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 treating tissue, e.g., sealing and/or transecting tissue, and/or tissue sensing.
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 coagulate, cauterize, fuse, seal, cut, and/or desiccate tissue to effect hemostasis. 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 devices transmit Radio Frequency (RF) energy through tissue to treat tissue. An electrosurgical device may include, for example, opposing structures operable to clamp tissue therebetween and conduct energy, e.g., bipolar RF energy, through clamped tissue to treat, e.g., seal, the clamped tissue, or may include a monopolar probe configured to supply energy, e.g., monopolar RF energy, to tissue to treat, e.g., transect, tissue, while the energy is returned by a remote return electrode device. Additional or alternative electrosurgical devices, in either a monopolar or bipolar RF configuration, conduct RF through tissue to sense one or more properties.
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 method of treating tissue including clamping tissue between an ultrasonic blade and a jaw member, simultaneously transmitting ultrasonic energy and supplying electrosurgical energy, monitoring an impedance of the clamped tissue during the simultaneous transmission of ultrasonic energy and supply of electrosurgical energy, and terminating the simultaneous transmission of ultrasonic energy and supply of electrosurgical energy when the clamped tissue is sealed. The ultrasonic energy is transmitted to the ultrasonic blade to vibrate the ultrasonic blade at a first blade velocity, thereby heating the clamped tissue. The electrosurgical energy is supplied, at a constant voltage, to the jaw member and the ultrasonic blade at different potentials such that the electrosurgical energy is conducted therebetween and through the clamped tissue to heat the clamped tissue. Completion of sealing of the clamped tissue is indicated by the impedance of the clamped tissue being equal to or greater than a threshold impedance.
In an aspect of the present disclosure, the first blade velocity is from about 2.4 m/s to about 5.0 m/s, from about 3.0 m/s to about 4.2 m/s, or about 3.6 m/s.
In another aspect of the present disclosure, the constant voltage is an applied voltage of from about 20 Vrms to about 45 Vrms; in other aspects, from about 25 Vrms to about 40 Vrms; and in still other aspects, from about 30 Vrms to about 35 Vrms.
In still another aspect of the present disclosure, the method further includes, after terminating the simultaneous transmission of ultrasonic energy and supply of electrosurgical energy, transmitting ultrasonic energy to the ultrasonic blade to vibrate the ultrasonic blade at a second blade velocity greater than the first blade velocity to transect the sealed tissue.
In yet another aspect of the present disclosure, the second blade velocity is from about 7.0 m/s to about 10.0 m/s, from about 7.5 m/s to about 8.5 m/s, or about 8.0 m/s.
In still yet another aspect of the present disclosure, the method further includes terminating the transmission of ultrasonic energy to vibrate the ultrasonic blade at the second blade velocity when it is determined that transection of the sealed tissue is complete.
In another aspect of the present disclosure, the jaw member includes a body defining first and second radiused surfaces and a jaw liner defining a tissue contacting surface disposed between the first and second radiused surfaces. The tissue contacting surface opposes the ultrasonic blade when clamping tissue therebetween. In such aspects, supplying the electrosurgical energy includes conducting the electrosurgical energy between the ultrasonic blade and the first and second radiused surfaces.
In another aspect of the present disclosure, the first and second radiused surfaces define radii of curvature of from about 0.003 inches to about 0.012 inches, from about 0.005 inches to about 0.010 inches, or about 0.008 inches.
In yet another aspect of the present disclosure, a first plane is tangential to the first and second radiused surfaces and the tissue contacting surface defines a second plane. The second plane is recessed relative to the first plane a distance of from about 0.001 inches to about 0.010 inches, from about 0.002 inches to about 0.005 inches, or about 0.003 inches.
In still another aspect of the present disclosure, the ultrasonic blade defines a tissue contacting surface having first and second angled or arcuate surface portions meeting at an apex configured to oppose the jaw member when clamping tissue therebetween.
