The present disclosure relates to an electrosurgical forceps and more particularly, the present disclosure relates to an endoscopic bipolar electrosurgical forceps for coagulating, sealing and/or cutting tissue having a selectively energizable and/or extendable monopolar extension for enhanced electrosurgical effect.
Electrosurgical forceps utilize both mechanical clamping action and electrical energy to effect hemostasis by heating the tissue and blood vessels to coagulate, cauterize and/or seal tissue. As an alternative to open forceps for use with open surgical procedures, many modern surgeons use endoscopes and endoscopic instruments for remotely accessing organs through smaller, puncture-like incisions. As a direct result thereof, patients tend to benefit from less scarring and reduced healing time.
Endoscopic instruments are inserted into the patient through a cannula, or port, which has been made with a trocar. Typical sizes for cannulas range from three millimeters to twelve millimeters. Smaller cannulas are usually preferred, which, as can be appreciated, ultimately presents a design challenge to instrument manufacturers who must find ways to make endoscopic instruments that fit through the smaller cannulas.
Many endoscopic surgical procedures require cutting or ligating blood vessels or vascular tissue. Due to the inherent spatial considerations of the surgical cavity, surgeons often have difficulty suturing vessels or performing other traditional methods of controlling bleeding, e.g., clamping and/or tying-off transected blood vessels. By utilizing an electrosurgical scissors, the surgeon may cut tissue during a given surgical procedure utilizing a combination of mechanical cutting action and electrosurgical cutting. By utilizing an endoscopic electrosurgical forceps, a surgeon can cauterize, coagulate/desiccate and/or simply reduce or slow bleeding simply by controlling the intensity, frequency and duration of the electrosurgical energy applied through the jaw members to the tissue.
For treating larger vessels, a surgeon may opt to seal the tissue or vessel. Tissue sealing is fundamentally different than simply coagulating or cauterizing vessels. For the purposes herein, “coagulation” is defined as a process of desiccating tissue wherein the tissue cells are ruptured and dried. “Vessel sealing” or “tissue sealing” is defined as the process of liquefying the collagen in the tissue so that it reforms into a fused mass with limited demarcation between adjacent tissue structures. In order to effectively seal larger vessels (or tissue) two predominant mechanical parameters must be accurately controlled—the pressure applied to the vessel (tissue) preferably about 3 kg/cm2 to about 16 kg/cm2 and the gap distance between the electrodes preferably about 0.001 inches to about 0.006 inches. Several examples of endoscopic vessel sealing instruments are disclosed in commonly-owned U.S. patent application Ser. Nos. 10/116,944, 10/179,863, 10/369,894 and 10/180,926 and PCT/US01/11340 the entire contents of all of which are hereby incorporated by reference herein.
Generally, the electrical configuration of electrosurgical forceps can be categorized in two classifications: 1) monopolar electrosurgical forceps; and 2) bipolar electrosurgical forceps. Monopolar forceps utilize one active electrode associated with the clamping end effector and a remote patient return electrode or pad which is attached externally to the patient. When the electrosurgical energy is applied, the energy travels from the active electrode, to the surgical site, through the patient and to the return electrode.
Bipolar electrosurgical forceps utilize two generally opposing electrodes which are disposed on the inner opposing surfaces of end effectors and which are both electrically coupled to an electrosurgical generator. Each electrode is charged to a different electric potential. Since tissue is a conductor of electrical energy, when the effectors are utilized to grasp, seal or cut tissue therebetween, the electrical energy can be selectively transferred through the tissue.
One of the inherent disadvantages to utilizing a bipolar endoscopic forceps for cauterizing, coagulating cutting or sealing vessels and other tissues is the inability of the bipolar forceps to match the benefits or advantages of monopolar instruments (i.e., monopolar instruments have the ability to move through avascular tissue and dissect through narrow tissue planes) necessitating the need for the surgeon to replace the bipolar forceps during surgery to reap the benefits of using the monopolar instrument for certain applications. Likewise, during some monopolar endoscopic applications it may be advantageous to replace the monopolar instrument with a bipolar forceps, e.g., for sealing large tissue structures. For example, during a cholecystectomy the gallbladder is dissected from the liver which would typically entail using an endoscopic monopolar instrument, e.g., electrosurgical blade, electrosurgical pencil, loop electrode, etc. However, during the cholecystectomy procedure there may also be a need to seal the cystic duct or cystic artery which may require a bipolar vessel sealing instrument necessitating the need to replace the monopolar instrument. The surgeon may need to repeatedly remove the monopolar instrument from the operating cavity to utilize the bipolar instrument and vice versa.
Thus there exists a need to develop an instrument which can combine the benefits of both monopolar and bipolar operation thereby reducing the need for the surgeon to substitute instruments during surgical certain procedures.
The present disclosure relates to an endoscopic forceps for treating tissue and includes a housing having a shaft affixed thereto and first and second jaw members attached to a distal end of the shaft. The forceps also includes an actuator for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. A source of electrosurgical energy is connected to each jaw member such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween to treat tissue. The forceps also includes a monopolar element housed within at least the first jaw member which is selectively movable from a first position within the first jaw member to a second position distal to the first jaw member. The monopolar element is connected to the source of electrosurgical energy and is selectively activateable independent of the jaw members.
In one embodiment according to the present disclosure, the forceps includes a knife which is selectively moveable within a knife channel defined within at least one of the first and second jaw members to cut tissue disposed between the first and second jaw members. Advantageously, a knife actuator allows a user to selectively move the knife to cut tissue disposed between the jaw members. The source of electrosurgical energy carries electrical potentials to each respective jaw member such that the jaw members are capable of conducting bipolar energy through tissue held therebetween to effect a tissue seal.
Advantageously, the knife is designed to initially cut tissue disposed between the first and second jaw members and subsequently extend distally from the jaw members to treat tissue in a monopolar fashion. Preferably, the forceps includes a safety (e.g. a safety circuit or mechanical safety element) which only allows electrical activation of the knife (or monopolar element) when the knife (or monopolar element) is extended from the distal ends of the jaw members. The safety may also deactivate the jaw members through circuitry or utilizing a mechanical safety element.
In one embodiment, the first jaw member and the second jaw member each include an elongated slot which runs in opposition substantially along the respective lengths thereof such that the two opposing elongated slots form the knife channel for reciprocating the knife to divide tissue disposed between the two jaw members.
In another embodiment, the forceps is a vessel sealing forceps and at least one of the jaw members includes at least one non-conductive stop member disposed thereon which controls the distance between the first and second jaw members when tissue is held therebetween. Advantageously, the stop member(s) maintains a gap distance of about 0.001 inches to about 0.006 inches between the jaw members when tissue is compressed between the jaw members.
In yet another embodiment according to the present disclosure, the forceps includes an actuator which operates to both move the knife to cut tissue disposed between jaw members and to extend the knife or a separate monopolar element from the first position within the first jaw member to the second position distal to the first jaw member. In still yet another embodiment according to the present disclosure, the forceps includes an actuator which operates to both move the jaw members relative to one another from the first to second positions to grasp tissue therebetween and to extend the monopolar element from the first position within the first jaw member to the second position distal to the first jaw member.
In another embodiment according to the present disclosure, a first actuator may be designed to operate the jaw members for grasping tissue and a second actuator may be included which operates to extend the monopolar element from the first position within the first jaw member to the second position distal to the first jaw member.
The present disclosure also relates to an endoscopic forceps which includes a housing having a shaft affixed thereto and first and second jaw members attached to a distal end of the shaft. The first jaw member is configured to extend distally relative to the second jaw member. A actuator is includes for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. The jaw members are connected to a source of electrosurgical energy such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween.
The forceps also includes a control switch which, upon selective activation, deactivates the second jaw member and activates the first jaw member with a first electrical potential. At relatively the same time, the control switch also activates a return electrode or return pad with a different electrical potential which is placed adjacent to the patient to enable the first jaw member to selectively treat tissue in a monopolar fashion. Preferably, a safety is included which limits electrical activation of the control switch to when the jaw members are disposed in the second position.
The present disclosure also relates to an endoscopic forceps which includes a housing having a shaft affixed thereto. The shaft includes first and second jaw members attached to a distal end thereof. Preferably, the first and second jaw members each include a tapered or elongated distal end. The forceps also includes an actuator for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. A source of electrosurgical energy is connected to each jaw member such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween.
A control switch is also included which, upon selective activation thereof, activates the first jaw member and the second jaw member with a first electrical potential and activates a return electrode with a different electrical potential. The return electrode is preferably placed adjacent to the patient which enables the first and second jaw members to selectively treat tissue in a monopolar fashion. Preferably, the forceps includes a safety which only allows electrical activation of the control switch when the jaw members are disposed in the second position.
In another embodiment of the present disclosure, the actuator is selectively lockable to maintain a closure pressure in the range of about 3 kg/cm2 to about 16 kg/cm2 and, preferably, about 7 kg/cm2 to about 13 kg/cm2 between the jaw members which is advantageous in producing effective and reliable tissue seals. In yet another embodiment, the forceps may also include a rotating assembly for rotating the jaw members about a longitudinal axis defined through the shaft. Advantageously, the forceps includes a unilateral jaw assembly, i.e., the first jaw member is movable relative to the second jaw member and the second jaw member is substantially fixed. Attentively, the forceps may include a bilateral jaw assembly, i.e., both jaw members move relative to one another.
