U.S. patent application number 16/885881 was filed with the patent office on 2021-07-01 for electrosurgical instrument with monopolar and bipolar energy capabilities.
The applicant listed for this patent is Ethicon LLC. Invention is credited to Taylor W. Aronhalt, Kevin M. Fiebig, Frederick E. Shelton, IV, Sarah A. Worthington.
Application Number | 20210196361 16/885881 |
Document ID | / |
Family ID | 1000004902299 |
Filed Date | 2021-07-01 |
United States Patent
Application |
20210196361 |
Kind Code |
A1 |
Shelton, IV; Frederick E. ;
et al. |
July 1, 2021 |
ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGY
CAPABILITIES
Abstract
An electrosurgical instrument comprising an end effector
including a first jaw, a second jaw, and an electrical circuit is
disclosed. The first jaw comprises a first conductive skeleton, a
first insulative coating selectively covering portions of the first
conductive skeleton, and first-jaw electrodes comprising exposed
portions of the first conductive skeleton. The second jaw comprises
a second conductive skeleton, a second insulative coating
selectively covering portions of the second conductive skeleton,
and second-jaw electrodes comprising exposed portions of the second
conductive skeleton. The circuit is configured to transmit a
bipolar RF energy and a monopolar RF energy to the tissue through
the first-jaw electrodes and the second-jaw electrodes. The
monopolar RF energy shares a first electrical pathway and a second
electrical pathway defined by the electrical circuit for
transmission of the bipolar RF energy.
Inventors: |
Shelton, IV; Frederick E.;
(Hillsboro, OH) ; Fiebig; Kevin M.; (Cincinnati,
OH) ; Aronhalt; Taylor W.; (Loveland, OH) ;
Worthington; Sarah A.; (Cincinnati, OH) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Ethicon LLC |
Guaynabo |
PR |
US |
|
|
Family ID: |
1000004902299 |
Appl. No.: |
16/885881 |
Filed: |
May 28, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
62955299 |
Dec 30, 2019 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2018/00077
20130101; A61B 2018/00083 20130101; A61B 2018/126 20130101; A61B
18/1206 20130101; A61B 2018/1253 20130101; A61B 2018/00607
20130101; A61B 18/1445 20130101 |
International
Class: |
A61B 18/14 20060101
A61B018/14; A61B 18/12 20060101 A61B018/12 |
Claims
1. An electrosurgical instrument, comprising an end effector, the
end effector comprising: a first jaw, comprising: a first
electrically conductive skeleton; a first insulative coating
selectively covering portions of the first electrically conductive
skeleton; and first-jaw electrodes comprising exposed portions of
the first electrically conductive skeleton; a second jaw, wherein
at least one of the first jaw and the second jaw is movable to
transition the end effector from an open configuration to a closed
configuration to grasp tissue therebetween, the second jaw
comprising: a second electrically conductive skeleton; a second
insulative coating selectively covering portions of the second
electrically conductive skeleton; and second-jaw electrodes
comprising exposed portions of the second electrically conductive
skeleton; and an electrical circuit configured to transmit a
bipolar RF energy and a monopolar RF energy to the tissue through
the first-jaw electrodes and the second-jaw electrodes, wherein the
monopolar RF energy shares a first electrical pathway and a second
electrical pathway defined by the electrical circuit for
transmission of the bipolar RF energy.
2. The electrosurgical instrument of claim 1, wherein the
electrical circuit defines a third electrical pathway separate from
the first electrical pathway and the second electrical pathway.
3. The electrosurgical instrument of claim 2, wherein the end
effector comprises a cutting electrode electrically insulated from
the first electrically conductive skeleton and the second
electrically conductive skeleton.
4. The electrosurgical instrument of claim 3, wherein the cutting
electrode is configured to receive a cutting monopolar RF energy
through the third electrical pathway.
5. The electrosurgical instrument of claim 4, wherein the cutting
electrode is configured to cut the tissue with the cutting
monopolar RF energy after coagulation of the tissue has commenced
with the bipolar RF energy.
6. The electrosurgical instrument of claim 3, wherein the cutting
electrode is centrally located in one of the first jaw and the
second jaw.
7. The electrosurgical instrument of claim 4, wherein the end
effector is configured to simultaneously deliver the cutting
monopolar RF energy and the bipolar RF energy to the tissue.
8. The electrosurgical instrument of claim 1, wherein the first-jaw
electrodes comprise a first distal-tip electrode, and wherein the
second-jaw electrodes comprise a second distal-tip electrode.
9. The electrosurgical instrument of claim 8, wherein first
electrically conductive skeleton and the second electrically
conductive skeleton are energized simultaneously to deliver the
monopolar RF energy to a tissue surface through the first
distal-tip electrode and the second distal-tip electrode.
10. The electrosurgical instrument of claim 1, wherein the second
jaw comprises a dissection electrode extending along a peripheral
surface of the second jaw.
11. An electrosurgical instrument, comprising: an end effector,
comprising: at least two electrode sets; a first jaw; and a second
jaw, wherein at least one of the first jaw and the second jaw is
movable to transition the end effector from an open configuration
to a closed configuration to grasp tissue therebetween, and wherein
the end effector is configured to deliver a combination of bipolar
RF energy and monopolar RF energy to the grasped tissue from the at
least two electrode sets; and an electrical circuit configured to
transmit the bipolar RF energy and the monopolar RF energy, wherein
the monopolar RF energy shares an active pathway and a return
pathway defined by the electrical circuit for transmission of the
bipolar RF energy.
12. The electrosurgical instrument of claim 11, wherein the at
least two electrodes sets comprise three electrical
interconnections that are used together in the electrical
circuit.
13. The electrosurgical instrument of claim 11, wherein the at
least two electrodes sets comprise three electrical
interconnections that define at least a portion of the electrical
circuit and another separate electrical circuit.
14. The electrosurgical instrument of claim 13, wherein the
separate electrical circuit leads to a cutting electrode of the at
least two electrode sets that is isolated and centrally located in
one of the first jaw and the second jaw.
15. The electrosurgical instrument of claim 14, wherein the cutting
electrode is configured to cut the tissue after coagulation of the
tissue has commenced using second and third electrodes of the at
least two electrode sets.
16. The electrosurgical instrument of claim 15, wherein the at
least two electrode sets are configured to simultaneously deliver
the monopolar RF energy and the bipolar RF energy to the
tissue.
17. An electrosurgical instrument, comprising: an end effector,
comprising: a first jaw; and a second jaw, wherein at least one of
the first jaw and the second jaw is movable to transition the end
effector from an open configuration to a closed configuration to
grasp tissue therebetween, and wherein the second jaw comprises a
composite skeleton of at least two different materials that are
configured to selectively yield electrically conductive portions
and thermally insulted portions.
18. The electrosurgical instrument of claim 17, wherein the
composite skeleton comprises a titanium ceramic-composite.
19. The electrosurgical instrument of claim 18, wherein the
composite skeleton comprises: a ceramic base; and a titanium crown
attachable to the ceramic base.
20. The electrosurgical instrument of claim 17, wherein the
composite skeleton is partially coated with an electrically
insulative material.
21. A method for manufacturing a jaw of an end effector of an
electrosurgical instrument, the method comprising: preparing a
composite skeleton of the jaw by fusing a titanium powder with a
ceramic powder in a metal injection molding process; and
selectively coating the composite skeleton with an electrically
insulative material to yield a plurality of electrodes.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This non-provisional application claims the benefit under 35
U.S.C. .sctn. 119(e) of U.S. Provisional Patent Application Ser.
No. 62/955,299, entitled DEVICES AND SYSTEMS FOR ELECTROSURGERY,
filed Dec. 30, 2019, the disclosure of which is incorporated by
reference herein in its entirety.
BACKGROUND
[0002] The present invention relates to surgical instruments
designed to treat tissue, including but not limited to surgical
instruments that are configured to cut and fasten tissue. The
surgical instruments may include electrosurgical instruments
powered by generators to effect tissue dissecting, cutting, and/or
coagulation during surgical procedures. The surgical instruments
may include instruments that are configured to cut and staple
tissue using surgical staples and/or fasteners. The surgical
instruments may be configured for use in open surgical procedures,
but have applications in other types of surgery, such as
laparoscopic, endoscopic, and robotic-assisted procedures and may
include end effectors that are articulatable relative to a shaft
portion of the instrument to facilitate precise positioning within
a patient.
SUMMARY
[0003] In various embodiments, an electrosurgical instrument
comprising an end effector is disclosed. The end effector comprises
a first jaw, a second jaw, and an electrical circuit. The first jaw
comprises a first electrically conductive skeleton, a first
insulative coating selectively covering portions of the first
electrically conductive skeleton, and first-jaw electrodes
comprising exposed portions of the first electrically conductive
skeleton. At least one of the first jaw and the second jaw is
movable to transition the end effector from an open configuration
to a closed configuration to grasp tissue therebetween. The second
jaw comprises a second electrically conductive skeleton, a second
insulative coating selectively covering portions of the second
electrically conductive skeleton, and second-jaw electrodes
comprising exposed portions of the second electrically conductive
skeleton. The electrical circuit is configured to transmit a
bipolar RF energy and a monopolar RF energy to the tissue through
the first-jaw electrodes and the second-jaw electrodes. The
monopolar RF energy shares a first electrical pathway and a second
electrical pathway defined by the electrical circuit for
transmission of the bipolar RF energy.
[0004] In various embodiments, an electrosurgical instrument
comprising an end effector and an electrical circuit is disclosed.
The end effector comprises at least two electrode sets, a first
jaw, and a second jaw. At least one of the first jaw and the second
jaw is movable to transition the end effector from an open
configuration to a closed configuration to grasp tissue
therebetween. The end effector is configured to deliver a
combination of bipolar RF energy and monopolar RF energy to the
grasped tissue from the at least two electrode sets. The electrical
circuit is configured to transmit the bipolar RF energy and the
monopolar RF energy. The monopolar RF energy shares an active
pathway and a return pathway defined by the electrical circuit for
transmission of the bipolar RF energy.
[0005] In various embodiments, an electrosurgical instrument
comprising an end effector is disclosed. The end effector comprises
a first jaw and a second jaw. At least one of the first jaw and the
second jaw is movable to transition the end effector from an open
configuration to a closed configuration to grasp tissue
therebetween. The second jaw comprises a composite skeleton of at
least two different materials that are configured to selectively
yield electrically conductive portions and thermally insulted
portions.
[0006] In various embodiments, a method for manufacturing a jaw of
an end effector of an electrosurgical instrument is disclosed. The
method comprises preparing a composite skeleton of the jaw by
fusing a titanium powder with a ceramic powder in a metal injection
molding process and selectively coating the composite skeleton with
an electrically insulative material to yield a plurality of
electrodes.
DRAWINGS
[0007] The novel features of the various aspects are set forth with
particularity in the appended claims. The described aspects,
however, both as to organization and methods of operation, may be
best understood by reference to the following description, taken in
conjunction with the accompanying drawings in which:
[0008] FIG. 1 illustrates an example of a generator for use with a
surgical system, in accordance with at least one aspect of the
present disclosure;
[0009] FIG. 2 illustrates one form of a surgical system comprising
a generator and an electrosurgical instrument usable therewith, in
accordance with at least one aspect of the present disclosure;
[0010] FIG. 3 illustrates a schematic diagram of a surgical
instrument or tool, in accordance with at least one aspect of the
present disclosure;
[0011] FIG. 4 is an exploded view of an end effector of an electro
surgical instrument, in accordance with at least one aspect of the
present disclosure;
[0012] FIG. 5 is a cross-sectional view of the of the end effector
of FIG. 4;
[0013] FIGS. 6-8 depict three different operational modes of the
end effector of FIG. 4 prior to energy application to tissue;
[0014] FIGS. 9-11 depict three different operational modes of the
end effector of FIG. 4 during energy application to tissue;
[0015] FIG. 12 illustrates a method of manufacturing a jaw of an
end effector, in accordance with at least one aspect of the present
disclosure;
[0016] FIG. 13 illustrates a method of manufacturing a jaw of an
end effector, in accordance with at least one aspect of the present
disclosure;
[0017] FIG. 14 illustrates a partial perspective view of a jaw of
an end effector of an electrosurgical instrument, in accordance
with at least one aspect of the present disclosure;
[0018] FIG. 15 illustrates steps of a process of manufacturing the
jaw of FIG. 14;
[0019] FIG. 16 illustrates steps of a process of manufacturing the
jaw of FIG. 14;
[0020] FIGS. 17-19 illustrates steps of a process of manufacturing
the jaw of FIG. 14;
[0021] FIG. 20 illustrates a cross-sectional view of a jaw of an
end effector of an electrosurgical instrument taken through line
20-20 in FIG. 22, in accordance with at least one aspect of the
present disclosure;
[0022] FIG. 21 illustrates a cross-sectional view of the jaw of the
end effector of the electrosurgical instrument taken through line
21-21 in FIG. 22;
[0023] FIG. 22 illustrates a perspective view of the jaw of the end
effector of the electrosurgical instrument of FIG. 20;
[0024] FIG. 23 illustrates a cross-sectional view of a jaw of an
end effector of an electrosurgical instrument, in accordance with
at least one aspect of the present disclosure;
[0025] FIG. 24 illustrates a partial perspective view of a jaw of
an end effector of an electrosurgical instrument, in accordance
with at least one aspect of the present disclosure;
[0026] FIG. 25 illustrates a cross-sectional view of an end
effector of an electrosurgical instrument, in accordance with at
least one aspect of the present disclosure;
[0027] FIG. 26 illustrates a partial exploded view of an end
effector of an electrosurgical instrument, in accordance with at
least one aspect of the present disclosure;
[0028] FIG. 27 illustrates an exploded perspective assembly view of
a portion of an electrosurgical instrument including an electrical
connection assembly, in accordance with at least one aspect of the
present disclosure;
[0029] FIG. 28 illustrates a top view of electrical pathways
defined in the surgical instrument portion of FIG. 27, in
accordance with at least one aspect of the present disclosure;
[0030] FIG. 29 illustrates a cross-sectional view of a flex
circuit, in accordance with at least one aspect of the present
disclosure;
[0031] FIG. 30 illustrates a cross-sectional view of a flex circuit
extending through a coil tube, in accordance with at least one
aspect of the present disclosure;
[0032] FIG. 31 illustrates a cross-sectional view of a flex circuit
extending through a coil tube, in accordance with at least one
aspect of the present disclosure;
[0033] FIG. 32 illustrates a cross-sectional view of a flex circuit
extending through a coil tube, in accordance with at least one
aspect of the present disclosure;
[0034] FIG. 33 illustrates a cross-sectional view of a flex circuit
extending through a coil tube, in accordance with at least one
aspect of the present disclosure;
[0035] FIG. 34 is a graph illustrating a power scheme for
coagulating and cutting a tissue treatment region in a treatment
cycle applied by an end effector, in accordance with at least one
aspect of the present disclosure;
[0036] FIG. 35 is a graph illustrating a power scheme for
coagulating and cutting a tissue treatment region in a treatment
cycle applied by an end effector and a number of measured
parameters of the end effector and the tissue, in accordance with
at least one aspect of the present disclosure;
[0037] FIG. 36 is a schematic diagram of an electrosurgical system,
in accordance with at least one aspect of the present
disclosure;
[0038] FIG. 37 is a table illustrating a power scheme for
coagulating and cutting a tissue treatment region in a treatment
cycle applied by an end effector, in accordance with at least one
aspect of the present disclosure;
[0039] FIGS. 38-40 illustrate a tissue treatment cycle applied by
an end effector to a tissue treatment region, in accordance with at
least one aspect of the present disclosure;
[0040] FIG. 41 illustrates an end effector applying therapeutic
energy to a tissue grasped by the end effector, the therapeutic
energy generated by a monopolar power source and a bipolar power
source, in accordance with at least one aspect of the present
disclosure;
[0041] FIG. 42 illustrates a simplified schematic diagram of an
electrosurgical system, in accordance with at least one aspect of
the present disclosure;
[0042] FIG. 43 is a graph illustrating a power scheme for
coagulating and cutting a tissue treatment region in a treatment
cycle applied by an end effector and corresponding temperature
readings of the tissue treatment region, in accordance with at
least one aspect of the present disclosure;
[0043] FIG. 44 illustrate an end effector treating an artery, in
accordance with at least one aspect of the present disclosure;
[0044] FIG. 45 illustrate an end effector treating an artery, in
accordance with at least one aspect of the present disclosure;
[0045] FIG. 46 illustrates an end effector applying therapeutic
energy to a tissue grasped by the end effector, the therapeutic
energy generated by a monopolar power source and a bipolar power
source, in accordance with at least one aspect of the present
disclosure;
[0046] FIG. 47 illustrates a simplified schematic diagram of an
electrosurgical system, in accordance with at least one aspect of
the present disclosure;
[0047] FIG. 48 is a graph illustrating a power scheme including a
therapeutic portion for coagulating and cutting a tissue treatment
range in a treatment cycle applied by an end effector, and
non-therapeutic range, in accordance with at least one aspect of
the present disclosure; and
[0048] FIG. 49 is a graph illustrating a power scheme including for
coagulating and cutting a tissue treatment range in a treatment
cycle applied by an end effector, and corresponding monopolar and
bipolar impedances and a ratio thereof, in accordance with at least
one aspect of the present disclosure.
DESCRIPTION
[0049] Applicant of the present application owns the following U.S.
patent applications that are filed on even date herewith, and which
are each herein incorporated by reference in their respective
entireties:
[0050] Attorney Docket No. END9234USNP1/190717-1M, entitled METHOD
FOR AN ELECTROSURGICAL PROCEDURE;
[0051] Attorney Docket No. END9234USNP2/190717-2, entitled
ARTICULATABLE SURGICAL INSTRUMENT;
[0052] Attorney Docket No. END9234USNP3/190717-3, entitled SURGICAL
INSTRUMENT WITH JAW ALIGNMENT FEATURES;
[0053] Attorney Docket No. END9234USNP4/190717-4, entitled SURGICAL
INSTRUMENT WITH ROTATABLE AND ARTICULATABLE SURGICAL END
EFFECTOR;
[0054] Attorney Docket No. END9234USNP5/190717-5, entitled
ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING
ELECTRODES;
[0055] Attorney Docket No. END9234USNP6/190717-6, entitled
ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT;
[0056] Attorney Docket No. END9234USNP7/190717-7, entitled
ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES;
[0057] Attorney Docket No. END9234USNP8/190717-8, entitled
ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS;
[0058] Attorney Docket No. END9234USNP9/190717-9, entitled
ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWER
SOURCES;
[0059] Attorney Docket No. END9234USNP10/190717-10, entitled
ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING
FEATURES;
[0060] Attorney Docket No. END9234USNP11/190717-11, entitled
ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLE ENERGY
DENSITIES;
[0061] Attorney Docket No. END9234USNP13/190717-13, entitled
ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND
THERMALLY CONDUCTIVE PORTIONS;
[0062] Attorney Docket No. END9234USNP14/190717-14, entitled
ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND
MONOPOLAR MODES;
[0063] Attorney Docket No. END9234USNP15/190717-15, entitled
ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES
TO TISSUE;
[0064] Attorney Docket No. END9234USNP16/190717-16, entitled
CONTROL PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USER
INPUT;
[0065] Attorney Docket No. END9234USNP17/190717-17, entitled
CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE; and
[0066] Attorney Docket No. END9234USNP18/190717-18, entitled
SURGICAL SYSTEM COMMUNICATION PATHWAYS.
[0067] Applicant of the present application owns the following U.S.
Provisional Patent applications that were filed on Dec. 30, 2019,
the disclosure of each of which is herein incorporated by reference
in its entirety:
[0068] U.S. Provisional Patent Application Ser. No. 62/955,294,
entitled USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION
ENERGY MODALITY END-EFFECTOR;
[0069] U.S. Provisional Patent Application Ser. No. 62/955,292,
entitled COMBINATION ENERGY MODALITY END-EFFECTOR; and
[0070] U.S. Provisional Patent Application Ser. No. 62/955,306,
entitled SURGICAL INSTRUMENT SYSTEMS.
[0071] Applicant of the present application owns the following U.S.
patent applications, the disclosure of each of which is herein
incorporated by reference in its entirety:
[0072] U.S. patent application Ser. No. 16/209,395, titled METHOD
OF HUB COMMUNICATION, now U.S. Patent Application Publication No.
2019/0201136;
[0073] U.S. patent application Ser. No. 16/209,403, titled METHOD
OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB, now U.S. Patent
Application Publication No. 2019/0206569;
[0074] U.S. patent application Ser. No. 16/209,407, titled METHOD
OF ROBOTIC HUB COMMUNICATION, DETECTION, AND CONTROL, now U.S.
Patent Application Publication No. 2019/0201137;
[0075] U.S. patent application Ser. No. 16/209,416, titled METHOD
OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS, now
U.S. Patent Application Publication No. 2019/0206562;
[0076] U.S. patent application Ser. No. 16/209,423, titled METHOD
OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY
DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS, now U.S.
Patent Application Publication No. 2019/0200981;
[0077] U.S. patent application Ser. No. 16/209,427, titled METHOD
OF USING REINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO
OPTIMIZE PERFORMANCE OF RADIO FREQUENCY DEVICES, now U.S. Patent
Application Publication No. 2019/0208641;
[0078] U.S. patent application Ser. No. 16/209,433, titled METHOD
OF SENSING PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT,
ADJUSTING THE PUMP SPEED BASED ON THE SENSED INFORMATION, AND
COMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB,
now U.S. Patent Application Publication No. 2019/0201594;
[0079] U.S. patent application Ser. No. 16/209,447, titled METHOD
FOR SMOKE EVACUATION FOR SURGICAL HUB, now U.S. Patent Application
Publication No. 2019/0201045;
[0080] U.S. patent application Ser. No. 16/209,453, titled METHOD
FOR CONTROLLING SMART ENERGY DEVICES, now U.S. Patent Application
Publication No. 2019/0201046;
[0081] U.S. patent application Ser. No. 16/209,458, titled METHOD
FOR SMART ENERGY DEVICE INFRASTRUCTURE, now U.S. Patent Application
Publication No. 2019/0201047;
[0082] U.S. patent application Ser. No. 16/209,465, titled METHOD
FOR ADAPTIVE CONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND
INTERACTION, now U.S. Patent Application Publication No.
2019/0206563;
[0083] U.S. patent application Ser. No. 16/209,478, titled METHOD
FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK
CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED
SITUATION OR USAGE, now U.S. Patent Application Publication No.
2019/0104919;
[0084] U.S. patent application Ser. No. 16/209,490, titled METHOD
FOR FACILITY DATA COLLECTION AND INTERPRETATION, now U.S. Patent
Application Publication No. 2019/0206564;
[0085] U.S. patent application Ser. No. 16/209,491, titled METHOD
FOR CIRCULAR STAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON
SITUATIONAL AWARENESS, now U.S. Patent Application Publication No.
2019/0200998;
[0086] U.S. patent application Ser. No. 16/562,123, titled METHOD
FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH
MULTIPLE DEVICES;
[0087] U.S. patent application Ser. No. 16/562,135, titled METHOD
FOR CONTROLLING AN ENERGY MODULE OUTPUT;
[0088] U.S. patent application Ser. No. 16/562,144, titled METHOD
FOR CONTROLLING A MODULAR ENERGY SYSTEM USER INTERFACE; and
[0089] U.S. patent application Ser. No. 16/562,125, titled METHOD
FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL
SYSTEM.
