Note: Descriptions are shown in the official language in which they were submitted.
2 ~ 2 ~
The present intention relates to medical tools for general
and specific surgery and more particularly to
electrocutting/coagulation instruments which also include a
cleaning device for the removal of ash formed in use.
Most surgical procedures now use an electrocutting/coagulation
instrument. Cutting with an electric blade or laser blade creates
irritating smoke, and cuts blood vessels which bleed. This
bleeding in turn disturbs its proper action.
Inhaling the smoke is a health hazard similar to that of air
pollution and cigarette smoking. Also, with continuing exposure,
it has an accumulative detrimental effect on the lungs. Therefore,
providing an electrocutting instrument with the ability to remove
such smoke health hazard, is an advantage.
Usually, the blood that results from cutting covers the line
of the cutting and also impairs the quality of the electrocutting;
thus the blood has to be removed before the electrocutting can be
continued.
In the course of the cutting or coagulation with an electric
(or laser) blade, ash is formed and sticks to the cutting edge of
the blade. This ash has to be scraped off to restore the normal
function of the instrument. Usually the surgeon has to stop the
course of the surgical procedure and clean the tip with another
instrument.
Every -major surgical procedure in the chest, abdomen (or
limbs) includes, as the first stage of the operation, opening the
chest or abdominal wall by cutting through its layers. The main
instrument used in this stage of the operation is the
electrocutting-coagulation scalpel by which the different layers
are cut by the main surgeon. The assistant in this stage holds a
separate suction apparatus and/or sponges and wipes the blood.
However, the steady increase in time needed for the cutting
and/or coagulation, which finally leads to the inevitable arrest
of the instrument function, and the inevitable necessity to stop
2 ~ 2 ~
the course of surgery and to clean the instrument, are two major
disadvantages of the existing forms of electrocutting bla,~es.
One prior art electrosurgical instrument was that disclosed
in Patent 4,562,838, issued January 7, 1986 to Walker. That patent
provided an electrosurgical instrument including a hollow,
elongated tube having an inner surface defining an internal
longitudinally extending fluid conduit, the tube also having a
mounting channel extending longitudinally along the length of the
tube. The instrument included an active electrode. The instrument
also included a nose piece mounted in the tube and holding the
active electrode, the periphery of the nose piece being provided
with at least one longitudinal flute which, together with the inner
surface of the tube, defined a duct in fluid communication with the
remainder of the fluid conduit, the duet being positioned to guide
a fluid stream past the active electrode, the nose piece being
constructed of an electrically nonconducting material. The
instrument also included an electrical lead connected to the active
electrode. Finally, the instrument included a light-transmitting
cable slidably received within the mounting channel, with the light
emitting end of the cable positioned adjacent to the active
electrode to illuminate a region around the electrode. This patent
did not solve-the problem of removiny the smoke, but only postponed
the solution to the problem by diffusing the smoke into the
operating room.
Another prior art electrosurgica] instrument was that
disclosed in ~.S. Patent 4,719,914 issued January 19, 1988 to G.
N. Johnson. That electrosurgical instrument included a hollow
tubular member having an opening at one end adapted for connection
by hollow tubing to a source of vacuum, and a ride opening adjacent
to one end. The opposite end of the tubular member included a
tapered hollow nose portion. An electrocauterizing blade ~as
secured in, and had one end extending outward from, the end of the
nose portion, and had the other end positioned inside the tubular
member. Electric heating means were provided for the
3 ~ 3 2 ~
electrocauterizing blade including an electric lead extending
through the tubular member and through the side opening for
connection to a power source. The nose portion had a plurality of
openings adjacent to the tapered surface thereof adapted to
withdraw smoke from a surgical area being cut and cauterized by
means of a cam connected to the tubular member open end. Means
selectively controlled the application of vacuum through the nose
portion openings were provided by means supported on the tubular
member for selectively covering and uncovering the nose portion
openings. ~hile this patent attempted to use suction to remove
smoke, the application of the suction was not at the optimum
location with respect to the electrocauterizing blade.
Yet another prior art electrosurgical instrument was the
electrocautery surgery apparatus disclosed in ~.S. Patent 4,919,129
patented April 24, 1990 by Weber, Jr., et al. That apparatus
included an elongated body having an electrical conductor
positionable along a slidable path extending substantially
therethrough toward a forward end thereof. The apparatus included
connector means disposed near the forward end, the connector means
being disposed to receive a conductive element therein for
selective slidable positioning thereof relative to the forward end
in response to slidable movement of the electrical conductor.
Slider means were disposed o~ the body and were coupled to the
electrical conductor for selectively altering the position thereof
and of the connector means between forward and rearward positions
thereof relative to -the forward end. Circuit means were disposed
in the body to be actuated by the electrical conductor for
controlling the application of electrical signal thereto in
response to the position of the electrical conductor along the
slidable path thereof. The circuit means included an interlock
switch operable in both the conductive state and the non-conductive
state in response to the electrical conductor being positioned near
the rearward position along the slidable path thereof. The
interlock switch included auxiliary circuit means disposed in the
2 ~
body for grounding the electrical conductor during operation in the
non-conductive state. This patent did not address the problem of
the removal of smoke from the area of the electrocautering
apparatus.
An object of this invention is to provide means which could
be mounted and/or removed easily from existing forms of electric
or laser scalpels and which could provide means for the removal of
smoke from the region of the electric or laser scalpel blades.
Another object of this invention is to provide a combined
cutting-coagulation-suction apparatus, and/or combined cutting-
suction apparatus and which provides means for the removal of smoke
from the region of the electric or laser scalpel blades.
Applicant, in allowed copending Application Serial No.