Also provided in accordance with aspects of the present disclosure is an end effector assembly of a surgical instrument. The end effector assembly includes an ultrasonic blade adapted to receive ultrasonic energy to vibrate the ultrasonic blade at a blade velocity and adapted to connect to a source of electrosurgical energy at a first potential. The end effector assembly further includes a jaw member movable relative to the ultrasonic blade from a spaced-apart position to an approximated position for clamping tissue therebetween. The jaw member includes a structural body including first and second uprights extending longitudinally along the structural body in spaced-apart relation relative to one another. The first and second uprights define radiused free ends and are adapted to connect to the source of electrosurgical energy at a second potential. A first plane is defined tangential to the radiused free ends of the first and second uprights. The jaw member further includes a jaw liner disposed within the structural body between the first and second uprights. The jaw liner defines a tissue contacting surface positioned to oppose the ultrasonic blade in the approximated position. The tissue contacting surface defines a second plane recessed relative to the first plane.
The ultrasonic blade and/or the jaw member may be configured similar to any of the aspects detailed hereinabove or otherwise herein.
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, in some aspects, active and return monopolar electrosurgical plug ports 250, 260, respectively. 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 in an ultrasonic mode of operation 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 in an electrosurgical mode of operation. It is also contemplated that one or more common ports (not shown) may be configured to act as any two or more of ports 230-260. In monopolar configurations, plug 520 of return electrode device 500 is connected to return monopolar electrosurgical plug port 260.
Continuing with reference to
Elongated assembly 150 of surgical instrument 100 includes an outer drive sleeve 152, an inner support sleeve 153 (
The drive assembly may be tuned to provide a specific jaw clamping force, or jaw clamping force within a jaw clamping force range, to tissue clamped between jaw member 164 and blade 162 or may include a force-limiting feature whereby the clamping force applied to tissue clamped between jaw member 164 and blade 162 is limited to a particular jaw clamping force or a jaw clamping force within a jaw clamping force range. The jaw clamping force, measured at a distance of about 0.192 inches from a distal end of jaw member 164 when clamp trigger 130 is fully actuated, may be from about 2 lbf to about 7 lbf, in other aspects from about 2.5 lbf to about 6.0 lbf, and, in still other aspects, about 3.2 lbf. Alternatively, the jaw clamping force may be about 5.5 lbf.
Waveguide 154, as noted above, extends from handle assembly 110 through the inner support sleeve. Waveguide 154 includes blade 162 disposed at a distal end thereof. Blade 162 may be integrally formed with waveguide 154, separately formed and subsequently attached (permanently or removably) to waveguide 154, or otherwise operably coupled with waveguide 154. Waveguide 154 and/or blade 162 may be formed from titanium, a titanium alloy, or other suitable electrically conductive material(s). Waveguide 154 includes a proximal connector (not shown), e.g., a threaded male connector, configured for engagement, e.g., threaded engagement within a threaded female receiver, of ultrasonic transducer 140 such that ultrasonic motion produced by ultrasonic transducer 140 is transmitted along waveguide 154 to blade 162 for treating tissue clamped between blade 162 and jaw member 164 or positioned adjacent to blade 162.
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 activation button 120 in an ultrasonic mode of operation. 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 such that, as detailed below, bipolar electrosurgical energy may be conducted between blade 162 and jaw member 164. In monopolar configurations, an electrical lead wire 199 is electrically coupled to waveguide 154 such that, as also detailed below, monopolar electrosurgical energy may be supplied to tissue from blade 162.
Alternatively, an 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. One or more 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 activation button 120 in an electrosurgical mode of operation.
Referring to
As surgical instrument 300 is similar to and may include any of the features of surgical system 10 (
Body portion 306 of housing 304 is configured to support TAG 330 thereon or therein. TAG 330 includes an ultrasonic generator 332 and an ultrasonic transducer 334. TAG 330 may be permanently engaged with body portion 306 of housing 304 or removable therefrom. Ultrasonic generator 332 includes a housing 336 configured to house the internal electronics of ultrasonic generator 332, and a cradle 338 configured to rotatably support ultrasonic transducer 334.
