BACKGROUND
Various embodiments are directed to surgical instruments that may be used, for example, in open and minimally invasive surgical environments.
In various circumstances, a surgical instrument can be configured to apply energy to tissue in order to treat and/or destroy the tissue. In certain circumstances, a surgical instrument can comprise one or more electrodes which can be positioned against and/or positioned relative to the tissue such that electrical current can flow from one electrode, through the tissue, and to the other electrode. The surgical instrument can comprise an electrical input, a supply conductor electrically coupled with the electrodes, and/or a return conductor which can be configured to allow current to flow from the electrical input, through the supply conductor, through the electrodes and the tissue, and then through the return conductor to an electrical output, for example. Alternatively, the surgical instrument can comprise an electrical input, a supply conductor electrically coupled with the electrodes, and/or a return conductor which can be configured to allow current to flow from the electrical input, through the supply conductor, through the active electrode and the tissue, and to the return electrode through the return conductor to an electrical output. In various circumstances, heat can be generated by the current flowing through the tissue, wherein the heat can cause one or more hemostatic seals to form within the tissue and/or between tissues. Such embodiments may be particularly useful for sealing blood vessels, for example. The surgical instrument can also comprise a cutting member that can be moved relative to the tissue and the electrodes in order to transect the tissue.
By way of example, energy applied by a surgical instrument may be in the form of radio frequency (“RF”) energy. RF energy is a form of electrical energy that may be in the frequency range of 300 kilohertz (kHz) to 1 megahertz (MHz). In application, RF surgical instruments transmit low frequency radio waves through electrodes, which cause ionic agitation, or friction, in effect resistive heating, increasing the temperature of the tissue. Since a sharp boundary is created between the affected tissue and that surrounding it, surgeons can operate with a high level of precision and control, without much sacrifice to the adjacent normal tissue. The low operating temperatures of RF energy enables surgeons to remove, shrink or sculpt soft tissue while simultaneously sealing blood vessels. RF energy works particularly well on connective tissue, which is primarily comprised of collagen and shrinks when contacted by heat.
Further, in various open and laparoscopic surgeries, it is necessary to coagulate, seal or fuse tissues. One preferred means of tissue-sealing relies upon the application of electrical energy to captured tissue to cause thermal effects therein for sealing purposes. Various mono-polar and bi-polar RF jaw structures have been developed for such purposes. In general, the delivery of RF energy to a captured tissue volume elevates the tissue temperature and thereby at least partially denatures proteins in the tissue. Such proteins, including collagen, are denatured into a pertinacious amalgam that intermixes and fuses together as the proteins denature or form new cross links. As the treated region heals over time, this biological “weld” is reabsorbed by the body's wound healing process.
In a typical arrangement of a bi-polar radiofrequency (RF) jaw, the face of each jaw comprises an electrode. RF current flows across the captured tissue between electrodes in opposing jaws. Most commercially available bi-polar jaws provide a low tissue strength weld immediately post-treatment.
During some procedures, it is often necessary to access target tissue that requires severe manipulation of the end effector. In such applications, it would be desirable to have a curved and/or articulatable end effector arrangement to improve access and visualization of the surgical area by the surgeon.
The foregoing discussion is intended only to illustrate various aspects of the related art in the field of the invention at the time, and should not be taken as a disavowal of claim scope.
SUMMARY
In accordance with various non-limiting embodiments, there is provided an electrosurgical instrument that includes an elongate shaft that has a distal end and defines a first longitudinal axis. An end effector may be operably coupled to the distal end of the elongate shaft. The end effector may comprise a first jaw that has a first elongate portion and a first curved distal end. The end effector may further include a second jaw that has a second elongate portion and a second curved distal end. The first elongate portion of the first jaw may be movably coupled to the second elongate portion of the second jaw. The first and second elongate portions may define a second axis that is offset from the first longitudinal axis.
In accordance with various other non-limiting embodiments of the present invention, there is provided a surgical instrument that may include an elongate shaft that defines a longitudinal axis. The surgical instrument may further include an end effector that is operably supported at a distal end of the elongate shaft. The end effector may comprise a first jaw that has a first proximal portion that is coaxially aligned with the elongate shaft. The end effector may include a second jaw that has a second proximal portion that is coaxially aligned with the elongate shaft. The first and second jaws may be selectively movable between open and closed positions. The instrument may further include an actuation system that interfaces with the first and second jaws for selectively moving at least one other portion of the first jaw and at least one other portion of the second jaw out of axial alignment with the elongate shaft.
In accordance with still other various non-limiting embodiments of the present invention, there is provided an electrosurgical instrument that may include a first jaw that has a first tapered distal end portion. The instrument may further include a second jaw that has a second tapered distal end portion wherein the first and second jaws are selectively movable between open and closed positions and wherein the first tapered end and the second tapered end converge to form a substantially conical end effector tip when the first and second jaws are in a closed position. The instrument may further include an axially translatable reciprocal member that is supported for axial reciprocal travel within the first and second jaws. The axially translatable reciprocal member may comprise a first flange that is configured for axial movable engagement with said first jaw. The first flange may have a first distal-most edge. The instrument may further include a second flange that is coupled to the first flange by a central web portion. The second flange may be configured for axial movable engagement with the second jaw. The second flange may further have a second distal-most edge that protrudes distally beyond said first distal-most edge of the first flange. A cutting edge may be formed on a distal end of the central web that extends from the second distal-most edge to the first distal-most edge.
In accordance with other various non-limiting embodiments of the present invention, there is provided a surgical instrument that comprises a handle and an elongate shaft that is coupled thereto such that a least a portion of the elongate shaft is selectively movable in more than two directions. An end effector may be coupled to the elongate shaft.
In accordance with other non-limiting embodiments of the present invention, there is provided an electrosurgical instrument that may comprise an elongate shaft and a flexible electrode assembly that is movably coupled to a distal end of the elongate shaft.
BRIEF DESCRIPTION OF THE DRAWINGS
Various features of the embodiments described herein are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation, together with advantages thereof, may be understood in accordance with the following description taken in conjunction with the accompanying drawings as follows.
