U.S. patent number 3,744,481 [Application Number 05/144,468] was granted by the patent office on 1973-07-10 for medical examining method and means.
Invention is credited to Bernard McDonald.
United States Patent |
3,744,481 |
McDonald |
July 10, 1973 |
MEDICAL EXAMINING METHOD AND MEANS
Abstract
A device for viewing the cervix and vaginal segment of a human
uterus has two, three or four elongate blades removably mounted on
a holder. The blades are adjustable to spread and to retain the
vaginal walls including the cervico-vaginal fornix for visual
observation and accessibility of surgical instruments to the
uterus. A handle supports the blades and preferably has
illumination sources and, optionally, a viewing lens mounted
thereon. Each of the blades includes means at its distal end for
securely engaging the exterior peripheral rim of a cervix for
immobilizing it during surgical procedures. The two blades are
resiliently biased towards each other.
Inventors: |
McDonald; Bernard (Malibu,
CA) |
Family
ID: |
22508728 |
Appl.
No.: |
05/144,468 |
Filed: |
May 18, 1971 |
Current U.S.
Class: |
600/213; 600/217;
600/223; 600/224 |
Current CPC
Class: |
A61B
1/32 (20130101) |
Current International
Class: |
A61B
1/32 (20060101); A61b 001/06 (); A61b 001/30 ();
A61b 001/32 () |
Field of
Search: |
;128/6,17,18,2B |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Pace; Channing L.
Claims
I claim:
1. A combined vaginal speculum and tenaculum comprising:
a handle;
a first speculum blade connected to the handle;
a second speculum blade opposed to the first blade;
means for connecting the second blade to the handle for relative
movement of the first and second blades towards and away from each
other;
means on the distal end of each of the blades for securely engaging
the exterior peripheral rim of a cervix; and
means for resiliently biasing the blades towards each other.
2. A combined vaginal speculum and tenaculum as defined in claim 1
wherein the means for engaging the cervix comprises a plurality of
spaced apart projections on each blade, said projections on one of
the blades extending generally towards the projections on the
opposed blade.
3. A combined vaginal speculum and tenaculum as defined in claim 1
wherein the means for engaging a cervix comprises cups of flexible
resilient material having a thin, easily deformed, peripheral
edge.
4. A combined vaginal speculum and tenaculum as defined in claim 3
further comprising means for connecting a vacuum to the interior of
the cups.
5. A combined vaginal speculum and tenaculum as defined in claim 1
further comprising means for illuminating a proximal end portion of
at least one of the blades and wherein said illuminated blade is
transparent and has a sufficiently regular exterior for
transmitting light from the proximal end portion substantially to
the distal end.
6. A combined vaginal speculum and tenaculum as defined in claim 1
wherein the means for connecting each of the blades to the handle
comprises means for temporarily connecting the blade to the
handle.
7. A combined vaginal speculum and tenaculum as defined in claim 6
wherein each of the blades includes a frangible portion for
disconnecting the respective blade from the handle.
8. A combined vaginal speculum and tenaculum as defined in claim 6
wherein the means for connecting the second blade to the handle for
relative movement comprises:
means for translating a proximal end portion of the second blade
relative to the first blade; and
means for tilting one of the blades about its proximal end relative
to the other blade.
9. A combined vaginal speculum and tenaculum as defined in claim 6
wherein the means for connecting each of the blades to the handle
comprises a slot in the handle; and wherein the blade includes a
curved portion fittable into the slot, the relative size of the
curved portion of the blade and the slot providing an interference
fit whereby the blade is slightly deformed in the slot.
10. A vaginal speculum comprising:
a handle;
a first speculum blade;
means for temporarily connecting the first speculum blade to the
handle;
a second speculum blade;
means for temporarily connecting the second speculum blade to the
handle and opposed to the first speculum blade; and
means on the handle for moving the blades towards and away from
each other; and wherein
each of the speculum blades includes a frangible portion for
disconnecting the blades from the handle.
11. A vaginal speculum as defined in claim 10 wherein the frangible
portion comprises a region of reduced transverse cross section on
the blade for a manual breakage thereof.
12. A vaginal speculum as defined in claim 10 wherein the means for
temporarily connecting each speculum blade to the handle
comprises:
a slot in the handle elongated in a direction transverse to the
length of the blade; and
a transversely curved portion on the blade fittable into the slot,
the relative size of the blade and slot requiring increased
curvature of the blade to fit into the slot for providing an
interference fit therebetween.