Fixed handle portion 308 of housing 304 defines a compartment 314 configured to receive electrosurgical generator 340 and battery assembly 350 and a door 318 configured to enclose compartment 314. Electrosurgical generator 340 and battery assembly 350 may be integrally formed, releasably engaged, or separate from one another and, are configured for releasably receipt within compartment 314, accessible via door 318. As an alternative to electrosurgical generator 340 being insertable into compartment 314, electrosurgical generator 340 may be mounted, e.g., permanently or releasably, to an exterior of fixed handle portion 308, e.g., depending therefrom, or may be disposed on or within housing 336 of TAG 330 (permanently or removably).
Electrical connections (not shown) within housing 304 of handle assembly 302 serve to electrically couple activation button 310 and/or battery assembly 350 when surgical instrument 300 is assembled for use. In some configurations, surgical instrument 300 may be utilized without electrosurgical generator 340, thus functioning only in the ultrasonic mode of operation. Additionally or alternatively, surgical instrument 300 may be utilized without TAG 330, thus functioning only in the electrosurgical mode of operation. Surgical instrument 100 (
With reference 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 ultrasonic surgical instrument 100 (
Referring to
End effector assembly 160 includes a blade 162 and a jaw member 164. Blade 162 may define a linear configuration, may define a curved configuration, or may define any other suitable configuration, e.g., straight and/or curved surfaces, portions, and/or sections; one or more convex and/or concave surfaces, portions, and/or sections; etc. With respect to curved configurations, blade 162, more specifically, may be curved in any direction relative to jaw member 164, for example, such that the distal tip of blade 162 is curved towards jaw member 164, away from jaw member 164, or laterally (in either direction) relative to jaw member 164. Further, blade 162 may be formed to include multiple curves in similar directions, multiple curves in different directions within a single plane, and/or multiple curves in different directions in different planes. In addition, although one configuration of blade 162 is described and illustrated herein, it is contemplated that blade 162 may additionally or alternatively be formed to include any suitable features, e.g., a tapered configuration, various different cross-sectional configurations along its length, cut-outs, indents, edges, protrusions, straight surfaces, curved surfaces, angled surfaces, wide edges, narrow edges, and/or other features.
In embodiments, blade 162 defines a generally convex first tissue contacting surface 171, e.g., the surface that opposes jaw member 164 in the approximated position thereof. Generally convex first tissue contacting surface 171 may be defined by a pair of surfaces 172a, 172b (flat or arcuate, e.g., convex, surfaces) that converge at an apex 172c, or may be formed by a continuously arcuate surface defining an apex 172c. Blade 162 may further define substantially flat lateral surfaces 174 (excluding any curvature due to the curvature of blade 162 itself) on either side of first tissue contacting surface 171, and a second tissue contacting surface 175 opposite first tissue contacting surface 171 and similarly configured relative thereto, e.g., with surfaces 176a, 176b (or surface portions) converging at an apex 176c, although other configurations are also contemplated.
Waveguide 154 (
First tissue contacting surface 171 is configured to contact tissue clamped between blade 162 and jaw member 164 for treating clamped tissue, e.g., sealing and/or transecting clamped tissue, while second tissue contacting surface 175 may be utilized for, e.g., tissue transection, back scoring, etc. The distal end of blade 162 and/or some or all of the other surfaces of blade 162 may additionally or alternatively be utilized to treat tissue.
Lateral surfaces 174 and, in aspects, tapered surfaces 178 and/or the proximal tapered surfaces (not shown), may be coated with an electrically insulative material such that, in the electrosurgical mode of operation, current is directed from first tissue contacting surface 171 of blade 162 to jaw member 164 rather than from lateral surfaces 174 (or tapered surfaces 178 or the proximal tapered surfaces (not shown)). Suitable electrically insulative 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.