Preferably, a spring is included with the actuator or drive assembly to facilitate actuation of the movable handle and to assure the closure force is maintained within a working range of about 3kg/cm2 to about 16 kg/cm2.
In yet another embodiment, the monopolar element is housed within at least the first jaw member and is integrally associated with the knife. In this particular embodiment, the monopolar element is selectively movable with the knife from a first position within the first jaw member to a second position distal to the first jaw member. Preferably, the knife channel includes a first knife channel defined within one of the jaw members and a second knife channel disposed within the other of the jaw members wherein the second knife channel is wider than the first knife channel to allow reciprocation of the monopolar element therethrough.
Preferably, the first jaw member includes an aperture defined in the distal end thereof which permits selective distal translation of the monopolar element therethrough for monopolar treatment of tissue. A safety may also be included which only allows electrical activation of the monopolar element when the monopolar element is extended from the distal end of the first jaw member. Preferably, a trigger operates to move both the knife to divide tissue disposed between the jaw members and to extend the monopolar element from the first position within the first jaw member to the second position distal to the first jaw member.
The present disclosure also relates to a method for treating tissue with electrosurgical energy from an electrosurgical generator which includes the steps of: providing an endoscopic forceps including a housing having a shaft affixed thereto. The shaft includes first and second jaw members attached to a distal end thereof. An actuator is included for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. A monopolar element is also included which is housed within at least the first jaw member and selectively movable from a first position within the first jaw member to a second position distal to the first jaw member. A return electrode is provided and placed in contact with patient tissue.
The method also includes the steps of: connecting to each jaw member, the monopolar element and the return electrode to the electrosurgical generator; grasping tissue between the jaw members; selectively activating the jaw members to treat tissue disposed between the jaw members in a bipolar fashion; and selectively activating the monopolar element and the return electrode independent of the jaw members to treat tissue in a monopolar fashion.
Preferably, after the step of selectively activating the jaw members to treat tissue, the method includes the step of: extending the monopolar element from the distal end of the jaw members. Advantageously, the step of selectively activating the monopolar element includes deactivating the jaw members.
After the step of selectively activating the jaw members to treat tissue, the method may include the step of: releasing the tissue from the jaw members.
Various embodiments of the subject instrument are described herein with reference to the drawings wherein:
Turning now to
Forceps 10 generally includes a housing 20, a handle assembly 30, a rotating assembly 80, a trigger assembly 70 and an end effector assembly 100 which mutually cooperate to grasp, treat and divide tissue. For the purposes herein, the handle assembly 30, rotating assembly, trigger assembly 70 and end effector assembly 100 are only generally described. A more detailed explanation of all of these cooperating elements are described in commonly owned, co-pending U.S. patent application Ser. No. 10/460,926 the entire contents of which is hereby incorporated by reference herein.
Forceps 10 includes a shaft 12 which has a distal end 16 dimensioned to mechanically engage the end effector assembly 100 and a proximal end 14 which mechanically engages the housing 20. In the drawings and in the descriptions which follow, the term “proximal”, as is traditional, will refer to the end of the forceps 10 which is closer to the user, while the term “distal” will refer to the end which is further from the user. Details of how the shaft 12 connects to the end effector assembly 100 and how the proximal end connects to the housing 20 are explained in the above-mentioned commonly owned, co-pending U.S. patent application Ser. No. 10/460,926.
As best seen in
Preferably, the generator 300 includes various safety and performance features including isolated output, independent activation of accessories. Preferably, the electrosurgical generator 300 includes Valleylab's Instant Response™ technology which provides an advanced feedback system to sense changes in tissue 200 times per second and adjust voltage and current to maintain appropriate power.
Handle assembly 30 includes a fixed handle 50 and a movable handle 40. Fixed handle 50 is integrally associated with housing 20 and handle 40 is movable relative to fixed handle 50. Rotating assembly 80 is preferably integrally associated with the housing 20 and is rotatable approximately 180 degrees in either direction about a longitudinal axis “A”. Details of the handle assembly 30 and the rotating assembly 80 are described in more detail with respect to U.S. patent application Ser. No. 10/460,926.
As mentioned above, end effector assembly 100 is attached at the distal end 16 of shaft 12 and includes a pair of opposing jaw members 110 and 120. Movable handle 40 of handle assembly 30 is ultimately connected to an internally disposed drive assembly (not shown) which, together, mechanically cooperate to impart movement of the jaw members 110 and 120 from an open position wherein the jaw members 110 and 120 are disposed in spaced relation relative to one another, to a clamping or closed position wherein the jaw members 110 and 120 cooperate to grasp tissue therebetween.
Turning now to the more detailed features of one embodiment of the present disclosure as described with respect to
The lower end of the movable handle 40 includes a flange 90 which, upon movement of the handle 40 proximally, is reciprocated within fixed handle 50. Flange 90 rides within a predefined channel (not shown) disposed within fixed handle 50 to lock the movable handle 40 relative to the fixed handle 50.
As best shown in
As explained in detail in co-pending U.S. patent application Ser. No. 10/460,926, movable handle 40 is designed to provide a distinct mechanical advantage over conventional handle assemblies due to the unique position of the pivot point relative to the longitudinal axis “A” of the shaft 12. In other words, by positioning the pivot point above the driving element, the user gains lever-like mechanical advantage to actuate the jaw members 110 and 120 enabling the user to close the jaw members 110 and 120 with lesser force while still generating the required forces necessary to effect a proper and effective tissue seal. It is also envisioned that the unilateral design of the end effector assembly 100 will also increase mechanical advantage.
As best seen in
More particularly, the unilateral end effector assembly 100 includes one stationary or fixed jaw member 120 mounted in fixed relation to the shaft 12 and pivoting jaw member 110 mounted about a pivot pin 103 attached to the stationary jaw member 120. A reciprocating sleeve 60 is slidingly disposed within the shaft 12 and is remotely operable by the drive assembly (not shown) which cooperates with handle 40 as explained above to open and close the jaw members 110 and 120. The pivoting jaw member 110 includes a detent or protrusion 117 which extends from jaw member 110 through an aperture 62 disposed within the reciprocating sleeve 60 (
Once actuated, handle 40 moves in a generally arcuate fashion towards fixed handle 50 about the pivot point which forces the driving flange (not shown) proximally against the drive assembly (not shown) which, in turn, pulls reciprocating sleeve 60 in a generally proximal direction to close jaw member 110 relative to jaw member 120. Moreover, proximal rotation of the handle 40 causes the locking flange 44 to release, i.e., “unlock” the trigger assembly 70 for selective actuation. These features are shown and explained in detail with reference to commonly-owned, co-pending U.S. application Ser. No. 10/460,926.
As best illustrated in
As best shown in
All of produce jaw member 110 having an electrically conductive surface 112 which is substantially surrounded by an insulating substrate 114. The insulator 114, electrically conductive sealing surface 112 and the outer, non-conductive jaw housing 116 are preferably dimensioned to limit and/or reduce many of the known undesirable effects related to tissue sealing, e.g., flashover, thermal spread and stray current dissipation.
As best seen in
Preferably, the electrically conductive surface 112 and the insulator 114, when assembled, form the longitudinally-oriented knife slot 115a defined therethrough for reciprocation of the knife blade 185. As mentioned above, knife channel 115a cooperates with corresponding knife channel 115b defined in stationary jaw member 120 to facilitate longitudinal translation of the knife blade 185 along a preferred cutting plane to effectively and accurately separate tissue along the formed tissue seal.
Jaw member 120 includes similar elements to jaw member 110 such as jaw housing 126 having an insulator 124 and an electrically conductive sealing surface 122 which is dimensioned to securely engage the insulator 124. Likewise, the electrically conductive surface 122 and the insulator 124, when assembled, include longitudinally-oriented channel 115b defined therethrough for reciprocation of the knife blade 185. As mentioned above, when the jaw members 110 and 120 are closed about tissue 420, knife channels 115a and 115b form a complete knife channel 115 to allow longitudinal translation of the knife 185 in a distal fashion to sever tissue along the tissue seal.
As mentioned above, jaw member 120 may include a series of stop members 150a-150c preferably disposed on the inner facing surfaces of the electrically conductive sealing surface 122 to facilitate gripping and manipulation of tissue and to define a gap “G” (
Jaw member 120 is designed to be fixed to the end of a rotating tube (not shown) which is part of the rotating assembly 80 such that rotation of the tube will impart rotation to the end effector assembly 100. Jaw member 120 is connected to a second electrical potential through the rotating tube (not shown) which is connected at its proximal end to a lead 310c from cable 310. Details relating to the mechanical and electromechanical engagement of the jaw member 120 to the rotating assembly 80 are described in above-mentioned, commonly-owned, co-pending U.S. patent application Ser. No. 10/460,926.