13. A vaginal speculum as defined in claim 12 wherein each blade
further comprises a projecting bead for engaging a portion of the
handle for positioning the blade in a predetermined position.
14. In a vaginal speculum comprising a pair of opposed speculum
blades connected at their proximal ends to an operating handle,
said handle including means for translating the proximal ends of
the blades towards and away from each other and means for tilting
the blades relative to each other about their proximal ends, the
improvement comprising:
means on the distal end of each of the blades for securely engaging
the exterior peripheral rim of a cervix; and means for resiliently
biasing the blades toward each other.
15. In an improved speculum as defined in claim 14 the further
improvement wherein the means for engaging a cervix comprises a
plurality of teeth on the distal end of each of the blades for
engaging the cervix with sufficient force to stabilize it.
16. In an improved speculum as defined in claim 15 the further
improvement wherein each of the blades includes a frangible portion
for selectively removing the blade from the handle.
Description
BACKGROUND OF THE INVENTION
In a normal dormant state, the walls of the vagina are situated in
close juxtaposition about their axial center, thus preventing
direct visual observation of the cervix uteri as required for
medical examination or surgery thereon. The prior art includes a
familiar type of device known as a vaginal speculum having two
elongate metal blades pivotally joined together about a fulcrum,
whereby parting of the blades after their initial placement in situ
separates and holds apart the vaginal walls unidirectionally. The
foregoing type of device applies localized pressure on two
oppositely confronting vaginal wall portions to establish and
maintain a small distance between the same, but does not otherwise
engage the walls in a manner which would prevent their displacement
during contact by surgical instruments or the like. It is an
inherent disadvantage of vaginal specula that the fulcrum
supporting structure, and of the holding means for retaining the
blades in a spaced-apart relationship, unavoidably restrict both
the access area and the field of view of the situs which is sought
to be examined or operated upon, particularly when instrumental
contact with the cervix must be made.
In order to surgically or diagnostically operate on the cervix, as
associated with conization, cauterization, specimen collection of
the like, it is necessary to hold the organ securely against
movement. The device most widely used in the prior art for this
purpose is of the type known as tenacula. A tenaculum forcibly
engages and holds the cervix to prevent its movement during
surgical procedures involving the cervix uteri. This type of
instrument is functionally distinguishable from the vaginal specula
in that the latter does not grasp anything but merely spreads the
vaginal wall unidirectionally apart, and it is not an uncommon
practice for some operative techniques to involve both instruments
simultaneously, which is especially cumbersome, confining, and
severely restricts both the field of observation and the freedom of
surgical instrument movement. Moreover, neither of the types of
instrument discussed above offers any solution to the problem of
providing adequate illumination to permit detailed examination of
surfaces within the uterus.
SUMMARY OF INVENTION
The invention consists of a manually portable medical instrument,
one embodiment as seen in FIGS. 1-5 consisting of device 10,
generally comprising a handle 12, a hollow housing 14 mounted
thereon, and a plurality of blades 16, 18, and 20 releasably
secured to the housing. Illumination means 56 and 58 are mounted on
housing 14 and are electrically energized by dry cell batteries
within handle 12. Two or more blades such as 16 and 18 are adapted
to hold in spaced-apart relationship the vaginal walls of a patient
during medical examination, treatment or surgery, while one or more
additional blades such as blade 20 is provided with suitable means
for securely engaging and grasping the outside of the cervix
adjacent the cervico-vaginal fornix by suitable means such as
vacuum cups 88 (FIGS. 13 & 14) or slanted projections 82 (FIG.
12).
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows a general perspective view of the inventive device in
sample illustrative form,
FIG. 2 shows an end elevational view, partly fragmented, of a
portion of the device from FIG. 1,
FIG. 3 shows a side elevational view, partly fragmented, of the
structure shown in FIG. 2,
FIG. 4 shows a top plan view of the structure seen in FIGS. 2 and
3,
FIG. 5 shows a cross-sectional view taken along line 5--5 in FIG.
4,
FIG. 6 is an isolated view, partly in cross-section, of a detail
from the structure seen in FIGS. 2, 3 and 4,
FIGS. 7 and 8 are isolated views of two modifications involving
details of the structure seen in FIGS. 1 through 5, FIGS. 9 and 10
are both fragmented perspective views of two modifications
involving details from structure shown in FIG. 1,
FIG. 11 is an isolated fragmentary plan view, partly in
cross-section showing a detail from the structure in FIG. 4,
FIGS. 12, 13 and 14 are isolated fragmentary perspective views
showing modifications of a detail from the structure seen in FIG.
