U.S. patent number 3,913,585 [Application Number 05/382,951] was granted by the patent office on 1975-10-21 for surgical cutting instrument.
This patent grant is currently assigned to Technibiotics, Inc.. Invention is credited to Sidney Wolvek.
United States Patent |
3,913,585 |
Wolvek |
October 21, 1975 |
Surgical cutting instrument
Abstract
A surgical tool for cutting bones, casts and the like including
a housing having a cutting knife extending from its forward end.
The cutting knife is pivoted to a plunger which is movably disposed
within one end of the housing while a piston is normally positioned
at the other end. The piston is accelerated under air pressure to
impact the plunger thereby causing the knife to move through a
cutting stroke. Suitable valve means are provided to control the
entry and venting of compressed air to and from the housing.
Inventors: |
Wolvek; Sidney (Brooklyn,
NY) |
Assignee: |
Technibiotics, Inc. (Brooklyn,
NY)
|
Family
ID: |
23511085 |
Appl.
No.: |
05/382,951 |
Filed: |
July 26, 1973 |
Current U.S.
Class: |
606/178; 602/5;
30/277; 606/84 |
Current CPC
Class: |
A61B
17/32 (20130101); B26B 7/00 (20130101); A61B
2017/00544 (20130101); A61B 2017/922 (20130101) |
Current International
Class: |
A61B
17/32 (20060101); B26B 7/00 (20060101); A61B
17/92 (20060101); A61B 17/88 (20060101); A61B
17/00 (20060101); A61B 017/32 (); B26B
007/00 () |
Field of
Search: |
;30/272R,273,277
;128/305,317 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Darby & Darby
Claims
What is claimed is:
1. A surgical cutting instrument comprising:
a housing;
a knife including a shank portion which extends into said housing
and a knife edge portion, said shank being pivotally connected to
said housing;
a movable piston slidably disposed within said housing;
a floating plunger slidably disposed within said housing in coaxial
alignment with said piston; and
a movable linkage connected to said housing and permanently
connecting said knife shank portion to said plunger for causing
said knife edge portion to move in a cutting stroke substantially
parallel to the longitudinal axis of the housing upon movement of
said plunger.
2. A cutting instrument as recited in claim 1 wherein said blade as
a knife edge which follows a generally straight line sloping
downwardly and inwardly and has and arcuate shaped lower edge.
3. A cutting instrument as recited in calim 1 wherein said knife is
connected with said housing so that it forms a substantially right
angle to the longitudinal axis of said housing.
4. A cutting instrument as recited in claim 1 wherein said moving
means includes pivot means for connecting said knife shank portion
to said housing so that movement of said knife comprises a pivotal
movement.
5. A cutting instrument as recited in claim 4 wherein said knife
shank portion has a slot formed therein and said plunger includes a
pin which is disposed within said slot so that when said plunger is
driven forward upon being struck by the piston, said knife is
pivoted.
6. A cutting instrument as recited in claim 1 further including a
planar guide shoe provided on the free end of said knife edge
portion, said shoe having a leading edge which is formed with a
rounded lip.
7. A cutting instrument as recited in claim 1 wherein said means
for moving said piston toward said plunger comprises pneumatic
valve means, said valve means, upon actuation, causing said piston
to strike said plunger a single time.
8. A cutting instrument as recited in claim 7 wherein said valve
means comprise:
actuation means;
a first passage from the interior of said housing to the external
atmosphere having a normally open first port;
a second passage from the interior of said housing to the external
atmosphere having a normally closed second port; and
means for closing said first port and opening said second port upon
operation of said actuation means.
9. A cutting instrument as recited in claim 8 wherein said valve
means further include:
an elongated rod movably mounted in said housing wherein said
actuation means includes means for moving said rod along its
axis;
a first ball slidably mounted on said rod;
spring means yieldingly urging said ball to an extreme position on
said rod so that upon actuating said rodmoving means said rod moves
a first distance and said ball is moved against and closes said
first port; and
a second ball normally yieldingly urged against and closing said
second port in axial alignment with said elongate rod so that upon
movement beyond said first distance, said rod end contacts said
second ball moving it away from and opening said second port.
10. A surgical cutting instrument comprising:
an elongate housing having a forward end and a rearward end;
a knife movably connected to said forward end and extending from
the housing at a substantially right angle to the longitudinal axis
thereof;
yielding means for normally urging said knife toward said housing
rearward end; and
means including a movable piston slidably disposed within said
housing and normally biased toward said rearward end and a movable
plunger normally spaced apart from said piston and permanently
connected through a slotted linkage to the shank of said knife for
moving said knife through a cutting stroke when said piston is
driven against said plunger, the path of said stroke being
substantially parallel to the longitudinal axis of said housing.
