Patent Application
20200390488
The present disclosure relates to surgical instruments and, more particularly, to surgical instruments for performing tonsillectomy, adenoidectomy, and other surgical procedures.
The tonsils and adenoids are part of the lymphatic system and are generally located in the back of the throat. These parts of the lymphatic system are generally used for sampling bacteria and viruses entering the body and activating the immune system when warranted to produce antibodies to fight oncoming infections. More particularly, the tonsils and adenoids break down the bacteria or virus and send pieces of the bacteria or virus to the immune system to produce antibodies for fighting off infections.
Inflammation of the tonsils and adenoids (e.g., tonsillitis) impedes the ability of the tonsils and adenoids to destroy the bacteria resulting in a bacterial infection. In many instances, the bacteria remain even after treatment and serve as a reservoir for repeated infections (e.g., tonsillitis or ear infections).
A tonsillectomy and/or adenoidectomy may be performed when infections persist and antibiotic treatments fail. Some individuals are also born with larger tonsils that are more prone to cause obstruction. An adenoidectomy may also be required to remove adenoid tissue when ear pain persists, or when nose breathing or function of the Eustachian tube is impaired. Often times, tonsillectomy and adenoidectomy procedures are performed at the same time.
As used herein, the term “distal” refers to the portion that is being described which is further from a user, while the term “proximal” refers to the portion that is being described which is closer to a user. Further, to the extent consistent, any of the aspects described herein may be used in conjunction with any or all of the other aspects described herein.
A surgical instrument provided in accordance with aspects of the present disclosure includes a housing having a barrel with distal and proximal end portions. The barrel includes a handle depending from a lower end thereof and a concave portion defined within and extending along an upper surface thereof from the proximal end portion of the barrel to the distal end portion of the barrel. A shaft is included and extends from the distal end portion of the barrel and supports an end effector assembly at a distal end thereof configured to treat tissue. The concave portion enhances visibility of the end effector assembly during tissue treatment.
In aspects according to the present disclosure, the surgical instrument further includes a movable handle operably coupled to the housing and movable relative thereto between an initial position and a compressed position. In other aspects according to the present disclosure, a trigger is operably coupled to the housing within a slot defined therein, the trigger movable relative to the housing and the movable handle between an un-actuated position and an actuated position. In aspects, movement of the trigger from the un-actuated position to the actuated position deploys a knife.
In other aspects according to the present disclosure, the movable handle and the trigger are pivotably coupled to the housing. In yet other aspects according to the present disclosure, the movable handle and the trigger are pivotably coupled to the housing about a common pivot. In still other aspects according to the present disclosure, the trigger at least partially surrounds the movable handle.
In aspects according to the present disclosure, the barrel includes a width and the concave portion extend at least partially across the width of the barrel. In other aspects according to the present disclosure, the barrel includes a width and the concave portion extend fully across the width of the barrel.
The present disclosure also relates to a surgical instrument that includes a housing having a barrel with distal and proximal end portions. The barrel includes a handle depending from a lower end thereof and a flat portion extending along an upper surface thereof from the proximal end portion of the barrel to the distal end portion of the barrel. A shaft is included and extends from the distal end portion of the barrel and supports an end effector assembly at a distal end thereof configured to treat tissue. The flat portion enhances visibility of the end effector assembly during tissue treatment.
The present disclosure also relates to a surgical instrument that includes a housing having distal and proximal end portions. A shaft is included that extends from the distal end portion of the housing and includes a longitudinal axis defined therethrough. An end effector assembly is supported at a distal end of the shaft and includes a pair of first and second jaw members movable about a pivot from a first, spaced configuration to one or more second positions for approximating tissue. A bend is disposed proximate the distal end of the shaft and proximal to the end effector assembly and pivot. The bend is configured to enhance visibility of the end effector assembly during tissue treatment.
In aspects according to the present disclosure, an angle of the bend is about 90° relative to the longitudinal axis of the shaft. In other aspects according to the present disclosure, an angle of the bend is less than 90° relative to the longitudinal axis of the shaft. In still other aspects according to the present disclosure, an angle of the bend is more than 90° relative to the longitudinal axis of the shaft.
Various aspects and features of the present disclosure described herein with reference to the drawings wherein:
Referring generally to
With reference to
Instrument 10 also includes an electrosurgical cable 200 including a proximal plug 210 that connects instrument 10 to a generator (not shown) or other suitable power source, although instrument 10 may alternatively be configured as a battery-powered instrument. Electrosurgical cable 200 includes lead wires extending therethrough that have sufficient length to extend through housing 20 and shaft 80 in order to operably couple the generator, energy activation assembly 190, and end effector assembly 100 with one another to enable the selective supply of energy to jaw members 110, 120 of end effector assembly 100, e.g., upon activation of activation switch 194 of energy activation assembly 190.
