Electrosurgical instruments and connections thereto

Abstract
An electrosurgical instrument includes jaws having an electrode configuration utilized to electrically modify tissue in contact with one or more electrodes. The instrument is removably connectable to an electrosurgical unit via an electrosurgical connector extending from the instrument and a receptacle on the electrosurgical unit. The electrosurgical instrument is rotatable without disrupting electrical connection to the electrodes of the jaws. One or more of the electrodes is retractable. The electrosurgical unit and instrument optimally seals and/or cuts tissue based on identifying the tissue and monitoring the modification of the tissue by the application of radio frequency energy.
Description
BACKGROUND

The present application relates generally to electrosurgical systems and methods and more particularly to electrosurgical instruments and connections between the instruments and electrosurgical units.


Surgical procedures often involve cutting and connecting bodily tissue including organic materials, musculature, connective tissue and vascular conduits. For centuries, sharpened blades and sutures have been mainstays of cutting and reconnecting procedures. As bodily tissue, especially relatively highly vascularized tissue is cut during a surgical procedure, it tends to bleed. Thus, medical practitioners such as surgeons have long sought surgical instruments and methods that slow or reduce bleeding during surgical procedures.


More recently, electrosurgical instruments have become available that use electrical energy to perform certain surgical tasks. Typically, electrosurgical instruments are hand instruments such as graspers, scissors, tweezers, blades, needles, and other hand instruments that include one or more electrodes that are configured to be supplied with electrical energy from an electrosurgical unit including a power supply. The electrical energy can be used to coagulate, fuse, or cut tissue to which it is applied. Advantageously, unlike typical mechanical blade procedures, application of electrical energy to tissue tends to stop bleeding of the tissue.


Electrosurgical instruments typically fall within two classifications: monopolar and bipolar. In monopolar instruments, electrical energy of a certain polarity is supplied to one or more electrodes on the instrument. A separate return electrode is electrically coupled to a patient. Monopolar electrosurgical instruments can be useful in certain procedures, but can include a risk of certain types of patient injuries such as electrical burns often at least partially attributable to functioning of the return electrode. In bipolar electrosurgical instruments, one or more electrodes is electrically coupled to a source of electrical energy of a first polarity and one or more other electrodes is electrically coupled to a source of electrical energy of a second polarity opposite the first polarity. Thus, bipolar electrosurgical instruments, which operate without separate return electrodes, can deliver electrical signals to a focused tissue area with a reduced risk of patient injuries.


Even with the relatively focused surgical effects of bipolar electrosurgical instruments, however, surgical outcomes are often highly dependent on surgeon skill. For example, thermal tissue damage and necrosis can occur in instances where electrical energy is delivered for a relatively long duration or where a relatively high-powered electrical signal is delivered even for a short duration. The rate at which a tissue will achieve the desired coagulation or cutting effect upon the application of electrical energy varies based on the tissue type and can also vary based on pressure applied to the tissue by an electrosurgical instrument. However, even for a highly experienced surgeon, it can be difficult for a surgeon to assess how quickly a mass of combined tissue types grasped in an electrosurgical instrument will be fused a desirable amount.


Attempts have been made to reduce the risk of tissue damage during electrosurgical procedures. For example, previous electrosurgical systems have included generators that monitor an ohmic resistance or tissue temperature during the electrosurgical procedure, and terminated electrical energy once a predetermined point was reached. However, these systems have had shortcomings in that they have not provided consistent results at determining tissue coagulation, fusion, or cutting endpoints for varied tissue types or combined tissue masses. These systems can also fail to provide consistent electrosurgical results among use of different instruments having different instrument and electrode geometries. Typically, even where the change is a relatively minor upgrade to instrument geometry during a product's lifespan, the electrosurgical unit must be recalibrated for each instrument type to be used, a costly, time consuming procedure which can undesirably remove an electrosurgical unit from service.


SUMMARY

Generally, electrosurgical instrument, units and connections between them are provided. Various embodiments described with various instruments, units and/or connections can be interchangeable or applicable as provided below. In one embodiment, an electrosurgical instrument is provided and comprises a first jaw and a second jaw opposing the first jaw and is coupled to the first jaw to capture tissue between the first and second jaws. A first electrode is connected to the first jaw and extendable from a first position within the first jaw to a second position outside the first jaw. The first electrode is electrically connected to a stationary electrode positioned on the first or the second jaw.


In another embodiment, an electrosurgical unit comprising a radio frequency (RF) amplifier is provided. The RF amplifier is configured to supply RF energy to coagulate and cut tissue and the RF amplifier supplies RF energy to tissue that is not sufficient to completely coagulate tissue prior to the supplying of RF energy to cut tissue.


In another embodiment, an electrosurgical instrument is provided and comprises a first jaw and a second jaw opposing the first jaws and coupled to the first jaw to capture tissue between the first and second jaws. First, second, third and fourth electrodes are disposed on the first jaw and a fifth electrode is disposed on the second jaw.


In yet another embodiment, an electrosurgical instrument is provided and comprises a first jaw and a second jaw opposing the first jaws and coupled to the first jaw to capture tissue between the first and second jaws. A first electrode is connected to the first jaw and a movable cutter is connected to the first or second jaw. The instrument also comprises an actuator having a stationary handle and a movable trigger connected to at least one of the first and second jaws to move the jaws between spaced and proximate positions, an elongate shaft connected to the actuator and the first or second jaws, and a blade trigger connected to a blade shaft connected to the movable cutter disposed within the elongate shaft and movable along a longitudinal axis. The instrument also comprises a first stop limiting distal travel of the blade shaft along the longitudinal axis.


In one embodiment, an electrosurgical instrument comprises a first jaw and a second jaw opposing the first jaws and coupled to the first jaw to capture tissue between the first and second jaws. A first electrode is connected to the first jaw and an actuator comprises a rotatable elongate shaft connected to the actuator and the first or second jaws; at least one conductive connection surrounds a portion of the rotatable elongate shaft within the actuator; and at least one stationary contact is disposed within the actuator and electrically connectable to the at least one conductive connection, the at least one conductive ring electrically connected to the first electrode.





BRIEF DESCRIPTION OF THE DRAWINGS

The present inventions may be understood by reference to the following description, taken in connection with the accompanying drawings in which the reference numerals designate like parts throughout the figures thereof.



FIG. 1 is a perspective view of an embodiment of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 2A is a side view of an electrosurgical instrument with an associated coupler to connect to an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 2B is a dissembled view of an electrosurgical instrument with an associated coupler to connect to an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 3A-1 is a side view of an interior of an actuator of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 3A-2 is a side view of an interior of an actuator of an electrosurgical instrument in accordance with various embodiments of the invention with some components removed to facilitate viewing.



FIG. 3A-3 is a perspective view of conductive connectors of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 3A-4 is a perspective view of an interior of an actuator of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 3A-5 is a perspective view of a conductive ring of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 3A-6 is a perspective view of an interior of an actuator of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 3A-7 is a perspective view of a contact brush of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 3A-8 is a perspective view of a rotary connector with an exemplary single wire in accordance with various embodiments of the invention.



FIGS. 3B-1 to 3B-2 illustrate side views of an interior of an actuator of an electrosurgical instrument at different stages of actuation in accordance with various embodiments of the invention.



FIG. 4A illustrates a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 4B illustrates a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 4C illustrates a cross-sectional view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 5 is a focused view of one of the jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 6 is a side view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 7 is a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 8 is a focused view of one of the jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 9 is a front view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 10 is a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 11 is a perspective view of an electrosurgical instrument with an associated coupler to connect to an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 12 is a side view of an electrosurgical instrument with portions of an associated coupler to connect to an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 13A is a side view of an interior of an actuator of an electrosurgical instrument in accordance with various embodiments of the invention.



FIGS. 13B-1 to 13B-3 illustrate side views of an interior of an actuator of an electrosurgical instrument at different stages of actuation in accordance with various embodiments of the invention.



FIG. 13C-1 illustrates a perspective view of jaws and a shaft of an electrosurgical instrument in accordance with various embodiments of the invention with a portion of the shaft removed (not shown).



FIG. 13C-2 illustrates a cross-sectional view of a cover tube of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 13C-3 illustrates a perspective view of a cover tube of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 13C-4 illustrates a side view of a cover tube of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 13C-5 illustrates a perspective view of jaws and a shaft of an electrosurgical instrument in accordance with various embodiments of the invention with a portion of the shaft removed (not shown).



FIG. 13C-6 illustrates a perspective view of jaws and a blade shaft of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 13C-7 illustrates a side view of a blade shaft of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 13C-8 illustrates a cross-sectional view of a shaft of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 14 is a disassembled view of an electrosurgical instrument and coupler in accordance with various embodiments of the invention.



FIG. 15A illustrates a top view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 15B illustrates a bottom view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 15C illustrates a bottom view of one of the jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 15D illustrates a top view of an opposing jaw of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 15E illustrates a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 15F illustrates a side view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 15G illustrates a cross-sectional view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 16 is a side view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 17 is a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 18 is a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 19 is a disassembled view of an electrosurgical instrument and coupler in accordance with various embodiments of the invention.



FIG. 20 is a side view of a coupler of an electrosurgical instrument to connect to an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 21 is a disassembled view of a coupler of an electrosurgical instrument to connect to an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 22 is a disassembled view of a coupler of an electrosurgical instrument to connect to an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 23 is a perspective view of a connector in accordance with various embodiments of the invention.



FIG. 24 is a perspective view of connector in accordance with various embodiments of the invention.



FIG. 25 is a back view of connector in accordance with various embodiments of the invention.



FIG. 26 is a back view of circuitry, memory and pin arrangements of a connector in accordance with various embodiments of the invention.



FIG. 27 is a perspective view of circuitry, memory and pin arrangements of a connector in accordance with various embodiments of the invention.



FIG. 28 is a perspective view of circuitry, memory and pin arrangements of a connector in accordance with various embodiments of the invention.



FIG. 29 is a front view of a receptacle of an electrosurgical unit in accordance with various embodiments of the invention.



FIGS. 30A-B are perspective views of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 31 is a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 32 is a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 33 is a perspective view of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIGS. 34A-B are perspective views of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIGS. 35A-B are perspective views of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIGS. 36A-D are perspective views of jaws of an electrosurgical instrument in accordance with various embodiments of the invention.



FIGS. 37A-B are perspective views of an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 38 is an exemplary chart illustrating electrode configurations in accordance with various embodiments of the invention.



FIG. 39A-1 is a perspective view of a monopolar pad and an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 39A-2 is a close-up perspective view of a monopolar port of an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 39B is a perspective view of a monopolar pad, a monopolar and/or bipolar electrosurgical instrument, and an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 40 is a flow chart illustrating a pre-cut process for an electrosurgical instrument in accordance with various embodiments of the invention.



FIG. 41 is a block diagram of an electrosurgical unit in accordance with various embodiments of the invention.



FIG. 42 is semi-schematic diagram of an electrosurgical unit in accordance with various embodiments of the invention.





DETAILED DESCRIPTION

The electrosurgical system in one embodiment includes an electrosurgical unit or generator capable of supplying radio frequency energy to one or more removably coupled electrosurgical instruments or tools. Examples of such instruments and connectors between the instrument and the electrosurgical unit are provided in the drawings. Each instrument is particularly designed to accomplish particular clinical and/or technical operations or procedures. Additionally, the coupling or partnership between the electrosurgical unit and instruments are specifically provided to further enhance the operational capabilities of both the electrosurgical unit and instruments such that clinical and/or technical operations are achieved.


One such electrosurgical instrument is shown in FIGS. 1-10 which illustrate a fusion and cutting electrosurgical instrument 10 connectable to an electrosurgical unit in accordance with various embodiments of the invention. As illustrated, the instrument includes jaws 12 for manipulating tissue and the actuator 14 for manipulating the jaws. A shaft 16 connects the jaws to the actuator. In one embodiment, the shaft and jaws are sized and arranged to fit through a cannula to perform a laparoscopic procedure. In one embodiment, the actuator includes a barrel connected to a pivotable trigger 112 for opening and closing of the jaws and to capture and/or compress tissue between the jaws and a rotatable knob 114 and connector providing rotational movement of the jaws. The actuator may also include switches 116, 118 to activate cut, coagulate, seal, fuse or other electrosurgical activities and indicators to identify or highlight the activated or deactivated activity.


The jaws 12 include a first jaw 102 and a second jaw 104. The first jaw is stationary and the second jaw is movable through actuation by the actuator coupled to the second jaw via the shaft and/or components therein. In one embodiment, both jaws may be movable or mobility of the jaws reversed, e.g., the movable jaw is stationary and the stationary jaw is movable. It should also be noted that the first or second jaw being upper or lower jaws is relative as the shaft and the jaws are rotatable and thereby can assume either position. The first jaw includes four electrodes. The first and second electrodes 103a, 103b are substantially hemispherical in shape and cover or occupy a majority of the total surface area of the first jaw. In one embodiment, the hemispherical shape of the electrodes and/or a corresponding mating shape of the second jaw promote tissue after being cut to slide away or otherwise disengage from the jaw. The first and second electrodes are also mirror image of each other and thereby occupy equal halves or side portions along the first jaw 102 as the electrodes extend substantially along the length of the second jaw 104. Disposed between the first and second electrodes are third and fourth electrodes 105a, 105b generally rectangular in shape extending substantially perpendicular relative to the first and second electrodes 103a, 103b and also extending along the length of the first jaw. The edges or the upper portions of the third and fourth electrodes can be beveled or otherwise tapered, slanted, rounded or curved to provide an atraumatic edge to assist in a surgical procedure, e.g., grasping tissue, or alternatively a defined edge to assist for example in cutting tissue.


The third electrode 105a extends towards the second jaw and the fourth electrode 105b extends away from the second jaw. The third electrode 105a extends or has a height somewhat greater than the height or extension of the fourth electrode 105b extending out of the first jaw. The fourth electrode also includes a distal portion 105b′ that extends along the tip of the first jaw 102 curving up along the tip. The lengthwise path of the third and fourth electrodes substantially follows the lengthwise shape of the first jaw. Thus, in the illustrated embodiment, the third and fourth electrodes are somewhat curvilinear.


When the first and second jaws 102, 104 are closed, e.g., in a proximate relationship with each other, the third electrode 105a is substantially covered by the second jaw 104 and thereby leaving the third electrode unexposed. The fourth electrode 105b however remains uncovered regardless of the position of the second jaw. Each of the electrodes on the first jaw are electrically insulated or isolated from each other. Additionally, operationally, each electrode can assume a particular electrical polarity. As such, each electrode can assist in accomplishing a particular surgical functionality, e.g., cut, coagulation, fuse, seal, weld, etc. In one embodiment, the second jaw can also include one or more electrodes, e.g., a fifth or sixth electrode, which in conjunction with the electrodes on the first jaw can also assist in accomplishing the desired surgical functionality.


In one embodiment, when the first and second jaws 102, 104 are closed (or not fully opened or partially closed) and a user activates a coagulation operation or condition, the first and second electrodes 103a, 103b assume a particular polarity and a fifth electrode 107 assumes an opposite polarity, through which RF energy is transmitted through clamped tissue between the first and second jaws to coagulate the tissue. Likewise, when the user activates a cut operation and the first and second jaws are closed, the first and second electrodes 103a, 103b assume a particular polarity and the third electrode 105a on the first jaw assumes an opposite polarity to first coagulate the tissue and then to cut tissue between the first and second jaws 102, 104 and in particular at a point or section where the third electrode 105a contacts the tissue between the jaws. In one particular embodiment, in a cut operation with the first and second jaws are closed, the first and second electrodes 103a, 103b assume opposite polarity to coagulate the tissue up to and/or prior to complete coagulation or a predetermined pre-cut condition. After reaching the pre-cut condition based on a predetermined phase value, in one embodiment, the first and second electrodes 103a, 103b assume a polarity opposite to the polarity of the third electrode 105a. In one embodiment, the actuator 14 includes a trigger switch that is inactive or not activated by the position of the trigger positioned away from the switch.


Additionally, when the first and second jaws are not closed (fully opened or partially opened) and a user activates a coagulation operation or condition, the first electrode 103a assumes a particular polarity and the second electrode 103b assumes an opposite polarity, through which RF energy is transmitted through tissue between the first and second electrodes 103a, 103b to coagulate the tissue. Likewise, when the user activates a cut operation and the first and second jaws are not closed, the first and second electrodes assume a particular polarity and the third and fourth electrode 105a, 105b on the first jaw 102 assumes an opposite polarity to first coagulate the tissue and then to cut tissue between the electrodes and in particular at a point or section where the third electrode contacts the tissue between the jaws. It should be appreciated that over or completely coagulating tissue increases the difficulty in cutting the tissue as the tissue's conductivity is substantially reduced. This is contrary to the tendency to “over coagulate” tissue to ensure that blood loss is avoided (i.e., the tissue is sealed).


In one embodiment, a trigger switch 103 of the actuator 14 is activated by the position of the trigger 112 causing contact with the switch. The trigger in the illustrated embodiment includes a flexible arm 101 connected to or incorporated with the trigger utilized to activate or deactivate a trigger switch in the actuator 14. The trigger switch 103 is internal or housed within the actuator and not accessible by a surgeon. The trigger switch however activates or permits the activation or effect of one or more external switches that is accessible by the surgeon. For example, a “cut” button or switch accessible by a surgeon will not operate or cause the application of RF energy to cut tissue even if the button is depressed by the surgeon unless the internal trigger switch is also activated. In one embodiment, the internal trigger switch is only activated depending on the position of the trigger and/or the jaws. The internal trigger switch can also be activated via relays based on commands or programming provided by the electrosurgical unit, the instrument and/or the connector. It should be appreciated that in various embodiments the internal trigger switch does not activate or permit by itself the activation of RF energy and thereby avoids unintended operation of the instrument without active and deliberate participation by the surgeon. Additionally, it should be appreciated that in various embodiments the switches accessible by the surgeon can only activate while the internal trigger switch is also simultaneously active or activated and thereby avoids unintended operation of the instrument without active and deliberate participation by the surgeon and active communication or deliberate programming or commands embedded or provided for the electrosurgical unit, the instrument and/or the connector.


It should thus be appreciated that tissue between the first and second jaws can be cut with the jaws closed or not closed. Additionally, tissue can be cut beneath and/or in front of the first jaw, i.e., tissue not between the first and second jaws, when the first and second jaws are not closed (the cutting occurring to the tissue between the fourth and first electrodes; the fourth and second electrodes; and/or the fourth and first and second electrodes). It should also be appreciated that the electrodes to assume the appropriate polarity or connection for a particular operation, e.g., cut or coagulation, are switched in or connected to the energizing circuitry of the electrosurgical unit to apply the specific RF energy to cut or coagulate tissue. Such switching or control information in one embodiment is provided via script data stored on a memory chip of a plug adapter or coupler connectable to the electrosurgical instrument.