Blade 162 may define a maximum width between lateral surfaces 174, at the proximal end portions thereof, of from about 0.60 inches to about 0.70 inches; and in other aspects, of about 0.65 inches. Blade 162 and may taper in width in a proximal-to-distal direction along at least a portion of a length thereof to a minimum width between lateral surfaces 174 and/or at the distal end of blade 162, of from about 0.27 inches to about 0.33 inches; and in other aspects, of about 0.30 inches. The apexes 172c, 176c of blade 162 may define surfaces having widths of from about 0.000 inches to about 0.010 inches; and, in other aspects, of about 0.003 inches.
With additional reference to
Structural body 182 of jaw member 164 further includes an elongated distal portion defining a generally U-shaped configuration including a backspan 185a and a pair of spaced-apart uprights 185b extending from backspan 185a in generally perpendicular orientation relative to backspan 185a and generally parallel orientation relative to one another. Backspan 185a and uprights 185b cooperate to define a cavity 185c therein. Cavity 185c defines an elongated, generally T-shaped configuration for slidable receipt and retention of jaw liner 184 therein, although other suitable configurations for receiving and retaining jaw liner 184 are also contemplated.
Structural body 182 is adapted to connect to a source of electrosurgical energy and, in a bipolar electrosurgical mode of operation, is charged to a different potential as compared to blade 162 to enable the conduction of bipolar electrosurgical (e.g., RF) energy therebetween, through tissue clamped therebetween, to treat the tissue. More specifically, bipolar electrosurgical energy is configured to flow between first tissue contacting surface 171 of blade 162 and free ends 186 of uprights 185b of structural body 182 and through tissue disposed therebetween to complete the electrosurgical energy circuit. In a monopolar electrosurgical mode of operation, structural body 182 may be un-energized, may be charged to the same potential as compared to blade 162, or may be energized while blade 162 is not energized.
Free ends 186 of uprights 185b of structural body 182 define radiused edges to inhibit current concentrations and facilitate the conduction of energy between free ends 186 and blade 162. More specifically, free ends 186 may define radii of curvature of from about 0.003 inches to about 0.012 inches; in other aspects, from about 0.005 inches to about 0.010 inches; and, in still other aspects, of about 0.008 inches. Other suitable raidused or other configurations are also contemplated, as are other surface features such as, for example, teeth, scallops, etc. to facilitate tissue grasping and retention (see, e.g.,
Referring to
Turning to
Structural body 582 includes a pair of proximal flanges (not shown) and an elongated distal portion defining a pair of spaced-apart upright supports 588 which may be separate from one another along the lengths thereof or joined via a backspan (not shown) along at least portions of the lengths thereof). Insulative housing 585 is formed via overmolding, e.g., with one or multiple-shot overmolds, or is otherwise configured, and serves to capture and retain structural body 582, jaw liner 584, and first and second electrically-conductive plates 586a, 586b in position relative to one another. Insulative housing 585 and/or electrically-conductive plates 586a, 586b are not limited to the configuration illustrated in
Referring back to
Jaw liner 184 includes a tissue contacting surface 188 that is substantially planar (not withstanding gripping teeth and/or indentations formed therein). Tissue contacting surface 188 defines a plane “P2.” Plane “P2” is substantially parallel with a transverse plane “P1.” Plane “P1” is tangential to free ends 186 of uprights 185b of structural body 182. Planes “P1” and “P2” may define a gap distance therebetween, e.g., wherein plane “P2” is recessed within jaw member 164 as compared to plane “P1,” of from about 0.001 inches to about 0.010 inches; in other aspects, from about 0.002 inches to about 0.005 inches; and in still other aspects, of about 0.003 inches. In other configurations, planes “P1” and “P2” are coplanar.
