U.S. patent number 3,643,649 [Application Number 04/878,457] was granted by the patent office on 1972-02-22 for mechanized tracheotome.
This patent grant is currently assigned to United States Surgical Corporation. Invention is credited to Joseph John Amato.
United States Patent |
3,643,649 |
Amato |
February 22, 1972 |
MECHANIZED TRACHEOTOME
Abstract
A tracheotome for the mechanized performance of a tracheostomy.
The inventive tracheotome, upon triggering, makes an incision
through the skin, fascia and trachea of the patient. Then, after
the incision has been made, a delayed-action plunger is activated
and serves to bend a staple which maintains the opening in the
trachea.
Inventors: |
Amato; Joseph John (North
Riverside, IL) |
Assignee: |
United States Surgical
Corporation (Baltimore, MD)
|
Family
ID: |
25372070 |
Appl.
No.: |
04/878,457 |
Filed: |
November 20, 1969 |
Current U.S.
Class: |
606/185 |
Current CPC
Class: |
A61M
16/0472 (20130101); A61B 17/068 (20130101); A61M
16/04 (20130101); A61M 16/0497 (20130101) |
Current International
Class: |
A61M
16/04 (20060101); A61B 17/068 (20060101); A61b
017/00 (); A61b 017/10 () |
Field of
Search: |
;128/1R,305,329,330 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Pace; Channing L.
Claims
What is claimed is:
1. A method of performing a tracheostomy, the method comprising the
steps of: positioning over the neck of a patient in alignment with
the area where the incision is to be made, a tracheostomy staple
having a central region provided with a pair of crossed slits;
inserting an instrument through said slits and making an incision
through the skin, fascia and trachea of the patient; and bending
portions of said tracheostomy staple into the trachea to ensure
that the staple maintains the skin, fascia and trachea of the
patient in a position whereby an airway is established.
2. The method as described in claim 1 wherein said crossed slits
define triangular subregions; and wherein said triangular
subregions, when bent, maintain the skin, fascia and trachea of the
patient in a position defining an airway.
3. The method as defined in claim 1 wherein the incision is made by
a tracheotome inserted through the slits in said tracheostomy
staple and wherein said staple is bent by means of a plunger in the
tracheotome.
Description
BACKGROUND OF THE INVENTION
The need for a tracheostomy generally occurs without previous
warning, and because of the urgency of the situation, the time
allowed for the successful establishment of an airway is extremely
limited. The conventional hospital procedure, however, requires
anywhere from 15 to 30 minutes for the insertion of a standard
tracheostomy tube.
While newer and quicker methods for the performance of a
tracheostomy have been presented, and while some of these methods
are presently in use, the use is not as widespread as perhaps could
be expected. This is because of numerous drawbacks. The major
disadvantages of the more current tracheostomy methods are twofold.
First, the number of occurrences of complications has been high.
And second, numerous of these methods require the skills of the
operator to be extremely high.
At the present time, there is no known method for performing a
tracheostomy which is quick, effective and yet which can be
performed by other than the most skilled surgeons. It is toward the
provision of such a method, and an apparatus for practicing the
method, that the present invention is directed.
SUMMARY OF THE INVENTION
The present invention relates to a mechanized tracheotome. The
inventive tracheotome is simple in design, is versatile in use, is
relatively simple to operate, is effective, and is relatively
inexpensive to manufacture.
The present invention further relates to an economical tracheostomy
staple adapted to be used with the mechanized tracheotome, which
staple effectively serves to maintain the opening in the trachea in
a simple and yet effective manner.
More particularly, the mechanized tracheotome of the present
invention is adapted to perform the tracheostomy as a two-step
process. Preliminary to the activation of the mechanized
tracheotome, the tracheostomy staple is fixedly secured to the neck
of the patient so that it is positioned directly over the area
where the incision is to be made. The tracheotome is then
activated. First, a cruciate-shaped blade is thrust forward,
through the staple, the skin, fascia and trachea of the patient.
Then, a delayed-action plunger is thrust forward. The plunger
causes the tracheostomy staple to be bent open in such a manner
that the skin, fascia and trachea of the patient are entrapped by,
and retained by, the leaves of the staple. Finally, the tracheotome
is removed, leaving behind a tracheostomy staple which defines a
square opening in the trachea.
