U.S. patent application number 15/355892 was filed with the patent office on 2017-06-15 for method of treating tissue using end effector with ultrasonic and electrosurgical features.
The applicant listed for this patent is Ethicon Endo-Surgery, LLC. Invention is credited to Chad P. Boudreaux, Adam Brown, Kai Chen, William E. Clem, Catherine A. Corbett, Nathan Cummings, William D. Dannaher, Mark A. Davison, Frederick L. Estera, Craig N. Faller, Ellen Gentry, John A. Hibner, Christina M. Hough, Joseph Isosaki, Gregory W. Johnson, Amy M. Krumm, Jason R. Lesko, Jeffrey D. Messerly, Matthew C. Miller, Candice Otrembiak, Shan Wan, William B. Weisenburgh, II, Eitan T. Wiener, Barry C. Worrell.
Application Number | 20170164997 15/355892 |
Document ID | / |
Family ID | 59019334 |
Filed Date | 2017-06-15 |
United States Patent
Application |
20170164997 |
Kind Code |
A1 |
Johnson; Gregory W. ; et
al. |
June 15, 2017 |
METHOD OF TREATING TISSUE USING END EFFECTOR WITH ULTRASONIC AND
ELECTROSURGICAL FEATURES
Abstract
An end effector of an instrument is positioned in a patient. An
ultrasonic blade of the end effector is positioned against tissue
in the patient. The ultrasonic blade is activated to vibrate
ultrasonically while the ultrasonic blade is positioned against
tissue. At least one electrode of the end effector is positioned
against tissue in the patient. The at least one electrode is
activated to apply RF electrosurgical energy to tissue against
which the at least one electrode is positioned against tissue.
Inventors: |
Johnson; Gregory W.;
(Milford, OH) ; Lesko; Jason R.; (Cincinnati,
OH) ; Estera; Frederick L.; (Cincinnati, OH) ;
Krumm; Amy M.; (Bellbrook, OH) ; Corbett; Catherine
A.; (Cincinnati, OH) ; Weisenburgh, II; William
B.; (Maineville, OH) ; Worrell; Barry C.;
(Centerville, OH) ; Davison; Mark A.; (Maineville,
OH) ; Boudreaux; Chad P.; (Cincinnati, OH) ;
Hibner; John A.; (Mason, OH) ; Cummings; Nathan;
(Cincinnati, OH) ; Gentry; Ellen; (Cincinnati,
OH) ; Dannaher; William D.; (Cincinnati, OH) ;
Hough; Christina M.; (Cincinnati, OH) ; Isosaki;
Joseph; (Cincinnati, OH) ; Faller; Craig N.;
(Batavia, OH) ; Wan; Shan; (Mason, OH) ;
Brown; Adam; (Cincinnati, OH) ; Otrembiak;
Candice; (Loveland, OH) ; Wiener; Eitan T.;
(Cincinnati, OH) ; Messerly; Jeffrey D.;
(Cincinnati, OH) ; Chen; Kai; (US) ;
Miller; Matthew C.; (Cincinnati, OH) ; Clem; William
E.; (Bozeman, MT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Ethicon Endo-Surgery, LLC |
Guaynabo |
PR |
US |
|
|
Family ID: |
59019334 |
Appl. No.: |
15/355892 |
Filed: |
November 18, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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62265611 |
Dec 10, 2015 |
|
|
|
62324428 |
Apr 19, 2016 |
|
|
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62365543 |
Jul 22, 2016 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/2945 20130101;
A61B 2018/00994 20130101; A61B 2017/00389 20130101; A61B 2018/00607
20130101; A61B 17/320092 20130101; A61B 18/1445 20130101; A61B
2017/2825 20130101; A61B 2017/320073 20170801; A61B 2018/1452
20130101; A61B 2017/320094 20170801; A61B 2018/126 20130101; A61B
2017/320095 20170801; A61B 2017/320078 20170801 |
International
Class: |
A61B 18/14 20060101
A61B018/14; A61N 7/02 20060101 A61N007/02; A61B 17/32 20060101
A61B017/32 |
Claims
1. A method of using an instrument, the method comprising: (a)
positioning an instrument end effector within a patient, wherein
the end effector comprises: (i) an ultrasonic blade, (ii) a clamp
pad, and (iii) at least one electrode; (b) positioning the
ultrasonic blade against tissue in the patient; (c) activating the
ultrasonic blade to vibrate ultrasonically while the ultrasonic
blade is positioned against tissue; (d) positioning the at least
one electrode against tissue in the patient; and (e) activating the
at least one electrode to apply RF electrosurgical energy to tissue
against which the at least one electrode is positioned against
tissue.
2. The method of claim 1, further comprising compressing tissue
between the clamp pad and the ultrasonic blade.
3. The method of claim 2, wherein the act of activating the
ultrasonic blade is performed while the tissue is compressed
between the clamp pad and the ultrasonic blade.
4. The method of claim 2, wherein the act of activating the at
least one electrode is performed while the tissue is compressed
between the clamp pad and the ultrasonic blade.
5. The method of claim 2, wherein the end effector further
comprises a clamp arm, wherein the clamp arm is pivotable relative
to the ultrasonic blade, wherein the at least one electrode is
supported by the clamp arm, wherein the act of compressing tissue
between the clamp pad and the ultrasonic blade comprises pivoting
the at least one electrode toward the tissue.
6. The method of claim 1, wherein the ultrasonic blade provides a
return path for the electrode, wherein the act of activating the at
least one electrode to apply RF electrosurgical energy to tissue
results in the application of bipolar RF electrosurgical energy to
the tissue via the at least one electrode and the ultrasonic
blade.
7. The method of claim 1, wherein the clamp pad has a pair of
lateral sides, wherein the electrode extends along both lateral
sides of the clamp pad, wherein the act of activating the at least
one electrode to apply RF electrosurgical energy to tissue
comprises applying RF electrosurgical energy to tissue at both
lateral sides of the clamp pad.
8. The method of claim 1, wherein the ultrasonic blade is
positioned against tissue extending along a first plane, wherein
the at least one electrode is positioned against tissue extending
along a second plane, wherein the second plane is substantially
parallel with the first plane.
9. The method of claim 1, wherein the ultrasonic blade is
positioned against tissue extending along a first plane, wherein
the at least one electrode is positioned against tissue extending
along a second plane, wherein the second plane is obliquely
oriented relative to the first plane.
10. The method of claim 1, wherein the end effector further
comprises a plurality of stand-off features, wherein the stand-off
features prevent the at least one electrode from contacting the
ultrasonic blade.
11. The method of claim 1, wherein the end effector further
comprises a clamp arm body, wherein the at least one electrode is
interposed between the clamp pad and the clamp arm body, wherein
the clamp pad defines a plurality of openings, wherein the act of
positioning the at least one electrode against tissue comprises
pressing the tissue through at least some of the openings to
contact the at least one electrode.
12. The method of claim 1, wherein the end effector further
comprises a blade guard, wherein the blade guard extends along at
least a portion of the length of the ultrasonic blade, wherein the
blade guard is spaced away from the ultrasonic blade, wherein the
at least one electrode is positioned on the blade guard, wherein
the act of positioning the at least one electrode against tissue
comprises urging the blade guard into contact with the tissue.
13. The method of claim 1, wherein the end effector further
comprises a clamp arm assembly, wherein the clamp arm assembly
comprises the clamp pad and the at least one electrode, wherein the
at least one electrode comprises a first electrode and a second
electrode, wherein the act of activating the at least one electrode
comprises activating the first and second electrodes to apply
bipolar RF electrosurgical energy to tissue.
14. The method of claim 1, wherein the at least one electrode
comprises a first electrode and a second electrode, wherein the
clamp pad is laterally interposed between the first and second
electrodes, wherein the act of positioning the at least one
electrode against tissue further comprises positioning the first
and second electrodes against the tissue while simultaneously
positioning the clamp pad against the tissue.
15. The method of claim 14, wherein the act of positioning the
first and second electrodes against the tissue while simultaneously
positioning the clamp pad against the tissue further comprises
compressing the tissue between the clamp pad and the ultrasonic
blade.
16. The method of claim 15, wherein the act of activating the
ultrasonic blade to vibrate ultrasonically while the ultrasonic
blade is positioned against tissue is performed while the tissue is
compressed between the clamp pad and the ultrasonic blade.
17. The method of claim 1, wherein the end effector further
comprises a clamp arm body defining a plurality of recesses,
wherein at least a portion of the clamp pad flows into at least
some of the recesses during one or both of the act of activating
the ultrasonic blade to vibrate ultrasonically while the ultrasonic
blade is positioned against tissue or the act of activating the at
least one electrode to apply RF electrosurgical energy to tissue
against which the at least one electrode is positioned.
18. The method of claim 1, wherein the at least one electrode
comprises a first electrode and a second electrode, wherein the end
effector further comprises a first arm and a second arm, wherein
the first electrode is carried by the first arm, wherein the second
electrode is carried by the second arm, wherein the act of
positioning the at least one electrode against tissue in the
patient comprises: (i) pivoting the first arm toward the tissue,
and (ii) pivoting the second arm toward the tissue.
19. A method of using an instrument, the method comprising: (a)
positioning an instrument end effector within a patient, wherein
the end effector comprises: (i) an ultrasonic blade, and (ii) a
clamp arm assembly, wherein the clamp arm assembly comprises: (A) a
clamp pad, (B) a first electrode, and (C) a second electrode; (b)
pivoting the clamp arm assembly toward the ultrasonic blade,
thereby compressing tissue between the ultrasonic blade and the
clamp pad, and thereby bringing the first and second electrodes
into contact with the tissue; and (c) activating one or both of:
(i) the ultrasonic blade to vibrate ultrasonically to thereby apply
the ultrasonic energy to the tissue, or (ii) the first and second
electrodes to thereby apply bipolar RF electrosurgical energy to
the tissue.
20. A method of using an instrument, the method comprising: (a)
positioning an instrument end effector within a patient, wherein
the end effector comprises: (i) an ultrasonic blade, (ii) a clamp
arm assembly, (iii) a first conductive arm, wherein the first
conductive arm is spaced apart from the ultrasonic blade and from
the clamp arm assembly, and (iv) a second conductive arm, wherein
the second conductive arm is spaced apart from the ultrasonic blade
and from the clamp arm assembly; (b) pivoting the clamp arm
assembly toward the ultrasonic blade, thereby compressing tissue
between the ultrasonic blade and the clamp arm assembly; and (c)
activating one or both of: (i) the ultrasonic blade to vibrate
ultrasonically to thereby apply the ultrasonic energy to the
tissue, or (ii) the first and second conductive arms to thereby
apply bipolar RF electrosurgical energy to the tissue.
Description
PRIORITY
[0001] This application claims priority to U.S. Provisional Pat.
App. No. 62/265,611, entitled "End Effector for Instrument with
Ultrasonic and Electrosurgical Features," filed Dec. 10, 2015, the
disclosure of which is incorporated by reference herein.
[0002] This application also claims priority to U.S. Provisional
Pat. App. No. 62/324,428, entitled "End Effector for Instrument
with Ultrasonic and Electrosurgical Features," filed Apr. 19, 2016,
the disclosure of which is incorporated by reference herein.
[0003] This application also claims priority to U.S. Provisional
Pat. App. No. 62/365,543, entitled "End Effector for Instrument
with Ultrasonic and Electrosurgical Features," filed Jul. 22, 2016,
the disclosure of which is incorporated by reference herein.
BACKGROUND
[0004] A variety of surgical instruments include an end effector
having a blade element that vibrates at ultrasonic frequencies to
cut and/or seal tissue (e.g., by denaturing proteins in tissue
cells). These instruments include one or more piezoelectric
elements that convert electrical power into ultrasonic vibrations,
which are communicated along an acoustic waveguide to the blade
element. The precision of cutting and coagulation may be controlled
by the operator's technique and adjusting the power level, blade
edge angle, tissue traction, and blade pressure. The power level
used to drive the blade element may be varied (e.g., in real time)
based on sensed parameters such as tissue impedance, tissue
temperature, tissue thickness, and/or other factors. Some
instruments have a clamp arm and clamp pad for grasping tissue with
the blade element.
[0005] Examples of ultrasonic surgical instruments include the
HARMONIC ACE.RTM. Ultrasonic Shears, the HARMONIC WAVE.RTM.
Ultrasonic Shears, the HARMONIC FOCUS.RTM. Ultrasonic Shears, and
the HARMONIC SYNERGY.RTM. Ultrasonic Blades, all by Ethicon
Endo-Surgery, Inc. of Cincinnati, Ohio. Further examples of such
devices and related concepts are disclosed in U.S. Pat. No.
5,322,055, entitled "Clamp Coagulator/Cutting System for Ultrasonic
Surgical Instruments," issued Jun. 21, 1994, the disclosure of
which is incorporated by reference herein; U.S. Pat. No. 5,873,873,
entitled "Ultrasonic Clamp Coagulator Apparatus Having Improved
Clamp Mechanism," issued Feb. 23, 1999, the disclosure of which is
incorporated by reference herein; U.S. Pat. No. 5,980,510, entitled
"Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Arm
Pivot Mount," issued Nov. 9, 1999, the disclosure of which is
incorporated by reference herein; U.S. Pat. No. 6,283,981, entitled
"Method of Balancing Asymmetric Ultrasonic Surgical Blades," issued
Sep. 4, 2001, the disclosure of which is incorporated by reference
herein; U.S. Pat. No. 6,309,400, entitled "Curved Ultrasonic Blade
having a Trapezoidal Cross Section," issued Oct. 30, 2001, the
disclosure of which is incorporated by reference herein; U.S. Pat.
No. 6,325,811, entitled "Blades with Functional Balance Asymmetries
for use with Ultrasonic Surgical Instruments," issued Dec. 4, 2001,
the disclosure of which is incorporated by reference herein; U.S.
Pat. No. 6,423,082, entitled "Ultrasonic Surgical Blade with
Improved Cutting and Coagulation Features," issued Jul. 23, 2002,
the disclosure of which is incorporated by reference herein; U.S.
Pat. No. 6,773,444, entitled "Blades with Functional Balance
Asymmetries for Use with Ultrasonic Surgical Instruments," issued
Aug. 10, 2004, the disclosure of which is incorporated by reference
herein; U.S. Pat. No. 6,783,524, entitled "Robotic Surgical Tool
with Ultrasound Cauterizing and Cutting Instrument," issued Aug.
31, 2004, the disclosure of which is incorporated by reference
herein; U.S. Pat. No. 8,057,498, entitled "Ultrasonic Surgical
Instrument Blades," issued Nov. 15, 2011, the disclosure of which
is incorporated by reference herein; U.S. Pat. No. 8,461,744,
entitled "Rotating Transducer Mount for Ultrasonic Surgical
Instruments," issued Jun. 11, 2013, the disclosure of which is
incorporated by reference herein; U.S. Pat. No. 8,591,536, entitled
"Ultrasonic Surgical Instrument Blades," issued Nov. 26, 2013, the
disclosure of which is incorporated by reference herein; and U.S.
Pat. No. 8,623,027, entitled "Ergonomic Surgical Instruments,"
issued Jan. 7, 2014, the disclosure of which is incorporated by
reference herein.
[0006] Still further examples of ultrasonic surgical instruments
are disclosed in U.S. Pub. No. 2006/0079874, entitled "Clamp pad
for Use with an Ultrasonic Surgical Instrument," published Apr. 13,
2006, the disclosure of which is incorporated by reference herein;
U.S. Pub. No. 2007/0191713, entitled "Ultrasonic Device for Cutting
and Coagulating," published Aug. 16, 2007, the disclosure of which
is incorporated by reference herein; U.S. Pub. No. 2007/0282333,
entitled "Ultrasonic Waveguide and Blade," published Dec. 6, 2007,
the disclosure of which is incorporated by reference herein; U.S.
Pub. No. 2008/0200940, entitled "Ultrasonic Device for Cutting and
Coagulating," published Aug. 21, 2008, the disclosure of which is
incorporated by reference herein; U.S. Pub. No. 2008/0234710,
entitled "Ultrasonic Surgical Instruments," published Sep. 25,
2008, the disclosure of which is incorporated by reference herein;
and U.S. Pub. No. 2010/0069940, entitled "Ultrasonic Device for
Fingertip Control," published Mar. 18, 2010, the disclosure of
which is incorporated by reference herein.
[0007] Some ultrasonic surgical instruments may include a cordless
transducer such as that disclosed in U.S. Pub. No. 2012/0112687,
entitled "Recharge System for Medical Devices," published May 10,
2012, the disclosure of which is incorporated by reference herein;
U.S. Pub. No. 2012/0116265, entitled "Surgical Instrument with
Charging Devices," published May 10, 2012, the disclosure of which
is incorporated by reference herein; and/or U.S. Pat. App. No.
61/410,603, filed Nov. 5, 2010, entitled "Energy-Based Surgical
Instruments," the disclosure of which is incorporated by reference
herein.
[0008] Additionally, some ultrasonic surgical instruments may
include an articulating shaft section. Examples of such ultrasonic
surgical instruments are disclosed in U.S. Pub. No. 2014/0005701,
published Jan. 2, 2014, entitled "Surgical Instruments with
Articulating Shafts," the disclosure of which is incorporated by
reference herein; and U.S. Pub. No. 2014/0114334, published Apr.
24, 2014, entitled "Flexible Harmonic Waveguides/Blades for
Surgical Instruments," the disclosure of which is incorporated by
reference herein.
[0009] Some instruments are operable to seal tissue by applying
radiofrequency (RF) electrosurgical energy to the tissue. An
example of a surgical instrument that is operable to seal tissue by
applying RF energy to the tissue is the ENSEAL.RTM. Tissue Sealing
Device by Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio. Further
examples of such devices and related concepts are disclosed in U.S.
Pat. No. 6,500,176 entitled "Electrosurgical Systems and Techniques
for Sealing Tissue," issued Dec. 31, 2002, the disclosure of which
is incorporated by reference herein; U.S. Pat. No. 7,112,201
entitled "Electrosurgical Instrument and Method of Use," issued
Sep. 26, 2006, the disclosure of which is incorporated by reference
herein; U.S. Pat. No. 7,125,409, entitled "Electrosurgical Working
End for Controlled Energy Delivery," issued Oct. 24, 2006, the
disclosure of which is incorporated by reference herein; U.S. Pat.
No. 7,169,146 entitled "Electrosurgical Probe and Method of Use,"
issued Jan. 30, 2007, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 7,186,253, entitled
"Electrosurgical Jaw Structure for Controlled Energy Delivery,"
issued Mar. 6, 2007, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 7,189,233, entitled
"Electrosurgical Instrument," issued Mar. 13, 2007, the disclosure
of which is incorporated by reference herein; U.S. Pat. No.
7,220,951, entitled "Surgical Sealing Surfaces and Methods of Use,"
issued May 22, 2007, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 7,309,849, entitled "Polymer
Compositions Exhibiting a PTC Property and Methods of Fabrication,"
issued Dec. 18, 2007, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 7,311,709, entitled
"Electrosurgical Instrument and Method of Use," issued Dec. 25,
2007, the disclosure of which is incorporated by reference herein;
U.S. Pat. No. 7,354,440, entitled "Electrosurgical Instrument and
Method of Use," issued Apr. 8, 2008, the disclosure of which is
incorporated by reference herein; U.S. Pat. No. 7,381,209, entitled
"Electrosurgical Instrument," issued Jun. 3, 2008, the disclosure
of which is incorporated by reference herein.
[0010] Some instruments are capable of applying both ultrasonic
energy and RF electrosurgical energy to tissue. Examples of such
instruments are described in U.S. Pub. No. 2015/0141981, entitled
"Ultrasonic Surgical Instrument with Electrosurgical Feature,"
published May 21, 2015, the disclosure of which is incorporated by
reference herein; and U.S. Pat. No. 8,663,220, entitled "Ultrasonic
Electrosurgical Instruments," issued Mar. 4, 2014, the disclosure
of which is incorporated by reference herein.
[0011] While several surgical instruments and systems have been
made and used, it is believed that no one prior to the inventors
has made or used the invention described in the appended
claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0012] While the specification concludes with claims which
particularly point out and distinctly claim this technology, it is
believed this technology will be better understood from the
following description of certain examples taken in conjunction with
the accompanying drawings, in which like reference numerals
identify the same elements and in which:
[0013] FIG. 1 depicts a side elevational view of an exemplary
surgical instrument;
[0014] FIG. 2A depicts a perspective view of an exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the end effector in an open configuration;
[0015] FIG. 2B depicts a perspective view of the end effector of
FIG. 2A, with the end effector in a closed configuration;
[0016] FIG. 3A depicts a side elevational view of the end effector
of FIG. 2A, with the end effector in the open configuration;
[0017] FIG. 3B depicts a side elevational view of the end effector
of FIG. 2A, with the end effector in the closed configuration;
[0018] FIG. 4 depicts an exploded perspective view of a clamp arm
assembly of the end effector of FIG. 2A;
[0019] FIG. 5 depicts a perspective view of the clamp arm assembly
of FIG. 4;
[0020] FIG. 6 depicts a perspective view of an ultrasonic blade of
the end effector of FIG. 2A;
[0021] FIG. 7 depicts a perspective cross-sectional view of the
ultrasonic blade of FIG. 6, with the cross-section taken at a
distal portion of the ultrasonic blade;
[0022] FIG. 8 depicts a perspective cross-sectional view of the
ultrasonic blade of FIG. 6, with the cross-section taken at an
intermediate portion of the ultrasonic blade;
[0023] FIG. 9 depicts a perspective cross-sectional view of the
ultrasonic blade of FIG. 6, with the cross-section taken at a
proximal portion of the ultrasonic blade;
[0024] FIG. 10 depicts a cross-sectional end view of the end
effector of FIG. 2A, with the end effector in the closed
configuration;
[0025] FIG. 11 depicts a cross-sectional end view of the end
effector of FIG. 2A, with the end effector compressing tissue
between the clamp arm and the ultrasonic blade;
[0026] FIG. 12A depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the end effector in an open configuration;
[0027] FIG. 12B depicts a perspective view of the end effector of
FIG. 12A, with the end effector in a closed configuration;
[0028] FIG. 13 depicts a perspective view of an ultrasonic blade of
the end effector of FIG. 12A;
[0029] FIG. 14 depicts a top plan view of the ultrasonic blade of
FIG. 13;
[0030] FIG. 15 depicts a perspective cross-sectional view of the
ultrasonic blade of FIG. 13, with the cross-section taken at an
intermediate portion of the ultrasonic blade;
[0031] FIG. 16 depicts a cross-sectional end view of the end
effector of FIG. 12A, with the end effector compressing tissue
between the clamp arm and the ultrasonic blade;
[0032] FIG. 17 depicts a cross-sectional end view of another
exemplary end effector that may be incorporated into the instrument
of FIG. 1, with the end effector in a closed configuration;
[0033] FIG. 18 depicts a cross-sectional end view of another
exemplary end effector that may be incorporated into the instrument
of FIG. 1, with the end effector in a closed configuration;
[0034] FIG. 19 depicts a cross-sectional end view of another
exemplary end effector that may be incorporated into the instrument
of FIG. 1, with the end effector in a closed configuration;
[0035] FIG. 20 depicts a cross-sectional end view of another
exemplary end effector that may be incorporated into the instrument
of FIG. 1, with the end effector in a closed configuration;
[0036] FIG. 21 depicts a cross-sectional end view of another
exemplary end effector that may be incorporated into the instrument
of FIG. 1, with the end effector in a closed configuration;
[0037] FIG. 22 depicts a perspective view of an exemplary
alternative handle assembly that may be incorporated into the
instrument of FIG. 1;
[0038] FIG. 23 depicts a side elevational view of the handle
assembly of FIG. 22;
[0039] FIG. 24 depicts a front end view of the handle assembly of
FIG. 22;
[0040] FIG. 25 depicts a side elevational view of another exemplary
alternative handle assembly that may be incorporated into the
instrument of FIG. 1;
[0041] FIG. 26A depicts a perspective view of the handle assembly
of FIG. 25, with an activation paddle in a centered position;
[0042] FIG. 26B depicts a perspective view of the handle assembly
of FIG. 25, with the activation paddle actuated in a first
direction;
[0043] FIG. 26C depicts a perspective view of the handle assembly
of FIG. 25, with the activation paddle actuated in a second
direction;
[0044] FIG. 27A depicts a front end view of the handle assembly of
FIG. 25, with the activation paddle in the centered position;
[0045] FIG. 27B depicts a front end view of the handle assembly of
FIG. 25, with the activation paddle actuated in the first
direction;
[0046] FIG. 27C depicts a front end view of the handle assembly of
FIG. 25, with the activation paddle actuated in the second
direction;
[0047] FIG. 28 depicts a perspective view of another exemplary
alternative handle assembly that may be incorporated into the
instrument of FIG. 1;
[0048] FIG. 29 depicts a front end view of the handle assembly of
FIG. 28;
[0049] FIG. 30 depicts a side elevational view of the handle
assembly of FIG. 28;
[0050] FIG. 31 depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the end effector in an open configuration;
[0051] FIG. 32 depicts a bottom view of the clamp arm assembly of
FIG. 31;
[0052] FIG. 33 depicts an exploded view of the end effector of FIG.
31;
[0053] FIG. 34A depicts a perspective cross-sectional view of the
end effector of FIG. 31, with the cross-section taken along line
34A-34A of FIG. 32;
[0054] FIG. 34B depicts a perspective cross-sectional view of the
end effector of FIG. 31, with the cross-section taken along line
34B-34B of FIG. 32;
[0055] FIG. 35 depicts a bottom view of another exemplary end
effector, shown without the blade, that may be incorporated into
the instrument of FIG. 1;
[0056] FIG. 36A depicts a cross-sectional view of the end effector
of FIG. 35 taken along line 36A-36A as shown in FIG. 35;
[0057] FIG. 36B depicts a cross-sectional view of the end effector
of FIG. 35 taken along line 36B-36B as shown in FIG. 35;
[0058] FIG. 37 depicts a bottom view of another exemplary end
effector, shown without the blade, that may be incorporated into
the instrument of FIG. 1;
[0059] FIG. 38A depicts a cross-sectional view of the end effector
of FIG. 37 taken along line 38A-38A as shown in FIG. 37;
[0060] FIG. 38B depicts a cross-sectional view of the end effector
of FIG. 37 taken along line 38B-38B as shown in FIG. 37;
[0061] FIG. 39 depicts a bottom view of another exemplary end
effector, shown without the blade, that may be incorporated into
the instrument of FIG. 1;
[0062] FIG. 40A depicts a cross-sectional view of the end effector
of FIG. 39 taken along line 40A-40A as shown in FIG. 39;
[0063] FIG. 40B depicts a cross-sectional view of the end effector
of FIG. 39 taken along line 40B-40B as shown in FIG. 39;
[0064] FIG. 41 depicts a perspective view of another exemplary
clamp arm assembly of an end effector that may be incorporated into
the instrument of FIG. 1;
[0065] FIG. 42 depicts an exploded view of the clamp arm assembly
of FIG. 41 and an ultrasonic blade that forms an end effector with
the clamp arm assembly of FIG. 41;
[0066] FIG. 43 depicts a bottom view of the clamp arm assembly of
FIG. 41;
[0067] FIG. 44 depicts a perspective cross-sectional view of the
clamp arm assembly of FIG. 43 taken along line 44-44 of FIG.
43;
[0068] FIG. 45 depicts a bottom view of another exemplary clamp arm
assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
[0069] FIG. 46 depicts a perspective cross-sectional view of the
clamp arm assembly of FIG. 45 taken along line 46-46 of FIG.
45;
[0070] FIG. 47A depicts a cross-sectional view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1, with the cross-sectional view taken prior to machining;
[0071] FIG. 47B depicts a cross-sectional view of the end effector
of FIG. 47A taken after machining;
[0072] FIG. 48A depicts a cross-sectional view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1, with the cross-sectional view taken prior to machining;
[0073] FIG. 48B depicts a cross-sectional view of the end effector
of FIG. 47A taken after machining;
[0074] FIG. 49 depicts a perspective view of another exemplary
clamp arm assembly of an end effector that may be incorporated into
the instrument of FIG. 1;
[0075] FIG. 50 depicts a perspective view of another exemplary
clamp arm assembly of an end effector that may be incorporated into
the instrument of FIG. 1;
[0076] FIG. 51 depicts an exploded view of the clamp arm assembly
of FIG. 49;
[0077] FIG. 52A depicts a bottom view of the clamp arm assembly of
FIG. 49;
[0078] FIG. 52B depicts a perspective cross-sectional view of the
clamp arm assembly of FIG. 52A, taken along line 52B-52B of FIG.
52A;
[0079] FIG. 53A depicts a bottom view of another exemplary clamp
arm assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
[0080] FIG. 53B depicts a perspective cross-sectional view of the
clamp arm assembly of FIG. 53A, taken along line 53B-53B of FIG.
53A;
[0081] FIG. 54A depicts a bottom view of another exemplary clamp
arm assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
[0082] FIG. 54B depicts a perspective cross-sectional view of the
clamp arm assembly of FIG. 54A, taken along line 54B-54B of FIG.
54A;
[0083] FIG. 55 depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the end effector in an open configuration;
[0084] FIG. 56 depicts an exploded view of the clamp arm assembly
of the end effector of FIG. 55;
[0085] FIG. 57A depicts a perspective cross-sectional view of the
end effector of FIG. 55, shown in a closed configuration at a first
position along the length of the end effector;
[0086] FIG. 57B depicts a perspective cross-sectional view of the
end effector of FIG. 55, shown in a closed configuration at a
second position along the length of the end effector;
[0087] FIG. 58 depicts a perspective view of another exemplary
clamp arm assembly of an end effector that may be incorporated into
the instrument of FIG. 1;
[0088] FIG. 59 depicts an exploded view of the clamp arm assembly
of FIG. 58;
[0089] FIG. 60A depicts a bottom view of the clamp arm assembly of
FIG. 58;
[0090] FIG. 60B depicts a perspective cross-sectional view of the
clamp arm assembly of FIG. 58;
[0091] FIG. 61 depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the end effector in a closed configuration;
[0092] FIG. 62 depicts another perspective view of the end effector
of FIG. 61;
[0093] FIG. 63 depicts a perspective view of the clamp arm assembly
of FIG. 61;
[0094] FIG. 64 depicts a perspective cross-sectional view of the
end effector of FIG. 61;
[0095] FIG. 65A depicts another perspective cross-sectional view of
the end effector of FIG. 61;
[0096] FIG. 65B depicts another perspective cross-sectional view of
the end effector of FIG. 61;
[0097] FIG. 66 depicts a side view of another blade of an end
effector that may be incorporated into the instrument of FIG.
