WO1990003813A1

WO1990003813A1 - Vented surgical speculum

Info

Publication number: WO1990003813A1
Application number: PCT/US1989/004380
Authority: WO
Inventors: Reza S. Mohajer
Original assignee: Mohajer Reza S
Priority date: 1988-10-03
Filing date: 1989-10-03
Publication date: 1990-04-19
Also published as: CA2000117A1; AU4424689A

Abstract

A speculum (10) for use in surgical procedures comprising a blade (14) which is at least partially hollow and which defines a chamber therein. The blade includes an exterior tissue contacting face (12) and a perforated interior face which defines at least one opening (34) therein in communication with the chamber. The opening permits surgical by-products to pass into the chamber. The speculum further comprises evacuation means (36) communicating with the chamber so as to withdraw the surgical by-products from the chamber. Also disclosed is a surgical by-product evacuator for use in conjunction with the speculum. The evacuator comprises a sleeve-shaped member (139) retainably received by at least a portion of a speculum blade (136). The member is at least partially hollow so as to define a chamber therein and includes a perforated interior face which defines at least one opening in communication with the chamber. An evacuation conduit (148) communicates with the chamber.

Description

VENTED SURGICAL SPECULUM

Field of the Invention

This invention relates to surgical instruments and more specifically to a speculum with evacuation means for removing gaseous, fluid and solid surgical by-products at an operation site. The speculum has particular utility in laser surgical procedures.

Background of the Invention Laser surgery has experienced an exponential growth in recent years. Approximately 4,000 laser surgeries per day are now being performed in the United States. Lasers are being used in almost every conceivable kind of surgery, from correcting eye dysfunctions to removing warts and corns from the bottom of the foot. Laser surgery is also being increasingly utilized in cancer therapy as well, wherein cancerous tissue is vaporized by a laser beam of a preselected wavelength. Laser surgical procedures are presently used extensively in gynecological practice for removing and/or cauterizing a variety of vaginal and cervical lesions.

Laser surgery offers many benefits to the patient such as lower cost, reduced length of hospital stay and reduced recovery time since major incisions are often not as necessary as they are in conventional types of surgery. However, it now appears that laser surgery is posing serious health risks to the physician performing" the surgery, the nurses attending the physician and the rest of the supporting personnel in the operating room. An increased number of lesions have been noted in the personnel who perform or assist during laser surgeries. Lesions and other pre-cancerous conditions such as papillomas and condylomas are appearing on the face, eyes, nose, hands, lips, and in the larynx and lungs of those performing the surgeries. During laser surgery of cancerous tissue, the malignant tissue • is vaporized by a laser beam. This vaporization produces gaseous by-products which can carry infectious, live virus into the surrounding air of the operating room. These live viruses contained in the gaseous surgical by-products can settle onto the eyes, skin and lungs of the personnel in the operating room, causing the above-mentioned lesions. These problems are especially prevalent where laser surgery is done through narrow openings in the body, such as the throat and vagina. Airflow to these restricted areas is minimal, hence, ventilation of the infectious, gaseous by- products produced by vaporizing infected tissue in these areas is extremely poor and as a result, surgical by-products often vent directly into the faces or onto the hands of those performing the surgery.

In removing human papilloma virus from the cervix of a woman by laser surgery, the physician first inserts a vaginal speculum. The speculum separates the vaginal walls allowing for the application of a surgical laser beam to the infected site. A laser beam of a preselected wavelength is then activated and directed to vaporize the infected tissue. In heretofore employed techniques, the plume of gaseous by-products produced by the laser vents directly into the air of the operating room, possibly infecting those in the room. It is therefore desirable to provide means for trapping and. evacuating these infectious, gaseous by-products as well as other conventional surgical by-products such as blood and excised tissue.