Tissue contacting surface 188 of jaw liner 184 may define a width of from about 0.030 to about 0.70 inches; in other aspects, from about 0.050 to about 0.054 inches; and, in still other aspects, of about 0.052 inches. The width of tissue contacting surface 188 is also substantially the lateral spacing between uprights 185b of structural body 182 (defined between the interior surfaces thereof). Tissue contacting surface 188 may further define a length of about 0.56 inches. Tissue contacting surface 188 may define a surface area of from about 0.020 in2 to about 0.040 in2; in other aspects, from about 0.025 in2 to about 0.035 in2; and, in still other aspects, about 0.028 in2. As pressure is force per unit area, jaw clamping pressure may be stated as jaw clamping force (as detailed above) divided by the surface are of tissue contacting surface 188 (with the assumption that tissue contacts the entire surface area). The jaw clamping pressure applied to tissue may be from about 35 psi to about 285 psi; in other aspects, from about 70 psi to about 180 psi; and in still other aspects from about 90 psi to about 160 psi.
Referring generally to
The ultrasonic mode of operation may include one or more energy level settings such as, for example, a first, e.g., LOW, setting and a second, e.g., HIGH, setting. Activation button 120 may include multiple activation switches, multiple activation buttons 120 may be provided, a suitable activation algorithm, etc., may be utilized to enable activation between an OFF condition, a first activated condition corresponding to the first energy level setting, e.g., LOW, and a second activated condition corresponding to the second energy level setting, e.g., HIGH. The first and second energy level settings may correspond to different vibration velocities of blade 162. For example, the first energy level setting may correspond to an unloaded velocity of blade 162 of from 2.4 m/s to about 5.0 m/s, in other aspects, from about 3.0 m/s to about 4.2 m/s; and in still other aspects, of about 3.6 m/s. The second energy level setting may correspond to an unloaded velocity of blade 162 of from 7.0 m/s to about 10.0 m/s; in other aspects, from about 7.5 m/s to about 8.5 m/s; and, in still other aspects, of about 8.0 m/s.
The one or more electrosurgical energy modes of operation may include bipolar electrosurgical modes and/or monopolar electrosurgical modes. In order to enable bipolar electrosurgical modes, structural body 182 and waveguide 154 are adapted to connect to a source of electrosurgical energy, e.g., generator 200. For monopolar electrosurgical modes, structural body 182 and/or waveguide 154 are adapted to connect to generator 200. The bipolar and/or monopolar electrosurgical modes may be tissue treating modes and/or sensing modes, and may be utilized together with one another and/or the ultrasonic modes, e.g., simultaneously, overlapping, sequentially, etc., and/or separately from one and/or the ultrasonic modes.
End effector assembly 160, more specifically, may be configured for use in a bipolar electrosurgical tissue treatment mode of operation, a bipolar electrosurgical sensing mode of operation, a monopolar electrosurgical tissue treatment mode of operation, and/or a monopolar sensing mode of operation. With respect to bipolar electrosurgical tissue treatment, bipolar electrosurgical energy is conducted between first tissue contacting surface 171 of blade 162 and structural body 182 of jaw member 164 to treat, e.g., seal, tissue clamped between first tissue contacting surface 171 and jaw liner 184.
Bipolar electrosurgical tissue treatment may be utilized simultaneously, or otherwise in cooperation with, the ultrasonic mode of operation, e.g., in the first energy level setting, to facilitate treating, e.g., sealing, tissue. Other suitable configurations for bipolar electrosurgical tissue treatment are also contemplated. Bipolar electrosurgical tissue treatment energy, e.g., simultaneously with the ultrasonic mode of operation at the first energy level setting, may be provided at a constant voltage. The constant voltage may be an applied voltage (the voltage applied to tissue; not the voltage output from generator 200) of from about 20 Vrms to about 45 Vrms; in other aspects, from about 25 Vrms to about 40 Vrms; and in still other aspects, from about 30 Vrms to about 35 Vrms. Feedback-based control of output and/or applied electrical properties may be utilized to maintain constant voltage. The constant voltage may be provided at between about 200 kHz and about 400 kHz. The power draw during constant voltage output may be between about 0 W to about 20 W.