The surgical operation employing the inventive mechanized
tracheotome and the inventive tracheostomy staple may be performed
rapidly and, because of its simplicity, by persons having only
minimal knowledge of anatomy. In addition, the tracheotome is
economical and uses an extremely inexpensive tracheostomy
staple.
Accordingly, it is one object of the invention to provide a
mechanized tracheotome for the performance of a tracheostomy in a
minimum of time and with a maximum of effectiveness.
It is another object of the invention to provide a mechanized
tracheotome which is simple to use and yet which is as effective as
it is simple.
It is still another object of the invention to provide a mechanized
tracheotome which is simple in design and economical in cost.
It is a further object of the invention to provide a tracheostomy
staple for use with the inventive mechanized tracheotome, which
staple serves to efficiently maintain an opening in the trachea
after the completion of the tracheotome stroke.
It is yet another object of the invention to provide a tracheostomy
staple which is simple in design and economical in cost.
Still a further object of the invention is to provide a method for
performing a tracheostomy in a minimum time and yet with a maximum
effectiveness.
Yet another object of the invention is the provision of a method
for performing a tracheostomy, which method is simple, quick and
yet extremely effective.
These and other objects of the invention, as well as many of the
attendant advantages thereof, will become more readily apparent
when reference is made to the following description taken in
conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an exploded perspective of the inventive mechanized
tracheotome and the inventive tracheostomy staple;
FIG. 2 is a top plan view of the inventive mechanized
tracheotome;
FIG. 3 is a longitudinal section of the tracheotome shown in FIG.
2;
FIG. 4 is a front plan view of the tracheotome shown in FIG. 2;
FIG. 5 is a front plan view of the inventive tracheostomy staple
before being acted upon by the mechanized tracheotome;
FIG. 6 is a top view of the staple shown in FIG. 5;
FIG. 7 is a view, partially in section, of the mechanized
tracheotome as it is positioned with respect to the patient during
the forwardmost portion of the tracheotome stroke; and
FIG. 8 is a front view of the tracheostomy staple as it appears
after the completion of the tracheotome stroke.
DETAILED DESCRIPTION OF THE DRAWINGS
With reference first to FIGS. 1 through 4, the inventive mechanized
tracheotome will be described. The tracheotome is shown generally
at 10 and comprises a partially hollowed body 12 having a trigger
14 on a handle 90. A cruciate-shaped blade 16, having cutting
surfaces 15, is fixedly mounted within a blade sleeve 18 which
slides in the hollowed portion of the body 12. A plunger 20 having
four tines 22 is adapted to slide within the blade sleeve 18 so
that, in its forwardmost position, the plunger 20 entirely masks
the cutting surfaces 15 of the blade 16. The total cross section of
the four tines 22 is substantially equal to the internal cross
section of the blade sleeve 15 and, in order that the plunger 20
may mask the cruciate-shaped blade 16, the tines 22 are positioned
so that four slots 24 are defined thereby. In this manner, relative
motion is permitted between the blade 16 and the slots 24, defined
by the tines 22. A spring 26 biases the plunger 20 toward the front
region of the body 12, the spring 26 being maintained in position
by a projection 28 in the hollow of the body 12 and by a bore 30 in
the body of the plunger 20.
A resilient strap 32 is mounted in a recess on the body 12 by means
of a pair of rivets 34. The rearwardmost region of the strap 32 has
a pair of downwardly extending flanges shown generally at 35
defining a camming surface 36 and a stop 38. An upwardly extending
flair 40 is also provided on the rearwardmost portion of the strap
32. The plunger 20 is provided with a pair of grooves shown
generally at 42, each groove 42 adapted to associate with a
respective downwardly extending flange 35 on the strap 32. The
grooves 42 each have an inclined surface 44, a flat 46 and a
stop-engaging surface 48. The stop-engaging surface 48 on the
plunger 20 is adapted to associate with the stop 38 on the
resilient strap 32. The incline 44 and the flat 46 in a given
groove 42 serve to house a respective downwardly extending flange
35.