1,
FIG. 15 is an isolated, fragmented view of a detail of structure
suggested by broken lines in FIG. 2, FIG. 16 is an end elevational
view, partly fragmented, of a modification of the device shown in
FIGS. 1 through 5,
FIG. 17 is a side elevational view, partly fragmented, of the
structure shown in FIG. 16,
FIG. 18 is an isolated perspective view of two component detailed
parts from the structure shown in FIGS. 16 and 17,
FIG. 19 is an end elevational view, partly fragmented, of another
modification of the device differing from that shown in FIGS. 1-5
inclusive, and in FIGS. 16 through 18, inclusive,
FIG. 20 is a side elevational view, partly fragmented, of the
structure shown in FIG. 19,
FIG. 21 is an isolated perspective view of two component detailed
parts from the structure shown in FIGS. 19 and 20,
FIG. 22 is an end elevational view, partly fragmented, of a fourth
modification of the device differing from those shown in FIGS. 1.5,
inclusive; in FIGS. 16 through 18, inclusive; and in FIGS. 19
through 21, inclusive,
FIG. 23 is a side elevational view, partly in cross-section and
fragmented of the structure shown in FIG. 22,
FIGS. 24, 25 and 26 are isolated perspective views of three
component detailed parts, respectively, from the structure shown in
FIGS. 22 and 23,
FIG. 27 is general perspective view of a fifth modification of a
device incorporating the inventive principles taught herein and
differing from all the other modifications shown in the previous
Figures,
FIG. 28 is a side elevational view of the structure shown in FIG.
27,
FIG. 29 is a front elevational view of the structure shown in FIGS.
27 and 28, and
FIG. 30 is an isolated fragmentary view, partly in cross-section,
of a portion of the structure shown in FIGS. 27 through 29,
inclusive.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to the first embodiment shown in FIG. 1, it may be seen
that the novel structure is a manual implement generally designated
by reference numeral 10 having handle portion 12, housing assembly
portion 14 and elongate blade elements 16, 18 and 20 secured
thereto. Housing portion 14 principally comprises mounting block
22, hollow box member 24 best seen in FIG. 5, and oppositely
confronting brackets 26 and 28 secured in pivotal relationship with
block 22 by suitable pivots and holding means as suggested by pivot
screw 30.
As further seen in FIG. 5, handle 12 may be shaped and sized to
accommodate one or more standard dry cell batteries such as battery
32 axially aligned within the handle. Block 22 is provided with a
flanged cylindrical cavity adapted to fit over the adjoining upper
end of handle 12 and to be secured thereto by suitable means such
as a lug 46 projecting from handle 12 as seen in FIG. 2 and
engaging an offset or eccentric groove 33 formed in circular flange
34. Hollow box member 24 may be of sheet metal construction and has
a flat upper surface 36 joined to four downwardly-depending sides
including laterally spaced-apart side portions 38 and 40 seen in
FIG. 5, as well as forward and aft portions 42 and 44 situated in
the manner suggested by FIG. 4.
Brackets 26 and 28 are adjustably pivotal with respect to block 22
and held in any desired position of adjustment by knurled knobs 48
and 50, respectively, seen in FIG. 5, for example. Both mentioned
brackets include support means for blade elements 16 and 18 in the
form of spaced-apart apertures such as suggested by apertures 52
and 54 in brackets 26 and 28, respectively, seen in FIG. 2. The
blade elements, which are preferably of rigid or stiffly deformable
material, are releasably secured within the mentioned apertures
such as by deforming the blades into slight arcuate cross-sectional
shape, inserting the same through the apertures, and then releasing
the same. Residual stress in the deformed blade material will tend
to flatten the blades against the restraint offered by the
surrounding aperture edges in the manner suggested particularly by
blade 16 in aperture 52 of bracket 26 shown in FIG. 6. With
appropriate sizing of interfitting components no further retention
means need be utilized to secure blade 16 in bracket 26. However,
where greater security against movement of the mentioned blades
relative to their supporting brackets is desired, depending upon
the materials selected, a bead or projecting ridge of substantially
greater width than slots 52 or 54 may be formed on the blades as
suggested by intermediate ridge 86 on blade 18 contacting the
forward edge of bracket 28 in FIG. 7, or by terminal ridge or
bulbous projection 90 contacting the aft edge of bracket 28 as seen
in FIG. 8. Projection 90 is adapted to be manually broken off by
application of force sufficient to fracture through blade 18 at
reduced cross-section groove 91 to facilitate removal of blade 18
from bracket 28 after use of the device. In either case, it will be
understood that only one of the expedients suggested by FIGS. 7 and
8 is used on any one blade 18 and not both on the same blade.
