U.S. patent number 3,763,864 [Application Number 05/193,658] was granted by the patent office on 1973-10-09 for powered resectoscope.
Invention is credited to George H. Dremann.
United States Patent |
3,763,864 |
Dremann |
October 9, 1973 |
POWERED RESECTOSCOPE
Abstract
A cold-punch resectoscope is provided with a hydraulic actuator
for automatically reciprocating the blade of the resectoscope
within its sheath. A source of fluid pressure is connected to the
hydraulic actuator and provided with a control means. A hydraulic
circuit is connected between the control means and the hydraulic
actuator for selective operation thereof.
Inventors: |
Dremann; George H. (Berkeley,
CA) |
Family
ID: |
22714500 |
Appl.
No.: |
05/193,658 |
Filed: |
October 29, 1971 |
Current U.S.
Class: |
606/171; 600/105;
600/126 |
Current CPC
Class: |
A61B
17/32 (20130101); A61B 17/320016 (20130101); A61B
2017/00973 (20130101); A61B 2017/00539 (20130101); A61B
2017/00398 (20130101); A61B 2017/00274 (20130101); A61B
2018/00547 (20130101) |
Current International
Class: |
A61B
17/32 (20060101); A61B 17/00 (20060101); A61b
017/32 () |
Field of
Search: |
;128/305,303,311,7 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Laudenslager; Lucie H.
Claims
I claim:
1. A hydraulic actuator for use with a cold-punch resectoscope
having an elongated sheath which is formed for insertion in the
transurethral tract comprising
an elongated assembly secured to said sheath and having a
reciprocating piston mounted therein, said piston having a hollow
cylindrical rod extending from one end thereof and carrying a
resecting knife at the free end of said rod disposed internally of
said sheath, said elongated assembly including a pair of inlet
ports communicating internally of said assembly on opposite ends of
said piston to enable said piston to be reciprocated, and
a manually controlled hydraulic operating circuit connected with
said inlet ports for powered reciprocation of said piston and said
resecting knife in said sheath, said hydraulic operating circuit
being portable and wholly contained within a separate carrying case
and having means for connection to said inlet ports of said
assembly and to a separate pressurized fluid source.
2. The hydraulic actuator of claim 1 wherein said carrying case is
provided with a liner of insulating material completely surrounding
said operating circuit when said carrying case is closed to muffle
the noise of said circuit during operation of said
resectoscope.
3. The hydraulic actuator of claim 2 wherein said carrying case is
in the form of a brief case or the like having external connections
mounted thereon to facilitate connection of said operating circuit
between said resectoscope and said pressurized source of fluid.
4. The hydraulic actuator of claim 3 wherein said hydraulic
operating circuit is comprised of a plurality of separate modular
units secured together within said case.
5. The hydraulic actuator of claim 1 wherein said operating circuit
includes a foot pedal operator connected to said source of
pressurized fluid and said hydraulic circuit to permit said circuit
and said resectoscope to be normally controlled by the foot of a
user upon depression and release of said operator.
6. The hydraulic actuator of claim 1 including means connected
between said elongated assembly and said piston for rotation of
said piston and said knife during reciprocation thereof.
7. The hydraulic actuator of claim 6 wherein said rotation means
comprises
a spiral slot formed internally of said assembly, and
means engaged with said cylindrical rod and coacting with said slot
whereby said resecting blade is caused to rotate as said means
moves within said slot during reciprocation of said rod in said
sheath.
8. A hydraulic actuator for use with a cold-punch resectoscope
having an elongated sheath which is formed for insertion in the
transurethral tract comprising
an elongated operating handle assembly capable of being connected
to said sheath,
a double ended piston mounted in said handle and capable of being
reciprocated therein,
a hollow cylindrical rod secured to one end of said piston, the
other end of said rod disposed in said sheath and carrying a
cutting blade at the free end thereof,
a pair of inlet ports formed in said handle assembly to allow
pressurized fluid to be fed to opposite sides of said piston
alternately to cause reciprocation of said piston and said blade
with respect to said sheath,
a portable hydraulic operating means fluidly connectable to said
parts and to a source of fluid pressure, and
a foot pedal operator connected to said operating means and to said
source of fluid pressure to permit normal control of the speed of
reciprocation of said piston and said cutting blade by the degree
of depression and retraction of said foot pedal.
9. The hydraulic actuator of claim 8 including
a spiral slot formed within said assembly,
a sleeve mounted on said rod, and
a pin fixed to said sleeve and coacting with said slot whereby,
upon reciprocation of said piston and said rod within said
assembly, said rod will be rotated as said pin moves within said
slot.