As mentioned above, the jaw members 110 and 120 may be opened, closed and rotated to manipulate tissue until sealing is desired. This enables the user to position and re-position the forceps 10 prior to activation and sealing. As illustrated in
Again as best shown in
The trigger assembly 70 is designed to cooperate with a drive bar 64 which connects to the knife assembly 180. Proximal activation of the finger actuator 71 rotates the trigger assembly 70 about pivot pin 73 which, in turn, forces the drive bar 64 distally, which ultimately extends the knife 185 through tissue. A spring (not shown) may be employed to bias the knife assembly 180 in a retracted position such that after severing tissue the knife 185 and the knife assembly 180 are automatically returned to a pre-firing position. In addition, when the handle 40 is actuated and flange 90 is fully reciprocated within fixed handle 50, the locking flange 44 moves proximally allowing activation of the trigger assembly 70.
As best shown in
As explained in detail above, the second electrical potential (i.e., lead 310c) is conducted to jaw member 120 through the rotating tube. The two potentials are preferably isolated from one another by insulative sheathing (or the like) which surrounds the trigger lead. Preferably, the jaw members 110 and 120 are electrically isolated from one another such that bipolar electrosurgical energy can be effectively transferred through the tissue to form a tissue seal.
Once the desired position for the sealing site is determined and the jaw members 110 and 120 are properly positioned, handle 40 may be compressed fully such that the flange 90 is reciprocated and locked within fixed handle 50. Handle 40 is now secured in position relative to fixed handle 50 which, in turn, locks the jaw members 110 and 120 in a closed position about tissue. The forceps 10 is now ready for selective application of electrosurgical energy and subsequent separation of tissue, i.e., when movable handle 10 reciprocates within fixed handle 50, locking flange 44 moves into a position to permit activation of the trigger assembly 70 as explained above.
As can be appreciated, the combination of the mechanical advantage of the over-the-center pivot along with the assisting compressive forces associated with a compression spring (not shown) facilitate and assure consistent, uniform and accurate closure pressure about tissue within the desired working pressure range of about 3 kg/cm2 to about 16 kg/cm2 and, preferably about 7 kg/cm2 to about 13 kg/cm2. As mentioned above, at least one jaw member, e.g., 120, may include a stop member e.g., 150a, which limits the movement of the two opposing jaw members 110 and 120 relative to one another. Preferably, a series of stop members are to yield a consistent and accurate gap distance “G” during sealing (
As energy is being selectively transferred to the end effector assembly 100, across the jaw members 110 and 120 and through the tissue, a tissue seal forms isolating two tissue halves. At this point and with other known vessel sealing instruments, the user must remove and replace the forceps 10 with a cutting instrument (not shown) to divide the tissue halves along the tissue seal which is both time consuming and tedious and may result in inaccurate tissue division across the tissue seal due to misalignment or misplacement of the cutting instrument along the ideal tissue cutting plane.
The present disclosure incorporates knife assembly 180 which, when activated via the trigger assembly 70, progressively and selectively divides the tissue along an ideal tissue plane in precise manner to effectively and reliably divide the tissue. The knife assembly 180 allows the user to quickly separate the tissue immediately after sealing without substituting a cutting instrument through a cannula or trocar port. As can be appreciated, accurate sealing and dividing of tissue is accomplished with the same forceps 10.
Once the tissue is divided into tissue halves, the jaw members 110 and 120 may be opened by re-grasping the handle 40 which release the flange 90 from fixed handle 50. Details relating to the releasing of the flange from handle are described in commonly-owned, co-pending U.S. application Ser. No. 10/460,926.
Tuming now to the operating characteristics of the present disclosure and as seen in the majority of the figures, forceps 10 is designed for both bipolar electrosurgical treatment of tissue (either by vessel sealing as described above or coagulation or cauterization with other similar instruments) and monopolar treatment of tissue. For example,
Preferably, the monopolar element 154 is connected to a reciprocating rod 65 which extends through an elongated notch 13 in the outer periphery of the shaft 12 as best seen in
It is envisioned that the trigger assembly 70 may be designed such that the monopolar element 154 may be extended when the jaw members 110 and 120 are in the open position. For example, the trigger 71 may be moved distally (or upwardly) from its original, rested, neutral or pre-actuated position to advance the monopolar element 154. Alternatively, the monopolar element 154 may be advanced irrespective of the orientation of the jaw ,members 110 and 120. For example, the trigger assembly 70 could be designed such that the it can be moved laterally (i.e., perpendicular to the longitudinal axis “A”) to advance the monopolar element 154 or the trigger assembly 70 could be designed such that the monopolar element 154 is extendible when the trigger 71 is moved to a proximal-most position (i.e., past the “cut” position as described above) and/or when the trigger 71 is advanced distally from the neutral or pre-actuated orientation. A return spring (not shown) may be included to return the monopolar element 154 to a non-extended position upon release of the trigger 71.
Upon extension of the monopolar element 154, the generator 300 is preferably configured to automatically switch the forceps 10 from a bipolar activation mode (i.e., deactivating energy delivery to jaw members 110 and 120) to a monopolar activation mode (i.e., activating the monopolar element 154). As can be appreciated, the forceps 10 may also (or alternatively) be configured for manual switching between the bipolar activation mode and the monopolar activation mode.
As described above, when the forceps 10 is configured for bipolar operation, the activation of switch 200 transfers energy from jaw member 110 through the tissue and to jaw member 120 to treat tissue. In the monopolar mode, activation of switch 200 (or a separate switch, e.g., a footswitch), transfers energy to the monopolar element 154, through the tissue and to a return electrode 550, e.g., a return pad, placed adjacent to or in contact with the patient. The monopolar activation mode allows the monopolar element 154 to quickly treat avascular tissue structures and/or quickly dissect narrow tissue planes. Generally, this type of monopolar activation is common throughout the variously-described embodiments shown in the accompanying figures.
As can be appreciated, it is also envisioned that the trigger assembly 70 may be electrically configured to transmit electrical energy to the monopolar element 154 when extended. For example, the trigger assembly 70 may be configured such that proximal-most actuation of the trigger 71 (
For example and as depicted in the activation sequence shown in
It is envisioned that once the knife 185 extends beyond the jaw members 110 and 120, a safety or switch deactivates energizing circuitry to the jaw members 110 and 120 and activates the energizing circuitry to the knife 185 such that activation of the switch 200 energizes the knife 185 and the jaw members remain neutral. For example, the stop 119 may act as a safety switch such that upon being forced by the knife 185 out of or away from the knife channel 115, the stop 119 deactivates circuitry to the jaw members 110 and 120 and activates circuitry to the monopolar knife 185 and the return electrode 550. A separate lead 69 may be used to electrically communicate with the generator 300. As can be appreciated, the knife 185 may now be used in a monopolar fashion to treat tissue.
Upon release of the trigger 71, the knife 185 automatically retracts into the knife channel 115 and back to the pre-actuated position as shown in
A control switch 500 is preferably included which regulates the transition between bipolar mode and monopolar mode. Control switch 500 is connected to generator 300 via cables 360 and 370. A series of leads 510, 520 and 530 are connected to the jaw members 110, 120 and the return electrode 550, respectively. As best shown in the table depicted in
In a monopolar mode, jaw member 110″ and 120″ are both energized with the same electrical potential and the return pad 550 is energized with a second electrical potential forcing the electrical current to travel from the jaw members 110″ and 120″, through the tissue and to the return electrode 550. This enables the jaw members 110″ and 120″ to treat tissue in a monopolar fashion which, as mentioned above, advantageously treats avascular tissue structures and/or allows quick dissection of narrow tissue planes. As can be appreciated, all of the leads 510, 520 and 530 may be deactivated when the forceps 10″ is turned off or idle.
It is envisioned that the tissue sealing surface 522 may be curved or straight depending upon a particular surgical purpose. The jaw housing 524 preferably is overmolded to encapsulate the hem 535 of the skeleton 530 and sealing plate 522 which serves to insulate surrounding tissue from the conductive surfaces of the sealing plate 522 as well as give the jaw member 520 a desired shaped at assembly.
It is envisioned that the insulating material 634 will isolate the monopolar portion 632 during electrical activation of tissue surface 622 and isolate the tissue surface 622 during electrical activation of monopolar element 632. As can be appreciated, the two different electrically conductive elements 622 and 632 are connected to electrical generator 300 by different electrical connections and may be selectively activated by the user. Various switches or electrical control elements or the like (not shown) may be employed to accomplish this purpose. Preferably, the tip 632 is substantially blunt to avoid accidental mechanical cutting or injury.
As best shown in
As can be appreciated various switching algorithms may be employed to activate both the bipolar mode for vessel sealing and the monopolar mode for additional tissue treatments (e.g., dissection). It is also envisioned that a safety or lockout may be employed either electrically, mechanically or electromechanically to “lock out” one electrical mode during activation of the other electrical mode. In addition, it is contemplated that a toggle switch (or the like) may be employed to activate one mode at a time for safety reasons. The monopolar element 754 may also include a safety (either mechanical, electrical or electromechanical—not shown) which only allows electrical activation of the monopolar element 754 when the monopolar element 754 is extended from the distal end of jaw member 720.
Tissue sealing surface 822 also includes a sealing surface extension 822b which extends through a distal end 824a of the overmolded jaw housing 824. As can be appreciated, sealing surface extension 822b is designed for monopolar tissue dissection, enterotomies or other surgical functions and may be separately electrically energized by the user by a hand switch, footswitch or at the generator 300 in a similar manner as described above. As can be appreciated, the extension 822b also serves to further anchor the sealing plate 822 in the jaw housing 824 during the overmolding process.