Description
BACKGROUND OF THE INVENTION
This invention relates to surgical instruments and, more
particularly, to a tool for cutting bones and the like during
surgical operations.
During surgery, especially in the chest cavity region, it is often
necessary for the physician to obtain access to areas which are
obstructed by bone structure. One example is in open heart surgery
where unobstructed access to the hear is a necessity. In this case,
the sternum or breastbone covers the chest cavity and prevents the
required access. Therefore, the sternum must be cut to enable the
surgeon to work.
Various types of apparatus have been used to cut through bones
during surgery. For example, a hand-held chisel-type instrument has
been employed wherein the knife end of the chisel is held against
the bone while the surgeon taps the other end with a mallet. This
type of device is not entirely satisfactory since it is difficult
to control the direction of the chisel and, additionally, the
surgeon must make a conscious effort to avoid hitting the patient
with the mallet. Another bone cutting instrument in current use is
a compact saber-saw type device sometimes referred to as a "Sarnes"
saw. However, the depth of cut of such an instrument is not always
precisely controllable and its use may result in inadvertently
cutting into an organ. Further, this device is actuated by a foot
pedal which has been found to be rather cumbersome. Still another
instrument used in surgical applications of the type described is a
circular-type saw whose blade traverses an arcuate cutting stroke,
commonly known as a "Stryker" saw. This instrument is rather slow
in operation and its depth of cut is rather limited due to the
configuration of its gearbox. Further, it is possible that the saw
may inadvertently damage underlying tissue during the cutting
operation.
OBJECTS OF THE INVENTION
Accordingly, an object of this invention is to provide a new and
improved surgical cutting instrument.
Another object is the provision of a new and improved surgical
cutting instrument for bones and the like having a configuration
especially suitable for cutting the sternum or breastbone.
Still another object is to provide a new and improved surgical
cutting instrument whose cutting rate and direction is precisely
controllable and is capable of being operated using only one
hand.
A further object is to provide a surgical cutting instrument
wherein the cutting knife has an arcuate cutting stroke whose
action is away from the thoracic contents.
A still further object is to equip the cutting knife with safety
features so that the danger of mishaps during surgery is
lessened.
A still further object of this invention is to provide a new and
improved valve system for controlling the entry and venting of
compressed air to and from the instrument.
SUMMARY OF THE INVENTION
In accordance with a preferred embodiment of this invention, these
and other objects are attained by providing a surgical instrument
in which a knife having an end yoked to a plunger is located within
a housing. A piston is provided rearwardly of the plunger and is
accelerated by an air drive to move forwardly and impact the
plunger thereby moving the knife through a cutting stroke. The
knife forms an angle with the housing and has a cutting edge which
moves tranversely during a cutting stroke. A valve system forms a
part of the air drive and operates in a manner such that the
depression of a trigger causes the knife to move through a single
cutting stroke. To repeat another stroke, the trigger must be
released and then depressed again.
DESCRIPTION OF THE DRAWINGS
A more complete description of the invention and its advantages
will be readily appreciated by reference to the following detailed
description when considered in connection with the accompanying
drawings in which:
FIG. 1 is a side view of the surgical cutting instrument of the
present invention illustrating a typical application;
FIG. 2 is a side view in partial section of the instrument
illustrating the movement of the knife;
FIG. 3 is a view of the knife in section taken along line 3--3 of
FIG. 2;
FIG. 4 is a view of the knife in section taken along line 4--4 of
FIG. 2;
FIG. 5 is a top view partially broken away showing the valve
structure of the instrument;
FIG. 6 is a view in section taken along line 6--6 of FIG. 2;
FIG. 7 is a view in section taken along line 7--7 of FIG. 2;
FIG. 8 is an enlarged detail view in section of the valve showing
the compressed air entry passage and venting passage closed;
and
FIG. 9 is an enlarged detail view in section of the valve system
showing the venting passage closed and the compressed air entry
passage open.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring now to the drawings wherein like reference characters
designate identical or corresponding parts throughout the several
views, FIG. 1 illustrates the instrument 10 of the present
invention used to cut through the sternum, or breastbone, of a
patient. This is one typical use of the instrument. The instrument
10 includes a generally cylindrical housing 12 and a knife 14
operably connected to the housing's forward end. Generally, one end
of a flexible tube 16 is coupled to a fitting extending from the
rear of housing 12 while the other end (not shown) is coupled to a
source of compressed air or other suitable gas for driving the
knife. The lower end, or protective shoe, 18 of the knife 14 is
inserted within the clavicular notch in the sternum 22 of a patient
24 situated at the top of the sternum at the base of the neck. As
seen, the instrument is held so that the top surface of guide 18
engages the lower surface of the sternum, resulting in the knife
being accurately positioned. Upon depressing a trigger 28 (FIG. 5),
knife 14 travels through a cutting stroke transverse to the knife
edge in the direction of arrow 26. Upon releasing trigger 28, knife
14 returns to its original retracted position. In this manner, a
surgeon may guide the instrument 10 in a desired path at a
precisely controlled rate.
