U.S. patent number 3,882,852 [Application Number 05/432,666] was granted by the patent office on 1975-05-13 for surgical dilators having insufflating means.
Invention is credited to Manfred Sinnreich.
United States Patent |
3,882,852 |
Sinnreich |
May 13, 1975 |
Surgical dilators having insufflating means
Abstract
Surgical instrments for obstretical use including a first device
for dilating the cervical neck, and a second defice for dilating
the uterus. Each device includes a relatively rigid element
surrounded by a pneumatically inflatable element, the rigid element
projecting through the inflatable element to permit complete
dilation and the performance of surgical procedures through a
longitudinally extending bore in the rigid element. The invention
may be incorporated into known endoscope constructions, and permits
the controlled expansion of the cavity being expanded to the degree
required. One embodiment of the invention is suitable for use in
creating a pneumoperitoneum, and offers added safety by confining
the inflating gas to the interior of the inflatable element.
Inventors: |
Sinnreich; Manfred (Scarsdale,
NY) |
Family
ID: |
23717107 |
Appl.
No.: |
05/432,666 |
Filed: |
January 11, 1974 |
Current U.S.
Class: |
600/104; 606/197;
606/192; 600/115; 604/100.01; 604/98.02; 604/913 |
Current CPC
Class: |
A61M
29/02 (20130101); A61M 2025/1093 (20130101) |
Current International
Class: |
A61M
29/02 (20060101); A61m 003/00 (); A61m
029/00 () |
Field of
Search: |
;128/4,344,5,6,7,8,242,245,246 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Pace; Channing L.
Claims
I claim:
1. A combination surgical dilating and endoscopic device
comprising: a rigid shaft element having proximal and distal ends
bordering an outer surface, an expandable element surrounding said
shaft element and secured to said outer surface, means supplying an
inflating medium to said expandable element communicating
therewith, and means for determining the degree of inflation of
said inflatable element, said shaft element penetrating said
inflatable element and defining a longitudinal bore extending
substantailly the length thereof; and an endoscopic element having
an elongated barrel within the bore of said rigid shaft element and
capable of longitudinal movement relative thereto; whereby said
device may be inserted into a body opening to a position in which
said inflatable element is positioned within a body cavity,
following which said expandable element is expanded to
correspondingly expand said body cavity, and said endoscope is
manipulated relative to said rigid shaft element to perform a
required surgical function.
2. Structure in accordance with claim 1 in which said expandable
element is of generally cylindrical configuration.
3. Structure in accordance with claim 1 in which said expandable
element is of frusto-conical configuration with the wider portion
thereof located at the distal end of said rigid shaft element.
4. Structure in accordance with claim 1 in which said expandable
element is of spherical configuration.
5. Structure in accordance with claim 1, in which said means for
determining the degree of inflation of said expandable element
includes a pressure gauge.
Description
BACKGROUND OF THE INVENTION
This invention relates to surgical instruments, and more
particularly to those for use in obstretical procedures.
The examination of the cervix and uterus, as well as the
performance of surgical procedures in these areas has been greatly
facilitated by the development of the endoscope, which permits not
only the examination under illuminated conditions within these
organs, but the performance of biopsy and cauterizing procedures as
well. As a part of the obtaining of access to the uterus, it is
normal to dilate the cervix by the serial insertion and withdrawal
of a plurality of obturators, normally ranging in diameter from
approximately 3 mm. to 12 mm. Once dilated, the cervix will remain
in such condition sufficiently long to permit the introduction of
the endoscope past the cervix and into the uterus. Dilation of the
uterus is presently accomplished by the introduction of an inert
gas past a seal effected at the cervical neck.
When the surgical procedure is accomplished by penetrating the
abdomen, it is also known to inflate the abdominal cavity, again,
employing an inert gas, this procedure being employed to gain
access to the fallopian tubes to effect sterilization by
electro-cauterization.
Unfortunately, the introduction of a relatively inert gas under
pressure into body cavities is not without substantial danger. In
some cases, injury has resulted from excess dialation as a result
of excess gaseous pressure. More serious has been the formation of
embolisms and resulting complications.
Another form of know surgical inflating device is the Foley
catheter useful for draining the bladder, where the ducts have
become blocked. This device is formed substantially of non-rigid
material, and its use as a dialator is correspondingly limited.
BRIEF DESCRIPTION OF THE PRESENT INVENTION
Briefly stated, the invention contemplates the provision of a set
of instruments in which dilation is accomplished by the inflation
of an expandable element, after insertion of the same into the body
cavity, so that the inflating gas is confined within the element.
The inflating element may be formed so as to permit inflation only
to a predetermined degree, or expansion may be controlled solely by
inflation pressure within the elastic limit of the element. The
element is formed to surround a rigid shaft extending to the
opposite ends of the inflatable element, so that the expansive
pressure is maintained substantially uniform along the longitudinal
axis of the shaft. Where the shaft is hollow, an endoscope may be
positioned within a longitudinally extending bore, whereby biopsy,
cauterization, and simple examination can be performed at the
distal end of the cavity. When the inflatable element is employed
in the uterus, it may be frustoconically shaped, with the base
thereof at the distal end, to permit maximum exposure of the walls
of the uterus, and the exposed ends of the fallopian tubes.
BRIEF DESCRIPTION OF THE DRAWINGS
In the drawings, to which reference will be made in the
specification, similar reference characters have been employed to
designate corresponding parts throughout the several views.
FIG. 1 is a perspective view of a first embodiment of the
invention.
FIG. 2 is an enlarged fragmentary sectional view of the first
embodiment showing the same in expanded condition.
