Tracheotomy; A New Dilator
Boston Medical and Surgical Journal
The operation of tracheotomy is by no means a simple operation, and its performance is probably more dreaded by surgeons than that of any other. Numerous instruments have from time to time been invented for the purpose of making its performance more easy ; but of these very few are in general use, nor can it be said that any of them are indispensable, as any competent surgeon could if called upon suddenly perform the operation with the instruments found in the ordinary pocket-case, improvising
... -case, improvising a tube by bending up a probe or a piece of wire, or dispensing with the tube entirely and stitching the cut edges of skin and trachea together. If, however, the surgeon has sufficient time to select his instruments according to the peculiarities of the case, it is then that some of the special instruments will be found of great assistance. For convenience the operation of tracheotomy may be divided into three parts: (1) to expose the trachea ; (2) to open the trachea ; (3) to insert the tube. The instruments necessary for (1) are knife, forceps, and director ; for (2) a tenaculum, or a pair of small hooks and knife par excellence, or, in case the rings of the trachea are ossified, scissors, small saw, or bone forceps may be necessary ; for (3) dilator and tracheotomy tube. Of the numerous instruments that have been invented for this operation the greater part of them are either tracheotomes or dilators. There can be no doubt of the superiority of the knife over any trachetome, and iu the hands of the incompetent the latter may prove a dangerous instrument. As for the dilators they are not easy to insert, are liable to slip out, and take up so much room in the trachéal wound that it is difficult to insert the tube. The accompanying cut represents an instrument de. Figure 1. vised by the writer, the peculiar feature of which is a tenaculum and dilator combined. The action is the same as in the Richardson dilator, the blades being bent at an angle instead of being parallel, so as to act as retractors of the soft parts, and each blade terminating in a hook. Figure 2 shows the position of the hooks when the blades are closed ready for use. The point of each hook being turned down aids in introducing. By pressing the points lightly against the trachea and opening the blades the honks in- Fig. 2 . sert themselves firmly into the trachea, leaving space enough between them for the knife to pass. The instrument is now a tenaculum, by which the trachea can be lifted forward and held firmly before opening it, which is particularly to be desired when operating on children, where the trachea is situated deeply and often has a great range of up-and-down movement. To open the trachea the knife is inserted between the blades, and as the rings of the trachea are cut the instrument can now be used as a dilator, holding open the edges of the cut perfectly with no danger of slipping out.