Surgical instrument

Application filed November 5, 1928. Serial No. 317,333.

This invention relates generally to surgi- lated, and which is efficient in the perform cal instruments and, more particularly, to ance of its intended functions. ^Pa. certain new and useful improvement in ‘ ’ ·· surgical instruments of the type known as 5 tonsillotomes.

In tonsillotomy, a hemorrhage concomitant with the excision generally occurs when using an ordinary tonsillotome having the form of a pair of blunt edged shears, the application of a suitable astringent in the form preferably of a styptic medicine being required to contract the soft tissues and check the flow of blood.

. Ordinary tonsillotomes perform the exci15 sion of the tonsil by compressing the same .. between the blunt edges of the shears to masticate the tissue along the line of cleavage and thus leave the root of the tonsil in a condition favorable to the rapid coagulation 2'’ of the blood and to the suppression of the hemorrhage. Nevertheless, the flow of blood may not altogether be .permanently suppressed, especially in patients suffering from hemorraghic diathesis or the like, so that the operation may be, and* often is, followed by a lesion difficult to correct.

I have found that the hemorrhage’ may be suppressed and morbid conditions averted by a form of diathermic tonsillotome having its exciding members each connected to one * of the opposite terminals of a source of electrical energy preferably furnishing an alternating current of a frequency· of not less .5 ^an five hundred kilocycles per second, commonly referred to as a high frequency current.

My present invention has hence for its prime object the provision of a tonsillotome 40 for diathermically effecting .separation and removal of the tonsil.

. My present invention has for further objects the provision of a tonsillotome: of the type stated which may be readily manufac- : j ⁴³ tured, which may be conveniently manipu- i

And with the above and other objects in view, my invention resides in the novel features of form, construction, arrangement, _V}and combination of parts hereinafter described and pointed out in the claims.

In the accompanying drawing,—

Figure 1 is a sectional view of the pharyngeal .region of a human being, illustrating a tonsillotome of my invention orally presented therein, for a tonsillar operation; w Figure 2 is a longitudinally sectional view through the tonsillotome;

' Figure 3 is a top plan view of the tonsillotome; and

Figure .4 is a sectional view, of the tonsillotome. along the line 4—4, Figure 2

Referring now more in detafl and by reference characters to the drawing, which illus- ₀₅trates a preferred embodiment of my invention,· the instrument includes a suitably elongated, relatively strip-like-rigid member or so-called frame A of spatulate contour, as at 1,. at its forward end, and suitably con- 70 nected or conjoined to frame A at its rear end, is a preferably obliquely disposed insulation handle 2. The frame A is approximately flat and smooth upon its_: upper face, 101 .purposes presently appearing, and in its 75 spatulate or head-end 1 is provided with a tonsillar fenestra or aperture 3.: Integrally or otherwise fixed upon and extending continuously along, the margin .of the spatulate or head-end 1 of frame A, as best seen in Fig- so uie 3, is an, undercut or recessed wall 4 providing a guide-way for the correspondingly spatulate head-end 5 of a likewise elongated rigid co-operating member B, presently more fully described,: flat and smooth on its under so face and^at said face disposed longitudinally toi slidable or shiftable movement upon and relatively to the frame A. The members A and B are preferably of reduced sectional area through their middle or oral portion, as ⁱⁱ⁰ ,902 bedded in the insulating strip 21 and leads from the exciding member 23 to a contactbutton 25 disposed in the rear end portion of the member B and terminating flush xvitli the under face thereof for exposure to and con- ₇₀tact with the plunger 19 on predetermined movement of the shiftable member B in operating direction, that is to say,, in a direction to move the shiftable exciding member 23 over the tonsillar aperture 3,. both of the 75 exciding members being electrically energized in opposition when the button 25 engages with the contact plunger 19. In such manner also, the shiftable exciding member 23 is adapted for inclusion in, and to provide ₈o terminal of the opposite side of, the circuit.

A trigger 26 is pivotally supported, as. at 27, upon the frame A in gripping relation with the handle 2, the latter being preferably provided with finger notches 28 in the usual 85 manner. Extending from the trigger 26 into a slot 29 in the frame A, is a dog 30 adapted to swingably pass into and out of a slot 31 in the shiftable member B for engagement with an end wall thereof to move the member 90 B in operating direction on the trigger 26 being pressed or pulled towards the handle 2. On the trigger 26 being actuated away from the handled, the dog 30 may be entirely disengaged from the shiftable member slot 31, 95 and the member B then shifted rearwardly upon the frame A until the end portion thereof is disengaged from the guide-walls 6 and the head-end 5 disengaged from the guide_;wall 4, whereupon, since the intermediate por- 109 tion of member B is narrower than the distance between the walls 6, the member B may be lifted from the frame A.