10. The hydraulic actuator of claim 8 wherein said hydraulic
operating means includes
bypass means for locking the rod either fully retracted or fully
extended, and
manually separately operable throttle control valves to vary the
back pressure on the piston for controlling the speed of retraction
and/or extension of the rod and knife in the sheath.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to cold-punch transurethral
resectoscopes, and more particularly to a means for powering the
resectoscope to provide automatic continuous as well as single
stroke controllable reciprocation of the cutting blade.
2. Description of the Prior Art
The well-known Thompson cold-punch resectoscope was first described
and used in 1935. This resectoscope is considered by many doctors
to be the preferred instrument for transurethral resection and to
this day still maintains its basic form and its mode of operation
as originally devised.
Generally, prostatic carcinomas are discoverd only after they have
extended beyond the limits of the gland and are therefore not
amenable to cure by total prostatectomy by one of the classical
open surgical procedures. As a result, urinary obstructions
associated with prostatic cancer must be dealt with by
transurethral resection. The preferred form of resection of these
urinary obstructions is accomplished manually by exerting a
fulcrummed bending pressure on the external end of a Thompson
cold-punch instrument. In this manner, the prostatic tissue is
forced into the fenestra of the Thompson resectoscope where it can
be resected by operation of the cutting blade.
The Thompson instrument is manually operated and requires
considerable agility and dexterity of the user. In its present
form, the manually operated resectoscope requires the use of both
hands during transurethral surgery, one to hold the instrument and
one to reciprocate the cutting blade. Since the resectoscope must
be partially rotated during use to position the cutting blade, the
ability of the user to manipulate the instrument is considerably
restricted.
The actuator of the existing Thompson instrument is a thumb lever
located in a fixed position on one side thereof, and a user of the
instrument is greatly restricted in his movements due to the
variable positioning of the lever as a result of rotating the
instrument during the resectioning operation. The restricted
movement, together with the large number of manipulations required
to complete the operation normally causes a high degree of fatigue
in the user.
A different form of transurethral resection is provided by
electrosection technique. In this technique, an electral cutting
loop formed by an electrode is reciprocally mounted within a
sheath. The electrical cutting loop actually burns the undesired
portion of material away producing large amounts of heat together
with the attendant disagreeable odor and associated shock. A
further problem with this technique can occur if the obturator
nerve is accidentally stimulated during a transurethral
electroresection causing a sudden thigh movement. Although this
occurs infrequently, it can cause the electric cutting loop to bite
more deeply than desired. This in turn can possibly produce a
catastrophic accidental perforation, resulting in severe shock, and
even death. This type of perforation is virtually impossible when
using the cold-punch technique because only a small discreet
segment of tissue can be resected with a single stroke of the
cutting knife. Likewise, no appreciable heat is generated in the
surrounding tissues when the cold-punch technique is employed.
There therefore exists a need for a completely automatic cold-punch
resectoscope which overcomes the above set forth disadvantages, and
which may be utilized in one hand to thereby free the other hand of
the user. The facility of use will help to further improve the
user's surgical technique and allow him to more readily deal with
any other problems that may arise during an operation.
The present invention produces the above-mentioned results by means
of a completely atuomatic, fluid operated, cold-punch transurethral
resectoscope which allows a user to more easily and accurately
sculpture the various prostatic sectors, and it is provided with
built-in safety features whereby the resecting blade may be locked
in position at either end of its stroke.
The present invention converts the present Thompson manually
actuated two-handed resectoscope into a true single handed
instrument of significantly greater flexibility and which frees a
user's other hand for supporting functions during the course of an
operation.
SUMMARY OF THE INVENTION
A hydraulic actuator for use with a cold-punch resectoscope having
an elongated sheath which is formed for insertion in the
transurethral tract. The actuator comprises an elongated assembly
secured to the sheath and has a reciprocating piston mounted
therein. The piston includes a hollow cylindrical rod extending
from one end thereof which carries a resecting knife at the free
end of the rod. The rod is disposed internally of the sheath. The
assembly includes a pair of fluid inlet ports communicating
internally of the assembly on opposite ends of the piston to enable
it to be reciprocated. A manually controlled circuit is connected
with the inlet ports for powered reciprocation of the piston and
resecting knife in the sheath.
OBJECT OF THE INVENTION
It is therfore an important object of the present invention to
provide a resectoscope having a powered reciprocating blade
contained therein.
Another object of the invention is to provide manually controlled
powered resectoscope capable of being used with one hand.
A further object of the instant invention is to provide a
resectoscope which requires fewer manipulations, smaller angular
excursions, and shorter sheath insertions.
