BRIEF DESCRIPTION OF THE DRAWINGS
The novel features of the invention are set forth with particularity in the appended claims. The invention itself, however, both as to organization and methods of operation, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings in which:
FIG. 1 is an isometric view of an electrosurgical instrument of the present invention, showing an electrosurgical generator operably coupled to an actuation foot switch and to an electrosurgical instrument having a distal end effector with an angularly open anvil.
FIG. 2 is a side view, in cross section, of the end effector of the electrosurgical instrument of FIG. 1 showing a first unfired staple cartridge located below the angularly open anvil, and a coating on the anvil.
FIG. 3 is a cross sectional end view of the end effector of FIG. 1 with the anvil in a closed position, the cross section taken along lines A-A (FIG. 2) and showing the anvil and cartridge coatings.
FIG. 4 is a cross sectional end view of a prior art end effector clamped on tissue and showing the path of RF energy between the electrodes.
FIG. 5 is a cross sectional view of an end effector with a coated anvil clamped on tissue and showing the RF energy paths into uncoated staple pockets and channel.
FIG. 6 is an isometric view showing the prior art end effector of FIG. 4 being placed on a portion of severed tissue containing a plurality of formed staples, the prior art end effector of FIG. 4 being positioned for a second clamp, coagulation, staple and cutline on top of the prior staple lines.
FIG. 7 is a cross sectional view of the prior art end effector of FIG. 6 clamped on the portion of tissue containing a plurality of formed staples and showing how a staple formed in tissue can induce shorting between the first pole electrode and the anvil.
FIG. 8 is a cross sectional view of the end effector of FIG. 5 clamped on the portion of tissue containing a plurality of formed staples and showing how an anvil coating can eliminate shorting with a formed staple;
FIG. 9 is an alternate embodiment of the coatings of the present invention with a portion of the coating removed from an upper surface of the anvil.
FIG. 10 shows a second alternate anvil coating of the present invention placed on the anvil wherein the anvil coating has no openings along the tissue contact areas.
FIG. 11 shows an alternate E-beam electrosurgical instrument 120 of the present invention.
FIG. 12 is a cross sectional view of the E-beam end effector of FIG. 11 clamped on tissue containing one formed staple and showing how an anvil coating prevents shorting between a first pole electrode and anvil.
DETAILED DESCRIPTION OF THE INVENTION
As best shown in FIG. 1, the present invention includes an electrosurgical instrument, generally designated 20, used for the cauterization, coagulation and/or tissue welding in the performance of surgical procedures. Electrosurgical instrument 20 clamps on tissue, can apply RF energy for tissue coagulation, and can be fired to place a plurality of parallel rows of staples and cut tissue between the innermost rows of staples. Electrosurgical instruments of this type are described in the U.S. Pat. No. 5,735,848, U.S. Pat. No. 5,688,270 and U.S. Pat. No. 5,709,680 by Yates et al. which are incorporated herein by reference. However, the electrosurgical instrument 20 can have coating improvements to an end effector 45 that will be described in detail below.
The electrosurgical instrument 20 has a handle 30 and a shaft 40 extending distally from the handle 30. End effector 45 extends distally from a distal end of the shaft 40. Rotation knob 35 is located between the handle 30 and shaft 40 for simultaneous rotation of the shaft 40 and the end effector 45 about a longitudinal axis LL. End effector 45 extends distally from shaft 40 and has a moveable anvil 55 and a fixed lower channel 47. Anvil 55 is moveable from a first open position FIG. 1) angled away from the channel 47 to a second clamped or closed position parallel to and spaced away from channel 47 (FIG. 3). A cartridge 50 containing a plurality of staples 53 (FIG. 3) is removably mounted within the channel 47. A closure trigger 32 and a firing trigger 34 are rotatably mounted within the handle 30 near a grip 31. Actuation of closure trigger 32 rotates the trigger adjacent to grip 31, closes of the anvil 55, and unlocks of the firing trigger 34. Actuation of the firing trigger 34 ejects the plurality of staples 53 and moves a knife 66 between the inner most rows of staples 53 (not shown). Release button 36 is located at the proximal end of the handle 30 for opening the anvil 55 from its closed position.