07/594,704, of which the present application is a continuation-in-
part, provided several instruments involving novel combinations to
solve such problems. These combinations were as follows:
In one embodiment of such instrument, the combination provided
was a cutting-coagulation scalpel including a handle, an electrical
lead to the handle, switch means on the handle, a blade electrode
mounted at one end of the handle and connected to the electrical
lead through the switch means on the handle for selectively
activating and deactivating the blade electrode for cutting action
or for coagulation action. A suction tube was removably mounted
on the handle, the suction tube being connectable to a source of
suction and comprising a modified L-shaped hard plastic transparent
tube having a longitudinal arm and an angular arm, with an angle
of about 135 between the longitudinal arm and the angular arm, the
longitudinal arm having an open end and a back end, and being
provided, at the open end, with an orifice, and, at the back end,
with a thickened wall having a slot therethrough allowing
penetration of the blade electrode therethrough. A soft plastic
tube was also provided, which was connected to the angular arm.
The soft plastic tube had a first set of hooks thereon, the first
set of hooks each comprising two rings, one ring completely
encircling the soft plastic tube, the other ring being constituted
by two flexible arms to allow the handle to pop in between a gap
between the two flexible arms thereby allowing the ring to be
mounted on, and being positively attached to, the handle, and
having a further set of hooks thereon for holding only the electric
lead, each of the further set of hooks having a closed ring
encircling the soft tube, and an open ring, the open ring being
formed by two flexible arms, each of the further set of hooks being
sized to allow the electrical lead of the cutting-coagulation
scalpel to be engaged and disengaged in it. The blade electrode
penetrated the modified L~shaped tube through the slot in the back
end of the longitudinal arm, and was held in the center thereof by
the thickened wall and protruded out of the orifice so that the
blade electrode approached the cut and coagulated tissue areas.
A tap was disposed on the suction tube, the tap being selectively
operable to connect the suction tube to the source of suction, or
to disconnect the suction tube from the source of suction.
In another embodiment of such instrument, the combination
further included a cleaning device for the blade electrode. The
blade electrode cleaning device included a metallic scraper element
having a cylinder-like tip, the tip having razor-sharp edges
encircling the blade electrode and having a slightly larger cross-
section than the blade electrode, the tip being slidable on the
blade electrode. The blade electrode had two slightly raised
holding points thereon and was fixed to the scalpel handle and the
slot in the back end of the scalpel handle and the slot in the back
end of the modified L-shaped tube. A spring encircled the blade
electrode around a portion of the blade electrode between one end
of the handle and the holding points and was retained behind the
holding points. An actuating lever was provided on the blade
electrode, with a metallic strip connecting the tip and the lever.
A portion of the metal]ic strip was slidable with respect to a
portion of the blade electrode, the strip being integrally formed,
at one end thereof, with a cylinder-like tip. Thus, when the lever
2~3~2~
was pushed towards the tip, it caused sliding of the tip in close
proximity to the blade electrode, thereby to scrape the blade
electrode and to cause compression of the spring. When the lever
was released, the tip was restored to its initial position by
spring energy.
In another embodiment of such patented instrument, the
electrosurgical instrument included an insulated housing. A blade
electrode was mounted at one end of the housing. An electrical
unit was provided, which included switch means for selectively
activating and deactivating the blade electrode. The electrical
unit was disposed in the insulated housing. A suction channel was
provided which had an orifice adjacent a tip of the blade
electrode. A second channel was operatively connected to the
suction channel for conveying flushing fluid to the suction
channel. Scraping cleaning means were provided for scraping the
blade electrode, the scraping cleaning means being carried by the
blade electrode. The scraping cleaning means included manually-
operable means for urging the scraping cleaning means to a forward
position. The manually-operable means operated against spring
means which urged the scraping cleaning means to a retracted,
stored position. Release of the manually-operable means allowed
the spring means to urge the scraping cleaning means from its
forward position to its retracted stored position. In such
embodiment the switch means was a two position switch for
controlling cutting and coagulation procedures. The switch means
was preferably provided on the housing.
In another embodiment of such instrument, the electrosurgical
instrument included a handle having a forward end and a rear end.
A suction tube having a forward end, a rear end, and side walls,
was connected to the handle, the rear end of the suction tube being
adapted to be connected to a source of suction, and the forward end
of the suction tube projecting beyond the forward end of the
handle. The suction tube included an aperture in a side wall of
the forward end thereof. The forward end of the suction tube was
2 ~ 2 ~
flattened to an ellipsoidal cross-section in a region where it
surrounded a blade electrode. The forward end of the suction tube
terminated in a distal, obliquely-slanted outer face, and included
an elliptically-shaped perforated membrane secured to the aperture.
The membrane included a slot through which the blade electrode
protruded. An electrical lead extended into the handle from the
rear end thereof. A blade electrode was provided, the blade
electrode having a forward end and a rear end, the rear end of the
blade electrode being secured to the forward end of the handle, and
being in electrical connection to the electrical lead. The forward
end of the blade electrode projected through the aperture in the
side wall of the forward end of the suction tube, and projected
beyond the forward end of the suction tube. The blade electrode
was completely surrounded by the suction tube. A switch was
connected between the electrical lead and the blade electrode for
selectively activating and deactivating the blade electrode. In
such embodiment, the electrosurgical instrument included a thin,
lightweight, flexible tube of soft rubber or siliconer the rear end
of the suction tube being connected to the thin lightweight
flexible tube, the thin lightweight flexible tube being adapted to
be connected to a source of suction. The thin lightweight flexible
tube had sufficient resiliency to allow flexibility at the rear
end of the handle for ensuring convenient manipulation of the
instrument.
