The present disclosure relates to surgical instruments, systems, and methods. More specifically, the present disclosure relates to ultrasonic and multi-energy surgical instruments, systems, and methods for sealing, cutting, and/or sensing tissue.
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.
Ultrasonic surgical instruments typically employ a transducer coupled to a handle of the ultrasonic surgical instrument and configured to produce ultrasonic energy for transmission along a waveguide to an end effector of the ultrasonic surgical instrument that is designed to treat tissue with the ultrasonic energy. The transducer may be driven by an ultrasonic generator that is on-board, e.g., on or within the handle of the ultrasonic surgical instrument, or remotely disposed, e.g., as a set-top box connected to the ultrasonic surgical instrument via a surgical cable. The end effector of the ultrasonic surgical instrument may include a blade that receives the ultrasonic energy from the waveguide for application to tissue and a jaw member configured to clamp tissue between the blade and the jaw member to facilitate treatment thereof.
As used herein, the term “distal” refers to the portion that is 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, 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 an ultrasonic surgical instrument including a housing, an ultrasonic transducer supported by the housing, and an elongated assembly extending distally from the housing. The elongated assembly includes a waveguide configured to operably couple to the ultrasonic transducer. The waveguide defines a blade at a distal end portion thereof. The elongated assembly further includes first and second panels disposed on opposite sides of the blade in laterally-spaced relation relative thereto and extending along at least a portion of a length of the blade, and jaw pivotable relative to the blade and the first and second panels between a spaced-apart position and an approximated position. In the approximated position, the blade and the jaw are configured to define a first distance therebetween and grasp a center portion of tissue therebetween under a first clamping force, and the jaw and each of the first and second panels are configured to define a second distance therebetween greater than the first distance and grasp outer lateral portions of tissue therebetween under a second clamping pressure less than the first clamping pressure. In other aspects, the second distance may be substantially equal to the first distance or less than the first distance such that the second clamping pressure is substantially equal to or greater than the first clamping pressure.
In an aspect of the present disclosure, the blade includes a tissue-contacting surface having a convex configuration defining an apex. In such aspects, in the clamping position, the tissue-contacting surface of the blade and the jaw are configured to grasp a center portion of tissue therebetween.
In another aspect of the present disclosure, the apex of the tissue-contacting surface of the blade extends further towards the jaw as compared to tissue-contacting surfaces of the first and second panels.
In still another aspect of the present disclosure, the jaw includes a structural body and a jaw liner. The jaw liner defines a tissue-contacting surface and the structural body defines first and second tissue-contacting surfaces disposed on either side of the tissue-contacting surface of the jaw liner. In such aspects, in the approximated position, the tissue-contacting surface of the jaw liner and the blade are configured to grasp a center portion of tissue therebetween, and the first and second tissue-contacting surfaces of the structural body and the first and second panels, respectively, are configured to grasp outer lateral portions of tissue therebetween.
In yet another aspect of the present disclosure, the first and second tissue-contacting surfaces of the structural body are recessed relative to the tissue-contacting surface of the jaw liner. In other aspects, the first and second tissue-contacting surfaces of the structural body are substantially level, e.g., co-planar, relative to the tissue-contacting surface of the jaw liner or protrude further towards the blade as compared to the tissue-contacting surface of the jaw liner.
In still yet another aspect of the present disclosure, the blade includes a tissue-contacting surface having a convex configuration defining an apex, and the jaw includes a structural body and a jaw liner. The jaw liner defines a tissue-contacting surface and the structural body defines first and second tissue-contacting surfaces disposed on either side of the tissue-contacting surface of the jaw liner. In such aspects, in the approximated position, the tissue-contacting surface of the blade and the tissue-contacting surface of the jaw liner are configured to grasp a center portion of tissue therebetween, and the first and second tissue-contacting surfaces of the structural body and the first and second panels, respectively, are configured to grasp outer lateral portions of tissue therebetween.
In another aspect of the present disclosure, the first and second panels are fixed relative to the blade. Alternatively, the first and second panels are movable relative to the blade between a more-proximal position and a more-distal position. In such movable aspects, the first and second panels may be movable relative to the blade between the more-proximal position and the more-distal position in connection with pivoting of the jaw between the spaced-apart position and the approximated position.
