US 2891250 A
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` YAsUHlRo HIRATA 2,891,250
BRoNcHus SEAMING INSTRUMENT June 23, 1959 2 Sheets-Sheet 1 Filed Oct. l0, 1957 a u w Y., Hmm f/ INVENTUE June 23,` 1959 YAsuHxRo HIRATA 2,891,250
i BRoNcHus SEAMING INSTRUMENT Filedct. 10,. 1957 i 2 Sheets-Sheet E mvENmR Y H l-RAT-A BRONCHUS` SEAMING INSTRUMENT Yasuhiro Hirata, Nishiku, Osaka, Japan Application October 10, 1957, Serial No. 689,378`
Claims priority,.application Japan October 15,1956
4` Claims. (Cl. 1-50) This invention relates to bronchus seaming and aims generally to improve the same. In particular the invention-aims to provide an improved instrument for effecting bronchial tube seaming, for example, after excision of a .diseased portion of` a lung, without cracking or mashing of the cartilaginous structure of the bronchus.
In recent years, surgical removal of diseased portions ofthe lungshas become an` established surgical treatment. For this purpose, an incis-ion is made in the chest, opening a small hole, the bronchi in the diseased (eg.
tubercular) portion of the lung are dismembered and.- the diseased portion is excised. The dismembered bronchi are then required to be seamed tightly. Prior to` the present invention the practice has been for the surgeon to sew the bronchus ends with silk or nylon threads. This technique is very diflicult, especially where the chest opening issmall, and is dangerous whenworking near` the heart,` but has been adopted because no means has been available adaptable for successful stapling of the cartilaginous bronchus through the small chest opening.
By the present inventionhowever, an instrument is provided which is particularly, though not exclusively, adapted for this purpose, which in its preferred embodiments aiords maximum visibility while the internal body element (e.g. severedV bronchus) is being engaged and stapled by the instrument, which affords easy control, of the degree of pressure exerted on the body element to holdA it in position for stapling, which can quickly and simultaneously set a plurality of'staples through the body element with ample staple clinching pressure which clinching pressure, however, is not exerted against the bodyl element itself, which is readily released and removed after effecting `theseamingt operation, and whichis simple and effective in` construction `and readily adapted for sterilization.
In the accompanying.` drawings offillustrative embodiments of the invention:
Fig. 1 is a front elevation of single row embodiment of bronchus seaming instrument;
Figs. 2 and 3 are right and left side-.elevationsthereof, and f Fig. 4 is a section taken on the line A-A of Fig. 1;
Fig. 5 is a View similar to Fig. 4, of a modification lfor setting a double row of staples;
Figs. 6 and 7 are enlarged details of the working end of Fig. l, illustrating the Working conditions of the instrument;
Fig. 8 is a front elevation of a staple applicable by this instrument; and
Fig. 9 is a sectional View of the seamed bronchus.
Referring to Figs. 1 4, 6 and 7, the instrument therein shown comprises three juxtaposed and relatively movable L-shaped slide members, namely, a first slide member 10, a second slide member 20 and a third slide member 30.
First and second pressure jaws 13 and 25 are carried by the ii-rst and second slide members and 20 and extend at right angles thereto. Means is provided for longitudinally adjusting the relative positions of the rst and United States Patent 1M 2,`8 9 1,25 o Patented t J une 23, 1959 lCC second slidemembers 10 and 20 to move said jaws 13 and 25 for pressing therebetween a bodyV elementB (Figs. 6, 7 andAS), e.g. the severed end `of a bronchus after dismemberment thereof incidentto the excision of tubercular lung tissue. This adjusting means in the form shown comprises finger grips 12 mounted on theV iirst slide member at the side thereof oppositefrom the jaws 13, 25, and a cooperating means in the form of -a padl22 at the end of the second slide means 20 engageable by the thumb of an operators hand Iwhile his iingersare engaged with the finger grip means. By this means the slides 10 and20 may be relatively moved, from a position quite well removed from 4the jaws 13 and 24, to ladjust the said jaws for compressing and holding the body part B without exerting excessive pressure, such as could crack or smash the cartilaginous structure of the bronchus, for example.
The means for adjusting the relative positions of the first and second slides 10 and 20, in the form shown, also comprises a ratchet rack 40 carried by a spring 41 mounted on the rst slide 10 atthe `side thereof opposite to the jaws 13, 25. The teeth of the ratchet rack engage a ratchet detent 23 carried by the second slide 20. Thus, on advance of the second slide 20 by pressure of the thumb on the pad 22, the ratchet detent passes one tooth at a timeof the ratchet rack and is 4retained thereby from retrograde movement when the desired compression has been effected by the jaws 13, 25, until the ratchet rack is lifted to release the instrument for removal from the bodyl part.` t
To supplement the touch of the surgeon in determining when the proper degree of` compression of the body part B has beenattained, the instrument in the form shown further comprises an indicator scale 11 carried `on the sideof the slide 10 proximate to said finger grip means 12, and an indicator pointer 21, carried by the second slide 20 in position to indicate on the scale the spacing of the jaws .13, 25.
Referring more particularly to Figs. 4, 6 and 7 in the formshown the second jaw 25 has therein means in the form of rectangular slots 26 for guiding staplesH (Figs. 6, 7 and 8) toward the tixed jaw 13; and the first jaw 13 has therein point turning means in the form of arcuate guideways 14 positioned to receive and turn the points of staples driven thereagainst from the staple guideways 26.