Although the general operating components and inter-cooperating relationships among these components have been generally described with respect to a vessel sealing forceps 10, other instruments may also be utilized which can be configured to allow a surgeon to selectively treat tissue in both a bipolar and monopolar fashion. For example, bipolar grasping and coagulating instruments, cauterizing instruments, bipolar scissors, etc.
The present disclosure also relates to a method for treating tissue with electrosurgical energy from the electrosurgical generator 300 which includes the steps of: providing an endoscopic forceps 10 including a housing 20 having a shaft 12 affixed thereto. The shaft 12 includes first and second jaw members, 110 and 120, respectively, attached to a distal end of the shaft 12. An actuator or handle assembly 30 is included for moving jaw members 110 and 120 relative to one another from a first position wherein the jaw members 110 and 120 are disposed in spaced relation relative to one another to a second position wherein the jaw members 110 and 120 cooperate to grasp tissue therebetween. A monopolar element 154 is also included which is housed within at least the first jaw member 120 and selectively movable from a first position within the first jaw member 120 to a second position distal to the first jaw member 120. A return electrode 550 is provided and placed in contact with patient tissue.
The method also includes the steps of: connecting to each jaw member 110 and 120, the monopolar element 154 and the return electrode 550 to the electrosurgical generator 300; grasping tissue between the jaw members 110 and 120; selectively activating the jaw members 110 and 120 to treat tissue disposed between the jaw members 110 and 120 in a bipolar fashion; and selectively activating the monopolar element 154 and the return electrode 550 independent of the jaw members 110 and 120 to treat tissue in a monopolar fashion.
Preferably, after the step of selectively activating the jaw members 110 and 120 to treat tissue, the method includes the step of: extending the monopolar element 154 from the distal end of the jaw members 110 and 120. Advantageously, the step of selectively activating the monopolar element 154 includes deactivating the jaw members 110 and 120.
After the step of selectively activating the jaw members 110 and 120 to treat tissue, the method may include the step of: releasing the tissue from the jaw members 110 and 120.
From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. For example, it may be preferable to add other features to the forceps 10, e.g., an articulating assembly to axially displace the end effector assembly 100 relative to the elongated shaft 12.
It is envisioned that the forceps 10 may be designed such that it is fully or partially disposable depending upon a particular purpose or to achieve a particular result. For example, end effector assembly 100 may be selectively and releasably engageable with the distal end 16 of the shaft 12 and/or the proximal end 14 of shaft 12 may be selectively and releasably engageable with the housing 20 and the handle assembly 30. In either of these two instances, the forceps 10 would be considered “partially disposable” or “reposable”, i.e., a new or different end effector assembly 100 (or end effector assembly 100 and shaft 12) selectively replaces the old end effector assembly 100 as needed. As can be appreciated, the presently disclosed electrical connections would have to be altered to modify the instrument to a reposable forceps.
Moreover, it is envisioned that the switch 200 may be decommissioned during the cutting process. Decommissioning the switch 200 when the trigger 71 is actuated eliminates unintentionally activating the forceps during the cutting process. It is also envisioned that the switch 200 may be disposed on another part of the forceps 10, e.g., the fixed handle 40, rotating assembly 80, housing 20, etc.
While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
This application is a Continuation Application claiming the benefit of and priority to U.S. application Ser. No. 10/970,307, filed Oct. 21, 2004 now U.S. Pat. No. 7,232,440, which claims the benefit of priority to U.S. Provisional Application Ser. No. 60/520,579 filed on Nov. 17, 2003 by Lawes et al. Entitled “BIPOLAR FORCEPS HAVING MONOPOLAR EXTENSION” the entire contents of which being incorporated by reference herein.
Number | Name | Date | Kind |
---|---|---|---|
371664 | Brannan et al. | Oct 1887 | A |
702472 | Pignolet | Jun 1902 | A |
728883 | Downes | May 1903 | A |
1586645 | Bierman | Jun 1926 | A |
1813902 | Bovie | Jul 1931 | A |
2002594 | Wappler et al. | May 1935 | A |
2011169 | Wappler | Aug 1935 | A |
2031682 | Wappler et al. | Feb 1936 | A |
2176479 | Willis | Oct 1939 | A |
2279753 | Knopp | Apr 1942 | A |
2305156 | Grubel | Dec 1942 | A |
2632661 | Cristofv | Mar 1953 | A |
2668538 | Baker | Feb 1954 | A |
2796065 | Kapp | Jun 1957 | A |
3459187 | Pallotta | Aug 1969 | A |
3643663 | Sutter | Feb 1972 | A |
3651811 | Hildebrandt et al. | Mar 1972 | A |
3720896 | Beierlein | Mar 1973 | A |
3862630 | Balamuth | Jan 1975 | A |
3863339 | Reaney et al. | Feb 1975 | A |
3866610 | Kletschka | Feb 1975 | A |
3911766 | Fridolph et al. | Oct 1975 | A |
3920021 | Hiltebrandt | Nov 1975 | A |
3921641 | Hulka | Nov 1975 | A |
3938527 | Rioux et al. | Feb 1976 | A |
3952749 | Fridolph et al. | Apr 1976 | A |
3970088 | Morrison | Jul 1976 | A |
3987795 | Morrison | Oct 1976 | A |
4005714 | Hiltebrandt | Feb 1977 | A |
4041952 | Morrison, Jr. et al. | Aug 1977 | A |
4043342 | Morrison, Jr. | Aug 1977 | A |
4074718 | Morrison, Jr. | Feb 1978 | A |
4088134 | Mazzariello | May 1978 | A |
4112950 | Pike | Sep 1978 | A |
4127222 | Adams | Nov 1978 | A |
4128099 | Bauer | Dec 1978 | A |
4165746 | Burgin | Aug 1979 | A |
4233734 | Bies | Nov 1980 | A |
4300564 | Furihata | Nov 1981 | A |
D263020 | Rau, III | Feb 1982 | S |
4370980 | Lottick | Feb 1983 | A |
4375218 | DiGeronimo | Mar 1983 | A |
4416276 | Newton et al. | Nov 1983 | A |
4418692 | Guay | Dec 1983 | A |
4452246 | Bader et al. | Jun 1984 | A |
4492231 | Auth | Jan 1985 | A |
4552143 | Lottick | Nov 1985 | A |
4574804 | Kurwa | Mar 1986 | A |
4597379 | Kihn et al. | Jul 1986 | A |
4600007 | Lahodny et al. | Jul 1986 | A |
4655215 | Pike | Apr 1987 | A |
4655216 | Tischer | Apr 1987 | A |
4657016 | Garito et al. | Apr 1987 | A |
4662372 | Sharkany et al. | May 1987 | A |
4671274 | Sorochenko | Jun 1987 | A |
4685459 | Xoch et al. | Aug 1987 | A |