In yet another aspect of the present disclosure, the blade is curved and the first and second panels are similarly curved.
In still another aspect of the present disclosure, the housing further supports an ultrasonic generator configured to drive the ultrasonic transducer. In such aspects, the housing may further support a battery assembly configured to power the ultrasonic generator.
A method of sealing and cutting tissue provided in accordance with aspects of the present disclosure includes clamping tissue with an end effector including an ultrasonic blade, first and second panels disposed on opposite sides of the ultrasonic blade in laterally-spaced relation relative thereto and extending along at least a portion of a length of the ultrasonic blade, and a jaw. Tissue is clamped such that the ultrasonic blade and the jaw define a first distance therebetween and grasp a center portion of tissue therebetween under a first clamping force, and such that the jaw and each of the first and second panels define a second distance therebetween greater than the first distance and grasp outer lateral portions of tissue therebetween under a second clamping pressure less than the first clamping pressure. In other aspects, the second distance may be substantially equal to the first distance or less than the first distance such that the second clamping pressure is substantially equal to or greater than the first clamping pressure.
The method further includes activating the ultrasonic blade to heat the center portion of tissue to a first temperature and cut the center portion of tissue, and heat the outer lateral portions of tissue to a second temperature less than the first temperature and seal the outer lateral portions of tissue.
In an aspect of the present disclosure, clamping the tissue includes applying a first compression to the center portion of tissue and applying a second compression to the outer lateral portions of tissue that is less than the first compression.
In another aspect of the present disclosure, clamping the tissue includes moving the jaw from a spaced-apart position to an approximated position relative to the ultrasonic blade and the first and second panels. Moving the jaw from the spaced-apart position to the approximated position, in aspects, may effect deployment of the first and second panels from a more-proximal position to a more-distal position.
In yet another aspect of the present disclosure, the center portion of tissue is clamped between the ultrasonic blade and a jaw liner of the jaw, and wherein the outer lateral portions of tissue are clamped between a structural body of the jaw and the first and second panels.
In still another aspect of the present disclosure, activating the ultrasonic blade includes driving an ultrasonic transducer to transmit ultrasonic energy along a waveguide to the ultrasonic blade.
Also provided in accordance with aspects of the present disclosure is an ultrasonic surgical system including an ultrasonic generator, a housing, an ultrasonic transducer supported by the housing, a waveguide coupled to the ultrasonic transducer, the waveguide defining a blade at a distal end portion thereof, and first and second panels disposed on opposite sides of the blade in laterally-spaced relation relative thereto. The ultrasonic generator is electrically coupled to the ultrasonic transducer for transmitting an ultrasonic drive signal to the ultrasonic transducer for driving the ultrasonic transducer to transmit ultrasonic energy along the waveguide to the blade. The ultrasonic generator is also electrically coupled to the blade and the first and second panels for transmitting an interrogation signal between the blade, the first and second panels, and tissue.
In an aspect of the present disclosure, the interrogation signal is a Radio Frequency (RF) signal. In such aspects, the blade may be configured to define a first potential and the first and second panels may be configured to define a second, different potential for transmitting the RF signal therebetween and through tissue.
In another aspect of the present disclosure, the ultrasonic generator is configured to alternatingly or simultaneously transmit the ultrasonic drive signal and the interrogation signal.
In another aspect of the present disclosure, the ultrasonic drive signal includes an AC waveform. Alternatively or additionally, the interrogation signal includes at least one pulse.
In still another aspect of the present disclosure, the ultrasonic generator is configured to determine tissue impedance based upon the interrogation signal.
In yet another aspect of the present disclosure, the ultrasonic surgical system further includes a jaw pivotable relative to the blade and the first and second panels between a spaced-apart position and an approximated position.
In still yet another aspect of the present disclosure, the housing further supports the ultrasonic generator. In such aspects, the housing may also support a battery assembly configured to power the ultrasonic generator.
A method of treating tissue provided in accordance with aspects of the present disclosure includes transmitting an ultrasonic drive signal from an ultrasonic generator to an ultrasonic transducer to drive the ultrasonic transducer to transmit ultrasonic energy along a waveguide to a blade. The method further includes transmitting an interrogation signal from the ultrasonic generator to the blade, through tissue, to first and second panels disposed on opposite sides of the blade in laterally-spaced relation relative thereto, and back to the ultrasonic generator to determine at least one parameter of tissue.