At the rear upper portion of the body 12 is provided a slot 50. The
slot 50 allows for the communication of a plunger-engaging
extension 52 on a drive shaft 54 with a slot 56 in the blade sleeve
18. The drive shaft 54 is activated by means of a power unit shown
generally at 58. The forwardmost region of the slot 56 in the blade
sleeve 18 is fitted with an upwardly extending flange 60 to ensure
positive engagement between the sleeve 18 and the pusher-engaging
extension 52 on the drive shaft 54.
The blade sleeve 18 is provided with a pair of elongated slots 62
on the upper rear surface thereof, the slots 62 being fitted to
allow the blade sleeve 18 to slide in the hollow of the body 12
without interfering with the downwardly extending flanges 35 on the
strap 32. Thus, the blade sleeve 18 is free to move in its hollow
while the resilient strap 32 is flat in its housing and in
engagement with the plunger 20.
The forwardmost part of the blade sleeve 18 is, in cross section, a
square. The rearwardmost part, however, is U-shaped in cross
section. This can best be seen in FIGS. 1 and 3. At the transition
between the square cross section and the U-shaped cross section of
the blade sleeve 18, there is defined a ledge 64. This ledge 64 is
adapted to engage a corresponding ledge 66, extending across the
bottom surface of the plunger 20. In this manner, the forward
motion of the plunger 20, relative to the blade sleeve 18, is
limited to the position taken by the plunger when the respective
ledges 64 and 66 are in communication with one another. This
forwardmost position is fixed so that the tines 22 of the plunger
20 mask the cutting surfaces 15 of the blade 16.
As best seen in FIG. 3, the blade sleeve 18 slides in the hollow of
the body 12 on its wall 68. Similarly, the plunger 20 slides in the
hollow of the body 12 on a bottom extension 70. The tines 22 of the
plunger 20, however, slide within the square cross-sectional region
of the blade sleeve 18 and, therefore, slide along the internal
surface of the lower wall 68 of the sleeve 18.
The forwardmost region of the body 12 defines a nozzle shown
generally at 72. See FIG. 2. The nozzle 72 is in the form of a wide
fan-shaped member with an indentation 74 therein, and is provided
with a cushion 76 on its forwardmost surface completely
encompassing the indentation 74. The nozzle 72 and the indentation
74 are adapted so that the indentation may comfortably be placed
and pushed against the lower border of the neck so as to encompass
the anterior surface of the trachea.
With reference now to FIGS. 1, 5 and 6, the configuration of the
tracheostomy staple will be described. The staple is shown
generally at 78 and comprises a pair of side straps 80, each strap
having a hole 82 therein, and further comprising a central region
shown generally at 83. As shown best in FIG. 6, the central region
83 is an extension of the side straps 80 and has fixed thereon four
pyramid-shaped projections 84.
Through the central region of the staple 78 are a pair of slits 86,
the slits 86 forming a cross adapted to accommodate the
cruciate-shaped blade 16 and to permit the passage of same
therethrough. For reasons which will become more readily apparent
from the following, it may be necessary to provide the central
region 83 of the tracheostomy staple 78 with some arrangement of
means for allowing the bases of the pyramid-shaped projections 84
to be bent along the lines 88.
The holes 82 in the side straps 80 provide means for securing neck
straps to the staple, which neck straps encircle the neck of the
patient and hold the staple 78 secure over the area where it is
desired to make the incision.
In operation, the mechanized tracheotome of the present invention
functions as follows. The tracheostomy staple 78 is first strapped
to the neck 92 of the patient, comfortably and yet firmly, at the
position over the region where the incision is to be made. Then,
the nozzle 72 is placed at the throat of the patient so that the
indentation 74 encompasses the anterior surface of the trachea.
This is shown in FIG. 7 (the neck strap shown at 94, but hanging
loosely for clarity). The operator holds the mechanized tracheotome
at the handle 90 of the body 12. When the operator is ready to
perform the tracheostomy, the trigger 14 is depressed.
Before the depression of the trigger 14, the relative positions of
the blade 16 and the plunger 20 are as shown in FIG. 3. Once the
trigger is depressed, the power unit 58 is activated (by means not
shown), and the drive shaft 54 is thrust forward. Since the
pusher-engaging extension 52 of the drive shaft 54 is in positive
engagement with the slot 56 in the blade sleeve 18, the blade
sleeve, with its associated blade 16, is thrust forward with the
drive shaft 54.