1;
[0098] FIG. 67 depicts a top view of the blade of FIG. 66 taken
along the line 67-67 of FIG. 66;
[0099] FIG. 68 depicts a cross-section view of the exemplary end
effector incorporating the blade of FIG. 66, taken along line 68-68
of FIG. 66;
[0100] FIG. 69 depicts a side view of another blade of an end
effector that may be incorporated into the instrument of FIG.
1;
[0101] FIG. 70 depicts a top view of the blade of FIG. 69 taken
along the line 70-70 of FIG. 69;
[0102] FIG. 71 depicts a cross-section view of the exemplary end
effector incorporating the blade of FIG. 69, taken along line 71-71
of FIG. 69;
[0103] FIG. 72 depicts a side view of another exemplary clamp arm
assembly for use with the blade of FIG. 66;
[0104] FIG. 73 depicts a side view of another exemplary clamp arm
assembly for use with the blade of FIG. 66;
[0105] FIG. 74 depicts a perspective cross-section view of another
exemplary end effector that may be incorporated into the instrument
of FIG. 1, with the end effector in a partially closed
configuration;
[0106] FIG. 75 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1, with the end effector in a partially closed configuration;
[0107] FIG. 76 depicts a side view of another exemplary end
effector, shown without the blade, that may be incorporated into
the instrument of FIG. 1;
[0108] FIG. 77A depicts a cross-section view of the end effector of
FIG. 76 taken along line 77A-77A of FIG. 76;
[0109] FIG. 77B depicts a cross-section view of the end effector of
FIG. 76 taken along line 77B-77B of FIG. 76;
[0110] FIG. 77C depicts a bottom view of the end effector of FIG.
76 taken along line 77C-77C of FIG. 76;
[0111] FIG. 78 depicts a bottom view of another exemplary end
effector, shown without the blade, that may be incorporated into
the instrument of FIG. 1;
[0112] FIG. 79 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1, with the end effector in a closed configuration;
[0113] FIG. 80 depicts an end view of the end effector of FIG. 79,
with the end effector compressing tissue between the clamp arm and
the ultrasonic blade;
[0114] FIG. 81 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1, with the end effector in a closed configuration;
[0115] FIG. 82 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0116] FIG. 83 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0117] FIG. 84 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0118] FIG. 85 depicts a partial perspective view of the end
effector of FIG. 84;
[0119] FIG. 86 depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
[0120] FIG. 87 depicts an end view of a portion of the end effector
of FIG. 86;
[0121] FIG. 88 depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
[0122] FIG. 89 depicts a cross-section view of the end effector of
FIG. 88, taken along line 89-89 of FIG. 88;
[0123] FIG. 90 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0124] FIG. 91 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0125] FIG. 92 depicts a perspective view of the clamp arm of the
end effector of FIG. 91;
[0126] FIG. 93 depicts another perspective view of the clamp arm of
the end effector of FIG. 91;
[0127] FIG. 94 depicts another cross-section view of the clamp arm
of the end effector of FIG. 91;
[0128] FIG. 95 depicts a partial exploded view of the end effector
of FIG. 91, with a tube assembly that may be incorporated into the
shaft assembly of FIG. 1 and used with the end effector of FIG.
91;
[0129] FIG. 96 depicts a cross-section view of the tube assembly of
FIG. 95;
[0130] FIG. 97 depicts an exploded view of another exemplary tube
assembly that may be incorporated into the shaft assembly of FIG. 1
and used with the end effector of FIG. 91;
[0131] FIG. 98 depicts a perspective view of the tube assembly of
FIG. 97;
[0132] FIG. 99 depicts a side view of a proximal portion of the
tube assembly of FIG. 95, showing electrical connections of the
tube assembly with electrical components;
[0133] FIG. 100 depicts a perspective view of the proximal portion
of the tube assembly of FIG. 99;
[0134] FIG. 101 depicts a perspective view of an exemplary
actuation ring usable with the end effector of FIG. 91 to open and
close the end effector;
[0135] FIG. 102 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0136] FIG. 103 depicts a bottom view of an exemplary clamp pad of
the end effector of FIG. 102;
[0137] FIG. 104 depicts a bottom view of another exemplary clamp
pad of the end effector of FIG. 102;
[0138] FIG. 105 depicts a side view of another exemplary end
effector, shown in a shear device;
[0139] FIG. 106 depicts a cross-section view of the end effector of
FIG. 105 taken along the distal section at line A-A of FIG.
105;
[0140] FIG. 107 depicts a cross-section view of the end effector of
FIG. 105 taken along the proximal section at line B-B of FIG.
105;
[0141] FIG. 108 depicts a cross-section view of another version of
the end effector of FIG. 105 taken along the distal section at line
A-A of FIG. 105;
[0142] FIG. 109 depicts a cross-section view of the end effector of
FIG. 108 taken along the proximal section at line B-B of FIG.
105;
[0143] FIG. 110 depicts a perspective view in side cross-section of
another version of the end effector of FIG. 105;
[0144] FIG. 111 depicts a perspective view in end cross-section of
the end effector of FIG. 110;
[0145] FIG. 112 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0146] FIG. 113 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0147] FIG. 114 depicts a cross-section view of another exemplary
end effector that may be incorporated into the instrument of FIG.
1;
[0148] FIG. 115 depicts a cross-section view of an exemplary
alternative clamp pad to clamp arm arrangement that may be
incorporated into the instrument of FIG. 1;
[0149] FIG. 116 depicts a cross-section view of another exemplary
alternative clamp pad to clamp arm arrangement that may be
incorporated into the instrument of FIG. 1; and
[0150] FIG. 117 depicts a cross-section view of another exemplary
alternative clamp pad to clamp arm arrangement that may be
incorporated into the instrument of FIG. 1.
[0151] The drawings are not intended to be limiting in any way, and
it is contemplated that various embodiments of the technology may
be carried out in a variety of other ways, including those not
necessarily depicted in the drawings. The accompanying drawings
incorporated in and forming a part of the specification illustrate
several aspects of the present technology, and together with the
description serve to explain the principles of the technology; it
being understood, however, that this technology is not limited to
the precise arrangements shown.
DETAILED DESCRIPTION
[0152] The following description of certain examples of the
technology should not be used to limit its scope. Other examples,
features, aspects, embodiments, and advantages of the technology
will become apparent to those skilled in the art from the following
description, which is by way of illustration, one of the best modes
contemplated for carrying out the technology. As will be realized,
the technology described herein is capable of other different and
obvious aspects, all without departing from the technology.
Accordingly, the drawings and descriptions should be regarded as
illustrative in nature and not restrictive.
[0153] It is further understood that any one or more of the
teachings, expressions, embodiments, examples, etc. described
herein may be combined with any one or more of the other teachings,
expressions, embodiments, examples, etc. that are described herein.
The following-described teachings, expressions, embodiments,
examples, etc. should therefore not be viewed in isolation relative
to each other. Various suitable ways in which the teachings herein
may be combined will be readily apparent to those of ordinary skill
in the art in view of the teachings herein. Such modifications and
variations are intended to be included within the scope of the
claims.
[0154] For clarity of disclosure, the terms "proximal" and "distal"
are defined herein relative to a human or robotic operator of the
surgical instrument. The term "proximal" refers the position of an
element closer to the human or robotic operator of the surgical
instrument and further away from the surgical end effector of the
surgical instrument. The term "distal" refers to the position of an
element closer to the surgical end effector of the surgical
instrument and further away from the human or robotic operator of
the surgical instrument.
I. EXEMPLARY ULTRASONIC SURGICAL INSTRUMENT WITH INTEGRATED RF
ENERGY
[0155] FIG. 1 illustrates an exemplary ultrasonic surgical
instrument (110). At least part of instrument (110) may be
constructed and operable in accordance with at least some of the
teachings of U.S. Pat. No. 5,322,055; U.S. Pat. No. 5,873,873; U.S.
Pat. No. 5,980,510; U.S. Pat. No. 6,325,811; U.S. Pat. No.
6,773,444; U.S. Pat. No. 6,783,524; U.S. Pat. No. 8,461,744; U.S.
Pat. No. 8,623,027; U.S. Pub. No. 2006/0079874; U.S. Pub. No.
2007/0191713; U.S. Pub. No. 2007/0282333; U.S. Pub. No.
2008/0200940; U.S. Pub. No. 2010/0069940; U.S. Pub. No.
2012/0112687; U.S. Pub. No. 2012/0116265; U.S. Pub. No.
2014/0005701; U.S. Pub. No. 2014/0114334; U.S. Pat. App. No.
61/410,603; and/or U.S. patent application Ser. No. 14/028,717. The
disclosures of each of the foregoing patents, publications, and
applications are incorporated by reference herein. As described
therein and as will be described in greater detail below,
instrument (110) is operable to cut tissue and seal or weld tissue
(e.g., a blood vessel, etc.) substantially simultaneously. It
should also be understood that instrument (110) may have various
structural and functional similarities with the HARMONIC ACE.RTM.
Ultrasonic Shears, the HARMONIC WAVE.RTM. Ultrasonic Shears, the
HARMONIC FOCUS.RTM. Ultrasonic Shears, and/or the HARMONIC
SYNERGY.RTM. Ultrasonic Blades. Furthermore, instrument (110) may
have various structural and functional similarities with the
devices taught in any of the other references that are cited and
incorporated by reference herein.
[0156] To the extent that there is some degree of overlap between
the teachings of the references cited herein, the HARMONIC ACE.RTM.
Ultrasonic Shears, the HARMONIC WAVE.RTM. Ultrasonic Shears, the
HARMONIC FOCUS.RTM. Ultrasonic Shears, and/or the HARMONIC
SYNERGY.RTM. Ultrasonic Blades, and the following teachings
relating to instrument (110), there is no intent for any of the
description herein to be presumed as admitted prior art. Several
teachings herein will in fact go beyond the scope of the teachings
of the references cited herein and the HARMONIC ACE.RTM. Ultrasonic
Shears, the HARMONIC WAVE.RTM. Ultrasonic Shears, the HARMONIC
FOCUS.RTM. Ultrasonic Shears, and the HARMONIC SYNERGY.RTM.
Ultrasonic Blades.
[0157] Instrument (110) of the present example comprises a handle
assembly (120), a shaft assembly (130), and an end effector (140).
Handle assembly (120) comprises a body (122) including a pistol
grip (124) and a pair of buttons (125, 126). Handle assembly (120)
also includes a trigger (128) that is pivotable toward and away
from pistol grip (124). It should be understood, however, that
various other suitable configurations may be used, including but
not limited to a scissor grip configuration. End effector (140)
includes an ultrasonic blade (160) and a pivoting clamp arm (144).
Clamp arm (144) is coupled with trigger (128) such that clamp arm
(144) is pivotable toward ultrasonic blade (160) in response to
pivoting of trigger (128) toward pistol grip (124); and such that
clamp arm (144) is pivotable away from ultrasonic blade (160) in
response to pivoting of trigger (128) away from pistol grip (124).
Various suitable ways in which clamp arm (144) may be coupled with
trigger (128) will be apparent to those of ordinary skill in the
art in view of the teachings herein. In some versions, one or more
resilient members are used to bias clamp arm (144) and/or trigger
(128) to the open position shown in FIG. 1.
[0158] An ultrasonic transducer assembly (112) extends proximally
from body (122) of handle assembly (120) in the present example. In
some other versions, transducer assembly (112) is fully integrated
within body (122). Transducer assembly (112) receives electrical
power from generator (116) and converts that power into ultrasonic
vibrations through piezoelectric principles. Generator (116)
cooperates with a controller (118) to provide a power profile to
transducer assembly (112) that is particularly suited for the
generation of ultrasonic vibrations through transducer assembly
(112). While controller (118) is represented by a box that is
separate from generator (116) in FIG. 1, it should be understood
that controller (118) and generator (116) may be integrated
together in a single unit. By way of example only, generator (116)
may comprise a GEN04, GEN11, or GEN 300 sold by Ethicon
Endo-Surgery, Inc. of Cincinnati, Ohio. In addition or in the
alternative, generator (116) may be constructed in accordance with
at least some of the teachings of U.S. Pub. No. 2011/0087212,
entitled "Surgical Generator for Ultrasonic and Electrosurgical
Devices," published Apr. 14, 2011, the disclosure of which is
incorporated by reference herein. It should also be understood that
at least some of the functionality of generator (116) may be
integrated into handle assembly (120), and that handle assembly
(120) may even include a battery or other on-board power source
such that cable (114) is omitted. Still other suitable forms that
generator (116) may take, as well as various features and
operabilities that generator (116) may provide, will be apparent to
those of ordinary skill in the art in view of the teachings
herein.
[0159] End effector (140) of the present example comprises clamp
arm (144) and ultrasonic blade (160). Clamp arm (144) includes a
clamp pad that is secured to the underside of clamp arm (144),
facing blade (160). By way of example only, the clamp pad may be
formed of a polytetrafluoroethylene (PTFE) material and/or any
other suitable material(s). By way of further example only, the
clamp pad may be further constructed and operable in accordance
with at least some of the teachings of U.S. Pat. No. 7,544,200,
entitled "Combination Tissue Pad for Use with an Ultrasonic
Surgical Instrument," issued Jun. 9, 2009, the disclosure of which
is incorporated by reference herein.
[0160] Clamp arm (144) is operable to selectively pivot toward and
away from blade (160) to selectively clamp tissue between clamp arm
(144) and blade (160) in response to pivoting of trigger (128)
toward pistol grip (124). Blade (160) of the present example is
operable to vibrate at ultrasonic frequencies in order to
effectively cut through and seal tissue, particularly when the
tissue is being clamped between clamp arm (144) and blade (160).
Blade (160) is positioned at the distal end of an acoustic
drivetrain that includes an acoustic waveguide (not shown) and
transducer assembly (112) to vibrate blade (160). By way of example
only, the acoustic waveguide and blade (160) may comprise
components sold under product codes SNGHK and SNGCB by Ethicon
Endo-Surgery, Inc. of Cincinnati, Ohio. By way of further example
only, the acoustic waveguide and blade (160) may be constructed and
operable in accordance with the teachings of U.S. Pat. No.
6,423,082, entitled "Ultrasonic Surgical Blade with Improved
Cutting and Coagulation Features," issued Jul. 23, 2002, the
disclosure of which is incorporated by reference herein. As another
merely illustrative example, the acoustic waveguide and blade (160)
may be constructed and operable in accordance with the teachings of
U.S. Pat. No. 5,324,299, entitled "Ultrasonic Scalpel Blade and
Methods of Application," issued Jun. 28, 1994, the disclosure of
which is incorporated by reference herein. Other suitable
properties and configurations that may be used for the acoustic
waveguide and blade (160) will be apparent to those of ordinary
skill in the art in view of the teachings herein.
[0161] In the present example, the distal end of blade (160) is
located at a position corresponding to an anti-node associated with
resonant ultrasonic vibrations communicated through a flexible
acoustic waveguide, in order to tune the acoustic assembly to a
preferred resonant frequency f.sub.o when the acoustic assembly is
not loaded by tissue. When transducer assembly (112) is energized,
the distal end of blade (160) is configured to move longitudinally
in the range of, for example, approximately 10 to 500 microns
peak-to-peak, and in some instances in the range of about 20 to
about 200 microns at a predetermined vibratory frequency f.sub.o
of, for example, 50 kHz or 55.5 kHz. When transducer assembly (112)
of the present example is activated, these mechanical oscillations
are transmitted through waveguides to reach blade (160), thereby
providing oscillation of blade (160) at the resonant ultrasonic
frequency. Thus, when tissue is secured between blade (160) and
clamp arm (144), the ultrasonic oscillation of blade (160) may
simultaneously sever the tissue and denature the proteins in
adjacent tissue cells, thereby providing a coagulative effect with
relatively little thermal spread. In some versions, an electrical
current may also be provided through blade (160) and clamp arm
(144) to also cauterize the tissue. For instance, blade (160) and
clamp arm (144) may be configured to apply radiofrequency (RF)
electrosurgical energy to tissue in addition to being configured to
apply ultrasonic energy to tissue.
[0162] End effector (140) of the present example is further
operable to apply radiofrequency (RF) electrosurgical energy to
tissue that is captured between clamp arm (144) and blade (160). By
way of example only, end effector (140) may include a single
electrode that cooperates with a conventional ground pad that is
secured to the patient, such that end effector (140) applies
monopolar RF electrosurgical energy to the tissue. As another
merely illustrative example, clamp arm (144) may include two
electrodes that are operable to apply bipolar RF electrosurgical
energy to the tissue. As yet another merely illustrative example,
clamp arm (144) may include a single electrode and ultrasonic blade
(160) may serve as a return path, such that ultrasonic blade (160)
cooperates with the electrode of clamp arm (144) to apply bipolar
RF electrosurgical energy to the tissue. In addition to or as an
alternative to the foregoing, end effector (140) may be constructed
and operable in accordance with at least some of the teachings of
U.S. Pat. No. 8,663,220, entitled "Ultrasonic Electrosurgical
Instruments," issued Mar. 4, 2014, the disclosure of which is
incorporated by reference herein. Other suitable arrangements will
be apparent to those of ordinary skill in the art in view of the
teachings herein.
[0163] Instrument (110) may provide the operator with various ways
in which to selectively apply only ultrasonic energy to tissue via
end effector (140), only RF electrosurgical energy to tissue via
end effector (140), or some combination of ultrasonic energy and RF
electrosurgical energy to tissue via end effector (140). In
versions where end effector (140) is operable to apply a
combination of ultrasonic energy and RF electrosurgical energy to
tissue, end effector (140) may be configured to apply ultrasonic
energy and RF electrosurgical energy to tissue simultaneously. In
addition or in the alternative, in versions where end effector
(140) is operable to apply a combination of ultrasonic energy and
RF electrosurgical energy to tissue, end effector (140) may be
configured to apply ultrasonic energy and RF electrosurgical energy
to tissue in a sequence. Such a sequence may be predetermined; or
may be based on sensed tissue conditions (e.g., tissue temperature,
density, thickness, etc.). Various suitable control algorithms that
may be used are disclosed in U.S. Pub. No. 2015/0141981, entitled
"Ultrasonic Surgical Instrument with Electrosurgical Feature,"
published May 21, 2015, the disclosure of which is incorporated by
reference herein. It should also be understood that the control of
ultrasonic energy and RF electrosurgical energy may be provided in
accordance with at least some of the teachings of U.S. Pat. No.
8,663,220, entitled "Ultrasonic Electrosurgical Instruments,"
issued Mar. 4, 2014, the disclosure of which is incorporated by
reference herein.
[0164] Buttons (125, 126) may provide the operator with varied
control of the energy that is applied to tissue through end
effector (140). For instance, in some versions, button (125) may be
activated to apply RF electrosurgical energy to tissue; while
button (126) may be activated to apply ultrasonic energy to tissue.
As another merely illustrative example, button (125) may be
activated to apply ultrasonic energy to tissue at a low power level
(e.g., without also applying RF electrosurgical energy to tissue,
applying RF electrosurgical energy to tissue simultaneously, or
applying RF electrosurgical energy to tissue in a sequence with the
ultrasonic energy); while button (126) may be activated to apply
ultrasonic energy to tissue at a high power level (e.g., without
also applying RF electrosurgical energy to tissue, applying RF
electrosurgical energy to tissue simultaneously, or applying RF
electrosurgical energy to tissue in a sequence with the ultrasonic
energy). In addition or in the alternative, buttons (125, 126) may
provide functionality in accordance with at least some of the
teachings of U.S. Pub. No. 2015/0141981, entitled "Ultrasonic
Surgical Instrument with Electrosurgical Feature," published May
21, 2015, the disclosure of which is incorporated by reference
herein. Other suitable ways in which buttons (125, 126) may provide
operation of instrument (110) will be apparent to those of ordinary
skill in the art in view of the teachings herein.
II. EXEMPLARY END EFFECTOR CONFIGURATIONS
[0165] As noted above, end effector (140) may include various kinds
of electrode configurations to apply RF electrosurgical energy to
tissue. It should also be understood that ultrasonic blade (160)
may have various structural configurations. These various
structural configurations of ultrasonic blade (160) may provide
different kinds of effects on tissue. In particular, the particular
structural configuration of ultrasonic blade (160) may influence
the way in which ultrasonic blade (160) applies ultrasonic energy
to tissue. For instance, some ultrasonic blade (160) configurations
may provide better ultrasonic cutting of tissue while other
ultrasonic blade (160) configurations may provide better ultrasonic
sealing of tissue. The relationships between the structural
configurations of the electrode(s) and ultrasonic blade (160) may
also influence the way in which end effector (140) applies RF
electrosurgical energy to tissue. The following discussion provides
various examples of different end effector configurations. It
should be understood that any of the various end effectors
described below may be readily incorporated into instrument (110),
in place of end effector (140).
[0166] It should also be understood that all of the end effectors
described below may include features that are configured to ensure
that a minimum gap is defined between the variation of clamp arm
(144) and the variation of blade (160), even when the variation of
end effector (140) is in a fully closed configuration. Such a
minimum gap will prevent the variation of clamp arm (144) from
contacting the variation of blade (160), which will prevent
formation of a short circuit between an electrode of the variation
of clamp arm (144) and the variation of blade (160). This may be
particularly important when the variation of end effector is being
used to provide bipolar RF electrosurgical energy to tissue, with
the electrode of the variation of clamp arm (144) providing one
pole for the RF electrosurgical energy and the variation of blade
(160) providing the other pole for the RF electrosurgical energy. A
minimum gap may also selected to prevent arcing of such energy,
where the arcing might otherwise occur when a gap is sized below
the predetermined minimum amount. By way of example only, a minimum
gap may be provided in accordance with at least some of the
teachings of U.S. patent application Ser. No. 14/928,375, entitled
"Ultrasonic Surgical Instrument Clamp Arm with Proximal Nodal Pad,"
filed Oct. 30, 2015, the disclosure of which is incorporated by
reference herein. Other suitable ways in which a minimum gap may be
provided will be apparent to those of ordinary skill in the art in
view of the teachings herein.
[0167] A. End Effector with Blade Having Narrow Width and Peaked
Contact Surface
[0168] FIGS. 2A-3B and 10-11 show one merely illustrative example
of an end effector (200) that may be readily incorporated into
instrument (110) in place of end effector (140). End effector (200)
of this example comprises a clamp arm (210) and an ultrasonic blade
(240). Clamp arm (210) is configured to pivot relative to blade
(240) between an open position (FIGS. 2A and 3A) and a closed
position (FIGS. 2B and 3B) to selectively receive and clamp tissue
in end effector (200). To provide this pivotal movement, clamp arm
(210) is pivotably coupled with an outer tube (202) at one pivot
point; and with inner tube (204) at another pivot point. Thus,
relative longitudinal movement between tubes (202, 204) provides
pivotal movement of clamp arm (210). In some versions, outer tube
(202) is configured to translate longitudinally relative to inner
tube (204), while inner tube (204) remains longitudinally
stationary, to provide pivotal movement of clamp arm (210). In some
other versions, inner tube (204) is configured to translate
longitudinally relative to outer tube (202), while outer tube (202)
remains longitudinally stationary, to provides pivotal movement of
clamp arm (210). Whichever tube (202, 204) is movable, the movable
tube (202, 204) may be coupled with trigger (128) such that pivotal
movement of trigger (128) relative to pistol grip (124) may provide
the longitudinal movement of the movable tube (202, 204). Various
suitable ways in which trigger (128) may be coupled with the
movable tube (202, 204) will be apparent to those of ordinary skill
in the art in view of the teachings herein. It should also be
understood that tubes (202, 204) may form part of shaft assembly
(130).
[0169] As best seen in FIGS. 2A-2B and 4-5, clamp arm (210) of the
present example includes a clamp pad (220) and a clamp pad retainer
member (230). As best seen in FIG. 5, clamp arm (210) further
includes a U-shaped electrode surface (212). Clamp pad (220)
includes a plurality of teeth (222) and valleys (224) that assist
in gripping tissue that is clamped between clamp arm (210) and
blade (240). As best seen in FIG. 4, clamp pad (220) includes a
rail (226) that allows clamp pad (220) to be slid into the body of
clamp arm (210). Retainer member (230) is also configured to be
secured to the body of clamp arm (210), proximal to clamp pad
(220), to thereby further secure clamp pad (220) to the body of
clamp arm (210). It should also be understood that retainer member
(230) may engage the sides of blade (240) in order to ensure proper
lateral/yaw alignment of clamp arm (210) relative to blade (240)
during closure of clamp arm (210). By way of example only, retainer
member (230) may provide such alignment in accordance with at least
some of the teachings of U.S. patent application Ser. No.
14/928,375, entitled "Ultrasonic Surgical Instrument Clamp Arm with
Proximal Nodal Pad," filed Oct. 30, 2015, the disclosure of which
is incorporated by reference herein. Other suitable ways in which
end effector (200) may provide proper alignment between clamp arm
(210) and blade (240) will be apparent to those of ordinary skill
in the art in view of the teachings herein. Similarly, other
suitable ways in which clamp pad (220) may be secured to the body
of clamp arm (210) will be apparent to those of ordinary skill in
the art in view of the teachings herein.
[0170] As best seen in FIG. 5, electrode surface (212) extends all
the way around the distal end (211) of clamp arm (210), surrounding
the outer perimeter of clamp pad (220). In the present example,
electrode surface (212) is flush with the ridges of teeth (222),
such that valleys (224) are recessed relative to electrode surface
(212). In some alternative versions, the ridges of teeth (222) are
recessed relative to electrode surface (212). In some other
alternative versions, the ridges of teeth (222) are proud relative
to electrode surface (212), such that electrode surface is recessed
relative to the ridges of teeth (222). Other suitable relationships
will be apparent to those of ordinary skill in the art in view of
the teachings herein.
[0171] Electrode surface (212) is coupled with generator (116) and
controller (118) such that electrode surface (212) is configured to
provide one pole of bipolar RF electrosurgical energy to tissue. In
the present example, blade (240) is configured to provide the other
pole of bipolar RF electrosurgical energy to tissue. Thus,
electrode surface (212) and blade (240) cooperate to apply bipolar
RF electrosurgical energy to tissue. Various suitable ways in which
electrode surface (212) and blade (240) may be coupled with
generator (116) and controller (118) to apply bipolar RF
electrosurgical energy to tissue will be apparent to those of
ordinary skill in the art in view of the teachings herein. In some
versions, outer tube (202) provides an electrical path between
electrode surface (212) and generator (116). In some such versions,
a sheath (206) may be disposed about outer tube (202). Such a
sheath (206) may be formed of an electrically insulative material,
such that sheath (206) shields the operator from the electrical
path provided along outer tube (202).
[0172] FIGS. 6-9 show blade (240) in greater detail. As best seen
in FIG. 6, blade (240) is curved, such that blade (240) extends
along a path that curvingly deviates from the longitudinal axis
defined by acoustic waveguide (242). Clamp arm (210) follows the
same curve. In some versions, blade (240) and clamp arm (210) are
straight instead of being curved. It should be understood that
acoustic waveguide (242) may be coupled with transducer (112); and
that acoustic waveguide (242) may form part of shaft assembly
(130). In particular, acoustic waveguide (242) may be coaxially
positioned within tubes (202, 204) described above. Blade (240)
includes a distal portion (250) and a proximal portion (260).
Distal portion (250) is located within a region of end effector
(200) that is intended to grasp and manipulate tissue. In
particular, distal portion (250) is located at a region associated
with the length of clamp pad (220). Proximal portion (260) is
located within a region of end effector (200) that is not intended
to grasp and manipulate tissue. In particular, proximal portion
(260) is located at a region associated with the length of retainer
member (230). In the present example, end effector (200) is
configured such that tissue may nevertheless be received between
proximal portion (260) and retainer member (230) when end effector
(200) is in a fully open configuration. In some other versions, end
effector (200) includes stops or other features that prevent tissue
from reaching the region between proximal portion (260) and
retainer member (230).
[0173] As best seen in FIGS. 7-8, distal portion (250) of blade
(240) has an upper contact surface (252) flanked by a pair of
oblique surfaces (254); as well as a pair of laterally presented
surfaces (256). The bottom of blade (240) includes a concave cutout
(258). In some versions, upper contact surface (252) is flat. In
some other versions, upper contact surface (252) is curved. Oblique
surfaces (254) are flat in this example, though other versions may
have oblique surfaces (254) that are curved or have some other
surface geometry. Laterally presented surfaces (256) are also flat
in this example, though other versions may have surfaces (256) that
are curved, angled, or have some other surface geometry. Concave
cutout (258) is configured to provide blade (240) with back-cutting
capabilities as is known in the art. It should be understood that
cutout (258) may be configured in numerous ways; and may even be
omitted if desired.
[0174] As best seen in FIGS. 6 and 9, proximal portion (260) of
blade (240) has an upper curved surface (262), a pair of chamfers
(264), and a pair of laterally presented surfaces (266). In the
present example, chamfers (264) extend along only part of the
length of proximal portion (260), at the distal end of proximal
portion (260). In some other versions, chamfers (264) extend along
the full length of proximal portion (260). As also shown in FIG. 9,
at least a portion of cutout (258) extends into at least a portion
of the length of proximal portion (260). In some other versions,
cutout (258) stops short of proximal portion (260), such that
cutout (258) does not extend into any portion of the length of
proximal portion (260). In still other versions cutout (258)
extends along the full length of proximal portion (260).