In a further embodiment of such instrument, the
electrosurgical instrument included a handle having a forward end,
a rear end and a longitudinal axis. A suction tube having a
forward end, a rear end, and sidewalls, was connected to the
handle, the rear end of the suction tube being adapted to be
connected to a source of suction. The forward end of the suction
tube projected beyond the forward end of the handle, and extended
along an imaginary extension of the longitudinal axis of the
handle. The suction tube included an aperture in a side wall of
the forward end thereof. An electrical lead extended into the
2`~3
handle from the rear end thereof. A blade electrode was provided,
the blade electrode having a forward end, an intermediate portion
and a rear end, a top edge of the rear end of the blade electrode
was secured to the forward end of the handle, and was in electrical
connection to the electrical lead. The intermediate portion of the
blade electrode was disposed through the aperture in the side wall
of the suction tube, the aperture being operatively associated with
a rearwardly-extending ledge. The blade electrode was supported
on the rearwardly-extending ledge. The forward end of the blade
electrode projected beyond the forward end of the suction tube.
The blade electrode was completely surrounded by the suction tube.
A switch was connected between the electrical lead and the blade
electrode for selectively activating and deactivating the blade
electrode. Scraper cleaner means were provided for scraping the
blade electrode, the scraper cleaner means being slidably mounted
on the blade electrode. Manually-movable means were provided for
moving the scraper cleaner means from an inactive position to a
forward position in scraping sliding contact with the blade
electrode, and back to the rearward, inactive position.
In one variant of this embodiment, the electrosurgical
instrument included a thin, lightweight, flexible tube of soft
rubber or silicone, the rear end of the suction tube being
connected to the thin, lightweight, flexible tùbe. The thin,
lightweight, flexible tube was adapted to be connected to a source
of suction. The thin, lightweight, flexible tube had sufficient
resiliency to allow flexibility at the rear end of the handle for
ensuring convenient manipulation of the instrument.
In another variant of this embodiment, the electrosurgical
instrument had a handle which included a longitudinally-extending
slot within which the scraper cleaner means was adapted to slide.
The scraper cleaner means included a scraper member having the same
cross-section as the blade electrode but which was just slightly
larger thereof. A rearwardly-extending connecting member enveloped
the top edge of the blade electrode and extended into the
longitudinally-extending slot in the handle. A lever was integral
with, and upstood from, the rearwardly-extending connecting member
and was slidable in the longitudinally-extending slot. A coil
spring encircled a portion of the blade electrode, the coil spring
S being disposed between the forward end of the handle and a rear
edge of the rearwardly-extending ledge.
In yet another variant of such embodiment, the electrosurgical
instrument included an infusion tube only adapted to be connected
to a source of flushing fluid, the infusion tube having a rear end,
a forward end, and a side wall. The infusion tube ran parallel
to, and was in contact with, the suction tube. The rear end of the
infusion tube was connected to a source of flushing fluid. The
forward end of the infusion tube was provided with an aperture in
the side wall thereof connecting with an aligned aperture in an
adjacent side wall of the suction tube.
While the above-described embodiment of applicant's above-
identified co-pending application provided many advantages, it is
a further objective of this invention to give the surgeon a
practical, handy electrocutting or lasercutting apparatus which is
provided with an assisting suction tube and flushing capability
for the suction tube, the apparatus being able to be grasped like
one grasps a pencil, and is thus being easy to manipulate while
doing the main procedures of cutting and coagulating.
This invention provides an electrosurgical instrument
comprising a handle having a forward end and a rear end. A suction
tube is secured to the handle and is adapted to be connected only
to a source of suction. The SUCtiOll tube has a forward end and a
rear end, the rear end being connected to the handle, and also
being connected to the source of suction, and the forward end of
the tube projecting beyond the forward end of the handle. A
manually-controllable, electrically-actuated cutting/coagulating
blade electrode is operatively connected to the handle, a portion
of the cutting/coagulating blade electrode projecting beyond the
forward end of the handle. A lead is securely connected to the
~'~t~
blade electrode and is adapted to be connected from a source of
electricity to the cutting/coagulating blade electrode. Switch
means are provided to actuate the cutting/coagulating blade
electrode, so that the suction tube provides a suction surrounding,
and in close proximity to all portions of the cutting/coagulating
blade electrode. A connector is provided which has a leg and a
pair of arms, the rear end of the suction tube being connected to
one arm of the connector, the other arm of the connector being
connected to a separate suction handle, and the leg of the
connector being connected to a source of suction.
The electrosurgical instrument preferably includes an
electrical lead extending into the handle from the rear end
thereof, and the suction is provided by the suction tube which
completely surrounds the tip of the blade electrode in close
proximity thereto.
In the electrosurgical instrument embodiment of this
invention, the means to actuate the cutting/coagulating blade
electrode preferably comprises a low profile, finger-actuatable
switch assembly. The suction tube preferably terminates in an
oblique cut through which the cutting/coagulating blade electrode
is adapted to project. Still more preferably, the suction tube is
transparent at a region where the cutting/coagulating blade
electrode is adapted to be in close proximity.
This invention also provides a laser surgical instrument
comprising a handle having a forward end and a rear end. A suction
tube is secured to the handle, the suction tube having a forward
end and a rear end connected to the handle, the rear end of the
tube being connected to a source of suction, the forward end of the
tube projecting beyond the forward end of the handle. A laser
source is provided within the handle. A lead extends from a laser
generator to the laser source. Means are provided to actuate the
laser generator to project a laser beam through the forward end of
the suction tube. In this way, the suction tube provides a suction
surrounding, and in close proximity, to the emergent laser beam.
