Abstract:
The present invention is directed to a four function microsurgery instrument performing the functions of aspiration, irrigation, dilation and cauterization. An embodiment of the present invention has a body; a first and second side arms with integral dilation tips having an electrical conducting surface; a power control and transmission system; a common conduit that delivers irrigation-fluid and aspiration-suction in proximity to the dilation tips and an irrigation-fluid and aspiration-suction control and transmission system. The instrument provides the advantages of being small in size, being ergonomical, being all-in-one, eliminating the need for a surgeon-user to fumble around in switching between instruments, reducing time consumption and reducing frustration.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
   I hereby claim the benefit of my earlier filed provisional application (application No. 60/692,479) filed Jun. 21, 2005. 

   BACKGROUND OF THE INVENTION 
   1. Field of the Invention 
   This invention is in the field of surgical instruments and more particularly in the field of vessel dilators. 
   2. Related Art 
   A vessel dilator provides intra-luminal vessel dilation during surgery. Vessel dilators are frequently used during surgical procedures as aid in fine dissection and vessel anastomosis. As a vessel dilator is inserted into a vessel, the dilator helps to hold the vessel wall and avoid suturing the back to the front wall of the vessel. A conventional vessel dilator comprises a modified forceps having elongated parallel tips which are highly polished. The parallel tips are pressed together to provide a single tapered shaft. The tapered shaft is inserted into a vessel, and the parallel tips are allowed to separate thereby dilating the vessel. 
   Often, when a vessel is to be sutured, the vessel must be irrigated using an irrigator. Irrigation is used to prevent drying of tissue, to remove tissue debris and blood, to keep vessel ends open and prevent floating adventitia at vessel ends interrupting satisfactory microvascular suturing and anastomosis. Irrigation keeps the operative field clean, and inhibits blood clotting inside the lumen of the blood vessel. 
   Suction keep the operative field clean and inhibit blood clotting inside the lumen of the blood vessel. 
   Anastomosis covers a variety of procedures in which blood vessels (or other tubular members) are joined or reconnected. Vessels may be joined in a variety of relative orientations, including end-to-side, and end-to-end. Anastomosis is traditionally performed by suturing the vessels together at the juncture between them. Alternatives to suturing have been developed, in order to prevent thrombosis which tends to occur at the points of penetration of the sutures. One such alternative, particularly for larger vessels, involves mechanical connectors such as collars. A second alternative is the use of surgical clips which are applied along the vessel juncture to perform a holding function similar to that of sutures, without penetrating the vessel walls. 
   Cauterization seals vessels and arrest bleeding. A conventional bipolar-type blood vessel coagulation/stanching device uses high-frequency current. A number of such conventional devices employing a spark gap method generating high frequency ranging between 0.5 to 3 MHz have been used. The two electrodes (active and inactive electrodes) of the bipolar type device are provided at both ends of a pair of forceps to be held by hand. Electric current flows only through the living tissue held between the ends of the forceps. Since electric damage to a patient is applied only to a limited portion to be coagulated, bleeding from a blood vessel can be stopped completely without injuring other tissues. More specifically, the stanching effect of the device is obtained by coagulating the blood vessel using localized heating caused by the high-frequency current flowing through the living tissue. 
   The surgeon must alternate among dilation, irrigation, suction during vessel dissection and anastomosis and cauterization, using separate dilation, suction, irrigation and cauterization instruments. The act of switching among these four instruments is time-consuming and can interrupt the surgeon&#39;s attention and concentration. 
   Applicant herein has invented a three functional vessel dilator performing the functions of dilation, irrigation, suction during vessel dissection and anastomosis. Still, when suturing a blood vessel or otherwise performing operative tasks, a surgeon must alternate between three functional vessel dilator and a cauterization instrument. Alternating between these instruments is time consuming, and interrupts the surgeon&#39;s attention. 
   There is a need for a four function vessel dilator performing the functions of dilation, irrigation, suction during vessel dissection and anastomosis and cauterization. A simple to use, easy to handle, lightweight, atraumatic, all-in-one instrument can significantly reduce operative time and improve the overall efficiency of the operative procedure. The advantage of a totally disposable instrument is also evident in its low cost and the avoidance of transmission of pathogenic agents, because current sterilization techniques are not totally fail-safe. 
   The present invention satisfies these needs, as well as others, and generally overcomes the presently known deficiencies in the art. 
