The present disclosure relates to energy based surgical instruments and, more particularly, to surgical instruments, systems, and methods incorporating ultrasonic and electrosurgical functionality to facilitate energy based tissue treatment.
Ultrasonic surgical instruments and systems utilize ultrasonic energy, i.e., ultrasonic vibrations, to treat tissue. More specifically, ultrasonic surgical instruments and systems utilize mechanical vibration energy transmitted at ultrasonic frequencies to treat tissue. An ultrasonic surgical device may include, for example, an ultrasonic blade and a clamp mechanism to enable clamping of tissue against the blade. Ultrasonic energy transmitted to the blade causes the blade to vibrate at very high frequencies, which allows for heating tissue to treat tissue clamped against or otherwise in contact with the blade.
Electrosurgical instruments and systems conduct Radio Frequency (RF) energy through tissue to treat tissue. An electrosurgical instrument or system may be configured to conduct bipolar RF energy between oppositely charged electrodes and through tissue, e.g., tissue clamped between the electrodes or otherwise in contact therewith, to treat tissue. Alternatively or additionally, an electrosurgical instrument or system may be configured to deliver monopolar RF energy from an active electrode to tissue in contact with the electrode, with the energy returning via a remote return electrode device to complete the circuit.
As used herein, the term “distal” refers to the portion that is described which is further from an operator (whether a human surgeon or a surgical robot), while the term “proximal” refers to the portion that is being described which is closer to the operator. Terms including “generally,” “about,” “substantially,” and the like, as utilized herein, are meant to encompass variations, e.g., manufacturing tolerances, material tolerances, use and environmental tolerances, measurement variations, and/or other variations, up to and including plus or minus 10 percent. Further, any or all of the aspects described herein, to the extent consistent, may be used in conjunction with any or all of the other aspects described herein.
Provided in accordance with aspects of the present disclosure is a surgical system including a surgical instrument having an end effector assembly including an ultrasonic blade operably coupled to an ultrasonic transducer for receiving ultrasonic energy produced by the ultrasonic transducer, and a jaw member pivotable relative to the ultrasonic blade between an open position and a closed position for clamping tissue between the ultrasonic blade and the jaw member. The end effector assembly is configured to be activated in an ultrasonic state wherein ultrasonic energy is transmitted to tissue via the ultrasonic blade, in a bipolar state wherein electrosurgical energy is conducted between the ultrasonic blade and the jaw member and through tissue disposed therebetween, and in a monopolar state wherein electrosurgical energy is conducted from at least one of the ultrasonic blade or the jaw member to tissue and is returned via a remote return device. The surgical system further includes a processor configured to determine a use profile of the surgical instrument upon activation of the surgical instrument and, based on the determined use profile, to initiate at least one of the ultrasonic state, the bipolar state, or the monopolar state.
In an aspect of the present disclosure, in at least one first use profile, the ultrasonic state and the bipolar state are initiated and the monopolar state is not initiated. In at least one second use profile, the ultrasonic state and the monopolar state are initiated and the bipolar state is not initiated. In aspects, in at least one third use profile, the bipolar state is initiated and the ultrasonic state and the monopolar state are not initiated.
In another aspect of the present disclosure, in at least one first use profile where at least the ultrasonic state is initiated, the ultrasonic energy is supplied in a low power mode. In at least one second use profile where at least the ultrasonic state is initiated, the ultrasonic energy is supplied in a high power mode.
In still another aspect of the present disclosure, in at least one first use profile where at least the monopolar state is initiated, the monopolar energy is supplied in a coagulation (“coag”) mode. In at least one second use profile where at least the monopolar state is initiated, the monopolar energy is supplied in a cut mode.
In yet another aspect of the present disclosure, the processor is configured to determine the use profile based on at least two of, at least three of, or all of: a position of an actuator, a position of the jaw member, a position of an activation button, or temporal considerations. Additionally or alternatively, field conditions, e.g., based on impedance feedback and/or other feedback data, may also be utilized to determine the use profile.
