U.S. patent number 3,651,811 [Application Number 04/865,442] was granted by the patent office on 1972-03-28 for surgical cutting instrument.
This patent grant is currently assigned to Aesculap-Werke Aktiengesellschaft vormals Jetter & Scheerer. Invention is credited to Hans G. Hildebrandt, Fritz Hilzinger.
United States Patent |
3,651,811 |
Hildebrandt , et
al. |
March 28, 1972 |
SURGICAL CUTTING INSTRUMENT
Abstract
A surgical cutting instrument that incorporates electrodes
capable of coagulating or cauterizing a severed blood vessel at the
same time that it is cut.
Inventors: |
Hildebrandt; Hans G.
(Ludwigshafen, DT), Hilzinger; Fritz (Tuttlingen,
DT) |
Assignee: |
Aesculap-Werke Aktiengesellschaft
vormals Jetter & Scheerer (Tuttlinger (Baden-Wuertemberg),
DT)
|
Family
ID: |
25345519 |
Appl.
No.: |
04/865,442 |
Filed: |
October 10, 1969 |
Current U.S.
Class: |
606/51 |
Current CPC
Class: |
A61B
17/3201 (20130101); A61B 18/1442 (20130101); A61B
18/1402 (20130101) |
Current International
Class: |
A61B
17/32 (20060101); A61B 18/14 (20060101); A61b
017/36 () |
Field of
Search: |
;128/303.1,303.13,303.14,303.15,303.16,303.17,318,305 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
Stevenson, Review of Books, 10/24/59, pp. 650-651..
|
Primary Examiner: Trapp; L. W.
Claims
What is claimed is:
1. A combination cutting and coagulating surgical instrument for
use in microsurgery which comprises:
a. a pair of cutting members movable with respect to one another
adapted to perform a cutting function;
b. insulating means to electrically insulate each of said pair of
cutting members from one another;
c. a pair of connecting means one being provided for each of said
pair of cutting members, each of said connecting means being
adapted to be connected to the respective pole of an electric
current source and thereby form a pair of coagulation electrodes at
said cutting members for bipolar coagulation when each of said
connecting means is connected to the respective poles of an
electric current source.
2. A surgical instrument according to claim 1 wherein each of said
pair of cutting members is pivotally mounted with respect to one
another and include handle means extending therefrom, said handle
means being in the form of a leaf spring which cooperate with one
another.
3. A surgical instrument in accordance with claim 2 which further
includes a lateral projection on one of said handle means and
wherein a cooperating recess is provided in the other of said
handle means to receive said projection when said handle means are
brought toward engagement with one another.
4. A surgical instrument in accordance with claim 1 wherein said
pair of cutting members are in the form of cooperating cutting
blades pivotally mounted with respect to one another so as to
operate in a scissor-like manner, and wherein said insulating means
comprises an insulating plate interposed at the pivot point between
said pair of cutting blades.
5. A surgical instrument in accordance with claim 4 which further
includes a screw means for pivotally mounting said pair of cutting
blades, said screw means including a head, a bearing surface
adjacent said head, and a threaded portion at the lower end
thereof, said screw being threadedly fastened to the cutting blade
engaged with the lower end thereof while the other cutting blade is
pivotally supported about said bearing surface, and an insulating
means interposed between the screw head and said other cutting
blade so as to provide additional insulating means between said
pair of cutting blades.
6. A surgical instrument in accordance with claim 4 wherein one of
said cutting blades include a recess therein adapted to accept said
insulating means.
7. A surgical instrument in accordance with claim 2 wherein said
cutting members are in the form of cutting blades which contact one
another only at their edges upon closing.
8. A surgical instrument in accordance with claim 7 wherein the
edges of said cutting blades are shaped such that they will upon
cutting contact one another first at their free ends.
9. A surgical instrument in accordance with claim 8 wherein the
free end of at least one of said cutting blades includes a
projection thereon adapted to clamp the tissue to be coagulated
upon closing prior to said cutting blades contacting one
another.
10. A surgical instrument in accordance with claim 1 wherein said
cutting members are pivotally mounted with respect to one another
so as to form scissor like cutting legs having handle portions
extending therefrom, said handle portions being divergently
disposed with respect to one another after the pivotal connecting
point, spring members at the free end of said handle portions
converging toward one another so as to meet upon closing thereof,
and an insulating head interposed between said mating spring
members upon closing thereof.