Illumination means are also included in implement 10 and preferably
include at least two light sources such as bulbs 56 and 58 situated
within light-containing covers 60 and 62, respectively. Bulbs 56
and 58 are connected electrically by suitable means to the
batteries within handle 12 such as suggested by leads 64 and 66 in
FIGS. 4 and 5, and are energizable by an appropriate switch 68
shown in FIG. 2, for example. Covers 60 and 62 preferable have
limited illumination escape means such as narrow slits to permit
the controlled escape of light as suggested by slit 70 in cover 60
over bulb 56 shown in FIG. 11. Due to the foregoing relationship,
light rays emitted through slit 70 will enter the material in blade
16 which is preferably adapted to receive the same and conduct such
light rays to the distal end of the blade opposite from its
supporting portion within aperture 52. The light rays so conducted
according to the principles of fiber optics will thereafter be
emitted from the stated distal blade end and illuminate the
surfaces within the body cavity in which blade 16 is situated. To
facilitate or enhance the light-receiving and transmitting
properties of blade 16, a portion of the surface thereof is
preferably cut away as shown by surface 72 in FIG. 11 to produce a
planar surface portion 74 oriented substantially normal to the
dominant direction of the light rays emitted from source 56 through
slit 70.
As further suggested by the modifications shown in FIGS. 9 and 10,
blade 16 may be strengthened by integrally formed beads at the
center thereof in the manner shown by bead 76 on blade 17 of FIG.
9, or by beads 78 and 80 at the edges of the blade as shown by
blade 19 in FIG. 10. The mentioned strengthening means are usable
to increase resistance to bending of the blades along their length,
but the blades may also be provided with a groove or other means
defining a linear area of localized weakness oriented transversely
across each blade to facilitate fracture thereof as required to
break off the blades to dispose of the same when their material of
construction is conductive to such disposability.
Lower blade 20 is provided near the distal end thereof with holding
means for engaging and holding a radially contracted peripheral rim
such as characterized by the cervix, by radially inward directed
pulling force applied either directly to the cervix or closely
proximate thereto, in order to grasp the same and to secure the
cervix against movement or displacement upon contact with other
surgical implements. In the example shown by FIG. 12, the stated
means comprises integrally formed and spaced-apart projections 82
which may be of generally conical form situated with the major axis
at a slanted angle relative to the principal center or longitudinal
axis of blade 20, the stated angle being preferably about 75
degrees from the mentioned axis as suggested by angle A in FIG. 12,
although this angle could vary from 45 to 90 degrees. The distal
edges or tips 84 on projections 82 are adapted to engage the lower
outside rim of the cervico-vaginal fornix and apply pulling force
thereto radially outwardly to stabilize the same against movement
or to dilate the same. Alternatively, projections 82, which are
preferably formed with spanwise breadth in the shape of a tooth,
may be omitted and replaced by small vacuum or suction cups as
suggested by cups 88 in FIG. 13. Cups 88 are of flexible resilient
material and have a thin easily deformed peripheral edge thereon
capable of adhering to a moistened surface when pressed firmly
thereagainst. A further modification is suggested by FIG. 14
wherein cups 88 communicate with one or more hollow passages such
as passage 89 in blade 20 which may be connected to an external
vacuum source (not shown).
From the foregoing, it may be seen that the construction of device
10 adapts the same particularly for use in clinical or surgical
manipulations associated with the structure of the human cervix.
Thus, since the cervix is deeply recessed within the vaginal
passage, it cannot be operated upon unless the vaginal walls are
sufficiently displaced to permit access to the situs of the cervix
and otherwise stabilized to minimize or prevent their movement. In
order to gain such access initially, blades 16, 18 and 20 should be
contractible or displacable generally toward each other to achieve,
in so far as possible, mutual contact between the blades along most
of their length. This contraction of the blades into a close
grouping relationship allows the blades to be inserted into the
vagina with a minimum of difficulty or discomfiture to the patient.