FIG. 1 is a perspective view of an electrosurgical instrument according to one non-limiting embodiment of the present invention;
FIG. 2 is a side view of the handle depicted in FIG. 1 with a portion of the housing thereof omitted to illustrate various handle components;
FIG. 3 is a top view of an end effector according to one non-limiting embodiment of the present invention;
FIG. 4 is a partial perspective view of the end effector embodiment depicted in FIG. 3 in an open position;
FIG. 5 is a partial perspective view of a portion of a translatable member according to one non-limiting embodiment of the present invention with an alternative flexed position shown in phantom;
FIG. 6 is a perspective view of a portion of a translatable member according to another non-limiting embodiment of the present invention;
FIG. 7 is a partial cross-sectional perspective view of a translatable member according to another non-limiting embodiment of the present invention;
FIG. 8 is a perspective view of an electrosurgical instrument according to another non-limiting embodiment of the present invention;
FIG. 9 is a partial perspective view of an end effector of another non-limiting embodiment of the present invention in an open position;
FIG. 10 is another partial perspective view of the end effector of FIG. 9 in a closed position;
FIG. 11 is a cross-sectional view of the end effector of FIG. 10 taken along line 11-11 in FIG. 10;
FIG. 12 is a top diagrammatical view of the end effector of FIGS. 9 and 10 with alternative flexed positions being shown in phantom;
FIG. 13 is a perspective view of an electrosurgical instrument according to another non-limiting embodiment of the present invention;
FIG. 14 is a side view of the handle depicted in FIG. 13 with a portion of the housing thereof omitted to illustrate various handle components;
FIG. 15 is a side elevational view of an end effector according to another non-limiting embodiment of the present invention with the jaw members thereof in a closed position;
FIG. 16 is a partial perspective view of the end effector of FIG. 15 in an open position;
FIG. 17 is a top diagrammatical view of the end effector of FIGS. 15 and 16 with alternative flexed positions being shown in phantom;
FIG. 18 is a perspective view of a portion of another end effector according to another non-limiting embodiment of the present invention;
FIG. 19 is a perspective view of a portion of another end effector according to another non-limiting embodiment of the present invention;
FIG. 20 is a perspective view of a portion of another end effector according to another non-limiting embodiment of the present invention;
FIG. 21 is a side view of the end effector embodiment of FIG. 20 being used to dissect tissue;
FIG. 22 is a perspective view of an electrosurgical instrument according to another non-limiting embodiment of the present invention;
FIG. 23 is a cross-sectional view of the end effector depicted in FIG. 22 in a closed position;
FIG. 24 is a top cross-sectional view of the lower jaw of the end effector of FIG. 23 in a partially articulated position;
FIG. 25 is another top cross-sectional view of the lower jaw of FIG. 24 in a straight position;
FIG. 26 is a partial perspective view of an end effector according to another non-limiting embodiment of the present invention with a portion of a translatable member thereof shown in phantom;
FIG. 27 is a side elevational view of a portion of the translatable member depicted in FIG. 26 with the end effector jaw portions shown in phantom;
FIG. 28 is a perspective view of an electrosurgical instrument according to another non-limiting embodiment of the present invention;
FIG. 29 is a partial perspective view of a portion of an articulatable elongate shaft according to a non-limiting embodiment of the present invention;
FIG. 30 is a perspective view of a spine segment according to an embodiment of the present invention;
FIG. 31 is a cross-sectional view of the spine segment of FIG. 30;
FIG. 32 is a partial side elevational view of the articulatable elongate shaft depicted in FIGS. 29-31 attached to an end effector;
FIG. 33 is a side elevational view of an electrosurgical instrument according to another non-limiting embodiment of the present invention;
FIG. 34 is a side elevational view of the end effector depicted in FIG. 33, with alternative positions illustrated in phantom;
FIG. 35 is another side elevational view of the end effector of FIG. 34 engaging tissue;
FIG. 36 is a perspective view of an end effector according to another embodiment of the present invention; and
FIG. 37 is a cross-sectional view of a portion of the end effector of FIG. 36 taken along line 37-37 in FIG. 36.
Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.
DETAILED DESCRIPTION
Various embodiments are directed to apparatuses, systems, and methods for the treatment of tissue. Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. It will be understood by those skilled in the art, however, that the embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and illustrative. Variations and changes thereto may be made without departing from the scope of the claims.
Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation.
It will be appreciated that the terms “proximal” and “distal” may be used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” refers to the portion of the instrument closest to the clinician and the term “distal” refers to the portion located furthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute.
Various embodiments of systems and methods of the invention relate to creating thermal “welds” or “fusion” within native tissue volumes. The alternative terms of tissue “welding” and tissue “fusion” may be used interchangeably herein to describe thermal treatments of a targeted tissue volume that result in a substantially uniform fused-together tissue mass, for example, in welding blood vessels that exhibit substantial burst strength immediately post-treatment. The strength of such welds is particularly useful for (I) permanently sealing blood vessels in vessel transaction procedures; (ii) welding organ margins in resection procedures; (iii) welding other anatomic ducts wherein permanent closure is required; and also (iv) for performing vessel anastomosis, vessel closure or other procedures that join together anatomic structures or portions thereof. The welding or fusion of tissue as disclosed herein is to be distinguished from “coagulation”, “hemostasis” and other similar descriptive terms that generally relate to the occlusion of blood flow within small blood vessels or vascular zed tissue. For example, any surface application of thermal energy can cause coagulation or hemostasis—but does not fall into the category of “welding” as the term is used herein. Such surface coagulation does not create a weld that provides any substantial strength in the treated tissue.
At the molecular level, the phenomena of truly “welding” tissue as disclosed herein may result from the thermally-induced penetration of collagen and other protein molecules in a targeted tissue volume to create a transient liquid or gel-like pertinacious amalgam. A selected energy density is provided in the targeted tissue to cause hydrothermal breakdown of intra- and intermolecular hydrogen crosslink's in collagen and other proteins. The denatured amalgam is maintained at a selected level of hydration—without desiccation—for a selected time interval which can be very brief. The targeted tissue volume is maintained under a selected very high level of mechanical compression to ensure that the unwound strands of the denatured proteins are in close proximity to allow their intertwining and entanglement. Upon thermal relaxation, the intermixed amalgam results in protein entanglement as re-cross linking or repatriation occurs to thereby cause a uniform fused-together mass.
Various embodiments disclosed herein provide electrosurgical jaw structures adapted for transecting captured tissue between the jaws and for contemporaneously welding the captured tissue margins with controlled application of RF energy. The jaw structures of certain embodiments can comprise first and second opposing jaws that carry positive temperature coefficient (PTC) or resistance bodies for modulating RF energy delivery to the engaged tissue.
FIG. 1 shows an electrosurgical instrument 100 according to a non-limiting embodiment of the invention. Electrosurgical instrument 100 comprises a proximal handle 105, a distal end effector 200, and an introducer or elongate shaft member 106 disposed in-between. In various embodiments, end effector 200 comprises a set of operable-closeable jaws 220A and 220B. The end effector 200 may be adapted for capturing, welding, and transecting tissue, for example. First jaw 220A and second jaw 220B may close to thereby capture or engage tissue therebetween. First jaw 220A and second jaw 220B may also apply compression to the tissue. In alternative embodiments, the end effector may be comprised of one or two movable jaws.
