U.S. patent number 3,739,784 [Application Number 05/203,633] was granted by the patent office on 1973-06-19 for surgical instrument.
This patent grant is currently assigned to Olympus Optical Co., Ltd.. Invention is credited to Mitsuto Itoh.
United States Patent |
3,739,784 |
Itoh |
June 19, 1973 |
SURGICAL INSTRUMENT
Abstract
Forceps for use with an endoscope. The distal end portion of the
forceps is provided with a pair of longitudinal parallel legs
separated by a slot therebetween. The longitudinal edge of at least
one of the legs is made a sharp cutting edge and the front end of a
wire having a diameter slightly smaller than the width of the slot
and extending through the flexible tube of the forceps so as to be
manually operated at its rearward end is pivotally mounted on the
forward ends of the legs in the slot so that the forward end
portion of the wire is bent to form a loop so as to capture a
projecting mass such as a polyp when the wire is pushed forwardly
while the wire is tensioned to move into the slot when the wire is
pulled rearwardly, thereby severing the captured projecting mass by
the cooperation of the wire with the cutting edge of the leg.
Inventors: |
Itoh; Mitsuto (Hachioji-shi,
Tokyo, JA) |
Assignee: |
Olympus Optical Co., Ltd.
(Tokyo, JA)
|
Family
ID: |
22754714 |
Appl.
No.: |
05/203,633 |
Filed: |
December 1, 1971 |
Current U.S.
Class: |
606/113 |
Current CPC
Class: |
A61B
1/018 (20130101); A61B 17/320016 (20130101); A61B
17/32056 (20130101); A61B 17/29 (20130101); A61B
2018/1407 (20130101) |
Current International
Class: |
A61B
17/28 (20060101); A61B 17/32 (20060101); A61B
1/018 (20060101); A61B 1/012 (20060101); A61B
18/14 (20060101); A61b 001/06 (); A61b 017/00 ();
A61b 001/72 () |
Field of
Search: |
;128/320,309,306,328,356 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Medbery; Aldrich F.
Claims
I claim:
1. A forceps for use with an endoscope comprising:
a. an elongated flexible tube having two longitudinally terminal
portions and formed with a longitudinal bore therethrough;
b. wall means elongated in the direction of elongation of said tube
and longitudinally projecting from one of said terminal
portions,
1. said wall means defining a recess elongated in said direction
and having a side open transversely of said direction,
2. said wall means having an elongated cutting edge adjacent said
recess,
3. said recess having one longitudinal part adjacent said one
terminal portion and communicating with said bore and another
longitudinal part spaced from said one part and remote from said
one terminal portion;
c. an elongated flexible member slidably guided in said bore and
said recess;
d. pivot means securing one longitudinal end portion of said
flexible member to said wall means for pivotal movement about an
axis transverse to said direction in said other part of said recess
and for limiting movement of said one end portion in said
direction; and
e. control means on the other longitudinally terminal portion of
said tube operatively connected to the other longitudinal end
portion of said flexible member for moving said other end portion
toward and away from said one terminal portion and for thereby
moving said one end portion transversely of said direction outward
of said recess through said open side until said one end portion
and said wall means bound a loop, and for thereafter reducing the
size of said loop and moving said one end portion into said
recess.
2. A forceps as set forth in claim 1, wherein said wall means
include two leg members elongated in said direction and laterally
bounding said recess.
3. A forceps as set forth in claim 2, wherein said leg members have
respective opposite faces in said recess, one of said faces
terminating in said cutting edge, and the other face being formed
with a receptacle.
4. A forceps as set forth in claim 1, wherein said pivot means
include an elongated arm pivoted to said wall means for angular
movement about said axis inward and outward of said open side and
having a free end fastened to said one end portion of said flexible
member, said arm being more rigid than said flexible member.
5. A forceps as set forth in claim 4, wherein said arm has a
longitudinal cutting edge located for shearing cooperation with the
cutting edge of said wall means during said angular movement.
6. A forceps as set forth in claim 1, further comprising means in
said recess for limiting buckling of said one end portion of the
flexible member away from said open side.
Description
BACKGROUND OF THE INVENTION
The present invention relates to a forceps for use with an
endoscope and, more particularly, to forceps capable of positively
capturing and severing a mass projecting into a body cavity such as
a polyp without destroying the tissue surrounding the polyp and
taking out the severed mass.
Heretofore, no effective forceps for use with an endoscope has been
developed for severing and taking out a projecting mass such as a
polyp growing in the stomach, gullet and the like of a living
body.