D295893 | Sharkany et al. | May 1988 | S |
D295894 | Sharkany et al. | May 1988 | S |
4754892 | Retief | Jul 1988 | A |
4763669 | Jaeger | Aug 1988 | A |
4827929 | Hodge | May 1989 | A |
4846171 | Kauphusman et al. | Jul 1989 | A |
4887612 | Esser et al. | Dec 1989 | A |
4938761 | Ensslin | Jul 1990 | A |
4985030 | Melzer et al. | Jan 1991 | A |
5007908 | Rydell | Apr 1991 | A |
5026370 | Lottick | Jun 1991 | A |
5035695 | Weber, Jr. et al. | Jul 1991 | A |
5084057 | Green et al. | Jan 1992 | A |
5099840 | Goble et al. | Mar 1992 | A |
5116332 | Lottick | May 1992 | A |
5147357 | Rose et al. | Sep 1992 | A |
5151102 | Xamiyama et al. | Sep 1992 | A |
5176695 | Dulebohn | Jan 1993 | A |
5190541 | Abele et al. | Mar 1993 | A |
5196009 | Kirwan, Jr. | Mar 1993 | A |
5197964 | Parins | Mar 1993 | A |
5215101 | Jacobs et al. | Jun 1993 | A |
5217457 | Delahuerga et al. | Jun 1993 | A |
5217458 | Parins | Jun 1993 | A |
5217460 | Knoepfler | Jun 1993 | A |
5219354 | Choudhury et al. | Jun 1993 | A |
5244462 | Delahuerga et al. | Sep 1993 | A |
5250047 | Rydell | Oct 1993 | A |
5250063 | Abidin et al. | Oct 1993 | A |
5258001 | Corman | Nov 1993 | A |
5258006 | Rydell et al. | Nov 1993 | A |
5261918 | Phillips et al. | Nov 1993 | A |
5275615 | Rose | Jan 1994 | A |
5277201 | Stern | Jan 1994 | A |
5282799 | Rydell | Feb 1994 | A |
5290286 | Parins | Mar 1994 | A |
5304203 | El-Mallawany et al. | Apr 1994 | A |
5308357 | Lichtman | May 1994 | A |
5314445 | Degwitz et al. | May 1994 | A |
5318589 | Lichtman | Jun 1994 | A |
5324289 | Eggers | Jun 1994 | A |
5326806 | Yokoshima et al. | Jul 1994 | A |
5330471 | Eggers | Jul 1994 | A |
5334183 | Wuchinich | Aug 1994 | A |
5334215 | Chen | Aug 1994 | A |
5336220 | Ryan et al. | Aug 1994 | A |
5336221 | Anderson | Aug 1994 | A |
5342359 | Rydell | Aug 1994 | A |
5342381 | Tidemand | Aug 1994 | A |
5342393 | Stack | Aug 1994 | A |
5344424 | Roberts et al. | Sep 1994 | A |
5352222 | Rydell | Oct 1994 | A |
5354271 | Voda | Oct 1994 | A |
5356408 | Rydell | Oct 1994 | A |
5366477 | LeMarie, III et al. | Nov 1994 | A |
5368600 | Failla et al. | Nov 1994 | A |
5376089 | Smith | Dec 1994 | A |
5383897 | Wholey | Jan 1995 | A |
5389098 | Tsuruta et al. | Feb 1995 | A |
5389104 | Hahnen et al. | Feb 1995 | A |
5391166 | Eggers | Feb 1995 | A |
5391183 | Janzen et al. | Feb 1995 | A |
5396900 | Slater et al. | Mar 1995 | A |
5403312 | Yates et al. | Apr 1995 | A |
5411519 | Tovey et al. | May 1995 | A |
5411520 | Nash et al. | May 1995 | A |
5413571 | Katsaros et al. | May 1995 | A |
5415657 | Taymor-Luria | May 1995 | A |
5422567 | Matsunaga | Jun 1995 | A |
5423810 | Goble et al. | Jun 1995 | A |
5425690 | Chang | Jun 1995 | A |
5425739 | Jessen | Jun 1995 | A |
5429616 | Schaffer | Jul 1995 | A |
5431672 | Cote et al. | Jul 1995 | A |
5431674 | Basile et al. | Jul 1995 | A |
5437292 | Kipshidze et al. | Aug 1995 | A |
5438302 | Goble | Aug 1995 | A |
5441517 | Kensey et al. | Aug 1995 | A |
5443463 | Stern et al. | Aug 1995 | A |
5443464 | Russell et al. | Aug 1995 | A |
5443480 | Jacobs et al. | Aug 1995 | A |
5445638 | Rydell et al. | Aug 1995 | A |
5445658 | Durrfeld et al. | Aug 1995 | A |
5451224 | Goble et al. | Sep 1995 | A |
5456684 | Schmidt et al. | Oct 1995 | A |
5458598 | Feinberg et al. | Oct 1995 | A |
5460629 | Shlain et al. | Oct 1995 | A |
5462546 | Rydell | Oct 1995 | A |
5472443 | Cordis et al. | Dec 1995 | A |
5478351 | Meade et al. | Dec 1995 | A |
5480409 | Riza | Jan 1996 | A |
5484436 | Eggers et al. | Jan 1996 | A |
5496312 | Klicek | Mar 1996 | A |
5496317 | Goble et al. | Mar 1996 | A |
5496347 | Hashiguchi et al. | Mar 1996 | A |
5499997 | Sharpe et al. | Mar 1996 | A |
5509922 | Aranyi et al. | Apr 1996 | A |
5514134 | Rydell et al. | May 1996 | A |
5527313 | Scott et al. | Jun 1996 | A |
5531744 | Nardella et al. | Jul 1996 | A |
5536251 | Evard et al. | Jul 1996 | A |
5540684 | Hassler, Jr. | Jul 1996 | A |
5540685 | Parins et al. | Jul 1996 | A |
5540715 | Katsaros et al. | Jul 1996 | A |
5542945 | Fritzsch | Aug 1996 | A |
5558671 | Yates | Sep 1996 | A |
5558672 | Edwards et al. | Sep 1996 | A |
5562699 | Heimberger et al. | Oct 1996 | A |
5569241 | Edwardds | Oct 1996 | A |
5569243 | Kortenbach et al. | Oct 1996 | A |
5571100 | Goble et al. | Nov 1996 | A |
5573424 | Poppe | Nov 1996 | A |
5573534 | Stone | Nov 1996 | A |
5573535 | Viklund | Nov 1996 | A |
5575805 | Li | Nov 1996 | A |
5578052 | Koros et al. | Nov 1996 | A |
5582611 | Tsukagoshi et al. | Dec 1996 | A |
5585896 | Yamazaki et al. | Dec 1996 | A |
5590570 | LeMaire, III et al. | Jan 1997 | A |
5601601 | Tal et al. | Feb 1997 | A |
5603711 | Parins et al. | Feb 1997 | A |
5603723 | Aranyi et al. | Feb 1997 | A |
5611798 | Eggers | Mar 1997 | A |
5620453 | Nallakrishnan | Apr 1997 | A |
5624452 | Yates | Apr 1997 | A |
5626578 | Tihon | May 1997 | A |
5626609 | Zvenyatsky et al. | May 1997 | A |
5630833 | Katsaros et al. | May 1997 | A |
5637110 | Pennybacker et al. | Jun 1997 | A |
5638003 | Hall | Jun 1997 | A |
5643294 | Tovey et al. | Jul 1997 | A |
5647869 | Goble et al. | Jul 1997 | A |
5647871 | Levine et al. | Jul 1997 | A |
5649959 | Hannam et al. | Jul 1997 | A |
5658281 | Heard | Aug 1997 | A |
5662667 | Knodel | Sep 1997 | A |
5665100 | Yoon | Sep 1997 | A |
5667526 | Levin | Sep 1997 | A |
5674220 | Fox et al. | Oct 1997 | A |
5681282 | Eggers et al. | Oct 1997 | A |
5688270 | Yates et al. | Nov 1997 | A |
5693051 | Schulze et al. | Dec 1997 | A |
5695522 | LeMaire, III et al. | Dec 1997 | A |
5700261 | Brinkerhoff | Dec 1997 | A |
5702390 | Austin et al. | Dec 1997 | A |
5707369 | Vaitekunas et al. | Jan 1998 | A |
5709680 | Yates et al. | Jan 1998 | A |
5716366 | Yates | Feb 1998 | A |
5720744 | Eggleston et al. | Feb 1998 | A |
5722421 | Francese et al. | Mar 1998 | A |
5725536 | Oberlin et al. | Mar 1998 | A |
5727428 | LeMaire, III et al. | Mar 1998 | A |
5735848 | Yates et al. | Apr 1998 | A |
5743906 | Parins et al. | Apr 1998 | A |
5755717 | Yates et al. | May 1998 | A |
5766130 | Selmonosky | Jun 1998 | A |
5766166 | Hooven | Jun 1998 | A |
5766170 | Eggers | Jun 1998 | A |
5769849 | Eggers | Jun 1998 | A |
5772655 | Bauer et al. | Jun 1998 | A |
5772670 | Brosa | Jun 1998 | A |
5776128 | Eggers | Jul 1998 | A |
5776130 | Buysse et al. | Jul 1998 | A |
5779701 | McBrayer et al. | Jul 1998 | A |
H1745 | Paraschac | Aug 1998 | H |
H001745 | Paraschac | Aug 1998 | H |
5792137 | Carr et al. | Aug 1998 | A |
5792177 | Kaseda | Aug 1998 | A |
5797927 | Yoon | Aug 1998 | A |
5797938 | Paraschac et al. | Aug 1998 | A |