Moving now to FIG. 2, a side view of the handle 105 is shown with half of a first handle body 106A (see FIG. 1) being removed to illustrate some of the components within second handle body 106B. Handle 105 may comprise a lever arm 128 which may be pulled along a path 129. Lever arm 128 may be coupled to a translatable member 140 that is disposed within the elongate shaft 106 by a shuttle 146 that is operably engaged to an extension 127 of lever arm 128. The shuttle 146 may further be connected to a biasing device, such as spring 141. The spring 141 may also be connected to the second handle body 106B, to bias the shuttle 146 and thus the translatable member 140 in a proximal direction, thereby urging the jaws 220A and 220B to an open position as seen in FIG. 1. Also, referring to FIGS. 1 and 2, a locking member 131 (see FIG. 2) may be moved by a locking switch 130 (see FIG. 1) between a locked position, where the shuttle 146 is substantially prevented from moving distally as illustrated, and an unlocked position, where the shuttle 146 may be allowed to freely move in the distal direction, toward the elongate shaft 106. The handle 105 can be any type of pistol-grip or other type of handle known in the art that is configured to carry actuator levers, triggers or sliders for actuating the first jaw 220A and second jaw 220B. Elongate shaft 106 may have a cylindrical or rectangular cross-section and can comprise a thin-wall tubular sleeve that extends from handle 105. Elongate shaft 106 may have a bore extending therethrough for carrying actuator mechanisms such as, for example, translatable member 140, for actuating the jaws 220A, 220B and for carrying electrical leads for delivery of electrical energy to electrosurgical components of end effector 200.
The elongate shaft member 106 along with first jaw 220A and second jaw 220B may, in some embodiments, be continuously rotatable in either a clockwise or counterclockwise direction, as shown by arrow 117 (FIG. 1), relative to handle 105 through, for example, a rotary triple contact. First jaw 220A and second jaw 220B can remain operable-closeable and openable while being rotated. First jaw 220A and second jaw 220B may be coupled to the electrical source 145 and controller 150 through electrical leads in cable 152 to function as paired bi-polar electrodes with a positive polarity (+) and a negative polarity (−) or alternatively monopolar electrodes with positive (+) polarity and a remote grounding pad with a negative (−) polarity.
The first jaw 220A may have a first elongate portion 221A that is pivotally coupled to a second elongate portion 221B of the second jaw 220B by, for example, pins, grunions, or other known attachment arrangement such that the first jaw 220A may be pivoted toward and away from the second jaw 220B as represented by arrow 251 in FIG. 4. Further, the first jaw 220A and second jaw 220B may each have tissue-gripping elements, such as teeth 243, disposed on the inner portions of first jaw 220A and second jaw 220B. First jaw 220A may comprise a first jaw body 231A with a first outward-facing surface 232A and a first energy delivery surface 235A. Second jaw 220B may comprise a second jaw body 231B with a second outward-facing surface 232B and a second energy delivery surface 235B. First energy delivery surface 235A and second energy delivery surface 235B may, for example, both extend in a “U” shape about the distal end of working end 200.
As can be seen in FIGS. 1 and 3, the elongate shaft 106 defines a first longitudinal axis A-A. In various non-limiting embodiments, the first and second elongate portions 221A, 221B of the first and second jaws 220A, 220B, respectively are aligned along a second axis B-B that is offset from the first axis A-A. As can be further seen in FIG. 4, the first jaw body 231A may have a curved distal portion 222A and the second jaw body 231B may have a curved distal portion 222B. FIG. 3 is a top view of the end effector 200 and illustrates an embodiment wherein the first jaw 220A and the second jaw 220B have substantially matching shapes. As used herein, the terms “substantially” and “substantially the same” refer to characteristics or components that are otherwise identical, but for the normal manufacturing tolerances commonly experienced when manufacturing such components. As can be further seen in FIG. 3, the distal tip portion 224A of the jaw body 231A as well as the distal tip portion 224B of the second jaw body 231B are preferably located within the diameter “D” or “footprint FP” (for elongate shafts 106 that do not have a circular cross-sectional shape) of the elongate shaft 106 such that the end effector 200 may be inserted through an opening that can accommodate the elongate shaft 106. The offset nature of the end effector 200 enables the jaws 220A, 220B to be provided with a curved or irregular portion that is curved relatively sharper than other jaw embodiments wherein the jaws are axially aligned with the elongate shaft 106. It will be understood that the jaws 220A, 220B may have various curved portions, provided that no portion of the jaws 220A, 220B protrude laterally outward beyond the diameter “D” or footprint FP of the elongate shaft 106 for a distance that might otherwise prevent the insertion through a lumen such as, for example, a trocar or the like unless it is deflectable thereby allowing insertion through such a lumen.
FIGS. 3-5 show a portion of translatable, reciprocating member or reciprocating “I-beam” member 240. The lever arm 128 of handle 105 may be adapted to actuate translatable member 240 which also functions as a jaw-closing mechanism. For example, translatable member 240 may be urged distally as lever arm 128 is pulled proximally along path 129. The distal end of translatable member 240 comprises a flanged “I”-beam that is configured to slide within slots 242 in jaws 220A and 220B. See FIG. 4. Translatable member 240 slides within slots 242 to open and close first jaw 220A and second jaw 220B. As can be most particularly seen in FIG. 5, the distal end of translatable member 240 comprises an upper flange 244 and a lower flange 246 that are separated by a web portion 248 that has a sharpened distal end 250 for cutting tissue. In various embodiments, the translatable member 240 may be fabricated from, for example, stainless steel or similar elastic materials or alternatively from the class of superelastic materials such as Nitinol or the like. In various embodiments, the upper flange 244 and the lower flange 246 of translatable member 240 may each be optionally provided with cutout portions 252. The cutouts 252 may be substantially V-shaped with their narrowest portion adjacent the web 248 and their widest portion opening at the lateral edge of the flange as shown in FIG. 5. The cutouts 252 in the upper flange 244 may be substantially aligned with like cutouts 252 in the lower flange 246. To facilitate relatively tight bending of the translatable member 240 (as illustrated in phantom lines in FIG. 5), the cutouts 252 may be oriented relatively close together. Such translatable member arrangements enable the translatable member to flex around the curved slots 242 in the first and second jaws 220A, 220B. Thus, as the translatable member 240 is advanced distally by actuating the lever 128, the upper and lower flanged portions 244, 246 engage the first jaw 220A and the second jaw 220B to cam the jaws 220A, 220B together to clamp and cut tissue therebetween.
FIG. 6 illustrates another translatable member 240′ that is similar to translatable member 240 described above, except that a tissue-cutting wire 260 is provided between the upper and lower flanges for tissue cutting purposes. The wire 260 may be fabricated from, for example, stainless steel or the like and be mounted in tension between the upper flange 244 and the lower flange 246. The wire 260 may also be used in connection with a translatable member 240 that does not have the cutouts 252 in its flanges 244, 246. In an alternative embodiment, the wire 260 may be connected to the RF power source either directly or indirectly to cut electrically.
In various embodiments, the translatable member 240 may be provided with the cut outs 252 as described above and be fabricated from, for example, a relatively flexible or super elastic material or alloy such as Nitinol, NiTi or other alloys with similar properties. In other embodiments, the translatable member may be fabricated out of Nitinol, NiTi or similar material and have the shape of an I-beam without the cut outs 252 in the flanges. See FIG. 7.
