US2107057A - Surgical apparatus - Google Patents

Description

' Feb. 1, 1938.

J. G. H. LIEBEL ET AL SURGICAL APPARATUS Filed April 5, 1933 2 Shets-Sheet 1 F" D a INT/E TO Wit/451 4 ATTORN EYS Patented Feb. 1, 1938 UNITED STATES PATENT OFFICE SURGICAL APPARATUS tion of Ohio Application April 5, 1933, Serial No. 664,574 I 9 Claim.

This invention relates to electro-surglcal instruments of the general type disclosed in Liebel the ileld'of usage for which they were intended,

still there is a substantial demand for a type of instrument of extreme simplicity from the point of view of the technique of operation, yet sacrificing nothing in the quality of its modalities, and which provides all of the different types of electrical current which have been found suitable for surgical or therapeutic purposes.

One of the types of current, which the instrument of this invention is adapted to provide, is a surgical or cutting current possessed of dehydratingproperties found as a result of years of experience to be suitable for providing hemostasis under normal conditions in operations of the gen- 0 eral type for which electro-surgery has been found to be particularly eflicacious. At the present time, the removal of cancerous tissue, intracranial tumors, both malignant and benign, and the transurethral removal of prostatic tissue, bladder tumors, etc, are examples of surgical operations in which electrical cutting is frequently used.

The surgical apparatus of this invention likewise provides coagulating current adapted to stop the flow of blood when particularly vascular tissue is dissected or when blood vessels or small arteries are encountered.

A third type of current, not usually employed in surgical operations but which has been found very useful for general therapeutic purposes, is the so-called diathermie current, the purpose of which is to generate heat within the tissues themselves either as a result of the passage of the current or inductively The surgical apparatus of this invention likewise provides such a type of current. g

At the present time, the type of diathermy treatment most' usually administered is that wherein electrodes are fastened directly to the patient.

On this account the description and drawings disclose circuits adaptedto provide a type of current suitable for this treatment. These circuits, however, may be altered to provide the type of current used in diathermy treatment inwhich the electrodes are insulated, from the patient and the heating effect secured by placing the patient in the high frequency electrostatic field.

The invention herein disclosed may be looked at from either one of two rather different points of view. It can be looked at from the point of view of the electrical engineer or from the point of view of the surgeon. By and large the invention may be said to reside in selecting of instrumentalities from the electrical art and. arranging them to solve the problems of the wholly unrelated surgical art.

In the accompanying drawings, Sheet 1 discloses the invention from the point of view of the surgeon; that is, discloses the adjustments and other-elements'with whlch the surgeon deals in performing the operation. Sheet 2, on the other hand, discloses the combination-of electrical elements which provide the surgeon with the operative resources, found by these inventors, to be the most useful to the average surgeon in pertioned. v

The major problem to be solved as a part of this invention was the, determination of the requirements of the surgeon who is performing an operate a multitude of adjustments selectively and with good effect during a surgical operation. It has been the effort of the inventors in designing the present apparatus to do away with all adjustments which were not useful to the surgeon during an operation and to build into the machine the capacity to supply the surgeon with the types of current and the ranges of current determined by the inventors to be most useful to the surgeon on the, basis of years of observation of thousands of actual operations.

Therefore, one object of the invention is to provide a surgical apparatus of the. nature disclosed, wherein the mechanism accessible to the surgeon or to be used by the surgeon during the operation I is extremely simple yet provides the surgeon with all of the modalities of current and the prompt selection of power requisite for performing surgical operations with the-apparatus.

above specified.

Still another object of the invention is to provide an arrangement of the electrical instrumentalities of the simplest possible nature consistent with the complexity of the functiomthe arrangement characterized by'the utilization of the greatest possible number of electrical instruiorming operations of the general type menmentalities as common elements in the different circuits providing the different modalities of current.

Other objects and further advantages will be more fully apparent from a description of the accompanying drawings.

In the accompanying drawings, Figure 1 is a perspective view of the control cabinet.

Figure 2 is a top plan view of the cabinet.

