Two surgical tasks typically encountered in both open and endoscopic surgery include cutting or severing tissues and controlling bleeding. A large percentage of the time spent during surgery involves the control of bleeding. If bleeding is not controlled, blood can obscure the view of the surgical space on a patient, adversely affect the precision of the cutting or severing tissue, and prolong the surgery. Too much blood loss can cause trauma to the patient that may require a blood transfusion.
Cutting or ligating blood vessels include special considerations. Surgeons often have difficulty suturing vessels. Other traditional methods for controlling bleeding such as clamping or tying-off transected blood vessels are made difficult if surgery is performed in a remote operating space. Traditional methods also impractically prolong surgeries in cases where many blood vessels are cut. For example, a surgeon attempting to resect a neoplasm such as a brain tumor or spinal tumor may transect hundreds of blood vessels before the abnormal mass can be removed.
Electrosurgical instruments are often used to control bleeding in such circumstances. Electrosurgical forceps and hemostats can be used to cauterize, coagulate/desiccate or simply reduce blood flow by controlling electrosurgical energy applied to the tissue. Small blood vessels, e.g., those having a diameter of less than about two millimeters, can be coapted through coagulation, i.e., the process of desiccating tissue where the tissue cells are ruptured and dried. Larger blood vessels may be coapted through sealing, i.e., the process of liquefying the collagen in the tissue so that it reforms into a fused mass. A surgeon can then cut through the coapted portion of the vessel with a device such as microscissors to effect little or no bleeding in the surgical space.
In order to resect a neoplasm in the brain or spinal column, a surgeon performs the surgical tasks of controlling the bleeding and cutting the tissues with multiple surgical instruments. Switching between instruments is time consuming, tedious, and could cause the surgeon to lose focus. Difficulties lie in finding the coapted portions after the surgeon has switch to a cutting device in the case of a surgeon using multiple devices and cutting through the coapted portions so that both ends of the ligated vessels remain coapted.
This summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to limit the scope of the claimed subject matter.
In one aspect, the disclosure relates to a surgical device. The surgical device includes a longitudinal first leg having a first distal tip portion pivotably coupled to a longitudinal second leg having a second distal tip portion. The first and second legs are transitionable between a first position where the first and second tip portions are spaced apart from each other and a second position where the first and second tip portions are proximate each other. The first tip portion includes a concave face and the second tip portion includes a convex face configured such that the first and second faces oppose each other in the first and second positions and touch each other in the second position. The convex face fits within the concave face in the second position.
In another aspect, the disclosure relates to an electrosurgical device. The electrosurgical device includes a longitudinal first leg having a first distal electrode pivotably coupled to a longitudinal second leg having a second distal electrode. The first and second legs are transitionable from a first position where that the first and second electrodes are spaced apart from each other to a second position where the first and second electrodes are proximate each other. The first electrode includes a concave face and the second electrode includes a convex face such that the first and second faces oppose each other in the first and second positions and touch each other in the second position. The convex face fits within the concave face in the second position.
In another aspect, the disclosure related to a bipolar electrosurgical forceps. The bipolar forceps include a longitudinal first leg having a first distal tip, where the first distal tip includes a first electrode and a first irrigational tube. The bipolar forceps also include a longitudinal second leg having a second distal tip, where the second distal tip includes a second electrode and a second irrigational tube. The first leg is pivotably coupled to the second leg, and the first and second legs are yieldably urged apart in a first position where that the first and second tips are spaced apart from each other and transitionable under force to a second position where the first and second tips are proximate each other. The first electrode includes a concave face and the second electrode includes a convex face such that the first and second faces oppose each other in the first and second positions and touch each other in the second position. The convex face fits within the concave face in the second position.
The accompanying drawings are included to provide a further understanding of embodiments and are incorporated in and constitute a part of this specification. The drawings illustrate embodiments and together with the description serve to explain principles of embodiments. Other embodiments and many of the intended advantages of embodiments will be readily appreciated, as they become better understood by reference to the following detailed description. The elements of the drawings are not necessarily to scale relative to each other. Like reference numerals designate corresponding similar parts.
In the following Detailed Description, reference is made to the accompanying drawings, which form a part hereof, and in which is shown by way of illustration specific embodiments, or examples, in which the disclosure may be practiced. Other embodiments may be utilized and structural or logical changes may be made without departing from the scope of the present disclosure. The following Detailed Description, therefore, is not to be taken in a limiting sense, and the scope of the present disclosure is defined by the appended claims. It is to be understood that features of the described various exemplary embodiments may be combined with each other, unless specifically noted otherwise.