FIGS. 8-11 illustrate another electrosurgical instrument 300 that employs another non-limiting end effector embodiment 400 of the present invention. The electrosurgical instrument 300 may be identical in construction and operation as electrical surgical instrument 100 except for the differences noted below. Turning to FIGS. 9 and 10, it can be seen that the end effector 400 includes a first jaw 420A and a second jaw 420B. The first jaw 420A may be pivotally coupled to the second jaw 420B to enable the first jaw 420A to pivot between an open position (FIG. 9) and a closed position (FIG. 10). First jaw 420A may comprise an upper first jaw body 431A that is formed from a series of vertically laminated layers 432A of material. In various embodiments, the laminated layers 432A may be fabricated from materials that comprise a thermal and/or electrical insulator, for example, zirconium, partially stabilized zirconium, aluminum oxide, silicon nitride, alumina-chromic, hydroxyapatite, other non-conductive glass materials, or other non-conductive ceramic materials. Other non-conductive glass-ceramic materials may also be employed. The layers 432A may be vertically laminated together by an electrometric material 434A such as, for example, polyisoprene, silicone, etc. See FIG. 11. The laminated layers 432A may serve to define a slot 442A for accommodating a translatable member 240 or 240′ in the manner described above. The first jaw body 431A has an upper first outward-facing surface 433A and an upper first energy delivery surface 435A. As used herein, the term “vertically laminated” means that the layers of material extend perpendicular to a plane along with the energy delivery surface lies. Second jaw 420B may comprise a lower second jaw body 431B that is formed from another series of vertically laminated layers 432B that may be fabricated and laminated from the various materials described above. The second jaw body 431B may have a lower second outward-facing surface 433B and a lower second energy delivery surface 435B. First energy delivery surface 435A and second energy delivery surface 435B may both extend in a “U” shape about the distal end of the end effector 200.
As seen in FIG. 11, electrosurgical energy may be delivered through current paths 477 between first energy delivery surface 435A and second energy delivery surface 435B. Translatable member 240 may comprise an insulating layer to prevent member 240 from functioning as a conductive path for current delivery. Opposing first and second energy delivery surfaces 435A and 435B may carry variable resistive positive temperature coefficient (PTC) bodies or matrices that are coupled to electrical source 145 and controller 150 in series and parallel circuit components. First energy delivery surface 435A and the corresponding PTC body can have a negative polarity (−) while second energy delivery surface 435B and the corresponding PTC body can have a positive polarity (+). PTC materials will “trip” and become highly resistive or non-conductive once a selected trip temperature is exceeded. First energy delivery surface 435A and second energy delivery surface 435B can carry any of the PTC matrix and electrode components disclosed in U.S. Pat. No. 6,929,644 entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY and U.S. Pat. No. 6,770,072 entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY, the respective disclosures of which are each fully incorporated herein by reference. The use of PTC materials in electrosurgical instruments is also described in U.S. Pat. No. 7,112,201 entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY, U.S. Pat. No. 6,929,622 entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY, and U.S. Patent Application Publication No. 2010/0036370 entitled ELECTROSURGICAL INSTRUMENT JAW STRUCTURE WITH CUTTING TIP, the respective disclosures of which are each fully incorporated herein by reference. In various embodiments, however, the first energy delivery surface 435A and the second energy delivery surface 435B are each fabricated from layers that are laminated together by, for example, adhesive or mechanical means.
FIG. 12 is a top diagrammatical view of the end effector 400 and an actuating system 491 that may be employed to flex the end effector 400 between the three positions illustrated therein. As can be seen in that Figure, the actuating system 491 may comprise at least one “first” cable 492 attached to each of said first and second jaws 420A, 420B. That is at least one first cable 492 is attached to the first jaw 420A and at least one other first cable 492 is attached to the second jaw 420B. Likewise, at least one “second” cable 496 is attached to each of the first jaw 420A and the second jaw 420B. That is, at least one second cable 496 is attached to the first jaw 420A and at least one other second cable 496 is attached to the second jaw 420B. Such actuation system 491 enables the clinician to “pull” portions of the first jaw 420A and portions of the second jaw 420B out of axial alignment with the elongate shaft 106. That is, for example, the first cables 492 may be used to pull portions of the first and second jaws 420A, 420B to the left of axis 125 and the second cables 496 may be used to pull portions of the first and second jaws 420A, 420B to the right of the axis 125. The first cables 492 may extend through the hollow elongated shaft 106 to be coupled to a first actuation member 494 that is operably supported by the handle 105. See FIG. 12. Similarly, the second cables 496 may extend through the hollow elongated shaft 106 to be coupled to a left actuation member 498 that is operably supported by the handle 105. For example, each actuation member 494, 498 may comprise a lever arm, button, etc. that is movably supported on the handle 105 and coupled to the corresponding cables 492, 496 such that movement of the actuation member 494 in one direction applies tension to the cables 492 to cause the end effector to flex to one side of axis 125. Movement of the actuation members 494, 498 in other directions permits the cables 492, 496 to assume positions wherein the end effector 400 can assume a relatively coaxial orientation with the elongated shaft member 106 to permit insertion of the end effector 400 through a lumen that will accept the hollow elongated shaft member 106. Similarly, movement of the actuation member 498 in one direction applies tension to the cables 496 to flex the end effector 400 to another side of axis 125. The actuation members 494, 498 may be selectively lockable in the various positions using known locking arrangements. In still other embodiments, one or more motors may be employed to apply tension to and relieve tension from the cables to effectuate a desired flexing or bending of the end effector 400. It will be understood that the end effector 400 may otherwise operate in the various manners disclosed herein and that the unique and novel design of the translatable member 240 or 240′ may flex or bend to travel through the respective slots 442A, 442B.
FIGS. 13-17 illustrate an electrosurgical instrument 500 according to another non-limiting embodiment of the present invention. This embodiment may employ a handle 105′ that is somewhat similar to handle 105 described above. However, the electrosurgical instrument 500 does not employ a translatable member that is designed to cut tissue and close the jaws 520A and 520B of the end effector 510. In this embodiment, the second jaw 520B is coupled to a spine member 530 that extends through the hollow elongate tube 106 and is attached to the handle 105′. The proximal end of the hollow elongate tube 106 interfaces with a shuttle member 146 that is movably supported in handle 105′ and interfaces with the lever 128 such that pivotal movement of the lever arm 128 along path 129 will cause the shuttle 146 and elongate tube 106 to move axially relative to the handle 105′ and the spine member 530 as represented by arrow 523. See FIGS. 14 and 15. Such closure arrangements are generally known in the art relating to other forms of surgical instruments, such as, for example, endocutters and the like. See, for example, U.S. Pat. No. 7,588,176 entitled SURGICAL CUTTING INSTRUMENT WITH IMPROVED CLOSURE SYSTEM and U.S. Pat. No. 7,665,647 entitled SURGICAL CUTTING AND STAPLING DEVICE WITH CLOSURE APPARATUS FOR LIMITING MAXIMUM TISSUE COMPRESSION FORCE, the disclosures of which are herein incorporated by reference in their respective entireties.