2 Q ~
11 ,
In the laser surgical instrument, the means to actuate the
laser electrode preferably comprises a low profile, finger-
actuatable switch assembly. The suction tube preferably terminates
in an oblique cut through which the laser beam is adapted to
project. Still more preferably, the suction tube is transparent
at a region where the laser beam is adapted to be in close
proximity.
One feature of the present invention is the provision of a
specifically constructed tube that may be mounted on, and removed
easily from, the prior art existing forms of electric or laser
scalpels. The invention therefore provides a combined cutting-
coagulation-suction apparatus, and/or combined cutting-suction
apparatus.
One advance made in the art of surgery is that this suction
tube, which is light-weight and can easily be mounted on an
electric scalpel, removes the irritating smoke, which is usually
inhaled by the surgeon and his staff, immediately after its
formation. In fact, it removes the smoke substantially,
simultaneously with the cutting and prevents it from being inhaled
by the operating staff.
Another advance, by the present invention, in the art of
surgery, is that it remcves the blood simultaneously with the
electrocutting. This also applies when it is mounted on a simple
scalpel with a sharp-edged blade. Removing the blood
simultaneously with the cutting action spares the need to stop and
wipe the blood or the need for an assistant for that purpose (the
two actions are done by the surgeon who holds the combined
instrument).
Another advance, by the present invention, is that, when
mounted on an electric scalpel that is designed also to accomplish
coagulation, it sucks the blood from the surrounding area of the
cut-end of the blood vessel and enables proper coagulation of the
bleeding vessel.
2 ~ 2 ~
12
Another feature of the invention is the provision of an
optional infusion tube that is connected to the suction tube, and
is arranged to pour saline or sterile water into the suction tube
in order constantly to flush the blood that might stick to the
walls of the suction tube. Usually, the suction tubes do not
block. However, in an especially long operation with an enlarged
input of blood through the suction tube, the lumen of the suction
tube could be narrowed by the clotted blood. The flushing will
abolish this possibility completely.
This invention provides an instrument which frees the surgeon
from stopping the course of surgery for cleaning the instrument.
This invention provides a blade with a device that scrapes the ash
from the tip by a single one cm movement of the index finger tip
of the hand which holds the instrument. Because this is a very
simple action, it could be performed during the course of procedure
without stopping the main procedure. When this blade is mounted
together with the suction device on the blade, the suction area
will immediately suck the debri~ that is being scraped from the tip
and prevent it from falling on the surgical field.
In the accompanying drawings,
Fig. 1 is an isometric view showing one embodiment of a
suction tube for an electrocutting/coagulation scalpel handle,
constructed and operated in accordance with the principles of the
present invention;
Figs. 2A and 2B are side elevational views, partly in phantom,
which show, respectively, penetration of a scalpel blade through
a slot in the suction tube of Fig. 1, and an isometric view
thereof;
Figs. 3A, 3B and 3C are side elevational views, partly in
phantom, which show, respectively, an optional perforated orifice
plate for use with the suction tube of the embodiment of Fig. 1,
13
and a lock therefor, a cap-type of perforated plate, and a screw-
cap type of perforated plate;
Figs. 4A, and 4B is a central longitudinal cross-section in
transverse section, which show, respectively, a cleaning device
for the electrocutting/coagulation scalpel handie of the embodiment
of Fig. 1, and a cross-section thereof;
Fig. 5A and 5s is a side elevational view, partly in section
and partly in phantom, which show, respectively, a flushing system
for the electrocutting/coagulation scalpel handle of Fig. l, and
a cross-section thereof;
Figs. 6A, 6B, 6C, 6D, and 6E collectively are an isometric
view and sections, which show, respectively, a scalpel handle
having a tube in which all the cutting/coagulation-suction-flushing
functions are included, a perforated plate for cleaning the blade,
optional inverse construction of the tube, alternate perforated
plate construction, and an optional cleaning tube;
Fig. 7 is a central longitudinal cross-~ection of an
alternative construction of the electrocutting/coagulation-suction
apparatus of the invention; and
Fig. 8 is a schematic view of yet another alternative
construction of the electrocutting/coagulation-suction instrument
of the invention.
One embodiment of the invention consists of six parts, namely
tube 10, tube 12, connector 14, blade 16, electric scalpel 18 with
handle 18 and wire 20, which is attached to each other in the
manner described in Fig. 1. Tube 10 is an essential element and
is made of hollow, round, hard transparent plastic tube, shaped in
the form of a modified letter "L", with an angle of about 135
between the horizontal and vertical arms of the "L". As seen in
Fig. 2A, and Fig. 2B, the end of the horizontal arm is cut
obliquely at a 45 angle to the plane of the horizontal arm to form
an ellipse-shaped orifice 21. Through this orifice 21, the blade
16 of the electric scalpel 18 protrudes and approaches the tissue
that is cut or the blood vessel that is coagulated. Through this
2 ~ 2 ~
14
orifice 21, the blood and smoke are sucked out of the tissue, to
the inside of the tube 10.
The tube 12 is connected to another tube 30 by means of a
plastic connector 14. Tube 30 leads to a negative pressure
generating apparatus that provides the suction power. The tube
12 is indirectly connected to the handle 18 through tube 10,
which is connected to blade 16, which in turn is connected to the
handle 18.
The vacuum generating apparatus ~not shown~ attached to the
tube 30 provides the suction.
The cutting blade 16 penetrates the horizontal arm of the
modified L-shaped tube through the ellipsoid slot 22 (in the form
complementary to the blade 16) adjacent the conjunction between the
two tubes 10,12. The conjunction is thickened ~see Fig. 2B) and
the slot 22 is shaped exactly in the center of the tube 10, thus
holding the blade 16 at the center of the round lumen of the tube
10 and enabling the blade 16 to protrude right in the center of the
ellipsoidal orifice 21.