[0175] FIGS. 2A-3B and 10 show the relationships between the
structures of clamp arm (210) and blade (240). In particular, FIGS.
2B and 3B show how the distal end (211) of clamp arm (210) extends
distally past the distal end (241) of blade (240). This ensures
that electrode surface (212) (best seen in FIGS. 5 and 10) may be
used to fully seal the full perimeter of a cut line formed in
tissue that has been severed by blade (240). FIG. 10 shows how the
lateral portions of electrode surface (212) are positioned
laterally outwardly relative to surfaces (256) of distal portion
(250) of blade (240). In other words, the width separating the
lateral portions of electrode surface (212) is greater than the
width separating surfaces (256), such that distal portion (250) of
blade (240) is narrower than clamp arm (210).
[0176] FIG. 11 shows how end effector (200) would engage tissue (T)
with end effector (200) in the closed configuration. While just a
single layer of tissue (T) is shown in this example, it should be
understood that two or more layers of tissue (T) may be captured in
end effector (200) in some examples. As shown, the compression
forces on the tissue (T) are focused in the region between upper
contact surface (252) and clamp pad (220). These compression forces
are directed mainly along the same vertical plane along which clamp
arm (210) pivots toward blade (240). The tissue (T) is also
contacted by oblique surfaces (254). However, the compression
provided by oblique surfaces (254) is lower than the compression
provided by upper contact surface (252). Moreover, the compression
forces imposed on the tissue (T) by oblique surfaces (254) are
directed obliquely outwardly, mainly toward electrode surfaces
(212). It should be understood that the above-described manner in
which end effector (200) engages tissue (T) may provide ultrasonic
severing of tissue (T) in the region between upper contact surface
(252) and clamp pad (220); with combined ultrasonic and RF
electrosurgical sealing of tissue (T) in the regions between
oblique surfaces (254) and electrode surfaces (212).
[0177] B. End Effector with Blade Having Wide Width and Curved
Contact Surface
[0178] FIGS. 12A-12B and 16 show another exemplary end effector
(300) that may be readily incorporated into instrument (110) in
place of end effector (140). End effector (300) of this example
comprises clamp arm (210) and an ultrasonic blade (340). Clamp arm
(210) of end effector (300) is configured and operable just like
clamp arm (210) of end effector (200) as described above.
Therefore, the details of clamp arm (210) will not be repeated
here.
[0179] FIGS. 13-15 show blade (340) in greater detail. As best seen
in FIG. 14, blade (340) is curved, such that blade (340) extends
along a path that curvingly deviates from the longitudinal axis
defined by acoustic waveguide (342). Clamp arm (210) follows the
same curve. In some versions, blade (340) and clamp arm (210) are
straight instead of being curved. It should be understood that
acoustic waveguide (342) may be coupled with transducer (112); and
that acoustic waveguide (342) may form part of shaft assembly
(130). In particular, acoustic waveguide (342) may be coaxially
positioned within tubes (202, 204) described above. As best seen in
FIG. 15, blade (340) includes a curved upper contact surface (352),
a pair of flat laterally presented surfaces (356), and a curved
lower surface (358). In some alternative versions, lower surface
(358) may include a cutout similar to cutout (258) described above.
It should also be understood that surfaces (356) may be curved,
angled, or have any other suitable surface geometry.
[0180] FIGS. 12A-12B and 16 show the relationships between the
structures of clamp arm (210) and blade (340). In particular, FIG.
12B shows how the distal end (211) of clamp arm (210) extends
distally past the distal end (341) of blade (340). This ensures
that electrode surface (212) may be used to fully seal the full
perimeter of a cut line formed in tissue that has been severed by
blade (350). FIG. 16 shows how the lateral portions of electrode
surface (212) terminate laterally at the same vertical planes
defined by surfaces (356) of blade (340). In other words, the width
of clamp arm (210) is equal to the width of blade (340).
[0181] FIG. 16 also shows how end effector (300) would engage
tissue (T) with end effector (300) in the closed configuration.
While just a single layer of tissue (T) is shown in this example,
it should be understood that two or more layers of tissue (T) may
be captured in end effector (300) in some examples. As shown, the
compression forces on the tissue (T) are focused in the region at
and near the peak of the curve defined by upper contact surface
(352). These compression forces are directed mainly along the same
vertical plane along which clamp arm (210) pivots toward blade
(350). The tissue (T) is also contacted by the laterally outboard
region of upper contact surface (352) (i.e., the regions that are
closest to lateral surfaces (356)). However, the compression
provided at these outermost regions of upper contact surface (352)
is lower than the compression provided by the laterally central
region of upper contact surface (352). Moreover, the compression
forces imposed on the tissue (T) by outermost regions of upper
contact surface (352) are directed obliquely outwardly, mainly
toward electrode surfaces (212). It should be understood that the
above-described manner in which end effector (300) engages tissue
(T) may provide ultrasonic severing of tissue (T) in the laterally
central region between upper contact surface (352) and clamp pad
(220); with combined ultrasonic and RF electrosurgical sealing of
tissue (T) in the outer regions between upper contact surface (352)
and electrode surfaces (212).
[0182] C. End Effector with Clamp Arm Having Electrode Skirt
[0183] FIG. 17 shows another exemplary end effector (400) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (400) of this example comprises a
clamp arm (410) and an ultrasonic blade (430). Clamp arm (410) is
operable to pivot toward and away from blade (430) in the manner
described above. Clamp arm (410) of this example comprises a clamp
pad (420) and electrode surfaces (412) that are laterally outboard
of clamp pad (420). Clamp pad (420) has a flat tissue engagement
surface (422) that is recessed relative to electrode surfaces
(412). Electrode surfaces (412) are at the bottoms of arms that are
configured to receive blade (430). Blade (430) of this example
includes a generally flat upper surface (432), a pair of generally
flat outer surfaces (434), and a lower cutout (436). While surfaces
(432, 434) are generally flat, and surfaces (434) are perpendicular
to surface (432), blade (430) provides curved transitions from
surface (432) to surfaces (434) in this example. Thus, the upper
region of blade (430) (i.e., the region that faces clamp arm (410))
has rounded corners instead of sharp corners. It should also be
understood that surfaces (434) may be curved, angled, or have any
other suitable surface geometry.
[0184] In the present example, the lateral portions of electrode
surface (412) are positioned laterally outwardly relative to
surfaces (434) of blade (430). In other words, the width separating
the lateral portions of electrode surface (412) is greater than the
width separating surfaces (434), such that blade (430) is narrower
than clamp arm (410). End effector (400) is configured to compress
tissue between surface (432) and clamp pad (420), and thereby
ultrasonically sever the tissue in a region that is laterally
positioned between electrode surfaces (412). End effector (400) is
further operable to provide ultrasonic and RF electrosurgical
sealing of tissue in regions of tissue that are contacted by
electrode surfaces (412), which would include tissue that is
laterally outward from the cut line formed by upper surface (432)
and clamp pad (420).
[0185] D. End Effector with Clamp Pad Having Proud Contact
Surface
[0186] FIG. 18 shows another exemplary end effector (500) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (500) of this example comprises a
clamp arm (510) and an ultrasonic blade (530). Clamp arm (510) is
operable to pivot toward and away from blade (530) in the manner
described above. Clamp arm (510) of this example comprises a clamp
pad (520) and electrode surfaces (512) that are laterally outboard
of clamp pad (520). Clamp pad (520) is also proud relative to
electrode surfaces (512), such that electrode surfaces (512) are
recessed relative to a flat tissue engagement surface (522) of
clamp pad (520). Blade (530) of this example includes a generally
flat upper surface (532), a pair of generally flat outer surfaces
(534), and a lower cutout (536). While surfaces (532, 534) are
generally flat, and surfaces (534) are perpendicular to surface
(532), blade (530) provides curved transitions from surface (532)
to surfaces (534) in this example. Thus, the upper region of blade
(530) (i.e., the region that faces clamp arm (510)) has rounded
corners instead of sharp corners. It should also be understood that
surfaces (534) may be curved, angled, or have any other suitable
surface geometry.
[0187] In the present example, the lateral portions of electrode
surface (512) terminate laterally at the same vertical planes
defined by surfaces (534) of blade (530). In other words, the width
of clamp arm (510) is equal to the width of blade (530). End
effector (500) is configured to compress tissue between surface
(532) and clamp pad (520), and thereby ultrasonically sever the
tissue in a region that is laterally positioned between electrode
surfaces (512). End effector (500) is further operable to provide
ultrasonic and RF electrosurgical sealing of tissue in regions of
tissue that are contacted by electrode surfaces (512), which would
include tissue that is laterally outward from the cut line formed
by upper surface (532) and clamp pad (520).
[0188] E. End Effector with Clamp Pad Having Rounded Contact
Surface
[0189] FIG. 19 shows another exemplary end effector (600) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (600) of this example comprises a
clamp arm (610) and an ultrasonic blade (630). Clamp arm (610) is
operable to pivot toward and away from blade (630) in the manner
described above. Clamp arm (610) of this example comprises a clamp
pad (620) and electrode surfaces (612) that are laterally outboard
of clamp pad (620). Clamp pad (620) is also proud relative to
electrode surfaces (612), such that electrode surfaces (612) are
recessed relative a portion of the tissue engagement surface (622)
of clamp pad (620). In particular, tissue engagement surface (622)
of this example is curved such that the peak of the curve (at the
laterally central region of surface (622)) is proud relative to
electrode surfaces (612); while the laterally outer regions of
surface (622) are recessed relative to electrode surfaces (612).
Blade (630) of this example includes a generally flat upper surface
(632), a pair of generally flat outer surfaces (634), and a lower
cutout (636). While surfaces (632, 634) are generally flat, and
surfaces (634) are perpendicular to surface (632), blade (630)
provides curved transitions from surface (632) to surfaces (634) in
this example. Thus, the upper region of blade (630) (i.e., the
region that faces clamp arm (610)) has rounded corners instead of
sharp corners. It should also be understood that surfaces (634) may
be curved, angled, or have any other suitable surface geometry.
[0190] In the present example, the lateral portions of electrode
surface (612) terminate laterally at the same vertical planes
defined by surfaces (634) of blade (630). In other words, the width
of clamp arm (610) is equal to the width of blade (630). End
effector (600) is configured to compress tissue between surface
(632) and clamp pad (620), and thereby ultrasonically sever the
tissue in a region that is laterally positioned between electrode
surfaces (612). End effector (600) is further operable to provide
ultrasonic and RF electrosurgical sealing of tissue in regions of
tissue that are contacted by electrode surfaces (612), which would
include tissue that is laterally outward from the cut line formed
by upper surface (632) and clamp pad (620).
[0191] F. End Effector with Oblique Electrode Surfaces and Flat
Contact Region
[0192] FIG. 20 shows another exemplary end effector (700) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (700) of this example comprises a
clamp arm (710) and an ultrasonic blade (730). Clamp arm (710) is
operable to pivot toward and away from blade (730) in the manner
described above. Clamp arm (710) of this example comprises a clamp
pad (720) and electrode surfaces (712) that are laterally outboard
of clamp pad (720). In the present example, electrode surfaces
(712) are obliquely oriented such that the laterally outboard edges
of electrode surfaces (712) are positioned lower than the laterally
inboard edges of electrode surfaces (712). Clamp pad (720) is proud
relative to the laterally inboard edges of electrode surfaces
(712), such that the laterally inboard edges of electrode surfaces
(712) are recessed relative to the flat tissue engagement surface
(722) of clamp pad (720). However, the laterally outboard edges of
electrode surfaces (712) are proud relative to the flat tissue
engagement surface (722) of clamp pad (720). Blade (730) of this
example includes a generally flat upper surface (732) flanked by a
pair of oblique surfaces (733), a pair of generally flat outer
surfaces (734), and a lower cutout (736). The width of flat upper
surface (732) corresponds to the width of tissue engagement surface
(722). Similarly, the width and angle of surfaces (733) correspond
to the width and angle of electrode surfaces (712). It should also
be understood that surfaces (734) may be curved, angled, or have
any other suitable surface geometry.
[0193] In the present example, the lateral portions of electrode
surfaces (712) terminate laterally at the same vertical planes
defined by surfaces (734) of blade (730). In other words, the width
of clamp arm (710) is equal to the width of blade (730). End
effector (700) is configured to compress tissue between surface
(732) and clamp pad (720), and thereby ultrasonically sever the
tissue in a region that is laterally positioned between electrode
surfaces (712). End effector (700) is further operable to provide
ultrasonic and RF electrosurgical sealing of tissue in regions of
tissue that are contacted by electrode surfaces (712), which would
include tissue that is laterally outward from the cut line formed
by upper surface (732) and clamp pad (720).
[0194] G. End Effector with Oblique Electrode Surfaces and Peaked
Contact Region
[0195] FIG. 21 shows another exemplary end effector (800) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (800) of this example comprises a
clamp arm (810) and an ultrasonic blade (830). Clamp arm (810) is
operable to pivot toward and away from blade (830) in the manner
described above. Clamp arm (810) of this example comprises a clamp
pad (820) and electrode surfaces (812) that are laterally outboard
of clamp pad (820). In the present example, electrode surfaces
(812) are obliquely oriented such that the laterally outboard edges
of electrode surfaces (812) are positioned lower than the laterally
inboard edges of electrode surfaces (812). Clamp pad (820) is proud
relative to the laterally inboard edges of electrode surfaces
(812), such that the laterally inboard edges of electrode surfaces
(812) are recessed relative to the flat tissue engagement surface
(822) of clamp pad (820). However, the laterally outboard edges of
electrode surfaces (812) are proud relative to the flat tissue
engagement surface (822) of clamp pad (820). Blade (830) of this
example includes a pair of oblique surfaces (833) that converge at
a peak (832), a pair of generally flat outer surfaces (834), and a
lower cutout (836). In the present example, peak (832) is formed as
a curved transition from one oblique surface (833) to the other
oblique surface (833). In some other versions, peak (832) is formed
as a sharp transition or a flat transition. The width and angle of
surfaces (833) corresponds to the angle of electrode surfaces
(812). It should also be understood that surfaces (834) may be
curved, angled, or have any other suitable surface geometry.
[0196] In the present example, the lateral portions of electrode
surfaces (812) terminate laterally at the same vertical planes
defined by surfaces (834) of blade (830). In other words, the width
of clamp arm (810) is equal to the width of blade (830). End
effector (800) is configured to compress tissue between clamp pad
(820) and peak (832) (and adjacent regions of surfaces (833), and
thereby ultrasonically sever the tissue in a region that is
laterally positioned between electrode surfaces (812). End effector
(800) is further operable to provide ultrasonic and RF
electrosurgical sealing of tissue in regions of tissue that are
contacted by electrode surfaces (812), which would include tissue
that is laterally outward from the cut line formed by peak (832)
and clamp pad (820).
[0197] H. End Effector with Single Electrode Insert within Clamp
Pad
[0198] FIGS. 31-34B show another exemplary end effector (2000) that
may be readily incorporated into instrument (110) in place of end
effector (140). End effector (2000) of this example comprises a
clamp arm (2010) and an ultrasonic blade (240). Clamp arm (2010)
connects with inner tube (204) via pin (205) and is operable to
pivot toward and away from blade (240) in the manner described
above. Referring to FIG. 33, clamp arm (2010) of this example
comprises a distal clamp pad (2020), proximal clamp pad (2030),
insulator (2050), and electrode (2060). In some versions, distal
clamp pad (2020) is part of a laminate structure that isolates
clamp arm (2010) from electrode (2060). In some other versions,
clamp arm (2010) itself provides an integral electrode that
projects downwardly toward blade (240). In the present example,
proximal clamp pad (2030) is retained in clamp arm (2010) with a
dovetail or similar feature. Proximal clamp pad (2030) and distal
clamp pad (2020) could be formed of the same material(s) or of
different material(s).
[0199] Referring to FIG. 32, clamp pad (2020) comprises openings
(2021) that provide access to electrode (2060). In the present
example, openings (2021) are configured as pairs of opposing
semi-circle shapes that are separated by a first portion (2023) of
clamp pad (2020). The pairs of openings (2021) are spaced apart
from each other along the length of clamp pad (2020). In this
configuration, each pair of openings (2021) is separated by second
portion (2025) of clamp pad (2020). This configuration provides
regions of accessible electrode (2060) alternating with regions of
inaccessible electrode (2060) that are concealed by clamp pad
(2020). Furthermore, this configuration also provides for
continuous clamping surface along a centerline region of clamp pad
(2020). In the present example, the centerline region may be
understood as the center-most region of clamp pad (2020) extending
along the length of clamp pad (2020) and including the alternating
first and second portions (2023, 2025) of clamp pad (2020). In
versions with a curved clamp pad, as is the case with clamp pad
(2020), the centerline region comprises the same or similar
curvature. In this configuration there is continuous clamp pad
(2020) adjacent upper surface (252) of blade (240). In view of the
teachings herein, other configurations for openings (2021) in clamp
pad (2020) to provide access to electrode (2060) will be apparent
to those of ordinary skill in the art.
[0200] In the present example, electrode (2060) comprises proximal
end (2062) configured to receive pin (205). Pin (205) also extends
through openings in inner tube (204) and clamp arm (2010). In this
manner, clamp arm (2010), electrode (2060), and inner tube (204)
connect about a common axis defined by pin (205). In the present
example, pin (205) is electrically isolated at the locations where
pin (205) contacts clamp arm (2010). In particular, the free ends
of pin (205) are coated with (or otherwise provided with) an
electrically insulative material. By way of example only, such a
material may comprise parylene, xylan, etc. Alternatively, the full
length of pin (205) may be coated with (or otherwise provided with)
an electrically insulative material. As another merely illustrative
alternative, the openings in clamp arm (2010) that receive pin
(205) may be coated with (or otherwise provided with) an
electrically insulative material. As yet another merely
illustrative alternative, the entire body of clamp arm (2010) that
may be coated with (or otherwise provided with) an electrically
insulative material.
[0201] Insulator (2050) is positioned between clamp arm (2010) and
electrode (2060) such that when electrode (2060) is activated,
clamp arm (2010) remains neutral due to the insulative coating.
Proximal clamp pad (2030) is configured with an opening (2031)
through which electrode (2060) passes. In this manner, proximal
clamp pad (2030) separates electrode (2060) from the proximal
portion of clamp arm (2010) to insulate clamp arm (2010) from
electrode (2060). In some versions, electrode (2060) is activated
through its connection with pin (205) and inner tube (204). For
example, inner tube (204) may receive electrical power and then
transmit that to electrode (2060). Inner tube (204) may then be
coated with an insulating material or shielded by outer tube to
protect a user of instrument (110). In the present example, blade
(240) serves as a negative pole while electrode (2060) serves as a
positive pole. In this manner, bipolar RF electrosurgical energy
can be communicated through tissue that is positioned between (and
in contact with) electrode (2060) and blade (240). In view of the
teachings herein, other ways to provide electrical communication to
electrode (2060) while insulating clamp arm (2010), and/or to
provide electrical communication to blade (240), will be apparent
to those of ordinary skill in the art.
[0202] In some versions, when fabricating end effector (2000),
proximal clamp pad (2030) is formed in a first molding step. In
this step proximal clamp pad (2030) is molded over electrode (2060)
and joined with clamp arm (2010) through molded rail (2026). Rail
(2026) is received within a complementary shaped recess within
clamp arm (2010) as described in other versions above. Distal clamp
pad (2020) is then formed in a second molding step and joined with
clamp arm (2010). In versions where clamp pads (2020, 2030) are
formed of the same material, clamp pads (2020, 2030) may be formed
and joined simultaneously. Openings (2021) are machined in molded
distal clamp pad (2020) to expose areas of electrode (2060). In
some versions, proximal clamp pad (2030) and/or distal clamp pad
(2020) are molded and/or machined separate from clamp arm (2010)
and electrode (2060) and then assembled with clamp arm (2010) and
electrode (2060) after molding and/or machining. In view of the
teachings herein, other ways to fabricate and assemble end effector
(2000) will be apparent to those of ordinary skill in the art.
[0203] Referring to FIGS. 34A and 34B, clamp pad (2020) comprises
teeth (2022) as described above. As also described above, end
effector (2000) is configured for tissue engagement between blade
(240) and the toothed surface of clamp pad (2020). Clamp pad (2020)
remains proud relative the surface of electrode (2060), such that
the surface of electrode (2060) is recessed relative to the
tissue-engaging toothed surface of clamp pad (2020) by a
predetermined initial starting gap (e.g., ranging from
approximately 0.004'' to approximately 0.012''). In those regions
having openings (2021), when tissue is compressed between clamp pad
(2020) and blade (240), tissue can fill openings (2021) and thereby
contact electrode (2060). In this manner, a conductive pathway is
established through the tissue between electrode (2060) and blade
(240). With tissue compressed between clamp pad (2020) and blade
(240), ultrasonic energy can be imparted to waveguide (242) and
thereby ultrasonically sever the tissue along the continuous
centerline region of clamp pad (2020). On each side of the cut
line, ultrasonic sealing occurs as described above. In addition,
end effector (2000) is further operable to provide RF
electrosurgical sealing of tissue along the conductive pathways
described above, which would include tissue that is laterally
outward from the cut line formed between upper surface (252) of
blade (240) and the centerline region of clamp pad (2020). In some
versions, the spacing of openings (2021) is such that the RF
electrosurgical sealing occurs not only at the openings (2021), but
between openings (2021) as well. In this manner, RF electrosurgical
sealing may be obtained along the length of clamp pad (2020) and
thus the length of the tissue cut line. In other versions, RF
electrosurgical sealing is not required to be continuous along each
side of the cut line, and instead may occur at multiple points
along each side of the cut line in a discontinuous fashion.
[0204] FIGS. 35-36B show another exemplary end effector (3000) that
may be readily incorporated into instrument (110) in place of end
effector (140). End effector (3000) is similar to end effector
(2000) described above. However, end effector (3000) comprises
clamp pad (3020) having openings (3021) configured with rectangular
shapes where openings (3021) are spaced apart longitudinally along
each side of a centerline region (3027) of clamp pad (3020).
Similar to clamp pad (2020), clamp pad (3020) also provides for
maintaining a continuous clamping surface or region of clamp pad
(3020) along centerline region (3027). In the present example,
blade (240) aligns along centerline region (3027) such that when
tissue (T) is compressed between blade (240) and clamp pad (3020),
ultrasonic energy may be provided to sever the tissue (T) along a
cut line that coincides with the aligned upper surface (252) of
blade (240) and centerline region (3027) of clamp pad (3020). While
the present example illustrates end effector (3000) and associated
clamp pad (3020) as having straight configurations, in other
versions end effector (3000) and associated clamp pad (3020) are
curved similarly to the curvature of end effector (2000) and clamp
pad (2020) for example.
[0205] In the present example, openings (3021) on a first side of
centerline region (3027) are staggered or longitudinally offset
compared to openings (3021) on a second opposite side of centerline
region (3027). Similar to end effector (2000) described above,
openings (3021) in end effector (3000) provide access to or expose
electrode (2060). Referring to FIGS. 36A and 36B, with this
configuration, when tissue (T) is compressed between blade (240)
and clamp pad (3020), tissue (T) can at least partially fill
openings (3021) to contact electrode (2060) at alternating
locations along the length of clamp pad (3020). In this manner, a
conductive pathway is established through the tissue (T) between
electrode (2060) and blade (240). With tissue (T) compressed
between clamp pad (3020) and blade (240), ultrasonic energy can be
imparted to waveguide (242) and thereby ultrasonically sever the
tissue (T) along the continuous centerline region (3027) of clamp
pad (3020). On each side of the cut line, ultrasonic sealing occurs
as described above. In addition, end effector (3000) is further
operable to provide RF electrosurgical sealing of tissue (T) along
the conductive pathways described above, which would include tissue
(T) that is laterally outward from the cut line formed between
upper surface (252) of blade (240) and the centerline region (3027)
of clamp pad (3020). In some versions, the spacing of openings
(3021) is such that the RF electrosurgical sealing occurs not only
at the openings (3021), but between longitudinally adjacent
openings (3021) as well. In this manner, RF electrosurgical sealing
may be obtained along the length of clamp pad (3020) and thus the
length of the tissue cut line. In other versions, RF
electrosurgical sealing is not required to be continuous along each
side of the cut line, and instead may occur at multiple points
along each side of the cut line in a discontinuous fashion.
[0206] Another difference between end effector (3000) and end
effector (2000) pertains to the orientation of the clamp pads
(2020, 3020) with respect to electrode (2060). With end effector
(2000), electrode (2060) is positioned on top of clamp pad (2020)
as shown in FIG. 33. With end effector (3000), electrode (2060) is
positioned within a channel of clamp pad (3020) as shown in FIGS.
36A and 36B. In the present example, but not required in all
versions, this configuration for clamp pad (3020) and electrode
(2060) is achieved by molding clamp pad (3020) around electrode
(2060) and then machining clamp pad (3020) to form openings (3021).
In the molding process, clamp pad (3020) is also attached with
clamp arm (3010) using complementary engagement features, e.g. a
molded rail (3029) of clamp pad (3020) engages a complementary
shaped recess in clamp arm (3010). In some other versions, clamp
arm (3010) has a rail machined/molded into it and clamp pad (3020)
has a complementary matching rail machined/molded into it. Clamp
arm (3010) and clamp arm (3010) pad can now be installed along the
length of the rail instead of being molded as a single component.
In view of the teachings herein, other configurations for orienting
electrode (2060) with respect to clamp pad (3020) will be apparent
to those of ordinary skill in the art. By way of example only,
clamp pad (3020) may be modified in some versions such that
electrode (2060) is positioned on top of clamp pad (3020) similar
to clamp pad (2020). Separately or in addition, clamp pad (3020)
may be modified to use various alternate configurations for
openings (3021) as will be understood in view of the teachings
herein.
[0207] FIGS. 37-38B show another exemplary end effector (4000) that
may be readily incorporated into instrument (110) in place of end
effector (140). End effector (4000) is similar to end effector
(2000) described above. However, end effector (4000) comprises
clamp arm (4010) and clamp pad (4020) having openings (4021)
configured with rectangular shapes, where openings (4021) extend
laterally across clamp pad (4020). This configuration provides for
end effector (4000) having a centerline region (4027) of clamp pad
(4020) with electrode (2060) partially accessible or exposed. In
the present example, blade (240) aligns along centerline region
(4027) such that when tissue (T) is compressed between blade (240)
and clamp pad (4020), ultrasonic energy may be provided to sever
the tissue (T) along a cut line that coincides with the aligned
upper surface (252) of blade (240) and centerline region (4027) of
clamp pad (4020). In the present configuration, clamp pad (4020)
contacts tissue (T) intermittently or in a discontinuous fashion
when end effector (4000) is in a closed configuration gripping
tissue (T) because openings (4021) interrupt centerline region
(4027) aligned with blade (240). However, the spacing of openings
(4021) and the ultrasonic energy applied are configured such that a
continuous cut of tissue (T) is made over the length of clamp pad
(4020) even without continuous contact between clamp pad (4020) and
tissue (T) along centerline region (4027). While the present
example illustrates end effector (4000) and associated clamp pad
(4020) as having straight configurations, in other versions end
effector (4000) and associated clamp pad (4020) are curved
similarly to the curvature of end effector (2000) and clamp pad
(2020) for example.
[0208] In the present example, openings (4021) in end effector
(4000) provide access to or expose electrode (2060). Referring to
FIGS. 38A and 38B, with this configuration, when tissue (T) is
compressed between blade (240) and clamp pad (4020), tissue (T) can
at least partially fill openings (4021) to contact electrode (2060)
at locations along the length of clamp pad (4020). In this manner,
a conductive pathway is established through the tissue (T) between
electrode (2060) and blade (240). With tissue (T) compressed
between clamp pad (4020) and blade (240), ultrasonic energy can be
imparted to waveguide (242) and thereby ultrasonically sever the
tissue (T) along the length of clamp pad (4020) as discussed above.
On each side of the cut line, ultrasonic sealing occurs as
described above. In addition, with portions of electrode (2060)
exposed along the centerline region (4027) of clamp pad (4020)--and
thus along the tissue cut line--end effector (4000) is further
operable to provide RF electrosurgical sealing of tissue (T) along
the conductive pathways described above, which would include tissue
(T) that is along the cut line formed between upper surface (252)
of blade (240) and centerline region (4027) of clamp pad (4020). In
some versions, the spacing of openings (4021) is such that the RF
electrosurgical sealing occurs not only at the openings (4021), but
between openings (4021) as well. In this manner, RF electrosurgical
sealing may be obtained along the length of clamp pad (4020) and
thus the length of the tissue cut line. In other versions, RF
electrosurgical sealing is not required to be continuous along each
side of the cut line, and instead may occur at multiple points
along each side of the cut line in a discontinuous fashion.
[0209] End effector (4000) uses a similar orientation for clamp pad
(4020) and electrode (2060) as shown and described above with
respect to end effector (3000), e.g. having electrode (2060) within
clamp pad (4020) instead of being on top of clamp pad (4020). In
view of the teachings herein, other configurations for orienting
electrode (2060) with respect to clamp pad (4020) will be apparent
to those of ordinary skill in the art. By way of example only,
clamp pad (4020) may be modified in some versions such that
electrode (2060) is positioned on top of clamp pad (4020) similar
to clamp pad (2020). Additionally, electrode (2060) could be part
of clamp arm (4010), and clamp pad (4020) could be molded to clamp
arm (4010). Separately or in addition, clamp pad (4020) may be
modified to use various alternate configurations for openings
(4021) as will be understood in view of the teachings herein.
