U.S. patent number 3,677,262 [Application Number 05/057,502] was granted by the patent office on 1972-07-18 for surgical instrument illuminating endotracheal tube inserter.
Invention is credited to Henry J. Zukowski.
United States Patent |
3,677,262 |
Zukowski |
July 18, 1972 |
SURGICAL INSTRUMENT ILLUMINATING ENDOTRACHEAL TUBE INSERTER
Abstract
A surgical instrument used as an endotracheal tube introducer
consists of a central curved fiberoptic bundle for viewing and a
surrounding tubular fiberoptic bundle to carry light to the area to
be viewed and an outermost metallic sheath to give rigidity. The
distal end of the instrument is bent laterally at an angle so that
it can be twisted to permit scanning around anatomical obstructions
so that a path of entry can be found whereby the instrument will
bypass obstructions without damage. The tube to be inserted is
sleeved on the instrument with provision for detaching the tube
after insertion into the trachea thereby permitting withdrawal of
the instrument after intubation.
Inventors: |
Zukowski; Henry J. (Grosse
Pointe Shores, MI) |
Family
ID: |
22010961 |
Appl.
No.: |
05/057,502 |
Filed: |
July 23, 1970 |
Current U.S.
Class: |
600/120; 601/108;
600/131; 385/117 |
Current CPC
Class: |
A61B
1/00165 (20130101) |
Current International
Class: |
A61B
1/00 (20060101); A61b 001/06 (); A61m 016/00 ();
G02b 005/16 () |
Field of
Search: |
;128/6,11,351,8,10 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Pace; Channing L.
Claims
WHAT I CLAIM AS MY INVENTION IS:
1. A surgical instrument for facilitating the introduction into a
human patient of an endotracheal tube comprising an elongated
casing non-flexible and rigid for its entire length, a central
fiberoptic bundle adapted to transmit an image, a surrounding
tubular fiberoptic bundle for transmitting light, an opaque layer
between said bundles, said casing with bundles therein having its
rigid distal end curved to extend at a fixed angle to the main
portion for insertion into the throat of a human patient, the outer
surface of said casing being cylindrical and having sleeved thereon
an endotracheal tube, a light source connected to said tubular
bundle, and an eyepiece connected to said central bundle, said
instrument providing means for observation of an unobstructed path
through which the instrument and tube may be moved into position
within the trachea.
2. A surgical instrument comprising an elongated tubular
non-flexible rigid casing of substantially uniform outside diameter
having at its distal end a non-flexible portion which is curved to
extend at an angle thereto, said rigid casing having removably
sleeved thereon an endotracheal tube, a central fiberoptic viewing
bundle extending within said casing from the curved distal end to
the proximal end thereof, an eyepiece at the proximal end of said
casing to permit observation of the image of the illuminated area
at the distal end which is transmitted through said fiber-optic
bundle, thereby enabling the observer to direct the curved distal
end to bypass the epiglottis and vocal cords and penetrate the
trachea whereupon the endotracheal tube can be slid off the casing
and moved further into the trachea, while the casing is withdrawn
from the implanted tube.
3. A surgical instrument according to claim 2 wherein there is a
layer of surgical lubricant between the tube and the casing to
facilitate withdrawal of the instrument after the tube is
implanted.
4. A surgical instrument according to claim 2 in combination with
means for illuminating the area adjacent the distal end of said
casing.
5. A surgical instrument according to claim 4 in which said
illuminating means is provided by a separate illuminating
instrument.
6. A surgical instrument according to claim 4 in which said
illuminating means comprises a tubular fiberoptic bundle
surrounding said central fiberoptic bundle and a light source
connected to the proximal end of said tubular bundle.
Description
BACKGROUND OF THE INVENTION
The present invention relates to an improvement in surgical
instruments and more particularly to an endotracheal tube
introducer. In modern surgery, it is common procedure to provide
the patient with a tube extending into the trachea for various
purposes, particularly prior to the administration of an
anesthetic. With a majority of patients, little difficulty is
experienced, and intubation into the trachea is accomplished in a
routine manner. In a small percentage of patients there are
abnormalities in the structure of the throat which interfere with
intubation, sometimes making it very difficult and in some
instances creating an apparently impossible situation. Presently,
there is no surgical instrument that provides a satisfactory and
safe means for intubation in such anatomically difficult situations
where the surgeon cannot visualize the entire route through which
the tube must pass. Without the means for visual inspection, there
is danger that the vocal cords would be damaged by endeavoring to
force the tube past the obstructions.
SUMMARY OF THE INVENTION
The present invention provides a new surgical instrument which
enables the surgeon to complete the insertion of the tube even when
the anatomy is such that no direct line of sight can be provided.
This is accomplished by providing a tube-introducing instrument
with means for visualizing in a curved line, so that when the
instrument meets with an obstruction it can be pointed in different
direction and probing continued until the operator can visually
determine a new path other than a straight line through which the
tube can bypass the obstruction.