   SUMMARY OF THE INVENTION 
   The present invention is directed to a four function microsurgery instrument  10  performing the functions of aspiration, irrigation, dilation and cauterization. An embodiment of the present invention has a body; a first and second side arms with integral dilation tips having an electrical conducting surface; a power control and transmission system; a common conduit that delivers irrigation-fluid and aspiration-suction in proximity to the dilation tips and an irrigation-fluid and aspiration-suction control and transmission system. Other embodiments containing some or all of the foregoing elements, as well as other elements, fall within the scope of this invention. The present invention has many advantages which include an microinstrument configured so all the functions fit together in one instrument and enabling a user surgeon to perform operative tasks without having to switch instruments. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     These and other features, aspects and advantages of the present invention will become better understood with reference to the following description, appended claims and accompanying drawings where: 
       FIG. 1  which is a perspective view of the invention looking across a side with a top lid portion removed and showing internal tubing, along with a blowup insert featuring tubing inserted on tube ports; 
       FIG. 2  which is a perspective view of the four function microsurgery instrument according to the present invention looking from the top and down and 
       FIG. 3  which is a hybrid perspective and schematic view of the four function microsurgery instrument according to the present invention looking from the top and down with the foot pedal switch shown in schematic format. 
   

   DETAILED DESCRIPTION OF THE INVENTION 
   The invention is a four function microsurgery instrument  10  performing the functions of aspiration, irrigation, dilation and cauterization. The device is a micro-instrument designed for work with vessels having a diameter of on or about one or two millimeters. 
   Referring to  FIG. 1 , an embodiment of the four function microsurgery instrument  10  has a body  12 . The body  12  is dimensioned to be held in user&#39;s palm having front, back, side, top and bottom regions. The body  12  is typically and preferably made of plastic and most preferably a polycarbonate. Preferably, the body  12  is palm sized and ergonomically shaped to fit within a palm. 
   Continuing to refer to  FIG. 1 , there are a pair of opposing side arms  14 ,  16  (referred to as a first side arm  14  and a second side arm  16 ) that extend from the front region of the body  12  in a direction away from the front region. The opposing side arms  14 ,  16  extend in substantially parallel fashion. These side arms  14 ,  16  have a shaft like configuration. Typically, the side arms  14 ,  16  taper gradually to a narrow breadth as distance increases from the body  12 . 
   Preferably, the outer surfaces of the side arms  14 ,  16  (that is the surface that does not oppose the other side arm) are provided with undulations which facilitate gripping of the side arms  14 ,  16 . Most preferably, there can be a thumb/finger tab  18  to enhance ergonomics. This thumb/finger tab  18  obtrusively projects from a side arm and is positioned to enhance gripping, control and the ergonomics of the instruments. The thumb/finger tab  18  can further have an array recesses and protrusions/nodulations to further enhance gripping. 
   The side arms  14 ,  16  are fabricated from a resilient and insulative material. Preferably, the side arms  14 ,  16  are made of plastic; more preferably, they are made from a polycarbonate and most preferably, the side arms  14 ,  16  are the same material as the body  12 . 
   Each side arm is joined to the body  12  at the front region of the body  12  such that the side arms  14 ,  16  are resiliently held apart from one another, but may be squeezed or pressed together. Accordingly, the ends of the first and second side arms  14 ,  16 , referred to as dilation tips  22  and discussed below, are in a spaced apart relationship with a gap there between. A user can squeeze and release the side arms  14 ,  16  to adjust the size of this gap. 
   Preferably, the side arms  14 ,  16  can be squeezed so as to bring together the dilation tips  22  at the ends of the side arms  14 ,  16 . In one embodiment, the side arms  14 ,  16  are spaced apart a sufficient distance on the front region of the body  12  so that the common conduit (discussed below) does not interfere with the closure of the side arms  14 ,  16  as the dilator tips are brought together. 
   In another embodiment, there is a groove (not illustrated) in the inner surface of the first side arm  14  (that is, the surface that opposes the second side arm  16 ). The common conduit  20  is received in this groove in the inner surface of the first side arm  14 . The groove is dimensioned such that the common conduit  20  totally fits within it. In the alternative, the groove is dimensioned so that the common conduit  20  partially fits into the first side arm  14  and there is a groove in the inner surface of the second side arm  16  that mates with the common conduit  20  in the first side arm  14 . Thus with the side arms  14 ,  16  are pressed together, this groove in the second side arm  16  allows the dilation tips of the side arms  14 ,  16  to close with perfect approximation. 
