Surgery – Instruments – Forceps
Reexamination Certificate
1996-07-29
2001-04-17
Donnelly, Jerome W. (Department: 3764)
Surgery
Instruments
Forceps
C128S200170, C128S898000, C606S198000, C606S185000, C606S170000, C606S084000, C606S190000, C606S153000, C606S207000
Reexamination Certificate
active
06217602
ABSTRACT:
BACKGROUND OF THE INVENTION
The invention relates to a surgical instrument for and a method of performing subcutaneous surgery, specifically the utilization of the surgical instrument to illuminate the carpal tunnel area of a patient to effect the severance of the transverse carpal ligament.
The carpal tunnel is a small channel formed by the carpal bones of the wrist. The median nerve runs through it and provides sensation and feeling to much of a person's hand. Tendons that connect to the fingers also run through the carpal tunnel. The median nerve and those tendons stretch and retract and press the top of the carpal tunnel during repetitive hand motions, and long term stress irritates the tendons causing the same to swell. As the tendons swell even more they press against the median nerve causing irritation, irritation feeds upon itself, cycle after cycle, and thus is the beginning of carpal tunnel syndrome.
The first warning symptoms of carpal tunnel syndrome generally are slight tingling in one's fingertips which can continue accompanied by increasing pain until they reach an excruciating level. Hand function is also severely impaired.
At times the only relief afforded a person afflicted with carpal tunnel syndrome is through surgery, and heretofore there were two distinct surgical approaches. In one case a relatively large incision is made to gain access to the surgical area, but obviously this is undesirable because a relatively large incision involves increased pain, longer mend time, a larger scar, etc. The alternative is endoscopic surgery which obviates the latter problems but reduces visibility and can create a far greater problem should the lack of visibility result in the inadvertent or accidental cutting of the median nerve. The latter conventional surgical methods and disadvantages related thereto have led to the development of the present surgical instrument and the surgery associated therewith involving a very minor incision by the utilization of the surgical instrument to both enlarge and illuminate the carpal tunnel surgery arena and assure severance of only the transverse carpal ligament absent damage to the median nerve and/or muscles, tendons, ligaments passing through the carpal tunnel.
Various instruments are provided for a variety of surgical procedures, and during a prior art search of the present invention, several patents worthy of comment were uncovered and include the following:
U.S. Pat. No. 3,893,454 in the name of Karl W. Hagelin issued on Jul. 8, 1975 discloses a coniotomy instrument which includes a speculum portion defined by two separable specula blades each carried by a leg with the legs being pivotally secured relative to each other. A spring biases a handle portion of the legs away from each other and by squeezing the handle portions the specula blades can be spread. A knife unit is carried by the specula blades and has a point which projects beyond the ends of the specula blades. The knife penetrates soft portions of the throat and into the lumen of the trachea under thumb pressure creating an incision which is widened by spreading the specula blades.
U.S. Pat. No. 614,854 issued on Nov. 29, 1898 to A. Frank et al. discloses an intubator defined by a pair of pivotally united levers having at one end a handle and at the other end a pair of jaws which are relatively slender, somewhat conical, and are designed for insertion within the interior of intubation tubes.
U.S. Pat. No. 1,097,978 in the name of C. L. Johnson issued on May 26, 1914 discloses a dilator and catheter instrument formed by a pair of members pivotally connected together having handles at one end and jaws at an opposite end which can be spread against the bias of a spring.
U.S. Pat. No. 889,112 granted to A. Schachner et al. on Dec. 26, 1989 discloses an instrument for performing a tracheostomy operation including a pair of pivotal members having hand grips at one end and an elongated nose at the opposite end thereof. The elongated noses are substantially of a conical configuration decreasing in diameter toward outer tips for facilitating the insertion of the noses into a trachea opening. The two elongated noses are movable apart by squeezing the handle grips toward each other to widen the trachea opening and thereby to facilitate the insertion of a cannula therethrough.
U.S. Pat. No. 5,014,409 in the name of L. Boughten et al. granted on May 14, 1991 illustrates a tool defined by a pair of pivotally connected lever arms having handles at one end and tips at opposite ends for gripping and/or expanding items.
U.S. Pat. No. 5,217,007 granted to P. Ciaglia on Jun. 8, 1993 discloses a speculum for forming an ostomy in a trachea. The speculum includes a pair of opposing, pivotally interconnected elongated members and respective distal nose portions extending distally from the elongated members. The elongated members have respective handle portions of which the distal nose portions extend laterally therefrom. The handles are squeezed against the bias of springs to spread the distal nose portions.
SUMMARY OF THE INVENTION
In its broadest aspects the surgical instrument of the present invention is utilized in conjunction with surgery to relieve carpal tunnel syndrome by cutting the transverse carpal ligament. The surgical instrument includes a pair of legs pivotally connected to each other and having a blade portion at one end and a handle portion at an opposite end. The blade portions define a nose which can be inserted into a relatively small incision adjacent the area of the carpal tunnel after which the instrument is rotated approxmately 90° and the handle portions pressed to spread the blade portions to enlarge the carpal tunnel surgical arena. One of the blade portions includes an illuminating means, preferably in the form of fiberoptics for illuminating the area between blade portions which assures optimum visibility for effecting the severance of the transverse carpal ligament absent damage to adjacent anatomical structure, such as the median nerve and associated ligaments and tendons passing through the carpal tunnel. By directing the light rays generally normal to the blade portion carrying the fiberoptics, the surgical area is highly illuminated to thus provide both high visibility and high accessibility to the surgical area, as compared to the absence thereof in known prior art surgical procedures.
Pursuant to the method of this invention, a small incision of a determinate length is made in a patient's skin and a nose formed by closed blade portions of the instrument is progressively inserted through the incision with a width defining surface of one of the blade portions being contiguous the epidermis adjacent the incision. Once the blade portions are inserted through the incision into the carpal tunnel area, and specifically palmar the transverse carpal ligament, the surgical instrument is rotated substantially 90° which brings a thickness defining surface of the blade portions contiguous the epidermis. The latter rotational movement basically transforms the horizontal closed nature of the incision to a vertical elongated opening which is subsequently spread further along the entirety of the blade portions by moving the same away from each other to create a volume beneath the epidermis accessible through the incision opening for the eventual severance of the transverse carpal ligament. Upon completion of the latter procedure, the surgical instrument is again rotated to its initial insertion position, withdrawn from the incision and the incision is subsequently closed by suturing or the equivalent.
With the above and other objects in view that will hereinafter appeal, the nature of the invention will be more clearly understood by reference to the following detailed description, the appended claims and the several views illustrated in the accompanying drawings.
REFERENCES:
patent: 614854 (1898-11-01), Frank et al.
patent: 1097978 (1914-05-01), Johnson
patent: 3664330 (1972-05-01), Deutsch
patent: 3762400 (1973-10-01), McDonald
patent: 3893454 (1975-07-
Diller, Ramik & Wigh
Donnelly Jerome W.
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