A prior art forceps of the type described above uses a loop of a
wire extending from the distal end portion of a forceps and the
projecting mass captured by the loop of the wire is severed by
pulling the branches of the wire extending from the loop and
extending through the elongated tube of the forceps rearwardly by
means of a control means in the proximal control portion of the
forceps so as to contract the loop to sever the projecting
mass.
In such a forceps, a wire having a relatively large diameter must
be used for forming the loop in order to avoid the breakage of the
wire during the repeated use of the forceps, thereby deteriorating
the efficient severing performance of the wire. Further, there is a
danger to destroy the tissue surrounding the projecting mass to be
severed because of the deteriorated severing performance of the
wire.
Further, it has been very difficult to positively take out the
severed mass such as the polyp without fail because of the
peristaltic movement of organ through which the severed mass must
be taken out, thereby resulting in substantial inconvenience in the
operation of the forceps.
SUMMARY OF THE INVENTION
The object of the present invention is to provide a novel and
useful forceps for use with an endoscope capable of positively
capturing, severing a projecting mass such as a polyp growing in a
hollow portion of a living body and taking the severed mass out of
the hollow portion without destroying the portions surrounding the
projecting mass to be severed.
The above object is achieved in accordnace with the present
invention by the provision of a forceps having a proximal control
portion, a distal end portion and an elongated flexible tube
connecting the distal end portion to the proximal control portion,
the forceps being characterized by the distal end portion having a
pair of longitudinal parallel legs separated from each other by a
longitudinal slot formed in the distal end portion, a wire
shiftably extending through the flexible tube and the slot, a pin
secured to the pair of legs adjacent to the forward ends thereof so
as to extend in the slot laterally thereto, the forward end of the
wire being swingably attached to the pin, and control means
provided in the proximal control portion, the rearward end of the
wire being connected to the control means so as to be actuated
thereby, so that, when the wire is pushed forwardly, the forward
portion thereof is bent to form a loop in the range of the legs
thereby providing a space between the loop of the wire and the
legs, while the wire is tensioned to move into the slot when the
wire is pulled rearwardly at least one of the longitudinal edges of
the pair of legs forming a cutting edge while the width of the slot
is slightly larger than the diameter of the wire, so that the
cutting edge cooperates with the wire when the same is tensioned,
thereby permitting a projecting mass such as a polyp captured in
the space between the loop of the wire and the legs to be severed
by the cutting edge cooperating with the wire thus tensioned.
An inclined capturing surface may be formed in the surface of one
of the legs facing against the other of the legs for positively
holding the severed projecting mass on the capturing surface by the
wire tensioned by the control means so as to sever the projecting
mass.
A sharp cutting edge may be formed in either or both of the legs by
cutting aslant the outer surface thereof along the longitudinal
edge of the leg forming the cutting edge so as to move effectively
sever the projecting mass.
Alternatively, a cutting member may be provided having one end
swingably fixed to the pin and having a length and a width less
than those of the slot, respectively, so that the cutting member is
swung into and out of the slot by the swinging movement of the
cutting member, the cutting member being formed with a cutting edge
while one of the legs is provided at its longitudinal edge with a
longitudinal cutting edge cooperating with the cutting edge of the
cutting member. The wire shiftably extending through the flexible
tube is pivotally secured to the free end of the cutting member at
its forward end, while the rearward end of the wire is connected to
the control means so as to be actuated thereby, so that, when the
wire is pushed forwardly, the cutting member is swung out of the
slot to provide a space between the cutting member and the legs for
capturing the projecting mass therein, while the cutting member is
swung into the slot when the wire is tensioned, thereby permitting
the projecting mass captured in the space to be severed by the
cutting member cooperating with the cutting edge of the leg.
In accordance with another characteristic feature of the present
invention, the forceps may be provided with a first wire forming a
loop projecting from the distal end portion, the branches which
extend from the loop shiftably extending through the flexible tube,
a second wire shiftably extending through the flexible tube with
its forward end swingably connected to the distal end of the loop
of the first wire, a first control means provided in the proximal
control portion, the rearward ends of the branches of the first
wire being connected to the first control means so as to be
actuated thereby, so that the loop is enlarged when the first wire
is pushed forwardly so as to facilitate to capture a projecting
mass therein while the loop is contracted to sever the projecting
mass captured in the loop when the first wire is pulled rearwardly,
and a second control means provided in the proximal control
portion, the rearward end of the second wire being connected to the
second control means so as to be actuated thereby, so that the thus
severed projecting mass is positively captured by the second wire,
when the same is pulled rearwardly.