FIG. 3 is a perspective view of a second embodiment of the
invention.
FIG. 4 is a perspective view of a third embodiment of the
invention, partly in section.
FIG. 5 is a view in elevation, partly in section showing a fourth
embodiment of the invention.
FIG. 6 is an exploded view in elevation of the fourth
embodiment.
DETAILED DESCRIPTION OF THE DISCLOSED EMBODIMENTS
Referring to FIGS. 1 and 2 in the drawings, the first embodiment,
generally indicated by reference character 10, comprises broadly: a
rigid shaft member 11 approximately 3 mm. in diameter and bounded
between first and second ends 12 and 13, respectively, by an outer
surface 14. A proximal portion 15 forms a handle.
Surrounding a distal portion adjacent the first end 12 is an
expandable membrane formed of rubber or synthetic resinous
materials such as polyurethane. The membrane is of elongated
configuration, and is bonded at first and second marginal edges 17
and 18 to the surface 14, as best seen in FIG. 2. Communicating
with the interior of the membrane is a supply tube 19 having a
pressure guage 20, a bleeder valve 21 and inflating means 22, which
may be in the form of a manually engageable bulb. It will be
understood that the inflating means 22 may be substituted by a
source of pressurized gas (not shown) having suitable valving
means.
The first embodiment is used for dilating the cervix, and in
unflated condition has a diameter approximating 3 mm. It is
inserted in normal manner into the cervical neck, following which
the membrane 16 is inflated under pressure to exert a substantial
force against the inner surface of the cervix sufficient to dilate
it to approximately 12 mm. The amount of internal pressure required
to accomplish this will vary from patient to patient, and a
suitable range of inflation pressures is established empirically.
The dilation of the cervix is preferably accomplished gradually, so
as not to impart any undue stresses to the patient, and normally
dilation can be accomplished by gradually building pressure up to
15 to 20 lbs. per square inch. Once dilation has been obtained to a
range of about 12 mm. to 14 mm., the bleeder valve 21 may be
opened, and the device 10 easily withdrawn.
The second embodiment, generally indicated by reference character
30, is employed after the cervix has reached a dilated condition,
and is projected into the uterus prior to expansion. It includes a
hollow tube 31 having an outer diameter of approximately 12 mm.,
the tube having a continuous longitudinally extending bore
communicating with proximal and distal ends 33 and 34,
respectively. The outer surface 35 is provided with finger engaging
means 36 to permit convenient insertion and withdrawal.
The expandable member 37 is preferably a molded type, including an
inner cylindrical wall 38, a planar end wall 39 and a conical wall
40 joining the end wall 39 in a curvilinear edge 41. Sealed areas
42 and 43 interconnect the member 37 with the outer surface 35 of
the tube 31. An inflating tube 44 includes a pressure guage 45
communicating with inflating means 46. Because of the larger volume
of the member 37, inflation is preferably done from a source of
compressed inert gas rather than a hand operated bulb.
When inflated, the frustoconical shape of the member 37 exposes a
wide area of the uterine wall to examination and surgical procedure
performed by the insertion of an endoscope through the bore 32, and
relative movement of the barrel of the endoscope permits
examination and the performance of surgical procedures at the
distal end of the tube 31.
FIG. 4 illustrates a third embodiment of the invention, generally
indicated by reference character 50 which incorporates a
conventional endoscope 51 secured in fixed relation therewith. The
inflating means 52 is similar to that of the second embodiment, and
may be secured to the outer surface 53 of the barrel. Where the
interconnection is permanent, a degree of flexibility is lost in
that the distal end of the endoscope cannot be shifted relative to
the distal end of the tube, but this disadvantage may be offset by
convenience in insertion during certain surgical procedures.
Turning now to the fourth embodiment of the invention, as
illustrated in FIGS. 5 and 6 in the drawings, this structure is
useful where access through the cervix is not desirable..sup.1 The
fourth embodiment, generally indicated by reference character 60,
includes a tubular member 61 having a hollow bore 62 extending
between first and second ends 63 and 64, respectively. Hand
engaging means 65 is mounted on the outer surface of the tubular
member, as in the second embodiment.
The expandable membrane 66 is of generally spherical configuration,
and includes a supply tube 67, gauge 68, bleeder valve 69 and an
inflation source 70. Selectively penetrating the bore 62 is a
stylet 71 which permits the puncturing of the abdomen for insertion
of the tubular member 61, and an obturator 72 having a rounded
distal end which permits the spreading of the cavity prior to
inflation. Once insuflation has been accomplished, the obturator is
removed to be replaced by an endoscope.
Use of the fourth embodiment forms a pneumoperitoneum, as known in
the art, but the inflating gas is confined within the expandable
membrane 66, and not permitted to contact tissue.
It may thus be seen that I have invented novel and highly useful
improvements in surgical instruments affording the insuflation of
body cavities with a facility that has heretofore been impossible.
In the case of dilation of the cervix, the entire dilation can be
accomplished using a single instrument, which employes pneumatic
pressure rather than the insertion of a series of dilators.
Examination of the uterus, and the performance of surgical
procedures therein is accomplised in a somewhat similar manner, the
inflating gases being confined within an inflatable member, and not
permitted to contact tissue being treated. In the case of the
fourth embodiment, the treatment may be accomplished by penetrating
the abdomen, and inflating the abdominal cavity, again with
complete insulation of the inflating gas from the tissue of the
patient.
I wish it to be understood that I do not consider the invention
limited to the precise details of structure shown and set forth in
this specification, for obvious modifications will occur to those
skilled in the art to which the invention pertains.
* * * * *