The back of the horizontal arm of the tube 10 is formed with
thickened plastic (see Fig. 2s) whose purpose is to give strength
to the central positioning of the cutting blade 16 in the lumen of
the horizontal arm of the tube 10. An enlarged drawing is shown
in Fig. 2B.
The vertical arm of the modified L-shaped tube 10 is a
continuation of the lumen of the horizontal arm; it serves as a
connector to tube 12.
Tube 12 is a hollow round tube made from soft rubber or
silicone. It is thin, lightweight and flexible. It is attached
to the handle of the electric scalpel 18 by two large plastic hooks
26 with an internal diameter which is the same as that of the
handle of the electric scalpel 18, and with a shape as shown in
Figure 1.
Each hook 26 consists of two rings: one is full and encircles
the tube 12. The other is partial and has two flexible arms with
~3~2~
a spring quality that enables the handle of the scalpel 18 to "pop
in" by forcing it through the gap between the two spring-like arms
of the partial ring. Along the tube 12 are other hooks 28 (only
one of which being shown) which are designed to hold the electric
wire 20. These hooks 28 are the same as the hooks 2~, but with
smaller arms or "open rings" to fit the smaller diameter of the
wire 20.
The wire 20 is connected to the distal part of the handle of
the scalpel 18. At the other end, wire 20 is connected to the
cutting-coagulation generator ~not shown).
Another embodiment of the invention is shown in Figs. 3A, 3B
and 3C. As seen therein, an ellipsoid perforated ~with multiple
perforations) plastic membrane 32 is mounted on the ellip~soid
orifice 21 of tube 10. The membrane 32 also has a slot 34 in its
centre through which the electrocutting blade 16 protrudes.
This perforated membrane 32 is attached firmly to the
ellipsoid orifice 21, causing a partial occlusion of the lumen
(partial because of the perforations). The membrane cou~d be
removed from the orifice 21, all at the surgeon's choice.
There are several ways to give the membrane 32 and/or cover,
and/or cap the ability to occlude or to be removed from the orifice
21 at the surgeon's will. In the embodiment shown in Fig. 3A, a
plastic perforated plate, membrane 32, is attached to tube 10 in
the upper pole of the ellipsoid orifice 21, by means of a segment
of soft plastic 38. This segment 38 serves like a hinge around
which the plate 32 can be rotated. The plate 32 may be an integral
part of tube 10. Tube 10 will have two plastic locks, one, 40, on
top of the "roof" of the tube 10 and the other, 42, on the lower
pole of the ellipsoid orifice 21.
These plastic locks are designed to have a hook-shape which
enables them to lock the plate 32, either parallel to the tube 10
by means of the lock in position 40, or closing on the ellipsoid
orifice 21 by means of the lock in position 42. Additional hook-
locks may be placed on both sides of the ellipsoid orifice 21 to
2 ~
16
add extra strength to the closure of the orifice 21, as an option
of this invention.
Other possibilities of construction are a tight fitting cap-
like perforated plate 32, which is fitted to cover firmly the
distal part of the tube 10 (as shown in Fig. 3B); or one that could
be screwed over tube 10 on threads 52 ~as shown in Fig. 3C).
All three forms described above give the surgeon the
possibility to open and/or close the orifice 21, as desired.
Figs. 4A and 4B show a modified embodiment of this invention
provided with a blade cleaning device. It will be appreciated that
building a blade 16 with an "auto cleaning" mechanism which is easy
to operate by movement of the index finger of a surgeon is very
desirable. The cleaning device 53 is fitted to the blade 16 which
is connected to the handle of the scalpel 18 at 54. The blade 16
protrudes through aperture 21. The blade 16 enters the lumen of
the horizontal arm of tube 10 through a slot 22 in the thickened
wall of the vertical arm of the tube 10. Blade 16 has t-~o slightly
raised holding points which prevent the spring 58, which encircles
blade 16, from moving forward when the spring 58 is pushed in the
direction of the arrow 60, by the ring 62 which has a slightly
different diameter. Ring 62 is an integra] par* of the body of the
cleaning device 53.
The cleaning device itself in the embodiment, as shown in Fig.
4A, is a long hollow metal tube 64, about 1 cm long, that has the
same ellipsoid cross-section as blade 16. However, the tube 64 is
very slightly larger, to allow the blade 16 to fill the lumen of
this ellipsoid cleaning tube 64. This tube 64 has a razor sharp
leading edge 66 which lies very close to the blade 16 it encircles.
The size of the gap between the tube 64 and the blade 16 is just
big enough to allow sliding of the tube 64 along the tip of the
blade 16.
Tube 64 is connected, by means of its upper wall, to a
metallic, semicircular strip 68 which is, in fact, an integral part
of tube 64. The semi-circular strip 68 lies over the upper part
2 ~
17
of blade 16, and "runs" along it, parallel and adjacent to blade
16. This strip 68 can slide over the blade 16, and also emerges
from the plastic tube 10 through slot 22, at the back of the
vertical arm of tube 10. At one point, strip 68 is attached to a
ring 62, which encircles the blade 16 and can slide over it.
Because ring 62 has a "rim" like a "doughnut", that covers the
last ring of the spring 58, it can push and compress spring 58 if
pushed in the direction of arrow 60. Two enlargements or holding
points 56, in the blade 16 prevent the spring 58 from "running"
forward. On the other hand, the compressed spring 58 can push ring
62 back by its stored energy.
The semi-circular -strip 68 enters the handle of the
- scalpel 18 at point 70 and ends in a lever-shaped upstanding
edge 72 that bulges out of the handle of the scalpel 18 near the
on/off knob 74. The scalpel 18 is held like a pencil by its
handle, i.e. the index finger pushes on knob 74 and the thumb on
point 76.