Patent No. 4,735,603 to Goodson et al. discloses a laser smoke evacuation system and method for removing laser smoke from the site of a laser laparoscopy. Disclosed therein is a closed-loop system wherein C0₂ gas is pumped through a laparoscope tube into a body cavity. The laser smoke mixes with the pumped in C0₂ gas which is then vented through a second laparoscopy tube inserted into the patient. This system only removes laser smoke produced during laparoscopic surgical procedures and requires the insertion of at least two tubes into a patient's body as well as insertion of C0₂ gas. The system does not remove any other by-products of laser surgery such as blood or excised tissue and can only be used in connection with procedures invasive of the abdominal cavity. Patent No. 4,668,215 to Allgood discloses a valve device for the connection and control of an irrigation solution and vacuum to a patient undergoing laparoscopic surgery. This device is specific for laparoscopic surgeries only and requires the flow of an irrigating solution into a patient's body cavity with a resulting vacuum to remove the solution. The embodiment does not remove laser smoke produced by laser surgery. Patent Nos. 3,679,980 and Divisional 3,835,843 to Karman disclose a disposable vaginal speculum including a disposable cannula for a suction aspirator which is used for performing abortions. A plastic tube protrudes from between the blades of the speculum and extends into the cervix to perform suction abortions. The speculum is not adapted to laser -surgery and therefore has no means for evacuating both gaseous by-products and conventional surgical by-products produced by laser surgery.

Patent No. 4,615,334 to Jaeger discloses a surgical pad for use on a speculum blade to absorb blood and other by-products, but no evacuation means are provided for removing gaseous materials.

Patent No. 4,597,382 discloses a sleeve-shaped body for insertion over a speculum blade. The body has a liquid absorbent segment which is wetted after being placed on the blades of the speculum to inhibit reflection of the laser beam. However, no means are provided for removing laser smoke or other conventional by-products produced during surgery. None of the prior art cited above acts as a whole to teach or suggest a combination to remove laser produced smoke and other surgical by-products resulting during laser surgery.

It will thus be appreciated that there is yet a need for a surgical instrument which traps and evacuates all surgical by-products such as blood, excised tissue and infectious gaseous by-products produced by laser vaporization of infectious tissue. The present invention addresses these problems by providing a speculum for use in surgery which includes means for trapping and evacuating various surgical by-products. These and other advantages of the present invention will be readily apparent from the drawings, discussion, description and claims which follow.

Summary of the Invention

There is disclosed herein a speculum for use in surgical procedures including a blade for contacting and separating tissue so as to allow penetration of a surgical instrument to a tissue site. The blade is at least partially hollow so as to define a chamber therein, and the blade includes an exterior tissue-contacting face and a perforated interior face. The perforated interior face defines at least one opening therein in communication with the chamber. At least one opening is configured to permit surgical by-products to pass through it to the chamber. The speculum also comprises evacuation means communicating with the chamber for the purposes of withdrawing the surgical by-products from the chamber.

In another embodiment of the invention, the speculum includes an upper blade and a lower blade. One or both of these blades is at least partially hollow so as to define a chamber therein, and the blade includes a perforated interior face with at least one opening in communication with the chamber. The other of the blades is optionally solid. In another variation of the present invention, the opening of the perforated interior face is configured as at least one slot. The perforated interior face may alternatively define a plurality of openings configured to permit surgical by-products to pass through to the chamber. In some instances, at least a portion of the speculum is of low reflectivity for the laser beam. In a further variation of this embodiment, the evacuation means^• includes two evacuation conduits in communication with the chamber. The first conduit is disposed so as to primarily withdraw gaseous surgical by-products from the chamber and the second conduit is disposed so as to primarily withdraw solid and fluid surgical by-products from the chamber.

In yet another embodiment of the present invention, the chamber is divided into two portions by a divider which is configured to permit surgical by-products to pass from one portion of the chamber to another. Each of the portions o.f the chamber includes its own evacuation means for withdrawing surgical by-products therefrom.

There is further disclosed herein a surgical by-product evacuator for use in conjunction with a speculum. The evacuator comprises a sleeve-like member which is configured to be retainably received by a speculum blade. The sleeve-like member is at least partially hollow so as to define an exterior chamber and includes a perforated face disposed so as to cover at least a portion of the interior face of the speculum blade. The perforated face includes at least one opening therethrough communicating with the chamber. The evacuator further includes an evacuation conduit communicating with the chamber for withdrawing surgical by-products therefrom.