5797941 | Schulze et al. | Aug 1998 | A |
5797958 | Yoon | Aug 1998 | A |
5800449 | Wales | Sep 1998 | A |
5807393 | Williamson, IV et al. | Sep 1998 | A |
5810808 | Eggers | Sep 1998 | A |
5810811 | Yates et al. | Sep 1998 | A |
5810877 | Roth et al. | Sep 1998 | A |
5814043 | Shapeton | Sep 1998 | A |
5817093 | Williamson, IV et al. | Oct 1998 | A |
5820630 | Lind | Oct 1998 | A |
5827271 | Buysse et al. | Oct 1998 | A |
5827279 | Hughett et al. | Oct 1998 | A |
5827281 | Levin | Oct 1998 | A |
5827323 | Klieman et al. | Oct 1998 | A |
5827548 | Lavallee et al. | Oct 1998 | A |
5833690 | Yates et al. | Nov 1998 | A |
5843080 | Fleenor et al. | Dec 1998 | A |
5849022 | Sakashita et al. | Dec 1998 | A |
5853412 | Mayenberger | Dec 1998 | A |
5860976 | Billings et al. | Jan 1999 | A |
5876401 | Schulze et al. | Mar 1999 | A |
5882567 | Cavallaro et al. | Mar 1999 | A |
5891141 | Rydell | Apr 1999 | A |
5891142 | Eggers et al. | Apr 1999 | A |
5893863 | Yoon | Apr 1999 | A |
5893875 | O'Connor et al. | Apr 1999 | A |
5893877 | Gampp, Jr. et al. | Apr 1999 | A |
5902301 | Olig | May 1999 | A |
5906630 | Anderhub et al. | May 1999 | A |
5908420 | Parins et al. | Jun 1999 | A |
5908432 | Pan | Jun 1999 | A |
5911719 | Eggers | Jun 1999 | A |
5913874 | Berns et al. | Jun 1999 | A |
5921984 | Sutcu et al. | Jul 1999 | A |
5925043 | Kumar et al. | Jul 1999 | A |
5935126 | Riza | Aug 1999 | A |
5944718 | Dafforn et al. | Aug 1999 | A |
5951549 | Richardson et al. | Sep 1999 | A |
5954720 | Wilson et al. | Sep 1999 | A |
5957923 | Hahnen et al. | Sep 1999 | A |
5960544 | Beyers | Oct 1999 | A |
5961514 | Long et al. | Oct 1999 | A |
5964758 | Dresden | Oct 1999 | A |
5976132 | Morris | Nov 1999 | A |
5984939 | Yoon | Nov 1999 | A |
5989277 | LeMaire, III et al. | Nov 1999 | A |
5997565 | Inoue | Dec 1999 | A |
6004335 | Vaitekunas et al. | Dec 1999 | A |
6010516 | Hulka | Jan 2000 | A |
6024741 | Williamson et al. | Feb 2000 | A |
6024744 | Kese et al. | Feb 2000 | A |
6030384 | Nezhat | Feb 2000 | A |
6033399 | Gines | Mar 2000 | A |
6039733 | Buysse et al. | Mar 2000 | A |
6041679 | Slater et al. | Mar 2000 | A |
6050996 | Schmaltz et al. | Apr 2000 | A |
6053914 | Eggers et al. | Apr 2000 | A |
6053933 | Balazs et al. | Apr 2000 | A |
D424694 | Tetzlaff et al. | May 2000 | S |
D425201 | Tetzlaff et al. | May 2000 | S |
6059782 | Novak et al. | May 2000 | A |
6074386 | Goble et al. | Jun 2000 | A |
RE36795 | Rydell | Jul 2000 | E |
6083223 | Baker | Jul 2000 | A |
6086586 | Hooven | Jul 2000 | A |
6090107 | Borgmeier et al. | Jul 2000 | A |
6096037 | Mulier et al. | Aug 2000 | A |
6099550 | Yoon | Aug 2000 | A |
6102909 | Chen et al. | Aug 2000 | A |
6110171 | Rydell | Aug 2000 | A |
6113596 | Hooven et al. | Sep 2000 | A |
6113598 | Baker | Sep 2000 | A |
6117158 | Measamer et al. | Sep 2000 | A |
6123701 | Nezhat | Sep 2000 | A |
H1904 | Yates et al. | Oct 2000 | H |
6126658 | Baker | Oct 2000 | A |
6152923 | Ryan | Nov 2000 | A |
6162220 | Nezhat | Dec 2000 | A |
6174309 | Wrublewski et al. | Jan 2001 | B1 |
6179834 | Buysse et al. | Jan 2001 | B1 |
6179837 | Hooven | Jan 2001 | B1 |
6183467 | Shapeton et al. | Feb 2001 | B1 |
6187003 | Buysse et al. | Feb 2001 | B1 |
6190386 | Rydell | Feb 2001 | B1 |
6193718 | Kortenbach et al. | Feb 2001 | B1 |
6206876 | Levine et al. | Mar 2001 | B1 |
6206877 | Kese et al. | Mar 2001 | B1 |
6217602 | Redmon | Apr 2001 | B1 |
6221039 | Durgin et al. | Apr 2001 | B1 |
6224593 | Ryan et al. | May 2001 | B1 |
6228080 | Gines | May 2001 | B1 |
6228083 | Lands et al. | May 2001 | B1 |
6267761 | Ryan | Jul 2001 | B1 |
6270497 | Sekino et al. | Aug 2001 | B1 |
6270508 | Klieman et al. | Aug 2001 | B1 |
6273887 | Yamauchi et al. | Aug 2001 | B1 |
6277117 | Tetzlaff et al. | Aug 2001 | B1 |
6280458 | Boche et al. | Aug 2001 | B1 |
6283961 | Underwood et al. | Sep 2001 | B1 |
D449886 | Tetzlaff et al. | Oct 2001 | S |
6302424 | Gisinger et al. | Oct 2001 | B1 |
6319451 | Brune | Nov 2001 | B1 |
6322561 | Eggers et al. | Nov 2001 | B1 |
6334860 | Dorn | Jan 2002 | B1 |
6334861 | Chandler et al. | Jan 2002 | B1 |
6345532 | Coudray et al. | Feb 2002 | B1 |
6350264 | Hooven | Feb 2002 | B1 |
6352536 | Buysse et al. | Mar 2002 | B1 |
6358249 | Chen et al. | Mar 2002 | B1 |
6358268 | Hunt et al. | Mar 2002 | B1 |
D457958 | Dycus et al. | May 2002 | S |
D457959 | Tetzlaff et al. | May 2002 | S |
6387094 | Eitenmuller | May 2002 | B1 |
6391035 | Appleby et al. | May 2002 | B1 |
6398779 | Buysse et al. | Jun 2002 | B1 |
6402747 | Lindemann et al. | Jun 2002 | B1 |
6409728 | Ehr et al. | Jun 2002 | B1 |
H2037 | Yates et al. | Jul 2002 | H |
6419675 | Gallo, Sr. | Jul 2002 | B1 |
6425896 | Baltschun et al. | Jul 2002 | B1 |
6440144 | Bacher | Aug 2002 | B1 |
6443952 | Mulier et al. | Sep 2002 | B1 |
6443970 | Schulze et al. | Sep 2002 | B1 |
6451018 | Lands et al. | Sep 2002 | B1 |
6458125 | Cosmescu | Oct 2002 | B1 |
6458128 | Schulze | Oct 2002 | B1 |
6458130 | Frazier et al. | Oct 2002 | B1 |
6464701 | Hooven et al. | Oct 2002 | B1 |
6464702 | Schulze et al. | Oct 2002 | B2 |
6464704 | Schmaltz et al. | Oct 2002 | B2 |
6500176 | Truckai et al. | Dec 2002 | B1 |
6511480 | Tetzlaff et al. | Jan 2003 | B1 |
6514252 | Nezhat et al. | Feb 2003 | B2 |
6527771 | Weadock et al. | Mar 2003 | B1 |
6558385 | McClurken et al. | May 2003 | B1 |
6562037 | Paton et al. | May 2003 | B2 |
6585735 | Frazier et al. | Jul 2003 | B1 |
6602252 | Mollenauer | Aug 2003 | B2 |
6616658 | Ineson | Sep 2003 | B2 |
6616661 | Wellman et al. | Sep 2003 | B2 |
6620161 | Schulze et al. | Sep 2003 | B2 |
6626901 | Treat et al. | Sep 2003 | B1 |
6641595 | Moran et al. | Nov 2003 | B1 |
6652514 | Ellman et al. | Nov 2003 | B2 |
6652521 | Schulze | Nov 2003 | B2 |
6656177 | Truckai et al. | Dec 2003 | B2 |
6660072 | Chatterjee | Dec 2003 | B2 |
6669696 | Bacher et al. | Dec 2003 | B2 |
6676660 | Wampler et al. | Jan 2004 | B2 |
6679882 | Kornerup | Jan 2004 | B1 |
6682527 | Strul | Jan 2004 | B2 |
6682528 | Frazier et al. | Jan 2004 | B2 |
6685724 | Haluck | Feb 2004 | B1 |
6689131 | McClurken | Feb 2004 | B2 |
6692445 | Roberts et al. | Feb 2004 | B2 |
6695840 | Schulze | Feb 2004 | B2 |
6702810 | McClurken et al. | Mar 2004 | B2 |
6726068 | Miller | Apr 2004 | B2 |
6726686 | Buysse et al. | Apr 2004 | B2 |
6733498 | Paton et al. | May 2004 | B2 |
6736813 | Yamauchi et al. | May 2004 | B2 |
6743229 | Buysse et al. | Jun 2004 | B2 |
6743230 | Lutze et al. | Jun 2004 | B2 |
6757977 | Dambal et al. | Jul 2004 | B2 |
6770072 | Truckai et al. | Aug 2004 | B1 |
6773409 | Truckai et al. | Aug 2004 | B2 |