[0090] Before explaining various aspects of an electrosurgical
system in detail, it should be noted that the illustrative examples
are not limited in application or use to the details of
construction and arrangement of parts illustrated in the
accompanying drawings and description. The illustrative examples
may be implemented or incorporated in other aspects, variations,
and modifications, and may be practiced or carried out in various
ways. Further, unless otherwise indicated, the terms and
expressions employed herein have been chosen for the purpose of
describing the illustrative examples for the convenience of the
reader and are not for the purpose of limitation thereof. Also, it
will be appreciated that one or more of the following-described
aspects, expressions of aspects, and/or examples, can be combined
with any one or more of the other following-described aspects,
expressions of aspects, and/or examples.
[0091] Various aspects are directed to electrosurgical systems that
include electrosurgical instruments powered by generators to effect
tissue dissecting, cutting, and/or coagulation during surgical
procedures. The electrosurgical instruments may be configured for
use in open surgical procedures, but has applications in other
types of surgery, such as laparoscopic, endoscopic, and
robotic-assisted procedures.
[0092] As described below in greater detail, an electrosurgical
instrument generally includes a shaft having a distally-mounted end
effector (e.g., one or more electrodes). The end effector can be
positioned against the tissue such that electrical current is
introduced into the tissue. Electrosurgical instruments can be
configured for bipolar or monopolar operation. During bipolar
operation, current is introduced into and returned from the tissue
by active and return electrodes, respectively, of the end effector.
During monopolar operation, current is introduced into the tissue
by an active electrode of the end effector and returned through a
return electrode (e.g., a grounding pad) separately located on a
patient's body. Heat generated by the current flowing through the
tissue may form hemostatic seals within the tissue and/or between
tissues and thus may be particularly useful for sealing blood
vessels, for example.
[0093] FIG. 1 illustrates an example of a generator 900 configured
to deliver multiple energy modalities to a surgical instrument. The
generator 900 provides RF and/or ultrasonic signals for delivering
energy to a surgical instrument. The generator 900 comprises at
least one generator output that can deliver multiple energy
modalities (e.g., ultrasonic, bipolar or monopolar RF, irreversible
and/or reversible electroporation, and/or microwave energy, among
others) through a single port, and these signals can be delivered
separately or simultaneously to an end effector to treat tissue.
The generator 900 comprises a processor 902 coupled to a waveform
generator 904. The processor 902 and waveform generator 904 are
configured to generate a variety of signal waveforms based on
information stored in a memory coupled to the processor 902, not
shown for clarity of disclosure. The digital information associated
with a waveform is provided to the waveform generator 904 which
includes one or more DAC circuits to convert the digital input into
an analog output. The analog output is fed to an amplifier 906 for
signal conditioning and amplification. The conditioned and
amplified output of the amplifier 906 is coupled to a power
transformer 908. The signals are coupled across the power
transformer 908 to the secondary side, which is in the patient
isolation side. A first signal of a first energy modality is
provided to the surgical instrument between the terminals labeled
ENERGY.sub.1 and RETURN. A second signal of a second energy
modality is coupled across a capacitor 910 and is provided to the
surgical instrument between the terminals labeled ENERGY.sub.2 and
RETURN. It will be appreciated that more than two energy modalities
may be output and thus the subscript "n" may be used to designate
that up to n ENERGY.sub.n terminals may be provided, where n is a
positive integer greater than 1. It also will be appreciated that
up to "n" return paths RETURN.sub.n may be provided without
departing from the scope of the present disclosure.
[0094] A first voltage sensing circuit 912 is coupled across the
terminals labeled ENERGY.sub.1 and the RETURN path to measure the
output voltage therebetween. A second voltage sensing circuit 924
is coupled across the terminals labeled ENERGY.sub.2 and the RETURN
path to measure the output voltage therebetween. A current sensing
circuit 914 is disposed in series with the RETURN leg of the
secondary side of the power transformer 908 as shown to measure the
output current for either energy modality. If different return
paths are provided for each energy modality, then a separate
current sensing circuit should be provided in each return leg. The
outputs of the first and second voltage sensing circuits 912, 924
are provided to respective isolation transformers 928, 922 and the
output of the current sensing circuit 914 is provided to another
isolation transformer 916. The outputs of the isolation
transformers 916, 928, 922 on the primary side of the power
transformer 908 (non-patient isolated side) are provided to a one
or more ADC circuit 926. The digitized output of the ADC circuit
926 is provided to the processor 902 for further processing and
computation. The output voltages and output current feedback
information can be employed to adjust the output voltage and
current provided to the surgical instrument and to compute output
impedance, among other parameters. Input/output communications
between the processor 902 and patient isolated circuits is provided
through an interface circuit 920. Sensors also may be in electrical
communication with the processor 902 by way of the interface
circuit 920.
[0095] In one aspect, the impedance may be determined by the
processor 902 by dividing the output of either the first voltage
sensing circuit 912 coupled across the terminals labeled
ENERGY.sub.1/RETURN or the second voltage sensing circuit 924
coupled across the terminals labeled ENERGY.sub.2/RETURN by the
output of the current sensing circuit 914 disposed in series with
the RETURN leg of the secondary side of the power transformer 908.
The outputs of the first and second voltage sensing circuits 912,
924 are provided to separate isolations transformers 928, 922 and
the output of the current sensing circuit 914 is provided to
another isolation transformer 916. The digitized voltage and
current sensing measurements from the ADC circuit 926 are provided
the processor 902 for computing impedance. As an example, the first
energy modality ENERGY.sub.1 may be RF monopolar energy and the
second energy modality ENERGY.sub.2 may be RF bipolar energy.
Nevertheless, in addition to bipolar and monopolar RF energy
modalities, other energy modalities include ultrasonic energy,
irreversible and/or reversible electroporation and/or microwave
energy, among others. Also, although the example illustrated in
FIG. 1 shows a single return path RETURN may be provided for two or
more energy modalities, in other aspects, multiple return paths
RETURN.sub.n may be provided for each energy modality
ENERGY.sub.n.
[0096] As shown in FIG. 1, the generator 900 comprising at least
one output port can include a power transformer 908 with a single
output and with multiple taps to provide power in the form of one
or more energy modalities, such as ultrasonic, bipolar or monopolar
RF, irreversible and/or reversible electroporation, and/or
microwave energy, among others, for example, to the end effector
depending on the type of treatment of tissue being performed. For
example, the generator 900 can deliver energy with higher voltage
and lower current to drive an ultrasonic transducer, with lower
voltage and higher current to drive RF electrodes for sealing
tissue, or with a coagulation waveform for spot coagulation using
either monopolar or bipolar RF electrosurgical electrodes. The
output waveform from the generator 900 can be steered, switched, or
filtered to provide the frequency to the end effector of the
surgical instrument. In one example, a connection of RF bipolar
electrodes to the generator 900 output would be preferably located
between the output labeled ENERGY.sub.2 and RETURN. In the case of
monopolar output, the preferred connections would be active
electrode (e.g., pencil or other probe) to the ENERGY.sub.2 output
and a suitable return pad connected to the RETURN output.
[0097] Additional details are disclosed in U.S. Patent Application
Publication No. 2017/0086914, titled TECHNIQUES FOR OPERATING
GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND
SURGICAL INSTRUMENTS, which published on Mar. 30, 2017, which is
herein incorporated by reference in its entirety.
[0098] FIG. 2 illustrates one form of a surgical system 1000
comprising a generator 1100 and various surgical instruments 1104,
1106, 1108 usable therewith, where the surgical instrument 1104 is
an ultrasonic surgical instrument, the surgical instrument 1106 is
an RF electrosurgical instrument, and the multifunction surgical
instrument 1108 is a combination ultrasonic/RF electrosurgical
instrument. The generator 1100 is configurable for use with a
variety of surgical instruments. According to various forms, the
generator 1100 may be configurable for use with different surgical
instruments of different types including, for example, ultrasonic
surgical instruments 1104, RF electrosurgical instruments 1106, and
multifunction surgical instruments 1108 that integrate RF and
ultrasonic energies delivered simultaneously from the generator
1100. Although in the form of FIG. 2 the generator 1100 is shown
separate from the surgical instruments 1104, 1106, 1108 in one
form, the generator 1100 may be formed integrally with any of the
surgical instruments 1104, 1106, 1108 to form a unitary surgical
system. The generator 1100 comprises an input device 1110 located
on a front panel of the generator 1100 console. The input device
1110 may comprise any suitable device that generates signals
suitable for programming the operation of the generator 1100. The
generator 1100 may be configured for wired or wireless
communication.
[0099] The generator 1100 is configured to drive multiple surgical
instruments 1104, 1106, 1108. The first surgical instrument is an
ultrasonic surgical instrument 1104 and comprises a handpiece 1105
(HP), an ultrasonic transducer 1120, a shaft 1126, and an end
effector 1122. The end effector 1122 comprises an ultrasonic blade
1128 acoustically coupled to the ultrasonic transducer 1120 and a
clamp arm 1140. The handpiece 1105 comprises a trigger 1143 to
operate the clamp arm 1140 and a combination of the toggle buttons
1137, 1134b, 1134c to energize and drive the ultrasonic blade 1128
or other function. The toggle buttons 1137, 1134b, 1134c can be
configured to energize the ultrasonic transducer 1120 with the
generator 1100.
[0100] The generator 1100 also is configured to drive a second
surgical instrument 1106. The second surgical instrument 1106 is an
RF electrosurgical instrument and comprises a handpiece 1107 (HP),
a shaft 1127, and an end effector 1124. The end effector 1124
comprises electrodes in clamp arms 1145, 1142b and return through
an electrical conductor portion of the shaft 1127. The electrodes
are coupled to and energized by a bipolar energy source within the
generator 1100. The handpiece 1107 comprises a trigger 1145 to
operate the clamp arms 1145, 1142b and an energy button 1135 to
actuate an energy switch to energize the electrodes in the end
effector 1124. The second surgical instrument 1106 can also be used
with a return pad to deliver monopolar energy to tissue.
[0101] The generator 1100 also is configured to drive a
multifunction surgical instrument 1108. The multifunction surgical
instrument 1108 comprises a handpiece 1109 (HP), a shaft 1129, and
an end effector 1125. The end effector 1125 comprises an ultrasonic
blade 1149 and a clamp arm 1146. The ultrasonic blade 1149 is
acoustically coupled to the ultrasonic transducer 1120. The
handpiece 1109 comprises a trigger 1147 to operate the clamp arm
1146 and a combination of the toggle buttons 11310, 1137b, 1137c to
energize and drive the ultrasonic blade 1149 or other function. The
toggle buttons 11310, 1137b, 1137c can be configured to energize
the ultrasonic transducer 1120 with the generator 1100 and energize
the ultrasonic blade 1149 with a bipolar energy source also
contained within the generator 1100. Monopolar energy can be
delivered to the tissue in combination with, or separately from,
the bipolar energy.
[0102] The generator 1100 is configurable for use with a variety of
surgical instruments. According to various forms, the generator
1100 may be configurable for use with different surgical
instruments of different types including, for example, the
ultrasonic surgical instrument 1104, the RF electrosurgical
instrument 1106, and the multifunction surgical instrument 1108
that integrates RF and ultrasonic energies delivered simultaneously
from the generator 1100. Although in the form of FIG. 2, the
generator 1100 is shown separate from the surgical instruments
1104, 1106, 1108, in another form the generator 1100 may be formed
integrally with any one of the surgical instruments 1104, 1106,
1108 to form a unitary surgical system. As discussed above, the
generator 1100 comprises an input device 1110 located on a front
panel of the generator 1100 console. The input device 1110 may
comprise any suitable device that generates signals suitable for
programming the operation of the generator 1100. The generator 1100
also may comprise one or more output devices 1112. Further aspects
of generators for digitally generating electrical signal waveforms
and surgical instruments are described in US patent application
publication US-2017-0086914-A1, which is herein incorporated by
reference in its entirety.
[0103] FIG. 3 illustrates a schematic diagram of a surgical
instrument or tool 600 comprising a plurality of motor assemblies
that can be activated to perform various functions. In the
illustrated example, a closure motor assembly 610 is operable to
transition an end effector between an open configuration and a
closed configuration, and an articulation motor assembly 620 is
operable to articulate the end effector relative to a shaft
assembly. In certain instances, the plurality of motors assemblies
can be individually activated to cause firing, closure, and/or
articulation motions in the end effector. The firing, closure,
and/or articulation motions can be transmitted to the end effector
through a shaft assembly, for example.
[0104] In certain instances, the closure motor assembly 610
includes a closure motor. The closure 603 may be operably coupled
to a closure motor drive assembly 612 which can be configured to
transmit closure motions, generated by the motor to the end
effector, in particular to displace a closure member to close to
transition the end effector to the closed configuration. The
closure motions may cause the end effector to transition from an
open configuration to a closed configuration to capture tissue, for
example. The end effector may be transitioned to an open position
by reversing the direction of the motor.
[0105] In certain instances, the articulation motor assembly 620
includes an articulation motor that be operably coupled to an
articulation drive assembly 622 which can be configured to transmit
articulation motions, generated by the motor to the end effector.
In certain instances, the articulation motions may cause the end
effector to articulate relative to the shaft, for example.
[0106] One or more of the motors of the surgical instrument 600 may
comprise a torque sensor to measure the output torque on the shaft
of the motor. The force on an end effector may be sensed in any
conventional manner, such as by force sensors on the outer sides of
the jaws or by a torque sensor for the motor actuating the
jaws.
[0107] In various instances, the motor assemblies 610, 620 include
one or more motor drivers that may comprise one or more H-Bridge
FETs. The motor drivers may modulate the power transmitted from a
power source 630 to a motor based on input from a microcontroller
640 (the "controller"), for example, of a control circuit 601. In
certain instances, the microcontroller 640 can be employed to
determine the current drawn by the motor, for example.
[0108] In certain instances, the microcontroller 640 may include a
microprocessor 642 (the "processor") and one or more non-transitory
computer-readable mediums or memory units 644 (the "memory"). In
certain instances, the memory 644 may store various program
instructions, which when executed may cause the processor 642 to
perform a plurality of functions and/or calculations described
herein. In certain instances, one or more of the memory units 644
may be coupled to the processor 642, for example. In various
aspects, the microcontroller 640 may communicate over a wired or
wireless channel, or combinations thereof.
[0109] In certain instances, the power source 630 can be employed
to supply power to the microcontroller 640, for example. In certain
instances, the power source 630 may comprise a battery (or "battery
pack" or "power pack"), such as a lithium-ion battery, for example.
In certain instances, the battery pack may be configured to be
releasably mounted to a handle for supplying power to the surgical
instrument 600. A number of battery cells connected in series may
be used as the power source 630. In certain instances, the power
source 630 may be replaceable and/or rechargeable, for example.
[0110] In various instances, the processor 642 may control a motor
driver to control the position, direction of rotation, and/or
velocity of a motor of the assemblies 610, 620. In certain
instances, the processor 642 can signal the motor driver to stop
and/or disable the motor. It should be understood that the term
"processor" as used herein includes any suitable microprocessor,
microcontroller, or other basic computing device that incorporates
the functions of a computer's central processing unit (CPU) on an
integrated circuit or, at most, a few integrated circuits. The
processor 642 is a multipurpose, programmable device that accepts
digital data as input, processes it according to instructions
stored in its memory, and provides results as output. It is an
example of sequential digital logic, as it has internal memory.
Processors operate on numbers and symbols represented in the binary
numeral system.
[0111] In one instance, the processor 642 may be any single-core or
multicore processor such as those known under the trade name ARM
Cortex by Texas Instruments. In certain instances, the
microcontroller 620 may be an LM 4F230H5QR, available from Texas
Instruments, for example. In at least one example, the Texas
Instruments LM4F230H5QR is an ARM Cortex-M4F Processor Core
comprising an on-chip memory of 256 KB single-cycle flash memory,
or other non-volatile memory, up to 40 MHz, a prefetch buffer to
improve performance above 40 MHz, a 32 KB single-cycle SRAM, an
internal ROM loaded with StellarisWare.RTM. software, a 2 KB
EEPROM, one or more PWM modules, one or more QEI analogs, one or
more 12-bit ADCs with 12 analog input channels, among other
features that are readily available for the product datasheet.
Other microcontrollers may be readily substituted for use with the
surgical instrument 600. Accordingly, the present disclosure should
not be limited in this context.
[0112] In certain instances, the memory 644 may include program
instructions for controlling each of the motors of the surgical
instrument 600. For example, the memory 644 may include program
instructions for controlling the closure motor and the articulation
motor. Such program instructions may cause the processor 642 to
control the closure and articulation functions in accordance with
inputs from algorithms or control programs of the surgical
instrument 600.
[0113] In certain instances, one or more mechanisms and/or sensors
such as, for example, sensors 645 can be employed to alert the
processor 642 to the program instructions that should be used in a
particular setting. For example, the sensors 645 may alert the
processor 642 to use the program instructions associated with
closing and articulating the end effector. In certain instances,
the sensors 645 may comprise position sensors which can be employed
to sense the position of a closure actuator, for example.
Accordingly, the processor 642 may use the program instructions
associated with closing the end effector to activate the motor of
the closure drive assembly 620 if the processor 642 receives a
signal from the sensors 630 indicative of actuation of the closure
actuator.
[0114] In some examples, the motors may be brushless DC electric
motors, and the respective motor drive signals may comprise a PWM
signal provided to one or more stator windings of the motors. Also,
in some examples, the motor drivers may be omitted and the control
circuit 601 may generate the motor drive signals directly.
[0115] It is common practice during various laparoscopic surgical
procedures to insert a surgical end effector portion of a surgical
instrument through a trocar that has been installed in the
abdominal wall of a patient to access a surgical site located
inside the patient's abdomen. In its simplest form, a trocar is a
pen-shaped instrument with a sharp triangular point at one end that
is typically used inside a hollow tube, known as a cannula or
sleeve, to create an opening into the body through which surgical
end effectors may be introduced. Such arrangement forms an access
port into the body cavity through which surgical end effectors may
be inserted. The inner diameter of the trocar's cannula necessarily
limits the size of the end effector and drive-supporting shaft of
the surgical instrument that may be inserted through the
trocar.
[0116] Regardless of the specific type of surgical procedure being
performed, once the surgical end effector has been inserted into
the patient through the trocar cannula, it is often necessary to
move the surgical end effector relative to the shaft assembly that
is positioned within the trocar cannula in order to properly
position the surgical end effector relative to the tissue or organ
to be treated. This movement or positioning of the surgical end
effector relative to the portion of the shaft that remains within
the trocar cannula is often referred to as "articulation" of the
surgical end effector. A variety of articulation joints have been
developed to attach a surgical end effector to an associated shaft
in order to facilitate such articulation of the surgical end
effector. As one might expect, in many surgical procedures, it is
desirable to employ a surgical end effector that has as large a
range of articulation as possible.
[0117] Due to the size constraints imposed by the size of the
trocar cannula, the articulation joint components must be sized so
as to be freely insertable through the trocar cannula. These size
constraints also limit the size and composition of various drive
members and components that operably interface with the motors
and/or other control systems that are supported in a housing that
may be handheld or comprise a portion of a larger automated system.
In many instances, these drive members must operably pass through
the articulation joint to be operably coupled to or operably
interface with the surgical end effector. For example, one such
drive member is commonly employed to apply articulation control
motions to the surgical end effector. During use, the articulation
drive member may be unactuated to position the surgical end
effector in an unarticulated position to facilitate insertion of
the surgical end effector through the trocar and then be actuated
to articulate the surgical end effector to a desired position once
the surgical end effector has entered the patient.
[0118] Thus, the aforementioned size constraints form many
challenges to developing an articulation system that can effectuate
a desired range of articulation, yet accommodate a variety of
different drive systems that are necessary to operate various
features of the surgical end effector. Further, once the surgical
end effector has been positioned in a desired articulated position,
the articulation system and articulation joint must be able to
retain the surgical end effector in that position during the
actuation of the end effector and completion of the surgical
procedure. Such articulation joint arrangements must also be able
to withstand external forces that are experienced by the end
effector during use.
[0119] Various modes of one or more surgical devices are often used
throughout a particular surgical procedure. Communication pathways
extending between the surgical devices and a centralized surgical
hub can promote efficiency and increase success of the surgical
procedure, for example. In various instances, each surgical device
within a surgical system comprises a display, wherein the display
communicates a presence and/or an operating status of other
surgical devices within the surgical system. The surgical hub can
use the information received through the communication pathways to
assess compatibility of the surgical devices for use with one
another, assess compatibility of the surgical devices for use
during a particular surgical procedure, and/or optimize operating
parameters of the surgical devices. As described in greater detail
herein, the operating parameters of the one or more surgical
devices can be optimized based on patient demographics, a
particular surgical procedure, and/or detected environmental
conditions such as tissue thickness, for example.
[0120] FIGS. 4 and 5 illustrate an exploded view (FIG. 4) and a
cross-sectional view (FIG. 5) of an end effector 1200 of an
electrosurgical instrument (e.g. surgical instruments described in
U.S. Patent Application Attorney Docket No. END9234USNP2/190717-2).
For example, the end effector 1200 can be, actuated, articulated,
and/or rotated with respect to a shaft assembly of a surgical
instrument in a similar manner to end effectors described in U.S.
Patent Application Attorney Docket No. END9234USNP2/190717-2.
Additionally, the end effectors 1200 and other similar end
effectors, which are described elsewhere herein, can be powered by
one or more generators of a surgical system. Example surgical
systems for use with the surgical instrument are described in U.S.
application Ser. No. 16/562,123, filed Sep. 5, 2019, and titled
METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM
WITH MULTIPLE DEVICES, which is hereby incorporated herein in its
entirety.
[0121] Referring to FIGS. 6-8, the end effector 1200 includes a
first jaw 1250 and a second jaw 1270. At least one of the first jaw
1250 and the second jaw 1270 is pivotable toward and away from the
other jaw to transition the end effector 1200 between an open
configuration and a closed configuration. The jaws 1250, 1270 are
configured to grasp tissue therebetween to apply at least one of a
therapeutic energy and a non-therapeutic energy to the tissue.
Energy delivery to the tissue grasped by the jaws 1250, 1270 of the
end effector 1200 is achieved by electrodes 1252, 1272, 1274, which
are configured to deliver the energy in a monopolar mode, bipolar
mode, and/or a combination mode with alternating or blended bipolar
and monopolar energies. The different energy modalities that can be
delivered to the tissue by the end effector 1200 are described in
greater detail elsewhere in the present disclosure.
[0122] In addition to the electrodes 1252, 1272, 1274, a patient
return pad is employed with the application of monopolar energy.
Furthermore, the bipolar and monopolar energies are delivered using
electrically isolated generators. During use, the patient return
pad can detect unexpected power crossover by monitoring power
transmission to the return pad via one or more suitable sensors on
the return pad. The unexpected power crossover can occur where the
bipolar and monopolar energy modalities are used simultaneously. In
at least one example, the bipolar mode uses a higher current (e.g.
2-3 amp) than the monopolar mode (e.g. 1 amp). In at least one
example, the return pad includes a control circuit and at least one
sensor (e.g. current sensor) coupled thereto. In use, the control
circuit can receive an input indicative of an unexpected power
crossover based on measurements of the at least one sensor. In
response, the control circuit may employ a feedback system to issue
an alert and/or pause application of one or both of the bipolar and
monopolar energy modalities to tissue.