RF energy is supplied to the electrosurgical instrument 20 from an electrosurgical generator 21 when the surgeon activates a foot switch 22. A first pole wire 38 and a second pole wire 39 electrically connect the generator 21 to the electrosurgical instrument 20 for delivery of RF energy to a first and second pole electrode. The first and second pole wires 38 and 39 respectively extend from the generator, into a strain relief 37 and to the first and second pole electrodes in end effector 45.
As best shown in FIG. 2, shaft 40 has a longitudinally moveable hollow closure tube 4 and a longitudinally fixed to a nonconductive retainer 42 made from a suitable material such as glass reinforced polycarbonate. Retainer 42 is rotatably restrained within handle 30 and is prevented from moving longitudinally but allowed to rotate about the longitudinal axis LL Channel 47 is fixed to a distal end of retainer 42, extends distally from closure tube 41, and has anvil 55 moveably mounted within. Anvil 55 can be formed from a conductive material such as stainless steel, and is shown in the open position angularly spaced away from channel 47 and cartridge 50. Anvil 55 contains a plurality of staple forming pockets 58 that are brought into alignment above the staples 53 in the cartridge 50 when anvil 55 is closed (see FIG. 3). A “C” shaped insulator 62 is fixedly attached within groove 59 (FIG. 3) of anvil 55, and a first pole electrode 60 having a tissue contact surface and mounted within the inner portion of the “C”. Insulator 62 electrically isolates the first pole electrode 60 from the electrically conductive anvil 55. A distal end of first pole wire 38 forms an electrical connection with first pole electrode 60 and a proximal end is electrically connected to generator 21 (FIG. 1). First pole wire 38 is electrically isolated from all elements of electrosurgical instrument 20 therebetween. Staple forming anvil 55 also acts as the return path or second pole electrode 56 for the electrosurgical device 20 of the present invention. Anvil 55 is closed by activating the closure trigger 32. Closure trigger 32 is operably coupled to closure tube 41 of shaft 40 and moves closure tube 41 distally from a proximal position shown in FIG. 2. This motion brings closure tube 41 into contact with a ramp 57 of anvil 55 and through wedging action, moves anvil 55 to the closed position of FIG. 3. Closure tube 41 is also in sliding and electrical contact with channel 47. The anvil 55 of the present invention is covered in a dielectric or non-conducting coating 75 in selected areas. As shown in FIG. 2, the ramp 57 of the anvil 55 is not coated to ensure an electrically conducting path with the closure tube 41. Closure tube 41 is brought into electrical contact with the second pole wire 39 when the closure trigger 32 is activated to form a second pole electrical circuit extending from the generator 21 to the second pole anvil 55.
Actuation of the firing trigger 34 ejects the staples 53 from the cartridge 50, forms staples 53 against the anvil 55, and move a knife 66 along a knife slot 54 to sever tissue between the inner most rows of staples 53 (action not shown). Firing trigger 34 moves wedge block 51 and knife 66 distally through the cartridge 50 to form the staples 53 against the anvil 55. Knife 66 attaches to the wedge block 51 and moves longitudinally through knife slot 54 within cartridge 50 and first electrode 60 (see FIG. 3) in response to movement of firing trigger 34. Knife 66 trails the formation of the staples 53 so tissue is stapled first and cut second. FIG. 3 is a cross sectional end view AA of the end effector 45 of the present invention when the anvil 55 is in the closed position spaced away from and generally parallel to cartridge 50 and channel 47. See FIG. 2 for the longitudinal location of cross section AA on end effector 45. In FIG. 3, the cross section of the anvil is taken across staple pockets 58, and electrode groove 59. The electrosurgical instrument of the present invention includes a non-conducting or dielectric anvil coating 75 on anvil 55. By way of example, the dielectric coating 75 could be but is not limited to a PTFE (polytetrafluroethylene), Paralene™ or Parylene™, titanium dioxide, or an epoxy. Paralene™ or Parylene™ are generic names for a series of polymers based on paraxylene and are available from Advance Coating, 10723 Edison Court, Rancho Cucamonga, Calif. 