US 2012363 A
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Aug. 27, 1 935. RYVOGEL SURGICAL DEVICE Filed July 29, 1935 2 Sheets-Sheet l Aug. 27, 1935. R. VOGEL SURGICAL DEVICE Filed July 29, 1933 2 Sheets-Sheet 2 A964 M v/farzzey Patented Aug. 27, 1935 UNITED STATES PATNT orrics Application Julyza 1933, Serial No. 682,824
. InGermany August 1, 1932 4 Claims.
impossible with entire certainty. According to the most commonly practised method sutures were laid tangentially in the wall of the closed hollow body, either after the fashion of a so called tobacco pouch seam or after the fashion of the well known artificial oblique fistula, called Witzel-fistula. Then the wall was perforated and the tube or the like serving to discharge the contents was instantly introduced into the cavity,
' and the seam drawn togetheras rapidly as possible. Thereby the stitches were submerged and covered over.
The main drawbacks and dangers of this method are as follows:
In thegreat majority of cases it is not possible to lay a tangential suture successfully in the usually extremely thin, tightly stretched and. decayed wall of the hollow organ in such away that the infectious contents cannot pass through microscopically small openings or, in consequence of the loosening of the seam, from the intestine into the surrounding region.
Infection of the surrounding region is brought about generally by reason that onperforating the wall some of the infectious contents squirt out of the, organ in question, even when the seams are hurriedly drawn together. Particularly with high pressure caused by penned-up gases or liquids, germs are squirted Iout ingreater or less number, so thatinfection of the region surrounding the organ to be opened cannot be avoidedwith certainty. i
These drawbacks are overcome by the device according to the invention'which renders it possible to open the cavities entirely aseptically with great certainty without affecting the surrounding region. With the invention a restricted part of the wall of the organ to be opened can be sucked air-tightly under vacuum, whereupon the opening is formed in that part of the wall .whichis under suction and the infectiouscontentstare sucked away under vacuum under the protection ofthe vacuum-tight fit or closure.
cording to the invention, is so constructed that a tubular or hose-shaped hollow body receiving the opening instrument, preferably adjustable, and connected to a vacuum device is so formed at one end that, on applying the hollow body to the part of the wall to be treated before opem'ng the 5 organ in question, due to the vacuum there is effected at this point a vacuum-tight fit under the protection of which the wall is opened with the instrument and the infectious contents of the 10 organ are led away through the hollow body.
Preferably the instrument, formed, for example, as a high frequency electrode is resiliently held or guided in the hollow body. a
In connection with suction discharge devices, that is, devices which with the use of a pump or the like and asuction cup or the like suck away whatever contents there may be from organs of the body, it is known to provide a vacuum-tight fit at the edge of the suction cup. In such cases, however, there is no occasion for first forming an opening in the wall of the organ in question, but rather there is already an opening in such organ over which the suction cup or the like is laced. Further, there are already known devices (suction syringes) in which a piercer or trochar is guided in a suction body (hollow needle).
With none of the known devices is it possible to open a wall in an organ of the body under the protection of a suction-tight fit and then to lead away infectious contents without affecting the surrounding region.
In the accompanying drawings there are illustrated by way of example embodiments of the invention.
Fig. 1 shows diagrammatically the complete device.
, Fig. 2 shows in section the main part of the device consisting of the suction tube and the electrode with the holder and supply wire.
Fig.3 is a section through the lower end of the suction tube on the line 33 of Fig. 2. t Fig. 4 shows a modified construction of the device in longitudinal section.
Fig. 5 shows the device in Fig. 4 turned through 90? in a different longitudinal section.
, Fig. 6 is an end view of the mouthpiece of this construction to be placed on the. wall of the organ.
Referring to Figs. 1 to 3, l denotes the intestine or the like to be opened. 2 denotes an electric conductor which leads from a high frequency (diathermy) apparatus 3 into the interior of a suction body adapted to be applied to the intestine. Thissuction body maybe formed as a 5 strong rubber hose 4 which does not collapse with suction and which is fitted to the tubular piece 6 provided with a branch 5. A perforated or incised rubber stopper 7 or the like serves as a guiding means for the conducting wire 2 while maintaining the tubular piece closed tightly on top.
Fitted to the branch 5 is a second hose 8 which leads to a suction vessel 9 connected with a suction pump i2 by a tube H provided with a manometer ill.