As previously described, in one embodiment, the first jaw 102 is stationary or not movable and includes inner and outer vertical electrodes. Such an electrode configuration provides directed energy delivery based on the position of one jaw relative to the other jaw. For example, the electrode configuration provides cutting at the tip of a jaw and/or along the length of both the outer and inner surfaces of the jaw. Also, with the electrode configuration being located on a jaw that is stationary relative to the other jaw operation when the jaws are open can be performed such that a surgeon can manipulate the direction or path of the cut directly through manipulation of the actuator as the jaw is stationary in relation to the shaft and the actuator. In one embodiment, tissue captured between the jaws can also be cut by the electrodes on both jaws operating together.


It should be appreciated that the addition of multiple electrodes on one or more jaws is not a trivial design choice. Reducing the number electrodes is often desired, especially in the limited confines of laparoscopic procedures, to avoid shorting or undesired thermal spread or modification of tissue, e.g., charring or cutting of tissue, introduced at least by the additional conductive material proximate the active or energized electrodes. Accordingly, the electrodes as provided in various embodiments are specifically arranged, structured and utilized to overcome such challenges.


In one embodiment, an electrosurgical instrument is provided that includes multiple cutting blades or surfaces. Some or all the blades are movable and/or electrically connected. Operationally, the instrument or parts thereof can be energized to fuse or coagulate and cut tissue as needed. In another embodiment, one or more blades are stationary and/or electrically connected.


In one embodiment, wires are welded onto the electrodes in the first jaw 102. The wires are routed around a rotary connector 27 and conductive rings 24a-24d are attached to the rotary connector within the actuator 14. In one embodiment, a rotary lock is installed and holds the conductive rings in place. In one embodiment, conductive ring 24a is coupled to the electrode 103a and conductive ring 24d is coupled to the electrode 103b. The conductive ring 24b is coupled to the electrode 105a and conductive ring 24c is coupled to the electrode 105b. The rotary connector 27 includes one or more slots through which wires from electrodes are threaded or managed through slots. Conductive rings are secured to the rotary connector such that individual corresponding wires for associated electrodes are electrically connected to associated conductive rings. As such, the conductive rings rotate as the rotary connector rotates along with the associated wires extending from the electrodes of the jaws through the shaft and to the rotary connector and thus the wires do not wind around the shaft as the jaws are rotated.


The actuator 14 also includes contact brushes 26a-d are disposed in contact with an associated conductive ring 24a-d. For example, in the illustrated embodiment, contact brush 26a is positioned next conductive ring 24a. Each contact brush is also connected to a wire or similar connections to the connector and ultimately to an electrosurgical unit to provide or communicate RF energy, measurement, diagnostic or similar signals through an associated electrode at the jaws of the electrosurgical instrument. Slots within the handle of the actuator in one embodiment facilitate the wire placement and connection with a contact brush and the electrosurgical unit. As such, the conductive rings provide a conduction or communication surface that is continually in contact with the contact brushes and vice versa regardless of the rotation of the shaft. In one embodiment, the contact brushes are slanted or biased to maintain contact with the conductive rings.


A “U” shaped tube clip 25 within the actuator 14 is welded onto a wire in which the other end of the wire is welded to the second jaw 104. In one embodiment, the second jaw 104 is held in place by a pull tube. The pull tube serves as an electrical connection for the second jaw 104. The conductive rings and clip provides constant electrical conductivity between the electrodes and the electrosurgical unit while simultaneously allowing or not hindering complete 360 degrees of rotation in any direction of the jaws 102, 104. For example, wires coupled to the electrodes to the rings or clip follow the rotational movement of the jaws and the shaft attached thereto and as a result do not get intertwined or tangled within or along the shaft or the actuator thereby limiting rotational movement, disconnecting or dislodging the connections and/or interfering with operation of the actuator.


In one embodiment, individual wires are welded to individual electrodes of the jaws of the electrosurgical instrument. The wires, e.g., wire 29, are threaded along the shaft connected to the jaws through a rotary knob and into slots in a rotary connector 27. In one embodiment, some of the wires are placed on one side of the connector and other wires on an opposing side of the connector. The wires are staggered along the length of the connector to match the staggered placement of the conductive rings. In one embodiment, the staggered placement prevents inadvertent shorting or conduction between rings. Conductive rings are thus in one embodiment slide over the connector and are placed in spaced slots along the connector to mate each conductive ring to an associated staggered wire. Individual wires in one embodiment are also installed into slots in the handle of the actuator and an associated contact brush is installed over the associated wire to mate each wire to an associated contact brush. The rotary connector thus installed into the handle of the actuator mates or sets up an electrical connection or conduction area for each conductive ring with a corresponding contact brush.


Turning now to FIGS. 11-19, a fusion and cutting electrosurgical instrument 20 is shown connectable to an electrosurgical unit in accordance with various embodiments of the invention. The instrument 20 includes jaws 22 connected to a shaft 26 that is connected to an actuator 24 which when manipulated manipulates the jaws 22. In one embodiment, the actuator includes a floating pivot mechanism 221 including a pivot block connected to a trigger 222 for the opening and closing of the jaws and to capture and/or compress tissue between the jaws. The actuator in one embodiment also has a rotary knob 224 and connector providing rotational movement of the jaws and in one embodiment also includes a blade trigger 225 coupled to a push bar or blade shaft coupled to or incorporating a distal cutting element to translate the cutting element through the jaws and to cut tissue between the jaws. The actuator may also include switches 226, 227, 228 to activate cut, coagulate, seal, fuse or other similar electrosurgical activities and indicators to identify or highlight the activated or deactivated activity.


In accordance with various embodiments, a blade or cutter 191 is included in the instrument and is movable relative to the jaws 22 of the instrument. The cutter is displaced substantially orthogonal to surface one or both jaws and is movable along a longitudinal axis of the instrument. In one embodiment, the cutter is positioned horizontally or parallel relative to one or both jaws. The cutter in one embodiment can move outside the confines of the jaws or is placed on the outside or outer surface of one or both jaws. For example, the cutter can act as a retractable electrode or retractable blade placed within one or both jaws and exposed externally or on the outside of a jaw upon manipulation by an actuator coupled to the cutter. The cutter edge can extend along all or some of the cutter and some or all of the edge is sharpened, beveled, energized or otherwise configured to cut tissue.


In the illustrated embodiment, the cutter 191 traverses through a channel within the jaws to cut tissue between the jaws. The channel does not extend beyond the outer periphery of the jaws and thus the cutter remains within the distal confines of the jaws. A blade shaft 196 is connected or incorporated with the cutter as a monolithic structure extends into the actuator. A blade trigger upon actuation moves the cutter through the channel in the jaws. The blade shaft 196 is biased to pull the cutter back to its initial rest position once the trigger is released. In one embodiment, a spring coupled to the blade shaft biases the cutter towards the actuator. Actuation of the blade trigger thus overcomes the spring bias to move the cutter distally through, out or along the inside or outside of one or both jaws.


In one embodiment, one or more stops 195, 197 along the blade shaft limits movement of the blade shaft 196 and thus the cutter 191. In the illustrated embodiment, a stop projection disposed on or within the blade shaft moves with the blade shaft and when moved distally to a predetermined point, e.g., near a distal end of the channel in a jaw, the stop projection interacts with a corresponding stop projection or slot 194 preventing further distal movement of the stop projection beyond the stop slot. In one embodiment, the stop slot is disposed on, from or within a cover tube 192 disposed over the blade shaft and positioned to contact the stop projection on the blade shaft when the cutter is moved distally to a predetermined point.


In one embodiment, a second stop projection 197 is disposed on or within the blade shaft 196 and spaced from a first stop projection 195. The second stop projection is placed closer to the actuator or away from the jaws 22. In the illustrated embodiment, the second stop projection 197 prevents the spring from pulling the blade proximally beyond a predetermined point, e.g., near a proximal end of the channel in a jaw. As such, in various embodiments, the blade stop limits forward and/or reverse travel of the blade or cutter when extended or retraced either towards or away from the distal end of the instrument. The blade stops in one embodiment are crimped or deformed portions 194 in the cover tube 192. The crimped portions interacting with the stop projections of the blade shaft act as a positive stop as the inside dimension of the cover tube is narrower than the overall width of the stop projections on the blade shaft. A pull tube 193 coupled to the jaws to actuate and/or energize one or both jaws is disposed over the blade shaft and in one embodiment includes one or more slots to provide exposure or interaction of the stops of the blade shaft with the stops of the cover tube.


The stops ensure that if force is applied the cutter will not beyond a predetermined point. The cutter could be allowed to continue to move distally or proximally upon actuation and the distal or proximal end of the channel or portions thereof can halt further movement of the cutter. However, if further pressure or bias is applied to move the cutter distally or proximally, the contact with one or both jaws under pressure can damage or dull the cutter. The stop projections prevent such a condition. In one embodiment, the second stop projection prevents further movement of the cutter proximally and thus the spring biasing the cutter towards the proximal direction, the spring can hold the cutter in place. Thus, the cutter can be moved along tissue to cut tissue with the jaws opened or closed without movement of the blade shaft through movement of the instrument along or through tissue. Tissue pressed against the cutter is cut as the pressure or force of the spring along with the interaction of the stop projections holds the cutter in place.


In one embodiment, the jaws 22 include a stationary first jaw 202 and a movable second jaw 204 that moves relative to the first jaw. In one embodiment, both jaws may be movable or the first jaw movable and the second jaw stationary. The first jaw 202 is entirely conductive or includes conductive material. In one embodiment, the first jaw includes an electrode generally planar and covering or extending over an upper surface of the first jaw. The second jaw 204 includes first and second electrodes 205, 206 with an insulator between the electrodes. In one embodiment, the second electrode 206 is on an upper portion of the second jaw 204 distal from the first jaw 202 and the first electrode 205 is on a lower portion of the second jaw 204 proximate to the first jaw 202. The second jaw is pivotally connected to the first jaw or the shaft or other components connected to the first jaw. Through this pivot connection, the first jaw 202 in one embodiment is electrically connected to the second electrode 206 of the second jaw 204. The second electrode 206 is entirely conductive or includes conductive material and is generally shaped like the first jaw. The second electrode 206 in one embodiment is generally hemispherical. The first jaw 202 in one embodiment is generally hemispherical. Tissue however clamped or captured between the first and second jaws 202, 204 is positioned between the first electrode and the second jaw. As such, the second electrode 206 in one embodiment does not participate or is not involved electrically in the cutting or sealing of tissue grasped or captured between the first and second jaws 202, 204. The second electrode 206 when electrically added or switched in, in one embodiment, is involved in the cutting and/or sealing of tissue outside or at least with tissue in contact with the second electrode. In one embodiment, this configuration makes it unnecessary to electrically insulate the first jaw and second jaw and in one embodiment may be commonly connected via a jaw pin. As such, manufacturing is eased and multiple or excessive electrical connections are reduced.


For example, in one embodiment, the first electrode 205 of the second jaw 204 and the first jaw 202 are electrically connected to assume a first and second polarity such that tissue positioned between (clamped or not clamped) and in contact with the first electrode 205 and the first jaw 202 can be sealed when a user activates a sealing operation. As such, RF energy appropriate for sealing tissue is transmitted through the tissue between the first electrode 205 and first jaw 202 to seal the tissue. In one embodiment, a movable cutting blade can be activated by the user to cut the tissue between the first electrode 205 and first jaw 202. The cutting blade in one embodiment is electrically conductive and energized such that RF energy appropriate for cutting tissue is transmitted between the cutting blade and the first jaw 202, second jaw 204, or both. In one embodiment, the cutting blade is stationary. The cutting blade in one embodiment may be relatively blunt or sharp that may or may not depend on the electrical connectivity of the blade. There may also be multiple blades and some or all may be electrically conductive or connected. The cutting blade in one embodiment is positioned generally perpendicular to the first jaw 202 and/or can traverse through the length or a portion thereof of the first or second jaws.


In one embodiment, tissue outside of the first and second jaws 202, 204 can be cut and/or coagulated. In one embodiment, the second electrode 206 and first jaw 202 can be energized to coagulate tissue between the contact point or area of the second electrode to tissue and the contact point or area with the first jaw. As such, jaws are positioned on its side in its opened or closed position and can be dragged or slid across the tissue to coagulate and/or cut tissue. Also, the jaws can be positioned with its front or tips of the jaws (opened or closed) contacting tissue and dragged or slid across the tissue to coagulate and/or cut tissue. In one embodiment, the first electrode 205 of the second jaw 204 and the second electrode 206 of the second jaw 204 are electrically connected to assume a first and second polarity such that tissue positioned between or in contact with the first and second electrodes to be cut and coagulate when a user activates a respective cut or coagulate operation.


As such, RF energy appropriate for cutting or coagulating tissue is transmitted through the tissue between the first electrode 205 and second electrode 206 to respectively cut, coagulate, fuse or weld the tissue. As such, second jaw 204 can be dragged, pushed or slid across tissue to coagulate and/or cut tissue. In one embodiment, cutting or coagulation is only allowed when jaws 202, 204 are partially or fully spaced from each other. In one embodiment, a switch or sensor is activated to indicate the spaced relationship or the lack thereof between the jaws to allow activation of cut or coagulation of the tissue.


In one embodiment, the first electrode 205 extends along an outer portion of the distal end or tip of the second jaw 204. The first and second electrodes 205, 206 can be energized to cut, coagulate, fuse or weld tissue between or in contact with the electrodes. By limiting the first electrode to a specific area or arrangement relative to the second electrode, the focus or applicable energizing area can be limited to the specified portion of the first electrode and the second electrode 205, 206. In one embodiment, the second electrode 206 can also be similarly arranged to extend along a limited portion of the second jaw 204. In the illustrated embodiment, an insulator 207 disposed adjacent the first electrode 205 limits the focus area of the first electrode. In one embodiment, the size, shape and/or orientation of the first electrode, the second electrode and/or an additional provided electrode is limited to provide the appropriate or desired focus area. The first electrode extending along the outer periphery of the second jaw is positioned generally horizontal relative to the second jaw and in one embodiment may be relatively blunt. The orientation, size and location of the first electrode can vary based on the desired surgical operation and there may be additional electrodes similarly positioned.


The first electrode 205, the first jaw 202 and/or the second electrode 206 in one embodiment is a contiguous or monolithic electrode with a contiguous or monolithic seal surface. In one embodiment, the monolithic seal surface includes spaced or interrupted portions to provide a plurality of seal paths or surfaces. For example, first electrode 205 includes first and second seal paths 217a, 217b. The first and second seal paths surround and are adjacent to the blade or cut channel of the jaw through which the blade or cut electrode is situated or traverses therethrough. In the illustrated embodiment, the monolithic seal surface also includes spaces or cavities 215a, 215b and a third and a fourth seal path 219a, 219b positioned near but spaced from the first and second seal paths. The first and second seal paths in one embodiment are inner paths relative to the outer paths of the third and fourth seal paths. The multiple interrupted or spaced seal paths provide redundant seal areas or portions of the tissue being sealed separated by a portion of the tissue not electrically or otherwise treated or manipulated by the jaws. As such, by situating a separated or unaffected tissue between seal paths, the overall tissue seal is enhanced and thermal spread along the tissue and effects thereof are reduced. In the illustrated embodiment, tissue between the first seal path and the fourth seal path remains unaffected by energy being transmitted to the electrode while tissue along the first and third seal paths is electrically sealed. Likewise, tissue between the second seal path and the fourth seal path is electrically sealed and the tissue between the paths or within or along the cavities remains unaffected. Tissue along the cavities is also not compressed or mechanically manipulated as compared to the tissue along the seal paths.


In one embodiment, the first electrode 205 can be activated by the user to cut, coagulate, fuse or weld tissue in contact with or between the first electrode 205 and the first jaw 202 and/or the second electrode 206. In one embodiment, the second electrode 206 and the first jaw 202 share a common electrical contact and/or common polarity such that RF energy can be transmitted between the first electrode 205 and the first jaw 202 and/or between the first electrode 205, the second electrode 206 and the first jaw 202.


In one embodiment, when the jaws are not fully opened or closed, i.e., in a state or condition between being open and being closed, tissue positioned between the jaws 202, 204 can be fused. Automatic disruption of RF energy in one embodiment however is not used, is not activated or is deactivated as the appropriate conditions for automatic disruption of RF energy is not satisfied or cannot be assured. Cutting can also be prevented (mechanically and/or electrically). Identification of the intermediate state in one embodiment is determined based on the activation or lack thereof of a switch and/or sensor within the instrument adjacent the trigger and/or jaws or detecting the position of the trigger or the jaws relative to each other.


In accordance with various embodiments, electrosurgical RF energy to cut and/or coagulate tissue in a bipolar fashion utilizes both an active and a return electrode and can be used for example in general and gynecological laparoscopic procedures. In such configurations, the desired surgical effect (e.g., cut, coagulate, etc.) is based upon the current density ratio between the electrodes, the electrode geometry and the current and voltage supplied to the electrodes. In one embodiment, cutting tissue utilizes a voltage output greater than 200 V and coagulating utilizes a voltage below 200V. Current density is measured as the (Delivered Current)/(Electrode Surface Area). As such, the active and return electrodes can be assessed by the following current density ratio: Active Electrode/Return Electrode=(Large Current Density)/(Small Current Density). It should be appreciated that an electrode can assume or switch between roles as an active electrode or a return electrode relative to another electrode based on current density, electrode geometry and/or current and voltage supplied to the electrodes. Generally, the active and the return electrodes are electrically insulated or isolated from each other.


Various electrode configurations of the jaws of the electrosurgical instrument in accordance with various embodiment of the invention are shown in FIGS. 30-38. In various embodiments, at least one or only one electrode is located on one of the jaws. For example, the electrode in one embodiment is located on the top jaw and horizontally oriented relative to the jaw. It should be appreciated that the electrode could be on an opposite jaw than illustrated and the top and bottom jaws are relative to each other. As such, referral to a top jaw can equally be a referral to a bottom jaw as well as movable jaw to stationary jaw.


In FIGS. 30A-B, a movable jaw 602 includes an outer vertical electrode 605. This electrode configuration provides cutting at the tip of an articulating or movable jaw and/or along the length of the jaw. In one embodiment, the cutting follows in an articulating manner and/or path relative to the shaft and actuator of the instrument. For example, tissue can be cut as the top jaw opens as the electrode on the jaw is parallel or in-line with the path that the jaw travels (e.g., path 601 and/or 603 (in both or one direction)). In the illustrated embodiment, the electrode 605 in conjunction with a larger conductive portion 606 surrounding the electrode on the jaw or a second electrode 607 conduct RF energy there between to effectuate the cutting path.


In one embodiment, a stationary jaw 704 includes an outer vertical electrode 705 as shown in FIG. 31. This electrode configuration provides cutting at the tip of a stationary jaw 704 and/or along the length of the outer portion of the jaw. The electrode 705 in one embodiment operates in conjunction with either an inner or an outer electrode acting as another electrode to conduct RF energy there between. In one embodiment, a movable jaw 702 does not include an electrode or is otherwise insulated or isolated from the electrode 705. In operation, a surgeon can manipulate the direction or path of the cut directly through the manipulation of the actuator as the jaw remains stationary relative to the shaft of the instrument.