91730. The Parylenes are formed by the pyrolysis of a di-p-xylene (dimer) in a vacuum environment which is then deposited on a cooler (i.e. room temperature) substrate under continuous vacuum. Paralene exhibits excellent dielectric strength, exceptionally high surface and volume resistivities; and electrical properties that are essentially independent of temperature. It provides a conformal, pinhole-free coating that is unexcelled for corrosion resistance and dielectric protection. If desired, coating 75 can be selectively coated onto desired areas of the anvil, or the anvil can be entirely coated. If desired, selected areas of coating 75 may be removed by laser etching, sandblasting, water jet, grinding and the like. As shown in FIG. 2, the anvil coating 75 has been selectively excluded or removed from the ramp 57 to ensure electrical conductivity of the anvil 55 to the closure tube 41. Closure tube 41 is electrically connected to the second pole wire 39 extending from the strain relief 37 to the generator 21 to complete the second pole ground circuit. Anvil 55 and channel 47 are both electrically connected to the second pole wire 39 by contact with closure tube 41. In FIG. 3, anvil coating 75 generally extends around the anvil 55 but does not extend into the plurality of uncoated staple pockets 58 extending upwardly into anvil 55. Additionally, the coating 75 has variable thickness near the staple pockets 58. Insulator 62 is constrained in groove 59 and holds first pole electrode 60.
Cartridge 50 is constructed from an engineering thermoplastic such as the liquid crystal polymer (LCP) Vectra™. Drivers 52 move vertically in cartridge 50 when pushed upwards by wedge block 51 to form staples 53 in anvil pockets 58. Drivers 52 are also constructed from an engineering thermoplastic such as polycarbonate or a liquid crystal polymer (LCP) such as Vectra™. When exposed to RF energy, some engineering thermoplastics can exhibit a strong sheet surface charge which can expose the plastics to high heat and possibly arcing. It is an object of the present invention to provide cartridge coating 80 on the cartridge 50 and/or drivers 52. Cartridge coating 80 can be a dielectric coating, reduce the surface charge effect on the cartridge 50, and prevent potential damage to the cartridge thermoplastics. Additionally, the cartridge coating 80 can provide some degree of thermal protection and/or add lubricity to the cartridge 50 and drivers 52 and, if desired, selectively excluded by masking or removed by laser etching, sandblasting, water jet, grinding and the like. Cartridge coatings 80 can be PTFE (polytetrafluroethylene), a Parlene™ or Parylene™, titanium dioxide, or an epoxy.
FIG. 4 is a cross sectional view of a prior art end effector 90 as disclosed in a U.S. Pat. No. 5,833,690 by Yates et al. which is hereby incorporated by reference. In FIG. 4, the prior art end effector 90 is clamped on tissue 70 and current paths from a first pole electrode 94 to a second pole electrode 95 are shown. In this invention, both a prior art anvil 91 and a prior art channel 92 form a prior art second pole electrode 95 (prior art anvil 91) by contact with a prior art closure tube 93 (not shown). Prior art cartridge 96 has staples 53, prior art drivers 97 and prior art wedges 98.
FIG. 5 is a cross sectional view of the end effector 45 of the present invention clamped on tissue 70 with RF energy being applied to the tissue. As shown, the anvil coating 75 of the preferred invention redirects current flow to the second pole electrode 56 formed from uncoated staple pockets 58 and uncoated channel 47.
FIG. 6 shows the open prior art end effector 90 being placed on top of a previously placed staple line in tissue just prior to placement of a second clamp, coagulation staple and cut line. The first firing of the prior art instrument has formed staples 71 shown extending along the cut line and directly below the first and second electrodes 94 and 95 respectively within anvil 91. A new cartridge 50 containing staples 53 has been loaded for this firing.
FIG. 7, shows the prior art end effector 90 of FIG. 6 after the prior art anvil 91 is clamped on tissue containing one formed staple 71. The formed staple 71 is in direct contact with the prior art first pole electrode 94, and with the second pole electrode 95 creating an electrical short. The prior art second pole electrode 92 can easily contact the staple 71 and can cause a short condition between the prior art first and second pole electrodes 94, 95 respectively. The short means the surgeon must unclamp the instrument, reposition it, and clamp it again.