   Continuing to refer to  FIG. 1 , the side arms  14 ,  16  each terminate in a dilation tip  22 . The dilation tip  22  is configured for contacting a blood vessel and is approximately shaped like “b” rotated 90 degrees. The dilation tips  22  are typically unitary with the side arms  14 ,  16 . The dilation tip  22  has an electrical conducting surface. The electrical conducting surface is made out of metal or conducting polymer/resin. Suitable metals include steel and titanium. A preferred material is a metal and a most preferred material is steel. 
   Referring to  FIG. 2 , each side arm  14 ,  16  contains an elongated electrical conductor  24 . The elongated electrical conductor  24  originates at the dilation tip  22  and is in electrical communication with the conducting surface of the dilation tip  22 . The elongated electrical conductor  24  runs laterally through the side arm. Each elongated electrical conductor  24  in each side arm is in electrical communication with a power cable means. The power cable means includes a portion that runs through the body  12  and a portion that extends from the body  12  in a direction away from the back region. Optionally, the power cable means  26  can include at the back region of the body  12  a connector to provide a junction for attachment and release of an electrical power cable means  26 . Thus an electric circuit is creatable from an electric power source so that electric power is supplied for bipolar cauterization at the dilation tips  22 . 
   There is power control means  28  for manually actuating the supply of electric power for bipolar cauterization at the dilation tips  22 . This power control means  28  along with the power transmission means comprise a power control and transmission system. In one embodiment of the present invention, the power control means  28  is a foot pedal switch  28  in electrical communication with the power transmission system whereby electric power from a power source is turned on so as to be supplied for bipolar cauterization at the dilation tips  22 . 
   In another embodiment of the present invention, the power control means  28  is momentary contact switch (touch surface or a pole) (not illustrated) which is in intermittent electrical communication between an elongated conductor in a side arm and the power transmission means. The power transmission means provides electric power from a power source which manually actuated by this switch so as to supply power for bipolar cauterization at the dilation tips  22 . 
   Referring to  FIG. 1 , a common conduit  20  extends from the body  12  in a direction away from the front region and delivers irrigation-fluid and aspiration-suction in proximity to the dilation tips  22 . The term common conduit  20  includes two separate conduits, co-axial conduits with two channels and side-by-side conduit strips where there are two conduits/channels with one delivering fluid and the other suction. Typically and preferably, the common conduit  20  is a single channel/conduit that is used to provide irrigating fluid, or alternatively the common conduit  20  can be used to extract fluid. The function provided by the common conduit  20  is determined by an irrigation-fluid and aspiration-suction control and transmission system. 
   The common conduit  20  is typically positioned between the opposing arms. It can also be positioned to run along or inside a side arm with a suitable exit port fixture to direct the flow of irrigation-fluid and aspiration suction (not illustrated.) The common conduit  20  can be positioned outside the pair side arms  14 ,  16  with a suitable exit port fixture to direct the flow of irrigation-fluid and aspiration suction. Preferably, the common conduit  20  is centrally located between the side arms  14 ,  16  such that when the side arms  14 ,  16  are pressed together, the common conduit  20  is located immediately behind the dilation tips  22  of the side arms  14 ,  16 . 
   Typically, the common conduit  20  is a removable plastic needle or cannula  20 . The plastics needle is a standard mini Yankauer, which is conventionally used as a cannula  20  in paediatric, anaesthetic and theatres. The needle/cannula  20  is attached to a central spar (common conduit port (not illustrated)) which extends from the front region of the body  12 . The needle/cannlula is pushed onto the common conduit port (not illustrated). Friction between the needle/cannula  20  and the common conduit port (not illustrated) is sufficient to hold the needle/cannula  20  in place. 
   There is an irrigation-fluid and aspiration-suction control and transmission system that is in fluid communication with the common conduit  20  and sources for fluid and vacuum. This system is comprised of a fluid control means  30  and a transmission means. 
   Referring to  FIG. 1 , one embodiment of the fluid control means  30  is a plunger valve  30  (discussed further below) extending from the body  12  in a direction away from a side region and positioned for actuation by a user for control of both irrigation-fluid and aspiration-suction control. This plunger valve  30  is in intermittent fluid communication with the common conduit  20  and the fluid communication means  32 ,  37  (discussed further below.) The term plunger includes valve  30  with a solenoid or other electrical assist that may be actuated by a switch and in particular a momentary contact switch. The term plunger valve ( 30 ) includes other forms of valves that have a lever, pole or other feature suitable for manual actuation by a user surgeon. The fluid communication means  32 ,  37  is in fluid communication with fluid and vacuum sources. Preferably there is a single shaft moveable valve  30  where one pump actuates vacuum and two pumps actuates irrigation fluid or vice versa. 