Thereafter, blades 16 and 18 are displaced apart from each other by
rotation of their supporting brackets 26 and 28, respectively,
about a rotation axis through pivot screw 30, until the blades are
spaced-apart in the position shown by FIG. 1. This will result in
lateral displacement of the vaginal wall whereby the cervix may be
viewed. When thus viewed, blade 20 is then moved by manipulation of
the entire implement 10 as required to engage projections 82
against the cervix by contacting the same along an area on the far
side of the tough callous ridge which surrounds the outer periphery
of the normal human cervix.
Use of device 10 in the manner described above may be seen to
provide the simultaneous advantages of holding separated the
vaginal walls to provide access to the cervix and securely engaging
a peripheral portion of the cervix to hold the same against
displacement, both in a single device which may be easily
positioned at any desired angularity according to the convenience
of the surgeon or diagnostician using the same.
After positioning of the device, detailed observation and further
operative procedures may be accomplished using viewing means such
as suggested in FIGS. 2, 3 and 15. From FIGS. 2, 3, and 15, it may
be seen that brackets 26 and 28 are preferably provided with
up-standing lugs or bosses 100 each having a tapped hole
therethrough. The holes thus formed in brackets 26 and 28 are each
adapted to receive the threaded shank of a thumbscrew 97 and 98,
respectively. A yoke member 92 has a laterally extending support
beam 94 with a slot at each end thereof as suggested by slots 95
and 96 in FIG. 15. The yoke 92 is thus supported on brackets 26 and
28 by thumbscrews 97 and 98 in such manner that tightening of the
thumbscrews clamps the yoke firmly against the brackets.
Conversely, when the thumbscrews are loosened the brackets may be
pivoted toward or away from each other about a center axis through
holding screw 30, and yoke 92 will always be adjustable so that
slots 95 and 96 are equidistantly spaced from holding screw 30.
Yoke 92 is also formed with a magnifying eyepiece 93 of any
suitable commercially available type whereby the viewing means thus
formed permits a direct line of vision between blades 16 and 18
after they have been positioned in the spaced-apart relationship
shown by FIGS. 1 and 2, for example.
While a number of modifications are suggested herein as discussed
below, it is basic in all of these modifications which incorporate
the inventive principles taught herein that a single device is
adapted to perform both of the functions formerly identified with
the separate types of medical instruments broadly characterized as
specula and a tenacula, and also provides additional advantages not
associated with either such types. Spreading or distention of the
vaginal walls and grasping or otherwise securely engaging the outer
peripheral surface of the cervix involves two very different
functional operations. The first is achieved in all modifications
of the device disclosed herein by initially placing at least two
elongate blade elements within the vaginal passage, and displacing
the blade elements away from each other a sufficient distance to
permit visual access entirely through the vaginal passage to view
the cervix. The second function is performed after the mentioned
access is gained and consists of engaging the rim of the cervix
about its outer periphery by structure adapted to apply sufficient
force to stabilize the cervix against displacement by physical
contact with other surgical, clinical, or diagnostic
implements.
In some cases, depending upon the size or location of the rest or
surgical situs and upon configurational differences between the
vaginal contours of different patients, it may be necessary to vary
the type of extent of blade movement or position best suited to the
needs of the doctor. Accordingly, the embodiment suggested in FIG.
16, for example, permits use of four blades rather than three as
shown in FIG. 1, and further permits a wider variation in angular
and translational adjustability of the blades than that permitted
by the structure of FIG. 1.
Thus, hollow handle 102 in FIG. 16 corresponds in function with
handle 12 in FIG. 5, except that handle 102 has U-shaped bracket
104 affixed thereto by any suitable means such as by integral
construction, or by a bayonet-type connection 33, 46 as described
between block 22 and handle 12 seen in FIGS. 2 and 5, for example.
Bracket 104 has transverse center portion 106 formed with
upstanding brackets or bosses 108 and 110 at either end thereof.
Sized to extend between bosses 108 and 110 is a solid mounting
block 112 held in place by two thumbscrews 114 and 116 in axial
rotational alignment and penetrating through suitable holes in
bosses 108 and 110, respectively. Loosening of screws 114 and 116,
each of which has a threaded shaft engaging a threaded hole in
block 112, permits pivotal movement of the block relative to
bracket 104 about an axis through the center of screws 114 and
116.
Block 112 has a pair of tapped holes adapted to receive the
threaded shafts of two more thumbscrews 118 and 120 shown in FIG.