A method of supplying energy in a surgical system provided in accordance with the present disclosure includes determining a use profile of a surgical instrument based upon use of the surgical instrument upon activation, and initiating, based on the determined use profile, at least one state. The at least one state includes: an ultrasonic state, wherein ultrasonic energy is transmitted to tissue via an ultrasonic blade of the surgical instrument; a bipolar state wherein electrosurgical energy is conducted between the ultrasonic blade and a jaw member of the surgical instrument and through tissue disposed therebetween; and a monopolar state wherein electrosurgical energy is conducted from at least one of the ultrasonic blade or the jaw member to tissue and is returned via a remote return device.
In an aspect of the present disclosure, the initiating, in at least one first use profile, includes initiating the ultrasonic state and the bipolar state but not the monopolar state. The initiating, in at least one second use profile, includes initiating the ultrasonic state and the monopolar state but not the bipolar state. The initiating, in at least one third use profile, includes initiating the bipolar state only.
In another aspect of the present disclosure, in at least one first use profile where at least the ultrasonic state is initiated, the initiating includes initiating the ultrasonic energy in a low power mode. In at least one second use profile where at least the ultrasonic state is initiated, the initiating includes initiating the ultrasonic energy in a high power mode.
In yet another aspect of the present disclosure, in at least one first use profile where at least the monopolar state is initiated, the initiating includes initiating the monopolar energy in a coag mode. In at least one second use profile where at least the monopolar state is initiated, the initiating includes initiating the monopolar energy in a cut mode.
In still another aspect of the present disclosure, determining the use profile is based on at least two of, at least three of, or all of: a position of an actuator, a position of the jaw member, a position of an activation button, or temporal considerations. Additionally or alternatively, field conditions, e.g., based on impedance feedback and/or other feedback data, may also be utilized to determine the use profile.
The above and other aspects and features of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings wherein like reference numerals identify similar or identical elements.
Referring to
Surgical generator 200 includes a display 210, a plurality user interface features 220, e.g., buttons, touch screens, switches, etc., an ultrasonic plug port 230, a bipolar electrosurgical plug port 240, and active and return monopolar electrosurgical plug ports 250, 260, respectively. As an alternative to plural dedicated ports 230-260, one or more common ports (not shown) may be configured to act as any two or more of ports 230-260.
Surgical instrument 100 is configured to supply electrosurgical, e.g., Radio Frequency (RF), energy to tissue to treat tissue, e.g., in a monopolar configuration and/or a bipolar configuration, and to supply ultrasonic energy to tissue to treat tissue. Surgical generator 200 is configured to produce ultrasonic drive signals for output through ultrasonic plug port 230 to surgical instrument 100 to activate surgical instrument 100 to supply ultrasonic energy and to provide electrosurgical energy, e.g., RF bipolar energy for output through bipolar electrosurgical plug port 240 and/or RF monopolar energy for output through active monopolar electrosurgical port 250 to surgical instrument 100 to activate surgical instrument 100 to supply electrosurgical energy. Plug 520 of return electrode device 500 is configured to connect to return monopolar electrosurgical plug port 260 to return monopolar electrosurgical energy from surgical instrument 100 during monopolar electrosurgical use.
Continuing with reference to
An activation button 120 is disposed on housing 112 and coupled to or between ultrasonic transducer 140 and/or surgical generator 200, e.g., via one or more of first electrical lead wires 197, to enable activation of ultrasonic transducer 140 in response to depression of activation button 120. In some configurations, activation button 120 may include an ON/OFF switch. In other configurations, activation button 120 may include multiple actuation switches to enable activation from an OFF state to different states corresponding to different activation settings, e.g., a first state corresponding to a first activation setting (such as a LOW power and/or tissue sealing setting) and a second state corresponding to a second activation setting (such as a HIGH power and/or tissue transection setting). In still other configurations, separate activation buttons may be provided, e.g., a first actuation button for activating a first activation setting and a second activation button for activating a second activation setting. Additional activation buttons, sliders, wheels, etc. are also contemplated to enable control of various different activation settings from housing 112.