Brief Description of the Drawings

FIGURE 1 is a perspective view of one particular embodiment of a speculum structured in accord with the principles of the -present invention;

FIGURE 2 is a cross-sectional view of the speculum of Figure 1 taken along a plane perpendicular to the line indicated at 2-2; FIGURE 3 is a cross-sectional view of another embodiment of a speculum structured in accord with the principles of the present invention taken along a plane through an evacuation means;

FIGURES 4A and 4B are top plan views of interior faces of speculum blades structured in accord with the principles of the present invention;

FIGURE 5 is a rear elevational view of another embodiment of a speculum structured in accord with the principles of the present invention; FIGURE 6 is a cross-sectional view of one particular embodiment of a speculum structured in accord with the principles of the present invention;

FIGURE 7 is a perspective view of one embodiment of a single bladed speculum structured in accord with the principles of the present invention; and

FIGURE 8 is a perspective view of one embodiment of a surgical by-product evacuator structured in accord with the principles of the present invention.

Detailed Description of the Specific Embodiment

Referring to the drawings. Figure 1 is a perspective view of a vaginal speculum 10 comprising an upper blade 14 and a lower blade 18. The speculum 10 may be fabricated from a variety of materials including stainless steels, metals and most preferably from synthetic polymeric materials such as ABS or nylon. The blades of the speculum 10 may be coated with a fluorocarbon material, such as "Teflon" which aids in inserting the blades into a patient.

Integral with the upper blade 14 is an adjustment arm 22 which allows for the opening of the upper blade 14. A locking nut 26 positions the adjustment arm 22 while securing the upper speculum blade 14 in an open position after it has been inserted into a patient. Speculum 10 also includes a handle 28 which has affixed thereto an adjustment member 30 which allows for the adjustment of the distance between the upper 14 and lower 18 blade of the speculum. A second locking nut 32 securedly affixes the adjustment member 30 into the desired open position.

The upper 14 and lower 18 blades of the speculum 10 are utilized for contacting and separating tissue so as to allow penetration of a surgical instrument to a tissue site. The upper blade 14 of speculum 10 is at least partially hollow so as to define a chamber therein. The upper blade 14 includes an exterior tissue contacting face 12 and a perforated interior face as will be more fully developed herein below. The perforated interior face of blade 14 has a plurality of openings 34 in communication with the chamber. These openings are configured to permit surgical by-products to pass into the chamber. Evacuation means such as the conduit 36 communicates with the chamber for withdrawing the surgical by-products from the chamber. Any standard suction-type hosing can be connected to the evacuation conduit 36 to withdraw the products from the chamber within the speculum blade. The speculum 10 in Figure 1 also comprises a solid lower blade 18 having an interior face 20 and an exterior tissue contacting face 24. Figure 2 is a cross-sectional view of the speculum in Figure 1 taken along a plane perpendicular to the line indicated at 2-2. Upper blade 12 has an exterior tissue contacting face 12 and a perforated interior face 16 which defines a plurality of openings 34 therein. The openings 34 are in communication with a hollow interior chamber 38. Upon application of a suction through the evacuation means, surgical by-products such as fluid, excised tissue, and gaseous laser produced smoke pass through the openings 34 and into the chamber 38 for withdrawal therefrom. The lower blade 18 is solid and therefore has no perforated openings defined therein. Figure 3 is a cross-sectional view of another embodiment of the present invention taken along a plane through evacuation conduits 49 and 51. In this embodiment, an upper blade 42 and a lower blade 46 are both hollow. The upper blade 42 has an exterior tissue contacting face 44 and a perforated interior face 52. The upper blade 42 is hollow and defines a chamber 50 therein. The perforated interior face 52 defines a plurality of openings 54 which are in communication with the chamber 50. The openings 54 are configured in such a manner so as to permit the passage of surgical by-products through them and into the chamber 50 where they are subsequently removed through an evacuation conduit 49.

The lower blade 46 also has an exterior tissue contacting face. 48 and a perforated interior face 58 defining a plurality of openings 60 therein. The lower blade 46 is also hollow and defines a chamber 56 therein. The opening 60 are configured to permit surgical by-products to pass from the perforated interior face 58 into the chamber 56 where they are subsequently removed through evacuation conduit 51.