11. A surgical instrument in accordance with claim 10 wherein said
insulating head is in the form of a plug.
12. A surgical instrument in accordance with claim 10 wherein said
pair of scissor-like cutting legs are interconnected so as to be
axially displacable with respect to one another, and which further
includes slidable insulating elements adapted to electrically
insulate each of said scissor-like cutting legs from one another.
Description
This invention relates to a surgical cutting instrument with two
cutting blades movable toward one another during cutting in scissor
or knife-like fashion.
Surgical cutting instruments of this kind are known in a wide range
of embodiments as scissors and knives, for instance as instruments
for valvulotomies, commissurotomies, or the like. If these cutting
instruments are being used for the sectioning of blood vessels, the
blood vessels must subsequently be closed. To this end, it is known
to connect the cutting instrument to one pole of a current source
the other pole of which is connected to the patient's body. The
moment the vessel has been cut through by the cutting instrument,
the current source is connected. It then suffices to contact the
severed blood vessel with the cutting instrument in order to close
it by means of coagulation. It is also possible to achieve the
coagulation upon cutting with a knife, simultaneously with the
cutting. These surgical processes are however possible with larger
blood vessels only. In micro-vessel surgery and in neurosurgery,
these monopolar coagulation processes cannot always be used because
the electric currents required to achieve coagulation are
comparatively substantial and, in addition, all fabrics and vessels
coming in contact with the instrument are coagulated as well which,
in case of the coagulating of small vessels and in particular with
coagulations in the area of the brain, the marrow and the jaws, may
result in major complications.
For this reason, one uses in such cases bipolar coagulation forceps
the two legs of which are electrically insulated from one another
and can be connected to the two poles of a current source, thereby
coagulating only what is being encompassed between the forceps
arms. The use of these coagulation forceps is however quite
cumbersome in view of the fact that the operating surgeon must,
following coagulation of the blood vessel, remove the forceps from
the operating area and subsequently use the cutting instrument, for
instance a pair of scissors. The result is not only a time delay of
the operation, which ought to be avoided at any cost, but also an
increasing of the infection hazard. Besides, in micro-surgery, the
introduction of a second instrument into the most narrow areas
viewed under the microscope is extremely difficult.
It is the object of the invention to remedy this situation and to
create a surgical cutting instrument by means of which the
coagulation can be achieved without hazard of damage to the patient
and without any need for the interchanging of instruments.
This object is achieved in the case of a surgical cutting
instrument of the aforementioned kind in accordance with the
invention in that there is provided an electrode electrically
insulated from the first cutting blade and, to form two coagulation
electrodes to achieve a bipolar coagulation, the first cutting
blade and the electrode can be connected to the poles of an
electric current source. The result is that the surgical instrument
constitutes at the same time an instrument for bipolar coagulation,
by means of which the vessel can be severed during bipolar
coagulation or shortly thereafter, and consequently there is no
need to interchange the instrument or to introduce a second
instrument to the coagulated point.
With a preferred embodiment of the invention it may be provided
that, for the purpose of forming the electrode by means of the
second cutting blade, the latter is electrically insulated from the
first cutting blade. The result is a preferred design of the
instrument that differs little in appearance or function from
standard cutting instruments thereby exhibiting all the benefits of
the latter and nevertheless permitting a bipolar coagulation.
By means of suitable insulation, the invention can be used with
practically all conventional surgical cutting instruments having
two cutting blades movable with respect to one another.
The applicabilities of the invention are not limited to
micro-surgery in view of the fact that it is advantageous also in
the case of macro-surgery to cause a coagulation to take place only
between the parts forming the electrodes and not, as in the case of
the known monopolar process, at all those points where the
instrument constituting as a whole the one electrode contacts parts
of the patient's body and coagulates or damages them.
The invention is explained in detail below in the following
description of four exemplified embodiments illustrated in the
drawings of surgical scissors in accordance with the invention.