Elongated assembly 150 of surgical instrument 100 includes an outer drive sleeve 152, an inner support sleeve 153 (
Referring still to
Waveguide 154, as noted above, extends from handle assembly 110 through inner sleeve 153 (
Cable assembly 190 of surgical instrument 100 includes a cable 192, an ultrasonic plug 194, and an electrosurgical plug 196. Ultrasonic plug 194 is configured for connection with ultrasonic plug port 230 of surgical generator 200 while electrosurgical plug 196 is configured for connection with bipolar electrosurgical plug port 240 of surgical generator 200 and/or active monopolar electrosurgical plug port 250 of surgical generator 200. In configurations where generator 200 includes a common port, cable assembly 190 may include a common plug (not shown) configured to act as both the ultrasonic plug 194 and the electrosurgical plug 196.
Plural first electrical lead wires 197 electrically coupled to ultrasonic plug 194 extend through cable 192 and into handle assembly 110 for electrical connection to ultrasonic transducer 140 and/or activation button 120 to enable the selective supply of ultrasonic drive signals from surgical generator 200 to ultrasonic transducer 140 upon activation of ultrasonic energy. In addition, plural second electrical lead wires 199 are electrically coupled to electrosurgical plug 196 and extend through cable 192 into handle assembly 110. In bipolar configurations, separate second electrical lead wires 199 are electrically coupled to waveguide 154 and jaw member 164 (and/or different portions of jaw member 164) such that bipolar electrosurgical energy may be conducted between blade 162 and jaw member 164 (and/or between different portions of jaw member 164). In monopolar configurations, a second electrical lead wire 199 is electrically coupled to waveguide 154 such that monopolar electrosurgical energy may be supplied to tissue from blade 162. Alternatively or additionally, a second electrical lead wire 199 may electrically couple to jaw member 164 in the monopolar configuration to enable monopolar electrosurgical energy to be supplied to tissue from jaw member 164. In configurations where both bipolar and monopolar functionality are enabled, one or more of the second electrical lead wires 199 may be used for both the delivery of bipolar energy and monopolar energy; alternatively, bipolar and monopolar energy delivery may be provided by separate second electrical lead wires 199. One or more other second electrical lead wires 199 is electrically coupled to activation button 120 to enable the selective supply of electrosurgical energy from surgical generator 200 to waveguide 154 and/or jaw member 164 upon activation of electrosurgical energy.
As an alternative to a remote generator 200, surgical system 10 may be at least partially cordless in that it incorporates an ultrasonic generator, an electrosurgical generator, and/or a power source, e.g., a battery, thereon or therein. In this manner, the connections from surgical instrument 100 to external devices, e.g., generator(s) and/or power source(s), is reduced or eliminated. More specifically, with reference to
Housing 112 of surgical instrument 20 includes a body portion 113 and a fixed handle portion 114 depending from body portion 113. Body portion 113 of housing 112 is configured to support an ultrasonic transducer and generator assembly (“TAG”) 300 including ultrasonic generator 310 and ultrasonic transducer 140. TAG 300 may be permanently engaged with body portion 113 of housing 112 or removable therefrom.
Fixed handle portion 114 of housing 112 defines a compartment 116 configured to receive battery assembly 400 and electrosurgical generator 600 and a door 118 configured to enclose compartment 116. An electrical connection assembly (not shown) is disposed within housing 112 and serves to electrically couple activation button 120, ultrasonic generator 310 of TAG 300, and battery assembly 400 with one another when TAG 300 is supported on or in body portion 113 of housing 112 and battery assembly 400 is disposed within compartment 116 of fixed handle portion 114 of housing 112, thus enabling activation of surgical instrument 20 in an ultrasonic mode in response to appropriate actuation of activation button 120. Further, the electrical connection assembly or a different electrical connection assembly disposed within housing 112 serves to electrically couple activation button 120, electrosurgical generator 600, battery assembly 400, and end effector assembly 160 (e.g., blade 162 and jaw member 164 and/or different portions of jaw member 164) with one another when electrosurgical generator 600 and battery assembly 400 are disposed within compartment 116 of fixed handle portion 114 of housing 112, thus enabling activation of surgical instrument 20 to supply electrosurgical energy, e.g., bipolar RF energy, in response to appropriate actuation of activation button 120. To enable the supply of monopolar electrosurgical energy, plug 520 of return electrode device 500 may be configured to connect to surgical instrument 20 (electrosurgical generator 600 thereof, more specifically), to complete a monopolar circuit through tissue and between surgical instrument 20 (e.g., blade 162 and/or jaw member 164) and return electrode device 500.