Referring now to FIG. 32, in one embodiment, one of the jaws 802 includes a horizontal electrode 803 and a vertical electrode 805. This electrode configuration provides directed energy delivery based on the position of the jaws relative to each other. The configuration also makes it unnecessary to electrically insulate the top jaw actuating member from the lower jaw. While the jaws are closed, the horizontal electrode 807 on the lower jaw 804 can be used to dissect tissue utilizing the lower jaw 804 as a return electrode. While the jaws are open, the vertical electrode 805 can cut tissue at the tip of the top jaw 802 as well as along the length of the top jaw in an articulating manner relative to the shaft and hand-piece of the instrument. Tissue can be cut as the top jaw opens because the active electrode is parallel to the path that the top jaw travels. The active electrode utilizes the top jaw actuating member as the return electrode. The orientation of both electrodes can be switched, e.g., vertical to horizontal and horizontal to vertical, to achieve similar effects.


In one embodiment, an electrosurgical cutting electrode 811 can be used to dissect tissue as shown in FIG. 33. A mechanical cutting blade 812 is used to divide tissue captured in the jaws 815, 816 of the instrument along the length of the jaws of the instrument by activation of a lever located on the actuator of the instrument. It should be appreciated that the mechanical blade and electrical electrodes can be reversed. In one embodiment, a first cutting electrode 811 can be used to dissect tissue. A second cutting electrode 812 is used to divide tissue captured in the jaws of the device by using the lower jaw 816 as a return electrode. This second electrode can travel along the length of the jaws of the instrument by activation of a lever located on the actuator of the instrument.


In various embodiments, electrodes (and portions in which they are attached) can be used to probe and/or manipulate tissue in a physical manner when not electrically active. In various embodiments, retractable electrodes provide an atraumatic jaw assembly for tissue contact and for movement through trocar seals. In one embodiment, retraction of a cutting electrode into the body of either jaws of the instrument can facilitate the removing or cleaning eschar that has built up on the electrode.


In one embodiment, the retraction of an electrode 91 can be actuated through movement in relation to the trigger of the actuator (FIGS. 34A-B). For example, the retraction would occur in relation to the movement of the jaws. Such an actuation can indicate which position the electrode can be used to cut tissue. In one embodiment, when the electrode is extended, the electrode can be activated and when retracted inactive. The placement of the retractable electrode can be on either or both jaws. In one embodiment, the retraction of the electrode 91 can occur through a lever or similar actuator separate from the trigger or actuator (FIGS. 35A-B). As such, the electrode can be extended and retracted independently of the jaw position. The electrode can also be activated independently and in an extended position.


The retractable electrodes described above and as shown in FIGS. 36A-D can be rounded 95, pointed 96, L-Hook shaped 93, or J-Hook shaped 94. In various embodiments in which the electrodes are L-Hook shaped, J-Hook shaped or similarly shaped and retractable, such electrodes can be used to capture tissue between the jaws of the instrument and/or the hook portion of the electrode.


In one embodiment, an electrode on one of the jaws may be separated or be two adjacent electrodes (e.g., a distal electrode and a proximal electrode). Each electrode can be energized simultaneously or individually. Also, one of the electrodes can allow a different tissue type to be treated differently from the other electrode (e.g., one cuts and the other coagulates, one treats one type of tissue and the other is used for another type of tissue). The separate electrodes can also provide a comparison of tissue type or phase monitoring to ensure proper treatment (e.g., cut, coagulation, etc.) of the tissue or multiple tissue types in contact with the separate electrodes. The other jaw or other portions of the same jaw in one embodiment can act as an electrode in which RF energy is exchanged between the electrodes and the jaws.


Referring now to FIGS. 20-29, electrosurgical instruments are connectable to an electrosurgical unit through a coupler 50 in accordance with various embodiments of the invention. The coupler 50 includes a plug 502 attached to a cable 501 attached to and extending from the connecting instrument. Attached to the plug 502 is a connector 503 which is connectable to the electrosurgical unit. In one embodiment, the plug 502 is not connectable to the electrosurgical unit without the connector 503.


In one embodiment, the plug 502 is removably attached to a connector 503 that is directly connectable to an electrosurgical unit. The connector 503 provides a conduit such that radio frequency energy is supplied from the electrosurgical unit through the cable to the instrument. Additionally, communication back to the electrosurgical unit is transmitted through the cable and connector from the instrument. For example, the instrument via switches or actuation of the handle or trigger transmits signals or closes circuits to ensure RF energy is delivered as requested by the instrument.


The connector 503 in one embodiment includes memory circuitry 503b′ and a pin arrangement 503b″. The pin arrangement 503b″ is specifically arranged to couple to a corresponding pin arrangement 501d of the cable 501 associated with the electrosurgical instrument. On the other end of the cable, contacts 501a, 501b, and 501c are arranged to connect to corresponding contact points for switches, indicators and/or sensors as appropriate for the associated electrosurgical instrument. Accordingly, the pin arrangements can vary to couple the cable to the connector 503 and the contacts 501a, 501b, 501c, 501e, and 501f can vary to couple the cable to the corresponding electrosurgical instrument.


The memory circuitry in one embodiment includes instrument or tool data that outlines the operation of the instrument in conjunction with the electrosurgical unit. The tool data in one embodiment is transmitted from the chip to the electrosurgical unit. The unit in analysis of the tool data recognizes or identifies the electrosurgical instrument to which the connector is attached thereto. Additionally, the tool data includes script information that describes the operational aspects of the attached electrosurgical instrument. For example, the script information can include a total number of electrodes on the electrosurgical instrument and the state or condition in which one or more of the electrodes are utilized or software to be transferred to an electrosurgical unit upon successful electrical connection of the instrument to the electrosurgical unit. The tool data can also include data regarding various electrosurgical procedures to be performed by the instrument and corresponding energy level ranges and durations for these procedures, data regarding electrode configuration of an instrument, and/or data regarding switching between electrodes to perform different the electrosurgical procedures. Similarly, customized data, e.g., settings preferred by a particular surgeon or a surgical procedure to be performed, can also be included in the tool data and utilized for example to set the electrosurgical unit in a mode or particular configuration preferred by the surgeon, e.g., a particular power setting or the user interface's appearance or control.


In one embodiment, the electrosurgical unit has limited capabilities to supply or not supply RF energy. The electrosurgical unit can also incrementally increase or decrease the amount or intensity of the supply of RF energy. However, the control or regulation of the RF energy is not included or incorporated with the electrosurgical unit but instead is located on the memory circuitry as script information. The script information provides the control data that directs the supply of radiofrequency energy such that when a button or switch is activated by the user, RF energy is directed to corresponding electrodes as indicated in the control data. Similarly, the control data also includes information to identify and recognize the button being activated. After initial handshaking between the electrosurgical instrument and the unit when an instrument is connected to the unit, the script information is transferred to the electrosurgical unit. In one embodiment, subsequent or further access or requests to deliver the script information to the unit is not provided or permitted to prevent reuse of the connector 503.


The connector in one embodiment is non-sterile and the cable and the electrosurgical instrument to which the cable is connected are sterile. It should be noted that the non-sterile characteristic of the connector is not typically used in the other electrosurgical systems. However, due to the electrical components, e.g., the memory circuitry, within the connector typical sterilization of the connector is not readily available or usable. Accordingly, embedding or otherwise including such components with an electrosurgical instrument that must be sterile is typically not provided. However, by providing a separate and attachable connector the electrosurgical systems can be customized and/or configured while the sterilization concerns are overcome.


In one embodiment, the connector 503 allows the electrosurgical unit to be customizable and/or configurable to adjust or accommodate various electrosurgical instruments that are connectable to the electrosurgical unit. Accordingly, as an electrosurgical instrument changes or improves over time and/or surgical procedures or operational procedures change, the electrosurgical unit can be supplied the latest or most recent information from the connector specifically tailored or addressed to the electrosurgical instrument attached thereto. Therefore, changes to instrument or tool profiles and periodic tool updates can be rapidly made without downtime to electrosurgical units, as the software for instrument operation can reside with the electrosurgical instrument itself, rather than the electrosurgical unit. Accordingly, updates can be made during instrument production and thereby avoiding the potentially expensive and time prohibited activity of removing or replacing the electrosurgical unit from for example hospital operating rooms to perform updates to the unit.


The connector 503 also ensures a proper connection between an electrosurgical instrument and the electrosurgical unit. In one embodiment, script information stored in the connector is tailored only for the accompanying electrosurgical instrument and no other instrument. For example, if user connects a vessel sealer to the provided connector, the script information stored in the memory circuitry only includes information for that particular vessel sealer. Thus, if a user does connect the same connector to a different instrument, such as an electrosurgical scalpel, (mechanical and electrical features aside that prevent such attachment), the script information to recognize and/or supply power to such an instrument is not available to the electrosurgical unit. As such, even if a user activates the scalpel, the electrosurgical unit without any script information about such an instrument will not supply RF energy to the instrument. In this example, the script information provided is for a vessel sealer. Utilizing this script information the electrosurgical unit is also able to identify that the attached device is not a vessel sealer and in particular not the appropriate instrument for the provided script information. This in one embodiment can also be recognized by initial handshaking of an attached instrument and the electrosurgical unit, the script information thereby also providing a layer of insurance for proper instrument usage.


The connector 503 in one embodiment also provides a uniform configuration for the connection to the electrosurgical unit on one side or end and the plug of the electrosurgical instrument on the other end. The pin or recess arrangement 503a, 503b′″ provides an uniform and expected mating or coupling to corresponding pin or recess arrangements on the instrument ports of the electrosurgical unit. Similarly, the plug 501d includes a recess or pin arrangement that couples to the corresponding pin or recess arrangement 503b″ of the connector 503. Covers 502a, 502b and 503c cover or enclose the associated components of the plug 502 or connector 503. Accordingly, the connector 503 provides a uniform mechanical connection between the electrosurgical unit and the associated electrosurgical instrument. Therefore, manufacturing and operational use are facilitated. However, the circuitry provided with the connector 503 can provide a customized or non-uniform electrical connection between the unit and the instrument and/or script information to the unit for the instrument. Therefore, upgrade flexibility and instrument customization are enhanced.


It should be appreciated that there are various RF electrosurgical units that supply RF energy and likewise various electrosurgical instruments or tools that can connect to such electrosurgical units to receive the supplied RF energy which is operationally used in various surgical procedures. However, particular electrosurgical instruments require or optimally function when supplied RF energy within a particular specification or manner. In some cases, such instruments or electrosurgical units simply do not operate with the electrosurgical units or instruments, thereby leaving a surgical team to wonder if the instrument or electrosurgical unit is defective. As a result, operating devices are improperly discarded or surgical procedures delayed as the source of the problem is investigated and uncovered.


In other cases, the instruments or electrosurgical units do operate together in the sense that the instrument is supplied RF energy by the electrosurgical unit. However, the instrument or electrosurgical unit expecting a particular or specific application of such energy can result in damage to the devices or improper operation of the instrument, e.g., the instrument not cutting a tissue sufficiently or a vessel not sealing after the application of RF energy by the instrument. Therefore, in some cases, particular electrosurgical instruments should not be connected to particular RF electrosurgical units and vice versa.


Additionally, in particular cases, a specific operational quality and performance of an electrosurgical instrument or electrosurgical unit is expected by a surgical team for use in a particular surgical procedure. Such operational performance however results only when the specific electrosurgical instrument is utilized with the specific electrosurgical unit. Accordingly, this pairing of specialized devices is required to provide the expected operational quality and performance. Therefore, there is a need to ensure the proper connection between electrosurgical instruments and electrosurgical units to ensure operational quality and performance and to prevent unexpected and unintended operation failures or damage to the devices.


In one embodiment, systems and methods are provided to ensure the proper connection of specialized or specific electrosurgical instruments to the specialized or corresponding specific receptacles of an electrosurgical unit. Improper connection or connection with a non-specialized electrosurgical instrument with the specialized receptacles is thus prevented. As such, among other things, this ensures that only electrosurgical instruments of a specific quality and performance are used that match the specific quality and performance of the electrosurgical unit.


In one embodiment, the tool connector 503 mates with a tool connector receptacle 302 of a tool port of an electrosurgical unit. An embossment on the connector and an excavation or channel 303 on the tool receptacle ensures proper orientation upon instrument or tool insertion. The embossment on the connector and the excavation on the receptacle also ensures that proper or expected instruments are being plugged in the corresponding instrument port, e.g., DC port versus a dedicated instrument port (and vice versa). Upon insertion, a latching mechanism, in one embodiment, including latch arms on the instrument plug and corresponding latch shelves 301 on the receptacle locks the connection, resulting in an engagement of flat surfaced contact pads on the connector with a series of extending pins 304, e.g., spring-loaded pogo-pins, of the receptacle of the electrosurgical unit. In one embodiment, a series of pins extending from a receptacle of the electrosurgical unit are removably and electrically coupled to flat surface pads on the connector. As such, the flat surface pads do not include any mechanical connectors to interact or interlock the pins with the associated pad. Additionally, in one embodiment, the connector or plug does not include mechanical connections or interlocks to couple the pins from the receptacle to the connector. In the illustrated embodiment, the contact pads are recessed within individual cavities in the plug and the cavities do not interlock with the associated pins extending to contact the associated contact pad when the plug is inserted into the receptacle. In one embodiment, the receptacle also includes a switch 305 recessed within receptacle that is operatively activated by the plug and in particular an interlock pin or projection 504 extending from the plug and being inserted into the receptacle. In one embodiment, the receptacle is circular or similarly shaped along with the corresponding plug that reduces the overall surface or working area along the electrosurgical unit. In one embodiment, the pins extend from the plug or connector while flat surface pads are arrayed along the receptacle of the electrosurgical unit.


In various embodiments, on the other side of the tool connector plug contact pads are shown. In this view, a printed circuit board (PCB) with a circuitry housing an encrypted tool memory chip and a tool connector head that provides connection to the instrument are given. The tool connector head in various embodiments connects the instrument electrodes (up to five), functional instrument switches (cut, coag and fuse), instrument position switches (instrument fully open and instrument fully close), as well as a three-colored LEDs in the electrosurgical instrument to the electrosurgical unit. As such, the pin/receptacle assignment on the instrument receptacles corresponds to the pin/receptacle assignment on the tool connector plug.


In one embodiment, script-based or instrument-specific generator intelligence is stored in a non-volatile memory section of the memory chip in the tool connector that communicates with an electrosurgical unit. A script parser in a central processing unit (CPU) of the electrosurgical unit reads and processes tool script information such as, but not limited to, instrument authentication (ensuring original manufacturer use), single-use assurance, instrument expiration date, instrument recognition, user interface control (electrosurgical unit's display and/or tones), instrument interface settings (e.g., LEDs on instruments), electrode selection and electrosurgical unit settings (voltage and current) which can also be based on position of the jaw elements (fully open or fully clamped), time-out limits to de-activate power based on time, as well as tissue feedback-activated endpoints (e.g., fuse end point based on phase between voltage and current) and switch points (e.g., switching from coag to cut, fuse to cut, based for example on phase between voltage and current).


The memory chip in one embodiment is written by the electrosurgical unit CPU to store procedure-specific data such as, but not limited to, the serial number of the electrosurgical unit used, a time stamp of instrument connection, the number of instrument uses, the power setting used during each use, the tissue feedback data before, during and after a instrument use, the nature of the instrument use (cut, coag, fuse), the duration of the instrument use, the nature of the shut off point (auto stop, fault, manual stop, etc.), as well as the event and nature of any faults (instrument short, expired or unrecognized instrument, etc.).


An embodiment of a pin-assignment for the dedicated RF instrument receptacles provides pin contacts numbered 1 through 8 are reserved for to the tool memory circuitry, pins 9 through 17 for the instrument switches and LEDs (cut, coag, fuse, instrument open, instrument close, red, blue, green LED and return), and pins 18 through 22 for five instrument electrodes. In another embodiment a pin-assignment for the dedicated DC instrument receptacle provides pin contacts numbered 1 through 8 are reserved for to the memory circuitry, pins 9 through 17 for the instrument switches and LED (on1, on2, on3, instrument position 1, instrument position 2, red, blue, green LED and return), and pins 20 and 21 for provision of DC power.


Electrosurgical systems and processes in various embodiments apply monopolar or bipolar high-frequency electrical energy to a patient during surgery. Such systems and processes are particularly adapted for laparoscopic and endoscopic surgeries, where spatially limited access and visibility call for simple handling, and are used to fuse blood vessels and weld other biological tissue and in one aspect to cut, dissect and separate tissue/vessels. In particular embodiments, the systems and processes include the application of RF energy to mechanically compressed tissue to thereby fuse, weld, coagulate, seal or cut the tissue. In various embodiments, the determination of the end-point of the electrosurgical process is given by monitoring or identifying the phase shift of voltage and current during the process. In one embodiment, unlike impedance, the phase shift changes are more pronounced at times where the tissue desiccates and the fusion process completes, and hence offers a more sensitive control value than the impedance. Accordingly, the application of RF energy via an electrosurgical unit in conjunction with the measuring or monitoring of phase shift via an electrosurgical controller are provided to fuse, weld, coagulate, seal, cut or otherwise electrically modify or affect vessels and tissue in accordance with various embodiments of electrosurgical system.


In one embodiment, measurement of the dielectric properties of the tissue and control and feedback of the phase difference allows for a precise control and feedback mechanism for various tissue types, regardless of the tissue size. For example, a controller of the electrosurgical unit is configured to determine the product of dielectric constant and conductivity, as well as the phase difference between the applied voltage and current to monitor and control the tissue electrosurgical process. In particular, control and feedback circuitry of the controller determines when the phase difference reaches a phase shift value determined by the results of dielectric and/or conductivity measurements. When such a threshold or derived threshold is reached, the electrosurgical process is terminated or another operation is commenced or condition activated. An indicator, e.g., visual or audible, is provided to signal the termination or state/operation change and in one aspect the controller restricts (completely, nearly completely or to a predetermined minimum) further delivery of electrical energy through the electrodes. In one embodiment, the electrosurgical instrument in conjunction with the controller thereby provides atraumatic contact to the connecting tissue and provides enough burst pressure, tensile strength, or breaking strength within the tissue.


In one embodiment, instead of the tissue quickly reaching a pre-determined phase (e.g., ranging from 40 to 60 degrees, depending on type of tissue), the measured phase shift approaches the cut-off threshold asymptotically. Such an asymptotic approach can require an extended amount of time to reach a final phase threshold. As such, instead of depending on the phase value to reach a definite value alone, additionally the derivate of the phase can be used to avoid asymptotic approaches to a finalized phase value. Additionally, the determined phase value can be overshot without being detected or before the processor is able to recognize that a final phase stop has been reached. As such, instead of solely relying on the phase value to reach a definite value alone, the derivate of the phase is also used.


As previously described and described throughout the application, the electrosurgical unit ultimately supplies RF energy to a connected electrosurgical instrument. The electrosurgical unit ensures that the supplied RF energy does not exceed specified parameters and detects faults or error conditions. In various embodiments, however, an electrosurgical instrument provides the commands or logic used to appropriately apply RF energy for a surgical procedure. An electrosurgical instrument includes memory having commands and parameters that dictate the operation of the instrument in conjunction with the electrosurgical unit. For example, in a simple case, the electrosurgical unit can supply the RF energy but the connected instrument decides how much energy is applied. The electrosurgical unit however does not allow the supply of RF energy to exceed a set threshold even if directed to by the connected instrument thereby providing a check or assurance against a faulty instrument or tool command.