Referring now to FIG. 15, the first jaw 520A is pivotally coupled to the second jaw 520B for selective pivotal travel relative to the second jaw 520B (represented by arrow 521) upon the axial movement of the elongate tube 106 represented by arrow 523. First jaw 520A may comprise an upper first jaw body 531A that is formed from a series of vertically laminated layers 532A. See FIG. 16. In various embodiments, the laminated layers 532A may be fabricated from materials that comprise a thermal and/or electrical insulator, for example, zirconium, partially stabilized zirconium, aluminum oxide, silicon nitride, alumina-chromic, hydroxyapatite, other non-conductive glass materials, or other non-conductive ceramic materials. Other non-conductive glass-ceramic materials may be employed. The layers 532A may be laminated together by an elastomeric material such as, for example, polyisoprene, silicone, etc. The first jaw body 531A has an upper first outward-facing surface 533A and an upper first energy delivery surface 535A. Second jaw 520B may comprise a lower second jaw body 531B that is formed from another series of laminated layers 532B that may be fabricated and laminated from the various materials described above. The second jaw body 531B may have a lower second outward-facing surface 533B and a lower second energy delivery surface 535B. First energy delivery surface 535A and second energy delivery surface 535B may both extend in a “U” shape about the distal end of the end effector 510 and comprise vertical laminated layers of material. As discussed above, electrosurgical energy may be delivered through current paths between first energy delivery surface 535A and second energy delivery surface 535B. The first energy delivery surface 535A and the second energy delivery surface 535B may be configured to contact tissue and deliver electrosurgical energy to engaged tissue which is adapted to seal or weld the tissue. Opposing first and second energy delivery surfaces 535A and 535B may carry a variable resistive positive temperature coefficient (PTC) layer 540 that is coupled to electrical source 145 and controller 150 in series and parallel circuit components. First energy delivery surface 535A and the corresponding PTC layer 540 can have a negative polarity (−) while second energy delivery surface 535B and the corresponding PTC body 540 can have a positive polarity (+). PTC materials will “trip” and become substantially more resistive or non-conductive once a selected trip temperature is exceeded. First energy delivery surface 535A and second energy delivery surface 435B can carry any of the PTC matrix and electrode components in a laminated arrangement. Controller 150 can regulate the electrical energy delivered by electrical source 145 which in turn delivers electrosurgical energy to first energy delivery surface 535A and second energy delivery surface 535B. The energy delivery may be initiated by activation button 124 operably engaged with lever arm 128 and in electrical communication with controller 150 via cable 152. As mentioned above, the electrosurgical energy delivered by electrical source 145 may comprise radio frequency “RF” energy.
To facilitate flexible travel of the end effector 510 in the manners, for example, depicted in FIG. 17, an actuating arrangement 600 of the type described above may be employed. In particular, the actuating arrangement may comprise left cables 602 and right cables 606 that are attached to the first jaw 520A and the second jaw 520B to essentially enable the clinician to “pull” the first jaw 520A and second jaw 520B to the left and right of the axis 125. The right cables 606 may extend through the hollow spine member 530 to be coupled to a right actuation member 608 that is operably supported by the handle 105′. See FIGS. 13 and 17. Similarly, the left cables 602 may extend through the hollow spine member 530 to be coupled to a left actuation member 604 that is operably supported by the handle 105′. For example, each actuation member 604, 608 may comprise a lever arm, button, etc. that is movably supported on the handle 105′ and coupled to the corresponding cables 602, 606 such that movement of the actuation member 604, 608 in one direction applies tension to the cables 602, 606 and movement of the actuation member 604, 608 in another direction permits the cables 602, 606 to assume positions wherein the end effector 510 can assume a relatively coaxial orientation with the elongated member 106 to permit insertion of the end effector 510 through a lumen that will accept the hollow elongated member 106. The actuation members 604, 608 may be selectively lockable in the various positions using known locking arrangements. In still other embodiments, one or more motors may be employed to apply tension to and relieve tension from the cables to effectuate a desired flexing of the end effector 510.
FIG. 18 illustrates an end effector 700 according to another non-limiting embodiment of the present invention. End effector 700 may comprise a flexible end effector of the type described above or it could be essentially rigid. The end effector 700 has a first jaw 720A that is movably supported relative to a second jaw 720B. In various non-limiting embodiments, for example, the first jaw 720A may be pivotally coupled to or is otherwise pivotable relative to a second jaw 720B by means of the axial displacement of the elongate tube 106 in the various manners described above. As with various other embodiments described above, the first jaw 720A has a first jaw body 731A that has a width “W”, an upper first outward-facing surface 733A, an upper first energy delivery surface 735A and a distal end 737A. Second jaw 720B may comprise a lower second jaw body 731B that also has a width “W” which may or may not be identical to width “W” of the first jaw body 731A and thus enable the end effector 700 to be conveniently inserted through a trocar or other lumen. The second jaw body 731B may have a second outward-facing surface 733B, a second energy delivery surface 735B and a second distal end 737B. First energy delivery surface 735A and second energy delivery surface 735B may both extend in a “U” shape about the distal end of the end effector 700. The energy delivery surfaces 735A, 735B may otherwise operate in the various manners described above. In this embodiment, to assist the surgeon with dissecting the target tissue to be cauterized, a distally extending blunt tip 760 may be provided on one or both of the first and second jaws 735A, 735B. The blunt tip 760 may be relatively smooth or in other embodiments, the blunt tip 760 may be coated with or otherwise provided with fibrous structures 761 to allow better non-powered dissection. As can be seen in FIG. 18, the blunt tip 760 may have a diameter or width “D” that is less than the widths “W”, “W” to enable the tip 760 to be more easily inserted into areas in which the jaws 720A, 720B could not otherwise enter. In still other embodiments, an electrode (not shown) may be provided in the tip 760 such that it is configured to work as a monopolar dissector or alternatively a bipolar dissector.
In other non-limiting embodiments, the end effector 700′ may have a blunt tip portion 760′ that is pivotally coupled to an extension 764 that protrudes from one or both of the first and second jaws 720A, 720B. See FIG. 19. The blunt tip portion 760′ may be pivotally coupled to the extension 764 by a hinge 766 that will frictionally retain the blunt tip portion 760′ in a desired articulated position. For example, the surgeon may bring the blunt tip portion 760′ into contact with tissue or other structure to pivot the blunt tip portion 760′ to a desired position about a vertical axis VA-VA that is substantially transverse to a longitudinal axis LA-LA. The blunt tip portion 760′ may be retained in that position by friction between the components of the hinge 766. While FIG. 19 illustrates that the blunt tip portion is attached to the extension 764 for pivotal travel about a vertical axis, the blunt tip portion 760′ may be attached to the extension 764 for selective pivotal travel about a horizontal axis (not shown). In still other non-limiting embodiments, the blunt tip portion 760′ may be movably coupled to the extension by a “universal” hinge arrangement that facilitates pivotal positioning of the blunt tip portion 760′ about a horizontal axis and a vertical axis and thereafter retained in such desired position by friction. In still other non-limiting embodiments, the blunt tip portion 760 may be attached to extension 764 by a plurality of hinges and intermediate tip portions to further enable the blunt tip portion to be positioned in a desired orientation for dissection purposes. Alternatively, the blunt tip portion may be formed on the jaw members(s) and be constructed of a malleable material that allows the user to pre-sect the shape prior to insertion into the patient or after insertion with the use of another instrument.