In one example, the electrosurgical unit 102 can be a generator such as the generator sold under the trade designation Aquamantys 3, available from Medtronic, Inc., of Minnesota, United States. The electrosurgical unit 102 in the example is configured to provide both electrical energy and fluid to the electrosurgical device 106 in one of two or more selectable and mutually exclusive modes. In a first mode, the unit 102 provides both fluid and a first selected amount of electrical energy to the device 106 that is suitable to irrigate and to coapt tissue such as blood vessels. In a second mode, the unit provides a second selected amount of electrical energy to the device that is suitable to cut the tissue, such as the coapted tissue. In one example, the mode settings of electrical energy and fluid flow are preselected prior to surgery. The modes are selected and controlled with switch 108. Examples of suitable generator and flow rate controllers are described in U.S. Pat. No. 7,815,634, and published U.S. Pat. Application Nos. 2001-0032002; 2006-0149225 and 2005-0090816, which are incorporated by reference into this disclosure.
Fluid source 104, in one example, includes a bag 124 of fluid 126 hung from pole 122. Fluid 126 flows from the bag 124 to a drip chamber 128. Flexible delivery tubing 130 carries the fluid to from the drip chamber 128 to the electrosurgical device 106. In one example, the fluid 126 includes saline and can include physiologic saline. Saline is an electrically conductive fluid, and other suitable electrically conductive fluids can be used. In other examples, the fluid 126 may include a nonconductive fluid, such as deionized water, which may still provide advantages over using no fluid.
A pump, such as pump 130, conveys fluid 126 to the electrosurgical device 106, and unit 102 can provide controls for the fluid flow. In one example, delivery tubing 132 is passed through pump 130 on unit 102. Pump 130 in one example is a peristaltic pump such as a rotary peristaltic pump or a linear peristaltic pump. Pump 130 can convey the fluid 126 through the delivery tubing 132 by way of intermittent forces placed on the external surface of the delivery tubing 132. Peristaltic pumps are often preferred because the mechanical elements of the pump places forces are placed on the external surface of the delivery tubing and do not come into direct contact with the fluid, which can reduce the likelihood of fluid contamination. Other examples of the electrosurgical instrument 100 might not include a pump, and fluid 126 is provided to the electrosurgical device 106 via gravity.
Switch 108 can be used to activate or control fluid flow to the electrosurgical device 106. In one example, the switch can include two activators 134, 136 or toggles. One activator can be depressed to select the first mode to coapt the tissue and a second activator can be depressed to select the second mode to cut the tissue. The switch 108 can be a foot switch, which may be preferable over a finger switch or other switch due to provide more stability and steadiness at the electrosurgical device 106, for example, when used in neurosurgery.
The electrosurgical device 106 is also in electrical communication with the electro surgical unit 102, for example, via cable 140 that can include electrically insulated wire conductors, a plug 142 at the electrosurgical unit 106, and another plug 144 to fit the electrosurgical unit 102. The electrosurgical unit 102 provides electrical energy via cable 140 to the electrosurgical device 106, such as radio-frequency (RF) energy. In one example, the delivery tubing 132 can be coupled to the cable 140 over a portion of its length in a way so that keep neat the connections between the electrosurgical unit 102 and the electrosurgical device 106.
The electrosurgical device 106 includes a proximal portion 150, distal portion 152, and a pivot 154. The device 106 is configured in the form similar to tweezers if the pivot 154 is disposed at the proximal portion 150, and device 106 is configured similar to form of scissors, or microscissors, if the pivot 154 is disposed between the proximal portion 150 and the distal portion 152. In either case, the device 106 is transitional between a first or open position where the distal portions are spaced apart from and a second or closed position where the distal portions are proximate to each other. Device 106 can be of any suitable length. The proximal portion 150 is configured to receive plug 142. The device 106 includes longitudinally extending legs 156 with tips 158, or blades, designed to engage tissue at the distal portion 152. The tips 158 include one or more electrodes in electrical communication with the electrosurgical unit 102 to provide energy to the tissue in each of the coapting and cutting modes. The tips 158 also include perforated tubing in fluid communication with the fluid source 104 to irrigate the tissue with fluid 126 in the coapting mode.
The electrosurgical device 106 can take a number of configurations. For instance, the device 106 can be reusable after it is cleaned and disinfected or sterilized before each use or it can be disposable after each use. Each type can include a bipolar variation with two operating electrodes or a monopolar variation with one operating electrode. Radio frequency energy is passed between the two closely spaced electrodes in bipolar instruments. In monopolar instruments, RF energy is conducted through the operating electrode to a remote conductive body-plate or grounding pad. Many neurosurgeons prefer bipolar instruments that causes the energy and current flow remains localized to the tissue adjacent to the working area between the electrodes rather than a monopolar instrument that causes energy and current to flow through brain or spinal tissue to the grounding pad. U.S. Pat. No. 8,414,572 and published U.S. Pat. No. 2012-0004657 describe examples of devices operable in the monopolar and bipolar modes and are incorporated by reference into this disclosure.