In an aspect of the present disclosure, transmitting the interrogation signal includes defining a first potential at the blade and defining a second, different potential at the first and second panels to transmit an RF signal therebetween and through tissue.
In another aspect of the present disclosure, transmitting the ultrasonic drive signal includes transmitting an AC waveform and/or transmitting the interrogation signal includes transmitting at least one pulse.
In yet another aspect of the present disclosure, the method further includes stopping transmission of the ultrasonic drive signal before transmitting the interrogation signal and resuming transmission of the ultrasonic drive signal after transmitting the interrogation signal.
In still another aspect of the present disclosure, the ultrasonic generator is configured to alternatingly transmit the ultrasonic drive signal and the interrogation signal.
In another aspect of the present disclosure, determining the at least one parameter of tissue includes determining tissue impedance.
In another aspect of the present disclosure, the method further includes providing at least one output in response to determining the at least one parameter of tissue.
In still yet another aspect of the present disclosure, the method further includes modifying the ultrasonic drive signal in response to determining the at least one parameter of tissue.
A surgical end effector assembly provided in accordance with the present disclosure and configured for use with any of the instruments or systems detailed herein or other suitable instruments or systems includes an ultrasonic blade adapted to connect to an ultrasonic transducer configured to transmit ultrasonic energy to the ultrasonic blade, first and second panels disposed on opposite sides of the ultrasonic blade in laterally-spaced relation relative thereto, and a jaw pivotable relative to the ultrasonic blade and the first and second panels between open and clamping positions. At least two of the ultrasonic blade, the first and second panels, or the jaw are energizable to different electrical potentials for transmitting an electric (e.g., a Radio Frequency (RF) or a Direct Current (DC)) signal therebetween and through tissue for at least one of interrogating tissue or treating tissue.
In an aspect of the present disclosure, the ultrasonic blade is configured to be energized to a first potential and the first and second panels are configured to be energized to a second, different potential for transmitting the electric signal therebetween and through tissue.
In another aspect of the present disclosure, the jaw is configured to be energized to a first potential and the first and second panels are configured to be energized to a second, different potential for transmitting the electric signal therebetween and through tissue.
In yet another aspect, the jaw includes a structural body defining first and second surfaces, and a jaw liner disposed between the first and second surfaces. In such aspects, the first and second surfaces are energizable for transmitting the electric signal.
In still another aspect of the present disclosure, the jaw includes a structural body supporting first and second electrically-conductive plates, and a jaw liner disposed between the first and second electrically-conductive plates. In such aspects, the first and second electrically-conductive plates are energizable for transmitting the electric signal.
In still yet another aspect of the present disclosure, an insulative coating is disposed on at least one of outer lateral sides of the ultrasonic blade or inner lateral sides of the first and second panels.
In another aspect of the present disclosure, a gap distance is maintained between outer lateral sides of the ultrasonic blade and inner lateral sides of the first and second panels.
In still another aspect of the present disclosure each of the first and second panels includes a vertical body and a shelf extending laterally from the vertical body. The shelf defines an opposing surface positioned to oppose the jaw in the clamping position of the jaw.
In yet another aspect of the present disclosure, each of the first and second panels tapers in height in a proximal-to-distal direction from lower portions thereof to increasingly expose a bottom portion of the blade in a proximal-to-distal direction.
Another surgical end effector assembly provided in accordance with the present disclosure and configured for use with any of the instruments or systems detailed herein or other suitable instruments or systems includes an ultrasonic blade adapted to connect to an ultrasonic transducer configured to transmit ultrasonic energy to the ultrasonic blade, first and second panels disposed on opposite sides of the ultrasonic blade in laterally-spaced relation relative thereto, and a jaw pivotable relative to the ultrasonic blade and the first and second panels between open and clamping positions. The jaw includes a structural body, a jaw liner supported by the structural body and positioned to oppose the ultrasonic blade in the clamping position of the jaw, and first and second energy elements supported by the structural body on either side of the jaw liner and positioned to oppose the first and second panels, respectively, in the clamping position of the jaw. The first and second energy elements are configured to facilitate delivery of another energy to tissue disposed between the first and second energy elements and the first and second panels, respectively. The another energy may be different from ultrasonic energy.