As shown in FIG. 2, housing 12 is formed by a generally cylindrical
barrel 30 connected to a threaded cap member 32. A piston 34 is
normally held by a spring 36 against the edge of a bumper 38 which
is integrally formed with an end plug 40, which plug is threaded
into the rear end of housing 12 to make an air-tight seal at that
end. The rear surface 42 of piston 34 and the forward surface 44 of
bumper 38 define a chamber 45 into which compressed air is admitted
through a valve (described below) at the initiation of a cutting
stoke. A pair of O-rings 46 are fastened around the outer surface
of piston 34 to prevent compressed air from leaking around the
piston into the portion of housing 12 forward of piston 34.
Cap 32 is formed having an interior slot 58 which extends from the
threaded lip 48 terminating slightly before the cap's front end. A
cylindrical recess 54 is formed in the inner wall 47 of the cap
coaxial with the housing longitudinal axis 52. Finally, an
elongated reduced diameter cylindrical recess 50 is formed
tangentially to recess 54 and extends from the end of recess 54
beyond the end of slot 58 and terminates just before opening to the
exterior. Referring to FIG. 2, it is seen that one end of spring 36
bears against a shoulder contiguous with wall 47 formed between
recess 54 and the threaded lip 48 of the cap.
A plunger 62 is slidably mounted within cap 32. The plunger 62 has
a cylindrical body 64 integrally formed with a reduced diameter
cylindrical boss 66. The boss 66 is eccentrically formed relative
to the cylindrical body 64 so that the cylindrical surfaces are
tangential along an imaginary line 56 (FIG. 7). The plunger has
appropriate dimensions so that the cylindrical body is slidably
received within cylindrical recess 54 while the cylindrical boss is
received within the elongate recess 50 as seen in FIG. 2. A slot 68
is formed laterally through boss 66 which is aligned with the slot
58 in cap 32. Finally, an extended aperture 69 is provided in the
side wall of cap member 32 which communicates with the bore 50 and
is in alignment with the slot 58.
The knife 14 includes a blade 70 at its lower end and a shank
portion 74 at its upper end. The blade 70 has a cutting edge 72
which slopes downwardly and inwardly in a generally straight line
terminating in an arcuate portion adjacent the base of the blade.
This shape is important for reasons discussed below. As seen in
FIGS. 3 and 4, the blade 70 has a sharp cutting edge 72 while the
shank edge 76 is blunt. The lower end 18 of the knife is provided
with a guide, or shoe, 77 having a substantially planar surface
with a rounded, upturned leading lip 78.
A compression spring 80 has one end seated within recess 50 while
the other normally bears against the end of the boss 66 of the
plunger. The shank portion 74 of knife 14 is inserted through the
aligned openings of aperture 69, and cooperating slots 68, 58.
Referring to FIG. 2 in conjunction with FIG. 6, stepped bore 82 is
formed through an upper portion of cap 32. A bore 84 is provided
within the knife shank portion 74 which aligns with bore 82 when
the knife is positioned. A bolt 86 is threaded within aligned bores
82, 84 to provide a pivot for the knife. Further, a slot 90 is
formed in that portion of the knife shank which is positioned
within the confines of the slot 68 in boss 66. Another bore 92
(FIG. 6) is formed in boss 66 and is aligned with slot 90. A stub
shaft 94 is then inserted through an access bore 95 to cooperate
with the aligned slot and bore, the shaft being held in place by a
set screw 96. The piston 34 is positioned within barrel 30, and
spring 36 normally urges the piston to the rear of the barrel.