FIGS. 20 and 21 illustrate an end effector 800 of another non-limiting embodiment of the present invention that may be identical to the end effector 700 except for the differences noted below. End effector 800 may comprise a flexible end effector of the type described above or it could be essentially rigid (not capable of flexing out of axial alignment with the elongate tube 106). The end effector 800 has a first jaw 820A that is pivotally coupled to or is otherwise pivotable relative to a second jaw 820B by means of the axial displacement of the elongate tube 106 in the various manners described above. As with various other non-limiting embodiments described above, the first jaw 820A has a first jaw body 831A that has a first outward-facing surface 833A and a first energy delivery surface 835A. Second jaw 820B may comprise a lower second jaw body 831B that has a second outward-facing surface 833B and a second energy delivery surface 835B. First energy delivery surface 835A and second energy delivery surface 835B may both extend in a “U” shape about the distal end of the end effector 800. The energy delivery surfaces 835A, 835B may otherwise operate in the various manners described above. In this embodiment, to assist the surgeon with dissecting or otherwise separating the target tissue to be cauterized, a distally extending first tip 860A may be provided on the first jaw 820A and a distally extending second tip 860B may be provided on the second jaw 820B. The first tip 860A may have a tapered outwardly facing surface 861A and a relatively planar inwardly facing surface 862A. Tissue gripping grooves 865A or bumps or other structures may be provided on the outer facing surface 861A and or inwardly facing surface 862A. Similarly, the second tip 860B may have a tapered outwardly facing surface 861B and a relatively planar inwardly facing surface 862B. Tissue gripping grooves 865B or bumps or other structures may be provided on the outer facing surface 861B and/or the inwardly facing surface 862B.
In various non-limiting embodiments, the first and second tips 860A, 860B are not powered. In other non-limiting embodiments, however, the tip 860A comprises a portion of the first energy delivery surface 835A or otherwise has an electrode portion therein. Likewise, the second tip 860B comprises a portion of the second energy delivery surface 835B or otherwise has an electrode portion therein. When powered, the energy may arc from tip to tip in a bipolar configuration or tip to tissue in a monopolar configuration. FIG. 21 illustrates one potential use of the end effector 800 to separate or dissect tissue “T”.
FIGS. 22-25 illustrate an electrosurgical instrument 900 according to another non-limiting embodiment of the present invention. This non-limiting embodiment may employ a handle 105′ that is somewhat similar to handle 105 described above. However, the electrosurgical instrument 900 does not employ a translatable member that is designed to cut tissue and close the jaws 920A and 920B of an end effector 910. In this embodiment, the second jaw 920B is coupled to a spine member 930 (FIG. 23) that extends through the hollow elongate tube 106 and is attached to the handle 105′ in the manner described above. Axial travel of the elongate tube 106 causes the first jaw 920A to pivot relative to the second jaw 920B. Other jaw closing mechanisms may also be employed.
First jaw 920A may comprise a series of pivotally interconnected first body segments 922A as shown in FIGS. 23-25. The first body segments 922A are coupled together by a ball and socket-type joint arrangement 923A such that they may pivot relative to each other about a vertical axis VA-VA as shown in FIG. 23. Each first body segment 922A may be fabricated from, for example, a thermal and/or electrical insulator. For example, zirconium, partially stabilized zirconium, aluminum oxide, silicon nitride, alumina-chromic, hydroxyapatite, other non-conductive glass materials, other non-conductive ceramic materials, and other non-conductive glass-ceramic materials may be employed. Each first body segment 922B further has a first energy delivery electrode 935A mounted therein.
Similarly, the second jaw 920B may comprise a series of pivotally interconnected second body segments 922B that are pivotally interconnected by a ball and socket-type joint arrangement 923B as shown in FIGS. 24 and 25. The second body segments 922B are coupled together such that they may pivot relative to each other about the vertical axes VA-VA as shown in FIG. 23. Each second body segment 922B corresponds to a first body segment 922A and may be fabricated from, for example, the same or different material comprising the corresponding first body segment 922A. Each second body segment 922B further has a second energy delivery electrode 935B mounted therein that corresponds to, and is substantially vertically aligned with, the first energy delivery electrode 935A in the corresponding first body segment 922A. The first energy delivery electrodes 935A and the second energy delivery electrodes 935B may be configured to contact tissue and deliver electrosurgical energy to engaged tissue which is adapted to seal or weld the tissue. Opposing first and second energy delivery electrodes 935A and 935B may be coupled to electrical source 145 and controller 150 in series and parallel circuit components. First energy delivery electrode 935A and the first body segment 922A can have a negative polarity (−) while second energy delivery surface 935B and the corresponding second body segment 922B can have a positive polarity (+) or vice versa. The first and second body segments 922A, 922B materials may “trip” and become resistive or non-conductive once a selected trip temperature is exceeded. Controller 150 can regulate the electrical energy delivered by electrical source 145 which in turn delivers electrosurgical energy to the first energy delivery electrodes 935A and the second energy delivery electrodes 9353B. The energy delivery may be initiated by activation button 124 operably engaged with lever arm 128 and in electrical communication with controller 150 via cable 152. As mentioned above, the electrosurgical energy delivered by electrical source 145 may comprise radio frequency “RF” energy and may be either monopolar or bipolar in nature.
In various non-limiting embodiments, once the first body segments 922A are oriented in a desired orientation relative to each other, friction between the ball and socket components 923A serve to retain the first body segments 922A in that position. Similarly, once the second body segments 922B are oriented in a desired orientation relative to each other, friction between the ball and socket components 923B retain the second body segments 922B in that position. Optionally, a first locking cable 929A may extend from a locking mechanism on the handle 105′ through each first body segment 922A to the distal-most body segment 922A. Once the body segments 922A have been moved to a desired orientation, the surgeon may apply tension to the first locking cable 929A by means of the locking mechanism to pull the first body segments 922A together to thereby lock them in place. Likewise, a second locking cable 929B may extend from the locking mechanism 940 or another locking mechanism on the handle 105′ through each body segment 922B to the distal-most body segment 922B. Once the body segments 922B have been moved to the desired orientation, the surgeon may apply tension to the second locking cable 929B to pull the second body segments 922B together to thereby lock them in place.