The hinge can be configured to allow the tips to move freely or to be held in a particular position. In one example, the hinge 206 is formed from fusing the legs 210, 212 together at the proximal portion 202. In another example, hinge 206 is integrally formed with the legs 210, 212. Using these or similar examples of hinges, spring tension from the hinge 206 holds the tips 214, 216 apart in an open position until a force is applied to bring the tips together in a closed position.
In the example of forceps 200, tips 214, 216 include electrodes 222, 224, respectively, in electrical communication with plug 208 and irrigation ducts 226, 228, respectively, within the tips 214, 216, in fluid communication with plug 208. Each of the irrigation ducts 226, 228, are terminated with holes 230 on or proximate to the electrodes 222, 224 to emit or weep fluid 126 from the irrigation ducts 226, 228 during coapting mode. The number of holes 230 can vary considerably, such as from one to ten and, preferably, from two to eight holes 230 on each tip 214, 216. The size of the holes 230 may vary. In some examples, one or both of the tips 214, 216 are associated with porous or microporous material to weep the fluid 126. In the example shown, both tips 214 and 216 include irrigation ducts, but examples are contemplated where irrigation ducts are provided in just one of the tips 214, 216.
The electrodes 222, 224 afford proper application of both coapting energy for coagulation and cutting energy. The electrodes 222, 224 each include opposing faces 232, 234, respectively, or edges that are designed to contact each other in the closed position or to tissue contact the tissue when a force is applied to the legs 210, 212. In the example shown in
While the thin opposing faces presents advantages, thin opposing faces, such as bayonet shaped tips, can also provide performance drawbacks not addressed with irrigation. For example, as the opposing faces come together in a closed position, they have a tendency to slip off each other if additional force is applied. The opposing faces can be pushed past the closed position and begin become further separated. This effect can be described as “scissoring” where the opposing faces deflect each other and extend past each other. Scissoring can have adverse effects on the tissue in that the field of the RF energy becomes larger than if the opposing faces were more proximate and approaching the closed position. As the field of the RF energy increases, more tissue is affected, and the cutting and coapting of tissue becomes imprecise. A surgeon can find it difficult to detect whether scissoring has occurred at the tips of the forceps, and the surgeon can also find it difficult to determine the precise amount of force to apply to the legs approach the closed position and to avoid scissoring.
The range of dimensions described with reference to
Although the electrodes 224, 226 are shown having opposing faces 232, 234 particularly design as mating concave and convex semicircles, other concave and convex configurations are possible.
The electrodes 224, 226 can be formed from a metal such as titanium, copper, tantalum, molybdenum, tungsten, or stainless steel. In some variations, the electrodes are formed from a metal foil. These materials are capable of withstanding the high temperatures used in the creation of plasma in the cutting mode. Additionally, these materials have sufficient rigidity when used as a blade. Further, these materials have a low thermal conductivity, which reduces the outflow heat from electrode to the tissue. In one example, the electrodes 224, 226 are machined so the opposing faces 232, 234 are approximately 500 micrometers wide.
One or more of the electrodes can also be covered with one or more insulators 302, 304, as illustrated in
The surgeon selects the coapting mode or the cutting mode with switch 108. The generator is preconfigured to deliver the first selected power or the second selected power to the electrosurgical device 106 depending on which mode is selected. If the coapting mode is selected, the first selected power is delivered to one of the electrodes 224, 226 and the pump 130 is turned on to provide fluid to the tips 214, 216 in the example. If the cutting mode is selected, the second selected power is delivered to one of the electrodes 224, 226 and the pump 130 is turned off so fluid 126 is not supplied to the tips 214, 216.
In one example, the tissue 604 can include small blood vessels in the brain or spine of a patient. Electrosurgical devices 106 like forceps 200 or microscissors engage the tissue 604 with small electrodes to minimize disruption to adjacent tissues and to improve visibility at the surgical site. The small electrodes also allow for precise coapting and cutting with the same device. The self-alignment provide by the concave/convex opposing faces 232, 234 improves precision in coapting and cutting as the surgeon can grasp the tissue 604 with sufficient force that would otherwise deflect or scissors other small electrodes.
In coapting mode, shown in
In cutting mode, shown in
Although the present disclosure has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the present disclosure.
This Non-Provisional patent application claims the benefit of U.S. Provisional Patent Application Ser. No. 61/729,979, filed Nov. 26, 2012, and titled “BIPOLAR FORCEPS WITH TIPS FOR RF CUTTING AND IRRIGATED COAGULATION,” which is herein incorporated by reference.
Number | Date | Country | |
---|---|---|---|
61729979 | Nov 2012 | US |