Figure 3 is a wiring diagram of the circuits and devices employed in the-control cabinet.

Noting Figure 1, it will be observed that the surgical apparatus of this invention is provided with one set-up adjustment and three operating adjustment devices, the former being the spark gap setting it, the latter being one current selector ii and two power adjusters l2, l3.

The current selector may be moved to any one. of four diiferent positions, these being the off position, diathermy position, coagulation position, and scalpel or cutting position.

One of the power adjustments is for the scalpel or diathermy current and the other for the co agulation current. The point of this double power control is that in performing an operation, it is frequently necessary for the surgeon to shift rapidly back and forth between scalpel and coagulation positions. The scalpel current is usually used in one power range and the coagulation current in a different power range. If therewere but one power control, then it would be necessary for the operator of the machine, during the operation, to readjust the power every time a shift was made from scalpel to coagulation or vice versa. With the two different power control devices, one may be set in the range appropriate for cutting and the other in the deal of time is saved during the course of an operation. In many of these operations, especially so in neuro-surgery and prostatic resection, time is an extremely important factor, often determining the success or failure of the operation.

Another feature of the invention is that the off position of the selector (see Figures 2 and 3) is disposed between the coagulation and dis-- thermic positions so that there is little likelihood of the operator of the machine moving it to a diathermic position by accident during the progress of the operation.

Connected to the selector is a device (not shown) which tends to lock it or hold it in one of the four desired positions so that it cannot be brushed accidentally to an undesired position during the course of an operation. It is also to be noted that the handles l5 on the selector and the two power controls are detachable so that they may be sterilized before an operation, thereby permitting the surgeon himself to operate the device if necessary.

As disclosed there arev four lead wires from the'apparatus, one, namely l6, being adapted to be attached to the indifferent elect ode, the other three, namely ll, being attached to active or operating electrodes. Attached to the apparatus cabinet is a removable electrode holder so that the electrodes and their holder can be sterilized before an operation and the surgeon remove any desired electrode from the holder without contaminating his fingers. Of course, it is to be recognized that different types of electrodes are used,

such as loops, wires, stylus electrodes, etc. Therefore, the surgeon's instrument, as a whole, is

designed so that the surgeon can perform the entire operation single-handed if necessary, with no chance of infection and with a small number of adjustments readily understood and accessible, so that the surgeon's entire attention may be free from pre-occupation with the electrical problems and be concentrated entirely on the surgical problems.

The essential parts of this apparatus which is designed to produce cutting, coagulation, and diathermy current of satisfactory amounts of power and proper quality of each of these modalities, consist of a main transformer II which is in operation on cutting, coagulation and diathermy. An iron core inductance 19, which has two steps of inductance, is in the primary circuits of this transformer and is used for coagulation and diathermy respectively. The primary of the main transformer is designed for 110 to 120 volts or other supply line voltage available and the output is wound for 1400 volts. The output of the secondary of this transformer which is of the leakage type is connected to the spark gap in which is of special design allowing for compensated micro-metric adjustment and of the type disclosed in the Flarsheim Patent No. 1,696,157 granted December 18, 1928.

The spark gap is utilized on all three of the settings of scalpel, coagulation and diathermy. In addition there are three primary oscillating circuit condensers 22, 2|, 20, which are used respectively on the three current modalites, and a. specially designed resonator inductance 23 which is wound on two tubes, one inside of the other and which has various taps for primary and secondary, a different combination of which is used for each of the current modalities. In addition to the above, there is a potentiometer 24 which is used for controlling the output of the machine and also for selection of the two power controls, one of which controls the output for scalpel and diathermy and the other of which controls the output for coagulation. This particular arrangement is used to allow for immediate and instant change from scalpel to coagula- Now, the change between the electrical selection of the above parts is accomplished through a specially designed five pole, four throw (three operating positions and an off position) selector switch. A I

In addition to selecting the proper primary and secondary electrical connections this selector switch is arranged so that on the scalpel and coagulation positions the foot switch I4 is operative, whereas on the diathermy setting the foot switch is notoperative and the machine starts to function as soon as the selector switch is turned to the diathermy setting.