   Another embodiment (not illustrated) of the irrigation-fluid and aspiration-suction control system is comprised of a first plunger valve  30  extending from the body  12  in a direction away from a side region and positioned for actuation by a user for control of irrigation-fluid and a second plunger valve (not illustrated) extending from the body  12  in a direction away from a side region and positioned for actuation by a user for control of aspiration-suction. Each plunger valve  30  is in intermittent fluid communication between the common conduit  20  and the fluid communication means  32 . The fluid communication means  32  is in fluid communication with fluid and vacuum sources. 
   The plunger valve  30  is comprised of a central chamber defined by a cylindrical housing, the chamber being connected to the two tube ports and a further port on an opposite side of the chamber (this port is and had been referred to as the common conduit port (not illustrated)). A valve stopper comprises a lower stopping region, a middle cut away region and an upper stopping region. O-rings or molded seals are provided in recesses of the stopping region and are arranged to ensure that a seal is maintained between the stopping regions and the chamber defined by the cylinder. 
   The operation of the plunger valve  30  is as follows. In a first uppermost position, the lower stopping region is located between the tube ports  34  and the common conduit port (not illustrated). No fluid is allowed to flow to or from the plunger valve  30 . In a second middle position, the open region of the stopper is located between the upper tube port  24  and the common conduit port (not illustrated), thereby providing suction to the common conduit  20  (needle/cannula  20 ) via one of the plastic tubes  32 . The lower stopper region is located between the lower tube port  34  and the common conduit port (not illustrated) extending out of the front region of the body  12 , thereby preventing the flow of fluid via the lower tube port  34 . In a third lowermost position the open region is located between the lower tube port  34  and the common conduit port (not illustrated), thereby allowing fluid to flow from one of the plastics tube  32  to the common conduit  20  (needle/cannula.) The upper stopping region is located between the upper port  34  and the common conduit port (not illustrated), thereby preventing suction from common conduit  20  (needle/cannula) via one of the plastics tubes. 32   
   A helical spring is located in the base of the cylinder and biases the stopper to the first uppermost position in which both inlet ports are closed. The stopper is provided with a hook which engages a recess provided in the exterior of the cylinder. The hook and the recess combine to limit the movement of the stopper to a predetermined range of motion. In particular, the hook and recess prevent the stopper from inadvertently being removed from the cylinder. 
   Referring to  FIG. 2 , a fluid communication means  32  is configured as follows. A pair of tubes  32  runs through the body  12 . One tube  32  provides vacuum and the other tube provides a irrigation fluid  32 . At the rear of the body  12  there can be connectors (not illustrated) for the tubing  32  for attachment to a vacuum and irrigation fluid source (not illustrated.) The connector can be a standard luer lock (not illustrated) (a known apparatus conventionally used to connect a needle to an intravenous set) which is attached onto the rear end of the body  12 . Optionally, the body  12  can have a lid  36  on the top or side of the body  12  with connectors for the tubing (ports)  34  being within the body  12 . When the lid  36  is open, tubing  32  can be attached to or released from the connectors (ports)  34 . 
   In an embodiment of the four function microsurgery instrument  10 , a luer lock (not illustrated) on the rear region of the body is connected to an appropriately sized connecting tube  32  (an intravenous set), which is in turn can be attached to a 50 milliliter syringe containing heparin/saline. Variation of pressure applied to the syringe will produce a corresponding variation of the rate of fluid flow from the common conduit  20 . The rate of fluid flow from the conduit can thus be altered at the request of a user (surgeon.) The four function microsurgery instrument  10  may be connected to more than one syringe through a multi-channel connector. Where more than one syringe is provided, it is possible for more than one assistant to assist with irrigating. The length of the connecting tube can be selected depending upon how close or far away a surgical assistant is situated from a surgeon. Commercially available dispensable intravenous sets of different lengths may be used. 
   In an alternative embodiment, the fluid may be delivered to the four function microsurgery instrument  10  under pressure using an automated pump. The four function microsurgery instrument  10  may then include a valve  30  which is used by the surgeon to control the rate of flow of fluid from the four function microsurgery instrument  10 . The valve  30  is suitably provided on the first side arm  14 . 
   In an alternative embodiment, the four function microsurgery instrument  10  is in a modular configuration so that the instrument can be disassembled for easy cleaning and reassembled. Preferably, there is one module comprised of the side arms  14 ,  16  with a harness or docking apparatus to receive a central unit contain the other components of the instrument as previously described. 