[0123] Further to the above, the jaws 1250, 1270 of the end
effector 1200 comprise angular profiles where a plurality of angles
are defined between discrete portions of each of the jaws 1250,
1270. For example, a first angle is defined by portions 1250a,
1250b (FIG. 4), and a second angle is defined by portions 1250b,
1250c of the first jaw 1250. Similarly, a first angle is defined by
portions 1270a, 1270b, and a second angle is defined by portions
1270b, 1270c of the second jaw 1270. In various aspects, the
discrete portions of the jaws 1250, 1270 are linear segments.
Consecutive linear segments intersect at angles such as, for
example, the first angle, or the second angle. The linear segments
cooperate to form a generally angular profile of each of the jaws
1250, 1270. The angular profile is general bent away from a central
axis.
[0124] In one example, the first angles and the second angles are
the same, or at least substantially the same. In another example,
the first angles and the second angles are different. In another
example, the first angle and the second angle comprise values
selected from a range of about 120.degree. to about 175.degree.. In
yet another example, the first angle and the second angle comprise
values selected from a range of about 130.degree. to about
170.degree..
[0125] Furthermore, the portions 1250a, 1270a, which are proximal
portions, are larger than the portions 1250b, 1270b, which are
intermediate portions. Similarly, the intermediate portions 1250b,
1270b are larger than the portions 1250c, 1270c. In other examples,
the distal portions can be larger than the intermediate and/or
proximal portions. In other examples, the intermediate portions are
larger than the proximal and/or distal portions.
[0126] Further to the above, the electrodes 1252, 1272, 1274 of the
jaws 1250, 1270 comprise angular profiles that are similar to the
angular profiles of the jaws 1250, 1270. In the example of FIGS. 4,
5, the electrodes 1252, 1272, 1274 include discrete segments 1252a,
1252b, 1252c, 1272a, 1272b, 1272c, 1274a, 1274b, 1274c,
respectively, which define first and second angles at their
respective intersections, as described above.
[0127] When in the closed configuration, the jaws 1250, 1270
cooperate to define a tip electrode 1260 formed of electrode
portions 1261, 1262 at the distal ends of the jaws 1250, 1270,
respectively. The tip electrode 1260 can be energized to deliver
monopolar energy to tissue in contact therewith. Both of the
electrode portions 1261, 1262 can be activated simultaneously to
deliver the monopolar energy, as illustrated in FIG. 6 or,
alternatively, only one of the electrode portions 1261, 1262 can be
selectively activated to deliver the monopolar energy on one side
of the distal tip electrode 1260, as illustrated in FIG. 10, for
example.
[0128] The angular profiles of the jaws 1250, 1270 cause the tip
electrode 1260 to be on one side of a plane extending laterally
between the proximal portion 1252c and the proximal portion 1272c
in the closed configuration. The angular profiles may also cause
the intersections between portions 1252b, 1252c, portions, 1272b,
1272c, and portions 1274b, 1274c to be on the same side of the
plane as the tip electrode 1260.
[0129] In at least one example, the jaws 1250, 1270 include
conductive skeletons 1253, 1273, which can be comprised, or at
least partially comprised, of a conductive material such as, for
example, Titanium. The skeletons 1253, 1273 can be comprised of
other conductive materials such as, for example, Aluminum. In at
least one example, the skeletons 1253, 1273 are prepared by
injection molding. In various examples, the skeletons 1253, 1273
are selectively coated/covered with an insulative material to
prevent thermal conduction and electrical conduction in all but
predefined thin energizable zones forming the electrodes 1252,
1272, 1274, 1260. The skeletons 1253, 1273 act as electrodes with
electron focusing where the jaws 1250, 1270 have built-in isolation
from one jaw to the other. The insulative material can be an
insulative polymer such as, for example, PolyTetraFluoroEthylene
(e.g. Teflon.RTM.). The energizable zones that are defined by the
electrodes 1252, 1272 are on the inside of the jaws 1250, 1270, and
are operable independently in a bipolar mode to deliver energy to
tissue grasped between the jaws 1250, 1270. Meanwhile, the
energizable zones that are defined by the electrode tip 1260 and
the electrode 1274 are on the outside of the jaws 1250, 1270, and
are operable to deliver energy to tissue adjacent an external
surface of the end effector 1200 in a monopolar mode. Both of the
jaws 1250, 1270 can be energized to deliver the energy in the
monopolar mode.
[0130] In various aspects, the coating 1264 is a high temperature
PolyTetraFluoroEthylene (e.g. Teflon.RTM.) coating that is
selectively applied to a conductive skeleton yielding selective
exposed metallic internal portions that define a three-dimensional
geometric electron modulation (GEM) for a focused dissection and
coagulation. In at least one example, the coating 1264 comprises a
thickness of about 0.003 inches, about 0.0035 inches, or about
0.0025 inches. In various examples, the thickness of the coating
1264 can be any value selected from a range of about 0.002 inches
to about 0.004 inches, a range of about 0.0025 inches to about
0.0035 inches, or a range of about 0.0027 inches to about 0.0033
inches. Other thicknesses for the coating 1263 that are capable of
three-dimensional geometric electron modulation (GEM) are
contemplated by the present disclosure.
[0131] The electrodes 1252, 1272, which cooperate to transmit
bipolar energy through the tissue, are offset to prevent circuit
shorting. As energy flows between the offset electrodes 1252, 1272,
the tissue-grasped therebetween is heated generating a seal at the
area between electrodes 1252, 1272. Meanwhile, regions of the jaws
1250, 1270 surrounding the electrodes 1252, 1272 provide
non-conductive tissue contact surfaces owing to an insulative
coating 1264 selectively deposited onto the jaws 1250, 1270 on such
regions but not the electrodes 1252, 1272. Accordingly, the
electrodes 1252, 1272 are defined by regions of the metallic jaws
1250, 1270, which remain exposed following application of the
insulative coating 1264 to the jaws 1250, 1270. While the jaws
1250, 1270 are generally formed of electrically conductive material
in this example, the non-conductive regions are defined by the
electrically insulative coating 1264.
[0132] FIG. 6 illustrates an application of a bipolar energy mode
to tissue grasped between the jaws 1250, 1270. In the bipolar
energy mode, RF energy flows through the tissue along a path 1271
that is oblique relative to a curved plane (CL) extending
centrally, and longitudinally bisecting, the jaws 1250, 1270 such
that the electrodes 1252, 1272 are on opposite sides of the curved
plane (CL). In other words, the region of tissue that actually
receives bipolar RF energy will only be the tissue that is
contacting and extending between the electrodes 1252, 1257. Thus,
the tissue grasped by the jaws 1250, 1270 will not receive RF
energy across the entire lateral width of jaws 1250, 1270. This
configuration may thus minimize the thermal spread of heat caused
by the application of bipolar RF energy to the tissue. Such
minimization of thermal spread may in turn minimize potential
collateral damage to tissue that is adjacent to the particular
tissue region that the surgeon wishes to weld/seal/coagulate and/or
cut.
[0133] In at least one example, a lateral gap is defined between
the offset electrodes 1252, 1272 in a closed configuration without
tissue therebetween. In at least one example, the lateral gap is
defined between the offset electrodes 1252, 1272 in the closed
configuration by any distance selected from a range of about 0.01
inch to about 0.025 inch, a range of about 0.015 inch to about
0.020 inch, or a range of about 0.016 inch to about 0.019 inch. In
at least one example, the lateral gap is defined by a distance of
about 0.017 inch.
[0134] In the example illustrated in FIGS. 4 and 5, the electrodes
1252, 1272, 1274 comprise gradually narrowing widths as each of the
electrodes 1252, 1272, 1274 extends from a proximal end to a distal
end. Consequently, the proximal segments 1252a, 1272a, 1274a
comprise surface areas that are greater than the intermediate
portions 1252b, 1272b, 1274b, respectively. Also, the intermediate
segments 1252b, 1272b, 1274b comprise surfaces that are greater
than the distal segments 1252c, 1272c, 1274c.
[0135] The angular and narrowing profiles of the jaws 1250, 1270
gives the end effector 1200 a bent finger-like shape or an angular
hook shape in the closed configuration. This shape permits accurate
delivery of energy to a small portion of the tissue using the tip
electrode 1260 (FIG. 10) by orienting the end effector 1200 such
that the electrode tip 1260 is pointed down toward the tissue. In
such orientation, only the electrode tip 1260 is in contact with
the tissue, which focuses the energy delivery to the tissue.
[0136] Furthermore, as illustrated in FIG. 8, the electrode 1274
extends on an outer surface on a peripheral side 1275 of the second
jaw 1270, which affords it the ability effectively separate tissue
in contact therewith while the end effector 1200 is in the closed
configuration. To separate the tissue, the end effector 1200 is
positioned, at least partially, on the peripheral side 1275 that
includes the electrode 1274. Activation of the monopolar energy
mode through the jaw 1270 cause monopolar energy to flow through
the electrode 1274 into the tissue in contact therewith.
[0137] FIGS. 9-11 illustrate an end effector 1200' in use to
deliver bipolar energy to tissue through electrodes 1252', 1272'
(FIG. 9) in a bipolar energy mode of operation, to deliver
monopolar energy to tissue through the electrode tip 1261 in a
first monopolar mode of operation, and/or to deliver monopolar
energy to tissue through the external electrode 1274 in a second
monopolar mode of operation. The end effector 1200' is similar in
many respects to the end effector 1200. Accordingly, various
features of the end effector 1200' that are previously described
with respect to the end effector 1200 are not repeated herein in
the same level of detail for brevity.
[0138] The electrodes 1252', 1272' are different from the
electrodes 1252'', 1272'' in that they define stepped, or uneven,
tissue contacting surfaces 1257, 1277. Electrically conductive
skeletons 1253', 1273' of the jaws 1250', 1270' include bulging, or
protruding, portions that form the conductive tissue contacting
surfaces of the electrodes 1252', 1272'. The coating 1264 partially
wraps around the bulging, or protruding portions, that form the
electrodes 1252', 1272', only leaving exposed the conductive tissue
contacting surfaces of the electrodes 1252', 1272'. Accordingly, in
the example illustrated in FIG. 9, each of the tissue-contacting
surfaces 1257, 1277 includes a step comprising a conductive
tissue-contacting surface positioned between two insulative
tissue-contacting surfaces that gradually descend the step. Said
another way, each of the tissue-contacting surfaces 1257, 1277
includes a first partially conductive tissue-contacting surface and
a second insulative tissue-contacting surface stepped down with
respect to the first partially conductive tissue-contacting
surface. Methods for forming the electrodes 1252', 1272' are later
described in connection with FIG. 12.
[0139] Furthermore, in a closed configuration without tissue
therebetween, the offset electrodes 1252', 1272' overlap defining a
gap between opposing insulative outer surfaces of the jaws 1250',
1270'. Accordingly, this configuration provides electrode surfaces
that are both vertically offset from each other and laterally
offset from each other when jaws 1250', 1270' are closed. In one
example, the gap is about 0.01 inch to about 0.025 inch. In
addition, while overlapping, the electrodes 1252', 1272' are spaced
apart by a lateral gap. To prevent circuit shorting, the lateral
gap is less than or equal to a predetermined threshold. In one
example, the predetermined threshold is selected from a range of
0.006 inch to 0.008 inch. In one example, the predetermined
threshold is about 0.006 inch.
[0140] Referring again to FIGS. 7, 10, the tip electrode 1260 is
defined by uncoated electrode portions 1261, 1262 that are directly
preceded by proximal coated portions that are circumferentially
coated to allow for tip coagulation and otomy creation from either
or both jaws 1250, 1270. In certain examples, the electrode
portions 1261, 1262 are covered by spring-biased, or compliant,
insulative housings that allow the electrode portions 1261, 1262 to
be exposed only when the distal end of the end effector 1200 is
pressed against the tissue to be treated.
[0141] Additionally, the segments 1274a, 1274b, 1274c define an
angular profile extending along the peripheral side 1275 of the jaw
1270. The segments 1274a, 1274b, 1274c are defined by uncoated
linear portions protruding from an angular body of the skeleton
1273 on the peripheral side 1275. The segments 1274a, 1274b, 1274c
comprise outer surfaces that are flush with an outer surface of the
coating 1264 defined on the peripheral side 1275. In various
examples, a horizontal plane extends through the segments 1274a,
1274b, 1274c. The angular profile of the electrode 1274 is defined
in the horizontal plane such that the electrode 1274 does not
extend more than 45 degrees off a curvature centerline to prevent
unintended lateral thermal damage while using the electrode 1274 to
dissect or separate tissue.
[0142] FIG. 14 illustrates a jaw 6270 for use with an end effector
(e.g. 1200) of an electrosurgical instrument (e.g. electrosurgical
instrument 1106) to treat tissue using RF energy. Further, the jaw
6270 is electrically couplable to a generator (e.g. generator
1100), and is energizable by the generator to deliver a monopolar
RF energy to the tissue and/or cooperate with another jaw of the
end effector to deliver a bipolar RF energy to the tissue. In
addition, the jaw 6270 is similar in many respects to the jaws
1250, 1270. For example, the jaw 6270 comprises an angular profile
that is similar to the angular profile of the jaw 1270. In
addition, the jaw 6270 presents a thermal mitigation improvement
that can be applied to one or both of the jaws 1250, 1270.
[0143] In use, jaws of an end effector of an electrosurgical
instrument are subjected to a thermal load that can interfere with
the performance of their electrode(s). To minimize the thermal load
interference without negatively affecting the electrode(s) tissue
treatment capabilities, the jaw 6270 includes an electrically
conductive skeleton 6273 that has a thermally insulative portion
and a thermally conductive portion integral with the thermally
insulative portion. The thermally conductive portion defines a heat
sink and the thermally insulative portion resists heat transfer. In
certain examples, the thermally insulative portion includes inner
gaps, voids, or pockets that effectively isolate the thermal mass
of the outer surfaces of the jaw 6270 that are directly in contact
with the tissue without compromising the electrical conductivity of
the jaw 6270.
[0144] In the illustrated example, the thermally conductive portion
defines a conductive outer layer 6269 that surrounds, or at least
partially surrounds, an inner conductive core. In at least one
example, the inner conductive core comprises gap-setting members,
which can be in the form of pillars, columns, and/or walls
extending between opposite sides of the outer layer 6269 with gaps,
voids, or pockets extending between the gap setting members.
[0145] In at least one example, the gap-setting members form
honeycomb-like lattice structures 6267 to provide directional force
capabilities as the jaws (i.e. the jaw 6270 and another jaw of the
end effector) are transitioned into a closed configuration to grasp
tissue therebetween (similar to the jaws 1250, 1270 of FIG. 6). The
directional force can be accomplished by aligning the lattices 6267
in a direction that intersects the tissue-contacting surface of the
jaw 6270 such that their honeycomb walls 6268 are positioned
perpendicularly with respect to the tissue-contacting surface.
[0146] Alternatively, or additionally, the conductive inner core of
jaw 6270 may include micro pockets of air, which could be more
homogeneously distributed and shaped with no predefined
organization relative to exterior shape of the jaw to create a more
homogeneous stress-strain distribution within the jaw. In various
aspects, the electrically conductive skeleton 6273 can be prepared
by three-dimensional printing, and may include three dimensionally
printed interior pockets that produce electrically conductive but
proportionally thermally insulated cores.
[0147] Referring still to FIG. 14, the electrically conductive
skeleton 6273 is connectable to an energy source (e.g. generator
1100), and comprises electrodes 6262, 6272, and 6274 that are
defined on portions of the outer layer 6273 that are selectively
not covered by the coating 1264. Accordingly, the jaw 6270
selective thermal and electrical conductivity that controls/focuses
energy interaction with tissue through the electrodes 6272, 6274,
while reducing thermal spread and thermal mass. The thermally
insulated portions of the conductive skeleton 6273 limit the
thermal load on the electrodes 6262, 6272, and 6274 during use.
[0148] Furthermore, the outer layer 6273 defines gripping features
6277 that extend on opposite sides of the electrode 6272, and are
at least partially covered by the coating 1264. The gripping
features 6277 improve the ability of the jaw 6270 to adhere to
tissue, and resist tissue slippage with respect to the jaw
6270.
[0149] In the illustrated examples, the walls 6268 extend
diagonally from a first lateral side of the jaw 6270 to a second
lateral side of the jaw 6270. The walls 6268 intersect at
structural nodes. In the illustrated example, intersecting walls
6268 define pockets 6271 that are covered from the top and/or
bottom by the outer layer 6269. Various methods for manufacturing
the jaw 6270 are described below.
[0150] FIGS. 12, 13 illustrate methods 1280, 1281 for manufacturing
jaws 1273'', 1273'''. In various examples, one more of the jaws
1250, 1270, 1250', 1270' are manufactured in accordance with the
methods 1280, 1281. The jaws 1273'', 1273''' are prepared by
applying a coating 1264 (e.g. with a thickness d) to their entire
external surfaces. Then, electrodes are defined by selectively
removing portions of the coating 1264 from desired zones to expose
the external surface of the skeletons 1273'', 1273''' at such
zones. In at least one example, selective removal of the coating
can be performed by etching (FIG. 12) or by partially cutting away
(FIG. 13) tapered portions of the skeleton 1273''' along with their
respective coating portions to form flush conductive and
non-conductive surfaces. In the example illustrated FIG. 12,
electrodes 1272'', 1274'' are formed by etching. In the example
illustrated FIG. 13, an electrode 1274''' is formed from a raised
narrow band or ridge 1274d extending alongside the skeleton
1273'''. A portion of the ridge 1274D and the coating 1264,
directly covering the ridge 1274D, are cut away yielding an
external surface of the electrode 1274''' that is flush with an
external surface of the coating 1264.
[0151] Accordingly, a jaw 1270''' manufactured by the method 1281
includes a tapered electrode 1274''' that is comprised of narrow
raised electrically conductive portion 1274e extending alongside
the skeleton 1273''', which can help focus the energy delivered
from the skeleton 1273''' to the tissue, wherein the portion 1274e
has a conductive external surface that is flush with the coating
1264.
[0152] In another manufacturing process 6200, the jaw 6270 can be
prepared as depicted in FIG. 15. The electrically conductive
skeleton 6273 is formed with narrow raised bands or ridges 6274e,
6274f that define the electrodes 6272, and 6274. In the illustrated
example, the skeleton 6273 of the jaw 6270 includes ridges 6274e,
6274f, with flat, or at least substantially flat, outer surfaces
that are configured to define the electrodes 6272, 6274. In at
least one example, the skeleton 6273 is prepared by 3D printing.
Masks 6265, 6266 are applied to the ridges 6274e, 6274f, and a
coating 1264, which is similar to the coating 1264, is applied to
the skeleton 6273. After coating, the masks 6265, 6266 are removed
exposing outer surfaces of the electrodes 6272, 6274 that are flush
with the outer surface of the coating 1264.
[0153] Referring to FIGS. 14 and 15, in various examples, the outer
layer 6269 comprises gripping features 6277 extending laterally on
one or both sides of each of the electrode 6272. The gripping
features 6277 are covered by the coating 1264. In one example, the
coating 1264 defines compressible features causing the gap between
the jaws of an end effector to vary depending on clamping loads
applied to the end effector 1200. In at least one example, the
coating 1264 on the jaws yields at least a 0.010''-0.020'' overlap
of insulation along the centerline of the jaws. The coating 1264
could be applied directly over the gripping features 6277 and/or
clamp induced jaw re-alignment features.
[0154] In various aspects, the coating 1264 may comprise coating
materials such as Titanium Nitride, Diamond-Like coating (DLC),
Chromium Nitride, Graphit iC.TM., etc. In at least one example, the
DLC is comprised of an amorphous carbon-hydrogen network with
graphite and diamond bondings between the carbon atoms. The DLC
coating 1264 can form films with low friction and high hardness
characteristics around the skeletons 1253, 1273 (FIG. 6). The DLC
coating 1264 can be doped or undoped, and is generally in the form
of amorphous carbon (a-C) or hydrogenated amorphous carbon (a-C:H)
containing a large fraction of sp3 bonds. Various surface coating
technologies can be utilized to form the DLC coating 1264 such as
the surface coating technologies developed by Oerlikon Balzers. In
at least one example, the DLC coating 1264 is generated using
Plasma-assisted Chemical Vapor Deposition (PACVD).
[0155] Referring still to FIG. 15, in use, electrical energy flows
from the electrically conductive skeleton 6269 to tissue through
the electrode 6272. The coating 1264 prevents transfer of the
electrical energy to the tissue from other regions of the outer
layer 6269 that are covered with the coating 1264. As the surface
of the electrode 6272 increases in temperature during a tissue
treatment, the thermal energy transfer from the outer layer 6269 to
the inner core of the skeleton 6273 is slowed down, or dampened,
due to the gaps, voids, or pockets defined by the walls 6268 of the
inner core.
[0156] FIG. 16 illustrates a skeleton 6290 manufactured for use
with a jaw of an end effector of an electrosurgical instrument. One
more of the skeletons 1253, 1273, 1253', 1273', 1273'', 1273''' can
comprise a material composition and/or can be manufactured in a
similar manner to the skeleton 6290. In the illustrated example,
the skeleton 6290 is comprised of at least two materials: an
electrically conductive material such as, for example, Titanium,
and a thermally insulative material such as, for example, a ceramic
material (e.g. Ceramic Oxide). The Titanium and Ceramic Oxide
combination yields jaw components with composite thermal,
mechanical, and electrical properties.
[0157] In the illustrated example, the composite skeleton 6290
comprises a ceramic base 6291 formed by three-dimensional printing,
for example. Additionally, the composite skeleton 6290 includes a
titanium crown 6292 prepared separately from the ceramic base 6291
using, for example, three-dimensional printing. The base 6291 and
the crown 6292 include complementing attachment features 6294. In
the illustrated example, the base 6291 includes posts or
projections that are received in corresponding apertures of the
crown 6292. The attachment features 6294 also control shrinking.
Additionally, or alternatively, contacting surfaces of the base
6291 and the crown 6292 include complementing surface
irregularities 6296 specifically design for a mating engagement
with one another. The surface irregularities 6296 also resist
shrinking caused by the different material compositions of the base
6291 and the crown 6292. In various examples, the composite
skeleton 6290 is selectively coated with an insulative coating 1264
leaving exposed certain portions of the crown 6292, which define
electrodes, as described above in connection with the jaws 1250,
1270, for example.
[0158] FIGS. 17 and 18 illustrate a manufacturing process for
making a skeleton 6296 for use with a jaw of an end effector of an
electrosurgical instrument. One more of the skeletons 1253, 1273,
1253', 1273', 1273'', 1273''' can comprise a material composition
and/or can be manufactured in a similar manner to the skeleton
6295. In the illustrated example, the composite skeleton 6295 is
produced by injection molding utilizing a ceramic powder 6297 and a
titanium powder 6298. The powders are fused together (FIG. 18) to
form the titanium-ceramic composite 6299 (FIG. 19). In at least one
example, a PolyTetraFluoroEthylene (e.g. Teflon.RTM.) coating can
be selectively applied to the metallic regions of the composite
skeleton 6295 for thermal insulation as well as electrical
insulation.
[0159] FIGS. 20-22 illustrate a jaw 1290 for use with an end
effector (e.g. 1200) of an electrosurgical instrument (e.g.
electrosurgical instrument 1106) to treat tissue using RF energy.
Further, the jaw 6270 is electrically couplable to a generator
(e.g. generator 1100), and is energizable by the generator to
deliver a monopolar RF energy to the tissue and/or cooperate with
another jaw of the end effector to deliver a bipolar RF energy to
the tissue. In addition, the jaw 1290 is similar in many respects
to the jaws 1250, 1270. For example, the jaw 1290 comprises an
angular profile that is similar to the angular or curved profile of
the jaw 1270.