In accordance with various embodiments, continuous and/or periodically monitoring the phase value of the tissue being contacted can be correlated to a transition from one tissue condition or type to the next or from one tissue condition or type to no contact. In one illustrated embodiment, an obturator 41 includes two electrodes 44a, 44b used to monitor the phase of the tissue being contacted (FIGS. 37A-B). As the obturator is inserted into the abdominal cavity, the phase value can be used to indicate the point at which the tip of the obturator is inside or through the abdominal wall at which point the surgeon can begin insufflation. This entry point can be indicated with a visual, audible or tactile alert. It should be appreciated that an insufflation needle, a probe or similar instruments can likewise be configured as the obturator to ensure that a specific entry point or condition is identified as appropriate for a specific surgical procedure. Similar applications can also be applied to the placement of stents, ensuring proper contacts of grounding pads and the like. Additionally, utilizing phase value, tissue identification or condition can assist in replacing or removing the need for tactile feedback. For example, in robotic surgical operations and instruments used therein phase/tissue identification monitoring can remove the need to “feel” that tissue is being cut, sealed or grasped or to exert a particular pressure to perform such operations.


In various embodiments, continuous and/or periodically monitoring of the phase value of the tissue being treated can be correlated to either a change in tissue type or a change in the tissue properties due to delivery of energy. In one embodiment, based on the monitoring of the phase value of tissue, the output current and voltage to the instrument can be modified (e.g., increased or decreased based on the desired tissue effect (Cut, Coag, or Fuse)), electrodes can be activated or deactivated, and delivery of energy to the active accessory can begin or end.


Electrosurgical modality transitions based on the phase value of the tissue for electrosurgical instruments in accordance with various embodiments of the invention can be characterized as:

    • 1. Coagulate to Cut
    • 2. Coagulate to Cut to Coagulate (Automatic shut-off—RF energy shut off when a phase value is reached or exceeded)
    • 3. Coagulate to Cut to Coagulate (User shut-off—RF energy shut off when the surgeon releases the delivery of energy)
    • 4. Cut to Coagulate (Automatic shut-off)
    • 5. Cut to Coagulate (User shut-off)


In one embodiment, when coming into contact with tissue of specific phase values, the modalities (Cut, Coag, and Fuse) of the active instrument could be rendered active or inactive. In another embodiment, when coming into contact with tissue of specific phase values, an instrument can automatically provide energy to the tissue (cut, coagulate, fuse, weld or any combination thereof and/or the above noted modalities) until a predetermined phase value is reached.


In one embodiment, a visual, audible, and/or tactile indication can be used to indicate a tissue type that the active instrument is in contact with and thereby the electrosurgical instrument can probe for a specific tissue type. When used in combination with multiple electrodes of the active electrosurgical instrument, combinations of tissue type could be indicated visually, audibly, and/or tactilely and specific electrodes can be activated to provide energy to a portion of the device as desired to perform a specific surgical operation and based on the specific tissue.


In one embodiment, in order to cut tissue using bipolar RF energy, the tissue being treated cannot be desiccated or dehydrated to a point in which the collagen seal is all that remains. At this point the “seal” is unable to conduct electricity in the manner necessary or safely cut the tissue utilizing bipolar energy delivery (e.g., tissue resistance is too high). Likewise, at this point, cutting the seal or the tissue around the seal utilizing a mechanical (non-energized) blade or cutting instrument can also be difficult due to for example the tissue calcifying. Therefore, when utilizing phase values to identify the transitions of “pre-cut” or “partial seal”, the tissue can be coagulated to known phase value less than the predetermined phase value indicated for complete tissue coagulation. Subsequently, cutting is performed (either mechanically or electrically). After cutting, energy delivery can be continued until a predetermined phase values indicated for complete tissue sealing is reached.


It should be appreciated that the tissue to be cut should have minimal thermal damage or desiccation to ensure that the tissue is still conductive to be electrically cut. In one embodiment, the electrosurgical instrument provides that about 1-2 mm of lateral thermal damage outside of the jaws of the device at a phase shift of 45°. The spacing between the coagulating electrodes electrosurgical instrument is about 0.040″ or 1 mm such that at a phase shift beyond 45° the tissue is desiccated too much to be cut effectively. As such, in one embodiment, the larger the spacing between electrodes, the higher a pre-cut transition point or condition can be set and a lower pre-cut transition supports closer electrode spacing. The lower pre-cut transition represents the phase value in which less coagulation occurs versus complete tissue coagulation. Additionally, applying RF energy, e.g., voltage faster or at a high or steep rate, is provided to support closer electrodes as the pre-cut transition is lower than a pre-cut transition with larger spacing between electrodes. Likewise, applying RF energy at a slower or less steep rate can be provided for larger spaced electrodes. Additionally, with the tissue being enclosed in between jaws, tissue within the confines of the jaw subjected to higher temperatures than on the outside edges of the jaw. As such, tissue less confined or subject to lower temperatures can have reduced thermal damage and thereby a higher pre-cut transition point can be used.


Referring to FIGS. 40-42, in one embodiment, a pre-cut process is shown which initially starts for example by the receipt of a cut command (601) from the activation of a button or switch on the actuator. The activation of the cut button is communicated or recognized by the electrosurgical unit coupled to the electrosurgical instrument. In one embodiment, a processor within the electrosurgical unit instructs or initiates the output or supply of RF energy (603) to the electrosurgical instrument. However, the RF energy supplied is not energy sufficient to cut tissue disposed at the jaws of the electrosurgical instrument. Instead the RF energy supplied is used for coagulation which is lower than the energy sufficient to cut tissue. The processor monitors the phase between the current and voltage of the RF energy being supplied to the tissue (605). In one embodiment, through current and voltage monitoring circuitry and filters, the phase between the current and voltage of the RF energy is monitored. A comparison is made to a pre-cut phase condition or switch (607). In one embodiment, the pre-cut phase condition is a predetermined value or range of values that is specific for the particular electrosurgical instrument and the type of tissue indicated to be used or specifically used or to be treated by the instrument. In other embodiments, the pre-cut phase condition is determined dynamically based or relative to initial or periodic determinations about the tissue type via for example tissue permittivity and/or conductivity measurements to identify different predetermined values or range of values for a given tissue type. For example, an initial determination of a tissue type is used to lookup or compare to a table of values, e.g., pre-cut phase values, that are experimentally or otherwise predetermined to be the optimal or specific phase value to identify a pre-cut phase condition.


As previously described, the pre-cut phase condition is identified as a point or condition in which the tissue being applied with RF energy is nearly coagulation but less than or not up to the point of complete coagulation, e.g., near complete desiccated, dehydrated and/or calcification of the tissue. If it is not determined that the pre-cut phase switch is reached or exceeded, the process continues as the RF energy continues to be supplied and the phase monitored. Once it is determined that the pre-cut phase condition has been met, cutting of the tissue then proceeds. In one embodiment, the processor commands or initiates the raising or initiation of the RF energy suitable for cutting tissue at the jaws of the electrosurgical instrument (609). In one embodiment, the application of RF energy to pre-cut and then cut tissue is quick such that the rate at which the electrosurgical unit reaches or provides the maximum output voltage is accelerated. If there is a long ramp-up cycle or step function for the voltage to follow, the tissue intended to be cut will be only coagulated. As such, by the time the electrosurgical unit reaches the cut voltage levels the tissue will be too dessicated to properly cut.


In one embodiment, the process continues as phase between applied current and voltage is measured and/or monitored to determine or ensure that the tissue is properly cut. Additionally, in one embodiment, after the tissue is cut, complete coagulation of the tissue can be performed or initiated as RF energy for coagulation is supplied again to the tissue and a determination is made that the tissue has been coagulated.


The tissue pre-cut and then cut is the same or nearly the same, but it should be noted that the tissue can refer to surrounding tissue first being coagulated to a pre-cut condition and tissue between the nearly coagulated tissue is then cut. The application of the coagulation RF energy and/or cut RF energy is also dependent on the electrodes supplying the associated RF energy. As such, the tissue affected can also be based on the location or application of the RF energy from the electrode locations to be pre-cut and then a cut using different sets of electrodes. For example, when a cut command is initiated, one or more electrodes can be energized to apply RF energy to coagulate tissue in contact with the one or more electrodes and once a pre-cut condition is reached, one or more different electrodes are energized to apply RF energy to cut tissue in contact with these different electrodes. Thus, in one embodiment, when a cut button is activated on the electrosurgical instrument, tissue in one area may be supplied RF energy for coagulation to a pre-cut condition and a different tissue in a different are may be subsequently supplied RF energy to cut the different tissue. In one embodiment, one or more electrodes are used in transmitting RF energy for coagulation and one or more electrodes different from the other electrode used for coagulation are used in transmitting RF energy for cutting. Additionally, one or more electrodes can be used as a common or shared electrode utilized to accommodate both the transmission of RF energy for coagulation and cutting.


In one embodiment, an electrosurgical unit 420 can comprise input/output circuitry 422, RF supply circuitry 424, a phase discriminator 426 and a processor 428. One or more circuitry may be incorporated into an associated circuitry. For example, the RF supply circuitry may be included with the input/output circuitry and vice versa. The input/output circuitry receives and transmits RF energy from the RF supply circuitry and out of the electrosurgical unit and to a connected electrosurgical instrument (not shown). The input/output circuitry also receives tool data and/or tissue data from the electrosurgical instrument and/or through a connector therebetween. In one embodiment, the phase discriminator calculates a phase difference between the applied voltage and current from the RF supply circuitry. In one embodiment, the applied voltage and current are rectified and compared or combined, e.g., through an XOR logic gate, to generate a pulse width modulated signal. The duty cycle of the generated signal mirrors or represents the phase difference between the applied voltage and current. The determined phase difference is then supplied to a processor that compares to a predetermined phase threshold based on a particular tissue in contact with the electrosurgical instrument. In one embodiment, the processor provides the above described process of determining a pre-cut condition to completing a cut.


In one embodiment, an electrosurgical generator includes an RF amplifier 633, RF amplifier control and monitor 634, energy monitor 642 and relay and tissue measurement 635. The electrosurgical generator is coupled to a 120 Hz Voltage main input. The main input is isolated with a low leakage isolation transformer of a power supply 631. The power supply provides operational voltages for the control processor 637 and the RF amplifier 633. Additionally, the power supply includes two 50 VDC output modules connected in series to provide a total output of 100 VDC and 8 Amps. RF power is generated by the RF amplifier, e.g., a switched mode low impedance RF generator that produces the RF output voltage. In one embodiment, a 500 peak cut voltage for cutting and 7 Amp current for coagulation/fusing is generated.


Fusing tissue in one embodiment involves applying RF current to a relatively large piece of tissue. Because of the potentially large tool contact area tissue impedance is very low. Accordingly, to deliver an effective amount of RF power, the current capability of the RF amplifier is large. As such, where a typical generator might be capable of 2 to 3 amps of current, the RF amplifier of the generator can supply more than 5 Amps RMS into low impedance loads. This results in rapid tissue fusion with minimal damage to adjacent tissue.


The RF amplifier circuitry has redundant voltage and current monitoring. One set of voltage and current sensors are connected to the RF amplifier control and monitor and are used for servo control. The voltage and current can also be read by the processor 637 using an analog to digital converter (ADC) located on the RF amplifier control and monitor. The RF amplifier control and monitor also has an analog multiplier, which calculates power by computing the product of the voltage and current. The RF amplifier control and monitor uses the average value of voltage and current and does not include a phase angle and thus is actually calculating Volt Amps Reactive (VAR) rather than actual power. A second set of voltage and current sensors are also connected to the energy monitor 642. The signals are connected to an ADC for redundant monitoring of the voltage and current. The processor multiplies the voltage and current readings to verity that power output does not exceed 400 Watts. The energy monitor has monitoring circuits that are completely independent of the RF amplifier control and monitor. This includes the ADC, which has an independent voltage reference.


The RF amplifier in one embodiment is a switching class D push pull circuitry. As such, the amplifier can generate large RF voltages into a high tissue impedance, as well as large RF currents into low tissue impedance. The output level of the RF amplifier is controlled by Pulse Width Modulation (PWM). This high voltage PWM output signal is turned into a sine wave by a low pass filter on the RF amplifier. The output of the filter is the coagulation output of the RF amplifier. The output is also stepped up in voltage by an output transformer resulting in the cut output of the RF amplifier. Only one output is connected to the control servo on the RF amplifier control and monitor at a time and only one output is selected for use at a time.


Coupled to the RF amplifier is the RF amplifier control and monitor 634. The RF amplifier control and monitor 634 in one embodiment receives voltage and current set points, which are input by the user through a user interface, to set the output level of the RF amplifier. The user sets points are translated into the operating levels by digital to analog converters of the RF amplifier control and monitor. The user sets points are translated into the operating levels by digital to analog converters of the RF amplifier control and monitor. The set points in one embodiment include a maximum voltage output, maximum current output, maximum power output, and a phase stop. The servo circuit of the RF amplifier control and monitor controls the RF output based on the three set points. The servo circuit as such controls the output voltage of the RF amplifier so that the voltage, current, and power set points are not exceeded. For example, the output of the ESG is restricted to be less than 400 watts. The individual voltage and current set point can be set to exceed 400 watts depending on the tissue impedance. The power servo however limits the power output to less than 400 watts.


The RF output voltage and current are regulated by a feedback control system. The output voltage and current are compared to set point values and the output voltage is adjusted to maintain the commanded output. The RF output is limited to 400 Watts. Two tool connections are supported by using relays 635 to multiplex the RF output and control signals. The EMI line filter 636 limits the RF leakage current by the use of an RF isolation transformer and coupling capacitors.


The cut and coagulation output voltages of the RF amplifier are connected to the relay and tissue measurement circuitry 635. The relay and tissue measurement circuitry in one embodiment contains a relay matrix, which steers the RF amplifiers output to one of the three output ports of the electrosurgical unit. The relay matrix also selects the configuration of the tool electrodes. The RF output is always switched off before relays are switched to prevent damage to the relay contacts. To mitigate against stuck relays steering RF to an idle output port each output port has a leakage current sensor. The sensor looks for unbalanced RF currents, such as a current leaving one tool port and returning through another tool port. The current sensors on are located on the Relay PCB, and the detectors and ADC are on the energy monitor PCB. The CPU monitors the ADC for leakage currents. Any fault detected results in an alarm condition that turns off RF power.


The relay and tissue measurement circuitry also contains a low voltage network analyzer circuit used to measure tool impedance before RF power is turned on. The circuit measures impedance and tissue phase angle and in one embodiment using a 10V signal operating at 100 Hz. The processor 637 uses the impedance measurement to see if the tool is short-circuited. If a Tool A or B output is shorted the system warns the user and will not turn on RF power. The RF amplifier is fully protected against short circuits. Depending on the servo settings the system can operate normally into a short circuit, and not cause a fault condition. In one embodiment, initial impedance and/or phase measurements can determine if the jaws are open and/or having no tissue in contact with the jaws and/or the jaws are dirty, e.g., excessive or interfering eschar build-up.


Voltage and current feedback is provided using isolation transformers to insure low leakage current. The processor 637 computes the power output of the RF amplifier and compares it to the power set point, which in one embodiment is input by the user. The processor also monitors the phase lag or difference between current and voltage. Additionally, in one embodiment, the processor matches the different phase settings, which depend on tissue types to the monitored phase difference. The processor as such measures a phase shift of tissue prior to any application of RF energy. As will be described in greater detail below, the phase measurement is proportional to tissue permeability and conductivity that uniquely identifies the tissue type. Once the tissue type is identified, the phase angle associated with an end point determination of that tissue type can be determined. The generator in one embodiment has three RF output ports (Tool A, Tool B and generic bipolar). The tool A and B ports 639 are used to connect smart tools, while the generic bipolar port 640 supports standard electro surgical tools. Audible tones are produced when the RF output is active or an alarm condition exists.


The hand and foot controls are also isolated to limit leakage current. The control processor checks the inputs for valid selections before enabling the RF output. When two control inputs from the switches are simultaneously activated the RF output is turned off and an alarm is generated. Digital to analog converters are used to translate control outputs into signals useable by the Analog Servo Control. The control set points are output voltage and current. The analog to digital converter is used to process the analog phase angle measurement. Voltage RMS, current RMS, and power RMS information from the controller is also converted into a form usable for presentation to the user. The digital I/O bus interface 638 provides digital communication between the user, controller and hand/foot switches. Isolation circuitry is used to eliminate a possible leakage path from the electrosurgical generator. It also provides communication between the user and the generator though a data channel protocol.


In one embodiment, there are four tool Interface circuits in the unit. These circuits are used to electrically isolate the user input switches from mains power inside the system. The four tool interface circuits are identical and have an on board microprocessor to read the user switch inputs as well as the tool crypto memory and script memories. The switch closure resistance is measured with an ADC to eliminate a contaminated switch contact being read as a closure. Switch closures below 300 Ohms are valid, while any reading above 1000 Ohms is open. Readings between 300 and 1000 Ohms are considered to be faulty inputs.


The four tool interface circuits communicate with the processor using an RS485 network. Each tool interface circuit has jumpers to select its address and location in the unit. The RS485 interface is isolated to eliminate any potential leakage current paths. One tool interface circuit is connected to each of the Tool A and B ports. A third tool interface circuit is connected to the DC output port, and the fourth circuit is connected to the rear panel foot switch inputs. The processor is the network master and each of the four circuits is a network slave. The processor polls each circuit for input. The tool interface circuitry can only reply to commands. This makes the network deterministic and prevents any kind of dead lock. Each Tool Interface circuit is connected to a System OK logic signal. If a system error is detected by a Tool Interface circuit, this signal is asserted. The processor monitors this signal and indicates a fault. This signal also has a hardware connection to the RF amplifier control and monitor and will disable the RF amplifier when asserted. A system error could be two input switches activated at the same time, or a loss of communication with the processor. The Tool A & B ports as well as the DC port have a micro switch that detects when a tool is plugged into the receptacle. Until this switch is depressed the Tool Interface circuit front panel connections are configured off to prevent any leakage current flowing from front panel connections. Once the switch is depressed the Tool Interface allows the processor to initiate reads and writes to the tool crypto memory and script memory. Once a tool is detected a window opens in the user interface display showing the type of tool connected and status. The generic bipolar port supports legacy tools, which do not have any configuration memory. The tissue measurement circuitry is used to monitor the bipolar connection contacts. When a bipolar tool is connected the tool capacitance is detected and the processor opens the bipolar tool window on the user interface display and shows status for the bipolar tool. The DC port is used to interface with 12 Volt DC powered custom surgical tools. When a tool is plugged into this port a window opens in the user interface display showing the type of tool connected and status. When the DC tool script commands power on, the processor closes a relay on the Power Control and Isolation circuitry 643 turning on the isolated 12 Volt tool power.