In the example illustrated the electrode consists of two crossing sheet metal pieces 83, It or the like. Each of these sheet metal pieces has serrations 55 with which the electrode contacts with the organ to be opened without effecting a mechanical cut. The sheet metal pieces in question are about 3 centimeters long and are fitted to a holder it which is connected with the conducting wire 2.
The arrangement and construction of the parts must be such that there is sufilcient space at the lower end of the suction tube for the escape of gases and liquids. The holder carries, for example, on a perforated disk or a wire ring, four resilient metal pieces I? which are formed after the fashion of blade springs. These springs or the like are for example one centimeter shorter than the sheet metal electrode members and form an angle which is open at the side next the hose opening. They serve to hold the electrode in the hose. 3
The suction body is applied to the organ to be opened. After connection to the suction vessel 9, or after starting the pump l2, the part of the body to be opened is sucked fast on to or into the lower edge of the suction hose. Between the wall of the organ and the suction hose there is produced a perfect airtight fit or fitting. After opening the wall by the electrode the contents of the organ pass exclusively into the interior of the hose without being able to pass into the surrounding region and infecting the latter.
We thus dispense with the heretofore usual stitching of threads into the thin (because stretched) decayed wall. Instead of such stitching operation an-airtight fitting is realized by the suction hosewithout injuring or damaging the wall. The passage outwards of germs is thus entirely prevented. The lower edge of the suction hose 4 must be smooth so as to secure as nearly ai tight a closure as possible. If desired, the lower edge of the hose may be formed as a suction cup or the like, that is, funnel shaped. The plain construction shown in Fig. 2 is, however, very suitable.
After the suction-tight fit has been effected the opemng of the hollow organ is effected internally of the hose or tube. By means of the electrode which is located close to the lower edge of the hose the wall of the organ is opened by diathermy action. The contents'of the opened organ are then discharged with continued suction into the suction hose and pass through the latter as well as through the branch 5 and the hose 8 into the suction vessel Q which may be set up at a. suitable distance from the operating point. As the sucked part of the organ always remains tightly connected with the lower edge of the suction body, infectious germs cannot pass into the surrounding region of the organ in question.
After the organ has been opened and discharged by sufficient suction action, the hose can be sewn to the Wall which is no longer stretched,
that is, no longer thin. In order to effect this seam in a manner free from objection, it is also necessary that the region of the wall where the seam is to be provided should not be injured by the diathermy action.
When the Wire and the electrode are retracted from the hose t or the tube 6, then, in lieu of the perforated rubber stopper 1, another closure is fitted to the upper end of the tube 6.
In the case where several parts of an organ, for example, an intestine, are to be opened simultaneously several suction devices may be used and connected to a common suction vessel. Each connection must in that case be provided with a cook or the like adapted to be closed independently.
In the construction shown in Figs. 4 to 6 there is not used for opening the wall of the organ an electrode operating by diathermy but there is used a cutting instrument which opens the wall mechanically.
Slidably guided in a tube 21] is a tube 2i having at one end a cutting blade 22. At the other end the tube 2! is provided with a handle 23. For guiding the cutting tube 2! there serves a pin 25 engaging a helical slot 2a in the tube wall, which pin is urged into the slot by a spring 26 and can be retracted by aid of a knob 2'5, and by rotation through 90? held in retracted position on the outer edge of the pin and spring casing 28. The casing 28 is mounted on a sleeve 1 which is screwed on to the end of the outer tube 20 and secured by a bolt 30.
Slidably guided in the cutting tube 2! is a cylindrical bar 35 which is hollow at least at the end of the tube 2i next the blade 22. Elsewhere it may be in the form of a solid cylinder. In the example illustrated it is shown as being entirely tubular and provided with a filling 32. This bar 3! presents an elongated slot 33 which is also engaged by the pin 25, so that the bar 35, which is provided at the outer end with a knob 3 can be slid within the cutting tube 28. At the other end the bar 3! carries a wire basket 35.
Connected to the outer tube 2b is a tubular piece 36 which is connectible with a vacuum device. At the end with which it is applied to the wall of the organ to be opened the tube 29 is widened to form a mouthpiece 37 of which the interior annular space 38 is connected with a tubular piece 39 which may also be connected to a vacuum device. The mouthpiece 3? is provided with openings it] arranged in a circle. The edge M of the mouthpiece projects preferably, as shown in the drawings, beyond the openings 40. The cutting tube 2! is provided with an elongated opening 42 and the hollow bar 3i is provided with a similar opening 43.