Figures 4A and 4B show top plan views of various perforated interior faces of speculum blades configured in accordance with the principles of the present invention. In Figure 4A, the interior perforated face 62 of the speculum blade defines a plurality of circular openings 64 in communication with a chamber defined in the blade, and permit the passage of surgical by-products from the speculum into the chamber.

Figure 4B shows a perforated interior face 66 of another speculum blade which defines a plurality of slot-like openings 68. The slot-like openings 68 are configured to permit the passage of surgical by-products from the speculum into a chamber located beneath said openings. Other alternative configurations of openings may be employed such as one long slot extending longitudinally along the interior face of a speculum, or a plurality of longitudinal slot-like openings. The openings need not extend to the end" of the speculum blade and may only be incorporated as to a portion of the blade. The configuration of openings in Figures 4A and 4B are meant as examples only and not limitations upon the preferred embodiment of the present embodiment. Obviously other configurations of openings may be suitably incorporated. Figure 5 shows a rear elevational view of yet another embodiment of a speculum 70 wherein both the upper blade 72 and lower blade 74 are hollow. The speculum 70 further includes a handle 78 and adjustment means 76 and 80 as described above. The hollow upper blade 72 defines a chamber therein (not shown) and has a perforated interior face 82 which includes a plurality of openings 84 therein. Integral with the upper blade 72 is an evacuation conduit 86 which is connected to an evacuation means 96 by means of a valve 92. The lower blade 74 also has a perforated interior face defining a plurality of openings 88 therein. Integral with the lower blade 74 is a second evacuator conduit 90 which is also attached to the evacuation means 96 by another valve 94. The valves 92 and 94 permit the regulation of the suction through the evacuation conduits 86 and 90 to the speculum. For example, a surgeon could decrease the suction to the evacuation conduit 86 of the upper blade 72 so as to increase the suction to the evacuation conduit 90 of the lower blade 74 if, for example, there are more or heavier surgical by-products to dispose of on the lower blade 74. Alternatively, the surgeon could shut off or decrease suction to the evacuation conduit 90 of the lower blade 74 to increase the suction force through the evacuation conduit 86 of the upper blade 72.

Figure 6 is a cross-sectioήal view of another particular embodiment of a speculum wherein one of the speculum blades has a plurality of evacuation conduits affixed thereto. Figure 6 depicts a speculum having a hollow upper blade 98 and a hollow lower blade 100. The upper blade 98 defines a chamber 102 therein and includes openings 104. Affixed to or integral with the chamber 102 is an evacuation conduit 106. A valve 108 affixes the evacuation conduit 106 to an evacuation means. The chamber

102 of the upper blade 98 in Figure 6 extends generally the entire length of the blade. Alternatively, the chamber 102 need only extend partially along the length of the blade

98.

The lower blade 100 is also hollow and defines a chamber 110 therein. The lower blade 100 has a perforated interior face (not shown) which includes a plurality of openings 112 in communication with the chamber 110. Affixed to or integral with the chamber 110 is an upper evacuation conduit 114 and a lower evacuation conduit 116. The upper evacuation conduit 114 is disposed to primarily withdraw gaseous surgical by-products from the chamber while the lower evacuation conduit 116 is disposed so as to primarily withdraw heavier surgical by-products such as fluid and solid materials. Valves 118 and 120 affix the evacuation conduits 114 and 116 respectively to a suction source.. The valves operate so as to allow a surgeon to regulate suction pressure through the evacuation conduits as explained above.

Alternatively chamber 110 could be divided into two portions by providing a divider 113 therebetween. The divider 113 could extend longitudinally along the length of the chamber, or could be placed transversely in the chamber. The divider 113 includes holes therein to permit passage of surgical by-products from one portion of the chamber to another. Each portion of the chamber would include its own evacuation conduit integral therewith for removing surgical by-products in that portion of the chamber. Use of such a divider facilitates direction of gaseous materials to conduit 114, and fluid or solid materials to the lower conduit 116.