In an aspect of the present disclosure, the first and second energy elements are optical emitters configured to emit optical energy through tissue disposed between the first and second energy elements and the first and second panels, respectively. In such aspects, the first and second panels may be configured as optical absorbers or optical reflectors.
In another aspect of the present disclosure, the first and second energy elements are ultrasound transducers configured to emit ultrasound wave energy through tissue disposed between the first and second energy elements and the first and second panels, respectively. In such aspects, the first and second panels may be configured as ultrasound absorbers or ultrasound reflectors.
In yet another aspect of the present disclosure, the first and second energy elements are thermal heaters configured to conduct thermal energy to tissue disposed between the first and second energy elements and the first and second panels, respectively.
In still another aspect of the present disclosure, the another energy is utilized to treat tissue and/or to interrogate tissue.
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
Body portion 112 of housing 110 is configured to support an ultrasonic transducer and generator assembly (“TAG”) 300 including a generator 310 and an ultrasonic transducer 320. TAG 300 may be permanently engaged with body portion 112 of housing 110 or removable therefrom. Generator 310 includes a housing 312 configured to house the internal electronics of generator 310, and a cradle 314 configured to rotatably support ultrasonic transducer 320.
Continuing with reference to
A set of connectors 330 and corresponding rotational contacts 334 associated with generator 310 and ultrasonic transducer 320, respectively, enable ultrasonic drive signals to be communicated from generator 310 to piezoelectric stack 322 of ultrasonic transducer 320 to drive ultrasonic transducer 320 regardless of the rotational orientation of ultrasonic transducer 320 relative to generator 310. Horn 324, in turn, is configured to transmit the ultrasonic energy produced by piezoelectric stack 322 to waveguide 230 of elongated assembly 200 for transmission therealong to blade 282 of end effector 280 of elongated assembly 200, as detailed below.
Referring still to
Referring to
Surgical generator 1200 of surgical system 1010 includes an ultrasonic plug port 1230, and a Radio Frequency (RF) plug port 1240. Surgical generator 1200 is configured to produce ultrasonic drive signals for output through ultrasonic plug port 1230 to surgical instrument 1100 to activate surgical instrument 1100 in an ultrasonic mode of operation and to provide RF energy for output through RF plug port 1240 to surgical instrument 1100 to activate surgical instrument 1100 in an RF mode of operation, e.g., for treating tissue and/or sensing one or more parameters of tissue and/or surgical instrument 1100. It is also contemplated that a common port (not shown) configured to act as both ultrasonic plug port 1230 and an RF plug port 1240 may be utilized.
Surgical instrument 1010 includes a handle assembly 1110, an elongated assembly 1150 extending distally from handle assembly 1110, and cable and plug assembly 1190 which is operably coupled with handle assembly 1110 and extends therefrom for connection to surgical generator 1200. Elongated assembly 1150 is similar to elongated assembly 200 (
Activation button 1120 of handle assembly 1100 is coupled to or between ultrasonic transducer 1140 and/or surgical generator 1200, e.g., via one or more of first electrical lead wires 1197, to enable activation of ultrasonic transducer 1140 in response to depression of activation button 1120. In embodiments, activation button 1120 may be an ON/OFF switch. In other embodiments, activation button 1120 may include multiple actuated stages to enable activation from an OFF position to different actuated positions corresponding to different modes, e.g., a first actuated position corresponding to a first mode and a second actuated position corresponding to a second mode. In still other embodiments, separate activation buttons may be provided, e.g., a first actuation button for activating a first mode and a second activation button for activating a second mode.
Continuing with reference to
With reference to
Waveguide 230, as noted above, extends through inner support sleeve 220. Waveguide 230 defines a body 232 and blade 282 extending from the distal end of body 232. Waveguide 230 (including blade 282) may be formed from titanium, a titanium alloy, or other suitable material(s). Blade 282 serves as the blade of end effector 280 and may be integrally formed with waveguide 230 or separately formed and subsequently attached (permanently or removably) to waveguide 230. Waveguide 230 further includes a proximal threaded male connector 236 configured for threaded engagement within threaded female receiver 349 of horn 324 such that ultrasonic motion produced by ultrasonic transducer 320 is transmitted along waveguide 230 to blade 282 for treating tissue clamped between blade 282 and jaw 284 or positioned adjacent to blade 282.