[0210] FIGS. 39-40B show another exemplary end effector (5000) that
may be readily incorporated into instrument (110) in place of end
effector (140). End effector (5000) is similar to end effector
(2000) described above. However, end effector (5000) comprises
clamp arm (5010) and clamp pad (5020) having openings (5021)
configured with circular shapes, where openings (5021) extend along
the length of clamp pad (5020) in two offset rows extending along
the length of clamp pad (5020). This configuration provides for end
effector (5000) having a centerline region (5027) of clamp pad
(5020) with electrode (2060) partially accessible or exposed. In
the present example, blade (240) aligns along centerline region
(5027) such that when tissue (T) is compressed between blade (240)
and clamp pad (5020), ultrasonic energy may be provided to sever
the tissue (T) along a cut line that coincides with the aligned
upper surface (252) of blade (240) and centerline region (5027) of
clamp pad (5020). In the present configuration clamp pad (5020)
contacts tissue (T) intermittently or in a discontinuous fashion
when end effector (5000) is in a closed configuration gripping
tissue (T) because openings (5021) interrupt centerline region
(5027). However, the spacing of openings (5021) and the ultrasonic
energy applied are configured such that a continuous cut of tissue
(T) is made over the length of clamp pad (5020) even without
continuous contact between clamp pad (5020) and tissue (T) along
centerline region (5027). While the present example illustrates end
effector (5000) and associated clamp pad (5020) as having straight
configurations, in other versions end effector (5000) and
associated clamp pad (5020) are curved similarly to the curvature
of end effector (2000) and clamp pad (2020) for example.
[0211] In the present example, openings (5021) in end effector
(5000) provide access to or expose electrode (2060). Referring to
FIGS. 40A and 40B, with this configuration, when tissue (T) is
compressed between blade (240) and clamp pad (5020), tissue (T) can
at least partially fill openings (5021) to contact electrode (2060)
at alternating locations along the length of clamp pad (5020). In
this manner, a conductive pathway is established through the tissue
(T) between electrode (2060) and blade (240). With tissue (T)
compressed between clamp pad (5020) and blade (240), ultrasonic
energy can be imparted to waveguide (242) and thereby
ultrasonically sever the tissue (T) along the length of clamp pad
(5020) as discussed above. On each side of the cut line, ultrasonic
sealing occurs as described above. In addition, with portions of
electrode (2060) exposed along the centerline region (5027) of
clamp pad (5020)--and thus along the tissue cut line--end effector
(5000) is further operable to provide RF electrosurgical sealing of
tissue (T) along the conductive pathways described above, which
would include tissue (T) that is along the cut line formed between
upper surface (252) of blade (240) and centerline region (5027) of
clamp pad (5020). In some versions, the spacing of openings (5021)
is such that the RF electrosurgical sealing occurs not only at the
openings (5021), but between openings (5021) as well. In this
manner, RF electrosurgical sealing may be obtained along the length
of clamp pad (5020) and thus the length of the tissue cut line. In
other versions, RF electrosurgical sealing is not required to be
continuous along each side of the cut line, and instead may occur
at multiple points along each side of the cut line in a
discontinuous fashion.
[0212] End effector (5000) uses a similar orientation for clamp pad
(5020) and electrode (2060) as shown and described above with
respect to end effector (3000), e.g. having electrode (2060) within
clamp pad (5020) as opposed to on top of clamp pad (5020). In some
other versions, electrode (2060) is provided as a unitary feature
of clamp arm (5010), and clamp pad (5020) is overmolded to provide
a gap between clamp pad (5020) and electrode (2060). In view of the
teachings herein, other configurations for orienting electrode
(2060) with respect to clamp pad (5020) will be apparent to those
of ordinary skill in the art. By way of example only, clamp pad
(5020) may be modified in some versions such that electrode (2060)
is positioned on top of clamp pad (5020) similar to clamp pad
(2020). Separately or in addition, clamp pad (5020) may be modified
to use various alternate configurations for openings (5021) as will
be understood in view of the teachings herein.
[0213] I. End Effector with Dual Electrode Insert within Clamp
Pad
[0214] FIGS. 41-46 show portions of other exemplary end effectors
that may be readily incorporated into instrument (110) in place of
end effector (140). More specifically, FIG. 41 shows a clamp arm
assembly (6001) of end effector (6000) shown in FIG. 42. In the
present example, a blade of end effector (6000) is the same as
blade (240) as described above, while other blade configurations
may be used in other examples. End effector (6000) further
comprises a clamp arm (6010), a clamp pad (6020), a clamp pad
retainer member (6030), a first electrode (6060), and a second
electrode (6061).
[0215] Clamp arm (6010) is configured with multiple bores (6011)
that align with corresponding bores (6021) of clamp pad (6020) and
corresponding bores (6031) of retainer member (6030). Clamp arm
(6010) comprises an opening (6012) that is shaped to receive clamp
pad (6020), which is formed with corresponding features that are
shaped to fit within opening (6012). Similarly, retainer member
(6030) is formed with features that are shaped to engage with
corresponding features of clamp arm (6010). For example, retainer
member (6030) includes a rail (6032) similar to rail (226)
described above, with rail (6032) engaging a recess within clamp
arm (6010) that is shaped to receive rail (6032). With clamp pad
(6020) and retainer member (6030) positioned within clamp arm
(6010), multiple pins may be used to secure clamp pad (6020) and
retainer member (6030) to clamp arm (6010) by inserting the pins
through the aligning bores (6011, 6021, 6031). By way of example
only, this method of assembly could be achieved by overmolding
clamp pad (6020) and retainer member (6030) to clamp arm (6010)
while capturing electrodes (6060, 6061).
[0216] First electrode (6060) comprises a pair of contacts or
terminals (6062), while second electrode (6061) also comprises a
pair of contacts or terminals (6063). In some other versions, the
pair of contacts may be modified or replaced such that each
electrode (6060, 6061) comprises only a single contact or terminal.
First and second electrodes (6060, 6061) also comprise respective
body portions (6064, 6065). The pairs of terminals (6062, 6063)
extend from their respective body portions (6064, 6065) in a manner
such that pairs of terminals (6062, 6063) are generally orthogonal
with respect to their respective body portions (6064, 6065).
[0217] Referring now also to FIGS. 43 and 44, in the connection
with clamp arm assembly (6001), first electrode (6060) is received
within clamp pad (6020), with pair of terminals (6062) extending
through clamp pad (6020) such that pair of terminals (6062) are
exposed and accessible from a top outer region of clamp arm (6010)
as seen in FIG. 41. Second electrode (6061) connects with clamp arm
assembly (6001) in the same manner as first electrode (6060). To
accommodate first and second electrodes (6060, 6061), clamp pad
(6020) comprises a pair of longitudinal slots (6022) for receiving
body portions (6064, 6065) of electrodes (6060, 6061). Clamp pad
(6020) also comprises bores (6023) that allow pairs of terminals
(6062, 6063) of electrodes (6060, 6061) to pass through clamp pad
(6020) for access from the top outer region of clamp arm (6010). In
some other versions, these exposed terminals (6062, 6063) bend
90.degree. and terminate into the proximal end of clamp pad (6020);
and connect to an insulated wire.
[0218] Referring to FIGS. 43 and 44, clamp pad (6020) comprises
teeth (6025) as described above. As also described above, end
effector (6000) is configured for tissue engagement between blade
(240) and the toothed surface of clamp pad (6020). Clamp pad (6020)
remains proud relative to the surfaces of electrodes (6060, 6061),
such that the surfaces of electrodes (6060, 6061) are recessed
relative to the tissue engaging toothed surface of clamp pad
(6020). In those regions with longitudinal slots (6022), when
tissue is held between clamp pad (6020) and blade (240), tissue can
at least partially fill slots (6022) contacting electrodes (6060,
6061). In this manner, a conductive pathway is established through
the tissue between electrodes (6060, 6061) and blade (240). Blade
(240) is aligned with a centerline region (6024) of clamp pad
(6020) that extends between first and second electrodes (6060,
6061). With tissue compressed between clamp pad (6020) and blade
(240), ultrasonic energy can be imparted to waveguide (242) and
thereby ultrasonically sever the tissue along the continuous
centerline region (6024) of clamp pad (6020). On each side of the
cut line, ultrasonic sealing occurs as described above. In
addition, end effector (6000) is further operable to provide RF
electrosurgical sealing of tissue along the conductive pathways
described above, which would include tissue that is laterally
outward from the cut line formed between upper surface (252) of
blade (240) and centerline region (6024) of clamp pad (6020). With
the continuously exposed electrodes (6060, 6061) along a majority
of the length of clamp pad (6020), RF electrosurgical sealing may
be obtained along each side of the length of the tissue cut
line.
[0219] Referring to FIGS. 45 and 46, in other versions, RF
electrosurgical sealing is not required to be continuous along each
side of the cut line, and instead may occur at multiple points
along each side of the cut line in a discontinuous fashion. As
shown in FIG. 45, clamp pad (6120) may replace clamp pad (6020).
Clamp pad (6120) comprises transverse oval shaped openings (6122)
as opposed to longitudinal slots (6022) of clamp pad (6020).
Openings (6122) extend across centerline region (6124) of clamp pad
(6120) such that centerline region (6124) of clamp pad (6120) is
not continuous pad material along the length of centerline region
(6124) as opposed to the configuration with clamp pad (6020) having
continuous centerline region (6024).
[0220] In the example shown in FIGS. 45 and 46, ultrasonic energy
may be provided to sever the tissue along a cut line that coincides
with the aligned upper surface (252) of blade (240) and centerline
region (6124) of clamp pad (6120). In the present configuration
clamp pad (6120) contacts gripped tissue intermittently or in a
discontinuous fashion because openings (6122) interrupt centerline
region (6124). However, the spacing of openings (6122) and the
ultrasonic energy applied are configured such that a continuous cut
of the tissue is made over the length of clamp pad (6120) even
without continuous contact between clamp pad (6120) and the tissue
along centerline region (6124).
[0221] Openings (6122) in clamp pad (6120) provide access to or
expose electrodes (6060, 6061). With this configuration, when the
tissue is compressed between blade (240) and clamp pad (6120), the
tissue can at least partially fill openings (6122) to contact
electrodes (6060, 6061) at locations along the length of clamp pad
(6120). In this manner, a conductive pathway is established through
the tissue between electrodes (6060, 6061) and blade (240). With
the tissue compressed between clamp pad (6120) and blade (240),
ultrasonic energy can be imparted to waveguide (242) and thereby
ultrasonically sever the tissue along the length of clamp pad
(6120) as discussed above. On each side of the cut line, ultrasonic
sealing occurs as described above. In addition, the end effector
with clamp pad (6120) is further operable to provide RF
electrosurgical sealing of tissue along the conductive pathways
described above, which would include tissue that is laterally
outward from the cut line formed between upper surface (252) of
blade (240) and centerline region (6124) of clamp pad (6120). In
some versions using openings (6122) the RF electrosurgical sealing
occurs at those locations on each side of the cut line
corresponding to the locations of respective openings (6122). In
some versions, the spacing of openings (6122) is such that the RF
electrosurgical sealing occurs not only at the openings (6122), but
between openings (6122) as well. In this manner, RF electrosurgical
sealing may be obtained along the length of clamp pad (6120) and
thus along each side of the length of the tissue cut line. In view
of the teachings herein, other configurations for openings (6122)
to provide RF electrosurgical sealing will be apparent to those of
ordinary skill in the art.
[0222] In the examples discussed above with respect to FIGS. 41-46,
pairs of terminals (6062, 6063) connect to an electrical source
such that each electrode (6060, 6061) has the same polarity, with
blade (240) having the opposite polarity such that the conductive
pathways exist between each of electrodes (6060, 6061) and blade
(240). In other versions, blade (240) is electrically neutral and
electrode (6060) has an opposite polarity to electrode (6061). In
such examples with two oppositely polarized electrodes (6060, 6061)
and a neutral blade (240), pairs of terminals (6062, 6063) connect
to electrical sources such that one of electrodes (6060, 6061) has
positive polarity and the other has negative polarity. With this
configuration, the conductive pathways are established through the
tissue between electrodes (6060, 6061). With these conductive
pathways, the RF electrosurgical sealing occurs laterally across
the tissue cut line. In versions using clamp pad (6020), the RF
electrosurgical sealing may be continuous along the length of clamp
pad (6020) and the tissue cut line. In versions using clamp pad
(6120), the RF electrosurgical sealing may be discontinuous along
the length of clamp pad (6120) and the tissue cut line. In view of
the teachings herein, other ways to configure electrodes (6060,
6061) and clamp pads (6020, 6120) to achieve a desired conductive
pathway for RF electrosurgical sealing will be apparent to those of
ordinary skill in the art.
[0223] J. End Effector with Dual Electrode Molded within Clamp
Pad
[0224] FIGS. 47A-48B show exemplary end effectors (7000, 7100) that
may be readily incorporated into instrument (110) in place of end
effector (140). FIGS. 47A and 47B show end effector (7000), which
comprises clamp arm (210), a clamp pad (7020), blade (240), and
first and second wires (7060, 7061). FIG. 47A shows a first state
of manufacture for end effector (7000), prior to machining clamp
pad (7020). FIG. 47B shows a second state of manufacture for end
effector (7000), after machining clamp pad (7020) to expose
electrodes (7062, 7063) within wires (7060, 7061), which have an
insulating material surrounding electrodes (7062, 7063). In the
present example, clamp pad (7020) is formed in a molding process
such that clamp pad (7020) is formed with clamp arm (210) and
molded over wires (7060, 7061). In other examples, clamp pad (7020)
may be formed separate from clamp arm (210) and/or wires (7060,
7061) and then later combined with clamp arm (210) and/or wires
(7060, 7061). After combining wires (7060, 7061), clamp pad (7020),
and clamp arm (210), clamp pad (7020) is machined such that
portions of clamp pad (7020) are cut away along with insulator
portions of wires (7060, 7061) to expose electrodes (7062, 7063).
In some instances, it is not necessary to combine clamp pad (7020)
and wires (7060, 7061) with clamp arm (210) prior to machining
assembled clamp pad (7020) and wires (7060, 7061).
[0225] In the present example, each of wires (7060, 7061) have the
same polarity with blade (240) having the opposite polarity. With
identically polarized wires (7060, 7061) positioned opposite to
oppositely polarized blade (240), this can be considered an
opposing or offset electrode configuration. In some versions, wires
(7060, 7061) each serve as a positive pole while blade (240) serves
as a negative pole. In this configuration the conductive pathway is
created through tissue between wires (7060, 7061) and blade (240).
It should also be understood that, in some other versions, wires
(7060, 7061) may have opposing polarity while blade (240) is
electrically neutral.
[0226] Furthermore, as will be apparent to those of ordinary skill
in the art in view of the teachings herein, the configuration of
the machined cutouts, and the resulting openings created in clamp
pad (7020) to expose electrodes (7062, 7063) will impact the
configuration of the conductive pathways and the resulting RF
electrosurgical sealing. By way of example only, and not
limitation, clamp pad (7020) and wires (7060, 7061) may be machined
such that there are continuous openings along clamp pad (7020)
exposing electrodes (7062, 7063) in a continuous fashion along the
length of clamp pad (7020). In other versions, clamp pad (7020) and
wires (7060, 7061) may be machined such that there are intermittent
openings along clamp pad (7020) exposing electrodes (7062, 7063)
intermittently along the length of clamp pad (7020). In either
approach, clamp pad (7020) and blade (240) are configured such that
after machining clamp pad (7020), a sufficient gap is maintained
between electrodes (7062, 7063) and blade (240) to prevent short
circuiting as discussed above. In use, ultrasonic cutting,
ultrasonic sealing, and RF electrosurgical sealing occur in the
same or similar manner as described above and will be apparent to
those of ordinary skill in the art in view of the teachings
herein.
[0227] FIGS. 48A and 48B show end effector (7100), which comprises
clamp arm (210), a clamp pad (7120), blade (240), and first and
second wires (7060, 7061). FIG. 48A shows a first state of
manufacture for end effector (7100), prior to machining clamp pad
(7120). FIG. 48B shows a second state of manufacture for end
effector (7100), after machining clamp pad (7120) to expose
electrodes (7062, 7063) within wires (7060, 7061), which have an
insulating material surrounding electrodes (7062, 7063). In the
present example, clamp pad (7120) is formed in a molding process
such that clamp pad (7120) is formed with clamp arm (210) and
molded over wires (7060, 7061). In other examples, clamp pad (7120)
may be formed separate from clamp arm (210) and/or wires (7060,
7061) and then later combined with clamp arm (210) and/or wires
(7060, 7061). After combining wires (7060, 7061), clamp pad (7120),
and clamp arm (210), clamp pad (7120) is machined such that
portions of clamp pad (7120) are cut away along with insulator
portions of wires (7060, 7061) to expose electrodes (7062, 7063).
In some instances, it is not necessary to combine clamp pad (7120)
and wires (7060, 7061) with clamp arm (210) prior to machining
assembled clamp pad (7120) and wires (7060, 7061).
[0228] In the present example, each wire (7060, 7061) has an
opposite polarity with blade (240) being neutral. With oppositely
polarized wires (7060, 7061) positioned offset from one another
within clamp pad (7120), this can be considered an offset electrode
configuration. In a configuration where wire (7060) serves as a
positive pole and wire (7061) serves as a negative pole, the
conductive pathway is created from electrode (7062) of wire (7060),
through the gripped tissue, and to electrode (7063) of wire (7061).
To facilitate this conductive pathway, wires (7060, 7061) are
positioned closer together compared to the arrangement shown in
FIGS. 47A and 47B. In view of the teachings herein, other positions
for wires (7060, 7061) relative to clamp pad (7120) to achieve a
desired conductive pathway through tissue will be apparent to those
of ordinary skill in the art. It should also be understood that end
effector (7100) may be modified such that electrodes (7062, 7063)
both provide one pole (e.g., a positive pole) while blade (240)
provides an opposite pole (e.g., a negative pole).
[0229] Furthermore, as will be apparent to those of ordinary skill
in the art in view of the teachings herein, the configuration of
the machined cutouts, and the resulting openings created in clamp
pad (7120) to expose electrodes (7062, 7063) will impact the
configuration of the conductive pathways and the resulting RF
electrosurgical sealing. By way of example only, and not
limitation, clamp pad (7120) and wires (7060, 7061) may be machined
such that there are continuous openings along clamp pad (7120)
exposing electrodes (7062, 7063) in a continuous fashion along the
length of clamp pad (7120). In other versions, clamp pad (7120) and
wires (7060, 7061) may be machined such that there are intermittent
openings along clamp pad (7120) exposing electrodes (7062, 7063)
intermittently along the length of clamp pad (7120). In either
approach, although blade (240) is neutral, clamp pad (7120) and
blade (240) may be configured such that after machining clamp pad
(7120), a sufficient gap is maintained between electrodes (7062,
7063) and blade (240) to prevent short circuiting as discussed
above. In use, ultrasonic cutting, ultrasonic sealing, and RF
electrosurgical sealing occur in the same or similar manner as
described above and will be apparent to those of ordinary skill in
the art in view of the teachings herein. Furthermore, in some
versions end effector (7100) may be configured such that electrodes
(7062, 7063) have the same polarity and are used with blade (240)
having an opposite polarity, similar to the description above with
respect to end effector (7000).
[0230] K. End Effector with Dual Nested Electrode within Clamp
Pad
[0231] FIGS. 49-54B show clamp assemblies (8001, 8101, 8201) of
three other exemplary end effectors that may be readily
incorporated into instrument (110) in place of end effector (140).
Each end effector of these examples comprises the same clamp arm
(8010), clamp pad retainer member (8030), wires (8040, 8041),
insulators (8050, 8051), electrodes (8060, 8061), and blade (240).
However, each end effector of these examples comprises a different
configuration for clamp pads (8020, 8120, 8220) as will be
described in greater detail below.
[0232] Referring to FIGS. 49 and 51-52B, the end effector of this
example comprises a clamp arm assembly (8001). Clamp arm assembly
(8001) is operable to pivot toward and away from blade (240) in the
manner described above. Clamp arm assembly (8001) comprises clamp
arm (8010), clamp pad (8020), clamp pad retainer member (8030),
wires (8040, 8041), insulators (8050, 8051), and electrodes (8060,
8061). Clamp pad retainer member (8030) operates similar to clamp
pad retainer member (230) discussed above. Clamp pad (8020)
comprises openings (8021) that provide access to electrodes (8060,
8061). In the present example, openings (8021) are configured as
rectangular shapes, where openings (8021) extend laterally across
clamp pad (8020). This configuration provides for a centerline
region (8027) of clamp pad (8020) with electrodes (8060, 8061)
partially accessible or exposed. In the present example, blade
(240) aligns along centerline region (8027) such that when tissue
is compressed between blade (240) and clamp pad (8020), ultrasonic
energy may be provided to sever the tissue along a cut line that
coincides with the aligned upper surface (252) of blade (240) and
centerline region (8027) of clamp pad (8020). In the present
configuration clamp pad (8020) provides intermittent contact with
the tissue along centerline region (8027) when the end effector is
in a closed configuration gripping the tissue because openings
(8021) interrupt centerline region (8027).
[0233] Openings (8021) in clamp pad (8020) provide access to or
expose electrodes (8060, 8061). Electrodes (8060, 8061) each
comprise projections (8062, 8063) that extend from respective body
portions (8064, 8065) of electrodes (8060, 8061). Furthermore,
electrodes (8060, 8061) each comprise spaces (8066, 8067) between
respective projections (8062, 8063) of electrodes (8060, 8061).
Projections (8062) and spaces (8066) are offset along the length of
electrode (8060) relative to projections (8063) and spaces (8067)
of electrode (8061). With this offset configuration, electrodes
(8060, 8061) have a nested, interdigitated arrangement as best seen
in FIG. 51, where projections (8062) are positionable within spaces
(8067), and projections (8063) are positionable within spaces
(8066). As seen in FIG. 51, although nested, electrodes (8060,
8061) maintain a space or gap from one another such that they are
not in contact. Electrodes (8060, 8061) are connectable with wires
(8040, 8041) such that electrodes (8060, 8061) can serve as
positive and negative poles. While wires (8040, 8041) are shown as
being exposed above clamp arm (8010) in FIGS. 49-51, 52B, 53B, and
54B, it should be understood that this is an exaggerated
representation of wires (8040, 8041). In practical contexts, wires
(8040, 8041) may in fact be disposed in clamp pad (8020) and
retainer member (8030) such that wires (8040, 8041) are not exposed
above clamp arm (8010).
[0234] Insulators (8050, 8051) are positioned between clamp arm
(8010) and electrodes (8060, 8061) such that clamp arm (8010)
remains electrically neutral. In the present example, blade (240)
can be coated such that blade (240) remains electrically neutral
also. The coating used with blade (240) can also provide non-stick
features that help prevent tissue from sticking to blade (240).
[0235] With this configuration, when the tissue is compressed
between blade (240) and clamp pad (8020), the tissue can at least
partially fill openings (8021) to contact electrodes (8060, 8061)
at locations along the length of clamp pad (8020). Moreover, at
least some of the tissue that fills openings (8021) can at least
partially fill spaces (8066, 8067) between electrodes (8060, 8061).
In this manner, a conductive pathway is established through the
tissue between electrodes (8060, 8061). With the tissue compressed
between clamp pad (8020) and blade (240), ultrasonic energy can be
imparted to waveguide (242) and thereby ultrasonically sever the
tissue along the length of clamp pad (8020) as discussed above. On
each side of the cut line, ultrasonic sealing occurs as described
above. In addition, the end effector is further operable to provide
RF electrosurgical sealing of the tissue along the conductive
pathways described above, which would include RF electrosurgical
sealing through tissue from one side of the cut line to tissue on
the other side of the cut line since the cut line is generally
centered along the nested area of electrodes (8060, 8061). In some
versions, the spacing of openings (8021) is such that the RF
electrosurgical sealing occurs not only at the openings (8021), but
between openings (8021) as well. In this manner, RF electrosurgical
sealing may be obtained along the entire length of clamp pad (8020)
and thus the entire length of the tissue cut line. In other
versions, RF electrosurgical sealing is not required to be
continuous along the cut line, and instead may occur at multiple
points along the cut line in a discontinuous fashion as described
above.
[0236] In some other versions using an end effector as configured
as shown in FIGS. 49 and 51-52B, the end effector may be modified
such that each electrode (8060, 8061) has the same polarity and
with the blade (240) having the opposite polarity from the
electrodes (8060, 8061). In this configuration, and where the
electrodes (8060, 8061) serve as positive poles and blade (240)
serves as the negative pole, the conductive path will extend from
each of the electrodes (8060, 8061), through the tissue, and to the
blade (240). As will be understood by those of ordinary skill in
the art in view of the teachings herein, the RF electrosurgical
sealing will then occur as described above with respect to those
versions using a polarized blade.
[0237] FIGS. 50, 53A, and 53B show a similar end effector that uses
clamp arm assembly (8101), which incorporates clamp pad (8120). As
mentioned above, clamp arm assembly (8101) includes many of the
same components and operates similarly to clamp arm assembly (8001)
described above. One difference is with clamp arm assembly (8101),
clamp pad (8120) is formed with a rail (8126) for engaging with
clamp arm (8010). Rail (8126) is structurally and operably similar
to rail (226) described above. Another difference with clamp arm
assembly (8101) is that clamp pad (8120) comprises openings (8121)
that are shaped as pairs of longitudinally elongated circles that
repeat along the length of clamp pad (8120). With this alternate
opening configuration for clamp pad (8120), the pattern of the RF
electrosurgical sealing may differ from that described above with
respect to clamp pad (8020) and openings (8021). As described
above, this end effector using clamp arm assembly (8101) may be
configured such that an electrically neutral blade (240) is used
with oppositely polarized electrodes (8060, 8061); or in other
versions each electrode (8060, 8061) may have the same polarity,
with blade (240) being oppositely polarized. The gap between
openings (8121) may vary to ensure there is material to engage
blade (240) for the ultrasonic functionality. For instance, distal
openings (8121) may be smaller out at the tapered end of clamp arm
(8010). Alternatively, blade (240) may be reconfigured to contact
outside of the centerline to allow a cut along the entire length of
clamp arm (8010).
[0238] FIGS. 54A and 54B show a similar end effector that uses
clamp arm assembly (8201), which incorporates clamp pad (8220). As
mentioned above, clamp arm assembly (8201) includes many of the
same components and operates similarly to clamp arm assembly (8001)
described above. One difference with clamp arm assembly (8201) is
that clamp pad (8220) is formed with a rail (8226) for engaging
with clamp arm (8010). Rail (8226) is structurally and operably
similar to rail (226) described above. Another difference with
clamp arm assembly (8201) is that clamp pad (8220) comprises
openings (8221) that are shaped as pairs of circles that repeat
along the length of clamp pad (8220). With this alternate opening
configuration for clamp pad (8220), the pattern of the RF
electrosurgical sealing may differ from that described above with
respect to clamp pad (8020) and openings (8021). As described
above, this end effector using clamp arm assembly (8201) may be
configured such that an electrically neutral blade (240) is used
with oppositely polarized electrodes (8060, 8061); or in other
versions each electrode (8060, 8061) may have the same polarity
with blade (240) being oppositely polarized.
[0239] While the above version illustrate electrodes (8060, 8061)
as flat conductors, such as stamped metal, etc., in some other
versions electrodes (8060, 8061) can be wire structures. For
example, a pair of wires may be configured in a close nested
arrangement, similar to the nested arrangement shown for electrodes
(8060, 8061) in FIG. 51. The wires may then have opposite polarity
and be used with a neutral blade (240) or the wires may have the
same polarity and be used with an oppositely polarized blade (240)
as described above. In view of the teachings herein, other nested
structures and arrangements for electrodes (8060, 8061) will be
apparent to those of ordinary skill in the art.
[0240] L. End Effector with Patterned Clamp Arm Electrode
[0241] FIGS. 55-60B show other exemplary end effectors that may be
readily incorporated into instrument (110) in place of end effector
(140). FIG. 55 shows end effector (9000), which comprises blade
(9040), clamp arm (9010), and clamp pad (9020). Referring to FIG.
56, clamp arm (9010) includes body (9011) and cap (9012). Body
(9011) is configured with a patterned opening (9013) that in the
present example represents a mirrored sinusoidal shape. Opening
(9013) extends along the length of body (9011). Cap (9012) is
configured to attach with a top surface of body (9011) to cover and
close off opening (9013). Clamp pad (9020) comprises a shape that
is configured to fit within patterned opening (9013) of clamp arm
(9010). In the present example, clamp pad (9020) comprises a
mirrored sinusoidal shape such that when clamp pad (9020) is
positioned within clamp arm (9010), clamp pad (9020) fits within
opening (9013). Clamp pad (9020) is further configured with shelf
portions (9021) along each side. When clamp pad (9020) is inserted
within body (9011) from the top side, shelf portions (9021) contact
an upper surface (9015) of body (9011) outlining opening (9013). In
this configuration, clamp pad (9020) can only be installed within
clamp arm (9010) from one side, and furthermore clamp pad (9020)
cannot pass entirely through opening (9013). With clamp pad (9020)
positioned within body (9011), cap (9012) can be installed to
secure clamp pad (9020) in place.
[0242] Referring to FIGS. 57A and 57B, clamp pad (9020) is proud of
body (9011) such that when end effector (9000) is in a closed
configuration without tissue between blade (9040) and clamp arm
(9010), blade (9040) contacts clamp pad (9020) and not body (9011).
In this manner, a gap (9041) is maintained between blade (9040) and
clamp arm (9010). In some versions, in the absence of gripped
tissue between clamp pad (9020) and blade (9040), the degree of
contact between clamp pad (9020) and blade (9040) may vary along
the length of clamp pad (9020) in an alternating fashion due to the
mirrored sinusoidal shape of clamp pad (9020). For instance, as
seen in FIG. 57A, a cross-section along mirrored peaks of the
sinusoidal shape of clamp pad (9020) shows that blade (9040) has
maximum contact with clamp pad (9020) at those points. On the
contrary, as seen in FIG. 57B, a cross-section along mirrored
valleys of the sinusoidal shape of clamp pad (9020) shows that
blade (9040) has a minimum contact with clamp pad (9020) at those
points. However, in both instances, gap (9041) is maintained so
that blade (9040) does not contact clamp arm (9010).