Figure 7 is a perspective view of a particular speculum known as a single bladed weighted speculum as configured in accord with the present invention. Speculum ₁₂2 has a weight 124 on its handle and includes only a single blade 126. In the preferred embodiment, blade 126 has an exterior tissue contacting face 120 and a perforated interior face 132. The perforated interior face 132 defines a plurality of openings 130 which are in communication with a chamber defined in the hollow blade as explained in the above embodiments. The openings 130 are configured so as to permit surgical by-products to pass through the perforated interior face 132 and into the chamber where they are withdrawn through an evacuation means 134. Again", this speculum may be fabricated from stainless steels, metals, or synthetic polymeric materials and may be manufactured by any of a number of conventional processes. The speculums fabricated from metals and stainless steel are adapted to be sterilized for reuse, whereas the speculums fabricated from synthetic polymeric materials are designed so as to be disposable.

All of the previously described speculums are adapted to be used in conventional types of surgery as well as in laser surgery wherein a laser beam of a preselected wavelength is used to vaporize tissue. The surfaces of interior faces of the speculum blades which are used in laser surgery may be coated with a light- absorbing material such as pigment loaded polymer or a metallic oxide which is substantially non-reflective of the laser beam. Use of such low reflectivity coating minimizes dangers of reflected laser beams.

Figure 8 is perspective view of a surgical by- product evacuator 138 structured in accord with the principles disclosed herein, for use in conjunction with a speculum having solid blades. The evacuator 138 comprises a sleeve-like member 139 configured to be retainably received by a speculum blade 136. The sleeve-like member 139 is at least partially hollow and defines a chamber 140 therein. The member 139 includes a perforated interior face 144 which is disposed so as to cover at least a portion of the interior face of the speculum blade 136. Alternatively, the member 139 may cover substantially all of the speculum blade 136 or may only cover a portion of the blade 136. The perforated interior face 144 includes a plurality of openings 146 communicating with the internal chamber 140. The openings 146 are configured so as to permit surgical by-products to pass through the interior face 144 and into the internal chamber 140. The surgical products are then withdrawn from the internal chamber 140 through an evacuation conduit 148 which communicates with the chamber 140. The sleeve-like member 139 defines an opening 142 for the insertion and retention of the blade 136. The sleeve-like member 139 is received by the speculum blade 136 and retained or securedly affixed to the blade. Alternatively, a means for receiving the speculum blade 136 may be affixed to the bottom of the surgical by-product evacuator and thus . obviating the need for the blade receiving opening 142. The surgical by-product evacuator 138 is preferably a disposable item fabricated from synthetic polymeric materials, but alternatively, metals, such as stainless steel may also be employed. The surgical by-product evacuator 138 may be coated with a fluorocarbon polymeric material, such as Teflon, so as to facilitate ease of insertion into a patient and may also be made substantially non-reflective of a laser beam for use in laser surgeries.

Use in Surgical Procedures In order to perform surgery or other medical procedures on the "reproductive tract of a woman, a surgeon or obstetrician/gynecologist must first insert a vaginal speculum into the woman's vagina. The speculum, which may be either εingle-bladed or double-bladed, has at least one blade for contacting and separating the vaginal walls. After inserting the speculum, the surgeon adjusts the blades to an appropriate opening diameter. A conventional suction device having a tubular hose is then connected, to the evacuation conduit which is integral with the hollow speculum blade and the suction device is turned on.