Referring in particular to
In embodiments, blade 282 defines a generally convex first tissue-contacting surface 283a, e.g., the surface that opposes jaw 284. Generally convex first tissue-contacting surface 283a may defined by a pair of surfaces 283b (flat or arcuate surfaces) that converge at an apex 283c, or may be formed by a single arcuate surface defining an apex 283c. Blade 282 may further define substantially flat lateral surfaces 283d (excluding any curvature due to the curvature of blade 282 itself) on either side of first tissue-contacting surface 283a, and a second tissue-contacting surface 283e opposite first tissue-contacting surface 283a and similarly configured relative thereto, although other configurations are also contemplated. First tissue-contacting surface 283a is configured to contact tissue clamped between blade 282 and jaw 284 for, e.g., sealing and cutting clamped tissue, while second tissue-contacting surface 283e may be utilized for, e.g., tissue dissection, back scoring, etc.
Jaw 284 of end effector 280 includes a more-rigid structural body 286 and a more-compliant jaw liner 288. Structural body 286 includes a pair of proximal flanges 287 that are pivotably coupled to inner support sleeve 220 and operably associated with outer drive sleeve 210, e.g., via receipt within apertures defined within outer drive sleeve 210, such that sliding of outer drive sleeve 210 about inner support sleeve 220 pivots jaw 284 relative to blade 282 from a spaced-apart position to an approximated position to clamp tissue between jaw liner 288 of jaw 284 and blade 282.
Jaw liner 288 of jaw 284 may be fabricated from a compliant material such as, for example, polytetrafluoroethylene (PTFE), such that blade 282 is permitted to vibrate while in contact with jaw liner 288 without damaging components of ultrasonic surgical instrument 10 (
In embodiments, as illustrated in
Panels 290 extend distally from outer and inner sleeves 210, 220 on either side of blade 282 in laterally-spaced relation relative thereto such that the spaces between panels 290 and blade 282, e.g., between lateral surfaces 283d of blade 282, form thermally-insulating air gaps therebetween. Panels 290 define relatively thin, plate-like configurations disposed in vertical orientation such that the height dimensions thereof extend parallel relative to an axis of motion of jaw 284 between the spaced-apart and approximated positions, and such that the width dimensions thereof extend perpendicular relative to the axis of motion of jaw 284 between the spaced-apart and approximated positions. In this manner, panels 290 define relatively narrow tissue-contacting surfaces 292. In embodiments, panels 290 are flared outwardly away from blade 282 or inwardly towards blade 282 whereby the flared portions of panels 290 define tissue-contacting surfaces 292 of greater surface area. In such embodiments, the flared portions of panels 290 may extend generally perpendicularly relative to the vertical body portions of panels 290 such that tissue-contacting surfaces 292 are generally parallel with tissue-contacting surfaces 299a of structural body 286. Other configurations are also contemplated.
Panels 290, in embodiments, are positioned such that blade 282 is laterally centered relative to panels 290, e.g., wherein panels 290 are evenly spaced-apart from blade 282 on either side thereof. Further, in embodiments where blade 282 defines a laterally-curved configuration, panels 290 may likewise define similar curvatures to track the curvature of blade 282 and maintain a substantially uniform spacing therebetween, although other configurations are also contemplated. Alternatively, panels 290 may be positioned such that a uniform gap between blade 282 and the corresponding panel 290 on the concave side of blade 282 is smaller than a uniform gap between blade 282 and the corresponding pane 290 on the convex side of blade 282. In embodiments, protrusions or other features (not shown) extend from panels 290 to contact blade 282, e.g., at a node point, in order to maintain appropriate spacing between panels 290 and blade 282. Panels 290 may be formed from stainless steel or other suitable material(s).