6773434 | Ciarrocca | Aug 2004 | B2 |
6775575 | Bommannan et al. | Aug 2004 | B2 |
6776780 | Mulier et al. | Aug 2004 | B2 |
6790217 | Schulze et al. | Sep 2004 | B2 |
6796981 | Wham et al. | Sep 2004 | B2 |
D496997 | Dycus et al. | Oct 2004 | S |
6802843 | Truckai et al. | Oct 2004 | B2 |
6808525 | Latterell et al. | Oct 2004 | B2 |
D499181 | Dycus et al. | Nov 2004 | S |
6818000 | Muller et al. | Nov 2004 | B2 |
6860880 | Treat et al. | Mar 2005 | B2 |
6887240 | Lands et al. | May 2005 | B1 |
6926716 | Baker et al. | Aug 2005 | B2 |
6929644 | Truckai et al. | Aug 2005 | B2 |
6932810 | Ryan | Aug 2005 | B2 |
6932816 | Phan | Aug 2005 | B2 |
6934134 | Mori et al. | Aug 2005 | B2 |
6936061 | Sasaki | Aug 2005 | B2 |
6942662 | Goble et al. | Sep 2005 | B2 |
6953461 | McClurken et al. | Oct 2005 | B2 |
6958070 | Witt et al. | Oct 2005 | B2 |
6960210 | Lands et al. | Nov 2005 | B2 |
6964662 | Kidooka | Nov 2005 | B2 |
6966907 | Goble | Nov 2005 | B2 |
6977495 | Donofrio | Dec 2005 | B2 |
6979786 | Aukland et al. | Dec 2005 | B2 |
6994707 | Ellman et al. | Feb 2006 | B2 |
6994709 | Iida | Feb 2006 | B2 |
7011657 | Truckai et al. | Mar 2006 | B2 |
7033354 | Keppel | Apr 2006 | B2 |
7033356 | Latterell et al. | Apr 2006 | B2 |
7041102 | Truckai et al. | May 2006 | B2 |
7044948 | Keppel | May 2006 | B2 |
7052496 | Yamauchi | May 2006 | B2 |
D525361 | Hushka | Jul 2006 | S |
7070597 | Truckai et al. | Jul 2006 | B2 |
7083618 | Couture et al. | Aug 2006 | B2 |
7083619 | Truckai et al. | Aug 2006 | B2 |
7087054 | Truckai et al. | Aug 2006 | B2 |
7090673 | Dycus et al. | Aug 2006 | B2 |
7090689 | Nagase et al. | Aug 2006 | B2 |
7101371 | Dycus et al. | Sep 2006 | B2 |
7101372 | Dycus et al. | Sep 2006 | B2 |
7101373 | Dycus et al. | Sep 2006 | B2 |
7103947 | Sartor et al. | Sep 2006 | B2 |
7112199 | Cosmescu | Sep 2006 | B2 |
D531311 | Guerra et al. | Oct 2006 | S |
7115123 | Knowlton et al. | Oct 2006 | B2 |
7118570 | Tetzlaff et al. | Oct 2006 | B2 |
7118587 | Dycus et al. | Oct 2006 | B2 |
7131860 | Sartor et al. | Nov 2006 | B2 |
7131970 | Moses et al. | Nov 2006 | B2 |
7131971 | Dycus et al. | Nov 2006 | B2 |
7135020 | Lawes et al. | Nov 2006 | B2 |
D533942 | Kerr et al. | Dec 2006 | S |
7145757 | Shea et al. | Dec 2006 | B2 |
7147638 | Chapman et al. | Dec 2006 | B2 |
7150097 | Sremcich et al. | Dec 2006 | B2 |
7150749 | Dycus et al. | Dec 2006 | B2 |
D535027 | James et al. | Jan 2007 | S |
7156842 | Sartor et al. | Jan 2007 | B2 |
7156846 | Dycus et al. | Jan 2007 | B2 |
7160298 | Lawes et al. | Jan 2007 | B2 |
7160299 | Baily | Jan 2007 | B2 |
7169146 | Truckai et al. | Jan 2007 | B2 |
7179258 | Buysse et al. | Feb 2007 | B2 |
7195631 | Dumbauld | Mar 2007 | B2 |
D541418 | Schechter et al. | Apr 2007 | S |
7207990 | Lands et al. | Apr 2007 | B2 |
D541938 | Kerr et al. | May 2007 | S |
7223265 | Keppel | May 2007 | B2 |
7232440 | Dumbauld et al. | Jun 2007 | B2 |
7241288 | Braun | Jul 2007 | B2 |
7241296 | Buysse et al. | Jul 2007 | B2 |
7252667 | Moses et al. | Aug 2007 | B2 |
7255697 | Dycus et al. | Aug 2007 | B2 |
7267677 | Johnson et al. | Sep 2007 | B2 |
7270660 | Ryan | Sep 2007 | B2 |
7270664 | Johnson et al. | Sep 2007 | B2 |
7276068 | Johnson et al. | Oct 2007 | B2 |
7300435 | Wham et al. | Nov 2007 | B2 |
7303557 | Wham et al. | Dec 2007 | B2 |
7314471 | Holman | Jan 2008 | B2 |
7329256 | Johnson et al. | Feb 2008 | B2 |
7329257 | Kanehira et al. | Feb 2008 | B2 |
D564662 | Moses et al. | Mar 2008 | S |
7342754 | Fitzgerald et al. | Mar 2008 | B2 |
7344268 | Jigamian | Mar 2008 | B2 |
7367976 | Lawes et al. | May 2008 | B2 |
20020013583 | Camran et al. | Jan 2002 | A1 |
20020049442 | Roberts et al. | Apr 2002 | A1 |
20020099372 | Schulze et al. | Jul 2002 | A1 |
20020107517 | Witt et al. | Aug 2002 | A1 |
20020111624 | Witt et al. | Aug 2002 | A1 |
20020188294 | Couture et al. | Dec 2002 | A1 |
20030004510 | Wham et al. | Jan 2003 | A1 |
20030014052 | Buysse et al. | Jan 2003 | A1 |
20030014063 | Nguyen et al. | Jan 2003 | A1 |
20030018331 | Dycus et al. | Jan 2003 | A1 |
20030018332 | Schmaltz et al. | Jan 2003 | A1 |
20030032956 | Lands et al. | Feb 2003 | A1 |
20030069571 | Treat et al. | Apr 2003 | A1 |
20030078578 | Truckai Csaba et al. | Apr 2003 | A1 |
20030109875 | Tetzlaff et al. | Jun 2003 | A1 |
20030114851 | Truckai et al. | Jun 2003 | A1 |
20030139741 | Goble et al. | Jul 2003 | A1 |
20030139742 | Wampler et al. | Jul 2003 | A1 |
20030158549 | Swanson | Aug 2003 | A1 |
20030181910 | Dycus et al. | Sep 2003 | A1 |
20030216732 | Truckai et al. | Nov 2003 | A1 |
20030220637 | Csaba Truckai et al. | Nov 2003 | A1 |
20030229344 | Dycus et al. | Dec 2003 | A1 |
20030236325 | Bonora | Dec 2003 | A1 |
20040030330 | Brassell et al. | Feb 2004 | A1 |
20040030332 | Knowlton et al. | Feb 2004 | A1 |
20040049185 | Latterell et al. | Mar 2004 | A1 |
20040064151 | Mollenauer | Apr 2004 | A1 |
20040078035 | Kanehira et al. | Apr 2004 | A1 |
20040082952 | Dycus et al. | Apr 2004 | A1 |
20040087943 | Dycus et al. | May 2004 | A1 |
20040115296 | Duffin | Jun 2004 | A1 |
20040116924 | Dycus et al. | Jun 2004 | A1 |
20040116979 | Truckai et al. | Jun 2004 | A1 |
20040122423 | Dycus et al. | Jun 2004 | A1 |
20040143263 | Schechter et al. | Jul 2004 | A1 |
20040162557 | Tetzaff et al. | Aug 2004 | A1 |
20040193153 | Sarter et al. | Sep 2004 | A1 |
20040230189 | Keppel | Nov 2004 | A1 |
20040236326 | Schulze et al. | Nov 2004 | A1 |
20040243125 | Dycus et al. | Dec 2004 | A1 |
20040249371 | Dycus et al. | Dec 2004 | A1 |
20040249374 | Tetxlaff et al. | Dec 2004 | A1 |
20040260281 | Baxter et al. | Dec 2004 | A1 |
20050004564 | Wham et al. | Jan 2005 | A1 |
20050021025 | Buysse et al. | Jan 2005 | A1 |
20050021027 | Shields et al. | Jan 2005 | A1 |
20050033278 | McClurken et al. | Feb 2005 | A1 |
20050096645 | Wellman et al. | May 2005 | A1 |
20050101951 | Wham et al. | May 2005 | A1 |
20050101952 | Lands et al. | May 2005 | A1 |
20050113626 | Johnson et al. | May 2005 | A1 |
20050113818 | Sartor et al. | May 2005 | A1 |
20050113819 | Wham et al. | May 2005 | A1 |
20050113826 | Johnson et al. | May 2005 | A1 |
20050113828 | Shields et al. | May 2005 | A1 |
20050149017 | Dycus | Jul 2005 | A1 |
20050149151 | Orszulak et al. | Jul 2005 | A1 |
20050187547 | Sugi | Aug 2005 | A1 |
20050197659 | Bahney | Sep 2005 | A1 |
20050203504 | Wham et al. | Sep 2005 | A1 |
20050240179 | Buysse et al. | Oct 2005 | A1 |
20060052778 | Chapman | Mar 2006 | A1 |
20060064085 | Schechter et al. | Mar 2006 | A1 |
20060074417 | Cunningham et al. | Apr 2006 | A1 |
20060079888 | Mulier et al. | Apr 2006 | A1 |