FIGS. 26 and 27 illustrate a portion of an end effector 1000 of another non-limiting embodiment of the present invention that includes a first jaw 1020A and a second jaw 1020B. The first jaw 1020A may have a first tapered distal end portion 1021A and the second jaw 1020B may have a second tapered distal end portion 1021B that converges with the first tapered distal end portion 1021A to form a substantially conical end effector tip 1022 that is particularly well-suited for dissection purposes. The embodiment may further include a reciprocating I-beam member 1040 that may be identical in construction and operation as the I-beam members described above, except for the following differences. More specifically, as can be seen in FIG. 27, the I-beam member 1040 has an upper flange 1042 and a lower flange 1044 that are interconnected by a central web portion 1046. The central web portion 1046 extends through aligned slots (not shown) in the first jaw member 1020A and the second jaw member 1020B in the manner described above. The upper flange 1042 may ride in a groove, slot or recessed area in the first jaw member 1020A and the lower flange 1044 may ride in a groove, slot or recessed area in the second jaw member 1020B such that, as the I beam member 1040 is distally advanced through the first and second jaw members 1020A, 1020B, the upper and lower flanges 1042, 1044 pivot the first and second jaws 1020A, 1020B together in the manner described above. As can be most particularly seen in FIG. 27, the lower flange 1044 protrudes further in the distal direction than does the upper flange 1042. The portion of the central web 1046 that extends from the distal-most edge of the lower flange 1044 to the distal-most edge of the upper flange 1042 has a cutting edge 1047 formed thereon. In various embodiments, the cutting edge 1047 may have an arcuate profile when viewed from the side. See, for example, FIG. 27. Such “recessed” I-beam arrangement, with an arcuate cutting surface, in combination with the tapered distal tip of the end effector, allows some compression of the first and second jaws 1020A, 1020B without transecting the tissue clamped between the first and second jaws 1020A, 1020B. Stated another way, as the I-beam is advanced distally within the end effector, the portion of the cutting surface that protrudes out of the slot in the second jaw 1020B is proximal to the distal most end of the portion of I-beam advancing through the second jaw 1020B. In various applications, the jaws can be actuated to add surface coagulation to cutting for tissue laying on the extended portion of the lower jaw, for example. In still other non-limiting embodiments, the distal edge of the web (i.e., edge 1047) may have a “C” shape or “U” shape. Stated another way, when viewed from the side, the edge 1047 may form a substantially horizontal “U” shape. Such unique I-beam configurations facilitate the compression of tissue between the jaws which serves to drive out water from the tissue. Current is then applied to the compressed tissue before it is ultimately cut with the advancing cutting edge. As a result, more robust seals are generally attained.
FIGS. 28-31 illustrate an electrosurgical instrument 1100 according to another non-limiting embodiment of the invention. Electrosurgical instrument 1100 comprises a proximal handle end 105″, a distal end effector 1200 and an introducer or elongate shaft member 1106 disposed in-between. In this non-limiting embodiment, however, the elongate shaft member 1106 includes a flexible spine assembly 1110 that is enclosed in a flexible hollow sheath 1112.
FIGS. 29-31 illustrate various spine assembly components. In particular, in at least one non-limiting embodiment, the spine assembly 1110 may be fabricated from a plurality of interconnected spine segments 1120. As can be seen in FIGS. 30 and 31, each spine segment 1120 has a hollow body 1122 that is somewhat cylindrical in shape. One end of the hollow body 1122 has an outwardly protruding ball member 1124 formed thereon. The other end of the body 1122 has a socket 1126 that is sized to rotatably receive and retain the ball member 1124 of an adjacent segment 1120 therein. In various embodiments, the proximal-most segment 1122 may be non-movably attached to actuator wheel 107 rotatably supported on the handle 105″. See FIG. 28. Thus, rotation of the actuator wheel 107 will cause the spine assembly 1110 to rotate about axis 125. The distal-most spine segment 1120 is attached to the end effector 1200. In one embodiment, the end effector 1200 may include a set of operable-closeable jaws 1220A and 1220B. The end effector 1200 may be adapted for capturing, welding and transecting tissue. First jaw 1220A and second jaw 12206 may close to thereby capture or engage tissue therebetween. First jaw 1220A and second jaw 1220B may also apply compression to the tissue. The second jaw 1220B may be attached to the distal-most spine segment 1120 and the first jaw 1220A may be pivotally or otherwise movably coupled to the second jaw 1220B. In one embodiment, for example, the end effector 1200 may be identical in construction and operation to end effector 200 described in detail above.
The electrosurgical instrument 1110 may also employ a translatable, reciprocating member or reciprocating “I-beam” member 240. The lever arm 128 of handle 105″ may be adapted to actuate a flexible translatable member 240 which also functions as a jaw-closing mechanism. For example, translatable member 240 may be urged distally as lever arm 128 is pulled proximally along path 129. The distal end of translatable member 240 comprises a flexible flanged “I”-beam that is configured to interface with the first and second jaw members 1220A, 1220B in the manner described above. The flexible translatable member 240 extends through the lumen 1130 provided through each spine segment 1120. See FIG. 31. The distal end of the flexible translatable member 240 interfaces with the first and second jaws 1220A, 1220B in the manner described above. Wires for powering the end effector 1200 may also extend through the lumen 1130 or extend through other passages (not shown) in the spine segments 1120. The unique and novel aspects of the spine assembly 1110 may also be employed with a host of other end effector arrangements. For example, the lumens 1130 in the spine segments 1120 may accommodate a variety of different actuator arrangements, wires, cables etc. that may be used to control and actuate the end effector.
The spine assembly 1110 may be effectively flexed in more than two directions (some of which are represented by arrows 1111 in FIG. 29) by a control assembly generally designated as 1300. In various embodiments, for example, control assembly 1300 may comprise at least one actuation member 1310 that extends through corresponding aligned hollow lugs 1130 formed on the perimeter of the hollow body 1122 of each spine segment 1120. In the depicted embodiment, the actuation members 1310 comprise four control cables. In alternative embodiments, however, three control cables could be employed to essentially achieve the same degrees of motion achieved with four cables. U.S. Pat. No. 8,262,563, entitled ENDOSCOPIC TRANSLUMENAL ARTICULATABLE STEERABLE OVERTUBE, the disclosure of which is herein incorporated by reference, discloses other steerable tubular arrangements that may be employed. In alternative embodiments, the control members 1310 may also comprise electrical conductors that communicate with the RF source to carry the RF energy to the end effector.
In the illustrated non-limiting embodiment, each spine segment 1122 has four diametrically opposed lugs 1130 formed thereon. Each of the control cables 1310 extend through the hollow sheath 1106 and into the handle 105″ to interface with articulation control mechanism 1400. In the depicted embodiment, the articulation control mechanism 1400 comprises a joy stick arrangement 1402 that is operably supported by the handle 105″. Thus, movement of the joy stick arrangement 1402 will apply tension to one or more of the cables 1310 to thereby cause the spine assembly 1110 to articulate. Other cable control arrangements could also be employed.