In accordance with a further characteristic feature of the present
invention, a high frequency electric source is provided and the
forceps are electrically isolated from the endoscope through which
the forceps extends, one terminal of the high frequency electric
source being connected to the forceps while the other terminal is
adapted to contact with a body of which the hollow portion is to be
operated by the forceps introduced therein together with the
endoscope, thereby permitting the severing of the projecting mass
projecting from the hollow portion to be carried out under the
influence of a high frequency electric current so as to locally
heat the portion to be severed.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an enlarged side view showing the distal end portion of a
prior art forceps for use with an endoscope;
FIGS. 2 to 12 are fragmentary views showing the first embodiment of
the forceps constructed in accordance with the present invention,
FIG. 2 showing the distal end portion in enlarged plan view, FIG. 3
being a sectional view taken along line A--A in FIG. 2, FIG. 4
being a cross-section taken along line B--B in FIG. 2, FIG. 5
showing the proximal control portion of the forceps in elevational
section, FIGS. 6 to 9 show various steps of operation of the
forceps of FIG. 3, while FIGS. 10 to 12 show the devices of in
FIGS. 7 to 9, respectively, in section on the line C--C;
FIGS. 13 to 17 are views showing a modification of the forceps
shown in FIGS. 2 to 12, FIG. 13 being a plan view showing the
distal end portion of the forceps as seen from the upper side
thereof, FIG. 14 being a longitudinal sectional view taken along
line D--D in FIG. 13, FIG. 15 being a cross-sectional view taken
along line E--E in FIG. 13, FIG. 16 being the longitudinal
sectional view similar to FIG. 14 but showing the severed
projecting mass which is captured on the capturing surface by the
wire while FIG. 17 is a cross-sectional view taken along line F--F
in FIG. 16;
FIGS. 18 to 21 are views showing a further modification of the
forceps shown in FIGS. 2 to 12 which is provided with a cutting
member, FIG. 18 being a plan view showing the distal end portion of
the forceps as seen from the upper side thereof, FIG. 19 being the
longitudinal sectional view taken along line G--G in FIG. 18, FIG.
20 being a cross-sectional view taken along line H--H in FIG. 18,
while FIG. 21 is a view similar to FIG. 19 but showing the cutting
member swung out of the distal end portion to be ready for
commencing the severing of the projecting mass;
FIGS. 22 to 26 are views showing a still further modification of
the forceps shown in FIGS. 2 to 12, FIG. 22 being a plan view
showing the distal end portion as seen from the upper side thereof,
FIG. 23 being the longitudinal sectional view taken along line I--I
in FIG. 22, FIG. 24 being a cross-sectional view taken along line
J--J in FIG. 22, FIG. 25 being the sectional view similar to FIG.
23 but showing the projecting mass captured between the distal end
portion and the wire, while FIG. 26 is a cross-sectional view taken
along line K--K in FIG. 25 showing the manner how the projecting
mass captured between the distal end portion and the wire is
severed;
FIG. 27 is a schematic perspective view showing the essential part
of the distal end portion of the second embodiment of the forceps
of the present invention;
FIG. 28 is a plan view showing the connection of the wires used in
the forceps of FIG. 27;
FIG. 29 is a perspective view of FIG. 28;
FIG. 30 is a fragmentary view in magnified scale showing the distal
end portion of the forceps of FIG. 27;
FIG. 31 is a front view showing the configuration of the distal end
portion of FIG. 30;
FIGS. 32 is a fragmentary side view showing the proximal control
portion of the forceps of FIG. 27;
FIGS. 33 to 35 are views showing the steps how the projecting mass
is captured and severed by the forceps of FIG. 27;
FIGS. 36 and 37 are fragmentary views showing a modification of
connection of the first wire to the second wire; and
FIG. 38 is a fragmentary view similar to FIG. 36 but showing a
further modification of connection of the first and second
wires.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to FIG. 1 showing the prior art forceps, a wire 2 is
shown to form a loop extending from the distal end portion 1 of the
forceps which is connected to a proximal control portion (not
shown) by an elongated flexible tube a portion of which is shown as
connected to the distal end portion 1. The branches of the wire 2
extending from the loop extend through the distal end portion 1 and
the elongated flexible tube and the rearward ends of the branches
of the wire 2 are connected to a control means (not shown) provided
in the proximal control portion so that the wire 2 is pushed
forwardly and pulled backwardly by the operation of the control
means. In operation, the wire 2 is first pushed forwardly after the
distal end portion 1 is inserted into a hollow portion to be
operated together with the endoscope with which the forceps is used
so that the loop of the wire 2 is enlarged so as to capture a
projecting mass 3 such as a polyp growing in the hollow portion as
shown. Then the wire 2 is pulled rearwardly by the operation of the
control means, thereby contacting the loop to sever the projecting
mass 3. In such a forceps, since the distal end of the loop formed
by the wire 2 is turned back upon itself during the operation of
the forceps to form a node 2', the wire 2 tends to be easily broken
at the node 2' as the operation of the forceps is repeated. Further
it is difficult to capture the projecting mass by such a forceps
thereby making the operation of the forceps troublesome and time
consuming in addition to the danger which might occur when the wire
2 is broken.