FIGS. 5, 8 and 9 show the valve system. The housing barrel 30 is
formed with a pair of handgrips 97 having fluted edges to
facilitate holding by the operating physician. In the preferred
embodiment of the invention, one of these handgrips provides a
housing for the valve system. As the actuating trigger protrudes
from the front edge of the handgrip containing the valve system, it
is apparent that a right-handed physician would prefer the valve
apparatus to be provided in the upper handgrip (as seen in FIG. 5)
so as to be able to depress the trigger with his right forefinger,
while a left-handed physician would prefer such apparatus to be
provided in the lower handgrip. Of course, bot embodiments come
within the scope of the present invention.
A bore 98 terminating in an enlarged diameter length 100 is formed
in the handgrip parallel to the longitudinal axis of the housing.
An actuating rod 102 having an enlarged rearward end 104 has its
forward end fixed to trigger 28 and is slidably mounted within bore
98. A spring 106 is provided around rod 102 and received within a
counterbore 107 immediately behind trigger 28, the cross section of
the trigger and counterbore preferably being identical and
non-circular so as to prevent rotation of the former in the latter.
The force of spring 106 normally maintains the trigger and
actuating rod in the position shown in FIG. 5 which is the forward
or neutral position.
Still referring to FIGS. 5, 8 and 9, a ferrule 108 is fit into the
enlarged diameter length of bore 98 adjacent to a shoulder 110
defined by the intersection of the enlarged and reduced diameter
lengths of bore 98. Ferrule 108 has an inwardly turned lip 109
formed at its rearward end defining a venting port 112 (FIGS. 8 and
9) and has a second venting port 114 formed in its side wall. This
second venting port 114 communicates with an air passage 116 which
opens to the external atmosphere at the rear edge of the handgrip
97. A fitting 118 which includes a fluid connector 120 on one end
on which the flexible tube 16 may be attached and an inwardly
turned lip 126 on the other end is threaded to the end of the
enlarged diameter length 100 of bore 98. Prior to threading fitting
118 into the bore, a ball 124 and a spring 122 are inserted and a
snap ring 125 is provided within an internal groove to retain them
therewithin so that the ball is urged against an inlet port 128
formed by lip 126. This inlet port is normally closed by ball 124
which is urged over the opening action of spring 122. As best seen
in FIG. 8, an elongate bolt 130 is threaded into the enlarged end
104 of actuating rod 102. A ball 132 is slidably mounted on the
bolt's shank via a bore formed through the ball. A spring 136 is
positioned over the bolt shank and normally urges the ball against
the bolt head 134. Finally, an air passage 138 is provided having
one end extending into the chamber 45 within the housing (FIG. 5)
and the other end opening into the length of bore 98 between
venting port 112 and inlet port 128.
An understanding of the cooperation of the valve elements can best
be understood through a description of the operation of the device.
FIG. 5 shows the instrument in its neutral state, i.e., the knife
14 is in its retracted position (see solid lines in FIG. 2), the
piston 34 is biased against bumper 38 under the force of spring 36,
and the trigger 28 is in its forwardmost position. As seen in FIG.
5, with the trigger in its neutral (forward) position, the ball 132
is in a position within ferrule 108 such that venting ports 112,
114 are open. When a source of compressed air (or any other gas
under pressure) is attached to the end (not shown) of flexible tube
16, the combination of forces due to air pressure and spring 122
maintains ball 124 against inlet port 128 thereby closing it. As
the operating physician depresses trigger 28, the actuating rod 102
moves bolt 130 rearwardly together with ball 132. As shown in FIG.
8, after a certain amount of movement, ball 132 is positioned over
venting port 112 thereby closing it. As the trigger is further
depressed, the bolt 130 continues to travel rearwardly through the
bore formed in ball 132 while spring 136 maintains the ball against
venting port 112. In the last stages of trigger depression, the
bolt head 134 advances through the aligned port 128 and contacts
ball 124 moving it against the force of the compressed air and
spring 122 thereby opening inlet port 128. This allows compressed
air to enter through the inlet port and into the chamber behind
piston 34 through air passage 138. The forces exerted on the piston
by he compressed air move the piston at great velocity until it
impacts plunger 62 driving it forward. The moving plunger causes
the cutting tool 70 to move through a cutting arc to its final
position shown in phantom lines in FIG. 2.