FIG. 8 is a cross sectional view of the end effector 45 of the present invention clamped on tissue 70 containing one formed staple 71. As shown, the anvil coating 75 prevents the formed staple 71 from contacting the exposed areas of second pole electrode 56 located in staple pockets 58 and “U” shaped channel 47 (extending below cartridge 50—see FIG. 1) and creating an electrical short. Thus, anvil coating 75 of the preferred invention allows current flow through tissue to the staple pockets 58 and channel 47, but prevents the formed staple 71 from easily contacting the second pole electrode 56 and shorting within the end effector 45. Current paths can be to the staple pockets 58 or to the channel 47, or a combination of both. In the presence of staples 71, current paths can also be from first pole electrode 60, to the staple 71, and then to the pockets 58 and channel 47. Electrical energy flows mostly through the path of least resistance though some portion also flows through higher resistance portions of the circuit as well. The current through any individual element of the circuit can be calculated using Ohm's Law (V=IR where V is voltage, I is current and R is the resistance). In the case of the formed staple 71, the least resistive current path (and therefore the path of greatest current flow) is from the first pole electrode 60, through the staple 71, through tissue 70 and into pockets 58. This path coagulates and desiccates tissue 70 adjacent to the formed staple 71. As the tissue 70 near staple 71 desiccates, it becomes more resistive and less current flows to staple pocket 58. With the conductive path through staple 71 and pocket 58 is in contact with more resistive coagulated tissue, the uncoagulated tissue 70 adjacent to the next least resistive path begins to coagulate.
FIG. 9 is an alternate embodiment of the coatings of the present invention. In this embodiment, alternate anvil coating 76 is masked from or removed from an upper anvil surface 55a, from the staple pockets 58 of the anvil 55, and from the ramp 57 (see FIG. 2) of the anvil 55. This alternate embodiment reduces the area of the alternate anvil coating 76 and the material cost of the coating 76 without reducing effectiveness.
FIG. 10 shows anvil 55 with an alternate capacitive coupling coating 100 or dielectric coating that can be placed across the entire surface of the anvil 55 with the exception of the electrical contact area at ramp 57 (see FIG. 2). As a consequence, the contact network from the first pole electrode 60, through the tissue 70 and to a second pole electrode 85 (anvil 55 for this example) is blocked by the capacitive coupling anvil coating 100 on the anvil 55 and the tissue coagulation method shifts to capacitive coupling. Whereas the second pole electrode 56 is shown fully coated, a partial coating may suffice provided it creates capacitive coupling circuit with tissue. A rule of capacitance is that the impedance presented by the capacitor is inversely proportional to the frequency. In other words, capacitive coupling favors transfer of the higher frequency components of a signal, and has been found to work well at RF electrosurgical generator frequencies from about 300 kHz to about 3 MHz, and between about 500 kHz and about 700 kHz. Capacitive coupling works well over short distances such as that found between the electrodes of an electrosurgical device. Capacitive coupling coating 100 can be a dielectric such as but not limited to PTFE (polytetrafluroethylene), a Parlene™ or Parylene™, titanium dioxide or an epoxy.
In FIG. 10, tissue 70 contains a formed staple 71 in direct contact with first pole electrode 56 but contact with second pole electrode 56 is prevented by capacitive coupling coating 100. The anvil 55 and second pole electrode 56 can have a large generally flat portion which is prevented from creating a direct contact circuit with the tissue 70 by capacitive coupling coating 100. The surface area of the second pole electrode 56 is much larger than the surface area of the first pole electrode 60. Capacitive coupling circuits with at least one large surface area electrode (second pole electrode 56) and one small surface area electrode (first pole electrode 60) can exhibit a subtle but different effect. This effect works as follows. There is a threshold of electrosurgical energy density in tissue that must be met before tissue effects can occur. When the energy density is below the threshold, the tissue is unaffected by the application of energy. When the energy density rises above the threshold, the tissue is affected by the energy and begins to heat or cook. With the second alternate anvil coating 100 of the present invention, the energy density is spread between the first and second pole electrodes 60, 56, somewhat analogous to magnetic lines of force between two magnets. This concentrates the energy density at the first pole electrode 60 and spreads or dilutes the field lines across the horizontal surface of second pole electrode 56. When a small metallic object, such as formed staple 71 is present in tissue 70 of the above capacitive circuit, the capacitive coupled RF energy can ignore the small area of the conductive staple 71 as a path of least resistance. This means capacitive coupling coagulation can occur near the first pole electrode and not around the formed staple 71, unlike contact RF circuits.