In the drawings:
FIGS. 1 and 2 show an elevation and side view, respectively, of the
first exemplified embodiment;
FIG. 3 shows a cross-section, on an enlarged scale, along line
III--III of FIG. 1;
FIGS. 4 and 5 show an elevation and side view, respectively, of a
second exemplified embodiment;
FIG. 6 shows a cross-section, on an enlarged scale, along line
VI--VI of FIG. 4;
FIGS. 7 and 8 show a partial elevation and side view of a third
exemplified embodiment; and
FIGS. 9 and 10 show an elevation and side view of a fourth
exemplified embodiment.
The first exemplified embodiment of a pair of surgical scissors
illustrated in FIGS. 1 to 3 shows a first scissor leg 1 and a
second scissor leg 2 pivotally interconnected by means of the
closing screw 3 of the pair of scissors, around the axis of said
screw. The two cutting arms 4 and 5 of the two scissor legs 1 and 2
are designed at their free ends as cutting blades 6 and 7 in such a
way that they will touch one another with their cutting edges 8 and
9, respectively, upon closing of the scissors only.
The two scissor legs 1 and 2 are electrically insulated from one
another. To this end, an insulating plate 11 has been provided at
the joint of the scissors between the two legs 1 and 2 of the
scissors, which is fastened in a recess 12 of the first leg 1 of
the scissors and which contains substantially in its center a bore
for the shaft 13 of the closing screw 3 fastened with its thread in
a taphole of the first leg 1 of the pair of scissors.
The closing screw 3 passing with its stem 13 through a bore of the
second leg 2 of the scissors is electrically insulated from the
second leg 2 of the scissors, by the fact that between the head 14
and the stem 13 of the closing screw 3, on the one hand, and the
second leg 2 of the scissors, on the other, there has been provided
an electrically insulating washer 15 or an electrically insulating
sleeve 16.
The ends of the legs 1 and 2 opposite the cutting blades 6 and 7
are designed as flat springs 17 and 18, respectively, and joined at
their free ends by a disk-shaped insulating head 19. For this
purpose, the insulating head 19 is provided with two recesses 21
and 22, respectively, for engaging the free ends of the flat
springs 17 and 18, these recesses having the shape of circle
segments in a plane parallel to the flat faces of the disk 19, and
being laterally defined by the flanges 23 forming the faces of the
insulating head 19. In each of the flanges 23 there have been
provided bores adjacent to one another as shown in FIG. 1, in which
are fitted pins 24 and 25 to which the ends of the flat springs 17
and 18 are firmly connected within the recesses 21 and 22.
The handles 26 and 27 of the scissor legs 1 and 2, designed at
their ends as flat springs 17 and 18, are provided with knurlings
28 along their sides facing away from one another. To prevent the
contacting of the two handles 26 and 27 upon cutting with this pair
of surgical scissors, thereby causing a short-circuit, a projecting
electrically insulating pin 29 is attached to the side of the
handle 27 facing the handle 26.
The moment the two pins 24 and 25 are inserted into the contact
recesses of an electric socket connected to a power source, the two
scissor legs 1 and 2 and hence also the two cutting blades 6 and 7
form two electrodes that are electrically insulated from one
another. If, in the course of a surgical operation, a vessel is to
be severed by means of the blades 8 and 9, there then occurs a
coagulation between the two blades 8 and 9 the moment said blades
touch the vessel to be severed. To that end, the voltage of the
current source can be selected in such a way that a coagulation
will occur only at the moment when the distance of the two
electrodes is as great as the distance of the two blades 8 and 9
during the surgical operation so that a contacting of other parts
of the patient by parts of the two scissor legs 1 and 2 that are
further apart will not cause any coagulation or damage to the
patient.
To avoid repetitions in the description of the subsequent
exemplified embodiment, the parts in the drawing corresponding to
those of the first exemplified embodiment are designated by
reference digits increased in each case by 100 so that, through
this assigning of said digits in the description of the following
exemplified embodiments, reference is had to the first exemplified
embodiment.
In the case of the second exemplified embodiment illustrated in
FIGS. 4, 5 and 6, the two scissor legs 101 and 102 are insulated
with respect to one another in like manner by an insulating plate
111, a washer 115, and a sleeve 116. The essential difference of
the second exemplified embodiment, as compared with the first, is
that projections 131 and 132 respectively have been provided at the
free ends of the blades 108 and 109 of the cutting blades 106 and
107, respectively, which for the purpose of forming the coagulation
electrodes proper upon the closing of the scissors, will clamp the
tissue to be coagulated, before the edges 108 and 109 become
effective. One reliably achieves, as a result, that the coagulation
will occur prior to the actual cutting.