[0160] In addition, the jaw 1290 is similar to the jaw 6270 in that
the jaw 1290 also presents a thermal mitigation improvement. Like
the jaw 6270, the jaw 1290 includes a conductive skeleton 1293 that
has a thermally insulative portion and a thermally conductive
portion integral with, or attached to, the thermally insulative
portion. The thermally conductive portion defines a heat sink and
the thermally insulative portion resists heat transfer. In certain
examples, the thermally insulative portion of the conductive
skeleton 1293 comprises a conductive inner core 1297 with inner
gaps, voids, or pockets that effectively isolate the thermal mass
of the outer surface of the jaw 1290, which defines an electrode
1294 that is directly in contact with the tissue, without
compromising the electrical conductivity of the jaw 1290. The
thermally conductive portions define a conductive outer layer 1303
that surrounds, or at least partially surrounds, the conductive
inner core 1297. In at least one example, the conductive inner core
1297 comprises gap-setting members 1299, which can be in the form
of pillars, columns, and/or walls extending between opposite sides
of the outer layer 1303 of the jaw 1290 with gaps, voids, or
pockets extending between the gap setting members.
[0161] Alternatively, or additionally, the conductive inner core
1297 may include micro pockets of air, which could be
homogeneously, or non-homogenously, distributed in the conductive
inner core 1297. The pockets can comprise predefined, or random
shapes, and can be dispersed at predetermined, or random, portions
of the conductive inner core 1297. In at least one example, the
pockets are dispersed in a manner that creates a more homogeneous
stress-strain distribution within the jaw 1290. In various aspects,
the skeleton 1293 can be prepared by three-dimensional printing,
and may include three dimensionally printed interior pockets that
produce electrically conductive but proportionally thermally
insulated cores.
[0162] Accordingly, the jaw 1290 comprises selective thermal and
electrical conductivity that controls/focuses the energy
interaction with tissue, while reducing thermal spread and thermal
mass. The thermally insulated portions of the conductive skeleton
1293 limit the thermal load on the electrodes of the jaw 1290
during use.
[0163] FIG. 22 illustrates an expanded portion of a
tissue-contacting surface 1291 of the jaw 1290. In various aspects,
the outer layer 1303 of the skeleton 1293 is selectively
coated/covered with a first insulative layer 1264 comprising a
first material such as, for example, DLC. In the illustrated
example, the DLC coating causes the tissue-contacting surface 1291
to be electrically insulated except an intermediate area extending
along a length of the tissue-contacting surface 1291, which defines
the electrode 1294. In at least one example, the DLC coating
extends around the skeleton 1293 covering the jaw 1290 up to
perimeters defined on opposite sides 1294', 1294'' of the electrode
1294. Conductive zones 1294a, 1294b, 1294c remain exposed, and
alternate with insulative zones 1298 along a length of the
electrode 1294. In various aspects, the insulative zones 1298
comprise a high temperature PolyTetraFluoroEthylene (e.g.
Teflon.RTM.). Since the DLC coating is thermally conductive, only
the portions of the tissue-contacting surface 1291 that comprise
the insulative regions 1298 are thermally insulated. The portions
of the issue-contacting surface 1291 that are covered with the DLC
coating and the thin conductive energizable zones 1294a, 1294b,
1294c are thermally conductive. Further, only the thin conductive
energizable zones 1294a, 1294b, 1294c are electrically conductive.
The remaining portions of the tissue-contacting surface 1291, which
are covered with either the DLC coating or the
PolyTetraFluoroEthylene (e.g. Teflon.RTM.), are electrically
insulated.
[0164] The conductive zones 1294a, 1294b, 1294c define energy
concentration locations along the jaw 1290 based on the geometry of
the zones 1294a, 1294b, 1294c. Further, the size, shape, and
arrangement of the conductive zones 1294a, 1294b, 1294c and
insulative zones 1298 causes coagulation energy transmitted through
the electrode 1294 to be directed into the tissue in predefined
treatment regions thereby preventing parasitic leaching of both the
energy and heat from the treatment regions. Furthermore, the
thermally insulative conductive inner core 1297 resists heat
transfer to portions of the jaw 1290 that do not form treatment
regions, which prevents inadvertent collateral thermal damage by
incidental contact of tissue with non-treatment areas of the jaw
1290.
[0165] The electrode 1294 is selectively interrupted by the regions
1298. Selective application of the high temperature
PolyTetraFluoroEthylene (e.g. Teflon.RTM.) coating to portions of
the electrode 1294 yields selectively exposed metallic internal
portions that define a three-dimensional geometric electron
modulation (GEM) for a focused dissection and coagulation at the
conductive zones 1294a, 1294b, 1294c of the electrode 1294. The
regions 1298 are selectively deposited onto the electrode 1294, as
illustrated in FIG. 22, yielding a treatment surface with
alternating thermally and electrically conductive regions and
thermally and electrically insulative regions surrounded by a
thermally conductive but electrically insulative outer perimeter
region defined by the DLC coating.
[0166] Referring to FIG. 22, the jaw 1290 comprises an angular
profile where a plurality of angles are defined between discrete
portions 1290a, 1290b, 1290c, 1290d of the jaw 1290. For example, a
first angle (.alpha.1) is defined by portions 1290a, 1290b, a
second angle (.alpha.2) is defined by portions 1290b, 1290c, and a
third angle (.alpha.3) is defined by portions 1290c, 1290d of the
first jaw 1250. In other examples, at least a portion of a jaw 1290
comprises a smooth curved profile with no angles. In various
aspects, the discrete portions 1290a, 1290b, 1290c, 1290d of the
jaw 1290 are linear segments. Consecutive linear segments intersect
at angles such as, for example, the first angle (.alpha.1), or the
second angle (.alpha.2), and the third angle (.alpha.3). The linear
segments cooperate to form a generally curved profile of each of
the jaw 1290.
[0167] In one example, the angles (.alpha.1, .alpha.2, .alpha.3)
comprise the same, or at least substantially the same, values. In
another example, at least two of the angles (.alpha.1, .alpha.2,
.alpha.3) comprise different values. In another example, at least
one of the angles (.alpha.1, .alpha.2, .alpha.3) comprises a value
selected from a range of about 120.degree. to about 175.degree.. In
yet another example, at least one of the angles (.alpha.1,
.alpha.2, .alpha.3) comprises a value selected from a range of
about 130.degree. to about 170.degree..
[0168] Furthermore, due to the gradually narrowing profile of the
jaw 1290, the portion 1290a, which is a proximal portion, is larger
than the portion 1290b, which is an intermediate portion.
Similarly, the intermediate portion 1290b is larger than the
portion 1290d that defines a distal portion of the jaw 1290. In
other examples, the distal portion can be larger than the
intermediate and/or proximal portions. In other examples, the
intermediate portion is larger than the proximal and/or distal
portions. In addition, the electrode 1294 of the jaw 1290 comprises
an angular profile that is similar to the angular profile of the
jaw 1290.
[0169] Referring to FIG. 23, in certain aspects, a jaw 1300
includes a solid conductive skeleton 1301 that is partially
surrounded by a DLC coating 1264. The exposed regions of the
skeleton 1301 define one or more electrodes 1302. This arrangement
yields a thermally conductive and electrically conductive portion
of the jaw 1300, wherein the thermal energy is delivered
indiscriminately, but the electrical energy is exclusively
delivered through the one or more electrodes 1302.
[0170] Referring now to FIGS. 24-26, an electrosurgical instrument
1500 includes an end effector 1400 configured to deliver monopolar
energy and/or bipolar energy to tissue grasped by the end effector
1400, as described in greater detail below. The end effector 1400
is similar in many respects to the end effector 1200. For example,
the end effector 1400 includes a first jaw 1450 and a second jaw
1470. At least one of the first jaw 1450 and the second jaw 1470 is
movable relative to the other jaw to transition the end effector
1400 from an open configuration to a closed configuration to grasp
the tissue therebetween. The grasped tissue can then be sealed
and/or cut using monopolar and bipolar energies. As described below
in greater details, the end effector 1400 utilizes GEM to adjust
energy densities at a tissue treatment interface of the jaws 1450,
1470 to effect a desired tissue treatment.
[0171] Like the jaws 1250, 1270, the jaws 1450, 1470 include
generally angular profiles formed from linear portions that are
angled with respect to one another, yielding a bent or finger-like
shape, as illustrated in FIG. 26. Furthermore, the jaws 1450, 1470
include conductive skeletons 1452, 1472 that have narrowing angular
bodies extending distally along the angular profile of the jaws
1450, 1470. The conductive skeletons 1452, 1472 can be comprised of
a conductive material such as, for example, Titanium. In certain
aspects, each of the conductive skeletons 1453, 1473 comprise a
thermally insulative portion and a thermally conductive portion
integral with the thermally insulative portion. The thermally
conductive portion defines a heat sink and the thermally insulative
portion resists heat transfer. In certain examples, the thermally
insulative portions of the skeletons 1453, 1473 define inner cores
comprising inner gaps, voids, or pockets that effectively isolate
the thermal mass of the outer surfaces of the jaws 1452, 1472 that
are directly in contact with the tissue without compromising the
electrical conductivity of the jaws 1450, 1470.
[0172] The thermally conductive portions comprise conductive outer
layers 1469, 1469' that surround, or at least partially surround,
the inner conductive cores. In at least one example, the inner
conductive cores comprise gap-setting members, which can be in the
form of pillars, columns, and/or walls extending between opposite
sides of the outer layers 1469, 1469' of each of the jaws 1250,
1270 with gaps, voids, or pockets extending between the gap setting
members. In at least one example, the gap-setting members form
honeycomb-like lattice structures 1467, 1467'.
[0173] Further to the above, the conductive skeletons 1453, 1473
include first conductive portions 1453a, 1473a extending distally
along the angular profile of the jaws 1450, 1470 and second
conductive portions 1453b, 1473b defining a tapered electrodes
protruding from the first conductive portions 1453a, 1473a and
extending distally along at least a portion of the gradually
narrowing body of the skeletons 1453, 1473. In at least on example,
the first conductive portions 1453a, 1473a are thicker than the
second conductive portions 1453b, 1473b in a transverse
cross-section (e.g. FIG. 25) of the gradually narrowing bodies of
the skeletons 1453, 1473. In at least one example, the second
conductive portions 1453b, 1473b are integral with, or permanently
attached to, the first conductive portions 1453a, 1473a such that
electrical energy flows from the first conductive portions 1453a,
1473a to the tissue only through the second conductive portions
1453b, 1473b. Electrically insulative layers 1464, 1464' are
configured to completely electrically insulate the first conductive
portions 1453a, 1473a but not the second conductive portions 1453b,
1473b. At least outer surfaces of the second conductive portions
1453b, 1473b, which define electrodes 1452, 1472, are not covered
by the electrically insulative layers 1464, 1464'. In the
illustrated example, the electrodes 1452, 1472 and the electrically
insulative layers 1464, 1464' define flush tissue treatment
surfaces.
[0174] As described above, the first conductive portions 1453a,
1473a are generally thicker than the second conductive portions
1453b, 1473b, and are wrapped with the electrically insulative
layers 1464, 1464', which causes the second conductive portions
1453b, 1473b to become high energy density areas. In at least one
example, the electrically insulative layers 1464, 1464' are
comprised of high temperature PolyTetraFluoroEthylene (e.g.
Teflon.RTM.) coatings, DLC coatings, and/or ceramic coatings for
insulation and resistance to char sticking. In various examples,
the thicker first conductive portion 1453a conducts more potential
power with a smaller resistance to the tissue-contacting second
conductive portion 1453b yielding the higher energy density at the
electrode 1452.
[0175] In various aspects, the outer surfaces of the electrodes
1452, 1472 include consecutive linear segments that extend along
angled tissue treatment surfaces of the jaws 1450, 1470. The linear
segments intersect at predefined angles, and comprise widths that
gradually narrow as the linear segments extend distally. In the
example illustrated in FIG. 24, the electrode 1452 includes
segments 1452a, 1452b, 1452c, 1452c, 1452d, and the electrode 1472
includes segments 1472a, 1472b, 1472c, 1472c, 1472d. The electrode
1452 of the jaw 1450 is illustrated by dashed lines on the jaw 1470
of FIG. 24 to show the lateral position of the electrode 1452 with
respect to the electrode 1452 in a closed configuration of the end
effector 1400. The electrodes 1452, 1472 are laterally offset from
one another in the closed configuration. In a bipolar energy mode,
the electrical energy supplied by the generator (e.g. generator
1100) flows from the first conductive portion 1453a to the
electrode 1452 of the second conductive portion 1453b, and from the
electrode 1452 to the tissue grasped between the jaws 1450, 1470.
The bipolar energy then flows from the tissue to the electrode 1472
of the second conductive portion 1473b, and from the electrode 1472
to the first conductive portion 1473a.
[0176] In various aspects, as illustrated in FIGS. 24, 25, the
second jaw 1470 further includes an electrode 1474 spaced apart
from the skeleton 1473. In at least one example, the electrode 1474
is a monopolar electrode configured to deliver monopolar energy to
the tissue grasped between the jaws 1450, 1470 in the closed
configuration. A return pad can be placed under the patient, for
example, to receive the monopolar energy from the patient. Like the
electrode 1472, the electrode 1474 includes consecutive linear
segments 1474a, 1474b, 1474c, 1474d that extend distally along the
angular profile defined by the second jaw 1470 from an electrode
proximal end to an electrode distal end. Further, the electrode
1474 is laterally offset from the electrodes 1472, 1452.
[0177] The electrode 1474 includes a base 1474e positioned in a
cradle 1480 extending distally along the angular profile of the
second jaw 1470 from a cradle proximal 1480a and to a cradle distal
end 1480b. The cradle 1480 is centrally situated with respect to
lateral edges 1470e, 1470f of the second jaw 1470. The electrode
1474 further comprises a tapered edge 1474f extending from the base
1474e beyond sidewalls of the cradle 1480. In addition, the cradle
1480 is partially embedded in a valley defined in an outer
tissue-treatment surface of the narrowing curved body. The cradle
1480 is spaced apart from the gradually narrowing body of the
skeleton 1473 by the electrically insulative coating 1464'. As
illustrated in FIG. 24, the base 1480 comprises widths that
gradually narrow as the base extends along the angular profile from
a base proximal end 1480a to a base distal end 1480b.
[0178] In various examples, the cradle 1480 is comprised of a
compliant substrate. In an uncompressed state, as illustrated in
FIG. 25, the sidewalls of the cradle 1480 extend beyond a tissue
treatment surface of the jaw 1472. When tissue is compressed
between the jaws 1450, 1470, the compressed tissue applies a
biasing force against the sidewalls of the cradle 1480 further
exposing the tapered edge 1474f of the electrode 1474.
[0179] One or more of the jaws described by the present disclosure
include stop members or gap-setting members, which are features
extending outwardly from one or both of the tissue treatment
surfaces of the jaws of an end effector. The stop members help
maintain a separation or a predetermined gap between the jaws in a
closed configuration with no tissue between the jaws. In at least
one example, the sidewalls of the cradle 1480 define such stop
members. In another example, the stop members can be in the form of
insulative pillars or laterally extending spring-biased features
that allow the gap between opposing jaws and the closed
configuration to vary based on clamping loads.
[0180] Most electrosurgery generators use constant power modes.
With constant power modes, the power output remains constant as
impedance increases. In constant power modes, the voltage increases
as the impedance increases. Increased voltage causes thermal damage
to tissue. GEM focuses the energy output of the jaws 1250, 1270,
for example, by controlling the size and shape of the electrodes
1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474, as described above,
and modulating the power level based on tissue impedance to create
a low voltage plasma.
[0181] In certain instances, GEM maintains a constant minimum
voltage required for cutting at the surgical site. The generator
(e.g. 1100) modulates the power in order to maintain the voltage as
close as possible to the minimum voltage required for cutting at
the surgical site. In order to obtain an arc plasma and cut,
current is pushed by voltage from gradually narrowing portions of
the electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474, to
the tissue. In certain examples, a minimum voltage of approximately
200 Volts is maintained. Cutting with greater than 200 Volts
increases thermal damage and cutting with less than 200 Volts
results in minimal arcing and drag in the tissue. Accordingly, the
generator (e.g. 1100) modulates the power to ensure utilizing the
minimum voltage possible that will still form an arc plasma and
cut.
[0182] Referring primarily to FIG. 26, a surgical instrument 1500
includes the end effector 1400. The surgical instrument 1500 is
similar in many respects to other surgical instruments described in
U.S. Patent Application Attorney Docket No. END9234USNP2/190717-2.
Various actuation and articulation mechanisms described elsewhere
in connection with such surgical instruments could be similarly
utilized to articulate and/or actuate the surgical instrument 1500.
For brevity, such mechanisms are not repeated herein.
[0183] The end effector 1400 comprises an end effector frame
assembly 11210 that comprises a distal frame member 11220 that is
rotatably supported in a proximal frame housing 11230. In the
illustrated example, the distal frame member 11220 is rotatably
attached to the proximal frame housing 11230 by an annular rib on
the distal frame member 11220 that is received within an annular
groove in the proximal frame housing 11230.
[0184] Electrical energy is transmitted to the electrodes 1452,
1472, 1474 of the end effector 1400 by one or more flex circuits
extending distally through, or alongside, the distal frame member
11220. In the illustrated example, a flex circuit 1490 is fixedly
attached to the first jaw 1450. More particularly, the flex circuit
1490 includes a distal portion 1492 that can be fixedly attached to
an exposed portion 1491 of the first jaw 1450, which is not covered
by the insulative layer 1464.
[0185] A slip ring assembly 1550 within the proximal frame housing
11230 allows free rotation of the end effector 1400 about a shaft
of the surgical instrument 1500 without entanglement of the wires
of the circuits transmitting electrical energy to the electrodes
1452, 1472, 1474. In the illustrated example, the flex circuit 1490
includes an electrical contact 1493 in movable engagement with a
slip ring 1550a of the slip ring assembly 1550. Electrical energy
is transmitted from the slip ring 1550a to the conductive skeleton
1453, and then to the electrode 1452, through the flex circuit
1490. Since the electrical contact 1493 is not fixedly attached to
the slip ring 1550a, the rotation of the end effector 1400 about
the shaft of the surgical instrument 1500 is permissible without
losing the electrical connection between the electrical contact
1493 and the slip ring 1550a. Further, a similar electrical contact
transmits the electrical energy to the slip ring 1550a.
[0186] In the example illustrated in FIG. 26, the slip ring 1550a
is configured to transmit bipolar energy to the electrode 1452 of
the jaw 1450. A slip ring 1550b cooperates with similar electrical
contacts and the electrode 1472 to define a return path for the
bipolar energy. In addition, a slip ring 1550c cooperates with
similar electrical contacts and the electrode 1474 to provide a
pathway for monopolar electrical energy into tissue. The bipolar
and monopolar electrical energies can be delivered to the slip
rings 1550a, 1550b through one or more electrical generators (e.g.
generator 1100). The bipolar and monopolar electrical energies can
be delivered simultaneously or separately, as described in greater
detail elsewhere herein.
[0187] In various examples, the slip rings 1550a, 1550b, 1550c are
integrated electrical slip rings with mechanical features 1556a,
1556b, 1556c configured to couple the slip rings 1550a, 1550b,
1550c to an insulative support structure 1557, or a conductive
support structure coated with an insulative material, as
illustrated in FIG. 26. Furthermore, the slip rings 1550a, 1550b,
1550c are sufficiently spaced apart to ensure that circuit shorting
will not occur if a conductive fluid fills the space between the
slip rings 1550a, 1550b, 1550c. In at least one example, a core
flat stamped metallic shaft member includes a three dimensionally
printed, or over-molded, nonconductive portion for supporting the
slip ring assembly 1550.
[0188] FIG. 27 illustrates a portion of an electrosurgical
instrument 12000 that comprises a surgical end effector 12200 that
may be coupled to a proximal shaft segment by an articulation joint
in the various suitable manners. In certain instances, the surgical
end effector 12200 comprises an end effector frame assembly 12210
that comprises a distal frame member 12220 that is rotatably
supported in a proximal frame housing that is attached to the
articulation joint.
[0189] The surgical end effector 12200 comprises a first jaw 12250
and a second jaw 12270. In the illustrated example, the first jaw
12250 is pivotally pinned to the distal frame member 12220 for
selective pivotal travel relative thereto about a first jaw axis
FJA defined by a first jaw pin 12221. The second jaw 12270 is
pivotally pinned to the first jaw 12250 for selective pivotal
travel relative to the first jaw 12250 about a second jaw axis SJA
that is defined by a second jaw pin 12272. In the illustrated
example, the surgical end effector 12200 employs an actuator yoke
assembly 12610 that is pivotally coupled to the second jaw 12270 by
a second jaw attachment pin 12273 for pivotal travel about a jaw
actuation axis JAA that is proximal and parallel to the first jaw
axis FJA and the second jaw axis SJA. The actuator yoke assembly
12610 comprises a proximal threaded drive shaft 12614 that is
threadably received in a threaded bore 12632 in a distal lock plate
12630. The threaded drive shaft 12614 is mounted to the actuator
yoke assembly 12610 for relative rotation therebetween. The distal
lock plate 12630 is supported for rotational travel within the
distal frame member 12220. Thus rotation of the distal lock plate
12630 will result in the axial travel of the actuator yoke assembly
12610.
[0190] In certain instances, the distal lock plate 12630 comprises
a portion of an end effector locking system 12225. The end effector
locking system 12225 further comprises a dual-acting rotary lock
head 12640 that is attached to a rotary drive shaft 12602 of the
various types disclosed herein. The lock head 12640 comprises a
first plurality of radially arranged distal lock features 12642
that are adapted to lockingly engage a plurality of
proximally-facing, radial grooves or recesses 12634 that are formed
in the distal lock plate 12630. When the distal lock features 12642
are in locking engagement with the radial grooves 12634 in the
distal lock plate 12630, rotation of the rotary lock head 12640
will cause the distal lock plate 12630 to rotate within the distal
frame member 12220. Also in at least one example, the rotary lock
head 12640 further comprises a second series of proximally-facing
proximal lock features 12644 that are adapted to lockingly engage a
corresponding series of lock grooves that are provided in the
distal frame member 12220. A locking spring 12646 serves to bias
the rotary lock head distally into locking engagement with the
distal lock plate 12630. In various instances, the rotary lock head
12640 may be pulled proximally by an unlocking cable or other
member in the manner described herein. In another arrangement, the
rotary drive shaft 12602 may be configured to also move axially to
move the rotary lock head 12640 axially within the distal frame
member 12220. When the proximal lock features 12644 in the rotary
lock head 12640 are in locking engagement with the series of lock
grooves in the distal frame member 12220, rotation of the rotary
drive shaft 12602 will result in rotation of the surgical end
effector 12200 about the shaft axis SA.
[0191] In certain instances, the first and second jaws 12250, 12270
are opened and closed as follows. To open and close the jaws, as
was discussed in detail above, the rotary lock head 12640 is in
locking engagement with the distal lock plate 12630. Thereafter,
rotation of the rotary drive shaft 12602 in a first direction will
rotate the distal lock plate 12630 which will axially drive the
actuator yoke assembly 12610 in the distal direction DD and move
the first jaw 12250 and the second jaw 12270 toward an open
position. Rotation of the rotary drive shaft 12602 in an opposite
second direction will axially drive the actuator yoke assembly
12610 proximally and pull the jaws 12250, 12270 toward a closed
position. To rotate the surgical end effector 12200 about the shaft
axis SA, the locking cable or member is pulled proximally to cause
the rotary lock head 12640 to disengage from the distal lock plate
12630 and engage the distal frame member 12220. Thereafter, when
the rotary drive shaft 12602 is rotated in a desired direction, the
distal frame member 12220 (and the surgical end effector 12200)
will rotate about the shaft axis SA.