There are other possibilities of mounting the retrieving
mechanism of the device 53. The spring 58 may be placed around
the semi-circular strip at segment 82, thus hiding it inside the
handle of the scalpel 18~ The holding point 56 of the blade 16
may be placed at point 84, the "doughnut" ring 62 of the semi-
circular strip 68 in point 86 of the semi-circular strip 68 and
the spring 58 encircling the blade 16 between point 84 and 86.
This will also hide the retrieving part inside the handle of the
scalpel 18. A similar cleaning device 53 mounted on bipolar
forceps coagulation and/or bipolar coagulation suction apparatus
is an option of this inventior..
Figs. 5A and 5B show a modified embodiment of this invention
provided with an infusion device. As seen in Fig. 5A, an infusion
tube 88 runs parallel to the suction tube 12. In fact, tube 10
and 12 may be provided as a double lumen tube, the small diameter
lumen 88 being for the flow of flushing fluid and the large
diameter lumen 12 being the suction tube itself. (See Fig. SB).
2 ~ 2 ~
18
Tube 88 is connected to tube 10 through connector tube 90 at one
end thereof. At the other end, tube 88 is connected to an infusion
fluid bag (not shown).
The flow of the fluid in the tube 88 is caused by hydrostatic
pressure which results from placing the infusion bag on a level
higher than the level of connector 90 or 14. The rate of flow is
regulated by means of a plastic tap 102 provided with a squeezing
ball which controls the width of the lumen of the tube 88 and is
placed close to the connection of the tube 88 with the fluid bag
or bottle or on the part close to the tube 12. Connector 90 has
a hollow lumen and is an integral part of tube 12.
The continuing whistle resulting from the continuous suction
through the tube 10 is annoying to some surgeons. This may
be abolished by placing an intravenous infusion type tap 102 on
tube 12 that could narrow and close the lumen of the tube 12 by
turning the wheel of the tap 1030
Figs. 6A - 6E show yet another embodiment of this invention.
This alternative embodiment of this invention of cutting/
coagulation-suction-flushing apparatus involves replacing the
handle of the scalpel 18 (as shown in Fig. 1) and arranging the
suction tube 12 and flushing (infusion) tube 88 in the position of
the handle. This concept provides one tube which will include all
functions of the apparatus, namely isolated connection to the
electric wire 20 and off/on knob 74, the suction tube ~10 and 12),
and the flushing tube 88. Figs. 6A - D illustrate the invention.
The tube 104 is formed of round, transparent plastic with a
semi-cylindrical depression 106 towards the frontal edge of the
tube 104. Thus, the tube 104 consists of an oblique or round
orifice, leading to a hollow cylinder which continues as a semi-
cylindrical lumen in the segment 108 of the depression 106 and then
continues as a hollow round tube 134. The semi-circular plastic
plate 109 that constitutes the "back" of the frontal cylinder 110
has an ellipsoid hole 112 through which the electric blade 16 is
adapted to be inserted.
2 ~
19
In the upper part of the tube 104, the flushing tube 88 is
provided as a second small tube in which the flushing fluid flows
and pours into the lumen of tube 104 near the orifice at point 116.
In the lower wall of the posterior cylinder 118 of tube 104,
there is a longitudinal groove 120 which is elastic and is designed
to house the electric cord 20. The groove 120 starts in the
posterior wall of the depression, in plate 122, and ends at the
back of the tube 104 at region 124. However, the groove may be
continued into the following tube 134 that is connected by
connector 14~
The electric unit 126 is made from plastic in a semi-
cylindrical shape, similar to the shape of the depression 106. It
is made in one piece with the electric cord 2~ and is completely
isolated except in point 128 where it is designed to grasp the
posterior edge of blade 16. The unit 126 has an off/on apparatus
and knob 130 on its side. The apparatus at point 128 that grasps
the blade 16 in the unit 126 is a conventional apparatus and has
four metal straps an a circular arrangement that spread forcefully
when the blade 16, which has a larger diameter than that formed by
the cross-section of the metal strips, penetrates between them when
mounted on the unit 126.
The unit 126 fits exactly in the depression 106 in tube 104,
and is kept in place by the blade 16 that penetrates the unit 126
in front and by the cord 20 in the groove 120 in the back. Plate
109 is especially thickened to add extra strength for holding the
blade 16 and the unit 126.
Because of the suction area there will be no leakage from the
hole 112 on plate 109 through which the blade 16 exits the tube
104. The connection in the rear is as follows: Tube 104 connects
to another tube 134 through connector 14, and this in turn leads
to the vacuum generating apparatus. Cord 20 remains as one unit
until it connects to the electrocutting generator, this to maximize
isolation of the current. The flushing tube 88 connects to the
infusion tube 136 through a regular connector.
3 ~ ~
2~
Arrows show fluid flowing in tube 88, pouring through point
116 and being sucked in the opposite direction in tube 104.
In another alternative embodiment of this invention, a
rotatable, lock-hooked, perforated plate 138 with a slot 140 for
the blade 16 is provided similar to that described in Fig. 3A.
However, in this embodiment there is a modification that enables
the plate 138 to clean the blade 16 from accumulating ash. The
slot 140 has two sharp razor pieces 142a, 142b, in both sides of
the slot 140, incorporated firmly into the plastic plate 138 (see
Fig. 6e). When the plate 138 is rotated downward towards the
orifice, blade 16 has to penetrate the slot 140. Since the slot
140 is very narrow, the razors 142a, 142b shave and push the debris
inward to tube 104, where they are sucked away by the existing
vacuum, as seen by the arrows in Fig. 6A.