Housing 20 houses the internal working components of instrument 10 and is formed from first and second housing components configured to engage one another via a plurality of pin-aperture engagements spaced around housing 20, although other suitable engagements, e.g., screws, snap-fit connections, adhesion, ultrasonic welding, etc., are also contemplated, as are different formations of housing 20. Housing 20 defines a pistol-style configuration having a longitudinally-extending barrel portion 22 and a fixed handle portion 28 that extends from barrel portion 22 in generally perpendicular orientation relative thereto.
Barrel portion 22 of housing 20 defines a distal aperture configured to receive and engage the proximal end of shaft 80 therein. Shaft 80 extends distally from barrel portion 22 of housing 20 and defines a generally rectangular cross-sectional configuration oriented such that the larger width dimension thereof extends laterally and the smaller height dimension thereof extends vertically. This configuration of shaft 80 relative to the orientation of jaw members 110, 120 provides enhanced “line-of-sight” for visualizing the surgical site adjacent end effector assembly 100. As described in greater detail below, shaft 80 includes a pair of spaced-apart clevis members 84 extending from the top and bottom walls, e.g., the larger width dimension walls, of shaft 80 at the distal end of shaft 80. Each clevis member 84 defines an aperture for receiving a pivot pin 103 to operably support end effector assembly 100 at the distal end of shaft 80.
Barrel portion 22 of housing further includes a pair of opposed pivot apertures 23 (only one of which is shown), a longitudinal track 24, a pair of opposed pivot bosses 25 (only one of which is shown), and a block 26. Each pivot aperture 23 is configured to receive an end of pivot pin 48 to pivotably couple movable handle 40 and trigger 72 to housing 20. Longitudinal track 24 is configured to guide translation of drive assembly 140 relative to housing 20. Pivot bosses 25 extend inwardly into housing 20 and are configured to pivotably couple linkage 76 of trigger assembly 70 to housing 20.
Energy activation assembly 190 includes a depressible button 192 that is mechanically coupled to a switch 194 mounted within a bay 29 defined within fixed handle portion 28 of housing 20 and is engagable by a button activation post 196 extending proximally from a proximal side of movable handle 40 upon movement of movable handle 40 to the activated position, as detailed below. Switch 194 is configured to electrically communicate with end effector assembly 100 and the generator (not shown) via suitable electrical wiring to enable energy to be supplied from the generator (not shown) to end effector assembly 100 upon activation of switch 194.
Continuing with reference to
Movable handle 40, as noted above, includes grasping portion 42, which extends from housing 20 adjacent fixed handle portion 28, and flange portion 47, which extends upwardly into housing 20. Flange portion 47 is pivotably coupled within housing 20 at the free end of flange portion 47 via pivot pin 48. Pivot pin 48 is engaged within and extends between pivot apertures 23 of housing 20 to permit movable handle 40 to pivot about pivot pin 48 and relative to housing 20 between the initial position (
In use movable handle 40 is biased towards the initial position by the abutment of a lower leg 163 of a drive torsion spring (not shown) with block 26 of housing 20. With movable handle 40 in the initial position, slider assembly 150 is likewise disposed in a distal-most position. With slider assembly 150 disposed in its distal-most position, an upper leg 162 of the drive torsion spring 160 retains drive plate 142 in a distal-most position with the proximal edge 145 of drive plate 142 disposed in abutment with abutment rib 154 of proximal housing 152 of slider assembly 150. In the distal-most position of drive plate 142, drive plate 142 maintains the jaw cam pin (not shown) at the distal ends of oppositely-angled cam slots of the proximal flanges of the jaw members 110, 120 to thereby maintain jaw members 110, 120 in the spaced-apart position.
At this point, trigger 72 is disposed in the un-actuated position, wherein trigger 72 is in a distal-most position under the bias of biasing member 71 such that upper end cam slot 77b of linkage 76 is disposed in a proximal-most position while lower end cam slot 77c of linkage 76 is disposed in a distal-most position. Thus, knife plate 172 is disposed in a proximal-most position, corresponding to a retracted position of knife blade 174, wherein knife blade 174 is disposed between proximal flanges of jaw frames of jaw members 110, 120 but does not extend distally therefrom. Further, with movable handle 40 disposed in its initial position, proximal housing 152 of slider assembly 150 is disposed in the movement path of lockout peg 79 of linkage 76, inhibiting rotation of linkage 76 and, thus, inhibiting movement of trigger 72 from the un-actuated position to the actuated position. As such, knife blade 174 is inhibited from being deployed when jaw members 110, 120 are disposed in the spaced-apart position.