In the formcf Figs. 5, 6 and 7, the arrangement is` similar except that the jaw 25 carries two rows of staple guides 26 and the jaw 13 has two cooperating rows of point turningelements 14. v
The driving of the staples, after the jaws have beenY closedontthe bodypartB, as shown in Fig. 6, isleifected by` the-third slide means 30, which is juxtaposed against the second slide 20, and which has afoot 32 extending atright-anglesto the leg of the slide, under which are` located a `plurality of staple `driving plungers 33 entering` the staple guide slots 26, and which are advancedzto drive `the staples by motion of the slide 30 relative to the slide 2Q, as will be evident by comparing the positions of the parts before and after driving of the staples, illustrated in Figs. 6 and 7.
Adjustable means is provided for advancing the third slide 30 along the second slide 20 to effect driving and clenching of the staples H, which in the form shown comprises an adjusting screw 50 lying parallel to the first, second, and third slides Where it offers minimum interference with a full view of the jaws 13 and 25 and the body p'art B being stapled. This screw 50* is suitably associated with the slides 20 and `30; in the form shown, its tip is rotatably mounted in and abuts the end of the third slide 30, at 31, and is threaded through a portion 24 of the second slide 20. The screw 50 carries an oper the slides 20 and 30, respectively, as shown. This modev of assembly establishes and limits the relative sliding motion of the parts, which motion is further guided by any suitable cooperating means such as the guide ears b shown extending from slide 10 and embracing thesides of slides and 30.
In operating the instrument, the hooks or staples H, preferably of silver or tantalum steel, are inserted in the staple guides 26 with their points directed toward the jaw 13 as shown in Fig. 6. It will be seen from Figs. 1-3 that the screw 50 is of a length which enables the slide 30 and plunger 33 to be withdrawn so that the staples H may be inserted into the guides 26 point rst from above, ir' desired, and also that this provision for withdrawal of the plunger 33 from the guides 26 facilitates sterilization of the instrument.
For applying the instrument to the body part-B it is grasped by the finger grips 12 with the thumb of the same hand resting on the pad 22. The body part B isthen inserted between the jaws 13, and with thumb pressure on pad 22 the slide 20 (fand 30 therewith) is moved to close the jaws until the severed body part, e.g. the bronchus end B, is closed with a gentle pressure, as indicated by the known position of the indicator 11, 21 or as observed by the surgeon, which observation is facili- -tated by the fact that the jaws 13, 25 and 32 are all in one narrow plane and offset laterally from the main body of the instrument.
The knob 51 being then rotated gently, drives forwardly the hooks or staples H to the position shown in Fig.v 6, and thereafter advances them through the body part B into clenching engagement with the point turning elements 14 in the jaw 13. It will be observed, however, that the clenching force is exerted between the slide and, the slide 10, slide 20 actually being drawn back' tightly against the ratchet rack 4,0 during this operation. Thus the considerable clenching force is exerted only on the staple and no further compressing force is applied to the body part B by the jaws 25 and 13. When the staples have1 been clenched to a degree corresponding with the thicknessl of the part B (which may be determined in 'anyr suitable way, as by observing the number of turns given to the knob 51 after resistance is encountered when the staple tips touch the jaw 13, or by observing the clenching-of an extra staple outside this area being seamed as shown in Fig. 7) the instrument is ready for removal.
The removal is quickly and easily etected merely by releasing the ratchet rack 40 from the ratchetdetent 23 (the screw 50 preferably being backed olf slightly to facilitate this operation). The slides 20 and 30 may then be drawn back to free the body part B from the jaws, care being `taken to remove any staple which may have been clenched other than those which are clenched in the body part B.
y, moving said second slide and detent lengthwise of said ratchet rack.
As shown by X-ray observation, the employment of this new instrument for closing severed bronchi produces less interference with good blood circulation and more rapid healing and convalescence of the patient than the much more difficult and dangerous suturing with needle and thread heretofore employed in such operations.
1. A surgical instrument of the class describedcomprising juxtaposedv rst and second relatively movable slides, first and second pressure jaws extending atright angles from said first and second slides respectively, means for longitudinally adjusting the Arelative positions of said first and second slides to move said jaws for pressing therebetween a body element to be stapled and for latching said iirst and second slides in adjusted position, said second jaw having means therein for guiding staples toward said rst jaw, said first jaw having therein point-turning means positioned to receive and tum the pointsV of staples guided thereagainst by said staple guiding means, a'third slide juxtaposed adjacent Ysaid second slide and adjustably mounted for movement longitudinally of said second slide, said third slide Lhaving a foot extending at right angles thereto and having plungers underlying said foot and entering said staple guiding means for driving said staples as said third vslidey is advanced along said second slide, and
adjustable'means for second slide.
' 2. A surgical instrument according to 'claim l, said adjustable means comprising an' adjusting screw lying parallel to `the juxtaposed rst, second, and third slides,
advancing said third slide along said abutting said third slide, and threaded through a portion v of said second slide.
3. A surgical instrument according to claim l', said means for longitudinally'adjusting the relative positions v of said first and second slides and for latching said rst and secondV slides -in adjusted position comprising fingerl grip means and a spring pressed ratchet rack carried by said Vfirst slide at the side thereof opposite from said jaws, a ratchet detent engaging with said ratchet rack and carried by said second slide, and means at the end of said second slide engageable by the thumb of an operators hand when his ngers are engaged with said finger grip means for 4.` A surgical instrument according to claim 3 further comprising an indicator scale on the side of said rst slide, 'proximate to said finger grip means, and a pointer carried by said second slide and movable on said scale v'for indicating the gap established between said jaws.
ReferencesCitedin the tile of this patent j UNITED STATES PATENTS