Turning to
Robotic surgical system 1000 generally includes a plurality of robot arms 1002, 1003; a control device 1004; and an operating console 1005 coupled with control device 1004. Operating console 1005 may include a display device 1006, which may be set up in particular to display three dimensional images; and manual input devices 1007, 1008, by means of which a person (not shown), for example a surgeon, may be able to telemanipulate robot arms 1002, 1003 in a first operating mode. Robotic surgical system 1000 may be configured for use on a patient 1013 lying on a patient table 1012 to be treated in a minimally invasive manner. Robotic surgical system 1000 may further include a database 1014, in particular coupled to control device 1004, in which are stored, for example, pre-operative data from patient 1013 and/or anatomical atlases.
Each of the robot arms 1002, 1003 may include a plurality of members, which are connected through joints, and an attaching device 1009, 1011, to which may be attached, for example, a surgical tool “ST” supporting an end effector 1050, 1060. One of the surgical tools “ST” may be surgical instrument 100 (
Referring to
Blade 162 may define a polygonal, rounded polygonal, or any other suitable cross-sectional configuration(s). Waveguide 154 or at least the portion of waveguide 154 proximally adjacent blade 162, may define a cylindrical shaped configuration. Plural tapered surfaces (not shown) may interconnect the cylindrically shaped waveguide 154 with the polygonal (rounded edge polygonal, or other suitable shape) configuration of blade 162 to define smooth transitions between the body of waveguide 154 and blade 162.
Blade 162 may be wholly or selectively coated with a suitable material, e.g., a non-stick material, an electrically insulative material, an electrically conductive material, combinations thereof, etc. Suitable coatings and/or methods of applying coatings include but are not limited to Teflon®, polyphenylene oxide (PPO), deposited liquid ceramic insulative coatings; thermally sprayed coatings, e.g., thermally sprayed ceramic; Plasma Electrolytic Oxidation (PEO) coatings; anodization coatings; sputtered coatings, e.g., silica; ElectroBond® coating available from Surface Solutions Group of Chicago, IL, USA; or other suitable coatings and/or methods of applying coatings.
Continuing with reference to
Jaw member 164 of end effector assembly 160 includes more rigid structural body 182 and more compliant jaw liner 184. Structural body 182 may be formed from an electrically conductive material, e.g., stainless steel, and/or may include electrically conductive portions. Structural body 182 includes a pair of proximal flanges 183a that are pivotably coupled to the inner support sleeve 153 via receipt of pivot bosses (not shown) of proximal flanges 183a within corresponding openings (not shown) defined within the inner support sleeve 153 and operably coupled with outer drive sleeve 152 via a drive pin 155 secured relative to outer drive sleeve 152 and pivotably received within apertures 183b defined within proximal flanges 183a. As such, sliding of outer drive sleeve 152 about inner support sleeve 153 pivots jaw member 164 relative to blade 162 from the open position towards the closed position to clamp tissue between jaw liner 184 of jaw member 164 and blade 162.