[0192] FIG. 27 further illustrates an electrical connection
assembly 5000 for electrically coupling the jaws 12250, 12270 to
one or more power sources such as, for example, generators 3106,
3107 (FIG. 36). The electrical connection assembly 5000 defines two
separate electrical pathways 5001, 5002 extending through the
electrosurgical instrument 12000, as illustrated in FIG. 27. In a
first configuration, the electrical pathways 5001, 5002 cooperate
to deliver bipolar energy to the end effector 12200 where one of
the electrical pathways 5001, 5002 acts as a return pathway. In
addition, in a second configuration, the electrical pathways 5001,
5002 separately and/or simultaneously deliver monopolar energy
12200. Accordingly, in the second configuration, both of the
electrical pathways 5001, 5002 can be used as supply pathways.
Further, the electrical connection assembly 5000 can be utilized
with other surgical instruments described elsewhere herein (e.g.
the surgical instrument 1500) to electrically couple such surgical
instruments with one or more power sources (e.g. generators 3106,
3107).
[0193] In the illustrated example, the electrical pathways 5001,
5002 are implemented using a flex circuit 5004 extending, at least
partially, through a coil tube 5005. As illustrated in FIG. 30, the
flex circuit 5004 includes two separate conductive trace elements
5006, 5007 embedded in a PCB (printed circuit board) substrate
5009. In certain instances, a flex circuit 5004 could be attached
to a core flat stamped metallic shaft member with a 3D printed or
an over molded plastic casing to provide full shaft
fill/support.
[0194] In alternative examples, as illustrated in FIG. 32, a flex
circuit 5004' extending through a coil tube 5005' can include
conductive trace elements 5006', 5007' twisted in a PCB substrate
5009' in a helical profile resulting in a reduction of the overall
size of the flex circuit 5004' and, in turn, a reduction in the
inner/outer diameter of the coil tube 5005'. FIGS. 31 and 32
illustrate other examples of flex circuits 5004'', 5004'''
extending through coil tubes 5005'', 5005''' and including
conductive trace elements 5006'', 5007'' and 5006''', 5007''',
respectively, which comprise alternative profiles for size
reduction. For example, the flex circuit 5004''' comprises a folded
profile while the flex circuit 5004'' comprises trace elements
5006'', 5007'' on opposite sides of the PCB 5009''.
[0195] Further to the above, the pathways 5001, 5002 are defined by
trace portions 5006a-5006g, 5007a-5007g, respectively. The trace
portions 5006b, 5006c and the trace portions 5007b, 5007c are in
the form of rings that define a ring assembly 5010 which maintains
electrical connections through the pathways 5001, 5002 while
allowing rotation of the end effector 12200 relative to the shaft
of the surgical instrument 12000. Further, trace portions 5006e,
5007e are disposed on opposite sides of the actuator yoke assembly
12610. In the illustrated example, the portions 5006e, 5007e are
disposed around holes configured to receive the second jaw
attachment pin 12273, as illustrated in FIG. 27. The trace portions
5006e, 5007e are configured to come into electrical contact with
corresponding portions 5006f, 5007f disposed on the second jaw
12270. In addition, the trace portions 5007f, 5007g become
electrically connected when the first jaw 12250 is assembled with
the second jaw 12270.
[0196] Referring to FIG. 29, a flex circuit 5014 includes
spring-biased trace elements 5016, 5017. The trace elements 5016,
5017 are configured to exert a biasing force against corresponding
trace elements to ensure maintaining an electrical connection
therewith particularly when corresponding trace portions are moving
relative to one another. One or more of the trace portions of the
pathways 5001, 5002 can be modified to include spring-biased trace
elements in accordance with the flex circuit 5014.
[0197] Referring to FIG. 34, a graph 3000 illustrates a power
scheme 3005' of a tissue treatment cycle 3001 applied by an end
effector 1400, or any other suitable end effector of the present
disclosure, to a tissue grasped by the end effector 1400. The
tissue treatment cycle 3001 includes a tissue coagulation stage
3006 including a feathering segment 3008, a tissue-warming segment
3009, and a sealing segment 3010. The tissue treatment cycle 3001
further includes a tissue transection or cutting stage 3007.
[0198] FIG. 36 illustrates an electrosurgical system 3100 including
a control circuit 3101 configured to execute the power scheme
3005'. In the illustrated example, the control circuit 3101
includes a controller 3104 with storage medium in the form of a
memory 3103 and a processor 3102. The storage medium stores program
instructions for executing the power scheme 3005'. The
electrosurgical system 3100 includes a generator 3106 configured to
supply monopolar energy to the end effector 1400, and a generator
3107 configured to supply bipolar energy to the end effector 1400,
in accordance with the power scheme 3005'. In the illustrated
example, control circuit 3101 is depicted separately from the
surgical instrument 1500 and the generators 3106, 3107. In other
examples, however, the control circuit 3101 can be integrated with
the surgical instrument 1500, the generator 3106, or the generator
3107. In various aspects, the power scheme 3005' can be stored in
the memory 3103 in the form of an algorism, equation, and/or
look-up table, or any suitable other suitable format. The control
circuit 3101 may cause the generators 3106, 3107 to supply
monopolar and/or bipolar energies to the end effector 1400 in
accordance with the power scheme 3005'.
[0199] In the illustrated example, the electrosurgical system 3100
further includes a feedback system 3109 in communication with the
control circuit 3101. The feedback system 3109 can be a standalone
system, or can be integrated with the surgical instrument 1500, for
example. In various aspects, the feedback system 3109 can be
employed by the control circuit 3101 to perform a predetermined
function such as, for example, issuing an alert when one or more
predetermined conditions are met. In certain instances, the
feedback system 3109 may comprise one or more visual feedback
systems such as display screens, backlights, and/or LEDs, for
example. In certain instances, the feedback system 3109 may
comprise one or more audio feedback systems such as speakers and/or
buzzers, for example. In certain instances, the feedback system
3109 may comprise one or more haptic feedback systems, for example.
In certain instances, the feedback system 3109 may comprise
combinations of visual, audio, and/or haptic feedback systems, for
example. Additionally, the electrosurgical system 3100 further
includes a user interface 3110 in communication with the control
circuit 3101. The user interface 3110 can be a standalone
interface, or can be integrated with the surgical instrument 1500,
for example.
[0200] The graph 3000 depicts power (W) on the y-axis and time on
the x-axis. A bipolar energy curve 3020 spans the tissue
coagulation stage 3005, and a monopolar energy curve 3030 starts in
the tissue coagulation stage 3006 and terminates at the end of the
tissue transection stage 3007. Accordingly, tissue treatment cycle
3001 is configured to apply a bipolar energy to the tissue
throughout the tissue coagulation stage 3006, but not the tissue
transection stage 3007, and apply a monopolar energy to the tissue
in a portion of the coagulation stage 3006 and the transection
stage 3007, as illustrated in FIG. 34.
[0201] In various aspects, a user input can be received by the
control circuit 3101 from the user interface 3110. The user input
causes the control circuit 3101 to initialize execution of the
power scheme 3005' at time t.sub.1. Alternatively, the
initialization of the execution of the power scheme 3005' can be
triggered automatically by sensor signals from one or more sensors
3111 in communication with the control circuit 3101. For example,
the power scheme 3005' can be triggered automatically by the
control circuit 3101 in response to a sensor signal indicative of a
predetermined gap between the jaws 1450, 1470 of the end effector
1400.
[0202] During the feathering segment 3008, the control circuit 3101
causes generator 3107 to gradually increase the bipolar energy
power supplied to the end effector 1400 to a predetermined power
value P1 (e.g. 100 W), and to maintain the bipolar energy power at,
or substantially at, the predetermined power value P1 throughout
the remainder of the feathering segment 3008 and the tissue-warming
segment 3009. The predetermined power value P1 can be stored in the
memory 3103 and/or can be provided by a user through the user
interface 3110. During the sealing segment 3010, the control
circuit 3101 causes generator 3107 to gradually decrease the
bipolar energy power. Bipolar energy application is terminated at
the end of the sealing segment 3010 of the tissue coagulation stage
3006, and prior to the beginning of the cutting/transecting stage
3007.
[0203] Further to the above, at t.sub.2, the control circuit 3101
causes generator 3107 to begin supplying monopolar energy power to
the electrode 1474 of the end effector 1400, for example. The
monopolar energy application to the tissue commences at the end of
the feathering segment 3008 and the beginning of the tissue-warming
segment 3009. The control circuit 3101 causes generator 3107 to
gradually increase the monopolar energy power to a predetermined
power level P2 (e.g. 75 W), and to maintain, or at least
substantially maintain, the predetermined power level P2 for the
remainder of the tissue-warming segment 3009 and a first portion of
the sealing segment 3010. The predetermined power level P2 can also
be stored in the memory 3103 and/or can be provided by a user
through the user interface 3110.
[0204] During the sealing segment 3010 of the tissue coagulation
stage 3006, the control circuit 3101 causes generator 3107 to
gradually increase the monopolar energy power supplied to the end
effector 1400. The beginning of the tissue transection stage 3007
is ushered by an inflection point in the monopolar energy curve
3030 where the previous gradual increase in monopolar energy,
experienced during the sealing segment 3010, is followed by a step
up to a predetermined maximum threshold power level P3 (e.g. 150 W)
sufficient to transect the coagulated tissue.
[0205] At t.sub.4, the control circuit 3101 causes generator 3107
to step up the monopolar energy power supplied to the end effector
1400 to the predetermined maximum threshold power level P3, and to
maintain, or at least substantially maintain, predetermined maximum
threshold power level P3 for a predetermined time period
(t.sub.4-t.sub.6), or to the end of the tissue transection stage
3007. In the illustrated example, the monopolar energy power is
terminated by the control circuit 3101 at t5. The tissue
transection continues mechanically, as the jaws 1450, 1470 continue
to apply pressure on the grasped tissue until the end of the issue
transection stage 3007 at t.sub.6. Alternatively, in other
examples, the control circuit 3101 may cause the generator 3107 to
continue supplying monopolar energy power to the end effector 1400
to the end of the tissue transection stage 3007.
[0206] Sensor readings of the sensors 3111 and/or a timer clock of
the processor 3102 can be employed by the control circuit 3101 to
determine when to cause the generator 3107 and/or the generator
3106 to begin, increase, decrease, and/or terminate energy supply
to the end effector 1400, in accordance with a power scheme such
as, for example, the power scheme 3005'. The control circuit 3101
may execute the power scheme 3005' by causing one or more timer
clocks to count down from one or more predetermined time periods
(e.g. t.sub.1-t.sub.2, t.sub.2-t.sub.3, t.sub.3-t.sub.4,
t.sub.5-t.sub.6) that can be stored in the memory 3103, for
example. Although the power scheme 3005' is time based, the control
circuit 3101 may adjust predetermined time periods for any of the
individual segments 3008, 3009, 3010 and/or the stages 3006, 3007
based on sensor readings received from one or more of the sensors
3111 such as, for example, a tissue impedance sensor.
[0207] The end effector 1400 is configured to deliver three
different energy modalities to the grasped tissue. The first energy
modality, which is applied to the tissue during the feathering
segment 3008, includes bipolar energy but not monopolar energy. The
second energy modality is a blended energy modality that includes a
combination of monopolar energy and bipolar energy, and is applied
to the tissue during the tissue warming stage 3009 and the tissue
sealing stage 3010. Lastly, the third energy modality includes
monopolar energy but not bipolar energy, and is applied to the
tissue during the cutting stage 3007. In various aspects, the
second energy modality comprises a power level that is the sum 3040
of the power levels of monopolar energy and bipolar energy. In at
least one example, the power level of the second energy modality
includes a maximum threshold Ps (e.g. 120 W).
[0208] In various aspects, the control circuit 3101 causes the
monopolar energy and the bipolar energy to be delivered to the end
effector 1400 from two different electrical generators 3106, 3107.
In at least one example, energy from one of the generators 3106,
3107 can be detected using a return path of the other generator, or
utilizing attached electrodes of the other generator to short to an
unintended tissue interaction. Accordingly, a parasitic loss of
energy through a return path that is not the intended can be
detected by a generator connected to the return path. The
inadvertent conductive path can be mitigated by effecting the
voltage, power, waveform, or timing between uses.
[0209] Integrated sensors within the flex circuits of the surgical
instrument 1500 can detect energizing/shorting of an
electrode/conductive path when no potential should be present and
the ability to prevent that conductive path once inadvertent use is
sensed. Further, directional electronic gating elements that
prevent cross talk from one generator down the source of the other
generator can also be utilized.
[0210] One or more of the electrodes described by the present
disclosure (e.g. electrodes 1452, 1472, 1474 in connection with the
jaws 1450, 1470) may include a segmented pattern with segments that
are linked together when the electrode is energized by a generator
(e.g. generator 1100). However, when the electrode is not
energized, the segments are separated to prevent circuit shorting
across the electrode to other areas of the jaw.
[0211] In various aspects, thermal resistive electrode material are
utilized with the end effector 1400. The material can be configured
to inhibit electrical flow through electrodes that are at or above
a predefined temperature level but continues to allow the
energizing of other portions of the electrodes that are below the
temperature threshold.
[0212] FIG. 37 illustrates a table representing an alternative
power scheme 3005'' that can be stored in the memory 3103, and can
be executed by the processor 3102 in a similar manner to the power
scheme 3005'. In executing the power scheme 3005'', the control
circuit 3101 relies on jaw aperture in addition to, or in lieu of,
time in setting power values of the generators 3106, 3107.
Accordingly, the power scheme 3005'' is a jaw-aperture based power
scheme.
[0213] In the illustrated example, jaw apertures d.sub.0, d.sub.1,
d.sub.2, d.sub.3, d.sub.4 from the power scheme 3005'' correspond
to the time values t.sub.1, t.sub.2, t.sub.3, t.sub.4 from the
power scheme 3005'. Accordingly, the feathering segment corresponds
to a jaw aperture from about d.sub.1 to about d.sub.2 (e.g. from
about 0.700'' to about 0.500''). In addition, the tissue-warming
segment corresponds to a jaw aperture from about d.sub.2 to about
d.sub.3 (e.g. from about 0.500'' to about 0.300''). Further, the
sealing segment corresponds to a jaw aperture from about d.sub.2 to
about d.sub.3 (e.g. from about 0.030'' to about 0.010''). Further,
the tissue cutting stage corresponds to a jaw aperture from about
d.sub.3 to about d.sub.4 (e.g. from about 0.010'' to about
0.003'').
[0214] Accordingly, the control circuit 3101 is configured to cause
the generator 3106 to begin supplying bipolar energy power to the
end effector 1400 when readings from one or more of the sensors
3111 corresponds to the predetermined jaw aperture d1, for example,
thereby initializing the feathering segment. Likewise, the control
circuit 3101 is configured to cause the generator 3106 to stop
supplying bipolar energy power to the end effector 1400 when
readings from one or more of the sensors 3111 corresponds to the
predetermined jaw aperture d2, for example, thereby terminating the
feathering segment. Likewise, the control circuit 3101 is
configured to cause the generator 3107 to begin supplying monopolar
energy power to the end effector 1400 when readings from one or
more of the sensors 3111 corresponds to the predetermined jaw
aperture d2, for example, thereby initializing the warming
segment.
[0215] In the illustrated example, the jaw aperture is defined by
the distance between two corresponding datum points on the jaws
1450, 1470. The corresponding datum points are in contact with one
another when the jaws 1450, 1470 are in a closed configuration with
no tissue therebetween. Alternatively, the jaw aperture can be
defined by a distance between the jaws 1450, 1470 measured along a
line intersecting the jaws 1450, 1470 and perpendicularly
intersecting a longitudinal axis extending centrally through the
end effector 1500. Alternatively, the jaw aperture can be defined
by a distance between first and second parallel lines intersecting
the jaws 1450, 1470, respectively. The distance is measured along a
line extending perpendicularly to the first and second parallel
lines, and extending through the intersection point between the
first parallel line and the first jaw 1450, and through the
intersection point between the second parallel line and the second
jaw 1470.
[0216] Referring to FIG. 35, in various examples, an
electrosurgical system 3100 (FIG. 36) is configured to perform a
tissue treatment cycle 4003 using a power scheme 3005. The tissue
treatment cycle 4003 includes an initial tissue contacting stage
4013, a tissue coagulation stage 4006, and a tissue transection
stage 4007. The tissue contacting stage 4013 include an open
configuration segment 4011 where tissue is not between the jaws
1450 and 1470, and a proper orientation segment 4012 where the jaws
1450 and 1470 are properly positioned with respect to a desired
tissue treatment region. The tissue coagulation stage 4006 includes
a feathering segment 4008, a tissue-warming segment 4009, and the
sealing segment 3010. The tissue transection stage 4007 includes a
tissue-cutting segment. The tissue treatment cycle 4003 involves
application of a bipolar energy and a monopolar energy separately
and simultaneously to the tissue treatment region in accordance
with a power scheme 3005. The tissue treatment cycle 4003 is
similar in many respects to the tissue treatment cycle 3001, which
are not repeated herein in the same level of detail for
brevity.
[0217] FIG. 35 illustrates a graph 4000 that represents a power
scheme 3005 similar in many respects to the power scheme 3005'. For
example, the control circuit 3101 can execute the power scheme
3005, in a similar manner to the power scheme 3005', to deliver
three different energy modalities to the tissue treatment region at
three consecutive time periods of a tissue treatment cycle 4001.
The first energy modality, which includes bipolar energy but not
monopolar energy, is applied to the tissue treatment region from
t.sub.1 to t.sub.2, in the feathering segment 4008. The second
energy modality, which is a blended energy modality that includes a
combination of monopolar energy and bipolar energy, is applied to
the tissue treatment region from t.sub.2 to t.sub.4, in the
tissue-warming segment 4009 and tissue-sealing segment. Lastly, the
third energy modality, which includes monopolar energy but not
bipolar energy 4010, is applied to the tissue from t.sub.4 to
t.sub.5, in tissue transection stage 4007. Furthermore, the second
energy modality comprises a power level that is the sum of the
power levels of monopolar energy and bipolar energy. In at least
one example, the power level of the second energy modality includes
a maximum threshold (e.g. 120 W). In various aspects, the power
scheme 3005 can be delivered to the end effector 1400 from two
different electrical generators 3106, 3107. Additional aspects of
the power scheme 3005 that are similar to aspects of the power
scheme 3005' are not repeated herein in the same level of detail
for brevity.
[0218] In various aspects, the control circuit 3101 causes the
generators 3106, 3107 to adjust the bipolar and/or monopolar power
levels of the power scheme 3005 applied to the tissue treatment
region by the end effector 1400 based on one or more measured
parameters including tissue impedance 4002, jaw motor velocity
27920d, jaw motor force 27920c, jaws aperture 27920b of the end
effector 1400, and/or current draw of the motor effecting the end
effector closure. FIG. 35 is a graph 4000 illustrating correlations
between such measured parameters and the power scheme 3005 over
time.
[0219] In various examples, the control circuit 3101 causes the
generators 3106, 3107 to adjust the power levels of a power scheme
(e.g. power schemes 3005, 3005') applied by the end effector 1400
to the tissue treatment region based on one or more parameters
(e.g. tissue impedance 4002, jaw/closure motor velocity 27920d,
jaw/closure motor force 27920c, jaws gap/aperture 27920b of the end
effector 1400, and/or current draw of the motor) determined by one
or more sensors 3111. For example, the control circuit 3101 may
cause the generators 3106, 3107 to adjust the power levels based on
the pressure within the jaws 1450, 1470.
[0220] In at least one example, the power levels are inversely
proportional to the pressure within the jaws 1450, 1470. The
control circuit 3101 may utilize such an inverse correlation to
select the power levels based on the pressure values. In at least
one example, current draw of the motor effecting the end effector
closure is employed to determine the pressure values.
Alternatively, the inverse correlation utilized by the control
circuit 3101 can be directly based on the current draw as a proxy
for the pressure. In various examples, the greater the compression
applied by the jaws 1450, 1470 onto the tissue treatment region,
the lower the power levels set by the control circuit 3101, which
aids in minimizing sticking and inadvertent cutting of the
tissue.
[0221] Graph 4000 provides several cues in the measured parameters
of tissue impedance 4002, jaw/closure motor velocity 27920d,
jaw/closure motor force 27920c, jaws gap/aperture 27920b of the end
effector 1400, and/or current draw of the motor effecting the end
effector closure, which can trigger an activation, an adjustment,
and/or a termination of the bipolar energy and/or the monopolar
energy application to tissue during the tissue treatment cycle
4003.
[0222] The control circuit 3101 may rely on one or more of such
cues in executing and/or adjusting the default power scheme 3005 in
the tissue treatment cycle 4003. In certain examples, the control
circuit 3101 may rely on sensor readings of the one or more sensors
3111 to detect when one or more monitored parameters satisfy one or
more predetermined conditions that can be stored in the memory
3103, for example. The one or more predetermined conditions can be
reaching a predetermined threshold and/or detecting a meaningful
increase and/or decrease in one or more of the monitored
parameters. Satisfaction of the predetermined conditions, or the
lack thereof, constitutes trigger/confirmation points for executing
and/or adjusting portions of the default power scheme 3005 in the
tissue treatment cycle 4003. The control circuit 3101 may rely
exclusively on the cues in executing and/or adjusting a power
scheme or, alternatively, use the cues to guide, or adjust, a timer
clock of a time-based power scheme such as, for example, the power
scheme 3005'.
[0223] For example, a sudden decrease (A.sub.1) in tissue impedance
to a predetermined threshold value (Z.sub.1), occurring alone or
coinciding with an increase (A.sub.2) in jaw motor force to a
predetermined threshold value (F.sub.1) and/or a decrease (A.sub.3)
in jaw aperture to a predetermined threshold value (d1) (e.g.
0.5'') may trigger the control circuit 3101 to begin the feathering
segment 4008 of the tissue coagulation stage 4006 by activating the
application of bipolar energy to the tissue treatment region. The
control circuit 3101 may signal the generator 3106 to begin
supplying bipolar power to the end effector 1400.
[0224] Furthermore, a decrease (B.sub.1) in jaw motor velocity to a
predetermined value (v1) following the activation of the bipolar
energy triggers the control circuit 3101 to signal the generator
3106 to stabilize (B.sub.2) the power level for bipolar energy at a
constant, or at least substantially constant, value (e.g. 100
W).
[0225] In yet another example, the shifting from the feathering
segment 4008 to the warming segment 4009 at t.sub.2, which triggers
an activation (D1) of the monopolar energy application to the
tissue treatment region, coincides with an increase (C.sub.2) in
the jaw motor force to a predetermined threshold (F.sub.2), a
decrease (C.sub.3) in the jaw aperture to a predetermined threshold
(e.g. 0.03''), and/or a decrease (C1) in tissue impedance to a
predetermined value Z.sub.2. Satisfaction of one, or in certain
instances two, or in certain instances all, of the conditions C1,
C2, C3 causes the control circuit 3101 to cause the generator 3101
to begin application of monopolar energy to the tissue treatment
region. In another example, satisfaction of one, or in certain
instances two, or in certain instances all, of the conditions C1,
C2, C3 at, or about, the time t2, triggers the application of
monopolar energy to the tissue treatment region.