FIGS. 33-35 illustrate a monopolar electrosurgical instrument 1500 according to another non-limiting embodiment of the present invention. Electrosurgical instrument 1500 comprises a proximal handle 105, a distal end effector 1600, and an introducer or elongated shaft member 106 disposed in-between. The end effector 1600 in conjunction with a return pad (not shown) may be adapted for controlled surface ablation in Barrett's esophagus, liver or endometriosis procedures. As will be discussed in further detail below, the end effector 1600 is movable relative to the elongate shaft 106 which makes it particularly well-suited for laparoscopic or open procedural use.
Handle 105 may comprise a lever arm 128 which may be pulled along a path 129. The handle 105 can be any type of pistol-grip or other type of handle known in the art that is configured to carry actuator levers, triggers, etc. Elongate shaft 106 may have a cylindrical or rectangular cross-section and can comprise a thin-wall tubular sleeve that extends from handle 105. Elongate shaft 106 may be fabricated from, for example, metal such as stainless steel or plastics such as Ultem®, or Vectra®, etc. In still other embodiments, the elongate shaft 106 may comprise a polyolefin heat shrunk tube and have a bore extending therethrough for carrying actuator cables or members as well as for carrying electrical leads for delivery of electrical energy to electrosurgical components of end effector 1600. The elongate shaft member 106 along with the end effector 1600 may, in some embodiments, be rotatable a full 360° about an axis 125, relative to handle 105 through, for example, a rotary triple contact.
The end effector 1600 may comprise a pad support 1602 that is pinned or otherwise movably coupled to a distal end 107 of the elongate shaft 106. In various embodiments, the pad support 1602 may be fabricated from relatively flexible material such as, for example, poly carbonate or a relatively high durometer silicone elastomer. However, other materials may be employed. Attached to the flexible pad support 1602 is a conductor or electrode element 1604 and a flexible pad member 1606 that is fabricated from positive temperature coefficient (PTC) material. For example, the flexible pad member 1604 may be fabricated from that PTC material disclosed in U.S. Pat. No. 6,770,072, entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY, the disclosure of which is herein incorporated by reference in its entirety. The conductor or electrode element 1604 may be fabricated from, for example, metals such as stainless steel or copper and be coupled to an RF source 145 and controller 150 through electrical leads in cable 152. Such end effector 1600 includes an activation control button 131 that facilitates the application of controlled energy to tissue. The energy delivery may be initiated by activation button 131 in electrical communication with controller 150 via cable 152. As mentioned above, the electrosurgical energy delivered by electrical source 145 may comprise radio frequency “RF”. Lever 128 can provide control of the pad support 1602 relative to the elongate shaft 106 for better alignment and approximation of the pad 1602 to the tissue. The lever 128 may alternatively control articulation of the elongate shaft proximal the distal end of the elongate shaft 107.
This embodiment of the present invention provides the ability to supply current/power to targeted tissue at a predetermined critical temperature level. This is accomplished when the applied RF energy to the tissue reaches the point in time that the PTC pad 1606 is heated to its selected switching range. Thereafter, current flow from the conductive electrode 1604 through the flexible pad 1606 will be terminated due to the exponential increase in the resistance of the PTC to provide instant and automatic reduction of RF energy. Thus, the end effector 1600 can automatically modulate the application of energy to tissue between active RF heating and passive conductive heating to maintain a target temperature level. In various embodiments, the PTC pad 1606 is engineered to exhibit a dramatically increasing resistance above a specific temperature of the material. The energy delivery electrode 1604 is applied internally to the patient's body. A grounding pad applied externally to the patient's body completes the circuit. The PTC material 1606 will “trip” and become resistive or non-conductive once a selected trip temperature is exceeded. As can be seen in FIG. 35, the flexible nature of the end effector components enables the end effector to somewhat conform to irregular tissue “T”. These various embodiments may be employed to treat tissues, such as, for example, liver tissue, lung tissue cardiac tissue, prostate tissue breast tissue vascular tissue, etc. by the application of radio frequencies thereto. The device can be constructed for laparoscopic or open procedures. The flexible end effector can be designed to allow access through an access port such as a trocar. Further, the end effector can effectively apply controlled energy to the tissue. The term “controlled” refers to the ability to provide current/power to targeted tissue at a predetermined critical temperature level. This may be accomplished when the RF energy is applied to the tissue reaches the point in time that the PTC material is heated to is selected switching range. Thereafter, current flow from the conductive electrode through the flexible engagement surface may be terminated due to the exponential increase in the resistance of the PTC to provide instant and automatic reduction of RF energy. Thus, the flexible end effector can automatically modulate the application of energy to tissue between active RF heating and passive conduct heating to maintain a target temperature level.
FIGS. 36 and 37 depict another end effector 1600′ that is similar to end effector 1600 described above except for the differences noted below. As can be seen in FIG. 36, the elongate shaft 106 is attached to a yoke 109. The elongate shaft 106 may be fabricated from an insulator material such as Ultem®, Vectra, etc. or a conductive material such as stainless steel. In other embodiments, for example, the elongate shaft 106 may be fabricated from a polyolefin heat shrunk tube. Yoke 109 may be fabricated from an elastomer such as, for example, polyurethane or a shrink material such as a polyolefin, polyvinylchloride (PVC) or Neoprene. Yoke 109 is pivotally attached to a rigid pad portion 1620 that may be fabricated from, for example, polycarbonate or a high durometer silicone elastomer. The rigid pad portion 1620 is attached to a flexible pad portion 1622 by, for example, an elastomeric adhesive or overmolding process. Flexible pad portion 1622 may be fabricated from polyisoprene or silicone. The flexible pad portion 1622 may also be fabricated from closed or open cell Neoprene or silicone foam. In the embodiment depicted in FIG. 36, two (conductive) made from stainless steel, copper, etc.) electrodes 1630 are attached to the flexible pad portion 1622 by, for example, an elastomeric adhesive and are attached to the controller and source of RF energy by cables that extend through the elongate shaft 106 and handle. In one non-limiting embodiment, the two electrodes 1630 may serve as the source and return of the electrical circuit, as in a bipolar instrument. In another non-limiting embodiment, the two electrodes may be electrically connected and serve as a single source with an external patient return as in a monopolar instrument. In other embodiments, a single conductive electrode which may be substantially coextensive with the flexible pad portion may be employed. A flexible PTC member 1640 may be attached to the electrode(s) 1630 by, for example, adhesive or mechanically attached. This embodiment may be operated in the manner described above.
The devices disclosed herein may be designed to be disposed of after a single use, or they may be designed to be used multiple times. In either case, however, the device may be reconditioned for reuse after at least one use. Reconditioning may include a combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device may be disassembled, and any number of particular pieces or parts of the device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device may be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those of ordinary skill in the art will appreciate that the reconditioning of a device may utilize a variety of different techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of this application.
Preferably, the various embodiments of the devices described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility. Other sterilization techniques can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, and/or steam.
Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
Patent Application
20180125571