[0243] In still other versions, the angled surfaces of blade (9040)
and the angled surfaces of clamp pad (9020) are configured such
that, in the absence of gripped tissue between clamp pad (9020) and
blade (9040), the degree of contact between clamp pad (9020) and
blade (9040) is constant along the length of clamp pad (9020). In
some such versions, an upper contact surface (9052) of blade (9040)
contacts only a lower contact surface (9022) of clamp pad (9020),
while oblique surfaces (9054) of blade (9040) and oblique surfaces
(9024) of clamp pad (9020) remain out of contact, e.g. by the
angles of these surfaces differing so that they diverge when end
effector (9000) is in the closed configuration.
[0244] As seen in FIGS. 55, 57A, and 57B, blade (9040) includes an
upper contact surface (9052) flanked by a pair of oblique surfaces
(9054); as well as a pair of laterally presented surfaces (9056).
In some versions, upper contact surface (9052) is flat. In some
other versions, upper contact surface (9052) is curved. Oblique
surfaces (9054) may be flat, though other versions may have oblique
surfaces (9054) that are curved or have some other surface
geometry. Laterally presented surfaces (9056) are also flat in this
example, though other versions may have surfaces (9056) that are
curved, angled, or have some other surface geometry. In some
versions, blade (9040) may be configured with a concave cutout
similar to concave cutout (258) described above.
[0245] In the present example, clamp pad (9020) includes a lower
contact surface (9022) flanked by a pair of oblique surfaces
(9024). In some versions, lower contact surface (9022) is flat. In
some other versions, lower contact surface (9022) is curved.
Oblique surfaces (9024) may be flat, though other versions may have
oblique surfaces (9024) that are curved or have some other surface
geometry. As best seen in FIGS. 57A and 57B, with the shapes of
blade (9040) and clamp pad (9020) as described above, blade (9040)
and clamp pad (9020) have complementary profiles.
[0246] When grasping tissue within end effector (9000) for sealing
and/or cutting, the compression forces on the tissue are focused in
the region between upper contact surface (9052) of blade (9040) and
lower contact surface (9022) of clamp pad (9020). These compression
forces are directed mainly along the same vertical plane along
which clamp arm (9010) pivots toward blade (9040). The tissue is
also contacted by oblique surfaces (9054) of blade (9040) and
oblique surfaces (9024) of clamp pad (9020). However, the
compression provided by oblique surfaces (9054, 9024) is lower than
the compression provided by upper and lower contact surfaces (9052,
9022). Moreover, the compression forces imposed on the tissue by
oblique surfaces (9054, 9022) are directed obliquely outwardly,
mainly toward surfaces of clamp arm (9010). It should be understood
that the above-described manner in which end effector (9000)
engages tissue may provide ultrasonic severing of the tissue in the
region between upper contact surface (9052) of blade (9040) and
lower contact surface (9022) of clamp pad (9020); with ultrasonic
sealing of the tissue in the regions between oblique surfaces
(9054, 9024). Additionally, RF electrosurgical sealing can be
provided as described below.
[0247] In the present example, clamp arm (9010) serves as a
positive pole while blade (9040) serves as a negative pole. Thus in
the present example, clamp arm (9010) serves as one electrode while
blade (9040) serves as the other electrode in a bipolar
arrangement. Clamp pad (9020) is constructed of an insulating
material and so remains electrically neutral. To provide the
polarity to clamp arm (9010), in some versions, clamp arm (9010)
attaches with outer tube (202) and/or inner tube (204) as described
above, and electrical power is transmitted to clamp arm (9010)
using outer tube (202) and/or inner tube (204). As also described
above, inner and/or outer tubes (204, 202) can be coated or covered
to protect a user from exposure to electrical power and also
prevent a short circuit when using instrument (110). Similarly,
select portions of clamp arm (9010) can be coated or covered so as
to maintain electrical power in desired areas of clamp arm (9010)
while shielding other areas and preventing short circuits. In view
of the teachings herein, other ways to provide electrical
communication to clamp arm (9010) and/or blade (9040) will be
apparent to those of ordinary skill in the art.
[0248] With this configuration, when the tissue is compressed
between blade (9040) and clamp pad (9020), the tissue contacts
perimeter surface (9016) of clamp arm (9010) that surrounds clamp
pad (9020). With clamp arm (9010) being electrically activated,
perimeter surface (9016) serves as one electrode with blade (9040)
being the other electrode. In this manner, a conductive pathway is
established through the tissue between perimeter surface (9016),
and blade (9040). In addition to the ultrasonic cutting and
ultrasonic sealing as described above, end effector (9000) is
further operable to provide RF electrosurgical sealing of the
tissue along the conductive pathways described above, which would
include RF electrosurgical sealing through tissue on each side of
the cut line.
[0249] FIGS. 58-60B show an alternate version of end effector
(9000), having a different clamp arm assembly (9101) with a
different clamp arm (9110) and different clamp pad (9120). In this
alternate version of end effector (9000) clamp arm (9110) is
configured to serve as one electrode, and blade (9040) is
oppositely configured to serve as the other electrode to provide
the bipolar RF electrosurgical sealing. However, clamp arm (9110)
comprises cylindrical protrusions (9112), while clamp pad (9120)
comprises openings (9122) that are configured to receive
cylindrical protrusions (9112). Clamp pad (9120) connects with
clamp arm (9110) using suitable fastening structures such as
adhesive or other mechanical fastening structures (e.g.,
overmolding). As seen in FIG. 60B, when clamp pad (9120) is
attached with clamp arm (9110), clamp pad (9120) is proud of
cylindrical protrusions (9112) such that cylindrical protrusions
(9112) are recessed within openings (9122). This configuration
prevents contact between cylindrical protrusions (9112) and blade
(9040) to avoid short circuits to the desired conductive
pathway.
[0250] When tissue is held between clamp pad (9120) and blade
(9040), tissue can fill openings (9122) contacting cylindrical
protrusions (9112). In this manner, a conductive pathway is
established through the tissue between cylindrical protrusions
(9112) and blade (9040). With tissue compressed between clamp pad
(9120) and blade (9040), ultrasonic energy can be imparted to
waveguide (242), and thus to blade (9040), and thereby
ultrasonically sever the tissue, e.g., along a continuous
centerline region (9124) of clamp pad (9120). On each side of the
cut line, ultrasonic sealing occurs as described above. In
addition, alternate end effector (9000) is further operable to
provide RF electrosurgical sealing of tissue along the conductive
pathways described above, which would include tissue that is
laterally outward from the cut line formed between upper surface
(9052) of blade (9040) and centerline region (9124) of clamp pad
(9120). In some versions, the spacing of openings (9122) is such
that the RF electrosurgical sealing occurs not only at the openings
(9122), but between openings (9122) as well. In this manner, RF
electrosurgical sealing may be obtained along the entire length of
clamp pad (9120) and thus the entire length of the tissue cut line.
In other versions, RF electrosurgical sealing is not required to be
continuous along each side of the cut line, and instead may occur
at multiple points along each side of the cut line in a
discontinuous fashion.
[0251] M. End Effector with Split Clamp Arm Electrodes
[0252] FIGS. 61-65B show another exemplary end effector (2100) that
may be readily incorporated into instrument (110) in place of end
effector (140). End effector (2100) comprises a clamp arm (2110),
blade (240), and a pad (2120). Clamp arm (2110) has a split
configuration where clamp arm (2110) comprises a first body (2111)
and a second body (2112). As will be discussed further below, first
body (2111) and second body (2112) each have opposite polarity and
serve as electrodes for RF electrosurgical sealing.
[0253] Positioned between first body (2111) and second body (2112)
of clamp arm (2110) is an electrically insulating clamp pad (2120).
In the present example, clamp pad (2120) is molded and formed
between first and second bodies (2111, 2112). First body (2111)
comprises bores (2113) that are configured to receive portions of
molded clamp pad (2120) to secure clamp pad (2120) with first body
(2111). Similarly, second body (2112) comprises bores (2114) that
are also configured to receive portions of molded clamp pad (2120)
to secure clamp pad (2120) with first body (2111). As shown in FIG.
64, molded clamp pad (2120) extends within bores (2113, 2114),
connecting first body (2111) and second body (2112) together.
Collectively, first body (2111), second body (2112), and clamp pad
(2120) make up clamp arm assembly (2101). While the present example
shows bores (2113) and bores (2114) generally aligned across from
each other, such alignment is not required in all versions. In
assembling clamp arm (2110), clamp pad (2120) is formed between
first body (2111) and second body (2112) such that first body
(2111) and second body (2112) do not directly contact one another.
In this manner, with first body (2111) oppositely polarized from
second body (2112), short circuits can be avoided. In view of the
teachings herein, other ways to configure clamp arm (2110) and
clamp pad (2120) to achieve a multi part clamp arm that provides
both positive and negative polarity will be apparent to those of
ordinary skill in the art.
[0254] In the present example, clamp arm assembly (2101) connects
with inner tube (204) and outer tube (202). Clamp arm assembly
(2101) is operable to open and close to grip tissue in the same
manner to that described above with respect to end effector (200).
In the present example, first body (2111) makes connects with outer
tube (202) by way of a post (2115) engaging an opening (208) in
outer tube (202). Post (2115) is directly formed as part of first
body (2111) such that post (2115) provides a path for electrical
communication between outer tube (202) and first body (2111).
Second body (2112) connects with inner tube (204) by way of a pin
(2116) engaging an opening (209) in inner tube (204). Pin (2116)
extends through an opening (2118) in second body (2112), which
aligns with opening (209) in inner tube (204). Pin (2116) is
comprised of a conductive material such that pin (2116) provides a
path for electrical communication between inner tube (204) and
second body (2112).
[0255] To provide electrical isolation between outer tube (202) and
inner tube (204), first body (2111) does not directly connect with
inner tube (204). Instead, pin (2116) extends through a molded bore
(2121) in clamp pad (2120), which is securely attached with first
body (2111) as described above. Similarly, second body (2112) does
not directly connect with outer tube (202), but instead clamp pad
(2120) is formed with a post (2122) that engages an opening (207)
in outer tube (202). With this configuration, clamp arm assembly
(2101) has a pivoting connection with inner tube (204) as well as a
pivoting connection with outer tube (202) such that clamp arm
assembly (2101) is operable to open and close in response to
translating movement of outer and/or inner tubes (202, 204) as
described above. Moreover, clamp arm assembly (2101) is operable to
open and close while maintaining two sides of clamp arm (2110)
having opposite polarity. In view of the teachings herein, other
ways to connect clamp arm assembly (2101) with inner and outer
tubes (204, 202) for open/close operability, while maintaining the
polarity configuration descried above, will be apparent to those of
ordinary skill in the art.
[0256] Referring to FIG. 64, with its split configuration, clamp
arm (2110) includes a split U-shaped electrode surface (2117)
formed by first and second bodies (2111, 2112). Clamp pad (2120)
includes a plurality of teeth (2123) that assist in gripping tissue
that is clamped between clamp arm (2110) and blade (240). Electrode
surface (2117) extends around clamp arm (2110), surrounding the
outer perimeter of clamp pad (2120) except where clamp pad (2120)
separates first body (2111) from second body (2112) at the
distal-most end of clamp arm (2110). In the present example,
electrode surface (2117) is flush with the ridges of teeth (2123),
such that valleys of teeth (2123) are recessed relative to
electrode surface (2117). In some alternative versions, the ridges
of teeth (2123) are recessed relative to electrode surface (2117).
In some other alternative versions, the ridges of teeth (2123) are
proud relative to electrode surface (2117), such that electrode
surface is recessed relative to the ridges of teeth (2123). Other
suitable relationships will be apparent to those of ordinary skill
in the art in view of the teachings herein.
[0257] End effector (2100) may capture a single layer of tissue or
two or more layers of tissue may be captured in some examples. As
similarly described above with respect to end effector (200), the
compression forces on the tissue with end effector (2100) are
focused in the region between upper contact surface (252) of blade
(240) and clamp pad (2120). These compression forces are directed
mainly along the same vertical plane along which clamp arm (2110)
pivots toward blade (240). The tissue is also contacted by oblique
surfaces (254) of blade (240). However, the compression provided by
oblique surfaces (254) is lower than the compression provided by
upper contact surface (252). Moreover, the compression forces
imposed on the tissue by oblique surfaces (254) are directed
obliquely outwardly, mainly toward electrode surface (2117). It
should be understood that the above-described manner in which end
effector (2100) engages tissue may provide ultrasonic severing of
tissue in the region between upper contact surface (252) and clamp
pad (2120); with combined ultrasonic sealing of tissue in the
regions between oblique surfaces (254) and clamp pad (2120) and/or
electrode surface (2117).
[0258] Additionally, with oppositely polarized first body (2111)
and second body (2112) of clamp arm (2110), when end effector
(2100) captures tissue in a closed configuration, a conductive
pathway is created between the positive pole of e.g. first body
(2111), laterally through the captured tissue, and the negative
pole of e.g. second body (2112). Of course in other versions the
polarity of first and second bodies (2111, 2112) may be switched
such that the conductive pathway would be similar but flow from
second body (2112), through the tissue, and to first body (2111).
In the present example, RF electrosurgical sealing occurs along the
conductive pathway described above, which includes RF
electrosurgical sealing laterally through the compresses tissue
along and across the cut line of the tissue. In this example, blade
(240) may be neutral or blade (240) may be electrically
conductive.
[0259] N. End Effector with Selectively Coated Blade and/or Pad
[0260] FIGS. 66-73 show other exemplary end effectors that may be
readily incorporated into instrument (110) in place of end effector
(140). FIGS. 66-68 show end effector (2200), or portions of end
effector (2200). End effector (2200) comprises clamp arm (2210),
clamp pad (2220), and blade (2240). In the present example, clamp
arm (2210) is configured to serve as a positive pole. In view of
the teachings herein, various ways to provide electrical
communication to clamp arm (2210) will be apparent to those of
ordinary skill in the art. Clamp pad (2220) comprises a
nonconductive material and thus remains electrically neutral. Blade
(2240) is configured to serve as a negative pole. Again, in view of
the teachings herein, various ways to provide electrical
communication to blade (2240) will be apparent to those of ordinary
skill in the art. Blade (2240) further includes a selectively
placed nonconductive coating (2241). Where applied, coating (2241)
electrically insulates portions of blade (2240), such that only the
uncoated portions of blade (2240) provide a negative pole to
cooperate with clamp arm (2210) for communication of bipolar RF
electrosurgical energy through contacted tissue. Referring to FIGS.
66-68, coating (2241) is applied to blade (2240) except in circular
shaped uncoated regions (2242). In the present example, uncoated
areas (2242) are located along blade (2240) such that uncoated
areas (2242) align with clamp pad (2220).
[0261] End effector (2200) may capture a single layer of tissue or
two or more layers of tissue may be captured in some examples. As
described above with respect to other end effectors, the
compression forces on the tissue with end effector (2200) are
focused in the region between blade (2240) and clamp pad (2220).
These compression forces are directed mainly along the same
vertical plane along which clamp arm (2210) pivots toward blade
(2240). With this configuration, end effector (2200) engages tissue
to provide ultrasonic severing of tissue in the region between
blade (2240) and clamp pad (2220); with combined ultrasonic sealing
of tissue in the regions of tissue adjacent the cut line.
[0262] Additionally, with oppositely polarized clamp arm (2210) and
uncoated areas (2242) of blade (2240), when end effector (2200)
captures tissue in a closed configuration, a conductive pathway is
created through the tissue captured between clamp arm (2210) and
uncoated areas (2242) of blade (2240). Of course in other versions
the polarity of clamp arm (2210) and blade (2240) may be switched
such that the conductive pathway would be similar. In the present
example, RF electrosurgical sealing occurs along the conductive
pathways described above, which includes RF electrosurgical sealing
along the cut line of the tissue at those locations of uncoated
areas (2242). In some versions, the spacing of uncoated areas
(2242) is such that the RF electrosurgical sealing occurs not only
at uncoated areas (2242), but between uncoated areas (2242) as
well. In this manner, RF electrosurgical sealing may be obtained
along the entire length of the combined uncoated areas (2242) of
blade (2240). In some versions, this entire length of the combined
uncoated areas (2242) is the same as, or approximates, the entire
length of the tissue cut line such that RF electrosurgical sealing
is obtained along the entire length of the cut line. In other
versions, RF electrosurgical sealing is not required to be
continuous along the cut line, and instead may occur at multiple
points along the cut line in a discontinuous fashion, e.g. those
points contacting the locations of uncoated areas (2242). The
pattern of these uncoated areas could range from a percentage of
approximately 20% to approximately 85%, and various patterns are
possible to include various shapes and sizes.
[0263] FIGS. 69-71 show another exemplary end effector (2300),
similar to end effector (2200) descried above, that may be readily
incorporated into instrument (110) in place of end effector (140).
In this example, a blade (2340) serves as a negative pole and again
includes a coating (2341) that is selectively applied to blade
(2340) such that portions of blade (2340) are shielded while other
portions are exposed. As shown in FIGS. 69-71, uncoated areas
(2342) exposing polarized portions of blade (2340) are located
along each side of blade (2340) instead of along the top surface as
was the example with blade (2240) of end effector (2200). End
effector (2300) further comprises clamp arm (2210) and clamp pad
(2220) as described above. In the present example, clamp arm (2210)
is electrically neutral while clamp pad (2220) serves as a positive
pole; and blade (2340) serves as a negative pole. In other
versions, this polarity arrangement may be reversed. Also, in the
present example the entire tissue contacting surface of clamp pad
(2220) serves as a positive pole electrode, though in other
versions modified clamp pads may be used that using various
techniques described above to provide an electrode that contacts
tissue in discrete regions forming a particular pattern.
[0264] End effector (2300) may capture a single layer of tissue or
two or more layers of tissue may be captured in some examples. As
described above with respect to other end effectors, the
compression forces on the tissue with end effector (2300) are
focused in the region between blade (2340) and clamp pad (2220).
These compression forces are directed mainly along the same
vertical plane along which clamp arm (2210) pivots toward blade
(2340). With this configuration, end effector (2300) engages tissue
to provide ultrasonic severing of tissue in the region between
blade (2340) and clamp pad (2220); with combined ultrasonic sealing
of tissue in the regions of tissue adjacent the cut line.
[0265] Additionally, with oppositely polarized clamp arm (2210) and
uncoated areas (2342) of blade (2340), when end effector (2300)
captures tissue in a closed configuration, a conductive pathway is
created through the tissue captured between clamp pad (2220) and
uncoated areas (2342) of blade (2340). Of course in other versions
the polarity of clamp pad (2220) and blade (2340) may be switched.
In the present example, RF electrosurgical sealing occurs along the
conductive pathways described above, which includes RF
electrosurgical sealing along each side of the cut line of the
tissue at those locations of uncoated areas (2342). In some
versions, the spacing of uncoated areas (2342) is such that the RF
electrosurgical sealing occurs not only at uncoated areas (2342),
but between adjacent uncoated areas (2342) as well. In this manner,
RF electrosurgical sealing may be obtained along the entire length
of the combined uncoated areas (2342) on each side of blade (2340).
In some versions, this entire length of the combined uncoated areas
(2342) on each side of blade (2340) is the same as, or
approximates, the entire length of the tissue cut line such that RF
electrosurgical sealing is obtained lateral to the cut line yet
along the entire length of the cut line. In other versions, RF
electrosurgical sealing is not required to be continuous lateral to
and along the length of the cut line, and instead may occur at
multiple points lateral to and along the length of the cut line in
a discontinuous fashion, e.g. those points contacting the locations
of uncoated areas (2342).
[0266] While the uncoated areas shown for end effectors (2100,
2200) have a general circular configuration, in other version
uncoated areas (2242, 2342) can have other shapes and patterns to
locate areas of exposed electrode surfaces in a desired fashion. In
view of the teachings herein, such other shapes and patterns for
uncoated areas (2242, 2342) will be apparent to those of ordinary
skill in the art.
[0267] FIGS. 72 and 73 show other exemplary end effectors (2400,
2500), similar to end effectors (2200, 2300) described above, that
may be readily incorporated into instrument (110) in place of end
effector (140). Each end effector (2400, 2500) comprises blade
(2240) as described above with selective coating (2241) and
uncoated areas (2242). Each end effector (2400, 2500) further
comprises clamp arm (2210) as described above. With each end
effector (2400, 2500), clamp arm (2210) is electrically
neutral.
[0268] Referring to FIG. 72, end effector (2400) further comprises
clamp pad (2420) that is coated with a conductive coating (2421)
such that clamp pad (2420) can be configured to provide a polarity
using the techniques described above. In the present example, the
conductive coating (2421) is applied uniformly to at least the
surface of clamp pad (2420) contacting tissue captured between
clamp pad (2420) and blade (2240); but may be applied to the entire
outer surface of clamp pad (2420). To prevent short circuits
between clamp pad (2420) and exposed uncoated areas (2242) of blade
(2240), clamp pad (2420) comprises cutouts (2422) that recess
portions of clamp pad (2420) that align above uncoated areas (2242)
of blade (2240). In the present example, cutouts (2422) are
machined into clamp pad (2420) or formed with clamp pad (2420)
prior to coating clamp pad (2420) with conductive coating (2421).
In other examples, clamp pad (2420) may be coated and then cutouts
(2422) machined into clamp pad (2420). In the configuration
described above, in the absence of tissue between blade (2240) and
clamp pad (2420), when end effector (2400) is closed and blade
(2240) contacts clamp pad (2420), conductively coated projections
(2423) of clamp pad (2420) only contact areas of blade (2240) with
nonconductive coating (2241) and do not contact any uncoated areas
(2242) of blade (2240).
[0269] When tissue is compressed between blade (2240) and clamp pad
(2420), tissue contacts clamp pad (2420) and uncoated areas (2242)
of blade (2240). In this manner, conductive pathways are
established through the tissue between clamp pad (2420) and
uncoated areas (2242) of blade (2240). With tissue compressed
between clamp pad (2420) and blade (2240), ultrasonic energy can be
imparted to waveguide (242) and thereby ultrasonically sever the
tissue along the length of clamp pad (2420), with ultrasonic
sealing as well, as discussed above. End effector (2400) is further
operable to provide RF electrosurgical sealing of the tissue along
the conductive pathways described above, which would include tissue
that is along the cut line formed between blade (2240) and clamp
pad (2420). In some versions, the spacing of uncoated areas (2242)
and coated projections (2423) is such that the RF electrosurgical
sealing occurs along the entire length of clamp pad (2420) and thus
the entire length of the tissue cut line. In other versions, RF
electrosurgical sealing is not required to be continuous along the
cut line, and instead may occur at multiple points along the cut
line in a discontinuous fashion.
[0270] FIG. 73 shows end effector (2500), which is similar in
structure and operability to end effector (2400), but which
comprises clamp pad (2520). A conductive coating is applied
selectively to clamp pad (2520), such that clamp pad (2520) can be
configured with areas (2523) using the techniques described above.
In this configuration, clamp pad (2520) comprises areas (2523)
having conductive coating, and neutral areas (2524) without
conductive coating.
[0271] To prevent short circuits between areas (2523) of clamp pad
(2520) and uncoated areas (2242) of blade (2240), clamp pad (2520)
is configured such that areas (2523) with the conductive coating do
not align with uncoated areas (2242) of blade (2240). When end
effector (2500) is closed with blade (2240) contacting clamp pad
(2520), areas (2523) of clamp pad (2520) only contact the neutral
areas of blade (2240), which are covered by nonconductive coating
(2241) as described above. Similarly, any areas of blade (2240),
i.e. uncoated areas (2242), will not contact areas (2523) of clamp
pad (2520). Instead, uncoated areas (2242) of blade (2240) are
offset longitudinally in alignment with areas (2523) of clamp pad
(2520) with the conductive coating. In this configuration, uncoated
areas (2242) of blade (2240) are aligned with neutral areas (2524)
of clamp pad (2520), which are the uncoated areas of clamp pad
(2520). In some variations, clamp pad (2520) itself is conductive.
By way of example only, clamp pad (2520) may be formed of a molded,
carbon filled polytetrafluoroethylene, etc.
[0272] Additionally, in the present example, neutral areas (2524)
of clamp pad (2520) are recessed relative to areas (2523) of clamp
pad (2520). In some instances this recessed configuration may be
attributable to the thickness of the conductive coating on areas
(2523). In some instances this recessed configuration may be
created through molding or machining techniques when forming clamp
pad (2520). In one example, cutouts are machined into clamp pad
(2520) or formed with clamp pad (2520) prior to coating clamp pad
(2520) with the conductive coating. In other examples, clamp pad
(2520) may be coated and then cutouts machined into clamp pad
(2520).
[0273] When tissue is compressed between blade (2240) and clamp pad
(2520), tissue contacts areas (2523) of clamp pad (2520) and
uncoated areas (2242) of blade (2240). In this manner, conductive
pathways are established through the tissue between electrode areas
(2523) of clamp pad (2520) and uncoated areas (2242) of blade
(2240). With tissue compressed between clamp pad (2520) and blade
(2240), ultrasonic energy can be imparted to waveguide (242) and
thereby ultrasonically sever the tissue along the length of clamp
pad (2520), with ultrasonic sealing as well, as discussed above.
End effector (2500) is further operable to provide RF
electrosurgical sealing of the tissue along the conductive pathways
described above, which would include tissue that is along the cut
line formed between blade (2240) and clamp pad (2520). In some
versions, the spacing of uncoated areas (2242) and areas (2523)
with conductive coating is such that the RF electrosurgical sealing
occurs along the entire length of clamp pad (2520) and thus the
entire length of the tissue cut line. In other versions, RF
electrosurgical sealing is not required to be continuous along the
cut line, and instead may occur at multiple points along the cut
line in a discontinuous fashion.
[0274] O. End Effector with Molded Projections for Short Circuit
Protection
[0275] FIGS. 74 and 75 show other exemplary end effectors (2600,
2700) that may be readily incorporated into instrument (110) in
place of end effector (140). Referring to FIG. 74, end effector
(2600) comprises clamp arm (2610), clamp pad (2620), blade (2640),
and sheath (2630). Blade (2640) comprises upper contact surface
(2652) and oblique surfaces (2654) on each side of upper contact
surface (2652). In the present example, clamp arm (2610) comprises
oblique surfaces (2611) that have a generally corresponding surface
angle with oblique surfaces (2654) of blade (2640). Clamp pad
(2620) is molded with clamp arm (2610) and clamp pad (2620)
comprises contact surface (2622) that extends between oblique
surfaces (2611) of clamp arm (2610). Contact surface (2622) is
aligned above upper contact surface (2652) of blade (2640) such
that when end effector (2600) captures tissue and is closed, tissue
will be compressed between contact surface (2622) of clamp pad
(2620) and upper contact surface (2652) of blade (2640). Tissue may
also be compressed between oblique surfaces (2654) of blade (2640)
and oblique surfaces (2611) of clamp arm (2610).
[0276] In the present example, a second molding process connects
sheath (2630) with clamp arm (2610). Sheath (2630) is molded over
combined clamp arm (2610) with clamp pad (2620), with sheath (2630)
covering an outer surface of clamp arm (2610). In this
configuration, sheath (2630) is operable to insulate clamp arm
(2610) such that any heat build-up during use is not transferred to
surrounding tissue or organs. Additionally, sheath (2630) is molded
with inwardly projecting protruding members (2632) that extend
toward oblique surfaces (2654) of blade (2640). Protruding members
(2632) are operable to serve as gap setting structures that prevent
blade (2640) from contacting clamp arm (2610). While the present
example uses two separate molding steps to form clamp pad (2620)
and sheath (2630), in some other versions greater or fewer separate
molding steps can be used to form clamp pad (2620) and sheath
(2630).
[0277] In some configurations, end effector (2600) is configured
for RF electrosurgical sealing where clamp arm (2610) serves as a
positive pole and blade (2640) serves as a negative pole. With
tissue compressed between blade (2640) and clamp pad (2620), the
tissue contacts clamp arm (2610) and blade (2640), which results in
a conductive pathway through the tissue between clamp arm (2610)
and blade (2640). As discussed in greater detail above, RF
electrosurgical sealing occurs along this conductive pathway. In
some versions, ultrasonic severing of the tissue may also occur
along the region where tissue is compressed between upper contact
surface (2652) of blade (2640) and contact surface (2622) of clamp
pad (2620) as described in greater detail above.
[0278] Over time, clamp pad (2620) can wear with use. When clamp
pad (2620) is not yet worn, end effector (2600) is configured such
that when end effector (2600) captures tissue between blade (2640)
and clamp pad (2620), blade (2640) will not make contact with clamp
arm (2610). Furthermore, when clamp pad (2620) is new or not yet
worn down, protruding members (2632) approach blade (2640) but do
not contact blade (2640). As clamp pad (2620) wears, protruding
members (2632) are configured to serve as gap setting structures
that prevent blade (2640) from contacting clamp arm (2610) and
thereby creating a short circuit to the desired RF electrosurgical
sealing pathway. It should be understood that, when end effector
(2600) is first used, protruding members (2632) do not necessarily
contact tissue or blade (2640). Instead, protruding members (2632)
may be fully contained within clamp pad (2620) when end effector
(2600) is first used; and the tips of protruding members (2632) may
eventually be exposed relative to clamp pad (2620) after clamp pad
(2620) has encountered wear due to use.
[0279] In one example of end effector (2600), protruding members
(2632) are formed on each side of clamp arm (2610) at the distal
end of clamp arm (2610). In other examples, clamp arm (2610)
comprises openings extending through oblique surfaces (2611) along
its length such that when molding sheath (2630) over clamp arm
(2610), protruding members (2632) are formed in multiple locations
along the length of clamp arm (2610). In view of the teachings
herein, other ways to provide protruding members on an end effector
to prevent short circuits by acting to maintain a gap between an
oppositely polarized blade and clamp arm will be apparent to those
of ordinary skill in the art.