The surgeon then inserts the surgical instrument, such as a laser or other thermal cauterizer, and begins to vaporize infected or unwanted tissue. The vaporization of this tissue produces a plume of gas as well as conventional surgical by-products such as blood. The gas produced by the laser vaporization is then drawn into the speculum blade through the openings on the perforated interior face of the hollow blade and into the chamber defined in the blade. The gas is then withdrawn from the chamber through the evacuation means by the suction device into a collector means which are commonly known in the art. Blood and excised or vaporized tissue are also drawn into the chamber through the openings in the perforated interior space of the speculum and subsequently withdrawn from the chamber through the evacuation means via the suction device. In this manner, no gaseous plume of infectious laser smoke is emitted into the air or surrounding atmosphere of the operating room. ^• The smoke vents directly into the collector means through the speculum blades and does not infect the physician's hands, face or lungs as previously was the case. When the surgery is finished, the surgeon withdraws the speculum and can either dispose of it or have it resterilized for the next procedure if the speculum is fabricated from a material which is capable of withstanding the sterilization pressures and temperatures. An alternative embodiment of the speculum may be utilized during laser surgery wherein one of the hollow blades of the speculum include two or more evacuation conduits in communication with the chamber in the blade as shown in Figure 6. During laser surgery, laser smoke has a tendency to rise while blood and excise tissue by-products are heavier and settle to the bottom of the speculum blade. This embodiment provides two evacuation conduits wherein the upper evacuation conduit is disposed so as to primarily withdraw only the gaseous laser smoke produced during the surgery and the bottom or lower evacuation conduit is disposed so as to withdraw the heavier fluid and solid by-products. The valves on evacuation conduits allow the surgeon to regulate and control the amount of suction to each of the evacuation conduits. For example, if little or no blood or excise tissue is produced during the surgery, the surgeon may want to shut-off the lower evacuation conduit and have just the one conduit removing the laser smoke.

If laser surgery is being performed, the perforated interior faces of the speculum blade are preferably coated with a material which is substantially non-reflective of the wavelength of the laser beam. This decreases the chances for a laser beam at reflect off the speculum blade and reflect back to the physician performing the surgery or reflect to a site which was not intended to be vaporized.

Another embodiment for use with current speculums which have solid blades is a sleeve-like surgical by-product evacuator member. The surgical by- product evacuator member is received on a speculum blade and retained thereon in any number of conventional ways. The evacuation conduit is connected to an evacuator means through the use of a valve and the speculum is inserted to begin the surgical procedure. Surgical by-products such as gas., liquids or solids are drawn into a hollow chamber in the surgical by-product evacuator member through openings on the perforated interior face and are withdrawn through the evacuation conduit by suction means, typically those employed in conventional surgeries such as aspirators or the "Shop-Vac" tank type vacuum. When the surgery is finished, the surgeon simply removes the sleeve-like member from the speculum blade and either disposes it or sends it to be resterilized for use in subsequent procedures.

In light of the foregoing, it should be apparent that many variations are possible within the scope of the present invention. For example, speculums for use during surgery in other parts of the body, such as an otolaryngeal speculum for the throat, may emply all of the above described embodiments. Accordingly, the foregoing drawings, discussion and description are merely meant to be illustrative of particular embodiments of the invention and not limitations upon the practice thereof. It is the following claims including all equivalents, which define the scope of the invention.

Claims

1. A speculum for use^' in surgical procedures including: a blade for contacting and separating tissue so as to allow penetration of a surgical instrument to a tissue site, said blade being at least partially hollow so as to define a chamber therein, said blade including an exterior tissue- contacting face and a perforated interior face defining at least one opening therein in communication with said chamber,* said at least one opening configured to permit surgical by-products to pass therethrough; and evacuation means communicating with said chamber for withdrawing the surgical by-products therefrom.

2. A speculum as in claim 1, including an upper blade and a lower blade.

3. A speculum as in claim 2, wherein one of said blades is at least partially hollow so as to define a chamber therein, said blade including a perforated interior face defining at least one opening therein in communication with said chamber, and the other of said blades is solid.

4. A speculum as in claim 1, wherein said at least one opening is configured as at least one slot.

5. A speculum as in claim 1, wherein ^"said chamber including at least two portions therein having a divider therebetween, said divider configured to permit surgical by-products to pass from one portion to another.

6. A speculum as in claim 5, further including evacuation means communicating with each of said portions of said chambers for withdrawing surgical by-products therefrom.

7. A speculum as in claim 5, wherein at least one of said portions is operative to receive gaseous surgical by-products and the other of said portion is operative to receive fluid and solid surgical by-products.

8. A speculum as in claim 1, wherein said evacuation means includes two evacuation conduits in communication with the chamber, the first conduit disposed so as to primarily withdraw gaseous surgical by-products from the chamber and the second conduit disposed so as to primarily withdraw solid and fluid surgical by-products from the chamber.