It should be noted that the articulated linkage assembly comprising
plunger 62, shaft 94, slot 90, knife 14, bolt 86 and cap 32
actually forms a Scotch or slotted yoke-type drive. Such a linkage
controls the force and direction of the knife during the cutting
stroke. Specifically, upon impact of the piston into the plunger,
sufficient force is transmitted through the linkage to cut through
most bone structure. The linkage also results in the knife moving
in the particular lateral direction as described above which
facilitates the bone-cutting operation. Of course, as the piston 34
moves forward, the air in front of it within the housing must be
vented. To accomplish this, a bore 140 (FIG. 2) is provided in
plunger 62 through which the air travels, finally exiting from the
device through the elongate aperture 69.
It should be noted that in the preferred embodiment, the knife edge
72 moves in a generally transverse direction relative to itself
and, broadly speaking, the direction of travel is substantially
parallel to the longitudinal axis of the cutting tool. This
direction makes the device suitable for cutting bone structure (and
especially the sternum) while resulting is less bone dust being
generated during the operation (relative to a "sawing" type of
action).
The instant device includes various safety features. After
inserting the knife 14 into the incision against the bone (FIG. 1)
and prior to commencing the cutting operation, the operating
physician urges the instrument upwardly to engage the planar shoe
or guide 77 with the lower surface of the sternum. This assures the
physician that the knife will not be inadvertently thrust too far
into the chest cavity. Further, referring to FIG. 2, it is seen
that the arc described by shoe 77 during a cutting stroke is in a
slightly upward direction due to the particular placement of
elements of the articulated linkage. This is inteded to assure that
the knife will not move downwardly and cut those internal organs
below the bone being cut. Another benefit of this upward direction
derives from the fact that after heart surgery, it is not uncommon
for the heart to actually adhere to the bottom surface of the
sternum. At reoperation, the cutting stroke allows the rounded shoe
lip 78 to insert itself between the heart and the sternum thereby
separating them. The shape of the cutting edge 72 also provides a
safety feature. As pointed out above, the cutting edge slopes
downwardly and inwardly in a generally straight line terminating in
an arcuate portion adjacent the base of the blade. As the knife
moves in the cutting direction, should the shoe not be flush
against the bottom surface of the sternum, the generally straight
edge portion acts as a wedge against the bone causing the knife to
move upwardly relative to the bone until the shoe engages the
bottom surface. At this point the arcuate portion of the cutting
edge begins its action. Thus, the shape of the blade itself
provides an important safety feature.
After the piston has impacted against the plunger, it is ready to
return to its original position under the force of spring 36 upon
release of the trigger. Residual high pressure air exits from the
cylinder through a high pressure vent 133 which extends from the
interior of the cylinder to the exterior through the handgrip which
does not house the trigger apparatus. The vent is directed
forwardly through bore 146 of the instrument so as not to direct a
high pressure stream of air towards the patient or the physician.
Without this venting, the piston would tend to jam and the cutting
action would be weaker since spring 36 would have to be heavy
enough to overcome the residual high pressure air in the
cylinder.
Upon release of the trigger, head 134 of bolt 130 retracts
permitting ball 124 to close the inlet port 128 cutting off the
supply of compressed air to the housing and, upon further
retraction, removes ball 132 from its closed position thereby
opening venting port 112. Piston 34 begins to move rearwardly under
the force of spring 36 causing the air contained within the housing
behind piston 34 to be vented through the air passage 138 through
venting ports 112, 114 and out through air passage 116. The ball
valves may be provided with packings as shown. The knife returns to
the initial neutral position under the force of spring 80 which
also causes the plunger 62 to return to its initial cocked
position.
Thus, each time the trigger 28 is depressed, the knife undergoes a
single cutting stroke and returns to the neutral position upon
release of the trigger. This arrangement provides precise control
of the cutting rate which is desirable in the surgical opertions in
which the tool is to be utilized. Of course, the instrument may be
employed in other applications within the scope of the present
invention. For example, it is also suitable for cutting casts,
i.e., removing casts from limbs after the bone has set.
The particular valve structure of the present invention provides
numerous advantages independent of the cutting instrument with
which it has been disclosed. The valve comprises a compound device
in that it handles high pressure air input while venting residual
air trapped between the piston and the cylinder head. This cycle is
undergone by only a single depression of the trigger. The valve is
adapted to admit high pressure air upon exertion of only a
relatively small force on the trigger. Further, the valve is simple
in construction and relatively easy to manufacture.
Obviously, numerous modifications and variations of the present
invention are possible in the light of the above teachings. It is
therefore to be understood that within the scope of the appended
claims, the invention may be practiced otherwise than as
specifically described herein.
* * * * *