[0280] Referring to FIG. 75, end effector (2700) comprises clamp
arm (2710), clamp pad (2720), blade (2740), and sheath (2730).
Blade (2740) comprises upper contact surface (2752), oblique
surfaces (2754) on each side of upper contact surface (2752), and
lateral surfaces (2756) on each side of oblique surfaces (2754). In
the present example, clamp arm (2710) comprises oblique surfaces
(2711) that have a generally corresponding surface angle with
oblique surfaces (2754) of blade (2740). Clamp pad (2720) is molded
with clamp arm (2710) and clamp pad (2720) comprises contact
surface (2722) that extends between oblique surfaces (2711) of
clamp arm (2710). Contact surface (2722) is aligned above upper
contact surface (2752) of blade (2740) such that when end effector
(2700) captures tissue and is closed, tissue will be compressed
between contact surface (2722) of clamp pad (2720) and upper
contact surface (2752) of blade (2740). Tissue may also be
compressed between oblique surfaces (2754) of blade (2740) and
oblique surfaces (2711) of clamp arm (2710), and also between
lateral surfaces (2756) of blade (2740) and clamp arm (2710).
[0281] In the present example, a second molding process connects
sheath (2730) with clamp arm (2710). Sheath (2730) is molded over
combined clamp arm (2710) with clamp pad (2720), with sheath (2730)
covering an outer surface of clamp arm (2710). In this
configuration, sheath (2730) is operable to insulate clamp arm
(2710) such that any heat build-up during use is not transferred to
surrounding tissue or organs. Additionally, sheath (2730) is molded
with protruding members (2732) that extend toward lateral surfaces
(2656) of blade (2740). Protruding members (2732) are operable to
serve as gap setting structures that prevent blade (2740) from
contacting clamp arm (2710) as pad (2720) wears when ultrasonic
energy is applied over time. While the present example uses two
separate molding steps to form clamp pad (2720) and sheath (2730),
in some other versions greater or fewer separate molding steps can
be used to form clamp pad (2720) and sheath (2730).
[0282] In some configurations, end effector (2700) is configured
for RF electrosurgical sealing where clamp arm (2710) serves as a
positive pole and blade (2740) serves as a negative pole. With
tissue compressed between blade (2740) and clamp pad (2720), the
tissue contacts clamp arm (2710) and blade (2740), which results in
a conductive pathway through the tissue between clamp arm (2710)
and blade (2740). As discussed in greater detail above, RF
electrosurgical sealing occurs along this conductive pathway. In
some versions, ultrasonic severing of the tissue may also occur
along the region where tissue is compressed between upper contact
surface (2752) of blade (2740) and contact surface (2722) of clamp
pad (2720) as described in greater detail above.
[0283] Over time, clamp pad (2720) can wear with use. When clamp
pad (2720) is not yet worn, end effector (2700) is configured such
that when end effector (2700) captures tissue between blade (2740)
and clamp pad (2720), blade (2740) will not make contact with clamp
arm (2710). Furthermore, when clamp pad (2720) is new or not yet
worn down, protruding members (2732) approach blade (2740) but do
not contact blade (2740). As clamp pad (2720) wears, protruding
members (2732) are configured to serve as gap setting structures
that prevent blade (2740) from contacting clamp arm (2710) and
thereby creating a short circuit to the desired RF electrosurgical
sealing pathway.
[0284] In one example of end effector (2700), protruding members
(2732) are formed along each side of clamp arm (2710) at the distal
end of clamp arm (2710). In other examples, protruding members
(2732) are formed continuously along the length of each side of
clamp arm (2710). Still in other examples, protruding members
(2732) are formed in a repeating configuration along the length of
each side of clamp arm (2710). In view of the teachings herein,
other ways to provide protruding members on an end effector to
prevent short circuits by acting to maintain a gap between an
oppositely polarized blade and clamp arm will be apparent to those
of ordinary skill in the art.
[0285] P. End Effector with Clamp Pad Flow Control
[0286] FIGS. 76-78 show other exemplary end effectors (2800, 2900)
that may be readily incorporated into instrument (110) in place of
end effector (140). End effectors (2800, 2900) include clamp pads
and clamp arms. There may be concern that, as the clamp pad
material wears, there will be need to be a path for the clamp pad
material to flow. Thus, the clamp pads of the following examples
include features that guide flow of the clamp pad material when
degradation occurs so that this clamp pad flow will not interfere
with the consistent gap desired between electrode poles of
respective end effectors (2800, 2900). A consistent gap between
electrode poles promotes consistent RF electrosurgical sealing.
[0287] Referring to FIGS. 76-77C, end effector (2800) comprises
clamp arm (2810), clamp pad (2820), and blade (2840). In the
present example, blade (2840) has serves as a negative pole and
thereby serves as one of the electrodes for RF electrosurgical
sealing. Furthermore, clamp arm (2810) serves as a positive pole
and thereby serves as the other electrode for RF electrosurgical
sealing. End effector (2800) is configured initially with a desired
gap between the electrodes--in the present example, between blade
(2840) and clamp arm (2810). Similarly to previously described end
effector versions, end effector (2800) is operable to capture,
ultrasonically sever, ultrasonically seal, and RF electrosurgical
seal tissue that is compressed between blade (2840) and clamp pad
(2820). These processes can create a heat build-up that can deform
clamp pad (2820). This deformation can cause clamp pad (2820) to
flow outwardly away from areas of compression with blade (2820).
Deformed portions of clamp pad (2820), can move out laterally where
there are not electrodes protruding downwardly from clamp arm
(2810). This deformation, flow, and deposit of clamp pad material
can alter the desired initial gap between the electrodes--in the
present example, between blade (2840) and clamp arm (2810).
[0288] With end effector (2800), clamp arm (2810) comprises
electrodes (2812) along its perimeter such that clamp arm (2810)
has a castellated appearance as shown in FIG. 76. Clamp pad (2820)
is formed within electrodes (2812) of clamp arm (2810) as seen by
comparing the cross-section views of FIGS. 77A and 77B. With this
configuration, when clamp pad (2820) degrades and begins to flow,
the clamp pad material can flow outwardly between electrodes (2812)
in clamp arm (2810) since clamp pad (2820) is not completely bound
by clamp arm (2812). This outward flow of degraded clamp pad
material prevents such degraded clamp material from depositing on
tissue-contacting surfaces of clamp arm (2810), or other tissue
contacting surfaces of clamp pad (2820). In this manner a constant
gap is maintained between conductive blade (2840) and conductive
clamp arm (2810) along those portions of clamp arm (2810) having a
conductive pathway from clamp arm (2810), through captured tissue,
and to blade (2840), as shown in FIG. 77B.
[0289] FIG. 78 shows an alternate clamp arm (2900) having an
electrode (2910) and clamp pad (2920) configured to provide pad
material flow control similarly as described above. In this
example, electrode (2910) is continuous around the perimeter of
clamp arm (2900) and extends inwardly toward the center line along
the length of clamp arm (2900). The body of clamp arm (2900)
defines recesses or chambers into which the material of clamp pad
(2920) may flow as clamp pad (2920) degrades. Such recesses or
chambers may be located above electrodes (2910) (i.e., further into
the page in the view of FIG. 78), such that as the material of
clamp pad (2920) degrades and is pushed upwardly, the material will
not flow out over clamp arm (2900) and thereby block electrode
(2910) from maintaining electrical continuity with the tissue.
[0290] In view of the teachings herein, other ways to configure
clamp arms and clamp pads to provide for flow control of degraded
clamp pad material will be apparent to those of ordinary skill in
the art.
[0291] Q. End Effector with Conductive Pad and Clamp Arm
[0292] FIGS. 79-80 show another exemplary end effector (10) that
may be readily incorporated into instrument (110) in place of end
effector (140). End effector (10) is configured such that a single
treatment region can be defined for both ultrasonic cutting and
electrosurgical sealing. End effector (10) of this example
comprises an ultrasonic blade (14) and a clamp arm assembly (15).
Clamp arm assembly (15) comprises a clamp arm (11), an insulator
(12), and a clamp pad (13). Clamp arm (11) connects with inner tube
(204) via pin (205) and is operable to pivot toward and away from
blade (14) in the manner described above. In this way, instrument
(110) is operable to provide ultrasonic cutting when tissue is
compressed between blade (14) and clamp arm assembly (15), and
blade (14) is activated to oscillate ultrasonically as described
further herein.
[0293] End effector (10) also provides electrosurgical sealing by
delivering electrosurgical energy from one electrical pole to
another. In the present example, clamp pad (13) comprises one of
the electrical poles while clamp arm (11) comprises the other of
the electrical poles. In this manner both clamp pad (13) and clamp
arm (11) are conductive and thereby configured to apply electrical
energy, with clamp pad (13) having an opposite polarity to that of
clamp arm (11). In some versions of end effector (10), clamp pad
(13) comprises a custom formulated pad having metallic alloy
particles that are electrically activated. In some other versions,
clamp pad (13) may be formulated with carbon particles, graphene,
and/or other conductive fillers instead of or in addition to
metallic alloy particles. Still in other versions, clamp pad (13)
may comprises a positive temperature coefficient (PTC) material,
which is both conductive and temperature reactive. In view of the
teachings herein, other materials and ways to configure clamp pad
(13) such that clamp pad (13) is electrically conductive will be
apparent to those of ordinary skill in the art. Conductive clamp
pad (13) connects with an electrical source, such as generator
(116), via a cable or other electrical pathway to electrically
activate clamp pad (13).
[0294] Clamp arm (11) is also formed of a conductive material as
mentioned above. In the present example, clamp arm (11) is coated
with an insulating material on its outer surface, which faces away
from clamped tissue. The inner surface of clamp arm (11), which
faces the clamped tissue, is not coated with an insulating material
such that the clamped tissue is exposed to the electrically
conductive surface of clamp arm (11) when end effector (10) is
providing electrosurgical sealing. Conductive clamp arm (11)
connects with an electrical source, such as generator (116), via a
cable or other electrical pathway to provide electrical polarity to
clamp arm (11). In the present example, clamp arm (11) is isolated
from clamp pad (13) by way of insulator (12). This isolation using
insulator (12) is configured so that any flow of electrical energy
from clamp pad (13) to clamp arm (11), or vice versa, when clamping
tissue, must be by the electrical energy flowing through the
clamped tissue.
[0295] In the present example, blade (14) comprises a coating on at
least a portion of blade (14) such that in the region for
ultrasonic cutting and RF electrosurgical sealing blade (14) is
electrically isolated from electrically activated clamp arm (11)
and clamp pad (13). In some versions, the coating used on blade
(14) may comprises parylene, xylan, or other suitable coatings that
electrically isolate blade (14) from the RF circuit.
[0296] During cutting and sealing, clamp arm assembly (15) is
actuated to the closed position such that tissue (T) is compressed
between clamp arm assembly (15) and blade (14) as shown in FIG. 80.
To provide ultrasonic cutting, vibrational energy is applied to
blade (14), which oscillates ultrasonically to sever clamped tissue
(T) at the region where tissue (T) is compressed between blade (14)
and clamp pad (13). To provide RF electrosurgical sealing, with
tissue (T) in the clamped and compressed state, RF electrosurgical
energy is provided from an electrical source, such as generator
(116). The electrical current travels from the positive pole though
the tissue (T) and to the negative pole. In the present example,
clamp pad (13) comprises the positive pole and clamp arm (11)
comprises the negative pole. However, in other versions these poles
may be reversed. Cutting and sealing operations may be performed in
any order or simultaneously. In some instances, only one of the
treatment modalities (ultrasonic cutting being one modality and
electrosurgical sealing being another) may be used with end
effector (10). Where both cutting and sealing modalities are used
for a portion of clamped tissue (T), as best understood from FIG.
80, electrosurgical sealing occurs along both sides of the cut
line, such that both of the cut ends of the tissue (T) are
sealed.
[0297] FIG. 81 shows another exemplary end effector (16) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (16) is similar to end effector (10)
described above. End effector (16) comprises ultrasonic blade (14)
and clamp arm assembly (19). With end effector (16), instead of
electrically isolating blade (14) by coating blade (14), the
electrical energy for clamp arm (11) and clamp pad (13) is provided
by running insulated wires (17, 18) through the shaft assembly
(130) of instrument (110) in channels (20) positioned within the
respective clamp arm (11) and clamp pad (13). Wires (17) are
positioned within clamp arm (11) in a manner where wires (17) are
located on each side of the clamp arm (11) and spaced away from
blade (14) such that there is a portion of clamp arm (11) between
wires (17) and blade (14). Similarly, wire (18) is positioned
within clamp pad (13) in a manner where wire (18) is spaced away
from blade (14) such that there is a portion of clamp pad (13)
between wire (18) and blade (14). In this manner, blade (14) is
electrically isolated from the RF circuit and the electrosurgical
energy is configured to flow through clamped tissue and wires (17,
18). Cutting and sealing operations with end effector (16) occur in
the same fashion as explained above with respect to end effector
(10).
[0298] R. End Effector with Double Coated Blade
[0299] FIG. 82 shows another exemplary end effector (30) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (30) comprises clamp arm (31), clamp
pad (32), and blade (33). In the present example, both clamp arm
(31) and clamp pad (32) are nonconductive and are thus not part of
the RF electrosurgical circuit or pathway. Blade (33) comprises
first coating (34) and second coating (35). First coating (34)
surrounds the surface of blade (33) and provides a nonconductive
coating for blade (33). As shown in the illustrated version, this
nonconductive coating extends over the top surface of blade (33)
that is directly beneath the bottom surface of clamp pad (32).
Thus, the treatment region for ultrasonic cutting is defined
between the nonconductive clamp pad (32) and the nonconductive top
surface of blade (33).
[0300] Second coating (35) is positioned along each side of blade
(33) as shown in the illustrated version. Second coating (35) is
conductive and the region where second coating (35) is applied on
one side of blade (33) is separate and isolated from the region
where second coating (35) is applied on the other or opposite side
of blade (33). In the present example, second coating (35) is
configured such that one side of blade (33) has a first electrical
polarity while the other side of blade (33) has a second electrical
polarity.
[0301] During cutting and sealing, clamp arm (31) is actuated to
the closed position such that tissue (T) is compressed between
clamp arm (31), clamp pad (32), and blade (33) as shown in FIG. 82.
To provide ultrasonic cutting, vibrational energy is applied to
blade (33), which oscillates ultrasonically to sever the clamped
tissue (T) at the region where the tissue (T) is compressed between
blade (33) and clamp pad (32). To provide RF electrosurgical
sealing, with tissue (T) in the clamped and compressed state, RF
electrosurgical energy is provided from an electrical source, such
as generator (116). The electrical current travels through the
tissue (T) between the opposing poles provided by second coating
(35). In the present example, second coating (35) on one side of
blade (33) provides an active pole and second coating (35) on the
other side of blade (33) provides return pole. Cutting and sealing
operations may be performed in any order or simultaneously. In some
instances, only one of the treatment modalities (ultrasonic cutting
being one modality and electrosurgical sealing being another) may
be used with end effector (30). Where both cutting and sealing
modalities are used for a portion of clamped tissue (T), as best
understood from FIG. 82, electrosurgical sealing occurs along and
through both sides of the cut line, such that both of the cut ends
of the tissue (T) are sealed.
[0302] S. End Effector with Two Pole Blade Guard
[0303] FIG. 83 shows another exemplary end effector (36) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (36) comprises clamp arm (31), clamp
pad (32), and blade (33). In the present example, both clamp arm
(31) and clamp pad (32) are nonconductive and are thus not part of
the RF electrosurgical circuit or pathway. Blade (33) comprises a
split blade guard (37) with a first portion (38) on one side of
blade (33) and a second portion (39) on the other side of blade
(33). In the present example, split blade guard (37) is spaced away
from blade (33) and thus blade (33) remains isolated from the RF
electrosurgical circuit or pathway. While blade (33) may be coated
in the present example with an insulating material and/or a
nonstick material, coating of blade (33) is not required. First and
second portions (38, 39) of split blade guard (37) are conductive,
with first portion (38) of split blade guard (37) being separate
and electrically isolated from the second portion (39) of split
blade guard (37). In the present example, first and second portions
(38, 39) of split blade guard (37) are oppositely polarized such
that the RF electrosurgical circuit or pathway is defined as
extending between first portion (38) and second portion (39) of
split blade guard (37).
[0304] During cutting and sealing, clamp arm (31) is actuated to
the closed position such that tissue (T) is compressed between
clamp arm (31), clamp pad (32), and blade (33) as shown in FIG. 83.
To provide ultrasonic cutting, vibrational energy is applied to
blade (33), which oscillates ultrasonically to sever the clamped
tissue at the region where the tissue is compressed between a top
surface of blade (33) and clamp pad (32). To provide RF
electrosurgical sealing, with tissue (T) in the clamped and
compressed state, RF electrosurgical energy is provided from an
electrical source, such as generator (116). The electrical current
travels through tissue (T) between first portion (38) of split
blade guard (37) and second portion (39) of split blade guard (37).
Cutting and sealing operations may be performed in any order or
simultaneously. In some instances, only one of the treatment
modalities (ultrasonic cutting being one modality and
electrosurgical sealing being another) may be used with end
effector (36). Where both cutting and sealing modalities are used
for a portion of clamped tissue (T), as best understood from FIG.
83, electrosurgical sealing occurs along and through both sides of
the cut line, such that both of the cut ends of the tissue (T) are
sealed.
[0305] FIGS. 84 and 85 show another exemplary end effector (50)
that may be readily incorporated into instrument (110) in place of
end effector (140). End effector (50) is similar to end effector
(36). However, end effector (50) of this example comprises a blade
guard (51) that includes an insulator (52), which connects a first
portion (53) with a second portion (54) of blade guard (51) yet
electrically isolates portions (53, 54) relative to each other.
Blade guard (51) extends around at least a distal region of a blade
(55) of end effector (50). Blade guard (51) further extends in a
fashion such that first and second sides of blade (55), as well as
the underside of blade (55), are protected by blade guard (51).
Blade guard (510) is further configured to have an open side
extending along the top surface of blade (55) so that the top
surface of blade (55) is accessible for contacting tissue for
ultrasonic cutting. As shown in FIGS. 84 and 85, blade guard (51)
comprises a profile having a U-shape. However, it should be
understood that other profile shapes may be used such as e.g. a
V-shape.
[0306] Similar to blade guard (37), first portion (53) and second
portion (54) of blade guard (51) are conductive. For example, first
and second portions (53, 54) of blade guard (51) are oppositely
polarized such that the RF electrosurgical circuit or pathway is
defined as extending between first portion (53) and second portion
(54) of blade guard (51) through compressed tissue (T) captured
between blade (55) and a clamp pad (56) of end effector (50). In
the present example, blade (55) is insulated using a coating
material so that blade (55) is nonconductive. Blade (55) may
instead or additionally be insulated at the transducer. Moreover,
clamp pad (56) is also non-conductive and may or may not be coated
to provide further electrical isolation from blade guard (51).
Clamp pad (56) attaches with clamp arm (57), and clamp arm (57) may
also be non-conductive and electrically insulated. In the
illustrated version of FIG. 84, blade guard (57) also comprises an
inner surface (58) facing blade (55). Inner surface (58) includes a
coating with an insulating material to further promote electrical
isolation of blade (55) from the conductive blade guard (57); and
to provide some degree of protection from blade (55) contacting
blade guard (57) during ultrasonic cutting.
[0307] During cutting and sealing, clamp arm (57) is actuated to
the closed position such that tissue (T) is compressed between
clamp pad (56) and blade (55) as shown in FIG. 84. To provide
ultrasonic cutting, vibrational energy is applied to blade (55),
which oscillates ultrasonically to sever the clamped tissue at the
region where the tissue is compressed between a top surface of
blade (55) and clamp pad (56). To provide RF electrosurgical
sealing, with tissue (T) in the clamped and compressed state, RF
electrosurgical energy is provided from an electrical source, such
as generator (116). The electrical current travels through tissue
(T) between first portion (53) of blade guard (51) and second
portion (54) of blade guard (51). Cutting and sealing operations
may be performed in any order or simultaneously. In some instances,
only one of the treatment modalities (ultrasonic cutting being one
modality and electrosurgical sealing being another) may be used
with end effector (50). Where both cutting and sealing modalities
are used for a portion of clamped tissue (T), as best understood
from FIG. 84, electrosurgical sealing occurs along and through both
sides of the cut line, such that both of the cut ends of the tissue
(T) are sealed.
[0308] T. End Effector with Dual Charged Clamp Pads
[0309] FIGS. 86 and 87 show another exemplary end effector (40)
that may be readily incorporated into instrument (110) in place of
end effector (140). End effector (40) comprises a first clamp pad
(41), and a second clamp pad (42). Clamp pad (41) is connectable
with clamp arm (43), and clamp pad (42) is connectable with clamp
arm (44). End effector (40) further comprises blade (45). Each
respective clamp arm (43, 44) and attached clamp pad (41, 42) is
configured to pivot relative to blade (45) between an open position
and a closed position to selectively receive and clamp tissue in
end effector (40). In the present example, this pivotal movement
occurs in the same or substantially the same manner as the pivoting
movement of clamp arm (210) described above. For example, each
respective clamp arm (43, 44) is pivotably coupled with an outer
tube (202) at one pivot point; and with inner tube (204) at another
pivot point. Thus, relative longitudinal movement between tubes
(202, 204) provides pivotal movement of clamp arms (43, 44).
[0310] In some versions, instrument (110) may be configured with
additional tubes or adapters that connect with clamp arms (43, 44)
to provide pivotal movement as described herein. Furthermore, clamp
arms (43, 44) and their associated clamp pads (41, 42) are
configured to move either independently or together. In view of the
teachings herein, various ways to configure clamp arms (43, 44)
with instrument (110) to provide this pivotal movement will be
apparent to those of ordinary skill in the art. By way of example
only, clamp arms (43, 44) may be configured and operable to move in
accordance with at least some of the teachings of U.S. Pat. No.
9,237,900, entitled "Surgical Instrument with Split Jaw," issued
Jan. 19, 2016, the disclosure of which is incorporated by reference
herein.
[0311] Each clamp pad (41, 42) in the present example is configured
with a different polarity so that an RF electrosurgical circuit or
pathway is created from clamp pad (41), through captured tissue, to
the clamp pad (43), and vice versa. For instance, clamp pad (41)
may have a first polarity while clamp pad (42) may have a second
polarity. As described above, the conductive nature of clamp pads
(41, 42) may be achieved by combining conductive material(s) (46)
with the clamp pad material when manufacturing clamp pads (41, 42).
The conductive clamp pad (41, 42) are then connectable with an
electrical source, such as generator (116), to provide the
respective electrical polarity to clamp pads (41, 42). In view of
the teachings herein, various ways for connecting conductive clamp
pads (41, 42) with generator (116) or another electrical source
will be apparent to those of ordinary skill in the art. Also, any
of the methods and techniques described above for altering or
modifying clamp pad design to shape the electrosurgical circuit or
pathway may be used with clamp pads (41, 42) of end effector (40).
In view of the teachings herein, such alterations or modification
of clamp pads (41, 42) to shape the electrosurgical circuit and
resultant sealing will be apparent to those of ordinary skill in
the art. Furthermore, each clamp arm (43, 44) is electrically
isolated from its respective clamp pad (41, 42) through various
insulating materials as will be understood by those of ordinary
skill in the art in view of the teachings herein.
[0312] In the example where clamp arms (43, 44) move independently
relative to blade (45), either or both clamp arms (43, 44) can be
moved to the closed position to compress tissue between the
respective clamp pad (41, 42) and blade (45). Blade (45) can be
activated to oscillate such that compressed tissue will be
ultrasonically severed along the regions where tissue is compressed
between clamp pads (41, 42) and blade (45). Because each clamp pad
(41, 42) in the present example has a different polarity, to
achieve RF electrosurgical sealing, both clamp pads (41, 42) are
moved so that they contact the captured tissue. This is
accomplished by moving each clamp arm (43, 44), containing clamp
pads (41, 42) respectively, to the closed position. With both clamp
arms (43, 44) closed, RF electrosurgical sealing can be provided
via clamp pads (41, 42) either before, during, or after the
ultrasonic cutting process.
[0313] U. End Effector with Outriggers with Selective
Insulation
[0314] FIGS. 88 and 89 show another exemplary end effector (60)
that may be readily incorporated into instrument (110) in place of
end effector (140). End effector (60) comprises clamp arm (61),
clamp pad (62), and blade (63), which are all nonconductive in the
present example. Ultrasonic cutting with end effector (60) occurs
in the manner described above, where tissue is compressed between
blade (63) and clamp pad (62) with blade (63) being activated to
oscillate ultrasonically to thereby sever clamped and compressed
tissue.
[0315] To provide RF electrosurgical sealing in a way where blade
(63) remains neutral or nonconductive, and may be coated with xylan
or another suitable coating, end effector (60) further comprises a
first and second outrigger (64, 65) that each extend from shaft
assembly (130). In some other versions, first and second outriggers
(64, 65) may extend from blade (63). In the present example,
outriggers (64, 65) include a coating (66). Coating (66) is applied
selectively to outriggers (64, 65). As shown in the illustrated
version of FIG. 89, the selective coating (66) is applied around
all sides of outriggers (64, 65) except for an exposed surface (67)
of each outrigger (64, 65), which faces or is adjacent to clamp pad
(62).
[0316] Coating (66) is configured such that coating (66) prevents
blade (63) from contacting outriggers (64, 65) directly. Coating
(66) also provides insulating properties so as to inhibit the
transfer of electrical energy from outriggers (64, 65) to blade
(63) or clamp arm (61) thereby causing a short circuit to the RF
electrosurgical path as discussed below. In some versions coating
(66) may comprise polytetrafluoroethylene, but other coating
materials may be used as will be apparent to those of ordinary
skill in the art in view of the teachings herein.
[0317] In the present example, each of outriggers (64, 65) are
conductive. Furthermore, outriggers (64, 65) have opposite
polarities. With this configuration, when tissue is clamped between
clamp arm (61) and blade (63), a RF electrosurgical circuit or path
is defined that extends from one of outriggers (64, 65) through the
clamped tissue, to the other of outriggers (64, 65). As shown in
the illustrated version, exposed surfaces (67) of outriggers (64,
65), which are closest to or facing clamp pad (62), are uncoated
thereby allowing electrosurgical energy to flow through the tissue
contacting outriggers (64, 65).
[0318] In some versions, selective coating (66) is applied such
that the exposed surfaces (67) of outriggers (64, 65) are uncoated
and thus exposed to clamp pad (62) and clamped tissue along the
length of clamp pad (62). In some other versions, selective coating
(66) may be applied to outriggers (64, 65) in a pattern so as to
alter the pathway of the RF electrosurgical energy flow and thus
the electrical field and the resultant sealing shape or pattern. By
way of example only, and not limitation, several such features and
techniques for altering or manipulating the pathway of the RF
electrosurgical energy are described herein with respect to other
end effector versions. In view of these teachings, such
modifications to the pattern of selective coating (66) on
outriggers (64, 65) to alter the RF electrosurgical pathways and
the resulting sealing patterns will be apparent to those of
ordinary skill in the art. For example, in some versions, instead
of exposed surfaces (67) being uncoated along the length of clamp
pad (62), selective coating (66) may be applied such that exposed
surfaces (67) comprise alternating regions of coating and uncoated
areas.
[0319] V. End Effector with Embedded Pole in Blade
[0320] FIG. 90 shows another exemplary end effector (70) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (70) comprises clamp arm (71), clamp
pad (72), and blade (73). Blade (73) is configured with a groove
(74). A conductive wire (75) is positioned within groove (74).
Between conductive wire (75) and an inner surface (76) of blade
(73) is an insulator (77) that electrically isolates blade (73)
from conductive wire (75). In some versions, insulator (77) and
wire (75) are glued to inner surface (77) of blade (75) defined by
groove (74). In some other examples, insulator (77) and wire (75)
may be embedded within groove (74) of blade (75) by other suitable
fastening features that will be apparent to those of ordinary skill
in the art in view of the teachings herein.
[0321] Clamp pad (72) of end effector (70) is configured to be
electrically conductive. Clamp pad (72) is further configured to
have opposite polarity to the polarity of conductive wire (75).
Various features and techniques described above are usable with end
effector (70) and in particular with clamp pad (72) to provide
clamp pad (72) with conductive properties. Conductive clamp pad
(72) and conductive wire (75) connect with an electrical source,
such as generator (116). Clamp arm (71) is electrically isolated
from clamp pad (72), and blade (73) is coated with an insulating
material to provide further electrical isolation from conductive
clamp pad (72) and wire (75). Groove (74) in blade (73) is
sufficiently deep such that when end effector (70) is in a closed
position, with or without clamping tissue (T), clamp pad (72) and
wire (75) do not contact one another. In this way, any short
circuit by such contact between clamp pad (72) and wire (75) is
prevented. With this configuration, blade (73) is considered to be
proud of wire (75) along at least the clamping region of end
effector (70).
[0322] When tissue (T) is clamped and compressed between clamp pad
(72) and blade (73), two harmonic zones are defined where blade
(73) compresses tissue (T) against clamp pad (72). These harmonic
zones may be located at longitudinal positions corresponding to
anti-nodes associated with resonant ultrasonic vibrations
communicated through blade (73). Along these two harmonic zones,
when blade (73) is activated, ultrasonic cutting occurs to sever
the tissue in two corresponding locations. Between the ultrasonic
cut lines is an RF electrosurgical zone defined by the electrical
path that extends through tissue (T) between clamp pad (72) and to
wire (75). As described above, the RF electrosurgical energy
provide for sealing of tissue (T). With this configuration, the
harmonic treatment zones are outside of the RF electrosurgical
treatment zone.