20060079890 | Guerra | Apr 2006 | A1 |
20060079891 | Arts et al. | Apr 2006 | A1 |
20060116675 | McClurken et al. | Jun 2006 | A1 |
20060116875 | McClurken et al. | Jun 2006 | A1 |
20060129146 | Dycus et al. | Jun 2006 | A1 |
20060167450 | Johnson et al. | Jul 2006 | A1 |
20060167452 | Moses et al. | Jul 2006 | A1 |
20060173452 | Buysse et al. | Aug 2006 | A1 |
20060189980 | Johnson et al. | Aug 2006 | A1 |
20060189981 | Dycus et al. | Aug 2006 | A1 |
20060190035 | Hushka et al. | Aug 2006 | A1 |
20060217709 | Couture et al. | Sep 2006 | A1 |
20060224158 | Odom et al. | Oct 2006 | A1 |
20060259036 | Tetzlaff et al. | Nov 2006 | A1 |
20060264922 | Sartor et al. | Nov 2006 | A1 |
20060264931 | Chapman et al. | Nov 2006 | A1 |
20060287641 | Perlin | Dec 2006 | A1 |
20070016182 | Lipson et al. | Jan 2007 | A1 |
20070016187 | Weinberg et al. | Jan 2007 | A1 |
20070043352 | Garrison et al. | Feb 2007 | A1 |
20070043353 | Dycus et al. | Feb 2007 | A1 |
20070060919 | Isaacson et al. | Mar 2007 | A1 |
20070062017 | Dycus et al. | Mar 2007 | A1 |
20070074807 | Guerra | Apr 2007 | A1 |
20070078456 | Dumbauld et al. | Apr 2007 | A1 |
20070078458 | Dumbauld et al. | Apr 2007 | A1 |
20070078459 | Johnson et al. | Apr 2007 | A1 |
20070088356 | Moses et al. | Apr 2007 | A1 |
20070106295 | Garrison et al. | May 2007 | A1 |
20070106297 | Dumbauld et al. | May 2007 | A1 |
20070118111 | Weinberg | May 2007 | A1 |
20070118115 | Artale et al. | May 2007 | A1 |
20070142833 | Dycus et al. | Jun 2007 | A1 |
20070142834 | Dumbauld | Jun 2007 | A1 |
20070156139 | Schechter et al. | Jul 2007 | A1 |
20070156140 | Baily | Jul 2007 | A1 |
20070173811 | Couture et al. | Jul 2007 | A1 |
20070173814 | Hixson et al. | Jul 2007 | A1 |
20070179499 | Garrison | Aug 2007 | A1 |
20070203485 | Keppel | Aug 2007 | A1 |
20070213706 | Dumbauld et al. | Sep 2007 | A1 |
20070213707 | Dumbauld et al. | Sep 2007 | A1 |
20070213708 | Dumbauld et al. | Sep 2007 | A1 |
20070213712 | Buysse et al. | Sep 2007 | A1 |
20070255279 | Buysse et al. | Nov 2007 | A1 |
20070260235 | Podhajsky | Nov 2007 | A1 |
20070260238 | Guerra | Nov 2007 | A1 |
20070260241 | Dalla Betta et al. | Nov 2007 | A1 |
20070260242 | Dycus et al. | Nov 2007 | A1 |
20070265616 | Couture et al. | Nov 2007 | A1 |
20080004616 | Patrick | Jan 2008 | A1 |
20080009860 | Odom | Jan 2008 | A1 |
20080015575 | Odom et al. | Jan 2008 | A1 |
20080021450 | Couture | Jan 2008 | A1 |
20080033428 | Artale et al. | Feb 2008 | A1 |
20080039835 | Johnson et al. | Feb 2008 | A1 |
20080045947 | Johnson et al. | Feb 2008 | A1 |
20080058802 | Couture et al. | Mar 2008 | A1 |
20080082100 | Orton et al. | Apr 2008 | A1 |
Number | Date | Country |
---|---|---|
2104423 | Feb 1994 | CA |
2415263 | Oct 1975 | DE |
2627679 | Jan 1977 | DE |
8712328 | Mar 1988 | DE |
4303882 | Aug 1994 | DE |
29616210 | Jan 1997 | DE |
19608716 | Apr 1997 | DE |
19751106 | May 1998 | DE |
19751108 | May 1999 | DE |
0634216 | Apr 1990 | EP |
518230 | Dec 1992 | EP |
0541930 | May 1993 | EP |
0572131 | Dec 1993 | EP |
584787 | Mar 1994 | EP |
0589453 | Mar 1994 | EP |
0623316 | Nov 1994 | EP |
0624348 | Nov 1994 | EP |
0650701 | May 1995 | EP |
0694290 | Mar 1996 | EP |
0717966 | Jun 1996 | EP |
0754437 | Mar 1997 | EP |
853922 | Jul 1998 | EP |
0875209 | Nov 1998 | EP |
0878169 | Nov 1998 | EP |
0887046 | Jan 1999 | EP |
0923907 | Jun 1999 | EP |
0986990 | Mar 2000 | EP |
1034747 | Sep 2000 | EP |
1034748 | Sep 2000 | EP |
1025807 | Oct 2000 | EP |
1034746 | Oct 2000 | EP |
1050278 | Nov 2000 | EP |
1053719 | Nov 2000 | EP |
1053720 | Nov 2000 | EP |
1055399 | Nov 2000 | EP |
1055400 | Nov 2000 | EP |
1080694 | Mar 2001 | EP |
1082944 | Mar 2001 | EP |
1159926 | Dec 2001 | EP |
1301135 | Apr 2003 | EP |
1330991 | Jul 2003 | EP |
1486177 | Jun 2004 | EP |
1472984 | Nov 2004 | EP |
1527747 | May 2005 | EP |
1530952 | May 2005 | EP |
1532932 | May 2005 | EP |
1535581 | Jun 2005 | EP |
1609430 | Dec 2005 | EP |
1632192 | Mar 2006 | EP |
1645238 | Apr 2006 | EP |
1645240 | Apr 2006 | EP |
1707143 | Oct 2006 | EP |
2214430 | Jun 1989 | GB |
2213416 | Aug 1989 | GB |
501068 | Sep 1984 | JP |
502328 | Mar 1992 | JP |
5-5106 | Jan 1993 | JP |
5-40112 | Feb 1993 | JP |
06343644 | Dec 1994 | JP |
07265328 | Oct 1995 | JP |
08056955 | Mar 1996 | JP |
08252263 | Oct 1996 | JP |
09010223 | Jan 1997 | JP |
11244298 | Sep 1999 | JP |
200342599 | Dec 2000 | JP |
2000350732 | Dec 2000 | JP |
2001008944 | Jan 2001 | JP |
2001029356 | Feb 2001 | JP |
2001128990 | May 2001 | JP |
401367 | Nov 1974 | SU |
WO 8900757 | Jan 1989 | WO |
WO 9204873 | Apr 1992 | WO |
WO 9206642 | Apr 1992 | WO |
WO 9408524 | Apr 1994 | WO |
WO 9420025 | Sep 1994 | WO |
WO 9502369 | Jan 1995 | WO |
WO 9507662 | Mar 1995 | WO |
WO 9515124 | Jun 1995 | WO |
WO 9605776 | Feb 1996 | WO |
WO 96022056 | Jul 1996 | WO |
WO 9613218 | Sep 1996 | WO |
WO 9700646 | Jan 1997 | WO |
WO 9700647 | Jan 1997 | WO |
WO 9710764 | Mar 1997 | WO |
WO 9724073 | Jul 1997 | WO |
WO 9724993 | Jul 1997 | WO |
WO 9827880 | Jul 1998 | WO |
WO 9903407 | Jan 1999 | WO |
WO 9903408 | Jan 1999 | WO |
WO 9903409 | Jan 1999 | WO |
WO 9912488 | Mar 1999 | WO |
WO 9940857 | Aug 1999 | WO |
WO 9940861 | Aug 1999 | WO |
WO 9951158 | Oct 1999 | WO |
WO 9966850 | Dec 1999 | WO |
WO 0024330 | May 2000 | WO |
WO 0024331 | May 2000 | WO |
WO 0041638 | Jul 2000 | WO |
WO 0047124 | Aug 2000 | WO |
WO 0053112 | Sep 2000 | WO |
WO 0117448 | Mar 2001 | WO |
WO 0154604 | Aug 2001 | WO |
WO 0207627 | Jan 2002 | WO |
WO 02067798 | Sep 2002 | WO |
WO 02080783 | Oct 2002 | WO |
WO 02080784 | Oct 2002 | WO |
WO 02080785 | Oct 2002 | WO |
WO 02080786 | Oct 2002 | WO |
WO 02080793 | Oct 2002 | WO |
WO 02080794 | Oct 2002 | WO |
WO 02080795 | Oct 2002 | WO |
WO 02080796 | Oct 2002 | WO |
WO 02080797 | Oct 2002 | WO |
WO 02080798 | Oct 2002 | WO |
WO 02080799 | Oct 2002 | WO |
WO 02081170 | Oct 2002 | WO |
WO 0309030 | Nov 2003 | WO |
WO 03101311 | Dec 2003 | WO |
WO 04032776 | Apr 2004 | WO |
WO 2004032777 | Apr 2004 | WO |
WO 2004052221 | Jun 2004 | WO |
WO 04073488 | Sep 2004 | WO |
WO 2004073490 | Sep 2004 | WO |
WO 2004073753 | Sep 2004 | WO |
WO 2004082495 | Sep 2004 | WO |
WO 2004098383 | Nov 2004 | WO |
WO 2004103156 | Dec 2004 | WO |
WO 05004734 | Jan 2005 | WO |
WO 2005004735 | Jan 2005 | WO |
WO 2005110264 | Nov 2005 | WO |
Number | Date | Country | |
---|---|---|---|
20070213707 A1 | Sep 2007 | US |
Number | Date | Country | |
---|---|---|---|
60520579 | Nov 2003 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 10970307 | Oct 2004 | US |
Child | 11800678 | US |