Another characteristic by which the second exemplified embodiment
differs from the first resides in the fact that, in this case, the
insulating head 119 is designed as a parallelepiped and that the
ends of the flat springs 117 and 118 passing through the slots 133
of the insulating head 119 form flat pins 124 and 125.
If the second exemplified embodiment of the pair of surgical
scissors according to FIGS. 4 to 6 is used in a surgical operation,
the tissue to be cut, for example a vessel, is first clamped
between the projections 131 and 132 of the cutting blades 106 and
107 and thus coagulated. Only after coagulation has occurred is the
vessel cut by means of the edges 108 and 109.
In the case of the third exemplified embodiment of a pair of
surgical scissors according to FIGS. 7 and 8, the two scissor legs
201 and 202 are, in customary manner, pivotally interconnected by
the closing screw 203, one in metal-to-metal contact with the other
and, as a result, not electrically insulated from one another. In
order to achieve nevertheless a bipolar coagulation in this case,
there has been provided an electrode 207a that is electrically
insulated from the pair of scissors and is formed by the free end
of a flexible spring 234 connected by means of two screws 235 to
the handle 227 of the second scissor leg 202, which are firmly
screwed down in tapholes of the handle 227 and are insulated from
the flexible spring 234 by insulating washers 215 and by insulating
sleeves (not shown) corresponding to the sleeve 16 of the first
exemplified embodiment. For purposes of cooperation of the
electrodes 207a with the cutting arm of the scissor leg 201, said
cutting arm forming in this instance the cutting blade 206, there
has been provided a lateral projection 236 at the free end of the
cutting blade 207 of the second cutting arm 202 a groove-like
recess 237 for the second cutting blade 207. The free end of the
flexible spring 234 forming the electrode 207a is bent in such a
way that it will contact the projection 236 upon the closing of the
pair of scissors before the free ends of the edges 208 and 209 have
come in contact with one another.
During a surgical operation, the tissue to be severed is first
clamped between the electrode 207a and the projection 236 and
coagulated because the electrode 207a , on the one hand, and the
scissors, preferably the first scissor leg 201, on the other, are
connected with the two poles of a current source. The cutting will
then occur subsequent to said coagulation only. This third
embodiment offers the advantage that the coagulation point is
situated in the direction of the swivel axis of the two scissor
legs next to the cutting point so that, upon cutting, it is not the
coagulation point itself but a point situated next to it that is
being severed.
In the case of the fourth exemplified embodiment of the surgical
scissors illustrated in FIGS. 9 and 10, the two scissor legs 301
and 302 are, by means of insulating pins 339 attached to the first
scissor leg 301 and slotted holes 338 in the second scissor leg,
interconnected in such a way that they are not pivotally connected
but are axially slidable. To keep the two scissor legs 301 and 302
at a distance from one another and to insulate them electrically
from one another at the same time, there have been provided
electrically insulating sliding elements 340 and 341 between the
legs next to the slotted holes 338.
At one of their extremities, the two scissor legs 301 and 302 are
provided with cutting blades 306 and 307, respectively, laterally
projecting in the same direction as seen in FIG. 9, which have
edges 308 and 309, respectively, corresponding to the edges 108 and
109 of the second exemplified embodiment, at the free ends of which
there have been provided projections 331 and 332, respectively, to
form coagulation electrodes.
At the opposite ends of the two scissor legs 301 and 302, finger
grips have been provided. In this embodiment the scissor leg 301
has been designed to be somewhat shorter than the scissor leg 302
and is provided with two laterally projecting finger grips 342,
while the somewhat longer second scissor leg 302 is provided at its
end with only one finger grip 343. At one of the two finger grips
342 and at the finger grip 343 there have been provided electrical
contact pins 342 and 325, respectively.
In the case of the first two exemplified embodiments according to
FIGS. 1 to 6 there has been provided a metal closing screw 3 or
103, respectively. Said closing screw may however consist also of
an insulating material, for instance a polyamide. In such a case
there is required for insulating purposes between the two scissor
legs 1 and 2, or 101 and 102, only the insulating plate 11 or 111.
In lieu of a closing screw there may also be provided a rivet.
* * * * *