[0323] W. End Effector with Clamp Arm with Overmolded
Electrodes
[0324] FIG. 91 shows another exemplary end effector (80) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (80) comprises clamp arm (81), clamp
pad (82), and blade (83). In the present example, blade (83) is
nonconductive and may be coated with an insulating and/or nonstick
material or coating. Clamp pad (82) is also nonconductive in the
present example. With tissue (T) compressed between clamp pad (82)
and blade (83) when end effector (80) is in a closed position,
blade (83) may be activated and tissue (T) ultrasonically cut or
severed.
[0325] In the present example, RF electrosurgical sealing features
are incorporated into clamp arm (81). For instance, clamp arm (81)
comprises an insulator (84) that extends along clamp arm (81) along
each side of clamp pad (82). Insulator (84) is overmolded onto
clamp arm (81), but may be connected with clamp arm (81) other ways
that will be apparent to those of ordinary skill in the art in view
of the teachings herein. First and second electrodes (85, 86) are
each located on and along insulator (84) along each side of clamp
pad (82). In this configuration, clamp arm (81) is electrically
isolated from first and second electrodes (85, 86) by insulator
(84). As will be discussed in greater detail below, each of first
and second electrodes (85, 86) are conductive and first electrode
(85) has an oppositely polarity from second electrode (86). With
this configuration, an RF electrosurgical path is defined extending
through tissue (T) between electrodes (85, 86).
[0326] FIGS. 92-94 show other views of clamp arm (81) and the RF
electrosurgical sealing features incorporated therein. As seen in
the illustrated version of FIGS. 92 and 94, in addition to clamp
pad (82) and first and second electrodes (85, 86), clamp arm (81)
includes pull slots (87A, 87B) on each side of clamp arm (81). Pull
slots (87A, 87B) are configured to connect with a tube of shaft
assembly (130) to provide pivoting movement of clamp arm (81) for
opening and closing end effector (80) as described above. In the
present example, pull slot (87A) is formed with and/or connects
with first electrode (85). Similarly, pull slot (87B) is formed
with and/or connects with second electrode (86). In exemplary
versions where pull slots (87A, 87B) are formed with respective
first and second electrodes (85, 86), each of first and second
electrodes (85, 86) comprise a respective longitudinally extending
portion and a respective transversely extending portion. In
particular, the transversely extending portion comprises the pull
slot (87A, 87B) and the longitudinally extending portion extends
along the length of clamp arm (81) on top of insulator (84). It
should further be understood, as shown in FIG. 94, that insulator
(84) also extends transversely, in addition to extending
longitudinally, such that clamp arm (81) is fully isolated from
first and second electrodes (85, 86). With pull slots (87A, 87B)
connecting with first and second electrodes (85, 86) respectively,
and with pull slots (87A, 87B) connectable with a tube of shaft
assembly (130), as will be described further below, one or more
tubes of shaft assembly (130) can be configured to deliver the
electrical energy to first and second electrodes (85, 86).
[0327] FIG. 93 shows another view of clamp arm (81), with clamp arm
(81) comprising openings (88) at each side of a top side of clamp
arm (81). Openings (88) are also visible in FIG. 94. Openings (88)
are configured to connect with one or more tubes of shaft assembly
(130). In the present example, openings (88) connect with
corresponding pins or posts located on outer tube of shaft assembly
(130). Pull slots (87A, 87B) connect with corresponding pins or
posts located on inner tube of shaft assembly (130). In this
manner, as described above, clamp arm (81) is pivotable to open and
close by translating inner and outer tubes relative to one another.
In the present example, openings (88) are isolated from first and
second electrodes (85, 86). For example, openings (88) comprise an
overmolded plastic insulating material in the present example. With
this insulating material, outer tube connecting with openings (88)
is also isolated from first and second electrodes (85, 86).
[0328] FIGS. 95-96 show a tube assembly (89) with first and second
electrodes (85, 86). Tube assembly (89) comprises outer tube (90),
first half inner tube (91), second half inner tube (92), and
insulator tube (93). Tube assembly (89) may replace outer tube
(202) and inner tube (204) described above, such that shaft
assembly (130) is usable with end effector (80) as further
described herein. In the assembled state for tube assembly (89),
insulator tube (93) sits within outer tube (90). First half inner
tube (91) and second half inner tube (92) each sit within insulator
tube (93). Insulator tube (93) comprises dividers (94) that
separate first and second half inner tubes (91, 92) such that first
and second half inner tubes (91, 92) do not directly contact one
another. Insulator tube (93) further separates outer tube (90) from
first and second half inner tubes (91, 92) such that outer tube
(90) does not directly contact first and/or second half inner tubes
(91, 92).
[0329] In the present example, outer tube (90) is nonconductive
while first and second half inner tubes (91, 92) are conductive.
First and second half inner tubes (91, 92) respectively connect
with pull slots (87A, 87B) of first and second electrodes (85, 86)
as described above. First half inner tube (91) is configured to
provide a first electrical polarity to first electrode (85) through
its connection with pull slot (87A). Second half inner tube (92) is
configured to provide a second electrical polarity to second
electrode (86) through its connection with pull slot (87B).
[0330] As described above, insulator (84) electrically isolates
clamp arm (81) from first and second electrodes (85, 86).
Additionally, openings (88) are insulated as mentioned. Outer tube
(90) includes elongated member (95) having pins or posts that
connect with openings (88) in clamp arm (81). With this
configuration, clamp arm (81) of end effector (80) connects with
both outer tube (90) and with first and second half inner tubes
(91, 92). First and second half inner tubes (91, 92) are configured
to translate in unison. As described above, with translational
movement of first and second half inner tubes (91, 92) relative to
outer tube (90), clamp arm (81) opens and closes with a pivoting
action. In other versions outer tube may translate relative to
first and second half inner tubes (91, 92) to pivot clamp arm
(81).
[0331] In the configuration described above, an RF electrosurgical
path is defined as extending through tissue (T) between electrodes
(85, 86). When tissue (T) is clamped between clamp arm (81) and
blade (83), tissue (T) can be ultrasonically cut along the region
between clamp pad (82) and blade (83). Furthermore, tissue (T) can
be sealed along each side of the cut line where tissue (T) contacts
first and second electrodes (85, 86).
[0332] FIGS. 97 and 98 show another tube assembly (96) that may be
used with end effector (80) instead of tube assembly (89). Tube
assembly (96) is similar to tube assembly (89). However, tube
assembly (96) of this example is configured such that the outer
tube provides the electrical energy to first and second electrodes
(85, 86) instead of the inner tube as in tube assembly (89).
[0333] Tube assembly (96) comprises first half outer tube (97),
second half outer tube (98), insulator tube (99), and inner tube
(not shown). Tube assembly (96) may replace outer tube (202) and
inner tube (204) described above, such that shaft assembly (130) is
usable with end effector (80) as further described herein. In the
assembled state for tube assembly (96), insulator tube (99) sits
within first and second half outer tubes (97, 98). Inner tube (not
shown) sits within insulator tube (99). Insulator tube (99)
comprises dividers (170, 171) that separate first and second half
outer tubes (97, 98) such that first and second half outer tubes
(97, 98) do not directly contact one another. Insulator tube (99)
further separates inner tube from first and second half outer tubes
(97, 98) such that inner tube does not directly contact first
and/or second half outer tubes (97, 98). Divider (170) of insulator
tube (99) defines a bore (172) that is configured such that wires
or cables can pass through bore (172) to extend through instrument
(110). Such wires and/or cables can be used to provide electrical
energy to first and second electrodes (85, 86) in some versions
instead of providing electrical energy through inner or outer tube
structures. It should also be understood that wires and/or cables
can be used for electrical grounding.
[0334] In the present example, inner tube is nonconductive while
first and second half outer tubes (97, 98) are conductive. First
and second half outer tubes (97, 98) respectively connect with
openings (88). In the present example using tube assembly (96),
clamp arm (81) and first and second electrodes (85, 86) are
modified such that electrical energy may be communicated through
openings (88) to first and second electrodes (85, 86) instead of
through pull slots (87A, 87B) as described above. In view of the
teachings herein, such modifications to clamp arm (81) to transfer
electrical energy to first and second electrodes (85, 86) by way of
openings (88) instead of pull slots (87A, 87B) will be apparent to
those of ordinary skill in the art. In this manner, first half
outer tube (97) is configured to provide a first electrical
polarity to first electrode (85) through its connection, and second
half outer tube (98) is configured to provide a second electrical
polarity to second electrode (86). As shown in FIG. 98, a heat
shrink tube (173) can surround first and second half outer tubes
(97, 98) to isolate other components of shaft assembly (130) and
instrument (110) from conductive first and second outer tube halves
(97, 98).
[0335] As described above, insulator (84) electrically isolates
clamp arm (81) from first and second electrodes (85, 86). In the
present example using tube assembly (96), insulator (84) and clamp
arm (81) are also modified such that clamp arm (81) remains
electrically isolated from first and second half outer tubes (97,
98). In view of the teachings herein, such modifications to
insulator (84) and clamp arm (81) to maintain electrical isolation
of clamp arm (81) will be apparent to those of ordinary skill in
the art. Additionally, with tube assembly (96) pull slots (87A,
87B) are insulated such that inner tube remains electrically
isolated from first and second electrodes (85, 86). With this
configuration, clamp arm (81) of end effector (80) connects with
both inner tube and with first and second half outer tubes (97,
98). First and second half outer tubes (97, 98) are configured to
translate in unison. As described above, with translational
movement of first and second half outer tubes (97, 98) relative to
inner tube, clamp arm (81) opens and closes with a pivoting action.
In some other versions, inner tube may translate relative to first
and second half outer tubes (97, 98) to pivot clamp arm (81).
[0336] In the configuration described above with tube assembly
(96), an RF electrosurgical path is defined as extending through
tissue (T) between electrodes (85, 86). When tissue (T) is clamped
between clamp arm (81) and blade (83), tissue (T) can be
ultrasonically cut along the region between clamp pad (82) and
blade (83). Furthermore, tissue (T) can be sealed along each side
of the cut line where tissue (T) contacts first and second
electrodes (85, 86).
[0337] FIGS. 99 and 100 show further proximal portions of tube
assembly (89), and in particular connections of first and second
half inner tubes (91, 92) with first and second rings (174, 175) to
provide RF electrical energy to first and second half inner tubes
(91, 92), and ultimately to first and second electrodes (85, 86).
In the present example, first half inner tube (91) connects with
first ring (174), and second half inner tube (92) connects with
second ring (175). Ring (174) further connects with ring contact
(176), which connects with one of the cables that connects with
generator (116) to provide the electrical energy. Ring (175)
further connects with ring contact (177), which connects with the
other of the cables that connects with generator (116) to provide
the electrical energy. In one version, ring contacts (176, 177)
comprise contact springs.
[0338] First ring (174) and second ring (175) comprise respective
connection members (178, 179). Connection member (178) contacts
first half inner tube (91) to provide electrical continuity with
first half inner tube (91). Connection member (179) contact second
half inner tube (92) to provide electrical continuity with second
half inner tube (92). In the present example, first ring (174) and
second ring (175) are welded or otherwise fixedly attached to
respective first and second half inner tubes (91, 92). In this
manner, shaft assembly (130) is rotatable 360 degrees and
electrical contact is maintained between first and second rings
(174, 175) and respective first and second half inner tubes (91,
92). In some versions, rings (174, 175) are rotatable relative to
respective first and second ring contacts (176, 177), such that
when shaft assembly rotates, rings (174, 175) rotate also based on
their fixed connection with respective first and second half inner
tubes (91, 92). This rotation of rings (174, 175) is relative to
ring contacts (176, 177). However, ring contacts (176, 177) remain
in electrical contact with respective rings (174, 175), thereby
providing electrical continuity from respective cables to
respective first and second half inner tubes (91, 92), and
ultimately to respective first and second electrodes (85, 86). With
rings (174, 175) rotatable relative to ring contacts (176, 177),
cables within instrument (110) that connect with ring contacts
(176, 177) can remain generally stationary when the shaft assembly
is rotated.
[0339] FIG. 101 shows actuation ring (180) with blade (83) passing
through actuation ring (180). In the present example, actuation
ring (180) is configured to connect with first inner half tube (91)
and second inner half tube (92) to translate inner half tubes (91,
92) relative to outer tube (90) so as to pivot clamp arm (81) to
open and close clamp arm (81). Actuation ring (180) is connectable
with trigger (128) such that clamp arm (81) is pivotable toward
ultrasonic blade (83) in response to pivoting of trigger (128)
toward pistol grip (124); and such that clamp arm (81) is pivotable
away from ultrasonic blade (83) in response to pivoting of trigger
(128) away from pistol grip (124). Various suitable ways in which
actuation ring (180) may be coupled with inner half tubes (91, 92)
and trigger (128) will be apparent to those of ordinary skill in
the art in view of the teachings herein. In some versions,
actuation ring (180) may be connectable with outer tube (90)
instead of with inner half tubes (91, 92) to provide the
translation necessary to pivot clamp arm (81) between open and
closed positions. As shown in FIG. 101, actuation ring (180) may be
configured with a bore (182) that allows wires (181) to pass
through actuation ring (180) in some versions.
[0340] X. End Effector with Conductive Pad with Two Poles
[0341] FIG. 102 shows another exemplary end effector (150) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (150) comprises clamp arm (151), clamp
pad (152), and blade (153). Clamp pad (152) comprises first portion
(154) and second portion (155). An insulator (156) separates first
and second portions (154, 155). Insulator (156) also separates
respective first and second portions (154, 155) of clamp (152) from
clamp arm (151).
[0342] Clamp pad (152) is constructed from conductive material
(157) such that first and second portion (154, 155) are each
electrically conductive. Furthermore, each conductive first and
second portions (154, 155) of clamp pad (152) connect either
directly or indirectly with respective cables that lead to
generator (116) or another source of RF electrosurgical power.
First and second portions (154, 155) of clamp pad (152) are
oppositely polarized. In some versions, conductive material (157)
within clamp pad (152) comprises conductive fibers that are formed
in clamp pad (152). These fibers may be oriented longitudinally
along clamp pad (152) as shown in FIG. 103. Alternatively, these
fibers may be oriented transversely along clamp pad (152) as shown
in FIG. 104. Any other suitable fiber orientation may be used.
[0343] As yet another merely illustrative variation, conductive
material (157) comprises metal that is impregnated within rubber
during clamp pad (152) construction. This metal may also be
oriented longitudinally, transversely, or otherwise along clamp pad
(152), or in any other suitable pattern including a random
orientation. Some exemplary metals that may be used with clamp pad
(152) to impart conductivity to clamp pad (152) include, but are
not limited to, silver, silver-plated aluminum, silver-plated
copper, silver-plated glass, nickel-plated graphite, among others.
Another exemplary conductive material (157) usable with clamp pad
(152) includes black carbon. In view of the teachings herein, other
materials that may be used with clamp pad (152) to make clamp pad
(152) conductive, as well as techniques for incorporating such
materials with clamp pad (152), will be apparent to those of
ordinary skill in the art.
[0344] With the orientation of insulator (156) as described above,
end effector (150) first and second portions (154, 155) of
conductive pad (152) provide oppositely polarized electrodes of an
RF electrosurgical pathway or circuit. Furthermore, the
electrically conductive portions of clamp pad (152) are isolated
from one another and from clamp arm (151). With this configuration,
a single treatment region is defined between clamp pad (152) and
blade (153), and both ultrasonic cutting and RF electrosurgical
sealing of tissue sealing can be provided within the single
treatment region.
[0345] In some versions, clamp pad (152) is configured as a
disposable clamp pad (152) that wears away gradually as heat is
generated by blade (153). With this configuration, conductive
material (157) within clamp pad (152) may be configured to wear
away such that RF electrosurgical sealing becomes less effective
and thereby serves to indicate the time is right to replace clamp
pad (152).
[0346] When end effector (150) is used with instrument (110) to cut
and seal tissue (T), as mentioned above a single treatment region
is defined by tissue (T) compressed between blade (153) and clamp
pad (152). With tissue (T) compressed and blade (153) activated,
ultrasonic cutting of tissue (T) occurs along this compressed
region of tissue (T). Additionally, or separately, RF
electrosurgical sealing occurs in this single treatment region.
More specifically, with tissue (T) clamped between blade (153) and
pad (152), an RF electrosurgical pathway or circuit is defined as
extending through tissue between first portion (154) of clamp pad
(152) and second portion (155) of clamp pad (152). In this
exemplary RF electrosurgical circuit, first portion (154) is
provided at a first electrical polarity while second portion (155)
is provided at a second electrical polarity. When using end
effector (150) for ultrasonic cutting and RF electrosurgical
sealing, these modalities may be used in any order, or at the same
time. Furthermore, just one of these modalities may be used in some
applications, such that it is not necessary in all circumstances to
use both modalities with end effector (150).
[0347] Y. End Effector with Dual Lengthwise Sections
[0348] FIG. 105 shows another exemplary end effector (450)
configured for use with a shears device (451). While the present
example illustrates shears device (451), in view of the teachings
herein, the features and techniques pertaining to the ultrasonic
cutting and RF electrosurgical sealing are also applicable to
instrument (110) and one or more of the end effectors described
herein that are readily usable with instrument (110).
[0349] In certain procedure, e.g. solid organ procedures, it may be
desirable to crush tissues to divide the parenchymous tissues
without disturbing the vessels and ducts lying within. By way of
example only, this may occur in procedures where a portion of a
patient's liver is removed. After crushing the parenchyma, the
exposed vessels and ducts can then be sealed and cut. In some
instances, larger jaw or clamp arm devices are used with such
procedures. Some such larger jaw or clamp arm devices may include
shears like shears (451) shown in FIG. 105. It should therefore be
understood that the same shears (451) may be used to crush the
parenchyma, sever the exposed vessels and ducts, and seal the
severed vessels and ducts. In view of the teachings herein, other
devices usable in such procedures as described here will be
apparent to those of ordinary skill in the art. Such other devices
include, but are not limited to, instrument (110) and end effectors
readily usable with instrument (110), including end effectors
incorporating modifications based on the teachings described and
shown here with respect to end effector (450).
[0350] Referring to FIGS. 105-109, end effector (450) comprises
clamp arm (452), clamp pad (453), blade (454), and blade cover
(455). End effector (450) further comprises two sections that
extend lengthwise along clamp arm (452). The two lengthwise
sections comprise a proximal section (456) and a distal section
(457). In the present example, proximal section (456) is configured
for clamping tissue without or with minimal energy-based cutting.
Instead of being configured for energy-based cutting, proximal
section (456) is configured to provide mechanical crushing of
tissue as described above; and/or to deliver bipolar
electrosurgical energy to seal tissue. Distal section (457) is
configured for cutting tissue by delivering ultrasonic and/or
bipolar electrosurgical energy, where the tissue is cut by way of
ultrasonic energy. While the energy-based cutting section is distal
section (457) in the present example, in some other versions, the
functions of the proximal and distal sections (456, 457) may be
reversed such that the energy-based cutting occurs at proximal
section (456), while the bipolar coagulation and sealing occurs at
the distal section (457).
[0351] In the present example, proximal section (456) for sealing
and coagulation includes opposing clamping electrode surfaces that
deliver bipolar electrosurgical energy to clamped tissue. For
instance, the clamp arm side comprises a first electrode (458) and
blade side comprises a second electrode (459). In some versions,
first electrode (458) is configured with clamp arm (452) such that
clamp arm (452) provides a first polarity in the bipolar RF
electrosurgical circuit. In some other versions, first electrode
(458) is configured with clamp pad (453) such that clamp pad (453)
provides a first polarity in the bipolar RF electrosurgical
circuit. In still other versions, first electrode (458) comprises a
conductive plate connectable with clamp arm (452) and/or clamp pad
(453), where the conductive plate is configured to provide a first
polarity in the bipolar RF electrosurgical circuit. In view of the
teachings herein, other various ways to provide first electrode
(458) on clamp arm side of end effector (450) will be apparent to
those of ordinary skill in the art.
[0352] In some versions, second electrode (459) is configured with
blade (454) such that blade (454) provides a second polarity of the
bipolar RF electrosurgical circuit. In some other versions, second
electrode (459) is configured with blade cover (455) such that
blade cover (455) provides the second polarity of the bipolar RF
electrosurgical circuit. In still other versions, second electrode
(459) comprises a conductive plate connectable with blade (454) or
blade cover (455), where the conductive plate provides the second
polarity of the bipolar RF electrosurgical circuit. In examples
where second electrode (459) is formed by blade (454), second
electrode (459) can be ultrasonically active even though present in
proximal section (456). In examples where second electrode (459) is
formed by separate components not part of blade (454), second
electrode (459) is not ultrasonically active. Furthermore, even
where second electrode (459) is formed as part of blade (454) and
thus is ultrasonically active, the displacement of blade (454) in
proximal section (456) is about 70% less than the displacement that
occurs at the distal tip of blade (454). In view of the teachings
herein, other various ways to provide second electrode (459) on
blade side of end effector (450) will be apparent to those of
ordinary skill in the art.
[0353] In the present example, distal section (457) for ultrasonic
cutting includes clamp pad (453) and blade (454) such that tissue
can be clamped between and severed by ultrasonic cutting when blade
(454) is activated to oscillate ultrasonically. Distal section
(457) can optionally include opposing clamping electrode surfaces
that deliver bipolar energy to clamped tissue so that sealing and
coagulation can be provided in distal section (457) also. For
instance, in an example that includes RF electrosurgical sealing in
distal section (457), the clamp arm side comprises a third
electrode (460) and blade side comprises a fourth electrode (461).
In some versions, third electrode (460) is configured with clamp
arm (452) such that clamp arm (452) provides a first polarity of
the bipolar RF electrosurgical circuit. In some other versions,
third electrode (460) is configured with clamp pad (453) such that
clamp pad (453) provides the first polarity of the bipolar RF
electrosurgical circuit. In still other versions, third electrode
(460) comprises a conductive plate connectable with clamp arm (452)
and/or clamp pad (453), where the conductive plate provides the
first polarity of the bipolar RF electrosurgical circuit. In some
versions, first electrode (458) and third electrode (460) may be
the same structure that spans both proximal and distal sections
(456, 457) of end effector (450). In view of the teachings herein,
other various ways to provide third electrode (460) on clamp arm
side of end effector (450) will be apparent to those of ordinary
skill in the art.
[0354] In some versions, fourth electrode (461) is configured with
blade (454) such that blade (454) provides the second polarity of
the bipolar RF electrosurgical circuit. In some other versions,
fourth electrode (461) is configured with blade cover (455) such
that blade cover (455) provides the second polarity of the bipolar
RF electrosurgical circuit. In still other versions, fourth
electrode (461) comprises a conductive plate connectable with blade
(454) or blade cover (455), where the conductive plate provides the
second polarity of the bipolar RF electrosurgical circuit. In some
versions, second electrode (459) and fourth electrode (461) may be
the same structure that spans both proximal and distal sections
(456, 457) of end effector (450). In view of the teachings herein,
other various ways to provide fourth electrode (461) on blade side
of end effector (450) will be apparent to those of ordinary skill
in the art.
[0355] FIGS. 106 and 107 show exemplary cross-sections of a version
of end effector (450) where clamp arm (452) provides the first
polarity of the bipolar RF electrosurgical circuit. In distal
section (457) shown in FIG. 106, tissue can be clamped between
clamp pad (453) and blade (454). Blade (454) oscillates
ultrasonically to sever the tissue. Furthermore, in the present
example blade (454) provides the second polarity of the bipolar RF
electrosurgical circuit. Thus, in addition to ultrasonic cutting
occurring in distal section (457), RF electrosurgical sealing and
coagulation can occur based on the RF electrosurgical pathway
extending through tissue between clamp arm (452) and blade
(454).
[0356] In the illustrated example in FIGS. 106 and 107, blade (454)
comprises a groove (462) that extends along its underside. Groove
(462) aides in minimizing the thermal capacitance of blade (454)
and/or matching the blade's (454) thermal capacitance with that of
clamp arm (452). In the present example, groove (462) extends along
blade (454) through both distal and proximal sections (457, 456).
As seen by comparing blade (454) profile in proximal section (456)
versus distal section (457), groove (462) is more pronounced in
proximal section (456) where RF electrosurgical sealing occurs.
[0357] In proximal section (456) shown in FIG. 107, end effector
(450) further includes blade cover (455) that extends along the
sides and underside of blade (454). Blade cover (455) is
constructed of a nonconductive material in the present example,
such as a polymer or ceramic; or coated, dipped, or overmolded
stainless steel. As illustrated, the top surfaces of blade cover
(455) are raised or elevated relative to the top of blade (454)
such that clamp arm (452) engages blade cover (455) when end
effector (450) is closed. In the present example the distance that
blade cover (455) is raised or elevated relative to blade (454) is
represented by D1. Blade cover (455) is also configured such that
when clamp arm (452) engages blade cover (455), blade cover (455)
deflects. The deflection distance in the present example is
represented by D2. The deflection distance is configured to be less
than the elevated distance D1 so that blade cover (455) will
prevent electrically energized clamp arm (452) from contacting
electrically energized blade (454) and thereby short circuiting the
desired RF electrosurgical pathway.
[0358] FIGS. 108-109 show other exemplary cross-sections of a
version of end effector (450). With this example, distal section
(457) is configured for ultrasonic cutting without RF
electrosurgical sealing or coagulation. Furthermore, blade (454)
lacks groove (462) along distal section (457). Proximal section
(456) in this example is similar to that described with respect to
FIG. 107. However, clamp pad (453) is omitted along proximal
section (456). Again, blade cover (455) extends above the top of
blade (454) to prevent contact between clamp arm (452) and blade
(454) when end effector (450) is closed.
[0359] FIGS. 110 and 111 show exemplary views of a version of end
effector (450) where the poles of the RF electrosurgical circuit
are provided by two conductive plates. FIG. 110 shows distal
section (457) defining one lengthwise section of the clamping area,
and in particular the region where ultrasonic cutting occurs. In
the present example, third electrode (460) sits atop of clamp pad
(453). A molded top holder (463) is positioned above first
electrode (458) and electrically isolates clamp arm (452) from
first electrode (458). On the blade side in distal section (457), a
top surface of blade (454) is exposed and accessible for contacting
clamp pad (453) when end effector (450) is closed. As discussed
above, this configuration provides for ultrasonic cutting of
clamped tissue. At distal section (457), blade cover (455) extends
along the bottom and sides of blade (454), but does not cover the
top surface of blade (454).
[0360] Referring to FIG. 111, in proximal section (456) blade cover
(455) surrounds blade (454) on all sides. Second electrode (459) is
positioned on top of blade cover (455) and beneath clamp pad (453).
Furthermore, first electrode (458) extends above and along the
sides of second electrode (459). With this configuration, clamp pad
(453) in proximal section (456) prevents first electrode (458) and
second electrode (459) from directly contacting each other when end
effector (450) is in a closed position and thus preventing a short
circuit. As described above, when tissue is clamped within proximal
section (456), RF electrosurgical sealing and coagulation can be
delivered through RF electrosurgical energy flowing through the
tissue between electrodes (458, 459).
[0361] With the configuration of end effector (450) described in
the above examples, a larger jaw or clamp can be used while
minimizing the power needed for ultrasonic cutting since cutting is
limited to only a portion of the entire length of the jaw or clamp.
This also reduces the amount of heat generation associated with
larger jaw or clamp devices. Furthermore, because of the reduced
power need, smaller and/or lightweight transducers can be used.
[0362] Z. End Effector with Dual Charged Clamp Arms
[0363] FIG. 112 shows another exemplary end effector (550) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (550) comprises a first clamp arm
(551), and a second clamp arm (552). Clamp arm (551) is connectable
with clamp pad (553), and clamp arm (552) is connectable with clamp
pad (554). End effector (550) further comprises blade (555). Each
respective clamp arm (551, 552) and attached clamp pad (553, 554)
is configured to pivot relative to blade (555) between an open
position and a closed position to selectively receive and clamp
tissue (T) in end effector (550).
[0364] In the present example, the pivotal movement of clamp arms
(551, 552) occurs in the same or substantially the same manner as
the pivoting movement of clamp arm (210) described above. For
example, each respective clamp arm (551, 552) is pivotably coupled
with an outer tube (202) at one pivot point; and with inner tube
(204) at another pivot point. Thus, relative longitudinal movement
between tubes (202, 204) provides pivotal movement of clamp arms
(551, 552). In some versions, instrument (110) may be configured
with additional tubes or adapters that connect with clamp arms
(551, 552) to provide pivotal movement as described herein.
Furthermore, clamp arms (551, 552) and their associated clamp pads
(553, 554) are configured to move either independently or together.
In view of the teachings herein, various ways to configure clamp
arms (551, 552) with instrument (110) to provide this pivotal
movement will be apparent to those of ordinary skill in the
art.
[0365] Each clamp arm (551, 552) in the present example is provided
with a different polarity so that an RF electrosurgical circuit or
pathway is created through tissue captured between from clamp arms
(551, 552). For instance, clamp arm (551) may have a first
electrical polarity while clamp arm (552) may have a second
electrical polarity. As described above, the conductive nature of
clamp arms (551, 552) may be achieved by combining conductive
material(s) (46) with clamp arms (551, 552). The conductive clamp
arms (551, 552) are then connectable with an electrical source,
such as generator (116), to deliver the electrical energy to clamp
arms (551, 552). In view of the teachings herein, various ways for
connecting conductive clamp arms (551, 552) with generator (116) or
another electrical source will be apparent to those of ordinary
skill in the art. Also, any of the methods and techniques described
above for altering or modifying clamp arm design to shape the
electrosurgical circuit or pathway may be used with clamp arms
(551, 552) of end effector (550). In view of the teachings herein,
such alterations or modification of clamp arms (551, 552) to shape
the electrosurgical circuit and resultant sealing will be apparent
to those of ordinary skill in the art. Furthermore, each clamp pad
(553, 554) is electrically isolated from its respective clamp arm
(551, 552) through various insulating materials as will be
understood by those of ordinary skill in the art in view of the
teachings herein.