The power control and isolation circuitry 643 has two other features. It controls the 100 Volt power supply that drives the RF amplifier. This power supply is turned on by a relay controlled from the RF amplifier control and monitor. The processor commands this power supply on via the RF amplifier control and monitor. If the RF amplifier control and monitor is reset or detects a fault condition, the relay will not operate leaving the 100 Volt power supply off. Also located on the power control and isolation circuitry is a RS485 isolation circuit that adds an extra layer of isolation.


The front panel interface circuitry 641 is used to connect the front panel control switches and LCD display to the processor. The front panel interface circuitry also contains a microprocessor, which is powered by an isolated standby power supply, which is on whenever the main power switch is on. When the front panel power switch is pressed, the microprocessor uses a relay on the Power Control and Isolation circuitry to turn on the main logic power supply. When the button is pressed to turn power off, the microprocessor signals a power off request to the processor. When the processor is ready for power to be turned off it signals the microprocessor to turn off power. The power control relay is then opened, turning off the main power supply.


In one embodiment, the generator accepts only single switch input commands. With no RF active, e.g., RF energy applied, multiple switch closures, either from a footswitch, tool, or a combination of footswitch and tool are ignored. With RF active, dual closures shall cause an alarm and RF shall be terminated. The footswitch in one embodiment includes momentary switches providing activation of the application of RF energy. The switches for example when manipulated initiates activation of the RF energy for coagulation, for cutting and/or sequenced coagulation or cutting. A two-position pushbutton on the foot pedal switch allows toggling between different tools. The active port is indicated on the display of the generator and an LED on the hand tool.


In one embodiment, all RF activation results in a RF ON Tone. Activation tone volume is adjustable, between 40 dBA (minimum) and 65 dB (maximum) with a rear panel mounted control knob. The volume control however does not affect audio volume for alarms. Also, in one embodiment, a universal input power supply is coupled to the generator and operates over the input voltage and frequency range without the use of switches or settings. A programming port in one embodiment is used to download code to the generator and is used to upload operational data.


The generator in one embodiment provides output power has a 12V DC at 3 Amps. Examples of such tools that use DC power are, but are not limited to, a suction/irrigation pump, stapler, and a morcellator (tool for dividing into small pieces and removing, such as a tumor, etc.). The DC connector has intuitive one-way connection. Similar to the other tool receptacles, a non-sterile electronic chip module is imparted into the connector of the appropriate DC-powered hand tool by a one-time, one-way locking mechanism. Tool-specific engravings on both the connector and chip module ensure that the chip module fits only to the type of tool for which it has been programmed. The chip connector allows tool recognition and the storage of data on tool utilization. The DC connector is also configured to prevent improper insertion. The generator is also configured to recognize the attached DC-powered tool. The generator reads configuration data from the tool connector, allowing tool recognition and the storage of tool utilization data.


In one embodiment, phase measurement is a relative measurement between two sinusoidal signals. One signal is used as a reference, and the phase shift is measured relative to that reference. Since the signals are time varying, the measurement cannot be done instantaneously. The signals must be monitored long enough so that difference between them can be determined. Typically the time difference between two know points (sine wave cross through zero) are measured to determine the phase angle. In the case of the phase controller, the device makes the output sine wave with a precise crystal controlled clock. That exact same clock is use to read the input samples with the analog to digital converter. In this way the output of the phased controller is exactly in phase with the input of the phase controller. The phase controller in one embodiment compares the input sine wave signal to a reference sine wave to determine the amount of phase shift.


The phase controller does this comparison using a mathematical process known as a Discreet Fourier Transform (DFT). In this particular case 1024 samples of the input signal are correlated point by point with both a sine function, and a cosine function. By convention the cosine part is called real, and the sine part is called imaginary. If the input signal has no phase shift the result of the DFT is 100% real. If the input signal has a 90-degree phase shift the result of the DFT is 100% imaginary. If the result of the DFT has both a real and imaginary component, the phase angle can be calculated as the arctangent of ratio of the imaginary and real values.


It should be appreciated that the phase angle calculation is independent of units of the real and imaginary numbers. Only the ratio matters. The phase results of the phase controller are also independent of gain and no calculation of impedance is made in the process of calculating the phase angle. By performing a DFT, the phase controller encodes the phase measurement as a pair of numbers.


In accordance with various embodiments, precise knowledge of the phase endpoint prior to energy delivery allows for tighter control, and for delivery of more current than other electrosurgical units (7 A, 400 W). In accordance with various embodiments, the memory capability of the instrument key portion of each instrument connector allows the reading and writing of information between the electrosurgical unit and the instrument key or connector. The information can include recording treatment data (energy profile, tissue types, etc.) or data to prevent device reuse. In one embodiment, the use-before-date (UBD), number of uses, device serial number and expiration after first use values are encrypted to prevent reprocessing and reuse of the instrument key. In one example, to assist in managing inventory, the information may include the serial number of the electrosurgical unit that can be retrieved and stored into the memory upon connection of the instrument to the unit. The serial number or similar information is then used in parallel with lot and sales data to locate the electrosurgical unit and/or track electrosurgical unit's movements. Likewise, locators or trackers using GPS, RFID, IP addresses, Cellular Triangulation can be incorporated in the instruments and/or electro surgical unit to locate and track electrosurgical units or instruments.


In one embodiment, the information may include metrics such as recording tissue types encountered during a procedure and/or tracking performance of an instrument or electrosurgical unit (how often used, number of procedures, and so on). Pre-customized surgeon settings can also be included in which the device output parameters (e.g., voltage, current, and power) stored in the connector or instrument key and read into the electrosurgical unit when connected. The specific settings can be programmed or stored prior to shipment of the instrument/connector. Diagnostic information on instrument/electrosurgical unit can also be included. For example, calibration and output verification information can be stored on the electrosurgical unit and then downloaded to the instrument key when connected. In one embodiment, software upgrades can also be delivered via the memory and the instrument ports on the electrosurgical unit.


In one embodiment, the electrosurgical generator or unit can automatically sense or identify a standard bipolar instrument insertion/connection. In one embodiment, the electrosurgical unit can compensate for or enhance a standard bipolar instrument to phase monitor and/or identify tissue or its condition. For example, a tissue measurement circuitry could be included in the electrosurgical unit or as an intermediate connector between the instrument and electrosurgical unit. The circuitry and/or program could include phase monitoring and/or tissue type or condition identification functionality. The tissue measurement circuitry in one embodiment can include a phase measurement adjustment circuit or program to account for impedance in the circuitry and cables that run between the tissue and the tool port. The circuitry may also include temperature correction as an actual change in phase value due to the instrument may be less than potential changes due to temperature fluctuations.


Using the phase difference between voltage and current as a control value in a fusion or welding process, instead of the impedance, can be further shown when characterizing the tissue electrically. When considering vessels and tissue to be a time-dependent ohmic resistor R and capacitor C in parallel (both of which depend on the tissue size and type) the phase difference can be obtained with







R
=


ρ
·
d

A


,





where R is the ohmic resistance, ρ the specific resistance, A the area, and d the thickness of the fused tissue,








X
C

=

1

ω
·
C



,





where Xc is the capacitive impedance, ω the frequency, and C the capacity of the tissue, and







C
=


ɛ
·

ɛ
0

·
A

d


,





where ε e and ε0 are the relative and absolute permittivity.


The phase difference φ can then be expressed as







φ
=


arctan


(


X
C

R

)


=

arctan


[


(

ω
·
ɛ
·

ɛ
0

·
ρ

)


-
1


]




,





where ρ is equal to (1/conductivity).


As such, the difference between monitoring the phase difference φ as opposed to the (ohmic) resistance R is that φ depends on the applied frequency Ω and material properties only (namely, the dielectric constant ε and the conductivity), but not on tissue dimensions (namely the compressed tissue area A and tissue thickness d). Furthermore, the relative change in phase difference is much larger at the end of the fusion process than the change in tissue resistance, allowing for easier and more precise measurement.


In addition, with measurement of the initial dielectric properties of the tissue (dielectric constant ε and conductivity) at a certain frequency, the type of tissue can be determined. The dielectric properties for various types of biological tissue, arranged by increasing values of the product of dielectric constant c and conductivity) are given in FIG. 30 at a frequency of 350 kHz (which is in the frequency range of a typical electrosurgical generator). By measurement of the product of dielectric constant c and conductivity of the tissue (which are material characteristics and independent of tissue dimensions) before the actual tissue fusion or welding process, the phase shift required to adequately fuse or seal the specific biological tissue can be determined. The phase shift required to reliably fuse or seal the respective type of tissue is measured as function of the product of dielectric constant c and conductivity of the tissue. Additionally, endpoint determination can be represented as a function of an initial phase reading of the tissue determination and likewise end point determination can be represented as a function of tissue properties (conductivity times relative permittivity).


As a result, (a) measurement of the dielectric properties of the tissue and (b) control and feedback of the phase difference allows for a precise control and feedback mechanism for various tissue types, regardless of the tissue size and allows employing standard electrosurgical power supplies (which individually run in a very close range of frequencies). It should be noted that however that specific frequency of the tissue properties measurement is performed can be the same or different from the specific frequency of the phase. If the tissue measurement is based on the driving frequency of the generator, and various generators are used (all of which run in a close range of frequencies) though, the end points will be different. Hence, for such a case, it can be desirable to (1) use an external measurement signal (which is at the same frequency), or (b) utilize a stand-alone generator.


As such, the controller is configured to determine the product of dielectric constant and conductivity, as well as the phase difference between the applied voltage and current to monitor and control the tissue fusion or welding process. In particular, control and feedback circuitry of the controller determines when the phase difference reaches the phase shift value determined by the result of the dielectric and conductivity measurements. When this threshold is reached, the fusion or welding process is terminated. An indicator, e.g., visual or audible, is provided to signal the termination and in one aspect the controller restricts (completely, nearly completely or to a predetermined minimum) further delivery of electrical energy through the electrodes. As such, the tool generating the seal, weld or connection of the tissue provides atraumatic contact to the connecting tissue and provides enough burst pressure, tensile strength, or breaking strength within the tissue.


In one embodiment, a bipolar/monopolar single connector plug is provided to allow the connection of monopolar instruments to the electrosurgical unit. In one embodiment, the connector includes a grounding pad port 310 that acts as another electrode (e.g., a 6th electrode (F)) that the electrosurgical unit 420 turns on and off through internal relays in the electrosurgical unit (FIGS. 38-39). Based on the programming of the relay/electrode configuration or pattern on the instruments (e.g., stored in memory of the connector), an electrosurgical instrument 450 can cut and coagulate in either a bipolar manner, monopolar manner of both. In one embodiment, in bipolar mode, the electrosurgical unit 420 utilizes two or more electrodes, e.g., electrodes designated “B” and “C”, to create active and return paths and in monopolar mode, the electrosurgical unit utilizes one or more of the electrodes as active, e.g., electrodes designated “A” through “E”, and only an electrode where the grounding pad 315 would be designated or used as the return only electrode 310, e.g., electrode designated “F”. In one embodiment, switches internally or externally on the electrosurgical instrument, the connector and/or the port can be used to identify or notify the electrosurgical unit that a monopolar operation is being used. Additionally, in one embodiment phase measurements of applied RF energy can be used to identify if the monopolar pad is removed, not providing sufficient contact with the patient and/or electrical conductivity to the electrosurgical instrument.


Further examples of the electrosurgical unit, instruments and connections there between and operations and/or functionalities thereof are described in U.S. patent application Ser. No. 12/416,668, filed Apr. 1, 2009, entitled “Electrosurgical System”; Ser. No. 12/416,751, filed Apr. 1, 2009, entitled “Electrosurgical System”; Ser. No. 12/416,695, filed Apr. 1, 2009, entitled “Electrosurgical System”; Ser. No. 12/416,765, filed Apr. 1, 2009, entitled “Electrosurgical System”; and Ser. No. 12/416,128, filed Mar. 31, 2009, entitled “Electrosurgical System”; the entire disclosures of which are hereby incorporated by reference as if set in full herein.


Although this application discloses certain preferred embodiments and examples, it will be understood by those skilled in the art that the present inventions extend beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. Further, the various features of these inventions can be used alone, or in combination with other features of these inventions other than as expressly described above. Thus, it is intended that the scope of the present inventions herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by a fair reading of the following claims.

Claims
  • 1. An electrosurgical system comprising an electrosurgical instrument comprising: an elongate shaft having a proximal end, a distal end and a longitudinal axis extending from the proximal end to the distal end;a first jaw connected to the elongate shaft, aligned with the longitudinal axis of the elongate shaft and being stationary relative to the elongate shaft, the first jaw being entirely conductive and having a cut channel extending lengthwise along and through the first jaw, and the first jaw comprising a monolithic seal surface comprising a plurality of seal paths surrounding the cut channel and spaced by a plurality of cavities between each of the plurality of seal paths, each of the plurality of seal paths having identical widths and differing lengths and each of the plurality of cavities having identical widths and differing lengths;a second jaw pivotably coupled to the elongate shaft and pivotably movable relative to the first jaw, the second jaw comprising a first electrode, a second electrode and an insulator positioned between the first and second electrodes, the second electrode being shaped and sized like the first jaw and being on an upper portion of the second jaw and distal from the first jaw, and the first electrode being on a lower portion of the second jaw proximate to the first jaw and extending along an outer portion of a distal tip end of the second jaw, the first electrode being parallel with the second electrode; anda cutting blade connected to a blade shaft disposed within the elongate shaft, the cutting blade arranged to fit within the cut channel of the first jaw; andan electrosurgical generator arranged to supply radiofrequency (RF) energy to the electrosurgical instrument removably coupled to the electrosurgical generator, the generator being arranged to supply RF energy between the first electrode and the first jaw to coagulate tissue in contact with the first electrode and the first jaw and being arranged to supply RF energy between the first electrode, the second electrode and the first jaw to coagulate tissue in contact with the first electrode, the second electrode and the first jaw.
  • 2. The system of claim 1 wherein the first electrode comprises a monolithic seal surface comprising a plurality of seal paths surrounding a second cut channel and spaced by a plurality of cavities between each of the plurality of seal paths, each of the plurality of seal paths having identical widths and differing lengths and each of the plurality of cavities having identical widths and differing lengths.
  • 3. The system of claim 2 wherein the generator is arranged to supply RF energy between the first jaw and the second electrode to coagulate tissue in front of the second jaw and tissue on at least one side of the second jaw.
  • 4. The system of claim 3 wherein the second electrode and the first jaw share a common electrical contact in that the generator supplies RF energy between the first electrode and the first jaw and between the first electrode, the second electrode and the first jaw.
  • 5. The system of claim 4 wherein when the first and second jaws are in an intermediate state between an open position and a closed position, the first electrode and the first jaw are electrically connected to assume a first and second polarity in that tissue positioned between and in contact with the first electrode and the first jaw are fused when a fusing operation is activated and cutting by the cutting blade is prevented.
  • 6. The system of claim 5 wherein the cutting blade is blunt, electrically conductive and positioned perpendicular relative to the first jaw and wherein in the generator is arranged to supply RF energy between the cutting blade and the first jaw to cut tissue in contact with the cutting blade and the first jaw.
  • 7. The system of claim 6 wherein the instrument further comprises: an actuator connected to the elongate shaft, the actuator further comprises a blade trigger connected to the blade shaft, a stationary handle and a movable trigger, the movable trigger being movable towards the stationary handle to close the first and second jaws and movable away from the stationary handle to open the first and second jaws and the cutting blade being movable proximally and distally lengthwise through the first and second jaws and within the cut channel of the first jaw and the second cut channel of the second jaw; anda distal stop arranged to interact with a first corresponding stop disposed along the elongate shaft and arranged to prevent distal movement of the blade shaft beyond a distal interaction point of the first corresponding stop of the elongate shaft interacting with the distal stop of the blade shaft when the blade shaft is moved distally.
  • 8. The system of claim 7 wherein the instrument further comprises a proximal stop arranged to interact with a second corresponding stop disposed along the elongate shaft and arranged to prevent proximal movement of the blade shaft beyond a proximal interaction point of the second corresponding stop of the elongate shaft interacting with the proximal stop of the blade shaft when the blade shaft is moved proximally.
  • 9. The system of claim 8 wherein the instrument further comprises a spring connected to the blade shaft and biasing the blade shaft proximally and wherein the proximal stop and the second corresponding stop are arranged to prevent the spring from pulling the cutting blade proximally beyond the proximal interaction point and the spring, the proximal stop and the second corresponding stop arranged to hold the cutting blade stationary at the proximal interaction point.
  • 10. The system of claim 9 wherein the elongate shaft comprises a cover tube and the first and second corresponding stops are deformed portions on the cover tube, the deformed portions interacting with the distal and proximal stops of the blade shaft.
  • 11. The system of claim 10 wherein the instrument further comprises: an internal switch disposed within the stationary handle and not externally accessible, the internal switch being activated by a flexible arm extending from the movable trigger and contacting with the internal switch when the movable trigger is moved towards the stationary handle; andat least one external switch disposed on the actuator and an electrical connection being established with the at least one external switch and the internal switch being both activated;wherein the generator is arranged to supply RF energy to the first jaw and the cutting blade with the internal switch being activated.
  • 12. The system of claim 11 wherein the at least one external switch further comprises a first external switch to activate an electrosurgical activity and a second external switch to activate a different electrosurgical activity, the first external switch disposed above the second external switch.
  • 13. The system of claim 12 further comprising a second cutting blade positioned generally perpendicular to the second jaw and movable proximally and distally lengthwise through the second electrode of the first jaw.
  • 14. The system of claim 11 wherein the generator, after the at least one external switch is deactivated, is arranged to supply RF energy between the first electrode and the first jaw instead of the cutting blade and the first jaw.
  • 15. The system of claim 14 wherein the generator is arranged to determine a phase value of the supplied RF energy between the first electrode and the first jaw and to determine when the determined phase value of the supplied RF energy equals or exceeds a predetermined phase value; wherein the generator, after determining the determined phase value of the supplied RF energy equals or has exceeded the predetermined phase value, is arranged to supply RF energy between the first jaw and the cutting blade instead of the first electrode and the first jaw, wherein the generator is arranged to determine a phase value of the supplied RF energy between the first jaw and the cutting blade to determine when the determined phase value of the supplied RF energy equals or exceeds a second predetermined phase value; and wherein the generator, after determining the determined phase value of the supplied RF energy equals or has exceeded the second predetermined phase value, is arranged to supply RF energy between the first electrode and the first jaw.
  • 16. The system of claim 15 wherein the generator is arranged to not determine when the determined phase value of the supplied RF energy equals or exceeds a predetermined phase value when the first and second jaws are in the intermediate state.
  • 17. The system of claim 16 wherein the instrument further comprises a cable having a proximal end and a distal end, the distal end of the cable being attached to and extending from the stationary handle, a plug having one end connected to the proximal end of the cable and another end attached to a connector; and wherein the generator further comprises a tool connector receptacle; and wherein the connector of the instrument is removably attached to the tool connector receptacle and comprises memory circuitry configured to be utilized by the generator.
  • 18. The system of claim 17 wherein the tool connector receptacle includes a switch recessed within the tool connector receptacle that is operatively activated by the connector being inserted into the tool connector receptacle.
  • 19. The system of claim 18 wherein the instrument further comprises a third electrode connected to the first jaw and extendable from a first position within the first jaw to a second position outside the first jaw and past a distal most end of the first jaw when the first and second jaws are in the closed position; and wherein the generator is arranged to supply RF energy between the third electrode and the first jaw.
  • 20. The system of claim 18 wherein the instrument further comprises a sensor adjacent to the movable trigger arranged to detect a position of the movable trigger to identify the intermediate state.
  • 21. The system of claim 7 wherein each of the plurality of cavities of the monolithic seal surface of the first jaw are unfilled cavities and each of the plurality of cavities of the monolithic seal surface of the first electrode are unfilled cavities.
CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 15/936,914, filed Mar. 27, 2018, which is a continuation of U.S. application Ser. No. 15/136,652, filed Apr. 22, 2016, which is a continuation of U.S. application Ser. No. 13/366,487, filed Feb. 6, 2012, now U.S. Pat. No. 9,320,563, which is a continuation of International Application No. PCT/US2011/054661, filed on Oct. 3, 2011, which claims the benefit of US Provisional Application No. 61/389,012, filed on Oct. 1, 2010, the entire disclosures of which are incorporated by reference as if set forth in full herein.