When an organ of the body is to be opened, the mouthpiece 3? is applied to the wall of the organ, as indicated in chain-dotted lines at i l in Fig. 5. The wall 14 is sucked by the tube 39 connected to a Vacuum device, so that it is drawn fast into the edge at on to the openings as shown in Fig. 5. Thereby there is obtained a perfectly tight closure between the wall of the organ and the device. a The cutting tube 2| is now displaced by aid of the handle 23, so that the blade 22 opens the wall M of the organ. At this time the bar 3| is held somewhat retracted (chain-dotted posi tion in Fig. 4), so. that the basket does not project from the mouthpiece 3 After the opening of the wall 44 of the organ by the instrument 2!, 22 the infectious contents of the organ pass exclusively into the interiorof the cutting tube 2| without being able to enter the surrounding region and infect the latter. The filling 32 in the hollow bar 3| prevents the infectious contents from passing into the interior of the bar. Through the openings 43 or 42 the infectious contents pass into the tubular piece 36 through which they are sucked away. After the opening operation, by advancing the bar 3|, the wire basket 35 is advanced from the mouthpiece 31 intothe opening in the wall of the organ and holds back the opposed wall-for example, if an intestine is to be openedso that it cannot be sucked into the mouthpiece.
The parts 2i and 3| may be replaced by other instruments, while the suction-tight fit or closure is upheld.
l. A device for opening, hollow organs of the body having infectious contents, said device comprising a tubular or hose-like hollow body adapted to be connected to a vacuum device, a mouth piece attached to the end of said hollow body and forming a skirt thereabout, said mouth piece forming together with the hollow body an annular space, means defining a closure for said annular space and extending between the hollow body and the mouth piece adjacent the bottom thereof, and having circular openings adjacent the outer edge of the said closure-defining means, i
a tubular member connected to said annular space and adapted to be connected to a second vacuum device, for creating and maintaining an airtight fit or closure between the wall of the said organ and the circumference of the said hollow body and an opening instrument mounted for movement in and along said hollow body.
' 2. A device for opening hollow organs of the body having infectious contents, said device comprising a tubular or hose-like hollow body adapted to be connected to a vacuum device, a mouth piece attached to the end of said hOllOW body and forming a skirt thereabout, said mouth piece forming together with the hollow body an annular space, means defining aclosure for said annular space and extending between the hollow body and the mouth piece adjacent the bottom thereof and having circular openings adjacent the outer edge of the said closure-defining means, the edge of the mouth piece projecting slightly beyond the said closure means and its openings, a tubular member connected to said annular space and adapted to be connected to a second vacuum device, for creating and maintaining an airtight fit or closure between the wall of said organ and the circumference of the said hollow body and an opening instrument mounted for movement in and along said hollow body.
3. A device for opening hollow organs of the body having infectious contents, said device comprising a tubular or hose-like hollow body, a tubular member formed on saidhollow body and adapted to be connected with a vacuum device, a tube mounted in said hollow body for movement therealong and adapted to be guided thereby, and having a cutting edge at one end thereof, a cylindrical bar slidable within the cutting tube and hollow at least in its portion adjacent the cutting edge of the said cutting tube, and having a basket formed on one end thereof, both the hollow part of said cylindrical bar and the said cutting tube having elongated openings which incide and which communicate with the tubular member, the basket being adapted, upon movement of the cylindrical bar, to push back the skin after the organ has been out, for facilitating drainage through the said elongated openings into the tubular member, and means for creating and maintaining an airtight fit between the wall of said organ and the circumference of said hollow body and adapted to be connected to a second vacuum device.
4. A device for opening hollow organs of the body having infectious contents, said device comprising a tubular or hose-1ike hollow body, a tubular member formed on said hollow body and adapted to be connected with a vacuum device, a tube mounted in said hollow body for movement therealong and adapted to be guided thereby, and having a cutting edge at one end thereof, a hollow cylindrical bar slidable in said cut-- ting tube and having a filling therein which leaves hollow only the end thereof which is adjacent the cutting edge of said cutting tube, and having a basket formed on one end thereof, both the hollow part of said cylindrical bar and the said cutting tube having elongated openings which coincide and which communicate with the tubular member, the basket being adapted, upon movement of the cylindrical bar, to push back the skin after the organ has been cut, for facilitating drainage through the said elongated openings into the tubular member, and means for creating and maintaining an airtight fit between the wall of said organ and the circumference of said hollow body and adapted to be connected to a second vacuum device.