As noted above, the ledge 64 on the blade sleeve 18 is adapted to
abut the ledge 66 on the plunger 20. Therefore, as shown in FIG. 3,
before the activation of the power unit 58, the blade sleeve 18 is
held in its rearwardmost position by the drive shaft 54. The
plunger 20 is, in turn, held in its rearwardmost position, against
the thrust of the spring 26, by the abutting ledges 64 and 66 of
the blade sleeve and plunger, respectively. In this position, the
downwardly extending flanges 35 on the resilient strap 32 rest
comfortably within the depressions 42 in the plunger 20. However, a
small space, shown at 92, is present between the stop 38 on the
strap 32 and the stop-engaging surface 48 on the plunger 20.
When the power unit is activated, as noted above, the blade sleeve
18 is thrust forward. Due to the force exerted by the spring 26,
the plunger 20 is also thrust forward, a small distance, until the
stop 38 on the resilient strap 32 contacts the stop-engaging
surface 48 on the plunger 20. When this occurs, the plunger 20 is
held fixed while the blade sleeve 18 moves forward with its
associated cruciate-shaped blade 16. The blade continues its
forward motion while the plunger remains stationary until a camming
surface 94, on the drive shaft 54, engages the upwardly extending
flare 40 on the resilient strap 32.
When the drive shaft 54 moves forward a small distance after
contacting the flare 40, the resilient strap 32 is bent upwardly
and, as a consequence, the downwardly extending flanges 35 become
disengaged from the grooves 42 in the plunger 20. When the stop 38
on the strap 32 is free from the stop-engaging surface 48 on the
plunger 20, the plunger is thrust forward by the action of the
spring 26. This occurs near the end of the stroke of the blade
16.
As noted previously, and as is shown in FIG. 7, the tines 22 on the
plunger 20 mask the cutting surfaces 15 of the blade 16 when the
plunger is forward with respect to the blade sleeve. In this
manner, the instrument may be retracted from the neck of the
patient without the fear of injury to the patient.
Relating the operation described above to the formation of the
tracheostomy staple 78, the following is pertinent. When the blade
16 is thrust forward, the cutting elements 15 comfortably pass
through the slits 86 in the staple 78. The blade 16 then cuts
through the skin 96, fascia 98 and trachea 100 of the patient.
When the blade 16 nears the forwardmost portion of its stroke, the
plunger 20 is released from its stop. Therefore, the plunger is
thrust toward the staple 78 and the forwardmost and tapered regions
of the tines 22 engage the rear surface of the staple 78. The tines
are arranged to abut the staple near the central region thereof and
are adapted to bend the staple about the dotted lines 88 and into
the position shown in FIGS. 7 and 8.
Thus, the blade first slides between the leaves of the staple and,
upon so doing, makes way for the passage of the staple into the
area of the incision. Then, the plunger comes forward and the
staple leaves are forced laterally into the trachea with each leaf
holding the tissue back, resulting in a square opening in the
trachea. As seen in FIG. 7, the pyramid-shaped extensions 84 on the
staple 78 maintain the skin 96, fascia 98 and trachea 100 in an
open position. The shape of extensions 84 aids in the prevention of
excessive bleeding of the patient in the area of the incision.
Above, there has been described a specific embodiment of the
present invention. The invention relates to a mechanized
tracheotome for positioning a tracheostomy staple which replaces
the tracheostomy tube presently in use, the function of the
tracheostomy staple being to maintain the airway open and, thus,
performing an identical function with the conventional tracheostomy
tube. It should be appreciated that the specific embodiment of the
present invention has been described for illustrative purposes only
and that many alterations and modifications of the invention may be
practiced by those skilled in the art without departing from the
spirit and the scope thereof. Particularly, the configuration of
the tracheostomy staple may be changed and the configuration of the
blade may be changed. The power unit may be in the form of springs
or in the form of a gas-powered thrust mechanism. Many other
alterations will be obvious to those skilled in the art. It is the
intent, therefore, that the invention not be limited to the above,
but be limited only as defined in the appended claims.
* * * * *