A modification of this invention is a cleaning tube 64
encircling the blade 16 that has sharp edges 66, ( as seen in Fig.
6D), and a lever 72 that extends outside the top of tube 104
through slot 154. Another modification of this invention is a
retrieving mechanism as in Fig. 4D, provided with holding points
56 in Fig. 6D.
A further embodiment is shown in Fig. 7. As shown in Figure
7 an electrocutting instrument, shown generally as 200 includes
the suction cleaning cauterizing and cutting functions all combined
within a handle 218 of the instrument. The instrument 200 has an
electrode blade 216 having an inner end connected to two position
switch means 217 (to cut or cauterize) which is in turn connected
to a source of R.F. energy through a supply ware 219.
A suction channel 210 having an orifice 221 adjacent the tip
of blade 216, surrounds the blade 216 and extends under the handle
218. The suction channel 210 becomes a tube 212 at the trailing
end of the handle where at is either formed of flexible plastic or
is joined to flexible supply tubing by a connector at 214. A
second and smaller channel and supply tube 213 provides flushing
fluid to the first channel 210 adjacent the orifice 221.
2~$~2~
21
The cleaning means 230 of this embodiment is a cylindrical
member 232 carried by the blade 216 adjacent its forward end. The
cylindrical member as similar to that of Fig. 4b and therefore need
not be described in detail. A member 234 interconnects the
cylindrical member 232 and a manually engageable portion 234 which
extends out of the handle adjacent the switch assembly 217. A
helical compression spring 236 is interposed between the manually-
engageable portion 232 and stop means 238 provided in the handle
of the instrument 200. The spring 236 is compressed when the
cleaning element is moved forward and returns the cleaning element
to a stored position when released.
As seen in Fig. 8, the laser surgical instrument 800 includes
a handle 801 having a forward end 802, generally as a downwardly
sloping face 803, and a rear end 804. The rear end 804 is provided
with an opening 805 which is connectable to a source of vacuum (not
seen). This source of vacuum applies vacuum to the hollow
longitudinally-extending base 806 of the handle 801. The rear end
804 is also provided with an aperture 807. Within the handle 801
is a laser source, i.e. a fiber optics mechanism 809. A lead 810
extends from a laser generator (not shown) through the aperture 807
to the fiber optics mechanism 809. The lead 810 is provided with
switch means 811. While not shown, the handle may be provided with
a flushing tube as described in Figures 5A and 5B. The output of
the fibre optics mechanism 809 is a sharp laser beam 812 which is
useful for surgery. The beam 812 is completely surrounded by the
suction in base 806 as shown by arrow 813.
The ellipsoid shape of the blade 16 and the slot 22 in the
thickened "back" of the tube 10 is to prevent rotation of the blade
16 inside the lumen of the horizontal arm and, of course, to
prevent rotation of the protruding part of the blade 16.
Prevention of rotation is important because, when cutting, the
sharper edge of the blade 16 has to be consistently opposite to the
tissue that it cuts, otherwise the cut will not be sharp and
straight.
2 ~
Membrane 32 serves two purposes: One purpose of the membrane
32 is that, because it partially occludes the orifice 21, it
enables application of a smaller negative pressure or suction power
on the blood, smoke and tissue underneath, than without it.
Another purpose is that, because it is firmly attached to the walls
that form the orifice 21, and because of the central positioning
of the slot 34 through which the blade 16 protrudes, extra strength
is added to the central positioning and fixation of the blade 16.
Thus, when in use, the electrosurgical blade performs the
cutting action, while the suction draws away substantially all the
smoke in the area of the cut, since it substantially completely
surrounds the electrocutting blade.
The greater part of formed ash adheres to the part of the
electric blade 16 that is in touch with the cut tissue. This
latter part of ash forms an isolating barrier between the metallic
blade 16 and the tissue it is supposed to cut. This barrier
increases the resistance to the flow of current (and consequently
of the heat) from the blade 16 to the tissue that is cut or
coagulated, and consequently impairs the optimal cutting and/or
coagulating function of the blade 16.
The amount of ash that adheres to the blade 16 is directly
proportional to the amount of cutting or coagulating ("burning" in
surgeons' slang) that is being performed. As the ash accumulates
on the blade 16, resulting in a growing layer of ash formed
thereon, the resistance to the flow of current becomes
proportionately greater. This necessitates a longer application
of the blade 16 on the tissue in order to achieve the same cut or
coagulation that would have been achieved if the blade was clean
from ash. Finally, the layer becomes so thick that no current
flows to the tissue and it neither cuts nor coagulates and the
surgeon had to make a break in the procedure and clean the blade
16 by means of scraping out the ash with a sharp metal blade or the
blade of a scissors. This cleaning restores the conductance of the
surface of the electric blade 16 and consequently, the proper flow
2 ~ 2 ~
of electric current from the blade 16 to the tissue is restored,
thus achieving the proper cutting and coagulation functions of the
instrument.
The process of cutting through the layers by the primary
surgeon consists of cutting with the electrocutting instrument and
when a considerably-sized blood vessel is cut and needs to be
coagulated, the main surgeon presses on the coagulation button and
the electric blade 16 coagulates; of course, he has to wipe out or
clean the blood as explained before. Thus, the process is one of
alternating operations of cutting and coagulation by the same blade
16 which differs only by pressing on different buttons; each button
releases current which results in the respective operation, namely
either suction or coagulation.
Now, both operations, suction and/or coagulation contribute
ash that clings to the blade 16 as explained before. Cleaning the
blade 16 constitutes a break and/or deviation from the "natural"
course of the operation, namely, cutting and coagulation and thus
consumes time and interferes with the practicability of the
procedure.