FIGS. 2 to 12 show first embodiment of the forceps of the present
invention. The forceps shown comprises a distal tubular end portion
11 and a proximal tubular control portion 12 connected to the
distal end portion 11 by an elongated flexible tube 13 made of a
closely wound helical coil.
The distal end 11 carries a pair of parallel legs 16 extending
forwardly of the distal end portion 11 and separated from each
other by a slot or elongated recess 15.
The end wall 11' of the distal end portion 11 is formed with a
central hole through which a wire 14 shiftably extends into the
bore of the tube 13. The forward end of the wire 14 is secured to a
connecting piece 19 by means of solder 19a, the connecting piece 19
being in turn rotatably mounted on a pin 18 secured to the legs 16
and extending in the slot 15 laterally thereto. The longitudinal
end portion of the wire 14 seen in FIG. 2 is thus limited in its
longitudinal movement while being capable of pivotal movement about
an axis transverse of the elongation of the slot 15.
The rearward end of the wire 14 extends outwardly of the
cylindrical portion of the proximal control portion 12 through an
elongated slot 12a formed in the cylindrical portion and secured by
solder 20a to an operating or control ring 20, slidably mounted on
the cylindrical portion so that the wire 14 is pushed forwardly or
pulled rearwardly by the operation of the operating ring 20.
Thus, when the wire 14 is pushed forwardly, the forward portion of
the flexible wire 14 between the connecting piece 19 and the end
wall 11' is bent outward of the open side of the slot 15 to form a
loop 24 between a wire 14 and the legs 16 in which the projecting
mass 3 is easily captured. When the wire 14 is pulled rearwardly,
the loop is contracted so that the wire 14 moves into the slot 15
in tensioned state.
At least one leg 16 has a sharp, longitudinal cutting edge 17, and
the width of the slot 15 between the wall faces of the legs 16 is
only slightly greater than the diameter of the wire 14 permitting
the same to easily move into the slot 15 while close contact of the
cutting edge 17 with the wire 14 is insured.
Thus, the projecting mass 3 captured in the loop 24 is easily and
efficiently severed by the cutting edge 17 when the wire 14 is
pulled rearwardly by the operating ring 20 without damage to tissue
surrounding the projecting mass 3. The thus severed mass 3 is
positively held in the slot 15 by means of the tensioned wire
14.
Pin 21 extending between the legs 16 in the slot 15 serves to
prevent the wire 14 from bucking in the direction opposite to that
shown in the figures so that the loop of the wire 14 is positively
formed at the side where the cutting edge 17 is formed in the leg
16.
In the drawings, the slot 15 is shown as extending from one
peripheral surface to the diametrically opposite peripheral
surface, however, the slot 15 may be partly closed by a
longitudinal bottom surface.
FIGS. 13 to 17 show a modification of the forceps shown in FIG. 2.
The forceps of FIGS. 13 to 17 is substantially similar to that
shown in FIG. 2 except that a shallow, concave receptacle 15' is
formed in the face of one of the legs directed toward the slot 15
and the cut-ting edge 17 on the other leg 16. The bottom wall of
the receptacle is obliquely inclined relative the slot 15.
The operation of the forceps of FIG. 13 is similar to that of FIG.
2, except that the severed projecting mass 3 is more safely held in
the slot 15 by virtue of the provision of the receptacle 15' as
shown in FIG. 17.
FIG. 18 to 21 show a further modification of the forceps of FIG. 2.
In this embodiment, one end of an arm member 22 having a cutting
edge 22' is swingably mounted on the pin 18 and the free end of the
more rigid member 22 is pivotally connected to the forward end of
the wire 14 so that the member 22 is swung out of the open side of
the slot 15 when the wire 14 is pushed forwardly while the member
22 is moved into the slot 15 when the wire 14 is pulled rearwardly.
The width of the member 22 is made slightly smaller than the width
of the slot 15 for free swinging movement of the member 22 into and
out of the slot 15 while the cutting edge 22' of the member 22
shearingly cooperates with the cutting edge 17 of the leg 16 when
the member 22 is swung into the slot 15.
The operation of the embodiment of FIG. 18 is substantially similar
to that of FIG. 2.