In embodiments, panels 290 define heights that are equal to or greater than the heights of lateral surfaces 283d of blade 282 but equal to or less than the overall height of blade 282, e.g., from the apex 283c of first tissue-contacting surface 283a to the apex of second tissue-contacting surface 283e. More specifically, in embodiments, panels 290 are vertically positioned relative to blade 282 such that tissue-contacting surfaces 292 of panels 290 are horizontally-aligned with the upper ends of lateral surfaces 283d of blade 282. As such, at least a portion of first tissue-contacting surface 283a of blade 282 extends above panels 290 towards jaw 284. The opposite surfaces 294 of panels 290 may be horizontally-aligned with the lower ends of lateral surfaces 283d of blade 282, may be horizontally-aligned with the apex of second tissue-contacting surface 283e of blade 282 (as illustrated (see
Panels 290 are spaced-apart from one another a distance greater than the width of tissue-contacting surface 299b of jaw liner 288 such that, in the approximated position of jaw 284, no portion of tissue-contacting surface 299b of jaw liner 288 directly opposes the tissue-contacting surface 292 of either of panels 290 (see also
Continuing with reference to
As an alternative to panels 290 being fixed relative to blade 282, panels 290 may be fixedly engaged with and extend from outer drive sleeve 210 such that panels 290 are movable between a more-proximal position, wherein panels 290 do not extend to blade 282 or extend along a relatively smaller portion of the length of blade 282, and a more-distal position, wherein panels 290 extend along the entire or a relatively greater portion of the length of blade 282, in response to translation of outer drive sleeve 210, e.g., via squeezing clamp trigger 130 towards fixed handle portion 114 (see
In embodiments, panels 290 are engaged with a third sleeve (not shown), e.g., disposed between outer and inner sleeves 210, 220, respectively, to enable movement of panels 290 between the more-proximal and more-distal positions. This may be accomplished independently of the pivoting of jaw 284, e.g., via a separate actuator (not shown) disposed on handle assembly 100 (
Referring generally to
Turning to
With tissue clamped in the manner detailed above, blade 282 may be activated, e.g., via depression of activation button 120 (
Also during activation, the ultrasonic energy provided at blade 282 heats the outer lateral portions of tissue “T2.” However, this is indirect heating given that the outer lateral portions of tissue “T2” are laterally displaced from blade 282. This, coupled with the relatively lower compression and clamping force on the outer lateral portions of tissue “T2,” results in heating of the outer lateral portions of tissue “T2” to a relatively lower temperature and sealing of the outer lateral portions of tissue “T2.” Although some cutting of the outer lateral portions of tissue “T2” may be accomplished, the majority of the tissue effect on the outer lateral portions of tissue “T2” is sealing. The result of the above is that tissue “T” is sealed in two laterally spaced-apart locations, e.g., at both portions “T2,” and cut therebetween, e.g., at portion “T1.” Panels 290, in embodiments, may also help limit thermal spread laterally therebeyond.
Turning to
To enable tissue interrogation and/or tissue treatment, blade 282 may be electrically coupled to generator 310 via a first electrical path 316 which may, for example, extend between generator 310 and blade 282 by way of connectors 330, rotational contacts 334, horn 324, and waveguide 230 (see
Continuing with reference to
Generator 310 is configured to evaluate the returned signal, e.g., the voltage, current, resistance, etc. thereof, and, based thereon, determine one or more parameters of tissue “T.” For example, generator 310 may be configured to determine the impedance of tissue “T” which is indicative of whether tissue “T” is sufficiently sealed. As such, the interrogation signal “IS” may be utilized to determine whether tissue “T” is sufficiently sealed. If it is determined that tissue “T” is sufficiently sealed, generator 310 may be configured to produce an audible tone, visual indicator, haptic feedback, and/or other output to indicate to the surgeon that tissue “T” has been sufficiently sealed. Additionally or alternatively, determination of sufficiently sealed tissue may be utilized as part of a feedback loop to, for example, modify the ultrasonic drive signal output from generator 310, e.g., by increasing power, to facilitate cutting of the sealed tissue. Other tissue parameters may additionally or alternatively be utilized to determine whether tissue is sealed and/or for other purposes. For example, temperature measurement of one or both of panels 290 at one or more locations thereon, e.g., using thermocouples, may be taken and fed back to generator 310.