[0366] In the example where clamp arms (551, 552) move
independently relative to blade (555), either or both clamp arms
(551, 552) can be moved to the closed position to compress tissue
between the respective clamp pad (553, 554) and blade (555). Blade
(555) can be activated to oscillate such that compressed tissue
will be ultrasonically severed along the regions where tissue is
compressed between clamp pads (553, 554) and blade (555). Because
each clamp arm (551, 552) in the present example has a different
polarity, to achieve RF electrosurgical sealing, both clamp arms
(551, 552) are moved to the closed position so that they contact
the captured tissue. With both clamp arms (551, 552) closed, RF
electrosurgical sealing can be provided either before, during, or
after the ultrasonic cutting process.
[0367] FIG. 113 shows another exemplary end effector (560) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (560) comprises a first clamp arm
(561), a second clamp arm (562), a first clamp pad (563), a second
clamp pad (564), and a blade (565). End effector (560) operates the
same or similar to end effector (550), and thus the discussion
above regarding end effector (550) should be understood to apply
also to end effector (560). A difference between end effector (560)
and end effector (550) pertains to clamp pads (563, 564). With end
effector (560), clamp pads (563, 564) each extend inwardly toward a
centerline longitudinal axis of blade (565). In this configuration,
clamp arms (561, 562) contact clamped tissue at each outer portion
of clamp arms (561, 562). Accordingly, the RF electrosurgical
pathway from one clamp arm (561) to the other clamp arm (562)
extends only from the outer surface of one clamp arm (561) to the
outer surface of the other clamp arm (562). Comparing back to end
effector (550), clamp arms (551, 552) are each in contact with
clamped tissue on both sides of clamp arms (551, 552). Therefore,
with end effector (550) there are four RF electrosurgical pathways
from one clamp arm (551) through clamped tissue (T), and to the
other clamp arm (552).
[0368] FIG. 114 shows another exemplary end effector (570) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (570) comprises split clamp arm (571)
having a first portion (572) and a second portion (573) that are
each oppositely polarized and isolated from one another by pad
(574). End effector (570) further comprises nonconductive blade
(575). With the split clamp arm configuration, ultrasonic cutting
occurs in the same manner as described above with other single
clamp arm end effectors. RF electrosurgical sealing occurs
similarly to such sealing described above with respect to end
effector (560) shown in FIG. 113, there being a single RF
electrosurgical pathway from first portion (572) to second portion
(573).
[0369] FIGS. 115-117 show additional clamp pad (584, 594, 596) to
clamp arm (581, 591, 595) configurations. For example, FIGS. 115
and 116 show configurations where clamp arms (581, 591) each
include two extending portions that may be used to define RF
electrosurgical pathways for sealing. FIG. 117 shows a clamp arm
(595) attached with a clamp pad (596) where clamp pad (596)
comprises multiple capillaries that can be filled with conductive
gel to provide RF electrosurgical energy. In view of the teachings
herein, other modifications to clamp arm and clamp pad to achieve a
desired RF electrosurgical pathway arrangement will be apparent to
those of ordinary skill in the art.
III. EXEMPLARY HANDLE ASSEMBLY CONFIGURATIONS
[0370] As noted above, handle assembly (120) provides operator
control over ultrasonic and/or RF electrosurgical activation of end
effector (140) via buttons (125, 126). It may be desirable to
provide an operator with additional forms of control over
ultrasonic and/or RF electrosurgical activation of end effector
(140). The following description relates to several merely
illustrative examples of alternative forms that handle assembly
(120) may take. It should therefore be understood that the handle
assemblies described below may be readily incorporated into
instrument (110) in place of handle assembly (120). It should also
be understood that the handle assemblies described below may be
readily combined with any of the various end effectors described
herein, including but not limited to end effector (140) and the
variations of end effector (140) described above.
[0371] A. Handle Assembly with Three Discrete Buttons
[0372] FIGS. 22-24 show an exemplary handle assembly (900) that may
be readily incorporated into instrument (110) in place of handle
assembly (120). Handle assembly (900) of this example is
substantially identical to handle assembly (120) described above.
For instance, handle assembly (900) of this example comprises a
body (902) defining a pistol grip (904), with a trigger (906) that
is pivotable relative to pistol grip (904). Shaft assembly (130)
extends distally from handle assembly (900). Any of the various end
effectors described herein may be positioned at the distal end of
shaft assembly (130).
[0373] Unlike handle assembly (120), handle assembly (900) of this
example has three discrete buttons (910, 920, 930). Buttons (910)
are provided on both lateral sides of handle assembly (900), as
best seen in FIG. 24. Buttons (910) are positioned such that a
button (910) is configured to be actuated by the thumb of the hand
that grasps pistol grip (904). By having buttons (910) on both
lateral sides of handle assembly (900), handle assembly (900)
provides easy access to at least one button (910) regardless of
whether the operator is grasping pistol grip (904) in the
operator's right hand or the operator's left hand. It should be
understood that buttons (910) of handle assembly (900) are
substantially similar to buttons (125) of handle assembly
(120).
[0374] Buttons (920, 930) are each positioned such that each button
(920, 930) is configured to be actuated by the index finger of the
hand that grasps pistol grip (904). Each button (920, 930) may be
accessed just as easily regardless of whether the operator is
grasping pistol grip (904) in the operator's right hand or the
operator's left hand. It should be understood that button (920) of
handle assembly (900) is substantially similar to button (126) of
handle assembly (120). However, button (930) of handle assembly
(900) has no analog in handle assembly (120).
[0375] As noted above, buttons (910, 920, 930) may be used to
selectively activate the application of ultrasonic and/or RF
electrosurgical energy to tissue via the end effector that is
coupled with shaft assembly (130). In some versions, buttons (910)
are operable to activate an "advanced hemostasis" operation via the
end effector. In some such versions, the advanced hemostasis
operation includes application of only ultrasonic energy to tissue,
with a power profile that is configured to maximize hemostasis in
tissue while reducing the cutting speed. By way of example only,
this power profile may be provided in accordance with at least some
of the teachings of U.S. Pub. No. 2015/0141981, entitled
"Ultrasonic Surgical Instrument with Electrosurgical Feature,"
published May 21, 2015, the disclosure of which is incorporated by
reference herein. In some versions, the advanced hemostasis
operation is configured to seal vessels having a diameter up to
approximately 7 mm.
[0376] In the present example, button (920) is operable to activate
a "max seal and cut" operation via the end effector. By way of
example only, an operator may choose this operation to seal and cut
vessels having a diameter between approximately 3 mm and
approximately 5 mm. In some such versions, the max seal and cut
operation includes application of either only ultrasonic energy or
a combination of ultrasonic and RF electrosurgical energy. Again,
this operation may be provided in accordance with at least some of
the teachings of U.S. Pub. No. 2015/0141981, entitled "Ultrasonic
Surgical Instrument with Electrosurgical Feature," published May
21, 2015, the disclosure of which is incorporated by reference
herein.
[0377] In the present example, button (930) is operable to activate
a "seal only" operation via the end effector. By way of example
only, an operator may choose this operation to seal vessels having
a diameter between approximately 3 mm and approximately 7 mm. In
some such versions, the seal only operation includes application of
a combination of ultrasonic and RF electrosurgical energy. Again,
this operation may be provided in accordance with at least some of
the teachings of U.S. Pub. No. 2015/0141981, entitled "Ultrasonic
Surgical Instrument with Electrosurgical Feature," published May
21, 2015, the disclosure of which is incorporated by reference
herein.
[0378] Of course, the foregoing examples are merely illustrative
examples. Buttons (910, 920, 930) may alternatively be configured
to activate any other suitable operations via the end effector.
Further examples will be apparent to those of ordinary skill in the
art in view of the teachings herein.
[0379] B. Handle Assembly with Two Discrete Buttons and Rotary
Paddle
[0380] FIGS. 25-27C show another exemplary handle assembly (1000)
that may be readily incorporated into instrument (110) in place of
handle assembly (120). Handle assembly (1000) of this example is
substantially identical to handle assembly (120) described above.
For instance, handle assembly (1000) of this example comprises a
body (1002) defining a pistol grip (1004), with a trigger (1006)
that is pivotable relative to pistol grip (1004). Shaft assembly
(130) extends distally from handle assembly (1000). Any of the
various end effectors described herein may be positioned at the
distal end of shaft assembly (130).
[0381] Unlike handle assembly (120), handle assembly (1000) of this
example has two discrete buttons (1010, 1020) in combination with
an activation paddle (1030). Buttons (1010) are provided on both
lateral sides of handle assembly (1000), as best seen in FIGS.
27A-27C. Buttons (1010) are positioned such that a button (1010) is
configured to be actuated by the thumb of the hand that grasps
pistol grip (1004). By having buttons (1010) on both lateral sides
of handle assembly (1000), handle assembly (1000) provides easy
access to at least one button (1010) regardless of whether the
operator is grasping pistol grip (1004) in the operator's right
hand or the operator's left hand. It should be understood that
buttons (1010) of handle assembly (1000) are substantially similar
to buttons (125) of handle assembly (120).
[0382] Button (1020) is positioned such that button (1020) is
configured to be actuated by the index finger of the hand that
grasps pistol grip (1004). Button (1020) may be accessed just as
easily regardless of whether the operator is grasping pistol grip
(1004) in the operator's right hand or the operator's left hand. It
should be understood that button (1020) of handle assembly (1000)
is substantially similar to button (126) of handle assembly
(120).
[0383] Activation paddle (1030) extends distally relative to body
(1002) and is secured to a ring (1032). Ring (1032) is coaxially
disposed about the longitudinal axis of shaft assembly (130).
Paddle (1030) of handle assembly (1000) has no analog in handle
assembly (120). While buttons (1010, 1020) are configured to be
pressed inwardly by the operator to activate a function in the end
effector (e.g., as described below); paddle (1030) is configured to
be pressed laterally by the operator, thereby rotating ring (1032)
about the longitudinal axis of shaft assembly (130), to activate a
function in the end effector (e.g., as described below). In
particular, paddle (1030) may be pressed laterally in one direction
to transition from the neutral state shown in FIGS. 26A and 27A to
the deflected state shown in FIGS. 26B and 27B; or in the other
lateral direction to transition from the neutral state shown in
FIGS. 26A and 27A to the deflected state shown in FIGS. 26C and
27C. It should be understood that the degree of paddle (1030)
deflection shown in FIGS. 26B-26C and 27B-27C is exaggerated for
purposes of illustration only. In actual versions of handle
assembly (1000), paddle (1030) may be configured to move along only
a relatively short distance in the directions shown FIGS. 26B-26C
and 27B-27C.
[0384] Paddle (1030) is positioned such that paddle (1030) is
configured to be actuated by the index finger of the hand that
grasps pistol grip (1004). Paddle (1030) may be accessed just as
easily regardless of whether the operator is grasping pistol grip
(1004) in the operator's right hand or the operator's left hand.
Right-handed operators may find it easier to depress paddle (1030)
in the direction shown in FIGS. 26B and 27B; while left-handed
operators may find it easier to depress paddle (1030) in the
direction shown in FIGS. 26C and 27C.
[0385] As noted above, buttons (1010, 1020) and paddle (1030) may
be used to selectively activate the application of ultrasonic
and/or RF electrosurgical energy to tissue via the end effector
that is coupled with shaft assembly (130). In some versions,
buttons (1010) are operable to activate an "advanced hemostasis"
operation via the end effector. In some such versions, the advanced
hemostasis operation includes application of only ultrasonic energy
to tissue, with a power profile that is configured to maximize
hemostasis in tissue. By way of example only, this power profile
may be provided in accordance with at least some of the teachings
of U.S. Pub. No. 2015/0141981, entitled "Ultrasonic Surgical
Instrument with Electrosurgical Feature," published May 21, 2015,
the disclosure of which is incorporated by reference herein.
[0386] In the present example, button (1020) is operable to
activate a "max seal and cut" operation via the end effector. By
way of example only, an operator may choose this operation to seal
and cut vessels having a diameter between approximately 3 mm and
approximately 5 mm. In some such versions, the max seal and cut
operation includes application of either only ultrasonic energy or
a combination of ultrasonic and RF electrosurgical energy. Again,
this operation may be provided in accordance with at least some of
the teachings of U.S. Pub. No. 2015/0141981, entitled "Ultrasonic
Surgical Instrument with Electrosurgical Feature," published May
21, 2015, the disclosure of which is incorporated by reference
herein.
[0387] In the present example, paddle (1030) is operable to
activate a "seal only" operation via the end effector. By way of
example only, an operator may choose this operation to seal vessels
having a diameter between approximately 3 mm and approximately 7
mm. In some such versions, the seal only operation includes
application of a combination of ultrasonic and RF electrosurgical
energy. Again, this operation may be provided in accordance with at
least some of the teachings of U.S. Pub. No. 2015/0141981, entitled
"Ultrasonic Surgical Instrument with Electrosurgical Feature,"
published May 21, 2015, the disclosure of which is incorporated by
reference herein.
[0388] Of course, the foregoing examples are merely illustrative
examples. Buttons (1010, 1020) and paddle (1030) may alternatively
be configured to activate any other suitable operations via the end
effector. Further examples will be apparent to those of ordinary
skill in the art in view of the teachings herein. It should also be
understood that, since paddle (1030) may be actuated in two
different directions from the neutral position of FIGS. 26A and
27A, paddle (1030) may activate different operations via the end
effector depending on the direction in which paddle (1030) is
deflected.
[0389] C. Handle Assembly with Discrete Button and Rocker
Assembly
[0390] FIGS. 28-30 show another exemplary handle assembly (1100)
that may be readily incorporated into instrument (110) in place of
handle assembly (120). Handle assembly (1100) of this example is
substantially identical to handle assembly (120) described above.
For instance, handle assembly (1100) of this example comprises a
body (1102) defining a pistol grip (1104), with a trigger (1106)
that is pivotable relative to pistol grip (1104). Shaft assembly
(130) extends distally from handle assembly (1100). Any of the
various end effectors described herein may be positioned at the
distal end of shaft assembly (130).
[0391] Unlike handle assembly (120), handle assembly (1100) of this
example a discrete button (1100) in combination with a rocker
assembly (1040). Buttons (1110) are provided on both lateral sides
of handle assembly (1100), as best seen in FIG. 29. Buttons (1110)
are positioned such that a button (1110) is configured to be
actuated by the thumb of the hand that grasps pistol grip (1104).
By having buttons (1110) on both lateral sides of handle assembly
(1100), handle assembly (1100) provides easy access to at least one
button (1110) regardless of whether the operator is grasping pistol
grip (1104) in the operator's right hand or the operator's left
hand. It should be understood that buttons (1110) of handle
assembly (1100) are substantially similar to buttons (125) of
handle assembly (120).
[0392] Rocker assembly (1040) is positioned such that rocker
assembly (1040) is configured to be actuated by the index finger of
the hand that grasps pistol grip (1104). Rocker assembly (1040) may
be accessed just as easily regardless of whether the operator is
grasping pistol grip (1104) in the operator's right hand or the
operator's left hand. Rocker assembly (1040) presents an upper
button feature (1044) and a lower button feature (1042). Rocker
assembly (1040) is pivotably coupled with body (1102) such that
rocker (1040) is configured to rock about a laterally oriented axis
that is perpendicular to the longitudinal axis of shaft assembly
(130). For instance, if an operator depresses upper button feature
(1044), rocker assembly (1040) will pivot relative to body (1102)
such that upper button feature (1044) will travel proximally
relative to body (1102) and lower button feature (1042) will travel
distally relative to body (1102). Similarly, if an operator
depresses lower button feature (1042), rocker assembly (1040) will
pivot relative to body (1102) such that lower button feature (1042)
will travel proximally relative to body (1102) and upper button
feature (1044) will travel distally relative to body (1102). It
should be understood that lower button feature (1042) of handle
assembly (1100) is substantially similar to button (126) of handle
assembly (120). However, upper button feature (1044) has no analog
in handle assembly (120).
[0393] As noted above, buttons (1110) and rocker assembly (1040)
may be used to selectively activate the application of ultrasonic
and/or RF electrosurgical energy to tissue via the end effector
that is coupled with shaft assembly (130). In some versions,
buttons (1110) are operable to activate an "advanced hemostasis"
operation via the end effector. In some such versions, the advanced
hemostasis operation includes application of only ultrasonic energy
to tissue, with a power profile that is configured to maximize
hemostasis in tissue. By way of example only, this power profile
may be provided in accordance with at least some of the teachings
of U.S. Pub. No. 2015/0141981, entitled "Ultrasonic Surgical
Instrument with Electrosurgical Feature," published May 21, 2015,
the disclosure of which is incorporated by reference herein.
[0394] In the present example, lower button feature (1042) is
operable to activate a "max seal and cut" operation via the end
effector. By way of example only, an operator may choose this
operation to seal and cut vessels having a diameter between
approximately 3 mm and approximately 5 mm. In some such versions,
the max seal and cut operation includes application of either only
ultrasonic energy or a combination of ultrasonic and RF
electrosurgical energy. Again, this operation may be provided in
accordance with at least some of the teachings of U.S. Pub. No.
2015/0141981, entitled "Ultrasonic Surgical Instrument with
Electrosurgical Feature," published May 21, 2015, the disclosure of
which is incorporated by reference herein.
[0395] In the present example, upper button feature (1044) is
operable to activate a "seal only" operation via the end effector.
By way of example only, an operator may choose this operation to
seal vessels having a diameter between approximately 3 mm and
approximately 7 mm. In some such versions, the seal only operation
includes application of a combination of ultrasonic and RF
electrosurgical energy. Again, this operation may be provided in
accordance with at least some of the teachings of U.S. Pub. No.
2015/0141981, entitled "Ultrasonic Surgical Instrument with
Electrosurgical Feature," published May 21, 2015, the disclosure of
which is incorporated by reference herein.
[0396] Of course, the foregoing examples are merely illustrative
examples. Buttons (1110) and rocker assembly (1040) may
alternatively be configured to activate any other suitable
operations via the end effector. Further examples will be apparent
to those of ordinary skill in the art in view of the teachings
herein.
IV. EXEMPLARY COMBINATIONS
[0397] The following examples relate to various non-exhaustive ways
in which the teachings herein may be combined or applied. It should
be understood that the following examples are not intended to
restrict the coverage of any claims that may be presented at any
time in this application or in subsequent filings of this
application. No disclaimer is intended. The following examples are
being provided for nothing more than merely illustrative purposes.
It is contemplated that the various teachings herein may be
arranged and applied in numerous other ways. It is also
contemplated that some variations may omit certain features
referred to in the below examples. Therefore, none of the aspects
or features referred to below should be deemed critical unless
otherwise explicitly indicated as such at a later date by the
inventors or by a successor in interest to the inventors. If any
claims are presented in this application or in subsequent filings
related to this application that include additional features beyond
those referred to below, those additional features shall not be
presumed to have been added for any reason relating to
patentability.
Example 1
[0398] A method of using an instrument, the method comprising: (a)
positioning an instrument end effector within a patient, wherein
the end effector comprises: (i) an ultrasonic blade, (ii) a clamp
pad, and (iii) at least one electrode; (b) positioning the
ultrasonic blade against tissue in the patient; (c) activating the
ultrasonic blade to vibrate ultrasonically while the ultrasonic
blade is positioned against tissue; (d) positioning the at least
one electrode against tissue in the patient; and (e) activating the
at least one electrode to apply RF electrosurgical energy to tissue
against which the at least one electrode is positioned against
tissue.
Example 2
[0399] The method of Example 1, further comprising compressing
tissue between the clamp pad and the ultrasonic blade.
Example 3
[0400] The method of Example 2, wherein the act of activating the
ultrasonic blade is performed while the tissue is compressed
between the clamp pad and the ultrasonic blade.
Example 4
[0401] The method of any one or more of Examples 2 through 3,
wherein the act of activating the at least one electrode is
performed while the tissue is compressed between the clamp pad and
the ultrasonic blade.
Example 5
[0402] The method of any one or more of Examples 2 through 4,
wherein the end effector further comprises a clamp arm, wherein the
clamp arm is pivotable relative to the ultrasonic blade, wherein
the at least one electrode is supported by the clamp arm, wherein
the act of compressing tissue between the clamp pad and the
ultrasonic blade comprises pivoting the at least one electrode
toward the tissue.
Example 6
[0403] The method of any one or more of Examples 1 through 5,
wherein the ultrasonic blade provides a return path for the
electrode, wherein the act of activating the at least one electrode
to apply RF electrosurgical energy to tissue results in the
application of bipolar RF electrosurgical energy to the tissue via
the at least one electrode and the ultrasonic blade.
Example 7
[0404] The method of any one or more of Examples 1 through 6,
wherein the clamp pad has a pair of lateral sides, wherein the at
least one electrode extends along both lateral sides of the clamp
pad, wherein the act of activating the at least one electrode to
apply RF electrosurgical energy to tissue comprises applying RF
electrosurgical energy to tissue at both lateral sides of the clamp
pad.
Example 8
[0405] The method of any one or more of Examples 1 through 7,
wherein the ultrasonic blade is positioned against tissue extending
along a first plane, wherein the at least one electrode is
positioned against tissue extending along a second plane, wherein
the second plane is substantially parallel with the first
plane.
Example 9
[0406] The method of any one or more of Examples 1 through 7,
wherein the ultrasonic blade is positioned against tissue extending
along a first plane, wherein the at least one electrode is
positioned against tissue extending along a second plane, wherein
the second plane is obliquely oriented relative to the first
plane.
Example 10
[0407] The method of any one or more of Examples 1 through 9,
wherein the end effector further comprises a plurality of stand-off
features, wherein the stand-off features prevent the at least one
electrode from contacting the ultrasonic blade.
Example 11
[0408] The method of any one or more of Examples 1 through 6 and 8
through 10, wherein the end effector further comprises a clamp arm
body, wherein the at least one electrode is interposed between the
clamp pad and the clamp arm body, wherein the clamp pad defines a
plurality of openings, wherein the act of positioning the at least
one electrode against tissue comprises pressing the tissue through
at least some of the openings to contact the at least one
electrode.
Example 12
[0409] The method of any one or more of Examples 1 through 4,
wherein the end effector further comprises a blade guard, wherein
the blade guard extends along at least a portion of the length of
the ultrasonic blade, wherein the blade guard is spaced away from
the ultrasonic blade, wherein the at least one electrode is
positioned on the blade guard, wherein the act of positioning the
at least one electrode against tissue comprises urging the blade
guard into contact with the tissue.
Example 13
[0410] The method of any one or more of Examples 1 through 5 and 7
through 11, wherein the end effector further comprises a clamp arm
assembly, wherein the clamp arm assembly comprises the clamp pad
and the at least one electrode, wherein the at least one electrode
comprises a first electrode and a second electrode, wherein the act
of activating the at least one electrode comprises activating the
first and second electrodes to apply bipolar RF electrosurgical
energy to tissue.
Example 14
[0411] The method of any one or more of Examples 1 through 5, 7
through 11, and 13, wherein the at least one electrode comprises a
first electrode and a second electrode, wherein the clamp pad is
laterally interposed between the first and second electrodes,
wherein the act of positioning the at least one electrode against
tissue further comprises positioning the first and second
electrodes against the tissue while simultaneously positioning the
clamp pad against the tissue.
Example 15
[0412] The method of Example 14, wherein the act of positioning the
first and second electrodes against the tissue while simultaneously
positioning the clamp pad against the tissue further comprises
compressing the tissue between the clamp pad and the ultrasonic
blade.
Example 16
[0413] The method of Example 15, wherein the act of activating the
ultrasonic blade to vibrate ultrasonically while the ultrasonic
blade is positioned against tissue is performed while the tissue is
compressed between the clamp pad and the ultrasonic blade.
Example 17
[0414] The method of any one or more of Examples 1 through 16,
wherein the end effector further comprises a clamp arm body
defining a plurality of recesses, wherein at least a portion of the
clamp pad flows into at least some of the recesses during one or
both of the act of activating the ultrasonic blade to vibrate
ultrasonically while the ultrasonic blade is positioned against
tissue or the act of activating the at least one electrode to apply
RF electrosurgical energy to tissue against which the at least one
electrode is positioned.
Example 18
[0415] The method of Example 1, wherein the at least one electrode
comprises a first electrode and a second electrode, wherein the end
effector further comprises a first arm and a second arm, wherein
the first electrode is carried by the first arm, wherein the second
electrode is carried by the second arm, wherein the act of
positioning the at least one electrode against tissue in the
patient comprises: (i) pivoting the first arm toward the tissue,
and (ii) pivoting the second arm toward the tissue.
Example 19
[0416] A method of using an instrument, the method comprising: (a)
positioning an instrument end effector within a patient, wherein
the end effector comprises: (i) an ultrasonic blade, and (ii) a
clamp arm assembly, wherein the clamp arm assembly comprises: (A) a
clamp pad, (B) a first electrode, and (C) a second electrode; (b)
pivoting the clamp arm assembly toward the ultrasonic blade,
thereby compressing tissue between the ultrasonic blade and the
clamp pad, and thereby bringing the first and second electrodes
into contact with the tissue; and (c) activating one or both of:
(i) the ultrasonic blade to vibrate ultrasonically to thereby apply
the ultrasonic energy to the tissue, or (ii) the first and second
electrodes to thereby apply bipolar RF electrosurgical energy to
the tissue.
Example 20
[0417] A method of using an instrument, the method comprising: (a)
positioning an instrument end effector within a patient, wherein
the end effector comprises: (i) an ultrasonic blade, (ii) a clamp
arm assembly, (iii) a first conductive arm, wherein the first
conductive arm is spaced apart from the ultrasonic blade and from
the clamp arm assembly, and (iv) a second conductive arm, wherein
the second conductive arm is spaced apart from the ultrasonic blade
and from the clamp arm assembly; (b) pivoting the clamp arm
assembly toward the ultrasonic blade, thereby compressing tissue
between the ultrasonic blade and the clamp arm assembly; and (c)
activating one or both of: (i) the ultrasonic blade to vibrate
ultrasonically to thereby apply the ultrasonic energy to the
tissue, or (ii) the first and second conductive arms to thereby
apply bipolar RF electrosurgical energy to the tissue.
V. MISCELLANEOUS
[0418] It should be understood that any of the versions of
instruments described herein may include various other features in
addition to or in lieu of those described above. By way of example
only, any of the instruments described herein may also include one
or more of the various features disclosed in any of the various
references that are incorporated by reference herein. It should
also be understood that the teachings herein may be readily applied
to any of the instruments described in any of the other references
cited herein, such that the teachings herein may be readily
combined with the teachings of any of the references cited herein
in numerous ways. Other types of instruments into which the
teachings herein may be incorporated will be apparent to those of
ordinary skill in the art.
[0419] It should also be understood that any ranges of values
referred to herein should be read to include the upper and lower
boundaries of such ranges. For instance, a range expressed as
ranging "between approximately 1.0 inches and approximately 1.5
inches" should be read to include approximately 1.0 inches and
approximately 1.5 inches, in addition to including the values
between those upper and lower boundaries.
[0420] It should be appreciated that any patent, publication, or
other disclosure material, in whole or in part, that is said to be
incorporated by reference herein is incorporated herein only to the
extent that the incorporated material does not conflict with
existing definitions, statements, or other disclosure material set
forth in this disclosure. As such, and to the extent necessary, the
disclosure as explicitly set forth herein supersedes any
conflicting material incorporated herein by reference. Any
material, or portion thereof, that is said to be incorporated by
reference herein, but which conflicts with existing definitions,
statements, or other disclosure material set forth herein will only
be incorporated to the extent that no conflict arises between that
incorporated material and the existing disclosure material.
[0421] Versions of the devices described above may have application
in conventional medical treatments and procedures conducted by a
medical professional, as well as application in robotic-assisted
medical treatments and procedures. By way of example only, various
teachings herein may be readily incorporated into a robotic
surgical system such as the DAVINCI.TM. system by Intuitive
Surgical, Inc., of Sunnyvale, Calif. Similarly, those of ordinary
skill in the art will recognize that various teachings herein may
be readily combined with various teachings of U.S. Pat. No.
6,783,524, entitled "Robotic Surgical Tool with Ultrasound
Cauterizing and Cutting Instrument," published Aug. 31, 2004, the
disclosure of which is incorporated by reference herein.
[0422] Versions described above may be designed to be disposed of
after a single use, or they can be designed to be used multiple
times. Versions may, in either or both cases, be reconditioned for
reuse after at least one use. Reconditioning may include any
combination of the steps of disassembly of the device, followed by
cleaning or replacement of particular pieces, and subsequent
reassembly. In particular, some versions of the device may be
disassembled, and any number of the particular pieces or parts of
the device may be selectively replaced or removed in any
combination. Upon cleaning and/or replacement of particular parts,
some versions of the device may be reassembled for subsequent use
either at a reconditioning facility, or by an operator immediately
prior to a procedure. Those skilled in the art will appreciate that
reconditioning of a device may utilize a variety of techniques for
disassembly, cleaning/replacement, and reassembly. Use of such
techniques, and the resulting reconditioned device, are all within
the scope of the present application.
[0423] By way of example only, versions described herein may be
sterilized before and/or after a procedure. In one sterilization
technique, the device is placed in a closed and sealed container,
such as a plastic or TYVEK bag. The container and device may then
be placed in a field of radiation that can penetrate the container,
such as gamma radiation, x-rays, or high-energy electrons. The
radiation may kill bacteria on the device and in the container. The
sterilized device may then be stored in the sterile container for
later use. A device may also be sterilized using any other
technique known in the art, including but not limited to beta or
gamma radiation, ethylene oxide, or steam.
[0424] Having shown and described various embodiments of the
present invention, further adaptations of the methods and systems
described herein may be accomplished by appropriate modifications
by one of ordinary skill in the art without departing from the
scope of the present invention. Several of such potential
modifications have been mentioned, and others will be apparent to
those skilled in the art. For instance, the examples, embodiments,
geometrics, materials, dimensions, ratios, steps, and the like
discussed above are illustrative and are not required. Accordingly,
the scope of the present invention should be considered in terms of
the following claims and is understood not to be limited to the
details of structure and operation shown and described in the
specification and drawings.
* * * * *