FIGS. 22 to 26 show a further modification of the forceps of FIG.
2.
This embodiment is substantially similar to that of FIG. 2 except
that a surface 23a is formed in either one of the outer surfaces of
the legs 16 merging with the longitudinal edge thereof so as to
form a sharp cutting edge 23 as shown in FIG. 24. Thus, the
projecting mass 3 captured between the wire 14 and the legs 16 can
be most efficiently severed by the cutting edge 23 cooperating with
the tensioned wire 14.
FIGS. 27 to 32 show the second embodiment of a forceps of the
present invention which comprises a first wire 104 forming a loop
extending from the distal end portion 107 with the branches or the
portions of the wire 104 extending from the respective ends of the
loop through the flexible tube 13 toward the proximal control
portion 12. The ends of the branches of the wire 104 pass through
an elongated slot (not shown) formed in a cylindrical guide tube
111 and are connected to a first operating or control ring 112
slidably guided on the cylindrical guide tube 111 so that the wire
104 is pushed forwardly to enlarge the loop or pulled rearwardly to
contract the loop by the operation of the operating ring 112. The
loop of the wire 104 serves to capture the projecting mass and
sever the same when the loop is contracted.
A second wire 105 extends through the flexible tube 13, and an eye
106 provided at its distal end is pivotably connected to a bent
back portion 104a formed at the distal end of the loop of the wire
104 while the rearward end of the wire 105 passes through the
elongated slot in the cylindrical guide tube 111 and is connected
to a second operating ring 113 slidably guided on the cylindrical
guide tube 111 so that, when the operating ring 113 is actuated,
the wire 105 is pushed forwardly to form a loop between the eye 106
and the distal end portion 107 or is pulled rearwardly to contract
the loop. The second wire 105 serves to positively hold the severed
projecting mass. Stationary stop rings 114 are secured to the
cylindrical guide tube 111 of the proximal control portion 12 so
that the stroke of each of the operating rings 112, 113 is
appropriately limited. The stop rings 114 may be adjustable to suit
the conditions under which the operation is to be carried out.
As is shown in FIG. 31, a hole 109 formed in the end wall of the
distal end portion 107 is used to slidably pass therethrough the
second wire 105 while the elongated hole 108 is used for slidably
passing therethrough the branches of the wire 104 extending from
the loop of the wire 104.
FIGS. 33 to 35 show the manner how a polyp projecting from an inner
wall of a living body is captured and severed by the forceps of
FIG. 27.
First, the first and second wires 104, 105 are pushed forwardly by
the operation of the operating rings 112, 113 after the distal end
portion 107 is inserted together with the endoscope into a body
cavity so as to capture the projecting mass within the loop of the
wire 104 and in the loop of the wire 105 as shown in FIG. 33 while
the projecting mass is observed through the optical system of the
endoscope, not shown. Then, the operation ring 112 is manually
moved rearwardly to pull the wire 104 so as to contract the loop of
the wire 104 thereby severing the projecting mass captured therein.
At the same time or after the operation of the first operating ring
112, the second operating ring 113 is moved rearwardly to contract
the loop of the wire 105 so that the severed projecting mass is
positively held by the wire 105 as shown in FIG. 35.
FIGS. 36 and 37 show a modification of the connection of the wire
104 with the wire 105. The leg end of a U-shaped connecting piece
116 having a slot 115 are attached to respective, distal end
portions of the wire 104. A pin 118 is secured to the piece 116
extending laterally of the slot 115 and a pivot piece 117 connected
to the distal end of the wire 105 is pivotally mounted on the pin
118 in the slot 115. The operation of the embodiment is similar to
that shown in FIG. 28.
FIG. 38 shows a further modification of the connection between the
wires 104 and 105. In this embodiment, an eye 119 is provided at
the distal end of the loop formed by the wire 104 and the eye 119
is pivotally engaged with the eye 106 of the wire 105.
In accordance with a further feature of the present invention, a
high frequency electric operation may be carried out during the
operation of the forceps.
In this case, the forceps is electrically isolated from the
endoscope through which the forceps is inserted for the operation
thereof. One of the terminals of a high frequency electric source
(not shown) is connected to the forceps while the other terminal of
the electric source is contacted with the body of which the hollow
portion is to be operated by the forceps.
In operation, a high frequency electric current is supplied through
the forceps to the portion of the body to which the operation of
the forceps is applied by appropriately operating the switch of the
electric source during the operation of the forceps. Therefore, the
portion severed by the forceps is locally heated to minimize the
damage such as blooding in the portion to which the operation is
applied.
* * * * *