[0226] Activation of the monopolar energy by the generator 3107, in
response to activation signals by the control circuit 3101, causes
a blend (D.sub.1) of the monopolar energy and bipolar energy to be
delivered to the tissue treatment region, which causes a shift in
the impedance curve characterized by a quicker decrease (E1) in
impedance from Z.sub.2 to Z.sub.3 in comparison to a steady
decrease (C1) prior to activation of the monopolar energy. In the
illustrated example, the tissue impedance Z.sub.3 defines a minimum
impedance for the tissue treatment cycle 4003.
[0227] In the illustrated example, the control circuit 3101
determines that an acceptable seal is being achieved if (E.sub.1)
the minimum impedance value Z.sub.3 coincides, or at least
substantially coincides, with (E.sub.3) a predetermined maximum jaw
motor force threshold (F.sub.3) and/or (E.sub.2) a predetermined
jaw aperture threshold range (e.g. 0.01''-0.003''). Satisfaction of
one, or in certain instances two, or in certain instances all, of
the conditions E1, E2, E3 signals the control circuit 3101 to shift
from the warming segment 4009 to the sealing segment 4010.
[0228] Further to the above, beyond the minimum impedance value
Z.sub.3, the impedance level gradually increases to a threshold
value Z4 corresponding to the end of the sealing segment 4010, at
t.sub.4. Satisfaction of the threshold value Z4 causes the control
circuit 3101 to signal the generator 3107 to step up the monopolar
power level to commence the tissue transection stage 4007, and
signal the generator 3106 to terminate application of the bipolar
energy application to the tissue treatment region.
[0229] In various examples, the control circuit 3101 can be
configured to (G.sub.2) verify that the jaw motor force is
decreasing as (G.sub.1) the impedance gradually increases from its
minimum value Z.sub.3, and/or (G.sub.3) that the jaw aperture has
decreased to a predetermined threshold (e.g. 0.01''-0.003''), prior
to stepping up the power level of the monopolar energy to cut the
tissue.
[0230] If, however, the jaw motor force continues to increase, the
control circuit 3101 may pause application of the monopolar energy
to the tissue treatment region for a predetermined time period to
allow the jaw motor force to begin decreasing. Alternatively, the
control circuit may signal the generator 3107 to deactivate the
monopolar energy, and complete the seal using only the bipolar
energy.
[0231] In certain instances, the control circuit 3101 may employ
the feedback system 3109 to alert a user and/or provide
instructions or recommendations to pause the application of the
monopolar energy. In certain instances, the control circuit 3101
may instruct the user to utilize on a mechanical knife to transect
the tissue.
[0232] In the illustrated example, the control circuit 3101
maintains (H) the stepped up monopolar power until a spike (I) is
detected in tissue impedance. The control circuit 3101 may cause
the generator 3107 to terminate (J) application of the monopolar
energy to the tissue upon detection of the spike (I) in the
impedance level to Z.sub.5 following the gradual increase from
Z.sub.3 to Z.sub.4. The spike indicates completion of the tissue
treatment cycle 4003.
[0233] In various examples, the control circuit 3101 prevents the
electrodes of the jaws 1450, 1470 from being energized before a
suitable closure threshold is reached. The closure threshold can be
based on a predetermined jaw aperture threshold and/or a
predetermined jaw motor force threshold, for example, which can be
stored in the memory 3103. In such examples, the control circuit
3101 may not act on user inputs through the user interface 3110
requesting of the treatment cycle 4003. In certain instances, the
control circuit 3101 may respond by alerting the user through the
feedback system 3109 that the suitable closure threshold has not
been reached. The control circuit 3101 may also offer the user an
override option.
[0234] Ultimately between time t.sub.4 and t.sub.5, monopolar
energy is the only energy being delivered in order to cut the
patient tissue. While the patient tissue is being cut, the force to
clamp the jaws of the end effector may vary. In instances where the
force to clamp the jaws decreases 27952 from its steady-state level
maintained between time t.sub.3 and t.sub.4, an efficient and/or
effective tissue cut is recognized by the surgical instrument
and/or the surgical hub. In instances where the force to clamp the
jaws increases 27954 from its steady-state level maintained between
time t.sub.3 and t.sub.4, an inefficient and/or ineffective tissue
cut is recognized by the surgical instrument and/or the surgical
hub. In such instances, an error can be communicated to the
user.
[0235] Referring to FIGS. 38-42, a surgical instrument 1601
includes an end effector 1600 similar in many respects to the end
effectors 1400, 1500, which are not repeated herein in the same
level of detail for brevity. The end effector 1600 includes a first
jaw 1650 and a second jaw 1670. At least one of the first jaw 1650
and the second jaw 1670 is movable to transition the end effector
1600 from an open configuration to a closed configuration to grasp
tissue (T) between the first jaw 1650 and the second jaw 1670.
Electrodes 1652, 1672 are configured to cooperate to deliver a
bipolar energy to the tissue from a bipolar energy source 1610, as
illustrated in FIG. 39. An electrode 1674 is configured to deliver
a monopolar energy to the tissue from a monopolar energy source
1620. A return pad 1621 defines a return pathway for the monopolar
energy. In at least one example, the monopolar energy and the
bipolar energy are delivered to the tissue either simultaneously
(FIG. 36), or in an alternating fashion, as illustrated in FIG. 36,
to seal and/or cut the tissue, for example.
[0236] FIG. 42 illustrates a simplified schematic diagram of an
electrosurgical system 1607 includes a monopolar power source 1620
and bipolar power source 1610 connectable to an electrosurgical
instrument 1601 that includes the end effector 1600. The
electrosurgical system 1607 further includes a conductive circuit
1602 selectively transitionable between a connected configuration
with the electrode 1672 and a disconnected configuration with the
electrode 1672. The switching mechanism can be comprised of any
suitable switch that can open and close the conductive circuit
1602, for example. In the connected configuration, the electrode
1672 is configured to cooperate with the electrode 1652 to deliver
bipolar energy to the tissue, wherein the conductive circuit 1602
defines a return path for the bipolar energy after passing through
the tissue. However, in the disconnected configuration, the
electrode 1672 is isolated and therefore becomes an inert
internally conductive and externally insulated structure on the jaw
1670. Accordingly, in the disconnected configuration the electrode
1652 is configured to deliver a monopolar energy to the tissue in
addition to, or separate from, the monopolar energy delivered
through the electrode 1674. In alternative examples, the electrode
1652, instead of the electrode 1672, can be transitionable between
a connected configuration and a disconnected configuration with the
conductive circuit 1602, allowing the electrode 1672 deliver
monopolar energy to the tissue in addition to, or separate from,
the monopolar energy delivered through the electrode 1674.
[0237] In various aspects, the electrosurgical instrument 1601
further includes a control circuit 1604 configured to adjust levels
of the monopolar energy and the bipolar energy delivered to the
tissue to minimize unintended thermal damage to surrounding tissue.
The adjustments can be based on readings of at least one sensor
such as, for example, a temperature sensor, an impedance sensor,
and/or a current sensor. In the example illustrated in FIGS. 41 and
42, the control circuit 1604 is coupled to temperature sensors
1651, 1671 on the jaws 1650, 1670, respectively. The levels of the
monopolar energy and the bipolar energy delivered to the tissue are
adjusted by the control circuit 1604 based on temperature readings
of the sensors 1651, 1671.
[0238] In the illustrated example, the control circuit 1604
includes a controller 3104 with a storage medium in the form of a
memory 3103 and a processor 3102. The memory 3103 stores program
instructions that, when executed by the processor 3102, cause the
processor 3102 to adjust levels of the monopolar energy and the
bipolar energy delivered to the tissue based on sensor readings
received from one or more sensors such as, for example, the
temperature sensors 1651, 1671. In various examples, as described
in greater detail below, the control circuit 1604 may adjust a
default power scheme 1701 based on readings from one or more
sensors such as, for example, the temperature sensors 1651, 1671.
The power scheme 1701 is similar in many respects to the power
scheme 3005', which are not repeated herein in the same level of
detail for brevity.
[0239] FIG. 43 illustrates a temperature-based adjustment of the
power scheme 1701 for energy delivery to a tissue grasped by an end
effector 1600. A graph 1700 depicts time on the x-axis, and power
and temperature on the y-axis. In a tissue feathering segment
(t.sub.1-t.sub.2), the control circuit 1604 causes the power level
of the bipolar energy to gradually increase up to a predetermined
threshold (e.g. 120 W), which causes the temperature of the tissue
grasped by the end effector 1600 to gradually increase to a
temperature within a predetermined range (e.g. 100.degree.
C.-120.degree. C.). The power level of the bipolar energy is then
maintained at the predetermined threshold as long as the tissue
temperature remains within the predetermined range. In a
tissue-warming segment (t.sub.2-t.sub.3), the control circuit 1604
activates the monopolar energy, and gradually decreases the power
level of the bipolar energy, while gradually increasing the power
level of the monopolar energy to maintain the tissue temperature
within the predetermined range.
[0240] In the illustrated example, during a tissue-sealing segment
(t.sub.3-t.sub.4), the control circuit 1604 detects that the tissue
temperature has reached the upper limit of the predetermined range
based on readings the temperature sensors 1651, 1671. The control
circuit 1604 responds by stepping down the power level of the
monopolar energy. In other examples, the reduction can be performed
gradually. In certain examples, the reduction value, or a manner
for determining the reduction value such as, for example, a table
or an equation can be stored in the memory 3103. In certain
examples, the reduction value can be a percentage of the present
power level of the monopolar energy. In other examples, the
reduction value can be based on a previous power level of the
monopolar energy that corresponded to a tissue temperature within
the predetermined range. In certain examples, the reduction can be
performed in multiple steps that are temporally spaced apart. After
each downward step, the control circuit 1604 allows a predetermined
time period to pass before evaluating the tissue temperature.
[0241] In the illustrated example, the control circuit 1604
maintains the power level of the bipolar energy in accordance with
the default power scheme 1701, but reduces the power level of the
monopolar energy to maintain the temperature of the tissue within
the predetermined range, while tissue sealing is completed. In
other examples, the reduction in the power level of the monopolar
energy is combined, or replaced, by a reduction in the power level
of the bipolar energy.
[0242] Further to the above, an alert can be issued, through the
feedback system 3109, to complete transection of the tissue using a
mechanical knife, for example, instead of the monopolar energy to
avoid unintended lateral thermal damage to surrounding tissue. In
certain examples, the control circuit 1604 may temporarily pause
the monopolar energy and/or the bipolar energy until the
temperature of the tissue returns to a level within the
predetermined temperature range. Monopolar energy can then be
reactivated to perform a transection of the sealed tissue.
[0243] Referring to FIG. 44, an end effector 1600 is applying
monopolar energy to a tissue treatment region 1683 at a blood
vessel such as, for example, an artery grasped by the end effector
1600. The monopolar energy flows from the end effector 1600 to the
treatment region 1683, and eventually to a return pad (e.g. return
pad 1621). Temperature of the tissue at the treatment region 1683
rises as monopolar energy is applied to the tissue. However, an
actual thermal spread 1681 is greater than an expected thermal
spread 1682, due to a constricted portion 1684 of the artery that
inadvertently draws the monopolar energy, for example.
[0244] In various aspects, the control circuit 1604 monitors
thermal effects at the treatment region 1683 resulting from
application of the monopolar energy to the treatment region 1683.
The control circuit 1604 can further detect a failure of the
monitored thermal effects to comply with a predetermined
correlation between the applied monopolar energy and thermal
effects expected from application of the monopolar energy at the
treatment region. In the illustrated example, the inadvertent
energy draw at the constricted portion of the artery reduces the
thermal effects at the treatment region, which is detected by the
control circuit 1604.
[0245] In certain examples, the memory 3103 stores a predetermined
correlation algorithm between monopolar energy level, as applied to
a tissue treatment region grasped by the end effector 1600, and the
thermal effects expected to result from application of the
monopolar energy to the tissue treatment region. The correlation
algorithm can be in the form of, for example, an array, lookup
table, database, mathematical equation, or formula, etc. In at
least one example, the stored correlation algorithm defines a
correlation between power levels of the monopolar energy and
expected temperatures. The control circuit 1604 can monitor the
temperature of the tissue at the treatment region 1683 using the
temperature sensors 1651, 1671, and can determine if a monitored
temperature reading corresponds to an expected temperature reading
at a certain power level.
[0246] The control circuit 1604 can be configured to take certain
actions if a failure to comply with the stored correlation is
detected. For example, the control circuit 1604 may alert a user of
the failure. Additionally, or alternatively, the control circuit
1604 may reduce or pause delivery of the monopolar energy to the
treatment region. In at least one example, the control circuit 1604
may adjust, or shift, from the monopolar energy to a bipolar energy
application to the tissue treatment region to confirm the presence
of a parasitic power draw. The control circuit 1604 may continue
using bipolar energy at the treatment region if the parasitic power
draw is confirmed. If, however, the control circuit 1604 refutes
the presence of a parasitic power draw, the control circuit 1604
may reactivate, or re-increase, the monopolar power level. Changes
to the monopolar and/or bipolar power levels can be achieved by the
control circuit 1604 by signaling the monopolar power source 1620
and/or the bipolar power source 1610, for example.
[0247] In various aspects, one or more imaging devices such as, for
example, a multi-spectral scope 1690 and/or an infrared imaging
device can be utilized to monitor spectral tissue changes and/or
the thermal effects at a tissue treatment region 1691, as
illustrated in FIG. 45. Imaging data from the one or more imaging
devices can be processed to estimate the temperature at the tissue
treatment region 1691. For example, a user may direct the infrared
imaging device at the treatment region 1691 as monopolar energy is
being applied to the treatment region 1691 by the end effector of
1600. As the treatment region 1691 heats up, its infrared heat
signature changes. Accordingly, changes in the heat signature
correspond to changes in the temperature of the tissue at the
treatment region 1691. Accordingly, the temperature of the tissue
at the treatment region 1691 can be determined based on the heat
signature captured by the one or more imaging devices. If the
temperature estimated based on the heat signature at the treatment
region 1691 associated with a certain part level is less than or
equal to an expected temperature at the power level, the control
circuit 1604 detects a discrepancy in the thermal effects at the
treatment region 1691.
[0248] In other examples, the heat signature captured by the one or
more imaging devices is not converted into an estimated
temperature. Instead, it is directly compared heat signatures
stored into the memory 3103 to assess whether a power level
adjustment is needed.
[0249] In certain examples, the memory 3103 stores a predetermined
a correlation algorithm between power levels of the monopolar
energy, as applied to a tissue treatment region 1691 by the end
effector 1600, and the heat signatures expected to result from
application of the monopolar energy to the tissue treatment region.
The correlation algorithm can be in the form of, for example, an
array, lookup table, database, mathematical equation, or formula,
etc. In at least one example, the stored correlation algorithm
defines a correlation between power levels of the monopolar energy
and expected heat signatures, or temperatures associated with the
expected heat signatures.
[0250] Referring to FIGS. 46 and 47, an electrosurgical system
includes an electrosurgical instrument 1801 that has an end
effector 1800 similar to the end effectors 1400, 1500, 1600 in many
respects, which are not repeated herein in the same level of detail
for brevity. The end effector 1800 includes a first jaw 1850 and a
second jaw 1870. At least one of the first jaw 1850 and the second
jaw 1870 is movable to transition the end effector 1800 from an
open configuration to a closed configuration to grasp tissue (T)
between the first jaw 1850 and the second jaw 1870. Electrodes
1852, 1872 are configured to cooperate to deliver a bipolar energy
to the tissue. An electrode 1874 is configured to deliver a
monopolar energy to the tissue. In at least one example, the
monopolar energy and the bipolar energy are delivered to the tissue
either simultaneously, or in an alternating fashion, as illustrated
in FIG. 34, to seal and/or cut the tissue, for example.
[0251] In the illustrated example, the bipolar energy and monopolar
energy are generated by separate generators 1880, 1881, and are
provided to the tissue by separate electrical circuits 1882, 1883
that connect the generator 1880 to the electrodes 1852, 1872, and
the generator 1881 to the electrode 1874 and the return pad 1803,
respectively. The power levels associated was the bipolar energy
delivered to the tissue by the electrodes 1852, 1872 is set by the
generator 1880, and the power levels associated with the monopolar
energy delivered to the tissue by the electrode 1874 is set by the
generator 1881, in accordance with the power scheme 3005', for
example.
[0252] In use, as illustrated in FIG. 46, the end effector 1800
applies bipolar energy and/or monopolar energy to a tissue
treatment region 1804 to seal and, in certain instances, transect
the tissue. However, in certain instances, the energy is diverted
from an intended target at the tissue treatment region 1804 causing
an off-site thermal damage to surrounding tissue. To avoid, or at
least reduce, such occurrences, the surgical instrument 1801
includes impedance sensors 1810, 1811, 1812, 1813, which are
positioned between different electrodes and in different locations,
as illustrated in FIG. 46, in order to detect off-site thermal
damage.
[0253] In various aspects, the surgical system 1807 further
includes a control circuit 1809 coupled to the impedance sensors
1810, 1811, 1812, 1813. The control circuit 1809 can detect an
off-site, or an unintended, thermal damage based on one or more
readings of the impedance sensors 1810, 1811, 1812, 1813. In
response, the control circuit 1809 may alert a user to the off-site
thermal damage, and instruct the user to pause energy delivery to
the tissue treatment region 1804, or automatically pause the energy
delivery, while maintaining the bipolar energy in accordance with a
predetermined power scheme (e.g. power scheme 3005') to complete
the tissue sealing. In certain instances, the control circuit 1809
may instruct the user to employ a mechanical knife to transect the
tissue to avoid further off-site thermal damage.
[0254] Referring still to FIG. 46, the impedance sensor 1810 is
configured to measure an impedance between the bipolar electrodes
1852, 1872. Further, the impedance sensor 1811 is configured to
measure an impedance between the electrode 1874 and the return pad
1803. In addition, the impedance sensor 1812 is configured to
measure an impedance between the electrode 1872 and the return pad
1803. In addition, the impedance sensor 1813 is configured to
measure an impedance between the electrode 1852 and the return pad
1803. In other examples, additional impedance sensors are added
inline between the monopolar and bipolar circuits 1882, 1883, which
can be utilized to measure impedances at various locations to
detect off-site thermal abnormalities with greater specificity as
to the location and impedance path.
[0255] In various aspects, the off-site thermal damage occurs in
tissue on one side (left/right) of the end effector 1800. The
control circuit 1809 may detect the side on which the off-site
thermal damage has occurred by comparing the readings of the
impedance sensors 1810, 1811, 1812, 1813. In one example, a
non-proportional change in the monopolar and bipolar impedance
readings is indicative of an off-site thermal damage. On the
contrary, if proportionality in the impedance readings is detected,
the control circuit 1809 maintains that no off-site thermal damage
has occurred. In one example, as described in greater detail below,
the off-site thermal damage can be detected by the control circuit
1809 from a ratio of the bipolar to monopolar impedances.
[0256] FIG. 48 illustrates a graph 1900 depicting time on the
x-axis and power on the y-axis. The graph 1900 illustrates a power
scheme 1901 similar in many respects to the power scheme 3005'
illustrated in FIG. 34, which are not repeated in the same level of
detail herein for brevity. A control circuit 3101 causes the power
scheme 1901 to be applied by the generators 1880 (GEN. 2), 1881
(GEN. 1) to effect a tissue treatment cycle by the end effector
1800. The power scheme 1901 includes a therapeutic power component
1902 and a nontherapeutic, or sensing, power component 1903. The
therapeutic power component 1902 defines monopolar and bipolar
power levels similar to the monopolar and bipolar power levels
described in connection with the power scheme 3005'. The sensing
power component 1903 includes monopolar 1905 and bipolar 1904
sensing pings delivered at various points throughout the tissue
treatment cycle performed by the end effector 1800. In at least one
example, the sensing pings 1903, 1904 of the sensing power
component are delivered at a predetermined current value (e.g. 10
mA) or a predetermined range. In at least one example, three
different sensing pings are utilized to determine
location/orientation of a potential off-site thermal damage.
[0257] The control circuit 3101 may determine whether energy is
being diverted to a non-tissue therapy directed site during a
tissue treatment cycle by causing the sensing pings 1903, 1904 to
be delivered at predetermined time intervals. The control circuit
3101 may then assess return-path conductivity based on the
delivered sensing pings. If it is determined that energy is being
diverted from a target site, the control circuit 3101 can take one
or more reactive measures. For example, the control circuit 3101
can adjust the power scheme 1901 to be applied by the generators
1880 (GEN. 2), 1881 (GEN. 1). The control circuit 3101 may pause
bipolar and/or monopolar energy application to the target site.
Further, the control circuit 3101 may issue an alert to a user
through feedback system 3109, for example. If, however, determines
that no energy diversion is detected, the control circuit 3101
continues execution of the power scheme 1901.
[0258] In various aspects, the control circuit 3101 assesses
return-path conductivity by comparing a measured
return-conductivity to a predetermined return-path conductivity
stored in the memory 3103, for example. If the comparison indicates
that the measured and predetermined return-path conductivities are
different beyond a predetermined threshold, the control circuit
3101 concludes that energy is being diverted to a non-tissue
therapy directed site, and performs one or more of the previously
described reactive measures.
[0259] FIG. 49 is a graph 2000 illustrating a power scheme 2001
interrupted, at t3', due to a detected off-site thermal damage. The
power scheme 2001 is similar in many respects to the power schemes
illustrated in FIGS. 34, 48, which are not repeated herein in the
same level of detail for brevity. The control circuit 1809 causes
the generators 1880 (curve line 2010), 1881 (curve line 2020) to
apply the power scheme 2001 to effect a tissue treatment cycle by
the end effector 1800, for example. In addition to the power scheme
2001, the graph 2000 further depicts bipolar impedance 2011
(Z.sub.bipolar), monopolar impedance 2021 (Z.sub.monopolar), and a
ratio 2030 (Z.sub.monopolar/Z.sub.bipolar) of the monopolar
impedance to the bipolar impedance on the y-axis. During normal
operation, while the monopolar energy and the bipolar energy are
being applied to the tissue simultaneously, values of the bipolar
impedance 2011 (Z.sub.bipolar) and monopolar impedance 2021
(Z.sub.monopolar) remain proportional, or at least substantially
proportional. It follows that a constant, or at least substantially
constant, impedance ratio 2030 (Z.sub.monopolar/Z.sub.bipolar) of
the monopolar impedance 2021 to the bipolar impedance 2011 is
maintained within a predetermined range 2031 during normal
operation.
[0260] In various aspects, the control circuit 1809 monitors the
impedance ratio 2030 to assess whether the monopolar energy is
diverting to non-tissue therapy directed site. The diversion
changes the proportionality of the detected values of the bipolar
impedance 2011 (Z.sub.bipolar) and monopolar impedance 2021
(Z.sub.monopolar), which changes the impedance ratio 2030. A change
in the impedance ratio 2030 within the predetermined range 2031 may
cause the control circuit 1908 to issue a warning. If, however, the
change extends to, or below, a lower threshold of the predetermined
range 2031 the control circuit 1908 may take additional reactive
measures.
[0261] In the illustrated example, the impedance ratio 2030
(Z.sub.monopolar/Z.sub.bipolar) remains constant, or at least
substantially constant, for an initial part of treatment cycle that
involves a blended monopolar and bipolar energy application to the
tissue. At B1, however, a discrepancy occurs where the monopolar
impedance (Z.sub.monopolar) drops unexpectedly, or
un-proportionally with, the bipolar impedance (Z.sub.bipolar)
indicating a potential off-site thermal damage. In at least one
example, the control circuit 1809 monitors changes in the ratio of
ratio (Z.sub.monopolar/Z.sub.bipolar) of the monopolar impedance to
the bipolar impedance, and detects an off-site thermal damage if
the changes persist for a predetermined amount of time, and/or
change in value to, or below, a lower threshold of the
predetermined range 2031. At B1, since the detected the impedance
ratio 2030 is still within the predetermined range 2031, the
control circuit 3101 only issues a warning through the feedback
system 3109 that an off-site thermal damage has been detected, and
continues to monitor the impedance ratio 2030.