Continuing with reference to
Although the exemplary interrogation signal “IS” and tissue-treating energy “TT” are detailed above utilizing RF energy, it is also contemplated that other forms of energy can be utilized such as, for example: microwave energy, thermal energy, optical energy (such as infrared energy), ultrasound energy, low frequency or direct current electrical energy, etc. Various configurations facilitating application of one or more of these energies for interrogating and/or treating tissue, in conjunction with ultrasonic tissue treatment, are detailed below with respect to
Turning to
Referring to
The frequency with which the interrogation signals “IS” are output may additionally or alternatively depend upon the mode of operation and/or other factors. For example, interrogation signals “IS” may be provided more frequently, e.g., at shorter intervals, in the HIGH power mode of operation and less frequently, e.g., at longer intervals, in the LOW power mode of operation. As another example, the frequency with which the interrogation signals “IS” are output may depend upon the tissue parameter determined, e.g., the interrogation signals “IS” may be output more frequently as the impedance of tissue indicates that a sufficiently sealed condition is approaching. The number of pulses in each interrogation signal “IS” may also be fixed or variable similarly as with the frequency of the interrogation signal “IS” or in any other suitable manner.
With reference to
Referring to
With reference to
With respect to the supply of ultrasonic energy using end effector assembly 580, ultrasonic energy is transmitted to blade 582 for treating tissue clamped between blade 582 and jaw liner 588 of jaw 584 or positioned near blade 582.
To supply other energy, e.g., RF energy, for interrogating tissue, the generator (not shown) is configured to transmit an interrogation signal to blade 582 via a first electrical path, e.g., an RF signal at a positive potential (+), and to establish a second, different potential structural body 586 of jaw 584, e.g., a negative potential (−), such that the interrogation signal is transmitted from blade 582 through tissue, to structural body 586 of jaw 584 due to the potential difference therebetween and returned to the generator via a second, different electrical path, thus allowing the generator to evaluate the returned signal.
With respect to the supply of other energy, e.g., RF energy, for treating tissue, the generator (not shown) is configured to energize blade 582 to a first potential via a first electrical path, e.g., RF energy at a positive potential (+), and to energize structural body 586 of jaw 584 to a second, different potential via a second, different electrical path, e.g., RF energy at a negative potential (−), to enable the conduction of energy, e.g., a bipolar RF tissue-treating current, through tissue disposed therebetween to treat the tissue disposed therebetween.
Referring to
End effector assembly 680 includes a blade 682, a jaw 684 including a structural body 686, a jaw liner 688, and first and second electrically-conductive plates 689, and first and second panels 690 disposed on either side of blade 682. Structural body 686 supports first and second electrically-conductive plates 689 on either side of jaw liner 688. First and second electrically-conductive plates 689 may be electrically-isolated from structural body 686 or may be electrically coupled thereto (and, thus, to one another). First and second electrically-conductive plates 689 are configured to connect to the generator to enable energization thereof to a first potential, e.g., RF energy at a positive potential (+).
First and second panels 690, in addition or as an alternative to providing the above-detailed function of panels 290 (
Continuing with reference to
As an alternative to blade 682 being non-energized with RF energy, blade 682 may alternatively be energized to the same potential as either panels 690 or plates 689. The insulative coatings 699 isolate blade 682 from panels 690 as detailed above while jaw liner 688 isolates blade 682 from plates 689.
With reference to
In use, first and second electrically-conductive plates 789 are configured to connect to the generator to enable energization thereof to a first potential, e.g., RF energy at a positive potential (+), while first and second panels 790 function as electrodes that are configured to connect to the generator to enable energization thereof to a second, different potential, e.g., RF energy at a negative potential (−), such that an RF tissue-treating current can be conducted between plates 789 and panels 790 and through tissue disposed therebetween to treat, e.g., seal, tissue. Plates 789 and panels 790 may additionally or alternatively be used to interrogate tissue to sense one or more parameters thereof, similarly as detailed above.
With respect to RF tissue treatment or RF tissue interrogation, blade 782 may remain unenergized (with respect to RF energy; blade 782 may be energized with ultrasonic energy to ultrasonically treat tissue). The gap distance(s) “G,” “GG” maintain isolation of blade 782. As an alternative to blade 782 being non-energized with RF energy, blade 782 may alternatively be energized to the same potential as either panels 790 or plates 789 with gap distance(s) “G,” “GG” isolating blade 782 therefrom.