First we will consider the arrangement and connection of parts as used for the scalpel or cutting modality. The scalpel current must be of comparatively undamped characteristics approaching somewhat near a continuous wave current and to obtain this condition the connections made by the selector switch are as follows:

Current is fed directly from the input, indicated at 25, through a lead 28 to pole No. 2 through the scalpel contact 21, thence by way of lead 2! directly to the primary ll of the main transformer. The circuit to the primary of the transformer i completed through lead 12, foot (l 7 when there was no primary inductance interposed switch ll, scalpel contact 33 of pole No. 1, then through lead II of the input.

extends to pole No. 3 through the scalpel contact 32, thence by lead 33 through the .001'75 micro-'- i'arad oscillating circuit condenser 22 to the 15 turn tap of the resonator inductance 23. From the start or zero turn of the resonator inductance 23, indicated at 34, the circuit leads back to the other side of the spark gap through a lead 35.

One end of the potentiometer coil 24 is connected to the zero turn tap of the resonator inductance coil through alead 53. This combination of a very small capacity and a moderately large inductance is necessary to produce the slightly damped current in combination with a full and sustained output from the main transformer.

The output of the resonator inductance coil is taken from the zero tap indicated at 34 and from the 30% turn tap as at 36 from which it is led to the potentiometer through a lead 31 extending to the scalpel contact 38 of pole No. 4 and from pole No. 4 through a lead 38 to the potentiometer.

The selector switch also selects the proper power control for the output which is marked on the drawings Scalpel and diathermy". This is done through pole No. 5 by way of power control slider I3, lead 40, scalpel contact 4|, switch arm, and output lead 32 to the lead wires l1.

In the output lead 42, a meter 13 and a filter H are inserted. The purpose of the filter is to tune for the high frequency current and to block any low frequency current flow to the patient. It willalso be noted that grounding condensers I3 and 13 are placed in leads 30 and 3! extending, respectively, between the secondary and primary of the transformer and between the core of the transformer and the primary thereof. These are low capacity condensers and are designed for bypassing high frequency currents. v

Now, in considering the connections for coagulation, it will be noted that the requirements for coagulation current are quite opposite from that of the scalpel or cutting current in that a current of very much greater damping is required in order that the proper coagulation effect be secured and so that the current will be essentially free from cutting action. For this modality the connections are as follows: Current is fed to the primary of the main transformer through the lead 28, through pole No. 2 to coagulation contact 33, then through lead 44. through the 875 turns or-total winding of the choke coil l3, then to the transformer primary through lead 29. The circuit to the primary of the transformer is completed through lead 12, foot switch i4, coagulation contact 69 of pole No. 1, then through lead H of the input.

The passage of current through the total winding of the choke cell has the effect of reducing the voltage on the primary of the main transformer and of also reducing its ability to deliver power to the secondary circuit. In other words. it prolongs its time of recovery so that it cannot followone current impulse to the secondary quickly with a succeeding one as was the case in the circuit. Under these conditions the transformer draws approximately six amperes primary current when the machine is operating instead of thirteen amperes primary current as was the case when the transformer was connected for the scalpel current.

The secondary 48 of the transformer when used for coagulation is invconnection across the spark gap ill the same as before, but one side of the gap is now connected through lead 3!, pole No. 3, coagulation contact 41, lead 43, through the coagulating condenser 2| which is of .032 microfarad capacity. This it will be noted is a capacity of more than fifteen times that used for the scalpel oscillating circuit condenser and this greater capacity will necessarily be charged at a much slower rate by the maintransformer secondary especially because of the fact that the choke coil in the primary tends to reduce the regulation of the transformer 'as described above. 7

From this condenser the circuit passes through a lead 43 to the three turn tap of the resonator inductance coil and from the zero turn tap 34 of the resonator inductance coil the circuit is connected to the other side of the spark gap through lead 35. The output for this condition is taken from the 24 turn tap SI of the resonator inductance coil from which it passes through lead 52 to the coagulation contact 53 of pole No. 4 through lead 33 to one end of the .potentiometer coil. The other end of the potentiometer coil 24 is connected to the zero turn tap of the resonator inductance coil as before through a lead 83.