[0262] At t3', the control circuit 3101 further detects that the
impedance ratio 2030 has changed to a value at, or below, a lower
threshold of the predetermined range 2031. In response, the control
circuit 3101 may issue another warning and, optionally, may
instruct the user to pause energy delivery to the tissue, or
automatically pause the energy delivery, at B2, while maintaining
or adjusting the power level of the bipolar energy to complete the
tissue sealing without monopolar energy. In certain examples, the
control circuit 1809 further instructs the user to employ a
mechanical knife (t4') to transect the tissue to avoid further
off-site thermal damage. In the illustrated example, the control
circuit 1809 further causes the generator 1880 to adjust its power
level to complete the tissue sealing without monopolar energy, and
increases the time period allotted for the tissue sealing segment
from time t4 to time t4'. In other words, the control circuit 1809
increases the bipolar energy delivery to the tissue to compensate
for the loss of monopolar energy by increasing the bipolar power
level and its delivery time.
[0263] Various aspects of the subject matter described herein are
set out in the following examples.
[0264] Various aspects of the subject matter described herein are
set out in the following examples.
Example Set 1
[0265] Example 1--An electrosurgical instrument comprising an end
effector. The end effector comprises a first jaw and a second jaw.
At least one of the first jaw and the second jaw is movable to
transition the end effector from an open configuration to a closed
configuration to grasp tissue therebetween. The second jaw
comprises a gradually narrowing body extending from a proximal end
to a distal end. The gradually narrowing body comprises a
conductive material. The gradually narrowing body comprises a first
conductive portion extending from the proximal end to the distal
end and a second conductive portion defining a tapered electrode
protruding from the first conductive portion and extending distally
along at least a portion of the gradually narrowing body. The
second conductive portion is integral with the first conductive
portion. The first conductive portion is thicker than the second
conductive portion in a transverse cross-section of the gradually
narrowing body. The second jaw further comprises an electrically
insulative layer configured to electrically insulate the first
conductive portion from the tissue but not the second conductive
portion. The first conductive portion is configured to transmit an
electrical energy to the tissue only through the second conductive
portion.
[0266] Example 2--The electrosurgical instrument of Example 1,
wherein the tapered electrode comprises an outer surface flush with
an outer surface of the electrically insulative layer.
[0267] Example 3--The electrosurgical instrument of Examples 1 or
2, wherein the tapered electrode comprises a width that gradually
narrows as the tapered electrode extends from the proximal end
toward the distal end.
[0268] Example 4--The electrosurgical instrument of Examples 1, 2,
or 3, wherein the electrical energy is delivered to the tissue
through an outer surface of the tapered electrode.
[0269] Example 5--The electrosurgical instrument of Examples 1, 2,
3, or 4, wherein the first jaw comprises a first electrode
extending distally along at least a portion of the first jaw,
wherein the tapered electrode is a second electrode, and wherein
the first electrode is laterally offset from the second electrode
in the closed configuration.
[0270] Example 6--The electrosurgical instrument of Example 5,
wherein the second jaw further comprises a third electrode spaced
apart from the narrowing gradually body.
[0271] Example 7--The electrosurgical instrument of Example 6,
wherein the third electrode extends distally along an angular
profile defined by the second jaw from an electrode proximal end to
an electrode distal end.
[0272] Example 8--The electrosurgical instrument of Example 7,
wherein the third electrode comprises a base positioned in a cradle
extending distally along the angular profile of the second jaw from
a cradle proximal and to a cradle distal end.
[0273] Example 9--The electrosurgical instrument of Example 8,
wherein the cradle is centrally situated with respect to lateral
edges the second jaw.
[0274] Example 10--The electrosurgical instrument of Examples 8 or
9, wherein the third electrode further comprises a tapered edge
extending from the base beyond sidewalls of the cradle.
[0275] Example 11--The electrosurgical instrument of Examples 8, 9,
or 10, wherein the cradle is comprised of a compliant
substrate.
[0276] Example 12--The electrosurgical instrument of Examples 8, 9,
10, or 11, wherein the cradle is partially embedded in a valley
defined in the gradually narrowing body.
[0277] Example 13--The electrosurgical instrument of Examples 8, 9,
10, 11, or 12, wherein the cradle is spaced apart from the
gradually narrowing body by an electrically insulative coating.
[0278] Example 14--The electrosurgical instrument of Examples 8, 9,
10, 11, 12, or 13, wherein the base comprises a base proximal end,
a base distal end, and a width that gradually narrows as the base
extends along the angular profile from the base proximal end to the
base distal end.
[0279] Example 15--An electrosurgical instrument comprising an end
effector. The end effector comprises a first jaw and a second jaw.
At least one of the first jaw and the second jaw is movable to
transition the end effector from an open configuration to a closed
configuration to grasp tissue therebetween. The second jaw
comprises a conductive body comprising a tapered angular profile
extending from a proximal end to a distal end. The conductive body
comprises a first conductive portion extending from the proximal
end to the distal end and a second conductive portion defining a
tapered electrode protruding from the first conductive portion and
extending distally along at least a portion of the conductive body.
The second conductive portion is integral with the first conductive
portion. The first conductive portion is thicker than the second
conductive portion. The second jaw further comprises an
electrically insulative layer configured to electrically insulate
the first conductive portion from the tissue but not the second
conductive portion. The first conductive portion is configured to
transmit an electrical energy to the tissue only through the second
conductive portion.
[0280] Example 16--The electrosurgical instrument of Example 15,
wherein the tapered electrode comprises a width that gradually
narrows as the tapered electrode extends from the proximal end
toward the distal end.
[0281] Example 17--The electrosurgical instrument of Examples 15 or
16, wherein the first jaw comprises a first electrode extending
distally along at least a portion of the first jaw, wherein the
tapered electrode is a second electrode, and wherein the first
electrode is laterally offset from the second electrode in the
closed configuration.
[0282] Example 18--The electrosurgical instrument of Examples 15,
16, or 17, wherein the second jaw further comprises a third
electrode spaced apart from the conductive body.
[0283] Example 19--The electrosurgical instrument of Example 18,
wherein the third electrode extends distally along at least a
portion of the tapered angular profile.
[0284] Example 20--The electrosurgical instrument of Example 19,
wherein the third electrode comprises a base positioned in a cradle
extending distally along the at least a portion of the tapered
angular profile from a cradle proximal and to a cradle distal end,
and wherein the cradle is comprised of a compliant substrate.
Example Set 2
[0285] Example 1--An electrosurgical instrument comprising an end
effector. The end effector comprises a first jaw and a second jaw.
At least one of the first jaw and the second jaw is movable to
transition the end effector from an open configuration to a closed
configuration to grasp tissue therebetween. The second jaw
comprises linear portions cooperating to form an angular profile
and a treatment surface comprising segments extending along the
angular profile. The segments comprise different geometries and
different conductivities. The segments are configured to produce
variable energy densities along the treatment surface.
[0286] Example 2--The electrosurgical instrument of Example 1,
wherein the segments comprise a proximal segment and a distal
segment. The proximal segment comprises a first surface area. The
distal segment comprises a second surface area. The second surface
area is smaller than the first surface area.
[0287] Example 3--The electrosurgical instrument of Examples 1 or
2, wherein at least one of the segments comprises conductive
treatment regions longitudinally interrupted by nonconductive
treatment regions.
[0288] Example 4--The electrosurgical instrument of Examples 1, 2,
or 3, wherein the variable energy densities are predetermined based
on a selection of the different geometries and different
conductivities of the segments.
[0289] Example 5--The electrosurgical instrument of Examples 1, 2,
3, or 4, wherein at least one of the segments comprises a gradually
narrowing width along its length.
[0290] Example 6--The electrosurgical instrument of Examples 1, 2,
3, 4, or 5, wherein the segments extend along a peripheral side of
the second jaw.
[0291] Example 7--The electrosurgical instrument of Examples 1, 2,
3, 4, 5, or 6, wherein the segments are defined in the second jaw
but not the first jaw.
[0292] Example 8--The electrosurgical instrument of Examples 1, 2,
3, 4, 5, 6, or 7, wherein the second jaw comprises an electrically
conductive skeleton partially coated with a first material and a
second material, wherein the first material is thermally conductive
but electrically insulative, and wherein the second material is
thermally and electrically insulative.
[0293] Example 9--The electrosurgical instrument of Example 8,
wherein the first material comprises diamond-like carbon.
[0294] Example 10--The electrosurgical instrument of Examples 8 or
9, wherein the second material comprises
PolyTetraFluoroEthylene.
[0295] Example 11--An electrosurgical instrument comprising an end
effector. The end effector comprises a first jaw and a second jaw.
At least one of the first jaw and the second jaw is movable to
transition the end effector from an open configuration to a closed
configuration to grasp tissue therebetween. The second jaw
comprises a gradually narrowing body extending from a proximal end
to a distal end. The gradually narrowing body comprises a tissue
contacting surface. The tissue contacting surface comprises an
insulative layer comprising a first material. The insulative layer
extends on opposite sides of an intermediate area extending along a
length of the gradually narrowing body. The tissue contacting
surface further comprises segments configured to yield variable
energy densities along the tissue contacting surface. The segments
comprise conductive segments and insulative segments alternating
with the conductive segments along the intermediate area. The
insulative segments comprise a second material different from the
first material.
[0296] Example 12--The electrosurgical instrument of Example 11,
wherein the conductive segments comprise a proximal segment and a
distal segment. The proximal segment comprises a first surface
area. The distal segment comprises a second surface area. The
second surface area is smaller than the first surface area.
[0297] Example 13--The electrosurgical instrument of Examples 11 or
12, wherein the second jaw comprises an electrically conductive
skeleton partially coated with the first material.
[0298] Example 14--The electrosurgical instrument of Example 13,
wherein the electrically conductive skeleton comprises an inner
thermally-insulative core and an outer thermally-conductive layer
at least partially surrounding the inner thermally-insulative
core.
[0299] Example 15--The electrosurgical instrument of Examples 11,
12, 13, or 14, wherein the variable energy densities are
predetermined based on a selection of different geometries and
different conductivities of the conductive segments.
[0300] Example 16--The electrosurgical instrument of Examples 11,
12, 13, 14, or 15, wherein at least one of the segments comprises a
gradually narrowing width along its length.
[0301] Example 17--The electrosurgical instrument of Examples 11,
12, 13, 14, 15, or 16, wherein the segments extend along a
peripheral side of the second jaw.
[0302] Example 18--The electrosurgical instrument of Examples 11,
12, 13, 14, 15, 16, or 17, wherein the segments are defined in the
second jaw but not the first jaw.
[0303] Example 19--The electrosurgical instrument of Examples 11,
12, 13, 14, 15, 16, 17, or 18, wherein the first material comprises
diamond-like carbon.
[0304] Example 20--The electrosurgical instrument of Examples 11,
12, 13, 14, 15, 16, 17, 18, or 19, wherein the second material
comprises PolyTetraFluoroEthylene.
Example Set 3
[0305] Example 1--An electrosurgical instrument comprising an end
effector. The end effector comprises a first jaw, a second jaw, and
an electrical circuit. The first jaw comprises a first electrically
conductive skeleton, a first insulative coating selectively
covering portions of the first electrically conductive skeleton,
and first-jaw electrodes comprising exposed portions of the first
electrically conductive skeleton. At least one of the first jaw and
the second jaw is movable to transition the end effector from an
open configuration to a closed configuration to grasp tissue
therebetween. The second jaw comprises a second electrically
conductive skeleton, a second insulative coating selectively
covering portions of the second electrically conductive skeleton,
and second-jaw electrodes comprising exposed portions of the second
electrically conductive skeleton. The electrical circuit is
configured to transmit a bipolar RF energy and a monopolar RF
energy to the tissue through the first-jaw electrodes and the
second-jaw electrodes. The monopolar RF energy shares a first
electrical pathway and a second electrical pathway defined by the
electrical circuit for transmission of the bipolar RF energy.
[0306] Example 2--The electrosurgical instrument of Example 1,
wherein the electrical circuit defines a third electrical pathway
separate from the first electrical pathway and the second
electrical pathway.
[0307] Example 3--The electrosurgical instrument of Example 1 or 2,
wherein the end effector comprises a cutting electrode electrically
insulated from the first electrically conductive skeleton and the
second electrically conductive skeleton.
[0308] Example 4--The electrosurgical instrument of Example 3,
wherein the cutting electrode is configured to receive a cutting
monopolar RF energy through the third electrical pathway.
[0309] Example 5--The electrosurgical instrument of Example 4,
wherein the cutting electrode is configured to cut the tissue with
the cutting monopolar RF energy after coagulation of the tissue has
commenced with the bipolar RF energy.
[0310] Example 6--The electrosurgical instrument of Examples 3, 4
or 5, wherein the cutting electrode is centrally located in one of
the first jaw and the second jaw.
[0311] Example 7--The electrosurgical instrument of Examples 4 or
5, wherein the end effector is configured to simultaneously deliver
the cutting monopolar RF energy and the bipolar RF energy to the
tissue.
[0312] Example 8--The electrosurgical instrument of Examples 1, 2,
3, 4, 5, 6, or 7, wherein the first-jaw electrodes comprise a first
distal-tip electrode, and wherein the second-jaw electrodes
comprise a second distal-tip electrode.
[0313] Example 9--The electrosurgical instrument of Example 8,
wherein first electrically conductive skeleton and the second
electrically conductive skeleton are energized simultaneously to
deliver the monopolar RF energy to a tissue surface through the
first distal-tip electrode and the second distal-tip electrode.
[0314] Example 10--The electrosurgical instrument of Examples 1, 2,
3, 4, 5, 6, 7, 8, or 9, wherein the second jaw comprises a
dissection electrode extending along a peripheral surface of the
second jaw.
[0315] Example 11--An electrosurgical instrument comprising an end
effector and an electrical circuit. The end effector comprises at
least two electrode sets, a first jaw, and a second jaw. At least
one of the first jaw and the second jaw is movable to transition
the end effector from an open configuration to a closed
configuration to grasp tissue therebetween. The end effector is
configured to deliver a combination of bipolar RF energy and
monopolar RF energy to the grasped tissue from the at least two
electrode sets. The electrical circuit is configured to transmit
the bipolar RF energy and the monopolar RF energy. The monopolar RF
energy shares an active pathway and a return pathway defined by the
electrical circuit for transmission of the bipolar RF energy.
[0316] Example 12--The electrosurgical instrument of Example 11,
wherein the at least two electrodes sets comprise three electrical
interconnections that are used together in the electrical
circuit.
[0317] Example 13--The electrosurgical instrument of Examples 11 or
12, wherein the at least two electrodes sets comprise three
electrical interconnections that define at least a portion of the
electrical circuit and another separate electrical circuit.
[0318] Example 14--The electrosurgical instrument of Example 13,
wherein the separate electrical circuit leads to a cutting
electrode of the at least two electrode sets that is isolated and
centrally located in one of the first jaw and the second jaw.
[0319] Example 15--The electrosurgical instrument of Example 14,
wherein the cutting electrode is configured to cut the tissue after
coagulation of the tissue has commenced using second and third
electrodes of the at least two electrode sets.
[0320] Example 16--The electrosurgical instrument of Examples 14 or
15, wherein the at least two electrode sets are configured to
simultaneously deliver the monopolar RF energy and the bipolar RF
energy to the tissue.
[0321] Example 17--An electrosurgical instrument comprising an end
effector. The end effector comprises a first jaw and a second jaw.
At least one of the first jaw and the second jaw is movable to
transition the end effector from an open configuration to a closed
configuration to grasp tissue therebetween. The second jaw
comprises a composite skeleton of at least two different materials
that are configured to selectively yield electrically conductive
portions and thermally insulted portions.
[0322] Example 18--The electrosurgical instrument of Example 17,
wherein the composite skeleton comprises a titanium
ceramic-composite.
[0323] Example 19--The electrosurgical instrument of Examples 17 or
18, wherein the composite skeleton comprises a ceramic base and a
titanium crown attachable to the ceramic base.
[0324] Example 20--The electrosurgical instrument of Examples 17,
18, or 19, wherein the composite skeleton is partially coated with
an electrically insulative material.
[0325] Example 21--A method for manufacturing a jaw of an end
effector of an electrosurgical instrument. The method comprises
preparing a composite skeleton of the jaw by fusing a titanium
powder with a ceramic powder in a metal injection molding process
and selectively coating the composite skeleton with an electrically
insulative material to yield a plurality of electrodes.
Example Set 4
[0326] Example 1--An electrosurgical instrument comprising a first
jaw and a second jaw. The first jaw is configured to define a first
electrode. The first jaw comprises a first electrically conductive
skeleton and a first electrically insulative layer. The first
electrically conductive skeleton comprises a first thermally
insulative core and a first thermally conductive outer layer
integral with and extending at least partially around the first
thermally insulative core. The first electrode is defined by
selective application of the first electrically insulative layer to
an outer surface of the first thermally conductive outer layer. The
second jaw is configured to define a second electrode. The second
jaw comprises a second electrically conductive skeleton and a
second electrically insulative layer. The second electrically
conductive skeleton comprises a second thermally insulative core
and a second thermally conductive outer layer integral with and
extending at least partially around the second thermally insulative
core. The second electrode is defined by selective application of
the second electrically insulative layer to an outer surface of the
second thermally conductive outer layer.
[0327] Example 2--The electrosurgical instrument of Example 1,
wherein the first electrode is configured to transmit an RF energy
to the second electrode through tissue positioned therebetween in a
bipolar energy mode of operation.
[0328] Example 3--The electrosurgical instrument of Examples 1 or
2, wherein the first thermally insulative core comprises air
pockets.
[0329] Example 4--The electrosurgical instrument of Examples 1, 2,
or 3, wherein the first thermally insulative core comprises a
lattice structure.
[0330] Example 5--The electrosurgical instrument of Examples 1, 2,
3, or 4, wherein the second jaw comprises a third electrode, and
wherein the third electrode is defined by selective application of
the second electrically insulative layer to the outer surface of
the second thermally conductive outer layer.
[0331] Example 6--The electrosurgical instrument of Example 5,
wherein the third electrode is configured to deliver an RF energy
to tissue in contact with the third electrode in a monopolar energy
mode of operation.
[0332] Example 7--The electrosurgical instrument of Examples 1, 2,
3, 4, 5, or 6, wherein at least one of the first electrically
insulative layer and the second electrically insulative layer
comprises a diamond-like material.
[0333] Example 8--The electrosurgical instrument of Examples 1, 2,
3, 4, 5, 6, or 7, wherein the first jaw comprises a
tissue-contacting surface, and wherein the first thermally
insulative core comprises a lattice structure including walls
erected in a direction that transects the tissue-contacting
surface.
[0334] Example 9--The electrosurgical instrument of Example 8,
wherein the direction is perpendicular to the tissue-contacting
surface.
[0335] Example 10--An electrosurgical instrument comprising a jaw
configured to define an electrode. The jaw comprises a first
electrically conductive portion, a second electrically conductive
portion, and an electrically insulative layer. The first
electrically conductive portion is configured to resist heat
transfer therethrough. The second electrically conductive portion
is integral with and extending at least partially around the first
electrically conductive portion. The second electrically conductive
portion is configured to define a heat sink. The electrode is
defined by selective application of the electrically insulative
layer to an outer surface of the second electrically conductive
portion.
[0336] Example 11--The electrosurgical instrument of Example 10,
wherein the electrode is configured to transmit an RF energy to
tissue positioned against the electrode.
[0337] Example 12--The electrosurgical instrument of Examples 10 or
11, wherein the first electrically conductive portion comprises air
pockets.
[0338] Example 13--The electrosurgical instrument of Examples 10,
11, or 12, wherein the first electrically conductive portion
comprises a lattice structure.
[0339] Example 14--The electrosurgical instrument of Examples 10,
11, 12, or 13, wherein the electrically insulative layer comprises
a diamond-like material.
[0340] Example 15--The electrosurgical instrument of Examples 10,
11, 12, 13, or 14, wherein the jaw comprises a tissue-contacting
surface, and wherein the first electrically conductive portion
comprises a lattice structure including walls erected in a
direction that transects the tissue-contacting surface.
[0341] Example 16--The electrosurgical instrument of Example 15,
wherein the direction is perpendicular to the tissue-contacting
surface.
[0342] Example 17--An electrosurgical instrument comprising a jaw
configured to define an electrode. The jaw comprises an
electrically conductive skeleton and an electrically insulative
layer. The electrically conductive skeleton comprises a thermally
insulative core and a thermally conductive outer layer integral
with and extending at least partially around the thermally
insulative core. The electrode is defined by selective application
of the electrically insulative layer to an outer surface of the
thermally conductive outer layer.
[0343] Example 18--The electrosurgical instrument of Example 17,
wherein the thermally insulative core comprises a lattice
structure.
[0344] Example 19--The electrosurgical instrument of Example 18,
wherein the jaw comprises a tissue-contacting surface, and wherein
the lattice structure includes walls erected in a direction that
transects the tissue-contacting surface.
[0345] Example 20--The electrosurgical instrument of Example 19,
wherein the direction is perpendicular to the tissue-contacting
surface.
Example Set 5
[0346] Example 1--An electrosurgical instrument comprising an end
effector. The end effector comprises a first jaw and a second jaw.
The first jaw comprises a first electrode. At least one of the
first jaw and the second jaw is movable to transition the end
effector from an open configuration to a closed configuration to
grasp tissue therebetween. The second jaw comprises a second
electrode configured to deliver a first monopolar energy to the
tissue, a third electrode, and a conductive circuit selectively
transitionable between a connected configuration with the third
electrode and a disconnected configuration with the third
electrode. In the connected configuration, the third electrode is
configured to cooperate with the first electrode to deliver bipolar
energy to the tissue. The conductive circuit defines a return path
for the bipolar energy. In the disconnected configuration, the
first electrode is configured to deliver a second monopolar energy
to the tissue.
[0347] Example 2--The electrosurgical instrument of Example 1,
further comprising a switching mechanism for alternating between
the connected configuration and the disconnected configuration.
[0348] Example 3--The electrosurgical instrument of Examples 1 or
2, further comprising a switching mechanism for alternating between
delivering the bipolar energy and the second monopolar energy to
the tissue through the first electrode.
[0349] Example 4--The electrosurgical instrument of Examples 1, 2
or 3, wherein the end effector is configured to deliver the bipolar
energy and the first monopolar energy to the tissue
simultaneously.
[0350] Example 5--The electrosurgical instrument of Examples 1, 2,
3, or 4, wherein the end effector is configured to deliver an
energy blend of the bipolar energy and the first monopolar energy
to the tissue.
[0351] Example 6--The electrosurgical instrument of Example 5,
wherein levels of the bipolar energy and the first monopolar energy
in the energy blend are determined based on at least one reading of
a temperature sensor indicative of at least one temperature of the
tissue.
[0352] Example 7--The electrosurgical instrument of Examples 5 or
6, wherein levels of the bipolar energy and the first monopolar
energy in the energy blend are determined based on at least one
reading of an impedance sensor indicative of at least one impedance
of the tissue.