The point at which the button 25 contacts the plunger 19 is selected; so that the toiisil 105 tissue will be firmly grasped between the exciding members 7 and 23 when the current is applied therebetween. This position is most easily attained by the operator pressing the shiftable member B with his thumb while no grasping the handle 2, a thumb-piece 32 being provided on the member B for the purpose. Thereafter the movable exciding member 23 is gently and firmly moved by means of the trigger 26 kerf-like through the tonsil ¹¹⁵tissue as it is separated by the diathermic action of the high-frequency current occurring concomitantly._: The diathermic effect increases as the distance between the exciding ₁₂₀members is decreased, hence it is not necessary that the current be supplied during the entire travel of the exciding member 23 across the aperture 3. For this reason, the dimensions of the contact-button 25 are chosen to insure 125 the passage of the current through the tonsil tissue where wanted and cut off the supply of current before the completion of the exciding movement· of the member B, as well as also to prevent a short circuit when the movable ex- 134

1,798 best seen in Figure 3, for both reducing the weight of the instrument and facilitating its use, the frame A being provided longitudinally upon its opposite side margins at and ,- adjacent its rear end with undercut or grooved upstanding parallel guide and retaining walls or flanges 6 for the rear end portion of the shiftable member B.

The frame A is constructed of suitable ₁₀ metallic material, the arcuate or pharyngeal wall 7 of the window or aperture 3 forming the stationary exciding member of the instrument, the conductivity of which is preferably increased by a strip of copper or the ₁₅ like disposed within the groove thereof, as best seen in Figure 2, and electrically attached, as at 8, to the frame A and thence passing downwardly through and out of handle 2, is one lead 9 . of a conducting cable ₂₀ 10 for electrically connecting the frame A with a source (not shown) of alternating electrical energy having a frequency of at least five hundred kilocycles per; second, a conveniently operable switch or othef suitable 25 make-and-break device, as at 11, being incorporated in the lead 9, as seen in Figure 1. In such manner, the stationary excidingmember 7 is connected or included electrically in, and may be described as the terminal of ·<-> one side of, the circuit.

The other lead 12 of the conducting-cable 10 passes through a tube 13 forming substantially a part of frame A and depending therefrom through the handle 2, the latter being 35 preferably split in the plane of the tube 13 and secured therearound by suitable fastening elements 14, as seen in Figure 2.

Disposed in a recess 15 in the upper face of the frame A preferably intermediate the guide-walls 6, is an insulating member 16 ' having a cup-like chamber 17 depending into the upper end of the tube 13. Springset by a spring 18 for normal endwise presentation through the insulation 16 for yield45 ing engagement with the shiftable member B, is a reciprocable contact-plunger 19 flexibly connected electrically with the lead. 12 through a suitable aperture, as at 20, in the bottom rvall of the chamber 17, as best seen co in Figure 2. _

The member B is likewise constructed of suitable metallic material, and disposed in and along the center line of member B and extending from adjacent the rear end there5.-. of to and through its head-end .5, is a strip of insulating material 2.1, which is laterally extended over the margin of the head-end 5 in an arcuate or horn-like shape to form an exciding member-support 22. Mounted on, c' and insulated by the support 22 from, the shiftable member B, is the shiftable metallic exciding member 23, whose exciding edge is formed complementary to, and adapted to enoa»e the groove of, the stationary metallic G5 exciding member 7. A conductor 24 is em1,798,902 3 ciding member 23 touches the stationary exciding member 7.

. In practice, as shown in Figure 1, the tonsillotome is orally presented into the pharynx ⁵ of the patient and manipulated to pass the lobe of the tonsil through the tonsillary aperture 3. The location of the excision having been determined, the operator grasps the tonsil between the exciding members 7 and 23 ¹⁰ and proceeds with the .operation as hereinbefore set forth, whereupon the operation is completed, the effect of the high frequency current being to close the wound, through coagulation of the tissues, after the diather¹⁵ my, thereby preventing hemorrhagic lesions, the result of the operation being to effect a neat and complete and substantially bloodless severance of the tonsil.

_ Thus the excision is performed by my ton²⁰ sillotome without incising or masticating the tissue of the tonsil, the separation being effected by diathermy and hemorrhage prevented by the coagulation produced by the high frequency of the current in passing from ²⁵ one exciding member of the tonsillotome to the other through the tissue of the tonsil along the desired line of separation. Hence it will be seen that my new tonsillotome, when used in combination with a source of high³⁰ frequency alternating current, is an efficient instrument for the surgical purposes intended; it is of simple construction, light in weight, relatively inexpensive to manufacture, and effective in operation.

³⁵ While I have shown and described herein the preferred form of my invention, it will be understood that changes and modifications in the form, construction, arrangement, and combination of the several parts of the in⁴⁰ strument may be made and substituted for those herein shown and described without departing from the nature and principle of my invention.