 is in communication with the second
annular chamber 57. Chamber 57 is isolated from chamber 41 by the
ring 43 of the cap.
The bore 50 receives one of the two conduits 30a or 32a from the
irrigation and suction sources while the bore 54 receives the other
conduit. Depending upon which of the bores receives the respective
conduit, the irrigation fluid or suction pressure is available in
either of the passages 25 or 27. Normally, the irrigation fluid is
provided in passage 27. The probe 24 is being cooled through the
shield 46 and by the outgoing fluid.
Either of the modified shield structures of FIGS. 2A and 2B can be
used with the instrument of FIG. 4.
FIG. 4A shows a modification of the shield structure instrument of
FIG 4. Here, a nipple 61 is provided at the front end of the
instrument to seal off the exit of passage 27 between the two
sleeves 59 and 46. Outer sleeve 59 is provided with a hole 59a
adjacent the collar. The remainder of the construction of the
instrument of FIG. 4A is the same as that of FIG. 4.
In the instrument of FIG. 4A instead of having the irrigation fluid
or suction pressure in the second passage 27 exit at the tip of the
instrument, this fluid or suction pressure will exit through the
opening 59a. There will be side irrigation or suction of the area
being operated upon. Here again, only a small portion of the tip
24a of the probe is exposed and the majority of the tip is shielded
against radiation of ultrasonic energy.
In the instrument of FIG. 4A, irrigation fluid is normally supplied
through passage 27 and suction pressure through passage 25. Thus,
the tissue is drawn toward the tip of probe 24. If desired, the
structures of FIGS. 2A and 2B also can be used for the shield 46 of
FIG. 4A to space the tissue from the tip of the probe.
In each of the embodiments of FIGS. 4 and 4A, the suction pressure
draws the tissue toward the tip of probe 24 where it is acted upon
by the ultrasonic energy. Any particles which are formed by the
emulsification action are drawn out of the operational field by the
suction pressure through passage 25.
FIG. 5 shows a still further embodiment of the invention. The
portion of the instrument in the area of cap 40 is substantially
similar to that of FIG. 4. Here, an opening 59b provided in the
outer sleeve 59 and a curved nipple 66 closes off the passageway 27
between sleeves 46 and 59 at the tip end of the instrument and in
front of opening 59b. Thus, the only exit for irrigation fluid
applied from conduit 30a into passage 27 is through the opening
59b. The irrigation fluid does not interfere with the substance to
be treated by the tip of the probe.
As seen best in FIG. 5A, a portion of 69 of the front of nipple 66
is cut off at an angle to expose the tip of probe 24 and to provide
an exit from the inner passage 25 for the suction pressure. The
nipple 66 can be fully circular to seal off the entire passage 27
or else, as shown in FIG. 5A, the lower portion of sleeve 59 can be
bent, as at 61, and attached to the outer surface of sleeve 46 to
provide the fluid seal.
As seen, the irrigation fluid exiting from opening 59b will be to
one side of the active area of the tip of probe 24. The suction
pressure is available at the front of the tip to draw the tissue to
be operated upon toward the probe tip. Radiation of ultrasonic
energy is confined substantially to the angled opening 69 by the
nipple 66. Also, the nipple 66 prevents tissue from coming into
contact with the major portion of the probe tip.
FIG. 5A shows a modification of the instrument of FIG. 5 in that
the nipple 66 has been shortened to bring the exit port 59b for
irrigation fluid closer to the tip of the instrument. In both of
the instruments of FIGS. 5 and 5A, the particles of tissue broken
from the larger mass are removed from the operating field via the
passage 25.
FIG. 6 shows a further embodiment of the instrument which is
similar in many respects to that of FIGS. 5 and 5A. Here, rather
than have the hole 95b in the outer sleeve 59 so that the
irrigation fluid can exit into the operation field, the outer
sleeve 59 is made continuous and a hole 46a is provided in the
inner sleeve 56. Nipple 66a closes off passage 27 at the probe tip
and the irrigation fluid will exit through port 46a back into
passage 25. Passage 25 also receives suction pressure to draw
tissue adjacent the exposed tip portion of probe 24. The mixture of
irrigation fluid and suction pressure in passage 25 rapidly removes
the free tissue particles from the operating field. In addition,
some of the irrigation fluid can also leave the tip to enter the
operating field.
FIGS. 7 and 7A show a further embodiment of the invention with
provisions to control the suction pressure. This instrument has the
same cap structure and is similar in some respects to the
instrument of FIG. 6. The sleeve 46 has a second opening 46b in
addition to the first opening 46a for directing the irrigation
fluid from passage 27 to passage 25. Sleeve 59 is sealed at the
bent area 61 at the lower portion of the instrument to the rear of
exit port 46b. The latter post communicates with passage 25. A
nipple 70 with a rounded front end seals off the remainder of
passage 27.
A movable sleeve 75, which also can be of stainless steel or other
suitable material, is positioned to slide over the outside of
sleeve 59. In FIG. 7, the sleeve 75 is shown in a position leaving
the opening 46b unobstructed so that the suction pressure applied
form opening 46b can bring the tissue into active relationship with
probe 24. In FIG. 7A, sleeve 75 is shown in the forward position
with the opening 46b blocked.
It should be noted that in the embodiment of FIGS. 7 and 7A, the
nipple 70 prevents the tissue from coming into direct contact with
the tip of the probe 24. Here again, as in FIG. 6, the particles of
tissue are removed rapidly by the combined irrigation fluid and
pressure flow.
Each of the embodiments of the invention described above utilize
the cap assembly containing the energy shield. The same cap
assembly can also have provision for suction and/or irrigation. The
cap assemblies are removable so that the same transducer can be
used with a number of different assemblies. Each assembly is such
that a concentric relationship is maintained between the probe and
the shield and also between the shield and another sleeve, the
space between the latter two members defining a passage for suction
pressure or fluid flow.
In each of the embodiments of the invention the space between the
tip 24 and the sleeve 46 provides a safe distance between an active
(vibrating) component and an insulating element preventing
transmission of ultrasonic energy and rubbing which might generate
a prohibitive amount of heat. Also, the use of metallic shield,
such as 46, provides effective reflection of the energy back to the
probe so that it does not radiate into the object being operated
upon.
The cap 40 and O-ring seal 42 also provide a highly effective
arrangement for changing shield and suction/irrigation flow
configurations. In addition, the O-ring 42 also serves to dampen
the vibrations of the probe. The use of the threaded cap also
provides a range of adjustment for the shield with respect to how
much of the probe tip is to be left uncovered.
It should be understood the instruments disclosed herein have
particular advantages when used to emulsify semi-solid material
such as the vitreous humor which is found in the eye. Here, the
novel suction arrangements will bring the material, which is in a
viscous and flowable state, adjacent the tip end of the ultrasonic
probe. A portion of the vitreous body is moved toward the tip as
the suction pressure is applied and the material moved into active
relationship with the tip is emulsified. The tip itself does not
have to be moved directly into the area of the body which is to be
emulsified. This gives the user of the instrument a safety factor
in that he does not have to come close to tissue which is to be
left untouched by the ultrasonic energy. A typical of this is where
the retina is to be protected during an operation. Where the
various fully or partially shielded tips are used, additional
protection is provided for the other tissue which is not to be
effected by the energy.
* * * * *