[0353] Example 8--The electrosurgical instrument of Examples 5, 6,
or 7, wherein levels of the bipolar energy and the first monopolar
energy in the energy blend are adjusted to reduce a detected
lateral thermal damage beyond a tissue treatment region between the
first jaw and the second jaw.
[0354] Example 9--An electrosurgical instrument comprising an end
effector and a control circuit. The end effector comprises a first
jaw, a second jaw, and at least one sensor. The first jaw comprises
a first electrode. At least one of the first jaw and the second jaw
is movable to transition the end effector from an open
configuration to a closed configuration to grasp tissue
therebetween. The second jaw comprises a second electrode
configured to deliver a monopolar energy to the tissue and third
electrode configured to cooperate with the first electrode to
deliver a bipolar energy. The control circuit is configured to
execute a predetermined power scheme to seal and cut the tissue in
a tissue treatment cycle. The power scheme comprises predetermined
power levels of the monopolar energy and the bipolar energy. The
control circuit is further configured to adjust at least one of the
predetermined power levels of the monopolar energy and the bipolar
energy based on readings of at least one sensor during the tissue
treatment cycle.
[0355] Example 10--The electrosurgical instrument of Example 9,
wherein the predetermined power scheme comprises a simultaneous
application and a separate application of the bipolar energy and
the monopolar energy to the tissue in the tissue treatment
cycle.
[0356] Example 11--The electrosurgical instrument of Examples 9 or
10, wherein the predetermined power scheme comprises an application
of the bipolar energy but not the monopolar energy to the tissue in
a feathering segment of the tissue treatment cycle and a
simultaneous application of the bipolar energy and the monopolar
energy to the tissue in a tissue warming segment and a tissue
sealing segment of the tissue treatment cycle.
[0357] Example 12--The electrosurgical instrument of Example 11,
wherein the power scheme further comprises an application of the
monopolar energy but not the bipolar energy to the tissue in a
tissue transection segment of the tissue treatment cycle.
[0358] Example 13--The electrosurgical instrument of Examples 9,
10, 11, or 12, wherein the at least one sensor comprises impedance
sensors.
[0359] Example 14--The electrosurgical instrument of Example 13,
wherein the control circuit is configured to monitor an impedance
ratio of a monopolar tissue-impedance to a bipolar tissue-impedance
based on readings from the impedance sensors.
[0360] Example 15--The electrosurgical instrument of Example 14,
wherein a change in the impedance ratio within a predetermined
range causes the control circuit to issue a warning.
[0361] Example 16--The electrosurgical instrument of Example 15,
wherein a change in the impedance ratio to, or below, a lower
threshold of the predetermined range causes the control circuit to
adjust the predetermined power scheme.
[0362] Example 17--The electrosurgical instrument of Examples 15 or
16, wherein a change in the impedance ratio to, or below, a lower
threshold of the predetermined range causes the control circuit to
pause an application of the monopolar energy to the tissue.
[0363] Example 18--The electrosurgical instrument of Example 17,
wherein the change in the impedance ratio to, or below, a lower
threshold of the predetermined range further causes the control
circuit to adjust an application of the bipolar energy to the
tissue to complete sealing the tissue.
[0364] Example 19--An electrosurgical instrument comprising an end
effector and a control circuit. The end effector comprises a first
jaw and a second jaw. The first jaw comprising a first electrode.
At least one of the first jaw and the second jaw is movable to
transition the end effector from an open configuration to a closed
configuration to grasp tissue therebetween. The tissue being at a
target site. The second jaw comprises a second electrode configured
to deliver a monopolar energy to the tissue and a third electrode
configured to cooperate with the first electrode to deliver a
bipolar energy. The control circuit is configured to execute a
predetermined power scheme to seal and cut the tissue in a tissue
treatment cycle. The power scheme comprises predetermined power
levels of the monopolar energy and the bipolar energy. The control
circuit is further configured to detect an energy diversion off the
target site and adjust at least one of the predetermined power
levels of the monopolar energy and the bipolar energy to mitigate
the energy diversion.
[0365] Example 20--The electrosurgical instrument of Example 19,
wherein the predetermined power scheme comprises a simultaneous
application and a separate application of the bipolar energy and
the monopolar energy to the tissue in the tissue treatment
cycle.
[0366] Example 21--The electrosurgical instrument of Examples 19 or
20, wherein the predetermined power scheme comprises an application
of the bipolar energy but not the monopolar energy to the tissue in
a feathering segment of the tissue treatment cycle and a
simultaneous application of the bipolar energy and the monopolar
energy to the tissue in a tissue warming segment and a tissue
sealing segment of the tissue treatment cycle.
Example Set 6
[0367] Example 1--An electrosurgical system comprising an end
effector and a control circuit. The end effector comprises a first
jaw and a second jaw. At least one of the first jaw and the second
jaw is movable to transition the end effector from an open
configuration to a closed configuration to grasp tissue
therebetween. The control circuit is configured to cause an
application of two different energy modalities to the tissue
simultaneously and separately during a tissue treatment cycle
comprising a tissue coagulation stage and a tissue transection
stage.
[0368] Example 2--The electrosurgical system of Example 1, wherein
the first energy modality is a monopolar energy modality.
[0369] Example 3--The electrosurgical system of Example 2, wherein
the second energy modality is a bipolar energy modality.
[0370] Example 4--The electrosurgical system of Examples 2 or 3,
wherein the control circuit is configured to activate the
application of the monopolar energy modality to the tissue prior to
a completion of the tissue coagulation stage by the bipolar energy
modality.
[0371] Example 5--The electrosurgical system of Examples 2 or 3,
wherein the control circuit is configured to activate the
application of the monopolar energy modality to the tissue prior to
deactivation of the bipolar energy modality application to the
tissue.
[0372] Example 6--The electrosurgical system of Examples 3, 4, or
5, wherein the control circuit is configured to cause a
simultaneous application of the monopolar energy modality and the
bipolar energy modality to the tissue during the tissue coagulation
stage.
[0373] Example 7--The electrosurgical system of Examples 1, 2, 3,
4, 5, or 6, wherein the control circuit comprises a processor and a
storage medium, and wherein the application of the two different
energy modalities to the tissue is based on a default power scheme
stored in the storage medium.
[0374] Example 8--The electrosurgical system of Example 7, further
comprising at least one sensor, and wherein the control circuit is
configured to modify the default power scheme based on one more
sensor readings of the at least one sensor.
[0375] Example 9--An electrosurgical instrument comprising an end
effector. The end effector comprises a first jaw and a second jaw.
At least one of the first jaw and the second jaw is movable to
transition the end effector from an open configuration to a closed
configuration to grasp tissue therebetween. The end effector is
configured to cause an application of three different energy
modalities to the tissue during a tissue treatment cycle comprising
a tissue coagulation stage and a tissue transection stage.
[0376] Example 10--The electrosurgical instrument of Example 9,
wherein the first energy modality comprises a bipolar energy.
[0377] Example 11--The electrosurgical instrument of Example 10,
wherein the second energy modality comprises an energy blend of a
monopolar energy and the bipolar energy.
[0378] Example 12--The electrosurgical instrument of Example 11,
wherein the third energy modality comprises the monopolar energy
but not the bipolar energy.
[0379] Example 13--The electrosurgical instrument of Examples 11 or
12, wherein an activation of the monopolar energy application to
the tissue is configured to begin prior to a completion of the
tissue coagulation stage.
[0380] Example 14--The electrosurgical instrument of Examples 12 or
13, wherein an activation of the monopolar energy application to
the tissue is configured to begin prior to a deactivation of the
application of the bipolar energy modality to the tissue.
[0381] Example 15--The electrosurgical instrument of Examples 9,
10, 11, 12, 13, or 14, further comprising a control circuit,
wherein the control circuit comprises a processor and a storage
medium, and wherein the application of the two different energy
modalities to the tissue is based on a default power scheme stored
in the storage medium.
[0382] Example 16--The electrosurgical instrument of Example 15,
further comprising at least one sensor, wherein the control circuit
is configured to adjust the default power scheme during the tissue
treatment cycle based on one more sensor readings of the at least
one sensor.
[0383] Example 17--An electrosurgical system comprising a first
generator configured output a bipolar energy, a second generator
configured to output a monopolar energy, a surgical instrument
electrically coupled to the first generator and the second
generator, and a control circuit. The surgical instrument comprises
an end effector. The end effector comprises a first jaw and a
second jaw. At least one of the first jaw and the second jaw is
movable to transition the end effector from an open configuration
to a closed configuration to grasp tissue therebetween. The control
circuit comprises a processor and a storage medium comprising
program instructions that, when executed by the processor, causes
the processor to cause the first generator and the second generator
to apply a predetermined power scheme to the end effector. The
power scheme comprises a simultaneous application and a separate
application of the bipolar energy and the monopolar energy to the
tissue in a tissue treatment cycle.
[0384] Example 18--The electrosurgical system of Example 17,
further comprising at least one sensor, wherein the control circuit
is configured to adjust the power scheme during the tissue
treatment cycle based on one more sensor readings of the at least
one sensor.
[0385] Example 19--The electrosurgical system of Examples 17 or 18,
wherein the power scheme comprises an application of the bipolar
energy but not the monopolar energy to the tissue in a feathering
segment of the tissue treatment cycle, and a simultaneous
application of the bipolar energy and the monopolar energy to the
tissue in a tissue warming segment and a tissue sealing segment of
the tissue treatment cycle.
[0386] Example 20--The electrosurgical system of Examples 17, 18,
or 19, wherein the power scheme further comprises an application of
the monopolar energy but not the bipolar energy to the tissue in a
tissue transection segment of the tissue treatment cycle.
[0387] While several forms have been illustrated and described, it
is not the intention of Applicant to restrict or limit the scope of
the appended claims to such detail. Numerous modifications,
variations, changes, substitutions, combinations, and equivalents
to those forms may be implemented and will occur to those skilled
in the art without departing from the scope of the present
disclosure. Moreover, the structure of each element associated with
the described forms can be alternatively described as a means for
providing the function performed by the element. Also, where
materials are disclosed for certain components, other materials may
be used. It is therefore to be understood that the foregoing
description and the appended claims are intended to cover all such
modifications, combinations, and variations as falling within the
scope of the disclosed forms. The appended claims are intended to
cover all such modifications, variations, changes, substitutions,
modifications, and equivalents.
[0388] The foregoing detailed description has set forth various
forms of the devices and/or processes via the use of block
diagrams, flowcharts, and/or examples. Insofar as such block
diagrams, flowcharts, and/or examples contain one or more functions
and/or operations, it will be understood by those within the art
that each function and/or operation within such block diagrams,
flowcharts, and/or examples can be implemented, individually and/or
collectively, by a wide range of hardware, software, firmware, or
virtually any combination thereof. Those skilled in the art will
recognize that some aspects of the forms disclosed herein, in whole
or in part, can be equivalently implemented in integrated circuits,
as one or more computer programs running on one or more computers
(e.g., as one or more programs running on one or more computer
systems), as one or more programs running on one or more processors
(e.g., as one or more programs running on one or more
microprocessors), as firmware, or as virtually any combination
thereof, and that designing the circuitry and/or writing the code
for the software and or firmware would be well within the skill of
one of skill in the art in light of this disclosure. In addition,
those skilled in the art will appreciate that the mechanisms of the
subject matter described herein are capable of being distributed as
one or more program products in a variety of forms, and that an
illustrative form of the subject matter described herein applies
regardless of the particular type of signal bearing medium used to
actually carry out the distribution.
[0389] Instructions used to program logic to perform various
disclosed aspects can be stored within a memory in the system, such
as dynamic random access memory (DRAM), cache, flash memory, or
other storage. Furthermore, the instructions can be distributed via
a network or by way of other computer readable media. Thus a
machine-readable medium may include any mechanism for storing or
transmitting information in a form readable by a machine (e.g., a
computer), but is not limited to, floppy diskettes, optical disks,
compact disc, read-only memory (CD-ROMs), and magneto-optical
disks, read-only memory (ROMs), random access memory (RAM),
erasable programmable read-only memory (EPROM), electrically
erasable programmable read-only memory (EEPROM), magnetic or
optical cards, flash memory, or a tangible, machine-readable
storage used in the transmission of information over the Internet
via electrical, optical, acoustical or other forms of propagated
signals (e.g., carrier waves, infrared signals, digital signals,
etc.). Accordingly, the non-transitory computer-readable medium
includes any type of tangible machine-readable medium suitable for
storing or transmitting electronic instructions or information in a
form readable by a machine (e.g., a computer).
[0390] As used in any aspect herein, the term "control circuit" may
refer to, for example, hardwired circuitry, programmable circuitry
(e.g., a computer processor including one or more individual
instruction processing cores, processing unit, processor,
microcontroller, microcontroller unit, controller, digital signal
processor (DSP), programmable logic device (PLD), programmable
logic array (PLA), or field programmable gate array (FPGA)), state
machine circuitry, firmware that stores instructions executed by
programmable circuitry, and any combination thereof. The control
circuit may, collectively or individually, be embodied as circuitry
that forms part of a larger system, for example, an integrated
circuit (IC), an application-specific integrated circuit (ASIC), a
system on-chip (SoC), desktop computers, laptop computers, tablet
computers, servers, smart phones, etc. Accordingly, as used herein
"control circuit" includes, but is not limited to, electrical
circuitry having at least one discrete electrical circuit,
electrical circuitry having at least one integrated circuit,
electrical circuitry having at least one application specific
integrated circuit, electrical circuitry forming a general purpose
computing device configured by a computer program (e.g., a general
purpose computer configured by a computer program which at least
partially carries out processes and/or devices described herein, or
a microprocessor configured by a computer program which at least
partially carries out processes and/or devices described herein),
electrical circuitry forming a memory device (e.g., forms of random
access memory), and/or electrical circuitry forming a
communications device (e.g., a modem, communications switch, or
optical-electrical equipment). Those having skill in the art will
recognize that the subject matter described herein may be
implemented in an analog or digital fashion or some combination
thereof.
[0391] As used in any aspect herein, the term "logic" may refer to
an app, software, firmware and/or circuitry configured to perform
any of the aforementioned operations. Software may be embodied as a
software package, code, instructions, instruction sets and/or data
recorded on non-transitory computer readable storage medium.
Firmware may be embodied as code, instructions or instruction sets
and/or data that are hard-coded (e.g., nonvolatile) in memory
devices.
[0392] As used in any aspect herein, the terms "component,"
"system," "module" and the like can refer to a computer-related
entity, either hardware, a combination of hardware and software,
software, or software in execution.
[0393] As used in any aspect herein, an "algorithm" refers to a
self-consistent sequence of steps leading to a desired result,
where a "step" refers to a manipulation of physical quantities
and/or logic states which may, though need not necessarily, take
the form of electrical or magnetic signals capable of being stored,
transferred, combined, compared, and otherwise manipulated. It is
common usage to refer to these signals as bits, values, elements,
symbols, characters, terms, numbers, or the like. These and similar
terms may be associated with the appropriate physical quantities
and are merely convenient labels applied to these quantities and/or
states.
[0394] A network may include a packet switched network. The
communication devices may be capable of communicating with each
other using a selected packet switched network communications
protocol. One example communications protocol may include an
Ethernet communications protocol which may be capable permitting
communication using a Transmission Control Protocol/Internet
Protocol (TCP/IP). The Ethernet protocol may comply or be
compatible with the Ethernet standard published by the Institute of
Electrical and Electronics Engineers (IEEE) titled "IEEE 802.3
Standard", published in December, 2008 and/or later versions of
this standard. Alternatively or additionally, the communication
devices may be capable of communicating with each other using an
X.25 communications protocol. The X.25 communications protocol may
comply or be compatible with a standard promulgated by the
International Telecommunication Union-Telecommunication
Standardization Sector (ITU-T). Alternatively or additionally, the
communication devices may be capable of communicating with each
other using a frame relay communications protocol. The frame relay
communications protocol may comply or be compatible with a standard
promulgated by Consultative Committee for International Telegraph
and Telephone (CCITT) and/or the American National Standards
Institute (ANSI). Alternatively or additionally, the transceivers
may be capable of communicating with each other using an
Asynchronous Transfer Mode (ATM) communications protocol. The ATM
communications protocol may comply or be compatible with an ATM
standard published by the ATM Forum titled "ATM-MPLS Network
Interworking 2.0" published August 2001, and/or later versions of
this standard. Of course, different and/or after-developed
connection-oriented network communication protocols are equally
contemplated herein.
[0395] Unless specifically stated otherwise as apparent from the
foregoing disclosure, it is appreciated that, throughout the
foregoing disclosure, discussions using terms such as "processing,"
"computing," "calculating," "determining," "displaying," or the
like, refer to the action and processes of a computer system, or
similar electronic computing device, that manipulates and
transforms data represented as physical (electronic) quantities
within the computer system's registers and memories into other data
similarly represented as physical quantities within the computer
system memories or registers or other such information storage,
transmission or display devices.
[0396] One or more components may be referred to herein as
"configured to," "configurable to," "operable/operative to,"
"adapted/adaptable," "able to," "conformable/conformed to," etc.
Those skilled in the art will recognize that "configured to" can
generally encompass active-state components and/or inactive-state
components and/or standby-state components, unless context requires
otherwise.
[0397] The terms "proximal" and "distal" are used herein with
reference to a clinician manipulating the handle portion of the
surgical instrument. The term "proximal" refers to the portion
closest to the clinician and the term "distal" refers to the
portion located away from the clinician. It will be further
appreciated that, for convenience and clarity, spatial terms such
as "vertical", "horizontal", "up", and "down" may be used herein
with respect to the drawings. However, surgical instruments are
used in many orientations and positions, and these terms are not
intended to be limiting and/or absolute.
[0398] Those skilled in the art will recognize that, in general,
terms used herein, and especially in the appended claims (e.g.,
bodies of the appended claims) are generally intended as "open"
terms (e.g., the term "including" should be interpreted as
"including but not limited to," the term "having" should be
interpreted as "having at least," the term "includes" should be
interpreted as "includes but is not limited to," etc.). It will be
further understood by those within the art that if a specific
number of an introduced claim recitation is intended, such an
intent will be explicitly recited in the claim, and in the absence
of such recitation no such intent is present. For example, as an
aid to understanding, the following appended claims may contain
usage of the introductory phrases "at least one" and "one or more"
to introduce claim recitations. However, the use of such phrases
should not be construed to imply that the introduction of a claim
recitation by the indefinite articles "a" or "an" limits any
particular claim containing such introduced claim recitation to
claims containing only one such recitation, even when the same
claim includes the introductory phrases "one or more" or "at least
one" and indefinite articles such as "a" or "an" (e.g., "a" and/or
"an" should typically be interpreted to mean "at least one" or "one
or more"); the same holds true for the use of definite articles
used to introduce claim recitations.
[0399] In addition, even if a specific number of an introduced
claim recitation is explicitly recited, those skilled in the art
will recognize that such recitation should typically be interpreted
to mean at least the recited number (e.g., the bare recitation of
"two recitations," without other modifiers, typically means at
least two recitations, or two or more recitations). Furthermore, in
those instances where a convention analogous to "at least one of A,
B, and C, etc." is used, in general such a construction is intended
in the sense one having skill in the art would understand the
convention (e.g., "a system having at least one of A, B, and C"
would include but not be limited to systems that have A alone, B
alone, C alone, A and B together, A and C together, B and C
together, and/or A, B, and C together, etc.). In those instances
where a convention analogous to "at least one of A, B, or C, etc."
is used, in general such a construction is intended in the sense
one having skill in the art would understand the convention (e.g.,
"a system having at least one of A, B, or C" would include but not
be limited to systems that have A alone, B alone, C alone, A and B
together, A and C together, B and C together, and/or A, B, and C
together, etc.). It will be further understood by those within the
art that typically a disjunctive word and/or phrase presenting two
or more alternative terms, whether in the description, claims, or
drawings, should be understood to contemplate the possibilities of
including one of the terms, either of the terms, or both terms
unless context dictates otherwise. For example, the phrase "A or B"
will be typically understood to include the possibilities of "A" or
"B" or "A and B."
[0400] With respect to the appended claims, those skilled in the
art will appreciate that recited operations therein may generally
be performed in any order. Also, although various operational flow
diagrams are presented in a sequence(s), it should be understood
that the various operations may be performed in other orders than
those which are illustrated, or may be performed concurrently.
Examples of such alternate orderings may include overlapping,
interleaved, interrupted, reordered, incremental, preparatory,
supplemental, simultaneous, reverse, or other variant orderings,
unless context dictates otherwise. Furthermore, terms like
"responsive to," "related to," or other past-tense adjectives are
generally not intended to exclude such variants, unless context
dictates otherwise.
[0401] It is worthy to note that any reference to "one aspect," "an
aspect," "an exemplification," "one exemplification," and the like
means that a particular feature, structure, or characteristic
described in connection with the aspect is included in at least one
aspect. Thus, appearances of the phrases "in one aspect," "in an
aspect," "in an exemplification," and "in one exemplification" in
various places throughout the specification are not necessarily all
referring to the same aspect. Furthermore, the particular features,
structures or characteristics may be combined in any suitable
manner in one or more aspects.
[0402] In this specification, unless otherwise indicated, terms
"about" or "approximately" as used in the present disclosure,
unless otherwise specified, means an acceptable error for a
particular value as determined by one of ordinary skill in the art,
which depends in part on how the value is measured or determined.
In certain embodiments, the term "about" or "approximately" means
within 1, 2, 3, or 4 standard deviations. In certain embodiments,
the term "about" or "approximately" means within 50%, 20%, 15%,
10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, or 0.05% of a given
value or range.
[0403] In this specification, unless otherwise indicated, all
numerical parameters are to be understood as being prefaced and
modified in all instances by the term "about," in which the
numerical parameters possess the inherent variability
characteristic of the underlying measurement techniques used to
determine the numerical value of the parameter. At the very least,
and not as an attempt to limit the application of the doctrine of
equivalents to the scope of the claims, each numerical parameter
described herein should at least be construed in light of the
number of reported significant digits and by applying ordinary
rounding techniques.
[0404] Any numerical range recited herein includes all sub-ranges
subsumed within the recited range. For example, a range of "1 to
10" includes all sub-ranges between (and including) the recited
minimum value of 1 and the recited maximum value of 10, that is,
having a minimum value equal to or greater than 1 and a maximum
value equal to or less than 10. Also, all ranges recited herein are
inclusive of the end points of the recited ranges. For example, a
range of "1 to 10" includes the end points 1 and 10. Any maximum
numerical limitation recited in this specification is intended to
include all lower numerical limitations subsumed therein, and any
minimum numerical limitation recited in this specification is
intended to include all higher numerical limitations subsumed
therein. Accordingly, Applicant reserves the right to amend this
specification, including the claims, to expressly recite any
sub-range subsumed within the ranges expressly recited. All such
ranges are inherently described in this specification.
[0405] Any patent application, patent, non-patent publication, or
other disclosure material referred to in this specification and/or
listed in any Application Data Sheet is incorporated by reference
herein, to the extent that the incorporated materials is not
inconsistent herewith. 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.
[0406] In summary, numerous benefits have been described which
result from employing the concepts described herein. The foregoing
description of the one or more forms has been presented for
purposes of illustration and description. It is not intended to be
exhaustive or limiting to the precise form disclosed. Modifications
or variations are possible in light of the above teachings. The one
or more forms were chosen and described in order to illustrate
principles and practical application to thereby enable one of
ordinary skill in the art to utilize the various forms and with
various modifications as are suited to the particular use
contemplated. It is intended that the claims submitted herewith
define the overall scope.
* * * * *