The new instrument of the present invention consists of a tubular
casing projecting in a generally straight line from a handle and
having at the distal end a laterally bent portion extending at an
angle thereto. Centrally within the casing is a fiberoptic viewing
bundle extending from an eyepiece in the handle to the open end of
the casing. The viewing bundle follows the contour of the casing
being straight from the eyepiece for the greater part of its length
and then being curved and laterally bent at the distal end to the
same degree as the distal end of the casing. Surrounding the
central fiberoptic viewing bundle is a tubular fiberoptic light
bearing bundle which leads from a light source in the handle. When
the instrument is inserted in the throat of a patient, light is
conducted through the tubular bundle and illuminates the area
distally of the instrument. This enables the operator to see the
illuminated area since the view is transmitted back to the eyepiece
through the central optic bundle. The operator can twist the
instrument to cause the distal end to move in various directions
and can then determine by observation a path avoiding obstructions
through which the instrument can safely be moved and can insert the
instrument through that path. The tube to be inserted is sleeved
over the casing and when the instrument reaches its destination the
tube can be detached and left in that position while the instrument
can be withdrawn.
DRAWINGS
FIG. 1 is a side view of the instrument with the endotracheal tube
sleeved thereon
FIG. 2 is a longitudinal section.
FIG. 3 is a transverse section on line 3--3 of FIG. 2.
Referring to the drawings, the surgical instrument consists of an
outer tubular casing 10 containing a central fiberoptic bundle 11,
a surrounding tubular fiberoptic bundle 12, and an opaque layer 13
between the bundles. The central fiberoptic bundle is a standard
type of device which transmits the image from the scanning end to
the observation end. The tubular fiberoptic bundle 12 is a standard
type of device which transmits light from a suitable light source
and projects it into the space surrounding the image to be viewed.
The instrument casing has a straight portion 14 for the greater
part of its length and at the distal end the casing and the
fiberoptic bundles contained therein are laterally bent forming a
distal portion 15 extending at an angle to the straight portion.
The proximal end of the casing 10 is attached to a suitable handle
16 which, as shown, is in the form of pistol grip. The free end of
the handle has attached thereto by means of conduit 17 the standard
fiberoptic light source. Conduit 17 continues through the pistol
grip handle by means of fiberoptic bundle 18 having a curved
portion 19 which merges with tubular bundle 12 within the handle
16. The central viewing bundle 11 from the straight portion 14 of
the casing projects through the curved portion 19 and continues
through the handle 16 as shown at 20 to a suitable eyepiece 21. The
endotracheal tube 22 to be placed in the patient, may be sleeved
onto the casing 10 with one end 23 in alignment with the distal end
of the casing and the other end abutting the handle. 24 is a
standard yoke fitting for the tube. This is retained in position by
a suitable catch 25 that can be released when the instrument is
withdrawn.
The purpose of the instrument as described is to facilitate the
placement of an endotracheal tube in the anatomically difficult
situation. Usually it will be used for intubation for anesthesia.
It can be used alone like a bronchoscope or with aid of a Magill
type laryngoscope to expose the epiglottis. It is unique in that it
provides a curved line of vision so that the vocal cords can be
viewed behind the epiglottis when they are highly situated and
cannot be viewed in the straight line of vision normal endotracheal
procedure entails.
The usage of the instrument as above described is as follows: the
patient is positioned in the normal supine attitude with the head
hyperextended. The mouth is opened and the tip of the instrument
with the endotracheal tube in place is introduced under direct
vision into the pharynx. The epiglottis is bypassed by swinging the
handle to the left thereby placing the curved tip of the instrument
to the right and under the epiglottis. As the vocal cords lie just
beyond the epiglottis the field may then be scanned laterally by
swinging the handle to the right and left. When the cords are
identified the entire instrument is advanced beyond them into the
trachea. As soon as engagement is made the catch on the instrument
is released and the endotracheal tube is slid off the instrument
and deeper into the trachea. An alternate method of use is to
expose the epiglottis with a Magill type laryngoscope and work as
above from this reference point.
In using the instrument of this invention, it is preferable to
employ a wire wound latex endotracheal tube because a thin walled
tube with no danger of kinking is thus provided. A thicker walled
plastic endotracheal tube can be used if the subject is large. A
No. 8 tube diameter is specified only because this is a compromise
in size which will fit all adults. Intubation is seldom a problem
in children so that the instrument may only be produced in an adult
size. It will be necessary to apply a coat of surgical lubricant on
the outer wall of the instrument before the tube is applied to
insure easy movement once the intubation is accomplished and the
tube must be moved down. A variation of the handle might provide a
trigger mechanism to release the catch and start the tube moving
down the shaft.
It will be understood that the invention can be embodied in
modified forms, and is not limited to the exact details as shown
and described. Instead of supplying the standard fiberoptic light
source by means of the conduit 17, it can be provided within the
handle 16 by means of a rechargeable battery.
* * * * *