The output of the machine as controlled through pole No. 5 for coagulation is selected by the switch through coagulation contact 31, lead 58 and the coagulation power control slider l2. Inasmuch as a very large oscillating circuit condenser is used, a much higher damping is secured in the output current. The greater ratio between the'primary and secondaryresonator inductance coil turns still further reduces the regulation and this is also necessary in order to develop the proper voltage on the output.

'Now for the diathermy current, the primary of the main transformer current is supplied through lead 26 to pole No. 2, through diathermy contact 53, lead 80, through 325 turns of the choke coil l3, and thence to the primary of the transformer l3 through lead 29. Passing the current through 325 turns of the choke coil reduces the primary current to 6 amperes as compared to 13 amperes on the scalpel and 6 amperes on the coagulation. The circuit to the primary of the transformer is completed through lead 15, diathermy contact 10 of pole No. 1 and lead ll of the input.

The secondary output from the transformer is now led to the spark gap as in the previous two cases but from one side of the spark gap the circuit is delivered through lead 3| to pole No. 3, thence through diathermy contact 8i, lead 32 and through the diathermy condenser 23 which is of .0075 micro-farad capacity and thence to the third turn 60 of the resonator inductance through a lead 63 as was the case in the coagulation circuit.

The capacity of the diathermy condenser is in between the scalpel condenser and the coagulation condenser and provides a current which is of a damping somewhere in between the coagulation and the scalpel circuits. The zero turn 34 of the resonator inductance is again connected to the other side of the spark gap through lead 35. The output of the resonator inductance is connected to the 15 turn tap 64 and extends to the diathermy contact 65 through a lead 66 The correctness of the function of all of the alcove factors is determined by the exact electrical characteristics of all of the parts used. in order to obtain a satisfactory output on all of the three modalities of scalpel, coagulation diathermy, the electrical parts must he so proportioned as to operate not only when the circuit is arranged for that particular modality used, but in order to have the machine reasononly simpie, since as many parts are used for the circuits in common as is practical. For example, the exact design of the resonator inductance coilthe number of turns used on both the outer and inner tubes and the exact position of tapping these turns oil, is absolutely necessary to get proper operation.

The ease of control with which this machine can he used by the operator depends upon the quick and easy selection of the current desired, the exactness and range of control and the quallty of the currents produced.

A pilot light it burns at all times except when the switch is in oiI-position, and to accomplish this the light is placed in a lead 14 extending between pole No. l and one end of the choke coil it: since the choke coil is connected to the other side of the input through any of the contacts of pole No. 2.

Having described our invention, we claim:

1. An electro-surgical apparatus, comprising, a transformer adapted to provide current of appropriate power for performing surgical operations, and a spark gap connected to the secondary of the transformer to provide a high freuency current, a capacity and inductance inc rpcrable in said secondary circuit to provide a cutting current, a capacity and inductance in corporable in said circuit to provide a coagulating current, two power control devices, one functionally operative for controlling the power of the cutting current, the other functionallyv operative for controlling the power of the coagulating current, and means for switching from one type of current and one power control device to the other type of current and other power control device.

.2. An electro-surgical instrument, comprising, a transformer adapted to provide current of appropriate power for performing surgicaloper- I ations, and a spark gap connected to the secof the coagulating current, and means for switching from one type of current, the power of which is controlled by one of said power control handles, to the other type of current, the power of which is controlled by the other of said power control handles.

3. In a surgeons instrument of the type described, means ior generating a high frequency electrical current, and means for modifying the power and dampingof said current to provide a cutting current, a coagulating current, and a diathermy current, and a switch adapted to incorporate said modifying means into circuit so that at one position of the switch the instrument delivers a cutting current, at another position of the switch the instrument delivers a coagulating current, and at another position of the switch the instrument delivers a diathermy current, and two power control handles, one adapted to adjust the power of the cutting or the diathermy current, the other adapted to adjust the power of the coagulating current.