   Regarding alternative best modes for carrying out this invention, preferably, the dilator tip  20  of the tapered shaft side arm  14 ,  16  has a diameter of less than 5 millimeters. Preferably, the dilation tip  22  of the tapered shaft side arm  14 ,  16  has a diameter of 3 millimeters or less. Preferably, the side arms  14 ,  16  are provided with gripping means such as a thumb/finger tab  18 . Preferably, the thumb/finger tab gripping means  18  comprises a recess provided with a series of protrusions. Preferably, the connection between the side arms  14 ,  16  and body  12  is resilient. 
   Regarding alternative best modes for carrying out this invention, preferably, the common conduit  20  is arranged to deliver irrigating fluid or suction to a dilator tip  20  of the side arm  14 ,  16 . Preferably, the common conduit  20  extends between the side arms  14 ,  16  of the four function microsurgery instrument  10 . Preferably, the common conduit  20  is fabricated from plastics. Preferably, a groove is provided in an opposing side arm  14 ,  16 , the groove being dimensioned to receive the common conduit  20  when the side arms  14 ,  16  are held together and preferably, a common conduit  20  is fixed to one of the side arms  14 ,  16 . Preferably, the common conduit  20  is connected to a luer lock or common conduit port (not illustrated) extending out from the front region of the body  12 . Preferably, the common conduit  20  is a 24 gauge needle/cannula. 
   Regarding alternative best modes for carrying out this invention, preferably, the four function microsurgery instrument  10  is provided with a valve  30  moveable between an irrigating position in which irrigating fluid passes through the plunger valve  30 , a suction position in which air and extracted fluid passes through the plunger valve  30 , and an off position in which the plunger valve  30  is shut. Preferably, the plunger valve  30  is provided with cylindrical ports  34 , each cylindrical port  34  being dimensioned to allow a tube  32  to be pushed onto the port such that the tube  32  is fixed to the port  34  by friction between the tube  32  and the port  34 . Preferably, the plunger valve  30  comprises a moveable stopper which in the irrigating position provides a connection between the first tube and the common conduit  20 , in the suction position provides a connection between the second tube and the common conduit  20 , and in the off position provides no connection between the common conduit  20  and the first tube or the second tube. Preferably, the moveable stopper is resiliently biased towards the off position. Preferably, the moveable stopper is provided with a catch which prevents the stopper from inadvertently becoming detached from the four function microsurgery instrument  10 . 
   Regarding alternative best modes for carrying out this invention, preferably, two tubes  32  are connected to the plunger valve  30 , a first tube  32  carrying irrigating fluid, and a second tube  32  delivering suction. Preferably, the luer lock (not illustrated) is connected via flexible tubing  32  to one or more reservoirs (not illustrated) containing irrigating fluid. Preferably, the one or more reservoirs are syringes. Preferably, irrigating fluid is delivered to the four function microsurgery instrument  10  using an automated pump. 
   Regarding alternative best modes for carrying out this invention, preferably, the four function microsurgery instrument  10  may be dismantled into its constituent parts to facilitate sterilization. 
   The four function microsurgery instrument  10  is suitable for microsurgical operations in the fields of: plastic and reconstructive surgery, hand surgery, head and neck surgery, otolaryngology, obstetrics and gynecology, oral and maxillofacial surgery, neurosurgery, dental surgery, opthalmology, cardiothoracic surgery, pediatric surgery and urology. A larger dimensioned four function microsurgery instrument  10  is suitable for use in other types of surgery such as general surgery, vascular surgery, spinal surgery, orthopaedic surgery, and breast surgery. 
   The instrument provides the advantages of size, being a microinstrument, and four cooperating functions. 
   EXAMPLES 
   The following example further describe and demonstrate embodiments within the scope of the present invention. The examples are given solely for the purpose of illustration and are not to be construed as limitations or restrictions of the present invention, as persons skilled in the art will quickly realize many variations thereof are possible that are all within the spirit and scope of the invention. 
   The four function microsurgery instrument  10  is approximately 11 centimeters in length. An angulation of each dilation tip  22  of 10 degrees, a tip diameter 3 millimeters and common conduit needle  20  that is a 24 gauge needle. 
   Although the present invention has been described in considerable detail with reference to certain preferred versions thereof, other versions are possible with substituted, varied and/or modified materials and steps are employed. These other versions do not depart from the invention. Therefore, the spirit and scope of the appended claims should not be limited to the description of the preferred versions contained herein.