It is still another object of the invention to provide powered
cold-punch resectoscope in which a single stroke or continuous
reciprocating movement of the blade is controllable and
adjustable.
It is still a further object of the present invention to provide a
hydraulically operated resectoscope capable of being variably
controlled by a foot pedal.
It is yet another object of the present invention to provide a
powered reciprocating resectoscope with a portable hydraulic
operating circuit capable of being placed in a portable carrying
case.
And yet a further object of the present invention is the provision
of a fluid operated resectoscope with a safety cutoff means whereby
the operating blade of the resectoscope may be locked at either end
of its reciprocating movement.
BRIEF DESCRIPTION OF THE DRAWINGS
Other objects and advantages of the present invention will become
apparent when the powered resectoscope disclose herein is
considered in conjunction with the accompanying drawings,
wherein:
FIG. 1 is a side elevation view of the carrying case for the
hydraulic operating circuit of the present invention showing the
manifold connection for the different elements;
FIG. 2 is a cross-section taken along the line 2--2 of FIG. 1;
FIG. 3 is a top plan view of the improved powered resectoscope of
the present invention;
FIG. 4 is a side elevation of the foot pedal operator for the
instant invention; and
FIG. 5 is a partial cross-sectional view of the operating cylinder
of the powered resectoscope having means for rotation of the
cutting blade.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring now to the drawings, there shown in FIGS. 1 and 2 is a
preferred embodiment of a fluid operating circuit for use with the
present invention. The circuit may take any number of forms,
including a modular construction wherein individual modules are
fastened together to form the complete operating circuit. The
circuit is preferably held entirely within a carrying case 11, such
as a briefcase, having upper and lower portions 13, 15. The upper
portion 13 is formed as a lid hingely mounted on the lower portion
15, so as to be capable of being pivoted between the closed
position shown in FIG. 1 and an open position at 180.degree.
thereto. A clasp 17 is provided at the front of the carrying case
to hold or lock the upper and lower portions together, and if
desired, may be provided with a lock of any suitable type, so as to
prevent the unauthorized opening thereof.
Both the upper and lower portions are provided with insulating
material 19 internally thereof, which completely surrounds the
operating circuit in the closed position to muffle any noise caused
by the operation of the circuit.
As shown more clearly in FIG. 2, the insulating material 19 is
provided with a recessed area 21 housing the hydraulic operating
circuit of the invention. A manifold assembly 23 is provided
exteriorly of the lower portion 15, and has a plurality of conduits
24,25,26,27,30 extending into the recess 21 in the interior of the
carrying case.
The outer end of conduit 27 is connected to a suitably filtered,
regulated and lubricated fluid pressure source 28, such as an air
compressor or the like. The inner end of this conduit is connected
to the hydraulic operating circuit by a line 29 for feeding
pressurized fluid into a multi-port distributor 31. The pressurized
fluid is then simultaneously distributed, via lines 33,35, to a
normally closed, manually operated, by-pass valve 37 and to the
inner end of conduit 25. By-pass valve 37 includes a switch 39
mounted on the outside of the carrying case for operation of the
by-pass valve, for reasons explained more clearly hereinafter.
Fluid passing through line 35 to conduit 30 is preferably connected
to a control means such as a foot pedal operator 41 of the type
shown more clearly in FIG. 4. This foot pedal contains a normally
closed, manually operated, spring returned, two way valve 42
connected by a line, not shown, to a further conduit 25.
Pressurized fluid passes from the valve 42 through conduit 25 to a
line 43 contained within the carrying case.
Multi-port distributor 31 further distributes pressurized fluid,
via line 45, to a normally opened, manually operated, spring
returned, three-way valve 47 and into a direct acting, manually
operated, four-way spool valve 49. The pressure of the fluid
passing from distributor 31 into the hydraulic operating circuit
will be the same throughout the circuit due to the simultaneous
distribution thereof from the distributor.
With the hydraulic operating circuit containing pressurized fluid,
any depression of the foot pedal operator 41 will open normally
closed valve 42 to allow pressurized fluid to pass therethrough
into line 43 and thus into a shuttle or double check valve 55.
Fluid in valve 55 is fed to a normally opened, manually operated,
spring return, three-way valve 57.
When valve 57 is in its normally opened position, fluid passes
unrestricted therethrough to a pilot actuator 63 having a piston
contained therein. The fluid pressure will move the piston against
the action of a return spring to thereby contact and move a spool
contained in the four-way valve 49 toward a further pilot actuator
65 contained on the other side of valve 49.