9. A speculum as in claim 2, wherein each of said upper and lower blades are at least partially hollow and define an interior chamber therein, and wherein each of said upper and lower blades include an exterior tissue contacting face and a perforated interior face defining at least one opening therein communicating with the chamber, said speculum further including: evacuation means communicating with each of said chambers for withdrawing surgical by-products therefrom.

10. A speculum as in claim 1, wherein said blade is fabricated from a material selected from the group consisting essentially of: synthetic polymeric materials, metals, stainless steel, and combinations thereof.

11. A speculum as in claim 1, wherein at least a portion of said blade is coated with a fluorocarbon polymer.

12. A speculum as in claim 1, wherein said surgical instrument is a laser and said at least one opening is configured to permit passage therethrough of gaseous surgical by-products resultant from interaction of the laser beam with tissue.

13. A speculum as in claim 1, wherein said surgical instrument is a laser producing a preselected wavelength and said interior surface of said blade is substantially non-reflective of the wavelength emitted by said laser.

14. A speculum as in claim 1, configured as a vaginal speculum.

15. A speculum as in claim 1, configured as an otolaryngeal speculum.

16. A speculum as in claim 1, wherein said perforated interior face defines a plurality of openings therein in communication with said chamber, said openings configured to permit surgical by-products to pass therethrough.

17. A speculum as in claim 3 further including a sleeve-shaped member slidably affixable to said solid blade, said sleeve-shaped member being at least partially hollow so as to define a chamber therein and including an exterior tissue contacting face and a perforated interior face defining at least one opening therein in communication with said chamber, said opening configured to permit surgical by-products to pass therethrough.

18. A speculum as in clam 17, further including evacuation means communicating with said chamber for withdrawing the surgical by-products therefrom.

19. A speculum for use in surgical procedures comprising: an upper blade and a lower blade for contacting and separating tissue so as to allow penetration of a surgical laser producing a preselected wavelength, at least one of said blades being at least partially hollow so as to define a chamber therein, said hollow blade including an exterior tissue-contacting face and a perforated interior face having at least one opening therethrough in communication with said chamber, said opening configured to permit surgical by-products to pass therethrough; and evacuation means communicating with said chamber for withdrawing the surgical by-products therefrom.

20. A speculum as in claim 19, wherein said chamber including -a divider defining two portions therein, said divider configured to permit surgical by-products to pass from one portion to another.

21. A speculum as in claim 19, further including evacuation means communicating with each of said portions of said chambers for withdrawing surgical by-products therefrom.

22. A speculum as in claim 19, wherein at least one of said portions is operative to receive gaseous surgical by-products and the other of said portion is operative to receive fluid and solid surgical by-products.

23. A speculum as in claim 19, wherein said evacuation means includes two evacuation conduits in communication with the chamber, the first conduit disposed so as to primarily withdraw gaseous surgical by-products from the chamber and the second conduit disposed so as to primarily withdraw solid and fluid surgical by-products from the chamber.

24. A speculum as in claim 19, wherein each of said upper and lower blades are at least partially hollow and define an interior chamber therein, and wherein each of said upper and lower blades include an exterior tissue contacting face and -a perforated interior face defining at least one opening therein communicating with the chamber, said speculum further including: evacuation means communicating with each of said chambers for withdrawing surgical by-products therefrom.

25. A surgical by-product evacuator for use in conjunction with a speculum, said evacuator comprising: a sleeve-like member configured to be retainably received by a speculum blade, said member being at least partially hollow so as to define an interior chamber and including a perforated face disposed so as to cover at least a portion of the interior face of the speculum blade, said perforated face including at least one opening therethrough communicating with said chamber, said evacuator further including an evacuation conduit communicating with said chamber for withdrawing surgical by-products therefrom.

26. An evacuator as in claim 25, wherein 'said evacuator is fabricated from a material selected from the group consisting essentially of: ^' synthetic polymeric materials, elastomeric polymeric materials, metals, stainless steels and combinations thereof.

27. An evacuator as in claim 25, wherein said sleeve-like member covers substantially all of said speculum blade.

28. An. evacuator as in claim 25, wherein said sleeve-like member covers only a portion of said speculum blade.