17, the center axes of which are in mutual alignment and oriented
perpendicular to the center axes of thumbscrews 114 and 116. The
mentioned threaded shafts of screws 118 and 120 penetrate through
two smooth holes in a pair of downwardly depending lobes or bosses
122 and 124, respectively, formed on housing box 126 and
illustratively by lobe 122 in FIG. 18. Lobes 122 and 124 permit box
portion 126 to be adjustably pivoted about an axis through the
center of screws 118 and 120 when the screws are loose, and to be
immovably joined to block 112 when the screws are firmly tightened
so as to clamp the lobes against the block.
Box portion 126 has transverse base portion 128 and upstanding side
portions 130 and 132 as seen, for example, from FIG. 18, together
with forward and aft portions 134 and 136, respectively. Forward
and aft portions 134 and 136 are provided with aligned slots 138
and 140 adapted to receive a blade such as blade 20 in the same
manner and purpose as shown and discussed above in connection with
FIG. 1. Box portion 126 is adapted to receive and support another
box portion 142 in nesting relationship. Box portion 142 may be
seen to include a pair of downwardly depending side portions 144
and 146 integrally formed or otherwise secured to a pair of
transverse frame portions 148 and 150 comprising forward and aft
surfaces of box portion 142, respectively. Frame portions 148 and
150 include slots 152 and 154, respectively, to receive and support
an elongate blade-like element corresponding in form to blade 20
shown in FIG. 1 but oriented oppositely in respect thereto.
Box portion 142 is vertically slidable relative to and supported
within box portion 126, the side portions 130 and 132 of box
portion 126 being in substantially uniform surface contact with
side portions 144 and 146, respectively, of box portion 142. The
limits of such relative movement are defined by the length of slots
156 and 158, through which separate thumbscrews 160 and 162
threadedly secured in side surfaces 144 and 146, respectively,
penetrate as suggested by holes 164 and 166 is side portions 144
and 146 as shown in FIG. 18 and adapted to receive thumbscrews 160
and 162 shown in FIG. 16. It will be understood that tightening of
the thumbscrews by rotation thereof will cause them to clamp
against the sides of slots 156 and 158, thus preventing movement
between box portions 126 and 142, and holding the same in any
desired position of adjustment, and that this position of
adjustment will determine the adjusted distance between the two
elongate blades 180 and 182 which are respectively secured within
slots 138, 140 of box portion 126, and within slots 152, 154 of box
portion 142. A separate pair of aligned slots on each side of box
portion 142 is adapted to receive two more elongate blades 170 and
172 as suggested by slots 174, 176 and 178 seen in FIG. 18, for
example. To complete the instrument shown in FIG. 16, for example,
viewing means in the form of eyepiece assembly 184 is desirably
included and corresponds in structure and mounting arrangement
generally as described above for viewing means 92 shown in FIG. 15,
except for certain obvious variations necessitated by the different
overall configuration of the implement.
From the discussion set forth above, it will be understood that
pivotal adjustment about two axes may be made in the device shown
by FIGS. 16 and 17, these axes being defined by the common rotation
axis of thumbscrews 114 and 116 in the first instance, and of
thumbscrews 118 and 120 in the second instance. Moreover, after
initial placement of the instrument in the examination or operative
situs, lateral blades 170 and 172 will retain the vaginal walls
distended or spaced-apart, while blades 180 and 182 may be
positioned so that grasping means on the distal end of each blade
corresponding to those discussed for blade 20 may grasp or
otherwise secure the cervix against displacement.
Referring to FIGS. 19 through 21, another embodiment of the basic
inventive principles may be seen wherein four blades are involved,
similar to the embodiment of FIGS. 16 through 18. However, instead
of the lateral blades being mounted in fixed relationship regarding
the distance therebetween, and the vertically spaced-apart blades
being adjustable as to the space therebetween as in the device
shown by FIGS. 16 through 18, the device in FIGS. 19 through 21
involves vertically spaced blades 226 and 228 which are not
adjustable as to spacing, and laterally spaced blades 230 and 232
which are adjustably variable as to the distance therebetween.
Referring to FIG. 19, hollow handle 190 corresponds in function
with handle 102 in FIG. 16 and has U-shaped bracket 192 secured
thereto by any appropriate means such the bayonet connection 33, 46
shown in FIG. 2. Bracket 192 supports block 194 between two
releasable clamping thumbscrews 196 and 198 in the same manner as
block 112 described above in connection with FIG. 16. Block 194 in
turn pivotally supports a generally box-shaped assembly 200, 202 in
the same manner as discussed above regarding block 112 and its
relationship with the box assembly formed by elements 126 and 142.