With respect to bipolar electrosurgical sensing, an electrical signal is conducted between first tissue contacting surface 171 of blade 162 and structural body 182 of jaw member 164 to enable generator 200 to ascertain one or more properties such as, for example, current, voltage, power, impedance, slopes of these properties, etc. The electrical signal may be the supply of electrosurgical tissue treatment energy or a separate sensing signal and may be utilized before, during, intermittently, and/or after the supply of electrosurgical tissue treatment energy and/or the supply of ultrasonic tissue treatment energy, or separately therefrom. The property(s) sensed during bipolar electrosurgical sensing may be utilized for identifying tissue type, identifying tissue thickness, identifying tissue compressibility, identifying tissue composition (vascular tissue, organ tissue, muscle tissue, etc.), feedback-based control, etc.
Monopolar electrosurgical tissue treatment involves the supply of electrosurgical energy from blade 162 (with jaw member 164 un-energized), from jaw member 164 (with blade 162 un-energized), or from both blade 162 and jaw member 164 (with both energized to the same potential) to tissue to treat, e.g., transect and/or spot coagulate, tissue. Monopolar electrosurgical tissue treatment utilizes a remote return electrode device, e.g., return pad 510 of device 500 (see
Monopolar electrosurgical sensing enables blade 162 (and/or jaw member 164) to function as a monitoring probe, transmitting an electrosurgical signal to tissue such as, for example, for critical anatomical structure identification, nerve monitoring, nearby instrument detection, etc. Monopolar electrosurgical sensing may also be utilized to identify tissue properties, for feedback-based control, etc. in open-jaw conditions, e.g., wherein the monopolar electrosurgical sensing signal is transmitted from blade 162 to tissue and returned via return pad 510 of device 500 (see
With additional reference to
In order to supply electrosurgical energy to structural body 182 of jaw member 164, one of the electrical lead wires 199 extending from cable assembly 190 into housing 112 is electrically connected to one of the sleeves 152, 153 of elongated assembly 150, e.g., inner support sleeve 153, within housing 112, e.g., via a slip ring connection (not shown), to enable rotation of sleeve 153 relative to housing 112. Inner support sleeve 153, in turn, is electrically coupled to structural body 182 of jaw member 164 via direct contact between pivot bosses 183c of proximal flanges 183a, 183b of structural body 182 and inner support sleeve 153. Thus, electrosurgical energy may be conducted from generator 200, through the electrical lead wire 199, and through inner support sleeve 153 to structural body 182 of jaw member 164. First and second insulators 157, 159 are provided to electrically isolate waveguide 154, inner support sleeve 153, and outer drive sleeve 152 from one another. Insulators 157, 159 may be configured as sheaths, spaced-apart rings, or in any other suitable manner so as to maintain electrical isolation. Waveguide 154, inner support sleeve 153, and outer drive sleeve 152 may be concentrically disposed relative to one another. Other configurations are also contemplated.
Turning to
In order to seal tissue, tissue is first clamped between blade 162 and jaw member 164 in the approximated position of jaw member 164 such that tissue is held by and in contact with tissue contacting surface 188 of jaw liner 184 and free ends 186 of uprights 185b of structural body 182 on the jaw side of tissue, and first tissue contacting surface 171 of blade 162 on the blade side of tissue.
With respect to simultaneous use of the bipolar electrosurgical tissue treatment mode of operation and the ultrasonic mode of operation to seal tissue, as indicated at 600 (
Tissue impedance is monitored (at 630 (
Once tissue has been sealed, it is determined whether the second activation has been effected at 660 (
Turning to
Referring to
Turning to
While several embodiments 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 embodiments. 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/US2021/061631, filed Dec. 2, 2021, which claims the benefit of, and priority to, U.S. Provisional Patent Application No. 63/122,633 filed on Dec. 8, 2020, the entire contents of which are hereby incorporated herein by reference.
Filing Document | Filing Date | Country | Kind |
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PCT/US2021/061631 | 12/2/2021 | WO |
Number | Date | Country | |
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63122633 | Dec 2020 | US |