In this embodiment, the mode of operation of the
electrosurgical blade is as described for Figures 1, 2A and 2B.
However, for its blade cleaning facet, the mode of operation is as
follows: the surgeon by his index finger pushes the lever 72 about
one (1) cm in the direction of arrow 78. This results in a
movement of l cm of -the strip 68, of which lever 72 is an integral
part. The movement of the strip 68 in the direction of arrow 78
~forward) pushes the tube 64 with its sharp leading edge 66 in the
same direction (arrow 60), namely forward. The moving sharp edge
66 which lies intimately on the blade 16 shaves the debris from the
tip of the blade 16 that was in touch with the burnt tissue and on
which the ash accumulated; the ash accumulates only on the part
that touches the cut tissue.
In other words, a small movement, e.g. about 1 cm, causes
the leading edge 66 to pass over the tip of blade 16, shaving and
205602ll
24
pushing the debris off the blade 16, where the debris "meets" the
suction area provided by tube 10. In other words, the negative
pressure in the ellipsoid orifice 21 area of tube 10 sucks the
debris (like a vacuum cleaner) in the direction towards tube 12 and
prevents it from falling on the surgical field. Simultaneously,
the pushing of the lever 72 causes compression of the spring 58 in
the direction of arrow 60. Thus, the spring 58 is squeezed between
ring 62 and the holding points 56 on the blade 16, which results
in increasing the stored energy of the spring providing a
retrieving mechanism.
Now, when the-surgeon releases his index fingertip from the
lever 72, the spring 58 pushes the whole device 53 with the
cleaning tube 64 backwards to the resting position. This releases
the tip of the blade 16 that was covered by tube 64 when the spring
58 was compressed when cleaning device 53 is in the active
position) and now the tip is clean and ready for action again.
The great advantage of this arrangement is that the easy
operation fingertip movement should encourage the surgeon to clean
the edge more frequently than he does. He does not have to make
a break in the flow of the procedure. Thus the blade 16 is kept
constantly at its optimal quality of no debris, no increased
resistance to the flow of the electric current. This will have a
significant contribution to the fluency of the surgical procedure.
The operation of cutting and coagulation and removal of ash
is the same as previously described for Figures 1, 2A and 2B.
However, for the additional feature of flushing, the mode of
operation is as follows: the flushing fluid is constantly flowing
in the direction of arrow 94 in tube 88; due to the hydrostatic
pressure, and flows into tube 10 through the connector nozzle 90.
The fluid spreads inside tube 10, and since there is a constant
suction area in tube 10, it is immediately sucked in the direction
of arrow 96, flushing the wall of the tube 10 from blood or debris.
The flushing fluid cannot leak either through the ellipsoidal
orifice 21 or through the slight gap that exists in slot 22 in the
2 ~ 2 ~
rear. This is due to the existence of air movement towards the
tube 10 at both areas ~arrows 98 and 100~ that is caused by the
constant negative pressure inside tube 10. It is clear that
connector 90 can be placed in any point along tube 10 or 12.
The operation of cutting and coagulation and removing of smoke
is the same as previously described for Figures 1, 2A and 2B.
However, the additional mode of operation with this instrument is
as follows: First the electric unit 126 is inserted into the
depression 106, the cord 20 is inserted in the groove 120 of tube
104, then the blade 16 is inserted through the orifice 21 and
through the hole 112 in plate 109 to the "blade grasper" at point
128, which is part of the electric unit 126. The on/off knob is
on the right side of the instrument and is activated by the index
finger of the hand which grasps the instrument like a pencil.
The operation of this embodiment is the same as for the
embodiments of Figures 1, 2~, 2B and 4A. However, in this
embodiment it will be appreciated that when in use as described
above, suction is available at the tip of the instrument to remove
smoke, blood and ash. The suction tube is cleaned by fluid drawn
in from the fluid supply tube 213. The surgeon also has fingertip
control of the blade cleaning element so that cutting and
cauterizing can continue without delays previously encountered in
such surgical procedures.
The cutting and/or coagulation, with laser-generated heat
during surgical procedures creates ash from the burnt tissue in
the line of the cut or from points that are coagulated. Part of
this ash evaporates as smoke, and another part sticks to the tissue
that is being cut.
In operation, once the laser generator is actuated, the laser
beam is formed. The beam passes through the hollow forward portion
of the instrument and passes out through the oblique fron-t face.
It is preferred that the forward portion be formed of a transparent
n~aterial. The laser beam performs the cutting operation, and the
suction which surrounds it removes the smoke.
2 ~ 2 ~
26
In this embodiment, there is, of course, no need to include
the blade~scraping feature.
In conclusion, the four parts of the disclosure describe
different aspects of a major surgical instrument: the
electrocutting-coagulation apparatus. Note that many combinations
are possible in constructing the instrument, and these include:
(a) Electrocutting-coagulation-suction apparatus.
(b) Electrocutting-coagulation with built-in cleaning
mechanism.
(c) Combination of the electrocutting-coagulation-suction
apparatus with a built-in cleaning mechanism.
(d) A laser cutting-coagulation-cutting apparatus with or
without a flushng system.
(e) The combination that includes all the above options
namely: electrocutting-coagulation-suction apparatus with a built-
in cleaning system for electric blade and built-in flushing system
for suction tube.
It is important to note that this device has a primary
function to cut and coagulate. The secondary actions of the
suction, flushing and cleaning of the blade are only to assist or
to clear the way for the fluent execution of the main function,
namely cutting and coagulation and this whole combination as such
constitutes a new original concept of the mode of operating the
cutting-coagulation apparatus in surgical procedures.