US Referenced Citations (1154)
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
1935289 Evans Apr 1933 A
2002584 Wappler et al. May 1935 A
2031682 Wappler et al. Feb 1936 A
2113246 Wappler Apr 1938 A
2176479 Willis Oct 1939 A
2305156 Grubel Apr 1941 A
2632661 Cristofv Mar 1953 A
2827056 Degelman Mar 1958 A
3086566 Tolles Apr 1963 A
3459187 Pallotta Aug 1969 A
3494363 Jackson Feb 1970 A
3588710 Masters Jun 1971 A
3651811 Hildebrandt et al. Mar 1972 A
3685518 Beuerle et al. Aug 1972 A
3780416 Rider Dec 1973 A
3826263 Cage Jul 1974 A
3911766 Fridolph Oct 1975 A
3920021 Hiltebrandt Nov 1975 A
3938527 Rioux Feb 1976 A
3963030 Newton Jun 1976 A
3970088 Morrison Jul 1976 A
3980085 Ikuno Sep 1976 A
3987795 Morrison Oct 1976 A
4030501 Archibald Jun 1977 A
4041952 Morrison, Jr. et al. Aug 1977 A
4043342 Morrison Aug 1977 A
4060088 Morrison, Jr. et al. Nov 1977 A
4074718 Morrison, Jr. Feb 1978 A
4089336 Cage Jun 1978 A
4092986 Schneiderman Jun 1978 A
4094320 Newton et al. Jun 1978 A
4114623 Meinke Sep 1978 A
4126137 Archibald Nov 1978 A
4154240 Ikuno May 1979 A
4171700 Farin Oct 1979 A
4181131 Ogui Jan 1980 A
4231372 Newton Jan 1980 A
4188927 Harris Feb 1980 A
4196734 Harris Apr 1980 A
4198957 Cage et al. Apr 1980 A
4198960 Utsugi Apr 1980 A
4200104 Harris Apr 1980 A
4237887 Gonser Dec 1980 A
4244371 Farin Jan 1981 A
4325374 Komiya Apr 1982 A
4331149 Gonser May 1982 A
4338940 Ikuno Jul 1982 A
4352156 Gyugyi Sep 1982 A
4370980 Lottick Feb 1983 A
4416276 Newton Nov 1983 A
4416277 Newton et al. Nov 1983 A
4427014 Bel Jan 1984 A
4429694 McGreevy Feb 1984 A
4463759 Garito et al. Aug 1984 A
4487489 Takamatsu Dec 1984 A
4514619 Kugelman Apr 1985 A
4522206 Whipple et al. Jun 1985 A
4552143 Lottick Nov 1985 A
4569131 Faulk et al. Feb 1986 A
4569345 Manes et al. Feb 1986 A
4590934 Malis et al. May 1986 A
4599553 Brennen et al. Jul 1986 A
4630218 Hurley Dec 1986 A
4632109 Paterson Dec 1986 A
4644950 Valli Feb 1987 A
4651280 Chang et al. Mar 1987 A
4655216 Tischer Apr 1987 A
4657018 Hakky Apr 1987 A
4658815 Farin et al. Apr 1987 A
4658819 Harris et al. Apr 1987 A
4658820 Klicek Apr 1987 A
4674498 Stasz Jun 1987 A
4685459 Koch et al. Aug 1987 A
4699146 Sieverding Oct 1987 A
4712545 Honkanen Dec 1987 A
4716897 Noguchi et al. Jan 1988 A
4727874 Bowers Mar 1988 A
4739759 Rexroth et al. Apr 1988 A
4741334 Irnich May 1988 A
4752864 Clappier Jun 1988 A
4754757 Feucht Jul 1988 A
4788977 Farin et al. Dec 1988 A
4802476 Noerenberg et al. Feb 1989 A
4818954 Flachenecker Apr 1989 A
4827927 Newton May 1989 A
4848335 Manes Jul 1989 A
4850353 Stasz et al. Jul 1989 A
4860745 Farin et al. Aug 1989 A
4862889 Feucht Sep 1989 A
4862890 Stasz et al. Sep 1989 A
4872456 Hasson Oct 1989 A
4887612 Esser et al. Dec 1989 A
4889722 Sheffield et al. Dec 1989 A
4903696 Stasz et al. Feb 1990 A
4905691 Rydell Mar 1990 A
4922903 Welch et al. May 1990 A
4936281 Stasz Jun 1990 A
4937254 Sheffield et al. Jun 1990 A
4938761 Ensslin Jul 1990 A
4942313 Kinzel Jul 1990 A
4958539 Stasz et al. Sep 1990 A
4969067 Farin Nov 1990 A
4969885 Farin Nov 1990 A
4976711 Parins et al. Dec 1990 A
5007908 Rydell Apr 1991 A
5013312 Parins et al. May 1991 A
5015227 Broadwin et al. May 1991 A
5016521 Haka May 1991 A
5026370 Lottick Jun 1991 A
5026371 Rydell et al. Jun 1991 A
5035696 Rydell Jul 1991 A
5038109 Goble et al. Aug 1991 A
5047026 Rydell Sep 1991 A
5047027 Rydell Sep 1991 A
5052402 Bencini et al. Oct 1991 A
5057107 Parins et al. Oct 1991 A
5061269 Muller Oct 1991 A
5062031 Flachenecker et al. Oct 1991 A
5071419 Rydell et al. Dec 1991 A
5078717 Parins et al. Jan 1992 A
5083565 Parins Jan 1992 A
5085658 Rydell Feb 1992 A
5087257 Farin et al. Feb 1992 A
5098431 Rydell Mar 1992 A
5116332 Lottick May 1992 A
5125928 Parins et al. May 1992 A
5122137 Lennox Jun 1992 A
5127412 Cosmetto et al. Jul 1992 A
5151102 Kamiyama et al. Sep 1992 A
5158561 Rydell et al. Oct 1992 A
5160343 Brancel et al. Nov 1992 A
5167658 Ensslin Dec 1992 A
5171255 Rydell Dec 1992 A
5171311 Rydell Dec 1992 A
5190517 Klicek et al. Mar 1993 A
5190541 Abele et al. Mar 1993 A
5192280 Parins Mar 1993 A
5197963 Parins Mar 1993 A
5197964 Parins Mar 1993 A
5201732 Parins et al. Apr 1993 A
5217457 Delahuerga et al. Jun 1993 A
5217458 Parins Jun 1993 A
5234427 Ohtorno et al. Aug 1993 A
5244462 Delahuerga et al. Sep 1993 A
5246440 Van Noord Sep 1993 A
5250047 Rydell Oct 1993 A
5250056 Hasson Oct 1993 A
5254126 Filipi et al. Oct 1993 A
5256149 Banik et al. Oct 1993 A
5258006 Rydell et al. Nov 1993 A
5267997 Farin et al. Dec 1993 A
5269780 Roos Dec 1993 A
5273524 Fox et al. Dec 1993 A
5281216 Klicek Jan 1994 A
5282799 Rydell Feb 1994 A
5286255 Weber Feb 1994 A
5290286 Parins Mar 1994 A
5300070 Gentelia et al. Apr 1994 A
5304190 Reckelhoff et al. Apr 1994 A
5312329 Beaty et al. May 1994 A
5314424 Nicholas May 1994 A
5318563 Malis et al. Jun 1994 A
5322055 Davison et al. Jun 1994 A
5324289 Eggers Jun 1994 A
5330471 Eggers Jul 1994 A
5334183 Wuchinich Aug 1994 A
5338317 Hasson et al. Aug 1994 A
5341807 Nardella Aug 1994 A
5341815 Cofone et al. Aug 1994 A
5342359 Rydell Aug 1994 A
5342381 Tidemand Aug 1994 A
5352222 Rydell Oct 1994 A
5352223 McBrayer et al. Oct 1994 A
5354313 Boebel Oct 1994 A
5356408 Rydell Oct 1994 A
5370645 Klicek et al. Dec 1994 A
5372124 Takayama et al. Dec 1994 A
5372596 Klicek et al. Dec 1994 A
5374277 Hassler Dec 1994 A
5382247 Cimino et al. Jan 1995 A
5383880 Hovven Jan 1995 A
5383922 Zipes et al. Jan 1995 A
5387196 Green et al. Feb 1995 A
5387197 Smith et al. Feb 1995 A
5389104 Hahnen et al. Feb 1995 A
5389849 Asano et al. Feb 1995 A
5391166 Eggers Feb 1995 A
5392917 Alpern et al. Feb 1995 A
5400267 Denen Mar 1995 A
5403312 Yates et al. Apr 1995 A
5403342 Tovey et al. Apr 1995 A
5405344 Willaimson et al. Apr 1995 A
5409498 Braddock et al. Apr 1995 A
5417687 Nardella et al. May 1995 A
5423808 Edwards et al. Jun 1995 A
5423810 Goble et al. Jun 1995 A
5431638 Hennig et al. Jul 1995 A
5431649 Mulier et al. Jul 1995 A
5431674 Basile et al. Jul 1995 A
5432459 Thompson et al. Jul 1995 A
5436566 Thompson et al. Jul 1995 A
5422567 Matsunaga Aug 1995 A
5437664 Cohen et al. Aug 1995 A
5438302 Goble Aug 1995 A
5443463 Stern et al. Aug 1995 A
5445142 Hassler, Jr. Aug 1995 A
5445638 Rydell et al. Aug 1995 A
5447513 Davison et al. Sep 1995 A
5449355 Rhum et al. Sep 1995 A
5456684 Schmidt et al. Oct 1995 A
5458598 Feinberg et al. Oct 1995 A
5460182 Goodman et al. Oct 1995 A
5462546 Rydell Oct 1995 A
5464144 Guy et al. Nov 1995 A
5472439 Hurd Dec 1995 A
5472442 Klicek Dec 1995 A
5472443 Cordis et al. Dec 1995 A
5472451 Freitas et al. Dec 1995 A
5474057 Makower et al. Dec 1995 A
5476479 Green et al. Dec 1995 A
5478351 Meade et al. Dec 1995 A
5486185 Freitas et al. Jan 1996 A
5496312 Klicek Mar 1996 A
5496317 Goble et al. Mar 1996 A
5499992 Meade et al. Mar 1996 A
5499998 Meade et al. Mar 1996 A
5503320 Webster et al. Apr 1996 A
5507773 Hutema et al. Apr 1996 A
5509916 Taylor et al. Apr 1996 A
5514129 Smith May 1996 A
5514134 Rydell et al. May 1996 A
5518163 Kupershmidt et al. May 1996 A
5518164 Hooven May 1996 A
5527313 Scott et al. Jun 1996 A
5527330 Tovey Jun 1996 A
5531744 Nardella et al. Jul 1996 A
5540081 Strul et al. Jul 1996 A
5540684 Hassler et al. Jul 1996 A
5540685 Parins et al. Jul 1996 A
5541376 Ladtkow et al. Jul 1996 A
5551945 Yabe et al. Sep 1996 A
5558429 Cain Sep 1996 A
5558671 Yates Sep 1996 A
5562699 Heimberger et al. Oct 1996 A
5562700 Huitema et al. Oct 1996 A
5571100 Goble et al. Nov 1996 A
5571121 Heifetz Nov 1996 A
5573424 Poppe Nov 1996 A
5573533 Strul Nov 1996 A
5573534 Stone Nov 1996 A
5573535 Viklund Nov 1996 A
5575789 Bell et al. Nov 1996 A
5575805 Li Nov 1996 A
5584830 Ladd et al. Dec 1996 A
5599344 Paterson Feb 1997 A
5599350 Schulze et al. Feb 1997 A
5603711 Parins et al. Feb 1997 A
D378611 Croley Mar 1997 S
5600151 Mulier et al. Mar 1997 A
5607391 Klinger et al. Mar 1997 A
5609560 Ichikawa et al. Mar 1997 A
5609573 Sandock Mar 1997 A
5611709 McAnulty Mar 1997 A
5613966 Makower et al. Mar 1997 A
5620415 Lucey et al. Apr 1997 A
5620447 Smith et al. Apr 1997 A
5624452 Yates Apr 1997 A
5626575 Crenner May 1997 A
5626607 Malecki et al. May 1997 A
5626608 Cuny et al. May 1997 A
5627584 Nishikori et al. May 1997 A
5633578 Eggers et al. May 1997 A
5645540 Henniges et al. Jul 1997 A
5647869 Goble et al. Jul 1997 A
5651780 Jackson et al. Jul 1997 A
5658279 Nardella et al. Aug 1997 A
5658281 Heard Aug 1997 A
5665100 Yoon Sep 1997 A
5665105 Furnish et al. Sep 1997 A
5667517 Hooven Sep 1997 A
5669907 Platt, Jr. et al. Sep 1997 A
5674184 Hassler, Jr. Oct 1997 A
5674220 Fox et al. Oct 1997 A
5683349 Makower et al. Nov 1997 A
5688270 Yates et al. Nov 1997 A
5693045 Eggers Dec 1997 A
5693051 Schulze et al. Dec 1997 A
5695494 Becker Dec 1997 A
5697281 Eggers et al. Dec 1997 A
5697909 Eggers et al. Dec 1997 A
5700261 Brinkerhoff Dec 1997 A
5702386 Stern et al. Dec 1997 A
5702387 Arts et al. Dec 1997 A
5703390 Austin et al. Dec 1997 A
5707369 Vaitekunas et al. Jan 1998 A
5709680 Yates et al. Jan 1998 A
5713128 Schrenk et al. Feb 1998 A
5713806 Nardella Feb 1998 A
5713895 Lontine et al. Feb 1998 A
5720293 Quinn et al. Feb 1998 A
5720742 Zacharias Feb 1998 A
5720744 Eggleston et al. Feb 1998 A
5720745 Farin et al. Feb 1998 A
5722975 Edwards et al. Mar 1998 A
5725524 Mulier et al. Mar 1998 A
5772659 Gluth Mar 1998 A
5735848 Yates et al. Apr 1998 A
5735849 Baden et al. Apr 1998 A
5743456 Jones et al. Apr 1998 A
5743906 Parins et al. Apr 1998 A
5746210 Benaron et al. May 1998 A
5746740 Nicholas May 1998 A
5746759 Meade et al. May 1998 A
5752519 Benaron et al. May 1998 A
5755717 Yates et al. May 1998 A
5759185 Grinberg Jun 1998 A
5762609 Benaron et al. Jun 1998 A
5766167 Eggers et al. Jun 1998 A
5769791 Benaron et al. Jun 1998 A
5769841 Odell et al. Jun 1998 A
5772597 Goldberger et al. Jun 1998 A
5772660 Young et al. Jun 1998 A
5776092 Farin et al. Jul 1998 A
5776129 Mersch Jul 1998 A
5776130 Buysse et al. Jul 1998 A
5776155 Beaupre et al. Jul 1998 A
5782397 Koukline Jul 1998 A
5785658 Benaron et al. Jul 1998 A
5792139 Chambers et al. Aug 1998 A
5792178 Welch et al. Aug 1998 A
5797906 Rhum et al. Aug 1998 A
5797938 Paraschac et al. Aug 1998 A
5797941 Schulze Aug 1998 A
5800449 Wales Sep 1998 A
5807261 Benaron et al. Sep 1998 A
5807393 Williamson, IV et al. Sep 1998 A
5807395 Mulier et al. Sep 1998 A
5810806 Ritchart et al. Sep 1998 A
5810811 Yates et al. Sep 1998 A
5810859 Dimatteo et al. Sep 1998 A
5817091 Nardella et al. Oct 1998 A
5817093 Williamson, IV et al. Oct 1998 A
5817119 Klieman et al. Oct 1998 A
5827271 Buysse et al. Oct 1998 A
5827279 Hughett et al. Oct 1998 A
5827299 Thomason et al. Oct 1998 A
5830231 Geiges, Jr. Nov 1998 A
5833690 Yates et al. Nov 1998 A
5836942 Netherly et al. Nov 1998 A
5836943 Miller, III Nov 1998 A
5846194 Wasson et al. Dec 1998 A
5849020 Long et al. Dec 1998 A
5853412 Mayenberger Dec 1998 A
5860975 Goble et al. Jan 1999 A
5873873 Smith et al. Feb 1999 A
5876398 Mulier et al. Mar 1999 A
5876401 Schulze et al. Mar 1999 A
5885277 Korth Mar 1999 A
5891095 Eggers et al. Apr 1999 A
5891141 Rydell Apr 1999 A
5891142 Eggers et al. Apr 1999 A
5893835 Witt et al. Apr 1999 A
5893873 Rader et al. Apr 1999 A
5897490 Fox et al. Apr 1999 A
5897523 Wright et al. Apr 1999 A
5897553 Mulier et al. Apr 1999 A
5897569 Kellogg et al. Apr 1999 A
5902264 Toso et al. May 1999 A
5902301 Olig May 1999 A
5904709 Arndt et al. May 1999 A
5906613 Mulier et al. May 1999 A
5908402 Blythe Jun 1999 A
5908420 Parins et al. Jun 1999 A
5910152 Bays Jun 1999 A
5928137 Green Jul 1999 A
5928255 Meade et al. Jul 1999 A
5928256 Riza Jul 1999 A
5931836 Hatta et al. Aug 1999 A
5935126 Riza Aug 1999 A
5938633 Besupre Aug 1999 A
5944715 Goble et al. Aug 1999 A
5944718 Austin et al. Aug 1999 A
5944737 Tsonton et al. Aug 1999 A
5947284 Foster Sep 1999 A
5947984 Whipple Sep 1999 A
5951552 Long et al. Sep 1999 A
5954736 Bishop et al. Sep 1999 A
5954746 Holthaus et al. Sep 1999 A
5957943 Vaitekunas Sep 1999 A
5961514 Long et al. Oct 1999 A
5968062 Thomas et al. Oct 1999 A
5968074 Prestel Oct 1999 A
5976077 Wittens et al. Nov 1999 A
5976128 Schilling et al. Nov 1999 A
5980510 Tsonton et al. Nov 1999 A
5980516 Mulier et al. Nov 1999 A
5984921 Long et al. Nov 1999 A
5987346 Benaron et al. Nov 1999 A
5993380 Yabe et al. Nov 1999 A
5993447 Blewett et al. Nov 1999 A
5995875 Blewett et al. Nov 1999 A
5997533 Kuhns Dec 1999 A
6003517 Sheffield et al. Dec 1999 A
6004319 Goble et al. Dec 1999 A
6004335 Vaitekunas et al. Dec 1999 A
6010499 Cobb Jan 2000 A
6010516 Hulka Jan 2000 A
6013076 Goble et al. Jan 2000 A
6015406 Goble et al. Jan 2000 A
6016809 Mulier et al. Jan 2000 A
D420741 Croley Feb 2000 S
6024741 Williamson, IV et al. Feb 2000 A
6024744 Kese et al. Feb 2000 A
6027501 Goble et al. Feb 2000 A