With reference to
Referring to
Returning to
In aspects, a sensor 161 is provided on or within end effector assembly 160. Sensor 161 may be any suitable sensor, e.g., a motion sensor, a proximity sensor, a contact sensor, etc., configured to sense whether jaw member 164 is disposed in the fully closed position, an extent to which jaw member 164 is closed, and/or an overall position of jaw member 164. Sensor 161 may be configured to discretely or continuously sense one or more positions of jaw member 164, e.g., the open position, the fully closed position, and/or one or more positions therebetween, as an absolute distance, relative distance, absolute angle, or relative angle. Sensor 161 may sense the position of jaw member 164 directly or indirectly, e.g., via sensing the position of one or more components coupled to jaw member 164 such as, for example, outer drive sleeve 152 and/or drive pin 155. Alternatively, sensor 161 may be disposed on or incorporated into a separate device, e.g., a surgical camera, configured to detect the position of jaw member 164.
With reference to
In aspects, the use of a surgical instrument or system may be categorized at the time of activation and/or a change in condition (e.g., a change in activation, clamp lever position, jaw member position, etc.). With respect to surgical instrument 100 (
Continuing with reference to
A use may be categorized in use profile “B” when it is determined that the instrument or system is activated in a second state corresponding to a second activation setting (such as a HIGH power and/or tissue cutting setting). This categorization may be made regardless of the clamp lever position, the jaw member position, and/or temporal considerations.
Uses are categorized in one of use profiles “C,” “D,” “E,” or “F” when it is determined that the clamp lever is fully actuated and that instrument or system is activated in the first state corresponding to the first activation setting. Where it is further determined that the jaw member is fully closed and that the time since the start of the activation is less than a predefined threshold and/or no prior tissue seals have been completed (within a predefined threshold), the use is categorized in use profile “C.” Alternatively, where it is further determined that the jaw member is fully closed and that: the time since the start of the activation is longer than a predefined threshold; and/or that a tissue seal has been previously completed (within a predefined threshold), the use is categorized in use profile “D.”
Where it is further determined that the jaw member is partially open, e.g., not fully closed, and that the time since the start of the activation is less than a predefined threshold and/or no prior tissue seals have been completed (within a predefined threshold), the use is categorized in use profile “E.” Alternatively, where it is further determined that the jaw member is partially open, e.g., not fully closed, and that the time since the start of the activation is longer than a predefined threshold (but within a second predefined threshold) and/or a tissue seal has been previously completed (within a predefined threshold), the use is categorized in use profile “F.”
Turning now to
In aspects, e.g., robotic or other at least partially-automated aspects, rather than determining the use profile based on a plurality of factors, e.g., clamp lever position, activation state, jaw member position, and temporal relation, the user may input an intended surgical task and the instrument or system may achieve the conditions, e.g., the clamp lever position (or corresponding position in aspects where a manual clamp lever is not utilized), activation state, jaw member position, and temporal considerations, for the use profile associated with that surgical task. The corresponding energy settings, as detailed below, may then be implemented. In other aspects, e.g., with respect to manual instruments or systems, instructions, recommendations, and/or warnings on how to operate the surgical instrument or system may be provided based on the conditions for a use profile associated with a user-input surgical task.
Referring to
With reference to
Although exemplary use profiles are detailed above, it is contemplated that any additional or alternative use profiles may be provided and determined based on the above/and or different information, e.g., using impedance feedback to determine a use profile. In aspects, machine learning may be implemented to determine, e.g., using the above information, impedance feedback, and/or any other available data from the instrument or other instruments, in order to determine a use profile. Machine learning may also be utilized to determine appropriate energy-delivery settings for each use profile.
While several aspects of the disclosure have been detailed above and are 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 and accompanying drawings should not be construed as limiting, but merely as exemplifications of particular aspects. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
This application is a 371 National Stage Application of International Application No. PCT/IB2022/053819, filed Apr. 25, 2022, which claims the benefit of, and priority to, U.S. Provisional Patent Application No. 63/183,489, filed on May 3, 2021, the entire contents of each of which are hereby incorporated herein by reference.
Filing Document | Filing Date | Country | Kind |
---|---|---|---|
PCT/IB2022/053819 | 4/25/2022 | WO |
Number | Date | Country | |
---|---|---|---|
63183489 | May 2021 | US |