After the spool contained in four-way valve 49 has been completely
shifted toward pilot actuator 65, the pressurized fluid contained
in distributor 31 will pass through an internal passageway formed
in four-way valve 49 to a line 67. Fluid flows unrestricted through
a combination flow control and directional check valve 69 in the
direction of a manifold 71 where it is simultaneously distributed
to a pilot actuator 73 and to line 75. Fluid pressure from line 75
passes through conduits 24 to one of the lines 79 which may be
connected so as to provide pressurized fluid to one side or the
other of a cushioned piston actuator 78 mounted within the
operating cylinder 80 of the resectoscope to thereby move the
piston and a hollow rod 82 connected thereto. Rod 82 includes a
cutting blade or resecting knife 83 attached to the free end of the
rod. The knife is preferably the sharpened end of the hollow
rod.
As shown in FIG. 5, the piston 78 is provided with tapered end or
side portions to cushion the contact of the piston at either end of
its stake. While the piston is reciprocating within the operating
cylinder, a further piston contained within pilot actuator 73 is
simultaneously moved toward three-way valve 57 against the action
of a spring biasing means. This movement of the piston held within
the pilot actuator 73 closes three-way valve 57 thereby blocking
the flow of fluid therethrough into pilot actuator 63. As this
occurs, the fluid pressure acting against the depressed piston of
the pilot actuator 63 is exhausted to atmosphere through a port
(not shown) within the three-way valve 57.
During the operation of the circuit components, as described above,
fluid will also be exhausted from the other end of the instrument
cylinder containing piston 78 through one of the lines 77 into
conduits 26 to a further line 81 in the carrying case. The
exhausted fluid then enters a manifold 83 for simultaneous
distribution through a combination flow control and directional
check valve 85 and into a pilot actuator 87. Fluid passing through
throttle control valve 85 then passes through a line 89 into a
portion of the four-way valve 49 where it is exhausted to the
atmosphere through a port (not shown). However, this flow of
exhaust fluid to the atmosphere is restricted in its passage
through throttle control valve 85, and a back pressure of
sufficient magnitude is provided in line 81 to act against a piston
contained in pilot actuator 87 and to move the piston downwardly
thereby closing a normally opened three-way valve 91.
The speed of retraction or extension of the cutting rod can be
separately controlled by adjusting the throttle control valves 69
and 85 to vary the back pressure on the piston 78.
The closing of valve 91 prevents fluid from passing from manifold
31 through line 45 to the three-way valve 47 for entry into valve
91 and thus into the pilot actuator 65. Upon exhaustion of the
fluid from the circuit described above, the piston contained in
pilot actuator 87 will be returned to its normal position by the
action of a spring bias means contained therein. This will cause
three-way valve 91 to be moved to its normally opened position to
allow pressurized fluid to flow from manifold 31 through line 45,
valve 47, valve 91 and into the pilot actuator 65.
A further piston contained in pilot actuator 65 will be moved
toward the four-way spool valve 49 thereby moving the spool of the
four-way valve in the direction of pilot actuator 63. At the same
time, flow of fluid through the spool valve 49 will be switched
from line 67 to line 89. This will apply fluid pressure to the
exhausted side of the instrument cylinder while at the same time
allowing the pressurized side to be exhausted.
In this manner, it can be seen that fluid pressure can be
alternately applied to and exhausted from both sides of piston 78
to automatically provide a single stroke or continuous
reciprocation of the piston and knife attached thereto.
The reciprocating motion of the piston and knife will continue as
long as there is pressure in the circuit and the foot pedal 41
remains depressed with valve 42 in the open position.
With the connection of lines 75 and 81 to conduits 24 and 26, as
shown the piston within the operating cylinder will automatically
retract when the foot of a user is removed from the foot pedal
operating means 41. The piston will remain in this retracted
position since pressurized fluid will be trapped in the hydraulic
cylinder to act against one side of piston 78, while at the same
time exhausting the other side of the operating cylinder.
If the connection of these lines 75 and 81 to the conduits are
interchanged, the operating cylinder will automatically stop with
the piston in the fully extended position when pressure is removed
from the foot pedal operator.
The operating circuit is provided with the by-pass valve 37 for
safety purposes. In the closed position, as shown by the position
of switch 39 in FIG. 2, fluid pressure present in manifold 31, and
line 33, can not pass through valve 37 to manifold 61. However,
when by-pass valve 37 is opened, by moving the switch 39 to the
left as shown in FIG. 2, the pressurized fluid contained in valve
37 will be simultaneously delivered through line 93 to a right
angle port 97 and line 95 to a shuttle or double check valve.
The pressurized fluid from the right angle port 97 is fed into a
pilot actuator 99 to move the piston thereof in the direction
toward three-way valve 47 to thereby close valve 47 and to block
the flow of fluid from manifold 31 to line 45 and through valve
47.