6027522 Palmer Feb 2000 A
6030384 Nezhat Feb 2000 A
6030402 Thompson et al. Feb 2000 A
6033399 Gines Mar 2000 A
6033404 Melzer et al. Mar 2000 A
6036657 Milliman et al. Mar 2000 A
6039733 Buysse et al. Mar 2000 A
6039734 Goble et al. Mar 2000 A
6039736 Platt, Jr. Mar 2000 A
6050996 Schmaltz et al. Apr 2000 A
6051010 Dimatteo et al. Apr 2000 A
6053172 Hovda et al. Apr 2000 A
6053914 Eggers et al. Apr 2000 A
6056746 Goble et al. May 2000 A
6063050 Manna et al. May 2000 A
6063075 Mohori May 2000 A
6063081 Mulier et al. May 2000 A
6063086 Benecke et al. May 2000 A
6066139 Ryan et al. May 2000 A
6068627 Orszulak et al. May 2000 A
6068647 Witt et al. Jun 2000 A
6070444 Lontine et al. Jun 2000 A
6074386 Goble et al. Jun 2000 A
RE36795 Rydell Jul 2000 E
6083191 Rose Jul 2000 A
6086586 Hooven Jul 2000 A
6090106 Goble et al. Jul 2000 A
6090120 Wright et al. Jul 2000 A
6092722 Heinrichs et al. Jul 2000 A
6093186 Goble Jul 2000 A
6096037 Mulier et al. Aug 2000 A
6102909 Chen et al. Aug 2000 A
6106521 Blewett et al. Aug 2000 A
6109268 Thapliyal et al. Aug 2000 A
6110171 Rydell Aug 2000 A
6113591 Whayne et al. Sep 2000 A
6113594 Savage Sep 2000 A
6113596 Hooven et al. Sep 2000 A
6113598 Baker Sep 2000 A
6117152 Huitema Sep 2000 A
6120501 Long et al. Sep 2000 A
H1904 Yates Oct 2000 H
6132429 Baker Oct 2000 A
6135998 Palanker Oct 2000 A
6139519 Blythe Oct 2000 A
6139547 Lontine et al. Oct 2000 A
6142992 Cheng et al. Nov 2000 A
6152923 Ryan Nov 2000 A
6159146 El Gazayerli Dec 2000 A
6162235 Vaitekunas Dec 2000 A
6165175 Wampler et al. Dec 2000 A
6168605 Measamer et al. Jan 2001 B1
6171304 Netherly et al. Jan 2001 B1
6174308 Goble et al. Jan 2001 B1
6174309 Wrublewski et al. Jan 2001 B1
6179834 Buysse et al. Jan 2001 B1
6186147 Cobb Feb 2001 B1
6187003 Buysse et al. Feb 2001 B1
6187026 Devlin et al. Feb 2001 B1
6190383 Schmaltz et al. Feb 2001 B1
6190385 Tom et al. Feb 2001 B1
6190386 Rydell Feb 2001 B1
6193129 Bittner et al. Feb 2001 B1
6193653 Evans et al. Feb 2001 B1
6193713 Geistert et al. Feb 2001 B1
6197026 Farin et al. Mar 2001 B1
6203641 Keppel Mar 2001 B1
6206823 Kolata et al. Mar 2001 B1
6206844 Reichel et al. Mar 2001 B1
6206875 Long et al. Mar 2001 B1
6206877 Kese et al. Mar 2001 B1
6210403 Klicek Apr 2001 B1
6210405 Goble et al. Apr 2001 B1
6214003 Morgan et al. Apr 2001 B1
6214023 Whipple et al. Apr 2001 B1
6228023 Zaslavsky et al. May 2001 B1
6228055 Foerster et al. May 2001 B1
6228080 Gines May 2001 B1
6228081 Goble May 2001 B1
6228083 Lands et al. May 2001 B1
6234178 Goble et al. May 2001 B1
6237604 Burnside et al. May 2001 B1
6238366 Savage et al. May 2001 B1
6238392 Long May 2001 B1
6238393 Mulier et al. May 2001 B1
6242741 Miller et al. Jun 2001 B1
6246912 Sluijter et al. Jun 2001 B1
6251106 Becker et al. Jun 2001 B1
6251110 Wampler Jun 2001 B1
6254623 Haibel et al. Jul 2001 B1
6257241 Wampler Jul 2001 B1
6258085 Eggleston Jul 2001 B1
6261286 Goble et al. Jul 2001 B1
6267761 Ryan Jul 2001 B1
6270497 Sekino et al. Aug 2001 B1
6273862 Privitera et al. Aug 2001 B1
6277114 Bullivant et al. Aug 2001 B1
6277115 Saadat Aug 2001 B1
6277117 Tetzlaff et al. Aug 2001 B1
6280398 Ritchart et al. Aug 2001 B1
6280407 Manna et al. Aug 2001 B1
6280441 Ryan Aug 2001 B1
6283963 Regula Sep 2001 B1
6287344 Wampler Sep 2001 B1
6293942 Goble et al. Sep 2001 B1
6293945 Parins et al. Sep 2001 B1
6296637 Thorne et al. Oct 2001 B1
6296640 Wampler et al. Oct 2001 B1
6298550 Kirwan, Jr. Oct 2001 B1
6302903 Mulier et al. Oct 2001 B1
6306131 Hareyama et al. Oct 2001 B1
6306134 Goble et al. Oct 2001 B1
6308089 von der Ruhr et al. Oct 2001 B1
6309400 Beaupre Oct 2001 B2
6312426 Goldberg et al. Nov 2001 B1
6315777 Comben Nov 2001 B1
6319221 Savage et al. Nov 2001 B1
6322494 Bullivant et al. Nov 2001 B1
6322549 Eggers et al. Nov 2001 B1
6322561 Eggers et al. Nov 2001 B1
6325795 Lindemann et al. Dec 2001 B1
6325799 Goble Dec 2001 B1
6325811 Messerly Dec 2001 B1
6328736 Mulier et al. Dec 2001 B1
6328751 Beaupre Dec 2001 B1
6331181 Tierney et al. Dec 2001 B1
6334068 Hacker Dec 2001 B1
6334861 Chandler et al. Jan 2002 B1
6336926 Goble et al. Jan 2002 B1
6348051 Farin et al. Feb 2002 B1
6371967 Long et al. Feb 2002 B1
6352532 Kramer et al. Mar 2002 B1
6352536 Buysse et al. Mar 2002 B1
6358248 Mulier et al. Mar 2002 B1
6358249 Chen et al. Mar 2002 B1
6358267 Murakami Mar 2002 B1
6361534 Chen et al. Mar 2002 B1
6364877 Goble et al. Apr 2002 B1
6364879 Chen et al. Apr 2002 B1
D457958 Dycus May 2002 S
6383183 Sekino et al. May 2002 B1
6387092 Burnside et al. May 2002 B1
6387109 Davison et al. May 2002 B1
6391024 Sun et al. May 2002 B1
6391025 Weinstein et al. May 2002 B1
6398779 Buysse et al. Jun 2002 B1
6398781 Goble et al. Jun 2002 B1
6402741 Keppel et al. Jun 2002 B1
6402742 Biewett et al. Jun 2002 B1
6402743 Orszulak et al. Jun 2002 B1
6402747 Lindemann et al. Jun 2002 B1
6402748 Schoenman et al. Jun 2002 B1
6406475 Wenzler et al. Jun 2002 B1
6409722 Hoey et al. Jun 2002 B1
6409724 Penny et al. Jun 2002 B1
6409728 Ehr et al. Jun 2002 B1
6416486 Wampler Jul 2002 B1
6416509 Goble et al. Jul 2002 B1
6423057 He et al. Jul 2002 B1
6423082 Houser et al. Jul 2002 B1
6432118 Messerly Aug 2002 B1
6436096 Hareyama Aug 2002 B1
6440130 Mulier et al. Aug 2002 B1
6443952 Mulier et al. Sep 2002 B1
6443968 Holthaus et al. Sep 2002 B1
6443970 Schulze et al. Sep 2002 B1
6451013 Bays et al. Sep 2002 B1
6451018 Lands et al. Sep 2002 B1
6454764 Fleenor et al. Sep 2002 B1
6454781 Witt et al. Sep 2002 B1
6454782 Schwemberger Sep 2002 B1
6458078 Luedtke et al. Oct 2002 B1
6458128 Schulze Oct 2002 B1
6458130 Frazier et al. Oct 2002 B1
6458142 Faller et al. Oct 2002 B1
6461352 Morgan et al. Oct 2002 B2
6464689 Qin et al. Oct 2002 B1
6464702 Schulze et al. Oct 2002 B2
6464704 Schmaltz et al. Oct 2002 B2
6468275 Wampler et al. Oct 2002 B1
6468286 Mastri et al. Oct 2002 B2
6475217 Platt Nov 2002 B1
6478030 Shaoeton et al. Nov 2002 B1
6482202 Goble et al. Nov 2002 B1
6485490 Wampler et al. Nov 2002 B2
6488507 Stoloff et al. Dec 2002 B1
6488680 Francischelli et al. Dec 2002 B1
6491690 Goble et al. Dec 2002 B1
6491708 Madan et al. Dec 2002 B2
6493589 Medhkour et al. Dec 2002 B1
6494877 Odell et al. Dec 2002 B2
6494902 Hoey et al. Dec 2002 B2
6497705 Comben Dec 2002 B2
6500176 Truckai et al. Dec 2002 B1
6500188 Harper et al. Dec 2002 B2
6503263 Adams Jan 2003 B2
6506189 Rittman et al. Jan 2003 B1
6506208 Hunt et al. Jan 2003 B2
6510854 Goble et al. Jan 2003 B2
6511476 Hareyama Jan 2003 B2
6511480 Tetzlaff et al. Jan 2003 B1
6514252 Nezhat et al. Feb 2003 B2
6517536 Hooven et al. Feb 2003 B2
6517538 Jacob et al. Feb 2003 B1
6526320 Mitchell Feb 2003 B2
6527771 Weadock et al. Mar 2003 B1
6533784 Truckai et al. Mar 2003 B2
6534770 Miller et al. Mar 2003 B2
6537248 Mulier et al. Mar 2003 B2
6537272 Christopherson et al. Mar 2003 B2
6540695 Burbank et al. Apr 2003 B1
6543456 Freeman Apr 2003 B1
6547783 Vilendrer et al. Apr 2003 B1
6547786 Goble et al. Apr 2003 B1
6554829 Schulze et al. Apr 2003 B2
6558379 Batchelor et al. May 2003 B1
6558383 Cunningham et al. May 2003 B2
6561983 Cronin et al. May 2003 B2
6562037 Paton et al. May 2003 B2
6565559 Eggleston May 2003 B2
6565560 Goble et al. May 2003 B1
6569105 Kortenbach et al. May 2003 B1
6569109 Sakurai et al. May 2003 B2
6572615 Schulze et al. Jun 2003 B2
6579288 Schnitzler Jun 2003 B1
6582424 Fleenor et al. Jun 2003 B2
6582427 Goble et al. Jun 2003 B1
6584360 Francischelli et al. Jun 2003 B2
D477408 Bromley Jul 2003 S
6585732 Mulier et al. Jul 2003 B2
6585733 Wellman Jul 2003 B2
6585735 Frazier et al. Jul 2003 B1
6589200 Schwemberger et al. Jul 2003 B1
6591719 Poole et al. Jul 2003 B1
6592582 Hess et al. Jul 2003 B2
6594518 Benaron et al. Jul 2003 B1
6602227 Cimino et al. Aug 2003 B1
6602249 Stoddard et al. Aug 2003 B1
6602252 Mollenauer Aug 2003 B2
6605036 Wild Aug 2003 B1
6607529 Jones et al. Aug 2003 B1
6610060 Mulier et al. Aug 2003 B2
6611793 Burnside et al. Aug 2003 B1
6613048 Mulier et al. Sep 2003 B2
6616656 Brommersma Sep 2003 B2
6616660 Platt Sep 2003 B1
6616661 Wellman et al. Sep 2003 B2
6620157 Dabney et al. Sep 2003 B1
6620161 Schulze et al. Sep 2003 B2
6623482 Pendekanti et al. Sep 2003 B2
6623515 Mulier et al. Sep 2003 B2
6626901 Treat et al. Sep 2003 B1
6629974 Penny et al. Oct 2003 B2
6638274 Yamamoto Oct 2003 B2
6648883 Francischelli et al. Nov 2003 B2
6652514 Ellman et al. Nov 2003 B2
6652521 Schulze Nov 2003 B2
6656110 Irion et al. Dec 2003 B1
6656175 Francischelli et al. Dec 2003 B2
6656176 Hess et al. Dec 2003 B2
6656177 Truckai et al. Dec 2003 B2
6660017 Beaupre Dec 2003 B2
6662050 Olson Dec 2003 B2
6662127 Wiener et al. Dec 2003 B2
6663622 Foley et al. Dec 2003 B1
6663627 Francischelli et al. Dec 2003 B2
6663628 Peters Dec 2003 B2
6666865 Platt Dec 2003 B2
6676660 Wampler et al. Jan 2004 B2
6678621 Wiener et al. Jan 2004 B2
6679882 Komerup Jan 2004 B1
6682527 Strul Jan 2004 B2
6682528 Frazier et al. Jan 2004 B2
6682544 Mastri et al. Jan 2004 B2
6685701 Orszulak et al. Feb 2004 B2
6685703 Pearson et al. Feb 2004 B2
6692450 Coleman Feb 2004 B1
6692489 Heim et al. Feb 2004 B1
6695837 Howell Feb 2004 B2
6695840 Schulze Feb 2004 B2
6699240 Francischelli et al. Mar 2004 B2
6706038 Francischelli et al. Mar 2004 B2
6706039 Mulier et al. Mar 2004 B2
6709432 Ferek-Petric Mar 2004 B2
6695838 Wellman et al. Apr 2004 B2
6723091 Goble et al. Apr 2004 B2
6726683 Shaw Apr 2004 B1
6726686 Buysse et al. Apr 2004 B2
6733498 Paton et al. May 2004 B2
6736810 Hoey et al. May 2004 B2
6740084 Ryan May 2004 B2
6740085 Hareyama et al. May 2004 B2
6740102 Hess et al. May 2004 B2
6743229 Buysse et al. Jun 2004 B2
6752804 Simpson et al. Jun 2004 B2
6755825 Schoenman et al. Jun 2004 B2
6755827 Mulier et al. Jun 2004 B2
6755841 Fraser et al. Jun 2004 B2
6758846 Goble et al. Jul 2004 B2
6764487 Mulier et al. Jul 2004 B2
6770071 Woloszko et al. Aug 2004 B2
6770072 Truckai et al. Aug 2004 B1
6773409 Truckai et al. Aug 2004 B2
6773434 Ciarrocca Aug 2004 B2
6773435 Schulze et al. Aug 2004 B2
6773444 Messerly Aug 2004 B2
6775675 Bommannan et al. Aug 2004 B1
6776780 Mulier et al. Aug 2004 B2
6780180 Goble et al. Aug 2004 B1
6786906 Cobb Sep 2004 B1
6790217 Schulze et al. Sep 2004 B2
6796828 Ehr et al. Sep 2004 B2
6796981 Wham et al. Sep 2004 B2
6807444 Tu et al. Oct 2004 B2
6807968 Francischelli et al. Oct 2004 B2
6808518 Wellman et al. Oct 2004 B2
6808525 Latterell et al. Oct 2004 B2
6814745 Prestel Nov 2004 B2
6821273 Mollenauer Nov 2004 B2
6827715 Francischelli et al. Dec 2004 B2
6827717 Brommersma et al. Dec 2004 B2
6827725 Batchelor et al. Dec 2004 B2
6830568 Thompson et al. Dec 2004 B1
6832111 Tu et al. Dec 2004 B2
6832985 Irion et al. Dec 2004 B2
6832998 Goble Dec 2004 B2
6835082 Gonnering Dec 2004 B2
6835195 Schulze et al. Dec 2004 B2
6837887 Woloszko et al. Jan 2005 B2
6843789 Goble Jan 2005 B2
6849073 Hoy et al. Feb 2005 B2
6852112 Platt Feb 2005 B2
6855142 Harano et al. Feb 2005 B2
6855145 Ciarrocca Feb 2005 B2
6858028 Mulier et al. Feb 2005 B2
6860881 Sturm Mar 2005 B2
6860894 Pittman Mar 2005 B1
6887240 Lands et al. May 2005 B1
6889694 Hooven May 2005 B2
6893435 Goble May 2005 B2
6893441 Brommersma et al. May 2005 B2
6899710 Hooven May 2005 B2
6905497 Truckai et al. Jun 2005 B2
6905498 Hooven Jun 2005 B2
6908472 Wiener et al. Jun 2005 B2
6911019 Mulier et al. Jun 2005 B2
6913579 Truckai et al. Jul 2005 B2
6916318 Francischelli et al. Jul 2005 B2
6918880 Brookner et al. Jul 2005 B2
6923803 Goble Aug 2005 B2
6923804 Eggers et al. Aug 2005 B2
6923806 Hooven et al. Aug 2005 B2
6926716 Baker et al. Aug 2005 B2
6929641 Goble et al. Aug 2005 B2
6929644 Truckai et al. Aug 2005 B2
6932810 Ryan Aug 2005 B2
6932811 Hooven et al. Aug 2005 B2
6937033 Boronkay et al. Aug 2005 B2
6939347 Thompson Sep 2005 B2
6942660 Pantera et al. Sep 2005 B2
6942662 Goble et al. Sep 2005 B2
6945972 Frigg et al. Sep 2005 B2
6945981 Donofrio et al. Sep 2005 B2
6948503 Refior et al. Sep 2005 B2
6949098 Mulier et al. Sep 2005 B2
6958063 Soll et al. Oct 2005 B1
6960209 Clague et al. Nov 2005 B2
6960210 Lands et al. Nov 2005 B2
6962587 Johnson et al. Nov 2005 B2
6962589 Mulier et al. Nov 2005 B2
6966907 Goble Nov 2005 B2
6966909 Marshall et al. Nov 2005 B2
6971988 Orban et al. Dec 2005 B2
6974453 Woloszko et al. Dec 2005 B2
6974454 Hooven Dec 2005 B2
6976969 Messerly Dec 2005 B2
6979332 Adams Dec 2005 B2
6984231 Goble et al. Jan 2006 B2
6984233 Hooven Jan 2006 B2
6984826 Miller et al. Jan 2006 B2
6989010 Francischelli et al. Jan 2006 B2
6994705 Nobis et al. Feb 2006 B2
6997735 Ehr et al. Feb 2006 B2
6997935 Anderson et al. Feb 2006 B2
7001380 Goble Feb 2006 B2
7001415 Hooven Feb 2006 B2
7011657 Truckai et al. Mar 2006 B2
7025764 Paton et al. Apr 2006 B2
7029470 Francischelli et al. Apr 2006 B2
7033351 Howell Apr 2006 B2