FIG. 11 shows an alternate E-beam electrosurgical instrument 120. The E-beam electrosurgical instrument 120 is similar in operation to that of the previously described electrosurgical instrument 20. That is, both electrosurgical instruments clamp, apply RF energy, form rows of staples in the tissue, and cut the tissue between the innermost rows of staples. E-beam electrosurgical instrument 120 has first and second pole E-beam wires 138, 139 respectively. These e-beam wires 138, 139 are attachable to generator 21 and foot switch 22 (See FIG. 1) by connector 140 to deliver RF energy to an E-beam end effector 145. The E-beam end effector 145 of the alternate electrosurgical instrument 120 has some mechanical improvements over the original electrosurgical instrument 20.
As best shown in FIG. 12, the alternate electrosurgical instrument has an E-beam 165 that travels through the end effector 145 during firing to maintain a uniform tissue gap between an E-beam anvil 155 and an E-beam channel 147. E-beam 165 has upper supports 167 that travel within an anvil slot (in anvil 155 about upper supports 167), lower supports 169 that travel below a channel slot 148 and middle supports 168 that run along an inner surface of E-beam channel 147. E-beam upper supports 167 and E-beam lower supports 169 tie the E-beam anvil 155 and an E-beam channel 147 together in the vertical direction prevent spreading of the end effector 145 from thick tissue. E-beam upper supports 167 and E-beam middle supports 168 prevent the E-beam end effector 145 from coming together when clamped on thin tissue. Since E-beam cartridge 150 mounts within E-beam channel 147, the tissue gap between E-beam cartridge 150 and E-beam anvil 155 is also maintained. E-beam electrosurgical instruments such as E-beam electrosurgical instrument 120 are well known in the art such as that found in US. Patent Publication number 20040232196 by Shelton et al. and filed on May 20, 2003 which is incorporated herein in its entirety by reference.
The E-beam mechanism has necessitated some changes in the design of the first pole electrode 60, insulator 62 and second pole electrode 56 of the electrosurgical instrument 20. As shown in FIG. 11, the electrode design of -beam electrosurgical instrument 120 has a pair of E-beam first pole electrodes 160 mounted on E-beam insulators 162. E-beam anvil 155 acts as E-beam second pole electrode 156. Tissue 70 is shown clamped within The E-beam end effector 145 and a formed staple 71 is in contact with one of the E-beam first pole electrodes 160 and in contact with E-beam anvil coating 175. E-beam anvil coating 175 prevents contact of the formed staple 71 with E-beam second pole electrode 156. E-beam cartridge coating 180 prevents the formation of a surface charge on the E-beam cartridge 150.
Whereas the above stapling devices are straight, it would be obvious to one skilled in the art to apply the coatings to anvils and cartridges of any stapling device of any shape, including but not limited to actuator circular. Alternately, staples or other conductive fasteners used in the body could also be coated in dielectric coatings, the dielectric coatings making the staples nonconductive when subjected to electrosurgical energy. Dielectric staple coatings could be but are not limited to PTFE (polytetrafluroethylene), a Parlene™ or Parylene™, titanium dioxide or an epoxy.
It will be recognized that equivalent structures may be substituted for the structures illustrated and described herein and that the described embodiment of the invention is not the only structure which may be employed to implement the claimed invention. As one example of an equivalent structure which may be used to implement the present invention, a coating such as PTFE can be used as a dielectric coating in a bipolar electrosurgical device. As a further example of an equivalent structure which may be used to implement the present invention, an alternate coating such as a coating having polymers based on paraxylene can be used as a dielectric coating in a bipolar electrosurgical device.
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. Accordingly, it is intended that the invention be limited only by the spirit and scope of the appended claims.
Patent Application
20080077131