4. An electro-surgical apparatus, comprising, a transformer adapted to provide current of appropriate power for performing surgical. opera tions, a choke coil inserted in the connections to the primary of the transformer, a spark gap con nected with the secondary of the transformer to provide a high frequency current, a capacity and inductance incorporable in said secondary clrcult to provide a cutting current, a capacity and inductance incorporable in said circuit to provide a coagulating current, a potentiometer for controlling the power output of the machine for either type of current, and a plurality of selector switches comprising switches operable by a common control element and other switches individually operable, the operation of switches of both theah-ove described characteristics serving for establishing the proper connections for the voltage delivered to the transformer and at the same time controlling the selection of the proper capacity and inductance as well as the power output through the potentiometer.

5. An electro-surgical apparatus, comprising, a transformer adapted to provide c' rent or ap- .propriate power for performing surgical opera tions, a spark gap connected to thesecondary of the transformer to provide a high frequency current, a condenser and an inductance coil lncorporated in said secondary circuit to provide a cutting current, a condenser having a capacity of more than fifteen times that of the first mentioned condenser and an inductance incorporated in said circuit to provide a coagulating current, a selector switch, and,power control devices for controlling the respective types or current, said switch including contacts controlled thereby, whereby the operator can shift between the types of current without changing the settings the power control devices.

6. An electrc-surgical apparatus, comprising, a transformer adapted to provide current of appropriate power for performing surgical operations, a voltage control device inserted in the circuit to the primary of the transformer, a spark gap connected with the secondary of the transformer to provide a high frequency current, capacities and inductances incorporable respectively in said secondary circuit to provide a. cutting current and coagulating current as desirable, a device for controlling the power output of the machine for either type of current, and a plurality of switches, comprising, switches operable by a common control element and other switches individually operable, the operation of the switches of both the abovedescribed characteristics serving for coincidentally establishing the circuits for. either type of current in the proper ratio of voltage, capacity, inductance and power output.

'7. An electro-surgical instrument comprising a transformer adapted to provide current of appropriate power for performing surgical and diathermy operations, a spark gap connected to the secondary of the transformer to provide a high frequency current, capacities and inductances incorporable into said secondary current to provide cutting, current, a potentiometer for controlling the power output of the machine for either type of current, and a plurality of switches, comprising, switches operable by a common control element and other switches individually operable, the operation of the switches of both the above described characteristics serving for establishing the proper connections for the voltagedelivered to the transformer and at the same time controlling the selection of the proper capacities and inductances as well as the power output through the potentiometer.

8. In a surgeon's instrument of the type described, means for generating a high frequency electrical current and means for modifying the power and damping of said current to provide a cutting current, a coagulating current and a diathermy current, and a switch adapted to incorporate said modifying means into said circuit so that at one position of the switch the instrument delivers a cutting current, at another posicoagulating or diathermy v tion'of the switch the instrument delivers a coagulating current, at another position of the switch the instrument delivers a diathermy current, and at a fourth position of the switch the instrument delivers no current, said latter position being disposed for traversal by the switch in passing from the diathermy current position to the coagulating current position.

9. An electro-surgical instrument, comprising, means for generating a high frequency electrical current which includes a transformer adapted to provide current of appropriate power for surgical and therapeutic operation, and a spark gap connected with the secondary of said transformer to provide a high frequency current, and means for modifying the power and. damping the current furnished by said spark gap and said transformer to provide a cutting current, a coagulating current and a diathermy current, said means including a switch adapted to incorporate said modifying means into the circuit so that at one position of the switch the instrument delivers a cutting current, at another position of the switch the instrument delivers a coagulating current and at another position of the switch the instrument delivers a diathermy current, and a device for controlling the power output of the machine for cutting or coagulating current, said device controlled by a handle for adjusting the power oi? the coagulating current and said device controlled by a second handle for adjusting the power of the cutting current. l

JOHN G. H. LIEBEL. EDWIN S. FLARSHEDK.

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