Thus, a pair of thumbscrews 204 and 206 in mutual alignment have
threaded shafts which engage tapped holes in block 194 and served
to clamp two lobes 208 and 210 formed on box element 200 to prevent
its movement relative to block 194 when the thumbscrews 204 and 206
are firmly rotated into clamping position.
Box elements 200 and 202 nest together in translationally slidable
relationship in the manner discussed above for box elements 126 and
142, except that the latter are vertically movable where the
elements 200 and 202 are laterally movable. Spaced-apart and
aligned pairs of slots formed in each of the elements 200 and 202
are adapted to receive blade elements of the same type as discussed
above in connection with blades 16, 18 and 20 in FIGS. 1-5. The
mentioned slots include slots 212, 214, 216, 218 and 220 in element
200 and slots 222, 224 in element 202, all of which support blades
226, 228, 230 and 232 shown or suggested in FIGS. 19 and 20.
Relative movement between box elements 200 and 202 result in
adjustably varying of distance between blades 230 and 232, after
which tightening of thumbscrew 234 holds the mentioned elements in
the desired position and prevents further movement thereof.
In the device shown by FIGS. 19 through 21, blade elements 230 and
232 could appropriately be provided with positive grasping means to
secure the cervix such as shown in FIGS. 12, 13 or 14 and discussed
above. Use of the device which permits lateral adjustment of blade
distance between blades 230 and 232 would be appropriate in those
cases where the localized area of medical and pathological interest
in the patient would be obscured, irritated or otherwise poorly
suited to the vertical type blade adjustment provided by the device
of FIGS. 16-18. As in the case of the latter instrument, it will be
understood that suitable optical or magnifying means may be
supported substantially at the center of the box assembly 200, 202
shown in FIG. 19 as discussed above for viewing means 184 in FIG.
16. Similarly, illuminating means involving use of fiber optic
material for any or all of the blades 226, 228, 230 or 232 could be
used in connection with the device discussed above in connection
with FIGS. 16-18 or 19 through 21. Alternatively, any of the
modifications disclosed herein could be used in combination with a
miniature flashlight to provide a direct beam of light toward the
test situs instead of using fiber optics.
Although both of the embodiments suggested in FIGS. 16-18 and in
FIGS. 19-21 provide results and advantages unobtainable with
devices known to the prior art, both have the basic functional
limitation that at least one pair of blades required to be inserted
within the vaginal passage are non-adjustable as to the distance
therebetween. It is a distinct advantage, both from the medical
practitioner's, as well as from the patient's, viewpoint, if all
the blades can be so collapsed or closely grouped that penetration
into the vaginal passage is relatively easy after which the blades
may be adjustably positioned in widely spaced-apart relationship.
Moreover, while the entire implement may be rotated through
application of force manually to the handle 12 or 102 in the
previous embodiments, as required to position the blade in such
manner as to expose the precise localized area of interest to the
surgeon or diagnostician, it would be most helpful in either case
for rotary adjustment to be accomplished without the need for
external weights or angular displacement of the entire implement to
achieve desired relative positioning between the various blades
used for spreading apart the vaginal walls and for grasping the
cervix. It would, in other words, be desirable and advantageous for
the instrument used both to gain access to the inner vaginal
terminal area and to engage the cervix, to accomplish these
functions by completely adjustable blades offering a minim of
resistance to penetration into the vaginal constriction which
typifies the normal patient and permits angular positioning of the
blades. Although complete adjustability in the foregoing sense is
not achievable in the embodiment discussed hereinabove, this
objective is achieved to a most remarkable extent in the devices
suggested by the modifications of FIGS. 22-30, inclusive.
Referring to FIG. 22, a modification is shown wherein handle 240 is
secured to two semi-circular elements 242 and 244 shown in FIGS. 24
and 25, respectively, each having a portion of an arcuate track or
guide as suggested by tracks 246 and 248 on element 242 and by
tracks 250 and 252 on element 244. When these two elements 242 and
244 are secured to handle 240 in operative relationship by suitable
means such as threaded screw 254, two separate parallel and
perfectly circular tracks are formed, one comprising portions 246
and 250, while the other track comprises portions 248 and 252.