Turning to
Referring to
The optical elements 1389, 1391 configured as optical emitters are configured to emit light energy and direct the light energy through tissue disposed between optical elements 1389, 1391. The optical elements 1389, 1391 configured as optical absorbers or optical reflectors are configured to absorb light energy that has passed through tissue or reflect the light energy that has passed through tissue back into tissue, respectively. This light energy passing through tissue may be utilized to treat, e.g., seal, tissue, and/or to interrogate tissue. The light energy may include infrared light, ultraviolet light, visible light, laser light, or any other suitable light or combinations thereof.
First and second optical elements 1489 may be oriented to direct light energy towards blade 1482 in a generally perpendicular direction relative to the outer surface of blade 1482. More specifically, in some aspects, blade 1482 may define a cylindrical configuration with first and second optical elements 1489 oriented to direct light energy in directions that intersect a center of blade 1482, as shown in
Referring to
Turning to
End effector assembly 1780 includes a panel member 1790 having a base 1795 surrounding, on the bottom and lateral sides, a portion of blade 1782, and first and second panels 1796 extending distally from base 1795 on either lateral side of blade 1782.
Base 1795 defines a U-shaped configuration and extends, in fixed or movable relation, distally from outer and/or inner sleeves 1710, 1720. Base 1795, more specifically, extends less than about 50% of the operative length of blade 1782 (defines as the portion of blade 1782 that opposes the jaw liner 1788 of jaw 1784 in the closed position), less than about 40% of the operative length of blade 1782, or less than about 30% of the operative length of blade 1782. As a result, the bottom portion of blade 1782 is exposed along the distal 50%, 60%, or 70% of the operative length thereof.
Panels 1796 extend distally from base 1795 on either side of blade 1782. Panels 1796 may include shelves 1792 extending perpendicularly and outwardly from upper ends of the vertical bodies 1794 thereof. Panels 1796 may further include tapers, from the lower ends thereof, whereby the height of panels 1796 decreasingly tapers from the proximal end thereof towards the distal end thereof. As a result, the bottom portion and lateral sides of blade 1782 are increasing exposed in a proximal-to-distal direction. This configuration facilitates use of the distal, bottom portion of blade 1782, e.g., for enterotomies, backscoring, and/or or other surgical tasks, while still providing the functionality of the panels as detailed with respect to any of the above configurations.
Referring generally to
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.
Referring in particular to
Jaw 1884 includes a structural body 1886 and a jaw liner 1888. Structural body 1886 itself or electrically-conductive plates (not shown) mounted thereon may be configured to connect to the generator to serve as one electrode (or portion) of an RF (or other energy-based) circuit. Blade 1882 is configured to connect to the generator to serve as the other electrode (or portion) of the RF (or other energy-based) circuit. The opposed surfaces 1887 of structural body 1886 (or the opposed surfaces of electrically-conductive plates, if so provided) are radiused to complement the cylindrical configuration of blade 1882 such that the gap distance between opposed surfaces 1887 and blade 1882 with tissue grasped therebetween is substantially (e.g., within about 15%) uniform at any point therealong. RF signals may be communicated between structural body 1886 and blade 1882 to interrogate and/or treat tissue similarly as detailed above. Other suitable energy configurations are also contemplated such as those detailed above.
With reference to
End effector assembly 1980 is positioned distally of one of more articulation joints 1981a of a robotic shaft assembly 1981b and includes a proximal housing 1981c supporting an ultrasonic transducer 1981d therein. A waveguide (not explicitly shown) extends distally form the ultrasonic transducer 1981d and includes a blade 1982 defined at a distal end thereof. A jaw 1984 is pivotably mounted to the housing 1981c to enable pivoting of the jaw 1984 relative to the blade 1982 between open and clamping positions for clamping tissue between the jaw 1984 and blade 1982.
End effector assembly 1980 differs from end effector assembly 1880 (
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 claims the benefit of, and priority to, U.S. Provisional Patent Application Nos. 62/823,769 and 62/823,875, both filed on Mar. 26, 2019, the entire contents of each of which is hereby incorporated herein by reference.
Filing Document | Filing Date | Country | Kind |
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PCT/US2020/024732 | 3/25/2020 | WO | 00 |
Number | Date | Country | |
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62823769 | Mar 2019 | US | |
62823875 | Mar 2019 | US |