At the same time, pressurized fluid from manifold 61 flows through
line 95 to shuttle or double check valve 55 and into three-way
valve 57 to thereby operate the piston in pilot actuator 63. This
moves the spool contained within spool valve 49 toward the pilot
actuator 65 to redirect the flow of pressurized fluid through spool
valve 49 from line 89 into line 67. Fluid pressure is then applied
to piston 78 for movement of the rod 82 to the extended
position.
As pointed out above, if lines 77 and 79 from the instrument to
conduits 24 and 26 are interchanged, the instrument cylinder rod
will be moved to the retracted position when by-pass valve 37 is
manually opened.
With valve 37 in the open position, the piston of the operating
cylinder can be locked in either the extended or retracted position
depending on the connection of lines 77 and 79, and depression or
retraction of the foot pedal will not operate the piston. This
locking of the piston in position, provides a built-in safety
feature which prevents the accidental movement of the instrument
cylinder rod and blade during either insertion or withdrawal of the
instrument should the foot pedal operator be inadvertantly
depressed.
Turning now to FIG. 3 there shown is a preferred embodiment of the
resectoscope of the present invention having the operating cylinder
80 attached to one end thereof. Conduits 77, 79 are shown connected
thereto for attachment to conduits 24,26 for the application of
fluid pressure from lines 75,81 for operation of piston 78. As
shown, the preferred instrument comprises a wellknown Thompson
resectoscope having a sheath 101 with a fenestra 103 formed
therein. The rod 82 is connected (FIG. 5) to piston 78 and carries
the cutting blade (not shown) within the sheath for resecting a
portion of tissue forced into the fenestra 103. Therefore, upon
reciprocation of the piston 78 within the operating cylinder 80 by
the application and exhausting of fluid pressure to opposite sides
thereof, the rod and blade will be automatically reciprocated.
FIG. 5 shows an improved embodiment of the Thompson resectoscope
also having the piston 78 reciprocally mounted within the opeating
cylinder 80. A sleeve 105 is secured to rod 82 and a pin 107 is
fixed to the sleeve. The pin extends into a spiral opening or slot
109 formed within a sleeve 111 held in the cylinder 80. In this
manner, as the piston 78 is moved in either direction by the
application of fluid presure thereto, the coaction of the pin 107
in the slot 109 will cause the rod 82 and its attached blade to
rotate to further facilitate the cutting of tissue forced into the
fenestra of the resectoscope.
As shown in FIG. 3, a base 113 is attached to the operating
cylinder and is provided with the usual connections as well as the
observation port concentric with hollow rod 82 now provided on
Thompson resectoscopes. This observation can also be optically
ground to suit the individual surgeons eye prescription.
The present invention is provided with additional safety features
should the cutter engage a hard object, such as a stone or the
like, contained within the prostate being resected. Normally, the
cutting force applied by the movement of the piston will not be
sufficient for the blade to pass through the hard object and the
cylinder rod will not advance. The automatic action of the present
invention allows the rod and cutting blade to stop, retract and
continnuously engage the object to repeat the complete cutting
cycle until the fluid pressure is increased sufficiently to allow
the blade to pass through the object.
Throttle vlaves 69,85 are preferably adjustable needle valves to
allow the fluid pressure within the circuit, and therefore the
speed of reciprocation of the blade, to be regulated from
essentially zero to that allowed with the maximum fluid pressure
available from the pressure source.
It is therefore an important advantage of the present invention
that an automatic, continuously operated resectoscope for resecting
a prostrate gland or the like is provided. This resection may be
accomplished by using only one hand to thereby free the other hand
of the user.
Because of its automatic operation, the present invention requires
fewer manipulations, smaller angular excursions and shorter sheath
insertions because of the inherent increase in speed and cutting
force available with the instrument. This also diminishes trauma to
the normal surrounding tissues of a patient being operated on and
appreciably reduces the time that the patient must be held under
anesthesia.
A further advantage is provided by the safety features of the
present invention whereby the cutting blade of the invention may
rest within the retracted or extended position by release of the
foot pedal operator or by the operation of the by-pass valve for
permanently locking the cutting blade in the desired position.
And yet another advantage of the invention is the fact that all
valves and fittings of the operating circuit are commercially
available elements which can be easily assembled to achieve the
foregoing advantages, and no special equipment need be manufactured
or designed.
Obviously many modifications and variations of the present
invention are possible in the light of the above teachings. It is
therefore to be understood that within the scope of the appended
claims, the invention may be practiced otherwise than as
specifically described.
* * * * *