Within the stated tracks a supporting frame or chassis 256 is
slidably movable throughout 360 degrees of rotation relative to the
stationary elements 242 and 244, as required to position the same
in any desired condition of adjustment prior to use of the
instrument. Chassis 256 is so constructed as to constitute a single
unitary element including two circular support rings 258 and 260
which are each substantially planar and uniformly parallel to each
other. The rings 258 and 260 are joined in fixed relationship by a
connecting mass in the form of block 262. Block 262 functions
essentially similar to block 22 discussed above in connection with
FIG. 5. Thus, hollow box 264 in FIG. 23 corresponds with box member
24, while brackets 266 and 268, pivotally secured to block 262 by
adjustable holding screw 270 corresponds to brackets 26, 28 and
holding screw 30 shown in FIG. 2. Suitable slots 272, 274 and 276
in elements 264, 266 and 268, respectively, are adapted to receive
and support elongate blade elements in the same manner as blades
16, 18 and 20 of FIG. 1, as suggested by blades 278 and 280 in FIG.
23.
From the above, it will be understood that complete 360 degree
freedom is permitted in the initial adjustment of the blade
elements using the device of FIGS. 22-26, and that adjustment is
accomplished by rotating block or mass 262 along a path defined by
the circular tracks within which rings 258 and 260 are confined and
guided. When a desired positional adjustment is achieved, a holding
screw 282 having a threaded shaft operatively engaging a tapped
hole 284 in block 262 (see FIG. 26) is turned to apply clamping
force to ring elements 246 or 250 and thus prevent further
rotational movement. As further discussed above, optical viewing
means of the type suggested in FIG. 15 may be included in the
device shown by FIGS. 22 and 23.
A further modification of the device disclosed herein is shown by
FIG. 27 wherein two handle elements 300 and 302 are pivotally
joined together about a pivot axis defined by pin 304 having shaft
306 which penetrates through lobe portion 308 formed on handle
element 300 as seen in FIG. 29.
Handle element 302 includes an upwardly extending lobe 310 having a
slot 312 therein. A thumbscrew 314 has a threaded shaft 316
operatively engaging a tapped hole 318 in a blade support element
or bracket 320 seen in FIG. 29. Shaft 316 is linealy movable within
narrow slot 312 to displace bracket 320 toward or away from the
pivot axis defined by pin 304. Blade support means are included in
bracket 320 as well as in another bracket 322 formed integrally
with or otherwise secured to handle element 300. The stated means
comprise slots or cavities 324 and 326 in brackets 320 and 322,
respectively, in each of which is releasably secured a blade
corresponding to blade 20 shown in FIGS. 1 and 12. Because pivot
pin 304 is positioned somewhere between brackets 320 and 322, it
will be understood that movement of handle grips 328 and 340 toward
or away from each other will cause rotation of handle elements 300
and 302 about a pivot axis through pin 304 with consequent movement
of brackets 320 and 322 secured to each of the handle elements
whereby blades 332 and 334 will move in an arcuate path toward or
away from each other.
Preferably, resilient biasing means of any suitable type is secured
between handle grips 328 and 330 in such manner as to bias the
grips away from each other toward the limit of their movement,
which desirably will occur when the distal ends of blades 332 and
334 contact each other. Illustratively, a single coil spring as
suggested by spring 336 may be used for the foregoing purpose as
shown in FIGS. 27 and 28. To prevent escape of spring 336 when no
blades are mounted in the instrument shown in FIG. 27, for example,
a limit stop such as a lug 338 integrally formed on lobe 310 may be
used to make interfering contact with a projecting boss 340
integrally formed on lobe 308 of handle 300 to prevent any further
relative rotation between handles 300 and 302 under the force of
spring 336 after the stated lug and boss contact each other. In
addition to the structure described above, it may seen from FIG. 30
that means are included in the device shown by FIG. 27 for easily
ejecting blades 332 and 334 from their supported position within
cavities 324 and 326 in brackets 320 and 322, respectively. As seen
from FIG. 30, the stated ejection means include a rotatable lever
344 which is adapted to make bearing contact with the end of blade
element when it is inserted within cavities 324 and 326, this
action resulting in rotation of the stated lever in a direction
resulting in a portion of the lever projecting outwardly from each
of the brackets 320 and 322. Upon completion of use, manual force
applied to the mentioned levers will apply force to each of the
blades in a direction which will result in ejection of each blade
from its cavity.
* * * * *