In order to move jaw members 110, 120 to the approximated position to grasp tissue therebetween, movable handle 40 is pulled proximally towards fixed handle portion 28 of housing 20 from the initial position to the compressed position (
In order to apply energy to tissue grasped between jaw members 110, 120 to treat tissue, movable handle 40 is compressed further towards fixed handle portion 28 of housing 20 to an activation position, wherein an appropriate closure force or closure force within an appropriate range, is achieved and energy activation is initiated (See
The decoupling of proximal housing 152 of slider assembly 150 and drive plate 142 to permit relative motion therebetween is provided via torsion spring 160. More specifically, upon proximal movement of movable handle 40, a first force is imparted from movable handle 40, through proximal housing 152 of slider assembly 150, body 161 of torsion spring 160, and upper leg 162 of torsion spring 160, to drive plate 142 to urge drive plate 142 in a proximal direction, while a second, opposite force acts on drive plate 142 and, thus, upper leg 162 of torsion spring 160 in a distal direction to control the amount of compression of tissue between jaw members 110, 120. Once the second, opposite force exceeds the spring force of torsion spring 160, proximal movement of proximal housing 152 no longer results in proximal movement of drive plate 142 but, rather, results in further tensioning of torsion spring 160, wherein torsion spring 160 is wound-up, absorbing the force imparted thereto from movement of movable handle 40.
Thus, once this point has been reached, further proximal translation of proximal housing 152 of slider assembly 150 urges body 161 of torsion spring 160 proximally while upper leg 162 of torsion spring 160 remains in position as a result of the wind-up tensioning of torsion spring 160. With upper leg 162 of torsion spring 160 retained in position, drive plate 142 is likewise retained in position despite the proximal translation of movable handle 40. As such, an upper threshold of pressure applied to tissue grasped between jaw members 110, 120 is defined.
Referring to
Referring to
As detailed above, movement of trigger 72 from the un-actuated position to the actuated position urges knife plate 172 distally. More specifically, knife plate 172 is urged distally such that knife blade 174 is advanced distally from the retracted position to the extended position. As knife blade 174 is advanced distally, knife blade 174 extends through knife slots 112a, 112b defined within electrically-conductive plates 112, 122 to cut tissue grasped between jaw members 110, 120.
Upon release, trigger 72 and knife plate 172 are returned proximally under the bias of biasing member 71 such that knife blade 174 is returned to the retracted position. Thereafter, movable handle 40 may be released, allowing movable handle 40 to return to the initial position under the bias of lower leg 163 of torsion spring 160 abutting block 26 of housing 20, thereby returning jaw members 110, 120 to the spaced-apart position and releasing the treated and/or divided tissue.
Barrel portion 522 includes a concave portion 535 extending along an upper surface thereof from the proximal portion 522a of the barrel portion 522 to the distal portion 522a of the barrel portion 522. The concave portion 535 is configured to enhance line-of-sight to the end effector assembly 100 during surgery and handling. The concave portion 535 may be dimensioned at varying depths depending upon a particular purpose or a particular surgical need. In embodiments, the concave portion 535 extends the entire width of the barrel portion 522 to enhance line-of-sight for the surgeon. In other embodiments, the concave portion 535 extends partially across the width of the barrel portion 522. Other instruments are envisioned that may provide a maximum concave portion.
Barrel portion 622 includes a substantially flat portion 635 extending along an upper surface thereof from the proximal portion 622a of the barrel portion 622 to the distal portion 622a of the barrel portion 622. The flat portion 635 is configured to enhance line-of-sight to the end effector assembly 100 during surgery and handling. The flat portion 635 extends the entire width of the barrel portion 622 to enhance line-of-sight for the surgeon. In other embodiments, the flat portion 635 may extend partially across the width of the barrel portion 622 and be configured more like a notch.
Distal end 782 of the end effector assembly 700 is angled at elbow 781 such that the end effector assembly 700 extends at an angle of about ninety degrees (90°) relative to a longitudinal axis of the shaft 780. Orienting the distal end 782 at an angle of about 90° relative to the proximal end of the shaft 780 provides better line-of-sight of the end effector assembly 700 for the surgeon during manipulation and handling. The distal end 782 may be configured at angles other than 90° (less than 90° or greater than 90° to facilitate a particular purpose or to achieve a particular result, e.g., better line-of-sight of the end effector assembly 700 during a particular surgery wherein the view of the end effector assembly 700 may be obstructed or otherwise compromised.
The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the surgeon and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.
The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.
The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s).
The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon's ability to mimic actual operating conditions.
From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