7033354 Keppel Apr 2006 B2
7033356 Latterell Apr 2006 B2
7041096 Malis May 2006 B2
7041102 Truckai et al. May 2006 B2
7044948 Keppel May 2006 B2
7044949 Orszulak May 2006 B2
7044950 Yamamoto May 2006 B2
7048687 Reuss et al. May 2006 B1
7049599 Miller et al. May 2006 B2
7052494 Goble et al. May 2006 B2
7060063 Marion et al. Jun 2006 B2
7063698 Hess Jun 2006 B2
7066933 Hagg Jun 2006 B2
7066936 Ryan Jun 2006 B2
7070597 Truckai et al. Jul 2006 B2
7074218 Washington et al. Jul 2006 B2
7074219 Levine et al. Jul 2006 B2
7083618 Couture et al. Aug 2006 B2
7083619 Truckai et al. Aug 2006 B2
7083620 Jahns et al. Aug 2006 B2
7087054 Truckai et al. Aug 2006 B2
7090673 Dycus Aug 2006 B2
7094202 Nobis et al. Aug 2006 B2
7094235 Francischelli Aug 2006 B2
7097644 Long Aug 2006 B2
7104989 Skarda 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
7104834 Robinson et al. Sep 2006 B2
7108695 Witt et al. Sep 2006 B2
7111769 Wales et al. Sep 2006 B2
7112201 Truckai et al. Sep 2006 B2
RE39358 Goble Oct 2006 E
7116157 Ross Oct 2006 B2
7118564 Ritchie et al. Oct 2006 B2
7118570 Tetzlaff et al. Oct 2006 B2
7118587 Dycus et al. Oct 2006 B2
7119516 Denning Oct 2006 B2
7124932 Isaacson Oct 2006 B2
7125409 Truckai et al. Oct 2006 B2
7126125 Miller et al. Oct 2006 B2
7131445 Amoah Nov 2006 B2
7131860 Sartor Nov 2006 B2
7131970 Moses et al. Nov 2006 B2
7131971 Dycus et al. Nov 2006 B2
7135018 Ryan et al. Nov 2006 B2
7135020 Lawes et al. Nov 2006 B2
7137980 Buysse Nov 2006 B2
D533942 Kerr et al. Dec 2006 S
7147635 Ciarrocca Dec 2006 B2
7147637 Goble Dec 2006 B2
7147638 Chapman et al. Dec 2006 B2
7150097 Sremcich Dec 2006 B2
7150748 Ebbutt Dec 2006 B2
7150749 Dycus et al. Dec 2006 B2
7153300 Goble Dec 2006 B2
7156843 Skarda Jan 2007 B2
7156845 Mulier et al. Jan 2007 B2
7156846 Dycus et al. Jan 2007 B2
7159750 Racenet et al. Jan 2007 B2
7160293 Sturm et al. Jan 2007 B2
7160298 Lawes et al. Jan 2007 B2
7160299 Baily Jan 2007 B2
7163548 Stulen et al. Jan 2007 B2
7166105 Mulier et al. Jan 2007 B2
7169115 Nobis et al. Jan 2007 B2
7169144 Hoey Jan 2007 B2
7169145 Isaacson Jan 2007 B2
7169146 Truckai et al. Jan 2007 B2
7172591 Harano et al. Feb 2007 B2
7179254 Pendkanti Feb 2007 B2
7179258 Buysse et al. Feb 2007 B2
7182604 Ehr et al. Feb 2007 B2
7186252 Nobis et al. Mar 2007 B2
7186253 Truckai et al. Mar 2007 B2
7187790 Sabol Mar 2007 B2
7189231 Clague et al. Mar 2007 B2
7189232 Scholl et al. Mar 2007 B2
7189233 Truckai et al. Mar 2007 B2
7191015 Lamson et al. Mar 2007 B2
7195627 Amoah Mar 2007 B2
7195630 Ciarrocca Mar 2007 B2
7195631 Dumbauld Mar 2007 B2
7204835 Latterell et al. Apr 2007 B2
7207471 Heinrich et al. Apr 2007 B2
7207990 Lands et al. Apr 2007 B2
D541938 Kerr et al. May 2007 S
7211081 Goble May 2007 B2
7211084 Goble May 2007 B2
7214224 Goble May 2007 B2
7216001 Hacker et al. May 2007 B2
7220260 Fleming May 2007 B2
7220951 Truckai et al. May 2007 B2
7223239 Schulze et al. May 2007 B2
7223265 Keppel May 2007 B2
7226447 Uchida Jun 2007 B2
7229307 Ehr et al. Jun 2007 B2
7231971 McCalvin Jun 2007 B2
7232439 Ciarrocca Jun 2007 B2
7232440 Dumbald et al. Jun 2007 B2
7235048 Rein et al. Jun 2007 B2
7235072 Sartor et al. Jun 2007 B2
7235073 Levine et al. Jun 2007 B2
7237708 Guy Jul 2007 B1
7241296 Buysse et al. Jul 2007 B2
7247141 Makin et al. Jul 2007 B2
7247155 Hoey et al. Jul 2007 B2
7250048 Francischelli et al. Jul 2007 B2
7250051 Francischelli Jul 2007 B2
7252667 Moses Aug 2007 B2
7255694 Keppel Aug 2007 B2
7255696 Goble et al. Aug 2007 B2
7255697 Dycus et al. Aug 2007 B2
7259340 Blaha et al. Aug 2007 B2
7261711 Mulier et al. Aug 2007 B2
7267677 Johnson et al. Aug 2007 B2
7270660 Ryan Sep 2007 B2
7270664 Johnson et al. Sep 2007 B2
7273483 Weiner et al. Sep 2007 B2
7276068 Johnson et al. Oct 2007 B2
7278994 Goble Oct 2007 B2
7282048 Goble et al. Oct 2007 B2
7282049 Oraszulak et al. Oct 2007 B2
7291161 Hooven Nov 2007 B2
7297145 Woloszko et al. Nov 2007 B2
7300435 Wham et al. Nov 2007 B2
7300446 Beaupre Nov 2007 B2
7300450 Vleugels et al. Nov 2007 B2
7303557 Wham Dec 2007 B2
7309325 Mulier et al. Dec 2007 B2
7309849 Truckai et al. Dec 2007 B2
7311560 Ehr et al. Dec 2007 B2
7311706 Schoenman et al. Dec 2007 B2
7311707 Hagg et al. Dec 2007 B2
7311709 Truckai et al. Dec 2007 B2
7322975 Goble et al. Jan 2008 B2
7329256 Johnson et al. Feb 2008 B2
7335997 Weiner Feb 2008 B2
7344532 Goble et al. Mar 2008 B2
7347858 Francischelli et al. Mar 2008 B2
RE40279 Sluijter et al. Apr 2008 E
D567943 Moses et al. Apr 2008 S
7353068 Tanake et al. Apr 2008 B2
7354435 Farin et al. Apr 2008 B2
7354440 Truckai et al. Apr 2008 B2
7354443 Moll et al. Apr 2008 B2
7364577 Wham et al. Apr 2008 B2
7364579 Miller et al. Apr 2008 B2
7364678 Francischelli et al. Apr 2008 B2
7367972 Francischelli et al. May 2008 B2
7367976 Lawes et al. May 2008 B2
7371246 Viola May 2008 B2
7377902 Burbank et al. May 2008 B2
7377918 Amoah May 2008 B2
7377920 Buysse et al. May 2008 B2
RE40388 Gines Jun 2008 E
7381209 Truckai et al. Jun 2008 B2
7384420 Dycus et al. Jun 2008 B2
7396336 Orszulak et al. Jul 2008 B2
D575395 Hushka Aug 2008 S
D575401 Hixson et al. Aug 2008 S
7384421 Hushka Aug 2008 B2
7416101 Shelton Aug 2008 B2
7416437 Sartor et al. Aug 2008 B2
7419487 Johnson et al. Sep 2008 B2
7422139 Shelton et al. Sep 2008 B2
7422588 Mulier et al. Sep 2008 B2
7424965 Racenet et al. Sep 2008 B2
7425835 Eisele Sep 2008 B2
7426415 Kuhner Sep 2008 B2
7431720 Pendekanti et al. Oct 2008 B2
7431721 Paton et al. Oct 2008 B2
7435249 Buysse et al. Oct 2008 B2
7435250 Francischelli et al. Oct 2008 B2
7442187 Dunki-Jacobs Oct 2008 B2
7442193 Shelds Oct 2008 B2
7442194 Dumbauld Oct 2008 B2
7445621 Dumbauld et al. Nov 2008 B2
7458972 Keppel Dec 2008 B2
7464846 Shelton et al. Dec 2008 B2
7470272 Mulier et al. Dec 2008 B2
7473250 Makin et al. Jan 2009 B2
7473253 Dycus et al. Jan 2009 B2
7476233 Wiener et al. Jan 2009 B1
7481808 Koyfman et al. Jan 2009 B2
7491199 Goble et al. Feb 2009 B2
7497858 Chapelon et al. Mar 2009 B2
7621910 Sugi Nov 2009 B2
7811283 Moses et al. Oct 2010 B2
7841765 Keller Nov 2010 B2
8561615 Pannell et al. Oct 2013 B2
8784417 Hanna Jul 2014 B2
8808288 Rescheke Aug 2014 B2
9161813 Benamou Oct 2015 B2
20010037110 Schmaltz Nov 2001 A1
20010039417 Harano et al. Nov 2001 A1
20020052599 Goble May 2002 A1
20020115997 Truckai Aug 2002 A1
20020120262 Bek Aug 2002 A1
20020120266 Truckai Aug 2002 A1
20020128650 McClurken Sep 2002 A1
20020151884 Hoey et al. Oct 2002 A1
20020161363 Fodor et al. Oct 2002 A1
20020165541 Whitman Nov 2002 A1
20020188294 Couture et al. Dec 2002 A1
20030004510 Wham Jan 2003 A1
20030014052 Buysse Jan 2003 A1
20030065327 Wellman Apr 2003 A1
20030065358 Frecker et al. Apr 2003 A1
20030069571 Treat Apr 2003 A1
20030109871 Johnson Jun 2003 A1
20030114845 Paton et al. Jun 2003 A1
20030114848 Cobb Jun 2003 A1
20030114851 Csaba et al. Jun 2003 A1
20030125728 Nezhat et al. Jul 2003 A1
20030125731 Smith et al. Jul 2003 A1
20030125734 Mollenauer Jul 2003 A1
20030139741 Goble et al. Jul 2003 A1
20030181910 Dycus Sep 2003 A1
20030199863 Swanson et al. Oct 2003 A1
20030199870 Truckai Oct 2003 A1
20030229344 Dycus et al. Dec 2003 A1
20030236549 Bonadio et al. Dec 2003 A1
20040006340 Latterell Jan 2004 A1
20040068274 Hooven Apr 2004 A1
20040068304 Paton et al. Apr 2004 A1
20040073247 Loshakove et al. Apr 2004 A1
20040082946 Malis et al. Apr 2004 A1
20040092922 Kadziauskas et al. May 2004 A1
20040122423 Dycus Jun 2004 A1
20040162557 Tetzlaff et al. Aug 2004 A1
20040193148 Wham Sep 2004 A1
20040215127 Kadziauskas et al. Oct 2004 A1
20040225288 Buysse Nov 2004 A1
20040250419 Sremich Dec 2004 A1
20050004564 Wham et al. Jan 2005 A1
20050021027 Shields et al. Jan 2005 A1
20050033282 Hooven Feb 2005 A1
20050033352 Zepf Feb 2005 A1
20050080319 Dinkler, II et al. Apr 2005 A1
20050090815 Francischelli et al. Apr 2005 A1
20050096681 Desinger et al. May 2005 A1
20050101951 Wham May 2005 A1
20050107785 Dycus May 2005 A1
20050113817 Isaacson May 2005 A1
20050113819 Wham et al. May 2005 A1
20050004563 Racz et al. Jun 2005 A1
20050124915 Eggers et al. Jun 2005 A1
20050137592 Nguyen et al. Jun 2005 A1
20050149017 Dycus Jul 2005 A1
20050159745 Truckai Jul 2005 A1
20050165444 Hart Jul 2005 A1
20050192568 Truckai et al. Sep 2005 A1
20050203504 Wham Sep 2005 A1
20050234447 Paton et al. Oct 2005 A1
20050245918 Sliwa, Jr. et al. Nov 2005 A1
20050245922 Goble Nov 2005 A1
20060020265 Ryan Jan 2006 A1
20060041254 Francischelli et al. Feb 2006 A1
20060052777 Dumbauld Mar 2006 A1
20060079788 Anderson et al. Apr 2006 A1
20060079878 Houser Apr 2006 A1
20060129146 Dycus Jun 2006 A1
20060181190 Gadberry et al. Jul 2006 A1
20060187450 Johnson Jul 2006 A1
20060173453 Gruhl Aug 2006 A1
20060217697 Lau et al. Sep 2006 A1
20060217706 Lau et al. Sep 2006 A1
20060217707 Daniel et al. Sep 2006 A1
20060224152 Behnke et al. Oct 2006 A1
20060224158 Odom Oct 2006 A1
20060247498 Bonadio et al. Nov 2006 A1
20060271042 Latterell et al. Nov 2006 A1
20070016185 Tullis et al. Jan 2007 A1
20070043352 Garrison et al. Feb 2007 A1
20070043353 Dycus Feb 2007 A1
20070062017 Dycus et al. Mar 2007 A1
20070088202 Albrecht et al. Apr 2007 A1
20070090788 Hansford et al. Apr 2007 A1
20070093800 Wham et al. Apr 2007 A1
20070123847 Mihori May 2007 A1
20070135811 Hooven Jun 2007 A1
20070142833 Dycus Jun 2007 A1
20070142834 Dumbauld Jun 2007 A1
20070156139 Schecter Jul 2007 A1
20070156140 Baily Jul 2007 A1
20070167941 Hamel et al. Jul 2007 A1
20070173811 Couture et al. Jul 2007 A1
20070173813 Odom Jul 2007 A1
20070173814 Hixson et al. Jul 2007 A1
20070179499 Garrison Aug 2007 A1
20070191827 Lishinsky et al. Aug 2007 A1
20070191828 Houser et al. Aug 2007 A1
20070203481 Gregg et al. Aug 2007 A1
20070213712 Buysse et al. Sep 2007 A1
20070260242 Dycus et al. Nov 2007 A1
20070276363 Patton et al. Nov 2007 A1
20070282195 Masini et al. Dec 2007 A1
20070282320 Buysse et al. Dec 2007 A1
20070282332 Witt et al. Dec 2007 A1
20070287997 Tolmei Dec 2007 A1
20080009860 Odom Jan 2008 A1
20080015563 Hoey et al. Jan 2008 A1
20080015564 Wham et al. Jan 2008 A1
20080030206 Podhajsky et al. Feb 2008 A1
20080039831 Odom et al. Feb 2008 A1
20080045947 Johnson et al. Feb 2008 A1
20080058802 Couture Mar 2008 A1
20080082098 Tanaka et al. Apr 2008 A1
20080091189 Carlton Apr 2008 A1
20080114356 Johnson et al. May 2008 A1
20080125772 Stone et al. May 2008 A1
20080132893 D'Amelio et al. Jun 2008 A1
20080172048 Martin Jul 2008 A1
20080187651 Tetzlaff et al. Jul 2008 A1
20080188848 Deutmeyer et al. Aug 2008 A1
20080208246 Livneh Aug 2008 A1
20080215050 Bakos Sep 2008 A1
20080215051 Buysse et al. Sep 2008 A1
20080228179 Eder et al. Sep 2008 A1
20080294222 Schecter Nov 2008 A1
20080300589 Paul et al. Dec 2008 A1
20080300590 Horne et al. Dec 2008 A1
20080300591 Darin et al. Dec 2008 A1
20090012520 Hixson et al. Jan 2009 A1
20090024126 Artale Jan 2009 A1
20090248007 Falkenstein et al. Jan 2009 A1
20090082769 Unger Mar 2009 A1
20090275490 Malackowski May 2009 A1
20090248021 McKenna Oct 2009 A1
20090275940 Malackowski et al. Nov 2009 A1
20120010614 Couture Jan 2012 A1
20120059371 Anderson et al. Mar 2012 A1
20120083785 Roy et al. Apr 2012 A1
20120136347 Brustad et al. May 2012 A1
20120197243 Sherman et al. Aug 2012 A1
20120215220 Manzo et al. Aug 2012 A1
20130018411 Collings et al. Jan 2013 A1
20130138101 Kerr May 2013 A1
20130274743 Banfalvi Oct 2013 A1
20130296843 Boudrequx et al. Nov 2013 A1
20140005658 Rosenbegr Jan 2014 A1
20140088583 Singh Mar 2014 A1
20140214019 Baxter, III et al. Jul 2014 A1
Non-Patent Literature Citations (5)
Entry
Annotated McKenna Fig 4 (Year: 2023).
International Preliminary Examining Authority/US, International Preliminary Report on Patentability for International Application No. PCT/US2019/049768, titled “Electrosurgical Generator Verification System,” dated Mar. 18, 2021, 13 pgs.
International Preliminary Examining Authority/US, International Preliminary Report on Patentability for International Application No. PCT/US2019/049807, titled “Electrosurgical Generator Control System,” dated Mar. 18, 2021, 13 pgs.
European Patent Office, Extended European Search Report for European Application No. EP 21215386.0, dated May 24, 2022, 6 pgs.
International Preliminary Examining Authority/US, International Preliminary Report on Patentability for International Application No. PCT/US2019/059909, titled “Electrosurgical System,” dated May 27, 2021, 15 pgs.
Related Publications (1)
Number Date Country
20210137582 A1 May 2021 US
Provisional Applications (1)
Number Date Country
61389012 Oct 2010 US
Continuations (4)
Number Date Country
Parent 15936914 Mar 2018 US
Child 17135520 US
Parent 15136652 Apr 2016 US
Child 15936914 US
Parent 13366487 Feb 2012 US
Child 15136652 US
Parent PCT/US2011/054661 Oct 2011 US
Child 13366487 US